Presentation and Management of Atypical Orofacial Clefts: A Single-Institution Experience for 13 Year Period.

This study reviews the craniofacial clefts that presented at a Nigerian tertiary health facility, highlighting our experience with the pattern of presentation and surgical care of these patients.A retrospective review of the smile train database and medical records of all individuals who had been diagnosed with any of the Tessier craniofacial clefts and managed between 1st January 2007 and 31st December 2020 was done. The data were presented as numbers and percentages of cases.The cleft clinic of a tertiary health facility and a major cleft referral center in South-West Nigeria.Forty-five patients with craniofacial clefts were managed over the study period. 15.6% had associated syndromes, 2.2% had a family history of similar craniofacial cleft and 11% had a history of a possible teratogen. There were 21 (46.7%) middle clefts, 14(31.1%) lateral clefts and 10(22.2%) oblique clefts. The most common type of cleft was Tessier 0 while the Tessier 6 was the least common type. The median age at surgery was 10 months for male and 5months for female subjects, 15.3% complication rate was found in this study. Four patients had revision surgeries to correct residual deformities in this study.The diverse presentations and occurrence of the rare craniofacial clefts present complex aesthetic and functional problems that require individualized often multidisciplinary care. The execution of a properly planned treatment will reduce complications and the need for revision surgeries.

Risk of congenital cardiovascular anomalies in patients with non-syndromic orofacial cleft: A preliminary case-control study.

BACKGROUND: Orofacial clefts (OCs) are one of the most common craniofacial anomalies and are reported to be associated with congenital cardiovascular anomalies (CCAs). However, there is paucity of data in African populations on the risk of CCAs in OC patients compared to the general population. AIMS: This study aims to determine the odds of congenital cardiovascular anomalies in patients with OC compared to the general population. SUBJECTS AND METHODS: A case-control study design was used. Case subjects were non-syndromic OC subjects, while controls were non-syndromic subjects without OC. All subjects were thoroughly assessed by a pediatric cardiologist for CCAs; and grouped by OC phenotypic type (cleft lip and/or alveolus, cleft lip and palate, cleft palate only and Tessier cleft). Statistical analysis was done using STATA version 14 (College Station, Texas), and significance was placed at P value ≤0.05. RESULTS: A total of 120 subjects (60 cases and 60 controls) were enrolled in the study. In total, 23.3% of the subjects had CCAs. Among the case group, 40% had CCAs compared to 6.7% in the control group. Patent foramen ovale (18.3%) and atrial septal defects (10.0%) were the most common type of CCAs in cases, respectively. Further, cases had significantly higher odds of CCAs compared to controls (OR: 9.3; CI: 2.8, 39.4). CONCLUSIONS: Our finding reveals that the odds of CCAs are significantly higher in patients with OC than the general population. Future studies could assess the effect of CCAs on surgical outcome.

Loss-of-Function GRHL3 Variants Detected in African Patients with Isolated Cleft Palate.

In contrast to the progress that has been made toward understanding the genetic etiology of cleft lip with or without cleft palate, relatively little is known about the genetic etiology for cleft palate only (CPO). A common coding variant of grainyhead like transcription factor 3 ( GRHL3) was recently shown to be associated with risk for CPO in Europeans. Mutations in this gene were also reported in families with Van der Woude syndrome. To identify rare mutations in GRHL3 that might explain the missing heritability for CPO, we sequenced GRHL3 in cases of CPO from Africa. We recruited participants from Ghana, Ethiopia, and Nigeria. This cohort included case-parent trios, cases and other family members, as well as controls. We sequenced exons of this gene in DNA from a total of 134 nonsyndromic cases. When possible, we sequenced them in parents to identify de novo mutations. Five novel mutations were identified: 2 missense (c.497C>A; p.Pro166His and c.1229A>G; p.Asp410Gly), 1 splice site (c.1282A>C p.Ser428Arg), 1 frameshift (c.470delC; p.Gly158Alafster55), and 1 nonsense (c.1677C>A; p.Tyr559Ter). These mutations were absent from 270 sequenced controls and from all public exome and whole genome databases, including the 1000 Genomes database (which includes data from Africa). However, 4 of the 5 mutations were present in unaffected mothers, indicating that their penetrance is incomplete. Interestingly, 1 mutation damaged a predicted sumoylation site, and another disrupted a predicted CK1 phosphorylation site. Overexpression assays in zebrafish and reporter assays in vitro indicated that 4 variants were functionally null or hypomorphic, while 1 was dominant negative. This study provides evidence that, as in Caucasian populations, mutations in GRHL3 contribute to the risk of nonsyndromic CPO in the African population.

