Cosmetic oral and maxillofacial surgery

The dental specialty of oral and maxillofacial surgery over the last fifteen years has been intimately involved in not only altering the bony facial skeleton, but also the esthetic defects of the facial soft tissue drape. These procedures are currently being taught, in many of our residency programs, along side the art and science of dentoalveolar surgery. When one combines the modification of both the skeletal and soft tissues, the resultant effect can be greater than the sum of its parts. Should one take this a step further and add to the list, proper arch form as prepared by the orthodontist along with cosmetic shape and appearance of the dentition by the restorative dentist using the latest in cosmetic dental techniques, what transforms is a result that has never been seen heretofore in the annals of dentofacial care. To follow are a number of case reports illustrating some salient points.     

Piezosurgery in oral and maxillofacial surgery

This review summarizes current knowledge and experience with piezosurgery, a promising, meticulous and soft tissue-sparing system for bone cutting, based on ultrasonic microvibrations. The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient and protection of tooth structure. To date it has been indicationed for use in oral and maxillofacial surgery, otorhinolaryngology, neurosurgery, ophthalmology, traumatology and orthopaedics. The main indications in oral surgery are sinus lift, bone graft harvesting, osteogenic distraction, ridge expansion, endodontic surgery, periodontal surgery, inferior alveolar nerve decompression, cyst removal, dental extraction and impacted tooth removal. In conclusion, piezosurgery is a promising technical modality for different aspects of bone surgery with a rapidly increasing number of indications throughout the whole field of surgery.     

Lasers in oral and maxillofacial surgery

Because of their many advantages, lasers have become indispensable in OMS as a modality for soft tissue surgery. Based on manufacturer estimates, approximately 10% to 20% of all oral and maxillofacial surgeons have one or more lasers in their offices, and most surgeons have access to lasers in the hospital. Lasers not only enhance the current surgical options for treatment, but also have expanded the scope of practice. There are many uses for lasers in OMS, and the advent of new wavelengths will undoubtedly lead to new procedures that can be performed with them. One [figure: see text] elusive use is hard tissue surgery. Although the Er:YAG has been approved for hard tissue use in the United States and currently is being used in general dentistry, it is still not yet practical or proven for large-volume osseous or extraction surgery, in which the greatest opportunity for innovation and clinical use exists. With future research, it is possible that the right wavelength laser will be developed for this purpose, allowing an increased base of procedures performed with lasers in OMS.     

Stereotactic navigation in oral and maxillofacial surgery

Navigation is an adjunct to existing surgical procedures. It is potentially useful in any procedure where it is possible to make a three-dimensional surgical plan from computed tomography (CT) or magnetic resonance imaging (MRI) data, but is not easy to translate this plan into surgical reality because of absolute limitations of access or lack of anatomical landmarks.     

Computed tomography in oral and maxillofacial surgery

The use of computed tomography (CT) in oral and maxillofacial surgery is discussed. The CT scan delineates lesions in the oral and maxillofacial complex to aid in planning of surgical treatment. Case examples are presented, and the indications for the use of CT scanning are discussed.     

Arteriography in oral and maxillofacial surgery.

A brief review of the methodology of selective external carotid arteriography is presented together with its risks, complications, and contraindications. The indications for this procedure are described with illustrative case material to demonstrate its usefulness in both diagnosis and preoperative evaluation of various types of lesions of the head and neck that may be encountered in the practice of oral and maxillofacial surgery.     

Image-guided navigation in oral and maxillofacial surgery

Image-guided surgery is the logical extension of imaging as it integrates previously acquired radiological or nuclear medicine images with the operative field. In conventional image-guided surgery, a surgeon uses a surgical instrument or a pointer to establish correspondence between features in the preoperative images and the surgical scene. This is not ideal because the surgeon has to look away from the operative field to view the data. Augmented reality guidance systems offer a solution to this problem but are limited by deformation of soft tissues. Real-time intraoperative imaging offers a potential solution but is currently only experimental. The additional precision and confidence that this technology provides make it a useful tool, and recent advances in image-guided surgery offer new opportunities in the field of oral and maxillofacial surgery. Here, we review the development, current technologies, and applications of image-guided surgery and illustrate them with two case reports.     

Lasers in contemporary oral and maxillofacial surgery

The practice of oral and maxillofacial surgery has included the use of lasers since the 1960s. Over the past few decades, the use of lasers among oral and maxillofacial surgeons has grown dramatically. Their evolution within the specialty not only has enhanced current surgical options for treatment, but also contributed to a variety of new procedures that are now commonplace in oral and maxillofacial surgery. The management of patients with sleep apnea, temporomandibular joint derangements, dental implants, premalignant lesions, and posttraumatic facial scarring has improved significantly with the advent of laser surgery. As the number of laser systems grows and their technology becomes more advanced, a thorough understanding regarding the principles of their use is paramount to providing safe and effective patient care.     

Infrared thermography in oral and maxillofacial surgery

A highly sensitive infrared thermographic camera was evaluated in a variety of physiologic and pathologic conditions associated with the head and neck. Although it may have clinical applications, particularly in the field of facial pain and the temporomandibular joint, such wide variations in normal values were noted that any standardization was extremely difficult.     

Regenerative nanotechnology in oral and maxillofacial surgery

Regenerative nanotechnology is at the forefront of medical research, and translational medicine is a challenge to both scientists and clinicians. Although there has been an exponential rise in the volume of research generated about it for both medical and surgical uses, key questions remain about its actual benefits. Nevertheless, some people think that therapeutics based on its principles may form the core of applied research for the future. Here we give an account of its current use in oral and maxillofacial surgery, and implications and challenges for the future.     

Risk management in oral and maxillofacial surgery

The goal of risk management in the oral and maxillofacial surgery practice is to reduce the risk of care rendered to patients. Of all the elements of risk management, communication and documentation are two of the most important. Ensuring that a patient is truly educated about all facets of procedures to be performed and thoroughly documenting all aspects of the care that is rendered can greatly reduce the risk of claims. Oral and maxillofacial surgeons should practice these principles regularly and not wait for a claim to occur to teach them their benefits.