Mandibular defect reconstruction with nonvascularized iliac crest bone graft.

CONTEXT: Reconstruction of mandibular defect is a challenge to the head and neck surgeon because of associated functional and esthetic problems. Our experience with the use of nonvascularized iliac crest bone graft is hereby reported. AIM: The aim was to report our experience with the use of nonvascularized iliac crest bone for mandibular defect reconstruction at University College Hospital, Ibadan. Nigeria. SETTINGS AND DESIGN: A retrospective descriptive study was performed. MATERIALS AND METHODS: Cases of mandibular reconstruction with iliac crest bone graft between January 2001 and December 2007 were included in this study. Grafts were secured with either a stainless steel wire or a titanium plate. Preoperative diagnosis, postoperative follow-up records including investigations, diagnosis of graft infection and subsequent treatment modalities were extracted from the available records. STATISTICAL ANALYSIS USED: Descriptive variables were analyzed with SPSS version 14. RESULTS: A total of 47 patients had mandibular defect reconstruction with nonvascularized iliac crest block bone during the study period. Thirty-eight patients had graft secured with transosseous wire [NVIBw] while 9 had a titanium plate [NVIBp]. The male:female ratio was 26:21 while the mean age of the patients was 24.6±4.25 years. Ten patients (21.3%) developed persistent graft infection during the postoperative period. All cases of infection occurred in patients who had transosseous wiring and analysis showed that 60% of the infected grafts revealed mixed microbial isolates containing Klebsiela spp, Pseudomonas Aeurogenosa, and E coli. Six (60%) of the infected grafts were removed as a result of unabated infection while 4 (40%) were successfully treated by exploration and pus drainage. CONCLUSIONS: Nonvascularized iliac crest bone graft provides an affordable and less technical choice for mandibular reconstruction with minimal complications in a resource-limited economy.

Epidermoid cyst of the tongue causing airway obstruction.

Epidermoid cyst occurring within the tongue is rare. The aim of this article is to discuss the management of an adult patient who presented with respiratory obstruction due to this congenital epidermoid cyst within the tongue. A 32-year-old male patient who was brought to the accident and emergency department of the University of Port Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria was presented. He came with a history of difficulty in breathing as a result of a slow growing swelling of the tongue which started from birth. There was associated pain, difficulty in speech and mastication as the swelling increased in size. Detailed physical examination, sonographic imaging and histopathology were carried out. On examination, patient was acutely ill-looking, in severe respiratory distress, febrile, mildly pale and dehydrated but anicteric. Extra-oral examination revealed mildly protruded upper and lower dento-alveolar arch as well splaying and recession of the anterior and posterior teeth of the upper arch. Intra-oral examination revealed moderately tender, fluctuant and grossly enlarged tongue obstructing the oro- and nasopharyx. A diagnosis of dermoid cyst was made and the patient was booked for surgery after resuscitation. Excision of the cyst was done under general anaesthesia/naso-tracheal intubation by an intra-oral approach. Ultrasound was able to give a thorough assessment of the cystic nature of the swelling while post-operative histopathology was used to confirm the specific type of teratoma. The relationship of the cyst to the intrinsic and extrinsic muscles of the tongue and mylohyoid muscle was relevant to the surgical approach to the lesion.

Management of mandibular chronic osteomyelitis using Belfast technique.

Chronic osteomyelitis is still common in developing countries like Nigeria due to the fact that conditions associated with the lowering of resistance to infections like malnutrition, malaria, anaemia, and acute eruptive fever are still prevalent in our society. Various operative techniques have been described for the treatment of chronic osteomyelitis with various outcomes. A case of chronic osteomyelitis of the mandible managed using the Belfast technique is presented. The Patient was followed up for 2 years with no evidence of recurrence of infection and a repeat radiograph at the end of follow-up revealed new bone formation. The Belfast technique is effective in the treatment of chronic osteomyelitis of the mandible and is recommended in the management of this condition.

Comparative effect of tube drain on post operative inflammatory complications of impacted mandibular third molar surgery College Hospital, Ibadan, Nigeria.

