Oral and Jaw Surgery Curriculum

The Egyptian Fellowship Board

Oral and Jaw Surgery Curriculum

Preface

T he Egyptian Fellowship Board and the Oral and Jaw surgery scientific council worked col-

laboratively to make this curriculum available for trainees’ guidance and support.

Postgraduate medical education world wide are now governed by sets of academic standards that

describe the qualities and abilities of graduates. In addition, there are standards for the training

processes , trainers’ selection and methods of assessment. standards ensure transparency and

clarify expectations.

The Egyptian fellowship board had defined and published its standards for the general and profes-

sional competencies expected from our graduates in different specialties upon successful comple-

tion of training. These expectations are reflected in the oral and Jaw surgery curriculum.

The curriculum describes what trainees will know and be able to do upon completion of training.

In additions, methods of teaching and learning needed to deliver the curriculum are listed . The

curriculum also describes in details, expectations from trainees during their rotations in “The

training rules and regulations section”. Methods of assessment and examination regulations are

also available in the last section of the curriculum.

All topics covered during practical and theoretical studies are outlined. This will help trainees to

guide their readings and their choice of learning activities. To help our trainers, supervisors and

maximize benefits, we provided a guide for required lectures at various training stages. Mandatory

courses are also mentioned in the logbook and the Egyptian Fellowship Board will work closely

with the oral and Jaw surgery scientific council to ensure proper organization and implementation

of courses at appropriate training stages.

We strongly advise our trainees and trainers to refer on regular basis to the Egyptian Board web-

site for new updates on curriculum, training, assessment and electronic learning opportunities

We hope that all our trainees, trainers and educational supervisors will follow the guides provided

in the curriculum and cooperate with The Egyptian Fellowship Board and Oral and Jaw surgery Sci-

entific Council to implement the curriculum in the best ways. Esmat Ahmed Sheba

Secretary General

Higher Committee of Medical Specialties

Acknowledgement

This curriculum has been created through collaboration between The Oral and Jaw surgery

Scientific Council and The Egyptian Fellowship Curriculum Committee. The following mem-

bers of the Oral and Jaw surgery Scientific Council have made substantial contribution to

the curriculum development as subject matter experts

The Egyptian Fellowship Curriculum Committee has made significant contribution to The

curriculum through Collaboration with the council in the design and formulation of the educa-

tional structure. The Member who participated in The work is

The Committees consulted international and national curricula in oral and Jaw

surgery. The external references for the development of this curriculum are:

1. The maxillofacial curriculum approved by the Joint Royal Colleges of Sur-

geons Training Board 2007

2. The previous Egyptian Board curriculum in Oral and Jaw Surgery

3. The Egyptian Board Guidelines for curriculum development 2007

4. Postgraduate Medical Education and Training Board UK (Guidelines for

curriculum development 2006)

The curriculum then has been revised and approved by the Oral and Jaw Sur-

gery Scientific council at May 2008

Professor Dr Emad Yusuf, Senior Consultant of oral and Jaw surgery El Sahel

Teaching hospital

Professor Dr Emad Tawfeek Mahmoud, Professor of oral and Jaw surgery, Cairo

University

Associate Professor Dr Ghada Mohammed Anwar , Associate Professor of Pediatric

endocrinology and Educational expert at the Medical Education Development Cen-

tre, Faculty of medicine, Cairo University

Oral and Jaw Surgery Egyptian Fellowship Board

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

6

Oral and Jaw Egyptian Fellowship Board

7

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

CONTENTS………………….

The Structure of Oral and Jaw Surgery...…...….….. 9

Trainees duties and obligations ……………..….…... 11

General rules and regulations……………………….. 13

Rational statement……………………...…………… 14

Curriculum aim…………………………………….... 14

Intended learning outcome………………….……… 15

Basic Surgical Skills and Knowledge…………………… 16

First part syllabus 20

Oral and jaw surgery intended learning outcomes 24

Key Clinical Cases …………………………………... 41

Key Lectures in Oral and Jaw Surgery……………... 44

Surgical Procedures and Levels of Competency 47

Methods of teaching and training 55

Methods and regulations of assessment…………….. 57


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

8


9

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Important notice

before Trainees must pass successfully all the foundation courses

Full information about .being promoted to the second year of training

foundation courses is available at the EF website and administration office.

The structure of Oral and Jaw

Surgery Training Program

The Egyptian Fellowship Board requires five years of supervised training program

that must be conducted in accredited hospitals before sitting for the final examina-

tion. It also requires the presentation of a review article on a subject approved by

the supervisors. A list of accredited hospitals will be announced yearly by the

board. During the entire training program, the candidate must be dedicated full time

and must be responsible for patient care under supervision. The program has the

following requirements for trainees who are affiliated to MOHP:

1. Graduation from dental school and successful completion of the pre-

registration house officers' year.

2. Enrolment in the Ministry of health and population residency program as

oral and jaw surgery resident.

3. Trainees who finished their master degree in oral and jaw surgery will join

the program from the third year and are exempted from the first part exam.

It is to be noted that this rule only applies for those who get their master

degree within five years, otherwise they must resite for the first part exam.

4. Trainees who finished their oral and jaw surgery diploma might join the

program from its second year. However, they must sit for the first part

exam.

The trainees should spend the first two years of training in oral and jaw surgery

practice and emergency department. During this period, they will work as full time

residents

During the third and fourth years of training, trainees must get experience in differ-

ent medical and surgical specialties mentioned in the curriculum. The training cen-

ters should have these specialties’clinics and operative services that ensure full cov-

erage of all cases and operative procedures mentioned in the curriculum.

First and Second years

Third and fourth years


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

10

The trainees will have rotations in different medical and surgical specialties as

follows:

Rotation The determined

duration

(months)

Expected cases

Orthopedic surgery 3 Bone grafting

Neurosurgery 1 Multiple trauma, head injury

Plastic surgery 6 Cleft lip, cleft palate, wound closure,

skin graft and flaps

General surgery 3 Poly-traumatized patients

ENT 1 Tracheostomy, O.A.F operation

General medicine 2 Medical diseases related to oral and

jaw surgery.

