Oral & Maxillofacial Surgery Syllabus for DCI Workshop, Delhi April 29 th 2006 .
(This document has been compiled at the secretariat of the AOMSI with inputs from the committee formed by the EC)

1. Dr Krishnamoorthy Bonanthaya
2. Dr Vinod Narayanan
3. Dr Gunaseelan Rajan
4. Dr Sunil Kelkar- President AOMSI
5. Dr George Paul- Secretary AOMSI

Suggestions from other members are welcome before 21 st April
Rough draft for public viewing, comments and suggestions by AOMSI members

1. The Oral and Maxillofacial Surgery Course shall be for a period of Four years.
   Explanation: There is a global trend to make maxillofacial surgery qualification a dual degree or an integrated programme to include medical degree as part of advance training. As this is not practical in India at this stage an advanced training programme to equip trainees with better medical knowledge and surgical skills will require an extended course.
2. There will be an examination at the end of the first year/ or six months in basic medical sciences. A separate syllabus for different specialties recommended.
3. A second examination in Medicine, Human Diseases, Surgery, critical care and relevant specialties at the end of 24 months.
   Explanation: This will be unique to OMFS in view of additional medical and surgical requirements.
4. Training in parent department in all areas of Maxillofacial surgery as specified below. If the department does not have adequate case load in pivotal sub-areas of maxiollofacial surgery, they may be sent to other OMFS units for the same. It is mandatory that they have training in all the broad areas of specialties outlined in syllabus below.
5. Third examination at the end of 48 months to cover all aspects of maxillofacial surgery.
6. Performance of surgical removal of impacted teeth for examinations should be abolished as it is unfair to the student and unethical to treat patients in a stressful and vitiated environment.
   Explanation: Surgical procedures during examinations have been done away with in examinations everywhere else and are non existent in other surgical specialties
7. It is advisable that all examiners are external (as in DNB) to avoid internal bias based on individual likings and allegations of favoritism.
8. While dissertation is a good way to learn research methodology an option of publishing in indexed journals should be given as an alternate. Minimum number of presentations at National conferences, seminars and other internal assessments can be evolved to ascertain if candidate is suitably trained before appearing for examinations. The exact numbers can be evolved as institutional or university stipulation.
9. Rotation in Medical / Surgical Specialties should include:

• General Medicine
• General Surgery
• Critical Care
• Anaesthesia
• Paediatrics
• Otolaryngology
• Neurosurgery
• Plastic Surgery
• Or any other specialty found necessary

Not more than 9 months should be spent outside the parent department. All medical/ surgical postings to be made mandatory with responsibilities as on call or as supervised on call duties in respective departments.

11.Practical requirements for the course.
Each student must perform (under supervision or as first assistant)
50 major oral & maxillofacial surgical operations under general anesthesia including adults and children. There must be atleast 7 patients in each category of surgery. The categories of major surgery are defined as: 1) trauma 2) orthognathic surgery 3) pathology 4)TM Joint, cleft lip & palate 5) dentoalveolar .
This is in addition to various categories of minor oral surgical procedures like impaction, surgical extractions, endodontic surgeries, biopsies etc. A minimum of 100 minor oral surgical procedures should have been performed independently under supervision by a candidate appearing for the final MDS examination.

12. Seminars and lectures.
Every candidate must have presented the prescribed number of seminars, journal clubs and case presentations. A record of the same endorsed by the HOD or Professor in charge, must be presented along with log book and dissertation/ published article at the time of examinations.
Teaching shall mainly be in the form of seminars, symposiums and didactic sessions conducted by the staff of the departments. The exact mechanism and number of hours can be worked out and stipulated by the Institutions/ universities.

13. Record of Surgical Training
Candidates will be required to submit a record of Surgical Training (logbook) which should indicate the candidate's breadth of experience in the specialty. This record of Surgical Training (logbook) should enumerate the various surgical procedures undertaken in which the candidate was the principal operator. It should also indicate the method of anaesthesia and should identify basic details of the surgery undertaken. It will be signed by the trainer and it will confirm the completion of the procedures recorded. The Record of Surgical Training (logbook) should indicate the practical experience obtained by the candidate in surgery and that they have the appropriate knowledge and skills required for the practice of oral and maxillofacial surgery to a high standard. At the completion of training it would be expected that the candidate was experienced and had a thorough understanding of the topics prescribed as shown hereunder.

PART 1

Specific to specialty basic sciences must be the norm. Examination at the end of six months or one year.(discretion of University)

Embryology and gross anatomy of head & neck in relation to practice of dentistry
Histology of oral & dental tissues
Applied pathology in general and of relevance to the practice of dentistry
The principles of applied physiology and biochemistry with particular reference to bone growth and development, respiration, circulation, mastication, deglutition and speech.
Human disease in relation to Dentistry including relevant microbiology, pathology and immunology.
Applied pharmacology as relevant to the practice of dentistry
Epidemiology, statistics, research methodology and clinical information technology.
Anatomy of Thorax and Abdomen may be added as special requirements for OMFS post graduates . Any other additional requirement for OMFS may be added

PART 2

Examination at the end of 24 months .
Principles of prevention of oral diseases.
Medical and surgical problems related to oral and maxillofacial surgery.
Relevant inter-relationships with other clinical dental disciplines.
Relevant diagnostic procedures and techniques to include applied dental, oral and maxillofacial radiography and radiology.

