Surgismile Dental and Maxillofacial Surgery Clinic

02/04/2023

Let's appreciate our peace and like good health, peace is often taken for granted until it's lost.

14/12/2019

18/02/2019

MONDAY CHAT WITH A MAXILLOFACIAL SURGEON
THE IMPACTED OR BURIED TEETH
In todays chat we discuss the impacted teeth or teeth that fail grow into (erupt) the mouth. Teeth that remain buried in the jaw, partially or fully are described as impacted.
WHY DO TEETH GET IMPACTED?
In most cases teeth are impacted due to lack of adequate space in the jaws and therefore teeth that erupt late are more likely not to find space in the jaws. For this reason the third molars that erupt last are often the most impacted followed by canines that are the last to erupt among the front teeth. The canines, especially of the maxilla (upper jaw) are also often displaced to erupt outside the jaws (creating warthog-like look) or inside the palate when there is inadequate space in their correct position.
But this discrepancy in the teeth size jaw size (big teeth small jaws) is not the only explanation for teeth impaction.
Sometimes teeth fail to erupt even where there is more than adequate space in the jaws. There are certain inherited developmental conditions (syndromes) in which genes associated with defects in teeth development may lead to impaction of several or all the teeth ( examples are conditions like amelogenesis imperfecta and Gardner's syndrome, cleft palate among many others).
In some cases injuries during teeth development , the developing tooth may be displace by injury to the jaws or by abnormal growth of tumours and cysts that obstruct their line of eruption or simply push the affected teeth out of normal position.
(NOTE THAT TEETH DEVELOP SEVERAL MONTHS OR EVEN YEARS BEFORE THEY ERUPT IN THE JAWS).
Injuries may also lead to a condition known as ankylosis in which the tooth totally fuses with the bone as if fixed with hard cement, such a tooth loses the ability to erupt and remain stuck in the bone.
Failure of the baby teeth (deciduous or milk teeth) to fall off has also been implicated in impaction of teeth but it is usually not clear if the deciduous teeth overstay or fail to drop off due to the failure of impacted teeth to push them out. (case of is it the hen or the egg that came first).
NOTE THAT impaction only refers to teeth that fail to erupt well after their time (age) or are evidently out of their position and cannot be expected to erupt. Teeth that are buried in the jaws as part of the normal development are referred to as unerupted and not impacted.
Next week I will share images of various types of impacted teeth as well as the problems or disease conditions that may arise from them.
WHAT IS ORAL AND MAXILLOFACIAL SURGERY?
This is a surgical discipline that deals with diseases including injuries, infections neoplams (cancers), birth defects and other developmental defects that affect the face, the jaws and the tissues around the mouth.
I will answer your questions every Monday.
You may also use messenger for more personal or where you prefer confidentiality.
WHATEVER IS POSTED HERE DOES NOT SUBSTITUTE PROFESSIONAL CONSULTATION AND I AM NOT RESPONSIBLE FOR ANY USE OF THE INFORMATION POSTED HERE BY A NON-QUALIFIED PERSON TO OFFER TREATMENT OR ANY FORM OF THERAPY!

