Oral & Maxillofacial Surgery European Training Requirement

The UEMS is a non-governmental organisation representing national associations of medical specialists at the European level. With a current membership of 40 national associations and operating through 43 Specialist Sections and their European Boards, 17 Multidisciplinary Joint Committees and 4 Thematic Federations the UEMS is committed to promote the free movement of medical specialists across Europe while ensuring the highest level of training which will pave the way to the improvement of quality of care for the benefit of all European citizens and beyond. The UEMS areas of expertise notably encompass Continuing Medical Education, Post Graduate Training and Quality Assurance in Medical Specialist Practice.

It is the UEMS' conviction that the quality of medical care and expertise are directly linked to the quality of training provided to the medical professionals. Therefore the UEMS committed itself to contribute to the improvement of medical training at the European level through the development of European Training Requirements (ETR) in the medical disciplines. No matter where doctors are trained, they should have at least the same core competencies.

In 1994, the UEMS adopted its Charter on Post Graduate Training aiming at providing the recommendations at the European level for good medical training. Made up of six chapters, this Charter set the basis for the European approach in the field of Post Graduate Training. With five chapters being common to all specialties, the Charter provided a sixth chapter (“Chapter 6”), that Specialist Sections and their Divisions were to complete according to the specific needs of their discipline.

After the introduction of this Charter, the UEMS Specialist Sections and other UEMS Bodies have continued working on developing these ETRs that reflect modern medical practice and current scientific findings. The UEMS ETRs are a voluntary effort of European medical specialists and do not aim to supersede the national curricula developed by National Competent Authorities that define the content and course of postgraduate training in their own States. UEMS aim is to indicate the knowledge and competencies that should be achieved by trainees in EU/EEA countries and also competencies and organization of the training centers. The training environment and results described in UEMS European Training Requirements may be achieved in many ways, depending on local traditions, organization of healthcare system and of medical specialist training. Adaptation of UEMS ETRs to local conditions assures the highest quality of specialist training and each state may include additional requirements, depending on local needs. UEMS ETRs are developed on the basis of medical specialist training in EU/EEA countries but are applicable and relevant globally, and may be implemented in any country with organized medical specialist training. 

At the European level, the legal mechanism ensuring the free movement of doctors through the recognition of their qualifications was established back in the 1970s by the European Union. Sectorial Directives were adopted, and one Directive addressed specifically the issue of medical Training at the European level. In 2005, the European Commission proposed to the European Parliament and Council to have a unique legal framework for the recognition of the Professional Qualifications to facilitate and improve the mobility of all workers throughout Europe. This Directive 2005/36/EC established the mechanism of automatic mutual recognition of qualifications for medical doctors among all Member States. The recognition is based on a review of the training content, its duration and on a certificate of completion of education and training. Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare introduced a strong incentive for harmonization of training and competencies among EU/EEA Countries through requirements to assure good quality of care to increasingly mobile European citizens.

Given the long-standing experience of UEMS Specialist Sections and other UEMS Bodies on the one hand and the European legal framework enabling medical specialists and trainees to move from one country to another the UEMS is uniquely in position to provide specialty-based recommendations. The UEMS values professional competence as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served”[1]. While professional activity is regulated by national law in EU Member States, it is the UEMS understanding that it has to comply with international treaties and UN declarations on Human Rights as well as the WMA International Code of Medical Ethics.

The UEMS ETR documents derive from the previous Chapter 6 of the Training Charter and provide definitions of specialist competencies and procedures as well as how to document and assess them. The ETRs aim to provide the basic training requirements for each specialty as well as optional elements and should be regularly updated by UEMS Specialist Sections and European Boards to reflect scientific and medical progress. The three-part structure of these documents reflects the UEMS approach to have a coherent pragmatic document not only for medical specialists but also for decision-makers at the national and European level interested in knowing more about medical specialist training.

The key element of every UEMS ETR is that its contents should reflect the key elements of specialist training and practice within countries where DOMFS or MFS are recognised (see map below). The authors’ approach has been to seek out the most clearly defined and well documented elements describing the core capabilities, competencies, knowledge base and behaviours within all existing OMFS training programmes across the countries of UEMS and combine them into this  ETR. To this end all the national delegates to the OMFS Section have shared their nation’s OMFS training curriculum. These documents have been placed on the OMFS Section website www.omfsuems.eu where they can be downloaded by anyone who is interested. There are no elements within this ETR which are not written in existing curricula.

Summarising the size of the 20 written OMFS curricula used to generate this ETR they range from 2 to 286 pages with a mean of 63 pages. The areas of competency within this ETR have been mapped across all these curricula. The longer curricula include detailed competencies. Others provide higher level capabilities e.g. “managing an unfiltered acute take of OMFS patients”. Both competencies and capabilities are useful for setting objectives and assessing progress of trainees and so both are included in this ETR.

A detailed syllabus or knowledge base is only present in the longer OMFS curricula. Where the knowledge base is defined, these have been collated along with extracting topics from the previous European Board Examinations (clinical and written exams). Topics and details from both sources were added to the structure defined on the eLearning for Health format of e-Face https://portal.e-lfh.org.uk/ . Most importantly, the knowledge base in this ETR has been defined by contributions from UEMS Bodies listed in Appendix 5. Some of these contributions were extensive and detailed, and the authors gratefully acknowledge their time and effort.

Where indicative numbers of procedures exist, these have been summarised onto the table at www.omfsuems.eu . The few UEMS nations in which DOMFS or MFS exist as specialty which do not yet have a written curriculum or syllabus may use this ETR when it is approved.

In common with all surgical training programmes, the primary goal of an OMFS training is to provide the trainee with a broad knowledge base, the necessary generic surgical skills and experience as well as professional judgement for independent surgical practice. A further goal is to promote critical evaluation and assessment, the ability of self-directed learning aiming to achieve clinical expertise, professionalism, excellence in management, communication skills, as well as the ability to interact with other specialties and to conduct research.

It is recognised that there are a number of national structural and operational differences in the national healthcare systems, appointments and registration procedures, as well as training pathways in these different countries. This document provides the basis for the development of a harmonised, comprehensive, structured and balanced training programme in OMFS.

Every OMFS trainee and specialist should be a good doctor. We have focused the content of this ETR on those areas of being a doctor which we consider specific to OMFS. All doctors should have the patient’s care at the forefront of their thoughts. They should be able and willing to work in a multi-disciplinary way with all professions who work in and around healthcare for the benefit of the patient.

OMFS covers the examination, prevention, treatment and rehabilitation of the congenital and acquired pathologic conditions of the head (cranium, face), the neck, the mouth, the teeth and the jaws, including the skin. Acquired conditions may result from disease, tumour, trauma, degeneration and ageing. The focus within these areas may vary within each country.

Patient safety and competent practice are both essential elements of specialty training and specialty practice. This ETR aims to promote safety and competence with  safety-critical training programme content, defined levels of performance of the trainee, the definition of critical progression points, as well as the degree of trainer supervision. The aim is that upon satisfactory completion of training programmes and trainees should be able to work safely and competently in the defined area of practice and to be able to manage or mitigate relevant risks effectively. A curriculum should be specific and refers to the entire content taught in the training programme, detailing the objectives, academic content and the methodologies to be adopted during training in order to achieve the aims. The syllabus is more descriptive and explicitly describes what areas of knowledge are required to complete training.

A feature of the curriculum is that it promotes and encourages clinical excellence through a staged progression with adjusted supervision, regular assessments, and feedback, enabling trainees to safely and steadily progress.

The human face, in most cultures, is the visible manifestation of the individual. Judgments are made based on the appearance of the face and so diseases of the face impact on individuals much more than similar diseases of internal organs or limbs.

The face lies below, above and in front of critical anatomical and functional structures. Above it is the brain, behind the spinal cord and below all the major vessels and organs of the neck. Facial operations require complex skills in hard and soft tissue surgery. In addition to surgical skills, much facial surgery is inter-disciplinary. Surgeons in this field must be able to work with colleagues across medical and dental disciplines. Allied professionals also have a key role in patient care. A facial surgeon must be an empathetic physician, a team leader and a team player within a multi-disciplinary and multi-professional workplace. They must also be a critical reviewer of scientific information, an innovator and a self-driven professional. Patients who have had facial surgery understand and appreciate this.

The two surgical specialties which include “facial surgery” within Annex V are Dental-Oral-Maxillo-Facial surgery (DOMFS) and Maxillo-Facial Surgery (MFS). Within UEMS these specialties are represented by the Section of Oral and Maxillo-Facial Surgery. Specialists in DOMFS hold both medical and dental qualifications. The majority of countries within the EEA have a specialty which includes two professions – dentists and doctors – which highlights the complex nature of delivering the highest quality of care for patients with facial problems. Because this ETR is aimed at both DOMFS and MFS, we will use the abbreviation ‘Facial Surgery and OMFS to refer to both through-out this document. The specialty names remain as they are in Annex V for each country. Throughout the remainder of this ETR for both ease of reading and clarity, we will refer to both DOMFS and MFS using Oral & Maxillo-Facial Surgery (OMFS) and ‘Facial Surgery. For individual member states this refers to MFS or DOMFS in Annex V. We hope users of this ETR will understand the pragmatic advantage of this approach.

Dental and Oral are words that the public understand to mean teeth and mouths. Maxillo originates from the Latin for jaw. Over the last 30 years the surgery undertaken by specialists trained in these two Annex V specialties has been much wider than just teeth, mouth, jaws and face. This is because reconstructing the complex skeletal structures of the face may require bone grafts taken as living transfers from the leg, hip, shoulder or arm. Removing cancer of the face may require removal of lymph nodes from the neck where metastasis may be present.

Many specialists from DOMFS and MFS undertake these resections/reconstructions within a single specialty team but others work in a multi-specialty team with the elements of the surgery being undertaken by the specialists most current in this sub-specialty competency. We have included ETRs from UEMS Sections representing the surgical and medical teams with whom we collaborate in Appendix 3 as an acknowledgement that collaborative care is essential for OMFS practice.

The key surgical domains are the major headings in our curriculum (training programme), syllabus (knowledge base), and surgical experience register (logbook). These are surgery for facial trauma, facial aesthetic & deformity, face mouth & neck cancer with reconstruction, salivary disease, oral medicine & diagnosis, head and neck cancer, cleft and craniofacial, oral and dental pathology including pre-prosthetic surgery; management of facial pain including temporomandibular joint. To these surgical domains are added the professional domains common to all surgeons including leadership, professionalism, research & ethics, lifetime learning & personal development.

Providing the highest quality care for patients with developmental or acquired diseases of the face, mouth, jaws and neck demands surgeons with wide knowledge, understanding, and skills across many domains. The balance needed at the end of training may be different as the specialist develops sub-specialty interests, focusing their vocation in a key area of care. For future surgeons in our field to be able to respond to technical and scientific innovations, a broad-based training which includes the foundations of personal development is mandatory.

Finally, we would like to highlight the difference between specialty names and the names of units in which we work. Some units try to clarify complexity of our specialty name by lengthening, rephrasing or shortening the name of their offices. Some OMFS units/departments are called ‘Facial Surgery, others Oral and Facial Surgery, Cranio-Maxillo-Facial Surgery or Maxillo-Facial/Head & Neck surgery, Paediatric Craniofacial Cleft Lip and Palate Surgery and Oral - Maxillo-and Aesthetic Facial Surgery. Often these departments are multi-disciplinary rather than single specialty based. Even when single specialty based, they will have multi-disciplinary clinics and operating lists across medical and dental boundaries. Although our training and specialists are in the specialties of OMFS, neither our patients nor their diseases recognise artificial boundaries and so it is therefore important that this ETR stresses the value of collaborative care

OMFS has a long and proud history in Europe. Doctors and dentists managing the horrific facial injuries during the First World War 1914-8 realised that patient care would be improved if they shared skills and knowledge across the areas of practice. Dentists realised a medical degree combined with surgical training would improve their capabilities. Surgeons working closely with dentists recognised that if they shared some the knowledge and skills of dentists, they could do more and better. As early as 1924 Christian Bruhn demanded and initiated the double dental and medical qualification for surgeons in this field and in 1926 August Lindemann was appointed as the first dual degree Professor of OMFS.

The original reasons for the specialty of OMFS which the pioneers of the last century recognised, still exist today in both in nations with OMFS and in nations where it does not yet exist and care is provided by other surgeons who do not have dental training, and dentists who do not have medical degrees and surgical training. In the few European nations without a recognised specialty of OMFS, there are colleagues who have acquired dual degrees for the benefit of their patients even though it is not required by national regulations. Similarly in MFS nations like Czech Republic and Hungary younger surgeons are acquiring dental degrees too.

For example a severely injured patient with a fractured mandible who has a difficult wisdom tooth in the line of the fracture close to the nerve that gives feeling to the lip could present to a hospital. A surgeon without dental training and recent experience of oral surgery would not have the skills to remove the tooth safely. A dentist could be skilled enough to remove the tooth but without a medical degree and surgical training would not be able to manage a sick patient. An OMFS surgeon has the skills to manage the whole patient.

In the field of oncology in the last century a typical treatment when a surgeon removed a patient's upper jaw, a dentist would be asked to fill the gap with a large plastic bung called an obturator. The surgeon only knew how to remove the tumour and the dentist only knew how to make an obturator. OMFS surgery combines dental and surgical training and allows to fully understand the benefits of replacing the bone of the upper jaw with bone from the iliac crest, fibula or other donor sites, inserting dental implants in this new bone, and achieving full oral rehabilitation. This was a huge step forward for the care of patients with tumours involving the facial skeleton.

As integrated national training and services are designed in areas of patient care which sit at the interface of many specialties, OMFS is recognised as a key specialty.

Definitions of Major Trauma Centres (MTCs) across the world including Europe[1] include OMFS, and training programmes for MTC leads include OMFS trainees.

The first face transplant on a patient whose face was severely damaged by a dog-attack was undertaken by a French OMFS surgeon, Bernard Devauchelle[2] and his team.

National oncology services recognise the contribution of OMFS on a par with other specialties most recently in The Netherlands[3].

One of the largest published papers on Cleft surgery was based in Europe and recognised the role of OMFS[4].

Known as the father of modern craniofacial surgery, Paul Tessier was a French OMFS surgeon[5].

 

---

We hope that this European Training Requirements (ETR) will be useful in those countries with Dental-Oral-Maxillo-Facial surgery (DOMFS) and also  Maxillo-Facial Surgery (MFS) in Annex V. For full understanding of the current situation please review Annex V PQD 2005/36 and following Documents 2013/55, Delegated Act 2016/790, COM 2016/820, Delegated Act 2017/2113, etc. - for the approval of training programmes in the member states. The denomination DOMFS corresponds to the countries where a double qualification in dentistry and medicine (assumes completion and validation of basic medical studies (Article 24) and, in addition, completion and validation of basic dental studies (Article 34) Annex V PQD 2005/36 ff.) is required to be eligible for training. MFS corresponds to the countries where a single medical qualification is required to be eligible for training and dental education has to be completed during the training.

This ETR is not aimed at colleagues who hold a single dental qualification.

For full information about OMFS in Europe, please go to www.omfsuems.eu

Defining the objectives in surgical training programmes is as important as it is complex. From within the existing OMFS curricula, and using validated medical education criteria, five areas are described within this document.

Roles: We use the CANMED[1] descriptors for roles of a surgeon these being Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional. The competencies in these domains our outlined in an agreed format in Appendix 6.

Capabilities: these describe clearly defined activities within surgical practice. An example is being able to manage an unfiltered OMFS emergency take. Demonstrating this capability is a combination of undertaking roles, demonstrating competencies, applying experience and demonstrating knowledge. The value of including capabilities within an ETR is that when a trainee demonstrates a capability without requiring support it is an important step toward independent practice. Assessing capabilities are useful toward the end of specialty training and they can be recorded as a multi-trainer feedback document or as a procedure-based assessment (PBA).

Competencies: are more focused and complex than capabilities which are broader and blended. They are particularly useful in surgery where psychomotor skills are so important but include planning, consent, team-management and all elements of care. Experience and knowledge are not competencies.

Experience: includes observations of clinical care and operative procedures. Many nations OMFS training programmes include mandated time spent working in Oto-Rhino-Laryngology (ORL) as part of early years training. This experience is recorded in a surgical experience register sometimes called a logbook. Experience in other specialties widens understanding of interface areas, improving collaborative working and inter-specialty referrals which are key capabilities for OMFS trainees and specialists. There is an OMFS European Surgical Experience Register which runs in Microsoft Access© which can be downloaded from www.omfsuems.eu and is summarised and defined in Appendix 2.

Knowledge and Understanding: are essential for good decision making, operative planning and multi-professional working. The breadth and depth of knowledge is defined in a knowledge base or syllabus (Appendix 1 of this ETR). Knowledge during training using in-training assessments such as the OMFS UEMS ITA and Case Based Discussions, Summative assessments towards the end of training also assess both knowledge and understanding in MCQs and oral examinations.

UEMS ETR Committee has defined a formal approach to overlapping competencies[1]. The authors of this ETR have consulted widely and responded to comments and suggestions. Those from whom these comments were received are acknowledged. Readers are asked to review this document and then contribute any comments or suggestions via the comments link on the OMFS Section Website www.omfsuems.eu

The authors of the OMFS ETR recognise that, as it is the case with almost all elements of modern specialist practice, there are certain areas of knowledge and competencies in the ETR which overlap with other neighbouring specialties. These overlaps include, but are not limited to: ORL, Neurosurgery, Plastic Reconstructive and Aesthetic Surgery (PRAS), Dermatology & Venereology, Endocrine Surgery, Paediatric Surgery and General Surgery.

The knowledge base or syllabus (Appendix 1) of the ETR aims to describe the knowledge base that an OMFS surgeon needs. As stated before, this knowledge overlaps in certain areas with the knowledge required in other specialties (including but not limited to ORL, Neurosurgery, Plastic Reconstructive and Aesthetic Surgery, Dermatology & Venereology, Endocrine Surgery, Paediatric Surgery and General Surgery).  However, it needs to be emphasized that required knowledge does not mean and does not translate in any way whatsoever into required competence to practice. We would like to thank all of our colleagues for their help in both highlighting and improving these areas of overlap within our syllabus and ensuring that the knowledge described is appropriate and up-to-date.

The logbook attached to this ETR (Appendix 2) aims to be a record of surgical training - operations in which a trainee has been involved.  This includes training of OMFS surgeons offered via rotations in neighbouring specialties (including but not limited to ORL, Neurosurgery, Plastic Reconstructive and Aesthetic Surgery, Dermatology & Venereology, Endocrine Surgery, Paediatric Surgery and General Surgery).  Experience offered by rotating in neighbouring specialties does not translate in any way to competence in that specialty partly or in total.  The universal principle accepted by the UEMS is that only those that only those who are recognised as specialists should be practicing independently in that specialty.

