{"id":4214,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/"},"modified":"2026-01-26T11:16:03","modified_gmt":"2026-01-26T11:16:03","slug":"oralmaxillofacialsurgery","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/","title":{"rendered":"Oral and Maxillofacial Surgery"},"content":{"rendered":"\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-54ba25fbaefd500e9260564b2590b6af\"><span style=\"text-decoration: underline\"><strong>Oral and Maxillofacial Cancer<\/strong><\/span><\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\">NHS Lothian complies with the <a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Referral Guidelines for Suspected Cancer<\/a>, which include a <a href=\"https:\/\/www.cancerreferral.scot.nhs.uk\/head-and-neck-cancers\/?alttemplate=guideline\" target=\"_blank\" rel=\"noreferrer noopener\">head, neck and thyroid cancer section<\/a>.&nbsp;<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-5c34581b0e5c49f17dbc597d86659884\">In terms of OMFS cancers, an urgent suspicion of cancer (USC) referral should be made for those with any of the following unexplained clinical features lasting three weeks or more:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-b742fa7253ad4716122c9abbd0b5be6f\">Red or mixed red and white patches of the oral mucosa (not oral thrush)<\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-d392c7c26c824357a5fa414b211d75d4\">Ulceration or swelling\/induration of the oral mucosa<\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-76a1fe2766d7332a0faf59e5964c681c\">Neck or parotid lump.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-alert-red-color has-text-color\">&nbsp;Red flag throat symptoms require referral to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/entadult\/neck-lump-and-throat-cancer-risk-assessment\/\" target=\"_blank\" rel=\"noreferrer noopener\">ENT<\/a>.<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-28a369dfd0c546232bc9960a5a2f7c4b\"><strong>Patients with lesions in their mouth considered urgent suspicious of cancer should be referred directly to the OMFS service at St John\u2019s Hospital using the specific SCI Gateway pathway. They should not be referred to oral medicine or oral surgery.<\/strong><\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\">Please&nbsp;<strong>do not<\/strong>&nbsp;use this pathway for other conditions that might require urgent review.<\/p>\n\n\n\n<p><span>Oral and Maxillofacial Surgery specialises in the diagnosis and management of benign and malignant diseases affecting the mouth, jaws, face and neck.<\/span><br><\/p>\n\n\n\n<p>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&#8217;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).<\/p>\n\n\n\n<p>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. <\/p>\n\n\n\n<p><span style=\"text-decoration:underline\">These include<\/span>:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Benign and malignant tumours of the mouth, face, jaws and neck (further detail below)<\/li>\n\n\n\n<li>Non-melanoma skin cancer of the head and neck<\/li>\n\n\n\n<li>Benign and malignant salivary gland disease<\/li>\n\n\n\n<li>Obstructive salivary disease<\/li>\n\n\n\n<li>Neck lumps or swellings<\/li>\n\n\n\n<li>Oral Epithelial Dysplasia<\/li>\n\n\n\n<li>Facial Deformity \u2013 Developmental and Acquired<\/li>\n\n\n\n<li>Post cancer \/ trauma oral and facial rehabilitation.<\/li>\n\n\n\n<li>Temporomandibular Joint Dysfunction Syndrome \u2013 Surgical and Non-surgical management.<\/li>\n\n\n\n<li>Facial Trauma \u2013 hard and soft tissue repair<\/li>\n\n\n\n<li>Head and Neck fascial space infections<\/li>\n<\/ol>\n\n\n\n<p><span style=\"text-decoration:underline\"><strong>Associated specialties are<\/strong><\/span><strong>:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralSurgery\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralSurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">ORAL SURGERY<\/a><\/strong> &#8211; deals with the diagnosis and management of pathology of the mouth and jaws that&nbsp;requires surgical intervention, but where cancer is not suspected.<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralMedicine\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralMedicine\/\" target=\"_blank\" rel=\"noreferrer noopener\">ORAL MEDICINE<\/a><\/strong> &#8211; 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.<\/li>\n<\/ul>\n\n\n\n<p><strong>C.M. &amp; J.M. 03-04-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>Please see above for details of conditions managed.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p>The service will not accept referrals for:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Temporomandibular joint (TMJ) dysfunction<\/strong>&nbsp;where conservative management has not been provided.<\/li>\n\n\n\n<li><strong>Primarily Dental Conditions<\/strong>:<\/li>\n<\/ol>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Routine extractions in otherwise healthy patients.<\/li>\n\n\n\n<li>Routine extractions in patients who are at lower risk of MRONJ (see SDCEP guidance on Oral Health Management of Patients at Risk of Medication- related Osteonecrosis of the Jaw)<\/li>\n\n\n\n<li>Routine extractions where the patient is on a single anticoagulant or where the INR is maintained below 3.5 (see SDCEP guidance on Management of Dental Patients Taking Anticoagulants or Antiplatelet drugs)<\/li>\n\n\n\n<li>Patients with dental problems that require restorative treatment.