J. Maxillofac. Oral Surg.
https://doi.org/10.1007/s12663-019-01310-0
ORIGINAL ARTICLE
Perception and Awareness of Oral and Maxillofacial Surgery
Speciality Among Medical Postgraduate Trainees
V. Nandagopal1 • Y. Meghna1 • G. Rajasekhar1 • R. Sudheer1
Received: 30 March 2019 / Accepted: 17 November 2019
Ó The Association of Oral and Maxillofacial Surgeons of India 2019
Abstract
Introduction Oral and maxillofacial surgery evolves
around the head and neck region, and acts as a connecting
bridge between medical and dental specialities. Little is
known regarding the scope of oral and maxillofacial sur-
gery among the medical postgraduates; good awareness
towards oral and maxillofacial surgery among different
branches of medical professionals is essential for better
referral and, in turn, for the benefit of the patient. The main
objective of this study was to assess the knowledge and
awareness of oral and maxillofacial surgery speciality
among medical postgraduates.
Materials and methods A questionnaire survey was con-
ducted among 306 medical postgraduates of medical
institutions associated with and without dental institutions.
Results In this study, we found that there is a very low
awareness of oral and maxillofacial surgery speciality in
the medical postgraduates in terms of its scope of service
and emphasis should be laid on the public image regarding
this speciality.
Keywords Awareness
Maxillofacial
Postgraduate

Speciality
List of abbreviations
OMFS Oral and maxillofacial surgery
ENT Ear–nose–throat
& V. Nandagopal
vura_gopal@yahoo.co.uk
1
Mamata Dental College and Hospital, Khammam, India
Introduction
The scope of oral and maxillofacial surgery (OMFS) often
overlaps with that of other surgical specialities [1]. It acts
as a border between dentistry and medicine [2, 3]. This
specialty has gained interest in areas of facial trauma,
dentofacial deformities, pathologies, temporo-mandibular
joint disorders, salivary gland pathologies, oral cancer,
distraction osteogenesis, dental implants, and of cleft lip
and palate [4].
In contrast to common myth that the work of an oral and
maxillofacial surgeon does not end with tooth and its sur-
roundings, it expands to include procedures that enhance
the quality of life by providing better form, function and
aesthetics, as well as life-saving procedures.
Patients regularly present to their general practitioners,
dentists or emergency departments with problems that
require expertise of specialists in oral and maxillofacial
surgery. Our medical colleagues need to have the necessary
knowledge and understanding about the scope of the spe-
ciality for a timely referral of patients to the specialist, for
prompt assessment and treatment [5].
This short survey is undertaken among the medical
postgraduate trainees of medical institutions associated
with and without dental institutions to assess their per-
ception and awareness towards oral and maxillofacial
surgery as a speciality and about the diverse scope of
surgical procedures that an oral and maxillofacial surgeon
performs. The objectives of this study are: (1) to assess the
perception and awareness of OMFS speciality among
medical postgraduate trainees studying in medical institu-
tion associated with dental institution; (2) to assess the
perception and awareness of OMFS speciality among
medical postgraduate trainees studying in medical institu-
tion not associated with dental institution; and (3) to
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Table 1 Definitive management of a patient with jaw bone fractures in casuality are effectively managed by?
Maxillofacial surgeon Plastic surgeon Orthopaedic surgeon Neurosurgeon Total

