Oral and Maxillofacial Surgery: Everything You Need to Know

In This Article

Oral and maxillofacial surgery is used to treat complex dental problems and medical conditions related to the mouth, teeth, jaws, and face. Much of the practice is focused on facial reconstructive surgery, facial trauma surgery, and dental procedures involving the jawbone (like wisdom tooth extractions and dental implants).

What Is Oral and Maxillofacial Surgery?

Oral and maxillofacial surgery encompasses a variety of procedures that involve surgery of the mouth (oral), jaw (maxilla), and face (facial). Some people regard oral and maxillofacial surgery as an "upgraded" form of dental surgery, but the practice extends far beyond what a dentist can perform.

Oral and maxillofacial surgeons (OMSs) train as dentists but undergo six additional years of education, including two to attain a medical degree (MD).

Some oral and maxillofacial surgeons embark on further training to perform facial cosmetic surgery, treat conditions related to cancer, perform microvascular surgery of the head or neck, or correct congenital face and skull abnormalities in children (such as cleft lip and palate).

Depending on the condition, oral and maxillofacial surgery may be performed as an inpatient, outpatient, scheduled, elective, or emergency procedure. OMSs often work alongside other surgeons (like orthopedic surgeons, surgical oncologists, or otolaryngologists) to treat complex conditions or in cases involving severe head or facial trauma.

Contraindications

There are few absolute contraindications to oral and maxillofacial surgery other than the inability to tolerate general anesthesia. In such cases, other forms of anesthesia—like regional blocks or local anesthesia with intravenous sedation—may be used.

There are relative contraindications that may exclude certain elective procedures. Cases like these are evaluated on an individual basis, weighing the benefits against the risks. Among the conditions of concern are:

Potential Risks

As with all surgeries, oral and maxillofacial surgery has risks. Even relatively common procedures like tooth extractions pose a risk of potentially serious complications.

In addition to the general risks of surgery (such as excessive bleeding, unfavorable scarring, post-operative infection, and an adverse reaction to anesthesia), oral and maxillofacial surgery poses specific risks, especially with regards to reconstructive surgery or in cases of facial trauma.

These include:

  • Unintended changes in appearance
  • Changes in jaw alignment and bite
  • Changes in airflow through the nose and sinuses
  • Injury of facial nerves, which may cause numbness, loss of facial muscle control, or unremitting nerve pain
  • Alveolar osteitis: Also known as dry socket, this is caused when a blood clot doesn't form or is lost at the site of a tooth extraction before it has time to heal.
  • Condensing osteitis: Bone inflammation in the jaw characterized by pain with movement
  • Tissue necrosis (tissue death), usually caused by the severe restriction of blood flow to tissues following surgery

Purpose of Oral and Maxillofacial Surgery

Oral and maxillofacial surgery is used to treat a wide range of conditions affecting the craniomaxillofacial complex comprised of the mouth, jaws, face, neck, and skull.

The procedures can be broadly defined as being diagnostic/therapeutic, dentoalveolar (involving the teeth, gum, jawbone, and mouth), reconstructive, or cosmetic.

Diagnostic and therapeutic procedures include:

Dentoalveolar procedures include:

  • Dental implants: Including endosteal implants placed directly into the jawbone and subperiosteal implants placed under the gum but above the jawbone
  • Orthognathic surgery: Also known as corrective jaw surgery, used to straighten a crooked bite or misaligned jaw
  • Pre-prosthetic bone grafting: The surgical implantation of autologous bone (extracted from the patient) to provide a solid foundation for dental implants or implanted hearing devices, like a cochlear implant
  • Wisdom tooth extraction: A surgical procedure that requires the removal of bone around the root of the third molar (wisdom tooth)

Reconstructive procedures include:

  • Craniofacial surgery: Used to correct congenital malformations like cleft palate or craniosynostosis (the premature fusing of bones in a baby's skull), or to repair traumatic fractures (include jaw fractures, cheekbone fractures, nasal fractures, eye socket fractures, and LeFort fractures of the mid-face)
  • Lip reconstructive surgery: Used after the removal of skin cancer of the lip (typically squamous cell carcinoma, but also melanoma) to restore not only the appearance of the lips but their function
  • Microvascular reconstructive surgery: Used to reroute blood vessels after the removal of a tumor in people with head and neck cancer
  • Skin grafts and flaps: A procedure used after skin cancer surgery in which skin is either taken from another part of the body to replace resected tissues or partially removed and repositioned to cover an adjacent area of resection

