Predicting Pain Intensity after Mandibular Third Molar Surgery using Cold Pressor Testing: A Quasi-Experimental Study.

BACKGROUND: Patients complain differently about their experiences of post-operative pain. However, clinicians are often guided by their own viewpoints despite the highly subjective nature of pain resulting in suboptimal post-operative pain management. This impacts negatively on the quality of life of patients in the immediate post-operative period. Investigating patients' pain behavior in the pre-operative period may therefore help to predict the intensity of post-operative pain, thereby assisting in identifying patients who are at risk of greater pain after third molar surgery, and allocating extra resources for pain control. AIM: This study aims to predict the intensity of pain after third molar surgery by correlating post-operative pain perception with the sensory-discriminative dimension and affective response to a cold pressor stimulus. MATERIALS AND METHODS: This study is a quasi-experimental study that was conducted in the oral surgery clinic of (name of hospital in the title page). The procedure was undertaken in an isolated clinic cubicle with well-controlled room temperature and minimal distraction. Study participants were recruited by convenience sampling. Forty-three consenting participants, 20 years and above, who met eligibility criteria were subjected to pre-operative cold pressor testing. Subsequently, third molar surgery was done and post-operative pain intensity was recorded at specific intervals. Data analyses were completed using IBM SPSS version 25. The Kolmogorov-Smirnov (KS) test was used to test for normality of continuous variables. Ordinal regression was used to test for contributory value of pre-operative measurement while Spearman's rank correlation test was used to test their degree of relationships with post-operative pain P < 0.05. RESULT: The median pain threshold was 20 s (Interquartile Range, IQR 12.75-32.25) and the median pain tolerance was 33 s (IQR = 23.00-54.00) from the cold pressor test. The peak median pain score in this study was reached at 3-h after the last stitch. There was a statistically significant predictive effect of both variables on post-operative pain at 3-h. CONCLUSION: Sensory-discriminative dimension and affective response to cold pressor test are significant predictors of peak post-operative pain after impacted mandibular third molar surgery.

LUDWIG'S ANGINA: AN ANALYSIS OF CASES SEEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN.

BACKGROUND: Ludwig's angina (LA) is defined as a rapidly spreading cellulitis involving submandibular, sublingual and submental tissue spaces bilaterally and simultaneously. AIM: The aim of this study was to determine the causes, complications, duration of hospital stay and outcome of cases that presented within a 2- year period in the University College Hospital Ibadan and reviewing the management protocols used for such cases. MATERIALS AND METHODS: All cases of LA seen in the department of Oral and Maxillofacial Surgery from January 2015 to December 2016 were studied. Information retrieved from patients' case files included the aetiology, signs and symptoms at presentation, possible predisposing factors, results of laboratory investigations, duration of hospital stay and treatment outcome. Data obtained was analysed using SPSS 22.0 statistical software package (SPSS Inc., Chicago, IL, USA) to present descriptive statistics. RESULTS: There were 13 cases of LA, consisting of 7 males and 6 females with a mean age of 47.7 ± 16.8 years (age range 24-80 years). An odontogenic focus was noted in all cases. Almost all patients underwent surgical treatment, which consisted of an extraction of the offending teeth as well as incision and drainage of abscesses. Length of hospital stay ranged from 1 to 30days (Mean 10 days) with all but 2 patients surviving. CONCLUSION: This Study recorded an 84.6% survival rate because our management is handled as a surgical emergency with early recognition and attention paid to the airway in collaboration with the Otorhinolaryngology Unit in our center.

ORO-FACIAL FASCIAL SPACE INFECTION IN A PAEDIATRIC GAMBIAN POPULATION: A REVIEW OF 93 CASES.

