Odontogenic Tumours: A Clinicopathologic Appraisal of Cases seen in a Nigerian Tertiary Hospital using 2017 WHO Classification.

BACKGROUND: Odontogenic tumours (OT) are a group of diverse lesions seen in the maxillofacial region. They are categorized according to their tissues of origin as; epithelial, mesenchymal or mixed tumours. OBJECTIVES: The aim of this study is to present the proportion of odontogenic tumours seen in Lagos University Teaching Hospital using the 2017 WHO classification. METHODS: Data from cases of OT histologically diagnosed from January 2006 to December 2016 were collected from records of the Oral and Maxillofacial Surgery and Oral and Maxillofacial Pathology Departments. Information on age, sex, site of occurrence and histologic diagnosis were recorded. After reconfirmation of diagnosis, cases were categorized according to the latest World Health Organization (WHO) classification for OT. Ethical approval was obtained and data was analyzed using SPSS software for Windows (version 22: SPSS, Chicago IL). RESULTS: A total of 232 odontogenic tumours were diagnosed during the period of study, 227(97.8%) cases were benign OT and 82.8% occurred in the mandible. The mean age ± SD of patients was 32.1±13.8 years and the age range from 2-73 years. OT was slightly more common in females (119) with an almost equal male-to-female ratio of 1:1.1. Most of the patients were in the 21-30 year age group and ameloblastoma 148(63.8%) was the most common OT. The histological types of odontogenic tumours and the age group of patients were significantly associated with the site of occurrence of tumours (P=0.000* and P=0.037* respectively). CONCLUSION: Epithelial odontogenic tumours are still by far the most common odontogenic tumours.

CONTEXTE: Les tumeurs odontogènes (TO) sont un groupe de lésions diverses observées dans la région maxillo-faciale. Elles sont classées selon leurs tissus d'origine en tumeurs épithéliales, mésenchymateuses ou mixtes. OBJECTIFS: Le but de cette étude est de présenter la proportion de tumeurs odontogènes observées à l'hôpital universitaire de Lagos en utilisant la classification 2017 de l'OMS. MÉTHODES: Les données des cas d'OT diagnostiqués histologiquement de janvier 2006 à décembre 2016 ont été collectées à partir des dossiers des départements de chirurgie orale et maxillofaciale et de pathologie orale et maxillo-faciale. Les informations relatives à l'âge, au sexe, au site d'apparition et au diagnostic histologique ont été enregistrées. Après reconfirmation du diagnostic, les cas ont été classés selon la dernière classification de l'Organisation mondiale de la santé (OMS) pour l'OT. L'approbation éthique a été obtenue et les données ont été analysées à l'aide du logiciel SPSS pour Windows (version 22 : SPSS, Chicago IL). RÉSULTATS: Un total de 232 tumeurs odontogènes ont été diagnostiquées au cours de la période d'étude, 227 (97,8%) cas étaient bénins d'ergothérapie et 82,8% sont survenus dans la mandibule. L'âge moyen ± écart-type des patients était de 32,1±13,8 ans et la tranche d'âge de 2 à 73 ans. L'ergothérapie était légèrement plus fréquente chez les femmes (119) avec un ratio hommes-femmes presque égal de 1:1,1. La plupart des patients étaient âgés de 21 à 30 ans et l'améloblastome 148 (63,8%) était l'ergothérapie la plus fréquente. Les types histologiques de tumeurs odontogènes et le groupe d'âge des patients étaient significativement associés au site d'apparition des tumeurs (P=0,000* et P=0,037* respectivement). CONCLUSION: Les tumeurs odontogènes épithéliales sont encore de loin les tumeurs odontogènes les plus courantes. Mots-clés: Tumeurs odontogènes, Classification des tumeurs odontogènes, Épidémiologie.

Are systemic antibiotics necessary in the prevention of wound healing complications after intra-alveolar dental extraction?