The authors of this ETR believe that is most important that the readers of the ETR also read the ETRs (especially the areas related to knowledge and competencies) of the following specialties - ORL, Neurosurgery, Plastic Reconstructive and Aesthetic Surgery, Dermatology & Venereology, Endocrine Surgery, Paediatric Surgery and General Surgery).

We have listed some of the most closely related ETRs below (with active links).

• UEMS 2020.31 ETR in ORL.pdf
• UEMS 2017.29 – ETR in Dermatology & Venerology
• UEMS 2015.34 - ETR in Neurosurgery.pdf
• UEMS 2015.29 - ETR Plastic, Reconstructive & Aesthetic Surgery (PRAS).pdf

A full list of related ETRs is found in Appendix 3.

If you find that areas of our syllabus are deficient, inaccurate or not up-to-date, please contact the OMFS Section. ETRs are living documents. We would be very happy to add or amend any or all parts.

Prerequesites for OMFS training

To complete OMFS specialty training requires a medical degree recognised in one of the EEA countries. At the end of training a professional education in dentistry is essential which may be the result of focused dental training (MFS) or a dental qualification recognised in the EEA (DOMFS) as listed in Annex V PQD 2005/36. 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.

Training Outcome Overview

To complete training successfully the trainee should acquire sufficient theoretical knowledge, practical skills and general core competencies to allow safe practice in a public or an independent institution / clinic. This involves development of competence in terms of professional judgement, diagnostic reasoning, managing uncertainty, dealing with co-morbidities, recognising when another specialty opinion or care is required, as well as developing skills in the specific areas listed below. The knowledge base is described in syllabus listed in Appendix 1. Neither the curriculum (training programme) or the syllabus (knowledge base) should be viewed as static. In common with all European Training Requirements (ETRs) they are living documents requiring regular revision and updating.

Theoretical knowledge

OMFS requires the acquisition of a solid theoretical knowledge in basic medical and surgical sciences (incl. anatomy, physiology, histopathology, pharmacology, biomechanics, etc...) as well as core knowledge related to the specialty of OMFS (see Appendix 1). Core and specialty knowledge and understanding are essential for the development of clinical and operative skills required in an elective and acute surgical setting. Knowledge and understanding of the acutely ill surgical/trauma patient and the practical skills to accompany this are core to all surgical practice.

Core surgical knowledge includes knowledge of  prevention, diagnostics (including imaging techniques), non-operative, pharmacological and surgical treatments and rehabilitation of degenerative, traumatic, inflammatory, infectious, metabolic and neoplastic pathologies. It also includes contributions to the multi-disciplinary management of congenital and neoplastic disorders and rare diseases.

The trainees in OMFS will be also expected to acquire an understanding of research methodology and carry out supervised research projects. There should be protected periods of time where a trainee can work on a research project.

All trainees must be able to demonstrate the ability to evaluate scientific publications, evidence of which will include publishing in peer reviewed journals.

Educational psychologists describe knowledge acquisition in 4 progressive steps:

• Knows of (general knowledge - undergraduate)
• Knows basic concepts (foundation)
• Knows generally (core)
• Knows specifically and broadly (specialty specific)

These descriptors could be used in trainer reports about trainees, for example in Case Based Discussions, Clinical Evaluation Exercises, or oral examinations.

Qualities Expected at Certification

By the time the trainee acquires certification in OMFS, they would be expected to possess the following qualities:

• For nations who are DOMFS in Annex V they will require full recognition and allowance to practice as a dentist in their country of training
• Knowledge and understanding of the relevant medical sciences, epidemiology, pathophysiology and principles of management and care of patients with any of the core OMFS clinical conditions.
• The ability to request and interpret appropriate diagnostic testing: laboratory tests, diagnostic imaging techniques, test performance characteristics.
• The ability to use computer-assisted technology for planning complex surgery (VSP), including the provision of patient specific implants.
• A solid understanding of the benefits and potential adverse effects of therapeutic modalities and the ability to explain these clearly to the patient or caregiver (in paediatric or geriatric patients), who can then be part of the decision-making process.
• An understanding of the benefits and risks of surgical procedures, their chances of success and failure, their potential complications and the time needed to achieve a stable result.
• The ability to keep up-to-date with scientific advances and research in the field of medicine, dentistry and OMFS, in order to maintain an evidence-based clinical practice.
• An understanding of the healthcare system(s) within their country of training.
• The ability to be an effective member and a leader of a multi-disciplinary team.

All the below competencies and capabilities are built on the core skills of managing the acutely ill surgical/trauma patient. Acquiring these skills requires core training in medicine, surgery and dentistry including an on-call rota of appropriate frequency.

As mentioned earlier, these competencies and capabilities reflect OMFS training and practice across UEMS nations and are present in published national curricula, all of which are listed at www.omfsuems.eu . Were very specific definitions are present in a nation for example in Germany the Facharzt/Fachärztin für Mund-Kiefer-Gesichtschirurgie[1] specifies ‘skin surgery on the entire integument’ the authors have ensured that this ETR is compatible with these competencies.

Key Capabilities in OMFS Practice

Working in a multi-disciplinary team – is able to safely and appropriately treat all patients with conditions requiring inter-disciplinary management and work with colleagues from across all the allied professions of medicine and dentistry.

Patients presenting with emergencies – is able to safely and appropriately manage patients.

Outpatient care – is able to safely and appropriately manage an outpatient clinic including all the clinical and administrative tasks.

Inpatient care – is able to safely and appropriately manage inpatients including all the clinical and administrative tasks including oral and parenteral nutrition, tissue and wound care, ward round leadership, and working with the multi-professional team.

Operating list - is able to safely and appropriately organise and run an operating list including all the clinical and administrative tasks.

Surgical care of the paediatric patient - Recognise limitations of own knowledge and experience and seek early advice from dedicated paediatric teams, recognising an unwell child including assessment of respiratory and cardiovascular status.

Consent - is able to safely and appropriately obtain consent across all operations within the curriculum.

Schedule of training

The minimum length of OMFS training in Annex V is 4 years for dual degree DOMFS and 5 years for single medical degree Maxillo-Facial Surgery. These are minimum training times. In most nations OMFS specialty trainees spend longer in training than these lower limits for a range of reasons.

To extend/deepen knowledge, skills and competencies in sub-specialty areas additional focused training periods (sometimes called Fellowships) may be used. These may be within the normal training period, or a defined extension to training. Often these fellowships will involve working closely with other medical and surgical disciplines. The duration of sub-specialty training may be competency or time based.

In some nations dual degree DOMFS training incorporates the acquisition of the second degree. ‘Run-through’ training programmes which incorporate core surgical/dental training and/or the second degree into a single scheme continuous with specialty training are very popular with trainees.

OMFS training must include adequate exposure to surgery in general, internal medicine and dentistry including oral surgery. Optional rotations may include General Surgery, Neurosurgery, ORL, Plastic & Reconstructive Surgery, extra-ocular ophthalmic surgery, Intensive Care/Anaesthetics, Paediatric Surgery and other medical/surgical disciplines, depending on local and national requirements. Exchanging of trainees between recognised training centres within the member states of the EU and other countries is encouraged.

Specialty training should be carried out within a specialised training programme in OMFS Training institutions or, if present, responsible administrative bodies, should select and/or appoint trainees suitable for the specialty in accordance to an established and recognised selection procedure. This selection procedure should be transparent and fair, and open to all candidates fulfilling the above criteria.

Trainees must be exposed to the full spectrum of OMFS procedures, as described in the definition of the specialty, during their training. This may require(s) a tutorship by different trainers, and it is advisable that the scope of the training is broadened by working in different training centres. The establishment of “rotation periods” covering all main areas of the specialty is advisable. The trainees should be given progressively increasing responsibilities as in the management of their patients and in surgical practice.

There should be a well-documented Education Programme throughout the training, which should include regular conferences, meetings, etc. There must be protected time allocated for study and teaching.

This Education Programme should consist of

• A programme of basic/ advanced lectures including visiting speakers
• Clinical presentations from related disciplines in joint meetings
• Pathology and radiology conferences
• Journal club
• Audit meetings
• Research meetings
• Teaching in ethics, administration, management and economics

Sub-specialty training leading to certification in an OMFS subspecialty (e.g. head and neck oncology, facial plastic aesthetic (cosmetic) surgery, cleft and craniofacial surgery) could require one or more years after completion of specialty training or demonstration of key competencies in these areas.

Curriculum of training

Within surgery the curriculum defines the whole trainee experience. In many ways a European Training Requirement (ETR) is a curriculum. The knowledge based required within a training programme is called a syllabus. A curriculum does not define how this knowledge should be acquired but it often describes how this knowledge should be assessed. The topic areas are defined within the ETR and further detail to the level of possible topics for multiple choice questions – are listed in Appendix 1. Some variations in terms of emphasis may exist, depending on the Training Centre and the country where the training takes place. However, this curriculum of training should include all the skills for generic competences and OMFS specific competences. The knowledge base defined in Appendix 1 is used within the European Board Examination in OMFS.

A European OMFS Surgeon should:

• Be a versatile specialist, as illustrated by the medical training and dental training / education.
• Be competent in history taking, clinical examination, management of patients with OMFS medical, dental and surgical conditions including unselected adult and paediatric OMFS emergencies
• Be a good communicator (with patients, their families and colleagues).
• Adhere to evidence-based medicine/surgery principles.
• Describe the healthcare provision related financial implications.
• Be fully aware of potential complications related to surgical decisions.
• Keep up-to-date with the developments of the Specialty.
• Actively participate and, when necessary, lead multi-disciplinary team (MDT) work.
• Have an understanding of OMFS Public Health issues.
• Teach and support trainees effectively.
• Maintain an ethical behaviour, adhering strictly to profession-led regulations and high standards of clinical practice.

All medical training, but especially training in craft specialties such as surgery, benefits from a professional approach to the mentoring and support of trainees. High quality induction at the start of training, the allocation of a specific and dedicated assigned educational supervisor (who may not be directly involved in clinical supervision to give some separation/perspective), and access to support from outside the training programme can all contribute to an excellent training environment.

A guide to supporting trainees is available from the UK National Association of Clinical Tutors (NACT) website Supporting Trainees 2018 http://www.nact.org.uk/getfile/8153

Training of skills and the assessment of knowledge/competence should follow a clear, structured format https://publishing.rcseng.ac.uk/doi/pdf/10.1308/003588408X286017 which will facilitatethe documentation of progress. These should include performance assessment, competence assessment, context based tests and factual texts.

The UEMS OMFS Section and the European Board in Oral& Maxillo-Facial Surgery encourage the adoption of harmonised European Standards for the assessment and evaluation of OMFS Trainees.

The training programme aims to stimulate critical self-evaluation and assessment, self-directed learning in order to achieve the highest possible level of clinical expertise, professionalism, as well as excellence in management and communication skills, including the ability to lead, to interact with other specialties and to conduct research.

Assessment and Governance of Training Programme

The governance of each training programme is the responsibility of the Programme Director and the Institution(s) in which the scheme is being delivered. Trainers will be responsible to the Programme Director for delivering a training in their area of expertise. The overall governance at national or regional level will be a core competence of the national authority in charge.

In the countries where this does not still apply, UEMS strongly encourages the implementation of structures on a national level that allow for continued reassessment of specialty training programs, in close cooperation with all participants.

Formative Assessment of Trainees

A tutor/trainer will be supervising the trainee’s clinical work and performance: regular feedback as well as guidance will be given to the trainee.

Trainees should keep a portfolio which meets the standards of the UEMS-EBOMFS application portfolio (http://www.ebomfs.eu/becoming-a-member/ ), containing details of previous training posts, examinations, lists of publications and presentations at meetings at a local, national and international level, courses attended with the CME/CPD accredited points, evidence of teaching of medical students and junior trainees which is encouraged as a means of learning for the trainee, cumulative operative totals, evidence of completed audits, copies of assessment forms corresponding to the different training periods.

The portfolio will be reviewed by the trainee’s trainer, together with the trainee in a formative manner. Operative logbooks will be scrutinized and undersigned by the appropriate trainer and the Training Program Director.

The Programme Director (or designated members of staff) leading the training institution will be meeting with the trainee at regular intervals to discuss work and progress. This appraisal will be documented. The purpose of the appraisal is to engage a constructive discussion on how the trainee’s learning needs should be met and to provide support to the trainee.

The logbook must be available at the national medical Board examination.

In summary, the assessment of the trainee should establish a balance between formative and summative assessment and different types of examinations, the use of a logbook, and should make use of specified types of medical examination formats (e.g. DOPS – direct observation of procedural skills, Mini-Cex – mini clinical examination, OSCE – Objective Structured Clinical Examinations, GRS – Global Rating Scales, OSATS – Objective Structured Assessment of Technical Skills).

This includes the assessment of Generic Professional Capabilities (GPCs), which describe common, minimum and generic standards expected of all medical practitioners achieving certification or its equivalent. The GPCs have equal weight in the training and assessment of clinical capabilities and responsibilities in the training programme.

The GPC framework includes:

1. Professional knowledge
2. Professional skills
3. Professional values and behaviours
4. Health promotion and illness prevention
5. Leadership and team-working
6. Patient safety and quality improvement
7. Safeguarding vulnerable groups

Professional behaviour is part of the trainee’s assessment using various tools including a multi-source feedback (MSF).

In return, trainee feedback regarding their training is highly recommended.

Having achieved competency in OMFS during their training, trainees will become eligible to take nationally implemented Board examinations in order to obtain certification (summative assessment).

Summative Assessment of Trainees

National assessment

Dedicated National Authorities are responsible for recognition/certification of medical specialties in each member state of the UEMS member states, in accordance to national rules and EU legislation. The majority of these countries now have a compulsory National Examination consisting of an oral or a written examination or both, in order to assess knowledge, skills and clinical judgement of the candidates.

European Board Exam in Oral and Maxillo-Facial / Head and Neck Surgery EBOMFS:

The European Board examination (EBOMFS) does not replace national certification but provides a European standard of certification for OMFS specialists. This examination may be taken by trainees from EU Countries in their last year of training or after completion of training. Nevertheless the certificate will only be validated after the national exam in the respective EU country.

Candidates for the EBOMFS Assessment must satisfy one of the three following terms:

• Recognised specialists in dental oral and maxillo-facial surgery based on a medical and dental degree.
• Recognised specialists in oral and maxillo-facial surgery based on a medical degree and dental education.
• Recognised specialists in oral and maxillo-facial surgery which is dual degree but under dental specialties (e.g. The Netherlands).

The EBOMFS Assessment is composed of two parts

Step 1. Evaluation of the Curriculum vitae (CV) and Logbook, i.e. the candidate’s record of the operations performed personally, including the last two years of specialty training, by the EBOMFS scientific committee.

Step 2. Multiple Choice Question exam (MCQ) and the Oral examination.

The available languages of oral examination are English, French, German, Italian, Spanish.

The knowledge, the clinical acumen and the professional behaviour of candidates will be evaluated. Fellows of the European Board in OMFS should be proficient surgeons, able to make rational decisions decision based on the relevance of the clinical findings, the investigations performed, and in the best interest of their patient. The EBOMFS Assessment is composed of two parts:

Step 1. Evaluation of the Curriculum vitae (CV) and Logbook, i.e. the candidate’s record of the operations performed personally, including the last two years of specialty training, by the EBOMFS scientific committee.

The Assessment will be conducted under the following broad headings:

1. Doctoral thesis, PhD, professorship, other research and academic achievements
2. Publications in recognized national and international journals
3. Presentations at national or international meetings
4. Attendance at CME (continuing medical education) conferences and courses
5. Clinical Activity (Logbook): Operations performed: major, intermediate, minor.

Step 2.  2A Multiple Choice Question exam (MCQ) and the Oral examination.

The MCQ Exam will be conducted before the Oral examination. The assessment of MCQ will be proportional, i.e. the final points given are in relation to correct answers, The total number of MCQs is 50 + 5. One choice out of four per question is correct, no negative points..  All participants will proceed to the oral examination. Candidates not participating in the MCQ cannot take part in the oral examination. The MCQ examination is executed in English.

- 2B Oral examination:

1. Case report. Each candidate must be ready to present three well documented personal cases using electronic presentation. The jury will select one to be presented within 15 minutes, including discussion.
2. Questions and discussion covering the whole scope of the specialty (40 minutes).

The available languages of oral examination are English, French, German , Italy or Spanish.

The attitude, the clinical skills and the professional behaviour of candidates will be scrutinised. Fellows of the European Board in OMFS should be proficient surgeons, able to make rational decisions decision based on the relevance of the clinical findings, the investigations performed, and in the best interest of their patient.

Process for recognition as trainer

A trainer is a registered medical practitioner and certified OMFS surgeon who can demonstrate that he is in compliance with the requirements of continuing professional development. They must be recognised by the responsible national authority.

A trainer should possess the necessary administrative, communicative, teaching and clinical skills, and commitment to conduct the programme. They should have received instruction for training (assessment of needs and teaching objectives) and evaluation of trainees. They should be able to assess learning needs, advise on teaching objectives.

A trainer should provide evidence of academic activities (clinical and/or basic research, publications in peer reviewed journals and participation in OMFS scientific meetings).

Standards for trainers are available from the Faculty of Surgical Trainers, Royal College of Surgeons Edinburgh https://fst.rcsed.ac.uk/media/15968/standards-for-surgical-trainers-version-2.pdf

There should be a sufficient number of trainers. The ratio between the number of qualified specialists (teaching faculty) and the number of trainees should provide a close personal monitoring and provide versatile exposure to different schools of thoughts. Trainers will require administrative support.

Responsibilities of trainers

• To set realistic aims and objectives for a rotation or training period.
• To supervise the day to day work of the trainee in the ward, clinic, the operating theatre and during on-call commitments.
• To support and assess the trainees’ progress at the end of each rotation or training period.
• To encourage the trainee to carry out research.
• To ensure an appropriate balance between service commitment and training.
• To ensure that the regular assessments and reports are completed and agreed upon both by the trainer and the trainee (under the supervision of Training Program Director).
• To keep the Training Program Director informed of any problems at an early stage.
• To manage with the other trainers under the guidance of the Training Program Director any inadequacies/ deficiencies demonstrated by a trainee (see 2.5.3). The institution/ network and if necessary the relevant national authority should become involved if the local conflict between the Training Program Director and the trainee cannot be resolved.
• Recognition across the EU as regards competence to be a trainer despite practitioners coming from different countries and having different routes and extents of training is covered by Directive 2005/36/ EC (Paragraph C2/20).

Training Programme Director

The Training Programme Director must be a certified specialist in OMFS for a minimum of 5 years. Their substantial working contract must be within the training institution/network. They organise, supervise and coordinate the training activities.

The CV of the Training Program Director should provide evidence of their continuing professional development (CPD) in the field of OMFS.

