M.D.S.:ORAL AND MAXILLOFACIAL SURGERY

M.D.S.:ORAL AND MAXILLOFACIAL SURGERY

Course content:
The program outlines addresses both the knowledge needed in Oral and Maxillofacial Surgery
and allied medical specialties in its scope. A minimum of three years of formal training through a
graded system of education as specified will equip the trainee with skill and knowledge at its
completion to be able to practice basic oral and Maxillofacial surgeon competently and have the
ability to intelligently pursue further apprenticeship towards advance Maxillofacial surgery.
The topics are considered as under:-
 Basic sciences
 Oral and Maxillofacial surgery
 Allied specialties
Applied Basic Sciences:
A thorough knowledge both on theory and principles in general and in particular the basic
medical subjects as relevant to the practice of maxillofacial surgery. It is desirable to have
adequate knowledge in bio-statistics. Epidemiology. research methodology, nutrition and
computers.
 Anatomy
Development of face, paranasal sinuses and associated structures and their anomalies; surgical
anatomy of scalp temple and face, anatomy and its applied aspects of triangles of neck, deep
structures of neck, cranial facial bones and its surrounding soft tissues, cranial nerves tongue,
stemporal and infratemporal region, orbits and its contents, muscles of face and neck, paranasal
sinuses, eyelids and nasal septum teeth gums and palate, salivary glands, pharynx, thyroid and
parathyroid glands, larynx, trachea and esophagus, congenital abnormality of orofacial regions,
General consideration of the structure and function brain and applied anatomy of intracranial
venous sinuses; cavernous sinus and superior sagital sinus, Brief consideration of autonomous
nervous system of head and neck, Functional anatomy of mastication, deglutition, speech,
respiration and circulation, Histology of skin oral mucosa, connective tissue bone, cartilage
cellular elements of blood vessels, lymphatic, nerves, muscles, tongue, tooth and its surrounding
structures.
2
 Physiology
Nervous system-physiology of nerve conduction, pain pathway, sympathetic and
parasympathetic nervous system, hypothalamus and mechanism of controlling body
temperature; Blood-its composition hemostasis, blood dyscrasias and its management,
hemorrhage and its control, blood grouping, cross matching, blood component therapy,
complications of blood transfusion, blood substitutes, auto transfusion, cell savers; digestive
system composition and functions of saliva mastication deglutition, digestion, assimilation, urine
formation, normal and abnormal constituents; Respiration control of ventilation anoxia, asphyxia,
artificial respiration, hypoxia - types and management; CVS - cardiac cycle, shock, heart sounds.
blood pressure, hypertension; Endocrinology-metabolism of calcium; endocrinal activity and
disorder relating to thyroid gland, parathyroid gland, adrenal gland, pituitary gland, pancreas and
gonads; Nutrition-general principles balanced diet. Effect of dietary deficiency, protein energy
malnutrition, Kwashiorkor, Marasmus, Nutritional assessment, metabolic, responses to stress,
need for nutritional support, entrails nutrition, roots of access to GI tract, Parenteral nutrition,
Access to central veins, Nutritional support; Fluid and Electrolytic balance / Acid Base
metabolism - the body fluid compartment, metabolism of water and electrolytes, factors
maintaining hemostasis, causes for treatment of acidosis and alkalosis.
 Biochemistry
General principles governing the various biological principles of the body, such as osmotic;
pressure, electrolytes, dissociation, oxidation, reduction etc; general composition of body,
intermediary metabolism, carbohydrate, proteins, lipids, enzymes, vitamins, minerals and
antimetabolites.
 General Pathology
Inflammation - Acute and chronic inflammation, repair and regeneration, necrosis and gangrene,
role of component system in acute inflammation, role of arachidonic acid and its metabolites in
acute inflammation, growth factors in acute inflammation role of NSAIDS in inflammation, cellular
changes in radiation injury and its manifestation; wound management - Wound healing factors
influencing healing; properties if suture materials, appropriate uses of sutures; hemostasis -role
of endothelium in thrombogenesis; arterial and venous thrombi, disseminated intravascular
coagulation; Hypersensitivity; Shock and pulmonary failure: types of shock, diagnosis,
resuscitation, pharmacological support, ARDS and its causes and prevention, ventilation and
support, Neoplasm - classification of tumors, Carcinogens and Carcinogenesis, grading and
staging of tumors, various laboratory investigation.
