Missense Variants Within GJB2 Gene Locus and the Risk of Hearing Defects in Nonsyndromic Cleft Lip and Palate.

AIM: The aim of the study was to investigate the role of variants in GJB2 gene in the etiology of hearing defects in nonsyndromic cleft lip/palate. METHOD: Saliva samples were obtained from cases (subjects with orofacial clefts) and control (subjects without orofacial clefts) who consented to the study. Deoxyribonucleic acid (DNA) was extracted using standardized protocol at Butali Lab (Iowa, IA). Primers for the coding region of GJB2 was designed using Primer 3 (http://bioinfo.ut.ee/primer3-0.4.0/) and optimized in the Butali lab using a gradient polymerase chain reaction to determine the annealing temperature for each primer set (forward and reverse). We measured the DNA concentration using Qubit and XY genotyping done for quality control. A concentration of 5 ng/µL of DNA was used for Sanger sequencing. RESULTS: A total of 150 subjects were sequenced (66 cases; 84 controls). Mutations in GJB2 gene were detected in 2 individuals with cleft palate. We found p.Arg165Trp variant in 1 case and p.Leu81Val variant in the second case. Although p.Arg165Trp was predicted to be either benign or tolerated by SIFT/POLYPHEN, the single nucleotide change from C>T, that is, CGG>TGG leads to a premature stop codon preventing the protein formation. The p.Leu81Val variant was predicted to be probably damaging/ deleterious. CONCLUSIONS: The present study implicates variants in the GJB2 gene in the etiology of hearing defects in nonsyndromic cleft lip and palate in the Nigerian population. Screening for variations in GJB2 gene is important for genetic counseling especially in high-risk families.

Rare functional variants in genome-wide association identified candidate genes for nonsyndromic clefts in the African population.

Nonsyndromic clefts of the lip and palate (NSCLP) are complex genetic traits. Together, they are classified as one of the most common birth defects with a prevalence of 1/700 live births. Genome-wide association studies (GWAS) for nonsyndromic cleft lip with or without cleft palate (NSCL[P]) revealed significant association for common single nucleotide polymorphisms near genes involved in craniofacial development i.e., MAFB, PAX7, VAX1, ARHGAP29 (ABCA4 locus), and IRF6. Sequencing of protein coding regions of the NSCL(P) GWAS candidate genes or adjacent genes suggest a role for rare functional variants. Replication studies in the African population did not observe any significant association with the GWAS candidate genes. On the other hand, the role of rare functional variants in GWAS candidate genes has not been evaluated in the African population. We obtained saliva samples from case triads in Nigeria and Ethiopia for Sanger sequencing of the GWAS candidate genes (MAFB, PAX7, VAX1, ARHGAP29, and IRF6) in order to identify rare functional variants. A total of 220 African samples (140 Nigerians and 80 Ethiopians) were sequenced and we found the following new rare variants- p.His165Asn in the MAFB gene, p.Asp428Asn in the PAX7, a splice-site variant that creates a new donor splice-site in PAX7. We also found three previously reported missense variants p.Gly466Ser in PAX7; p.Leu913Ser and Arg955His in ARHGAP29. No de novo mutations were found. Future genome-wide association and sequencing studies should be conducted using samples from Africa in order to identify new molecular genetic factors that contribute to the etiology of NSCLP.

Prevalence and bacteriology of bacteremia associated with cleft lip and palate surgery.

The aim of the study was to determine the prevalence and bacteriology of bacteremia associated with cleft lip and palate (CLP) surgery. Three venous blood samples were obtained from 90 eligible subjects who presented for CLP surgery: before surgical incision, 1 minute after placement of the last suture, and 15 minutes thereafter. The samples were injected into an Oxoid Signal blood culture and transported to the laboratory for gram-positive/negative and aerobic/anaerobic bacteria analysis. Prevalence of bacteremia associated with cleft surgery was 38.1%. Prevalence rates of bacteremia in cleft lip surgery, cleft palate surgery, and alveoloplasty were 40.9%, 33.3%, and 50%, respectively. There was no significant difference in prevalence rate of positive blood culture in cleft lip surgery, cleft palate surgery, and alveoloplasty (P = 0.69). Positive blood culture was detected most frequently (47%) 1 minute after placement of the last suture. Of the 23 subjects who had positive blood culture at 1 minute, bacteremia persisted in 8 (35%) of them after 15 minutes. The most common bacteria isolated were coagulase-negative staphylococcus, Acinetobacter lwoffii, and coagulase-positive Staphylococcus aureus. Sex and age of the subjects, duration of surgery, blood loss, and type of cleft surgery were not significantly associated with positive blood culture. Bacteremia associated with CLP surgery is polymicrobial and persisted for at least 15 minutes after surgery in 35% of cases. This may reinforce the need for prophylactic antibiotics to protect at-risk patients from developing focal infection of the heart by oral flora.

