Oral and maxillofacial surgery is used to treat complex dental problems and medical conditions related to the mouth, teeth, jaws, and face. Much of the practice is focused on facial reconstructive surgery, facial trauma surgery, and dental procedures involving the jawbone (like wisdom tooth extractions and dental implants).
What Is Oral and Maxillofacial Surgery?
Oral and maxillofacial surgery encompasses a variety of procedures that involve surgery of the mouth (oral), jaw (maxilla), and face (facial). Some people regard oral and maxillofacial surgery as an "upgraded" form of dental surgery, but the practice extends far beyond what a dentist can perform.
Oral and maxillofacial surgeons (OMSs) train as dentists but undergo six additional years of education, including two to attain a medical degree (MD).
Some oral and maxillofacial surgeons embark on further training to perform facial cosmetic surgery, treat conditions related to cancer, perform microvascular surgery of the head or neck, or correct congenital face and skull abnormalities in children (such as cleft lip and palate).
Depending on the condition, oral and maxillofacial surgery may be performed as an inpatient, outpatient, scheduled, elective, or emergency procedure. OMSs often work alongside other surgeons (like orthopedic surgeons, surgical oncologists, or otolaryngologists) to treat complex conditions or in cases involving severe head or facial trauma.
Contraindications
There are few absolute contraindications to oral and maxillofacial surgery other than the inability to tolerate general anesthesia. In such cases, other forms of anesthesia—like regional blocks or local anesthesia with intravenous sedation—may be used.
There are relative contraindications that may exclude certain elective procedures. Cases like these are evaluated on an individual basis, weighing the benefits against the risks. Among the conditions of concern are:
- High blood pressure (generally when the systolicpressureis 180 mmHg or higher or thediastolic pressureis 110 mmHg or higher)
- Active infections, which must be treated for surgery can be performed
- Extensive osteonecrosis (bone death)
- Certain cancers, which may metastasize if such surgery is performed
Potential Risks
As with all surgeries, oral and maxillofacial surgery has risks. Even relatively common procedures like tooth extractions pose a risk of potentially serious complications.
In addition to the general risks of surgery (such as excessive bleeding, unfavorable scarring, post-operative infection, and an adverse reaction to anesthesia), oral and maxillofacial surgery poses specific risks, especially with regards to reconstructive surgery or in cases of facial trauma.
These include:
- Unintended changes in appearance
- Changes in jaw alignment and bite
- Changes in airflow through the nose and sinuses
- Injury of facial nerves, which may cause numbness, loss of facial muscle control, or unremitting nerve pain
- Alveolar osteitis: Also known as dry socket, this is caused when a blood clot doesn't form or is lost at the site of a tooth extraction before it has time to heal.
- Condensing osteitis: Bone inflammation in the jaw characterized by pain with movement
- Tissue necrosis (tissue death), usually caused by the severe restriction of blood flow to tissues following surgery
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Purpose of Oral and Maxillofacial Surgery
Oral and maxillofacial surgery is used to treat a wide range of conditions affecting the craniomaxillofacial complex comprised of the mouth, jaws, face, neck, and skull.
The procedures can be broadly defined as being diagnostic/therapeutic, dentoalveolar (involving the teeth, gum, jawbone, and mouth), reconstructive, or cosmetic.
Diagnostic and therapeutic procedures include:
- Mandibular joint surgery: Used to repair or reposition the jaw to treat temporomandibular joint (TMJ) disorder, masticatory musculoskeletal pain (pain while chewing), or burning mouth syndrome
- Maxillomandibular osteotomy: The surgical repositioning of the upper and lower jaw to improve breathing and treat obstructive sleep apnea
- Radiofrequency needle ablation: A minimally invasive procedure employing high-frequency radio waves to sever nerve pathways that trigger trigeminal neuralgia, migraine, and similar chronic pain disorders
- Septoplasty with turbinate reduction: A therapeutic procedure involving the straightening of a deviated septum and the removal of nasal bones and tissues (turbinates) to improve breathing, reduce snoring, and treat sleep apnea
- Tumor resection: The surgical removal of abnormal growths and masses, both benign and malignant
Dentoalveolar procedures include:
- Dental implants: Including endosteal implants placed directly into the jawbone and subperiosteal implants placed under the gum but above the jawbone
- Orthognathic surgery: Also known as corrective jaw surgery, used to straighten a crooked bite or misaligned jaw
- Pre-prosthetic bone grafting: The surgical implantation of autologous bone (extracted from the patient) to provide a solid foundation for dental implants or implanted hearing devices, like a cochlear implant
- Wisdom tooth extraction: A surgical procedure that requires the removal of bone around the root of the third molar (wisdom tooth)
Reconstructive procedures include:
- Craniofacial surgery: Used to correct congenital malformations like cleft palate or craniosynostosis (the premature fusing of bones in a baby's skull), or to repair traumatic fractures (include jaw fractures, cheekbone fractures, nasal fractures, eye socket fractures, and LeFort fractures of the mid-face)
