Surgical Glove Perforation and Percutaneous Injury during Intermaxillary Fixation with 0.5 Mm Stainless Steel Wire.

INTRODUCTION: The risk of exposure of either the patient or the surgeon to pathogens when the surgical glove is perforated is significant. This is particularly so in jaw fractures when intermaxillary fixation is done with the stainless-steel wire as many perforations also result in percutaneous injury. MATERIAL AND METHOD: This study was carried out in two tertiary Hospitals in Abuja, Nigeria. Adult patients for intermaxillary fixation as a result of jaw fractures were consecutively recruited into the study. Similarly, surgeons and their trainees (assistants) were also recruited. Factors investigated included the method of gloving used by surgeons and trainees (single versus double gloving), glove perforations and percutaneous injury rates, years of operator's experience, among others. During surgical operations, percutaneous injuries were recorded and obviously perforated or torn gloves were labelled and changed. At the end of every surgical procedure, gloves used were investigated for perforation. RESULTS: A total of 564 gloves were investigated (Surgeons-337; Trainees-227) after use for wire intermaxillary fixation procedures. The frequency of glove perforations for the surgeons was 72 (21.4%). Forefinger perforations were most frequent; 40 (55.6%) cases. Assistants, had 35 (15.4%) cases of glove perforations. Percutaneous injury occurred in 9.7% (7/72) and 5.7% (2/35 cases) of cases for surgeons and assistants, respectively. CONCLUSION: The study revealed high risk for wire-based IMF procedures. Single gloving was more frequently associated with percutaneous injuries although double gloving was more associated with perforations with higher surgeon infection risk. Double gloving reduces the risk of percutaneous injuries and, therefore, the likelihood of exposure to blood-borne pathogens.

INTRODUCTION: Le risque d'exposition du patient ou du chirurgien à des agents pathogènes lorsque le gant chirurgical est perforé est important. Cela est particulièrement le cas dans les fractures de la mâchoire lorsque la fixation intermaxillaire est effectuée avec le fil en acier inoxydable, car de nombreuses perforations entraînent également des lésions percutanées. MATÉRIEL ET MÉTHODE: Cette étude a été réalisée dans deux hôpitaux tertiaires à Abuja, au Nigeria. Des patients adultes pour une fixation intermaxillaire à la suite de fractures de la mâchoire ont été recrutés consécutivement dans l'étude. De même, des chirurgiens et leurs stagiaires (assistants) ont également été recrutés. Les facteurs étudiés comprenaient la méthode de gloving utilisée par les chirurgiens et les stagiaires (simple versus double gloving), les perforations de gants et les taux de blessures percutanées, les années d'expérience de l'opérateur, entre autres. Au cours des opérations chirurgicales, des blessures percutanées ont été enregistrées et des gants manifestement perforés ou déchirés ont été étiquetés et changés. À la fin de chaque intervention chirurgicale, les gants utilisés ont été étudiés pour la perforation. RÉSULTATS: Au total, 895 gants ont fait l'objet d'une enquête (Surgeons-337; Stagiaires-227) après utilisation pour les procédures de fixation intermaxillaire du fil. La fréquence des perforations de gants chez les chirurgiens était de 72 (21,4 %). Les perforations de l'index étaient les plus fréquentes, 40 (55,6 %) cas. Assistant, avait 35 (15,4%) cas de perforations de gants. Des lésions percutanées sont survenues dans 9,7 % (7/72) et 5,7 % (2/35 cas) des cas chez les chirurgiens et les assistants respectivement. CONCLUSION: L'étude a révélé un risque élevé pour les procédures filaires du FMI. Le gloving simple était plus fréquemment associé à des blessures percutanées, bien que le double gloving soit plus associé à des perforations avec un risque d'infection plus élevé chez le chirurgien. Le double gloving réduit le risque de blessures percutanées et, par conséquent, la probabilité d'exposition à des agents pathogènes transmissibles par le sang. MOTS CLÉS: Fixation intermaxillaire, gants, Chirurgien, Lésion percutanée.

ANTENATAL EVENTS AMONGST MOTHERS OF BABIES WITH OROFACIAL CLEFTS.

