Awareness, knowledge and attitude on cleft lip and palate among antenatal clinic attendees of tertiary hospitals in Nigeria.

BACKGROUND: Adequate knowledge and awareness of cleft lip and palate (CLP) deformity may help to counter the negative beliefs and attitudes toward the condition. The objective of this study was to assess the level of awareness, knowledge and attitude of women attending antenatal clinics about CLP. MATERIALS AND METHODS: A cross-sectional descriptive study with the aid of a structured interview administered questionnaire was conducted among 200 women attending antenatal clinics in three Federal Government Teaching Hospitals in the Northern and Southwestern regions of Nigeria. The main outcome measure was the level of awareness and the mean cumulative knowledge score. RESULTS: The mean age of the subjects was 28.9 ± 5.1 years (age range: 16-42 years). Half of the women (50.5%) reported that they had seen or heard about CLP. The mean cumulative knowledge score was 6.9, with only 19.8% having adequate knowledge. Many respondents had neither read an article on CLP nor participated in any public enlightenment program, and 31.5% indicated that they would like to know more about the condition. Level of educational attainment had a statistically significant effect on the level of awareness and knowledge on CLP, as more educated respondents tend to be more aware and knowledgeable ( P < 0.001). CONCLUSION: There is need for increased public enlightenment/health education to increase awareness and subsequently help develop more positive attitudes toward children with CLP. Such programs should include distribution of pamphlets on CLP at clinics, especially antenatal clinics, media campaigns on radio, TV and newspaper as well as establishment of cleft support groups by the relevant governmental and professional organizations.

Unusual foreign bodies in the orofacial soft tissue spaces: a report of three cases.

The ingestion and inhalation of foreign bodies with their associated morbidity and mortality have been widely reported in the literature. However, reports on foreign body impaction in the orofacial region are comparatively fewer. Three unusual cases of foreign body impaction into the buccal and submasseteric spaces are presented. The three patients were adults and they presented with history of painful facial swelling associated with limited mouth opening. Plain skull radiographs revealed the foreign bodies within the facial soft tissue spaces in two patients while it was not helpful in the third patient. Surgical explorations of the left buccal, left submasseteric and the right buccal spaces led to the retrieval of the foreign bodies. Prompt diagnosis and surgical removal of such foreign bodies will greatly minimize the associated complications which may include; cellulitis, facial abscess, allergic reactions, necrotizing fasciitis and osteomyelitis.

Preparation of platelet-rich plasma from small volume of whole blood - a simplified approach.

AIM AND OBJECTIVES: Platelet-rich plasma (PRP) is frequently used to enhance wound healing in numerous surgical applications. There are many methods of preparation of PRP. The present report describes a laboratory technique which is rapid, simple and inexpensive for preparing PRP from small volume of whole blood. MATERIALS AND METHODS: Whole blood was drawn from 30 patients undergoing oral and maxillofacial surgery. PRP was prepared by the modified open system. Platelet counts for whole blood and PRP were determined using a cell counter. RESULTS: The data from 30 patients aged 20 to 33 years, with a mean of 24.4 (± 3.3) and male : female ratio of 1:1.1, were analysed. The platelet count in PRP was 3,157,667 ± 984,380 while that in whole blood was 268,667 (± 64,678) platelets /cubic ml, reflecting an 11-fold increase in platelet concentration. No effect of gender or ageing on platelet count was observed. CONCLUSION: This study demonstrates a simple, rapid and inexpensive technique that is useful in obtaining platelets concentrated approximately 11-fold.

Genetic studies in the Nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders.

BACKGROUND: Orofacial clefts are the most common malformations of the head and neck, with a worldwide prevalence of 1 in 700 births. They are commonly divided into CL(P) and CP based on anatomic, genetic, and embryologic findings. A Nigerian craniofacial anomalies study (NigeriaCRAN) was set up in 2006 to investigate the role of gene-environment interaction in the origin of orofacial clefts in Nigeria. SUBJECTS AND METHODS: DNA isolated from saliva from Nigerian probands was used for genotype association studies and direct sequencing of cleft candidate genes: MSX1 , IRF6 , FOXE1, FGFR1 , FGFR2 , BMP4 , MAFB, ABCA4 , PAX7, and VAX1 , and the chromosome 8q region. RESULTS: A missense mutation A34G in MSX1 was observed in nine cases and four HapMap controls. No other apparent causative variations were identified. Deviation from Hardy Weinberg equilibrium (HWE) was observed in these cases (p = .00002). A significant difference was noted between the affected side for unilateral CL (p = .03) and bilateral clefts and between clefts on either side (p = .02). A significant gender difference was also observed for CP (p = .008). CONCLUSIONS: Replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the development of CL(P).

