Maxillofacial Surgery Overview

Surgical procedures performed on the facial bones and jaws. Common reasons include skeletal abnormalities, dental issues, soft tissue deformities, injuries, infections, or tumors.

A crucial aspect of maxillofacial surgery, considering the intricate anatomy and potential for complications related to breathing.

A special type of endotracheal tube designed for patients with facial surgeries, allowing good visualization and access to surgical areas.

A significant concern after maxillofacial surgery due to the surgical procedure and potential for aspiration.

A significant amount of blood loss can occur in maxillofacial surgery, ranging up to 1500 mL, due to the extent and complexity of the facial surgery.

Surgical procedures performed on the face and jaws. Examples include tooth extractions, correction of jaw alignment, and reconstruction after trauma.

A condition where the jaw is too far forward, causing an overbite and potentially affecting facial aesthetics.

A condition where the jaw is too far back, causing an underbite and potential facial asymmetry.

Surgical procedures aimed at correcting jaw misalignment and improving facial aesthetics or functional issues.

A condition where the upper jaw is too small or underdeveloped, affecting facial aesthetics and teeth alignment.

Surgical procedures that modify the jawbones, often for correcting misalignment, improving aesthetics, or treating functional issues.

A condition where the lower jaw is positioned too far forward, resulting in an overbite and potentially impacting facial appearance.

A condition where the lower jaw is positioned too far back, leading to an underbite and possible facial asymmetry.

A condition where the upper jaw is underdeveloped, affecting facial aesthetics and dental alignment.

A surgical procedure that separates the maxilla from the palate, allowing it to be repositioned to improve facial aesthetics and functionality.

A type of facial fracture that occurs along the maxillary alveolar rim, affecting the upper jaw bone.

A surgical technique that uses an oscillating saw to cut through bone, allowing for repositioning.

The use of titanium plates and screws to secure the repositioned maxilla in place.

The surgical incisions for Le Fort I Osteotomy are made inside the mouth at the junction of the upper lip and the gum.

Multiple surgical incisions are required for Le Fort II Osteotomy, including the upper lip/gum junction, a bi-coronal incision across the scalp, and eye-related incisions.

Patients undergoing Le Fort II Osteotomy often experience significant blood loss due to the extensive bone manipulation involved, potentially requiring blood transfusions.

Because of the complexity and significant trauma involved in Le Fort II Osteotomy, patients often experience substantial bruising, edema, and pain, requiring close monitoring and care.

A surgical procedure that involves splitting the lower jaw bone (mandible) lengthwise to adjust its position and length.

The MSSO procedure typically involves removing or adding small amounts of bone at the split points to achieve the desired jaw length.

Titanium plates and screws are used to stabilize the repositioned jawbone segments after the MSSO procedure.

The airway begins at the external nares and vestibulum oris (mouth), passing through the nasal and oral cavities, nasopharynx, oropharynx, larynx, glottis, and trachea. It then branches into the bronchial tree, ending in the alveoli.

The turbulence created by the turbinates prolongs the time air spends in contact with the nasal mucosa, increasing moisture and heat before reaching the lungs.

Orthognathic procedures, which reshape the bony structures of the face, usually necessitate general anesthesia and nasal intubation.

Before nasotracheal intubation, the anesthetist must assess the patency (openness) of both nares, examining for size differences, septal deviation, airflow restrictions, and unilateral choanal atresia.

Both nares should be prepared for endotracheal tube placement, despite the assessment of nasal passage patency.

Nasal intubation is when a tube is inserted through the nose to help a patient breathe during surgery. It can be dangerous if a patient has a Le Fort II or III fracture because the cribriform plate, which separates the nasal cavity from the brain, could be damaged, leading to potential brain injury.

The cribriform plate separates the nasal cavity from the cranial vault. If it is damaged, placing an endotracheal tube or a nasogastric tube into the nose can directly injure the brain.

Nasal intubation can cause complications like epistaxis (nosebleeds), turbinectomy (removal of turbinates), pressure injury to the forehead, and dental trauma. These can lead to breathing issues, blood aspiration, and even laryngospasm.

Blood loss during maxillofacial surgery can be significant because of the complex procedures involved. It can range from 250 to 1500 mL. If the surgery includes bone grafting, even more blood loss may occur due to the additional incisions and bone harvesting.

The decision to transfuse blood should consider the patient's overall health and the severity of the surgery. Transfusions are usually necessary during moderate and major craniofacial procedures.

Postoperative nausea and vomiting (PONV) is a common concern after maxillofacial surgery, as it can disrupt jaw alignment and increase bleeding. It's caused by factors such as hypotension, hypovolemia, and narcotic administration.

To prevent PONV, medications like gastrokinetic agents (metoclopramide), steroids (dexamethasone), and 5-HT3-receptor antagonists (ondansetron) can be administered. Adequate hydration and pain management are also crucial.

Extensive maxillofacial surgeries often lead to substantial facial and tracheal edema due to fluid accumulation and surgical trauma. This can make breathing and extubation difficult.

Before extubation, carefully check for tracheal edema by deflating the endotracheal tube cuff and assessing for a leak during a positive pressure breath. If edema is present, it's best to keep the patient intubated.

Airway assessment and management are crucial after maxillofacial surgery due to the increased risk of airway obstruction and aspiration. The anesthetist must always be ready to intervene.

A condition where bone tissue dies due to lack of blood supply, often occurring in the jaw after surgery.

Bleeding from the inferior alveolar artery, a major blood vessel supplying the lower jaw, which may occur during or after surgery.

Damage to the mental nerve, responsible for sensation in the lower lip and chin, which can be injured during surgery.

The repositioned jawbone segment may move out of its intended position, requiring additional surgery to correct it.

A condition where the condyle of the mandible, the part of the jaw that connects to the skull, gradually reabsorbs and shrinks after surgery.

Bleeding during or after maxillofacial surgery can be significant due to the procedure's complexity and the rich blood supply in the face.

The loss of blood supply to teeth, resulting in their death, can be a serious complication of maxillofacial surgery.

This happens when gum tissue pulls back from the teeth, exposing the roots. It can be caused by surgical trauma or poor oral hygiene.

When plates or screws used to hold bones together in surgical procedures become visible through the skin, it's called hardware exposure.

After maxillofacial surgery, bones might not heal properly, leading to malunion (bones healing in the wrong position) or nonunion (bones not healing at all).

A rare but serious complication where a direct connection forms between an artery and a vein, leading to abnormal blood flow and potential for heart failure.

An injury that affects the nerve responsible for sensation in the lower eyelid, cheek, and upper lip. It can cause numbness, tingling, and pain in these areas.

A condition where the soft palate doesn't seal properly during swallowing or speech, leading to nasal regurgitation and difficulty with speech.

Inflammation of the sinuses located in the space behind the cheekbones, often resulting in pain, pressure, and drainage.