The Tamil Nadu Dr. M.G.R. Medical University Courses

M.D.S. (Oral & Maxillofacial Surgery)

Course Content:

The program outline addresses both the knowledge needed in Oral and Maxillofacial Surgery and allied medical specialties in its scope. A minimum of three years of formal training through a graded system of education as specified will equip the trainee with skill and knowledge at its completion to be able to practice basic oral and Maxillofacial surgery competently and have the ability to intelligently pursue further apprenticeship towards advanced Maxillofacial surgery. The topics are considered as under:-

• Basic sciences
• Oral and Maxillofacial surgery
• Allied specialties                          

Applied Basic Sciences:

A thorough knowledge both on theory and principles in general and particularly the basic medical subjects as relevant to the practice of maxillofacial surgery. It is desirable to have adequate knowledge in bio-statistics, Epidemiology, research methodology, nutrition and computers.

Anatomy

Development of face, paranasal sinuses and associated structures and their anomalies: surgical anatomy of scalp temple and face, anatomy and its applied aspects of triangles of neck, deep structures of neck, cranial and facial bones and its surrounding soft tissues, cranial nerves tongue, temporal and infratemporal region, orbits and its contents, muscles of face and neck, paranasal sinuses, eyelids and nasal septum, teeth, gums and palate, salivary glands, pharynx, thyroid and parathyroid glands, larynx, trachea and esophagus, congenital abnormality of orofacial regions, General consideration of the structure and function of brain and applied anatomy of intracranial venous sinuses; cavernous sinus and superior sagital sinus, Brief consideration of autonomous nervous system of head and neck, Functional anatomy of mastication, deglutition, speech, respiration and circulation. Histology of skin, oral mucosa, connective tissue bone, cartilage cellular elements of blood vessels, lymphatic, nerves, muscles, tongue, tooth and its surrounding structures.

Physiology

Nervous system-physiology of nerve conduction, pain pathway, sympathetic and parasympathetic nervous system, hypothalamus and mechanism of controlling body temperature; Blood-its composition hemostasis, blood dyscrasias and its management, hemorrhage and its control, blood grouping, cross matching, blood component therapy, complications of blood transfusion, blood substitutes, auto transfusion, cell savers; Digestive system composition and functions of saliva mastication deglutition, digestion, assimilation, urine formation, normal and abnormal constituents; Respiration control of ventilation anoxia, asphyxia, artificial respiration, hypoxia – types and management; CVS – cardiac cycle, shock, heart sounds, blood pressure, hypertension; Endocrinology-metabolism of calcium; endocrinal activity and disorder relating to thyroid gland, parathyroid gland, adrenal gland, pituitary gland, pancreas and gonads; Nutrition-general principles balanced diet. Effect of dietary deficiency, protein energy malnutrition, Kwashiorkor, Marasmus, Nutritional assessment, metabolic responses to stress, need for nutritional support, entrails nutrition, roots of access to GI tract, Parenteral nutrition, Access to central veins, Nutritional support; Fluid and Electrolytic balance/Acid Base metabolism-body fluid compartment, metabolism of water and electrolytes, factors maintaining hemostasis, causes & treatment of acidosis and alkalosis.

Biochemistry

General principles governing the various biological principles of the body, such as osmotic pressure, electrolytes, dissociation, oxidation, reduction etc; general composition of body, intermediary metabolism, carbohydrate, proteins, lipids, enzymes, vitamins, minerals and antimetabolites

General Pathology

Inflammation – Acute and chronic inflammation, repair and regeneration, necrosis and gangrene, role of component system in acute inflammation, role of arachidonic acid and its metabolites in acute inflammation, growth factors in acute inflammation role of NSAIDS in inflammation, cellular changes in radiation injury and its manifestation; Wound management – Wound healing factors influencing healing; properties of suture materials, appropriate uses of sutures; hemostasis – role of endothelium in thrombogenesis; arterial and venous thrombi, disseminated intravascular coagulation; Hypersensitivity; Shock and pulmonary failure: types of shock, diagnosis, resuscitation, pharmacological support, ARDS and its causes and prevention, ventilation and support, Neoplasm – classification of tumors, Carcinogens and Carcinogenesis, grading and staging of tumors, various laboratory investigation.

General Microbiology

Immunity, Hepatitis B and its prophylaxis, Knowledge of organisms, commonly associated with diseases of oral cavity, culture and sensitivity tests, various staining techniques-Smears and cultures, urine analysis and culture.

Oral Pathology and Microbiology

Developmental disturbances of oral and para oral structures, regressive changes of teeth, bacterial, viral, mycotic infection of oral cavity, Dental caries, diseases of pulp and Periapical tissues, physical and chemical injuries of oral  cavity, wide range of pathological lesions of hard and soft tissues of the orofacial regions like cysts, odontogenic infection, benign & malignant neoplasms, salivary gland diseases, maxillary sinus diseases, mucosal diseases, oral aspects of various systemic diseases & role of laboratory investigation in oral surgery.

Pharmacology and Therapeutics

Definition of terminology used, pharmacokinetics and pharmadynamic dosage and mode of administration of drugs, action and fate in the body, drug addiction, tolerance and hypersensitivity reactions, drugs acting on CNS, general and local anesthetics, antibiotics and analgesics, antiseptics, antitubercular, sialagogues, hematinics, anti diabetic, Vitamins A, B-complex, C,D,E,K

Computer Science

Use of computers in surgery, components of computer and its use in practice, principles of word processing, spreadsheet function database and presentations; the internet and its use. The value of computer based systems in biomedical equipment.

Oral and Maxillofacial Surgery

• Evolution of Maxillofacial surgery.
• Diagnosis, history taking, clinical examination, investigations.
• Informed consent/medico-legal issues.
• Concept of essential drugs and rational use of drugs.
• Communication skills with patients- understanding, clarity in communication, compassionate explanations and giving emotional support at the time of suffering and bereavement
• Principles of surgical audit – understanding the audit of process and outcome. Methods adopted for the same. Basic statistics.
• Principles of evidence based surgery- understanding journal based literature study; the value of textbook, reference book articles, value of review articles; original articles and their critical assessment, understanding the value of retrospective, prospective, randomized control and blinded studies, understanding the principles and the meaning of various Bio-statistical tests applied in these studies.
• Principles of surgery- developing a surgical diagnosis, basic necessities for surgery, aseptic technique, incisions, flap designs, tissue handling, hemostasis, dead space management, decontamination and debridement, suturing, edema control, patient general health and nutrition.
• Medical emergencies – Prevention and management of altered consciousness, hyper sensitivity reaction, chest discomfort, respiratory difficulty.
• Pre operative workup – Concept of fitness for surgery; basic medical work up; work up in special situation like diabetes, renal failure, cardiac and respiratory illness; risk stratification
• Surgical sutures, drains
• Post operative care- concept of recovery room care, Airway management, Assessment of Wakefulness, management of cardio vascular instability in this period, Criteria for shifting to the ward, pain management
• Wound management- Wound healing, factors influencing healing, basic surgical techniques, Properties of suture materials, appropriate use of sutures.
• Surgical Infections – Asepsis and antisepsis, Microbiological principles, Rational use of
• antibiotics, special infections like Synergistic Gangrene and Diabetic foot infection, Hepatitis and HIV infection and cross infection.
• Airway obstruction/management – Anatomy of the airway, principles of keeping the airway patent, mouth to mouth resuscitation, Oropharyngeal airway, endotracheal intubation, Cricothyroidectomy, Tracheostomy.
• Anesthesia – stages of Anesthesia, pharmacology of inhalation, intravenous and regional anesthetics, muscle relaxants.
• Facial pain; Facial palsy and nerve injuries.
• Pain control – acute and chronic pain, cancer and non-cancer pain, patient controlled analgesia
• General patient management – competence in physical assessment of patients of surgery, competence in evaluation of patients presenting with acute injury, particularly to maxillofacial region. Competence in the evaluation of management of patients for Anesthesia
• Clinical oral surgery – all aspects of dento alveolar surgery
• Pre-prosthetic surgery – A wide range of surgical reconstructive procedures involving their hard and soft tissues of the edentulous jaws.
• Temporomandibular joint disorders – TMJ disorders and their sequelae need expert evaluation, assessment and management. It is preferable to be familiar with diagnostic and therapeutic arthroscopic surgery procedures.
• Tissue grafting – Understanding of the biological mechanisms involved in autogenous and heterogeneous tissue grafting.
• Reconstructive oral and maxillofacial surgery – hard tissue and soft tissue reconstruction.
• Cyst and tumors of head and neck region and their management – including principles of tumor surgery, giant cell lesion of jaw bones, fibro osseous lesions of jaw.
• Neurological disorders of maxillofacial region-diagnosis and management of Trigeminal Neuralgia, MPDS, Bells palsy, Frey’s Syndrome, Nerve injuries
• Maxillofacial trauma – basic principles of treatment, primary care, diagnosis and management of hard and soft tissue injuries, Comprehensive management including polytrauma patients
• Assessment of trauma-multiple injuries patient, closed abdominal and chest injuries, penetrating injuries, pelvic fractures, urological injuries, vascular injuries.
• Orthognathic surgery – The trainee must be familiar with the assessment and correcting of jaw deformities
• Laser surgery – The application of laser technology in the surgical treatment of lesions amenable to such therapy
• Distraction osteogenesis in maxillofacial region.
• Cryosurgeries – Principles, the application of cryosurgery in the surgical management of lesions amenable to such surgeries.
• Cleft lip and palate surgery- detailed knowledge of the development of the face, head and neck, diagnosis and treatment planning, Current concepts in the management of cleft lip and palate deformity, knowledge of nasal endoscopy and other diagnostic techniques in the evaluation of speech and hearing, concept of multi disciplinary team management.
• Aesthetic facial surgery – detailed knowledge of structures of face & neck including skin and underlying soft tissues, diagnosis and treatment planning of deformities and conditions affecting  facial kin, underlying facial muscles, bone, eyelids, external ear etc., surgical management of post acne scaring, face lift, blepharoplasty, otoplasty, facial bone recountouring etc.
• Craniofacial surgery – basic knowledge of developmental anomalies of face, head and neck, basics concept in the diagnosis and planning of various head and neck anomalies including facial cleft, craniosynostosis, syndromes, etc., Current concepts in the management of craniofacial anomalies.
• Head and neck oncology – understanding of the principles of management of head and neck oncology including various pre cancerous lesions, Experience in the surgical techniques of reconstruction following ablative surgery.
• Micro vascular surgery.
• Implantology – principles, surgical procedures for insertion of various types of implants.
• Maxillofacial radiology/ radio diagnosis
• Other diagnostic methods and imaging techniques
  

Allied Specialties:

• General medicine: General assessment of the patient including children with special emphasis on cardiovascular diseases, endocrinal, metabolic respiratory and renal diseases, Blood dyscrasias • General surgery: Principles of general surgery, exposure to common general surgical procedures.
• Neuro – surgery: Evaluation of a patient with head injury, knowledge & exposure of various Neuro – surgical procedures
• ENT/Ophthalmology: Examination of ear, nose, throat, exposure to ENT surgical procedures, ophthalmic examination and evaluation, exposure to ophthalmic surgical procedures.
• Orthopedic: basic principles of orthopedic surgery, bone diseases and trauma as relevant to Maxillofacial surgery, interpretation of radiographs, CT, MRI and ultrasound
• Anesthesia: Evaluation of patients for GA technique and management of emergencies, various IV sedation techniques
  

Academic Clinical programme (applicable for all three years):

• Seminars to be presented & attended once in a week.
• Journal clubs (departmental and interdepartmental) to be conducted once in fifteen days.
• Departmental and interdepartmental discussions to be held once in a month.
• Minimum 2 scientific papers should be presented.
• Every candidate shall maintain a logbook to record his/her work or participation in all activities such as journal clubs, seminars, CDE programs etc. This work shall be scrutinized and certified by the head of the department and head of the institution and presented to the university every year
  

Year by Year Programme:

I Year

• First term
  • Dissection, basic sciences, basic computer sciences, exodontia, seminars on basic topics, selection of dissertation topic, library assignment topic, attending O.T and ward rounds, preparation of synopsis and its submission within the six months after admission to the university as per calendar of events.
    
• Second term (rotation and postings in other department):
  • Oncology - 2 months
  • Emergency - 1 month
  • General medicine - 15 days
  • General surgery/anesthesia - 15 days
  • Ophthalmology - 15 days
  • Neurology - 15 days
  • ENT - 15 days
  • Orthopedic - 15 days
  • Examination of basic sciences – one paper of three hours duration to be conducted by the college
    

II Year

• Minor oral surgery and higher surgical training
• Submission of library assignment by the end of first term
• Examination on minor oral surgical procedures - one paper of three hours duration to be conducted by the college.
  

III Year

• Maxillofacial surgery, submission of dissertation in the first term, i.e. six months before the final examination to the university. Examination of three hours duration three months before the final examination to be conducted by the college. It is desirable to enter general surgical skills and operative procedure that are observed, assisted or performed in the log book in the format as given by RGUHS in the revised ordinance governing MDS degree course.
  

Final examination at the end of the third year.