मुख तथा अनुहार शल्यचिकित्सा

Oral र Maxillofacial Surgery is surgery to correct a wide spectrum of diseases, injuries र defects in the head, neck, face, jaws र the hard र soft tissues of the oral र maxillofacial region. It is a recognized international medical specialty, which requires a minimum length of formation of 5 years for a basic medical training र 4 years for a basic medical र dental training, in the European Union. In the U.S.A. र Canada it is one of the 9 dental specialties recognized by the American Dental Association र the Royal College of Dentists of Canada.

Area of Specialty

Oral र maxillofacial surgeons are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors र cysts of the jaw र mouth, र to perform dental implant surgery. They are also trained to administer anesthesia, र provide care in an office setting.[१] The scope of this specialty is extensive र concerns the diagnosis र treatment of diseases affecting the oral (mouth) र maxillofacial (face र neck) regions, including the following:

1. Oral र Dentoalveolar Surgery (removal of impacted र buried teeth, cysts, etc.)
2. Preprosthetic Surgery (bone augmentation)
3. Dental implant surgery र associated bone grafting (to replace missing teeth or stabilise dentures; rehabilitation of patients having undergone surgery for tumours; to retain facial prostheses)
4. Orthognathic surgery (dentofacial deformities)
5. Facial trauma surgery (facial bone fractures र injuries)
6. Surgery of Odontogenic र non-odontogenic Tumors
7. Reconstructive surgery
8. Cleft lip र palate surgery
9. Congenital craniofacial deformities
10. Facial plastic surgery (rhinoplasty, rhytidectomy, blepharoplasty, facial implants, etc.)
11. Temporomandibular joint disorder (TMJD)

Oral र Maxillofacial Surgeons (OMFS) frequently work alongside other specialists including dentists, orthodontists, prosthodontists, radiologists, pathologists, oncologists, ENT surgeons, neurosurgeons, plastic surgeons र professionals allied to medicine (British Association of Oral र Maxillofacial Surgeons [२]).

Oral र Maxillofacial Surgery is often found at the bridge of dentistry र medicine, and, as such, is recognized as a medical specialty in most countries, a dental specialty in others. Most countries require dual-certification in both dentistry (DDS, DMD, or BDS) र medicine (MD, MBBS, MBBCh, or equivalent) to practice Oral र Maxillofacial Surgery.

United States

In the U.S.A., Oral र Maxillofacial Surgery is one of the 9 dental specialties recognized by the American Dental Association र requires 4–6 years of further formal University training after dental school (DDS or DMD). The 4-year residency programs grant a certificate of specialty training in Oral र Maxillofacial Surgery. The 6-year residency programs grant the specialty certificate in addition to a medical degree (MD). Specialists in this field are designated registrable U.S. “Board Eligible” र warrant exclusive titles. Approximately 50% of the training programs in the U.S. are dual-degree programs, leading to dual certification in dentistry (DMD, DDS) र medicine (MD).

The typical training program for a U.S. Oral र Maxillofacial Surgeon is:

• 4 Years Undergraduate Study (BA, BS, or equivalent)
• 4 Years Graduate Dental Study (DMD or DDS)
• 4 - 6 Years Residency Training (6 Year training includes MD Degree)
• Total Length after Secondary School: 12 - 14 Years

In addition, graduates of Oral र Maxillofacial Surgery training programs can pursue advanced fellowships, typically 1 – 2 years in length, training in the following areas:

• Craniofacial/Pediatric Maxillofacial Surgery (cleft lip र palate repair)
• Head र Neck Surgical Oncology (cancer र microvascular surgery)
• Facial Cosmetic Surgery
• Maxillofacial Trauma Surgery

Europe, UK र Australia/New Zealand

The Oral र Maxillofacial Surgeon (OMFS) is a person with a medical (MD: 6 years) र a dental degree (DDS or DMD : 5 years) or equivalent qualifications, examples of which would be a specialist certificate in Stomatology. This training must be a University Course authenticated by a certificate.

This specialty is defined within Europe, including the United Kingdom, under the medical Directive 2001/19/EC (Official Journal of the European Communities L 206, 31.07.2001). It requires 5 years for a basic medical training (MD) or 4 years of further formal University training after a dual qualification in Medicine (MD) र Dentistry (DDS or DMD).

The training program for an E.C. Oral र Maxillofacial Surgeon is:

Spain, France, Italy, Austria

• 6 Years Graduate Medical Study (including MD Degree)
• Certificate accompanying qualification: certificate of experience in Medicine
• 5 Years of formal qualification in specialised medicine for Maxillofacial Surgery
• Total Length : 11 Years

Belgium, Germany, Ireland, Luxembourg, Finland, United Kingdom

• 6 Years Graduate Medical Study (including MD Degree)
• Certificate accompanying qualification: certificate of experience in Medicine
• 3 (to 5) Years Graduate Dental Study (DMD or DDS)
• Certificate accompanying qualification: certificate of experience in Dentistry
• 4 Years of formal qualification in specialised medicine for Maxillofacial Surgery
• Total Length : 13 (to 15) Years

Belgium, Germany, Ireland, Luxembourg, Finland र the United Kingdom grant entry to higher years (usually year two or year three, depending on the course structure) to applicants with a medical or a dental degree. This shortens training time by a year or two.

Italy does not grant any shortening of training time for both degrees र specialty.

