Surgical demands of patients attending an Oral and Maxillofacial Surgery clinic in a Nigerian Hospital

INTRODUCTION

Oral and maxillofacial surgery (OMFS) is the surgical specialty that is concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face, and neck.^[1] Oral and maxillofacial surgical procedures (OMSPs) range from simple tooth extraction to ablative surgeries such as resection with disarticulation of the mandible.^[2] It also encompasses soft- or hard-tissue surgical procedures.^[3] OMSPs done under general anesthesia (GA) and local anesthesia (LA) are known as major and minor OMSPs, respectively.^[4,5] While some surgical procedures are routinely performed in developing countries, others can be regarded as luxuries due to a lack of expertise and facilities.^[6] As healthcare provision continues to improve and the demands on the available facilities increase, the need for evaluating existing health systems to improve their efficiency becomes more challenging.^[7] Such evaluation plays a key role in improving service delivery and enabling informed distribution of resources.^[8] To achieve this, there is often a need to assess the demands being placed on the system, the challenges being experienced, and the successes being accomplished. A retrospective review of surgical services provided is one of the ways of ensuring optimal or improved service delivery.^[9,10] Evaluation of the pattern of demands of OMFS will play a very important role in policy formulation, research, improvement in service delivery, teaching, and mentoring while also enabling prioritization and proper allocation and distribution of limited resources, especially in resource-limited countries.^[11,12]

Previous literature reports^[13-20] are conflicting regarding the most performed OMSPs globally. Therefore, this study aims to determine the pattern of OMSPs demanded by patients attending a Nigerian teaching hospital. It is hoped that the findings of this study will assist oral and maxillofacial surgeons in the appropriation of limited resources for optimum treatment outcomes and assist in the growth of oral and maxillofacial surgery in developing countries.

MATERIALS AND METHODS

This is a retrospective and cross-sectional study of patients managed in the Department of Oral and Maxillofacial Surgery from March 2011 to April 2021. The inclusion criteria were all in-patients treated under GA, while those with incomplete information were excluded. Data were retrieved from theater logbooks and patients’ case notes for surgery. The data collected were the age of patients, gender, employment status, educational status, distance of residential address, and type of surgery done. Descriptive statistics were performed using the IBM Statistical Package for the Social Sciences statistics for Windows version 20 (Armonk, NY: IBM Corp) software.

RESULTS

A total number of 550 patients were seen in the ten-year study period. The age of the patients ranges between 2 and 97 years. The mean age was 32.5 ± 2.08 years. Table 1 shows the sociodemographic characteristics of patients who have undergone oral and maxillofacial surgery. Patients with age >60 years had less (7.7%) demand for oral and maxillofacial surgery compared to those with age <60 years that needed greater (50.5%) demand for services. About one-third (41.8%) of the patients who required oral and maxillofacial surgery were <17 years. More than half (55.6%) of the patients were male. As shown in Table 1, the demands of major oral and maxillofacial surgery were greatest among the dependent patients (55.5%), and this was followed by the employed (18.2%) and self-employed (15.6%). The highest (47.1%) number of patients that had oral and maxillofacial surgical services had only primary education, followed by tertiary education (25.1%), secondary (17.8%), and no formal education (10.0%). Almost two-thirds (73.3%) of the patients utilizing oral and maxillofacial surgical services reside outside Edo state. Table 2 shows the clinical characteristics of patients who had oral and maxillofacial surgery. Cleft lip and palate repairs were the most common surgical demands (34.5%), followed by mandibulectomy and open reduction and fixation. The least surgical demands were neck dissections (0.36%), and none (0.0%) of the patients had cosmetic surgery.

DISCUSSION

Oral and maxillofacial surgery (OMFS) is a specialty that treats a wide spectrum of diseases, injuries, and defects affecting the head, neck, jaw bones, face, and the hard and soft tissues of the oral cavity.^[1] The department in our hospital manages patients referred from healthcare facilities in Edo state as well as the neighboring states that lack the necessary skilled professionals, facilities, and resources to manage them. This study provides data on both current and prospective patients who had a wide range of services that are available in the institution. It is hoped that it would also guide the appropriate use of resources so that the more frequently performed OMFS procedures could be determined and the allocation of funding and resources could be achieved more appropriately. The department deals with a large number of patients with maxillofacial trauma, oral cancers, tumors, cysts, salivary gland disorders, infective disorders, and developmental anomalies. In 10 years, the total number of patients that demanded the services of oral and maxillofacial surgeons in the department was 550, which gives a surgical procedure volume of 55 patients yearly. A previous report^[6] had indicated this volume of patients to be high. Surgical procedure volume is defined as the number of patients receiving a specific procedure in the hospital each year.^[21] From the March 2011 to April 2021 periods under review, none of the patients was discharged against medical advice preoperatively, which further confirms the high volume of patients treated at the center.

The mean age of patients who mostly sought oral and maxillofacial services was 32.5 ± 2.08 years. This is comparable to that reported in the previous studies.^[16,17] The reason for the peak of oral and maxillofacial procedures in this decade of life could be related to their involvement in daily activities.^[12] More males demanded OMSPs than females. This finding is similar to that reported in the previous studies.^[2-4] The reason for this finding is probably related to the fact that females seek medical attention than males.^[5] Patients whose source of living solely depended on their guardians or parents mostly sought oral and maxillofacial surgery services for palatoplasty and cheiloplasty at the center.^[17] The effect of educational status on oral and maxillofacial surgery demand was also evaluated, and we found that patients with a primary level of education demanded oral and maxillofacial surgical services more compared to other levels of education. It could be deduced that patients with high educational backgrounds seek medical attention earlier, and this can reduce their demand for debilitating major surgical procedures.^[7]

Cleft lip and palate repairs were the most common surgical procedures performed, which agrees with a similar finding reported in a previous study^[18] but differs from those that reported mandibulectomy^[19] and open reduction and internal fixation^[20] as the most performed procedures. The availability of experts and facilities could be the reason for this variation.

This study has some limitations, as some relevant data must have been missed due to its retrospective nature. Since procedures under LA were not considered, a further study on the pattern of minor oral and maxillofacial procedures is recommended.

CONCLUSION

The most common surgical demands by patients were cleft lip and palate repairs, while neck dissection was the least common demand, respectively