We have an emphasis on TEMPOROMANDIBULAR JOINT (TMJ) SURGERY.
Surgical Management of the Temporomandibular Joint
What are Temporomandibular Disorders (TMDs)?
Temporomandibular disorders are a common problem occurring in most people at some stage during their lifetime. Most of these problems resolve without significant intervention with correct diagnosis and treatment advice. Common symptoms can be facial pain, headaches, jaw clicking, grating and limited mouth opening.
Procedures Involved in the Treatment of TMJ Disorders
- Arthroscopic surgery
- Arthroplasty involving disc repositioning, adhesiolysis and bone anchors
- TMJ Total joint replacement
For more detailed information regarding these, please click here.
Wisdom Teeth Surgery
What are wisdom teeth?
Wisdom teeth, also known as third molars are teeth furthest to the back and last to erupt into the mouth and are more than often non-functioning teeth. There are many theories as to why we have these teeth but none of these are proven. We do not need wisdom teeth to function properly.
Figure: Impacted third molars which are impossible to clean
Why remove wisdom teeth?
Often these teeth are impacted against the adjacent tooth leading to difficulty with cleaning. Gum disease, decay and infection can arise if these teeth are left alone and in some circumstances, these infections can be life threatening.
How are wisdom teeth removed?
More than often, removal of third molars necessitates a surgical procedure. Under a local anaesthetic (you are awake but the area is numb), IV sedation or general anaesthetic (near sleep or completely asleep) your surgeon will raise a "flap" to access the underlying bone and tooth.
Bone removal and the tooth division are often needed for safe extraction. Once the tooth is removed, stitches are placed to maintain the integrity of the soft tissues inside your mouth. These are often self-resorbing and eventually fall out several weeks later once the incision is healed. The details will be discussed with you at the time of your consultation.
Figure: Diagramatic explanation of a possible thrid molar extraction
What are the main risks of the procedure?
All patients will invariably have a degree of pain after the procedure. However, with good anaesthetic techniques and medications, post operative pain can be minimized and you can achieve excellent comfort levels after your surgery.
Standard medications will include a combination of Paracetamol and Ibuprofen in most instances with substitution of these when necessary. Further analgesia can be achieved with opioids such as Codeine only if required. The side effects of these medications must always be considered when prescribing. Your surgeon will discuss this with you at the consultation and on the day of surgery.
Pre-operative analgesics are also prescribed for added benefit.
A small number of patients will have injury to the dental nerves leading to numbness of the tongue, chin or lip during lower wisdom teeth extraction. These numbers range from 1% to 5% depending on many factors. Some of these include the tooth location, degree of difficulty, age of the patient and surgeons skill level.
Most injuries are transient and are due to slight “bruising” of the nerve. In very rare circumstances these injuries can be permanent. However, these injuries will not affect functionality such as chewing or smiling. Your surgeon will discuss this at your consultation.
Post-operative bleeding can occur and in most instances, only a trickle of fresh blood will be seen. This is rarely life threatening. Potential causes of post-operative bleeding can be due to poor surgical technique, an increase in blood pressure or an undiagnosed bleeding disorder. Significant post-operative bleeding in large volumes is a rare event. However, if this occurs, seek immediate advice from your surgeon or present to your nearest hospital emergency department.
Swelling is a normal reaction of trauma to the body. This often occurs in the cheeks after wisdom teeth removal. We can minimize this with cold packs and anti-inflammatory medications. Swelling will last for 2 to 5 days in most instances and will naturally resolve with time. During this period you may have a “chipmunk look”. In most instances, this is normal and does not imply an infection is present. If you are concerned, please discuss this with your surgeon during the post-operative period.
Unfortunately, a low rate of infection does occur with wisdom teeth removal . This is in the realms of less than 5% of cases. Treatment is with antibiotics, surgical drainage or a combination of both depending on severity. Some signs can be fever, extreme pain, significant swelling and severe limitation of mouth opening. If there are any issues, please discuss this with your surgeon before and after your procedure. Other rare complications can include:
- osteomyelitis (bone infection),
- jaw fracture,
- damage to adjacent teeth
We will endevour to do our best to avoid all these complications with meticulous attention to detail before, during and after your surgery.
Some patients are born with smaller or larger than normal jaw bones which can interfere with their oral function and also their appearance. The oral and maxillofacial surgeon is in an ideal position to treat these being trained in both dentistry and medicine. Moving the position of the jaw bones are unique to our speciality due to our understanding of the facial structures including the dentition.
Depending upon the diagnosis, an oral and maxillofacial surgeon can choose to move the mandible(lower jaw), the maxilla(upper jaw) or both.
The usual treatment regime involves a duration of orthodontics in the first instance to straighten and align the teeth followed by jaw surgery and then a shorter period of orthodontics to help refine the dental occlusion(bite). Treatment time is typically between 18 months to 2 years.
Schematic diagrams to demonstrate how jaws can be moved
Facial Trauma Surgery
Having a background in both dentistry and medicine places the Oral and Maxillofacial Surgeon in the perfect position to treat facial trauma. Most facial trauma is undertaken in an acute public hospital setting. Injuries can range from small cuts and lacerations to multiple facial fractures.
Today, advanced techniques with 3D imaging, hidden incision lines to minimise visible scarring, titanium plating systems and biomodelling lead to optimal aesthetic and functional outcomes in facial trauma surgery. All Maxillofacial Surgeons at CDHB have access to these systems at Christchurch Public Hospital which are the most advanced systems available in Australiasia for treating facial trauma.
Figure 1: A left cheekbone fracture in multiple pieces after an industrial accident.
This patients vision was threatened by this injury.
Figure 2: The same patient above after an extensive procedure repairing
his eye socket and cheek bone with multiple plates and screws.
Figure 3: A 3D model generated from a 3D printer used to assess
and treat an eye socket fracture.
Figure 4: Intra-operative imaging is used to assess the degree of bone alignment
whilst a patient is asleep to minimise the need for revision surgeries.