Cleft Lip and Palate Orthognatic Surgery Facial Trauma Oral Pathology

Cleft Lip and Palate

Cleft means split or separation of parts. During early pregnancy, separate areas of the face develop individually and then join together. If some parts do not join properly the result is a cleft. The type and severity of clefts vary from child to child.

A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts.

What is a cleft palate?

The palate is the roof of your mouth. It is made of bone and muscle and is covered by a thin, wet skin that forms the red covering inside the mouth. You can feel your own palate by running your tongue over the top of your mouth. Its purpose is to separate your nose from your mouth. The palate has an extremely important role during speech because when you talk, it prevents air from blowing out of your nose instead of your mouth. The palate is also very important when eating. It prevents food and liquids from going up into the nose.

As in cleft lip, a cleft palate occurs in early pregnancy when separate areas of the face have developed individually do not join together properly. A cleft palate occurs when there is an opening in the roof of the mouth. The back of the palate is called the soft palate and the front is known as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).

Drs. Drs. Zajkowski, MacCarthy, Jacobsen, and Lawler are all on the Cleft Palate Team at Maine Medical Center. The team meets monthly and is composed of plastic surgeons, speech therapists, social workers, geneticists, orthodontists, prosthodontists, pediatric dentists, and oral and maxillofacial surgeons. As oral surgeons, we care for the child with clefts multiple times as they grow. We will close the hole from the mouth to the nose around age 8. We then can later perform jaw surgery in the late teenage years. Lastly, when the patient has finished growing we can place dental implants to help replace missing teeth.

Orthognatic Surgery

Orthognathic surgery is needed when jaws don’t meet correctly and/or teeth don’t seem to fit with jaws. Teeth are straightened with orthodontics, and then corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance but also ensures that teeth meet correctly and function properly.

Who needs Orthognathic Surgery?

People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and, in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health, and appearance. Injury to the jaw and birth defects can also affect jaw alignment. While orthodontics alone can correct bite problems if only the teeth are involved, orthognathic surgery may be required if the jaws also need repositioning.

Difficulty in the following areas should be evaluated:

Difficulty in chewing, biting or swallowing
Speech problems
Chronic jaw or TMJ pain
Open bite
Protruding jaw
Breathing problems
Clefts

Any of these can exist at birth or may be acquired after birth as a result of hereditary or environmental influences or, trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with X-rays. During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together.

Technology and Orthognathic Surgery

Our surgeons use modern computer techniques and three-dimensional models to show you exactly how your surgery will be approached. Using comprehensive facial X-rays and computer video imaging, we can show you how your bite will be improved and even give you an idea of how you’ll look after surgery. This helps you understand the surgical process and the extent of the treatment prescribed, and to see the benefits of orthognathic surgery.

If you are a candidate for Corrective Jaw Surgery, our surgeons will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.

To provide you with a better understanding of orthognathic surgery, we have provided the following multimedia presentation. Many common questions pertaining to orthognathic surgery are discussed.

Having trouble? Please make sure you have the Adobe Flash Player plugin installed in order to correctly view this presentation. This software is available as a free download.

Testimonial

Facial Trauma

Maxillofacial Trauma
Oral and Maxillofacial Surgeons are trained, skilled and uniquely qualified to manage and treat Facial Trauma. The doctors of Oral and Maxillofacial Surgery Associates are on staff at Maine Medical Center and provide emergency room coverage for facial injuries including:

Facial lacerations
Intraoral lacerations
Avulsed (knocked out) teeth
Fractured facial bones (cheek, nose, or eye socket)
Fractured jaws (upper and lower jaw)

Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.

The Nature of Maxillofacial Trauma

There are a number of possible causes of facial trauma. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries account for many. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face.

Bone Injuries of the Maxillofacial Region

Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the age and general health of the patient. When an arm or a leg is fractured, a “cast” is often applied to stabilize the bone and allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.

One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. However, certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small “plates and screws” at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique has profoundly improved the recovery period for many patients by allowing them to return to normal function more quickly.

The treatment of facial fractures should be accomplished in a thorough and predictable manner. Importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is “hidden”.

Injuries to the Teeth and Surrounding Dental Structures

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth, which have been displaced or “knocked out”. These types of injuries are treated by one of a number of forms of “splinting” (stabilizing by wiring or bonding teeth together). If a tooth is “knocked out”, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better for the survival of the tooth. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to “wipe the tooth off”, since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.

The proper treatment of facial injuries is now the realm of specialists, well versed in the emergency care, acute treatment and long-term reconstruction and rehabilitation of the patient.

Oral Pathology

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer.

The following can be signs of a pathologic process or cancerous growth:

Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth.
A sore that fails to heal and bleeds easily.
A lump or thickening on the skin lining the inside of the mouth.
Chronic sore throat or hoarseness.
Difficulty in chewing or swallowing.

Your dentist might see areas of concern on your radiographs (x-rays) and might refer you to our office for specialized 3D images to better determine what is going on inside your jaws. Not all of the lesions will need surgical intervention. If a procedure is needed then the specialized images will allow more precise approaches.

Major Jaw Surgery