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.

Odontogenic Infections: General Principles

When the host defense mechanism is low, a highly virulent pathogen from a decayed tooth, either through a periapical or periodontal route, may get an environment that favours it growth, leading to odontogenic infection that follows the path of least resistance. Such an infection may spread locally into various facial spaces or may present systemic involvement, leading to mild, moderate or severe infection. Management of such infection involves assessment of the cause, severity, hosts immune response, removal of the cause, surgical intervention including drainage along with pharmacotherapeutics and regular follow ups till it is completely resolved.

Medicolegal Issues in Maxillofacial Surgery

Every profession is governed by a set of rules and regulations, and the same applies to the field of maxillofacial surgery. The young surgeon must therefore be aware of what legal requirements he/she must fulfil while practising the profession. Maxillofacial surgery is a challenging field that straddles both medicine and surgery, and therefore surgeons must be very aware of the legal scope of this field. Record keeping such as the informed consent and procedure notes are important legal requirements and must be maintained to provide legal proof of service and respect patient’s rights Maxillofacial surgeons play an important role as expert witnesses in cases of violence that have affected the head and neck region. In addition to all these legal requirements, the maxillofacial surgeon is also extremely vulnerable to civil or criminal litigation in the form of negligence. Surgeons must be aware of their duties and rights. They must also be familiar with legal issues like negligence and how to deal with it.