Oral and Maxillofacial Surgery Syllabus                  Page 1 of 117              © Copyright ISCP 2007
ContentsOral and Maxillofacial Surgery Syllabus .........................................................1  Contents.........
Patients requiring rhinoplasty ......................................................................98  Reconstructive Su...
1. Specialty OverviewOverviewOral and Maxillofacial surgery is the surgical specialty concerned with the diagnosis andtrea...
the treatment of orbital trauma, oncology and deformity, and carry out orbitaldecompression in thyroid eye disease.Dental ...
Respiratory Medicine - OMF Surgeons liaise with respiratory physicians and orthodontistsfor the provision of intra-oral de...
2. Key ConditionsKey Conditions Oral and Maxillofacial SurgeryKey conditions are those that are considered core to the spe...
3. Initial StageFour point scalesWhat the 4 point scale means for Knowledge   1.   Knows   of   2.   Knows   basic concept...
3.1 OverviewOverview of Initial StageThe purpose of the initial stage ST1 and 2 is to allow a trainee to acquire and devel...
•   Fractures of the facial bones    •   Diagnosis and management of temporomandibular joint pain and facial pain    •   D...
•   Excision of malignant skin tumourReconstructive surgery    •   Harvest of skin graft    •   Harvest of intra-oral bone...
3.2 ConditionsGeneric Surgical Skills and Knowledge- All SpecialtiesBasic sciencesObjectiveUnderpinning basic science know...
Professional SkillsNo contentBasic surgical skillsObjectiveAcquisition of basic surgical skills in instrument and tissue h...
4 Ability to use scalpel, diathermy and scissorsClosure of skin and subcutaneous tissue:4 Accurate and tension free apposi...
Technical SkillsNo contentProfessional SkillsNo contentPerioperative careObjectiveAbility to manage patient care in the pe...
Preoperative assessment and management:4   History and examination4   Interpretation of preop investigations3   Management...
3 Referral to appropriate surgical subspecialtiesTechnical Skills3 Central venous line insertion3 Chest drain insertion2 D...
Coagulation:2 Clotting mechanism (Virchow Triad)2 Effect of surgery and trauma on coagulation2 Tests for thrombophilia and...
Clinical Skills3 Arrange access to suitable artificial nutritional support, preferably via a nutrition team:Dietary supple...
3 Understanding the role of the coroner and the certification of deathClinical SkillsPalliative Care:3 Symptom control in ...
Cortico-steroid therapy4 Peri-operative management of patients on steroid therapyDiabetes Mellitus4 Peri-operative managem...
Basic Science KnowledgeAnatomyObjectiveTo understand the surgical anatomy that oral and maxillofacial surgeons will encoun...
0 Disorders of development0 Applied surgical anatomyBlood supply to skin, fascia, muscle and bone:0 Knowledge of principle...
0 Mechanical, chemical and hormonal factors protecting the oral cavity0 Immunological protective mechanismsMastication and...
Inflammatory reactive and infectious diseases:0   The acute inflammatory response0   The chronic inflammatory response0   ...
0   Mechanisms of tumour initiation and growth0   Malignant transformation0   Mechanisms of metastasis0   Tumour staging0 ...
Genetics:0 Genetics in normal development0 Role of genetics in pathological processesClinical Skills0 Application of this ...
Drug therapy of systemic disease relevant to maxillofacial surgical practice:0 Knowledge of specific agents, their effects...
0 Definition and causes of PUO0 Investigation of PUOThe immuno compromised patient:0 Causes and related conditions0 Specif...
Dentoalveolar PathologyImpacted Wisdom ToothObjectiveTo be able to assess a patient presenting either acutely or in the ou...
Clinical Skills0 Ability to formulate treatment plan0 Liaison with restorative dentist0 Treat/drain infection and/or remov...
To be able to assess a patient presenting either acutely or in the out-patient clinicTo be able to formulate a differentia...
0 Investigations and radiographic interpretation0 Pharmacology and therapeutics of analgesia0   Anatomy of mouth, jaws, te...
To be able to assess a patient presenting either acutely or in the out-patient clinicTo be able to formulate a differentia...
0 Recognition of systemic sepsis (sepsis syndrome)0 Recognition of infection as an early indicator of immuno supression e....
Oral mucosal lesionsOral ulcerationObjectiveTo be able to assess an patient presenting with a mucosal lesion either acutel...
Professional SkillsNo content                         Page 37 of 117                      © Copyright ISCP 2007
Infections of the Head and NeckInfections of the Head and NeckObjectiveTo be able to assess a patient presenting with infe...
0 Prepare and confirm adequacy of specimenDrainage of tissue space infection:0   Appropriate aseptic preparation0   Exposu...
Cranio Maxillofacial TraumaFacial Laceration(s)ObjectiveTo be able to fully assess an injured patient presenting either ac...
0   Aetiology0   Interpretation of radiographs0   Potential complications0   Pharmacology and therapeutics of postoperativ...
0   Anatomy of scalp, facial skeleton, orbit and contents0   Anatomy of eyelids0   Classification of facial fractures0   P...
0 Ability to formulate a treatment plan and prioritise management0 Pain control /prevention of infection0 infiltration / n...
0 Techniques of intermaxillary fixation0 Intra/extra-oral soft tissue handling and suturing techniquesProfessional SkillsN...
0 An awareness of other factors affecting timing of surgery0 Involving the maxillofacial technican in treatment planningTe...
0 Techniques for approach to naso-ethmoid complex0 Safe exposure of fracture sites and reduction of fragments0 Bone grafti...
Facial painOro-facial painObjectiveTo be able to assess a patient presenting with pain either acutely or in the out-patien...
Peri-operative carePeri-operative careObjectiveTo ensure the trainee has reached a level of competence in peri-operative c...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
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Intercollegiate Surgical Curriculum Project (2007) - Oral and ...
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  1. 1. Oral and Maxillofacial Surgery Syllabus Page 1 of 117 © Copyright ISCP 2007
  2. 2. ContentsOral and Maxillofacial Surgery Syllabus .........................................................1 Contents..................................................................................................................21. Specialty Overview............................................................................................42. Key Conditions ....................................................................................................73. Initial Stage..........................................................................................................83.1 Overview.............................................................................................................93.2 Conditions.........................................................................................................12 Generic Surgical Skills and Knowledge- All Specialties......................12 Basic Science Knowledge ...............................................................................22 Dentoalveolar Pathology ................................................................................30 Oral mucosal lesions ........................................................................................36 Infections of the Head and Neck.................................................................38 Cranio Maxillofacial Trauma ..........................................................................40 Facial pain ............................................................................................................47 Peri-operative care ...........................................................................................48 Salivary gland / Neck swellings ...................................................................49 Neck Swellings ...............................................................................................49 Salivary gland swellings .............................................................................51 Head and Neck Cancer....................................................................................54 Reconstructive Surgery...................................................................................56 Aesthetic Surgery..............................................................................................574. Intermediate Stage .........................................................................................584.1 Overview...........................................................................................................594.2 Conditions.........................................................................................................61 Temporomandibular Disorders.....................................................................61 Cranio Maxillofacial Trauma ..........................................................................62 Facial Fractures ..............................................................................................62 Facial pain ............................................................................................................69 Temporomandibular joint disorders.......................................................69 Peri-operative care ...........................................................................................71 Salivary gland / Neck swellings ...................................................................72 Salivary gland swellings .............................................................................72 Head and Neck Cancer....................................................................................76 Facial Deformity.................................................................................................78 Orthognathic Surgery ......................................................................................79 Reconstructive Surgery...................................................................................815. Final Stage..........................................................................................................835.1 Overview...........................................................................................................845.2 Conditions.........................................................................................................87 Cranio Maxillofacial Trauma ..........................................................................87 Facial Fractures ..............................................................................................87 Temporomandibular Disorders.....................................................................94 Peri-operative care ...........................................................................................95 Orthognathic Surgery ......................................................................................96 Patient requiring osseointegrated implants ............................................97 Page 2 of 117 © Copyright ISCP 2007
