Salivary glands

There are three main pairs of major salivary glands in the head and neck, namely the parotid, submandibular, and sublingual salivary glands. In addition to these major glands there are numerous minor salivary glands distributed throughout the oral cavity. These minor salivary glands are situated in the adnexal layer of the oral mucosa. This chapter covers the relevant anatomy, physiology, taking a history, clinical examination, and investigations. It then goes on to discuss xerostomia, Sjögren’s syndrome, diffuse and localized gland swelling, sialolithiasis, ranula, and disorders of the minor salivary glands.

Eponyms in OMFS

This chapter contains an alphabetical list of eponyms in oral and maxillofacial surgery.

The temporomandibular joint

This chapter first describes and illustrates the anatomy of the temporomandibular joint (TMJ). It then proceeds to detail the fundamental principles of TMJ disorders (both developmental and acquired), trismus, myofascial pain, temporomandibular joint dysfunction, TMJ replacement, ankylosis, and dislocation. For each topic, useful terms and definitions are introduced and appropriate diagnostic studies are recommended. Treatment considerations are then discussed, including medical management, minor surgical procedures, and open joint surgical interventions. Finally, some of the rarer TMJ disorders are outlined, and these serve as a useful reminder of the range of differential diagnoses that exist for signs and symptoms that arise around the temporomandibular joint complex.

Cleft lip and palate

Cleft lip and palate is the most common facial anomaly in the UK. This chapter describes the cleft lip and palate, alongside their aetiology and diagnosis. It then describes the management of the cleft lip, including principles, surgical options, the unilateral and bilateral cleft lip and palate, and then the management of the palate and alveolus. Revision procedures are outlined. The management of the nose and orthognathic surgery for different cleft types are all outlined. Speech development, hearing, and orthodontics are all covered. Finally, there is a section on psychology, and the importance of a clinical psychologist to monitor important transitional points in the child.

Oral medicine

This chapter covers a disparate group of conditions that may present within the oral cavity, primarily affecting the oral mucosa. Many are common, and will be seen regularly in clinical practice. Others are rare, but awareness is required in order to be able to identify these cases. Some are manifestations of systemic disease, such as gastrointestinal or dermatological disorders; others are localized to the head and neck region. An overview of the common infective conditions of the mouth is included. Finally, the many conditions resulting in facial pain are considered. The aetiology, presentation and management of these conditions is explored.

Aesthetics

Aesthetic surgery can be defined as surgery carried out in an attempt to increase an individual’s beauty. The term is used interchangeably with cosmetic surgery. It is surgery performed on normal individuals purely to improve appearance and, as such, implies that there is no functional or direct health-benefit gain. This chapter includes non-surgical aesthetic techniques, such as Botox®, fillers, and resurfacing techniques, alongside surgical procedures to increase the aesthetics of the face. This includes blepharoplasty, otoplasty, facelifts, liposuction, implants, rhinoplasty, and cheiloplasty. Other considerations, including medicolegal aspects, regulation of cosmetic practice, and training in cosmetic surgery in the UK are included.

Craniofacial surgery

Craniofacial surgery is the subspecialist area of surgery that diagnoses and manages a large heterogeneous group of both congenital and acquired conditions. The common factor is the involvement of the cranium (and its contents) and the face. This chapter first introduces craniofacial surgery and goes on to cover craniosynostosis, single-suture synostosis, syndromic synostosis, torticollis and positional skull deformity, craniofacial procedures, craniofacial clefting disorders, tumours, vascular malformations of the head and neck, hemifacial microsomia, and Treacher Collins syndrome. Finally it outlines the members of the craniofacial team, and the organization of craniofacial services in the UK.

Surgical dermatology

This chapter covers surgical dermatology of the head and neck. It starts with a glossary of the common skin terms, goes on to define the various skin types and effects of ultraviolet radiation, before covering the diagnosis, management, and treatment options of premalignant skin lesions, skin cancer, basal cell carcinoma, cutaneous squamous cell carcinoma, cutaneous melanoma, and other forms of less common skin cancers that can occur in the head and neck. The possible reconstructive options following the excision of tumours are then described. The chapter ends by outlining both the early and late complications that can occur following surgical treatment.

Surgical principles and oral surgery

This chapter begins by discussing general surgical principles, such as informed consent, preventing thromboembolic disease, and preventing infection. It then describes anaesthesia and management of the medically compromised patient. The chapter then covers dentoalveolar surgery, odontogenic infections, and non-odontogenic infections. Biopsy, cysts, and intraoral benign tumours are described. Neoplastic and non-neoplastic bone disorders are then discussed, along with the classic radiographic appearances of jaw lesions. Neck lumps (including cervical lymph nodes, Lymphoma, midline neck swellings, and lateral swellings), facial palsy, and paranasal sinuses are all covered. The chapter ends with a section on osseointegrated implants.

Trauma

Maxillofacial trauma can affect any part of the head and neck and frequently occurs in conjunction with injuries, particularly ophthalmic and neurosurgical. This chapter begins by covering the initial assessment, and then describes advanced trauma life support and facial trauma, and priority setting in polytrauma. It contains a section on how to perform emergency procedures. The initial management of head injuries and ocular injuries are both covered, followed by first aid, antibiotics, and how to manage tetanus. Definitive diagnosis, along with site-specific investigations, are explained, along with principles of management for various traumatic injuries.