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.

DENTAL RESIDENTS' PERCEPTION OF LEARNING ENVIRONMENT: EXPERIENCE OF A NIGERIAN TRAINING INSTITUTION.

BACKGROUND: Learning environment has been described as crucial in determining the success of medical and dental education. Continuous evaluation of this environment will help in maximizing the learning opportunities of the training program. OBJECTIVE: To assess the resident doctors' perception of their learning environment at a teaching hospital in Nigeria. METHODS: The DREEM questionnaire was administered to participants undergoing residency training in the faculty of Dental Surgery at the University College Hospital, Ibadan. RESULTS: Thirty-nine resident doctors participated in the study (23 Males, 16 Females), mean age (±SD) was 35.7 (±4.22) ranging from 28 years to 46 years. Mean global score (±SD) was 105.3 (±26.8), 52.7%, out of a maximum of 200. The mean global score according to gender was significantly higher among males than females. The overall perception of the training environment by residents is more positive than negative and the male gender appears to have a more positive perception than the female gender. However, this perception is borderline as the environment was perceived as having many problems and residents' perception of their learning environment is mostly negative. Attention of the institution and trainers should be drawn to possibilities of combating the problem areas for better outcome of residency training in our environment.

AN AUDIT OF ORAL AND MAXILLOFACIAL PROCEDURES UNDER GENERAL ANAESTHESIA AT THE UNIVERSITY COLLEGE HOSPITAL IBADAN, NIGERIA.

BACKGROUND: Operating theatre time management is a constant source of tension among the healthcare professionals responsible for the use of the facility. It is important that all effort should be geared at optimal utilization of available resources and minimization of waste. AIM: To appraise time management, frequency and duration of surgical procedures, frequency and determinants of blood transfusion in oral and maxillofacial surgery. DESIGN OF THE STUDY: Prospective clinical study. SETTING: The University College Hospital, Ibadan. Nigeria. METHODOLOGY: This was a cross-sectional study of consecutive patients who had maxillofacial surgical procedures. Information was collected on number of cases scheduled per list, number of cases done per list, each patient's biodata, time intervals between patient arrival and departure from operating theatre, route and duration of intubation, type of surgical procedure, surgical time, preoperative and postoperative packed cell volume estimations, volume of blood loss and the frequency and volume of blood transfusions. RESULTS: The main points of delay were identified as the patient wait at the theatre reception and in the operating suite before intubation. Mandibulectomy procedures were the longest procedures with approximately five (5) hours, followed by maxillectomy with four (4) hours and maxillofacial trauma with three and a half (3.5) hours. Maxillectomy procedures had highest transfusion probability. The surgical time and the estimated blood loss significantly determined whether a patient would be transfused or not. The nasotracheal was the commonest route of intubation while cleft surgeries were the most frequent procedures performed followed by trauma surgeries. Majority of the patients were not transfused and two units of blood was the most frequent transfused volume for a patient. CONCLUSION: The main areas of delay have been identified as patients' waiting periods before the surgical procedures. The reasons why these delays occur need to be investigated and addressed to have an optimally functional facility. Reservation of blood for maxillofacial surgical procedures should be based on the anticipated need for blood transfusion for the particular procedure.

Dental students' perception of their interactions with faculty and learning activities in Nigeria.

BACKGROUND: For effective development of policy for faculty advances, it is necessary to know students' views. This study describes the perceptions of clinical students about teaching skills of faculty in the dental schools in Nigeria. METHODS: A validated, self-administered questionnaire adapted from Clinical Education Instructional Quality was used to survey 109 dental students from the three dental schools in Nigeria. Score of > or = 45 and > or = 39 was considered good perceptions for "interaction with clinical instructors" and "involvement in specific learning" respectively. Computed perception scores were compared by year of training. RESULTS: Participants comprised 64 males and 45 females; aged 21.0 to 35.0 years (mean age = 24.2 +/- 2.5 years). Majority (89.0%) of the students had good perception of their interaction with clinical instructors while 89.9% had good perception about their involvement in learning activities. More students in year three than two had positive perception about their interaction with clinical instructors and involvement in activities. CONCLUSION: Overall, dental students in Nigeria had good perception of their interaction with their clinical instructors and involvement in various learning activities but they desired more opportunity to get involve especially in the aspects of dental procedures, patients' vital signs and interpretation of laboratory tests.

DENTAL IMPLANT TREATMENT AT A NIGERIAN TEACHING HOSPITAL.

