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Maxillofacial Trauma
A patient of polytrauma requires the assistance of various medical specialties. Sparsh has a dedicated team of skilled maxillofacial surgeons, all the team members of Sparsh have special skills to handle maxillofacial trauma the maxillofacial team is an integral part of trauma team at Sparsh thus ensuring comprehensive trauma care.
Oral and Maxillofacial Surgeons are trained, skilled and uniquely qualified to manage and treat Facial Trauma.
Our surgeons meet and exceed these modern standards. They are trained, highly skilled and uniquely qualified to manage and treat facial trauma. They deliver emergency room coverage for facial injuries, which include the following conditions.
- Facial lacerations
- Intra oral lacerations
- Avulsed (knocked out) teeth
- Fractured facial bones (cheek, nose or eye socket)
- Fractured jaws (upper and lower jaw)
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The Nature of Maxillofacial Trauma
There are a number of possible causes of facial trauma. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).
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Soft Tissue Injuries of the Maxillofacial Region
When soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts (or outflow channels). Our doctors are well-trained oral and maxillofacial surgeons and are proficient at diagnosing and treating all types of facial lacerations.
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Bone Injuries of the Maxillofacial Region
Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the age and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
Fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique is called "rigid fixation" of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly.
The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient's facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is hidden.
 
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Injuries to the Teeth and Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.
The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long term reconstruction and rehabilitation of the patient.
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Oral cancer/oral tumors
Maxillofacial team at Sparsh Hospital are passionate about oncosurgery the team has all the necessary skills and dedication in managing such cases. All the team members have received special training in renowned cancer centres in the country.
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth:
- Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
- A sore that fails to heal and bleeds easily
- A lump or thickening on the skin lining the inside of the mouth
- Chronic sore throat or hoarseness
- Difficulty in chewing or swallowing
These changes can be detected on the lips, cheeks, palate and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.
We would recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we may help
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Cancer Surgery
What is reconstructive Cancer Surgery?
Cancers can be found on any part of the body, when they appear on the face, head, or neck, where they can be disfiguring as well as dangerous. Complete surgical removal (excision) is the most successful and the most common treatment. The lymph nodes may also need to be removed (lymphadenectomy).
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Who is a good candidate for reconstructive Cancer Surgery?
The different techniques used in treating oral cancers can be life saving, but they may leave a patient with less than pleasing cosmetic or functional results. Depending on the location and severity of the cancer, the consequences may range from a small but unsightly scar to permanent changes in facial structures such as your nose, ear, or lip.
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How is the procedure performed?
Reconstructive techniques- ranging from a simple scar revision to a complex transfer of tissue flaps from elsewhere on the body-can often repair damaged tissue, rebuild body parts, and restore most patients to acceptable appearance and function.
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Cleft lip and palate surgery
Maxillofacial team of Sparsh has special interests in treatment of congenital anomalies. The surgeons have received special training in managing such deformities. The team is dedicated in establishing an excellent and finest unit in the country if not the world to manage such cases. Team members are not only passionate in treating such cases but are also involved in various research activities, and are also constantly undergoing training in higher centers to upgrade skills and keep in touch with the newer techniques.
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Frequenty asked questions about cleft lip and palate
What causes cleft lips and palates?
Cleft lips and palates happen when there isn’t proper closure of the facial structure during growth of a fetus. The parts of the face and mouth develop separately, but ordinarily come together in the early months of fetal life. If for some reason the process is interrupted, the fusing may not take place or only partially take place. It is not known at this time why interruption in the fusing process happens.
For a small percentage of children born with cleft lip/cleft palate there may be a genetic factor. If one parent or child in a family has a cleft, the chances of a future child being born with a cleft increases.
What is the best way to feed a new baby with a cleft?
In the initial days feeding may be a challenge. A baby with a cleft may have difficulty making a tight seal around the nipple of a bottle or breast, and the baby with a cleft palate often cannot generate an effective suck.
There are special bottles and nipples which help to make the feeding easier. Some mothers planning breast feeding may decide to pump and use a bottle until the surgical repair has taken place.
Infants with cleft lip and/or palate may have longer feeding times which can cause them to get tired; they may swallow air with feeding. Sometimes breast milk or formula may come out the nose, but being aware of this you can experiment with positioning and some of the bottles available.
When will my baby/child have surgery?
Cleft lips are usually repaired within the first three months after birth or when the baby weighs at least ten pounds. Cleft palates are usually repaired at nine to twelve months of age.
