Maxillofacial surgery and links with other dental specialties

on 8th April 2019

Nicola Parten touches on the interworking relationships and day-to-day interactions a maxillofacial senior house officer may have with different dental specialties.

Often when applying for dental speciality training the applicant is required to have undertaken at least six months in a maxillofacial surgery role. This is not simply a tick box exercise, but is important for a wider understanding of the speciality as many disciplines work closely with the maxillofacial department in one way or another.

Paediatric dentistry

Depending on the unit the maxillofacial team forms part of the multidisciplinary team caring for patients with cleft lip and palate, alongside paediatric dentists, orthodontists and speech and language therapists.

These patients undergo extensive surgeries at different stages in which each discipline has a roll to play contributing to the patient’s final function and aesthetics.

Paediatric dental caries and trauma are common and often present to the accident and emergency department. Management such as extractions, and/or immediate trauma management in the form of splinting and composite bandages may be provided by the maxillofacial team or referred appropriately; this relies on close links with the paediatric team.

Orthognathic surgery

Depending on the unit, orthognathic surgery is a common procedure undertaken by the maxillofacial team. Patients will attend appointments with both orthodontist and surgeon and undergo careful planning to ensure a good final outcome.

Therefore, a broad understanding of orthodontics is required and experience of complex orthodontic cases is gained by spending time in the maxillofacial department. In addition, the maxfacs SHO may interact with these patients on the wards and is able to experience first-hand the post-surgical impact orthognathic surgery has upon the patient enabling better understanding, which may influence decision making in the future.

Oral cancer

The diagnosis and management of patients with oral cancer forms a large proportion of those seen by the maxillofacial team. Treatments may involve large surgical resections with reconstruction and graft placement.

A multidisciplinary approach to manage these patients is often taken involving teams such as restorative dentists and oncologists. To enable function post-surgery, often prostheses are used in the form of implant supported over dentures or fixed bridges.

The team must work together effectively and sometimes within the same surgery as the maxillofacial surgeon or restorative dentist may place implants at the time of resection or as part of second-stage surgery. Again, close working relationships are required and being part of the maxillofacial team exposes you to complex restorative and surgical procedures.

Special care dentistry

Special care dentistry cares for a wide range of patients. These may require dental treatment in a secondary care setting for many reasons such as dental phobia, bariatric, medically compromised patients or those with learning difficulties or mental health issues.

The maxillofacial team often helps to facilitate this along with the special care dentists. Involvement as a maxfacs SHO may include assessing these patients in a pre-admission clinic, assisting in surgery or looking after these patients on the ward following treatment.

This article shows that by spending some time as a maxfacs SHO you have the opportunity to interact with a wide range of dental specialties. It is not simply a box to tick to get you onto the next stage of national recruitment and onto specialty training, but allows you to work with the specialties from the opposite side. This provides a different experience and further insight, which may help you decide what speciality is for you, benefiting future career plans and pathways.

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