Association Studies and Direct DNA Sequencing Implicate Genetic Susceptibility Loci in the Etiology of Nonsyndromic Orofacial Clefts in Sub-Saharan African Populations.

Orofacial clefts (OFCs) are congenital dysmorphologies of the human face and oral cavity, with a global incidence of 1 per 700 live births. These anomalies exhibit a multifactorial pattern of inheritance, with genetic and environmental factors both playing crucial roles. Many loci have been implicated in the etiology of nonsyndromic cleft lip with or without cleft palate (NSCL/P) in populations of Asian and European ancestries, through genome-wide association studies and candidate gene studies. However, few populations of African descent have been studied to date. Here, the authors show evidence of an association of some loci with NSCL/P and nonsyndromic cleft palate only (NSCPO) in cohorts from Africa (Ghana, Ethiopia, and Nigeria). The authors genotyped 48 single-nucleotide polymorphisms that were selected from previous genome-wide association studies and candidate gene studies. These markers were successfully genotyped on 701 NSCL/P and 163 NSCPO cases, 1,070 unaffected relatives, and 1,078 unrelated controls. The authors also directly sequenced 7 genes in 184 nonsyndromic OFC (NSOFC) cases and 96 controls from Ghana. Population-specific associations were observed in the case-control analyses of the subpopulations, with West African subpopulations (Ghana and Nigeria) showing a similar pattern of associations. In meta-analyses of the case-control cohort, PAX7 (rs742071, P = 5.10 × 10(-3)), 8q24 (rs987525, P = 1.22 × 10(-3)), and VAX1 (rs7078160, P = 0.04) were nominally associated with NSCL/P, and MSX1 (rs115200552, P = 0.01), TULP4 (rs651333, P = 0.04), CRISPLD2 (rs4783099, P = 0.02), and NOG1 (rs17760296, P = 0.04) were nominally associated with NSCPO. Moreover, 7 loci exhibited evidence of threshold overtransmission in NSOFC cases through the transmission disequilibrium test and through analyses of the family-based association for disease traits. Through DNA sequencing, the authors also identified 2 novel, rare, potentially pathogenic variants (p.Asn323Asp and p.Lys426IlefsTer6) in ARHGAP29 In conclusion, the authors have shown evidence for the association of many loci with NSCL/P and NSCPO. To the best of this knowledge, this study is the first to demonstrate any of these association signals in any African population.

Prevalence of orofacial clefts in Nigeria.

Orofacial clefts are the most common malformations of the head and neck. In Africa, orofacial clefts are underascertained, with little or no surveillance system in most parts for clefts and other birth defects. A Nigerian craniofacial anomalies study, NigeriaCRAN, was established in 2006 to support cleft research specifically for epidemiological studies, treatment outcomes, and studies into etiology and prevention. We pooled data from seven of the largest Smile Train treatment centers in the six geopolitical zones in Nigeria. Data from September 2006 to June 2011 were analyzed and clefts compared between sides and genders using the Fisher exact test. A total of 2197 cases were identified during the study period, with an estimated prevalence rate of 0.5 per 1000. Of the total number of orofacial clefts, 54.4% occur in males and 45.6% in females. There was a significant difference (P = .0001) between unilateral left clefts and unilateral right clefts, and there was a significant difference (P = .0001) between bilateral clefts and clefts on either the left or right side. A significant gender difference (P = .03) was also observed for cleft palate, with more females than males. A total of 103 (4.7%) associated anomalies were identified. There were nine syndromic cleft cases, and 10.4% of the total number of individuals with clefts have an affected relative. The significant difference between unilateral clefts and the gender differences in the proportion of cleft palate only are consistent with the literature. The present study emphasizes the need for birth defects registries in developing countries in order to estimate the exact prevalence of birth defects including orofacial clefts.

