A Clinicobiochemical Study of C - reactive protein among Patients with Odontogenic Infections in a Nigerian Tertiary Hospital.

Background: It appears that studies on the association between CRP levels and odontogenic infections are limited. The aim of this study is to determine the difference in CPR levels between the different types of odontogenic infections. Methodology: All consecutive patients that were diagnosed and treated for dentoalveolar and fascial space infections of odontogenic origin that met the inclusion criteria were studied. The data collected were age, gender, tobacco use, alcohol intake, and drug abuse. Other collected data were pain, trismus, dysphagia, antibiotics abuse, pre-existing medical condition, pulse rate, blood pressure, respiratory rate, body temperature, white blood cell, type of odontogenic infection, type of treatment, length of hospital stay and C-reactive protein. All analysis were done using IBM SPSS version 21.0 (IBM Corp, New York, USA). P- Value less than 5% was considered statistically significant. Results: A total of 44 patients with a mean age of 45.3±1.39 years ranging from 10 to 60 years were enrolled in this study. The C-reactive protein was significantly higher among patients with positive history of pain compared to those without pain (P = 0.01). The patients with fascial space infection had C-reactive protein levels higher than those with dentoalveolar infection and the difference in their means was statistically significant (P = 0.02). Likewise, the C-reactive protein was 17.5mg/dl significantly higher in the patients that stayed more than 5days in the hospital compared to those that stayed less than the same days(P = 0.03). Conclusions: The total mean of C-reactive protein of 75.4±3.53 mg/dl was greater than the critical level while the 9.62 X 109/L of WBC counts was lower than that of the reference value. Patients that had pain, fascial space infection and stayed more than five days in the hospital had higher levels of C-reactive protein following odontogenic infections.

Efficacy of Computed Tomography and Ultrasonography in Diagnosis of Metastatic Cervical Lymph Nodes in Orofacial Cancer.

INTRODUCTION: There is no consensus on which imaging modality is better for the detection of metastatic cervical lymph nodes in orofacial malignancies. This study evaluates the efficacy of computed tomography (CT) and ultrasonography (US) in diagnosis of metastatic cervical lymph nodes in orofacial cancer. MATERIALS AND METHODS: Sixty patients with various histologically diagnosed orofacial malignant lesions and clinical evidence of cervical lymph node metastasis were examined using US and CT. Further, the affected lymph nodes were biopsied and examined histologically. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the techniques were calculated. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 19 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2010 (Microsoft, Redmond, WA, USA). Test of statistical significance was set at 0.05. RESULTS: US recorded a sensitivity, specificity, PPV, NPV, and accuracy of 80.0%, 57.1%, 77.5%, 60.0%, and 71.7%, respectively (P = 0.004), while CT recorded a sensitivity, specificity, PPV, NPV, and accuracy of 87.1%, 71.4%, 85.0%, 75.0%, and 81.7%, respectively (P< 0.0001). Lymph node size was the commonest criterion in the diagnoses of metastases in cases with cervical lymph nodes. CONCLUSION: Although we obtained great results using US, our results indicated CT to be a better imaging modality for detecting metastatic cervical lymph nodes in orofacial malignancies.

A comparative study of the efficacy of intravenous benzylpenicillin and intravenous augmentin in the empirical management of Ludwig's angina.

Background: Ludwig's angina is a potentially life-threatening condition characterized by bilateral cellulitis of the submandibular, submental, and sublingual spaces. Intravenous (I.V) penicillin G or amoxicillin-clavulanate (Augmentin) has been recommended for use as empirical management before obtaining culture and sensitivity results. Aim: The aim of this study was to compare the therapeutic efficacies and clinical outcomes of I.V benzylpenicillin with I.V Augmentin in the empirical management of Ludwig's angina. Methods: This was a prospective randomized clinical study carried out to measure the rate of swelling reduction (using the lobar rate, Adam's rate, and interincisal distance) and other clinical parameters among the two drug groups (I.V penicillin G and Augmentin). Descriptive summaries of variables were generated, and Student's t-test was used to compare the mean outcomes of the two groups. Results: A total of 26 individuals participated in the study, consisting of 46% (12) males and 54% (14) females. The participants ranged from 13 to 61 years with mean and median of 34.4 (±12.7) and 35 years, respectively. Only 8% of the cases of Ludwig's angina were not attributable to odontogenic factors, compared to 92% resulting from odontogenic causes. There was no significant difference in the efficacy of the two antibiotics used in this study. Conclusion: The efficacies and the clinical outcomes of the two antibiotics were similar. Benzylpenicillin is probably a suitable empirical alternative where Augmentin cannot be afforded, to reduce the mortality associated with the condition.

