Epidemiology of Blindness From Facial Trauma: A Multi-Centre Nigerian Study.

Study Design: This is a multi-centre retrospective study. Objective: To determine the prevalence of blindness and pattern of facial trauma associated with blindness among Nigerians. Methods: A multi-centre retrospective study of all patients with facial trauma resulting in blindness, that were co-managed by maxillofacial surgeons and ophthalmologists in 4 Nigerian public tertiary hospitals between January 2010 and December 2019 was undertaken. Data was analysed by IBM SPSS Statistics (version 21.0 for windows, IBM© Inc, Chicago, IL). Results: Of 2070 patients who presented with major facial injuries during the study period, 61 eyes of 56 (2.7%) patients were blind. Blindness was bilateral and unilateral in 5 (8.9%) and 51 (92.1%) patients, respectively. The mean age (SD) at presentation was 36.2 (16.6) years, and 47 (83.9%) of these patients were males. Road traffic accident (n = 27; 48%) was the commonest mechanism of facial trauma, the cheek (n = 18; 40.9%) was the commonest site of associated soft tissue injury and zygomatic complex fracture (n = 19; 24.1%) was the commonest related fracture. Globe rupture (n = 34; 55.7%) was the leading cause of blindness. Enucleation (n = 7; 13.2%) and evisceration (n = 22; 41.5%) were performed on 29 eyes of which 12 (41.4%) patients had ocular prosthesis post-operatively. Conclusions: Blindness was recorded in 2.7% of Nigerians with facial trauma. The commonest mechanism of trauma and cause of blindness in at least one eye were road traffic accident and globe rupture, respectively. Eye removal surgery was necessary in about half of the blind eyes.

An evidence-based surgical algorithm for management of odontogenic keratocyst.

The effective management of odontogenic keratocyst (OKC) remains a subject of interest and confusion in the oral and maxillofacial surgery literature. Currently, there is a lack of consensus regarding the most appropriate treatment for patients with OKC. Of the various treatment options available, no modality to date has been shown to demonstrate a zero or near-zero recurrence rates except wide resection with clear margins. With the prevailing dearth of evidence based surgical protocols for the management of patients with OKC in the literature, this study aims to present a surgical algorithm, based on meta-analysis results, that hopefully will be beneficial in enhancing treatment of patients with this condition. Also, new meta-analysis was done to compare between modified Carnoy's solution (MCS) and 5-fluorouracil (5-FU) in respect of recurrence rate of OKC. Using parameters like size, lesion type (primary or secondary), syndromic or solitary nature of the lesion, presence of cortical perforations, and locularity; we present a decision tree, to aid treatment planning and help attain the least chance of recurrence in the management of the OKC. There was very low-quality evidence indicating that application of 5-FU, after enucleation and peripheral ostectomy of OKCs, significantly lowered recurrence rate when compared to MCS (RR = 0.087, CI: 0.017 to 0.436, P value = 0.003).

Inclusion of gerodontology in dental curriculum: An urgent case for India.

The proportion of older adults is on the rise. Management of dental problems in this group is different from the general population, and hence requires special training. Gerodontology is yet to find its place in the Indian dental curriculum. A lack of training would result in inadequate care delivery. In this article, we share our views on the need for inclusion of the subject, potential challenges, and a guide for incorporation of gerodontology in undergraduate and postgraduate curriculum in the Indian dental institutes. We propose a framework based on the salient features of Kern's 6-step approach for curriculum development and Kotter's 8-step change management model. Some features are common to both the models. A combination of these models includes the following salient features: Problem identification and general needs assessment, beginning with a sense of urgency and targeted needs assessment, communication of the vision for change, working in guided coalitions and defining clear goals and objectives, adopting the relevant educational strategies, implementation strategies to enable change and generating short-term wins, evaluating the effectiveness of the curricular reform and sustaining and anchoring the change. The proposed framework may also be useful for countries where gerodontology is yet to be implemented.

Nigerian law enforcement agents' knowledge and enforcement of drink-drive law.