  3. 3. Patients requiring rhinoplasty ......................................................................98 Reconstructive Surgery...................................................................................996. Special Interest Stage .................................................................................1016.1 Overview.........................................................................................................1026.2 Conditions.......................................................................................................1037. Professional and Generic Skills.................................................................1047.1. Initial...............................................................................................................1047.2. Intermediate ................................................................................................1087.3. Final.................................................................................................................113 Page 3 of 117 © Copyright ISCP 2007
  4. 4. 1. Specialty OverviewOverviewOral and Maxillofacial surgery is the surgical specialty concerned with the diagnosis andtreatment of diseases affecting the mouth, jaws, face and neck. Specialists working in thisarea are known as Oral and Maxillofacial surgeons. The specialty is unique in requiring adual qualification in medicine and dentistry and is a recognised international specialty that,within Europe, is defined under the Medical Directives. The scope of the specialty isextensive and includes facial injuries, head and neck cancers, salivary gland diseases,facial disproportion, facial pain, temporomandibular joint (TMJ) disorders, impacted teeth,cysts and tumours of the jaws as well as numerous problems affecting the oral mucosasuch as mouth ulcers and infections. Oral and maxillofacial surgeons frequently workalongside other specialists including orthodontists, oncologists, neurosurgeons, plasticsurgeons, and ENT surgeons. Specialty specific criteria, standards and evidence for thepractice of oral and maxillofacial surgery in the UK have been defined by the specialty.The majority of Maxillofacial Surgeons working in the United Kingdom have qualified indentistry before qualifying in medicine. The specialty is, however, open to traineesqualifying first in medicine and then obtaining a qualification in dentistry. The majority ofdental graduates will obtain an MFDS before or during their medical training. However, anMFDS is not a requirement for entry into specialist training.ENTRY INTO SPECIALIST TRAININGSpecialist training is a continuum with the MRCS taken in the early years of training and anexit FRCS examination taken towards the end of specialist training. This, together withsuccessful completion of the RITA assessment, allows the Specialist Registrar to beawarded a Certificate of Completion of Training (CCT) in Oral & Maxillofacial Surgery and,therefore, be eligible for appointment as a Consultant in Oral & Maxillofacial Surgery, andwith registration with the GMC and GDC appear in the Specialist List in Oral & MaxillofacialSurgery held by the GMC. There are two areas of special interest, cleft lip and palate andhead and neck surgery, and interface groups are developing the training requirements inthese areas.RELATIONS WITH OTHER SPECIALTIESOral & Maxillofacial (OMF) Surgeons are the specific experts on diseases affecting themouth, face, jaw and neck; they diagnose and treat symptoms, pathology, deformity andtrauma affecting the mouth, face, jaws and neck. As a result of treating diseases located inthis well-defined anatomical region, OMF Surgeons can provide advice on multi-systempathology where this affects the head and neck. Furthermore, advice is provided for otherspecialties, such as clinical oncology, to minimise and treat complications in the head andneck, following therapies provided by these other specialty groups. A large number ofmedical and dental specialities, therefore, have a strong relationship with Oral &Maxillofacial Surgery as follows:Accident & Emergency - OMF Surgeons provide major support to all hospital A & EDepartments, for soft and hard tissue injuries to the face, scalp and neck and for infectionsin this region.Sport injuries - Clinicians specialising in sports injuries seek OMFS advice in relation tofacial injuries sustained during sporting activities. Neurosurgery & Neurosciences - OMFSurgeons collaborate on surgery for trauma, deformity and oncology, which straddles theface and head and are involved in the diagnosis of facial symptoms indicative of neuralpathology. This is particularly important in the diagnosis and treatment of cervico-facialpain. OMF Surgeons conduct facial disassembly procedures for intra-cranial and spinalaccess surgery and provide skull base reconstruction for neurosurgeons, fulfilling animportant role in Craniofacial Surgical Units. Ophthalmology - OMF Surgeons collaborate in Page 4 of 117 © Copyright ISCP 2007
  5. 5. the treatment of orbital trauma, oncology and deformity, and carry out orbitaldecompression in thyroid eye disease.Dental Specialties - OMF Surgeons have a close relationship with orthodontists, restorativedental surgeons in relation to prosthetics, periodontal disease and advanced restorativeprocedures for dental implants. There is an important collaborative role in the preparationof oral oncology patients before, during and after radiotherapy. OMF Surgeons work closelywith oral medicine consultants in the diagnosis and management of oral mucosal disease,and dental hygienists have an important role in Maxillofacial Units. OMF surgeons sendtissue to oral pathologists who have specialist diagnostic skills in the orofacial region.Dermatology - OMF Surgeons consult with dermatologists in the treatment of patients withvesiculobullous disease, oral mucosal disease and connective tissue disorders, such assystemic sclerosis, and provide an important surgical service for facial skin cancer.Clinical Genetics - OMF Surgeons seek advice from geneticists for the families of childrenwith severe facial deformity and other head and neck syndromes.Clinical Oncology and Radiotherapy - OMF Surgeons have a leading role in themanagement of head and neck neoplasia, working as part of multi-disciplinary teams witha special relationship with oncology and radiotherapy. The speciality provides a surgicalservice in the diagnosis and management of these conditions and can advise and manageproblems arising in the oral cavity in patients with other neoplasms, who become immuno-suppressed.OMF surgeons play a major role in reconstructing patients following ablative surgery forhead and neck malignancy as well as for post traumatic deformity. Frequently this mayinclude free tissue transfer and microsurgical vascular anastomoses.Anaesthetics - OMF Surgeons liaise closely with this specialty in patients with upper airwayproblems. Anaesthetists are vital members of the team treating surgical disease in theorofacial region, developing special expertise in this field.Endocrinology - OMF Surgeons can provide a surgical service to reduce the size ofprominent jaws in patients with acromegaly and Pagets disease and have the technicalexpertise to provide a surgical service for thyroid and parathyroid disease.Cardiology and Cardiothoracic Surgery - OMF Surgeons advise on the oral and dentalstatus of patients with valvular heart disease and coronary heart disease.Paediatrics - OMF Surgeons collaborate with paediatricians in the diagnosis and treatmentof cervical and orofacial infections and neoplasia, and provide treatment for neonates withcraniofacial deformity, as part of the multi-disciplinary approach in cleft lip and palate andcraniofacial units. Orthopaedics - OMF Surgeons provide vital expertise in themultidisciplinary treatment of trauma patients.Otolaryngology - There is often a very close relationship between OMF Surgeons and theirENT colleagues, with significant anatomical overlap in the areas of practice.Psychiatry - OMF Surgeons request psychiatric assessments on some patients, prior tofacial deformity surgery, and collaborate in the management of patients with facial pain.Rheumatology - OMF Surgeons collaborate in the management of patients with joint andconnective tissue diseases, where they affect the temporomandibular joint, face andmouth. They also provide a surgical service for those patients with Sjögrens disease, whohave problems or develop lymphoma in their salivary glands. They provide a diagnosticsurgical service in suspected giant cell arteritis.Intensive Care - OMF Surgeons are trained to provide a surgical tracheostomy service forthose patients requiring prolonged endotracheal intubation Page 5 of 117 © Copyright ISCP 2007
  6. 6. Respiratory Medicine - OMF Surgeons liaise with respiratory physicians and orthodontistsfor the provision of intra-oral devices to control obstructive sleep apnoea and surgicallyenlarge micrognathic mandibles by conducting jaw osteotomies in a select group of thesepatients. They also provide a surgical service for neck node biopsy in suspected cases oftuberculosis sarcoidosis, and other conditions.We seek advice from these specialities in our patients with compromised respiratoryefficiency before their surgery.Gastroenterology - OMF Surgeons often see patients whose first manifestation of agastroenterological disease is in the mouth and liaise with gastroenterologists over themanagement of these patients. The specialties have a close relationship in the provision ofpercutaneous endoscopic gastrostomies (PEG) in major head and neck procedures.Renal Medicine - Following immuno-suppression, renal transplant patients are at risk ofskin and oral cancer. We help with the management of these patients where the diseaseaffects the face and mouth.Allied Health Professions - OMF Surgeons have close relationships with speech andlanguage therapists, dieticians, physiotherapists, occupational therapists, audiologists andother specialities allied to medicine in the management of a large range of patientsrequiring support and rehabilitation during and after treatment of conditions affecting themouth, face, jaws and neck.RESEARCHResearch has an essential role in the development of any industry and healthcare is noexception. Apart from allowing medical horizons to be widened, health economists are nowkeenly aware of the need to refine the application of past discoveries through serviceresearch and to identify the most cost-effective method of providing treatment, resulting inevidence-based medical practice.Oral & Maxillofacial Surgery is well placed to meet these needs as the discipline has astrong academic base within the Dental Schools in the United Kingdom. Close links withthe Universities provides access to laboratories and inter-action with complementarydisciplines (oral pathology, virology, molecular biology, material sciences, etc.) thatproduce both the appropriate environment and critical mass that is fundamental toeffective research. The future potential of maxillofacial surgery is readily found in itsresearch portfolio.There are active research projects in head & neck cancer, craniofacial trauma, day caseand high volume surgery, facial deformity and salivary lithotripsy.SAC Chair and Editor: Andrew Carton Page 6 of 117 © Copyright ISCP 2007