BACKGROUND: Exogenous factors occurring in the antenatal period could be contributory to the formation of orofacial cleft. This study sought to determine the antenatal events in mothers that may have contributed to orofacial cleft deformity of their children. METHODOLOGY: It was a prospective observational cross sectional study of consenting mothers of babies with orofacial cleft who met the inclusion criteria. The study instrument was a questionnaire. RESULTS: Seventy-two mothers participated in the study. Most of these mothers were below 35 years of age and more than half, 43 (59.7%) were of the low-intermediate socioeconomic status. Although majority, 70 (97.2) of the mothers had antenatal care, the mean gestational age at commencement of antenatal care was 4 months. Almost all, 69 (95.8%) mothers had ultrasound scans however the detection of the orofacial cleft was in only 2 (2.8%) mothers. The commonest medication taken was haematinics, 26 (36.1%). Herbal medication, 15 (20.8%) and antimalarial, 12 (16.7%) were the other drugs more frequently taken. The mean age of pregnancy at commencement of these medications was 3.6 months. CONCLUSION: Although uptake of antenatal service was common practice among mothers of babies with orofacial clefts in this study, no antenatal predisposing factors were identified.

Mortality Trends among Older Patients Admitted to the Geriatric Centre, University College Hospital, Ibadan, Nigeria, 2013-2017.

BACKGROUND: Attaining successful clinical outcomes in the management of hospitalised older patients in the overburdened healthcare services in Nigeria constitutes a major challenge against the backdrop of dearth of data on the predictors of mortality among them. OBJECTIVES: To describe the mortality trends and associated factors among older patients (>60 years) at the Geriatric Centre, University College Hospital, Ibadan between January 2013 and December 2017. METHODS: Hospital records of older patients admitted were analysed. Data extracted included socio-demographic, diagnoses, length of stay from date of admission to discharge or death. Results of vital signs, anthropometric measurements and laboratory tests carried out at admission were also obtained. RESULTS: The mean age of the 1,091 older patients admitted was 73.6±8.6 years. The overall crude proportion of in-hospital deaths was 9.0% (males=11.3% > females=7.2%, p=0.024) and it increased from 4.1% in 2013 to 12.1% in 2017. The overall unadjusted 30-day mortality rate per 1000 patient-days was 28.9 deaths (95% CI 23.5-35.3). The predictors of mortality were increased length of stay on admission OR=1.061 (95% CI 1.005-1.119), being retired OR=1.672 (95% CI 1.011-2.778), stroke OR=4.019 (95% CI 2.258- 7.138), heart failure OR=3.435 (95% CI 1.455-8.100), Sepsis OR=2.176 (95% CI 1.294-3.654), Anaemia OR=2.820 (95% CI 1.320-6.017), Dementia OR=3.701 (95% CI 1.433-9.549) and malignancies OR=2.658 (95% CI 1.181-5.979). CONCLUSION: There was a temporal increase in mortality among older patients. Similarly, staying longer on admission and chronic medical conditions with their complications were the most significant contributors to mortality.

DENTAL RESIDENTS' PERCEPTION OF LEARNING ENVIRONMENT: EXPERIENCE OF A NIGERIAN TRAINING INSTITUTION.

BACKGROUND: Learning environment has been described as crucial in determining the success of medical and dental education. Continuous evaluation of this environment will help in maximizing the learning opportunities of the training program. OBJECTIVE: To assess the resident doctors' perception of their learning environment at a teaching hospital in Nigeria. METHODS: The DREEM questionnaire was administered to participants undergoing residency training in the faculty of Dental Surgery at the University College Hospital, Ibadan. RESULTS: Thirty-nine resident doctors participated in the study (23 Males, 16 Females), mean age (±SD) was 35.7 (±4.22) ranging from 28 years to 46 years. Mean global score (±SD) was 105.3 (±26.8), 52.7%, out of a maximum of 200. The mean global score according to gender was significantly higher among males than females. The overall perception of the training environment by residents is more positive than negative and the male gender appears to have a more positive perception than the female gender. However, this perception is borderline as the environment was perceived as having many problems and residents' perception of their learning environment is mostly negative. Attention of the institution and trainers should be drawn to possibilities of combating the problem areas for better outcome of residency training in our environment.

Maxillectomy and Quality of Life: Experience from a Nigerian Tertiary Institution.

