ISSN: 2320-5407 Int. J. Adv. Res.

10(10), 146-152

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/15473
DOI URL: http://dx.doi.org/10.21474/IJAR01/15473

RESEARCH ARTICLE
EVALUATION AMONG HEALTH CARE PROFESSIONALS AND GENERAL PUBLIC ON THE SCOPE
OF MAXILLOFACIAL SURGERY: CROSS SECTIONAL STUDY

Ranjith Kumar Pittala1, Bikash Kumar Bal2 and Venkata Subbaiah Rajala3
1. Consultant Oral and Maxillofacial Surgeon, Hyderabad, Telangana.
2. Consultant Oral and Maxillofacial Surgeon, Hyderabad, Telangana.
3. Consultant Oral and Maxillofacial Surgeon, Kadapa, Andhra Pradesh.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Objectives: Oral and Maxillofacial surgery (OMFS) is a dental
Received: 05 August 2022 speciality which is bridged between medicine and dentistry. This
Final Accepted: 09 September 2022 department deals with the anatomical region of head and neck region.
Published: October 2022 OMFS has evolved from ages just not ending with tooth extraction.The
aim of the study was to survey the knowledge of OMFS among
Key words:-
Maxillofacial Surgery, Knowledge, medical, dental interns and general population.
Questionnaire Material and methods: An organized survey twenty clinical
questionnaire was framed and was asked to medical and dental interns
as well as general public.173 participants took part in this survey of
which 27 were general public, 80 were medical interns and 66 were
dental interns. The data were formulated using Microsoft excel, the
results were analyzed, percentage of the population were taken into
consideration.
Results: The results were tabulated and percentage of the populations
were analyzed. Medical and dental interns recognized that most of the
treatments are mainly treated by maxillofacial surgeons
Conclusions: The study brought to light that dental interns are aware
of the treatments what OMFS does. There is still lack of knowledge
among general population. So the current concept of oral surgery
should be aware so that the interns gain ample knowledge in this field
and ensure correct referral of all the patients.

Copy Right, IJAR, 2022,. All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
Maxillofacial dentistry is a bridging department between dentistry and medicine. In Spite of growing awareness and
knowledge around the globe about what Maxillofacial surgeon’s are capable of handling, there is still a lack of
knowledge about what this speciality of surgeons do.Many think that this is the branch in dentistry which only deals
with the extraction of teeth. Apart from extraction of teeth this is a speciality in dentistry that focuses on diagnosis and
treatment modalities in head and neck region. In early day’s where this speciality had restricted to dento alveolar
surgery and basic Maxillofacial trauma. Currently Maxillofacial surgeons can manage congenital craniofacial
deformities which includes full range of treatment for cleft lip and palate, head and neck pathology (benign and
malignant) with reconstruction using local flaps and microvascular free tissue transfer, Orthognathic surgeries,
Temporomandibular surgeries, bone grafts, salivary gland disorders, facial space infections.

Corresponding Author:- Ranjith Kumar Pittala

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Address:- Consultant Oral and Maxillofacial Surgeon, Hyderabad, Telangana.
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This speciality also offers an array of treatments including distraction osteogenesis, cosmetic procedures, implant
dentistry and surgical management of complex prosthodontics problems1.

Disparities remain regarding proper recognition of OMFS surgical procedures among healthcare professionals. The
recognition of our speciality and the treatment that we offer to the patient’s is still a mystery to a large number of
people. As a consequence, the health care professionals need to have the necessary knowledge and understanding the
scope of practice of what OMFS specialty does and timely referral of patients to the OMFS specialty, for prompt
assessment and treatment.

The aim of the study was to conduct a questionnaire based study to know the current level of awareness and
knowledge about OMFS speciality among general public and healthcare professionals and educate them.

Material And Methods:-

This cross sectional survey consisting of twenty clinical situations questionnaires was designed and each
questionnaire was given five options to choose which specialty was appropriate. The questionnaire was given to three
groups (healthcare professionals divided into two groups, one group medical and second group dental and the third
group is general public).The subjects were asked to select against the speciality they thought were the most
appropriate to deal with. The specialities were Plastic surgeons, Ear nose throat surgeon’s (ENT), Maxillofacial
surgeons, General surgeons and others.The questionnaires were then reviewed, evaluated and analyzed. The study
consists of 173 subjects of whom 80 were medical interns, 66 were dental interns and 27 were general public.

