Video consultation with a maxillofacial surgeon: a second opinion from wherever you are

A video consultation lets you start without traveling: I review the CT scan or X-rays you already have, give you guidance and, if another professional has proposed surgery, a second opinion. It doesn't replace an exam: on video I can't feel the area or measure your bite, so what we conclude is provisional until I see you. I am an oral and maxillofacial surgeon (UNAM), certified by the Mexican Board of Oral and Maxillofacial Surgery and a professor at the University of Costa Rica School of Dentistry since 2006; I see patients in Tower 1 of Hospital CIMA, in Escazú.

Video consultation

20,000 colones

What to send

CT or panoramic X-ray, photos and medications

Languages

Spanish and English

If an exam is needed

Visit at CIMA, 60,000 colones

When it's indicated

• You already have a CT scan, a panoramic or other X-rays and want to know what they show.
• Another professional has proposed surgery —wisdom teeth, implants, bone grafts or jaw surgery— and you want a second opinion before deciding.
• You live far from Escazú or outside Costa Rica and want guidance before you travel; I see patients in Spanish and English.
• Jaw or TMJ pain, as a first assessment: in a small study (16 people), video examination agreed well on muscle and joint pain, but poorly on disc displacement with reduction, which I confirm in person.

Before surgery

• Your CT scan in DICOM (CD, USB drive or a link from the imaging center) with its report; send it before the appointment, as the office indicates.
• Any panoramic or other X-rays you have; if you have none, I tell you which one to get.
• Well-lit photos: from the front, in profile, smiling and of your bite; if there's a lesion or swelling, a close-up.
• Your medications with doses, allergies and medical conditions. Tell me if you take blood thinners or osteoporosis drugs; don't stop any of them on your own.
• For a second opinion: the plan or quote you were given, the other professional's report and your questions in writing.

How I plan it

How I do it

1. 01You book the appointmentFrom the booking page, like any visit: note that it's a video consultation and send me your imaging first.
2. 02Your historyWhat's happening and since when, your conditions, your medications and what you've been told.
3. 03Your imagingWe go through it together: what looks fine, what concerns me and what would change the plan.
4. 04Camera-guided examI ask you to open and close your mouth and show me the area that hurts. It helps, but it doesn't replace examining you.
5. 05What comes nextI tell you what can be concluded and what can't. If you need an exam, another scan or surgery, we continue at my office in Tower 1 of Hospital CIMA.

Recovery

• Often another review is needed: in UK maxillofacial surgery telephone consultations during the pandemic, 59.5% ended with a recommendation for further review.
• If surgery is needed, the decision and date come after I examine you at the office.
• Some checkups after surgery can be done by video: in a university oral medicine and oral and maxillofacial surgery clinic, 87% of telehealth visits were follow-ups for returning patients.
• A photo doesn't replace examining you: in a review of 6 studies on surgical wounds, in-person examination found 15 infections beyond the 66 detected remotely; if something isn't healing well, I see you in person.
• If a warning sign appears after surgery, don't wait for the checkup: call the office or go to the emergency room.

Risks and how I prevent them

Something being missed

You see less on video. In a review of 9 studies of remote dental consultation, the ability to detect a real problem varied widely from study to study; of 30 reviews on the subject, 83% were of low or critically low quality. That's why I tell you what I can't conclude.

Not being able to examine you

In the UK telephone consultations cited above, the inability to examine was a concern in 43.5% of patients' and clinicians' comments. I make up for it with imaging, photos and a guided exam; the rest waits for the in-person visit.

Connection problems

In a study of oral surgery video consultations, technical problems occurred in 44% of cases. Test your camera, audio and connection beforehand.

Delaying an emergency

A video consultation is not for emergencies: with warning signs, go to the emergency room.

Other options

An office visit

It's the standard: it lets me examine you fully and is still regarded as the safe default. If you live nearby or the problem needs an exam, start there.

Going back to whoever proposed the surgery

Ask them what they see in your imaging, what happens if you wait and what other options there are. A second opinion complements that conversation.

Waiting and monitoring, when appropriate

Not every proposed surgery is urgent. If reviewing your case shows that surgery isn't needed yet, I tell you that too.

Frequently asked questions