Anesthesia and ICU 4 CPR, management of bleeding and

syncope, intubations (nasal and oral)

Pediatric and genetic

department 1 Pediatric and genetic diseases related

to oral and jaw surgery

Dermatology 1 Dermatological diseases of dental

interest.

The rotations will be on part time basis depending upon the predetermined ar-

rangement between the trainers and other specialties. Trainees shall spend two

or three days in the rotation and the rest of the week in the oral and jaw surgery

services

Rotation will be either in or outside the campus depending on presence of

accredited centers. There will be weekly assignments at ER depending on the

hospital’s rules and regulations.

It is to be noted that those with oral and jaw surgery diploma will spend the first

2 years in oral and jaw surgery practice, then 1 year in different rotation

specialties, and the final year back to oral and jaw surgery practice; while those

with master or MD degrees in oral and jaw surgery will spend the first year in

oral and jaw surgery practice, then 1 year in different rotation specialties, and

the final year back to oral and jaw surgery.

The fifth year of the training should be spent in the oral and jaw surgery practice, so

that the trainees would have chances to apply what they learnt in the previous year.

Their obligations, duties and responsibilities will be matching their experience, level

of training, and available supervision.

The fifth year


11

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Trainees' duties and obligations

1. Trainees must attend at least 75% of lectures on surgical subjects.

2. They should be actively involved and fully responsible for patient care includ-

ing sharing in the decision making about diagnosis and management under su-

pervision of the consultant.

3. They must attend 75% of weekly meeting including clinical rounds, tutorials,

journal clubs and morbidity and mortality meeting.

4. Their performance will be monitored and evaluated by trainers and a report will

be issued on monthly basis to the Egyptian Fellowship Board.

5. All trainees will work as residents in the training specialty and they must fulfill

all residents' jobs defined by supervisors and trainers.

6. They should be responsible under supervision for outpatients and inpatients rou-

tine care and must take supervised shifts according to hospital regulations.

a. The trainee will be responsible for supervised admission of patients from the

outpatient department or emergency room.

b. He will share in the completion of the following documents under supervision

for each case:

Complete history and physical examination form.

Investigation requests, (laboratory, radiology, pathology, etc.).

Documentation of results of the investigations.

Plan of management.

Preoperative assessment and preparation.

Operative consent and invasive procedure consent.

Operative records.

Postoperative orders.

Daily progress notes.

Orders and medication sheets

Orders of the necessary diagnostic procedures

Discharge summaries.

Sick leaves and medical reports.

The trainee should inform the senior staff of any high risk patient admission

During the hospital rotations

1. The admitted patients:


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

12

The trainee should attend the outpatient clinics related to the rotation and its sub-

specialties as requested by trainers and supervisory staff.

He should also attend operative sessions in outpatients.

The trainees must attend and participate in the mandatory academic and clinical ac-

tivities of the department. Attendance and participation should not be less than 75%

of the total number of activities within any training rotation / period including.

Daily morning endorsement meetings.

Clinical round

Journal club meeting.

Surgical morbidity/mortality meetings and audit sessions.

The trainees shall be required to keep a Logbook where they record all activities and

skills performed and learned during the training program. The activities should be

dated and categorized to whether been performed by the trainee him/herself or as an

assistant or participant. Each activity registered in the Logbook should be counter

signed by the trainer and finally the educational supervisor. The Trainer and educa-

tional supervisor shall sign the completed Logbook.

The trainee shall write one review article during the training program under the

guidance and supervision of the trainer. Such review article should be written,

discussed and accepted before the trainee is accepted for admission to the final

certifying examination.

The trainee should have completed satisfactorily the rotations described in the

structure of the program and performed him/herself and assisted in the various

requested procedures and operations.

3. Mandatory clinical and academic activities:

2. The outpatients' clinics:

4. The log book:

5. The review article:

Before the completion of the training program:


13

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

General rules and regulations

a. Holidays and on call duties

b. Evaluation procedures

According to Ministry of Health and Population regulation

Performance of the trainee shall be evaluated on regular and continuous basis, the

evaluation process should involve all aspects of the training including theoreti-

cal, clinical and operative procedures skills as well as his attendance and partici-

pation.

The trainers who are required to write confidential reports of the performance of

each trainee should evaluate the trainee periodically. The trainee should not be

allowed to proceed in the training program and move to the next stage of training

unless he/she attains a satisfactory level of performance acceptable to the respon-

sible trainer and educational supervisor.

The trainee shall not be allowed to proceed to year 3 before successfully passing

the first part Exam

It is not permissible to interrupt such a structured training program except in major

unavoidable circumstances. Such circumstances should be convincing and approved

by the Secretary General. The Interruption once approved should not be for more

than one year. Interruption of the training program for more than one year shall re-

sult in dismissal from the program and cancellation of the preceding training period.

Interruption of training


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

14

The Rationale Statements

The purpose of this curriculum is describe the knowledge, skills, behaviors and atti-

tudes expected from oral and jaw surgeon upon completion of training in Egyptian

Fellowship for oral and jaw surgery. The curriculum also describes the methods of

teaching and learning that will be used to facilitate the delivery of curriculum. In

addition, it highlights the different methods of trainees’ performance evaluation that

are going to be used whether formative or summative.

The curriculum contents have been delivered through the following methods:

1. Revision of previous fellowship curriculum

2. Revision of international curricula for postgraduate training in oral and jaw sur-

gery. We specifically mention the maxillofacial curriculum approved by the

Joint Committee on surgical training and PMETB 2007

3. Consultation of experts in the field of oral and jaw surgery and other related spe-

cialties. Experts were consulted regarding their vision for oral and jaw surgery

practice in Egypt and how international standards would fit. We also consulted

them regarding the level of knowledge and skills required in each training year

and in each specialty while putting in mind expected practice constrains.

