ENT/plastics as an alternative to OMFS? Advice needed to decide between dental and med school

[deleted1106656]

a

---

Members don't see this ad.

 

[Banco]

There is a lot of potential overlap in these fields. At your stage what you should be thinking is, if you fail to make it in this competitive surgical path, what sounds more appealing to you?

1) General Dentistry

or

2) Primary Care Medicine

 

[operaman]

You’ve got a number of fundamental misconceptions about the fields so it’s hard to give much advice. The bottleneck is going to be ENT residency or OMFS residency. Both are highly competitive fields and match rates will likely continue to fall by the time you get there.

Sleep fellowships after ENT are not competitive at all. There’s a huge demand for sleep surgeons right now but not much interest and not much incentive financially to do it. You can actually practice sleep surgery even without the fellowship - I thought about it since I did a good bit in residency but I don’t want to become “the sleep guy” and get overwhelmed with those referrals.

Honestly I would aim for Med school because there are multiple paths to a sleep practice. There are even non surgical options for sleep medicine via internal medicine/Pulm. You wouldn’t been doing big craniofacial whacks but you’d still be taking care of sleep patients if that’s your goal.

 

[VA Hopeful Dr]

You’ve got a number of fundamental misconceptions about the fields so it’s hard to give much advice. The bottleneck is going to be ENT residency or OMFS residency. Both are highly competitive fields and match rates will likely continue to fall by the time you get there.

Sleep fellowships after ENT are not competitive at all. There’s a huge demand for sleep surgeons right now but not much interest and not much incentive financially to do it. You can actually practice sleep surgery even without the fellowship - I thought about it since I did a good bit in residency but I don’t want to become “the sleep guy” and get overwhelmed with those referrals.

Honestly I would aim for Med school because there are multiple paths to a sleep practice. There are even non surgical options for sleep medicine via internal medicine/Pulm. You wouldn’t been doing big craniofacial whacks but you’d still be taking care of sleep patients if that’s your goal.

Non surgical sleep fellowships can be done after several specialties (including the largest and easiest to get into): FM, IM, anesthesia, psych, neuro, and peds.

Is surgery for OSA still done routinely? I haven't seen it much since I finished residency in 2013 (and it wasn't exactly in vogue then from what I recall), but I'll readily admit to not keeping up with everything ENT does.

 

[operaman]

Non surgical sleep fellowships can be done after several specialties (including the largest and easiest to get into): FM, IM, anesthesia, psych, neuro, and peds.

Is surgery for OSA still done routinely? I haven't seen it much since I finished residency in 2013 (and it wasn't exactly in vogue then from what I recall), but I'll readily admit to not keeping up with everything ENT does.

Oh yeah definitely. Probably the most common is adentonsillectomy for pediatric OSA. In adults CPAP is still the gold standard. Sinonasal surgeries can be a big help in lower pressures and improving cpap tolerance so those get done quite a bit. The hypoglossal nerve stimulators are pretty amazing for patients that meet criteria. The bigger orthognathic procedures seem to be less common just because those are pretty big painful whacks but they work extremely well for the right patient. And of course there’s always a trach though patients always seem a wee bit reluctant to have a tube in their throat.

 

[Dave1980]

I realize that as an undergrad this is far too early to be thinking about fellowships and residencies a decade or two into the future, but in my case it matters a lot because it determines whether I should be doing ECs and preparation related to dental school or med school. The goal is sleep medicine, preferably OSA surgery, which is over time shifting heavily away from soft-tissue surgeries in favor of far more successful and better treatments like maxillary expansion and jaw surgery, which obviously would be done by oral surgeons. So right now, I'm trying to figure out if dental school or med school would be best at giving me a decent chance at making it into something that could treat OSA/do orthognathics without screwing me over if I can't get into these highly competitive residencies.

my questions are -

1) How competitive is ENT/plastics and craniofacial surgery fellowships compared to oral surgery?
2) If I went to dental school and failed to match into OMFS, then went to med school and finished residency, would I be able to do OMFS residency after, and would med school + a residency impact my chances at all?
3) If I were to do ENT/plastics then a craniofacial surgery fellowship and sleep medicine fellowship, would I be able to do orthognathic surgery (which would include TMJ surgery as well) through treating OSA

As far as I can tell, the current options are as follow:

