ENT vs Otolaryngology vs OMS Surgeons

[Yah-E]

Sounds to me that all three of these surgeons share quite a bit in their scope of practices such as head & neck plastic and reconstructive surgeries, remove cancer, and deal with trauma patients. Do hospitals use these 3 types of specialist interchangeably routinely for basic superficial trauma and H&N procedures?

Although a 4-year, non-M.D. OMS receives adequate training in surgery, we'll just use a 6-year, double degree OMS/MD for the sake of discussion.

Since I am aiming in the OMS/MD direction, I would like to inquire about my future counterpart colleagues in ENT and Otolarnygo? Will I be sharing some resposibilities and procedures with these specialists in the hospital?

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[ItsGavinC]

Excellent question--I too am looking for an answer to this.

 

[eddieberetta]

ENT is oto(ear)[rhino(nose)]laryngology(throat). Generally, they do not share responsibilities with OMFS in most north american hospitals. Occasionally they share trauma call but usually it is ENT/plastics for trauma. ENT tends to handle most head and neck cancer/oral cancer (and obviously ear nose and throat surgery) and OMF tends to focus on dental/jaw procedures. There used to be some interplay with sinus surgery but now FESS has become standard non-onc disease and I do not believe it is commonly done by OMF. There is sometimes collaboration when dental incisions must be made prior to or during the surgery. The MD part of the DDS/MD does not change the equation -- however I'm sure it is useful for OMF as they admit patients and must manage them in hospital.

 

[Yah-E]

During my externship with University of Minnesota, I saw some of the emergency trauma calls with OMS residents. I know for fact that an OMS commonly performs a bi-coronal flap to repair the medial socket wall, reconstructing of nasal bones such as the perpendicular plate, Le Fort I trhough III fractures from accidents, augment and/or reconstruct a zygomatic process, remove cancers of H&N (more commonly melanomas and SCC) and even pituitary cancers (stepping on some Neurosurgeon's domain). I've also seen OMS seminars where an OMS surgeon did a nerve graft from a branch of the CN V, reconstructing and restore facial muscle function, and creating an angle of the lip.

Of course the orthognathic, TMJ, cleft palate & lip, plastic and mandible reconstruction surgeries are in the domain of OMS practices.

I know that OMS does not get into the Otolaryngologist's practice of treating ear and throat diseases and all that audiology stuff, but I do believe that OMS performs quite a bit of surgical procedures in the same scope with the ENTs.

Since every OMS residency in the US has its own characteristics, the 6-year OMS/MD residencies tend to gain more various surgical exposures than a 4-year non-MD residency. Some OMS residencies are very heavy trauma emphasized while some learn more in anesthesiology.

Is there any current ENT surgeons or residents lurking around here to inform us of his/her experiences with this topic? Just FYI, I am sure you guy know this, but for a US hospital to be considered a "level one" trauma hospital, the hospital is required to have at least one OMS on staff for calls in the ER.

 

[eddieberetta]

Originally posted by Yah-E
During my externship with University of Minnesota, I saw some of the emergency trauma calls with OMS residents. I know for fact that an OMS commonly performs a bi-coronal flap to repair the medial socket wall, reconstructing of nasal bones such as the perpendicular plate, Le Fort I trhough III fractures from accidents, augment and/or reconstruct a zygomatic process, remove cancers of H&N (more commonly melanomas and SCC) and even pituitary cancers (stepping on some Neurosurgeon's domain).

Sorry, I don't believe that OMF "commonly" perform pituitary surgery -- In the case you are talking about they may have been scrubbed in on the case to help with some aspect of the trans-sphenoidal approach -- I have actually only ever seen ENTs do those surgeries with NS. However, I believe there is a lot of variation in the extent to which OMF enter onc/plastic surgery, depending on the institution and availability of ENT/plastics.

However, in the vast majority of cases, the focus of OMF is on dental/jaw procedures. Of course if you are interested there is room for you to develop skills in related surgical areas. There was a thread about this before, and people kept finding specific examples of a particular OMF who was doing this or that surgery -- but I am saying what the common division of labor is in hospitals.

If you want to be an expert in facial reconstruction, head and neck plastic and facial reanimation, you need to train in plastics (preferably) or else ENT+fellowship. If you want to be a head and neck surgical oncologist, you have to train in ENT (preferably) or sometimes gen/plastic +fellowship. If you want to perform advanced dental/jaw procedures you have to train in OMF. And if you want to operate on the pituitary or brain, better consider NS
(though some ENTS do pituitarys by themselves) 🙄

Cheers

 

[Yah-E]

The pituitary surgery, I should've typed on rare cases, but other surgeries I've listed are commonly performed by OMS. I appreciate your perspective insight on this matter Eddie, but I would like to hear from surgeons and/or surgery residents that are more experienced in this field.

 

[maxheadroom]

I know of a few places where ENT does cleft lip/palate instead or in conjunction with plastics, but I don't know of any OMFS who do clefts. Sounds like you've seen some OMFSs who do a broader than typical practice. Good for them, but I think you'll find that most OMFS practices are much more as previously posted. Jaw, dental stuff, TMJ, some maxillary work. Facial reanimation sounds like a long stretch.

 

[Yah-E]

Q: What kinds of procedures do oral and maxillofacial surgeons do?
A: Extraction of wisdom teeth, or third molars, is the most widely known oral and maxillofaciail surgical procedure. But OMSs do much more. Since the Civil War, OMSs have expanded their scope of practice to include surgery of the entire face. The knowledge and skills OMSs have developed, often during wars under battlefield conditions, have enabled them to become proficient in the management of bony and soft tissue reconstruction of the entire maxillofacial skeleton as well as management of severe maxillofacial trauma. Major areas of OMS expertise and practice include:

? Physical diagnosis, pathophysiology and clinical medicine. OMSs are fully trained in these areas so they can diagnose problems and develop treatment plans that take into account patients? specific maxillofacial needs as well as their overall physical condition.

