History, training and scope of oral and maxillofacial surgery

Presented by:SARIN A NIZAR

1ST YEAR OMFS PG STUDENT

INTRODUCTION

• “The heritages of the past are the seeds that bring forth the harvest of the futureNot to know what has been transacted in former times is to continue always as a child. If no use is made of the labors of the past ages, the world must remain in the infancy of knowledge. ”

- Cicero, the great Roman orator

DEFINITION“ Oral and Maxillofacial surgery is

the specialty of dentistry that includes the diagnosis and surgical and adjunctive treatment of disease, injuries and defect, including both the functional and esthetic aspects of hard and soft tissues of oral and maxillofacial region”

- Peterson

History of oral & maxillofacial surgery

Hippocrates (460 BC)• Father of medicine• The famous Greek physician Hippocrates, described

manually reducing dislocation of the mandible, indicating the long history of this discipline

• Corpus Hippocraticum-or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings.

Sushruta -FATHER OF INDIAN SURGERY

Sushruta, an ancient Indian sage is universally acknowledged

as the first dental anatomist of the world

Sushruta• Taught dentistry scientifically at Kashi, at around 600 AD.

During which dentistry flourished scientifically all over. • wrote the book ‘Sushruta Samhita’.

– Described treatments of diseases of the oral cavity and emphasized the importance of tongue hygiene

• “Surgery is the first and the highest division of the healing art, pure in itself, perpetual in its applicability, a working product of heaven and sure of fame on earth" - Sushruta (400 B.C.)

• Sushruta (600 BC) taught and practiced surgery on the banks of the Ganges

• His contribution:1. Authored Susruta Samhita. 2. 120 surgical instruments3. 300 surgical procedures4. 650 drugs 5. Father of plastic surgery and cosmetic

surgery

Susruta’s knowledge from India to world

• The Sushruta samhita was translated into Arabic and Persian.

• Sushruta used skin flaps for repairing nose, procedure is described in Sushruta Samhita. This procedure was observed in India by a British Surgeon in 1793 and published in London

Vagbhata

650 ADAdvocated extraction of carious tooth with specially designed instruments.

THE DEVELOPMENT OF THE SPECIALTY

Jan Steen 1626-1696

A tooth-drawer holding up a tooth he has just extracted on stage to try and sell his skills;

THE PIONEERS OF THE SPECIALTY

Anatomists, beginning with Vesalius (1514-1564)

1575 Ambrose Pare (the Father of Surgery) published Complete Works. Carried information on tooth extraction and jaw fractures

Pierre Fauchard in

1728 wrote a

treatise called

"The Surgeon

Dentist.”

Important discoveries that supported early development

• 1.Bacteria as cause of infection. Louis Pasteur, 1822-1895

• 2. Antisepsis. Joseph Lister,1827-1912

• 3. General Anaesthesia. Horace Wells,1844 (nitrous oxide), William TG Morton,1846 (ether) and James Simpson,1846 (chloroform).

• 4.Split skin graft. Carl Thiersch, 1874

• 5. X-rays. Carl Röntgen, 1874

• Simon Hullen (1810-1857)after completing medical degree was inspired about Oral and Maxillofacial Surgery. He helped develop many modern technique of Maxillofacial surgery and contributed to the establishment of Oral and Maxillofacial Surgery as a surgical speciality in U.S. He is considered to be the first oral surgeon in U.S

The development of a specialty

Father of oral surgeryJames Edmund Garretson

• James Edmund Garretson  (1829-1895)  MB DDS was a professor of Dental college in Philadelphia.

• With his work a treatise on The Diseases And Surgery Of Mouth Jaws And Associated Parts first published in 1869, helped to establish Oral & Maxillofacial surgery in U.S

• He is known as the father of oral surgery

• He established oral surgery as a branch of medicine and dentistry though distinct from both

Truman William Brophy 1848-1928

“Oral Surgery; A Treatise on Diseases, Injuries and Malformations of the Mouth and Associated Parts” 1916

• CHALMERS J. LYONS (1874-1935)

He established principles of gentle surgery that advanced

the specialty and made extensive contributions to the oral

surgery literature.

• MATHEW H. CRYER (1840-1921)

He invented many instruments for the removal of teeth and

other surgical procedures In 1901 he established the first

dental service at the Philadelphia hospital.

