Print

Oral and maxillofacial surgery

Written by KARL PAYNE, RORY O’CONNOR, NABEELA AHMED.

skullsWhat do maxillofacial surgeons actually do?

It may sound like a cliché, but think of the face and ask what a maxillofacial surgeon can't do! It isn't only teeth and maxillofacial surgeons aren't all just dentists (although yes, you do need a medical and dental degree to start speciality training).

As a junior trainee you will spend your on-call shift seeing facial trauma. That includes suspected fractures, soft tissue injuries and dento-facial infection. Maxillofacial surgery is one of the few specialities where you are able to undertake a wide array of soft tissue work in A&E - and given the number of soft tissue injuries that present via A&E, a significant number of these will be referred to maxillofacial surgery. Being on-call is not just about admitting and clerking patients, you actually get to treat them too unlike many specialties.

For a specialist trainee the scope of surgery is broad and diverse (see table 1) and operations can range from a 12-hour head and neck cancer free flap to advancing a patients mandible and maxilla - both are complex and engaging and you acquire a unique surgical skillset.

Is maxillofacial surgery right for me?

The face is a 'high stakes' surgery and anatomically complex. These technical and aesthetic concerns make oral and maxillofacial surgery (OMFS) both a challenging and rewarding speciality.

You may be a Medical student, Foundation doctor, or a Core Surgical Trainee considering ST applications - but all the usual tactics still apply. Speak to trainees and registrars already committed to the speciality.

The Junior Trainees Group of the British Association of Oral and Maxillofacial Surgeons is an invaluable resource1; email a committee member, join the group, or attend their annual conference. If you are a medical student reading this then speak to your local hospital OMFS team and get some exposure.

As a Foundation or Core Trainee you should 'try before you buy'. Within your hospital introduce yourself to the lead Consultant and arrange to spend some time in the department. Medical school special study modules or trainee taster days/weeks are also great for this. An up-to-date article (Tahim et al.) lists all the above and more, describing the various avenues of learning more about OMFS as a career2, and the online OMFS trainee journal Face Mouth & Jaw Surgery is an excellent source of information3.

maxfax-fig1

How do I get into Maxillofacial Surgery?

If you like what you see then the Trent, Northern and Oxford deaneries all offer Foundation jobs in OMFS, and the London and Northern deaneries offer Core Training posts. As most Senior House Officer positions in OMFS are filled by dental graduates, departments are always willing to employ enthusiastic medical graduates.

You may choose to take a year out after Foundation or Core training and get real OMFS job experience as this will always be helpful in future dental school or ST application interviews.

If your decide to pursue OMFS options for dental school will soon begin to occupy your thoughts. Currently there are several four-year postgraduate courses available, with only one 3-year course offered by King's College London. However, please note that the length of Dentistry degrees is under review by the EU and may be subject to change (always check the UCAS website).

Although a considerable time commitment, returning to university is a unique opportunity to step off the surgical career escalator and spend time gaining OMFS experience, beefing up you CV and pursuing other extra-curricular activities. Touching base with a local OMFS unit during this time is crucial; they can offer you on-call shifts, projects and help you keep a foot in the door.

Unfortunately, all the pros listed above are overshadowed by the recent rise in university tuition fees. A second degree is now a major financial burden. Previously students were able to obtain NHS bursaries to pay one or two years tuition, however this commitment has not yet been confirmed for the raised fees. Either way get ready to do plenty of locum shifts and be a poor student again!

It's fair to say that the training pathway for OMFS is complex, changing and very confusing (figure 1).

If you have done Foundation Training only, but have been able to pass your MRCS and gain OMFS experience, then you are eligible to complete Core Training competencies in one year and proceed to Specialist training4. ST applications are now centralised and run out of the Severn Deanery, with two annual recruitment rounds. Compared to its competitive surgical counterparts of Plastic or Neurosurgery, the odds in OMFS are currently very favourable. Be sure to read the person specification well in advance to help tailor you CV4.

maxfaxpath-fig1

Opportunities within Maxillofacial Surgery

As a young expanding speciality there are great opportunities for academic and career fulfilment. Oral cancer is one of the most prevalent cancer types with evidence of an increasing incidence in the UK6.

The survival rate has not improved in the last 20 years, as largely patients still present late because of poor awareness on their part and delayed diagnosis by other clinicians7. These statistics are finally getting the attention and research dedication they deserve there is great scope to undertake practice changing clinical research.

Perhaps more than other surgical specialities there is the opportunity to practice OMFS abroad in developing countries. Charities such as Facing Africa or Mercy Ships treat facial conditions from clefts to noma and are always willing to recruit keen trainees to assist in projects abroad.

OMFS is exciting, expanding and engaging; and those willing to take a leap of faith and invest in a degree in dentistry will find the job opportunities and satisfaction a just reward. If this article has sparked your interest then take the time to read and discover more about OMFS as a career, and the training pathway.

References

1. http://www.baoms.org.uk/page.asp?id=84
2. Tahim A, Awal D. What resources are available for undergraduates considering a career in Oral and Maxillofacial Surgery: A review. Face Mouth Jaw Surg 2011; 1(2): 71-175
3. Face Mouth & Jaw Surgery. www.fmjs.co.uk 
4. http://www.mmc.nhs.uk/pdf/PS%202012%20ST3%20OMFS1.pdf 
5. http://info.cancerresearchuk.org/cancerstats/mortality/cancerdeaths
6. Doobaree IU, Landis SH, Linklater KM, El-Hariry I, Moller H, Tyczynski J. Head and neck cancer in South East England between 1995-1999 and 2000-2004: An estimation of incidence and distribution by site, stage and histological type. Oral Oncol 2009; 45(9): 809-14
7. Rogers SN, Vedpathak SV, Lowe D. Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective. Br J Oral Maxillofac Surg. 2011 Jul;49(5):349-53.

 

Previous issues