? Anesthesia. OMSs are expert in all aspects of pain and anxiety control, including general anesthesia/deep sedation through out their four to six years of anesthesia training. Much of their training focuses on ambulatory anesthesia, preparing them for practice in office and other ambulatory settings. In addition, the OMS is trained in conscious sedation and local anesthetic techniques. All of these experiences must include appropriate patient monitoring modalities and certification in Advanced Cardiac Life Support (ACLS).

? Esthetic surgery. OMSs master both skeletal and soft tissue alterations of facial form, including but not limited to esthetic surgery such as rhinoplasty (nose), blepharoplasty (eyelids), lipectomy (fatty tissue removal or transplant), facial implants, otoplasty (ears), and scar revision.

? Cleft Lip/Palate and Craniofacial Surgery. OMS training includes cleft lip and palate surgery and correction of craniofacial deformities.

? Surgical procedures involving the tissues holding teeth in place, technically known as the dentoalveolar tissues. Procedures include management of dentoalveolar injuries, infections, and pathologic conditions and other hard and soft tissue surgery related to the alveolar structures. Diagnosis of oral disease and lesions, biopsy techniques, removal of erupted and impacted teeth, hard and soft tissue grafts, and preparation of the mouth for prostheses are significant areas of OMS expertise and practice.

? Dental and other facial implants. Reconstruction of the oral and maxillofacial region with implant devices designed to support prostheses is an important part of oral and maxillofacial surgery. OMSs have an in-depth understanding of the use of implants in a variety of clinical situations including replacement of some or all teeth, use of implants to reconstruct damaged facial bones, including the orbits of the eye, and even place implants to support prosthetic ears, noses and eyebrows.

? Microneurosurgery. OMS are trained in the diagnosis and treatment of individuals suffering from neurosensory and neuromotor deficits, including repair or revision of a damaged sensory nerves of the face.

? Jaw realignment, or orthognathic surgery. OMSs are fully trained in restoring proper jaw function by surgically realigning the jaws and surrounding facial bones.

? TMJ. The diagnosis and management of temporomandibular joint disorders are part of the OMS training, including evaluation of patients with TMD, as well as differential diagnosis of head, neck, and facial pain, non-surgical treatment options, and the surgical management of TMJ abnormalities. The comprehensive long-term management of the patient following surgery is an important aspect of the OMS?s training and practice.

? Trauma management and construction. Comprehensive management of trauma of the oral and maxillofacial region is an integral part of the OMS?s training. Learning principles of shock management, fluid and electrolyte balance, resuscitation, and surgical airway procurement and assessment management and treatment of maxillofacial and multiple systems trauma are required. The OMS must successfully complete an Advanced Trauma Life Support (ATLS) course. Trauma management includes, but is not limited to, surgical management of the airway, including performance of tracheostomies, treatment of fractures of the dentoalveolar, mandible, maxilla, zygoma, nose, orbit, naso-frontal-orbital-ethmoidal and midface region and repair of soft tissue of the head and neck region. The OMS is rained in the emergency department and during training must be available to the emergency services at all times.

? Tumor and cancer surgery. OMSs are expert in treating all types of cancerous and non cancerous tumors and lesions of the face and neck. Some OMS are trained in the management of malignant tumors of the head and neck and regional metastasis, head and neck ablative surgery, including the management of complications and parenteral/enteral nutritional support.

http://www.aaoms.org/residency/residency_template.asp?entity_id=25&content_type_id=73

 

[ItsGavinC]

Originally posted by maxheadroom
but I don't know of any OMFS who do clefts.

That *really* surprises me!

 

[Thewonderer]

Originally posted by Yah-E

? Anesthesia. OMSs are expert in all aspects of pain and anxiety control, including general anesthesia/deep sedation through out their four to six years of anesthesia training. Much of their training focuses on ambulatory anesthesia, preparing them for practice in office and other ambulatory settings. In addition, the OMS is trained in conscious sedation and local anesthetic techniques. All of these experiences must include appropriate patient monitoring modalities and certification in Advanced Cardiac Life Support (ACLS).

http://www.aaoms.org/residency/residency_template.asp?entity_id=25&content_type_id=73

AAOMS is a political organization and like all others, they have their own agenda.

That particular phrase on anesthesia surprises me. When did they get "anethesia" training of 4-6 years? Participating in a surgery counts as anesthesia training? I would imagine for general anesthesia, OMS still needs an anesthesiologist around to do that. That is such a dubious claim that I am suspicious of the rest of the progenda spewed out by AAOMS. I am sure that OMS are trained in "conscious sedation and local anesthetic techniques" but the rest of the paragraph just does not sound right.

I am sure that at the end of the day, it is the hospital that decides on who does what. If you want to do all these things, then you might want to go to U of Minnesota later on.

 

[Yah-E]

While I'm not in this thread to explain every little detail about what a OMS can do and can not do in their scope of practice, if you guys don't know it, then research more on your own if you wish.

I am here to seek experienced advices and opinions on the differences and similarities between ENTs and OMSs and perhaps also Otolaryngologists.

If you're a pre-med, 1st year med student, 2nd year med student, 3rd year med student, even a 4th year medical student, radiology resident, pediatric resident and/or any type of resident besides surgery, although I appreciate your inputs, but I rather hear from ENT, Gen. surgery and Oto surgeons and surgery residents.

If there's one thing I've noticed, is that over 90% of medical students and medical doctors really have no idea what an OMS can or can not do. I did not start this thread to explain, defend, debate, and/or educate about OMS to you guys. If you don't know about OMS, then don't type things and pretend that you know. If you've interacted with OMS because you're a current surgeon or surgery resident, the I'd love to hear from you.

