Ophthalmic Injuries in Patients with Maxillofacial Trauma Presenting to a Teaching Hospital in North Central Nigeria.

Background: Ophthalmic injuries in patients with maxillofacial trauma are potential causes of a permanent visual loss. These injuries can easily be missed; hence, there is a need for the ophthalmic evaluation of patients with maxillofacial trauma. The main objective of this study was to determine the prevalence, patterns, etiology, and risk factors of ophthalmic injuries in patients presenting with maxillofacial trauma in a teaching hospital in North Central Nigeria. Materials and Methods: The study was a hospital-based, descriptive, cross-sectional study of 67 patients with maxillofacial trauma recruited over a 6-month study period. Information on the sociodemographic and clinical characteristics of the study participants was obtained. The data were analysed using SPSS version 20 statistical software. Pearson's chi-square test was used to test for statistical significance. Results: Ophthalmic involvement was seen in 77.6% of the study participants, with males and individuals aged 21-30 years being more commonly affected. The leading cause of ophthalmic injuries in patients with maxillofacial trauma was road traffic accident (RTA) (75.5%). Others included assaults and fall from heights. Amongst the RTA cases, 71.4% was due to motorcycle-related accident with 91.9% of the patients with ophthalmic injuries observed not to use helmet/seat belt. The use of alcohol and not wearing protective gears were seen as the risk factors. Simple zygomatic complex fracture was the most common trauma observed (44.2%). Conclusion: Ophthalmologic assessment should be conducted for all patients presenting with maxillofacial trauma. The laws on the use of protective gears such as helmets and seat belts should be enforced.

A comparative study of quality of life of patients with maxillofacial fracture and healthy controls at two tertiary healthcare institutions.

OBJECTIVES: Despite treatment, the pre-traumatic facial appearance of patients with maxillofacial fractures might not be able to be restored, and this difference can affect the person's quality of life (QoL). This study was designed to evaluate changes in QoL of people with maxillofacial fractures. MATERIALS AND METHODS: The study population was comprised of participants with maxillofacial fracture and age- and sex-matched healthy controls without history of such fracture. QoL was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF) questionnaire, which was administered to the patients before treatment (Time 1), at 6 weeks post-treatment (Time 2), and at 12 weeks postoperatively (Time 3). The values were compared with those of healthy controls. The QoL was compared between closed reduction group and open reduction and internal fixation group. RESULTS: The QoL scores of people with maxillofacial fracture before treatment were significantly lower (P=0.001) than those of healthy controls in all domains of the WHOQOL-BREF. The QoL scores in the psychological and social domains of patients with maxillofacial fracture at Time 3 were still lower than those of healthy controls (P=0.001). CONCLUSION: The QoL of patients with maxillofacial fracture was significantly reduced before treatment in all domains and remained reduced in both psychological and social domains weeks after treatment. Therefore, clinicians must be aware of and manage the residual psychosocial issues that can accompany the post-treatment period of maxillofacial injury.

Paediatric jaw tumours: experiences and findings from a resource limited tertiary health care center.

INTRODUCTION: primary maxillofacial tumors are uncommon in pediatric patients. When they do occur, the tissue damage caused directly alters facial growth, development as well as psycho-social evolution. This study was carried out to determine the pattern, sociodemographic characteristics and histologic peculiarities of paediatric jaw tumors in our environment. METHODS: a retrospective hospital-based study where the case notes of children below the age of 14 years who presented with jaw tumors and tumor-like lesions from January 2014 to December 2018 were studied. RESULTS: eighty-two patients were studied; patients aged 10-14 years had the highest representation. Mean time of presentation was 8 months with jaw swelling being the commonest presentation (84.1%). Majority of the fathers were in their 4th decade of life while most of the mothers were in their third decade of life and both parents possessed primary school certificate as their highest level of educational attainment. Fathers were mostly traders, while mothers were mostly full-time housewives. The maxilla and mandible were most commonly affected with the left side showing higher preponderance. Burkitt lymphoma (19 (23.2%)) and adenomatoid odontogenic tumor (14 (17.1%)) were the commonest lesions. When the tumor involved both the maxilla and the mandible, the tumor was most likely malignant. CONCLUSION: in our center, paediatric jaw tumors are commonest in male children with the 10-14 years´ age group most commonly affected. Burkitt lymphoma and adenomatoid odontogenic tumors were the commonest tumors. Early presentation must be encouraged since these tumors if presented early can be successfully treated.

