Oral and maxillofacial surgery Expertise

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 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:

• facial injuries
• head and neck cancers (including facial skin cancer)
• salivary gland diseases
• facial disproportion
• disorders of the jaw joints (a.k.a. temporomandibular 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:

• 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.