The Training Program Director must have full secretarial and administrative support and there must be sufficient protected time for them to carry out their responsibilities.

Responsibilities of the Training Programme Director:

• To establish a transparent and fair selection and appointment process for trainees.
• To organise a balanced training programme with established rotations ensuring that the trainee will have complete exposure to all aspects of OMFS. The programme must be clearly defined and available to trainers and trainees.
• To ensure that there is dedicated time allocated for training and that the trainers are fulfilling their responsibilities to oversee, support and assess the trainees.
• To ensure that the individual trainees’ documentation (training portfolios) are up to date.
• To advise trainees and ensure that they attend appropriate and approved courses.
• To provide valid documentation as to the satisfactory completion of training.
• To ensure the annual collection and compilation of the number and types of operative procedures performed in the department and also in participating units connected with the training programme.
• To ensure that European and international evolving training guidelines are implemented and respected.
• To provide opportunity for research, audit and other educationally valid activities such as attending courses and scientific meetings.
• To provide a yearly and the final report on each trainee.

Quality management for trainers:

Quality management for trainers remains a core competency of respective national medical specialty boards.

Trainers should actively keep informed and involved in the new developments of the discipline through a regular attendance to Congresses and Courses duly accredited for CME. Their teaching activity should be supervised and monitored by the training programme director.

To assure the quality of the training programmes, the programme director and trainers may undergo regular auditing and external visitations of the department. This may include evaluation of their cv, practice evaluation in clinical work, surgical work and scientific publications.

Process for recognition as training centre

OMFS training may take place in a single institution or in a network of institutions working together to provide training in the full spectrum of clinical conditions and skills detailed in the curriculum.

The standards for recognition of national training institutions and educational networks are matters for national authorities, in accordance with national rules and EU legislation. In order to harmonize the different training programmes of OMFS, the European Specialist Section and Board of Oro-Maxillo-Facial Surgery have to set guidelines, which should be met at national level. Therefore, visitation and evaluation of training institutions is considered an important feedback mechanism for maintaining standards and of quality control. The evaluation should be performed by the regulatory authority, medical society or medical chamber in accordance with the national regulations. The site visiting committee may be assisted by representatives from the EBOMFS, if required.

A training institution / educational network must have national recognition / accreditation, in agreement with UEMS / national standards. In order to be accredited, an educational programme must substantially comply with the special requirements for residency training in OMFS as set down by the national medical Association

The training institution / educational network should possess an adequate infrastructure and offer qualitative and quantitative clinical exposure as defined in the scope of OMFS (European guidelines for specialty training of OMFS/ 2002, www.ebomfs.eu).

The nationally accredited training programmes which abide to the criteria set out by EBOMFS will obtain UEMS European programme approval delivered by the Board.

A training programme must be reviewed every 5 years, or within 12 months following the appointment of a new Training Programme Director.

Training institutions/ networks must offer high standards of training. The training programme should include the following requirements:

A large referral base providing an adequate case mix to support the training programme.

At least one designated fully staffed and appropriately equipped operating theatre available at all times.

Anaesthetic cover available at all times.

Access to designated and fully staffed surgical intensive care beds.

Emergency Department or Major Trauma Unit with 24 hrs admission.

On-call OMFS provision in which the trainees can participate to gain experience of emergencies including urgent/emergency airway (cricothyroidotomy/tracheostomy).

Hospitalization ward with experience in airway management.

Inpatient and outpatient clinics where non-emergency patients are seen before and after surgical procedures.

Access to paediatric OMFS as a mandatory component of a training programme. Where this is not possible, a six-month rotation in an appropriate paediatric unit will be arranged. It must be recognised that in some European states paediatric surgery requires specific training in a protected environment.

Ongoing participation of OMFS surgeons in multi-disciplinary care such as trauma and oncology.

Highly specialised centres not covering the whole OMFS field may be included in rotational systems but cannot be training centres in their own right.

Allied specialities should be sufficiently present in order to provide the trainee with the opportunity of developing their skills, in a team approach, to patient care. The training programme should be closely associated with the following departments or units officially certified for training:

Anaesthesiology, intensive care Dental/ maxillo-facial technical laboratory Dentistry ORL General surgery and traumatology Internal medicine Imaging modalities (radiology, nuclear medicine)

Neurosurgery Oncology, radiotherapy and palliative care Ophthalmology Paediatrics Pathology Plastic Aesthetic & Reconstructive Surgery (PRAS) Vascular surgery

Training institutions must be accredited with the competent national authority.

Additional accreditation on a European level such as provided by the European Board of Oral & Maxillo-Facial Surgery (EBOMFS) is strongly recommended.

Clinical Governance

The Institution needs to ensure all training requirements are met, in particular prioritisation of training above service commitment. UEMS can contribute to the establishment of a robust clinical governance via the participation of CESMA (examination quality control), EACCME (continued professional development and CME points) and NASCE (accredited skills centres).

Manpower planning

will be the prerogative of the national authority and the programme training director of the training institution overlooking the training programme. Manpower planning should be periodically revisited, based on local needs and national priorities.

External auditing

is highly recommended in order to ensure compliance of the training programme with EU directives, national guidelines and regulations, under the auspices of the national authorities.

Transparency of training programmes

UEMS strongly encourages all training institutions to make publicly available their training programmes (e.g. on their website) and selection criteria.

Framework of approval

training programmes should fully clarify how and by whom key achievements of training will be evaluated, in order to enable the trainee to progress in a structured way.

Policies on safeguarding children, adolescents and vulnerable adults

All OMFS departments must have policies in place to safeguard all children, adolescents and vulnerable adults. These policies should include provisions, where appropriate, for implementing reasonable adjustments to accommodate vulnerable patients.

Competencies - Children, adolescents and vulnerable adults

Children and adolescents are considered vulnerable by virtue of their age and stage of development.

Vulnerable patients can also include adults who – due to any number of reasons - may be unable to take care of themselves, or unable to protect themselves against significant harm or exploitation.

The reasons for this vulnerability could include, but are not limited to, any one or a combination of the following factors: learning disabilities, dementia, other psychiatric or physical disorders, adverse financial or social circumstances, a previous history of abuse and/or neglect.

Whilst it is clear that any patient who lacks capacity will by definition be vulnerable, many patients with capacity may still be unable to take care of themselves, or unable to protect themselves from significant harm or exploitation; often due to the infirmity that led them to become patients in the first place. An acute OMFS illness or injury resulting in hospital admission or attendance can heighten these vulnerabilities.

The healthcare professional is expected to represent the best interests of the patient. A collaborative working relationship with the patient and/or their carers is most likely to support this goal. The design and delivery of services should also consider the views of, and the specific needs of, the most vulnerable patients as well as those known to have low levels of access to healthcare and poor clinical outcomes. Patient safety, dignity and the delivery of patient-focused care in a safe environment should always be primary objectives of the doctor.

All doctors should be familiar with departmental policies for obtaining informed consent for procedures for children, adolescents, and vulnerable adults, and any guidelines relating to the implementation of “reasonable adjustments” for vulnerable patients. All doctors should also have the ability to contribute to multidisciplinary assessments relevant to capacity and, where a person is deemed to lack capacity, ability to sensitively inform the 'Best Interests' procedures.

The following knowledge base or syllabus indicates the range of knowledge and understanding expected of a specialist in OMFS. A knowledge base or syllabus is not a list of competencies. Knowledge of an area of clinical care or of a procedure/intervention does not equate to competency to practice in that domain. This is especially true where the knowledge is of conditions or procedures at the interface with other specialties. Where knowledge is expected at these interfaces, there are references within this syllabus to ETRs of other specialties. These highlight where knowledge of how to share care or refer are essential.

OMFS European National Curricula

Like the whole OMFS ETR, this knowledge base reflects the practice of OMFS across Europe. The national curricula of all OMFS nations in UEMS are available from the OMFS Section website www.omfsuems.eu . The detail within each curriculum varies, but the range is consistent.

Evolving Knowledge Base – Books and Journals

The breadth and depth of the knowledge base of our specialty is illustrated by a number of definitive textbooks.

The knowledge base is continually evolving and being updated through textbooks and scientific journals. Some available journals include:

European: https://www.journals.elsevier.com/journal-of-cranio-maxillofacial-surgery

Belgium: https://ojs.uclouvain.be/index.php/nemesis/about

Czech (inc PRAS): https://www.prolekare.cz/en/journals/acta-chirurgiae-plasticae

France: https://www.journals.elsevier.com/journal-of-stomatology-oral-and-maxillofacial-surgery

Germany: https://www.springer.com/journal/10006

Germany: https://www.springer.com/journal/12285

Greece: http://www.haomsjournal.org

UK: https://www.bjoms.com/

International: https://www.ijoms.com/

Open Access Textbooks

Oral and Maxillofacial Surgery for the Clinician:
https://link.springer.com/book/10.1007/978-981-15-1346-6

Critical Issues in Head and Neck Oncology:
https://link.springer.com/book/10.1007/978-3-030-63234-2

Acknowledgements

The UEMS Section and Board would like to acknowledge that the structure and content of this syllabus is based on the work of Miss Daljit Dhariwal (OMFS Consultant Surgeon: Oxford, UK) and Miss Carrie Newlands (OMFS Consultant Surgeon: Guildford, UK) through their activity as the originators of e-Face, the OMFS part of eLearning for Health https://portal.e-lfh.org.uk/ There have also been some valuable contributions from Sections of UEMS in their areas of expertise.

eLfH website provides on-line education which is restricted to those based in the UK who provide services to the NHS and Social Care in the UK. The dentistry elements ‘eDen’ are accessible through https://www.eintegrity.org/ but at present the e-Face (OMFS) elements of eLfH are not licenced for use in this way. Nations interested in gaining access to e-Face platform should contact eIntegrity via their website.

Resource link and e-Face material shared by kind permission of Health Education England e-Learning for Healthcare.

Index of Syllabus

1. Trauma
2. Head and Neck Oncology
3. Reconstruction
4. Salivary Diseases and Other Swellings of the Face and Neck
5. Deformity
6. Cleft
7. Facial Aesthetic Surgery
8. Facial Pain
9. Disorders of the TMJ
10. Oral Surgery
11. Pre-prosthetic Surgery
12. Infection
13. Oral Mucosa
14. Skin surgery
15. Craniofacial Surgery
16. Research and Ethics
17. Professional and Behavioural Standards
18. New Technologies in OMFS

1 Trauma

1.1 Epidemiology of maxillo-facial trauma

1.1.1  "Epidemiology of cranio-maxillo-facial trauma

• Present changes and trends in the incidence and aetiology of cranio-maxillo-facial trauma (CMF) with time and explain these changes.
• List associated and predisposing factors associated with CMF trauma.
• Discuss what strategies have been used in the past and are currently being applied to prevent or reduce the experience of cranio-maxillo-facial trauma.
• To make suggestions for future strategies.

1.2 Principles of bone healing

1.2.1 The structure, function and healing of normal bone

• Describe the normal development, ossification and structure of bones of the craniofacial skeleton
• Describe how a broken bone heals comparing direct with indirect bone healing
• Discuss the importance of reduction and adequate stability in bone healing
• Describe the effects of compression and tension on bone healing

 

1.2.2 What factors can influence bone healing and what can go wrong   

• Define the terms “delayed union”, “mal-union” and “non-union”
• Define the terms “osteonecrosis”, “osteoradionecrosis” and “osteomyelitis
• Identify patient factors which may adversely affect healing
• Identify fracture factors which may adversely affect healing
• Identify management factors which may adversely affect healing

 

1.3 Radiology for maxillo-facial trauma

1.3.1 Assessment of plain film radiology. Occipitomental, OPG,PA mandible

List the commonly available plain films, taken as part of a trauma series

• Critically evaluate the quality of the radiographs, and describe the radiological appearance with respect to anatomy
• Critically evaluate the diagnostic value of the various plain films
• Give approximate x-ray dose of all of the radiographs commonly encountered

1.3.2  Medical CT scan, cone beam CT, use of bone and soft tissue windows

• Define the indications for ordering a CT scan
• Describe in detail a CT scan with respect to craniofacial fracture diagnosis
• Describe the principles of ‘windowing and threshold values of CT data’
• Describe the relevance of slice thickness
• Describe the difference between a cone beam scan and a medical CT with respect to radiation dose and diagnostic potential

 

1.3.3 Radiological assessment of mandibular fractures including the condyle

• Describe the radiographs used for all fractures of the mandible.
• Accurately describe different fracture configurations.
• Discuss the radiological assessment of fractures of the mandibular condyle
• Define which fractures require CT scans
• Accurately assess intracapsular fractures of the mandibular condyle

 

1.3.4 Radiological assessment of midfacial and orbital fractures, orbital foreign body

• Accurately describe fractures of the midface, and orbito-zygomatic complex
• Describe which fractures are best imaged by CT scans
• Describe the limitations of the Le Fort classification
• Describe the role of CT and b mode ultrasound within the orbit

 

1.3.5 Radiological assessment of Craniofacial fractures

• Demonstrate the common fractures of the anterior skull base
• Describe the different types of frontal sinus and NOE fractures
• Describe the role of imaging in CSF rhinorrhoea

 

1.4 Principles of fixation

1.4.1 What is fixation and what does it aim to achieve?

• Explain the role and expectations of fixation techniques used in fracture management and in particular should explain the importance of achieving and maintaining anatomical reduction, bony alignment and fracture stability.
• Revise the concept of direct and indirect bone healing
• Explain the concept of weight-sharing and weight-bearing situations in fracture management.
• Explain the concept of tension & compression across fracture sites
• Explain the differences between rigid, semi-rigid and non-rigid fixation

1.4.2 Different methods for fixation: External fixation

• Define the term external fixation
• Describe and compare different methods of external fixation including IMF (intermaxillary fixation), arch-bars, splints and other external fixation devices incorporating pins and/or plates
• List indications for the use of external fixation devices
• Discuss advantages and disadvantages of external fixation devices

 

1.4.3         Biomechanics of plates & screws

• Describe the materials used to make internal fixation devices
• Describe the essential features of plates and screws (size, structure etc)
• Explain what is meant by the following terms: Positional screw, lag screw, tapping, self-tapping screw, self-drilling screw, non-compression plate, compression plate, locking plate

 

1.4.4         Different methods for fixation: Internal fixation

• Define the term internal fixation
• Describe and compare different methods of internal fixation including the use of screws and plates
• List indications for the use of internal fixation techniques
• Discuss advantages and disadvantages of internal fixation devices

 

1.4.5         Resorbable fixation devices

• Discuss the differences between resorbable and non-resorbable fixation devices
• Describe some of the materials which have been used in resorbable devices
• Describe how resorbable devices resorb
• Discuss advantages and disadvantages in clinical practice

 

1.5 Overall management of the traumatised patient (cross-specialty co-ordination)

1.5.1 Overview of how a Trauma Team works including ATLS (European Trauma course - ETc)

• Explain the principles of triage for trauma victims in both a civilian and military setting
• Describe the principles of caring for trauma victims in the pre-hospital setting
• Demonstrate clear understanding of the working of a Trauma Team, and the role an OMFS surgeon may play.
• Give an overview of ATLS/ETc including a description of the primary survey, monitoring and resuscitation, secondary survey and transfer to definitive care.

 

1.5.2 Primary survey (emphasising specific elements relating to CMF trauma)

• Describe how to approach a victim of trauma, assessing the airway and protecting the cervical spine
• Describe how to achieve a patent airway whilst maintaining c-spine protection
• Describe how to identify and treat potentially life-threatening breathing problems whilst maintaining ventilation
• Describe how to identify and treat potentially life-threatening circulatory problems whilst controlling haemorrhage
• Describe how to assess for a head injury and detect potentially life-threatening intra-cranial problems
• Explain the importance of exposure with control of temperature
• Explain the principles of resuscitation, stabilisation and monitoring

 

1.5.3 Secondary survey and transfer to definitive care

• Demonstrate the importance of re-assessment and monitoring of a trauma patient
• Describe how to perform a tip to toe examination
• Describe the principles of formulating a plan for definitive treatment or safe transfer

 

1.6 Mandibular fractures

1.6.1 Surgical anatomy of the mandible including presenting features, assessment, investigation and diagnosis of mandibular fractures

• Describe the component parts of the mandible including bone, muscle attachments, articulations, dental structures, nerves, vessels and main blood supply.
• Outline how the anatomical features of the mandible at different ages influence fracture patterns.
• Describe how muscle attachments affect fracture displacement.