Cosmetic procedures include:

Pre-Operative Evaluation

If oral and maxillofacial surgery is indicated, the surgeon may order a series of tests to map out the surgical plan. These may include:

  • X-ray: A plain film imaging technique using ionizing radiation
  • Panorex: A form of X-ray used in dentistry and for the viewing of the sinuses
  • Computed tomography (CT): An imaging technique involving multiple X-ray images to create three-dimensional "slices" of the surgical site
  • Magnetic resonance imaging (MRI): An imaging technique that doesn't involve radiation and is superior in imaging soft tissues
  • Duplex ultrasound: An specialized form of ultrasound specifically used to evaluate blood flow through the arteries and veins
  • Nerve conduction studies (NCS): A test in which a mild electrical pulse is applied to muscles of the face and head to detect areas of nerve damage

How to Prepare

The preparation for oral and maxillofacial surgery can vary depending on the condition being treated and the aims of the surgery. If oral and maxillofacial surgery is indicated, you will meet with your surgeon to review the pre-operative results and walk through the suggested procedure step-by-step.

To fully comprehend what's involved, do not hesitate to ask as many questions about not only the procedure but what to expect during recovery.

Location

Many oral and maxillofacial surgeries are performed in-office, including tooth extractions and other dental procedures. Those that involve reconstruction or require open surgery need to be performed in an operating room of a hospital or specialized surgical facility.

Depending on the surgery, an anesthesiologist may or may not be needed. All OMSs are qualified to administer anesthesia, but complex procedures like microvascular reconstruction need a dedicated anesthesiologist to monitor the health of the patient during surgery.

What to Wear

You may be asked to wear a hospital gown and surgical bib over your clothes when undergoing dental surgery. Wear something that is machine washable on the odd chance you get a spot of blood on your clothing.

Other surgical procedures, particularly those involving general anesthesia, will require you to undress and put on a hospital gown. The day of your procedure, wear something comfortable that you can easily take off/put back on.

Food and Drink

If undergoing general anesthesia or any form of sedation, you will need to adhere to certain food and drink restrictions prior to surgery.

In most cases, you will be advised to stop eating at midnight on the night before your surgery. The next morning, you will be allowed a few small sips of water to take any morning pills, but nothing further.

If local or regional anesthesia is to be used, there may be no such restrictions. The only exception is if intravenous sedation is used alongside local or regional anesthesia. In such cases, the same food and drink restrictions apply.

Medications

As a general rule, nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants (blood thinners) are avoided in the days the preceding surgery. Both of these classes of drugs can promote bleeding and affect the proper healing of wounds.

The restrictions vary by surgery but, generally speaking, NSAIDs like aspirin, Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and Voltaren (oral diclofenac) are stopped a week or two before surgery. Anticoagulants like Coumadin (warfarin) and Plavix (clopidogrel) are usually stopped five days before surgery.

To avoid complications, advise your surgeon about any and all drugs you take, whether they are prescription, over-the-counter, nutritional, herbal, or recreational.

What to Bring

You will need to bring your driver's license or another form of government photo ID to check in to your appointment. If you have insurance, bring your insurance card.

You may also need a credit card or other approved form of payment if the facility requires upfront payment of coinsurance or copay costs. Call in advance to be sure that they accept your form of insurance, if you are enrolled in a plan.

Leave any valuables at home.

It is best to bring someone with you to drive you home. Even if only local anesthesia is used, you may experience significant pain after surgery, which can impair your ability to drive. If general anesthesia and any form of sedation is used, under no circumstance should you get behind the wheel of a car.

Pre-Op Lifestyle Changes

Every effort should be made to stop smoking at least two weeks before and after surgery. Cigarette smoke causes the profound constriction of blood vessels, reducing the amount of blood and oxygen that reaches the surgical wound. This not only impedes healing but increases the risk of treatment failure, such as loss of a skin graft or improper bonding of bones.

