Introduction
Unclear mandibular margins can cause a variety of problems, including difficulty chewing, speaking, and breathing, as well as aesthetic concerns. In New York City, several top - notch hospitals are equipped with advanced techniques and expert medical teams to address these issues. This article will introduce the top five hospitals in New York City that are outstanding in improving unclear mandibular margins.
1. Mount Sinai Hospital
Expertise in Jaw Surgery
Mount Sinai's plastic and reconstructive surgeons are highly proficient in treating all forms of jaw deformities. They work as a well - coordinated team of specialists, coordinating patient care with dentists, orthodontists, and other plastic surgeons as required. The hospital can restore both the function and appearance of the jaw, striving for the best possible outcomes for patients.
At Mount Sinai, they treat numerous jaw - related conditions:
| Condition | Description |
|---|---|
| Mandibular hyperplasia (prognathism) | There is an excess of the lower third of the face, making it very prominent. It may also involve an underdeveloped upper jaw. |
| Mandibular hypoplasia | Characterized by a small lower jaw, an overbite (skeletal malocclusion), and possibly a tall upper jaw and long - face syndrome, with a small lower jaw and backward rotation of the lower jaw. |
| Maxillary hypoplasia | Appears as a small upper jaw with a shallow, concave mid - face and an under - bite (skeletal malocclusion). It may involve an undersized, oversized, or normal lower jaw and can be associated with a cleft of the lip and palate or other craniofacial syndromes. |
| Vertical maxillary deficiency (short face syndrome) | May lead to an older appearance due to insufficient dental show caused by a vertical deficiency of the upper jaw. |
| Vertical maxillary excess (long face syndrome) | Causes the appearance of a long face, possibly with an open bite where the teeth do not come together. This is due to the excess vertical height of the upper jaw, with more vertical growth at the back of the maxilla compared to the front, and an associated shortness of the lower jaw. |
Jaw deformities can occur due to different growth rates of the upper or lower jaw, birth - related conditions, traumatic accidents, or tumor growth. Mount Sinai is well - prepared to handle all these scenarios.
Orthognathic (Jaw) Surgery Details
Mount Sinai also conducts orthognathic/corrective jaw surgery for overbites, underbites, and cross - bites. The procedure aims to move the upper and lower jaws to an anatomically correct position, enabling a good occlusion (bite), airway opening, and facial symmetry.
The typical treatment process starts with an evaluation by an orthodontist and an oral and maxillofacial surgeon. This includes x - rays, models of the dentition, photographs, facial measurements, and a comprehensive data analysis to formulate a treatment plan. The hospital uses advanced 3D x - rays and computer - assisted technology for treatment planning.
The virtual surgical planning (VSP) process begins with pre - operative orthodontic therapy, which can take 12 to 18 months to level and align the teeth. When the patient is ready for surgery, a cone beam 3D CT scan and 3D photo morphometry are used for VSP. This allows the surgeon to “rehearse” the surgery in a virtual environment, predict the outcome, and design and fabricate surgical guides using 3D printers.
The orthognathic procedure is performed under general anesthesia with braces in place. Internal fixation devices are used, and patients usually stay in the hospital for about 1 to 2 days. After the procedure, training elastics are used, and the patient's diet is restricted to liquids or non - chew foods for four weeks. The post - operative orthodontic phase, which lasts 3 to 6 months, helps fine - tune the occlusion and ensure long - term stability.
Dentistry Department
The dentistry department at Mount Sinai has a long - standing history of over 100 years. Their expertise covers all aspects of general dentistry, including restorative, cosmetic, fixed and removable prosthetic, and implant restorative services. They also treat temporomandibular joint (TMJ) dysfunction disorders.
The department was among the first in the U.S. to use local anesthetics like procaine and contributed to the advancement of pain control in dentistry. It also focused on treating patients with severe comorbidities and published research on the use of penicillin in dentistry. Additionally, they established the first pilot cleft palate rehabilitation center in New York State through multidisciplinary collaboration.
2. Weill Cornell Medicine and New York - Presbyterian
Orthognathic Surgery Focus
Orthognathic surgery at Weill Cornell Medicine is performed to correct developmental growth abnormalities of the jaws and facial bones. Patients with these abnormalities often have imperfect tooth positioning when the jaws are closed, which can affect chewing, speech, overall health, and facial aesthetics.