An evaluation of surgical outcome of bilateral cleft lip surgery using a modified Millard's (Fork Flap) technique.

BACKGROUND: The central third of the face is distorted by the bilateral cleft of the lip and palate and restoring the normal facial form is one of the primary goals for the reconstructive surgeons. The history of bilateral cleft lip repair has evolved from discarding the premaxilla and prolabium and approximating the lateral lip elements to a definitive lip and primary cleft nasal repair utilising the underlying musculature. The aim of this study was to review surgical outcome of bilateral cleft lip surgery (BCLS) done at the Lagos University Teaching Hospital. MATERIALS AND METHODS: A review of all cases of BCLS done between January 2007 and December 2012 at the Lagos University Teaching Hospital was done. Data analysis included age and sex of patients, type of cleft deformity and type of surgery (primary or secondary) and whether the cleft deformity was syndromic and non-syndromic. Techniques of repair, surgical outcome and complications were also recorded. RESULTS: A total of 39 cases of BCLS involving 21 males and 18 females were done during the period. This constituted 10% (39/390) of all cases of cleft surgery done during the period. There were 5 syndromic and 34 non-syndromic cases. Age of patients at time of surgery ranged between 3 months and 32 years. There were 24 bilateral cleft lip and palate deformities and 15 bilateral cleft lip deformities. Thirty-one of the cases were primary surgery, while 8 were secondary (revision) surgery. The most common surgical technique employed was modified Fork flap (Millard) technique, which was employed in 37 (95%) cases. CONCLUSION: Bilateral cleft lip deformity is a common cleft deformity seen in clinical practice, surgical repair of which can be a challenge to an experienced surgeon. A modified Fork flap technique for repair of bilateral cleft lip is a reliable and versatile technique associated with excellent surgical outcome.

Mid-facial fractures: a 5-year retrospective review in a Nigerian teaching hospital.

OBJECTIVE: The aim of this study is to establish the pattern and actiology of mid-facial fractures, of patients seen and treated at the Lagos University Teaching Hospital, Lagos, Nigeria over a 5-year period. MATERIALS AND METHODS: All cases of midfacial fractures diagnosed and treated at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Lagos between January 2004 and December 2008 were reviewed. Data collected from case records of patients included age, sex, aetiology of fracture, anatomic site of fracture, associated maxillofacial fracture, types of treatment and postoperative complications. RESULTS: The leading cause of mid-facial fractures was road traffic crashes (RTC) which occurred in 93% of highest incidence of mid-facial fractures (36.5%) occurred in the age group of 21-30 years and the lowest in the age group of 60 years and above (2.6%); with male preponderance in nearly all age groups. Female patients were significantly younger than their male counterparts (P=0.000). The most common site of mid-facial bone fractures was the zygomatic complex (n=89, 44.5%), followed by dento-alveolar (n=26, 13%), and Le fort II (n=23, 12%). Conservative management of the fractures was employed in 2.6% (n=4) of the cases while 97.4% (n=152) of the patients required surgical, intervention CONCLUSIONS: Mid-facial fractures were most common in the 3rd decade of life; with a male-to-female ratio of 3.7: 1. Over 93% of the cases were due to road traffic crashes. Zygomatic complex was the most commonly fractured site. The fact that road traffic crashes still remain the major cause of mid-facial fracture in the studied environment is an indication that the enforcement of legislation to prevent road traffic crashes needs to be re-emphasised.

