For more information about the services we offer, please contact Head & Neck Surgical Associates today.
Head & Neck Surgical Associates
1849 NW Kearney
Suite 300
Portland, Oregon 97209
Telephone: 503.224.1371
Map
Futures Outpatient Cosmetic Surgery Center
1849 NW Kearney
Suite 300
Portland, Oregon 97209
Telephone: 503.224.1371
Map
Orthognathic and Reconstructive Surgery
Orthognathic (Corrective Jaw) Surgery
The surgeons at Head & Neck Surgical Associates are all Oral and Maxillofacial Surgeons with advanced training in head and neck surgery. They work in close consultation with orthodontists to provide the most comprehensive and experienced care to patients with a wide variety of developmental and congenital disorders of the teeth, jaws, maxillofacial and craniofacial regions.
Orthognathic surgery is also known as corrective jaw surgery. It is used to treat a variety of facial and jaw abnormalities in which the facial bones and teeth are not correctly developed. This results in difficulty with chewing, speech, and jaw function. In many cases, the facial appearance is affected by this problem. Orthognathic means "straight jaws," and orthognathic surgery corrects these jaw and facial deformities, usually in conjunction with an orthodontist. Once the jaws are corrected teeth will come together properly.
Prior to surgery, a considerable amount of planning is required and close consultation with an orthodontist is important. The initial surgical consultation involves a careful examination by the surgeon, as well as a number of photographs and radiographs that are used to individualize each patient’s treatment. HNSA utilizes the latest in digital imaging technology which allows for computerized treatment planning and visualization of the anticipated surgical changes to the patient's facial appearance. This helps the patient understand both the functional and esthetic benefits of the procedure. The two most commonly performed operations are the sagittal split osteotomy* of the mandible, or lower jaw, and the Le Fort I osteotomy** of the upper jaw. In addition, some patients may decide to have other cosmetic procedures done in conjunction with orthognathic surgery to further enhance their facial appearance. These include procedures to the chin, cheeks, eyes, nose, neck and facial skin. The patient usually then undergoes a period of pre-surgical orthodontics that lasts 6-12 months. Surgery is performed and, following recovery, the patient again undergoes a period of post-operative orthodontics, generally lasting from 3-12 months.
*Sagittal split osteotomy (lower jaw)
The sagittal split osteotomy of the lower jaw is done through incisions placed inside the mouth, near the back part of the cheek where it attaches to the lower jaw. The jaw bone is divided in the area of the angle of the jaw in a front-to-back plane. This allows the tooth-bearing part of the lower jaw to slide backwards, in the case of a protruding lower jaw, or forward in the case of a deficient or short lower jaw. In the past, thin wires were used to support the bones in the new positions, but because this was not stable, the patient also had to endure periods of 6 to 12 weeks of "intermaxillary fixation," or having their teeth and jaws wired together. Not only was this uncomfortable, but oral hygiene was difficult and post-operative weight loss was a problem. Fortunately, small titanium screws have been developed that are placed to hold the segments together during healing and the jaws need to be rubber-banded together for only about one week. Most recently, some of our surgeons have begun to utilize “resorbable bone plates and screws” that are placed at the time of surgery which stabilize the bones enough to heal, and then resorb away on their own.
**Le Fort 1 osteotomy (upper jaw)
The Le Fort I osteotomy of the upper jaw is performed through incisions placed inside the mouth, inside the upper lip. A horizontal transection of the upper jaws' attachment to the base of the nose and sinuses is performed, and the upper jaw can then be moved in the direction necessary for correction of the bite and facial problem. Like the sagittal split osteotomy, the repositioned upper jaw is maintained in position with tiny plates and screws made of titanium, a metal to which bone loves to bond. Rubber bands are used to keep the jaws together for about a week, and patients are placed on a soft diet for approximately five weeks.
To learn more about orthognathic (corrective jaw) surgery, please visit http://www.aaoms.org/pamphlets.cfm.
Reconstructive Surgery
Head & Neck Surgical Associates offers comprehensive, state-of-the-art reconstructive surgery for congenital, post-traumatic, and cancer treatment-related problems of the head and neck. A full range of surgical procedures are offered by our highly experienced surgeons for problems affecting the face, head, nose, ears, jaws, mouth, and throat that result in functional or aesthetic disabilities.
A multidisciplinary team approach is frequently used to evaluate the nature and severity of the underlying problems in order to determine the optimal treatment approach. Detailed radiological analysis using CT scans, MRI scans, and three-dimensional reconstructions are frequently used. The surgical team includes physicians with sub-specialty training in Facial Plastic Surgery, Microvascular Surgery, Maxillofacial Prosthodontics, and General Dentistry. Other team members include speech and swallowing therapists who frequently evaluate patients with associated voice or swallowing problems using acoustic analysis, laryngeal stroboscopy, and video swallowing studies. Maxillofacial Prosthodontics specialists are available for facial and oral prosthetic rehabilitation, including replacement of missing teeth using dental implants. Patients with facial paralysis are frequently evaluated by audiologists, and neurodiagnostic testing including evoked electromyography.
Microvascular Reconstruction
The physicians at Head & Neck Surgical Associates have extensive experience with microvascular free tissue transfer and were among the first group of surgeons in Oregon to utilize this state-of-the-art technique. Microvascular surgery is a technically demanding procedure during which tissue grafts harvested (taken) from the arms, legs, abdomen, or back are transferred to the mouth, throat, or face to replace missing tissues. Candidates for this type of surgery include patients who require surgery for, or suffer from, the effects of radiation therapy given to treat cancers or tumors of the head and neck, as well as patients with severe traumatic injuries of the face or neck. Areas commonly reconstructed include the jaws and mouth, the throat, and all areas of the face, scalp, and neck. A successful outcome in this type of reconstructive surgery depends upon meticulous suturing of 2 to 3mm blood vessels using a microscope and sutures that are finer than human hair to reestablish blood flow to the tissue graft. For patients undergoing surgery to remove a cancer, use of this technique allows for immediate reconstruction of the bone or soft tissue defect and generally ensures that the patient undergoes only one surgical procedure.
To read more about reconstructive surgery and procedures offered by the surgeons of HNSA, please visit http://www.plasticsurgery.org/public_education/procedures/ ReconstructiveSurgery.cfm.
Nasal Reconstruction
HNSA’s surgeons are experienced with reconstructing nasal injuries or deformities and functional breathing problems arising as a result of a broken nose, previous nasal surgery, treatment of nasal skin cancer, and congenital problems, including the nasal deformity commonly associated with cleft lips. Patients who have suffered a recent broken nose are advised to be evaluated between 5 and 10 days after the injury has occurred, as they may be candidates to undergo reduction of a displaced nasal bone fracture in the office setting, potentially avoiding the need for surgery. Patients with longstanding nasal fractures resulting in a nasal deformity or nasal breathing difficulty may be considered for reconstruction of their problem by means of septorhinoplasty. Patients with an unsatisfactory result after previous nasal surgery may be considered to be candidates for revision surgery by our surgical team.
To read more about nasal reconstruction and rhinoplasty visit, please visit http://www.entnet.org/healthinfo/nose/surgery_nose.cfm.
Facial Bone Reconstruction
Surgical team members are highly skilled and experienced in treating patients who have suffered fractures involving the jaw bones, the cheek bones, the orbital bones, and the skull. Surgery can often be accomplished using incisions which are well hidden by placement inside the mouth, in hair bearing scalp skin, and on the inside of the eyelids, often avoiding visible facial scars. Patients with recent fractures or problems that persist after remote facial fractures are often considered to be candidates for reconstruction.