Oral and maxillofacial surgery

Oral and maxillofacial surgeon
	Oral surgery aboard the USS Kitty Hawk (CV 63)
Occupation
Names	Oral and maxillofacial surgeon
Occupation type	Specialty
Activity sectors	Medicine, dentistry, surgery
Description
Education required	Doctor of Dental Medicine (D.M.D); Doctor of Dental Surgery (D.D.S); Bachelor of Dental Surgery (B.D.S); Doctor of Medicine (M.D.); Doctor of Osteopathic Medicine (D.O.);

Oral and maxillofacial surgery (OMFS or OMS) specializes in surgery of the face, mouth, and jaws. It is an internationally recognized surgical specialty. OMFS is a specialty of dentistry in North America, Central America, South America, Australia, New Zealand, Russia, Asia, and Scandinavia (Sweden, Finland, Denmark, Norway). After a full degree in dentistry, the dental specialty residency training of oral and maxillofacial surgery may or may not include a degree in medicine. In countries such as the UK and most of Europe, it is recognized as a specialty of medicine and a degree in medicine or both degrees in dentistry and medicine are compulsory.^[1]

Regulations

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.

Summary

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^{[clarification needed]}. 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.^[2]

Surgical procedures

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, hair transplantation, lip enhancement, injectable cosmetic treatments like botox, fillers, platelet rich plasma, stem cells, chemical peel, mesotherapy.
Orthognathic surgery, surgical treatment/correction of dentofacial deformity as well as management of facial trauma, and sleep apnea
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).

Anesthesia training

In the United States, oral and maxillofacial surgeons are required to undergo five months of intensive general anesthesia training.^{[citation needed]} An additional month of pediatric anesthesia training is also required.^{[citation needed]}

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 and maxillofacial surgery residents, anesthesiologist assistants, and nurse anesthetists.^[3]

In Australia, New Zealand, and North America

Oral and maxillofacial surgery is one of the ten 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%^[4] 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).^[5]
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)