02.05.01

By Kevin Crossett

It happens all too often.

A late-night traffic accident calls out emergency crews to treat and transport injured people to the emergency room for immediate care. Broken legs, contusions and lacerations are attended to while the ambulance transports the patients to the hospital for an examination by a doctor's trained eye.

But what about people with facial injuries - those with missing teeth, or worse yet, a broken jaw that requires specialized surgery?

Often the last thing on a patient's mind is whether the law permits a board certified oral surgeon to operate on his injuries - fixing jaws as well as reconstructing damaged facial features, such as eyes or ears.

Over the past 50 years, the specialized dental field known as oral and maxillofacial surgery has evolved from primarily dental surgery to treatment of the entire face, according to a report presented to Virginia's General Assembly by the Virginia Dental Association and the Virginia Society of Oral and Maxillofacial Surgery.

All of this is legal, said Sen. Warren E. Barry, R-Fairfax, referring to the surgery done to repair other damaged facial regions.

The problem some have, he said, comes after oral surgery when the doctor performs matching surgery to an undamaged area for cosmetic purposes - such as matching the work done on an undamaged eye to provide symmetry to the patient's face.

Some plastic surgeons who specialize in re-constructive facial surgery both for cosmetic as well as for more serious problems think oral surgeons should stay within their limits – the mouth of the patient.

"It's a turf battle," Barry said, referring to a controversial bill slowly drilling its way through the Virginia General Assembly that would clarify the definition of dentistry to include maxillofacial surgery - specialized surgery pertaining to the jaws and face - as part of their duties.

"The way the definition is now dentists can only work in the oral cavity," Barry said, adding that under current law, dentists are limited to treating disease and injury to teeth and the surrounding supporting structures.

People who do complicated bridge work must also restore eyes, ears and noses of patients, said Ronald Tankersley, an oral surgeon practicing in Newport News and part-time instructor at the Medical College of Virginia, speaking to the Senate Education and Health Professions Subcommittee.

Virginia's definition of dentistry goes back to the 1950s as part of the Virginia Dental Practice Act, which only specifically covers the prevention, diagnosis and treatment of diseases and injuries to the oral cavity.

"Under the present definition," Barry said, "the oral surgeon is breaking the law," adding that the bill would reflect the practices already being done by oral surgeons through clarification of the legal definition – bringing it up to contemporary standards.

The new definition, as outlined in his bill, would include surgery of areas pertaining to the jaws and face as well as adjacent and associated structures.

One of the bill’s main opponents is Andrew Roth, a plastic and re-constructive surgeon from Roanoke, who spoke against it in front of the subcommittee.

In a prepared statement, he said that certain procedures, such as surgical eyelid enhancement, facelifts and skin cancer surgery, should be performed only by doctors who are trained to recognize the complications of cosmetic surgery.

"Cosmetic surgery is still surgery," he said, "and doctors remain the only true patient advocates in this arena."

Dental practitioners disagree, citing examples that maxillofacial surgeons are licensed in Virginia to perform operations such as bone grafting to reconstruct a patient’s facial features – often going to the hip to harvest bone for victims suffering from a smashed jaw.

Both professions require about the same amount of education – between eight and 11 years. Plastic surgeon residencies spend three years studying general surgery before moving to more specialized training designed specifically for their profession.

Maxillofacial residents, by comparison, divide their time into surgical rotations – concentrating in many different areas ranging from general surgery to anesthesia – followed by two years concentrating specifically on oral surgery.

Oral and plastic surgeons specialties crossover one another, Barry said. The methods of rebuilding the facial structures of a patient remain the same whether performing maxillofacial or purely cosmetic surgery.

"It’s a friends versus friends fight," said Sen. R. Edward Houck, D-Spotsylvania, adding that he thinks the parties can reach a compromise.

Committee members have delayed voting on the bill to allow both sides one last time to address each other’s concerns and reach compromise.

If the bill fails to come out of committee before the Feb. 7 crossover date. then both sides must either wait another year to reintroduce the legislation, or tack the measure onto another bill as an amendment.

The crossover date marks the time when each chamber reviews and votes on the other’s legislation. A bill must pass on both sides of the Capitol before it goes to the Governor.

The most important factor, Houck said, remains the welfare of Virginians.