Afterall, this thread is not "Let's list what OMS can't do!" Thanks for your cooperation.

 

[eddieberetta]

Originally posted by Yah-E
If you're a pre-med, 1st year med student, 2nd year med student, 3rd year med student, even a 4th year medical student, radiology resident, pediatric resident and/or any type of resident besides surgery, although I appreciate your inputs, but I rather hear from ENT, Gen. surgery and Oto surgeons and surgery residents.

If there's one thing I've notice, is that over 90% of medical students and medical doctors really have no idea what an OMS can or can not do. I did not start this thread to explain, defend, debate, and/or educate about OMS to you guys. If you don't know about OMS, then don't type things and pretend that you know. If you've interacted with OMS because you're a current surgeon or surgery resident, the I'd love to hear from you.

Even a dumb old radiology resident knows that an ENT is the same thing as an otolaryngologist.

One does not need to be a surgery resident or surgeon to have interacted extensively with these specialists and know their usual scope of practice.

Thanks for copying all that stuff off the internet. Why are you even asking the question if you have all the answers? I am sure that website is a totally unbiased view of what OMFs do in the community. 🙄 I guess we don't need anesthesiologists, ENTs, plastic surgeons, neurosurgeons, or critical care doctors -- the OMFs are fully trained to replace them and much much more...

 

[Yah-E]

Anyone else besides this radiology resident? 🙄

 

[canuckfan]

Sounds to me that all three of these surgeons share quite a bit in their scope of practices such as head & neck plastic and reconstructive surgeries, remove cancer, and deal with trauma patients. Do hospitals use these 3 types of specialist interchangeably routinely for basic superficial trauma and H&N procedures?

I, like eddieb (AB? from TO), am not an ENT resident, although I hope to be soon. I've worked with a couple OMFS residents who were on an ENT rotation along with me.

First off, as has been pointed out, ENT = Otolaryngology = Otorhinolaryngology. As far as what defines ENT vs OMFS, that is a bit more murky, as they obviously both operate in the same anatomical area. As a corollary to this, general surgeons, urologists, and gynecologists all spend time in the belly, but their procedure list, and surgical skills are different. A product of their training, and future practice goals. I think ENT and OFMS can be approached similarly.

ENT does breadth. Outpatient procedures like tubes and adenoids, and inpatient stuff like big head and neck resections and reconstruction. As the specialty name notes, you could be whacking out a thyroid one day, doing a septoplasty the next, and finishing off with a tympanoplasty the day after as a general otolaryngologist (ears, noses, and throats). Subspecialized ENT's can spend their time drilling into temporal bones for all sorts of reasons (cochlear implants, cholesteatomas, acoustic neuromas), doing facial cosmetic surgery, doing endoscopic sinus surgery, head and neck onc and recon, and all sorts of laryngological surgeries (lasers, implants).

ENT call will often get you in for facial trauma, peritonsillar abscesses, epistaxis, airway issues (trachs), and any complications on your inpatients.

From what I know of OMFS, their procedures do not overlap greatly with ENT (with most turf encroachment being on stuff like clefts, palates, facial cosmetic surgery). Most oral surgeons I've heard about spend their time happily in their own clinic yanking thirds all day, with perhaps some TMJ, maybe a few implants, maxillary advancements and osteotomies mixed in. I do not see them coming into the hospital except to cover facial trauma call; they certainly are not putting in trachs, packing nosebleeds, chopping out thyroids or big head and neck ca, and them doing pituitaries strikes me as being way off my own experience, limited though it is. If OMFS are doing head and neck cancers, I suspect it's mainly excisional biopsies of small intra-oral SCC's, or facial SCC's/BCC's, and not things like thyroids, parotids, neck dissections and all that stuff that ENT's do routinely.

Just a hunch, but OFMS seems pretty procedural-based. See a patient, get the Panorex, and pull the wizzies all in one visit. In ENT, while there are lots of procedures, there's also tons of medical management for things like GERD, sinusitis, allergies, acute and chronic ear disease.

If there is an overlap, I'd say it's in the facial trauma and cosmetic areas. Just my opinion.

 

[Yah-E]

Canuck:

Very informative, thanks for sharing!

 

[neutropeniaboy]

Here's my account of the extent of OMFS and ENT at our institution.

We have a rotating call schedule with respect to trauma. ENT, OMFS, and plastic surgery all rotate trauma call. This includes facial lacerations, auricular lacerations, mandibular fractures, facial fractures, orbital floor fractures (sometimes OMFS passes on this), and nasal bone fractures. Plastic surgery and OMFS do not handle temporal bone fractures, laryngeal fractures, or penetrating neck trauma.

Neck or facial abscesses of dental origin usually go to OMFS, unless there is a complicated airway issue.

There are dentists, DMD-MDs, and DDS-MDs on the OMFS team at our institution. There is a fellow too, I believe. The fellow handles head and neck cancer cases for the OMFS team, although they don't do H&N cancer as frequently as we do. The OMFS team will do neck dissections, but they typically call us if they have difficulty. OMFS does Phase II sleep apnea surgery (maxillary advancements). ENT and OMFS do mandibular osteotomies, genioplasties, and mortised genioplasties. OMFS does all extractions. OMFS does all alveoloplasties. They will do tracheotomies if they need to; difficult ones come to us. They typically do the infant mandibular fractures/facial fractures.

OMFS does not do transphenoidals, sinus surgery, free flaps, rotational flaps, laryngology, or ear surgery at our institution. They also do not do external approaches for orbital abscesses, periorbital abscesses, or external ethmoidectomies or Caldwell-Luc procedures. They don't do face lifts, rhinoplasties, blephs, rhinoseptoplasties, or otoplasties.

