Oral and Maxillofacial Surgery

The procedures requiring general anesthesia are performed at the Hospital São João Batista (www.hsjb.com.br), in the city of Criciúma – Santa Catarina.

Responsible for all the monitoring and evaluation of the implementation of anesthesia, pre-anesthetic General itself and for monitoring postoperative, are an essential part in securing the safety of the procedure and in pain control, providing an immediate postoperative period quite comfortable.

The buccal cavity biopsies performed in the clinic may be total or partial character. They are performed in any kind of injury since characteristics that differ from normal patterns of the tissues of the oral cavity, be they hard tissue (bone) or soft (gums, mucous membranes, salivary glands, etc.).

When performed in a total way, the result of the anatomopathological examination is awaited to define if the treatment was really conducted completely.

When performed partially, after the result of the anatomopathological examination, a surgical planning is established according to the result for the total removal of the pathology.

For your convenience, the clinic is responsible for conducting your lesion to the anatomopathological examination until the result is released.

The surgery of the temporomandibular joint (TMJ) is indicated when there are problems in one or more components of these joints, proven through diagnosis with magnetic resonance imaging (MRI). Similar to other joints in the human body, such as the knee, shoulders, the components that make up the temporomandibular joint may be injured and only be passable of recovery through surgical treatment.

Many professionals treat TMJ pathologies only clinically through muscle relaxant plates that must be used by the patient for a good part of the day. This treatment is correct if the diagnosis of the pathology involving the joint is also correct. In some cases, the structures of these joints are so injured and displaced that the treatment to conduct the installed pathology in the TMJ is unique and exclusively surgical.

Oral pathology surgery is understood as any surgery conducted in the oral cavity for the removal of structures that interfere with the patient's well-being and the conduction of treatments conducted by other professionals who work in this region: Orthodontists, Head and Neck Surgeons, Periodontists, etc.

Among these procedures, we can cite the removal of lingual and labial frena, extraction or traction of included and impacted teeth, conventional tooth extractions, abscess drainage, etc. Also included in this subdivision is the definitive treatment of lesions that were biopsied in a partial way: cysts and tumors (benign or malignant) of odontogenic or non-odontogenic origin, dysplasias of the oral cavity, etc.

 All pathologies of hard and soft tissues of the bucomaxillofacial region, including included teeth.

The orthognathic surgery, as the name suggests (orthos = correct / gnathus = jaw), is a surgery performed on the middle and lower thirds of the face to correct the defective positioning of the bones in this region. Although it is a surgery of refined technical complexity, it can be performed with great predictability and safety.

A multidisciplinary team composed of anesthesiologist, bucomaxillofacial surgeon, nurses, nutritionist, orthodontist and psychologist provides patients with a pre, trans and postoperative period calm and comfortable.

This type of surgery is indicated for patients who have any type of discrepancy between the maxilla and mandible, whether in a mild, moderate or severe way, causing malocclusion, that is, the bite does not fit properly. The patient presents a change in the entire physiology of the stomatognathic system: speech, swallowing, breathing, chewing. Only surgery restores normality to these functions.

Another indication is given to patients who have obstructive sleep apnea syndrome. In these cases, the advancement of the maxilla and mandible that orthognathic surgery provides, has the capacity to eliminate the obstruction in the posterior airway, because all the musculature of this region advances concomitantly to the advance of the bones.

The clinical treatment of obstructive sleep apnea with mandibular advancement plates depends on the use of it. At the moment the patient suspends the use of the plate already occurs the return of the apnea episodes. Therefore, orthognathic surgery in these cases is the definitive treatment.

For patients who have the paranasal region and nasolabial sulcus deep, causing an appearance of premature aging of the face due to the presence of a very marked nasolabial fold, surgery is indicated for the installation of Porex prosthesis to Increase the Volume of the Paranasal Region.

The installation of the prosthesis (which has several sizes) causes an increase in volume in the local, stretching and projecting the soft tissues.

The patient rejuvenates, improving the appearance of the region definitively, through a surgical procedure of unique time, without having to constantly undergo facial fillings in the nasolabial sulcus region, which must be performed each time the tissue volume disappears with the absorption of the filling by the organism.