4. The curriculum then was re-revised by representative members from the oral and

jaw surgery scientific council and approved by the council in April 2008.

Aims of the Oral and Jaw Surgery Fellowship training

To provide the trainees with the knowledge, and skills which enable him/her to

identify, assess and manage common and important oral and jaw surgical prob-

lems, whether elective or emergent.

To enable the development and application of appropriate professional attitudes,

ethical principles and communication skills necessary for safe and effective

practice in the field of oral and jaw surgery

Curriculum aim


15

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Intended Learning Outcomes

Generic Surgical Skills and Knowledge

1. Basic sciences

By the end of this module the trainee will be able to discuss the following topics in

the following basic sciences:

Applied anatomy: Development, organs and structures, surface and imaging

anatomy of head and neck as appropriate for surgical operations.

Physiology: Homeostasis, thermoregulation, metabolic pathways, blood loss,

sepsis, fluid balance and fluid replacement therapy, and metabolic abnormali-

ties.

Pathology: Inflammation, wound healing, cellular injury, vascular disorders,

disorders of growth differentiation and morphogenesis as related to oral and

jaw surgery.

Microbiology: Surgically important microorganisms, sources of infection,

asepsis and antisepsis, sterilization, antibiotics, high risk patient management.

Pharmacology and therapeutics: pharmacological basis of antimicrobial

agents, analgesics, local anesthetic agents.

Radiology: Principles of diagnostic and interventional radiology as it applied

to the field of oral and jaw surgery.

Knowledge


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

16

By the end of this module, the trainee will be able to outline the principles and per-

form competently without assistance the following surgical techniques:

Incision and closure of skin and subcutaneous tissue.

Knot tying.

Hemostasis: control of bleeding vessel.

Tissue retraction.

Use of drains: insertion, fixation, and removal.

Tissue handling

Take surgical history and examination (elective and emergency).

Construct a differential diagnosis.

Plan for appropriate investigations.

Plan initial and subsequent management

Take consent from patients for all types of invasive interventions

By the end of training, the trainee will be able to discuss the following topics:

Preoperative assessment and management including, cardio-respiratory

risk and diseases, diabetes mellitus, renal failure, blood loss, sepsis and other

risk factors for surgeries

Intraoperative care including, safety in theatre , sharps safety, diathermy,

laser use, infection risks, radiation use and risks, tourniquets, principles of

local, regional and general anesthesia.

Postoperative care.

Blood Products: use and complications.

Use of antibiotics , common pathogens in surgical patient, antibiotic

sensitivities, antibiotic side-effects, principles of prophylaxis and treatment.

3. The Assessment and Management

of the Surgical Patient

4. Peri-operative care

Knowledge

Clinical skills

2. Basic surgical skills


17

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

By the end of the course, the trainee will be able to perform competently the

following:

Preoperative assessment and management: history and examination,

interpretation of preoperative investigations, management of co-morbidities in

collaboration with colleagues from other medical and surgical specialties

Resuscitation according to the principles of fundamental life support

Safe conduct of intraoperative care.

Postoperative care: postoperative analgesia, fluid and electrolyte

management, monitoring of patient, detection and initial management of

impending organ failure and shock.

Use of blood products and Appropriate prescription of antibiotics.

Consult medical and surgical specialties appropriately and when indicated

Communicate effectively with patient, relatives and other staff members.

Clinical skills

Professional Skills


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

18

5. Bleeding diathesis

Clinical Skills

Recognize abnormal bleeding during surgery.

Perform corrective measures, e.g. warming, packing.

Discuss coagulation: clotting mechanism, effect of surgery and trauma on

coagulation.

List methods of investigation for suspected thrombo-embolic disease.

Describe various treatment modalities including prophylaxis.

By the end of the course, the trainee will be able to:

Recognize patients at risk and take prophylactic measures.

Diagnose, investigate, initiate and monitor treatment of coagulation disorders.

List effects of malnutrition, both excess and depletion.

Discuss methods of screening and assessment.

Recognize the need for and arrange access to artificial nutritional support, via a

nutrition team: enteral and parenteral.

6. Venous thrombosis and embolism

Knowledge

Clinical skills

7. Nutrition

Knowledge

Clinical skills


19

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

By the end of the training, the trainees will be able to discuss the pathophysiology,

clinical presentation, surgical impact of:

Thyrotoxicosis.

Hypothyroidism.

Hypercalcemia.

Cortico-steroid therapy.

Diabetes Mellitus.

Hyponatremia.

Trainees must be able to recognize the previous conditions in the peri-operative

period and consult appropriate medical and surgical specialties regarding their

management.

8. Endocrine and Metabolic Disorders

Knowledge

Clinical skills


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

20

First part Syllabus for oral and jaw surgery

1. Anatomy

Knowledge

Clinical skills

The trainee should be able to describe the embryology and applied surgical anatomy

of the following :

Skull, brain and cranial cavity.

Orbit and eye.

Nose and paranasal sinuses.

Facial musculature/soft tissues.

Temporomandibular joint and infratemporal fossa

Functional anatomy of the TMJ.

Oral cavity, teeth and supporting structures, pharynx.

Mandible and maxilla.

Larynx, trachea, neck and thoracic inlet.

Blood supply to skin, fascia, muscle and bone of the head and neck:

Regional anatomy relevant to bone grafts and common pedicled/free flaps.

Apply the previous knowledge appropriately in the clinical setting.

The trainee will be able to discuss the following:

Metabolism and functions of the oral mucosa and connective tissues of the oral

cavity.

Calcium/phosphorus metabolism:

Mineral, calcium and phosphates metabolism.

Composition and metabolism of bone and teeth.

Mechanisms of calcification.

2. Physiology

Knowledge


21

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Bone growth and remodelling:

Mechanisms of osteogenesis, ossification and bone growth.

Bone remodeling.

Mechanisms of tooth eruption:

Normal and abnormal tooth eruption.

