About OMFS

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 an internationally recognized surgical specialty.


In the US (and many other countries) it is one of the nine specialties of dentistry.
It is also recognized as a medical specialty in certain parts of the world, such as the UK.


Regulations

In the US, the UK, Canada, Australia, New Zealand and Brazil, oral and maxillofacial surgery is one of the nine specialties of dentistry recognized by 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 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.


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.

Maxillofacial surgeons are usually initially qualified in dentistry and have undergone further surgical training. Some OMS residencies integrate a medical education as well and 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 OMS can do compared to someone who earned a four year certificate.

Generally, dual-degree programs have become more commonplace as the profession of OMS has recognized the value of holding a medical degree in terms of obtaining hospital and OR privileges. 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 requiring both medical and dental degrees, culminating in the FRCS (Fellowship of the Royal College of Surgeons).

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 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 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, New Zealand, and North America

Oral and Maxillofacial Surgery is one of the 9 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.). 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". The trainees obtain a degree in Medicine (MD, DO, MBBS, MBChB etc.) as well as a specialty certificate in Oral and Maxillofacial Surgery.

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: (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)