Surgical Glove Perforation and Percutaneous Injury during Intermaxillary Fixation with 0.5 Mm Stainless Steel Wire.

INTRODUCTION: The risk of exposure of either the patient or the surgeon to pathogens when the surgical glove is perforated is significant. This is particularly so in jaw fractures when intermaxillary fixation is done with the stainless-steel wire as many perforations also result in percutaneous injury. MATERIAL AND METHOD: This study was carried out in two tertiary Hospitals in Abuja, Nigeria. Adult patients for intermaxillary fixation as a result of jaw fractures were consecutively recruited into the study. Similarly, surgeons and their trainees (assistants) were also recruited. Factors investigated included the method of gloving used by surgeons and trainees (single versus double gloving), glove perforations and percutaneous injury rates, years of operator's experience, among others. During surgical operations, percutaneous injuries were recorded and obviously perforated or torn gloves were labelled and changed. At the end of every surgical procedure, gloves used were investigated for perforation. RESULTS: A total of 564 gloves were investigated (Surgeons-337; Trainees-227) after use for wire intermaxillary fixation procedures. The frequency of glove perforations for the surgeons was 72 (21.4%). Forefinger perforations were most frequent; 40 (55.6%) cases. Assistants, had 35 (15.4%) cases of glove perforations. Percutaneous injury occurred in 9.7% (7/72) and 5.7% (2/35 cases) of cases for surgeons and assistants, respectively. CONCLUSION: The study revealed high risk for wire-based IMF procedures. Single gloving was more frequently associated with percutaneous injuries although double gloving was more associated with perforations with higher surgeon infection risk. Double gloving reduces the risk of percutaneous injuries and, therefore, the likelihood of exposure to blood-borne pathogens.

INTRODUCTION: Le risque d'exposition du patient ou du chirurgien à des agents pathogènes lorsque le gant chirurgical est perforé est important. Cela est particulièrement le cas dans les fractures de la mâchoire lorsque la fixation intermaxillaire est effectuée avec le fil en acier inoxydable, car de nombreuses perforations entraînent également des lésions percutanées. MATÉRIEL ET MÉTHODE: Cette étude a été réalisée dans deux hôpitaux tertiaires à Abuja, au Nigeria. Des patients adultes pour une fixation intermaxillaire à la suite de fractures de la mâchoire ont été recrutés consécutivement dans l'étude. De même, des chirurgiens et leurs stagiaires (assistants) ont également été recrutés. Les facteurs étudiés comprenaient la méthode de gloving utilisée par les chirurgiens et les stagiaires (simple versus double gloving), les perforations de gants et les taux de blessures percutanées, les années d'expérience de l'opérateur, entre autres. Au cours des opérations chirurgicales, des blessures percutanées ont été enregistrées et des gants manifestement perforés ou déchirés ont été étiquetés et changés. À la fin de chaque intervention chirurgicale, les gants utilisés ont été étudiés pour la perforation. RÉSULTATS: Au total, 895 gants ont fait l'objet d'une enquête (Surgeons-337; Stagiaires-227) après utilisation pour les procédures de fixation intermaxillaire du fil. La fréquence des perforations de gants chez les chirurgiens était de 72 (21,4 %). Les perforations de l'index étaient les plus fréquentes, 40 (55,6 %) cas. Assistant, avait 35 (15,4%) cas de perforations de gants. Des lésions percutanées sont survenues dans 9,7 % (7/72) et 5,7 % (2/35 cas) des cas chez les chirurgiens et les assistants respectivement. CONCLUSION: L'étude a révélé un risque élevé pour les procédures filaires du FMI. Le gloving simple était plus fréquemment associé à des blessures percutanées, bien que le double gloving soit plus associé à des perforations avec un risque d'infection plus élevé chez le chirurgien. Le double gloving réduit le risque de blessures percutanées et, par conséquent, la probabilité d'exposition à des agents pathogènes transmissibles par le sang. MOTS CLÉS: Fixation intermaxillaire, gants, Chirurgien, Lésion percutanée.

Pre-Caesarean Section Vaginal Preparation with Chlorhexidine Solution in Preventing Puerperal Infectious Morbidities: A Randomized Controlled Trial.

