ADVANCED MAXILLOFACIAL SURGERY
A- ORTHOGNATHIC SURGERY, BIMAXILLARY OSTEOTOMY:
These are surgical procedures performed when the patient's maxillofacial appearance needs correction, when the jaws are not compatible with each other or when the teeth are not compatible with the jaws. In these treatments, it may be necessary to get support from an orthodontist. The need for treatment is determined by performing various analyses about the structure of teeth, jaws, and face. Although first the surgical procedure and then orthodontic procedure can be performed in this kind of treatments when necessary, but mostly the teeth are firstly corrected by orthodontic treatment and then the jaws are surgically repositioned. These procedures not only improve the facial appearance, but also ensure the compatibility and proper functioning of the teeth, thereby making a positive contribution to the patient's chewing and speaking, along with improved aesthetic appearance and increased self-confidence. In other words, they provide both aesthetic and functional improvement.
In general, patients notice problems with the closure of their teeth and the disorder in their appearance. In such cases, the upper or lower jaw is often located in an anterior or posterior position. Sometimes, when viewed from the front, there is an asymmetrical appearance. In some patients, although there is no apparent discomfort, there is a functional problem such as biting problem. In both cases, chewing and eating disorders arise as the teeth do not fully close.
It is possible to correct this problem in the jaws with advanced surgical methods, depending on the severity of the case, with surgical procedures performed on a single chin or double chin. In case of any bone growth and bone protrusions, these types of abnormal developments are corrected by surgical procedures.
B- MAXILLOFACIAL PAIN: TRIGEMINAL NEURALGIA
Trigeminal neuralgia is characterized by intense, stabbing, electric shock-like pain felt in the face, usually on its one side. The pain usually begins with a triggering factor such as eating, drinking, touching, talking, or washing the face. In trigeminal neuralgia, patients usually tend to think that their complaints are caused by teeth. In patients with trigeminal neuralgia, it is usually seen that the tooth or teeth in the relevant region are treated with root canal treatment and even extracted. This situation both causes unnecessary and wrong treatment of the patient's healthy teeth and delays the diagnosis of Trigeminal Neuralgia (TN). Early diagnosis and treatment of TN is of big importance. Anticonvulsant drugs such as carbamazepine and phenytoin are widely used in the treatment of the disease. Drug therapy cannot cure TN completely, but only has a symptomatic effect in the form of reducing pain during the time the drugs are used. It can also be treated with interventional treatments such as cryotherapy and Peripheral Alcohol Blockage. In recent years, botulinum toxin A (botox) injection has been used for the treatment of TN. Studies have shown that botox has very positive results on trigeminal neuralgia.
MIGRAINE
Migraine is a throbbing headache that is often accompanied by nausea, vomiting, and extreme sensitivity to light or sound. Although the exact cause of migraine is not known, it is considered that genetic or environmental factors play a role in occurrence of the migraine. Medicines used in the treatment of migraine can help to eliminate pain during headache attacks or to stop accompanying symptoms such as nausea and vomiting, or to control the frequency of frequent headache attacks.
Botox treatment, which is also used in the field of aesthetics, is among the new-generation treatment methods. The indication that migraine-related headaches decreased in patients who got botulinum toxin (botox) treatment for the purpose of eliminating facial wrinkles, led to the use of botox in the treatment of migraine. Botox blocks the chemical transmitters that trigger pain, by being released from sensory nerve endings in people with chronic migraine. As a result of the prevention of the release of these chemical transmitters, the pain pathways reaching the central nervous system from the nerve endings under the skin cannot be activated and the pain is controlled before it reaches the brain.
In the treatment of migraine, botox is applied by injecting botulinum toxin into certain points on the forehead, temples, nape and neck regions with a subcutaneous injection. Since the effect of the treatment will last for about 3-4 months, the application should be repeated.
Botox injection takes about 5-10 minutes. In order to prevent the spread of botulinum toxin after the procedure, it is recommended that you do not tilt your head and not rest in a horizontal position for two hours. Chronic migraine patients should not take a hot shower on the application day of Botox. The Botox treatment becomes effective within 4-10 days. Although rare, adverse effects such as swelling, redness and sensitivity may occur. Ice compression during the application can prevent swelling and pain. Rarely, temporary weakness of the upper eyelid or asymmetry of the facial muscles may occur.
MUSCLE AND JOINT ACHES
Detailed information on this subject is presented in our ‘temporomandibular joint disorders’ section.
There may also be pain in the maxillofacial region due to other reasons. The differential diagnosis should be made completely, and treatment should be done with the correct diagnosis. For example, pain caused by sinusitis can be misdiagnosed as toothache. Pain caused by jaw joint can be misdiagnosed as ear pain. Or in swallowing and sore throat problems, eagle syndrome can be neglected.