Effect of submucosal or oral administration of prednisolone on postoperative sequelae following surgical extraction of impacted mandibular third molar: A randomized controlled study.

BACKGROUND: The aim of the study was to evaluate the effect of preoperatively administered submucosal and oral prednisolone on postoperative pain, facial swelling, and trismus following third molar surgery. PATIENTS AND METHODS: This was a randomized controlled trial in which subjects were randomly distributed into three groups. Group A consisted of subjects who received 40 mg oral prednisolone; Group B consisted of subjects who received 40 mg submucosal injection of prednisolone while Group C consisted of subjects who did not receive prednisolone. Each group had 62 subjects. Measurements for facial width/facial swelling, pain, and mouth opening were recorded preoperatively and postoperatively. The postoperative evaluation points were postoperative days 1, 3, and 7. These measurements were compared with the preoperative values both within and among the groups. RESULTS: Most of the subjects were in their third decade of life. A considerable increase in the mean postoperative values for pain, facial width and trismus was observed. Notably, subjects who did not receive prednisolone showed comparatively higher values for the measured parameters throughout the postoperative evaluation period. Subjects who received submucosal injection of prednisolone showed overall lower values compared to those who received oral prednisolone. CONCLUSION: The results of this study indicate that the administration of prednisolone has a significantly beneficial effect in ameliorating the postoperative sequelae of the third molar surgery. In addition, the effect of submucosally injected prednisolone is comparable to the orally administered prednisolone; indeed it shows superiority to the latter in a number of dimensions. Submucosal injection of prednisolone offers a simple, effective, easy, safe, and minimally invasive option to existing therapeutic methods of reducing these postoperative sequelae.

Oral health-related quality of life following third molar surgery with either oral administration or submucosal injection of prednisolone.

AIM: The aim of this study was to evaluate the changes in oral health-related Quality of Life (QoL) following third molar surgery with either oral administration or submucosal injection of prednisolone. PATIENT AND METHODS: Subjects were randomly distributed into three groups of 62 subjects each: Group A consisted of subjects who received 40 mg oral prednisolone; group B received 40 mg submucosal injection of prednisolone, while group C did not receive prednisolone. Preoperative and postoperative quality of life evaluations of all subjects were done using the 14-item Oral Health Impact Profile (OHIP-14) questionnaire. Postoperatively, quality of life evaluation was done on postoperative days 1, 3, and 7. Subjects were categorized as either affected (OHIP score ≤28) or not affected (OHIP score >28). Mean OHIP scores between preoperative and postoperative periods, as well as between the three groups, were compared. RESULTS: A significant increase in the mean total and subscale scores was found in all the groups postoperatively. This was most marked on the first postoperative day, and it gradually improved throughout the immediate postoperative period. Subjects who received prednisolone experienced a statistically significant better quality of life than those who did not. Subjects who received submucosal injection of prednisolone showed statistically significant less deterioration in QoL than those who received oral prednisolone (P = 0.001). CONCLUSION: Administration of prednisolone was significantly associated with less deterioration in quality of life and earlier recovery when compared with subjects who did not receive prednisolone. Submucosal injection of prednisolone 40 mg (which offers a simple, safe, painless, and cost-effective therapeutic option) is an effective therapeutic strategy for improving the quality of life after surgical removal of impacted lower third molars.

Assessment of factors associated with surgical difficulty in impacted mandibular third molar extraction.

