By Samwel Doe Ouma@samweldoe
Lack of specialists and training facilities on Oral Cranio and Maxillofacial surgery (OMFS) – a specialty in dental practice- are major causes of fatalities, a specialist surgeon has said.
According to Dr. Edwin Rono, consultant and lecturer in Oral Cranio and Maxillofacial surgery, low public awareness on the role of Oral Cranio and Maxillofacial Surgeons and specialists impedes on best treatment outcomes for patients seeking facial and cranio surgeries.
He said most patients present themselves very late, making referral of patients to specialists problematic.“Many health professionals lack proper understanding on the wide scope of surgical procedures that Oral Cranio and Maxillofacial surgeons offer,” Rono said.
He noted that there are 31 Oral Cranio and Maxillofacial surgeons serving a population of over 48 million Kenyans, translating to 10 doctors serving 4.8 million patients.
The World Health Organisation (WHO) recommends a ratio of 23 health workers to 10,000 people or 40 clinical officers per 100,000 people, 32 doctors per 100,000 people or 95 nurses per 100,000 people.
Injuries from accidents caused by motor vehicle accidents including motorcycles and acts of violence are major public health issues.
In Kenya, increasing road crashes pose a greater need for Cranio and maxillofacial surgeries. According to the National Transport and Safety Authority (NTSA), Kenya records an average of 3,000 fatalities from road crashes while over 20,000 survive with injuries.
The specialty includes diagnosis and management of facial injuries, head and neck cancers, salivary gland diseases, facial disproportion, facial pain, temporomandibular joint (TMJ) disorders, impacted teeth, cysts and tumors of the jaws, as well as numerous problems affecting the oral mucosa such as mouth ulcers and infections.
Diagnosis and management of these conditions remains a challenge Rono said adding patients lack awareness on where to seek medication.
Medical practitioners often refer patients to oral Cranio and Maxilofacial surgeons very late something Rono noted complicates “better treatment outcomes”.
He explains that Oral Cranio and maxillofacial surgeons correct cleft palates, rebuild jaws, cheeks, noses, eye sockets, foreheads and diseases of the mouth.
“The speciality also deals with non-surgical management of conditions such as facial pain, oral mucosal disease and infections,” he told Health Business magazine.
He adds that a maxillofacial surgeon helps in reconstructing the face of patients with fractured facial bones.
To qualify as an oral and maxillofacial surgeon, one needs to undergo a five-year undergraduate degree program in oral and maxillofacial surgery.
In Europe and the Unites States, one needs to have both medical and dental undergraduate degrees prior to embarking on training in oral and maxillofacial surgery.
Rono says that the mouth is a mirror of health or disease, a sentinel or early warning system, adding that early detection of oral diseases especially oral cancers makes them more amenable to treatment and allows the greatest chance of cure.
Lack of general medical practitioner’s knowledge of oral diseases has been shown to contribute to delays in referral and treatment, thus affecting the associated morbidity and mortality, he adds.
“If one is experience non-healing wounds in the mouth, swellings, bleeding or colour changes around your oral and cranio area that cannot be explained, it could be an early sign of dangerous diseases and one is advised to seek an oral cranio and maxillofacial services,” he said.
Early detection and immediate treatment of oral cancer may reduce mortality rates. However, patients seek services of a maxillofacial surgeon after visiting two or three non-specialty doctors.
He added that diagnostics equipment required are numerous, sophisticated and expensive as different operations require different tools.
“The overlapping nature of bones and the inability to visualize soft tissue swelling and fracture displacement, especially in the face, makes radiography less reliable,” Rono said, adding that three dimensional (3D) printing equipment is used for visualizing the area of operation.
The 3D radiographic anatomical displays (CT scans), and Magnetic Resonance Imaging (MRI scans) allow surgeons to view accurate and detailed pictures of a patients’ head, neck anatomy and pathology.
“We manipulate images by computer in order to generate precise models for planning surgery,” he said.