BACKGROUND: Globally, peripartum or puerperal infections account for about one tenth of maternal mortality, most of which occur in low income countries. Therefore, vaginal preparation with an antiseptic prior to a caesarean delivery could be considered an additional measure to prevent subsequent infectious morbidities. OBJECTIVES: To evaluate vaginal preparation with 0.3% chlorhexidine solution in the prevention of endometritis, surgical site infection and post-operative fever following emergency caesarean section. METHODS: This prospective randomized controlled trial (RCT) was conducted among 240 participants planned for emergency caesarean sections (CS) at term in the University of Medical Sciences Teaching Hospital Complex, Ondo State, Nigeria. Participants were randomised into either group "A" (study) or "B" (control). The former had vaginal preparation with 0.3% chlorhexidine gluconate immediately after anaesthesia while the latter received normal saline. Participants were followed up post-operatively during which clinical features of puerperal infectious morbidities were observed for each during admission as well as 8th and 14th days after delivery. RESULTS: The rate and risk of endometritis were significantly lower in the study group compared to the control; 5.0% versus 13.3%, respectively (chi squared =5.004; p=0.042, RR = 0.38; 95% CI = 0.15-0.94; p = 0.042; RRR = 0.62). Post-operative fever and surgical site infection, were also lower in the study group compared to the controls, but the difference was not statistically significant. CONCLUSION: When compared to placebo, pre-caesarean section vaginal preparation with 0.3% chlorhexidine solution significantly reduced only the rate and risk of post-operative endometritis among infectious morbidities.

CONTEXTE: À l'échelle mondiale, infections péripartum ou puerpérales représentent environ un dixième de la mortalité maternelle, dont la plupart se produisent dans les pays à faible revenu. Par conséquent, la préparation vaginale avec un antiseptique avant un accouchement par césarienne pourrait être considéré comme un mesure supplémentaire pour prévenir les morbidités infectieuses subséquentes. OBJECTIFS: Évaluer la préparation vaginale avec 0.3%solution de chlorhexidine dans la prévention de l'endométrite, site chirurgical infection et fièvre postopératoire après une césarienne d'urgence section. MÉTHODES: Cet essai prospectif randomisé contrôlé (ECR)a été menée auprès de 240 participants prévus pour une urgence césariennes (CS) à terme à l'Université des sciences médicales Complexe hospitalier universitaire, État d'Ondo, Nigéria. Les participants étaient randomisé dans le groupe "A" (étude) ou "B" (témoin). Celui-là avait une préparation vaginale avec 0.3 % de gluconate de chlorhexidine immédiatement après l'anesthésie alors que ce dernier a reçu une solution saline normale. Les participants ont été suivis postopératoirement au cours desquels des caractéristiques de morbidité infectieuse puerpérale ont été observées pour chaquelors de l'admission ainsi que les 8ème et 14ème jours après la livraison. RÉSULTATS: Le taux et le risque d'endométrite étaient significativement plus faibles dans le groupe d'étude par rapport au groupe témoin; 5.0 % contre 13.3 %, respectivement (chi carré =5.004; p=0.042, RR = 0.38; 95% CI = 0.15­0.94; p = 0.042; RRR = 0.62). Fièvre postopératoire et infection du site chirurgical, étaient également plus faibles dans le groupe d'étude par rapport aux témoins, mais lela différence n'était pas statistiquement significative. CONCLUSION: Par rapport au placebo, pré-césarienne préparation vaginale avec une solution de chlorhexidine à 0.3% significativement réduit uniquement le taux et le risque d'endométrite postopératoire chez morbidités infectieuses. Mots-clés: Chlorhexidine, Préparation Vaginale, Infection Puerpéral emorbidité, Césarienne, Endométrite, Fièvre Postopératoire, Infection Du Site Chirurgical.

Congenital syngnathia: review of clinical profile and proposal of a new classification-based management protocol.

