Reconstruction of mandibular defects using nonvascularized autogenous bone graft in nigerians.

OBJECTIVES: The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria. PATIENTS AND METHODS: A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patients' records. This information include patients' demographics (age and sex) as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications. RESULT: There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ± standard deviation (SD) 12.9 and for females 35.0 ± SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%). Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients) and postoperative wound infection (eight patients) were the most common complications recorded. CONCLUSION: The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care contributed to the good outcome.

Histopathological study of salivary gland tumours in Ile-Ife, Nigeria.

AIMS AND OBJECTIVES: The objective of this study is to document the prevalence and clinicopathologic features/pattern of salivary gland tumours in Ile-Ife, southwestern Nigeria. PATIENTS AND METHODS: Fifty eight (58) cases of salivary gland tumours histologically diagnosed between January 1989 and December 2007 were identified from the biopsy records of the Departments of Morbid Anatomy and Forensic Medicine and Oral/Maxillofacial Pathology of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. The records of the patients were extracted and data on incidence, age, gender and site of the various tumours were analysed using descriptive statistics. RESULTS: Pleomorphic adenoma was the most common salivary gland tumour reported accounting for twenty-five (43.1%), followed by Mucoepidermoid carcinoma (eight, 13.8%). Adenoid cystic carcinoma and myoepithelioma each accounted for six cases (10.3%). Non-Hodgkin's lymphoma of the salivary gland occurred in two patients. Twenty-six (44.8%) cases occurred in males while thirty-two (55.2%) occurred in females giving a male-to-female ratio of 1:1.2. The parotid region was the most common site accounting for twenty-eight (49.1%) cases, followed by the submandibular region 16 (28.1%) and palate 10(17.5%). CONCLUSIONS: Pleomorphic adenoma is the most common salivary gland tumour. Contrary to other African studies, our series reveals mucoepidermoid carcinoma as the commonest malignant salivary gland tumour.

Can autologous platelet-rich plasma gel enhance healing after surgical extraction of mandibular third molars?

PURPOSE: This investigation assesses the effect of platelet-rich plasma (PRP) gel on postoperative pain, swelling, and trismus as well as healing and bone regeneration potential on mandibular third molar extraction sockets. PATIENTS AND METHODS: A prospective randomized comparative clinical study was undertaken over a 2-year period. Patients requiring surgical extraction of a single impacted third molar and who fell within the inclusion criteria and indicated willingness to return for recall visits were recruited. The predictor variable was application of PRP gel to the socket of the third molar in the test group, whereas the control group had no PRP. The outcome variables were pain, swelling, and maximum mouth opening, which were measured using a 10-point visual analog scale, tape, and millimeter caliper, respectively. Socket healing was assessed radiographically by allocating scores for lamina dura, overall density, and trabecular pattern. Quantitative data were presented as mean. Mann-Whitney test was used to compare means between groups for continuous variables, whereas Fischer exact test was used for categorical variables. Statistical significance was inferred at P < .05. RESULTS: Sixty patients aged 19 to 35 years (mean: 24.7 ± 3.6 years) were divided into both test and control groups of 30 patients each. The mean postoperative pain score (visual analog scale) was lower for the PRP group at all time points and this was statistically significant (P < .05). Although the figures for swelling and interincisal mouth opening were lower in the test group, this difference was not statistically significant. Similarly, the scores for lamina dura, trabecular pattern, and bone density were better among patients in the PRP group. This difference was also not statistically significant. CONCLUSION: The PRP group recorded reduced pain, swelling, and trismus as well as enhanced and faster bone healing compared with those in the control. Hence the study showed that topical application of PRP gel has a beneficial effect in enhancing socket healing after third molar surgery.

Ameloblastic carcinoma: a multicenter Nigerian study.

