Effect of manuka honey socket dressing on postoperative sequelae and complications following third molar extraction: A randomized controlled study.

To evaluate the effect of manuka honey on the healing of mandibular third molar extraction sockets. This was a prospective randomized study at a tertiary health institution in Lagos, Nigeria. All extractions were transalveolar, using the distobuccal bone guttering technique. Participants were randomized into two study groups. Group A underwent intrasocket application of manuka honey, after which sockets were completely closed using the mucosal flap, while participants in group B underwent mucosal flap closure of the socket without application of manuka honey. The primary outcome was healing of the extraction socket at 7 days postoperatively. The secondary outcomes measured were postoperative sequelae, namely pain, swelling, and trismus on postoperative days 1, 3, and 7, and socket healing complications - specifically inflamed socket, infected socket, and alveolar osteitis. In total, 112 participants completed the study, with 56 participants per group. There were no significant differences in demographic variables between both groups. On the 7th day postoperatively, 26.8% of participants in group B had an unhealed extraction site, compared with 10.3% of participants in group A (p = 0.029). A significant difference was observed between pre- and postoperative pain scores in both study groups (p = 0.001). A comparison of postoperative mean facial swelling between the two groups showed no statistically significant differences on all the review days (p = 0.66). The difference in postoperative socket healing complication rate between both groups was statistically significant (χ2 = 4.747, p = 0.029). Within the limitations of the study it seems that the application of manuka honey appears to aid earlier healing of the third molar extraction socket, with a significantly lower frequency of complications. Therefore, the application of manuka honey is recommended whenever appropriate.

Alkaline Phosphatase Profile of Patients with Fibro-Osseous Lesions.

Introduction: Although some studies on craniofacial fibro-osseous lesions have assayed serum alkaline phosphatase levels of affected patients, the findings of these reports are often inconclusive. The aim of this study was to determine the association between the serum ALP levels of individuals with craniofacial fibro-osseous lesions (CFOLs) and treatment outcome. Materials and Methods: Consecutive patients who presented at the Ahmadu Bello University Teaching Hospital, Zaria from May, 2016 to December, 2017 with lesions histologically diagnosed as CFOLs. The Speight and Carlos' (2006) classification of CFOLs was adopted, and the serum ALP level of patients and their age- and- gender matched apparently healthy controls were measured at presentation, and repeated at the 3rd and 6th post-operative months for subjects only. Treatment outcomes were assessed 6 months post treatment. Results: Fifty cases of CFOLs were recorded with a male preponderance, while fibrous dysplasia was the most prevalent lesion, and the maxilla was the most affected jaw (62%). Only 11 subjects had elevated serum ALP levels at presentation, and the mean serum ALP level of subjects with CFOLs was higher (341.2 ± 198.1 IU/L) than that of their age-and gender-matched controls (190.7 ± 110.2 IU/L). With the exception of subjects whose lesions recurred, there was a decrease in the mean serum ALP levels of subjects by the 3rd (245 ± 170.2 IU/L) and 6th (240.5 ± 172.7 IU/L) months post-treatment. Thirty three subjects had elimination of lesions, while three cases each recurred or developed morbidity. Conclusion: The treatment outcomes of patients with fibrous dysplasia appear to be associated with their serum ALP level. Therefore, serial serum ALP level monitoring suggested in the management of patients with fibrous dysplasia of the craniofacial region.

Efficacy of Computed Tomography and Ultrasonography in Diagnosis of Metastatic Cervical Lymph Nodes in Orofacial Cancer.

INTRODUCTION: There is no consensus on which imaging modality is better for the detection of metastatic cervical lymph nodes in orofacial malignancies. This study evaluates the efficacy of computed tomography (CT) and ultrasonography (US) in diagnosis of metastatic cervical lymph nodes in orofacial cancer. MATERIALS AND METHODS: Sixty patients with various histologically diagnosed orofacial malignant lesions and clinical evidence of cervical lymph node metastasis were examined using US and CT. Further, the affected lymph nodes were biopsied and examined histologically. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the techniques were calculated. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 19 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2010 (Microsoft, Redmond, WA, USA). Test of statistical significance was set at 0.05. RESULTS: US recorded a sensitivity, specificity, PPV, NPV, and accuracy of 80.0%, 57.1%, 77.5%, 60.0%, and 71.7%, respectively (P = 0.004), while CT recorded a sensitivity, specificity, PPV, NPV, and accuracy of 87.1%, 71.4%, 85.0%, 75.0%, and 81.7%, respectively (P< 0.0001). Lymph node size was the commonest criterion in the diagnoses of metastases in cases with cervical lymph nodes. CONCLUSION: Although we obtained great results using US, our results indicated CT to be a better imaging modality for detecting metastatic cervical lymph nodes in orofacial malignancies.

Multifocal Epithelial Hyperplasia: a case report and review of literature

Objective: Multifocal epithelial hyperplasia (MEH) or Heck's disease is a rare benign disorder caused by Human Papilloma Virus (HPV). It is characterized by multiple soft well demarcated nodules of the oral mucosa. They are commonly seen in buccal, labial and lingual mucosa. However, tonsilar and gingival lesions have also been reported. A detailed clinical history, examination and histopahological review is needed to arrive at a diagnosis. The aim of this report is to show the successful treatment of MEH using Salicylic acid and Zinc supplement. Case Report. Two cases of a 5year old Hausa girl and 7-year-old Hausa boy with a widespread oral lesion of 8 months and 1-year duration respectively. The diagnosis of the case reported were based on clinical evaluation and histopathological investigation. The presence of multiple painless pink nodules and papules on the lips, buccal mucosa and the gingiva as well as histological presence of koliocytes and mitosoid seen on hematoxylin and eosin slide led to the diagnosis of MultifocalEpithelial Hyperplasia. Conclusion: We reported 2 cases of MEH, a rare benign oral mucosa lesion in a 5-year-old Hausa female and a 7year old Hausa male in North-West Nigeria who presented with 8 months and 1-year history of widespread oral mucosa lesion respectively and was treated successfully using salicylic acid and zinc supplement

Anaesthesia for cleft lip surgeries in a resource poor setting: techniques, outcome and safety.