Syngnathia is a rare congenital anomaly that presents as fusion of the jaws. The aims of this study were to review the clinical profile of reported cases of syngnathia available in the literature with a view to suggesting a classification that may simplify the understanding of syngnathia and to propose an appropriate management protocol. A PubMed database search of articles published in English was conducted. Selected articles were analyzed according to year of publication, type of article, number of cases per article, patient biodata, description of syngnathia, and associated anomalies. Data were analyzed using IBM SPSS version 19; the level of statistical significance was set at P≤ 0.05. Cases were categorized according to a proposed classification, and a review of the management of congenital syngnathia from 153 previously reported cases (in 110 articles) was done to propose a treatment protocol based on the proposed classification model. The findings are presented under three headings: pre-surgical considerations, surgical (intraoperative) considerations, and post-surgical considerations. The proposed classification categorizes syngnathia into soft tissue union (type 1) and hard tissue union (type 2). These two types were found to have similar frequencies in the literature, while their management differed in terms of mode of anaesthesia and surgical approach.

Emergency Peripartum Hysterectomy: A Multicenter Study of Incidence, Indications and Outcomes in Southwestern Nigeria.

Objective To determine the incidence, indications and outcomes of emergency peripartum hysterectomy (EPH) in three tertiary institutions in south-west Nigeria between January, 2010 and December , 2013. Methods A retrospective review of all cases of EPH over a 4 year period was done. EPH was defined as hysterectomy performed at the time of delivery or within 24 h of delivery for uncontrollable postpartum bleeding not responsive to conservative measures. Relevant information was extracted from the hospital records and operation notes. Statistical analysis was done using SPSS software version 17.0. Statistical significance was set at p < 0.05. Results There were 102 EPHs performed among 39,738 deliveries within the study period, giving a rate of 2.6 per thousand deliveries. Indications were uterine rupture (44.1 %), uterine atony (37.3 %), morbidly adherent placenta (17.6 %) and extension of caesarean section incision involving the uterine arteries (1 %). Subtotal hysterectomy was performed in most cases (67.6 %).Maternal case fatality rate was 11.8 % and perinatal mortality rate was 55.9 %. Blood transfusion, severe postoperative anaemia, wound sepsis, febrile morbidity and acute kidney injury were common morbidities associated with the procedure. Following multivariate logistic regression, the unbooked status [odds-ratio 95 % CI = 12.80 (1.22-133.97) p = 0.03] was the only variable that significantly predicted maternal death. Conclusion The incidence of EPH from our study is high. Much more needs to be done in maternal health services, particularly provision of quality obstetric care to reduce the rates of EPH and the associated high maternal and perinatal morbidity and mortality.

Evaluation of the scope and practice of oral and maxillofacial surgery in Nigeria.

BACKGROUND: Oral and maxillofacial surgery is still evolving, with the scope of practice in Nigeria inadequately determined. AIMS AND OBJECTIVES: This study aims to ascertain the level of practice in various parts of the country vis-a-vis the global trend and factors influencing the scope in Nigeria. DESIGN OF THE STUDY: Cross-sectional. SETTING: The study was carried out at the University of Ibadan. Participants included all the maxillofacial surgeons on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons and Practicing in Nigeria as at December, 2012. MATERIALS AND METHODS: Structured questionnaires were delivered to all on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons. Respondents were asked to provide information about their demographics, years of practice, areas of practice and factors influencing the choice of practice among others. Nonresponders were reminded a month after initial contact. Data were entered into a personal computer and variables analyzed using descriptive statistical analysis. RESULTS: Thirty-two (56%) of the 57 questionnaires were returned. Most respondents were aged 41-45 years ( n = 11, 34.4%). Twenty-six (81.3%) were males, whereas 6 (18.8%) were females. Twenty respondents (62.5%) practiced in the teaching hospitals. Eighteen respondents (56.3%) practiced in the south-west geopolitical region. Twelve respondents (37.5%) were the only maxillofacial surgeons in their centers. 81.3% routinely practiced traumatology against 15.6% for implantology. Seventy-eight percent ( n = 25) had satisfactory facilities for traumatology, dentoalveolar surgery, and cleft repair surgery, while facilities were least satisfactory in implantology and orthognathic surgery (15.6% and 12.5%, respectively). The highest single factor influencing choice/area of practice was financial reward (100% of respondents). Fifty percent ( n = 16) claimed not to have had adequate training in their area of interest. Most respondents (93.8%) believe the greatest challenge facing oncological maxillofacial surgery in Nigeria was late presentation of patients. CONCLUSION: The scope of practice of oral and maxillofacial surgery is largely limited in the country relative to what obtains globally.

