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SERVICES & PROCEDURES TMJ Surgery Sleep Apnea & Snoring Botox Wrinkle Removal Perioral Skin Resurfacing Cosmetic Maxillofacial Surgery Cleft and Craniofacial Surgery Dental Implants Trauma Surgery Reconstructive Jaw Surgery Temporomandibular Joint Arthroscopy Click Here to Learn More About TMJ Temporomandibular Joint Arthroscopy or TMJ Arthroscopy can be a very valuable treatment option for TMJ problems. I have been using TMJ Arthroscopy since 1986 and have taught and certified sixty surgeons on this technique using formal Continuing Education Courses. It is important to remember that the best treatment for TMJ problems requires making the correct diagnosis. Our practice success rate is 94% utilizing TMJ Arthroscopy over an 18 year period. Arthroscopy of the TMJ is usually performed in a surgery center or sometimes under intravenous sedation in our office. It is a relatively non-invasive procedure that requires a very small "nick" incision over the TMJ area just in front of the ear. Through this small puncture the arthroscope is introduced and the entire joint is visualized and any abnormalities that may be present are easily seen. Detail is excellent as the magnification is approximately 30 times normal. The joint is often washed out with sterile saline and a small amount of physiologic lubricant is injected. This lubricant which is normally produced by the normal joint is sometimes deficient in people with TMJ problems. Other findings such as adhesions or stuck discs, (the small pad that normally protects the joint) can be treated with arthroscopy. These procedures are designed to improve mobility of the jaw and to lessen or completely eliminate pain. Prior to the introduction of TMJ arthroscopy patients would have to undergo open surgical procedures. These procedures would require an extended incision, more invasive surgery and longer recovery. The graph shown below shows the trend in our practice of TMJ arthroscopy versus open surgery since 1986. As we can see, there has been a decided trend toward arthroscopy, again when indicated. Patients are back to work immediately after arthroscopy with no down time. The use of a range of motion device called a THERABITE has been instrumental and vitally important to the success of the procedure. This simple and portable range of motion appliance is used to perform home physical therapy. The success of arthroscopy is dependent on the use of the THERABITE. Further it feels good to use it. Please feel free to contact us with any questions you may have regarding this discussion. - Dr. Anthony Farole, D.M.D. Click Here to Learn More About TMJ Sleep Apnea & Snoring Click Here to Learn More About Sleep Apnea If your snoring is habitual and disruptive to others, you may be a prime candidate for LAUP. Your otolaryngologist will evaluate you and ask the following questions: Do you snore loudly and disturb your family and friends? Do you have daytime sleepiness? Do you wake up frequently in the middle of the night? Do you have frequent episodes of obstructed breathing during sleep? Do you have morning headaches or tiredness? Suitability for LAUP is determined after a review your health history, lifestyle factors (alcohol and tobacco intake as well as exercise), cardiovascular condition, and current medications in use. You will also receive a physical and otolaryngological (ear, nose, and throat) examination to evaluate the cause of the snoring. Before the laser procedure is conducted, you will participate in a "sleep study," which will grade the level of actual snoring and sleep apnea. This will complete the evaluation necessary for prescribing the appropriate treatment for your condition. Click Here to Learn More About Sleep Apnea Botox Wrinkle Removal Click Here to Learn More About Botox Wrinkle Removal Glabellar lines are the wrinkles between the brows that form when you frown. To make this expression, you move the corrugator and procerus muscles, which are located between and above the brows. Movement of facial muscles can cause the skin between the brows to crease. As skin becomes less elastic over time, repeated frowning may create visible lines and wrinkles-even when your face is relaxed. BOTOX® Cosmetic is a natural, purified protein that relaxes muscles by blocking nerve impulses. With a few tiny injections administered by a physician, BOTOX® Cosmetic relaxes the muscles that cause skin to crease.1 Once the muscles are at rest, the skin becomes smoother, creating a more natural and relaxed appearance. Click Here to Learn More About Botox Wrinkle Removal Perioral Skin Resurfacing (click here for details and appointment information) Sun Exposure, squinting, and smiling. They all contribute to wrinkles that appear on your face. You may have noticed them around your eyes or mouth. And you may have realized how they alter your appearance, making you look tired, sad, or older. Fine skin wrinkles are a fact of life. And now, so is treating them, right in your doctor's office, with a CO2 laser. Physicians around the world are using the NovaPulseTM laser and a technique called "cosmetic skin resurfacing" to reduce wrinkles