Orthodontic treatment alone can often not lead to a functionally and esthetically satisfactory result in patients with pronounced jaw misalignment (dysgnathia). In these cases, we offer surgical correction (corrective osteotomy) of the jaws in late adolescence and in adults. Treatment is always carried out on an interdisciplinary basis in consultation with the practicing orthodontist or the Clinical Department of Orthodontics at Hannover Medical School.

In our dysgnathia consultation, we will advise you on the surgical part of a combined surgical-orthodontic treatment. If necessary, the necessary professional coordination with the treating orthodontist will be initiated. As a rule, 2-3 visits to our consultation are necessary before the operation. The total duration of orthodontic and oral surgery treatment is 2-4 years on average.

Operations offered:

- Repositioning osteotomies of the upper and lower jaw, Obwegeser/Dalpont procedure

- Surgically assisted palatal expansion

- Distraction of upper and lower jaw

- Chinplasty

- Corrective surgery for syndromic malformations, e.g. Crouzon's disease, Goldenhar syndrome

Preoperative planning of dysgnathic surgical procedures can be carried out digitally in the case of pronounced malocclusions. The tooth-supported positioning splints required for the surgical procedure are produced in our in-house dental laboratory using the CAD-CAM 3D printing process.

Please bring the following documents with you to the consultation:

• Health insurance card
• Preliminary findings
• X-ray images (in DICOM format on CD in unencrypted form with written findings)
• Current medication list
• If applicable, patient ID cards (e.g. pacemaker card, anesthesia card, allergy pass, Marcumar pass)
• Current dental models
• Medical referral
• Doctor's letter from the orthodontist, if applicable

Please bring the following documents with you when you are admitted as an inpatient:

• Current dental models (not older than 4 weeks)
• Current x-rays, if applicable

 

CONSULTATION HOURS: WEDNESDAYS, 14:00 - 16:00

MAKE AN APPOINTMENT: +49 (0) 511 532 64781

Cleft lip, jaw and palate are among the most common congenital malformations, occurring in around 1:500 births. If a cleft lip and palate is diagnosed during pregnancy, the parents-to-be can attend a consultation to get to know the treatment team and therapy concept. If, on the other hand, the cleft deformity is only detected after birth, the initial consultation usually takes place a few days after birth. The aim of the treatment is complete aesthetic and functional rehabilitation in order to enable the best possible and undisturbed development of the child. This treatment goal can only be achieved as part of an interdisciplinary treatment concept that accompanies the patient from birth to the end of the growing years.

If your child undergoes surgery with us, they will be accommodated in the MHH Children's Hospital. One parent can also be admitted as an inpatient. Post-operatively, your child will be visited by us daily and usually discharged home a few days after the operation.

Follow-up care takes place regularly as part of our LKG consultation hours.

Once a month, we also hold an interdisciplinary consultation with our colleagues from pediatric audiology and phoniatrics as well as orthodontics. As a rule, your children will be looked after until the age of 18. You and your child will be invited for this annual check-up in the month of your child's birth as part of a recall system.

Further information on our interdisciplinary treatment concept at Hannover Medical School can be found in the brochure on cleft lip, jaw and palate.

Please bring the following documents with you:

• Health insurance card
• Preliminary findings
• X-ray images (in DICOM format on CD in unencrypted form with written findings)
• Current medication list
• If applicable, patient ID cards (e.g. U-booklet, maternity pass, anesthesia pass, allergy pass)

 

CONSULTATION HOURS: TUESDAYS 14:00 - 16:00

MAKE AN APPOINTMENT: +49 (0) 511 532 64781

Accident-related changes to the facial skull can lead to considerable functional impairments and aesthetic limitations in the affected patients. Our aim is to achieve a comprehensive reconstruction as early as possible. We benefit from our high level of expertise in the interactive use of 3D image data in combination with modern analysis and production technologies. This enables us, for example, to create virtual blueprints of the planned surgical result before the procedure and to produce patient-specific implants. Thanks to a one-fit-only design, these implants can be clearly positioned even in complex operations.

This approach allows affected patients to be returned to their almost original condition as quickly as possible.

In the case of secondary or tertiary corrections, a careful clinical assessment of the existing deformity and the associated functional limitations is particularly important. A surgical quality assurance pathway (as already described) plays a decisive role here in order to achieve an optimal surgical result with minimal risk. Intraoperative localization technology, for example, can also provide valuable support here.

Of course, our standard portfolio also includes intraoperative 3D imaging techniques - i.e. the recording of current actual conditions in deep, often invisible tissue areas.

