Maxillofacial Surgery
TM JOINT DISORDERS:
Commonly termed as Temporo-Mandibular Joint or Facial Joint.
Problems are related to the joint itself, that are of the disc, ligament, muscle of the joint or arthritis of the bone. Clinically appears as difficulty in moving the lower jaw with lock and sound or painful movement of the jaw. It can appear at any age and in both the genders. Main factors causing joint problems are mainly related to joint within, then the muscles of face and lastly sometimes abnormal positioning of the teeth.
Joint problems are variable ranging from displacement of the disc, tear in the primary ligament, tear in the disc and holding tissue, arthritis of the joint and lastly damage to the entire joint including disc, ligament, muscles and bone.
Diagnosis can be made through history and physical examination where range of motion of lower jaw and stratification of pain are established.
Blood investigations are required to rule out systemic involvement.
Radiological investigation range from X-rays and CT-scan to view the bones and MRI to evaluate the soft tissue structures, inflammation and space in the joint.
Diagnostic Arthroscopy can be carried out under General Anesthesia for perfect evaluation and debridement of the joint.
Management protocol is same as in any other joint of the body, divided in to 2 parts : Conservative and Surgical.
Conservative management with medicines such as anti-inflammatory, analgesic and anti-depressants allows control over pain and inflammation. Dental orthotic treatment and splints helps to relieve pain in the joint.
Physiotherapy helps in strengthening the tone and movement of muscle and ligament.
Surgical management is mainstay in all joint disorders.
Arthroscopic guided procedures that helps in managing early to intermediate stage disorders and arthritis. Intermediate to late stage disorders and arthritis are managed with Open Joint Surgeries and last Total Joint Replacement Surgery.
Surgical management is never an emergency or of urgency. But avoiding and ignoring surgery and myth that only medicines cure, will lead to degenerative process in the joint, compelling the surgeon to opt for more aggressive procedure.
Cranio-Maxillofacial Trauma:
CMF Trauma mainly included trauma or fracture of the bones of skull and face such as cheek bones, orbit, nose, upper jaw and lower jaw. They are either open or closed in the skin and muscles. Fractures can be simple; restricted to one bone and site, complex; involves multiple bones and sites and comminuted; broken into pieces.
Fracture of lower jaw compresses the airway and restricts the movement. Fracture of the upper jaw compresses the airways and damages the stress lines over face. Cheek bones being the wall of the face preventing damage to vital structures such as eyes, skull bones and brain base, hence fractures of that though do not appear prominent on face leads to further problems and risk to the above mentioned structures.
Fractures of the skull are associated with brain injury, hence requires stabilization.
Diagnosis is made through physical finding and radiologically through Xrays and CT-Scan.
Most fracture needs urgent care and best before formation of abnormal bone between fragments.
Fractures over face are operated through pre-determined lines or crease over face which gives acceptable scar post-operatively and hidden in skin folds.
Facial Skeletal Deformity:
CMF skeletal deformities are of various kinds. Where in there is deformity over skull bone, upper jaw and lower jaw. This largely effects the cosmetics, function of the jaw, compression the airway and causing TM Joint disorders.
Jaws are either large are small and formed in forward and backward position.
These deformity can be Congenital; right from birth, Acquired; during growth phase and Traumatic.
Deformities are diagnosed on clinical, functional and radiological basis.
They need to be managed surgically known as Orthognathic Surgery where jaws are manipulated and fixed in near ideal position for better esthetics and functional purpose.
TMJ ANKYLOSIS where the lower is jaw is fused with the upper jaw giving the face bird like shape and restricting or totally negating the movement of lower jaw. Ankylosis can be managed as per the determined surgical protocol based on the age of the individual. The modern protocol suggests replacing the entire joint artificially providing excellent function of the jaw.
Nasal Deformity:
These deformity again can be Congenital; right from birth, Acquired; during growth phase and Traumatic.
Variedly shaped nose compromises look and compresses the upper airway.
Various deformities are crooked nose, parrot beak shaped nose, depressed bridge of nose, deviated nose, humped nose.
These deformity can be managed with Rhinoplasty where nose can reshaped according to esthetic requirement and acceptance. This can be performed along with septoplasty where deviated septum can be reshaped to open the nares for respiration.
Oral Submucous Fibrosis:
This is the condition where mucosa in the mouth gets fibrosed restricting and negating the opening of the mouth. This is a precancerous condition. Main causes are tobacco comsumption, spicy food consumption and continuous trauma. If not managed will turn in carcinoma.
Management mainly comprises of medications, fibrolytics, steroidal injections.
Surgical treatment is utmost important where the fibres are separated, adequate mouth opening is achieved and the created gap is filled or reconstructed with various types of flap.