PURPOSE: The aim of this prospective study was to investigate radiologic and clinical factors associated with increased difficulty in the removal of impacted mandibular third molars. We also aimed to form an index to measure the difficulty of removal of the impacted molars preoperatively. PATIENTS AND METHODS: A total of 87 patients who required 90 surgical extractions of impacted mandibular third molars from November 2003 to May 2004 were involved in the study. Radiologic and clinical data were taken preoperatively. All extractions were performed under local anesthesia by a single operator. Surgical difficulty was measured by the total intervention time. RESULTS: Increased surgical difficulty was associated with increasing age and body mass index. It was also associated with the curvature of roots of the impacted tooth and the depth from point of elevation (P < .05). CONCLUSION: Both clinical and radiologic variables are important in predicting surgical difficulty in impacted mandibular third molar extractions.

Malignant orofacial neoplasms in children and adolescents: a clinicopathologic review of cases in a Nigerian tertiary hospital.

OBJECTIVE: The aim of the study was to determine the relative frequency of orofacial malignant neoplasm in children and adolescents. METHODS: A retrospective review of malignant orofacial tumours in children and adolescents

Influence of trans-operative complications on socket healing following dental extractions.

AIM: Extraction healing complications have been attributed to several factors. The influence of trans-operative complications on an extraction site wound healing was the focus of this investigation. METHODS AND MATERIALS: This prospective study was conducted at the Oral Surgery Clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (LUTH) in Nigeria . Subjects selected were those referred for one or two adjacent extractions and who satisfied the inclusion criteria for the study. The relevant pre-operative information recorded for each patient were age and sex of patient, indications for extraction, time taken to extract the tooth, tooth/teeth removed, and any trans-operative complications. Extractions were performed with dental forceps, elevators, or both under local anaesthesia. Patients were blindly evaluated on the third and seventh post-operative day for socket healing assessment without reference to pre-operative information on the patients. RESULTS: Seventy-three (24.25%) of 301 teeth considered for socket healing assessment had various trans-operative complications due to accidental crown, root, or alveolar bone fractures. Of the 73 extractions with trans-operative complications during extraction, 18 developed a socket healing complication, while 17 of the 228 extractions without trans-operative complications developed socket healing complications (p = .000). The mean (SD) time taken to extract teeth developing healing complications was also found to be significantly longer than those without healing complications (p < .01). CONCLUSIONS: The study demonstrated the combination of tooth/bone fragments in the socket and increased time of extraction due to trans-operative complications and accidents predispose to the development of extraction site wound healing disturbance.

Clinical evaluation of post-extraction site wound healing.

AIM: The aim of this prospective study was to evaluate the clinical pattern of post-extraction wound healing with a view to identify the types, incidence, and pattern of healing complications following non-surgical tooth extraction. STUDY DESIGN: A total of 311 patients, who were referred for non-surgical (intra-alveolar) extractions, were included in the study. The relevant pre-operative information recorded for each patient included age and gender of the patient, indications for extraction, and tooth/teeth removed. Extractions were performed under local anesthesia with dental forceps, elevators, or both. Patients were evaluated on the third and seventh postoperative days for alveolus healing assessment. Data recorded were: biodata, day of presentation for alveolus healing assessment, day of onset of any symptoms, body temperature (degrees C) in cases of alveolus infection, and presence or absence of pain. RESULTS: Two hundred eighty-two patients (282) with 318 extraction sites were evaluated for alveolus healing. Healing was uneventful in 283 alveoli (89%), while 35 alveoli (11%) developed healing complications. These complications were: localized osteitis 26 (8.2%); acutely infected alveolus 5 (1.6%); and an acutely inflamed alveolus 4 (1.2%). Females developed more complications than males (p=0.003). Most complications were found in molars (60%) and premolars (37.1%). Localized osteitis caused severe pain in all cases, while infected and inflamed alveolus caused mild or no pain. Thirty patients (12%) among those without healing complications experienced mild pain. CONCLUSIONS: Most of the post-extraction alveoli healed uneventfully. Apart from alveolar osteitis (AO), post-extraction alveolus healing was also complicated by acutely infected alveoli and acutely inflamed alveoli. This study also demonstrated a painful alveolus is not necessarily a disturbance of post-extraction site wound healing; a thorough clinical examination must, therefore, be made to exclude any of the complications.

Ameloblastoma: analysis of 207 cases in a Nigerian teaching hospital.

