The resident has the opportunity to learn general anesthesia in the uncomplicated setting with close staff guidance. Personal awareness of the subject can increase the types of cases handled. Cases handled include those in Oral and Maxillofacial Surgery, GU, Gyn, Orthopedic, ENT, Plastic Surgery, General Surgery, Ophthalmology and limited Pediatric, Neurosurgery and Vascular Surgery. As experience is gained, cases involving more complicated surgery and less healthy patients can be requested and are assigned. The majority of these cases require knowledge of specific monitoring techniques of which there is an abundance of case material.
Besides general anesthesia, the interested individual can learn a variety of regional block techniques primarily used for OB and orthopedic purposes.
Daily conferences on specific subjects of interest in anesthesia are attended. A weekly conference is also held to expound upon complications, which have occurred during the preceding week.
Regardless of specific areas and interests an individual wishes to pursue, a thorough knowledge of intubation and anesthetic pharmacology is achieved when dealing with a variety of medically compromised patients.
This rotation involves 12-hour shifts, six days a week, and is an intensive learning experience. Usually 4-6 doctors are on each 12-hour shift. All trauma and trauma-related complaints are triaged to the accident room.
In major trauma cases, the resident functions as a team member in initial evaluation and stabilization. Management of these life-threatening problems is included within the team. Acute non-life-threatening problems are dealt with on a one-to-one basis, where the resident treats or works up the patient for consultation or admission.
Minor trauma is dealt with by assignment with treatment and release reviewed by charge residents.
Skills learned in the accident room include physical evaluation, rapid assessment procedures, advanced life support, central and peripheral IV's, intubation, and suturing.
While rotating on the general surgery service residents function exclusively as a general surgery resident. Comprehensive patient care is assumed by the resident in the emergency room, operating room, outpatient clinics, intensive care units and the floor. Residents actively participate in emergent as well as elective cases in the operating room. Resident rotations while on the general surgery service also include all subspecialties of surgery. Residents may have the opportunity to rotate in general surgery, trauma surgery, ICU, vascular surgery, cardio-thoracic surgery, plastic surgery, pediatric surgery, surgical oncology, colo-rectal surgery and burn surgery. Residents gain valuable experience on surgical technique as well as management of critically ill patients. As always, call for any service will be covered on a regular basis and may be in-house call or home call depending on the rotation.
The rotating residents assume many of the responsibilities of a neurosurgery resident, taking first call every fourth night and house call (on Tulane admit nights) every fourth night. Patient care on the wards, including the intensive care unit, provides the residents experience with critically ill patients and patients who have suffered complicated head trauma. The residents actively participate in the operating room in emergency and in elective cases. Many tracheostomys are performed by the oral and maxillofacial surgery resident on the service. By providing an active role on the neurosurgery service, the oral and maxillofacial surgery resident gains valuable insight into care and diagnosis of patients with neurosurgical problems.
Oral & Maxillofacial Surgery - ILH
The University Hospital rotation is the major teaching service in oral and maxillofacial surgery. There are usually 5-6 residents on service at a time. The call schedule is staggered with first year residents taking calls 8-10 times a month; 2nd year residents 7-8 times a month; 3m year residents 6-7 times a month; 4th year 5-7 times a month.
The outpatient service sees 15,000 patients a year. The inpatient service operates 4 full days a week. The scope of surgery is vast and includes all aspects of trauma, reconstruction, TMJ, pathology, pre-prosthetic, orthognathic, salivary gland and infection type surgery.
The outpatient clinic is segmented into general clinics, work-up clinics, and sedation clinics.
The residents have primary care of all patients on this service. There are staff rounds daily to aid in patient evaluation.
First, Third, Fifth and Sixth Years
Oral & Maxillofacial Surgery - Our Lady of the Lake (OLOL)
The rotation at Our Lady of the Lake, an hour from New Orleans, is an out-of-town stay, where in the Oral and Maxillofacial surgeon is the primary consultant for all facial trauma and pathology in that hospital. Surgery involves all types of facial fractures including dental, mandibular, Lefort I, II and ill with isolated zygomaticomaxillary complex fractures, and naso-orbital ethmoid fractures. Close cooperation with the Pathology Department allows a combined approach to the interpretation of all forms of oral and facial neoplasms. Surgery of head and neck malignancies often occurs in concert with the General Surgery Department.
