Comparison of the aesthetic surgery curriculum for oral and maxillofacial surgery, plastic surgery, and otorhinolaryngology training in Germany

P. Pitak-Arnnop

doi:10.1016/j.bjoms.2020.01.018

Letter to the Editor| Volume 58, ISSUE 3, P372-374, April 2020

Comparison of the aesthetic surgery curriculum for oral and maxillofacial surgery, plastic surgery, and otorhinolaryngology training in Germany

P. Pitak-Arnnop
P. Pitak-Arnnop
Correspondence
Corresponding author at: Sektion Plastische, Rekonstruktive, Ästhetische und Kiefer-Gesichtschirurgie (Büro 1.0G/BT6/1.31), Unfallklinik, Ortenau Klinikum Offenburg-Kehl, Ebertplatz 12, 77654 Offenburg, Germany. Tel.: +49 781 472 3601, Fax: +49 781 472 3604.
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Affiliations
Division of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Department of Trauma Surgery, Ortenau Medical Centre Offenburg-Kehl — Academic Teaching Hospital of University of Freiburg, Offenburg, Germany
Department of Oral and Maxillofacial Surgery, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany
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Published:February 28, 2020DOI:https://doi.org/10.1016/j.bjoms.2020.01.018

The recent article by Awal et al

¹

Awal D.H.
Walker T.W.
Mills C.

Review of the Intercollegiate Surgical Curriculum Programme for oral and maxillofacial surgery aesthetics: are we underselling ourselves?.

in this journal triggered me to share some information. In Germany, there is also huge variation in the aesthetic surgery curriculum among oral and maxillofacial surgery (OMFS), plastic surgery, and otorhinolaryngology (ORL). The recent study by Momeni and colleagues

²

Momeni A.
Goerke S.M.
Bannasch H.
et al.

The quality of aesthetic surgery training in plastic surgery residency: a survey among residents in Germany.

showed the lack of aesthetic surgery training in plastic surgery residency in Germany. This situation is similar for German OMFS training. Although OMFS trainees stay in their department for the entire training period, the Medical Council of every German State has no requirement for aesthetic surgery for the German Board of OMFS Examination (Table 1). The German Sub-board of Facial Plastic Surgery is awarded for OMF or ORL surgeons with facial plastic surgery fellowship for at least two years. However, some OMFS/ORL surgeons have never done a facelift, even though they are entitled to hold a Diploma of the German Board of Facial Plastic Surgery. It may be because many cosmetic surgical patients in this country visit their surgeon in private clinics rather than in university or public hospitals. Facial plastic surgery in Germany is, therefore, directed towards cleft-craniofacial surgery and facial reconstructive surgery after trauma or treatment for tumours.

Table 1Operative requirements for the German Boards of Oral-Maxillofacial Surgery (OMFS), Otorhinolaryngology (ORL), Facial Plastic Surgery, and (General) Plastic Surgery according to the German Law on Postgraduate Medical Education (adapted from “Weiterbildungsordnung 2003 in der Fassung vom 25.06.2010”; “Richtlinien, in der Fassung vom 18.02.2011”).