This double-blind, randomized controlled study was done to assess the necessity of systemic antibiotics in the prevention of wound healing complications after intra-alveolar dental extraction. A consecutive recruitment method was used to allocate participants to two treatment groups. Subjects in group A (antibiotics group, n=75) received amoxicillin and metronidazole for 5 days postoperatively, while those in group B (placebo group, n=75) were given identical-looking placebo drugs in place of the antibiotics. Postoperative socket healing complications, pain, and compliance with postoperative instructions were assessed postoperatively. Healing was uneventful in 129 patients (86%). Twenty-one patients (14%) developed wound healing complications. Dry socket was the most common complication in the antibiotics group (six subjects), while acutely inflamed sockets was the most common in the placebo group (five subjects). Non-adherence to postoperative instructions and postoperative pain were found to be significantly associated with the development of wound healing complications. The prescription of antibiotics after routine intra-alveolar dental extraction in healthy patients may not play any significant role in preventing wound healing complications. However, non-compliance with postoperative instructions might be associated with increased wound healing complications.

An Audit of Malignant Oro-facial Tumors Presenting at a Tertiary Hospital in Lagos.

Oro-facial malignancies are reported to have a high mortality and morbidity, this is further worsened when patient report late. To analyze the malignant oro-facial lesions seen at a Hospital in the Lagos, Nigeria. Successive patients that presented in the hospital and met criteria of study during 15 months period were recruited into the study. Demographics, clinical variables, and treatment provided for each patient in the hospital was recorded. Data collected were presented as tables and percentages. There were 36 cases seen, their ages ranged from 10 to 72 years (median 49 years), and there were 21 males and 15 females. Time lapse before presentation to the clinic ranged from 2 to 30 months, mean (9.9 (±5.5 months and the largest dimension of lesions at presentation ranged from 2 cm to 12 cm (mean 6.4 ± 2.0 cm). Most common site of presentation was posterior tongue (16.7%; 6/36) and Squamous cell carcinoma (41.6%; 15/36) was the most common histopathologic diagnosis. Twenty-three patients (63.9%; 23/36) had primary surgeries in the hospital. Patients seen in this case series generally reported late with large lesions.

Emerging Trends in the Epidemiological Pattern of Head and Neck Cancers in Lagos, Nigeria.

BACKGROUND: Unfortunately, despite an increase in medical knowledge, survival rates of head and neck cancers (HNCs) have not been observed to improve greatly. This is true, especially in tumors located in obscure primary sites or late presentation. AIM: The purpose of this study is to assess the epidemiologic pattern of HNCs and to evaluate its emerging trends and patterns in Lagos state. SUBJECTS AND METHODS: A retrospective study was conducted from 2003 to 2013 that analyzed histologically diagnosed cases of HNC at the Pathology Departments of the two tertiary teaching hospitals in Lagos. Data analysis was performed using the Statistical Package for the Social Sciences (version 20) statistical software. RESULTS: One thousand and eighty-three cases of head and neck malignancies were recorded. A female: male ratio of 1.01:1 was reported with mean age of 39.6 (standard deviation 21.1) years. The oral cavity was the most affected anatomic site (21.2%, 230/1083) in the period under review. Malignant epithelial tumors accounted for 72% (779/1083) of cases seen. Carcinomas were the most common histological variant seen (67%, 726/1083) and squamous cell carcinoma accounted for 58% (421/726) of carcinomas recorded. Oral cavity malignancies (21.8%, 118/540) were the most common in males while thyroid malignancies (28.5%, 155/543) were the most seen in females. In children (≤15 years), the most common histologic findings were carcinomas (42.3%; 77/182) and retinoblastomas (23.6%; 43/182). CONCLUSION: Epithelial malignancies were the most common malignancy in the study, and the oral cavity appears to be the increasingly predominant site for HNCs. A changing pattern in gender predominance, age distribution, and frequency with histological variants and anatomical sites was also observed in this study.

PATTERN OF ASSAULT-RELATED MAXILLOFACIAL INJURIES TREATED AT THE GENERAL HOSPITAL, LAGOS, NIGERIA.

