Oral and Maxillofacial Surgery (OMFS) is a highly specialized field that bridges medicine and dentistry. This surgical specialty focuses on the diagnosis and treatment of diseases, injuries, and defects involving the functional and aesthetic aspects of the mouth, jaws, face, and neck. An oral and maxillofacial surgeon is uniquely trained to manage the hard and soft tissues of the entire craniomaxillofacial complex, from the forehead down to the neck. The discipline requires extensive knowledge of both general surgery principles and complex dental structures.
The Specialized Training Required
The educational path to becoming an oral and maxillofacial surgeon is one of the most rigorous in the surgical specialties. Candidates must first complete a four-year dental degree, earning either a Doctor of Dental Surgery (DDS) or a Doctor of Dental Medicine (DMD). This is followed by a hospital-based surgical residency program that typically lasts an additional four to six years. The residency provides intensive training in anesthesia, internal medicine, general surgery, and emergency medicine, which distinguishes them from general dentists.
Many surgeons choose the dual-degree pathway, which incorporates medical school into the residency, resulting in both a dental degree and a Doctor of Medicine (MD). This combined program extends the training timeline but equips the surgeon with a deeper understanding of systemic diseases and advanced surgical principles. The residency includes significant experience in advanced anesthesia techniques, such as intravenous sedation and general anesthesia. Upon completion of residency, surgeons often seek board certification, which confirms their mastery of the field through a comprehensive examination process.
Common Ambulatory Procedures
The most frequent patient interactions occur in an outpatient setting for common dentoalveolar procedures. The removal of impacted third molars, commonly known as wisdom teeth, is the most common procedure performed. This involves surgically accessing teeth trapped beneath the gum line or bone to prevent infection, damage to adjacent teeth, or cyst formation.
Complex dental extractions that a general dentist may not be equipped to handle are routine in the OMFS office. This includes removing fractured or severely decayed teeth, or teeth in patients with compromised medical conditions, such as those on blood thinners. Another frequent procedure is the placement of dental implants, which are titanium posts surgically integrated into the jawbone to replace missing tooth roots. This procedure often requires specialized bone grafting techniques to augment jawbone volume if the natural bone has deteriorated following tooth loss.
Pre-prosthetic surgery involves preparing the mouth and jaw to receive dentures or other dental prostheses. This may include smoothing or reshaping the jawbone (alveoloplasty) or removing excess soft tissue to ensure a secure and comfortable fit. The diagnosis and treatment of minor oral pathology, such as conducting biopsies of suspicious lesions, cysts, or benign tumors, is also an important office-based function. These procedures are managed with local anesthesia, conscious sedation, or deep sedation.
Major Reconstructive and Corrective Surgery
The “maxillofacial” aspect of the specialty encompasses complex, hospital-based surgical interventions that address severe functional and aesthetic issues. A major part of this work involves the management of facial trauma, where the surgeon is often a member of the hospital’s emergency team. This includes the repair of fractures involving the lower jaw (mandible), upper jaw (maxilla), cheekbones (zygoma), and the bones surrounding the eye sockets (orbital fractures). The goal of trauma surgery is to precisely restore the alignment of the facial skeleton to ensure correct function and appearance.
Corrective jaw surgery, known as orthognathic surgery, resolves severe bite discrepancies (malocclusion) that cannot be fixed with orthodontics alone. This surgery involves cutting and repositioning the maxilla, mandible, or both, to correct skeletal problems like underbites or overbites, improving chewing, breathing, and speech. Surgeons also treat disorders of the temporomandibular joint (TMJ), which connects the jawbone to the skull. Treatment ranges from minimally invasive arthroscopic procedures to open joint surgery or total joint replacement for severe degeneration.
The specialty also treats head and neck pathology, including the surgical removal of cysts, benign tumors, and malignant cancers of the oral cavity and jaws. Following the removal of large tumors, extensive reconstructive surgery is necessary to restore the patient’s form and function. This often involves microvascular free tissue transfer, a demanding technique where tissue is harvested from another part of the body and transplanted to the face or jaw. The surgeon uses a microscope to meticulously suture tiny blood vessels to reestablish blood supply to the transplanted tissue. This method allows for the immediate reconstruction of large defects, ensuring the best possible outcome for patients recovering from cancer or severe trauma.