OMFS * All cases must be performed by the resident or fellow himself/herself. (5 years)	ORL (5 years)	(General) Plastic Surgery (6 years)
- Ultrasonography of the head and neck (≥ 200 cases) - Local and regional anesthesia (≥ 50 cases) - Infusion, blood transfusion, enteral and parenteral nutrition (≥ 50 cases) - Punction and insertion of catheters (as many cases as possible) - Tracheostomy (≥ 10 cases) - Dentoalveolar procedures (≥ 200 cases) - Head and neck infections, including sinus and salivary gland surgery (≥ 100 cases) - Maxillofacial trauma (≥ 100 cases) - Cleft-craniofacial surgery (≥ 10 cases) - Orthognathic surgery, including craniomaxillofacial distraction osteogenesis (≥ 10 cases) - Preprosthetic surgery, including dental implantology (≥ 25 cases) - Head and neck tumor surgery (≥ 50 cases) - Surgery of peripheral nerves in the facial region (≥ 10 cases) - Plastic and reconstructive surgery of the head and neck (≥ 25 cases) - Microsurgical anastomosis (≥ 10 cases) - Laser therapy (≥ 20 cases)	- Ultrasonography of the head and neck (≥ 200 cases) - Local and regional anesthesia (≥ 50 cases) - Infusion, blood transfusion, enteral and parenteral nutrition (≥ 50 cases) - Punction and insertion of catheters (as many cases as possible) - Audiological examinations (≥ 200 cases) - Neuro-otological examinations (≥ 200 cases) - Speech tests (≥ 25 cases) - Ventilation tests, including rhinomanometry, spirometry and spirography (≥ 50 cases) - Smell and taste tests (≥ 10 cases) - Microscopic and endoscopic examinations, including rhino-, antro-, nasopharyngo-, trachea- and esophagoscopies (≥ 500 cases) - Swallowing tests (≥ 20 cases) - Management of tracheal canulae and oro-/nasogastric tubes (≥ 100 cases) - Allergy test (≥ 200 cases) - Desensitization (≥ 25 cases) - Ear surgery (≥ 50 cases) - Surgery of the nose, paranasal sinuses and facial soft tissue (≥ 50 cases) - Plastic and reconstructive surgery of the nose and ears (≥ 25 cases) - Plastic and reconstructive surgery of the pharynx (≥ 100 cases) - Plastic and reconstructive surgery of the larynx and airway, including tracheostomy (≥ 50 cases) - Tracheobronchoscopy (as many as possible) - Plastic and reconstructive surgery of the neck (≥ 10 cases) - Surgery of salivary glands and ducts (≥ 25 cases) - Surgery for sleep apnea (≥ 10 cases) - Head and neck trauma (≥ 25 cases) - Laser therapy (≥ 20 cases) - Assisting on difficult procedures, e.g. microsurgical ear surgery, resection of invasive head and neck tumors, endoscopic ethmoidectomy, pansinus surgery, microsurgical anastomosis (≥ 100 cases)	- Ultrasonography in surgical and trauma patients (≥ 50 cases) - Local and regional anesthesia (≥ 50 cases) - Infusion, blood transfusion, enteral and parenteral nutrition (≥ 50 cases) - Punction and drainage (≥ 10 cases) - Insertion of central venous catheters (≥ 25 cases) - Ambulant surgery (≥ 50 cases) - Assisting on difficult plastic surgery (≥ 50 cases) - Identification and observation of physical therapy measures (as many as possible) - Plastic and reconstructive surgery of the head and neck (≥ 25 cases, which include at least 10 cosmetic surgeries of the nose, ears, skin and eyelids) - Plastic and reconstructive surgery of the back and breast (≥ 100 cases, which include at least 25 cosmetic breast surgeries) - Hand surgery (≥ 100 cases) - Plastic and reconstructive surgery of the ligaments and tendons (≥ 25 cases) - Plastic and reconstructive surgery of the skin and subcutaneous tissues, including blood vessels (≥ 50 cases) - Primary management of burn (≥ 25 cases) - Intensive burn care (≥ 25 cases) - Plastic and reconstructive surgery for burn defects (≥ 50 cases) - Medical documentation for occupation-related injuries, accidental heath insurance and courts (≥ 25 cases)
Facial Plastic Surgery * All cases must be performed by the resident or fellow himself/herself. (≥ 2 years after OMFS or ORL)
Total cases: ≥ 200 cases, which include - Plastic dentoalveolar/periodontal surgery (≥ 10 cases) - Reconstructive surgery after head and neck infections (≥ 10 cases) - Reconstructive surgery after maxillofacial trauma (≥ 25 cases) - Reconstructive surgery after head and neck tumor surgery (≥ 25 cases) - Cleft-craniofacial surgery (≥ 25 cases) - Temporomandibular joint surgery or orthognathic surgery (≥ 25 cases) - Preprosthetic surgery with/without dental implants (≥ 10 cases) - Surgery of peripheral nerves and blood vessels in the head and neck region, including microsurgical anastomosis (≥ 10 cases) - Cosmetic facial surgery (≥ 10 cases)	Total cases: ≥ 200 cases, which include - Reconstructive surgery of head and neck anomalies, including cochlear implants (≥ 50 cases) - Management of trauma and infections in the head and neck region (≥ 50 cases) - Reconstructive surgery after trauma and tumor surgery with local, regional and free flaps, or multiple skin grafts (≥ 50 cases) - Surgery of peripheral nerves and blood vessels in the head and neck region, including microsurgical anastomosis (≥ 10 cases) - Cosmetic facial surgery (≥ 10 cases)

* All cases must be performed by the resident or fellow himself/herself.

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References

- Awal D.H.
- Walker T.W.
- Mills C.
Review of the Intercollegiate Surgical Curriculum Programme for oral and maxillofacial surgery aesthetics: are we underselling ourselves?.
Br J Oral Maxillofac Surg. 2019; 57: 918-922
View in Article
- Momeni A.
- Goerke S.M.
- Bannasch H.
- et al.
The quality of aesthetic surgery training in plastic surgery residency: a survey among residents in Germany.
Ann Plast Surg. 2013; 70: 704-708
View in Article
Postgraduate programme, University of Witten/Herdecke. Available from URL: https://www.uni-wh.de/studium/studiengaenge/postgraduiertenprogramme/. (Last accessed 12 January 2020, website in German).
View in Article
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Comparison of the aesthetic surgery curriculum for oral and maxillofacial surgery, plastic surgery, and otorhinolaryngology training in Germany

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