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Oral and maxillofacial surgery: Perception of its scope among the medical
fraternity and general public

Article · January 2015


DOI: 10.4103/2278-9588.151898

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Original Article

Oral and maxillofacial surgery: Perception of


its scope among the medical fraternity and
general public
Ashwant Kumar Vadepally, Ramen Sinha, Uday Kiran Uppada, Rama Krishna Reddy BV, Anmol Agarwal
Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Opposite Siva Sagar, Kothrepally,
Vikarabad, Telangana, India

ABSTRACT
Purpose: The study was intended to evaluate the existing perceptions about the specialty of oral and maxillofacial
surgery (OMFS) and to promote its awareness among the medical professionals and the general public.
Materials and Methods: A  questionnaire listing ten clinical situations was designed. It was given randomly to
100 medical professionals and 500 members of the general public. They were asked to choose the appropriate
specialty that they would prefer to approach for undergoing treatment of certain specific conditions related to the
head and neck regions.
Results: The results were compiled and tabulated and the data analysed. The current status pertaining to the
perception about the specialty was not promising. Only 30% of the medical professionals and 7% of the general
public had ever approached an oral and maxillofacial surgeon (OMS) directly.
Conclusion: The specialty of OMFS is critical for addressing several medical and surgical issues. There is a need to
promote and increase awareness regarding a large spectrum of work that is being carried out by OMS’s in order to
enhance better patient care and outcome.
Keywords: Awareness, general public, medical doctors, oral and maxillofacial surgeon, oral and maxillofacial surgery

INTRODUCTION life by providing better function and aesthetics. In the


The term ‘oral and maxillofacial surgery’ (OMFS) Indian scenario, OMFS as a specialty till date is far
evolves from the anatomical region with removed in the thoughts of medical professionals
which it deals. Contrary to common belief, the and the general public.[1] It is well documented that
work performed by an oral and maxillofacial medical professionals and the general public in
various other countries across the globe too have
surgeon (OMS) does not start and end with teeth.
a low awareness pertaining to OMFS.[2‑5]
It expands to incorporate procedures that are life
saving, as well as those that enhance the quality of Our medical and dental colleagues need to have
Access this article online
a basic knowledge of the specialty to make informed
Quick Response Code:
Website:
decisions regarding patient management.[6] Equally,
the general public would benefit from knowing what
www.craniomaxillary.com OMFS can offer so that they can request appropriate
DOI: referrals.[3] The present study undertook such an
endeavour to analyse several aspects regarding
10.4103/2278-9588.151898
awareness among medical professionals and the

Correspondence to:
Dr. Ashwant Kumar Vadepally, Department of Oral and Maxillofacial Surgery, Opposite Siva Sagar, Kothrepally, Vikarabad - 501 101, Telangana, India.
E‑mail: drashwantkumar@gmail.com

Journal of Cranio-Maxillary Diseases / Vol 4 / Issue 1 / January 2015 21


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Vadepally, et al.: Perception of oral and maxillofacial surgery

general public about this specialty in Hyderabad, Demographic data relating to age and gender were
mimicking the Indian scenario. also collected. The respondents in both the groups
were chosen randomly.
MATERIALS AND METHODS
This study was conducted in and around RESULTS
Hyderabad Metropolitan City, Telangana, India, A total number of 5000 (10 × 500) replies from
to assess the current awareness levels of the general public and 1000 (10 × 100) replies from
specialty in the Indian society. A questionnaire medical professionals for different clinical situations
comprising 10 clinical situations was designed presented in the questionnaire, were obtained and
and given to two groups of people by hand are depicted in Tables 2 and 3. The age range
and personal interview as delineated in Table 1. was similar in both the groups. The mean ages
Group ‑ I comprised of 100 doctors belonging to for medical professionals and general public were
various allied specialties and Group ‑ II comprised 38 and 36 years, respectively. The sex distribution
of 500 members of the general public with a showed that men were the predominant gender in
minimum qualification of graduation, working both medical professionals (68%) and the general
in different fields such as education, banking, public (62%).
multinational companies, government, business,
and engineering. Graduation level education was The results were unexpected. There was a
the sole inclusion criterion. general lack of awareness in both the groups
about the specialty pertaining to the spectrum of
The subjects were asked to mark a tick () against work that is being carried out by OMS’s. Only 30%
the specialty they thought was the most appropriate of medical professionals and 7% of the general
to deal with the different clinical situations. public had, in the past, approached OMS’s for

