Specialty Leadership.

Infinite cornucopia: The future of education and training in oral and maxillofacial surgery

Dual-degree oral and maxillofacial surgery: evidence-based view of Chilean candidates

David Stanley Precious (1944-2015)

To What Extent is Each Area of Oral-Maxillofacial Surgery Practiced in the United States Today?

Objective To understand the current status of the discipline and work out the developmental tactics of oral and maxillofacial surgery in China. Methods A questionnaire on the status of oral and maxillofacial surgery was designed and dispatched to the departments of stomatology in general hospitals at the level of prefecture or higher, stomatological hospitals and schools of stomatology. The contents of the questionnaire included the scale, manpower, professional extent, amount of clinical work and professional training of oral and maxillofacial surgery. The current status was compared with the previous status 5 and 10 years ago. Results In the most institutions which were surveyed, the number of oral and maxillofacial surgeons, beds and out-patients increased, the professional extent enlarged, and the clinical level improved. However, the above-mentioned clinical parameters decreased in some basic level institutions. The number of graduate students and trainees of oral and maxillofacial surgery decreased in one-third of institutions. Conclusions The discipline of oral and maxillofacial surgery is continuously developing, but it is weakened in some basic level institutions. An effective developmental tactics should be carried on to improve the competition capability of the discipline. Key words: Questionnaires; Surgery, oral; Oral and maxillofacial surgery

Musings of Chairs

Recruitment of Future Maxillofacial Surgeons

Objective To assess the feasibility,acceptability and effects of mini-clinical evaluation exercise(mini-CEX)for performance evaluation among students or graduate students of oral and maxillofacial surgery outpatient or emergency department.Methods From 2010 to 2011,the clinical performances of forty medical college students in the outpatient department of oral and maxillofacial surgery or department of oral emergency were evaluated by three doctors.Four to eight times assessments were performed for every student during the entire study period.The patients were elected randomly in the outpatient or emergency department of oral and maxillofacial surgery,who were informed and consent to the study.Every participant assessed the evaluation at the end of the evaluation.We analyzed the processes and results of the evaluation,and assessed the effects of mini-CEX in the performance evaluation among students or graduate students of oral and maxillofacial surgery outpatient or emergency department.Results We completed 265 successfully evaluations.It took 25.3 minutes for the evaluation,and 4.1 minutes for the feedback in mean.At the end of teaching course,all students met the teaching requirement.All participants were satisfied with this kind of mini-CEX,and all participants believed that mini-CEX was a good evaluation and learning tool,too.Conclusions The mini-CEX is a reliable tool for learning and performance evaluation of students or graduate students of oral and maxillofacial surgery outpatient or emergency department,and is acceptable and well received by both students and supervisors. Key words: Mini-clinical evaluation exercise; Oral and maxillofacial surgery; Clinical teaching; Application

The International Association of oral and maxillofacial Surgeons (IAOMS) is committed to quality patient care. The education of oral and maxillofacial surgeons has, however, been in constant evolution ever since the inception of this speciality; and this state of flux reflects the dynamic expansion of its scope. Oral surgery has a unique relationship with medicine and dentistry as it straddles both professions. To understand this dynamic expansion, it is pertinent to review the present scope of oral and maxillofacial surgery. Today an oral and maxillofacial surgeon’s training includes management of trauma, surgical reconstruction of acquired and developmental deformities, temporomandibular joint surgery, dentoalveolar surgery, preprosthetic surgery including implants, management of odontogenic infections, management of oral pathology, and administration of general anaesthesia and sedation. The oral and maxillofacial surgeon routinely treats patients with systemic diseases such as acute and chronic alcoholism, diabetes mellitus, hypertension, cardiovascular and pulmonary disease, neurological problems, as well as drug abusers. The new requirement for oral and maxillofacial surgery training programmes is 48 months with rotations in anaesthesia, medicine and surgery, and a minimum of 30 months in the oral and maxillofacial surgery service. Eighteen months of off-service rotations, most or all of which are taken at an intern or resident level instead of medical student or clerk level, give oral and maxillofacial surgery (OMFS) residents high quality medical education. Their rotation in general surgery and surgical sub-specialties result in a broad exposure to the concepts and principles of surgery beyond that provided by the oral and maxillofacial surgery rotation. It is the dental education that differentiates oral and maxillofacial surgeons from other surgical specialties; therefore, formal dental education culminating in a D.D.S or D.M.D. degree is strongly encouraged. It is most desirable that this formal dental education be complemented by formal medical education culminating in a medical degree. [Jnl College of Medicine Vol.7(1) 2002: 27-29]

Surprise Billing and the No Surprises Act: Considerations for Oral-Maxillofacial Surgery

Instagram as a Marketing Tool for Oral and Maxillofacial Surgery Residencies: Overcoming Resident Recruitment Challenges in the Year of COVID-19

Do Practice Characteristics Influence Online Ratings of Oral and Maxillofacial Surgeons?

