Craniomaxillofacial and Trauma Surgery Fellowship

The Head and Neck Surgical Associates (HNSA) and the Head and Neck Institute (HNI) offer a 12- month fellowship in Advanced Craniomaxillofacial and Trauma Surgery (ACMF-Trauma). This fellowship will focus on the development of advanced skills in a variety of areas within craniomaxillofacial surgery and trauma management. The fellowship will be broad in scope, emphasizing major surgery and will include both ample clinical experience as well as research activities. Previously, we have had an occasional fellow in this position depending on availability of funding. We now have funding in place for one fellow per year, in an ongoing basis. We hope the tradition of this fellowship will soon rival that of the long and illustrious history of our other fellowship in Head and Neck Oncologic and Microvascular Reconstructive Surgery.

This 12-month fellowship program is primarily clinical in nature and is based within the Head and Neck Surgical Associates (HNSA) and the Head and Neck Institute (HNI). The HNI is our umbrella organization that links our various hospital, research, patient care and teaching activities, and the HNSA is our practice group and business entity through which patients are seen by HNSA surgeons, fellows and residents. This fellowship is centered at Legacy Emanuel Medical Center in Portland, Oregon and is affiliated with the Providence Cancer Center at the Providence Portland Medical Center and other hospitals (see below). The surgeons and fellows of the HNSA are involved in the teaching of full-time residents in oral and maxillofacial surgery from the Oregon Health & Science University (OHSU) program as well as a variety of other rotating residents including those from the Mayo Clinic, and ENT residents from the OHSU ENT residency program. No actual surgical activities take place at OHSU. The HNSA regularly hosts a number of rotators from other American and foreign OMFS programs with whom the fellow would be involved. The fellow is also involved in the teaching of a variety of externs, as well as medical/dental students from other institutions and foreign countries.

The clinical experience is derived from working within HNSA, which is an academically-affiliated practice of six active oral and maxillofacial surgeons. Dr. Eric Dierks is also board-certified in otolaryngology- head and neck surgery, and a former academic otolaryngologist/head and neck surgeon. He is retired and serves as an emeritus faculty member. Dr. R. Bryan Bell has also completed this fellowship in craniomaxillofacial trauma as well as the HNSA fellowship in head & neck oncologic surgery. Dr. Allen Cheng and Dr. Ashish Patel have completed the HNSA two-year fellowship in head & neck oncologic surgery and microvascular reconstructive surgery. Dr. Caitlin Magraw completed a fellowship in Cleft and Craniofacial Surgery at Arnold Palmer Hospital for Children. Dr. Baber Khatib completed our fellowships in advanced craniomaxillofacial surgery and microvascular reconstructive surgery. Dr. Lance Thompson, our newest member, completed a fellowship in Cleft and Craniofacial Surgery in El Paso, Texas.

Legacy Emanuel Medical Center is a 407 bed hospital that serves as the busiest level I trauma center for the state of Oregon and surrounding areas. It is a tertiary care referral center for a variety of disorders. It is affiliated with the orthopedic Biomechanical Research Center, which is the site of origin of rib plating for flail chest injuries, the Pelvic Sling and other innovations in trauma care that are now used internationally. The affiliated Randall Children’s’ Hospital is the largest and busiest pediatric hospital in Oregon. Emanuel is the site of the Oregon Burn Center, which is the only burn center in Oregon. Emanuel receives rotating general surgery and other residents from OHSU and several other institutions. Emanuel is home to a residency in internal medicine.

For the last 30 years, the HNSA has been the single service responsible for all craniomaxillofacial trauma, working closely with general and vascular surgery, neurosurgery, etc. Unlike most other trauma centers, Emanuel has no rotating call schedule for OMFS, plastics and ENT. It is HNSA on call 24/7/365.

Legacy Good Samaritan Hospital is the designated cancer center for the five hospital Legacy system in the greater Portland area. The HNSA will increase its activities at Good Samaritan during 2016-2017, under the direction of Dr. Allen Cheng. Non-oncologic surgery also takes place at Good Samaritan.

