oral maxillo-facial surgery

Discussion in 'General Residency Issues' started by beezar, Mar 17, 2004.

  1. beezar

    beezar Senior Member
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    Hey, what do OMFS people have to go through? I know they have to do some sort of medical school, but what is the extent of this and their training?

    For that matter, what's the difference in scope between ENT and OMFS?

    Now, I can see how this thread might potentially start some flaming, so let's not go there... I'm just curious, that's all.
     
  2. River13

    River13 Senior Member
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    http://www.aaoms.org/residency/residency_template.asp?entity_id=25&content_type_id=73

    http://www.lsuoralsurgery.com/dept/resi/index.html

    Residencies are 4-7 years long after dental school. 4 year residencies don't include a medical degree. Several 6 year ones accept applicants from medical school as well...these surgeons would earn a dental degree during their 6 years of training, the same way as the dental students earn medical degrees during theirs.

    Here's the layout for the OMS residency at Charity hospital in New Orleans:

    LSU Six-Year
    Oral & Maxillofacial Surgery
    MD Program

    Typical Resident Curriculum

    1st Year: OMS - 10 months integrated with:
    Graduate Head and Neck Anatomy
    Graduate Oral Pathology Course
    Introduction to Clinical Medicine
    Dermatology
    Clinical Pathology
    General Anesthesia - 2 months
    Pass Part I of Medical National Boards

    2nd Year: Clerkships of 3rd academic year - LSU Medical School

    3rd Year: Clerkships of 4th academic year - LSU Medical School
    Anesthesiology, 2 months
    Oral and Maxillofacial Surgery, 2-3 months
    M.D. Awarded in May


    4th Year: General Surgery Year
    General Surgery and subspecialties, 4-6 months
    Neurosurgery, 3-4 months
    OMS, 3 months


    5th Year: OMS, 12 months
    Graduate Orthognathic Surgery Course

    6th Year: OMS, 12 months
    Elective Cosmetic or Cleft Palate rotation (optional)
    Certificate Awarded



    What OMSs do and how they are trained

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

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

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


    Q: What special training do oral and maxillofacial surgeons receive?
    A: Following graduation from four years of dental school, oral and maxillofacial surgeons complete a hospital-based surgical residency of at least four years. This residency includes training in medicine, general surgery, anesthesia and physical diagnosis. The core surgical training is identical to that provided to medical residents, and in most cases OMSs and medical doctors are trained together. Some OMS residents earn medical degrees through residency programs that integrate OMS and MD training. All OMS residents, whether they hold a dental degree or a dental and medical degree, rotate through hospital medical, surgical and anesthesia services, where they perform the same duties and procedures as residents in medical specialties.

    In addition to core surgical and medical training, OMS residency emphasizes diagnosis, treatment, and management of problems of the oral and maxillofacial region ? the mouth face and jaws. OMS residents spend at least 30 months focusing specifically on the oral and maxillofacial area. Because of this specialized education, oral and maxillofacial surgeons are licensed to perform many procedures that are also performed by physicians, including reconstruction of the nose, orbits of the eye, cleft palate and facial esthetic surgery. OMS training programs must provide a minimum of 48 months of full-time training in a hospital-based residency as required in the Standards for Advanced Specialty Education Programs in Oral and Maxillofacial Surgery.


    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.

    Q: What degree(s) is necessary to perform the above procedures?
    A: The scope of oral and maxillofacial surgery privileges is not based upon the professional degree, which the individual possesses. Rather, privileges to perform surgery are granted based upon the OMS? education and training in accordance with the previously mentioned Standards. This principle is consistent with a 1979 American Medical Association policy, which follows the Joint Commission on Accreditation of Healthcare Organization?s guidelines for credentialing a medical staff member. The AMA policy states that individual character, training, competence, experience, and judgement should be the criteria for granting privileges in hospitals; and that practitioners representing several specialties can and should be permitted to perform the same procedures if they meet the criteria.
     
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  3. Larry Renal

    Larry Renal Member
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    Great stuff, River...

    Do you have any info on doing the reverse? Getting a DDS/DMD in an OMS residency after completion of med school? Thanks!

    Lar
     
  4. River13

    River13 Senior Member
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    That has actually been discussed on a couple of different threads...I know Louisville and Baylor both accept med school graduates into their OMS residencies, and I've heard UPENN does as well. There's a handfull of others. These residents would complete more or less the 3rd and 4th year of dental school during the 2nd and 3rd years of the 6 year OMS residency. One of the OMS residents here at Louisville is doing that...did med school at Oregon first...
     
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