Salivary glands and saliva

Composition and functions of saliva and mechanism of salivation.

Importance of saliva in relation to oral disease.

Immunology and defense mechanisms of the mouth:

Mechanical, chemical, immunological and hormonal factors protecting the

oral cavity.

Properties and functions of the muscles of mastication.

Taste and olfaction.

Control of deglutition, and dysphagia.

Effects of dietary deficiencies and hormonal imbalances on the oral and jaw

health

Age changes in the oral structures.

Physiological responses to surgical treatment:

Physiology of stress.

The anxious patient.

Vasovagal reactions, hyperventilation and arrhythmias.

Wound healing.

Oro-facial pain:

Sensory innervation of the head and neck.

Referred pain.

Apply these knowledge appropriately in the clinical setting.

The trainee will be able to discuss the pathology of the following:

Inflammation and inflammatory reaction

pathological basis for the immune response.

Hyperplasias, hamartomas, and neoplasms of soft tissues and bones.

Benign epithelial tumors of the mucosa and skin.

Clinical skills

3. Surgical Pathology

Knowledge


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

22

Potentially malignant and malignant epithelial tumors of the mucosa and skin:

Mechanisms of growth, malignant transformation and metastasis.

Tumor staging.

Effects of radiation and osteoradionecrosis.

Benign soft tissue tumors of mesenchymal origin.

Malignant soft tissue tumors of mesenchymal origin:

Mechanisms of tumors initiation and growth, malignant transformation.

Tumors staging.

Non-neoplastic salivary gland diseases.

Salivary gland neoplasms: metastasis, and staging.

Odontogenic and non-odontogenic cysts.

Odontogenic tumors, hamartomas and neoplasms.

Pigmented lesions of the skin and mucosa: normal and abnormal pigmentation.

Fibro osseous diseases and systemic diseases affecting bone.

Benign and malignant neoplasms of bone:

Mechanisms of tumor initiation, growth, and metastasis.

Tumor staging.

The immune system: Hypersensitivity, tissue grafts and autoimmunity.

Trauma:

Hemorrhage and shock.

Edema.

Fever and hypothermia.

Prepare and preserve pathological specimens.

Apply previous knowledge appropriately in the clinical setting.

The trainee will be able to outline the following:

The principles of drug prescription.

Drug interactions, and adverse reactions.

Differences in drug therapy in different age groups and pregnancy .

Drug therapy of systemic disease relevant to oral and jaw surgical practice .

Clinical skills

4. Clinical pharmacology

Knowledge


23

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Relief of pain and anesthesia:

Mechanism of action and practical use of analgesics.

Treatment of intractable pain (e.g. in terminal care).

Local and general anesthetics.

Drug dependence and abuse.

Principles of cancer chemotherapy and immunosuppression.

Applying this knowledge appropriately in the clinical setting.

The trainee will be able to outline the following:

Classification and pathogenesis of micro-organisms.

Antimicrobial chemotherapy: spectrum of activity, principles of clinical use,

antibiotic resistance.

The immuno-compromised patient:

Causes and related conditions.

Specific precautions and management protocols.

Septicemia:

Clinical features and causative organisms.

Investigation and antimicrobial treatment.

Opportunistic and fungal infections:

Diagnosis and treatment.

Specific infections of the head and neck:

Odontogenic infections.

Infections of the paranasal sinuses.

Osteomyelitis.

Tissue space infections and skin infections.

Necrotizing fasciitis.

Infective endocarditis:

Clinical features and predisposing factors.

Investigation, Treatment and prophylaxis.

Hospital acquired infection.

Principles of disinfection and sterilization

Applying this knowledge appropriately in the clinical setting.

Clinical skills

5. Clinical Microbiology

Knowledge

Clinical skills


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

24

The trainee will be able to discuss:

The signs and symptoms, differential diagnosis, investigations and radiographic

interpretation.

The methods of medical management including treatment of inflammation/

infection.

The relevance of endoscopic examination of maxillary antrum.

The indications and techniques of oro-antral communication.

The presentation and management of cystic lesions of the jaw.

The potential complications including management of compromised airway.

At the end of training, trainees must be able to:

Formulate treatment plan.

Treat/drain infection and/or remove tooth.

Manage compromised airway (surgical airway).

Recognize and initiate management of systemic sepsis (sepsis syndrome).

Recognize infection as an early indicator of immuno suppression e.g. diabetes.

Institute aftercare.

The trainee will be able to perform competently:

Surgical extraction of unerupted/impacted teeth and roots:

Local anesthetic and sedation techniques.

Treat/drain infection and/or remove tooth.

Techniques of bone removal and tooth division.

Intra-oral suturing techniques.

Dentoalveolar pathology

Knowledge

Clinical skills

1. Impacted Wisdom Tooth, Dental Extrac-

tions and Unerupted Tooth

Technical Skills

Oral and Jaw Intended Learning Outcomes


25

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

2. Oro-antral communication/

root in Maxillary antrum


Closure of oro-antral communication:

Techniques of local flap closure.

Techniques of antral exploration / lavage.

Antrostomy.

Removal of retained root or dental fragment from maxillary antrum

Endoscopic examination of maxillary antrum .

Intra-oral suturing techniques .


Apical surgery / excision of jaw cyst.

Techniques of exposure, bone removal and enucleation of pathology.


Excision / biopsy of benign oral soft tissue / hard tissue lesion:

Techniques of incisional / excisional biopsy.

Local flap closure.

Control of hemorrhage.

Technical Skills

3. Prominent lingual / labial frenum

Technical Skills

4. Jaw Cysts

Technical Skills

5. Benign oral soft tissue/hard tissue lesion

/Abscess/Infection

Technical Skills


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

26

Trainee will be able to discuss

Etiological factors, differential diagnosis and investigations.

Possible relationship to systemic disease.

Signs of malignant disease.

Examine the oral mucosa.

Perform biopsy/cytology techniques.