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.

Genetic studies in the Nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders.

BACKGROUND: Orofacial clefts are the most common malformations of the head and neck, with a worldwide prevalence of 1 in 700 births. They are commonly divided into CL(P) and CP based on anatomic, genetic, and embryologic findings. A Nigerian craniofacial anomalies study (NigeriaCRAN) was set up in 2006 to investigate the role of gene-environment interaction in the origin of orofacial clefts in Nigeria. SUBJECTS AND METHODS: DNA isolated from saliva from Nigerian probands was used for genotype association studies and direct sequencing of cleft candidate genes: MSX1 , IRF6 , FOXE1, FGFR1 , FGFR2 , BMP4 , MAFB, ABCA4 , PAX7, and VAX1 , and the chromosome 8q region. RESULTS: A missense mutation A34G in MSX1 was observed in nine cases and four HapMap controls. No other apparent causative variations were identified. Deviation from Hardy Weinberg equilibrium (HWE) was observed in these cases (p = .00002). A significant difference was noted between the affected side for unilateral CL (p = .03) and bilateral clefts and between clefts on either side (p = .02). A significant gender difference was also observed for CP (p = .008). CONCLUSIONS: Replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the development of CL(P).

Submental / transmylohyoid intubation in maxillofacial surgery: report of two cases.

The submental / transmylohyoid intubation technique, as an alternative technique of airway management in oral and maxillofacial surgery, and its modifications, have been widely reported in the literature since it was first described by Altemir in 1986. However, the technique is not yet popular in Nigeria and Africa in general. A report of two cases in which this technique was used in orofacial reconstruction is presented here. The surgical / anesthetic outcome was satisfactory. No complication was seen in the two cases, and healing of the submental wound was uneventful. Submental intubation is a reliable technique of alternative airway management in oral and maxillofacial surgery. The submental / transmylohyoid technique should be considered by both the anesthetist and the maxillofacial surgeon in challenging cases, where an alternative airway technique is required for maxillofacial surgery.

Overweight and obesity among patients attending a Nigerian oral surgery clinic: implications for oral surgical practice in Nigeria.

AIM: To determine the prevalence of overweight and obesity among patients attending oral and maxillofacial outpatient clinic of the Lagos University Teaching Hospital, Nigeria; and discuss the clinical and surgical implications that obesity has on the delivery of oral and maxillofacial surgical and anaesthetic care. METHODS: Consecutive patients presenting to the oral and maxillofacial surgery outpatient clinic at the Lagos University Teaching Hospital, Nigeria over a 4-month period (May-August 2004) were screened for age, sex, height and weight. All of the patients were treated for dentoalveolar surgical procedures (routine and surgical extractions), incisional and excisional biopsies, and enucleation under local anaesthesia. RESULTS: The BMIs of the studied patients ranged from 16.7 to 39.8 kg/m(2), with a mean of 24.6 +/- 4.5 kg/m(2). Prevalence of excess weight was 39.1%. Thirty-one (11.4%) patients were obese and 75 (27.7%) patients were overweight. A significant difference was observed in the BMIs of male and female patients (P=0.000). The age groups < 30 years had mean BMIs that were considered normal; whereas other age groups above 30 years had mean BMIs that were considered overweight. Prevalence of obesity increases with increasing age. Obese individuals were seen in all the age groups except those < 20 years. CONCLUSIONS: The prevalence of excess weight (overweight and obesity) in patients presenting in the studied oral and maxillofacial outpatient setting was 39.1%. Oral and maxillofacial surgeon needs to be aware of obesity-/overweight-related medical and surgical issues and take them into consideration when treating these patients.

Tumours of the submandibular salivary gland: a clinicopathologic review of cases over a 17-year period.

