IntermedIAte module

In
orAl & mAXIlloFACIAl
SurGerY
REQUIREMENTS FOR TRAINING & EXAMINATION

PY
CO
2011 CE
FI
OF
Addendum
Basic Life Support (BLS) is a mandatory course for
CoLLege oF
all postgraduate trainees
PhySICIAnS And
(FCPS and MCPS). All Fellowship residents are
SurgeonS
required to attend BLS course before they can
PAkIStAn
appear in Intermediate Module (IMM) examination.
Composed by:
Syed Faisal Babar
Department of Medical Education

Published: October, 2011

COLLEGEOF PH YS I
CIA N S A N D S U R GEON S PA K I
ST A N
7th Central Street, Defence Housing Authority, Karachi-75500.
Phone No. 99207100-10 UAN: 111-606-606 Fax No. 99266432
 CONTENTS

1 ABOUT THE COLLEGE

5 TRAINING AND EXAMINATION

9 ASSESSMENT

14 SYLLABUS

30 USEFUL ADDRESSES AND TELEPHONE NUMBERS

 ABOUT THE
COLLEGE
The College was established in 1962 through an ordinance of the
Federal Government. The objectives/functions of the College include
promoting specialist practice of Medicine, Obstetrics & Gynaecology,
Surgery and other specialties by securing improvement of teaching
and training, arranging postgraduate medical, surgical and other
specialists training, providing opportunities for research, holding and
conducting examinations for awarding College diplomas and
admission to the Fellowship of the College.

Since its inception, the College has taken great strides in improving
postgraduate medical and dental education in Pakistan. Competency-
based structured Residency Programs have now been developed,
along with criteria for accreditation of training institutions, and for the
appointment of supervisors and examiners. The format of examinations
has evolved over the years to achieve greater objectivity and reliability
in methods of assessment. The recognition of the standards of College
qualifications nationally and internationally, particularly of its
Intermediate Module in Oral & Maxillofacial Surgery 2011

Fellowship, has enormously increased the number of trainees and

consequently the number of training institutions and the supervisors.
The rapid increase in knowledge base of medical sciences and
consequent emergence of new subspecialties have gradually
increased the number of CPSP fellowship disciplines to sixty two.

After completing two years of core training during IMM, the trainees
are allowed to proceed to the advanced phase of FCPS training in the
specific specialty of choice for 2-3 years. However, it is mandatory to
qualify IMM examinations before taking the FCPS-II exit
examinations.

1
 The prospectii of IMM in each discipline have been extensively
revised and structured so as to delineate well defined competencies
to be achieved along with their level of participation. These
prospectuses have been complemented by color coded Structured
Visual Curriculum Display (SVCD) charts to be placed at a prominent
place in each training Unit. They help remind at a glance, the trainees
and the supervisors, about the competencies and their levels to be
achieved at a given time period along with the minimum number of
cases. They also describe the rotations to be performed along with
their duration and objectives, mandatory workshops to be attended,
and the requirements and deadlines for submitting research synopsis
and dissertation (or two research articles in lieu of the dissertation as
per CPSP rules).

The work performed by the trainee is to be recorded in the e-logbook

on daily basis. The purpose of the e-log is to ensure that the entries
are made on a regular basis and to avoid belated and fabricated
entries. It will hence promote accuracy, authenticity and vigilance on
the part of trainees and the supervisors.

The average number of candidates taking CPSP examinations each

Intermediate Module in Oral & Maxillofacial Surgery 2011

year is over 15,000. The College conducts examinations for FCPS I

(12 groups of disciplines), IMM, FCPS II (62 disciplines), MCPS 20
disciplines, including MCPS in HPE and also Diploma in Health Care
System Managment (DCPS-HCSM). A large number of Fellows and
senior medical teachers from within the country and overseas are
involved at various levels of examinations of the College.

Since IMM examination is used merely as a midway assessment, it now

includes TOACS (Task Oriented Assessment of Clinical Skills) only,
which is more objective and standardized method to assess
clinical skills.

2
It is important to note that in the overall scenario of health delivery
over 85% of the total functioning and registered health care
specialists of the country have been provided by the CPSP. To
coordinate training and examination, and provide assistance to the
candidates stationed in cities other than Karachi, the College has
established 14 Regional Centers (including five Provincial
Headquarter Centers) in the country.

The five Provincial Headquarter Centers, in addition to organizing the

capacity building workshops/short courses also have facilities of
libraries, I.T, and evaluation of synopses and dissertations along with
providing guidance to the candidates in conducting their research work.

The training towards Fellowship can be undertaken in more than 146

accredited medical institutions throughout the country and 100 plus
accredited institutions abroad. The total number of trainees in these
institutions is over 13360.

These continuous efforts of the College have even more importantly

developed a credible system of postgraduate medical education for
the country. The College strives to make its courses and training
Intermediate Module in Oral & Maxillofacial Surgery 2011

programs ‘evidence’ and need ‘based’ so as to meet international

standards as well as to cater to the specialist healthcare needs not
only for this country but also for the entire region.