  7. 7. 2. Key ConditionsKey Conditions Oral and Maxillofacial SurgeryKey conditions are those that are considered core to the specialty. The conditions haveassociated key procedures. All trainees should have been routinely exposed to them, andhave acquired the relevant clinical competencies, prior to the award of a CCT. Trainersshould ensure that trainees are fully assessed in the management of theseconditions/procedures in particular:Important note: Competence in these conditions/procedures will be taken to denotecompetence in the management of closely related pathology or less complex procedures inthe same anatomical area.Key Conditions and Associated Core Procedures • Management of a patient with dento-alveolar pathology o Surgical extraction of unerupted/impacted teeth and roots o Apical surgery / excision of jaw cyst • Management of infections of the head and neck o Drainage of tissue space infection • Management of patient with compromised airway o Surgical access to airway (tracheostomy / cricothyroidotomy) • Management of maxillofacial trauma o Repair of facial lacerations o Reduction and fixation of fracture of mandible o Fracture of mandibular condyle - open reduction and fixation o Elevation and fixation of fractured zygoma o Fracture of orbital floor – repair and graft • Management of salivary gland swellings o Submandibular gland excision o Parotidectomy • Management of oro-facial pain / temporomandibular joint dysfunction o Temporomandibular joint arthrocentesis • Management of a patient with benign jaw tumour o Resection of odontogenic tumour / fibro-osseous lesion o Harvest of bone graft • Potentially malignant and malignant epithelial tumours of the mucosa and skin o Local skin flaps o Excision of malignant skin tumour • Management of patient with a neck lump / swelling o Neck dissection(s) • Management of a patient with developmental/acquired deformity of facial skeleton o Mandibular ramus osteotomy o Maxillary osteotomy o Rhinoplasty • Cancer of the head and neck region o Excision of oral / oropharyngeal or jaw malignancy • Reconstructive surgery o Pedicled flaps o Free tissue transfer • Patient requiring osseointegrated implants o Insertion of intra-oral implants and abutment connection Page 7 of 117 © Copyright ISCP 2007
  8. 8. 3. Initial StageFour point scalesWhat the 4 point scale means for Knowledge 1. Knows of 2. Knows basic concepts 3. Knows generally 4. Knows both specifically and broadlyWhat the 4 point sclaes means for Clinical Skills and Technical Skills and Procedures 1. Has observed 2. Can do with assistance 3. Can do whole but may need assistance 4. Competent to do whole without assistance, including managing complications Page 8 of 117 © Copyright ISCP 2007
  9. 9. 3.1 OverviewOverview of Initial StageThe purpose of the initial stage ST1 and 2 is to allow a trainee to acquire and develop thekey fundamental skills that will form a basis for further progress in the specialty.The initial stage of specialist training will combine experience in other surgical specialtieswith training in basic aspects of oral and maxillofacial surgery. The aim should be toacquire competencies and basic surgical skills that will improve understanding of the careof the surgical patient. The ‘Generic Surgical Skills and Knowledge - All Specialties’is common across all the surgical specialties.Related surgical disciplines that can contribute to training at this stage include: • General surgery • Otolaryngology • Plastic surgery • Orthopaedic surgery • Neurosurgery • Accident and emergency medicineA logbook and training portfolio should be kept to allow assessment of relevantcompetencies that can be accepted towards specialist training. Successful attendance atbasic surgical skills and ATLS courses would be expected during this stage of training.Instructional and skills courses in basic aspects of the specialty will also be attended duringthe first two years. These include, for example, head and neck anatomy and maxillofacialplating courses.By the end of ST2 the OMFS trainee will have acquired the following: • Experience in at least one, and preferably two, related surgical specialties • Generic skills to allow team working, and management of and communication with both colleagues and patients, as well as a high standard of professionalism • Clear understanding of the basic sciences as they relate to the pathology and practice of surgery, and oral and maxillofacial surgery in particular • Competence in basic operative skills • Competence in the basic perioperative care of the surgical patient • Competence in the diagnosis and clinical management of common oral and maxillofacial conditions • Competence in the operative management of a range of common oral and maxillofacial conditions as defined below.The syllabus details the areas that it is reasonable to expect a trainee in the initial stage oftraining to be able to deal with whether encountered as a result of being ‘on-call’ orworking in an out-patient clinic setting. It is recognised that different trainees start withdifferent levels of experience and will progress at different rates. The progress made willvary both with the trainee’s innate abilities and also the workload and casemix of thetrainers with whom they work. Those trainees following an academic pathway will beexpected to achieve the same level of competence at the end of ST2 as traineesundertaking a ‘Surgery in general – OMFS programme’.The following problems are commonly encountered and should be managed competentlyby the end of ST2, up to and including operative intervention if appropriate. • Diagnosis and management of dento-alveolar pathology • Diagnosis and management of common oral mucosal disease • Facial lacerations Page 9 of 117 © Copyright ISCP 2007
  10. 10. • Fractures of the facial bones • Diagnosis and management of temporomandibular joint pain and facial pain • Diagnosis and investigation of salivary gland and neck swellingsThe objective to be achieved for these conditions is: • To be able to assess a patient presenting either acutely or in the out-patient clinic • To be able to formulate a differential diagnosis and an investigation and management plan • To be able to treat the patient appropriately up to and including operative intervention if appropriate • To be able to communicate the above information at the required level to patients/carers/other team membersDuring this stage the trainee will gain competence to the level defined in the syllabus in anumber of technical skills and procedures. A trainee would be expected to be able toperform all of the procedures listed below without the direct scrubbed assistance orsupervision of a trainer. The list is not exhaustive, although it covers most of the commonprocedures expected at this stage.It should be noted that competence in some additional procedures can be obtained at thisstage rather than in the later stages in training. Once more this may be due to a numberof reasons, such as increased exposure to the procedures, past experience and innatesurgical ability.Dento-alveolar Surgery • Surgical extraction of retained/buried roots/teeth • Surgical exposure of unerupted tooth • Transplantation of tooth • Apicectomy/retrograde root sealing • Enucleation of jaw cyst • Closure of oro-antral fistula • Removal of tooth/root from maxillary antrum • Excision of benign oral/gingival soft tissue lesion • Lingual/labial frenectomy • Excision of exostosis/benign lesion of boneMaxillofacial Trauma • Repair of facial lacerations • Treatment of dento-alveolar fractures • Reduction of fractured nasal bonesSalivary gland surgery • Labial gland biopsy • FNAC of salivary gland • Excision of mucocoele of lipNeck surgery • Drainage of tissue space infection • FNAC neck massResection of malignant tumours Page 10 of 117 © Copyright ISCP 2007
  11. 11. • Excision of malignant skin tumourReconstructive surgery • Harvest of skin graft • Harvest of intra-oral bone graft • Local skin flapsST1 Placement in Oral and Maxillofacial SurgeryThe purpose of a 4 or 6-month placement in an OMFS service during ST1 will include thefollowing: • To develop some of the key skills that will underpin further training and experience in the specialty • To provide experience in OMFS for the trainee intending to take up a career in one of the head and neck surgical specialtiesKnowledge • Enhanced knowledge of regional and developmental head and neck anatomy • Natural history and patho-physiology of common head and neck conditions with particular emphasis on oncology and trauma • Management pathways for conditions presenting both as emergencies and electively to the OMFS service.Clinical Skills • The examination and investigation of common maxillo-facial clinical problems – elective and emergency • The ability to construct an appropriate management plan for common OMFS patients • Specialist examination techniques applicable to OMFS conditions, including endoscopic techniques • The ability to apply and evaluate the results of head and neck imaging techniquesTechnical Skills • Perform minor oral surgical procedures under local and/or general anaesthetic. • Become a competent assistant for OMFS surgical procedures • By the end of the attachment to be competent to perform at least one intermediate surgical procedure in the head and neck under direct supervision e.g. excision of the submandibular salivary gland, excision of thyroglossal cystProfessional SkillsIn the context of OMFS practice: • Demonstrate good team working skills, including teaching where appropriate and accepting and acting on feedback • Demonstrate a caring, professional attitude to patients and their relatives. • Demonstrate a satisfactory work ethic e.g. commitment to the patient, support of colleagues and task completion. • Demonstrate good time-management Page 11 of 117 © Copyright ISCP 2007
  12. 12. 3.2 ConditionsGeneric Surgical Skills and Knowledge- All SpecialtiesBasic sciencesObjectiveUnderpinning basic science knowledge appropriate for the practice of surgery.Applied anatomy: Knowledge of anatomy appropriate for surgeryPhysiology: Knowledge of physiology relevant to surgical practicePathology: Knowledge of pathological principles underlying system specific pathologyMicrobiology: Knowledge of microbiology relevant to surgical practiceRadiology: Knowledge of diagnostic and interventional radiologyKnowledgeApplied anatomy:4 Development, organs and structures, surface and imaging anatomy of thorax, abdomen,pelvis, perineum, limbs, neck as appropriate for surgical operationsPhysiology:4 Homeostasis3 Thermoregulation3 Metabolic pathways4 Blood loss4 Sepsis4 Fluid balance and fluid replacement therapy3 Metabolic abnormalitiesPathology:4 Inflammation4 Wound healing4 Cellular injury4 Vascular disorders4 Disorders of growth, differentiation and morphogenesis4 Tumours3 Surgical immunology3 Surgical haematologyMicrobiology:4 Surgically important microorganisms4 Sources of infection4 Asepsis and antisepsis4 Sterilisation4 Antibiotics4 High risk patient managementRadiology:3 Principles of diagnostic and interventional radiologyClinical SkillsNo contentTechnical SkillsNo content Page 12 of 117 © Copyright ISCP 2007
