Maxillofacial and oral surgery

• Dento-alveolar surgery: extraction/attachment of included and displaced teeth, surgical preservation of teeth such as apicoectomy or root amputations, tooth transplantation.
• Jaw cysts: diagnosis by clinical procedures, biopsies under local and general anesthesia of odontogenic and non-odontogenic cysts and their treatment.
• Oral mucosal diseases and changes: diagnosis by objective examinations and biopsies under local and/or general anesthesia, and conservative and/or surgical treatment.
• Implantology and implant-supported prosthetics: oral rehabilitation in patients after tumor resections or trauma (treatment takes place in close collaboration with patients' family dentists).
• Temporomandibular joint (TMJ) disorders and pathologies: diagnosis and treatment of functional TMJ disorders, surrounding masticatory muscles, and TMJ pathologies.
• Surgical remediation of maxillofacial and oral infectious processes: diagnosis and treatment of infections in the maxillofacial and oral region, about 90% of which arise from a dead tooth, infected socket, gingival pocket, or dental cyst.
• Osteonecrosis of the maxilla and mandible: diagnosis and treatment of necrosis of infectious origin, radiotherapy and/or associated treatment with antiresorptive agents, possibly in combination with immunomodulators or anti-angiogenic drugs (MRONJ).
• Traumatology: diagnosis and treatment of hard or soft tissue injuries and wounds in the maxillofacial and oral region caused by external force.
• Orthognathic surgery: surgical correction of the position of the jaws and teeth for alignment and coordination, improving the functional and aesthetic appearance of the face.
• Tumor diseases: diagnosis and treatment of benign and malignant tumors of the head, neck, and oral cavity with long-term outpatient checkups (tumor follow-up) at regular intervals.
• Reconstructive plastic surgery of the jaws and face: functional and aesthetic restoration of tissues damaged by trauma or tumors.
• Labiognatopalatoschisis: diagnosis and treatment of various labiognatopalatoschisis and their combinations, in collaboration with the craniofacial center of the University of Zurich;
• Craniofacial surgery: diagnosis and treatment of congenital, syndromic or non-syndromic craniosynostoses, in collaboration with the craniofacial center of the University of Zurich.

Dento-alveolar surgery

The term dento-alveolar surgery refers to surgeries performed in the area of the teeth and periodontium/bone alveolar. Below are some examples of the treatments offered.

• The simple, surgical extraction/removal of teeth:
  • simple tooth extraction: the tooth is extracted under local anesthesia with dental forceps;
  • surgical extraction: under local anesthesia the gum is opened, the surrounding bone removed with burs, the included and/or displaced tooth extracted, and the wound stitched.
• Surgical lacing of included and displaced teeth:
  • After surgical exposure of the crown of the included tooth under local anesthesia, a special attachment is glued to the crown of the tooth. Then the orthodontist will periodically activate traction to slowly position the tooth in the arch.
• Root excision and amputation:
  • In selected cases, as an alternative to whole tooth extraction, only one root is removed;
  • root hemisection for mandibular molars (two roots);
  • root amputation for upper jaw molars (three roots).
• Root apex resection (apicoectomy):
  • the mucosa at the level of the apex of the inflamed tooth is opened; the root tip is surgically removed along with the surrounding inflammatory tissue;
  • retrograde root filling during the procedure makes it possible to prevent recurrence of inflammation.
• Self tooth transplantation:
  • In cases of premature loss or failure to form permanent teeth in the adolescent dentition (between 10 and 25 years of age);
  • stabilization of the tooth germ in the prepared socket with a splint for two weeks.

Jaw cysts (benign neoplasms)

They are often discovered as a chance finding on radiographs and originate from the teeth or periodontium. The most common cause of maxillary cysts is inflammation at or around the tooth root (root cyst) or around the crowns (follicular cyst) of included teeth. While cysts grow expansively and destroy bone, a particular form of them, the keratocyst, grows aggressively by forming satellite cells (daughter cysts).

• Diagnostics
  • CT computed tomography and/or magnetic resonance imaging MRI.
  • Biopsy and examination of fine tissues (histopathology).
• Treatment
  • Cystectomy: removal of the entire cyst, along with the tooth in the case of an included tooth.
  • Cystostomy: the cystic cavity becomes a lateral indentation of the oral cavity.
  • Jaw resection (in case of extensive findings): reconstruction via titanium plates, bone grafts or free tissue.