Prof. Zafar Ullah Chaudhry

President
College of Physicians
and Surgeons Pakistan

3
 INTERMEDIATE MODULE

To ensure better training, the CPSP introduced an Intermediate

Module Examination in several disciplines in 2001. This mid-training
assessment strengthens the monitoring and in-training assessment
systems by providing trainees with an estimate of mid-training
competence. It also serves as a diagnostic tool for trainees and
supervisors, provides a curricular link between basic and advanced
training, and an opportunity for sampling a wider domain of
knowledge and skills.

In compliance with Notification No. 6-1/ Exame-04 / CPS /1438 S and

R, the Intermediate Module (IMM) examination is a mandatory
eligibility requirement for all FCPS II examinations as from September
2007. Trainees who will start their FCPS-II Training in Oral &
Maxillofacial Surgery from July 2009 and onward are required to
complete two years training and take the Intermediate Module (IMM)
examination.

In case of failure in the intermediate Module examination, the trainees

are permitted to continue their training in the advanced phase (FCPS
Intermediate Module in Oral & Maxillofacial Surgery 2011

II) of the specialty but must pass the intermediate Module

examination prior to appearing in the Final FCPS II examination.

4
 TRAINING AND
EXAMINATION
GENERAL REGULATIONS
Candidate will be admitted to the examination in the name (surname
and other names) as given in the BDS degree and PMDC certificate.
CPSP will not entertain any application for change of name on the
basis of marriage / divorce / deed.

REGISTRATION AND SUPERVISION

All training must be supervised, and trainees are required to register with
the Research and Training Monitoring Cell (RTMC) within 30 days of
starting their training for Intermediate Module. In case of delay in
registration, the start of training will be considered from the date of receipt
of application by the RTMC. Registration forms are sent to successful
candidate with the result of the FCPS I examination. They must submit the
name of their supervisor by the date indicated on the registration form.
Training is compulsorily monitored by an approved supervisor who is a
CPSP fellow or a specialist with relevant postgraduate qualification Intermediate Module in Oral & Maxillofacial Surgery 2011

registered at the RTMC.

APPROVED TRAINING CENTRES

Training must be undertaken in units, departments and institutions
approved by the College. A current list of approved institutions is
available from the College and its Regional Centres as well as on the
College website: www.cpsp.edu.pk

DURATION
The duration of training for the Intermediate Module (IMM) is two
years; the Intermediate Module examination is taken on
completion of the two years training.

5
 ROTATIONS
The two years of competency based training in Oral &
Maxillofacial surgery includes two months rotation in each of the
following disciplines:
● General surgery ● Anaesthesia

ROAD MAP

COMPONENTS OF TRAINING
Mandatory Workshops
It is mandatory for all Intermediate Module trainees to attend the
Intermediate Module in Oral & Maxillofacial Surgery 2011

following CPSP certified workshops during Intermediate Module

training:
1. Introduction to Computer and Internet
2. Research Methodology and Dissertation Writing
3. Communication Skills
4. Basic Surgical Skills
5. BLS (Basic Life Support)
Any other workshop/s as may be introduced by CPSP.

NOTE: No candidate will be allowed to appear in IMM

examination without attending the abovementioned
workshops including BLS.

6
Logbook
Trainees are required to maintain a logbook in which entries of
academic / professional work done during the period of training
should be made on daily basis, and signed by the supervisor.
Completed and duly certified logbook will form part of the application
for appearing in IMM examination.
E-logbook
The CPSP council has decided to introduce E-logbook system for all
residency program trainees in FCPS. Upon registration with RTMC
each trainees is allocated a registration number and a password to
log on to the e-logbook on the CPSP website. The trainee is required
to enter all work performed and the academic activities undertaken in
the logbook on daily basis. The concerned supervisor is required to
verify the entries made by the trainee. This system ensures timely
entries by the trainee and prompt verification by the supervisor. It also
helps in monitoring the progress of trainee and vigilance of
supervisors.

Research (Dissertation / Two Papers)

One of the training requirements for fellowship trainees is a
dissertation or two research papers on the topic related to the field of
specialization published/accepted for publication in CPSP approved
journals. For trainees in oral & maxillofacial surgery the dissertation Intermediate Module in Oral & Maxillofacial Surgery 2011

synopsis or abstracts of the research papers must be submitted for

approval to the Research and Evaluation Unit (REU) by the end of
first year of the Intermediate Module.

General Requirements
Training should incorporate the principle of gradually increasing
responsibility, and provide each trainee with a sufficient scope,
volume and variety of experience in a range of settings, with patients
varying from simple to complex management requirements. The
emphasis shall be on principles of consultation with other specialties
and essential concepts of patient care undergoing oral and
maxillofacial surgery.