  13. 13. Professional SkillsNo contentBasic surgical skillsObjectiveAcquisition of basic surgical skills in instrument and tissue handling.Incision of skin and subcutaneous tissue: Ability to incise superficial tissues accurately withsuitable instruments.Closure of skin and subcutaneous tissue: Ability to close superficial tissues accurately.Knot tying: Ability to tie secure knots.Haemostasis: Ability to achieve haemostasis of superficial vessels.Tissue retraction: Use of suitable methods of retraction.Use of drains: Knowledge of when to use a drain and which to choose.Tissue handling: Ability to handle tissues gently with appropriate instruments.Skill as assistant: Ability to assist helpfully, even when the operation is not familiar.KnowledgeIncision of skin and subcutaneous tissue:4 Langer’s lines4 Healing mechanism4 Choice of instrument4 Safe practice4 Basic Surgical Skills courseClosure of skin and subcutaneous tissue:4 Options for closure4 Suture and needle choice4 Safe practiceKnot tying:4 Choice of materialHaemostasis:4 TechniquesTissue retraction:4 Choice of instrumentsUse of drains:4 Indications4 Types4 Management/removalTissue handling:4 Choice of instrumentsClinical SkillsIncision of skin and subcutaneous tissue: Page 13 of 117 © Copyright ISCP 2007
  14. 14. 4 Ability to use scalpel, diathermy and scissorsClosure of skin and subcutaneous tissue:4 Accurate and tension free apposition of wound edgesKnot tying:4 Single handed4 Double handed4 Instrument4 Superficial4 DeepHaemostasis:4 Control of bleeding vessel (superficial)4 Diathermy4 Suture ligation4 Tie ligation4 Clip applicationTissue retraction:4 Tissue forceps4 Placement of wound retractorsUse of drains:4 Insertion4 Fixation4 RemovalTissue handling:4 Appropriate application of instruments and respect for tissuesSkill as assistant:4 Anticipation of needs of surgeon when assistingTechnical SkillsNo contentProfessional SkillsNo contentThe Assessment and Management of the Surgical PatientObjectiveAbility to assess the patient and manage the patient, and propose surgical or non-surgicalmanagement.KnowledgeNo contentClinical Skills3 Surgical history and examination (elective and emergency)3 Construct a differential diagnosis3 Plan investigations3 Clinical decision making3 Case work up and evaluation; risk management3 Active participation in MDTs3 Taking consent for intermediate level intervention; emergency and elective3 Written clinical communication skills3 Interactive clinical communication skills: patients3 Interactive clinical communication skills: colleages Page 14 of 117 © Copyright ISCP 2007
  15. 15. Technical SkillsNo contentProfessional SkillsNo contentPerioperative careObjectiveAbility to manage patient care in the perioperative period.Preoperative assessment and management: Ability to assess the patient adequately priorto operation and manage any preoperative problems appropriately.Intraoperative care: Ability to conduct safe surgery in the operating theatre environment.Postoperative care: Ability to care for the patient in the postoperative period.Blood Products: Appropriate use of blood products.Antibiotics: Appropriate use of antibiotics.KnowledgePreoperative assessment and management:4 Cardiorespiratory physiology3 Diabetes mellitus3 Renal failure4 Pathophysiology of blood loss4 Pathophysiology of sepsis4 Risk factors for surgery and scoring systems3 Principles of day surgeryIntraoperative care:4 Safety in theatre4 Sharps safety4 Diathermy, laser use4 Infection risks3 Radiation use and risks4 Tourniquets3 Principles of local, regional and general anaesthesiaPostoperative care:4 Cardiorespiratory physiology3 Diabetes mellitus3 Renal failure4 Pathophysiology of blood loss4 Pathophysiology of sepsis4 Complications specific to particular operation2 Critical careBlood Products:4 Components of blood4 Alternatives to use of blood productsAntibiotics:4 Common pathogens in surgical patients4 Antibiotic sensitivities4 Antibiotic side-effects4 Principles of prophylaxis and treatmentClinical Skills Page 15 of 117 © Copyright ISCP 2007
  16. 16. Preoperative assessment and management:4 History and examination4 Interpretation of preop investigations3 Management of comorbidity4 ResuscitationIntraoperative care:4 Safe conduct of intraoperative carePostoperative care:4 Assessment of patient’s condition4 Postoperative analgesia4 Fluid and electrolyte management4 Monitoring of postoperative patient4 Detection of impending organ failure4 Initial management of organ failure4 Use of MDT meetingsBlood Products:4 Appropriate use of blood products4 Management of the complications of blood product transfusionAntibiotics:4 Appropriate prescription of antibioticsTechnical SkillsNo contentProfessional SkillsPreoperative assessment and management:0 Communication with patient and relatives0 Liason with physicians and ITU staffIntraoperative care:0 Communication with other staff membersPostoperative care:0 Communication with patient and relatives0 Liason with physicians and ITU staffBlood Products:0 Communication with patient and relativesAssessment of multiple injured patients including childrenObjectiveSafely assess the multiply injured patient.Knowledge3 Anatomy3 Pathogenesis of shock1 Differences In ChildrenClinical Skills4 History and examination3 Investigation4 Resuscitation and early management according to ATLS and APLS guidelines Page 16 of 117 © Copyright ISCP 2007
  17. 17. 3 Referral to appropriate surgical subspecialtiesTechnical Skills3 Central venous line insertion3 Chest drain insertion2 Diagnostic peritoneal lavageProfessional SkillsNo contentBleeding diathesisObjectiveUnderstand, Recognise and Manage bleeding diathesis in the surgical patient.Diagnosis: Diagnose possible bleeding diathesis in the surgical patient.Treatment: Manage bleeding diathesis in the surgical patient.KnowledgeDiagnosis:3 Mechanism of haemostasis3 Pathology of impaired haemostasis e.g. haemophilia, liver disease, massive haemorrhageTreatment:3 Understands use of blood productsClinical SkillsDiagnosis:4 Recognition of conditions likely to lead to the diathesis3 Recognition of abnormal bleeding during surgeryTreatment:3 Avoidance by correct surgical techniques3 Corrective measures, e.g. warming, packingTechnical SkillsNo contentProfessional SkillsDiagnosis:0 Communication with laboratory staffTreatment:0 Communication with anaesthetist, theatre team and laboratory staffVenous thrombosis + embolismObjectiveUnderstanding of practice in the prevention and management of Venous thrombosis andEmbolism.Coagulation: Understanding of the physiology and pathophysiology of coagulation.Diagnosis: Able to arrange basic investigation of patients with suspected venousthrombosis and embolism.Treatment: Ability to initiate treatment of venous thrombosis and embolism.Prophylaxis: Use of common methods of prophylaxis against venous thrombosis andembolism.Knowledge Page 17 of 117 © Copyright ISCP 2007
  18. 18. Coagulation:2 Clotting mechanism (Virchow Triad)2 Effect of surgery and trauma on coagulation2 Tests for thrombophilia and other disorders of coagulationDiagnosis:2 Methods of investigation for suspected thromboembolic diseaseTreatment:4 Anticoagulation, heparin and warfarin2 Role of V/Q scanning, CT angiography and thrombolysis2 Place of pulmonary embolectomyProphylaxis:3 Knowledge of methods of prevention, mechanical and pharmacologicalClinical SkillsCoagulation:4 Recognition of patients at riskDiagnosis:3 Awareness of symptoms and signs associated with pulmonary embolism and DVT2 Role of duplex scanning, venography and d-dimer measurementTreatment:3 Initiate and monitor treatmentProphylaxis:4 Awareness at all times of the importance of prophylaxisTechnical SkillsNo contentProfessional SkillsCoagulation:0 Protocol managementDiagnosis:0 Ability to organise and time appropriate investigationTreatment:0 Prioritisation of investigation and treatment0 Patient counsellingProphylaxis:0 Able to implement in the team setting the culture of prophylaxisNutritionObjectiveRecognise the need for artificial nutritional support and arrange enteral nutrition.Knowledge3 Effects of malnutrition, both excess and depletion3 Methods of screening and assessment Page 18 of 117 © Copyright ISCP 2007
  19. 19. Clinical Skills3 Arrange access to suitable artificial nutritional support, preferably via a nutrition team:Dietary supplements2 Arrange access to suitable artificial nutritional support, preferably via a nutrition team:Enteral nutrition1 Arrange access to suitable artificial nutritional support, preferably via a nutrition team:Parenteral nutritionTechnical SkillsNo contentProfessional SkillsNo contentAcademic activityObjectiveAn introduction to research methodology and to teaching others.Research: Ability to perform a simple research study and present the results.Teaching: Ability to teach small groups such as medical students.KnowledgeResearch:2 Research methodologyTeaching:2 Teaching methodsClinical SkillsResearch:2 Ability to analyse published evidenceTeaching:3 Ability to teach small groupsTechnical SkillsNo contentProfessional SkillsNo contentManagement of the dying patientObjectiveAbility to manage the dying patient appropriately.Palliative Care: Good management of the dying patient in consultation with the palliativecare team.Principles of organ donation: Knowledge of the principles of organ donation.KnowledgePalliative Care:3 Care of the terminally ill4 Analgesia3 Antiemetics3 LaxativesPrinciples of organ donation:3 Circumstances in which consideration of organ donation is appropriate3 Principles of brain death Page 19 of 117 © Copyright ISCP 2007
  20. 20. 3 Understanding the role of the coroner and the certification of deathClinical SkillsPalliative Care:3 Symptom control in the terminally ill patientTechnical SkillsNo contentProfessional SkillsPalliative Care:0 Communication with the patient and relatives0 Liason with the palliative care teamPrinciples of organ donation:0 Communication with relatives0 Liason with the transplant team0 Learn to cope with crisis and mortalityEndocrine and Metabolic DisordersObjectiveTo identify, investigate and managesurgical patients with common metabolic disorders- To identify, investigate and manage surgical patients with Thyrotoxicosis- To identify, investigate and manage surgical patients with Hypothyroidism- To identify, investigate and manage surgical patients with Hypercalcaemia- Knowledge of the significance of corticosteroid therapy in patient care- To identify, investigate and manage surgical patients with diabetes mellitus- To identify, investigate and manage surgical patients with HyponatraemiaKnowledgeThyrotoxicosis4 Pathophysiology of thyroid hormone excess and associated risks from surgeryHypothyroidism4 Pathophysiology of thyroid hormone deficiency and associated risks from surgeryHypercalcaemia3 Causes and effects of hypercalcaemiaCortico-steroid therapy4 Complications4 Steroid insufficiencyDiabetes Mellitus4 ComplicationsHyponatraemia4 Pathophysiology of fluid and electrolyte balance4 Causes of hyponatraemiaClinical SkillsThyrotoxicosis4 History and examination3 Investigation of thyrotoxicosisHypothyroidism4 History and examination4 InvestigationHypercalcaemia3 Investigation of hypercalcaemia3 Treatment of hypercalcaemia Page 20 of 117 © Copyright ISCP 2007
