Maxillofacial surgery is concerned with the disease and treatment of the face (Lat. facies), especially the jaws (Lat. maxilla). The speciality is one of the surgical disciplines of the FMH Swiss Medical Association. Swiss maxillofacial surgeons are qualified doctors and dentists (diploma in both disciplines). They also have the qualification of Specialist in Oral (Buccal) Surgery, a speciality that comes under Dental Medicine (SSO).
The various key areas covered by specialists in maxillofacial surgery are as follows:
1 Dental-maxillofacial trauma: this discipline historically forms the basis of the speciality. It is carried out in close collaboration with Neurosurgery (Photo CT 3D).
2 Orthognathic surgery
Maxillo-mandibular deformities such as, for instance, mandibular prognathism, facial asymmetry or the sequelae of cleft lip and palate are corrected by osteotomies (cutting sections of bone). The cut sections are subsequently repositioned correctly. The bone is fixed in the new position using titanium screws and plates. Surgery is planned on plaster moulds and finally using computer simulation (Photo of the skull).
Close collaboration with orthodontists (dental medical experts) is essential.
3 Dental implantology
This new discipline has become extremely popular. Before implants can be inserted, the site in question often has to be reconstructed using bone grafts. In most cases, the specialist removes bone from the lower jaw and also uses artificial bone. In the event of significant bone loss following dental extraction or trauma, the iliac wing offers a copious quantity of bone that will be used to reconstruct the jawbones, allowing the insertion of dental implants (Photos 1, 2).
4 Dental surgery
The treatment of diseased wisdom teeth and other misaligned teeth, the removal of cysts, benign bone tumours and mucosa as well as the treatment of other dental problems all fall within the competence of the maxillofacial surgeon.
5 Diagnosis and treatment of the temporo-mandibular joint (TMJ)
TMJ diseases are largely unknown and often misdiagnosed. Specialists have conservative and surgical treatments for this type of condition. The diagnostic and therapeutic arthroscopy of the TMJ has proved its worth. Arthrotomy via the pre-auricular route is required in the treatment of some advanced diseases. The total replacement of a joint by a prosthesis is a very rare and extremely difficult procedure (Photo Rx).
6 Surgical oncology and reconstructive surgery
Surgery for facial cancer is extremely difficult and requires a large hospital infrastructure. The management and treatment of this condition are managed by several disciplines (ENT and cervico-facial surgery, plastic and reconstructive surgery, oncology, radiology, radiotherapy, logopaedia, psychology and others) and require close, long-term follow-up.
