Oral and maxillofacial surgery

Oral and Maxillofacial Surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. It is a recognized international surgical specialty.[1]

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Regulations

• In the U.S.A., Canada, Australia, and New Zealand Oral and Maxillofacial Surgery is one of the 9 specialties recognized by the American Dental Association, Royal College of Dentists of Canada, and Royal Australasian College of Dental Surgeons, however some training programs lead to the trainee obtaining qualifications in both Medicine and Dentistry.

• In the United Kingdom, Oral Surgery is a specialty recognized and regulated by the General Dental Council as a Dental specialty while Oral&Maxillofacial Surgery ("Maxfacs") is a specialty recognized and regulated by the General Medical Council as a Medical specialty requiring both Medical and Dental degrees and culminating in the qualification FRCS(OMFS).

• In the European Union, The Directive 2001/19/EC also distinguishes Oral Surgery from Oral and Maxillofacial Surgery, which requires both Dental and Medical qualifications.

In other parts of the world Oral and Maxillofacial Surgery as a speciality 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.

Oral and maxillofacial surgeons

An oral and maxillofacial surgeon is a regional specialist surgeon treating the anatomical area of the mouth, jaws, face, skull, as well as associated structures.

Oral & maxillofacial surgeons are usually initially qualified in dentistry and have undergone further surgical training. Some OMS residencies integrate a medical education as well & an appropriate degree medicine (MBBS or MD or equivalent) is earned, although in the United States there is legally no difference in what a dual degree OMFS can do compared to someone who earned a four year certificate. Oral & maxillofacial surgery is universally recognized as a one of the nine specialties of dentistry. However also in the UK and many other countries OMFS is a medical specialty as well culminating in the FRCS (Fellowship of the Royal College of Surgeons). Regardless, all oral & maxillofacial surgeons must obtain a degree in dentistry (BDS, BDent, DDS, or DMD or equivalent) before being allowed to begin residency training in oral and maxillofacial surgery.

They also may choose to undergo further training in a 1 or 2 year fellowship to expand the scope of practice to areas such as:

• Head and neck cancer - microvascular reconstruction
• Cosmetic facial surgery
• Craniofacial surgery/Pediatric Maxillofacial surgery
• Cranio-maxillofacial trauma

The popularity of oral and maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing. Integrated programs are becoming more available to medical graduates allowing them to complete the dental degree requirement in about 3 years in order for them to advance to subsequently complete Oral and Maxillofacial surgical training.

Surgical procedures

Treatments may be performed on the mouth, jaws, neck, face, 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 dentures or other dental prostheses)
• Diagnosis and treatment of benign pathology of the region (cysts, tumors etc.)
• Diagnosis and treatment (ablative and reconstructive surgery) of malignant pathology of the region (oral & head and neck cancer)
• Diagnosis and treatment of cutaneous malignancy (skin cancer)
• Diagnosis and treatment of congenital craniofacial malformations such as cleft lip and palate and cranial vault malformations such as craniosynostosis, (craniofacial surgery)
• Diagnosis and treatment of chronic facial pain disorders
• Diagnosis and treatment of temporomandibular joint (TMJ) disorders
• Diagnosis and treatment of dysgnathia (incorrect bite), and orthognathic (literally "straight bite") reconstructive surgery, orthognathic surgery, Maxillomandibular advancement
• Diagnosis and treatment of soft and hard tissue trauma of the oral and maxillofacial region (jaw fractures, cheek bone fractures, nasal fractures, skull fractures and eye socket fractures.
• Splint and surgical treatment of sleep apnea, Maxillomandibular advancement (in conjunction with sleep labs or physicians)
• Surgery to insert osseointegrated (bone fused) dental implants or Maxillofacial implants for attaching Craniofacial prosthesis.
• Cosmetic surgery limited to the head and neck (Rhytidectomy/facelift, Blepharoplasty, Otoplasty, Rhinoplasty, Genioplasty, etc.)

A well known example of a facial trauma case was the reconstruction of Trevor Rees-Jones's face, which was literally flattened by the impact of the car crash that killed Diana, Princess of Wales. Dr Luc Chikhani rebuilt the shattered facial bones, working from photographs, and implanting hundreds of titanium screws and brackets.

In November 2005 Isabelle Dinoire became the first person in the world to receive a face transplant.[2] The procedure was completed by Dr Bernard Devauchelle a French oral and maxillofacial surgeon at Amiens University Hospital.

United States, Canada, Australia, and New Zealand

Oral and Maxillofacial Surgery is one of the 9 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 4-6 years of further formal University training after dental school (DDS,BDent,DMD, or BDS). 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 medical degree (MD,MBBS,MBChB, etc). Specialists in this field are designated registrable U.S. “Board Eligible” and warrant exclusive titles. Approximately 50% of the training programs in the U.S., 100% of the programs in Australia and New Zealand, and 1/5 of Canadian training programs, are dual-degree leading to dual certification in Oral and Maxillofacial Surgery and medicine (MD,MBBS,MBChB, etc).

The typical training program for an Oral and Maxillofacial Surgeon is:

• 4 Years Undergraduate Study (BA, BSc, or equivalent)
• 4 Years Dental Study (DMD,BDent,DDS, or BDS)
• 4 - 6 Years Residency Training (additional time for acquiring medical degree)
• After completion of surgical training most undertake final specialty examinations: (U.S. "Board Certified (ABOMS)"), (Australia/NZ: "FRACDS(OMS)"), or (Canada: "FRCD(C)(OMS)").
• Many dually 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 advanced 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/Pediatric Maxillofacial surgery (cleft lip and palate repair, surgery for craniosynostoses, etc.)
• Cranio-maxillofacial trauma (soft tissue and skeletal injuries to the face, head and neck)

Organizations

• Association of Oral and Maxillofacial Surgeons of India [3]
• American Association of Oral and Maxillofacial Surgeons [4]
• American Board of Oral and Maxillofacial Surgery [5]
• American College of Surgeons [6]
• Australian and New Zealand Association of Oral and Maxillofacial Surgeons [7]
• The Royal College of Surgeons of England
• Canadian Association of Oral and Maxillofacial Surgeons [8]
• Faculty of Dental Surgery of The Royal College of Surgeons of England
• Directive 2001/19/EC (Official Journal of the European Communities L 206, 31.07.2001) [9]
• European Association for Cranio-Maxillofacial Surgery [10]
• Internacional Association of Oral and Maxillofacial Surgeons [11]
• British Association of Oral and Maxillofacial Surgeons [12]
• Clinica de Cirujia Maxilofacial - Clinimax [13]
• Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie [14]
• Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [15]
• Oesterreichische Gesellschaft fuer Mund-, Kiefer- and Gesichtchirurgie [16]
• Sociedad Española de Cirugía Oral y Maxilofacial [17]
• Société Française de Stomatologie et Chirurgie Maxillo-Faciale [18]
• Société Royale Belge de Stomatologie et de Chirurgie Maxillo-Faciale [19]
• Société Souisse de Chirurgie Maxillo-Faciale [20]
• Società Italiana di Chirurgia Maxillo-Facciale [21]
• OMS Foundation [22]

See also

• Distraction osteogenesis
• Operation Smile
• Orthognathic surgery
• The Smile Train

References

• European Cranio-maxillofacial Sugery [23]
• Journal of Cranio-Maxillofacial Surgery [24]
• International Association of Oral and Maxillofacial Surgeons [25]
• British Association of Maxillofacial Surgeons [26]