Clinical Signs and Intraocular Pressure Changes in Patients with Orbitozygomatic Complex Fractures.

OBJECTIVES: The study investigated the association between intraocular pressure changes and clinical ocular signs in 51 patients with orbitozygomatic complex fractures. Diplopia, chemosis, enophthalmos, subconjunctival haemorrhage, periorbital ecchymosis and extraocular muscles entrapment were assessed. STUDY DESIGN: Intraocular pressure was measured in mmHg at different time intervals with Perkins and Goldman tonometers; within first 3 days of injury (T1), 24 h post-elevation within 3-14 days of injury (T2), 1 month after initial treatment assessment (T3), 2 months after initial treatment assessment (T4), and 3 months after initial treatment assessment (T5). Intraocular pressure changes between T2/T1 and T3/T1 were analysed as change 1 and change 2, respectively, with paired t test. Significance was set at p < 0.05. RESULTS: Minimum intraocular pressure recorded in the affected eye was 5 mmHg at T1 and T2, while maximum intraocular pressure was 28 mmHg at T1. Mean intraocular pressure at T1 and T2 was 15.90 ± 4.73 mmHg and 16.80 ± 4.43 mmHg, respectively. All eye signs had completely resolved at T3 except enophthalmos, which persisted till T5. Statistical significant relationship exist between orbitozygomatic complex fracture and enophthalmos (T1: p = 0.04). subconjunctival haemorrhage (T2: p = 0.003), periorbital ecchymosis (T2: p = 0.005),and T3: p = 0.001). CONCLUSION: Chemosis, diplopia, enophthalmos, periorbital ecchymosis and subconjunctival haemorrhage showed positive contributory effect to intraocular pressure elevation in orbitozygomatic complex fracture.

Community members' engagement with and involvement in genomic research: lessons to learn from the field.

In this paper, we describe the potential role laypersons on ethics committees can play in ensuring community concerns are addressed in the design and implementation of genomic research. We draw inferences from the outcome of an empirical study of the impact of training of laypersons to address community engagement issues in ethics review of research protocol. While this paper does not advocate a particular solution, it describes the importance of community engagement in genomic research, the current limitations there are in engaging communities in the design of these research projects and how communities can be indirectly engaged in the design and implementation of genomic research through the engagement of laypersons on ethics committees. However, to ensure that these laypersons can play this role, their capacity needs to be built to play this role appropriately. There is evidence to show that where resources are invested in building the capacity of laypersons to play their role as community 'watchdogs' in research, they play this role aptly. Community engagement is important in genomic research as genomic researchers will increasingly require community perspectives in critical ethics decision making.

The role of human immunodeficiency virus infection in infranuclear facial paralysis.

BACKGROUND: This study describes the pattern of idiopathic infranuclear facial palsy (facial neuropathy) and highlights the role of human immunodeficiency virus (HIV)/AIDS in its occurrence and management. PATIENTS AND METHODS: This study conducted in Ile-Ife, Nigeria, assessed individuals with idiopathic facial neuropathy seen at the neurology; maxillofacial surgery; and ear, nose and throat outpatient clinics between 1994 and 2006. RESULTS: Eighty-eight patients with idiopathic facial neuropathy were seen during the 13-year study period. Forty-six (52.3%) were males, and the age range was 15 to 76 years, with a median of 35.5 years and interquartile range of 24.5 to 54 years. The right side was affected in 59.1%, compared with 40.9% on the left side. Twenty-six patients (29.5%) were HIV positive at presentation: 16 males, 10 females; mean age for HIV-positive patients was 29.15 +/- 8.12 years and 44.39 +/- 18.48 years for HIV-negative patients. There was a significant relationship among the status of the patients and the severity at presentation (p = .035), treatment given (p = .019), and the occurrence of flu-like symptoms (p = .004). CONCLUSION: A high index of suspicion of seroconversion is essential in patients presenting with idiopathic facial neuropathy since it has implications for management. Serological testing for HIV, especially in patients at risk and those with history of recent flu-like symptoms, is recommended.

Multiple midface degloving injury in an elderly man: challenges and management outcome.

We present a case of multiple degloving injuries in an elderly man following a fall from a palm tree. Multiple midface injuries are very rare, although individual types have been reported. Our patient sustained injuries in the lower and middle thirds of the face, including multiple tongue lacerations and a deep jagged laceration at the lower posterior part of the neck with a piece of wood in place. The facial degloving injury in this case posed an immediate danger from disruption of the respiratory system and hemorrhage. Emergency care involved prevention of respiratory embarrassment through a tracheostomy, maintenance of hemostasis and wound contamination. All the bone fractures were immobilized using interosseous wires and the avulsed nasal cartilage was immobilized with polyglactin 910 sutures against the anterior nasal spine. This case was unique because it was possible to manage the various challenges and significant risk to life by emergency tracheostomy and adoption of a multidisciplinary approach.

Management outcome and associated factors in burn injuries with and without facial involvement in a Nigerian population.