- Lip reconstructive surgery: Used after the removal of skin cancer of the lip (typically squamous cell carcinoma, but also melanoma) to restore not only the appearance of the lips but their function
- Microvascular reconstructive surgery: Used to reroute blood vessels after the removal of a tumor in people with head and neck cancer
- Skin grafts and flaps: A procedure used after skin cancer surgery in which skin is either taken from another part of the body to replace resected tissues or partially removed and repositioned to cover an adjacent area of resection
Cosmetic procedures include:
- Blepharoplasty: Eyelid surgery
- Cheek augmentation: Cheek implants
- Genioplasty and mentoplasty: Aesthetic chin surgery
- Hair transplantation
- Neck liposuction
- Otoplasty: Reshaping of the outer ear
- Rhinoplasty (nose job)
- Rhytidectomy (facelift)
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Pre-Operative Evaluation
If oral and maxillofacial surgery is indicated, the surgeon may order a series of tests to map out the surgical plan. These may include:
- X-ray: A plain film imaging technique using ionizing radiation
- Panorex: A form of X-ray used in dentistry and for the viewing of the sinuses
- Computed tomography (CT): An imaging technique involving multiple X-ray images to create three-dimensional "slices" of the surgical site
- Magnetic resonance imaging (MRI): An imaging technique that doesn't involve radiation and is superior in imaging soft tissues
- Duplex ultrasound: An specialized form of ultrasound specifically used to evaluate blood flow through thearteries and veins
- Nerve conduction studies (NCS): A test in which a mild electrical pulse is applied to muscles of the face and head to detect areas of nerve damage
How to Prepare
The preparation for oral and maxillofacial surgery can vary depending on the condition being treated and the aims of the surgery. If oral and maxillofacial surgery is indicated, you will meet with your surgeon to review the pre-operative results and walk through the suggested procedure step-by-step.
To fully comprehend what's involved, do not hesitate to ask as many questions about not only the procedure but what to expect during recovery.
Important Questions to Ask Before You Have Surgery
Location
Many oral and maxillofacial surgeries are performed in-office, including tooth extractions and other dental procedures. Those that involve reconstruction or require open surgery need to be performed in an operating room of a hospital or specialized surgical facility.
Depending on the surgery, an anesthesiologist may or may not be needed. All OMSs are qualified to administer anesthesia, but complex procedures like microvascular reconstruction need a dedicated anesthesiologist to monitor the health of the patient during surgery.
What to Wear
You may be asked to wear a hospital gown and surgical bib over your clothes when undergoing dental surgery. Wear something that is machine washable on the odd chance you get a spot of blood on your clothing.
Other surgical procedures, particularly those involving general anesthesia, will require you to undress and put on a hospital gown. The day of your procedure, wear something comfortable that you can easily take off/put back on.
Food and Drink
If undergoing general anesthesia or any form of sedation, you will need to adhere to certain food and drink restrictions prior to surgery.
In most cases, you will be advised to stop eating at midnight on the night before your surgery. The next morning, you will be allowed a few small sips of water to take any morning pills, but nothing further.
If local or regional anesthesia is to be used, there may be no such restrictions. The only exception is if intravenous sedation is used alongside local or regional anesthesia. In such cases, the same food and drink restrictions apply.
Why You Can't Eat or Drink Before Surgery
Medications
As a general rule, nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants (blood thinners) are avoided in the days the preceding surgery. Both of these classes of drugs can promote bleeding and affect the proper healing of wounds.
The restrictions vary by surgery but, generally speaking, NSAIDs like aspirin, Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and Voltaren (oral diclofenac) are stopped a week or two before surgery. Anticoagulants like Coumadin (warfarin) and Plavix (clopidogrel) are usually stopped five days before surgery.
To avoid complications, advise your surgeon about any and all drugs you take, whether they are prescription, over-the-counter, nutritional, herbal, or recreational.
What to Bring
You will need to bring your driver's license or another form of government photo ID to check in to your appointment. If you have insurance, bring your insurance card.
You may also need a credit card or other approved form of payment if the facility requires upfront payment of coinsurance or copay costs. Call in advance to be sure that they accept your form of insurance, if you are enrolled in a plan.
Leave any valuables at home.
It is best to bring someone with you to drive you home. Even if only local anesthesia is used, you may experience significant pain after surgery, which can impair your ability to drive. If general anesthesia and any form of sedation is used, under no circ*mstance should you get behind the wheel of a car.
Driving After Surgery or Anesthesia
Pre-Op Lifestyle Changes
Every effort should be made to stop smoking at least two weeks before and after surgery. Cigarette smoke causes the profound constriction of blood vessels, reducing the amount of blood and oxygen that reaches the surgical wound. This not only impedes healing but increases the risk of treatment failure, such as loss of a skin graft or improper bonding of bones.