-dental school -> oral surgery -> short otolaryngology residency
-med school -> ENT -> dental school -> oral surgery
? dental school -> fail -> med school -> specialty that lets me do sleep medicine, or possible acceptance to OMFS residency
? med school -> ENT/plastics -> craniofacial -> sleep medicine

I wouldn't want to be a general dentist, so if I were to fail to match into oral surgery (which, given how competitive it is, seems pretty likely) I'd be screwed and might have to go to med school and end up practicing in my late 30s minimum. Alternatively, if I went to med school and matched into otolaryngology, and decided to go to dental school for oral surgery, I'd be a literal 40 year old. But, if I don't do so well, I'd still have a huge variety of other options open, which I take it wouldn't be the case with dental school.

If anyone has advice/can answer the above questions that would be very helpful and appreciated.

go to med school.you will have way more options

 

[Davidfromcali]

Defiantly do not go to dental school unless youre ok with being a general dentist.

 

[operaman]

Ok but if I were to make it into ENT and a craniofacial surgery fellowship, would that open me up to being able to practice the full scope of sleep surgery including maxillary expansion and maxillomandibular advancement, or would you have to be an OMFS for that

You wouldn’t do a craniofacial fellowship most likely. You would do a sleep fellowship with someone who does a lot of those.

 

[operaman]

But a sleep fellowship wouldn't let an ENT be able to do orthognathics, my question is if doing a craniofacial fellowship would, or if you would have to be an OMFS for that

Well I know ENTs who are sleep trained who do those procedures so clearly they got enough experience to make it happen. Craniofacial is a separate deal from sleep so seems like it would be a waste of time.

 

[operaman]

Is that a thing? The only ENTs I know of who did MMA were Riley and Powell, and I was under the assumption that these days it's done almost exclusively by oral surgeons. The reason I ask about finding a path to orthognathics through med school is because that's what I'm mainly interested in, and had seen a FFS do MMA, and had also seen that practically all craniofacial fellows are trained in orthognathics and distraction osteogenesis, so I wanted to see if that's an option to essentially do most of what an OMFS could do without risking going to dental school.

Yeah I know a number who do it. I know that there’s a guy at Stanford who does them and then Penn has a sleep guy who also does them. One of my attendings had done them in fellowship and was credentialed for them but I never saw him do one. They’re definitely cool surgeries - I’ve heard them called the 69 procedure, as in turning sixes into nines. It is amazing how much better most people look post op! Conceptually I don’t think they’re that challenging to learn given what you’ll do in a good ent program. You can get a lot of CF work in peds ENT and your trauma experience teaches you all the approaches to the facial skeleton and how to do MMF. Really it’s just the nuances of the osteotomies and patient selection and whatnot, but i think any well trained ent could learn to do MMA. If you did a residency somewhere that does those cases a lot you might not even need a fellowship unless you want to practice in a very saturated area or want a broader training in sleep medicine/surgery overall.

 

[operaman]

I know who you're talking about at Stanford, he's an OMFS that did an otolaryngology residency after and was mentored by Riley iirc.

So what you're saying is that an ENT can pretty much practice oral surgery if they want to, like maxillary expansion and MMA? To me it just feels weird aspiring to become an ENT with the goal of primarily doing what is almost always done by oral surgeons, and rarely considered something ENTs deal with. Also it doesn't sound like it'd be very easy to establish yourself as an orthognathics person

Yeah that’s an excellent point. It’s a lot of training focused on the rest of ENT where MMA and the like are a relatively small aspect of what you do. There are probably more similar procedure in OMFS so you’d theoretically find them somewhat as interesting.

Yeah there’s definitely a lot of overlap in ent and OMFS in this particular area. I think some of the key differences are we don’t mess with the teeth other than to pull them or use them for MMF. We also tend to shy away from the TMJ. Otherwise there’s definitely a lot of shared territory. What people actually do is largely driven more by the institutional sand box and local referral patterns. If you’re an ENT wanting to do MMA, you’ll have a hard time somewhere that OMFS is well established doing those, but if you start somewhere without them you would be the only game in town and might have an easier time getting those patients.

 

[FindersFee5]

I know who you're talking about at Stanford, he's an OMFS that did an otolaryngology residency after and was mentored by Riley iirc.