A consultation visit with our maxillofacial surgeon soon after birth will give parents full details about the procedure and scheduling surgery.
What is Nasoalveolar Molding (NAM)?
Depending on the width of the cleft and the presence or absence of a cleft palate, a short period of reshaping the mouth and nose may be recommended.
NAM is a technique in which the alveolus (gum ridges) and/or nose are molded with an appliance similar to an orthodontic retainer. This is usually done by a specially trained orthodontist prior to surgery, in order to make surgery simpler.
The baby wears the appliance 24 hours a day for a period of weeks or months. It does not interfere with feeding or breathing for the baby.
Will my child need any further treatment for the teeth?
Nearly all children with cleft palate need braces because the teeth closest to the cleft tend to come in at incorrect angles or not at all. Orthodontics may begin as early as age 5 or 6.
In some older children a “bone graft” is needed to allow the adult teeth to come in properly. Small bone fragments are taken from the hip and placed in the gap in the alveolus (bone edges of the gum) by an oral surgeon. This allows the adult teeth to have a solid surface to erupt into. The orthodontist and the oral surgeon will determine if this is necessary some time between ages 8 and 10.
What is Distraction Osteogenisis?
For some children with more severe facial problems more oral surgery becomes necessary when they are teenagers.
Distraction Osteogenisis (DO) is a surgical technique in which bones in the jaw are cut and an appliance applied. This procedure is usually done to advance the mid-face or upper jaw. After surgery the appliance is left on for 6-8 weeks and gradually adjusted, moving the bones (distraction).
The bone then responds by filling the gap with new bone. Mispositioned bones may then be gradually brought into more correct alignment. It may look awkward but is really fairly painless.
What is Cleft lip/palate clinic and when is the first visit?
Treatment of cleft lip and palate is multidiciplinary
The team includes:
- Maxillofacial surgeons- perform reconstructive and cosmetic surgery. treats the mouth, jaws and face.
- Pediatric otolaryngologist - ear, nose and throat doctor
- Orthodontist - treats misaligned teeth
- Speech pathologist - evaluates and treats speech, language, voice, swallowing, fluency, and other related disorders.
- Geneticist - diagnoses, treats, and counsels patients with genetic disorders or syndromes.
- Audiologist - diagnoses and treatment of hearing problems.
- Social worker - performs casework and counseling.
- Nurses - coordinates care, clinic visits, provides support and information.
All have many years of experience working with children with clefts and their families.
The first clinic visit usually happens in the first year, but not necessarily before surgery. For the first few years children are seen annually, but after that it may be every two or three years depending on the child and his/her needs. Certainly the family may always request an appointment.
Why do I need to have my child’s hearing tested?
Annual hearing testing is recommended to monitor children with cleft lip/palate because they are more prone to middle ear infections and problems.
Testing may happen more frequently if middle ear problems last for a long time. If a child shows a decrease in hearing or is having chronic middle ear problems, they may be referred to an ear, nose, and throat (ENT) specialist.
Will my child require speech therapy?
Because of the cleft in the roof of the mouth, children with cleft palate cannot seal off the nose when they talk. This may make the speech sound “hypernasal”. By repairing the cleft at the appropriate time many children develop normal speech.
Despite palate surgery some children are unable to effectively seal off the nose when speaking and they may require speech therapy or an additional surgical procedure. A surgery called a “pharyngeal flap” uses tissue from the back of the throat to partially close off communication between the mouth and the nose, and improve speech.
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Pharyngoplasty
Children with a repaired cleft palate may have a resulting condition referred to as "VPI" (Velopharyngeal Incompetence). This means that too much air escapes through the nose during speech, resulting in a nasal sounding speech. This occurs because the repaired soft palate is too short or does not move adequately.
A surgical operation called a pharyngoplasty improves the function of the soft palate. In these operations, some of the tissue from the palate and the back of the throat are repositioned to help close off the escape of air through the nose.
The goal of a pharyngoplasty is successful communication for a child with cleft lip and palate. The speech pathologist regularly monitors the development of using and understanding language and the development of speech abilities including pronunciation of words (articulation), the sound of the voice and the amount of nasality during speech. When necessary, recommendations for speech therapy are made based on the child's specific needs.
After Your Child's Procedure
Appearance
After pharyngoplasty, there will be sutures on the back of the child's throat (Pharynx) that extends to the roof of the mouth. You will not be able to see these from the outside. Your child may have some red drainage from his nose and mouth.