• ROBERT H. IVY(1881-1974)

He was a great founder of oral surgery and plastic surgery.

“Ivy loop” for the treatment of jaw fractures

Factors defining the evolution of the profession since 1960.

• The emerge of the Journals.• The development of elective OMF surgery.• The understanding of bone healing.• The introduction of plate and screw fixation.• Endosteal implants.• The evolution of imaging techniques.• Better understanding of the pathophysiology of

benign and malignant tumours.• The understanding that complex treatment needs

team work (Cleft lip and palate, Head and Neck cancer).

• Research

Developments within the specialty that gave a boost to

the specialty.• 1960’s :Preprosthetic and orthognathic surgery.• 1970’s : The concept of primary bone healing and

subsequently the introduction of screws and mini-plates.• 1980’s Introduction Ct and MRI scans• 1980’s: Increased number of patients suffering from oral

cancer. Introduction of micro-vascular techniques for reconstruction.

• 1980’s: The introduction of titanium implants• 1990’s: The gradual introduction of esthetic surgery in the

armamentarium of OMF surgeons• 1990’s Distraction osteogenesis introduced in OMF surgery• 2000’s: 3-D imaging, Stereolithography, Stem Cell Therapy

• Oral and Maxillofacial Surgery is an evolving field and development of new techniques has widened the scope of Oral and Maxillofacial Surgery

• Today the scope of OMFS practice continues to expand as a result of educational process that is responsive to the changing needs of the specialty.

• Stem cell technology ,Microvascular surgery, skull base surgery is finding a promisable scope in Oral and Maxillofacial Surgery

PAST PRESENT

GENERAL DENTIST ORAL SURGEON

ORAL AND MAXILLOFACIAL

SURGEON

CRANIO-MAXILLOFACIAL

SURGEON

Scope......

• Diagnosis and treatment of chronic facial pain disorders

• Dento-alveolar surgery  

•  Diagnosis and treatment of benign pathology, cyst tumors and head and neck oncology

• Management of the cranio-maxillo-facial trauma ( bone, teeth, and soft tissues ), both acute injuries and sequellae 

• Preprosthetic surgery including implantology 

• Surgical and non surgical management of the temporomandibular joint disease and disorders  

• Oncological surgery and treatment in the head and neck area, including benign and malignant salivary gland tumours, and management of regional lymph node stations 

• Regional reconstructive surgery including harvesting of hard and soft tissue grafts and free tissue transfer including microsurgery 

• Orthognathic/facial orthopaedic surgery and treatment 

• Aesthetic/cosmetic/plastic facial surgery 

• Surgery and treatment of congenital abnormalities including clefts of the lips and palate. 

• Craniofacial surgery

DIAGNOSIS AND TREATMENT OF CHRONIC FACIAL PAIN DISORDERS

DENTOALVEOLAR SURGERY

• Surgery to remove impacted teeth, difficult tooth extractions,

extractions on medically compromised patients.

• Bone grafting or preprosthetic surgery to provide better anatomy

for the placement of implants, dentures, or other dental prostheses.

DIAGNOSIS AND TREATMENT OF BENIGN PATHOLOGY, CYST TUMORS AND HEAD AND NECK ONCOLOGY

MANAGEMENT OF THE CRANIO-MAXILLO-FACIAL TRAUMA ( BONE, TEETH, AND SOFT TISSUES ), BOTH ACUTE INJURIES AND SEQUELLAE

• Mandibular fractures

• Zygomatic fractures

• Nasal bone fractures

• Le-Fort fractures

• Skull fractures

• Orbital fractures

ORTHOGNATHIC/FACIAL ORTHOPAEDIC SURGERY

AND TREATMENT 

SURGERY AND TREATMENT OF CONGENITAL ABNORMALITIES INCLUDING CLEFTS OF THE LIPS AND PALATE. 

SURGICAL AND NON SURGICAL MANAGEMENT OF THE TEMPOROMANDIBULAR JOINT DISEASE AND DISORDERS 

 • Muscle disorders

• Derangement disorders

• Degenerative disorders

• Ankylosis

PREPROSTHETIC SURGERY INCLUDING IMPLANTOLOGY 

ONCOLOGICAL SURGERY AND TREATMENT IN THE HEAD AND NECK AREA, INCLUDING BENIGN AND MALIGNANT SALIVARY GLAND TUMOURS, AND MANAGEMENT OF REGIONAL LYMPH NODE

STATIONS 

AESTHETIC/COSMETIC/PLASTIC FACIAL SURGERY 

• Rhytidectomy/facelift, browlift/blepharoplasty, otoplasty,

rhinoplasty, septoplasty.