Osteolipoma of the palate: report of a case and review of the literature.

Oral lipomas, though rare, predominantly affect the buccal mucosa, tongue, and lips. The occurrence of lipomas in the palate is extremely rare. Osteolipoma is a very rare histological variant of lipoma accounting for less than 1% of all cases. Although a few cases involving the soft palate have been reported, there is only one reported case of osteolipoma of the hard palate in the English-language literature and it was a congenital osteolipoma associated with a cleft palate in a 6-year-old male child. This paper aims to describe an additional case uniquely located in the hard palate of an adult female.

Cultural and religious components in Nigerian parents' perceptions of the aetiology of cleft lip and palate: implications for treatment and rehabilitation.

The present study was conducted to find out the perceptions of mothers from two Nigerian ethnic groups who had children with cleft lip and palate (CLP) about the aetiology of the defect. Mothers of 16 children with CLP from the Yoruba ethnic group who attended the maxillofacial clinic of the Obafemi Awolowo University teaching hospital in southern Nigeria and 20 children with CLP from the Hausa/Fulani ethnic group who attended the maxillofacial clinic of the University of Maiduguri teaching hospital in northeastern Nigeria were interviewed over an 8-month period. We used standardised interviews including questions with ethnographic components to allow us to collect information about traditional beliefs about clefts. Interviews were recorded on tape for later analysis. Thirteen of the 16 parents from the Yoruba group attributed the aetiology of CLP to supernatural forces (evil spirits and ancestral spirits), while 16 of the 20 Hausa/Fulani parents attributed it to the "will of God". Twelve of 16 Yoruba parents had consulted traditional healers for treatment before coming to the hospital. Various plants and animal products were used to treat clefts and 10 of the Yoruba parents were referred to the hospital for further treatment by the traditional healers. Cultural and religious factors seem to have an important role in the explanations, labels and treatment that followed the birth of a child with CLP in this environment. There is a need for greater collaboration and sharing of information between modern medical practitioners and traditional healers.

Bacterial infections of the head and neck fascial spaces in Nigerians.

BACKGROUND: Bacterial infections of the head and neck region remain a major public health concern in Nigeria despite the availability and widespread use of antibiotics in the country. OBJECTIVE: This study was conducted to determine the pattern, aetiology, management and outcome of head and neck fascial space infections at Ife. METHODS: All consecutive patients who presented with fascial space infections between January 1995 and July 2004 at the Maxillofacial Unit of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria were admitted into the study. A structured questionnaire was completed for each patient and analyzed in respect of patients' demographics, source of infection, predisposing factors, location of infection; treatment and outcome. RESULTS: One hundred and three patients were managed during the study period. There were 55(53.4%) males and 48(46.6%) females with age ranging from 1-85 years. Submandibular space was the most common single space involved followed by the buccal space. The fascial spaces around the mandible were more involved those around the maxillae and scalp for all age groups. Four patients presented with Ludwigs' angina. Odontogenic infections arising from pulpitis, periodontitis and pericoronitis caused over 70% of the space infections. Microbial cultures showed mixed aerobic and anaerobic bacteriology. Management was by incision and drainage/decompression, removal of the source, use of antibiotics and supportive care. Two deaths were recorded in the course of this study. CONCLUSION: Bacterial infections of the head and neck region remain a major health hazard among Nigerians with spread of infection commonly involving the submandibular and the buccal spaces.

Blindness and visual impairment from severe midface trauma in Nigerians.

Reports have shown that severe midface trauma causes blindness and visual impairment but information from sub-Saharan Africa is sparse. A retrospective analysis was carried out of patients who sustained trauma to the midface and subsequently lost vision in one or both eyes. There were 25 males and 7 females whose ages ranged from 5 to 65 years (mean +/- SD, 33 +/- 13.3 years). All patients presented between 1 h and 7 days of sustaining injury (mean +/- SD, 1.9 +/- 1.9 days). Road traffic accidents (37.5%) and gunshot injuries (34.4%) were the commonest causes. Of the 32 patients identified with loss of vision, half sustained fractures of the zygomatic complex while a total of 54 soft-tissue and bony injuries were recorded. The majority of patients (68.8%) had a ruptured globe, followed by vitreoretinal haemorrhage and traumatic optic neuropathy in 18.7% and 12.5%, respectively. Visual acuity ranged from 6/60 to 'no light perception'. Surgical exploration, enucleation, evisceration or exenteration was the treatment method used for those with ruptured globes. About 10.8% of patients with severe midface trauma also sustained loss of vision in one eye. Loss of vision associated with severe midface trauma is most likely to occur with road traffic accidents and gunshot injuries. High impact from such incidents often causes extensive damage to the eyeball resulting in immediate and irreversible blindness.

