OMS Handbook 2020 v1.0 PDF

HANDBOOK FOR
ACCREDITED
EDUCATION AND
TRAINING
IN ORAL AND
MAXILLOFACIAL
SURGERY
April 2020
Published by Royal Australasian College of Dental Surgeons
ABN: 97 343 369 579 | ACN: 617 702 548
Level 13, 37 York Street Sydney 2000 Australia
Version 1 April 2020
Copyright © Royal Australasian College of Dental Surgeons
The information in this handbook is correct at the time of publication. The Handbook is regularly updated,
users of the handbook are advised to consult the latest version which is available on the College website
at www.racds.org. Enquiries can be made to oms@racds.org
While the College has made every effort to provide accurate and relevant information, the onus is on
users of the handbook to ensure that they have made every effort to validate the information.
Contents Accredited Education and Training in Oral and Maxillofacial Surgery
Contents
INTRODUCTION ......................................................................................................................................7
ORAL MAXILLOFACIAL SURGERY EDUCATION PROGRAM OBJECTIVES....................................8
OMS DATES FOR 2020...........................................................................................................................9
GLOSSARY OF TERMS ........................................................................................................................10
FEES FOR 2020 .....................................................................................................................................12
Training ................................................................................................................................ 12
Assessment .......................................................................................................................... 12
Fellowship ............................................................................................................................ 12
TRAINING REGIONS AND REGIONAL DIRECTORS OF TRAINING .................................................13
APPROVED HOSPITALS AND ACCREDITED TRAINING POSTS ....................................................13
BOARD OF STUDIES FOR ORAL AND MAXILLOFACIAL SURGERY AND COMMITTEES ...........14
Board of Studies ................................................................................................................... 14
Regional Surgical Committees ............................................................................................. 15
Accreditation Committee ...................................................................................................... 16
Overseas Trained Specialist Sub-Group (OTSC) ................................................................ 16
Training Committee .............................................................................................................. 17
Education Committee ........................................................................................................... 18
Research Subcommittee ...................................................................................................... 18
Examinations Committee ..................................................................................................... 19
Continuing Professional Development (CPD) Committee ................................................... 20
Selection Committee ............................................................................................................ 21
1 A – Section 1 .............................................................................................................................23
ELIGIBILITY PROCESS FOR SURGICAL TRAINING ............................................................ 23
1.1.1 Eligibility for OMS Surgical Training .......................................................................... 23
1.1.2 Eligibility Criteria for Surgical Training ...................................................................... 23
1.1.3 Registration in Australia ............................................................................................ 23
1.1.4 Registration in New Zealand ..................................................................................... 24
1.1.5 Failure to Maintain Required Registration ................................................................. 24
1.1.6 Eligibility Documentation .......................................................................................... 24
SELECTION PROCESS FOR SURGICAL TRAINING ............................................................ 25
1.2.1 Principles and Elements of the Selection Process .................................................... 25
1.2.2 Overview of Curriculum Vitae Assessment ............................................................... 25
1.2.3 Overview of Professional Performance Appraisal (PPA) Reports ............................ 26
1.2.4 Structured Interviews................................................................................................. 26
1.2.5 Guiding Principles ..................................................................................................... 26
1.2.6 Interview Procedures................................................................................................. 27
1.2.7 Outcome and Offers from Selection Process ............................................................ 27
2 A – Section 2 .............................................................................................................................29
SURGICAL TRAINING IN ORAL AND MAXILLOFACIAL SURGERY ..................................... 29
2.1.1 Enrolment of Surgical Trainees ................................................................................. 29
2.1.2 Duration of the Program ............................................................................................ 29
2.1.3 Training Requirements of the Program ..................................................................... 30
2.1.4 Research ................................................................................................................... 30
2.1.5 Extension of Training for completion of research requirements................................ 32
2.1.6 Recognition of Overseas Training Experience .......................................................... 32
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2.1.7 Learning Portfolio ...................................................................................................... 33

2.1.8 Leave from Training .................................................................................................. 33
2.1.9 Part-time and Interrupted Training ............................................................................ 33
2.1.10 Mandatory course requirements ............................................................................... 33
2.1.11 Examination Requirements ....................................................................................... 33
2.1.12 Unsuccessful Candidates in examinations ............................................................... 33
2.1.13 Unsuccessful Final Examination result – eligibility to re-present .............................. 34
2.1.14 Withdrawal from the Training Program ..................................................................... 34
2.1.15 Reapplying for entry into the Oral & Maxillofacial Surgery Training Program........... 34
3 A – Section 3 .............................................................................................................................35
CLINICAL TRAINING ASSESSMENT (CTA) ........................................................................... 35
3.1.1 Case Presentation plus Discussion ........................................................................... 35
3.1.2 Competencies Assessed and Descriptors ................................................................ 36
3.1.3 Completing the Assessment ..................................................................................... 36
3.1.4 Assessment of Operative Process (AOP) ................................................................. 37
3.1.6 Team Appraisal of Conduct (TAC) ............................................................................ 39
4 A – Section 4 .............................................................................................................................42
SIX-MONTHLY ASSESSMENT AND PROGRESS REGULATIONS ...................................... 42
4.1.1 Objectives of Assessment ......................................................................................... 42
4.1.2 Assessment Reports ................................................................................................. 42
4.1.3 Process ..................................................................................................................... 42
4.1.4 Formal Warnings ....................................................................................................... 44
4.1.5 Management of Six-Monthly Assessment Reports by the Director of Training ........ 44
4.1.6 Possible Outcomes of Director’s Review of Assessment Reports: ........................... 44
4.1.7 Action by the Director of Training when Six-Monthly Assessment reports are
Borderline .................................................................................................................. 45
4.1.8 Unsatisfactory Performance ...................................................................................... 46
4.1.9 Termination of Employment ...................................................................................... 46
4.1.10 Re-entry into training program .................................................................................. 46
5 A – Section 5 .............................................................................................................................47
PART-TIME AND INTERRUPTED TRAINING ......................................................................... 47
5.1.1 Part-time training ....................................................................................................... 47
5.1.2 Interrupted training .................................................................................................... 47
5.1.3 Interrupted Training Prior to the Commencement of Training................................... 48
6 A – Section 6 .............................................................................................................................49
GUIDELINES FOR MAINTAINING LOGBOOKS ..................................................................... 49
6.1.1 Operation Details ....................................................................................................... 49
6.1.2 Role ........................................................................................................................... 49
6.1.3 Operation Categories ................................................................................................ 50
1 B - Section 1 ..............................................................................................................................53
POLICIES AND PROCEDURES SUPPORTING THE ACCREDITATION PROCESS OF
TRAINING CENTRES AND POSTS ................................................................................................... 53
1.1.1 Aims of the Accreditation Process ............................................................................ 53
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1.1.2 What the College Accredits ....................................................................................... 53

1.1.3 Performance against Individual Standards ............................................................... 53
1.1.4 Level(s) of Accreditation ............................................................................................ 54
1.1.5 Accreditation Cycle .................................................................................................... 54
1.1.6 Achieving Accreditation of a New Training Post ....................................................... 55
1.1.7 Accreditation Review of a Regional Training Centre ................................................ 55
1.1.8 The Site Visit ............................................................................................................. 56
1.1.9 Allocation ................................................................................................................... 56
1.1.10 Accreditation Review Team / Review Committees ................................................... 57
1.1.11 Provision of Reports and Opportunity for Review ..................................................... 57
1.1.12 Withdrawal of Accreditation ....................................................................................... 58
1.1.13 Notification of Changed Circumstances and Implications ......................................... 58
1.1.14 Appeals Process ....................................................................................................... 58
1.1.15 Accreditation Process and Standards Review .......................................................... 58
2 B - Section 2 ..............................................................................................................................59
ACCREDITED TRAINING CENTRES ...................................................................................... 59
2.1.1 Institutional Responsibilities ...................................................................................... 59
2.1.2 Training ..................................................................................................................... 59
2.1.3 Directors of Training .................................................................................................. 59
2.1.4 Chair of the Regional Surgical Committee ................................................................ 60
2.1.5 Supervisors of Training ............................................................................................. 61
2.1.6 Visiting Medical Officers ............................................................................................ 62
3 B - Section 3 ..............................................................................................................................63
REGIONAL SURGICAL COMMITTEES (RSC)........................................................................ 63
3.1.1 Membership of the RSC ............................................................................................ 63
1 C - Section 1 ..............................................................................................................................67
THE CURRICULUM – AN OVERVIEW .................................................................................... 67
1.1.1 Introduction ................................................................................................................ 67
1.1.2 Philosophy of the training program ........................................................................... 69
1.1.3 Goals of the training program .................................................................................... 70
1.1.4 Broad competencies of the training program ............................................................ 70
1.1.5 Curriculum ................................................................................................................. 71
1.1.6 The Modules .............................................................................................................. 73
2 C – Section 2 .............................................................................................................................76
THE CURRICULUM MAP......................................................................................................... 76
3 C - Section 3 ..............................................................................................................................81
THE MODULES ........................................................................................................................ 81
3.1.1 MODULE 1 Anatomy and Embryology of the Head and Neck ................................. 81
3.1.2 MODULE 2: Radiology and Nuclear Medicine .......................................................... 89
3.1.3 MODULE 3: Dentoalveolar Surgery .......................................................................... 94
3.1.4 MODULE 4: Pre-prosthetic Surgery and Implantology ........................................... 101
3.1.5 MODULE 5: Paediatric Oral and Maxillofacial Surgery ........................................... 107
3.1.6 MODULE 6: Oral & Maxillofacial Pathology ............................................................ 113
3.1.7 MODULE 7: Oral Mucosal Diseases ....................................................................... 121
3.1.8 MODULE 8: Maxillary Sinus Disease ...................................................................... 128
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3.1.9 MODULE 9: Oral & Maxillofacial Oncology ............................................................. 132

3.1.10 MODULE 10: Reconstructive Oral and Maxillofacial Surgery ................................. 138
3.1.11 MODULE 11: Oral & Maxillofacial Trauma.............................................................. 149
3.1.12 MODULE 12: Orthognathic Surgery ........................................................................ 158
3.1.13 MODULE 13: Facial Pain ........................................................................................ 169
3.1.14 MODULE 14: Temporomandibular Joint Disorders ................................................ 173
3.1.15 MODULE 15: Oral and Maxillofacial Prosthetics and Technology .......................... 179
3.1.16 MODULE 16: Adjunctive Technologies in Oral and Maxillofacial Surgery .............. 183
4 C - Section 4 ............................................................................................................................188
CULTURAL COMPETENCY AND SAFETY........................................................................... 188
1 D - Section 1 ............................................................................................................................190
Surgical Science and Training in Oral and Maxillofacial Surgery (SST) ................................ 190
Examination Passing Standards ........................................................................................ 192
1.1.1 Syllabus for SST ...................................................................................................... 193
1.1.2 Anatomy .................................................................................................................. 194
1.1.3 Physiology and Immunology ................................................................................... 194
1.1.4 Immunology ............................................................................................................. 195
1.1.5 Pathology and Neoplasia ........................................................................................ 195
1.1.6 Applied pathology and tissue response to injury ..................................................... 196
1.1.7 Microbiology ............................................................................................................ 196
1.1.8 Pharmacology and Therapeutics ............................................................................ 196
1.1.9 Management of the critically ill surgical patient ....................................................... 197
1.1.10 Surgical skills and clinical care ................................................................................ 197
1 E - Section 1 ............................................................................................................................200
The Final Examination ............................................................................................................ 200
1.1.1 Assessment of Eligibility for the Final Examination ................................................. 200
Enrolment for the Examination ............................................................................................... 200
The Final Examination ............................................................................................................ 200
1.3.1 Written Examination ................................................................................................ 201
1.3.2 Clinical Examination ................................................................................................ 201
1.3.3 Surgical Anatomy .................................................................................................... 201
1.3.4 Oral and Maxillofacial Surgery ................................................................................ 201
Examination Passing Standards ............................................................................................. 201
Examiners ............................................................................................................................... 202
Conflict during the Examination .............................................................................................. 202
Special Considerations ........................................................................................................... 202
1.7.1 Prior to the Examination .......................................................................................... 202
1.7.2 Events during the Examination ............................................................................... 203
1.7.3 Cheating or the use of prohibited equipment or material during the Examination .. 203
Notification of Results ............................................................................................................. 203
Unsuccessful Final Examination result ................................................................................... 203
Approved position ................................................................................................................... 204
2 E- Section 2 .............................................................................................................................205
The Award of Fellowship ........................................................................................................ 205
Credentialling of Fellows......................................................................................................... 205
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1 F - Section 1 ............................................................................................................................208
OMS MENTORING SCHEME ................................................................................................ 208
2 F - Section 2 ............................................................................................................................210
POLICIES ............................................................................................................................... 210
2.1.1 Reconsideration, Review and Appeal ..................................................................... 210
2.1.2 Plagiarism ................................................................................................................ 210
2.1.3 Trainees Requiring Assistance ............................................................................... 210
2.1.4 Bullying, Harassment & Discrimination ................................................................... 210
2.1.5 Admission to Fellowship .......................................................................................... 210
2.1.6 Overseas Trained Specialist Assessment Policy .................................................... 211
2.1.7 Complaints Policy .................................................................................................... 211
2.1.8 OMS FINAL EXAMINATION FORMAT AND MARKING POLICY .......................... 211
2.1.9 OMS Surgical Science and Training (SST) Examination Format and Marking Policy
211
2.1.10 Refund Policy .......................................................................................................... 212
2.1.11 Special consideration in assessment policy ............................................................ 212
APPENDIX 1- GUIDELINES FOR THE COMPILATION OF A LEARNING PORTFOLIO FOR ORAL
AND MAXILLOFACIAL SURGERY ....................................................................................................214
APPENDIX 2- CASE PRESENTATION ...............................................................................................216
APPENDIX 3- ASSESSMENT OF OPERATIVE PROCESS – REMOVAL OF AN IMPACTED 3RD
MOLAR.................................................................................................................................................217
APPENDIX 4- ASSESSMENT OF OPERATIVE PROCESS – HARVEST OF A LOCAL BONE
GRAFT .................................................................................................................................................220
APPENDIX 5- ASSESSMENT OF OPERATIVE PROCESS – HARVEST OF A DISTANT BONE
GRAFT .................................................................................................................................................223
APPENDIX 6- ASSESSMENT OF OPERATIVE PROCESS - UNCOMPLICATED PLACEMENT OF
DENTAL IMPLANT ..............................................................................................................................226
APPENDIX 7- ASSESSMENT OF OPERATIVE PROCESS – CLOSURE OF ORO-ANTRAL
FISTULA...............................................................................................................................................229
APPENDIX 8- ASSESSMENT OF OPERATIVE PROCESS – TRACHEOSTOMY............................232
APPENDIX 9- ASSESSMENT OF OPERATIVE PROCESS – MANDIBULAR OSTEOTOMY ..........235
APPENDIX 10- ASSESSMENT OF OPERATIVE PROCESS – MAXILLARY OSTEOTOMY ...........238
APPENDIX 11- ASSESSMENT OF OPERATIVE PROCESS – INCISION AND DRAINAGE FACIAL
ABSCESS ............................................................................................................................................241
APPENDIX 12- ASSESSMENT OF OPERATIVE PROCESS – ENUCLEATION OF A JAW CYST .244
APPENDIX 13- ASSESSMENT OF OPERATIVE PROCESS - SURGICAL APPROACHES TO THE
MANDIBLE – INTRAORAL .................................................................................................................247
APPENDIX 14- ASSESSMENT OF OPERATIVE PROCESS - SURGICAL APPROACH TO THE
MANDIBLE – EXTRAORAL ................................................................................................................250
APPENDIX 15- ASSESSMENT OF OPERATIVE PROCESS - SURGICAL APPROACH TO THE
ZYGOMATIC – ORBITAL COMPLEX .................................................................................................253
APPENDIX 16- ASSESSMENT OF OPERATIVE PROCESS – MANDIBULAR FRACTURES
(EXCLUDING CONDYLES) .................................................................................................................256
APPENDIX 17- ASSESSMENT OF OPERATIVE PROCESS – MAXILLARY FRACTURES ............259
APPENDIX 18- ASSESSMENT OF OPERATIVE PROCESS – ZYGOMATIC COMPLEX
FRACTURES .......................................................................................................................................262
APPENDIX 19- ASSESSMENT OF OPERATIVE PROCESS – REMOVAL OF SUBMANDIBULAR
GLAND .................................................................................................................................................265
APPENDIX 20- TAC RATER SURVEY ...............................................................................................268
APPENDIX 21- SIX MONTHLY FORMATIVE ASSESSMENT REPORT FORM ...............................269
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APPENDIX 22- TRAINEE REPORT FORM ........................................................................................273

APPENDIX 23- ANNUAL LOGBOOK SUMMARY SHEET ................................................................274
APPENDIX 23A-ANNUAL LOGBOOK SUMMARY SHEET ...............................................................273
APPENDIX 24- FINAL LOGBOOK SUMMARY SHEET – CONCLUSION OF TRAINING ................272
APPENDIX 24A- FINAL LOGBOOK SUMMARY SHEET – CONCLUSION OF TRAINING .............274
APPENDIX 25- STANDARDS AND CRITERIA FOR OMS (SCOMS) – ACCREDITATION OF
REGIONAL TRAINING CENTRES, HOSPITALS AND POSTS .........................................................276
APPENDIX 26- PRE-VISIT ACCREDITATION SURVEY FOR AN ORAL AND MAXILLOFACIAL
SURGERY TRAINING POST ..............................................................................................................289
APPENDIX 27- OMS MENTORING SCHEME – MENTORING AGREEMENT ..................................296
APPENDIX 28- OMS MENTORING SCHEME – PROGRESS REPORT ...........................................298
APPENDIX 29- OMS MENTORING SCHEME – COMPLETION ADVICE FORM..............................301
APPENDIX 30- FORMER TRAINEES SEEKING TO REAPPLY TO THE ORAL AND
MAXILLOFACIAL SURGICAL TRAINING PROGRAM ......................................................................302
© copyright – RACDS All rights reserved. vi

Introduction Accredited Education and Training in Oral and Maxillofacial Surgery
INTRODUCTION
The Handbook for Education and Training in Oral and Maxillofacial Surgery (the Handbook) –
April 2020 supersedes the March 2019 Edition.
The Handbook provides comprehensive information on the policy and guidelines for the training
program including an outline of the curriculum and related administrative instructions and general
information for trainees, Supervisors of trainees, Directors of Training, and members of
committees involved in the education and training program for oral and maxillofacial surgeons.
The Handbook is revised regularly, and trainees must comply with the version that is current at
the time that they commence the first year of training.
The Board and its sub-committees will continue their commitment to develop and improve the
way in which the OMS training program is implemented. The Board’s endeavours are
strengthened by input from those involved in the OMS specialty at all levels, so please feel
encouraged to contact the College via oms@racds.org. Thank you to those who have provided
feedback.
© copyright – RACDS All rights reserved. 7

ORAL MAXILLOFACIAL SURGERY EDUCATION PROGRAM OBJECTIVES
The primary objectives of the Royal Australasian College of Dental Surgeons (RACDS) are:
• to advance the science and art of dentistry
• to encourage study and research in the field of dental science and cognate subjects, and
The RACDS’ Vision is: “To enhance oral health in the community through respected international
leadership in the provision of postgraduate education, professional development and educational
qualifications in dentistry.”
The Mission of the RACDS: “Promotes professional excellence in dentistry through the provision of
evidenced based dental education, professional development and examination.”
The OMS training program is committed to:

• Providing the highest possible quality and safety of service to meet the relevant healthcare needs of
all communities in Australia and New Zealand
• Actively promoting and participating in improving the healthcare of Aboriginal and Torres Strait
Islander and Maori communities
The purpose of the OMS training program is to ensure that all candidates who are awarded the
FRACDS(OMS):
• are highly competent practitioners in OMS
• have the requisite knowledge, skills and professional attitudes for successful independent practice,
and
• have the necessary attitudes and attributes to strive for continual review and improvement of their
practice.

OMS DATES FOR 2020
Saturday 8th February Trainee Induction Day

Venue: RACDS Office Sydney
Saturday 15th February Final date for Logbook Summaries, Six-Monthly Formative
Assessment Forms and Clinical Training Assessments to
be received by the College for trainees occupying
accredited training posts in 2020
Final date for trainees to complete registration requirements

and make payment
Final date for submission of application for exemption from

SST examination
Monday 2nd March Closing date for registration for the SST Examination
Tuesday 1st April Enrolments close for applications for re-entry for training
Friday 8th May Closing date for Applications for Eligibility for Surgical
Training positions for 2021
Friday 12th and Saturday 13th June SST Examination

Venue: Sydney
Monday 22nd June Closing date for Applications for Assessment of Eligibility
for the Final Examination
Saturday 25th July Training Program Selection Interviews for 2021, Sydney
Friday 14th August Closing date for registration for the Final Examination
Saturday 15th August Due date for Six-Monthly Formative Assessment Forms
and Clinical Training Assessments to be received by the
College for trainees occupying accredited training posts in
2020
Monday 26th & Tuesday 27th October Final Examination - Written papers
Venue: Regionally and New Zealand
Friday 13th & Saturday 14th Final Examination – Clinical and Viva Voce
November Venue: Epworth Centre, Melbourne
Tuesday 15th December Closing date for submission of applications for Approved
Positions for 2021
For further 2020 calendar dates please visit the RACDS website

GLOSSARY OF TERMS
ADC Australian Dental Council
AMC Australian Medical Council
ANZAOMS Australian and New Zealand Association of Oral and Maxillofacial Surgeons
AOP Assessment of Operative Process
AST Advanced Surgical Training
ASSET Australian and New Zealand Surgical Skills Education and Training
Board/BoS OMS Board of Studies for Oral and Maxillofacial Surgery, RACDS
BSS Basic Surgical Sciences
BST Basic Surgical Training
CCrISP Care of the Critically Ill Surgical Patient
CEO Chief Executive Officer
CPD Continuing Professional Development
DBA Dental Board of Australia
DC(NZ) Dental Council New Zealand
DoT Director of Training
EMST Early Management of Severe Trauma
EO Education Officer, Oral & Maxillofacial Surgery
FRACDS Fellow of the Royal Australasian College of Dental Surgeons
HETOMS Handbook for Accredited Education and Training in Oral and Maxillofacial
Surgery
IAOMS International Association of Oral and Maxillofacial Surgeons
IMG International Medical Graduate
LMS Learning Management System
MCNZ Medical Council of New Zealand
MDT Multi-Disciplinary Team
OMS Oral and Maxillofacial Surgery
OTOMS Overseas Trained Oral and Maxillofacial Surgeon
OTSWG Overseas Trained Specialist Working Group
PPA Professional Performance Appraisal
RACDS Royal Australasian College of Dental Surgeons

RACS Royal Australasian College of Surgeons
RCS(Eng) Royal College of Surgeons, England
Registrar Registrar in Oral & Maxillofacial Surgery
RSC Regional Surgical Committee
SCOMS Standards and Criteria for Oral and Maxillofacial Surgery (Accreditation)
SIG Surgery in General
SST Surgical Science and Training in Oral and Maxillofacial Surgery
TAC Team Appraisal of Conduct

FEES FOR 2020
Training
Overseas Australian
Resident Resident
$AUD $AUD
Enrolment or Re-enrolment in the College (valid for a maximum

661.82# 728.00*
six years)
Annual Trainee Registration Fee (Trainees occupying an

4,261.82# 4,688.00*
accredited/approved training post)
Extension of OMS Training for Completion of Research

2,130.91# 2,344.00*
Requirements (6 months)
Assessment
Application for selection for Surgical Training Positions 2020 1,588.00# 1,588.00#
Surgical Science and Training Examination 3,284.00# 3,284.00#
Exemption from Surgical Science and Training Examination 1,588.00# 1,588.00#
Application for Assessment of Eligibility for the Final Examination 629.00 # 629.0 0 #
Final Examination 4,603.00# 4,603.00#

Assessment of an International Medical Graduate 5,197.00* 5,197.00*
Fellowship
Admission to Fellowship 320.91# 353.00*
Annual Fee 2020/2021 624.55# 687.00*

Fellowship by Assessment in the Specialist Discipline of Oral
7,074.00* 7,074.00*
Maxillofacial Surgery for International Medical Graduates
Prices are subject to change

# GST not applicable
* Price includes GST

TRAINING REGIONS AND REGIONAL DIRECTORS OF TRAINING
These Directors of Training, covering Australia and New Zealand, are responsible for the relevant OMS
training centre (refer to Part B - Section 2 for an expanded list of responsibilities)
New South Wales & Australian Capital South Australia

Territory
Dr Andrew Cheng
A/Prof Bruce Austin Director of Training, SA Training Centre
Director of Training, NSW & ACT Training Centre
Victoria & Tasmania Queensland
A/Prof Jocelyn Shand Dr Scott Borgna

Director of Training, VIC & TAS Training Centre Director of Training, QLD Training Centre
Western Australia New Zealand
Dr Emma Lewis Dr Cameron Lewis

Director of Training, WA Training Centre Director of Training, NZ Training Centre
APPROVED HOSPITALS AND ACCREDITED TRAINING POSTS
This information can be obtained from the Education Officer – OMS or the Director of Training in each
Training Centre.

BOARD OF STUDIES FOR ORAL AND MAXILLOFACIAL SURGERY AND

COMMITTEES
The Board of Studies for Oral and Maxillofacial Surgery and its Committees have been established to
formulate and review training and assessment in requirements leading to the attainment of the FRACDS
(OMS) and maintenance of professional standards in the specialty. The Board reverses the right to end
the term of service for Committee members at any point for any reason.
Membership is for the period 2020 - 2022
Board of Studies
Membership
Dr Scott Borgna Chair (DoT - QLD Training Centre)

Dr Emma Lewis Deputy Chair (DoT- WA Training Centre)
Dr Geoffrey Findlay Past Chair
A/Prof Bruce Austin DoT - NSW & ACT Training Centre
Dr Andrew Cheng DoT - SA Training Centre
Dr Jason Erasmus Member
A/Prof Dylan Hyam Member
Dr Kenneth Sun Member
Dr Cameron Lewis DoT - NZ Training Centre
A/Prof Jocelyn Shand DoT - VIC & TAS Training Centre
Dr Weber Huang New Graduate Member
Dr James Clohessy Trainee Representative
Ex officio
Dr Julia Dando Registrar - OMS
Dr Paul Sambrook President - RACDS
Dr Dimitrious Nikolarakos President - ANZAOMS
Terms of Reference
• Training in Oral & Maxillofacial Surgery
• The Fellowship Examination
• Continuing Professional Development (CPD)
• Assessment of International Medical Graduates for the regulatory bodies in Australia and New
Zealand
• Advise the Board of the College and the Council of ANZAOMS in relation to teaching and training
programs in the special field of Oral and Maxillofacial Surgery.
• Assist the Board of Examiners in the conduct of examinations for Fellowship in the Special Field of
Oral and Maxillofacial Surgery.
• Hold three business meetings per annum and any other meetings convened by the Chair. One of
these business meetings annually is to be known as the Annual Meeting and held not later than
October.
• Forward minutes of the business meetings to the Board of the College
• Advise the Finance Committee, Board of the College and the Council of ANZAOMS in advance on
the financial aspects of the Board of Studies’ activities.
• Advise the Board of the College and the Council of ANZAOMS on any matters in the Special Field
that may concern the interests of the College or the Association.
• Prepare guidelines to assist in the continued management of the Board of Studies’ activities.
This should include:

- Recommendations regarding the guidelines, policies or regulations for selection, registration,

examination, etc. of candidates.
- Recommendations regarding the subject matter of the Handbook for education and training.
- Assessment of trainees after they have enrolled and commenced in the Training Program.
- Assessment and accreditation of the Specialist Training Program
- Recommendation of specialists as suitable examiners.
- Accreditation of Training Centres and advice as to the appropriateness of available training
positions, including personnel.
• Review future strategies and developments related to training.
• Liaise with the Regional Surgical Committees regarding training requirements.
• Receive notification regarding poorly performing Fellows and facilitate appointment of an
appropriate mentor.
• The Chair of the Board is invited to meetings of the Board of the College and is an ex officio member
on the Council of ANZAOMS.
Regional Surgical Committees
Regional Chairs
Dr Simon Lou New Zealand
Dr Robert Witherspoon New South Wales & Australian Capital Territory
Dr Alistair Reid Queensland
Dr Miles Doddridge South Australia
A/Prof Alf Nastri Victoria & Tasmania
A/Prof Dieter Gebauer Western Australia
Terms of Reference
• To discuss and act on any matter of interest related to Oral & Maxillofacial Surgery training in the
Training Centre; and in keeping with existing College policy, to act upon determinations from the
discussions
• To implement and supervise the provision of training to accredited trainees within their Training
Centre, by discussion with the supervisors of training at each individual campus
• To facilitate educational training, based on the curriculum, to Trainees
• To conduct a biennial review of Trainee progress and to convene specific meetings with trainees
who have borderline or unsatisfactory reports to discuss their progress
• To discuss the allocation of trainees to training posts
• To advise the Selection Committee of available training posts for commencement of training the
following year
• To discuss any matters referred from the College and to provide reports as required for accreditation
• The RSC reports to the Board of Studies – Oral & Maxillofacial Surgery
• The RSC will be responsible for submitting applications for new posts to the Accreditation
Committee
• The RSC will be involved in the preparation and the conduct of the Accreditation Review of the
Training Centre
• To appoint subcommittees and working parties, such as Research & Education, as may be required,
to conduct the business of the RSC
• To nominate or appoint State or NZ representatives to the College committees as required

Accreditation Committee
Membership
Dr Robert Witherspoon Chair

Dr Geoffrey Findlay Deputy Chair
Dr Jason Erasmus Member
Dr Richard Wood Member
Dr John Harrison Member
Dr Paul Meara Member
Dr Christopher Sealey Member
Ex officio
Dr Scott Borgna Chair, BoS - OMS
Terms of Reference
• Implement Board of Studies’ policy on accreditation and provide advice to the Board of Studies on
accreditation matters
• Develop and ongoing review of accreditation guidelines for regional training centres and posts of
the Oral and Maxillofacial Surgery training program
• Develop and review accreditation template documentation
• Appoint accreditation teams and undertake site visits for the purposes of accreditation of regional
training centres and posts of the Oral and Maxillofacial Surgery training program
• Monitor the performance of regional training centres to ensure they maintain minimum standards
whilst accredited and meet any conditions imposed on their accreditation
• Collect and analyse annual survey data for training centres for report to the Board of Studies
• Maintain an up to date record of training centres and posts, including accreditation conditions and
status
• Recommend to the Board of Studies for review of the accreditation status of training centres or posts
which do not fulfil accreditation guidelines or meet any conditions imposed on their accreditation
• Develop and review the roles and responsibilities of Directors of Training, Supervisors of Training
and the Regional Surgical Committee
• Support the development of additional training posts in Australia and New Zealand
• Develop and implement -
- Post fellowship credentialing and
- Micro-credentialing for Oral and Maxillofacial Surgeons.
• Advise the Board on applications from overseas trained specialist Oral and Maxillofacial Surgeons
• Advise the Board of the Accreditation Visits being conducted each year, to allow the College to
budget for the expenditure related to the conduct of the accreditation process
Overseas Trained Specialist Sub-Group (OTSC)
Membership
Standing Members
Dr Jason Erasmus Chair, Accreditation Committee Member
Dr Christopher Sealey Member, Accreditation Committee Member
Dr Geoff Findlay Member, Accreditation Committee Member

Ex officio
Members by invitation per application

• Specialist IMG who has been through the process
• Community member
• Director of Training from the relevant jurisdiction
Terms of Reference
• Implement Board of Studies’ policy on the assessment of Overseas Trained OMS (OTOMS) and
provide advice to the Board of Studies on registration of OMS matters.
• Assess all OTOMS submission documentation.
• Conduct interviews with the OTOMS when necessary.
• Assess Area of Need applications to ensure the applicant will meet the requirements of the
position description as determined by the hospital.
• Appoint a SIMG that has been through the Specialist International Medical Graduate process to
the OTSC as required
• Appoint a Community member OTSC as required
• Liaise with the AMC and MCNZ to ensure RACDS is meeting the processes and protocols of the
registration of International Medical Graduates.
• Complete all documentation as required by Medical Board of Australia (MBA) and the Medical
council of New Zealand (MCNZ)
• Regularly review the OTOMS policy to ensure compliance with the MBA and the MBA policy,
requirements and guidelines
• Recommend to the Board of Studies any changes that may be required to the OTOMS policy
Training Committee
Membership
A/Prof Jocelyn Shand Chair
Dr Benjamin Erzetic Member
Dr Christopher Poon Member
Dr Geoff Findlay Member
Dr Robert Witherspoon Member
Ex officio
Terms of Reference
• Review borderline and unsatisfactory reports following formative assessment processes
• Advise trainees on their current training status, progression in the program and variation due to
part-time, interrupted or leave from training
• Advise trainees who have received borderline or unsatisfactory formative assessment reports of
their current training status and of variation in training requirements
• Advise the relevant Regional Surgical Committee and Board of Studies regarding trainees who
have received borderline or unsatisfactory formative assessment reports, variation in training
requirements and remedial plan
• Review mentor progress reports for any trainees who have received a borderline or unsatisfactory

formative assessment report

• Review reports regarding trainees requiring assistance and remediation plans
• Assess the eligibility of accredited trainees on the OMS Training Program to sit the Final
Examination
• To advise trainees who have undergone assessment for eligibility to sit the Final Examination of
areas of clinical practice requiring further experience before the completion of their training time
• Review of approved posts for trainees who fail the Final Examination
• Assess applications for re-entry onto the OMS Training Program and provide advice to the Registrar
OMS
Education Committee
Membership
A/Prof Dylan Hyam Chair
Dr Andrew Cheng Member
Dr George Chu Member
Dr Stuart Deane Member
A/Prof Dieter Gebauer Member
Prof Robert Jones Member
Dr Simon Lou Member
Ex officio
Terms of Reference
• Monitor the content and duration of oral and maxillofacial surgery training, including research
• Identify resources for the implementation of the modular curriculum in regional training centres
• Oversee the implementation and conduct of the modular curriculum in regional training centres
• Design and implement an assessment strategy based on the modular curriculum
• Review evaluate and update curriculum and assessment methodology
• Review submitted research study proposals via the Research Subcommittee
• Assess the completion of the trainees’ research requirements
• Annually audit trainee log-books and to review the experience of trainees in relation to the curriculum
• Develop and implement workshops for regional directors and supervisors of training to ensure
consistent trainee assessment across Australia and New Zealand
• Oversee the establishment and maintenance of the mentoring scheme
Research Subcommittee
Membership
Dr Richard Harris Chair
Prof Alastair Goss Member
Prof Robert Jones Member
Prof Frank Monsour Member
A/Prof Arun Chandu Member
Ex officio


Terms of Reference
• Approve research proposals for OMS trainees in accordance with the Handbook for Accredited
Education and Training in Oral and Maxillofacial Surgery (Handbook) and determine the nature of
the research and its relevance to OMS or Surgery in General
• Advise on the methods of assessment for the research projects
• Review the requirements for research published in the Handbook
• Monitor and review the six-monthly progress reports
• Ensure that all OMS trainees are able to:
- Understand basic research methodology
- To critically review and understand the scientific literature
- Carry out a research project which is peer reviewed and acceptable for publication in a recognised
journal or a University degree which has been peer reviewed and accepted by the University
involved.
• Provide advice to the Education Committee regarding research proposals and projects
Examinations Committee
Membership
Dr Julia Dando Chair
Dr John Harrison Member
Prof Andrew Heggie Member
A/Prof Dylan Hyam Member
Dr Christopher Poon Member
A/ Prof Jocelyn Shand Member
Ex officio
Terms of Reference
• Implement College Board policy on examination standards and procedures and provide advice to
the Board of Studies on examination matters
• Ensure the SST Examination is at an appropriate standard
• Ensure the Final Examination is at an appropriate exit level standard for a specialist Oral and
Maxillofacial Surgeon
• Develop guidelines for the conduct of examinations and recommend location and time of
examinations each year
• Determine the format of the examinations and the structure and marking scheme of each individual
component of the examination
• Maintain a list of potential Examiners and have responsibility for succession planning for the position
of Chair of the Court of Examiners
• Recommend to the Board of Studies appointment of Examiners and a co-ordinator for each
Examination
• Develop guidelines for the conduct of examinations, responsibilities of Examiners and undertake
training of Examiners

• Monitor and analyse, and periodically evaluate examinations, including feedback from Examiners
(including external Examiners), observers and candidates regarding the standard, format and
conduct.
• Provide a report to the Board regarding the conduct of the examinations within eight weeks of the
examination
• Advise the Board of the examination processes being conducted each year, to allow the College to
budget for the expenditure related to the conduct of the examinations
Continuing Professional Development (CPD) Committee
Membership
Dr Weber Huang Chair
A/Prof Bruce Austin Member
Dr Ankit Garg Member
Dr Derek Goodisson Member
Dr James Kim Member
Dr Samuel Kim Member
A/Prof Kai Lee Member
Dr Christopher Lim Member
Dr Jameel Kaderbhai New Fellow Member
Dr Timothy Manzie Trainee Representative
Ex officio
Terms of Reference
• Ensure the CPD Program meets the requirements of the MCNZ, DBA, DCNZ and the Medical Board
of Australia’s Professional Performance Framework,
• Develop appropriate criteria for minimum levels of participation of OMS Fellows in Continuing
Professional Development (CPD) activities
• Maintain and review the program of CPD in Oral and Maxillofacial Surgery
• Liaise with ANZAOMS to ensure an appropriate range and level of CPD activities are provided to
assist Fellows in meeting their CPD requirements
• Develop credentialing guidelines for Oral and Maxillofacial Surgery
• Act as an advisory body for Oral and Maxillofacial surgical credentialing issues
• Assist hospital credentialing bodies by nominating appropriate Fellows to participate in periodic
appointment reviews and advise on relevant guidelines and standards
• On request of registration bodies, and with the permission of the Fellow concerned, provide
appropriate statements to these bodies in relation to the participation of Fellows in CPD activities
• Consider applications and provide guidelines for the performance of surgical procedures, which are
new, or as yet of unproven value
• Recommend to the Board of Studies for provision of an annual course of revision in Oral and
Maxillofacial Surgery for trainees and existing specialists

Selection Committee
Membership
A/Prof Jocelyn Shand Chair
Dr Benjamin Erzetic Member
Dr Emma Lewis Member
Dr Robert Witherspoon Member
Ex officio
Terms of Reference
• To manage the eligibility process for surgical training in oral and maxillofacial surgery (OMS) and to
identify the applicants who are deemed eligible to apply for selection
• To identify training positions in Australia and New Zealand available for the commencement of
training for the following year
• To ensure that the Selection Process is appropriately structured to reflect the standard required for
specialist surgical training in OMS as accredited by the joint Australian Medical Council and
Australian Dental Council, and New Zealand bodies
• To maintain and continue to develop the guidelines for the selection process and the marking
templates for the individual components of the selection process
• To maintain and continue to develop the guidelines for the conduct of the selection process and to
recommend the location and date for the annual selection interviews
• To constitute interview panels for the annual selection process and to develop standardised
questions for the panels
• To recommend to the Board of Studies a benchmark for the selection process for each year below
which applicants are deemed unsuitable for training in the specialty
• To co-ordinate and monitor the process of offers to selected applicants for accredited training within
the Training Centres
• To provide a report to the Board of Studies regarding the conduct of the selection process and
interviews within eight weeks of the completion of each annual selection process
• To assist the College in the preparation of a feedback report for unsuitable applicants
• To monitor, analyse and periodically evaluate the selection process by seeking feedback from the
Directors of Training and other independent observers

PART A
SURGICAL TRAINING
A – Section 1 Accredited Education and Training in Oral and Maxillofacial Surgery
1 A – SECTION 1
ELIGIBILITY PROCESS FOR SURGICAL TRAINING
1.1.1 ELIGIBILITY FOR OMS SURGICAL TRAINING
The purpose of the eligibility process is to determine the applicant’s eligibility to apply for selection for
appointment to an accredited training post in the next calendar year. Eligibility is only valid for the
calendar year as stated and if the applicant is unsuccessful in gaining a post during the stated year
eligibility lapses.
If an applicant is deemed eligible but does not occupy an accredited training post for the next calendar
year, their eligibility will lapse, and it will be necessary to reapply for eligibility in the following year.
1.1.2 ELIGIBILITY CRITERIA FOR SURGICAL

TRAINING
In order to apply for eligibility for OMS Training, the applicant will be required to have completed the
following pre-requisites, or to have completed them prior to the commencement of surgical training:
1. A Dental degree and full registration as a dentist in Australia or New Zealand
2. A Medical degree and full registration as a medical practitioner in Australia or New Zealand
3. A full year of surgery in general (SIG) must be completed prior to the commencement of OMS
training. Surgical rotations during this year should be undertaken in related surgical disciplines for
a minimum of nine months e.g. ENT surgery, orthopaedic surgery, neurosurgery, ophthalmology,
general & trauma surgery, plastic surgery, ICU, Anaesthetics and Emergency Medicine. If
undertaking a first-year general surgical resident position in Oral & Maxillofacial Surgery, three (3)
months to a maximum of six (6) months duration will be considered.
4. Meet any residency or visa requirements enabling employment at any hospital within the
jurisdiction(s) for which they are applying
For applicants who are undertaking the final year of a dental degree, the successful completion of
the degree will be required prior to the commencement of surgical training.
1.1.3 REGISTRATION IN AUSTRALIA
1. Trainees in Australia are required to have general registration from the Medical Board of Australia
and the Dental Board of Australia without conditions or undertakings.
2. Trainees who receive conditions or undertakings on their registration, or whose registration is

cancelled or suspended, must notify the College within 2 working days of notification from the
Australian Health Practitioners Regulatory Authority (AHPRA). Failure to report this could result in
disciplinary action.
3. Trainees based in New Zealand for the majority of their training must, for the duration of any
Australian rotations, obtain a level of registration from the Medical Board of Australia and Dentist
Board of Australia that enables full participation in the training program.

1.1.4 REGISTRATION IN NEW ZEALAND
1. Trainees based in New Zealand are required to have general scope registration or restricted
general scope registration in the speciality of training from the Medical Council of New Zealand and
the Dental Council of New Zealand without conditions.
2. Trainees who receive conditions on their registration, or whose registration is cancelled or

suspended, must notify the College within 2 working days of notification from the Medical Council
of New Zealand, or Dental Council of New Zealand. Failure to report this could result in disciplinary
action.
3. Trainees based in Australia for the majority of their training must, for the duration of New Zealand
rotations, obtain from the Medical Council of New Zealand and Dental Council of New Zealand a
level of registration that enables full participation in the training program.
1.1.5 FAILURE TO MAINTAIN REQUIRED

REGISTRATION
Failure to maintain the required level of registration may result in disciplinary action, include (but not
limited to) dismissal from the training program.
1.1.6 ELIGIBILITY DOCUMENTATION
The Board of Studies will issue an Application for Eligibility for Surgical Training Positions 2021 on
request. The following certified documents will be required to satisfy the criteria in 1.2, and should be
attached to the application:
• certified copies of dental & medical degrees
• certified copies of dental & medical registration certificates
• certified copies of academic transcripts.
• A detailed CV containing all academic results, past posts, research, awards, electives, and
publications.
• For those applicants engaged in a research degree application paperwork for selection should
include a letter of support from candidate’s research supervisor.
• A list of all consultants with whom the applicant has worked during their basic training and
undergraduate years is also to be provided along with their contact email addresses. This list should
contain a minimum of eight consultants and a standardised questionnaire regarding the applicant
will be used to collate the information for Professional Performance Appraisal (PPA).
The information above must be submitted to the College by 5 pm on Friday, 8 May 2020. Late
applications will not be accepted. Applicants are responsible for submitting the supporting
documentation by the published deadline and documents will not be accepted following this.
Incomplete applications may result in withdrawal from the eligibility process. Applications
should be submitted to the OMS Education Officer, via post. The “Selection Process” is
overseen by the Selection Committee, Board of Studies. Selection Interviews will take place on
Saturday, 25 July 2020. Selection Interviews will take place on Saturday, 25 July 2020 however
this date is provisional and may be reviewed depending on the progress of the virus pandemic.

SELECTION PROCESS FOR SURGICAL TRAINING
1.2.1 PRINCIPLES AND ELEMENTS OF THE

SELECTION PROCESS
Principles of Selection
• Potential for successful training in OMS is the basis for selection.
• Selection aims to identify those applicants with the knowledge, skills, values, attitudes and aptitude
required to become a competent OMS.
• Selection involves assessment of the attributes and behaviours and takes into account applicants’
clinical experience, academic and other achievements.
• Selection criteria for application to OMS training include generic and specialty specific components.
• Selection methodology is predetermined, transparent, includes a range of approaches to maximise

validity and reliability, involves multiple raters, contains criteria for marking and allocates weighting
for each tool to permit ranking of the applicants.
• Selection is the responsibility of the agencies (including employers) which deliver the education
and training and involves suitably trained & experienced members of the OMS profession and other
independent persons.
• Structured curricula vitae (CV) assessment provides important verifiable biographical information
on clinical experience, academic and other accomplishments.
• Structured professional performance appraisal (PPA) reports credible information from consultants
and supervisors based on their first-hand experience of an applicant’s performance in the working
and learning environment.
• Structured interviews yield important information not available from other selection tools and use
questions particularly targeting non-technical personal attributes and behaviours.
Elements of the Selection Process
There are three major elements of the selection process for Surgical Training.
The tools to be utilised in this process are set out below.
Tools %
Curriculum Vitae 20
Professional Performance Appraisal 35
Interview 45
Total 100
Interviews are conducted mid-year.
1.2.2 OVERVIEW OF CURRICULUM VITAE

ASSESSMENT
The curriculum vitae is designed to capture information on the applicant’s academic record, research,
publications, presentations and awards, and aspects of his/her training and experience.

The curriculum vitae will account for 20% of the overall score. Representatives from each Training
Centre will assess the application forms independently. Marks will be given according to a standardised
assessment in the following areas and a CV scoring guideline can be found here:
a. undergraduate and tertiary academic achievement
b. surgical experience
c. scientific meetings
d. preparation for OMS Training (e.g. courses and clinical experience in OMS)
e. research and/or publications, presentations
f. prizes and awards
g. special achievements (other than dentistry and medicine).
The Selection Committee may contact hospital units and Consultants to ensure that the information
provided in the applicant’s history is correct.
1.2.3 OVERVIEW OF PROFESSIONAL

PERFORMANCE APPRAISAL (PPA) REPORTS
The PPA is on on-line tool to gather confidential information from consultants and supervisors who are
familiar with the applicant’s professional and/or technical capabilities and skills, as well as clinical
performance and personal attributes.
The PPA accounts for 35% of the overall score for OMS applicants.
The following areas are evaluated in the reports:

a. personal qualities
b. clinical skills
c. technical skills
d. knowledge and academic performance
e. post-graduate experience.
The PPA reports will be sought from at least eight consultants who have been named by the applicant
as previous supervisors. Four consultants will be nominated by the applicant and four will be selected
by the Selection Committee from the list provided of all previous posts and Consultants. An online
system will be utilised to facilitate the confidential responses from supervisors and to enable each
Training Centre representative(s) to assign marks for each applicant independently.
1.2.4 STRUCTURED INTERVIEWS
The structured interview is intended to enable evaluation of the applicants’ professional attributes and
behaviours relating to the broad competencies for training in OMS, other than ‘medical and dental expert’
and ‘technical expert’, as well as preparation for OMS training. The interview is conducted by a panel.
The broad competencies for OMS are outlined in Section C.
The structured interview accounts for 45% of the overall score for applicants.
1.2.5 GUIDING PRINCIPLES
The fair and transparent interview process is underpinned by the following principles:
• Three separate Panels will conduct interviews as part of the “Selection Process”
• Up to three representatives from each Training Centre Program will be present

• Representatives from each Program will change at regular intervals between the Panels to provide
a fair and even mix for assessment.
• The interview is to be used to explore the capacities and qualities of the interviewee in relation to
matters in the criteria for selection
• Applicants will be given sufficient notice of interview to allow them to be present and to prospectively
consider their responses to the selection criteria.
1.2.6 INTERVIEW PROCEDURES
Applicants should normally be supplied with their interview time and advice of the nature of the
interview at least one week before the interview.
The Interview
• Interviews will be scheduled on the same day at a location to be notified on the College website
• Applicants are responsible for all of the travel & accommodation costs incurred when attending the
interview
• The same amount of time will be allowed for the semi-structured interview of each applicant
(approximately 15 minutes) in each of the three Panels (total 45 minutes)
• The Chair of the Selection Committee will determine a final list of questions to be put to all
interviewees. However, these standard questions will be supplemented with questions which arise
from the interview process and the follow-up questions may vary based on the responses provided
• All interviews will be standardised
• There will be opportunity for interviewees to ask questions and comment on any matters related to
the process.
Interview Questions
Five areas related to the selection criteria will be covered in the interview:
1. professional experience and communication
2. ethics and judgement
3. academic skills and medical/dental expertise
4. patient care and clinical decision making
5. preparation for OMS training.
1.2.7 OUTCOME AND OFFERS FROM SELECTION

PROCESS
Each Training Centre will collate the results of the tools of the “Selection Process” for a final score and
the applicants will be ranked. Offers will be made simultaneously on the Monday morning, following the
interviews, by each Training Centre Program for their available accredited posts. Applicants will have
two (2) days to respond, until the COB Tuesday (AEST) to decline or accept the offer. Following this
first round of offers, remaining available posts will then be simultaneously offered to those yet to be
selected on Thursday with a two (2) day response period until COB on Friday. The process will be
continued until all posts are filled. When this has occurred, unsuccessful applicants will be informed,
and unsuitable applicants will be notified.
Applicants may be classified as one of the following:
Successful: an applicant who has satisfied the criteria and as a result of their ranking has been
selected for a training position

Unsuccessful: an applicant who has satisfied the criteria but as a result of their ranking has not been
selected for a training position in the first round of offers. An unsuccessful applicant can be
considered if a post becomes available in the second-round offer process.
Unsuitable: an applicant who does not satisfy the minimum selection criteria and will not be eligible
for consideration for a training position
Successful applicants will be contacted by the relevant Director of Training who, together with the
Regional Surgical Committee, will organise the training rotations and hospital affiliations.
Applicants who are deemed Unsuitable will receive general information on the minimum selection criteria
that was not achieved.

2 A – SECTION 2
SURGICAL TRAINING IN ORAL AND MAXILLOFACIAL SURGERY
2.1.1 ENROLMENT OF SURGICAL TRAINEES
All trainees must complete the subscription and enrolment process with the College and pay the
requisite fees prior to occupying an accredited training position.
It is the trainee’s responsibility to enrol with the College by 15 February each year. Trainees who have
not enrolled by 15 February will not have training accredited for the period of time they remain
non-financial.
Enrolment forms are available from the College website.
Trainees enrolled in previous years must submit to the College also by the 15 February:
• Annual Logbook summary for the previous year verified by the Director of Training
• The two, Six-Monthly Formative Assessment forms.
In summary, a completed trainee enrolment form will only be accepted when:
a. it has been signed by the trainee and the Director of Training

b. it indicates the start date of the training post for the relevant year
c. it is accompanied by the prescribed fee
d. the previous year’s assessments and logbook have been received by the College
2.1.2 DURATION OF THE PROGRAM
Trainees are not appointed for the entire training period; they occupy accredited posts on a yearly basis.
It is the responsibility of the trainee to secure suitable training posts. The period of four years of
continuous training is a minimum, and additional time may be required if logbook experience is
inadequate, formative assessments are unsatisfactory, if there is loss of training time due to illness or
other problems or failure to complete any of the listed requirements for the completion of training such
as the mandatory research requirements.
The maximum leave entitlement for trainees who are undertaking full-time training is six (6) weeks per
year and is inclusive of annual leave, compassionate, parental leave, study & examination leave and
personal & carers leave. Trainees who wish to take more than the annual leave and additional leave
entitlements must receive prior approval for interruption of training or extension of leave from the Board
of Studies and it is also subject to approval by the employing authority.
It is recognised that a single training post in any training centre may not offer complete training. A
combination of training posts by rotation in the same, or various training centres, constitutes the training
pathway.
Transfer between Training Centres must be approved by the Regional Surgical Committees of both
Training Centres and written confirmation of the planned transfer is submitted to the OMS Education
Officer by the Training Centres. Trainees must demonstrate satisfactory training progress and requests
for transfer will not be approved during an unsatisfactory term or where the previous term has been
borderline or unsatisfactory. A rotation between Training Centres that has been approved may be
withdrawn if the transfer coincides with a subsequent borderline or unsatisfactory term.

In summary:
a. Surgical training is for a minimum of four (4) years.

b. Training is continuous unless approval for interrupted training has been applied for and granted, by
the College.
c. Requests for Interruptions in Training should be addressed to the Training Committee, c/o the OMS
Education Officer at oms@racds.org.
2.1.3 TRAINING REQUIREMENTS OF THE PROGRAM
1. Trainees must successfully complete a minimum of four years full time in accredited posts.
2. Training time completed in an accredited post is credited in periods of six (6) or 12 months only.
The six (6) month training rotations must be undertaken continuously in the same position.
3. Trainees are required to keep logbooks of clinical training. An Annual Logbook Summary must be
completed, included in the trainee’s learning portfolio and submitted to the College.
For further information on logbooks, please refer to A - Section 6.
4. Six-Monthly Assessment reports are to be completed by the end of July and January and
submitted to the College by 15 August and 15 February respectively.
For further information on Assessments, please refer to A- Section 4.
5. If a Six-Monthly Assessment is reported by the Director of Training as unsatisfactory, this training

period will not count towards the four years of surgical training.
For further information on Assessment, refer to A- Section 4.
2.1.4 RESEARCH
The mandatory research requirements are required for the award of Fellowship for trainees who
commenced OMS 1 or BST (OMS) training after June 2009.
The research requirements have two parts:
• Research study
• Presentations
The research requirement can be completed via two pathways:
Pathway 1 - Completion a formal research project undertaken as part of a postgraduate research

qualification
Pathway 2 - Independent research culminating in a paper that is deemed acceptable for publication
in a peer-reviewed journal for trainees who commenced training prior to 2018. Those who
commenced training in 2018 or beyond are required to have their paper accepted for publication.
Research Proposal Submissions
All trainees must submit their research study proposal to the Research Subcommittee by 15th February
of OMS 2. There are research requirement forms for pathway 1 and 2, FOMS13 and FOMS14, and
these should be submitted at the earliest date for consideration by the Research Sub-committee so that

any recommendations for change or modification can be undertaken in timely way. Please allow up to
four (4) weeks for a research proposal submission to be considered by the Research Sub-committee.
Pathway 1 Proposal
Trainees who are undertaking a University qualification must complete and submit FOMS14 - OMS
Research Requirement Pathway 1 when the research study has been approved by the University and
enrolment completed. The submission of the form must be made by 15th February of OMS 2.
Trainees who choose to fulfil this requirement by enrolling in a PhD will be required to take leave of
absence from the training course and will need to apply for Interrupted Training.
Pathway 2 Proposal
Trainees who plan to fulfil the research requirement independently of a postgraduate degree
(Pathway 2) must apply to the Research Sub-Committee (of the Education Committee) with the
submission of FOMS13 and an outline of the research paper for approval of their proposed research
study and their supervisors. If relevant to the study, ethics approval should also be submitted. The Sub-
Committee will assess the research proposal and advise trainees of the requirements for the submission
of their study, which will be of an equivalent standard to that of a higher degree qualification.
Trainees are advised to contact the OMS Education Officer if they wish to make a submission to the
Research Sub-committee. The submissions must be made to the Research Subcommittee by 15th
February of OMS 2. Clinical case reports and stand-alone literature reviews will not be approved for this
purpose.
Prior Completion of Research Qualification
Trainees who wish to submit a completed research qualification for consideration of fulfilment of their
research requirements must submit the following to the OMS Education Officer, for review by the
Research Subcommittee, by 30 June of OMS 2:
1. Details of the research supervisor(s) and institution
2. Brief description of the research
3. Details of any paper /publications related to the study
4. Details of any related presentations
5. Certified copy of degree
It is recommended that trainees applying for recognition of prior research submit their application in their
first year of training and well in advance of 30 June OMS 2.
Completed Research
Following completion of the research project the paper must be submitted to the Research Sub-
committee for review and approval for the fulfilment of the requirements. For those who have
commenced training in 2018 or beyond, a copy of the paper accepted for publication in a referred journal
must be provided.
Completed research must be submitted to the College for review by the Research Sub-committee by 1st
December of the final year of training, OMS4. Please allow up to four (4) weeks for a completed research
to be considered by the Research Sub-committee.
A Completion of Research Requirement Form must be completed by trainees and their DoTs and
attached to applications for Fellowship (FRACDS(OMS)).The research component must have been
completed prior to the award of the Fellowship.