PURPOSE: To obtain a national profile on the prevalence and management of ameloblastic carcinoma in Nigerians. MATERIALS AND METHODS: Data were collected from the case files of patients with a histologic diagnosis of ameloblastic carcinoma from 4 tertiary referral centers in Nigeria from January 1980 to December 2008. RESULTS: Twenty patients were seen within the study period. There were 11 male and 9 female patients, with a male-to-female ratio of 1.2:1. Their ages ranged from 16 to 85 years (mean +/- SD, 41.63 +/- 19.8 years). The duration of the lesion before presentation was 6 months to 4 years. Twelve cases occurred in the posterior mandible alone, 1 case occurred in the anterior mandible alone, and 4 cases involved the anterior and posterior mandible. The posterior part of the maxilla was involved in 3 cases. A majority of the cases (17) occurred de novo, and 3 patients presented with carcinoma ex-ameloblastoma. Treatment included surgical resection with or without neck dissection. Eight patients declined treatment after diagnosis. Surgery was planned for 12 patients, but 2 patients died of intractable bleeding episodes before surgery. Mandibulectomies and maxillectomies were performed for 10 patients. Follow-up was carried out for 5 patients. Recurrence ranged from 6 to 96 months after the first surgery. Overall deaths recorded involved 6 patients. Three patients died within 3 years after the initial surgery and 1 patient died about 8 years after the initial surgery. One patient is still alive and well 1 year after surgery. CONCLUSION: Ameloblastic carcinoma is an uncommon malignancy. Most cases occur in the mandible and arise de novo. Early diagnosis and radical local excision remain the mainstay of treatment.

Prevalence and causes of fractured permanent incisors in 12-year-old suburban Nigerian schoolchildren.

The aim of the study was to assess the prevalence and causes of traumatic dental injuries to the permanent dentition of 12-year-old school children in Ile-Ife, a suburban population in the south west of Nigeria. A dental trauma cross-sectional survey was carried out through clinical examination of upper and lower permanent incisors and interviews with 415 (212 boys, 203 girls) 12-year-old children attending private and public secondary schools in Ile-Ife, in 2004/2005 by one calibrated examiner. Garcia-Godoy's classification was used. The prevalence of traumatic dental injuries was 12.8%. There was no statistical difference in the prevalence between boys and girls P > 0.05. The most common cause of injuries was falls (49.1%), followed by traffic accidents (13.2%), collision against objects or people (11.3%) and misuse of teeth 9.4%. The commonest type of injury was enamel fracture alone (9.9%), followed by enamel-dentine fracture (4.8%). Majority of the accidents occurred at home (60.4%), followed by school (26.4%). The prevalence of traumatic dental injuries was on the increase among suburban Nigerian children in Ile-Ife and it has a potential to be considered an emerging public health problem.

Knowledge, attitude, and practice of Nigerian commercial motorcyclists in the use of crash helmet and other safety measures.

OBJECTIVE: This study was designed to evaluate the knowledge, attitude, and practice of some commercial motorcyclists in Nigeria in the use of crash helmet and other cycling safety measures. METHODS: At randomly selected commercial motorcycle parks from two South Western Nigerian locations (Lagos and Ile-Ife), we obtained verbal consent from commercial motorcyclists (randomly selected) and thereafter administered structured questionnaires to consenting motorcyclists. The questionnaire sought to know the respondents' biodata (age, gender, and educational attainment inclusive), cycling background, and experience (trainer, duration of training and cycling, and history of crashes). Furthermore, risk factors and practices like alcoholism, maintenance history of the motorcycle, maximum number of pillion passengers carried, and use of crash helmet were elicited. Respondents' knowledge of available safety measures was also investigated. Data was entered into an IBM compatible computer and analyzed using the SPSS 11.0 statistical software. Statistical significance was inferred at p value<0.05. RESULTS: There were 224 male respondents aged 15-58 years. Their peak age was 25-29 years and mean 35.1+/-8.9 years; 8.4% had no formal education; 10.3% received formal training but the majority were either trained by self (35.5%) or an acquaintance (34.6%). Training lasted

Orofacial injuries associated with prehospital management of febrile convulsion in Nigerian children.

