Oral and Maxillofacial Surgery

OMFS Outpatient Procedures

TOOTH EXTRACTIONS
A dental extraction is the removal of a tooth. You may need to have a dental extraction if:
•    Your tooth is diseased or damaged and cannot be saved.
•    Your mouth needs room for other teeth to grow in or to align properly.
•    You’re scheduled for another treatment or surgery that requires teeth to be removed to lower the chance of complications.

In some situations, the right choice for your oral health is to have a tooth removed. A tooth extraction is usually our last resort after your dentist and our team have exhausted all other efforts to save the tooth. When damage or infection occurs, it’s not only uncomfortable, but it can also lead to more widespread issues. A simple extraction is completed if the tooth is visible in the mouth and is above the gumline. A surgical extraction is completed if the tooth is below the gumline or if the tooth cannot be removed by a simple extraction. Typically, having a tooth removed reduces pain and prevents the future risk of infection. 

WISDOM TEETH REMOVAL
Your mouth goes through many changes in your lifetime. One major dental milestone that usually takes place between the ages of 17 and 21 is the appearance of your third molars, commonly known as your wisdom teeth. Wisdom teeth can lead to problems if there isn’t enough space for them to surface or if they come through in the wrong position. If your dentist says your wisdom teeth are impacted, they mean these teeth are trapped in your jaw or under your gums. Physicians suggest that young adults with impacted wisdom teeth have them removed as soon as possible. It’s best to have wisdom teeth removed before adulthood because the roots of your teeth are not fully formed and the jawbone is not as dense. Surgery is usually performed in the oral and maxillofacial surgeon’s office on an outpatient basis, which allows you to go home the same day and return to your normal activities within 24 hours. The most efficient way to find out if you or your child needs third molars removed is to attend a consultation at our office. Our oral surgeons are qualified to examine and safely remove wisdom teeth.

DENTAL IMPLANTS  
Dental implant surgery is a procedure that replaces tooth roots with metal, screwlike posts and replaces damaged or missing teeth with artificial teeth that look and function much like real ones. Because of dental implants, thousands of people today are eating foods they have not been able to enjoy for years and are smiling with renewed self-confidence. Most implants today are made of titanium alloy. The implant process generally consists of a surgical procedure for placement of the implant, followed by a healing period of three to four months. The final restoration is placed by your dentist. If you are missing one or more teeth, or have full or partial dentures that cause pain or embarrassment, you might be a good candidate for dental implants.
 

OMFS Inpatient Procedures

CRANIOMAXILLOFACIAL TRAUMA AND RECONSTRUCTION 
Oral and maxillofacial surgeons specialize in treating patients with facial injuries including lacerations of the face and fractures of the bones of the face, skull and teeth. This includes fractures of the forehead, eye sockets, nasal bones, jaws and teeth. These specialists also manage complex soft-tissue injuries of the scalp, face, neck, eyelids, nose, ears and mouth. A maxillofacial fracture, also called a midface fracture, is a break in the bones of the middle part of the face. These bones include:
•    The maxilla or upper jaw.
•    The mandible or lower jaw.
•    The zygomas or cheekbones.
•    The orbits or eye sockets.
•    The nasal cavity.  

Sometimes, maxillofacial fractures involve multiple facial bones, also called complex fractures, that may partially or completely detach from the skull (Le Fort fractures). Le Fort fractures can be very severe and can even be life-threatening. Maxillofacial fractures are usually caused by strong, blunt force to the midface area. Treatment depends on how severe the fracture is and where it is found.

In most cases, this condition may require a procedure to wire the upper teeth to the lower teeth (maxillomandibular fixation). You may need to have your teeth wired together for several weeks to stabilize the fracture during healing. For minor fractures, this may be the only treatment needed.

Fractures that are out of position (displaced) or unstable may require surgery to move the broken bones back into position and then support them with plates and screws or wires. Patients with facial injuries often have multiple other injuries and related problems. The patient’s surgical plans and care are always coordinated with the other surgical and medical specialists. The oral and maxillofacial surgeon’s goal is to return patients to normal function as quickly as possible.  

PEDIATRIC CLEFT LIP AND PALATE SURGERY
Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. Together, these birth defects commonly are called “orofacial clefts.” Children with a cleft lip and/or cleft palate often have problems with feeding and speaking clearly. They also might have hearing problems and problems with their teeth. If your infant is diagnosed with cleft lip and/or palate or another craniofacial condition, our team has the expertise to treat these conditions. Our multidisciplinary treatment approach allows us to address a wide spectrum of needs for each child.  We work closely with your primary care provider to coordinate care while conducting comprehensive evaluations, advanced surgical procedures and follow-up care. Visit our Cleft Lip and Cleft Palate Clinic webpage for more information. 