BACKGROUND: There has been an increase in the awareness of dental implant as a replacement option for missing teeth and this has consequently led to an increased demand for dental implant. AIM & OBJECTIVES: To determine the distribution and pattern of implant placement in a tertiary hospital in a developing country. MATERIALS & METHODS: This retrospective study was conducted at the University College Hospital to assess the treatment outcome of all the patients who had had osseointegrated root form endosseous dental implants over a period of five years. The data obtained included age, gender, socioeconomic status (SES), medical history, reason for implant placement, number of implants per patient, distribution of missing teeth, complications and treatment outcome. The data were analyzed for percentages, means, SD and presented in tables and figures. RESULTS: Forty two implants (40 conventional & 2 immediate) were placed in the 23 patients (M-15, F=8).There were 15(65.2%) males and 8(34.8%) females. Pre-implant placement ridge augmentation was done in 3(7.1%) patients while 9 (39.1%) patients had augmentation during implant placement surgery. Left maxillary central incisor was the most commonly replaced tooth in 31% followed by the right maxillary central incisor in 19%. The success rates in the study at 1 year and 5 years were 97.4% and 95.2% respectively. CONCLUSION: A high success rate (95.2%) of implant therapy at 5 years recorded in this study compared favorably with what is obtainable in many other countries of the world.

PATTERN OF OROFACIAL BACTERIAL INFECTIONS IN A TERTIARY HOSPITAL IN SOUTHWEST, NIGERIA.

BACKGROUND: Orofacial bacterial infections present in diverse patterns due to the anatomical complexity of the area. The likelihood of spread from the initial area of infection is also high because of the presence of contiguous spaces in the head and neck region. AIM: To determine the pattern and management outcome of orofacial bacterial infections in Southwest Nigeria. STUDY DESIGN: A prospective study. SETTING: University College Hospital, Ibadan, Nigeria. MATERIALS AND METHODS: A prospective study on 102 patients with orofacial bacterial infections seen between June and December, 2011 was carried out. The information collected with data sheet included socio- demographic data, clinical history and examination, treatment and outcome. Frequencies, means, medians and diagrams of relevant variable generated. Chi square test was used to test association between categorical variables at p<0.05. RESULTS: Male to female ratio was 1.1: 1 with age range 10 months to 83 years and mean age 33.0 (±20.3) years. The median number of days between onset of orofacial bacterial infection and presentation for treatment was 7 (range 3-90) days. Sixty seven (65.7%) patients presented to hospital within 7 days of the onset of symptoms of infection. Pain was the common symptom 100 (98.04%), followed by sleep disturbance 71 (69.6%) while the least common symptom was dyspnea 18 (17.7%). Most of the early presenters had complaint of sleep disturbance (67.6%) while most of the late presenters had dyspnea (44.4%). Positive medical history including diabetes mellitus was reported by 28 patients (27.6%). Sixty seven (65.7%) had fascial space involvement, of which the majority 38 (56.7%) had multiple space involvement. Eight (21%) of those with multiple space involvement had submental, bilateral sublingual and submandibular spaces (Ludwig's angina).The majority 12 (41.4%) of those with single space infection had it in submandibular space. The majority 35 (45%) of the patients with odontogenic infections had it in right posterior mandible. All the patients had antibiotics prescribed for them and also had one form of surgical treatment or the other which included extraction, incision and draina cge with extraction, decompression, exploration and debridement and sequestrectomy. The majority (90.5%) of the participants whose orofacial bacterial infection resulted into swelling had regression of the swelling and majority (90.0%) of those who had inadequate mouth opening had adequate mouth opening after treatment. Three mortalities were recorded in the course of the study. CONCLUSION: Odontogenic aetiology is commoner than non odontogenic. Multiple fascial space involvement occurred more than single space. Outcome was good with adequate treatment although few cases of mortalities were recorded.

Gross surgical features and treatment outcome of ameloblastoma at a Nigerian tertiary hospital.

BACKGROUND: Ameloblastoma is a benign odontogenic tumour which is locally infiltrative and may cause severe craniofacial deformities. Its epidemiology, clinical and histologic configurations are replete in local and international literature, but data about its gross surgical patterns and treatment outcome in Nigeria is sparse. We therefore describe the clinical, gross surgical configuration, histopathologic features and the outcome of management seen at a Nigerian tertiary hospital. METHODS: Records of all histologically diagnosed Ameloblastoma from January 2000 to December 2011 at the University College Hospital, Ibadan, Nigeria, were retrieved from the departments of Oral and Maxillofacial Surgery and Oral Pathology. Patients' biodata, clinical, radiographical, gross surgical and histological features of the tumours, type of treatment, mode of jaw reconstruction and post-surgical follow up period data were documented. RESULTS: One hundred and sixty-three ameloblastomas were diagnosed during the study period, only 92 had complete records and were therefore included in the study. The mean age was 34.2 years (+/- 14.25) and the male to female ratio was 1:1.1. Majority of the patients were in the low socioeconomic class (67.4%). Majority of the patients (76.5%) had segmental jaw resection and reconstruction was done mainly with non-vascularised iliac crest grafts. The gross surgical configurations were described as solid, cavitated and cystic. CONCLUSION: Despite the locally aggressive nature of ameloblastoma, patients presented late for treatment and majority of them had segmental jaw resection as a mode of treatment. Three gross surgical configurations of the specimens were described.

