|Year : 2020 | Volume
| Issue : 1 | Page : 1-2
Our challenges in practicing oral oncology
Akhilesh Kumar Singh
Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
|Date of Submission||13-May-2020|
|Date of Acceptance||25-May-2020|
|Date of Web Publication||18-Jun-2020|
Akhilesh Kumar Singh
Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh AK. Our challenges in practicing oral oncology. Natl J Maxillofac Surg 2020;11:1-2
Oral Cancer is one of the top three types of malignancies reported in Indian subcontinent. In a recent study, it was reported that the incidence of oral cancer was 20 per 100,000 population and accounts for 30% of all cancer cases in our country. According to the Global Adult Tobacco Survey of India conducted in 2016–2017, 28.6% (266.8 million) of all adults currently use tobacco, which is considered as the most common etiological agent. Out of all, 21.4% (199.4 million) use smokeless tobacco, which is a common oral abusive agent in lower socioeconomic groups. The most important challenge is the lack of awareness and delay in diagnosis. Most of the cases are referred to tertiary health-care centers in a very advanced stage (Stages III and IV), which results in poor prognosis. Moreover, lack of adequate health care professionals and infrastructure in the rural areas of the country leads to a delay in induction of treatment. Surgery, radiotherapy, and chemotherapy are the three important pillars in the management of oral cancer. Surgery is considered as the most important out of the three, which is performed at the early stages of the disease. No doubt, surgery for oral cancer patients requires a team of dedicated professionals and a well-equipped center with advanced diagnostic as well as postoperative management facilities. At present, surgical oncologists, head-and-neck oncologists, otorhinolaryngologists, oral and maxillofacial surgeons, and general surgeons are the specialists in the management. Apart from it, plastic surgeons are also involved in the complex reconstruction of postsurgical defects. In addition to that, a team of dedicated anaesthetists, intensive care specialists, nursing staff, paramedical staff, nutritionists, and speech therapists are also important in intraoperative and postoperative care. All these facilities are possible only in hospitals like medical colleges and corporate sector health center present in major cities of the country. A huge monetary burden is also faced in managing this disease, which is another challenge both for the patients and for the health-care professionals.
As an oral and maxillofacial surgeon, my consideration is to discuss the challenges faced by us in learning and managing this curse. Oral and maxillofacial surgery (OMFS) is among one of the nine specialties of dentistry. In India, to become an OMFS specialist, one has to do 4 years of graduation (Bachelor of Dental Surgery) along with 1 year of internship in various medical and dental departments, followed by 3 years of postgraduation (Master of Dental Surgery) in the field of oral and maxillofacial surgery, whereas in other parts of the world, some countries recognize the dual-degree program in both medicine and dentistry to become an OMFS specialist, whereas some countries have the same curriculum. No doubt, this specialty acts as a bridge between the dental and medical sciences. The wide spectrum of OMFS includes the management of a diseased tooth, orofacial infections, various cyst and tumors of the maxillofacial region, facial bone fractures, cleft lip and cleft palate surgeries, temporomandibular joint disorders, salivary gland disorders, and facial esthetic procedures along with malignant conditions of the oral cavity. Most of the treatments are invasive, are technique sensitive, and are associated with various medical comorbidities as well as mortalities. Oral and maxillofacial region is an integral part of our airway, which again raises the complexity of its location while managing various conditions and maintaining the patency of airway. Hence, a basic knowledge of human anatomy, physiology, and clinical aspects of various associated systemic conditions is mandatory.
In the last two to three decades, OMFS specialists have developed a keen interest in the management of oral malignancies and also learnt complex oncologic and reconstructive surgeries including free flap reconstruction. The training of OMFS in India is very diverse, Around 10% of the training institutes are from government sectors, whereas the rest are from private sectors. Due to the wide spectrum of the subject and availability of the resources, centers have developed their own area of interest. Few centers are popular for the management of trauma cases due to association with medical institute or trauma centers, few have interest in managing cleft and craniofacial anomalies, and very few training institutes provide good exposure for oral cancer management. The young aspiring OMF surgeons with a keen interest in learning oral oncology have limited scope in the current situation. In the last one decade, various fellowship centers have been developed by the International Association of Oral and Maxillofacial Surgeons and the Association of Oral and Maxillofacial Surgeons of India. Recently, the Foundation for Head and Neck Oncologists has also started its fellowship in oral oncology exclusively for OMFS specialists. But still, the number is too less to accomplish the goal.
Another challenge is our acceptability as an oral oncologist in the society. Even the corporate sector hospitals also doubt the capabilities in spite of adequate training, whereas due to the medical background and sound training, the surgical oncologists and head-and-neck oncologists have good acceptance in the private sector. I want to share one of my own experiences with you all. In 2013, when I started my practice in Varanasi, I posted one case of squamous cell carcinoma of the buccal mucosa in a hospital and asked the management to arrange a plastic surgeon for reconstruction of the defect with pectoralis major flap. But, I was surprised to know that he refused to work with me. Then, I had to perform the flap on my own. The reason may be the lack of trust between the other surgical specialists and OMFS specialists due to our dental background. But with the period of time in last 7 years. Now, I have developed a good relationship with our medical colleagues, and now, we love to work together in most of our surgeries. The need of the hour is to synchronize the things; OMFS specialist is a well-trained professional in the management of various conditions of the oral cavity, jaw bone and face. The other allied surgical professionals should recognize the skills and caliber of an OMFS specialist, utilize them together to work for more promising results. The corporate sector should also join hands with our young professionals to prevail good career opportunities. We are much aware of the increasing burden of oral cancer cases and the shortage of oncospecialists and trained health professionals. OMFS specialists can play a significant role in reducing the menace by providing them equal opportunities.
My sole motive through this editorial is to create a positive environment and better future for OMFS in our country and the world. I owe most of my learning of oral oncology from head-and-neck surgeons, oncosurgeons, and plastic surgeons, who loved to inculcate the art of oncology and reconstruction during my training years.
Jai Hind, Jai OMFS
The author would like to acknowledge Prof. I B Kar, Prof. U S Pal, Prof. N K Sharma, and Dr. Niranjan Mishra for mentorship and support. He is also grateful to his parents Capt (Retd) J R Singh and Mrs Madhu Singh and wife Dr. Shreya Singh for their immense support and motivation throughout and to Ms. Shristi Gupta for editing the content.
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