Table 1: Questionnaire form (please tick the specialty which you think is appropriate to treat the problem)
Problem/chief complaint Orthopedic ENT Plastic Oral and General General Others I don’t
surgeon surgeon maxilla‑facial dentist surgeon including family know
surgeon physician
Wisdom tooth removal
Facial cut injuries
Facial bone fractures
Jaw deformities
(micrognathia, retrognathia etc)
Cleft lip and palate
(split lip and palate)
Oral cancer and oral submucous
fibrosis (trismus and stiff joint)
Facial abscess (space infections)
Sinus problems
TMJ disorders
(TMJ ankylosis, dislocations etc)
Aesthetic surgery (rhinoplasty,
face lift, etc)
For example
Mode of Orthopedic Oral and Ophthalmologist ENT surgeon General surgeon Others
problem surgeon maxillofacial surgeon
Fracture of leg 
Loss of vision 
Hearing deficits 
ENT=Ear, Nose and Throat, TMJ=Temporomandibular joint

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Vadepally, et al.: Perception of oral and maxillofacial surgery

Table 2: Response to the questionnaire by the medical professionals (100)


Problem/chief complaint Orthopaedic ENT Plastic Oral and General General Others I don’t
surgeon surgeon maxillofacial dentist surgeon including family know
surgeon physician
Wisdom tooth removal 0 0 0 05 95 0 0 ‑
Facial cut injuries 0 0 53 0 0 47 0 ‑
Facial bone fractures 22 0 28 14 11 16 9 ‑
Facial deformities 31 0 33 03 06 17 10 ‑
(micrognathia, retrognathia etc)
Cleft lip and palate 0 0 78 02 03 07 10 ‑
Oral cancer and oral 0 02 0 0 0 13 85 ‑
submucous fibrosis
Facial abscess (space infections) 0 04 09 0 0 87 0 ‑
Sinus problems 0 97 0 0 0 01 02 ‑
TMJ disorders 0 0 0 06 01 0 93 ‑
(TMJ ankylosis, dislocations etc)
Aesthetic surgery 0 0 100 0 0 0 0 ‑
(rhinoplasty, face lift, etc)
ENT=Ear, Nose and Throat, TMJ=Temporomandibular joint

Table 3: Response to the questionnaire by the general public (500)


Problem/chief complaint Orthopaedic ENT Plastic Oral and General General Others I don’t
surgeon surgeon maxilla‑facial dentist surgeon including family know
surgeon physician
Wisdom tooth removal 0 0 0 57 403 13 27 ‑
Facial cut injuries 0 0 242 0 0 248 56 ‑
Facial bone fractures 133 0 96 58 90 112 11 ‑
Facial deformities 97 0 129 62 82 95 ‑ 35
(micrognathia, retrognathia etc)
Cleft lip and palate 0 58 261 24 43 109 ‑ 42
Oral cancer and oral 0 0 0 33 107 237 123 ‑
submucous fibrosis
Facial abscess (space infections) 0 23 95 63 85 158 ‑ 76
Sinus problems 0 367 0 0 0 89 44 ‑
TMJ disorders 191 0 0 42 103 134 ‑ 30
(TMJ ankylosis, dislocations etc)
Aesthetic surgery 0 0 454 0 0 68 20 ‑
(rhinoplasty, face lift, etc)
ENT=Ear, Nose and Throat, TMJ=Temporomandibular joint

problems related to specific clinical situations Statistical analysis


described in Table 4. Percentage of people opting The statistical analysis was done using SPSS
for an OMS and other specialties for a particular version 14. A P < 0.05 was considered statistically
problem is shown in Figure 1. Responses from significant. Comparison of categorical variables
both the groups as to who from other specialties was done using Chi‑square test.
is preferred are depicted in Table 5. Our study
revealed that the general public actually does not
know as to who they should approach for clinical DISCUSSION
scenarios like dentofacial deformities (35%), cleft Oral and maxillofacial surgery is an interesting and
lip and palate (42%), facial abscess (76%) and fascinating field that forms a bridge between medical
temporomandibular joint (TMJ) disorders (30%) and dental professionals to resolve many clinical
respectively. issues related to head and neck regions.[7] Oral and