Speech
This procedure has been done to improve the function of the palate in speech. Immediately after the operation, your child may not speak due to pain. After this operation, speech therapy is still needed to change speech habits, which have been used over time and will not automatically change because of the operation.
Wound Care
The wounds inside your child's mouth require no special care. If there is a complaint of pain that gets worse over time instead of better, if there is swelling or foul smelling drainage from the mouth, there may be a wound infection and you should contact our hospital immediately.
Pain
Your child will have throat pain, may have a stiff neck and may be irritable due to hunger. By the time he is ready to go home from the hospital, his pain should be well-controlled on oral pain medications
Diet
Your child should be on a soft diet for about one week to protect the repair and because his throat will be sore. Nothing hard (such as feeding utensils and popsicle sticks) should be placed in the mouth. Small, frequent snacks may be necessary for the first couple of days. Follow meals and snacks with water to clean the inside of the mouth.
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Distraction Osteogenesis
Distraction osteogenesis (DO) is a relatively new method of treatment for selected deformities and defects of the oral and facial skeleton. It was first used in 1903. Then, in the 1950’s the Russian orthopedic surgeon, Dr. Gabriel Ilizarov slowly perfected the surgical and postoperative management of distraction osteogenesis treatment to correct deformities and repair defects of the arms and legs. His work went mostly unnoticed until he presented to the Western Medical Society in the mid-1960’s.
Distraction osteogenesis was initially used to treat defects of the oral and facial region in 1990. Since then, the surgical and technological advances made in the field of distraction osteogenesis have provided the oral and maxillofacial surgeons with a safe and predictable method to treat selected deformities of the oral and facial skeleton.
Our surgeons use distraction osteogenesis to treat selected deformities and defects of the oral and facial skeleton. Our surgeons have received continuing education in the field of distraction osteogenesis. If you have questions about distraction osteogenesis, please call our hospital and schedule an appointment with one of our doctors.
Frequently Asked Questions About Distraction Osteogenesis
1. What does the term distraction osteogenesis mean?
Simply stated, distraction osteogenesis means the slow movement apart (distraction) of two bony segments in a manner such that new bone is allowed to fill in the gap created by the separating bony segments.
2. Is the surgery for distraction osteogenesis more involved than "traditional surgery" for a similar procedure?
No. Distraction osteogenesis surgery is usually done on an outpatient basis with most of the patients going home the same day of surgery. The surgical procedure itself is less invasive so there is usually less pain and swelling.
3. Is distraction osteogenesis painful?
Since all distraction osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Postoperatively, you will be supplied with appropriate analgesics (pain killers) to keep you comfortable, and antibiotics to fight off infection. Activation of the distraction device to slowly separate the bones may cause some patients mild discomfort. In general, the slow movement of bony segments produces discomfort roughly analogous to having braces tightened.
4. What are the benefits of distraction osteogenesis versus traditional surgery for a similar condition?
Distraction osteogenesis surgical procedures typically produce less pain and swelling than the traditional surgical procedure for a similar condition. Distraction osteogenesis eliminates the need for bone grafts, and therefore, another surgical site. Lastly, distraction osteogenesis is associated with greater stability when used in major cases where significant movement of bony segments are involved.
5. What are the disadvantages of distraction osteogenesis?
Distraction osteogenesis requires the patient to return to the surgeon's office frequently during the initial two weeks after surgery. This is necessary because in this time frame the surgeon will need to closely monitor the patient for any infection and teach the patient how to activate the appliance.
6. In some cases, a second minor office surgical procedure is necessary to remove the distraction appliance.
7. Can distraction osteogenesis be used instead of bone grafts to add bone to my jaws?
Yes. Recent advances in technology have provided the oral and maxillofacial surgeon with an easy to place and use distraction device that can be used to slowly grow bone in selected areas of bone loss that has occurred in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.
8. Does distraction osteogenesis leave scars on the face?
No. The entire surgery is done within the mouth and the distraction devices used by our doctors remain inside the mouth. There are no facial surgical incisions are made so no unsightly facial scars result.
9. Are there any age limitations for patients who can receive osteogenesis?
No. distraction osteogenesis works well on patients of all ages. In general, the younger the patient the shorter the distraction time and the faster the consolidation phase. Adults require slightly longer period of distraction and consolidation because the bone regenerative capabilities are slightly slower than those of adolescence or infants.