BACKGROUND: The human face often constitutes the first point of contact in various human interactions and it is frequently the preferred target for blows in assault cases. AIM: To analyze the pattern of assault-related maxillofacial injuries treated at the General Hospital, Lagos over a period of one year. METHODOLOGY: This is one year prospective study of assault-related maxillofacial injuries treated at the Department of Oral-Maxillofacial Surgery, Dental Centre, General Hospital, Lagos, Nigeria. A face-to-face interviewer-administered structured proforma was used to obtain information from study subjects. RESULTS: Thirty-three patients with maxillofacial injuries met the inclusion criteria for this study. Their age ranged between 16 and 48 years with a mean age of 28.2 ± 7.4 years. There were 25(75.8%) males and 8(24.2%) females with a male/female ratio of 3:1. Majority of the patients, 24(72.7%) did not have any skilled employment while the remaining 9(27.3%) were road transport workers, specifically commercial bus drivers and motorcycle riders. The most frequently seen soft tissue injury was contusion which accounted for 17(51.5%) cases while 13 (39%) of the patients sustained mandibular fracture which was the most common hard tissue injury. CONCLUSION: Assault-related maxillofacial injuries are most common amongst young adult males who are not skillfully employed; this can be attributed to the increased disposition to violence in males in our environment.

Pattern of presentation and management of lip injuries in a Nigerian hospital.

AIM: Human lip injuries, although uncommon, present major challenges in terms of reconstructive options and the outcome of surgical management. The reconstructive techniques are usually varied but the ultimate objectives of treatment are to achieve healing, function, and aesthetics. The aim of this study was to report the etiology, pattern of presentation, and surgical management of lip injuries in Lagos University Teaching Hospital (LUTH). MATERIALS AND METHODS: A prospective study of consecutive cases of lip injury was conducted at the Oral and Maxillofacial Surgery Clinic of the Lagos University Teaching Hospital. Data collected included age and sex of patients, etiology, pattern of presentation, and surgical techniques of repair. RESULTS: A total of 13 patients with lip injury to the lip were included in the study (M = 6, F = 7). Human bite (11 cases) was the most common cause of injury followed by electric burns (2 cases). The most (81.8%) frequently affected site was the lower lip. Most patients presented within 72 hours after injury with infected wound. Treatment offered included thorough debridement and primary repair using various surgical techniques. A one-stage surgical technique was employed in all cases. Healing was uneventful in all cases and satisfactory. CONCLUSION: Most of the lip injuries in the present study were due to human bites with almost equal sex distribution. Lower lip was most commonly affected. All cases were successfully treated by debridement, broad spectrum antibiotic coverage, and one-stage surgical repair with a favorable outcome.

Preparedness of government owned dental clinics for the management of medical emergencies: a survey of government dental clinics in Lagos.

BACKGROUND: An emergency is a medical condition demanding immediate treatments. OBJECTIVE: The aim of the study was to determine the knowledge and ability of dental surgeons in the management of medical emergencies and the availability of emergency drugs and equipment in government dental clinics and hospitals in Lagos State. METHODS: The study was a descriptive cross-sectional study of knowledge and ability of Dental Surgeons in the management of medical emergencies, prevalence of medical emergencies in dental practice and availability of emergency drugs and equipment in dental practice in government dental clinics and hospitals in Lagos State. The study covered 22 government dental clinics and hospitals in Lagos State. Data obtained was entered into a computerand analyzed using Statistical Package for Social Science (SPSS) Version-16 data analysis software. Chi Square and cross-tabulations were used for the analysis. A 95% Confidence Level was used and a p-value of less than or equal to 0.05 was considered statistically significant. RESULTS: Of a population of 255 Dental Surgeons on the nominal rolls of all the health institutions, 224 (87%)responded.Of the total respondents, 204 (91.1%) stated they had no emergency kit in their dental clinics (p < 0.05) while 158 respondents (70.5%) stated they had no emergency drugs in their dental practice to manage medical emergencies (p < 0.05). The commonest emergencies reported was syncope 104 respondents (33.8%). 161 respondents (71.9%) claimed they are able to manage medical emergencies encountered in their dental practice if kits and drugs are available. CONCLUSION: The findings of the study show that government dental clinics/hospital in Lagos seem not to be adequately prepared to manage medical emergency. Although 71.9% of the dentist claimed they could mange such emergencies should they arise 91.1% and 70% of the respondent claimed they and no emergency kits and drugs to manage such emergencies in their hospital respectively should they arise.