Medical college with dental college 134 25 7 0 166

Medical college without dental college 44 49 40 7 140
Total 178 74 47 7 306

Table 2 Chi-square tests 180

Value Df P value
Pearson’s Chi-square 81.841 a
3 .0001
a 80
2 cells (25.0%) have expected count less than 5. The minimum
expected count is 3.20
correlate between the perception and awareness of medical
postgraduate trainees of medical institutions associated
with and without dental institution about OMFS speciality.
Materials and methods
The cross-sectional study of ‘Perception and Awareness of
oral and maxillofacial surgery specially among medical
postgraduate trainees’ is a questionnaire study. Closed-
ended questions were formulated for the evaluation of
awareness about a variety of conditions treated by the oral
and maxillofacial surgeons. The questionnaire was dis-
tributed among 306 medical postgraduate trainees of
medical institutions associated with and without dental
institutions. The questionnaires were then evaluated and
analysed.
Results
A total of 306 medical postgraduates (of which 166 are
from medical institution associated with dental institution
and 140 are from medical institution without dental insti-
tution) were given questionnaires to assess the knowledge
and awareness about oral and maxillofacial surgery. In this
study, postgraduates of different clinical and non-clinical
medical specialities from first, second and third years were
included in the study.
In this study, in a total of 306 participants 185 were
aware of oral and maxillofacial surgery as a speciality in
the branch of dentistry, whereas 121 were not aware of the
speciality and 97 of them had visited, consulted or referred
a patient to an oral and maxillofacial surgeon. In this study,
178 medical postgraduates knew that jaw fractures are
managed by maxillofacial surgeon (Tables 1, 2 and Fig. 1).
160 07
140 25 Neuro surgeon
7
120
40
100 orthopaedic
134 49 surgeon
60
40 plastic surgeon
20 44
0
maxillofacial
medical medical
surgeon
college with college without
dental dental
Fig. 1 Graph showing the referral pattern of medical postgraduates
for management of jaw bone fractures
According to this survey, out of 306, 125 medical post-
graduates were aware that injuries to the bony cavity of
orbit are treated by maxillofacial surgeon, followed by
ophthalmologist (104), neurosurgeon (27) and plastic sur-
geon (50). With regard to nasoethmoidal complex frac-
tures, only 73 of all medical postgraduates referred the
patients to maxillofacial surgeon, followed by ENT spe-
cialist (172), neurosurgeon (1) and plastic surgeon (48).
Medical postgraduates were asked about various con-
ditions, which are managed by oral and maxillofacial sur-
geons. Only 160 of them knew that wisdom tooth removal
is a specialist job, performed by an oral and maxillofacial
surgeon. Only 72 of them are aware that dental implant
surgery is performed by oral and maxillofacial surgeon.
Remaining participants think it is performed by
prosthodontist (221) and periodontist (13).
According to 225 medical postgraduates, cleft lip and
palate repairs are executed by plastic surgeon, followed by
maxillofacial surgeon (45) and paediatric surgeon (36).
Temporo-mandibular joint disorders (ankylosis, joint dis-
locations, etc.) are best treated by ENT specialist according
to 92 medical postgraduates, followed by orthopaedic
surgeon (65), plastic surgeon (57) and maxillofacial sur-
geon (9) (Tables 3, 4, 5, 6 and Fig. 2, 3). Only 97 of all
medical postgraduates knew that reconstructive surgeries
of malignant tumours can be performed by oral and max-
illofacial surgeon and 33 of them think that cysts of the
jaws are managed by maxillofacial surgeon. Only 56 of
them knew that the common facial pains like trigeminal
neuralgia can be treated by maxillofacial surgeon.

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J. Maxillofac. Oral Surg.

Table 3 Temporo-mandibular joint disorders (ankylosis, joint dislocations) are best treated by?
Plastic surgeon ENT specialist Orthopaedic surgeon Maxillofacial surgeon Total

Medical college with dental college 7 61 33 6 166

Medical college without dental college 50 31 32 2 140
Total 57 92 65 9 306

Table 4 Chi-square tests

Value df Asymptomatic significance (two-sided)
a
Pearson’s Chi-square 56.128 3 .000
Likelihood ratio 60.499 3 .000
Linear-by-linear association 29.209 1 .000
No. of valid associations 306
a
0 cells (.0%) have expected count less than 5. The minimum expected count is 4.20

Table 5 Cleft lip and palate repairs are executed by?

Plastic surgeon Maxillofacial surgeon Paediatric surgeon Total

Medical college with dental college 116 41 9 166

Medical college without dental college 109 4 27 140
Total 225 45 36 306

180
Table 6 Chi-square tests
160 9
Value Df P value 140 41
120 27 Pediatric surgeon
4
Pearson’s Chi-square 37.703a 2 .000 100
a
80 Maxillofacial
0 cells (.0%) have expected count less than 5. The minimum 60 116 surgeon
109
expected count is 1.10 40 Plastic surgeon
20
0
medical college medical college
with dental without dental
200
maxillofacial Fig. 3 Graph showing the referral pattern of medical postgraduates
150 surgeon for cleft lip repairs
65 27
Orthopaedic
100 32 surgeon
33
31 ENT specialist
50
61 followed by ENT specialist (101), maxillofacial surgeon
50
0 7 plastic surgeon (19) and neurosurgeon (3). Patients with maxillary sinus
medical college medical college pathology are referred to ENT specialist by 245, followed
with dental without dental
by maxillofacial surgeon (41) and general surgeon
Fig. 2 Graph showing the referral pattern of medical postgraduates (20) (Tables 7, 8 and Fig. 4). Among 306 medical post-
for temporomandibular joint disorders graduates, only 60 of them knew that aesthetic corrections
of jaw deformities are best treated by maxillofacial sur-
Among all medical postgraduates, 199 are of the view geon, followed by plastic surgeon (219) and orthopaedic
that salivary gland disorders would be treated by general surgeon (27) (Tables 9, 10 and Fig. 5).
surgeon, followed by maxillofacial surgeon (87) and plastic At the end of the survey, only 133 of the medical
surgeon (20). In total, 147 of all medical postgraduates postgraduates feel that oral and maxillofacial surgeon has a
referred patients with facial space infections (Ludwig’s role to play in emergency management of head and neck
angina, cavernous sinus thrombosis) to general surgeon trauma. In total, 153 of them agree that OMFS is an

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 J. Maxillofac. Oral Surg.

