Oral and Maxillofacial Surgery

Oral and Maxillofacial Surgery specialises in the diagnosis and management of benign and malignant diseases affecting the mouth, jaws, face and neck.

The Regional Oral and Maxillofacial Surgery service covers all of NHS Lothian and NHS Borders, and patients of all ages, including children and adolescents. It is based at St John’s Hospital in Livingston. The service also manages Oral Medicine and Surgery patients referred to St Johns (West Lothian patients only; Edinburgh, Mid- or East Lothian patients should be referred to Oral Health Services at the Edinburgh Dental Institute).

OMFS is a unique specialty, requiring a dual qualification in medicine and dentistry and is often seen as the bridge between the two, treating conditions that require expertise from both backgrounds.

These include:

1. Benign and malignant tumours of the mouth, face, jaws and neck (further detail below)
2. Non-melanoma skin cancer of the head and neck
3. Benign and malignant salivary gland disease
4. Obstructive salivary disease
5. Neck lumps or swellings
6. Oral Epithelial Dysplasia
7. Facial Deformity – Developmental and Acquired
8. Post cancer / trauma oral and facial rehabilitation.
9. Temporomandibular Joint Dysfunction Syndrome – Surgical and Non-surgical management.
10. Facial Trauma – hard and soft tissue repair
11. Head and Neck fascial space infections

Oral and Maxillofacial Cancer

NHS Lothian complies with the Scottish referral guidelines for head and neck cancer. The referral criteria are:

• “Persistent unexplained head and neck lumps for >three weeks
• Unexplained ulceration or unexplained swelling/induration of the oral mucosa persisting for >three weeks
• All unexplained red or mixed red and white patches of the oral mucosa persisting for >three weeks

Red flag throat symptoms require referral to ENT.

Patients with lesions in their mouth considered urgent suspicious of should be referred directly to the OMFS service at St John’s Hospital using the specific SCI Gateway pathway. They should not be referred to oral medicine or oral surgery.

Please do not use this pathway for other conditions that might require urgent review.

Associated specialties are:

• ORAL SURGERY – deals with the diagnosis and management of pathology of the mouth and jaws that requires surgical intervention, but where cancer is not suspected.
• ORAL MEDICINE – deals with the diagnosis and non-surgical management of patients with chronic / recurrent, benign conditions of the oral mucosa and facial pain. These conditions are often intractable and related to systemic disease requiring multi-disciplinary care.