Research Methodology Course
In addition, trainees in Pathway 2 must enrol in a research methodology course (such as a University
post-graduate course or an approved research skills course) or undertake the RACS Critical Literature
Evaluation and Research (CLEAR) course, unless otherwise advised by the Research Subcommittee.
Presentations
All trainees with mandatory research requirements are also required to:
a. present a paper each year at a scientific meeting, the annual conference of the specialty, college
convocation, a hospital grand round, or equivalent; and
b. present a paper at the annual conference of the specialty or equivalent as approved by the
Research Subcommittee at least once during their advanced surgical training.
2.1.5 EXTENSION OF TRAINING FOR COMPLETION

OF RESEARCH REQUIREMENTS
If trainees have completed their training time and the Final Examination however they have not fulfilled
the mandatory research requirements, then an extension of training time will be required to complete
their research. Extension of training for the completion of research is undertaken in six (6) month periods
to a maximum of three (3) periods of extension, to 18-months. A fee of 50% of the Annual Trainee
Registration will apply for each six (6) month period of extension.
A maximum of three (3) periods of extension only is permitted.
All trainees must complete the Extension of Training form enrolment process with the College and pay
the requisite fees for extension of training for the completion of research.
2.1.6 RECOGNITION OF OVERSEAS TRAINING

EXPERIENCE
a. Prospective approval must be obtained for recognition of overseas training experience. An

application must be made to the OMS Education Officer in writing and be accompanied by:
i. a proposed roster/timetable
ii. a letter of appointment
iii. name and contact details of the supervisor of training in the overseas training facility
b. A retrospective application for recognition of overseas training will not be accepted.

A minimum of six (6) months and a maximum of 12 months experience will be considered.
The training facility should be recognised for surgical training within the relevant national system of
training.
c. A suitable supervisor must be identified, this supervisor will be responsible for the:
i. completion of Six-Monthly Formative Assessments
ii. overseeing the completion of any clinical training assessments during the overseas
rotation.
d. An Annual Logbook summary Sheet must be completed then verified by the identified supervisor
and submitted to the College at the completion of the training rotation for training time to be
accredited.
e. Satisfactory Six-Monthly Formative Assessment reports must be submitted to the College, for
training time to be accredited.

f. Trainees must continue to undertake components of the program in accordance with the normal
progression of program requirements.
g. Trainees must remain enrolled with the College and pay the trainee enrolment fee whilst
participating in an approved overseas program.
2.1.7 LEARNING PORTFOLIO
Trainees must maintain a Learning Portfolio. The Portfolio should contain annual logbook summaries,
copies of all assessment forms, Team Appraisal of Conduct (TAC) report, certificates of any relevant
courses completed, conferences attended and all presentations. The portfolio must be keep up-to-date
and contain all the required documentation and reports. It will be submitted to the Director of Training
as part of the completion of training requirements.
The Training Portfolio is reviewed as part of the completion of training requirements and it must be
satisfactorily maintained.
A full explanation of what the Learning Portfolio should contain and how it should be presented and
maintained is described in Appendix 1.
2.1.8 LEAVE FROM TRAINING
Leave from training is allowed only in special circumstances and according to the employment
conditions of the locality in which the trainee is employed.
2.1.9 PART-TIME AND INTERRUPTED TRAINING
The College has policies on Part-time Training and Interrupted Training (refer Part A - Section 5).
2.1.10 MANDATORY COURSE REQUIREMENTS
Trainees must complete prescribed courses, currently: Australian and New Zealand Surgical Skills
Education and Training (ASSET), Emergency Management of Severe Trauma (EMST) and Care of the
Critically Ill Surgical Patient (CCrlSP), by 31 October in their second year, OMS 2, of training.
2.1.11 EXAMINATION REQUIREMENTS
The SST examination is to be undertaken in the first year (OMS1) or in the year of applying for selection
into the program if the applicant has both registration in medicine and dentistry and undertaking or has
completed a surgery-in-general (SIG) year from 2019 onwards. A pass in this examination is mandatory
to proceed into OMS 2.
A final examination is undertaken during the last 18 months of the training year (OMS 3/OMS 4) and a
pass in this examination is mandatory for completion of the training program and award of Fellowship.
2.1.12 UNSUCCESSFUL CANDIDATES IN

EXAMINATIONS
Trainees who are unsuccessful in examinations receive a report from the Registrar within five weeks
following the examination. The report comprises Examiner feedback with the aim of supporting the
candidate in further attempts.

For further information on examinations, please refer to: SST – C - Section 3. Final Examination – D -
Section 1.
2.1.13 UNSUCCESSFUL FINAL EXAMINATION

RESULT – ELIGIBILITY TO RE-PRESENT
Please refer to Final Examination – D - Section 1.
2.1.14 WITHDRAWAL FROM THE TRAINING

PROGRAM
Trainees must advise in writing the College office and the Director of Training for their region their
intention to withdraw from the program. There is no refund of fees.
2.1.15 REAPPLYING FOR ENTRY INTO THE ORAL &

MAXILLOFACIAL SURGERY TRAINING
PROGRAM
For further information on re-applying to the training program after failing an examination, please refer
to the Former Trainees Seeking to Reapply to the Oral and Maxillofacial Surgical Training Program
Guidelines.

3 A – SECTION 3
CLINICAL TRAINING ASSESSMENT (CTA)
Clinical Training Assessment comprises three forms of assessment:

1. Case Presentation plus Discussion,
2. Assessment of Operative Process (AOP) and
3. Team Appraisal of Conduct (TAC).
Collectively, these workplace assessments will provide evidence that a trainee is competent in the
practice of Oral and Maxillofacial Surgery.
Trainees are encouraged to try to spread assessments over the training period to ensure there is
adequate time to repeat assessments if development is required. By the end of training, each trainee
should have satisfactorily completed assessment forms for all areas listed. For those trainees who have
already started surgical training prior to the introduction of CTAs, the number of assessments required
will be proportionate to the remaining training period. In this case the Director of Training will determine
the number of assessments which need to be satisfactorily completed. To assist the trainee’s
development as a surgeon, the Director of Training, in conjunction with the Supervisor of Training, may
specify the assessment areas required or give a selection from which to choose.
3.1.1 CASE PRESENTATION PLUS DISCUSSION
The Case Presentation plus Discussion is an assessment used to facilitate the documenting of
presentations of cases by trainees. This activity happens throughout training but may not be conducted
in a way that provides systematic assessment and structured feedback. Case Presentation plus
Discussion will assess clinical decision making and the application and use of medical and dental
knowledge in relation to patient care for which the trainee has been responsible. It also facilitates the
discussion of the ethical and legal framework of practice and requires the trainees to discuss why they
acted as they did. Although the primary purpose is not medical record keeping, as the actual record is
the focus of the presentation and discussion, the Supervisor of Training can assess the record in this
instance. The presentation and discussion process should take 10-15 minutes, plus 5 minutes for
feedback.
By the end of training, each trainee must have completed satisfactorily Case Presentation and
Discussion Assessment forms for the following:
a. Management of the persistent oro-antral fistula
b. Management of dento-alveolar injuries
c. Formulate detailed differential diagnoses for lesions of the maxillofacial region using advanced
imaging techniques including intraoperative imaging
d. Manage, as part of a multidisciplinary team, pathology of the maxillofacial region, e.g. ORN,
vascular lesions
e. Management of surgical and non-surgical treatments for a patient with facial pain
f. Management of non-surgical treatment of TMJ disorders, e.g. dislocations of the jaw joint, internal
derangements, occlusal splints, exercises, physiotherapy, etc.
OR
Management of common intra operative complications of TMJ surgery
OR
Post-operative and continuing care of the patient with a TMJ disorder

g. Management of advanced oral malignancy
h. Application of technologies, e.g. endoscopy, sialoendoscopy, laser ablation in maxillofacial surgery

and 3-D imaging for surgical planning.
3.1.2 COMPETENCIES ASSESSED AND

DESCRIPTORS
Area Descriptor – A satisfactory trainee:
Medical Record Keeping The record is legible, signed, dated and appropriate to the problem,
meaningful in relation to, and in sequence with, other entries. It
helps the next clinician to give effective and appropriate care.
Clinical Assessment Can demonstrate an understanding of the patient’s story and how,
through the use of further questions and an examination
appropriate to the clinical problem, a clinical assessment was made
from which further action was derived.
Investigation(s) Can discuss the rationale for the investigations and necessary
referrals. Shows understanding of why the diagnostic studies were
ordered/performed, including the risks and benefits and
relationship to the differential diagnosis.
Differential Diagnosis Can discuss the outcomes of investigations and explain the
formulation of a differential and then a final diagnosis.
Treatment Can discuss the rationale for the treatment, including the risks and
benefits.
Follow Up and Future Planning Can discuss the rationale for the formulation of the management
plan including follow up.
3.1.3 COMPLETING THE ASSESSMENT
It is the trainee’s responsibility to initiate the assessment process with their Supervisor of Training or
Trainer. The trainee advises the Supervisor of Training or Trainer that a particular case provides an
opportunity for assessment, organises a mutually acceptable time for the assessment to take place, and
ensures that the appropriate assessment form is given to the Supervisor or Trainer for completion.
The trainee will have selected a case record from a patient they have seen recently, and in whose notes
they have made an entry. The presentation and discussion must start from, and be centred around, the
trainee’s own record in the notes.
Trainees are assessed on their knowledge, understanding and presentation of:

a. Medical Record
b. Clinical Assessment
c. Investigation (s)
d. Differential Diagnosis
e. Treatment
f. Follow Up and Future Planning.
The assessment form is located in Appendix 2.

In order to maximise the educational impact of this assessment, the Supervisor of Training or Trainer
and the trainee need to identify agreed strengths, areas for development and an action plan. This should
be done one on one in a suitable environment.
Once the assessment has been completed, the trainee must copy the completed form for the Supervisor
of Training and keep the original form in their Learning Portfolio. Trainees should retain originals of all
assessments in their Learning Portfolio. It is expected that each trainee’s Learning Portfolio will have
completed assessment forms which detail that development is required, followed by a satisfactorily
completed form which shows that, through experience, the trainee has achieved the standard required.
To monitor progress, when submitting the Six-Monthly Assessment form, trainees must submit any
satisfactory Case Presentation plus Discussion forms completed in that six (6) month period.
Trainees will be required to submit a minimum of one satisfactorily completed Case Presentation plus
Discussion form for each six (6) months of accredited OMS training. These forms must be included in
an application for Assessment of Eligibility for the Final Examination.
3.1.4 ASSESSMENT OF OPERATIVE PROCESS (AOP)
This assessment involves the observation of procedures performed by the trainee. The AOP is designed
to assess a trainee’s technical skills and their ability to safely and effectively perform appropriate surgical
procedures. The Supervisor of Training or Trainer will also be able to assess the trainee’s ability to adapt
their skills in the context of each patient, for each procedure. The AOP should not be completed
retrospectively.
The AOP has two principal components, one consisting of a series of competencies within six (6) core
domains. Most of the competencies are common to all procedures, but a relatively small number of
competencies within certain domains are very specific to the particular procedure in question. The
second part of the evaluation consists of a global assessment which is divided into four levels of overall
global rating, the highest of which is the ability to perform the procedure to a standard expected of a
specialist in practice.
The trainee is assessed as either achieving a satisfactory standard or development required on items
within the following areas:
a. Consent
b. Pre-operative Planning
c. Pre-operative Preparation
d. Exposure and Closure
e. Intra-operative technique
f. Post-operative management.
The AOP may also serve as a form of checklist for the trainee on the steps required for each procedure.
Either whole or part of a procedure is assessed and AOP assessment forms have been developed for
specific procedures. They can be located at Appendix 3-19.
By the end of training, each trainee should have satisfactorily completed AOP assessment forms for the
following:
a. The removal of an impacted tooth requiring raising a flap, bone removal, tooth division and elevation
and repair
b. Treatment requiring a hard tissue graft or flap from:
i. A local site

ii. A distant site

c. Placement of implant fixtures (s)
d. The closure of an oro-antral communication
e. Tracheostomy
f. Osteotomy:
i. Mandibular
ii. Maxillary
g. Incision and drainage for infection – cervico-facial
h. Enucleation of a jaw cyst
i. Surgical approaches:
i. Mandibular
ii. Maxillary
iii. Zygomatic/Orbital
j. Open reduction and internal fixation of fractures –
i. Mandible
ii. Maxilla
iii. Zygomatico/Orbital
By the end of training, each trainee when possible should satisfactorily completed AOP assessment
forms for the following
k. Removal of submandibular gland.
To aid the trainee’s development, additional procedures may be recommended by the Supervisor of
Training.
It is the trainee’s responsibility to initiate the assessment process with their Supervisor of Training or
Trainer. The trainee advises the Supervisor of Training or Trainer that a particular case provides an
opportunity for assessment and ensures that the appropriate assessment form is given to the Supervisor
or Trainer for completion.
On most occasions the trainee’s Supervisor of Training will complete the assessment, but it is
anticipated that in any one training period, particularly for certain procedures, other surgical consultants
may be available depending on the trainee’s work pattern. The trainee must approach a Trainer
suggesting a case provides the opportunity for assessment. The procedure should be representative of
those the trainee would normally carry out at that level and should be one from the list of procedures
above.
The Supervisor of Training or Trainer should observe the trainee undertaking the agreed sections of the
AOP in the normal course of workplace activity (usually scrubbed). Given the priority of patient care, the
Trainer should choose the appropriate level of supervision depending on the trainee’s stage of training.
Trainees should carry out the procedure, explaining what they intend to do throughout. If the trainee is
in danger of harming the patient at any point s/he must be warned or stopped by the Trainer immediately.
Trainees will also find that reflecting on the assessment criteria (as detailed in the assessment form)
can help them define any gaps in their understanding or ability which they can bring to the discussion
with the Trainer and other senior colleagues.

As an entire collection, they form a summative assessment of the trainee’s competence in learning to
perform operative procedures using the correct protocols to the correct standards. Trainees are
encouraged to perform as many as possible.
When an AOP is completed, the Supervisor or Trainer should provide immediate feedback to the trainee
in a debriefing session. The assessor should identify areas of achievement and opportunities for
development. This should be done sensitively and in a suitable environment. The AOP will take as long
as the procedure itself but the completion of the form should take about 15 minutes including feedback
to the trainee.
Once the assessment has been completed, the trainee must copy the completed form for the Supervisor
of Training and keep the original form in their Learning Portfolio. Trainees should retain originals of all
assessments in their Learning Portfolio. It is expected that each trainee’s Learning Portfolio will have
completed assessment forms which detail that development is required, followed by a satisfactorily
completed form which shows that, through experience, the trainee has achieved the standard required.
To monitor progress, when submitting the Six-Monthly Formative Assessment form, trainees should
submit any satisfactory AOP forms completed in that six (6) month period to the College.
Trainees are required to submit a minimum of two satisfactorily completed Assessment of Operative
Process forms for each six (6) months of accredited OMS training. These forms must be included in an
application for Assessment of Eligibility for the Final Examination.
3.1.6 TEAM APPRAISAL OF CONDUCT (TAC)
Trainees should complete one TAC assessment during their third year of surgical training
(OMS 3).
The TAC form is a peer assessment tool comprising a self-assessment by the trainee and the collated
ratings from a range of colleagues who work with the trainee (refer to Appendix 20 for an example of
the Rater form). As part of a multidisciplinary team, surgical trainees work with other people who have
complementary skills. They are expected to understand the range of roles and expertise of team
members in order to work effectively within that team. The TAC is used as an educational method of
assessing competence in professional skills within a team-working environment. Trainees should
complete one TAC assessment during the third year of their surgical training.
The trainee is assessed on items within the following areas:

a. Good Clinical Care
b. Maintaining Good Clinical Practice
c. Teaching and Training, Appraising and Assessing
d. Relationship with Patients
e. Working with Colleagues.
The assessment provides developmental feedback to the trainee in order to improve the trainee’s clinical
care and professional competence by directing learning and improving insight. Trainees are assessed
doing what is normally expected of them in their usual working environment. It is important that the
trainee selects different raters to cover a variety of perspectives.
The TAC assessment is confidential. Individual assessments are anonymised and are not disclosed to
the trainee. Feedback to the trainee is delivered through a report which is sent to the trainee, the

trainee’s Supervisor of Training and the Director of Training and comprises the raters’ aggregate ratings
compared with the trainee’s self-assessment, plus raters’ comments which are included verbatim.
The assessment should be held in approximately the fourth month of a six (6) month rotation, or the
eighth month of a 12-month rotation. This will give sufficient time for development, if required.
It is the trainee’s responsibility to initiate the assessment process with the Education Officer.
The trainee must select a minimum of eight (8) raters (maximum of 12) to assess them. The trainee then
must liaise with the OMS Education Officer to provide the list of names and email addresses of the
raters. The OMS Education Officer will provide a link to each of the assessors as well as a link for the
trainee, so they can complete a self-assessment. The raters should be members of the trainee’s
multidisciplinary healthcare team who represent a range of different grades and environments (e.g.
ward, theatre, outpatients) and who have sufficient expertise to be able to make an objective judgment
about the trainee’s performance. Raters do not include administrators, support staff or patients.
The assessment must be completed online and should only take 10-15 minutes to complete. Raters are
given a date (approximately one to two weeks after receiving the survey) by when the completed form
must be submitted. The data is collated, and the feedback will then be provided to the trainee and
Supervisor of Training in a report.
The feedback is designed to highlight several factors for discussion:

a. The team perception of the trainee’s performance covering a range of competencies, including any
serious concerns (the Supervisor of Training may need to make further inquiries from individual
raters)
b. The trainee’s awareness of his/her own strengths and weaknesses in relation to working within a
team
c. The trainee’s learning and development needs.
Once the results have been received the Supervisor of Training should sign off the TAC report by
selecting the appropriate outcome for the comments box: satisfactory, development required or
unsatisfactory. If development is required, a targeted training plan should be detailed in the comments
box. The re-assessment should take place when the Supervisor of Training indicates that progress has
been made in areas identified for development. Unsatisfactory reports should be referred to the Director
of Training.
Situations in which the TAC is deemed to be unsatisfactory are listed below with recommended actions.
a. The TAC was not carried out -
The TAC form cannot be signed off until completed. At the earliest opportunity the Supervisor of
Training and trainee must ascertain the reasons preventing the TAC from being carried out and
take any necessary action to resolve the difficulties so that the TAC can be completed within a
suitable period.
b. There were not enough raters to generate a feedback report -

The Supervisor of Training must decide whether the range of evaluations received is enough to
enable a judgment to be made about a trainee’s performance. If not enough ratings have been
provided, signing off must be deferred. The Supervisor of Training and trainee must then take any
necessary action to resolve difficulties so that the TAC can be completed within a suitable period.
c. The feedback report showed that the trainee needed to improve performance
The trainee and Supervisor of Training develop a learning and development plan for improvement

including a timeframe for achieving this. The Supervisor of Training can recommend additional
training or support, such as mentoring or personal development activities. The Supervisor of
Training can also recommend a repeat of the TAC assessment. The repeat assessment could
occur in the following six (6) months under the supervision of the next Supervisor of Training.
d. Serious concerns were raised -

The Supervisor of Training must identify strengths and weaknesses in the trainee’s professional
behaviour and sign off the TAC form as unsatisfactory if concerns are justified. The Supervisor of
Training must notify the Director of Training. The Director of Training should undertake a review
of the trainee’s overall performance and decide on a support strategy.
Trainees will be required to submit one satisfactory Team Appraisal of Conduct. This assessment must
be included in the application for Assessment of Eligibility for the Final Examination.

4 A – SECTION 4
SIX-MONTHLY ASSESSMENT AND PROGRESS REGULATIONS
Supervision and assessment of trainees by Supervisors of Training is necessary to ensure quality of

training, progression and suitability to sit the Final Examination, and the completion of training. During
training each trainee will be the subject of a formative assessment report at the end of every six (6)
months. The assessment of such training will be the responsibility of the Supervisor of Training. The
Supervisor of Training will consult with colleagues or consultants involved in training about the trainees
performance. Comprehensive assessment of trainees is provided through the formative assessments
and logbooks.
Formative assessment aims to be supportive of the trainee. Summative assessment is an external

validation of the trainee’s development, measured against objective criteria, for example by examination.
4.1.1 OBJECTIVES OF ASSESSMENT
The broad objectives of the Six-Monthly Formative Assessment are to:

a. assist with trainee’s progress through the training program by identifying trainees’ strengths and
weaknesses
b. provide an opportunity for regular, written feedback to trainees
c. develop any remedial activities for the trainee should they be required.
4.1.2 ASSESSMENT REPORTS
The Six-Monthly Assessment report form will not be considered valid unless it is signed by the trainee,
Supervisor of Training responsible for its completion, and the Director of Training.
The assessment relates to the trainee’s overall performance during the previous period and takes into
account all aspects including:
a. Clinical knowledge and skills
Clinical knowledge of subject, professional knowledge, clinical clerking, history taking, relevant
procedural skills
b. Clinical judgement
Diagnostic skills, patient management, time management, recognising limits, ethical skills
c. Communication
Communication skills, ability to communicate with patients and families, sensitivity and ethical
awareness
d. Co-operation and teamwork

Ability to cooperate with other healthcare professionals, show initiative and enthusiasm, take
responsibility for own learning and motivation to teach
e. Professional attitudes and behaviour
f. Reliability and dependability, ability to cope with stress, emotional demands, and emergency
situations and personal manner.
4.1.3 PROCESS
From 2007, each trainee must maintain a Learning Portfolio throughout their training. It should contain
originals or copies of formal documents related to training as well as a detailed logbook. It must contain

the original signed copy of each Six-Monthly Assessment Report form from each assessment with a
Supervisor of Training.
a. Formal assessment meetings should occur between the Supervisor of Training (SoT) and
each trainee at the beginning and end of each six (6) month period. At the beginning of the
rotation it is the trainee’s responsibility to show the Supervisor their learning portfolio including
copies of all previous assessments. The learning portfolio is to be used by the Supervisor and
trainee to set appropriate educational and clinical goals for the following rotation. For trainees
should arrange an interview with the SoT at three (3) monthly intervals during the rotation to
discuss progress to allow feedback and to identify any weaknesses or deficiencies during the
course of the clinical rotation.
The meeting at the end of the rotation is specifically to review and discuss performance of the
trainee in the completed rotation. Additional meetings between the trainee and the Supervisor
should occur as appropriate. Any trainee experiencing difficulty should bring this to the
attention of their Supervisor of Training as early as possible. If the trainee is continuing at the
same institution, with the same Supervisor for the following six (6) months, the assessment
and goal setting interviews may be joined.
b. The Six-Monthly Assessment report of the trainee over the previous rotation should be compiled
from the Supervisor’s own observations and from the feedback from the other Trainers and
consultants who have worked with the trainee during the six (6) month training period.
c. The Six-monthly Assessment report form must be signed by the Supervisor of Training and the
trainee, after the trainee has had the opportunity to add comments.
d. The following points may assist a Supervisor of Training in situations where the trainee’s
performance is not at the level indicative of satisfactory assessment:
i. If a performance is below expectation or unsatisfactory on any of the

skills/attitudes/abilities on the form, then it must be discussed with the trainee with a
view to establishing remedial strategies. An isolated ‘unsatisfactory’ attribute does not
necessarily constitute an unsatisfactory assessment
ii. A consistent unsatisfactory attribute over more than one assessment or multiple
unsatisfactory attributes on the one occasion must be discussed with the trainee and,
together with the Director of Training, remedial strategies established.
iii. The Trainee Report Form is completed (Appendix 22)
e. Within four weeks of a completed assessment, the trainee should meet with the Director of
Training. The Director of Training will review the assessment and deem the report satisfactory,
borderline or unsatisfactory and sign the form. The trainee should keep the original copy of the
signed form in their learning portfolio and send a copy of the form to the College office. The
College office must receive a copy of the assessment report by the published date provided in
the Handbook each year. Failure to submit a Six-Month Formative Assessment Report within a
maximum of two (2) weeks of the published date will result in the period of training from that
time forward not being recognised until the report is submitted. Additional training time may be
required as a result of the deficit in accredited training time.
The Trainees Requiring Assistance Policy provides an overview to assist Directors of Training and
Supervisors of Training who are assisting a trainee requiring assistance.

4.1.4 FORMAL WARNINGS
In the event that the Supervisor of Training is seriously concerned about a trainee’s performance and
progress, a formal warning may be given to the trainee by the Director of Training, prior to the Six-
Monthly Formative Assessment. The trainee will be advised that improvement in performance and
progress will be expected in specified areas or an unsatisfactory Six-Monthly Assessment report may
result. This warning must be indicated on a Trainee Report form (refer to Appendix 22) and signed and
dated by the Director of Training and the trainee. A copy of the Trainee Report form should be filed in
the trainee’s Learning Portfolio and the original kept by the Director of Training.
Initial steps by the Director of Training (in consultation with the Supervisor of Training):
a. a formal time should be set aside for a discussion with advance notice for the trainee
b. the presence of a support person should be offered
c. shortcomings in progress/performance should be clearly identified and documented by the

Supervisor of Training on the Trainee Report Form (or attached to it)
d. clear expectations on required progress/performance should be provided to the trainee
e. agreed, achievable goals should be set
f. assistance and resources available to the trainee should be identified and offered (this may
include assistance in identifying a mentor for advice or counselling from a professional counsellor)
g. a documented action plan including follow up meeting dates (with the Director and Supervisor of
Training) should be developed.
4.1.5 MANAGEMENT OF SIX-MONTHLY

ASSESSMENT REPORTS BY THE DIRECTOR OF
TRAINING
The Director of Training will meet with each trainee and consider their assessment report within four
weeks of the completion of the relevant six (6) month training period. The Director of Training, after
discussion with the relevant Supervisor of Training, must decide whether the report is deemed as
Satisfactory, Borderline or Unsatisfactory.
4.1.6 POSSIBLE OUTCOMES OF DIRECTOR’S

REVIEW OF ASSESSMENT REPORTS:
a. Six-Monthly Assessment Report considered Satisfactory
The Supervisor of Training and trainee are informed that the training is satisfactory
b. Borderline
The Director of Training advises the trainee of specific problems and makes recommendations for
improvements required. The Trainee Report Form, Appendix 22, is completed. The trainee should also
be informed of the potential consequences of the assessment of their next six (6) months of training:
• If the next Six-Monthly Assessment report is deemed as Satisfactory, then the Borderline six (6)
months will be deemed as Satisfactory.
• If the next Six-Monthly Assessment report is deemed as Borderline, then both assessments will be
deemed as Unsatisfactory and the training time for these 12 months will not be credited.

• If the next Six-Monthly Assessment is deemed Unsatisfactory, then the Borderline six (6) months
will be deemed Unsatisfactory and the training time for these 12 months will not be credited.
• Six (6) monthly training periods are regarded as continuous and they are not based on a calendar
year. A trainee who receives a Borderline Six-Monthly Assessment report for the second part of
one calendar year and for the first part of the following calendar year will have this training period
deemed Unsatisfactory.
• If a trainee receives a Borderline report following an Unsatisfactory report in the previous six (6)
months, then the Borderline report will be deemed Unsatisfactory and the training time for these 12
months will not be credited.
c. Unsatisfactory
If the Six-Monthly Assessment was unsatisfactory, the trainee will be notified in writing by the College
that this training period will not be credited.
Any Six-Monthly Assessment reports which are deemed as Borderline or Unsatisfactory should be
reported to the relevant Regional Surgical Committee at their next meeting and from the Director of
Training to the Training Committee, Board of Studies (BoS). The Training Committee will meet and
review every Borderline and Unsatisfactory report. Trainees will receive written correspondence from
the College following this.
If a trainee receives three (3) unsatisfactory Six-Monthly Assessment reports at any time during the
course of their training, then they will cease to be a trainee.
4.1.7 ACTION BY THE DIRECTOR OF TRAINING WHEN

SIX-MONTHLY ASSESSMENT REPORTS ARE
BORDERLINE
a. The Director of Training will discuss the assessment report with the relevant Supervisor of Training
b. The trainee’s previous assessment reports and progress will be reviewed
c. Specific areas of concern will be identified and listed. Trainee Report Form (Appendix 22) is
completed.
d. When applicable, the Trainees Requiring Assistance Policy should be reviewed.
An assessment will be made of:

a. The likely impact of the issues noted. Can they be improved in a reasonable period of time (e.g.
lack of knowledge) or are they more difficult to deal with (e.g. inability to cope with emotional
demands)?
b. The insight of the trainee and his/her willingness to modify their behaviour (e.g. accepting, keen to
improve on the unsatisfactory attribute or denial of the problem)
c. Factors such as personality differences with a staff member(s) or psychosocial stress which may
have influenced behaviour or affected performance
d. Whether or not specific assistance can be provided
e. Whether the trainee is likely to improve his/her performance or whether he/she is at risk of ongoing
problems.

4.1.8 UNSATISFACTORY PERFORMANCE
When a trainee performs at a standard which is below that to be acceptable for a developing oral and
maxillofacial surgeon, notwithstanding repeated documented attempts at remediation, the Director of
Training will notify the BoS. After ensuring that appropriate counselling and remedial measures have
occurred the BoS of the College may recommend any of the following options, depending on the nature
of the problem.
Options for the trainee may include:

a. A further period of specified training and review of progress
b. Leave of absence to be followed by a specified period of training (see regulations on interrupted

training)
c. A career change on a temporary or permanent basis.
The processes of procedural fairness must be observed so that the trainee is notified of any steps being
taken. The Director of Training must advise the BoS of any action which may alter the training status of
the trainee. The trainee may appeal to the College against any decision that affects his/her training. The
College will consider this appeal according to its established procedures – Reconsideration, Review &
Appeals Policy.
If a trainee has three (3) Six-Monthly Assessments reports deemed Unsatisfactory, during the course of
his/her training, the trainee will cease to be a trainee.
4.1.9 TERMINATION OF EMPLOYMENT
If a trainee is dismissed or terminated from their hospital employment, they will be automatically
terminated from their accredited training position and the Training Program.
4.1.10 RE-ENTRY INTO TRAINING PROGRAM
A former Trainee who has been terminated from the OMS Training Program for any reasons noted in
Appendix 30 (Section 3) and outlined below, will not be eligible to reapply for selection for OMS
Training in the future.
A former trainee who has been dismissed from the OMS training programme and/or an employing
institution due to the following reasons will not be granted permission to reapply for OMS training:
a. failure to complete the SST exam after 3 diets of the examination
b. unsatisfactory performance or formative report
c. failure to satisfy hospital employment requirements
d. unprofessional conduct, professional misconduct or notifiable conduct as
e. defined by the registering bodies for medicine and dentistry in Australia and New Zealand

5 A – SECTION 5
PART-TIME AND INTERRUPTED TRAINING
Applications for part-time or interrupted training may be approved in a range of circumstances, including
availability of accredited positions, research, ill-health or parenting.
As the College does not employ its trainees, the College can only mandate the approval of training which
will be accredited by the College. The specific part-time training arrangements must be documented and
supported in writing by the trainee’s Director of Training.
5.1.1 PART-TIME TRAINING
• Applications for part-time training must be made in writing in advance to the Registrar (OMS), for
consideration by the Board of Studies
• Trainees who are approved to undertake part-time training must have a clinical training commitment
of at least 50% of a full-time trainee in one calendar year
• Trainees who are approved to undertake part-time training must complete training within six (6)
years
• Trainees who are approved for part-time training must undertake the same training components as
full-time trainees
• Trainees who are approved for part-time training are required to submit logbook summary forms
and fulfil course requirements
• Trainees may apply to enter part-time training from a period of interrupted training
• Part-time training requires enrolment with the College and normal payment of the annual trainee
enrolment fee
• Where there are exceptional circumstances the BoS may approve an amended training program .
5.1.2 INTERRUPTED TRAINING
• Applications for interrupted training must be made in writing in advance to the Registrar (OMS) for
consideration by the Training Committee. Trainees are required to maintain enrolment during any
period of interrupted training. When the period of interrupted training is for up to 12 months, the full
annual trainee enrolment fee applies
• Where interrupted training extends for more than one (1) year, an administration fee is payable by
the trainee
• Trainees who are approved for interruption of training must complete training within six (6) years.
However, a period of continuous interruption of training exceeding two (2) years will necessitate a
period of additional training, due to loss of skills and rapid change in medical and dental knowledge
• During a period of interrupted training trainees cannot sit for examinations or participate in any part
of the program
• It is the responsibility of the trainee to re-enrol following a period of interrupted training
• Trainees may apply for part-time training after a period of interrupted training. Notwithstanding any
provision within this policy, where there are exceptional circumstances recognised and approved
by the BoS, the Training Committee may approve an amended training program

5.1.3 INTERRUPTED TRAINING PRIOR TO THE

COMMENCEMENT OF TRAINING
• Applications for delay in the planned commencement of training date must be made in
writing in advance to the Registrar (OMS) for consideration by the Training
Committee. Applications must fulfil one of the special circumstances outlined in the Special
Consideration in Assessment Policy.
• Applications should be made as soon as possible when a special circumstance is identified.
• Applications for interruption of training, to delay the commencement of training, will only be
considered for a period of up to 12-months.
• Applicants who are not able to commence training 12-months after the anticipated date will
be ineligible for any further extension of interrupted training under Special Consideration
and will need to apply for training via the Selection Process.

6 A – SECTION 6
GUIDELINES FOR MAINTAINING LOGBOOKS
All trainees are expected to maintain logbooks to demonstrate their clinical experience. These must be
maintained on a contemporaneous basis in the trainee’s Learning Portfolio and should be available for
review by the Supervisor of Training or Director of Training at any stage.
All logbooks are reviewed at least six (6) monthly by the Director of Training, and a summary is submitted
to the College on an annual basis (refer to Appendix 21 and 23). Logbooks are audited by the Training
Committee.
Details should include:

• Hospital number/Name
Generally, the expectation is that one would use the Hospital Identifier Label. Virtually all public and
private hospitals in Australia and New Zealand use these for inpatients. If these are not available for
outpatients or private room patients, write in the details.
• Gender
• Date of birth
• Supervisor of Training/Trainer/Consultant
• Date of Operation
For investigative procedures, use the date when completed. If a patient has two operations at different
times, then both are counted.
6.1.1 OPERATION DETAILS
The basic unit of the logbook is the individual patient having an operation, not a series of procedures.
Thus, generally the operation will be covered by a single description in a single category. These
categories of operations used by the College for analysis are included for your guidance. However, the
operation must be described in writing not using your own interpretation of the description. There are
some defined exceptions to this:
a. When a graft is taken from a distant site (Category 15) and used as part of an orthognathic
(Category 8-10), pre-prosthetic (Category 6) or reconstruction (Category 13-14) operation.
b. When there is an extensive operation for removal of a pathology (Category 4-5) involving a graft
from a distant site (Category 15) as part of a reconstruction.
The details of the operation should be written using standard descriptive terms of what was done. Avoid
eponymous terms for operations.
6.1.2 ROLE
There are two categories of involvement – Surgeon or Assistant.

a. Surgeon
Performing the operation in the absence of the responsible trainer or consultant
Performing the operation in the presence of the trainer or consultant
Performing a substantial part of the operation with the consultant, i.e. “doing one side”
Note: Generally, only one trainee may be the surgeon for an operation. If two trainees each “do
one side” then only one is the surgeon, the other is the Assistant.

b. Assistant
Assisting another surgeon, either Trainer, consultant or trainee
Note: If a more experienced trainee is supervising another on how to perform a whole operation,
then the more experienced is the Assistant. If the more experienced trainee is doing the
procedure but supervising the junior in some part, then the junior is the Assistant.
A person who does not scrub or is not the first assistant should not claim to be an assistant on the case.
If a trainee has difficulties in applying these guidelines, or in the event of dispute between two trainees,
then the Supervisor of Training or Director of Training will arbitrate.
6.1.3 OPERATION CATEGORIES
The following are included for guidance. The operation must be described in full in writing.
1. Dentoalveolar
2. Oral & Facial Infection
3. Facial Trauma
4. Pathology – benign
5. Pathology – malignant
6. Preprosthetic & adjunctive procedures
7. Implantology
8. Orthognathic – single jaw +/- genioplasty or SAME
9. Orthognathic – bimaxillary +/- genioplasty
10. Orthognathic – other
11. Temporomandibular Joint
12. Maxillary Sinus
13. Reconstructive – hard tissue
14. Reconstructive – soft tissue & composite
15. Reconstructive – graft harvest
16. Other procedures
Notes:
Preprosthetic & adjunctive implant procedures
The category includes procedures to facilitate the placement of prosthesis such as tori reduction,
reduction of tuberosity and sulcoplasty/vestibuloplasty. Adjunctive procedures relate to the procedures
performed to facilitate fixture placement with local augmentation, closed sinus lift, socket
augmentation procedures and soft tissue grafts (connective tissue grafts).
Other procedures
This category can include other procedures such as tracheostomy and the figures for each of these
should be recorded and listed separately under ‘other procedures’
Distraction procedures
Mid-facial, maxillary and mandibular distraction procedures should be recorded in 10. Orthognathic
other.
Orthognathic workup
Detailed clinical, cephalometric, photographic, model surgery, computer planning, medical and
psychosocial evaluation. Consultation with colleagues in orthodontics, speech pathology, etc.
A quick look at the models and the lateral ceph. radiograph is not an orthognathic workup.

Pathology, malignant
Detailed clinical, medical and psychosocial evaluation, imaging and pathologic studies. Consultation
with Head and Neck colleagues so that the malignancy is fully staged (TNM) and management planned.
Biopsy and referral is not a malignancy workup.
Temporomandibular joint
Detailed clinical, imaging, medical and psychosocial evaluation and consultations as appropriate.
Implementation of non-surgical management to resolution or surgery.
Oral medicine
Detailed clinical, medical and psychosocial evaluation, and appropriate pathologic investigation.
Consultations as appropriate and implementation of non-surgical management to control of the
condition.

PART B
PROVISION OF TRAINING
B - Section 1 Accredited Education and Training in Oral and Maxillofacial Surgery
1 B - SECTION 1
POLICIES AND PROCEDURES SUPPORTING THE ACCREDITATION

PROCESS OF TRAINING CENTRES AND POSTS
1.1.1 AIMS OF THE ACCREDITATION PROCESS
In accrediting training posts within institutions such as hospitals, oral health centres or private practices,
the College seeks to ensure that the institution and training post meet all the necessary accreditation
standards and criteria to allow both optimal delivery and reception of OMS education and training.
The standards may include assessment of:

• A Culture of Respect;
• Education facilities and systems required;
• Quality of education, training and learning;
• Surgical supervisors and staff;
• Support service and flexibility for trainees;
• Clinical load and theatre sessions;
• Equipment and clinical support services; and
• Clinical governance, quality and safety
1.1.2 WHAT THE COLLEGE ACCREDITS
The College accredits training posts within institutions. Examples of institutions include a hospital, an
oral health centre or a private practice.
A Regional Training Centre is defined as a group of accredited training positions/posts. Each individual
accredited training post has an accreditation status (i.e. conditional or full). Ideally, all accredited training
posts within one Regional Training Centre would be reviewed at the same time.
An accreditation review of a Regional Training Centre must include the review of each individual post
(by site visit or detailed teleconference). A thorough accreditation review of a Regional Training Centre
will take approximately three hours per training post. Each individual accredited training post’s
performance is compared to the standards and criteria for oral and maxillofacial surgery (SCOMS – refer
Appendix 25).
An accreditation report is compiled for the Regional Training Centre and will include a section for each
accredited training post. The report for a Regional Training Centre is a combination of individual
reports/sections on each training post. The accreditation review team will provide recommendations for
each training post based on the post’s performance against SCOMS.
1.1.3 PERFORMANCE AGAINST INDIVIDUAL

STANDARDS
The Accreditation Standards and Criteria of Oral and Maxillofacial Surgery (SCOMS) have been set and
there are two types of criteria:
a. MUST (mandatory) – the Accreditation Committee consider it absolutely necessary that this
criterion be met if the training post is to be accredited
b. SHOULD (desirable) – the Accreditation Committee consider it highly desirable that this criterion
be met and will make a judgment as to whether or not its absence may compromise compliance
with all of the requirements for accreditation.
copyright – RACDS All rights reserved. 53

Mandatory standards are included as a guide to what the College considers to be a priority in order to
provide a safe, supportive and educational environment for trainees. If a training institution is unable to
meet one or more of the mandatory criteria, accreditation will not be withdrawn immediately however
the post will convert to Conditional Accreditation. If the training institution works with the College to
address the identified deficiencies and makes reasonable progress on these areas over time, conditional
accreditation will continue for the time period specified by the accreditation team or the post is reviewed.
Any mandatory criteria which are unmet will be identified and the institution will be given the opportunity
to meet the expected minimum.
The agreed process that will be followed if a criterion is identified as unmet is outlined below:
a. An agreement is negotiated with the institution to address the deficiencies identified.
b. Conditional accreditation status is conferred (with an appropriate timeframe to meet the criteria, as
negotiated, usually six (6) or 12 months).
c. Full accreditation is conferred when the criteria are met.
Any desirable criteria which are unmet will be identified and the institution is expected to make
reasonable progress on such recommendations within the accreditation period.
1.1.4 LEVEL(S) OF ACCREDITATION
There are two levels of accreditation available to a post:

a. Full Accreditation
Full accreditation will be granted to a post when all mandatory requirements have been met and
the accreditation team is satisfied that the core requirements for accreditation have been
achieved. Posts that receive full accreditation will be subject to periodic review every five (5)
years.
b. Conditional Accreditation
Conditional accreditation will be granted to a post when the mandatory criteria have not all been
met but the accreditation team is satisfied that there is the potential for significant progress to be
made in that area within the next 12 months. The training institution would be required to report
progress within 12 months of the visit.
It is the responsibility of the Director of Training to notify the College of any significant change to a post
within the Regional Training Centre. This may be done via a supplementary Annual Survey. The College
will then determine if the post requires reassessment. The College will then write to the hospital and
confirm the information provided. The responsibility of the College is primarily towards the trainee and
their continuation of training.
If the post fails to qualify for any of the above levels, accreditation will be withdrawn.
1.1.5 ACCREDITATION CYCLE
Posts that receive full accreditation will be reviewed through the usual five (5) year accreditation cycle.
Posts that receive conditional accreditation will be reviewed at the appropriate 12-month stage.
The College reserves the right to request an accreditation review of a Regional Training Centre within
the five (5) year accreditation period.

1.1.6 ACHIEVING ACCREDITATION OF A NEW

TRAINING POST
Application for accreditation of all new and potential training posts must occur before an accredited
trainee can occupy the post. The process for application is as follows:
a. The Director of Training, in conjunction with the Regional Surgical Committee, writes to the
Accreditation Committee with notification that a new training post is being offered.
b. The proposed Supervisor of Training completes the Application for Accreditation of an additional
or new OMS Training Post.
c. The Accreditation Committee reviews the documentation and requests any additional information
that may be required.
d. The application is considered by the Accreditation Committee. The Supervisor of Training and the
hospital are notified that Committee meetings are usually held three (3) to four (4) times a year.
Completed applications should be received at least four (4) weeks prior to a meeting. The
Accreditation Committee considers the application and nominates a review team at the meeting.
The review team is responsible for the preparation of a teleconference review of the post. If the
post is in a hospital which does not have an accredited training post, a site visit may be warranted.
If the application is for an additional post at an institution which already has an RACDS accredited
post, a subcommittee/review team needs to review the details for all posts accredited at the hospital
to ensure the new training post does not dilute the training experience of others.
e. The Accreditation Committee makes a final decision about the accreditation status of the post
based on recommendations from the review team. The Board of Studies and College Board are
informed.
Once full accreditation status has been achieved by a post, it will enter onto that training centre’s review cycle.
1.1.7 ACCREDITATION REVIEW OF A REGIONAL

TRAINING CENTRE
This section describes the process involved in the accreditation of a Regional Training Centre. The
Accreditation Committee aims to conduct a thorough and efficient review of each post during the
accreditation review. The process is defined below:
a. The Regional Surgical Committee is notified by the College at least six (6) months prior to an
accreditation review. The Chair of the Accreditation Committee through the Education Officer will
write to the Director of Training and Chair of the Regional Surgical Committee proposing three
dates for the visit to occur. The Training Centre will be advised of the approximate length of the
visit, and it will be requested that the finalised date is communicated to the College no less than
three (3) months prior to the visit.
b. The Accreditation Committee nominates an accreditation review team.
c. The College forwards to the Supervisor of Training of the institution a pre-visit accreditation survey
and draft itinerary which is to be completed and returned within four (4) to six (6) weeks.
d. The accreditation review team reviews the returned surveys and identifies any outstanding
information that may be required prior to the visit. In conjunction with the College the review team
will finalise a site visit program with the Director of Training and Chair, Regional Surgical Committee

e. A letter is sent to each institution’s Supervisor of Training & Head of Unit or Section detailing when
their post will be reviewed and with whom the accreditation team would like an interview, including
medical / surgical administration.
f. A visit timetable is prepared by the OMS Education Officer in consultation with the Director of
Training, the Chair of the Regional Surgical Committee and the Supervisor of Training for each
post. At the time of the visit it is the responsibility of the Supervisor of Training to ensure that
incumbent trainees are available for interviewing and that up to date learning portfolios and logbook
summaries are available. The Supervisor of Training is responsible for contacting and confirming
the appointments for all of the relevant stakeholders for their hospital visit. The final agreed
timetable is then confirmed with the Director of Training, Chair of the Regional Surgical Committee
and Supervisor of Training.
g. The Accreditation Review team conducts a pre-visit teleconference to identify any areas of concern
based on the pre-visit survey. All timetables and travel will be confirmed at the same meeting. The
Chair of the Accreditation Committee will participate in this teleconference.
1.1.8 THE SITE VISIT
The Accreditation Review team retains the right to visit any and all sites involved in OMS training. The
purpose of site visits is to allow both the training institutions and the review team to confirm the
information provided in the pre-visit survey (Appendix 26) and to allow the hospital to provide any
outstanding information or address any queries based on the available documents.
Site visits will usually consist of multiple interviews with significant stakeholders involved in the provision
of training. The Supervisor of Training for each hospital will arrange the meeting room, A-V requirements
and any catering that is required during the course of the Accreditors visit to the hospital.
The cost of accreditation site visit for the review team will be paid by the College.
Each post will take approximately three hours to review thoroughly. There will be an adequate time
allowed for travel between each hospital if possible, for the review team to consolidate findings following
each hospital site visit.
1.1.9 ALLOCATION
a. Where there are suitable candidates who meet the minimum criteria for selection the College
will appoint trainees to fill available posts.
b. Trainees are recommended to employers for appointment to accredited posts.
c. Employers retain the right to not employ recommended trainees.
d. A post may remain vacant if:

• There are no suitable applicants who meet the minimum criteria for appointment to the
training program; or
• The post is suitable only for senior trainees and there is no active trainee able to be
allocated to the post; or
• The appointment of a trainee to a post would otherwise result in more trainees than posts
in a subsequent year; or
• The accreditation of a post is being reviewed and the allocation of a trainee may
compromise the quality of training afforded to that trainee.
• A post becomes vacant at a time (eg due to refusal of employment, illness or withdrawal)
when it is logistically difficult to accommodate an appointment.

1.1.10 ACCREDITATION REVIEW TEAM / REVIEW

COMMITTEES
The accreditation review team will be appointed by the Accreditation Committee.
The accreditation review team should consist of:

a. A Senior Surgeon– This individual should have experience in supervision and training in a hospital
similar to that seeking accreditation and be from a state or country other than the one being
accredited. He or she will usually be a member of the Accreditation Committee and be experienced
in conducting accreditation reviews
b. Another Fellow – This individual should have experience in supervision and training, and preferably
be a Supervisor of Training.
c. A senior staff member from the RACDS – Education and Training, such as the Education Officer
All members of the accreditation team are to be fully trained to ensure the consistency of process
including interview questions.
Position descriptions for Accreditors will also be developed including information regarding conflict of
interest and confidentiality.
1.1.11 PROVISION OF REPORTS AND OPPORTUNITY

FOR REVIEW
The provision and review of reports will follow the following process:
a. The accreditation review team prepares a draft Preliminary Report for the Accreditation Committee.
This report should be available within six (6) weeks. Provision of three (3) hours should be allowed
for at the end of the accreditation visit for the review team to begin the draft report. The Preliminary
Report should include (in appendix form) copies of the pre-visit surveys, trainee logbooks, trainee
timetables and educational logs for each post.
b. A copy of the draft Preliminary Report is distributed to members of the Accreditation Committee
and discussed at the next Accreditation Committee meeting.
c. The OMS Education Officer on the direction of the Chair of the Accreditation Committee distributes
copies of the Preliminary Report to the Director of Training, Chair of the Regional Surgical
Committee and the Director of Surgery/Director of Medical Services or equivalent of the relevant
institution for factual accuracy and comment. All comments must be received in writing within three
(3) weeks to be considered.
d. The Accreditation Committee considers comments and the report is amended and approved as the
Final Report.
e. The amended and approved Final Report is sent for ratification by the Board of Studies, OMS and
noted by Council
f. The commencement date of the accreditation period will be the date that the Final Report is ratified
by the Board of Studies, OMS.
g. A copy of the ratified Final Report will be distributed to all relevant parties.

1.1.12 WITHDRAWAL OF ACCREDITATION
The College reserves the right to request an accreditation review of a training post within the five (5)
year accreditation period. Such a review may be initiated after advice from the institution or Regional
Surgical Committee that a significant change to the quality of training has occurred. A complaint from a
Fellow or Trainee, for example, may also precipitate the need for a review of a training post/s.
Accreditation status of a training post may be altered if the training post no longer meets the accreditation
standards and criteria. The College will work with a training institution to make the required
improvements in a realistic timeframe. The College would also be available to support training
institutions in negotiations with jurisdictions. Full Accreditation status would be withdrawn only if the
training post failed to meet mandatory accreditation criteria and negotiations with the institution involved
consistently fail to produce a workable outcome.
In view of the seriousness of withdrawing accreditation of a training post, the final decision on taking
such action will be made by the CEO, the Chair of the Board of Studies and the Chair of the Accreditation
Committee in close consultation with the relevant review team and the relevant Regional Surgical
Committee.
1.1.13 NOTIFICATION OF CHANGED CIRCUMSTANCES

AND IMPLICATIONS
If possible, an institution with an accredited training post should notify the College when there will be, or
if there has been, any significant change to the way in which education and/or training is delivered or
monitored. This is particularly the case if the change affects the institution meeting accreditation
standards and criteria as published in Standards and Criteria for Oral and Maxillofacial Surgery
(SCOMS).
The institution may do this by completing an interim survey.
1.1.14 APPEALS PROCESS
With the exception of appeals concerning trainees who have been adversely affected (see below), only
appeals that are based on errors in process will be considered. Complaints must be lodged with the
CEO of the College in line with the College Complaints Policy. The complaints will be reviewed by a
constituted College Appeals Committee. Such application shall be in writing and accompanied by all
relevant information or grounds upon which the person seeks to rely in respect of the review.
If a trainee has been adversely affected by a decision which has not been resolved through
Reconsideration or Review, within 30 days of notification of the outcome of a request for Review, then
he or she may lodge an appeal with the CEO in line with the RACDS Reconsideration, Review and
Appeals Policy. Such application shall be in writing and accompanied by all relevant information or
grounds upon which the person seeks to rely in respect of the review.
1.1.15 ACCREDITATION PROCESS AND STANDARDS

REVIEW
The Accreditation Policies and Process will be reviewed every five (5) years or as required.

2 B - SECTION 2
ACCREDITED TRAINING CENTRES
2.1.1 INSTITUTIONAL RESPONSIBILITIES
Training centres and training posts are accredited to ensure provision of training of the highest standard.
Accreditation requirements include ensuring an administrative process which is dedicated to education
and provides for involvement of the teaching faculty and the Regional Surgical Committee in program
planning, review and evaluation on a regular basis.
2.1.2 TRAINING
While acknowledging that training is provided through service, the College requires that there must be
an appropriate balance between training and service commitments in training posts. Research is an
essential part of the education process.
The recognition of the OMS training program, training centre and training posts within the administrative
structure of the hospitals involved in training should be consistent with that of training programs of other
surgical specialties.
The Director of Training of the training centre should have the appropriate authority, responsibility and
privileges within the overall medical and surgical administrative structures of the institutions involved
with training.
2.1.3 DIRECTORS OF TRAINING
Each accredited training centre must have a Director of Training. The Director of Training must be an
Oral and Maxillofacial Surgeon, holding the FRACDS(OMS) or equivalent qualification acceptable to the
BoS, a Consultant involved in training in an accredited hospital and be a member of the Regional
Surgical Committee. The Regional Surgical Committee recommends a Director of Training to the Board
of Studies for appointment.
The Director of Training must have sufficient authority and time to fulfil administrative and teaching
responsibilities in order to achieve the educational goals of the training program. In addition, it is the
Director of Training’s responsibility to ensure that trainees completing the program, through the regional
training centre they are responsible for, have achieved the standards of performance necessary for them
to proceed to the Final Examination.
The Director of Training has the following responsibilities in conjunction with the Regional Surgical
Committee:
a. Appointment of College selected trainees for training posts in accordance with the policies
determined by the appointing bodies and by the College
b. Implementation of the curriculum
c. Regular review of the training program within the training centre in order to evaluate the quality of
the educational experience obtained by the trainees and to ensure that the resources available for
training are being used effectively
d. Program administration and surgical audit
e. Planning and operation of facilities used in the educational program
f. Evaluation of trainees’ supervision

g. Evaluation of trainees’ performance and activities.
h. In addition, the Director of Training has the following responsibilities:
i. To be familiar with the College’s guidelines and regulations on eligibility assessment, registration
of trainees, training and examinations
j. To notify the Education Officer of any changes created by trainees joining or leaving the rotational
training scheme during the hospital employment year. It is particularly important that the date of
such changes is noted to allow verification of training
k. To notify the Education Officer of any senior staffing or workload changes likely to impact on the
training programs of trainees and to provide required information as requested
l. To advise the Accreditation Committee if there are any significant changes in any hospital within
the training centre such that it may no longer be suitable for training
m. To advise potential and current registered trainees on their training, registration requirements, fee
payments and examination preparation
n. To monitor supervision, experience and fair allocation of duties for trainees and to facilitate such
changes as may be necessary
o. Trainee Assessment: -
i. In the event that a Supervisor of Training raises concerns about a trainee’s performance
and progress, it is essential that the trainee is advised of this, and if required, a formal
warning is given to the trainee by the Director of Training. The Trainees Requiring
Assistance Policy provides guidelines for the DoT and RSC on this. The trainee must be
advised that improvement in performance and progress will be expected in specified
areas or an unsatisfactory Six-Monthly Report may result. This warning must be indicated
on the Trainee Report form (refer to Appendix 22) and signed and dated by the Director of
Training and the trainee.
The warning should be accompanied by a written remedial plan prepared by the
Supervisor of Training and the trainee, which clearly identifies the areas of concern and
what the trainee needs to do to improve. This plan should be noted on the form or
attached to it.
ii. Review and signing of Six-Monthly Formative Assessment Reports. The Director of
Training should deem each assessment report as Satisfactory, Borderline or
Unsatisfactory. All assessment reports deemed as Borderline or Unsatisfactory should be
reported to the Regional Surgical Committee at the next meeting.
iii. To review and sign off each trainee’s learning portfolio.
p. To liaise with the relevant persons, particularly the Supervisors of Training, within the hospitals
comprising the training centre, to ensure that the training program is being implemented and
supported appropriately.
The Director of Training may also assume the Supervisor of Training role at the hospital within which he
or she is located.
2.1.4 CHAIR OF THE REGIONAL SURGICAL

COMMITTEE
Each accredited training centre must have an elected Chair of the Regional Surgical Committee (RSC).
The Chair of the RSC must be an Oral and Maxillofacial Surgeon, holding the FRACDS(OMS) or
equivalent qualification acceptable to the BoS, a Consultant involved in training in an accredited hospital

and member of the Regional Surgical Committee. The DoT may also hold the position of Chair of the
RSC.
The Chair of the RSC has the following responsibilities in conjunction with the Regional Surgical
Committee:
a. To be familiar with the Handbook for Education and Training in Oral & Maxillofacial Surgery, and
the College guidelines and regulations
b. Provide support to the Director of Training in their role and responsibilities, which are outlined in
Part B - Section 2 of the Handbook
c. Assist in the preparation and conduct of an Accreditation visit to the Training Centre
d. To conduct regular meetings of the Regional Surgical Committee and ensure minutes are
recorded
2.1.5 SUPERVISORS OF TRAINING
The Supervisors of Training in Oral and Maxillofacial Surgery shall be nominated by the Regional
Surgical Committee and hold the FRACDS(OMS) or an equivalent qualification acceptable to the Board
of Studies. In hospitals with larger numbers of trainees, the Board of Studies may approve more than
one Supervisor of Training. Where possible there should be one Supervisor of Training for up to four
trainees and two Supervisors of Training for up to seven trainees.
Responsibilities include:
a. To provide support to trainees and ensure hands-on supervision and training. This supervision
must include:
i. Regular, constructive formal and informal feedback

ii. Ensuring trainees are taken through each new procedure with a consultant or senior
registrar and are given opportunities to practise their skills under supervision
iii. Ensuring, or making every reasonable effort to ensure, that trainees have appropriate
support from on-call consultants after hours
iv. Encouraging trainees to improve their communication and decision making skills
v. Listening to trainees’ concerns about training and respecting their right to be assertive and
questioning
b. Co-ordination of training within the hospital to ensure that each trainee obtains experience and
responsibility appropriate to their level of training and accesses the opportunities available within
the hospital.
c. Continuing assessment of trainees as per the College’s Six-Monthly Formative Assessment

process, including the provision of constructive feedback and encouragement.
i. It is advised that Supervisors of Training have a confidential face-to-face discussion with the
trainee about his/her performance and progress every three (3) months. The Director of
Training should be notified if there are concerns about a trainee’s performance and progress
so that a formal warning may be given prior to the six (6) monthly assessment. In this
instance, the Supervisor of Training may need to liaise with the Director of Training and
trainee to develop a remedial program.
ii. The Six-Monthly Formative Assessment report should be compiled from the supervisor’s
own observations and feedback from consultants who have worked with the trainee during
the six (6) month training period.
The Six-Monthly Formative Assessment must include a confidential face-to-face discussion

between the Supervisor of Training and the trainee about his/her performance and
progress.
If the Six-Monthly Formative Assessment report is satisfactory – both supervisor of training

and trainee sign and date the form, and the trainee meets with the Director of Training for
review and signing.
If the Six-Monthly Formative Assessment report is other than satisfactory – the Supervisor
of Training should contact the Director of Training to discuss possible remedial strategies.
The Director of Training will decide whether the report should be Satisfactory, Borderline or
Unsatisfactory – in consultation with the Supervisor of Training.
d. To review and sign each trainee’s Logbook every three (3) months to ensure accuracy.
e. To liaise closely with the Director of Training and/or Regional Surgical Committee Chair (including
attending Regional Surgical Committee meetings when required) in order to discuss training
issues and problems, particularly where the hospital is having difficulty providing trainees with the
clinical experience and support outlined in College regulations.
f. Participate in any training workshops or other requirements organised by the College.
2.1.6 VISITING MEDICAL OFFICERS
Instruction and supervision within the OMS specialty must be conducted by fully qualified and registered
specialists (OMS or related specialties).
The number and time commitment of teaching staff should be sufficient to ensure:
a. The supervision of trainees at all times
b. Provision of all teaching activities, including conferences and seminar.
c. Review, with trainees, of patient evaluation, treatment planning, management, complications and
outcomes of all their cases
d. Trainees are not undertaking activities beyond their competence
e. Trainees assume gradual and increasing responsibility as their training proceeds
f. Trainees are granted surgical privileges commensurate with their level of training and clinical skills.
When a trainee is granted privilege to operate alone:

a. The authorising surgeon retains overall responsibility for the management of the patient
b. Specific permission is given by the authorising surgeon
c. The authorising surgeon shall remain readily available for attendance if necessary
d. When consultation is necessary with another surgeon the matter is referred back to the authorising
surgeon.

