UNDERSTANDING MAXILLOFACIAL SURGERY: PROCEDURES, BENEFITS, RISKS AND MORE

Medically Reviewed and Updated by Dr. Shilpy Bhandari - August 9, 2024

Maxillofacial surgery is a branch of surgery that concentrates on treating defects in the head, neck, face, and jaws along with hard and soft tissues of the orofacial region. It is a complex and diverse field encompassing various procedures, offering functional, cosmetic, and reconstructive outcomes.

Maxillofacial surgeons undergo extensive training in both dentistry and medicine, making them qualified to perform a wide range of procedures in the head and neck area.^[1] This comprehensive training differentiates their practice from oral surgery, which focuses mainly on the teeth, gums, face and jaw.

What Does a Maxillofacial Surgeon Do?

Maxillofacial surgical procedures are performed by a highly skilled and specialized maxillofacial surgeon. Besides the surgeon, the team includes an anesthesiologist, nurses, and support staff. The surgeon performs the surgery, while the anesthesiologist ensures patient safety and comfort. Nurses and support staff assist with pre-op, post-op, and complications, if any.Maxillofacial surgery encompasses many procedures to treat head, neck, face, and jaw defects, injuries and other conditions. These can be ordered into surgical and non-surgical techniques.^[2]

Maxillofacial Surgical Procedures

Some of the most common maxillofacial surgeries performed by the specialist include^[3]:

1. Facial Trauma Reconstruction: Maxillofacial surgeons are skilled in reconstructing facial bones and tissues damaged or fractured due to traumatic injuries, such as fractures caused by accidents or sports-related incidents. The surgeon restores facial symmetry, function, and aesthetics through surgical interventions, helping patients regain their confidence and quality of life.
2. Cleft Lip and Palate Repair: Cleft lip and palate are congenital defects that affect the formation of the top lip and roof of the mouth. By closing the gaps and reconstructing the affected areas, maxillofacial surgery helps to improve speech, feeding, and overall facial structure.
3. Microsurgical Facial Reconstruction: This technique uses surgery to restore facial tissues and structures. It involves microsurgery and grafting to fix defects caused by trauma, cancer, or birth issues. The goal is to improve function and appearance.
4. Dental Implant Surgery: Dental implant surgery concerns the placement of artificial tooth roots into the jaw to support artificial teeth. It offers a long-term solution for individuals with missing teeth, improving their ability to bite, chew, and speak confidently.
5. Head and Neck Cancer Surgery: Maxillofacial surgeons work closely with oncologists and other specialists to excise tumors from the head and neck area while preserving vital structures and functions. Head and neck cancer surgery can involve removing tumors, reconstructing affected areas, and restoring the patient's appearance and functionality.
6. Orthognathic Surgery for Jaw Misalignment: Orthognathic surgery corrects jawbone and teeth alignment irregularities. This procedure can improve functions such as chewing, breathing, and speaking and enhance the overall facial aesthetic.

Maxillofacial Non-Surgical Procedures

In addition to surgical procedures, maxillofacial surgeons are trained in non-surgical facial rejuvenation techniques. These cosmetic procedures focus on enhancing facial appearance through non-invasive or minimally invasive methods. These non-surgical alternatives provide cosmetic enhancements and rejuvenation with shorter recovery times and fewer risks.

Some of the standard non-surgical procedures performed by the specialist include^[4]::

1. Botox: Botox injections reduce facial wrinkles and fine lines by temporarily relaxing the underlying muscles.
2. Lasers: Laser treatments can be used for various purposes, such as skin resurfacing, scar revision, and hair removal, to improve the overall texture and appearance of the skin.
3. Rhinoplasty^[5]: While surgical rhinoplasty involves reshaping the nose through surgery, non-surgical rhinoplasty involves using dermal fillers to enhance the nose's appearance, such as correcting minor imperfections or smoothing out contour irregularities.

The Maxillofacial Surgery Journey

Maxillofacial surgery begins with a surgeon consultation. The surgeon evaluates the patient's condition, discusses their options, and clarifies the risks and benefits of the most appropriate surgery options.

Once the patient decides to proceed with the surgery, they will book an appointment and prepare for the day of surgery.

The maxillofacial surgery procedure can vary depending on the specific surgery. It is usually an outpatient procedure, meaning the patient does not need to stay overnight. However, for more invasive procedures, the patient stay may vary from overnight to a few days.

Pre-Operative Preparation

Pre-operative preparation includes medical tests and imaging scans to allow the surgeon to plan adequately.

The surgeon also provides the patient with instructions for the day of the surgery. These precautions ensure that the patient is physically and mentally prepared for the surgery and help minimize the risk of complications.

Some standard pre-operative instructions to prepare the patient for surgery include^[6]:

• Fasting for a certain period prior to the surgery
• Ceasing or tapering down on medications that may interfere with the surgery or anesthesia
• Quitting smoking to improve healing and reduce the risk of complications
• Organizing for someone to collect the patient and drive them home after the surgery
• Preparing the home for recovery, such as setting up a comfortable recovery area and stocking up on soft foods
• Organizing comfortable clothing for the day of the surgery

Maxillofacial Surgery Procedure Steps

The exact steps of a maxillofacial surgery procedure will vary depending on the specific surgery. However, some common steps include^[7]:

1. Anesthesia: The patient receives anesthesia to ensure they are comfortable and pain-free during the operation.
2. Incision: The surgeon makes calculated cuts in the skin or bone to access the affected area.
3. Repair/Reconstruction: The surgeon will repair or reconstruct the affected area using various techniques and materials, such as bone grafts, plates, and screws.
4. Closure: The surgeon will use sutures or other methods to close the incisions.
5. Recovery: The patient recovers in a separate room from the anesthesia. Medical staff monitor them for signs of complications.

Post-Operative Recovery Timeline

The post-operative recovery timeline for maxillofacial surgery can differ and depends on the surgery and the patient. Some general guidelines for recovery include:

• The first 24 hours after surgery: The patient will likely experience some pain and swelling, manageable with pain medication and ice packs. They may also have some bleeding from the incision sites that they can control. by biting on folded gauze pads. Doctors also suggest rinsing the mouth with salt instead of brushing until the area heals.
• The first week after surgery: The patient must rest and avoid overexertion. They may need to follow a soft diet and avoid using straws to discourage dislodging stitches.
• The first month after surgery: The patient will attend follow-up consultations with the surgeon to monitor their healing and remove any stitches. They may also need to continue taking pain medication and using ice packs to manage pain and swelling.
• The first few months after surgery: The patient will gradually resume their normal activities and may need to attend physical therapy to regain full function in the affected area.

Managing Pain and Complications

Pain and complications are common concerns for patients undergoing maxillofacial surgery.

While complications are possible, they are relatively rare, and most patients undergo maxillofacial surgery without experiencing any significant issues. Surgeons prioritize patient safety with thorough pre and post-operative care. Promptly contacting healthcare providers for complications is essential.

Here are some potential complications associated with maxillofacial surgery and how to handle them best ^[8]:

1. Infection risk in head and neck surgery - This condition may require antibiotics.
2. Potential bleeding complications- Follow your healthcare team’s instructions on how to manage.
3. Nerve damage risk - This may cause temporary or permanent loss of sensation or weakness.
4. Joint swelling and bruising - This may be severe in some cases.
5. Scarring - A skilled surgeon will minimize the risk by placing incisions discreetly.
6. Anesthesia-related risks, such as allergies, respiratory issues, or other adverse reactions.
7. Changes in facial sensation or appearance - This may happen after extensive procedures, from mild to significant alterations.

For maxillofacial procedures, choose a highly skilled specialist with extensive years of experience.

Some other ways you can manage pain, and lower complication risk after maxillofacial surgery include^[9]:

• Using pain relief as prescribed by the surgeon
• Applying ice packs to decrease painful swelling
• Following post-operative care instructions carefully
• Arranging and attending follow-up appointments with the surgeon

Common Misconceptions

Maxillofacial surgery is often misunderstood. Here are five common misconceptions:

Myth: Maxillofacial procedures are only for cosmetic purposes

Fact: Maxillofacial surgery is a multidisciplinary field that focuses on functional and reconstructive aspects in addition to cosmetic purposes.

Myth: The surgery is too risky

Fact: Complications of this type of surgery are relatively rare. Advancements in surgical techniques and extensive surgeon training have improved maxillofacial treatment safety.

Myth: There is a high degree of pain during and after surgery

Fact: Pain management is an integral part of the surgical process.

Surgeons work with anesthesiologists during the procedure to ensure patient comfort and medication to manage post-operative pain effectively. Patients receive pain management instructions, and the healthcare team closely monitors and addresses any concerns.

Myth: The surgery will lead to undesirable changes in appearance or sensation

Fact: While temporary changes are possible, permanent alterations are rare. Surgeons strive to achieve a balance between aesthetic harmony and functional restoration, considering each patient's goals and facial structure.

Having realistic expectations and a direct line of communication with the surgeon about the preferred outcome is essential.

Is Maxillofacial Surgery Right for You?

Determining whether maxillofacial surgery is the right choice for you requires careful consideration of the following:

• Your medical history
• The severity of the issue requiring treatment
• Your treatment goals
• Your financial situation and insurance coverage

Like any surgical procedure, maxillofacial surgery carries both risks and potential benefits. The pros and cons of maxillofacial surgery may influence your decision.

Maxillofacial Surgery Benefits:

• Functional improvements in speech, breathing, chewing, and pain relief
• Aesthetic enhancement, positively influencing confidence, self-esteem, and social interactions
• Reconstructive benefits include more functionality and a better quality of life

Risks of Maxillofacial Surgery:

• Potential for complications such as pain, infection, or scarring
• Potential for unsatisfactory results
• Emotional turmoil

Talk to a qualified surgeon to decide if maxillofacial surgery suits you. They will evaluate your situation, discuss the procedure, and help you make an informed decision that aligns with your goals and well-being.

Future Advances in Maxillofacial Surgery

As medical technologies continue to evolve, the field of maxillofacial surgery is also constantly improving. Some potential future advances in maxillofacial surgery include:

• The use of virtual reality, AI, and 3D printing for surgical planning and simulation^[10]
• Robots that assist in tasks like bone cutting, implant placement, and suturing, offering increased precision and control^[11]
• The development of new materials and techniques for bone grafting and reconstruction
• The use of regenerative medicine to promote faster healing and better outcomes
• Stem cell technology to regrow and regenerate teeth, bone, and other facial tissues^[12]

Conclusion

Maxillofacial surgery is a type of surgery that focuses on treating problems of the head, neck, face, and jaw. This type of surgery aims to restore function, correct deformities, and improve appearance. These improvements can significantly enhance a person's life. If you are considering maxillofacial surgery, talk to a qualified surgeon to see if it is the right choice for you. As technology and medicine advance, there may be even better options available.