Oral reconstructive surgery is the surgery
of rebuilding the tissues of the mouth
and jaws and face and this includes
the skin of the face, the bone of the jaw,
the muscle of the tongue, and the soft
tissues in the cheeks and the palate, and
the floor of the mouth, and these are obviously very
complex structures and very important
for normal function; for speech and
swallowing and eating, of course, and the
importance of having well supported
teeth. And the rebuilding of those
structures is very complex and relies on a
lot of different techniques including
using the patient's own tissues, using
artificial tissues. Sometimes it can be very
small amounts of reconstruction, for example
dental implanting, or it can be very
large surgery; transplanting bones from
the legs example after a large tumour
resection and as an oral reconstructive
surgeon I carry out the full range of those surgeries.
Oral reconstructive surgery can be
required for a very large range of reasons,
from something very simple to an
infection from the tooth which causes
the bone of the jaw to be lost and would
need to be rebuilt, for example so that an
an implant can be placed,
to more extensive problems such as a
jaw cancer or lip cancer or tongue cancer
which can require the resection of quite
an extensive part of the mouth and
jaw, which would require
reconstruction often requiring freeflap
surgery, where tissue is transplanted
from one part of the body to another
and relies on microsurgical techniques to
rebuild the tissues. If the jaw joint is damaged,
either through an accident or tumour
or arthritis, then we employ very detailed CT
scans to recreate an artificial joint
using 3D printing and computer design of
an artificial joint which can be implanted
and used to restore excellent function
to the jaw - and that's one of the latest
technologies in oral reconstructive
surgery.
Oral reconstruction uses a very
wide range of techniques and it can
range from fairly simple techniques such
as bone grafting to rebuild part of the jaw
for a dental implant, and that might use the
patient's own bone or it can use artificial
bone or demineralised bone matrix. There
are other more extensive types of
surgeries and that can include free flap
surgery, where tissue is transplanted from
elsewhere in the body and that can be bone,
or skin, or muscle
or a combination of those
and they are moved from one part of the body, completely
detached and then anastamosed
using microsurgery under a miscroscope
to restore the blood supply
to those tissues. Other techniques using
the latest developments in scanning and
computer design and printing can build,
essentially, implants to restore the
tissues and that could be orbital
floors or jaw joints or parts of the
mandible, or cheekbones, these can all be
manufactured using the unaffected side
as a template and using a computer design
to create a millimetre perfect
implant to rebuild those tissues.
The post-op stage in
oral reconstructive surgery depends very much
on the extent of the surgery. Simple
reconstruction for example bone grafting,
sinus lift, etc, plus or minus a dental
implant can be done as a day case
procedure in an office environment
like this, and the post op period will be
fairly simple. It will be sore for a few days
etc. More extensive surgery, free
flap surgery for example, can require more
prolonged stay in hospital, often with some
period in intensive care and anywhere
between five and 15 days actually in
hospital. During that period of time there is
very intense rehabilitation for the
patient and there's a big input from the
other members of the team including
speech language therapists,
physiotherapists, and dietitians to help the
patient relearn their normal function
in those tissues which have been
reconstructed.