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Oral and maxillofacial surgery
Systemhead, neck, face, jaws, hard and soft tissues of the oral and maxillofacial region
SpecialistOral and maxillofacial surgeon
GlossaryGlossary of medicine

Oral and maxillofacial surgery (OMFS) is a surgical specialty focusing on reconstructive surgery of the face, facial trauma surgery, the mouth, head and neck, and jaws, as well as facial plastic surgery including cleft lip and cleft palate surgery and rhinoplasty .

Specialty

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An oral and maxillofacial surgeon is a specialist surgeon who treats the entire craniomaxillofacial complex: anatomical area of the mouth, jaws, face, and skull, head and neck as well as associated structures. Depending upon the national jurisdiction, oral and maxillofacial surgery may require a degree in medicine, dentistry or both.

United States

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In the U.S., oral and maxillofacial surgeons, whether possessing a single or dual degree, may further specialise after residency, undergoing additional one or two year sub-specialty oral and maxillofacial surgery fellowship training in the following areas:

  • Cosmetic facial surgery, including eyelid (blepharoplasty), nose (rhinoplasty), facial lift, brow lift, and laser resurfacing
  • Cranio-maxillofacial trauma, including zygomatic (cheek bone), orbital (eye socket), mandibular and nasal fractures as well as facial soft tissue lacerations and penetrating neck injuries
  • Craniofacial surgery/paediatric maxillofacial surgery, including cleft lip and palate surgery and trans-cranial craniofacial surgery including Fronto-Orbital Advancement and Remodelling (FOAR) and total vault remodelling
  • Head and neck cancer and microvascular reconstruction free flap surgery
  • Maxillofacial regeneration, which is re-formation of the facial region by advanced stem cell technique

United Kingdom and Europe

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In countries such as the UK and most of Europe, it is recognised as a specialty of medicine with a degree in medicine and an additional degree in dentistry being compulsory.[1] The scope of practice is mainly head and neck cancer, microvascular reconstruction, craniofacial surgery and cranio-maxillofacial trauma, skin cancer, facial deformity, cleft lip and palate, craniofacial surgery, TMJ surgery and cosmetic facial surgery.

In the UK, maxillofacial surgery is a specialty of the Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh. Intercollegiate Board Certification is provided through the JCIE, and is the same as plastic surgery, ENT, general surgery, orthopaedics, paediatric surgery, neurosurgery and cardiothoracic surgery.

The FRCS (Fellowship of the Royal College of Surgeons) is the specialist exam at the end of surgical training, and is required to work as a Consultant Surgeon in maxillofacial surgery.

In the EU, OMFS is defined within Directive 2005/36 on professional qualifications (updated 2021). The two OMFS specialties are 'dual degree' dental, oral, and maxillofacial surgery (DOMFS) and 'single medical degree' maxillofacial surgery (MFS). In some cases a dental degree may be required to enter specialty training but in all cases the medical degree must be obtained before starting OMFS specialty training.[2]

In Poland, maxillofacial surgery has always been dominated by dentists and still the majority of current OMFS trainees are dental graduates.

Since 2019, Norway switched from dual degree requirement for maxillofacial surgery to medical degree only. Similarly, Sweden has started several maxillofacial surgery training programs for medical graduates. [3]

Canada and Asia

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In Asia[where?], oral and maxillofacial surgery is also recognized as a dental specialty and requires a degree in dentistry prior to surgical residency training. The Canadian model is the same as the model used in the United States of America.

Pakistan

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In Pakistan, OMFS is recognized as a specialty of dentistry which requires FCPS from CPSP after 4 years BDS degree and a one-year housejob. The candidate has to pass FCPS-1 in order to commence their training followed by PGMI Exam (not in all cases).[4]

India

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Oral and maxillofacial surgery, also known as OMFS, is a branch recognized by DCI (Dental Council of India). Becoming a maxillofacial surgeon requires a five-year dental degree followed by three years of post-graduate specialisation. Oral and maxillofacial surgery includes the treatment of complex dental surgery, including wisdom tooth removal, dental implant, craniomaxillofacial trauma, orofacial pain (trigeminal neuralgia) and jaw joint pain (temporomandibular disorder) management, jaw joint replacement for ankylosis and deformed jaw joint cases, Lefort-3 distraction for craniosynostosis case, jaw tumour and cyst removal surgery, head and neck cancer, facial aesthetic like rhinoplasty, eye and ear plastic surgery, facial cosmetic surgery, microvascular surgery, and cleft and craniomaxillofacial surgery. A maxillofacial surgeon is considered one of the required members of an emergency team. Almost 20-25% of trauma patients usually have sustained facial trauma, and that needs urgent opinion and primary management that can be better managed by maxillofacial experts.

Australia and New Zealand

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In Australia and New Zealand, oral and maxillofacial surgery is recognised as both a specialty of medicine and dentistry. Degrees in both medicine and dentistry are compulsory prior to being accepted for surgical training. The scope of practice is broad and there is the ability to undertake subspecialty fellowships in areas such as head and neck surgery and microvascular reconstruction.

Globally

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In other countries, oral and maxillofacial surgery as a specialty exists but under different forms, as the work is sometimes performed by a single or dual qualified specialist depending on each country's regulations and training opportunities available. In several countries, oral and maxillofacial surgery is a specialty recognized by a professional association, as is the case with the Dental Council of India, American Dental Association, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Dentists of Canada, Royal Australasian College of Surgeons and Brazilian Federal Council of Odontology (CFO).

Regulation in the United States

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Main article: Regulation of oral and maxillofacial surgery in the United States

Oral and maxillofacial surgery is an internationally recognized surgical specialty. Oral and maxillofacial surgery is formally designated as either a medical, dental or dual (medical and dental) specialty.

