Oral and maxillofacial surgery

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Oral and Maxillofacial Surgery
)
"Facial reconstruction" redirects here. For the process of visualizing a face from a skull, see Forensic facial reconstruction.

Oral and maxillofacial surgery
System
maxillofacial region
SpecialistOral and Maxillofacial Surgeon
GlossaryGlossary of medicine

Oral and maxillofacial surgery is a surgical specialty focusing on

cosmetic surgery
/facial plastic surgery including cleft lip and cleft palate surgery.

Specialty

An oral and maxillofacial surgeon is a regional

skull, head and neck as well as associated structures. Depending upon the national jurisdiction, oral and maxillofacial surgery may require a degree in medicine, dentistry
or both.

Subspecialties

In the U.S., oral and maxillofacial surgeons, whether possessing a single or dual degree, may further specialize after residency, undergoing additional one or two year sub-specialty oral and maxillofacial surgery fellowship training in the following areas:

United Kingdom and Europe

In countries such as the UK and most of Europe, it is recognised as a

cosmetic facial surgery
.

In the UK, Maxillofacial surgery is a specialty of the Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh. Intercollegiate Board Certification is provided through the JCIE, and is the same as Plastic Surgery, ENT, General Surgery, Orthopaedics, Paediatric Surgery, Neurosurgery and Cardiothoracic Surgery.

The FRCS (Fellowship of the Royal College of Surgeons) is the specialist exam at the end of surgical training, and is required to work as a Consultant Surgeon in Maxillofacial Surgery.

In Poland however, despite EU directive, maxillofacial surgery has always been dominated by dentists and still the majority of current maxillofacial surgery trainees are dental graduates.

Canada, Asia, and Scandinavia

In Canada, Asia and Denmark oral and maxillofacial surgery is also recognized as a dental specialty and requires a degree in dentistry prior to surgical residency training. The Canadian model is the same as the model used in the United States of America.

Since 2019, Norway switched from dual degree requirement for Maxillofacial Surgery to medical degree only. Similarly, Sweden has started several Maxillofacial Surgery training programs for medical graduates. [2]

Pakistan

In Pakistan, OMFS is recognized as specialty of dentistry which requires FCPS from CPSP after 4 years BDS degree and a one-year housejob. The candidate has to pass FCPS-1 in order to commence his/her training followed by PGMI Exam(not in all cases).[3]

India

Oral and maxillofacial surgery, also known as OMFS, is a branch recognized by DCI (Dental Council of India) in countries such as India. In India, becoming a maxillofacial surgeon requires a five-year dental degree followed by three years of post-graduate specialisation. In India, oral and maxillofacial surgery includes the treatment of complex dental surgery, including wisdom tooth removal, dental implant, craniomaxillofacial trauma, Orofacial pain (trigeminal neuralgia) and jaw joint pain (Temporomandibular disorder(TMD) or TMJ Pain) management, jaw joint(TMJ) replacement for TMJ ankylosis and deformed jaw joint cases, Lefort-3 distraction for Craniosynostosis case, jaw tumor and cyst removal surgery, head and neck cancer, facial aesthetic like rhinoplasty, eye and ear plastic surgery, Facial cosmetic surgery, microvascular surgery, and cleft and craniomaxillofacial surgery. In India, a Maxillofacial surgeon is considered one of the required members of the emergency team. Almost 20-25% of trauma patients usually have sustained facial trauma, and that needs urgent opinion and primary management that can be better managed by Maxillofacial experts.

Australia and New Zealand

In Australia and New Zealand Oral and Maxillofacial Surgery is recognised as both a specialty of medicine and dentistry. Degrees in both medicine and dentistry are compulsory prior to being accepted for surgical training. The scope of practice is broad and there is the ability to undertake subspecialty fellowships in areas such as head and neck surgery and microvascular reconstruction.

Globally

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. In several countries oral and maxillofacial surgery is a specialty 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 Surgeons and Brazilian Federal Council of Odontology (CFO).

Regulation

Oral and maxillofacial surgery is an internationally recognized surgical specialty. Oral and maxillofacial surgery is formally designated as either a medical, dental or dual (medical and dental) specialty.