RésuméContexte: L'angine de Ludwig est une condition potentiellement mortelle caractérisée par la cellulite bilatérale des espaces sousmandibulaires, sousmentaux et souslinguaux. On a recommandé la pénicilline (I.V) intraveineuse G ou l'amoxicilline-clavulanate (Augmentin) pour l'utilisation comme la gestion(direction) empirique avant l'obtention de résultats de sensibilité et la culture. Objectif: Le but de cette étude était de comparer les efficacités thérapeutiques et les résultats cliniques d'I.V benzylpenicillin avec I.V Augmentin dans la gestion(direction) empirique de l'angine de Ludwig. Procédés: C'était une étude clinique randomisée éventuelle a effectué mesurer le taux de réduction se gonflant (utilisant le taux de lobar, le taux d'Adam et la distance interincisal) et d'autres paramètres cliniques parmi les deux groupes de médicament (la pénicilline I.V G et Augmentin). Les résumés descriptifs de variables ont été produits et le t-test de l'Étudiant a été utilisé pour comparer les résultats moyens des deux groupes. Résultats: un total de 26 individus a participé à l'étude, consistant de 46 % (12) mâles et 54 % (14) femelles. Les participants se sont étendus de 13 à 61 ans avec moyen et médian de 34.4 (±12.7) et 35 ans, respectivement. Seulement 8 % des cas(affaires) de l'angine de Ludwig n'étaient pas attribuables aux facteurs odontogenic, comparés à 92 % résultant odontogenic des causes. Il n'y avait aucune différence significative dans l'efficacité des deux antibiotiques utilisés dans cette étude. Conclusion: Il n'y avait aucune différence significative dans les efficacités des deux antibiotiques dans le résultat clinique de traitement. Benzylpenicillin est probablement une alternative empirique appropriée où Augmentin ne peut pas avoir droit, réduire la mortalité associée à la condition.

Otitis media with effusion in Nigerian children with cleft palate: incidence and risk factors.

Otitis media with effusion is common in children with cleft palate, and the aim of this study was to find out its incidence and risk factors in Nigerians. We prospectively studied 84 patients (42 with cleft palate and 42 control subjects); 27 were male and 15 female, who were age and sex matched with control subjects. The extent and size of the clefts were measured using a dental cast and Vernier calipers, and the otitis media was diagnosed with otoscopy and tympanometry. The mean (SD) age of the groups was 11 (7) months (range 1-33). Twelve children in the cleft group had otitis media compared with three in the control group. Infants and boys were more likely to be affected. There was a significant association between age (p=0.02), sex (p=0.01), and size of cleft (p=0.00). However, only the size of the cleft was confirmed to be an independent predictor, with children who had extremely wide clefts being more likely to develop otitis media than those with narrow clefts (OR=8.71, 95%CI=1.07 to 70.5).We conclude that the incidence of otitis media with effusion was higher among children with cleft palate than among those who did not have a cleft. Infants had a higher incidence than older children, and boys had a higher incidence than girls. Age, sex, and the size of the palatal cleft were significantly associated with otitis media, but not the extent of clefting.

Comparison of Outcomes in Conservative versus Surgical Treatments for Ludwig's Angina.