Evaluation of haemodynamic changes in hypertensive patients during tooth extraction under local anaesthesia.

OBJECTIVE: This study was conducted to determine the changes in blood pressure and the pulse rate of patients with controlled hypertension having dental extraction under local anaesthesia utilizing 2% lignocaine with adrenaline, and to evaluate whether these changes in blood pressure were are attributable to addition of adrenaline. METHODS: This prospective study was carried out in 33 consecutive hypertensive patients who presented at the exodontia clinic of the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, from December 2004 to August 2005 for intra-alveolar tooth extraction. Patients were randomly allocated to two groups according to the type of anaesthetic solution employed. Group A had tooth extraction done under 2% lignocaine with 1:80 000 adrenaline while group B had tooth extraction done under 2% lignocaine without vasoconstrictor (plain lignocaine). One tooth was extracted from each patient. Blood pressure and pulse rate measurements were recorded in the waiting room before surgery, in the surgery after local anaesthetic injection, during tooth extraction and 15 minutes after tooth extraction. RESULTS: The sample consisted of 20 females and 13 males age range 24 to 75 years (mean +/- SD = 50.1 +/- 11.7 years). There was no statistically significant difference between the systolic and diastolic blood pressure and pulse rate in the two groups after administration of local anaesthesia. However the highest alteration in parameters was observed during tooth extraction in the two groups. CONCLUSION: The haemodynamic changes induced by injecting 2% lignocaine with adrenaline in patients with controlled hypertension during tooth extraction is within normal range and is not different from that induced by 2% lignocaine without adrenaline. We consider it essential that all precautions to prevent inadvertent intravascular injection be undertaken by the care provider.

Knowledge and practice of alternatives to the conventional inferior dental block amongst dentists in Lagos.

BACKGROUND: The conventional inferior alveolar nerve block (IANB) has been used for mandibular anaesthesia for many years. It is associated with a number of complications including failure of anaesthesia. Alternative techniques were therefore developed for the mandibular anaesthesia. OBJECTIVE: This study is to evaluate the knowledge and practice of alternatives to the conventional inferior alveolar nerve block (IANB) amongst dentist in government owned hospitals in Lagos, Nigeria. METHODS: Self administered questionnaires to assess the knowledge and practice of alternatives to the conventional inferior dental block for mandibular anaesthesia were sent to dentists in clinics situated in General hospitals and Teaching hospitals in Lagos. The information recorded included demographics (age and sex), institution of practice, and length of practice. The knowledge and practice of alternatives to the conventional IANB were also recorded. RESULTS: Of the 90 questionnaires sent out, only 66 (73.3%) were returned. Most respondents 43 (65.5%) practiced in the tertiary institutions. All respondents used the conventional IANB as their primary technique. Difficulty to achieve anaesthesia due to trismus 22 (34.4%) and pain on injection 20 (32.3%) were the most common complications/difficulty associated with the IANB. Forty (60.6%) of the respondent practiced the Akinosi/Varzirani technique (AVT) as a secondary technique while only 1 had ever attempted the Gow-Gate technique (GGT). Both the knowledge and practice of the alternative techniques had a statistically significant relationship to both formal training and primary training institution (P < 0.05). CONCLUSION: Formal training in the use of alternative techniques to the IANB in achieving mandibular anaesthesia was a very important factor that determined the practice and knowledge of these techniques. Although the IANB was still the primarychoice for all of our respondents, there are claims by a lot of the respondents that with more formal training the alternatives will used more regularly.

A review of temporomandibular joint disorders (TMD's) presenting at the Lagos University Teaching Hospital.

