Oral and maxillofacial surgery: Current and future.

Over the past two decades, the field of oral and maxillofacial surgery (OMS) has grown tremendously. A good scientific journal, one that is reputable and that serves its audience justly, is one that features both the novelty and depth of its coverage of our rapidly changing field. The editorial staff at Annals of Maxillofacial Surgery (AMS) has successfully strived for this goal, to disseminate knowledge and to foster a medium for exchange and innovation among fellow oral and maxillofacial surgeons and colleagues of related disciplines. This open access, peer-reviewed journal does particularly well at staying updated and abreast of the emerging research and techniques of OMS, which is arguably the most important job for an annal of a field that has evolved from a mere subspecialty of dentistry to an integral part of the interdisciplinary patient care system. Every breakthrough in the history of our field has taken place not only because of the ingenious step to invent a novel technique, but also because of the many practitioners that have later heard about the technique, seen the value thereof, then popularized and perfected it. A review of recent progress in our field reveals the importance of an active and critical scholarly forum, like AMS that allows the development of revolutionary concepts such as functional and minimally invasive surgical approaches as well as the computer-aided surgical techniques.

The complex anatomical structures in the oral and maxillofacial region are involved in various physiological functions including speech, mastication, swallowing and breathing, not to mention facial esthetics. In the treatment of diseases affecting this region, clinicians must take into account the preservation and rehabilitation of vital organs and functions; hence, the emergence of a functional surgery approaches. Since the inception of neck dissection at the end of 19th century,[1] surgeons have gradually moved away from the traditionally en bloc resection to the more conservative selective removal of involved regional lymph nodes, so as to preserve the sternocleidomastoid muscle, internal jugular vein and the spinal accessory nerve. This has brought much alleviation to common postoperative complications such as shoulder syndrome, facial asymmetry and hindrance to neck movement.[2] It also makes oral and maxillofacial surgeons one of the first groups to practice functional surgery. Over the years, clinicians have expanded the concept to other procedures: To treat certain benign parotid gland tumors, part of the gland tissue and auricular nerve may be preserved;[3] submandibular hilar calculi may now be extracted endoscopically or through an intraoral incision, hence no longer requiring the removal of the submandibular gland,[4] for nasopharyngeal or oropharyngeal cancer patients needing radiotherapy, surgical transfer of the submandibular gland to the submental region markedly reduces radiation-induced xerostomia.[5]

Functional surgeries can be either preservative or reparative. A classic example of the latter in our field includes the repair of maxilla and mandible after tumor removal. Conventional approach involves rehabilitation with prosthesis, often leaving breach in the affected area as well as poor occlusion and mastication. Modern techniques employing vascularized composite fibula flap, together with dental implants, have brought about successful rehabilitation in terms of speech, mastication and facial esthetics.[6]

Since the emergence of laparoscopic surgery, minimally invasive procedures have garnered popularity among surgeons in every discipline. In OMS, arthroscopy of the temporomandibular joint and sialendoscopy are now routinely performed.[7] A borrowed concept perhaps, yet minimal invasiveness has become a driving force behind many innovations in our field to reduce the physical and psychological trauma to our patients.

In this digital age, we have also embraced the revolutionary changes that modern computer technologies have brought to our field. From computer-aided design/computer-aided manufacturing to surgical navigation to robotic surgery, computer-aided surgery has gradually become an indispensable part of our modern practice – one with greater accuracy, safety and simplicity.[8] First devised in neurosurgery and orthopedics, computer-assisted navigation has gained acceptance in maxillofacial surgery with application in an increasing range of procedures. Transoral robotic surgery is also gathering steam with the prospects of offering surgeons greater precision, sensitivity and flexibility to overcome challenges associated with conventional approaches.

All in all, OMS is a discipline that constantly re-creates itself. Over the years, we have witnessed simple modifications to procedural steps setting forth paradigm shifts in the field; we have also seen innovations in other disciplines being borrowed and adapted to aid our cause. The Chinese proverb that says it all, “All rivers flow into the sea, yet the sea never overflows.” OMS is, in itself, an integral field that encompasses aspects of science, clinical techniques and esthetics. And we sincerely hope that our journals can help us modern oral and maxillofacial surgeons become the “sea,” absorbing knowledge from different channels and staying current to the waves of change.