 General microbiology
Immunity, Hepatitis B and its prophylaxis, Knowledge of organisms, commonly associated with
diseases of oral cavity, culture and sensitivity tests, various staining techniques - Smears and
cultures, urine analysis and culture.
3
 Oral pathology and microbiology:
Developmental disturbances of oral and para oral structures, regressive changes of teeth,
bacterial, viral, mycotic infection of oral cavity, dental caries, diseases of pulp and Periapical
tissues, physical and chemical injuries of oral cavity, wide range of pathological lesions of hard
and soft tissues of the orofacial regions like the cysts odontogenic infection, benign, malignant
neoplasms, salivary gland diseases, maxillary sinus diseases, mucosal diseases, oral aspects of
various systemic diseases, role of laboratory investigation in oral surgery.
 Pharmacology and therapeutics:
Definition of terminology used, pharmacokinetics and pharmadynamic dosage and mode of
administration of drugs, action and fate in the body, drug addiction, tolerance and hypersensitive
reactions, drugs acting on CNS, general and local anesthetics, antibiotics and analgesics,
antiseptics, antitubercular, sialagogues, hematinics, anti diabetic, vitamins A, B-complex,
C,D,E,K.
 Computer science:
Use of computers in surgery, components of computer and its use in practice-principles of word
processing, spreadsheet function database and presentations; the internet and its use. The value
of computer based systems in biomedical equipment.
ORAL AND MAXILLOFACIAL SURGERY:
 Evolution of Maxillofacial surgery.
 Diagnosis, history taking, clinical examination, investigations.
 Informed consent/medico-legal issues.
 Concept of essential drugs and rational use of drugs.
 Communication skills with patients - understanding clarity in communication, compassionate
explanations and giving emotional support at the time of suffering and bereavement
 Principles of surgical audit - understanding the audit of process and outcome. Methods
adopted for the same Basic statistics.
 Principles of evidence bases surgery - understanding journal based literature study; the value
of textbook, reference book articles, value of review articles; original articles and their critical
assessment, understanding the value of retrospective, prospective, randomized control and
blinded studies, understanding the principles and the meaning of various Bio-statistical tests
applied in these studies.
 Principles of surgery - developing a surgical diagnosis, basic necessities for surgery, aseptic
techniques, incisions, flap designs, tissue handling, hemostasis, dead space management,
decontamination and debridement, suturing, edema control, patient general health and
nutrition.
 Medical emergencies - Prevention and management of altered consciousness, hyper
sensitivity reaction, chest discomfort, respiratory difficulty.
 Pre operative workup - Concept of fitnes-s for surgery; basic medical work up; work up in
4
special situation like diabetes renal failure, cardiac and respiratory illness; risk stratification
 Surgical sutures, drains
 Post operative care - concept of recovery room care, Airway management, Assessment of
Wakefulness, management of cardiovascular instability in this period, Criteria for shifting to
the ward, pain management
 Wound management - Wound healing, factors influencing healing, basic surgical techniques,
Properties of suture materials, appropriate use of sutures.
 Surgical Infections - Asepsis and antisepsis, Microbiological principles, Rational use of
antibiotics infections like Synergistic Gangrene and Diabetic foot infection, Hepatitis and HIV
Infection and cross infection.
 Airway obstruction / management - Anatomy of the airway, principles of keeping the airway
patent, mouth to mouth resuscitation, Orpharyngeal airway, endotracheal intubation,
Cricothyroidectomy, Tracheostomy.
 Anaesthesia - stages of Anaesthesia, pharmacology of inhalation, intravenous and regional
anaesthetics, muscle relaxants.
 Facial pain; Facial palsy and nerve injuries.
 Pain control - acute and chronic pain, cancer and non-cancer pain, patient controlled
analgesia.
 General patient management - competence in physical assessment of patients of surgery,
competence in evaluation of patients presenting with acute injury, particularly to maxillofacial
region. Competence in the evaluation of management of patients for Anaesthesia.
 Clinical oral surgery - all aspects of dento alveolar surgery
 Pre-prosthetic surgery - A wide range of surgical reconstructive procedures involving their
hard and soft tissues of the edentulous jaws.
