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Minimally Invasive Techniques Move OMS Procedures from O.R. to Office and Speed Recovery
"All of these developments share the goal of taking a more involved surgical procedure and making it simpler--transitioning a procedure that was traditionally done in the hospital under general anesthesia to an outpatient or office-based procedure using local anesthesia," states symposium moderator Joseph E. Van Sickels, DDS, division chief of oral and maxillofacial surgery and director of the oral and maxillofacial residency program at the University of Kentucky in Lexington. Orthognathic surgery repositions, widens and/or narrows the upper and/or lower jaws in order to improve function and appearance. As orthognathic surgery specialists, oral and maxillofacial surgeons often work with orthodontists to achieve results braces alone cannot accomplish. Until recently, orthognathic surgery involved at least an overnight stay in the hospital. As in virtually every other surgical specialty, the development of minimally invasive techniques in orthognathic surgery is now saving patients the discomfort and expense of longer, more elaborate operations and hospitalizations, Dr. Van Sickels says. Though the techniques vary, "they are all about reducing patient discomfort and recovery time and minimizing costs without compromising results," he says.
Orthodontists often refer their patients to oral and maxillofacial surgeons for an orthognathic procedure known as a maxillary osteotomy, traditionally performed under general anesthesia in a hospital operating room. The procedure raises the upper jaw in the back of the mouth in order to close the bite in front and achieve a more functional and esthetically pleasing jaw alignment.
Through the new minimally invasive technique, the oral and maxillofacial surgeon surgically places titanium miniplates in the cheekbone, where they function as skeletal anchors that move the molars in the back of the mouth up, facilitating bite closure. "This combined approach to open bite treatment appears to be stable and effective," Dr. Sherwood says.
Another technique, known as selective alveolar decortication, can reduce the length of orthodontic treatment in adult patients by 60 to 70%, according to Boston OMS Ruben Figueroa, D.M.D., M.S. "Six month treatment times are common when standard orthodontia and alveolar decortication are combined to treat moderate and severe malocclusions, including crowding, cross bite and open bite treated with or without orthognathic surgery," he reports.
A technique first used by orthopedic surgeons known as distraction osteogenesis now offers OMSs a less invasive method for more effectively remedying many severe, difficult to treat facial skeletal deformities, including cleft palate. The OMS makes a gradual, controlled series of small, surgically created fractures to "stretch" bone in a given direction. By triggering the body's natural healing process, the technique "tricks" the body into forming new bone and can even be used to extend bone between specific teeth.
Because distraction osteogenesis is done slowly, in small increments, over several office visits, the technique facilitates the simultaneous generation of surrounding gum and other soft tissues as the bone gradually lengthens or widens, Dr. Van Sickels reports.
The American Association of Oral and Maxillofacial Surgeons (AAOMS), the professional organization representing more than 7,000 oral and maxillofacial surgeons in the United States, supports its members' ability to practice their specialty through education, research, and advocacy. AAOMS members comply with rigorous continuing education requirements and submit to periodic office examinations, ensuring the public that all office procedures and personnel meet stringent national standards
SOURCE: American Association of Oral and Maxillofacial Surgeons
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