Oral and maxillofacial surgery
Oral surgery aboard the USS Kitty Hawk (CV 63)
|Names||Oral and maxillofacial surgeon|
|Medicine, dentistry, surgery|
Oral and maxillofacial surgery (OMS or OMFS) specializes in treating many diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral (mouth) and maxillofacial (jaws and face) region. It is an internationally recognized surgical specialty. In countries such as the UK, Australia, New Zealand and most of Europe, it is recognized as both a specialty of medicine and dentistry, and a dual degree in medicine and dentistry is compulsory. In other countries including the United States, India, Canada, Brazil, and Sweden, it is a recognized specialty of dentistry.
In several countries oral and maxillofacial surgery is a speciality recognized by a professional association, as is the case with the Dental Council of India, American Dental Association, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Dentists of Canada, Royal Australasian College of Dental Surgeons and Brazilian Federal Council of Odontology (CFO).
In other countries oral and maxillofacial surgery as a specialty exists but under different forms, as the work is sometimes performed by a single or dual qualified specialist depending on each country's regulations and training opportunities available.
An oral and maxillofacial surgeon is a regional specialist surgeon treating the entire craniomaxillofacial complex: anatomical area of the mouth, jaws, face, and skull, as well as associated structures.
Depending upon the jurisdiction, maxillofacial surgeons may require training in dentistry, surgery, and general medicine; training and qualification in medicine may be undertaken optionally even if not required.
Oral and maxillofacial surgery is widely recognized as one of the specialties of dentistry. In many countries, however, maxillofacial surgery is a medical specialty requiring both medical and dental degrees, culminating in an appropriate qualification (e.g. Fellow of the Royal College of Surgeons, FRCS, in the UK). All oral and maxillofacial surgeons, however, must obtain a university degree in dentistry before beginning residency training in oral and maxillofacial surgery. In the United States oral and maxillofacial residency programs are either four or six years in duration. Programs that grant the MD degree are six years in duration.
They also may choose to undergo further training in a one or two year subspecialty Oral and Maxillofacial Surgery Fellowship Training in the following areas:
- Cosmetic facial surgery
- Cranio-maxillofacial trauma
- Craniofacial surgery/pediatric maxillofacial surgery/cleft surgery
- Head and neck cancer – microvascular reconstruction
- Maxillofacial regeneration (reformation of the facial region by advanced stem cell technique)
The popularity of oral and maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing in a few EU countries. However, the public funds spent for 14 years of training are of a major concern for governments. Integrated programs are becoming more available to medical graduates allowing them to complete the dental degree requirement in about three years in order for them to advance to subsequently complete oral and maxillofacial surgical training.
Treatments may be performed on the craniomaxillofacial complex: mouth, jaws, face, neck, and skull, and include:
- Dentoalveolar surgery (surgery to remove impacted teeth, difficult tooth extractions, extractions on medically compromised patients, bone grafting or preprosthetic surgery to provide better anatomy for the placement of implants, dentures, or other dental prostheses)
- Surgery to insert osseointegrated (bone fused) dental implants and maxillofacial implants for attaching craniofacial prostheses and bone anchored hearing aids.
- Cosmetic surgery of the head and neck: (rhytidectomy/facelift, browlift, blepharoplasty/Asian blepharoplasty, otoplasty, rhinoplasty, septoplasty, cheek augmentation, chin augmentation, genioplasty, oculoplastics, neck liposuction, lip enhancement, injectable cosmetic treatments, botox, chemical peel etc.)
- Corrective jaw surgery (orthognathic surgery), surgical treatment and/or splinting of sleep apnea, maxillomandibular advancement, genioplasty
- Diagnosis and treatment of:
- benign pathology (cysts, tumors etc.)
- malignant pathology (oral & head and neck cancer) with (ablative and reconstructive surgery, microsurgery)
- cutaneous malignancy (skin cancer), lip reconstruction
- congenital craniofacial malformations such as cleft lip and palate and cranial vault malformations such as craniosynostosis, (craniofacial surgery)
- chronic facial pain disorders
- temporomandibular joint (TMJ) disorders
- dysgnathia (incorrect bite), and orthognathic (literally "straight bite") reconstructive surgery, orthognathic surgery, maxillomandibular advancement, surgical correction of facial asymmetry.
- soft and hard tissue trauma of the oral and maxillofacial region (jaw fractures, cheek bone fractures, nasal fractures, LeFort fracture, skull fractures and eye socket fractures).
In the United States, oral and maxillofacial surgeons are required to undergo five months of intensive general anesthesia training. An additional month of pediatric anesthesia training is also required.
The American Society of Anesthesiologists published a Statement on the Anesthesia Care Team which specifies qualified anesthesia personnel and practitioners as anesthesiologists, anesthesiology fellows, anesthesiology residents, oral surgery residents, anesthesiologist assistants, and nurse anesthetists.
Laser applications in OMS
Lasers were first introduced to OMS in the mid-1980s starting with the CO2 laser. The CO2 (carbon dioxide) laser remains the gold standard for the soft tissue surgery because of the ease of simultaneous photo-thermal ablation and coagulation (and small blood capillary hemostasis). The CO2 laser is used in oral and dental surgery for virtually all soft-tissue procedures, such as gingivecomies, vestibuloplasties, frenectomies and operculectomies. The CO2 laser's 10,600 nm wavelength is also safe around implants as it is reflected by titanium, and thus has been gaining popularity in the field of periodontology. It may be effective in treating peri-implantitis.
In the UK and most of Europe
Oral and maxillofacial (OMF) surgeons specialise in the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck.
