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ENT/Facial Plastic Surgery

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Idiopathic

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Does anyone know if this is a typical way to describe an 'ordinary' ENT residency program? I have seen a couple with this name and wonder if there is anything that sets it apart (i.e. extra training/different training). Any help from current or future ENT's would be appreciated.
 

nuclearrabbit77

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http://www.mdmatch.org/otofellowships.htm
from otomatch.com

1. Facial Plastics / Reconstructive Surgery

The surgical subspecialty of cosmetic and reconstructive facial plastic surgery has naturally evolved to become a major part of otolaryngology. This is simply because all of the surgical skills acquired during residency training involve operating safely and efficiently on the face and head and neck. Since the majority of facial plastics procedures are elective, avoiding complications and maintaining function while achieving optimal cosmetic outcomes are crucial. Aside from focused training in facial plastics during residency, cases in the other areas of otolaryngology provide additional, concentrated surgical experience in and around the anatomy of the face, especially with regards to preserving the facial nerve and its branches, and assessing and restoring nasal function.Although a significant proportion of training includes facial plastics, the vast majority of otolaryngologists and other surgeons who practice predominantly facial plastics complete fellowship training in either facial plastics or general plastic surgery (if interested in cosmetic and reconstructive surgery of the entire body).

Facial plastics ? reconstructive surgery is a very popular fellowship among graduating residents. The fellowship is typically one year in duration and provides focused surgical training in cosmetic facial surgery (including septorhinoplasty, otoplasty, rhytidectomy (facelifts), browlift, blepharoplasty, botox injections, implants, facial peels and dermabrasion, hair transplants), reconstructive surgery (including Mohs defect reconstruction, microtia repair/auricular reconstruction, scar revision, repair of facial fractures, cleft lip/palate repair, and pedicled and free-tissue transfer and microvascular anastamoses head and neck defects following oncologic resection), and rehabilitative surgery for facial nerve paralysis (free graft and nerve transfers, facial slings, upper lid gold weight placement).

Fellowships are offered through the American Academy of Facial Plastics and Reconstructive Surgery ( www.aafprs.org ) via the San Francisco Match program, and one must be a resident member of this Academy prior to applying for fellowship. Information about the fellowships offered can be found at www.sfmatch.org, and applications are due usually in February of the PGY-4 year.

Prior to applying for fellowship in Facial Plastics and Reconstructive Surgery, one should determine whether to pursue an academic or private practice position and whether one wants to focus on reconstruction (especially microvascular techniques) and/or cosmetic surgery. Certification in this subspecialty requires successful completion of a clinical facial plastics fellowship followed by passage of the rigorous written and oral facial plastics ? reconstructive surgical board examinations.
 

LuckyMD2b

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Thanks for the info.:)

Do you think there is much of an overlap between general plastics and head and neck surgery w/ facial plastics fellowship? Does going the ENT route provide any additional training that you may not recieve in platic/reconstructive? Do plastic/reconstructive residencies prepare thier grads for head and neck tumor surgery?

:rolleyes:Also I've got a dumb question too: Is their a big lifestyle difference between general ENT and general plastics?
 

Leforte

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If you are interested in H&N cancer and reconstruction, you may consider an ENT residency and a 1 year H&N fellowship. Many of these focus on the microvascular techniques involved in free-flap transfer as well as extirpating the tumor. Many ENT departments do their own reconstructions, either 1 surgeon doing the removal and reconstruction (very long) or a team of 2 H&N surgeons, 1 removing the tumor and the other freeing up the flap and then reconstructing.

Many ENT facial plastic fellowships have the fellow mainly observing, although a few have the fellow operate significantly.

If I were interested in ENT/facial plastics - I would ask myself the questions asked previously.

1) Am I interested in solely facial cosmetics? Then do a facial plastics felowship.

2) Am I interested in reconstruction? ENT/H&N fellowship or ENT/Gen Plastics fellowship - I guess this would depend on what else I wanted to do and if I have significant exposure in residency to major H&N surgeries.

3) Do I want to specialize in H&N cancer? ENT/H&N fellowship.