7
 Instructional Methodology
Teaching occurs using several methods that range from formal
didactic lectures to planned clinical experiences. Aspects covered
will include knowledge, skills and practices relevant to the
discipline in order to achieve specific learning outcomes and
competencies.
The theoretical part or the curriculum represents the current body
of knowledge necessary for practice. This can by imparted
through lectures, clinical and technical exercises, clinic-
pathological meetings, competition / problems review meetings,
literature reviews and presentation, journal clubs meetings, self
directed learning, conferences and seminars.

Clinical learning is to be organized to provide appropriate

expertise and competence necessary to evaluate and manage
common clinical problems. Demonstration in clinics and
procedural skills training on simulators, mannequins and patients
are all practical training modalities.
Intermediate Module in Oral & Maxillofacial Surgery 2011

8
ASSESSMENT
ELIGIBILITY REQUIREMENTS
For appearing in Intermediate Module examination a candidate
should have:
● Passed FCPS I in Dentistry or granted exemption
● Completed two years of RTMC registered training under an approved
supervisor in an institution recognized by the CPSP. A certificate of
completion must be submitted.
● Submitted a complete and attested logbook by respective
supervisors.
● Submitted certificates of attendance of mandatory workshops.
● Submitted synopsis of dissertation or abstract of research articles.

EXAMINATION SCHEDULE
● The intermediate Module theory examination will be held twice a
year
● Theory examinations are held in various cities of the country
usually at Abbottabad, Bahwalpur, Fasisalabad, Hyderabad,
Islamabad, Rawalpindi, Karachi, Nawabshah, Larkana, Lahore, Intermediate Module in Oral & Maxillofacial Surgery 2011

Multan, Peshawar and Quetta centres. The College shall decide

where to hold TOACS examinations depending on the number of
candidates in a city and shall inform the candidates accordingly.
● English shall be the medium of all examinations for theory and
TOACS.
● The College will notify of any change in the centres, the dates and
format of the examination.
● A competent authority appointed by the College has the power to
debar any candidate from any examination if it is satisfied that the
candidate has indulged in unfair practices in College examination,
misconduct or because of any other disciplinary reason.

9
 EXAMINATION FEE
● Application along with the prescribed examination fee and
required documents must be submitted by the last date notified for
this purpose before each examination.
● The detail of examination fee and fee for change of centre,
subject, etc. shall be notified before each examination.
● Fee deposited for a particular examination shall not be carried
over to the next examination in case of withdrawal, absence or
exclusion.

REFUND OF FEES
If after submitting an application for examination, a candidate decides
not to appear, a written request for a refund must be submitted before
the last date for withdrawal with the receipt of applications. In such
cases a refund is admissible to the extent of 75% of fees only. No
request for refund will be accepted after the closing date for receipt of
applications. If an application is rejected by the CPSP, 75% of the
examination fee will be refunded, the remaining 25% being retained
as a processing charge.No refund will be made for fees paid for any
other reason, e.g late fee , change of centre/subject fee ,etc

FORMAT OF EXAMINATIONS
Intermediate Module examination consists of the following two
Intermediate Module in Oral & Maxillofacial Surgery 2011

components:
Theory examination:
Theory examination consists of:
Paper I 10 Short Answer Questions (SAQs) 3 hours
Paper II 100 Single Best MCQs 3 hours

Clinical examination:
To test clinical skills, the examination shall consist of:
TOACS (Task Oriented Assessment of Clinical Skills)

Only those candidates who qualify in the theory will be eligible to

take the TOACS examination which will be held at the nearest
regional centers depending upon the number of candidates.

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TOACS
TOACS will comprise of 10 to 15 stations with time alloted at each
station being 5-8 minutes and change over time of one minute to
move from one station to the other. The stations may have an
examiner, a patient or both Structured clinical tasks will be set at
each station. At stations where no examiner is present the
candidates will have to submit written responses to short answer
question/s MCQs on a response sheet.

There will be two types of stations: static and interactive. On Static

stations the candidate will be presented with patient data, a clinical
problem or a research study and will be asked. At the Interactive
stations the candidate will have to demonstrate a competency for
example, taking history, performing a clinical examination,
counseling, assembling an instrument, etc. One examiner will be
present at each interactive station and will either rate the
performance of the candidate or ask questions testing reasoning and
problem solving skills.

Intermediate Module in Oral & Maxillofacial Surgery 2011

11
 COURSE WORK FOR ORAL &
MAXILLOFACIAL SURGERY TRAINING
PROGRAM
GENERAL OBJECTIVES
Upon completion of specified training the resident must have acquired
the competencies comprising of knowledge, skills and attitudes
forming the foundation of the standard practice for an Oral &
Maxillofacial specialist who is able to:
● Provide an appropriate, cost effective and standard care to patients
seeking consultation.
● Promote health and prevent disease in patients, families and
communities.
● Apply Knowledge and expertise in clinical and procedural
management of diseases.
● Perform prescribed Maxillofacial surgical skills.
● Attain decision making skills for dealing with oral & maxillofacial
problems
● Participate in Continuing Professional Development programs.

