Craniofacial, Maxillofacial, Sleep Apnea Blog

What is Orthognathic Surgery and How Can it Help Improve Facial Deformities

August 19th, 2010

Orthognathic surgery combines maxillofacial surgery or jaw surgery with orthodontics. The ideals of this type of surgery are to improve one’s bite and make chewing easier. The surgeries done are designed to correct misalignment of the jaw and make the jaw fit together properly. Facial imbalances such as an underbite, overbite or cleft palate can be corrected using orthognathic surgery. Orthodontics are used to correct malocclusions of the teeth and to improve gummy smiles, where large areas of gums are showing when a person smiles. TMJ disease can be corrected or prevented using orthognathic jaw surgery. Patients who have jaw problems that can’t be treated with orthodontics alone have orthognathic surgery to correct the jaw abnormality so the teeth work properly.

Surgery on the upper jaw is called a maxillary osteotomy and surgery on the lower jaw is called a mandibular osteotomy. A patient can have one or both of these surgeries at the same time in order to correct the alignment of the upper and lower jaw and to improve the functionality of the upper and lower jaw. The surgery is generally done using incisions inside the mouth so that there is no external scarring visible.

The term “orthognathic surgery” was first coined by Dr. Harold Hargis, a Doctor of Dentistry. He was the first to consider cleft palate as part of orthognathic surgery. The surgery is used to treat dental problems that can’t be treated with orthodontic treatments alone. Bones are cut and re-aligned and then held in place as part of the surgery using screws, plates or screws.

The various indications for orthognathic surgery include the following:

  • Discrepancies between the upper and lower jaw alignment, which can be vertical, transverse or antero-posterior
  • Facial skeletal abnormalities that result in airway problems, sleep apnea or soft tissue problems
  • TMJ pathology that causes facial skeletal discrepancies.

Orthognathic surgery is done by an oral and maxillofacial surgery specialist or a craniofacial surgery specialist and is aided by an orthodontist who straightens and aligns the teeth. Braces are often placed before the surgery and after the surgery are complete. There are retainers used as well, often after the braces are completed and removed. Orthognathic surgery is also a part of repairing cleft lips and cleft palates. The orthodontist and the orthognathic surgeon work together to align the bite and teeth.

The surgeon who does orthognathic surgery needs to have training in dentistry as well. Oral and maxillary surgery specialists are often trained in dental procedures so they can identify what is a normal bite and how to achieve one. This allows the maxillofacial surgery specialist to work best in conjunction with the orthodontist to achieve the best in a normal bite.

Orthognathic surgery requires a great deal of planning by a multidisciplinary team. Sometimes a speech and language therapist is included along with the maxillofacial surgery specialist and the orthodontist. There may need to be molds of the face created so the anatomy of the person’s face is well understood and the surgery can be planned. X-rays need to be taken as well as photographs and software exists that can predict how the person will look after the proposed surgical procedure. The patient can see what he or she will look like after the procedure is over with.

The primary goal of orthognathic surgery is to get a normal bite and a face that looks as pleasant as possible. The airway may need to be enlarged. In fact, orthognathic surgery can correct obstructive sleep apnea in 90 to 100 percent of cases. Both the upper and lower jaws may need surgery in order to enlarge the airway. A nasal tube is used to intubate the patient because the mouth needs to be easily accessed. Bones are cut for greater patency of the airway and the individual can breathe more easily in their sleep.

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Nasal Reconstruction for a Healthier Look and Better Good Night Sleep

July 28th, 2010
Nasal Reconstructive Surgery

 

Nasal reconstructive surgery is performed on the outside or the inside of the nose. It is a common surgery seeking to accomplish the following:

1) Repair injuries to the nose

2) Change the size or shape of the nose

3) Improve breathing

4) Correct congenital or acquired deformities

Several factors will be considered when deciding which type of nasal surgery is needed. They are:

1) Age and overall health

2) Preference of procedure and rehabilitation

3) Severity of the deformity

There are several different types of nasal surgery, each one correcting or repairing the anatomy of the nose to reach a function or cosmetic goal.

The following procedures correct the most common nasal issues:

Septoplasty

Correctable Symptoms:

Stuffy nose on one or both sides

Nose bleeding

Postnasal Drip

Headache or face pain

Sinus infection

Noisy breathing during sleep

Surgery:

Septoplasty surgery corrects defects and deformities of the nasal septum (the divider between the nostrils) or rebuilds it if it is damaged. The actual procedure involves trimming or removing bony spurs if present. The cartilage is then repositioned back to its original position. Bone is also centered to achieve straightening and better airflow. It is performed through the nostrils without any outside incisions.

Benefits:

Increased airflow and a straightening in the overall look of the nose.

Turbinectomy

Correctible Symptoms:

Chronic dryness within the nose

Inflammation

Loss of airflow leading to breathing problems

Dizziness

Chronic nasal infections

Diminished quality of life

Often clinical depression

Surgery:

Surgeons used to remove the enlarged inferior turbinates and the surface mucus lining together. Patients would then complain of feelings of obstruction. The physician would then examine the patient and see they had adequate air flow. The problem causing the patient discomfort was the removal of the surface mucus lining. There were no airflow receptors left to tell the brain that there was indeed air flowing through the nose, just a perceived feeling of an obstruction. Therefore, instead of turbinate removal, surgeons now perform a turbinate reduction and out fracture.