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Vadepally, et al.: Perception of oral and maxillofacial surgery

Table 4: Number of general public and medical doctors who preferred an OMS
Problem or chief complaint General public number (%) Medical professionals number (%) P value
Wisdom tooth removal 57 (11.4) 05 (5) 0.05
Facial cut injuries 0 0 ‑
Facial bone fractures 58 (11.6) 14 (14) >0.05
Facial deformities (micrognathia, retrognathia etc) 62 (12.4) 03 (3) 0.006
Cleft lip and palate 24 (4.8) 02 (2) >0.05
Oral cancer and oral submucous fibrosis 33 (6.6) 0 0.008
Facial abscess (space infections) 63 (12.6) 0 <0.001
Sinus problems 0 0 ‑
TMJ disorders (TMJ ankylosis, dislocations etc) 42 (8.4) 06 (6) >0.05
Aesthetic surgery (rhinoplasty, face lift, etc) 0 0 ‑
Total 339 (6.9) 30 (30) <0.05
TMJ=Temporomandibular joint, OMS=Oral and maxillofacial surgeon

Table 5: Number of general public and medical doctors who preferred other specialties to treat the problem
Problem or chief complaint General public Number Medical Number
(percentage) professionals (percentage)
Wisdom tooth removal General dentist 403 (80.6) General dentist 95
Facial cut injuries General surgeon 248 (49.6) Plastic surgeon 53
Facial bone fractures Orthopaedic 133 (26.6) Plastic surgeon 28
Facial deformities (micrognathia, retrognathia etc) Plastic surgeon 129 (25.8) Plastic surgeon 33
Cleft lip and palate Plastic surgeon 261 (52.2) Plastic surgeon 78
Oral cancer and oral submucous fibrosis General Surgeon 237 (47.4) Oncosurgeon 85
Facial abscess (space infections) General surgeon 158 (31.6) General surgeon 87
Sinus problems ENT Surgeon 367 (73.4) ENT surgeon 97
TMJ disorders (TMJ ankylosis, dislocations etc) Orthopaedic 191 (38.2) Family physician 93
Aesthetic surgery (rhinoplasty, face lift etc) Plastic surgeon 453 (90.6) Plastic surgeon 100
Total 2580 (51.6) 749 (75)
ENT=Ear, Nose and Throat, TMJ=Temporomandibular joint

a b
Figure 1: (a and b) Percentage of people opting for an Oral and Maxillofacial Surgeon and other specialties for a particular problem

maxillofacial surgeons are commonly known as as seen in Figure 1a and b. This was consistent with
‘dentists’ in the medical fraternity and as ‘surgeons’ previously published data. Other studies indicated
in the dental fraternity.[8] Despite tremendous increase an extremely poor recognition of the specialty by the
in awareness regarding personal health in India, the general public.[1,4] The results of the present study
specialty of OMFS is still in its infancy. showed only 7% of the general public and 30%
of medical professionals approached an OMS for
It was observed that our medical colleagues and the clinical situations shown in Table 4. This was in
the general public lack awareness about the OMFS accordance with the findings of Lau[9] who reported
specialty and also the spectrum of work that it covers a perception of OMS in about 11.5% of the general