OBJECTIVE: The aim of the study was to review all the cases of ameloblastoma seen at the Oral and Maxillofacial Surgery Clinic of the Lagos University Teaching Hospital, Nigeria, between 1980 and 2003. METHODS AND MATERIALS: In this retrospective study, case files and biopsy reports of new cases of ameloblastoma covering a 24-year period were retrieved and analyzed for sex, age on presentation, histologic type, and site distribution. RESULTS: A total of 207 cases of ameloblastoma were seen in the given period. One hundred and ninety-eight (95.7%) were benign, and 9 (4.3%) were malignant. A male-to-female ratio of 1.1:1 was found. The average ages on presentation for ameloblastoma and ameloblastic carcinoma were 31.67 and 46.44 years, respectively. The lesion was found to be more common in the premolar-molar region of the mandible. The most common histologic type was follicular ameloblastoma (25.1%). Nine (4.3%) cases of ameloblastic carcinoma were also reported. CONCLUSIONS: Ameloblastoma with a predilection for the posterior mandibular region is relatively common in our environment. Sex and site distributions are similar to previous reports in the literature.

Osteogenic sarcoma of the jaw bones: a single institution experience over a 21-year period.

OBJECTIVE: The purpose of this article is to review cases of osteogenic sarcoma of the jaw bones diagnosed in our institution during a 21-year period. STUDY DESIGN: Records of patients seen at the Lagos University Teaching Hospital between January 1983 and December 2003 with histologic diagnosis of osteogenic sarcoma were analyzed for age and gender of patients, as well as sites and histologic types of tumor. RESULTS: Osteogenic sarcoma of the jaws constituted 0.6% of all the biopsies of oral and jaw lesions seen within the period under study. The mean (+/-SD) age of patients at presentation was 27.2 +/- 13.6 years (range 11-70 years). The mean age of patients with maxillary lesions, 30.7 +/- 15.8 years (range 17-70 years), was higher than that of patients with mandibular lesions, 23.4 +/- 10.1 years (range 11-40 years); however, no statistical significance difference was found (P = .08) There were 12 male and 5 female patients, a ratio of 2.4:1. Nine (53%) tumors were found in the maxilla and 8 (47%) in the mandible, a ratio of 1.1:1. The mandibular lesions were predominant in female patients, while the maxillary lesions were predominant in male patients. The most common histologic subtype was chondroblastic (47%), followed by fibroblastic (35.3%) and osteoblastic types (17.7%). CONCLUSION: Osteogenic sarcoma of the jaws is rare in patients who presented with tumor and tumor-like lesions of the jaws in our center, in agreement with previous reports from Africa and other centers around the world. However, the mean age at presentation of our patients was lower than reported in other parts of the world.

Prospective, randomized, open-label, pilot clinical trial comparing the effects of dexamethasone coadministered with diclofenac potassium or acetaminophen and diclofenac potassium monotherapy after third-molar extraction in adults.