Is healing outcome of 2 weeks intermaxillary fixation different from that of 4 to 6 weeks intermaxillary fixation in the treatment of mandibular fractures?

PURPOSE: This study was undertaken to compare the healing outcome of a short period (2 weeks) of intermaxillary fixation (IMF) with conventional (4-6 weeks) IMF in the management of fractures of the mandibular tooth-bearing area. MATERIALS AND METHODS: This was a randomized controlled study conducted at the Lagos University Teaching Hospital, Lagos, Nigeria, between November 2007 and January 2009. Subjects with minimally displaced mandibular fractures in the tooth-bearing area were randomly allocated into 2 treatment groups: IMF for 2 weeks (study group) or IMF for 4 to 6 weeks (control group). For the purpose of study analysis, the primary predictor variable was the treatment (IMF for 2 weeks vs IMF for 4-6 weeks). Other predictor variables were the age and gender of subjects. The primary healing outcome was considered either satisfactory or unsatisfactory. The following outcome variables that described the healing process were also compared in the 2 groups: healing time, postoperative infection, paresthesia, and maximal interincisal opening. Loss of body weight and oral hygiene status at the end of treatment were compared in the 2 groups. A value of P < .05 was considered significant. RESULTS: Satisfactory healing was observed in all cases in both groups. However, satisfactory healing was observed earlier (5.4 ± 0.9 weeks) in the control group than in patients with the short IMF period (7.2 ± 0.9 weeks) (P < .001). Malocclusion that was amenable to selective grinding was the only complication seen in both groups (n = 2 in study group and n = 1 in control group) (P = .492). Subjects in the control group lost more weight after treatment than those in the study group (P < .001). The recovery of interincisal mouth opening was also better in the study group than in the control group (P < .001). The study group had better oral hygiene than the control group at the end of treatment. CONCLUSIONS: The healing outcome was comparable in both groups. However, the healing time was significantly longer in the group with the short IMF period. The recovery of maximal mouth opening, oral hygiene status, and loss of weight body in the study group were significantly better than those in the control group. This study suggests that a short period (2 weeks) of IMF in the management of minimally displaced mandibular fractures of the tooth-bearing area in young adults is a suitable alternative to the conventional method in terms of the healing outcome.

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 randomized comparison of the effect of partial and total wound closure techniques on postoperative morbidity after mandibular third molar surgery.

PURPOSE: To compare the effect of total and partial wound closure techniques on immediate postoperative tissue reactions and complications after mandibular third molar surgery. PATIENTS AND METHODS: This prospective, randomized, controlled study was carried out at the Department of Oral and Maxillofacial Surgery, National Hospital, Abuja, Nigeria. Patients were randomly allocated to partial (group I) and total (group II) wound closure groups. Data were collected on pain, trismus, swelling, and complications experienced by the patients. Data analysis was carried out with SPSS software for Windows (version 13.0; SPSS, Chicago, IL) and GenStat (Discovery Edition, 2005; VSN International Ltd, Hemel Hempstead, UK). RESULTS: We studied 82 patients, consisting of 54 female and 28 male patients, with mandibular third molar teeth impaction. There were 40 patients (48.8%) in group I and 42 patients (51.2%) in group II. A statistically significant reduction in facial swelling (P = .001) was found in group I compared with group II, but no difference was recorded for pain and trismus. Group I presented with significant postoperative reactionary bleeding (P = .007), but no difference was recorded between the 2 groups regarding dry socket and socket infection. CONCLUSION: The partial wound closure technique after third molar surgery was considered to be associated with more postoperative morbidity, in view of the distressing nature of reactionary bleeding that was found to be associated with it. However, patients should be adequately informed about the possibility of attendant facial swelling each time the technique of total wound closure is used.

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.

Congenital heart defects in orofacial cleft: A prospective cohort study.