Interpret results.

Carry out steps of procedure safely and correctly including harvesting pathol-

ogically appropriate specimen.

Discriminate between those who need surgery or not.

Trainees will be able to discuss:

Causes of swelling of head and neck and methods of their investigations.

Potential complications.

Relevance to immunocompromized state.

Principles of medical and surgical management.

Techniques of surgical and non-surgical airway management.

Examine the head, neck and salivary glands.

Recognize infections specific to the head and neck.

Treat acute infected swelling.

Drain facial abscess

Oral mucosal lesions

Knowledge

Clinical skills

Technical Skills

Oral ulceration and leukoplakia

Infections of the Head and Neck

Knowledge

Clinical skills


27

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Technical Skills


Drainage of tissue space infection.

Surgical access to airway ( assist in Tracheostomy / cricothyroidotomy):

Exposure and access to airway.

Placement and securing of tube in airway.

Trainee will be able to discuss:

Classification of dental trauma and dento-alveolar fractures.

Classification of condylar fractures.

Classification of mid-facial fractures.

Signs and symptoms of fractures of facial skeleton.

Clinical manifestations of lacrimal/parotid duct injury and appropriate investi-

gations.

Assessment of airway and level of consciousness (Glasgow coma scale).

Eyes/ears assessment.

Assessment of head injury and cranial nerve function.

Relevant investigations and radiographic interpretation.

Management/prevention of unfavorable scarring.

Prevention and treatment of infection.

Principles of stenting of lacrimal/parotid duct.

Benefits and indications of both open and closed treatments.

Surgical approaches to the orbit.

Available techniques for orbital wall reconstruction.

Assess traumatized patient.

Assess patient with facial laceration (s)/trauma.

Recognize involvement of other anatomical structures e.g. nerves, parotid duct

Examine eyelids and lacrimal apparatus.

Examine oral cavity, facial skeleton and cranial nerves.

Prioritize management (airway management/emergency treatment of facial

trauma.

Infiltration/ nerve block anesthesia.

Cranio Maxillofacial Trauma

Knowledge

Clinical skills


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

28

The trainee will be able to perform:

Repair of facial laceration (s):

Management of contaminated wound, thorough debridement.

Management of laceration involving key structures or tissue loss.

Management of nerve/parotid duct injury.


Use of loupes / operating microscope.

Surgical repair under magnification.

Stenting of the duct.


Techniques of preservation of damaged teeth, reduction and fixation.


Manipulation of nasal bones and septum.

Management of epistaxis.

Nasal packing and external splint.

1. Facial Lacerations

Technical Skills

2. Lacrimal/Parotid duct injury

Technical Skills

3. Dental Trauma and dento-alveolar fractures

Technical Skills

4. Nasal Fractures

Technical Skills


29

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….


Basic ophthalmic and orthoptic assessment.

Techniques of exposure of fracture site (s) and bone manipulation.

Plate handling skills.

Soft tissue handling and suturing techniques.


Techniques of inter-maxillary fixation.


Closed reduction:

Techniques of inter-maxillary fixation.

Open Reduction

exposure of the fracture site and manipulation of condylar fragments.

plate handling skills.


Techniques of cranio-maxillary fixation.

5. Fractured Zygoma

Technical Skills

6. Fracture of mandible (excluding condyle)

Technical Skills

7. Fracture of mandibular condyle

Technical Skills

8. Fracture of maxilla

Technical Skills


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

30

The trainee will be able to assist in :

Assessment of eye function.

Techniques for approach to orbital floor.

Safe exposure of fracture sites and reduction of fragments.

Bone grafting and plating skills.

The trainee will be able to assist in :

Techniques for approach to naso-ethmoid complex, and frontal bones fractures.

Safe exposure of fracture sites and reduction of fragments.

Bone grafting and plating skills.

Management of frontal sinus involvement.

trainee will be able to discuss:

Signs and symptoms of common causes of oro-facial pain and required

investigations.

Methods of medical and surgical management.

Various techniques of nerve blockade relevant to oral and jaw surgical interven-

tions.

9. Fracture of orbital floor

Technical Skills

10. Fractures of Naso-orbito-ethmoid complex,

frontal bones and craniofacial fractures

Technical Skills

1. Oro-facial pain

Facial pain

Knowledge


31

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

(Intra-capsular TMJ and condylar head pathology/recurrent

dislocation/ankylosis/disc displacement/reconstruction of TMJ)

Elicit and interpret an accurate pain history.

Examine patient.

The trainee will be able to perform

Local anesthetic techniques including nerve blocks.

Cryo blockade, neurolysis and surgical nerve disruption.

trainee will be able to discuss:

Signs and symptoms of TMJ dysfunction.

Causes of TMJ/capsular/meniscal pathology.

Investigations and radiographic interpretation.

Indication for joint replacement and reconstruction.

Methods of medical and surgical management.

Indication for open surgery.

Examine TMJ and muscles of mastication.


Use of occlusal adjustment therapy.

Arthrocentesis, arthrograms and arthroscopy.

Open joint procedures e.g. disc plication, eminectomy.

Approaches to the TMJ and mandibular condyle.

Harvest of costochondral graft.

2. Temporomandibular joint disorders

Clinical skills

Technical Skills

Knowledge

Clinical skills

Technical Skills


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

32

Trainee will be able to explain

Pre-operative Care

Necessary pre-operative investigations.

Outcomes and complications of surgery.

Intra-operative care

Knowledge of alternative procedures in case of encountering difficulties.

Post-operative care

Potential complications of procedure.

Likely post-operative progress from disease process and intervention.

Pre-operative care

Take history and perform examination for operative management plan.

Explain procedure and outcomes to patient and caregivers at an appropri-

ate level.

Take informed consent.

Intra-operative care

Communicate with other members of theatre team.

Post-operative Care

Assess the patient and physiological parameters.

Use communication skills for dealing with team members, patients and

carers.

Recognize different complications of the procedure.