Diseases and alterations of the oral mucosa

The causes of diseases and alterations of the oral mucosa are many: physicochemical irritations (caused by heat/cold), mechanical irritations (caused by inadequate prostheses or the habit of biting and chewing the mucosa), systemic and infectious diseases (caused by bacteria, fungi and viruses) or nicotine and alcohol (development of the whitish, non-erasable lesions, leucplachiae). If atypical changes, so-called dysplasias, are present in the tissue structure, there is a risk of development of a malignant tumor of the oral cavity.

• Diagnostics
  • Objective examination of the oral cavity followed by panoramic radiography (OPT).
  • Local tissue sampling and examination of fine tissues (histopathology).
• Treatment based on diagnostic findings
  • Monitoring with elimination of possible risk factors and pharmacological treatment.
  • Surgery: complete removal of oral mucosal changes.
  • Long-term outpatient follow-ups to detect tumor development early.

Dental implantology and dental implant-supported prosthetics

Per-Ingvar Brånemark published his studies on osseointegration in 1969, thus providing the basis for dental implants used today. After the scientific and practical recognition of dental implantology in the dental and maxillofacial and oral society in the 1980s, implantology has now become an indispensable factor in daily clinical practice and oral rehabilitation.

• Dental implantology - a modern procedure to replace lost teeth
  • The most important prerequisite for implant tooth replacement is sufficient bone availability, both in terms of quantity and quality.
  • If this condition is not given, it can almost always be custom-created so that implantology is an available solution for many patients.
• Dental prosthetics supported by dental implants
  • Implants allow stable anchorage of dentures in the jaw area, thus better chewing comfort.
• Diagnostics
  • Patient situations are very diverse and require individual analysis (digital volumetric tomography and computer-aided planning).
• The surgical part of the treatment
  • The treatment plan will be discussed in close cooperation with the patient's dentist/dental technician; it can vary greatly in terms of commitment.
  • For simplicity, only the case where sufficient bone is available from the beginning will be discussed:
    • administration of local anesthesia;
    • incision and visualization of the surgical area;
    • milling of the bone to the appropriate size for the dental implant.
    • Insertion of the dental implant and wound closure.

Temporomandibular joint (TMJ) disorders

Disorders in the area of the temporomandibular joint (TMJ) and masticatory muscles can have many different causes. Basically, it is necessary to distinguish:

• functional disorders of the temporomandibular joint and surrounding masticatory muscles (cranio-mandibular disorder = CMD);
• pathologies of the TMJ itself;
• diagnostics:
  • functional disorders due to parafunctional habits;
  • functional disorders due to systemic diseases;
  • painless snapping in the TMJ area, unilateral or bilateral;
  • articular disc dislocation;
  • dislocation of the mandibular condyle;
  • degenerative osteoarthritis;
  • malformations and tumors of the TMJ.
• Treatment of functional disorders and pathologies of the TMJ:
  • arthrocentesis;
  • TMJ arthroscopy;
  • arthroplasty with disc repositioning and fixation;
  • interlocking arthroplasty (Leclerc osteotomy, T-plate and screws);
  • hemicectomy (Murhaug technique);
  • condylotomy and condylectomy;
  • TMJ reconstruction with rib or total alloplastic endoprosthesis.

Surgical remediation of maxillofacial and oral infectious processes

Numerous bacteria and pathogens are constantly present on the outer skin and in the oral cavity. They do not normally pose a danger to humans.
However, these germs can enter the body through a portal of entry (e.g., a decayed tooth, periodontium, or through mucosal or skin lesions), settle, multiply, and cause a serious and life-threatening infection.
In patients with corresponding symptoms and complaints, necessary measures are applied and more specifically:

• outpatient treatment (under local anesthesia);
• inpatient treatment (under general anesthesia).

Osteonecrosis of the maxilla and mandible

Bone necrosis (osteonecrosis) is a disease in which parts of a bone or the entire bone die. All forms are based on insufficient blood supply to the bone, with a lack of oxygen, nutrients and minerals. In the head and neck area, the upper and lower jaws are the most frequently affected sections.
We treat the:

• infected osteoradionecrosis of the maxilla;
• drug-associated osteochymonecrosis (MRONJ).

