The subspecialty of maxillofacial surgery focuses on corrective and aesthetic procedures for the face, jaws, mouth, teeth, and neck.
People may require maxillofacial surgery if they have an injury or disease process affecting their face or atypical facial structures or features.
Procedures in this category include rhinoplasty and microvascular reconstruction. Highly trained dental surgeons perform maxillofacial surgery.
This article explains what maxillofacial surgery is, why people may need it, the general procedure, the risks, and more.
Maxillofacial surgery involves the removal, repair, or readjustment of soft and hard tissues in the face, jaw, teeth, mouth, or neck. It is a surgical specialty recognized by the American College of Surgeons.
Maxillofacial surgeons typically complete 12–14 years of education and may specialize in:
- cosmetic facial surgery
- head and neck cancer
- cranio-maxillofacial trauma
- pediatric maxillofacial and craniofacial surgery
Is a maxillofacial surgeon the same as a plastic surgeon?
Plastic surgeons and maxillofacial surgeons perform many of the same procedures, but they are not interchangeable titles.
Plastic surgeons hold a doctor of medicine degree (MD) or equivalent and may perform reconstructive surgery on other areas of the body, not just the maxillofacial region. Many maxillofacial surgeons have earned both MD and doctor of dental surgery (DDS) degrees, though their practice is limited to the head and neck.
There are many reasons a person may need maxillofacial surgery, including the treatment of certain health conditions, such as:
- jaw misalignment
- tumors or cysts
- facial injury or trauma
- obstructive sleep apnea
- cleft palate/lip
- temporomandibular joint (TMJ) disorders
- severe infection
- broken bones
- bone grafts
The following procedures may also require maxillofacial surgery:
- wisdom tooth extraction
- dental implants
- microvascular reconstruction
- dental prosthetics
What happens before maxillofacial surgery largely depends on why and when that surgery is taking place. In an emergency, such as a car accident, a person may require immediate care without some of the standard preoperative processes.
Dr. Rohan Prabhu, an oral and maxillofacial surgeon from New Brunswick, NJ, indicates that in a nonurgent situation, the first step often takes place with a person’s regular dentist.
Dr. Prabhu told us, “If you were to need oral maxillofacial surgery, your dentist will refer you to an oral maxillofacial surgeon with whom you will have a consultation.”
He also explained that, during the consultation, many things take place, including:
- symptom evaluation
- review of medical history
- update of current medications
- a full examination of the maxillofacial area
- diagnostic imaging
“After a full diagnosis is identified, treatment options will be discussed, and a plan will be made for moving forward,” Dr. Prabhu said.
Depending on a person’s age, health, and need for anesthesia, additional laboratory testing may be necessary.
Blood work, chest X-ray, and electrocardiogram (ECG) are common tests that can help ensure a person’s body will safely handle the stress of being under surgical anesthesia.
For people with chronic conditions, a maxillofacial surgeon may consult with other healthcare team members, such as a:
- primary care doctor
The type of maxillofacial surgery will determine which level of fluid therapy and anesthesia a person requires.
Intravenous (IV) fluid therapy may be necessary if the procedure is lengthy or a person has underlying health concerns.
Fluid therapy serves as a way to support cardiovascular function during anesthesia and can help people recover from the effects of sedation post-operatively.
The four types of anesthesia are:
- general (deep) anesthesia
- IV sedation (conscious sedation)
- regional anesthesia
- local anesthesia
Extensive procedures, such as jaw repair, require general anesthesia, which doctors give using an injection or mask.
Not all maxillofacial surgeries require general anesthesia. Some, such as wisdom teeth removal, may only require local anesthetic or conscious sedation.
“Given the nature of maxillofacial surgery, a breathing tube through your nose is often necessary, which will be decided upon between the anesthesiologist and the surgeon and explained to you in the preoperative period,” said Dr. Jaclyn Tomsic, an oral and maxillofacial surgeon from Cleveland, OH.
Dr. Tomsic explained that once a person enters the desired plane of anesthesia, the maxillofacial surgeon accesses the areas of concern through the skin or the interior of the mouth.
“You will be under general anesthesia with a breathing tube, so you will not remember or feel any part of the surgery.”
Once a surgeon is satisfied with the surgery, they will administer wound care appropriate for the procedure. This may include using stitches or gauze packing to absorb discharge or blood.
If a person received sedation or general anesthesia during the procedure, they will likely be transferred to a quiet recovery suite while the effects of the anesthetic wear off.
During this time, the healthcare team may administer pain management medications, maintain fluid therapy, and monitor the person’s vitals.
Some facilities may provide heated blankets to warm a person as their body regains thermal regulation that anesthesia may depress.
When a person is alert and can meet specific performance markers, such as walking or using the bathroom, they will be eligible for discharge.
Some surgical procedures may require a stay in the hospital for several days.
Dr. Tomsic explains, “The most common complications include general post-op pain, swelling, bleeding, infection, and the possible need for further procedures and follow-ups, which are common with most surgeries.”
- excessive bleeding/hemorrhage
- nasal deviation or nose widening
- TMJ disorder
- persistent pain sensations
- nerve injury
- shifting of other maxillofacial structures
- facial numbness
- tooth loss
- dry socket
Dr. Prabhu told us of one particular complication to look out for: “Developing a dry socket, which is when a blood clot is not formed or dislodged after tooth extraction. This can cause severe pain.”
There are also potential risks anytime a person has anesthesia, which also applies to maxillofacial surgery.
Presurgical laboratory tests and diagnostic imaging can help assess a person’s anesthetic risks.
Dr. Tomsic advises rest for the first 3–5 days with light activity for the following 2 weeks or more, depending on the type and intensity of the surgery.
During the first 48–72 hours, applying an ice pack may be necessary to help reduce pain and swelling, along with using any prescriptions to manage pain or infection.
“Most maxillofacial surgeries will require a soft or liquid diet for the first few weeks due to the nature of the body part being operated on,” Dr. Tomsic adds.
Dr. Prabhu recommends using an approved mouth rinse to help reduce bacteria inside the mouth during recovery.
At the time of surgical discharge, doctors may send a person home with a list of symptoms to watch out for specific to their procedure.
If a person experiences the following warning signs, they should contact a doctor:
- extreme or progressive pain
- new, painful, or spreading swelling
- abnormal amounts of drainage
- pus-colored drainage
- inflamed, red, or irritated surgical site
- popped stitches
- new symptoms
Addressing questions or concerns as soon as possible may prevent post-surgical challenges from progressing to serious complications.
Sepsis and septic shock, which are systemic reactions to bloodstream bacterial infection, can be life threatening. They may begin as subtle signs of infection and develop quickly if a doctor does not diagnose and treat them early.
Many maxillofacial surgeries can be uncomplicated, one-time procedures.
The outlook for others, such as those addressing cancer concerns, may vary depending on your overall health, stage of cancer or disease, age, and other contributing factors.
A maxillofacial surgeon can discuss the pros, cons, and outlook with a person before they undergo surgery.
Maxillofacial surgery involves any reconstruction, removal, or repair related to the neck, jaw, mouth, teeth, and face.
Though it is considered a specialized form of dentistry, maxillofacial surgeons are skilled in anesthesia, pain management, wound care, and soft tissue techniques.
A general dentist may refer an individual to a maxillofacial surgeon for issues such as impacted teeth, jaw realignment, and rhinoplasty.
A healthcare team will provide information based on a person’s specific surgical procedure.