The diseases treated by the Service are:

  • Oral Cavity Pathology: Refers to diseases or disorders that may affect the soft parts (mucosa, gums, tongue) or hard parts (teeth, bones) of the mouth. Diagnosis is based on physical and radiological examination (panoramic radiography, CT).

Surgical procedures:

These procedures are performed under local anaesthesia in the outpatient clinic or outpatient surgery unit (OSU) or in the inpatient surgical block, depending on the nature of the procedure and the patient's characteristics.

  • Biopsies, excision of cystic and tumour lesions of the maxilla, lips and oral cavity.
  • Exodontia of impacted teeth (wisdom teeth, supernumerary teeth, etc.).
  • Correction of lingual or labial frenula.
  • Treatments to complement orthodontic treatments (fenestrations, tractions).
  • Head and Neck Tumours: Tumours affecting this territory can derive from many different structures (skin, salivary glands, bones, mucous membranes, orbits, etc.) in congenital or acquired form. Diagnosis is based on physical examination supported by imaging tests (CT, MRI) and pathological studies (biopsies). Treating these lesions is multidisciplinary and includes, from a surgical perspective, not only removing the lesion but also reconstructing any defects in order to ensure better quality of life for the patient. In cases of malignant tumours, treating the lymph nodes in the neck may be necessary to prevent systemic dissemination.

Surgical procedures:

These procedures are usually performed on inpatients under general anaesthesia, depending on the nature of the pathology and the patient's characteristics.

  • Oncologic Resection of Head and Neck Tumours.
  • Functional and aesthetic reconstruction based on local, regional and microsurgical techniques.
  • Cervical lymph node emptying.
  • Sentinel lymph node biopsy.
  • Facial trauma: Refers to all injuries caused by direct or indirect trauma that affect the face and may involve soft tissue injury, such as burns, lacerations, contusions, and especially fractures of the facial mass and jaw. These are the result of traffic, sports or casual accidents (assaults, falls, etc.). An appropriate action protocol is essential, with emphasis on how to deal with airways. Subsequently, thorough treatment of both the soft tissues and the affected bone structures will be carried out in order to minimise sequelae and morbidity in the short and long term. Diagnosis is based on physical examination and imaging tests (panoramic radiography, CT). Computerised tomography with 3D reconstruction systems allows us to accurately and precisely diagnose the type of facial fracture and plan the most appropriate reconstruction in each case.

Surgical procedures:

The fundamental principle of fracture management entails aligning and reducing the fractured fragments, enabling bone consolidation (healing). The fragments must then be maintained in the correct position using osteosynthesis systems (fixation with mini-plates and screws). We mainly use the intraoral approach to surgery for fractures, combined, if necessary, with approaches based on the face’s natural skin (eyelids, preauricular area, hairline, etc.). These incisions follow the tension lines, allowing us to avoid scars or camouflage them so they are practically imperceptible.

These procedures are usually performed on inpatients under general anaesthesia or on an outpatient basis, depending on the nature of the pathology and the patient's characteristics.

  • Reconstruction and osteosynthesis of fractures of the face.
  • Functional and aesthetic reconstruction of post-traumatic defects.
  • Salivary gland diseases: This refers to disorders of an inflammatory and/or tumourous nature affecting both major (parotid, submaxillary) and minor salivary glands. Their origin can be multifactorial, and the symptoms or presentation may be associated with either an enlargement (bulging or inflammation) or with their function resulting in an increase or decrease in saliva production (sialorrhea or xerostomia). Diagnosis is based on physical examination supported by imaging tests (ultrasound, CT, MRI) and cytology.

Surgical procedures:

These procedures are usually performed on inpatients under local or general anaesthesia, either requiring hospitalisation or on an outpatient basis, depending on the nature of the pathology and the patient's characteristics.