OBJECTIVE: To understand how knowledgeable and equipped the law enforcement agents in Nigeria are to enforce the drink-drive law. METHOD: We conducted a descriptive cross-sectional study of Law Enforcement Agents in four Nigerian states selected by convenient sampling. The study utilized a pre-tested questionnaire designed to obtain subjects' demographic data, elicit their knowledge about drink-drive law, and understand how equipped the subjects are. A team member walked respondents through the questions to ensure comprehension and accuracy with completion of the questions. RESULT: 496 law enforcement agents were studied. They were 414(83.5%) male and 82(16.5%) females, mostly aged 21-40 years (64.3%). Close to half (48.2%) were police officers, while 35.7% were officers in the Federal Road Safety Corp (FRSC). 45% of respondents had secondary/high school education, while 39.5% had bachelor's degree; with a significant majority in the FRSC. 269(54.2%) respondents had convicted a road user of drunk driving/riding on the basis of subjective assessment. The use of breathalyzers and awareness of permissible Blood Alcohol Concentration (BAC)/Breath Alcohol Concentration (BrAC), was reported by a few respondents (5%), mostly FRSC officers, and others with relatively higher educational attainment. The majority were ignorant of the approved BAC limit in Nigeria (0.05 g/100 dl) and objective methods of assessing breath alcohol concentrations. CONCLUSION: In Nigeria, there is a huge knowledge gap on the drink-drive law and the acceptable penalties for offenders in Nigeria among law enforcement agents. The law enforcement agents lack equipment for objectively detecting drunk driving among road users. Our findings call for an urgent intervention in the training and practice of law enforcement agents if the prevalence of RTC arising from drunk driving will be reduced in Nigeria.

Pulmonary functions of patients with isolated mandibular fractures: a preliminary report.

OBJECTIVES: The aim of this study was to evaluate pulmonary function in patients with mandibular fractures and to determine the pattern of pulmonary functions in these patients. MATERIALS AND METHODS: This was a cross-sectional study of pulmonary functions in Nigerian non-smoking patients with isolated mandibular fractures managed at our health institution from December 2015 to June 2017. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR), and ratio of FEV1 to FVC (FEV1/FVC) were measured for all participants using a portable spirometer just before treatment. The pulmonary indices were compared with the predicted reference values for Nigerians to determine the respiratory pattern. RESULTS: Forty participants consisting of six females (15.0%) and thirty-four males (85.0%) with a female to male ratio of 1:5.7 were included in this study. The mean patient age was 34.5±13.1 years (range, 17-63 years). The mean FVC, FEV1, FEV1/FVC, and PEFR were 3.8±1.2 L, 3.0±1.0 L, 74.3%±13.8%, and 5.2±2.2 L/s, respectively. Comparison of data with predicted values revealed that 17 subjects (42.5%) had normal pulmonary function pattern while 23 subjects (57.5%) had features suggestive of obstructive and restrictive pulmonary function patterns. CONCLUSION: Isolated mandibular fractures presented with abnormal pulmonary function pattern.

Tissue-engineered bone using mesenchymal stem cells versus conventional bone grafts in the regeneration of maxillary alveolar bone: A systematic review and meta-analysis.

PURPOSE: The aim of this study was to compare tissue-engineered bone using mesenchymal stem cells (MSCs) and conventional bone grafts in terms of histomorphometric outcome, bone gained, and implant failure in the atrophic maxilla. MATERIALS AND METHODS: A systematic review and meta-analysis of randomized clinical trials (RCTs) was conducted. An electronic search of several databases was performed. RCTs comparing tissue-engineered bone using MSCs to bone graft alone in rehabilitation of the atrophic maxilla were included. Outcome variables were a mean percentage of new bone formation, residual graft particles, and connective tissue. Bone gained and implant failure rate were also assessed. Risk ratio (RR) or standardized mean differences (SMD) were statistically analyzed. RESULTS: A total of 190 augmented sites enrolled in 12 RCTs were included in this study. Nine of the 12 RCTs included 153 maxillary sinuses that underwent sinus elevation, and three RCTs included 28 patients with bone grafting only. There was no significant increase in new bone formation between the two groups at 3 to 4 months (SMD = -0.232, CI, -0.659 to 0.195, low-quality evidence). However, at 6 months postgrafting, a statistically significant increase in new bone formation was found in favor of the tissue-engineered bone using the MSC group (SMD = 0.869%, CI, -1.98 to 9.310, moderate-quality evidence). No substantial difference was found between the two groups with respect to residual graft particles, connective tissue, bone gained, and implant failure rate (RR = 2.8, CI: 0.517 to 16.6, P = .226, very low-quality evidence). CONCLUSION: There is moderate- to very low-quality evidence supporting the use of tissue-engineered bone using MSC therapy in maxillary alveolar bone regeneration compared with conventional bone grafting without MSCs.

