Oral and maxillofacial surgery

Oral and maxillofacial surgeon

Occupation
Names	Oral and Maxillofacial Surgeon
Activity sectors	Dentistry Medicine Surgery
Description
Education required	Dental degree Medical degree (depending on country)

Oral and maxillofacial surgery is surgery to treat 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 some countries, including the United States, it is a recognized specialty of dentistry; in others, including the UK, it is recognized as a medical specialty.

Regulations

In several countries oral and maxillofacial surgery is a speciality recognized by a professional association, as is the case with the 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 the 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.

Summary

An oral and maxillofacial surgeon is a regional specialist surgeon treating the entire craniomaxillofacial complex: anatomical area of the mouth, jaws, face, 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. An optional medical qualification can qualify the holder for hospital and operating room access not open to others.

Oral and maxillofacial surgery is universally recognized as one of the specialties of dentistry. In the UK and many other countries OMS 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 must obtain a university degree in dentistry before beginning residency training in oral and maxillofacial surgery.

They also may choose to undergo further training in a 1 or 2 year subspecialty Oral and Maxillofacial Surgery Fellowship Training in the following areas:

• Head and neck cancer – microvascular reconstruction
• Cosmetic facial surgery
• Craniofacial surgery/Pediatric Maxillofacial surgery/Cleft Surgery
• Cranio-maxillofacial trauma
• Head and neck reconstruction (plastic surgery of the head and neck region)
• 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 few EU countries. However, the public fund spend for 14 years of training is a big concern of the state. 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 craniomaxillofacial complex: 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 implants, dentures, or other dental prostheses)
• Diagnosis and treatment of benign pathology (cysts, tumors etc.)
• Diagnosis and treatment (ablative and reconstructive surgery, microsurgery) of malignant pathology (oral & head and neck cancer).
• Diagnosis and treatment of cutaneous malignancy (skin cancer), lip reconstruction
• 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, surgical correction of facial asymmetry.
• Diagnosis and treatment of 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).
• Splint and surgical treatment of sleep apnea, maxillomandibular advancement, genioplasty (in conjunction with sleep labs or physicians)
• 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.)

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, 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, DO, MBBS, MBChB etc.). Both 4 and 6 year graduates are designated US "Board Eligible," those that earn "Certification" are Diplomats'. Approximately 50% of the training programs in the US, 100% of the programs in Australia and New Zealand, and 20% of Canadian training programs, are "dual-degree". The trainees obtain a degree in medicine (MD, DO, MBBS, MBChB etc.) as well as a specialty certificate in oral and maxillofacial surgery, although the scope of surgery remains unchanged.

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 (6 years includes 2 additional years for acquiring medical degree)
• After completion of surgical training most undertake final specialty examinations: (US "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 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)

Notable oral and maxillofacial surgeons

• Luc Chikhani reconstructed Trevor Rees-Jones's face, which was flattened by the impact of the car crash that killed Diana, Princess of Wales.
• Bernard Devauchelle a French oral and maxillofacial surgeon at Amiens University Hospital who in November 2005 successfully completed the first face transplant on Isabelle Dinoire.
• Varaztad Kazanjian Pioneer in plastic and reconstructive surgery, Harvard's first professor of plastic surgery

Organizations

• American Association of Oral and Maxillofacial Surgeons
• American Board of Oral and Maxillofacial Surgery
• Association Of Oral and Maxillofacial Surgeons Of India
• American College of Surgeons
• College of Physicians and Surgeons Pakistan
• Faculty of Dental Surgery of The Royal College of Surgeons of England
• Indonesian Association of Oral and Maxillofacial Surgeons

See also

• Craniofacial surgery
• Craniofacial team
• Dental implant
• Distraction osteogenesis
• Forensic facial reconstruction
• Hilotherapy, a therapy to improve healing post surgery
• Journal of Oral and Maxillofacial Surgery
• Léon Dufourmentel
• Operation Smile
• Oral surgery
• Orthognathic surgery
• Osseointegration
• Project Harar
• Scalp surgery
• The Smile Train

External links

• Journal of Cranio-Maxillofacial Surgery
• International Association of Oral and Maxillofacial Surgeons
• British Association of Oral and Maxillofacial Surgeons
• American Academy of Oral and Maxillofacial Pathology
• American Board of Oral and Maxillofacial Surgery
• International Association of Oral and Maxillofacial Surgeons
• Indonesian Association of Oral and Maxillofacial Surgeons