|Year : 2017 | Volume
| Issue : 2 | Page : 182-186
Perception of oral and maxillofacial surgery specialty among physicians in Sokoto, Northwest Nigeria
Ramat Oyebunmi Braimah1, Abdurrazaq Olanrewaju Taiwo2, Adebayo Aremu Ibikunle1, Olalekan Micah Gbotolorun3, Mike Adeyemi3
1 Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Surgery, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
3 Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
|Date of Web Publication||15-Dec-2017|
Ramat Oyebunmi Braimah
Department of Dental and Maxillofacial Surgery, Usmanu Danfodio University Teaching Hospital, Sokoto
Source of Support: None, Conflict of Interest: None
Background: Oral and maxillofacial surgery (OMS) evolves from the anatomical region within the head and neck region. Contrary to common belief, its scope does not start and end with teeth. This study is to assess the awareness of physicians in Sokoto, Northwest Nigeria, about the scope of practice of OMS. Materials and Methods: This is a prospective cross-sectional study carried out during annual general meeting of the Nigerian Medical Association in Sokoto. This is the largest gathering of physicians in the state. Data were stored and analyzed using IBM SPSS Statistics for Windows version 20 (IBM Corp., Armonk, NY, USA) and results presented in simple descriptive statistics and frequencies only. Results: One hundred and twenty-five questionnaires of the 150 distributed were returned and analyzed with a response rate of 83.3%. The analysis showed that there is high awareness of the respondents about the scope of oral and maxillofacial surgeons (OMFS) in facial bone fracture, jaw deformities, orofacial tumors, and temporomandibular joint ankylosis (81.0%, 88.1%, 88.1%, and 82.5%) respectively. There is, however, low awareness about its scope in sinus problems, cleft lip and palate, and esthetic facial surgery (9.5%, 12.7%, and 14.3%) respectively. Conclusion: The awareness of the scope of OMS practices needs to be increased among physicians, especially in cleft lip and palate, sinus problems, and esthetic facial surgeries. It is imperative as OMFS specialty to raise awareness of our specialty among physicians.
Keywords: Awareness, oral and maxillofacial surgeon, oral and maxillofacial surgery, perception, physicians
|How to cite this article:|
Braimah RO, Taiwo AO, Ibikunle AA, Gbotolorun OM, Adeyemi M. Perception of oral and maxillofacial surgery specialty among physicians in Sokoto, Northwest Nigeria. Arch Med Health Sci 2017;5:182-6
|How to cite this URL:|
Braimah RO, Taiwo AO, Ibikunle AA, Gbotolorun OM, Adeyemi M. Perception of oral and maxillofacial surgery specialty among physicians in Sokoto, Northwest Nigeria. Arch Med Health Sci [serial online] 2017 [cited 2018 Sep 22];5:182-6. Available from: http://www.amhsjournal.org/text.asp?2017/5/2/182/220824
| Introduction|| |
Oral and maxillofacial surgery (OMS) is a specialty that is responsible for the diagnosis, clinical and surgical treatment of tumors, traumatic, congenital, developmental lesions, and infection in the maxillofacial complex. The first indigenous OMFS by examination in Nigeria came on board in 1985. Since then, OMFS has continued to be produced, and currently, there is a little <100 OMFS serving a population of over 170 million. Studies have shown that the general public in other countries has a low awareness concerning OMS, other studies have identified similar trend among physicians.,,, It is important that physicians should have knowledge and understanding about the scope of the specialty for appropriate referral and optimal patients' management. There is paucity of such study in Nigeria, especially Northwest region, hence the present study aimed at finding out the awareness among physicians about the specialty of OMS and to identify clinical conditions in which medical colleagues may misjudge the role of an OMFS in Sokoto, extreme Northwest Nigeria.
| Materials and Methods|| |
This prospective cross-sectional study was conducted in Sokoto, Northwest Nigeria, to assess the current awareness levels of the specialty of OMS in Nigeria. One hundred and fifty validated questionnaires [Table 1] were distributed during the opening ceremony and scientific sessions of the 5th Annual General Meeting and Scientific Conference, Nigerian Medical Association, Sokoto State branch in July 2016. Study duration was 3 days. This conference is the largest gathering of physicians in the state. Inclusion criteria were participants that are house officers, medical officers, registrars and consultants, whereas nurses, other paramedical professionals, and guests were excluded.
|Table 1: Questionnaire on perception of scope of oral and maxillofacial surgery|
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Data were stored and analyzed using IBM SPSS Statistics for Windows Version 20 (IBM Corp., Armonk, NY, USA). Results were presented as simple descriptive statistics and frequencies. A P < 0.05 was considered statistically significant.
| Results|| |
One hundred and twenty-five questionnaires of the 150 distributed were returned and analyzed with a response rate of 83.3%. The analysis showed that there is high awareness of the respondents about the scope of OMFS in jaw deformities, orofacial tumors, temporomandibular joint (TMJ) ankylosis, and facial bone fracture (88.1%, 88.1%, 82.5%, and 81.0%), respectively [Table 2]. There is, however, low awareness level about its scope in sinus problems, cleft lip and palate, and esthetic facial surgery (9.5%, 12.7%, and 14.3%), respectively [Table 2]. Salivary gland diseases management between the OMFS and the ENT surgeons showed a balanced response rate (43.7% and 37.3%), respectively [Table 2]. Responses from the physicians as to which other specialities are preferred to OMFS in management of these conditions are shown in [Table 3]. P values and confidence intervals are presented in [Table 4].