 

1.6.2 Presenting features, assessment, investigation and diagnosis of mandibular fractures

• Describe how to assess a patient who may have sustained a fractured mandible
• List signs and symptoms suggestive of a mandibular fracture
• Specify appropriate investigations to aid diagnosis

 

1.6.4 Principles of treatment applied to mandibular fractures (excluding the condyle).

• Formulate a treatment plan for patients with mandibular fractures involving the angle, body and parasymphysis taking into account factors relating to the patient and to the fracture
• Apply principles of bone healing and fixation techniques to treatment planning
• Describe and compare different methods of internal fixation

 

1.6.5 Unfavourable fractures of the mandible (Fractures of the atrophic, osteoporotic and edentulous mandible and mandibular fractures which are comminuted or infected)

• Identify mandibular fractures with unfavourable features
• Formulate a treatment plan for patients with mandibular fractures with unfavourable features taking into account factors relating to the patient and to the fracture
• Apply principles of bone healing and fixation techniques to treatment planning
• Discuss the use of bone grafts in the treatment of unfavourable mandibular fractures

 

1.6.6 Mandibular condyle fractures - an overview of the controversies.

• Present the commonly used classifications of condylar fractures
• Give an overview of the options available for the treatment of fractures involving the mandibular condyle
• Explain why there has been uncertainty regarding the best form of treatment
• Present the current guidelines in European and UK practice for the treatment of condylar fractures

 

1.6.7 Surgical treatment of mandibular condyle fractures

• Describe, compare and contrast the common surgical approaches to the mandibular condyle (Pre-auricular, retromandibular, submandibular, intra-oral inc. endoscopic)
• Describe methods for reduction and aids to reduction
• Compare and contrast different methods of fixation (plates & screws, lag screws, cannulated screws etc)

 

1.6.8 Outcomes, complications and late/revision surgery after mandibular trauma.

• State the desired outcomes after treatment of patients with fractured mandibles
• List complications which may occur after a fractured mandible whether treated or not (immediate, early, delayed, late)
• Discuss management options for complications

 

1.7 Maxillary fractures

1.7.1 Surgical anatomy of the midface

• Describe the component parts of the maxilla including bone, muscle attachments, articulations, dental structures, nerves, vessels and main blood supply.
• Outline how the anatomical features of the maxilla influence fracture patterns, and reflect strategies of reconstruction

 

1.7.2 Presenting features and diagnosis of maxillary injuries

• Describe the cardinal physical signs of a maxillary fracture
• Correlate physical findings with the appearance on plain film and CT imaging
• Describe the differences in the Le Fort patterns
• Describe the significance of the pterygoid plates
• Describe the relevance of sagittal fractures of the palate

 

1.7.3 General principles of reduction and fixation of maxillary fractures

• Describe the different techniques available for reduction of a maxillary fracture
• Identify and decide which instruments to use for reduction
• Plan sites of osteosynthesis with respect to the pillars of reconstruction, and the fracture elements
• Briefly discuss methods of external fixation (note cross reference to avulsive injuries)

 

1.7.4  Surgical approaches to the midface (excluding the orbit)

• Describe the different incisions used to access the midface.
• Know the advantages and limitations of the different orbital incisions

 

1.7.5 Principles of open reduction and internal fixation applied to maxillary fractures

• Describe the different thicknesses of osteosynthesis materials used in the different anatomical zones of the midface
• Describe the plating configurations for each type of maxillary fracture
• Describe the indications and application of primary bone grafting
• Describe the various strategies for managing sagittal fractures of the maxilla

 

1.8 Orbito-zygomatic fractures

1.8.1 Surgical anatomy of the zygoma including surgical approaches

• Describe the morphology and articulations of the zygomatic bone
• Describe the soft tissue attachments to the zygoma and their role in function and fracture
• Describe the anatomical structures adjacent to the zygoma
• Describe intra-oral and extra-oral surgical approaches to the zygoma

 

1.8.2 Zygomatic injuries

• Discuss the common mechanisms of zygomatic fractures and the fracture patterns produced
• Quote common classifications of zygomatic fractures and discuss their usefulness
• Describe how to assess a patient who may have sustained a fractured zygoma
• List signs and symptoms suggestive of a zygomatic fracture
• Specify appropriate investigations to aid diagnosis

 

1.8.3 Treatment options for zygomatic fractures

• Formulate a treatment plan for patients with zygomatic fractures
• Explain what are the indications for closed reduction (+/- external fixation)
• Explain what are the indications for open reduction (+/- internal fixation)
• Describe methods for closed reduction (+/- external fixation)
• Describe methods for open reduction (+/- internal fixation)

 

1.8.4 Outcomes, complications and late/revision surgery after zygomatic trauma

• State the desired outcomes after treatment of patients with fractured zygomatic complex
• List complications which may occur after a fractured zygoma whether treated or not (immediate, early, delayed, late)
• Discuss management options for complications

 

1.9 Orbital trauma (inc. Ocular injuries cross-specialty co-ordination)

1.9.1 Surgical anatomy of the orbit,

• Describe the osteology of the bony orbit, together with relevance to the types of fracture seen.
• Describe the dimensions of the orbit, together with the relationship to vital structures
• Describe the relevant curves within the orbit which alter anteroposterior position of the globe.

 

1.9.2 Presenting features and diagnosis of orbital fractures, emergency management of retrobulbar haemorrhage

• Describe the signs and symptoms of orbital floor and wall fractures
• Relate physical findings to radiological appearance
• Define the concept of orbital volume and pathogenesis of enophthalmos
• Define the cardinal signs of retrobulbar haemorrhage, and the acute medical and surgical management

 

1.9.3 General principles of assessment of visual acuity, orthoptic assessment, assessment of eye position.

• Accurately assess and record visual acuity
• Describe the role of visually evoked potentials
• Define the role of the orthoptist
• Interpret Hess charts and fields of binocular single vision
• Differentiate between surgical and myogenic, and monocular diplopia
• Describe the use and limitations of the Hertel exophthalmometer
• Define the radiological assessment of enophthalmos
• Describe the role of working with orthoptists and ophthalmologists in a multi-disciplinary way in the management of peri-orbital trauma. This must include awareness of presentation and management of injuries to the globe and retina and how ophthalmology manage these injuries.

 

1.9.4 Surgical access to the orbit

• Describe the different orbital incisions to access the orbital floor and medial wall
• Contrast the advantages and disadvantages of the various techniques
• Describe and manage the different complications that may arise from each incision

 

1.9.5 Principles of inferior and medial wall reconstruction. Use of autogenous and alloplastic materials.

• List the different autogenous and alloplastic materials used in orbital wall surgery
• Contrast the advantages and disadvantages of the various materials available
• Describe the principles of safe dissection of the orbit

 

1.9.6 Paediatric orbital injuries

• Describe the concept and consequences of a white eye blow out fracture
• Debate the pros and cons of early versus delayed management

 

1.9.7 Orbital roof fractures

• Describe the relationship between fractures of the orbital roof and signs and symptoms of these injuries
• Prognosticate and treatment plan orbital roof fractures
• Describe the role of the neurosurgeon in these injuries

 

1.9.8 The management of late enophthalmos

• Describe the relationship between position and extent of orbital fractures and enophthalmos
• Describe the principles and the various strategies of management of this deformity

 

1.10 Naso-orbito-ethmoid trauma (inc. Nasal fractures – cross-specialty co-ordination)

1.10.1 Surgical anatomy of the NOE complex including canthal tendon, lacrimal apparatus

• Describe the component parts of the NOE region, specifically in relation to the medial canthal tendons. You will understand the relationship of the proximal lacrimal duct to the fracture patterns of the medial orbit.

 

1.10.2 Surgical anatomy and development of the frontal sinus

• Describe the development and anatomy of the frontal sinus, and the implications of trauma to the structure.
• Describe the anatomical variation and the effect of this in the different fracture patterns in this region

 

1.10.3 Presenting features and diagnosis of NOE fractures :- differentiation from nasal injuries

• Differentiate between nasal injuries requiring simple management, and those injuries demanding a more advanced surgical approach
• Describe the clinical features of NOE fractures, together with associated features which prognosticate to outcome
• Apply clinical findings to radiological appearance

 

1.10.4 Classification of NOE and frontal sinus fractures, and treatment planning

• Describe the different classifications used with respect to these injuries
• Describe the relevance of the central fragment in treatment planning
• Define which injuries require neurosurgical collaboration.
• Predict which fractures will be technically more challenging
• Describe the relevance of the posterior wall of the sinus, together with involvement of the nasal frontal duct.

 

1.10.5 Surgical approaches to the NOE and frontal sinus

• Describe the different approaches to the region
• Describe the surgical anatomy and technique of raising of a coronal scalp flap, together with manoeuvres to increase exposure
• Describe the principles of the neurosurgical approach to the frontal sinus, including the surgical anatomy of the superior sagittal sinus

 

1.10.6 General principles of reduction and fixation and bone reconstruction of NOE fractures,

• Describe the techniques used in reduction, and the typical plating configurations of these injuries.
• Describe techniques used to reduce fractures of the anterior wall of the frontal sinus.
• Predict which fractures require bone grafting, together with external and internal table bone grafts

 

1.10.7 Canthal tendon reconstruction, principles of lacrimal duct reconstruction

• Describe the principles of canthal tendon repair, together with the use of the canthal tendon wire.
• Describe the different types of incision required for tendon repair
• Describe the difference in management and prognostication in mono canalicular and bicanalicular injuries.

 

1.10.8 Management of late complications of fractures of the NOE and frontal sinus

• Appreciate the need to obtain the best primary repair possible
• Describe the appearance of malunion of this area.
• List the long term complications of frontal sinus fractures.
• Describe the principles of mucocele management of the frontal sinus

 

1.11 Pan-facial fractures (sequencing)

1.11.1 "An introduction to patients with pan-facial injuries

• Define the term “pan-facial fracture
• Discuss the common aetiologies of pan-facial fractures
• Describe the presenting signs and symptoms of a pan-facial fracture
• Describe how to assess, investigate and classify pan-facial fractures
• Describe the initial management and stabilisation of the patient with regard to ATLS/ETc principles.
• Discuss factors influencing the timing of treatment

 

1.11.2 Surgical treatment of pan-facial fractures

• Discuss the choice of airway (nasal, oral, tracheostomy, submental)
• Emphasize the importance of wide surgical access and describe how this may be achieved.
• Discuss different approaches to sequencing of reduction and fixation ( “inside to outside” –Manson / “outside to inside” – Gruss)
• Discuss the role of primary bone-grafting and reconstruction in the treatment of pan-facial fractures

 

1.11.3 "Post-traumatic/post-treatment complications and management options after pan-facial injuries

• State the desired outcomes after treatment of patients with pan-facial fractures
• List complications which may occur after a pan-facial fracture (immediate, early, delayed, late)
• Suggest management options for complications (deficits in form and function)

 

1.12 Craniofacial interface fractures (cross-specialty co-ordination)

1.12.1  "Introduction to craniofacial injuries

• Describe the normal development, ossification and structure of bones of the craniofacial skeleton
• Describe how a broken bone heals comparing direct with indirect bone healing
• Discuss the importance of reduction and adequate stability in bone healing
• Describe the effects of compression and tension on bone healing

 

1.12.2 "Initial presentation, assessment, investigation and management of patients with craniofacial injuries

• Identify patient factors which may adversely affect healing
• Identify fracture factors which may adversely affect healing
• Identify management factors which may adversely affect healing

 

1.12.3 Definitive treatment of patients with craniofacial injuries

• State the treatment planning objectives for definitive treatment
• Discuss how to decide on the optimal timing for definitive treatment
• Decide upon the most appropriate choice of airway and surgical access
• Sequence repair of craniofacial fractures
• Describe the principles of frontal sinus management
• Describe the options for repair of a CSF leak

 

1.12.4 Post-traumatic/post-treatment complications and management options after craniofacial injuries

• List complications of craniofacial trauma (immediate, early, delayed. late)
• Suggest management options for complications
• Describe the management options for a persistent CSF leak
• Describe the management options for frontal sinus complications (persistent communication/mucocoele
• Describe cranioplasty techniques

 

1.13 Paediatric fractures 

1.13.1 An introduction to paediatric trauma

• Compare and contrast the epidemiology of childhood cranio-maxillo-facial trauma with the adult experience
• Discuss “Non-accidental injury” (NAI) in children
• Describe those features in childhood craniomaxillofacial trauma which might be suspicious of Non-Accidental Injury (see also vulnerable child/adult)
• State what steps should be taken in cases of suspected NAI

 

1.13.2 The assessment and general management of the traumatised child

• Describe how to assess a paediatric trauma patient using ATLS/ETc principles
• Describe how to manage a paediatric trauma patient using ATLS/ETc principles
• Highlight the differences and similarities compared with the adult situation

 

1.13.3 Paediatric cranio-maxillo-facial trauma

• Discuss the management of soft tissue injuries in children mentioning specifically the management of facial bites.
• Highlight the differences in management of mandibular fractures in children compared to adults
• Highlight the differences in management of mid-facial fractures in children compared to adults
• Highlight differences in complications between children and adults sustaining cranio-maxillo-facial trauma

 

1.13.4 Dental and Dentoalveolar trauma

• Classify crown and root fractures in traumatised teeth
• Describe the initial assessment, investigation and management of fractured, subluxed or avulsed teeth.
• Present different methods for splinting subluxed/avulsed teeth or dento-alveolar fractures

 

1.14 Fixation of bone fractures

1.14.1 What is fixation and what does it aim to achieve (incorporating load-sharing & load bearing concept)?

• Explain the role and expectations of fixation techniques used in fracture management and in particular should be able to explain the importance of achieving and maintaining anatomical reduction, bony alignment and fracture stability
• Revise the concept of direct and indirect bone healing
• Explain the concept of weight-sharing and weight-bearing situations in fracture management
• Explain the concept of tension & compression across fracture sites
• Explain the differences between rigid, semi-rigid and non-rigid fixation

 

1.14.2 External fixation

• Define the term external fixation
• Describe and compare different methods of external fixation including IMF (intermaxillary fixation), arch-bars, splints and other external fixation devices incorporating pins and/or plates
• List indications for the use of external fixation devices
• Discuss advantages and disadvantages of external fixation devices.

 

1.14.3 Biomechanics of metal plates & screws

• Describe the materials used to make internal fixation devices
• Describe the essential features of plates and screws (size, structure etc)
• Explain what is meant by the following terms: Positional screw, lag screw, tapping, self-tapping screw, self-drilling screw, non-compression plate, compression plate, locking plate

 

1.14.4 Bioresorbable fixation devices

• Discuss the differences between resorbable and non-resorbable fixation devices
• Describe some of the materials which have been used in resorbable devices
• Describe how resorbable devices resorb
• Discuss advantages and disadvantages in clinical practice

 

1.14.5 Different methods for fixation: Internal fixation

• Define the term internal fixation
• Describe and compare different methods of internal fixation including the use of screws and plates
• List indications for the use of internal fixation techniques
• Discuss advantages and disadvantages of internal fixation devices

 

1.15 Soft tissue injuries (cross-specialty co-ordination)

1.15.1 Assessment of acute facial soft tissue injury.

• Appreciate the prognostic factors in the acute injury
• Recognise the importance of wound toilet and the strategies and methods used to achieve it
• Describe the concept of the role of aesthetic subunits in wound reconstruction

 

1.15.2 Principles of repair of acute soft tissue injuries, including wound toilet, primary suturing, local flap repair. Aftercare.

• Describe the different techniques in managing the closure of traumatic wounds.
• Describe the management of the shelved and triangulated wound
• Plan strategies for typical patterns of tissue loss
• Describe the role of wound dressings

 

1.15.3 Principles of assessment and management of established facial scars.

• The geo-topographic approach, z-plasty, geometric broken line. Facial camouflage. Laser treatment.
• Appreciate the different components of a ‘bad scar’
• Differentiate between a keloid and hypertrophic scar
• Discuss the timing of medical and surgical intervention
• Describe the ‘Z’plasty, and geometric line as examples of scar revision, and discuss the differences, advantages, disadvantages of both
• Plan a simple Z plasty
• Discuss different types of skin camouflage
• Discuss the role of laser in depigmentation, and resurfacing

 

1.15.4 Acute repair and secondary correction of dog bite injuries

• Appreciate the difficulties in repair with respect to microbiology, and technical aspects
• Discuss timing of intervention
• Discuss management of different patterns of tissue loss typical in these injuries

 

1.15.5 Advanced techniques in secondary reconstruction. -Midfacial suspension, Coleman fat transfer, use of fillers.

• Describe the subtleties of soft tissue management particularly around the midface and lower eyelids
• Discuss different strategies for redraping of orofacial tissues
• Demonstrate an understanding of the surgical anatomy of the midface with respect to the position of the malar fat pad and manipulation thereof
• Discuss in broad terms the use of dermal fat, Coleman fat and fillers

 

1.15.6 Special consideration of the eyelids

• Describe the surgical anatomy of the eyelids with respect to the anterior and posterior lamellae, and strategies of reconstruction.
• Discuss the repair of lacerations of the upper and lower lids
• Discuss the anatomy of the lateral canthus, and principles of canthus repositioning techniques

 

1.16 High velocity/avulsive injuries

1.16.1 Principles of management of the polytraumatized patient. Typical injuries, timing of surgical intervention.

• Recognise the association of facial injuries with major neck, thoracic, musculo-skeletal and abdominal trauma.
• Discuss timing of surgery with respect to local facial considerations, head injury and systemic damage.
• Discuss principles of control of major facial bleeding

 

1.16.2 Principles of management of complex injuries of the craniofacial skeleton .

• Internal fixation techniques. Adjunctive methods Including use of intermaxillary fixation, external fixation , internal skeletal fixation as adjuncts to conventional management.
• Recognise the complexity of the craniofacial fracture as a function of energy transfer.
• Treatment and sequence craniofacial fracture in broad terms (note cross reference to sequencing module)
• Recognise the role of ‘old fashioned techniques’ which may be used in the acute phase, or as support to osteosynthesis techniques.

 

1.16.3 Management of fractures of the skull base.

• Clinical assessment, radiological diagnosis and management of anterior skull base injuries.
• Recognise the likelihood of base of skull fractures
• Identify radiologically fractures of the skull vault, anterior/middle and posterior cranial base, and recognise the associated physical signs.
• Diagnose extra and intradural cerebral haemorrhages

 

1.16.4 Principles of assessment and management of gunshot injuries of the craniofacial region

• Describe the pathophysiology of gunshot and blast injuries
• The principles of management in the primary setting, and principles of reconstruction
• 1.16.5  Principles of management of avulsive trauma. Use of soft tissue and composite flap reconstruction.
• Describe the concept of avulsive trauma and the management challenges that occur
• Treatment plan with respect to quanta of tissue loss.
• Re-examine the concept of primary bone grafting.
• Discuss the reconstructive ladder in the setting of facial trauma
• Discuss the relative merits of the various bone and composite free flaps available.
• 1.16.6  Principles of managing penetrating eye trauma
• Describe the surgical anatomy and pathology of a penetrating eye wound
• Describe the difference between primary repair, evisceration, and enucleation
• Describe the role of orbital implants

1.17 Endoscopic and stereotactically-assisted fracture management

1.17.1 Principles of stereotactic navigation

• Describe the equipment requirements for stereotactic surgery
• Describe the stages in registration and use of stereotactic equipment

 

1.17.2 Technology used in endoscopic and stereotactic navigational aids to fracture management

• Describe the fracture patterns for which adjunctive and collaborative techniques would facilitate management.
• Describe the benefits and limitations of endoscopic assistance in fractures of face, skull base and paranasal sinuses.

 

1.17.3 Novel use of 3 D , and orthogonal CT data to aid surgical planning

 

1.18 Nasendoscopic examination and surgery of the maxillary, ethmoidal and frontal sinuses (see ORL ETR)

1.18.1 Endoscopically assisted sinus surgery

• Describe the use of endoscopic equipment in management of cranioorbital mucoceles, and lacrimal duct injuries by surgeons with experience and training in these fields e.g. ORL surgeons with a sub-specialty interest and high volume practice.

 

1.18.2 Indications for orbital stereotactic surgery

 

1.18.3 Principles of endoscopic assisted repair of the medial orbital wall

• mucocele decompression
• endoscopic assisted dacrorhinocystostomy
• Risks associated with this surgery even when undertaken by a surgeon with a sub-specialty interest and a high volume practice.