04/02/2019

MONDAY CHAT WITH A MAXILLOFACIAL SURGEON
TODAY IS WORLD CANCER DAY!
After the Christmas and New Year festive season break, MONDAY CHAT WITH A MAXILLOFACIAL SURGEON resumes and those who were following this weekly chat can recall that our discussions in the two weeks prior to the break were on cancers that affect the maxillofacial region. In those two previous chats we discussed the causes and prevention of these cancers.
Today coincides with the World Cancer Day, the aim of which is to raise awareness on the prevention, early detection and treatment of cancer. In today's chat I will focus on treatment of cancers that affect the maxillofacial region which is not very different from treatment of cancers that affect other parts of the body.
As with all diseases the number one treatment is prevention and while the cause of most cancers remain unknown, environmental and behavioural or lifestyle factors contribute to individual likelihood of getting cancer. These factors were discussed in my previous chats and will not be repeated today's chat. Avoiding these factors or minimising exposure to them is therefore key to the prevention.
The next step in cancer management strategy is early detection of the disease which is very critical to success in treatment, for whatever we do to be safe from cancer, we may still get the disease.
Therefore any abnormal or unexplained growth(swelling), wound(ulcer), change in skin colour (skin pigmentation) that persists for more than two weeks, even if not painful should be investigated by a competent clinician. In the mouth these may appear as white patches, red or black pigmentations.
Swellings may appear anywhere on the face as well as the neck.
The most effective and most commonly used mode of treatment for most cancers in the maxillofacial region is surgery. Surgery if performed early is quite effective and can even eliminate the disease. Early surgery also leads to small invisible scar that often require no reconstruction. In more advanced cancers of the maxillofacial region, required surgery may be extensive leaving behind a huge defect that must be closed by surgical reconstruction with implants and tissues taken from other parts of the body. Such cases also require additional neck surgery to remove the lymph nodes through which cancer cells spread to other parts of the body (metastases).
Radiotherapy which is treatment of cancer by subjecting cancer cells to ionising radiation may at times be used alone but quite often it is performed after the surgery to eliminate any residual cancer cells that could have been left behind during surgery. Radiotherapy may be used alone in arears that cannot be easily reached by surgery or where the scars left behind after surgery can be a major problem. Radiotherapy has many side effects that are worse at the beginning of treatment but tend to reduce to bearable levels as the treatment progress.
The other mode of treatment is chemotherapy which is quite effective in some cancers such as lymphomas but is not very effective on some cancers like oral squamous cell carcinoma the most common cancer of the head and neck region. Chemotherapy also gives good results when combined with surgery in the treatment of cancers that arise from bones ,muscles and other tissues ( they are referred to as sarcomas).
In most advanced cancers a combination of surgery, radiotherapy and chemotherapy is necessary to control the rapid progress of the disease.
Chemotherapy and radiotherapy have many side effects that include loss of hair, dryness of the mouth, painful mouth ulcers, wasting of the skin and poor healing of wounds including bones and recurrent infections among others.
Throughout treatment the person needs a lot of support including nutritional supplements and pain management is critical. AND ABOVE ALL FAMILY AND FRIENDS LOVE AND SUPPORT IS INVALUABLE.
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WHAT IS ORAL AND MAXILLOFACIAL SURGERY?
This is a surgical discipline that deals with diseases including injuries, infections neoplasms (cancers), birth defects and other developmental defects that affect the face, the jaws and the tissues around the mouth.
I will answer your questions every Monday.
You may also use messenger for more personal or where you prefer confidentiality.
WHATEVER IS POSTED HERE DOES NOT SUBSTITUTE PROFESSIONAL CONSULTATION AND I AM NOT RESPONSIBLE FOR ANY USE OF THE INFORMATION POSTED HERE BY A NON-QUALIFIED PERSON TO OFFER TREATMENT OR ANY FORM OF THERAPY!

25/12/2018

MONDAY CHAT WITH A MAXILLOFACIAL SURGEON

HAPPY FESTIVE SEASON AND OBSERVE SAFETY.
In today's chat I will not discuss the complications from cancer treatment as initially planned, I will instead share a most recent WHO publication on global status of road safety.
As most of us take a respite from our work stations and travel to different parts in a celebratory moods let's keep road safety measures in mind. It is during these carnivals that most are injured. Responsible and cautious consumption of alcohol should be your resolve for those who drink.
Pedestrians constitute the largest percentage of road traffic deaths in Kenya, so take care when crossing roads, wear reflective clothing that make you visible at night if you routinely walk or ride along the highways.
Motorists please be on the look out for careless pedestrians. Speeding is quite thrilling during festivities, but remember "Speed that thrills, kills". DO NOT SPOIL YOUR FESTIVE SEASON OR OF THOSE YOU LOVE BY GETTING INVOLVED IN DEATH OR INJURY THAT COULD HAVE BEEN PREVENTED

Read the WHO article below

New WHO report highlights insufficient progress to tackle lack of safety on the world's roads

7 DECEMBER 2018 | Geneva, Switzerland - A new report by the World Health Organization (WHO) indicates road traffic deaths continue to rise, with an annual 1.35 million fatalities. The WHO Global status report on road safety 2018 highlights that road traffic injuries are now the leading killer of children and young people aged 5-29 years.



