Making of a perfectionist maxillofacial surgeon – path and ways

Abstract

Oral and maxillofacial surgery is an upcoming super specialty caters to all disorders affecting the face, mouth and jaws also head and neck, in a specialized way. The surgical specialist must have the knowledge of Dentistry as well as medicine. The surgical procedures are often challenging, difficult to execute, take long hours and often require delicate post-surgical care. Being complex anatomically and functionally has morbidity if not dealt with utmost artistry and skills. Operating surgeon should have aesthetic sense to get acceptable facial shape, scars, and balance also working physiology. The expanding horizon of maxillofacial field mainly microvascular reconstruction including dynamic reconstructions, correction of craniofacial anomalies, patient-specific implants in 3D reconstruction of craniofacial complex and temporomandibular joint reconstruction, navigation surgeries of skull base, stem cell-based tissue engineering have added new dimensions toward the treatment with perfection. Technology mainly in the form of 3D printing, navigation as well as software-based innovations will lead the way toward perfection in the results. What does the perfection mean to me is getting the outcome of surgery absolute close to the original anatomy, working physiology, desirable esthetics, longevity without recurrent issues, non-morbid as well as financially viable. The dictionary meaning of the perfectionist is the person who strives for the highest standards of excellence in the work. In the surgical perspective, perfection has some important angles like punctual diagnosis of the disorder, planning and execution of the plan, skill of the operating surgeon. Diagnosis of the disorder is based on the knowledge of the subject, which is achievable, planning could be formula based with the added element of the individual experience while surgical skills are person based, their dimensions are changed with the experience and honing. Basic training and exposure of the surgical procedure plays the vital role in the mastering the procedure. It is like seeing the procedure, assisting the procedure followed by doing it under the guidance then doing by yourself. This gives the base line result or the optimum result, perfection will start creeping slowly when the same procedure is done multiple times with true critic like evaluation of your technique related to ease of performing, fineness of the technique, time duration of the procedure, complications, and remedy for the same also modifications in the procedure. Watching the same procedure done by the other surgeon from the same specialty or also from the overlapping specialty will also add to the true evaluation of the individual surgical skills. True learner is like a sponge, imbibes whatever comes to him and implements further. It is wisely said that learning is a continuous process required in perfection. At the individual level, maxillofacial surgeon can choose the trade of the maxillofacial surgery for example may be Trauma, Oncology, Reconstruction, Orthognathic surgery, Implantology, and so on. Put the desired efforts to excel and perfect, this can help him to concentrate on the limited domain leading to the perfection. Lot has been said about the educational training pattern for the maxillofacial surgery mainly for the Indian stature. I personally feel dual qualification like in the UK is ideal for learning this complex specialty. In India, tailored Medical and Dental qualification can be designed. Exposure to the allied specialties like Otolaryngology, Plastic surgery, Neurosurgery, and General Oncology is like adding spice to the knowledge. Maxillofacial surgeon needs to have different physical, mental, and emotional mind set as most of the surgical procedures are often critical, critical anatomically, prolonged duration and with the high rates of complications, life-threatening situations, the best example is the head and neck oncology with microsurgical reconstruction. Teamwork can share the pressure reducing the duration of the procedure and everyone in the team is assigned a particular job. Individual and exclusive institutes of maxillofacial surgery are the need of the time this will uplift the image of the specialty in the masses. The public perception of the maxillofacial surgery in the society in India is still that of the Dental surgeon. Majority of them are not aware about the current spectrum of the maxillofacial surgery which has gone up to the head and neck surgery including microsurgical reconstruction. Maxillofacial surgeon can do unique work in the field of Cleft Lip-palate, CLP deformity right from the primary repairs, secondary corrections, Orthognathic surgery, Distraction osteogenesis till Rhinoplasty as a single surgeon. Perfection can make maxillofacial surgeon stand differently in the crowd as compared to the overlapping super specialties like Plastic surgery, Oncology, Otolaryngology. This means doing the same surgery with different sense of esthetics for example scars of oncologic resection. Perfection is not expected to peep in immediately but would require years of experience, skills, knowledge, attitude, constant desire to refine, consistent working, upgrading, accepting new challenges, building of a dedicated team, and many more characteristics. Perfection is often a long journey and a destination far …… but achievable.