  21. 21. Cortico-steroid therapy4 Peri-operative management of patients on steroid therapyDiabetes Mellitus4 Peri-operative management of diabetic patientsHyponatraemia4 TreatmentTechnical SkillsNo contentProfessional SkillsLiaise with endocrinologistsLiaise with diabetic teamChild ProtectionObjectiveNo contentKnowledge4 Working knowledge of Trust and ACPC Child Protection Procedures4 Basic understanding of child protection law4 Understanding of Childrens rights4 Working knowledge of types and catagories of child maltreatment, presentations, signsand other features (primarily physical, emotional, sexual, neglect, professional)4 Understanding of one personal role, responsibilities and appropriate referral patterns inchild protection4 Understanding of the challenges of working in partnership with children and familiesClinical SkillsAbility to:4 recognise the possibility of abuse or maltreatment4 recognise limitations of own knowledge and experience and seek appropriate expertadvice4 urgently consult immediate senior in surgery to enable referral to paediatricians4 keep appropriate written documentation relating to child protection matters4 Communicate effectively with those involved with child protection, including children andtheir familiesTechnical SkillsNo contentProfessional SkillsNo content Page 21 of 117 © Copyright ISCP 2007
  22. 22. Basic Science KnowledgeAnatomyObjectiveTo understand the surgical anatomy that oral and maxillofacial surgeons will encounterduring the management of surgical patients and the development of anatomical systems.KnowledgeSkull, brain and cranial cavity:0 Embryogenesis of skull0 Functional knowledge of brain and its coverings0 Knowledge of common anatomical variations of skull0 Applied surgical anatomy.Orbit and eye:0 Development of orbit and eye.0 Relations within maxillofacial skeleton0 Applied surgical anatomyNose and paranasal sinuses:0 Development of nose and paranasal sinuses.0 Relations of these structures to the maxillofacial skeleton0 Applied surgical anatomyFacial musculature/soft tissues:0 Development of facial musculature and its effect on development of the head and neck ingeneral0 Applied surgical anatomyTemporomandibular joint and infratemporal fossa:0 Embryogenesis and development of the temporomandibular joint0 Functional anatomy of the TMJ0 Applied surgical anatomy of the TMJ and infratemporal fossaExternal, middle and inner ear:0 Functional anatomy0 Applied surgical anatomyOral cavity, teeth and supporting structures, pharynx:0 Embryogenesis and development of the oral cavity and pharynx0 Applied surgical anatomyMandible and maxilla:0 Embryogenesis of maxilla and mandible0 Facial growth0 Disorders of development0 Applied surgical anatomyLarynx, trachea, neck and thoracic inlet0 Developmental anatomy of the neck. Page 22 of 117 © Copyright ISCP 2007
  23. 23. 0 Disorders of development0 Applied surgical anatomyBlood supply to skin, fascia, muscle and bone:0 Knowledge of principles of blood supply to skin, fascia, muscle and bone0 Applied surgical anatomyRegional anatomy relevant to bone grafts and common pedicled/free flaps:0 Applied surgical anatomy of limbs, thoracic cage, back, abdominal wall, groin and pelvisClinical Skills0 Application of this knowledge appropriately in the clinical settingBlood supply to skin, fascia, muscle and bone:0 Application of this knowledge appropriately in relation to design of reconstructive flapsTechnical SkillsNo contentProfessional SkillsNo contentPhysiologyObjectiveTo understand the normal physiological processes at different ages and to understand theeffects of disease and trauma in these processes as they relate to oral and maxillofacialsurgery.KnowledgeOral mucosa and connective tissues of the mouth:0 Metabolism and functions of the oral mucosa and connective tissues of the oral cavityCalcium/phosphorus metabolism and calcification:0 Mineral metabolism0 Chemistry of calcium and phosphates0 Composition of bone and teeth0 Metabolism of bone and teeth0 Mechanisms of calcificationBone growth and remodelling:0 Mechanisms of osteogenesis and ossification0 Bone remodelling0 Mechanisms of bone growth0 Post-natal remodelling of the facial skeleton0 Effects of soft tissues on skull growthMechanisms of tooth eruption:0 Normal tooth eruption and theories0 Abnormal tooth eruption0 Factors affecting tooth eruptionSalivary glands and saliva0 Composition and functions of saliva0 Stimulus and mechanisms of salivation0 Importance of saliva in relation to oral diseaseImmunology and defence mechanisms of the mouth: Page 23 of 117 © Copyright ISCP 2007
  24. 24. 0 Mechanical, chemical and hormonal factors protecting the oral cavity0 Immunological protective mechanismsMastication and deglutition:0 Properties and functions of the muscles of mastication0 Co-ordination of the masticatory system0 Taste and olfaction0 Phases of deglutition0 Control of deglutition0 DysphagiaEffects of dietary deficiencies and hormonal imbalances:0 Physiological effects of dietary deficiency0 Physiological effects of hormonal imbalance0 Nutrition and malnutritionAge changes in the oral structures:0 Physiological effects of aging within the head and neckPhysiological responses to surgical treatment:0 Physiology of stress0 The anxious patient0 Vasovagal reactions, hyperventilation and arrhythmiasWound healing:0 Wounding agents and sequelae0 The inflammatory response0 Healing of oral and other wounds0 Abnormal healingOro-facial pain:0 Sensory innervation of the head and neck0 Transmission of trigeminal impulses within the central nervous system.0 Pain perception0 Referred pain0 Theories of pain0 Physiological effects of painClinical SkillsApplication of this knowledge appropriately in the clinical settingTechnical SkillsNo contentProfessional SkillsNo contentSurgical Pathology (and Genetics)ObjectiveTo understand pathological processes as they present in the common oral and maxillofacialdiseases/conditions/illnesses.KnowledgeBiopsy principles and techniques:0 Rationale and techniques for biopsy (FNA, core biopsies, incisional and excisional)0 Preparation and preservation of pathological specimens0 Use of the pathology laboratory Page 24 of 117 © Copyright ISCP 2007
  25. 25. Inflammatory reactive and infectious diseases:0 The acute inflammatory response0 The chronic inflammatory response0 Principles of wound healing0 Abnormal wound healing0 Healing in specialized tissuesImmune-based diseases:0 Pathological basis for the immune response0 Auto-immune diseaseConditions of developmental disturbance:0 Disorders of metabolism0 Disorders of nutritionHyperplasias, hamartomas, and neoplasms of soft tissues and bones:0 Disorders of growth and development0 Differential diagnosis0 Treatment modalities (if required)Benign epithelial tumours of the mucosa and skin:0 Pathology of disorders of growth0 Differential diagnoses0 Treatment modalitiesPotentially malignant and malignant epithelial tumours of the mucosa and skin:0 Mechanisms of tumour initiation and growth0 Malignant transformation0 Mechanisms of metastasis0 Tumour staging0 Treatment modalitiesEffects of radiation and osteoradionecrosis:0 The effects of ionizing radiationBenign soft tissue tumours of mesenchymal origin:0 Pathology of disorders of growth0 Differential diagnoses0 Treatment modalitiesMalignant soft tissue tumours of mesenchymal origin:0 Mechanisms of tumour initiation and growth0 Malignant transformation0 Mechanisms of metastasis0 Tumour staging0 Treatment modalitiesNon-neoplastic salivary gland diseases:0 Pathology of salivary gland disease0 Differential diagnosis0 Treatment modalitiesSalivary gland neoplasms: Page 25 of 117 © Copyright ISCP 2007
  26. 26. 0 Mechanisms of tumour initiation and growth0 Malignant transformation0 Mechanisms of metastasis0 Tumour staging0 Treatment modalitiesOdontogenic and non-odontogenic cysts:0 Pathology of non-neoplastic conditions involving odontogenic tissues0 Differential diagnosis0 Treatment optionsOdontogenic tumours, hamartomas and neoplasms:0 Pathology of neoplastic conditions involving odontogenic tissues0 Differential diagnosis0 Treatment optionsPigmented lesions of the skin and mucosa:0 Pathological basis of pigmentation0 Normal and abnormal pigmentation0 Diagnostic procedures0 Treatment optionsFibro osseous diseases and systemic diseases affecting bone:0 Pathology of disorders of growth0 Differential diagnoses0 Treatment modalitiesBenign and malignant neoplasms of bone:0 Pathology of disorders of growth0 Calcium metabolism0 Differential diagnoses0 Mechanisms of tumour initiation and growth0 Mechanisms of metastasis0 Tumour staging0 Treatment modalitiesNeoplasms of the immune system:0 Pathology of the immune response0 Immunity to infection0 Hypersensitivity, tissue grafts and autoimmunityTrauma:0 Haemorrhage and shock0 Oedema0 Fever and hypothermiaOncology:0 Mechanisms of tumour initiation and growth0 Role of environmental factors0 Role of genetic factors0 Tumour staging0 Treatment strategies0 Mechanisms of chemotherapy and radiotherapy Page 26 of 117 © Copyright ISCP 2007
  27. 27. Genetics:0 Genetics in normal development0 Role of genetics in pathological processesClinical Skills0 Application of this knowledge appropriately in the clinical settingTechnical SkillsNo contentProfessional SkillsNo contentClinical pharmacologyObjectiveTo understand the uses and effects of therapeutic agents used in the treatment ofconditions presenting to the oral and maxillofacial surgeon.KnowledgeAdverse reactions to drugs:0 Incidence of adverse drug reactions0 Classification of adverse drug reactions0 Long-term and delayed effects causing adverse reactions0 Surveillance methodsPractical drug prescribing:0 Principles of prescribing0 Prescription writing0 Drug informationDrug interactions:0 Incidence of drug interactions0 Pharmaceutical interactions0 Pharmacokinetic interactions0 Pharmacodynamic interactionsDrug therapy in the young, the elderly, and in pregnancy:0 Differences in drug therapy(a) in the young(b) in the elderly(c) in pregnancyPatient compliance:0 Factors affecting compliance0 Measuring compliance0 Improving compliancePlacebos:0 The placebo effect0 Mode of action of placebos0 Adverse effects of placebosDrug development and clinical trials:0 The pharmaceutical industry and the regulatory authorities0 Definition of a clinical trial0 The conduct of a clinical trial0 Ethics of clinical trials Page 27 of 117 © Copyright ISCP 2007