BACKGROUND: Oro-facial fascial space infection is known to be a clinical presentation of neglected dental care. The proportion of children with dental sepsis has also been known to increase markedly with caries experience. Such fascial space infection in the paediatric age group is known to progress rapidly within a short period and is thus potentially more fatal than in the adult population. AIM: This study aimed to document and evaluate the pattern of oro-facial fascial space infection amongst paediatric Gambian population. PATIENTS AND METHODS: The study was a 4-year descriptive retrospective survey of all patients with oro-facial fascial space infection seen and managed at the dental unit of the polyclinic attached to the Edward Francis Small Teaching Hospital in Banjul, The Gambia from May 2015 to April 2019. The information collated were patients' sociodemographic data as well as clinical features related to their medical and dental condition. The extracted data were analyzed using Statistical Package for Social Sciences (SPSS) version 15.0 (SPSS Inc, Chicago, IL). Absolute numbers and simple percentages were used to describe categorical variables. Quantitative variables were described using mean (with standard deviation), median and range. Categorical variables were compared using chi square test and numeric variables compared using student t-test. Differences were considered significant if p<0.05. RESULTS: A total of 322 patients with oro-facial fascial space infection were managed within the period of the study out of whom 93 patients that met the inclusion criteria were studied. Their ages ranged from 3 months to 16 years, with a mean age of 8.5(SD2.1) years. There were 54 males and 39 females with a gender (M: F) ratio of 1.4: 1. All the patients presented with painful facial swelling and fever. Eighty-one (87.1%) had a history of toothache. The median number of fascial space involvement was 1 space; the submandibular space was involved unilaterally in 43 (46.2%) and bilaterally in 8 patients (8.6%). Eighty-one (87.1%) were odontogenic in origin and 12 (12.9%) were non-odontogenic. Seventy-two (88.89%) of odontogenic cases involved posterior teeth and 45 (62.5%) of these were the first permanent molars. Incision and decompression and teeth extraction were done for all the odontogenic cases. Staphylococci and/or streptococci were cultured from six patients. All the patients had inpatient treatment with a combination of intravenous amoxicillin, metronidazole and gentamicin treatment. Mortality rate was 5.4% (5 out of 93) and the mean age of patients who died, 3.0 (SD0.3) years, was significantly lower than that of those who survived, 8.3 (SD1.4) years, (p<0.0001). CONCLUSION: The commonest symptoms of oro-facial fascial space infection in the Gambian paediatric population were fever, facial swelling and toothache. Most of the infections were odontogenic and affected most commonly the submandibular space. Posterior teeth were more commonly involved than the anterior, with the first permanent molar being the most commonly affected tooth. Incision and decompression were performed in all odontogenic cases, with extraction of all culprit teeth. All patients had in-patient treatment with intravenous amoxicillin, metronidazole and gentamicin. The mortality rate was 5.4%. The burden of dental caries with its complications is huge in the paediatric population of the Gambia. Training of dental surgeons and specialists and their auxiliaries with advocacy on the need for regular dental checkup for children, as well as prompt attention to dental diseases will help to reduce this scourge.

MANAGING TEMPOROMANDIBULAR JOINT DISLOCATION IN IBADAN: A REVIEW OF 11 CASES.

AIM: The study presents a case series which evaluates the presentation, management and outcome of TMJ dislocation in a tertiary health centre in Nigeria. MATERIALS AND METHODS: Case review of 11 patients with TMJ dislocation seen in the University College Hospital (UCH) Ibadan over a period of 10 years. The criteria for the diagnosis of TMJ dislocation were based on history, clinical examination and radiologic findings. RESULTS: Mean age of patients was 44.4 years (SD +/-15.9years); age range was 25-65 years with 4 males and 7 females. Aetiology was trauma in 4 cases, wide mouth opening in 6 cases and unknown in a patient. There were 7 acute presentations, 2 recurrences and 2 chronic presentations; bilateral anterior presentation in 10 cases, unilateral (right) anterior presentation in 1 case. 4 of the acute cases were successfully managed using the Hippocrates manoeuvre, 1 had the manoeuvre under GA, and 2 had spontaneous reduction. All recurrent cases were successfully managed with the Hippocrates manoeuvre and IMF. Fifty percent of the chronic cases were successfully managed with the Hippocrates manoeuvre. Follow up was ≤ 2 weeks in 7 of the cases. CONCLUSION: The pattern of presentation of TMJ dislocation in the above named hospital was anterior dislocation, the female gender predominance, aetiology of wide mouth opening, as well as early presentation. A conservative method of management - the Hippocrates manoeuvre - was effective in most cases irrespective of duration of dislocation. Most patients had a poor attitude to follow up.

Awareness, knowledge and attitude on cleft lip and palate among antenatal clinic attendees of tertiary hospitals in Nigeria.

BACKGROUND: Adequate knowledge and awareness of cleft lip and palate (CLP) deformity may help to counter the negative beliefs and attitudes toward the condition. The objective of this study was to assess the level of awareness, knowledge and attitude of women attending antenatal clinics about CLP. MATERIALS AND METHODS: A cross-sectional descriptive study with the aid of a structured interview administered questionnaire was conducted among 200 women attending antenatal clinics in three Federal Government Teaching Hospitals in the Northern and Southwestern regions of Nigeria. The main outcome measure was the level of awareness and the mean cumulative knowledge score. RESULTS: The mean age of the subjects was 28.9 ± 5.1 years (age range: 16-42 years). Half of the women (50.5%) reported that they had seen or heard about CLP. The mean cumulative knowledge score was 6.9, with only 19.8% having adequate knowledge. Many respondents had neither read an article on CLP nor participated in any public enlightenment program, and 31.5% indicated that they would like to know more about the condition. Level of educational attainment had a statistically significant effect on the level of awareness and knowledge on CLP, as more educated respondents tend to be more aware and knowledgeable ( P < 0.001). CONCLUSION: There is need for increased public enlightenment/health education to increase awareness and subsequently help develop more positive attitudes toward children with CLP. Such programs should include distribution of pamphlets on CLP at clinics, especially antenatal clinics, media campaigns on radio, TV and newspaper as well as establishment of cleft support groups by the relevant governmental and professional organizations.