Evaluation of the scope and practice of oral and maxillofacial surgery in Nigeria

Background: Oral and maxillofacial surgery is still evolving; with the scope of practice in Nigeria inadequately determined. Aims and Objectives: This study aims to ascertain the level of practice in various parts of the country vis-a-vis the global trend and factors influencing the scope in Nigeria. Design of the Study: Cross-sectional. Setting: The study was carried out at the University of Ibadan. Participants included all the maxillofacial surgeons on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons and Practicing in Nigeria as at December; 2012. Materials and Methods: Structured questionnaires were delivered to all on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons. Respondents were asked to provide information about their demographics; years of practice; areas of practice and factors influencing the choice of practice among others. Nonresponders were reminded a month after initial contact. Data were entered into a personal computer and variables analyzed using descriptive statistical analysis. Results: Thirty-two (56) of the 57 questionnaires were returned. Most respondents were aged 41-45 years ( n = 11; 34.4). Twenty-six (81.3) were males; whereas 6 (18.8) were females. Twenty respondents (62.5) practiced in the teaching hospitals. Eighteen respondents (56.3) practiced in the south-west geopolitical region. Twelve respondents (37.5) were the only maxillofacial surgeons in their centers. 81.3 routinely practiced traumatology against 15.6 for implantology. Seventy-eight percent ( n = 25) had satisfactory facilities for traumatology; dentoalveolar surgery; and cleft repair surgery; while facilities were least satisfactory in implantology and orthognathic surgery (15.6 and 12.5; respectively). The highest single factor influencing choice/area of practice was financial reward (100 of respondents). Fifty percent ( n = 16) claimed not to have had adequate training in their area of interest. Most respondents (93.8) believe the greatest challenge facing oncological maxillofacial surgery in Nigeria was late presentation of patients. Conclusion: The scope of practice of oral and maxillofacial surgery is largely limited in the country relative to what obtains globally

Evaluation of pedestrian road traffic maxillofacial injuries in a Nigerian tertiary hospital.

UNLABELLED: Background: Walking is the most basic form of mobility and forms an important part of daily activities; however, walking could often be associated with risks. This is more so when pedestrians share a common space with motorized vehicles especially in developing countries. Despite the frequency of road traffic crashes (RTC) related pedestrian injuries in many developing countries, there is a dearth of documentation of maxillofacial injuries in victims of pedestrian road traffic crashes. The aim of this study was to determine the causes, frequency, pattern, severity, concomitant injuries and outcome of pedestrian maxillofacial injuries observed at a tertiary trauma centre in Nigeria. METHOD: Pedestrian victims of RTC were prospectively recruited from among all maxillofacial trauma patients seen at the Accident and Emergency department and the Department of Oral and Maxillofacial Surgery of the University College Hospital, Ibadan between April 2011 and November 2011. Ethical approval was obtained from the UI/UCH Joint Ethics Review Board before the commencement of the study and informed consent was obtained from participants. Patients' demography, the crash events, types of maxillofacial injuries, and concomitant injuries were recorded. Severity of maxillofacial injury was estimated based on the Maxillofacial Injury Severity Scale (MFISS). RESULTS: Forty-six participants (22.9% of all victims of road traffic crashes seen within the study period) were victims of pedestrian RTC. Pedestrian RTC occurred in all age groups with almost 40% of the victims in their 1st and 2nd decades of life. The most severe MFISS was observed in the 21 - 30 year age group while the least severe injury observed was in the 71 - 80 years age group. Thirty participants (65.2%) were hit by a car or minibus while fourteen (30.4%) were knocked down by a motorcycle. Two (4.4%) were hit by a truck. Soft tissue injury was the most common maxillofacial injury and head injury was the commonest concomitant injury observed. The median MFISS score of victims of motorcycle was 4.0 while the median scores for victims of car/minibus pedestrian RTC was 9.0. The most severe maxillofacial injury was seen in victim of car/minibus pedestrian crashes. Seventeen percent (8) of the victims had a fatal outcome. Conclusion: Pedestrian RTC resulting in maxillofacial injuries are common in the studied environment. It is particularly common among the 11 -20 year age group and victims are usually hit by cars/minibuses. These injuries are often severe and fatal outcome is not infrequent. Therefore, definitive preventive measures are imperative.