INTRODUCTION: Maxillectomy is a surgical procedure for managing tumors affecting the maxilla; the goal of maxillectomy however should not be limited to tumor extirpation but should include restoration of oronasal function and facial contours, as failure to do these may give rise to psychosocial and functional challenges. This study aimed to appraise the pattern of maxillectomies, challenges of management, and quality of life (QOL) of a proportion of the study population. MATERIALS AND METHODS: This was a cross-sectional study carried out at the Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan. Patients' case files from year 2000 to 2016 were retrieved and reviewed. Data extracted for analysis included age, gender, site of lesion, and histologic diagnosis; lesions were grouped as benign or malignant. Contacts were made with patients or their next of kin for a clinic review appointment where QOL was assessed with the University of Washington Quality of Life version 4 Questionnaire. Data were analyzed and result presented as means and frequencies. RESULTS: Out of the 78 cases of maxillectomy recorded in the department within the study period, records were available and adequate in 67 cases. There were 37 (55.2%) females with a mean age of 35.88 ± 14.9 years. Swelling was the most common reason for presentation (63, 94%). The mean period between onset of disease and presentation for treatment was 3.66 ± 3.35 years. Distribution of lesions was benign 35 (52.2%) and malignant 32 (47.8%). Hemi-maxillectomy was the commonest surgical procedure (23, 34.8%). While majority had some prosthetic rehabilitation, 31 participants (48.5%) obtained no prosthesis. Eight participants gave scores of ≥75% when comparing their present health-related QOL (HR-QOL) with a month before surgery; the overall QOL was ≥60%. However, HR-QOL and overall QOL in the last 7 days before assessment were rated as good in 55.6% and 66.7%, respectively. Chewing was the most important domain to participants. CONCLUSION: The pattern of presentation and indications for maxillectomy in this series are similar to that from previous studies. The uptake of prosthetic rehabilitation was low and overall QOL was rated as fair. QOL should be considered as part of treatment outcome measure for maxillectomy.

STATE DISTRIBUTION OF NEW PATIENTS PRESENTING WITH CLEFT LIP AND PALATE TO THE UNIVERSITY COLLEGE HOSPITAL: A PILOT STUDY.

BACKGROUND: The UCH/Smile Train partnership, which offers free cleft surgeries to patients provides succor. OBJECTIVE: The objective of the study was to determine the state distribution of new patients presenting with cleft lip and palate, to The UCH. METHODS: A retrospective review of all new cleft patients presenting to The UCH between January 2012 and June 2015. The data obtained were their local government area of residence, age of the patients, gender of the patients and the type of cleft. Descriptive statistics was used to analyze the distribution of patients seen while Chi square test was used to analyze the influence of gender and laterality on the type of cleft. RESULTS: Sixty-seven eligible patients were seen within the study period. Majority (83.6%) of patients seen were from 14 of the 33 Local Government Areas (LGA's) in Oyo state. Patients were seen from LGA's in proximity to UCH. A few (16.4%) of the patients came from outside the state. Iwajowa, the LGA with the least number of patients (1.8%) was furthest from UCH. Left sided clefts were significantly more than bilateral or right-sided clefts (p=0.001). Most of the patients from Oluyole LGA had CP while no patient with CP was seen from Lagelu and Akinyele LGA's. CONCLUSION: There is the need to intensify cleft awareness programs. Further studies into the health habits, cultural beliefs and genetic profile of communities may explain some regional distribution of cleft types seen.

Evaluation of the scope and practice of oral and maxillofacial surgery in Nigeria.

BACKGROUND: Oral and maxillofacial surgery is still evolving, with the scope of practice in Nigeria inadequately determined. AIMS AND OBJECTIVES: This study aims to ascertain the level of practice in various parts of the country vis-a-vis the global trend and factors influencing the scope in Nigeria. DESIGN OF THE STUDY: Cross-sectional. SETTING: The study was carried out at the University of Ibadan. Participants included all the maxillofacial surgeons on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons and Practicing in Nigeria as at December, 2012. MATERIALS AND METHODS: Structured questionnaires were delivered to all on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons. Respondents were asked to provide information about their demographics, years of practice, areas of practice and factors influencing the choice of practice among others. Nonresponders were reminded a month after initial contact. Data were entered into a personal computer and variables analyzed using descriptive statistical analysis. RESULTS: Thirty-two (56%) of the 57 questionnaires were returned. Most respondents were aged 41-45 years ( n = 11, 34.4%). Twenty-six (81.3%) were males, whereas 6 (18.8%) were females. Twenty respondents (62.5%) practiced in the teaching hospitals. Eighteen respondents (56.3%) practiced in the south-west geopolitical region. Twelve respondents (37.5%) were the only maxillofacial surgeons in their centers. 81.3% routinely practiced traumatology against 15.6% for implantology. Seventy-eight percent ( n = 25) had satisfactory facilities for traumatology, dentoalveolar surgery, and cleft repair surgery, while facilities were least satisfactory in implantology and orthognathic surgery (15.6% and 12.5%, respectively). The highest single factor influencing choice/area of practice was financial reward (100% of respondents). Fifty percent ( n = 16) claimed not to have had adequate training in their area of interest. Most respondents (93.8%) believe the greatest challenge facing oncological maxillofacial surgery in Nigeria was late presentation of patients. CONCLUSION: The scope of practice of oral and maxillofacial surgery is largely limited in the country relative to what obtains globally.