|Table 3: Physicians who preferred other specialists to treat the complaints|
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| Discussion|| |
The OMS specialty serves as a link between medical and dental fields in resolving many clinical problems in the head and neck regions. The OMFS is perceived as a “surgeon” by the dental professionals while they are thought of as dentists by the medical professionals. The specialty of OMS is still immature despite its 30 years of existence in Nigeria, especially Northwest Nigeria where the only dental school is still at infancy. Since the formation of the American Association of Oral and Maxillofacial Surgeons in 1918, the scope of the specialty has continued to evolve from oral surgery to craniofacial surgery with services ranging from complex facial reconstruction following tumor ablation using local flaps and microvascular free tissue transfer, cleft lip/palate repair, facial infection management, salivary gland surgery, skeletal deformities of the craniofacial region including TMJ disorders, esthetic facial surgery, and rhinoplasty.,,
Despite this evolution over the past 90 years, physicians and the general public are still unaware of its scope. In Africa, especially Sub-Saharan, awareness is low, probably because of very few dental schools. Vadepally et al. have reported a similar lack of awareness in Hyderabad in India. It is important that the general public and physicians are aware of the scope of OMS because an informed health-care professional will refer to the appropriate specialist which will lead to efficient delivery of quality health-care services.,
This study demonstrated that >80% of the physicians in the region are aware of the role of OMFS in the treatment of facial bone fracture management [Figure 1]. These findings have been reported by Rocha et al. and Jarosz et al. in Brazil and New Jersey, respectively. In contrast, Vadepally et al. in India reported low awareness (14%) where the casualty refers oral and maxillofacial cases to other physicians. We opined that this may be due to the high involvement of the specialty in Sokoto in both clinical and academic activities.,,
Jaw deformities pose a great challenge to the surgeon because orthognathic surgical procedures may be required in correcting such facio-dental abnormalities. This complex surgical procedure requires a multidisciplinary approach to include orthodontists, periodontologists, and prosthodontists. The OMFS will mostly be qualified to give the patient a good esthetic outcome and at the same time securing good occlusion for mastication. Our finding revealed that there is a high awareness of the strategic role of OMFS in managing this condition (88.1%). This is in contrast to other studies where there is a lack of awareness as the physicians will prefer plastic surgeons to handle such cases.,
The current study also highlighted high (88.1%) preference for OMFS in managing oral tumor contrary to the study by Al-khatib et al. in Saudi Arabia where there is low awareness. Despite this high awareness among physicians, patients still present at advanced stage of the tumor. We speculate that presentation to unorthodox traditional practitioners in this region might be a contributing factor to this late presentation. Furthermore, ignorance on the part of patients and relatives about whether there are specialists that can manage such conditions can lead to late presentation.
It is also interesting to know that many of the respondents are aware of the role of OMFS in the management of TMJ ankylosis (82.5%). This finding is in contrast to Vadepally et al. where there is low awareness. The TMJ is a complex joint with many associated structures, whose symptoms are diverse in terms of location.
In facial infection management, the present study showed a moderate awareness (59.5%). This is contrary to study in India where ENT, plastic surgeons, and general surgeons are preferred due to the fact that these three specialities were also responsible for treatment of facial infection in the past. Most of facial space infections are secondary to odontogenic origin and its sequelae, hence the high involvement of the OMFS. This response rate in the present study is not surprising as the physicians are aware of the active role of OMFS in facial infection management in this region.,,,
The finding of this study also revealed preference for management of salivary gland lesions by OMFS (43.7%). This might be attributed to the success track record of the specialty in optimally managing such cases generally.,,
However, the study observed that the physicians lack awareness about OMS specialty, especially in management of cleft lip and palate, sinus problems, and esthetic facial surgery [Figure 2]. This poor recognition of the scope of OMS specialty by the physicians has been consistent with other studies.,,, Cleft lip and palate management involve multidisciplinary approach spanning through neonatal period to early adulthood. OMFS traditionally has played a vital role in the correction of dentofacial deformity.
It is intriguing that in this research most physicians would prefer a general dentist (51.6%) to extract the third molar than OMFS (43.7%). This may be due to the fact that most of them are unaware that the OMFS is better suited for management of this condition that is intensely trained and can give satisfactory treatment.
This study has highlighted the perceived awareness of the scope of OMS in Northwest Nigeria, however, because the study was conducted only in the northwest region of Nigeria, it may not represent the perceived scope of the entire physicians in Nigeria. Furthermore, there may be deliberate miss information by the respondents.
It is also interesting to note that this study has made known ENT and plastic surgeons to be the greatest competitor in the management of cases closely related to the scope of the OMS. A future research direction is to compare the awareness of physicians about the scope of OMS to that of the general public in other regions of Nigeria.
To the best of our knowledge, no study has been carried out on perception of scope of OMS in Nigeria where there could be basis for comparison; however, this study will serve as a baseline study where future research can be based on. Furthermore, more studies need to be carried out in other regions of Nigeria, especially where there are many oral and maxillofacial surgeons.
| Conclusion|| |
The current study demonstrated a high-level awareness among physicians in the northwest region of Nigeria on the leading role of OMFS in managing facial bone fracture, facial infections, jaw deformities, orofacial tumors, and TMJ ankylosis. However, there is serious need to increase awareness among physicians in other conditions such as cleft lip and palate management, sinus problems, and esthetic facial surgeries. Hence, to achieve this objective, we recommend expansion of medical curriculum to incorporate OMS posting during training. In addition, establishment of dental schools in all existing medical schools will further increase awareness of this noble speciality. Furthermore, there is need to sustain and increase awareness regarding the wide scope of work performed by the OMFS through advertisement, conferences, and workshops.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]