Further information can be found on our clinic page for reconstructive facial surgery.

 

Neoplasms of the face and oral cavity are common and affect an aesthetically, functionally and emotionally very sensitive area. If a neoplasm is suspected in the head area or a carcinoma has already been diagnosed, it is important to act quickly in order to prevent unnecessary aesthetic and functional restrictions.

In our opinion, adequate and up-to-date tumor therapy should take into account the following essential points:

• Biopsy and, if necessary, initial imaging: The biopsy is usually carried out as part of a short procedure under

local anaesthetic in our outpatient clinic and, if necessary, initial diagnostic imaging by the general practitioner and the resident radiologist. Evaluation of the dental status and, if necessary, initiation of conservative or surgical tooth restoration.

• Panendoscopy and staging: Advanced treatment planning takes place during a short inpatient stay on our ward 77.

Here, the exact extent of the tumor is determined and any secondary tumors or distant metastases are excluded as part of a panendoscopy under general anesthesia and extensive staging (e.g. computer tomography of the head/neck, sonography of the neck/abdominal organs, X-ray of the upper body).

• Interdisciplinary tumor conference: After completion of the staging, each case is discussed individually in our

interdisciplinary conference (maxillofacial surgery, ENT, radiotherapy, radiology, oncology, pathology) for head and neck tumors. The therapy concept created in this way is then discussed with you and, with your consent, implemented over the course of the treatment

• Tumor therapy: In addition to tumor resection and removal of the lymph nodes, we pay particular attention to

special attention to the reconstruction of any resulting defects. The focus here is on early rehabilitation of swallowing and speech function as well as the restoration of satisfactory aesthetics. If chemotherapy and/or radiotherapy are indicated, we will put you in touch with the relevant departments at the MHH. Treatment close to home is also possible, and here too we will arrange and ensure smooth further treatment.

• Aftercare: Regular aftercare follows the end of treatment. Here

In addition to the early detection of recurrences, further reconstructive steps, such as dental rehabilitation, can be planned and carried out later as part of further treatment

Please bring the following documents with you:

• Health insurance card
• Previous findings
• X-ray images (in DICOM format on CD in unencrypted form with written findings)
• Current medication list
• If applicable, patient ID cards (e.g. pacemaker card, anesthesia card, allergy pass, Marcumar pass)
• Histological findings

 

CONSULTATION HOURS: MONDAYS + THURSDAYS, 2:00 - 4:00 P.M.

MAKE AN APPOINTMENT: +49 (0) 511 532 64781

 

The Head and Neck Tumor Center also treats benign and malignant facial skin tumors, which typically occur in non-exposed regions. In oral and maxillofacial surgery, we specialize not only in the safe removal of facial skin tumours, but also in their primary and (depending on the individual situation) delayed restoration in order to achieve the best possible aesthetic and functional result.

Oral and maxillofacial surgery also includes aesthetic surgical procedures such as eyelid lifting (upper/lower eyelid), eyebrow lifts, facelifts and neck skin tightening. We will advise you on this in our consultation hours.

Implants are artificial tooth roots made of titanium or ceramic that are inserted into the jaw and grow into the jawbone.

The situations in which implants can be used are varied and range from toothless jaws to improve the retention of dentures to the restoration of larger gaps and the replacement of individual teeth, especially in the aesthetically demanding incisor area. Treatment with implants makes it unnecessary to grind down healthy neighboring teeth to make a bridge.

As the bone can recede after tooth loss, in some cases it is necessary to add or supplement bone before implantation. In our Clinical Department, we have all the possibilities of modern dentistry at your disposal. Bone augmentation with the patient's own bone is still considered the gold standard, which is why we deliberately avoid the use of bone replacement material (foreign material).

A clinical examination is carried out during the initial consultation. An X-ray is also required. However, you can also bring current images with you. If necessary, a three-dimensional image of the jaw will be taken. Our Department has a modern computer-assisted examination device, the so-called dental digital volume tomograph, at its disposal for this purpose.

Implant treatment is carried out at the Dental Clinic of Hannover Medical School in cooperation with the Clinical Department of Oral and Maxillofacial Surgery, the Department of Dental Prosthetics and the Department of Conservative Dentistry and Periodontology.

We offer you the highest level of care with the involvement of specialists from all areas involved. This gives you the medical care you can expect from a maximum care Clinical Department.

In cases where implant treatments carried out elsewhere have not been successful or the bone situation is so problematic and the general medical situation is very restrictive for the patient, the most modern forms of patient-specific scaffold implants can also be planned and inserted at our Clinical Department. These special implant forms are a supplement to conventional dental implant treatment and require a similar amount of planning, which is then completed in collaboration with biomedical technology to create an individual implant that is just right for you. As part of an outpatient procedure, this implant can then be used by you with primary functional stability, i.e. without restricted loading. You can find out more about this in our special consultation hours.