OBJECTIVE: This study presents a clinicopathologic review of cases of submandibular salivary gland tumours at the Lagos University Teaching Hospital, Nigeria, over a period of 17 years. METHODS: The records of all patients with histological diagnosis of submandibular salivary gland tumours at the Lagos University Teaching Hospital over a period of 17 years (January 1990 to December 2006) were retrospectively reviewed. Parameters studied were; age and gender of patients, symptoms and duration of symptoms, and histological diagnosis. RESULTS: A total of 36 patients with submandibular gland tumours were seen during the period. Male-to-female ratio was 1.8:1 (male=23, female=13). Mean age (+/- SD) at presentation was 43 (+/- 19) years (age range, 17-84 years). There were 19 malignant tumours and 17 benign ones. Pleomorphic adenoma (36.1%) was the most frequent tumours, followed by adenoid cystic carcinoma (11.1%), anaplastic carcinoma (11.1%) and malignant lymphoma (11.1%). Patients with histological diagnosis of malignant tumours were significantly older than those with benign tumours (p = 0.01). Most patients (80.6%) presented with painless swelling. CONCLUSION: Malignant submandibular salivary gland tumours were slightly more than the benign ones in the studied population. Painful swelling or ulceration is indicative of a malignant submandibular gland tumour

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.

Conebeam computed tomography (CBCT): the new vista in oral and maxillofacial imaging.

Cone beam computed tomography (CBCT) has the potential to reduce the size and cost of CT scanners. This emerging technology produces images with isotropic sub-millimeter spatial resolution with high diagnostic quality, short scanning times of about 10-30 seconds, and radiation dosages of up to 15 times lower than those of conventional CT scans. It is ideally suited for dedicated dentomaxillofacial CT scanning. This technology provides dental practitioners with complete solution for performing specific diagnostic and clinical tasks, including implant planning, temporomandibular joint evaluation, facial fractures, dentoalveolar surgery, orthognathic surgery and periodontal surgery. CBCT is capable of providing a 3-dimensional representation of the maxillofacial hard tissues with minimal distortion. The objective of this article is to highlight the clinical applications of CBCT to oral and maxillofacial surgeons and other dental specialists in Nigeria.

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.

Indications for extraction of third molars: a review of 1763 cases.

OBJECTIVE: Third molars have been described as different from other teeth in the oral cavity. They have the highest rate of developmental abnormalities and, most importantly, are last in the eruption sequence. We investigated reasons for third molar teeth extraction in patients attending the outpatient oral surgery clinic of the Lagos University Teaching Hospital, Nigeria. MATERIALS AND METHODS: A retrospective review of patients who had third molar extractions between January 2001 and June 2006 was conducted. Data retrieved and analysed were: age and sex of patients, indication for extractions, type of teeth extracted, technique of extractions (surgical and non-surgical) and angulations of impaction in case of impacted lower third molars. RESULTS: A total of 1763 patients (mean age +/-SD, 33.74+/- 13.3 years; range 15 - 92 years) had their third molars extracted during the period. Majority (58%) of them were females. Surgical extraction was carried out in 506 (28.7%) patients while 1257 (71.3%) patients had non-surgical extractions. Caries and its sequela (63.2%) was the major reason for teeth extraction followed by recurrent pericoronitis (26.3%) and periodontitis (9.2%). Only 11 (0.6%) cases were removed for prophylactic reason. Patients who had their teeth removed for caries were significantly younger than those for periodontitis (P=0.000) but older than those for pericoronitis (P=0.000). CONCLUSIONS: Caries and periodontal diseases occurring in relatively older age group were the major reasons for non-surgical extraction of third molars while recurrent pericoronitis occurring in relatively younger age was the major reason for surgical extraction of impacted third molars. Prophylactic surgical extraction of third molars is not a common practice in our environment.

Mechanisms of orbital blowout fracture: a critical review of the literature.