BACKGROUND AND OBJECTIVES: Swelling, pain and trismus are acute reversible inflammatory complications of impacted mandibular third molar (M3) surgery. They contribute to the deterioration of quality of life and loss of several useful working hours. This study aimed to investigate whether the use of a surgical drain following M3 surgery can minimise these inflammatory complications. PATIENTS AND METHODS: Eighty consecutive patients who gave consent were enrolled into the study. Patients were assigned into two groups (drain and no drain) by systematic sampling method which was modified to ensure matching of patients by age, sex and spatial relationship of the impacted mandibular third molar. The patients in the drain group (n=40) had a Foley's catheter drain inserted into the wound after the surgical procedure while the patients in the no drain group (n=40) had their wound closed without the use of drain. All patients had primary wound closure with 3.0 black silk sutures after the procedure. Demographic data, cheek dimension and maximal mouth opening were recorded before the procedure. Pain, swelling and trismus were evaluated in the two groups at 24 hours, 48 hours and 7th day after surgery. RESULTS: Post operative swelling and visual analogue scale score for pain were comparatively lesser in the drain group patients. The maximal interincisal distance was also more in the drain group patients. CONCLUSION: The findings from this study indicated that there is a significant benefit of using a surgical drain in minimising postoperative oedema, pain and trismus following surgical removal of impacted mandibular third molar.

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.

Applications of ultrasonography in the diagnosis of soft tissue swellings of the cervicofacial region.

PURPOSE: To determine the accuracy, sensitivity, specificity and prediction values of ultrasound as a means of diagnosis of cervico-facial soft tissue swellings. MATERIALS AND METHODS: We carried out ultrasonographic evaluation of 76 consecutive cases of cervico-facial soft tissue swellings that presented at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria from August 2002 to November 2003. The patients' demographics and relevant clinical information were obtained. Ultrasonographic evaluation was done using the B-mode transcutaneous ultrasonic imaging device with a transducer frequency of 5MHz. All the lesions were subjected to histopathological examination. RESULTS: There were 43(56.6%) males and 33(43.4%) females whose ages ranged from 2 weeks to 70 years (mean +/- SD; 22 +/- 19.7 years). Histologically, tumours constituted the highest percentage of swellings (35.5%), followed by cysts (26.3%). Males were more predominant in all classes of swellings except benign tumours. The accuracy of ultrasound in the diagnosis of pleomorphic adenoma was 80% and 100% for both adenocarcinoma and hemangioma. It was also 100% for majority of the cysts and HIV associated salivary gland swellings. The sensitivity of ultrasound in the diagnosis of pleomorphic adenoma was 80% and 100% for adenocarcinoma, hemangioma, all the cysts and HIV associated swellings. Ultrasound was also 100% specific in the diagnosis of monomorphic adenoma and hemangioma. CONCLUSION: Ultrasound is a useful diagnostic tool for cervicofacial soft tissue swellings. The accuracy of diagnosis is enhanced by the characteristics of the probe and the experience of the sonologist.

Oral manifestation of HIV/AIDS.

The Human Immunodeficiency Virus (HIV) infection and Acquired Deficiency Syndrome (AIDS) have become a pandemic with about 40 million infected people world-wide. The virus attacks the immune cells resulting in a defective cell-mediated immune response thus exposing the host to opportunistic infections. Oral and peri-oral lesions are often seen in HIV infections and sometimes, appear as the first indicators of the disease. The appearance of these lesions in a known HIV infected person could also be a signal of the deterioration of the infection into a full-blown AIDS. It is therefore necessary that Health care givers should have a good working knowledge of the possible oral manifestations of the disease. This write-up highlights the clinical features and treatment of oral lesions associated with HIV infections.

Concomitant craniospinal injuries with maxillofacial trauma--a review of 266 cases.

Maxillofacial injuries are fairly common and they are usually found in association with multiple injuries. The proximity of the face to the craniospinal axis results in significant association between maxillofacial trauma and craniospinal injuries. Previous studies have enumerated this association but the injury types, classifications and influences of the concomitant injuries on the outcome of management are sketchy. In this study, road traffic accident was the commonest cause of maxillofacial and concomitant c raniospinal injuries: mild closed head injuries was the commonest concomitant injury occurring in almost 60% of the cases whilst mandibular fracture was the maxillofacial injury frequently encountered. The average duration of hospitalization in patients with maxillofacial trauma and concomitant mild head injury was 19 days but it was much higher (average 34.9 days) in patients with concomitant spinal injuries. The high incidence of head injury would suggest that maxillofacial units are best cited in hospitals with functional neurosurgical services.

Orofacial lesions in 126 newly diagnosed HIV/AIDS patients seen at the University College Hospital, Ibadan.

