A Thirteen-year Retrospective Analysis of 179 Odontogenic Tumours in a Nigerian Tertiary Healthcare Facility / Análisis retrospectivo de trece años de 179 tumores odontogénicos en un centro de salud terciaria nigeriana

ABSTRACT Background: Tumours of odontogenic origin (OTs) resulting from epithelial and mesenchymal elements that are part of the tooth-forming apparatus must be considered as a differential diagnosis when analysing jaw lesions. They may be cystic, myxomatous or sometimes have a mixture of cystic and solid areas. Objective: To analyse the OTs seen at the Maxillofacial Surgery Department, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, between 2001 and 2013 based on the World Health Organization 's 2005 classification of OTs. Methods: A retrospective search and analysis was conducted of the medical records of all patients with a histopathologic diagnosis of orofacial tumours and tumour-like lesions seen at the Maxillofacial Surgery Department, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, from 2001 to 2013. Results: Odontogenic tumours constituted 179 (15.3%) cases out of a total of 1170 orofacial tumours and tumour-like lesions seen within the study period. The 179 OTs were found in 101 (56.4%) males and 78 (43.6%) females, giving a male to female ratio of 1.3:1. The ages of the patients ranged from 12 to 88 years (mean, standard deviation: 33.31, 14.07 years). The lesions were predominantly benign (n = 176; 98.3%), with only three (1.7%) being malignant OTs. Conclusion: The distribution of OTs in this study compared well with that in previous reports from Nigeria.

RESUMEN Antecedentes: Los tumores de origen odontogénico (TO) como resultado de los elementos epiteliales y mesenquimales que son parte del aparato de formación de los dientes, se deben considerar como diagnosis diferencial a la hora de analizar lesiones maxilares. Pueden ser quísticos, mixomatosos, o constituidas a veces por una mezcla de áreas quísticas y sólidas. Objetivo: Analizar los TO vistos en el Departamento de Cirugía Maxilofacial del Hospital Docente Ahmadu Bello de Zaria, Nigeria, de 2001 a 2013, a partir de la clasificación de TO de la Organización Mundial de la Salud de 2005. Métodos: Se realizó una búsqueda y análisis retrospectivo de las historias clínicas de todos los pacientes con diagnóstico histopatológico de tumores orofaciales y lesiones tumorales observadas en el Departamento de Cirugía Maxilofacial del Hospital Docente Ahmadu Bello en Zaria, Nigeria, de 2001 a 2013. Resultados: Los tumores odontogénicos constituyeron 179 casos (15.3%) de un total de 1170 tumores orofaciales y lesiones tumorales vistas en el período de estudio. Los 179 TO fueron encontrados en 101 (56.4%) varones y 78 (43.6%) hembras, para un ratio varón-hembra de 1.3:1. Las edades de los pacientes variaron de 12 a 88 años (media, desviación estándar: 33.31, 14.07 años). Las lesiones fueron predominante benignas (n = 176; 98.3%), hallándose solamente tres TO malignos (1.7%). Conclusión: La distribución de TO en este estudio es comparable con la de los reportes anteriores en Nigeria.

Use of oral mucoperiosteal and pterygo-masseteric muscle flaps as interposition material in surgery of temporomandibular joint ankylosis: a comparative study.

BACKGROUND: The most common complication of surgery for the release of temporomandibular joint (TMJ) ankylosis is relapse of the ankylosis. To prevent re-ankylosis, a variety of interpositional materials have been used. AIM: The aim was to compare the surgical outcome of oral mucoperiosteal flap, not hitherto used as interpositional material, with pterygo-masseteric muscles flap after surgical release of TMJ ankylosis. SUBJECTS AND METHODS: This was a prospective randomized study of all consecutive patients treated for the release of complete TMJ bony ankylosis, from January 2003 to December 2012, at the Oral and Maxillofacial unit of our institution. The patients were randomized into two groups: The pterygo-masseteric group comprises 22 patients while the oral mucoperiosteal group had 23 patients. Information on demographics, clinical characteristics, and postoperative complications over a 5 year follow-up period were obtained, and analyzed using the statistical package for social sciences (Statistical Package for the Social Sciences version 13, Chicago, IL, USA). A P < 0.05 was considered significant. RESULTS: The age of the patients ranged from 15 to 28 mean 20.3 (3.35) years while the duration of ankylosis ranged from 2 to 16 mean 5.1 (3.4) years. The baseline demographic (gender; P = 0.92; side; P = 0.58) and clinical characteristics in terms of etiology (P = 0.60) and age (P = 0.52) were comparable in both treatment groups. All the patients presented with complete bony TMJ ankylosis with a preoperative inter-incisal distance of <0.5 cm. The intraoperative mouth opening achieved ranged from 4 cm to 5 cm, mean 4.6 (0.27) cm and this was not different for either group (P = 0.51). The patients were followed up postoperatively for a period ranging from 3 to 5 years, mean 3.4 (0.62) years. The mouth opening decreased, over the period of postoperative review, from the initial range of 4-5 cm to 2.9-3.6 cm, and this was not different in both groups (P = 0.18). CONCLUSION: This study suggests that oral mucoperiosteal flap could be an option in the choice of interpositional materials in surgery of TMJ ankylosis.

Indications and risk factors for complications of lower third molar surgery in a nigerian teaching hospital.

