Antenatal determinants of oro-facial clefts in Southern Nigeria.

OBJECTIVES: Cleft lip with or without cleft palate, is the most common serious congenital anomaly that affects the orofacial regions. The management and care of the cleft patient constitutes a substantial proportion of the workload of the Nigerian maxillofacial surgeon and allied specialties. Yet, there are no specific programmes targeted at this group. We believe that the findings of this study is capable of identifying useful interventions for designing programs that will lead to a reduction in the burden of orofacial cleft in Nigeria. METHODS: It was a transverse cross-sectional study that was undertaken at the Maxillofacial Units of the University of Benin Teaching Hospital and the Central Hospital, Benin City respectively. The prevalence and antenatal determinants of cleft lip and palate were determined. RESULTS: Cleft lip and palate were often encountered in clinical practice in Benin City with a prevalence of 1.35%. The results showed that orofacial clefts were commoner in females and that the combined unilateral cleft lip and palate was the commonest entity encountered amongst the cases. The following risk factors were associated with the risk of development of cleft lip and palate: Paternal age >40 years, maternal age >35 years, genetic/family history, low socio-economic status, alcohol consumption and indulgence in the intake of herbal medications in pregnancy. CONCLUSION: Public health education programmes and advocacy activities geared towards raising awareness of the identified risk factors for the development of cleft lip and or cleft palate would go a long way to obviate the occurrence and reduce the burden.

Aetiological Factors for Mandibular Fractures Seen in the University of CalabarTeaching Hospital; Calabar; South-South Nigeria

The objective of this study was to determine prospectively the common aetiological factors leading to fractures of the mandible in patients seen in the University of Calabar Teaching Hospital (UCTH); Calabar; Nigeria. A total 252 patients with fractures of the facial skeleton were seen out of which 174 (69) presented with mandibular fractures over a period of two years. Road traffic accidents; both vehicular road and traffic accidents (VRTA) and Motorcycle road traffic accidents (MRTA) were the commonest cause (79.9) of mandibular fractures with MRTA accounting for 36.2of total and 45.3of all the RTS's followed by assault; sporting events; falls from heights; gun shot and industrial accidents. Majority of the patients were males 142 (81.6) with fewer females 32 (18.4) giving a male-female ratio of 4.4:1. Most of the patients were aged between 21 and 30 years. Government should ban use of motorcycle as a means of commercial transportation and make more motor vehicles available for this purpose

Periradicular burkitt's lymphoma: a report of 2 cases from Nigeria and review of the literature.

This article reports two cases of periradicular Burkitt's lymphoma from Nigeria, to emphasize the difficulties in differentiating the early lesion from other periradicular lesions with similar clinical and radiological findings Case 1, is a 4-year-old boy who presented with a one-month history of a painless, hard, posterior mandibular swelling (right), which was causing loosening and displacement of deciduous teeth (84 and 85). Histopathological examination of periradicular tissues from extracted tooth (85), confirmed the diagnosis of early periradicular B urkitt's lymphoma. Case 2, is a 6-year-old boy who presented with one-week history of a loose, extruded right mandibular first molar tooth (46) and an exfoliated left mandibular first molar tooth (36). After two weeks of follow-up, the patient developed bilateral mandibular swelling at the molar region, as well as peri-orbital and bilateral pedal oedema. Incisional biopsy of the oral lesion at the region of exfoliated left first mandibular molar (36) was useful for histopathological diagnosis of early Burkitt's lymphoma of the jaw. In the face of limited diagnostic tools such as clinico-radiological assessment, cytology or incisional biopsy for incipient periradicular lesions, a high index of suspicion of Burkitt's lymphoma of the jaw may be helpful in early diagnosis and treatment of a lesion, presenting in a child as periradicular radiolucency or mixed radiolucency and radiopacity, with associated loosening and displacement of teeth.

Aneurysmal bone cyst: a primary or secondary lesion?

OBJECTIVES: To emphasize the origin of aneurysmal bone cyst as "primary" or "secondary" to other lesions of the jaws and 2. Report two cases of the cyst that illustrate its controversial origin in the hope that it will add to the literature on the subject in Africa. REPORT: Two cases of aneurysmal bone cyst occurring in the mandible and maxilla are reported. One of the cysts that occurred in a 13-year-old was a primary lesion while the other in a 5-year-old was associated with a cementifying fibroma. METHOD: The diagnoses of both lesions were confirmed by biopsy. The lesion that occurred in the 13-year-old was treated by curettage while the other in the 5-year-old was treated by excision under general anaesthesia respectively. RESULT: While the lesion in the 13-year-old was haemorrhagic with 'welling up' of blood, the second lesion though haemorrhagic was not associated with this phenomenon. Both patients were transfused with 2 pints and 1 pint of blood respectively. There has not been recurrence of the lesions after two years post operatively. CONCLUSION: Aneurysmal bone cyst can arise as a primary lesion or associated with a fibro-osseous lesion as demonstrated by these two cases. There is a need to serially section biopsy specimens of the cyst to detect coexisting lesions.