In the United States, oral and maxillofacial surgery is a recognised surgical specialty, formally designated as a dental specialty. A professional dental degree is required,[5] a qualification in medicine may be undertaken optionally during residency training. In this respect, oral and maxillofacial surgery is sui generis among surgical specialties.[6] Board certification in the U.S. is governed by the American Board of Oral and Maxillofacial Surgery (ABOMS).[7] Oral and maxillofacial surgery is among the fourteen surgical specialties recognized by the American College of Surgeons.[8] Oral and maxillofacial surgeons in the United States, whether single or dual degree, may become Fellows of the American College of Surgeons, "FACS" (Fellow, American College of Surgeons).[9]

The American Association of Oral and Maxillofacial Surgeons (AAOMS) is the chief professional organization representing the roughly 9,000 oral and maxillofacial surgeons in the United States.[10] The American Association of Oral and Maxillofacial Surgeons publishes the peer-reviewed Journal of Oral and Maxillofacial Surgery.

Surgical procedures

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Globally, treatments may be performed on the craniomaxillofacial complex: mouth, jaws, face, neck, and skull, and include:

Occupation

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Oral and maxillofacial surgery is intellectually and physically demanding and is among the most highly compensated surgical specialties in the United States[11] with a 2008 average annual income of $568,968.[12]

The popularity of oral and maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing. At least one program (University of Alabama at Birmingham) exists that allows highly qualified candidates whose first degree is in medicine to earn the required dental degree, so as to qualify for entrance into oral and maxillofacial residency training programs and ultimately achieve board eligibility and certification in the surgical specialty.[13]

Education and training

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In the UK, oral and maxillofacial surgery is one of the ten medical specialties, requiring MRCS and FRCS examinations.

In mainland Europe, its status, including whether or not oral surgery, maxillofacial surgery, and stomatology are considered separate specialties, varies by country. The required qualifications (medical degree, dental degree, or both, as well as the required internship and residency programs) also vary.

In the US, Australia and South Africa, oral and maxillofacial surgery is one of the ten dental specialties recognised by the American Dental Association, Royal College of Dentists of Canada, and the Royal Australasian College of Dental Surgeons. Oral and maxillofacial surgery requires four to six years of further formal university training after dental school (i.e., DDS, BDent, DMD, or BDS).

Residency training programs are either four or six years in duration. In the United States, four-year residency programs grant a certificate of specialty training in oral and maxillofacial surgery. Six-year programs granting an optional MD degree emerged in the early 1990s in the United States. Typically, six-year residency programs grant the specialty certificate and an additional degree such as a medical degree (e.g., MD, DO, MBBS, MBChB) or research degree (e.g., MS, MSc, MPhil, MDS, MSD, MDSc, DClinDent, DSc, DMSc, PhD). Both four– and six–year graduates are designated US "board eligible" and those who earn "board certification" are diplomats. Approximately 50% of the training programs in the US and 66%[14] of Canadian training programs are "dual-degree." The typical length of education and training, in post-secondary school is 12 to 14 years. Beyond these years, some sub-specialise, adding an additional 1-2 year fellowship.

The typical training program for an oral and maxillofacial surgeon is:

  • 2–4 years of undergraduate study (BS, BA, or equivalent degrees)
  • 4 years dental study (DMD, BDent, DDS or BDS)
  • 4–6 years residency training – Some programs integrate an additional degree such as a master's degree (MS, MDS, MSc, MClinDent, MScDent, MDent), doctoral degree (PhD, DMSc, DClinDent, DSc), or medical degree (e.g., MBBS, MD, DO, MBChB, MDCM)
  • After completion of surgical training most undertake final specialty examinations: US: "Board Certified (ABOMS)", Australia/NZ: FRACDS, or Canada: "FRCDC"
  • Some colleges offer membership or fellowships in oral/maxillofacial surgery: MOralSurg RCS, M(OMS) RCPS, FFD RCSI, FEBOS, FACOMS, FFD RCS, FAMS, FCDSHK, FCMFOS (SA)
  • Both single and dual qualified oral and maxillofacial surgeons may obtain fellowship with the American College of Surgeons (FACS).[15]

Surgical sub-specialty fellowship training

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In addition, single and dual-qualified graduates of oral and maxillofacial surgery training programs can pursue post-residency sub-specialty fellowships, typically 1–2 years in length, in the following areas:

Charities

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Several notable philanthropic organizations provide humanitarian oral and maxillofacial surgery globally. Smile Train was created in 1998 by Charles Wang focusing on childhood facial deformity. Operation Smile focuses on correcting cleft lips and palates in children. AboutFace, created by Paul Stanley, of the rock band KISS, who was born with a facial deformity, focuses on craniofacial disfiguration.

See also

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References

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Revisions and contributorsEdit on WikipediaRead on Wikipedia

Oral and maxillofacial surgery

View on Grokipedia
from Grokipedia
Oral and maxillofacial surgery (OMFS) is an internationally recognized surgical specialty. , it is a recognized that encompasses the diagnosis, surgical, and adjunctive treatment of diseases, injuries, and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. Recognition and training requirements vary by country; for example, in the and parts of , it is typically a dual dental-medical qualification. This field bridges and , addressing conditions affecting the mouth, jaws, face, head, and neck, including dentoalveolar issues, trauma, congenital deformities, and oncologic pathologies. Oral and maxillofacial surgeons (OMS) manage a broad , from routine procedures like extractions and placement to complex interventions such as for jaw correction, repair, and following tumor resection. They also handle benign and malignant tumors, cysts, severe infections, and disorders, often providing comprehensive care that integrates , , and reconstructive techniques. The specialty emphasizes both functional restoration and aesthetic outcomes, with OMS professionals frequently collaborating in multidisciplinary teams for head and neck and craniofacial anomalies. In the United States, training to become an OMS requires completion of a (DDS or DMD), followed by a minimum of 48 months of accredited residency in a hospital-based program, where residents gain surgical proficiency through rotations in , , and related fields. Many programs extend to 72 months and include integrated medical education leading to an MD degree, enabling dual licensure in and in numerous jurisdictions. Post-residency, by organizations like the American Board of Oral and Maxillofacial Surgery is pursued through rigorous examinations, ensuring competence in the evolving standards of the field.