The European Directive 2001/19/EC also distinguishes Oral र Maxillofacial Surgery from other evidence of formal qualifications in specialised dentistry, such as Oral Surgery , which requires a minimum length of 3 years, is limited to Oral Surgery र is reserved to the dental practitioners, who consequently are not allowed to practice Oral र Maxillofacial Surgery.

Switzerland grants shortening of training time for Medicine र Dentistry. A formal qualification in Medicine (MD: 6 years) grants entry to the 3rd year of Dentistry (DDS or DMD : 3 years), while Dentistry (DDS or DMD : 5 years) to the 3rd year od Medicine (MD: 4 years). In Switzerland Oral र Maxillofacial Surgery requires 3 years of formal qualification in specialised Medicine.

In Eastern European states that were Communist before the end of the Cold War (U.S.S.R., D.D.R., Romania, Czechoslovakia, Hungary, Poland), Oral र Maxillofacial Surgery was a specialty of Dentistry.

Oral र Maxillofacial Surgery occupies a unique position in Australia, New Zealand र the UK, र is regarded as a true specialty of both medicine र dentistry combined.

Changes in length of training र course curriculum

Traditionally training in Oral र Maxillofacial Surgery in the UK was of four years duration र was regarded as a discipline of dentistry alone. Trainees would emerge with a Fellowship in Dental Surgery from one of the Royal Colleges of Surgeons (England, Edinburgh, Glasgow, Ireland) र the entitlement to use the FDSRCS title. Training in Australia र New Zealand followed a similar pathway, with four years of clinical training but this time generally administrated through universities, earning a Master of Dental Science degree.

However in the 1980s र 1990s due to changing trends in the practice of oral र maxillofacial surgery around the world, legislative changes occurred, first in the UK र followed shortly by Australia र New Zealand, whereby in order to train in Oral र Maxillofacial Surgery, applicants needed to be dually qualified with undergraduate degrees in dentistry र medicine. This represented official recognition of the unique position Oral र Maxillofacial Surgery occupies at the interface of the "traditionally medical" र "traditionally dental" spheres of health care.

Here the UK र the Antipodes diverged somewhat. In Australia र New Zealand, training courses were adapted to provide "integrated" training in Medicine र Oral Surgery i.e. singly qualified dentists (who at that time were the overwhelming majority of trainees) would enter into a comprehensive program, the first 3 years of which were spent as a full time medical student in order to obtain the necessary prerequisite qualifications to proceed to the surgical training. Obtaining a medical degree in Australia any other way at that time took 6 years. The shortened time was a reflection of basic sciences knowledge already possessed by the trainees. Unfortunately for trainees, training time suddenly doubled to 8 years.

In the UK however, persons wishing to practice as an Oral र Maxillofacial Surgeon had to obtain a medical degree independently of any training program. Once qualified as a dentist र as a physician, the trainee could then apply for training as an Oral र Maxillofacial Surgeon. Some UK medical schools grant entry to higher years (usually year two or year three, depending on the course structure) to applicants with a dental degree. This shortens training time by a year or two.

Oral र Maxillofacial Surgeons trained in the UK (and also in Australia र New Zealand, if training requirements increase as predicted) probably spend more aggregate time in training than any other surgical specialty.

Aggregate training time:

• 5 years Dental degree
• 4–6 years Medical degree
• 1 year Internship
• 2 years minimum Basic Surgical Training (training in a wide range of surgical disciplines)
• 4–5 years Oral र Maxillofacial Surgery Training
• 1 year Fellowship (a common practice of spending a year training at overseas institutions)

Total time: 19 years training (average)

By comparison, US-trained surgeons generally spend more time as undergraduate "Pre-med" students र less time in residency training. One might therefore regard US doctors as having a more well-rounded education, but shorter clinical training.

The popularity of oral र maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing in Australia. Integrated programs are available to medical graduates allowing them to complete a dental degree in about 3–4 years in order for them to advance to surgical training.

India

Oral & Maxillofacial Surgery (OMFS) in India is a post-graduate degree in Dentistry. The prospective surgeon has to take an examination to enter an undergraduate program in dentistry. This course is usually 4 years long. Upon completion of the program, the student has to do a 1 year internship in a dental college to get the BDS (Bachelor in Dental Surgery). In order to specialize in OMFS, the student has to take another examination to enter a 3-year MDS (Masters in Dental Surgery) program. During this period the student does a residency in general medicine, anaesthesia, general surgery, र neurosurgery . A dissertation has to submitted as part of the master's degree, र is followed by a theory exam र practical surgery exam. The degree is conferred after he is found eligible by the examiners.

There are about 3500 Oral & Maxillofacial Surgeons in India.

Organizations

• American Association of Oral र Maxillofacial Surgeons [३]
• American Board of Oral र Maxillofacial Surgery [४]
• American College of Surgeons [५]
• Directive 2001/19/EC (Official Journal of the European Communities L 206, 31.07.2001) [६]
• European Association for Cranio-Maxillofacial Surgery [७]
• Internacional Association of Oral र Maxillofacial Surgeons [८]
• British Association of Oral र Maxillofacial Surgeons [९]
• Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie [१०]
• Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [११]
• Oesterreichische Gesellschaft fuer Mund-, Kiefer- र Gesichtchirurgie [१२]
• Société Française de Stomatologie et Chirurgie Maxillo-Faciale [१३]
• Société Royale Belge de Stomatologie et de Chirurgie Maxillo-Faciale [१४]
• Société Souisse de Chirurgie Maxillo-Faciale [१५]
• Società Italiana di Chirurgia Maxillo-Facciale [१६]