Oral and Maxillofacial Surgery Services
The Universty of Maryland Oral-Maxillofacial Surgery Associates team is well known throughout the Mid-Atlantic region for specialization in various surgical areas. To make an appointment with our oral-maxillofacial surgery specialists, call 410-706-6195.
Learn more about the different services we provide:
Cancer and Tumors
Over 50,000 people are diagnosed with some form of head and neck cancer each year within the USA.
Head and Neck cancer treatment requires a multidisciplinary approach to care involving surgeons, radiation oncologists, medical oncologists, speech/language pathologists, maxillofacial prosthodontists, nutritionists and rehabilitation therapists.
The Oncology team at UMOMSA are an experienced team of surgeons with a focus on the surgical management (ablation and reconstruction) of cancers of the head and neck.
Drs. Donita Dyalram, Joshua Lubek and Robert Ord are all active members of the multidisciplinary head and neck cancer team at the University of Maryland Greenebaum Comprehensive Cancer Center.
Tumors and cysts of the jaws represent a diverse group of diseases that can originate from both tooth-related structures (odontogenic) and non-tooth-related (non-odontogenic) sources within the jaws, including:
- Cysts associated with impacted teeth can very often be treated with curettage of the cyst and removal associated tooth
- Jaw tumors such as ameloblastoma or myxoma require a more aggressive approach with surgical resection of the jaw to ensure complete removal and minimize chance of recurrence
- Patients requiring surgical removal of these tumors can often have immediate jaw reconstruction with microvascular free flaps and simultaneous dental implant replacement
- Other less aggressive tumors such as fibro-osseous tumors and giant cell lesions can often be treated with removal and preservation of the surrounding jaw and facial bone structure
Some jaw tumors can be associated with systemic conditions, including:
- Giant cell tumors and parathyroid disease
- Keratocysts of the jaws and basal cell nevus syndrome
Following treatment of such diseases, the UMOMSA team will continue to follow patients closely to watch for any signs of recurrence with clinical exam and various radiographic imaging techniques (orthopantomogram and CT scan).
Neck masses represent a diverse group of diseases that can develop within the head and neck.
There are 3 broad categories of neck masses.
- Congenital (ie. branchial cleft cyst, thyroglossal duct cyst)
- Neoplastic (benign and malignant tumors)
Malignant growths can be associated with cancers of the head and neck originating from the oral cavity, oropharynx, throat or thyroid.
Other cancers such as lymphoma can also present with a neck mass.
At your consultation the UMOMSA faculty will perform a detailed history and clinical exam that may also include the use of a specialized fiberoptic camera to look at structures within the mouth and throat.
Patients will likely require imaging with CT scan, MRI or ultrasound to help visualize the neck mass.
Biopsy may be performed in the office setting using a needle technique or with an open surgical technique in the operating room under general anesthesia as an outpatient day case.
The oral cavity has a specialized skin (mucosa) that can be affected by various disease processes. Although natural pigment may occur, the mucosa is generally 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 pathological 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 and/or difficulty in chewing or swallowing
Biopsy is considered the gold standard to establish a diagnosis, often able to be performed in the UMOMSA office.
Pre-cancerous lesions such as dysplasia can often be managed by laser removal in the comfort of the UMOMSA office.
Drs. Donita Dyalram, Joshua Lubek and Robert Ord are experts in the management of oral cancer and pre-malignant disease (oral dysplasia) and provide comprehensive compassionate care during all phases of treatment (diagnosis, treatment, reconstruction and surveillance).
Drs. Donita Dyalram and Joshua Lubek are trained in minimally invasive techniques using robotic surgery (TORS) to access and surgically remove tumors and growths of the oral cavity and oropharynx (tonsil and tongue base).
The salivary glands are specialized glands that produce saliva that drain into the mouth and throat.
The major glands (parotid, submandibular, sublingual glands) are paired glands that drain into the mouth.
The minor salivary glands are located throughout the oral cavity, palate and throat.
The two most common problems associated with salivary gland disease include obstructive diseases (result of salivary stones or trauma) and tumors (can be either benign or malignant).
Salivary gland cancers are rare accounting for 3-6 percent of all head and neck cancers.
Patients referred for management of salivary disease will often require advanced imaging techniques such as CT scan, MRI (magnetic resonance imaging) or ultrasound guided imaging with biopsy to help establish a diagnosis.
Skin cancer is an abnormal growth of cells of the skin.
It is most often caused by sun exposure/damage.
Skin cancer can occur in all people regardless of skin color or pigmentation.
Basal cell carcinoma is the most common form of skin cancer.
Actinic keratosis is a risk factor for developing skin cancer often occurring on the lower lip and face.