3 B - SECTION 3
REGIONAL SURGICAL COMMITTEES (RSC)
For each Training Centre there is a Regional Surgical Committee. Membership of the RSC shall consist
of the Director of Training, Chair of the RSC, Heads of Unit and representatives from the Training
Hospitals, Supervisors of Training, persons providing academic & surgical input in the accredited posts
as well as a trainee representative, as outlined in 3.1.1. The RSC reports to the Board of Studies – Oral
& Maxillofacial Surgery.
The RSC is convened locally and chaired by a member of the Committee. When possible the DoT and
Chair roles should be undertaken by different Consultants. The Committee will meet at least (4) times
per year. The minutes of the meetings are to be ratified at the following meeting. The minutes must be
submitted to the College and the minutes or reports from the RSC are provided for the Board of Studies
meetings.
The functions of the RSC are outlined in the Terms of Reference.
3.1.1 MEMBERSHIP OF THE RSC
1 The membership of the Training Centre RSC shall consist of:
1.1 One elected Director of Training (DoT) Member (1) – this member will be elected by the
RSC. They do not have to be a Supervisor of Training or a Head of Department at the
time of election or during their tenure.
1.2 One elected Chair of the Regional Surgical Committee (1) – this member will be elected
by the RSC. They do not have to be a Supervisor of Training or a Head of Department
at the time of election or during their tenure.
1.3 Head of Department (Section or Unit) Members– one member from each of the training
campuses.
1.4 Regional Supervisors of Training– one or more members from each of the training
campuses. These members will be the Supervisors of Training and/or other nominated
Trainers at the training campuses.
1.5 In the event that there becomes another campus that provides training, distinct from the
current campuses, that campus will be entitled to a Supervisor of training member, and
a Head of Department member, in addition to those members listed above.
1.6 In the event one of the appointed members is elected to be the Head of Training, the
resident Campus may nominate a replacement delegate to fulfil the term of the
incumbent.
1.7 One Trainee Representative, nominated and appointed by the RSC.
2 Tenure
2.1 All members shall be appointed for five (5) years. A member is eligible for re-
appointment, up to maximum of four (4) continuous terms.
2.2 The Director of Training shall be elected for a period of three (3) years. The Director of
Training is eligible for re-election, up to a maximum of three (3) continuous terms.
2.3 The Chair of the Regional Surgical Committee shall be elected for a period of three (3)
years. The Chair is eligible for re-election, up to a maximum of three (3) continuous
terms.

2.4 If a member no longer participates in training at their appointed campus, an alternative

member may be nominated by that campus, to complete the remainder of the previous
member’s term.
2.5 If a Member of the RSC no longer participates in or is found to be unsuitable to be

involved in training of Trainees, the Regional Surgical Committee (RSC) can initiate the
replacement or removal of the Member of the RSC. This process will be initiated by the
Chair of the RSC through an internal vote and depending on the outcome of the vote
the affected Member will be suspended and notified.
Following the notification of suspension from the RSC, the Member of the RSC will no
longer attend meetings of the RSC and will have the opportunity to make a submission
to the RSC in this regard within 14 days. The RSC may choose to appoint an interim
Member of the RSC for the duration of the suspension.
Following this, the Chair of the RSC will formally notify the Board of Studies. The Board
of Studies will make the final decision on the outcome and notify the RSC and the
Member of the RSC.
2.6 If a Regional Director of Training (DoT) no longer participates in or is found to be

unsuitable to hold the position, the Regional Surgical Committee (RSC) can initiate the
replacement of the DoT with another member of the RSC.
This will be initiated by the Chair of the RSC through an internal vote, and the affected
DoT will be notified of the outcome of the vote within 14 days. Following the notification
of intention of replacement, the DoT will have the opportunity to make a submission to
the RSC in this regard within 14 days.
Following this, the Chair of the RSC will formally notify the Board of Studies. The Board
of Studies will make the final decision on the outcome and notify the RSC and the DoT.
2.7 If a Chair of the Regional Surgical Committee no longer participates in or is found to be

unsuitable to hold the position, the Regional Surgical Committee (RSC) can initiate the
replacement of the Chair with another member of the RSC.
This will be initiated through an internal vote of the RSC membership, and the affected
Chair will be notified of the outcome of the vote within 14 days. Following the
notification of intention of replacement, the Chair will have the opportunity to make a
submission to the RSC in this regard within 14 days.
Following this, the RSC DoT will formally notify the Board of Studies. The Board of
Studies will make the final decision on the outcome and notify the RSC and the Chair.
3 Eligibility
3.1 To be eligible to be a member of the RSC, the member must be a registered Oral and
Maxillofacial Surgeon.
4 Voting
4.1 Each Training Campus is eligible to cast one (1) vote.
4.2 The Director of Training may vote on all matters with one (1) vote; except for the
election of the DoT.
4.3 The Chair (if not also the DoT) may vote on all matters with one (1) vote; except for the
election of the Chair
In the event a member from the Training Campus cannot attend a vote, another member may cast a
vote on their behalf, if in possession of a signed proxy.

5 Election
An election shall be held every three (3) years (or earlier if the Director of Training or Chair of
the RSC resigns).
5.1 Three (3) months prior to the election a call for nominations should be distributed. Any
person involved in training and eligible to be on the RSC may nominate, with a
seconder who is also eligible to be a member of the RSC. Nominations should be
addressed to the Chair of the RSC.
5.2 Two (2) weeks prior to the election meeting the Chairperson will distribute the
nominee’s details to the RSC
5.3 At the election meeting, the Chairperson shall conduct an anonymous written ballot
following the guidelines for voting.
5.4 The Chairperson shall inform the nominees of the outcome the same day.
5.5 In the event the DoT or Chair of the RSC becoming ineligible to be a member of the
RSC, a new Election will be held

PART C
CURRICULUM FRAMEWORK AND MODULES
C - Section 1 Accredited Education and Training in Oral and Maxillofacial Surgery
1 C - SECTION 1
THE CURRICULUM – AN OVERVIEW
1.1.1 INTRODUCTION
The Royal Australasian College of Dental Surgeons (the College) through its Board of Studies in Oral
and Maxillofacial Surgery (the Board) is committed to providing a postgraduate specialist training
program in Oral and Maxillofacial Surgery (OMS) which is of an international standard and produces
specialist practitioners with a high level of knowledge and advanced clinical skills and attitudes in the
specialty in order to provide the best quality and service to the communities of Australia and New
Zealand.
The Board and the College have adopted the international definition for the scope of practice in Oral
and Maxillofacial Surgery.
Oral and Maxillofacial Surgery is defined as:

‘that part of surgery which deals with the diagnosis, surgical and adjunctive
treatment of diseases, injuries and defects of the human jaws and associated
structures.’
(International Association of Oral and Maxillofacial Surgeons, 2001)
The structured training program includes basic and advanced surgical training. It is predicated on
trainees undertaking surgery with increasing levels of independence and incremental complexity. The
Surgical Science and Training Examination in Oral and Maxillofacial Surgery (SST), is conducted within
the first year of OMS training. A pass in the SST examination is required before entering the second
year of training. The overall training in Oral and Maxillofacial Surgery is completed under the supervision
of trained Oral and Maxillofacial Surgeons and other surgical consultants where rotations in other
disciplines are required, such as the year in Surgery in General. The College program establishes a
common standard across Australia and New Zealand through regional training centres which operate in
a consistent manner based on bi-nationally agreed requirements and protocols, which are centrally
regulated and accredited through the Board. All trainees must complete clinical training assessments
and a common final examination which is centrally conducted and leads to the award of Fellowship in
Oral and Maxillofacial Surgery, FRACDS(OMS).
The overall structure of the curriculum is demonstrated in the following flow chart:

Broad Competencies of Oral and Maxillofacial Surgeons
OMS Curriculum Examination

Four years of clinical SST Examination by the
Training. end of first year (OMS 1)
Curriculum Module
Clinical Education (x16) Clinical Training
Planned learning experiences in Exposure to re-occurring events within
regional training centre the hospital environment and
supervised experience
• Acquisition of • Application of
knowledge knowledge
• Development of • Technical skills
technical skills • Case management
• Theoretical skills
understanding of • Risk minimisation /
managing patients contingency
Delivery through • Research management skills Delivery through
demonstrations, • CPD • Professional role as registrar
tutorials, etc. behaviour / skills and learning from
Self-directed immediate
learning through supervisor
literature reviews,
web cases, etc.
Trainee does not Trainee does not

meet expectations for Evidence of completion of Evidence of performance based on meet expectations
level of training learning portfolio checklists, clinical training assessments and for level of training
literature reviews, etc. satisfactory logbook summary
FINAL EXAMINATION

As can be seen in this chart, the teaching of the curriculum can be divided into two distinct areas, clinical
education and clinical training.
Clinical education is delivered in planned learning experiences. Evidence of participation in these

learning experiences is to be included in the learning portfolios. These learning experiences are taught
within the regional centres and are delivered by means of demonstrations, tutorials, lectures, seminars,
literature review, web-cases and are directed towards self-learning.
Research is also an integral part of the training program.
Evidence of completion will be determined by portfolio reviews and checks, literature reviews and the
trainees’ log of web-based cases.
Clinical training is delivered by supervised training in teaching hospitals associated with the regional
centres and relevant university departments. Training posts are accredited by the College for this
purpose. The application of knowledge and technical skills are passed on by teachers and mentors who
are skilled in their specialty and are able to deliver this training in a timely and expert way.
Case management and risk management skills are learned in this setting along with professional skills
which are passed on through registrar teaching and supervised training.
Evidence of training is assessed by portfolio and logbook review and by the various clinical assessment
tools used by the College.
1.1.2 PHILOSOPHY OF THE TRAINING PROGRAM
The broad philosophy of the Board and the College in its approach to OMS education and training is
based on the following interlinking beliefs and values:
1.1.2.1. Curriculum through which the elements of teaching and learning are translated into practices
which:
a. encompass everything that a trainee experiences
b. provides a rich learning resource, and
c. are open to interpretation and understanding.
1.1.2.2 A system of adult learning and a commitment to lifelong learning in which it is acknowledged
that trainees
a. take responsibility for their own decisions
b. need to know why they should learn
c. learn experientially, and
d. learn at the time which is most appropriate for them, their context and the kind of
learning required.
1.1.2.3 A structured model for training during which a trainee learns skills from a consultant in order
to undertake surgery with increasing independence and incremental complexity which in turn
provides the best environment for –
a. modelling of the art, craft and science of surgery
b. integration of theoretical and practical knowledge, and
c. development of necessary skills, attitudes and ethical approaches.
1.1.2.4 A view of learning and knowledge which –

a. encourages cognitive flexibility, critical reflection and independent research
b. acknowledges that individuals’ approach and experience learning activities in different
ways
c. enhances self-direction, discovery and problem-solving, and
d. requires that trainees develop their own understanding, so they can respond flexibly in
situations of complexity and uncertainty.

1.1.3 GOALS OF THE TRAINING PROGRAM
The broad goals of the training program in OMS are to ensure that all candidates who are awarded the
FRACDS (OMS) qualification:
a. are highly competent practitioners in OMS

b. have the requisite knowledge, skills and professional attitudes for successful independent practice
and
c. have the necessary attitudes and attributes to strive for continual review and improvement of their
practice.
These attributes are essential to providing the highest possible quality of service to meet the relevant
health care needs of the communities in Australia and New Zealand.
1.1.4 BROAD COMPETENCIES OF THE TRAINING

PROGRAM
In order to fulfil these goals, the Board and the College have identified a number of broad competencies
for OMS, which are based on the CanMEDS 1 competencies. To encompass the full spectrum of the
profession two further competencies have been added; they are Technical Expert and Clinical Decision
Maker.
1.1.4.1 Medical and Dental Expert

a. Practice medicine within their defined scope of practice and expertise
b. Perform a patient-centred clinical assessment and establish a management plan
c. Plan and perform procedures and therapies for the purpose of assessment and/or
management
d. Establish plans for ongoing care and, when appropriate, timely consultation
e. Actively contribute, as an individual and as a member of a team providing care, to the
continuous improvement of health care quality and patient safety
1.1.4.2 Communicator
a. Establish professional therapeutic relationships with patients and their families
b. Elicit and synthesize accurate and relevant information, incorporating the perspectives of
patients and their families
c. Share health care information and plans for patients and their families
d. Engage patients and their families in developing plans that reflect the patient’s health care
needs and goals
e. Document and share written and electronic information about the medical encounter to
optimise clinical decision-making, patient safety, confidentiality, and privacy
1.1.4.3 Collaborator
a. Work effectively with physicians and other colleagues in the health care professions
b. Work with physicians and other colleagues in the health care professions to promote
understanding, manage differences, and resolve conflicts
c. Hand over the care of a patient to another health care professional to facilitate continuity of
safe patient care
1.1.4.4 Leader
a. Contribute to the improvement of health care delivery in teams, organizations, and systems
1Frank JR, Snell L, Sherbino J editors. CanMEDS 2015 Physician Competency Framework. Ottawa:
Royal College of Physicians and Surgeons of Canada; 2015
http://rcpsc.medical.org/canmeds/bestpractices/framework_e.pdf

b. Engage in the stewardship of health care resources

c. Demonstrate leadership in professional practice
d. Manage career planning, finances and health human resources in a practice
1.1.4.5 Health Advocate

a. Respond to an individual patient’s health needs by advocating with the patient within and
beyond the clinical environment
b. Respond to the needs of the communities or populations they serve by advocating with them
for system-level change in a socially accountable manner
1.1.4.6 Scholar
a. Engage in the continuous enhancement of their professional activities through ongoing
learning
b. Teach students, residents, the public and other health care professionals
c. Integrate best available evidence into practice
d. Contribute to the creation and dissemination of knowledge and practices applicable to health
1.1.4.7 Professional
a. Demonstrate a commitment to patients by applying best practices and adhering to high ethical
standards
b. Demonstrate a commitment to society by recognizing and responding to societal expectations
in health care
c. Demonstrate a commitment to the profession by adhering to standards and participating in
physician-led regulation
d. Demonstrate a commitment to physician health and well-being to foster optimal patient care
1.1.4.8 Clinical Decision Making

a. Provide compassionate patient-centred care
b. Perform a complete and appropriate assessment of a patient
c. Organise diagnostic testing, imaging and consultation as appropriate
1.1.4.9 Technical Expert

a. Safely and effectively perform appropriate surgical procedures
b. Consistently demonstrate sound surgical skills
c. Demonstrate procedural knowledge and technical skill at a level appropriate to their level of
experience
d. Demonstrate manual dexterity required to carry out procedures
e. Adapt their skills in the context of each patient-each procedure
f. Maintain skills and learn new skills
g. Approach and carry out procedures with due attention to safety of patient, self, and others
h. Analyse their own clinical performance for continuous improvement
In order to acquire these broad competencies, trainees are provided with the opportunity to understand
both the scientific basis of OMS, through the teaching of the modular curriculum, and the opportunity to
apply this understanding in the clinical environment.
The learning outcomes are delivered through a number of learning methods including structured
educational programs, skills courses, self-directed learning and workplace hands on teaching by
specialist surgeons. This occurs in the various centres which have been accredited for this purpose.
1.1.5 CURRICULUM
1.1.5.1 The curriculum in OMS is designed to bring all of the competencies and elements of training
together in order to produce a well-trained consultant Oral and Maxillofacial Surgeon capable
of independent practice.
1.1.5.2 The central part of the curriculum are the modules which are both self-contained and, when
combined, define the domains of learning which are required of a qualified Oral and

Maxillofacial Surgeon with the FRACDS (OMS). They have been designed in this way to
complement the asynchronous nature of a trainee's experience.
1.1.5.3 The learning of these components is embedded in the trainees' experiences during their
hospital rotations, planned learning sessions (in the form of lectures and/or tutorials, group
discussion, structured experiences, etc.) and self-directed learning (in the form of reading,
literature reviews, case studies, etc.).
1.1.5.4 There will be a balance of inpatient and outpatient, adult and paediatric cases during
clinical training.
1.1.5.5 To be eligible for the award of the Fellowship, trainees are required to have completed an
approved research study. The completion of a higher degree would fulfil the research
requirements.
The College will accept as fulfilment of this requirement either a formal research project
undertaken as part of a postgraduate research qualification or through the completion of a
research project and a paper that is deemed acceptable for publication in a peer reviewed
journal.
In addition, trainees who fulfil the research requirement independently of a postgraduate

degree (Pathway 2) must enrol in a research methodology course (such as a University
post-graduate course or research skills course) or undertake the RACS Critical Literature
Evaluation and Research (CLEAR) course.
Trainees who choose to fulfil this requirement by enrolling in a PhD will be required to take
leave of absence from the training course.
Clinical case reports and stand-alone literature reviews will not be approved for this
purpose.
Trainees are also required to:
a. present a paper each year at a scientific meeting, the annual conference of the
specialty, a hospital grand round, or equivalent; and
b. present a paper at the annual conference of the specialty at least once during their
advanced surgical training.
Should trainees wish to fulfil their research requirement independently of a structured

qualification, approval needs to be sought via the Research Sub-committee of the Education
Committee by applying for approval with an outline of their research proposal and their
proposed supervisors.
1.1.5.6 Clinical training always includes a balance between education and service and as such
trainees will progress through each module at varying rates. Due to this the completion of
each module will occur at different times in the training sequence for each trainee, however,
all trainees will complete the required competencies for each module by the end of their
training.
1.1.5.7 Attainment of competencies will be assessed by formal clinical training assessment through
regional training centres and by the final examination at a bi-national level.
1.1.5.8 Trainees will complete all modules in the desired time frame. It will be necessary for each
trainee to keep a learning portfolio which will be assessed on a regular basis.

1.1.5.9 The learning portfolio will encourage trainees to monitor their own progress in their
development of the competencies as defined in the curriculum. Checks for the various clinical
training assessments will be conducted and all assessments must be contained within the
portfolio. The portfolio will be reviewed regularly and will be used to assist directors of training
with any remedial teaching a trainee may require.
1.1.6 THE MODULES
The Surgical Science and Training Examination in Oral and Maxillofacial Surgery (SST) is to be
completed by the end of the first year of training and is included as part of the requirements for all of the
modules in the Curriculum.
The scope of specialist practice in OMS has been distilled into modules which are competency based.
The curriculum allows stair-cased progression through each of the 16 modules as knowledge and
surgical skills are acquired by the trainee. Modules are not recommended in any particular order and
this is in keeping with the curriculum frameworks of OMS programs internationally. This is also in line
with other Australian specialist medical colleges which rely on trainees completing clinical training within
the hospital environment for the attainment of these competencies.
The 16 modules which must be completed in order to meet the requirements of the FRACDS (OMS) are
below. They are presented in full in Part C - Section 3.
• Anatomy and Embryology of the Head and Neck

• Radiology and Nuclear Medicine
• Dentoalveolar Surgery
• Pre-prosthetic Surgery and Implantology
• Paediatric Oral & Maxillofacial Surgery
• Oral & Maxillofacial Pathology
• Oral Mucosal Diseases
• Maxillary Sinus Disease
• Oral & Maxillofacial Oncology
• Reconstructive Oral & Maxillofacial Surgery
• Oral & Maxillofacial Trauma
• Orthognathic Surgery
• Facial Pain
• Temporomandibular Joint Disorders
• Oral and Maxillofacial Prosthetics and Technology
• Adjunctive Technologies in Oral and Maxillofacial Surgery
Each module is set out in the following consistent format:
• Summary of module competencies

• Learning opportunities and methods
• Resources - including textbooks, journals and specific articles
• Related assessment
• Program level competencies for each module.
1.1.6.1 A Summary of Module Competencies is included. These are further elaborated on in

competencies identified for each level of the program and are included at the end of each
module.
1.1.6.2 Learning Opportunities and Methods have been identified and relate specifically to the type
of competency listed in the curriculum. The knowledge and skills acquired through these
activities are all likely to be assessed in the Examination.

a. Learning Portfolio Checklist

Checklists are to be included in the trainee’s learning portfolio. These give direction on
activities which should be encouraged so that trainees can develop skills leading towards the
achievement of competencies.
The checklists correspond with the requirements of the modules and are to be checked off
on a regular basis in order to determine the progress of the trainee through the program. In
this way any inconsistencies and problems can be determined and remedial exercises
introduced as required.
By the end of training each trainee will have checked off all of the required tasks.
b. Logbook
Trainees are exposed to practical experience in a variety of procedures and will progress
through the role of “assistant” to “surgeon”. This progression commences initially under the
supervision of the consulting surgeon and then through performing the operation on their
own. The Logbook is used to determine the number of surgical cases the trainee has
performed alone or as an assistant or observer.
Logbooks are also used to determine the spread of the trainee’s surgical scope and
competence to perform various procedures. This is coupled with the AOP assessments of
technical competence. The numbers associated with the Logbook encounters listed in the
various modules refer to the groups of procedures within the logbook itself.
c. Literature Reviews, Case Studies and Essays

These three learning opportunities are designed as self-learning packages:
i. Literature Reviews: topics are offered and suggested in each module. They will be
discussed in various different ways, for example in mini seminars
ii. Case Studies: are suitable for presentation from time to time during seminars and tutorials
iii. Essays: develop skills in information gathering and writing which form the basis for the
written papers during the examinations
d. Teaching Methods
A number of instructional techniques appropriate for each category of learning (acquiring
knowledge, cognitive skills, psychomotor skills and changing and/or improving attitudes) are
included. A variety of techniques, such as lectures, tutorials, and demonstrations with guided
observation, ensures that the different trainee learning styles are catered for.
1.1.6.3 Resources
Textbooks, journals and specific articles have been listed. These lists are regularly reviewed to ensure
currency, and include some older seminal articles, which continue to be relevant and remain as stable
references. Library access is important, as are the electronic forms of information such as the internet.
1.1.6.4 Assessments
a. The assessment of basic surgical science and training is completed once a trainee has
passed the SST examination and completed the mandatory course requirements.
b. Clinical training assessments of the remaining modules are included at the end of each
module and indicate the assessment for this stage of a trainee’s program, however, these
assessments could be completed before or after this time (depending on the ability of the
trainee during the latter years in the training program and the posts a trainee has
occupied). For example, if a trainee occupies an OMS training post at a children’s
hospital early in their training program they may be more advanced on competencies

from the Paediatric OMS module while in OMS 3, as compared to a trainee who has not
occupied a post within a children’s hospital until OMS 3.
The Assessment of Operative Process (AOP) is designed to assess the technical and
procedural skills of the trainees to perform a specific task or operation. The selected
AOPs are specific procedures which are considered to be the minimum key procedures
which trainees are required to achieve through OMS 2, 3 and 4.
The SST Examination, Team Appraisal of Conduct (TAC) and the Final Examination are
included in all module assessment criteria.
c. Once the trainee has completed these experiences their portfolio and Logbook are
assessed by the Trainee Advisory Committee and if satisfactory they are then able to
proceed to examination leading to FRACDS (OMS).

C – Section 2 Accredited Education and Training in Oral and Maxillofacial Surgery
2 C – SECTION 2
THE CURRICULUM MAP
This chart shows the broad competences mapped out and coupled with the modules in which they are found, and the assessments used to determine
that the competencies have been achieved.
Throughout this document the CanMed competencies have been followd, the mapping below maps the curriculum with those Entry Level Competencies
adopted by the DBA/DCNZ in Oral and Maxillofacial Surgery.
The following MAP refers to the advanced training modules. The SST has a separate syllabus and must be completed with a satisfactory pass at the
SST examination, by the end of the first year of training.
Key:
CP & D – Case Presentation plus Discussion
AOP – Assessment of Operative Process
TAC – Team Appraisal of Conduct
Exam – Surgical Science and Training (SST) Examination and/or Final Examination
Competency Module in which competency is Assessment DBA/DCNZ OMS

gained Entry-Level
Competencies
Medical and Dental Expert
Provide optimal, ethical and patient-centred medical and dental care Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, CP & D 1c
11, 12, 13, 14, 15, 16 AOP
Establish and maintain clinical knowledge, skills and attitudes Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, D 4(G)a - c
11, 12, 13, 14, 15, 16
Demonstrate medical and dental expertise in situations other than Module 2, 3, 4, 5, 6, 8, 10, 11, 12, Learning Portfolio 1f
patient care, such as providing expert legal testimony or advising 13, 14
governments
Clinical Decision Maker
Elicit a relevant, complete and concise history Module 2, 4, 6, 7, 9, 10, 11, 14, 4(G)b, (S)a
16
Perform a focused and accurate physical examination Module 3, 4, 5, 6, 7, 8, 9, 10, 11, Examination CP & D 4(G)b., 4(G)c
12, 13, 14, 15, 16
Critically evaluate the advantages and disadvantages of different Module 2, 3, 4, 5, 6, 7, 8, 9, 10, Examination 4(G)d
investigative modalities 11, 12, 13, 14, 15, 16 CP & D

Select appropriate investigative methods and monitoring techniques in Module 2, 4, 5, 6, 7, 8, 9, 10, 11, 4(G)d, 4(G)e, 5(G)a
a resource-effective, and ethical manner 14, 16
Recognise the most common disorders and differentiate those Module 2, 3, 4, 5, 6, 7, 8, 9, 10, 4(G)e, 4(S)f, 4(S)a
amenable to operative and non-operative treatment 11, 12, 13, 14
Demonstrate effective clinical problem solving and judgment to Module 2, 3, 4, 5, 6, 7, 8, 9, 10, CP & D Domain 4(S)a,
address patient problems, including interpreting the available data and 11, 12, 13, 14, 15, 16 4(S)f, 5(G)a, 5(G)b.
integrating information to generate differential diagnoses and
management plans
Accurately identify the risks, benefits, and mechanisms of action of Module 3, 4, 5, 6, 7, 8, 9, 10, 11, Exam 4(S)i
currently used drugs 12, 13, 14
Apply preventative and therapeutic interventions in an effective and Module 3, 4, 5, 6, 7, 8, 9, 10, 11, CP & D 5(G)c
timely manner 12, 13, 14, 16 TAC
Identify risk and, where necessary, plan a risk management strategy Module 3, 4, 5, 6, 7, 8, 9, 10, 11, CP & D 5(G)a. 5(G)b
12, 13, 14, 15, 16
Effectively manage complications of operative procedures and the Module 2, 3, 4, 5, 7, 8, 10, 11, 12, CP & D 5(G)c
underlying disease process 14, 16
Ensure adequate follow up is arranged for procedures performed Module 2, 3, 4, 5, 6, 7, 8, 9, 10, CP & D 5(G)a. 5(G)b
11, 12, 13, 14
Effectively and appropriately prioritises professional duties when faced Module 2, 3, 4, 5, 6, 7, 8, 9, 10, CP & D 5(G)b
with multiple patients and/or problems 11, 12, 13, 14,
Technical Expert
Safely and effectively perform appropriate surgical procedures Module 3, 4, 5, 8, 9 10, 11, 12, AOP 4(G)b, 4(G)c, 5(S)
13, 14, 15, 16 b-e
Demonstrate manual dexterity required to carry out procedures Module 3, 4, 7, 8, 9, 10, 11, 12, i)AOP 5(S) b,- e
14, 15, 16
Approach and carry out procedures with due attention to the safety of Module 4, 5, 9, 10, 11, 12, 14, 15, AOP 4 (S) b - g
patient, self and others 16 5(S) b - e
Adapt skills in the context of each patient and each procedure Module 3, 4, 5, 7, 8, 9, 10,11, 12, CP & D AOP 5(S) b - e
13, 14, 15, 16
Employ a critically reflective approach to one’s own clinical Module 3, 4, 5, 6, 7, 8, 9, 10, 11, Learning Portfolio 4(S) a - i,
performance with the view to continuous improvement 12, 13, 14, 15, 16. 5 (S)a - f
Communicator
Communicate effectively with patients, their families and the Module 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 2a, 2b
community through verbal and written means of communication, 11, 12, 13, 14, 15
respecting the diversity of background and cultural values

Listen effectively, including being aware and responsive to nonverbal Module 3, 4, 5, 6, 7, 8, 9, 10, 11, TAC 2d, 2e
cues 12, 13, 14, 15, 16
Establish effective relationships with patients, their families (where Module 3, 4, 5, 6, 7, 8, 9, 10, 11, TAC 2a, 2b
appropriate) and the community, which are characterised by 12, 13, 14
understanding, trust, respect, honesty and empathy
Accurately obtain and synthesise relevant information as well as the Module 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 2a, 2b
perspectives of patients and families, and other health professionals 11, 12, 13, 14
Communicate information to patients and their families (where Module 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 2a, 2b, 2d, 2e
appropriate) about surgery and treatment options in such a way that it 11, 12, 13, 14, 15, 16
is easily understood and promotes the patient’s participation in
informed decision making
Demonstrate the importance of cooperation and communication Module 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 2d
among health professionals so as to maximise the benefits to patient 11, 12, 13, 14, 15, 16
care and outcomes
Address challenging communication issues such as obtaining informed Module 4, 5, 6, 7, 8, 10, 11, 12, TAC 2b, 2d, 2e
consent, delivering bad news, anger, confusion and misunderstanding 13, 14, 15, 16
Convey effective oral and written information about a medical Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 2c, 2d.
encounter 11, 12, 13, 14, 15, 16
Collaborator
Assess, plan, provide and integrate care for individual patients (or Module 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 1e
groups of patients) in collaboration with others 11, 12, 13, 14, 15, 16
Recognise the need to refer patients to other professionals Module 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 1e
11, 12, 13, 14, 15, 16
Participate in inter-professional team meetings and demonstrate the Module 2, 3, 4, 6, 7, 8, 9, 10, 11, TAC 1e, 5(G)b
ability to accept, consider and respect the opinions of other team 12, 13, 14, 15, 16 Learning Portfolio
members, whilst contributing OMS specific expertise him/herself
Contribute effectively to other inter-professional team activities Module 2, 4, 6, 7, 8, 9, 10, 11, 12, TAC 1e
including activities in alternate settings such as committee work, 13, 14, 15, 16
research, teaching and learning
Respect team ethics, including confidentiality, resource allocation and Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 1e
professionalism 11, 12, 13, 14, 15, 16
Effectively work with other health professionals to prevent, negotiate, Module 3, 4, 5, 6, 7, 8, 10, 11, 12, TAC 1e
and resolve inter-professional conflict 13, 14, 15, 16
Manager

Participate in activities that contribute to the effectiveness of their Module 2, 3, 4, 5, 6, 7, 8, 10, 11, Learning Portfolio 1i
healthcare organisation, e.g. systemic quality process evaluation and 12, 13, 14, 15, 16
improvement
Utilise personal resources effectively in order to balance patient care, Mode1,2,3,4,5,6,7,8,9,10,11,12,1 TAC 1a
practice requirements, learning needs and personal life 3,14,15,16
Make sound judgments on the allocation of healthcare resources, Module 2, 3, 4, 5, 6, 7, 8, 10, 11, TAC 1c
balancing effectiveness, efficiency and access with optimal patient 12, 13, 14, 15, 16
care
Describe the structure and function of the healthcare system as it Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 1f
relates to OMS 11, 12, 13, 14, 15, 16
Employ information technology to optimise patient care, lifelong Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, Learning Portfolio 2c
learning and other activities 11, 12, 13, 14, 15, 16
Plan relevant elements of health care delivery, e.g. work schedules, Module 4, 7, 8, 10, 11, 12, 15, 16, Learning Portfolio 4 (S)a - i,
budgeting, organisational funding 5a - f
Serve in leadership roles effectively Module 4, 5, 6, 7, 8, 10, 11, 15, TAC 1i
16
Health Advocate
Identify the opportunities for advocacy, health promotion and disease Module 3, 4, 5, 6, 7, 8, 10, 11, 12, Learning Portfolio 1i
prevention with individual patients, communities and populations, and 13, 14,
respond appropriately
Identify the determinants of the health of the population they serve, Module 3, 4, 5, 6, 7, 8, 10, 11, 12, TAC 1i
including barriers to access to care and resources 13, 14, 15, 16
Describe how public policy is developed and employ methods of Module 3,4, 5, 7, 8, 10, 11, 12, Exam 1i
influencing the development of health and social policy 13, 14,15,16
Scholar and Teacher
Maintain and enhance professional activities through lifelong learning Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, Learning Portfolio 1h, 3a, 3b
11, 12, 13, 14, 15, 16
Critically appraise sources of medical information, and apply Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, Research 3a, 3b
appropriately 11, 12, 13, 14, 15, 16
Facilitate the learning of others Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 1h
11, 12, 13, 14, 15, 16
Contribute to the development, dissemination, and translation of new Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, Research Project 1h
knowledge and practices 11, 12, 13, 14, 15, 16
Professional

Appreciate and consistently apply ethical codes of practice Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 1b, 1e
11, 12, 13, 14, 15, 16
Apply the principles and practice of law as they apply to the practice of Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, Examination 1f
OMS 11, 12, 13, 14, 15, 16
Short course in law and
jurisprudence
Demonstrate a commitment to their patients, profession and society Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, Learning Portfolio 1d, 1g, 1h
through participation in profession-led regulation 11, 12, 13, 14, 15, 16
Demonstrate insight into their own limitations of expertise via self- Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, Learning Portfolio 1a
assessment 11, 12, 13, 14, 15, 16 Reflection
Be reliable and responsible Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, TAC 1b, 1c, 1e
11, 12, 13, 14, 15, 16
Demonstrate a commitment to personal health and sustainable Module 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, Learning Portfolio 1c
practice 11, 12, 13, 14, 15, 16

3 C - SECTION 3
THE MODULES
3.1.1 MODULE 1 ANATOMY AND EMBRYOLOGY OF THE HEAD AND NECK
MODULE 1: Anatomy and Embryology of the Head and Neck

Broad competencies Learning opportunities and methods
A trainee eligible to sit for the FRACDS (OMS) should be able to: Learning Portfolio Checklist
 Application of applied anatomy in the maxillofacial region
• Constantly revise anatomy in order to maintain an adequate knowledge  Application of applied anatomy to radiological diagnosis
base  Understand and apply anatomical knowledge to reconstruction in the
• Precisely describe the anatomical structures implicated in oral and maxillofacial region
maxillofacial surgery, as well as describing in detail other anatomical
sites of the body – particularly related to adjunctive surgical procedures Logbook
utilised by the oral and maxillofacial surgeon. This includes bone Trainee to log -
harvesting from other sites which may include the iliac crest, cranium,
• Removal of submandibular gland and the anatomy (5, 6)
fibular, and ribs
• Identify the embryological causes of craniofacial deformities and apply
• Reconstruction of the orbit and the anatomy (4, 17)
this knowledge to the surgical corrections, e.g. facial clefts, Treacher • Reconstruction of the mandible including the anatomy of the bone graft
Collins Syndrome, Pierre Robin Syndrome, Crouzon’s harvest (17, 18)
(Number refers to category in Logbook)
• Develop a suitable framework of knowledge on which to continually
build
• Apply anatomical knowledge to planning and carrying out complex Literature Review
surgical procedures • Applied anatomy of the orbit relative to orbital trauma
• Apply knowledge to new surgical techniques • Anatomy of the trigeminal nerve
• Be in a position to use this knowledge to educate his/her junior peers • Anatomy of the facial nerve along with repair
and undergraduate students • Anatomy of the neck and its application to neck dissection
• Describe the angiosomes of the head and neck and apply this • Embryology of facial cleft and craniofacial syndromes
knowledge and understanding to flaps for reconstruction in the oral and
maxillofacial region Case Study
• Describe facial planes in the head and neck and understand the • The applied anatomy and mechanisms of spread from SCC in the floor of the
importance in spread of infection mouth
• Consult, cooperate and discuss with other clinicians as required • Hemifacial microsomia and its management
• Teach, hand down knowledge and encourage other juniors,
undergraduates and graduates on ward rounds, clinics and other
classes as required

• Understand the processes involved in the employing hospital as well as Tutorial

the funding and administration of the employing hospital and health • The anatomy of the infratemporal fossa and its application to skull base
department tumours
• The anatomy of the maxilla and the maxillary sinus and its application to
Refer below for a complete list of competencies by level. implant reconstruction
• The anatomy of the mandible and its reconstruction, including the TMJ
• The anatomy of the anterior neck and tracheostomy
• Craniofacial syndromes and their operative management
• Craniofacial growth and development
• Completion of a College recognised course in Basic and Applied Anatomy
Resources
Textbooks Specific articles
Standring S (2008). Gray’s Anatomy: The Anatomical Basis of Clinical Landmarks of the facial nerve: implications for parotidectomy.
Practice. Churchill Livingstone. Pather N, Osman M.
Surg Radiol Anat. 2006 May;28(2):170-5.
Norton NS (2011). Netter’s Head and Neck Anatomy for Dentistry. Elsevier. Identification of the facial nerve main trunk by retrograde dissection of the
postauricular branch.
Ellis E, Zide MF (2018). Surgical Approaches to the Facial Skeleton Keefe MA, Castro JR, Keefe MS.
(3rded). LWW. Otolaryngol Head Neck Surg. 2009 Jan;140(1):126-7.
Schoenwolf GC (2014). Larsen’s Human Embryology. Churchill A modified pre-auricular approach to the temporomandibular joint and malar arch.
Livingstone. Al-Kayat A, Bramley P.
Br J Oral Surg. 1979 Nov;17(2):91-103.
Mark L. Urken MD, FACS, Mack L. Cheney MD, FACS, Keith E. Blackwell
MD, Jeffrey R. Harris MD, Tessa A. Hadlock MD, Neal Futran MD, DMD Surgical anatomy of the mandibular ramus of the facial nerve based on the
dissection of 100 facial halves.
(2011). Atlas of Regional and Free Flaps for Head and Neck
DINGMAN RO, GRABB WC.
Reconstruction
Plast Reconstr Surg Transplant Bull. 1962 Mar;29:266-72.
Journals
Australian Dental Journal The surgical anatomy of the mandibular distribution of the facial nerve.
Ziarah HA, Atkinson ME.
British Journal of Oral and Maxillofacial Surgery Br J Oral Surg. 1981 Sep;19(3):159-70.
Journal of Oral and Maxillofacial Surgery Facial nerve anatomy relevant to cosmetic surgery.
Burnham MA.
Journal of Cranio-Maxillofacial Surgery Oral Maxillofac Surg Clin North Am. 2000 Nov;12(4):613-621.
Journal of Craniofacial Surgery

The vascular anatomy of the human temporalis muscle: implications

International Journal of Oral and Maxillofacial Surgery for surgical splitting techniques.
Cheung LK.
Journal of Plastic and Reconstructive Surgery Int J Oral Maxillofac Surg. 1996 Dec;25(6):414-21.
Anatomical structure of the buccal fat pad and its clinical adaptations.
Zhang HM, Yan YP, Qi KM, Wang JQ, Liu ZF.
Plast Reconstr Surg. 2002 Jun;109(7):2509-18
Wound healing after multisegmental Le Fort I osteotomy and transection of the

descending palatine vessels.
Bell WH, You ZH, Finn RA, Fields RT.
J Oral Maxillofac Surg. 1995 Dec;53(12):1425-33
A radiological investigation into the age changes of the inferior dental artery.
Bradley JC.
Br J Oral Surg. 1975 Jul;13(1):82-90.
Neck dissection classification update: revisions proposed by the American Head

and Neck Society and the American Academy of Otolaryngology-Head and Neck
Surgery.
Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf
GT; American Head and Neck Society; American Academy of Otolaryngology--
Head and Neck Surgery.
Arch Otolaryngol Head Neck Surg. 2002 Jul;128(7):751-8.
Post-traumatic orbital reconstruction: anatomical landmarks and the concept of the

deep orbit.
Evans BT, Webb AA.
Br J Oral Maxillofac Surg. 2007 Apr;45(3):183-9.
An experimental investigation of the safe distance for internal orbital dissection.

Danko I, Haug RH.
J Oral Maxillofac Surg. 1998 Jun;56(6):749-52.
Clinical and Anatomic observations on the relationship of the lingual nerve to the
mandibular third molar region.

Kiesselbach JE, Chamberlain JG.

J Oral Maxillofac Surg. 1984 Sep;42(9):565-7.
The relationship of the lingual nerve to the mandibular third molar region: an
anatomic study.
Pogrel MA, Renaut A, Schmidt B, Ammar A.
J Oral Maxillofac Surg. 1995 Oct;53(10):1178-81
Cervical fascia: a terminological pain in the neck

Guidera AK, Dawes PJ, Stringer MD
ANZ J Surg. 2012 Nov;82(11):786-91.
The anterior loop of the inferior alveolar nerve: prevalence, measurement of its
length and a recommendation for interforaminal implant installation based on cone
beam CT imaging.
Apostolakis D, Brown JE.
Clin Oral Implants Res. 2012 Sep;23(9):1022-30.
Anatomic study of the mandibular formen, lingula and antilingula in dry mandibles,
and its statistical relationship between the true lingula and antilingula.
Monnazzi MS, Passeri LA, Gabrielli MF, Bolini PD, de Carvalho WR, da Costa
Machado H.
Int J Oral Maxillofac Surg. 2012 Jan;41(1):74-8
Clinical Anatomy of the Lingual Nerve: A Review.

Sittitavornwong S, Babston M, Denson D, Zehren S, J Friend
J Oral Maxillofac Surg. 2017 May;75(5):926
Three nearly anatomical forgotten anatomical triangles of the next: triangles of

Beclard, Lesser and Pirogoff and their potential applications in surgical dissection
of the neck.
Tubbs RS, Rasmussen M, Loukas M, Shoja MM, Cohen-Gadol AA.
Surg Radiol Anat. 2011 Jan;33(1):53-7
Landmarks for parotid gland surgery.

de Ru JA, van Benthem PP, Bleys RL, Lubsen H, Hordijk GJ.
J Laryngol Otol. 2001 Feb;115(2):122-5.
Facial Nerve Function after parotidectomy

Luc P. Bron, MD; Christopher J. O'Brien, MS, FRACS

Arch Otolaryngol Head Neck Surg. 1997;123(10):1091-1096.
An anatomic study of the lingual nerve in the third molar region.

Behnia H, Kheradvar A, Shahrokhi M.
J Oral Maxillofac Surg. 2000 Jun;58(6):649-51; discussion 652-3.
Cleft lip and palate

Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC.
Lancet. 2009 Nov 21,374(9703):1773-85.
Illustrated review of the embryology and development of the facial region, part 2:
Late development of the fetal face and changes in the face from the newborn to
adulthood.
Som PM, Naidich TP.
AJNR AM J Neuroradiol. 2014 Jan;35(1):10-8.
In situ location of the temporal branch of the facial nerve.

Miloro M, Redlinger S, Pennington DM, Kolodge T.
Branchial arch syndromes

Alfi D, Lam D, Gateno J.
Atlas Oral Maxillofac Surg Clin North Am. 2014 Sep;22(2):167-73

Assessments
OMS 1 OMS 2 OMS 3 OMS 4

SST EXAMINATION
AOP HEAD AND NECK
AOP REMOVAL OF SUBMANDIBULAR
GLAND APPLIED ANATOMY
CP AND D - MANAGEMENT
SCC FLOOR MOUTH
RESECT’N RECONSTRUCTION
APPLIED ANATOMY
AOP – RECONSTRUCTION
ORBIT APPLIED ANATOMY
TEAM APPRAISAL OF CONDUCT (TAC) FINAL EXAMINATION
FINAL EXAMINATION
List of competencies by level

Level One Level Two Level Three
• Describe clearly, accurately, and in detail • Describe the importance and timing of the various • Apply anatomical knowledge to the
the embryology and anatomy of the head embryological stages of head and neck development interpretation of radiological investigations
and neck and related structure and and the possible anomalies and resulting deformities including plain films, computed tomography
function that can occur (CT) scans, magnetic resonance imaging (MRI),
• Identify the differences between cadaveric • Discuss the embryology of the neck, face, eye, nasal ultrasound and vascular investigations
anatomy and surgical anatomy cavity, paranasal sinuses, mouth, palate and pharynx, • Apply anatomical knowledge to the examination
• Use appropriate anatomical terminology larynx, ear and that of the central nervous system of the patient
• Recognise and identify common • Describe the growth and developmental changes from • Explain to the patient the risks of surgery based

anatomical variants and their clinical the foetal skull to that of the child and subsequently on anatomical principles
relevance the adult skull • Critically evaluate and discuss anatomical and
• Discuss the osteology of the skull including • Describe the growth and development of the hard and embryological studies in the literature
both intra- and extra-cranial landmarks soft tissues of the face including the theories of facial • Apply anatomical knowledge to complex
• Discuss the skull and bony articulations growth such as the functional matrix surgical procedures
including the orbital and nasal apertures, • Describe the difference and clinical significance of • Apply knowledge of other anatomical sites of
the base of skull and the pterygopalatine cartilaginous and membranous bony growth the body by carrying out bone harvesting
fossa • Describe the topography of the central nervous • Apply the knowledge of embryology to the
• List the cervical vertebrae, their system including a general organisation of the aetiology of craniofacial syndromes and to their
articulations and soft tissue attachments sensory and motor pathways surgical management
• Describe the hyoid bone and its soft tissue
•
attachments
Describe the anatomy of the spinal cord and spinal • Plan and apply surgical access and approaches
nerves including the autonomic nervous system, and based on regional anatomy
• Identify in detail the anatomy of the neck internal structure of the spinal cord
including surface anatomy, cutaneous • Recognise and predict the spread of infection
• Describe the brainstem, cranial nerves and their and malignancy in the head and neck region
innervation, superficial and deep structures
nuclei including the ascending sensory pathways, based on anatomical principles
• Identify in detail the anatomy of the face,
including the surface anatomy, superficial
motor nuclei and descending pathways • Communicate anatomical knowledge in
structures (muscles of facial expression, • Describe the cerebellum and the cerebellar appropriate terminology to patients and co-
connections workers
nerves, arteries, veins, lymphatics, the
parotid gland) and deep structures (the • Describe the gross topography of the diencephalon
muscles of mastication, the (hypothalamus, subthalamus, thalamus and
temporomandibular joint, and infratemporal epithalamus)
fossa) • Describe the anatomy of the cerebral hemispheres
• Describe the scalp including its innervation including the external topography, cerebral cortex and
and blood supply their internal structures
• Describe the anatomy and physiology of • Describe the anatomy of the choroid plexus and
the eye, eyelids, the lacrimal apparatus, cerebrospinal fluid
extra-ocular muscles, the nerves, arteries, • Describe in detail the vasculature of the central
and veins of the orbit nervous system including the concept of the blood
• Describe the anatomy of the external nose brain barrier
and nasal cavity, the paranasal sinuses, • Describe the anatomy of the larynx including its
and the pterygopalatine fossa cartilaginous skeleton, musculature and ligaments,
• Describe the anatomy of the mouth and mucosa, innervation, and blood supply
palate, including the teeth, oral mucosa, • Describe the anatomy and functioning of the
salivary glands, oral and palatal structures involved in speech
musculature, including the innervation, • Describe the anatomy of the external, middle and
arterial and venous blood supply, and inner ear
lymphatic drainage
• Describe the cranial cavity and contents of the
• Explain the anatomy and functioning of the
anterior, middle and posterior cranial fossae including
pharynx including its three regions

(nasopharynx, oropharynx, the meninges

laryngopharynx), musculature, innervation, • Describe the anatomy of sites from which soft and
and blood supply hard tissue grafts and flaps may be harvested

3.1.2 MODULE 2: RADIOLOGY AND NUCLEAR MEDICINE
MODULE 2: Radiology and Nuclear Medicine

Learning Portfolio Checklist
A trainee eligible to sit for the FRACDS (OMS) should be able to:
 Interpret orthopantomograms
 Interpret frontal and lateral cephalograms
• Request appropriate imaging relating to a patient’s presenting complaint, in  Read CT for dental implant assessment
consultation with an oral and maxillofacial radiologist  Read CT for orthognathic surgery assessment
• Safely use intraoral and fluoroscopic apparatus  Read CT of complex maxillofacial trauma
• Understand the safe use of conventional and cone beam CT, especially potential  CT and MRI for tumours of the jaws
hazards of ionising radiation and an understanding of relative radiation doses  Read MRI for TMJ pathology
• Understand the safe use of MRI, and know the absolute contra-indications to
MRI Literature Review
• Demonstrate knowledge of radiographic anatomy, distortion and artefacts • Review current imaging of temporomandibular joint pathology
• Perform basic interpretation of plain radiographs, panoramic tomography (OPG), • Compare cone beam CT with conventional CT in assessment for dental
CT, MRI and Bone Scans of the maxillofacial region with description of implant surgery
radiographic findings and formulation of a differential diagnosis based on these
• Request and accurately read appropriate radiographs, OPG and CT in trauma Lecture / Tutorial
• Request the appropriate imaging investigation (usually MRI) for the evaluation of • Imaging evaluation of tumours in the maxillofacial region
the temporomandibular joints, and perform basic interpretation of TMJ MRI • CT evaluation of maxillofacial fractures
• Summarise and evaluate nuclear medicine techniques applicable to oral and • CT dentascans in the assessment of jaw anatomy prior to implant placement
maxillofacial surgery, including the role of PET in malignant disease, SPECT in • MRI of the temporomandibular joint
condylar hyperplasia and Gallium scanning in infection • Anatomy, distortion and artefact on the orthopantomogram
• Demonstrate knowledge of the appropriate implementation of interventional
radiology and its application(s) to oral and maxillofacial surgery Observation
Ideally, a period of secondment to an oral and maxillofacial radiologist
• Consult, cooperate and discuss with other clinicians as required
• Teach, hand down and encourage other juniors, undergraduates and graduates Clinicopathological Conferences
on ward rounds, clinics and other classes as required
• Understand the processes involved in the employing hospital as well as the
funding and administration of the employing hospital and health department
Refer below for a complete list of competencies by level.

Resources

White SC, Pharoah MJ (2013). Oral Radiology (7th ed). Inferior alveolar nerve injury and surgical difficulty prediction in third molar surgery: the role of dental
Mosby. panoramic tomography.
Jerjes W, El-Maaytah M, Swinson B, Upile T, Thompson G, Gittelmon S, Baldwin D, Hadi H, Vourvachis M,
Koenig LJ (2011). Diagnostic Imaging: Oral and Abizadeh N, Al Khawalde M, Hopper C.
Maxillofacial. LWW. J Clin Dent. 2006;17(5):122-30.
Harnsberger HR, Glastonbury CM, Michel MA, Koch BL MR imaging of temporomandibular joint dysfunction: a pictorial review.
(2010). Diagnostic Imaging: Head and Neck 2nd ed). Tomas X, Pomes J, Berenguer J, Quinto L, Nicolau C, Mercader JM, Castro V.
LWW. Radiographics. 2006 May-Jun;26(3):765-81.
MacDonald D (2011). Oral and Maxillofacial Radiology: A Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC,
Diagnostic Approach. Wiley Blackwell. CT and MR imaging.
de Bondt RB, Nelemans PJ, Hofman PA, Casselman JW, Kremer B, van Engelshoven JM, Beets-Tan RG.
Eur J Radiol. 2007 Nov;64(2):266-72.
Journals
Dentomaxillofacial Radiology http://dmfr.birjournals.org/ 18F-fluorodeoxyglucose positron emission tomography to evaluate cervical node metastases in patients with
head and neck squamous cell carcinoma: a meta-analysis.
Oral surgery, oral medicine, oral pathology, oral radiology Kyzas PA, Evangelou E, Denaxa-Kyza D, Ioannidis JP.
and endodontology J Natl Cancer Inst. 2008 May 21;100(10):712-20.
http://www.ooooe.net/
Detection of cervical lymph node metastasis in head and neck cancer patients with clinically N0 neck-a
meta-analysis comparing different imaging modalities.
Liao LJ, Lo WC, Hsu WL, Wang CT, Lai MS.
BMC Cancer. 2012 Jun 12;12:236. doi: 10.1186/1471-2407-12-236
Application of cone beam computed tomography in oral and maxillofacial surgery.

Ahmad M, Jenny J, Downie M.
Aust Dent J. 2012 Mar;57 Suppl 1:82-94.
Effective dose from cone beam CT examinations in dentistry.

Roberts JA, Drage NA, Davies J, Thomas DW.
Br J Radiol. 2009 Jan;82(973):35-40.
Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: a systematic
review of the literature.
De Vos W, Casselman J, Swennen GR.
Int J Oral Maxillofac Surg. 2009 Jun;38(6):609-25.

Applications of cone beam computed tomography in the practice of oral and maxillofacial surgery.
Quereshy FA, Savell TA, Palomo JM.
J Oral Maxillofac Surg. 2008 Apr;66(4):791-6.
Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology.
Ludlow JB, Ivanovic M.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Jul;106(1):106-14.
Clinical indications and perspectives for intraoperative cone-beam computed tomography in oral and
maxillofacial surgery.
Pohlenz P, Blessmann M, Blake F, Heinrich S, Schmelzle R, Heiland M.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Mar;103(3):412-7.
Computer-assisted craniomaxillofacial surgery.

Edwards SP.
Oral Maxillofac Surg Clin North Am. 2010 Feb;22(1):117-34
Stereotactic navigation in oral and maxillofacial surgery.

Collyer J.
Br J Oral Maxillofac Surg. 2010 Mar;48(2):79-83.
Computer planning and intraoperative navigation in cranio-maxillofacial surgery.

Bell RB.
Oral Maxillofac Surg Clin North Am. 2010 Feb;22(1):135-56.
Image-guided navigation in oral and maxillofacial surgery.

Nijmeh AD, Goodger NM, Hawkes D, Edwards PJ, McGurk M.
Br J Oral Maxillofac Surg. 2005 Aug;43(4):294-302.
Indications and limitations of intraoperative navigation in maxillofacial surgery.