Specifically if I can address those points advertised on the AAOMS website:

OMFS certainly is not an expert in anesthesia or pain management (neither is ENT or plastics). I certainly don't debate the expertise of the anesthesiologist when there's disagreement about those issues. The only time I do is when it comes to protecting the airway -- beyond their generally poorly developed technique of fiberoptic intubation, anesthesia is pretty much useless when it comes to complicated intubation or emergent intubation.

OMFS doesn't do any plastics at our institution.

OMFS doesn't do any cleft lip/palate surgery. We do it rarley.

OMFS isn't any more reliable than any other surgical subspecialty with respect to ACLS or ATLS. If any medicine resident saw an OMFS resident running a code, they'd probably push them out of the way, and unless we were doing a slash trach or cric, they'd probably do the same to us.

We (ENT) try to avoid TMJ surgery. OMFS does that at our institution.

ENT deals with all epistaxis, parapharyngeal/retropharyngeal/peritonsillar abscesses. We do not deal with prevertebral abscesses (neurosurg). ENT and gen surg do thyroids, not OMFS. OMFS does not treat GERD (although it's rather simple to manage). OMFS doesn't do T&As, though that's probably not something they desire to do anyway...

Anyway, that's all I want to say now.

 

[ItsGavinC]

Great post. Thanks for your response.

 

[maxheadroom]

Good post, neutrapeniaboy.

Most of what you posted correlates with my experience (as a PRS resident).

Enjoying PGY-2 year?

 

[neutropeniaboy]

Originally posted by maxheadroom


Most of what you posted correlates with my experience (as a PRS resident).


PRS = plastic/reconstructive surgery??


Enjoying PGY-2 year?

Hell, yeah.

 

[maxheadroom]

Yes, PRS=Plastics.

As a PGY-1 in an integrated program, I get 2-3 months PRS per year. Not nearly enough to make me happy, but it's only three years of general.

Very, very jealous of my friends in ENT and Ortho.

 

[ent_doc]

Originally posted by neutropeniaboy
Here's my account of the extent of OMFS and ENT at our institution.

There are dentists, DMD-MDs, and DDS-MDs on the OMFS team at our institution. There is a fellow too, I believe. The fellow handles head and neck cancer cases for the OMFS team, although they don't do H&N cancer as frequently as we do. The OMFS team will do neck dissections, but they typically call us if they have difficulty. OMFS does Phase II sleep apnea surgery (maxillary advancements). ENT and OMFS do mandibular osteotomies, genioplasties, and mortised genioplasties. OMFS does all extractions. OMFS does all alveoloplasties. They will do tracheotomies if they need to; difficult ones come to us. They typically do the infant mandibular fractures/facial fractures.

OMFS does not do transphenoidals, sinus surgery, free flaps, rotational flaps, laryngology, or ear surgery at our institution. They also do not do external approaches for orbital abscesses, periorbital abscesses, or external ethmoidectomies or Caldwell-Luc procedures. They don't do face lifts, rhinoplasties, blephs, rhinoseptoplasties, or otoplasties.

Anyway, that's all I want to say now.

OMFS doing neck dissection? That is pretty rare. At our institution we have strong OMFS (though no MD/DDS folks) and they wouldn't touch the neck. Trachs also mandate a quick page to ENT.

 

[DDSMD2018]

During my externship with University of Minnesota, I saw some of the emergency trauma calls with OMS residents. I know for fact that an OMS commonly performs a bi-coronal flap to repair the medial socket wall, reconstructing of nasal bones such as the perpendicular plate, Le Fort I trhough III fractures from accidents, augment and/or reconstruct a zygomatic process, remove cancers of H&N (more commonly melanomas and SCC) and even pituitary cancers (stepping on some Neurosurgeon's domain). I've also seen OMS seminars where an OMS surgeon did a nerve graft from a branch of the CN V, reconstructing and restore facial muscle function, and creating an angle of the lip.

Of course the orthognathic, TMJ, cleft palate & lip, plastic and mandible reconstruction surgeries are in the domain of OMS practices.

I know that OMS does not get into the Otolaryngologist's practice of treating ear and throat diseases and all that audiology stuff, but I do believe that OMS performs quite a bit of surgical procedures in the same scope with the ENTs.

Since every OMS residency in the US has its own characteristics, the 6-year OMS/MD residencies tend to gain more various surgical exposures than a 4-year non-MD residency. Some OMS residencies are very heavy trauma emphasized while some learn more in anesthesiology.

Is there any current ENT surgeons or residents lurking around here to inform us of his/her experiences with this topic? Just FYI, I am sure you guy know this, but for a US hospital to be considered a "level one" trauma hospital, the hospital is required to have at least one OMS on staff for calls in the ER.

I know this post is really old, but after reading it, I felt compelled to comment in case anybody in the future comes across it and reads it. OMFS do coronal flaps to gain access to craniomaxillofacial trauma involving the upper 1/3 of the face including frontal sinus, frontal bar, orbital roof, nasal, NOE, and sometimes ZMC factures. This is not unique to OMFS. ENT, Plastics, neurosurgery, and others use this same approach. The trauma is what determines the approach, NOT the specialty. It is true, OMFS does get extensive training in craniomaxillofacial trauma. So does ENT, Plastics, and neurosurgery. I would like to think the one area that OMFS does it better is mandible fractures and some thought process in certain facial fractures. Please do not take my opinion literally, I'm not trying to get into a pissing contest. All the specialties I just named have very good training and are very good at what they do.

