San Diego Center for Oral and Facial Surgery

Surgical Cases

(PLEASE DO NOT FORWARD THIS PAGE)

This page is for educational purposes only and should be viewed by dental and medical professionals only. If you are not a dental or medical professional, please leave this page immediately.

Young patient after being hit by a car while riding his bicycle. The patient was not wearing head or face protection.
6 upper front teeth were either lost or damaged beyond repair. The outer bony plate was also lost. After removal of the damaged teeth and debridment of the area. Bone grafting was performed and the wound was closed in anticipation of future dental implants.

 

Invasive squamous cell carcinoma of the tongue resulting from over 20 years of cigarette smoking. The patient did not know that he had a problem until he experienced difficulty speaking. Unfortunately, by the time the cancer was diagnosed, the cancer had spread to the lower jaw, neck, and larynx.
The patient's head is on the right. Due to the spread of the cancer, the patient's tongue, lower jaw, and larynx were removed. In order to cover the esophagus and the contents of the neck, a skin/muscle flap from the chest area was raised into the area of tumor removal. Immediate postoperative image demonstrating skin closure. The patient will now breath through the tracheostomy.

 

Young woman who presented to the office with massive neck swelling and respiratory distress. The condition was caused by an infected wisdom tooth. Months prior, the patient was given advice to have her wisdom teeth removed, but she failed to follow through with appropriate treatment. The condition is known as Ludwig's Angina which is caused by spread of bacterial infection throughout the tissue planes of the neck. Without immediate medical and surgical treatment, this process would most likely be fatal. 
The patient as she initially presented. Acutely ill and in respiratory distress. The swelling developed over a period of 2 days. She had a fever of 104.5. The patient was immediately transferred by ambulance to the hospital where immediate medical and surgical intervention was initiated. She was placed on intravenous antibiotics and transferred to the operating room where she was fiberoptically intubated for airway protection. The wisdom teeth were removed and the infection of the neck was surgically drained through several small incisions in the neck. After two days in the ICU and another three days in the hospital, the patient recovered well and was sent home on oral antibiotics. She is seen here one week later.

 

Injury caused by a 30-06 rifle in a suicide attempt. The patient placed the gun under his chin and fired the weapon. The initial blast deflected the head backwards, and therefore, the bullet missed the patient's brain leaving behind a devastating facial injury. The patient survived this injury and received multiple reconstructive surgeries and psychiatric counseling.

Massive blast injury of the soft tissue of the face. The blast resulted in the loss of most of the teeth and bone of the upper and lower jaws. The upper jaw (indicated by the yellow box) was hanging unsuspended in multiple fragments. These fragments had to be anatomically oriented and resuspended using micro titanium plates. A titanium plate was fixed to the remaining bone of the lower jaw in order to reestablish the anatomic space that the lower jaw once occupied.

Immediate post-operative view of the patient. 3 months after initial surgery. X-ray demonstrating the loss of teeth and bone in the upper and lower jaw. Bone harvested from the patient's hip was used to reconstruct the lower jaw.

 

43 year-old male with large ameloblastoma involving the right mandible. The patient presented with the complaint of swelling of the right jaw and inability to open his mouth. A review of his medical records showed that the patient had a cyst removed from the right side of the jaw 20 years previously. It was assumed that cells from the cyst remained in the jaw after the cyst was removed. These cells were either represented ameloblastoma at the time or later transformed into ameloblastoma.
Panorex x-ray demonstrating extensive tumor involvement of the right mandible. Intraoral appearance of the tumor. Lateral aspect of the resected specimen. The coronoid process of the mandible was removed and the condyle was spared.
Medial aspect of the specimen. Clear margins were confirmed by frozen. Note the inferior alveolar nerve within the specimen. A titanium reconstruction plate was placed to span the continuity defect of the mandible. Primary reconstruction of defect using autogenous rib graft was then performed. The rib graft was used to "frame" the mandibular defect. Autogenous corticocancellous iliac bone was placed in between the rib grafts to reconstruct the ramus and body of the mandible.