Evaluation of the scope and practice of oral and maxillofacial surgery in Nigeria

Background: Oral and maxillofacial surgery is still evolving; with the scope of practice in Nigeria inadequately determined. Aims and Objectives: This study aims to ascertain the level of practice in various parts of the country vis-a-vis the global trend and factors influencing the scope in Nigeria. Design of the Study: Cross-sectional. Setting: The study was carried out at the University of Ibadan. Participants included all the maxillofacial surgeons on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons and Practicing in Nigeria as at December; 2012. Materials and Methods: Structured questionnaires were delivered to all on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons. Respondents were asked to provide information about their demographics; years of practice; areas of practice and factors influencing the choice of practice among others. Nonresponders were reminded a month after initial contact. Data were entered into a personal computer and variables analyzed using descriptive statistical analysis. Results: Thirty-two (56) of the 57 questionnaires were returned. Most respondents were aged 41-45 years ( n = 11; 34.4). Twenty-six (81.3) were males; whereas 6 (18.8) were females. Twenty respondents (62.5) practiced in the teaching hospitals. Eighteen respondents (56.3) practiced in the south-west geopolitical region. Twelve respondents (37.5) were the only maxillofacial surgeons in their centers. 81.3 routinely practiced traumatology against 15.6 for implantology. Seventy-eight percent ( n = 25) had satisfactory facilities for traumatology; dentoalveolar surgery; and cleft repair surgery; while facilities were least satisfactory in implantology and orthognathic surgery (15.6 and 12.5; respectively). The highest single factor influencing choice/area of practice was financial reward (100 of respondents). Fifty percent ( n = 16) claimed not to have had adequate training in their area of interest. Most respondents (93.8) believe the greatest challenge facing oncological maxillofacial surgery in Nigeria was late presentation of patients. Conclusion: The scope of practice of oral and maxillofacial surgery is largely limited in the country relative to what obtains globally

Evaluation of the histopathology of orofacial lesions in a North-East Nigerian tertiary centre.

OBJECTIVE: The aim of this study was to evaluate the relative frequencies, types and site distribution of oro-facial lesions in a North-Eastern Nigerian tertiary centre. MATERIALS AND METHODS: The records of the Departments of Oral-Dental Surgery and Pathology of a tertiary hospital in Nigeria were reviewed and analyzed for patients with oro-facial lesions during a seven year period (January, 2001 - December, 2007). The main outcome measures were patients' age and sex, histology assessment, tissue type and location. RESULTS: A total of 102 (51.3%) benign lesions, 59 (29.6%) malignant lesions and 38 (19.1%) inflammatory/reactive lesions were seen. The common benign neoplasms were ameloblastoma (23.5%), fibrous dysplasia (15.7%) and pleomorphic adenoma (13.7%). The malignant lesions were mainly well differentiated squamous cell carcinomas (28.8%) and terminal duct carcinoma (11.9%). Inflammatory lesions comprised mainly of chronic osteomyelitis (15.8%) and non-specific chronic inflammatory lesions; giant cell granulomas, granulation tissues which constituted 10.5% each. [corrected] There were 104 (52.3%) males and 95 (47.7%) females giving a male: female ratio of 1.1:1. The mean age of the patients was 36.1(SD ± 18.9) years with a range of 1 to 85 years. Most tissue specimens were soft tissues (61.3%), while bone specimen accounted for 15.6% of all specimens analysed. There were 62 (31.2%) mandibular lesions, 24 (12.1%) palatal lesions and 15 (7.5%) parotid lesions, while maxillary antral lesions were the least, constituting only 0.5% of all lesions studied. [corrected]. CONCLUSION: The range of diagnosed lesions from our study was diverse, though our results do not represent the actual prevalence of orofacial lesions within the general population, but simply reflect the frequency of histologically diagnosed lesions at a health center in North-East Nigeria. This survey has shown that most oro-facial lesions studied were benign neoplasms and that most of these neoplasms were from the mandible.