OBJECTIVE: To evaluate the patterns of presentation of Temporomandibular joint Disorders (TMDs) in our institution in a 6 year period. PATIENT AND METHODS: A retrospective study of patients who presented in the Oral Medicine and Oral and Maxillofacial surgery clinics of the Lagos University Teaching Hospital (LUTH) between January 2000 and December 2005 with TMDs was done. Case files of these patients were retrieved and data collected included patients' age, sex, presenting complains and history of associated risk factors. Also collected were findings on clinical examination and mode of treatment. The data collected were evaluated and descriptive analysis was used as appropriate. RESULT: A total of 94 patients were seen. There were 55 males (58.5%) and 39 female (41.5%), male to female ratio was ratio was 1.5:1. The age ranged from 13 to 98 years (mean age 42.7 +/- 16.4 years). Majority, 59 (62.8%) of the patients seen were between the ages of 20 and 49 years. Nine (9.6%) had a previous history of stress, 18 (19.1%) a previous history of trauma while 5 (5.3%) had a history of associated habits. Pain was the most common presenting complaint. It occurred as a singular presenting complaint in 66 (70.2%) patients and in association with other complaints in 10 (10.6%) patients. Conservative management was the treatment of choice in all cases. CONCLUSION: Most patients with TMD in the studied environment are middle aged in agreement with the literature. However, there were more reported cases in males in contrast to previous studies. Previous history of trauma and stress were important risk factors elicited from patients with TMD in this study.

The role of preoperative and intraoperative variables in predicting post operative complications after impacted mandibular third molar exodontia.

OBJECTIVES: The aim of this prospective study was to investigate the role of pre and Intra operative variables in predicting postoperative complications after removal of impacted Mandibular third molars. PATIENTS AND METHODS: 87 patients who required 90 surgical extractions of impacted Mandibular teeth were involved in the study. Radiological and clinical data were taken preoperatively. Intra operative difficulty and complications were recorded. Postoperative complications were also recorded. RESULTS: Increasing body mass index (BMI), depth from point of elevation and occlusal level of teeth were significantly associated (P < 0.05) with the occurrence of postoperative complications. The Intra operative difficulty and Intra operative complications were both statistically significantly associated with postoperative complications (P < 0.05). CONCLUSIONS: The BMI, depth of point of elevation and occlusal level of teeth are important preoperative predictors of postoperative complications. Also important are the frequency of intra operative complication and the duration of surgery in the removal of impacted teeth. Specific intra operative complications were however not as helpful in predicting specific postoperative complications in this study.

Miniplate osteosynthesis of mandibular fractures at the Lagos University Teaching Hospital.

OBJECTIVE: To report the clinical outcome of the treatment of mandibular fractures with miniplate osteosynthesis alone, at Lagos University Teaching Hospital (LUTH). METHOD: 30 patients who presented with 41 mandibular fractures at the Lagos University Teaching Hospital between May 2005 and June 2006 were selected for treatment with miniplate osteosynthesis according to the principles of Champy et al. They were grouped according to the time lapsed from injury to treatment as: early (< 24 hours), delayed (> 24 hours - < 7 days) and "late" (> or = 7 days) osteosynthesis groups. Data collected included: age and gender distribution, the aetiology of trauma, site of fractures, pre and postoperative body weight and interincisal distance and postoperative complications. RESULTS: Only 28 of the 30 selected patients received miniplate osteosynthesis and were therefore included in the final analysis. In 25 of these patients (89%) miniplate osteosynthesis without maxillomandibular fixation (MMF) was used. In 3 patients (11%), supplementary MMF was combined with miniplate osteosynthesis. The male - female ratio was 5:1 and the most frequently affected age group was the 20 - 29 years age group (53%). The most frequent cause of fracture was fight and assault. The body of the mandible was the most fractured site. 14 patients (50%) each were classified as delayed and "late" osteosynthesis respectively. The time lapsed before patients attained a postoperative mouth opening of 35mm was 5 weeks while it took 6 weeks to regain lost weight. 46.4% of the patients had postoperative complications; the most frequent complication was malocclusion (23.3%). Patients in the late osteosynthesis group had a higher complication severity score (2.3) than those in the delayed osteosynthesis group (1.5). CONCLUSION: This study suggests that most of the mandibular osteosynthesis in our environment would be delayed or "late" and would develop higher complication rate.

Minor salivary gland tumours in a Nigerian hospital: a retrospective review of 146 cases.