Acceptance and perception of Nigerian patients to medical photography.

The aim of the study was to determine the acceptance and perception of Nigerian patients to medical photography. A self-administered questionnaire was distributed among Nigerian patients attending oral and maxillofacial surgery and plastic surgery clinics of 3 tertiary health institutions. Information requested included patients' opinion about consent process, capturing equipment, distribution and accessibility of medical photographs. The use of non-identifiable medical photographs was more acceptable than identifiable to respondents for all purposes (P = 0.003). Most respondents were favourably disposed to photographs being taken for inclusion in the case note, but opposed to identifiable photographs being used for other purposes most especially in medical websites and medical journals. Female respondents preferred non-identifiable medical photographs to identifiable ones (P = 0.001). Most respondents (78%) indicated that their consent be sought for each of the outline needs for medical photography. Half of the respondents indicated that identifiable photographs may have a negative effect on their persons; and the most commonly mentioned effects were social stigmatization, bad publicity and emotional/psychological effects. Most of the respondents preferred the use of hospital-owned camera to personal camera/personal camera-phone for their medical photographs. Most respondents (67.8%) indicated that they would like to be informed about the use of their photographs on every occasion, and 74% indicated that they would like to be informed of the specific journal in which their medical photographs are to be published. In conclusion, non-identifiable rather than identifiable medical photography is acceptable to most patients in the studied Nigerian environment. The use of personal camera/personal camera-phone should be discouraged as its acceptance by respondents is very low. Judicious use of medical photography is therefore advocated to avoid breach of principle of privacy and confidentiality in medical practice.

Maxillo-mandibular fixation: utility and current techniques in modern practice.

BACKGROUND: There appears to be a gradual relegation of maxillo-mandibular fixation (MMF) from the frontline of oral and maxillofacial surgical techniques because of the evolution and increasing sophistication of rigid internal fixation techniques, efficiency. AIM: To highlight the residual relevance, utility, and current techniques of achieving MMF in modern practice. METHODS: A rigorous search of the maxillofacial literature was undertaken to identify recent articles that discuss the techniques, usefulness, limitations, merits, demerits and cost effectiveness of MMF. A narrative review of the selected literature was done to provide concise and current evidence on MMF in modern maxillofacial surgery. The cost effectiveness of MMF as a modality in the treatment of maxillofacial fractures is also compared with that of open reduction and internal fixation (ORIF). RESULTS: MMF is employed as temporary intraoperative adjunct to rigid fixation techniques or as a supplement for postoperative stabilization after semi-rigid fixation. It is a adequate and more cost effective method in some types of mandibular fractures. Other indications are patients' refusal of open surgery, refusal of hardware insertion and lack of medical fitness for extensive surgical operation. Many innovative techniques of achieving MMF are now available and are in this article, categorized into MMF with direct wiring techniques, MMF with inter-arch straight tie wires or elastics, and MMF with Special devices. CONCLUSION: In spite of the growing enthusiasm for ORIF, MMF remains a relevant technique in maxillofacial surgery and in some cases are more cost effective than rigid internal fixation.

Naso-orbito-ethmoid fractures: perspective and practices of nigerian surgeons.

OBJECTIVE: The study was to appraise the level of expertise in the management of Naso-Orbito-Ethmoid (NOE) fractures and to provide recommendation for necessary improvement in an African population. MATERIALS AND METHODS: A questionnaire was designed and electronically mailed to Nigerian Oral & Maxillofacial surgeons, Plastic and Reconstructive surgeons, and Ear, Nose and Throat surgeons to assess their perspectives and practices in the diagnosis and management of NOE fractures. Further administration of questionnaire was done at the AO (Association of Osteosynthesis) principle course in Lagos, January, 2010. Information generated were coded and processed with statistical package for Social Sciences version 15.0, Chicago Illinois, USA. RESULTS: The questionnaire was delivered to 214 surgeons, there were 112 respondents out of which 78 expressed no interest in the management of NOE fractures and 34 had interest and so completed the questionnaire. Diagnosis is largely based on plain radiographs; only 22 surgeons perform NOE trauma surgery, majority (63.9%) use existing laceration or more conservative approaches like Lynch or open sky incisions. Mini and micro-plates are employed by only 31.8% of the surgeons. Bone grafting is rarely performed but when required, the iliac crest is preferred. Repair of the nasolacrimal duct system is rarely done. CONCLUSION: The management of NOE fractures in Nigeria, falls short of the current best evidence in the world literature. International collaboration for improvement is recommended.