  28. 28. Drug therapy of systemic disease relevant to maxillofacial surgical practice:0 Knowledge of specific agents, their effects and mechanisms of actionRelief of pain and anaesthesia:0 Anatomical and neuropharmacological mechanisms underlying pain sensation0 Mechanism of action of analgesics0 Practical use of analgesics0 Treatment of intractable pain (e.g. in terminal care)0 Local anaesthetics0 Analgesic effects of conscious sedation0 General anaestheticsDrug dependence and abuse:0 Factors predisposing to drug dependence0 Pharmacology of specific drugs of dependence0 Treatment of drug dependencePrinciples of cancer chemotherapy and immunosupression:0 Actions of chemotherapeutic agents0 Pre-treatment evaluation0 Combination chemotherapy0 Adverse effects of drugs used in cancer chemotherapy0 Practical use of cytotoxic agentsClinical Skills0 Application of this knowledge appropriately in the clinical settingTechnical SkillsNo contentProfessional SkillsNo contentClinical MicrobiologyObjectiveTo understand the microbiology of common infections/conditions which affect the head andneck.KnowledgeClassification and pathogenicity of micro-organisms:0 Classification of micro-organisms0 Pathogenesis0 Factors affecting the virulence and spread of micro=organismsUse of the microbiology laboratory:0 Collection of clinically-relevant specimens0 Transport of specimens0 Laboratory procedures for microbiological diagnosisAntimicrobial chemotherapy:0 Mode of action of antimicrobial agents0 Spectrum of activity0 Principles of clinical use0 Causes of treatment failure0 Antibiotic resistance0 Antibiotic prophylaxisPyrexia of unknown origin(PUO): Page 28 of 117 © Copyright ISCP 2007
  29. 29. 0 Definition and causes of PUO0 Investigation of PUOThe immuno compromised patient:0 Causes and related conditions0 Specific precautions and management protocolsSepticaemia:0 Clinical features and causative organisms0 Investigation0 Antimicrobial treatmentOpportunistic and fungal infections:0 Opportunistic organisms and conditions0 Diagnosis0 Treatment0 Antifungal agentsSpecific infections of the head and neck:0 Odontogenic infections0 Infections of the paranasal sinuses0 Osteomyelits0 Tissue space infections0 Spreading infections0 Skin infections0 Necrotizing fasciitisInfective endocarditis:0 Incidence, clinical features and predisposing factors0 Pathogenesis and causative organisms0 Investigation0 Treatment/prophylaxisHospital acquired infection:0 Types of hospital-acquired infection0 Surgical wound infections0 Infection in intensive care units0 Infections of risk to hospital staff0 Isolation proceduresPrinciples of disinfection:0 General considerations0 Disinfection methodsSterilisation:0 General considerations0 Sterilisation methodsClinical Skills0 Application of this knowledge appropriately in the clinical settingTechnical SkillsNo contentProfessional SkillsNo content Page 29 of 117 © Copyright ISCP 2007
  30. 30. Dentoalveolar PathologyImpacted Wisdom ToothObjectiveTo be able to assess a patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Signs and symptoms0 Differential diagnosis0 Investigations and radiographic interpretation0 Methods of medical management including treatment of inflammation/infection0 Pharmacology and therapeutics of analgesia0 Understanding of NICE/SIGN guidelines0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Indications including NICE/SIGN guidelines0 Potential complications0 Pharmacology and therapeutics of postoperative analgesiaClinical Skills0 Ability to formulate treatment plan0 Treat/drain infection and/or remove tooth0 Institute aftercare and reviewTechnical SkillsSurgical extraction of unerupted/impacted teeth and roots:0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Treat/drain infection and/or remove tooth0 Techniques of bone removal and tooth division0 Intra-oral suturing techniquesProfessional SkillsNo contentDental ExtractionsObjectiveTo be able to assess a patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Signs and symptoms0 Differential diagnosis0 Investigations and radiographic interpretation0 Methods of medical management including treatment of inflammation/infection0 Pharmacology and therapeutics of analgesia0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Potential complications0 Pharmacology and therapeutics of postoperative analgesia Page 30 of 117 © Copyright ISCP 2007
  31. 31. Clinical Skills0 Ability to formulate treatment plan0 Liaison with restorative dentist0 Treat/drain infection and/or remove tooth0 Safe and appropriate use of instruments0 Institute aftercare and reviewTechnical SkillsSurgical extraction of unerupted/impacted teeth and roots:0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Techniques of bone removal and tooth division0 Intra-oral suturing techniquesProfessional SkillsNo contentUnerupted toothObjectiveTo be able to assess a patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Signs and symptoms0 Differential diagnosis0 Investigations and radiographic interpretation0 Methods of medical management including treatment of inflammation/infection0 Pharmacology and therapeutics of analgesia0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Potential complications0 Pharmacology and therapeutics of postoperative analgesia0 Physiology of sinus function0 Pathology of inflammatory sinus disease, including its potential to mimic dental pain0 Relevance of other related conditions e.g atypical facial pain and TMJ pathologies0 Indications and techniquesClinical Skills0 Ability to formulate treatment plan0 Treat/drain infection and/or remove tooth0 Institute aftercare and reviewTechnical SkillsSurgical exposure or transplantation of unerupted tooth:0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Techniques of exposure and bone removal0 Packing and/or bonding of tooth0 Techniques of tooth splintage0 Intra-oral suturing techniquesProfessional SkillsNo contentOro-antral communication/root in Maxillary antrumObjective Page 31 of 117 © Copyright ISCP 2007
  32. 32. To be able to assess a patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Signs and symptoms0 Differential diagnosis0 Investigations and radiographic interpretation0 Methods of medical management including treatment of inflammation/infection0 Relevance of endoscopic examination of maxillary antrum0 Pharmacology and therapeutics of analgesia0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Potential complications0 Pharmacology and therapeutics of postoperative analgesia0 Physiology of sinus function0 Pathology of inflammatory sinus disease0 Indications and techniquesClinical Skills0 Ability to formulate treatment plan0 Treat/drain infection and/or remove tooth0 Institute aftercare and reviewTechnical SkillsClosure of oro-antral communication:0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Techniques of local flap closure0 Techniques of antral exploration / lavage0 Antrostomy0 Intra-oral suturing techniquesRemoval of root retained root or dental fragment from maxillary antrum0 Endoscopic examination of maxillary antrum0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Techniques of local flap closure0 Techniques of antral exploration / lavage0 Antrostomy0 Intra-oral suturing techniquesProfessional SkillsNo contentProminant lingual / labial frenumObjectiveTo be able to assess a patient presenting in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Signs and symptoms0 Differential diagnosis Page 32 of 117 © Copyright ISCP 2007
  33. 33. 0 Investigations and radiographic interpretation0 Pharmacology and therapeutics of analgesia0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Potential complications0 Pharmacology and therapeutics of postoperative analgesia0 Indications and techniquesClinical Skills0 Ability to formulate treatment plan0 Treat/drain infection and/or remove tooth0 Institute aftercare and review0 Ability to discriminate between those who need surgery and those who dont andcommunicate this effectivelyTechnical Skills0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Intra-oral suturing techniquesProfessional SkillsNo contentJaw CystsObjectiveTo be able to assess a patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Signs and symptoms0 Differential diagnosis0 Investigations and radiographic interpretation0 Methods of medical management0 Cystic lesions of the jaw0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Pathogenesis of chronic infection and cystic lesions0 Potential complications including management of compromised airway0 Pharmacology and therapeutics of postoperative analgesiaClinical Skills0 Ability to formulate treatment plan0 Relevance of early involvement of microbiologist0 Treat/drain infection0 Ability to manage compromised airway (surgical airway)0 Recognition of systemic sepsis (sepsis syndrome)0 Recognition of infection as an early indicator of immuno supression e.g. diabetes,immuno compromised states0 Institute aftercare and reviewTechnical SkillsApical surgery / excision of jaw cyst:0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Techniques of exposure, bone removal and enucleation of pathology0 Intra-oral suturing techniquesProfessional SkillsNo contentBenign oral soft tissue/hard tissue lesionObjective Page 33 of 117 © Copyright ISCP 2007
  34. 34. To be able to assess a patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Signs and symptoms0 Differential diagnosis0 Investigations and radiographic interpretation0 Methods of medical management0 Common oral mucosal & bony pathologies0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Pathogenesis of chronic infection and cystic lesions0 Potential complications including management of compromised airway0 Pharmacology and therapeutics of postoperative analgesiaClinical Skills0 Ability to formulate treatment plan0 Relevance of early involvement of microbiologist0 Treat/drain infection0 Ability to manage compromised airway (surgical airway)0 Recognition of systemic sepsis (sepsis syndrome)0 Recognition of infection as an early indicator of immuno supression e.g. diabetes,immuno compromised states0 Institute aftercare and reviewTechnical SkillsExcision / biopsy of benign oral soft tissue / hard tissue lesion:0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Techniques of incisional / excisional biopsy0 Control of haemorrhage0 Techniques of local flap closure0 Intra-oral suturing techniquesProfessional SkillsNo contentAbscess/InfectionObjectiveTo be able to assess a patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Signs and symptoms0 Differential diagnosis0 Investigations and radiographic interpretation0 Methods of medical management0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Pathogenesis of chronic infection and cystic lesions0 Potential complications including management of compromised airway0 Pharmacology and therapeutics of postoperative analgesiaClinical Skills0 Ability to formulate treatment plan0 Relevance of early involvement of microbiologist0 Treat/drain infection0 Ability to manage compromised airway (surgical airway) Page 34 of 117 © Copyright ISCP 2007
  35. 35. 0 Recognition of systemic sepsis (sepsis syndrome)0 Recognition of infection as an early indicator of immuno supression e.g. diabetes,immuno compromised states0 Institute aftercare and reviewTechnical SkillsApical surgery / excision of jaw cyst:0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Techniques of exposure, bone removal and enucleation of pathology0 Intra-oral suturing techniquesProfessional SkillsNo content Page 35 of 117 © Copyright ISCP 2007