From what I have observed - many ENT/Gen Plastics trained surgeons seem to migrate over to Plastics. Craniofacial as a further fellowship is also an option.

There are several ENT residencies that offer a decent amount of facial plastics in their training. Ohio State, UC Davis, Alabama do their own clefts, for example. The question with this is, however, would you be able to compete with a fellowship trained surgeon. I would venture to guess that in most instances it would be very difficult to do so.

I was struggling whether to go ENT or integrated plastics, too. I really liked both. I chose ENT as I really like the removal of the tumor, and can decide later if I want to focus on H&N cancer, cosmetics or even go with a dozen other fields, ie Otology, Laryngology, Rhinology, etc....

As a student, I think I focus on the cool aspect of surgery - and H&N surgeries are very cool. But at the same time, I also notice that of the fellowships, H&N seems to be less competitive than the others - in part I suppose to declining remuneration and long hours inherent in H&N patients.

I'll start my internship/ENT residency in a few months and will know more about my interests in a few years.
 

droliver

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Originally posted by LuckyMD2b
Do you think there is much of an overlap between general plastics and head and neck surgery w/ facial plastics fellowship?

In point of fact: There is no such field as general plastic surgery & trying to create a distinction b/w "general" & "facial" Plastic Surgery is a political move by the AAFPRS. There is Plastic Surgery & there are ENT's that do cosmetic surgery (in addition to Dermatologists, General Surgeons, OBGYN, Dentists, Opthamolgists, etc...)
 

neutropeniaboy

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Originally posted by droliver
In point of fact: There is no such field as general plastic surgery & trying to create a distinction b/w "general" & "facial" Plastic Surgery is a political move by the AAFPRS. There is Plastic Surgery & there are ENT's that do cosmetic surgery (in addition to Dermatologists, General Surgeons, OBGYN, Dentists, Opthamolgists, etc...)

While I disagree with the lumping of ENT physicians who have completed a facial plastics fellowship with Dermatologists, General surgeons, OBGYNs, and dentists who do plastic surgery, my thoughts are that if you want to do ENT and plastic surgery, do the general plastics fellowship after your ENT residency. If you solely want to do nose jobs and face lifts, just do the GS/plastics route.

But, please, don't liken ENT/plastics surgeons with the others, who do no real fellowship training.
 

neutropeniaboy

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Originally posted by Leforte
As a student, I think I focus on the cool aspect of surgery - and H&N surgeries are very cool. But at the same time, I also notice that of the fellowships, H&N seems to be less competitive than the others - in part I suppose to declining remuneration and long hours inherent in H&N patients.

I'll start my internship/ENT residency in a few months and will know more about my interests in a few years.

Head and neck, while still in great need, is a dying subspecialty. More and more patients are opting for chemoradiation, and many Phase III trials are showing that surgery is no more effective than chemo/rads for many head and neck cancer.

Personally, I'd rather not stand on my feet and whack out a huge mass for hours on end (only after working up a patient for weeks, getting all the dental, med-onc, rad-onc, and cardiology work-ups completed) and watch the patient in the ICU then floor for a week, and follow that patient for 5 years trying to convince yourself that there's a cancer hidden in there somewhere.

Who needs that jazz?
 

droliver

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Originally posted by neutropeniaboy
But, please, don't liken ENT/plastics surgeons with the others, who do no real fellowship training.

I don't mean to imply an equality of training or skill level (or lack therof), thats just a laundry list of some of the other practicioners performing cosmetic surgery. The separation in my mind I was communicating is the difference b/w shared techniques (in this case cosmetic surgery) versus a discipline in and of itself (Plastic Surgery)
 

omsres

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Originally posted by neutropeniaboy
While I disagree with the lumping of ENT physicians who have completed a facial plastics fellowship with Dermatologists, General surgeons, OBGYNs, and dentists who do plastic surgery, my thoughts are that if you want to do ENT and plastic surgery, do the general plastics fellowship after your ENT residency. If you solely want to do nose jobs and face lifts, just do the GS/plastics route.

But, please, don't liken ENT/plastics surgeons with the others, who do no real fellowship training.