Melanoma accounts for less than 1 percent of all skin cancers but the majority of skin cancer deaths.
Squamous cell carcinoma and melanoma can occur within the oral cavity and are not related to sun exposure.
The UMOMSA team advocates safe sun practice with proper clothing, hats and sunscreens with at least an SPF of 15.
The UMOMSA Head & Neck Cancer team utilize various techniques including laser therapy and surgery to treat both pre-cancerous and cancerous skin lesions.
Surgical reconstruction is performed both in the UMOMSA office practice (650 West Baltimore St, Ste. 1401) or at the University of Maryland Medical Center.
The most common vascular tumor of childhood is the hemangioma. Approximately 60% of hemangiomas occur within the head and neck
Vascular malformations include low-flow malformations of capillaries or veins and high-flow malformations of arteries. The majority of lymphatic malformations develop within the head and neck often occurring within the tongue causing symptoms of speech impairment, swelling and swallowing dysfunction.
Treatment includes both non-surgical (sclerotherapy) and surgical removal with reconstruction. The UMOMSA faculty work closely with interventional radiologists/vascular surgeons from the University of Maryland as embolization procedures are often needed prior to definitive surgical therapy.
The UMOMSA faculty, in close collaboration with the restorative dentist, help plan and then place dental implants used to replace missing teeth. Bone grafting (synthetic or autogenous) is often required to provide for an adequate bone foundation to allow for implant anchorage. The surgeon can also modify gingival (gum) tissue surrounding implants when necessary to make teeth placed on implants look even more natural.
Complex implant cases such as those involving significant trauma or reconstruction due to a tumor/cancer require the co-ordination between the surgeon and our specialized Maxillofacial Prosthodontist, Dr. Dima Ghunaim.
Comprehensive complex dental and maxillofacial prosthodontics is provided at the UMOMSA office under the expertise of Dr. Dima Ghunaim
Patients who benefit from such services include:
- Reconstruction following cancer surgery
- Dental rehabilitation of microvascular flap reconstructions
- Cleft palate patients
- Trismus following radiation therapy
- Zygomatic implant rehabilitation
- Facial prosthesis (eyes, ears, noses)
The UMOMSA faculty can safely remove impacted, damaged, and non-restorable teeth. They also provide sophisticated, safe, and effective anesthesia services in their office including intravenous (IV) sedation and general anesthesia.
Jaw Corrective Surgery
Orthognathic surgery is needed when jaws don't meet correctly and/or teeth don't seem to fit with jaws. Teeth are straightened with orthodontics, and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.
Orthognathic surgery can also help to correct the following functional issues including:
- Difficulty in chewing
- Biting or swallowing
- Speech problems
- Chronic jaw or TMJ pain
- Open bite
- Protruding jaw
- Breathing problems
Before any treatment begins, a consultation will be held to perform a complete examination with X-rays.
Drs. John Caccamese and Gary Warburton use modern computer techniques and three-dimensional models to plan your surgery .
Using comprehensive facial X-rays and video stills, we can show you how your bite will be improved and even give you an idea of how you'll look after surgery. This helps you understand the surgical process and the extent of the treatment prescribed, and to see the benefits of orthognathic surgery.
If you are a candidate for Corrective Jaw Surgery, our UMOMSA doctors will work closely with your dentist or orthodontist during your treatment.
Along with an interdisciplinary sleep disorders team, Dr. John Caccamese and Dr. Gary Warburton provide skeletal surgical correction for sleep apnea. Maxillomandibular (upper and lower jaw) advancement is over 95 percent effective in its ability to significantly enlarge the upper airway and limit obstruction by moving the upper and lower jaws forward, thereby opening the airway during sleep.
Additional sleep apnea information is available from the University of Maryland Sleep Disorders Center and the American Sleep Apnea Association.
TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking, or grating noise when you open your mouth, or trouble opening your mouth wide.
There are various diagnostic and treatment options Dr. Gary Warburton will utilize to help manage your TMJ disease, from minimally invasive arthroscopic procedures to advanced custom fabricated metallic joint replacement surgeries.
Dr. Gary Warburton also works closely with specialized dentists at the University of Maryland School of Dentistry to provide non-surgical management of TMJ disease and facial pain.
During early pregnancy the upper lip or palate may fail to fuse together resulting in either a cleft lip/palate or both.
Dr. John Caccamese works with an entire pediatric cleft lip and palate team comprised of specialized dentists/orthodontists, pediatricians, pediatric ENT physicians, speech and language pathologists to provide comprehensive care for your child.
Cleft lip surgery is usually performed when the child is about 10 weeks old. The goal of surgery is to close the separation, restore muscle function, and provide a normal shape to the mouth. The nostril deformity may be improved as a result of the procedure, or may require a subsequent surgery.