Please bring the following documents with you:

• Health insurance card
• Preliminary findings
• X-ray images (in DICOM format on CD in unencrypted form with written findings)
• Current medication list
• If applicable, patient ID cards (e.g. implant pass, pacemaker pass, anesthesia pass, allergy pass, Marcumar pass)
• Referral

CONSULTATION HOURS: TUESDAYS AND WEDNESDAYS, 1:30 - 4:00 PM

MAKE AN APPOINTMENT: +49 (0) 511 532 4742

The functional restoration of the facial skull and in particular the upper and lower jaw as well as the temporomandibular joints and surrounding soft tissue is playing an increasingly important role in modern oral and maxillofacial surgery. Appropriate restoration may be necessary for a wide variety of diseases and injuries, e.g:

• after extensive tumor diseases of the oral cavity and the face or facial skull
• after severe injuries as a result of accidents
• in the case of congenital malformations of the facial skull

Our Clinical Department regularly uses 3-dimensional virtual planning of individualized implants to replace the jaw and temporomandibular joints as well as microsurgical free tissue grafts of muscle, skin and bone. Examples include the following:

• Forearm or radialis graft
• Upper arm transplant
• Latissimus transplant
• Shoulder blade or scapula graft
• Pelvic transplant
• Fibula or fibula graft

We plan which transplant is used and how it is designed individually for each patient, taking into account their specific requirements and wishes.

In addition to these so-called autologous microvascular transplants, our Clinical Department is a world leader in the creation of individualized implants from various biomatierals, which help to support adequate hard tissue reconstruction. The choice of implant design is determined individually according to the initial situation specified by the patient and the initial situation to be corrected.

In most cases, temporomandibular joint disorders are primarily treated conservatively with medication, physiotherapy and tooth-supported splints. Only if these therapies are not sufficiently successful should the diagnostic and therapeutic methods of jaw surgery be considered. These are therefore almost always at the end of the diagnostic-therapeutic scale for temporomandibular joint disorders.

After examining various criteria, surgical intervention may be indicated for the following temporomandibular joint disorders, for example:

• Hypermobility disorder
• arthrosis deformans
• Chronic rheumatoid arthritis
• Ankylosis of the temporomandibular joint
• Developmental disorders such as condylar hyperplasia
• Tumors of the temporomandibular joint
• traumatic injuries, fractures

Further information on the surgical treatment of temporomandibular joint disorders can be found here.

Please bring the following documents with you:

• Health insurance card
• Previous findings
• All available X-ray images (in DICOM format on CD in unencrypted form with written findings)
• Current medication list
• If applicable, patient ID cards (e.g. pacemaker card, anesthesia card, allergy pass, Marcumar pass)

If you are considering a temporomandibular joint replacement, you will find information on this under the heading "Reconstruction".

Introduction

Disorders of the temporomandibular joint are not considered in isolation, but are classified in a superordinate system of clinical pictures of the masticatory system and the head and neck area, which in their entirety are referred to as craniomandibular dysfunctions (CMD). These are under the influence and in turn influence the elements of the masticatory system, which include the temporomandibular joint and its capsular and ligamentous apparatus, the masticatory muscles, the periodontium of the teeth, the occlusion, the associated proprioceptors and central nervous regions. The head and neck muscles as well as injuries sustained and psycho-neurological factors also play a role.

Within this complicated network of interactions, there is a wide variety of possible symptoms and a certain difficulty in clearly assigning joint-related symptoms to a defined clinical picture. This is partly due to the fact that symptoms such as noises when moving the lower jaw or lateral deviation of the lower jaw when opening the mouth occur in up to 70% of the healthy population without, however, having a disease value that requires treatment. The two most common complaints of craniomandibular dysfunction, limited mobility of the lower jaw and diffuse facial or temporomandibular joint pain, can be caused by many different diseases (see, for example, the classification of the American Academy of Orofacial Pain at www.aaop.org). This results in the need for extensive diagnostics and, if necessary, subsequent conservative therapy, which is primarily aimed at eliminating disruptive factors of the masticatory apparatus, harmonizing the sequence of jaw movements and thus avoiding or reducing mechanical overloading of the joint. Only after this therapy has been carried out for a sufficiently long time should the diagnostic and therapeutic means of jaw surgery be considered. These should be at the end of the diagnostic-therapeutic scale for temporomandibular joint complaints.