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.

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.

Role of Patients' Demographic Characteristics and Spatial Orientation in Predicting Operative Difficulty of Impacted Mandibular Third Molar

Background: The influence of patient factors such as age; sex; weight; body mass index (BMI) and spatial orientation on operative difficulty of impacted mandibular third molar (M3) surgery is a subject of controversy in the literature. Aim: To assess the risk indicators of operative difficulty of mandibular third molar surgery at our institution. Subjects and Methods: A descriptive cross.sectional study involving patients that presented for wisdom tooth extraction between January 2010 and December 2011. The correlation between patientsf factors such as age; sex; weight; height; BMI; radiographic spatial relationship of the impacted tooth and operation time was determined with Spearmanfs rank correlation coefficient. Statistically significant variables were selected for multiple regression analysis to determine which factors contribute most to operative difficulty of M3. P value was set at 0.05. Statistical analysis used SPSS 17.0. Results: Only patientsf age and radiographic spatial relationship showed a statistically significant correlation with operation time (P = 0.038 and 0.008; respectively). Linear regression analysis of patientsf age and angulation of M3 showed that both contribute 44.8 risk of increased operation time (regression coefficient = 0.448); with M3 angulation contributing more significantly to increase in operation time (P = 0.001) than increasing age of the patient (P = 0.005). Conclusions: Findings from this study have shown that increasing age of the patient and the angulation of M3 impaction increases the risk of operative difficulty of the impacted M3 significantly

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.

Tooth loss: are the patients prepared?

BACKGROUND AND AIM: Tooth loss is associated with esthetic, functional, psychological, and social impacts on the life of individuals. This study was designed to find out how Nigerians feel about losing their teeth and what effects, if any, this has on their lives. Most of the problems presented to the dentist as difficult denture tolerance could be as a result of the emotional effects of tooth loss rather than problems from the denture itself. MATERIALS AND METHODS: The study was carried using a self-administered questionnaire to consenting adult patients undergoing tooth extraction at the Oral and Maxillofacial Clinic, University College Hospital, Ibadan, Nigeria. The data collected were analyzed using SPSS, version 15.5. RESULTS: A total of 90 respondents completed the questionnaires; 35 (27.6%) were males while 55 (43.3%) were females. The respondents were aged 0-70 years. Immediate acceptance of tooth loss was noted in 88 (69.3%) cases, but 6 (47%) accepted the loss only after 1 year, while 8 (6.3%) of the cases found it difficult to accept losing their teeth and incidentally, all of them were 30 years and above. Only 52 (40.9%) of the patients were prepared for the emotional effect of losing their teeth. A feeling of relief immediately following tooth extraction was expressed by 75 (43.9%) cases and of these 32 (47.8%) were females. The emotional effects following teeth loss were sadness 22 (12.9%) cases, depression in 11 (6.4%), feeling of losing body part in 24 (14%), feeling of aging in 4 (2.3%), while 13 (7.6%) respondents felt unconcerned. CONCLUSION: We observed that emotional effects of tooth loss are also experienced among our patients with a range of emotions quite similar to those observed by previous authors from the developed world. The significant number of patients that failed to come to terms with their tooth loss indicates that the effect of tooth loss on self-esteem and self-image is not short lived as it has been assumed.

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.

HIV/AIDS and clinical dentistry: assessment of knowledge and attitude of patients attending a university dental centre.

BACKGROUND: A comprehensive test of knowledge of the public about HIV/AIDS, particularly as it relates to dentistry is not common in the literature. The objectives of this study are: to determine the current knowledge of dental patients about HIV/AIDS and its relationship with clinical dentistry; and to determine the general attitude and practice of dental patients as it relates to HIV infection. MATERIALS AND METHODS: This clinic study was conducted in the outpatient clinics, Dental Centre, University College Hospital, Ibadan. A structured anonymous questionnaire was used to collect data from randomly selected respondents. The formula n= z2pq/d2 was employed to determine the sample size. The items requested includes: educational background, awareness of HIV infection and source of knowledge, features of AIDS, high risk groups, HIV prognosis and routes of infection. Others include attitudes of respondents to HIV epidemics, infected patients, and safe sexual practices. RESULTS: Majority of the respondents (96.6%) was aware of HIV infection and the commonest source of information was TV and radio. Weight loss was the only feature of AIDS known to most of the respondents and only very few of them were aware of oral features like bleeding and painful gum (HIV gingivitis) and Kaposi's sarcoma. Most of the respondents were not aware that intravenous drug abusers and long distance drivers were high risk groups and most were not aware of the types of dental procedures during which infection could occur. Most of the respondents were aware that HIV infection has a good prognosis and most (64.3%) would like infected patients to have a special designated dental clinic for treatment of infected persons. Only about one-third use condom regularly or occasionally. CONCLUSION: Knowledge of the general and oral features of AIDS, the high risk groups and the routes of infection in dental clinical practice were not satisfactory. A cross-section of the respondents showed negative attitudes to infected patients and infection prevention strategies.