Heiland M, Habermann CR, Schmelzle R.
Bone scintigraphy as a diagnostic method in unilateral hyperactivity of the mandibular condyles: a review
and meta-analysis of the literature.
Saridin CP, Raijmakers PG, Tuinzing DB, Becking AG.
Int J Oral Maxillofac Surg. 2011 Jan;40(1):11-7.
Assessments


SST EXAMINATION
CP AND D ANATOMY
ARTIFACTS AND INTERPRETATION
OPG
CP AND D FORMULATE DETAILED
DIFFERENTIAL DIAGNOSIS
FOR LESIONS USING ADVANCED
IMAGING TECHNIQUES
CP AND D SAFETY
IN CT AND MRI
TEAM APPRAISAL OF CONDUCT
FINAL EXAMINATION
(TAC)
FINAL EXAMINATION


• Describe the safe use, design and function of • Order and interpret accurately CT in multiple planes in the • Apply and interpret intraoperative imaging
radiological equipment for intraoral use, the assessment of complex midfacial trauma • Formulate detailed differential diagnoses for lesions
panoramic radiograph, CT and MRI • Evaluate the limitations of arthrography including CT of the maxillofacial region using advanced imaging
• Describe the normal radiographic anatomy of arthrography in assessment of the temporomandibular joint techniques
the maxillofacial region and its associated • Critically evaluate MR imaging of the temporomandibular • Assess a reconstructed CT to determine the bone
areas including the cervical spine joint graft volume required for augmentation of the jaws
• Interpret facial radiographs and identify • Correctly assess reconstructed CT imaging of the upper and prior to implant placement
distortions and radiographic artifacts lower jaws for the placement of endosseous implants • Appropriately order and interpret imaging required
• Describe the radiographic assessment of • Evaluate the role of MRI in the investigation of the for the production of a biomodel
impacted teeth, dentoalveolar and odontogenic neoplasms • Identify the limitations and accuracy of biomodels
maxillofacial pathology
• Correctly select the appropriate nuclear medicine • Compare and evaluate the methods of confirming
• Describe the principles of imaging for examinations for investigation of chronic infection including skull base involvement in direct neoplastic invasion
orthognathic surgery and produce tracings of
lateral and PA cephalometric radiographs
osteomyelitis • Discuss the role of CT and intrathecal contrast in the
• Describe the role of angiography in the diagnosis of assessment and localisation of a cerebrospinal fluid
• Describe and interpret plain films and the role vascular anomalies in the maxillofacial region (CSF) leak
of CT in the diagnosis of maxillofacial trauma
• Describe the role of interventional radiological techniques in • Diagnose the need for, and correctly order and
• Describe the imaging modalities including CT the management of bleeding interpret PET scanning in the staging of head and
and MRI available for the investigation of
temporomandibular joint disease • Sensitively communicate to a patient the findings, risks, and neck malignancy and in the identification of
potential procedures resulting from these various images recurrence
• Describe the principles of radioactive labeling •
and list the nuclear medicine tests used in oral • Use CT and ultrasound accurately in the assessment of Describe the use of co-registration imaging in the
deep space infection of the neck identification of loco-regional recurrence and nodal
and maxillofacial surgery involvement in head and neck malignancy
• Identify the role of ultrasound in oral and maxillofacial
• Describe biological basis and accuracy of
surgery
technetium-99 (Tc99) bone scanning in the
diagnosis of growth disturbances of the • Formulate a limited differential diagnosis of radiographically
maxillofacial region evident lesions of the maxillofacial region
• List common radiographic (including MRI) contrast media
and describe their application in imaging of the oral and
maxillofacial region
• Evaluate the role of single proton emission computed
tomography (SPECT) in the diagnosis of condylar
hyperplasia

3.1.3 MODULE 3: DENTOALVEOLAR SURGERY
MODULE 3: Dentoalveolar Surgery

A trainee eligible to sit for the FRACDS (OMS) should be
 The accurate assessment of third molar teeth and removal of impacted teeth
able to:
 Perform model taking and articulation and design appropriate splints for pre-prosthetic surgery
 Outline the fascial spaces of the head and neck
• Apply LA for dentoalveolar surgery
 Selection and use of appropriate antibiotics for dental infections
• Carry out dentoalveolar procedures in order to:
 Appropriately treat dentoalveolar pathology
• eliminate acute and chronic infection
• limit or eliminate pain Logbook
• restore anatomic form Trainee to log –
• restore masticatory function • Dentoalveolar – elective (1)
• preserve vital structures • Dentoalveolar – infection (2)
• limit the period of disability (Number refers to category in Logbook)
• eliminate pathology
• Surgically remove erupted teeth, un-erupted teeth and Literature Review
impacted teeth, including impacted third molars • The indications for the removal of third molar teeth
• Reposition and transplant teeth as required
• Manage the impacted canine including their exposure Tutorial
• Manage odontogenic infections • Design of mucoperiosteal flaps for oral surgery procedures
• Recognise and treat dentoalveolar pathology, including • Management of impacted third molars, canines and other teeth
cysts and other related pathological conditions • Biopsy procedures
• Manage and surgically treat periradicular pathology and • The spread of odontogenic infections
be competent to perform apicectomy • The use of antibiotics in oral and maxillofacial surgery
• Carry out pre-prosthetic surgical procedures • The use of analgesics in oral and maxillofacial surgery
• Diagnose and perform alveolar reconstruction and • Local anaesthesia techniques
defect reconstruction of the alveolus with hard and soft
• Periapical surgery
tissues relevant to the problem
• Maxillary Sinus and relevance to oral and maxillofacial surgery
• Communicate with the patient and/or family of the
treatment options, potentials, complications, and risks Essay
and obtain informed consent
• Discuss the differential diagnosis of radiolucent and radiopaque lesions of the jaws
• Consult, cooperate and discuss with other clinicians as
required
• Discuss the pathways of the spread of odontogenic infections of the head and neck
• Teach and hand down, encourage other juniors, Observation and Demonstration
undergraduates and graduates on ward rounds, clinics
and other classes as required
• The surgical removal of impacted upper and lower third molar teeth
• The surgical exposure and attachment bonding of impacted maxillary canines

• Understand the processes involved in the employing • Incisional/excisional biopsies of hard/soft tissue lesions
hospital as well as the funding and administration of the • Removal of foreign body from maxillary sinus
employing hospital and health department • Closure of oro-antral communication
• Incision and drainage of fascial space infections of the head and neck
Case Study
• Nerve damage following the removal of a lower third molar tooth
• Odontogenic cysts and tumours of the jaws
• Surgical site infections
• Localised osteitis
Structured Experience
(Trainee to make written notes on patient encounters)
• Explanation for the removal of third molars including potential risks and complications
• Explanation of the management of periapical pathology and other odontogenic injections
• Explanation of the management of maxillary sinus pathology including retrieval of a foreign body from
the sinus and closure of an OAF
• Explanation of neuropathy, including Trigeminal Neuralgia, and its management
Resources
Fonseca RJ, Marciani RD, Turvey TA (2008). Oral and White Paper on Third Molar Data (2007)
Maxillofacial Surgery. Saunders. AAOMS
Miloro M, Ghali GE, Larsen P, Waite P (2011). Peterson’s The Management of Impacted Third Molar Teeth (2013)
Principles of Oral and Maxillofacial Surgery (3rd ed). AAOMS
PMPH USA.
Guidance on Extraction of Wisdom Teeth (2000)
Andreasen JO, Bakland LK, Flores MT, Andreasen FM, NICE
Andersson L (2011). Traumatic Dental Injuries: A Manual
(3rd ed). Wiley Blackwell. The effects of NICE guidelines on the management of third molar teeth.
McArdle LW, Renton T.
Br Dent J. 2012 Sep;213(5):E8.
Third molar removal: an overview of indications, imaging, evaluation, and assessment of risk.
Journals Marciani RD.

Australian Dental Journal Oral Maxillofac Surg Clin North Am. 2007 Feb;19(1):1-13
British Dental Journal General technique of third molar removal.

Farish SE, Bouloux GF.
British Journal of Oral and Maxillofacial Surgery Oral Maxillofac Surg Clin North Am. 2007 Feb;19(1):23-43
Journal of Oral and Maxillofacial Surgery Management of the impacted canine and second molar.
Alberto PL.
International Journal of Oral and Maxillofacial Surgery Oral Maxillofac Surg Clin North Am. 2007 Feb;19(1):59-68
Journal of the Canadian Dental Association Complications of third molar surgery.

Bouloux GF, Steed MB, Perciaccante VJ.
Effectiveness of antibiotic prophylaxis in third molar surgery: a meta-analysis of randomized controlled

clinical trials.
Ren YF, Malmstrom HS.
J Oral Maxillofac Surg. 2007 Oct;65(10):1909-21.
Coronectomy of the lower third molar is safe within the first 3 years.
Leung YY, Cheung LK.
J Oral Maxillofac Surg. 2012 Jul;70(7):1515-22.
Is endodontic treatment necessary during coronectomy procedure?

Sencimen M, Ortakoglu K, Aydin C, Aydintug YS, Ozyigit A, Ozen T, Gunaydin Y.
J Oral Maxillofac Surg. 2010 Oct;68(10):2385-90.
A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a
result of coronectomy and removal of mandibular third molars.
Renton T, Hankins M, Sproate C, McGurk M.
Br J Oral Maxillofac Surg. 2005 Feb;43(1):7-12.
Coronectomy: a technique to protect the inferior alveolar nerve.

Pogrel MA, Lee JS, Muff DF.
J Oral Maxillofac Surg. 2004 Dec;62(12):1447-52.
Nerve injuries after third molar removal.

Ziccardi VB, Zuniga JR.

Microsurgical repair of the inferior alveolar nerve: success rate and factors that adversely affect outcome.
Bagheri SC, Meyer RA, Cho SH, Thoppay J, Khan HA, Steed MB.
J Oral Maxillofac Surg. 2012 Aug;70(8):1978-90.
Retrospective review of microsurgical repair of 222 lingual nerve injuries.

Bagheri SC, Meyer RA, Khan HA, Kuhmichel A, Steed MB.
EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision.

Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T; European Federation of
Neurological Societies.
Eur J Neurol. 2010 Sep;17(9):1113-e88.
The displaced lower third molar: a literature review and suggestions for management.
Huang IY, Wu CW, Worthington P.
Optimal treatment of descending necrotising mediastinitis.

Corsten MJ, Shamji FM, Odell PF, Frederico JA, Laframboise GG, Reid KR, Vallieres E, Matzinger F.
Thorax. 1997 Aug;52(8):702-8.
EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients.
Einhäupl K, Stam J, Bousser MG, De Bruijn SF, Ferro JM, Martinelli I, Masuhr F; European Federation of
Eur J Neurol. 2010 Oct;17(10):1229-35.
Do dental infections really cause central nervous system infections?

Lazow SK, Izzo SR, Vazquez D.
Oral Maxillofac Surg Clin North Am. 2011 Nov;23(4):569-78
Contemporary management of third molars.

Hyam DM.
Australian Dental Journal 2018, 68:(1 suppl):519-26

Assessments
SST EXAMINATION
AOP REMOVAL OF AN IMPACTED
TOOTH
CP AND D MANAGEMENT OF
DENTOALVEOLAR INJURIES
AOP PATIENT WITH
DENTOALVEOLAR PATHOLOGY
USING APPROPRIATE IMAGING
FINAL EXAMINATION
Level One Levels Two and Three
Perform removal of erupted teeth also Surgical management of odontogenic infections
• Endodontic surgery • Carry out a thorough history, examination, and diagnosis of odontogenic infections
• Hemisection of teeth • Sensitively communicate to patients the findings of their assessment and diagnosis, the
potential procedures, and associated risks
• Periodontal surgery
• Localised grafting procedures, both hard and soft tissues • Obtain informed consent
• Guided tissue regeneration • Perform appropriate surgical management of odontogenic infections including management of
the airway
• Alveolar osseous surgery
Assess and manage co-existing medical problems
• Crown lengthening procedures
• Assess the location and severity for a patient with a spreading odontogenic infection
Manage impacted teeth
• Interpret appropriate imaging of infection using CT, ultrasound and MRI
• Diagnose impacted teeth, using appropriate clinical and
• Perform incision and drainage routines of odontogenic infections, e.g. submandibular buccal
radiographic interpretation to determine the position of and palatal abscesses
anatomical structures
• Utilise drains and drainage techniques that are appropriate for the patient’s needs
• Surgically remove, reposition, reimplant, and/or transplant,
impacted teeth • Accurately assess patients at risk of osteonecrosis
Odontogenic infections. • Apply knowledge of prophylactic protocols associated with the diagnosis and arrange
appropriate management of osteoradionecrosis including hyperbaric oxygen
• Describe in detail the anatomy of the fascial spaces of the
• Diagnose and undertake medical and surgical management of cases of osteomyelitis of the

head and neck and the spread of infection to these spaces jaws
• Explain the surgical management of such infections • Make appropriate decisions regarding airway management for patients with deep fascial
including Ludwig’s angina space infections
• Identify normal microflora of the mouth, para nasal sinuses • Consult and work effectively with anaesthetic and intensive care staff in the management of
and skin patients
• Recognise and describe the common microflora of • Work in teams in the appropriate response to fulminant and life threatening head and neck
odontogenic infections, facial skin infections, sinus infections, such as necrotising fascititis and rhinocerebral zygomycosis
infections, pharyngeal infections • Manage complications of severe infections including haemorrhage and shock, ophthalmic,
• Indicate the principles, and demonstrate the techniques of chest and cerebral complications
sampling and analysing micro-organisms involved in Deformities and defects of the dentoalveolar complex
infections, culture and sensitivity testing
• Carry out a thorough history, examination, and diagnosis of patients requiring surgical
• Explain the basis of empirical antibiotic therapy alteration, repair, graft, excision, reduction, or augmentation of the hard and or/soft tissues of
The medically compromised patient the dentoalveolar complex such as frenectomy, reduction of the tuberosity, excision of a
fibrous tuberosity, an osseous tuberosity and removal of bony exostoses including mandibular
• Discuss the management of the medically compromised
and maxillary tori, corticotomy
patient, including extremes of age
Augmentation of hard tissue defects
• Liaise with relevant medical specialists in the care of
medically compromised patients undergoing oral and • Bone grafting procedures, guided tissue regeneration, surgical revision procedures, Intraoral
maxillofacial surgery pedical soft tissue grafting procedures, free soft tissue grafts (including donor graft
procedures), subepithelial grafting procedures, Alveolar distraction procedures
Reconstruction of soft tissue defects
• Apically repositioned flap, bone replacement procedures, guided tissue regeneration, soft
tissue grafts and connective tissue grafts
• Vestibuloplasty procedures including soft tissue grafts and donor site management
• Lowering of the floor of the mouth with and without skin or mucosal grafting
• Alveoloplasty and alveolectomy
• Excision of redundant tissue, i.e., denture hyperplasia
• Mucogingival surgery, gingivectomy, gingivoplasty, free soft tissue grafting procedures,
apically repositioned flaps and pedicle flap procedures
• Management of oroantral and oronasal fistulae
• Sensitively communicate to patients the findings of their assessment and diagnosis, the
potential procedures, and associated benefits and risks
• Obtain informed consent
• Provide patients and/or family with post-operative instructions and arrange appropriate post-
operative follow up
• Examine, diagnose, manage, and perform appropriate procedures for patients with alveolar
pathology including odontogenic cysts and tumours or non-odontogenic lesions occurring

within the alveolus

• Perform and manage soft and hard tissue recontouring, osseous, osteoperiosteal and
cartilage grafting of the mandible or maxilla and repair of hard and soft tissues
The medically compromised patient
• Manage the medically compromised patient, including extremes of age

3.1.4 MODULE 4: PRE-PROSTHETIC SURGERY AND IMPLANTOLOGY
MODULE 4: Pre-prosthetic Surgery and Implantology

 Examination and diagnosis of a patient requiring pre-prosthetic
• Manage the implant patient from assessment through to, and have an understanding of,
and implant surgery
prosthetic rehabilitation
 Examine and interpret appropriate imaging including plain
• Independently and safely manage the implant patient including the pre-prosthetic soft
radiographs and CT scans
and hard tissue management of such patients
 Treatment plan including pre-prosthetic surgery and implant
• Identify (discuss/explain/evaluate/differentiate between/compare and contrast) various placement
methods involved with implant reconstruction
• Select appropriate investigative tools that are cost-effective and useful Logbook
• Appropriately select between the various methods involved with implant reconstruction Trainee to log –
according to the symptoms and needs of each patient • Pre-prosthetic – minor (7)
• Communicate with patients (and their families) about procedures, potentials, and risks • Pre-prosthetic – major (8)
associated with pre-prosthetic surgery and implants to the head and neck area in
• Pre-prosthetic – implants (9)
particular the face and jaws, in ways that encourage their participation in informed (Number refers to category in Logbook)
decision making
• Demonstrate sound basic surgical skills and competently carry out specific surgical Literature Review
procedures (including microscopic and endoscopic abilities), applying appropriate and
• Indications for pre-prosthetic surgery
safe operative techniques within each of these parameters
• Communicate with and co-ordinate surgical teams to achieve an optimal clinical
• Bone grafting to the maxilla
environment • Bone grafting to the mandible
• Converse with and work with colleagues in allied specialties • The placement of dental implants and where
• Manage patients in ways that demonstrate sensitivity to their psychological needs • Immediate implants and their problems
• Develop a care plan for a patient in collaboration with members of an multidisciplinary • Implant design and surface coatings
team
Case Study
• Make clinical decisions and judgements based on sound evidence for the benefit of the
patient • Rehabilitation of a patient with significant soft and hard tissue
defects with implants
• Demonstrate insight into his/her limitations of expertise and refer patients
Tutorial
• Teach and hand down, encourage other juniors, undergraduates and graduates on ward
rounds, clinics and other classes as required
• Clinical assessment of the patient for dental implant therapy
• Understand the processes involved in the employing hospital as well as the funding and
• Soft tissues in relation tom dental implants
administration of the employing hospital and health department • The immediate implant and the immediate bridge
• Understand the biological basis of success (or failure) of orofacial implants • Navigation in relation to implant placement
• Zygomatic implants

• Extra oral implants and their application

Refer below for a complete list of competencies by level. • The multidisciplinary approach to case management
• Establishing and maintaining an implant practice
Resources
Misch CE (2007). Contemporary Implant Dentistry (3rd ed). A classification of the edentulous jaws.
Mosby. Cawood JI, Howell RA.
Int J Oral Maxillofac Surg. 1988 Aug;17(4):232-6.
Fonseca RJ, Davis WH (1995). Reconstructive
Preprosthetic Oral and Maxillofacial Surgery (2nd ed). WB Tilted implants for the rehabilitation of edentulous jaws: a systematic review.
Saunders. Del Fabbro M, Bellini CM, Romeo D, Francetti L.
Clin Implant Dent Relat Res. 2012 Aug;14(4):612-21.
Journals
Journal or Oral and Maxillofacial Implants The All-on-Four Treatment Concept: A Systematic Review.
Patzelt SB, Bahat O, Reynolds MA, Strub JR.
Journal of Oral and Maxillofacial Surgery Clin Implant Dent Relat Res. 2013 Apr 5. [Epub ahead of print]
British Journal of Oral and Maxillofacial Surgery "All-on-4" immediate-function concept for completely edentulous maxillae: a clinical report on the
medium (3 years) and long-term (5 years) outcomes.
International Journal of Oral and Maxillofacial Surgery Maló P, de Araújo Nobre M, Lopes A, Francischone C, Rigolizzo M.
Clin Implant Dent Relat Res. 2012 May;14 Suppl 1:e139-50.
The all on 4 shelf: mandible.

Jensen OT, Adams MW, Cottam JR, Parel SM, Phillips WR 3rd.
J Oral Maxillofac Surg. 2011 Jan;69(1):175-81.
Sinus floor augmentation surgery using autologous bone grafts from various donorsites: a meta-
analysis of the total bone volume.
Klijn RJ, Meijer GJ, Bronkhorst EM, Jansen JA.
Tissue Eng Part B Rev. 2010 Jun;16(3):295-303.
Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus.
Esposito M, Felice P, Worthington HV.
Cochrane Database Syst Rev. 2014 May 13;5:CD008397.
De novo bone induction by recombinant human bone morphogenetic protein-2(rhBMP-2)

in maxillary sinus floor augmentation.
Boyne PJ, Lilly LC, Marx RE, Moy PK, Nevins M, Spagnoli DB, Triplett RG.

Pivotal, randomized, parallel evaluation of recombinant human bone morphogeneticprotein-

2/absorbable collagen sponge and autogenous bone graft for maxillarysinus floor augmentation.
Triplett RG, Nevins M, Marx RE, Spagnoli DB, Oates TW, Moy PK, Boyne PJ.
Oral bisphosphonate-associated osteonecrosis of the jaw after implant surgery: a case report and
literature review.
Bedogni A, Bettini G, Totola A, Saia G, Nocini PF.
The nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in dental implant
patients: a South Australian case series.
Goss A, Bartold M, Sambrook P, Hawker P.
J Oral Maxillofac Surg. 2010 Feb;68(2):337-43.
Oral implants in radiated patients: a systematic review.

Colella G, Cannavale R, Pentenero M, Gandolfo S.
Int J Oral Maxillofac Implants. 2007 Jul-Aug;22(4):616-22.
Effect of postoperative radiotherapy on

the functional result of implants placedduring ablative surgery for oral cancer.
Schepers RH, Slagter AP, Kaanders JH, van den Hoogen FJ, Merkx MA.
Int J Oral Maxillofac Surg. 2006 Sep;35(9):803-8.
The mental foramen and nerve: clinical and anatomical factors related to dentalimplant placement:
a literature review.
Greenstein G, Tarnow D.
J Periodontol. 2006 Dec;77(12):1933-43.
Vertical distance from the crest of bone to the height of

the interproximal papillabetween adjacent implants.
Tarnow D, Elian N, Fletcher P, Froum S, Magner A, Cho SC, Salama M, Salama H, Garber DA.
J Periodontol. 2003 Dec;74(12):1785-8.
The effect of inter-implant distance on the height of inter-implant bone crest.

Tarnow DP, Cho SC, Wallace SS.
J Periodontol. 2000 Apr;71(4):546-9.
A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans.

Tan WL, Wong TL, Wong MC, Lang NP.

Clin Oral Implants Res. 2012 Feb;23 Suppl 5:1-21.
Surgical protocols for ridge preservation after tooth extraction. A systematic review.
Vignoletti F, Matesanz P, Rodrigo D, Figuero E, Martin C, Sanz M.
Clin Oral Implants Res. 2012 Feb;23 Suppl 5:22-38.
Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for
dental implant treatment.
Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P.
Cochrane Database Syst Rev. 2009 Oct 7;(4):CD003607.
Assessments
SST EXAMINATION
AOP TREATMENT OF HARD SOFT

TISSUE PROBLEM PREPROSTHETIC
REASONS (VESTIBULOPLASTY)
AOP PLACEMMENT IMPLANT
AOP PLACEMENT IMPLANT
WITH ADJUNCTIVE
PROCEDURES
FINAL EXAMINATION
(TAC)
FINAL EXAMINATION
• Define the basic principles in the management of • Take a history, examine, diagnose and plan the • Perform complex surgical implant
prosthetic rehabilitation treatment for patients who need preprosthetic surgery procedures including adjunctive
• Recognise and identify indications for and implants procedures
preprosthetic surgery • Present well documented assessments and • Augmentation of the alveolar process
• Describe the anatomy and physiology of the head recommendations in written and verbal form Harvest autogenous bone utilising such
and neck with particular reference to implant • Communicate with patients (and their families) about donor sites as, lateral mandible, chin, iliac
surgery procedures, potentials, and risks associated with crest, tibia, etc
basic preprosthetic surgery and implants in ways that

• Identify and discuss medical factors affecting encourage their participation in informed decision Augmentation with alloplastic materials
treatment making such as calcium based compounds and
• Describe the implications for the aged patient in • Using appropriate medical terminology, clearly mixtures, such as platelet rich plasma
preprosthetic and implant surgery communicate with allied specialists (PRP) and bone morphogenetic protein
(BMP)
• Describe the anatomy and pathophysiology of • Describe the concepts of osseointegration and
edentulous bone loss transfer of load Lateralisation of the inferior dental nerve
Sinus lift procedures
• Resorption • Differentiate the various types of implants
Alveolar distraction
• Factors influencing bone loss • Perform basic preprosthetic surgical procedures to
include: Guided tissue regeneration with
• Metabolic membranes
Osteoporosis Frenectomy and socket preservation
Removal denture hyperplasia • Communicate with patients (and their
Osteomalacia families) about procedures, potentials and
Drug therapy Submucous vestibuloplasty risks associated with the above modalities
Renal osteodystrophy Vestibuloplasty with skin or mucosal graft in ways that encourage their participation
Nutritional Lowering floor of mouth with or without graft in informed decision making
Facial Morphology, etc Mylohyoid ridge reduction • Discuss the management of complex
Mechanical factors – trauma Reduction of tuberosity implant problems and rehabilitation
Alteration in form Tuberoplasty • Immediate loading and its implications
Mental nerve reposition Orthognathic surgery associated with
• Discuss the management of patients with
compromised bone – Mandibular and maxillary Bone augmentation implants
irradiated bone, bisphosphonate treated bone Alveoloplasty Bone graft procedures and augmentation
Secondary alveolar recontouring grafts
• Discuss the principles of bone induction and the
biology of grafting Redundant crestal tissue removal Distraction osteogenesis to reposition the
jaws and segments of the jaws
Principles of osteoinduction Maxillary tuberosity reduction
Orthopaedic and orthodontic applications
Principles of transplantation Tuberplasty
Restoration of acquired head and Neck
Bone grafts Tori removal
defects
Compare and contrast various diagnostic imaging Papillary hyperplasia, etc
Reconstruction of the trauma patient
modalities • Perform basic implant surgery (one or two implants in
Reconstruction of the patient with
• Conventional imaging for preprosthetic and implant the maxilla and/or mandible not requiring adjunctive
congenital deformity
surgery surgical procedures)
Reconstruction of the patient with
Panoranic radiograph • Manage post-operative complications developmental deformity
Lateral cephalometric radiograph Reconstruction and rehabilitation of the
Periapical radiograph Cancer patient
Occlusal radiograph Management of irradiated bone
Tomography Reconstruction of the patient with an
CT Imaging and computer aided planning alveolar cleft

3D reconstruction Extra-oral implants including zygomatic

MR imaging implants
Bone scans (Tc99) BAHA and its indications
3D biomodelling, etc

3.1.5 MODULE 5: PAEDIATRIC ORAL AND MAXILLOFACIAL SURGERY
MODULE 5: Paediatric Oral and Maxillofacial Surgery

A trainee eligible to sit for the FRACDS(OMS) should be  Perform a Cephalometric analysis (TE)
able to:  Participate in the cleft lip and palate/ craniofacial team (CDM)
• Explain and justify the current approaches to antenatal Logbook
investigation and limitations with respect to facial Trainee to log –
deformity
• Dentoalveolar – elective – syndromic or cleft patient (1)
• Appropriately examine the paediatric patient
• Trauma (3, 4)
• Communicate with patients (and their families) about
• Pathology (5, 6)
procedures, potentials and risks associated with
paediatric care • Orthognathic – complex - cleft/craniofacial (12)
• Manage patients and their parents in ways that • TMJ (13)
demonstrate sensitivity to their psychological as well • Reconstructive – distant grafts for congenial abnormalities (15, 18)
as physiological needs (Number refers to category in Log book)
• Identify the normal anatomy and physiology growth
Literature Review
curves and milestones of childhood
• Implement appropriate perioperative management • Discuss the use of distraction osteogenesis for the paediatric patient with airway obstruction
skills (including fluid and electrolyte management) • Use of resorbable materials in paediatric OMS
particularly related to care of the surgical paediatric
patient Lecture / Tutorial
• Manage the common oral and maxillofacial surgical • Alveolar bone grafting to the maxillary alveolar cleft (TE)
disorders of childhood • Principles of managing facial fractures in the paediatric patient (CDM)
• Discuss and understand the principles, and be able to • Orthognathic surgery in the cleft and craniofacial microsomia patient (TE)
manage and surgically treat oral and maxillofacial • Management of paediatric facial fractures (mid-facial and mandibular fractures) (TE)
pathological conditions, congenital and developmental • Principles of assessment of upper airway obstruction (CDM)
anomalies and trauma in children
• Participate in the paediatric OMS clinic and/or cleft lip Essay
and palate clinic and be able to competently assess • Discuss the pathway of management from birth to maturity in infant craniosynostoses
and treat patients as required • Discuss the management of TMJ ankylosis in the growing patient
• Consult, cooperate and discuss with other clinicians
as required Demonstration
• Teach and encourage other juniors, undergraduates (Trainee to practice the same procedure on the opposite side)
and graduates on ward rounds, clinics and other • Management of mandibular congenital asymmetry
classes as required

• Understand the processes involved in the employing (Trainee to make written notes on patient encounters)
hospital as well as the funding and administration of • Informed consent (parents and child)
the employing hospital and health department • Explanation of the procedure of alveolar bone grafting to a cleft and harvest of the graft, including
potential side effects, risks and specific complications
Refer below for a complete list of competencies by level. • Explanation of orbital floor exploration +/- reconstruction in a child following trauma, potential
post-operative course, risks and specific complications of orbital surgery
• Psychological and ethical management – balanced discussion with parents and child of the
option of orthognathic surgery in a patient who presents with a significant medical comorbidity
(e.g. cystic fibrosis), intellectual disability, limited life expectancy or religious belief which impacts
upon potential management
Resources
Kaban L, Troulis M (2004). Pediatric Oral and A proposed modification for the classification of cleft lip and cleft palate.
Maxillofacial Surgery. Saunders. Spina V.
Cleft Palate J. 1973 Jul;10:251-2.
Posnick JC (2000). Craniofacial and Maxillofacial Surgery
in Children and Young Adults. Saunders. From birth to maturity: a group of patients who have completed their protocol management. Part I.
Unilateral cleft lip and palate.
Atlas of Oral & Maxillofacial Surgery, Elsevier 2015 Schnitt DE, Agir H, David DJ.
Plast Reconstr Surg. 2004 Mar;113(3):805-17.
Oral & Maxillofacial Surgery- Eds Anderson,
Kahnberg and Pogrel, 2010. Chapter 45 “Cleft Lip & From birth to maturity: a group of patients who have completed their protocol management. Part II.
Isolated cleft palate.
Palate- an overview”
David DJ, Anderson PJ, Schnitt DE, Nugent MA, Sells R.
Plast Reconstr Surg. 2006 Feb;117(2):515-26.
Journals
The reconstruction of anterior residual bone defects in patients with cleft lip, alveolus and palate. A
International Journal of Oral and Maxillofacial Surgery
review.
Witsenburg B.
Cleft Palate and Craniofacial Surgery Journal
J Maxillofac Surg. 1985 Oct;13(5):197-208.
Ensuring success in alveolar bone grafting: a three-dimensional approach.
Craven C, Cole P, Hollier L Jr, Stal S.
Plastic & Reconstructive Surgery – (Cleft & Craniofacial
J Craniofac Surg. 2007 Jul;18(4):855-9.
Education modules)
Bergland O, Semb G, Abyholm FE. Elimination of the residual alveolar cleft by secondary bone grafting
and subsequent orthodontic treatment. Cleft Palate J 1986;23:175–204.

Secondary osteoplasty of the alveolar cleft defect.

Horswell BB, Henderson JM.
Not all dwarfed mandibles are alike

Pruzansky S.
Birth Defects 1969;1:120.
Surgical correction of hemifacial microsomia in the growing child.

Kaban LB, Moses MH, Mulliken JB.
Plast Reconstr Surg. 1988 Jul;82(1):9-19.
Three-dimensional approach to analysis and treatment of hemifacial microsomia.

Kaban LB, Mulliken JB, Murray JE.
Cleft Palate J. 1981 Apr;18(2):90-9.
The O.M.E.N.S. classification of hemifacial microsomia.

Vento AR, LaBrie RA, Mulliken JB.
Cleft Palate Craniofac J. 1991 Jan;28(1):68-76
OMENS-Plus: analysis of craniofacial and extracraniofacial anomalies in hemifacial microsomia.

Horgan JE, Padwa BL, LaBrie RA, Mulliken JB.
Cleft Palate Craniofac J. 1995 Sep;32(5):405-12.
Hemifacial Microsomia: use of the OMENS-Plus classification at the Royal Children’s Hospital of
Melbourne.
Poon C-H, Meara JG, Heggie AA.
Plast Reconstr Surg 2003;111:1011-8.
Longitudinal analysis of mandibular asymmetry in hemifacial microsomia.

Polley JW, Figueroa AA, Liou EJ, Cohen M.
A longitudinal three-dimensional evaluation of the growth pattern in hemifacial microsomia treated by

mandibular distraction osteogenesis: a preliminary report.
Kusnoto B, Figueroa AA, Polley JW.
J Craniofac Surg. 1999 Nov;10(6):480-6.

Midfacial growth after costochondral graft construction of the mandibular ramus in hemifacial
microsomia.
Padwa BL, Mulliken JB, Maghen A, Kaban LB.
J Oral Maxillofac Surg. 1998 Feb;56(2):122-7
Progression of facial asymmetry in hemifacial microsomia.

Kearns GJ, Padwa BL, Mulliken JB, Kaban LB.
Surgical correction of mandibular hypoplasia in hemifacial microsomia: the case for treatment in early
childhood.
Kaban LB, Padwa BL, Mulliken JB.
J Oral Maxillofac Surg. 1998 May;56(5):628-38.
No evidence for long-term effectiveness of early osteodistraction in hemifacial microsomia.

Nagy K, Kuijpers-Jagtman AM, Mommaerts MY.
Plast Reconstr Surg. 2009 Dec;124(6):2061-71
Hemimandibular hyperplasia--hemimandibular elongation.

Obwegeser HL, Makek MS.
J Maxillofac Surg. 1986 Aug;14(4):183-208.
Bone scintigraphy as a diagnostic method in unilateral hyperactivity of the mandibular condyles: a

review and meta-analysis of the literature.
Saridin CP, Raijmakers PG, Tuinzing DB, Becking AG.
Int J Oral Maxillofac Surg. 2011 Jan;40(1):11-7.
Effect of alveolar bone grafting in the mixed dentition on maxillary growth in complete unilateral cleft
lip and palate patients. Daskalogiannakis J, Ross R B. Cleft Palate Craniofac J 1997;34:455-458.
Nevoid basal cell carcinoma syndrome: a review of the literature. Manfredi M, Vescovi P, Bonanini M,
Porter S. Int J Oral Maxillofac Surg 2004;33:117-124.
Management of Airway Obstruction in Infants With Pierre Robin Sequence.

Runyan CM, Uribe-Rivera A, Tork S, Plast Reconstr Surg Glob Open. 2018 May 10;6(5):e1688. doi:
10.1097/GOX.0000000000001688.
The role of distraction osteogenesis in the management of craniofacial syndromes

Heggie AA, Kumar R, Shand JM. Annals of Maxillofacial Surgery 2013: 3; 4-10

Craniofacial Disorders.
Heggie AA
Aust Dent J 2018; 63: (1 Suppl): S58-68
Paediatric Oral & Maxillofacial Surgery

Shand JM
Aust Dent J 2018; 63: (1 Suppl): S69-78.
Assessments
SST EXAMINATION
DENTOALVEOLAR INJURIES IN A
PAEDIATRIC PATIENT
AOP HARVEST OF CANCELLOUS
ILIAC CREST BONE GRAFT
AOP MANAGEMENT OF
PAEDIATRIC MANDIBULAR
OR MID-FACIAL FRACTURE
FINAL EXAMINATION
(TAC)
FINAL EXAMINATION

• Perform an examination using techniques • Discuss the implications of surgery and trauma • Remove or expose impacted teeth in the syndromic
that are age appropriate and matched to on the growing patient or cleft patient
the needs of the patient • Remove or expose impacted/ankylosed teeth, • Describe the management of patients with bone
• Order and interpret appropriate and undertake management of medically disorders eg osteogenesis imperfecta, osteopetrosis,
investigations complicated patients (haematological disorders fibrous dysplasia
• Discuss the pharmacological aspects of etc) for dento-alveolar procedures • Perform surgery for cystic and fibro-osseous lesions
pain control and antimicrobial therapy for • Manage oro-facial infections • Describe the assessment, diagnosis and the
children • Describe TMJ disorders in children and management of patients with limited jaw opening /
• Perform the peri-operative management differences from the adult population. mandibular hypomobility

of the medically compromised paediatric • Perform surgery for intra-oral soft tissue • Describe the principles of surgical management in
patient anomalies and lesions: frenum, soft tissue the interdisciplinary management of clediocranial
• Communicate with patients and their lesions, gingivo-fibromatoses & salivary gland dysplasia or hypodontia syndromes, e.g. ectodermal
families about procedures, potential lesions (mucocoeles, ranula) etc dysplasia
complications and risks associated with • Manage dentoalveolar injuries • Surgical management of dento-alveolar and
the paediatric patient • Perform the initial assessment and management maxillofacial injuries in the paediatric patient
• Describe facial growth and development of the child patient with orbital, mid-facial and • Describe the principles of interdisciplinary
Discuss the management of cystic and mandibular fractures management of severe craniofacial trauma
odontogenic lesions in children • Discuss the options, principles of management • Participate in the cleft lip and palate/craniofacial team
and use of fixation in children and Orthognathic meetings
• Describe the pathology, genetics and • Describe and have knowledge of:
management of disorders of disorders presenting -Pre-surgical orthopaedics and early orthodontic
in childhood eg NBCCS, fibrous dysplasia, treatment
Langerhans cell histocytosis -The principles of primary cleft repair
• Understand the management of:
Cleft lip and palate / Craniofacial microsomia: -Maxillary alveolar cleft
• Describe the stages in management of the cleft / - Surgically-assisted maxillary expansion
CFM patient (pathway protocols) - Oronasal and palatal fistula repair
• Discuss treatment planning for surgical skeletal -The surgical management of the cleft maxilla and
correction related
• Perform a cephalometric analysis orthognathic surgery
• Perform model taking and articulation or - Reconstruction of the cleft alveolus for tooth
computer planning replacement
• Perform clinical photography - Craniofacial implantology - Ear and orbital
prostheses
- Surgical protocols in management of the more
common
craniofacial syndromes, e.g. Treacher Colins
Syndrome and craniosynostoses
• Discuss the assessment and management options
for upper airway obstruction in infants and children
• Discuss the role of distraction osteogenesis for the
paediatric patient

3.1.6 MODULE 6: ORAL & MAXILLOFACIAL PATHOLOGY
MODULE 6: Oral & Maxillofacial Pathology

 Recognise, describe and interpret radiological pathology in the maxillofacial region
able to:
 Recognise histopathology in the maxillofacial region
 Recognise and interpret various haematological and biochemical tests
• Apply knowledge of radiology in the interpretation of  Independently manage patients with pathology in the maxillofacial region
pathology in the maxillofacial region, including what  Independently or jointly manage malignant pathology of the maxillofacial region in a
radiological modality is indicated for various tissues multidisciplinary setting
types
• Understand the sequencing of investigations of head Logbook
and neck pathology, and the sensitivities and Trainee to log –
specificity of various investigations with respect to • Pathology – benign (5)
pathological type
• Pathology – malignant (6)
• Have a sound knowledge of normal histology and • Pathology – reconstruction of the defect after removal of the pathology (15,16,17)
apply this knowledge in the treatment of conditions in (Number refers to category in Logbook)
the maxillofacial area
• Have a sound knowledge of the histopathology of Literature Review
various conditions in the maxillofacial region and apply • Reconstruction of the mandible following tumour ablation
this knowledge in the treatment of these problems • Odontogenic tumours in the maxillofacial region
• Have a sound knowledge of normal and abnormal • Salivary Gland tumours and their management
haematological values in the management of patients • Staging of squamous cell carcinoma of the oral cavity
with maxillofacial diseases
• Keratocycts of the maxilla and mandible and their management
• Have a sound knowledge of normal and abnormal • Neoplasms of the immune system
biochemistry and special tests in the management of
• Management of malignant melanoma in the head and neck region
patients with maxillofacial disease
• Management of non-melanoma skin cancer in the head and neck region
• Investigate and treat benign pathology in the
maxillofacial region Tutorial
• Investigate and treat malignant pathology in the • Keratocysts of the mandible
maxillofacial region in association with a • Parotid salivary gland pathology
multidisciplinary clinic
• Minor salivary gland pathology
• Appropriately manage and treat pathology in the • Squamous cell carcinoma of the oral cavity
maxillofacial region using both surgical and non-
• Osteoradionecrosis of the jaws
surgical protocols
• Granulomatous diseases of the maxillofacial region
• Appropriately reconstruct defects following ablation of
• Premalignant disease
pathology in the maxillofacial region
• Haematology and diagnostic tests

• Understand concepts of dermoscopy, margin control • Fibro osseous disease and systemic diseases effecting bone
surgery and aesthetic subunit reconstruction in the
management of cutaneous malignancy Case Study
• Consult, cooperate and discuss with other clinicians as • Maxillary reconstruction after resection
required • Mandibular reconstruction after resection including rehabilitation
• Teach and hand down, encourage other juniors,
undergraduates and graduates on ward rounds, clinics Observation
and other classes as required • Neck dissection in relation to malignant disease in the head and neck
• Understand the processes involved in the employing • Parotidectomy for benign pathology
hospital as well as the funding and administration of • Nerve grafting and repair, microvascular free transfer of tissues
the employing hospital and health department
Simulation
Refer below for a complete list of competencies by level. • TMJ Arthroscopy
• Salivary endoscopy – Salivary stones and dilation of ducts (sialadenoscopy)
• Endoscopy of the maxillary sinus – removal of foreign bodies, orbital floor exploration
• Microneurosurgery/Microvascular surgery
• Explanation of malignant disease to a patient and family members
• Explanation, management and rehabilitation of the cancer patient
Resources

Neville BW, Damm DD, Allen CM, Bouquot J (2008). Oral KCOT
and Maxillofacial Pathology (3rd ed). Saunders.
Characterization and management of the keratocystic odontogenic tumor in relation to its
Cardesa A, Slootweg P (2006). Pathology of the Head and histopathological and biological features.
Neck. Springer. Mendes RA, Carvalho JF, van der Waal I.
Oral Oncol. 2010 Apr;46(4):219-25.
Barnes L, Reichart P, Sidransky D (2005). World Health
Organization Classification of Tumours: Pathology and The treatment of odontogenic keratocysts by excision of the overlying, attached mucosa,
Genetics of Head and Neck Tumours. WHO Press. enucleation, and treatment of the bony defect with carnoy solution.
Stoelinga PJ.
J Oral Maxillofac Surg. 2005 Nov;63(11):1662-6.
Journals Systematic review of the treatment and prognosis of the odontogenic keratocyst.
Blanas N, Freund B, Schwartz M, Furst IM.
Journal of Oral and Maxillofacial Surgery Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Nov;90(5):553-8.

International Journal of Oral and Maxillofacial Surgery A systematic review of the recurrence rate for keratocystic odontogenic tumour in relation to
treatment modalities.
Journal of Cranio-Maxillofacial Surgery Kaczmarzyk T, Mojsa I, Stypulkowska J.
Journal of Oral Pathology
Critical time of exposure of the rabbit inferior alveolar nerve to Carnoy's solution.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Frerich B, Cornelius CP, Wiethölter H.
Radiology and Endodontics J Oral Maxillofac Surg. 1994 Jun;52(6):599-606.
The effect of surgical medicaments on peripheral nerve function.

Loescher AR, Robinson PP.
Br J Oral Maxillofac Surg. 1998 Oct;36(5):327-32.
Nevoid basal cell carcinoma syndrome: a review of the literature.

Manfredi M, Vescovi P, Bonanini M, Porter S.
Int J Oral Maxillofac Surg. 2004 Mar;33(2):117-24.
Odontogenic keratocysts: a clinical and histologic comparison of the parakeratin and orthokeratin
variants.
Crowley TE, Kaugars GE, Gunsolley JC.
Journals J Oral Maxillofac Surg. 1992 Jan;50(1):22-6.
Journal of Oral and Maxillofacial Surgery
Ameloblastoma
The ameloblastoma: primary, curative surgical management.
Journal of Cranio-Maxillofacial Surgery Carlson ER, Marx RE.
J Oral Maxillofac Surg. 2006 Mar;64(3):484-94.
Journal of Oral Pathology
Ameloblastoma: a surgeon's dilemma.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Ghandhi D, Ayoub AF, Pogrel MA, MacDonald G, Brocklebank LM, Moos KF.
Radiology and Endodontics J Oral Maxillofac Surg. 2006 Jul;64(7):1010-4.
Rational approach to diagnosis and treatment of ameloblastomas and odontogenic keratocysts.

Chapelle KA, Stoelinga PJ, de Wilde PC, Brouns JJ, Voorsmit RA.
Surgical treatment of recurring ameloblastoma, are there options?

Hammarfjord O, Roslund J, Abrahamsson P, Nilsson P, Thor A, Magnusson M, Kjeller G,
Englesson-Sahlström C, Strandkvist T, Warfvinge G, Krüger-Weiner C.

Br J Oral Maxillofac Surg. 2013 Dec;51(8):762-6.
Long-term follow up on recurrence of 305 ameloblastoma cases.

Hong J, Yun PY, Chung IH, Myoung H, Suh JD, Seo BM, Lee JH, Choung PH.
Int J Oral Maxillofac Surg. 2007 Apr;36(4):283-8.
Comparison of long-term results between different approaches to ameloblastoma.

Nakamura N, Higuchi Y, Mitsuyasu T, Sandra F, Ohishi M.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jan;93(1):13-20.
Maxillary ameloblastoma: a retrospective study of 13 cases.

Nastri AL, Wiesenfeld D, Radden BG, Eveson J, Scully C.
Ameloblastoma in children.
Ord RA, Blanchaert RH Jr, Nikitakis NG, Sauk JJ.
J Oral Maxillofac Surg. 2002 Jul;60(7):762-70
The unicystic ameloblastoma: a clinicopathological study of 57 cases.

Ackermann GL, Altini M, Shear M.
J Oral Pathol. 1988 Nov;17(9-10):541-6.
Unicystic ameloblastoma. A review of 193 cases from the literature.

Philipsen HP, Reichart PA.
Oral Oncol. 1998 Sep;34(5):317-25.
Recurrence related to treatment modalities of unicystic ameloblastoma: a systematic review.

Lau SL, Samman N.
MRONJ
American Association of Oral and Maxillofacial Surgeons Position Paper on Medication-Related

Osteonecrosis of the Jaw—2014 Update
Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra Bhoomi, O’Ryan F.
Journal of Oral and Maxillofacial Surgery. 2014 Oct: 72(10):1938-1956.
Bisphosphonate osteonecrosis of the jaw--a literature review of UK policies versus international

policies on bisphosphonates, risk factors and prevention.

Patel V, McLeod NM, Rogers SN, Brennan PA.

Br J Oral Maxillofac Surg. 2011 Jun;49(4):251-7.
Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia.

Mavrokokki T, Cheng A, Stein B, Goss A.
Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing,
prevention, and treatment.
Marx RE, Cillo JE Jr, Ulloa JJ.
Clinical investigation of C-terminal cross-linking telopeptide test in prevention and management of

bisphosphonate-associated osteonecrosis of the jaws.
Kunchur R, Need A, Hughes T, Goss A.
A C-terminal crosslinking telopeptide test-based protocol for patients on oral bisphosphonates

requiring extraction: a prospective single-center controlled study.
Hutcheson A, Cheng A, Kunchar R, Stein B, Sambrook P, Goss A.
ORN
Risk factors for osteoradionecrosis after head and neck radiation: a systematic review.
Nabil S, Samman N.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Jan;113(1):54-69.
Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a

systematic review.
Nabil S, Samman N.
Osteoradionecrosis: a new concept of its pathophysiology.

Marx RE.
The radiation-induced fibroatrophic process: therapeutic perspective via the antioxidant pathway.
Delanian S, Lefaix JL.
Radiother Oncol. 2004 Nov;73(2):119-31.

Osteoradionecrosis of the mandible: scientific basis for clinical staging.

Schwartz HC, Kagan AR.
Am J Clin Oncol. 2002 Apr;25(2):168-71.
Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus

penicillin.
Marx RE, Johnson RP, Kline SN.
J Am Dent Assoc. 1985 Jul;111(1):49-54.
Efficacy of pre- and postirradiation hyperbaric oxygen therapy in the prevention of postextraction
osteoradionecrosis: a systematic review.
Fritz GW, Gunsolley JC, Abubaker O, Laskin DM.
A new concept in the treatment of osteoradionecrosis.

Marx RE.
Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled, double-
blind trial from the ORN96 study group.
Annane D, Depondt J, Aubert P, Villart M, Géhanno P, Gajdos P, Chevret S.
J Clin Oncol. 2004 Dec 15;22(24):4893-900.
Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and
tocopherol: a phase II trial.
Delanian S, Depondt J, Lefaix JL.
Head Neck. 2005 Feb;27(2):114-23.
Paradigm shifts in the management of osteoradionecrosis of the mandible.

Jacobson AS, Buchbinder D, Hu K, Urken ML.
Oral Oncol. 2010 Nov;46(11):795-801.
FNA CNB Frozen Section
Comparison of ultrasound-guided core-needle biopsy and fine-needle aspiration in the assessment

of head and neck lesions.
Kraft M, Laeng H, Schmuziger N, Arnoux A, Gürtler N.
Head Neck. 2008 Nov;30(11):1457-63.

The sensitivity and specificity of frozen-section histopathology in the management of benign oral and
maxillofacial lesions.
Aronovich S, Kim RY.
Accuracy of frozen sections in assessing margins in oral cancer resection.

Ord RA, Aisner S.
Accuracy, utility, and cost of frozen section margins in head and neck cancer surgery.
DiNardo LJ, Lin J, Karageorge LS, Powers CN.
Laryngoscope. 2000 Oct;110(10 Pt 1):1773-6.
Impact of use of frozen section assessment of operative margins on survival in oral cancer.
Pathak KA, Nason RW, Penner C, Viallet NR, Sutherland D, Kerr PD.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Feb;107(2):235-9.
Salivary gland
Modern management and pathophysiology of ranula: literature review.

Harrison JD.
Head Neck. 2010 Oct;32(10):1310-20.
A systematic review and meta-analysis of the diagnostic accuracy of fine-needle aspiration cytology
for parotid gland lesions.
Schmidt RL, Hall BJ, Wilson AR, Layfield LJ.
Am J Clin Pathol. 2011 Jul;136(1):45-59.
A systematic review and meta-analysis of the diagnostic accuracy of ultrasound-guided core needle
biopsy for salivary gland lesions.
Schmidt RL, Hall BJ, Layfield LJ.
Am J Clin Pathol. 2011 Oct;136(4):516-26.
Minimally invasive options for salivary calculi.

Witt RL, Iro H, Koch M, McGurk M, Nahlieli O, Zenk J.
Laryngoscope. 2012 Jun;122(6):1306-11.
Alternatives for the treatment of salivary duct obstruction.

McGurk M, Brown J.

Otolaryngol Clin North Am. 2009 Dec;42(6):1073-85
Outcome of minimally invasive management of salivary calculi in 4,691 patients.

Iro H, Zenk J, Escudier MP, Nahlieli O, Capaccio P, Katz P, Brown J, McGurk M.
Laryngoscope. 2009 Feb;119(2):263-8.
Sialoendoscopy: A new approach to salivary gland obstructive pathology.

Nahlieli O, Nakar LH, Nazarian Y, Turner MD.
J Am Dent Assoc. 2006 Oct;137(10):1394-400.
Assessments
SST EXAMINATION
AOP HEAD AND NECK
EXAMINATION PATHOLOGY
AOP TREATMENT REQUIRING
SOFT TISSUE GRAFT/FLAP LOCAL
AND DISTANT SITE
AOP INCISIONAL BIOPSY
AOP EXCISIONAL BIOPSY TREATMENT REQUIRING HARD
TISSUE GRAFT LOCAL DISTANT
SITE
CP AND D MANAGE PATHOLOGY
MAXILLOFACIAL REGION
TEAM APPRAISAL OF CONDUCT FINAL EXAMINATION
(TAC)
FINAL EXAMINATION

3.1.7 MODULE 7: ORAL MUCOSAL DISEASES
MODULE 7: Oral Mucosal Diseases

Involved in the examination, diagnosis, pathological assessment and treatment of patients with a
able to:
broad range of malignant and non-malignant oral mucosal disease including (CDM)
- Recurrent oral aphthae
• Recognise the presenting symptoms of malignant and - Oral lichen planus
non-malignant oral mucosal disease - Mucous membrane pemphigoid
• Understand the underlying pathology and aetiology of - Pemphigus vulgaris
malignant and non-malignant oral mucosal disease - Erythema multiforme
• Investigate and diagnose oral mucosal conditions - Lupus erythematosis
having a thorough knowledge about their biologic basis, - Temporomandibular Disorder
natural history, progression and prognosis - Oral dysaesthesia
• Communicate with patients (and their families) about - Oral candidosis
procedures, reasonable expectations, limitations and
risks associated with malignant and non-malignant oral Logbook
mucosal disease Trainee to attend –
• Identify and forecast the on-going relationship between • Oral medicine clinics
the conditions and general medical signs – ie be able to • Clinicopathological meetings
relate the condition to any underlying medical problem
• Assess the contribution of the more common testing Literature Review / Tutorials
regimens including the role of biopsy and tissue • The role of viruses in oral mucosal disorders
sampling • Current concepts of the immune response found in OLP and how these concepts may help
• Appropriately communicate with patients, general explain the clinical course of this disease
dental and medical practitioners, as well as other • The published evidence of the success of treatment for patients with mucosal disorders
specialties regarding management and treatment
• Develop a care plan for patients with non-malignant Essay
mucosal disease and follow-up these patients as • Briefly outline the diagnosis and treatment of burning mouth syndrome
required • Discuss the concepts of neuropathy and neuropathic pain as they relate to the clinical practice
• Develop a care plan for patients with malignant oral • Desquamative gingivitis is a clinical manifestation of several different disease processes.
mucosal disease in conjunction with a multidisciplinary Discuss these processes in terms of their immunopathogeneses as this relates to their
clinic diagnosis
• Consult, cooperate and discuss with other clinicians as • Outline the diagnosis and treatment of orofacial granulomatosis
required • Sjogren’s Syndrome (SS) is an inflammatory disease that affects the exocrine glands. Outline
the classification and diagnosis of SS
• The aetiology of oral lichen planus remains unknown; however, it has been postulated to

• Teach and hand down, encourage other juniors, involve immunogenic triggering of apoptosis in basal keratinocytes. Outline your
undergraduates and graduates on ward rounds, clinics understanding of the aetiology of oral lichen planus
• Understand the processes involved in the employing Observation
hospital as well as the funding and administration of the • The pathological assessment of a range of mucosal disease
employing hospital and health department
Case Study
Refer below for a complete list of competencies by level. Documented treatment of patients with -
− Recurrent aphthous ulceration
− Oral lichen planus
− Mucous membrane pemphigoid
− Pemphigus vulgaris
− Erythema multiforme
− Lupus erythematosis
− Temporomandibular Disorder
− Oral dysaesthesia
− Oral candidosis
− Dry mouth
• Explanation of the diagnosis, management and continuing care of patients with a range of
non-malignant mucosal disease as well as patients with TMD, oral dysaesthesia and
trigeminal neuropathies
Resources
OLP
Neville BW, Damm DD, Allen CM, Bouquot J (2008). Oral
and Maxillofacial Pathology (3rd ed). Saunders. Malignant transformation of oral lichen planus and oral lichenoid lesions: A meta-analysis of 20095
patient data.
Slootweg PJ, Cardesa A (2006). Pathology of the Head and Aghbari SMH, Abushouk AI, Attia A, Elmaraezy A, Menshawy A, Ahmed MS, Elsaadany BA,
Neck. Springer. Ahmed EM.
Oral Oncol. 2017 May;68:92-102.
Farah CS, Balasubramaniam R, McCullough MJ (2018).
Contemporary Oral Medicine. Springer. The malignant transformation of oral lichen planus and oral lichenoid lesions: a systematic review.
Fitzpatrick SG, Hirsch SA, Gordon SC.
J Am Dent Assoc. 2014 Jan;145(1):45-56.

Oral lichen planus: controversies surrounding malignant transformation.

Gonzalez-Moles MA, Scully C, Gil-Montoya JA.
Oral Dis. 2008 Apr;14(3):229-43.
Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently
available diagnostic criteria and suggestions for modifications.
van der Meij EH, van der Waal I.
J Oral Pathol Med. 2003 Oct;32(9):507-12.
Lichenoid dysplasia: a distinct histopathologic entity.

Krutchkoff DJ, Eisenberg E.
Journals & web based materials Oral Surg Oral Med Oral Pathol. 1985 Sep;60(3):308-15.
Pubmed Potentially malignant disorders
Oral Oncology Oral potentially malignant disorders: risk of progression to malignancy.
Speight P. M., Khurram S. A. and Kujan O.
Journal of Oral and Maxillofacial Surgery Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Jun;125(6):612-627
British Journal of Oral and Maxillofacial Surgery
Interventions for treating oral leukoplakia to prevent oral cancer.
International Journal of Oral and Maxillofacial Surgery Lodi G, Franchini R, Warnakulasuriya S, Varoni EM, Sardella A, Kerr AR, Carrassi A, MacDonald
LC, Worthington HV.
Australian Dental Journal Cochrane Database Syst Rev. 2016 Jul 29;7:CD001829.
Journal of Oral Pathology and Oral Medicine Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with
clinically evident lesions.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Macey R, Walsh T, Brocklehurst P, Kerr AR, Liu JL, Lingen MW, Ogden GR, Warnakulasuriya S,
Radiology and Endodontics Scully C.
Cochrane Database Syst Rev. 2015 May 29;(5):CD010276
Nomenclature and classification of potentially malignant disorders of the oral mucosa.

