A global science mapping analysis on odontogenic infections.

OBJECTIVES: Odontogenic infections are common and a topic of core interest for dentists, and maxillofacial surgeons. The aim of this study was to conduct a bibliometric analysis of the global literature on odontogenic infection and explore the top 100 most cited papers to identify the common causes, sequelae and management trends. METHODS: Following a comprehensive literature search, a list of top 100 most cited papers was created. The VOSviewer software (Leiden University, The Netherlands) was used to create a graphical representation of the data, and statistical analyses were performed to analyze the characteristics of the top 100 most cited papers. RESULTS: A total of 1,661 articles were retrieved with the first article published in 1947. There is an exponential upward trend on the number of publications (R2 = 0.919) and a majority of papers are in English language (n = 1,577, 94.94%). A total of 22,041 citations were found with a mean of 13.27 per article. The highest number of publications were recorded from developed countries. There was a male predilection in the reported cases and the most common sites included the submandibular and parapharyngeal spaces. Diabetes mellitus was identified as the commonest co-morbidity. Surgical drainage was ascertained to be the preferred method of management. CONCLUSIONS: Odontogenic infections remain prevalent and have a global distribution. Although prevention of odontogenic infection through meticulous dental care is ideal, early diagnosis and prompt management of established odontogenic infections is important to avoid morbidities and mortality. Surgical drainage is the most effective management strategy. There is lack of consensus regarding the role of antibiotics in the management of odontogenic infections.

Pattern of Ocular Involvement in Midface Injuries Seen at a Tertiary Care Hospital in Northern Nigeria.

AIM: The aim of the study was to report the etiology, pattern, and spectrum of ocular injuries in patients with maxillofacial injuries seen at a tertiary care hospital in northern Nigeria. PATIENTS AND METHODS: This is a retrospective evaluation of the etiology, spectrum, and treatment of ocular injures seen in patients with midfacial fractures, who presented at Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria, a tertiary care hospital in northern Nigeria. Cases were seen at the oral and maxillofacial clinic for those presenting with midfacial fractures, whereas those presenting with ocular injuries due to midfacial injuries were referred from the ophthalmology department. Data were collected on their demographics, etiology of injuries, body part(s) involved, and treatment. RESULTS: A total of 256 patients had midfacial injuries during the period, of which 219 patients had 357 associated ocular injuries. The age range was between 3 and 76 years. There were more males (83.8%) than females (16.2%), giving a male-to-female ratio of 5.2:1; the 21-30 years' age bracket was most frequently affected (38.4%). The predominant etiology of injuries was road traffic accidents (RTAs) (90.1%), followed by assault (4.9%). Zygomatic complex fractures (38.6%) and orbital wall fractures (24.7%) were the common midfacial injuries. There were 357 ocular injuries, giving a patient: injury ratio of 1:1.6, with subconjunctival hemorrhage (32.5%) and ruptured globe (20.0%) being common. Treatments performed were reduction and immobilization of midfacial fractures plus evisceration (32.0%), followed by reduction and immobilization of fractures alone (23.9%) and reduction and immobilization plus grafting of soft tissues (21.2%). CONCLUSION: Ocular injuries are quite common in patients with midfacial injuries, with a ratio of 1.6:1. RTA was the most common etiology, with zygomatic complex fractures as the most common midfacial injury. Subconjunctival hemorrhage was the most common ocular injury manifestation, with young adults (21-30 years of age) being most affected. Treatment often involved reduction and immobilization of midface fractures with evisceration and grafting of ocular tissues.