One of the advantages of this Porex prosthesis for the paranasal region is that it increases the volume of the paranasal region, causing positive but discreet changes in the nose, unlike the maxillary advancement through orthognathic surgery, which causes positive but significant changes in the nose.
Therefore, it is the perfect option for patients who do not have an indication for orthognathic surgery or who have a slight or moderate sinking of the paranasal region and who would like to have a face with a more natural, beautiful, young and harmonious appearance.

Patients with a cleft lip (cleft palate) who do not need to undergo orthognathic surgery or who would like to have their facial appearance improved while waiting for the right age to undergo surgery may have this procedure indicated temporarily (they stay with the prosthesis until the orthognathic surgery) or definitive (they do not remove the prosthesis, as they do not need other surgical procedures on the face)

This surgery is performed due to the aesthetic advantages it provides to the patient's face in a discreet, natural and anatomical way.

It is a pre-shaped polypropylene prosthesis in several sizes to be fitted to the chosen bone of the face, providing a contour of the same in a beautiful and elegant way. These prostheses fill the spaces causing a stretching of the skin preventing plastic surgery for facial lifting.

Without any extraoral scar (the surgery is performed entirely inside the mouth), the prostheses are fitted into the chosen site and, due to their microporosity, they become absolutely natural in relation to the underlying tissues, due to the incorporation of these tissues into the prosthesis.

You can leave the contour of the mandibular angle more prominent, increase the zygomatic region (cheekbone), reduce very deep mentolabial and nasolabial sulcus, etc.

Unlike fillings, the prostheses provide a definitive result, not needing maintenance (however, it can be removed if the patient is not satisfied with the result).

Obstructive sleep apnea syndrome is a syndrome characterized by snoring, gasping breathing and pauses in breathing during the night due to an obstruction of the upper airway. The cause is a relaxation of the musculature in this region, causing its collapse and preventing the passage of air to the lungs. It is characterized by several signs and symptoms:

+ Attention deficit

+ Headaches (especially upon waking)

+ Daytime sleepiness (regardless of the number of hours slept)

+ Snoring and gasping breathing

+ Increased blood pressure

+ Lethargy, malaise and fatigue

+ Dry throat upon waking

+ Sore throat

+ Light sleep

+ Depression

Treatment includes weight loss, use of devices to make the air pressure positive during the night (CPAP) and devices that provide mandibular advancement. However, some patients, especially those with severe apnea, may have their case solved only through surgery to advance the facial bones (orthognathic surgery). 

Although the surgery to advance the facial bones is technically similar to orthognathic surgery, it can be performed without any aesthetic involvement for the patient's face, that is, there are no significant changes in the appearance of the face.

It is a safe procedure, performed at the hospital level, but involves the participation of ALL our multidisciplinary team: anesthesiologist, bucomaxillofacial surgeon, psychologists, nutritionists and nursing team.

The clinical results are gratifying and provide well-being and quality of life to the patients operated.

http://abcnews.go.com/Health/Hypertension/sleep-apnea-heart/story?id=16401036

Periodontal plastic surgery is indicated for patients who have a smile with excessive gum exposure or who have an unevenness between the gingival margin of the teeth.

This technique has been widely used lately because it provides an increase in the dental size upwards, making the smile more harmonious and natural. It is a surgery under local anesthesia, performed in the clinic itself. There is always the realization of a virtual planning so that the patient can visualize in advance the result of their smile through a simulation of the same.

In some cases, there is a tooth under the gum and only the plastic is indicated. When the dental root is exposed after the plastic, porcelain veneers are indicated to cover the teeth.

However, very severe cases of gummy smile can only be treated through orthognathic surgery.

Responsible for the DIAGNOSIS, INDICATION, PLANNING, EXECUTION ITSELF AND SHORT, MEDIUM AND LONG TERM POSTOPERATIVE FOLLOW-UP of patients undergoing interventions in the bucomaxillofacial region.

For severely resorbed maxillae and mandibles, bone grafting from the iliac crest is indicated in order to recover all the bone lost over the past years with the absence of teeth.