"These deaths are an unacceptable price to pay for mobility," said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. "There is no excuse for inaction. This is a problem with proven solutions. This report is a call for governments and partners to take much greater action to implement these measures."



The WHO Global status report on road safety 2018 documents that despite an increase in the overall number of deaths, the rates of death relative to the size of the world population have stabilized in recent years. This suggests that existing road safety efforts in some middle- and high-income countries have mitigated the situation.



"Road safety is an issue that does not receive anywhere near the attention it deserves - and it really is one of our great opportunities to save lives around the world," said Michael R Bloomberg, Founder and CEO of Bloomberg Philanthropies and WHO Global Ambassador for Noncommunicable Diseases and Injuries. "We know which interventions work. Strong policies and enforcement, smart road design, and powerful public awareness campaigns can save millions of lives over the coming decades."



In the settings where progress has been made, it is largely attributed to better legislation around key risks such as speeding, drinking and driving, and failing to use seat-belts, motorcycle helmets and child restraints; safer infrastructure like sidewalks and dedicated lanes for cyclists and motorcyclists; improved vehicle standards such as those that mandate electronic stability control and advanced braking; and enhanced post-crash care.



The report documents that these measures have contributed to reductions in road traffic deaths in 48 middle- and high-income countries. However, not a single low-income country has demonstrated a reduction in overall deaths, in large part because these measures are lacking.



In fact, the risk of a road traffic death remains three times higher in low-income countries than in high-income countries. The rates are highest in Africa (26.6 per 100 000 population) and lowest in Europe (9.3 per 100 000 population). On the other hand, since the previous edition of the report, three regions of the world have reported a decline in road traffic death rates: Americas, Europe and the Western Pacific.



Variations in road traffic deaths are also reflected by type of road user. Globally, pedestrians and cyclists account for 26% of all road traffic deaths, with that figure as high as 44% in Africa and 36% in the Eastern Mediterranean. Motorcycle riders and passengers account for 28% of all road traffic deaths, but the proportion is higher in some regions, e.g. 43% in South-East Asia and 36% in the Western Pacific.

WHAT IS ORAL AND MAXILLOFACIAL SURGERY?
This is a surgical discipline that deals with diseases including injuries, infections neoplams (cancers), birth defects and other developmental defects that affect the face, the jaws and the tissues around the mouth.
I will answer your questions every Monday.
You may also use messenger for more personal or where you prefer confidentiality.
WHATEVER IS POSTED HERE DOES NOT SUBSTITUTE PROFESSIONAL CONSULTATION AND I AM NOT RESPONSIBLE FOR ANY USE OF THE INFORMATION POSTED HERE BY A NON-QUALIFIED PERSON TO OFFER TREATMENT OR ANY FORM OF THERAPY!