Maxillofacial injuries sustained during military peace keeping mission in Liberia: The Nigerian Experience (1990-1997)

Objective: Armed conflicts often cause maxillofacial injuries that could be challenging to manage. These injuries are often disproportionate to the relationship between the maxillofacial region and the entire body. Between 1990 and 1997, Nigerian soldiers were involved in military operations during the Liberian Civil War as part of a subregional intervention force. The aim of this paper is to review some characteristics of the maxillofacial injuries sustained by Nigerian soldiers as seen at a tertiary referral hospital with a view to drawing lessons for future management of maxillofacial and other casualties in the West African subregion. Methods: Retrospective review of hospital records of patients evacuated from Liberia from 1991 to 1997 was undertaken. Data was collected on demographics, sites of injuries, treatment received and discharge details. Results: Sixty one patients were seen, all males, between age 21-53years, most (57.4%) were between 21-29years of age. There were more soft tissue and dentoalveolar injuries (60.6%) than facial bone fractures (39.4%). Soft tissue injuries were debrided with secondary suturing while most fractures were treated by closed reduction and immobilisation. Most patients (98.4%) were successfully treated while one patient died. Conclusion: Maxillofacial injuries sustained during the conflict were mostly of soft tissues and most were treated successfully, This study showed the need for the deployment of maxillofacial trauma registries during armed conflicts for proper documentation victims and for maxillofacial surgeons to be included in combat surgical teams to ensure prompt and adequate treatment of patients closer to the point of wounding

Ameloblastic carcinoma of the maxilla: a report of two cases and a review of the literature.

Ameloblastic carcinoma is a malignant form of ameloblastoma defined by histological evidence of malignancy in primary, recurrent, or metastatic tumor. Such a tumor is rare, and the maxilla is an unusual site. Due to its rarity, the characteristics of this tumor in the maxilla have not been well described. Case 1: A 55-year-old, ill-appearing Nigerian male presented to our center with left maxillary swelling of seven-year duration. The swelling had been slow-growing and painless until one year prior, when the growth became rapid and was coupled with severe pain. The swelling affected both oral function and facial esthetics, and the patient reported difficulty breathing. There was a maxillary, ulcerated swelling extending from teeth 12 to 18 and blocking the left nostril. The involved teeth were moderately mobile. Case 2: A 32-year-old male farmer presented with recurrent right maxillary swelling of six-year duration. Prior to this episode, he had undergone surgery for ameloblastoma (follicular type). The present swelling was fungating through the skin and protruding into the right nostril. Ameloblastic carcinoma is an aggressive odontogenic tumor that requires aggressive surgical treatment.

Myositis ossificans of the platysma mimicking a malignancy: a case report with review of the literature.

The two main forms of myositis ossificans are congenital and acquired. Either form is rare in the head and neck region. The acquired form is often due to trauma, with bullying as a fairly common cause. This report of myositis ossificans of the platysma in an 11-year-old female patient emphasizes the need for a high index of suspicion in unexplainable facial swellings in children and the benefit of modern investigative modalities in their management.

Facial cleft with Amelia: a Nigerian case report.

Clefts of the lip and palate are the most common serious congenital anomalies in orofacial region. However, the occurrence of associated defects in the limbs is quite rare. This report presents a 12-week-old male child born with unilateral left cleft lip and palate, absence of the upper left arm and forearm, and fusion of both big and middle toes and absence of the entire small toe on the left foot. The repairs of lip and palate defects were done at 6 and 19 months of age while parents were referred for rehabilitation to ameliorate absence of upper left arm. We discuss the challenges of management of defects in a developing economy, issues of acceptance of children born with defects amenable to surgery and the benefit of parental education on the care of the child.

Concomitant injuries associated with maxillofacial fractures in Abuja, Nigeria.

BACKGROUND: Injury is the leading cause of death and disability and the third most common cause of death Little attention has been given to the concomitant injuries associated with maxillofacial fractures in scientific literatures. OBJECTIVES: For effective planning and efficient management of the patients, there is need to study the pattern ofthese injuries. METHODS: Consecutive patients who sustained one or more facial bone fractures over a period of 2 years were prospectively studied. RESULTS: There were 103 patients out of which 96 sustained concomitant injuries giving an incidence of 93.2%.There were 75 (78.1%) males and 21 (21.9%) females with a M:F of 3.6:1. The mean + (SD) age was 30.8 +13.0 with a range of 2.0 to 68.0 years. Road Traffic Crashes was the commonest (n = 81, 84.4%) cause of injury. Soft tissue of the face, with an incidence of 62.1% (n = 64) was the commonest concomitant injury. It was followed by neurologic injury (n = 51, 49.5%) and ophthalmic injury (n = 38, 36.9%) while abdominal injury (n = 2, 1.9%) was the least common. Majority (87.5%) of the ophthalmic injury patients sustained midfacial fracture while 12.5% of the them sustained mandibular fractures. Pulmonary and cervical injuries were found to be associated more with mandibularfractures. CONCLUSION: Concomitant injuries occur commonly with maxillofacial fractures and they were found to have significant effect on the management of the fractures. A multidisciplinary approach will bring about a very efficient management of patients.

