GOOD MORNING

History, training and scope of oral and maxillofacial surgery

- WORLD AND INDIAN SCENARIO

CONTENTS

• HISTORY OF ORAL AND MAXILLOFACIAL SURGERY• HISTORY OF SURGERY IN INDIA• SCOPE OF OMFS• TRAINING IN OMFS IN WESTERN COUNTRIES• TRAINING SCENARIO IN INDIA

DEFINITION OF OMFS

• “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

What we are today, as oral and maxillofacial surgeons and residents, is often taken for granted. However, it is important to remember our history, the development of our tremendous specialty, and the men and women

who helped to shape itA basic knowledge of where we came from creates the

foundation for a stronger future.

HISTORY OF ORAL AND MAXILLOFACIAL SURGERY

Early History• The history of oral surgery began from 500 BC to 300 BC

• The famous Greek physician Hippocrates, described manually reducing dislocation of the mandible, indicating the long history of this discipline

• 1210, A Guild of Barbers was created in France, split into two groups; surgeons for more complex operations, and surgeons for simpler procedures.

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

• In 1728, the oral surgeon Pierre Fauchard wrote a treatise called "The Surgeon Dentist.

• the earliest man to be designated as an oral surgeon was Simon P. Hullihen (1810-1857)

HIPPOCRATES

AMBROSE PARE

SIMON HULLIHEN

LEADERS OF THE 20TH CENTURY

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) In 1901 he established the first dental service at the philadelphia hospital. He invented many instruments for the removal of teeth and other surgical

procedures.

ROBERT H. IVY(1881-1974) He was a great founder of oral surgery and plastic surgery. “Ivy loop” for the treatment of jaw fractures.

FATHER OF ORAL SURGERY

• James Edmund Garretson (1829-1895) • He was known as the father of oral surgery, because he

named the specialty• A treatise on the diseases and surgery of the mouth, jaws

and associate parts, first published in 1869, he helped to establish oral and maxillofacial surgery as a specialty in the United States.

• Largely responsible for the establishment of oral surgery as a branch of medicine and dentistry, though distinct from both. Thus, it was the custom for several early generations of oral surgeons to hold dual degrees.

• During the second world war, omfs emerged as one of the major specialties.

• The evolution of omfs into a specialty was aided by international strife in the first half of the century.

INDIAN HISTORY

FATHER OF INDIAN SURGERY "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

Contributions-•authored Susrutha Samhita. • 120 surgical instruments, •300 surgical procedures•650 drugs .

•Also the father of Plastic Surgery and Cosmetic Surgery

•Used forehead flap rhinoplasty

CONTRIBUTION TO THE WORLD

• The conquest by Arabs of the Indian province of Sind (now a part of Pakistan)in the eighth century unleashed a scholarly exchange of scientific ideas. The Sushruta samhita was translated into Arabic and later into Persian.

• An operation using skin flaps, for example, to repair a nose, was also described in Sushruta. The procedure was observed in India by a British surgeon in 1793 and published in London the following year, thus changing the course of plastic surgery in Europe.

SCOPE OF ORAL AND MAXILLOFACIAL SURGERY

“ Courage well seasoned with prudence widens the boundaries of success”

• So is the scope of OMFS, tremendous advancement in knowledge, application of new concepts and evolvement of new techniques have considerably widened the scope of oral 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.

Scope of the specialty

• Dentoalveolar surgery• Diagnosis and treatment of benign pathology, cysts, tumors head

and neck oncology.• Diagnosis and treatment of congenital craniofacial malformations• Diagnosis and treatment of soft and hard tissue trauma of the oral

and maxillofacial region.• Diagnosis and treatment of chronic facial pain disorders• Diagnosis and treatment of temporomandibular joint (TMJ)

disorders.• Cosmetic surgery limited to the head and neck.

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 ,TUMORSAND HEAD AND NECK ONCOLOGY

DIAGNOSIS AND TREATMENT OF HARD AND SOFT TISSUE TRAUMA OF THE MAXILLOFACIAL REGION

Mandibular fractures zygomatic fractures Nasal bone fractures LeFort fractures Skull fractures Orbital fractures.