  36. 36. Oral mucosal lesionsOral ulcerationObjectiveTo be able to assess an patient presenting with a mucosal lesion either acutely or in theout-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Aetiological factors and differential diagnosis0 Investigations0 Possible relationship to systemic disease0 Relevant pharmacology and therapeutics0 Signs of malignant diseaseClinical Skills0 Examination of the oral mucosa0 Biopsy/cytology techniques0 Ability interpret results and formulate treatment planTechnical Skills0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly including harvesting pathologicallyappropriate specimen0 Intra-oral suturing techniques0 Ability to discriminate between those who need surgery and those who dont andcommunicate this effectivelyProfessional SkillsNo contentLeukoplakiaObjectiveTo be able to assess an patient presenting with a mucosal lesion either acutely or in theout-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Aetiological factors and differential diagnosis0 Investigations0 Possible relationship to systemic disease0 Relevant pharmacology and therapeutics0 Signs of malignant diseaseClinical Skills0 Examination of the oral mucosa0 Biopsy techniques0 Ability to interpret results and formulate treatment planTechnical Skills0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly including harvesting pathologicallyappropriate specimen0 Intra-oral suturing techniques0 Ability to discriminate between those who need surgery and those who dont andcommunicate this effectively Page 36 of 117 © Copyright ISCP 2007
  37. 37. Professional SkillsNo content Page 37 of 117 © Copyright ISCP 2007
  38. 38. Infections of the Head and NeckInfections of the Head and NeckObjectiveTo be able to assess a patient presenting with infections of the head and neck eitheracutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Causes of swelling of head and neck0 Differential diagnosis0 Investigations0 Methods of medical and principles surgical management0 Head and neck anatomy0 Head and neck pathology0 Awareness of appropriateness of procedure and alternatives0 Potential complications0 Awareness of relevance of immunocompromised state0 Anatomy of fascial spaces of head and neck0 Microbiology of head and neck infection0 Anatomy and physiology of the upper aerodigestive airway0 Anatomy of lymphatic drainage and vital structures0 Differential diagnosis of enlarged neck nodes0 Relevant investigations0 Understanding of microbiology of head and neck infections0 Awareness of issues around blood borne infections0 Anatomy of larynx, trachea and related structures0 Techniques of non-surgical airway management0 Physiology of respiration0 Upper airway pathology0 Techniques of surgical airway management0 Local anaesthesia and analgesia techniquesClinical Skills0 Ability to take and interpret a thorough history0 Clinical examination of the head, neck and salivary glands0 FNAC technique0 Treatment of acute infected swelling0 Drainage of neck abscessRecognition of infections specific to the head and neck:0 Odontogenic infection0 Infections of the paranasal sinuses0 Osteomyelitis0 Fascial space infections0 Spreading infections0 Necrotising fasciitis0 Prevention of nosocomial infectionTechnical SkillsFine needle aspiration of neck mass:0 Carry out of steps of procedure safely and correctly0 Assemble equipment / precautions0 Localisation of mass and aspiration Page 38 of 117 © Copyright ISCP 2007
  39. 39. 0 Prepare and confirm adequacy of specimenDrainage of tissue space infection:0 Appropriate aseptic preparation0 Exposure and exploration of tissue space(s)0 Collection of samples0 Securing appropriate drains and dressingsSurgical access to airway (Tracheostomy / cricothyroidotomy):0 Identify relevant instruments and support staff0 Appropriate aseptic preparation0 Exposure and access to airway0 Control of haemorrhage0 Placement and securing of tube in airway0 Tracheostomy careProfessional SkillsNo content Page 39 of 117 © Copyright ISCP 2007
  40. 40. Cranio Maxillofacial TraumaFacial Laceration(s)ObjectiveTo be able to fully assess an injured patient presenting either acutely or in the out-patientclinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Aetiology of facial trauma0 Principles of wound management and soft tissue repair0 Prevention/treatment of infections0 Anatomy of facial skin and underlying structures0 Assessment of cranial nerve function0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Wound healing and wound care0 Management/prevention of unfavourable scarringClinical Skills0 General assessment of the traumatised patient0 Assessment and examination of patient with facial laceration(s)0 Abilty to recognise involvement of other anatomical structures e.g. nerves, parotid duct0 Ability to formulate a treatment plan and prioritise management0 Repair of facial lacerations under local anaesthesiaTechnical SkillsRepair of facial laceration(s):0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Management of contaminated wound, thorough debridement0 Management of a laceration involving key structures or tissue loss0 Management of nerve/parotid duct injury0 Soft tissue handling and suturing techniquesProfessional SkillsNo contentDental Trauma and dento-alveolar fracturesObjectiveTo be able to assess an injured patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Aetiology of facial trauma0 Priorities of management0 Assessment of airway and level of consciousness (Glasgow coma scale)0 Signs and symptoms of fractures of facial skeleton0 Eyes/ears assessment0 Investigations and radiographic interpretation0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Classification of dental trauma and dento-alveolar fractures0 Assessment of head injury and cranial nerve function Page 40 of 117 © Copyright ISCP 2007
  41. 41. 0 Aetiology0 Interpretation of radiographs0 Potential complications0 Pharmacology and therapeutics of postoperative analgesia0 Anatomy of facial skeleton0 Physiology of nasal cavity0 Anatomy of scalp, facial skeleton, orbit and contents0 Anatomy of eyelids0 Classification of facial fractures0 Physiology of sight and occulomotor function0 Available techniques0 Anatomy of facial skeleton, teeth and supporting structures0 Dental occlusionClinical Skills0 General assessment of the traumatised patient0 Assessment and examination of patient with facial trauma0 Airway management and emergency treatment of facial trauma0 Ability to formulate a treatment plan and prioritise management0 Pain control /prevention of infection0 infiltration / nerve block anaesthesiaTechnical Skills0 Clinical examination of oral cavity, facial skeleton and cranial nerves0 Local anaesthetic and sedation techniques0 Carry out of steps of procedure safely and correctly0 Techniques for removal of damaged teeth/retained roots0 Techniques of preservation of damaged teeth, reduction and fixation0 Intra-oral soft tissue handling and suturing techniquesProfessional SkillsNo contentNasal FracturesObjectiveTo be able to assess an injured patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Aetiology of facial trauma0 Priorities of management0 Assessment of airway and level of consciousness (Glasgow coma scale)0 Signs and symptoms of fractures of facial skeleton0 Eyes/ears assessment0 Investigations and radiographic interpretation0 Anatomy of mouth, jaws, teeth and supporting structures and relevance dental occlusionwhere appropriate0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Classification of dental trauma and dento-alveolar fractures0 Assessment of head injury and cranial nerve function0 Aetiology0 Interpretation of radiographs0 Potential complications0 Pharmacology and therapeutics of postoperative analgesia0 Anatomy of facial skeleton0 Physiology of nasal cavity Page 41 of 117 © Copyright ISCP 2007
  42. 42. 0 Anatomy of scalp, facial skeleton, orbit and contents0 Anatomy of eyelids0 Classification of facial fractures0 Physiology of sight and occulomotor function0 Available techniquesClinical Skills0 General assessment of the traumatised patient0 Assessment and examination of patient with facial trauma0 Airway management and emergency treatment of facial trauma0 Ability to formulate a treatment plan and prioritise management0 Pain control /prevention of infection0 infiltration / nerve block anaesthesiaTechnical Skills0 Clinical examination of facial skeleton and cranial nerves0 Carry out of steps of proceudre safely and correctly0 Manipulation of nasal bones and septum0 Management of epistaxis0 Nasal packing and external splintageProfessional SkillsNo contentFractured ZygomaObjectiveTo be able to assess an injured patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Aetiology of facial trauma0 Priorities of management0 Assessment of airway and level of consciousness (Glasgow coma scale)0 Signs and symptoms of fractures of facial skeleton0 Eyes/ears assessment0 Investigations and radiographic interpretation0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Classification of dental trauma and dento-alveolar fractures0 Assessment of head injury and cranial nerve function0 Aetiology0 Interpretation of radiographs0 Potential complications0 Pharmacology and therapeutics of postoperative analgesia0 Anatomy of facial skeleton0 Physiology of nasal cavity0 Anatomy of scalp, facial skeleton, orbit and contents0 Anatomy of eyelids0 Classification of facial fractures0 Physiology of sight and occulomotor function0 Available techniques0 Anatomy of facial skeleton, teeth and supporting structures0 Dental occlusionClinical Skills0 General assessment of the traumatised patient0 Assessment and examination of patient with facial trauma0 Airway management and emergency treatment of facial trauma Page 42 of 117 © Copyright ISCP 2007
  43. 43. 0 Ability to formulate a treatment plan and prioritise management0 Pain control /prevention of infection0 infiltration / nerve block anaesthesiaTechnical Skills0 Clinical examination of facial skeleton and cranial nerves0 Basic ophthalmic and orthoptic assessment0 Carry out of steps of procedure safely and correctly0 Techniques of exposure of fracture site(s) and bone manipulation0 Plate handling skills0 Soft tissue handling and suturing techniquesProfessional SkillsNo contentFracture of mandible (excluding condyle)ObjectiveTo be able to assess an injured patient presenting either acutely or in the out-patient clinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Aetiology of facial trauma0 Priorities of management0 Assessment of airway and level of consciousness (Glasgow coma scale)0 Signs and symptoms of fractures of facial skeleton0 Eyes/ears assessment0 Investigations and radiographic interpretation0 Anatomy of mouth, jaws, teeth and supporting structures0 Anatomy of trigeminal nerve and infiltration / nerve block anaesthesia0 Classification of dental trauma and dento-alveolar fractures0 Assessment of head injury and cranial nerve function0 Aetiology0 Interpretation of radiographs0 Potential complications0 Pharmacology and therapeutics of postoperative analgesia0 Anatomy of facial skeleton0 Physiology of nasal cavity0 Anatomy of scalp, facial skeleton, orbit and contents0 Anatomy of eyelids0 Classification of facial fractures0 Physiology of sight and occulomotor function0 Available techniques0 Anatomy of facial skeleton, teeth and supporting structures0 Dental occlusionClinical Skills0 General assessment of the traumatised patient0 Assessment and examination of patient with facial trauma0 Airway management and emergency treatment of facial trauma0 Ability to formulate a treatment plan and prioritise management0 Pain control /prevention of infection0 infiltration / nerve block anaesthesiaTechnical Skills0 Clinical examination of teeth, oral cavity, facial skeleton and cranial nerves0 Carry out of steps of procedure safely and correctly0 Techniques for removal of damaged teeth/retianed roots0 Techniques of exposure of fracture site(s) and bone manipulation0 Plate handling skills Page 43 of 117 © Copyright ISCP 2007
