Oral and Maxillofacial Surgery


Treatment

The Unit of Maxillofacial Surgery of Clínica Planas has the best resources to solve the problems that may affect your face, neck, mouth and facial structure.

The Unit of Maxillofacial Surgery of Clinica Planas offers the latest in technology to diagnose and treat facial defects, problems in the oral cavity and correction of skeletal deformities of maxillae, as well as the treatment of the temporomandibular articulation (TMA).

The medical team of the Maxillofacial Surgery Unit works in collaboration with the Aesthetic Dentistry Unit, with a multidisciplinary approach in dental implants and oral surgery.

Oral and Maxillofacial Surgery is the medical-surgical specialty focused on prevention, study, diagnosis and treatment of the diseases of the oral cavity and facial skeleton, as well as the cervical structures directly or indirectly related.

Craneofacial surgery is a subdiscipline of plastic surgery, in the field of reconstructive. In Europe, this subspecialty does not exist but has its own entity as an independent medical specialty: oral and maxillofacial surgery.

This specialty involves a wide range of procedures as it works in a complex anatomical territory. The maxillofacial surgeon performs from wisdom teeth removal or dental implants placement to aesthetic, oncologic and reconstructive surgery. This specialty is related to plastic surgery, neurology and otolaryngology and works closely with them (overlapping in some aspects), as well as with dental specialties (orthodontics and prosthodontics).

Depending on the approach to the specialty (Medicine or Dentistry), its training program and the current legislation in each country, the field of the maxillofacial surgeon may be broader or narrower.

The maxillofacial surgeon attends problems of facial trauma, cleft lip, cleft palate, oral, craniofacial and neck oncology, skull base, reconstructive surgery, facial aesthetic surgery, pathology of salivary glands (benign and malignant tumours, stones, etc.) craniofacial deformities (from minor dentofacial deformities up to large malformative syndromes), cervicofacial infectious pathology (boils and facial and cervical abscesses), oral implantology (placement and rehabilitation of osseointegrated dental implants), third molars (wisdom teeth) or canines included, maxillary cysts, pathologies of the oral mucosa and the temporomandibular jaw (craneomandibular dysfunction), etc.

Clinica Planas aim is to offer the best dental study, service and treatment to the patient, based on a personalized attention, a high qualified staff and the new technologies that make them stand out in this specialty.


Treatments

Surgery of Implants

A dental implant is the same as the root of a tooth, like a stable pillar for the created crown. Dental implants are made of titanium or zirconium and its surface is usually treated with physicolchemical processes. Its placement usually just needs local anaesthesia. This titanium device fuses with the jawbone. This process is called osseointegration and it takes between 2 or 6 months. Since it is as a dental root, it is not necessary to lime the neighboring teeth for the placement of the definitive dental prosthesis.

There is one treatment called one day teeth, which consist on elaborating the prosthesis on the same moment as the surgery on few weeks after.

Up-to-date technology enables us to plan and program dental implants treatment with a computer program using a three-dimensional model, which provides a surgical guide that indicates exactly the position of the implants and crowns.

Some conditions are necessary in order to achieve the best results on the placement of implants:

  1. A professional with solid training and background on Oral and Maxillofacial Surgery, which provides the best treatment taking into account the individual needs of each patient, not only in the field of oral surgery, but also in general, taking into account other diseases and companion treatments.  
  2. Implants placement requires examination and correct diagnosis so the success percentage is on 96%. 
  3. A correct study including an orthopantomography, dental CAT and sometimes, surgical splint either by computer or traditional, depending on the case. 
  4. Implants surgery requires sterility and hygienic conditions to achieve the existing successful rates. 
  5. As in any other surgical treatment, dental implants is subject to possible complications and adverse effects, so the signature of prior informed consent is necessary.  
  6. Follow-up examinations with the oral and maxillofacial surgeon and restorative dentist are critical, in order that dental implants can perform correctly their function. It is also necessary the patient´s commitment to follow a strict oral hygiene.
Ortognatic surgery

Ortognatic surgery consists of carrying out surgical procedures to correct maxillary bones deformity, which involve a facial deformity and a problem of teeth occlusion.

Correction of maxillary, jaw or chin deformities implies a functional treatment of teeth occlusion, as well as an aesthetic approach to facial harmony.

Oral Surgery and Oral Medicine

Oral surgery is a specialty of maxillofacial surgery that treats all the medical and surgical problems in the mouth.

Surgery involves the following procedures:


Dento-alveolar surgery: It is the surgery of impacted teeth in the maxilla that cause pain, alterations in teeth eruption, maxillary or mandibular cysts, etc.