Human immune deficiency virus (HIV) infection is one of the most devastating infection in modern times. Oral manifestations of HIV infection occur in approximately 30-80% of patients infected with this virus and the factors, which predispose to these lesions include: CD4 count less than 200 cells/mm, viral load, xerostomia, poor oral hygiene and smoking. These manifestations have subsequently become important entry criteria for: clinical trials of various therapeutic regimes, prophylaxis of HIV related opportunistic infections, anti-retroviral trials and vaccine studies. Over a six month period, all newly diagnosed HIV/AIDS patients attending the Special Treatment Clinic at the Haematology Department of the University College Hospital, Ibadan, Nigeria were recruited into this study before anti-retroviral therapy was commenced. As part of the general physical examination of these patients, a thorough orofacial evaluation was also carried out and the findings were documented. The most prevalent orofacial lesions were candidiasis, xerostomia, melanotic hyperpigmentation and herpetic ulcer among others. The aim of this study was to evaluate the pattern of oral lesions found in patients who were newly diagnosed as having HIV infection prior to commencement of anti-retroviral drugs and relate these lesions to the age, sex and occupation of the patients. These findings may suggest the likelihood that there is a pattern of oral manifestation of HIV infection.

Applications of ultrasonography in the diagnosis of soft tissue swellings of the cervicofacial region

Purpose: To determine the accuracy; sensitivity; specificity and prediction values of ultrasound as a means of diagnosis of cervico-facial soft tissue swellings. Materials and methods: We carried out ultrasonographic evaluation of 76 consecutive cases of cervico-facial soft tissue swellings that presented at the Obafemi Awolowo University Teaching Hospital Complex; Ile-Ife; Nigeria from August 2002 to November 2003. The patients' demographics and relevant clinical information were obtained. Ultrasonographic evaluation was done using the B-mode transcutaneous ultrasonic imaging device with a transducer frequency of 5MHz. All the lesions were subjected to histopathological examination. Results: There were 43(56.6) males and 33(43.4) females whose ages ranged from 2 weeks to 70 years (mean + SD; 22 + 19.7 years). Histologically; tumours constituted the highest percentage of swellings (35.5); followed by cysts (26.3). Males were more predominant in all classes of swellings except benign tumours. The accuracy of ultrasound in the diagnosis of pleomorphic adenoma was 80and 100for both adenocarcinoma and hemangioma. It was also 100for majority of the cysts and HIV associated salivary gland swellings. The sensitivity of ultrasound in the diagnosis of pleomorphic adenoma was 80and 100for adenocarcinoma; hemangioma; all the cysts and HIV associated swellings. Ultrasound was also 100specific in the diagnosis of monomorphic adenoma and hemangioma. Conclusion: Ultrasound is a useful diagnostic tool for cervicofacial soft tissue swellings. The accuracy of diagnosis is enhanced by the characteristics of the probe and the experience of the sonologist

Periodontal health of the elderly people in South East local government area in Ibadan, Nigeria.

Health problems involving physical and mental conditions directly or indirectly affect the oral health of the elderly. Other ways in which physical and mental health conditions influence their health result from the various drug prescriptions given for these ailments. Periodontal health is the most affected. Various studies have demonstrated that the elderly have the highest rate of gingival bleeding, calculus deposits and periodontal pocketing. It is the aim of this study to determine the health of the supporting tissues of the teeth using periodontal indices such as the C.PI.T.N and mobility index. The study was carried out on 690 elderly individuals (403 males and 287 females) who were 65 years and above living in various wards in the South East Local Government Area of Ibadan (S.E.L.G.A). A multistage sampling technique was used to select elderly individuals for the study. Two interviewers, 2 record clerks and 2 examiners were trained and the examiners were calibrated. The elderly individuals were interviewed and examined concurrently. The results highlighted the high prevalence of periodontal disease in the elderly in this local government area. Only 5.2% were free from periodontal disease. 94.8% had one or another stage of periodontal disease. It also demonstrated the poor oral cleanliness among these elderly. More than 42% had gross accumulation of calculus. Among the elderly in this local government area, 21.6% and 28.8% had shallow and deep pockets, respectively whilst 39.3% had one or more mobile teeth. Pockets and excessive mobility of the teeth represent advance stages of periodontitis. Majority (70.4%) of the elderly in the study claimed they use chewing sticks to maintain oral hygiene. The pattern of deposit of calculus along the interdental surfaces, mesio and distobuccal surfaces as well as lingual surfaces, question the effectiveness of the chewing stick in cleaning these surfaces. This study confirms findings of other authors, on oral hygiene in Nigeria. There is an urgent need to establish a community based outreach programme to prevent and treat periodontal disease among the elderly in this local government area.