Although some professionals have the opinion that it is a very invasive surgery, for SEVERE defects of the maxilla and mandible it is the most indicated bone rehabilitation due to its cost-benefit. Filling the bone absence in resorptions of this magnitude with biomaterials ends up being a very expensive alternative due to the cost of this type of bone substitute in Brazil. Biomaterials are ideal for bone reconstructions of mild and moderate resorptions.

With adequate planning and the assistance of our multidisciplinary team, the patient undergoes this surgery in a very safe and predictable way. In addition to the advantage of being able to provide as a donor material your own bone, which is rich in osteoconductive and osteoinductive cells from your own organism (autogenous bone).

Responsible for addressing the entire issue of oral motricity in the pre and postoperative periods in surgeries, such as orthognathic surgery, which provides a considerable facial change, the speech therapist is fundamental in the follow-up before and after the operation, because this procedure repositions all the musculature of the face and oral cavity from the bone correction provided by the surgery.

The exercises are passed individually for each patient, anticipating their recovery. A lymphatic drainage of the soft tissues is performed, minimizing the postoperative edema, rehabilitating the musculature of the operated site more quickly and effectively, normalizing the functional and aesthetic region.

      Os implantes foram desenvolvidos para serem os substitutos das raízes dos dentes que por algum motivo devem ser condenados. Eles repõem de uma forma natural o dente ausente. Quando são de titânio puro não causam rejeição porque este metal é 100% biocompatível ao corpo humano.

      Mantendo a filosofia de primar pela utilização do que há de mais moderno e eficaz na odontologia, a clínica trabalha somente com o implante da marca alemã Ankylos™. Desde a fundação da clínica o implante eleito para a confeção dos casos clínicos é o Ankylos™ em virtude da estabilidade e beleza que a qualidade e o desing deste implante proporcionam.

Veja nos links abaixo, algumas características deste implante:

http://www.dentsply.com.br/isogesac/hiso_consultaanexo.aspx?1,2891,20111110164134,1

Muitos casos de reabilitação das ausências dentárias com implantes devem ter a porção óssea e gengival recuperadas previamente ou concomitantemente à realização do implante. Quando não diagnosticadas estas ausências, os resultados clínicos podem ser catastróficos.

Enfatiza-se, então, que sempre é muito importante um correto diagnóstico e planejamento dos casos clínicos pelo profissional que os conduzirá, através de um exame clínico apurado e exames de imagem com tecnologia avançada.

Bichat's fat pad or buccal fat pad is an adipose (fat) deposit that all humans have in the face, in the cheek region, located between the masticatory muscles masseter and buccinator. It serves as a cushion, to lubricate the interposition of these two muscles and fill the space of the cheeks in the face.

However, for patients who have a very round, fat, wide face or with a poorly defined facial contour, the removal of this fat is indicated. Even thin patients may have a round face appearance, as Bichat's fat pad is not associated with obesity, it is an anatomical organ, therefore, it does not disappear when we lose weight.

Its removal (Bichatectomy or Lipectomy Jugal) is a relatively simple surgical procedure, without great complexity, which provides patients with a face with a more prominent malar (zygomatic bone) and cheeks with a thinner and inward appearance, since the fat is completely removed through an intraoral access, that is, there are no scars on the face as the procedure is performed inside the mouth.

As only the fat is removed, without any concomitant muscle-level intervention, the aesthetic effect is very beautiful and discreet, as it defines and slims the patient's face without any scar. It is a routine aesthetic procedure, safe, which can be performed under local anesthesia (in the clinic) only being indicated general anesthesia when other interventions are associated such as:

1)    Mentoplasty (chin plastic);
2)    Surgery to highlight the mandibular angle through the installation of Mandibular Porex Prosthesis;
3)    Orthognathic surgery;
4)    Surgery to disguise the deep Nasolabial Sulcus through the installation of Porex Prosthesis for the Paranasal Region;
5)    Other Aesthetic Surgeries in the Face (the presence of two surgeons in the procedure is possible - Bucomaxillofacial Surgeon + Plastic Surgeon).