Applications of ultrasonography in the diagnosis of soft tissue swellings of the cervicofacial region.

PURPOSE: To determine the accuracy, sensitivity, specificity and prediction values of ultrasound as a means of diagnosis of cervico-facial soft tissue swellings. MATERIALS AND METHODS: We carried out ultrasonographic evaluation of 76 consecutive cases of cervico-facial soft tissue swellings that presented at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria from August 2002 to November 2003. The patients' demographics and relevant clinical information were obtained. Ultrasonographic evaluation was done using the B-mode transcutaneous ultrasonic imaging device with a transducer frequency of 5MHz. All the lesions were subjected to histopathological examination. RESULTS: There were 43(56.6%) males and 33(43.4%) females whose ages ranged from 2 weeks to 70 years (mean +/- SD; 22 +/- 19.7 years). Histologically, tumours constituted the highest percentage of swellings (35.5%), followed by cysts (26.3%). Males were more predominant in all classes of swellings except benign tumours. The accuracy of ultrasound in the diagnosis of pleomorphic adenoma was 80% and 100% for both adenocarcinoma and hemangioma. It was also 100% for majority of the cysts and HIV associated salivary gland swellings. The sensitivity of ultrasound in the diagnosis of pleomorphic adenoma was 80% and 100% for adenocarcinoma, hemangioma, all the cysts and HIV associated swellings. Ultrasound was also 100% specific in the diagnosis of monomorphic adenoma and hemangioma. CONCLUSION: Ultrasound is a useful diagnostic tool for cervicofacial soft tissue swellings. The accuracy of diagnosis is enhanced by the characteristics of the probe and the experience of the sonologist.

A survey of temporomandibular joint dislocation: aetiology, demographics, risk factors and management in 96 Nigerian cases.

A retrospective study of 96 cases of temporomandibular joint dislocation was undertaken. Patients' ages ranged from 9 to 85 years (mean+/-SD, 35.3+/-17.4 years) and peak incidence was at 20-29 years. Mean duration was 7.9 weeks (range, 1h to 3 years). Acute, chronic and recurrent dislocations were seen in 46 (47.9%), 29 (30.2%) and 21 (21.9%) patients, respectively. Males dominated in all three categories but this was not statistically significant (P = 0.8). Excessive mouth opening while yawning (44 cases) was the commonest cause of dislocation, followed by road traffic accidents (13 cases). Ten patients (10.4%) had an underlying systemic disease, the commonest being epilepsy (four cases); those with acute dislocation recorded the highest incidence of underlying illness. Bilateral anterior (86 cases) dislocations were the most frequent. Of the 96 patients, 89 (92.7%) were available for treatment. Manual reduction with or without anaesthesia proved effective for 38/45 acute, 5/24 chronic and 14/20 recurrent cases. Chronic dislocations were treated mainly by surgical osteotomy (13/24). Vertical subsigmoid and oblique ramus osteotomies were the commonest surgical techniques recorded. Treatment was satisfactory for all patients surgically handled except for one case of anterior open bite postoperatively. This study has shown that excessive mouth opening while yawning is the commonest cause of temporomandibular joint dislocation in Nigerians, and conservative approaches to management remain quite effective irrespective of the duration and clinical subtype. The best choice of surgical technique should be determined by proper clinical evaluation and the need to avoid or minimize postoperative morbidity.

Orofacial tumours in suburban Nigerian children and adolescents.

We report the type and distribution of orofacial tumours in south-western Nigerian children and adolescents. The 512 records of patients with oral and maxillofacial tumours in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, from 1991 to 2001, were searched and the 146 records (28%) of patients aged 19 years and less were reviewed. Their mean age was 10 years (female:male ratio 1:1.4). Of the 146 tumours 74 (51%) were malignant and 72 (49%) were benign. Of the latter 31 were from soft tissue and 41 were from the jaw (20 odontogenic and 21 non-odontogenic). The most common benign soft tissue and jaw tumours were gingival epulis and ameloblastoma respectively. Of the malignant tumours 67 were lymphomas, 5 sarcomas and 2 carcinomas.