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public of Hong Kong. In England, during the by an OMS. It was observed that 80.6% of the
1990’s, it was found that 79% of the general public general public and 95% of medical professionals
had never heard of OMFS.[2] However, a decade would seek the help of a general dentist as shown in
later, a survey performed and compared with the Table 5. This may be due to the fact that the majority
previous one found that the recognition of OMFS of them are unaware that the ideal operating
among the general public and health professionals surgeon is OMS who can deliver flawless treatment
had increased from 21 to 34%.[3] In contrast, with their trained and skillful hands.
Hunter et al.[4] showed that 72% of the public knew
about the specialty in Boston, USA. Pertaining to maxillofacial trauma, an OMS
would treat fractures of the jaw and facial cut
In the Indian scenario, 51.6% of the general injuries with ease in addition to delivering a scarless
public and 75% of medical professionals treatment, since he can approach most of the facial
approach doctors belonging to various allied skeleton intraorally. Patients with facial trauma and
medical specialties for conditions described in the lacerations, once stabilized in Casualty, ought to be
questionnaire as seen in Table 5. In real life, it channelized to an OMS for handling fractures of the
differs from individual to individual as to who refers facial skeleton.[3] The present survey demonstrated
these cases. A dental practitioner would refer mostly that in most circumstances such patients, after being
to an OMS, while a medical practitioner would do stabilized are treated by other medical professionals.
it differently.[9] This may be due to the fact that the Only 11.6% of the general public and 14%
recognition of the specialty of OMFS and all that medical professionals preferred an OMS. In such
it can offer is still unfamiliar to a large number of an instance, the question arises as to who else in
medical professionals here. An informed healthcare the medical specialty is better in understanding the
professional will be able to direct a patient to the biomechanics of the facial skeleton and the concept
correct specialist.[7] OMS seldom gets a direct of occlusion other than an OMS. In contrast, Rocha
patient attention. et al.[6] and Jarosz et al.[7] stated that in Brazil and
in New Jersey, respectively, patients are most likely
With the formation of the American Association referred to OMS for such conditions.
of Oral and Maxillofacial Surgeons in 1918, the
spectrum of the specialty has continued to evolve[7] Clinical entities like facial asymmetries are
and broaden from oral surgery to craniofacial a great challenge to any operating surgeon.
surgery. This specialty currently provides efficient Orthognathic surgical procedures may be needed
services pertaining to maxillofacial region, which in correcting such dentofacial deformities. This
includes facial skeletal fractures, cleft lip and palate, requires a multidisciplinary approach that includes
oral and facial cancers with reconstruction using orthodontists, periodontists, and prosthodontists.
local flaps and microvascular free tissue transfer, An OMS would live up to the realistic expectations
salivary gland diseases, TMJ disorders and surgical of the patient by giving a desired aesthetic look,
management of complex prosthodontic problems, simultaneously securing the occlusion. Of great
dental and skeletal deformities of the face, and concern is the undeniable fact that most of the
aesthetic surgery such as face lift and rhinoplasty.[2,9] general public (35%) are unaware of this fact. In this
Though the internal growth and development of regard, 25% of the general public and 33% of the
the specialty has continued to flourish over the last medical professionals preferred plastic surgeons.
90 years, comprehension of the same by our medical Similar findings were observed by Ifeacho et al.[3]
and dental colleagues as well as the general public
has not been concurrent.[7] The same is the picture Correcting cleft lip, cleft palate, and associated
here in Hyderabad, India. Awareness about the craniofacial syndrome requires a multidisciplinary
scope of OMFS would lead to efficient delivery of approach and is a staged protocol. Apart from
quality services.[3] correcting the condition, rectifying the dentofacial
deformity during the later stages of life in such
To reflect from a few examples, surgical removal patients is essential. In this study, it was seen that
of wisdom tooth is a routinely performed procedure only 4.8% of the general public and 3% of medical

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Vadepally, et al.: Perception of oral and maxillofacial surgery

professionals opted for OMS. OMS plays a pivotal name would facilitate better education of both the
role in handling such clinical scenarios. Cleft lip and groups. However, any change from the current name
palate services are largely provided by OMFS.[3] was rejected by the American Association of OMFS.
One of the concerns over changing the name was
In this study, it was seen that for facial infections, that another specialty of dentistry or medicine might
sinus problems, and aesthetic surgery both the adopt the abandoned name.[14]
groups opted for other specialties i.e. general
surgeon, Ear, Nose, and Throat (ENT) surgeon, and The Association of Oral and Maxillofacial
plastic surgeon as reflected in Table 5. This may be Surgeons of India (AOMSI) observe February 13th as
due to the fact that for these conditions all three the day of OMFS to commemorate its first meeting
specialties were also responsible for treatment in the held on this date in 1969. The objective of this
past. Similar situation prevails with respect to oral initiative is to bring about increased awareness in
cancer where most of the general public (47.4%) the general public about the advances the specialty
preferred a general surgeon whereas medical has made. This we feel needs to be followed and
professionals (85%) opted for an oncosurgeon. expanded.

