Oral & Maxillofacial surgery

Modern surgery has developed to such an extent that the body of knowledge and technical skills required have led to surgeons specialising in particular areas, usually an anatomical area of the body or occasionally in a particular technique or type of patient.

There are ten surgical specialties and this briefing covers Oral & Maxillofacial surgery.

The specialty of oral and maxillofacial surgery is unique in requiring a dual qualification in medicine and dentistry, followed by a comprehensive general and specialist surgical training, and is a recognised international specialty, which within Europe is defined under the medical directives. Most surgeons acquire a degree in dentistry before training in medicine, but it is becoming increasingly common for those acquiring a medical degree to subsequently undertake a dental qualification and then pursue a career in OMFS.

What do Oral and Maxillofacial surgeons do?

Often seen as the bridge between medicine and dentistry, oral and maxillofacial surgery is the surgical specialty concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck.

The scope of the specialty is extensive and includes the diagnosis and management of facial injuries, head and neck cancers, salivary gland diseases, facial disproportion, facial pain, impacted teeth, cysts and tumours of the jaws as well as numerous problems affecting the oral mucosa such as mouth ulcers and infections.

Subspecialties

Surgeons may choose to train and specialise in one or more of these specialised fields of Oral and Maxillofacial surgery:

• Surgical treatment of head and neck cancer – the removal of the tumours and subsequent reconstruction, including microvascualar free tissue transfer.
• Surgery for Craniofacial Facial Deformity - the correction of congenital or acquired facial deformity primarily to improve oro-facial function, but also often to overcome facial disfigurement and restore quality of life.
• Oral & Maxillofacial - surgery of the teeth (including implants), jaws, temporomandibular joints, salivary glands and facial skin lesions.
• Oral Medicine – diagnosis and management of medical conditions presenting in and around the cervico-facial structures.
• Craniofacial Trauma – treatment of facial soft and hard tissue injuries of the craniofacial structures.
• Cosmetic surgery – surgery to enhance facial aesthetics, and improve quality of life.

Main operations

A range of oral and maxillofacial surgical operations are carried out on an outpatient basis under local anaesthesia or conscious sedation. These include: pre-implant surgery placement of dental/facial implants, removal of impacted teeth, intra-oral and facial soft tissue procedures.
More major operations, for example those for salivary gland disease, trauma, facial deformity or cancer, are carried out on an inpatient basis under general anaesthetic.

• Facial injuries, management of complex craniofacial fractures and soft tissue injuries of the mouth, face, and neck.
• Head and neck cancer, access to tumours within the depths of the complex craniofacial anatomy, and ablation of tumours, including neck dissections.
• Reconstructive surgery, including microvascular free tissue transfer.
• Orthognathic surgery for the correction of facial disproportion.
• Pre-implant surgery, including the use of implants to retain facial or dental prostheses and associated bone grafting techniques as part of oro-facial reconstruction.
• Removal of impacted teeth and complex buried dental roots.
• Removal of cysts and tumours of the jaws.
• Primary and secondary surgery for cleft lip and palate, and other congenital facial deformities.
• Management of  benign and malignant lesions of the salivary glands.
• Removal of complex facial skin tumours and reconstruction.
• Cosmetic surgery including face lifts, eyelid and brow surgery and rhinoplasties.
• Temporomandibular joint surgery.

Due to the nature of the work, oral and maxillofacial surgeons often work alongside a variety of specialists in other fields such as ENT surgeons, clinical oncologists, plastic surgeons, orthodontists, restorative dentists, radiologists and neurosurgeons.

Developments

Three-dimensional radiographic anatomical displays (CT scans), and Magnetic Resonance Imaging (MRI scans) have allowed surgeons to view accurate and detailed three dimensional pictures of the inside of patients’ head and neck anatomy and pathology. Images may be manipulated by computer in order to generate precise models in order to plan surgery. Navigational systems linked to complex images allow the surgeon to view a “head up display” in the operating theatre, are being piloted.

Further Information

British Association of Oral and Maxillofacial Surgeons

Telephone number: +44(0) 207 405 8074
Fax number: +44(0) 207 430 9997
Email: office@baoms.org.uk