The Clinical Observership Program: A Valuable Experience for Oral & Maxillofacial Surgery Residents.

PURPOSE: Training during oral and maxillofacial surgery residency must include exposure to the scope of the specialty, but success in practice often requires particular experience and knowledge of complex oral regenerative procedures such as bone grafting and implant surgery, as well as practice management. Osteo Science Foundation created the Clinical Observership Program (COP) in 2017 to provide residents the opportunity to spend several weeks in an established oral and maxillofacial surgery practice to increase experience in these areas. The purpose of this study is to report the results of a survey of all resident participants in the COP from 2017 to 2021 in which participants were asked to rate their experience numerically. MATERIALS AND METHODS: This is an institutional retrospective case series completed via an electronic survey sent to all participants in the COP from 2017 to 2021. The primary outcome is the subjective assessment of the COP based on six questions in which the respondent was asked to rate the program on a scale of 1 to 10 (10 being best). Categories included: 1) Did the program achieve expectations? 2) Was adequate time spent with the mentor? 3) Did you observe/participate in a variety of procedures? 4) Did the mentor provide additional didactic education? 5) Did you learn about practice management? and 6) How would you rate the overall experience? Descriptive statistics including mean score and standard deviation of each question were calculated, and no other covariates were analyzed. RESULTS: All 55 participants in the COP from 2017 to 2021 were contacted and 55 complete responses were received. The overall mean score for all categories rated by the residents was 9.63, the mean rating for questions 1 to 6 were 9.55, 9.89, 9.21, 9.60, 9.69, and 9.86 respectively, and the range of scores was 7 to 10. CONCLUSION: Overall, residents rated the COP experience highly. This survey indicates that the COP is a valuable supplemental experience in oral and maxillofacial surgery resident education.

Safe, efficient, and cost-effective orthognathic surgery in the outpatient setting.

There has been a dramatic decline in the number of orthognathic surgery cases over the past 15 to 20 years. This decrease is a result of several compounding factors including decreasing coverage by major medical insurance companies and increasing health care costs. The difficulty associated with making orthognathic surgery financially practical has turned the interest of many oral and maxillofacial surgeons away from orthognathic procedures. The combination of these factors has resulted in decreased availability of surgeons participating in the correction of dentofacial deformities and has forced orthodontists and patients, without surgical correction as an option, to settle for less-than-ideal treatment results. To reverse this trend and make surgery more affordable and available, surgeons must work to make surgical treatment more acceptable to patients. This can be accomplished in several ways. First, the oral and maxillofacial surgery profession must reinforce the importance and value of orthognathic surgery to insurance providers, patients, and referring clinicians, as well as to surgeons within our own specialty. Alternative methods for providing high-quality surgical services at a reasonable cost must be explored including providing options for cost-effective outpatient surgical care, making better arrangements for financial assistance, and exploring options to obtain coverage from third-party providers. Outpatient surgery in facilities that can substantially reduce cost can be an effective way of providing quality treatment that is affordable to patients. Efficient, safe, and effective outpatient orthognathic surgery will help patients benefit from this valuable service.

Orthognathic surgery in the office setting.

The delivery of care by oral and maxillofacial surgeons is becoming more challenging because of escalating health care costs and limited reimbursement from insurance providers. The changing health care landscape forces surgical practices to be flexible and adaptive to change in order to remain viable. The delivery of surgical services continues to evolve as care traditionally performed in a hospital environment is now routinely achieved in an outpatient setting. Outpatient facilities can aid in controlling the perioperative costs associated with orthognathic surgery. Safe and efficient orthognathic surgery completed in the office can aid in controlling the escalation of health care costs.

Virtual surgical planning in orthognathic surgery.

Computer-aided surgical simulation has greatly enhanced the efficiency and accuracy of orthognathic surgery for correction of dentofacial deformities. Virtual surgical planning (VSP) improves the efficiency of the presurgical work-up and provides an opportunity to illustrate the multidimensional correction at the dental and skeletal level. VSP provides preoperative insight into the surgical intervention and the fabrication of cutting jigs/guides and templates can help decrease intraoperative surgical inaccuracies. VSP is rapidly becoming the standard of care for surgical treatment planning of dentofacial deformities.

Complications in orthognathic surgery: a report of 1,000 cases.

The authors review complications by studying those that occur in the preoperative, intraoperative, and postoperative phases of treatment. One thousand consecutive patients who underwent orthognathic surgery performed by the senior author over a 5-year time period were evaluated. These cases included 337 mandibular osteotomies, 274 maxillary osteotomies, and 389 combined osteotomies. A precise breakdown of the procedures is provided. Reviewing these cases provides a better understanding of the most common complications, management of these situations, and resolution of the complications.