Technical quality of root canal fillings done in a Nigerian general dental clinic.

BACKGROUND: Previous reports indicate that worldwide, the technical quality of root canal fillings is poor. There are few reports from sub-Saharan Africa and none yet from Nigeria where most patients access treatment from non-specialists especially at general dental clinics. The aim of this study was to evaluate the technical quality of root canal fillings done in a general dental clinic with emphasis on the effects of professional experience of the operator, whether tooth was anterior or posterior and whether it was a maxillary or mandibular tooth. METHODS: Retrospective study of case notes and periapical radiographs of patients with completed root canal fillings seen between 2008 and 2011. Inclusion criteria included cases of primary treatment with available case notes, good quality pre-operative and post-operative periapical radiographs. Technical quality that was assessed was root canal length and homogeneity. Root canal fillings were classified either as Good Quality Endodontic Work (GQEW) or Non- Good Quality Endodontic Work (NGQEW). RESULTS: Fifty-one patients aged between 8 and 54 years (mean 28) fulfilled the inclusion criteria for this study. From these, there were 62 root filled teeth giving a ratio of 1.2 root canal filled teeth per person. There were acceptable length of root canal fillings in 71% of teeth, 58.1% were homogeneous while 53.2% were GQEW. There was no statistically significant difference in whether tooth was root filled by junior or senior dentist (p=0.43), anterior or posterior (p=0.11). There was significant association between GQEW and maxillary teeth (p=0.03). CONCLUSION: This study showed that the overall technical quality of root canal fillings done by non-specialists was better than earlier reports but lower than that done by endodontists. Since many patients receive treatment from non-specialists in developing countries, it is necessary to improve technical quality of root canal fillings done in general dental clinics. These could be through improvement in the quality of undergraduate training and more post graduate continuing education courses for skills update.

Delayed soft tissue recurrence after treatment of ameloblastoma in a black African: case report and review of the literature.

INTRODUCTION: Ameloblastoma is rare worldwide. Delayed treatment can result in significant morbidity from facial deformity and infiltration of adjacent tissues. Mortality can occur from invasion of vital structures in the head and neck, super infection, recurrent and even distant metastases. Recurrence after radical treatment is not common. CASE REPORT: This paper presents a case of soft issue recurrence in the chin 21 years after radical resection of the mandible for ameloblastoma. The iliac crest bone grafted to the site was not involved in the tumour recurrence. Conclusion. Radical surgical resection is accepted treatment for solid/multicystic ameloblastoma. However, the surgical review should be for life as recurrence can occur after a long interval.

An updated clinical and epidemiological profile of the adenomatoid odontogenic tumour: a collaborative retrospective study.

BACKGROUND: Adenomatoid odontogenic tumour (AOT) is a benign odontogenic jaw lesion. The aim of this study was to update the biological profile of AOT. MATERIAL AND METHODS: Cases published in the literature and cases in files of co-authors were included. RESULTS: 550 new cases were retrieved, and of a total of 1082 cases analysed, 87.2% were found in the second and third decades. The M:F ratio was 1:1.9. 70.8% were of the follicular variant (extrafollicular: 26.9%, peripheral: 2.3%). 64.3% occurred in the maxilla. 60% of follicular AOTs were associated with unerupted canines. Nineteen cases of AOT (2.8%, M:F ratio was 1:1.4) were associated with embedded third molars. Twenty-two peripheral AOTs (2.3%, M:F ratio was 1:5.3) were recorded. The relative frequency (RF) of AOT ranged between 0.6% and 38.5%, revealing a considerably wider AOT/RF range than hitherto reported (2.2-7.1%). CONCLUSIONS: This updated review based on the largest number of AOT cases ever presented, confirms the distinctive, although not pathognomonic clinicopathological profile of the AOT, its worldwide occurrence, and its consistently benign behaviour.

