Karen Juggins and Simon Whitley explain what is involved

In most years at medical school there are usually one or two older students who seem to know more head and neck anatomy than their demonstrators or who suddenly appear for the first time at the beginning of the clinical years. It is likely that these strange individuals are qualified dentists training to be oral and maxillofacial surgeons.

A bit of history

Oral surgery has always had its roots in dentistry. In the past oral and maxillofacial surgeons were dentally qualified consultants. As the scope of the specialty has developed, dual qualification became the norm and is now mandatory. In 1994 it was established as one of the nine surgical specialties recognised by the surgical colleges.

What exactly do we do?

The scope of the surgery is very varied. It is certainly not all about extracting teeth. There is a mix of elective and emergency work in both children and adults. The kind of surgery we do includes the following.

Trauma

Injuries to the face are very common, ranging from simple cuts and bruises through to complex craniofacial trauma. The majority of trauma is caused by interpersonal violence resulting in lacerations and fractures of the facial bones. Increasingly, gunshot wounds and penetrating injuries are dealt with by our specialty.

Head and neck cancer

Although uncommon this occupies a significant proportion of the workload of many maxillofacial surgeons. As with all malignancy it is extremely distressing for the patient. The potential disfiguring nature of the surgery coupled with possible loss of functions, such as speech and swallowing, make management of these patients very complex. As part of a multidisciplinary team oral and maxillofacial surgeons often perform the tumour resection and subsequent reconstruction.

Facial deformity

The treatment of facial deformity ranges from soft tissue surgery such as rhinoplasties to orthognathic surgery (correction of skeletal disproportion and dental appearance) through to surgery for cleft lip and palate and congenital craniofacial syndromes.

Surgery of the teeth, jaws, and related structures

A wide range of pathological conditions are diagnosed and treated by our specialty including disorders of the temporomandibular joints, salivary glands, soft tissues of the oral cavity, and, of course, wisdom teeth.

Aesthetic facial surgery

There is an increasing number of oral and maxillofacial surgeons involved in this kind of surgery and it is part of the training programme for higher surgical trainees in oral and maxillofacial surgery.

Who do we work with?

Although the newest of the nine surgical specialties and perhaps the least well known, oral and maxillofacial surgery continues to develop strong links with other medical, dental, and surgical specialties.

The management of maxillofacial trauma involves close cooperation with emergency departments and our colleagues in anaesthetics, neurosurgery, and ophthalmology.

As part of the team approach to the management of head and neck cancer we also work closely with clinical oncologists, radiologists, and professions allied to medicine-for example, speech and language therapists. We maintain strong links with our dental colleagues in both hospital and primary care.

How do I become a maxillofacial surgeon?

At first glance the training pathway seems enormously long. You do need both a medical and a dental degree and postgraduate qualifications in dentistry and surgery. The majority of people undertake dental training first followed by a medical degree and surgical training. However, a few people have done this the other way around.

The training pathways possible

There are no hard and fast rules. We contacted all of the United Kingdom dental schools to inquire about their admissions policy for medical graduates wishing to pursue a career in oral and maxillofacial surgery. The response has been varied but it seems likely that a shortened course would be possible at some schools-for instance, of three and a half years instead of five. However, there seems to be no definite protocols and applications are considered on individual merit.

It would seem sensible to complete preregistration house officer jobs and undertake some basic surgical training before dental school. This provides you with the experience required to do locum work, which will help with funding through dental school. It will also help fulfil the requirements for the membership of the Royal College of Surgeons (MRCS) examination.

After dental training, a year as a senior house officer in maxillofacial surgery will enable you to sit the membership of the Faculty of Dental Surgery examination as well a completing the requirements to sit the MRCS.

Specialist training lasts five years with an exit FRCS examination taken in the last year. A certificate of completion of specialist training in oral and maxillofacial surgery is then awarded.

So, a training pathway might look something like this:

Is it for me?

Oral and maxillofacial surgery is an exciting, challenging, and emerging surgical specialty. The lifestyle for consultants and specialist registrars is favourable compared with other surgical specialties and there is good opportunity for private work.

In just one week you could resect an oral cancer and reconstruct the defect with a vascularised free flap, perform a bimaxillary osteotomy, remove a salivary gland for benign disease, fix a Le Fort III facial fracture, and revise a facial scar--oh, and better not forget--tweak out a few wisdom teeth!

Want to know more?

We tend to be a friendly bunch of people. If you are interested why not consider arranging a clinical attachment or elective at your local unit.

Further information

www.baoms.org.uk (The British Association of Oral and Maxillofacial Surgeons)
www.rcseng.ac.uk
www.rcse.ac.uk
www.rcsi.ie