OBJECTIVE: To compare the treatment outcomes in patients with early stage Ludwig's angina who received intravenous antibiotics alone with those who received surgical decompression and intravenous antibiotics. SUBJECTS AND METHODS: Individuals with early stage Ludwig's angina were studied using a retrospective cohort study design from August 1997 to September 2017. Data were collected from case notes and logbooks. Appropriate statistical tests were chosen to analyze both the independent and outcome variables. Using 2-tailed test, a level of significance of 0.05 was chosen. RESULTS: A total of 55 patients comprising 38 (69.1%) males and 17 (30.9%) females were studied. The conservative group had a higher number of cases that developed airway compromise (26.3%) when compared to those with surgical approach (2.9%). There was an association between the treatment approach and the development of airway compromise (χ2[1] = 4.83, p = 0.03). CONCLUSION: There was a higher incidence of airway compromise in patients treated with intravenous antibiotics alone than in those treated with surgical decompression and intravenous antibiotics.

A clinicopathologic correlation in the diagnosis of periradicular lesions of extracted teeth.

PURPOSE: We aimed to determine the contributory percentage of histopathologic diagnoses of routine biopsies and to ascertain the possible indicators for histopathologic examination to confirm the clinical diagnosis of periradicular lesions of extracted teeth. PATIENTS AND METHODS: This was a prospective study carried out over a period of 8 months on patients who had single tooth extraction and routine histopathologic examination of recoverable periradicular tissues from extracted teeth. RESULTS: A total of 136 patients participated in this study. There was a male/female incidence ratio of 3:2 and most of the patients with histopathologically diagnosed lesions were within the first, second, and third decades of life (n = 49, 36.0%). Seventy-five (55.2%) cases had histopathologically diagnosed periradicular lesions, which were mostly periapical abscess (n = 30, 22.8%) and inflammatory (periapical) granuloma (n = 23, 16.9%). Some clinical and radiologic features were associated significantly with histopathologic diagnosis of some periradicular lesions (P < .05). There also was a significant correlation of clinical diagnosis with histopathologic diagnosis of inflammatory (periapical) granuloma, periapical abscess, chronic osteomyelitis, and Burkitt's lymphoma (P < .05). CONCLUSIONS: This study shows a higher contributory percentage of histopathologic diagnoses after routine biopsies, compared to previous reports from selected biopsies of periradicular lesions. We identified clinical indicators for predicting possible histopathologic diagnosis of some periradicular lesions, in particular, those that predict possible histologic diagnosis of neoplastic periradicular lesions.

Pulmonary function of adult Nigerians placed on intermaxillary fixation.

OBJECTIVE: The use of intermaxillary fixation to treat jaw fractures is a procedure still widely carried out in third world countries either because of the unavailability of miniplates to treat jaw fractures or due to their expensive nature. The purpose of this study was to determine the effects of intermaxillary fixation on ventilatory functions of adult Nigerians so as to establish baseline data for future comparisons in Africans. METHODS: One hundred and forty-eight subjects comprising 120 (81%) males and 28 (19%) females were studied. Their age ranged from 18 to 60 years with a mean age of 24 years. The patients' pulmonary function tests were done using a vitalograph spirometer to measure FEV(1) and FVC immediately postoperatively, 7 days postoperatively, immediately after removal of IMF, and on the 7th day of IMF removal. The mean values of the FEV(1) and FVC at 7 days postoperatively were significantly higher than the values obtained immediate postoperatively (p<0.001). The FEV(1) and FVC values obtained immediate postoperatively and 7 days postoperatively were significantly lower than the values obtained immediately after removal of the wires (p<0.001). RESULTS: The results also show that there was a further increase of the mean values of FEV(1) and FVC on the 7th day of wires removal. CONCLUSION: It was observed that there was a reduction of pulmonary function values due to airway obstruction following IMF. The reduction was 5.7% to 8.9% in males, and 5.0% to 6.9% in females compared to the normal values established for adult Nigerians. In addition, the average of the mean FVC values immediately postoperatively and 7 days postoperatively were 87.9% and 90.9% for males and 91.7% to 93.6% for females respectively of their normal values obtained from the FVC values on the 7th day of wire removal.