Intra-tumoral ligation and the injection of sclerosant in the treatment of lingual cavernous haemangioma.

INTRODUCTION: Haemangiomas are developmental vascular abnormalities and more than 50% of these lesions occur in the head and neck region, with the tongue, buccal mucosa, lips and palate most commonly involve. They are considered as harmatomas rather than true neoplasms Factors such as patient's age, size and site of lesion and the proximity of lesion to vital structure are paramount in the determination of the therapeutic approach 7 surgical excision, cryotherapy, injection of feeder vessels with sclerosants and embolization of the blood vessels. CASE REPORT: We report the management of cavernous haemangioma of the tongue in a 38 year old man using intra-tumoral ligation (The Popescu Procedure) and injection of sclerosant under general anaesthesia. RESULT: The efficacy of this method lies in the fact that it obstructs the vascular channels to and from the entire tumour mass leading to progressive atrophy of the vascular endothelia, fibrous hyperplasia and the substitution of the angiomatous tissues by a fibroconnective tissue mass which initially appears excessive but remodels and produces an acceptable appearance which can be further improved by plastic surgery. CONCLUSION: The procedure was well tolerated and the patient made excellent recovery. It is recommended in our centre where facilities for technologically demanding methods are not available.

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.

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.

Identification of risk factors for short-term morbidity in third molar surgery.

AIM: The study was designed to identify preoperative variables that may constitute important risk factors for greater degree of facial swelling, pain and trismus. MATERIAL AND METHODS: The study involved 79 patients who presented for surgical removal of impacted mandibular third molars. Parameters such as age, sex, weight, body mass index, body surface area, and radiographic parameters such as depth of impaction, root morphology, ramus relationship, angulation of impaction, and proximity to inferior alveolar nerve {P-IAN} were measured and recorded. Swelling, trismus and pain were assessed by measuring facial dimension, inter incisal distance and using visual analogue scales respectively. The association between the preoperative parameters and extent of morbidity were determined by both a spearman correlation and multiple regression tests RESULTS: Sex, weight, and body surface area (BSA) correlated significantly with facial swelling. On the other hand, weight and body surface area were significant positive correlates of postoperative trismus. None of the preoperative variables studied correlated significantly with postoperative pain. In the regression analysis, sex, weight and BSA were also found to be significant determinants of facial swelling while postoperative pain severity was determined by sex, surface area and proximity to the inferior alveolar nerve. No statistically significant determinant of trismus was observed. CONCLUSION: Some non-operative parameters such as sex, weight and body surface area of patients are perhaps more important risk factors and determinants of individual variation of extent of morbidity than many radiographic variables to which more attention have been given in this regard. This requires further research.

Indications for the removal of impacted mandible third molars at Ibadan--any compliance with established guidelines?

The removal of impacted lower third molars has been a subject of controversy among dental practitioners since the turn of the twentieth century. A yet unresolved aspect of the controversy is the definition of appropriate indications for surgical extraction. Clinical guidelines have long been established but the effectiveness of adoption of the guidelines is still to be proved in our environment. A retrospective observational study of the indications for extractions in oral surgery clinic of the University College Hospital (UCH), Ibadan was conducted with the aim of identifying the common indications and to verify the level of compliance with established guidelines. There were 294 extractions out of which the indications for 268 cases were recorded. We found that pericoronitis constituted the most frequent indication 190 (33.6%) recurrent, 36 (13.4%) acute cases] while apical periodontitis 70, (26.1%) was next most frequent. Prophylactic extractions were performed in 34 (12.7%) cases. Other indications such as pulpitis 19, (7.1%), dental caries 13, (4.9%), dentoalveolar abscess (4, 1.5%), orthodontic reason (1, 0.3%) and tooth fracture (1, 0.37%) were also recorded. Compliance rate with NIH criteria and NICE guidelines were 87.3% and 73.9% respectively. We recommend that prophylactic extractions be discouraged while guidelines should be adequately emphasized for effective clinical practice.

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.