Minimally Invasive Aesthetic and Functional Jaw Surgery

Posted By SHL Librarian

Presented by: Sabine Girod, MD, DDS, PhD, FACS
Associate Professor, Oral and Maxillofacial Surgery
Stanford University Medical Center
October 20, 2011

When it comes to your face, how you look and what lies beneath your skin are intimately related. Facial aesthetics are based on balance and symmetry, which are determined by the set of your bones and teeth. From Nefertiti to Mona Lisa, attractive faces share uniform proportions that are balanced and relatively symmetrical. Research has shown that most people seem to have similar ideas about what constitutes an attractive face, which generally features wideset eyes, a large forehead, prominent cheekbones, thick lips, and a small, short nose and chin.

But aesthetics are only part of the issue, said Sabine Girod, MD, DDS, PhD, FACS, an associate professor of surgery, 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.

While skeletal and dental structures are the basis of good looks, more than your self-esteem can suffer when things are off-kilter. Poor skeletal structure or jaw alignment can cause chronic pain, dental or orthodontic problems, sleep disorders, breathing problems, or speech impediments.

“In OMS we do a lot of initial and ongoing analysis of both the bones and teeth to determine where the deficiencies and imbalances are and what changes we can make to improve symmetry and function,” Dr. Girod said. “Often we can change these asymmetries by doing oral surgery. In a case of a recessive jaw, for example, the right surgery can change move the jaw forward, which can balance the facial features, improve function, and make the bite better.”

Improving Function and Appearance
Surgical techniques have changed drastically over the past decade and most are now minimally invasive, leaving no facial scars. For problems like an imbalanced lower jaw or receding jaw, orthognathic surgery combines orthodontic treatment with surgery to correct function and balance between the teeth, jaws, and facial structures. Various techniques can be used to correct anomalies, such as when the jaws do not align or when the teeth do not fit. The surgeon will realign the jaw, working from the inside of the mouth or under the lip, and will stabilize the jaw by using small plates held in place with bands.

“The plates are stable enough that you don’t need to wire the jaw shut any more,” said Dr. Girod, who showed several before and after photos of patients. “After about 10 days we can take out the elastic bands and the patient can start on soft food. The jaw never needs to be wired shut.”

Addressing Sleep Disorders
Orthognathic surgery is used to treat people with obstructive sleep apnea, a condition that affects more than 13 million people in the United States—though less than one-quarter receive treatment. People with apnea experience recurrent episodes throughout the night in which their throat closes and they cannot pull enough air into their lungs. The lack of oxygen causes the person to awake repeatedly, which leads to extreme daytime drowsiness. People with untreated sleep apnea face a greater risk of stroke and are more likely to have heart disease, along with hypertension, arrhythmia, and stroke.

Dr. Girod is a specialist in maxillo-mandibular advancement, a surgery for obstructive sleep apnea that realigns the jaw. Because the procedure not only corrects the compressed airways but also affects the person’s profile, she utilizes computer simulation to plan the operation, using three-dimensional virtual planning programs to anticipate the end result.

“We always try to correct function in a way that makes the patient look good,” she said. “This procedure affects not only function but aesthetics, and most patients have been very happy with the results.”

Dr. Girod is also involved in refining a technique called distraction osteogenesis, which stimulates the growth of new bone. The jaw is cut and pulled apart slowly with a distractor in small increments—about a millimeter a day—allowing new cells to grow between the segments. She compared it to the process used to lengthen a leg and said that the technique can correct asymmetries and discrepancies in both the upper and lower jaw.

Minimally Invasive Procedures
Another minimally invasive procedure called orthodontic distraction has shown to remedy facial deformities and enhance orthodontic treatment in children, eliminating the need for jaw surgery later on. The technique pulls on the bone, rather than the teeth, and can correct many jaw problems during the child’s growth..

“You can pull on the bone while the sutures are still open,” said Dr. Girod. “It takes about a year, but all they have to do is use these rubber bands day and night. The idea is to avoid any other treatment later on. We’ve been seeing a lot of success and positive development with this approach.”

About the Speaker
Sabine Girod, MD, DDS, PhD, FACS is an associate professor in the Department of Surgery and chief of Stanford’s Oral Medicine and Maxillofacial Surgery Service. She is also director of the Stanford Plastic Surgery Adult Clinic. An expert in oral and maxillofacial surgery, Dr. Girod has a special interest in refining virtual surgical simulations to plan surgical outcomes. 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.

For More Information:

Stanford Health Library can do the searching for you. Send us your medical questions.

About Dr. Girod
http://stanfordhospital.org/profiles/Sabine_Girod

Stanford Oral Medicine and Maxillofacial Surgery
http://stanfordhospital.org/clinicsmedServices/COE/surgicalServices/oralsurgery/

Stanford’s Division of Plastic Surgery
http://plasticsurgery.stanford.edu/

American Association of Oral and Maxillofacial Surgeons
http://www.aaoms.org/jaw_surgery.php

Aesthetic and Functional Maxillofacial Surgery

Posted By SHL Librarian

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.

Improved Techniques
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

Revolutionary Advances
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.

For More Information:

Stanford Health Library can do the searching for you. Send us your medical questions.

About Dr. Girod

Maxillofacial Surgery Clinic

Stanford Oral Medicine and Maxillofacial Surgery

Division of Plastic Surgery