Maxillofacial and Craniofacial surgery
Plastic surgeons are uniquely qualified and trained to handle the full spectrum of problems, ranging from developmental issues to the injuries affecting the facial skeleton and soft tissue.
Maxillofacial & Craniofacial Surgery,is a subdivision of Plastic surgery that deals with various reconstructive, aesthetic and corrective problems of the craniofacial skeleton and soft tissue. The shape of the face is determined by the underlying bony skeleton draped with soft tissue and skin. Variety of Dentofacial deformities either congenital, developmental or acquired affects both appearance and function, which include ability to eat, speak and breath normally. Plastic surgery is synonymous with facial cosmetic surgery, and with corrective skeletal surgery, much desired changes could be achieved. More often, the common problems associated with the region of mouth, jaw, midface,cheekbones, forehead etc. are related to trauma.
Maxillofacial Injury: Road traffic accident still remains a major cause of facial injuries resulting in minor to devastating facial bone fractures , skin and soft tissue rupture and loss. Major injuries are life threatening and involves serious compromise to airway and breathing requiring immediate attention. Restoring facial fractured bones in proper position and repairing soft tissue involves several hours of surgical procedures. This re-establishes dental occlusion, sound facture healing, facial features and ability of functions such as breathing, chewing, and speech.
Plastic surgery units across the country receive a large number of facial trauma and many include panfacial injuries. This include fractures of lower jaw(mandible), midface (maxilla, nasal bone, nso orbit), upper face (ftrontal bones) and lateral face (zygomatic bone). With the availability of 3D CT imaging, advances in osteosynthesis (plate fixation techniques) and anaesthetic management, high success is achieved even in devastating injuries. However, many do require secondary procedures, camouflage techniques and orthodontic management, improve overall outcome, both functionally and aesthetically.
Corrective Jaw surgery- Orthognathic surgery:
This involves surgery for tooth bearing segments of the jaw, for severe malocclusions with abnormal growth of the upper or lower jaw. Misalignment of jaw and teeth during development due to various reasons, leads to many problems such as disturbed dental occlusion, abnormal chin shape, etc. These can be corrected with orthognathic surgery or corrective jaw surgery, where lower and upper jaw can be moved front or back to give desired shape to face and provide normal tooth alignment or occlusion. The procedures such as genioplasty, bilateral sagittal split osteotomy of mandible, Le Fort osteotomy of Maxilla are some commonly performed. The similar surgical procedure is used to treat obstructive sleep apnea, a disorder affecting natural sleep.
Temeromandibular Joint Surgery: The lower jaw is connected to face with Temperomandibular joint situated in front of both ears and responsible for smooth mouth opening. Problems of mouth opening results in locked jaw or ankylosis particularly among children are corrected with surgery.
Severe deformities of facial bones are treated effectively by gradually moving the lower jaw, upper jaw or midface in a controlled fashion by this technique of craniofacial distraction. Custom designed appliances are used for this purpose. This helps in achieving desired results for severe under developed bone and soft tissue with minimal functional disturbances.
It involves correction of complex deformities of the skull and face and several reconstructive procedures of the skull vault. Abnormal head shape due to underdevelopment of certain skull bones or union between them (craniosynostosis), craniofacial clefts involving different regions of the face such as lip, nose, cheek eyelids is corrected in craniofacial surgery. It also involves correction of many abnormalities of face, orbit (eye socket), nose with again a complex surgical procedure, often in teams with neurosurgeons. These problems are mostly by birth affecting the mid face, cranial vault and cranial base. They are often associated with anomalies of other parts of the body, such as limb and collectively called craniofacial syndromes. Many known such s includes Crouzon syndrome, Apert syndrome, Feifferr syndrome , orbital hypertelorism, which are operated upon at an early age to accommodate normal brain growth. It is followed by a correction of facial and dental anomalies with skeletal growth. Several procedures performed include- Craniotomy, fronto-orbital advancement, Lefort-III osteotomy and advancement, monoblock osteotomies, orbital shifts , craniofacial distraction etc.