 

1.19 Resorbable fixation devices

1.20 Airway inc Emergency Airway

1.20.1 Assessment of compromised airway

1.20.2 Options for emergency ‘front of neck access’ in trauma patients

• Cricothyroidotomy
• Tracheostomy

 

1. 20.3 Multi-disciplinary management of airway

• Awake fibre-optic intubation
• Percutaneous Tracheostomy

 

1. 20.4 Management of airway when nasal intubation inappropriate/impossible

• Planned sub-mental intubation
• Planned Tracheostomy

 

2 Head and Neck Oncology

2.1 Basic Principles

2.1.1 History of head and neck oncology

 

2.1.2 Epidemiology

 

2.1.3 Aetiology

 

2.1.4 Pathology

 

2.1.5 Molecular biology

 

2.1.6 Premalignant conditions

 

2.1.7 Prognosis

 

2.2 Diagnosis and investigations

2.2.1 Signs

 

2.2.2 Symptoms

 

2.2.3 Radiological investigations

 

2.2.4 Biopsy and cytology

 

2.2.5 Classification and staging

 

2.3 Principles of treatment

 

2.3.1 Anaesthesia

 

2.3.2 Nursing care

 

2.3.3 Nutritional support

 

2.3.4 Speech and language therapy

 

2.3.5 Dental management

 

2.3.6 Psycho-social aspects

 

2.3.7 Health-related quality of life

 

2.3.8 Palliative care

 

2.4 Surgery for oral and oro-pharyngeal malignancy

2.4.1 Anatomy

 

2.4.2 Conventional ablative surgery

 

2.4.3 Access procedures

 

2.4.4 Management of the Mandible

 

2.4.5 Management of the Maxilla

 

2.4.6 Treatment of the tongue base tumour

 

2.4.7 Laser surgery

 

2.4.8 Thermal surgery

 

2.4.9 PDT

 

2.4.10 Management of the airway

 

2.4.11 Complications

 

2.4.12 Prognosis

 

2.5 Management of the neck

2.5.1 Historical perspectives

 

2.5.2 Access and types of Neck Dissections

 

2.5.3 SNB

 

2.5.4 Management of the negative neck

 

2.5.5 Management of the positive neck

 

2.5.6 Prognosis

 

2.5.7 Complications

 

2.6 Tumours of the nasal cavity and paranasal sinuses

Outline the roles of the MDT in the planning of the management of these tumours and, where surgery is indicated, management by surgeons with a sub-specialty interest and a high volume practice (see ORL ETR).

 

2.6.1 Anatomy

 

2.6.2 Epidemiology

 

2.6.3 Discuss occupational risk factors involved in nasopharyngeal cancer

 

2.6.3 Pathology

 

2.6.4 Presenting features

 

2.6.5 Investigations

 

2.6.6 Staging

 

2.6.7 Management

 

2.6.8 Surgical access

 

2.6.9 Prognosis

 

2.7 Tumours of the skull base

2.7.1 Anatomy

 

2.7.2 Epidemiology

 

2.7.3 Pathology

 

2.7.4 Presenting features

 

2.7.5 Investigations

 

2.7.6 Staging

 

2.7.7 Management

 

2.7.8 Surgical access

 

2.7.9 Prognosis

 

2.8 Tumours of the parapharyngeal space

2.8.1 Anatomy

 

2.8.2 Epidemiology

 

2.8.3 Pathology

 

2.8.4 Presenting features

 

2.8.5 Investigations

 

2.8.6 Staging

 

2.8.7 Management

 

2.8.8 Surgical access

 

2.8.9 Prognosis

 

2.9 Rarer head and neck tumours

2.9.1 Soft tissue sarcomas

 

2.9.2 Hard tissue sarcomas

 

2.9.3 Odontogenic tumours

 

2.9.4 Lymphoproliferative Disease/tumours

 

2.9.5 Orbital Tumours inc. melanoma and lacrimal tumours

 

2.9.6 Metastases

 

2.9.7 Paediatric tumours

 

2.10 Radiotherapy

2.10.1 Historical perspectives

 

2.10.2 Principles of treatment

 

2.10.2 Modalities

Describe the different types of radiotherapy, their mechanisms of action, dosing and administration.

 

2.10.3 Primary Therapy

Describe when radiotherapy is the major modality in the treatment of cancer.

 

2.14.8 Adjuvant Therapy

Take a focused history, undertake a careful clinical examination and order relevant investigations to accurately diagnose conditions that may require adjuvant radiotherapy as well as neoadjuvant radiotherapy.

 

2.10.4 Scheduling

Discuss the scheduling of chemotherapy, radiotherapy and surgery in those cancers treated with combined modality therapy.

 

2.10.5 Side effects

Describe the clinically significant or common early, intermediate and late side-effects of radiotherapy for cancer.

 

2.10.6 Local recurrence

Describe when radiotherapy may offer a significant control in local recurrence, thereby impacting on disease-free survival and overall survival.

 

2.10.7 Cost Benefit analysis

Describe when the advantages of radiotherapy are limited, and the cost-benefits ratio is limited.

 

2.10.8 Delivery of therapy

 

2.10.9 Complications

 

2.10.10 Critically evaluate trials of radiotherapy treatments.

 

2.10.11 Future therapeutic options

 

2.11 Chemotherapy

2.11.1 Historical perspectives

 

2.11.2 Principles of treatment

 

2.11.3 Scheduling

Discuss the scheduling of chemotherapy, radiotherapy and surgery in those cancers treated with combined modality therapy.

 

2.11.3 Delivery of therapy

 

2.11.4 Side effects

Describe the clinically significant or common early, intermediate and late side-effects of chemotherapy for cancer.

 

2.11.5 Critically evaluate trials of chemotherapy treatments.

 

2.11.5 Palliative Care

 

2.11.6 Complications

 

2.11.5 Future therapeutic options

 

2.12 Dental rehabilitation

2.12.1 Principles of reconstruction

 

2.12.2 Prosthetic rehabilitation and obturation

 

2.12.3 Implant-borne prostheses

 

2.12.4 Cranio-facial rehabilitation

 

2.13 Future of head and neck oncology

2.13.1 Viral therapies

 

2.13.2 Robotic surgery

 

2.13.3 Gene therapies

 

2.14 Outcome Measures and Research

This should include participation in national and multinational audit projects

2.14.1 German-Swiss-Austrian Working Group on Maxillo-Facial Tumors

https://www.doesak.com/en-gb/home

 

2.14.2 Head and Neck Audits (national/international)

https://www.doesak.com/en-gb/home

https://savingfaces.co.uk/current-projects/national-head-and-neck-cancer-audit/

 

2.14.3 Peer Review

In complex areas of care like head and neck cancer, there are advantages to patients and clinicians to have external review of treatment pathways and outcomes.

 

2.15 Role of Physical and Rehabilitation Medicine (PRM) in the management of oncology patients

 

2.16 Imaging in Head and Neck Oncology

2.16.1 Radiography, CT/MRI/PET/Nuclear imaging

• Principles, indications, ordering, analysis.
• Guided investigations and treatment.
• Team working with other specialties.

 

3 Reconstruction

3.1 Introduction

 3.1.1 Ladder of reconstruction

• List the reasons why reconstruction in the head and neck is complex
• Illustrate the Reconstructive ladder
• Describe the requirements for the ideal reconstruction
• State the effects of radiotherapy on tissues and how it makes reconstruction difficult

 

3.2 Tissue expansion

• Introduction
• Principles
• Devices
• Application in head and neck reconstruction

 

3.3 Local and Random Pattern flaps

3.3.1 Buccal pad of fat

• Describe the anatomy and structure of the buccal pad of fat
• List uses for the buccal pad of fat
• Suggest contraindications to the use of the buccal pad of fat
• Illustrate the technique to mobilize the buccal pad of fat
• List the possible complications in using the buccal pad of fat

 

3.3.2 Nasolabial flap

• Define the principles of random pattern and axial flaps
• Describe the anatomy of the nasolabial flap
• Suggest the indications and contra-indications to the nasolabial flap
• Describe the technique in raising a nasolabial flap
• State the complications of a nasolabial flap

 

3.3.3 Tongue flap

• Define the principles of tongue flaps
• Describe the anatomy of the tongue flap
• Suggest the indications and contra-indications to the tongue flap
• Describe the technique in raising a tongue flap
• State the complications of a tongue flap

 

3.4 Pedicled flaps

3.4.1 Submental island flap

• Define the principles of flap
• Describe the anatomy of the flap
• Suggest the indications and contra-indications to the flap
• Describe the technique in raising the flap
• State the complications of the flap

 

3.4.2 Temporoparietal, Temporalis flaps

• Describe the anatomy of the scalp
• State the relationship of the flaps to the facial nerve
• Discuss the indications and contraindications to the temporoparietal and temporalis flaps
• Illustrate the operative procedure of the flaps
• Suggest complications of the flaps

 

3.4.3 Deltopectoral

• Describe the anatomy of the deltopectoral flap
• Illustrate the operative procedure in raising a deltopectoral flap
• Describe the principle of the “delay phenomenon”
• Illustrate the arc of rotation in the flap
• Suggest indications and complications related to the flap

 

3.4.4 Pectoralis Major flap

• Define the principles of the Mathes and Nahai classification of blood supply to muscles
• Describe the anatomy of the pectoralis major flap
• Suggest indications and complication related to the flap
• Describe the operative procedure in raising a pectoralis flap
• Illustrate the arc of rotation and the defensive incision

 

3.4.5 Latissimus Dorsi flap

• Define the principles of flap
• Describe the anatomy of the flap
• Suggest the indications and contra-indications to the flap
• Describe the technique in raising the flap
• State the complications of the flap

 

3.4.6 Sternocleidomastoid

• Define the principles of flap

 

3.4.7 Trapezius

• Describe the anatomy of the trapezius flap
• Suggest the indications and contra-indications to the flap
• Describe the operative procedure
• List the possible complications related to the flap

 

3.5 Free Flaps

3.5.1 Radial forearm flap to include supra-fascial, sub-fascial and osseo-cutaneous

• Describe the anatomy of the flap
• Describe the Allen’s test
• Suggest the indications and contraindications to the supra-fascial and subfascial flaps
• Describe the operative procedure for the flaps
• List the complications related to the flap

 

3.5.2 Radial forearm composite flap

• Describe the anatomy relevant to the composite radial flap
• Describe the operative procedure
• List ways of preventing fracture of the residual radius
• Discuss the role of innervated flaps in Head and Neck reconstruction

 

3.5.3 Antero-lateral thigh flap

• Describe the anatomy of the flap
• Suggest the indications and contraindications to the ALT flap
• Describe the operative procedure for the flap
• List the complications of the flap

 

3.5.4 Rectus Abdominis flap

• Describe the anatomy of the flap
• Suggest the indications and contraindications to the flap
• Describe the operative procedure for the flap
• List the complications of the flap

 

3.5.5 Lateral arm flap

• Describe the anatomy of the flap
• Suggest the indications and contra-indications to the lateral arm flap
• Describe the operative procedure for the flap
• List the complications of the flap

 

3.5.6 Composite fibula flap

• Describe the anatomy of the flap
• Suggest the indications and contra-indications to the fibula flap
• Describe the operative procedure for the flap
• List the complications of the flap

 

3.5.7 DCIA flap

• Describe the anatomy of the flap
• Suggest the indications and contra-indications to the DCIA flap
• Describe the operative procedure for the flap
• List ways of lengthening the DCIA pedicle
• List the complications of the flap

 

3.5.8 Scapula system of flaps - To include tip of scapula and TDAP

• Describe the anatomy of the flap
• Suggest the indications and contra-indications to the Scapula flap
• Describe the operative procedure for the Scapula flap
• Describe the operative procedure for the Tip of scapula flap
• Describe the TDAP flap
• List the complications of the flap

 

3.5.9 Jejunal flap

• Describe the anatomy of the flap
• Suggest the indications and contra-indications to the fibula flap
• Describe the operative procedure for the flap
• List the complications of the flap

 

3.5.10 Gastro-omental flap

• Describe the anatomy of the flap
• Suggest the indications and contra-indications to the fibula flap
• Describe the operative procedure for the flap
• List the complications of the flap

 

3.5.11 Gracilis flap

• Describe the anatomy of the flap
• Suggest the indications and contra-indications to the gracilis flap
• Describe the operative procedure for the flap
• List the complications of the flap
• List the reasons why this flap is good for facial reanimation

 

3.6 Surgery for facial paralysis

3.6.1 Causes of facial paralysis

• List the causes of facial paralysis
• Describe the investigations required in a patient with facial paralysis

 

3.6.2 Static surgery for facial paralysis

• Explain the role of specialist clinics and work up of patients with facial paralysis
• Describe the relevant facial anatomy
• Describe the various static procedures
• State the disadvantages of static procedures

 

3.6.3 Dynamic surgery for facial reanimation

• List the various dynamic reanimation techniques available
• Describe the relevant anatomy for facial reanimation
• Suggest protocols for postoperative care and follow up

 

3.7 Prosthetic Rehabilitation

3.7.1 Maxillary Obturators

• Classify maxillary defects
• List the indications for obturation
• Describe the steps in obturator construction

 

3.7.1 Maxillary Obturators

• List the indications for zygomatic implants
• Describe the placement of zygomatic implants

 

3.7.1 Nasal Prosthesis

• Classify nasal defects
• Illustrate ideal positions for placement of nasal implants
• Explain the importance of the soft tissue surrounding implants
• State the effects radiotherapy has on implant integration

 

3.7.1 Orbital Prosthesis

• Describe the anatomy of the bony orbit
• Illustrate the ideal position for placement of orbital implants
• Suggest steps for obturator maintenance

 

3.7.1 Ear Prosthesis

• Describe the bony anatomy around the ear
• Illustrate the ideal position for placement of orbital implants
• List the complications with placement of auricular implants

 

3.8 Non-vascularised Tissue Transfer

3.8.1 Skin grafts

• Full thickness
• Split Thickness
• Dermal alloplast

 

3.8.2 Bone Grafts to include bone grafting for implants

• Describe the various types of bone graft available
• List the advantages and disadvantages of each donor site
• Describe the operative technique for each donor site

 

3.9 Mandibular Reconstruction

3.9.1 Mandibular Reconstruction

• Describe the importance of the mandible
• Classify mandibular defects
• Describe reconstruction or not of each defect

 

3.10 Maxillary Reconstruction

3.10.1 Maxillary Reconstruction

• Classify maxillary defects
• Discuss prosthetic vs autologous reconstruction
• Suggest the ideal reconstruction for each type of maxillary defect

 

3.11 Pharyngeal Reconstruction

3.11.1 Pharyngeal Reconstruction

• Classify the various pharyngeal defects
• Describe the role of the various reconstructive options
• List the complications of pharyngeal reconstruction

 

3.12 Lateral Skull Base Reconstruction

3.12.1 Lateral Skull Base Reconstruction

• Classify the various lateral skull defects
• Describe the role of pedicle flaps in reconstruction
• Describe the role of free flaps in reconstruction

 

3.13 Reconstruction after cancer in children

3.13.1 Reconstruction in children

• List ways in which reconstruction in a child varies to that in an adult
• Describe the effects of radiotherapy on growth
• Suggest reconstructive options in a child and why

 

3.14 Principles of Microvascular Surgery

3.14.1 Principles of Microvascular Surgery

• Explain the assessment of a patient for a free flap
• Describe issues related to free flap reconstruction in patients who have had previous neck surgery or RT
• List essential criteria for successful microsurgery
• Discuss postoperative monitoring of free flaps

 

4 Salivary Diseases and Other Swellings of the Face and Neck

4.1 Surgical anatomy of the salivary glands

4.1.1 Embryology & Physiology of Parotid

• describe the basic embryology of the parotid salivary gland
• describe the basic physiology and nerve supply of the parotid salivary gland
• describe the basic histological features of the parotid salivary gland

 

4.1.2 Anatomy of Parotid

• define the anatomical boundaries of the parotid gland
• describe the gross anatomy of the superficial and deep lobes of the parotid gland
• list the anatomical structures within the parotid gland
• identify sites of aberrant parotid tissue

 

4.1.3 Anatomy of Facial Nerve

• describe the anatomical landmarks used to identify the position of the main trunk of the facial nerve
• list the common variations in patterns of branching of the facial nerve
• Precisely identify variations in the number and position of the mandibular branch of the facial nerve
• identify how the position of the facial nerve is affected by tumour masses within the gland

 

4.1.4 Embryology & Physiology of Submandibular Gland

• describe the basic embryology of the submandibular salivary gland
• describe the basic physiology and nerve supply of the submandibular salivary gland
• describe the basic histological features of the submandibular salivary gland

 

4.1.5 Anatomy of Submandibular Gland

• define the anatomical boundaries of the submandibular gland
• describe the gross anatomy of the lobes of the submandibular gland and relationship to adjacent structures
• define the relationship of the submandibular gland to the mandibular and cervical branches of the facial nerve, the lingual and hypoglossal nerves

 

4.1.6 Anatomy, Embryology & Physiology of Sublingual Gland

• describe the basic embryology and physiology of the sublingual salivary gland
• describe the basic histological features of the sublingual salivary gland
• describe the gross anatomy of the sublingual gland and define the relationship to adjacent structures

 

4.1.7 Anatomy, Embryology & Physiology of Minor Salivary Gland

• describe the basic embryology and physiology of the minor salivary glands
• describe the basic histological features of the minor salivary glands
• Locate the distribution of minor salivary gland tissues

 

4.1.8 Miscellaneous developmental disorders of the salivary glands

• describe incidence and nature of ductal aplasia or atresia
• Locate the distribution of minor salivary gland tissues
• describe incidence and nature of aberrant glands

 

4.2 Investigations of the salivary glands

4.2.1 Cross-sectional Imaging of major salivary Glands

• Explain the mechanism of MRI imaging and the interpretation of T1 and T2 weighted images
• Evaluate the roles and merits of CT and MRI imaging of the parotid gland
• Describe the roles and merits of CT and MRI imaging of the submandibular gland
• Explain the mechanisms of PET and PET/CT imaging
• Describe the current indications for PET and PET/CT imaging
• Describe the current role of radionucleotide imaging techniques.