TRAINING FOR INTERMEDIATE MODULE

Intermediate Module in Oral & Maxillofacial Surgery 2011

The curriculum of first two years in Oral & Maxillofacial surgery

involves balanced and objective integration of basic dental sciences
including dental and essential core clinical knowledge. The trainee
should be able to diagnose and manage common conditions prevalent
in the community. Further, that he/she should be able to recognize,
stabilize and refer the complicated cases to appropriate place/person.

The coverage that each discipline receives below is not indicative of

the relative importance placed on each discipline in the training
program, or in the examination. These are guidelines and not
comprehensive definitive lists. Only minimum levels of expected
competence have been identified but sufficient scope, volume and
variety of experience are desirable.

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COMPETENCIES
The competencies prescribed for the Intermediate Module are:
● Communicate effectively with patients, attendants & others
● Take proper history of the case
● Advise appropriate investigations & interpret them
● Refer patient to appropriate facilities, when needed
● Perform standardized clinical examination of the OMF region
● Establish final diagnosis of the case & manage it accordingly
● Practice safe and ethical OMFS
● Work as a leader or member of health care team
● Develop scientific paper writing and presentation skills
● Follow up and maintain patient records
● Work as OMFS professional, academician & researcher

Intermediate Module in Oral & Maxillofacial Surgery 2011

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 SYLLABUS
PRINCIPLES OF OMFS REGARDING:
● Evaluation of the preoperative health status of the surgical patient
● Making a surgical diagnosis and prerequisites of surgery
● Principles & types of incisions, flap design & methods of tissue
handling
● Haemostasis, edema control, decontamination, surgical wound
toilet
● Patho-physiology and principles of wound repair/ significance of
wound healing
● Mechanisms of scar and contracture formation & its prevention
● Surgical infection and its prevention and control
● Body response to infection and appropriate methods for carrying
out surgery in Hepatitis, HIV carriers and all other medically
compromised conditions.
● Use of common surgical instruments and operation theatre
appliances (suction, diathermy, retractors, general instruments etc)
● Appropriate uses of suture/ ligature materials and basic Principles
of anastamosis.
Intermediate Module in Oral & Maxillofacial Surgery 2011

● Management of postoperative patients by taking appropriate

measures to prevent complications

EXODONTIA:
a) General Principles
- Armamentarium used for basic Oral surgical practice
- Assesses medical condition of patient preoperatively and
knows basic principles of managing pain and anxiety control
- Indications and contraindications of performing tooth
extraction & related procedures
- Clinical and radiological assessment for tooth extraction

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b) Uncomplicated Exodontia
- Patient and surgeon preparation, chair positioning and
mechanical principles involved in tooth extraction.
- Principles of Forceps, Elevator use and procedures for
closed extractions including specific techniques for removal
of each tooth
- Post-extraction care of alveolar socket

c) Complicated Exodontia
- Flap design, types & development technique and
management
- Basic principles of suturing for complex cases
- Indications and contraindications of surgical extractions
- Techniques for performing surgical removal of single,
multi-rooted teeth, & root fragments
- Extraction sequence & technique when planning multiple
extractions for special scenarios.
- Management of post extraction complication.

MANAGEMENT OF IMPACTED TEETH:

● Indications and contraindications for removal of impacted teeth
● Classification of impacted teeth of Upper & Lower Jaws
● Difficulty Index of removal of impacted teeth Intermediate Module in Oral & Maxillofacial Surgery 2011

● Pre, Per and Post-operative Complications & management when

removing impacted teeth

ASEPSIS, STERILIZATION & CROSS INFECTION CONTROL:

● Surgically important and communicable microbes related to
OMFS
● Differentiation between sterilization, disinfection, asepsis etc
● Different techniques of instrument sterilization by heat, gas and by
chemicals
● Methods of maintenance of sterility in Dental Surgery Unit, Room
and OT
● Methods of scrubbing, gowning, gloving and assisting the surgical
staff
● Managing postsurgical asepsis

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 ANTIMICROBIAL THERAPY / ANALGESICS USE IN OMFS / DENTISTRY
● Commonly used antimicrobials and analgesics
● Basic principles of prophylactic and therapeutic antibiotic use
● Basic principles of analgesic use
● Indications, precautions & contraindications of antibiotic therapy
● Drug interactions, advantages & disadvantages of combination
therapy
● Significance of culture and sensitivity testing with basic
knowledge of dosage and routes of administration & their issues
● Consequences of under or over dosage, allergic reactions to
antibiotics and analgesics & their management

DIAGNOSTIC TECHNIQUES AND INVESTIGATIONS REQUIRED FOR

PATHOLOGIES OF HEAD AND NECK REGION:
● Appropriate radiological investigations
● Appropriate surgical diagnostic investigations including biopsies

RADIOLOGY AND IMAGING TECHNIQUES USED IN OMFS/

DENTISTRY:
● Ordering various techniques of radiology and imaging used,
including intra- and extraoral radiological investigations
● Evaluates and interprets them for providing OMF Surgical Care

MEDICAL EMERGENCIES IN OMFS / DENTISTRY :