OBJECTIVE: The aim of the present study is to critically review relevant literature regarding the mechanism of blowout fractures of the orbit and provide an answer to the question: Can one theory adequately explain the mechanism of orbital blowout fractures in the light of present day knowledge? MATERIALS AND METHODS: A computerised literature search using MEDLINE was conducted for published articles on orbital blowout fractures. Mesh phrases used in the search were: orbital blowout fractures AND mechanisms; orbital blowout fractures AND theory; orbital wall injury AND mechanisms. Only relevant articles were selected for the review. RESULTS: The physical mechanism of orbital blowout fracture has been a subject of debate for years by maxillofacial surgeons, ophthalmologists, plastic surgeons, otolaryngologists and orbitologists. However, only 3 mechanisms of injury have been proposed namely: "hydraulic" theory, "globe-to-wall" theory and "bone conduction" theory. Most of the theories of orbital blowout fractures have been confirmed through brilliant experiments and hypothetical explanation/analysis of clinical and radiologic findings, and each one appears to fit according to the different type of trauma received. CONCLUSIONS: Based on contemporary evidence, one theory may not adequately explain all types of fractures completely or be responsible exclusively in a given case for the pattern of fracture observed. Blowout fractures of the orbit could therefore be due to a combination of 2 or more mechanisms.

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.

Primary malignant neoplasms of orofacial origin: a retrospective review of 256 cases in a Nigerian tertiary hospital.

A retrospective review of cases histologically diagnosed as malignant lesions of the orofacial region in 1992-2003 from the records of the Department of Oral Pathology and Biology, Lagos University Teaching Hospital, Nigeria was carried out. All cases were subjected to analysis of age, gender, site distribution and histologic types. Malignant tumours constituted 18% of all the biopsies of orofacial lesions seen within the period. The mean age of patients was 42.2+/-21.5 years (range: 2.5-85). There were 177 (69%) epithelial tumours of which squamous cell carcinoma was predominant, 47 (18%) sarcomas and 32 (13%) lymphomas. Squamous cell carcinoma (44%) was the most common malignant orofacial tumour. Osteosarcoma (32%) and Burkitt's lymphoma (56%) was the predominant sarcoma and lymphoma, respectively. Patients with a histologic diagnosis of carcinoma were older than those with sarcomas and lymphomas (P<0.01), and those with a histologic diagnosis of malignant lymphoma were significantly younger than those with sarcomas (P<0.01). Almost 25% of patients with carcinomas were below the age of 40 years. Malignant orofacial tumours are not uncommon in the studied environment, with a sizable proportion of carcinomas occurring before the age of 40 years.

Incidence and pattern of presentation of dry socket following non-surgical tooth extraction.

OBJECTIVES: To determine the incidence and pattern of presentation of dry socket as a complication of intra-alveolar dental extraction at the Lagos University Teaching Hospital. METHODS: Patients who were referred for intra-alveolar dental extractions under local anaesthesia at the exodontia clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital between July and December 2002 were included in the study. The following data were recorded for each patient: biodata, reason for extraction, number and type of teeth extracted, time taken for the extraction to be done, smoking habit, and use of oral contraceptives. Onset of symptoms and type of teeth involved for those with diagnosis of dry socket were also recorded. RESULTS: Thirty-one teeth (5.6%) of a total of 554 teeth extracted during the period of the study developed dry socket. The mean age (SD) of the 27 patients who developed dry socket was 32.2 +/- 13.0 years, (m; f ratio of 1: 4.4). Most (44.5%) of the patients who presented with dry socket were in the 3rd decade of life, with more than half (59%) of them presenting on the 3rd day following extraction. Mandibular and maxillary teeth were equally affected. Molars and premolars were exclusively affected. Difficulty of extraction was significantly associated with the development of dry socket (p<.05). CONCLUSION: The incidence of dry socket in our centre is similar to previous reports. Female patients were significantly affected. Difficulty of extraction was significantly associated with the development of dry socket. Non-dressing treatment provided satisfactory relief of the symptoms and subsequent granulation of the socket.