Functional and/or aesthetic treatments in the jaw and facial area
Our specialist, Dr Albino Triaca, will be pleased to see you for an initial consultation at the Centre for Maxillo-facial Surgery. Please phone the centre to make an appointment. This first consultation can also be arranged by referral from your private dentist or orthodontist. A treatment plan is developed based on your individual documents (such as 3-D x-rays, photos, plaster models, etc.). For jaw correction and profile improvement, portrait photos are adjusted to illustrate possible changes, with the help of the face planning that has been carried out. The portraits are discussed with you and the definitive procedure is then determined. The procedure will be explained in detail using brochures and skull models, and the appointment can be made for your outpatient or inpatient treatment.
We specialise in the correction of jaw malformations (dysgnathia) and the consequences of cleft lip, jaw and palate, and we also cover a broad variety of procedures for the treatment of various other conditions. In addition to the well-known methods, we also use new techniques and specially developed surgical methods that enable us to achieve very aesthetically pleasing results. A number of innovations that were developed at our centre have become part of the standard repertoire of modern orthognathic surgery. In practically all of these procedures, surgical access is via the oral mucosa, leaving no visible scars on the face.
Jaw malformations (dysgnathia)
There are a variety of different types of malocclusion or misalignments of the teeth, arising from an unfavourable position of the maxilla, the mandible, or a combination of the two. The individual components of the jaw may be too long, too short, too narrow, too wide or asymmetric. This can lead to functional or aesthetic limitations that create the desire or the need for correction.
Corrective treatment requires teamwork. Since jaw malformations are usually accompanied by misalignment of the teeth, the treatment is carried out in close collaboration with an orthodontist. The specialists will analyse the situation together, based on 3-D x-rays, plaster models and images, and create an appropriate individual treatment plan. In the first phase of treatment, the necessary conditions are created using appropriate braces or other orthodontic appliances, so that the surgical correction can then be carried out. New developments mean that the appliances on offer today are very discreet or even invisible, so there is no need for any cosmetic concerns about the pre-surgical orthodontic phase.
Modern and well-established surgical techniques for the correction of jaw malformations (dysgnathia)
The surgical techniques for the correction of dysgnathia (called osteotomies, meaning procedures involving cutting through the bone) are as diverse as are jaw malformations themselves. Many of these have been in use for decades and have helped countless patients worldwide.
The Le Fort 1 osteotomy allows for the tooth-bearing area of the maxilla below the nose to be cut through and mobilised, for example. If necessary this can be further subdivided (segmented), brought into the correct position and fixed using small screws and plates.
Sagittal split osteotomy also allows for repositioning of the tooth-bearing region of the mandible, which can then be advanced or pushed back as needed to correct the malocclusion.
Using wing osteotomy of the mandibular rim, in a procedure called chin wing osteotomy which was developed at our centre, the profile can also be influenced such that, regardless of dental movement, the best possible result is achieved from both a functional and aesthetic point of view.
Distraction for narrow dental arch
If the dental arch lacks space or there is insufficient development of the jaw, growth in the desired dimension can be achieved using suitable apparatus (called a distractor).
Craniomandibular disorders (CMD) are frequent and widespread. They range from occasional localised discomfort to severe and painful conditions. They may be associated with significant restrictions in mobility and the opening of the mouth or with just a faint cracking sound. As the symptoms often radiate, there is an overlap with ear, nose and throat conditions, ophthalmology, neurology, rheumatology and dentistry. Psychological and behavioural factors also play an important role and should also be considered in the assessment of craniomandibular disorders.
With our broad-based training in medicine and dentistry, as maxillo-facial surgeons we can provide a much-needed overview of possible diagnoses and offer a full range of therapies. After careful clinical examination and a thorough discussion with the patient, the correct diagnosis will be apparent in many cases. If further specialist tests are necessary, these can be arranged quickly and effectively. In most cases, the condition can be treated with an appropriate combination of targeted interventions, and surgery can be avoided.
Treatment options range from simple exercises that the patient can easily perform at home, to physiotherapy treatments that aim to resolve the increased tension that is often present in the muscles and ligaments. Restriction of movement due to disc displacement can also be alleviated in this way. Occasionally, the short-term use of medication may be appropriate. If grinding or clenching of the teeth is also present, this can be treated successfully by creating individual splints. Another modern form of treatment is the targeted and longer-term easing of the masticatory muscles with botulinum toxin A. This is used routinely and with good results at our centre.
If all conservative measures have been exhausted and distressing symptoms still persist, surgical interventions may be considered. These include simple flushing of the joint (called lavage) under a local anaesthetic, or arthroscopy under general anaesthesia. More rarely, open joint surgery to reattach a displaced disc or the remodelling of a deformed mandibular condyle may be carried out.
Cleft lip, jaw and palate
Scarring and signs of this congenital malformation can be minimised through various procedures on the nose and lip. The Centre for Maxillo-facial Surgery has extensive experience in the treatment of cleft lip, jaw and palate.
The typical retraction of the upper lip scars and the lack of volume in the area of the vermilion in cleft lip, jaw and palate can be compensated and largely normalised through targeted local flap surgery, together with tissue transplants if needed.
Natural profile improvement can be achieved for a receding or overemphasised chin or any asymmetries. This is carried out without foreign objects or implants using the chin wing osteotomy. Chin wing osteotomy was developed at the Centre for Maxillo-facial Surgery and the results achieved have been presented at various international conferences and published in leading journals.
More information on chin wing surgery can be found on Wikipedia (in German).
Accentuation of the cheekbones
the cheekbone region has insufficient emphasis it can be accentuated
permanently by appropriate osteotomy, without using foreign objects or
Displaced wisdom teeth, cysts in the area of the tooth roots or other inflammatory and infectious conditions of the jaw can be removed and healed with gentle techniques and routine procedures.
If there is insufficient bone available for the provision of dental implants, this can be constructed by taking autologous bone from an appropriate place and transplanting it, in combination with bone substitutes or distraction procedures if required.
Removal of wisdom teeth
The removal of wisdom teeth is the most common oral surgical intervention. There may not be enough room for the teeth to break through easily, or their direction of growth may endanger the roots of the adjacent teeth. Wisdom teeth can also negatively affect the outcome of a completed procedure to correct tooth position, or may be displaced in such a way that they can cause health problems.
The wisdom teeth are removed quickly and carefully in a minor surgical procedure that can be performed easily under local anaesthetic. On request, brief outpatient general anaesthesia can be offered for reasons of comfort or anxiety.
Exposing impacted and displaced teeth (impacted canines)
If teeth do not break through themselves due to lack of space or a deviation of the axis, they may remain in the jaw bone and lead to misaligned teeth. In this case, they need to be surgically exposed and provided with an orthodontic button. The teeth are moved into the correct position using a wire loop and braces.
Digital volume tomography – DVT
The digital volume tomography (DVT) available at our centre allows for rapid, careful and reliable three-dimensional representation of the facial skeleton, which is essential for our treatment planning. With the use of appropriate settings and protocols, the radiation exposure can be limited to a minimum. This investigation may also be carried out on referral from your dentist, for example, in the context of planning a dental implant.
If the nose has unfavourable proportions or functional limitations, or in cleft lip, jaw and palate, the profile, size and shape of the nose can be individually adjusted and corrected.
For anatomic narrowness of the anterior sections of the nose, the space can be permanently expanded through a suitable small osteotomy at the base of the nose. This technique was also developed at our centre and published in a leading international journal. If necessary, the procedure can be combined with straightening of the nasal septum (septoplasty) or reduction of the turbinates (turbinectomy). Of course, aesthetic considerations are not neglected.