Head and Neck Oncologic Surgery
Some members of the American Academy of Craniomaxillofacial Surgery emphasize the surgical management of malignant tumors of the head and neck within their practice. Most AACMFS members who are active in this area have completed one-to two-year fellowships or have undertaken other training beyond residency in oral and maxillofacial surgery (OMFS). Some OMFS who practice within this area involve themselves only in cancer of the mouth, jaws and salivary glands, often referred to as MORS, or Maxillofacial Oncologic and Reconstructive Surgery. Others choose the wider field commonly termed Head and Neck Surgery, which encompasses management of malignant and benign tumors from the orbit, ethmoid and frontal sinus region all the way to include the larynx, thyroid and parathyroid. The field of Head and Neck Surgery is shared with colleagues based in otolaryngology, general surgery and plastic surgery.
Reconstruction is an intrinsic part of this area of practice and many OMFS who engage in this practice have also been trained in microvascular surgery and the use of microvascular free flaps to reconstruct complex defects resulting from tumor ablation. Reconstructive surgery is a core element of OMFS and microvascular reconstructive surgery takes this a step forward. The transfer of vascularized bone from the fibula, iliac crest and other sites can be optimally aligned to restore jaw and facial bone architecture, often with the aid of preoperative computer virtual planning, to allow placement of dental implants at the time of tumor resection and reconstruction. A reconstructive surgeon who is also an oral and maxillofacial surgeon brings a special and unique skill set to the head and neck cancer patient.
The training of OMFS who deal with malignant disease also includes training in medical oncology – chemotherapy as well as radiation. This enables them to optimally coordinate the involvement of these disciplines in the overall management of the cancer patient. Active involvement in a multidisciplinary tumor board is an integral part of this area of practice.