Providence Portland Medical Center is a 483 bed hospital where the HNSA is the designated head and neck oncology service and Dr. Ashish Patel directs their Oral/ Head and Neck Cancer program and clinic. The Providence Cancer Center facilitates regional cancer services for a health system that treats more than 4000 cancer patients annually, and houses a dedicated head and neck cancer clinic, which is directed by Dr. Patel. The Robert W. Franz Cancer Research Center, part of the Earle A. Chiles Research Institute (EACRI) within the Providence Cancer Center is a world-class research program and one of only a few research centers in the country focusing exclusively on immunotherapy. Dr. Bell and his colleagues in the Oral/Head and Neck Cancer Program are collaborating the translational immunologists at the EACRI to develop innovative treatment strategies that trigger the immune system to fight head and neck cancer.

Providence St. Vincent Medical Center is a 523 bed hospital where Dr. Caitlin Magraw is actively developing a practice in cleft and craniofacial surgery.

The clinical activities will include hands-on involvement in the following areas:

Craniomaxillofacial trauma: ranging from frontal sinus/skull base fractures to penetrating tracheo- esophageal injuries. The HNSA manages all of the CMF trauma at our Level 1 trauma center, Legacy Emanuel, which is the busiest Level 1 Trauma Center in Oregon. The fellow will work frequently with major trauma including the use of intra-operative CT scanning and navigation. Large and avulsive soft tissue injury management is also included.

Head and neck cancer and benign tumor surgery: The HNSA surgeons perform approximately 150 neck dissections per year along with a wide variety of various resections such as glossectomy, mandibulectomy, maxillectomy, orbital exenteration, etc. Trans Oral Robotic Surgery (TORS) is routinely performed by HNSA surgeons. Although the HNSA is the site of a two-year fellowship in Head and Neck Oncologic and Microvascular Reconstructive Surgery, the goal of involvement of the ACMF-Trauma fellow in this type of surgery is to develop comfort in surgery in the neck as well as major resections. There is no better way to develop skill and comfort in surgery of the neck than to learn techniques in neck dissection. Our objective is for our fellows to complete the year feeling comfortable with performing a neck dissection.

Airway management: HNSA is the airway consult service at Emanuel and we perform a large number of tracheostomy and its variations including emergency airway management. The ACMF-Trauma fellow will become very comfortable with tracheotomy.

Reconstructive surgery of major oral/head and neck defects, including microvascular reconstructive surgery. The HNSA surgeons perform at least 60 microvascular free flaps per year in addition to a variety of pedicled and other conventional flaps. These are the most challenging of all head and neck reconstructions. Our objective is for our fellows to finish the year feeling comfortable planning reconstruction of complex composite facial defects (using virtual surgical planning, CAD/CAM surgical guides, navigation, and intraoperative CT), elevation and use of pedicle flaps, and exposure to elevation of free flaps.

Orthognathic and Sleep apnea surgery: Although currently this is a lesser part of the fellowship, this will include involvement in “plasterless” computer modeling to plan orthognathic surgery and intraoperative surgical navigation. There is also a growing practice of placement of upper airway stimulators (Inspire).

The research activities will be coordinated through the HNSA/HNI and will comprise approximately 10% of the fellow’s time. Research activities can involve and will be directed by any of the HNSA surgeons. It is anticipated that the fellow will complete at least 2 clinical research papers involving topics related to CMF trauma, reconstructive surgery, or other topics of interest during the fellowship year.

The clinical experience is gained by working with the members of the HNSA, Drs. R. Bryan Bell, Allen Cheng, Ashish Patel, Caitlin Magraw, Baber Khatib, and Lance Thompson well as with the Legacy Emanuel trauma surgeons. Dr. Eric Dierks is an emeritus faculty member, and participates in didactics but is, for the most part, retired from clinical practice. The HNSA/HNI service is a very busy one and its members operate at the above-noted facilities, often with multiple operations occurring simultaneously.