 

4.2.2 Ultrasound imaging of the major salivary glands

• explain the mechanism of ultrasound imaging
• list the indications and contraindications for ultrasound imaging
• describe the benefits and shortcomings of ultrasound imaging
• describe the indications for ultrasound guided FNAC

 

4.2.3 Role of FNAC & Core Biopsy

• describe the technique of fine needle aspiration cytology
• identify shortcomings in the technique of fine needle aspiration cytology
• list success rates in interpretation of the results of fine needle aspiration cytology for benign and malignant parotid tumours
• identify the management scenarios when a fine needle aspiration cytology investigation may be especially helpful
• list indications and contraindications to core biopsy of the major salivary glands

 

4.2.4 Sialography

• Explain the technique of sialography
• Explain the indications and contraindications to sialography
• describe the classic features of a tumour and sialadenitis with sialography

 

4.3 Neoplasia of the salivary glands

4.3.1 Classification, Staging and Grading of tumours

• explain the benefits of a comprehensive classification system
• describe the TNM staging system
• explain the principles of histological grading of salivary gland tumours
• describe the relative importance of stage and grade in predicting tumour behaviour
• list the main categories of benign and malignant tumours in the WHO classification system

 

4.3.2 Benign Tumours of Parotid Gland

• list the commonest benign tumours of the parotid gland
• describe the typical behaviour and presentation of a pleomorphic adenoma
• quantify the risk of malignant change in a benign pleomorphic adenoma
• list the factors that increase the risk of malignant change
• quantify the risk of metastatic disease with benign tumours of the parotid gland

 

4.3.3 Benign tumours of the Submandibular and sublingual glands

• list commonest benign tumours of the submandibular and sublingual glands
• describe behaviour of the pleomorphic adenoma

 

4.3.4 Malignant Tumours of Parotid Gland

• list commonest malignant tumours of the parotid gland
• quantify risk of malignant transformation with a pleomorphic adenoma
• identify the clinical and imaging features of malignant transformation in a pleomorphic adenoma
• quantify risks of facial nerve involvement with malignant tumours
• identify the clinical and imaging features of malignant invasion of the facial nerve

 

4.3.5 Malignant Tumours of Submandibular and sublingual Glands

• list commonest malignant tumours of the submandibular and sublingual glands
• identify the clinical and imaging features of malignancy in the submandibular and sublingual glands
• compare the incidence and pattern of malignant tumours within the major salivary glands

 

4.3.6 Benign and malignant tumours of the minor salivary glands

• list commonest benign tumours of the minor salivary glands
• list commonest malignant tumours of the minor salivary glands
• describe the histological and clinical features of necrotising sialometaplasia
• describe the management of necrotising sialometaplasia

 

4.3.7 Tumours of non-salivary origin

• list commonest tumours of non-salivary origin
• describe the characteristic imaging features of a lipoma
• describe presentation of systemic lymphoma in the major salivary glands
• explain the options for management of malignant metastatic disease of the intra-parotid lymph nodes
• discuss the indications for sacrifice of the facial nerve

 

4.4 Management of neoplastic salivary gland disorders

4.4.1 Conservative surgical Approaches to Parotid Tumours

• describe the anatomy of the tumour capsule with a benign pleomorphic adenoma
• describe the technique of extra-capsular dissection
• define the rationale for an extra-capsular dissection
• list the indications for extra-capsular dissection.
• describe the indications and technique of retrograde nerve dissection

 

4.4.2 Conventional surgical approaches to parotid tumours

• classify the various parotidectomy surgical procedures
• list the surgical skin incisions available
• describe the anatomical markers and methods for identifying the facial nerve trunk and or branches
• list advantages and disadvantages of a face-lift surgical approach
• define the extent and roles of complete and partial superficial parotidectomy
• describe surgical approaches to a deep lobe parotidectomy
• explain the types of intra-operative facial nerve monitoring and during parotid surgery and how they should be used.

 

4.4.3 Anaesthesia for surgery of the major salivary glands

• identify the correct positioning of patient
• explain the issues involved in selection of the appropriate tube for the airway
• explain the rationale for use of hypotensive anaesthesia and list potential complications
• explain the management of neuromuscular blockade drugs and use of nerve stimulation
• evaluate the role of intra-operative monitoring of the facial nerve
• identify correct recovery procedure and observations

 

4.4.4 Facial Nerve Paralysis & Paresis

• Describe the House-Brackmann classification of nerve weakness
• compare the incidence of transient and permanent facial nerve palsy after total or partial superficial parotidectomy with extracapsular dissection for a benign tumour
• quantify the incidence of transient and permanent facial nerve palsy after superficial parotidectomy for a malignant tumour
• identify the common patterns of facial nerve weakness after parotid surgery
• list the factors associated with an increased risk of injury to the facial nerve
• list the indications and factors to consider for resection and reconstruction of the facial nerve

 

4.4.5 Other Complications of Parotid Surgery

• quantify incidence of sialocele
• evaluate management options for persistent sialocele
• quantify incidence of great auricular nerve injury and neuroma
• describe measures to minimise the risk to the great auricular nerve
• outline measures to avoid haematoma formation

 

4.4.6 Managing Parotid Deformity & Frey's Syndrome

• describe surgical techniques to minimise the contour deformity after superficial and total parotidectomy
• describe the technique for preservation of the superficial lobe during access to deep lobe tumours
• evaluate the role of the SMAS preserving surgical approach

 

4.4.7 Frey's syndrome

• quantify the Incidence of Frey's syndrome
• describe surgical techniques used to minimise the risk of Frey's syndrome
• evaluate the effectiveness of surgical techniques used to minimise the risk of Frey's syndrome
• describe the non-surgical management of Frey's syndrome

 

4.4.8 Tumour spillage and residual disease

• list factors associated with tumour spillage
• estimate the incidence of tumour spillage or residual disease after superficial parotidectomy for a pleomorphic adenoma
• evaluate role of radiotherapy for management of spillage of a benign pleomorphic adenoma
• evaluate merits of expectant management after spillage of a benign pleomorphic adenoma

 

4.4.9 Recurrent Tumour Disease

• quantify the risks of recurrence with extra-capsular dissection for a benign pleomorphic adenoma of the parotid
• quantify the risks of recurrence with partial or complete superficial parotidectomy for a benign pleomorphic adenoma of the parotid
• explain the roles of partial or complete superficial parotidectomy for a benign pleomorphic adenoma of the parotid
• explain how the management of recurrent unifocal and multifocal benign pleomorphic adenoma may differ
• list factors likely to cause an increased risk of recurrent disease that are associated with a malignant tumour

 

4.4.10 Metastatic neck and systemic disease

• estimate the incidence of metastatic neck and distant disease
• explain the relative importance of staging and histological grade
• outline the surgical and radiotherapy options for management of the neck

 

4.4.11 Role of radiotherapy

• explain role of radiotherapy in management of malignant disease
• list evidence for improved loco-regional control
• list evidence for improved survival
• Define role of fast neutron therapy

 

4.4.12 Radiation Induced complications

• list complications associated with radiotherapy
• explain measures aimed at reducing incidence of oral complications
• describe symptomatic treatments available for painful xerostomia

 

4.5 Inflammatory conditions of the salivary glands

4.5.1 Acute and chronic sialadenitis

• describe clinical features of acute and chronic sialadenitis
• list causes of acute and chronic sialadenitis
• describe the non-surgical management of acute and chronic sialadenitis

 

4.5.2 Acute and chronic sialadenitis

• identify the indications for surgical treatment of chronic sialadenitis of the parotid gland
• describe the merits of superficial, subtotal and total parotidectomy for chronic sialadenitis
• quantify the incidence of transient and permanent facial nerve palsy after surgery for chronic sialadenitis
• describe the pattern of facial nerve weakness after surgery for chronic sialadenitis
• discuss the management of the parotid duct

 

4.5.3 Acute and chronic sialadenitis

• identify the indications for surgical treatment of chronic sialadenitis of the submandibular gland
• identify the structures at increased risk of injury during surgical excision of the submandibular gland for chronic sialadenitis
• estimate the incidence of nerve injuries associated with surgical excision of the submandibular gland for chronic sialadenitis

 

4.5.4 Pathophysiology & Presentation of Sialolithiasis

• estimate the incidence of salivary calculi in the major salivary glands
• describe the pathophysiology of Sialolithiasis in the major salivary glands
• describe the clinical presentation of sialolithiasis in the submandibular and parotid glands
• evaluate the role of the imaging investigations available for sialolithiasis in the major salivary glands

 

4.5.5 Management of Sialolithiasis of parotid gland

• list conservative treatment measures
• list criteria for sialolithotomy & sialodochoplasty
• describe techniques of sialolithotomy & sialodochoplasty
• quantify success rates
• list differences between the nature of intraluminal obstructions of the parotid gland and those of the submandibular gland

 

4.5.6 Management of Sialolithiasis of submandibular gland

• list conservative treatment measures
• list criteria for sialolithotomy & sialodochoplasty
• describe techniques of sialolithotomy & sialodochoplasty
• quantify success rates

 

4.5.7 Minimally Invasive Surgery for Sialolithiasis

• list indications for sialadenoscopy of submandibular and parotid glands
• describe technique of sialadenoscopy
• evaluate the effectiveness of sialadenoscopy
• describe indications for intra-corporeal lithotripsy
• describe the role of extra-corporeallithotripsy

 

4.5.8 Systemic Disorders Affecting Salivary Glands

• list causes of unilateral & bilateral enlargement of the parotid gland
• list clinical features of primary & secondary Sjogren’s syndrome
• describe the interpretation of the salivary gland biopsy and other diagnostic tests available for Sjogren’s disease including immunohistochemistry
• describe the histological features of Sjogren’s syndrome
• estimate the incidence of lymphoma & benign lymphoepithelial lesions in Sjogren’s syndrome
• list features and management of sicca disease (this is a sixth objective, difficult to cover this much in one session)

 

4.5.9 Systemic Disorders Affecting Salivary Glands

• describe clinical features of sarcoidosis in head and neck region, and elsewhere
• list features of Heerfordts syndrome and Lofgrens syndrome
• describe the diagnostic tests available for sarcoidosis
• describe management options for soft tissue and intra-osseous lesions of sarcoidosis in the head and neck region
• describe the features and management of sialosis

 

4.5.10 Bacterial and fungal infections

• identify risk factors associated with infection of the major salivary glands
• identify organisms involved in community acquired and hospital acquired acute and chronic bacterial parotitis
• explain treatment options for acute and chronic bacterial parotitis
• describe features and management of chronic recurrent juvenile parotitis
• describe features and management of tuberculous and non-tuberculous mycobacterial infections

 

4.5.11 Viral Infections

• describe the presentation of mumps
• describe how to establish the diagnosis of mumps
• describe the pathological processes with HIV associated salivary gland disease
• identify the treatment options for lymphoepithelial cysts associated with HIV in the parotid gland
• identify infections associated with auto-immune disease or the immunosuppressed patient

 

4.5.12 Cysts of Major & Minor Salivary Glands

• construct a classification of cystic lesions of the major and minor salivary glands
• describe the mucous escape phenomenon or reaction
• define a mucous retention cyst
• identify the management options for a ranula and plunging ranula
• quantify the success rates of marsupialisation and surgical excision for treatment of a ranula

Topic 6 - Traumatic injuries of salivary glands

 

4.6 Injuries to the major salivary glands

• explain management of acute and persistent salivary fistula
• indicate how to make diagnosis of sialocoele
• list conservative and surgical management options for persistent sialocele
• classify facial nerve injury
• describe techniques of surgical repair of facial nerve

 

4.7 Paediatric disorders of salivary glands

4.7.1 Paediatric tumours and other pathology

• describe typical presentations of haemangiomas, haemangioendotheliomas and lymphangiomas
• describe the histological features of haemangiomas, haemangioendotheliomas and lymphangiomas
• outline the timing and nature of medical and surgical treatment options for haemangiomas, haemangioendotheliomas and lymphangiomas
• describe the management of first branchial arch cyst and fistulae
•  describe the medical and surgical management of drooling

 

4.8 Other Swellings of the Face and Neck

4.8.1 Differential diagnosis of face and neck lumps

 

4.8.2 Developmental cysts

• Dermoid cysts
• Branchial cleft cysts
• Thyroglossal duct cysts
• Cystic hygroma

 

4.8.3 Non-salivary Benign Neoplastic disease of the face and neck inc thyroid

Presentation, diagnosis, investigation and multi-disciplinary management of non-salivary benign tumours of the face and neck.

 

4.8.4 Non-salivary malignant neoplastic disease of the face and neck inc thyroid

Presentation, diagnosis, investigation and multi-disciplinary management of non-salivary malignant tumours of the face and neck.

Primary including lymphoma

Secondary

 

4.8.5 Inflammatory Causes of Swelling

• Infections
• Sarcoid
• Autoimmune

 

4.8.6 Vascular lesions

Management of AV malformations in co operation with other specialties including interventional radiologiy, vascular, endocrine, ORL, General and PRAS surgery.

AV malformations (PRAS involved

Carotid Body Tumours

 

4.8.7 Thyroid disease

• Describe the role of inter-specialty working in the management of thyroid disease including the value of endocrinologists, oncologists, and endocrine surgeons with a sub-specialty interest and a high volume practice (who may come from a range of surgical specialties including ORL, OMFS, and General Surgery)

 

5 Deformity

5.1 Introduction/ Basic theory

5.1.1 Craniofacial development

• Type your objectives in here

• To create a line break, press Alt & Enter keys

• Copy and paste the bullet to add another one

 

5.1.2 Dental development

• Describe the development of the facial skeleton
• Describe the development of the dentition and supporting structures
• Appreciate the impact growth modification or delay can have on facial and dental development
• Appreciate the importance of growth potential and its use in surgery

 

5.1.3 History of Orthognathic surgery

• Describe the evolution of modern orthognathic practice
• Describe the importance of the development of orthognathic practice
• Identify key developments and milestones
• Appreciate how future developments relate to past practice

 

5.2 Diagnosis

5.2.1 Facial norms

• Identify and measure facial norms
• Describe the concept of facial harmony
• Recognise the relationship between static and dynamic facial norms
• Describe the relationship between teeth, bone and soft tissue in overall facial appearance

 

5.2.2 Data Collection records, models

• Describe the different methods of data collection. Describe the importance of data collection
• List the essential items in data collection. Describe the role of databases in data collection
• Describe the importance of accurate study models
• Appreciate the importance of confidentiality

 

5.2.3 Imaging. Radiographs and photography

• Describe the role of different radiological investigations
• Recognise when to request radiological investigations appropriately
• Use of 3D CT imaging in treatment planning and computer models
• Identify the standard photographic views necessary for assessment and record-keeping in facial deformity.

 

5.2.4 Psychology

• Explain the importance of psychological assessment in the management of facial deformity
• Recognise psychological problems in patients presenting with facial deformity
• Define the role of the psychologist and psychiatrist in facial deformity management
• Describe the features of Body Dysmorphic Disorder (ICD10-CM F45.22)

 

5.3 Treatment planning

5.3.1 2D and 3D planning

• Describe the principles of planning
• Describe the limitations of 2D planning
• Describe the principles of 3D planning
• Describe the limitations of 3D planning

 

5.3.2 Software assisted Opal, Dolphin

• List the benefits and drawbacks of computer aided planning
• Describe the input of data and its limitations on planning

 

5.3.3 Errors in planning recognition and prevention

• List the common planning errors
• Describe how to recognise planning errors
• List steps used to minimise error’s in planning
• Describe how to manage late recognition of an error

 

5.3.4 Model Surgery

• List the benefits of model surgery
• Describe the main planning principles behind model surgery
• Appreciate how errors in model surgery can be identified
• Appreciate the different articulators used in mechanism of action

 

5.4 Orthodontics for Orthognathic Surgery

5.4.1 Pre surgical

• Define the principles of pre-surgical orthodontics and the importance regards good outcomes in orthognathic surgery
• Recognise extraction patterns in orthognathic surgery treatment plans
• Explain the mechanics of different orthodontic interventions and the role of temporary anchorage devices to a basic level
• Explain the effect of tooth movement on soft tissues
• Recognise when pre-surgical orthodontics is not necessary

 

5.4.2 Post surgical

• Explain the timing of post-surgical orthodontics
• Recognise what post-surgical orthodontics can and cannot achieve
• Illustrate the importance of long term orthodontic retention

 

5.5 Mandibular Surgery

5.5.1 Bilateral sagittal split

• List indications for BSSO
• Describe the technique including modifications
• Know the complications associated with the operation
• Appreciate the factors needed for informed consent

 

5.5.2 Sub sigmoid, Intra and Extra oral

• List indications for EO and IO Sub sigmoid osteotomy
• Describe the technique including modifications
• Know the complications associated with the operation
• Appreciate the factors needed for informed consent

 

5.5.3 Inverted L

• List indications for the inverted L osteotomy
• Describe the technique including modifications
• Know the complications associated with the operation
• Appreciate the factors needed for informed consent

 

5.5.4 Segmental and variations

• List indications for segmental procedures
• Describe the technique (s) including named modifications
• Know the complications associated with the operations
• Appreciate the factors needed for informed consent

 

5.5.5 Sub apical

• List indications for Mandibular sub apical osteotomy
• Describe the technique including modifications
• Know the complications associated with the operation
• Appreciate the factors needed for informed consent

 

5.5.6 Body ostectomy

• List indications for a body ostectomy
• Describe the technique including modifications
• Know the complications associated with the operation
• Appreciate the factors needed for informed consent

 

5.6 Genioplasty

5.6.1 Advancement, setback genioplasty

• Recognise the indications for advancement/setback genioplasty as an adjunct to jaw surgery
• Recognise when genioplasty as a sole treatment in facial deformity is indicated
• Describe the surgical technique for genioplasty
• List the complications associated with genioplasty and carry out consent for a patient appropriately

 

5.6.2 Reduction, augmentation and asymmetric genioplasty

• Recognise the indications for reduction, augmentation and asymmetric genioplasty as an adjunct to jaw surgery
• Recognise when genioplasty as a sole treatment in facial deformity is indicated
• Describe the surgical technique for genioplasty
• List the complications associated with genioplasty and carry out consent for a patient appropriately

 

5.7 Maxillary Surgery

5.7.1 Le Fort I

 

5.7.2 Le Fort II and III

 

5.7.3 Kufner procedure

 

5.7.4 Segmental and variations

 

5.8 Bimaxillary Surgery

5.8.1 Mandibular asymmetry

• List the causes of mandibular asymmetry and diagnose its various presentations
• Recognise its potential relationship with maxillary and pan facial asymmetry
• Investigate a patient presenting with mandibular asymmetry
• Describe the treatment options for mandibular asymmetry

 

5.8.2 Anterior open bite

• List the causes of anterior open bites
• Describe the principles of surgical treatment
• Describe the principles of pre-surgical orthodontics
• Appraise the controversies around the management of AOB malocclusions

 

5.8.3 Non conforming pattern

• Identify patients with jaw deformity not conforming to typical patterns
• Recognise the pitfalls of treatment of patients with non-conforming patterns of jaw deformity
• Design treatment plans to overcome problems with patients with non-conforming patterns of jaw deformity

 

5.8.4 Transverse discrepancy

• Identify patients with transverse discrepancy of the jaws
• Describe the options to treat transverse discrepancy
• Evaluate the advantages and disadvantages of treatment options

 

5.9 Treatment of specific patterns

5.9.1 Class I

 

5.9.2 Class II – Div l

 

5.9.3 Class II – Div II

 

5.9.4 Class III

 

5.10 Soft Tissue Changes / Procedures

5.10.1 Reliability in soft tissue changes

 

5.10.2 Lip lift

 

5.10.3 Alar base resection

 

5.10.4 Use of Hyaluronate or Botox

 

5.11 Adjunctive Procedures

5.11.1 Rhinoplasty

 

5.11.2 Liposuction

 

5.11.3 Facelift

 

5.12 Hierarchy of Stability

5.12.1 Maxillary

 

5.12.2 Mandibular

 

5.13 Complications – Prevention and Management

5.13.1 Intra operative

 

5.13.2 Post operative

 

5.13.3 Long term

 

5.13.4 Unfavourable results

 

5.13 Cleft Orthognathic Surgery

5.13.1 Link to Cleft section

 

5.14 Distraction osteogenesis

5.14.1 History

 

5.14.2 Mechanism of action

 

5.14.3 Mandibular

 

5.14.4 Maxillary

 

5.14.5 Alveolar

 

5.15 Obstructive sleep apnoea

5.15.1 Introduction

 

5.15.2 Sleep medicine basics

 

5.15.3 Non surgical treatment

 

5.15.4 Surgical options.inc Maxillo mandibular advancement

 

5.15.5 Adjunctive procedures

 

5.16 Gender Reassignment Facial Surgery

5.17 Facial and orbital surgery associated with endocrine disease

 

6 Cleft

6. 1 Incidence

6.1.1 Introduction

• Discuss the incidence of cleft lip and palate in the context of congenital abnormalities
• Estimate the number of clefts per live births
• Explore the effects of clefting on service provision.