Overview

Definition and scope

Oral and maxillofacial surgery (OMFS) is a surgical specialty that focuses on the , surgical, and adjunctive treatment of diseases, injuries, and defects involving the oral and maxillofacial regions, including the hard and soft tissues of the , jaws, face, head, and . Defined by professional bodies such as the , OMFS addresses both functional and esthetic aspects, aiming to restore normal form, function, and appearance in affected areas. This encompasses conditions ranging from trauma and infections to congenital deformities and neoplasms, with an emphasis on comprehensive patient management. The scope of OMFS extends to the structural, functional, and aesthetic rehabilitation of the craniofacial complex, including associated structures like the and salivary glands. Practitioners handle a wide array of pathologies, such as cysts, tumors, and developmental abnormalities, often integrating surgical interventions with nonsurgical adjunctive therapies to optimize outcomes in mastication, speech, and facial harmony. This broad remit positions OMFS at the intersection of and , enabling treatment in diverse settings from outpatient clinics to hospital operating rooms. A distinctive feature of OMFS is its requirement for dual qualification in and in many jurisdictions, which equips surgeons to navigate both dental and medical privileges while managing patients with multifaceted health needs. This foundation supports the specialty's interdisciplinary integration, where OMFS professionals collaborate closely with otolaryngologists for airway and sinus issues, plastic surgeons for reconstructive efforts, and oncologists for head and neck tumor management. Such teamwork ensures holistic care, particularly in complex cases involving multidisciplinary tumor boards and reconstructive protocols.

Historical development

The roots of oral and maxillofacial surgery trace back to the , when , often called the father of modern , published Le Chirurgien Dentiste in 1728, detailing systematic approaches to dental extractions, oral pathologies, and such as replanting avulsed teeth that laid foundational principles for surgical interventions in the region. In the , the specialty began to emerge more distinctly from general medicine and barber-surgery traditions, with advancements in treating maxillofacial injuries driven by industrial accidents and conflicts. Pioneers like Simon P. Hullihen advanced techniques for correcting jaw fractures and deformities through innovative wiring methods and resections in the 1840s, establishing early standards for trauma care. James E. Garretson's 1869 treatise A System of Oral Surgery further formalized the discipline by compiling surgical procedures for oral and facial conditions, influencing training and practice across the Atlantic. By the early 20th century, oral and maxillofacial surgery gained structure through dedicated organizations and initial training frameworks. In 1918, the American Association of Oral Surgeons—later renamed the American Association of Oral and Maxillofacial Surgeons (AAOMS)—was established by 29 dentists focused on exodontia to promote , ethics, and professional standards in the emerging field. Formal residency programs appeared in the 1920s, with mandating a three-year training period for oral surgeons starting in 1924 to ensure specialized competence in surgical techniques. In the United States, informal hospital-based apprenticeships evolved into structured programs at institutions like during this decade, though nationwide accreditation for residencies did not occur until 1947 at the Pittsburgh Veterans Administration Hospital. These developments marked a shift from dental practices toward recognized surgical . World War II profoundly accelerated the specialty's growth, as reconstructive demands from facial injuries among veterans spurred innovations in grafting, prosthetics, and multidisciplinary care, with oral surgeons collaborating closely with plastic and general surgeons in military units. The American Board of Oral Surgery (now the American Board of Oral and Maxillofacial Surgery) was authorized in 1945 to certify practitioners, enhancing professional legitimacy. Internationally, the International Association of Oral Surgeons (renamed the International Association of Oral and Maxillofacial Surgeons, or IAOMS, in 1989) was founded in 1962 to foster global collaboration and knowledge exchange among specialists. In the United States during the 1960s, momentum built for integrating medical training, culminating in the first dual-degree (DDS/MD) residency program in 1971 at Harvard and Massachusetts General Hospital, standardizing a pathway that blended dental and medical expertise to broaden the scope beyond oral confines toward full surgical integration. This evolution transformed oral and maxillofacial surgery from a dentistry adjunct into a hybrid medical-dental discipline capable of addressing complex head and neck pathologies.

Professional recognition

In the United States

Oral and maxillofacial surgery (OMS) is recognized by the (ADA) as one of the 12 dental specialties, with formal recognition of oral surgery occurring in 1947 following approval by the ADA House of Delegates. This recognition underscores OMS as a branch of focused on the and surgical treatment of diseases, injuries, and defects involving the oral and maxillofacial regions. Those OMS holding an MD degree are licensed as physicians, enabling them to function within broader medical-surgical frameworks alongside their dental specialization. A common feature of OMS training is the option for dual degrees, with surgeons first obtaining a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree, followed by residency programs that may integrate leading to a (MD) degree in many cases. Most accredited OMS residency programs are six years in duration, encompassing four to six years of surgical training with concurrent coursework, ensuring comprehensive preparation for complex head and neck procedures. This dual qualification distinguishes OMS from other dental specialties and aligns it closely with medical surgical disciplines. The Commission on Dental Accreditation (CODA), a joint entity of the ADA and the American Dental Education Association, oversees the of OMS residency programs to ensure they meet rigorous standards for advanced dental education. CODA evaluates programs based on criteria including , faculty qualifications, facilities, and patient care outcomes, with current standards emphasizing a minimum of 48 months of surgical training. Accredited programs prepare residents for the full spectrum of OMS practice. The for OMS in includes full surgical privileges in settings, administration of all levels of including general , and management of head and neck cases. Oral and maxillofacial surgeons perform procedures ranging from dentoalveolar to reconstructive interventions for trauma and tumors, often collaborating with other medical specialists in multidisciplinary teams. This broad authority stems from their dual dental-medical expertise, allowing seamless integration into hospital-based care environments. Board certification is provided exclusively by the American Board of Oral and Maxillofacial Surgery (ABOMS), the certifying body recognized by the ADA for OMS in the United States. involves passing a written qualifying examination after residency, followed by an oral certifying examination, with ongoing of required to continued competence. ABOMS diplomates demonstrate advanced and skills across the specialty's scope, enhancing standards and .

