Oral and Maxillofacial Surgeon

Do you remember when Bristol Palin claimed she had corrective jaw surgery but all of the surgeons claimed there's no way she could have because she didn't have braces leading up to it and that it was just cosmetic / plastic surgery. What was ur take?

Asked by BP almost 10 years ago

First a couple definitions: 

Plastic surgery: Often used as a misnomer. It is actually a certified specialty within medicine whose scope is much more than just boob jobs, tummy tucks and cosmetic procedures. It should be thought of as describing a person rather than the type of surgery performed. Neurosurgeon, Radiologist, Plastic Surgeon, etc... Plastic surgeons are actually trying to combat this misnomer by now referring to themselves as plastic and reconstructive surgeons. 

Cosmetic surgery: This is a surgery that is performed that has been deemed to have no physical therapeutic benefit. Cosmetic surgery is not strictly performed by plastic surgeons. Others performing this would include Oral and Maxillofacial Surgeons (like me), Dermatologists, Opthomologists, ENT (ear nose and throat, technically called otolaryngologist), etc. 

Orthognathic surgery: A surgery that will correct/improve someones occlusion (bite) by surgically repositioning the mandible (lower jaw), maxilla (upper jaw). This is typically not considered a cosmetic procedure.

Now on to Bristol... 

You don't ALWAYS need braces before having orthognathic surgery. Common examples of this would be when doing this for someone suffering with obstructive sleep apnea. The idea is that while they are sleeping, their tongue slips into their airway and causes them to obstruct. By advancing their mandible and maxilla forward, you bring the tongue musculature with it and reduce the abiliity to obstruct. The point here is that you are not changing the bite and do not necessarily need braces before hand. 

The only way to know for sure is to look at profile before and after pictures (which I have trouble finding for her) and also looking at her dental models (plaster molds). When I look at the before and after frontal photos a couple things seem obvious...

There is an impressive amount of facial and neck fat that is missing. My guess is that this is from a combination of dieting, excercise and PROBABLY a little bit of submental liposuction. Her cheekbones look pretty similar as far as I can tell but what really stands out is her chin. It looks like she either had a genioplasty or a chin implant but again it is hard to tell in the context of all the fat loss. 

To answer your question... In my opinion it looks as if she had cosmetic surgery. It is possible that no implants were put in as she simply could have just had liposuction and the placement of her existing chin altered. It doesn't look like her bite has changed much or the position of her facial skeleton has changed but again it is hard to tell without seeing actual preoperative data. She certainly has NOT had reconstructive surgery as that would imply something was missing that was reconstructed. Nevertheless... she looks amazing and I would go to see her surgeon any day :)

Did you just start as a regular dentist before deciding that breaking peoples' jaws and screwing them back together was your calling?

Asked by Man almost 10 years ago

No. I decided in dental school that I wanted to do oral surgery. You must complete a residency in oral and maxillofacial surgery in order to be able to do that. 

I got this surgery (for an open bite) and it was a nightmare getting insurance to cover it b/c we had to "prove" it wasn't cosmetic. Why do they make it so difficult to have covered?

Asked by dan79 almost 10 years ago

Thats insurance in general for you... They don't make money by paying for other people's surgeries. Very often they need to have it made very clear that by actually paying for a surgery, they will be saving money in the long run. In the case of the open bite, it is clear that there can lead to problems with the TMJ, chronic pain, and nutritional and quality of life issues given the difficulty chewing so you have to be persistent. 

How much does the surgery cost (for the patient), and roughly how much of that does the surgeon pocket himself?

Asked by LOUDNOISES almost 10 years ago

This question is too vague to answer. Not all surgeries are the same. Some surgeries are very long and cost more. Some surgeries are short... Some are technically very difficult and require multiple surgeons and cost more. Some surgeries are done with just regional anesthesia rather than general and may cost less. Some are elective and some are done on an emergency basis. All of these factors can lead to higher or lower costs. In general the biggest factor is time under general anesthesia. 

As far as what the surgeon takes home it is usually a smaller slice of the pie. The anesthesiologist and the hospital take bigger chunks than you would think. In oral and maxillofacial surgery, most of the money is made in the office doing procedures under local anesthesia or IV sedation where there is no anesthesiologist or hospital involved. 

Another thing to consider is trauma... these cases generally pay very little. This is because often the patient has no insurance or limited funds and the cost is absorbed by the state or the hospital, thus the reimbursement is not adequate. 