Benefits:

Relieve nasal blockage and restore normal breathing and function.

Minimize bleeding, crusting and pain

Allergies and hay fever

Internal and External Nasal Valve Collapse: with Alar Grafts and the use of Spreader Cartilage as part of the surgical component

Correctible Symptoms:

Compromised air flow

Gradually worsening nasal obstruction

External nasal deformity

Surgery:

With surgery of the nasal valve, the proper procedure will be dictated by properly identifying the anatomic cause of the collapse. This is done by first performing an external exam of the nose and taking a thorough history. If the patient sees improvement in air flow through the use of Breathe Rite Strips or “lifting the cheek” the suggestion is possible nasal valve collapse.

Spreader grafts are used to correct internal nasal valve collapse. This is between the nasal septum and nasal side walls just above the nostrils. If the angle formed between the septum and the side wall is less than 15 degrees, there is a high incidence of nasal collapse during inspiration of air. Spreader grafts are fashioned from septal cartilage and place between the septum and nasal side walls internally to increase the angle between them.

Alar batten grafts have been especially successful in external nasal valve collapse when caused by a weak nostrils. At times if a patient has had prior rhinoplasty and is experiencing excessive retraction and collapse of the area around the nose, then alar batten cartilage may be required. The graft is usually fashioned from harvested auricular or septal cartilage and placed in a precise pocket to support the structure of the nostrils. Currently alar batten grafts are the most popular method of correcting external nasal valve collapse.Benefits:

Patient will experience better overall airflow and less obstruction. Also, an aesthetic improvement will be seen.Post-Surgery:

Finally, healing for most nasal reconstructive surgery is slow and gradual. Some swelling could be present for months, especially in the tip of the nose. With increased airflow and improved aesthetics in the shape of the nose, nasal reconstructive surgery is a quality of life enhancing procedure.

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Craniofacial Syndromes and Deformities

July 22nd, 2010

Craniofacial syndromes and deformities are conditions of the head and face that are generally inherited and/or congenital. They result when the growing bones of the fetal head do not fuse properly together, forming an abnormally-looking head and face. The head fails to expand at the right rate and it can be too small, too large or parts of it can be disproportioned. Some are associated with developmental delay, while others are associated with normal intelligence. Some have their craniofacial abnormality as an isolated part of their problems, while others have deformities or physical ailments of other body areas.

One type of craniofacial syndrome is called acrocephalosyndactyly. There are many syndromes associated with acrocephalosyndactyly. One of them is Apert syndrome. Apert syndrome is rare, occurring in 15.5 per one million births. There is crowning of the infant skull, hypertelorism (or widening of the eyes) and fusion of one or more digits. In Apert syndrome, the skull prematurely fuses so normal brain growth and facial development cannot happen.

In Crouzon syndrome, a craniofacial abnormality, befalls 15.5 out of every million births. The skull is wide and the forehead is high. There is hypertelorism, eyeball protrusion, problems with airway obstruction and an underdevelopment of the upper jaw. There can be developmental delay or relatively little developmental delay.

Pfeiffer syndrome is an inherited disorder that involves several dental, soft tissue, and craniofacial abnormalities. It usually reveals itself as having acrocephaly, brachycephaly, hypertelorism, a beaked nose and a cleft or high palate. Delayed mental abilities and hearing loss are common. Other facial abnormalities are more rare.

In Carpenter syndrome, another rare craniofacial syndrome, also belongs to the category of acrocephalosyndactyly or ACPS syndromes. The fingers are fused together in some places and there is premature closure of the sutures between the bones of the skull. This is called craniosynostosis. The head is cone shaped or pointed.

Another syndrome, Jackson-Weiss syndrome, patients have a normal intelligence and live long. They have large big toes and large widely spaced eyes. The skull is misshapen and the forehead is bulging. Some patients just have the foot abnormalities and don’t have any facial abnormalities.

Saethre-Chotzen syndrome is another of the craniofacial syndromes. It involves premature closure of the coronal suture that runs from ear to ear. The shape of the head is not normal and the forehead is high. The frontal part of the hairline is low and the child has eyelids that droops (a condition called ptosis). The two sides of the face can become mismatched and the ears are small and shaped in an unusual way. This is a hereditary condition that also affects the fusion of fingers of the hands, especially between the second and third finger. The toes can be fused a well. Intelligence is normal. There is a related condition, called Robinow-Sorauf syndrome that used to be just similar to Saethre-Chotzen syndrome. Now it is considered as being a variant of Saethre-Chotzen syndrome.

Hemifacial microsomia involves a face that is normal on one side and small on the other side. The teeth can fit completely wrong and one ear is smaller and not in the right position when compared to the other. There can be hearing loss on one or both sides and significant psychosocial issues as the individual does not look at all normal.