PURPOSE: This is a retrospective study of the location, diagnosis, sex and age distribution and treatment of minor salivary glands tumours of the upper aero digestive tract in Lagos, Nigeria. MATERIAL AND METHODS: Case files and radiographs of patients treated over a 24-year period were reviewed. RESULTS: These tumours constituted 40.4% of all salivary gland tumours in the series. The majority (62.3%) of these tumours was malignant, and the most common malignant tumour was mucoepidermoid carcinoma (19.2%). However, pleomorphic adenoma (34.2%) was the most common tumour overall. Both benign (67.2%) and malignant (23.9%) tumors were most frequently located in the palate. Both sexes were equally affected (Male-female ratio 1 to 1), but a higher proportion of benign tumours were found in the palate of females (75%) than their male counterparts (64%). Patients with adenoid cystic carcinoma were significantly older at presentation than those with pleomorphic adenoma and adenocarcinoma (P < 0.05). CONCLUSION: These findings show that majority of these tumours were malignant (62.3%), though pleomorphic adenoma was the most common tumour. They also confirm the high predilection of pleomorphic adenoma (61.8%) for the palate of Black Africans.

Binder's maxillo-nasal dysplasia: report of a case.

Case report of a 20 year old female patient who presented with Binder's maxillonasal dysplasia. She presented with completely missing premaxilla, nasal bone and septum, there was however no associated cardiac abnormalities, mental retardation or other skeletal deformities. Her principal complaint was the associated missing incisors. The incisors and the premaxilla were satisfactorily replaced with a removable maxillofacial prosthesis.

Impacted mandibular third molars: presentation and postoperative complications at the Lagos University Teaching Hospital.

AIM: Surgical extraction of impacted Mandibular third molar is one of the commonest dentoalveolar surgeries. This study aims to investigate the pattern of presentation of impacted Mandibular third molars, the indications for extraction and the post operative complications after this procedure at the Lagos University Teaching Hospital. PATIENTS AND METHODS: A prospective study of patients who required surgical extraction of impacted Mandibular third molars between October 2003 and May 2006 at the Lagos University Teaching Hospital (LUTH) was carried out. Data collected included Patients' age, sex, indication for extraction, tooth/teeth extracted. Also collected were the types of impactions and surgical morbidity (postoperative complications). The data collected were evaluated using the SPSS for windows (version 11.0: SPSS Inc, Chicago, IL) descriptive analysis was used as appropriate. RESULTS: Three hundred and thirty one (331) Mandibular third molars were extracted from 329 patients. The ages ranged from 17 to 55 years with a mean of 26.63 (+/- 7.39). There were 153 males and 176 females; with male to female ratio was 1:1.15. Recurrent Pericoronitis was the most common indication for extraction (209 extractions; 63.1%), while the mesioangular impaction was the most common angulation (117 impactions; 53.4%). 47 (14.2%) of the extractions had postoperative complications and dry socket which occurred in 25 (53.2%) cases was most common. CONCLUSION: The pattern of presentation of impacted Mandibular third molars is similar to earlier reports. The morbidity is however higher than the average value in the literature, it however does not seem to increase with increasing age.

Prevalence and surgical morbidity of impacted mandibular third molar removal in the aging population: a retrospective study at the Lagos University Teaching Hospital.

Prophylactic surgical extraction of impacted third molars is not an uncommon practice in Europe and America. This has been justified on the basis that the risk of surgical morbidity increases with increasing age among other reasons. The purpose of this study is to report the prevalence of impacted third molar extraction and associated morbidity in patients = 40 years of age in our institution. A retrospective review of patients = 40 years of age who required surgical extraction of their impacted third molars between April 2001 and March 2006 at the Lagos University Teaching Hospital was carried out. Data collected included patients' age and sex, tooth/teeth extracted, indication(s) for tooth/teeth extraction, types of impaction, and surgical morbidity (intra-and postoperative complications). A total of 6.3% of patients requiring third molar surgical extraction were 40 years or older. No intraoperative complications occurred in any of the patients. Only 3 patients (9.7%) developed minor postoperative complications (infected socket, dry socket) which were reversible and of short duration). Less than 7% of patients requiring surgical extraction of impacted third molars in our institution were 40 years and above. In addition, minor postoperative complications were seen in only 3 patients. Our result does not support prophylactic surgical extraction of third molars based on the assumption that surgical morbidity increases with age.