What is oral and maxillofacial surgery?

From the Guidelines

Oral and maxillofacial surgery should be considered as a treatment option for obstructive sleep apnea (OSA) in patients who have failed or are intolerant of continuous positive airway pressure (CPAP) therapy or oral appliance (OA) therapy, or in those with severe obstructing anatomy that is surgically correctible. This surgical specialty requires extensive training and combines principles of medicine, dentistry, and surgery to address complex conditions affecting facial structures. Common procedures for OSA include uvulopalatopharyngoplasty, tonsillectomy, and genioglossus advancement, among others 1. The goal of these procedures is to improve the patient's airway and reduce the severity of OSA symptoms.

When evaluating patients for oral and maxillofacial surgery for OSA, it is essential to consider the severity of the disease, the patient's overall health, and the presence of any anatomical abnormalities that may be contributing to the condition 1. The patient should be counseled on the surgical options, likelihood of success, goals of treatment, risks and benefits of the procedure, possible side effects, and complications and alternative treatments 1. The frequency of post-surgical follow-up will be determined by the type of surgery but should include a surgery-specific evaluation as well as a general OSA-related evaluation.

Some key points to consider when evaluating the effectiveness of oral and maxillofacial surgery for OSA include:

• The success rate of the procedure, which can vary depending on the specific procedure and the patient's individual characteristics 1
• The potential risks and complications of the procedure, such as velopharyngeal insufficiency, dysphagia, and persistent dryness 1
• The need for long-term follow-up to assess the effectiveness of the procedure and to monitor for any potential complications 1
• The importance of a multidisciplinary approach to treatment, including collaboration with sleep specialists, pulmonologists, and other healthcare professionals 1

Overall, oral and maxillofacial surgery can be a effective treatment option for OSA in selected patients, and should be considered as part of a comprehensive treatment plan that takes into account the patient's individual needs and circumstances.

From the Research

Overview of Oral and Maxillofacial Surgery

• Oral and maxillofacial surgery encompasses a wide range of procedures, including dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting 2.
• The use of antibiotic prophylaxis in oral and maxillofacial surgery is crucial to prevent surgical site infections, which can lead to significant morbidity and mortality 2, 3, 4.

Antibiotic Prophylaxis

• Prophylactic antibiotic use is recommended in certain procedures, such as surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants 2.
• The choice of antibiotic depends on the type of surgery and the degree of contamination, with options including penicillin-derivates, cephalosporins, quinolones, and clindamycin 3.
• Long-term antibiotics can reduce the risk of surgical site infection in orthognathic surgery, but there is uncertainty regarding the effects of one dose of antibiotics preoperatively versus short-term antibiotics 5.

Patient Education and Informed Consent

• Written preoperative warnings about risks and outcomes of surgery can improve patients' recall and recognition of these warnings postoperatively compared to traditional verbal warnings 6.
• The timing of these warnings is not significant, as long as the patient receives written information before the procedure 6.

Areas for Further Research

• Further research is required to provide recommendations for antibiotic prophylaxis in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically-compromised patients 2.
• The optimal duration and timing of antibiotic prophylaxis in oral and maxillofacial surgery need to be determined 5.