Trainee will be able to outline:

Causes of intermittent/persistent swelling of neck.

Relevant investigations.

Methods of medical and principles of surgical management.

Knowledge

Clinical skills

Knowledge

Peri-operative care

Salivary glands/ Neck swellings


33

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Take and interpret medical history for patients with neck swelling.

Examine the neck and salivary glands.

Treat acute infected swelling.

Drain neck abscess.


Drainage of tissue space infection:

Exposure and exploration of tissue space (s).

Collection of samples.

Securing appropriate drains and dressings.

Cervical node biopsy:

Localization of mass and dissection.


Excision of mucocele of lip / labial gland biopsy.

Sublingual gland excision:

Intra-oral dissection.

Identification and protection of submandibular duct/lingual nerve.

The trainee will be able to:

Remove stone from submandibular duct:

Expose submandibular duct and do safe retrieval of stone.

Perform intra-oral soft tissue dissection and suturing techniques.

Clinical skills

1. Neck swellings

Technical Skills

2. Mucous Cyst of Sublingual Salivary Gland/ Ranula

Technical Skills

3. Stone Retrieval

Technical Skills


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

34

4. Obstructive/inflammatory disease of submandibular gland

Technical Skills

Trainee will be able to perform competently:

Submandibular gland excision:

Identification and protection of facial nerve..

Dissection of gland and ligation of duct.

Trainee will be able to perform competently:

Excision of neoplasm of minor salivary gland:

Biopsy techniques.

Excision and local flap repair.

Sublingual gland excision:

Identification and protection of submandibular duct/lingual nerve.

Submandibular gland excision:

Identification and protection of facial nerve.

Dissection of gland and ligation of duct.

trainee will be able to outline

Etiological factors and differential diagnosis.

Specialized investigations.

Interpretation of radiographs / scans.

Common access techniques to oral and jaw cancers.

Common excisional techniques for orofacial cancer including conservation

surgery.

Requirements for functional rehabilitation.

5. Neoplasm of Minor Salivary

Glands (sublingual/ submandibular)

Technical Skills

Head and Neck Cancer

1. Oro-Pharyngeal Cancer

Knowledge


35

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Take history and examine the patient with oral and jaw cancer.

Formulate treatment plan.

Carry out appropriate surgery according to competency.

Perform post-operative care and follow-up.

Demonstrate ability to function as part of a multidisciplinary team .


Biopsy techniques, incisional FNA TruCut.

Excision of Oral or Jaw Malignancy:

Sharp and blunt dissection of soft tissues.

Osteotomy technique and plate handling skills.

Safe isolation of tumor.

Preservation of vital structures.


The skin age changes.

The etiology and pathology of common skin cancers.

The principles of wound healing.

The techniques of skin excision and closure.

The common reconstructive skin procedures e.g. skin grafts, local flaps.

2. Skin Cancer

Knowledge

Clinical skills

Technical Skills


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

36

trainee will be able to outline:

Etiological factors.

Specialized investigations.

Classification of malocclusion/deformity.

Perform orthognathic surgery techniques.


Norms of facial proportions.

Classification and assessment of facial deformity.

The psychological impact of facial deformity.

Techniques of cephalometric analysis.

Take history and perform examination of the patient with facial deformity.

Perform different Orthognathic surgery techniques according to the level of

training.

Trainee will be able to perform:

Approaches to the anterior mandible

Identification and protection of mental nerves.

Safe use of power tools.

Plating and fixation skills.

Developmental/acquired deformity of facial skeleton

Knowledge

Facial Deformity

Technical Skills

Genioplasty/ Mandibular ramus osteotomy/

Maxillary osteotomy/ Zygomatic osteotomy

Knowledge

Orthognathic Surgery

Clinical skills

Technical Skills


37

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Approaches to the mandibular ramus

Identification and protection of key structures.

Intermaxillary fixation techniques.

Approaches to the maxilla.

Approaches to the zygoma.

Trainee will be able to outline

Advantages/disadvantages of different sites.

Surgical approaches to different sites.

Intraoral and extraoral donor sites.

Risks and complications of procedure.

Techniques of bone graft harvesting e.g. open versus closed, use of bone

trephines.

Selection of appropriate anesthetic technique.

Choose site appropriate for graft of required size/type.

Care of bone graft prior to fixation.

Safe harvesting of graft of appropriate size/type.

Repair of donor site.

Insetting and fixation of graft to recipient site.


Techniques of local flap design and use.

The principles of skin tension lines.

1. Harvest of bone graft (non-vascularized bone grafts)

Knowledge

Reconstructive Surge

Clinical skills

Technical Skills

2. Local Skin Flaps

Knowledge


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

38

Select the most appropriate flap.

Utilize the principles of skin tension lines to the advantage of the surgical repair.

Trainee will be able to perform:

Raising, mobilizing and insetting local flap.

Tissue handling and suturing techniques.


Indications for different types of flap.

Limitation of techniques .


Raising of pedicled cutaneous, muscle and myocutaneous flaps.

Insetting of flap.

Management of donor site and closure.

Management of complications.


Principles of microvascular anastomosis.

Limitation of techniques.


Raising of soft tissue and composite flaps.

Insetting of flap.

Use of operating microscope and loupes.

Preparation of donor and recipient vessels.

Arterial and venous microvascular anastomosis.

Management of donor site and closure.

Clinical skills

Technical Skills

4. Free tissue transfer

Knowledge

Technical skills

3. Pedicled flaps

Knowledge

Technical skills


39

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Scar Revision / Z-plasty

Knowledge

Aesthetic Surgery

Clinical skills

Technical Skills


Psychology of body dysmorphopsia and post-traumatic stress.

Techniques of scar revision and disguise.

Techniques of non surgical scar modification.

Carefully select patient..

Tissue handling and suturing techniques.