 Temporomandibular joint disorders - TMJ disorders and their sequelae need expert
evaluation, assessment and management. It is preferable to be familiar with diagnostic and
therapeutic arthroscopic surgery procedures.
 Tissue grafting -Understanding of the biological mechanisms involved in autogenous and
heterogeneous tissue grafting. Reconstructive oral and maxillofacial surgery - hard tissue
and soft tissue reconstruction.
 Anaesthesia - Stages of anaesthesia, pharmacology of inhalation, intravenous and regional
anaesthesia, muscle relaxants.
 Cyst and tumors of head and neck region and their management - including principles of
tumor surgery, giant cell lesion of jaw bones, fibro osseous lesion of jaw lesions.
 Neurological disorders of maxillofacial region-diagnosis and management of Trigeminal
Neuralgia, MPDS, Bells palsy, Frey's Syndrome, Nerve injuries.
 Maxillofacial trauma - basic principles of treatment, primary care, diagnosis and management
of hard and soft tissue injuries, Comprehensive, management including polytrauma patients.
 Assessment of trauma-multiple injuries patients/closed abdominal and chest
injuries/penetrating injuries, pelvic fractures, urological injuries, vascular injuries.
5
 Orthognathic surgery -The trainee must be familiar with the assessment and correcting of jaw
deformities
 Laser surgery - The application of laser technology in the surgical treatment of lesions
amenable to such therapy
 Distraction osteogenesis in maxillofacial region.
 Cryosurgeries - Principles, the application of cryosurgery in the surgical management of
lesions amenable to such surgeries.
 Cleft lip and palate surgery - detailed knowledge of the development of the face, head and
neck, diagnosis and treatment planning, Current concepts in the management of cleft lip and
palate deformity, knowledge of nasal endoscopy and other diagnostic techniques In the
evaluation of speech and hearing, concept of multi disciplinary team management.
 Aesthetic facial surgery - detailed knowledge of structures of facial neck including skin and
underlying soft tissues, diagnosis and treatment planning of deformities and conditions
affecting facial kin, underlying facial muscles, bone, eyelids, external ear etc. surgical
management of post acne scaring, face lift; blepharoplasty, otoplasty, facial bone
recountouring etc.
 Craniofacial surgery - basic knowledge of developmental anomalies of face, head and neck,
basics concept in the diagnosis and planning of various head and neck anomalies including
facial cleft, craniosynostosis, syndromes etc. Current concepts in the management of
craniofacial anomalies.
 Head and neck oncology - understanding of the principles of management of head and neck
oncology including various pre cancerous lesions, Experience in the surgical techniques of
reconstruction following ablative surgery.
 Micro vascular surgery.
 Implantology - principles, surgical procedures for insertion of various types of implants.
 Maxillofacial radiology / radio diagnosis
 Other diagnostic methods and imaging techniques
Allied specialties:
 General medicine: General assessment of the patient including children with special
emphasis on cardiovascular diseases endocrinal and metabolic respiratory and renal
diseases, Blood dyscrasias.
 General surgery: Principles of general surgery, exposure to common general surgical
procedures.
 Neuro - surgery: Evaluation of a patient with head injury, examination of various Neurosurgical
procedures
 ENT/Ophthalmology: Examination of ear, nose throat. exposure to ENT surgical procedures,
ophthalmic examination and evaluation, exposure to ophthalmic surgical procedures
 Orthopaedic: basic principles of orthopaedic surgery, bone diseases and trauma as relevant
to Maxillofacial surgery, interpretation of radiographs, CT, MRI and ultrasound
6
 Anesthesia: Evaluation of patients for GA techniques and management of emergencies,
various IV sedation techniques.
Academic Clinical programme (applicable for all three years):
 Seminars to be presented attended once in a week.
 Journal clubs (departmental and interdepartmental) to be conducted once in fifteen days.
 Departmental and Interdepartmental discussions to be held once in a month.
 Minimum 2 scientific papers should be presented.
 Every candidate shall maintain a logbook to record his/hers wok or participation in all
activities such as journal clubs, seminars, CDE programs etc. this work shall be scrutinized
and certified by the head of the departmental and head of the institution and presented to the
university every year.