Medical Procedures — Portland, Oregon and Vancouver, Washington Area Corrective Jaw, Craniofacial, and Cosmetic Surgery

At our practice in Portland, Oregon, serving the Vancouver, Washington area, craniofacial, corrective jaw surgery, cosmetic surgery, and a wide range of other procedures are offered by a team of surgeons who are board-certified physicians, as well as dentists. Patients visiting Head and Neck Surgical Associates benefit form the expertise of the Northwest's most highly specialized practice dedicated to head and neck, oral, maxillofacial, and facial cosmetic surgery needs.

After medical school, the professionals at Head and Neck Surgical Associates continued their specialized training in various residency programs in otolaryngology (head and neck surgery), oral and maxillofacial surgery, and plastic and reconstructive surgery.

Head and Neck Surgical Associate' surgeons have devoted their professional energies towards the management of a variety of complex problems affecting the head, neck, and cranio-maxillofacial skeleton. The practice offers Portland, Oregon and Vancouver, Washington area patients with the latest corrective jaw, craniofacial, and cosmetic surgery procedures, as well as a number of medical procedures including the diagnosis of cancers affecting the head and neck, temporomandibular joint (TMJ) surgery, and facial trauma surgery.

Our medical staff has spent their entire careers focusing on surgeries of the head and neck, thus you can be assured that you will receive the most comprehensive and specialized treatment available today. We look forward to meeting you and creating a personal treatment plan for you. To schedule a consultation at our Portland, Oregon office, contact our oral and maxillofacial surgery practice today to schedule a consultation.

The Procedures of Head and Neck Surgical Associates

The following procedures are provided by the board-certified physicians and dentists at Head and Neck Surgical Associates. Our services focus not only on a patient's immediate surgical needs, but on long term functionality and esthetics.

• Facial Trauma Surgery
• Head and Neck Oncological (Cancer) Surgery
• Orthognathic (Corrective Jaw) Surgery
• Reconstructive Surgery
• Snoring and Sleep Apnea Surgery
• Temporomandibular Joint (TMJ) Disorders and Surgery

Facial Trauma Surgery

The surgeons of Head and Neck Surgical Associates are all members of Legacy Emanuel Hospital's Level 1 Trauma Team and have extensive experience managing patients with severe maxillofacial and head and neck injuries. With academic appointments at Oregon Health & Science University in Portland, our craniofacial, corrective jaw, and cosmetic surgery providers are also heavily involved in education and research and have published extensively on the subject of maxillofacial trauma.

The physicians and surgeons at Head and Neck Surgical Associates are uniquely qualified to manage patients with facial injuries, as well as to treat the numerous cosmetic and functional deformities that can occur as a result of complex facial trauma. The face is a complicated structure that provides individuals with their primary sense of esthetic beauty, unique appearance, and self-esteem. Trauma to the facial region frequently results in injuries to the soft tissue, bony skeleton, jaws, mouth, teeth, lips, nose, eyes, and ears. Our physicians are both medical doctors, as well as dentists, and are trained to reconstruct the face and jaws from both a cosmetic and functional standpoint. The professionals at our office are proud to serve all of Oregon and Washington with the latest in cosmetic and reconstructive surgery to help heal the wounds of facial trauma.

Regardless if the injured patient requires primary soft tissue or skeletal repair, bone grafting or soft tissue reconstruction, dental implants to restore lost teeth and occlusion, or facial cosmetic surgery, the surgeons at Head and Neck Surgical Associates will provide the most comprehensive patient care, utilizing the most contemporary techniques and technology available in the world today.

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Snoring and Sleep Apnea Surgery

Head and Neck Surgical Associates offers comprehensive, state-of-the-art treatment for patients with sleep disordered breathing, including radiofrequency ablation, laser assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty, septoplasty, genioglossal advancement, maxillomandibular advancement, and tracheostomy.

Our physicians are part of the first group of surgeons in Portland to offer comprehensive treatment for all types of sleep disordered breathing including snoring and obstructive sleep apnea. Treatment is individualized for each patient depending upon the etiology and severity of the underlying disorder. Often, patients complaining of “snoring” may have underlying medical conditions or severe obstructive sleep apnea that will impact the treatment recommendation. Patients with obstructive sleep apnea that is documented on a sleep study are initially treated with CPAP. Those patients who fail, or cannot tolerate CPAP, are candidates for surgical treatment. Our practice philosophy generally consists of a staged approach in an effort to perform the smallest operation possible in order to achieve a cure.