So what you're saying is that an ENT can pretty much practice oral surgery if they want to, like maxillary expansion and MMA? To me it just feels weird aspiring to become an ENT with the goal of primarily doing what is almost always done by oral surgeons, and rarely considered something ENTs deal with. Also it doesn't sound like it'd be very easy to establish yourself as an orthognathics person

I think if you're primarily interested in boney work, plastics -> craniofacial fellowship is probably your best bet from the med school pathway. The craniofacial surgeon I work with does a lot of LeFort distractions and a reasonable number of mandibular distractions, and he's very comfortable with all the skeletal anatomy in the face. He leaves anything to do with the condyle to his OMFS partner though.

 

[Wordead]

I realize that as an undergrad this is far too early to be thinking about fellowships and residencies a decade or two into the future, but in my case it matters a lot because it determines whether I should be doing ECs and preparation related to dental school or med school. The goal is sleep medicine, preferably OSA surgery, which is over time shifting heavily away from soft-tissue surgeries in favor of far more successful and better treatments like maxillary expansion and jaw surgery, which obviously would be done by oral surgeons. So right now, I'm trying to figure out if dental school or med school would be best at giving me a decent chance at making it into something that could treat OSA/do orthognathics without screwing me over if I can't get into these highly competitive residencies.

my questions are -

1) How competitive is ENT/plastics and craniofacial surgery fellowships compared to oral surgery?
2) If I went to dental school and failed to match into OMFS, then went to med school and finished residency, would I be able to do OMFS residency after, and would med school + a residency impact my chances at all?
3) If I were to do ENT/plastics then a craniofacial surgery fellowship and sleep medicine fellowship, would I be able to do orthognathic surgery (which would include TMJ surgery as well) through treating OSA

As far as I can tell, the current options are as follow:

-dental school -> oral surgery -> short otolaryngology residency
-med school -> ENT -> dental school -> oral surgery
? dental school -> fail -> med school -> specialty that lets me do sleep medicine, or possible acceptance to OMFS residency
? med school -> ENT/plastics -> craniofacial -> sleep medicine

I wouldn't want to be a general dentist, so if I were to fail to match into oral surgery (which, given how competitive it is, seems pretty likely) I'd be screwed and might have to go to med school and end up practicing in my late 30s minimum. Alternatively, if I went to med school and matched into otolaryngology, and decided to go to dental school for oral surgery, I'd be a literal 40 year old. But, if I don't do so well, I'd still have a huge variety of other options open, which I take it wouldn't be the case with dental school.

If anyone has advice/can answer the above questions that would be very helpful and appreciated.

Not sure whos telling you that MMA is the future of sleep surgery but really doesnt seem correct. Between our 4 sleep medicine guys and our sleep surgeons maybe 1 or 2 gets referred for it. Maybe practice patterns vary widely but Id be surprised.

That said you seem to want to do bony work mostly so you should do plastics or omfs.

 

[catnip12]

The people telling me includes one of the greatest sleep surgeons of all time who developed the second most effective procedure after MMA, and worked closely throughout his career with the father of sleep medicine who helped discover OSA, discovered UARS, and completely carried the field with his 800 published papers. And, endless examples in the literature showing incredible reductions in AHI - in some cases with big movements an 80% cure rate & 100% success rate in severe OSA, compared to piling on useless soft-tissue surgeries that aren't even remotely comparable and are pathetically ineffective in adults. That said, I didn't say/wouldn't know if MMA was the future of sleep surgery. If anything, the trend is toward EASE or MSE, which reduce AHI by ~65%, are barely surgical + no le fort cut, and expand the entire nasal cavity on a completely parallel and skeletal level.

As for 'doing bony work', I'm more worried about if there's a path through med school to regularly do the skeletal surgeries that oral surgeons do like orthognathics, which is why I was asking about craniofacial fellowships - so I can avoid taking a gamble with dental school, since if there is a path that exists through med school, I'd choose med school in a heartbeat knowing if I fail to make surgery I'd still be happy as a neurologist or something with a sleep fellowship.

You sound like you have all the resources you need to make an informed decision. Unfortunately, no one here can predict the future of anything with the sort of precision you are seeking, especially in today's world. The best advice would be to reach out to your sleep surgeon contact and ask whether they could connect you with some of the oral surgeons they know. If they are ENT, they will know some oral surgeons. Then make a decision between Dental School and Medical school. The rest of it will come with time and experience.