Dental implants and Maxillary reconstruction: The maxillofacial and oral surgeon is the expert in diagnosis and treatment of patients who need dental rehabilitation; this means the patient without teeth that needs dental implants to recover his/her denture.
The specialized treatments offered by the Unit of Maxillofacial Surgery and the Unit of Aesthetic Dentistry of Clinica Planas are the following: Repositioning of missing teeth with dental implants of titanium and bone regeneration with procedures such as maxillary sinus elevation, guided bone regeneration or rehabilitation of maxillary big atrophies with zygomatic implants.

Zygomatic implants: They are a type of dental implant suitable for patients with less bone. This kind of implant, placed under general anaesthesia or sedation, allows the rehabilitation of a whole dental arch in only 24-48 hours.

For these treatments of implantology, the Unit of Maxillofacial Surgery of Clinica Planas works in collaboration with the Unit of Dental Aesthetics of Clinica Planas.

Oral Medicine

Many body diseases may show up in the mucosa of the oral cavity. The specialist in oral cavity, the maxillofacial surgeon may help you to assess all the symptoms that appear in this anatomic area by performing biopsies of other necessary tests.

The Unit of Maxillofacial Surgery of Clinica Planas and the Unit of Anaesthesia and Rehabilitation offer you the possibility of carrying out procedures of oral surgery through local anaesthesia or local anaesthesia and conscious sedation, providing a more comfortable situation, absence of pain and quality care.

Tumours of Mouth, Head and Neck

Tumours in the oral cavity, skin face, lips, neck and salivary glands, such as the parotid gland or submaxillary gland are treated in a special way by the maxillofacial surgeon. 

Surgery of the parotid gland is carried out with great experience by the Unit of Maxillofacial Surgery of Clínica Planas.

It may be recommended for glandular tumours, but also in situations of hypertrophy or gland enlargement that cause an inappropriate aesthetic and functional situation.

The Unit of Maxillofacial Surgery of Clinica Planas has a long experience in the diagnosis and treatment of tumours of head and neck, as well as their sequelae and reconstruction.

Traumatisms and Facial Fractures

Bone fractures of the face and sequelae of traumatisms and previous surgeries in the facial area are corrected with maxillofacial surgery.

Facial bone fractures due to sport accidents, traffic accidents, aggressions, or falls are treated by maxillofacial surgeons. Experienced surgeons in this type of surgeries will allow removing and hiding scars.

Today, it is possible to have 3D printings and to design personalized titanium plates for each patient, which enable a more accurate treatment.

The Unit of Maxillofacial Surgery of Clínica Planas manages with special interest those sequelae from previous treatments that have not achieved the desired functional or aesthetic results.

Surgery of the Sleep Apnea

Surgery of the sleep apnea is a severe disease caused by an obstruction of air flow through the airway during sleep, and oxygen saturation dropping, which implies serious health problems and shorter life expectancy.

Sleep apnea may be treated definitely with surgery in those patients that present defects of facial skeleton related to the cause of this disease.

There are many risk factors, such as obesity, obstruction of the nasal airway and oropharynx. At a maxillofacial level, facial morphology of grade II with mandibular retrusion is associated with a higher risk of developing sleep apnea. It is about correcting the position of maxilla and jaw by increasing the tension of the airway muscles of mouth and pharynx. Thus, volume of air flow is increased and collapse avoided during sleep.

By correcting these anatomic alterations, the patient may improve his/her airway, increasing volume and eliminating the collapse during sleep that cause snoring and apneas.

At the Unit of Maxillofacial Surgery of Clinica Planas we can assess and study your particular case, and in collaboration with your Pneumologist see the most suitable treatment.

Craneofacial Surgery and Facial Congenital Malformations

The Unit of Maxillofacial Surgery of Clinica Planas treats the most frequent craneofacial congenital deformities, such as cleft lip and palate, hemifacial microsomia, micrognathia and microtia, as well as their sequelae, and surgeries of revision and refinement.

These pathologies are diagnosed and treated during childhood; however many treatments are extended up to adolescence or adulthood.

Among the congenital malformations treated by the Unit of Maxillofacial Surgery of Clinica Planas are:

1-    Cleft lip and palate sequelae.
2-    Hemifacial microsomia.
3-    Treacher Collins Syndrome.
4-    Parry Romberg Syndrome.
5-    Microtia surgery.

We have a lot of experience in the treatment and correction of facial asymmetries, implants for auricular reconstruction, ortognatic surgery of the cleft lip patient and his/her dental rehabilitation, as well as surgery of the prosthesis of the temporomandibular joint.

Temporo-Mandibular Joint. TMJ

The joint that connects the lower jaw to the skull is a joint that requires a multidisciplinary diagnosis and treatment.
Dentists, orthodontists and physiotherapists get involved in this treatment, as well as the maxillofacial surgeon, if needed.

Surgical problems that may affect this joint are caused by tumours, traumatisms, congenital problems such as hemifacial microsomia and asymmetries in the mandibular growth (condilar hyperplasia, mandibular hemihypertrophy).