• Cheek augmentation, chin augmentation, genioplasty, neck

liposuction, lip enhancement.

• Injectable cosmetic treatments, botox, chemical peel.

AESTHETIC/COSMETIC/PLASTIC FACIAL SURGERY

 Is a surgical technique that transfers individual hair follicles from a part of the body called the 'donor site' to a balding part of the body known as the 'recipient site'. It is primarily used to treat male pattern baldness. In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to the bald scalp.It is also used to restore eyelashes and eyebrows and to fill in scars caused by accidents or surgery such as face lifts

Dimple Creation Hair transplantation

ARTICLE REVIEWN Y State Dent J. 1997 Nov;63(9):46-50.

1. Oral and maxillofacial surgery. A specialty altered by time and circumstance.

Roberts SL

The evolution of oral and maxillofacial surgery into a specialty was aided by international strife in the first half of the century. Today the scope of OMS practice continues to expand as the result of an educational process that is responsive to the changing needs of the specialty. But understanding and acceptance of the OMS scope of practice lags behind.

Nig Q J Hosp Med. 2007 Jan-Mar;17(1):8-12.

2. Public and professional perception of oral and maxillofacial surgery .

Adewole RA1, Akinwande JA

The figures indicate low awareness of the specialty by the public and the professionals

3. Are people aware of oral and maxillofacial surgery in India?

Reddy K1, Adalarasan S, Mohan S, Sreenivasan P, Thangavelu A.

• This study highlights the need to promote our speciality among the dentists, doctors and general public. and if need be even change the name of our speciality from oral and maxillofacial surgery to a more simple but more easily understood facial surgery

British Journal of Oral and Maxillofacial SurgeryVolume 51, Issue 1, January 2013, Pages e4–e5

4.Lost tribe? Awareness of oral and maxillofacial surgery (OMFS) among the general publicShahme A. Farooka, , , , Kulraj Rihalb, Anwer Abdullakuttya, Darryl Coombesa

TRAINING IN OMFS

BASIC PATTERN • The training followed in most of the countries is like• After high school candidate should do a pre med

degree (BS, BA) which will take 2-4 years (Two years in case of full time course and four years

in case of part time course)• Then 4 years of basic dental degree training (DMD,

BDent, DDS or BDS)• Then 4-6 years of speciality training program i.e four

year residency program or six year residency program

• After completing six year residency program oral and maxillofacial surgeons are now also obtaining fellowships with the American College of Surgeons (FACS)

USA

• Six Year Residency / Integrated MD Curriculum The six-year integrated MD training program has been

developed to prepare the graduate dentist for an academic and/or private practice career in Oral and Maxillofacial Surgery.

• It is an integrated clinical and didactic program designed to meet the requirements leading to certification by the American Board of Oral and Maxillofacial Surgery. The residency program is fully approved by the Commission on Dental Accreditation of the American Dental Association.

• Following successful completion of the residency program, the candidate will receive

1. a medical degree ,2. a certificate of completion for one year of General

Surgery residency, 3. a specialty certificate in Oral and Maxillofacial Surgery. 

• 4-Year Residency Curriculum• Four year Oral and Maxillofacial Surgery training program

encompassing the identical training as the six year integrated program with the exception of the medical degree. This residency program is also approved by the Commission on Dental Accreditation.

•  Standards of TrainingIn order to practice the full scope of the specialty oral and maxillo-facial surgeons are unique in that they require education and training in both medicine, dentistry and a training in surgery in general and in the relevant surgery of the specialty which should be formally recognised based on national requirements.The specialty training in oral & maxillo-facial surgery may be accomplished in a number of ways. The entry point may be either a medical degree or a dental degree. The duration of core training for Oral and Maxillo-Facial

Surgery should be 6 years.

