Presented by: Sabine Girod, MD, DDS, PhD, FACS
Associate Professor, Plastic and Reconstructive Surgery
May 19, 2016
Oral and maxillofacial surgery is a surgical specialty for the diagnosis and surgical treatment of diseases, injuries, and defects of the upper and lower jaw. Procedures range from repairing congenital deformities to realigning jaw placement to replacing bone removed during cancer treatment.
Poor skeletal structure or jaw alignment can cause chronic pain, dental or orthodontic problems, sleep disorders, breathing problems, or speech impediments. Since facial malformation or damage is so apparent, it can create psychological and emotional trauma as well as a social stigma for the patient.
“Procedures can make a huge change in a person’s appearance. It’s more than just surgery—it really does change people’s lives,” said Sabine Girod, MD, DDS, PhD, FACS, an associate professor of surgery, who spoke at a presentation sponsored by the Stanford Health Library. Dr. Girod specializes in oral and maxillofacial surgery (OMS), a specialty that combines dental, medical, and surgical skills.
Surgical techniques have changed drastically over the past decade. Instruments have been refined, and stabilizing techniques have made procedures safer, more comfortable, and with more predictable outcomes. Procedures have been shortened to as little as three to four hours, and most are now minimally invasive and done on an outpatient basis. Corrections are performed inside the mouth or under the lip, leaving no facial scars.
Orthognathic surgery is used when jaws don’t meet correctly, such as when the lower jaw juts out or teeth are misaligned, to correct function and balance. This not only improves facial appearance but also ensures that teeth meet correctly and function properly. The surgery can improve chewing, speaking, and breathing, as well as improve the appearance of the chin and jaw.
The practice has been used for more than 30 years, though in the past a patient’s jaw usually was wired shut for several weeks after the procedure to keep it stabilized while the bone realigned. Today small titanium plates are attached to the jaw that can be adjusted with bands that can easily be taken off for talking or eating. Food must be soft to avoid putting pressure on the jaw as it heals.
“The plates are stable enough that the jaw never needs to be wired shut,” said Dr. Girod. “The plates used in orthognathic surgery represent one of the field’s most dramatic advances.”
Growing New Bone
Distraction osteogenesis is the surgical technique of generating new bone by progressive stretching of divided segments. The jaw is cut and pulled apart slowly with a distractor in small increments, which allows new cells to grow between the segments. Once the new bone is strong enough, Dr. Girod removes the distraction device. The technique is used mostly in children with congenital deformities but also is used in adults to correct asymmetry and misalignment in the upper and lower jaw.
Since children’s bones are not yet completely fused, another minimally invasive procedure called orthodontic distraction can be used to repair facial and jaw deformities. The facial bones are pulled out using plates inserted into the jaw bones that are adjusted with rubber bands over time.
“There is a benefit to doing these corrective procedures in kids while they are young instead of waiting for them to get older,” Dr. Girod said. “Not only is the bite corrected, the facial deformity is removed and there is an improvement in facial aesthetics.”
Dr. Girod is a specialist in maxillomandibular advancement, a surgery for obstructive sleep apnea that opens the airway for easier breathing during sleep. Current treatment involves realigning the jaw 10-15mm; she is involved in studies to determine whether less displacement of the jaw will result in predictable and positive outcomes
Another revolutionary improvement is in the use of computer imaging. Computer modeling and virtual simulation are used both to plan procedures before Dr. Girod and her team head into the operating room and to show patients how they will look after the surgery.
“I used to make plaster molds of each patient to plan the surgery. Now I prepare with computer modeling,” she said. “It’s a big improvement.”
Treatment begins with meticulous measurements, photos, X-rays, skeletal analyses, and CT and MRI imaging scans that are consolidated into a composite image. Computer modeling creates precise three-dimensional mockups that are used to plan the operation and practice the steps that need to be taken. Dr. Girod uses Digital Imaging and Communications in Medicine (DICOM), a system for storing, printing, and transmitting medical imaging information, to create virtual fly-throughs of the skull to assess all aspects of the patient’s anatomy. This painstaking planning process ensures that the surgery will result in improved symmetry and function.
“I can see in three dimensions exactly how I need to move the jaw and go into surgery with guides for navigation and follow-up,” she said. “The advances over the past 10 years are simply amazing and bring us that much closer to providing personalized care.”
Dr. Girod has a special interest in refining virtual surgical simulations to plan surgical outcomes. She is collaborating with Da Vinci, a company that designs robotic surgical systems, to apply robotics to enhance facial contouring procedures, and she described new inroads in augmented reality that use surgical navigation systems that superimpose X-rays over the patient during an operation. Other research is developing “smart” contact lenses that project anatomical images into the eye.
About the Speaker
Sabine Girod, MD, DDS, PhD, FACS is an associate professor of surgery (plastic and reconstructive surgery) and, by courtesy, of otolaryngology-head and neck surgery. An expert in oral and maxillofacial surgery, she is chief of Stanford’s Oral Medicine and Maxillofacial Surgery Service and director of the Stanford Plastic Surgery Adult Clinic. She received her degree in dentistry from the University of Bonn in Germany and continued her medical training, residencies, and fellowship at Harvard Medical School, the University of Cologne, and Hannover Medical School in Germany. She has been at Stanford since 2000.
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