What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: A large systematic review and meta-analysis.

PURPOSE: Among the different surgical treatments for keratocystic odontogenic tumors (KOTs), there is no single method associated with a zero recurrence rate (RR). Thus, this study aimed to seek the best surgical treatment with the least RR using a weighted event rated meta-analysis. MATERIALS AND METHODS: To address our study purpose, a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was performed. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without language restrictions from inception to August 2016. Relevant articles were selected based on the following inclusion criteria: prospective, retrospective, and case series studies that assessed various treatments in non-syndromic KOTs in which RRs were included. The predictor variable was treatment groups, namely: enucleation alone, enucleation with peripheral ostectomy, enucleation with Carnoy's solution application, enucleation with cryotherapy, marsupialization alone, decompression followed by residual cystectomy, and resection. The outcome variable was RR. A weighted RR using a random effect model (because of variation in follow-up time) with a 95% confidence interval (CI) was performed. Data analysis was performed using a comprehensive meta-analysis software. RESULTS: A total of 2287 KOTs in 35 studies were included in this analysis. The weighted RR for various treatment techniques was as follows: enucleation alone (23.1%), enucleation with curettage (17.4%), enucleation and Carnoy's solution (11.5%), enucleation plus liquid nitrogen cryotherapy (14.5%), marsupialization alone (32.3%), decompression followed by residual cystectomy (14.6%), and resection (8.4%). The pooled weighted overall RR of KOTs for all different treatments was 16.6%. CONCLUSION: Radical resection remains the certain option for obtaining the lowest recurrence with KOTs. However, low recurrence accompanies enucleation with application of Carnoy's solution or cryotherapy as the first-line treatment for primary KOTs. Marsupialization (where indicated) must be followed by secondary cystectomy to minimize recurrence. We believe that to achieve the least possible morbidity, resections should be reserved for multiple recurrent lesions and possibly syndromic cases.

Facial Bone Fractures in Ile-Ife, Nigeria: An Update on Pattern of Presentation and Care.

AIMS: Traumatic injuries remain a major cause of morbidity, mortality and economic loss worldwide. An audit of maxillofacial injuries presenting and managed at any facility is key to understanding the trends, strategies for prevention and improving outcome of care. We sought to study the pattern and treatment of facial bone fractures managed at the Department of Maxillofacial Surgery, Obafemi Awolowo University Teaching Hospital, Ile-Ife, between 2005 and 2013. Also, to compare these with the pattern in the preceding 29 years. METHODS: Data on patients' socio-demographics, dates of injury and presentation, interval before presentation, agent of injury, type of crash, patient's status, type(s) of fracture, extent of injury, treatment offered and outcome were collected and analyzed. RESULTS: 311 patients aged 5-72 years were reviewed. A male preponderance was observed. Peak age incidence was 21-30 years and 86.1 % of injuries resulted from road traffic crashes (RTC) most (67.5 %) of which were motorcycle related injuries. 215 patients sustained mandibular fractures in 311 sites while 141 patients sustained 225 midface fractures. Of the 242 patients managed definitively, only 11.2 % had open reduction and internal fixation. CONCLUSION: Motorcycle related RTC remains the major cause of facial bone fractures. Management with osteosynthesis is gradually emerging, although demonstrating fewer complications, it is unaffordable for a majority.

Sublingual epidermoid cyst in a neonate.

Epidermoid cysts (EC) in the head and neck region could be considered a rare condition representing only 6.9% of all ECs occurring in the body. They occur rarely in children and neonates. We present a case of sublingual EC in a Nigerian neonate.