If you find it difficult to quit, ask your doctor for prescription smoking cessation aids that can reduce cravings. Many of these aids are available free of charge under the Essential Health Benefits (EHB) mandate of the Affordable Care Act.

What to Expect on the Day of Surgery

The expectations for oral and maxillofacial surgery are as diverse as the procedures used. With that said, there are some common elements involved in all of these procedures, and knowing more about them can help you prepare.

Before the Surgery

After you have checked-in and completed all of the necessary medical and consent forms, you will undergo pre-operative preparations. These preparations are largely directed by the type of anesthesia you are to undergo.

  • Local anesthesia: Procedures performed with local anesthesia, delivered either by injection or with nitrous oxide ("laughing gas"), may only require a review of your vital signs (temperature, heart rate, blood pressure) and a pre-operative dental exam with or without X-rays.
  • Regional block: Surgeries involving a regional block (an injection similar to local anesthesia that blocks nerve transmissions rather than numbing the skin) will also involve a pre-operative exam and review of vital signs.
  • Monitored anesthesia care (MAC): This form of sedation, sometimes used with local or regional anesthesia to induce "twilight sleep," is delivered via an intravenous (IV) line that has been inserted into a vein in your arm. You will also be connected to an electrocardiogram (ECG) machine to monitor your heart rate and a pulse oximeter to monitor your blood oxygen.
  • General anesthesia: The same procedures as MAC are used but often with a more extensive range of pre-operative blood tests, including a complete blood count (CBC), comprehensive metabolic panel (CMP), and arterial blood gas (ABG) test.

During the Surgery

Once you are prepped and the appropriate anesthesia has been administered, the surgery can begin. It may be open surgery (an invasive procedure involving a large incision), endoscopic surgery (also known as "keyhole surgery"), or minimally invasive open surgery (involving a small incision and minimal tissue damage).

The surgery may also be classified as being reconstructive (to repair or correct structural abnormalities) or aesthetic (used for cosmetic purposes).

Surgery Location Type Anesthesia
Mandibular joint surgery  Inpatient Open or endoscopic   General
Maxillomandibular osteotomy  Inpatient Open  General
Radiofrequency nedle ablation In-office or outpatient Percutaneous (with a needle through the skin) Often only a numbing agent
Septoplasty with turbinate reduction  Generally outpatient Mainly endoscopic Local with MAC, regional, or general
Dental implants In-office Minimally invasive Generally local
Orthognathic surgery Inpatient Open Local or regional with MAC or general
Pre-prosthetic bone grafting  In-office Minimally invasive Local, regional, MAC, or general
Wisdom tooth extraction In-office Minimally invasive Local, regional, MAC, or general
Craniofacial surgery Inpatient or outpatient Open or arthroscopic Local or regional with MAC or general
Lip reconstructive surgery Generally outpatient Reconstructive Local with MAC or general
Microvascular reconstructive surgery Inpatient Open or arthroscopic General
Skin grafts and flaps Inpatient or outpatient Reconstructive Local with MAC or general
Blepharoplasty Outpatient Aesthetic Local with MAC or general
Cheek augmentation Outpatient Aesthetic Generally local with MAC
Genioplasty In-office or outpatient Aesthetic Generally local with MAC
Mentoplasty Outpatient Aesthetic Usually general
Neck liposuction Outpatient Aesthetic Local with MAC or general
Otoplasty Outpatient Aesthetic Generally local with MAC
Rhinoplasty Outpatient Aesthetic or reconstructive Local or regional with MAC or general
Rhytidectomy Usually outpatient Aesthetic Local with MAC or general

Upon completion of the surgery, sutures, staples, or tape may be used to close your incisions. A sterile bandage is then applied.

Splints, spacers, and various braces (including headgear, mouthguards, and jaw wiring) may be used to immobilize the skull, jaw, or nose so that it heals properly and in the correct position.