 

6.1.2 Incidence of cleft lip and/or palate

• Classify clefts of the lip with or without palate.
• List the percentage breakdown of different cleft types
• Discuss the influence of race and twinning on the incidence of cleft lip and/or palate
• List some of the common syndromes that have a cleft of the lip and/or palate as part of the syndrome

 

6.1.3 Incidence of isolated cleft palate

• Predict the affect of clefts of the secondary palate on case load
• Classify clefts of the secondary palate
• List common syndromes that have a cleft of the secondary palate as part of the syndrome

 

6.1.4 Incidence of submucous cleft palate

• Estimate the incidence of submucous cleft palate in the general population
• Discuss the presentation of submucous cleft palate
• Recognise the importance of making the diagnosis

 

6. 2 Aetiology

6.2.1 Influence of environmental factors

• Describe the affect of environmental factors on the embryo during lip formation and palatogenesis
• List environmental factors implicated in clefting
• Summarise environmental influence on risk

 

6.2.2 Genetic influences

• Awareness of features which suggest a chromosomal abnormalities in clefting
• Awareness of features which suggest a monogenic condition in clefting
• Recognise where these genes exercise their influence during embryogenesis

 

6.2.3 Genetic and environment interactions

• Knowledge of the multifactorial aetiology of isolated clefts
• Knowledge of the difference between isolated and syndromic clefting
• Knowledge of the recurrence risk for siblings and children of a patient with isolated clefting
• Knowledge of the role of genetic assessment and counselling in the care of patients with clefts and their families,

and when to refer to genetic services

• Knowledge of how genes are inherited and basic patterns of inheritance: dominant and recessive
• Knowledge of de novo gene variants as a mechanism causing genetic conditions
• Awareness of variable expression and non-penetrance in hereditary conditions
• Awareness of germline mosaicism as a cause of recurrence of rare genetic conditions
• Assess features which suggest a condition is genetic and/or inherited in a patient and/or their parents

 

6. 3 Diagnosis

6.3.1 Antenatal diagnosis

• Discuss the timing, techniques and views used to make ultrasound antenatal diagnosis
• List the factors that influence ultrasound detection rate
• Classify clefts diagnosed on ultrasound
• Recognise the association between cleft type and other chromosomal abnormalities
• Recommend appropriate referral following antenatal diagnosis

 

6.3.2 Diagnosis at birth

• Quote aims of cleft units within the UK following birth of a child with a cleft
• Describe the referral process following diagnosis of a cleft at birth
• Explain the probable treatment pathway from birth to adulthood for different cleft types

 

6.3.3  Support at time of diagnosis

• Discuss the needs of a baby born with a cleft
• Recommend feeding strategies for the particular cleft type
• Summarise the support provided by the cleft team peri-natally

 

6. 4 Management of cleft lip

6.4.1 Principles of lip management

• Recognise the problems caused by clefts of the lip
• Classify clefts of the lip
• Describe the anatomical defect in a unilateral cleft lip and palate
• Describe the anatomical defect in a bilateral cleft lip and palate

 

6.4.2 Surgical options

• Recognise that different timing protocols exist for the management of cleft lip and palate
• Describe the various sequences for the closure of cleft lip and palate
• Explain the rationale for commonly practiced protocols

 

6.4.3 Management of unilateral cleft lip and/or palate

• List the steps in lip repair
• Discuss the aims of skin incision design
• Name and sketch commonly used techniques for lip repair
• List advantages and disadvantages of commonly used techniques
• Describe rotation-advancement repair
• Discuss nasal repair

 

6.4.4 Management of bilateral cleft lip and/or palate

• Analyse the defect
• Discuss the role of pre-surgical orthopaedics
• List the steps in lip repair
• Name and sketch commonly used techniques for lip repair
• Recognise the role of the nose in lip repair

 

6.4.5 Management of incomplete cleft lip and/or palate

• Analyse the defect
• Illustrate the technique best suited to deal with the defect
• Recognise the role of the nose in incomplete lip repair

 

6.4.6 Outcome of lip surgery (aesthetic and growth)

• List outcomes measured after lip surgery
• Discuss influence of lip surgery on growth
• Evaluate the aesthetic outcome of lip surgery

 

6. 5 Management of palate

6.5.1 Principles of palate management

• Describe the underlying anatomical defect in patients with clefts of the palate
• Differentiate between the closure of the soft palate from closure of the hard palate
• Explain the role of functional soft palate repair

 

6.5.2 Surgical options

• Describe techniques used to repair the hard palate
• Compare and contrast techniques used to repair the soft palate
• Describe in detail the Sommerlad micro-dissection repair of the soft palate

 

6.5.3 Outcome of palatal surgery (growth and speech)

• List the complications/sequelae of palatal surgery
• Discuss the influence of timing of palatal surgery on speech and growth
• Explain the influence of surgical technique on speech and growth

 

6. 6 Management of the cleft alveolus

6.6.1 Aims of alveolar bone grafting

• List aims of alveolar bone grafting
• Summarise the adverse affects if bone grafting is not carried out
• Describe the surgical technique for conventional alveolar bone grafting
• List the steps necessary for gingivoperioplasty

 

6.6.2 Timing of bone grafting

• Classify bone graft timing
• Explore the advantages and disadvantages of carrying out alveolar bone grafts at different ages
• Recognise the role of gingivoperioplasty

 

6.6.3 Pre-bone graft assessment and management

• Carry out an assessment for alveolar bone grafting
• Describe the role of the orthodontist in pre-bone graft management
• Discuss pre-bone graft teeth extraction

 

6.6.4 Donor site options and novel developments

• List the types of grafting material previously used for alveolar bone grafting
• Compare and contrast donor sites used for bone harvest in alveolar bone grafting
• Discuss the use of bone graft substitutes in the management of the alveolus

 

6.6.5 Outcome assessment of alveolar bone graft

• Recognise the need for outcome assessment
• List the most commonly used assessment methods
• Summarise the Bergland, Kindelan and Witherow assessment methods
• Explore the use of CT scanning in the assessment of alveolar bone grafting

 

6. 7 Revision procedures

6.7.1 Revision of the lip

• Discus the possible causes for poor lip outcome
• List the indications for lip revision
• Describe the common techniques for lip revision

 

6.7.2 Revision of the palate – speech surgery

• Define velopharyngeal insufficiency
• Assess velopharyngeal insufficiency
• Recommend surgical solutions for velopharyngeal insufficiency

 

6.7.3 Revision of the palate – oronasal fistula repair

• Classify oro-nasal fistulae
• Report the incidence of oro-nasal fistulae and the factors that influence their formation
• Describe the common symptoms and signs of fistulae
• Distinguish between symptomatic and asymptomatic fistulae
• List commonly used techniques for the repair of oro-nasal fistulae

 

6. 8 Management of the nose

6.8.1 Primary Rhinoplasty

• Define primary rhinoplasty
• Explore the evolution of primary rhinoplasty in cleft lip patients
• Discuss common surgical techniques
• Explain the need for and possible types of post-surgical splinting

 

6.8.2 Secondary Rhinoplasty

• Discuss the timing of secondary rhinoplasty
• Recognise the need for psychological support
• Analyse the nasal defect and decide on a logical approach
• Describe commonly employed grafting materials and suture techniques

 

6. 9 Orthognathic surgery

6.9.1 Principles of orthognathic surgery in cleft patients

• Recognise the influence of cleft type on the need for orthognathic surgery
• Summarise the common skeletal growth disturbances in cleft patients
• Evaluate a cleft patient for orthognathic surgery
• Explain the role of the psychologist in the decision making process

 

6.9.2 Traditional orthognathic surgery

• Reflect on the surgical technique to maximise movement and minimise avascular necrosis
• Assess the effect of orthognathic surgery on local anatomy
• Discuss the factors that contribute to relapse
• List probable complications

 

6.9.3 Distraction osteogenesis

• List the advantages and disadvantages of distraction osteogenesis
• Summarise the indications for distraction osteogenesis
• Describe the commonly used distraction osteogenesis techniques employed in cleft patients

 

6.9.4 Influence of orthognathic surgery on speech

• Recognise the risks posed by orthognathic surgery to speech
• Explain the pre-operative speech work-up for a cleft patient undergoing orthognathic surgery
• List the ways in which the risks to speech may be minimised

 

6.10 Speech

6.10.1 Introduction to the development of speech

• Recognise the complexity of speech development
• Discuss the role of the velopharyngeal mechanism in speech
• Describe velopharyngeal anatomy

 

6.10.2 Influence of cleft palate on speech

• Explore the relationship between speech development and timing of cleft palate surgery
• Explain the possible effects of clefting on velopharyngeal sufficiency
• Define and explain the role of the speech therapist in the cleft team

 

6.10.3 Speech assessment

• Demonstrate knowledge of the nationally-agreed parameters for the description and assessment of speech associated with cleft palate.
• Describe the methods used in the investigation of palatal structure and function during speech.
• Interpret findings from velopharyngeal/palatal investigations and explain how they influence treatment decisions

 

6.10.4 Role of speech therapy

• List the common types of speech therapy
• Explain the role of the different types of therapy in managing children with cleft palates
• Discuss the use of speech prostheses in the management of velopharyngeal insufficiency

 

6. 11 Hearing          

6.11.1 Introduction to hearing in cleft patients

• Explain the importance of hearing on the development of speech
• Describe the effect of cleft palate on Eustachian tube function
• Discuss the pathophysiology of Eustachian tube dysfunction in clefts
• Summarise the possible effects of cleft palate surgery on Eustachian tube dysfunction

 

6.11.2 Management of hearing loss and otitis media with effusion

• Discuss the current European, UK and international guidelines for the management of cleft patients with middle ear effusion
• Identify patients with hearing loss secondary to middle ear effusion that need intervention
• Describe the alternatives for the management of cleft patients with middle ear effusion with or without hearing loss including surgical management for example by an ORL surgeon who is part of the cleft team (and has a sub-specialty interest and a high volume practice) – see ORL ETR.

 

6.12 Orthodontics

6.12.1 Orthodontic intervention prior to primary lip surgery

• Describe the role of the orthodontist prior to primary surgery
• Explore the role of pre-surgical orthopaedics and naso-alveolar moulding in the management of cleft patients
• Summarise the dental and occlusal development in deciduous and mixed dentition in cleft patients.

 

6.12.2 Orthodontic management prior to and immediately after alveolar bone grafting

• Explain the rationale for pre-alveolar bone graft orthodontics
• Discuss the possible orthodontic interventions that may be indicated
• Formulate a plan for the management of the pre-maxilla in bilateral cleft patients

 

6.12.3 Definitive orthodontic management following eruption of the permanent dentition

• Summarize the dental and occlusal development in the permanent dentition in cleft patients.
• List the common orthodontic problems encountered in the permanent dentition in cleft patients
• Differentiate between orthodontic camouflage and de-compensation in cleft patients
• Discuss the options (orthodontic and prosthodontic) for dealing with missing teeth in the line of the cleft

 

6.13 Psychology

6.13.1 Introduction to the psychology in clefts of the lip and palate

• Discuss the factors important in determining healthy psychosocial adjustment
• Predict the transitional points when the risk of psychosocial maladjustment is increased
• List the psychological difficulties common in cleft lip and palate patients.

 

6.13.2 Role of the psychologist in the cleft team

• Discuss the influence the psychologist has on the team and the patient.
• Summarise the role of the psychologist as the child passes through the various developmental stages on the way to adulthood.
• Describe the common psychosocial adjustment problems in adult cleft patients and the psychological approach to these.
• Explore the need for psychological input prior to surgery for patients and families affected by clefting.

 

6.13.3 Evaluation of treatment outcome in clefts of the lip and palate

• Examine the need for outcome evaluation
• Differentiate between patient outcome evaluation and professional outcome evaluation
• Interpret the meaning of outcome evaluation

 

7 Facial Aesthetic Surgery

7. 1 Assessment of the patient for facial rejuveation surgery

7.1.1 Anatomy and physiology of the aging face.

• Describe the anatomical changes that occur with aging
• Describe the aetiology and physiology of aging

 

7.1.2 Assessment of the patient seeking facial rejuvenation surgery

• Describe the features of ageing seen in the face
• Explain how to assess a patient seeking facial rejuvenation

 

7.1.3 Specific assessment for upper face and eyelid surgery

• Explain how to assess hairline, brow position and upper lid in relation to facial rejuvenation surgery
• Describe the position of the lids and canthal areas in relation to facial rejuvenation
• List the causes of acquired upper eyelid ptosis

 

7.1.4 Specific assessment for lower face surgery

• Explain how to assess the midface and jowls
• Describe how to assess a patient with laxity of the neck
• Describe the role of fillers and implants for tissue volume replacement
• Discuss the role of surgery in lower face rejuvenation

 

7. 2 Browlifting

7.2.1 History and relevant surgical anatomy (ref coronal flaps)

• Describe the history of brow lifting
• Describe the anatomy of the forehead
• Revise coronal flap anatomy and technique

 

7.2.2 Open brow lifting techniques

• Describe the surgical procedures of open brow lifting
• Explain the different surgical approaches available
• Describe the advantages and disadvantages of each approach

 

7.2.3 Endoscopic techniques including relevant equipment

• Describe the equipment used in endoscopic brow lifting
• Describe the endoscopic approach to brow lifting
• List the types of fixation available

 

7.2.4 Complications and adaptation to facial deformity

• Describe how to avoid, diagnose and treat the complications associated with both open and endoscopic approaches
• Discuss how these techniques can be used for facial deformity

 

7. 3 Eyelid surgery

7.3.1 Surgical anatomy of the upper lid

• Describe the anatomy of the skin, muscles and septum of the upper lid
• Describe the anatomy of the orbital fat compartments, the course of the extraocular muscles and the muscle cone along with the vessels and innervation entering the orbit, and the anatomy of the lacrimal apparatus.
• Describe the normal anatomy of the globe position to the upper lid

 

7.3.2 Management of dermatochalasia

• Explain how to assess a patient with laxity of the skin of the upper eyelids
• Discuss the position of the brow in relation to the upper lid when considering lid surgery
• Describe the surgical procedures available for rejuvenation of the upper lid

 

7.3.3 Assessment and treatment of ptosis

• List the causes of acquired upper eyelid ptosis
• Explain how to assess a patient with acquired upper eyelid ptosis
• Describe the range of procedures available

 

7.3.4 Surgical anatomy of lower eyelid

• List the causes of laxity of the skin and tissues of the lower eyelids
• Describe the normal anatomy of the globe position to the lower lid
• Discuss how to assess the shape and position of the medial and lateral canthal attachments
• Describe that anatomy of the periocular fat in relation to the lower lid and orbital septum

 

7.3.5 Lower blepharoplasty surgical techniques

• Describe the transconjunctival, sub-ciliary approaches to lower lid rejuvenation
• Describe the different approaches to addressing the fat bags including fat removal and fat preservation techniques
• Describe the indications for and the surgical technique of lateral canthopexy

 

7.3.7 Complications of eyelid surgery and their management

• List the complications of eyelid surgery
• Discuss how to avoid, recognise and treat these complications

 

7. 4 Face and Necklifting

7.4.1 A history of facelifting

• Give an overview of the history of facelifting
• Discuss the commonly used terms in facelifting

 

7.4.2 Facelift and necklift surgical anatomy

• Describe the anatomy of the SMAS in the head and neck
• Describe the anatomy of the facial nerve and greater auricular nerve branches in relation to the SMAS
• Discuss the anatomy of the true facial ligaments and their importance in facelifting

 

7.4.3 Overview of current facelift techniques

• Describe the range of face lift procedures available
• Explain how to select the most suitable procedure for a given patient
• Describe the main steps taken to perform each
• Describe how to assess a patient's suitability for a face lift

 

7.4.4 Management of the neck in facial rejuvenation

• Explain the aetiology of platysmal bands
• Describe the surgical management of platysmal bands
• Describe a range of procedures for neck lifting
• Describe how to avoid, recognise & treat the complications of each

 

7.4.5 Complications of facelifting and secondary facelift surgery

• List the complications of face lift
• Describe the steps that should be taken to minimise complications
• Explain how to recognise and treat complications of face lift
• Describe how to assess the outcome of a face lift
• List the indications for secondary surgery following face lift
• Describe the range of procedures available

 

7. 5 Facial Reshaping (see also orthognathic)

7.5.1 Indications and imaging for facial reshaping

• Describe how to assess the facial proportions
• List the indications for facial reshaping
• Describe the differences between skeletal and soft tissue augmentation
• Describe clinical, photographic and radiographic assessment for facial augmentation

 

7.5.2 Materials used in facial augmentation

• List the material used in facial augmentation
• List the advantages and disadvantages of each material
• Describe fixation methods for the materials listed

 

7.5.3 Facial implants

• Discuss the anatomical types of cosmetic facial implants available
• Describe the surgical techniques for placement of implants
• Describe how to avoid, recognise & treat the complications of each

 

7.5.4 Malar osteotomies

• Describe the normal anatomy of the zygomatic complex
• Discuss the advantages and disadvantages of malar osteotomies v's implants
• Describe the surgical techniques of zygomatic osteotomies
• Describe how to avoid, recognise and treat any complications

 

7.5.5 Genioplasty (see also orthognathic surgery)

• Discuss the advantages and disadvantages of genioplasty v's chin implants
• Describe the surgical techniques and of osseous genioplasty
• Describe how to avoid recognise and treat complications of chin surgery

 

7.5.6 Management of the large chin and "witches" chin deformity

• Discuss the surgical management of the large/protruding chin
• Describe the surgical treatment for the ""witches chin” deformity
• Describe how to avoid, recognise and treat the complications of each

 

7.5.7 Lip surgery techniques

• Describe the anatomy of the lips in relation to the lower face and dentition
• Discuss how the aging process changes the appearance of the lips
• Describe the surgical techniques of lip reduction
• Describe surgical technique of lip augmentation with autologous and alloplastic materials
• Describe how to avoid, recognise and treat the complications of lip surgery

