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A summary of Oral and maxillofacial surgery expertise
(Mr John Townend, MBBS BDS MRCS LRCP FDSRCS, Consultant Oral & Maxillofacial
Surgeon).
Oral and maxillofacial surgery (OMFS) is probably the least known of the nine surgical
specialties recognised by the Senate of Surgery of Great Britain and Ireland, although
there are currently over 370 ‘OMF’ surgeons in the UK.
Uniquely, OMF consultants undergo a full training in both medicine and dentistry and are
registered with both the General Medical Council (GMC; www.gmc-uk.org) and the
General Dental Council (GDC; www.gdc-uk.org). They take referrals from both medical
and dental general practitioners (GDPs), and tend to act as the main channel of referral
for GDPs to the hospital sector.
What is OMFS?
Oral and maxillofacial surgery is the specialty concerned with the management of
conditions affecting the head and neck. Its scope is extensive and includes the
management of:
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facial injuries
head and neck cancers (including facial skin cancer)
salivary gland diseases
facial disproportion
disorders of the jaw joints (a.k.a. temporo-mandibular joints, or ‘TMJs’)
cleft lip and cleft palate
impacted teeth
cysts and tumours of the jaws
dental implantology
the management of non-surgical diseases of the mouth, such as ulcers,
infections and facial pain syndromes.
Many OMF surgeons are generalists, but there is an increasing tendency, particularly in
the larger hospital departments, for a surgeon to sub-specialise in either head and neck
cancer surgery or orthognathic (correction of jaw deformity) work. Smaller numbers
have developed sub-specialist interests in, for example, skull base surgery, cleft lip and
palate surgery, cranio-maxillary malformations or jaw joint surgery.
All OMF surgeons will undertake the bread-and-butter work of dento-alveolar surgery
(surgery of the teeth and their related structures), facial trauma (mostly resulting from
road traffic accidents or inter-personal violence), the non-surgical management of jaw
joint disorders and the more common oral mucosal diseases.
An increasing number of OMF surgeons have built up a dental implant practice, often in
association with one or more general dental practitioner colleagues who have an interest
in crown and bridge work.
When to ask for an OMF opinion
Head and neck surgery can be a confusing field because there are areas of overlap
between OMF surgery, ENT, plastic surgery, neurosurgery, dermatology (e.g. facial skin
cancers) and general dentistry. Most OMF medico-legal work falls into one of three
catagories:
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Facial injuries – A national survey conducted by the British Association of Oral
and Maxillofacial Surgeons (BAOMS; www.baoms.org.uk) showed that 500,000
facial injuries occur every year in the UK, with 180,000 of these being classified
as ‘of a serious nature’. Of this number, 25% were caused by assault. OMF
surgeons have expertise in the management of injuries to the teeth and their
supporting structures, facial soft tissues, fractures of the jaws and facial bones,
and whiplash injuries to the jaw joints and neck.
General dental practice – Complications following the removal of impacted
wisdom teeth or dental implant placement are common. An OMF surgeon can
advise on whether management has been optimal and whether a complication is
the result of negligence or misadventure.
Major head and neck surgery – This is a complex field of surgery and, again, an
OMF surgeon can advise whether any complications that have occurred can be
attributed to negligence or misadventure.
Qualifications to look for
FDSRCS – Fellow in Dental Surgery of one of the Royal Colleges of Surgeons (England
– www.rcseng.ac.uk; Edinburgh – www.rcsed.ac.uk; Glasgow – www.rcpsg.ac.uk;
Ireland – www.rcsi.ie)
FRCS – Fellow of the Royal College of Surgeons (www.rcseng.ac.uk). Senior OMF
consultants may not have this degree because the maxillofacial FRCS was introduced
fairly recently, in which case look for MB BS.
GMC, GDC – General Medical Council (www.gmc-uk.org) and General Dental Council
(www.gdc-uk.org). OMFS consultants are registered with both councils and most are on
the Oral Surgery Specialist Register of the GDC.
One may occasionally see FBAOMS – Fellow of the British Association of Oral and
Maxillofacial Surgeons (www.baoms.org.uk). Not to be confused with BAOS (British
Association of Oral Surgeons – www.baos.org.uk), whose members are mostly GDPs
with an interest in the surgical aspects of dentistry and may be on the specialist Oral
Surgery Register of the GDC, but are not medically qualified.