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Head and Neck Oncologic Surgery Fellowship at Legacy Emanuel Hospital in Portland, Oregon

The concept of the head and neck oncologic fellowship at Legacy Emanuel Hospital and Health Center began in 1990 when Dr. Eric J. Dierks left the faculty of the University of Texas Southwestern Medical School to join Dr. Bryce Potter in developing an academically affiliated group practice, Head and Neck Surgical Associates, in Portland, Oregon. With formal training in both otolaryngology/head and neck surgery, as well as oral and maxillofacial surgery, Dr. Potter and Dr. Dierks developed a unique practice that combined expertise in dentistry and medicine and provided the Northwest United States with a community resource for state-of-the-art cancer care, reconstruction, and rehabilitation. They were joined by a talented microvascular surgeon, Dr. Mark Buehler, and together became the first group in Oregon to perform microvascular reconstruction for patients with head and neck cancer. Recognizing a resurgence of interest in oral cancer amongst North American oral and maxillofacial surgeons, they began in 1992 the first fellowship in head and neck oncologic surgery for oral and maxillofacial surgeons. Although other fellowships have since developed, this fellowship continues to be the only one that provides the trainee with extensive experience beyond the oral cavity. As other oral and maxillofacial surgery oncologic fellowship programs evolved to primarily treat oral cavity cancers, the fellowship program at Legacy Emanuel offered experience in all head and neck sites, including the oropharynx, hypopharynx, larynx, and thyroid.

How the Fellowship Program Evolved

The fellowship began on July 1st, 1992 with Christopher Saal, DDS, MD. At that time, most dual-degree oral and maxillofacial surgeons like Chris were not products of integrated six-year M.D. / OMFS residencies. These individuals had completed medical school after their traditional OMFS residency and needed one year of general surgery to be eligible for medical licensure in most states. Therefore, the fellowship program began as a split year of surgical internship, allowing the fellow to spend six months on general surgery and six months on a surgical elective as a head and neck fellow. There was a great deal of overlap, as the fellow would often be able to temporarily leave his general surgery responsibilities and operate additional head and neck cases with us. Eventually, the fellowship evolved into a full year dedicated to clinical head and neck surgical oncology with rotations on medical oncology and radiation oncology.

Additions to the Head and Neck Surgical Associates

In 2003, R. Bryan Bell, MD, DDS, completed the fellowship, joined Head and Neck Surgical Associates, and began actively participating in all aspects of the program.

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Funding Sources

Our first 12-month head and neck fellow began his program in July of 1995. Dennis Youde, the owner of DAY Surgical Products in Black Diamond, Washington, generously stepped forward to personally fund the fellow’s stipend at $30,000 per year. The Dennis A. and Roberta R. Youde Fellowship in Head and Neck Surgery continued for five years, and ended in 2000 when Dennis and Head and Neck Surgical Associates had a very amicable parting of the ways. DAY Surgical Products’ base had shifted away from maxillofacial / head and neck surgery and into neurosurgery and the fellowship no longer made sense from a business perspective. The American Association of Oral and Maxillofacial Surgeons (AAOMS) recognized that the majority of our fellows had subsequently entered full-time academics at a time when academic oral and maxillofacial surgeons were in short supply. Beginning in 2000, the AAOMS funded the complete stipend ($40,000 per year) of the fellow, channeling their funding through the Oral and Maxillofacial Surgery Foundation. In 2006, Legacy Health System, the umbrella organization for Legacy Emanuel Hospital and Health Center, made the generous offer to take over the funding of the fellowship.