Problems related to the TMJ are another The present study, nevertheless, has shed
challenge in maxillofacial surgery. Unfortunately, light on what the perception is of the domain of
our survey revealed that most of the medical the OMS among medical professionals and the
doctors do not know where to refer the patients general public. Procedural awareness mentioned
with TMJ problems. This may be due to the fact that within the questionnaire was significantly still
TMJ involves many associated structures, whose weak. The Association of Oral and Maxillofacial
symptoms are indistinct in terms of location. Most of Surgeons should take a leading role to arouse
the patients come in with a history of seeking opinion public awareness concerning the specialty, by audit,
from different doctors without the problem being publications, or organizing public talks or camps
addressed.[9] Thirty percent of the general public are regularly.[2,9] Educational institutions are the leading
actually confused about such problems and do not lights to promote awareness. This would have an
understand who to approach. In this context, the effect on the dynamics of the entire system, not only
term TMJ seems to be the biggest obstacle. A term to the patients or the public, but also to the doctors
such as mouth joint, like knee joint or elbow joint, who provide the treatment.
can be contemplated for better understanding by
the general public. The survey was performed in and around
Hyderabad and, therefore, the results might not be
Laskin et al.[10] evaluated knowledge about 12 applicable elsewhere. Regional variations exist, and
different specialties to determine whether such surgeons themselves are responsible for educating
unfamiliarity was true only for OMFS or whether it their own community and referral circles about
occurs with other specialties. The result of this study the scope of their practice, which will depend on
revealed that name recognition was not a problem training, experience, and areas of interest. It is clear
only for OMFS. Although this does not mean that that greater progress needs to be made to change
no effort should be made to inform the public the perception of the medical professionals as well
about the spectrum of work that an OMF surgeon as the general public, if the specialty of OMFS is to
performs, it does indicate that name alone can be practiced to its full potential.[4,15,16]
never be completely descriptive.[11‑13]

The authors are of the opinion that the name CONCLUSION


‘Orofacial surgery’ may be suggested for this Despite advances in OMFS in our country, there
fascinating specialty so that it shall promote awareness are still a large number of patients with untreated
among both the groups. Similar name was suggested head and neck conditions and diseases present
by Ameerally et al.[2] due to the long and complicated since birth who report to OMS only at an advanced
latin name. He stated that a change to a much simpler stage owing to lack of awareness, ignorance, or

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Vadepally, et al.: Perception of oral and maxillofacial surgery

improper referral. The specialty of OMFS is critical J Oral Maxillofac Surg 2013;71:965‑73.
for addressing injuries, deformities, and diseases of 8. Reddy K, Adalarasan S, Mohan S, Sreenivasan P, Thangavelu A.
the maxillofacial region. There is a need to promote Are people aware of oral and maxillofacial surgery in India?
J Maxillofac Oral Surg 2011;10:185‑9.
and increase awareness regarding the wide spectrum
9. Lau SL. Do you think they know about us? Oral and maxillofacial
of work being performed by OMS.
surgery in Hong Kong. J Dent Health Oral Disord Ther 2014;1:11.
10. Laskin DM, Ellis JA Jr, Best AM. Public recognition of specialty
ACKNOWLEDGMENT designations. J Oral Maxillofac Surg 2002;60:1182‑5.
The authors would like to acknowledge Dr. Gireesha 11. McArdle PJ, Whitnall M. The referral practice of general
Reddy, Dr. Abhishek, Dr. Revanth Kumar for their kind medical practitioners to the surgical specialties: Implications
support for the future. Br J Oral Maxillofac Surg 1996;34:394‑9.
12. Spina AM, Smith TA, Marciani RD, Marshall EO. A survey of
resident selection procedures in oral maxillofacial surgery.
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Source of Support: Nil. Conflict of Interest: None declared.
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perceptions of oral and maxillofacial surgery as a specialty. Submission: July 07, 2014, Acceptance: Sep 17, 2014

Journal of Cranio-Maxillary Diseases / Vol 4 / Issue 1 / January 2015 27

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