In the United Kingdom, Europe, and other regions

In the United Kingdom, oral and maxillofacial surgery (OMFS) is recognized as a dental specialty by the General Dental Council (GDC) and as a surgical specialty by the General Medical Council (GMC), requiring dual qualification with both dental and medical degrees for specialist registration. This dual registration standard was mandated in 1995 to ensure comprehensive training and practice privileges across both dental and medical domains. Across , OMFS recognition varies under directives on professional qualifications, with most countries requiring a as a prerequisite for specialty training, alongside dental qualifications in many cases. In , for instance, training is accessible only to graduates with a , emphasizing integration into broader surgical frameworks. The European Association for Cranio-Maxillo-Facial Surgery (EACMFS) plays a key role in harmonizing standards through resources like its , which outlines training pathways and promotes consistency amid national differences. In Canada, OMFS is regulated as a dental specialty by the Royal College of Dentists of Canada (RCDC), which certifies specialists following advanced training programs that often incorporate dual degrees in dentistry and medicine, similar to models elsewhere. This approach allows practitioners to address a wide range of oral and facial conditions within integrated healthcare systems. In Asia, particularly in countries like and , OMFS remains predominantly dental-focused, with training typically following a in and a three-year master's program in oral and maxillofacial surgery. Efforts toward medical integration are emerging, but hospital privileges for complex procedures are often limited to those aligned with dental scopes, reflecting ongoing challenges in full interdisciplinary recognition. In and , OMFS is established as a under the Royal Australasian College of Dental Surgeons (RACDS), with a minimum four-year training program leading to fellowship (FRACDS in OMS) that emphasizes surgical competencies without mandatory medical degrees, though optional medical training pathways exist for enhanced scope. This model supports practice in both dental and hospital settings across the region. Globally, the International Association of Oral and Maxillofacial Surgeons (IAOMS) drives efforts through guidelines established since 1992 and ongoing initiatives to elevate training quality and safety amid diverse regional models, fostering international collaboration to address varying recognition barriers.

Education and training

Prerequisites and initial education

Aspiring oral and maxillofacial surgeons must complete a rigorous foundational pathway, typically spanning 8 to 12 years before entering residency , encompassing undergraduate studies, , and in some cases, . This structure ensures proficiency in biological sciences, clinical , and basic surgical principles essential for the specialty. Undergraduate education generally requires a from an accredited institution, with prerequisite coursework focused on the sciences to prepare for dental school admission. Common requirements include two semesters each of with laboratory, general ( with laboratory, with laboratory, and physics with laboratory, alongside English composition and sometimes or biochemistry. These courses, totaling around 60-90 credit hours in science, build a strong foundation in human , , and biochemistry. Admission to is highly competitive, emphasizing a high grade point average (GPA, often above 3.5), extracurricular activities such as shadowing or , and letters of recommendation. In the United States, applicants must also take the (DAT), a standardized exam assessing academic ability, perceptual ability, and scientific knowledge. In the , similar emphasis is placed on academic performance and extracurriculars, with the (UCAT) required for most dental programs. Following undergraduate studies, candidates enter a four-year Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) program, which provides comprehensive training in general dentistry, oral , and introductory oral . The integrates basic sciences like and with clinical skills, including of oral diseases, exodontia (tooth extraction), and management of infections, through didactic lectures, simulations, and patient care rotations. In the UK, the Bachelor of Dental (BDS) typically lasts five years and follows a similar structure. For dual-degree pathways common in oral and maxillofacial , candidates pursue an additional four-year (MD) degree following or integrated with dental training, incorporating clinical rotations in general , , and to broaden medical knowledge. This extended preparation, often totaling 8 years in single-degree US paths or up to 12 years in dual-degree UK routes (5-year BDS plus 5-6-year MBBS), equips graduates for the interdisciplinary demands of the field.

Residency and advanced training

In the United States, oral and maxillofacial surgery (OMFS) residency programs are accredited by the Commission on Dental Accreditation (CODA) and typically last 4 to 6 years, with a minimum of 48 months of surgical training required to ensure comprehensive preparation for board certification. Programs integrated with medical degree pathways often extend to 6 years, incorporating 2 to 3 years of general surgery internship or medical school components to fulfill dual-degree requirements for broader surgical competency. Residents must complete a minimum of 120 weeks (approximately 28 months) in direct clinical OMFS activities, with the remainder dedicated to off-service rotations in disciplines such as anesthesiology, internal medicine, general surgery, otolaryngology (ENT), and plastic surgery to build interdisciplinary expertise. The Commission on Dental Accreditation standards were revised effective January 1, 2025, specifying rotation requirements in weeks and additional details on case distributions. The curriculum emphasizes hands-on experience in core areas, including maxillofacial trauma management, for correcting jaw deformities, and (TMJ) disorder treatments, alongside didactic components like lectures, seminars, and simulations to integrate clinical sciences. To demonstrate proficiency, residents are required to log a minimum of 300 general cases, with at least 150 performed in settings and 50 involving patients younger than 13 years, and 175 major surgical procedures across categories such as , trauma, and reconstructive cases (with at least 20 in each major category), ensuring exposure to a volume sufficient for independent practice. Assessment occurs through continuous evaluation via case logbooks, written qualifying examinations, and oral certifying exams administered by the American Board of Oral and Maxillofacial Surgery (ABOMS), culminating in diplomate status upon successful completion. In the and much of , OMFS specialty training follows a structured 5-year higher specialty program at the ST3 level, overseen by bodies like the Royal College of Surgeons of England and the British Association of Oral and Maxillofacial Surgeons (BAOMS), building on prior dual medical and dental qualifications plus core training. This phase includes rotations across hospital departments for exposure to , ENT, , and trauma services, with a focus on progressive responsibility in operating theaters. The curriculum prioritizes practical skills in trauma reconstruction, orthognathic procedures, and TMJ interventions, delivered through at least four weekly supervised theater sessions and integrated with or audit requirements to foster . Trainees maintain logbooks to track case volumes, meeting benchmarks for major procedures similar to U.S. standards, such as substantial exposure to 50 or more orthognathic and trauma cases, though exact minima vary by program. Competency is evaluated via workplace-based assessments, annual reviews through the Intercollegiate Surgical Curriculum Programme (ISCP), and the Intercollegiate Specialty Fellowship Examination (FRCS in OMFS), leading to entry on the General Medical Council's Specialist Register. These residencies provide the foundational expertise for general OMFS practice, with opportunities for subsequent fellowships in subspecialties.