Table 1:- Questions which were put forward to assess the knowledge among general public, medical and dental
interns.

1) Facial bone fractures are treated by

2) Trauma to the teeth are treated by
3) Lacerations on the face are treated by
4) Nasal bone fractures are treated by
5) Tongue tie (Ankyloglossia) are treated by
6) Lesions of the tongue are treated by
7) Facial space infections are treated by
8) Biopsy of theoral lesions are treated by
9) Lumps in the oral cavity ( mucocele, ranula) are treated by
10) Salivary gland tumors are treated by
11) Sailoliths are treated by
12) Benign lesions of the oral cavity are treated by
13) Malignant lesions of the jaw are treated by
14) Temporomandibular joint disorders are treated by
15) Lock jaw (TMJ dislocation) are treated by
16) Reconstruction of the jaw defects can be done by
17) Jaw corrections (orthognathic surgeries) are done by
18) Cleft lip and palate are treated by
19) Cosmetic procedures (blepharoplasty, Rhytedectomy, chemical peels, lobuloplasty, Botulinum injections,
Hair therapy (FUEand FUT,PRP therapy) jowl corrections) are done by
20) Microvascular reconstruction of the jaw are done by

Results:-
The responses of the participants are shown in table 2 and 3 along with the percentage of each question’s by the
three groups. All most every participant were familiar with all the departments.The majority of the subjects
participated in this survey opted maxillofacial surgery as their prior option for the given questionnaire which was
then dominated by plastic surgeons and ENT (Ear Nose Throat surgeons). Most medical interns were aware of
maxillofacial surgery.

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Table 2:- The table shows the percentage of three groups for each questions above.
S no Question was related to General Medical Dental Combined
public interns(n=80) interns(n=66) (N=173)
(n=27)
1 Facial bone fracture 13(48.15%) 70(87.5%) 64(96.97%) 147(84.97%)
2 Trauma to the teeth 17(62.96%) 65(81.25%) 59(89.39%) 141(81.5%)
3 Lacerations on the face 12(44.44%) 51(63.75%) 52(78.79%) 115(66.47%)
4 Nasal bone fractures 11(40.74%) 42(52.5%) 46(69.7%) 99(57.23%)
5 Tongue tie 11(40.74%) 56(70%) 49(74.24%) 116(67.05%)
(ankyloglossia)
6 Lesions of the tongue 13(48.15%) 52(65%) 48(72.73%) 113(65.32%)
7 Facial space infections 12(44.44%) 58(72.5%) 62(93.94%) 132(76.3%)
8 Biopsy of the oral lesions 13(48.15%) 59(73.75%) 56(84.85%) 128(73.99%)
9 Lumps in the oral cavity 16(59.26%) 60(75%) 59(89.39%) 135(78.03%)
(Mucocele, Ranula)
10 Salivary gland tumors 14(51.85%) 59(73.75%) 59(89.39%) 132(76.3%)
11 Sailolith 16(59.26%) 59(73.75%) 53(80.3%) 128(73.99%)
12 Benign lesions of the oral 11(40.74%) 58(72.5%) 56(84.85%) 125(72.25%)
cavity
13 Malignant lesions of the oral 13(48.15%) 69(86.25%) 63(95.45%) 145(83.82%)
cavity
14 Temporomandibular joint 15(55.56%) 69(86.25%) 60(90.91%) 144(83.24%)
disorders
15 Lock jaw (TMJ dislocations) 14(51.85%) 69(86.25%) 60(90.91%) 143(82.66%)
16 Reconstructions of the jaw 15(55.56%) 67(83.75%) 59(89.39%) 141(81.5%)
defects
17 Jaw corrections (orthognathic 15(55.56%) 71(88.75%) 60(90.91%) 146(84.39%)
surgeries)
18 Cleft lip and palate 15(55.56%) 63(78.75%) 55(83.33%) 133(76.88%)
19 Cosmetic procedures 15(55.56%) 44(55%) 39(59.09%) 98(56.65%)
20 Microvascular reconstruction 19(70.37%) 60(75%) 59(89.39%) 138(79.77%)
of the jaw

