Oral and Maxillofacial Surgery
Nature of the work
Oral and maxillofacial surgery (OMFS) deals
with the diagnosis and treatment of diseases affecting the mouth,
jaws, face and neck. It is unique in requiring a dual qualification
in medicine and dentistry.
Working in oral and maxillofacial surgery
The scope of the specialty is large and
includes the surgical and non-surgical management of conditions of
the hard and soft tissues of the face, jaws and neck.
This can be further broken down into the
management of facial and cranio-maxillofacial injuries, head, neck
and facial skin cancers that require removal and often complex
reconstruction. The correction of congenital and acquired facial
deformity, the treatment of salivary gland diseases, and cosmetic
procedures are also carried out. Temporomandibular joint (TMJ)
disorders, impacted teeth, cysts and tumours of the jaws are all
treated, as well as intra-oral and extra-oral implantology with
associated hard and soft tissue augmentation as part of
pre-prosthetic surgery.
The specialty also deals with non-surgical
problems affecting the oro-facial region such as the management of
facial pain, oral mucosal disease and infections. Consultant
oral and maxillofacial surgeons usually work in teams, developing
areas of sub-specialisation in their practice that include head and
neck cancer and reconstruction, cranio-facial deformity, cleft lip
and palate and aesthetic facial surgery.
Common procedures/interventions
Common procedures range from relatively minor
dentoalveolar surgery through to complex major head and neck
surgery. They cover:
- oncology and reconstruction
- facial deformity
- trauma
- salivary gland surgery
- aesthetics
- oral, dentoalveolar and TMJ surgery.
Associated sub specialties
Sub-specialty interests are common. These can
be pursued from the latter stages of specialist training and
continued into a consultant’s career. They include:
- head and neck oncology
- cleft lip and palate surgery
- facial deformity and craniofacial surgery
- aesthetic facial surgery.
How is this specialty evolving
It has been calculated that in order to
provide a comprehensive service within accepted waiting times for
patients there should be 1 consultant for every 150,000 members of
the population. Numbers in this specialty currently fall short of
this ratio, so there is considerable scope for expansion. Increases
in interpersonal violence leading to facial injuries and an
increase in both oral and skin cancer (the majority is found in the
head and neck region) means this specialty is likely to be in
demand.
Within the specialty, there are a number of
key areas that are evolving both in the UK and abroad. These
include:
- Osteo-distraction
This is a technique of making cuts in a bone or bones but not
moving them at the time of surgery. Distracters are applied and the
bone is lengthened slowly over several weeks following the initial
operation to cut the bone. This slow growth also stimulates the
soft tissues to grow, which means there are fewer limits on the
moves that are possible.
- Navigational technology
This is the use of computer and CT modelling to exactly position
bones or prosthetic implants of the facial skeleton during the time
of surgery. This millimetre accuracy at the time of surgery can
optimise the final result and reduce the complications or need for
further procedures.
- Microvascular surgery
These are well-established techniques of transferring tissue from
one site on the body to another. Although the technique is well
established, the range of tissue and the range of applications is
still growing, and is being combined with other techniques, such as
distraction.
- Implantology
The placement of pure titanium implants to provide a foundation for
teeth, facial prostheses and bone anchored hearing aids has now a
40-year track record. There is still huge scope for work in hard
and soft tissue manipulation in order to optimise the functional
and cosmetic result.
Further information
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