For patients who do not like their profile and do not have an indication for orthognathic surgery, mentoplasty or chin surgery is a safe and effective procedure for correcting the profile. It is indicated:

** when the patient has a double chin, that is, the lack of chin causes the submental fat to protrude, giving the appearance of a double chin.

** when the patient has a very long chin, in this case a reduction in height is the most indicated.

** when the patient has a very short chin, causing a very deep mentolabial sulcus, in this case an increase in the height of the chin is indicated.

** when the patient has a chin that is too far forward, in this case a recession of the chin is the most indicated.

It is important to emphasize that no type of prosthesis is used in this type of surgery. The patient's own chin is cut and fixed in the desired position with the help of mini-plates and mini-screws made of titanium (see photo).

The patient should always check the predictive tracing that the surgeon will make of their face, because chin surgery, when poorly indicated, can have catastrophic consequences on the harmony of a face.

Responsible for planning and indicating a specific diet for the postoperative period, but in a personalized way, according to the characteristics and tastes of each patient.

Responsible for the preoperative evaluation of the patient with a focus on the donor area of the iliac crest bone. This bone from the hip region is used as a donor area when performing reconstructions of severe resorptions of the maxilla and mandible.

For the convenience and comfort of patients we offer the <strong>“Preoperative Afternoon”</strong>, an afternoon period that the patient spends in our clinic and does all the routine that a preoperative requires, <strong>in one moment and in one place.</strong>

1)      Pre-anesthetic evaluation with the Anesthesiologists team

2)      Nutritional assessment with the Nutrition team

3)      Oral motricity assessment with the Speech Therapy team

4)      Orthopedic assessment with the Orthopedics team (when necessary)

Patients who have undergone accidents with high-impact traumas, have undergone resection of tumors of large and medium extensions and different degrees of malignancy or who have congenital malformations in the maxillofacial region, find in the clinic a service for the rehabilitation of the portions absent from tissues that are generally present after the occurrence of one of the factors listed above, through the confection of prostheses of large extensions planned and customized for each client.

The clinical case will be analyzed in detail. Complementary exams, including tomography and 3D virtual analysis, will be requested for the ideal planning and prosthetic rehabilitation of the clinical case in question.

Bone anchorage (osseous supports) through various available models may be used to support the prosthesis that will rehabilitate the entire extension of absent tissues (osseous, muscular, dental, gingival tissues, etc.).

In this way, the patient will be able to reintegrate into social life with discreet, beautiful and, most importantly, extremely comfortable custom-made prostheses for use in essential daily activities, such as chewing, swallowing, breathing and phonation (speech).

It is the art of restoring dentition and smile to those who have lost them for various reasons throughout life: inadequate extractions, accidents (fractures), extensive caries, gum disease or even due to genetics, which may not favorably affect the teeth of an individual.

Through the execution of some or all of the dental procedures related below, we seek to restore function (chewing / speech / swallowing) and aesthetics in an individualized and personalized way for each client, restoring the dimensions of the smile and face, resulting in the recovery of well-being and self-esteem.

1. Functional and aesthetic restorations on teeth and implants - in resin or ceramic (porcelain): crowns, inlays, onlays, veneers, contact lenses, etc.;
2. Dental implants;
3. Bone and gum grafts;
4. Advanced surgeries in the maxillomandibular complex.

Facial trauma can be caused by several reasons, including: traffic accidents, physical assaults, falls or even during fun (football games, participation in rallies, races, etc.). At this moment, one or more bones of the face may be fractured, causing signs and symptoms not always perceived by the patient or other professionals other than a bucomaxillofacial surgeon.

High-technology imaging exams available in the region assist us in making a correct diagnosis and in a pre-surgical planning that leads us to the best forms of treatment, which should be conducted under general anesthesia, so that the fractures can be repositioned to their original position and fixed with mini-plates and mini-screws of titanium.

For these cases, we also provide the multidisciplinary team of our clinic, because considering the complexity of the anatomical structures involving the bones of the face, nutritional and psychological follow-up is necessary in most cases.