EACMFS RECOMMENDATIONS FOR EDUCATION AND TRAINING

 European Guidelines for Specialty Training in Oral &

Maxillo–Facial Surgery   

AUSTRALIA & NEW ZEALAND

4–6 years of further formal university training after dental

school (DDS, BDent, DMD or BDS)Four year residency program

• Residents will be granted the speciality training

certificate in Oral & Maxillofacial surgery

Six year residency program

• Residents will be granted the speciality

certificate in addition to the medical degree

Canada

• Canadian training programs, are "dual-degree". The trainees obtain a degree in medicine as well as a specialty certificate in oral and maxillofacial surgery.

TRAINING IN INDIA

• 5 years of undergraduate course in dentistry (BDS)

• 3 years of post graduation in OMFS (MDS)

• Research and specialization in micro vascular

surgery and reconstruction.

• Maxillofacial surgeons having the medical degree

can go for fellowships like FACS FORCS

• The IAOMS Foundation (IAOMSF) was established in

September 1996 with the mission of passing on the

priceless gift of knowledge.  The Foundation directly

supports surgeon-to-surgeon educational efforts led by

experienced clinicians who travel from East Africa and

Asia to Indonesia, Malaysia, Cambodia, Eastern Europe

and Latin America to teach young surgeons and trainees

state-of-the art skills and procedures. The Foundation

also works to help secure donations for needed medical

equipment in these underserved areas.

Asian Association of Oral and Maxillofacial Surgeons

• Asian Association of Oral and Maxillofacial Surgeons (Asian AOMS) is a not-for-profit professional association. Asian AOMS aims to improve the quality and standards of the specialty of Oral and Maxillofacial Surgery and is committed towards promoting academic and clinical excellence amongst oral and maxillofacial surgeons in the Region. Asian AOMS is affiliated to the International Association of Oral and Maxillofacial Surgeons. 

Association of Oral and Maxillofacial Surgeons in India (AOMSI)

• The AOMSI is a registered organization and admits qualified Oral and Maxillofacial Surgeons as Life or Annual members. The Association is committed to the promotion of the specialty through its scientific deliberations and social causes. 

• The American Association of Oral and Maxillofacial Surgeons

(AAOMS), the professional organization representing more

than 9,000 oral and maxillofacial surgeons in the United

States, supports its members' ability to practice their

specialty through education, research, and advocacy. AAOMS

members comply with rigorous continuing education

requirements and submit to periodic office examinations,

ensuring the public that all office procedures and personnel

meet stringent national standards.

• EACMFS was established in 1970 by a group of

innovative European surgeons who were keen

to advance the specialty. It is has become the

most prominent and highly respected

professional group for the specialty in Europe

and has a high profile in other parts of the

World.

• BAOMS is a registered charity, and a company

limited by guarantee, not having share

capital. The overall strategic direction of the

charity is determined by the trustees, who are

assisted and advised by the other officers and

members of the Council of the Association.

Dual degree?......is it required or not….

• Journal of Oral and Maxillofacial Surgery• Volume 69, Issue 1, January 2011, Pages 242–247

• Demand for Single- and Dual-Degree Oral and Maxillofacial Surgery Residency Positions

• The T. Phan, DDS, MD⁎, , , • Joel M. Davis, DDS†

• The proportions of single- and dual-degree OMS

residency positions and applicant preference for a single- or dual-degree position have remained relatively constant during the past 14 years. Recent trends have suggested a significantly greater demand for the single- versus dual-degree OMS residency position.

• Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology• Available online 22 July 2014

• A look at current oral and maxillofacial surgery (OMS) training requirements in comparison to 1994

• Talal Ranea, • Samir Tahab, , , • Firas Nasser

• OMS remains a dental speciality in the majority of countries in the world, despite earlier claims that dual qualification is superseding single degree training fast, with some countries having also a medical OMS speciality with same scope of practice.

 • J Oral Maxillofac Surg. 2010 Nov;68(11):2926; author reply

2926-7. doi: 10.1016/j.joms.2010.07.033.

• Single degree and dual degree: we are all oral and maxillofacial surgeons.

Sharafi A.

Tex Dent J. 2004 Apr;121(4):304-9.

• The "dual degree". Does it change the scope of practice for oral and maxillofacial surgery?

Byrne RP.

CONCLUSION

Oral surgery has emerged as a specialised branch of dentistry over the course of time

and has opened new options in fields of surgery beyond basic dentistry.

As a OMFS surgeon one can move out of oral cavity and explore the fields of

oncology, plastic surgeries, craniofacial surgeries ,microvascular surgeries and

much more……………..

REFERENCES