Orthognathics/TMJ fellowships have slowly become a large growing fellowship specialty. With graduates practicing only dentoalveolar, these skills are beginning to become more rare. A lot of programs don’t train you be fully competent in this especially TMJ. Also the marketability of a TMJ/orthognathics fellowship have driven up the popularity of these fellowships. I have no relationship to any of these programs. Just information I have learned over the years between a few people I know.
Dalhoussie - By orthognathic numbers, this is the busiest orthognathic fellowship. They do 370 orthognathic cases a year. You will for sure learn to be a master of the orthognathics. You cut and plate your side. There is no TMJ. There is a few primary cleft cases a year you’ll be exposed to as well. Level II/III arthroscopy is minimal. You have residents which is helpful. Easy attending a to work with. Halifax is a great city to live in but it is isolated from the rest of the country band is very cold. This fellowship has been around for decades but is relatively unknown to US grads. Only a few people have done it from the US.
Toronto - This is a solid fellowship with about 200 orthognathics a year. You cut and plate your side. The attendings are easy to work with. You do about 30-40 total joints a year which come from a private practice that brings cases to the hospital. You have residents which is helpful. Toronto is an amazingly cultural city to live in. Caminiti and Cuddy are easy going. They do get some interesting cases such as cleft re-dos from sick children’s. Only Toronto and UAB are full scope combined TMJ and orthognathics.
Michigan - Michigan was one of the best TMJ fellowships before one of the attendings left but now the arthroscopy experience is reduced because of it. Aronovich is a very meticulous TMJ surgeon and a perfectionist that can also be a lot for someone to handle as well. There is a fair bit of orthognathics but it’s TMJ related. You cut and plate your side. The attendings here are phenomenal. You still get a great experience and learn and see zebra cases
UAB - You will do about 120 orthognathics cases in a year but the real strength of this fellowship is the TMJ. It is the only orthognathics fellowship that will train you in level III arthroscopy outside of doing McCain’s fellowship. Louis is one of the most skilled TMJ surgeons in the country. (TMJ skill among surgeons isn’t based on number of replacements but rather your arthroscopy skills). You will see zebra TMJ cases.In terms of ortho, numbers are there, the attending for the orthognathic side can be hands on and will plate every single case. You share with residents and the attendings can be a difficult to work with. l
Emory - This is a TMJ fellowship exclusively. He does about 120 total joints a year. He also does arthroscopy as well. Orthognathic isn’t really a part of this fellowship as Bouloux focuses on TMJ. Attending can be a difficult attending to work with.
MGH - Moderate volume. The entire fellowship is based on doing procedure endoscopically which is a cool skill. It’s practical for TMJ not sure if trauma or orthognathics it is practical for. McCain is a well known TMJ arthroscopy guy and one of the top guys in this regard. No orthognathics experience is done in this regard. McCain is very old and does not have many years left practicing. There is a new graduate of his fellowship that is taking over as well.
Carolinas - You will do between 100-120 orthognathics cases, dentoalveolar and a random TMJ here and there. No TMJ. It is cool they have their only surgery suite in their office where they will do these cases and run general anesthesia. You will share a side with a LSU NOLA resident while the attending cuts the other side. (Either you cut the maxilla and the resident does mandible or vice versa) It is mostly a private practice based fellowship where you take call for the attendings of the Carolina’s practice and drain a lot of abscesses and do their trauma. The pay is very solid. It has the best pay of all the fellowships in this class. Attendings are easy going. The fellowship is almost like a recruiting fellowship as many of its grads stay with the big DSO in the Carolina’s.
Alfi - you do about 200-250 orthognathics cases a year. No TMJ. He only does custom orthognathic cases and everything is done with a piezo. This is a very unique way to operate but not entirely practical especially with the cost of piezo vs a recip saw. Still volume is pretty solid for a US based fellowship. It is also a recruiting fellowship for their practice. He has a lot of private pay patients as well.
Aziz - You do about 150 orthognathics a year. The great thing about this fellowship is Aziz is hands off and you run the show in the operating room. He also does a lot of custom orthognathics as well. This is the only fellowship of its kind that is like that. All others the attendings are scrubbed with you. No comprehensive TMJ experience in this fellowship. Some zygomatic implants and also you do the trauma with the residents. There are residents as well and usually they do the other side. He does a cleft trip so you get some speediness with that
Houston Methodist and St Louis - these are all lumped into the same class. They’re general omfs fellowships that train you to do everything but is not particularly busy in everything you’ll see maybe 20-30 routine ortho cases, TJRs, take out teeth, etc. It’s good for people who just want another year to refine all their skills.
Cleft/cranio - BCH (pediatric), Oklahoma, Tampa have the best orthognathics experience for craniofacial fellowships