17/12/2018

MONDAY CHAT WITH A MAXILLOFACIAL SURGEON
TREATMENT OF ORAL AND MAXILLOFACIAL CANCER

Like in nearly all types of cancer, the cause of oral cancer remains unknown, but as discussed in last week's chat there are many factors implicated.
The traditional adage 'prevention is better than cure' applies in the case of cancer more than any other disease.
Do not smoke, chew, sniff or inhale to***co, minimise alcohol, eat healthy diet if you can, avoid unnecessary radiation and exercise regularly to keep your physical health and immune system in shape. Have any infections treated as soon as possible.
PREVENTION, EARLY RECOGNITION OF THE DISEASE AND PROMPT TREATMENT are important in successful management of oral cancer.
Surgery is the main and most successful method of treatment. As we all know, surgery to the face is not easy especially if the disease is advanced and require removal of alot of tissue. Extensive surgery require complex reconstruction that take many hours and at times leave visible scars.
HOW CAN SOMEONE KNOW OR SUSPECT THEY HAVE ORAL CANCER?
Confirmation of cancer can only be done after a sample of the suspect tissue (a process called biopsy) is obtained and taken to the laboratory for analysis (the analysis may take a few hours to a couple of days depending on type of the tissue).
Persistent swelling, persistent wounds(ulcers) or unexplained change in colour of skin that persists for more than 2weeks should be investigated and biopsy may be required. The clinician may also recommend some imaging like x-rays CT scan and MRI to establish the nature and extent of the growth.
Once diagnosis of cancer is confirmed, your doctor will discuss with you the available treatment options.
As I have mentioned earlier, surgery is the number one recommended treatment in Oral cancer and can be used as the only treatment in small/ early cancers that can be totally removed. In these kinds of early trearment the disease can be totally eliminated.
In more advanced cancers, surgery is often more extensive and can include, neck surgery (neck dissection) to remove the lymph glands through which the disease spread. In such situations radiotherapy is done a few weeks after surgery to try and eliminate the hidden cancer cells and prevent recurrence of the disease. Chemotherapy may be used together with radiotherapy after surgery in some advanced oral cancers.
Rarely some cancers are very advanced and may be considered for a combination of radiotherapy and chemotherapy only. Usually this is done not for cure but to improve the quality of life even if the disease is considered terminal (Not curable).

Next week we discuss complications of treatment.

WHAT IS ORAL AND MAXILLOFACIAL SURGERY?
This is a surgical discipline that deals with diseases including injuries, infections neoplams (cancers), birth defects and other developmental defects that affect the face, the jaws and the tissues around the mouth.
I will answer your questions every Monday.
You may also use messenger for more personal or where you prefer confidentiality.
WHATEVER IS POSTED HERE DOES NOT SUBSTITUTE PROFESSIONAL CONSULTATION AND I AM NOT RESPONSIBLE FOR ANY USE OF THE INFORMATION POSTED HERE BY A NON-QUALIFIED PERSON TO OFFER TREATMENT OR ANY FORM OF THERAPY!

12/12/2018

MONDAY CHAT WITH A MAXILLOFACIAL SURGEON
ORAL AND MAXILLOFACIAL CANCER

In our last Monday's chat I stated that not all neoplasms or swellings and growths are cancer .
However, often when we hear the word neoplasm or tumour, it is cancer that come to mind.
You recall from the last chat i said that under normal circumstances, body cells have regulated multiplication and growth but in case of neoplasm they lose control and multiply continuously and haphazardly pushing away or destroying any normal tissue in their neighborhood. They may also spread to other parts of the body.
The rogue neoplastic or tumour cells behave like mutinous soldiers who refuse to obey their commander and instead turn against own people.
We also discussed that there are two broad categories of neoplasms; benign neoplasms that are usually slow growing, painless, less destructive and rarely kill the patient. Then there are malignant neoplasms commonly called cancer. These malignant ones often grow very rapidly, tend to be painful, destroy the neighbouring structures, spread to distant areas of the body and end up killing the patient if not promptly treated.
Cancer can arise from any type of cells of the body, but as discussed in our previous chat they are more likely to arise from cells that divide or multiply rapidly like those of the skin, the cervix, the breast, bone marrow and lining of the intestines among others. They are less likely to arise from cells that stop dividing in early childhood such as nerves and heart muscle cells.
Oral cancer can arise from any tissues in the mouth and surrounding structures. It can affect the lips, cheeks, tongue, palate, salivary glands and others.
Like in nearly all cancers the cause is not known. However, there is alot of evidence that certain conditions or factors initiate and promote the development of cancer.
In general cancer has been attributed to interaction between genetic factors and environmental factors. Therefore some unfortunate individuals carry genes that make them more at risk of cancer than others. Some of these cancer genes are passed from parents to offsprings while some of these dreaded genes result from changes in DNA that influence our genes, such changes are called mutations and can be due to factors such as exposure to radiation or toxic chemicals.
I will discuss the detailed processes of cancer initiation and progression in future chats.