Fellowship specializations

Fellowships in oral and maxillofacial surgery (OMFS) represent optional post-residency training programs, typically lasting 1 to 2 years, designed to provide advanced expertise in specialized areas beyond the core residency curriculum. These programs focus on subspecialties such as craniofacial surgery, head and neck , cosmetic facial surgery, and , allowing surgeons to develop proficiency in complex procedures like pediatric deformity correction, tumor ablation with microvascular reconstruction, aesthetic facial enhancements, and corrective jaw surgeries. Participation in these fellowships enhances surgical precision and decision-making in high-stakes cases, often involving multidisciplinary collaboration with plastic surgeons, , and anesthesiologists. In the United States, fellowships are commonly facilitated through the American Association of Oral and Maxillofacial Surgeons (AAOMS), which lists opportunities in focused areas including pediatric craniofacial surgery and microvascular reconstruction for head and neck defects. Many programs participate in the American Academy of Craniomaxillofacial Surgeons (AACMFS) Match, offering positions at institutions like the University of Michigan for oral/head and neck oncologic surgery or the University at Buffalo for pediatric-focused craniomaxillofacial training. These AAOMS-supported initiatives emphasize hands-on experience in trauma management, reconstructive techniques, and innovative surgical technologies, preparing fellows for leadership roles in academic or hospital-based practices. Internationally, the European Association for Cranio-Maxillo-Facial Surgery (EACMFS) administers fellowships through a competitive application process requiring a curriculum vitae and personal statement, targeting trainees in cranio-maxillofacial procedures across Europe. In Asia, programs often prioritize trauma and oncology, such as the 1-year Fellowship in Maxillofacial Trauma at Max Healthcare in India, which trains post-residency surgeons in managing facial injuries and reconstructive needs prevalent in high-trauma regions. Similarly, the AO CMF Foundation supports fellowships in facial trauma and head and neck reconstruction at Asian host centers, including those affiliated with Universiti Malaya in Malaysia for advanced craniomaxillofacial surgery. Completing an OMFS fellowship offers significant benefits, including refined skills for managing intricate cases, expanded research opportunities through clinical trials and publications, and improved prospects for academic positions such as professorships. Fellows often achieve higher research impact metrics, like elevated h-indexes, and greater access to federal funding, facilitating contributions to evidence-based advancements in the field. Additional credentials from organizations like the AACMFS provide recognition for specialized expertise in craniomaxillofacial surgery, requiring prior certification by the American Board of Oral and Maxillofacial Surgery (ABOMS) for active fellowship status. This certification underscores a surgeon's commitment to excellence, often leading to roles in multidisciplinary teams addressing complex deformities and traumas.

Regulation and practice

United States regulations

In the , oral and maxillofacial surgeons (OMS) are primarily licensed through state dental boards, requiring a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree from a Commission on Dental (CODA)-accredited program, passage of the Integrated (INBDE), and completion of a CODA-accredited OMS residency program typically lasting four to six years. State dental boards oversee this process, with variations in clinical examination requirements and specialty licensure; for instance, many states recognize by the American Board of Oral and Maxillofacial Surgery (ABOMS) as evidence of competency for specialty practice. OMS who pursue a dual-degree pathway during residency, earning an MD, must obtain a separate from state medical boards to fully exercise privileges in medical settings, though a dental suffices for core OMS practice. Hospital privileges for OMS are granted by individual facilities following processes that verify and , allowing full surgical rights in operating rooms, including administration of deep sedation and general anesthesia under state Dental Practice Acts. These privileges enable OMS to admit and treat patients for maxillofacial conditions in settings, with federal regulations under 42 CFR § 482.22 requiring hospitals to ensure medical staff competency regardless of degree type. To prescribe controlled substances, OMS must register with the (DEA), renewing every three years and completing an eight-hour training on safe prescribing as mandated by the Medication Access and Training Expansion (MATE) Act for registrations after June 27, 2023. Malpractice insurance is required in most states for OMS entering practice, often as a condition of hospital privileges or state licensure, with coverage tailored to the high-risk nature of surgical procedures; organizations like the Oral and Maxillofacial Surgery National Insurance Company (OMSNIC) provide specialty-specific policies. Scope of practice for OMS varies by state, generally encompassing , , and of conditions affecting the oral and maxillofacial regions, but some states impose limitations on non-MD OMS for certain advanced procedures, such as extensive head and neck or cosmetic beyond the jaws. For example, while all states permit OMS to perform and trauma repair, restrictions in a few jurisdictions may require an MD for hospital-based cardiac monitoring or specific reconstructive techniques. Oversight of OMS practice falls under the (ADA), which recognizes OMS as one of nine dental specialties since 1972, and the (AMA), which acknowledges it as a surgical discipline for dual-degree practitioners. Post-1970s state laws expanded OMS scope through strengthened training guidelines (1971) and credentialing for hospital-based care, enabling broader integration into medical systems amid growing dual-degree programs.

