by Bernard Speculand , MDS, FDSRCS(Eng), FFDRCS(Irel), FRACDS (OMS), Consultant Oral and Maxillofacial Surgeon, BMI Priory Hospital, Birmingham. Email: firstname.lastname@example.org - email@example.com Web: www.birminghamtmj.co.uk
Oral and Maxillofacial Surgery (OMFS) is a surgical specialty concerned with managing disorders and diseases of the mouth, jaws and face. Originally a specialty which arose out of Dentistry, partly as a result of war surgery experience, it today requires trainees to qualify in both Medicine and Dentistry and to have appropriate surgical training before starting specialty training.
In the UK and Ireland there is a trend towards subspecialisation into two broad areas of interest: deformity surgery , and head and neck oncology ( cancer ) surgery including salivary gland surgery. Surgeons who specialise in deformity surgery may further narrow down their interests into combinations of: orthognathic surgery using osteotomies to reset jaw positions; cleft lip and palate surgery; craniofacial surgery for skull/facial deformity; temporomandibular joint (TMJ) surgery; and aesthetic facial surgery (rhinoplasties, facelifts etc.). An additional area of interest which sometimes crosses these boundaries is dental implant surgery for correction of tooth loss, or even loss of ears, nose or eyes.
Instructing solicitors have, of course, two differing requirements – personal injury claims and medical negligence claims. Personal injury clients may have experienced dental, oral and facial damage as a consequence of injuries sustained in falls, pedestrian or cyclist versus motor vehicles, other road traffic accidents, or work-related injuries. Sports injuries which I have seen have involved causes ranging from a golf club to a horse !
Allegations of medical negligence in the field of OMFS may be concerned with surgical activities including but not restricted to: wisdom teeth surgery resulting in sensory loss on the tongue and/or lower lip, and even jaw fracture; dental implant surgery resulting in the same concerns ; complications from osteotomies to improve jaw position; surgery for facial injuries where a less than desirable outcome has been achieved; complications form TMJ surgery; and complications or perceived poor results from aesthetic facial surgery procedures.
OMFS surgeons specialising in head and neck cancer surgery may be asked to advise in cases where a suspicious mouth ulcer has been neglected and then later found to be a cancer. Other cases may concern graft failures, infections, inadequate tumour clearance leading to tumour recurrence, and even death.
It is obviously important for the expert to stay within his or her area of expertise within the specialty when accepting instructions. The case needs to be judged by the standards of practice applicable at the time of the alleged harm, and these may be different to those of today. Knowledge of the Bolam and Montgomery tests is important, the latter in relation to fully informed consent .
Instructing solicitors frequently ask for an initial scoping report before issuing instructions for a full Breach of Duty and Causation Report and perhaps also a Condition and Prognosis Report. I personally have difficulty with that type of request as in my experience it takes as much effort and time to go through all the documentation for a scoping report as it does for a full Breach of Duty and Causation report.
Finally many cases of alleged Breach of Duty boil down to a question of whether the index problem was as a consequence of bad luck or bad judgement, and where in the chain of events this took place.