BACKGROUND:In many health services communities the scope of oral and maxillofacial surgery (OMFS) as a discipline is frequently not probably understood. Good awareness towards OMFS among different branches of health services providers is essential for better referral strategies and will be for the benefit of the patient.MATERIALS AND METHODS:The cross-sectional study was done using a specially prepared questionnaire distributed randomly to 125 general medical practitioners working in Jazan province. In this questionnaire, there were also some close-ended questions to evaluate awareness regarding a variety of conditions treated by the oral and maxillofacial surgeons.RESULTS:Out of 125 participants, 105 (84%) were aware of the oral and maxillofacial surgery as a speciality branch of dentistry. Only 52 (41.6%) participants were aware of the different treatment modalities coming under the scope of oral and maxillofacial surgery. Also in the referral of cases to the oral and maxillofacial surgeon, 50 (40%) participants referred their oral and maxillofacial region cases to OMS. Tooth removal was the only procedure where most of the medical practitioners knew it is a speciality procedure of the oral and maxillofacial surgeon. For facial fractures, 76 medical practitioners believe it comes under the scope of the orthopaedic surgeon. Similarly, for facial abscesses, 81 and 36 practitioners responded that it is a job of a general surgeon and OMS respectively.CONCLUSION:There is low awareness toward the scope of oral and maxillofacial surgery in the medical community. Knowledge and awareness of the scope of oral and maxillofacial surgery can improve the success and promptness of delivery of health services.

Objective In order to provide evidence for the effective clinical prevention of postoperative delirium (POD) , this study analyzed the related risk factors of POD after oral and maxillofacial surgery. Methods Databases including Web of Science, PubMed, Cochrane Library and EMbase were included in the searching of literatures about delirium after oral and maxillofacial surgery. The searching period was from the establishment of the databases to July 1st, 2018. The literatures were screened strictly according to the included and excluded criteria, and their quality was evaluated afterwards. POD′s related factors were extracted as available data. Statistical analysis was carried out by using RevMan 5.3 and StataSE 12.0. Results In total, 11 original studies with 2429 patients were included, in which 415 patients (17.1%) suffered from POD. The results showed that age, gender, solitary life, mental status, history of hypertension, preoperative hemoglobin and total protein, intraoperative anesthesia time, operation time, blood loss, tracheotomy, postoperative pain were risk factors for delirium after oral and maxillofacial surgery (P 0.05) . Conclusions Patients′ age, gender, mental status, hypertension and related laboratory results (preoperative hemoglobin, total protein) should be paid close attention before oral and maxillofacial surgery. Factors including anesthesia time, operation time, bleeding and ventilation should be strictly controlled. Besides, postoperative analgesia should be well managed since it can effectively prevent POD. Key words: Oral and maxillofacial; Surgery, oral; Delirium, postoperative

Background Ideally, an airway for a surgical procedure should be secured with the method that offers the greatest safety, the most efficiency, and the least morbidity. General anesthesia for oral and maxillofacial surgery is one of the most challenging tasks for an anesthetist. Nasotracheal intubation is usually required in these patients to allow an unrestricted surgical approach. It poses an interesting problem, particularly when associated with difficult airways. The GlideScope video-laryngoscopy (GVL) appears to provide better glottic visualization than direct laryngoscopy. However, the effectiveness of GlideScope for nasotracheal intubation in patients for oral or maxillofacial surgery with difficult airways requires more investigation. The aim of this study is to evaluate the usefulness of GVL versus a direct laryngoscope for nasotracheal intubation in adult patients with difficult airways presenting for oral or maxillofacial surgery. Patients and methods In this study, the Macintosh laryngscope and the Glidescope were compared for nasotracheal intubation in 40 patients ASA I–III with difficult airways undergoing oral or maxillofacial surgery. The patients were randomly assigned to a laryngoscopic group (DL group) or a Glidescope group (GV group). Before nasotracheal intubation, all patients were given a Cormack and Lehane (C&L) grade by a separate anesthetist using a Macintosh laryngoscope. The patients were then intubated using direct laryngoscopy or the GlideScope. Outcome measures included grading of view, the success or failure of intubation, numbers of intubation attempts, time to intubation, usage of Magill forceps, and complications. Results There were no differences between groups with respect to hemodynamic and oxygen saturation during the study period, P greater than 0.05. There was a significant difference in laryngoscopic views according to the C&L classification. The C&L I and II views obtained by the conventional laryngoscope increased from 70 to 95% of cases with the GlideScope ( P P less than 0.05. The intubation was successful in 95% of the patients in the GV group versus 85% in the DL group. The nasotracheal intubation performed with the direct laryngoscope (45.1±7.8 s) was significantly faster than that with the GlideScope (53.5±14.7 s), P less than 0.033. Magill forceps were used in 25% in the GV group, but were used 60% of the time in the DL group, P =0.02. The intubation failure rate was higher using the direct laryngoscope 15 versus 5% with the GlideScope, P =0.49. The incidence of a postoperative sore throat was significantly reduced in the GV group 15 versus 40% in the DL group, P =0.07. Conclusion Oral and maxillofacial surgery has a potentially difficult airway, but if managed properly, the morbidity and mortality can be reduced or avoided. The GVL can be used successfully for nasotracheal intubation in difficult airways in oral and maxillofacial surgery.