International variations

In the United Kingdom, oral and maxillofacial surgeons (OMFS) must register with the General Medical Council (GMC) and may also require registration with the General Dental Council (GDC) depending on the scope of their practice, particularly for dentistry-specific tasks within the National Health Service (NHS), as clarified in the GDC's 2023 position statement. This dual qualification framework stems from the specialty's integration of dental and medical training, allowing full scope of practice in hospital settings. Across , the European Union's Directive 2005/36/EC facilitates harmonization of professional qualifications for OMFS by recognizing it as a specialty that generally requires combined dental and , enabling mutual recognition of credentials among member states. Despite this framework, implementation varies by country; for instance, in , OMFS is classified exclusively as a , mandating a medical (MD) for practice and excluding dental-only qualifications. Similar medical-centric requirements exist in countries like , , and , where OMFS falls under medical rather than dental regulatory bodies, influencing training pathways and scope of autonomy. In Canada, OMFS regulation occurs at the provincial and territorial levels through bodies like the Royal College of Dental Surgeons, resulting in variations such as differing mandates or privileging criteria across jurisdictions. While the core requirement mirrors dual dental and medical degrees, systems emphasize integration of OMFS into provincially funded services, with procedures often covered under universal health plans but subject to regional wait times and differences. Australia's national registration system under the Australian Health Practitioner Regulation Agency (AHPRA) requires OMFS specialists to hold qualifications recognized by both the Dental Board and Medical Board, though territorial variations in delivery—such as state-specific Medicare Dental programs—affect access to subsidized care and rural service provision. In developing regions of and , OMFS practice is frequently regulated solely by dental councils, leading to dental-only licensing that curtails surgical autonomy and restricts advanced interventions like tumor resections or trauma management to referral-based medical systems. This limitation exacerbates access barriers in resource-scarce settings, where shortages of trained surgeons contribute to untreated maxillofacial conditions. The International Association of Oral and Maxillofacial Surgeons (IAOMS) actively advocates for regulatory reforms, including enhanced training programs and policy alignment to elevate standards and expand scope in these areas. Globally, OMFS practitioners face challenges in international credentialing, as varying recognition of dual qualifications complicates mobility and requires case-by-case verification under frameworks like the World Health Organization's guidelines. Post-2020 telemedicine regulations have introduced further disparities, with some countries permitting virtual OMFS consultations across borders under temporary waivers, while others enforce strict licensure reciprocity, hindering remote care in underserved regions.

Surgical procedures

Core oral procedures

Core oral procedures encompass the foundational surgical interventions in oral and maxillofacial surgery that address issues within the oral cavity and supporting structures, primarily involving teeth, surrounding bone, and soft tissues. These procedures are essential for managing common dental pathologies, preventing complications, and restoring oral function, often performed under in outpatient settings. They form the backbone of daily practice for oral surgeons, emphasizing minimally invasive techniques to minimize patient discomfort and promote rapid recovery. Tooth extractions represent one of the most routine core procedures, involving the removal of erupted or impacted teeth to alleviate pain, infection, or overcrowding. Simple extractions utilize forceps and elevators to grasp and luxate the tooth from its alveolar socket, suitable for fully erupted teeth with intact crowns. Surgical extractions, particularly for impacted wisdom teeth, require incisions to access the tooth, bone removal with burs, and sectioning of the tooth for piecemeal removal, followed by suturing to promote healing. These techniques reduce the risk of complications such as alveolar osteitis, with success rates exceeding 95% when performed by trained surgeons. Impacted third molars, for instance, are commonly addressed prophylactically in young adults to prevent pericoronitis or cyst formation. Dentoalveolar surgery includes targeted interventions on the tooth-bearing areas of the jaws, such as , , and placements. involves resecting the apical portion of a to remove persistent after failed endodontic treatment, typically through a flap , , and retrograde filling with biocompatible materials like to seal the . This procedure achieves healing rates of 80-90% in selected cases. excise restrictive frenal attachments, such as lingual or labial frena, using or techniques to improve mobility or orthodontic alignment; frenectomy minimizes bleeding and postoperative edema compared to traditional methods. placement entails surgical insertion of fixtures into edentulous alveolar bone to support prosthetics, often in a two-stage process allowing over 3-6 months, with survival rates over 95% in healthy patients. Management of oral infections focuses on source control through of abscesses, combined with antimicrobial therapy to eradicate bacterial pathogens. Periapical or periodontal abscesses are addressed by incising the fluctuant area, establishing drainage, and irrigating with saline, often under ; this eliminates the need for tooth extraction in many cases. Antibiotic protocols typically initiate with oral amoxicillin (500 mg three times daily for 3-7 days) or penicillin VK for penicillin-sensitive patients, escalating to amoxicillin-clavulanate or clindamycin for resistant strains or immunocompromised individuals, guided by culture if severe. Adjunctive measures include warm compresses and analgesics, with hospitalization reserved for spreading infections involving . This approach reduces hospitalization rates and promotes resolution within 48-72 hours. Biopsies for oral s are critical for potentially malignant or inflammatory conditions, employing incisional or excisional methods based on characteristics. Incisional biopsies remove a representative sample (typically 5-10 mm) from larger or suspicious s, using or punch techniques with margins of normal tissue to ensure diagnostic adequacy while preserving the site for further treatment if malignancy is confirmed. Excisional biopsies fully remove small, benign-appearing s (under 1 cm) in one piece, including a 2-3 mm margin, to achieve both and therapeutic excision. Both require , suturing, and histopathological analysis, with laser-assisted variants reducing but potentially altering tissue architecture for . Early facilitates timely intervention, with complication rates below 5%. In pediatric patients, initial repairs for cleft lip and address congenital defects to support feeding, speech, and facial growth. Cleft lip repair typically occurs at 3-6 months via Millard or rotation-advancement techniques, approximating muscle and mucosa for aesthetic and functional closure. repair follows at 9-12 months, involving intravelar veloplasty to reconstruct the levator sling and close the cleft, often with deferred until later for alveolar involvement. These procedures, performed by multidisciplinary teams, improve velopharyngeal competence and reduce incidence, with long-term success dependent on timing to minimize growth disturbances.

