Combined Clinics


ORAL CANCER

No part of the body is spared from the possibility of being affected by cancer. The mouth gets no exception. Oral cancer is the 6th most common cancer in the world with 350,000 new cases reported each year.

Despite the advancement in the medical field, survival rate of oral cancer remains poorer than cervical and breast cancers. This raises a lot of concern as oral cancer can be very physically and socially debilitating.

The public has been educated on risk habits contributing to oral cancers, namely tobacco, alcohol and betel quid chewing. However, many other environmental factors may affect genetic mutation which ultimately results in cancer.

Therefore, early detection is the best preventive measure to reducing risk of mortality from oral cancer. “Mouth cancer self examination” campaign has been launched years ago and the public is being educated on the signs and symptoms of oral cancer. These preventive efforts require tireless repetition.

The Faculty of Dentistry, University of Malaya has been acknowledged as the tertiary referral centre for Oral Cancer. Patients with suspicious lesions, are referred to the Oral and Maxillofacial Surgery unit. Once disease is confirmed and necessary investigations have been executed, the patient’s management shall be discussed by a multidisciplinary team that will recommend the best evidence based treatment option for the particular patient.

Following the treatment, patients shall be regularly followed up at the oral cancer review clinic. Frequency of follow up is monthly for the first year after treatment, 3 monthly for the second year and 6 monthly then on. Appearance of new lesions will alter the frequency of follow up accordingly.

Table 1: Oral Cancer Clinic schedule

Day / Time

Frequency

Clinic

Remarks

Monday / 2-5pm

weekly

Oral cancer follow up clinic and Oral Premalignant Diseases clinic

By appointment

Wednesday / 3.30pm

weekly

Head and neck clinic

By appointment

 


MAXILLOFACIAL TRAUMA

In Malaysia, road traffic accident is the main cause of maxillofacial trauma followed by falls, occupational injuries, inter-personal violence and sports injuries.

Injuries resulting from maxillofacial trauma ranges from simple bruises to extensive facial bone fractures which are often associated with injury to the brain.

The unique aspect of maxillofacial fractures is their impact on the dentition either directly or indirectly. Hence, maxillofacial trauma is one of the core procedures of the dentally qualified oral and maxillofacial surgeons.

Unlike the long bone, fractures of the face and jaw bones (maxillofacial bones) are more resistant to infection given its rich blood supply. On the other hand, maxillofacial fractures may cause profuse bleeding and obstruct air passages (airway)

One of the key factors in the treatment of maxillofacial fractures is restoration of facial dimensions, which is dependent on jaw relationship, that is in turn, guided by teeth relationship. Therefore restoring pre-trauma teeth relationship is pivotal in correcting jaw position and may also be used to prevent movement of the fractured jaw bones.

Maxillofacial fractures may be treated surgically with fixation of plates and screws (Figure 1) or non-surgically with fixation of wires around teeth and between upper and lower teeth (Figure 2). One of the advantages of surgical intervention is fast restoration of chewing function. Surgery is often inevitable for complicated fractures that disturbs function and deforms the face.

Figure 1: Surgical treatment of fractures with plates and screws


Figure 2: Non-surgical treatment of fractures with wires and elastic bands

Patients with acute maxillofacial fractures that present to the Trauma Centre will be referred to the Oral and Maxillofacial unit. Patients may also come directly to the dental faculty as out patient.

We also offer management of post trauma deformity and oral rehabilitation.

 


ORTHOGNATHIC SURGERY

Abnormalities of jaw relationships affect facial form, chewing and speech.

Among the various types of abnormal jaw relationship includes condition where the lower jaw is more forward than the upper jaw or vice versa. Some cases presents with facial asymmetry. Fortunately, most of the deformities can be improved with orthognathic surgery.

Orthognathic surgery aims to correct teeth relationship by repositioning the jaw bones and by doing so, also affects the facial form. It is performed at the end of growth around the age of 17 years old. Usually, the surgery is preceded by specific orthodontic tooth movements that serve to allow teeth to meet in a normal relationship after the surgery. Orthodontic treatment continues after the surgery.

 The department runs a multidisciplinary orthognathic clinic on every last Friday of the month. Members of the clinic includes oral and maxillofacial surgeons and orthodontists.