BACKGROUND: Patients who experience pain, swelling, and trismus after third-molar extraction are reported to experience a 3-fold higher rate of adverse effects (AEs) on quality of life compared with those who are asymptomatic after this surgery. Therefore, investigators emphasize the necessity for better control of this triad of sequelae. Steroids can reduce the risk for physiologic processes of inflammation, thereby suppressing the development of inflammation. OBJECTIVE: The aim of this study was to compare the effects of dexamethasone 8 mg IM and diclofenac potassium (K) 50 mg PO, dexamethasone 8 mg IM and acetaminophen 1000 mg PO, and monotherapy with diclofenac K 50 mg PO on postoperative pain, swelling, and trismus after surgical removal of third molars. METHODS: This prospective, randomized, open-label pilot study was conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos, Nigeria. Patients were randomly allocated to 1 of 3 treatment groups: concomitant treatment with dexamethasone 8 mg IM and diclofenac K 50 mg PO or acetaminophen 1000 mg PO, or monotherapy with diclofenac K 50 mg PO. Overall analgesic efficacy of the drug combinations was assessed for 7 days postoperatively using a 4-point categorical pain-intensity rating scale (0 = no pain; 1 = mild pain; 2 = moderate pain; and 3 = severe pain). Facial swelling was measured in 1 dimension on days 1, 2, and 7 after surgery using a tape measure placed from the tip of the tragus, to gonion, to the tip of the contralateral tragus, and trismus was assessed using interincisal mouth-opening ability, measured using a vernier-calibrated caliper on postoperative days 1, 2, and 7. Tolerability was assessed using direct questioning of the patients at follow-up visits. RESULTS: A total of 150 patients (50 per treatment group) were included in the analysis (76 women, 74 men; mean [SD] age, 26.8 [5.04] years [range, 18-45 years]; 100% Nigerian). The proportion of patients reporting no pain on the pain-intensity rating scale was significantly higher in the group receiving dexamethasone and diclofenac K compared with that in the groups receiving dexamethasone and acetaminophen or diclofenac K monotherapy (44% vs 22% and 24%, respectively; both, P < 0.05). Facial swelling was significantly less with dexamethasone and diclofenac K or dexamethasone and acetaminophen compared with diclofenac K alone (day 1: P = 0.013 and P = 0.011, respectively; day 2: P = 0.002 and P = 0.004, respectively). However, trismus relief was statistically similar between the 3 treatment groups on postoperative days 1 and 2. No AEs or complications were recorded. CONCLUSION: In this open-label pilot study, concomitant treatment with dexamethasone and diclofenac K provided significant relief of postsurgical pain and swelling compared with dexamethasone and acetaminophen or monotherapy with diclofenac K after third-molar extraction in these patients.

Trends and characteristics of oral and maxillofacial injuries in Nigeria: a review of the literature.

BACKGROUND: The etiology of maxillofacial injuries varies from one country to another and even within the same country depending on the prevailing socioeconomic, cultural and environmental factors. Periodic verification of the etiology of maxillofacial injuries helps to recommend ways in which maxillofacial injuries can be averted. The aim of the present study is therefore to analyse the characteristics and trends of maxillofacial injuries in Nigeria based on a systematic review of the literature. METHODS: A literature search using MEDLINE was conducted for publications on maxillofacial injuries in Nigeria. The relevant references in these publications were manually searched for additional non-Medline articles or abstracts. Forty-two studies met the inclusion criteria and the full-texts of these articles were thoroughly examined. Due to lack of uniformity and consistency in assessment and measurement variables, and treatment modalities in most of the studies, it was impossible to apply the traditional methods of a systematic review. Therefore, a narrative approach was conducted to report the findings of the included studies. RESULTS: Although, other causes like assaults, sport injuries, and industrial accidents increased in numbers, throughout the period between 1965 and 2003, road traffic crashes remained the major etiological factor of maxillofacial injuries in all regions, except northeastern region where assault was the major cause. A significant increase in motorcycles related maxillofacial injuries was observed in most urban and suburban centres of the country. Animal attacks were not an unusual cause of maxillofacial injuries in most parts of northern Nigeria. Patients in the age group of 21-30 years were mostly involved. A strong tendency toward an equal male-to-female ratio was observed between earlier and later periods. CONCLUSION: Road traffic crashes remain the major cause of maxillofacial injuries in Nigeria, unlike in most developed countries where assaults/interpersonal violence has replaced road traffic crashes as the major cause of the injuries. There is a need to reinforce legislation aimed to prevent road traffic crashes and the total enforcement of existing laws to reduce maxillofacial injuries among children and adults. Special attention should also be paid by the authority to improve the socioeconomic conditions of Nigerian populace.

Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery.