Traumatology

Depending on the extent, severity, and general condition of the patient, various injuries are treated under local or general anesthesia on an outpatient or inpatient basis. Injuries in the field of maxillofacial and oral surgery (CMFO) are often accompanied by other injuries in the head region, such as concussion, skull base fractures, eye or ear canal injuries. In cases of multiple injuries as a result of serious accidents, close cooperation with the various specialist departments of the EOC and possibly a Swiss university clinic ensures optimal treatment of the patient. The various injuries in the cranio-maxillofacial complex that are treated by the CMFO include:

• dental injuries;
• soft tissue injuries;
• bone fractures.

Orthognathic surgery

"Dysgnathia" (malocclusion) refers to an abnormality in the position or shape of the teeth and/or jaw bones. A malposition of the maxillary bones can be the cause of a malocclusion. Functional disorders manifest themselves, for example, in the form of limitations in chewing function, speech disorders (e.g., sigmatism) or even breathing difficulties or snoring (patients with an Obstructive Sleep Apnea Syndrome, OSAS, treated in collaboration of the Sleep Medicine Service).

Surgical correction of malocclusions is performed in our maxillofacial and oral surgery clinic in close collaboration with the patient's dentists/orthodontists. The surgical corrections we deal with are:

• single-maxillary repositioning osteotomy;
• bimaxillary repositioning osteotomy;
• surgically assisted upper jaw expansion (SARPE).

Cancer diseases

Tumors of the face, oral cavity, and jaws are classified according to their severity into benign and malignant tumors. The term tumor basically refers to any type of abnormal increase in tissue size. Both diagnostics and treatment are carried out in collaboration with EOC colleagues in otolaryngology, plastic surgery, and the Istituto Oncologico della Svizzera Italiana

• Diagnostics
  • Biopsy.
  • Preoperative imaging (panoramic, CT, MRI).
  • Panendoscopy.
  • Each patient is discussed in our interdisciplinary tumor conference.
• Treatment
  • Temporary tracheotomy.
  • Tumor resection.
  • Neck dissection.
  • Plastic reconstructive measures.
  • Search for dental foci before postoperative radiotherapy.

Reconstructive plastic surgery of the jaws and face

The purpose is mainly to restore form and function after cancer operations, accidents, and in cases of congenital malformations. The goal is surgical rehabilitation of all affected tissues (e.g., skin, adipose tissue, bone, and peripheral nerves). In collaboration with EOC plastic surgery, all modern reconstructive procedures are used:

• plastic surgery with local pedicled flaps;
• expander technique;
• free flap surgery = microvascular flaps;
• dental rehabilitation (together with family dentists).

With the help of the latest computer-assisted procedures, we are able to virtually plan many surgeries to achieve an optimal postoperative result in terms of function and aesthetics.

Labiognatopalatoschisis

Cleft lip and palate are among the most common congenital malformations in humans. In Europe, about one in 500 babies is born with this malformation. They develop early between the 6th and 12th embryonic weeks. According to the extent of the cleft, one can distinguish between labio-, gnatho- (jaw) and palate (hard and/or soft palate) clefts and their combinations. They can be unilateral or bilateral.

• Counseling to parents and relatives: takes place even before the child is born.
• Interdisciplinary treatment program:
  • after birth.
  • Developed by CMFO, otolaryngology, plastic surgery, pediatrics, phoniatrics and orthodontics.
• Primary surgery (performed in the first year of life at a university center).
• Secondary surgery (performed in childhood than adolescence).
  

Craniofacial surgery

Craniofacial malformations are congenital malformations and often occur in the context of complex malformation syndromes. These malformations usually occur in more or less pronounced changes in the shape of the skull and face, and sometimes in the imperfect or missing formation of certain bony and soft tissue structures in the skull and facial area.

• Counseling to parents and relatives: takes place even before the birth of the child.
• Interdisciplinary treatment program:
  • activated after birth;
  • developed by CMFO, otolaryngology, plastic surgery, pediatrics, phoniatrics and orthodontics depending on the underlying disease and its severity.

Surgical therapy is performed in close interdisciplinary collaboration with the neurosurgery clinic. Follow-up and corrective surgery occur in both childhood and adolescence. The opportunity to be able to treat these cases at the EOC is still to be evaluated: we are currently establishing a collaboration with the interdisciplinary center for craniofacial surgery at the University of Zurich.