Control and management of pain in the maxillofacial and oral area.The management of discomfort and dental anxiety should be included with that of pain with the appropriate selection, prescription administration of relevant drugs.
All relevant aspects of technology related to the practice of oral and

maxillofacial surgery .
Principles and practice of clinical audit.
Provision of all aspects of care for special needs patients.

The principles of surgery in general and of relevance to the practice of oral and maxillofacial surgery in particular.

Perioperative Care
Assessment of Fitness for Surgery

Preoperative assessment and risk scoring systems
Laboratory testing and imaging

Management of Associated Medical Conditions

Organ specific diseases
Issues related to medications
General factors

Informed consent
Pre-medication
Risk management

General anaesthesia
Local anaesthesia

Non-invasive monitoring
Invasive monitoring

Positioning of the patient in surgery
Avoidance of injuries

Surgical aspects of disordered haemopoiesis
Haemolytic disorders
Disorders of bleeding and coagulation

Preparation and components of blood products
Indications for blood product transfusion
Complications associated with blood transfusion
Alternatives to blood transfusion

Postoperative management & critical care

Postoperative monitoring
Ventilatory support
Pain control
Intravenous drug delivery

Fluid & electrolyte management
Nutrition in the surgical patient

General surgical complications
Respiratory failure
Acute renal failure
Systemic inflammatory response syndrome (SIRS)
Multiple organ dysfunction syndrome (MODS)

Classification of surgical wounds
Principles of wound management
Pathophysiology of wound healing
Scars and contractures

Principles of safe surgery
Incisions and wound closure
Diathermy, laser, principles of cryosurgery
Sutures and ligature materials
Basic surgical instruments

Psychological effects of surgery
Communication skills in medicine and surgery
Working in teams
Breaking bad news
Dealing with conflict
Management of crises

Oral and maxillofacial surgery in relation to other dental and medical specialties.

Recognition of oral manifestations of human disease and an understanding of human disease in relation to the practice of oral and maxillofacial surgery.

Detailed knowledge of the management of emergencies and resuscitation in the practice of oral & maxillofacial surgery.

Basic & Advanced life support.

Management by pharmacological and non-pharmacological means of pain in the maxillofacial area, discomfort and dental anxiety including the selection prescription administration of relevant drugs.

Medico-legal implications for the practice of oral and maxillofacial surgery.

Control of cross infection including the principles and practice of sterilization procedures.

The principles of radiography and imaging and radiology related to oral and maxillofacial surgery.

PART 3

Examination at the end of 48th month

Clinical aspects of topics covered in Part 1 & Part 2

Diagnosis and management of oral and maxillofacial disease

All aspects of dentoalveolar surgery including extraction of teeth and roots and management of ectopic and impacted teeth, surgical endodontics, management of oro-antral/nasal communication and the fractured tuberosity.

Diagnosis and management of maxillofacial trauma including soft tissue injuries.

Diagnosis and management of cysts and benign lesions of the mouth, jaws and salivary glands

Diagnosis and management of orofacial pre-cancer and cancer including salivary glands.

The diagnosis and management of facial deformity including facial clefts.

(iii) The management of maxillofacial trauma including a good understanding of the management of soft tissue injuries;

(iv) Biopsy techniques and the management of minor soft tissue surgery;

(v) Management of benign lesions in mouth and jaws including cysts;

(vi) A knowledge of the management of salivary gland disease;

In view of global restructuring of the requirements of training and qualifications in oral and maxillofacial surgery, the AOMSI strongly urges the DCI to adopt the system of offering an integrated medical and maxillofacial surgery degree that is being used in many countries such as the USA, UK, Australia, European Union, New Zealand etc. The integrated degree is offered to dentally qualified and medically qualified graduates. Aspiring dental graduates who wish to do the integrated course will require a six year period to get a medical and maxillofacial degree. Similarly candidates with a medical degree will have to undergo an integrated six year course which will give them a dental and maxillofacial qualification.

This is a unique requirement of the specialty and the AOMSI is ready to negotiate the modalities along with the DCI and MCI to achieve this end.

The changes thus brought on will not in anyway undermine or threaten the existing operating privileges and competence of signally qualified maxillofacial surgeons.

Until such time, we will need to undertake the above mentioned curriculum and syllabus as a confidence building measure to tackle the complexities of the specialty.

Additional Suggestions :

Dr Krishnamoorthy Bonanthaya

1) I very firmy believe that if we as a profession are going to scale greater heights, if we are going to maintain world class standards of training, then it is imperative that the trainers too should come under the scanner from time to time. If we agree on this I think it should be institutionalized & what best way to do it than incorporate it in the curriculum itself. If we agree on this I think a feedback from the trainees at the end of their training & a periodic peer review is the way to go.

2) We must remember that as recently as 2005 we, from the AOMSI have proposed to the MCI for a combined programme. Do we now disown that altogether? It is another matter that it may not be feasible in the near future. But if that remains to be our long term objective then I think we will be failing in our duty if we did not mention those efforts parallel to this proposal. Alternatively you decide to bury that altogether, I feel we have to take this call now

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