BACKGROUND: Congenital heart defects (CHDs) are one of the most common associated anomalies in patients with an orofacial cleft (OFC). However, few studies have shown the association between cleft type and CHDs in our population. This study aimed to assess the prevalence of CHDs in a cohort of OFC patients at a tertiary health facility in Nigeria, as well as assess the risk of CHD by OFC type. MATERIALS AND METHODS: This was a prospective study design. Patients with an OFC were consecutively enrolled at a single OFC treatment facility. All subjects were assessed by a paediatric cardiologist and had echocardiography done. They were categorised based on the presence of CHDs, as well as the OFC phenotypic type (cleft lip and/or alveolus, cleft lip and palate and cleft palate only). Statistical analysis was done using STATA version 14 (College Station, Texas), and significance was set at P < 0.05. RESULTS: A total of 150 subjects enrolled in the study over a period of 2 years (2018-2020). The median age of subjects was 6 months (interquartile range: 2-24), and 54.7% were female. The prevalence of CHDs in the subjects reviewed was 30.7%. Based on the severity of CHDs, the majority presented with simple defects (95.6%). Overall, the most common presentation was patent foramen ovale (12.7%), followed by septal defects (8.0%). There was no significant association between cleft type and the odds of a CHD. CONCLUSION: The study reports a relatively high prevalence of CHDs in patients with OFC; however, there was no association between the risk of CHD by cleft type. Although a majority of CHDs may pose a low operative risk, cardiac evaluation is recommended for all cases of OFC to aid the identification of potentially high-risk cases.

Characterization of high risk human papilloma virus genotypes associated with oropharyngeal cancers in a Nigerian population.

INTRODUCTION: head and neck cancers have essentially been a disease of the elderly but recent studies are beginning to demonstrate their increasing incidence in young people with infections such as human papilloma virus (HPV). This study was carried out to determine the prevalence of high risk Human papilloma virus (hrHPV) related oropharyngeal carcinoma and its prevalent genotypes as well as their strength of association with HIV in adult Nigerian subjects. METHODS: this was a cross-sectional study of 41 patients with oropharyngeal carcinomas seen over a 2-year period. Patients had incisional and/or excisional biopsy done under anesthesia. A portion of the specimen from which the DNA was extracted was placed in Digene HC2 DNA collection device while the 2nd portion for histopathological analysis was fixed using 10% Neutral Buffered Formalin (NBF) and embedded in paraffin blocks. Oropharyngeal cancer HPV genotyping was done using HPV genotypes 14 real-tm quant kit (SACACE, Italy). The data was analyzed using SPSS version 23. RESULTS: prevalence of HPV was 17.1% with a male to female ratio of 2.7: 1. The identified genotypes were 16, 33, 35 and 52 with 28.6% of patients having more than one genotype. Most of the age groups studied were affected. Squamous cell carcinoma and ameloblastic carcinoma were the cancers associated with HPV. HPV was not identified in the HIV positive patients. CONCLUSION: high-risk human papilloma virus genotypes 16, 33, 35 and 52 are associated with oropharyngeal carcinoma in Nigeria but were not found in HIV patients. This finding provides a strong evidence for the use of the 9-valent prophylactic vaccine for the prevention of oropharyngeal cancer in Nigeria. Public awareness and HPV prevention strategies should reduce significantly the incidence of oropharyngeal carcinomas in our environment.

A comparative study of surgical morbidity associated with mandibular third-molar surgery in young and aging populations.

AIM: Prophylactic surgical extraction of impacted third molars is a common practice throughout the world justified on the presumption that the risk of surgical morbidity increases with increasing age, among other reasons. The aim of this study was to analyze and compare surgical morbidity associated with third-molar extractions in young and aging populations. METHODS AND MATERIALS: A review of records for all patients who underwent the surgical extraction of impacted third molars between April 2001 and June 2006 at the Lagos University Teaching Hospital was carried out. RESULTS: A total of 506 patients had surgical extractions of impacted third molars under local anaesthesia during the period of the study. Of these, 470 (92.9 percent) patients were below the age of 40 years (Group A) and 36 (7.1 percent) patients were 40 years of age and older (Group B). No incidences of severe intraoperative complications (excessive bleeding or mandibular fractures) were recorded in either group, but other postoperative complications were reported in 70 (13.8 percent) patients. Of these 70 patients, 65 (92.9 percent) were from Group A and 5 (7.1 percent) were from Group B, and their complications included infected socket, dry socket, paraesthesia, and buccal space abscess. CONCLUSION: No significant difference in post-operative complications following surgical removal of mandibular third molars was found between patients 40 years old and greater and those below age 40. Prophylactic surgical extraction of impacted mandibular third molars, based on the assumption that surgical morbidity increases with age, may not be justifiable. CLINICAL SIGNIFICANCE: Age does not predispose patients who had surgical extraction of mandibular third molars above 40 years of age to any additional surgical complications when compared to patients below the age of 40 years receiving comparable treatment.

Parental Age and the Risk of Cleft Lip and Palate in a Nigerian Population - A Case-Control Study.