The most frequent symptoms are pain, limitation of mobility, or difficulty in opening the mouth.
In joint ankylosis, there is a complete mouth opening limitation.

The Unit of Maxillofacial Surgery of Clinica Planas and the Unit of Dental Aesthetics offer you the right diagnosis and treatment to problems related to this joint, both medical and surgical.

Facial Paralysis Surgery

Facial paralysis surgery is carried out with the purpose of returning mobility and/or improving facial symmetry at rest, in those patients that due to congenital reasons, traumatisms or surgeries have the facial nerve damaged and show a partial or complete facial paralysis.

Patients with previous surgeries on the parotid gland, facial and maxillofacial oncology, surgery on the cranial nerve VIII (acoustic neurinomas), neurosurgery sequelae and intracranial surgery may have some problems with the function of the facial nerve.
From the Unit of Maxillofacial Surgery of Clinica Planas we can offer you different techniques to treat facial paralysis.

1-Infiltrations with Botulinum Toxin.
Insertion of gold eyelid weights for the upper-eyelid mobilization.

2-Static techniques of facial reanimation. They consist of returning symmetry to the face at rest, but not its mobility.

3- Dynamic techniques of facial reanimation. They are focused on returning mobility to the lower third of the face. They try to recover the smile movement.

There are different techniques that include transpositions of nerve trunk, nerve grafts, and muscular transplants with reconstructive surgery.


Oral Surgery

Dental inclusion

Milk teeth are changed for the definitive teeth at 7 and 12 years old, but sometimes there are problems of space, either because of traumatism or because of unknown causes and this change does not happen. These definitive teeth instead of being placed in their final location continue their normal development, both roots and crowns, inside the bone.

We called this process dental inclusion. Any teeth may suffer an inclusion process, although molars and wisdom teeth are more likely to suffer it, since they are the last ones to erupt and, thus, can have more space problems. The second more likely teeth to become inclusive are the superior cuspidate teeth, because of the same reasons.

Inclusive teeth have to be extracted when they cause inflammatory processes in neighboring tissues, caries in neighboring teeth as well as the reabsorption of their roots and early lost.

These teeth may originate dental cysts and tumors, as well as bone lost in neighboring teeth, favoring infections forming cavities.

So as to have more space for the orthodontic treatment, the extraction of the inclusive teeth is recommended.

This surgical operation is usually done under local anaesthesia, since soft and hard tissues of the mouth are manipulated. Swollenness may last some days, but complications and sequelae are usually minimal.

Dental cyst

Odontogenic cysts are one of main causes of destruction of maxillas, being a process relatively frequent. Most part of cases is related with neighboring tooth, being an infectious process originated on the teeth that expands to the closed bone. They can grow unnoticed. The first symptoms can be a dental phlegmon or the inflammation of soft tissue of face or neck, after years of development. A combined treatment will be necessary in most cases, for both the teeth and the cyst (since once formed, surgery will be necessary to excise it). These cysts may be due to other causes, such as alterations of development of maxillas, and sometimes, we may have to differentiate them from tumors with the same clinic and radiological appearance, so we should always have to do a microscopy study of the excised tissue to make a precise diagnosis that will allow us to determine the most complete treatment.

Confronted with any inflammatory process of dental origin, phlegmon, abscess, the visit to the odontologist is recommended. An orthompantomography will be necessary to discard cyst pathology in the maxillas.

Periodontal Surgery

Periodontal disease is the main cause of teeth extraction on patients older than 30 years old. This disease is caused by local agents such as bacterial plaque and scale, accumulation of food remaining, mouth breathing, nicotine, etc.

Defending themselves from these agents, gums reacted with a chronic inflammation, gingivitis (whose main characteristics are its red color, bleeding and pain on the gums). If not treated, this process continues and the infection grow to the root of teeth, causing an inflammatory reaction associated with the loss of the structures at periodontal level and the creation of permanent infectious focus at this level, periodontal pockets. Once these pockets formed, it is difficult for the patient to get rid of the amount of agents that are deposited on them. As the process advances, the loss of bone around the roots of teeth causes the mobility of them, in a first phase and the early fall, latter.

The treatment of this disease requires the coordination of several specialists. Maxillofacial surgeon will do the needed surgical procedures to get rid of the chronic focus of infection and reconstruction of the destroyed structures during the inflammatory process, suing new materials to substitute the bone. The periodontist will be in charge of the procedures de bite adjustment and rehabilitation of lost teeth and the patient will have a key role eradicating those habits that may cause the infection process.

Biopsy of oral mucosa

A biopsy on all new lesions on the oral cavity, with more than two weeks of evolution is advisable, especially for smokers. Biopsy consists of having a sample of the appropriate tissue under local anaesthetic, so as to make a microscopic study that will allow us to achieve a more precise diagnosis, especially whether the lesion is benign or malign. Once having the result, and taking it into account, we can follow up the patient or, if necessary, increase the surgical treatment.



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