Patients' attitude towards anterior teeth extraction an prosthetic replacement at the UPTH Dental Center, Port Harcourt.

AIM: The purpose of this study was to assess the attitude of patients towards anterior teeth extraction and prosthetic replacement of same at the Dental center of the University of Port Harcourt Teaching Hospital (UPTH). METHODS: A retrospective review of the data of patients who presented for anterior teeth extraction and prosthetic replacement or anterior teeth extraction only over a two-year period was done using the records of the oral surgery and prosthetic clinics of UPTH Dental centre. Demographic and clinical information were retrieved and analyzed using the SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). RESULTS: Ninety-two patients comprising 58 males(63%) and 34 females (37%), giving a male to female ratio of 1.7:1, were involved. The age range was 6 to 86 years with a median age of 34.5 years. Forty- three patients (46.7%) had both extraction and replacement within the study period while 49 patients (53.3%) had extraction without replacement. Trauma was the major cause of anterior tooth loss, especially among males and young individuals. Plastic removable partial denture was the main type of replacement offered. Fifty percent of the females (17/34) had replacement compared to 44.8% of the males (26/58). Among those who had both extraction and replacement, majority (74.4%, 32/43) requested for replacement within a month post extraction. Also, 86.2%t of the patients below 40 years either had immediate dentures or replacement within a month compared to 50% of those above 40 years. CONCLUSION: Most of the patients, surprisingly, tolerated anterior edentulousness. However, it appears that anterior edentulousness was more abhorent to female patients and younger individuals.

A systematic review of the diagnostic role of ultrasonography in maxillofacial fractures.

This systematic review assessed the diagnostic value of ultrasonography in maxillofacial fractures. A computerized literature search of MEDLINE, PubMed and GoogleMed databases was conducted for publications on diagnostic ultrasound and maxillofacial fractures in English. Search phrases were 'maxillofacial fractures' or 'midfacial fractures' or 'zygomatic complex fractures' or 'nasal bone fractures' or 'orbital fractures' or 'mandibular fractures' combined with 'ultrasound' or 'ultrasonography'. The Boolean operator 'AND' was used to narrow the searches. 17 articles published between 1992 and 2009 were reviewed: two on midfacial fractures, nine on orbital fractures, three on nasal fractures, and two on mandibular fractures. One article described case series of ultrasonographic diagnosis of mandibular and midfacial fractures. The sensitivity and specificity of ultrasound in detecting orbital fractures were 56-100% and 85-100%, respectively, whilst that of nasal fractures were 90-100% and 98-100%, respectively. Sensitivity and specificity of ultrasonography in detecting zygomatic fractures were >90%. For mandibular fractures, the sensitivity and specificity was 66-100% and 52-100%, respectively. Much evidence justifies the use of diagnostic ultrasonography in maxillofacial fractures, especially fractures involving the nasal bone, orbital walls, anterior maxillary wall and zygomatic complex. The sensitivity and specificity of ultrasonography is generally comparable with CT.

Polymorphous low grade adenocarcinoma: literature review and report of lower lip lesion with suspected lung metastasis.

Polymorphous low grade adenocarcinoma (PLGA) is an uncommon tumour that affects minor salivary glands mainly. It was known to be clinically benign and histologically polymorphic; sometimes misdiagnosed as pleomorphic adenomas, monomorphic adenomas, malignant pleomorphic adenomas, adenoid cystic carcinomas and adenocarcinoma not otherwise specified. More information about PLGA is cumulating in the current literature with new evidences suggesting that the tumour may not be as indolent as it was previously thought. A thorough understanding of the clinical and histological behaviour of the lesion has serious implications in management. Here, a case of lower lip lesion with suspected lung metastasis is reported to exemplify how the clinical behaviour of the lesion may affect management.

Evaluation of Pederson index as an instrument for predicting difficulty of third molar surgical extraction.