INTRODUCTION: Orofacial clefts are one of the most common congenital malformations in the facial region. Older maternal or paternal age presents higher odds of a child with an orofacial cleft. The objective of the study was to assess the association between parental age and risk of orofacial cleft. MATERIALS AND METHODS: This was a case-control study among 110 parents of children with orofacial cleft (case group) and 110 parents of children without orofacial cleft (control group). Information on maternal age, paternal age, and type of orofacial cleft in the children were obtained. The results were analyzed using descriptive statistics, Chi-square analysis, and bivariate logistic regressions to measure the association between parental age and orofacial cleft. The value of P was <0.05, with a 95% confidence interval (CI). RESULTS: Information on 219 children (109 cases and 110 controls) was analyzed, of which 52% were females. One respondent from the case group withdrew from the study. The odds of a child with orofacial cleft was statistically significantly lower in mothers aged 26-35 years compared to mothers aged 25 years and less (odds ratio [OR]: 0.32; 95% CI: 0.16, 0.79). Similarly, fathers aged above 35 years had statistically significantly lower odds of children with orofacial cleft than those 25 years and less (OR: 0.18; 95% CI: 0.02, 0.99). DISCUSSION: Our findings suggest that mothers aged 26-35 years may have lower odds of giving birth to babies with orofacial clefts, compared to younger mothers. Similarly, fathers aged above 35 years may have lower odds of giving birth to a child with orofacial cleft compared to fathers aged 25 years and less.

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.

Management of Orofacial Cleft in Nigeria - A Retrospective Study.

INTRODUCTION: Orofacial clefts (OFCs) are among the most common craniofacial developmental abnormalities worldwide and a significant cause of childhood morbidity and mortality. This study aimed to identify patterns of patient presentation, treatment approaches, and changes in our overall cleft care service between 2007 and 2019. METHODS AND METHODOLOGY: A retrospective review of patients managed at a tertiary health facility in Nigeria of all OFC cases operated between 2007 and 2019 was done using the postintervention data retrieved from the Smile Train database. Data of all OFC cases operated within the period were analyzed using the Statistical Package for the Social Sciences. Descriptive statistics were performed using the Statistical Package for the Social Sciences version 20.0. RESULTS: A total number of 740 OFC surgeries were performed in 565 patients, consisting of 269 females (48.2%) and 289 males (51.8%). The majority (63%) of the patients presented before the age of 2 years. Thirty-seven percent presented with cleft lip and alveolus, 27.1% with cleft palate only, and 36.7% with cleft lip, alveolus, and palate. Primary cleft lip repair was the most performed surgery (n = 320, 43.2%), the mean age at repair was 2.1 years. Since 2017, additional services such as speech therapy, mixed dentition orthodontics, and nutritional support were added to services provided to our cleft patients. Fifteen patients have undergone speech assessment and three have completed speech treatment. Eight patients have undergone mixed dentition stage orthodontic treatment. DISCUSSION: Our services have evolved from simply providing surgical care to comprehensive care with a multidisciplinary team approach and provision of a wide range of services including nutritional counseling, pediatric care, orthodontic services, and speech therapy. We believe these will improve the overall well-being of our patients while we continue to improve on services based on clinical research outcomes.

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.

A comparative study of quality of life of families with children born with cleft lip and/or palate before and after surgical treatment.

OBJECTIVES: The aim of this study was to compare the quality of life (QoL) of parents/caregivers of children with cleft lip and/or palate before and after surgical repair of an orofacial cleft. MATERIALS AND METHODS: Families of subjects who required either primary or secondary orofacial cleft repair who satisfied the inclusion criteria were recruited. A preoperative and postoperative health-related QoL questionnaire, the 'Impact on Family Scale' (IOFS), was applied in order to detect the subjectively perceived QoL in the affected family before and after surgical intervention. The mean pre- and postoperative total scores were compared using paired t-test. Pre- and postoperative mean scores were also compared across the 5 domains of the IOFS. RESULTS: The proportion of families whose QoL was affected before surgery was 95.7%. The domains with the greatest impact preoperatively were the financial domain and social domains. Families having children with bilateral cleft lip showed QoL effects mostly in the social domain and 'impact on sibling' domain. Postoperatively, the mean total QoL score was significantly lower than the mean preoperative QoL score, indicating significant improvement in QoL (P<0.001). The mean postoperative QoL score was also significantly lower than the mean preoperative QoL score in all domains. Only 3.2% of the families reported affectation of their QoL after surgery. The domains of mastery (61.3%) with a mean of 7.4±1.8 and finance (45.1%) with a mean score of 7.2±1.6 were those showing the greatest postoperative impact. The proportion of families whose QoL was affected by orofacial cleft was markedly different after treatment (95.7% preoperative and 3.2% postoperative). CONCLUSION: Caring for children with orofacial clefts significantly reduces the QoL of parents/caregivers in all domains. However, surgical intervention significantly improves the QoL of the parents/caregivers of these children.

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.

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.

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.

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.