Do you have a specific surgery in mind? 

How often do people actually wake up during surgery and if that happens is it because the anesthesiologist screwed up?

Asked by BRent almost 10 years ago

The reported incidence is around 0.1-0.2%. It is very rare and I have never seen it or met anyone who has. As with all calamities of surgery, it is usually a multifactorial process. Most of the cases in which it happens, the patient has a neuromuscular blocking agent on board (they are paralyzed) and can't respond to surgical stimulus, despite being able to hear, feel, etc. Most surgeons don't require a paralytic during surgery, but virtually EVERY patient needs a period of paralysis during induction of surgery. This is because during intubation, you can undergo vasospasm if your vocal cords are irritated while the breathing tube is inserted. Having a short acting paralytic going at this time prevents this. Some patients metabolize drugs slower than others and the drug could be lingering around for longer leading to the inability to demonstrate awareness. Thats not necessarily the anesthesiologists fault. However there are instances in which the anesthesiologist is just too inexperienced and their error is involved as well. 

It is important to note that most people who have described having an awareness episode reported not feeling pain. 

 

I HAD THIS SURGERY! Can you explain to me why my lower lip and chin is still partially numb over 10 years later? I was told most of the feeling would come back, but it looks like it'll be this way forever. Did the surgeon do something wrong?

Asked by Leah almost 10 years ago

Sounds like you had a BSSO - Bilateral sagittal split osteotomy. This surgery is done when you have a severe underbite that can't be corrected with braces alone. The surgery allows for repositioning of your lower jaw in a more forward position to correct the underbite. Occasionally it is done when you have a severe overbite (reposition the lower jaw backwards) but usually in this instance the upper jaw is moved forward. I digress....

The BSSO consists of 3 bone cuts (osteotomies) on each side of the mandible. Once the soft tissue dissection is complete, a horizontal cut is made on the inner side of the mandible, just above where the inferior alveolar nerve enters your mandible. This is the nerve that supplies sensation to your teeth, gums, lip, etc. This cut only goes through half of the bone. Think of your mandible as a ham sandwhich - 2 pieces of bread and a slice of ham. The pieces of bread are the dense cortex and the ham is the less dense marrow space. The nerve runs in the marrow space (the ham). So when the first cut is made, we are only going through the inner slice of bread (cortex). A vertical cut is then made from the edge of the first horizontal cut down the ramus and it is essentially going between the two cortices. This cut is extended to the level of the first molar. Finally, the third cut is also vertical and goes through the outer cortex only. Think of the 2nd cut as connecting the 1st and 3rd cuts. Google "bilateral sagittal split osteotomy" for a nice visual conceptualization of this. The reason the cuts are made this way is because we are trying to keep the nerve associated with that inner section of bone. With these cuts, believe it or not the bones are not very movable from each other. They are still connected by the slice of ham as well as by the bottom surface of the mandible. The pieces are actually separated with a series of osteotomes (chisels) and a mallet. The theory is that with our cuts we have introduced a manner in which the fracture will happen in a controlled manner and the nerve will be unharmed. This is done on both sides and it allows for free movement of the tooth bearing section of the mandible. We reposition that section to where we want it and then screw it back to the section of the mandible that has the joint attached. 

Things can go wrong at a few different points...

First with the intitial cuts, if the nerve is not visualized entering the mandible, the cut can be made too low and the nerve can be severed. Second, with the controlled fracture sometimes the mandible just splits in a way we don't want it to and the nerve gets injured. Finally, when all the pieces are screwed back together, the nerve can be compressed between the segments. In any of these instances, if it is not noticed during surgery you will be left with permanent paresthesia of the innervating structures. If we see the nerve was severed during surgery we can repair it right there and this has good results. Nevertheless, these complications are typically a function of experience. 

EVERYONE who has this surgery will be numb for a period of time after the procedure. This is because manipulation of any nerve will cause transient numbness. However, so long as everything went well the feeling will come back within a few months. When injuries occur, if the nerve is repaired generally a predictable population does better than others. That is age. People 25 and under generally will regain feeling. Older than that, if something happens to the nerve (incidence is ~25%), you will be numb on that side permanenetly. This is the reason mostly younger people are getting this surgery. 