AIM: This study was intended to assess the clinical reliability of the Pederson index as an instrument for preoperative determination of surgical difficulty in third molar surgery. METHODS: Pederson index was used to predict the difficulty of 79 cases of impacted mandibular third molar extractions. The predictions were compared with actual surgical difficulty determined by operation time. The reproducibility as well as the reliability of the index was determined. RESULTS: The index was found to be highly reproducible (P=0.00). The sensitivity and specificity were 94.9% and 45% respectively. The Positive predictive value (PPV) was 67.2% and the negative predictive value was 90% while the accuracy was 69.6%. CONCLUSION: The Pederson index though reproducible is not a reliable instrument for predicting surgical difficulty of third molar surgery when compared with actual surgical difficulty as determined by the operation time. There is a definite need to derive an index that could be used for preoperative prediction of difficulty; however it is much more important that any index so employed should provide accurate information as the consequence of wrong judgments could be quite deleterious to the patients and embarrassing to the surgeon. While it is not completely unimportant, the Pederson index should not be employed as a sole instrument for preoperative assessment of difficulty in third molar surgery.

Actions and comparative efficacy of phosphatidylcholine formulation and isolated sodium deoxycholate for different cell types.

BACKGROUND: Phosphatidylcholine formulation has been used to dissolve local fat deposits. This study aimed to evaluate and compare the effects of phosphatidylcholine formulation and its vehicle sodium deoxycholate alone on different cell lines to understand better its mechanism of action. METHODS: Cells and media including 3T3-L1 preadipocytes, normal foreskin fibroblasts, neonatal human dermal microvascular endothelial cells (CADMEC), and fetal human skeletal muscle cells (HSkMC) were used. After 24 h, cells were exposed in 3-4, 5-dimethylthiazol-2-yl-2, 3-diphenyl tetrazolium bromide reagent (MTT assays) to increasing dosages of phosphatidylcholine formulation (0.0156-0.5 mg/ml) or an equivalent vehicle, sodium deoxycholate solution, pH 9.0 (0.0066-0.210 mg/ml). Viability was assessed after 1, 2, and 3 days of treatment. Fat tissue (4 x 4 cm) obtained ex vivo from the dorsal fat pads of five rabbits was injected with 2 ml of phosphatidylcholine formulation (50 mg/ml), sodium deoxycholate (21 mg/ml), or normal saline and incubated for 24 h. These were examined histologically to identify cell lysis and morphologic changes. RESULTS: At 0.125- and 0.25-mg/ml doses of phosphatidylcholine solution, CADMEC and HSkMC were more sensitive (P < 0.001, one-way ANOVA) than adipocytes at all time points examined. Phosphatidylcholine formulation at a dose of 0.5 mg/ml and the equivalent vehicle, sodium deoxycholate, at a dose of 0.21-mg/ml both induced nearly 100% fat cell lysis after 24 h, and evidence of cell lysis as early as 6 h after exposure. After incubation of fat tissue for 24 h with phosphatidylcholine formulation, loss of intracellular lipid staining with an increase in extracellular lipids was seen. CONCLUSIONS: Isolated sodium deoxycholate was almost as effective as the phosphatidylcholine formulation, at clinical concentrations, in reducing the viability of mature adipocytes over time. Similar cytotoxic effects of phosphatidylcholine formulation on normal foreskin fibroblasts, endothelial cells, and human skeletal muscle cells also were observed. The data prove that the formulation acts in a nonspecific manner and that its unintentional administration to other tissues causes cell death.

Incidence and risk factors for nerve injuries in mandibular third molar surgery.

BACKGROUND: The inferioralveolar (IAN), lingual (LN) and long buccal nerves (LBN)are the three terminal branches of the trigeminal nerve which are susceptible to injury during surgical extraction of impacted mandibular third molars. While it is not always possible to accurately predict the patients that will be affected with these complications, understanding and identifying the risk factors may allow the adoption of appropriate technique and expertise for specific cases. We embarked on this study to document the incidence and duration of injury to the inferior alveolar nerve (IAN), lingual nerve (LN) and long buccal nerve (LBN) following the operative removal of impacted mandibular third molars and to identify the associated radiographic and operative risk factors. METHOD: Pre- and postoperative neurosensory tests were performed for seventy nine patients who had surgical extraction of unilateral impacted mandibular third molars to determine the incidence and duration of complicating nerve injuries. The risk factors for nerve injury were determined among the radiographic variables and documented operative events. RESULTS: The incidence reported were 6.6% for IAN, 2.6% for LN and 4.0% for LBN; all but one of the nerve injuries resolved within 2 weeks. Depth of impaction (Pell & Gregory Level C) and linguo-version were the significant risk factors for IAN and LN injuries respectively while no risk factors was detected for LBN injury. Some significant operative events were associated with nerve injuries. CONCLUSION: Nerve injury in third molar surgery can be predicted based on some radiographic risk factors and some unforeseen intraoperative events. Most of the injuries are transitory in nature.