● Common medical conditions which are likely to develop into
Intermediate Module in Oral & Maxillofacial Surgery 2011

emergencies in the dental office

● Drugs that should be included in a dental emergency kit.
● When, how & whom to refer patients, having serious medical
emergencies

MANAGEMENT, PREVENTION AND SPREAD OF ODONTOGENIC

INFECTIONS:
● Basic microbiology of odontogenic infections
● Routes of odontogenic infections, spread and its natural
progression
● Principles of managing and preventing odontogenic infections
● Prophylaxis against spread of infection
● Management of all complex odontogenic facial space
infections
● Diseases of the maxillary sinus and their management

16
MANAGEMENT OF PATHOLOGIC LESIONS AFFECTING OMFS
REGION:
● Basic principles of biopsy procedure
● Differential diagnosis
● Goals and principles of surgical management of oral pathologic
lesions
● Cysts and tumors of the OMFS region

TREATMENT OF PRE-CANCEROUS LESIONS AND ORAL

MALIGNANCES:
● Diagnosis of various precancerous lesions and conditions and
their management
● Identification of etiology and risk factors and the preventions of
oral cancer
● Clinical evaluation and differential diagnosis of suspected lesions
of the head and neck
● Principles and mode of action of chemotherapy and associated
medicines.
● Manage dental problems in patients undergoing brachytherapy,
radiotherapy & chemotherapy

DIAGNOSE AND OFFERS BASIC TREATMENT TO GENERAL AND

MAXILLOFACIAL TRAUMA PATIENT WITH: Intermediate Module in Oral & Maxillofacial Surgery 2011

● Management of the trauma patient using ATLS principles.

● Role and utility of oral and maxillofacial surgeon in the trauma
team
● Identification and management principles of life threatening, sight
threatening and limb threatening injuries.
● Soft tissue injuries such as abrasions, contusions and lacerations
● Traumatic injuries to teeth and supporting structures , including
dentoalveolar fractures.
● Facial trauma : Clinical and Radiological evaluation
● Fractures of mandible ,condyle, maxilla and other mid facial
bones
● Closed reduction techniques in management of facial fractures.
● Application of basis ORIF (Open Reduction And Internal Fixation)
and Reconstructive Surgery principles.

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 PRE-PROSTHETIC ORAL SURGERY:
● Objectives of pre-prosthetic surgery
● Principles of evaluation, treatment planning & needs of the
patient
● Various procedures of alveolar ridge augmentaion and their
relation with the jaws
● Maxillary and mandibular tori procedures and etc

DENTAL IMPLANTOLOGY AND ITS IMPLICATION:

● Biological considerations of osseointegration
● Dental implant types and its components
● Evaluation of medical condition of the patient preoperatively
● Planning & evaluation of surgical treatment procedure including
clinical and radiographic assessment of implant site and
associated structures
● Basic and advanced surgical Implant techniques their
complications and management

TEMPOROMANDIBULAR JOINT & FACIAL PAIN:

● Classification of temporomandibular Joint disorders
● Congenital and infectious disorders of the TMJ
Intermediate Module in Oral & Maxillofacial Surgery 2011

● Internal derangement of the TMJ; including its management

with different reversible and irreversible treatment methods
● Degenerative joint disease and systemic arthritic conditions
affecting TMJ
● TMJ hypomobility disorders; including TMJ ankylosis and their
management
● TMJ hypomobility disorders; recurrent dislocation and their
management
● Pain neurophysiology
● Facial pain management and related neuralgias
● Oral facial and its other types; including neuropathic facial pains
and chronic headache

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ANAESTHESIA (LOCAL/ REGIONAL/ GENERAL):
● Primary goals of giving local, general and sedation anesthesia
● Requesting preoperative G/A fitness from Anesthesiologist
● Classification, chemistry and pharmacologic effects of local and
general anesthetic drugs
● Adverse effects and drug interactions of local and general
anesthetic drugs
● Preparations and dosage of local anesthetic drugs, their
general therapeutic uses and side effects when used in dentistry
● Methods of administration and mechanisms of action of general
anesthetic drugs including inhalation agents and intravenous
agents
● Differentiation between analgesia and sedation and their
application in oral surgery
● Principles of general anesthesia and IV sedation

ESSENTIAL ORAL MEDICINE FOR THE OMFS:

● Vesiculobullous lesion of the oral cavity
● Oral ulcerations
● Autoimmune disorders related to OMFS
● Red and blue lesion of the oral cavity
● White lesion of the oral cavity
Intermediate Module in Oral & Maxillofacial Surgery 2011

BONE PATHOLOGY RELATED TO OMFS:

● Fibro osseous lesions of the OMFS region
● Giant cell lesions of the OMFS region
● Metabolic bone diseases
● Developmental bone disorders

ORTHOGNATHIC SURGERY:
● Dentofacial deformities
● Assessment of the dentofacial deformity patient; including
clinical assessment, essential imaging, cephalometry and
current assessment tools.
● Liason between orthodontic and maxillofacialsurgery in
planning for orthognathic surgery