INTRODUCTION: Cleft lip and palate is one of the more common congenital malformation and the most common craniofacial anomalies in children. The treatment is expensive and requires specialised care. Access to this care in middle and low income countries is compounded by socioeconomic status of patients and their relation and also the inadequacy of expertise in medical personnel and infrastructure. Objective: the study aimed to review the techniques of anaesthesia used in a low resource setting in terms of the techniques, outcome, and safety. METHODS: This is a retrospective review of 79 cases done in a resource poor setting. Information regarding the patients, surgeries and modes of anaesthesia were retrieved from the case notes. RESULTS: A total of 62 patients were operated with incomplete cleft accounting for 37 (59.7%), complete 23(37.1%), and 2 (3.2%) as bilateral. Forty-six (74.2%) of patients had their surgery done with ketamine anaesthesia without endotracheal intubation, 14 (22.6%) had regional anaesthesia and 2 patients (3.2%) had general anaesthesia with endotracheal intubation. CONCLUSION: This study demonstrates that with careful planning and expertise, cleft lip repair can be done safely in resource poor setting.

Myositis ossificans of the platysma mimicking a malignancy: a case report with review of the literature.

The two main forms of myositis ossificans are congenital and acquired. Either form is rare in the head and neck region. The acquired form is often due to trauma, with bullying as a fairly common cause. This report of myositis ossificans of the platysma in an 11-year-old female patient emphasizes the need for a high index of suspicion in unexplainable facial swellings in children and the benefit of modern investigative modalities in their management.

A review of 318 odontogenic tumors in Kaduna, Nigeria.

PURPOSE: To analyze 318 odontogenic tumors seen at a tertiary oral care center in Kaduna, Nigeria for comparison with findings in previous Nigerian and world records. MATERIALS AND METHODS: A retrospective survey of odontogenic tumors based on the classification of Kramer et al was undertaken at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria, from all histopathologically proven cases of tumors and tumor-like lesions of the oral and perioral structures. Data were retrieved from case notes, radiographs, histopathology results, and follow-up records. Information collected were used to complete a questionnaire and subjected to analysis. RESULTS: There were 990 tumor and tumor-like lesions of the oral and perioral structures, of which 318 were odontogenic tumors (32%). Twelve histopathologic types of odontogenic tumors were found with more benign (n=314; 99%) than malignant (n=4; 1%). Ameloblastoma made up 233 (73%) of the tumors, followed by odontogenic myxoma (n=38; 12%), ameloblastic fibroma (n=9; 3%), and the adenomatoid odontogenic tumor (2%). Three cases of calcifying odontogenic cyst were co-existent with ameloblastoma (2) and ameloblastic fibro-odontoma (1). Among 275 surgically treated odontogenic tumors, enucleation was performed in 64 cases (23%), dentoalveolar segment resection with preservation of lower border of the mandible (n=33; 12%), segmental resection (n=168; 61%), and composite resection (n=9; 3%); 1 case was deemed inoperable. At least 8 cases of ameloblastoma (13%) recurred out of 60 followed up. CONCLUSION: Ameloblastoma is a fairly common tumor of Nigerian Africans accounting for 73% of odontogenic tumors and 24% of all tumors and tumor-like lesions of the oral and perioral structures. Various forms of resection are practiced to eradicate the tumor in view of the late presentation in our environment. Patients in Nigeria do not often return for follow-up reviews. A minimum of 5 years of follow-up reviews are necessary after treatment of ameloblastoma.

Odontogenic tumours in children and adolescents: a study of 78 Nigerian cases.

BACKGROUND: There is paucity of literature on odontogenic tumours in children and adolescents. Available records are difficult to compare due to differences in study criteria. To contribute to the records, a 20-year study of odontogenic tumours on the basis of the WHO classification (Kramer et al., 1992) in Nigerian African children and adolescents < or =18 years of age was undertaken. MATERIAL: A retrospective survey of oral/jaw tumours and allied lesions in children and adolescents < or =18 years of age seen at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria between 1979 and 1998. Data collected were histopathologic type, age, clinical features, radiologic appearance, treatment and record of recurrence. METHOD: Odontogenic tumours selected using the WHO classification were used for further study. Data were collected from case notes, radiographs, histopathologic reports and follow-up records. Information retrieved was used to complete a questionnaire and subjected to analysis. RESULTS: Two hundred and fifty-two (252) subjects < or =18 years were recorded, from which 78 (31%) had odontogenic tumours. Among seven types of odontogenic tumours seen, ameloblastoma (54%), odontogenic myxoma (19%) and adenomatoid odontogenic tumour (9%) were predominant. All patients seen were from 6 to 18 years with more than half (53%) between 15 and 18 years of age. A patient with multiple, bilateral odontomas of the maxilla and mandible resembling Herrmann's syndrome was recorded. Seventy-three patients were treated using enucleation (37%), dentoalveolar resection with preservation of lower border (15%) and segmental resection (48%). Five patients absconded after tumour diagnosis. No tumour recurrence was recorded in 65 treated cases followed-up for between 2 months and 10 years. CONCLUSION: This report shows that while ameloblastoma was the predominant odontogenic tumour, its frequency in Nigerian African children was lower than in the adult population. A case resembling Herrmann's syndrome is also presented.