  • Removal of small stones by open techniques (drainage, marsupialisation).
  • Extraction of calculi or diagnostic and/or therapeutic procedures by endoscopic techniques (sialoendoscopy).
  • Excision of salivary glands, which is the preferred treatment for tumour-related conditions (submaxillectomy, parotidectomy), can be performed either radically or conservatively (preserving the facial nerve and other associated structures), in line with oncological criteria. Depending on the type of tumour, it is occasionally necessary to treat the cervical nodes for effective disease control.
  • Dentofacial Deformities: Any disorders that impact the size and/or position of the jaws, either by being too large or too small. One or both may be involved, generating a direct impact on facial aesthetics, as well as functional disorders in biting, known as malocclusion (bite misalignment that causes the teeth to "not fit" correctly). Diagnosis is based on physical examination supported by imaging tests (CT, CBCT).

Surgical procedures:

The collective set of procedures aimed at correcting dentofacial deformities is commonly referred to as orthognathic surgery (straight jaws), which focuses on positioning the affected bones in order to restore facial balance and harmony.

These treatments require joint work with the orthodontist, who is in charge of preparing the teeth, levelling and aligning them so they are congruent and fit perfectly after surgery.

Surgical treatment must be performed under general anaesthesia in a hospital, with a team of an anaesthesiologist and three maxillofacial surgeons. Orthognathic surgery techniques consist of sectioning the facial bones (osteotomies) and placing them in the most appropriate position. Surgery is performed on one of the jaws (monomaxillary) or on both (bimaxillary), and osteosynthesis (fixation) is done with mini-plates and screws through intraoral approaches that avoid unsightly external scars.

  • Bimaxillary Orthognathic Surgery (Maxillary and Mandibular).
  • Monomaxillary Orthognathic Surgery (Maxilla or Mandible).
  • Surgically Assisted Rapid Palatal Expansion (SARPE).
  • Temporomandibular Joint Pathology: Temporomandibular joint pathology encompasses those diseases that affect the masticatory system and everything related to it. They are caused by an alteration of the elements that make up the system: teeth, gums, jaw, maxilla, temporomandibular joint, muscles and ligaments. When one of them does not work properly, it breaks the balance and forces the others to adapt to the change in order to maintain the harmony needed by the masticatory system.

It is important to know that the facial territory is richly innervated, so patients with temporomandibular problems may come to the consultation for other types of pain (ear, head, neck, facial, jaw, shoulder and even back pain) that nevertheless have the same origin: the mandibular joint. Articular pathology is possibly one of the most complex pathologies of the facial territory, which is why a coordinated multidisciplinary treatment is necessary, working alongside oral and maxillofacial surgeons and other specialists such as dentists, physiotherapists, anaesthesiologists, psychiatrists and psychologists, prosthetists, etc.

Surgical procedures:

Treatment varies depending on the diagnosis and severity of the problem, starting with conservative treatment with general hygiene and diet measures, occlusal splint or medication, and ending, in the most complex cases, with various surgical procedures, both invasive and minimally invasive (arthroscopy and arthrocentesis).