Table 3:- The table shows the percentage of people who choose OMFS for each question above (N=173).
The table shows the percentage of people who choose OMFS for each question above (N=173)
S.no Question was related to Percentage of people opted OMFS
1 Facial bone fracture 147(84.97%)
2 Trauma to the teeth 141(81.5%)
3 Lacerations on the face 115(66.47%)
4 Nasal bone fractures 99(57.23%)
5 Tongue tie (ankyloglossia) 116(67.05%)
6 Lesions of the tongue 113(65.32%)
7 Facial space infections 132(76.3%)
8 Biopsy of the oral lesions 128(73.99%)
9 Lumps in the oral cavity (Mucocele, Ranula) 135(78.03%)
10 Salivary gland tumors 132(76.3%)
11 Sailolith 128(73.99%)
12 Benign lesions of the oral cavity 125(72.25%)
13 Malignant lesions of the oral cavity 145(83.82%)
14 Temporomandibular joint disorders 144(83.24%)

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15 Lock jaw (TMJ dislocations) 143(82.66%)

16 Reconstructions of the jaw defects 141(81.5%)
17 Jaw corrections (orthognathic surgeries) 146(84.39%)
18 Cleft lip and palate 133(76.88%)
19 Cosmetic procedures 98(56.65%)
20 Microvascular reconstruction of the jaw 138(79.77%)

plastic surgeon ENT OMFS General surgeon Others

84%

81%

66.40%

67%
57%
48.50%
42%

21.90%
13.29%

12.70%
11.50%

9.80%
9.80%
14%

8.60%
8.60%
6.90%

6.30%
3.40%
1.70%

8%
8%

4%
1%

1%
QUE S T I O N 1 QUE S T I O N 2 QUE S T I O N 3 QUE S T I O N 4 QUE S T I O N 5
Chart 1:-

Plastic surgeon ENT OMFS General Surgeon Others

76.30%
73.40%

78%
65.50%

42%
26%

16.70%
14.40%

14.40%
12.10%

11.50%
18%

18%
18%

18%
6.90%

5.70%
4.60%

3.40%
9%

5%
5%
4%

4%
3%

QUE S T I O N 6 QUE S T I O N 7 QUE S T I O N 8 QUE S T I O N 9 QUE S T I O N 10

Chart 2:-

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Plastic surgeons ENT OMFS General surgeons Others

82.50%
83%
82%
73.90%

72.25%
17.90%

14.40%

13.80%
13.20%

13.20%
15%

9.80%

9.80%
9.20%

8.60%
7.50%
7.50%
6.90%

6.90%

6.30%
4.60%
3.40%

4%

4%

4%
QUE S T I O N 11 QUE S T I O N 12 QUE S T I O N 13 QUE S T I O N 14 QUE S T I O N 15
Chart 3:-
84.30%

Plastic surgeons ENT OMFS General surgeons Others

81.50%

79.70%
76.80%

56.60%
47.30%

23.12%
20.81%

20.80%
14.40%

13.85%

13.20%
9.80%
13%

6.30%
10%
5.20%

4.65%

10.40%
8%

8%

9.80% 9.80%
2.80% 4%

QUE S T I O N 16 QUE S T I O N 17 QUE S T I O N 18 QUE S T I O N 19 QUE S T I O N 20

Chart 4:-
Chart 1,2,3 and 4 represents the response of the subjects to the questionnaire.

Discussion:-
Lasting from the ages oral and maxillofacial surgery is one of the oldest branch that interrelates with medicine and
the surgery, with the literary works of Hippocrates, Aristotle and Sushratha who described the dental extraction and
wiring techniques for maxillofacial fracture management 2,3. Oral surgery is one of the oldest branches which were
stated in 1957 by Thoma in his paper titled ‘History of Oral Surgery’4.The name Oral surgery was changed to oral
and Maxillofacial surgery in 1975 by the American Association with a goal to more clearly define the scope of
practice of the field to the general public5.