Maxillofacial and reconstructive procedures

Maxillofacial and reconstructive procedures in oral and maxillofacial surgery address complex skeletal, , and functional issues of the jaws and face, often requiring precise osteotomies, fixation techniques, and microvascular reconstruction to restore form and function. These interventions typically build on foundational in residency and may involve fellowships for advanced cases, distinguishing them from routine intraoral dentition-focused procedures. Common indications include congenital deformities, trauma, tumor , and degenerative conditions, with outcomes emphasizing stability, , and occlusion. Orthognathic surgery corrects dentofacial deformities such as Class II or III malocclusions and asymmetry through repositioning of the and . The Le Fort I , a horizontal cut above the teeth, allows advancement, setback, or impaction of the maxilla while preserving dental roots, performed entirely intraorally to minimize scarring. Bilateral sagittal split (BSSO) of the mandible, involving a vertical split along the ramus, enables mandibular advancement greater than 10 mm with high skeletal stability, reducing relapse rates to under 10% in many cases when combined with rigid . These procedures often use virtual surgical planning for precise cuts and plating, improving postoperative outcomes like facial harmony and airway patency. Trauma management focuses on timely reduction and stabilization of facial fractures to prevent , , or functional deficits. Mandibular fractures, the most common in maxillofacial trauma, are treated with open reduction and using miniplates and screws along the inferior border for condylar, body, or angle fractures, achieving union rates exceeding 95% when performed within 14 days of injury. Zygomatic complex fractures, often resulting from assaults or falls, require elevation via the Gillies temporal approach or intraoral access, followed by fixation with three-point miniplate osteosynthesis at the zygomaticomaxillary buttress, frontozygomatic suture, and infraorbital rim to restore orbital volume and facial projection. These techniques prioritize anatomical realignment to avoid complications like or . Reconstructive techniques restore continuity and vitality to defects from trauma, , or , using autologous tissues for optimal integration. Bone grafting employs cancellous or corticocancellous blocks from the or to augment contours or bridge gaps, promoting osteogenesis through creeping substitution and achieving incorporation in 3-6 months when vascularized. Free flaps, such as the osteocutaneous flap, provide vascularized (up to 25 cm) and for segmental defects post-tumor resection; the is harvested with its periosteal blood supply, shaped to mimic native contours, and anastomosed to recipient neck vessels under microscopy, enabling immediate placement and reducing risk to below 5%. These methods support long-term functionality, including mastication and speech, in up to 90% of patients. Temporomandibular joint (TMJ) surgery targets internal derangements, ankylosis, or arthritic destruction unresponsive to conservative measures. Arthrocentesis, a minimally invasive lavage using two 18-gauge needles to irrigate the superior joint space with 50-200 mL of saline, lyses adhesions and repositions anteriorly displaced discs, yielding pain reduction in 70-90% of cases and improved range of motion. Disc repair involves arthroscopic or open discoplasty to suture or reposition the articular disc, preserving joint mechanics in select non-perforated cases, while total joint replacement utilizes custom alloplastic prostheses (titanium fossa and ultra-high molecular weight polyethylene condyle) for end-stage disease, restoring vertical dimension and lateral excursion with success rates over 85% at 5 years. These procedures emphasize multidisciplinary evaluation to optimize outcomes. Oncologic resections prioritize complete tumor extirpation with adequate margins while preserving vital structures, often integrated with reconstructive efforts. For oral (OSCC), removes the primary lesion, followed by selective targeting levels I-III for clinically node-negative early-stage disease, which improves 3-year overall survival to 80% compared to 67.5% with observation alone by addressing occult micrometastases. Comprehensive , including levels I-V, is indicated for node-positive cases, removing lymphatics, fat, and attachments to achieve regional control rates of 90% when combined with . These approaches, guided by biopsy or imaging, minimize morbidity through nerve-sparing techniques.

Professional occupation

Scope of practice

Oral and maxillofacial surgeons (OMS) engage in a broad that encompasses the , surgical treatment, and of conditions affecting the oral cavity, jaws, face, and associated structures, often integrating dental and medical expertise to address both functional and aesthetic concerns. This practice extends to preventive care, trauma management, and reconstructive procedures, performed across diverse clinical environments to meet patient needs comprehensively. Daily roles for OMS practitioners typically involve conducting consultations in outpatient clinics to evaluate patients for conditions such as impacted teeth or deformities, performing inpatient surgeries for complex cases like tumor resections, and responding to emergency trauma calls for facial injuries resulting from accidents or . These activities require a blend of surgical precision and diagnostic acumen, often spanning routine extractions to advanced interventions, while ensuring continuity of care from initial assessment through postoperative follow-up. OMS professionals operate in varied settings, including private practices where they manage independent clinics focused on elective procedures, academic hospitals that emphasize and alongside patient care, and or facilities that prioritize trauma response and underserved populations. In contexts, for instance, OMS roles extend to deployment support and humanitarian missions, providing full-scope surgical services in resource-constrained environments. Multidisciplinary collaboration is integral to OMS practice, with surgeons partnering with orthodontists to coordinate orthognathic surgeries for correcting misalignments, and with oncologists to manage head and tumors through integrated treatment plans that combine resection and reconstruction. These teams facilitate comprehensive care, as seen in craniofacial programs where OMS input ensures alignment with prosthodontic and goals. Administrative duties form a critical component of OMS responsibilities, including patient education on treatment risks and benefits to foster informed decision-making, meticulous record-keeping to track clinical progress and comply with legal standards, and upholding ethical principles such as obtaining explicit prior to procedures. processes, in particular, involve detailed discussions to ensure patients understand potential complications, thereby mitigating liability and enhancing trust. Technological integration enhances OMS efficiency and outcomes, with widespread adoption of 3D imaging technologies like cone-beam computed for precise preoperative planning and intraoperative in procedures such as placement. are increasingly utilized for guided surgeries, offering haptic feedback and real-time adjustments to improve accuracy in delicate maxillofacial reconstructions, though their application remains evolving in routine practice.