The hospital's team of oral and maxillofacial surgeons are specialists in orthognathic/corrective jaw surgery for overbites, underbites, and cross - bites. Their goal is to correct these conditions as they can be the root causes of improper chewing, facial dysfunction, speech issues, joint pain, and sleep disorders.
Why Choose Weill Cornell Medicine?
- Convenient, individualized care: Patients receive personalized, comprehensive, and compassionate care. The hospital is sensitive to patients' needs and creates a supportive and comfortable environment while offering highly specialized services.
- Multidisciplinary care from leading experts: Orthognathic surgeries require coordinated care from both orthodontics and surgery. The unique multidisciplinary approach ensures focused support before, during, and after the surgery.
Surgical Correction of Maxillofacial Skeletal Deformities
The surgical correction of maxillofacial skeletal deformities includes procedures to correct deformities of the jaws, facial skeleton, and associated soft tissues. These abnormalities can be caused by genetic, environmental, developmental, functional, or pathologic factors. They can occur in different planes of space, unilaterally or bilaterally, and in one or both jaws.
The surgical procedures involve repositioning and recontouring the facial bones to correct functional and/or pathologic problems. The main goal is to restore or improve function and prevent potential sequelae.
Patient Experience
Before surgery, the hospital focuses on determining the exact need for jaw surgery. Data such as radiographs, facial and tooth measurements, clinical photographs, and health history are collected. The medical team answers patients' questions, analyzes the data, creates bite models, and develops a comprehensive treatment plan. Sometimes only the upper or lower jaw needs repositioning, and other times both must be realigned.
Patients need to work with an orthodontist for six to twelve months to move their teeth into the correct position. When the teeth are close to alignment, the surgery is scheduled. The surgery takes place at New York - Presbyterian Hospital, Cornell campus, a top - ranked hospital in the country. Patients typically stay in the hospital for one to two nights.
Approximately six weeks after surgery, patients return to the orthodontist to finish aligning their teeth. For the first six to eight weeks, the bones are healing, and patients are restricted to a liquid and soft - food diet, with limited activity. The patient and surgeon will discuss the return to full activity.
3. Lenox Hill Hospital (Northwell Health)
Advanced Technology in Mandibular Surgery
Lenox Hill Hospital is at the forefront of mandibular surgery technology. It is the first hospital in New York State to use ImmersiveTouch's state - of - the - art surgical planning technology. This technology creates virtual and augmented reality 3D models of patients' anatomy for enhanced visualization, custom surgical solutions, and improved patient communication.
The FDA - approved technology can import standard imaging files like CT scans and MRI to automatically construct a virtual 3D replica of a patient's anatomy in seconds. Surgeons can manipulate these models in an immersive virtual environment, enabling a digital workflow for planning patient - specific solutions for complicated reconstructive procedures within five to 30 minutes.
These advancements streamline the creation of custom digital plans, surgical guides, and reconstruction hardware, reducing the time between preoperative planning and surgery. The goal is to improve patient outcomes by enhancing the accuracy of surgical plans and reducing the risk of intraoperative complications.
Real - World Application
Dr. Brett Miles and Dr. David Hirsch used this technology when planning the removal of a cancer on a patient's lower jaw and the subsequent reconstructive jaw surgery. For a 58 - year - old man with a malignant tumor on the right side of his jaw, they were able to create a custom surgical plan and hardware using the digital workflow generated by the ImmersiveTouch technology. During an eight - hour surgery, they removed the mass and replaced it with a bone graft from the patient's lower leg.
Recognition and Future Outlook
Lenox Hill's mission to deliver expert care and stay at the forefront of technological advances has earned national recognition for superior patient outcomes in otolaryngology. U.S. News and World Report has ranked the hospital within the top 50 in the nation for ear, nose, and throat care for 2022 - 23. The future of mandibular surgery with this virtual and augmented reality technology looks promising, as it allows patients and their families to view the reconstruction plan in a virtual reality environment before the surgery, enhancing their understanding of the complex procedures.