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Orthognathic surgery
Surgeons of maxillofacial team at Sparsh Hospital have special skills in orthognathic/cosmetic surgery. The Maxillo facial surgeon of Sparsh Hospital are headed by Dr. Kishore Nayak, leading Orthognathic surgeon in the country. He has performed more than 1000 Complex orthognathic surgeries. The team is excellent and highly experienced performing these highly skilled and delicate surgeries. The team focuses on world class patient care and best outcome of results.
Orthognathic surgery is needed when jaws don't meet correctly and/or teeth don't seem to fit with jaws. Teeth are straightened with orthodontics and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.
Who Needs Orthognathic Surgery?
People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health and appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthodontics alone can correct bite problems when only the teeth are involved. Orthognathic surgery may be required for the jaws when needing repositioning.
Difficulty in the following areas should be evaluated:
- difficulty in chewing, biting or swallowing
- speech problems
- chronic jaw or TMJ pain
- open bite
- protruding jaw
- breathing problems
Any of these can exist at birth or may be acquired after birth as a result of hereditary or environmental influences or the result of trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with x-rays. During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together.
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Technology and Orthognathic Surgery
Our doctors use modern computer techniques and three-dimensional models to show you exactly how your surgery will be approached. Using comprehensive facial X-rays and computer video imaging, we can show you how your bite will be improved and even give you an idea of how you'll look after surgery. This helps you understand the surgical process and the extent of the treatment prescribed and to see the benefits of orthognathic surgery.
If you are a candidate for Corrective Jaw Surgery, our doctors will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.
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Dental Implants
The implants themselves are tiny titanium posts, which are inserted into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes. They are surgically placed into the jawbone. The bone bonds with the titanium, creating a strong foundation for artificial teeth. Small posts are then attached to the implant, which protrude through the gums. These posts provide stable anchors for artificial replacement teeth.
Implants also help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.
The Surgical Procedure
For most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone. For the first three to six months following surgery, the implants are beneath the surface of the gums gradually bonding with the jawbone. You should be able to wear temporary dentures and eat a soft diet during this time. At the same time, your dentist is forming new replacement teeth.
After the implant has bonded to the jawbone, the second phase begins. Our doctors will uncover the implants and attach small posts, which will act as anchors for the artificial teeth. These posts protrude through the gums. When the artificial teeth are placed these posts will not be seen. The entire rocedure usually takes six to eight months. Most patients experience minimal disruption in their daily life.
Surgical Advances
Using the most recent advances in dental implant technology, our doctors are able to place single stage implants. These implants do not require a second procedure to uncover them but do require a minimum of six weeks of healing time before placing artificial teeth on them. There are even situations where the implants can be placed at the same time as a tooth extraction further minimizing the number of surgical procedures. Advances in dental implant technology have made it possible in select cases, to extract teeth, and place implants with crowns at one visit. This process, called “immediate loading” greatly simplifies the surgical process.
Who actually performs the implant placement?
Implants are a team effort between an Oral and Maxillofacial Surgeon and a Restorative Dentist. While our doctor performs the actual implant surgery, and initial tooth extractions and bone grafting if necessary, the restorative dentist fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.
What types of prostheses are available?
A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis (over denture) attaches to a bar or ball in socket attachments, whereas a fixed one is permanent and removable only by the dentist.
Our doctors perform in-office implant surgery in a hospital-style operating suite, thus optimizing the level of sterility. Inpatient hospital implant surgery is for patients who have special medical or anesthetic needs or for those who need extensive bone grafting from the jaw, hip or tibia.
Why dental implants?
Once you learn about dental implants, you finally realize there is a way to improve you life. When you lose several teeth – whether it’s a new situation or something you have lived with for years – chances are you have never become fully accustomed to losing such a vital part of yourself.
Dental implants can be your doorway to renewed self-confidence and peace of mind.
A Swedish scientist and orthopedic surgeon, Dr. Per-Ingvar Branemark, developed this concept for oral rehabilitation more than thirty-five years ago. With his pioneering research, Dr. Branemark opened the door to a lifetime of renewed comfort and self-confidence for millions of individuals facing the frustration and embarrassment of tooth loss.
Why would you select dental implants over more traditional types of restorations?
There are several reasons: Why sacrifice the structure of surrounding good teeth to bridge a space? In addition, removing a denture or a “partial” at night may be inconvenient, not to mention that dentures that slip can be uncomfortable and rather embarrassing.