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Scope of the Fellowship

Since its inception, the fellowship has involved an extensive operative experience in head and neck cancer and reconstruction, as well as the adjuvant care of the head and neck cancer patient. The fellowship is appropriately termed a "head and neck fellowship" rather than an “oral cancer fellowship.” This is because it is important that the fellows be broadly trained and experienced in the full range of head and neck surgery, not just oral cancer surgery. The surgical caseload regularly includes thyroidectomy, laryngectomy, cervical esophageal surgery, tracheal resection, and other surgeries of the thoracic inlet. Skull base / craniofacial resection surgery, in addition to the steady stream of oral and salivary gland neoplasms, are also performed. The fellowship caseload also involves many benign jaw tumors, which gives the fellow the opportunity to work with residents in oral and maxillofacial surgery. The fellow’s one-year case numbers regularly exceed the average case log for neck dissections and other major head and neck surgery submitted to the American Board of Otolaryngology by their candidates after completion of a five or six year ENT residency. The fellowship also includes a one-month rotation on medical oncology as well as a month of radiation oncology. The fellow enjoys extensive involvement in microvascular free flap reconstruction and most fellows become proficient in microsurgery. Since 1988, Head and Neck Surgical Associates has held the contract for the management of head, neck, and maxillofacial trauma at Legacy Emanuel Hospital, the busier of the two level I trauma centers in Oregon. The fellow regularly participates in trauma surgery along with the OMFS residents.

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Accreditation

The Head and Neck fellowship at Emanuel Hospital is one of a relatively small number of fellowships of any medical or dental discipline to be accredited by an agency empowered by HICFA to confer accreditation status. In awarding accreditation, the Commission on Dental Accreditation stated:

“The clinical fellowship training program in oral and maxillofacial surgery oncology is accredited by the Commission on Dental Accreditation and has been granted the accreditation status of “approval without reporting requirements (1).” The Commission is a specialized accrediting body recognized by the United States Department of Education. The Commission on Dental Accreditation can be contacted at (312) 440-4653 or at 211 East Chicago Avenue, Chicago, IL 60611.”

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Former Fellows

Almost all the former OMFS fellows have entered an academic position upon completion of their fellowship. Most have entered tenure-track, full-time positions and some have joined practices that entail a significant academic commitment involving the training of residents and have a clinical or adjunct academic appointment:

FELLOW	FIRST ACADEMIC POSITION
1. Christopher Saal, DDS, MD	Louisiana State University (clinical) Shabert Hospital, Houma, LA
2. G.E. Ghali, DDS, MD, FACS	Louisiana State University, Shreveport
3. Robert Julian, DDS, MD, FACS	University Medical Center, Fresno, CA
4. Mark Karakourtis DDS, MD	University of Nebraska
5. Randall M. Wilk, DDS, MD, PhD	Univ. of Medicine and Dentistry of New Jersey
6. Thomas Teenier, DDS, MD	Louisiana State University, New Orleans
7. Andrew  W. Baker, BDS(Hons),FDSRCS (Eng), MBChB, FRCS (Eng):	Derbyshire Royal Infirmary, England
8. Jon Holmes, DMD, MD, FACS	University of Alabama
9. Gerold K. G. Eyrich, MD, DMD, PhD	University of Zürich
10. Brian L. Schmidt, DDS, MD, PhD, FACS	University of California, San Francisco
11. R. Bryan Bell, DDS, MD, FACS	Oregon Health & Science University (clinical) Head and Neck Surgical Associates
12. Deepak Kademani, DMD, MD, FACS	Mayo Clinic and Mayo Medical School
13. Kevin Arce, DDS, MD	Oregon Health & Science University
14. David L. Hirsch, DDS, MD, FACS	New York University
15. Anthony Siu-Leung Poon, BDS, MD, PhD	University of Missouri, Kansas City
16. Dimitrios Nikolarakos, MBBS, BDSc, FRACDS(OMS)	St Georges Hospital, London
17. Curtis Gregoire, DDS, MD	University of Dalhousie

To date, the alumni of our fellowship count among them two chairmen of departments and five program directors. Seven of our former fellows are Fellows of the American College of Surgeons and five are fellows of the American Head and Neck Society. Three of our former fellows, Dr. G.E. Ghali at LSU, Shreveport, Dr. Brian Schmidt at UCSF and Dr. David Hirsch at NYU have started oral cancer fellowships at their respective institutions.

Contact the Oral and Maxillofacial Surgery Service

To learn more about head and neck oncology surgery fellowship opportunities at the Legacy Emanuel Hospital and Health Center, contact the Oral and Maxillofacial Surgery Service.

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