Four Board certified OMFS staff actively participate in training of the residents at OLOL and at private hospitals in the Baton Rouge area. Orthognathic surgery comprises a large percentage of surgical cases and a weekly conference with staff provides necessary input into surgical treatment planning. The resident is intimately involved in all orthognathic and reconstruction work-ups and assists at all major surgical procedures on staff cases and private hospitals as well. Cosmetic experience is gained at OLOL and the Williamson cosmetic center.
All forms of dentoalveolar surgery and pre-prosthetic surgery are conducted at OLOL. Maxillary and mandibular osteotomies with bone grafts and skin grafts are utilized to facilitate normal ridge relations.
Temporomandibular joint pathology and internal derangements cases are done with contemporary techniques. Cosmetic surgery experience is gained at both the Williamson Cosmetic Center and OLOL Hospital.
The resident is encouraged to attend all major seminars at the main teaching center and gives lectures on Oral and Maxillofacial Surgery to the hospital staff. Teleconferencing with the New Orleans residents occurs on Tuesday night seminars.
Fourth and Sixth year
Oral & Maxillofacial Surgery - Carolina Healthcare System, Charlotte, NC
The rotation in Charlotte, NC is a combined hospital/private practice experience. Hospitals covered by the resident include Carolina's Medical Center, University Hospital, the Presbyterian Hospital in Charlotte, and Northeast Medical Center in Concord. Five Board Certified Oral and Maxillofacial surgery staff actively participates in training of the residents and provide clinical and didactic instruction.
Orthognathic surgery is a major component of this experience, representing 150-200 cases per year. The resident is intimately involved in the treatment planning, surgical work-up, surgery, and post-operative management of these patients. One-on-one staff instruction is provided for each case.
Management of temporomandibular disorders is also a large part of this experience. Nonsurgical management includes splint and pharmacologic therapy "oral medications and botox muscle injections", and office management with physical therapy. Surgical procedures range from arthrocentesis - arthroscopy - arthroplasty, including total joint reconstruction.
All aspects of hard and soft tissue pre-prosthethic surgery including bone frats and sinus lifts are perfonned both as outpatients and inpatients. A variety of implants systems are utilized for broad exposure to this aspect of treatment.
Facial cosmetic surgery is also currently available on a limited basis. Trauma and advanced dentoalveolar surgery round off this experience. Ambulatory anesthesia is perfonned routinely on all types of patients from the pediatric to geriatric age groups. The resident is give the option to pick and choose available experiences during their stay, since many times there will be more than one activity running simultaneously.
The resident is provided with housing and is expected to take call on a regular basis for both office and hospital cases. Leave time is available by request.
Oral & Maxillofacial Surgery - LSU School of Dentistry
The resident's rotation at the School of Dentistry encompasses the full scope of oral and maxillofacial surgery. Working independently in the outpatient clinic as well as closely with all the full time oral and maxillofacial surgery staff through the Intramural Practice, the resident picks up the necessary expertise to be able to handle a busy office/hospital practice. He is responsible for the outpatient clinic at the LSU School of Dentistry, which provides a wide range of dentoalveolar and implant surgery plus oral pathology. A significant number of cosmetic, orthognathic, and TMJ cases are done in the outpatient clinic at LSUSD before Katrina and Metairie Houma office after Katrina. In addition, he will actively participate in the preoperative, operative, and postoperative evaluation and management of all inpatients seen in the Oral and Maxillofacial Surgery Faculty Practice. The LSU faculty operates at all affiliated hospitals – EJGH and Children's.
Inpatient exposure encompasses a wide spectrum of orthognathic, TMJ, pre-prosthetic, and trauma procedures perfonned in a private practice setting. Also, by virtue of the reputation of the Oral and Maxillofacial Surgery staff, the Faculty Practice acts as a referral center especially for difficulty TMJ cases requiring major reconstruction and a combination of orthognathic surgery and craniofacial surgery.
Fifth and Sixth year
Oral & Maxillofacial Surgery Exchange Program (Optional)
During the residency program, a resident may wish to combine travel with education by participating in an exchange with a foreign resident who may have similar desires. Rotations are approved only if the LSU resident's experience and responsibility opportunities in the foreign country are at least equivalent to those at LSU. The opportunities for this are available if investigated well in advance and may include such diverse locations as Australia, Great Britain, Germany, etc. If interested a resident must express this interest early in the third year so all the necessary arrangements may be made.