Textbook of Oral and Maxillofacial Surgery Neelima Anil Malik
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1Principles of Oral and Maxillofacial Surgery
  1. Introduction to Oral and Maxillofacial Surgery
  2. Art of Diagnosis
  3. Diagnostic Imaging
  4. Management of Medically Compromised Patients in Oral Surgery
  5. Armamentarium Used in Oral and Maxillofacial Surgery
  6. Suturing Materials and Techniques
  7. Asepsis and Sterilization
  8. Infection Control
  9. Antimicrobial Therapy
  10. Minor Oral Surgical Procedures
    2

Introduction to Oral and Maxillofacial Surgery1

 
Definition
Oral and Maxillofacial surgery is a branch of Dentistry, that deals with the art of diagnosis and treatment of various diseases, injuries and defects involving the orofacial region.
Other specialities dealing with the cranio- oromaxillofacial region include the Plastic surgery, Neurosurgery, ENT surgery and Ophthalmology etc. Although, there is a considerable overlapping between these branches, in the past few years, a definite delineation has been made among each of these specialities. The Oral and Maxillofacial surgeon has carved a special niche in the multidisciplinary approach to craniofacial pathologies.
The field of Oral and Maxillofacial surgery has evolved through the ages. From extracting teeth by tying a thread around the tooth to refined techniques of today, the field has come a long way. Andre Fouchard is considered to be the father of dental surgery. Pioneers like Lister in the practice of asepsis, Wells in the introduction of anaesthetic techniques, Bell in the field of Orthognathic surgery, Gillie and Champy in the treatment of fractures have established a scientific basis to oral and maxillofacial surgical procedures. It is to them, we owe the modern day practice of Oral and Maxillofacial surgery.
 
Scope
The scope of Oral and Maxillofacial surgery depends on the qualifications and capabilities of the person. There is a definite distinction in the case selection for an undergraduate, trained in oral surgery, and a postgraduate, trained in Oral and Maxillofacial surgery and for cases that require multidisciplinary approach.
Oral and Maxillofacial surgery essentially deals with the treatment of the following conditions;
  1. Simple and complicated extractions of teeth and related management.
  2. Treatment of cysts and tumours of both odontogenic and non odontogenic origin, involving the jaw bones.
  3. Management of disorders of maxillary sinuses.
  4. Initial and definitive management of traumatic injuries of soft and hard tissues of orofacial region.
  5. Temporomandibular joint disorders including internal derangement and ankylosis.
  6. Salivary gland diseases and their management.
  7. Diagnosis and management of Dentofacial deformities, either acquired, developmental or congenital (including clefts of the lip and palate).
  8. Management of orofacial infections involving the soft and hard tissues.
  9. Pre-prosthetic surgical procedures including implantology.
  10. Precancerous lesions such as, oral submucous fibrosis and leukoplakia.
  11. Detection and management of oral cancer.
  12. Management of orofacial pain.
  13. Reconstruction of missing portion of jaw bones with bone graft/distraction osteogenesis.
  14. Detection and management of facial neuropathy.4
An undergraduate trained in oral surgery is expected to deal with simple exodontia, complications arising from routine extractions like, tooth/ root fractures, tissue laceration, post extraction bleeding, minor post extraction infections, immediate management of medical emergencies in the dental office and minor surgical procedures like apicoectomy and alveoloplasty.
A postgraduate student in Oral and Maxillofacial surgery deals with both the out patient department cases as well as the patients admitted in the indoor ward. Beginning with complicated exodontia, the postgraduate program gradually trains the student to become a full fledged Oral and Maxillofacial surgeon, capable of handling the various pathologies of the face and the jaw bones.
 
Multidisciplinary Team Approach
 
Cleft Lip and Palate
The oral and maxillofacial surgeon forms an important part of the cleft lip and palate management team, that comprises of the plastic surgeon, the paediatric surgeon, the orthodontist, the pedodontist, and the speech therapist. The oral and maxillofacial surgeon plays an important role in the primary as well as secondary closure of the palate, as well as in the correction of residual deformities of the maxilla and the mandible at a later stage.
 
Craniofacial Syndromes
The oral and maxillofacial surgeon also forms a part of the core group, consisting of neurosurgeon, plastic surgeon and ENT surgeon involved in treating craniofacial abnormalities, especially syndromal, like Crouzon's syndrome or Goldenhar syndrome etc.
 
Trauma Unit
The oral and maxillofacial surgeon is also involved in the trauma unit along with orthopaedic surgeon, general surgeon and plastic surgeon.
The oral surgeon, thus, forms an important link between the various specialities in the treatment of craniofacial pathologies.
 
Newer Advances
The field of oral and maxillofacial surgery is constantly evolving and adapting newer techniques, to refine the surgical procedures, and to achieve precision with minimally invasive techniques. One such technique that has revolutionized the treatment of facial deformities is Distraction Osteogenesis. The technique deals with the elongation of the bone by gradual callus distraction.
It is extremely difficult to outline the scope of a subject, where there is a constant adaptation with the introduction of research based technology and techniques. The students are advised to keep themselves updated with new literature on the subject.