MANDIBULAR FRACTURES:
Treatment of mandibular fractures is possible and frequently occurs as a result of a blow to the jaw. When a mandibular fracture occurs, a maxillofacial surgeon should be consulted immediately. The maxillofacial surgeon restores, aligns, and fixes the fractured parts in the correct spot using wires, plates, screws, prostheses, or special splints to fuse them together:
TEMPOROMANDIBULAR JOINT DISORDERS: A Temporomandibular Joint (TMJ) Surgery is a Top-Level Maxillofacial Surgery Procedure.
ANATOMY OF THE TEMPOROMANDIBULAR JOINT
The temporomandibular joints are located in front of the ear. It is a component of the mandible and connects the lower jaw to the skull.
It is a synovial joint, meaning it joins the bones and allows for movement. The bony components of the joint are the temporal bone and the condyle (rounded upper end of the lower jaw). A synovial fluid lubricates and nourishes the joint. A cartilaginous disc separates the two bones of the joint. This disc buffers the joint and allows smooth movement of the jaw during eating and speaking.
Symptoms of TMJ disorders include:
The most important finding in TMJ disorders is pain. Pain may be felt in the joint or jaw muscles when chewing, biting, speaking or yawning. These symptoms can arise from a variety of conditions. Anti-inflammatory and muscle relaxant medications help relieve pain. Difficulty in opening or closing the mouth or restricted jaw movement is another finding. All TMJ fractures indicate this symptom.
Another common symptom of this temporomandibular disorder (TMD) is a popping sound and clicking sensation occurring during a joint movement.
Symptoms such as neck pain, dizziness, earache, tinnitus or headache may occur in TMJ problems. Differential diagnoses for these symptoms are very broad. Cervical spondylitis, joint disc problems in the spine, some middle ear diseases can also cause these symptoms.
Mandibular deflection during mouth opening and closing is a classic indication of unilateral fibrous ankylosis of the temporomandibular joint. Infection of the posterior teeth can be caused by trismus (spasm) of the chewing muscles and clenching habit.
The clinical examination takes approximately 35-40 minutes. After receiving the necessary information about health problems and oral diseases from the patients, the dental specialist tries to reach the diagnosis with a detailed examination including the temporomandibular joint and head and neck muscles. If necessary, MRI or other imaging methods can be used for diagnosis.
Jaw Joint (Temporomandibular Joint – TMJ) Disorders and their Surgical Treatments
• Intra-articular Injections
• Arthrocentesis
• Trismus
• Jaw Cracking
• Bruxism - Teeth Grinding and Clenching
• Jaw Pain
• Arthroscopy
• Open-joint arthroplasty
• Problems arising from fractures or bone-related causes
Arthroscopy, non-surgical treatments, temporomandibular joint surgery
First of all, the correct diagnosis is made and it is decided whether a surgical procedure is required to relieve the discomfort.
CASES WHERE TMJ SURGERY IS REQUIRED
If temporomandibular joint disorders cannot be treated with conservative or minimally invasive methods, they should be treated with surgical methods. Tumoural or cystic lesions in the mandible can involve the TMJ and cause extensive destruction of the bone. They require extensive resection after reconstruction. The patient's rib grafts are used for reconstruction together with titanium plates. Jaw reconstruction surgery is a very difficult surgical procedure. Only highly experienced surgeons can perform TMJ reconstruction surgery.
Tumoral or cystic lesions in the mandible can involve the TMJ and cause extensive destruction of the bone. Sometimes it requires extensive resection. Sometimes grafts taken from the patient's rib are used for reconstruction with titanium plates. Jaw reconstruction surgery is a very difficult operation. Only highly experienced surgeons perform TMJ reconstruction surgery. This is a variety of joint replacement surgery.
TMJ ANKYLOSIS SURGERY
TMJ ankylosis, which is one of the causes of inability to fully open the mouth, may be bony or fibrous ankylosis. It can also be unilateral or bilateral. Unilateral ankylosis causes the jaw to deviate towards the ankylosing side. Bilateral ankylosis causes severe limitation of mouth opening, and both speech and eating of the patient are affected. Early mobilization of the joint and exercises in the post-treatment period help the joint function and prevent reankylosis.
Correct diagnosis of the patient is the first step towards treatment.
Maxillofacial Aesthetics:
BOTULINUM TOXIN APPLICATIONS, FILLERS, NON-SURGICAL FACE LIFT
In maxillofacial aesthetics, wrinkles, asymmetries, and age-related facial problems are non-surgically improved with minimally invasive procedures.
The medical use of botulinum toxin began in the 1980s. Botulinum toxin injection is a short-term procedure, which takes approx. 5-10 minutes. In order to prevent the spread of botulinum toxin after the procedure, it is recommended that you do not tilt your head and not rest in a horizontal position for two hours. The Botulinum toxin treatment becomes effective within 4-10 days. Although rare, adverse effects such as swelling, redness and sensitivity may occur.
STEM CELL: To put it briefly, stem cells are the main cells that have the potential to turn into any cell in the body. Stem cells are mostly obtained from bone marrow and adipose tissue by filtering and separation under sterile conditions. As it is used in orthopaedics, it is also used to accelerate the tissue healing process in the temporomandibular joint.