Central Maryland Oral and Maxillofacial Surgery, P.A. - Richard Nessif, DDS - Domenic Coletti, DDS, MD

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Facial Trauma


What are Types of Facial Trauma?


*   Knocked-out teeth
*   Fractured jaws (lower and upper jaw)
*   Fractured facial bones (eye socket, cheek, or nose)
*   Facial lacerations
*   Intra oral lacerations

What Causes Facial Trauma?


There are several causes of facial trauma, such as sports injuries, motor vehicle accidents,

interpersonal violence, accidental falls, and work-related injuries. The types of facial injuries range from moderate to severe (as moderate as injuries to teeth, to extremely severe injuries to the skin and bones of the face). Facial injuries are categorized as soft tissue injuries (skin and gums), bone injuries (fractures), or extraordinary regions (such as facial nerves, eyes or the salivary glands).


How are Facial Injuries Treated?


Soft Tissue Injuries:

Soft tissue injuries are repaired by suturing with the goal to ensure the best cosmetic results and that your facial nerves, salivary glands, and salivary ducts are intact and functioning properly.

Bone Injuries:

Fractures to the bones in your face are treated similarly to fractures in other parts of your body. The form of treatment is dependent on the location and severity of the fracture, your age and general health. A cast is often used when an arm or leg is fractured, but since a cast cannot be placed on your face, we have other methods to stabilize facial fractures.

Sometimes jaws are wired together for fractures to the upper and/or lower jaw. Other types of jaw fractures are treated by surgically placing small plates and screws at the injury site. This technique is often favored because jaws do not need to be wired together and can still allow for necessary healing. This type of procedure allows patients to return to normal function quickly.

We ensure your appearance will be minimally affected by accessing facial bones using the fewest incisions necessary. All necessary incisions are small and placed so the resultant scar is hidden.

Figure1: Jaw Fracture, Figure 2 : Surgical Plates Placed at the Surgical Site, Figure 3 : Normal Function Quickly Returned


Teeth and Surrounding Dental Structures Injuries:


Oral surgeons commonly treat fractures in the supporting bone to the injured teeth, or replanting teeth that have been knocked out or displaced. These injuries are treated by a number of forms of splinting (bonding or wiring teeth together). If your tooth is knocked out, it should be placed in salt water or milk to keep it healthy. The tooth needs to be inserted back into the dental socket as soon as possible for the best chance of survival. You should never wipe the tooth off because there may be remnants of the ligament that held the tooth in the jaw and are vital to replanting the tooth successfully.
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Cleft Lip and Cleft Palate

What is Cleft Lip and Cleft Palate?


Cleft lip and cleft palate are one of the most common major birth defects, occurring in approximately 1 of every 700 births in the United States. This occurs when the lip or mouth tissues do not form properly during pregnancy.

Child born with Cleft LipA cleft lip is easy to see and relatively simple to treat. The goal is to close the opening in the upper lip and restore the child’s ability to eat and speak.

An opening between the palate (the roof of your mouth) and the floor of the nose is known as Cleft Palate.

Cleft lip and palate can occur as an isolated event or in conjunction with over 400 different syndromes. It is important that if your child is born with a facial cleft that they are evaluated for other birth defects.

How Do I know If My Child Has a Cleft Lip or Cleft Palate?


Both cleft lip and cleft palate can vary in size from a narrow opening to a large hole in the roof of the mouth (cleft palate) or a complete split of the upper lip extending to the base of the nose (cleft lip). The diagnosis is often times made at birth or soon after, but is increasingly diagnosed in the prenatal period with the use of ultrasound.

We are available to provide prenatal counseling in the event that your child is diagnosed with a cleft before birth, or in the nursery after your child is born. We are aware that this can be an extremely difficult and confusing time, and are help to help you in anyway possible.

What Are the Difficulties With a Cleft Lip or Cleft Palate?


Depending on the severity, a cleft lip or palate can cause severe consequences for a child’s ability to speak, breathe, eat and as they grow older may also cause psychological problems.

What is the Treatment Plan for Cleft Lip or Cleft Palate?

Cleft lip and palate surgery can significantly improve your child’s facial appearance, ability to eat, breathe, speak and the defect can be corrected early on in their childhood.

A cleft lip is a relatively simple surgical procedure to close the gap in the upper lip, performed usually on a baby soon after birth (3-4 months).

Surgery to repair a cleft palate is usually carried out when the child is 12 -18 months old.

Bone graft surgery to repair the alveolar portion of the cleft is carried out at age 6-11, and usually precedes the eruption of the permanent canine teeth. It may be necessary and appropriate for the child to undergo orthodontics (braces) prior to this procedure.

Children with cleft lips and or palates often require multiple surgeries following their initial repair. These can include scar revisions, pharyngeal flaps (to aid in speech improvement), rhinoplasty (nose surgery to correct deformities associated with the cleft), and corrective jaw surgery to accommodate jaw size discrepancies that form as a result of the cleft and scar tissue formed over time.

Treatment of your child’s cleft requires a team approach of several professionals to achieve the optimal results. We will work closely with a cleft team usually consisting of a speech pathologist, audiologist, otolaryngologist, orthodontist, and pediatrician.
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