without scalpels or stitches. Instead, the doctor guides a laser beam over the wrinkled skin. This removes the outer layers, and the healing process results in a firmer, smoother appearance. Patients are treated with the NovaPulseTM laser right in the doctor's office, often under local anesthetic, and may return to work immediately or in the next few days. The treatment area will be red for some time after treatment and the doctor will provide directions on how to care for the area as it heals. Steps may include application of ointment, avoidance of sunlight, and other appropriate measures. Additional follow-up visits allow the doctor to monitor progress. A reduction in wrinkles is usually immediately noticeable. (click here for details and appointment information) Cosmetic Maxillofacial Surgery Click Here to Learn More About Cosmetic Maxillofacial Surgery Cosmetic maxillofacial surgery is used to repair physical malformations resulting from disease, injury, burns, birth defects or aging. It may also serve to restore normal function and improve individual appearance. Cosmetic maxillofacial surgery can be performed using a variety of techniques, and several different procedures are available to correct specific conditions. Because of their surgical and dental background, oral and maxillofacial surgeons are uniquely qualified in the treatment of the face, mouth, teeth and jaws. Extensive education and training in surgical procedures involving both the soft tissue (skin and muscle) and hard tissue (bone and cartilage) of the maxillofacial area make the oral and maxillofacial surgeon finely attuned to the importance of harmony between facial appearance and function. Click Here to Learn More About Cosmetic Maxillofacial Surgery Cleft and Craniofacial Surgery (click here for details and appointment information) Cleft lip can be an isolated event or can be found in conjunction with a cleft palate. It is caused by the failure of the normal structures to fuse together during the formation of the lip. The cleft is an opening in the lip. The skin, muscle, and oral lining tissue is present but has not fused leaving an opening. Cleft lips occur more often on the left side rather than the right side for reasons that we don't understand. More than half of cleft lips occur with a cleft palate where there is a failure of the two sides of the roof of the mouth to fuse in the midline to form a complete palate. Clefts of the lip, incomplete or complete, are associated with some degree of nasal distortion. The children with incomplete cleft lips have a smaller nasal deformity than the children with complete cleft lips. Clefts that involve the lip and the palate are more significant in that cleft palates can affect feeding, weight gain, middle ear function, speech and facial growth. Each of these issues may be noted at different ages, i.e. difficulty feeding and middle ear dysfunction are infant and early childhood issues. Speech difficulties present themselves later around two years of age. Facial growth and dental occlusion are preteen or adolescent issues. A craniofacial team is essential to provide the children and their families the care they need to give the best result. (click here for details and appointment information) Dental Implants Click Here to Learn More About Dental Implants Life’s simple pleasures can cause problems and pain for the millions of adults who suffer from permanent tooth loss. Men and women of all ages are self-conscious about their dentures, bridges or missing teeth. Some have difficulty speaking because their dentures slip or click. For others, the irritation and pain caused by dentures are constant reminders of the limitations they feel. Many are concerned about their appearance and may feel that their tooth loss has “aged them” before their time. Some regularly decline invitations to social events because they are unwilling to face the uncertainties of eating, speaking and laughing in public. Many can no longer enjoy their favorite foods, nor the social interaction with family and friends that accompanies special meals. Click Here to Learn More About Dental Implants Trauma Surgery (click here for details and appointment information) There are people specially trained to deal with injuries to the mouth, face, and jaw: oral and maxillofacial surgeons. Their training and experience uniquely qualify them to deal with these types of injuries. These can include a wide range of injuries, from facial cuts and lacerations to more serious problems, like broken teeth and fractured facial bones. THE SERIOUS SIDE OF FACIAL INJURY One of the most common types of serious injury to the face occurs when bones are broken. Fractures can involve the lower jaw, upper jaw, palate, cheekbones, eyesocket, and combinations of these bones. These injuries can affect sight, and the ability to breathe, speak and swallow. Treatment often requires hospitalization. SPECIALIZED TREATMENT The principles of treatment for facial fractures are the same as for a broken arm or leg. The parts of the bone must be lined up (reduced) and held in position long enough to permit them time to heal. This may require six or more weeks depending on the