United States of America

In the United States, oral and maxillofacial surgery is a recognized

general anesthesia and deep sedation.[6] As is the norm among surgical specialists, oral and maxillofacial surgery residents typically serve as Chief Resident
in their final year.

Following residency training, oral and maxillofacial surgeons, whether single or dual degree, have the option of undergoing 1-2 year surgical sub-specialty

cosmetic facial surgery, craniofacial surgery and cranio-maxillofacial trauma
.

Board certification

Board certification in the U.S. is governed by the American Board of Oral and Maxillofacial Surgery (ABOMS).

surgical specialties recognized by the American College of Surgeons.[8] Oral and maxillofacial surgeons in the United States, whether single or dual degree, may become Fellows of the American College of Surgeons, "FACS" (Fellow, American College of Surgeons).[9]

Professional organizations

The American Association of Oral and Maxillofacial Surgeons (AAOMS) is the chief professional organization representing the roughly 9,000 oral and maxillofacial surgeons in the United States.[10] The American Association of Oral and Maxillofacial Surgeons publishes the peer-reviewed Journal of Oral and Maxillofacial Surgery.

Anesthesia

In the U.S., 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, and oral and maxillofacial surgery residents.[11]

Unique among surgical specialists in the U.S.,

general anesthesia and deep sedation are licensed to do so in both hospital and office settings.[13]

In the specialty's infancy, dental and oral surgeons were plenary in the introduction of

Harvard
. Massachusetts General Hospital views the demonstration as among the institution's most significant claims to fame. Upon the successful completion of Dr. Morton's demonstration, Dr. Warren famously proclaimed to the crowded, astonished and elated amphitheater, what would become likely the most famous words in modern medicine, "Gentlemen, this is no humbug." Indeed, the event marked the beginning of modern anesthesia and surgical practice.

Immediately following the demonstration, in a congratulatory letter to Dr. William Thomas Green Morton, polymath and later Harvard Medical School Dean, Oliver Wendell Holmes Sr., father of Justice Oliver Wendell Holmes Jr. of the Supreme Court of the United States, proposed naming the state produced "anesthesia", and the procedure an "anesthetic."[14] Holmes wrote to Morton, "Everybody wants to have a hand in a great discovery. All I will do is to give a hint or two as to names—or the name—to be applied to the state produced and the agent. The state should, I think, be called 'Anaesthesia.' This signifies insensibility—more particularly ... to objects of touch." Holmes added poetically that the new term "will be repeated by the tongues of every civilized [member] of mankind."[15]

Dr. Ferdinand Hasbrouck, a New York oral surgeon and an 1870 graduate of the

Oneida in the Long Island Sound, NY. Dr. Hasbrouck, induced President Cleveland with nitrous oxide and extracted teeth from the corpus of the tumor. As Cleveland recovered from nitrous oxide, Dr. Hasbrouck began the administration of ether for the remainder of the procedure as he and the team performed the tumor surgery.[18] The procedure was a milestone for the practice of anesthesia.[19] Ferdinand Hasbrouck's son, James F. Hasbrouck, discussed below, was among the founders of the Columbia University College of Dental and Oral Surgeons in 1916.[20]

In 1945, oral and maxillofacial surgeon, Dr. Niels Jorgensen was first to develop intravenous moderate

Loma Linda University School of Medicine
, beginning in 1945.

In the United States, a close educational and professional relationship between oral and maxillofacial surgery and anesthesiology persists to the present day.[21][14]

Craniofacial surgery

Oral and maxillofacial surgery stands as a pillar of the modern practice of plastic surgery and plastic surgery's recognition in 1941[22] as a surgical specialty in the United States. In the early 1900s, plastic surgery was founded by a professional organization of oral surgeons with elite training and an interest in plastic and reconstructive surgery, the American Association of Oral and Plastic Surgery.[23] Over time, the exclusive organization began to elect a small number of non-oral surgeon members, the first of which was legendary general surgeon Dr. Vilray Blair of Washington University in St. Louis. The organization became the American Association of Plastic Surgeons in 1921.[24] At Harvard University, oral and maxillofacial surgeon, Dr. Varaztad Kazanjian pioneered plastic surgery and is considered to be a founder, if not, the founder of the modern practice of plastic surgery. He graduated from Harvard School of Dental Medicine in 1905. Dr. Kazanjian was Professor of Clinical Oral Surgery at Harvard from 1922 to 1941 when he was named Harvard's first Professor of Plastic Surgery. Dr. Kazanjian was instrumental in plastic surgery's formal recognition as an independent surgical specialty in 1941. Dr. Kazanjian joined the First Harvard Unit, serving with the British Forces in WWI, establishing the first dental and maxillofacial clinic in France, handling more than 3,000 cases of severe wounds to the face and jaws. He was honored for his surgical advances by British monarch George V, who invested him Companion to the Order of St Michael and St George.[25] Kazanjian served as an early president of American Association of Plastic Surgeons.