Warnakulasuriya S, Johnson NW, van der Waal I.
J Oral Pathol Med. 2007 Nov;36(10):575-80.
Potentially malignant disorders of the oral and oropharyngeal mucosa; terminology, classification
and present concepts of management.
van der Waal I.
Oral Oncol. 2009 Apr-May;45(4-5):317-23.

Oral leukoplakia and malignant transformation. A follow-up study of 257 patients.

Silverman S Jr, Gorsky M, Lozada F.
Cancer. 1984 Feb 1;53(3):563-8.
Erythroplakia of the oral cavity.

Shafer WG, Waldron CA.
Cancer. 1975 Sep;36(3):1021-8.
Malignant transformation rate in oral submucous fibrosis over a 17-year period.

Murti PR, Bhonsle RB, Pindborg JJ, Daftary DK, Gupta PC, Mehta FS.
Community Dent Oral Epidemiol. 1985 Dec;13(6):340-1.
Vesiculobullous disease
Definitions and outcome measures for mucous membrane pemphigoid: recommendations of an

international panel of experts.
Murrell DF, Marinovic B, Caux F et al.
J Am Acad Dermatol. 2015 Jan;72(1):168-74.
World Workshop on Oral Medicine VI: a systematic review of the treatment of mucocutaneous
pemphigus vulgaris.
McMillan R, Taylor J, Shephard M et al.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Aug;120(2):132-42.e61.
Consensus statement on definitions of disease, end points, and therapeutic response for
pemphigus.
Murrell DF, Dick S, Ahmed AR et al.
J Am Acad Dermatol. 2008 Jun;58(6):1043-6.
Immunopathology and molecular diagnosis of autoimmune bullous diseases.

Mihai S, Sitaru C.
J Cell Mol Med. 2007 May-Jun;11(3):462-81.
Pemphigus group (vulgaris, vegetans, foliaceus, herpetiformis, brasiliensis).

Joly P, Litrowski N.
Clin Dermatol. 2011 Jul-Aug;29(4):432-6.
Interventions for pemphigus vulgaris and pemphigus foliaceus.

Martin LK, Werth V, Villanueva E, Segall J, Murrell DF.
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006263.

The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria,
pathogenic factors, medical treatment, and prognostic indicators.
Chan LS, Ahmed AR, Anhalt GJ et al.
Arch Dermatol. 2002 Mar;138(3):370-9.
Interventions for mucous membrane pemphigoid and epidermolysis bullosa acquisita.

Kirtschig G, Murrell D, Wojnarowska F, Khumalo N.
Cochrane Database Syst Rev. 2003;(1):CD004056.
Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-
Johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study.
Auquier-Dunant A, Mockenhaupt M, Naldi L, Correia O, Schröder W, Roujeau JC; SCAR Study
Group. Severe Cutaneous Adverse Reactions.
Arch Dermatol. 2002 Aug;138(8):1019-24.
Recurrent erythema multiforme: clinical characteristics, etiologic associations, and treatment in a

series of 48 patients at Mayo Clinic, 2000 to 2007.
Wetter DA, Davis MD.
J Am Acad Dermatol. 2010 Jan;62(1):45-53.
Systemic Immunomodulating Therapies for Stevens-Johnson Syndrome and Toxic Epidermal

Necrolysis: A Systematic Review and Meta-analysis.
Zimmermann S, Sekula P, Venhoff M, Motschall E, Knaus J, Schumacher M, Mockenhaupt M.
JAMA Dermatol. 2017 Jun 1;153(6):514-522
Comprehensive survival analysis of a cohort of patients with Stevens-Johnson syndrome and toxic
epidermal necrolysis.
Sekula P, Dunant A, Mockenhaupt M, Naldi L, Bouwes Bavinck JN, Halevy S, Kardaun S, Sidoroff
A, Liss Y, Schumacher M, Roujeau JC; RegiSCAR study group.
J Invest Dermatol. 2013 May;133(5):1197-204.

Assessments
SST EXAMINATION
CP AND D ASSESSMENT AND
MANAGEMENT OF ORAL MUCOSAL
DISEASE INCLUDING
IMMUNOHISTOCHEMISTRY
CP AND D ASSESSMENT AND
UNDERSTANDING OF ORAL
MUCOSAL DISEASE
CP AND D ASSESSMENT, TMD ORAL
PAIN
(TAC)
FINAL EXAMINATION
• Describe the structure and function of normal oral and • Describe the manifestations of melanotic naevi of • Define the relationship between
facial mucosa maxillofacial area melanin pigmentation and systemic
• Describe the mucosal manifestations of systemic • Diagnose oral manifestations of sexually diseases and distinguish between
disease transmitted diseases them (this is quite rare)
• Discuss the incidence of clinical conditions with • Describe the maxillofacial manifestation of • Describe the manifestation of oro-facial
borderline abnormality, e.g. Linea Alba, Fordyce immunodeficiency states syndromes, e.g. Bechets, Sturge
anomaly, etc • Describe current pharmacology and therapeutics Weber and Basal Cell Naevus
• Describe and diagnose white and red patches of the for oral mucosal diseases including the role and Syndrome
oral mucosa efficacy of antiviral agents • Diagnose and manage the oral
• Describe, diagnose and manage patients with oral • Diagnose and manage bacterial, fungal and viral mucosal manifestations of
manifestations of: diseases of the oral mucosa haematological disorders
fungal disease • Diagnose and manage patients with vesiculo- • Diagnose and manage oral mucosal
viral disease bullous lesions of the oral mucosa dermatoses and auto-immune
bacterial disease • Diagnose and manage cysts of oral mucosa disorders
dermatoses, e.g. lichen planus • Diagnose oral malignancy, including the lip • Describe and manage the effects of
blood dyscrasias, e.g. anaemia • Discuss malignant transformation of the oral drugs on the oral mucosa
neoplasia mucosa • Management of oral mucosal
• Describe the similarities and difference between • Describe and manage the changes in oral mucosa ulceration

neoplasia, hypertrophy and hyperplasia in relation to systemic disease, e.g. diabetes and • Manage oral malignancy in association
• Describe the use of systemic and topical agents in the mal-absorption syndromes with a multidisciplinary team
management of oral mucosal conditions including the • Describe and manage the malignant transformation • Management of granulomatous
use of steroids. risk of Lichen Planus conditions of the head and neck
• Diagnose and manage gingival swellings • Management of vascular lesions of the oral mucosa
• Diagnose and manage salivary gland conditions
• Diagnose and manage sore mouth and differentiate
between the role of different underlying causes
• Diagnose causes of endogenous and exogenous
pigmentation of oral mucosa and peri-oral region
• Order and interpret appropriate and special tests to
confirm a diagnosis
• Incisional and excisional biopsy
• Immunofluorescence
• Identify and manage iatrogenic mucosal conditions
• Management of xerostomia
• Management of halitosis

3.1.8 MODULE 8: MAXILLARY SINUS DISEASE
MODULE 8: Maxillary Sinus Disease

At the completion of training a trainee should be
 Imaging of the paranasal sinuses
able to:
 Nasendoscopy – examination of the nose and naso-pharynx, including for tumours and cleft deformities
 Closure of oro-antral fistula
• Describe the detailed anatomy of the nose and  Options for the removal of foreign bodies from the maxillary sinus
paranasal sinuses including their relations to  Sinus lift procedure for reconstruction of the posterior maxilla
surrounding structures  Endoscopic sinus surgery
• Describe normal physiology of the nose and  Manage the paranasal sinuses in maxillary and mid-facial trauma
paranasal sinuses  Closure of oro-nasal fistula in cleft patients
• Describe the pathology and microbiology of
sinus mucosal disease Logbook
• Examine the nose and paranasal sinuses Trainee to log –
clinically and with appropriate imaging • Maxillary Sinus (13)
• Give a detailed differential diagnosis of sinus • Reconstructive – hard tissue (14)
disease, in particular sinusitis • Reconstructive – graft harvest (17)
• Discuss the surgical and non-surgical • Pathology – malignant (5)
management of antral disease • Pathology – benign (4)
• Diagnose and manage oro-antral and oro-nasal • Trauma – (3)
communications • Preprosthetic – implants (6,7)
• Have knowledge of the nose and paranasal (Number refers to category in Logbook)
sinuses as they relate to maxillofacial trauma
and orthognathic surgery Literature Review
• Discuss the role of endoscopy in sinus disease • Augmentation/reconstruction of the atrophic maxilla prior to implant placement/zygomatic fixtures
• Consult, cooperate and discuss with other • Management of sinus disease
clinical specialties as required • Microbiology of the infected sinus
• Management of neoplastic sinus pathology – maxillectomy, reconstruction, obturation
Refer below for a complete list of competencies by • Endoscopic sinus surgery
level.
Suggested tutorials or workshops
• Applied anatomy and physiology of the nose and paranasal sinuses
• Imaging of the paranasal sinuses
• The use of implants in the reconstruction of the maxilla
• Workshop on endoscopic sinus techniques
• Differential diagnosis of sinus disease

• The sinuses in mid-facial trauma

• The maxillary sinuses in orthognathic surgery
• Reconstruction of maxillary defects, the importance of maxillary sinus
Observation
• Surgical management of malignant sinus disease, maxillectomy and neck dissection
• Reconstruction options for resected maxillary with local, pedicled (regional) and vascularised (distant)
free flaps
Case Study
• Management of the recurrent oro-antral communication
• Surgical options for reconstruction of the maxillectomy defects (local, regional, distant tissues vs
alloplastic)
• Management of the atrophic maxilla, sinus lift bone grafts and implant fixture placement
• Management of severe life-threatening infections of the maxillary sinus eg fungal
Resources

Duncavage J, Becker S (2010). The Maxillary Sinus: Indications for the Caldwell-Luc approach in the endoscopic era.
Medical and Surgical Management. Thieme. Barzilai G, Greenberg E, Uri N.
Otolaryngol Head Neck Surg. 2005 Feb;132(2):219-20.
Wormald PJ (2007). Endoscopic Sinus Surgery:
Anatomy, Three-Dimensional Reconstruction, and Prognostic factors of maxillary sinus malignancies.
Surgical Technique (2nd ed). Thieme. Nazar G, Rodrigo JP, Llorente JL, Baragaño L, Suárez C.
Am J Rhinol. 2004 Jul-Aug;18(4):233-8.
Cardesa A, Alos L (2005). Nasal Cavity and
Paranasal Sinuses. In A Cardesa, PJ Slootweg Prevalence of maxillary sinus disease and abnormalities in patients scheduled for sinuslift procedures.
(eds), Pathology of the Head and Neck (pp 39 – 71). Beaumont C, Zafiropoulos GG, Rohmann K, Tatakis DN.
J Periodontol. 2005 Mar;76(3):461-7.
Maxillary sinus disease of odontogenic origin.

Mehra P, Murad H.
Otolaryngol Clin North Am. 2004 Apr;37(2):347-64.
Management of acute complicated sinusitis: a 5-year review.

Mortimore S, Wormald PJ.
Otolaryngol Head Neck Surg. 1999 Nov;121(5):639-42.
Applicability of buccal fat pad grafting for oral reconstruction.

Toshihiro Y, Nariai Y, Takamura Y, Yoshimura H, Tobita T, Yoshino A, Tatsumi H, Tsunematsu K, Ohba S,

Kondo S, Yanai C, Ishibashi H, Sekine J.
Int J Oral Maxillofac Surg. 2013 May;42(5):604-10.
Closure of oroantral communications: a review of the literature.

Visscher SH, van Minnen B, Bos RR.
Closure of oroantral fistula.

Awang MN.
Kiran Kumar Krishanappa S1, Eachempati P, Kumbargere Nagraj S, Shetty NY, Moe S, Aggarwal H, Mathew
RJ. Interventions for treating oro-antral communications and fistulae due to dental procedures. Cochrane
Database Syst Rev. 2018 Aug 16;8:CD011784. doi: 10.1002/14651858.CD011784.pub3.
Assessments

SST EXAMINATION
CP&D - MANAGEMENT OF AN OAF
AOP - SOFT TISSUE FLAP CLOSURE

OF OAF
AOP – MANAGEMENT OF BENIGN
MAXILLARY SINUS LESION
CP&D – MANAGEMENT OF SINUSITIS AOP – BONE GRAFT FOR

FOLLOWING MAXILLARY SURGERY MAXILLARY RECONSTRUCTION

(TAC)
FINAL EXAMINATION


• Describe the detailed anatomy of the nose and • Describe the use of and indications for • Perform the closure of oro-antral fistula using
paranasal sinuses prosthetic obturation in relation to the maxillary regional flaps
• Describe the range of diseases of the maxillary sinus • Discuss the management of recurrent oro-antral
sinus • Describe the techniques for foreign body fistulae
• Take a thorough history and perform an localisation and removal from the maxillary • Perform nasendoscopy
examination sinus • Discuss the diagnosis and management of
• Interpret the imaging of the maxillary sinus • Perform surgical repair of oro-antral severe maxillary sinus infections
• Assess risk to the maxillary sinus in communications using local flaps • Discuss the diagnosis, management and
dentoalveolar surgery from both clinical and • Perform oral and nasal antrostomy prognosis of maxillary sinus disease with the
radiographic examination including indications for • Discuss the development and management of patients and their families
advanced imaging oro-nasal and oro-antral fistulae following
• Describe the role of pharmacology and surgery in trauma to the palate
the management of sinus disease

3.1.9 MODULE 9: ORAL & MAXILLOFACIAL ONCOLOGY
MODULE 9: Oral & Maxillofacial Oncology

A trainee eligible to sit for the FRACDS(OMS) should Learning Portfolio Checklist
be able to: Diagnosis of oral malignancy
 Participate in the multi-disciplinary team as an effective oncology team member in operative procedures
• Recognise the early symptoms of Oral and in the surgical management of OM malignancy
Maxillofacial malignancy  Provide leadership to the multidisciplinary oncology team in terms of iOM cancer care
(The oral and maxillofacial surgeon is the principal expert in the area of oral and maxillofacial pathology
• Accurately identify the pathogenesis and
and the dental
aetiology of OM malignancy
management of oncology patients; expertise in this area is important for optimal patient care)
• Investigate and accurately diagnose patients that
potentially have OM malignancy Logbook
• Communicate with patients (and their families) Trainee to log –
about procedures, reasonable expectations, • Pathology-malignant (6)
limitations and risks associated with OM • Reconstructive (15-18)
malignancy (Number refers to category in Logbook)
• Manage the OM malignancy patient from
assessment through to rehabilitation within a Literature Review
multi-disciplinary Head and Neck team • Management of the clinically negative (N0) neck
• Demonstrate sound basic surgical skills and
competently carry out surgical procedures Tutorial
applying appropriate and safe operative • Assessment and staging of OM cancer
techniques in the treatment of OM malignancy • The use of radiotherapy in OM malignancy
• Communicate with and co-ordinate surgical • The use of grafts and flaps in the management of OM cancer
teams to achieve an optimal clinical environment • The indications and techniques for maxillectomy
• Develop a care plan for a patient in collaboration • Segmental or rim mandibulectomy
with members of an multi-disciplinary team
• Be prepared to enter advanced training in oral Observation
and maxillofacial oncology in such areas as Tumour Resection
independent practice in the neck and associated • Soft tissue - buccal mucosa, tongue, floor of mouth
areas and in such techniques as microvascular • Hard tissue – ramus, angle, symphysis, condyle maxilla
free tissue transfer • Reconstruction - palatal rotation flap, facial artery myomucosal flap, buccal fat pad flap, temporalis flap,
• Consult, cooperate and discuss with other free tissue transfer
clinicians as required
Case Study
• Tumour involving retromolar trigone

• Teach and hand down, encourage other juniors, • Tumour needing maxillectomy
undergraduates and graduates on ward rounds, • Tumour requiring Hemiglossectomy
clinics and other classes as required • Patient with Osteoradionecrosis
• Understand the processes involved in the
employing hospital as well as the funding and Structured Experience
administration of the employing hospital and (Trainee to make written notes on patient encounters)
health department Explanation of diagnosis of cancer
Refer below for a complete list of competencies by • Explanation of the management of cancer
level. • Explanation of continuing/palliative care
• Care of the palliative patient
• Behaviours and strategies to prevent self-harm (smoking and drinking)
Resources
Schmidt BL (2010). Principles of oral cancer Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract.
management. In L Andersson, KE Kahnberg, MA Shah JP.
Pogrel (eds), Oral and Maxillofacial Surgery (pp 705- Am J Surg. 1990 Oct;160(4):405-9.
734). Wiley-Blackwell.
Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC,
Shah JP, Shah J, Johnson NW (2003). Oral Cancer. CT and MR imaging.
Informa Healthcare. de Bondt RB, Nelemans PJ, Hofman PA, Casselman JW, Kremer B, van Engelshoven JM, Beets-Tan RG.
Eur J Radiol. 2007 Nov;64(2):266-72.
Neville BW, Damm DD, Allen CM, Bouquot J (2008).
Oral and Maxillofacial Pathology (3rd ed). Saunders. 18F-fluorodeoxyglucose positron emission tomography to evaluate cervical node metastases in patients with
head and neck squamous cell carcinoma: a meta-analysis.
Cardesa A, Slootweg P (2006). Pathology of the Kyzas PA, Evangelou E, Denaxa-Kyza D, Ioannidis JP.
Head and Neck. Springer. J Natl Cancer Inst. 2008 May 21;100(10):712-20.
Detection of cervical lymph node metastasis in head and neck cancer patients with clinically N0 neck-a meta-
Journals & web based materials
analysis comparing different imaging modalities.
International Journal of Oral and Maxillofacial surgery Liao LJ, Lo WC, Hsu WL, Wang CT, Lai MS.
BMC Cancer. 2012 Jun 12;12:236.
Journal of Oral and Maxillofacial Surgery
Treatment failure and margin status in head and neck cancer. A critical view on the potential value of
British Journal of Oral and Maxillofacial Surgery molecular pathology.
Slootweg PJ, Hordijk GJ, Schade Y, van Es RJ, Koole R.
Journal of Cranio-Maxillofacial Surgery Oral Oncol. 2002 Jul;38(5):500-3.

Journal of ENT and Head and Neck Surgery Discontinuous vs in-continuity neck dissection in carcinoma of the oral cavity.
Leemans CR, Tiwari R, Nauta JJ, Snow GB.
www.cancer.gov/cancertopics/types/oral/ Arch Otolaryngol Head Neck Surg. 1991 Sep;117(9):1003-6.
www.cancer.gov/cancertopics/types/head-and -neck/ Long-term follow-up of the RTOG 9501/intergroup phase III

trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of
www.eastman.ucl.ac.uk/iaoo/links.html the head and neck.
Cooper JS, Zhang Q, Pajak TF, Forastiere AA, Jacobs J, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman
iaoms E – learning Project train Web lectures M, Lustig R, Ensley JF, Thorstad W, Schultz CJ, Yom SS, Ang KK.
Needs Head and Neck Journals Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1198-205.
NCCN Guidelines Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head
and neck.
Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ,
Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK; Radiation Therapy Oncology Group
9501/Intergroup.
N Engl J Med. 2004 May 6;350(19):1937-44.
Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck
cancer.
Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F,
Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M; European Organization for Research and
Treatment of Cancer Trial 22931.
N Engl J Med. 2004 May 6;350(19):1945-52.
Patterns of invasion and routes of tumor entry into the mandible by oral squamous cell carcinoma.
Brown JS, Lowe D, Kalavrezos N, D'Souza J, Magennis P, Woolgar J.
Head Neck. 2002 Apr;24(4):370-83.
Evidence for imaging the mandible in the management of oral squamous cell carcinoma: a review.
Brown JS, Lewis-Jones H.
Influence of bone invasion and extent of mandibular resection on local control of cancers of the oral cavity
and oropharynx.
O'Brien CJ, Adams JR, McNeil EB, Taylor P, Laniewski P, Clifford A, Parker GD.
Int J Oral Maxillofac Surg. 2003 Oct;32(5):492-7.
Neck dissection classification update: revisions proposed by the American Head and Neck Society and the
American Academy of Otolaryngology-Head and Neck Surgery.

Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf GT;
American Head and NeckSociety; American Academy of Otolaryngology--Head and Neck Surgery.
An analysis of factors influencing the outcome of postoperative irradiation for squamous cell carcinoma of the
oral cavity.
Parsons JT, Mendenhall WM, Stringer SP, Cassisi NJ, Million RR.
Int J Radiat Oncol Biol Phys. 1997 Aug 1;39(1):137-48.
Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-
and-neck cancer.
Ang KK, Trotti A, Brown BW, Garden AS, Foote RL, Morrison WH, Geara FB, Klotch DW, Goepfert H, Peters
LJ.
Int J Radiat Oncol Biol Phys. 2001 Nov 1;51(3):571-8.
Extracapsular extension is a poor predictor of disease recurrence in surgically treated oropharyngeal

squamous cell carcinoma.
Lewis JS Jr, Carpenter DH, Thorstad WL, Zhang Q, Haughey BH.
Mod Pathol. 2011 Nov;24(11):1413-20.
Use of decision analysis in planning a management strategy for the stage N0 neck.
Weiss MH, Harrison LB, Isaacs RS.
Tumor thickness influences prognosis of T1 and T2 oral cavity cancer--but what thickness?
O'Brien CJ, Lauer CS, Fredricks S, Clifford AR, McNeil EB, Bagia JS, Koulmandas C.
Head Neck. 2003 Nov;25(11):937-45.
Gingival carcinoma: retrospective analysis of 72 patients and indications for elective neck dissection.
Lubek J, El-Hakim M, Salama AR, Liu X, Ord RA.
Frequency and therapeutic implications of "skip metastases" in the neck from squamous carcinoma of the
oral tongue.
Byers RM, Weber RS, Andrews T, McGill D, Kare R, Wolf P.
Head Neck. 1997 Jan;19(1):14-9.
Posterior triangle metastases of squamous cell carcinoma of the upper aerodigestive tract.
Davidson BJ, Kulkarny V, Delacure MD, Shah JP.
Am J Surg. 1993 Oct;166(4):395-8.

Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth.
Dias FL, Lima RA, Kligerman J, Farias TP, Soares JR, Manfro G, Sa GM.
Otolaryngol Head Neck Surg. 2006 Mar;134(3):460-5.
Metastases to level IIb in squamous cell carcinoma of the oral cavity: a systematic review and meta-analysis.
Lea J, Bachar G, Sawka AM, Lakra DC, Gilbert RW, Irish JC, Brown DH, Gullane PJ, Goldstein DP.
Head Neck. 2010 Feb;32(2):184-90.
Accuracy of frozen sections in assessing margins in oral cancer resection.

Ord RA, Aisner S.
Accuracy, utility, and cost of frozen section margins in head and neck cancer surgery.
DiNardo LJ, Lin J, Karageorge LS, Powers CN.
Laryngoscope. 2000 Oct;110(10 Pt 1):1773-6.
A meta-analysis of the randomized controlled trials on elective neck dissection versus

therapeutic neck dissection in oral cavity cancers with clinically node-negative neck.
Fasunla AJ, Greene BH, Timmesfeld N, Wiegand S, Werner JA, Sesterhenn AM.
Oral Oncol. 2011 May;47(5):320-4.
Assessments
SST Examination
AOP INCISIONAL BIOPSY

AOP EXCISIONAL BIOPSY
CP AND D MANAGEMENT OF AOP TRACHEOSTOMY

ADANCE MALIGNANCY
CP AND D POST OP FOLLOW UP AOP REMOVAL SUBMANDIBULAR GLAND

PATIENT WITH MALIGNANCY CP AND D NECK DIESSECTION
SKULL BASE APPROACH TEAM APPRAISAL OF CONDUCT(TAC) FINAL EXAMINATION
FINAL EXAMINATION


• Describe the molecular basis of the pathogenesis • Participate in the multidisciplinary oncology • Perform operative procedures in the surgical
of OM malignancy team management of OM malignancy
• Describe the concepts of pre-malignant lesions • Perform indirect laryngoscopy • Perform maxillectomy
and conditions • Perform a fibre optic naso-endoscopy • Perform wide surgical resection for oral
• Describe classification and staging for OM • Describe the surgical management of the neck malignancy
malignancy including disease in the neck in OM malignancy (levels 1-5) • Perform elective neck dissection
• Describe the assessment and diagnosis of a • Describe techniques involved in soft and hard • Perform complex reconstructions for oral
patient with OM malignancy tissue reconstruction of the jaws and malignancy
• Describe treatment planning for OM malignancy associated structures • Perform surgical access to the skull base
• Perform incisional biopsy • Perform intra-oral resection of oral malignancy • Direct postoperative and follow-up care for the
• Perform fine needle aspiration for cytology • Perform tracheostomy patient with OM malignancy
• Discuss the surgical management of a patient • Describe techniques for wide surgical • Surgically manage osteoradionecrosis
with OMmalignancy and the importance of the resection • Provide leadership to the multidisciplinary
multidisciplinary team • Harvest non-vascularised bone grafts oncology team
• Discuss postoperative and follow up care of • Perform postoperative and follow up care
patients with OM malignancy including the management of complications for
• Discuss the management of complications a patient with OM malignancy
including osteoradionecrosis • Communicate with patients (and their families)
• Perform clinical ward management of patients about procedures, potentials, and risks
with OMmalignancy associated with oral malignancy in ways that
• Discuss the use of radiotherapy in OM encourage their participation in informed
malignancy decision making

3.1.10 MODULE 10: RECONSTRUCTIVE ORAL AND MAXILLOFACIAL SURGERY
MODULE 10: Reconstructive Oral and Maxillofacial Surgery

 Perform reconstructive surgery on surgical defects including oro-antral fistula.
 Outline the graft sites available for non-vascularised grafts.
• Demonstrate sound basic surgical skills and competency to be  Outline the sites and anatomical basis of vascularised flaps for use in the
able to perform reconstructive surgery within the oral and
 Raising of a temporalis flap for palatal reconstruction
• Describe reconstructive techniques available for surgical  Harvest of a radial forearm free flap
rehabilitation:  Free fibula flap for mandibular reconstruction
• following resective surgery for tumours, osteoradionecrosis  Identification and protection of the facial nerve
• of congenital and developmental conditions  Identification of the appropriate landmarks in graft harvest including calvarial bone
• of secondary deformity harvest
• Communicate with patients (and their families) about procedures, Logbook
reasonable expectations, limitations and complications associated Trainee to log –
with specific reconstructive surgical techniques
• Reconstructive – hard tissue (15)
• Communicate and coordinate surgical teams and adjunctive • Reconstructive – soft tissue (16))
resources to achieve an optimal clinical outcome • Reconstructive – composite (17)
• Manage the patient from assessment through to comprehensive • Reconstructive – graft harvest (18)
rehabilitation (Number refers to category in Logbook)
• Recognise and be able to apply the most appropriate
reconstructive procedure to achieve an optimum functional Literature Review
outcome in each patient • Augmentation/reconstruction of the atrophic edentulous maxilla prior to implant
• Liaise with other medical and dental specialties for the optimum placement
reconstruction and rehabilitation of the maxillofacial patient • Reconstruction of the post oncologic maxillectomy defect
• Recognise the advantages and disadvantages of prosthetic • The utility of HBO in the management of osteoradionecrosis in the maxillofacial
obturation versus vital reconstruction for patients with defects in region
the oral cavity, e.g. maxillectomy • Reconstruction of the post traumatic orbital floor defect (alloplast versus autogenous)
• Recognise the advantages and disadvantages of prosthetic
Tutorial
obturation versus biological reconstruction for patients with
defects of the facial region, e.g. nose, eye, ear • The anatomical basis of flaps in the maxillofacial region
• The use of implants in reconstructive surgery
• Describe the various alloplastic materials used in facial
reconstruction and their indications, risks, advantages and
• Workshop on microvascular surgical techniques
disadvantages • Chemotherapy and radiotherapy – their applications for reconstructive surgery
• Reconstructive techniques on congenital conditions

• Integrate a knowledge of preprosthetic surgery and • Alloplastic and allogenic materials available to the reconstructive surgeon
osseointegration into a reconstructive plan for patients with • Which flap where?
maxillofacial defects • Reconstructive techniques on the orbit
• Describe the differences in healing of free and vascularised
autogenous hard and soft tissue grafts in the facial region Observation
• Understand the implications of growth in the paediatric patient on • Reconstructive surgery using vascularised free flaps
reconstructive techniques • Composite reconstruction and secondary deformity
• Understand the effect of surgery, radiotherapy, chemotherapy and Case Study
medical conditions on the performance and complications of
reconstructive facial surgery
• Mandibular reconstruction with free fibula flap
• Floor of mouth reconstruction using radial forearm flap
• Describe the indications for adjunctive techniques in
• Palatal defect reconstruction using buccal fat pad
reconstructive surgery such as hyperbaric oxygen, BMP, etc
• Reconstruction of floor of mandibular body defect caused by osteoradionecrosis
• Teach and hand down, encourage other juniors, undergraduates
and graduates on ward rounds, clinics and other classes as
required
• Understand the processes involved in the employing hospital as
well as the funding and administration of the employing hospital
and health department

Resources
Wei FC, Mardini S (2009). Flaps and Al-Moraissi, E.A. et al., 2018. Does the surgical approach for treating mandibular condylar fractures affect
Reconstructive Surgery. Saunders. the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new
classification for surgical approaches. Journal of Cranio-Maxillofacial Surgery, 46(3), pp.398–412.
Mathes SJ, Nahai F (1997). Reconstructive
Surgery: Principles, Anatomy, & Technique. Chrcanovic, B.R., 2015. Surgical versus non-surgical treatment of mandibular condylar fractures: A meta-
Churchill Livingstone. analysis. International Journal of Oral and Maxillofacial Surgery, 44(2), pp.158–179.
Al-Moraissi, E.A. & Ellis, E., 2015. Surgical treatment of adult mandibular condylar fractures provides better
outcomes than closed treatment: A systematic review and meta-analysis. Journal of Oral and Maxillofacial
Surgery.
Rozeboom, A.V.J. et al., 2017. Closed treatment of unilateral mandibular condyle fractures in adults: a
systematic review. International Journal of Oral and Maxillofacial Surgery, 46(4), pp.456–464.

Subclassification of fractures of the condylar process of the mandible. Loukota RA, Eckelt U, De Bont L,
Rasse M.
Nomenclature/classification of fractures of the mandibular condylar head. Loukota RA, Neff A, Rasse M.
Br J Oral Maxillofac Surg. 2010 Sep;48(6):477-8.
Indications for open reduction of mandibular condyle fractures. Zide MF, Kent JN.
Al-Kayat, A. & Bramley, P., 1979. A modified pre-auricular approach to the temporomandibular joint and
Journals malar arch. British Journal of Oral Surgery, 17(2), pp.91–103.
Journal of Plastic and Reconstructive Surgery
Patient benefit from endoscopically assisted fixation of condylar neck fractures--a randomized controlled
Journal of Oral and Maxillofacial Surgery trial.
Schmelzeisen R, Cienfuegos-Monroy R, Schön R, Chen CT, Cunningham L Jr, Goldhahn S.
International Journal of Oral and Maxillofacial J Oral Maxillofac Surg. 2009 Jan;67(1):147-58.
Surgery
Schneider, M. et al., 2008. Open Reduction and Internal Fixation Versus Closed Treatment and
British Journal of Oral and Maxillofacial Surgery Mandibulomaxillary Fixation of Fractures of the Mandibular Condylar Process: A Randomized, Prospective,
Multicenter Study With Special Evaluation of Fracture Level. Journal of Oral and Maxillofacial Surgery,
Journal of Head and Neck Surgery 66(12), pp.2537–2544.
Chrcanovic, B.R., 2012. Open versus closed reduction: Diacapitular fractures of the mandibular condyle.
Oral and Maxillofacial Surgery, 16(3), pp.257–265.
Osteosynthesis with miniaturized screwed plates in maxillo-facial surgery. Michelet FX, Deymes J, Dessus
B.
J Maxillofac Surg. 1973 Jun;1(2):79-84.
Mandibular osteosynthesis by miniature screwed plates via a buccal approach. Champy M, Loddé JP,
Schmitt R, Jaeger JH, Muster D.
J Maxillofac Surg. 1978 Feb;6(1):14-21.
Ellis, E., 2014. An algorithm for the treatment of noncondylar mandibular fractures. Journal of Oral and
Maxillofacial Surgery, 72(5), pp.939–949.

Al-Moraissi, E.A. & Ellis, E., 2014. What method for management of unilateral mandibular angle fractures
has the lowest rate of postoperative complications? a systematic review and meta-analysis. Journal of Oral
and Maxillofacial Surgery.
Internal fixation of mandibular angle fractures: a meta-analysis. Regev E, Shiff JS, Kiss A, Fialkov JA.
Plast Reconstr Surg. 2010 Jun;125(6):1753-60.
Bobrowski, A.N., Sonego, C.L. & Chagas, O.L., 2013. Postoperative infection associated with mandibular
angle fracture treatment in the presence of teeth on the fracture line: A systematic review and meta-
analysis. International Journal of Oral and Maxillofacial Surgery, 42(9), pp.1041–1048. Available at:
http://dx.doi.org/10.1016/j.ijom.2013.02.021.
McNamara, Z. et al., 2016. Removal versus retention of asymptomatic third molars in mandibular angle
fractures: a randomized controlled trial. International Journal of Oral and Maxillofacial Surgery, 45(5),
pp.571–574. Available at: http://dx.doi.org/10.1016/j.ijom.2016.01.007.
Ellis, E., 2002. Outcomes of patients with teeth in the line of mandibular angle fractures treated with stable
internal fixation. Journal of Oral and Maxillofacial Surgery, 60(8 SUPPL. 1), pp.863–865.
Cillo, J.E. & Ellis, E., 2014. Management of bilateral mandibular angle fractures with combined rigid and
nonrigid fixation. Journal of Oral and Maxillofacial Surgery, 72(1), pp.106–111. Available at:
http://dx.doi.org/10.1016/j.joms.2013.07.008.
A radiological investigation into the age changes of the inferior dental artery. Bradley JC.
Br J Oral Surg. 1975 Jul;13(1):82-90.
Results of treatment of fractures of the atrophic edentulous mandible by compression plating: a

retrospective evaluation of 84 consecutive cases.
Luhr HG, Reidick T, Merten HA.
J Oral Maxillofac Surg. 1996 Mar;54(3):250-4
Treatment protocol for fractures of the atrophic mandible. Ellis E 3rd, Price C.
Treatment considerations for comminuted mandibular fractures. Ellis E 3rd, Muniz O, Anand K.
Koury, M.E. & Kaban, L.B., 1994. The Use of Rigid Internal Fixation in Mandibular Fractures Complicated
by osteomyelitis. Journal of Oral and Maxillofacial Surgery, pp.1114–1119.

Mehra, P., Van Heukelom, E. & Cottrell, D.A., 2009. Rigid Internal Fixation of Infected Mandibular
Fractures. Journal of Oral and Maxillofacial Surgery, 67(5), pp.1046–1051.
Benson, P.D. et al., 2006. The use of immediate bone grafting in reconstruction of clinically infected
mandibular fractures: Bone grafts in the presence of pus. Journal of Oral and Maxillofacial Surgery, 64(1),
pp.122–126.
Reoperative mandibular trauma: management of posttraumatic mandibular deformities. Vega LG.

Manolidis, S., 2004. Frontal sinus injuries: Associated injuries and surgical management of 93 patients.
Journal of Oral and Maxillofacial Surgery, 62(7), pp.882–891.
Bell, R.B. et al., 2007. A Protocol for the Management of Frontal Sinus Fractures Emphasizing Sinus
Preservation. Journal of Oral and Maxillofacial Surgery, 65(5), pp.825–839.
Frontal sinus fractures.

Echo A, Troy JS, Hollier LH Jr.
Semin Plast Surg. 2010 Nov;24(4):375-82.
Smith, T.L. et al., 2002. Endoscopic management of the frontal recess in frontal sinus fractures: a shift in
the paradigm? The Laryngoscope, 112(5), pp.784–90.
Jafari, A. et al., 2015. Spontaneous ventilation of the frontal sinus after fractures involving the frontal
recess. American Journal of Otolaryngology - Head and Neck Medicine and Surgery, 36(6), pp.837–842.
Al-Qurainy, A. et al., 1991. Midfacial fractures and the eye : the development patients at risk of eye injury of
a system for detecting. British Journal of Oral and Maxillofacial Surgery, 29, pp.363–367.
Andrews, B.T. et al., 2016. Orbit fractures: Identifying patient factors indicating high risk for ocular and
periocular injury. Laryngoscope, 126, pp.S5–S11.
Blindness after facial fractures: a 19-year retrospective study. Ansari MH.

Magarakis, M. et al., 2012. Ocular injury, visual impairment, and blindness associated with facial fractures:
A systematic literature review. Plastic and Reconstructive Surgery, 129(1), pp.227–233.
Yeo, M.S., Ed, M.R.C.S. & Surg, M.M., 2010. Mydriasis during Orbital Floor Fracture Reconstruction : A
Novel Diagnostic and Treatment Algorithm. , 1(212), pp.209–216.

Turvey, T.A. & Golden, B.A., 2012. Orbital Anatomy for the Surgeon. Oral and Maxillofacial Surgery Clinics
of North America, 24(4), pp.525–536. Available at: http://dx.doi.org/10.1016/j.coms.2012.08.003.
Post-traumatic orbital reconstruction: anatomical landmarks and the concept of the deep orbit. Evans BT,
Webb AA.
Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysis.
Burnstine MA.
Ophthalmology. 2002 Jul;109(7):1207-10
Biomaterials for repair of orbital floor blowout fractures: a systematic review. Gunarajah DR, Samman N.
Jaquiery, C. et al., 2007. Reconstruction of orbital wall defects : critical review of 72 patients. International
Journal of Oral & Maxillofacial Surgery, (36), pp.193–199.
Dubois, L. et al., 2015. Controversies in orbital reconstruction - I. Defect-driven orbital reconstruction: A

systematic review. International Journal of Oral and Maxillofacial Surgery, 44(3), pp.308–315.
Dubois, L. et al., 2015. Controversies in orbital reconstruction - II. Timing of post-traumatic orbital
reconstruction: A systematic review. International Journal of Oral and Maxillofacial Surgery, 44(4), pp.433–
440.
Dubois, L. et al., 2016. Controversies in orbital reconstruction - III. Biomaterials for orbital reconstruction: A
review with clinical recommendations. International Journal of Oral and Maxillofacial Surgery, 45(1), pp.41–
50. Available at: http://dx.doi.org/10.1016/j.ijom.2015.06.024.
Mechanisms of global support and posttraumatic enophthalmos: I. The anatomy of the ligament sling and
its relation to intramuscular cone orbital fat.
Manson PN, Clifford CM, Su CT, Iliff NT, Morgan R.
Studies on enophthalmos: II. The measurement of orbital injuries and their treatment by quantitative
computed tomography.
Manson PN, Grivas A, Rosenbaum A, Vannier M, Zinreich J, Iliff N.

Prediction of late enophthalmos by volumetric analysis of orbital fractures. Raskin EM, Millman AL, Lubkin
V, della Rocca RC, Lisman RD, Maher EA. Ophthal Plast Reconstr Surg. 1998 Jan;14(1):19-26.
Prediction of enophthalmos by computed tomography after 'blow out' orbitalfracture. Whitehouse RW,
Batterbury M, Jackson A, Noble JL.
Br J Ophthalmol. 1994 Aug;78(8):618-20.
Reoperative orbital trauma: management of posttraumatic enophthalmos and aberrant eye position.
Holmes S.
The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and meta-
analysis comparing subtarsal, subciliary, and transconjunctival incisions.
Ridgway EB, Chen C, Colakoglu S, Gautam S, Lee BT.
Plast Reconstr Surg. 2009 Nov;124(5):1578-86.
Jacobs, S.M. et al., 2018. Incidence , Risk Factors , and Management of Blindness after Orbital Surgery.
Ophthalmology. Available at: https://doi.org/10.1016/j.ophtha.2018.01.030.
Toward CT-based facial fracture treatment.

Manson PN, Markowitz B, Mirvis S, Dunham M, Yaremchuk M. Plast Reconstr Surg. 1990 Feb;85(2):202-
12
Ellis, E. & Perez, D., 2014. An algorithm for the treatment of isolated zygomatico-orbital fractures. Journal
of Oral and Maxillofacial Surgery, 72(10), pp.1975–1983.
Ellis, E. & Perez, D., 2014. An algorithm for the treatment of isolated zygomatico-orbital fractures. Journal
of Oral and Maxillofacial Surgery, 72(10), pp.1975–1983. Available at:
http://dx.doi.org/10.1016/j.joms.2014.04.015.
Iii, E.E. & Reddy, L., 2004. Status of the Internal Orbit After Reduction of Zygomaticomaxillary. , pp.275–
283.
Rana, M. et al., 2012. Surgical treatment of zygomatic bone fracture using two points fixation versus three
point fixation-a randomised prospective clinical trial. , pp.1–10.
Kloss, F.R., Stigler, R.G. & Brandsta, A., 2011. Complications related to midfacial fractures : operative
versus non-surgical treatment. , pp.33–37.
Evidence-based medicine: zygoma fractures. Ellstrom CL, Evans GR.

Plast Reconstr Surg. 2013 Dec;132(6):1649-57.

Nasal fracture management: minimizing secondary nasal deformities. Rohrich RJ, Adams WP Jr.
Plast Reconstr Surg. 2000 Aug;106(2):266-73.
Avoiding revision rhinoplasty.

Waite PD.
Considerations in Revision Rhinoplasty: Lessons Learned Fattahi T

Management of the medial canthal tendon in nasoethmoid orbital fractures: the importance of the central
fragment in classification and treatment.
Markowitz BL, Manson PN, Sargent L, Vander Kolk CA, Yaremchuk M, Glassman D, Crawley WA.
Plast Reconstr Surg. 1991 May;87(5):843-53.
Sequencing treatment for naso-orbito-ethmoid fractures. Ellis E 3rd.

Gruss J, Wyck L, Phillips J, et al. The importance of the zygomatic arch in complex midfacial fracture repair
and correction of posttraumatic orbitozygo- matic deformities. Plast Reconstr Surg 1990;85:878
Markowitz B, Manson P. Panfacial fractures: organization of treatment. Clin Plast Surg 1989;16:105
Manson P, Clark N, Robertson B, et al. Subunit principles in midface fractures: the importance of sagittal
buttresses, soft-tissue reductions, and sequencing treatment of segmental fractures. Plast Reconstr Surg
1999;103:1287–307
Curtis, W. & Horswell, B.B., 2013. Panfacial fractures. An approach to management. Oral and Maxillofacial
Surgery Clinics of North America, 25(4), pp.649–660. Available at:
http://dx.doi.org/10.1016/j.coms.2013.07.010.
He D, Zhang Y, Ellis E. Panfacial fractures: analysis of 33 cases treated late. J Oral Maxillofac Surg
2007;65:2459–65.
Yang R, Zhang C, Liu Y, et al. Why should we start from mandibular fractures in the treatment of panfacial
fractures? J Oral Maxillofac Surg 2012;70:1386–92

Reoperative midface trauma.

Yang RS, Salama AR, Caccamese JF.
Andreasen JO, Jensen SS, Schwartz O, et al. A systematic review of prophylactic antibiotics in the surgical
treatment of maxillofacial fractures. J Oral Maxillofac Surg 2006;64(11):1664–8. Available
Miles, B.A., Potter, J.K. & Ellis, E., 2006. The efficacy of postoperative antibiotic regimens in the open
treatment of mandibular fractures: A prospective randomized trial. Journal of Oral and Maxillofacial
Surgery, 64(4), pp.576–582.
Mundinger, G. et al., 2014. Antibiotics and Facial Fractures: Evidence-Based Recommendations

Compared with Experience-Based Practice. Craniomaxillofacial Trauma and Reconstruction, 08(01),
pp.064–078. Available at: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1378187.
Ben Simon, G.J. et al., 2005. Orbital cellulitis: A rare complication after orbital blowout fracture.
Ophthalmology, 112(11), pp.2030–2034.
Morris, L.M. & Kellman, R.M., 2014. Are prophylactic antibiotics useful in the management of facial
fractures? Laryngoscope, 124(6), pp.1282–1284.
Ratilal B, Costa J, S.C., 2015. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull
fractures (Review). , (4).
Chrcanovic, B.R., 2012. Open versus closed reduction: Mandibular condylar fractures in children. Oral and
Maxillofacial Surgery, 16(3), pp.245–255.
Gerbino, G. & Roccia, F., 2010. Surgical Management of Orbital Trapdoor Fracture in a Pediatric
Population. YJOMS, 68(6), pp.1310–1316.
Yang, J.W., Woo, J.E. & An, J.H., 2015. Surgical outcomes of orbital trapdoor fracture in children and
adolescents. Journal of cranio-maxillo-facial surgery : official publication of the European Association for
Cranio-Maxillo-Facial Surgery, 43(4), pp.444–7.
Heggie, A.A. et al., 2015. Isolated orbital floor fractures in the paediatric patient : case series and review of
management. International Journal of Oral & Maxillofacial Surgery, 44(10), pp.1250–1254. Available at:
http://dx.doi.org/10.1016/j.ijom.2015.02.019.

Assessments

SST EXAMINATION
AOP SURGICAL APPROACHES TO

THE ORBIT
AOP TREATMENT REQUIRING SOFT
TISSUE HARVEST, LOCAL DISTANT
AOP TREATMENT REQUIRING HARD TISSUE HARVEST,

LOCAL DISTANT

(TAC)
FINAL EXAMINATION

• Describe the anatomy of the maxillo-facial • Discuss disorders of facial asymmetry including • Perform the reconstruction of orbital deformities
region post-traumatic deformity including dystopia and enopthalmos
• Describe the common pathological conditions • Hemifacial hypertrophy • Perform reconstructive procedures for correction
that lead to surgical intervention requiring • Hemifacial atrophy of facial asymmetry
reconstruction. These should include: • Hemi-mandibular hypertrophy, etc • Perform reconstructive procedures for complex
Cysts of the oral region • Describe the anatomical basis of local and defects of the maxillofacial region
Odontogenic tumours regional flaps in the maxillofacial region • Describe the principles and techniques of
Benign non-odontogenic tumours • Describe the classification of nerve injuries and distraction osteogenesis
Inflammatory jaw lesions their repair • Discuss techniques of soft tissue expansion
Metabolic and genetic jaw diseases • Perform the harvest of soft and hard tissue • Describe the anatomical basis of distant flaps for
Malignant tumours, etc grafts use in the maxillofacial region
• Describe the repair of oro-antral, oro-nasal
• Perform the reconstruction of alveolar defects • Describe the indications for the use of
and oro-cutaneous fistulae of the maxilla and mandible using appropriate vascularised free flaps in the maxillofacial region
• Discuss the importance of aesthetics in facial materials • Perform surgical access to the midface including
reconstruction and the placement of facial
• Describe the use of intra-oral and extra-oral nasal bones and cartilaginous skeleton, Weber-
incisions implant based devices used in reconstructive Ferguson and facial degloving approaches
• Describe the principles and materials for maxillofacial surgery • Understand role of maxillofacial surgeon in skull
fixation in reconstructive surgery
• Perform temporal and coronal flaps base access and common approaches
• Describe the types, clinical indications,

applications and complications of soft and • Perform surgical approaches to the orbit such • Discuss the implications of chemotherapy and
hard tissue grafts commonly used in the as: radiotherapy on reconstructive surgery
maxillofacial region Blepharoplasty
• Describe the types, clinical indications, Transconjunctival and Transcaruncular
applications and complications of alloplastic Mid-lid and Subtarsal
and allogeneic materials available to the Infraorbital
maxillofacial surgeon Subcilary
• Discuss of the use of prosthetic devices in Lateral brow, etc
reconstruction • Describe reconstructive techniques and the role
• Differentiate between the variety of intra-oral of adjunctive therapies for osteoradionecrosis
incisions available to the maxillofacial surgeon
• Discuss the role of adjunctive therapies in
reconstructive surgery by medical and dental
practitioners, prosthodontists, speech
pathologists, physiotherapists, dieticians etc

3.1.11 MODULE 11: ORAL & MAXILLOFACIAL TRAUMA
MODULE 11: Oral & Maxillofacial Trauma

A trainee eligible to sit for the FRACDS (OMS) should be  Perform a clinical examination on a multi trauma patient
able to:  Interpret a CT scan
 Interpret a MRI scan
• Competently manage the airway in the trauma patient  Independently manage the trauma patient – both hard and soft tissues
• Accurately examine and diagnose the patient with facial
trauma Logbook
• Investigate with appropriate tests the trauma patient Trainee to log –
• Appropriately order, understand and be able to read • Facial Trauma
special tests including plain radiographs, CT scans, (Number refers to category in Logbook)
MRI scans
Literature Review
• Independently manage facial trauma including both soft
and hard tissue components • Sequencing the treatment of the multi-trauma patient
• Competently manage and treat patients suffering from • Managing the frontal sinus
severe and acute oral and maxillofacial trauma • Fractures of the condylar neck, open and closed treatment
• Sensitively deal with such patients through all of the
Tutorial
stages of treatment from the initial assessment and
diagnosis through to the postoperative requirements • Management of the orbital in “orbital blowout” fractures
including education and ongoing medical, physical • Fracture dislocations of the mandibular condyle
and/or psychological needs • Approaches to the facial skeleton
• Work in conjunction with other surgeons as required • Interpretation of the CT and MRI scan
• Competently coordinate and manage a care plan for • Management of soft tissue injuries
trauma patients in order to produce an optimal result
Case Study
• Develop an optimal post-operative care and
rehabilitation plan in conjunction with nursing and
• Fracture dislocation condyle unilateral
rehabilitation staff • Fracture dislocation condyle bilateral
• Consult, cooperate and discuss with other clinicians as
• TMJankylosis
required • The rehabilitation of the head injured patient – co-ordination with speech pathologists,
physiotherapists, occupational therapists, etc
• Teach and hand down, encourage other juniors,
undergraduates and graduates on ward rounds, clinics Observation
• Treatment of a fractured mandible
• Treatment of a zygomatic fracture

• Understand the processes involved in the employing • Exploration of the orbital soft and hard tissue repair
hospital as well as the funding and administration of the
employing hospital and health department Simulation Laboratory
• Placement of plates for a bi lateral mandibular facture and a complicated fracture in the
Refer below for a complete list of competencies by level. mid-face
• Explanation of trauma to the family of a patient who attempted to commit suicide
• Explanation of the management of the trauma patient
• Explanation of the postoperative and continuing management of the trauma patient
including any rehabilitation required
Resources
Fonseca R, Barber HD, Powers M, Frost DE (2012). Oral Subclassification of fractures of the condylar process of the mandible.
and Maxillofacial Trauma (4th ed). Saunders. Loukota RA, Eckelt U, De Bont L, Rasse M.
Ward Booth P, Eppley B, Schmelzeisen R (2011).
Maxillofacial Trauma and Esthetic Facial Reconstruction Nomenclature/classification of fractures of the mandibular condylar head.
(2nd ed). Saunders. Loukota RA, Neff A, Rasse M.
Hammer B (1995). Orbital Fractures: Diagnosis, Operative
Treatment, Secondary Corrections. Hogrefe & Huber. Indications for open reduction of mandibular condyle fractures.
Zide MF, Kent JN.
Ellis E, Zide ME (2005). Surgical Approaches to the Facial J Oral Maxillofac Surg. 1983 Feb;41(2):89-98.
Skeleton (2nd ed). Lippencott Williams & Wilkins.
Mandibular condyle fractures: a consensus.
Journals Bos RR, Ward Booth RP, de Bont LG.
Journal of Oral and Maxillofacial Surgery Br J Oral Maxillofac Surg. 1999 Apr;37(2):87-9.
International Journal of Oral and Maxillofacial Surgery Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation
of fractures of the mandibular condylar process: a randomized, prospective, multicenter study
Journal of Craniofacial Surgery with special evaluation of fracture level.
Schneider M, Erasmus F, Gerlach KL, Kuhlisch E, Loukota RA, Rasse M, Schubert J,
Oral and Maxillofacial Clinics of North America Terheyden H, Eckelt U.
Open versus closed treatment of fractures of the mandibular condylar process-a prospective
randomized multi-centre study.

Eckelt U, Schneider M, Erasmus F, Gerlach KL, Kuhlisch E, Loukota R, Rasse M, Schubert J,

Terheyden H.
J Craniomaxillofac Surg. 2006 Jul;34(5):306-14.
Patient benefit from endoscopically assisted fixation of condylar neck fractures--a randomized
controlled trial.
Schmelzeisen R, Cienfuegos-Monroy R, Schön R, Chen CT, Cunningham L Jr, Goldhahn S.
Endoscope-assisted transoral reduction and internal fixation versus closed treatment of

mandibular condylar process fractures--a prospective double-center study.
Kokemueller H, Konstantinovic VS, Barth EL, Goldhahn S, von See C, Tavassol F, Essig H,
Gellrich NC.
Occlusal results after open or closed treatment of fractures of the mandibular condylar
process.
Ellis E 3rd, Simon P, Throckmorton GS.
Frontal sinus fractures.

Echo A, Troy JS, Hollier LH Jr.
Semin Plast Surg. 2010 Nov;24(4):375-82.
Osteosynthesis with miniaturized screwed plates in maxillo-facial surgery.

Michelet FX, Deymes J, Dessus B.
J Maxillofac Surg. 1973 Jun;1(2):79-84.
Mandibular osteosynthesis by miniature screwed plates via a buccal approach.

Champy M, Loddé JP, Schmitt R, Jaeger JH, Muster D.
J Maxillofac Surg. 1978 Feb;6(1):14-21.
Treatment of mandibular angle fractures using one noncompression miniplate.

Ellis E 3rd, Walker LR.
Internal fixation of mandibular angle fractures: a meta-analysis.

Regev E, Shiff JS, Kiss A, Fialkov JA.
Plast Reconstr Surg. 2010 Jun;125(6):1753-60.

Reoperative mandibular trauma: management of posttraumatic mandibular deformities.

Vega LG.
Bradley JC.
Br J Oral Surg. 1975 Jul;13(1):82-90.
Results of treatment of fractures of the atrophic edentulous mandible by compression plating:

a retrospective evaluation of 84 consecutive cases.
Luhr HG, Reidick T, Merten HA.
J Oral Maxillofac Surg. 1996 Mar;54(3):250-4
Treatment protocol for fractures of the atrophic mandible.

Ellis E 3rd, Price C.
Treatment of atrophic mandibular fractures based on the degree of atrophy--experience with

different plating systems: a retrospective study.
Wittwer G, Adeyemo WL, Turhani D, Ploder O.
Treatment of severe mandibular fractures using AO reconstruction plates.

Scolozzi P, Richter M.
Treatment considerations for comminuted mandibular fractures.

Ellis E 3rd, Muniz O, Anand K.
Reoperative midface trauma.

Yang RS, Salama AR, Caccamese JF.
Nasal fracture management: minimizing secondary nasal deformities.

Rohrich RJ, Adams WP Jr.
Plast Reconstr Surg. 2000 Aug;106(2):266-73.
Avoiding revision rhinoplasty.

Waite PD.

Considerations in Revision Rhinoplasty: Lessons Learned

Fattahi T
Management of the medial canthal tendon in nasoethmoid orbital fractures: the importance of
the central fragment in classification and treatment.
Markowitz BL, Manson PN, Sargent L, Vander Kolk CA, Yaremchuk M, Glassman D, Crawley
WA.
Plast Reconstr Surg. 1991 May;87(5):843-53.
Sequencing treatment for naso-orbito-ethmoid fractures.

Ellis E 3rd.
Post-traumatic orbital reconstruction: anatomical landmarks and the concept of the deep orbit.
Evans BT, Webb AA.
Biomaterials for repair of orbital floor blowout fractures: a systematic review.

Gunarajah DR, Samman N.
Reoperative orbital trauma: management of posttraumatic enophthalmos and aberrant eye

position.
Holmes S.
Mechanisms of global support and posttraumatic enophthalmos: I. The anatomy of the

ligament sling and its relation to intramuscular cone orbital fat.
Manson PN, Clifford CM, Su CT, Iliff NT, Morgan R.
Studies on enophthalmos: II. The measurement of orbital injuries and their treatment by
quantitative computed tomography.
Manson PN, Grivas A, Rosenbaum A, Vannier M, Zinreich J, Iliff N.

Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based

analysis.
Burnstine MA.
Ophthalmology. 2002 Jul;109(7):1207-10
The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and
meta-analysis comparing subtarsal, subciliary, and transconjunctival incisions.
Ridgway EB, Chen C, Colakoglu S, Gautam S, Lee BT.
Plast Reconstr Surg. 2009 Nov;124(5):1578-86.
Prediction of late enophthalmos by volumetric analysis of orbital fractures.

Raskin EM, Millman AL, Lubkin V, della Rocca RC, Lisman RD, Maher EA.
Ophthal Plast Reconstr Surg. 1998 Jan;14(1):19-26.
Prediction of enophthalmos by computed tomography after 'blow out' orbitalfracture.