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

40


41

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Key Clinical Cases

for

Oral and Jaw Surgery

Training Program


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

42


43

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

At the end of the program, the trainees should competently assess and

manage (including operative management) patients with the following

clinical presentations:

Cases/ Condition Cases/ Condition

Dental trauma and dento-alveolar

fracture Dentoalveolar pathology:

Facial pain and neuralgia Exodontias

Temporomandibular joint

disorders: Oroantral fistula

Myofascial dysfunction syndrome Root in maxillary antrum

Internal derangement Preprosthetic surgery

Ankylosis Jaw cysts and related structures

Condylar hyperplasia Oral and paraoral cysts

TMJ dislocation Benign and malignant oral soft

tissue/hard tissue lesions:

Salivary gland swellings: Soft tissue tumors of the tongue,

lips, soft palate

Stones

Hard tissue tumors of jaw (benign

and malignant) including odonto-

genic tumors.

Cysts Abscess/ infection:

Tumor Dentoalveolar abscess

Sialadenitis Facial space infections

Neck swellings Oral mucosal lesions:

Facial deformities Oral ulcers, white patches, and oral

pigmentations.

Cleft lip and palate Irregularities of the dentoalveolar

ridges/ ebulus (mucosal swellings).

Micro and macrognathia Cranio-Maxillo-Facial Trauma:

Open bite deformities Zygomatic complex

Prognathism Fracture middle third of the face

Facial asymmetry Fracture mandible

Long face syndrome and other

oro-facial and cranial syndromes. Facial lacerations

Key Clinical Cases for Oral and Jaw Surgery Program


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

44

Lectures of the first year of the training program (Basic

Sciences):

Embryology of the maxillofacial region

Innervation and blood supply of the head and neck (cranial nerves anatomy)

Musculoskeletal anatomy of the face

Applied incisions of the face (2 hr)

Fluids and electrolytes balance

Calcium, phosphorus and bone metabolism

Blood products transfusions

Interpretation of important laboratory tests

Cardiovascular physiology and ECG interpretation

Principles of immunology

Hormones of maxillofacial interest

Systemic diseases in relation to oral surgery and oral manifestations of systemic

diseases

Inflammation and infections

Hyperplasia, hamartomas, and neoplasm (benign and malignant)

Bone diseases affecting maxillofacial region

Salivary glands (anatomy, physiology, pathology )

Endocrine glands

Hemorrhage and shock

Antimicrobial therapy in oral and jaw field

Local anesthesia and pain killers

Interactions between systemic drug administration and oral and jaw practices

Key Lectures in Oral and Jaw Surgery

Anatomy

Physiology

Surgical pathology

Clinical pharmacology


45

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Principles of disinfection and sterilization in maxillofacial practice.

Lectures for the rest of the training program:

Oral and Jaw cysts (pathology and management)

Impacted and unerupted teeth/exodontia

Oro-antral communication and maxillary sinus

Management of benign and malignant tumors of oro-Maxillo-facial region

Oral ulceration and white patches

Oral and jaw Infections

Repair of soft tissue lacerations

Management of fractures of facial bones

Oro-facial pain

Temporomandibular joint (disorders and fractures)

peri and post-operative care

Disorders of salivary glands

Neck swellings

Facial deformities (congenital and acquired)

Orthognathic surgery

Reconstructive surgery (soft and bony tissue)

Esthetic surgery

Prosthetic surgery and dental implantology.

Clinical microbiology


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

46


47

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Oral and Jaw Surgical

Procedures

with Levels of

Competency


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

48


49

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Procedure Name O A Ps Pi

Apicectomy 5 5 10

Apical curettage 1 2 2

Enucleation/ Marsupialization of cyst 1 2 2

Expected year of achievement 2nd -3rd year

Expected rotation: oral and jaw surgery.


Simple extraction of maxillary and mandibular teeth

10 30 50

Multiple extraction 1 3 10

Surgical extraction 5 10 30

Expected year of achievement 1st -5th year


Level of competency:

O: observation

A: Assistance

Ps: Supervised performance

Pi: Independent performance

2. Simple and surgical extraction

3. Endodontic surgery

1. History and clinical examination (100 case)


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

50


Removal of salivary gland stones and cyst 2 4 4

Removal of tumors 1 2 2



4. Salivary gland surgery

5. Surgical management of infection


Abscess drainage 2 4 10

Facial space 1 1 5

Others 1 1 3

Bone sequestrectomy 1 1 3

Expected year of achievement 1st — 5th year


6. Maxillary antrum surgery


Caldwell Luc. 1 1 1

Antrostomy 1 1 1

Removal of tooth from antrum 1 1 1

Closure of antral fistula 2 2 2


Expected rotation: oral and jaw surgery and ENT.


51

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….


Gingivectomy 1 2 2

Repositioned flap 1 1 1

Gingivoplasty 1 1 1

Mucosal graft 1

Bone regeneration technique 1

Expected year of achievement 1st -3rd year.


7. Periodontal surgery

8. Skin surgery


Excision and primary closure 1 1 2 1

Skin graft 1 1 2 1

Skin biopsy 1 2 2 5

Expected year of achievement 2nd -5th year


9. Intraoral soft tissue surgery


Biopsy 1 2 2 5

Removal of soft tissue tumor 1 2 2 2

Expected year of achievement 2nd-5th year



…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

52

10. Local anesthesia


Infiltration 1 50

Nerve block 1 50

Field block 1 10

Expected year of achievement 1st-5th year


11. Jaw osteotomies


Mandibular osteotomy 2 2 1

Maxillary osteotomy 1 1 1

Mandibular distraction 1 1

Maxillary distraction 1 1

Bone graft 2 2

Expected year of achievement 3rd-5th year



Inter-maxillary fixation 2 2 3 10

Open reduction and rigid fixation 2 2 2 5

Other means of fixation 2 2 2

Expected year of achievement 2nd-5th year


12. Oral, Jaw and Mandibular trauma


53

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

13. Mid-face trauma


Suspension 2 2 2 4

Open reduction and rigid fixation 2 2 2 2

Others 2 2 2 2



14. Prosthetic surgery


Frenectomy 1 1 1 4

Vestibuloplasty 2 2 2 2

Maxillary tuberosity reduction 2 2 2 2

Removal of hyperplastic tissue 2 2 2 2

Removal of bone exostosis 2 2 2 2

Insertion of dental implants 2 2 2




Arthrocentesis 2 2 2

Dislocation 2 2 2 5

Subluxation ( Diagnosis) 2 2 2

Surgical treatment of ankylosis 2 2

Management of internal derangement 2 2 2



15. Temporomandibular joint procedures


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

54

16. Facial surgery


Face lift 1 1

Revision of scar 3 2 2 2

Dermabrasion 3 3


Expected rotation: plastic surgery.