  • Botulinum Toxin Infiltration: infiltration of the masticatory muscles may be indicated in cases of recurrent myofascial syndromes and/or severe bruxism, as a way to relax the muscles. Discomfort is minimal, and the effect starts to be noticeable after day three. Treatment is performed in 1 single session and lasts between 4 and 6 months.
  • Arthrocentesis: This consists of external treatment (via the skin) of the temporomandibular joint by means of needles or cannulas, in order to cleanse, drain and/or inject medications (such as anti-inflammatory drugs), hyaluronic acid or bioregenerative factors such as platelet-rich plasma (PrP). It is indicated in cases of osteoarthrosis with or without associated joint blockage. It is a minimally invasive procedure performed in the operating room under local anaesthesia and sedation on an outpatient basis, allowing an early return to daily activities.
  • Temporomandibular arthroscopy. This is performed externally, placing a small thin tube (cannula) in the joint space; a small camera (arthroscope) is then inserted and surgical instruments are used to clean the joint or reposition the joint structure if possible. It is performed in the operating room, under general anaesthesia and on an outpatient or inpatient basis, depending on the type of pathology. In some cases, arthroscopic surgery can be as effective as open joint surgery in treating different types of temporomandibular disorders, and has fewer risks and complications, albeit with some limitations.
  • Open surgery: Open joint surgery (arthrotomy) may be necessary to repair or replace the joint (joint replacement) if jaw pain persists following more conservative treatments and appears to be due to a structural problem in the joint. However, open joint surgery involves more risks than other procedures and should be considered very carefully, analysing all the pros and cons.
  • Congenital malformations: A group of defects caused by abnormal growth or development of soft tissue structures and/or bones of the head and face. We can distinguish two major groups: those caused by early closure of the sutures of the craniofacial skeleton, craniosynostosis and faciosynostosis, and those that can currently be considered neurocrestopathies, such as first and second branchial arch syndromes, and orofacial clefts such as cleft lip and palate. Diagnosis is made by physical examination at birth, although it is now also possible to perform prenatal intrauterine diagnosis based on the latest generation of imaging techniques. CT and MRI are useful tools for surgical studying and planning.

Surgical procedures:

Treatment requires a multidisciplinary approach involving a range of specialities, such as maxillofacial surgery, neurosurgery, paediatrics, genetics and orthodontics, among others.

Surgical treatment is carried out at different stages of life depending on severity, and is completed when growth ends.

  • Labiopalatal fissures: The treatment phases can be:
    • Pre-surgical orthopaedic treatment.
    • Nasolabial correction (around three months after birth).
    • Palate closure (around 10-12 months after birth).
    • Alveolar graft (around 6-9 years after birth).
    • Aesthetic touch-ups.
    • Orthognathic surgery.
    • Rhinoplasty.
    • Osseous distraction of the maxillary bones.
    • Sleep Apnoea Syndrome: Apnoeas are respiratory pauses that occur when the airways are blocked, possibly accompanied by snoring if the person is asleep. We speak of sleep apnoea/hypopnoea syndrome when these breathing pauses occur several times in an hour during the night, while the individual is asleep.

Airway obstruction can cause less oxygen than necessary to reach the organs, leading to issues such as hypertension (increasing cardiovascular risk), memory impairment, lack of concentration, and excessive daytime sleepiness (affecting daily activity).

Diagnosis is by clinical history and sleep tests (nocturnal polysomnography).

Treatment is multidisciplinary and involves several specialists in the Sleep Pathology Units: Pneumology, Otolaryngology, Maxillofacial Surgery, Neurology, Psychiatry, Paediatrics, among others. Some simple measures recommended for treating OSAHS include losing weight, avoiding alcoholic drinks at night, and sleeping on one side. However, these measures cannot always make OSAHS disappear, and continuous airway pressure (CPAP) may also be required.

CPAP is an effective treatment for sleep apnoea. This is based on a mask that provides a smooth flow of air through the nose, preventing the collapse of the upper airways, enabling comfortable breathing.

Another alternative treatment is the use of Mandibular Advancement Devices (MAD). These devices help ensure the passage of air and prevent respiratory collapse during sleep. The splint, which must be custom-made, adapts to the patient's mouth and does not cause discomfort while sleeping.

Placed in the mouth during the night, such devices move the jaw forward and open the airway, helping ensure the passage of air. This eliminates snoring and improves episodes of sleep apnoea.

Surgical procedures:

Surgical treatments can serve as supplementary alternatives or, in certain circumstances, the initial choice, especially for severe cases in younger patients. These procedures are usually performed on inpatients under local or general anaesthesia, either requiring hospitalisation or on an outpatient basis, depending on the nature of the pathology and the patient's characteristics.

  • Reduce, correct or remove soft tissues: tonsils, uvula and soft palate, nasal septum.
  • Maxillary and mandibular advancement surgery: increases airway space, improving soft tissue collapse.