19
 ● Model surgery; inclucing facebow transfer and articulator
mounting
● Maxillary, mandibular and genioplasty osteotomies ; indications
and surgical technique
● Patients , attendants etc counseling where needed
● Basic concepts of distraction osteogenesis
● Perioperative care of the orthognathic surgical patient

DEVELOPMENTAL ANOMALIES RELATED TO OMFS:

● Causative factors and embryology of Cleft lip and Palate
● Problems experienced by cleft lip and palate -afflicted
individuals
● Timing and principles of treatment of cleft lip and palate and
alveolar grafting
● Correction of maxillomandibular disharmonies and secondary
surgical procedures
● Dental needs of cleft-afflicted patients and the concepts of multi
disciplinary management

MEDICO-LEGAL AND ETHICAL ISSUES IN ORAL SURGERY/

DENTISTRY:
● Legal concepts influencing liability and risk reduction
● Principles of dental ethics and steps in ethical decision making
Intermediate Module in Oral & Maxillofacial Surgery 2011

● Basis of obligations in the Dentist-Patient relationship

● Informed consent, informed refusal, record keeping and
documentation including referral letters
● Counseling in cases of complications
● Documentation of patient management problems in case of
non-compliance or patient abandonment

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PROCEDURES:
The level of competence to be achieved each year is specified
according to the key, as follows:

Levels of competencies:
1. Observer status.
2. Assistant status.
3. Performed under supervision.
4. Performed under indirect supervision.
5. Performed independently

Note: Levels 4 and 5 for practical purposes are almost synonymous

Intermediate Module in Oral & Maxillofacial Surgery 2011

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 Procedural Competencies
Procedures/Tasks
1st Year 2nd Year Min #
Cases/year
Core Skills For OMFS Practice
History taking 4 4 50
Communicating effectively with
patients, families and Other Related
Health team Members 4 4 50
Understanding & obtaining
informed Consent 4 4 50
Performing clinical examination of
OMFS Region 4 4 50
Ordering appropriate investigations 2 3 50
Interpreting investigation results 2 3 50
Ordering Routine Radiology &
Ultra sound for OMFS region 2 3 25
Imaging for OMF problems: CT scan,
MRI, Doppler etc 2 3 25
Assessing patient fitness: for OMFS
procedure 3 4 50
Positioning of patient for diagnostic and
operative OMFS procedures under
Local & General Anesthesia 4 4 50
Intermediate Module in Oral & Maxillofacial Surgery 2011

Following basic management

Principles of hospitalized & medically
compromised patient 4 4 50
Post operative OPD patient
management & follow up 3 4 50
Post Operative patient management of
the hospitalized patients 4 4 50
Deciding & implementing final
OMFS treatment 2 3 50
Maintaining accurate patients records 4 4 50
Diagnosis & Management of OMF
Pre-Malignant disorders 4 4 50
Application of aseptic surgical
techniques in OMFS 4 4 50

22
Procedures/Tasks
1st Year 2nd Year Min #
Cases/year
Application of knowledge of
Basic Principles of Surgery 4 4 50
Use & Application of common surgical
instruments, suture materials and
techniques 4 4 50
CPR & related management 2 3 5
Procedural Skills
A) General
Suturing OMFS region soft tissues 2 3 25
OMFS ward patient management 2 3 25
OMFS OPD patient management 2 3 25
Prescribing suitable medications 2 3 20
B) Minor Oral Surgery
Complicated Exodontia Cases
under L/A 2-3 4 50
Pre-Prosthetic Surgery cases 2 3-4 30
Management of Impacted teeth 2-3 4 40
Re-implantation of Avulsed/ Intermediate Module in Oral & Maxillofacial Surgery 2011

luxated Teeth 2 3-4 10

Endodontic / Periapical Surgery 2 3-4 10
Incisional & Excisional Biopsy
OMF tissues 2 3-4 20
OMF repair 2 3-4 5
Dental implantology; including adjunct
procedures 1 2 5
C) Anaesthesia and Allied
Nasogastric intubation 3 4 25
Nasotracheal intubation 1 2-3 20
I/V sedation & local anesthesia cases 2-3 3-4 10
Tracheostomy 1 2-3 05

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 Procedures/Tasks
1st Year 2nd Year Min #
Cases/year

D) OMFS Infections
Diagnosis & management of
Odontogenic & related fascial space
infections in OMFS 2 3 10
Diagnosis, Prevention and
management of the spread of
complex Bacterial, Viral, Fungal and
Protozoal infections related to OMFS 2-3 3-4 10
E) Trauma - Management of
Dent alveolar fractures 2-3 4 10
Nasal fracture 2 3 10
Fracture Mandible 2 2-3 20
Fracture Maxilla 2 2-3 20
Fracture ZMC & Orbit 2 2-3 10
Fracture nose and frontal bone 1 2-3 05
F) TMj Related Pain Disorders
Intermediate Module in Oral & Maxillofacial Surgery 2011