Whitehouse RW, Batterbury M, Jackson A, Noble JL.
Br J Ophthalmol. 1994 Aug;78(8):618-20.
Computer-assisted orbital volume measurement in the surgical correction of

lateenophthalmos caused by blowout fractures.
Fan X, Li J, Zhu J, Li H, Zhang D.
Ophthal Plast Reconstr Surg. 2003 May;19(3):207-11.
Functional outcome after non-surgical management of orbital fractures--the bias of decision-

making according to size of defect: critical review of 48 patients.
Kunz C, Sigron GR, Jaquiéry C.
Surgery on orbital floor fractures. Influence of time of repair and fracture size.
Hawes MJ, Dortzbach RK.
Ophthalmology. 1983 Sep;90(9):1066-70.
Reoperative orbital trauma: management of posttraumatic enophthalmos and aberrant eye

position.
Holmes S.
Subunit principles in midface fractures: the importance of sagittal buttresses, soft-tissue

reductions, and sequencing treatment of segmental fractures.
Manson PN, Clark N, Robertson B, Slezak S, Wheatly M, Vander Kolk C, Iliff N.

Plast Reconstr Surg. 1999 Apr;103(4):1287-306
Secondary reconstruction of panfacial fractures.

Khader R, Wallender A, Van Sickels JE, Cunningham LL.
Oral Maxillofac Surg. 2014 Mar;18(1):99-109.
Panfacial fractures: analysis of 33 cases treated late.

He D, Zhang Y, Ellis E 3rd.
Toward CT-based facial fracture treatment.

Manson PN, Markowitz B, Mirvis S, Dunham M, Yaremchuk M.
Plast Reconstr Surg. 1990 Feb;85(2):202-12
Evidence-based medicine: zygoma fractures.

Ellstrom CL, Evans GR.
Plast Reconstr Surg. 2013 Dec;132(6):1649-57.
Blindness after facial fractures: a 19-year retrospective study.

Ansari MH.
Assessments

SST EXAMINATION
DENTOALVEOLAR INJURIES
CP AND D REPORT ON A PATIENT
WITH MAXILLOFACIAL TRAUMA
AOP OPEN REDUCTION AND
FIXATION OF A FRACTURED
MANDIBLE
AOP SPLINT CONSTRUCTION FOR
TRAUMA


• Describe and identify the metabolic response to • Obtain an emergency airway if needed • Design a treatment plan for the oral and maxillofacial
trauma Systematic approach to airway management trauma patient
Neuro-endocrine responses Endotracheal intubation Open reduction and internal rigid fixation of
Inflammatory mediators Tracheostomy mandibular fractures
Clinical implications Cricothyroidotomy Complications associated with mandibular fractures
• Explain the healing responses to traumatic injuries Prolonged artificial airway • Manage trauma and injuries to the TMJ and the TMJ
including: • Identify the salient features of the region
Soft tissues management of non-penetrating chest trauma Applied anatomy of the region
Bone • Examine and assess abdominal trauma and Incidence and classification of TMJ fractures
Cartilage indicate its management Diagnostic findings
The response of peripheral nerves to injury • Assess urological injuries Treatment of condylar fractures
• Manage patients experiencing shock – Early • Assess and prioritise the management of the Surgical approaches to the TMJ
management of severe trauma (EMST) poly- trauma patient Surgical approaches to the condyle (including
Classification • Differentiate between the different ophthalmic endoscopic approach)
Clinical manifestations of shock consequences of oral and maxillofacial Evaluation of chronic TMJ problems
Pathological changes of shock Injuries Late management of dysfunction
Irreversible shock • Ophthalmic assessment Late management of intraarticular injuries
Therapy Minor eye injuries Management of TMJ injuries
Common pitfalls in the treatment of shock Non-perforating eye injuries Management of malocclusion
• Order and supervise an appropriate nutritional Perforating eye injuries Management of TMJ dislocation
regime following trauma Perforating injuries to the orbit Management of TMJ ankylosis
Consequences of malnutrition Retrobulbar haemorrhage • Manage and treat fractures of the zygomatic
Nutritional assessment Traumatic optic neuropathy complex and arch
Metabolic response to starvation and trauma Disorders of ocular mobility Diagnose and treat injuries to the midface and orbits
Nutritional requirements Displacement of the globe Fractures of the maxilla
Enteral nutrition Nasolacrimal injuries Treatment of Le Fort I type fracture
Parenteral Nutrition Indirect ophthalmic consequences of injury Treatment of Le Fort II type fracture
• List the most significant components of emergency The relationship between maxillofacial and Treatment of Le Fort III type fracture
and intensive care of the traumatised patient eye injuries Treatment of naso-ethmoid fracture
Treatment of orbital fractures
(EMST) • Carry out an early assessment of a trauma
Pre-hospital care patient Anatomy and management of the medial canthal
Primary assessment and resuscitation Oral and maxillofacial examination ligament
Secondary survey and diagnosis Examination of the oral cavity Manage and treat orbital blow out fractures
Physical examination Extraoral examination • Manage and treat patients with traumatic injuries to
Neurologic re-evaluation Imaging for oral and maxillofacial trauma the frontal sinus
Diagnostic testing Treatment planning in complex oral and Function and physiology of the frontal sinus
Blood and urine tests maxillofacial trauma Diagnosis

Radiology • Request the correct radiology for assessing Surgical approaches to the frontal sinus
Operative priorities oral and maxillofacial Injury Classification
Intensive care priorities • Manage dentoalveolar injuries • Treatment of frontal sinus fractures
• Carry out a neurological evaluation and • Manage mandibular fractures • Manage and treat patients with nasal fractures
management of the trauma patient Statistics associated with mandibular injuries Anatomy
Initial Assessment Classification of mandibular fractures Patterns of injury
Detailed management Diagnosis of mandibular fractures Treatment
Grading the severity of injury Glasgow Coma Score General principles in the treatment of • Manage and treat injuries to structures requiring
(GCS) mandibular fractures special treatment, salivary ducts, trigeminal and
Diagnostic studies of head injury • Manage soft tissue injuries facial nerve injury
Special problems in head injury Anatomy of the skin • Classify the pathophysiology of gunshot wounds
Spinal cord injury Suturing • Assess and treat a patient suffering from gunshot
• Describe in detail the applied anatomy of the head Suture materials wounds and implement an appropriate and effective
and neck • Classification and management of soft tissue treatment plan
Skin lines and the lines of Langer wounds • Analyse the significant issues in relation to the
Scalp • Classification of bullets and firearms management and treatment of fractures in the
Skin of the face • Wound ballistics growing patient
Facial bones and the facial skeleton
• The physics of ballistics General considerations in the management of
Lower face
Extra-oral surgical approaches • Classification of gunshot wounds paediatric patients
• Treatment of gunshot wounds Incidence
Intra-oral surgical approaches Clinical examination
Muscles • Shot gun wounds to the head and neck
Radiographic examination
Arterial blood supply to the head and neck • Indicate the appropriate use of bio-materials
in facial trauma management Fracture management
Veins of the head and neck The late management and treatment of facial
Neuro anatomy • Implantable materials
fractures
Regional anatomy • TMJ reconstruction
• Manage and treat avulsive oral and maxillofacial
Nasal anatomy • Analyse the significant issues in relation to the injuries
Parotid region management of facial fractures in the geriatric
Assessment
Submandibular gland patient
Goals of reconstruction
Floor of the mouth Tissue changes in the ageing face Surgical approaches – soft tissues
• Evaluate the radiographs and imaging obtained Systemic considerations
• Indicate the appropriate use of oral and maxillofacial
Plain radiographs Special considerations in the management of
prosthetics and treatment for the trauma patient
CT scanning the geriatric patient (Blood supply to the
Intra oral rehabilitation
MRI evaluation mandible and the management of the atrophic
Extra oral rehabilitation
Ultrasound mandibular fracture)
Facial prostheses
• A thorough knowledge of the principles of internal Bone grafting of the atrophic ridge
Implantology for the trauma patient
fixation of facial fractures Postoperative complications
• Diagnose and effectively treat infections in the
AO principles (rigid and compression fixation) trauma patient
Champy principles (monocortical fixation)
Biomechanics of the facial skeleton

3.1.12 MODULE 12: ORTHOGNATHIC SURGERY
MODULE 12: Orthognathic Surgery

A trainee eligible to sit for the FRACDS (OMS) should be Learning Portfolio Checklist
able to: • Diagnosis of Dentofacial Deformity
• Perform Clinical examination recognizing the salient clinical features of the DFD patient
• Recognise and describe the various developmental, (important for case planning)
acquired and traumatic conditions leading to deformities • Perform Clinical photography
of the face and jaws • Perform Cephalometric analyses
• Examine, diagnose, plan and surgically treat such • Articulation of Study Models (refer to module on technology)
conditions at the correct time during growth and • Virtual surgical planning
development • Treatment and perioperative care of the orthognathic surgical patient
• Examine, diagnose, plan and surgically treat older Logbook
patients (>40 years of age) AND, patients with Trainee to log –
obstructive sleep apnoea requiring jaw(s) advancement • Orthognathic – single jaw (10)
• Correctly interpret the various diagnostic modalities and • Orthognathic – bimaxillary (11)
planning procedures applicable for such corrections • Orthognathic – complex (12)
• Demonstrate sound basic surgical skills and competently (Number refers to category in Logbook)
carry out the routine surgical procedures applying Literature Review
appropriate and safe operative techniques in the • Mandibular asymmetry
treatment of dento-facial deformity • Condylar hypoplastic conditions
• Implement the various pre-operative, operative and post- • Condylar hyperplastic conditions
operative management requirements for such patients, • Mandibular enlargement disorders- unilateral and bilateral
including possible complications and their treatment
• Mandibular AP disproportions
• Consult, cooperate and discuss with other specialist • Maxillary dysplasias in all manifestations
clinicians as required
Case Study
• Understand the principles of orthodontic treatment as
they relate to orthognathic surgery
• Condylar resorption following orthognathic surgery
• Teach and encourage other junior trainees, Tutorial
undergraduates and graduates on ward rounds, clinics • Clinical assessment of Dento Facial Deformity
and other classes as required • Model surgery and cephalometric analysis & Virtual surgical planning
• Understand the processes involved in the employing • Operative techniques – mandible, midface, bimaxillary
hospital as well as the funding and administration of the • Fixation methods
employing hospital and health department • Grafting techniques and materials
• Complications of orthognathic surgery
Refer below for a complete list of competencies by level. • Special considerations for cleft and craniofacial syndromes

• Obstructive sleep apnea, diagnosis and management with jaw advancement

Practical Tutorial
• Saw bone models, fixation and surgical simulation
• Use of cephalometric planning software, e.g. Dolphin, Quick Ceph Systems
Resources

Reyneke JP (2010). Essentials of Orthognathic Surgery (2nd Orthognathic surgery and a tale of how three procedures came to be: a letter to the next generations
ed). Quintessence. of surgeons.
Obwegeser HL.
Fonseca RJ, Marciani RD, Turvey TA (2008). Oral and Clin Plast Surg. 2007 Jul;34(3):331-55.
Maxillofacial Surgery. Saunders.
A review of the management of anterior open bite malocclusion.
Miloro M, Ghali GE, Larsen P, Waite P (2011). Peterson’s Lawry DM, Heggie AA, Ruljancich MK, Crawford EC
Principles of Oral and Maxillofacial Surgery (3rd ed). PMPH Aust Ortho J. 1990; 11:147-160
USA.
Anterior open bite correction by Le Fort I or bilateral sagittal split osteotomy.
Ward Booth P, Schendel SA, Hausamen JE (2006). Reyneke JP, Ferretti C.
Maxillofacial Surgery. Churchill Livingstone. Oral Maxillofac Surg Clin North Am. 2007 Aug;19(3):321-38
Journals & web based materials Three-year stability of open-bite correction by 1-piece maxillary osteotomy.
The International Journal of Adult Orthodontics and Espeland L, Dowling PA, Mobarak KA, Stenvik A.
Orthognathic Surgery Am J Orthod Dentofacial Orthop. 2008 Jul;134(1):60-6.
American Journal of Orthodontics and Dentofacial Long-term stability of surgical open-bite correction by Le Fort I osteotomy.
Orthopaedics Proffit WR, Bailey LJ, Phillips C, Turvey TA.
Angle Orthod. 2000 Apr;70(2):112-7.
Long-term stability of anterior open-bite closure with bilateral sagittal split osteotomy.
Journal of Oral and Maxillofacial Surgery Fontes AM, Joondeph DR, Bloomquist DS, Greenlee GM, Wallen TR, Huang GJ.
Am J Orthod Dentofacial Orthop. 2012 Dec;142(6):792-800.
The Cranio-maxillofacial Hyperguide -
www.cmf.hyperguides.com Anterior open bite malocclusion: stability of maxillary repositioning using rigid internal fixation.
Arpornmaeklong P, Heggie AA
International Journal of Oral and Maxillofacial Surgery Aust Ortho J. 2000; 16:69-81
Journal of Cranio-Maxillofacial Surgery Skeletal stability following maxillary impaction and mandibular advancement.
Arpornmaeklong P, Shand JM, Heggie AA
Int J Oral Maxillofac Surg. 2004; 33: 656-663

Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible.
Stansbury CD, Evans CA, Miloro M, BeGole EA, Morris DE.
Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible.
Stansbury CD, Evans CA, Miloro M, BeGole EA, Morris DE.
Closing anterior open bites by intruding molars with titanium miniplate anchorage.
Sherwood KH, Burch JG, Thompson WJ.
Long-term stability of anterior open-bite treatment by intrusion of maxillary posterior teeth.

Baek MS, Choi YJ, Yu HS, Lee KJ, Kwak J, Park YC.
Am J Orthod Dentofacial Orthop. 2010 Oct;138(4):396.e1-9
Bicortical screw stabilization of sagittal split osteotomies.

Ochs MW.
In vitro comparison of screw versus plate fixation in the sagittal split osteotomy.
Foley WL, Beckman TW.
Int J Adult Orthodon Orthognath Surg. 1992;7(3):147-51.
Comparison of biodegradable and titanium fixation systems in maxillofacial surgery: a two-year multi-
center randomized controlled trial.
van Bakelen NB, Buijs GJ, Jansma J, de Visscher JG, Hoppenreijs TJ, Bergsma JE, Stegenga B, Bos
RR.
J Dent Res. 2013 Dec;92(12):1100-5.
Simultaneous removal of third molars during sagittal split osteotomies: the case against.
Schwartz HC.
Removal of third molars with sagittal split osteotomies: the case for.
Precious DS.

Variations in the anatomical dimensions of the mandibular ramus and the presence of third molars: its
effect on the sagittal split ramus osteotomy.
Beukes J, Reyneke JP, Becker PJ.
The presence of mandibular third molars during sagittal split osteotomies does not increase the risk of
complications.
Doucet JC, Morrison AD, Davis BR, Gregoire CE, Goodday R, Precious DS.
Perioperative antibiotic prophylaxis in orthognathic surgery: a systematic review and meta-analysis of

clinical trials.
Tan SK, Lo J, Zwahlen RA.
Effects of dextrans, heparin and hyperbaric oxygen on mandibular tissue damage after osteotomy in
an experimental system.
Nilsson LP, Granström G, Röckert HO.
Int J Oral Maxillofac Surg. 1987 Feb;16(1):77-89.
Prospective study of the incidence of serious posterior maxillary haemorrhage during a tuberosity
osteotomy in low level Le Fort I operations.
O'Regan B, Bharadwaj G.
Neurosensory disturbance of the inferior alveolar nerve after bilateral sagittal split osteotomy: a
systematic review.
Colella G, Cannavale R, Vicidomini A, Lanza A.
Incidence of complications and problems related to orthognathic surgery: a review of 655 patients.
Panula K, Finne K, Oikarinen K.
J Oral Maxillofac Surg. 2001 Oct;59(10):1128-36
The accuracy of clinical neurosensory testing for nerve injury diagnosis.

Zuniga JR, Meyer RA, Gregg JM, Miloro M, Davis LF.
Microsurgical repair of the inferior alveolar nerve: success rate and factors that adversely affect
outcome.

Bagheri SC, Meyer RA, Cho SH, Thoppay J, Khan HA, Steed MB.
Retrospective review of microsurgical repair of 222 lingual nerve injuries.

Bagheri SC, Meyer RA, Khan HA, Kuhmichel A, Steed MB.
Craniofacial distraction osteogenesis: a review of the literature: Part 1: clinical studies.

Swennen G, Schliephake H, Dempf R, Schierle H, Malevez C.
Cranio-facial distraction osteogenesis: a review of the literature. Part II: Experimental studies.
Swennen G, Dempf R, Schliephake H.
Skeletal stability and complications of bilateral sagittal split osteotomies and mandibular distraction
osteogenesis: an evidence-based review.
Ow A, Cheung LK.
Wound healing after multisegmental Le Fort I osteotomy and transection of the descending palatine
vessels.
Bell WH, You ZH, Finn RA, Fields RT.
Intraoperative assessment of maxillary perfusion during Le Fort I osteotomy.

Dodson TB, Neuenschwander MC, Bays RA.
Wound healing associated with segmental total maxillary osteotomy.

Quejada JG, Kawamura H, Finn RA, Bell WH.
Bradley JC.
Br J Oral Surg. 1975 Jul;13(1):82-90.
The clinical significance of age changes in the vascular supply to the mandible.
Bradley JC.
Int J Oral Surg. 1981;10(Suppl 1):71-6.

Cephalometric measurement of upper airway length correlates with the presence and severity of
obstructive sleep apnea.
Susarla SM, Abramson ZR, Dodson TB, Kaban LB.
Craniofacial structure and obstructive sleep apnea syndrome--a qualitative analysis and meta-
analysis of the literature.
Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE Jr.
Am J Orthod Dentofacial Orthop. 1996 Feb;109(2):163-72.
Obstructive sleep apnea syndrome: a surgical protocol for dynamic upper airway reconstruction.
Riley RW, Powell NB, Guilleminault C.
The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea
syndrome.
Sher AE, Schechtman KB, Piccirillo JF.
Sleep. 1996 Feb;19(2):156-77.
Comparative effectiveness of maxillomandibular advancement and uvulopalatopharyngoplasty for the

treatment of moderate to severe obstructive sleep apnea.
Boyd SB, Walters AS, Song Y, Wang L.
Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review
and meta-analysis.
Holty JE, Guilleminault C.
Sleep Med Rev. 2010 Oct;14(5):287-97.
Maxillomandibular advancement for treatment of obstructive sleep apnea syndrome: a systematic

review.
Pirklbauer K, Russmueller G, Stiebellehner L, Nell C, Sinko K, Millesi G, Klug C.
J Oral Maxillofac Surg. 2011 Jun;69(6):e165-76.
Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review
and meta-analysis.
Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, Harwick JD.
Sleep. 2010 Oct;33(10):1396-407.

Surgically assisted rapid maxillary expansion (SARME): a review of the literature.

Koudstaal MJ, Poort LJ, van der Wal KG, Wolvius EB, Prahl-Andersen B, Schulten AJ.
Int J Oral Maxillofac Surg. 2005 Oct;34(7):709-14.
Dental and skeletal changes following surgically assisted rapid maxillary expansion.
Lagravère MO, Major PW, Flores-Mir C.
The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and
extension.
Proffit WR, Turvey TA, Phillips C.
Head Face Med. 2007 Apr 30;3:21.
Orthognathic surgery: a hierarchy of stability.

Proffit WR, Turvey TA, Phillips C.
Int J Adult Orthodon Orthognath Surg. 1996;11(3):191-204.
Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a
systematic review.
Joss CU, Vassalli IM.
Stability after bilateral sagittal split osteotomy setback surgery with rigid internal fixation: a systematic
review.
Joss CU, Vassalli IM.
Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy.
Reyneke JP, Ferretti C.
Br J Oral Maxillofac Surg. 2002 Aug;40(4):285-92.
Postoperative stability following bilateral intraoral vertical ramus osteotomy based on amount of
setback.
Jung HD, Jung YS, Kim SY, Kim DW, Park HS.
Maxillary quadrangular Le Fort I osteotomy: long-term skeletal stability and clinical outcome.
Stork JT, Kim RH, Regennitter FJ, Keller EE.
Int J Oral Maxillofac Surg. 2013 Dec;42(12):1533-46.

A comparison of the stability of single-piece and segmental Le Fort I maxillary advancements.

Arpornmaeklong P, Heggie AA, Shand JM.
J Craniofac Surg. 2003 Jan;14(1):3-9.
Postoperative skeletal stability following clockwise and counter-clockwise rotation of the

maxillomandibular complex compared to conventional orthognathic treatment.
Reyneke JP, Bryant RS, Suuronen R, Becker PJ.
Br J Oral Maxillofac Surg. 2007 Jan;45(1):56-64.
Occlusal plane alteration in orthognathic surgery--Part I: Effects on function and esthetics.

Wolford LM, Chemello PD, Hilliard F.
Am J Orthod Dentofacial Orthop. 1994 Sep;106(3):304-16.
Occlusal plane alteration in orthognathic surgery--Part II: Long-term stability of results.

Chemello PD, Wolford LM, Buschang PH.
Am J Orthod Dentofacial Orthop. 1994 Oct;106(4):434-40.
Temporary skeletal anchorage devices for orthodontics.

Costello BJ, Ruiz RL, Petrone J, Sohn J.
Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular setback: a systematic
review.
Joss CU, Joss-Vassalli IM, Bergé SJ, Kuijpers-Jagtman AM.
Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular advancement: a
systematic review.
Joss CU, Joss-Vassalli IM, Kiliaridis S, Kuijpers-Jagtman AM.
Long-term stability and prediction of soft tissue changes after LeFort I surgery.
Hack GA, de Mol van Otterloo JJ, Nanda R.
Other articles to consider:
Incidence and recovery of neurosensory disturbances after bilateral sagittal split osteotomy in
different age groups: retrospective study of 263 patients.
JP Verweij, G. Mensink, M. Fiocco, JPR Van Merkesteyn

Int. J. OralMaxillofac.surg. 2016;45: 898-903
Impact of orthognathic surgery on oral health-related quality of life in patients with jaw deformities
K. Kurabe, T, Kojima, Y. Kato, I. Saito, T. Kobayashi
Int. J. OralMaxillofac.surg. 2016
Orthgnathic surgery in patients over 40 years of age: indications and special considerations
ZS Peacock, CCY Lee, KP Klein, LB Kaban
J Oral Maxillofac Surg 72: 1995-2004, 2014
Accuracy of virtual surgical planning of orthognathic surgery with aid of CAD/CAM fabricated
surgical splint-A novel 3D analyzing algorithm.
Chin SJ1, Wilde F2, Neuhaus M1, Schramm A2, Gellrich NC1, Rana M3.
J Craniomaxillofac Surg. 2017 Dec;45(12):1962-1970. doi: 10.1016/j.jcms.2017.07.016. Epub 2017 Jul 29.
Computer-assisted orthognathic surgery: waferless maxillary positioning, versatility, and accuracy of

an image-guided visualisation display.
Zinser MJ1, Mischkowski RA, Dreiseidler T, Thamm OC, Rothamel D, Zöller JE.
Br J Oral Maxillofac Surg. 2013 Dec;51(8):827-33. doi: 10.1016/j.bjoms.2013.06.014. Epub 2013 Sep 14.
A paradigm shift in orthognathic surgery? A comparison of navigation, computer-aided
designed/computer-aided manufactured splints, and "classic" intermaxillary splints to surgical transfer
of virtual orthognathic planning.
Zinser MJ1, Sailer HF, Ritter L, Braumann B, Maegele M, Zöller JE.
J Oral Maxillofac Surg. 2013 Dec;71(12):2151.e1-21. doi: 10.1016/j.joms.2013.07.007.
Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional

orthodontics-first approach: a systematic review and meta-analysis.
Wei H1, Liu Z2, Zang J3, Wang X4.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Aug;126(2):107-116. doi: 10.1016/j.oooo.2018.02.018. Epub 2018
Mar 7.

Assessments

SST EXAMINATION
AOP MODEL SURGERY SPLINT
CONSTRUCTION ORTHOGNATHIC
SURGERY
AOP OSTEOTOMY MANDIBLE
MAXILLA
CP AND D PATIENT REQUIRING
ORTHOGNATHIC SURGERY
AOP HARD TISSUE GRAFT HARVEST
DISTANT SITE HIP

• Describe the anatomy and embryology of the • Describe the operative procedures involved with • Perform orthognathic surgical correction of
face and jaws orthognathic surgery in detail facial deformities including:
• Describe developmental and acquired -Mid-facial advancement • Lefort 1 maxillary osteotomies
deformities of the maxillofacial region -Le Fort I osteotomy repositiong including • Segmental maxillary osteotomies
• Describe the psychology and psychological segmentalization • Mandibular ramus and body procedures
impact of orthognathic surgery on the patient -Mandibular ramus & body osteotomies including genioplasty
• Describe the physiology and biomechanics of -Genioplasty • Understand the procedures for zygomatic and
the jaws and masticatory apparatus orbital osteotomies for facial correction in
• Take a thorough history, examination and order • Describe the principles of operative procedures developmental and secondary trauma patients
appropriate investigations for the patient involved with • Treat patients with secondary traumatic injury
-Le Fort II osteotomy
requiring orthognathic surgery • This includes any operative procedure in the
• Perform cephalometric analysis -Le Fort III osteotomy maxilla facial region requiring orthognathic
-Zygomatic osteotomy patterns
• Perform model taking and model articulation correction.
• Perform clinical photography • Manage intra-operative and post-operative
• Perform virtual surgical planning • Perform low-level maxillary and mandibular ramus complications including the surgical securing of
osteotomy procedures
• Describe the orthodontic principles and the airway and haemorrhage
treatment in orthognathic surgery • Describe the complications involved with orthognathic
• Perform distant graft harvest as required
surgery
• Describe the principles of orthognathic surgery • Manage a patient exhibiting relapse
• Identify and list implantable materials used for
•
• Identify the biological basis for orthognathic
augmentation and grafting
Perform orthognathic surgery on medically
surgery with respect to neuromuscular compromised patients with conditions such as:

adaptation Autologous materials - bone, PRP and BMP Obstructive sleep apnoea
• Describe the anatomy of the region with Frozen bone, lyophilised bone and cartilage Post traumatic injuries
specific reference to its blood supply Alloplastic materials, etc • Perform access osteotomies to the skull
• Identify the methods of fixation used in • Appropriate communication to a patient of the risks, base as required
orthognathic surgery including and benefits of the proposed procedures • Understand the role of distraction
waferless/splintless surgery; the biomaterials osteogenesis in mandibular and maxillary
used, and indicate possible risks of using those osteotomies
biomaterials and techniques

3.1.13 MODULE 13: FACIAL PAIN
MODULE 13: Facial Pain

 Examine and diagnose a patient with facial pain
 Examine and interpret appropriate investigations for the patient with facial pain
• Describe the pathophysiological basis and various theories
 Plan a course of treatment for the facial pain patient, surgical and non-surgical
of facial pain
 The chronic pain clinic and the management of facial pain
• Understand the essential differences between acute and
chronic facial pain and the psychological implications
Logbook
• Be competent in the interviewing and examination of a Trainee to log –
person presenting with facial pain
• Use of cryotherapy in chronic facial pain (5)
• Order and accurately interpret appropriate investigations in
order to diagnose and treat patients with facial pain
• Therapeutic use of nerve blocks in facial pain (5)
• Describe the differential diagnosis of facial pain
• Microneurosurgery in the management of facial pain (5)
(Number refers to category in Logbook)
• Review the pharmacological mechanisms of pain control
• Identify and acknowledge the multidisciplinary setting in the Literature Review
management of facial pain
• Pathophysiological basis and various theories of facial pain
• Understand the role of pharmacotherapy and counseling in
the treatment of a wide range of pain syndromes
• The role of diagnostic blocks in the management of facial pain
• Appreciate the limited but specific role of surgery in the
• The use of cryotherapy in the management of facial pain
management of pain syndromes • The pharmacotherapy of facial pain
• Review neurosurgical procedures for facial pain management
Refer below for a complete list of competencies by level. • Review nerve repairs (inferior alveolar nerve and lingual nerves)
Case Study
• Manage the multiply operated TMJ patient with facial pain
• Involvement with a facial pain clinic
• Trigeminal nerve repairs
Tutorial
• Differential diagnosis of chronic facial pain
• The management of chronic facial pain e.g.: pharmacotherapy and counselling
• Psychological aspects of facial pain
• Microsurgery in the management of trigeminal nerve pain
• Role of nerve repairs – for post traumatic neuromas

Resources

De Leeuw, Klasser GD (2013). Orofacial Pain: Guidelines The International Classification of Headache Disorders, 3rd edition (beta version).
for Assessment, Diagnosis, and Management (5th ed). Headache Classification Committee of the International Headache Society (IHS).
Quintessence. Cephalalgia. 2013 Jul;33(9):629-808.
Warfield C, Bajwa Z (2004). Principles and Practice of Management of burning mouth syndrome: systematic review and management recommendations.
Pain Medicine (2nd ed). McGraw-Hill. Patton LL, Siegel MA, Benoliel R, De Laat A.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Mar;103 Suppl:S39.e1-13.
Oleson J, Tfelt-Hansen P, Welch KMA, Goadsby PJ,
Ramadan NM (2005). The Headaches. LWW. Burning mouth syndrome.
Torgerson RR.
Dermatol Ther. 2010 May-Jun;23(3):291-8.
Journals
Journal of Orofacial Pain Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-
based review): report of the Quality Standards Subcommittee of the American Academy of
Neurology and the European Federation of Neurological Societies.
Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM.
Neurology. 2008 Oct 7;71(15):1183-90.
Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review):
report of the Quality Standards Subcommittee of the American Academy of Neurology.
Silberstein SD.
Neurology. 2000 Sep 26;55(6):754-62
EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force.
Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, Sándor PS; European Federation of
Eur J Neurol. 2009 Sep;16(9):968-81.
Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in

adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and
the American Headache Society.
Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E; Quality Standards
Subcommittee of the American Academy of Neurology and the American Headache Society.
Neurology. 2012 Apr 24;78(17):1337-45.
EFNS guideline on the treatment of tension-type headache - report of an EFNS task force.
Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J; EFNS.

Eur J Neurol. 2010 Nov;17(11):1318-25.
Acute and preventive pharmacologic treatment of cluster headache.

Francis GJ, Becker WJ, Pringsheim TM.
Neurology. 2010 Aug 3;75(5):463-73.
Cluster headache: pathogenesis, diagnosis, and management.

May A.
Lancet. 2005 Sep 3-9;366(9488):843-55.
Management of neuropathic orofacial pain.

Lewis MA, Sankar V, De Laat A, Benoliel R.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Mar;103 Suppl:S32.e1-24.
Evaluation and treatment of central pain syndromes.

Nicholson BD.
Neurology. 2004 Mar 9;62(5 Suppl 2):S30-6.
Review of current guidelines on the care of postherpetic neuralgia.

Argoff CE.
Postgrad Med. 2011 Sep;123(5):134-42.
Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality

Standards Subcommittee of the American Academy of Neurology.
Dubinsky RM, Kabbani H, El-Chami Z, Boutwell C, Ali H; Quality Standards Subcommittee of the
American Academy of Neurology.
Neurology. 2004 Sep 28;63(6):959-65.
Elongated styloid process and Eagle's syndrome.

Montalbetti L, Ferrandi D, Pergami P, Savoldi F.
Cephalalgia. 1995 Apr;15(2):80-93.
Cryotherapy for trigeminal neuralgia: a 10 year audit.
Zakrzewska J.
Repair of the trigeminal nerve: a review.

Jones R.
Aust Dent J. 2010 Jun;55(2):112-9. doi: 10.1111/j.1834-7819.2010.01216.x.

Assessments

SST EXAMINATION
CP AND D MANAGEMENT FOR

SURGICAL AND NON SURGICAL
TREATMENT OF PAIN
AOP MANAGEMENT OF A PERSON
PRESENTING WITH PAIN
AOP CRYOBLOCKADE OF FACIAL
PAIN
CD – Trigeminal nerve repairs
(TAC)
FINAL EXAMINATION

• Describe the neuroanatomy of the head • Order and interpret appropriate investigations for facial pain, • Perform cryoneurectomy
and neck e.g. CT, MRI and electro-encephalogram (EEG), etc • Discuss microsurgery – nerve
• Describe the theories and the • Differential diagnose: decompression, excision of neuroma
neurophysiology of pain Vascular facial pains • Discuss nerve ablation – chemical,
• Describe the pharmacology of analgesics Myofascial and other muscular pains radiofrequency
and anaesthetic agents, anti-epileptics Facial neuralgias
and psychotropic drugs Neuropathic pain
• Take a history of a patient presenting Temporomandibular pain
with facial pain Psychogenic pain including atypical facial pain
• Complete a detailed head and neck • Perform head and neck nerve blocks for diagnostic and
examination with emphasis on neurology therapeutic purposes
• Pharmacological management for a patient with facial pain

3.1.14 MODULE 14: TEMPOROMANDIBULAR JOINT DISORDERS
MODULE 14: Temporomandibular Joint Disorders

At the completion of training a trainee should be able to: Learning Portfolio Checklist
 Exam and diagnose TMD patients
• Describe the anatomy and physiology of the temporomandibular joint  Examine and interpret TMJ imaging: plain films, CT & MRI scans
 Treatment plan – surgical and non-surgical approaches for the TMJ patient
• Assess and differentiate the key signs and symptoms of the various
temporomandibular disorders (TMD)
Logbook
• Take a thorough history and examination Trainee to log –
• Select and interpret appropriate imaging for the temporomandibular • TMJ arthrocentesis (12)
joint and/or other investigations for TMD • TMJ arthrotomy (12)
• Discuss condylar resorption • TMJ reconstruction (12)
• Discuss the non-surgical and pharmacological treatment modalities • Reduction of dislocated TMJ (12)
• Discuss the indications for surgical intervention for TMD (Number refers to category in Logbook)
• Discuss the surgical approaches to the TMJ
• Discuss the surgical techniques: arthrocentesis, arthroscopy, Literature Review
arthrotomy and TMJ reconstruction or replacement • Indications for TMJ surgery
• Perform appropriate surgical procedures such as arthrocentesis • The role of TMJ arthrocentesis
• Implement appropriate aftercare for patients who have undergone • Management of TMJ ankylosis
TMJ surgery • Mandibular hypomobility
• Perform reduction of a dislocated mandible • Mandibular hypermobility
• Discuss the management of chronic dislocation of the mandible • TMJ replacement
• Discuss the benign and malignant pathological conditions involving
• Condylar resorption
the TMJ
Case Study
Refer below for a complete list of competencies by level. • The multiply operated TMJ leading to TMJ replacement
• Surgical management of recurrent TMJ dislocations
• Surgical management of TMJ ankylosis
Suggested Tutorials
• Clinical assessment of the TMD patient and interpretation of imaging
• Assessment & management of condylar resorption
• Treatment planning for TMD patients: conservative versus surgical
• Surgical approaches to the TMJ
• Options for TMJ reconstruction or replacement

• Management of complications following TMJ surgery

• Management of the dislocated mandible and recurrent dislocation
• Management of TMJ ankylosis
Resources

Atlas of Temporomandibular Joint Surgery. 2nd Edition Comparison of the outcomes of three surgical treatments for end-stage temporomandibular joint
Peter Quinn, Eric Granquist. Publ: Wiley-Blackwell 2015 disease.
Dimitroulis G.
Temporomandibular Joint Total Joint Replacement – TMJ TJR. Int J Oral Maxillofac Surg. 2014 Aug;43(8):980-9
Editor: Louis Mercuri. Publ: Springer 2016
A new surgical classification for temporomandibular joint disorders.
Operative Oral & Maxillofacial Surgery. 3rd Edition Dimitroulis G.
Ed. J. Langdon, M Patel, R Ord, P Brennan. Publ: Apple Int J Oral Maxillofac Surg. 2013 Feb;42(2):218-22.
Academic Press Inc Oakville, Canada 2017 (multiple chapters
on TMJ Surgery) A critical review of interpositional grafts following temporomandibular joint discectomy with an
overview of the dermis-fat graft.
Dimitroulis G.
Journals
Idiopathic Condylar Resorption: A Survey and Review of the Literature.
Journal of Oral and Maxillofacial Surgery Alsabban L, Amarista FJ, Mercuri LG, Perez D.
J Oral Maxillofac Surg. 2018 Jul 19. pii: S0278-2391(18)30771-7.
Journal of Orofacial Pain
Surgical Management of Idiopathic Condylar Resorption: Orthognathic Surgery
Versus Temporomandibular Total Joint Replacement.
Chigurupati R, Mehra P.
Oral Maxillofac Surg Clin North Am. 2018 Aug;30(3):355-367.
Costochondral grafting for paediatric temporomandibular joint reconstruction: 10-year outcomes

in 55 cases.
Awal DH, Jaffer M, Charan G, Ball RE, Kennedy G, Thomas S, Farook SA, Mills C, Ayliffe P.
Int J Oral Maxillofac Surg. 2018 Jun 27. pii: S0901-5027(18)30227-3. doi:
10.1016/j.ijom.2018.06.004. [Epub ahead of print]
Single puncture versus standard double needle arthrocentesis for the management
of temporomandibular joint disorders: A systematic review.
Nagori SA, Roy Chowdhury SK, Thukral H, Jose A, Roychoudhury A.
J Oral Rehabil. 2018 Oct;45(10):810-818. doi: 10.1111/joor.12665. Epub 2018 Jun 22. Review.

Combined or Staged Temporomandibular Joint and Orthognathic Surgery for Patients with
Internal Derangement and Dentofacial Deformities.
Kim S, Keith DA.
Oral Maxillofac Surg Clin North Am. 2018 Aug;30(3):351-354.
Is the Anchored Disc Phenomenon a Truly Distinct Entity? A Systematic Review.

Al-Belasy FA, Salem AS.
J Oral Maxillofac Surg. 2018 Sep;76(9):1883.e1-1883.e10
The sequential treatment of temporomandibular joint ankylosis with secondary deformities by

distraction osteogenesis and arthroplasty or TMJ reconstruction.
Zhang W, Yang X, Zhang Y, Zhao T, Jia J, Chang S, Liu Y, Yu B, Chen Y, Ma Q.
Evaluation of condylar resorption rates after orthognathic surgery in class II and III dentofacial
deformities: A systematic review.
Nunes de Lima V, Faverani LP, Santiago JF Jr, Palmieri C Jr, Magro Filho O, Pellizzer EP.
J Craniomaxillofac Surg. 2018 Apr;46(4):668-673.
Adaptability of stock TMJ prosthesis to joints that were previously treated with custom joint
prosthesis.
Abramowicz S, Barbick M, Rose SP, Dolwick MF.
Does Orthognathic Surgery Cause or Cure Temporomandibular Disorders? A Systematic Review

and Meta-Analysis.
Al-Moraissi EA, Wolford LM, Perez D, Laskin DM, Ellis E 3rd.
J Oral Maxillofac Surg. 2017 Sep;75(9):1835-1847
Temporomandibular Lavage Versus Nonsurgical Treatments for Temporomandibular Disorders:

A Systematic Review and Meta-Analysis.
Bouchard C, Goulet JP, El-Ouazzani M, Turgeon AF.
Retrospective study of facial nerve function following temporomandibular joint arthroplasty using
the endaural approach.
Liu F, Giannakopoulos H, Quinn PD, Granquist EJ.

Craniomaxillofac Trauma Reconstr. 2015 Jun;8(2):88-93.
Microbiology Alloplastic Total Joint Infections: A 20-Year Retrospective Study.

Riegel R, Sweeney K, Inverso G, Quinn PD, Granquist EJ.
Biomet Microfixation Temporomandibular Joint Replacement System: a 3-year follow-up study of

patients treated during 1995 to 2005.
Giannakopoulos HE, Sinn DP, Quinn PD.
J Oral Maxillofac Surg. 2012 Apr;70(4):787-94
Open versus arthroscopic surgery for the management of internal derangement of the
temporomandibular joint: a meta-analysis of the literature.
Al-Moraissi EA.
A protocol for management of temporomandibular joint ankylosis in children.

Kaban LB, Bouchard C, Troulis MJ.
A protocol for management of temporomandibular joint ankylosis.

Kaban LB, Perrott DH, Fisher K.
J Oral Maxillofac Surg. 1990 Nov;48(11):1145-51
Wolford LM. Twenty-year follow up on a patient fitted temporomandibular joint prosthesis: the
Techmedica/ TMJ concepts device. J Oral Maxillofac Surg 2015;73:952-960
Idiopathic condylar resorption: current clinical perspectives.

Posnick JC, Fantuzzo JJ.
Synovial chondromatosis of the temporomandibular joint:
a case description with systematic literature review.L. Guarda-Nardini, F. Piccotti, G. Ferronato,
D. Manfredini: Int. J. Oral Maxillofac. Surg. 2010; 39: 745–755.
Temporomandibular joint neoplasms and pseudotumors. Warner B, Luna M, Newland J.
Advances in Anatomic pathology, 2000; 7(6): 365-381

Assessments

SST EXAMINATION
TMJ anatomy and physiology CP&D – ASSESSMENT &

MANAGEMENT OF PATIENT WITH
TMD
Imaging review of TMJ
AOP – ARTHROCENTESIS
CP&D – CONDYLAR RESORPTION
CD – Ankylosis management AOP - SURGICAL APPROACH TO

CD- Recurrent TMJ dislocations TMJ
CP&D – MANAGEMENT OF
ADVANCED DISEASE OF THE TMJ/
TMJ replacement

(TAC)
FINAL EXAMINATION

• Describe the anatomy, histology and • Perform injections (intraarticular or intramuscular) • Perform a complete surgical approach to the
physiology of the masticatory apparatus • Understand the non-surgical treatment of TMJ TMJ for trauma or TMD
• Describe the systemic arthritides in disorders, e.g. occlusal splints, medications, • Perform arthrocentesis
relationship to the TMJ physiotherapy etc and know when to refer for • Participate in the following procedures as part
• Discuss the differences and management by other specialists of a surgical team:
interrelationship between the muscles and • Participate in the management of TMD in a multi- internal derangement
joint disciplinary setting hypomobility disorders of TMJ
• Describe internal derangement of the TMJ • Discuss arthroscopic procedures chronic dislocation
• Perform a history and examination • Manage the postoperative care of patients following ankylosis
• Perform appropriate imaging and interpret surgical treatment of TMD congenital & development anomalies
investigations for the TMJ • Describe the surgical procedures involving the TMJ • Discuss and participate in the management of

• Describe the correlation between clinical • Discuss the history of prosthetic reconstruction of the benign & malignant pathology of the TMJ
findings and the investigations TMJ • Describe the reconstruction of the TMJ with a
• Perform reduction of a dislocated mandible • Discuss the management of idiopathic condylar range of flaps or grafts
• Discuss the non-surgical management of resorption • Manage common intra- and postoperative
TMD • Discuss the management of chronic pain following complications of temporomandibular surgery
• Discuss the indications for surgical TMD surgery • Describe the indications, techniques and
management of TMD planning for total joint replacements
• Discuss the management of TMD in a • Discuss the medical and surgical management
multi-disciplinary setting patients with pain and dysfunction syndromes
after unsuccessful TMJ surgery
• Discuss the diagnosis, management and
prognosis of TMD with the patients and their
families

3.1.15 MODULE 15: ORAL AND MAXILLOFACIAL PROSTHETICS AND TECHNOLOGY
MODULE 15: Oral and Maxillofacial Prosthetics and Technology

 Make an appropriate selection of articulator and accurately
• Manage the needs of patients requiring Maxillofacial prosthetics mount models
• Perform the various techniques available to the OMS in order to treat surgical  Perform model surgery for orthognathic patients
 Perform model surgery for trauma patients
• deformity of the oral and maxillofacial region
 Design and Construct splints for palatal surgery and other
• Correctly determine and plan utilisation of such techniques during treatment procedures
planning, operative surgery, and post-surgical rehabilitation  Use Biomodels in OMS
• Carry out the appropriate steps and current laboratory procedures involved in
maxillofacial model surgery and splint preparation Logbook
• Perform implant therapy, including those pre-prosthetic procedures relevant to Trainee to log and document experience of at least 1 case in all
extra-oral and intra-oral implant placement, including incorporation into categories listed in the Learning Portfolio Checklist above
orthognathic and reconstructive surgical procedures
• Identify the resources needed to establish an appropriate working laboratory Case Presentation plus Discussion
facility in new or under-serviced area • Articulation and planning for a bimaxillary osteotomy
• Formulate treatment plans which include the appropriate application of recent
technological developments, including specifically: Literature Review / Essay Question / Tutorial
• • Discuss cthe utilisation of 3D biomodels in contemporary oral
ustom-made skeletal prosthetic parts and maxillofacial surgery
• • Discuss 3computer simulation in orthognathic surgical
D biomodelling planning
• Have a working knowledge/understanding of computer-aided navigational • Discuss use of alloplastic implants in reconstructive oral and
treatment planning and surgery maxillofacial surgery
• Teach and hand down, encourage other juniors, undergraduates and graduates
on ward rounds, clinics and other classes as required
• Understand the processes involved in the employing hospital as well as the
funding and administration of the employing hospital and health department
Refer below for a complete list of competencies by level

Resources
Beumer J, Marunick MT, Esposito SJ (2011). Maxillofacial Tissue engineering technology and its possible applications in oral and maxillofacial
Rehabilitation: Prosthodontic and Surgical Management of surgery.
Cancer-Related, Acquired, and Congenital Defects of the Payne KF, Balasundaram I, Deb S, Di Silvio L, Fan KF.
Head and Neck (3rd ed). Quintessence. Br J Oral Maxillofac Surg. 2014 Jan;52(1):7-15.
Parashis A, Diamantopoulos P (2013). Clinical Application of Secondary reconstruction of panfacial fractures.

Computer-Guided Implant Surgery. CRC Press. Khader R, Wallender A, Van Sickels JE, Cunningham LL.
Oral Maxillofac Surg. 2014 Mar;18(1):99-109.
Lynch SE, Marx RE, Nevins M, Wisner-Lynch LA (2008).
Tissue Engineering: Applications in Oral and Maxillofacial Computer-assisted craniomaxillofacial surgery.
Surgery and Periodontics (2nd ed). Quintessence. Edwards SP.
Journals
International Journal of Oral and Maxillofacial Surgery Collyer J.
British Journal of Oral and Maxillofacial Surgery
Journal of Oral and Maxillofacial Surgery Bell RB.
Journal of Cranio-Maxillofacial Surgery
Navigation-assisted mandibular body distraction osteogenesis: a preliminary study in
goats.
Cai M, Shen G, Cheng AH, Lin Y, Yu D, Ye M.
J Oral Maxillofac Surg. 2014 Jan;72(1):168.e1-7.

Assessments

SST EXAMINATION
AOP ARTICULATION OF
MODELS AND SPLINT
CONSTRUCTION
CP AND D USE OF COMPUTER
TECHNOLOGY IN PLANNING
AOP NAVIGATION IN ORAL AND MAXILLOFACIAL
SURGERY
FINAL EXAMINATION

Level One Levels Two and Three
• Describe the anatomical structures of the head and neck • Perform articulation of models
• Describe the physiology and biomechanics of the jaws and Appropriate choice of articulator
masticatory apparatus Correlate mounting of models with the clinical situation to ensure
• Identify the correct radiology for diagnosis including: accuracy
Cephalometric analysis • Perform model surgery
Model taking and articulation Appropriate segmental sectioning of models
Clinical photography Movement of segments, in accordance with the surgical treatment plan
• Understand and describe the materials used for intraoral and Stabilisation of segments in desired positions
extra oral prosthetic reconstruction, both of the hard tissues and Recording of quantum and direction of movement of each individual
soft tissues (eyes, ears, noses and other prosthetic components) segment
• Describe the use of Biomodels in Oral and Maxillofacial Surgery • Perform the construction of the surgical appliances commonly used in
• Understand the principals behind Navigation and discuss the use Oral and Maxillofacial Surgery
of Navigation techniques in Oral and Maxillofacial Surgery • Discuss, understand and guide the technicians in facial and body
prosthetic rehabilitation
• Discuss, understand and guide the use of biomodelling in maxillofacial
surgery

• Discuss, understand and use contemporary technologies in treatment

planning, computer aided cephalometrics and navigation surgery
• Discuss, understand and use 3D cephalmoetrics and virtual computer
planning in Oral and Maxillofacial Surgery
• Discuss the design and use of splints in maxillofacial surgery, e.g. TMJ
dysfunction, sleep apnoea
• Manage a patient requiring a Maxillary obturator

3.1.16 MODULE 16: ADJUNCTIVE TECHNOLOGIES IN ORAL AND MAXILLOFACIAL

SURGERY
MODULE 16: Adjunctive Technologies in Oral and Maxillofacial Surgery

A trainee eligible to sit for the FRACDS (OMS) should be able to:
• Describe the mechanism of laser production
 Complete a course on laser technology
• Apply this technology for therapeutic use  Use of lasers in the treatment of benign and malignant lesions of the maxillofacial
• Describe the mechanisms of cryotherapy and its use in oral Region
and maxillofacial surgery  Use of cryotherapy in the maxillofacial Region
• Apply these technologies in oral and maxillofacial surgery  Treatment planning using virtual techniques in the computer and navigation to the
• Be familiar and be able to use endoscopic approaches to patient
surgery in the maxillofacial region, eg. endoscopic sinus  Use of Computer planning in oral and maxillofacial surgery
surgery, endoscopic fracture surgery, arthroscopy of the TMJ
• Diagnose and select cases suited to endoscopic, laser and Logbook
cryotherapeutic surgical techniques Trainee to log –
• Effectively apply endoscopic, laser and cryotherapeutic • Use of laser therapy (5, 6)
surgical techniques to the spectrum of applications in both • use of cryotherapy (5, 6)
general use and specific applications in the maxillofacial • use of the arthroscope in the TMJ (13)
region • use of the endoscope in sinus disease (14)
• Apply the techniques of computer aided navigational surgery • endoscopically assisted trauma surgery (4)
in the oral and maxillofacial region (Number refers to category in Logbook)
• Apply the techniques of computer planning in the oral and
maxillofacial region Literature Review
• Consult, cooperate and discuss with other clinicians as • The use of lasers in Maxillofacial Surgery
required • The use of cryosurgery in Maxillofacial surgery
• Teach and hand down, encourage other juniors, • The use of endoscopic surgery in the Maxillofacial Region, arthroscope, endoscope
undergraduates and graduates on ward rounds, clinics and • Virtual planning of surgical procedure
other classes as required • The use of navigation in maxillofacial surgery
• Understand the processes involved in the employing hospital
as well as the funding and administration of the employing Case Study
hospital and health department • Use of navigation techniques for TMJ release or ankylosis or tumour resection
• Secondary orbital reconstruction
Refer below for a complete list of competencies by level
Tutorial

• Plan an orthodontic case using either Quick Ceph or Dolphin technology (CDM)
• Carry out model surgery following the STO production (CDM)
Resources
All hospitals expect surgeons and trainees to complete a laser course before using the laser. Such a course should be completed within the first 2 years.

Ward Booth P, Eppley B, Schmelzeisen R (2011). Computer assisted surgery
Maxillofacial Trauma and Esthetic Facial
Reconstruction (2nd ed). Saunders. Computer-assisted craniomaxillofacial surgery.
Edwards SP.

Collyer J.

Bell RB.
Journals Oral Maxillofac Surg Clin North Am. 2010 Feb;22(1):135-56.
International Journal of Oral and Maxillofacial
Surgery Navigation-assisted mandibular body distraction osteogenesis: a preliminary study in goats.
Cai M, Shen G, Cheng AH, Lin Y, Yu D, Ye M.
Journal of Oral and Maxillofacial Surgery J Oral Maxillofac Surg. 2014 Jan;72(1):168.e1-7.
British Journal of Oral and Maxillofacial Surgery Cone beam CT
Journal of Cranio-Maxillofacial Surgery Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: a systematic
review of the literature.
Journal of Craniofacial Surgery De Vos W, Casselman J, Swennen GR.
Applications of cone beam computed tomography in the practice of oral and maxillofacial surgery.
Quereshy FA, Savell TA, Palomo JM.
Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology.
Ludlow JB, Ivanovic M.

Clinical indications and perspectives for intraoperative cone-beam computed tomography in oral and
maxillofacial surgery.
Pohlenz P, Blessmann M, Blake F, Heinrich S, Schmelzle R, Heiland M.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Mar;103(3):412-7.
BMP
A comprehensive clinical review of recombinant human bone morphogenetic protein-2 (INFUSE Bone
Graft).
McKay WF, Peckham SM, Badura JM.
Int Orthop. 2007 Dec;31(6):729-34.
Bone morphogenetic proteins.

Chen D, Zhao M, Mundy GR.
Growth Factors. 2004 Dec;22(4):233-41.
De novo bone induction by recombinant human bone morphogenetic protein-2 (rhBMP-2) in maxillary sinus
floor augmentation.
Boyne PJ, Lilly LC, Marx RE, Moy PK, Nevins M, Spagnoli DB, Triplett RG.
Pivotal, randomized, parallel evaluation of recombinant human bone morphogenetic protein-2/absorbable

collagen sponge and autogenous bone graft for maxillary sinus floor augmentation.
Triplett RG, Nevins M, Marx RE, Spagnoli DB, Oates TW, Moy PK, Boyne PJ.
Randomized study evaluating recombinant human bone morphogenetic protein-2 for extraction socket
augmentation.
Fiorellini JP, Howell TH, Cochran D, Malmquist J, Lilly LC, Spagnoli D, Toljanic J, Jones A, Nevins M.
J Periodontol. 2005 Apr;76(4):605-13.
PRP
Platelet-rich plasma: Growth factor enhancement for bone grafts.

Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jun;85(6):638-46.
The biology of platelet-rich plasma and its application in oral surgery: literature review.
Nikolidakis D, Jansen JA.

Tissue Eng Part B Rev. 2008 Sep;14(3):249-58.
Botox
Clinical use of botulinum toxins in oral and maxillofacial surgery.
Majid OW.
Endoscopy
Endoscopic techniques in oral and maxillofacial surgery.

Pedroletti F, Johnson BS, McCain JP.
Laser
Intraoral laser surgery.

Wlodawsky RN, Strauss RA.
Oral Maxillofac Surg Clin North Am. 2004 May;16(2):149-63.
Low-level laser therapy in oral and maxillofacial surgery.

Kahraman SA.
Laser physics and tissue interaction.
Guttenberg SA, Emery RW 3rd.
Complications of CO2 laser procedures in oral and maxillofacial surgery

Brandon MS, Strauss RA.
Interventional laser surgery: an effective surgical and diagnostic tool in oral precancer management.
Thomson PJ, Wylie J.
The results of CO2 laser surgery in patients with oral leukoplakia: a 25 year follow up.
van der Hem PS, Nauta JM, van der Wal JE, Roodenburg JL.
Oral Oncol. 2005 Jan;41(1):31-7.

