Paediatric oral maxillofacial surgery

Maxillofacial means related to the jaws and face, paediatric to the treatment of children, infants and neonates – babies – so the phrase paediatric oral maxillofacial surgery refers to all of those together.

Working on the problems of the face, jaws and mouth of young children. Where surgery is necessary then that's what is done to correct the problems in this area.

The most common form of paediatric maxillofacial surgery thought about is for cleft lips and palates. This is something that has a well established care course and might have a series of treatments over time.

This is common with much paediatric surgery concerning bones and underlying structures. Rather, the defining feature of children is that they are still growing. Mismatches in growth rates, particular bone or teeth problems, these can and will often change over time. This requires course of treatment over the years, not a single one off cure.

For example, cleft palates, cleft lips, are well enough known in popular culture. So too the treatments with the NHS having cleft nurses, cleft teams. What is less well known is that the same underlying condition can lead to differences in tooth development. These can require secondary surgery over the years long after the cleft itself has been treated.

There are a number of problems that can occur in the faces, bones, jaws and teeth of children. Some are genetic in nature, others developmental and some the result of disease or infection. Paediatric oral maxillofacial surgery is a description of the processes used to treat these problems, not an identification of the underlying cause.

It is not a disease or condition, it is a treatment. Clearly, surgery is only used upon children when that is the best available – often the only – treatment for the condition.

The classic case for the necessity of maxillofacial surgery is the cleft palate or cleft lip. This is when either the palate, or perhaps just the lip, do not properly fuse during in utero development. This is treated with surgery in the first few months after birth for the lip and before 18 months for the palate. However, this is not the only condition that might need surgery to correct.

Canine teeth can remain unerupted, other teeth can become impacted. These might be thought of as dentistry, but the treatment is surgery inside the mouth – maxillofacial surgery. It is also possible for there to be jaw deformities which can be corrected, or imbalances in development that require treatment.

Accidents do happen, as all know, even to children. Sometimes surgery is the necessary treatment for the results of such accidents. Paediatric practice is complicated by how the bones and face will change with age and through puberty – serious consideration must be given here.

Disease also happens, from infection to cancer. Jaw cysts exist and must be investigated as to cause.

The starting point for paediatric oral maxillofacial surgery is often a reference from a dentist who has noted something to be dealt with.

The maxillofacial consultant will then evaluate the problem and design the best course of treatment which may well include surgery.

The exact requirements of oral maxillofacial surgery will depend upon the specific procedure being used to address what underlying problem. Often a general anaesthetic will be necessary. Further, that the exact diagnosis of the problem defines what the treatment is.

This might seem obvious, but maxillofacial surgery is a technique to fix a number of different problems. Which variation of technique is used will therefore depend upon the problem to be fixed or treated. Diagnosis then the planning of the course of treatment is the vital stage.

For example, there can be problems with the frenum. Such as ankyloglossia – also known as tongue tie. Tongue-tied as an actual condition, not just an embarrassment. The techniques to deal with this will be very different from those required for a tooth or jaw problem.

Almost by definition, surgery means a hospital stay. Almost, for in this oral area treatments that do not require surgery and significant recovery are more properly known as dentistry.

As with which treatment is appropriate for the problem, recovery time will depend upon the precise technique used.

The extraction of impacted teeth might necessitate a general anaesthetic and then an overnight stay for observation. It is worth noting that dentists are no longer allowed in the UK to do such in the normal dentists' office, a general anaesthetic upon a child requires a hospital visit.

Significant jaw surgery would involve the usual several weeks rest and recuperation any major surgery requires.

Maxillofacial surgery is a collection of techniques to treat problems and conditions in a certain area of the body.

Recovery time will be dependent upon which exact technique is used to treat what particular problem or condition. 

All surgery carries risks. This is true of oral, paediatric and maxillofacial surgery as any other. There are risks of infection, of bruising, of bleeding.

It is possible that nerves get damaged during the process. This can lead to permanent numbness in the affected areas. Surgery is, for these reasons, only recommended for those conditions that can be treated in no other or better way.

With paediatric surgery there is a further risk, in that by definition it is being carried out upon children. They may not understand matters, or parents may be hesitant to put them through the process. Yet the absence of other treatment possibilities plus the seriousness of the conditions under discussion can still make it necessary to overcome these concerns.

A further risk of surgery upon children is that further procedures might be necessary. Sometimes the one operation will be sufficient. But the further growth of children can lead to different expressions of the same underlying problem which need further treatment. Paediatric surgery can be a process rather than an event.

One large and often undiscussed risk or paediatric treatment is that of delay. Children only go through the development process the once. A delay in treating something that is making that more difficult is in itself a problem. There should be no intention to rush into surgery, but delays of a year or more can be commonplace in some treatment pipelines. Reducing that delay can be an important part of the overall treatment plan for psychological reasons if nothing else.

For example, fixing ankyloglossia, that tongue tie, can significantly improve speech almost immediately. And speech development is something which, if delayed, is never really quite caught up with again. Delay in paediatric care can be a significant risk as it can suppress the normal course and patterns of child development.