Non surgical management of TMJ and

related facial pain disorders 2 2-3 10
TMJ Ankylosis surgeries 1 2-3 10
Trigeminal Neuralgia
diagnosis & management 2 2-3 10
G) Orthognathic Surgery
Genioplasty & related
surgical procedures 1 2 05
Maxillary procedures 1 2 05
Mandibular procedures 1 2 05
Bone Grafting procedure 1 2 05

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Procedures/Tasks
1st Year 2nd Year Min #
Cases/year

H) OMFS Pathology/Oncology
Management of Oral
Submucous Fibrosis 1 2-3 05
Management of Odontogenic &
non Odontogenic Cysts & Tumours 2 3-4 15
Diagnosis & Management of
Ulcerations & Vesiculobullous Lesions
of OMF region 2 3 20
Soft tissue Extirpation 1 2 05
Diagnosis and management of
Fibro-osseous lesions of
the OMFS region 1 2 05
Maxillectomy procedures 1 2 05
Mandibulectomy/Resection procedures 1 2 05
OMFS Pre- Malignancies &
their Management 1 2 05
I) Reconstuctive And Plastic Surgery
Bone harvesting procedures 2 2-3 5
Intermediate Module in Oral & Maxillofacial Surgery 2011

Applying principles of bone

plating and ORIF 1-3 4 10
Regional and distant flaps * 1 2 5
Free flaps * 1 2 3
j) Salivary Gland Disorders
Diagnosis & Management of
Sjogren's Syndrome &
Surgical removal of ductal stones 2 3 10
Mucocoele removal Ranula
treatment procedures 2 3 10
Surgical Removal of minor/
major salivary glands 1 2 10

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 Procedures/Tasks
1st Year 2nd Year Min #
Cases/year

K) Cleft Lip Palate Surgery/

Developmental Conditions
Primary Cleft lip surgery * 1 2 5
Primary Cleft Palate surgery * 1 2 5
Alveolar bone grafting 2 2 5
L) Teaching/Education
Teaching Surgical
procedures to Under Graduate /
Post Graduate Trainees - - -

* Procedures possible at Plastic Surgery & other rotations are

subject to availability of respective expertise
Intermediate Module in Oral & Maxillofacial Surgery 2011

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COMPETENCIES FOR ROTATION
SURGERY
The purpose of rotation in General Surgery is that an OMFS resident
learn the basic principles and acquire core competencies required for
the practice of any discipline of surgery including Oral and Maxillo-
facial Surgery. These competencies are given below:

FIRST MONTH SECOND MONTH

Total
Competencies Cases
Level Cases Level Cases
Patient Management
Elicit a pertinent history 3 20 4 20 40

Communicate effectively with patients,

families & health team (observed) 3 20 4 20 40

Perform physical examination 3 20 4 20 40

Order appropriate investigations 3 20 4 20 40

Interpret the investigation results 3 20 4 20 40

Assess fitness to undergo surgery 3 20 4 20 40

Implement appropriate treatment 3 20 4 20 40

Intermediate Module in Oral & Maxillofacial Surgery 2011
Post operative Patient Ward
management and monitoring 3 20 4 20 40

Maintain accurate records 3 20 4 20 40

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 FIRST MONTH SECOND MONTH
Total
Competencies Cases
Level Cases Level Cases
Pre-operative preparation for surgical procedures
Use of aseptic technique 3 20 4 20 40
Positioning of patient for diagnostics
and operative procedures 3 10 4 10 20
Identification and appropriate use of
common surgical instruments,
suture materials and appliances 3 10 4 10 20
General Surgical Procedures

Hemorrhage control 2 10 3 10 20
Debridement, wound excision,
closure/suture of wound 2 5 3 10 15
Urethral catheterization 2 5 3 5 10
Nasogastric intubation 2 10 3 10 20
Tube thoracostomy 1 2 2 2 4
Venesection 1 3 2 3 6
Biopsy of neck lymph nodes 2 5 3 5 10
Biopsy of skin lesions,
subcutaneous lumps or swellings 2 5 3 5 10
Excision of soft tissue tumors and
cysts (surface surgery) 1 3 2 3 6
Intermediate Module in Oral & Maxillofacial Surgery 2011

Cricothyroidotomy 2 1 3 1 2
Percutaneous needle aspiration,
preferably under ultrasound guidance 2 1 3 1 2
Burn care 1 2 2 2 4
Wound healing and peri-operative
complications 1 3 2 3 6
Fluid and electrolyte balance 2 5 3 5 10
Care of unconscious patient 2 5 3 5 10
Replacement of Fluid and nutrition 2 5 3 5 10
Thyroid and Parathyroid Surgery 1 2 2 2 4
ER Abdominal trauma management 1 2 2 2 4

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ANESTHESIA
The OMFS Resident should be trained in such a manner so that
he/she is able to diagnose and accordingly manage cases requiring
anesthesia and develop clinical skills as identified below so as to
provide better patient care and improve the standard of Oral and
Maxillofacial Surgical practice in Pakistan.