Co-morbid psychiatric disorders in Nigerian patients suffering temporomandibular joint pain and dysfunction.

OBJECTIVES: To determine the prevalence of psychiatric morbidity among Nigerian patients with temporomandibular joint pain and dysfunction (facial arthromyalgia). to delineate the specific types of comorbid psychiatric disorders and identify the socio-demographic characteristics of the patients with psychiatric disorders. DESIGN: A two-stage design was adopted to study the prevalence and types of co-morbid psychiatric disorders of identified 24 patients with temporomandibular joint pain and dysfunction over a period of 5 years. SETTING: Pain and Psychiatric clinics of the University of Benin Teaching Hospital, Benini City, Nigeria. METHODS: The patients were controlled for age gender, and marital status. The State-Trait Anxiety Inventory. 28-item General Health Questionnaires and the Hospital Anxiety and Depression Scales were used for first stage screening while the second stage interview utilised the Psychiatric Assessment Schedule. RESULTS: The prevalence of psychiatric morbidity was 37.5% and 12.5% in the study and control groups respectively. Generalised anxiety disorder and dysthmia were the main forms of psychiatric disorders identified. Temporomandibular joint pain and dysfunction patients with co-morbid psychiatric disorders were significantly older (P<0.0001), had the illness for shorter periods before presentation (p<0.001) and were non-professionals. CONCLUSION: The findings highlight the need for multi-disciplinary approach to the assessment and management of patients with temporomandibular joint pain and dysfunction.

Normal values of medial and lateral canthal distances in 3 to 18 year-old Nigerians.

BACKGROUND: This study was carried out on male and female Nigerians whose age ranged from 3 to 18 years in order to provide a database of canthal measurements for a predominantly black population and compare them with Caucasians. STUDY DESIGN: All the healthy pupils and students were randomly selected. The ages of the children, adolescents and young adults were approximated to their nearest birthdays. Two different researchers measured each parameter and the mean values were recorded. SETTING: Nursery, primary, secondary schools and the University of Benin, in Benin City, Nigeria. RESULTS: Four hundred and sixty eight males (53.4%) and 408 (46.6%) females making up a total of 876 subjects were studied. The mean values for medial canthal distance for male Nigerians are slightly higher than those established for male Caucasians and these differences are significant (p>0.05). There was no significant difference in the lateral canthal distance between the two groups (p<0.05). Nigerian and Caucasian females have significant difference (p>0.05) in mean values for medial canthal distances but not in lateral canthal distance (p<0.05). The difference in these distances between Nigerian males and females are not significant. Weight and lateral canthal distance showed a covariance of 6.980 while age and lateral canthal distance, age and medial canthal distance showed a covariance of 2.970 and 1.140 respectively. There was no correlation between age, height, weight and the distances measured. CONCLUSION: Medial canthal distances between male and female Nigerians compared to males and female Caucasians show significant variations but not in the lateral canthal distances.

Influence of positions on the incidence and severity of maxillofacial injuries in vehicular crashes [corrected].

The objective of this study was to determine the influence of positions on the incidence and severity of maxillofacial injuries in vehicular crashes. Two hundred and fifty cases of RTA were seen and studied from October 1999 to May, 2000. They comprised 72.8% males and 27.2% females with a male to female ratio of 2.7:1. The age range was 1 to 80 years with a mean age of 40 years. The most common vehicle involved in RTA was the mini bus, 34.3% followed by motorcycle, 26.5%. Middle seat passengers, drivers and motorcycle passengers and riders sustained more and severe injuries during crashes. The mandible was more frequently fractured at the symphysis (24.6%) than at any other site while the maxilla was frequently fractured at the zygomatic bone and arch (10.8%). More injuries occurred in the age range of 20-30 years and these accounted for 31.8% of the cases. Only 6 occupants of motor vehicles wore seat belts before accident while no motorcycle rider or passenger wore any helmet. In conclusion, drivers, middle seat occupants of a vehicle, motorcycle passenger and riders sustained more and severe injuries than back seat occupants.

Midline lethal granuloma complicating pregnancy: case report.

A case of midline lethal granuloma in a 28-year- old female Nigerian patient is reported. Oral, ocular and nasal lesions were present and these preceded a spontaneous abortion of a three month old pregnancy. The clinical course of the disease and its similarity to other granulomatous diseases, which are generally classified as midline granuloma syndrome, are highlighted. The prognosis is poor but early diagnosis and treatment appears to improve a patient's condition