The human face is like no other part of the anatomy. It presides over some vital biological functions like eating and breathing, but it is also home to that other human essential — the personality.
Changes to a person’s face can have deep psychological ramifications, so working in this area requires incredible precision — and a very human touch, says Dr Anthony Lynham, maxillofacial surgeon at Royal Brisbane Hospital, and lecturer in surgery at the University of Queensland Medical School.
“It’s like a miniature version of orthopaedic surgery. We use lots of tiny incisions, we do lots of endoscopic surgery and our plates and screws are very, very small.
“But you can’t be just a technical surgeon. You have to be very responsive to patients’ needs, as the face is such an important area. You have to be terribly considerate and understanding. You need the time to dedicate to patients”, Dr Lynham says.
It’s no wonder, then, that you need two degrees — medical and dental — to practice the specialty known as oral and maxillofacial surgery, which drills down on diseases, injuries, defects and aesthetic aspects of the mouth, teeth, jaws, face, head and neck.
The cases oral and maxillofacial surgeons typically see include problem wisdom teeth, misaligned jaws, tumours and cysts as well as accident victims suffering facial injuries. Patients with abnormalities of the jaws or face and those needing reconstructive surgery are also part of the caseload.
“My week varies from seeing dentally referred patients in my rooms, to putting a face back together after a motor accident, to repairing a congenital skeletal malformation of the face”, says Gold Coast oral and maxillofacial surgeon and lecturer at the Royal Australasian College of Surgeons, Dr John Cosson.
The span of the work provides great variety — but also creates some confusion about the specialty, even among members of the medical profession, he says.
Some of this confusion, Dr Cosson says, lies in the fact that in the past you could enter the specialty from either dentistry or medicine. However, the complexity of the cases in the specialty today requires knowledge of both disciplines.
“The face is not like other parts of the body. If it doesn’t look the same after an operation, the psychological implications are huge. The patient really can’t return to society so it’s important to reconstruct the face as completely as possible.”
“It’s like doing a jigsaw puzzle. There are lots of little bits of bone which need to be re-bonded by titanium plates and screws. It may also require taking bone from a leg or hip to reconstruct a jaw to which you may need to add teeth implants. Then you reattach the skin and muscle and everything goes back to normal.”
Dr Cosson says one of his most memorable cases involved a man whose face was crushed when he was run over by a truck. It took four major operations to repair his facial skeleton and soft tissue, but the patient ended up looking the same as he did before the accident.
“The satisfaction comes when you get a complex case and you are able return the patient to the way they looked originally.”