Are you a candidate for implants?
If you are considering implants, your mouth must be examined thoroughly and your medical and dental history reviewed. If you mouth is not ideal for implants, ways of improving outcome, such as bone grafting, may be recommended.
What type of anesthesia is used?
The majority of dental implants and one graft can be performed in the office under local anesthesia, with or without general anesthesia.
Do Implants need special care?
Once the implants are in place, they will serve you well for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists.
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Dental surgery
By the age of eighteen, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth or molar teeth are used to grind food up into a consistency suitable for swallowing.
The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your Third Molars, also known as "wisdom teeth."
Why Should I Remove My Wisdom Teeth?
Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.
These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.
Oral Examination
With an oral examination and x-rays of the mouth, our doctors can evaluate the position of the wisdom teeth and predict if there may be present or future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid- teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.
All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Our doctors have the training, license and experience to provide various types of anesthesia for patients to select the best alternative.
Removal
In most cases, the removal of wisdom teeth is performed under local anesthesia, or general anesthesia. These options as well as the surgical risks (i.e. sensory nerve damager, sinus complications) will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured and gauze is placed in your mouth to bit on to control bleeding. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your post-operative kit will include postoperative instructions, a prescription for pain medication, antibiotics and a follow-up appointment in one week for suture removal. If you have any questions, please do not hesitate to call us.
Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff that are experienced in anesthesia techniques.
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TMJ Disorders/Tmj ankylosis
Tmj disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a "clicking" sound, you'll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles (muscles of mastication) do not work together correctly. TMJ stands for Temporomandibular Joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.
No one treatment can resolve TMJ disorders completely and treatment takes time to become effective. Our doctors can help you have a healthier and more comfortable jaw.
Trouble with Your Jaw?
TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noise when you open your mouth or trouble opening your mouth wide.
Do You Have a TMJ Disorder?
- Are you aware of grinding or clenching your teeth?
- Do you wake up with sore, stiff muscles around your jaws?
- Do you have frequent headaches or neck aches?
- Does the pain get worse when you clench your teeth?
- Does stress make your clenching and pain worse?
- Does your jaw click, pop, grate, catch, or lock when you open your mouth?
- Is it difficult or painful to open your mouth, eat or yawn?
- Have you ever injured your neck, head or jaws?
- Have you had problems (such as arthritis) with other joints?
- Do you have teeth that no longer touch when you bite?
- Do your teeth meet differently from time to time?
- Is it hard to use your front teeth to bite or tear food?
- Are your teeth sensitive, loose, broken or worn?
The more times you answered "yes," the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.
Treatment
There are various treatment options that our doctors can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, our doctors will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care.
The initial goals are to relieve the muscle spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:
- Resting your jaw
- Keeping your teeth apart when you are not swallowing or eating
- Eating soft foods
- Applying ice and heat
- Exercising your jaw
- Practicing good posture.
Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. A splint or nightgaurd fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night and helps to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relives pressure on parts of your jaw and aids in disk repositioning. It may be worn 24 hours/day to help your jaw heal. An orthotic stabilization appliance is worn 24 or just at night to move your jaw into proper position. Appliances also help to protect from tooth wear.
What about bite correction or surgery?
If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed but are reserved for severe cases.
Our doctors do not consider TMJ surgery unless the jaw can’t open, is dislocated and nonreducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.
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TMJ Ankylosis
The temporomandibular joint (TMJ) is the joint that allows mastication and speech. It is a synovial joint
formed between the mandibular condyle below and the articular fossa of the temporal bone above. The
joint is liable to suffer from a number of diseases,(commonly fractures of the mandible), some of which predispose to TMJ ankylosis. Ankylosis is defined as loss of joint movement resulting from fusion of bones within the joint or calcification of the ligaments around it.
Typically calcification of the ligaments around the joint is not painful, but the mouth can open only about 1 inch or less. Fusion of bones within the joint causes pain and more severely limits jaw movement. Occasionally, stretching exercises help people with calcification, but people with calcification or bone fusion usually need surgery to restore jaw movement.
TMJ ankylosis may be post- traumatic or post-surgery for TMJ disease in a majority of cases. More unusual causes include Rheumatoid Arthritis, Sickle Cell Anaemia and Fibrodysplasia Ossificans Progressiva. Surgical options for treatment include Gap Arthroplasty which is still preferred by some and Interpositional Surgery which is the standard procedure.
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