At the end of this chapter you should have an understanding of:
- 1. Where maxillofacial surgery is carried out and by whom.
- 2. The procedures that are included under the umbrella of maxillofacial surgery.
- 3. Why maxillofacial surgery is undertaken.
- 4. The members of the dental team that make up the maxillofacial team.
- 5. The referral system.
- 6. The legal aspects associated with the provision of maxillofacial procedures.
Maxillofacial surgery forms an appreciable part of daily practice for the non-specialist dentist. Some restrict their practice to straightforward extractions while others undertake a wide range of surgical procedures associated with the jaws, teeth and soft tissues. Many refer to this practice as minor oral surgery. There are specialist centres and departments within local dental and general hospitals where clinicians are committed to procedures that come under the umbrella of maxillofacial surgery. These include:
- • Straightforward extractions.
- • Surgical removal of impacted and broken-down teeth.
- • Surgical removal of retained roots.
- • Biopsies, which involve a sample of tissue being removed and sent for diagnosis to confirm or eliminate a diagnosis.
- • Exposure of impacted canines for patients undergoing orthodontic treatment.
- • Frenectomy, which is where either the labial or lingual frenulum is released.
- • The removal of cysts.
- • Alveolectomies, undertaken prior to dentures being supplied to a patient. This involves the smoothing off of the alveolar ridge.
- • Performing apicectomies where other root treatments have failed or it is impossible for them to be carried out. In dentistry an apicectomy comes under the auspices of endodontic treatments; however, as they involve raising a flap, it is classed as a surgical procedure.
- • Removal of tumours.
- • Reconstruction of the face following trauma or removal of facial tissues and structures.
- • Cosmetic treatments such as a face lift, rhinoplasty (the correction and reconstruction of the nose) or otoplasty (ears that stick out), commonly known as bat ears.
- • Orthognathic surgery, which is where surgical intervention is undertaken to correct jaw discrepancies.
For a clinician to undertake the last four procedures he/she must be dually qualified in dentistry and medicine.
The reason these procedures may be undertaken can be attributed to disease, accidental injury, congenital malformation, periodontal problems and caries. These treatments can be carried out with the use of local anaesthetic, either on its own or in combination with a form of conscious sedation, or a general anaesthetic, thereby involving many team members.
The maxillofacial team comprises the following members:
- • Consultant.
- • Registrar.
- • Oral surgeons.
- • Senior house officers.
- • Dental nurses.
- • Anaesthetists.
- • Recovery nurses who are state registered, with anaesthetic training.
When patients are being treated for cancerous lesions, a multi-disciplinary team approach involves additional team members. These are:
- • Oncologists (a specialist who treats cancerous lesions).
- • Radiologists (a specialist in interpreting images of the body).
- • Microbiologists and pathologists (who study micro-organisms and how they affect the human body).
- • Specialist head and neck nurses (registered general nurses).
- • Macmillan nurses (registered general nurses who specialise in the care of oncology patients).
- • Speech and language therapists (specialists who are trained to aid patients with their speech).
- • Dieticians (a specialist in nutrition or dietetics).
Patients are referred to specialist units and departments within local dental and general hospitals where maxillofacial surgery is undertaken. Reasons for referring patients can include the following: