craniofacial reconstructionI'm a bit curious as to what the pros and cons are of

[5150]

I'm a bit curious as to what the pros and cons are of doing craniofacial reconstruction through ENT versus plastics. Is the fellowship for craniofacial reconstruction right after the regular ENT residency? Can anyone shed some light on this for me? Is one pathway faster than the other? Training better in other versus the other?

Any information would be helpful, thanks.

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[5150]

Messed up the title... oops, sorry guys.

 

[vent]

I'm a bit curious as to what the pros and cons are of doing craniofacial reconstruction through ENT versus plastics. Is the fellowship for craniofacial reconstruction right after the regular ENT residency? Can anyone shed some light on this for me? Is one pathway faster than the other? Training better in other versus the other?

Any information would be helpful, thanks.

As far as I know you do Cranifacial fellowship after PS only. However you can do Head and Neck surgery after ENT or facial plastics after ENT, GS, PS.

 

[TheThroat]

Craniofacial is usu after PS. I have a buddy who will be doing a PS fellowship after oto residency, with the idea of eventually doing craniofacial surgery.

 

[maxheadroom]

It's more important to decide upon what general things you want to do. If you're really interested in craniofacial, Integrated Plastics is probably your best bet. More importantly, you need to figure out what things you really like doing. After interviewing plastics applicants for five years, I've recognized that very few people who say that they want to do Craniofacial actually go into it. There isn't that much demand for the pedi stuff. The adult craniofacial (panfacial fractures and orthognathic work) isn't compensated well at al. I've seen lots of people start residency saying, "I want to do craniofacial" and end up doing either micro or general plastics.

Decide if you like the general practice of Oto more or PRS and then you'll have a better idea about what you should do.

 

[toofache32]

...The adult craniofacial (panfacial fractures and orthognathic work) isn't compensated well at al....

Orthognathic surgery is generally fee-for-service (except cleft patients) and pays better than most people think. One of the private guys we rotate with gets $5000 per osteotomy, and he does 1-3 patients per week (usually double-jaw with 3- or 4-piece maxilla). The amount of pre-op planning and lab work is the biggest turn off and adds to the time. Facial trauma and orthognathics are bread and butter for oral & maxillofacial surgeons, I guess I never really considered it "craniofacial".

Are there really many plastic surgeons doing orthognathics these days? The big name guys at our Children's hospital do a few but it's usually just for distractor placement. There's one guy who will actually do an advancement sometimes, but he gets the orthodontist to do all his lab work and make his splints.

 

[maxheadroom]

True, not many craniofacial guys do orthognathics. I remember one PRS/Craniofacial surgeon that I met last year at ASPS who does do a fair amount of orthognathic surgery, but most of it was for post-traumatic malocculsions. The OMFS guys at my place barely do them anymore -- they say that insurance doesn't pay enough to make it worthwhile. I guess they don't get the fee-for-service that your guy does.

Also, I read a recent article (I think in PRS) that noted the decline in the number of major head and neck anomalies. While the authors didn't outright say it, the implication was that there are fewer anomalies because of obstetrical U/S picking up the anomalies, resulting in abortions.

Hey, anyone who can deal with the families of syndromic FLKs deserves a millions bucks and a Nobel Peace Prize. Just leave me to do upper extremity and general plastics any day of the week.

 

[gary_ruska]

Gary "Returning from Hiatus" Ruska here,

There was an interesting article about the decline in orthognathic surgical procedures in PRS:

Zins JE, Bruno J, Moreira-Gonzalez A, Bena J. Orthognathic surgery: is there a future? Plast Reconstr Surg. 2005 Oct;116(5):1442-50; discussion 1451-2.

 

[BlackSails]

Are there really many plastic surgeons doing orthognathics these days? The big name guys at our Children's hospital do a few but it's usually just for distractor placement. There's one guy who will actually do an advancement sometimes, but he gets the orthodontist to do all his lab work and make his splints.

I had orthognathic surgery, and the surgeons who did my surgery were actually dentists.

Also, I can vouch for the fact that they are very well compensated.

 

[toofache32]

I had orthognathic surgery, and the surgeons who did my surgery were actually dentists.

Also, I can vouch for the fact that they are very well compensated.

That's what I mean....oral & maxillofacial surgeons are dentists.

 

[ItsGavinC]

That's what I mean....oral & maxillofacial surgeons are dentists.

Liar.

 

[Moravian]

The reimbursments for any of the cranio or congential stuff is actually pretty good depending on where you practice. Where I am, the kids are either insured or on medicaid. The state reimburses us 120% of what medicaid pays. This includes all medicaid pediatric surgery.

I will agree that most of the orthognathic stuff (except for some of the distraction) is being done by the OMFS folks, and they do a damn fine job of it. In fact there are private OMF surgeons making a killing.

If you want to do craniofacial, plastics is the way to go. If you want facial plastic surgery, you can get there thru ENT. If you're only in this business to make money, you should pick another career.

--Moravian

p.s. For some reason, there's a program in Arkansas where most of the cleft stuff is being done by ENT. Go figure.

 

[Dr.Millisevert]

If you want to do craniofacial, plastics is the way to go.

If you want to do craniofacial: You need to complete a craniofacial surgery Fellowship.

This can be be done after either Plastics or OMFS. Either way you need the fellowship.

This is very similar to Hand recon: You need to do a fellowship and that can be done after either Plastics or Ortho.

 

[Antz002]

If you want to do craniofacial: You need to complete a craniofacial surgery Fellowship.

This can be be done after either Plastics or OMFS. Either way you need the fellowship.

This is very similar to Hand recon: You need to do a fellowship and that can be done after either Plastics or Ortho.

Do both of those: PS and OMFS, once subspecialized in craniofacial surgery get to do exactly the same stuff once they qualify?

 

[Dr.Millisevert]

Do both of those: PS and OMFS, once subspecialized in craniofacial surgery get to do exactly the same stuff once they qualify?

Yes. the craniofacial surgery training you receive during the fellowship is the same regardless of which background you come from and both are equally qualified to be able to manage the same types of cases within the scope of craniofacial.

Same could be said for Hand reconstruction. It doesn't matter if you've completed orthopedic or PRS training beforehand. After you complete a Hand Recon fellowship. As far as what is done for the hands.. both receive the same training and are equally as capable and use the same techniques
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