 

7. 6 Rhinoplasty  (see also cleft)

7.6.1 Surgical anatomy of the nose in relation to septorhinoplasty

• Name the surface markings of the nose
• Describe the anatomy of the nasal bones, Nasal analysis and treatment planning connecting soft tissues
• Discuss the anatomical variations between different ethnicities

 

7.6.2 Assessment of nasal function

• Discuss clinical, radiographic and endoscopic assessment of nasal function
• Discuss the pathophysiology of the turbinates in relation to nasal function

 

7.6.3 Nasal analysis and treatment planning

• Discuss general facial assessment and the relationship of the nose to the face
• Describe how to analyse the upper mid and lower thirds of the nose
• Outline specific assessment of the nasal tip and the nasal base
• Discuss how to formulate a surgical plan for septorhinoplasty

 

7.6.4 Nasal septal surgery

• List the indications for septoplasty
• Outline the approach and surgical techniques used in septoplasty
• Describe how to avoid, recognise and treat the complications of septoplasty

 

7.6.5 Harvesting of nasal septal cartilage

• Outline the surgical technique for septal cartilage harvest
• Describe how to avoid recognise and treat complications of septal cartilage harvest

 

7.6.6 Harvest of ear cartilage

• Describe the surgical techniques for harvest of ear cartilage
• Describe how to avoid, recognise and treat complications of harvest of ear cartilage

 

7.6.7 Harvest of costal cartilage

• Describe the surgical technique for costal cartilage harvest
• Describe how to avoid, recognise and treat the complications of costal cartilage harvest

 

7.6.8 Rhinoplasty - approaches/incisions

• Outline the basic incisions used in septorhinoplasty
• Discuss the advantages and disadvantages of endonasal v's open techniques

 

7.6.9 Basic rhinoplasty techniques

• Outline the basic surgical principles involved in rhinoplasty for dorsal hump reduction
• Discuss the delivery and non-delivery techniques for endonasal rhinoplasty
• Getting it right first time - basic principles discussed

 

7.6.10 Management of the nasal tip

• Discuss the support mechanisms of the nasal tip
• Outline the commonly used grafts in nasal tip surgery
• Outline suture techniques in nasal tip surgery

 

7.6.11 Nasal osteotomies and management of the nasal bones in septorhinoplasty

• List the indications for nasal bone osteotomies
• Discuss the surgical techniques of lateral and medial nasal bone osteotomies
• Describe how to avoid, recognise and treat complications of nasal bone osteotomies

 

7.6.12 Management of the deviated nose

• Analyse the cause of the deviated nose
• Outline the principles of treatment of the deviated nose
• Describe how to avoid recognise and treat complications of surgery for the deviated nose

 

7.6.13 Adult cleft rhinoplasty

• Discuss the timing of secondary cleft rhinoplasty
• Recognise the need for psychological support
• Analyse the nasal defect and decide on a logical approach
• Describe commonly employed grafting materials and suture techniques

 

7.6.14 Rhinoplasty complications

• List the general, functional and aesthetic complications of septorhinoplasty
• Summarise the terms for the key iatrogenic nasal deformities of septorhinoplasty
• Outline the management of complications of septorhinoplasty

 

7.6.15 Secondary rhinoplasty surgery

• Discuss assessment of the patient requesting secondary rhinoplasty
• Outline the surgical correction of iatrogenic nasal deformity
• Discuss how to avoid, recognise and treat complications of secondary nasal surgery

 

7. 7 Aesthetic Procedures on the Ears

7.7.1 Anatomy and assessment of ears in the child and the adult

• Be able to describe the normal anatomy of the ears
• Describe the anatomy of the protruding ear
• Explain how to assess a patient requesting surgery for prominent ears

 

7.7.2 Surgical Procedures to correct prominent ears

• Describe the common surgical approaches for correction of prominent ears
• List the advantages and limitations of the different approaches
• Explain how to avoid, recognise and treat complications of otoplasty

 

7.7.3 Correction of earlobe deformity

• Describe the aetiology of enlarged earlobes
• Describe a range of procedures for reduction of earlobes
• Explain how to avoid, recognise & treat complications of earlobe reduction

 

7.7.4 Repair of split earlobes

• Describe the causes of split earlobes
• Describe a range of procedures for correction of split earlobes
• Explain how to avoid, recognise & treat complications of surgery for split earlobes

 

7. 8 Fillers, Toxins and Peels

7.8.1 Anatomy and Physiology of aging skin

• Discuss the normal anatomy of the skin
• List the aetiological causes of aging of the skin
• Describe the changes in the anatomy of the skin with aging

 

7.8.2 Dermal fillers- types and indications

• Describe and classify the types of alloplastic material used as dermal fillers
• Give examples of the appropriate use of each alloplastic material
• Explain the relative advantages, risks and complications of each alloplastic material

 

7.8.3 Autologous fat grafting

• Discuss the principles of fat harvest
• Describe the surgical procedure of fat harvest and transfer
• List the complications of fat transfer
• Discuss how to avoid and treat the complications of fat transfer

 

7.8.4 Botulinum toxin cosmetic use

• Describe how to assess a suitability for botulinum injections in glabella, forehead, and crows feet
• Explain how to perform botulinum injections in the glabella, forehead and crows feet
• Describe how to avoid, recognise & treat complications

 

7.8.5 Botulinum toxin - head and neck indications and techniques - non cosmetic

• Describe how to assess a suitability for botulinum injections in the face
• Explain how to perform botulinum injections in the facial muscles
• Describe how to avoid, recognise & treat complications

 

7.8.6 Skin peels

• Explain the advantages & disadvantages of the agents available for facial peeling
• Describe how to assess a patient's suitability
• Describe how to perform a chemical peel
• Describe how to avoid, recognise & treat complications

 

7.8.7 Lasers and IPL in facial rejuvenation

• List the range of lasers available for facial rejuvenation
• Explain the advantages & disadvantages of fractional and ablative lasers
• Describe how to assess a patient's suitability for laser rejuvenation
• Describe how to avoid, recognise & treat complications

 

7.8.8 Cosmoceuticals and their relevance to the maxillofacial surgeon

• Name the 7.al agents available for rejuvenation of facial skin
• Explain the evidence base for each
• Describe how each should be used

 

7.9 Imaging in head and neck aesthetic and cosmetic surgery.

7.9.1 Photography, laser scanning and 3D imaging

• Principles, indications, ordering, analysis.
• Guided investigations and treatment.
• Team working with other specialties.

 

7.9.2  Radiography, CT/MRI/PET/Nuclear imaging

• Principles, indications, ordering, analysis.
• Guided investigations and treatment.
• Team working with other specialties.

Appendix 2 – OMFS UEMS Surgical Experience Register – Download free from www.omfsuems.eu

OMFS is a  specialty which works collaboratively with dental and medical specialties. Trainees and specialists in OMFS should have a good understanding of the skills, knowledge and understanding of their colleagues including colleagues in allied professions.

There are currently 86 ETRs on the UEMS website https://www.uems.eu/areas-of-expertise/postgraduate-training/european-standards-in-medical-training which include ETRs on specialties and competencies written by UEMS bodies including Multi-disciplinary Joint Committees (MJCs) and Sections, often with the collaboration and support of European scientific associations. Reading these documents may help OMFS trainee and specialists working with or referring to colleagues.

UEMS 2020.33 European Training Requirements in Paediatric Surgery.pdf

UEMS 2020.31 European Training Requirements in ORL.pdf

UEMS 2020.12 Syllabus - Rare Diseases

UEMS 2020.12 Description of Competency - Rare Diseases

UEMS 2020.11 European Training Requirements in Rare Adult Solid Cancers

UEMS 2018.37 European Training Requirements in Radiology.pdf

UEMS 2018.42 European Training Requirements in Transplant Surgery.pdf

UEMS 2018.35 European Training Requirements for Wound Healing.pdf

UEMS 2018.39 European Training Requirements in Infectious Diseases.pdf

UEMS 2018.19 - European Training Requirements in Emergency Medicine - .pdf

UEMS 2018.18 - European Training Requirements in Obstetrics and Gynaecology.pdf

UEMS 2018.17 - European Training Requirements in Anaesthesiology.pdf

UEMS 2018.16 - European Training Requirements in Endocrinology.pdf

UEMS 2018.15 - European Training Requirement PRM specialty.pdf

UEMS 2017.30 - European Training Requirements Orthopaedics

UEMS 2017.29 - European Training Requirements in Dermatology & Venerology

UEMS 2015.34 - Annex 1 - ETR Neurosurgery - Appendix.pdf

UEMS 2017.07 - European Training Requirements in Nuclear Medicine

UEMS 2015.34 - European Training Requirements in Neurosurgery.pdf

UEMS 2015.29 - European Training Requirements Plastic, Reconstructive and Aesthetic Surgery (PRAS).pdf

UEMS 2016.13 - European Training Requirements Internal Medicine.pdf

UK OMFS Curriculum – 2021

https://www.iscp.ac.uk/media/1105/oral-maxillofacial-surgery-curriculum-aug-2021-approved-oct-20.pdf

Joint oncology competences developed by surgeons, medical & radiation oncologists

O'Higgins N, Eriksen JG, Wyld L, Benstead K. Interdisciplinary training for cancer specialists: The time has come. Radiother Oncol. 2018 Dec;129(3):415-416. doi:10.1016/j.radonc.2018.08.004. Epub 2018 Sep 6. PMID: 30197152.

Landmark publications about training in OMFS

EACMFS Recommendations For Education And Training
European Association of Craniomaxillofacial Surgeons
https://www.eacmfs.org/information/training-guidelines/training-guidelines/

International guidelines for speciality training in oral and maxillofacial surgery,
Journal of Cranio-Maxillo-Facial Surgery, Volume 20, Issue 6, 1992, Pages 280-283,
ISSN 1010-5182, https://doi.org/10.1016/S1010-5182(05)80446-9
(http://www.sciencedirect.com/science/article/pii/S1010518205804469)

International guidelines for specialty training in oral and maxillofacial surgery.
Int J Oral Maxillofac Surg. 1992 Jun;21(3):130-2. doi: 10.1016/s0901-5027(05)80777-5. PMID: 1640123

Training in oral and maxillofacial surgery. What's in a name?
Stoelinga PJ. Int J Oral Maxillofac Surg. 1989 Jun;18(3):129. doi: 10.1016/s0901-5027(89)80106-7. PMID: 2503569

Oral and Maxillofacial Surgery in Europe
[Article in German]
Mund Kiefer Gesichtschir 2000 May;4 Suppl 1:S3-10. doi: 10.1007/PL00022956.
W K Busch PMID: 10938639 DOI: 10.1007/PL00022956

History of the German Society of Oral and Maxillofacial Surgery (1951-2001)
[Article in German]
Erdsach T: Die Geschichte der Deutschen Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (1951-2001).
Heinz Pier, Erftstadt, 2004. ISBN 3-924576-08-4

The History of Oral and Maxillo-Facial Surgery
Hoffann-Axthelm W: Die Geschichte der Mund-, Kiefer und Gesichtschirurgie.
Quintessenz, Berlin, Chicago, London, Sao Paulo, Tokio, Moskau, Prag, Warschau, 1995. ISBN 3-87 652-077-0 []

e-Face – Oral and Maxillofacial Surgery Training Programme
https://www.e-lfh.org.uk/programmes/oral-and-maxillofacial-surgery/

In addition to the help of the ETR Committee, and the UEMS Executive for their contributions, we would like to formally acknowledge the following and thank them for their help.

Contribution Sections                                                                       Named respondent (sometimes of many)

Allergology                                                                                                                    Prof. dr. Roy Gerth van Wijk

Anaesthesiology                                                                                                         Dr Olegs Sabeļņikovs

Cardiology                                                                                                                     Prof Lampros K Michalis

Child and Adolescent Psychiatry                                                                           Dr Sue Bailey
Dermato-Venereology*                                                                                           Prof Peter Arenberger

Emergency Medicine                                                                                                Dr Ruth Brown

Geriatric Medicine                                                                                                     Dr J.W.M. (Jaap) Krulder

Hand Surgery                                                                                                               Dr Maurizio Calcagni

Infectious diseases                                                                                                    Prof Jean-Paul Stahl

Laboratory Medicine                                                                                                 Prof.dr.sc. Vesna Kušec

Medical Genetics                                                                                                        Prof Peter D Turnpenny

Medical microbiology                                                                                                Dr Truls Michael Leegaard

Medical Oncology                                                                                                       Dr. Serdar Turhal

Nephrology                                                                                                                   Prof Itzchak Slotki

Neurology                                                                                                                     Dr. Patrick Cras

Neurosurgery                                                                                                              Prof Wilco Peul

Nuclear Medicine                                                                                                       Prof Siroos Mirzaei

Obstetrics and Gynaecology                                                                                  Prof. Basil C. Tarlatzis

Occupational Medicine Section                                                                             Ferenc Kudász

Orthopaedics and Traumatology                                                                          Dr Andreas Tanos

Oto-Rhino-Laryngology*                                                                                         Prof John Fenton

Paediatric Surgery                                                                                                      Prof Udo Rolle

Pharmacology                                                                                                              Dr Thomas Griesbacher

Physical and Rehabilitation Medicine (PRM)                                                   Prof Aydan Oral

Plastic Surgery                                                                                                             Dylan Murray

Psychiatry                                                                                                                      Dr Andrew Brittlebank

Public Health                                                                                                                Dr Marc Soethout

Radiation Oncology & Radiotherapy                                                                   Dr Kim Benstead

Radiology                                                                                                                       Prof. Michael Lee

Rheumatology                                                                                                             Prof. Jean Dudler

Surgery                                                                                                                           Prof D Casanova, Prof A Felice

Thoracic Surgery                                                                                                         Prof Dirk Van Raemdonck

Urology                                                                                                                           Prof Arnaldo Figueiredo

 

Non-UEMS non-OMFS bodies

BAHNO British Association of Head and Neck Oncologists                         Peter Brennan

eLearning For Health (eLfH)                                                                                   Stake-holder manager

European Association of Facial Plastic Surgeons (EAFPS)*                         Prof Hesham Saleh

Confederation of European Otorhinolaryngology H&N Surgery*            Prof Cem Meco

 

* Objections in letter(s) as yet unresolved – all correspondence shared on UEMS Dropbox.

 

Contributing non-UEMS International OMFS bodies

International Association of Oral and Maxillofacial Surgeons (IAOMS) Prof Ghali Ghali

European Association of Cranio-Maxillo-Facial Surgery                               Frank Hölzle

 

Contributing non-UEMS OMFS Bodies

Organisation                                                                                                                Contributors

Austrian Society of Oral-Maxillofacial-Surgery                                                Michael Öckher, Gert Santler

Belgian Royal Society for Oral and Maxillo-Facial Surgery                          Blaise Kovacs, Jan Van de Perre, Herman Vercruysse

Croatian Society of Maxillofacial Surgery                                                          Lukšić Ivica

Cyprus Association of Oral and Maxillofacial Surgery                                   Kostas Marinos

Czech Association for Maxillofacial Surgery                                                      René Foltan, Karel Klima

Danish Association for Oral and Maxillofacial Surgery                                 Troels Bundgaard, Thomas Steengaard

Estonian Association for Maxillofacial Surgery                                                Tauri Narits, Tiia Tamme

Finnish Association for Maxillofacial Surgery                                                   Risto Kontio, Patricia Stoor

French Association of Facial Surgeons: SFSCMFCO                                        Joël Ferri, Olivier Trost

Georgia Society of Oral and Maxillofacial Surgeons                                      Zurab Chichua, Ketevan Gogilashvili, Giorgi Menabde

German Society of Oral- and Maxillofacial-Surgery                                       Hans-Peter Ulrich, Frank Hölzle, Martin Keweloh

Hellenic Association for Oral and Maxillofacial Surgery (HAOMS)           Lampros Goutzanis, Constantinos Mourouzis

Hungarian Association of Oral and Maxillofacial Surgeons                         Zsolt Nemeth

Irish Oral and Maxillofacial Surgeons Group                                                    Tom Barry

Italian Society of Maxillo-Facial Surgery                                                            Davide Sozzi

Latvian Association of Oral and Maxillofacial Surgeons                               Kaspars Stamers

Lithuanian Oral and Maxillofacial Surgeons Group                                        Linas Zaleckas

Maltese OMFS Surgeons Group                                                                            Clarence Pace

Dutch Association of Oral and Maxillofacial Surgeons                                  Thijs Merkx, Toine Rosenberg

Norwegian Society  for Maxillofacial Surgery                                                   Jan Mangersnes

Polish Association for Cranio-Maxillofacial Surgery                                       Grażyna Wyszyńska

Portuguese Society of Maxillo-Facial Surgery                                                  Paulo Valejo Coelho

Romanian Society for Oral and Maxillofacial Surgery                                   Alexandru Bucur

Slovenian Association for Maxillofacial and Oral Surgery                            Nataša Ihan Hren

Spanish Association of Oral and Maxillofacial Surgery                                 Fernando Garcia Marin,
Carlos Navarro Vila

Swedish Society for Maxillofacial Surgery                                                         Lars Rasmusson

Swiss Society of Oral & Maxillo-facial Surgery                                                 Henri Thuau

British Association of Oral and Maxillofacial Surgeons                                Patrick Magennis,
Iain Hutchison

 

OMFS Section and Board Core ETR Development Team

Background

The team listed on this page are only the most recent group of European OMFS surgeons who have worked to define and refine training in OMFS. We acknowledge, with thanks, those who drafted our original Chapter 6, created and ran our European Board examination, and built the OMFS Section and Board into the vigorous entity it is today. There names are too many to list, but we are forever grateful to all of them.

This ETR draws heavily on all the national training programmes across Europe. All the national training programmes are available on the OMFS Section website www.omfsuems.eu . We hope that this hybrid document will return the favour and allow national training programmes to take the best of European OMFS training and included it within their national programme. Some nations, who do not currently have the specialty of OMFS or who do not have a written training curriculum, may wish to use this ETR to structure their OMFS training.

 

OMFS ETR Team (alphabetically by surname)

Paulo Coelho                       Lisboa, Portugal                Vice President of Board

Frank Hölzle                         Aachen, Germany             Liaison Officer

Risto Kontio                          Helsinki, Finland                Secretary General, Board

Blaise Kovacs                      Brussels, Belgium             President, Board

Patrick Magennis                 Liverpool, UK                    President Section

Rudolf Reich                        Bonn, Germany                 Past-President Scientific Committee

Henri Thuau                         Baar, Switzerland              President, Scientific Committee

Hans-Peter Ulrich                Lübeck, Germany             Secretary General, Section

Carlos Navarro Vila             Madrid, Spain                    Honorary Chair of Board.

Appendix 6 - CANMED  Competencies - Abridged for UEMS