There is a high potential for the occurrence of burns in Nigeria, yet very little is known about factors that are associated with management outcomes (death/survivorship) in burns affecting facial or other body areas among Nigerian populations. This study aimed at determining patterns of occurrences of burn injuries with and without facial involvement and the factors that are associated with mortality. A standardized data-collection instrument was designed and used to extract relevant information about burn patients that were seen at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, between 1998 and 2003. During the study period, fuel-related flames constituted the leading type of agent in both facial (71.1%) and nonfacial involved burns (65.3%). There was no significant difference in the incidence of contracture and inhalation injury between burns with facial involvement and burns without facial involvement, but cases of facial involvement have significantly lower incidences of wound infections. No significant difference was seen in the incidence of mortality between burns with facial involvement (31.6 %) and burns without facial involvement (30.7%). Significant bivariate correlates for mortality were age, flame as the agent of burns, depth of the burns and wound infections. Two correlates remained significant in the multivariate analysis (binary logistic regression): BSA involved and wound infection.

Is malaria a predisposing factor for third molar pericoronitis in the tropics?

BACKGROUND: Malaria is an important disease in the tropics, and its role as a predisposing factor or co morbidity has been investigated in many diseases including HIV infection and tuberculosis. There are very few studies, which have investigated its role in oral and dental diseases. Our study aimed to demonstrate the possible role of malaria in predisposing to pericoronitis, an infection affecting impacted third molars predominantly. PATIENTS AND METHODS: Thirty-eight patients presenting with pericoronitis were tested for malaria parasites and results compared with that obtained from controls that were equally susceptible to pericoronitis but did not have the infection. RESULTS: 19.7% of the study group compared to 6.6% of control group had malaria parasite in their blood. This difference was statistically significant, P=0.018 (Fisher's exact). The odds ratio was 4.3 (95% CI=1.2-17.0). CONCLUSIONS: Malaria appears to be a predisposing factor to pericoronitis in this study. There is a need for further studies on the possible role of malaria in oral and dental diseases.

Oral health status in a population of Nigerian diabetics.

Oral manifestations of diabetes mellitus have been documented, but the effect of glycemic control on the oral tissues has been scantily reported. The oral health status of 65 metabolically controlled adult diabetic patients attending the Diabetes Clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was prospectively assessed over six months and compared with that of 54 non-diabetic acting as controls. The mean duration of diabetes was 100.5+/-85.1 months. The difference in periodontal status of the patients and control, assessed using the Community Periodontal Index of Treatment Needs (CPITN), was not statistically significant (p=0.07). The degree of hyposalivation between the two groups was, however, statiscally significant (p<0.05). No significant difference was observed in the altered taste, burning mouth sensation, angular cheilitis, glossitis, and stomatitis status of the two groups. We conclude, with adequate metabolic control, the oral health status of a diabetic may not be significantly different from that of a non-diabetic except for xerostomia. A good understanding of the interactions between systemic diseases and oral health is imperative for physicians and dental practitioners. The need for early detection and closer linkages between the dental and medical professions in managing diabetic patients is emphasized.

Retrospective survey of antibiotic prescriptions in dentistry.

OBJECTIVE: To evaluate dentists' prescription writing patterns and their appreciation of the characteristics of antibiotics. DESIGN: Evaluation of drug prescriptions written over a six-month period. SETTING: Dental Hospital, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. SUBJECTS: Retrospective analysis of 313 prescriptions written by dentists attending to outpatient dental patients. RESULTS: The total number of drugs on one prescription ranged from one to seven with Penicillins being the most commonly prescribed drug. Some prescriptions were found to be incorrect with regards to dose, frequency, and duration. Instructions as to the best time of administering drugs with regards to meals were not stated in any prescription. CONCLUSION: Improvement through continuing education is desired on the part of prescribers to ensure a good standard of care and avoid practices that may increase antimicrobial resistance. Drug information services including side effects and drug interactions for professionals and consumers at the hospital is highly desirable.

Clinical experience with parotid gland enlargement in HIV infection: a report of five cases in Nigeria.

A changing picture of oral lesions associated with HIV/AIDS has been documented. With the use of antiretroviral therapy, salivary gland swellings and other less common conditions associated with HIV/AIDS are now becoming more common. Our review of the literature showed the presence of parotid swelling in HIV-1 infection has increased from a range of 5-10% to 20% in AIDS. However, to the best of our knowledge, none from sub-Saharan Africa, which is the epicenter of the HIV infection and where access to antiretroviral therapy is poorest, has been primarily reported in literature. This report documents five cases of bilateral parotid gland enlargement as the presenting clinical manifestation of HIV/AIDS. The combination of a fine needle aspiration (FNA) biopsy, ultrasound imaging, and histological diagnosis increased the accuracy of diagnosis. While two patients had access to antiretroviral therapy, other modes of management were cystic aspiration and parotidectomy. One of the patients treated with parotidectomy had facial nerve injury, and the short-term aesthetic outcome between surgical treatment and antiretroviral therapy did not appear different. However, all our patients were lost to follow-up within a 2-year period. For a resource-constrained environment like Nigeria where stigma and discrimination is high and access to antiretroviral therapy is limited, there is a need to understand how best to manage a lymphoepithelial lesion in HIV/AIDS patients.