OMFS scope is expanding more and more to treat H&N pathology including but definitely not limited to SCCa, melanoma, BCCa, adenocarinoma and others. This is not stepping on ENT's toes. In fact, general surgeons used to dominate the Surgical Oncology field including head and neck. They have been increasingly getting less and less since ENT does a lot and now OMFS is expanding into more and more H&N pathology. And in all fairness, pathology doesn't pay. I don't care if it's a tumor in the abdomen, thorax, or H&N. So nobody really cares or is going to "defend" their territory if OMFS was to expand more into H&N pathology with free flap reconstruction. As far as intercranial pathology like craniopharyngiomas and pituitary gland tumors, OMFS is NOT stepping on NS toes. You MAY have seen an OMFS scrubbed in on a pituitary case while he was on his NS rotation, but that's as far as it goes. Not even ENT, Plastics, or any specialty is going to "commonly" remove intercranial masses. If you want to learn to do these procedures, there is a little 7 year class you can sign up for after medical school call neurosurgery residency and you can learn it there.

In the above thread, it is true that OMFS dominates surgery relating to orthognathic, TMJ, mandible trauma. It is NOT true that they dominate CL&P and mandible recontruction (I assume you are referring to the fibula free flap). As of right now, Plastic and Reconstructive Surgery (which is actually the entire name of their specialty, a lot of people "forget" or leave off the reconstructive part) dominates CL&P and many many many other craniofacial deformities (ie Apert's, Crouzon's, Treacher-Collins). If you want to do craniofacial surgery, you will need to do a fellowship. You get exposure as an ENT, OMFS, or plastics resident, but you don't log enough cases to "commonly" do crainofacial surgery and this includes CL&P. Right now, there are MANY more craniofacial fellowships available ONLY to plastic surgeons (they have to go through ANOTHER match process because it is competitive) after their residency is complete. There are a FEW fellowships availabe to OMFS. That is why plastics still dominates craniofacial surgery. For reconstructive (ie flaps), there are more and more fellowships available to OMFS and it is getting more competitive too. In fact, they are starting a match process for H&N reconstructive fellowships this year. Again, Plastics and Reconstructive Surgery still dominates this field, but OMFS is expanding to do more and more.

OMFS is NOT stepping on ENT's toes with ear and throat procedures. ENT is like OMFS, they make their money doing ear tubes and tonsils. OMFS makes their money doing 3rd's and implants. The other thousands of procedures that ENT and OMFS do are not as mainstay as the procedures I just listed. However, OMFS IS expanding more and more into ENT territory by treating OSAS with the MMA. It used to be the UTTT (by ENT) for OSAS, but was we all know, that surgery doesn't work and nobody really does it any more. But, you are wrong again. OMFS does do implants for ear prosthetics, they do do cartilage grafts of ears, and they do do some ear surgery after trauma. Afterall, the ear is part of the face, hence our specialty's name "maxillofacial". And one area that ENT may not like is the maxillary sinus. More and more OMFS are doing surgery on this sinus in particular (mainly sinus lifts) which some ENT's may or may not like. Again, most don't care because tubes and tonsils make up the majority of their scope, just like 3rd's and dental implants for OMFS. If ENT started doing teeth, and OMFS started doing tonsils, then it would be an all out war.

You are wrong again on saying that the 6 year programs "get more various exposure". The exposure is completely program dependent. There are some very good 4 year programs and some very good 6 year programs. There are also some not very good 4 year programs and some not very good 6 year programs. It has to do with location, hospital affiliation, attendings, OMFS presence in the hospital, and many other things that determine "exposure". NOT the amount of years in residency. The 6 year programs tack on 2 years of formal medical education where you earn your MD while in medical school. That's the difference and only difference between the 2 types of programs. It DOESN'T mean you'll spend more time in the OR or get more exposure to surgical procedures. That depends on the program you do to. There are currently 101 OMFS programs in the US and all of the have their pros and cons.

And you are wrong again on the last part. Level 1 trauma doesn't mean you have an OMFS on staff. It means you have all the services available required to have a Level 1 trauma status. It is true, most level 1 traumas have and OMFS on staff, but a Plastics or ENT on staff that can handle craniomaxillofacial trauma, odontogenic infections etc can handle these if properly trained. Level 1 trauma means the facility has the appropriate staff to handle all levels of trauma. I included a link to the College of Surgeons requirements for Level 1 in case you want to read all the specific requirements.
https://www.facs.org/~/media/files/quality programs/trauma/vrc2.ashx

I know this was a long response, but hopefully this clears up any questions that may arise from the previously posted thread. My background, I am currently an OMFS resident in a 6 year program at a Level 1 trauma and academic/university center. Please post if you have further questions.

 

[DDSMD2018]

OMFS doing neck dissection? That is pretty rare. At our institution we have strong OMFS (though no MD/DDS folks) and they wouldn't touch the neck. Trachs also mandate a quick page to ENT.

OMFS is doing more and more neck dissections. We have an attending trained in H&N oncology and free flap reconstruction, so yes we do our own. We don't refer. As far as trachs, I hope you are joking. It is very sad that you are an OMFS resident and you don't learn how to do a trach. You SHOULD definitely learn how to do this, or hope that you never encounter Ludwigs angina in your career. Plus, we should do our own surgeries and handle our own complications so we don't get laughed at by the other specialties. We are oral and maxillofacial surgeons by the way, we should live up to what our specialty has named itself. My background, OMFS resident 6 year program at a Level 1 trauma academic/university center. And since we do our own surgeries and never page ENT or Plastics for ****ing anything, we are also some of the most respected residents in the hospital.

 

[rigid]

Far be it from me to deny anyone from doing anything, but OMFS doing neck dissections? Really? I think that is sort of getting out of their scope

 

[DDSMD2018]

Here's my account of the extent of OMFS and ENT at our institution.

