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.
Regulations
In the U.S.A., UK, Canada, Australia, and New Zealand, oral and maxillofacial surgery is one of the 9 specialties recognized by the American Dental Association, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Dentists of Canada, and Royal Australasian College of Dental Surgeons, training programs lead to the trainee obtaining qualifications in both Medicine and Dentistry.
In other parts of the world 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.
Oral and maxillofacial surgeons
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.
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 in 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 subspecialty fellowship training in the following areas:
- 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 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 limited to 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, Canada, New Zealand, and the United States
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 20% 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 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 craniosynostosis, etc.)
- Cranio-maxillofacial trauma (soft tissue and skeletal injuries to the face, head and neck)
Notable oral and maxillofacial surgeons
- William H.Bell:Pionneer and father of modern Orthognathic surgery.
- Hugo Obwegeser: Pioneer in orthongathic (facial skeletal) surgery, instrumental in introducing orthgnathic surgical technique to US surgeons in the 1960s.
- Luc Chikhani reconstructed Trevor Rees-Jones's face, which was literally 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.
- Thomas Dodson: US Oral and Maxillofacial Surgeon at Massachusetts General Hospital, instrumental in bringing Evidenced-Based Practice Methods to OMFS.
- Edward Ellis: US Oral and Maxillofacial Surgeon at UTSouthwestern/Parkland Memorial Hospital and author of definitive atlas on "Surgical Approaches to the Facial Skeleton"
- Raymond Fonseca: US Oral and Maxillofacial Surgeon, formerly at University of Pennsylvania and author of reknowned texts on management of Oral and Maxillofacial Trauma and Maxillofacial Surgery.
- Walter Guralnick: US Oral and Maxillofacial Surgeon, pioneer of dual degree (DMD, MD or DDS, MD) Oral and Maxillofacial/General Surgery residency programs in North America
- Eric Dierks: US Oral and Maxillofacial Surgeon, instrumental in enhancing head and neck surgical oncology training within OMFS programs. One of the few OMFS world-wide who is double-board certified in OMFS and Otolaryngology.
- Leonard B. Kaban: US Oral and Maxillofacial Surgeon, Chairman, Massachusetts General Hospital OMFS, pioneer in craniofacial surgery with significant contributions to the diagnosis and management of hemifacial microsomia and one of the first surgeons to successfully distract the human mandible. The first OMFS inducted into the American College of Surgeons.
- Jeffrey Posnick: US Oral, Maxillofacial, Plastic and Craniofacial Surgeon and pioneer for advances in managment of children with craniofacial anomalies
- Peter Quinn: US Oral and Maxillofacial Surgeon, Former Chairman, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, pioneer in Temporomandibular Joint Reconstruction.
- Robert Ord: US Oral and Maxillofacial Surgeon/Head and Neck Surgeon, Chief of Oral and Maxillofacial Surgery, University of Maryland Medical System
- Stephen Schendel: US Oral and Maxillofacial Surgeon, Former
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