Anesthetic challenges in oro-facial cleft repair in Ile-Ife, Nigeria.

BACKGROUND AND METHODS: A retrospective review of all patients with oro-facial lip defects operated at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria over an 18 month period was undertaken with a view to determine: the pattern of presentation; associated clinical problems and congenital anomalies; perioperative complications; anaesthetic techniques used and outcomes; and the determinants of outcome. RESULTS: Of the 80 patients treated, 74 were managed under general anaesthesia but the case records of only 60 (81%) of these patients were available for review. The ages ranged between 3 months and 59 years. The male to female ratio was 1:1. Eighty percent of all cases studied were cleft lip (CL) +/- cleft palate (CP). Of these, 65% were left sided CL, 23% were right sided while 12% were bilateral. All patients had ASA score 1 or 2 at the time of surgery. Halothane in O2 induction was employed in 60% of the patients while 40% had IV induction. Intubation was facilitated with muscle relaxant in 63.3% of these patients. Naso-tracheal intubation was performed in 82% of all cleft palate repairs. Preoperative complications were encountered in 18% of the patients. Associated congenital anomalies were noted in 5% of the cases. One case each of difficult intubation and failed intubation were encountered. Intra-operative dysrrhythmia was noted in 5% of cases; no life-threatening complication was encountered peri-operatively. CONCLUSIONS: There is a dramatic increase in the number of patients presenting for care due to improved awareness of the population. Peri-operative attention to detail is essential in handling the challenges posed by the condition.

Dry socket: a prospective study of prevalent risk factors in a Nigerian population.

PURPOSE: To identify major risk factors for developing dry socket in some Nigerians, and to formulate a nonpharmacologic protocol for its effective prevention. PATIENTS AND METHODS: Patients presenting with dry socket at the Oral Surgery Clinic of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria, over an 18-month period were studied. Biographic data, preoperative diagnoses, teeth extracted, oral hygiene status, and history relevant to the extractions and presentations of dry socket were documented. Procedures were classified as traumatic or atraumatic. Data were analyzed using SPSS version 11.0 (SPSS Inc, Chicago, IL) with simple descriptive statistics and the chi(2) test, as appropriate. P

Motorcycle-related maxillofacial injuries among Nigerian intracity road users.

PURPOSE: We sought to determine the etiology and pattern of motorcycle-related maxillofacial injuries among intracity road users in Nigeria. PATIENTS AND METHODS: We conducted a prospective review of all patients presenting at the maxillofacial surgery units of the Obafemi Awolowo University Teaching Hospital Ile-Ife and Usmanu Dan Fodiyo University Teaching Hospital Sokoto with motorcycle-related injuries. RESULTS: One hundred seven patients were included in the study. A significant male preponderance was observed (P = .002). Overall, the peak age incidence was 20 to 29 years, whereas female patients had a peak age incidence of 10 to 19 years. Victims were mostly riders (50.5%) but none of them was a female. While 8.4% of accidents occurred on motorcycles with more than one pillion passenger, none of the victims reported using a crash helmet. Mechanism of accident was mostly head-on collision (39.2%). The injuries sustained were predominantly soft tissue injuries or in combination with bone injury. Bone and dental injuries were attributed mostly to falls. Facial bone injuries occurred mostly in the mandible (64 of 104). A symmetric distribution of injuries was observed in the upper, middle, and lower thirds of the face, but the middle third had the highest injury sites while the upper third had the least. CONCLUSIONS: Motorcycle-related maxillofacial injuries among Nigerians affect males predominantly. The injuries sustained have a symmetric distribution and were mostly soft tissue injuries in isolation or in combination with bony injuries. The middle third of the face is most vulnerable. Mandatory use of safety helmets and education of cyclists on the appropriate number of pillion passengers are imperative to minimize the morbidity and mortality associated with motorcycle accidents.

Intra-operative pain perception in tooth extraction--possible causes.