Another founder and god-father of plastic surgery was

oral and maxillofacial surgeon, Dr. Hippolyte Morestin
.

Oral and maxillofacial surgery's stature and clout in university hospitals can be traced to its plenary role in the development of modern medicine and surgery.

State licensure

While a professional dental degree, i.e., D.D.S. or D.M.D. is mandatory in the U.S., oral and maxillofacial surgeons may possess various doctoral degree combinations, e.g., D.D.S., D.M.D., D.D.S./M.D., D.M.D./M.D., D.M.D./Ph.D. or D.D.S./Ph.D. Still, it is the completion of an oral and maxillofacial residency training program and corresponding certificate of specialty training that confers surgical specialty status and board eligibility,

general anesthesia[43] and deep sedation, not the surgeon's professional degree or degree combination.[13]

D.D.S. (Doctor of Dental Surgery) and D.M.D. (Doctor of Medicine in Dentistry or Doctor of Dental Medicine) are the same degrees. D.M.D. and D.D.S. represent the same education. The letters used are a function of university discretion, both degrees represent an identical curriculum, set of educational requirements and level of educational attainment.

Health Insurance Portability and Accountability Act taxonomy

Oral and maxillofacial surgery[44] is assigned Health Care Provider Taxonomy Code: 204E00000X [45]

Surgical procedures

In the United States and globally, treatments may be performed on the

craniomaxillofacial complex
: mouth, jaws, face, neck, and skull, and include:

Occupation

Oral and maxillofacial surgery is intellectually and physically demanding and is among the most highly compensated

surgical specialties in the United States[46] with a 2008 average annual income of $568,968.[47]

The popularity of oral and maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing. At least one program exists that allows highly qualified candidates whose first degree is in medicine, to earn the required dental degree, so as to qualify for entrance into oral and maxillofacial residency training programs and ultimately achieve board eligibility and certification in the surgical specialty.[48]

Education and training

In the UK, Oral and maxillofacial surgery is one of the ten medical specialties, requiring MRCS and FRCS examinations.

In mainland Europe, its status, including whether or not oral surgery, maxillofacial surgery and stomatology are considered separate specialties, varies by country. The required qualifications (medical degree, dental degree, or both, as well as the required internship and residency programs) also vary.

In the US, Australia and South Africa, 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).

Residency training programs are either four or six years in duration. In the United States, four-year residency programs grant a certificate of specialty training in oral and maxillofacial surgery. Six year programs granting an optional MD degree emerged in the early 1990s in the United States. Typically, Six-year residency programs grant the specialty certificate and an additional degree such as a medical degree (e.g., MD, 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 "Board Certification" are Diplomats. Approximately 50% of the training programs in the US and 66%[49] of Canadian training programs are "dual-degree." The typical total length of education and training, post-secondary school is 12 to 14 years. Beyond these years, some sub-specialize, adding an additional 1-2 year fellowship.

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)
  • Both single and dual qualified oral and maxillofacial surgeons may obtain fellowship with the American College of Surgeons (FACS).[50]
  • The International Board for the Certification of Specialists in Oral and Maxillofacial Surgery (IBCSOMS) was founded in May, 2013 to define an international standard for specialists in oral and maxillofacial surgery. Oral & Maxillofacial Surgeons may appear for international board certification examination after completion of surgical training.

Surgical sub-specialty fellowship training

In addition, single and dual qualified graduates of oral and maxillofacial surgery training programs can pursue post-residency sub-specialty fellowships, typically 1–2 years in length, in the following areas:

Charities

A number of notable philanthropic organizations provide humanitarian oral and maxillofacial surgery around the globe.

craniofacial
disfiguration.