Oral and Maxillofacial surgeons who are qualified today were able to treat simple dentoalveolar surgery,
Maxillofacial trauma to a wide variety of treatments which includes surgeries to Craniofacial deformities,
Temporomandibular disorders, Salivary gland lesions, Orthognathic surgeries, Benign and malignant oral lesions

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followed by reconstruction with local flaps to microvascular reconstruction of the jaw defects. Inspite of all these, it
is very peculiar to see that neither the public nor the medical community realize the role of OMFS and fail to
understandwhat the speciality has to afford them.

Patient usually reaches to their general medical practitioners, emergency departments or dentist with pathologies or
abnormalities requiring to an Oral and Maxillofacial surgeon. Basic knowledge of the speciality should be given to
our medical colleagues for the benefit of the patient in making in informed decisions. Also, the general public can
benefit from knowing OMFS scope so that they can request appropriate referral 6.

Jensen stated that almost all medical speciality have overlapping scope to some extent causing possible confusion
when choosing an appropriate speciality to case management7.

Majority of the medical and dental students were aware of surgical field of the OMFS and would refer them for
specified condition listed in the questionnaire. This finding was similar to the studies conducted by Rangarajan et
al.8 who demonstrated that for specified conditions related to oral and maxillofacial region being recognized by
dental students as within domain of oral and maxillofacial surgeon.

Rocha et al. in Brazil conducted a similar study to investigate the perception of the speciality by healthcare
professionals, but found good level of knowledge of the scope of OMFS, and concluded that specialty needs to
broaden its horizons in the education of medical and dental students, as well as the general public to ensure the
correct referral of all patients 9.

In the present study, many participants knew about the existence of the speciality, but most of them were ignorant
about the procedures performed. While majority believed that surgical speciality should be a part medicine and
believed that OMF surgeons are not sufficiently qualified to perform certain procedures.

In the current study all the three groups concluded that trauma to the teeth, lumps in the oral cavity, facial space
infections, biopsy of the oral cavity and with respect to oral pathological conditions Medical professionals believed
that OMF surgeons are more qualified to treat the problems. Nasal bone fracture due to its anatomical location, these
fractures present a distribution between ENT, OMFS and Plastic surgeons are responsible for the treatment and for
facial trauma no specification is justified that all the three groups vastly agreed with OMFS were qualified to treat
the problems.

Large number of participants believed that oral cancer management and reconstruction can be managed by oral
surgeons, while the half of the participants believes that these procedures can be done equally by Plastic surgeons
and ENT surgeons.With cleft surgery most participants believed that OMF surgeons are the one who are qualified to
manage. Regarding with the Cosmetic procedures both the medical and dental professionals thought these
procedures can be equally done by plastic surgeons and OMF surgeons.

Apart from the associative findings the results of our study was not in accordance with the other studies where
medical interns were aware of maxillofacial surgeons but were not fully aware about the surgical scope of the field.
This simply shows the changing nature of knowledge, among medical professionals.

According to shah et al regional variations exit and surgeons should have a capability to educate their own
community and referral circle on the scope of their practice10.

The present study enlightens the knowledge and awareness among medical and dental interns. General public were
not still aware of the specialty about the full scope of speciality. Therefore greater progress must be made in
educating the general public as well as health professionals, if the speciality of OMFS to be practiced to its full
potential.

Conclusions:-
From this study both the medical and dental interns are aware of the scope towards OMFS, however regarding the
cosmetic surgeries medical interns believe that plastic surgeons are the one who were qualified to do the treatment
and according to dental interns it is the OMF Surgeons can also deliver this treatment however general population
perceive cosmetic procedures are manageable by plastic surgeons. The focus need to be placed in key areas such as

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trauma and pathology, where patient care is crucial may be precipitated if all those involved are aware of what
OMFS scan perform and the current concept of oral surgery should be aware so that the interns gain ample
knowledge in this field and ensure correct referral of all the patients may be greater awareness should be spread
among the general population regarding the scope of OMFS. Doing so will help OMFS develop as aspeciality in
addition to delivering better care to the public.

Conflict Of Interest:
Nil.

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