The number one culprit that has been associated with oral cancer is to***co use in whatever form, whether smoked as in cigarette or chewed (mbaki) or betel nut or inhaled as Sh**ha. The risk of oral and throat cancer is higher among people who combine the use of to***co with alcohol. To***co is also associated with lung cancer.
Certain dietary deficiencies like lack of vitamin B12 and iron deficiency have been implicated as well as infection with certain viruses such as the human papilloma virus (HPV) a variant of which is now highly implicated in cancer of the cervix.
Other cancers associated with certain viruses are cancer of the lymph glands called Burkitt's lymphoma and cancer of blood vessels known as Karposi's sarcoma both of which are assocìated with different types of human herpes viruses (HHV)
Chances of infection with these cancer associated viruses increase in immunosuppressed patients as in untreated HIV AIDS or in transplant patients who are deliberately immunosuppressed to minimise rejection of the donated organ.
Exposure to too much direct sunlight has also been implicated in some changes on the skin especially of the lower lip known as actinic chelitis in which the lip turns raw-red, a condition that may progress to cancer if not treated.
Certain persistent injuries or irritation to the skin that line the inside of the mouth such as poorly fittng artificial teeth or dentures have also been implicated in oral cancer.(though with little evidence).
In conclusion, many factors are implicated in the progression of oral cancer but the actual cause or causes remain unknown.
HOW DO YOU KNOW THAT YOU HAVE CANCER? Confirmation of cancer can only be done after the sample of the affected tissue is taken to the laboratory for assessment. X-rays CT scan and MRI are useful aid in assessing the nature of the disease the extent or spread and treatmen planning or management.
HOWEVER WHEN YOU HAVE A SWELLING/GROWTH OR ULCER/WOUND THAT FAILS OR REFUSES TO HEAL AFTER 2-WEEKS then you should seek professional advise and examination.
Do not panic, the lesion most likely NOT cancer BUT IT IS SAFER TO ERROR ON THE POSITIVE SIDE.
Next Monday's chat we discuss signs and symptoms and treatment of Oral Maxillofacial CANCER.

WHAT IS ORAL AND MAXILLOFACIAL SURGERY?
This is a surgical discipline that deals with diseases including injuries, infections neoplams (cancers), birth defects and other developmental defects that affect the face, the jaws and the tissues around the mouth.
I will answer your questions every Monday.
You may also use messenger for more personal or where you prefer confidentiality.
WHATEVER IS POSTED HERE DOES NOT SUBSTITUTE PROFESSIONAL CONSULTATION AND I AM NOT RESPONSIBLE FOR ANY USE OF THE INFORMATION POSTED HERE BY A NON-QUALIFIED PERSON TO OFFER TREATMENT OR ANY FORM OF THERAPY!

03/12/2018

MONDAY CHAT WITH A MAXILLOFACIAL SURGEON
ABNORMAL GROWTHS OR SWELLINGS
This Monday and next two, I discuss the abnormal growths and swellings that may affect the facial region and the jaws.
There are many conditions that may cause swellings or lead to abnormal growths anywhere in the body. They may be due to infections as seen in abscess or as a result of injury (trauma) or due to uncontrolled multiplication of cells called neoplams or tumours and some may be cysts while others could be due to growth and development defects.
Swellings due to infections are most common and encountered in our day to day life (Will discuss them in future chats). Swellings due to injury (trauma) are also common and are die to infmmation that resolve in three or so days unless the injury is severe.
In today's chat I will focus on swellings that are due to abnormal tissue growth or uncontrolled cell multiplication called neoplasms or tumours.
Often when we hear the word neoplasm or tumour, it is cancer that come to mind. But, not all neoplasms are cancer.
Under normal circumstances, body cells have regulated multiplication and growth but in case of neoplasm they lose control and multiply continuously and haphazardly pushing away or destroying any normal tissue on there neighborhood they may also spread to other parts of the body. The rogue neoplastic or tumour cells behave like rogue or rebellious soldiers who nolonger listen to their commander.
There are two broad categories of neoplasms; benign neoplasms (tumours) and malignant neoplasms (tumours) these malignant ones are the ones referred to as cancer.
Benign neoplasms grow slowly are usually painless and will rarely kill the patient. They also do not spread to distant areas of the body (metastasis). Due to their slow growth and painless nature, they can and are often ignored by patients and some can grow to very massive sizes (see pictures). If they cause problems, it usually due to pressure on the neighbouring important structures such as brain, blood vessels or throat where the pressure can interfere with breathing or swallowing.
They can arise from any cells in the body including skin, muscles, bones, fat cells and the glands that produce saliva among others. In the Maxillofacial region, most of these benign tumours develop from the tissues from which the teeth develop.
The cause of these tumours are not known and it is important to have them treated early, otherwise delayed treatment create huge surgical detects that require reconstruction with expensive implants and bone graft. Often the bone graft is harvested from another part of the body of the same patient.
In the next chat I will discuss malignant neoplasms (cancers) of the face and jaws plus the surrounding structures