After the Surgery

Once the surgery is complete, you are taken to a recovery room or the post-anesthesia care unit (PACU), where you will be monitored until you are fully awakened from the anesthesia. With local anesthesia, this usually takes 10 to 15 minutes or so. With general anesthesia, it generally takes around 45 minutes.

Once your vital signs have normalized and you are able to walk stably, you can usually be taken home by a friend or family member. Some procedures may require a hospital stay of one or several days.

In addition to wound care instructions, you may be given pain medications to help ease post-operative pain as well as oral antibiotics to help prevent post-operative infection.

Recovery

In the same way that oral and maxillofacial surgeries can vary, so too can recovery times. While most people can return to work and normal activity within a few days of a wisdom tooth extraction, for example, those who undergo orthognathic surgery may take months before they are fully recovered.

Certain factors can increase or decrease recovery times, including your general health before surgery, how well you care for your surgical wound, and whether you or not you smoke.

Follow the recommended dietary plan, whether it is a soft diet or liquid diet, and work with a dietitian if needed to ensure proper nutrition. Surgeons often recommend eating smaller meals and snacks rather than a full meal for the first week or so as eating too much may irritate the surgical site.

Some oral and maxillofacial surgeries will require your jaw to be wired. Because you'll be limited to a liquid diet, you will need to rinse your mouth thoroughly after brushing, as well as rinse with salt water several times a day to remove bacteria from the gums and prevent plaque buildup.

People who undergo soft palate surgery may experience changes in speech articulation that require speech therapy to correct. In fact, any surgery of the jaw, tongue, or soft or hard palate can affect speech, either temporarily or permanently. A speech pathologist can help determine what, if any, treatment is needed.

Damage to branches of the trigeminal nerve is common following maxillofacial surgery, most cases of which resolve on their own over time. Severe cases may require medications and other treatments to block the nerve pain.

Some oral and maxillofacial surgeries require extensive rehabilitation to restore nerve sensations or the function of facial muscles. Similarly, some scars can take months of ongoing care to minimize their appearance or prevent the development of thick, raised patches (hypertrophic scarring).

To ensure that you heal completely, work closely with your doctor. Keep all scheduled appointments and have realistic expectations about what it will take to recover. Rushing this period is never a good idea.

Surgery Return to Work Full Recovery
Mandibular joint surgery  3 to 5 days in hospital, followed by 5 to 14 days at home 2 to 8 weeks, depending on the extent of the surgery
Maxillomandibular osteotomy  2 to 3 days in hospital, followed by 4 weeks at home 3 months
Radiofrequency needle ablation 24 to 72 hours 10 days
Septoplasty with turbinate reduction  Several days to a week 1 to 2 months 
Dental implants 1 to 2 days 1 month
Orthognathic surgery 1 to 2 days in hospital, followed by 2 weeks at home 3 months
Pre-prosthetic bone grafting  2 to 3 days 4 to 5 months
Wisdom tooth extraction 2 to 3 days 2 weeks
Craniofacial surgery 7days in hospital, followed by 10 to 14 days at home 3 months
Lip reconstructive surgery 1 week 3 weeks
Microvascular reconstructive surgery 4 to 5days in hospital, followed by 2 to 3 weeks at home 3 months
Skin grafts and flaps 5 days to 2 weeks 3 months
Blepharoplasty 7 to 10 days 3 months
Cheek augmentation 3 weeks 4 to 6 months
Genioplasty 7 to 10 days 6 to 8 weeks
Mentoplasty 1 to 2 weeks 6 to 8 weeks
Neck liposuction Several days to 1 week 1 month
Otoplasty 5 to 7 days 6 weeks
Rhinoplasty 1 to 2 weeks 6 to 8 weeks
Rhytidectomy 10 to 14 days Up to 1 year

A Word From Verywell

If you are referred to an oral and maxillofacial surgeon, it is likely because a specific procedure is beyond the scope of the doctor or dentist you are seeing. It doesn't necessarily mean that the condition is inherently more serious, but rather that the procedure would benefit from a specialist trained to work on the complex structures of the face, jaw, mouth, and skull.

If in need of an OMS in your area, speak with your insurance company or use the online locator offered by the non-profit American Association of Oral and Maxillofacial Surgeons (AAOMS).

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