PEDIATRIC CRANIOMAXILLOFACIAL SURGERY 
Craniofacial anomalies are deformities that affect a child's head and facial bones. Craniofacial anomalies may result from a birth defect, injury or tumor, and they vary considerably in the symptoms they cause and their severity. Cleft lip and cleft palate are two of the most common craniofacial anomalies. Children with any head or orbital abnormality should be evaluated by a Carle oral and maxillofacial surgeon (OMFS). Parents or guardians with concerns about these conditions should ask their child’s pediatrician and discuss referrals.

CORRECTIVE JAW SURGERY 
Orthognathic surgery, also called jaw surgery, treats severe jaw problems, such as underbites, overbites and crossbites. It can be a corrective option if you have jaw problems that can't be resolved with orthodontics alone. Any form of jaw dysfunction can cause problems eating, speaking or breathing, but jaw surgery has the potential to improve and even eliminate these issues. This surgery can dramatically improve your health and quality of life as well as help eliminate discomfort and improve breathing and chewing function.
You may be a candidate for jaw surgery if you are experiencing:
•    An uneven bite.
•    Chronic jaw pain.
•    Difficulty chewing food.
•    Trouble opening or closing your mouth.
•    Pain due to temporomandibular joint (TMJ) dysfunction and other jaw problems. 

Jaw surgery is appropriate after growth stops, usually around ages 14 to 16 years for females and ages 17 to 21 years for males. Most of the time, your orthodontist will be the one to refer you to a surgeon to discuss jaw surgery.

SALIVARY GLAND TUMOR SURGERY
Oral and maxillofacial surgeons are trained to identify, diagnose and manage many disorders of the saliva glands. This includes the surgical management of salivary gland tumors. Every person has three major paired salivary glands: the parotid glands (in front of the ears), submandibular glands (under the jaw) and sublingual glands (under the tongue). Patients can develop benign or malignant tumors of these glands.  Surgery is the primary treatment for these types of tumors. Removal of the parotid gland, submandibular gland or sublingual gland is often performed by a specially trained oral and maxillofacial surgeon.  

Removal of a parotid gland tumor requires an incision in front of the ear which extends into the upper neck. The parotid gland is removed with the tumor, while attempting to preserve the facial nerve. This important nerve moves the forehead, eyelids, cheeks and lips. A special monitor is used during surgery to identify and protect the nerve.  

Removal of a submandibular gland tumor is done through an incision in the neck under the jaw. The nerves which move the lower lip and tongue are identified and protected if not directly involved by the tumor. Also, the nerve which moves the tongue is identified and protected during surgery. The submandibular gland and the tumor are then removed with a margin of normal tissue to ensure complete removal. 

Removal of a benign sublingual gland tumor may be done through an incision in the mouth. The nerve which gives sensation to the tongue is protected as are other important structures located in the floor of the mouth. Unfortunately, tumors in this location are often cancerous and may require a more aggressive approach to ensure complete removal.  

RECONSTRUCTIVE BONE GRAFTING
Oral and maxillofacial surgeons are also experts in reconstructive bone grafting. This may be done in several different ways for different clinical needs.  

The most common situation requiring bone grafting is for dental implant reconstruction. After tooth removal, the bone which supports the teeth may atrophy and resorb – or break down and be absorbed into the bloodstream. To place dental implants, the bone may be supported or rebuilt with allograft bone. Allograft bone is from a human donor, and it is processed and sterilized so there is no living tissue. This graft serves to support new bone formation to allow dental implant placement after a period of healing. This is often done immediately after dental extraction or for smaller defects which do not require larger grafts. In the upper jaw, this may be used to “lift the sinus” to allow for implant placement where the bone has resorbed. These types of surgeries can be done in the office as an outpatient procedure.  

In other circumstances, larger grafts may be obtained from the hip or tibia. These types of grafts may be required after complex injuries or tumor surgery. The goals in this setting are to restore the normal anatomy and function of the jaw. Implants may be an option after these grafts have healed. These surgeries are often done in the main operating room and may require a short hospital stay.
 

OMFS Residency Program

The Advanced Educational Program in Oral and Maxillofacial Surgery at Carle is a fully accredited four-year program approved by the Commission on Dental Accreditation (CODA). The Carle OMFS Residency Program participates in the PASS application program and Match to allow two new residents to enter the program each year. Candidates who complete the program are eligible for examination by the American Board of Oral and Maxillofacial Surgery. This advanced education program incorporates all requirements necessary to attain board eligibility in oral and maxillofacial surgery. Visit our Oral and Maxillofacial Surgery Residency website for more information. 
 

OMFS Clinics and Programs

• Cleft Lip/Cleft Palate Clinic