Immediate reconstruction of the mandible after resection for aggressive odontogenic tumours: a cohort study.

The results are reported of a clinical follow-up study on 32 selected but consecutive patients with mandibular ameloblastoma. They were all treated by a segmental resection and reconstructed, using two 2.3 mm reconstruction plates and an autogenous particulate bone graft, taken from the anterior iliac crest, and platelet rich plasma. Follow-up ranged from 12 to 39 months, with an average of 27.9 months. Undisturbed healing occurred in 29 patients, while three had postoperative infections, but in only one case did that result in failure of the graft. The patients' appreciation was measured using an adapted quality of life questionnaire. The results were compared with a similar group who did not undergo reconstruction. The eating of solid food, appearance and speech were considerably better in the reconstructed group. The conclusion is that this means of reconstruction is appropriate for patients with benign but aggressive odontogenic tumours of the mandible, particularly in developing countries, since the expenses seem to be affordable.

Presentation and management of maxillofacial trauma in Dar es Salaam, Tanzania.

OBJECTIVE: To describe the presentation and management of maxillofacial trauma. DESIGN: A retrospective study. SETTING: Department of Oral and Maxillofacial Surgery, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. SUBJECTS: Patients presenting with maxillofacial trauma at the oral and maxillofacial surgery department of the MNH over a six year period (2001-2007). METHOD: Information was gathered including age, gender, length of interval between injury and presentation to the hospital, aetiology, pattern of soft tissue injury and fractures, therapy, co-morbidity, complications and number of hospitalisation days. RESULTS: The 21-30-year old age group was most affected. The overall male to female ratio was 4.3:1. The major cause of maxillofacial trauma was road traffic accidents (42.3%), followed by assaults (39.1%). Over 90% of the patients sustained soft tissue injuries, with cut wounds seen most frequently (45.0%). Of the soft tissue injuries, 75% required surgical intervention. Most of the fractures were located in the mandible (52.8%). Accompanying injuries elsewhere in the body occurred in 51.5%. Complications occurred in 13.3% of the cases. The mean hospitalisation period was 4.3 days. CONCLUSION: Road traffic accidents and assaults were the most common causes of maxillofacial trauma. Males below forty years of age were the majority of the victims.

Oral health status of handicapped primary school pupils in Dar es Salaam, Tanzania.

BACKGROUND: There is hardly any information regarding oral health status of handicapped primary school pupils in Tanzania. Determination of their oral health status could help in planning sustainable intervention programmes for this disadvantaged group. OBJECTIVES: To determine caries and periodontal status and treatment needs of handicapped primary school pupils in Dar es Salaam, Tanzania. DESIGN: A descriptive cross-sectional study. SETTING: Uhuru Mchanganyiko and Buguruni special schools, Dar es Salaam. RESULTS: The sample consisted of 179 (55.8%) males and 142 (44.2%) females aged between 7 and 22 years. Majority (71%) were deaf followed by blind (17.8%) and mentally retarded (8.7%). Six (1.9%) pupils were both deaf and blind, while one (0.3%) pupil was blind and mentally retarded. Forty one (12.8%) pupils had at least one decayed deciduous tooth, with the mean (dmfs) ranging from 0.25 to 3.24. The deaf had the highest mean decayed surfaces, followed by the mentally retarded and the blind. There was only one (0.3%) pupil who had a filled deciduous tooth. Thirty three (10.3%) pupils had decayed permanent teeth and 31 (9.7%) had missing permanent teeth. None of the decayed permanent teeth were restored. The blind had the lowest mean deciduous surfaces (DS) scores of between 0 and 1.0. In the mentally retarded group the mean DS ranged from 0.25 to 1.75. About 73.5% of the studied group had bleeding of the gums, with the blind having the highest mean bleeding index scores (p < 0.001) and about 82.8% of the pupils had calculus, with highest mean scores mainly among the blind (p = 0.008). CONCLUSION: The caries prevalence among handicapped primary school pupils was quite low. However, there was relatively high level of gingival bleeding and calculus. Regarding treatment needs, 23% required dental fillings mainly of one and two surface restorations and 82% required scaling and polishing. Despite these treatment needs these pupils had not received any dental attention.

Patients' satisfaction with dental care provided by public dental clinics in Dar es Salaam, Tanzania.

BACKGROUND: In Tanzania, patient satisfaction with dental services has received only minor attention. OBJECTIVE: To assess patients' satisfaction with public dental health services in Dar es Salaam. DESIGN: A cross-sectional study. SETTING: Five public dental clinics randomly selected from a list of all the nine public dental clinics in Dar es Salaam. SUBJECTS: Five hundred and sixteen consecutive patients, 193 males and 323 females aged between 12 and 77 years who, during the study period between July and November, 2002 were attending five dental clinics were randomly selected. RESULTS: No significant differences in patients' satisfaction level (overall or for the specific studied items) were found in all the five public dental clinics. The answers to the specific sub-items, apart from time spent with doctor, were around the average with very few responses with a high ranking. CONCLUSIONS: Findings indicate a moderate level of patient satisfaction with dental care offered in public dental clinics in Dar es Salaam. Areas identified as needing improvement included; technical quality of care, interpersonal aspects and communication.