Predictive variables for difficult intubations in oral and maxillofacial surgery.

SUMMARY: Many factors affect the difficulty of endotracheal intubation some of which are related to the condition of the patients. A few assessment tools have been developed to predict intubation difficulty but none is all inclusive thereby being inadequate for comprehensive and accurate evaluation. We assessed the usefulness of four categories of predictive variables namely; the LEMON score, Demographic indices, Tumour site and Intraoral Position of tumour (IOP), in predicting intubation difficulty among a group of patients with orofacial tumours. By statistical analysis, a significant correlation between predictions by LEMON score and actual intubation difficulty was observed while neck mobility (P=0.28) and Mallampati scores (P=0.49) were the most important criteria in the scoring system. Significant association was also observed with demographic indices and difficulty whereby the Optimal Interincisal Distance (OID) had the greatest impact (P=0.048). There was no difference in the difficulty posed by the different sites and intraoral positions of tumours in this study. We therefore suggest the adoption of the LEMON score and consideration of the demographic indices when assessing patients with orofacial tumours for intubation difficulty. Three important variables should be given greater value, these are, neck mobility, Mallampatti score and optimal interincisal distance.

Incidence and risk factors for nerve injuries in mandibular third molar surgery

Background: The inferior alveolar (IAN); lingual (LN) and long buccal nerves (LBN) are the three terminal branches of the trigeminal nerve which are susceptible to injury during surgical extraction of impacted mandibular third molars. While it is not always possible to accurately predict the patients that will be affected with these complications; understanding and identifying the risk factors may allow the adoption of appropriate technique and expertise for specific cases. We embarked on this study to document the incidence and duration of injury to the inferior alveolar nerve (IAN); lingual nerve (LN) and long buccal nerve (LBN) following the operative removal of impacted mandibular third molars and to identify the associated radiographic and operative risk factors. Method: Pre- and postoperative neurosensory tests were performed for seventy nine patients who had surgical extraction of unilateral impacted mandibular third molars to determine the incidence and duration of complicating nerve injuries. The risk factors for nerve injury were determined among the radiographic variables and documented operative events. Results: The incidence reported were 6.6for IAN; 2.6for LN and 4.0for LBN; all but one of the nerve injuries resolved within 2 weeks. Depth of impaction (Pellet Gregory Level C) and linguo-version were the significant risk factors for IAN and LN injuries respectively while no risk factors was detected for LBN injury. Some significant operative events were associated with nerve injuries Conclusion: Nerve injury in third molar surgery can be predicted based on some radiographic risk factors and some unforeseen intraoperative events. Most of the injuries are transitory in nature

Accidental displacement of mandibular third molar into soft tissue: a case report.

A case of accidental displacement of a mandibular molar tooth into adjacent submandibular space during routine extraction by a general practitioner is reported. The localization and surgical retrieval of the displaced tooth is described, post-operative period was uneventful and salient lessons for the practitioners highlighted.

An unusual case of total maxillary sequestration in a diabetic patient.

Osteomyelitis of the jaw is of relatively low incidence. Maxillary Osteomyelitis is however rare compared with mandibular osteomyelitis. The extensive blood supply and the strut-like bones of the maxilla make it less prone to chronic infections. Systemic conditions that alter the host's resistance such as diabetes mellitus, autoimmune disorders, agranulocytosis, anaemia, especially sickle cell anaemia are predisposing factors for the development of this condition. An unusual case of chronic maxillary osteomyelitis induced by trauma in a diabetic, with subsequent atypical necrotising ulceration of palatal mucosa resulting in total maxillary sequestration is presented.