Table 7 Patients with facial space infections (Ludwig’s angina, cavernous sinus thrombosis) are referred to?
General surgeon ENT specialist Maxillofacial surgeon Neurosurgeon Total

Medical college with dental college 41 89 17 1 166

Medical college without dental college 106 12 2 2 140
Total 147 101 19 3 306

Table 8 Chi-square tests

Value df Asymptomatic significance (two-sided)

Pearson’s Chi-square 97.809a 3 .000

Likelihood ratio 107.503 3 .000
Linear-by-linear association 21.641 1 .000
No. of valid associations 306
a
0 cells (.0%) have expected count less than 5. The minimum expected count is 8.69

180 Neuro 180

160 surgeon 160
19 14
140 17 140
20 13
120 2 Maxillofacial 120
12 surgeon Orthopaedic
100
80 89 100 113 surgeon
60 ENT specialist 80 106
106 Plastic surgeon
40 60
20 41 40
0 general
surgeon 20 39 Maxillofacial
medical college with medical college 21
0 surgeon
dental without dental
Medical medical
college with college
Fig. 4 Graph showing the referral pattern of medical postgraduates
for facial space infections dental without dental

Fig. 5 Graph showing the referral pattern of medical postgraduates

for aesthetic corrections of jaw deformities
Table 9 Aesthetic corrections of jaw deformities are best treated by?
Maxillofacial Plastic Orthopaedic Total Discussion
surgeon surgeon surgeon
OMFS as a department is recognized by majority of the
Medical college 39 113 14 166
with dental
medical postgraduates, but most of them were not aware of
college the wide surgical scope of this specialty; this is in accor-
Medical college 21 106 13 140 dance with the studies conducted by Laskin [5], Lesny [6],
without dental Spina et al. [7] and Langdon [8]. This is similar to the study
college done by us. Ameerally et al. conducted a study in England
Total 60 219 27 306 and concluded that up to 79% of the general population had
not heard of OMFS department, and around 74% of them
did not understand its role and scope [9]. Ifeacho et al. [10]
Table 10 Chi-square tests
concluded that although most of the medical professionals
Value Df P value had heard of this particular specialty, they were not clear
Pearson’s Chi-square 3.477a 2 .176 about the clinical expertise this branch could offer. In a
a
study done by Hunter et al. [11], it was found that in those
0 cells (.0%) have expected count less than 5. The minimum
expected count is 8.69
medical professionals who did not know about this branch,
the referral pattern for treatment of conditions that over-
lapped with different specialties mostly did not favour the
important integrated speciality which can help and aid the
choice of an oral and maxillofacial surgeon.
medical speciality. In total, 294 of them agree that oral and
According to Lau SL, the medical conditions asked to
maxillofacial surgery speciality needs more public
medical postgraduates could be treated by different
awareness.

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J. Maxillofac. Oral Surg.
specialties. In fact, oral and maxillofacial surgeons could
treat all of the listed conditions. Although there are over-
lapping responsibilities over some specialties, there are
never absolute right or wrong on who should do what. It all
depends on the training they have received and the culture
in different places. This study showed that postgraduates
from the medical college associated with a dental college
made better referrals of patients with various conditions in
the scope of OMFS compared to the postgraduates from
medical college which did not have an associated dental
college. A dental surgeon would mostly refer these cases to
an oral and maxillofacial surgeon, while a medical pro-
fessional would tend to do it differently [12]. Although
OMFS is involved in the treatment of a lot of important
conditions or diseases, it is disappointing to see the lack of
awareness among the medical postgraduates.
These results indicated that most of the medical post-
graduates were aware that maxillofacial surgeons deal with
facial trauma and most of them were unaware that max-
illofacial surgeons also deal with many other conditions of
head and neck region.
Compared with medical postgraduates from medical
college without dental college, medical postgraduates from
medical college with dental college have a better awareness
regarding some of the procedures performed by OMFS. For
example, more number of postgraduates from medical
college associated with dental college referred patients
with facial bone fractures to OMFS as shown by the results.
This could be because they are more frequently interacting
with postgraduates of OMFS and happened to see facial
trauma cases in casualty being managed by maxillofacial
surgeon. The medical postgraduates from medical college
without dental college do not have interaction with OMFS
postgraduates, which might lead to lack of awareness
regarding the scope of oral and maxillofacial surgeon.
Conclusion
There is a very low awareness of OMFS in the medical
postgraduates in terms of its scope of service. The
emphasis should be built on the public image regarding this
specialty, and awareness of the treatment this specialty
could provide. Awareness of the scope of OMFS should
lead to improved access and efficient delivery of a quality
service. Our medical colleagues need to have the necessary
knowledge to make informed decisions about their
patient’s management. The awareness of OMFS speciality
among the medical postgraduate trainees could be brought
by giving lectures, informative material and working as
team in complex head and neck surgeries. Equally, the
public would benefit from knowing what OMFS offers
them, so that they can request an appropriate referral.
Compliance with ethical standards
Conflict of interest No conflict of interests to disclose.
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