Cleft Lip

Many techniques exist at present for surgical repair of primary cleft lip. Since the introduction of Millard, most of the techniques are based on Millard’s Rotation advancement principle. However, every cleft surgeon aims to modify his/her technique to achieve optimum symmetry and function of the nose and lip. In this chapter, we have presented the principles of lip repair followed at our centre based on the very principles of Millard. We have also discussed embryology and anatomy from a surgical pint of view so as to understand the anatomic basis if cleft surgery.

Trigeminal Neuralgia

Neuralgia can be defined as paroxysmal, intense intermittent pain that is usually confined to specific nerve branches to the head and neck. The trigeminal nerve is responsible for sensory innervation of the scalp, face and mouth, and damage or disease to this nerve may result in sensory loss, pain or both. >85% of cases of Trigeminal Neuralgia are of the classic type known as Classical Trigeminal Neuralgia (CTN), while the remaining cases can be separated to secondary Trigeminal Neuralgia (STN). STN is thought to be initiated by multiple sclerosis or a space-occupying lesion affecting the trigeminal nerve, whereas the leading cause of CTN is known to be compression of the trigeminal nerve in the region of the dorsal root entry zone by a blood vessel. There is no guaranteed cure for the condition of Trigeminal Neuralgia, but there are several treatment options that can give relief. In this chapter, we review the common neuralgias occurring within the oral and maxillofacial region with special emphasis on Trigeminal Neuralgia. We will discuss the historical evolution of treatment including the medical and surgical modalities with the use of current literature and newer developments. It has been highlighted that the first line of treatment for trigeminal neuralgia is still pharmacological treatment, with Carbamazepine and Oxcarbazepine being the first choice. Possible surgical methods of treatment are discussed within this chapter including modalities such as Microvascular Decompression, Gamma Knife Radiosurgery and Peripheral Neurectomy. As an OMF surgeon, it is important to obtain a good clinical history to rule out other pathology including dental focus. Many clinicians involved ranging from primary care dentists and doctors to secondary care (neurologists, Oral Medicine, OMFS, etc.) to deliver the appropriate first course of action, which is the medical management. The management of TN patients should be carried out in a multidisciplinary setting to allow the patients to choose the best-suited option for them. It is also important to set up self-help groups to enable them to share knowledge and information for themselves and their family members for the best possible outcomes.

Salivary Gland Pathologies

Saliva is responsible for various functions from lubrication to digestion. The saliva is secreted by numerous minor and major salivary glands. These salivary glands are sometimes affected by various local and systemic inflammatory conditions, obstructive pathologies with benign and malignant tumors. This chapter deals with various pathologies of salivary glands and their management.

Computer-Assisted Navigation Surgery in Oral and Maxillofacial Surgery

Computer-assisted surgery (CAS) and navigation offers significant improvements in patient orientation and safety in every facet of our specialty of maxillofacial surgery. Ranging from precisely planned orthognathic procedures to the removal of foreign bodies requiring extremely flexible surgical options, and from minimally invasive dental implantology procedures to radical tumor resections of the skull base, they have made their mark for improving the procedure safety, predictability, and accuracy of surgery and options for intraoperative adaptations. In the future, the application of CAS is expected to further reduce operative risks and surgery time, accompanied by a considerable decrease in patient stress.Navigation systems are effective for delicate and accurate oral and maxillofacial surgery, neurosurgery, otolaryngology, and orthopedic surgery.This section presents an overview of available navigation systems and their applications with a focus on clinical utility and the solutions they offer for problems/challenges in the field of oral and maxillofacial surgery.

Pharmacotherapy in Oral and Maxillofacial Surgery

The field of pharmacology has always fascinated medical professionals—the ability to cure a disease by prescribing medicine is very tempting. Medical and surgical specialties benefit from the correct use of drugs, and oral and maxillofacial surgery (OMFS) is no exception. Antibiotics, analgesics, and anti-inflammatory drugs are among commonly prescribed medicines in a maxillofacial surgical practice. Umpteen number of literature studies are available on the usage of these medicines in maxillofacial surgery. A review of literature is attempted in this chapter to reach a consensus in matters pertaining to these drugs. The task was in no way an easy one as no two studies compared the same group of medicines or similar pharmacological properties. The key facts, which have emerged from this literature search, have been projected in this chapter.

Cleft Maxillary Hypoplasia

Cleft lip and palate patients are born with a challenging deformity that requires multiple surgical interventions in order to reach functional and esthetic harmony. Mid face deficiency in cleft patients is a challenging clinical problem very often encountered in the management of this congenital defect. Cleft maxillary hypoplasia can be attributed to the inherited traits, acquired traits and Induced traits. CLP patients usually present with symptoms varying from malocclusion, retrusion of midface, and a narrow hard palate. A detailed evaluation and individualized treatment planning is of utmost importance in dealing with these patients. Treatment involves the contribution from both the orthodontist and the craniofacial team. The goals for the treatment for cleft maxillary hypoplasia are improvement of aesthetic deficits as well as correction of malocclusion.

Hemifacial Microsomia (HFM) and Treacher Collins Syndrome

Hemifacial microsomia and Treacher Collins syndrome are two entities which arise as a consequence of abnormal development of first and second branchial arches in utero. As a result, these dentofacial deformities present with abnormal facies especially the maxilla and mandible. They may also occur as part of other syndromes and may involve other structures of the body. In this chapter, we have discussed the etiology, clinical features, radiological assessment and treatment planning of such cases. Special emphasis should be made on early diagnosis, challenges of airway management and feeding and parental counselling. Since the two deformities are largely considered to be non-progressive, early distraction plays an important role in correction of the dentofacial deformity in these patients.

Cysts of the “Oro-Maxillofacial Region”

Cysts of the Oro-Maxillofacial region have common occurrence in comparison to any other parts of the body. These can be true cysts or pseudocysts and can be found in the jaw bones or in the soft tissues. Cysts are of various types, and over the years, various classifications are put forward, which are helpful to identify each cyst, based on its origin and its clinical and histopathological presentation. Based on the classification, one can also decide the treatment plan accordingly. The classifications are given by various researchers and also by WHO. In this chapter, various odontogenic and nonodontogenic cysts and their treatment aspect are discussed in detail.

Principles and Techniques of Exodontia

Dental extraction is a routinely carried out procedure in any dental set up. Even after the tremendous progress in the fields of preventive and restorative dentistry, exodontia remains to be a vital procedure. The increase in the public awareness regarding retaining their natural teeth has made exodontia an even more challenging procedure as more extractions are being carried out in elderly patients. With the increasing average age, the difficulty and complexity of the extraction procedure increases.This chapter exhibits the general overview of the challenging procedure called exodontia highlighting its various aspects like indications, contraindications, complications, etc. with a special mention about the procedure to be carried out in different scenarios and various technological advances in exodontia.

Management of Impacted Canines

Impacted canines are one of the common problems encountered by the oral surgeon. Patients may present at different ages and many cases will be incidental findings. Close interaction with the paedodontist and orthodontist is required to get an optimal outcome. Surgical removal may not be the best treatment in all the cases and particular treatment plan will have to be tailored for the needs of the patient. Localizing the impacted canine seems not a challenge any more with the advent of CBCT, in indicated cases. This chapter elaborates on canine impaction, keeping in mind the basic principles mentioned in the chapter on third molar impactions. Premolars, incisors and other teeth may be impacted but most of the surgical principles and approaches mentioned for canine can be applied to them as well.