ORAL & MAXILLO FACIAL SURGERY

Oral & Maxillofacial (OMF) Surgeons specialise in the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck.

OMF surgery is unique in requiring a dual qualification in medicine and dentistry, and is often seen as the bridge between medicine and dentistry, treating conditions that require expertise from both backgrounds such as head and neck cancers, salivary gland diseases, facial disproportion, facial pain, temporomandibular joint disorders, impacted teeth, cysts and tumours of the jaws as well as numerous problems affecting the oral mucosa such as mouth ulcers and infections.

Oral and maxillofacial is involved in all aspects of the diagnosis and surgical care of the mouth, jaws, skull, face, head and neck as well as associated structures and their reconstruction. The aim of the specialty is to provide a comprehensive diagnostic and surgical service, often in a multidisciplinary manner to our medical and dental colleagues for a defined anatomical area – the Head and Neck

Nature of the work

To enter higher training you need to be qualified in both medicine and dentistry since many of the conditions treated require expertise from both fields. This requirement for dual qualification is recognised by the EU and makes OMFS unique amongst the 10 surgical specialties in the UK.
Most OMFS specialists are dentists first, but an increasing number of surgeons are coming from a medical background and taking advantage of shortened dental courses.
The scope of the specialty is large and includes the surgical and non-surgical management of conditions of the hard and soft tissues of the face, jaws and neck. Oral and maxillofacial surgeons work with patients of all ages from newborn babies to elderly people. They treat children who are born with or develop deformities of their skull or face including cleft lip/palate. Much of their work with young adults involves surgery following an injury or accident. In the older population they often treat oral cancer and skin tumours of the face and head.
In addition to performing surgery, oral and maxillofacial surgeons also deal with the non-surgical management of conditions such as facial pain, oral mucosal disease and infections.

Common procedures/interventions

Common to all surgical specialties, OMFS procedures range from the relatively minor through to complex major surgery.
The more straight-forward procedures include dento-alveolar surgery which is the surgical treatment of disorders of the teeth and their supporting hard and soft tissues. For example, a dentist may refer a patient with impacted wisdom teeth to an OMFS consultant.
Alternatively a general medical practitioner might refer a patient with a basal cell carcinoma on their nose. These conditions may be treated via the outpatient clinic without the need for general anaesthesia. Instead a local anaesthetic perhaps with conscious sedation is used.
If the condition cannot be treated under local anaesthetic, the patient will be admitted for electivesurgery or as an emergency when a general anaesthetic is necessary.

Major complex surgery in OMFS is exciting, and often collaborative. It includes:
• craniofacial surgery for congenital problems
• cancer and injuries involving the skull base (working with neurosurgeons)
• facial surgery for cancer (working with oncologists, ENT surgeons, and dental specialists)
• skin cancer surgery (working with dermatologists)

Procedures undertaken by oral and maxillofacial surgeons include:
• surgical treatment of facial injuries – complex craniofacial fractures, fractures of the lower jaw, upper jaw, cheekbone, nose, and orbit (sometimes all of these together) and soft tissue injuries of the mouth, face and neck
• removal of head and neck benign and malignant tumours
• reconstructive surgery – including micro-vascular free tissue transfer
• removal of impacted teeth and complex buried dental roots
• removal of jaw tumours and cysts
• cosmetic surgery such as face lifts, eyelid and brow surgery and correction and reconstruction of the nose (rhinoplasty)
• temporomandibular (jaw) joint surgery
• salivary gland surgery – for benign and malignant lesions
• surgical treatment of cleft lip and palate and other congenital facial deformities
• surgery of skin lesions of the head and neck

Oral and maxillofacial surgeons use the latest surgical techniques to assist them in their work. For example CT and MRI scans are used to enable surgeons to view head and neck anatomy in three dimensions. The images can then be manipulated in order to produce virtual 3D models which help the surgeon to plan surgery. Based on these models templates and custom implants are made, which are specific to each patient.
The same 3D technology allows surgeons to view the complex structures of the face and skull base on a screen during surgery and use surgical navigation apparatus to guide the surgeon showing them exactly where their instruments are in relation to the scanned images – useful when so many vital structures are so close together.
More recently, further advances have allowed radiological imaging to be combined with 3D photography to further improve patient assessment and preoperative planning.
For some years oral and maxillofacial surgeons have successfully used micro-vascular surgical techniques to help transfer tissue from one part of the body to another. The tissue including bone can be transferred from the forearm, thigh, lower leg, pelvis or abdomen to the face or neck. The small blood vessels of the tissue are then connected to the recipient vessels in the neck.
Face transplantation combines an understanding of facial surgery and anatomy with micro-surgical skills. The first face transplant in the world was performed by an oral & maxillofacial surgeon in France.

Associated sub-specialties

Oral and maxillofacial surgeons are trained in all areas of the specialty and may remain generalists, but they often choose to specialise in one or more areas.

The main sub-specialties within oral and maxillofacial surgery are:
• head and neck cancer – removal of tumours and reconstruction
• craniofacial deformity and orthognathic surgery – the correction of jaw disproportion
• salivary gland surgery including using minimally invasive techniques to remove stones from ducts
• cleft lip and palate surgery
• oral medicine – diagnosis and treatment of conditions in and around the cervico-facial structures
• dentoalveolar surgery – treatment of teeth (including implants)
• trauma – treatment of facial soft and hard tissue injuries of the craniofacial structures
• aesthetic facial surgery
• jaw joint problems and facial pain
• facial skin surgery including removing facial cancers and tumours
• academic surgery – increasing numbers of OMFS consultants work in universities as senior lecturers, readers and professors. They often also have a surgical sub-specialty interest