FIRST MONTH SECOND MONTH

Total
Competencies Cases
Level Cases Level Cases
Clinical Skills
History taking & Clinical examination
of Cases relevant to anesthesia 2 10 3 10 20
Management of ICU Admitted Cases 2 10 3 10 20
Interpretation of concurrent
medical diseases 2 10 3 10 20
Understanding and interpreting
relevant medication of patients 3 10 4 10 20
Organizing pre-op medication 3 10 4 10 20
Interpretation of investigations
relevant to anesthesia 2 10 3 10 20
Planning and organizing postop
pain management 3 10 4 10 20
Intermediate Module in Oral & Maxillofacial Surgery 2011

Procedures
Airway management
Facemask & supraglottic airway devices 3 2 3 3 5
Endotracheal intubation 3 10 3 15 25
Management of difficult airway 3 5 3 5 10
I.V. Cannulation 3 10 3 15 25
Use of anesthesia equipment 2 4 3 6 10
Use of monitors (ICU) 2 10 3 15 25
Lumbar puncture 2 2 2 2 5

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 USEFUL ADDRESSES
AND TELEPHONE
NUMBERS
1. Regional Offices of the CPSP

MUZAFFARABAD LAHORE
CMH Muzaffarabad Next to INMOL, Hospital
Azad Kashmir New Muslim Town, Block-D
TEL: 058810 - 43307 Lahore.
FAX: 058810 - 43902 UAN: 042-111-666-666
Email: ssgr-brehman@cpsp.edu.pk TEL: 042- 9231320-8
FAX: 042- 9231327
ABBOTTABAD Email: rc_lahore@cpsp.edu.pk
Ayub Hospital Complex
Abbottabad
MULTAN
TEL: 0992-383330
Nishtar Medical College,
Email: rc_abbottabad@cpsp.edu.pk
Distt. Jail Road, Opp Circuit House,
Multan.
PESHAWAR
Hayatabad Medical Complex UAN: 061-111-666-666
Phase IV, Hayatabad,  TEL: 061-9200946, 9200952
Peshawar Email: rc_multan@cpsp.edu.pk
UAN: 091-111-666-666
TEL: 091-9217011, 091-9217320-1 BAHAWALPUR
FAX: 091-9217062 Quaid-e-Azam Medical College
Intermediate Module in Oral & Maxillofacial Surgery 2011

Email: rc_peshawar@cpsp.edu.pk Bahawalpur

TEL: 062- 9250461
ISLAMABAD Email: rc_bahawalpur@cpsp.edu.pk
P.I.M.S, Ravi Road, Sector G- 8/ 3
Islamabad. NAWABSHAH
UAN: 051-111-666-666
Peoples Medical College for Girls
TEL: 051-9262590-1,
Nawabshah
FAX: 051-9262592
TEL: 0244-9370271, 9370479
Email: rc_islamabad@cpsp.edu.pk
FAX: 0244-9370478
FAISALABAD Email: rc_nawabshah@cpsp.edu.pk
Punjab Medical College
Faisalabad LARKANA
UAN: 041-111-666-666 Chandka Medical College
TEL: 041-9210131, 9210366-8 Larkana
FAX: 041-9210224 TEL: 074 – 9410726
il:rc_faisalabad@cpsp.edu.pk Email: rc_larkana@cpsp.edu.pk

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HYDERABAD
Adjacent to Sir Cowasji Jehangir
Institute of Psychiatry,
Hyderabad, Sindh.
TEL: 022-3860056
FAX: 022-3860057
Email: rc_hyderabad@cpsp.edu.pk
KARACHI
2. Departments of CPSP Karachi
UAN – 021-111-606-606
● Examination (FCPS Part I)
99207100 -10 Ext: 311
● Examination (FCPS Part II)
99207100 -10 Ext: 215
● Department of Medical
Education
99207100 -10 Ext: 305
● Registration, Training &
Monitoring Cell
99207100 -10 Ext: 320
For further Information:
Phone: 99207100-10
UAN 111-606-606
Facsimile: 99266450
Website: www.cpsp.edu.pk
QUETTA
CPSP Bolan Medical College
Sandeman Civil Hospital
TEL: 081- 9202424
Email: rc_quetta@cpsp.edu.pk
OVERSEAS CPSP CENTRES
3. Saudi Arabia
RIYADH
Saudi Commission for Health
Specialities,
Diplomatic Quarter,
P.O. Box 94656
Riyadh -11614, KSA.
TEL: 966-1-4822415 Ext: 156/141
966-2-6401000 Ext: 25843
Email: medexam5@scfhs.org
4. Nepal
KATHMANDU
T.U. Institute of Medicine
Maharajganj, Kathmandu,
Nepal
TEL: 977-1- 416224
Intermediate Module in Oral & Maxillofacial Surgery 2011
Email: cpsp@healthnet.org.np
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 Intermediate Module in Oral & Maxillofacial Surgery 2011

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Intermediate Module in Oral & Maxillofacial Surgery 2011