We have a rotating call schedule with respect to trauma. ENT, OMFS, and plastic surgery all rotate trauma call. This includes facial lacerations, auricular lacerations, mandibular fractures, facial fractures, orbital floor fractures (sometimes OMFS passes on this), and nasal bone fractures. Plastic surgery and OMFS do not handle temporal bone fractures, laryngeal fractures, or penetrating neck trauma.

Neck or facial abscesses of dental origin usually go to OMFS, unless there is a complicated airway issue.

There are dentists, DMD-MDs, and DDS-MDs on the OMFS team at our institution. There is a fellow too, I believe. The fellow handles head and neck cancer cases for the OMFS team, although they don't do H&N cancer as frequently as we do. The OMFS team will do neck dissections, but they typically call us if they have difficulty. OMFS does Phase II sleep apnea surgery (maxillary advancements). ENT and OMFS do mandibular osteotomies, genioplasties, and mortised genioplasties. OMFS does all extractions. OMFS does all alveoloplasties. They will do tracheotomies if they need to; difficult ones come to us. They typically do the infant mandibular fractures/facial fractures.

OMFS does not do transphenoidals, sinus surgery, free flaps, rotational flaps, laryngology, or ear surgery at our institution. They also do not do external approaches for orbital abscesses, periorbital abscesses, or external ethmoidectomies or Caldwell-Luc procedures. They don't do face lifts, rhinoplasties, blephs, rhinoseptoplasties, or otoplasties.

Specifically if I can address those points advertised on the AAOMS website:

OMFS certainly is not an expert in anesthesia or pain management (neither is ENT or plastics). I certainly don't debate the expertise of the anesthesiologist when there's disagreement about those issues. The only time I do is when it comes to protecting the airway -- beyond their generally poorly developed technique of fiberoptic intubation, anesthesia is pretty much useless when it comes to complicated intubation or emergent intubation.

OMFS doesn't do any plastics at our institution.

OMFS doesn't do any cleft lip/palate surgery. We do it rarley.

OMFS isn't any more reliable than any other surgical subspecialty with respect to ACLS or ATLS. If any medicine resident saw an OMFS resident running a code, they'd probably push them out of the way, and unless we were doing a slash trach or cric, they'd probably do the same to us.

We (ENT) try to avoid TMJ surgery. OMFS does that at our institution.

ENT deals with all epistaxis, parapharyngeal/retropharyngeal/peritonsillar abscesses. We do not deal with prevertebral abscesses (neurosurg). ENT and gen surg do thyroids, not OMFS. OMFS does not treat GERD (although it's rather simple to manage). OMFS doesn't do T&As, though that's probably not something they desire to do anyway...

Anyway, that's all I want to say now.

OMFS is very institution dependent and varies A LOT. So I'm going to contrast your previous comment at your institution with ours.

Facial trauma. OMFS we do almost everything. We also rotate with PLA and ENT. We NEVER refer orbital fractures. We do 1-2 per week, not a big surgery. We also do panfacial trauma, coronal flaps, and everything else. You ARE correct we do not handle temporal bone fractures. We consult our ENT colleagues in case of hearing deficit or other auditory problems. Some OMFS programs do manage temporal bone fractures however, so you can't say none do. We do penetrating neck trauma and laryngeal fractures.

We do handle ALL odontogenic infections since it involves teeth, but we also handle other H&N infections. We manage all our own airways and do our own trachs. We never consult ENT. We would get laughed at if we did. We are OMFS and we should be able to handle airways. In fact, even general surgery here will do some trachs. In my opinion, if you want to call yourself a surgeon, you better know how to manage airways, otherwise you are pretty useless when it comes to trauma. And I mean for all surgeons, ENT, PLA, OMFS, and general surgery.

Our program recently hired a fellow trained H&N oncology OMFS. We do all our own H&N pathology and flap reconstruction now. We don't refer. Where I'm located, we have the highest incidence of H&N cancer in the country. ENT was doing 5-6 resections/FFF per week. Now we are taking some of the case load. I'm sure they are happy about it too. As you are well aware, H&N cancer cases really suck to manage. Especially with patient's that love to smoke from their trach. Not that I particularly care for H&N cancer, I'm just saying that we are trained to do it. I personally hope to never to that **** when I'm done, ENT can have it all.

We do all our own osteotomies, whether it be LeFort 1, genio, BSSO, you name it. Our specialty was founded on sliding osteotomies. We don't refer anything. We also do craniofacial distraction cases and rhinoplasties. We have even do DCR cases and cannulated nasolacrimal ducts.

Our program does do sinus surgery, especially maxillary sinus (our specialty is named oral and maxillofacial for a reason), we do flaps, rotational flaps, and ear trauma/reconstructive surgery (limited to the external auricle, no middle ear surgery). We do NOT do laryngeal surgery, that is definitely ENT's specialty.

We DO perform I&D's of orbital and periorbital abscesses, Caldwell-Luc procedures, face lifts, rhinoplasties, belphs, septorhinoplasties (we do a septoplasty with every LeFort 1 advancement when indicated), and some otoplasties. We do NOT do ethmoidectomies, but on the topic of sinus surgery, we do handle frontal sinus open and endoscopic. Again we are oral and maxillofacial surgeons. We should be trained to handle all face surgery, our name implies it and we do it (at our institution).

As far as the AAMOS website, we are definitely not experts in anesthesia. The anesthesiologists are. That's why there are residencies for that. HOWEVER, we do 5 months of anesthesia where we are the ONLY person in the OR managing patient's under GA. We also are the only surgeons that are allowed to perform GA without an anesthesiologist (ie wisdom teeth, etc). So we do have significantly more training than ENT or PLA when is comes to ambulatory outpatient anesthesia and general anesthesia. I have yet to walk into an OR and see and ENT or PLA at the patient's head administering GA. At our institution, you will commonly see OMFS residents as the anesthesiologist in OR cases. And I mean for long cases, not short ones. I will admit, we don't get advanced training in anesthesia when it comes to craniotomies and transplant operations. But neither do most anesthesia residents. That's why there are fellowships for that. Those cases are much different from a GA standpoint that most OR cases.