If you find it difficult to quit, ask your healthcare provider for prescription smoking cessation aids that can reduce cravings. Many of these aids are available free of charge under the Essential Health Benefits (EHB) mandate of the Affordable Care Act.
Oral Surgery: What to Expect
What to Expect on the Day of Surgery
The expectations for oral and maxillofacial surgery are as diverse as the procedures used. With that said, there are some common elements involved in all of these procedures, and knowing more about them can help you prepare.
Before the Surgery
After you have checked-in and completed all of the necessary medical and consent forms, you will undergo pre-operative preparations. These preparations are largely directed by the type of anesthesia you are to undergo.
- Local anesthesia: Procedures performed with local anesthesia, delivered either by injection or with nitrous oxide ("laughing gas"), may only require a review of your vital signs (temperature, heart rate, blood pressure) and a pre-operative dental exam with or without X-rays.
- Regional block: Surgeries involving a regional block (an injection similar to local anesthesia that blocks nerve transmissions rather than numbing the skin) will also involve a pre-operative exam and review of vital signs.
- Monitored anesthesia care (MAC): This form of sedation, sometimes used with local or regional anesthesia to induce "twilight sleep," is delivered via an intravenous (IV) line that has been inserted into a vein in your arm. You will also be connected to an electrocardiogram (ECG) machine to monitor your heart rate and a pulse oximeter to monitor your blood oxygen.
- General anesthesia: The same procedures as MAC are used but often with a more extensive range of pre-operative blood tests, including a complete blood count (CBC), comprehensive metabolic panel (CMP), and arterial blood gas (ABG) test.
What You Should Know Before Undergoing Surgery
During the Surgery
Once you are prepped and the appropriate anesthesia has been administered, the surgery can begin. It may be open surgery (an invasive procedure involving a large incision), endoscopic surgery (also known as "keyhole surgery"), or minimally invasive open surgery (involving a small incision and minimal tissue damage).
The surgery may also be classified as being reconstructive (to repair or correct structural abnormalities) or aesthetic (used for cosmetic purposes).
| Surgery | Location | Type | Anesthesia |
|---|---|---|---|
| Mandibular joint surgery | Inpatient | Open or endoscopic | General |
| Maxillomandibular osteotomy | Inpatient | Open | General |
| Radiofrequency nedle ablation | In-office or outpatient | Percutaneous (with a needle through the skin) | Often only a numbing agent |
| Septoplasty with turbinate reduction | Generally outpatient | Mainly endoscopic | Local with MAC, regional, or general |
| Dental implants | In-office | Minimally invasive | Generally local |
| Orthognathic surgery | Inpatient | Open | Local or regional with MAC or general |
| Pre-prosthetic bone grafting | In-office | Minimally invasive | Local, regional, MAC, or general |
| Wisdom tooth extraction | In-office | Minimally invasive | Local, regional, MAC, or general |
| Craniofacial surgery | Inpatient or outpatient | Open or arthroscopic | Local or regional with MAC or general |
| Lip reconstructive surgery | Generally outpatient | Reconstructive | Local with MAC or general |
| Microvascular reconstructive surgery | Inpatient | Open or arthroscopic | General |
| Skin grafts and flaps | Inpatient or outpatient | Reconstructive | Local with MAC or general |
| Blepharoplasty | Outpatient | Aesthetic | Local with MAC or general |
| Cheek augmentation | Outpatient | Aesthetic | Generally local with MAC |
| Genioplasty | In-office or outpatient | Aesthetic | Generally local with MAC |
| Mentoplasty | Outpatient | Aesthetic | Usually general |
| Neck liposuction | Outpatient | Aesthetic | Local with MAC or general |
| Otoplasty | Outpatient | Aesthetic | Generally local with MAC |
| Rhinoplasty | Outpatient | Aesthetic or reconstructive | Local or regional with MAC or general |
| Rhytidectomy | Usually outpatient | Aesthetic | Local with MAC or general |
Upon completion of the surgery, sutures, staples, or tape may be used to close your incisions. A sterile bandage is then applied.
Splints, spacers, and various braces (including headgear, mouthguards, and jaw wiring) may be used to immobilize the skull, jaw, or nose so that it heals properly and in the correct position.
After the Surgery
Once the surgery is complete, you are taken to a recovery room or the post-anesthesia care unit (PACU), where you will be monitored until you are fully awakened from the anesthesia. With local anesthesia, this usually takes 10 to 15 minutes or so. With general anesthesia, it generally takes around 45 minutes.
Once your vital signs have normalized and you are able to walk stably, you can usually be taken home by a friend or family member. Some procedures may require a hospital stay of one or several days.