Incidence and pattern of maxillofacial fractures in the elderly.

The results of an audit analysing patients above 60 years and above treated for maxillofacial fractures over a 15-year period at the University College Hospital, lbadan are presented. Of the total number of 1689 patients of all ages treated for facial fractures, 53 (3.1%) were within the age range of the study. The male to female ratio was 1.1:1 and 41 (77.4%) patients were younger than 70 years. Road traffic accidents were the most common cause of facial fractures (58.5%) and the mandible was involved in 91% of cases. Complications were noted in 2 (3.8%) patients. Attention should be paid to update driving courses and home safety instructions in order to reduce the incidence of maxillofacial fractures in the elderly.

Mandibular segmental reconstruction with iliac crest.

Twenty patients consisting of 14 males and 6 females with benign destructive lesions of the mandible were reconstructed using free nonvascularised iliac crest. Harvested bone was contoured and secured with 0.5 mm stainless steel wire and reinforced with maxillo-mandibular fixation. Five patients has hemimandibulectomy with immediate reconstruction. The other 15 patients had 1 to 3 segments of the mandible reconstructed. There was only one failure. Mouth opening and closure were centric except in the patients that had hemimandibulectomy without condylar reconstruction. Mastication and facial appearance were satisfactory. In conclusion, the iliac crest is recommended for reconstruction of hemimandible as well as long contiguous segments of the mandible.

Inner city maxillofacial fractures due to road traffic accidents.

A prospective study of 159 patients seen with maxillofacial fractures as a result of road traffic accidents in a Nigerian inner city was performed. The male to female ratio was 2.9:1 and the dominant age group was 21-30 years. Occupants of commercial vehicles were the ones mostly involved; involvement of rear seat occupants was high. Increased numbers of patients were seen on Saturdays and in the month of June. This study substantiates the fact that there is added risk of sustaining facial fractures during the rainy and leisure periods. Therefore, there is a need to stress the importance of common restraint devices and good road habits during these 'high risk' periods to reduce the incidence of maxillofacial fractures due to the road traffic accidents.

Unusual presentation of NOMA: a case report.

A case of noma with involvement of other parts of the body from extension and spread of cancrum lesion in the oral cavity and primary herpetic stomatitis in a two-year-old male patient is reported. The possible routes of infection to other parts of the body are discussed. It is expected that this case report will stimulate the awareness of health practitioners to this unusual presentation of cancrum oris.

Prevalence of hepatitis B virus surface antigen (HBsAg) in patients undergoing extraction at the University College Hospital, Ibadan.

Hepatitis B Virus (HBV) infection and its sequelae (liver chirrhosis and hepatic carcinoma) are endemic in Africa. The risk of transmission of the infection during dental treatment is real. This study was carried out to determine the rate of Hepatits B Surface Antigen (HBsAg) as a marker of hepatitis B virus infection in patients undergoing dental extraction in order to highlight the potential risk of nosocomial transmission among the Dental Health Workers (DHW) and their patients. Three hundred (143 males and 157 females) consecutive patients requiring dental extraction who volunteered were enrolled into this study. Their ages ranged from 11 years to 95 years with a mean of 37.2 years (SD = 16.725) and a median of 36 years. The overall HBsAg infection rate was 18.3% (55/300). A higher infection rate (23.1%) occurred among the male patients compared with 14% in females (p = 0.0086). The high rate of HBV infection found among this study population suggests that Dental Surgeons in this environment have a high risk of exposure to hepatitis B virus and should be immunized at the beginning of their professional life. Universal biosafety measures should be observed strictly in all invasive procedures.

Human immuno-deficiency virus (HIV) infection among oral surgery patients at the University College Hospital, Ibadan, Nigeria.