A review of 318 odontogenic tumors in Kaduna, Nigeria.

PURPOSE: To analyze 318 odontogenic tumors seen at a tertiary oral care center in Kaduna, Nigeria for comparison with findings in previous Nigerian and world records. MATERIALS AND METHODS: A retrospective survey of odontogenic tumors based on the classification of Kramer et al was undertaken at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria, from all histopathologically proven cases of tumors and tumor-like lesions of the oral and perioral structures. Data were retrieved from case notes, radiographs, histopathology results, and follow-up records. Information collected were used to complete a questionnaire and subjected to analysis. RESULTS: There were 990 tumor and tumor-like lesions of the oral and perioral structures, of which 318 were odontogenic tumors (32%). Twelve histopathologic types of odontogenic tumors were found with more benign (n=314; 99%) than malignant (n=4; 1%). Ameloblastoma made up 233 (73%) of the tumors, followed by odontogenic myxoma (n=38; 12%), ameloblastic fibroma (n=9; 3%), and the adenomatoid odontogenic tumor (2%). Three cases of calcifying odontogenic cyst were co-existent with ameloblastoma (2) and ameloblastic fibro-odontoma (1). Among 275 surgically treated odontogenic tumors, enucleation was performed in 64 cases (23%), dentoalveolar segment resection with preservation of lower border of the mandible (n=33; 12%), segmental resection (n=168; 61%), and composite resection (n=9; 3%); 1 case was deemed inoperable. At least 8 cases of ameloblastoma (13%) recurred out of 60 followed up. CONCLUSION: Ameloblastoma is a fairly common tumor of Nigerian Africans accounting for 73% of odontogenic tumors and 24% of all tumors and tumor-like lesions of the oral and perioral structures. Various forms of resection are practiced to eradicate the tumor in view of the late presentation in our environment. Patients in Nigeria do not often return for follow-up reviews. A minimum of 5 years of follow-up reviews are necessary after treatment of ameloblastoma.

Odontogenic tumours in children and adolescents: a study of 78 Nigerian cases.

BACKGROUND: There is paucity of literature on odontogenic tumours in children and adolescents. Available records are difficult to compare due to differences in study criteria. To contribute to the records, a 20-year study of odontogenic tumours on the basis of the WHO classification (Kramer et al., 1992) in Nigerian African children and adolescents < or =18 years of age was undertaken. MATERIAL: A retrospective survey of oral/jaw tumours and allied lesions in children and adolescents < or =18 years of age seen at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria between 1979 and 1998. Data collected were histopathologic type, age, clinical features, radiologic appearance, treatment and record of recurrence. METHOD: Odontogenic tumours selected using the WHO classification were used for further study. Data were collected from case notes, radiographs, histopathologic reports and follow-up records. Information retrieved was used to complete a questionnaire and subjected to analysis. RESULTS: Two hundred and fifty-two (252) subjects < or =18 years were recorded, from which 78 (31%) had odontogenic tumours. Among seven types of odontogenic tumours seen, ameloblastoma (54%), odontogenic myxoma (19%) and adenomatoid odontogenic tumour (9%) were predominant. All patients seen were from 6 to 18 years with more than half (53%) between 15 and 18 years of age. A patient with multiple, bilateral odontomas of the maxilla and mandible resembling Herrmann's syndrome was recorded. Seventy-three patients were treated using enucleation (37%), dentoalveolar resection with preservation of lower border (15%) and segmental resection (48%). Five patients absconded after tumour diagnosis. No tumour recurrence was recorded in 65 treated cases followed-up for between 2 months and 10 years. CONCLUSION: This report shows that while ameloblastoma was the predominant odontogenic tumour, its frequency in Nigerian African children was lower than in the adult population. A case resembling Herrmann's syndrome is also presented.