Snoring

It is estimated that 40 million Americans snore at some time during their lives. Even more people are affected if you consider the sleeping partners of those who habitually snore. Significant snoring is sometimes so severe that it may be heard more than two bedrooms away.

Snoring is not sleep apnea, and sleep apnea is not snoring. Snoring is a social problem which may involve considerable sleep disturbance, waking episodes, etc., without the presence of obstructive sleep apnea. However, many patients with loud snoring may also have obstructive sleep apnea.

Treatment decisions are based on whether significant apnea is found to exist. For snorers, treatment can include non-surgical or surgical approaches. Non-surgical options include weight loss and positional changes (keeping snorer off his or her back). Surgical treatment methods include Laser-Assisted Uvulopalatoplasty (LAUP) or radiofrequency ablation treatments.

Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is characterized by frequent breathing interruptions during the night. These interruptions are caused by airway obstructions. When breathing stops, there may be a significant decrease in blood oxygen levels and cardiac arrhythmia (irregularities in the heart's normal beating pattern) may occur. In extreme cases, the result can be death. OSAS is a serious disorder, which can become a major health risk. Long-term effects can include both lung and heart problems. On a less drastic level, these disturbances may prevent the brain from entering the restorative rapid eye movement (REM) sleep stage. This can lead to mood, memory, and concentration problems.

Treatment options for patients with OSAS include weight loss, positional changes while sleeping, Continuous Positive Airway Pressure (CPAP), or Uvulopalatopharyngoplasty (UPPP or UP3), septoplasty, or maxillomandibular advancement surgery.

• CPAP—Continuous positive airway pressure, or CPAP, is the only non-surgical treatment for OSAS. With CPAP, pressurized air is administered using a facemask, which is worn while sleeping. The pressure of the air creates a clear airway. CPAP is effective in reducing the number of apneic episodes. Many patients find that while wearing this device, they experience a much improved sleep pattern with an overall better night's sleep. For others, however, the CPAP device is cumbersome and difficult to use. Some patients use CPAP for a while, and then choose surgical therapy because of the difficulties associated with consistently using the device.
• LAUP—Laser assisted uvulopalatoplasty (LAUP) is a surgical method used to treat mild-to-severe snorers and those with very mild OSAS. This procedure utilizes a laser beam to remove and tighten floppy soft palate tissue in the back of the mouth, thereby reducing the amount that these tissues contribute to snoring. This procedure, although surgical, can be performed in an outpatient setting. Most patients find that postoperative discomfort is mild, equivalent to a few days' worth of a sore throat. Many people find that their snoring is significantly reduced and sometimes eliminated through the LAUP procedure. Some patients do require multiple LAUP treatments to effectively eliminate severe snoring.
• Radiofrequency ablation (Somnoplasty)—Somnoplasty is a surgical therapy for snoring (not OSAS). The treatment is performed in our office under local anesthesia. Somnoplasty is a minimally invasive treatment which may result in less postoperative pain than traditional surgical snoring therapies.
  Radiofrequency ablation reduces snoring in two important ways: first, by removing a small amount of tissue via a patented process of molecular disintegration; and second, by heating tissue to cause controlled shrinkage and stiffening of the soft palate. Laser therapies, while similar in aim, are very different in their method of action. Laser snoring therapies involve cutting into the soft palate. With Somnoplasty, there is no cutting, only molecular disintegration and tissue shrinkage.
• UPPP—Uvulopalatopharyngoplasty (UPPP) has been the mainstay in the surgical treatment of severe snoring and OSAS. Thousands of patients have been effectively treated with this technique. While UPPP does not cure all OSAS, it will significantly reduce the degree of OSAS in over 50-60 percent of patients, and usually eliminates, or significantly reduces, snoring. Those patients who do not experience a significant correction of the OSAS may need to undergo other surgical treatment. Most people do, however, experience an improvement in their sleep patterns and overall quality of life.
• Maxillo-mandibular advancement (Orthognathic surgery)—Patients whose sleeping difficulties are not resolved through CPAP or soft tissue reduction surgeries such as UPPP are many times candidates for maxillo-mandibular (skeletal) advancement surgery. This surgical technique involves osteotomies (bone cuts) to reposition the jaw in a forward manner and “open the airway.” The procedure ideally involves combined orthodontic treatment to finalize the occlusion (bite). Treatment results for maxillo-mandibular advancement have been shown to be superior to all other techniques (except tracheostomy) and the procedure is curative in more than 90 percent of patients. Our surgeons serving the Vancouver, Washington and Portland, Oregon area have extensive experience in this type of maxillofacial surgery, as well as corrective jaw surgery, craniofacial surgery, and cosmetic surgery, among other procedures.