The Human Immuno-deficiency Virus is a World-wide epidemic and evidence abound that the infection is spreading rapidly in sub-Saharan Africa with little or no control. Nosocomial transmission of HIV in the Dental Surgery has been documented. This study was undertaken to determine the prevalence of HIV among dental patients undergoing extraction at the University College Hospital, Ibadan. Three hundred patients requiring dental extraction at the dental clinic, UCH, Ibadan who consented were enrolled for the study. Blood samples from these individuals were tested for the presence of HIV antibodies using commercially available ELISA (Monolisa Sanofi, Pasteur, France). All initially reactive samples were confirmed by a commercial Western immunoblot assay (Bio-Rad Norapath HIV kit). A prevalence of 2.3% (7/300) was obtained among individuals tested for this study. Four (2.8%) of the 143 males and 3 (1.9%) of 157 females were positive for HIV antibodies. All the seropositive patients except one were within the age range 20-39 years and most of them (6 out of 7) do not use condom during intercourse. More than half (57%) of the patients had more than one sexual partner. This study shows that the risk of transmitting HIV to DHCW during treatment is also a potential hazard in this environment. Hence, adequate preventive measure should be observed always.

A survey of the medical and dental consultants' management skills in University College Hospital, Ibadan, Nigeria.

Good management/administration is vital in the realisation of any business objective whether in a private or public establishment. The aims of this study were to assess the level of knowledge and ability on management/administrative skills by Medical/Dental consultants as perceived by themselves; to stimulate more interest in management/administrative skills acquisition, and to suggest possible ways in achieving such skills by doctors. A self-evaluation questionnaire was distributed to the doctors and 88 of them completed and returned their forms. They consisted of 55 (62.5%) males and 33 (37.5%) females cutting across all the specialities in medicine and dentistry in the University College Hospital, Ibadan, Nigeria. In all, 42 (47.7%) of the respondents reported that they had good ability of management/administration while 46 (52.3%) were below average. Of the 55 males, 28 (31.8%) had good ability while 27 (30.7%) were below average. Fourteen (15.9%) of the females had good ability while (21.6%) were below average. Good knowledge was assumed by 41 (46.6%) of the respondents while 47 (53.4%) were below average. Twenty-seven (30.7%) of the males showed good knowledge as against 14 (15.9%) of the females. Twenty-eight (31.8%) of the males were below average as against 19 (21.6%) of the female respondents. The sex differences were not statistically significant (P>0.05). The surgeons significantly (P<0.05) claimed better knowledge of management/administrative skills than physicians though their claim of ability to perform was higher too but significant (P>0.05). The percentage of the consultants with good knowledge and ability was found to increase with increasing age except for those under 40 years of age. The differences were not significant (P>0.05). A strong positive correlation (r=0.948; P<0.001) was found between ability and knowledge. Knowledge of the respondents was found to be good predictor of the ability using the regression equation: Ability = 11.151 + 0.835 (Knowledge). Suggestions on possible way forward were made. It was concluded that improving the knowledge of the doctors while in training on management/administrative skills will positively affect their performance abilities.

Zygomatic complex fractures at the University College Hospital, Ibadan, Nigeria.

OBJECTIVE: To determine the pattern of zygomatic complex fractures in a Nigerian population. DESIGN: A prospective study of cases managed. SETTING: University College Hospital, Ibadan, Nigeria. SUBJECTS: Seventy six patients seen and managed between 1995 and 1999. RESULTS: The most common aetiological factor was road traffic accidents (81.6%). The male/ female ratio was 5.3:1. Most of the fractures occurred in the age group 21-30 years (51.3%). The most common fracture type was type 3 (32.5%) while open reduction and transosseous wiring was the most commonly performed surgical procedure for the management of zygomatic complex fractures in this study (46.25%). CONCLUSION: There is a need to pay attention to the improvement in automobile safety devices, compliance by motor vehicle occupants and improvement in rules and regulations guiding sporting activities.

Concomitant injuries in 531 patients with maxillofacial fractures.

A ten-year review of five hundred and thirty one patients with facial fractures who sustained six hundred and forty eight associated injuries was presented. The male to female ratio was 2.7:1 and the highest incidence was in the 21-30 years age group. Road traffic accident was the commonest aetiology while the most frequently associated injury was soft tissue lacerations (71.0%). Neurological injuries constituted 9.9% of the total number of concomitant injuries. Other associated injuries seen were orthopaedic injuries 9.5%, ophthalmologic injuries 6.6%, chest injuries 1.9%, abdominal injuries 0.6% and urological injuries 0.5%. It is mandatory that the surgical team should be organised in the treatment of patients with concomitant injuries coexisting with maxillofacial fractures.