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.

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.

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.

Prophylaxis versus pre-emptive antibiotics in third molar surgery: a randomised control study.

OBJECTIVES: This study was carried out to compare the efficacy of preoperative single bolus antibiotics with a 5 day- postoperative antibiotic regimen in reducing pain, swelling, and trismus, surgical site infection (SSI) and alveolar osteitis (AO) after third molar surgery. PATIENTS AND METHODS: A randomised experiment was done involving eighty-four patients. The patients were divided into two groups consisting of 42 patients each. A preoperative group was given an oral bolus of 2g amoxycillin capsules and 1g metronidazole tablets one hour before extraction, while those in the postoperative group were given a five-day regimen oral 500mg amoxycillin capsules thrice daily and 400mg metronidazole tablets thrice daily. The occurrence of postoperative pain, swelling, trismus, SSI and AO were compared between the groups. RESULTS: Seventy-nine patients completed the study; 38 patients in the preoperative group and 41 patients in the postoperative group. There was no difference between the groups in respect of the inflammatory complications. The four cases of AO occurred in the preoperative group. CONCLUSION: Single bolus antibiotic prophylaxis should be adequate for most cases of third molar surgery as the degree of degree of postoperative pain, swelling and trismus was similar in both groups. The use of single bolus antibiotic prophylaxis would also help reduce the cost of treatment in developing countries as well as reduce the risk of development of resistant strains. However, a five-day postoperative antibiotic regimen is advised in patient with risk factors for AO.

Prevalence of neck and back pain among dentists and dental auxiliaries in South-western Nigeria.

Dental health workers like other workers have occupation related health problems and hazards which include neck and low back pain. Previous studies have shown that the prevalence and location of pain may be influenced by posture and work habits and as well as demographic factors. The aim of this study was to determine the prevalence of neck and back problems among dentists and dental auxiliaries in private and government dental hospitals in south western Nigeria. Structured self administered questionnaire was sent to dentist and dental auxiliaries by randomly selecting 3 out of the 6 state capital from the southwestern Nigeria. Participants included those in private clinics, teaching hospitals and general hospitals. The questionnaire was composed of respondents biodata, questions about specific information on neck and back pain and routine practice posture while working at chairside. The total number of properly filled questionnaire was 210 with a male to female ratio of 1.04:1. Respondents included 147 dentists, 37 dental surgeon assistants (DSA), 14 dental therapists and 12 dental technologists. Prevalence of back and neck pain among the respondents was 88.1% and 81.9% respectively. Among the male respondents, the prevalence of back pain was 86.9% and 89.3% in female while for neck pain, the prevalence was 83.2% in male and 80.6% in female. Within the different professional groups, the prevalence of back pain was highest among the DSA (89.2%), closely followed by the dentists (88.4%), then therapists (85.7%) and least among the technologists (83.3%). For neck pain, the prevalence was highest among therapists followed by technologists, dentists and least among the DSA. More females missed work due to back and neck pain than males. There is therefore the need to address ergonomic issues and change the way dentistry is practiced.

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.

Biologic; Anatomic and Clinical Considerations in the Management of the Classic Intraosseous Ameloblastoma of the Jaws

This paper reviews the types of surgical and nonsurgical treatment modalities that have been used to treat the classic intraosseous ameloblastoma of the jaws. The clinical; anatomic and biologic factors that may influence the clinicians' selection of a particular treatment modality were highlighted. Surgeons should be aware of these different modalities if they are to formulate a surgical treatment plan that is individualised to fit different clinical situations

Evaluation of Pederson index as an instrument for predicting difficulty of third molar surgical extraction.

AIM: This study was intended to assess the clinical reliability of the Pederson index as an instrument for preoperative determination of surgical difficulty in third molar surgery. METHODS: Pederson index was used to predict the difficulty of 79 cases of impacted mandibular third molar extractions. The predictions were compared with actual surgical difficulty determined by operation time. The reproducibility as well as the reliability of the index was determined. RESULTS: The index was found to be highly reproducible (P=0.00). The sensitivity and specificity were 94.9% and 45% respectively. The Positive predictive value (PPV) was 67.2% and the negative predictive value was 90% while the accuracy was 69.6%. CONCLUSION: The Pederson index though reproducible is not a reliable instrument for predicting surgical difficulty of third molar surgery when compared with actual surgical difficulty as determined by the operation time. There is a definite need to derive an index that could be used for preoperative prediction of difficulty; however it is much more important that any index so employed should provide accurate information as the consequence of wrong judgments could be quite deleterious to the patients and embarrassing to the surgeon. While it is not completely unimportant, the Pederson index should not be employed as a sole instrument for preoperative assessment of difficulty in third molar surgery.