Trace metals and total antioxidant potential in head and neck cancer patients.

BACKGROUND/OBJECTIVE: There are pieces of evidence suggesting that oxidative stress and immune responses play significant roles in the etiopathogenesis of some malignant diseases. Also increased oxidative stress in patients with certain cancer may result from changes in the levels of certain trace elements. Therefore antioxidants either in the form of trace metals or enzymes are important tools in the study of these conditions. This study aimed at measuring the level of oxidative stress in the head and neck cancer patients by using plasma total antioxidant potential and the plasma level of some antioxidant trace metals. MATERIALS AND METHODS: Twenty cases of head and neck squamous cell carcinoma recruited from the Oral and Maxillofacial surgery and Radiotherapy clinics of the University College Hospital, Ibadan were included in the study. While total antioxidant status was measured by ferric reducing antioxidant power (FRAP) assay of Benzie and Strain (1996), the plasma trace metals were assayed by atomic absorption spectrophotometry. RESULT: The total antioxidant potential was significantly reduced in the study group when compared with controls. Zinc, iron, and selenium were also found to be significantly lower in the study group compared with controls. CONCLUSION: The result suggests a state of oxidative stress in the head and neck cancer patients with likely impact on disease process and treatment outcome.

Team approach to management of oro-facial cleft among African practitioners: a survey.

BACKGROUND: An interdisciplinary team approach concept has been proposed for management of oro-facial cleft in the last two decades. Our objective was to evaluate the practice of the team approach concept and practices of the specialists involved in oro-facial cleft care in Africa. MATERIALS AND METHODS: A snapshot survey was conducted among the attendees of the 2 nd Pan-African Congress on Cleft Lip and Palate, at the International Institute of Tropical Agriculture, Nigeria, in February 2007. RESULT: Of the 120 questionnaires distributed, 91 were returned for analysis (75.8% response rate). Mean age of respondents was 43.6 ± 4.97 years and the range was 36-62 years. Male-to-female ratio was 3.5:1. Oral and Maxillofacial Surgeons and Plastic Surgeons constituted the majority of respondents (34.1% and 29.7% respectively). Only 48.4% (44 respondents) of the specialists belonged to cleft teams. Majority of Oral and Maxillofacial Surgeons and Plastic Surgeons belonged to cleft teams (65.9 and 79.5% respectively), while Speech Pathologists and Orthodontists were less represented (18.2% and 40.9% respectively). CONCLUSION: Findings from this study have shown that interdisciplinary care for the cleft patient is not yet fully established in Africa. The result obtained also suggests that cleft care in African population is young, and team care is perhaps many years behind the global trend. This may be a result of several reasons ranging from lack of sufficient specialists in African population generally to the relatively young age of cleft care practice in that part of the world.

Maxillectomy defects: a suggested classification scheme.

INTRODUCTION: The term "maxillectomy" has been used to describe a variety of surgical procedures for a spectrum of diseases involving a diverse anatomical site. Hence, classifications of maxillectomy defects have often made communication difficult. This article highlights this problem, emphasises the need for a uniform system of classification and suggests a classification system which is simple and comprehensive. METHODS: Articles related to this subject, especially those with specified classifications of maxillary surgical defects were sourced from the internet through Google, Scopus and PubMed using the search terms maxillectomy defects classification. A manual search through available literature was also done. The review of the materials revealed many classifications and modifications of classifications from the descriptive, reconstructive and prosthodontic perspectives. RESULTS: No globally acceptable classification exists among practitioners involved in the management of diseases in the mid-facial region. There were over 14 classifications of maxillary defects found in the English literature. CONCLUSION: Attempts made to address the inadequacies of previous classifications have tended to result in cumbersome and relatively complex classifications. A single classification that is based on both surgical and prosthetic considerations is most desirable and is hereby proposed.

