Maxillofacial Surgery — Medical Guide — MyMedicPlus

A dentist provides general dental care. An oral surgeon (in many countries) has completed a 4-year surgical residency after dental school and focuses on dentoalveolar procedures, implants, and facial trauma. An oral and maxillofacial surgeon (OMFS) in Europe, Australasia, and many other countries holds dual medical and dental degrees, enabling a broader scope including major head-and-neck oncology, craniofacial reconstruction, and complex midface/cranial surgery. In the US, OMFS training is a 4- or 6-year residency after dental school, with the 6-year pathway conferring an MD degree.

Initial recovery — swelling, bruising, jaw stiffness — takes 4–6 weeks. Most patients return to desk work within 2–3 weeks. A liquid and puree diet is maintained for 6 weeks. Post-surgical orthodontics to finalise occlusion takes a further 6–12 months. Complete bony consolidation and full neurosensory recovery may take 12–18 months. Osteotomy sites are radiographically healed by 3 months.

A fibula free flap (FFF) involves harvesting a segment of the fibula bone (up to 25 cm) along with its blood supply (peroneal artery and vena comitans) from the lower leg. The bone is shaped to reconstruct the resected mandible or maxilla and its pedicle is microsurgically anastomosed to neck vessels. The fibula is chosen because it is expendable (the tibia bears weight), provides long cortical bone, can be osteotomised into multiple segments, accepts osseointegrated dental implants, and its pedicle is long and reliable. Success rates exceed 95% at experienced centres.

Coverage depends on indication and insurer. Functional indications — jaw surgery for OSA, trauma, or cancer — are usually covered. Orthognathic surgery for documented malocclusion causing eating or speech difficulty is covered by many insurers and national health systems (NHS, Medicare). Purely aesthetic jaw surgery is typically excluded. Preauthorisation documentation from both the OMFS surgeon and orthodontist, including cephalometric analysis and occlusal records, is usually required. International patients should seek pre-treatment written cost estimates and insurance pre-authorisation.

Seek emergency care immediately for: progressive swelling of the neck or throat causing breathing difficulty; high fever (above 38.5 C) with redness and discharge from wounds; rapidly increasing pain not controlled by prescribed analgesia; complete loss of vision or double vision after orbital surgery; facial nerve weakness (drooping of eyelid or corner of mouth) that worsens acutely; or significant bleeding from surgical sites. These may indicate airway compromise, surgical site infection, flap failure, or orbital haematoma — all surgical emergencies.