To read more about surgery for snoring and obstructive sleep apnea, please click here.

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Temporomandibular Joint (TMJ) Disorders & Surgery

The surgeons of Head and Neck Surgical Associates have extensive experience with both surgical and non-surgical management of patients with temporomandibular joint (TMJ) disorders, and continue to attract patients from across the country. Treatment generally involves a multidisciplinary approach that includes close consultation with restorative dentists, orthodontists, and physical therapists.

TMJ dysfunction and disorders are related to the complex jaw joint. Symptoms usually come in the form of clicking, popping and pain in the ear and jaw area. Difficulty in eating, tightness and spasm within the muscles of the face are early indications of problems. This may lead to jaw locking and an inability to eat without pain. TMJ treatment is complex because both the jaw joint and the way bit must be taken into consideration. A bad bite or misaligned occlusion tends to complicate the problem. At our Portland practice, corrective jaw surgery is provided to patients by board-certified physicians and dentists to help treat all aspects of TMJ disorder. We understand that there is no simple treatment or prescription to successfully treat TMJ problems. Restoring your jaw function may include several kinds of treatments. However, at Head and Neck Surgical Associates, our staff has the experience necessary to provide comprehensive, effective care to address you TMJ issues.

Depending upon the particular diagnosis, treatment may involve various medications, diet restrictions, physical therapy, dental splints, orthodontics, and/or surgery.

Non-surgical Treatment

• Medications, splints and physical therapy — The foundation for treatment of most TMJ disorders includes the use of non-steroidal anti-inflammatory medications, a soft diet, and the use of a heating pad to alleviate pain. Initially, and for early stage treatment, occlusal splint therapy is used. This is a dental splint that acts as an anterior positioning device that moves the lower jaw ever so slightly forward and can serve as an effective treatment at out Portland practice. Corrective jaw surgery is usually reserved for severe TMJ cases. The slight forward movement of the jaw achieve by the dental split is many times enough to take pressure off the joint area and provide relief to the jaw. It is worn 24 hours a day for a three to six month period. In conjunction with this splint therapy, physical therapy is added to the regimen in order to achieve muscle relaxation and to decrease clenching and pressure upon the joints. Should this device be successful, treatment options such as bite correction can be entertained.
• Orthodontics and restorative dentistry — Orthodontics and occasionally restorative dentistry is a treatment option that works by repositioning the teeth to stabilize the bite. This is generally recommended following successful splint therapy. Missing teeth need to be replaced with bridges and/or dental implants; crowns and occasionally orthodontics is combined with a surgical procedure to reposition the jaws.

Surgical Treatment

• Arthrocentesis — Arthrocentesis is provided at our Portland practice. It is a relatively minor outpatient corrective jaw surgery that is recommended for patients with acute internal derangements or inflammatory conditions of the TMJ. The procedure involves a lavage (“washing out”) of the joint space using needles and injections of saline and steroid. This is designed to remove the mediators of inflammation, decrease pain, and improve function in patients with various TMJ disorders. It is an outpatient procedure performed under IV sedation in an office setting.
• Arthroscopy — Arthroscopy of the TMJ is similar to arthrocentesis. However, it involves the use of an endoscope in order to directly visualize the joint space and assist in direct repair of internal joint derangements or the removal of scar tissue within the joint. Arthroscopy is performed under a general anesthetic on an outpatient basis.
• Arthroplasty — TMJ arthroplasty is an open procedure that is performed under a general anesthetic for patients with painful internal derangements and advanced joint degeneration. At our Portland practice, this corrective jaw surgery is highly successful in relieving pain and improving jaw function. It is generally performed on an outpatient basis. No foreign materials are used and, if necessary, the joint meniscus may be reconstructed utilizing cartilage from the ear.
• Total joint reconstruction — Surgeons at Head and Neck Surgical Associates have pioneered the use of the 2nd metatarsal to TMJ joint replacement procedure as an alternative to alloplastic (metal) TMJ reconstruction. This procedure involves taking the second toe and a portion of the blood supply to this area and using it to replace the degenerative or mutilated TMJ. This type of microvascular reconstruction provides a “living joint” that is designed to improve the quality of life, decrease pain, and optimize function in patients who have few alternatives and chronic discomfort.

Contact Our Portland, Oregon Cosmetic, Craniofacial, and Cosmetic Surgery Professionals

To speak with an experienced, board-certified professional at our office serving the Portland, Oregon and Vancouver, Washington area to learn more about corrective jaw surgery, craniofacial surgery, cosmetic surgery, or any of our other practice areas, contact our Head and Neck Surgical Associates today.

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