Unmet orthodontic treatment need in rural Nigerian adolescents.

A survey of orthodontic treatment need was carried out among randomly selected rural Nigerian adolescents using the index of orthodontic treatment need. Altogether, 704 subjects (381 boys and 323 girls) aged 12-18 years (mean 14.8, SD 1.79) were recruited in the study. The results indicated that 12.6% of the population were in objective need of orthodontic treatment. Whilst there was a discrepancy in the proportions of Nigerian adolescents needing orthodontic treatment on aesthetic and dental health grounds, girls were found to have a more attractive dental appearance and less orthodontic treatment need than boys. However, the differences were not statistically significant (P>0.05). The correlation between the orthodontist's and the subject's rating of dental appearance was found to be low (r=0.35). The study also provided reliable baseline data for planning orthodontic services in Nigeria especially in areas where there are no dental services.

Maxillofacial fractures in a semi-urban Nigerian teaching hospital. A review of 442 cases.

A retrospective review of 442 patients, seen by one maxillofacial unit over a twelve-year period, is presented. Data concerning the patients' demographics and the aetiology, pattern, treatment and complications of the fractures were obtained and evaluated. Approximately 72% of the patients sustained fractures from road traffic accidents and 39% of the fractures occurred in the 21-30-year range. There was a male preponderence and 8% of all cases had postoperative infections. Over 20% of the patients sustained associated body injuries and only one-third reported for treatment within 24 hours of injury. Road traffic accidents continue to be the leading cause of maxillofacial fractures. The late presentation for treatment appears to be related to the rural and semi-urban dwelling of the patients and the attendant transportation and economic difficulties.

Eruption times of third molars in young rural Nigerians.

The eruption pattern of third molar amongst 1071 rural Nigerians (523 males and 548 females) aged 11-21 years was assessed. The earliest age at which the third molar erupted for males and females was 14 and 13 years respectively with females significantly ahead of males (P < 0.01). A full compliment of erupted third molars was recorded at age 14 years in 1.1 per cent of the population. However, the mean age for the eruption of 1, 2, or 3 and all third molars were 16.58 and 17.50 years respectively. Whilst third molar-eruption was significantly earlier in the mandible, no right-left side differences were found. Problems often associated with the erupting third molars are likely to be seen earlier in young rural Nigerians than in the western countries.

Oral malignancies in Ile-Ife, Nigeria.

Fifty nine patients with histologically confirmed cases of oral malignant neoplasia were included in this study. There was a male preponderance with the male to female ratio being 2.5 to 1.0. The average waiting period before presentation was 8.9 +/- 6.5 months (range: two to 24 months). Squamous cell carcinoma was the predominant variety, 50.8%, of all malignancies recorded. The alveolar ridge and the gingivae were the commonest sites accounting for 40.7% of all cases. Majority of the patients with squamous cell carcinoma, (80.8%), presented with stage IV of this disease. The pattern of oral malignancies in the population studied appears slightly different from earlier observations in Western Europe and Asia. The necessity to strengthen research on the epidemiology of the disease in Nigeria and other African countries is highlighted.

Burkitt's lymphoma presenting as lower lip paraesthesia in a 24 year old Nigerian. Case report.

An unusual case of stage D Burkitt's lymphoma in a 24 year old Nigerian female undergraduate is reported. There was a four month history of left lower lip paraesthesia followed three months later by a slowly progressive 'pimple-sized' nodular mandibular swelling arising from the mental foramen region. A full-blown, rapidly developing abdominal mass manifested only three weeks after a biopsy of the mandibular swelling. Aspiration of the latter and a histologic report of the mandibular mass confirmed Burkitt's lymphoma. The patient responded very well to appropriate chemotherapy. Clinicians should not overlook insidious jaw swellings in any adult residing in the endemic zone of Burkitt's lymphoma, in view of the fact that successful therapy is dependent on early diagnosis. Mental nerve paraesthesia is very rarely seen in Burkitt's lymphoma.

An investigation into the relationship between mandibular third molars and angle fractures in Nigerians.