Reconstruction of the mandible after ablative surgery for the treatment of aggressive, benign odontogenic tumours in Tanzania: a preliminary study.

This study presents results on 11 patients suffering from ameloblastoma who had ablative surgery followed by reconstruction of the mandible in a single operative procedure in Tanzania. The procedure included the use of autogenous particulate bone from the anterior or posterior iliac crest. In 6 of the patients, the tumour was removed from the cortical scaffold, which was then irradiated with 50 Gy. Perforations were made on the scaffold and it was then placed back to fit the defect and was held in place by custom-made titanium plates, fixed on both ends with screws. The particulate bone chips were mixed with autogenous platelet rich plasma (PRP) and Tissue Col. In 5 of the patients, the cortical scaffold was not used but rather a mixture of bone and PRP was packed into the defect under the titanium plates. Four patients had some complications varying from fracture of the scaffolds to infection. None from the group reconstructed without scaffolds suffered any complications. A quality of life (QOL) assessment of the 7 successful cases showed that these patients were satisfied and had a good QOL. These results imply that this immediate means of reconstruction is feasible and thus, offers a big advantage to the patients.

Evaluation of quality of life among patients after extirpation of mandibular ameloblastoma.

OBJECTIVE: To evaluate the quality of life (QOL) based on the functional, aesthetic and personal satisfaction among patients with ameloblastoma who underwent either partial or total mandibulectomy without reconstruction. DESIGN: Cross-sectional study. SETTING: The Department of Oral Surgery and Oral Pathology, School of Dentistry; Muhimbili University College of Health Sciences, Tanzania. SUBJECTS: Patients surgically treated for ameloblastoma without reconstruction. RESULTS. The postoperative problems were mostly associated with eating of solid foods, appearance and speech. All patients treated by total mandibulectomy had moderately severe problems with eating of solid foods and were dissatisfied with their appearance. CONCLUSION: The relatively small tumours resulted in a much better QOL. Public awareness programmes to avoid late referral and treatment is the most effective way to reduce the number of patients who after treatment suffer a poor QOL.

Salivary gland tumours in Tanzania.

OBJECTIVE: To determine the pattern of occurrence of salivary gland tumours in Tanzania over a period of twenty years. DESIGN: Cross-sectional retrospective study. SETTING: Two referral centres; Muhimbili National Hospital (MNH) and Kilimanjaro Christian Medical Centre (KCMC). METHODS: Medical records of patients who presented with tumours of the salivary glands in the two major referral centres over a period of twenty years from 1982 to 2001 were reviewed. Data regarding demographic, clinical and histologic information was analysed. RESULTS: Salivary gland tumours constituted 6.3% of all oral-facial tumours and tumour like lesions. Among the salivary gland tumours, 54% were benign and 46% malignant, which occurred in 80 males and 53 females. Peak age was between 20 and 49 years, with a male-female ratio of 1.5:1 (p<0.05). Pleomorphic adenoma was the commonest occurring tumour (44.4%) followed by adenoid cystic carcinoma (24.8%), mucoepidermoid carcinoma (9.8%) and adenocarcinoma (6.5%). Among the benign tumours, pleomorphic adenoma dominated (83.9%), followed by adenoma (9.9%). Among malignant tumours adenoid cystic carcinoma occurred in 54.3% followed by mucoepidemoid carcinoma (22.9%) and adenocarcinoma (11.4%). The parotid gland was the commonest site of occurrence followed by the palate. At initial stages the only complaint from the patients was essentially a slowly growing painless swelling. Treatment modality was mainly surgical in both benign and malignant tumours, however, for malignant tumours radiotherapy alone or in combination with surgery was sometimes employed. CONCLUSION: On average salivary gland tumours occurred at a relatively younger age compared to that reported in Western countries. Contrary to reports from Europe and America, adenoid cystic carcinoma was the most frequently occurring malignant salivary gland tumour. Late presentation was seen as a problem that needs to be addressed in order to maximise the effectiveness of treatment.

Odontogenic tumours and tumour-like lesions in Tanzania.

OBJECTIVES: To retrospectively document the pattern of occurrence of odontogenic tumours in Tanzania over fifteen years. DESIGN: The histologic types, site, age and sex distribution of odontogenic tumours in Tanzania from 1982 to 1997 were reviewed. Records of patients who presented to the four referral centres in Tanzania and who had histologically proven oral tumours and tumour-like conditions were examined. RESULTS: Odontogenic tumours comprised about 12.2% of all oral tumours and tumour-like conditions. The majority of odontogenic tumours (55.3%) were seen in patients below 30 years of age and they more commonly affected the mandible than maxilla. Ameloblastoma was the most commonly seen odontogenic tumour (73.7%), followed by odontogenic myxoma (10.3%). The site, sex, and histologic distribution of ameloblastoma did not differ from other African studies. Over 50% of patients with ameloblastoma presented to hospital late (after three or more years). CONCLUSION: In order to improve on the treatment outcome, the need for early detection and referral of patients by medical personnel and dentists is stressed.