 

Indications for surgical procedures on the temporomandibular joint

Surgical treatment is indicated in cases of severe functional restrictions and pain that are joint-related (arthrogenic) and have also proven resistant to conservative treatment measures.
In order to increase the chances of success of an operation, the muscle-related (myogenic), i.e. non-arthrogenic, conditions must be identified, as these should be treated conservatively rather than surgically. This once again underlines the importance of a precise differential diagnostic examination at the start of any treatment. This differentiation is sometimes difficult to make, as non-arthrogenic joint diseases can also lead to secondary changes in the joint. Even if, in such cases, an operation would at best create favorable mechanical conditions for a disorder-free function of the temporomandibular joint, it would not eliminate the primary cause of the pathological changes and thus ultimately not lead to long-term therapeutic success.
Mandatory indication criteria that should ensure a strict selection of patients who would benefit from surgery are

• Presence of pain and/or functional impairment to an impairing degree - painless joint noises or rubbing in the temporomandibular joint alone do not constitute an indication for surgery.
• Evidence of a morphological correlate to the clinical symptoms through imaging or invasive examinations.
• Probable causal relationship between the morphological correlate and the clinical symptoms and the likelihood of an improvement in symptoms after TMJ surgery.
• Resistance of the symptoms to conservative (non-surgical) therapy, which has been applied for a sufficiently long time - usually at least six months.
• Absence of contraindications for surgery, such as mental illness or muscular hyperactivity of the masticatory and facial muscles.
• Ensuring continued postoperative therapy in the form of physiotherapy or prosthetic splint therapy.
• Good patient cooperation (compliance). Patients who are reluctant to undergo surgery from the outset or who do not wish to participate in postoperative therapy should not undergo surgery.

 

After examining the aforementioned aspects and criteria, surgical intervention may be indicated for the following conditions, for example:

• Hypermobility disorder
• arthrosis deformans
• Chronic rheumatoid arthritis
• Ankylosis of the temporomandibular joint
• Developmental disorders such as condylar hyperplasia
• Tumors of the temporomandibular joint
• traumatic injuries, fractures

Surgical therapy of the temporomandibular joint

The aim of functional temporomandibular joint surgery is to create favorable conditions to promote the body's own adaptation of the joint, with the aim of achieving pain-free functionality. The earlier mechanistic concept has thus been replaced by a functional concept.
Today, we have both minimally invasive procedures such as arthrocenthesis and arthroscopy as well as open surgical measures, known as arthrotomy, at our disposal.
In arthrocentesis, the upper joint space is punctured and then rinsed using mouth-opening movements. This is expected to have a therapeutic effect by flushing out tissue debris and inflammatory mediators. During arthroscopy, direct inspection and certain therapeutic measures such as loosening adhesions or smoothing cartilage surfaces using a trochar and corresponding endoscopic instruments are also possible.
Open procedures are often a last resort and are only used when conservative and minimally invasive measures have not been successful. A choice can be made between an approach in front of the ear (preauricular), behind the ear (retroauricular) and below the angle of the jaw (submandibular). In principle, there is a risk, albeit small, of damage to the facial nerve (facial nerve) or its branches, resulting in paralysis of the mimic muscles. With the retroauricular approach, the aesthetically favorable position of the scar is offset by the risk of a sensitivity disorder of the auricle.

Orthodontic surgery

If dysgnathia (disproportion between the upper and lower jaw) is present at the same time as temporomandibular joint dysfunction and the dysgnathia is found to be the cause of the symptoms, normalization of the relationship of the joint head to the socket and the articular disc can be achieved by restoring orthognathic conditions through skeletal repositioning surgery. More precise data on the duration of the postoperative remodeling and adaptation processes of the temporomandibular joint are currently not available. Although, according to the literature, an improvement in symptoms can be observed in 25 to 66% of patients, it is not possible to guarantee the success of the treatment based on current knowledge. This is particularly critical for patients with Angle Class II. In this context, postoperative condylar resorption should be mentioned as an undesirable consequence of surgery. In patients who do not experience a reduction in symptoms after repositioning of the jaws, the indication for further minimally invasive or open temporomandibular joint surgery can be considered, taking into account the strict criteria mentioned above.

Oral and maxillofacial surgery offers various methods for the detection, classification and treatment of refractory TMJ disorders. This brief overview deliberately avoids a detailed description of the surgical techniques, which must be selected individually for each case and discussed with the patient. It is important that the patient, the referring physician or dentist and, in particular, the surgeon themselves realistically assess the available options with regard to the success of the treatment.