 

[FindersFee5]

The people telling me includes one of the greatest sleep surgeons of all time who developed the second most effective procedure after MMA, and worked closely throughout his career with the father of sleep medicine who helped discover OSA, discovered UARS, and completely carried the field with his 800 published papers. And, endless examples in the literature showing incredible reductions in AHI - in some cases with big movements an 80% cure rate & 100% success rate in severe OSA, compared to piling on useless soft-tissue surgeries that aren't even remotely comparable and are pathetically ineffective in adults. That said, I didn't say/wouldn't know if MMA was the future of sleep surgery. If anything, the trend is toward EASE or MSE, which reduce AHI by ~65%, are barely surgical + no le fort cut, and expand the entire nasal cavity on a completely parallel and skeletal level.

As for 'doing bony work', I'm more worried about if there's a path through med school to regularly do the skeletal surgeries that oral surgeons do like orthognathics, which is why I was asking about craniofacial fellowships - so I can avoid taking a gamble with dental school, since if there is a path that exists through med school, I'd choose med school in a heartbeat knowing if I fail to make surgery I'd still be happy as a neurologist or something with a sleep fellowship.

The one other thing I would add is that plastics/ENT are probably more competitive and difficult to get into than OMFS, which may factor in your decision as well. If you are totally opposed to being a general dentist though, med school probably is the right choice.

 

[Wordead]

The people telling me includes one of the greatest sleep surgeons of all time who developed the second most effective procedure after MMA, and worked closely throughout his career with the father of sleep medicine who helped discover OSA, discovered UARS, and completely carried the field with his 800 published papers. And, endless examples in the literature showing incredible reductions in AHI - in some cases with big movements an 80% cure rate & 100% success rate in severe OSA, compared to piling on useless soft-tissue surgeries that aren't even remotely comparable and are pathetically ineffective in adults. That said, I didn't say/wouldn't know if MMA was the future of sleep surgery. If anything, the trend is toward EASE or MSE, which reduce AHI by ~65%, are barely surgical + no le fort cut, and expand the entire nasal cavity on a completely parallel and skeletal level.

As for 'doing bony work', I'm more worried about if there's a path through med school to regularly do the skeletal surgeries that oral surgeons do like orthognathics, which is why I was asking about craniofacial fellowships - so I can avoid taking a gamble with dental school, since if there is a path that exists through med school, I'd choose med school in a heartbeat knowing if I fail to make surgery I'd still be happy as a neurologist or something with a sleep fellowship.

You seem to be pretty set in your thoughts so I'm not going to try and bother and change your mind and hero-worship of this guy. Im just telling you that we refer very few people for jaw surgery. I dont know why there is no mention of hypoglossal nerve stim in all your posts which is where things seem to be trending which is why I wonder at your source. Yes, pharyngeal soft tissue surgery has a lot of limitations and that's not where the future is.

If you want to do orthognathics OMFS is a better path. Not all craniofacial fellowships via plastics do them and OMFS just generally is better at it.

 

[dabears505]

I want to give you good advice. This is just dumb on so many levels. I'm not sure who told you that vast amounts of surgeries are being performed for osa. I work at a very busy hospital and our ent docs rarely do adult osa surgery. They do a fair bit of tonsils and adenoids on obese kids.

Do not make crazy plans like going to dental school, accumulating a ton of debt, then if you don't get into surgery to go to medical school and accumulate even more debt, and lose years of your life.

Please just be smart and decide if you would rather be a doctor or dentist, and plan accordingly. Everyone thinks they are a hot shot in undergrad. Once you get to med school, it's not easy getting into ENT. All those kids were hotshots. The chance of matching is low.

I'm not trying to be mean, but realize crazy things like doing medical school ND dental school will quite possibly set you into 400k+ of debt while going into a field which really does not exist. Do more research about osa treatments.

 

[PerioDont]

OMFS is a whole lot easier to get into. Doesn't even come close. DrBfixin on IG is OMFS and does plastic surgery all day long.
For ENT you'll need tons of research, high rank and high stats in addition to connections. For OMFS just have a decent class rank, 70% CBSE (equivalent to 210 on step) and you're golden

Maybe its easier...but it's definitely not easy.

I agree with the other posters. Don't go to dental school unless you are wanting to be a dentist.