We examined the relationship between the presence or absence of mandibular third molars and angle fractures in Nigerians between January 1976 and July 1997. Information was obtained from patients' case records and radiographs.A total of 490 patients were seen during the study period, 408 of whom (83%) had their third molars present, and 76 of whom had angle fractures. Road traffic accidents (n =304, 62%) were the main cause of the fractures. Of these, 44 (14%) had angle fractures compared with 14/75 (19%) patients in whom the mechanism of injury was a fight or assault.Sixty-five of the 408 patients whose third molars were present (16%) had angle fractures, as did 11/82 (13%) who did not have third molars (p =0.57). Of the 77 patients whose lower third molars were not erupted, 24 (31%) had angle fractures compared with 52/331 (16%) in whom the lower third molars were erupted (p =0.002). These findings suggest that angle fractures are uncommon in this population because of their particular mechanism of injury. In addition, the presence of a lower third molar does not necessarily predispose to fractures of the angle of the mandible. However, angle fractures are more likely to occur in people with unerupted lower third molars than in those in whom they have erupted.

Craniocervical necrotizing fasciitis in Ile-Ife, Nigeria.

Sixteen cases of necrotizing fasciitis were seen at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria from 1990 to 2000. Primary craniocervical involvement was recorded in seven patients (five men and two women). The clinical records of five patients were sufficiently detailed to allow us to report their age, aetiology, predisposing illness, clinical features, complications, management regimen and outcome. The patients were aged 30-75 years and in four of them odontogenic infections were the cause of the condition. Hypertension, diabetes mellitus and obesity were the underlying systemic diseases in three cases and the body/angle region of the mandible was the predominant site of the infection on the face. All five cases had involvement of the neck. Mediastinal extension was recorded in three cases. Two patients had complications: one had septicaemia and renal failure and the other developed bone necrosis. Pre-existing ill health, old age, late surgical intervention, and mediastinal and thoracic extension of infection were responsible for the only death. Treatment involved frequent and multiple surgical debridement, aggressive antimicrobial treatment and control of systemic disease. Early recognition, prompt surgical intervention, and aggressive antimicrobial treatment are essential to minimize morbidity and mortality. Rapid progression of infection, financial constraints, delayed referrals from rural clinics and distance to the tertiary hospital caused problems.

Facial injuries caused by animals in northern Nigeria.

We did a retrospective survey of 34 patients who sustained facial injuries after animal associated incidents and presented to three Nigerian teaching hospitals. There were 27 male (79%) and 7 female patients, whose ages ranged from 6 to 40 years. Sixteen (47%) were less than 15 years. Cows (n=14), camels (n=9), and donkeys (n=6) were the most commonly involved. Three dog bites were seen. Knocks from cows' horns (n=9) were the predominant mechanism of injury, followed by falls (n=8) and kicks (n=7). There were many facial lacerations and fractures, and the cheek (n=14), forehead (n=13), and chin (n=10) were the most common sites of soft tissue injury. All injuries were considered to be contaminated irrespective of the duration of the injury. Treatment consisted of thorough debridement and irrigation, primary closure where feasible, and secondary reconstruction in others. All patients were given prophylactic broad-spectrum antibiotics. Overall, outcome was satisfactory except for a few cases of scar formation, facial nerve palsy, and partial laryngeal stenosis. Associated injuries were recorded in nine cases (27%), with rupture of the globe in three patients (9%). One patient died of associated abdominal injuries after being trampled by a herd of cattle. There is a need for adequate protective measures to forstall animal-related incidents that could result in severe facial and other injuries.

Orofacial injuries in eclamptic Nigerians.

A retrospective review of one hundred and seventy three cases of eclampsia seen between 1994 and 2002 was conducted. Twenty one patients (12.1%) whose ages ranged from 18 to 35 years sustained orofacial injuries during the course of their eclamptic fits. Lacerations and bruises on the tongue, gingivae and lips accounted for injuries in all the patients. Temporomandibular joint dislocation was also recorded in one patient. Tongue lacerations were mainly due to tongue biting. Forceful insertion of objects during convulsive episodes was responsible for the bruises and deep lacerations at the ventral surface of the tongue in two patients. Two patients died from severe and uncontrolled bleeding complicated by renal failure and aspiration pneumonia from lacerations on the tongue and gingivae. Vigorous campaign should be carried out to encourage antenatal care attendance by pregnant mothers so that potential cases of eclampsia could be nipped in the bud before progressing to frank eclampsia. Furthermore, additional injuries usually inflicted on pregnant women by anxious relatives from forceful insertion of unpadded objects as mouth props should be discouraged through public health promotional campaigns. Obstetricians should be aware of the possibility of these injuries in an unconscious eclamptic patient and their life-threatening consequences if not promptly diagnosed and managed. The need to seek appropriate and early dental or maxillofacial consultation where such injuries are suspected and where services are available is imperative.