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Oral and
maxillofacial surgery is the medical specialty concerned
with the diagnosis and treatment of diseases affecting the
mouth, jaws, face and neck. Consultant specialists working
in this area are variously termed oral surgeons,
maxillofacial surgeons or oral and maxillofacial surgeons.
The range of conditions managed by oral and maxillofacial
surgeons is vast and includes broken jaws, head and neck
cancers, salivary gland diseases, facial disproportion,
facial pain, temporomandibular joint (TMJ) disorders,
impacted teeth, cysts and tumours of the jaws as well as
numerous problems affecting the oral mucosa such as mouth
ulcers and infections.
Oral and
maxillofacial surgeons frequently work alongside other
specialists including orthodontists, oncologists,
neurosurgeons, plastic surgeons, and ENT surgeons.
Please take
a look at the "About Us" section on the website where you
will find details of my training and qualifications as
well as the services I provide to the NHS and private
sector including medicolegal work for the legal profession
and courts.
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Temporomandibular Joint Information
TMJ problems are exceptionally common with as many as 70%
of people suffering from one or more signs or symptoms
(muscle or joint pain, joint noises, limitation of mouth
opening) at least once in their lifetime. They arise from
either acute or chronic trauma to the temporomandibular
joint apparatus. Read
more > Essentially the joint meniscus, which
normally moves smoothly in between the head of the
mandibular condyle and the base of the skull, becomes lax
in its attachment, producing intermittent joint noises and
occasional joint stiffness during function. Provided the
meniscus can be recaptured when the jaw is opened and
closed maximal mouth opening is usually maintained with
minimal pain despite joint noises and crepitus being
present resulting in the common scenario of the painless
clicking joint. However, if the meniscal attachment is
severely compromised the meniscus becomes displaced
anterior to the head of the condyle and maximal mouth
opening is reduced. Moreover, the pain receptors in the
posterior part of the meniscus, which are normally not
stimulated during function, come to lie in between the
mandibular condyle and fossa producing pain during
function. Read
more >
A very small number of
patients have such damaged TMJ's that replacing them
with artificial ones (Total Joint Replacement - TJR) is
the only treatment that may reasonably be expected to
improve their quality of life.
TJR
is complex, highly specialized surgery. In the UK in
2007 there were less than 70 TJR's performed (Read
more >) emphasizing that this treatment is only
indicated in a minority of patients with TMJ disorders
and only when all conservative and minimally invasive
procedures have failed and patients are still
experiencing significant adverse quality of life issues
such as pain, poor mouth opening and poor diet. Read
More >
In the UK, TJR is not routinely funded on the NHS and
before a patient can undergo TJR specific funding needs
to be obtained from their local NHS commissioning body -
currently the Primary Care Trust (PCT). Approval is
decided on an individual basis and will only be
considered when the PCT is satisfied that the patient
fulfills the criteria as specified in the NICE
guidelines. Read
more > PCT's are not bound to fund TJR.
There are basically 2 types of TJR. The patients TMJ may
be replaced with a "stock" joint which is one where the
manufacturer provides a small selection of shapes and
sizes of component or a "custom" joint where the
manufacturer fabricates the implant specific to the
individual patient. As a general rule I prefer to use
custom joints as I believe them to offer a superior fit
and hence function to the stock joints. A small but
significant minority of patients, especially those who
react to "cheap" jewelery, are allergic to one of the
metalic components most commonly used to manufacture the
implants. It is important to identify these patients
early by allergy testing so that alternative materials
can be used. See
image
Once PCT approval is obtained a high resolution CT scan
is obtained from which a life size 1-1 3-dimensional
model is made of the patients skull, jaws and TMJ's. In
conjunction with highly skilled technicians at the
implant manufacturer the surgeon designs the TJR to fit
the model. Once the surgeon is happy with the design the
implant is fabricated and sterilized by the manufacturer
and shipped to the surgeon ready to be fitted. (See
image >) Depending on the time taken to obtain
PCT approval and the complexity of the problem the whole
process can take from 3 to 9 months from decision to fit
a TJR to admission for surgery.
TJR
Patient Information
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