OMF surgery is unique in requiring a dual qualification in medicine and dentistry, and is often seen as the bridge between medicine and dentistry, treating conditions that require expertise from both backgrounds such as head and neck cancers, salivary gland diseases, facial disproportion, facial pain, temporomandibular joint disorders, impacted teeth, cysts and tumours of the jaws as well as numerous problems affecting the oral mucosa such as mouth ulcers and infections.
Many OMF surgeons focus on one of these areas to develop a sub-specialist interest within the scope of the wider specialty.
In Australia, New Zealand, and North America
Oral and maxillofacial surgery is one of the nine dental specialties recognized by the American Dental Association, Royal College of Dentists of Canada, and the Royal Australasian College of Dental Surgeons. Oral and maxillofacial surgery requires four to six years of further formal university training after dental school (i.e., DDS, BDent, DMD or BDS).
In the United States, four-year residency programs grant a certificate of specialty training in oral and maxillofacial surgery. Six-year residency programs grant the specialty certificate in addition to a degree such as a medical degree (e.g., MD, DO, MBBS, MBChB) or research degree (e.g., MS, MSc, MPhil, MDS, MSD, MDSc, DClinDent, DSc, DMSc, PhD). Both four– and six–year graduates are designated US "Board Eligible" and those who earn "Certification" are Diplomats. Approximately 50% of the training programs in the US and 66% of Canadian training programs are "dual-degree".
The typical training program for an oral and maxillofacial surgeon is:
- 2–4 years undergraduate study (BS, BA, or equivalent degrees)
- 4 years dental study (DMD, BDent, DDS or BDS)
- 4–6 years residency training – Some programs integrate an additional degree such as: a master's degree (MS, MDS, MSc, MClinDent, MScDent, MDent), doctoral degree (PhD, DMSc, DClinDent, DSc), or medical degree (MBBS, MD, DO, MBChB, MDCM)
- After completion of surgical training most undertake final specialty examinations: US: "Board Certified (ABOMS)", Australia/NZ: FRACDS, or Canada: "FRCDC"
- Some colleges offer membership or fellowships in oral/maxillofacial surgery: MOralSurg RCS, M(OMS) RCPS, FFD RCSI, FEBOS, FACOMS, FFD RCS, FAMS, FCDSHK, FCMFOS (SA)
- Recently both single and dual qualified oral and maxillofacial surgeons are now also obtaining fellowships with the American College of Surgeons (FACS).
- Average total length after secondary school: 12–14 years
In addition, graduates of oral and maxillofacial surgery training programs can pursue fellowships, typically 1–2 years in length, in the following areas:
- Head and neck cancer – microvascular reconstruction
- Cosmetic facial surgery (facelift, rhinoplasty, etc.)
- Craniofacial surgery and pediatric maxillofacial surgery (cleft lip and palate repair, surgery for craniosynostosis, etc.)
- Cranio-maxillofacial trauma (soft tissue and skeletal injuries to the face, head and neck)
In Hong Kong
In Hong Kong, a master's programme and an advanced diploma programme are offered by the Faculty of Dentistry of The University of Hong Kong. Oral and maxillofacial surgery departments are available at public hospitals managed by the Hospital Authority.
In Czech Republic (EU)
"Oral and Maxillofacial Surgery" is one of the three dental specialties. "Maxillofacial Surgery" is specialty of general medicine. Both specialties are represented by Czech Association for Maxillo-Facial Surgery.
Oral and Maxillofacial training takes at least 5 years and consists of: 48 months of training in OMFS. 12 moths of internships in: anesthesiology, internal medicine, general surgery, pediatrics, plastic, aesthetic and reconstructive surgery, ophthalmology, neurosurgery and ENT.
This programme is reserved for graduate of current 5-year programme of dentistry, who is recognized by title MDDr. (Medicinae Dentalis Doctor), or former 6-year programme of stomatology who is recognized by title MUDr. (Medicinae Universalis Doctor in Stomatologia). After finishing this programme, specialist in OMFS is eligible to provide treatment in full scope of Oral and Maxillofacial surgery and practical dentistry.
Maxillofacial surgery training takes at least 5 years and consist of: 30 months of core training including MFS and internships in: anesthesiology, internal medicine, general surgery.
30 months of special training including MFS and internships in: pediatrics, plastic, aesthetic and reconstructive surgery, ophthalmology, neurosurgery and ENT.
This programme is reserved for graduate of 6-year programme of general medicine, who is recognized by title MUDr. (Medicinae Universalis Doctor). After finishing this programme, specialist in MFS is eligible to provide treatment in Maxillofacial surgery. Treatment in Oral surgery can provide only if supervised by OMFS or dentistry specialist or holds also dental degree.
It is recommended by Czech Association for Maxillo-Facial Surgery to gain both degrees (dental and general medicine).
- "Baylor College of Dentistry: OMS Residency Admission Requirements". Archived from the original on 8 May 2008. Retrieved 2 July 2009.
- Statement on the Anesthesia Care Team Archived 6 July 2016 at the Wayback Machine.
- Pecaro, B. C.; Garehime, W. J. (November 1983). "The CO2 laser in oral and maxillofacial surgery". Journal of Oral and Maxillofacial Surgery. 41 (11): 725–728. ISSN 0278-2391. PMID 6415252.
- Strauss, RA; Coleman, M (2011). "Lasers in Major Oral and Maxillofacial Surgery". In Convissar, RA. Principles and Practice of Laser Dentistry. Mosby. pp. 234–250. doi:10.1016/B978-0-323-06206-0.00014-X.
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