  44. 44. 0 Techniques of intermaxillary fixation0 Intra/extra-oral soft tissue handling and suturing techniquesProfessional SkillsNo contentFracture of mandibular condyleObjectiveTo be able to identify a patient who has sustained this injury.To be alert for the potential for this injury to occur.To undestand the principles of surgical management of this injury.To be able to carry out these procedures safely and competentlyKnowledge0 Anatomy of facial skeleton, TM joint, parotid gland, facial nerve0 Classification of condylar fractures0 Assessment of head injury and cranial nerve function0 Dental occlusion0 Selection and interpretation of relevant imaging0 Undestanding the benefits and indications of both open and closed treatments0 Potential complications long and short termClinical Skills0 Abilty to correctly interpret physical signs and relevant imaging0 Clinical examination of teeth, oral cavity, facial skeleton and cranial nerves0 Demonstrates clinical judgment appropriate to injury and patient needsTechnical SkillsClosed reduction:0 Carry out of steps of procedure safely and correctly0 Techniques for removal of damaged teeth / retained roots0 Techniques of intermaxillary fixationOpen Reduction:0 Carry out of steps of procedure safely and correctly0 Techniques for removal of damaged teeth / retained roots0 Techniques for exposure of fracture site and manipulation of condylar fragment0 Plate handling skills0 Techniques of intermaxillary fixationProfessional SkillsNo contentFracture of maxillaObjectiveTo be able to identify a patient who has sustained this injury.To be alert for the potential for this injury to occur.To undestand the principles of surgical management of this injury.To be able to carry out these procedures safely and competentlyKnowledge0 Anatomy of facial skeleton0 Classification of mid -facial fractures0 Bone healing0 Head injury and cranial nerve function0 Dental occlusion0 Available techniques e.g. open fixation, closed fixation techniques0 Potential complications0 Awareness of possibility of other associated fractures0 Understanding the role of the maxillofacial technicanClinical Skills0 Systematic clinical examination of teeth, oral cavity, facial skeleton and cranial nerves0 Interpretation of radiographs/scans0 Assessment of head injury and cranial nerve function0 Selection of treatment plan appropriate to the patients injury Page 44 of 117 © Copyright ISCP 2007
  45. 45. 0 An awareness of other factors affecting timing of surgery0 Involving the maxillofacial technican in treatment planningTechnical Skills0 Carry out of steps of procedure safely and correctly0 Techniques for removal of damaged teeth / retained roots0 Techniques for exposure of fracture sites and reduction of fragments0 Plate handling skills0 Techniques of intermaxillary fixation0 Techniques of cranio-maxillary fixationProfessional SkillsNo contentFracture of orbital floorObjectiveTo be able to identify a patient who has sustained this injury.To be alert for the potential for this injury to occur.To understand the principles of surgical management of this injury.To be able to carry out these procedures safely and competentlyKnowledge0 Anatomy and physiology of facial skeleton, orbit and contents0 Awarenss of head injury and cranial nerve function0 Potential for complications involving sight and early involvement where appropriate ofopthalmologists/orthoptists0 Surgical approaches to the orbit0 Available techniques for orbital wall reconstruction0 Potential complicationsClinical Skills0 Clinical examination of eyes, facial skeleton and cranial nerves0 Assessment of head injury and cranial nerve function0 Choice of appropriate surgical technique0 Interpretation of radiographs/scansTechnical Skills0 Carry out of steps of procedure safely and correctly0 Assessment of eye function0 Techniques for approach to orbital floor0 Safe exposure of fracture sites and reduction of fragments0 Bone grafting and plating skillsProfessional SkillsNo contentFractures of Naso-orbito-ethmoid complexObjectiveCan perform complete task without direct assistance of scrubbed trainer.Knowledge0 Anatomy of craniofacial skeleton, nasal bones, orbit and contents0 Classification of facial fractures0 Assessment of head injury and cranial nerve function0 Interpretation of radiographs/scans0 Available techniques0 Potential complications0 Anatomy of craniofacial skeleton, frontal bones, nasal bones, orbit and contents0 Anatomy and physiology of frontal sinus drainage0 Classification of frontal bone and facial fracturesClinical Skills0 Clinical examination of eyes, facial skeleton and cranial nerves0 Carry out of steps of procedure safely and correctlyTechnical SkillsFractures of naso-orbito-ethmoid complex: Page 45 of 117 © Copyright ISCP 2007
  46. 46. 0 Techniques for approach to naso-ethmoid complex0 Safe exposure of fracture sites and reduction of fragments0 Bone grafting and plating skillsFracture of frontal bones and craniofacial fractures:0 Techniques for approach to frontal bone fractures0 Safe exposure of fracture sites and reduction of fragments0 Management of frontal sinus involvement0 Bone grafting and plating skillsProfessional SkillsNo contentFracture of frontal bones and craniofacial fracturesObjectiveCan perform complete task without direct assistance of scrubbed trainer.Knowledge0 Anatomy of craniofacial skeleton, nasal bones, orbit and contents0 Classification of facial fractures0 Assessment of head injury and cranial nerve function0 Interpretation of radiographs/scans0 Available techniques0 Potential complications0 Anatomy of craniofacial skeleton, frontal bones, nasal bones, orbit and contents0 Anatomy and physiology of frontal sinus drainage0 Classification of frontal bone and facial fracturesClinical Skills0 Clinical examination of eyes, facial skeleton and cranial nerves0 Carry out of steps of procedure safely and correctlyTechnical SkillsFractures of naso-orbito-ethmoid complex:0 Techniques for approach to naso-ethmoid complex0 Safe exposure of fracture sites and reduction of fragments0 Bone grafting and plating skillsFracture of frontal bones and craniofacial fractures:0 Techniques for approach to frontal bone fractures0 Safe exposure of fracture sites and reduction of fragments0 Management of frontal sinus involvement0 Bone grafting and plating skillsProfessional SkillsNo content Page 46 of 117 © Copyright ISCP 2007
  47. 47. Facial painOro-facial painObjectiveTo be able to assess a patient presenting with pain either acutely or in the out-patientclinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 History of presenting conditions0 Signs and symptoms of common causes of oro-facial pain0 Differential diagnosis0 Investigations0 Methods of medical and surgical management0 Relevant pharmacology and therapeutics0 Understanding of various techniques of nerve blockade0 Understanding of relevant neurosurgical interventionsClinical Skills0 Abilty to elicit and interpret an accurate pain history0 Ability to examine0 Ability to formulate treatment planTechnical Skills0 Local anaesthetic techniques including nerve blocks0 Cryoblockade, neurolysis and surgical nerve disruptionProfessional SkillsNo contentTemporomandibular joint disordersObjectiveTo be able to assess a patient presenting with pain either acutely or in the out-patientclinicTo be able to formulate a differential diagnosis and an investigation and management planTo be able to treat the patient appropriately up to and including operative intervention ifappropriateTo be able to communicate the above information at the required level topatients/carers/other team membersKnowledge0 Signs and symptoms of TMJ dysfunction0 Differential diagnosis0 Investigations and radiographic interpretation0 Methods of medical and surgical management0 Relevant pharmacology and therapeuticsClinical Skills0 Abilty to take a comprehensive pain history0 Ability to examine TMJ and muscles of mastication0 Ability to formulate and instigate treatment plan0 Understanding of potential role of occlusionTechnical Skills0 Use of TENS devices0 Use of occlusal adjustment therapy0 Arthrocentesis, arthrograms and arthroscopy0 Open joint procedures e.g. disc plication, emminectomyProfessional SkillsNo content Page 47 of 117 © Copyright ISCP 2007
  48. 48. Peri-operative carePeri-operative careObjectiveTo ensure the trainee has reached a level of competence in peri-operative care. Thefollowing should apply to each of the procedures in the common conditions and operativeskills category.KnowledgePre-operative Care0 Indications for surgery0 Required preparation for surgery to include necessary pre-operative investigations0 Outcomes and complications of surgery0 Knowledge of the admission processIntra-operative care0 Anatomy to be encountered during procedure0 Steps involved in operative procedure0 Knowledge of alternative procedures in case of encountering difficultiesPost-operative care0 Potential complications of procedure0 Outcomes of procedure0 Likely post-operative progress from disease process and intervention0 Physiological and pathological changes in condition as a result of interventionClinical SkillsPre-operative care0 Synthesis of history and examination into operative management plan0 Ability to explain procedure and outcomes to patient and parents at an appropriate level0 To be able to take informed consent0 To construct an appropriate theatre list0 Where appropriate to communicate with relevant other members of the theatre teame.g. anaesthetist, scrub nurseIntra-operative care0 Appropriate use of assistance0 Communication with other members of theatre teamPost-operative Care0 Assessment of patient and physiological parameters0 Appropriate intervention to deal with changing parameters0 Communication skills for dealing with team members, patients and carers0 Ability to prioritise interventions0 Recognition of complications of procedureTechnical Skills0 Necessary hand-eye dexterity to complete procedureProfessional SkillsNo content Page 48 of 117 © Copyright ISCP 2007

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