Although the fellowship is based at Emanuel, the Fellow will participate in clinical activities at all of the above sites. The HNSA/HNI also is the home of a two year fellowship in Head and Neck Oncologic and Microvascular Reconstruction. The ACMF/Trauma Fellows will work interactively with other Fellows and with the OHSU and other rotating residents, various other rotators and visitors, as well as with other members of the Emanuel Trauma Department. This program is not a part of Oregon Health and Science University (OHSU) and none of the clinical activities occur at the OHSU Hospital.

In addition, the fellow is to also gain experience as a junior faculty member, supervising the resident surgeons in management of patients with less advanced or complex problems.

There is no accreditation mechanism currently available for this fellowship and it is not accredited. As with most fellowship programs, this is not an ACGME position.

The ACMF/Trauma Fellow will:

1. Work interactively with the other fellows and residents in a communal learning environment. The ACMF-Trauma fellows will rotate the responsibility of directing the daily and weekly activities of the team for non-oncologic surgery.
2. Undertake and complete clinical research projects related to trauma. Other academic productivity such as continuation of on going studies is a part of the fellowship.
3. Provide OMFS/Head and Neck resident-level call coverage in a rotation with the OMS residents.
4. The fellow will be a fully credentialed OMS at Legacy Emanuel. For cases that are deemed suitable by the attending surgeon, the fellow will be the staff surgeon assigned the case and function as a junior faculty for the resident.

If selected for this position, you will be required to agree to an understanding not to compete with the HNSA upon either completion of the fellowship or upon termination. This fellowship is not subject to the 80-hour work week.

The annual salary is comparable to that of a PGY-5 general surgery resident with standard health insurance coverage. In addition, a separate collections based reimbursement schedule for procedures staffed by the fellow (as a junior faculty) will supplement this annual salary.

1. Fluency in the English language.
2. US citizenship or US green card. Canadians who are eligible for an H1B visa may apply.
   Unfortunately, at this time we cannot consider other foreign candidates.
3. Eligibility for medical or dental license in the state of Oregon.
   Single-degree dental applicants are eligible to apply for this fellowship, however, single-degree medical are not. Either an Oregon medical OR dental license MUST be obtained PRIOR to starting fellowship. Please be sure to review the Oregon Medical Board and Oregon Dental Board requirements for licensure.
4. Completion of a residency in oral and maxillofacial surgery prior to the commencement of the fellowship.

The fellow will be expected to have acquired these items prior to commencement of the fellowship:

1. Surgical loupes: 2.5 or 3.0 X recommended
2. A modern digital camera. A macro lens and ring flash are helpful. A camera with an articulating view finder and the ability to take photographs using live view is especially helpful.
3. Either an Oregon medical OR dental license MUST be obtained PRIOR to starting fellowship. Once the fellowship position is secured, application for licensure should be submitted as soon as possible, as it can take months for licensing to go through. Please be sure to review the Oregon Medical Board and/or Oregon Dental Board for requirements for licensure. No clinical activity can start until a license is obtained.

It is our intent, as well as the Legacy and Providence Hospital systems, that individuals who have completed this fellowship program go on to advance and disseminate the knowledge and experience gained during the fellowship by entering an academic position, or a similar position of major surgery and teaching, upon completion of the program. The HNSA | HNI have a strong tradition of producing leading academic surgeons. The HNSA has previously, on occasion, hosted CMF Fellows and we have seen several of these fellows go on to outstanding academic/clinical careers.

If you meet and agree to the criteria listed above, please send us the following in electronic format (pdf preferred):

1. A copy of your current Curriculum Vitae with a recent photo attached.
2. A letter describing your interests and your future plans after completion of your training. We are particularly interested in how you plan to utilize the experience the fellowship would offer you.
3. Two letters of reference:
   one from your residency chairman or program director
   one from another colleague or mentor.

A current list of the names, telephone numbers, and other contact information of former Portland fellows is listed below and any of our former or current fellows would welcome an inquiry regarding the program.

Interviews can be arranged at almost any time in Portland and/or can be done at the AAOMS annual meeting. Notification of acceptance in made on a rolling basis and is usually complete by January 1st of the year that the fellowship would begin, if not sooner.

If you have any further questions please contact Allen Cheng MD, DDS, FACS – Fellowship Director