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.

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).

Maxillofacial Trauma

A patient of Polytrauma requires the assistance of various medical specialties. SPARSH has a dedicated team of skilled Maxillo Facial surgeons, with all the team members having special skills to handle Maxillo Facial trauma. The Maxillo Facial team is an integral part of the trauma team at SPARSH, thus ensuring comprehensive trauma care.

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 nightguard 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 hours 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.

TMJ Ankylosis
The temporomandibular joint (TMJ) is the joint that allows mastication and speech. It is a synovial jointformed between the mandibular condyle below and the articular fossa of the temporal bone above. Thejoint 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.