Modified micromarsupialization technique as an alternative primary treatment for ranulas: A case series in a resource-challenged economy.

OBJECTIVES: Ranula is one of the commonest salivary gland cysts that mostly occur due to mucus extravasation from the sublingual salivary gland. Treatment of this lesion is still somewhat shrouded in controversy and varies from conservative treatment to surgical excision of the causative gland. MATERIALS AND METHODS: This was a case series in quasi-experimental design that evaluated the outcome and complications of the modified micromarsupialization technique as a newly introduced treatment at our center for simple sublingual ranula over a 2-year period. RESULTS: Twenty patients were treated by the modified micromarsupialization technique and followed up for 1 year. There was complete resolution following this technique in 17 patients (85%) with no evidence of recurrence or complications, whereas 2 patients (10%) showed partial resolution and the remaining 1 patient (5%) showed a failure and recurrence. The age of the patient, the size of the ranula, and the retention of sutures throughout the study period did not significantly affect the treatment outcome. CONCLUSIONS: The modified micromarsupialization technique was a simple and effective treatment that should be used as a primary treatment option for simple ranulas and we recommend it to be the first-choice treatment before surgical excision of the sublingual gland, especially in a resource-challenged economy like ours.

Evaluation of urinary hydroxyproline and creatinine level in patients with benign mandibular odontogenic tumor.

BACKGROUND: Odontogenic tumors are relatively common oro-facial tumors seen in our environment with challenges encountered with management in terms of inadequate infrastructure and high cost of treatment. They are often associated with bone resorption with concomitant collagen degradation and excretion of their by-products in serum or urine. The aim of this present study was to evaluate urinary hydroxyproline level in patients with benign mandibular odontogenic tumors. MATERIALS AND METHODS: Twenty-two consecutive patients with histologically diagnosed mandibular odontogenic tumors were recruited. Twenty-two controls who matched the study group for sex and age were also recruited. The study group had CT-Scan of their lesions done. All participants were required to fast 12 hours overnight and their early morning second void urine collected between 7 a.m and 8 a.m. The collected urine samples were stored frozen at -20°C until analysis. Colorimetric method of analysis of urinary hydroxyproline and creatinine were done using Biovision hydroxyproline kit and Randox creatinine kit, respectively. The results were recorded as urinary hydroxyproline alone (µg/µl) and as urinary hydroxyproline/creatinine ratio. RESULTS: The mean age of the participants was 28.45 ± 6.8 years. The mean duration of the tumors in the study group was 5.9 ± 4.4 years. A mean urinary hydroxyproline/ creatinine ratio of 0.081 ± 0.129 was noted in the study group as compared to 0.016 ± 0.006 that was noted among healthy Nigerian who served as controls in the study. CONCLUSION: There was a significant increase in urinary hydroxyproline level in patients with odontogenic tumors when compared with healthy Nigerians.

A synchronous presentation of malignant melanoma and dermatofibrosarcoma protuberans in a Nigerian female: A case report.

INTRODUCTION: The simultaneous occurrence of multiple primary malignancies in a patient has been widely reported. Oral mucosal malignant melanoma is a rare lesion of the oral cavity. The occurrence of this lesion with a very rare skin sarcoma at the same time has never to the best of our knowledge been reported previously. PRESENTATION OF CASE: A 64 year-old Nigerian woman with a 27-year history of a dark lesion in the right maxillary buccal and palatal mucosa with an anterior abdominal swelling of 24 years which was discovered on systemic examination. Both lesions were later discovered to be malignant melanoma and dermatofibrosarcoma protuberans respectively. She had a right hemimaxillectomy for the maxillary lesion and wide excision of the abdominal wall lesion, followed by six courses of chemotherapy. She has been undergoing regular reviews for the past 5 years and remains free of all malignancy; however, she died shortly after noticing the reappearance of both lesions. DISCUSSION: While evaluating patients with a tumor, it will be rewarding to rule out other similar swellings in the body. This is important to avoid metastasis or multiple primary malignancies, which can help prolong patient life. CONCLUSION: The synchronous occurrence of two different neoplastic lesions is rare. Our literature search revealed no previous report of such occurrence of oral malignant melanoma and DFSP at the same time in one patient. The importance of thorough examination of patients cannot be overemphasized as concurrent lesions may be missed.

Serum levels of 25-hydroxy-vitamin D in patients with oral squamous cell carcinoma: Making a case for chemoprevention.

OBJECTIVES: Serum level of vitamin D has been used as a predictor for cancer development. We intend to measure the baseline vitamin D level in patients with oral squamous cell carcinoma (OSCC) and to compare same with non-cancer controls to determine any association. MATERIALS AND METHODS: Patients with OSCC presenting to our clinics were included in this study. Their baseline serum vitamin D levels were measured prior to cancer treatment after obtaining their consents. These patients were then matched with at least 2 cancer-free subjects to serve as controls and whose serum vitamin D levels were also measured. The serum vitamin D levels obtained for the two groups were then categorized into normal (>35 ng/ml), mild deficiency (25-35 ng/ml), moderate deficiency (12.5-25 ng/ml), and severe deficiency (<12.5 ng/ml). The data were analyzed statistically and the two groups compared. RESULTS: A total of 51 patients with OSCC (Male 22 [43%] and female 29 [57%]) and 113 cancer-free controls (Male 36 [31.86%] and female 77 [68.14%]) were included in the study. The commonest site for OSCC was the tongue, accounting for 45% of the cancer cases. Mean age for cancer patients was 59.33 years ±12.54 and 49.24 years ±15.79 for the control. Among the OSCC patients, 74.51% had moderate to severe vitamin D deficiencies, whereas only 20.35% had a moderate deficiency in the control group with no severe deficiency. CONCLUSION: Logistic regression analysis shows a positive association between vitamin D deficiency and OSCC risk especially in levels below 25 ng/ml. This further corroborates the assertion that vitamin D deficiency may be a useful indicator of OSCC. It may, therefore, be necessary to routinely prescribe vitamin D supplements to subjects with moderate to severe deficiencies in order to decrease the chances of OSCC development.