The aim of this prospective study was to determine in a population of pediatric patients with febrile convulsions the prevalence and pattern of orofacial and dental injuries caused by traditional remedies used in a suburban Nigerian community. Over the study period of 28 months, 75 cases of febrile convulsion presented to the Children's Emergency unit of our hospital. Of these, 27 children (36%) sustained orofacial injuries caused by forceful insertion of a spoon into the mouth (96.3%) or a bite (3.7%) during convulsive episodes. The ages of the patients ranged from 12 to 84 months with a mean 39.8 +/- 18.3 months. There were 15 males and 11 females with a male to female ratio of 1.4:1. The orofacial and dental injuries sustained from prehospital treatment at home were lacerations and bruising of soft tissues including lips, tongue, mucosa and commissures and tooth subluxation, displacement or avulsion. Other injuries sustained outside the mouth include second-degree burns to the feet, a chin laceration and facial bruises resulting from a fall. Many oral injuries were overlooked by pediatricians. Prompt recognition and appropriate management of febrile convulsion would be of great benefit to the pediatric patients.

Clinicopathological analysis of histological variants of ameloblastoma in a suburban Nigerian population.

BACKGROUND: This study was carried out to establish the relative incidence and provide clinico-pathologic information on the various histological types of ameloblastoma seen at the Obafemi Awolowo University Teaching Hospital complex, Ile-Ife in order to provide a baseline data which will be of significance to the pathologist and clinician. METHODS: Clinico-pathologic data on a total of 77 histologically diagnosed cases of ameloblastoma archieved at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife over a 15 year period were obtained and analysed descriptively. RESULTS: Follicular ameloblastoma was the most common histological type (50 cases, 64.9%), followed by plexiform ameloblastoma (10 cases, 13.0%). 4 (5.2%) cases of desmoplastic and 3 (3.9%) cases of acanthomatous ameloblastoma were seen while the basal cell variant accounted for 2 (2.6%) cases. Only 1 case of the unicystic type was seen. Some of the 77 cases presented as a mixture of two or more histological types. Ameloblastoma occurred over an age range of 11 to 70 years with a peak age incidence in the 3rd decade. CONCLUSION: This study provides a baseline data on variants of ameloblastoma as obtained in a suburban Nigerian population. Since variants of ameloblastoma differ in biologic behaviour, the data collected in this study provides clinicopathologic information which is of significance to the pathologist and clinician.

Ameloblastoma in Nigerian children and adolescents: a review of 79 cases.

PURPOSE: To descriptively review the clinicopathologic presentation and management of ameloblastoma in Nigerian children and adolescents and compare this with previous reports in the literature. METHODS AND MATERIALS: Data were collected from the case files of patients managed at 4 tertiary referral centers in Nigeria. RESULTS: Out of a total of 360 patients with a diagnosis of ameloblastoma, 79 were under 20 years of age at presentation (21.9%). Only 2.5% of the patients were under 10 years of age. The male-female ratio was 1.3 to 1 with a peak age incidence of 15 years in males and 17 years in females. All the tumors were intraosseous and the majority (94.9%) were situated in the mandible. The most common morphologic type was solid multicystic ameloblastoma (82.3%). The majority (66.2%) had a multilocular radiographic presentation. In most patients (57.3%), the symphysial region of the mandible was involved by the tumor. However, exclusively anterior tumors constituted only 15.2% of the cases, while tumors involving anterior and posterior jaw regions constituted 41.1%. Resection was the predominant (72.2%) form of surgical management. CONCLUSION: Ameloblastoma in Nigerian children and adolescents exhibit some peculiar clinical features: these include the predominance of males, and of the solid multicystic morphologic type. In addition, there is site predilection for the symphysial region of the mandible. Radical surgical resection remains the predominant form of treatment. Therefore, varying degrees of interference with facial growth will be present in these children.