Before you feel too good about yourself, you might want to consider dual degree oral and maxillofacial surgeons who are just as eligible for 1 year accredited cosmetics, H/N cancer, reconstructive surgery fellowships. No offense to you, I just see too many egotistical comments on these forums when there reallly is no reason for it.
 

bigmuny

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Originally posted by Idiopathic
Does anyone know if this is a typical way to describe an 'ordinary' ENT residency program? I have seen a couple with this name and wonder if there is anything that sets it apart (i.e. extra training/different training). Any help from current or future ENT's would be appreciated.

This is what all DO ENT residencies are called, and no I don't think the training is much/any different. I don't know why they are called that, maybe trying to assert our "distintiveness," we have a fetish for being different, often at the expense of logic.
 

goobernaculum

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Head and neck, while still in great need, is a dying subspecialty

if H&N is a dying field why is it still such an attractive field to many ENT residents? isn't resection FOLLOWED by chemo/rads more of an effective means of treatment than either one alone (unless, of course, the tumor is very small)? i'm just a dumb ms1 but that's what we learned in our short onco block. i'd be interested in any input on this.
 

droliver

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I think he was communicating a global change of interest in ENT surgeons for those large oncologic operations. Has to do with a lot of reasons but mostly

1-better neoadjuvant treatments which have an increasing role
2-a lot of involved post-op care on morbid patients
3-shrinking reimbursements which is prob. the largest barrier to many people doing them (like every other specialty is going thru)
 

neutropeniaboy

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Originally posted by goobernaculum
if H&N is a dying field why is it still such an attractive field to many ENT residents? isn't resection FOLLOWED by chemo/rads more of an effective means of treatment than either one alone (unless, of course, the tumor is very small)? i'm just a dumb ms1 but that's what we learned in our short onco block. i'd be interested in any input on this.

Many head and neck cancers are treated with chemo/rads alone, while others are now being shown to have no better outcomes when treated by chemo/XRT alone vs. surgery; still others are never treated with surgery. Many more patients these days when presented with the facts are opting for chemo/XRT.

Head and neck is attractive to so many ENT residents because the surgeries, while long and painful, can be quite cool. And in the end, you generally do some surgeries that most people find unbelievable.
 

neutropeniaboy

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Originally posted by omsres
Before you feel too good about yourself, you might want to consider dual degree oral and maxillofacial surgeons who are just as eligible for 1 year accredited cosmetics, H/N cancer, reconstructive surgery fellowships. No offense to you, I just see too many egotistical comments on these forums when there reallly is no reason for it.

Well, I clearly believe that GS/PRS is the better way to go if you want to do cosmetics. If you want to do OMFS/PS or ENT/PS that's O.K. I just feel that in general the latter two aren't as good as the GS/PRS docs. I wouldn't call that egotistical, especially when I'm an ENT resident.

As far as OMFS and H&N cancer goes, I've seen some pretty savvy OMFS guys who do H&N cancer, but they don't touch as many areas as ENT H&N guys do. Having said that, if I had an intraoral cancer, espcially one that involved the mandible, I'd probably give an OMFS H&N surgeon a call.
 

omsres

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I will say that treatment of head and neck cancer especially those requiring neck dissection and extensive recontruction by oral surgeions is pretty much limited to institutional settings. It's simply not done in private practice mainly because 1)hospital privilages 2)lost income and 3)no residents to round on your patients for you.

Saying this, my view of OMFS programs is quite skewed. At my residency both faculty have done fellowships in H/N cancer, microvascular reconstruction and craniofacial reconstruction. Needless to say we are very broad scoped for our specialty. Your right though, most programs, especially those single degree ones will voluntarily limit their practice to dentoalveor, oral implants, H/N trauma, oral pathology, and corrective orthognathic surgery.

All ENT's and PRS's don't worry. There are not enough expanded scope OMFS's out there to make a dent in the # of cases out there. Why would they if they can do 10 sets of wizzies a day for $1500 a pop.

My whole point is OMFS's can and are trained to do it. In my opinion, I do think that ENT's and PRS's are awesome surgeons and among the best in the medical field.
 
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