4. NYU Langone's Head and Neck Center
Advanced Surgical Approaches
The multidisciplinary team of physicians at NYU Langone's Head and Neck Center uses minimally invasive and robotic surgical techniques, along with advanced reconstruction methods, to improve patient outcomes. They combine their expertise in the specialty with advanced technologies to provide more precise and individualized treatment options for patients with various head and neck conditions.
Enhancing Patient Selection for Robotic Surgery
Robotic approaches offer several advantages, such as more precise surgical targeting and decreased morbidity. The team at NYU Langone maintains careful, patient - centric criteria to determine when the robot is indicated. They consider variables like the stage of the head or neck tumor, the likelihood of achieving negative margins, and lymph node metastasis.
For patients amenable to the robotic approach, positive outcomes include complete tumor resection with a less invasive surgery, reduced need for adjuvant therapy, and intact speech and swallowing functions. The team also uses the robotic approach for patients with unknown primary tumors in the back of the throat, enabling more accurate targeted tissue removal and directed radiation therapy.
Addressing Complex Malformations
The head and neck team at NYU Langone is capable of treating complex vascular malformations and vascular head and neck tumors. Dr. Mark Persky collaborates with interventional radiologists to form a highly specialized multidisciplinary surgical group. High - flow malformations can be extensive and carry significant risks during treatment, but Dr. Persky has vast experience in treating them with a combination of surgery and embolization.
The team uses regular tumor board - style discussions to learn from each case and improve their multidisciplinary approach. Over time, they have been able to perform the procedures more quickly, with reduced blood loss and other complications.
Reconstruction Techniques
As primary surgeries become safer and more efficient, the experts at the center are enhancing reconstructive techniques. Virtual surgical planning has become an important part of the process, fostering more thoughtful and seamless planning between the extirpative and reconstructive teams.
For patients with tumors of the mouth or jaw, 3D holographic technology supports greater precision in preoperative planning, enabling mandibular replacement and functional dental restoration in the same surgery. The center also has a high success rate in free flap approaches and thyroidectomies, with low failure and complication rates.
5. Columbiadoctors Dentistry (College of Dental Medicine)
Orthognathic Surgery at Columbiadoctors Dentistry
An improper bite sometimes requires orthognathic surgery, especially when the problem involves the jawbones rather than just the teeth. A misaligned jaw can be caused by growth problems, traumatic injuries, or pathologic processes and can affect appearance, speech, chewing, breathing, and oral health.
The oral surgeons at Columbiadoctors Dentistry have extensive expertise in orthognathic surgery and use the most advanced diagnostic and surgical techniques. They work closely with orthodontists and dentists throughout the process.
Patient Journey
The first visits to the oral and maxillofacial surgeon focus on determining the need for jaw surgery. Data collection includes radiographs, facial and tooth measurements, clinical photographs, and health history. The medical team answers patients' questions, analyzes the data, creates bite models, and develops a comprehensive plan.
Before surgery, patients need to wear braces for six to twelve months to move their teeth into the correct position. When the teeth are close to alignment, the surgery is scheduled. The surgery takes place at New York - Presbyterian Hospital or the Morgan Stanley Children's Hospital of New York - Presbyterian, top - ranked hospitals in the country. Patients stay in the hospital for one to two nights.
Approximately six weeks after surgery, patients return to the orthodontist to finish aligning their teeth. For the first 6 to 8 weeks, the bones are healing, and patients are on a liquid and soft - food diet with limited activity. The patient and surgeon will discuss the return to full activity.
Conclusion
In conclusion, these five hospitals in New York City - Mount Sinai Hospital, Weill Cornell Medicine and New York - Presbyterian, Lenox Hill Hospital, NYU Langone's Head and Neck Center, and Columbiadoctors Dentistry - are leaders in improving unclear mandibular margins. Each hospital brings unique strengths to the table, whether it's advanced surgical techniques, cutting - edge technology, or multidisciplinary approaches. Their combined expertise and commitment to patient care offer hope and effective solutions for patients dealing with mandibular issues.
If you or someone you know is facing problems related to unclear mandibular margins, we encourage you to further explore these hospitals' services. Contact them for more information, schedule consultations, and take the first step towards improving your oral health and quality of life. Share this article with others who might benefit from this knowledge, and let's spread awareness about these top - notch healthcare options in New York City.