As far as pain experts, we aren't that either. We do manage pain just like any other surgeon like ENT, PLA, OMFS, OB/GYN, NS, General Surgery, etc. We all manage pain. The real pain experts are anesthesiologists. Again, there are fellowships for that.

OMFS does plastic surgery in regards to plastic (ie soft tissues), so does ENT and some DERM. So I don't really know what you are referring to. If you mean cosmetics, then again, it's still the same. OMFS, ENT, PLA all do some cosmetic procedures related to their specialty.

ACLS and ATLS at our institution is expected from ALL the surgery residents. I don't care if you are ENT, PLA, OMFS, general surgery, OB/GYN, ORTHO, whatever. If you consider yourself a surgeon, you better be well equipped to handle these. Medicine resident running a code? What are you talking about? I'm sure if ANY surgery resident walked in the room and saw internal medicine or any medical resident in the room, they would push them out of the way and take over. Again, surgery at our hospital dominates and runs everything. All surgery residents and held to the same standards when it comes to codes. Have you ever seen a medicine resident put in a line or a chest tube? They are a joke. If they collapse a lung, then what? They call surgery, that's what.

OMFS does all TMJ surgery.

We handle epistaxis. We sometimes have it after a LeFort 1 or orbital surgery if the posterior ethmoid arteries are violated. So we should know how to handle this. It would be embarrassing to consult ENT after one of our own surgical procedures to clean up our mess. We handle some peritonsilar abscesses but you are right, this is ENT's field. Prevertebral is NS. Thyroids and most gland pathology is handled by ENT however we do some. The gland pathology we handle is parotid or other salivary gland pathology. General surgery is moving away from thyroids as they should. ENT is much better trained to handle this surgery and their complications. They should be the ones doing this.

We don't manage GERD or T&A's. We don't want to either. That is definitely ENT's field. That's like ENT wanting to extract 3rd molars.

The main point I'm trying to get across with my long response is the scope of OMFS is completely dependent on the program. I know some OMFS programs that do a lot less than ours and I know some that do even more. You can't judge all OMFS residents based on your personal experience and your institution. Just like I would never judge all ENT or PLA based on the residents at my institution. But I will say this, for the most part I think OMFS, ENT, PLA are all very rigorous training programs and I think all residents who complete these residencies are very skilled and proficient surgeons. I have nothing bad to say about ENT or PLA. We should just be thankful we chose to specialize and not have to deal with all the BS that general surgeons do. I think their training and they way they get dumped on is miserable and unfair. Please respond if you have any comments or corrections.

 

[Pir8DeacDoc]

Just exactly who are you trying to impress? You guys are very well trained. But reality is you all pull thirds and do implants in private practice and leave the other stuff behind when training is over.

 

[anonperson]

OMFS is doing more and more neck dissections. We have an attending trained in H&N oncology and free flap reconstruction, so yes we do our own. We don't refer. As far as trachs, I hope you are joking. It is very sad that you are an OMFS resident and you don't learn how to do a trach. You SHOULD definitely learn how to do this, or hope that you never encounter Ludwigs angina in your career. Plus, we should do our own surgeries and handle our own complications so we don't get laughed at by the other specialties. We are oral and maxillofacial surgeons by the way, we should live up to what our specialty has named itself. My background, OMFS resident 6 year program at a Level 1 trauma academic/university center. And since we do our own surgeries and never page ENT or Plastics for ****ing anything, we are also some of the most respected residents in the hospital.

Sheeeeit... Anything you can't cover in the hospital?

 

[DermatoFIGHT]

Sheeeeit... Anything you can't cover in the hospital?

I seriously laughed out loud

 

[OtoHNS]

ENT is like OMFS, they make their money doing ear tubes and tonsils. OMFS makes their money doing 3rd's and implants.

I'll trade your wisdom teeth and implant money for my tube and tonsil "reimbursements."

 

[Pir8DeacDoc]

I'll trade your wisdom teeth and implant money for my tube and tonsil "reimbursements."

Yeah me too..

 

[DermatoFIGHT]

Yeah me too..

are they really that bad? the medicine model in this country absolutely sucks

 

[Slack3r]

OMFS is very institution dependent and varies A LOT. So I'm going to contrast your previous comment at your institution with ours.

Facial trauma. OMFS we do almost everything. We also rotate with PLA and ENT. We NEVER refer orbital fractures. We do 1-2 per week, not a big surgery. We also do panfacial trauma, coronal flaps, and everything else. You ARE correct we do not handle temporal bone fractures. We consult our ENT colleagues in case of hearing deficit or other auditory problems. Some OMFS programs do manage temporal bone fractures however, so you can't say none do. We do penetrating neck trauma and laryngeal fractures.

We do handle ALL odontogenic infections since it involves teeth, but we also handle other H&N infections. We manage all our own airways and do our own trachs. We never consult ENT. We would get laughed at if we did. We are OMFS and we should be able to handle airways. In fact, even general surgery here will do some trachs. In my opinion, if you want to call yourself a surgeon, you better know how to manage airways, otherwise you are pretty useless when it comes to trauma. And I mean for all surgeons, ENT, PLA, OMFS, and general surgery.

