Oral & maxillofacial surgery
Oral & maxillofacial surgery
◾ 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.
◾ Facial skin surgery including removing facial cancers and tumours
◾ Jaw joint problems and facial pain
◾ Aesthetic facial surgery
◾ Trauma – treatment of facial soft and hard tissue injuries of the craniofacial structures
◾ Dentoalveolar surgery – treatment of teeth (including implants)
◾ Oral medicine – diagnosis and treatment of conditions in and around the cervico-facial structures
◾ Cleft lip and palate surgery
◾ Salivary gland surgery including using minimally invasive techniques to remove stones from ducts
◾ Craniofacial deformity and orthognathic surgery – the correction of jaw disproportion
◾ Head and neck cancer – removal of tumours and reconstruction
The main sub-specialties within oral and maxillofacial surgery are:
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.
Associated sub-specialties
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.
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.
More recently, further advances have allowed radiological imaging to be combined with 3D photography to further improve patient assessment and preoperative planning.
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.
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.
surgery of skin lesions of the head and neck
◾ Surgical treatment of cleft lip and palate and other congenital facial deformities
◾ Salivary gland surgery – for benign and malignant lesions
◾ Temporomandibular (jaw) joint surgery
◾ Cosmetic surgery such as face lifts, eyelid and brow surgery and correction and reconstruction of the nose (rhinoplasty)
◾ Removal of jaw tumours and cysts
◾ Removal of impacted teeth and complex buried dental roots
◾ Reconstructive surgery – including micro-vascular free tissue transfer
◾ Removal of head and neck benign and malignant tumours
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
Procedures undertaken by oral and maxillofacial surgeons include:
◾ Skin cancer surgery (working with dermatologists)
◾ Facial surgery for cancer (working with oncologists, ENT surgeons, and dental specialists)
◾ Cancer and injuries involving the skull base (working with neurosurgeons)
◾ Craniofacial surgery for congenital problems
Major complex surgery in OMFS is exciting, and often collaborative. It includes:
If the condition cannot be treated under local anaesthetic, the patient will be admitted for elective surgery or as an emergency when a general anaesthetic is necessary.
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.
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.
Common to all surgical specialties, OMFS procedures range from the relatively minor through to complex major surgery.
Common procedures/interventions
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.
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.
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.
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.
Common procedures/interventions
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.
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.
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.
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.
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