Im sorry to hear that you are still partially numb. Given that you have some feeling you likely had a partial nerve injury and not a complete transection. From the studies that we do have, most people demonstrate more elation with the functional and cosmetic outcome of the surgery than unhappiness with their numbness. 

 

 

My friend had this surgery and she looked completely different afterward (way better, we all agreed). But are there some people who get much uglier?

Asked by slots almost 10 years ago

I haven't ever seen anyone whom I thought looked worse after orthognathic surgery (see bristol palin question for definition). Often, people getting orthognathic surgery have such severe underbites, or overbites that there is no way they can look anything but better after the surgery. 

The only reason I can think that someone would look worse is if they are getting obstructive sleep apnea surgery where their mandible and maxilla are being advanced forward upwards of 14 mm. This tends to make there lips and face kind protrude out. They are often heavy set though and their extra facial tissue usually hides this.

As far as cosmetic surgery goes, I see a lot of hideous looking people on TV that have had too much. Joan Rivers comes to mind... She is so surgerized she cant even make facial expressions and it looks unnatural. But for every person like that, there are multiple people out there who have had cosmetic surgery in which you would have no idea.  

Did you operate on anyone who got their jaw busted in a fight? And if so, is it better to do it as soon as they come to the ER, or do you have to wait til swelling goes down?

Asked by Drunk almost 10 years ago

This is one of my favorite things to do... although the pay is kind of crappy. Lets be real, the people getting their jaws busted didn't get it busted for no reason. The common presentation is the following... "I was minding my own business... and 9 guys jumped me for no reason" haha. Anyway, these people seldom have insurance or resources to pay for the surgery so it is often covered by the state at a much reduced reimbursment rate. Hence it is usually considered a service to the community. Nevertheless... It is one of the funnest surgeries to do! 

To answer your question... everyone who shows up to the ER with a broken mandible gets a procedure. There are very few indications for going to the operating room right then and there to put in plates and screws. It is nice to wait for the swelling to go down but some surgeons like to go in right away and fix it before the swelling even starts. This is not the practice of most people though. Nevertheless, it is bad form to let people walk around with floppy mandibles until their swelling goes down (infection risk) so they get wired shut. This is our equivelent of putting someone in a cast. The purpose is to put the bones back together and imobilize the jaw. This is often the only procedure that is needed. Sometimes though... for various reasons, the aforementioned surgery is needed (plates and screws) and yes this is usually done after swelling goes down. Although realistically it takes that amount of time to get on the OR schedule regardless. 

Now if we are talking about other bones of the face... cheek bones, eye sockets, forehead, etc. It is best to wait until the swelling goes down. This helps us get the contours of the face as symmetric as possible. 

In any situation however... you want to operate within 2 weeks. At that point the bones start to fuse. 

Are there some deformities so bad that a person isn't even a candidate for surgery and they just have to live with it?

Asked by maddy78 almost 10 years ago

I have never seen anyone turned down for surgery because they were TOO deformed. What you have to realize is that someone who is "too deformed" will likely never be 100% normal. A lot of times, surgery is adressing a funcional issue in those cases. For instance. Someone with micrognathia... will often be tracheostomy dependant (they have a breathing tube that goes to their trachea) because their mandible is too small. Usually this is in children. They usually have other deformities and are often syndromic. We can adress their small jaw by lengthening it and usually even get the trach out. But they still have other "deformities"

I don't get it... so are you a doctor or a dentist? What degree do you have? Are all oral surgeons doctors?

Asked by Loren almost 10 years ago

By doctor I am assuming you are referring to MD... I am both. Our training starts with dental school and we get that degree first (either DMD or DDS). After dental school we go to residency where we train in oral and maxillofacial surgery. While in residency some of us go to a portion of medical school (usually 3rd and 4th year) and obtain an MD. Not all training programs have that feature though. So while I have a DDS and MD, my training program was 6 years after dental school. There are others who have DDS/DMD without MD but are still fully trained oral and maxillofacial surgeons. Their training program was 4 years long. I don't know the exact numbers but about half of the oral surgeons are dual degree surgeons (ie DDS/DMD and MD) and the other half are single degree. 

My son's surgeon generated before and after projections of what he'll look like after the surgery, and they look good, but he's still worried. Just how accurate are those imaging programs? Are they ever way off base with their visual projections?

