Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery (OMFS) is the surgical specialty concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck. The specialty is unique in requiring degrees in both medicine and dentistry, followed by a comprehensive general and specialist surgical training. It is a recognised international specialty and within Europe is defined under the EU medical directives. For most UK OMFS specialists their first degree was dentistry, but a growing number have medicine as their first degree. This medicine first route is supported by shortened (3 year) dental degree courses for OMFS trainees. There are also shortened medical courses for (dental) graduates.
What do Oral and Maxillofacial Surgeons do?
Often seen as the bridge between medicine and dentistry, the scope of the specialty is extensive and includes the diagnosis and management of facial injuries, head and neck cancers, reconstructive maxillofacial surgery, salivary gland diseases, facial disproportion, craniofacial disorders, facial pain, head and neck cutaneous malignancy, impacted teeth, cysts and tumours of the jaws as well as numerous problems affecting the oral mucosa such as mouth ulcers and infections.
Training in Oral and Maxillofacial Surgery (OMFS)
To enter higher training in OMFS requires a registrable dental degree, a medical degree, a minimum of 12 months core surgical training, and possession of the MRCS. The MRCS (Membership of the Royal College of Surgeons) is the assessment of the required knowledge for completion of Core Training in surgery and is common across all surgical specialties.
Higher training in OMFS (5 years) is a year shorter than other surgical specialties. Throughout training progress is monitored and assessed utilising the on line Intercollegiate Surgical Curriculum Project (ISCP) with work based placed assessments and feedback linked to the curriculum. Every year there is an Annual Record of Competency Progression (ARCP). In the last year of training, each trainee must pass the Intercollegiate Fellowship Examination, leading to the award of the FRCS (OMFS) - the exit exam for our specialty. With the exam and a successful ARCP trainees are eligible for application for a Certificate of Completion of Training (CCT) to gain entry onto the GMC specialist list in OMFS.
Towards the end of training some OMFS trainees complete Interface Training Fellowships in Head & Neck Cancer, Cleft Surgery, Aesthetic Surgery, Laser Surgery or Trauma & Reconstructive Surgery. These fellowships are open to and interface with other specialties, hence their name.
Other areas within OMFS
Some surgeons concentrate on or have an interest in Higher Surgical Training in OMFS, which involves exposure to all the subspecialty areas of the specialty. However trainees may choose to obtain additional experience and training in one or more of these specialised fields of Oral and Maxillofacial Surgery:
- Surgical treatment of head and neck cancer: the removal of the tumours, the sites of metastases and subsequent reconstruction, including microvascular free.
- Surgery for Craniofacial Disorders: the correction of congenital or acquired craniofacial deformity primarily to improve oro-facial function, but also often to overcome facial disfigurement and restore quality of life.
- Oral and Maxillofacial: surgery of the teeth (including implants), jaws, temporomandibular joints, salivary glands and facial skin lesions including skin cancers.
- Oral Medicine: diagnosis and management of medical conditions presenting in and around the cervico-facial structures.
- Craniofacial Trauma: treatment of facial soft and hard tissue injuries of the craniofacial structures.
- Cosmetic Surgery: surgery to enhance facial aesthetics and improve quality of life.
- Academic OMFS Surgery: there are growing number of OMFS surgeons who are also university teachers, researchers and professors in medical and dental schools.
Due to the nature of the specialty, Oral and Maxillofacial Surgeons often work alongside a variety of specialists in other fields such as ENT Surgeons, Clinical Oncologists, Plastic Surgeons, Orthodontists, Restorative Dentists, Radiologists and Neurosurgeons.
Training in Oral Surgery (OS)
The specialty of OS is a dental specialty that concentrates on the surgical aspects of dentistry. Training in OS does not require a medical degree. Training programmes last between 3 and 5 years. After 3 years training, having passed the Membership in Oral Surgery, a trainee gains a CCT in OS and is eligible for entry onto the GDC OS specialist list. Further training is required to be a consultant in OS, this pathway remains under review. Most trainees will pass an intercollegiate fellowship exam (IFSE) during this extra period of training.
SAS Doctors in OMFS – An Alternative Career Pathway
The term SAS refers to Staff Grades, Associate Specialists and Specialty Doctors. Since 2008, for all new appointments, the Specialty Doctor grade has replaced the closed grades of Staff Grade, Associate Specialist, Clinical Medical Officer, Hospital Practitioner and Clinical Assistant. The specialty doctor contract does not automatically cover trust grade doctors.
The SAS doctors are non-training grade doctors and dentists with at least four years of postgraduate training, two of those years being in the relevant specialty. There are many reasons why one may decide to enter a SAS role. For example:
- Overseas doctors with difficulty getting a training post.
- Preference for work-life balance with more regular working hours.
- Keen to have distinct portfolio career.
- Enter as a temporary position while trying to get into a training post or second degree studies.
In OMFS to be a SAS doctor/dentist, full registration with GDC/GMC is required and for dentists MFDS/MJDF is usually needed. Other postgraduate qualifications may be desirable e.g. IV Sedation, Implants, Medical Education by some units.
The SAS doctor grade provides an opportunity for the doctors to have a rewarding and varied career with progression to the top of the grade over a number of years whilst gaining experience, and expanding and developing their skill base. Fundamental to accepting a SAS contract is the commitment to undertake annual job planning and appraisal while developing a portfolio to record your progress through two thresholds. SAS doctors are expected to get involved with teaching/training, leading service development and research.
There are an increasing numbers of national initiatives that have given SAS doctors/dentists an opportunity to access additional resources e.g. SAS Development Funds guided and monitored by SAS tutors/Educational Advisors of their particular trust.
With time and experience, the SAS grade doctor/dentist can acquire a high level of specialist knowledge and expertise and have the advantage of developing their roles to work independently within agreed lines of responsibility. The workload of SAS doctors in OMFS generally includes whole breadth of Oral Medicine and Oral surgery. In addition some units do offer on call activity and more specialist work including IV sedation, trauma, surgical dermatology and salivary glands.
Overall SAS doctors are passionate group of doctors/dentists considered as ‘Hidden Heroes of the NHS’ with highly valuable set of skills and are an asset to every Oral and Maxillofacial department in the country.