patient's age and the fracture's complexity. When fractures are extensive, multiple incisions to expose the bones and a combination of wiring or plating techniques may be needed. The repositioning technique used by the oral and maxillofacial surgeon depends upon the location and severity of the fracture. In the case of a break of the upper or lower jaw, metal braces may be fastened to the teeth and rubber bands or wires used to hold the jaws together. Patients with few or no teeth may need dentures or specially constructed splints to align and secure the fracture. What's more, many individuals who sustain facial fractures have other medical problems and the oral and maxillofacial surgeon is trained to coordinate his or her treatment with that of other doctors. During the healing period, when jaws are wired shut, the oral and maxillofacial surgeon prescribes a nutritional diet. This helps the injury heal as quickly as possible by keeping the patient in good health. After discharge from the hospital, the doctor gives the patient instructions dealing with continued facial and oral care. DON'T TREAT ANY FACIAL INJURY LIGHTLY Of course, not all facial injuries are extensive. The thing you should remember, though, is that they are all complex. Even in the case of a moderately cut lip, the expertise of the oral and maxillofacial surgeon is indispensable. If sutures are needed, placement must be precise to bring about the desired cosmetic result. So a good rule of thumb is that you shouldn't take any facial injury lightly. Not only that, but facial injuries are in a critical area of the body. After all, the functions of breathing, eating, speaking and seeing are located there. PREVENTION-THE BEST POLICY Because avoiding injury is always best, the oral and maxillofacial surgeon is a staunch advocate of the use of automobile seat belts. For the same reason, the use of protective mouth guards, and appropriate masks and helmets for athletes is recommended. The oral and maxillofacial surgeon maintains a constant vigilance, warning the public of hidden everyday hazards to their health. Now, as always, your oral and maxillofacial surgeon's concern is not just with oral health, but extends to the total health of the individual. (click here for details and appointment information) Reconstructive Jaw Surgery (click here for details and appointment information) Jaw growth is a slow and gradual process. Occasionally, something may go wrong with this process and the upper and lower jaws may grow at different rates. UNEQUAL JAW GROWTH—A CAUSE FOR CONCERN One or both jaws may grow too much or too little. The resulting abnormality may interfere with proper teeth alignment, speaking and chewing. The tongue and lips may be forced to move awkwardly during speech and swallowing in an attempt to compensate for the jaw malrelationship. There may be a speech defect or excessive mouth breathing. An improper bite may threaten the long-term health of the gums and teeth. The jaw joint (TMJ) can also be adversely affected by a jaw malrelationship. In addition, jaws of different sizes—that don’t match—can affect appearance. TREATMENT When unequal jaw growth is the source of the problem, corrective jaw surgery may be necessary. Orthodontic treatment (braces or other appliances) may also be needed to allow the teeth to align properly. Corrective jaw surgery involves moving all or part of the upper and/or lower jaw into a more favorable position. For example, the entire jaw can be moved backward if it’s too large. The goal of treatment is to improve function and restore facial balance. Some people have facial abnormalities involving just the upper face, cheek bones and nose. These can also be surgically corrected. The bones are repositioned so the facial features are more symmetrical. This is usually accompanied by the return of normal breathing, speaking and eating patterns. After the jaws are moved into their new position, rubber bands or wires attached to the teeth may be used to fasten the jaws together during healing. Alternatively, rigid internal fixation with miniature screws and plates may be used to allow you to open and close your jaws sooner after corrective surgery. TAKE A CLOSER LOOK Take a closer look at your bite and appearance. Does your chin stick out? Does it recede? Do your teeth fit together properly? Do you have “buck” teeth? Are your teeth straight? If you suspect there’s cause for concern, have your oral and maxillofacial surgeon examine your face and bite. Below is feedback from the mother of a patient who had orthognathic/jaw corrective surgery. "I was reading over my e-mail files for the past year and came across your name. Absolutely no one played a bigger role in our family's happiness in 2004 than you did. Even Seth has come to the point where he is glad he underwent the procedure. He obviously holds you in the highest esteem because I know he shared your name with an acquaintance in North Carolina with similar surgery to face. So let me take this time to wish you a new year of continued success, good health and personal happiness. We plan to see you in the Spring." - S.F. (click here for details and appointment information)