Asked by Susan Holmes almost 10 years ago

They are accurate to an extent. They have limited applications in situations where very large movements are planned (>8-10 mm) or when someone has an excess amount of soft tissue. Also, they are pretty much only accurate in predicting what you will look like in a profile view (looking from the side). The projections from the frontal perspective are not really that good. Those programs should be a supplement to help you guide your decision for surgery. They should not be the BASIS for deciding on surgery. Whatever the soft tissue projection looks like, remember this fundamental of orthognathic surgery.... It is a functional surgery (bring your bite together), with cosmetic side effects. In my time, I have only seen 1 or 2 people come back unsatisfied with their appearance. I think they understood the principle stated above as backwards. Most people who get this surgery, are so happy to have their bite in a normal position. They are so happy they can finally chew normally that any minor cosmetic change they experience is icing on the cake. 

Also please remember... your son will look nothing like those photos for the first 3-6 months. He will be very swollen :)

What kind of screws are used to screw into jaw bones and is there any risk that it could split the bone like a nail can sometimes splinter a wooden stud if it's not drilled dead center?

Asked by JIH123 almost 10 years ago

Titanium screws are used. The business of making hardware that goes into peoples bones is actually quite impressive. There are several companies and the science that goes into it is really neat. Synthes is one that comes to mind.

It is important to note that while bone and wood have some similarities, they don't always act in the same manner. Bone is quite calcified but does still have some pliable properties. Splitting a bone with a poorly angled screw is not really common. Generally the screw just stays in place and bone grows around it. Any minor splits that do occur remodel and aren't usually an issue. If there is some concern intraopertive radiographs can be obtained to make sure that the screws are in the right place. 

Also, the face is a unique part of the body in that there are some bones that are less then 1.0 mm thick (maxillary sinus, orbital floor). Imagine doing cabinet work on a piece of wood that is as thick as your fingernail!! The design of these screws to hold in place in those kind of conditions is phenomenal. 

Is there a wide disparity in ability among oral surgeons? Like are there some you know who you would never send a friend to? Or does the degree of difficulty mean that everyone's at least "pretty good"?

Asked by solong almost 10 years ago

There are some surgeons that I would never send a friend to but honestly it has more to do with their willingness and ability to take care of any complications. It is very troublesome to see a surgeon do a procedure on someone and then not be there for when they have a complication. It is not uncommon to see other surgeon's patients over the weekend or nighttime hours because they were unavailable. Those are the types of surgeons I would never send a friend to. 

As far as abilities, some surgeons do certain procedures more often than others. Surgeon A may be really good at taking out teeth and putting in implants but doesn't do trauma that often. Surgeon B may do a lot of trauma but not do teeth. So I would refer based on what I know about their scope of practice. 

I'm confused about whether it's better to be young or old if you're considering jaw surgery. Aren't kids' skeletons still developing into their late teens? Isn't it better to wait until they have their 'adult' skull?

Asked by judeinlaw almost 10 years ago

It really depends on your jaw growth pattern and your current state. 

Overbite: If you are done growing, it doesn't matter how old you are, your mandible will never catch up to your maxilla. If you have yet to have your growth spurt, than the mandible may catch up but often the maxilla will still grow as well and you will still need surgery. We often operate on these kids even if they haven't had their growth spurt because the mandible has demonstrated clear growth restriction. 

Underbite: Here your mandible sticks out farther than your maxilla. This usually means you had a late or prolonged growth spurt and that growth is just about finished. Operating is okay at anytime here. 

Would you have handled Roger Ebert's facial surgery differently?

Asked by Cobruh almost 10 years ago

I am not really at liberty to say. He had metastatic thyroid cancer and I am not a head and neck cancer trained surgeon. I just don't have the awareness of the specifics of his grade/stage of cancer or the behavioral patterns of that type of cancer. I know it is a rare form of cancer and what happened to him was very tragic. I am certain that those surgeons, oncologists and radiation oncologists were all working together and devised the best treatment that they could come up with. It is important to know that treating cancer isn't a one person show. It often takes an entire team to devise plans and coordinate therapy. 

What's the craziest thing that has happened to you in an operating room?

Asked by J7 almost 10 years ago

Its hard to say... A lot can go on in there. Surgeons are by nature not very squeemish so when crazy things do happen they don't stick out in my mind for very long. 

Something that I will always remember however... 