BACKGROUND: The apparent interactions between the mechanisms of action of non-steroidal anti-inflammatory drugs (NSAIDS) and steroids suggest that co-therapy may provide beneficial inflammatory and pain relief in the absence of side effects. The aim of the study was to compare the effect of co-administered dexamethasone and diclofenac potassium (diclofenac K) with diclofenac K alone on the postoperative pain, swelling and trismus after surgical removal of third molars. PATIENTS AND METHODS: A prospective randomized double-blind study was conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Nigeria. A total of 100 patients were randomly allocated to two treatment groups of dexamethasone (prophylactic 8 mg and postoperative 4 mg IV) and diclofenac K (50 mg Oral before and after surgery), and diclofenac K alone (as with first group). The overall analgesic efficacy of the drug combinations was assessed postoperatively by determination of pain intensity using a category rating scale. Facial swelling was measured using a tape measure placed from tragus to gonion to tragus, while interincisal mouth-opening of patients was measured using a vernier calibrated caliper pre-operatively and post-operatively. RESULTS: Co-administration of dexamethasone and diclofenac K was significantly superior to diclofenac alone for the relief of pain (P < 0.05), and facial swelling up to post-operative 48 hour (P < 0.05). However, there was no significant difference for trismus relief between the two medication protocols (P > 0.05). CONCLUSION: This study illustrates enhanced effects of co-administered dexamethasone and diclofenac K on short-term post-operative pain and swelling, compared to diclofenac potassium alone in third molar surgery.

Are sterile gloves necessary in nonsurgical dental extractions?

PURPOSE: The aim of the study was to compare the incidence of healing complications of extraction socket with the use of sterile or clean nonsterile gloves during nonsurgical dental extractions. MATERIAL AND METHODS: This was a randomized prospective study conducted at the exodontia clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (Nigeria), between October 2002 and January 2003. Patients who were referred for nonsurgical extractions of permanent teeth and who satisfied the inclusion criteria into the study were randomly allocated into 2 groups. One group had their extractions performed with the surgeon wearing a pair of sterile gloves and the second group had their extractions performed with the surgeon wearing a pair of clean nonsterile gloves. Two hundred sixty-nine patients who had 301 teeth extracted and satisfied the inclusion criteria for socket healing assessment were assessed for postoperative socket healing. RESULTS: Three different types of socket healing complications were identified (dry socket, acutely inflamed socket, and acutely infected socket). A total of 32 patients (11.9%) developed socket healing complications. Nineteen of 122 patients in the sterile glove group and 13 of 147 patients in the clean nonsterile glove group developed socket healing complications (P = .09). CONCLUSION: The study confirmed that the use of sterile surgical gloves offers no advantage over clean nonsterile gloves in minimizing extraction socket healing complications following dental extraction. Therefore, nonsurgical dental extraction can be safely performed with the surgeon wearing clean nonsterile gloves.

Odontogenic tumors: a review of 319 cases in a Nigerian teaching hospital.

OBJECTIVE: This study sought to determine the relative frequency of odontogenic tumors in a Nigerian population and to compare these data with previous reports. STUDY DESIGN: Records of patients seen at the Lagos University Teaching Hospital between January 1980 and December 2003, with histologic diagnosis of odontogenic tumors (based on World Health Organisation classification, 1992), were analyzed. RESULTS: Odontogenic tumors constituted 9.6% of all the biopsies of oral and jaw lesions seen within the period under study. Three hundred and eight (96.6%) were intraosseous, and 11 (3.4%) were peripheral (peripheral odontogenic fibroma=7; peripheral myxoma=3; peripheral ameloblastoma=1). The mean age of patients was 29.9+/-15.6 years (range, 4-85 years). Among these cases, 96.6% of the tumors were benign and 3.4% were malignant. Ameloblastoma with predilection for the mandible was the most frequent odontogenic tumor (63%), followed by adenomatoid odontogenic tumor (AOT) (7.5%), myxoma (6.5%), calcifying epithelial odontogenic cyst (5.3%), and odontogenic fibroma (5.3%). More cases of malignant odontogenic tumors were seen than cases of calcifying epithelial odontogenic tumor and odontomas. The mean ages of patients with AOT, ameloblastic fibroma, and odontoma were significantly lower than those with ameloblastoma ( P<.05). No significant difference was found between the mean ages of patients with benign odontogenic tumors and those with malignant odontogenic tumors ( P=.058). CONCLUSIONS: Odontogenic tumors, especially ameloblastoma, are not considered rare among Nigerians, whereas odontoma, regarded as the most frequent odontogenic tumor in North and South America, is rare.