McGann Facial Design offers patients the complete range of oral and maxillofacial surgical services. To determine how McGann Facial Design can address your particular concern, please book an appointment by contacting our office directly at (858) 874-8181. Temporomandibular Joint – TMJ What is TMJ? The temporomandibular joint or TMJ acts like a sliding hinge, connecting your jawbone to your skull. You have one joint on each side of your jaw. Why am I having pain/soreness and-or clicking/popping? The exact cause of a person’s TMJ disorder is often difficult to determine. Your pain may be due to a combination of factors, such as genetics, arthritis or jaw injury. Some people who have jaw pain also tend to clench or grind their teeth (bruxism), although many people habitually clench or grind their teeth and never develop TMJ disorders. In most cases, the pain and discomfort associated with TMJ disorders is temporary and can be relieved with self-managed care or nonsurgical treatments. Surgery is typically a last resort after conservative measures have failed, but some people with TMJ disorders may benefit from surgical treatments. Conservative Management for TMJ Pain 1) Rest the jaw muscles and joints; Soft food diet; avoid breads, nuts, chewing gum, tough meats, etc. If you are able to smash it through your fork then you are able to eat it. Ice the jaw on and off for 20 minutes to help with soreness and inflammation. 2) Medication use; NSAID’s: Naproxen Sodium; 2 in the morning and 2 at night for 4 weeks. Tylenol 8hr. to help break the pain cycle. If you are not experiencing pain you do not need to take Tylenol. Voltaren Gel: Decreases inflammation in the jaw joint, simply rub the topical gel to the area that hurts. (This is a prescription medication, it can be called in as needed. If you need a prescription please call (858)-874-8181 and we would be happy to assist you. Jaw Exercises Gentle rotations of the jaw to improve range of motion and stretch tight muscles. You should not manipulate or move your jaw in any way that causes pain. Do not force your jaw to open if you are having limited opening. Gently slide your jaw side to side until muscles relax enough to continue opening. Place your tongue on the roof of your mouth, then take your tongue to the front of your teeth and slide across them from one side to the other, take a deep breath in with your eyes closed and focus on your jaw muscles relaxing. Do this throughout the day to let your jaw muscles relax. This disease is one that will come and go and eventually burn itself out so hang in there! As there is not currently a perfect way to cure this disease, it takes patience and with basic management it usually calms down eventually. If your jaw completely locks open or fully closed for longer than 5 days please call (858)-874-8181 and we will schedule you ASAP. If you have any questions or concerns please contact us via phone or email. Our email is firstname.lastname@example.org. Thank you. Sleep Apnea People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp. Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration. Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms. The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons offer consultation and treatment options. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight. The bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital. OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment. Cleft Lip + Palate During early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. However, if some parts do not join properly, sections don’t meet and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip. A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft. A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate. Cleft Palate The palate is the roof of your mouth. It is made of bone and muscle and is covered by a thin, wet skin that forms the red covering inside the mouth. You can feel your own palate by running your tongue over the top of your mouth. Its purpose is to separate your nose from your mouth. The palate has an extremely important role during speech because when you talk, it prevents air from blowing out of your nose instead of your mouth. The palate is also very important when eating. It prevents food and liquids from going up into the nose. As in cleft lip, a cleft palate occurs in early pregnancy when separate areas of the face have developed individually do not join together properly. A cleft palate occurs when there is an opening in the roof of the mouth. The back of the palate is called the soft palate and the front is known as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate). Sometimes a baby with a cleft palate may have a small chin and a few babies with this combination may have difficulties with breathing easily. This condition may be called Pierre Robin sequence. Since the lip and palate develop separately, it is possible for a child to be born with a cleft lip, palate or both. Cleft defects occur in about one out of every 800 babies. Children born with either or both of these conditions usually need the skills of several professionals to manage the problems associated with the defect such as feeding, speech, hearing and psychological development. In most cases, surgery is recommended. When surgery is done by an experienced, qualified oral and maxillofacial surgeon such as Dr. McGann, the results can be quite positive. Facial Trauma The dental specialist performs the proper treatment of facial injuries. These professionals must be well versed in emergency care, acute treatment and long-term reconstruction and rehabilitation – not just for physical reasons but emotional as well. Oral and maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat facial trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance. Dr. McGann meets and exceeds these standards. He is trained, skilled, and uniquely qualified to manage and treat facial trauma including: • Facial lacerations • Intra oral lacerations • Avulsed (knocked out) teeth • Fractured facial bones (cheek, nose or eye socket) • Fractured jaws (upper and lower jaw) Oral Pathology The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth: • Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth. • A sore that fails to heal and bleeds easily. • A lump or thickening on the skin lining the inside of the mouth. • Chronic sore throat or hoarseness. • Difficulty in chewing or swallowing. These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer. We would recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body’s most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we may help. Office-Based Anesthesia At McGann Facial Design, we offer patients the convenience and safety of office-based anesthesia. There are a number of reasons why a patient may request anesthesia associated with their procedure, including but not limited to proper pain control and procedural anxiety. Patient safety is our first priority: • Dr. McGann and his staff are continuously training on the latest anesthetic and life-support technqiues. • Our office is licensed and inspected by applicable State authorities. • We are located directly accross the street from Sharp Memorial Hospital. To learn more about how office-based anesthesia is safe and may represent the best option for you, please visit the website for the American Association of Oral and Maxillofacial Surgeons.