As a resident, it was my birthday and I had to spend 13 hours in the OR... No bathroom or food breaks, scrubbed the entire time, occasionally cranky moments by the attending. I wen't home for the evening at around 8PM, fell asleep an hour later, woke up the next day and had to be back at the hospital at 7 AM for a 24 hr call shift. 

Why do people get their wisdom teeth taken out if they are not causing problems?

Asked by Zack almost 10 years ago

That is THE question facing OMFS right now. For the sake of discussion we are speaking explicity about impacted, non functional teeth. 

Allow me to answer this with 4 scenarios. I think your question specifically refers to scenario #4 so skip to that for the immediate answer. 

#1. Your wisdom teeth are bothering you and they show signs of disease (cavities, infection, loss of the periodontium - gums, etc). This is obvious, it makes sense to go ahead and take these out. 

#2. Your wisdom teeth are bothering you but there is no sign of disease: This is the least common scenario. Sometimes, it is not even the wisdom teeth that are the cause of the pain. Sometimes it is the TMJ's or muscle pain or even pain from another tooth. It is sometimes better to figure out what is going on in this case rather than just pulling the teeth because often the pain remains even after the wisdom teeth come out and the patient's are left dissatisfied. Discuss this with your surgeon if you are in this scenario. 

#3. Your wisdom teeth are not bothering you, but there is sign of disease. Most often the sign of disease is deep periodontal probing depths or evidence of bone loss associated with the next tooth forward. There is usually not enough room in the jaw for wisdom teeth to erupt into so they can easily grow in "sideways." When they do this, they can break the seal that the gums have with the teeth and bones leading to deep tracts (or pockets) for food, plaque and bacteria to get into and cause even further destruction of the teeth, gums and bone. Left long enough, these teeth will eventually become symptomatic. These teeth should usually come out. 

#4. Your wisdom teeth are not bothering you and they are not showing signs of disease. The traditional reason for doing this is the following. Taking them out can prevent problems in the future. This is considered prophylactic. Usually this is done at a young age. We have found that younger people have a few advantages in this regard. For one, the teeth are easier to get out as their bones are a little softer and the teeth aren't fully developed. 2 - they are often healthier and can tolerate being under sedation for an hour without problems. 3 - and most importantly, they tolerate complications better. Complications such as nerve injury are real with taking out wisdom teeth. This can lead to a numb lip, cheek and/or tongue. When this happens to young people, there is usually something that can be done about it and it is rarely permanent. When a nerve injury happens to older people, it is almost ALWAYS permanent. So you are facing a bird in the hand or two in the bushel type situation. While younger people don't always have symptomatic or disease wisdom teeth, they may very well develop them in the future and they are less able to tolerate the situation at an older age. Finally, although rare, there are tumors of the jaw that arise from the follicles of unerupted teeth. Some of these tumors, you cannot get if you don't have any unerupted teeth. They are easily visible on routine dental radiographs. So at the very least, if you decide not to get your impacted wisdom teeth removed, you should have them evaluated by your dentist or surgeon at least every 2-3 years to make sure they do not progress to a diseased state. This evaluation should include an x ray to make sure no problems are arrising. 

Hope that helps

How many doctors, nurses, anesthesiologists and other people are in the room during one of these surgeries, and do things always stay professional?

Asked by davidteschel almost 10 years ago

Bare minimum - 1 surgeon, 1 anesthesiologist, 3 nurses (scrub tech, surgical assistant, OR circulator) =  5 minimum. Aside from the surgeon you have pass off if the case is long (people take each others places) so you can get rotating personel. 

In a teaching hospital those numbers are inflated. You will have 1 attending surgeon + 1 or 2 residents. 1 anesthesia resident with a presiding anesthesia attending who may or may not be in the room but is nearby. There are usually still 3 nurses. 

Things for the most part stay professional but as in any workplace you can get a clash of attitudes, personalities. Situations can get tense and things can get heated. Problems can be started by nurses and doctors alike. Its not really like the olden days anymore where the surgeon gets all out command and dictatorship. I think there is no question who is in charge when things go sour but surgeons can't really bully everyone around like they used to. 

How many years has it been since this surgery became what you would consider "routine", and is it possible that there may be unexpected complications in old age that aren't known yet because it's not THAT old a procedure?

Asked by V.A.T. almost 10 years ago

I am not sure which procedure you are referring to? We do a vast array of surgeries ranging from emergent due to airway compromise from an infection or bleeding into the airway to elective cosmetic and orthognathic procedures. 

