Facial Reconstruction

Oral and maxillofacial surgeons routinely evaluate and treat patients with different levels of maxillofacial defects resulting from trauma, tumor resection and/or teeth extractions.

In acute trauma cases, the goal of reconstruction is a one-stage repair, made possible by the application of well-known oral and maxillofacial surgery techniques. Delayed treatment has been replaced by early or immediate surgical treatment and stabilization of small bone fragments augmented by bone grafts and miniplate rigid fixation. These advances have allowed surgeons to approach and often reach the goal of restoring pre-injury facial appearance and function while at the same time minimizing revision surgery.

Without treatment in a timely manner, many individuals will develop future problems, often more severe than if the injury had been immediately repaired. However, modern oral and maxillofacial surgery surgical techniques can now offer hope for patients with pre-existing post-traumatic facial deformities despite considerable delays between injury, diagnosis, and treatment. These innovative techniques establish a higher standard of care for the management of facial injuries.

Tumor resection can result in either a complete defect or significant discontinuity defect that not only creates considerable facial defects but also causes the patient significant functional insufficiencies, including masticatory and speech related deficiencies. Oral and maxillofacial surgeons can provide the patient with a variety of dental, bony, and soft tissue reconstructions techniques that will address the most complicated facial tumor related injuries. From bone grafting, with or without platelet rich plasma enhancement, to distraction osteogenesis and to orthognathic surgery, oral and maxillofacial surgeons are the most prepared surgeons to treat these defects.

When teeth are removed from the mouth in a traumatic way, as in an accident, the extraction itself will likely leave a significant dental alveolar defect. These defects can result in significant oral cosmetic abnormalities and/or functional bony defects that could prevent the patient from properly smiling and chewing. Oral and maxillofacial surgeons can offer a vast variety of treatments that almost always resolve these defects including bone grafting, distraction osteogenesis, soft tissue and skin grafting.

Cleft Lip

During early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. However, if some parts do not join properly, sections dont meet and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip.

A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft.

A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate.

Cleft Palate

The palate is the roof of your mouth. It is made of bone and muscle and is covered by a thin, wet skin that forms the red covering inside the mouth. You can feel your own palate by running your tongue over the top of your mouth. Its purpose is to separate your nose from your mouth. The palate has an extremely important role during speech because when you talk, it prevents air from blowing out of your nose instead of your mouth. The palate is also very important when eating. It prevents food and liquids from going up into the nose.

As in cleft lip, a cleft palate occurs in early pregnancy when separate areas of the face that develop individually do not join together properly. A cleft palate occurs when there is an opening in the roof of the mouth. The back of the palate is called the soft palate and the front is known as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).

Sometimes a baby with a cleft palate may have a small chin and a few babies with this combination may have difficulties with breathing easily. This condition may be called Pierre Robin sequence.

Since the lip and palate develop separately, it is possible for a child to be born with a cleft lip, palate or both. Cleft defects occur in about one out of every 800 babies.

Children born with either or both of these conditions usually need the skills of several professionals to manage the problems associated with the defect such as feeding, speech, hearing and psychological development. In most cases, surgery is recommended. When surgery is done by an experienced, qualified oral and maxillofacial surgeon, the results can be quite positive.

Cleft Lip Treatment

Cleft lip surgery is usually performed when the child is about ten years old. The goal of surgery is to close the separation, restore muscle function, and provide a normal shape to the mouth. The nostril deformity may be improved as a result of the procedure or may require a subsequent surgery.

Cleft Palate Treatment

A cleft palate is initially treated with surgery safely when the child is between 7 to 18 months old. This depends upon the individual child and his/her own situation. For example, if the child has other associated health problems, it is likely that the surgery will be delayed.

The major goals of surgery are to:

  1. Close the gap or hole between the roof of the mouth and the nose.
  2. Reconnect the muscles that make the palate work.
  3. Make the repaired palate long enough so that the palate can perform its function properly.

There are many different techniques that surgeons will use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and the surgeon prior to surgery.

The cleft hard palate is generally repaired between the ages of 8 and 12 when the cuspid teeth begin to develop. The procedure involves placement of bone from the hip into the bony defect, and closure of the communication from the nose to the gum tissue in three layers. It may also be performed in teenagers and adults as an individual procedure or combined with corrective jaw surgery.

What Can Be Expected After The Surgery?

After the palate has been fixed, children will immediately have an easier time in swallowing food and liquids. However, in about one out of every five children following cleft palate repair, a portion of the repair will split, causing a new hole to form between the nose and mouth. If small, this hole may result in only an occasional minor leakage of fluids into the nose. If large, it can cause significant eating problems, and most importantly, can even affect how the child speaks. This hole is referred to as a “fistula,” and may need further surgery to correct.