WHAT IS ORAL AND MAXILLOFACIAL SURGERY?
This is a surgical discipline that deals with diseases including injuries, infections neoplams (cancers), birth defects and other developmental defects that affect the face, the jaws and the tissues around the mouth.
I will answer your questions every Monday.
You may also use messenger for more personal or where you prefer confidentiality.
WHATEVER IS POSTED HERE DOES NOT SUBSTITUTE PROFESSIONAL CONSULTATION AND I AM NOT RESPONSIBLE FOR ANY USE OF THE INFORMATION POSTED HERE BY A NON-QUALIFIED PERSON TO OFFER TREATMENT OR ANY FORM OF THERAPY!

26/11/2018

Fractured face after fixation with multiple implants! This is the same face posted here last Monday

26/11/2018

MONDAY CHAT WITH A MAXILLOFACIAL SURGEON
FIXING THE FRACTURED FACE

In our chat last Monday I discussed that Maxillofacial injuries(trauma) often result from road traffic crashes (highest among boda boda users) and interpersonal violence (mostly assault by criminals or fights), falls (mostly children) and sports (mostly teenagers and young adults).
Once the injured person is stabilized as discussed last Monday investigations (usually x-rays and CTscans) are done. Injuries to the brain are more life threatening and if present are given priority treatment. Injuries to the eyes must be checked and treated immediately to prevent blindness.
Maxillofacial injuries are then addressed. These injuries may involve the soft tissue (cuts on the skin and muscles) or may be severe with multiple fractures of facial and jaw bones as posted here last Monday

YOUR FACE IS YOUR IDENTITY - NOBODY WANTS SCARS ON THEIR FACE!
Therefore stitching of the wounds on the face must be done meticulously with very fine sutures (not ropes used in hidden parts of the body).
The fractured bones must be put back together as accurately as possible and then fixed in position with implants. The implants used on the face are very tiny and are called mini-plates.(see the CT scan above) The implants used on the lower jaw(mandible) are larger and stronger so as to withstand chewing forces.
The treatment described so far is called open reduction and internal fixation (ORIF); the surgeon has to cut the skin open to reach the bone and fix.
There is an alternative approach called Closed reduction in which the skin is left intact but the upper and lower jaws are wired together for 4-6 weeks. During this period the patient cannot eat solid foods! There is some weight loss of about 6-10kgs (good for some people).
ARE THE IMPLANTS REMOVED AFTER HEALING? The mini-plates are usually not removed as they are quickly covered with normal bone. The large plates may be removed if the patient wishes but there is usually no problem even if they are not removed.
The implants are made of highly refined titanium with good bio-compatibility with human body.
Next week we discuss Maxillofacial tumours or abnormal jaw

WHAT IS ORAL AND MAXILLOFACIAL SURGERY?
This is a surgical discipline that deals with diseases including injuries, infections neoplams (cancers), birth defects and other developmental defects that affect the face, the jaws and the tissues around the mouth.
I will answer your questions every Monday.
You may also use messenger for more personal or where you prefer confidentiality.
WHATEVER IS POSTED HERE DOES NOT SUBSTITUTE PROFESSIONAL CONSULTATION AND I AM NOT RESPONSIBLE FOR ANY USE OF THE INFORMATION POSTED HERE BY A NON-QUALIFIED PERSON TO OFFER TREATMENT OR ANY FORM OF THERAPY!