Was your residency similar to what regular surgeons go through?

Asked by bigseac@hotmail.com almost 10 years ago

Sorry for the hiatus....

It is a different residency program but with some overlap. Remember that there are all types of surgeons and they all have some core overlapping principles. By "regular surgeon" I am going to assume you mean General Surgeon. General Surgery is a residency that lasts 5 years from start to finish. Oral and Maxillofacial Surgery is 4 years of residency training. Remember, though, that oral surgeons went to dental school, not medical school. Roughly half of the oral surgery residency programs actually send you to medical school for 2 years (last two years) in the middle of the residency to get your medical degree. For those programs, it takes 6 years to complete the training (4 years of residency with 2 years of medical school in the middle). 

Now there is overlap with General Surgery in that you rotate through general surgery department during your residency training. Each program has varying amounts of time spent on general surgery but is typically 1-2 years. 

How do you "practice" jaw surgery? With cadavers or mostly as an assistant to a more senior surgeon during actual surgeries?

Asked by Grassi.M almost 10 years ago

It is very much like a trade or a craft. When you start out, you basically watch the attending and chief resident do the operation. You hold retractors and help out when you can. Eventually they start letting you do minor tasks (place screws, close wounds, minor dissections etc). Between that and the procedures that you do routinely in the clinic you develop a surgical skill set. Cadaver dissection courses are taken yearly and are about 2 days long but this is more for anatomy then surgical technique. As your years in training go by you get to do more and more and by the time you are a chief resident you do basically the entire operation. 

Do you remember when Anquan Boldin got his jaw shattered and was back on the field 3 weeks later? (http://goo.gl/MLSa6d) How is that possible? When my brother had routine jaw surgery, he couldn't do anything active for like 3 months?

Asked by AB over 9 years ago

So I guess answering this question late makes it more relevant since Geno Smith is now in the picture... 

From the article it looks as if Boldin fractured his maxillary sinus. People use the term Jaw so loosely. Typically it refers to the chewing portions of the mouth and the associated bones. This would be the mandible and the maxilla. While the maxillary sinus is part of the maxilla it is not really a chewing portion... nevertheless... the maxillary sinus is an extremely thin bone (we are talking less than a mm) and is extremely easily fractured. In fact, it is one of the more common fractures I see in the emergency department. Most of the time we don't even do anything to fix the fracture. We simply tell the patient to not blow their nose, suck on straws or do anything that will put increased pressure into their sinus. We give them antibiotics and let them return to their activities after a couple weeks. Now if the sinus fracture is associated with other facial bones like the zygoma, orbital floor, nasal bone, etc... that is a different story. So with that said... I am not sure... I certainly can't imagine a scenario where boldin actually required 7 plates and 40 screws... there isn't that much real estate on the maxillary sinus, but its the media so who knows.

Geno smith had a mandible fracture in 2 places (again a common fracture pattern). This required legitimate surgery with a few plates I imagine and actually requires a few months on the sidelines as the fracture is very susceptible to not healing if he over does it.

I am 27 yrs old, not a smoker, my lips are 100% natural. For the past two weeks, my lips have been getting smaller daily, major volume loss, shape change, and drooping on both sides (but one side much greater). What disease/disorder could cause this?

Asked by Feli about 6 years ago

I have suspected erosive oral lichen planus. I had a biopsy, but they didn't take samples of the ulcerative section. They just did the very outer section that is white. Is this normal?

Asked by Jim Kent almost 6 years ago

I was wondering i have a broken tooth on the right lower back and it's warped around to layer of bone and one is my jaw bone will the surgeon have break my jaw or can he get it without doing so thank you for answering

Asked by Darren over 7 years ago

Have a spot on tip on left tongue

Asked by Robert k over 6 years ago

I had double jaw surgery 2 years ago to fix my underbite, and my face looks very unattractive now. I hardly receive compliments on it. I want to go back to my original face, but keep my improved bite. What else can I do?

Asked by Jo about 8 years ago

I had oral surgery to correct my bite in feb 2010 and developed an oral/nasal fistula (a quarter sized hole in the roof of my mouth), a crack in my rt orbital socket, and a deviated septum. 3 yrs of numerous surgeries etc to kinda fix..is this normal

Asked by Tracy over 8 years ago

I had bone graft (mine & cadaver) placed on lower jaw for implant of tooth #19. After 3 months surgeon placed implant. Graft partially separated when implant placed so he closed the gum over a short implant, said it will all heal. Will implant fail?