Incidence and risk factors for nerve injuries in mandibular third molar surgery.

BACKGROUND: The inferioralveolar (IAN), lingual (LN) and long buccal nerves (LBN)are the three terminal branches of the trigeminal nerve which are susceptible to injury during surgical extraction of impacted mandibular third molars. While it is not always possible to accurately predict the patients that will be affected with these complications, understanding and identifying the risk factors may allow the adoption of appropriate technique and expertise for specific cases. We embarked on this study to document the incidence and duration of injury to the inferior alveolar nerve (IAN), lingual nerve (LN) and long buccal nerve (LBN) following the operative removal of impacted mandibular third molars and to identify the associated radiographic and operative risk factors. METHOD: Pre- and postoperative neurosensory tests were performed for seventy nine patients who had surgical extraction of unilateral impacted mandibular third molars to determine the incidence and duration of complicating nerve injuries. The risk factors for nerve injury were determined among the radiographic variables and documented operative events. RESULTS: The incidence reported were 6.6% for IAN, 2.6% for LN and 4.0% for LBN; all but one of the nerve injuries resolved within 2 weeks. Depth of impaction (Pell & Gregory Level C) and linguo-version were the significant risk factors for IAN and LN injuries respectively while no risk factors was detected for LBN injury. Some significant operative events were associated with nerve injuries. CONCLUSION: Nerve injury in third molar surgery can be predicted based on some radiographic risk factors and some unforeseen intraoperative events. Most of the injuries are transitory in nature.

Incidence and risk factors for nerve injuries in mandibular third molar surgery

Background: The inferior alveolar (IAN); lingual (LN) and long buccal nerves (LBN) are the three terminal branches of the trigeminal nerve which are susceptible to injury during surgical extraction of impacted mandibular third molars. While it is not always possible to accurately predict the patients that will be affected with these complications; understanding and identifying the risk factors may allow the adoption of appropriate technique and expertise for specific cases. We embarked on this study to document the incidence and duration of injury to the inferior alveolar nerve (IAN); lingual nerve (LN) and long buccal nerve (LBN) following the operative removal of impacted mandibular third molars and to identify the associated radiographic and operative risk factors. Method: Pre- and postoperative neurosensory tests were performed for seventy nine patients who had surgical extraction of unilateral impacted mandibular third molars to determine the incidence and duration of complicating nerve injuries. The risk factors for nerve injury were determined among the radiographic variables and documented operative events. Results: The incidence reported were 6.6for IAN; 2.6for LN and 4.0for LBN; all but one of the nerve injuries resolved within 2 weeks. Depth of impaction (Pellet Gregory Level C) and linguo-version were the significant risk factors for IAN and LN injuries respectively while no risk factors was detected for LBN injury. Some significant operative events were associated with nerve injuries Conclusion: Nerve injury in third molar surgery can be predicted based on some radiographic risk factors and some unforeseen intraoperative events. Most of the injuries are transitory in nature

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.

The use of thromboembolic prophylaxis by surgeons: A multicentre Nigerian study.

BACKGROUND: Despite the well known contributions of deep vein thrombosis and pulmonary embolism to perioperative deaths, these major causes of morbidity and mortality appear not to be given adequate attention by surgeons in our environment. OBJECTIVE: To study the practice of thromboembolic prophylaxis among surgeons in some sub-specialties in three Nigerian tertiary institutions. MATERIALS AND METHODS: A structured questionnaire was used to collect information from consultants in the surgical sub-specialties on the use of thromboembolic prophylaxis in their practice. RESULTS: Fifty nine adequately completed questionnaires were returned. Of this, only 28 (47.5%) used prophylaxis routinely in major surgeries. Use was most frequent in orthopaedics and least in ophthalmology and otorhinolaringology. Subcutaneous heparin was the most commonly employed agent and the most important indication for prophylaxis was a previous history of thromboembolism. CONCLUSION: The results obtained suggest low use of prophylaxis. Evidenced-based guidelines are available on antithrombotic and thrombolytic therapy with the benefits outweighing risks, burdens and costs. Therefore greater attention should be paid to antithrombotic measures by all the surgical sub-specialties and patients stratified according to risk.

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.