BACKGROUND: The surgical extraction of impacted third molars is a common oral surgical procedure, and it is often associated with complications such as sensory nerve damage, dry socket, pain, swelling, trismus, infection and hemorrhage. AIM: The aim of this study was to determine the surgical indications and risk factors for complications of third molar surgery at a Nigerian teaching hospital. MATERIALS AND METHODS: Medical records of patients referred to the Oral Surgery Clinic of our institution for surgical extraction of their impacted mandibular third molars from January 2008 to December 2010 were retrospectively examined. Information on patients' demography, types of impaction, operative parameters and complications were obtained and analyzed using Statistical Package for Social Sciences (SPSS Version 13), Chicago, IL, USA. A P < 0.0.5 was considered significant. RESULTS: A total of 330 impacted teeth were extracted from 250 patients. Male comprises (104/250 [41.6%]) and female (146/250 [58.4%]). The mesioangular (176/330 [53.4%]) and distoangular (73/330 [22.1%]) impactions were the commonest types. Recurrent pericoronitis (154/330 [46.7%]) was the most common indication for extraction. The complications were delayed healing (19/330 [5.8%]), alveolar, osteitis (9/330 [2.7%]) and injury to alveolar nerve (2/330 [0.6%]). Cigarette smoking (P < 0.001), Oral contraceptives use (P = 0.01), age of the patient (P = 0.03) and the surgeon's experience (P = 0.04) were found to be significantly associated with the development of alveolar osteitis; nerves injuries were significantly associated with the raising of a lingual flap (P < 0.001) and the technique of surgery (P ≤ 0.001). CONCLUSION: The age of the patient, cigarette smoking and oral contraceptive use at the time of surgery are some of the factors affecting outcome in third molar surgery.

Management of Ludwig's Angina in Pregnancy: A Review of 10 Cases.

BACKGROUND: Ludwig's angina is a rapidly spreading cellulitis that may produce upper airway obstruction often leading to death. AIM: The present paper reviews the management of Ludwig's angina in the third trimester of pregnancy. The inherent dangers to the mother and her unborn child are highlighted. MATERIALS AND METHODS: The case files of pregnant patients who had emergent incision and drainage for life-threatening facial cellulitis at the maxillofacial unit of the Murtala Mohammed Specialist Hospital in Kano, Nigeria, over a 2 year period were retrieved and demographic and clinical characteristics were retrospectively obtained and analyzed descriptively using the statistical package for social sciences (SPSS version 13.0, for Windows, September 2004, Chicago, Illinois). Comparative statistics were determined using Pearson's Chi-square, Fisher's exact tests and independent t tests as appropriate. A P value of less than 0.05 was considered significant. RESULTS: A total of 10 patients were seen within the study period, age ranges from 23 to 40 years, mean 29.5 (5.3) years. Majority of the women were in their third decade [60% (6/10)] while the remaining 40% (4/10) were in their fourth decade of life. Two of the patients presented within the period of less than 1 week of onset of symptoms while those who presented within the periods of 1-2 weeks and periods of over 2 weeks accounted for 50% (5/10) and 30% (3/10) respectively. All the patients presented during the third trimester of their pregnancy and odontogenic infections were responsible for 80% (8/10) of the Ludwig's angina. There were 20% mortality among the patients and this was significant for those with underlying systemic conditions (P = 0.02). The time of presentation was not significant for the survival rate of the gravid patient (P = 0.36) but was significant for survival of the fetus (P = 0.01). CONCLUSION: During a life-threatening infectious situation such as Ludwig's angina, risks of maternal and fetal morbidity include both septicemia and asphyxia. Attending clinicians must consider the risks that the condition and the possible treatments may cause the mother and her unborn child.

Augmentation of craniofacial defects using alloplastic material / Técnica de aumento para la reparación de defectos craneofaciales usando materiales aloplásticos

BACKGROUND: Alloplastic materials are increasingly being used in augmentation of craniofacial defects because of its ready availability, good aesthetic outcome and absence of donor site morbidity. This paper highlights experience in the use of heat-cured acrylic in augmentation cranioplasty. SUBJECTS AND METHOD: The management of three patients with anterior skull defect who presented at the Dental and Maxillofacial Surgery Clinic of the Aminu Kano Teaching Hospital over a five-year period is presented. RESULTS: There was good aesthetic outcome in all the patients and no complications were recorded. CONCLUSION: Augmentation of craniofacial defects using customized prefabricated heat-cured acrylic provides patients with a durable, stable and structural repair ofcraniofacial defects with good aesthetic outcome.

ANTECEDENTES: Los materiales aloplásticos son usados cada vez más en la técnica de aumento para la reparación de defectos craneofaciales, debido a su disponibilidad inmediata, buen resultado estético y ausencia de morbosidad del sitio donante. Este trabajo destaca nuestra experiencia en el uso de acrílico curado por calor en las técnicas de aumento en la craneoplastia. SUJETOS Y MÉTODOS: Se describe el tratamiento de tres pacientes con defectos del cráneo anterior, que asistieron a la Clínica de Cirugía Maxilofacial y Dental del Hospital Docente Aminu Kano por un período de más de cinco años. RESULTADOS: Hubo un buen resultado estético en todos los pacientes y no se reportaron complicaciones. CONCLUSIÓN: La técnica de aumentación para los defectos craneofaciales, utilizando acrílico prefabricado curado con calor, proporciona a los pacientes una reparación duradera, estable y estructural de los defectos craneofaciales con buen resultado estético.

Juvenile aggressive ossifying fibroma of the maxilla: a case report and review of the literature.

Juvenile aggressive ossifying fibroma is a rare benign but locally aggressive tumor with high recurrent potentials. Juvenile aggressive ossifying fibroma poses diagnostic challenges because of its rapidly growing nature. A 7-years-old female child presented to the pediatric unit of our institution with a 9-month history of right maxillary tumor. An initial diagnosis of Burkitt's lymphoma was made and the child has several courses of chemotherapy without adequate histologic confirmation., She was later referred to the maxillofacial unit where the appropriate diagnosis and treatment were instituted. The importance of early recognition and adequate management is highlighted.