Asked by Gracie almost 7 years ago

Hi! I have short maxilla I think according to a doctor I consulted with in Korea. Is this rare? Would the average maxillofacial surgeon be able to fix this. Research online makes it sound rare and difficult but he said it’s a simple and easy fix. Ty!

Asked by Andrew over 3 years ago

Why there is a small white spot on my tongue after having had a biopsy?

Asked by Vito over 4 years ago

I had a biopsy done on the side of my tongue.
after a week there is a white spot at the place of the biopsy. Is it normal or not?
Thank you

Asked by Vito over 4 years ago

During BSSO of the mandible for hemimandibular hyperplasia, can the screws and the plate on the side of the mandible being stretched be placed bellow the alveolar nerve instead of above toward the top of the mandible? What are the consequences?

Asked by A.Moose about 7 years ago

I had my upper left wisdom tooth out on Thursday and now my left nostril is sore. Is it part of the oro-antral communication they say I have and are hoping will close up. Or is it infected?

Asked by Anna almost 7 years ago

20 years ago I had a car accident that caused total mouth tooth loss and a dislocated jaw , I’m having lots of denture problems as well as asymmetrical facial appearance and frequesntly have headaches and jaw pain. Is this something I could
Correct ?

Asked by Cassie about 4 years ago

Had triple wisdom tooth extraction nearly 72 hours ago. 2 extraction sites have clotted and are healing fine. My lower left, however, is still bleeding through a 2x2 in 20-30 minutes. My surgeon keeps telling me this is normal? I'm concerned.

Asked by Cassie83 about 6 years ago

I have a small underbite and it has been giving me tmj problems for the past four years, and giving me headaches all the time now. I dont want to wear mouth guards but I want to fix my underbite but would it help my TMJ if I get the surgery?

Asked by Natalia over 9 years ago

I was diagnosed Atypical Odontalgia 8 yrs ago tho I've had nerve pain around impacted tooth 38 for many yrs. Recent CT shows flattened mandib. canal between fused roots & buccal cortex. Cud this be pressing in on the IAN or is flat M.C. normal ?

Asked by Colette about 7 years ago

Will having both jaws broken and rotated clockwise and the upper moved slightly up change your face aesthetically? My surgeon said I will look the same but I’m afraid.

Asked by Montika over 5 years ago

Hi there,Is it possible to increase the chin length by surgery to look face and chin longer from frontal view?,not just with implants if yes;I mean any method of maxilary surgery like using distractors, I got so much thanks if you have an answer

Asked by Pourya.arabi89@gmail.com almost 6 years ago

My 13 yr old son is Dx with JIA. Has been on Methotrexate for almost 2 years. Had 2 MRIs done, the 2nd showing less inflammation than the first, but still some. They want to give him Humira and I don’t want that. Is arthrocentesis/plasty an opt?

Asked by Dave F about 5 years ago

Hi there, is it possible to have maxillary excess without lip incompetence? I have a gummy smile but I don't think it's due to a hypermobile lip as when I smile with my teeth my facial proportions look "off"

Asked by James about 7 years ago

What is the most intresting part of your job?

Asked by Sam over 5 years ago

In 2008 I had a dental implant on the upper right. 3 yrs ago I had all my upper teeth removed but he left the titanium screw. It came loose last nite & I took it out all offices are closed. Do I have any worries?

Asked by Beth Sargent over 5 years ago

Hello,
I'm having bimax and my biggest concern is unwanted vertical changes. My gum show is good now. Will forward maxillary movement in the approx 6mm range give me a gummier smile? Should surgeon perform a mild impaction to account for this?

Asked by Ken over 7 years ago

that first q on the side cracks me up because my jaw got broke cause some guy sucker punched me with brass knuckles and I still beat his ass lol any my jaw got a absess on it after my wires came off can this also be because of ingrown facial hairs

Asked by Brandon almost 6 years ago

What was the reason you chose to become an oral and maxillofacial surgeon? What motivated you? Thanks

Asked by Fresh about 8 years ago

This is an image of my condyles. Do you see any bone loss such as flattening or erosion of them? If so, how does this affect my bite? https://ibb.co/bBqOcK

Asked by Tatyana over 5 years ago