&nbsp; Ref Help guidance for &#8216;Oral Health Service: Restorative Dentistry&#8217; will be available soon.<\/li>\n\n\n\n<li>Patients for whom a purely radiographic opinion is requested.&nbsp; Please see RefHelp guidance for &#8216;Oral Health Service: Clinical Radiology&#8217; (available soon).&nbsp;<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a rel=\"noreferrer noopener\" href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/medication-related-osteonecrosis-of-the-jaw\/\" target=\"_blank\">Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/anticoagulants-and-antiplatelets\/\" target=\"_blank\" rel=\"noreferrer noopener\">Management of Dental Patients taking Anticoagulants or Antiplatelet Drugs (SDCEP)<\/a><\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/antibiotic-prophylaxis\/\" target=\"_blank\">Antibiotic Prophylaxis (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.baoms.org.uk\/#MainForm\">British Association of Oral and Maxillofacial Surgeons<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.baos.org.uk\/\">British Association of Oral Surgeons<\/a><\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.bsom.org.uk\/home\/\" target=\"_blank\">The British Society for Oral Medicine (BSOM)<\/a>: this website has produced patient information leaflets for a number of oral conditions.<\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"http:\/\/www.bad.org.uk\/\" target=\"_blank\">British Association of Dermatologists<\/a>: patient information leaflets available.<\/li>\n\n\n\n<li><a>International Association for the Study of Pain: <\/a><a href=\"https:\/\/www.iasp-pain.org\/resources\/\">patient resources available<\/a>.<\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.england.nhs.uk\/commissioning\/wp-content\/uploads\/sites\/12\/2015\/09\/guid-comms-oral.pdf\" target=\"_blank\">Guide for Commissioning Oral Surgery and Oral Medicine (NHS England)<\/a><br><br><strong>Primarily for dentists:<\/strong><\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.rcseng.ac.uk\/dental-faculties\/fds\/publications-guidelines\/clinical-guidelines\/\" target=\"_blank\">Guidelines for Selecting Appropriate Patients to Receive Treatment with Dental Implants: Priorities for the NHS (Royal College of Surgeons)<\/a><\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/sedation\/\" target=\"_blank\">Conscious Sedation in Dentistry (SDCEP)<\/a><\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"http:\/\/www.baos.org.uk\/\" target=\"_blank\">British Association of Oral Surgeons (BAOS)<\/a><\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/management-of-acute-dental-problems-madp\/\" target=\"_blank\">Management of Acute Dental Problems (SDCEP)<\/a><\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.england.nhs.uk\/commissioning\/wp-content\/uploads\/sites\/12\/2015\/09\/guid-comms-oral.pdf\" target=\"_blank\">Guide for Commissioning Oral Surgery and Oral Medicine (NHS England)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.bsperio.org.uk\/news\/dementia-friendly-dentistry-good-practice-guidelines\">Dementia friendly dentistry: good practice guidelines<\/a>.<\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/management-of-acute-dental-problems-madp\/\" target=\"_blank\">Management of Acute Dental Problems (SDCEP)<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Oral and Maxillofacial Cancer NHS Lothian complies with the Scottish Referral Guidelines for Suspected Cancer, which include a head, neck and thyroid cancer section.&nbsp; In terms of OMFS cancers, an urgent suspicion of cancer (USC) referral should be made for those with any of the following unexplained clinical features lasting three weeks or more: &nbsp;Red<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3664,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[503],"class_list":["post-4214","page","type-page","status-publish","hentry","category-oral-maxillofacial-surgery"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/oral-maxillofacial-surgery\/\" rel=\"tag\">Oral \uff06 Maxillofacial Surgery<\/a>","rttpg_excerpt":"Oral and Maxillofacial Cancer NHS Lothian complies with the Scottish Referral Guidelines for Suspected Cancer, which include a head, neck and thyroid cancer section.&nbsp; In terms of OMFS cancers, an urgent suspicion of cancer (USC) referral should be made for those with any of the following unexplained clinical features lasting three weeks or more: &nbsp;Red","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4214","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4214"}],"version-history":[{"count":13,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4214\/revisions"}],"predecessor-version":[{"id":26305,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4214\/revisions\/26305"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3664"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4214"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4214"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}