17. Facial deformity surgery


Cleft lip 2 2 1

Cleft palate 2 2 1

Others 1 1


Expected rotation: plastic surgery / Oral and Jaw surgery

18. Emergency procedures


Tracheotomy 1 1 1

Tracheostomy 1 1

Control of hemorrhage 1 2 2 5


Expected rotation: ER and ENT surgery.


55

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

The following methods of teaching and learning will be used in the fellowship of

oral and jaw surgery training program:

- Apprenticeship learning during surgical work (experiential learning):

a) Observation

b) Assisting

c) Participation

d) Supervised Performance

e) Independent Performance

- Formal Teaching:

a) Lectures

b) Seminars

c) Clinical ward rounds

d) Crash courses

e) Workshops

- Self-study:

a) Library

b) Textbooks

c) Journals

d) Internet

- Meetings and Conferences

- Supervised Research

Teaching and learning methods


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

56


57

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

Methods and Regulations

of Assessment


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

58

The general rules and regulations of assessment approved by the Egyptian fellowship

board and published at the training handbook and at the board web site applies for the

oral and jaw surgery specialty. In addition to the successful completion of the training

program, all candidates must successfully pass three exams in order to get the fellow-

ship certificate “Fellowship of the Egyptian Board of Oral and Jaw Surgery”.

The first part exam is a written exam. Trainees are allowed to sit for the first part

exam after at least six months of training. Each candidate has three chances to pass

the exam and one more additional chance may be granted in some special circum-

stances approved by the secretary general of the higher committee of medical special-

ties.

It is to be noted that after one year of training each time the candidate choose not

to enter the exam will be calculated as one of his three attempts.

The second part exam is a written exam. Trainees are allowed to sit for the second part

exam after passing successfully the first part and after completion of the five-year

training period. In addition, each candidate must submit his log book for final as-

sessment. The log book requirements must all be completed and signed by the

trainer and educational supervisor. The candidate will also submit his review article

before the final exam. This review article should be approved by the trainer. Each

candidate has three chances to pass the exam and one more additional chance may

be granted in special approved circumstances.

First part Exam

Pre-requisites for entering the first part exam

Trainees should pass the following courses in order to be eligible for

the first part exam

1. Local TOEFEL with a score of at least 500

2. Computer courses in word processing, power point and internet

Second part exam


59

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

The third part exam is a clinical, practical and oral exam. Candidates who pass suc-

cessfully the second part are allowed to sit for the third part. Again each candidate

has three chances to pass the clinical exam and an additional fourth chance may be

granted in special approved circumstances.

Holders of the master degree are exempted from the first part exam,

provided that no more than five years have passed since they got their

master degree.

aims to test trainee's knowledge in basic science as it applies to the oral and jaw sur-

gery practice (basic sciences mentioned in the curriculum).

PART I examination consists of two papers:

1. Paper I (2 hours): Multiple choice questions with a single best answer format.

2. Paper II (2 hours): short answer and /or problem solving questions.

aims to test trainees' knowledge, interpretative and patient’s management skills. In

this exam all the curriculum will be covered.

1. Two MCQ papers each two hours in duration. In both papers, facts, problem

solving, and patient’s management skills are going to be assessed. You will

choose one best answer in each question.

2. Two short assay papers each two hours in duration. They cover all subtopics

listed in the curriculum. Questions will assess Trainees' knowledge about various

oral and jaw surgical diseases and their management.

The third part exam

The structure of the examination

The first part exam

The structure of the first part exam

The Second part exam

The structure of the second part exam


…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

…………………….

60

It is the final certifying examination in Egyptian fellowship training program in oral

and jaw surgery. Part III exam is a clinical, practical, and oral exam:

The clinical exam remains the most important part of the examination as the long

case evaluates the potential performance of the candidate in oral and jaw surgery

practice while short cases assess clinical examination and history taking skills in

various problems. Passing this component of the exam independently is essential for

certification.

The date and place of the clinical examination will be announced by the Egyptian

Fellowship Board

1. Long Clinical Case : the candidate is observed in silence for the first part of the

examination by two examiners where he/she is taking the history from the patient

and performing physical examination and then the examiner asks him to present the

findings in history and examination and discuss his plan of management of the case.

Marks are given according to the predetermined weighting of the components of the

exam.

2. Short Clinical Case: each candidate examines two patients. The examiners

evaluate his ability to correctly elicit and interpret physical signs or his ability to

take focused clinical history. An agreed marking system is used to ensure objectivity

and fairness of the exam.

3. VIVA (the oral exam): the oral exam will follow the clinical exam and consists

of one station with three examiners, three topics will be covered, one by each exam-

iner, and the whole duration of the oral exam is 20 min.

4. OSPE (Objective Structured Practical Examination) is a multiple station ex-

amination consists of 15-20 OSPE stations, each station will focus on one of the fol-

lowing topics:

Radiological interpretation.

Instruments.

Problem solving and interpretation of investigations.

Medical ethics.

Infection control.

Photos.

Each station will be designed and approved by three examiners. The model an-

swer to each question in these stations will be approved by all examiners.

The third part exam

The structure of the third part exam

Clinical exam

Documents

Oral and Jaw Surgery Curriculum