Reliability of Clinical Diagnosis of Oral and Maxillofacial Lesions Compared with Histopathological Diagnosis in a Tertiary Hospital in Southwest Nigeria: Implications in the Era of Medical Brain Drain.

Abstract

Background:

Nigeria is experiencing an unprecedented medical brain drain, resulting in the loss of highly skilled clinicians. Consequently, many centres lack oral pathologists to provide accurate diagnoses for oral and maxillofacial lesions, which makes clinicians depend more on clinical assessment when managing patients. This study assessed the precision of clinical diagnosis compared with histopathological diagnosis of oral and maxillofacial lesions at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, over nine years (2017–2025).

Methods:

A comprehensive review of the archival biopsy service records from the Oral Pathology Unit, Department of Oral Medicine and Oral Pathology, were reviewed for the period January 2017 to December 2025. Extracted data included sociodemographic such as patient age, sex, lesion site, clinical diagnosis, histologic diagnosis, and broad diagnostic category (e.g., benign, malignant, or reactive). SPSS was used to generate descriptive statistics, sociodemographic distributions, and concordance rates between clinical impressions and histopathological findings.

Results:

A total of 451 cases were analyzed. Patients had a mean age of 38.5 years±20.3, with an age range of 3monts to 96 years. There was a slight female predominance, with 241 females and 209 males (female-to-male ratio: approximately 1.15:1) while the gender was not specified in one case. The mandible was the most common anatomical site of lesion presentation, and Ameloblastoma was the most frequently diagnosed pathology. Histologic Categorization: Benign lesions accounted for the largest diagnostic group, with 195 cases (43.5%), followed by malignant lesions in 114 cases (25.4%), reactive lesions in 93 cases (20.8%), cysts in 30 cases (6.7%), and developmental conditions in 16 cases (3.6%) while the three cases (0.7%) that were referred for further work-up were excluded from category-level comparisons. Exact clinical diagnoses corresponded with final histologic diagnoses in 53.66% of cases. In contrast, broader categorical concordance such as clinicians’ ability to correctly predict whether a lesion was benign, malignant, reactive, or another category was higher, at 76.94%.

Conclusion:

Clinical evaluation was able to predict the broad category of oral and maxillofacial lesions with an accuracy of ~77%. However, specific diagnosis was less accurate and establishes the indispensable necessity of histopathological diagnosis. The most common were benign lesions especially mandibular ameloblastoma. To improve diagnostics and strengthen patient care, histopathology services must improve and healthcare professionals must be retained.