Oral Surgery Before and After

 

 

 

Advanced Jaw Reconstruction

 

 

 

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A panoramic radiograph of a severely atrophic lower jaw. The patient was referred to Dr. Hakim by another oral surgeon for management because her jaw was so atrophic that doing dental implants was going to be very challenging, if not impossible.

 

 

 

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A CT scan redemonstrating how narrow the jaw bone was before surgery.

 

 

 

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Dr. Hakim performed advanced total jaw reconstruction and here is the immediate result.

 

 

 

 

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8 months later the patient had adequate bone and received 5 dental implants for full arch treatment.

 

 

 

 

Orthognathic (Corrective Jaw) Surgery

 

 

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This patient had an enlarged lower jaw and a deficient upper jaw resulting in esthetic concerns and an underbite that could not be corrected with braces alone.

 

 

 

 

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Surgery was performed to bring the upper jaw forward and the lower jaw backwards, while performing a separate surgery to move the chin forward and maintain a masculine look, resulting in facial harmony and correction of the bite.

 

 

 

 

Oral Pathology

 

 

 

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A large cyst in the left lower jaw that developed over the years in association with an impacted wisdom tooth that was never addressed earlier in the patient's life. The size of the cyst placed the patient at a high risk for nerve injury and mandible fracture.

 

 

 

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Instead of immediately removing the cyst and risking mandible fracture, a minimally invasive decompression technique was used to drain the cyst and reduce its size, so it could be removed safely. Notice the increase in the density of this xray compared to the first one. This is an indication that the cyst was shrinking and the bone was healing.

 

 

 

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After the cyst shrank completely, removing the cyst was easier and the jaw bone fully healed, except for the contour discrepancy that was esthetically not detectable. Notice how the bone density is the same on both sides of the mandible.

 

 

 

TMJ Disorders

 

 

 

TMJ Case One

 

 

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This patient had unexplained severely limited mouth opening, which affected her quality of life because it is very difficult to eat with such a small opening.

 

 

 

 

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Put these two side by side. Instead of jumping to open surgery like joint replacement, Dr. Hakim followed his principle of attempting minimally invasive techniques first to see if he could spare the patient the open procedure.  He performed advanced TMJ arthroscopy. The picture on the left shows a severely scarred down joint which prevented the patient from movement. With advanced arthroscopic technique, he was able to open the joint space (on the right) and improve the patient's range of motion. The patient went home the same day.

 

 

 

 

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After postoperative physical therapy, the patient returned for follow-up opening twice as wide. It's a great feeling to be able to help patients with a minimally; invasive technique sensitive procedure.

 

 

 

 

TMJ Case Two

 

 

 

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Sometimes arthroscopy fails or the disease process is too advanced that arthroscopy is no longer an option.  This patient had arthritis of the left TMJ that resulted in ankylosis (jaw fusion). It also shifted the lower jaw to the left side causing a midline shift and premature biting on the left side. Her teeth on the right side and in the front did not touch.

 

 

 

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Dr. Hakim performed total joint replacement with a custom made prosthesis, while simultaneously doing corrective jaw surgery on the right side. This allowed him to move the jaw back to the right side without putting excessive strain on the right TMJ. The result was improved mouth opening and stable bite correction. Notice how the both sides were now touching and how the midlines aligned after surgery.