Our program recently hired a fellow trained H&N oncology OMFS. We do all our own H&N pathology and flap reconstruction now. We don't refer. Where I'm located, we have the highest incidence of H&N cancer in the country. ENT was doing 5-6 resections/FFF per week. Now we are taking some of the case load. I'm sure they are happy about it too. As you are well aware, H&N cancer cases really suck to manage. Especially with patient's that love to smoke from their trach. Not that I particularly care for H&N cancer, I'm just saying that we are trained to do it. I personally hope to never to that **** when I'm done, ENT can have it all.

We do all our own osteotomies, whether it be LeFort 1, genio, BSSO, you name it. Our specialty was founded on sliding osteotomies. We don't refer anything. We also do craniofacial distraction cases and rhinoplasties. We have even do DCR cases and cannulated nasolacrimal ducts.

Our program does do sinus surgery, especially maxillary sinus (our specialty is named oral and maxillofacial for a reason), we do flaps, rotational flaps, and ear trauma/reconstructive surgery (limited to the external auricle, no middle ear surgery). We do NOT do laryngeal surgery, that is definitely ENT's specialty.

We DO perform I&D's of orbital and periorbital abscesses, Caldwell-Luc procedures, face lifts, rhinoplasties, belphs, septorhinoplasties (we do a septoplasty with every LeFort 1 advancement when indicated), and some otoplasties. We do NOT do ethmoidectomies, but on the topic of sinus surgery, we do handle frontal sinus open and endoscopic. Again we are oral and maxillofacial surgeons. We should be trained to handle all face surgery, our name implies it and we do it (at our institution).

As far as the AAMOS website, we are definitely not experts in anesthesia. The anesthesiologists are. That's why there are residencies for that. HOWEVER, we do 5 months of anesthesia where we are the ONLY person in the OR managing patient's under GA. We also are the only surgeons that are allowed to perform GA without an anesthesiologist (ie wisdom teeth, etc). So we do have significantly more training than ENT or PLA when is comes to ambulatory outpatient anesthesia and general anesthesia. I have yet to walk into an OR and see and ENT or PLA at the patient's head administering GA. At our institution, you will commonly see OMFS residents as the anesthesiologist in OR cases. And I mean for long cases, not short ones. I will admit, we don't get advanced training in anesthesia when it comes to craniotomies and transplant operations. But neither do most anesthesia residents. That's why there are fellowships for that. Those cases are much different from a GA standpoint that most OR cases.

As far as pain experts, we aren't that either. We do manage pain just like any other surgeon like ENT, PLA, OMFS, OB/GYN, NS, General Surgery, etc. We all manage pain. The real pain experts are anesthesiologists. Again, there are fellowships for that.

OMFS does plastic surgery in regards to plastic (ie soft tissues), so does ENT and some DERM. So I don't really know what you are referring to. If you mean cosmetics, then again, it's still the same. OMFS, ENT, PLA all do some cosmetic procedures related to their specialty.

ACLS and ATLS at our institution is expected from ALL the surgery residents. I don't care if you are ENT, PLA, OMFS, general surgery, OB/GYN, ORTHO, whatever. If you consider yourself a surgeon, you better be well equipped to handle these. Medicine resident running a code? What are you talking about? I'm sure if ANY surgery resident walked in the room and saw internal medicine or any medical resident in the room, they would push them out of the way and take over. Again, surgery at our hospital dominates and runs everything. All surgery residents and held to the same standards when it comes to codes. Have you ever seen a medicine resident put in a line or a chest tube? They are a joke. If they collapse a lung, then what? They call surgery, that's what.

OMFS does all TMJ surgery.

We handle epistaxis. We sometimes have it after a LeFort 1 or orbital surgery if the posterior ethmoid arteries are violated. So we should know how to handle this. It would be embarrassing to consult ENT after one of our own surgical procedures to clean up our mess. We handle some peritonsilar abscesses but you are right, this is ENT's field. Prevertebral is NS. Thyroids and most gland pathology is handled by ENT however we do some. The gland pathology we handle is parotid or other salivary gland pathology. General surgery is moving away from thyroids as they should. ENT is much better trained to handle this surgery and their complications. They should be the ones doing this.

We don't manage GERD or T&A's. We don't want to either. That is definitely ENT's field. That's like ENT wanting to extract 3rd molars.

The main point I'm trying to get across with my long response is the scope of OMFS is completely dependent on the program. I know some OMFS programs that do a lot less than ours and I know some that do even more. You can't judge all OMFS residents based on your personal experience and your institution. Just like I would never judge all ENT or PLA based on the residents at my institution. But I will say this, for the most part I think OMFS, ENT, PLA are all very rigorous training programs and I think all residents who complete these residencies are very skilled and proficient surgeons. I have nothing bad to say about ENT or PLA. We should just be thankful we chose to specialize and not have to deal with all the BS that general surgeons do. I think their training and they way they get dumped on is miserable and unfair. Please respond if you have any comments or corrections.

Is OMFS really trained for all of this? Interesting that they manage to become sufficiently trained in 4 years when it takes ENTs 5+fellowship...

 

[neutropeniaboy]

You sound like an insecure punk. I love my omfs colleagues, as we collaborate very frequently. I send them a lot of cases; I ask them for their opinions. I see their patients and they ask me for my opinions. You, I can't envision ever wanting to involve you in any aspect of care for my patients given your level of insecurity, arrogance and lack of experience in the real world. Keep this attitude up and one day you'll find that people aren't interested in collaborating with you.

But, I would be happy to send you any epistaxis patient I receive in the future. You're welcome.

 

[OtoHNS]

are they really that bad? the medicine model in this country absolutely sucks

Most tubes/tonsil patients are kids and depending where you practice, a lot of your pediatric patients will have Medicaid. The initial visit for these patients usually reimburses in the $80-100 range and the surgery reimburses around $200 for tubes and $250 for T+A. For private insurance patients, those numbers increase by 50-100%. These numbers will vary to some extent depending on what state/city you practice in.