Oral & Maxillofacial Surgery

Oral & Maxillofacial Surgery Oral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. An oral and maxillofacial surgeon is a regional specialist surgeon treating the entire craniomaxillofacial complex: anatomical area of the mouth, jaws, face, skull, as well as associated structures.

-The Extreme- OM surgery plus Plastics plus ENT, plus... These recently updated photos obtained May 5, 2009 from the Cleveland Clinic shows Connie Culp after an injury to her face and as she appears today. Five years ago, a shotgun blast left a ghastly hole where the middle of her face had been. Five months ago, she received a new face from a deceased woman.

A multi-disciplinary team of doctors and surgeons at Cleveland Clinic performed the first near-total face transplant in the United States. In a 22-hour procedure, surgeons transplanted 80 percent of a woman's face who suffered severe facial trauma � essentially replacing her entire face, except for her upper eyelids, forehead, lower lip and chin.

Terms Alveolar process - alveolar ridge: a ridge that forms the borders of the upper and lower jaws and contains the sockets of the teeth Arthroscopy Calvarial - skull Condyle - A rounded enlargement or process possessing an artculating surface. Coronal flap Craniosynostosis - Premature closing of joints or sutures in the skull. Dentition - teeth Glenoid fossa- jaw joint Inferior alveolar nerve -enters the mandible on the deep surface of the ramus, providing sensation to the teeth Gnath-jaw Labia - lip Malar bone - cheek Malocclusion Maxillofacial - relating to the lower half of the face Meniscus - cartilage that works to absorb weight and provide stability Mouth prop Mental Nerve - nerve which provides sensation to the anterior aspects of the chin and lower lip as well as the buccal gingivae of the mandibular anterior teeth and the premolars. Orbicular - circular in outline

Terms Osteotomy - operation in which the bone is cut through Ramus - the posterior part of the mandible that is more or less vertical Reduction Sagittal - [sagitt = arrow] Divides the body or structure into mirror images of right & left sides. Symphysis - the point of junction of two bones as in the two parts of the lower jaw in front: the tip of the chin TMJ - Tempero-mandibular joint, the two joints that connect the jaw to the skull.

Oral (Buccal) Cavity Lips Teeth Palate Cheeks Tongue

Lips (labia) Thermal receptors for protection from burns Muscles aiding in expressions, food retention, and mastication Space between lips extending to the cheeks is the vestibule (an entrance)

Teeth (Dentitions) Rest in alveolar processes Deciduous (primary) Appear = 6 mos. Continue to = 4 yrs For each jaw: 2 central incisors 2 lateral incisors 2 cuspids or canines 4 molars 20 total Loss begins = 6 yrs Permanent (secondary) For each jaw: 2 central incisors 2 lateral incisors 2 cuspids or canines 4 bicuspids 6 molars 3rd molars or wisdom teeth appear = 17-25 yrs

Teeth Speech Mastication

Teeth (3 Regions) 1. Crown is above/outside gumline Enamel covering of crown Hardest part Doesn’t reproduce Degenerates with age and injury Dentin Majority of tooth Harder than bone Encases pulp Pulp Blood vessels Nerves Connective tissue

Teeth (3 regions) Neck Junction of crown and root

Teeth (3 regions) Root Held by periodontal ligament Connects tooth to alveolar processes

Palate Roof of the mouth Anterior portion is hard palate Posterior portion is soft palate Uvula is the most posterior part of the soft palate Soft palate separates mouth from nasopharynx Soft palate rises with swallowing to prevent food going into nasal cavity

Cheeks Lateral walls of oral cavity Consist of major muscles for mastication

Tongue Chemoreceptors for taste Attached to floor of buccal cavity by lingual frenulum Function in speech, propelling food through oral cavity and swallowing

Appendicular Skeleton Skeletal System Axial Skeleton Along or connecting to the midline of the body Skull Vertebral column Sternum Rib Cage About 80 bones total Appendicular Skeleton Everything hanging off the axial skeleton

Skull

Skull

Skull Frontal Temporal Occipital Parietal Sphenoid Ethmoid Maxilla Zygomatic Mandible Lacrimal Hyoid

Skull Frontal bone Protection Twice as thick as others Supraorbital foramen allow for passage of blood vessels and nerves servicing the face and head

Skull Temporal Bone Protection External auditory canal allows for sound to enter skull Openings at base for carotid arteries and jugular veins called carotid foramen and jugular foramen Mastoid process where sternocleidomastoid muscle attaches

Skull Occipital bone Forms posterior base of skull Large hole at base is foramen magnum where spine enters skull Occipital condyles are connections between skull and vertebrae C-1 vertebrae most superior is the atlas which supports the skull/head C-2 is the axis which allows for movement of the head

Skull Sphenoid bone - butterfly-shaped bone at the base of the skull Center of base of skull Keystone of the skull (ties a lot of other bones together Sella turcica is where the pituitary gland sits - a saddle-shaped depression in the sphenoid bone at the base of the human skull.

Skull Ethmoid bone Forms part of nasal cavities Olfactory foramen open into nasal cavity Penetrates into frontal bone - cribiform bone Nerve ending in cribiform plate where sense of smell delivered and received

Skull Maxilla Attachment for upper teeth (alveolar processes) Infraorbital foramen for vessels and nerves Attachment for zygomatic bones/cheek bones

Skull Mandible Lower jaw Largest and only moving bone in face Attachment for lower teeth (alveolar processes) Articulates with glenoid fossa of each temporal bone = TMJ (temporomandibular joint)

Skull Lacrimal bone Smallest bone in face – very thin Small foramen become nasolacrimal ducts where tears drain Tears come from lacrimal gland in eyebrows (keep eyes and nares moist)

Skull Hyoid bone Only bone in body that does NOT connect directly to another bone Held in place by ligaments Holds tongue in place (tongue for swallowing and mastication)

Orbital Bones (* =‘s weakest bones) Frontal Lacrimal Ethmoid-* Maxilla- * Zygomatic Sphenoid Palatine

Facial Muscles Expressions Mastication Speaking