 

[PerioDont]

I realize that as an undergrad this is far too early to be thinking about fellowships and residencies a decade or two into the future, but in my case it matters a lot because it determines whether I should be doing ECs and preparation related to dental school or med school. The goal is sleep medicine, preferably OSA surgery, which is over time shifting heavily away from soft-tissue surgeries in favor of far more successful and better treatments like maxillary expansion and jaw surgery, which obviously would be done by oral surgeons. So right now, I'm trying to figure out if dental school or med school would be best at giving me a decent chance at making it into something that could treat OSA/do orthognathics without screwing me over if I can't get into these highly competitive residencies.

my questions are -

1) How competitive is ENT/plastics and craniofacial surgery fellowships compared to oral surgery?
2) If I went to dental school and failed to match into OMFS, then went to med school and finished residency, would I be able to do OMFS residency after, and would med school + a residency impact my chances at all?
3) If I were to do ENT/plastics then a craniofacial surgery fellowship and sleep medicine fellowship, would I be able to do orthognathic surgery (which would include TMJ surgery as well) through treating OSA

As far as I can tell, the current options are as follow:

-dental school -> oral surgery -> short otolaryngology residency This isn't a thing.
-med school -> ENT -> dental school -> oral surgery This would make little sense but is theoretically possible. Just would take 2 decades.
? dental school -> fail -> med school -> specialty that lets me do sleep medicine, or possible acceptance to OMFS residency. Failing dental school will not allow you to match OMFS.
? med school -> ENT/plastics -> craniofacial -> sleep medicine

I wouldn't want to be a general dentist, so if I were to fail to match into oral surgery (which, given how competitive it is, seems pretty likely) I'd be screwed and might have to go to med school and end up practicing in my late 30s minimum. Alternatively, if I went to med school and matched into otolaryngology, and decided to go to dental school for oral surgery, I'd be a literal 40 year old. But, if I don't do so well, I'd still have a huge variety of other options open, which I take it wouldn't be the case with dental school.

If anyone has advice/can answer the above questions that would be very helpful and appreciated.

If you are interested in dentistry, the way it works for OMFS is this: dental school, and then assuming you did well, you can apply for a 6 year combined medical school and oral surgery residency. You can then be a DMD, MD oral surgeon and do OSA/jaw surgery.

My real question though is how do you know you specifically just want to do those surgeries. Medicine and dentistry are both vastly enormous fields. Very likely your interest may change as you learn more. Have you shadowed other things?

 

[meowfish6868]

Ok but if I were to make it into ENT and a craniofacial surgery fellowship, would that open me up to being able to practice the full scope of sleep surgery including maxillary expansion and maxillomandibular advancement, or would you have to be an OMFS for that

Just did a cursory search, but it looks like craniofacial fellowships are for plastic surgery grads. If you are 120% deadset on doing orthognathic surgery, seems like OMFS would be your best bet. Would caution that there’s a decent chance your interests might change, so it might be worthwhile to avoid pigeon holing yourself and choose whichever general field is more interesting to you (medicine vs dentistry).

Would also keep in mind that each of the main surgical subspecialty residencies you’ve mentioned are all very competitive. In theory, you could do the procedures you’ve mentioned from any of the three if you get enough of those cases in your residency. In reality, there isn’t much of an opportunity for it in ENT as most of your bony work will be limited to facial trauma and mandibular distraction (varies significantly by program). In my anecdotal experience, OMFS residency would be best route for those procedures, which is only accessible via the dental school route.

 

[Aheadbyacentury]

oral surgeons dont need the hospital systems thus are not as well controlled by the system.
ENT surgeons tend to be pushed around more by the hospital.
The surgeries that oral surgeons do are more interesting to me..

 

[Masterus]

Some of the things mentioned in this thread are inaccurate. One, orthognathics surgery is almost exclusively done by oral surgeons because you need an orthodontist to help you align the teeth. Orthodontists pretty much only refer to oral surgeons.

craniofacial surgery is predominantly done by plastic surgeons and that is a pediatric population. Plastic surgeons do not generally do the orthognathics surgeries aside from something rare like a lefort 3. They are usually referred to the oral surgeon. You don’t do orthognathic surgery in most craniofacial fellowships. Like I mentioned earlier, you need a great understanding of occlusion and braces by the orthodontist.

Statistically, oral surgery is more difficult to get into than ENT. The match rate this last year was around 48% whereas ENT is 60-70. There’s fewer spots for oral surgery especially if you want the MD. There are only 100 spots a year in the entire country for the 6 year MD integrated oral surgery residency.