Oral and maxillofacial surgery, also known as cranio-maxillo-facial surgery or MKG for short, aims to heal injuries, malformations and diseases of the face and mouth, usually by means of surgical procedures. This ranges from minor maxillofacial procedures that can be performed on an outpatient basis, to closing cleft palates, to major, highly invasive procedures, such as reconstructing facial and jaw bones after serious accidents. Plastic surgery procedures to be performed in the facial area, commonly called “cosmetic surgery,” also fall into this area.
What is oral and maxillofacial surgery?
Oral and maxillofacial surgery aims to heal injuries, deformities and diseases of the face and mouth, usually by means of surgical procedures. The oral and maxillofacial surgeon must be licensed in both dental and human medicine and undergo several years of advanced training to become a “specialist in oral and maxillofacial surgery“. This enables him or her to perform complicated surgeries in the facial area, which may include the patient’s teeth and jaws. An aspiring MKG surgeon must be able to demonstrate extensive experience in the operating room. In addition, he or she stands out for his or her extended collaboration with colleagues in neighboring specialties. This is necessary due to the proximity to organs such as the eyes (ophthalmologist), nose, throat and pharynx (ENT), brain (neurology), etc., whose treatment requires extensive consultation with the respective specialists. Especially in the facial and oral area, many clinical pictures and injuries are extremely complex and therefore require a particularly comprehensive approach by the treating physicians. Even for procedures on the skull that do not take place directly in the facial area, for example, for the treatment of a bony skull or after accidents, an MKG surgeon is usually part of the surgical team.
Function, effect and goals
In addition to treatment, the area of responsibility of MKG surgery also includes diagnostics. This includes early detection, for example, of tumors in the oral cavity, which can be done by simple brush biopsy, as well as modern imaging 3-D procedures and X-rays. Anamnesis, the in-depth discussion with the patient regarding his or her complaints, is also performed by maxillofacial surgeons. There can be misinterpretations by patients who misclassify radiating pain, for example, perceiving jaw pain as ear pain. Experienced maxillofacial surgeons can often make an accurate diagnosis because they are familiar with the complex interactions of symptoms and complaints in the oral, maxillofacial region. Cranio-maxillo-facial surgery is specifically designed to restore normal functions of the mouth and throat, such as swallowing, speaking and chewing. Impairments in these areas can result from independent pathologies as well as be consequences of completely different surgeries, such as tumor removal. Aesthetic reconstruction is also a focus. It is intended to enable patients with severe syndromes, diseases or after accidents to lead a normal everyday life as far as possible. Especially in the face and mouth area, deformities can hardly be concealed and lead to an enormous psychological burden for those affected. For this reason, interventions to correct malformations in the facial region that do not represent any functional impairment of the organism are also beneficial to the psychological well-being of the patients. Frequent interventions concern cleft lip and palate, which is one of the malformations with the highest prevalence in newborns. Surgeries and treatments include procedures on bones, joints, as well as soft tissues, such as the posterior soft palate, salivary glands, and internal cheeks. In addition, maxillofacial surgeons may also perform purely dental procedures, such as the removal of wisdom teeth or the placement of dental implants. Complaints whose treatment falls into the areas of sleep medicine or inflammatory processes can also lead a patient to an oral and maxillofacial surgeon, although this does not correspond to the intuitive understanding of medical laypersons. General practitioners or dentists are often consulted for this purpose. However, depending on the case, an oral and maxillofacial surgeon may be able to make a more reliable and rapid diagnosis and weigh up the need for surgical intervention.Jaw malpositions, malformations of the nose and in the palate area can be the cause of sleep disorders and can be eliminated by the maxillofacial surgeon. Inflammatory processes, which can develop into abscesses, are possible consequences of infections of the mucous membranes, especially in the mouth and facial area. Here, too, oral and maxillofacial surgery can make a comprehensive diagnosis and decide whether conservative therapy, i.e., medication, is sufficient or whether inflammatory tissue must be surgically removed.
Risks, side effects and dangers
Surgical procedures in oral and maxillofacial surgery always take place on or in the skull and thus near the brain, eyes and other organs. General risks of surgery – postoperative inflammation, bursting of sutures, etc. – thus represent an increased risk. Wound infections that break out near the brain and can therefore easily affect it are particularly dangerous. Possible swelling of surgical wounds can also take on life-threatening forms in the throat area, if the swelling goes so far as to block the airways. The mouth and throat area is also a possible entry point for pathogens into the organism, which further promotes inflammation. Close monitoring of patients after cranio-maxillo-facial surgery is necessary, and the procedure is usually followed by a few days of stay in the intensive care unit. In case of complications, surgery may have to be performed again. The work of maxillofacial surgeons must always be in exchange with colleagues of adjacent specialties. This requires a high degree of professional interaction. Maxillofacial surgeons must always take into account the professional opinions of colleagues in other medical fields, which generally protects the patient but also harbors the potential for conflict in the event of differing opinions. This is the same in other areas of medicine, but oral and maxillofacial surgery exacerbates this problem because of its particular complexity.