Assessments

SST EXAMINATION
AOP ARTHROSCOPY TMJ/ENDOSCOPIC ORID MANDIBULAR CONDYLE
AOP SIALADENOSCOPY OF PAROTID DUCT OR SUBMANDIBULAR
CP AND D VIRTUAL PLANNING AND NAVIGATION ORBITAL

RECONSTRUCTION
(TAC)
FINAL EXAMINATION

• Describe technologies, e.g. endoscopes, • Perform a range of procedures using these • Perform complex procedures, e.g.
lasers, etc technologies, e.g. endoscopy, cryosurgery, and endoscopically assisted management of
• Describe the application of technologies in laser ablation, etc condylar neck fractures or removal of sialoliths
oral and maxillofacial surgery • Communicate with patients (and/or their families) from the salivary glands
• Perform laboratory and simulation procedures the procedures, risks and potential of each of • Use the Laser (as appropriate) for the removal
to obtain credentialing these forms of treatment of benign and malignant lesions in the Oral and
• Discuss the contribution of adjunctive Maxillofacial Region
procedures, e.g. physiotherapy, splint • Use Cryosurgical techniques in the Oral and
therapy, etc Maxillofacial Region
• Assist in procedures using these technologies • Manage complications of these procedures
• Design and communicate with patients
management plans that include alternative
operative procedures

C - Section 4 Accredited Education and Training in Oral and Maxillofacial
Surgery
4 C - SECTION 4
CULTURAL COMPETENCE AND SAFETY
The College is committed to providing basic training and the resources in cultural competence and its
relevance to the provision of health care in Australian and New Zealand.
The following Cultural Competency and Safety resources are available on the College’s Learning
Management Software:
Aboriginal and Torres Strait Islander Health Performance Framework
DCNZ Statement on Cultural Competence

E-Learning: Interviewing an Aboriginal or Torres Strait Islander Patient
MCNZ Statement on Cultural Safety
NZ Foundation Course in Cultural Competency
The Australian Indigenous Doctors’ Association (AIDA) Cultural Safety Toolkit
Cultural Competence in Australia A Guide - FECCA
© copyright – RACDS All rights reserved 188

PART D
SURGICAL SCIENCE & TRAINING (SST)
AND THE SST EXAMINATION

D - SECTION 1 Accredited Education and Training in Oral and Maxillofacial Surgery
1 D - SECTION 1
SURGICAL SCIENCE AND TRAINING IN ORAL AND MAXILLOFACIAL

SURGERY (SST)
Clinical Training Requirements

Trainees commencing from 2011 onwards must successfully complete the following requirements to
allow progression into OMS 2.
a. First year of OMS training - A minimum total of twelve (12) months (full time equivalent) in a hospital
post accredited by the Board of Studies – Oral and Maxillofacial Surgery. Preferably six (6) or twelve
(12) months will be spent in one position
b. SST Examination
c. Completion of the three skills courses: ASSET, EMST and CCrISP are expected to be undertaken
by the end of the first year of OMS training and must be completed by the 31 October of the second
year of OMS training (OMS 2).
Examination Requirements
The SST Examination is held annually and eligibility to sit the SST Examination is dependent upon all
fees being paid.
The SST Examination comprises a Multiple Choice Question (MCQ) examination, a written examination
comprising Short Answer Questions (SAQ) and a Clinical and Oral Viva Voce Examination.
The SST Examination is to be undertaken by eligible candidates (with full medical and dental
registration) during the first clinical OMS training year (OMS 1) from 2011 onwards. From 2019 onwards
eligible candidates are able to sit the SST Examination prior to entry to the OMS Training program.
Candidates must enrol for the SST Examination and pay the prescribed fee prior to the enrolment closing
date.
One diet of the SST Examination will be held each year.
Eligibility for the Surgical Science and Training Examination

a. For trainees who commence after 2010 and prior to 2018
Trainees accepted into the program from 2010 to 2018 will undertake the examination in OMS 1.
The examination must be successfully completed before progression into OMS 2.
b. For trainees who commence in 2019 onwards

Trainees accepted into the program can undertake the examination in OMS 1 and the
examination must be successfully completed before progression into OMS 2.
c. Those who meet the criteria to apply for selection to the program and who are currently in their
SIG year can apply for eligibility to sit the SST examination from 2019 onwards. The Eligibility
Criteria for OMS Training must be satisfied at the time of sitting the SST examination.
In the event of not being awarded a pass in the SST Examination, a Trainee (i.e. a Candidates already
accepted into the program) may be deemed eligible to take the examination for not more than TWO (2)

further diets. The trainee cannot commence OMS 2 until a pass in the SST examination has been
achieved. The time taken between the completion of OMS 1 year and the commencement of OMS 2
year will not be considered for accredited training time.
A maximum of three (3) attempts at the SST Examination will be permitted.
Trainees are advised that with the introduction of the SST Examination, it is no longer a requirement to
hold a pass in the College Primary Examination. Trainees and those who complete the SST Examination
will no longer need to present for the Primary Examination.
Exemption from Surgical Science & Training Examination

Candidates will only be eligible for an exemption from the SST Examination if they have completed the
RACS Generic SET Surgical Science and SET Clinical Examination (GSSE & CE) or the Intercollegiate
MRCS (United Kingdom) – Part A & B. Candidates must provide certified evidence of completion of ALL
components of the RACS Primary Examination or the Intercollegiate MRCS. Candidates who are
applying for exemption from the SST examination must submit their application and supportive
documentation by 15 February of OMS 1.
The SST Examination

Candidates should review the curriculum that will be assessed for the Surgical Science and Training
Examination in the OMS Syllabus.
1. This examination is conducted bi-nationally between Australia and New Zealand in the specialist
field of Oral and Maxillofacial Surgery for trainees in the first of the four-year training program.
2. Each candidate presenting for examination has completed both dental and medical degrees
together with a medical intern registration year and an accredited year of Surgery-in-General
(with the exception of the second category in 1, and from 2019 onwards, candidates in their SIG
year who meet eligibility).
3. The examination tests a candidate’s basic surgical science knowledge in Anatomy, Pathology,
Microbiology, Pharmacology and Physiology together with the level of practical experience
accumulated in caring for the “Surgical Patient”. Examiners are asked to be familiar with the
syllabus and curriculum for training contained in the Handbook.
4. The examination is designed to assess whether the candidate has the appropriate knowledge
and experience to care for the surgical patient. A pass in the examination is a requirement for
training. If a candidate is unsuccessful, another year in an approved post is required prior to
undertaking the examination again. A maximum of three (3) attempts will be permitted.
5. Examiners have a comprehensive knowledge of basic surgical science and practical patient care
and have been selected by the Board of Studies (OMS).
6. The Chairman of the Panel of Examiners will call a compulsory meeting of all Examiners on the
day preceding the commencement of the Clinical and Oral Viva Voce Examinations to
standardise the format and components of the examination which is to follow. This includes
review and finalisation of assessment rubrics.
7. Immediately following the last examination session, the Chairman will call a further meeting of
the Court of Examiners at which time the marks of all candidates are appraised. The Registrar
(OMS) will then arrange for the notification of results to the candidates according to College
guidelines.
8. The examination is in three parts:

i. MCQ examination
2 hours duration, basic surgical science
ii. SAQ examination
50 minutes duration; consisting of 5 short answer questions (10 minutes each)
iii. Clinical examination
5 stations (20 minutes each):
1. Anatomy
2. Acute care
3. Ward scenario
4. Critical care
5. Surgical skills
9. The MCQ examination contains single answer, relationship-analysis and variable response
questions
10. The Clinical and Oral Viva Voce Examination comprises various stations. The tasks required
include, but are not limited to, history taking and examination, demonstration of practical
technical skills, the application of basic science knowledge, data acquisition and analysis.
11. The MCQ and SAQ examinations must be taken concurrently with Clinical and Oral Viva Voce
Examination.
12. To allow progression to OMS 2 Trainees are required to gain a pass in the SST examination. A
pass in the SST examination is awarded to candidates who pass EACH of the following sections:
MCQ examination, SAQ examination, Critical care station, Clinical and Oral Viva Voce
examination overall.
13. By the end of OMS 2 Trainees must complete all necessary courses and satisfactory
assessments, in order to allow progression to OMS 3.
Examination Passing Standards
To successfully pass the SST examination, a candidate must achieve the passing standard in EACH of
the following sections at the same examination diet:
• MCQ examination
• SAQ examination
• Critical care station
• Clinical examination - Oral Viva Voce examination
The examination passing standard for each of these examinations is set by the relevant examination
review panel using formal standard setting methods. The ‘passing standard’ is reviewed at each
examination series and may be adjusted with consideration to differences in the difficulty of
examinations and to maintain the standards. The minimum score required to pass may be set by
applying an error adjustment to the ‘passing standard’ score. For the clinical examinations, candidates
must meet the passing standard in the Critical care station as well as meet the overall passing standard
for the Clinical examination overall.
As all components of the SST Examination are blueprinted to curriculum modules and proficiency
domains, minimum passing standards may also be set based on the aggregation of these. Therefore,
candidates must also achieve the passing standard across modules and proficiencies
The highest performing candidate in each diet of the examination will be identified by averaging both
sections of the examination (written and viva) so that a percentage out of 100% is achieved. The
Registrar (OMS) will notify ANZAOMS of the result.

Examiners
Examiners for the SST Examination are approved by the College and are listed on the website prior to
the Examination.
Observers
An observer may be present, and if a candidate has an objection to this, he/she should advise the
Registrar (OMS) before the examination. Whilst advance notification is preferred, candidates retain the
right to object to an observer being present at the time of the examination. The Chair of the Examination
Panel or the Registrar (OMS) may elect to observe any segment of the Examination.
Cheating or the use of prohibited equipment or material during the Examination

a. An examiner, invigilator or observer who identifies the candidate cheating or using prohibited
equipment or materials during the Examination will report this immediately to the Chair of the
Examination Panel and the Registrar (OMS), and prepare a written report.
b. The incident will be considered by the Court of Examiners.
Course Requirements
Trainees are required to complete three (3) skills courses by the end of the second year of Oral and
Maxillofacial Surgery training. These courses, listed below, are particularly relevant to the first year of
OMS training and the SST Examination. Trainees are expected to complete them by the end of the first
year of OMS training whenever possible; they must be completed by the end of the second year (OMS
2). These courses are conducted by the Royal Australasian College of Surgeons (RACS) and relevant
information, current course dates and fees can be found on the website www.surgeons.org.
• Australian and New Zealand Surgical Skills Education and Training (ASSET)
• Early Management of Severe Trauma course (EMST)
• Care of the Critically Ill Surgical Patient course (CCrISP)
Surgical Science and Training (SST) Syllabus

The syllabus for the SST Examination has been designed to assess the candidate’s knowledge,
understanding and application of the sciences basic to the practice of surgery.
For progression through Oral & Maxillofacial Surgery training, it is necessary to ensure that trainees
have acquired sufficient knowledge and practical experience in applying basic sciences in the
management of the surgical patient. It is required that competence is demonstrated in general medical
assessment, the diagnosis of common peri-operative complications, and the initiation of appropriate
investigations and treatment. It is expected that candidates will have a reasonable level of basic surgical
skills and a competence in clinical care.
1.1.1 SYLLABUS FOR SST
The syllabus for SST covers the following areas:
• Anatomy
• Physiology and immunology
• Pathology and neoplasia
• Applied pathology and tissue response to injury

• Microbiology
• Pharmacology and therapeutics
• Principles in the management of the trauma patient
• Management of the critically ill surgical patient
• Surgical skills and clinical care
1.1.2 ANATOMY
The candidate should demonstrate an adequate level of knowledge, understanding and application of
anatomy, particularly in the areas of:
• the genesis and implications of physical signs
• investigative procedures – radiology, organ imaging and endoscopy, e.g. identification of structures
on radiographs or CT scans
• the principles of surgical approaches, e.g. incision and drainage of facial space infections
• the genesis of operative complications, e.g. the maxillary artery and other vessels in mid-facial
osteotomies, the facial nerve in trauma
• the principles underlying the healing processes e.g. in bone or peripheral nerves
• the basic mechanisms of structure and function, e.g. the organisation of the muscle spindle
• a detailed understanding of head and neck anatomy.
The candidate should be able to identify:

• anatomical structures in the head and neck from prepared dissections and osteology
• detailed anatomy of the head and neck
• detailed anatomy of other parts of the body as it pertains to oral and maxillofacial surgery.
1.1.3 PHYSIOLOGY AND IMMUNOLOGY
The candidate should demonstrate an understanding of:
Physiology and Molecular Biology

• aspects of human physiology applicable to all surgical specialties
• how normal physiology may be altered by pathological processes, surgery or anaesthesia
• the correlation between physiological change and physical signs or symptoms elicited in patients
including, for example, physiological changes that:
o ensue a patient following prolonged periods of vomiting or diarrhoea
o occur in renal function after surgery, or
o prevail in a patient with, for example, oral cancer
• the physiological response to acute trauma or surgery
• metabolism and nutrition following surgery
• the physiology of coagulation
• respiratory compromise or dysfunction, peri-operative and post-operative
• endocrine physiology as it pertains to surgery, e.g. insulin dependent diabetes mellitus in relation to
surgery and infection
• physiology of pain
• nature of DNA and RNA, the cell cycle, the generation of genetic and chromosomal abnormalities
• principles of autosomal dominant and recessive conditions
• specific conditions in so far as they illustrate important principles or are common or important
disorders e.g. beta thalassemia, inheritance patterns of conditions such as neurofibromatosis.

1.1.4 IMMUNOLOGY
• basic immunology including non-specific defence mechanisms

• the complement system, the major histocompatibility complex
• the cells of the immune system, their functions and their interactions
• immunity and infection including bacteria, viruses, fungi and protozoa
• abnormal immunological responses including hypersensitivity, autoimmune disorders and
immunodeficiency disorders
• diagnostic immunology including the basic principles of commonly used immunological tests and
their applications.
1.1.5 PATHOLOGY AND NEOPLASIA
The candidate should demonstrate knowledge and understanding of the principles of Pathology and
Neoplasia particularly as applied to:
• the general pathological mechanisms (degenerative, reactive and neoplastic) underlying common
disease, including;
1) aetiology, pathogenesis, epidemiology, investigation and natural history
2) how these may be modified by the appropriate use of therapeutic agents
• common and important issues in systemic pathology so far as;
o a given lesion exemplifies a basic pathological process, e.g. anaphylaxis is an example of
hypersensitivity reactions; myocardial infarction in atherosclerosis; mucoepidermoid
carcinoma as an example of neoplasia
o disorders of a given system which are likely to be encountered in surgical practice, e.g.
post-operative pneumonia, thromboembolic disease
• Laboratory medicine so as to make the optimum use of diagnostic services e.g. microscopy and
sensitivity testing, blood gas analysis.
The candidate should be able to identify:
• the more common pathological processes from photographs of gross specimens and the
histopathological features of basic processes from photomicrographs
The candidate should demonstrate knowledge and understanding of neoplasia with specific detailed
emphasis upon:
• its cells and tissues of origin and components

• reproductive, growth (proliferative) patterns and host interactions
• mechanisms of invasion and metastasis
• the molecular basis of the pathogenesis of carcinoma, including oral cancer
• geographic and racial factors
• mechanisms and types of chemical, physical and microbial carcinogenesis
• distinctive pathological (macroscopic, histological and immunochemical) features which aid
diagnosis.

1.1.6 APPLIED PATHOLOGY AND TISSUE RESPONSE

TO INJURY
This area of the syllabus concentrates on the understanding of factors in the aetiology, pathogenesis,
epidemiology and natural history of common diseases, and their implications in the management of
surgical patients.
The candidate should demonstrate knowledge and understanding of:
• wound healing: skin, bone, nerves, cartilage, tendon and muscle

• pathological wound healing e.g. keloid scarring, radiotherapy
• factors in the aetiology, pathogenesis, epidemiology, aspects of investigation and natural history of
common diseases
• understand the implications of diseases in the care and management of surgical patients e.g.
ischaemic heart disease, renal impairment, insulin dependent diabetes and chronic obstructive
airways disease
• factors common to basic mechanisms of disease recognising passive, degenerative, reactive and
neoplastic phenomena
• general pathological phenomena include cell injury, adaptation and death, degenerations including
atherosclerosis and calculus formation, alterations of growth, differentiation and function of cells
• tissue response to injury includes the adaptive reactions of the body to injury
• important morphological manifestations and pathophysiology of important disease states e.g. major
organ failure, shock, sepsis
• the origin and differentiation of haematopoietic cells
• anaemias of acute and chronic blood loss
• types and mechanisms of haemolysis
• common bleeding disorders and their management in the patient undergoing surgery
• transfusion and the potential complications of transfusion.
1.1.7 MICROBIOLOGY
The candidate should demonstrate knowledge and understanding of:

• the microbial flora of the body and its role in disease
• pathogenesis of infection - host defence mechanisms and microbial virulence
• surgically relevant bacterial, viral, fungal and parasitic infections;
o infection following surgery, e.g. wound infection, septicaemia, urinary tract, pneumonia and
nosocomial infections
o infections with surgical implications e.g. HIV, necrotizing fasciitis, facial space infections
• antimicrobial agents and their scientific use in the therapy and prevention (prophylaxis) of infection
• sterilisation and disinfection
• laboratory medicine aspects of infectious diseases, e.g. principles behind blood culture techniques,
interpretation of gram stains, antimicrobial susceptibility techniques.
1.1.8 PHARMACOLOGY AND THERAPEUTICS
This area involves an expected knowledge of major therapeutic areas and major drug groups.
Candidates should be able to apply basic pharmacological principles and understand such information
as set out in a mini Pharmacopoeia. Candidates should understand the mechanism of drug actions and
side-effects, routes of administration and bioavailability, and metabolism and clearance. Detailed
knowledge is expected for medications commonly used in Oral and Maxillofacial Surgical practice.

For example, for antibiotic and antifungal therapy candidates should demonstrate knowledge and
understanding of:
• possible drug interactions e.g. warfarin, tetracyclines and absorption

• potential adverse effects e.g. nephrotoxicity, thrombophlebitis, pseudomembranous colitis
• monitoring of drugs e.g. aminoglycosides
• addition of special cases e.g. paediatric, pregnancy, ageing.
Basic Principles in the Management of the Trauma Patient
In consolidating the principles of EMST (Early Management of Severe Trauma) candidates should be
able to:
• demonstrate concepts and principles of primary and secondary patient assessment

• establish management priorities in a trauma situation
• initiate primary and secondary management of unstable patients
• demonstrate skills used in initial assessment and management and describe a systematic
evaluation of a traumatised patient for general trauma and for oral and maxillofacial surgery injuries
• accurately describe and identify the metabolic response to trauma
• assess and manage shock.
1.1.9 MANAGEMENT OF THE CRITICALLY ILL

SURGICAL PATIENT
In consolidating the principles of CCrISP (Care of the Critically ILL Surgical Patient) candidates should
be able to:
• systematically assess critically ill patients

• understand the variations in presentations of illness and the methods available for investigation
and to improve detection
• describe a plan of action to achieve a diagnosis, early treatment and clinical progress
• ask for appropriate assistance in a timely manner
• be aware of and discuss the support facilities available with specialties and multidisciplinary care
• understand the requirements of the patient, and family, and communicate appropriately.
1.1.10 SURGICAL SKILLS AND CLINICAL CARE
The candidate should be able to demonstrate knowledge of and perform:
• suturing techniques and the properties and indications for different suture materials
• wound care and management of infected wounds
• use of drains and surgical dressings
• knowledge of common surgical instruments and operating theatre equipment e.g. diathermy
• use of local anaesthetics including agents and side-effects
• pre-operative assessment of patients, understanding of co-morbidities and risks, and appropriate
investigations
• peri-operative management; fluids, analgesia, post-operative care
• assessment of patients presenting with facial emergencies and describe a management approach
e.g. facial and dento-alveolar trauma, facial and oral infections, oral and nasal haemorrhage.

Surgical Science and Training Recommended Texts

• Applied Basic Science for Basic Surgical Training (MRCS Study Guides) - A. Raftery
• MCQ's for Applied Basic Science for Basic Surgical Training (MRCS Study Guides) - S.
Jacob
• Textbook of Surgery - J. Tjandra, G. Clunie, A. Kaye, and J. Smith
• MCQ's for Applied Basic Science for Basic Surgical Training (MRCS Study Guides) - S.
Jacob
• MCQs and Short Answer Questions for Surgery - J. Tjandra
• Clinical Cases and OSCE’s in Surgery (MRCS Study Guides) - M. Ramachandran and M.
Gladman
• Abernathy's Surgical Secrets - A. Harken
• Surgery On Call - A. Lefor, L Gomella, B Mann
• Davidson's Principles and Practice of Medicine - N. Colledge, B. Walker, and S. Ralston
• MCQ's for General Medicine (MRCP Study Guides) - M. Ford and I. Wilkinson
• Care of the Critically Ill Surgical Patient - I. Anderson
• EMST Course Manual
• Basic Surgical Skills & Techniques - D. Stoke
• Head, Neck and Dental Emergencies (Oxford Medical Publications) - M Perry
• Robbins & Cotran Pathologic Basis of Disease - V. Kumar, A. Abbas, N. Fausto, and J. Aster
• Ganong's Review of Medical Physiology, 23rd Edition - K. Barrett, S. Barman, S. Boitano, and
H. Brooks
• Clinical Examination: A Systematic Guide to Physical Diagnosis - N. Talley and S. O'Connor
• Gray's Anatomy: The Anatomical Basis of Clinical Practice - S. Standring
• Head and Neck Anatomy: A Clinical Reference - B. Berkovitz and B. Moxham

PART E
THE FINAL EXAMINATION

E - Section 1 Accredited Education and Training in Oral and Maxillofacial Surgery
1 E - SECTION 1
1.1.1 ASSESSMENT OF ELIGIBILITY FOR THE FINAL

EXAMINATION
When trainees have completed their training, or are in the last 18 months of training they may apply for
Assessment of Eligibility for the Final Examination in Oral and Maxillofacial Surgery.
To be eligible for the Examination, candidates must:
a. have completed the SST examination

b. be in the final eighteen (18) months or have just completed the final eighteen (18) months of OMS
training at the time of the examination
c. have been registered as an accredited trainee for the duration of training
d. have satisfactory formative assessment reports for any approved training
e. have completed all required assessments during the training period and at least one (1) satisfactory
Team Appraisal of Conduct
An application form for Assessment of Eligibility can be downloaded from the College website.
The form should be accompanied by:
a. Annual Logbook Summary Sheets and a Final Logbook Summary Sheet (or part thereof) (refer to
Appendix 23 and 24) - if they have not been submitted to the College office prior to this application.
Logbook Summary Sheets must be verified by the Director of Training.
b. Copies of satisfactory Formative Assessment Reports, Case Presentation plus Discussion Reports,
and Assessment of Operative Process Reports for any training completed after January 2007 – if
they have not been submitted to the College office prior to this application.
c. The prescribed fee.
The Training Committee usually meets in mid-June. Trainees will be notified promptly after this meeting,
advising of the outcome of the application. Trainees who have been successful must then enrol for the
Examination prior to the closing date as published on the College website.
ENROLMENT FOR THE EXAMINATION
Once a candidate has received notification from the College that they are eligible for the Final
Examination in Oral and Maxillofacial Surgery, he/she may complete the examination enrolment form
and forward it to the College office, with the prescribed fee.
For the examination enrolment date and fee refer to the Dates and Fees sections at the front of this
Handbook. An enrolment form can be downloaded from here.
Enrolled candidates will receive advice from the College regarding the examination schedule.
The Final Examination consists of four sections (written papers, clinical examinations, surgical anatomy
viva, and Oral and Maxillofacial Surgery Vivas) (Fig 1.3). The two (2) written papers are held on two (2)

consecutive days two (2) to three (3) weeks in advance of the commencement of the oral examinations.
Each candidate must sit all of the components of the examination on each occasion that he/she presents
for the examination. Components from previous failed examinations will not be considered. The Final
Examination is held annually in October to November (refer to the dates page at the front of this
Handbook). Candidates may complete the Written Examination at regional locations.
Fig 1.3 Final Examination Sections

Written Papers Short answer questions
(2 papers of 3 hours each)
Clinical Examinations Six Medium Cases (17 minutes each)
Surgical anatomy viva Surgical Anatomy Viva (15 minutes)
Oral and Maxillofacial Three OMS Vivas (20 minutes each)

Surgery vivas
1.3.1 WRITTEN EXAMINATION
The written examination consists of two (2) written papers, each of three (3) hours duration. Each written
paper comprises short answer questions. Evidence-based medicine will be examined, and appropriate
citations of historical and contemporary research will be required
1.3.2 CLINICAL EXAMINATION
Six (6) medium case scenarios each of approximately 17 minutes duration will be examined and will
include a mix of clinical patients and associated investigations. Concurrent with and following the history
taking and the clinical examination an examiner will be present. Questions will be asked at any stage
during the 17 minutes. Any necessary examination equipment will be supplied to candidates. Candidates
may bring their own personal headlight and light source.
1.3.3 SURGICAL ANATOMY
The Surgical Anatomy Viva will consist of any combination of photos, diagrams or specimens for the
assessment of anatomical knowledge. Any area of the body with relevance to Oral and Maxillofacial
Surgery may be examined. The Viva will be 15 minutes in duration.
1.3.4 ORAL AND MAXILLOFACIAL SURGERY
Three (3) OMS viva voce examinations of 20 minutes each will be examined. These vivas involve
PowerPoint images of clinical material. Identical images are used for each candidate with standardised
questions. Surgical Pathology will be incorporated as a component of the OMS Vivas with photographic
presentations of histopathology specimens and case scenarios.
EXAMINATION PASSING STANDARDS
To successfully pass the Final examination, a candidate must:
• Have been deemed eligible for the Final Examination in that year
• Attempt all four sections (written, anatomy, medium cases, and OMS vivas) in the same
examination diet

• Achieve the passing standard across all proficiencies of the examination
• Achieve the passing standard across all modules of the examination
The examination passing standard for each of these examinations is set by the relevant examination
review panel using formal standard setting methods. The ‘passing standard’ is reviewed at each
examination series and may be adjusted with consideration to differences in the difficulty of
examinations and to maintain the standards. The minimum score required to pass may be set by
applying an error adjustment to the ‘passing standard’ score.
As all components of the final examination are blueprinted to curriculum modules and proficiency
domains, minimum passing standards may also be set based on the aggregation of these. Thus,
candidates must also achieve the passing standard across modules and proficiencies.
EXAMINERS
Examiners for the Final Examination are approved by the College and listed on the website prior to the
Examination.
Examiners examine singly or in pairs and are rotated between the candidates. The Chair of the
Examination Panel can also examine. At the completion of the Examination, a Court of Examiners’
meeting is held, chaired by the Registrar - OMS and is attended by the Chair of the Court of Examiners
and all of the Examiners.
Observers
An observer may be present in any of the exam components. Whilst advance notification is preferred,
candidates retain the right to object to an observer being present at the time of the examination. A
candidate may only object to the observer on the basis of a previous relationship. The Chair of the Court
of Examiners or the Registrar – OMS may elect to observe any segment of the Examination, and
candidates cannot object to their presence.
CONFLICT DURING THE EXAMINATION
If a dispute arises between a candidate and one or more of his/her Examiners the Chair of the Court of
Examiners will be asked to document and adjudicate. If the Chair is unavailable or unable to resolve the
dispute, it should be dealt with expeditiously by the Registrar. The arbitration of the Registrar will be final
at that time. The parties involved have the right to appeal to the Registrar and may do so in writing
through the College office. This is done through the Complaints Handling and Appeals Processes (refer
to Part F – Section 2; Reconsideration, Review & Appeal).
SPECIAL CONSIDERATIONS
1.7.1 PRIOR TO THE EXAMINATION
In the event of illness or bereavement, or any other matter warranting special consideration, prior to the
examination:
a. The candidate must notify the Registrar of the difficulty and forward the details of the problem on
the duly completed Application for Special Consideration form available from the College. In the
case of illness, a medical certificate must accompany the form
b. The Registrar will assess each case on its merits with respect to the acuteness or severity of the
event

c. The Registrar will advise the candidate whether to proceed with the examination
d. Where a candidate withdraws from an examination the enrolment fee is not normally refundable.
However, if the candidate satisfies the CEO that exceptional circumstances will preclude
presentation for the examination, a partial refund may be offered.
1.7.2 EVENTS DURING THE EXAMINATION
a. The candidate will inform the Chair of the Court of Examiners that a problem has arisen, and furnish
details using the Application for Special Consideration form. In the case of illness, a medical
certificate must accompany the form
b. The Chair (or nominee) will, if possible, interview the candidate and will then advise the candidate
whether to continue with the examination
c. If the candidate decides to continue with the examination, the details of the request will be
considered by the Court of Examiners after the candidate’s marks have been discussed, but prior
to final determination of a result
d. If a candidate fails to appear for the examination, or if withdrawal from the examination is advised,
a portion of the fee may be refunded to the candidate, at the discretion of the CEO. The evidence
for medical or compassionate grounds should be received by the College within seven (7) days.
1.7.3 CHEATING OR THE USE OF PROHIBITED

EQUIPMENT OR MATERIAL DURING THE
EXAMINATION
a. An examiner, invigilator or observer who identifies a candidate cheating or using prohibited

equipment or materials during the Examination will report this immediately to the Chair of the
Examination Panel and the OMS Registrar and prepare a written report.
b. The incident will be considered by the Court of Examiners.
NOTIFICATION OF RESULTS
Candidates will be sent formal notification of results from the Registrar (on behalf of the Council), in
writing, within two (2) working days.
In the event of an unsatisfactory result with failure of the examination, the Chair of the Court of
Examiners prepares a detailed account of the candidate’s performance in each segment of the
examination, using information provided by individual Examiners during the components of the
examination, and this is forwarded to the Registrar - OMS (SFS). The Registrar - OMS (SFS) provides
the feedback in the form of a letter and written report to the trainee and their Director of Training.
Trainees are encouraged to discuss the report with the Director of Training. (Refer to Part A section
4.4).
UNSUCCESSFUL FINAL EXAMINATION RESULT
Candidates who do not achieve a pass in the Final Examination do not satisfy the requirements for the
award of Fellowship.
Eligibility to re-present for the Final Examination remains for a period of three (3) years following the
assessment of eligibility. Candidates must be re-assessed for eligibility following expiry of the three (3)
years and will be required to complete the assessment of eligibility form and pay the prescribed fee.
A maximum of three (3) attempts at the Final Examination will be permitted.

APPROVED POSITION
All candidates re-presenting must hold an approved position at the time of the next diet of the Final
examination. This position should be primarily based in one Training Centre and be held for at least six
(6) months prior to the final examination.
This position must be approved by the BoS in advance of the Final Examination. The approved position
must be supported by the Regional Surgical Committee and the application signed by the Director of
Training. The candidate should submit the information in writing regarding the proposed approved post,
including a timetable for the position, and the FOMS06 application form to the Education Officer – OMS
by the 15th December, of the year of the final examination, for review by the Training Committee before
the Training Committee reports to the Board of Studies meeting. The candidate must demonstrate that
the position contains elements of clinical training and formal education sessions affiliated with a regional
training centre before endorsement can be considered.
All trainees must complete the enrolment process with the College and pay the requisite fees for trainees
occupying an approved position.
The BoS considers a mentor to be essential during this period and a list of potential mentors can be
obtained from the College The candidate re-presenting must also have completed all other training
requirements including accredited training time and assessments and maintain enrolment as an
approved trainee, not occupying an accredited post.

E- Section 2 Accredited Education and Training in Oral and Maxillofacial Surgery
2 E- SECTION 2
THE AWARD OF FELLOWSHIP
When trainees are notified of a pass in the Final Examination in Oral and Maxillofacial Surgery and have
successfully completed all components of Surgical Training, they are sent copies of the Constitution and
By Laws of the College and invited to complete an Application for Admission as a Fellow of the College
on the prescribed form.
Trainees who wish to have their Application for Admission to Fellowship considered should return the
Admission to Fellowship Form together with the Completion of Research Form, Completion of Training
Form and payment of the prescribed fee by the designated time. An Admission to Fellowship application
shall be submitted to College Board for formal consideration. The College Board may admit an applicant
to Fellowship once the College has received written confirmation from the Director of Training that the
prescribed training time and mandatory research requirements have been successfully completed.
For the award of Fellowship, FRACDS(OMS) the following must be completed:

1. Notification of a pass in the Final Examination in Oral and Maxillofacial Surgery;
2. Confirmation from the Director of Training that the trainee will complete the required duration of
training, of a minimum of 48 months (this can be confirmed up to three weeks prior to completion of
training);
3. Completion of Mandatory Research requirements (Completion of Research Form);
4. Receipt by the College of the completed, verified Final Logbook Summary;
5. Receipt by the College of the final signed satisfactory Six-Monthly Formative Assessment form;
6. Maintained a satisfactory Training Portfolio, reviewed by the Director of Training;
7. The Completion of Training Form is signed by the Director of Training.
Upon successful completion of training and following formal admission to Fellowship, the new Fellow
will receive a Testamur, together with other College literature and will be entitled to use the post-
nominals FRACDS(OMS).
The College Admission to Fellowship Policy outlines the eligibility requirements for application to
Fellowship in Oral & Maxillofacial Surgery (FRACDS(OMS)), prescribe the process for admission to
FRACDS(OMS) and to set the time limit for admission post eligibility requirements being met.
Applicants who are approved for Fellowship but who have not applied for the FRACDS(OMS) have an
18-month time limit for application to FRACDS(OMS).
CREDENTIALING OF FELLOWS
Credentialing in Oral and Maxillofacial Surgery (OMS) is the establishment of the range of activities that
Oral and Maxillofacial Surgeons can undertake in the core areas of the discipline, where specialist
knowledge and skills is required.
Credentialing needs to incorporate four processes that are interrelated:
1. The minimum qualification required to practice as a specialist in OMS.

2. The verification of individual’s credentials for employment at an institution or organisation.
3. The allocation of clinical responsibility within the institution or organisation
4. The process of re-credentialing on a regular basis

E- Section 2 Accredited Education and Training in Oral and Maxillofacial Surgery
From Zusman, J. (1998). Credentialing and Privileging Systems (2nd Ed). APCE: Florida
Micro-accreditation, is credentialing of Oral and Maxillofacial Surgeons in specific areas of surgery that
fall within the currently recognised scope of Oral and Maxillofacial Surgery but for which individuals need
to demonstrate that specific and advanced training, education and assessment has been undertaken.
Information regarding credentialing in Cranio-Maxillofacial Surgery and Head & Neck Surgery can be
obtained from the College. Credentialing is for 6-year periods and then renewal is required.
Please find the requirements for Microcredentialling in Craniofacial and Head & Neck surgery via this
link.

PART F
GENERAL INFORMATION
F - Section 1 Accredited Education and Training in Oral and Maxillofacial Surgery
1 F - SECTION 1
OMS MENTORING SCHEME
What is Mentoring?
Mentoring is a relationship that gives individuals the opportunity to share professional and personal
skills and develop in the process. It is based on encouragement, constructive comments, mutual
respect and a will to learn and share so that successes and failures can be evaluated.
OMS Mentoring Scheme Match trainees with positive role models

Expand trainee’s potential
This is available to all OMS College registered Trainees and Network with professional community
provides trainees the opportunity to access a Mentor
Translate teaching into practice
This is a relationship based on the individual needs of the Offer professional guidance
Trainee Reinforce learning in clinical coursework
Length of the Mentoring Scheme
It is recommended that Trainees have a Mentor(s) for the duration of their OMS training program. The
minimum commitment to the Mentor Scheme by either party is one year.
Finding your Mentor
The Board of Studies has compiled a list of OMS Fellows who are approved to become Mentors for
Trainees. You can request this list from the OMS Education Officer. It is the trainee's responsibility to
approach a possible Mentor and initiate the first meeting.
Relationship between Mentor and Trainee
Discussions are confidential. Both Mentor and Trainee need to have a clear and shared understanding
of the scheme and its roles and participants. Mentors and Trainees of the OMS Mentoring Scheme will
therefore be required to sign a Mentoring Agreement.
Mentors
Where possible, Mentors selected for the scheme will be Fellows of the College. Where practical,
approved Mentors will not be the Director of Training or Supervisor of Training responsible for the
trainee’s assessment. The Mentor should have had a minimum of three (3) years specialist OMS
experience.
Suggested Mentor responsibilities:
• Review the trainee’s logbook summary and give guidance

• Act as a sounding board for ideas and problems
• Facilitate self-directed learning, with constructive advice
• Provide encouragement and offer new or different perspectives
• Be open minded to the trainee’s opinions and assist in exploring options
• Guide trainees to making their own decisions
• If the need for ‘hard advice’ arises, think in terms of giving a clear, non-judgmental appraisal
Trainee responsibilities:
• Maintain a logbook summary and discuss experiences

• Be open to feedback
• Set realistic expectations with the Mentor
• Be honest about needs and deficiencies
• Follow through on commitments and seek help when necessary
• Discuss failures as well as successes
1. The introductory meeting

Prior to attending the introductory meeting, both participants should read through the Mentoring
Agreement (refer Appendix 27). It is important for both participants to have clear ideas on the
duration of the partnership, the likely frequency of meetings, and the expected outcomes of the
Mentoring Scheme.
At the introductory meeting both parties are required to complete the Mentoring Agreement. This
agreement is to be signed by the Mentor and trainee. Each party should retain a copy and a copy
should be forwarded to the College office within 14 days of completion.
The mentoring period commences after this meeting.
1.1 Introductory meeting guidelines

• Introductions and sharing background information
• Clarifying expectations and objectives
• Discussing possible concerns and difficulties
• Negotiating and agreeing meeting and contact arrangements
1.2 Suggested items in sharing background information:

• Describe your OMS experience
• How is your training going at the moment?
• What type of work have you been engaged in this week/this month?
• What key training and development have you completed in the past year?
• Goal setting?
• Professional development (What do you want to learn about next?)
• What feedback have you had so far from your immediate supervisors?
1.3 Mentors might share from the following topics

• Describe your current role
• What have you been engaged in this week/this month?
• Whether you have mentored anyone before
• What you think your strengths are and what you can offer as a Mentor
• Any particular fields of knowledge, contacts or resources you can offer
2. Progress reports and evaluation

A Progress Report template appears at Appendix 28 and should be completed half yearly.
Reports are to be signed by the Mentor and trainee. Completion Advice forms (Appendix 29)
should be forwarded to the College within 14 days of their completion.

2 F - SECTION 2
POLICIES
2.1.1 RECONSIDERATION, REVIEW AND APPEAL
The College policy relating to Reconsideration, Review and Appeal was reviewed and came into effect
on 1 July 2018.
The purpose of this policy is to outline College decisions which may be formally appealed and the
processes which must be followed to activate a formal appeal. It is intended that these processes enable
resolution between the College and those who have been subject to a decision which they consider
unsatisfactory.
Please find the latest version here.
2.1.2 PLAGIARISM
The College policy relating to Plagiarism was reviewed and came into effect on 1 July 2018.
The College conducts assessments and examinations at Membership and Fellowship level in General
and Specialist Dental Practice and the training program in Oral and Maxillofacial Surgery. The College at
all times strives to maintain fair, valid and consistent assessment and examination processes. The core
expectation of the College underpinning all candidate work is that of academic integrity and honesty.
2.1.3 TRAINEES REQUIRING ASSISTANCE
The College policy relating to Trainees Requiring Assistance Policy was introduced in 2015.
This Policy is designed to assist in the identification, support and management of Oral and Maxillofacial
Surgery (OMS) Trainees Requiring Assistance (TRA). This policy is designed to assist Directors of
Training (DoTs) and Supervisors of Training (SoTs) who are dealing with TRA, to identify TRA early and
to implement effective support systems for them. This policy applies to OMS trainees registered in
accredited OMS training posts within Training Centres accredited by the College.
2.1.4 BULLYING, HARASSMENT & DISCRIMINATION
The College policy relating to Bullying, Harassment and Discrimination was introduced in 2016.
This policy relates to the conduct of all members of the College community. The College is committed to
ensuring fair and equitable workplace practices and has a zero tolerance of all forms of harassment. The
College workplace includes training, examination, meeting and education sites in public and private
settings, electronic communications regarding members of the College community, and within the
College offices.
2.1.5 ADMISSION TO FELLOWSHIP
The College policy relating to Admission to Fellowship Policy came into effect in February 2018.

The policy is to confirm the eligibility requirements for the application for the FRACDS(OMS), prescribe
the process for admission to Fellowship and to set the time limit for admission post eligibility requirements
being met.
2.1.6 OVERSEAS TRAINED SPECIALIST ASSESSMENT POLICY
The College policy relating to Overseas Trained Specialist Assessment (OTOMS) Policy was reviewed
and came into effect in November 2018.
The purpose of this policy is to define the assessment of Specialist International Medical Graduates
(SIMG) referred to as Overseas Trained Oral and Maxillofacial Surgeon (OTOMS) seeking the right to
practice in Australia according to the directions of the Board of Studies, OMS, the Medical Board of
Australia and the Dental board of Australia. This policy defines the specialist assessment process, which
aims to determine whether an OTOMS primary and specialist qualifications, specialist training, and
consultant experience are comparable to those of an Australian or New Zealand-trained oral and
maxillofacial surgeon.
2.1.7 COMPLAINTS POLICY
The College Complaints Policy was introduced in 2018.
The purpose of this policy is to provide a process to address and resolve matters or complaints against
any member of the Royal Australasian College of Dental Surgeons (College) made by other members,
colleagues or other sources where the complaint relates to; the professional or ethical standard of
conduct of a member, the conduct of a member which affects the honour, good reputation, interests, or
work of the College or the College Code of Conduct.
2.1.8 OMS FINAL EXAMINATION FORMAT AND MARKING POLICY
The College OMS Final Examination Format and Marking Policy was reviewed and came into effect in
October 2018.
The purpose of this policy is to prescribe the process followed by the Royal Australasian College of Dental
Surgeons in setting and marking the Oral Maxillofacial Surgery (OMS) Final Examination.
2.1.9 OMS SURGICAL SCIENCE AND TRAINING (SST) EXAMINATION

FORMAT AND MARKING POLICY
The College OMS Surgical Science and Training (SST) Format and Marking Policy was reviewed and
came into effect in October 2018.
The purpose of this policy is to prescribe the process followed by the Royal Australasian College of Dental
Surgeons (RACDS) in setting and marking the Oral Maxillofacial Surgery (OMS) Surgical Science and
Training (SST) Examination.

2.1.10 REFUND POLICY
The College Refund Policy was reviewed and came into effect in July 2018.
The purpose of this policy is to provide guidance on the issuing of refunds for College subscriptions and
enrolment in courses and examinations.
2.1.11 SPECIAL CONSIDERATION IN ASSESSMENT POLICY
The College Special Consideration in Assessment Policy was introduced in 2014.
The purpose of this policy is to provide guidance regarding the circumstances under which special
consideration may be given in relation to assessments and examinations, as well the process for
application for special consideration.

PART G
APPENDICES 1 - 30
SECTION G -Appendix 1- GUIDELINES for the Compilation of a Learning Portfolio for Oral and Maxillofacial
Surgery
APPENDIX 1- GUIDELINES FOR THE COMPILATION OF A LEARNING

PORTFOLIO FOR ORAL AND MAXILLOFACIAL SURGERY
ROYAL AUSTRALASIAN COLLEGE OF DENTAL SURGEONS

Incorporated ABN 97 343 369 579
GUIDELINES FOR THE COMPILATION OF A LEARNING PORTFOLIO

FOR ORAL AND MAXILLOFACIAL SURGERY
A Learning Portfolio is far more than a curriculum vitae. It is a tailor-made document which states the
trainee’s experience and objectives in an orderly fashion and in the context of the requirements of the
Oral and Maxillofacial Surgery (OMS) Training Program of the Royal Australasian College of Dental
Surgeons (the College). The Portfolio need not be a bound volume but a neatly set out ring bound folder.
Separate sections are separated by page dividers. The Training Portfolio is reviewed by the Director of
Training as part of the completion of training requirements to ensure that the portfolio has been
satisfactory maintained
It should be used as a record of the trainee’s learning and achievements while undertaking the education
and training program in OMS and should include the following information:
• Personal details
• Summary of previous posts and learning
• Career intentions
• Courses attended
• Copies of all appraisal forms (confidential) – originals to be sent to the College
- AOP forms of various operative procedures
- TAC forms
- Case Presentation and Discussion forms
- Any formative assessments (Six-Monthly and yearly assessments)
- Logbook set out in prescribed form as outlined in the Handbook
• Research experience
• Publications, published abstracts and presentations
• Case presentations
• Audit projects undertaken and planned
• Teaching notes and critique
• Reading lists
• Memorable events and patients
• Updated and serialised CV
• Anything else considered relevant
The curriculum document MAPS (modules) include certain requirements which need to be checked off
and these are the learning portfolio check lists in each of the modules. These need to be marked off as
the modules are completed. It is the trainee’s responsibility to make sure that these are completed.
Trainees will also be assessed by completing formative assessments through the program. Any
deficiencies can then be remedied in a timely fashion and in such a way so as to reduce any lengthening
of the program or scrambling to complete requirements at the end.
Experience is the raw material for the Portfolio and therefore a record of all that has been learned
through the program should be kept and documented. This will also assist in feeding back any
constructive criticisms in order to improve the program.
The Portfolio should be reflective, as there is a need to be reflective in one’s practice. It should show
examples that demonstrate what has been learnt and indicate improved practice; this should also be
evident in the formative assessments throughout the program and the structured interviews with various
supervisors. A Portfolio which shows that everything is perfect might arouse suspicion and so trainees

SECTION G -Appendix 1- GUIDELINES for the Compilation of a Learning Portfolio for Oral and Maxillofacial
Surgery
should indicate that they have responded to problems which have arisen and describe how effectively
they have been dealt with. A good Portfolio shows a balance between reflection and evidence. Much of
this information will be personal and as such not all of the Portfolio will need to be assessed by the
Training Committee of the College, although anything considered to be relevant should be included.
It is worthwhile continuing this as a lifelong process as continuing medical, dental and surgical education
is an important process in which all professionals have to achieve. A contemporaneous and complete
Portfolio will help in this direction.
The Portfolio will be reviewed by the Director of Training as part of the requirements for the completion
of training for the award of the Fellowship.
The Learning Portfolio may also include the following elements:
• Patient care
- Checklists and other documentation
• Medical Knowledge
- Self-assessment modules or review questions completed
- Tutorials, seminars, etc. attended
- Essays completed
• Practice-based learning and improvement

- Lectures delivered
- Journal club presentations
- Literature reviews related to a specific topic
- Self-assessment
• Interpersonal and communication skills

- Medical record review
• Professionalism
- Any community service projects
- Medical organisation and membership activities
• Systems based practice

- A specific stressful event or conflict and how you managed this
- Development of a solution or system, i.e. audit system, computer program of some
sort or performance improvement activity
- Participation in a hospital committee or root cause analysis or problem-solving team

SECTION G -Appendix 2- Case Presentation
APPENDIX 2- CASE PRESENTATION

ORAL AND MAXILLOFACIAL SURGERY

CASE PRESENTATION
Trainee Name
Hospital OMS 1 ☐ OMS 2 ☐ OMS 3 ☐ OMS 4 ☐

Clinical Problem
Please grade knowledge and Below Borderline for Meets Above n/a*
understanding and the expectations for level of expectations for expectations for
presentation of: level of training training level of training level of training
Medical Record
Clinical Assessment
Investigation(s)
Differential Diagnosis
Treatment
Follow Up and Future Planning
Please mark this if you have not observed the behaviour and therefore feel unable to comment.
Strengths Suggestions for Development
Trainee Signature Assessor Name
Date Assessor Signature

SECTION G -Appendix 3- Assessment of Operative Process – Removal of an Impacted 3rd Molar
APPENDIX 3- ASSESSMENT OF OPERATIVE PROCESS – REMOVAL OF AN

IMPACTED 3RD MOLAR

ASSESSMENT OF OPERATIVE PROCESS
REMOVAL OF AN IMPACTED 3RD MOLAR
Trainee Name
Clinical Problem
Start Time: End Time: Duration:

The Trainee should explain what he/she intends throughout the procedure.
The Assessor should provide verbal prompts, if required, and intervene if patient safety is at risk.
Rating: N = not observed or not applicable D = development required C = competent (no prompting or intervention required)
Rating
Competencies and Definitions N/D/C
Comments
Consent
Demonstrates sound knowledge of indications and contraindications including
alternatives to surgery
Demonstrates awareness of sequelae of operative or non-operative
management
Demonstrates sound knowledge of complications of surgery
Explains the perioperative process to the patient and/or relatives or carers and
checks understanding
Explains likely outcome and time to recovery and checks understanding
Pre-operative planning
Demonstrates recognition of anatomical and pathological abnormalities (and
relevant co-morbidities) and selects appropriate operative
strategies/techniques to deal with these e.g. nutritional status
Demonstrates ability to make reasoned choice of appropriate equipment,
materials or devices (if any) taking into account appropriate investigations
Checks materials, equipment and device requirements with operating room
staff
Ensures the operation site is marked where applicable
Checks patient records, personally reviews investigations
Pre-operative preparation
Checks in theatre that consent has been obtained and appropriate time out
procedures
Gives effective briefing to theatre team
Ensures proper and safe positioning of the patient on the operating table
Demonstrates careful skin or mucosal preparation – as required
Demonstrates careful draping of the patient’s operative field

Ensures general equipment and materials are deployed safely (e.g. suction,
diathermy)
Ensures appropriate drugs, inc. local anaesthesia are administered where
appropriate
Deploys specialist supporting equipment (e.g. operating microscope) effectively
Exposure and closure
Demonstrates knowledge of optimum skin incision/mucosal/portal/access
Achieves an adequate exposure through purposeful dissection in correct tissue
planes and identifies all structures correctly
Completes a sound wound repair where appropriate
Protects the wounds with dressings, splints and drains where appropriate
Intra operative technique
Follows an agreed logical sequence or protocol for the procedure
Consistently handles tissue well with minimal damage
Controls bleeding promptly by appropriate method
Demonstrates a sound technique of knots and sutures/staples
Uses instruments appropriately and safely
Proceeds at appropriate pace with economy of movement
Anticipates and responds appropriately to variation e.g. anatomy
Deals calmly and effectively with unexpected events/complications
Uses assistant(s) to the best advantage at all times
Communicates clearly and consistently with the scrub team
Communicates clearly with the anaesthetist
Appropriate design of flap
Incision to correct length/depth/orientation
Smooth reflection of flap in correct plane
Gentle handling of tissue when reflecting flap
Correct application of buccal retractor
Correct protection of lingual nerve as necessary
Bone removal: bur – correct handling of handpiece with pengrip and pencil
support
Correct bone removal (site and amount)
Tooth division: correct angulation or judged unnecessary
Appropriate choice of elevator
Correct application of elevator
Tooth elevated correctly
Bone left with no rough edges
Socket debrided
Ensures correct apposition of flap
Post-operative management

Ensures the patient is transferred safely from the operating table to bed
Constructs a clear operation note
Records clear and appropriate post-operative instructions
Deals with specimens. Labels and orientates specimens appropriately
Level at which completed elements of the AOP were performed on this occasion Tick as appropriate
Level 0 Insufficient evidence observed to support a summary judgment ☐
Level 1 Unable to perform the procedure, or part observed, under supervision ☐
Level 2 Able to perform the procedure, or part observed, under supervision ☐
Level 3 Able to perform the procedure with minimum supervision (needed occasional
☐
help)
Level 4 Competent to perform the procedure unsupervised (could deal with
☐
complications that arose)
Comments by Trainee:
Trainee Signature: Assessor Name:
Date: Assessor Signature:

SECTION G -Appendix 4- Assessment of Operative Process – Harvest of a Local Bone Graft
APPENDIX 4- ASSESSMENT OF OPERATIVE PROCESS – HARVEST OF A

LOCAL BONE GRAFT

HARVEST OF A LOCAL BONE GRAFT
Trainee Name
Clinical Problem

Rating
Competencies and Definitions Comments
N/D/C
Consent
Demonstrates sound knowledge of indications and contraindications
including alternatives to surgery
management
Explains the perioperative process to the patient and/or relatives or carers
and checks understanding
Demonstrates recognition of anatomical and pathological abnormalities
(and relevant co-morbidities) and selects appropriate operative
staff
procedures

SECTION G -Appendix 4- Assessment of Operative Process – Harvest of a Local Bone Graft
Ensures general equipment and materials are deployed safely (e.g.

suction, diathermy)
appropriate
Deploys specialist supporting equipment (e.g. operating microscope)
effectively
Achieves an adequate exposure through purposeful dissection in correct
tissue planes and identifies all structures correctly
Demonstrates adequate planning and selection of local graft site
Appropriate soft tissue incision and exposure of graft harvest and recipient
sites
Correct use of retractors for the sites
Identification and protection of important structures e.g. nerves, roots
Appropriate design of bone cuts and adequate depth of cuts
Satisfactory harvest technique for the bone graft – cancellous or cortical
grafts
Careful handling of important structures on graft elevation e.g. IAN, mental
nerve
Adequate haemostasis measures and closure of graft site
Appropriate preparation of the recipient site
Bone graft to recipient site – adequate packing or contouring of graft
If cortical graft, application of fixation – good technique and adequate
fixation
Adjunctive procedures if required e.g. membrane placement
Satisfactory soft tissue closure of the recipient site
Prepares for extubation

SECTION G -
☐
help)
☐

SECTION G -Appendix 5- Assessment of Operative Process – Harvest of a Distant Bone Graft
APPENDIX 5- ASSESSMENT OF OPERATIVE PROCESS – HARVEST OF A

DISTANT BONE GRAFT

HARVEST OF A DISTANT BONE GRAFT
Trainee Name
Clinical Problem

Rating
Competencies and Definitions N/D/C Comments
Consent
management
staff
procedures

SECTION G -Appendix 5- Assessment of Operative Process – Harvest of a Distant Bone Graft

diathermy)
appropriate
effectively
Demonstrates adequate planning and selection of distant graft site
Appropriate soft tissue exposure and preparation of recipient site
Correct marking of the graft harvest site and identification of landmarks
Appropriate soft tissue incision and good technique for dissection through
layers
Correct use of instrumentation for dissection and retractors
Identification and protection of important adjacent structures e.g. nerves,
pleura
Adequate preparation and exposure of graft harvest site
Appropriate design and adequate depth of bone cuts
Satisfactory harvest of the bone graft and careful handling of important
structures
Demonstrates acceptable haemostasis measures for the harvest site
Appropriate closure of the wound and use of drains/dressings as required
Bone graft to the recipient site – adequate packing or contouring of the graft
Application and adequate fixation for cortical grafts

SECTION G -
Demonstrates appropriate soft tissue flap use and tissue handling for
closure
Adjustment of any overlying prosthesis e.g. denture
☐
help)
☐

SECTION G -Appendix 6- Assessment of Operative Process - Uncomplicated Placement of Dental Implant
APPENDIX 6- ASSESSMENT OF OPERATIVE PROCESS - UNCOMPLICATED

PLACEMENT OF DENTAL IMPLANT

UNCOMPLICATED PLACEMENT OF DENTAL IMPLANT
Trainee Name
Clinical Problem

Rating
Consent
management
relevant co-morbidities) and selects appropriate operative strategies/techniques
to deal with these e.g. nutritional status
Checks materials, equipment and device requirements with operating room staff
procedures
diathermy)
appropriate


Demonstrates appropriate use of surgical guide with respect to site of placement
Chooses appropriate drilling sequence
Maintains correct position, angulation and depth throughout drilling sequence
Chooses appropriate speed and torque for drilling and insertion to minimize
tissue trauma
Chooses appropriate fixture for insertion
Demonstrates understanding of need to modify choice of fixture according to
bone quality at site
Inserts fixture with correct position, angulation and depth
Makes appropriate choice of (size of) abutment vs cover screw
Adequately seats abutment/cover screw, eliminating interferences as required
☐
help)
☐


SECTION G -Appendix 7- Assessment of Operative Process – Closure of Oro-Antral Fistula
APPENDIX 7- ASSESSMENT OF OPERATIVE PROCESS – CLOSURE OF ORO-

ANTRAL FISTULA

CLOSURE OF ORO-ANTRAL FISTULA
Trainee Name
Clinical Problem

Rating
Consent
management
staff
procedures
diathermy)
appropriate


effectively
Decides on an appropriate flap design
Incision to correct length/ depth/ orientation
Gentle handling of tissues
Identification of bony defect in alveolus
Debrides/ irrigates defect
Bone removal as necessary
Development of deep layer of buccal fat if necessary
Advancement of mucoperiosteal flap with periosteal release
Trims flap to fit defect
Sutures flap to achieve a satisfactory seal
☐
help)
☐


SECTION G -Appendix 8- Assessment of Operative Process – Tracheostomy
APPENDIX 8- ASSESSMENT OF OPERATIVE PROCESS – TRACHEOSTOMY

ASSESSMENT OF OPERATIVE PROCESS –
TRACHEOSTOMY
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
relevant co-morbidities) and selects appropriate operative strategies/techniques
to deal with these e.g. nutritional status
Checks materials, equipment and device requirements with operating room staff
procedures
Ensures proper and safe positioning of the patient on the operating table (with
shoulder rolls and neck extension)
diathermy)
appropriate

SECTION G -

Ensures appropriate tracheostomy tube (type, additional sizes) ready, checks
cuff
Marks surgical site prior to neck extension: half way between cricoid cartilage
and sternal notch or uses lower end of cricoid cartilage as a guide where
unusual anatomy
Ensures easy access for anaesthetist to the endotracheal tube
Injects LA prior to skin incision, makes horizontal skin incision or able to justify
choice
Incises superficial fascia and down to investing layer, ligating branches ant
jugular
Incises midline fascia over strap muscles, and exposes thyroid isthmus and
veins (ligates as needed)
Divides thyroid isthmus (not mandatory for all cases), uses tranfixion suture
Uses cricoid hook to elevate trachea
Alerts anaesthetist when ready to incise trachea
Proceeds with tracheotomy at level of 2nd/3rd tracheal ring
Liaises with anaesthetist to deflate the endotracheal tube cuff and withdraw until
tip on sight
Inserts tracheostomy tube and connects to airway, inflates the cuff
Sutures wound edges as necessary, sutures/secures tracheostomy tube to skin
(avoids tape use if near site of microvascular anastomosis)
Places dressing between tracheostomy flange and skin, checks security and
function tube

SECTION G -
☐
help)
☐

SECTION G -Appendix 9- Assessment of Operative Process – Mandibular Osteotomy
APPENDIX 9- ASSESSMENT OF OPERATIVE PROCESS – MANDIBULAR

OSTEOTOMY

ASSESSMENT OF OPERATIVE PROCESS -
MANDIBULAR OSTEOTOMY
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)


appropriate
effectively
Model surgery and splints
Cephalometric planning
Flap design and exposure
Use of retractors
Identification of Lingula
Adequate depth and design of bone cuts
Develops osteotomy
Complete osteotomy – identify nerve
Mobilizes and protects nerve
Segment mobilization
Establishes occlusion
Positions condyles
Applies fixation
Checks occlusion


☐
help)
☐

SECTION G -Appendix 10- Assessment of Operative Process – Maxillary Osteotomy
APPENDIX 10- ASSESSMENT OF OPERATIVE PROCESS – MAXILLARY

OSTEOTOMY

MAXILLARY OSTEOTOMY
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)