OBJECTIVES: To elicit the perception of pain in patients undergoing dental extraction under local anaesthesia and also to identify factors that might contribute to this experience despite the administration of local anaesthesia. SETTING: Ile-Ife, Southwestern Nigeria. PARTICIPANTS: 122 randomly selected single-tooth extraction patients. METHODS: Informed consent was obtained from patients who subsequently completed a questionnaire on the Corah Dental Anxiety Scale prior to treatment. Details documented for each patient included the demographics, history of previous tooth extraction and the status of the operator. The extraction was timed from the application of instrument until tooth delivery. Immediately after extractions, patients were asked to indicate on a Visual Analogue Scale (VAS) scores graded 0-10, the level of pain perceived during extraction. The data were subjected to simple descriptive and statistical analysis using SPSS for Windows 11.0. RESULTS: Positive correlations were found between the VAS and the anxiety scores, the attending surgeons' status, patients' anxiety score and the duration of surgery. A significant difference was found between the anxiety and the VAS scores in the different occupational groups. CONCLUSIONS: These results suggest that the status of the attending surgeon may affect the level of anxiety in patients undergoing tooth extractions prior to surgery. While patient's occupational group and duration of surgery could contribute to patient's intraoperative pain perception despite the administration of local anaesthesia.

Tooth loss in a sub-urban Nigerian population: causes and pattern of mortality revisited.

AIM: To determine the current causes and pattern of tooth loss in Ile-Ife Nigeria. DESIGN: A retrospective review of records of dental extraction patients. SETTING: The dental hospitals of the Obafemi Awolowo University Teaching Hospital situated in South Western Nigeria. PARTICIPANTS: All patients that had dental extractions between January 1996 and December 2002. METHOD: Patients' case records were analysed for demographics, reason(s) for dental extraction, tooth/teeth extracted, method of extraction and complication(s). MAIN OUTCOME MEASURE: Reasons for tooth extraction and the pattern of tooth loss. RESULTS: 6348 (12.3%) of hospital attendees aged 4-102 years (mean 35 +/- 16.8 years) had extraction of 8338 teeth. A statistically significant female preponderance was observed. Dental caries was the leading cause of tooth loss (56.4%) followed by periodontal disease (24.6%). This shows a reversal of a trend reported in a previous study in the same location. Over half (69.2%) of the extracted teeth were molars (mostly mandibular). Only 4.1% extractions were trans alveolar. 3.9% were complicated by dry socket. CONCLUSION: 12.3% of the hospital attendees had undergone dental extraction. Despite previous warnings of a steady rise in dental caries, it has become the leading cause of tooth loss in our hospital. The urgent need to institute standardised preventive measures was highlighted.

Orofacial non-Hodgkins lymphoma in Nigerians.

PURPOSE: In this study, we sought to determine the occurrence of primary non-Hodgkins lymphoma (NHL) in the oral and maxillofacial region among Nigerians. PATIENTS AND METHODS: We retrospectively studied hospital records that included radiographs of all patients with a histopathologically confirmed diagnosis of NHL in the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, between January 1992 and December 1997. Data were expressed as mean +/- SD or number (%). RESULTS: During the study period, 66 cases of NHL were recorded. Seventeen patients had concomitant extranodal lymphomas involving the gastrointestinal tract, nasopharynx, skin, lungs, kidney, and thyroid, in descending order. Three patients (4.5%) presented primarily with extranodal oral and maxillofacial disease. The ages of these patients ranged from 18 to 50 years (mean +/- SD, 32.3 +/- 16.3 years; median, 29 years). Within the same period, there were 121 cases of Burkitts lymphoma. The onset of lesions varied from 6 to 20 weeks. Two patients had intermediate-grade lesions; the remainder had low-grade lesions. Two presented with stage II disease, and the remainder were stage I. All of the patients had chemotherapy with remission of their lesions but were followed up to 6 months. Most of them did not complete the treatment cycles due to financial and social constraints. CONCLUSIONS: The rarity of primary NHL of oral and maxillofacial region has been aptly shown in this study. The need for the establishment of an effective oncology policy with the active collaboration of voluntary agencies is emphasized. This would ensure ready availability of the required chemotherapeutic agents and hospital care at affordable costs.