Orbito-antro-cervical foreign body impaction: reminder of a CT scan and ultrasonography pitfall.

INTRODUCTION: Foreign body impaction within the maxillofacial region is not an uncommon occurrence. Imaging of such objects is of paramount importance to their retrieval in order to assess their relation to vital structures as well as avoid disruption of such structures while retrieving the foreign bodies. We report a case of wooden foreign body which traversed the maxillofacial region, imaging of which posed a significant challenge. METHODS: A sixteen year old female presented with a wooden foreign body impaction following a road traffic accident. Challenges in the course of investigation and events during the surgical retrieval of the foreign body are described. RESULT: An unusual case of foreign body impaction transecting the right orbit, right antrum and the pharynx is presented. The inability of both Computed Tomographic scan and Ultra Sound scan to identify the path and relations of the impacted foreign body was also discussed. CONCLUSION: Computed Tomography and Ultrasonography may not be sufficient to delineate the path and relations of an impacted foreign body especially if the nature of the foreign body is not metallic.

Evaluation of the haemodynamic and metabolic effects of local anaesthetic agent in routine dental extractions.

INTRODUCTION: The systemic effects of adrenaline administered during dental local anesthesia have been the subject of many studies. The purpose of this study was to investigate the haemodynamic and metabolic effects attributable to adrenaline injected during local anesthesia in dental extraction patients. METHODS: Apparently medically fit patients were included and randomized into two groups. Participants had breakfast before coming in for tooth extraction. The weight, height, blood pressure and pulse rate were measured and blood sample taken before administration of local anaesthetic injections. Blood pressure, pulse and blood sample were again taken at 15 and 30 min. RESULTS: While the adrenaline group showed a modest increase between pre- and post-drug administration states, the control group showed no difference in median systolic blood pressures. Both groups showed a slight increase in diastolic blood pressure observed between pre- and post-drug administration states. Also both groups showed no significant difference in median pulse rate throughout. Although blood glucose values were widely dispersed in the pre-drug administration state in both groups, the control group showed no difference in median values throughout. However, a modest increase was observed in the adrenaline group between pre- and post-drug administration states, which persisted beyond 30 min. CONCLUSION: The patients treated with local anesthesia with adrenaline showed a response similar to that observed in the control group.

Retrospective evaluation of necrotizing fasciitis in University College Hospital, Ibadan.

CONTEXT: Cervicofacial necrotizing fasciitis (CNF), although a potentially fatal fulminant infection has been largely under-reported in the dental literature. AIMS: To report our experience with cases seen and treated at the University College Hospital, Ibadan, Nigeria. SETTINGS AND DESIGN: A descriptive retrospective clinical study. MATERIALS AND METHODS: A retrospective survey of cases treated between January 2002 and January 2007 was done. Diagnosis of CNF was established by fascia necrosis found on surgical exploration. Patients' age, sex, medical status, etiology of infection, bacteriology, and treatment received and complications were reviewed. STATISTICAL ANALYSIS USED: SPSS version 15. RESULTS: Of the 48 cases of cervicofacial infection admitted during the study period, only 12 cases of CNF were found. Male:Female ratio was 4:8. The mean age of patients was 58.83 ± 11.91 years while the age range was 42-83 years. Those that had immunocompromised medical conditions included three cases each of diabetes mellitus and chronic nutritional anaemia and one case of retroviral infection. Mixed bacterial isolates of anaerobes and enterobacteriaceae were found in 10 cases while beta hemolytic streptococci were the sole isolate in two cases. All patients had serial debridement combined with intravenous antibiotic medications. Complications included anterior chest wall infection in three patients and one case of pleural effusion. The only mortality occurred in the patient with retroviral infection. CONCLUSIONS: We advocate early recognition, surgical debridement and intensive medical care for treatment of CNF in order to reduce morbidity and mortality from this condition.

An audit of mandibular defect reconstruction methods in a Nigerian Tertiary Hospital.