ORTHOGNATHIC SURGERY

MAXILLARY OSTEOTOMY MANDIBULAR OSTEOTOMY

GENIOPLASTY

DIAGNOSIS AND TREATMENT OF CHRONIC FACIAL PAIN DISORDERS

• TRIGEMINAL NUERALGIA• POST HERPETIC NUERALGIA• GLOSSOPHARYNGEAL NUERALGIA• GREATER OR LESSER OCCIPITAL NUERALGIA• TEMPOROMANDIBULAR JOINT DISORDER• ATYPICAL FACIAL PAIN

DIAGNOSIS AND TREATMENT OF CONGENITAL CRANIOFACIALMALFORMATIONS

• cleft lip and palate and cranial vault malformations such as craniosynostosis, (craniofacial surgery).

TMJ DISORDERS

• Muscle disorders• Derangement disorders• Degenerative disorders• ankylosis

MANAGEMENT OF PERIAPICAL PATHOLOGY

IMPLANTS

COSMETIC SURGERY LIMITED TO THE HEAD AND NECK

Rhytidectomy/facelift, browlift/blepharoplasty, otoplasty, rhinoplasty, septoplasty.

Cheek augmentation, chin augmentation, genioplasty, neck liposuction, lip enhancement.

Injectable cosmetic treatments, botox, chemical peel.

TRAINING IN OMFS

.

OMFS >> 4–6 years of further formal university training after dental school

(DDS,BDent, DMD or BDS)

Four-year residency program Six-year residency program

IN AUSTRALIA ,NEW ZEALAND AND NORTH AMERICA

grant the specialty certificate in addition to a medical degree

grant a certificate of specialty training in oral and maxillofacial surgery

DUAL DEGREE SYSTEM

• Canadian training programs, are "dual-degree". The trainees obtain a degree in medicine (MD, DO, MBBS, MBChB etc.) as well as a specialty certificate in oral and maxillofacial surgery.

• The typical training program for maxillofacial surgeon is:

• 2 – 4 years undergraduate study (BS, BA, or equivalent degrees)• 4 years dental study (DMD, BDent, DDS or BDS)• 4 – 6 years residency training (6 years includes 2 additional years for

acquiring medical degree)• Many dually qualified oral and maxillofacial surgeons are now also obtaining

fellowships with the American College of Surgeons (FACS)• Average total length after secondary school: 12 – 14 yrs

INDIAN SCENARIO

• No dual degree system • 5 years of undergraduate course in dentistry

(BDS)• 3 years of postgraduation in OMFS (MDS) • Ongoing trend of research and specialisation

in microvascular surgery and reconstruction.

Awareness of the Specialty of Oral and Maxillofacial Surgery Among Health Care Professionals in INDIA. (Journal of OMFS 2006)

A survey was done at Jawaharlal Institute of Postgraduate Medical and

Research Institute (Pondicherry)

• AIM- To establish the level of knowledge among dental, medical, and paramedical professionals of the hospital, regarding the role of oral and maxillofacial surgery in health care

• RESULT- Out of 100 41% of the medical students,

76% of the medical practitioners 58% of the paramedical workers

had heard of the name of the specialty. medical professionals are not fully aware of the expertise the specialty has to offer

• Recognition of the scope of oral and maxillofacial surgery by the public and health care professionals in USA

Journal of Oral and Maxillofacial Surgery 1996

Boston University School of Dentistry, Boston, U.S.A. survey was conducted in the Boston area to determine the awareness among

the general public and health professionals of the proper providers of treatment for the maxillofacial regi

on and the level of knowledge of the specialty of OMFS. RESULTS 90% of students 98% of practitioners had heard of OMFS 62% of the public 22% of the lay responders had ever been treated by an OMFS.

The results also suggested that many health professionals had a lack of understanding about the wide scope of surgical procedures that OMFSs offer.

• Despite all the progress that has occurred in OMFS, a large portion of the American population is still unaware of the specialty. If patients are to receive the best treatment available, it is essential to educate health care consumers and providers about the different specialties available and their role within the health profession.

CONCLUSION

• “A good maxillofacial surgeon needs to be a combination of a general surgeon, a plastic surgeon, an orthopedic surgeon, a vascular surgeon, an oncosurgeon, and a dentist.”

• This is quite daunting, but that is what makes the specialty “varied and exciting.”

REFERENCES

• R. J. FONSECA VOL 1 & 6 – OMFS• FONSECA VOL 2 - TRAUMA• TEXTBOOK OF OMFS ,LASKIN– VOL 1• CONTEMPRORARY OF OMFS, -PETERSON• AESTHETIC FACIAL SURGERY-TARDY H.BROWN• OPERATIVE MAXILLOFACIAL SURGERY-LANGDON AND PATEL• WWW.AOMSI.COM

THANK YOU