Goldenhar syndrome is a disease involving the face, eyes and ears. There can be vertebral abnormalities as well. It occurs in one in 3000-5000 births. There is facial asymmetry because one side has failed to grow when compared to the other side. The eyes look abnormal and there are soft tissue tags on the face along a line between the middle of the ear and the corner of the mouth. There can be hearing loss, heart problems and other abnormalities.

Treacher-Collins syndrome affects one in 50,000 births and there are abnormalities of the mouth, including a high arched palate, abnormalities of the nasal cavities and problems with the neck. The jaw is abnormal and there are obvious dental problems. The ears and eyes grow abnormally a do the ears. Nager’s syndrome is considered to be a variant of Treacher Collin’s syndrome.

Velo-cardio-facial syndrome or VCFS is a genetic condition that involves a partial deletion of chromosome 22. Children born with this have heart problems, problems with facial appearance and an underdeveloped or absent thymus gland. It is clinically related to DiGeorge syndrome.

Some of the craniofacial syndromes are obvious at birth, while some don’t show up for several months. It obviously worsens as the head grows because it increasingly grows abnormally. The best time to diagnose craniofacial abnormalities is during the first year of life, when the head is growing the fastest. It can be clinically diagnosed or it can be diagnosed using a CBCT scan of the head and face to show abnormal suture patterns and facial bone formation. An accurate diagnosis is not always easy, in part due to the fact that there are a number of related craniofacial abnormalities. Genetic testing also plays an intricate roll in diagnosis of craniofacial syndromes.

The treatment of craniofacial abnormalities depends on the condition and on what can be done to correct the physical defects. Surgery can be very intense and involve correction of bony abnormalities and recontouring of the bony structures of the head and face. Patients will require multiple surgeries through out there life time by multiple surgical specialties. With today’s advances in low dose 3D cat scan (Cone Beam CT) and 3D facial photography and software systems (3dMD), surgeries can be treatment planned on the software as a virtual surgery to see the finial outcome. This tremendously assists patient and family members better understand the treatment plan as well as give surgeons a precise tool in preparing for the surgery to be performed.

To learn more about Craniofacial Surgery visit the Cranio-Maxillofacial Surgical Institute of Beverly Hills CA.

Article Source: http://EzineArticles.com/?expert=Corbin_Montgomery

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What is Obstructive Sleep Apnea and Basic Treatments

July 9th, 2010

Sleep apnea (also called sleep-disordered breathing or Cheyne-Stokes breathing) is a common condition in which a person’s breathing becomes shallow or even stops completely during sleep, and the complete halting of airflow is called apnea. Each instance of halted breathing can range in duration from seconds to minutes and may occur once each hour or as many as 100 times each hour. Sleep apnea is a chronic condition and sufferers may experience impaired nighttime breathing three or more nights each week.

MOST COMMON FORM

The most common form of apnea is called obstructive sleep apnea (OSA), and it is caused by the person’s airway (which consists of the nose, mouth, throat, and windpipe) narrowing or completely closing during sleep. People with obstructive sleep apnea often snore loudly as they try hard to breathe and air is forced past the blockage in the airway. Obstructive sleep apnea can affect anyone but most often develops in overweight people because additional fatty tissue can cause the inside of the windpipe to narrow.

As a person’s breathing becomes shallow or stops completely, the amount of oxygen reaching the lungs decreases and, as a result, the amount of oxygen in the person’s blood decreases. When the blood oxygen level becomes dangerously low, it triggers the brain to interrupt the sleep process, and the person moves from a deeper level of sleep to a lighter one. This interruption causes the upper airway to open to its usual width and normal breathing resumes, often signaled with a loud gasp or snort. As the person drifts back to a deeper level of sleep, the muscles of the upper airway relax again and the cycle repeats.

IF LEFT UNTREATED…

While disrupted, poor-quality sleep is the initial result of obstructive sleep apnea, if left untreated, the condition also puts sufferers at elevated risk for diabetes, stroke, obesity, heart attack, and high blood pressure. Untreated sleep apnea makes people more likely to develop an irregular heartbeat or heart failure, and increases the likelihood of being involved in accidents while driving or at work.

TREATMENTS

Treatments for obstructive sleep apnea include changes to the person’s lifestyle such as smoking cessation; avoiding use of alcohol, or medications that cause drowsiness; losing weight, and sleeping on one’s side.

Many people use a CPAP (continuous positive airway pressure) machine at night to deliver air directly into the throat. The air pressure is carefully adjusted so that it is strong enough to keep the airway open without being disruptive to the sleep process.

Surgery is beneficial for certain people. Some procedures widen the airway passages by removing, reducing, or adding rigidity to soft tissues in the mouth and throat, while other procedures reposition the lower jaw.

OSA can be very disruptive to a person’s life. Left untreated, it can cause serious health problems. Fortunately, there is help available and working with a healthcare professional to diagnose the cause and choose the best treatment can safeguard a person’s health and restore their quality of life.

To learn more about obstructive sleep apnea visit the Cranio-Maxillofacial Surgical Institute of Beverly Hills.

Article Source:

http://EzineArticles.com/?expert=Corbin_Montgomery

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