AIMS AND OBJECTIVES: To audit methods of mandibular defect reconstruction used in our institution. MATERIALS AND METHODS: A retrospective study of mandibular bone reconstruction at the University College Hospital Ibadan between January 2001 and December 2007. Relevant records were retrieved from patients' case notes and operation register. Comparative analysis of various methods of reconstruction was done by assessing treatment outcomes such as restoration of continuity and stability, graft infection, extrusion and fractures. RESULTS: Only 65 of the 82 patients that had mandibular continuity defect during the study period had reconstruction. Ameloblastoma accounted for 67% [n=55] of pathologies that required mandibular resection. Methods of reconstruction included non vascularised iliac bone anchored with either stainless steel wire (NVIBw) [n=38] or titanium plate (NVIBp) [n=9], titanium reconstruction plate [n=4] Steinman pin [n=12], rib graft [1] and acrylic plate temporisation [n=1]. The findings showed that titanium plate and NVIBp had the least complications in terms of infection, graft extrusion, fracture and wound dehiscence. NVIBw and Steinman pin had the highest infection rates. CONCLUSION: We recommend the use of NVIBp and titanium reconstruction plate as they have the least complication rate. We also advocate future prospective study.

Polymorphous low grade adenocarcinoma: literature review and report of lower lip lesion with suspected lung metastasis.

Polymorphous low grade adenocarcinoma (PLGA) is an uncommon tumour that affects minor salivary glands mainly. It was known to be clinically benign and histologically polymorphic; sometimes misdiagnosed as pleomorphic adenomas, monomorphic adenomas, malignant pleomorphic adenomas, adenoid cystic carcinomas and adenocarcinoma not otherwise specified. More information about PLGA is cumulating in the current literature with new evidences suggesting that the tumour may not be as indolent as it was previously thought. A thorough understanding of the clinical and histological behaviour of the lesion has serious implications in management. Here, a case of lower lip lesion with suspected lung metastasis is reported to exemplify how the clinical behaviour of the lesion may affect management.

Self-medication profile of dental patients in Ondo State, Nigeria.

BACKGROUND: The practice of self medication has been extensively researched but there is dearth of information about its modality among dental patients in developing countries. Hence, this study was designed to determine the proportion of dental patients who practice, medications employed and the reasons for resorting to self medication in general dental populations in Ondo State, Nigeria and to make appropriate recommendations. METHODS: This study was conducted between June 2007 and June 2008 at the Federal Medical Centre, Owo and State Specialist Hospital, Akure, Ondo State, Nigeria. Five hundred and thirty six consenting respondents were selected by multistage sampling technique and interviewed with the aid of semi structured questionnaire. RESULTS: Almost half of the respondents (42% or n=225) admitted to self medication while the majority (58%) did not practice it. Drugs utilized are usually singly (56.4%) rather than in combination (43.6%), commonly analgesics (50.1%) and antibiotics (30.4%), with the majority (45.8%) using the medications for at least one week. The reasons cited by respondents for self medication were their perception that they know what to do and it saves time and money. CONCLUSION: A sizable majority of the respondents admitted to self-medication usually with analgesics. Adequate health education of the populace on the use and misuse of analgesics needs to be mounted, while dental services should be made readily available and affordable so that self medication among dental patients can be reduced to the barest minimum.

Self-medication profile of dental patients in Ondo state, Nigeria

The practice of selfmedication has been extensively researched but there is dearth of information about its modality among dental patients in developing countries. Hence; this study was designed to determine the proportion of dental patients who practice; medications employed and the reasons for resorting to self medication in general dental populations in Ondo State; Nigeria and tomake appropriate recommendations. This study was conducted between June 2007 and June 2008 at the Federal Medical Centre; Owo and State Specialist Hospital; Akure; Ondo State; Nigeria. Five hundred and thirty six consenting respondents were selected by multistage sampling technique and interviewed with the aid of semi structured questionnaire. Results: Almost half of the respondents (42or n=225) admitted to self medication while the majority (58) did not practice it. Drugs utilized are usually singly (56.4) rather than in combination (43.6); commonly analgesics (50.1) and antibiotics (30.4); with themajority (45.8) using the medications for at least one week. The reasons cited by respondents for self medication were their perception that they know what to do and it saves time andmoney. A sizable majority of the respondents admitted to self-medication usually with analgesics. Adequate health education of the populace on the use and misuse of analgesics needs to be mounted; while dental services should be made readily available and affordable so that self medication among dental patients can be reduced to the barest minimum

Accidental displacement of mandibular third molar into soft tissue: a case report.

A case of accidental displacement of a mandibular molar tooth into adjacent submandibular space during routine extraction by a general practitioner is reported. The localization and surgical retrieval of the displaced tooth is described, post-operative period was uneventful and salient lessons for the practitioners highlighted.