Career paths and challenges

Oral and maxillofacial surgeons (OMFS) follow varied professional trajectories that leverage their dual dental and medical expertise. Many enter private practice, either independently or within group settings, where they manage surgical caseloads including extractions, implants, and reconstructive procedures. Others pursue academic careers, combining clinical practice with teaching and research at universities, contributing to advancements in surgical techniques and biomaterials. Subspecialty clinics offer focused opportunities in areas such as , disorders, or head and neck , often in hospital-affiliated settings. Additionally, some OMFS professionals engage in international humanitarian work, participating in missions to provide surgical care in underserved regions through organizations like the Oral and Maxillofacial Surgery Foundation or . Career advancement in OMFS typically involves achieving through the American Board of Oral and Maxillofacial Surgery (ABOMS), which requires completion of an accredited residency and passing rigorous written and oral examinations to demonstrate expertise. Publishing research in peer-reviewed journals, such as the Journal of Oral and Maxillofacial Surgery, enhances professional standing and opens doors to academic promotions. Leadership roles in professional associations, like serving on committees of the American Association of Oral and Maxillofacial Surgeons (AAOMS), further elevate careers by influencing policy and education standards. OMFS practitioners face significant challenges, including a notable of malpractice litigation; early studies reported that approximately 15-17% of surgeons encountered at least one claim annually (as of the early ), often related to routine procedures like third molar extractions, though rates have since declined. Burnout is prevalent due to demanding on-call schedules and the emotional toll of complex trauma cases. disparities persist, with women comprising less than 10% of practicing OMFS and approximately 21% of as of 2024, influenced by barriers such as work-life balance concerns and historical underrepresentation; ongoing initiatives aim to promote greater . Compensation in the United States reflects the specialty's demands. According to the U.S. Bureau of Labor Statistics Occupational Employment and Wage Statistics (May 2024 data), the mean annual wage for oral and maxillofacial surgeons is $360,240 (mean hourly $173.19), with employment of 5,330; the median annual wage is equal to or greater than $239,200. Globally, salaries vary widely; for instance, they are substantially lower in countries like or parts of compared to the , influenced by healthcare system structures and economic factors. Looking ahead, emerging trends include the integration of for enhanced diagnostic imaging and treatment planning, as well as the adoption of minimally invasive techniques using and to reduce recovery times and complications.

Organizations and initiatives

Professional associations

The International Association of Oral and Maxillofacial Surgeons (IAOMS), founded in 1962 following the First International Conference on Oral Surgery in , serves as the primary global organization dedicated to advancing the art and science of oral and maxillofacial surgery through , promotion, and the establishment of international standards. It organizes biennial International Conferences on Oral and Maxillofacial Surgery (ICOMS), facilitates continuing via webinars and programs, and supports its foundation—established in 1996—to enhance clinical training and care standards worldwide. In the United States, the American Association of Oral and Maxillofacial Surgeons (AAOMS), formed in 1918 as the American Society of Exodontists by dentists specializing in tooth extraction, represents over 11,000 members including fellows, residents, and allied staff, advocating for comprehensive training models that integrate dental (DDS/DMD) and medical (MD) degrees to broaden the . The AAOMS supports research funding through the Oral and Maxillofacial Surgery Foundation, which provides grants for scientific investigations in the field, and issues position papers on policy issues such as scope expansion and professional standards. In the , the British Association of Oral and Maxillofacial Surgeons (BAOMS), established in 1962, promotes education, research, and the development of oral and maxillofacial surgery within the , organizing annual scientific meetings and audits to uphold clinical excellence. Across , the European Association for Cranio-Maxillo-Facial Surgery (EACMFS), founded in 1970, fosters collaboration among surgeons by promoting uniform training requirements based on dual medical and dental qualifications, working with bodies like the Union Européenne des Médecins Spécialistes (UEMS) and the European Board of Oral and Maxillofacial Surgery (EBOMFS) to conduct specialist assessments during its congresses. Regionally, the Asian Association of Oral and Maxillofacial Surgeons (Asian AOMS) focuses on elevating standards across through academic exchanges, publication of the peer-reviewed Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, and affiliation with IAOMS to support clinical excellence. In the Oceania region, the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS), originating from early societies in 1958 and formalized as a representative body, serves as the peak professional organization, contributing to IAOMS as a foundation member and coordinating training accreditation and ethical guidelines. These associations collectively provide functions such as certification oversight—exemplified by the American Board of Oral and Maxillofacial Surgery (ABOMS) in the US, which verifies specialist competency—development of ethics codes like the AAOMS Code of Conduct, organization of meetings for dissemination, and issuance of position papers addressing scope expansion and professional advocacy.

Charitable and research efforts

Oral and maxillofacial surgeons participate in charitable initiatives focused on providing free surgical care for congenital deformities and trauma in underserved populations. Operation Smile, a global nonprofit, delivers cleft lip and palate repairs to children worldwide, integrating oral health services to support comprehensive care beyond surgery. Korean oral and maxillofacial surgeons have contributed to such missions since the 1990s, performing repairs for cleft conditions and related facial anomalies in low-resource settings. Similarly, Smile Train empowers local medical teams to conduct free cleft surgeries, having facilitated over 2 million procedures across more than 90 countries, with over 105,000 children receiving care in fiscal year 2023 alone. In the UK, Facing the World conducts missions to treat pediatric facial disfigurements through complex reconstructive surgeries, training local surgeons and establishing centers of excellence in regions like Vietnam to enable sustainable care. The International Association of Oral and Maxillofacial Surgeons (IAOMS) supports global outreach via its Foundation's "Gift of Knowledge" programs, initiated in 2002, which provide education and training in craniomaxillofacial trauma management to professionals in low-resource countries across , , and beyond. These efforts build capacity for handling trauma in humanitarian contexts, such as post-disaster scenarios, by focusing on skill transfer rather than one-off interventions. Research efforts in oral and maxillofacial surgery are bolstered by funding from the Oral and Maxillofacial Surgery (OMS) Foundation, affiliated with the American Association of Oral and Maxillofacial Surgeons (AAOMS), which has awarded over $17 million in grants to advance clinical investigations, including those on and outcomes. The foundation's Support Grants, offering up to $150,000 over 24 months, prioritize patient-oriented studies to improve surgical techniques and materials in areas like bone regeneration for reconstructive procedures. Key initiatives include collaborations with the (WHO) on prevention, where oral and maxillofacial surgeons contribute to screening protocols for oral potentially malignant disorders through the WHO Collaborating Centre for . Additionally, diversity programs address workforce gaps; the AAOMS promotes equity through resident mentor initiatives targeting underrepresented minorities in pre-dental and dental to enhance recruitment into the specialty. These programs aim to foster inclusive professional environments and broaden access to surgical expertise.

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