SECTION G -Appendix 10- Assessment of Operative Process – Maxillary Osteotomy

appropriate
effectively
Model surgery and splints
Cephalometric planning
Flap design and exposure – preservation of vascular pedicle
Use of retractors
Identification of Lingula
Adequate depth and design of bone cuts
Develops osteotomy
Completes osteotomy – preserve nasal lining
Greater Palatine vessels mobilization and protection
Segment mobilization
Haemostatis
Establishes occlusion
Positions condyles
Appliesfixation
Checks occlusion

SECTION G -

☐
help)
☐

SECTION G -Appendix 11- Assessment of Operative Process – Incision and Drainage Facial Abscess
APPENDIX 11- ASSESSMENT OF OPERATIVE PROCESS – INCISION AND

DRAINAGE FACIAL ABSCESS

INCISION AND DRAINAGE FACIAL ABSCESS
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)


appropriate
effectively
Knowledge of anatomical cervico-facial spaces
Skin crease incision
Identification of platysma
Marginal mandibular branch identification/ protection
Hilton’s method
Exploration of abscess cavity
Positions and secures drain
☐
help)


☐

SECTION G -Appendix 12- Assessment of Operative Process – Enucleation of a Jaw Cyst
APPENDIX 12- ASSESSMENT OF OPERATIVE PROCESS – ENUCLEATION OF

A JAW CYST

ENUCLEATION OF A JAW CYST
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)


appropriate
effectively
Appropriate design of flap
Incision to correct length/depth/orientation
Reflection of the flap in correct plane
Gentle handling of tissues and retraction
Bone removal as necessary and to correct quantity to expose cyst lining
Dissection of cyst contents with correct instrument and in appropriate plane
Cares for underlying anatomical structures e.g. IAN
Correct delivery of cyst lining for histopathological examination
Bone smoothing
Cyst cavity debridement
Correct apposition of flap
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SECTION G -Appendix 13- Assessment of Operative Process - Surgical Approaches to the Mandible – Intraoral
APPENDIX 13- ASSESSMENT OF OPERATIVE PROCESS - SURGICAL

APPROACHES TO THE MANDIBLE – INTRAORAL

SURGICAL APPROACHES OF THE MANDIBLE- INTRAORAL
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)


appropriate
effectively
Mucoperiosteal incision with scalpel or diathermy
Incision to include gingival margin or sulcus incision
Subperiosteal dissection
Exposure and protection of mental nerve
Lingual nerve on lingual side
Debridement
Sutures interdentally or continuous resorbable non resorbable
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help)
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SECTION G -Appendix 14- Assessment of Operative Process - Surgical approach to the Mandible – Extraoral

APPROACH TO THE MANDIBLE – EXTRAORAL

SURGICAL APPROACH TO THE MANDIBLE - EXTRAORAL
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)


appropriate
effectively
Incision through skin to subcutaneous tissues
Wound edges undermined with scalpel or scissors
Dissection to platysma muscle scissors, scalpel or blunt dissection with
gauze
Platysma muscle divided along full length of incision
Dissection deepened within deep cervical fascia towards mandible
Facial artery and vein identified and tied if necessary
Mandibular branch of facial nerve identified
Incises muscle and periosteum depending on location
Periosteum swept of mandible
Pathology appropriately treated
Controls bleeding
Placement of drain
Debrides wound and closes in layers

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help)
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SECTION G -Appendix 15- Assessment of Operative Process - Surgical Approach to the Zygomatic – Orbital
Complex

APPROACH TO THE ZYGOMATIC – ORBITAL COMPLEX

SURGICAL APPROACH TO THE ZYGOMATIC- ORBITAL COMPLEX
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)

Complex

appropriate
effectively
Incision across the scalp through skin and subcutaneous tissues to
pericranium
Appropriate clips/diathermy used to control bleeding from incision line
Dissection continued towards the supra-orbital rim above the pericranium
Temporalis muscle and fascia identified sub fascia or sub muscular
dissection completed to lateral orbital rim and zygomatic arch as needed
Supra orbital nerves identified and isolated, if necessary foramen
osteotomised, if necessary ethmoid arteries identified and appropriately
controlled if required
Pericranium incised 1-2 cm above supraorbital margin and subpericranial
dissection completed over desired area
Entire zygoma is exposed including the arch and orbital walls excluding the
medial wall
Infra orbital wall and medial wall exposed via transconjunctival approach or
subcilliary approach in combination with flap as needed
Appropriate reduction and/or fixation procedure performed
Wound debrided
Drains wound and closes in layers, skin closure with clips or suture
Dresses wound appropriately

Complex

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help)
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SECTION G -Appendix 16- Assessment of Operative Process – Mandibular Fractures (Excluding Condyles)
APPENDIX 16- ASSESSMENT OF OPERATIVE PROCESS – MANDIBULAR

FRACTURES (EXCLUDING CONDYLES)

MANDIBULAR FRACTURES (EXCLUDING CONDYLES)
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)
appropriate


effectively
Application of arch bars
Placement of incision(s)/flap design
Exposure of fracture site
Debridement of fracture cleft
Removal of unsalvageable tooth/teeth in or adjacent to fracture site
Identifies and protects mental nerve
Reduction of fracture site/establish occlusion/intermaxillary fixation
Places appropriate bone fixation across fracture site
Checks occlusion
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help)
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SECTION G -Appendix 17- Assessment of Operative Process – Maxillary Fractures
APPENDIX 17- ASSESSMENT OF OPERATIVE PROCESS – MAXILLARY

FRACTURES

ASSESSMENT OF OPERATIVE PROCESS -
MAXILLARY FRACTURES
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)


appropriate
effectively
Application of arch bars
Placement of incision/flap design
Exposure of fracture site(s)
Debridement of fracture(s)
Identification and protection of infraorbital nerve
Removal of unsalvageable tooth/teeth in or adjacent to fracture site
Reduction of fractures with disimpaction forceps
Establish occlusion/intermaxillary fixation
Places appropriate bone fixation across fracture site(s)
Checks occlusion
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SECTION G -Appendix 18- Assessment of Operative Process – Zygomatic Complex Fractures
APPENDIX 18- ASSESSMENT OF OPERATIVE PROCESS – ZYGOMATIC

COMPLEX FRACTURES

ZYGOMATIC COMPLEX FRACTURES
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)


appropriate
effectively
Placement of incision(s)
Tissue dissection
Appropriate reduction of fracture
– Temporal approach
– Transcutaneous hook
– Intraoral approach
Direct exposure of fracture site(s)
- Intraoral
- Infraorbital margin
- Fronto-zygomatic process
- Zygomatic arch
Exploration of orbital floor where appropriate
Identifies and protects of infra-orbital nerve
Places appropriate bone fixation across fracture site(s)
Checks eye signs


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help)
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SECTION G -Appendix 19- Assessment of Operative Process – Removal of Submandibular Gland
APPENDIX 19- ASSESSMENT OF OPERATIVE PROCESS – REMOVAL OF

SUBMANDIBULAR GLAND

REMOVAL OF SUBMANDIBULAR GLAND
Trainee Name
Clinical Problem

Rating
N/D/C
Consent
management
staff
procedures
diathermy)


appropriate
effectively
Incision through skin to subcutaneous tissues
Wound edges undermined with scalpel or scissors
Dissection to platysma muscle scissors, scalpel or blunt dissection with gauze
Platysma muscle divided along full length of incision
Dissection deepened within deep cervical fascia
Mandibular branch of facial nerve identified
Fascia of the gland identified
Fascia entered, gland dissected free within fascia on gland
Facial artery identified and tied, deep to the gland and superficial if required
Submandibular duct and lingual nerve identified and dissected free, gland
removed
Controls bleeding
Places of drain
Debrides wound and closes in layers

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help)
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SECTION G -Appendix 20- TAC Rater Survey
APPENDIX 20- TAC RATER SURVEY
Team Appraisal of Conduct (TAC)
The Team Appraisal of Conduct (TAC) form is a peer assessment tool comprising a self-
assessment by the trainee and the collated ratings from a range of colleagues who work with
the trainee. As a part of a multidisciplinary team, surgical trainees work with other people who
have complementary skills. They are expected to understand the range of roles and expertise
of team members in order to work effectively within that team. The TAC is used as an
educational method of assessing competence in professional skills within a team-working
environment.
The assessment provides developmental feedback to the trainee in order to improve the
trainee’s clinical care and professional competence by directing learning and improving insight.
Trainees are assessed doing what is normally expected of them in their usual working
environment. The trainee selects different raters to cover a variety of perspectives.
The TAC assessment is confidential. Individual assessments are anonymised and are not
disclosed to the trainee. Feedback to the trainee is delivered through a report which is sent to
the trainee and the Director of Training and comprises the rater’s aggregate ratings compared
with the trainee’s self-assessment, plus rater’s comments which are listed verbatim.
Completing the Assessment
The process is commenced by the trainee completing the self-assessment TAC survey through
Informz which is collated at the College. Concurrently, the trainee selects a minimum of 8 raters
(maximum of 12). Raters should be members of the trainee’s multidisciplinary healthcare team
who represent a range of different grades and environments (e.g. ward, theatre, outpatients)
and who have sufficient expertise to be able to make an objective judgment about the trainee’s
performance. Raters should not include administrators, support staff or patients.
The trainee is to send the Education Officer the list of names and email addresses of who will
be rating the trainee. The Education Officer will then email a link of the survey to the raters
with an explanation of the TAC. The assessment form should only take 10-15 minutes to
complete. The data is then collected and the results and feedback will then be sent out to the
trainee and Director of Training in a report.
For raters: Indicate the environment in which you have primarily observed the trainee, your
position, and add any comments on particular strengths noted. If you have rated a particular
attitude or behaviour as borderline or below expectation, please describe your concerns or
areas that require development.
Thank you for your time to complete this survey and for contributing to training of OMS
trainees, specifically in the improvement of professional skills.

SECTION G -APPENDIX 21- Six Monthly Formative Assessment Report Form
APPENDIX 21- SIX MONTHLY FORMATIVE ASSESSMENT REPORT FORM


SIX MONTHLY FORMATIVE ASSESSMENT REPORT FORM
Trainee Name
Training Period to Centre
Post Occupied OMS 1 OMS 2 OMS 3 OMS 4 (circle)
Supervisor of
Training
Please consider the trainee’s performance in general terms and against the criteria (initial here)
provided. Initial the box on the right to confirm you have consulted with colleagues,
junior medical staff and allied health personnel prior to completing this report.
Key:
1 Unsatisfactory – performs significantly below that generally observed for this level of experience
2 Below expectation – requires further development
3 Meets expectation – performs at a satisfactory level
4 Above expectation – performs at a level better than that which would be expected for the level of
experience
5 Exceptional – performs at a level beyond that which would be expected for the level of experience
N/O Not observed
CLINICAL KNOWLEDGE 1 2 3 4 5 N/O
1 Clinical knowledge of subject (Perspective to patient care,
appropriate investigations, post-operative care)
2 Professional knowledge (Knowledge of hospital procedures, policy,
medico legal aspects)
3 Clinical clerking (Adequacy of detail in written records, legibility,
accurate drug charting)
4 History taking (Ability to take history and perform physical
examination, obtains pertinent information, perceptive, thorough)
PROCEDURAL SKILLS 1 2 3 4 5 N/O
5 Anatomical knowledge (demonstrates adequate knowledge of
anatomy during planning & procedures)
6 Surgical technique (demonstrates good surgical technique, tissue &
instrument handling, suturing & wound care)
7 Adaptive skills (adapts techniques to the requirements of the
situation)
8 Surgical judgment (demonstrates adequate surgical judgment during
procedures)
9 Surgical development (analyses own technique & demonstrates
quality improvement)
10 Ergonomics (demonstrates efficiency with maintenance of technique
and standards)
11 Assistance (seeks assistance appropriately and timely)
12 Operative complications (satisfactory response, in control – if not
observed N/O)
CLINICAL JUDGEMENT 1 2 3 4 5 N/O

13 Diagnostic skills (Identifies and prioritises patient problems, selects

appropriate tests, understands and can interpret results)
14 Patient management (Synthesises data, makes appropriate
management decisions, responds appropriately to call outs and
provides emergency care as required)
15 Time management (Plans and organises work, sets goals and meets
them, prioritises calls, seeks advice on priorities if needed)
16 Recognising limits (Accurate assessment of own skills, refers and
consults with others as required, takes responsibility for actions)
17 Ethical Skills (Shows understanding and judgement of ethical issues)
COMMUNICATION 1 2 3 4 5 N/O
18 Communication skills (Communicates effectively in English, with
clarity, logic of expression, etc.)
19 Ability to communicate with patients and families (Listening skills,
respect, avoidance of jargon, coping with antagonism, responsive to
patient’s concerns)
20 Sensitivity and ethical awareness (Is aware of options and
networks available to patients, treats patients as individuals,
recognises and values differences)
CO-OPERATION AND TEAMWORK 1 2 3 4 5 N/O
21 Ability to co-operate with other healthcare professionals (Ability
to work in a multidisciplinary team and with all team members
irrespective of gender/culture, contributes effectively to teamwork,
case presentations)
22 Initiative and enthusiasm (Gets involved, self-motivated, able to
identify needs of the job, follows up without being prompted, thinks
and plans ahead, shows commitment, asks questions of supervisors)
23 Takes responsibility for own learning (Evidence of reading up on
cases, attends seminars and teaching sessions, asks questions, keen
to discover new knowledge)
24 Motivation to teach (Medical staff, nurses, other health
professionals)
PROFESSIONAL ATTITUDES AND BEHAVIOUR 1 2 3 4 5 N/O
25 Reliability and dependability (Punctual, carries out instructions,
fulfils obligations, complies with hospital policies, keep up to date with
work including letters, arranging meetings, notifies staff if expecting to
be absent from duty)
26 Ability to cope with stress, emotional demands and emergency
situations (Reports when stressed, asks for help when needed,
shows coping skills)
27 Personal manner (Approachability, warmth, openness, rapport etc.)
PROGRESS ON ASSESSMENTS
Research activities during period (Please tick)
No progress Research in progress Study Completed
Clinical Training and Assessment (CTA) – Case Presentation plus Discussion
Number Completed
Clinical Training and Assessment (CTA) – Assessment of Operative Process (AOP)
Number Completed
Presentation of Paper (Please list)

TRAINEE’S STRENGTHS AND WEAKNESSES
AREAS FOR IMPROVEMENT:
AS THE SUPERVISOR OF TRAINING I HAVE DETERMINED THE OVERALL PERFORMANCE OF THE TRAINEE IN
THIS SIX MONTHS HAS BEEN:
Satisfactory
Borderline
Unsatisfactory
Supervisor of Training Name __________________________________

Please print name
Supervisor of Training Signature ______________________________ Date: _________________
My Supervisor of Training has discussed this assessment with me
Trainee Name __________________________________

Please print name
Trainee Signature __________________________________ Date: _________________
TO BE COMPLETED BY DIRECTOR OF TRAINING

This report has been confirmed as:
Satisfactory
Borderline For Borderline and Unsatisfactory assessments, please contact the College.
Unsatisfactory
The logbook has been confirmed as:

Satisfactory
Borderline
Unsatisfactory

Director of Training Name __________________________________

Please print name
Director of Training Signature __________________________________ Date: _________________

SECTION G -APPENDIX 22- Trainee Report Form
APPENDIX 22- TRAINEE REPORT FORM


TRAINEE REPORT FORM – REMEDIAL PLAN
Trainee Name
Training Period Centre
Post Occupied OMS 1 OMS 2 OMS 3 OMS 4 (circle)
Supervisor
Director of Training
Chair, RSC
SUPERVISOR OF TRAINING’S ASSESSMENT OF TRAINEE’S PROGRESS AND PERFORMANCE

Trainee’s Strengths:
Areas For Improvement:
Summary of Plan for Remedial Action:
(Use separate sheet if necessary)
Director of Training: I have advised the trainee that improvement will be expected over the next 3 to 6 month
rotation period in the areas specified above or another borderline or unsatisfactory six-month report may result.
Signature _____________________________________ Date: _________________
Name ____________________________________________________________
Trainee: I have had the implications of this warning explained to me and I understand them.
Signature _____________________________________ Date: _________________

SECTION G -APPENDIX 23- Annual Logbook Summary Sheet
APPENDIX 23- ANNUAL LOGBOOK SUMMARY SHEET


ANNUAL LOGBOOK SUMMARY SHEET – PRE 2016
Surname
First Name
Other Names
Training Year
Regional Training (e.g. OMS 1, 2, 3 or 4)
Centre
DATES (e.g.1 Jan 2011

-31 Dec 2011) CUMULATIVE
PROCEDURAL AREAS
TOTAL
Surgeon
1. Dentoalveolar
Assistant
Surgeon
2. Oral and Facial Infection
Assistant
Surgeon
3. Facial Trauma
Assistant
Surgeon
4. Pathology - benign
Assistant
Surgeon
5. Pathology - malignant
Assistant
Surgeon
6. Preprosthetic - minor
Assistant
Surgeon
7. Preprosthetic - major
Assistant
Surgeon
8. Preprosthetic - implants
Assistant
Surgeon
Assistant
Surgeon
Assistant
Surgeon
11. Orthognathic - other
Assistant
Surgeon
Assistant
Surgeon
13. Maxillary Sinus
Assistant
Surgeon
Assistant

SECTION G -APPENDIX 23- Annual Logbook Summary Sheet
Surgeon
15. Reconstructive – soft tissue
Assistant
Surgeon
16. Reconstructive – composite
Assistant
Surgeon
Assistant
18. Other procedures: Surgeon
Assistant
To be listed as surgeon the trainee must have done a substantial portion of the procedure and be the one in “charge” of
the procedure. The consultant may be present and act as a mentor. If registrars do a side of an operation each, both
cannot claim to be surgeon. The more senior or the one in-charge claims to be surgeon. The other may list as first
assistant. There can only be two surgeons if there are two different procedures at distant sites i.e. harvest of bone graft
and a mandibular reconstruction. A bimaxillary osteotomy is a single operation.
A person who does not scrub in or is not the first assistant on the case cannot claim to be an assistant.
I certify that this is a true and accurate summary of my training and understand that my complete logbook may be
audited for accuracy.
Trainee Signature: Date:
Director of Training Signature: Date:

SECTION G -APPENDIX 23a-Annual Logbook Summary Sheet
APPENDIX 23A-ANNUAL LOGBOOK SUMMARY SHEET


ANNUAL LOGBOOK SUMMARY SHEET – FROM 2016
Surname
First Name
Other Names
Regional Training Training Year

Centre (e.g. OMS 1, 2, 3 or 4)
DATES (e.g.1 Jan 2011 CUMULATIVE
PROCEDURAL AREAS
-31 Dec 2011) TOTAL
Surgeon
1. Dentoalveolar
Assistant
Surgeon
Assistant
Surgeon
3. Facial Trauma
Assistant
Surgeon
Assistant
Surgeon
Assistant
Surgeon
6. Preprosthetic & adjunctive implant procedures
Assistant
Surgeon
7. Implantology (cases)
Assistant
Implant fixtures (number)
Surgeon
Assistant
Surgeon
Assistant
Surgeon
Assistant
Surgeon
Assistant
Surgeon
12. Maxillary Sinus
Assistant
Surgeon
Assistant
Surgeon
Assistant
Surgeon
Assistant
16. Other procedures Surgeon

SECTION G -APPENDIX 23a-Annual Logbook Summary Sheet
Assistant
Other procedures:
To be listed as surgeon the trainee must have done a substantial portion of the procedure and be the one in
“charge” of the procedure. The consultant may be present and act as a mentor. If registrars do a side of an
operation each, both cannot claim to be surgeon. The more senior or the one in-charge claims to be surgeon. The
other may list as first assistant. There can only be two surgeons if there are two different procedures at distant
sites i.e. harvest of bone graft and a mandibular reconstruction. A bimaxillary osteotomy is a single operation.
I certify that this is a true and accurate summary of my training and understand that my complete logbook
may be audited for accuracy.

SECTION G -APPENDIX 24- Final Logbook Summary Sheet – Conclusion of Training
APPENDIX 24- FINAL LOGBOOK SUMMARY SHEET – CONCLUSION OF

TRAINING


FINAL LOGBOOK SUMMARY SHEET – CONCLUSION OF TRAINING PRE 2016
Surname
First Name
Other Names
Regional Training
Conclusion of Training (eg. OMS 4)
Centre
DATES (eg. 1 Jan 2011 CUMULATIVE
PROCEDURAL AREAS
– 31 Dec 2011) TOTAL
Surgeon
1. Dentoalveolar
Assistant
Surgeon
Assistant
Surgeon
3. Facial Trauma
Assistant
Surgeon
Assistant
Surgeon
Assistant
Surgeon
6. Preprosthetic - minor
Assistant
Surgeon
7. Preprosthetic - major
Assistant
Surgeon
8. Preprosthetic - implants
Assistant
Surgeon
Assistant
Surgeon
Assistant
Surgeon
11. Orthognathic - other
Assistant
Surgeon
Assistant
Surgeon
13. Maxillary Sinus
Assistant
Surgeon
Assistant
Surgeon
15. Reconstructive – soft tissue
Assistant
Surgeon
16. Reconstructive – composite
Assistant

SECTION G -APPENDIX 24- Final Logbook Summary Sheet – Conclusion of Training
Surgeon
Assistant
Surgeon
18. Other procedures:
Assistant
To be listed as surgeon the trainee must have done a substantial portion of the procedure and be the one in “charge” of the
procedure. The consultant may be present and act as a mentor. If registrars do a side of an operation each, both cannot
claim to be surgeon, the more senior or the one in-charge claims to be surgeon, the other may list as first assistant. There
can only be two surgeons if there are two different procedures at distant sites ie. harvest of bone graft and a mandibular
reconstruction. A bimaxillary osteotomy is a single operation.
I certify that this is a true and accurate summary of my training and understand that my complete logbook may
be audited for accuracy.

SECTION G -APPENDIX 24a- Final Logbook Summary Sheet – Conclusion of Training
APPENDIX 24A- FINAL LOGBOOK SUMMARY SHEET – CONCLUSION OF

TRAINING


FINAL LOGBOOK SUMMARY SHEET – CONCLUSION OF TRAINING FROM 2016
Family Name
First Name
Other Names
Regional Training
Conclusion of Training (eg. OMS 4)
Centre
DATES (eg. 1 Jan 2011 CUMULATIVE
PROCEDURAL AREAS
– 31 Dec 2011) TOTAL
Surgeon
1. Dentoalveolar
Assistant
Surgeon
Assistant
Surgeon
3. Facial Trauma
Assistant
Surgeon
Assistant
Surgeon
Assistant
Surgeon
6. Preprosthetic & adjunctive implant procedures
Assistant
Surgeon
7. Implantology (cases)
Assistant
Implant fixtures (number)
8. Orthognathic – single jaw +/- genioplasty or Surgeon
SAME Assistant
Surgeon
Assistant
Surgeon
Assistant
Surgeon
Assistant
Surgeon
12. Maxillary Sinus
Assistant
Surgeon
Assistant
Surgeon
Assistant

SECTION G -APPENDIX 24a- Final Logbook Summary Sheet – Conclusion of Training
Surgeon
Assistant
Surgeon
16. Other procedures
Assistant
Other procedures:
To be listed as surgeon the trainee must have done a substantial portion of the procedure and be the one in
“charge” of the procedure. The consultant may be present and act as a mentor. If registrars do a side of an
operation each, both cannot claim to be surgeon, the more senior or the one in-charge claims to be surgeon, the
other may list as first assistant. There can only be two surgeons if there are two different procedures at distant
sites ie. harvest of bone graft and a mandibular reconstruction. A bimaxillary osteotomy is a single operation.
I certify that this is a true and accurate summary of my training and understand that my complete
logbook may be audited for accuracy.

SECTION G -Appendix 25- Standards and Criteria for OMS (SCOMS) – Accreditation of Regional Training Centres, Hospitals and Posts
APPENDIX 25- STANDARDS AND CRITERIA FOR OMS (SCOMS) – ACCREDITATION OF REGIONAL TRAINING CENTRES,
HOSPITALS AND POSTS

STANDARDS AND CRITERIA FOR OMS (SCOMS)

ACCREDITATION OF REGIONAL TRAINING CENTRES, HOSPITALS AND POSTS
Adapted from NHWS Specialist Medical Colleges Project and RACS Process and Criteria for Accreditation
and informed by RCPS Canada General Standards of Accreditation and PMETB Generic Standards for Training
Key: Evidence/Information required by Institution Administration
Evidence/Information required from Supervisor of Training
Evidence/Information Required from Both
There should be no gross deficiencies in any area of the curriculum (approved 7/8/2010)
Standard 1 – Education and Training
The training program is appropriately delivered, managed and evaluated.
Criteria Assessed by: Minimum Mandatory Standard MET, UNMET or MET WITH EXCEPTION Provide
or Desirable written comments for those standards not fully met.
Co-ordinated schedule Weekly timetable of Formal structured Mandatory PROVIDED PRIOR TO VISIT
of learning experiences activities which incorporate didactic tutorial must be
for each trainee learning needs held on a weekly basis
E.g.: journal club (monthly)
1.1
Range of teaching Evidence of educational

methods is used to deliver material for trainees
modules
Clinical Training Implementation of RACDS Trainees have Mandatory PROVIDED PRIOR TO VISIT
Assessment assessment strategy completed number of
1.2 assessments
commensurate with level
of training

Feedback from trainees
Evidence of six monthly

Presentation of individual formative assessments
portfolios assessed by completed
verification of College
records of AOP completion
Access to external Documented hospital HR Trainees given leave to Mandatory PROVIDED PRIOR TO VISIT
educational activities for Policy on educational leave attend mandatory
trainees for trainees courses
1.3
Summary data of leave
taken Evidence to support
leave is provided

Opportunities for Regular research Mandatory PROVIDED PRIOR TO VISIT
research Minimum of 1 active meetings
research project per
trainee per year
1.4
Trainees enabled to
access medical records
once ethics approval for
study is obtained
Standard 2 – Clinical Experience
Trainees must be able to access clinical experience and educational opportunities that enable them to attain the required competencies and proficiencies
required by the RACDS training program.
Criteria Assessed by: Minimum Mandatory or Standard MET, UNMET or MET WITH
Desirable EXCEPTION Provide written comments for
those standards not fully met.

Supervised consultant Documentation on Trainees attend a minimum Mandatory PROVIDED PRIOR TO VISIT
outpatient clinics in frequency of consultative of one consultative clinic
consultative practice clinics per week
Documentation which Trainees see new and

2.1 shows trainees see new review patients under
patients and follow up / supervision
review patients
Trainees attend alternative
supervised consultative
clinics
Beds available for OMS Documentation on Sufficient beds to Mandatory PROVIDED PRIOR TO VISIT
unit accessible beds for OMS accommodate caseload
2.2
Consultant led ward Documentation on the One per week Mandatory

rounds with educational frequency of consultant led Teaching of trainees on
2.3 as well as clinical goals scheduled ward rounds each ward round
Timetable of postoperative Scheduled post-operative Desirable

ward rounds rounds
Caseload and Casemix Summary statistics of Regular elective and acute Mandatory
number and casemix of admissions.
surgical cases managed by
OMS in the previous year
There should be no gross

2.4 deficiencies in any area Annual Logbook Summary The focus being on Mandatory
of the curriculum for each trainee for the competence acquisition.
previous and current year
Trainees given increasing

professional responsibility,
under supervision, to their

Feedback from trainees level of training and

and trainers experience.
Operative experience of Documentation on weekly A minimum of two Mandatory
the trainee theatre schedule consultant supervised,
dedicated theatre sessions
per week per trainee or the
equivalent of 8 half day
theatre sessions per month
(focus is on opportunities to
2.5 gain the competencies and
is based on combination
theatre time, case numbers
and case mix)
No conflicting work
requirements
Experience in Clinical examination rooms Adequate rooms available Mandatory

perioperative care available to enable appropriate
2.6 clinical examination of all
pre and post-operative
patients
Access to daycare/minor Documentation on access Regular weekly experience Mandatory

surgery to day surgery and minor with day surgery and minor
2.7
surgery lists surgical procedures
Involvement in the Documentation showing Regular involvement in Desirable

acute/emergency care of frequency of involvement in acute/emergency care of
surgical patients acute/emergency care of surgical patients
2.8 surgical patients
Provision of on call roster

Evidence of trainees’ Rosters and work Desirable PROVIDED PRIOR TO VISIT
exposure to emergency scheduled enable trainee to
2.9 operative surgery participate in emergency
surgery

Standard 3 – Equipment and Support Services

Facilities, equipment and clinical support must enable trainees’ exposure to deliver patient care across the range of required clinical experience.
Criteria Assessed by: Minimum In Hospital or Standard MET, UNMET or MET WITH
Within EXCEPTION Provide written comments for those
Network? standards not fully met.
Facilities and equipment Hospital has accredited Evidence of accreditation Mandatory PROVIDED PRIOR TO VISIT
3.1 available to carry out status to undertake surgery by ACHS or NZCHS to
surgery undertake surgical care
Imaging – diagnostic and Documentation on Accredited by appropriate Mandatory PROVIDED PRIOR TO VISIT
3.2 intervention services accreditation body
Feedback from surgeons Basic general imaging Desirable PROVIDED PRIOR TO VISIT
and trainees Specific head and neck
imaging
Specific OMS inc dental

imaging (e.g. OPG, cone
beam)
Diagnostic laboratory Documentation on Accredited by appropriate Desirable PROVIDED PRIOR TO VISIT
services accreditation body
Extent of service
Funding support for Digital
3.3 interfacing for computer
planned clinical cases with
access to biomedical
engineering (on or offsite)
Theatre equipment Documentation on OMS This will vary depending on Desirable PROVIDED PRIOR TO VISIT
equipment available size and casemix of the Inventory of specific OMS equipment
3.4 Feedback from Supervisor unit
of Training

Support/ancillary services Documentation on services Physiotherapy Desirable PROVIDED PRIOR TO VISIT

Occupational Therapy
Dietitian & Nutrition,
3.5 Speech Pathology
Rehabilitation
Dental Sub-specialties
Standard 4 – Resources to support education and training

Trainees must have access to educational facilities/resources required to deliver the curriculum.
Desirable? EXCEPTION Provide written comments for those
standards not fully met.
Medical Library services Access to library and Library available with core Mandatory PROVIDED PRIOR TO VISIT
and access required learning resources textbooks and journals
4.1 either in hard copy or on
line
Computer facilities with Computer facilities with Computers available with Mandatory
IT support internet access free internet access
4.2
24 hour computer access
acknowledging security
issues
Tutorial room available Documented booking and Tutorial rooms available Mandatory
access processes when required
4.3
Feedback from supervisor
and trainees

Access to private study Designated study area Designated study Mandatory

area room/area available
4.4 Feedback from trainees isolated from busy clinical
area
24 hr access Desirable
acknowledging security
issues
General educational Publicised weekly hospital Weekly program publicised Desirable

activities in hospital educational program in advance
4.5
Feedback from trainees Weekly Grand Rounds
Opportunities for trainees
to present cases
Simulated learning Documentation on local Simple basic skills training Desirable
environment opportunities for self- equipment available
4.6 directed skills acquisition
and practice
Standard 5 – Supervision
Effective supervision must be provided to support trainees in acquiring the necessary education, skills and experience.
Criteria Assessed by: Minimum In Hospital or Standard MET, UNMET or MET WITH
Within EXCEPTION Provide written comments for those
Network? standards not fully met.
DoT - Director of FRACDS(OMS) or Mandatory
Training equivalent.
(per Network/Training
Centre) Consultant involved in OMS
5.1
training
Member of the Regional

Surgical Committee

DoT participates in College

supervisors’
course/meetings.
HoD – Head of Registered Specialist Mandatory

Department (with FRACDS(OMS) or
5.2
equivalent or FRACS)
SoT - Designated Documentation on Nominated Supervisor Mandatory

Supervisor of Training supervisor
FRACDS(OMS) or
(per training post) equivalent.
Supervisor participates in
College supervisors’
courses/meetings
5.3 Regularly available and
accessible to trainees –
equivalent of a minimum
two sessions per week per
trainee
For training hospitals with 4

or more registrars, two SoT
are required
Specialist surgical staff Documentation on Surgeons have Mandatory LIST PROVIDED PRIOR TO VISIT
appropriately qualified to qualifications of specialist FRACDS(OMS) or FRCS or
carry out surgical training surgical staff equivalent
5.4
College representative
included on interview panel
for the appointment of new
staff

Regular supervision, Documentation on Initial meeting between Mandatory

assessment and hospital/dept practices supervisor and trainee at
feedback to trainees relating to supervision, the commencement of each
assessment and feedback rotation – goals discussed
to trainees.
One to one regular
Feedback from trainees supervision
Regular constructive
feedback on performance
5.5
Opportunities for trainees to
rectify weaknesses
3-monthly progress review

with SoT
One to one discussion on

six monthly formative
assessment
Standard 6 – Organisational Support for Trainees
Institutions must support the OMS training program by demonstrating a culture that supports a commitment to education, training, learning and wellbeing
of trainees.
Desirable EXCEPTION Provide written comments for those
Hospital support for Safe hours practiced Rosters and work Mandatory PROVIDED PRIOR TO VISIT
trainees schedules take into
account the principles
outlined in the AMA or
NZMA
6.1
Common to surgical
Appropriate terms and trainees in other
conditions of service specialties

Safety procedures for Recognition of safety and

trainees leaving the hospital provision of security when
at unusual hours necessary
Readily accessible Human

Level and accessibility of Resources service
Human Resources services available to trainees inc.
counselling if required
Appropriate orientation Program in Orientation meeting to Mandatory PROVIDED PRIOR TO VISIT
for new trainees place/documentation advise trainees and to
acquaint trainees with the
6.2 hospital and department
practices
Standard 7 – Institutional Responsibilities

The institution fosters commitment to the OMS training program and the availability of skilled senior medical staff as supervisors.
Desirable EXCEPTION Provide written comments for those
Supervisor’s Role and Hospital documentation on Supervisor role complies Mandatory
Responsibilities supervisor’s role in keeping with College requirements
with College requirements as published in the
Handbook
7.1
HR Policy on educational Negotiated leave for

leave attendance at OMS
meetings/courses
Admin services available Accessible admin support Desirable
7.2 for Supervisor’s role for role related to training
Commitment to OMS Weekly scheduled Surgeons/Trainers attend Desirable

7.3 training program educational activities scheduled educational and
audit meetings

Feedback from trainees Surgeons/Trainers foster

learning of clinical/operative
skills
Support for relationships Feedback from trainees Trainees have access to Desirable
with educational education provided by
programs in related related disciplines
7.4 disciplines
Hospital support for Documentation on weekly Negotiated time for Desirable

surgeons involved in service and educational supervision/teaching
training activities of staff
HR policy on educational Negotiated leave for

7.5 leave surgeons/trainers who
attend RACDS
courses/meetings
Feedback from surgeons
Hospital response to Mechanisms for dealing Resolution of validated Desirable PROVIDED PRIOR TO VISIT
feedback conveyed by with feedback problems
7.6 the College on behalf of
trainees
Standard 8 – Quality and Safety

The training environment must be supported by a governance structure to deliver and monitor safe practices.
Criteria Assessed by: Minimum Mandatory of Standard MET, UNMET or MET WITH EXCEPTION
Desirable Provide written comments for those standards not
fully met.
Hospital accreditation Evidence of accreditation Hospital accredited by Mandatory PROVIDED PRIOR TO VISIT
8.1 status ACHS or NZCHS

Risk management Documentation on Quality Assurance Board or Mandatory PROVIDED PRIOR TO VISIT
processes with patient processes including those equivalent reporting to
safety and quality for correct site surgery appropriate governance
committee reporting to body
8.2 Quality Assurance Board
Documentation published
by HR, clinical risk
management and other
safety policies
Head of OMS Documentation on structure Head of OMS is a Mandatory PROVIDED PRIOR TO VISIT
Department and of surgical department recognised position in the
governance role hospital surgical committee
8.3
Position description and
reporting lines of OMS
service
Records of Surgical If criteria 8.3, the HoD, is Mandatory
Department meetings not an FRACDS(OMS) or
equivalent, an OMS
Consultant be in
attendance by invitation at
surgical committee
meetings
Hospital credentialing or Documentation on Clinicians credentialed Mandatory PROVIDED PRIOR TO VISIT
privileging committee credentialing or privileging every 5 years
8.4 committee and its activities
Surgical audit and peer Documentation on audit 6 Monthly audit review of Mandatory PROVIDED PRIOR TO VISIT
review program and peer review program morbidity/mortality
for unit
All surgical staff participate
8.5
Opportunity for trainees to
participate

Hospital systems Documentation on systems Surgeons and trainees Mandatory PROVIDED PRIOR TO VISIT
reviews reviews participate in review of
8.6
patient/system adverse
events
Occupational safety Evidence of education on Provision of education on Mandatory PROVIDED PRIOR TO VISIT
protection against ionising protection
radiation and/or Laser to
patients and staff
Radiation protective
equipment available
Documentation on hospital Clear protocol for dealing

protocol relating to with possible accident
accidental infection of staff infection
i.e. needle stick injury etc
(Infection Control)

SECTION G -Appendix 26- Pre-visit Accreditation Survey for an Oral and Maxillofacial Surgery Training Post
APPENDIX 26- PRE-VISIT ACCREDITATION SURVEY FOR AN ORAL AND

MAXILLOFACIAL SURGERY TRAINING POST

PRE-VISIT ACCREDITATION SURVEY

FOR AN ORAL AND MAXILLOFACIAL SURGERY TRAINING POST
APPLICATION FOR ACCREDITATION FOR ADDITIONAL OR A NEW POST 

APPLICATION FOR ACCREDITATION OF EXISTING POST/S 
Part 1 - Supervisor of Training to complete and return
NB – Applications for accreditation for an additional or a new post refer to unaccredited registrars.
Applications for accreditation of existing posts refer to accredited OMS trainees.
Post Information – Supervision & Hospital Structure
Post Title
Training Centre
Date of Visit
Director of Training
Supervisor of Training
Head of Department/Unit
Chief of Surgery
Name Public FTE # Lists /month # Clinics /week
Consultant Trainers
Hospital campuses where

training occurs
Number of theatres Number of beds

Is OMS a standalone
department or headed by
ENT/PRS?
Number of registered Dedicated OMS
Nurses / Dental Assistants Secretary /
in OMS unit Receptionist?
Name OMS Year FTE Split
Trainee details

Standard 1: Education and Training
Supporting
attachment
Standard Documentation Requested Comments / Response reference
if applicable
Please attach a copy of the
trainee’s/registrar’s weekly timetable.
Timetable
In units with more than one
trainee/registrar – please attach
individual trainee/registrar timetables.
Please indicate the frequency and
nature of co-ordinated learning
Co-ordinated Learning experiences
experiences
E.g. Audits, journal clubs, tutorials.
Presentation of individual portfolios
assessed by verification of College
Clinical Training records of AOP completion
Assessment
Have portfolio available for checking
during visit.
Access to external
Evidence of study leave policy for
educational activities for
training institution
trainees/registrars
Opportunities for research Please attach the five most recent
publications from the training unit
Standard 2: Clinical Experience
Supporting
attachment
if applicable
Beds available for OMS Advice on # of beds allocated for

unit OMS in the relevant hospital
Documentation on weekly theatre

schedule
Operative experience of
inc
the trainee/registrar
Last two logbooks for
trainee/registrar occupying post
Experience in peri- Are clinical examination rooms

operative care available for use?
Access to day care/minor Do you have regular access to

surgery day care/minor surgery lists

Documentation showing
Involvement in the frequency of involvement in
acute/emergency care of acute/emergency care of surgical
surgical patients patients
Provision of on call roster
Complete below summary table

Include the log books of current
Caseload and casemix accredited trainee (if an existing
position) or unaccredited registrar
(if a new position)
Summary statistics of number and casemix of surgical cases managed by OMS in the previous year
# Cases last 12
Scope of practice Full or limited scope? Shared with other service?
months
Dentoalveolar
Oral and Facial Infection
Facial Trauma
Pathology
(begin & malignant)
Preprosthetic & adjunctive
implant procedures
Implants
Orthognathic – single jaw
Orthognathic – bimaxillary
Orthognathic – other
TMJ
Maxillary sinus
Trauma
Reconstructive – hard tissue

Reconstructive – soft tissue &
composite
Reconstructive – graft harvest
Other procedures
Standard 3: Equipment and Support Services
Supporting
attachment
if applicable
Are there any shortfalls in the

Facilities and equipment
standards, facilities and
available to carry out
equipment available to carry out
surgery
OMS in your institution?
Imaging – diagnostic and Please provide a summary of

intervention services services available

Diagnostic laboratory Please provide a summary of

services services available
Please provide information about

Theatre equipment key equipment available for
OMFS
Please provide details of ancillary

Support/ancillary services / allied health services available
and pathway for referral
Indicate
Format of clinical record
Fully digital / Paper-based /
keeping
Combination
Standard 4: Resources to Support Education and Training
Supporting
attachment
if applicable
Please provide name and location

Medical Library services of library.
and access Do trainees/registrars have after-
hours access to the library?
Computers available with free

Computer facilities with internet access
IT support 24 hour computer access
acknowledging security issues
Tutorial rooms available when

Tutorial Room
required
Designated study room/area

Access to private study
available isolated from busy
area
clinical areas
Part 2 - Institution to complete and return

Standard 6: Organisational Support for Trainees/Registrars
Supporting
attachment
if applicable
Hospital support for Safe hours practiced

trainees/registrars Appropriate terms and conditions of
service
Safety procedures for
trainees/registrars leaving the
hospital at unusual hours
Please provide the following:
• A copy of the award under
which the trainee/registrar is

paid and safe working hours

are determined
• A summary of safety
procedures in place to provide
trainee/registrar safety whilst
working after hours.
Appropriate orientation for Interview record or induction

new trainees/registrars paperwork for trainee/registrar
Supervisor’s Role and Hospital documentation on

Responsibilities supervisor’s role in keeping with
College requirements
HR Policy on educational leave
Hospital accreditation Evidence of accreditation

status
Is the hospital accreditation by
ACHS or NZCHS?
Risk management Documentation on processes

processes with patient including those for correct site
safety and quality surgery
committee reporting to
• Quality Assurance Board or
Quality Assurance Board
equivalent reporting to
appropriate governance
body
• Documentation published
by HR, clinical risk
management and other
safety policies
Head of OMS Department Documentation on structure of
and governance role surgical department
Position description and reporting

lines of OMS service
Hospital credentialing or Documentation on credentialing or

privileging committee privileging committee and its
activities
Surgical audit and peer Documentation on audit and peer

review review program for unit
Hospital systems review Documentation on systems review
Occupational safety Evidence of education on

protection against ionising radiation
and/or laser to patients and staff
Documentation on hospital protocol

relating to accidental infection of
staff i.e. needle stick injury etc.
(e.g. Infection Control)
Standard 7: Institutional Responsibilities

Supporting
attachment
if applicable
Hospital documentation on
Supervisor’s Role and supervisor’s role in keeping with
Responsibilities College requirements HR Policy
on educational leave
Support services for SoT Admin services available for
role Supervisor’s role
Weekly scheduled educational
Commitment to OMS activities
training program
Support for relationships
with educational programs Feedback from trainees
in related disciplines
Documentation on weekly
Hospital support for service and educational
surgeons involved in activities of staff HR policy on
training educational leave.
Feedback from surgeons
Hospital response to
Documentation / policy outlining
feedback conveyed by the
mechanisms for dealing with
College on behalf of
feedback
trainees
Standard 8: Quality and Safety
Supporting
attachment
if applicable
Evidence of hospital
Hospital accreditation accreditation, minimum
status requirement accredited by
ACHS or NZCHS
Documentation on processes
including those for correct site
Risk management surgery Quality Assurance
processes with patient Board or equivalent reporting to
safety and quality appropriate governance body.
committee reporting to
Quality Assurance Board e.g. Documentation published
by HR, clinical risk management
and other safety policies
Documentation on structure of
Head of OMS Department surgical department- Head of
and governance role OMS is a recognised position in
the hospital surgical committee
Documentation on credentialing
Hospital credentialing or
or privileging committee and its
privileging committee
activities

Surgical audit and peer Documentation on audit and

review program peer review program for unit
Documentation on systems
Hospital systems reviews
reviews

SECTION G -Appendix 27- OMS Mentoring Scheme – Mentoring Agreement
APPENDIX 27- OMS MENTORING SCHEME – MENTORING AGREEMENT

OMS MENTORING SCHEME- MENTORING AGREEMENT
The OMS Mentoring Scheme targets two key outcomes:
• the development of a time limited association between the Mentor who is qualified and willing to
impart knowledge and experience, and the Trainee who is seeking knowledge, experience and
guidance
• acquisition by the Trainee, through his/her training program and this mentoring process, of the
competence and confidence necessary for advancement to Fellowship.
We are voluntarily entering into a mentoring relationship that we expect to benefit both of us. Our
signatures at the bottom of this agreement signify our mutual acceptance of the following terms of
participation in the Scheme.
1. The duration of the formal mentoring relationship between participants in the program is for a
minimum of 12 months (one (1) academic year).
The duration of the mentoring program will be _______ months, commencing on ____________.
We each agree to actively participate in the Mentoring Scheme for this period.
1. We each agree to be available, responsive to each other’s needs and willing to adjust schedules
if necessary in order to achieve the minimum number of contact hours described below.
2. We agree to have a minimum of ____ meetings, of 1 hour duration, over a one year period.
A minimum of two face-to-face meetings (one meeting each 6 months) is recommended.
We also agree to have contact on a regular basis.

Though any forms of communication between Mentor and Trainee are encouraged, it is recommended
that e-mail not be used as the exclusive communication means between Mentor and Trainee, but rather
as a support process for other forms of direct communication.
The likely frequency of meetings will be _________________________________
The maximum length of meetings will be ________________________________
Communication will be initiated by _____________________________________

3. We accept responsibility for completing the necessary paperwork associated with the program,
including six month (mid-year) progress reports and/or final report and forwarding the
completion advice to the College office.
4. We agree that information shared between us within the context of the formal mentoring
relationship is confidential and will not be shared outside the relationship without the express
permission of the other participant.

SECTION G -Appendix 27- OMS Mentoring Scheme – Mentoring Agreement
5. An individual pairing of Mentor and Trainee may prove to be unworkable or unsatisfactory to

either/both participants. If this is the case, either party has the option of discontinuing the
relationship, and he/she will advise the College of such as soon as possible.
We agree to a no-fault conclusion of this relationship if, for any reason, it seems appropriate.
6. We acknowledge:
• a Mentor’s role is limited to the furnishing of opinions, guidance and suggestions.
• Trainees should take all information given by a Mentor under advisement in making
personal, professional and career decisions.
7. As Mentor, I accept responsibility:

• to ensure that all opinions, guidance and suggestions provided as part of the formal
mentoring relationship, are accurate to the best of my knowledge, and
• not to recommend or suggest course(s) of actions for the Trainee that could be construed
as illegal, unethical or immoral.
8. We agree to accept individual responsibility for any cost we personally incur as part of the
formal relationship, including, but not limited to: postage, telephone calls.
9. We agree that during our discussions we will each comply with current privacy legislation and,
in particular, we will not disclose identifiable patient details or information.
We acknowledge that:
• Mentors are volunteers and not paid consultants.
• Neither Mentors nor the RACDS is responsible for career, personal or other decisions made by the
Trainee as a result of the mentoring relationship.
• Mentors only give guidance and/or information from their experience, perspective etc. Mentors do
not make decisions for Trainees.
• The Mentor and the RACDS do not accept any responsibility for decisions made by Trainees.
Name of Mentor Siganture of Mentor Date
Name of Trainee Signature of Trainee Date
Please forward copies of this form to the College office.

This form can be downloaded from the College website.

SECTION G -Appendix 28- OMS Mentoring Scheme – Progress Report
APPENDIX 28- OMS MENTORING SCHEME – PROGRESS REPORT

OMS MENTORING SCHEME- PROGRESS REPORT
This form is to be completed half yearly.
To be completed by the Mentor
1. Please comment on the Trainee’s personal, clinical and academic strengths, noting any areas that
would benefit from development (please include scope of clinical experience):
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
2. Goals for clinical experience over the next half year
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
3. Suggestions of alternative ways of gaining necessary experience, which could be investigated in

the next half year
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_

_________________________________________________________________________________
_
_________________________________________________________________________________
_
4. What are the main benefits you have noted to date from the mentoring relationship?
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
Trainee (to be completed by the Trainee)
1. How could the mentoring relationship be improved?
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
2. Mentor (to be completed by the Mentor)
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
3. Should the Mentoring Agreement be extended?

_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
_________________________________________________________________________________
_
Name of Mentor Signature of Mentor Date

SECTION G -Appendix 29- OMS Mentoring Scheme – Completion Advice Form
APPENDIX 29- OMS MENTORING SCHEME – COMPLETION ADVICE FORM

OMS MENTORING SCHEME- COMPLETION ADVICE FORM
To be forwarded to:
OMS Education Officer

Via email oms@racds.org
Or by post:
Royal Australasian College of Dental Surgeons
Level 13, 37 York Street
Sydney NSW 2000
Or by fax: +61 2 9262 1974
We have completed the progress report for the period _______________ to _____________.
(Date) (Date)
During this period we have had ___________ of meetings/contacts.

(number)
Our mentoring relationship will conclude on _________________.

(Date)
OR
We intend to extend our mentoring relationship and it will now conclude on _________________.
(Date)
Name of Mentor Siganture of Mentor Date

SECTION G -Appendix 30- Former Trainees Seeking to Reapply to the Oral and Maxillofacial Surgical Training
Program
APPENDIX 30- FORMER TRAINEES SEEKING TO REAPPLY TO THE ORAL AND

MAXILLOFACIAL SURGICAL TRAINING PROGRAM

FORMER TRAINEES SEEKING TO REAPPLY TO THE ORAL AND MAXILLOFACIAL

SURGICAL TRAINING PROGRAM GUIDELINES
Nature of Document: Guidelines

Document Number: F OMS 12
Version: 1.0
Policy Area: Former Trainees seeking re-entry to the OMS Training Program
Author: A/Prof Jocelyn Shand
Contact Officer: Education Officer, OMS oms@racds.org
Approval Details: Council, 22 November 2013
Date Effective: 1 January 2014
Date of Next Review: November 2016
Policy Status: New Guidelines
Related Policies: Nil
1. Purpose
These guidelines are for former trainees who have voluntarily withdrawn or have ceased training due
to failure of the SST exam or other reasons and are seeking to reapply to recommence accredited
training in OMS. These guidelines have been developed in accordance with the accreditation
requirements of the Australian Medical Council, the Australian Dental Council, the Medical Council of
New Zealand and the Dental Council of New Zealand.
2. Eligibility to apply for consideration to recommence surgical training
Practitioners wishing to make an application for re-entry into the RACDS Oral and Maxillofacial
Surgery Training Program must have:
• Formerly been in in a recognised Training Centre and,
• Under the following criteria (A and B), are regarded to be in good standing.
A former trainee is regarded as being in good standing, if at the time of withdrawal, they did not have a
borderline or unsatisfactory Six-Monthly Formative Assessment report or had not committed an act
that could result in an investigation for unprofessional conduct, professional misconduct or notifiable
conduct.
A. Permission to reapply to the Training Centre will be automatically granted to the following
former trainees in good standing (however may be subject to conditions):
a. trainees have voluntarily withdrawn in good standing from a Training Centre
b. trainees who have been dismissed from the College for failure to pay the annual
registration fee or any other outstanding monies
c. trainees who have failed to complete the SST examination
B. Former trainees who ceased training due to the following may be granted permission to apply
to the training programme:
a. dismissed for failure to satisfy dental or medical registration. (At the time of
reapplication, the doctor must have medical & dental registration with no restrictions)
b. ceased for failure to complete the SST examination within 2-years of completing OMS
1
3. Not eligible to reapply for training

SECTION G -Appendix 30- Former Trainees Seeking to Reapply to the Oral and Maxillofacial Surgical Training
Program
A former trainee who has been dismissed from the OMS training programme and/or an employing
institution due to the following reasons will not be granted permission to reapply for OMS training:
f. failure to complete the SST exam after 3 diets of the examination
g. unsatisfactory performance or formative report
h. failure to satisfy hospital employment requirements
i. unprofessional conduct, professional misconduct or notifiable conduct as defined
by the registering bodies for medicine and dentistry in Australia and New
Zealand
4. Application process
Former trainees seeking permission to reapply should do so in writing to the Assistant Registrar (Oral
& Maxillofacial Surgery) Special Stream by closing date stated in the Handbook (1st April), to be
considered for selection for commencement of training for the next year.
The correspondence must:

a. include a letter of good standing from Director of Training of the previous Training
Centre
b. provide information relating to any factors which may warrant special consideration
c. provide information giving the reasons for leaving the Training Programme and why
these reasons no longer apply
5. Consideration of applications
In considering applications to rejoin the training program after a period of absence, all OMS Fellows
engaged on the Board of Studies or the annual trainee selection process will declare any competing
interests they may have in relation to the applicant/s. These competing interests may not preclude the
member from providing relevant information to the process, however they will be excused from final
decision making.
The information submitted by the former trainee will be discussed with the Chair of the Board of
Studies (OMS). The Chair, on behalf of, or in conjunction with, the Board will determine whether the
trainee may apply to a Training Centre to recommence training on the Oral & Maxillofacial Surgery
Training Program.
The Chair of the Board may seek additional information from the previous Training Centre and may
consult with other OMS Fellows.
The Chair of the Board will make a recommendation to the Assistant Registrar (Oral & Maxillofacial
Surgery) Special Stream and the Registrar will communicate the decision to the former trainee.
If permission is granted to reapply for training in OMS the applicant will be informed of any conditions
attached to this such as (including but not limited to):
a. payment of registration fees or any outstanding monies (if dismissed for non-payment
of fees)
b. successful completion of the SST examination, prior to commencing OMS2
6. Process to recommence surgical training
For former trainees who satisfy eligibility criteria 2A and are automatically granted permission to
reapply, with good standing, the applicant should contact the Director of Training of their previous
Training Centre to discuss the recommencement of surgical training in that Centre in the following
year, pending an available position.
For former trainees who satisfy eligibility criteria 2B, the applicant should contact the Director of
Training of their previous Training Centre to discuss the recommencement of surgical training in that
Centre in the following year. If there is no position available in the original Training Centre, then
negotiations will be undertaken with other Training Centres to endeavour to enable training to
continue.

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HANDBOOK FOR

Level 13, 37 York Street Sydney 2000 Australia

Version 1 April 2020

Copyright © Royal Australasian College of Dental Surgeons

© copyright – RACDS All rights reserved. i

2.1.7 Learning Portfolio ...................................................................................................... 33

© copyright – RACDS All rights reserved. ii

1.1.2 What the College Accredits ....................................................................................... 53

© copyright – RACDS All rights reserved. iii

3.1.9 MODULE 9: Oral & Maxillofacial Oncology ............................................................. 132

© copyright – RACDS All rights reserved. iv

© copyright – RACDS All rights reserved. v

APPENDIX 22- TRAINEE REPORT FORM ........................................................................................273

© copyright – RACDS All rights reserved. vi

© copyright – RACDS All rights reserved. 7

ORAL MAXILLOFACIAL SURGERY EDUCATION PROGRAM OBJECTIVES

The OMS training program is committed to:

© copyright – RACDS All rights reserved. 8

OMS DATES FOR 2020

Saturday 8th February Trainee Induction Day

Final date for trainees to complete registration requirements

Final date for submission of application for exemption from

Friday 12th and Saturday 13th June SST Examination

© copyright – RACDS All rights reserved. 9

ADC Australian Dental Council

AMC Australian Medical Council

AOP Assessment of Operative Process

AST Advanced Surgical Training

BSS Basic Surgical Sciences

BST Basic Surgical Training

CCrISP Care of the Critically Ill Surgical Patient

CEO Chief Executive Officer

CPD Continuing Professional Development

DBA Dental Board of Australia

DC(NZ) Dental Council New Zealand

DoT Director of Training

EMST Early Management of Severe Trauma

EO Education Officer, Oral & Maxillofacial Surgery

FRACDS Fellow of the Royal Australasian College of Dental Surgeons

IMG International Medical Graduate

LMS Learning Management System

MCNZ Medical Council of New Zealand

MDT Multi-Disciplinary Team

OMS Oral and Maxillofacial Surgery

OTOMS Overseas Trained Oral and Maxillofacial Surgeon

OTSWG Overseas Trained Specialist Working Group

PPA Professional Performance Appraisal

RACDS Royal Australasian College of Dental Surgeons

© copyright – RACDS All rights reserved. 10

RACS Royal Australasian College of Surgeons

RCS(Eng) Royal College of Surgeons, England

Registrar Registrar in Oral & Maxillofacial Surgery

RSC Regional Surgical Committee

SIG Surgery in General

SST Surgical Science and Training in Oral and Maxillofacial Surgery

TAC Team Appraisal of Conduct

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FEES FOR 2020

Enrolment or Re-enrolment in the College (valid for a maximum

Annual Trainee Registration Fee (Trainees occupying an

Extension of OMS Training for Completion of Research

Surgical Science and Training Examination 3,284.00# 3,284.00#

Exemption from Surgical Science and Training Examination 1,588.00# 1,588.00#