A cleft palate is initially treated with surgery safely when the child is between 7 to 18 months old. This depends upon the individual child and his/her own situation. For example, if the child has other associated health problems, it is likely that the surgery will be delayed.
The major goals of surgery are to:
- Close the gap or hole between the roof of the mouth and the nose
- Reconnect the muscles that make the palate work
- Make the repaired palate long enough so that it can perform its function properly
- There are many different techniques that surgeons will use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and the surgeon prior to surgery.
- The cleft hard palate is generally repaired between the ages of 8 and 12, when the cuspid teeth begin to develop. The procedure involves placement of bone from the hip into the bony defect, and closure of the communication from the nose to the gum tissue in three layers. It may also be performed in teenagers and adults as an individual procedure, or combined with corrective jaw surgery.
Pediatric jaw tumors are an uncommon occurrence that requires a comprehensive team approach to achieve the long-term goals for your child including:.
- Tumor surveillance
- Maintaining normal facial skeletal and dental growth which may not cease until 18-21 years of age
- Normal speech and swallowing function
- Replacement of the missing dentition (teeth)
Majority of pediatric jaw tumors are benign and can often be managed with more conservative surgical approaches preserving the structure of the jaws and face.
Dr. John Caccamese along with members of the UMOMSA oncology/reconstructive surgery team, maxillofacial prosthodontics, and various departments within the University of Maryland School of Dentistry (pediatric dentistry and orthodontic departments) will assess the needs of your child/adolescent and provide comprehensive, compassionate integrated care.
Oral and Maxillofacial Surgeons are trained, skilled and uniquely qualified to manage and treat facial trauma.
Drs. John Caccamese, Donita Dyalram, Joshua Lubek and Gary Warburton, care for facial injuries by repairing routine and complex facial skin lacerations (cuts), setting fractured jaw and facial bones, reconnecting severed nerves and ducts, and treating other injuries. These procedures include care of oral tissues, the jaws, cheek and nasal bones, the forehead, and eye sockets.
Facial trauma care is provided through the R. Adams Cowley Shock Trauma Center.
University of Maryland Oral Maxillofacial Surgery Associates offers comprehensive, state of the art reconstructive surgery for post traumatic and cancer related problems of the head and neck for children and adults.
The UMOMSA faculty provide a full range of reconstructive surgical procedures including:
- Drs. Donita Dyalram and Joshua Lubek often utilize microvascular free flap surgical techniques to immediately reconstruct head and neck defects as a result of tumor/cancer extirpative surgery
- Bone grafting procedures (synthetic and autogenous) for oral-maxillofacial defects
- Reconstruction of bone, muscle, skin and mucosa via the transfer of tissue from other regions of the body
- Utilization of computer assisted preoperative surgical planning
- Stereotactic intraoperative computer navigation
With the development of advanced medical devices and biomaterials, many facial cosmetic procedures are minimally invasive and can be performed in an office setting using local and/or intravenous anesthesia. Some procedures may require use of an outpatient or same day surgery center or hospital
Dr. Gary Warburton and other members of the UMOMSA reconstructive faculty will evaluate each patient to assess their concerns and objectives to help meet their goals for facial rejuvenation
Various procedures offered include:
- Botox® Injections
- Cheekbone Implants
- Chin surgery/Genioplasty
- Eyelid Surgery
- Forehead/Brow lift
- Injectable Fillers
- Laser Treatment
- Nasal Reconstruction
Nerve injury to the face and jaws can occur as a result of:
- Removal of an impacted wisdom tooth
- Jaw infection
- Jaw corrective
- Tumor growth and its associated surgical removal
Often minor bruising of the nerve can result in temporary paresthesia (loss of feeling) or weakness that will heal over time.
Nerve injuries are managed both through non-surgical methods and surgical techniques using nerve grafts and primary repair.
Complete or partial facial paralysis may require various reconstructive techniques to either restore function or improve cosmesis.
Chronic nerve pain may develop as a result of late injury and the UMOMSA faculty work closely with facial pain specialists at the University of Maryland School of Dentistry for management of such conditions.
Infections within the jaw bones (mandible and maxilla) may occur as a result of dental infection, exposure to radiation for treatment of a head and neck cancer (osteoradionecrosis-ORN) or as a result of exposure to a bisphosphonate medication (MRONJ).
Ultimately the jaw bone may become non-vital (necrosis) and result in chronic infection, pain, bone exposure, foul mouth odor, fistula or pathologic jaw fracture.
The UMOMSA faculty are experts in the management of these conditions and treatment may range from medical therapy to advanced surgical techniques with immediate jaw reconstruction using microvascular free tissue transfer.