In addition to wound care instructions, you may be given pain medications to help ease post-operative pain as well as oral antibiotics to help prevent post-operative infection.
Recovery
In the same way that oral and maxillofacial surgeries can vary, so too can recovery times. While most people can return to work and normal activity within a few days of a wisdom tooth extraction, for example, those who undergo orthognathic surgery may take months before they are fully recovered.
Certain factors can increase or decrease recovery times, including your general health before surgery, how well you care for your surgical wound, and whether you or not you smoke.
Follow the recommended dietary plan, whether it is a soft diet or liquid diet, and work with a dietitian if needed to ensure proper nutrition. Surgeons often recommend eating smaller meals and snacks rather than a full meal for the first week or so as eating too much may irritate the surgical site.
Some oral and maxillofacial surgeries will require your jaw to be wired. Because you'll be limited to a liquid diet, you will need to rinse your mouth thoroughly after brushing, as well as rinse with salt water several times a day to remove bacteria from the gums and prevent plaque buildup.
People who undergo soft palate surgery may experience changes in speech articulation that require speech therapy to correct. In fact, any surgery of the jaw, tongue, or soft or hard palate can affect speech, either temporarily or permanently. A speech pathologist can help determine what, if any, treatment is needed.
Damageto branches of the trigeminalnerve is common following maxillofacial surgery, most cases of which resolve on their own over time. Severe cases may require medications and other treatments to block the nerve pain.
Some oral and maxillofacial surgeries require extensive rehabilitation to restore nerve sensations or the function of facial muscles. Similarly, some scars can take months of ongoing care to minimize their appearance or prevent the development of thick, raised patches (hypertrophic scarring).
To ensure that you heal completely, work closely with your healthcare provider. Keep all scheduled appointments and have realistic expectations about what it will take to recover. Rushing this period is never a good idea.
| Surgery | Return to Work | Full Recovery |
|---|---|---|
| Mandibular joint surgery | 3 to 5 days in hospital, followed by 5 to 14 days at home | 2 to 8 weeks, depending on the extent of the surgery |
| Maxillomandibular osteotomy | 2 to 3 days in hospital, followed by 4 weeks at home | 3 months |
| Radiofrequency needle ablation | 24 to 72 hours | 10 days |
| Septoplasty with turbinate reduction | Several days to a week | 1 to 2 months |
| Dental implants | 1 to 2 days | 1 month |
| Orthognathic surgery | 1 to 2 days in hospital, followed by 2 weeks at home | 3 months |
| Pre-prosthetic bone grafting | 2 to 3 days | 4 to 5 months |
| Wisdom tooth extraction | 2 to 3days | 2 weeks |
| Craniofacial surgery | 7 days in hospital, followed by 10 to 14 days at home | 3 months |
| Lip reconstructive surgery | 1 week | 3 weeks |
| Microvascular reconstructive surgery | 4 to 5days in hospital, followed by 2 to 3 weeks at home | 3 months |
| Skin grafts and flaps | 5 days to 2 weeks | 3 months |
| Blepharoplasty | 7 to 10 days | 3 months |
| Cheek augmentation | 3 weeks | 4 to 6 months |
| Genioplasty | 7 to 10 days | 6 to 8 weeks |
| Mentoplasty | 1 to 2 weeks | 6 to 8 weeks |
| Neck liposuction | Several days to 1 week | 1 month |
| Otoplasty | 5 to 7 days | 6 weeks |
| Rhinoplasty | 1 to 2 weeks | 6 to 8 weeks |
| Rhytidectomy | 10 to 14 days | Up to 1 year |
A Word From Verywell
If you are referred to an oral and maxillofacial surgeon, it is likely because a specific procedure is beyond the scope of the healthcare provider or dentist you are seeing. It doesn't necessarily mean that the condition is inherently more serious, but rather that the procedure would benefit from a specialist trained to work on the complex structures of the face, jaw, mouth, and skull.
If in need of an OMS in your area, speak with your insurance company or use the online locator offered by the non-profit American Association of Oral and Maxillofacial Surgeons (AAOMS).
Frequently Asked Questions
What should you eat after oral surgery?
Your surgeon may recommend either a liquid or soft-food diet, depending on the type of surgery. When possible, choose nutrient-rich foods to give your body the fuel it needs to heal. Some good options may include:
- Smoothies
- Yogurt
- Oatmeal
- Applesauce
- Scrambled eggs
- Meatloaf
- Tofu
- Mashed bananas
- Frozen yogurt or sorbet
Learn MoreWhat Is a Soft Diet?
How long does swelling last after oral surgery?
Swelling in your face may continue to increase for two to three days after surgery. It should start to lessen after three days. If the pain or swelling gets worse after that time, check with your surgeon.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Shawn Watson
Shawn Watson is an orthodontic dental assistant and writer with over 10 years of experience working in the field of dentistry.
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