Differences between Oral surgeon, Plastic and ENT

[Tiramisu]

Hi, can some of you shed some light comparing what are the differences and similarities between OMFS, Plastic and ENT in terms of what they are capable of doing Head and Neck wise. And also, when there's traum in the ER, who gets call first? Thanx guys.

---

Members don't see this ad.

 

[eddieberetta]

OMFS- dental-focussed oral surgery and some jaw stuff. No oncology in North America. They do operate on the maxillary sinus, but ENT have taken over a lot with endoscopic techniques. Certainly no plastics, and no neck surgery at all. I have heard that in the UK they do a lot more including oral cancer surgery. I assume you know that this is a dental specialty.

ENT- Otologic surgery, nose surgery, sinus surgery, oral surgery (no dental type work, mainly oral cancers) as well as tumors of the head and neck outside the brain. In the neck, ENT operate from the inside (largoscopic work on the vocal cords) and the outside (resection of masses). ENTs DO tend to operate on cancers of the orbit (most optho's are not into this) and collaborate with neurosurgeons to operate on the skull base (acoustic neuroma) and pituitary (trans-sphenoidal). In addition, ENTs have leveraged their head and neck expertise to market themselves as "facial plastic surgeon" specialists and thus do any plastic surgical operation of the head and neck, from laser resurfacing to face lifts to craniofacial reconstruction to facial fracture/trauma. However, more advanced cases usually go to plastic surgeons (though there are new 1 year mini-fellowships in facial plastic that ENT are doing--hard to know the impact).

General Plastics and reconstructive sx- The traditional "plastic surgeon" does all the head and neck plastics as above and on the rest of the body including breast reconstruction/implant, lipo, burn treatment, skin grafting, and some specialize in hand surgery. Out of the three, these are the guys who usually get called for facial trauma (some places use ENT as well. OMFS are usually not invloved in trauma unless teeth/dentition is at risk. PRS do the more advanced reconstructions/craniofacial stuff usually.

Hope this helps. (I was seriously considering a surgical subspecialty before I opted for rads).

Cheers

 

[Supernumerary]

Ummm... I have to disagree a little - well maybe a lot - with the previous description of OMFS. Here's what AAOMS has to say:

Oral and maxillofacial surgery is defined by the American Dental Association as the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the bone and soft tissues of the oral and maxillofacial region.

In plain English, this means oral and maxillofacial surgeons do all kinds of surgery involving the mouth, teeth, jaws and face. Oral and maxillofacial surgeons reconstruct faces shattered by car accidents and gunshots, remove tumors and cancerous lesions, correct bites by surgically repositioning the jaws, place dental implants, repair cleft palates, perform all kinds of facial cosmetic surgery, and extract impacted wisdom teeth.

Even though oral and maxillofacial surgeons perform many of the same procedures as plastic surgeons and other medical specialists, oral and maxillofacial surgery is a specialty of dentistry. All OMSs are dentists, though some also hold medical degrees, and the practice of oral and maxillofacial surgery is regulated by state dental boards rather than medical boards.

Because dentists are often the first to detect oral and facial cancers, patients are generally referred to the OMFS that the dentist is accustomed to working with. While OMFS are qualified to do reconstructions and trauma surgery, their bread and butter comes from the more dental related procedures - wisdom teeth, orthognathic surgery, implants, bone grafts, etc... Some are able to find a niche doing a lot of trauma and reconstructive surgery, while others do a fellowship in plastics and focus on cosmetic procedures, but this is not the norm.

It's a long road. Dental school, last two yrs. of med school (optional), and four yrs. of residency. And the spots are VERY difficult to get. Generally only around the top 5-10 of the dental class would even have a chance matching into this residency. If you are not interested in dentistry, OMFS is probably not for you.

 

[Winged Scapula]

Regarding Trauma call...

depends on the hospital. At ours, "Face call" is split between ENT and Plastics. The Trauma team (Gen Surg) responds first and determines whether a face specialist is needed; other hospitals use ER teams as the primary Trauma response.

Anyway, moving to General Residency Issues...

 

[eddieberetta]

Supernumerary,

I didn't mean to step on any toes. I don't think what you said is that different from what I originally posted.

Originally posted by Supernumerary
While OMFS are qualified to do reconstructions and trauma surgery, their bread and butter comes from the more dental related procedures - wisdom teeth, orthognathic surgery, implants, bone grafts, etc... Some are able to find a niche doing a lot of trauma and reconstructive surgery, while others do a fellowship in plastics and focus on cosmetic procedures, but this is not the norm.

I stand by what I said -- dental -focussed oral surgery. And this is exactly what I saw during several electives in ENT and in discussions with OMFS residents rotating with us. I have to disagree about cancer surgery. I have sometimes seen OMFS patients come in with the biopsy already done, but when the diagnosis is a malignant pathology, they generally refer to ENT.

I have not seen many (any) OMFS specializing in oncology or trauma, but perhaps they exist (in the UK perhaps?).

Thanks for the clarification KC. I meant after the trauma team leader had decided who needed to be called, it is usually PRS but as you say, in some places it is ENT.

 

[mary]

The OMFS service at our hospital (small, community based) does most of the emergent trauma and also cleft lip/palate surgeries. If nothing else, they stabilize patients along with the trauma surgeon and then PRS or ENT sees them later, if necessary. This is mostly because we have OMFS residents to abuse, while there is no ENT or PRS residency (unfortunately).

 

[LaCirujana]

Re. facial trauma--

At our hospital, facial trauma call is split among OMFS, plastics, and ENT. I think this may be somewhat unusual, however. Our OMFS program is very strong and is heavily integrated with the medical school and the sugery department. As is the case at Kimberli Cox's program, general surgery responds to all traumas first and then determines which additional specialists (ortho trauma, neurosurg, urology, etc.) are needed.

(BTW, we are a large, well-known tertiary care center.)

 

[Stanford Fencer]

I have not seen many (any) OMFS specializing in oncology or trauma, but perhaps they exist (in the UK perhaps?).


Don't need to go that far. My professor does a lot of oral cancer cases, and does his own neck dissection. These OMFS do exist. We're at SF 😎

 

[eddieberetta]

okay everyone, I stand corrected. My experience must have been tainted by the fact that our university has a very large and powerful ENT division, and our oral surgeons focus more on the dental procedures. I did not realize that many oral surgeons also do trauma, head and neck oncology and facial plastics/reconstruction. Cool. Any breast implant fellowships available for OMFS? 😛

Cheers

 

[droliver]

Eddie,

I don't think a large Oncology practice would be very common for many oral surgeons. They make their living thru office-based procedures & for the most part everything else is a money loser for them (think volume,volume,volume). There are as I understand some pockets where OMFS do some advanced cranial-facial surgery, but again this appears to be a rare exception. Most if not all the major craniofacial programs in the country are PRS staffed (of whom they may have varied backgrounds in gerneral surgery, ENT, or OMFS prior). They do a signifigant amount of facial fractures during their training, but I don't think that is common afterwards by choice.

The dabbling in cosmetic surgery is not that surprising as that can be a very lucrative area. By and large I don't know that the quality of their training is very good for that when they haven't done more advanced training (a la doing a PRS fellowship which they can apply for after several years of surgical training prior)