See also

References

  1. ^ "Affiliated Associations".
  2. ^ "About The CAOMS".
  3. ^ "Registration Of Training". cpsp.edu.pk. Retrieved 15 September 2023.
  4. ^ "Become a Board Certified Doctor | ABOMS". American Board of Oral and Maxillofacial Surgery.
  5. ^ "Information about Waivers for ACS Fellowship".
  6. ^ "Anesthesia for Oral and Maxillofacial Surgery | AAOMS". AAOMS Oral and Maxillofacial Surgeons.
  7. ^ "American Board of Oral and Maxillofacial Surgery | ABOMS". www.aboms.org.
  8. ^ "What are the surgical specialties?". ACS.
  9. ^ "Information about Waivers for ACS Fellowship". ACS.
  10. ^ "AAOMS". www.aaoms.org.
  11. ^ "Statement on the Anesthesia Care Team" (PDF). Archived from the original (PDF) on 6 July 2016.
  12. ^ "Statement from American Society of Anesthesiologists" (PDF).
  13. ^ a b Dentistry, Florida Board of. "Florida Board of Dentistry » Sedation Permits for General Anesthesia- Licensing, Renewals & Information".
  14. ^
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  18. ^ https://issuu.com/auamarketing/docs/brochuredesign1?e=2876235/79816035 Atlas and diagrams of the surgical procedure and photographs of the tumor, p.26.
  19. ^ "President Grover Cleveland".
  20. ^
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  22. ^ "ABPlasticsurgery.org". www.abplasticsurgery.org.
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  24. ^ a b "Our History".
  25. ^ "The Work of Varaztad H. Kazanjian · Noble Work for a Worthy End : Harvard Medical School in the First World War · OnView: Digital Collections & Exhibits". collections.countway.harvard.edu.
  26. ^ "The Dental Summary". 1919.
  27. ^ "Index of the Periodical Dental Literature Published in the English Language". American Dental Association. 7 March 1922 – via Google Books.
  28. ^ Uncle of Lillian Wald, founder of the Henry Street Settlement and among the founders of the NAACP and the Columbia University School of Nursing.
  29. ^ "New York State Journal of Medicine". 1923.
  30. ^ "Annual Register of the Officers and Students of Columbia College". 1884.
  31. ^ Supreme Court Appellate Division First Department.
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  34. ^ a b "Columbia Alumni News". 1916.
  35. ^ "Officers and Graduates of Columbia University, Originally the College of the Province of New York Known as King's College: General Catalogue". 1916.
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  37. ^ "Dental Columbian". 1937.
  38. ^ Weiner, Leonard and Wald, Arthur H., "Fibrin Foam and Thrombin as Used in the Surgical Removal of a Large Fibromyxoma of the Mandible," Plastic and Reconstructive Surgery: Journal of the American Society of Plastic Surgeons, (Grafting Abstracts) July 1947, Vol. 2, Issue 4, p.394, Originally the Journal of Plastic and Reconstructive Surgery
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  41. ^ "Oral and Maxillofacial Surgery Permits - Licensed Dentists - Dental Board of California". www.dbc.ca.gov.
  42. ^ "Elective Cosmetic Surgery Permits - Licensed Dentists - Dental Board of California". www.dbc.ca.gov.
  43. ^ "NYS Dentistry:Dental Anesthesia/Sedation Certification". www.op.nysed.gov.
  44. ^ "204E00000X Taxonomy Code | Oral & Maxillofacial Surgery (D.M.D.) | Allopathic & Osteopathic Physicians | Healthcare Provider Taxonomy Code Set | Medical Coding Library | www.HIPAASpace.com © 2023". www.hipaaspace.com.
  45. ^ Health Care Provider Taxonomy, p.41.
  46. ^ "Doximity". www.doximity.com.
  47. ^ http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0217_1.pdf?la=en [bare URL PDF]
  48. ^ "University of Alabama at Birmingham".
  49. ^ J. Gigliotti, N. Makhoul: Demographics, training satisfaction, and career plans of Canadian oral and maxillofacial surgery residents. Int. J. Oral Maxillofac. Surg. 2015; 44: 1574–1580.
  50. ^ "Fellows (U.S. And Canada)". Archived from the original on 22 September 2017. Retrieved 6 November 2017.

External links

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