OMFS or Plastic surgeon for jaw augmentation

[Lilith]

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I am doing some research on jaw augmentation procedure. I was wondering if one were to have this procedure done, who would be a better person to perform the procedure?

Thanks.

 

[dtdds]

I am doing some research on jaw augmentation procedure. I was wondering if one were to have this procedure done, who would be a better person to perform the procedure?

Thanks.

You are kidding right? After spending 4 years of dental school and 4-6 more years of residency studying the oral cavity, head and neck area, who do you think would be better at doing jaw surgery. It's a no brainer. It said so in our title ORAL and Maxillofacial Surgeon

 

[Yah-E]

OP may be refering to genioplasty, not orthognathics.

 

[Blue Tooth]

As an aside, we as a profession have to make sure we keep things "in-house" that belong "in-house". And if anyone ever asks you, don't let those plastics or ENTs set a broken jaw. Get them to an OMFS who understands occlusion and won't sent them in some wicked crossbite.

 

[Lilith]

Sorry I was not being more specific. I was referring to the kind of procedure used to correct facial assymmetry. (One side is more prominent than the other side without any bite problem.)

 

[toofache32]

My guess is that you're talking about hemifacial microsomia. The surgical correction usually involves orthognathic surgery, although some cases can be treated with distraction osteogenesis (DO). The orthognathic surgery involves cutting the mandible and maxilla free from the skull base and repositioning them. More severe cases require additional osteotomies or alloplastic augmentation to correct size discrepancies in the facial bones.

Sometimes the ear is deformed or even missing on the hypoplastic side of the face. This is probably the most challenging part to reconstruct because it is such a 3-dimensional structure which projects out from the face. I would probably just go with osseointegrated implants with an auricular prosthesis because the ones I've seen look much better than ears reconstructed with rib cartilage, etc.

I would definately see an oral surgeon first for a proper orthognathic examination, because this is the biggest portion of the treatment. He would also be the one to place implants for the ear if needed. If you go to a plastic surgeon, I would definately find one who has done a craniofacial fellowship. They are generally the only plastic surgeons who have really had any experience with orthognathic surgery, but it's funny how they still consult our OMFS faculty routinely for treatment plans.

 

[River13]

I would go even a step farther and find out how many of these cases the proposed surgeon did in his/her residency/fellowship or per year since graduation. Many craniofacial surgery "fellowships" in plastic surgery count everyday run of the mill orthognathic cases for their required # of craniofacial cases to finish the fellowship, and never even touch the real cases like hemifacial micros, crouzon's, etc. with complicated Leforte III's etc.

 

[tx oms]

OP may be refering to genioplasty, not orthognathics.

Genioplasty falls under orthognathics.

As for the OP, find the guy in your area that has the most experience. It will most likely have to be at an academic center. In some centers oral surgeons are the people to see, hands down. In other centers a plastic surgeon may be the guy to see. I would personally travel to the nearest oral surgeon capable of handling the surgery since oral surgeons have a better understanding of the jaws, teeth, and face than plastic surgeons--even fellowship trained plastic surgeons.

 

[Lilith]

Thank you all for your helpful info. 🙂

 

[nebuladds]

Plastic surgeons and oral and maxillofacial surgeons have the same basic qualifications to work on the head and neck. Where the difference lies is in who has done more of the procedure you seek. That applies to ANY type of procedure. When it comes to orthognathic surgery, OMFS usually has done more.

 

[DDSSlave]

Admittedly, I don't know squat about surgery, but how would you know the plastic surgeon didn't do the orthagnathic surgery 50X incorrectly? Quantity does not necessitate quality. When teeth and occlusion are involved, I would only trust an OMFS.

 

[toofache32]

Admittedly, I don't know squat about surgery, but how would you know the plastic surgeon didn't do the orthagnathic surgery 50X incorrectly? Quantity does not necessitate quality. When teeth and occlusion are involved, I would only trust an OMFS.

This is a good point. The ENT guys in Memphis (where I went to dental school) were notorious for plating fractured mandibles back in the wrong place. Then they would send them to an orthodontist to "fix the bite". Then the orthodontist would have to send the to the oral surgeons to redo it the right way. I don't know how these ENTs don't get nailed for malpractice.