Final
Final Stage Overview
The final stage of training comprises two indicative years (ST6 + ST7). The purpose of the final stage is to allow a trainee to acquire and develop the specialist skills, knowledge and attitude that will allow final progress towards and achievement of a CCT in the specialty, with the beginning of special interest training as appropriate.
The final stage of specialist training will complete exposure to the essential aspects of oral and maxillofacial surgery and increase exposure to special interest areas of choice. By the end of ST7 all trainees including those who have followed an academic pathway should have acquired the competencies and specialist surgical skills that will form the basis for safe clinical practice in the generality of the specialty. The logbook should record further development of operative skills and any deficiency in experience or competency during levels 1-4 must be corrected during this period. Most trainees will identify areas of special interest during this final period of essential training and individual logbooks will probably reflect a bias towards these chosen aspects of clinical practice.
Typical areas of special interest relevant to oral and maxillofacial surgery are:
- Craniofacial trauma and secondary reconstruction
- Craniofacial surgery for congenital and acquired deformity
- Osseodistraction of the facial skeleton
- Cleft lip and palate
- Head and neck oncology
- Advanced reconstruction of the mouth, face and jaws (including free tissue transfer)
- Osseointegrated implant techniques and surgery for rehabilitation of the head and neck cancer patient
- Aesthetic maxillofacial surgery
- Temporomandibular joint surgery and reconstruction
Attendance at relevant courses and regional study days, national and international conferences will be expected. Trainees should continue to develop their experience in audit, research, teaching, presentations and contributing to the specialty literature.
By the end of ST6 the trainee will have encountered and should be able manage competently the following conditions, in addition to those in the preceding stages, up to and including operative intervention:
- Diagnosis and management of patient requiring extra-oral and intra-oral osseointegrated implant rehabilitation
- Diagnosis and assessment of patient requiring rhinoplasty
During this stage the trainee will gain competence to the level defined in the syllabus in a number of technical skills and procedures. A trainee would be expected to be able to perform all of the procedures listed below without the direct scrubbed assistance or supervision of a trainer in addition to those identified in the initial and intermediate stages. The list is not exhaustive, although it covers most of the common procedures expected at this stage.
Maxillofacial trauma
- Repair of lacrimal/parotid duct injury
- Repair of facial nerve injury
- Open reduction and fixation of symphysis/body/angle of fractured mandible
- Open reduction and internal fixation of condylar neck of mandible
- Elevation of fractured zygoma
- Open reduction and fixation of fractured zygoma
- Orbital floor/wall exploration and repair/graft
- Reduction and fixation fractured maxilla (Le Fort II/III)
- Open reduction and fixation of naso-orbito-ethmoid complex fracture
- Reduction and fixation of frontal bone fracture
Salivary gland surgery
- Removal of stone from submandibular duct
- Excision of neoplasm of minor salivary gland
- Sublingual gland excision
- Submandibular gland excision
- Partial/superficial parotidectomy
- Total conservative parotidectomy
- Radical parotidectomy
Orthognathic surgery
- Genioplasty
- Mandibular ramus osteotomy
- Le Fort I maxillary osteotomy
- Le Fort II/III maxillary osteotomy
- Zygomatic/orbital osteotomy
- Mandibular osteodistraction procedures
- Maxillary osteodistraction procedures
Temporomandibular joint surgery
- Arthrocentesis
- Arthroscopy
- Open operation on capsule/disc/condylar head
- Surgery for recurrent TMJ dislocation
- Excision of benign odontogenic tumours
- Excision of fibro-osseous jaw tumours/dysplasia
Neck surgery
- Excision of lymphoepithelial (branchial) cyst
- Excision of thyroglossal cyst/fistula
- Selective neck dissection
- Comprehensive neck dissection
Resection of malignant tumours
- Excision of tongue/oro-pharyngeal tumour
- Resection of mandible/maxilla
- Orbital exenteration
- Reconstructive surgery
Harvest of skin graft
- Harvest of non-vascularised extra-oral bone graft
- Mandibular reconstruction with non-vascularised bone graft
- Pedicled muscle/fascial/myocutaneous flap
- Vascularised free tissue transfer
Osseointegrated implant surgery
- Insertion of extra-oral implants/abutments
- Insertion of intra-oral implants/abutments
- Sinus lift/onlay graft
Aesthetic surgery
- Cervico-facial liposuction
- Rhinoplasty
- Zygomatic/chin/nasal onlays
- Pinnaplasty
- Blepharoplasty
- Browlift
Neural surgery
- Harvest of peripheral nerve (e.g. sural)
- Lingual nerve exploration/repair
- Facial nerve repair/graft
Click on Workplace Based Assessments to view the assessment forms including DOPS and PBAs