Onychomycosis in Diabetics: Prevalence, Clinical Features and Spectrum of Causative Fungi in South-Eastern Nigeria.

INTRODUCTION: Onychomycosis is a fungal infection of the nail unit and one of the common nail diseases that occurs commonly in diabetic patients. It poses a threat of diabetic foot complications to diabetics and negatively affects the quality of life of the patients. OBJECTIVES: The overall aim of the study was to determine the prevalence and clinical features of onychomycosis in diabetics, as well as the spectrum of causative fungi in Nigeria as compared with age and sex-matched controls. METHODOLOGY: This was a hospital-based, comparative cross-sectional study. One hundred and fifty consecutive adult diabetics and 150 healthy controls (accompanied persons and staff) matched for age and sex were recruited from the Diabetic Clinics and the Dermatology Clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. The participants were interviewed using a pre-tested structured questionnaire, nail scrapings were collected for fungal studies, and clippings for nail histopathology using Periodic Acid Schiff. RESULTS: The prevalence of onychomycosis among DM subjects was 45.3% vs. 35.3% in controls, which was not statistically significant (P value 0.078). Distal-lateral subungual onychomycosis was the most common clinical type in both study groups and presented mainly with nail discolouration, onycholysis, and subungual hyperkeratosis. The most common fungi isolated were dermatophytes (Trichophyton soudanense), non-dermatophytes (Aspergillus spp.), and Candida species (Candida albicans). CONCLUSION: Onychomycosis in diabetics is a very common nail disorder in the South-Eastern part of Nigeria with a high prevalence. The presence of foot ulcers was associated with onychomycosis in diabetics, and they were more likely to have non-dermatophytic onychomycosis.

INTRODUCTION: L'onychomycose est une infection fongique de l'unité de l'ongle et l'une des maladies des ongles les plus courantes chez les patients diabétiques. Elle pose une menace de complications du pied diabétique et affecte négativement la qualité de vie des patients. OBJECTIFS: L'objectif général de l'étude était de déterminer la prévalence et les caractéristiques cliniques de l'onychomycose chez les diabétiques, ainsi que le spectre des champignons causaux au Nigeria par rapport à un groupe témoin apparié selon l'âge et le sexe. MÉTHODOLOGIE: Il s'agissait d'une étude transversale comparative réalisée en milieu hospitalier. Cent cinquante diabétiques adultes consécutifs et 150 témoins sains (personnes accompagnatrices et personnel) appariés selon l'âge et le sexe ont été recrutés dans les cliniques de diabète et la clinique de dermatologie de l'Hôpital Universitaire du Nigeria à Ituku-Ozalla. Les participants ont été interrogés à l'aide d'un questionnaire structuré pré-testé, des échantillons de grattage d'ongles ont été prélevés pour des études fongiques, et des échantillons pour l'histopathologie des ongles utilisant l'acide périodique de Schiff. RÉSULTATS: La prévalence de l'onychomycose chez les sujets atteints de diabète était de 45,3 % contre 35,3 % chez les témoins, ce qui n'était pas statistiquement significatif (valeur de p 0,078). L'onychomycose sousunguéale distale-latérale était le type clinique le plus courant dans les deux groupes d'étude et se manifestait principalement par une décoloration des ongles, une onycholyse et une hyperkératose sousunguéale. Les champignons les plus couramment isolés étaient les dermatophytes (Trichophyton soudanense), les non-dermatophytes (Aspergillus spp.) et les espèces de Candida (Candida albicans). CONCLUSION: L'onychomycose chez les diabétiques est un trouble des ongles très courant dans le sud-est du Nigeria avec une prévalence élevée. La présence d'ulcères du pied était associée à l'onychomycose chez les diabétiques, et ils étaient plus susceptibles de présenter une onychomycose non-dermatophytique. MOTS - CLÉS: Onychomycose, Diabète sucré, Prévalence, Champignons, Nigeria.

A Clinical Audit of Histopathologically Diagnosed Ossifying Fibroma of the Jaws in a Nigerian Population.

BACKGROUND: Ossifying fibroma (OF) is a benign tumor of the jaws, which belongs to the group of fibro-osseous lesions, and exhibits slowly progressive growth leading to jaw expansion with well-defined borders. OBJECTIVE: To evaluate the clinical and radiological characteristics of OFs and their treatment. MATERIALS AND METHODS: A 5-year retrospective study was done. The case notes of subjects were retrieved, analyzed, and evaluated. Relevant information about patients was categorized into bio-data, clinical, and radiological. The diagnosis of lesion was made histopathologically by the oral pathologist. RESULTS: Forty- five patients' case notes were retrieved and analyzed and the patients' age ranged from 2 to 70 years (mean 29.4 ± 16.9). Majority of the patients (55.5%; P = 0.23) were 10-29 years. There were 16 (35.6%) males and 29 (64.4%) females giving a male: female ratio of 1:1.8 (P = 0.01). The cross-sectional dimension of the tumors measured vertically and horizontally ranges from 1 cm2 to 420 cm2 (mean = 54.7 cm2 ± 82.9). There were 60% in the maxilla and 40% in the mandible (P = 0.014). Most of the lesions (68.9%; P = 0.01) showed patchy opacity and cotton wool appearances. Majority of the lesions were extirpated by enucleation alone (P = 0.01). CONCLUSION: The prevalence of OF among the fibro-osseous lesions was 51.0% while against other benign lesions, it was 16.0%. In conclusion, contrary to most other reports across the globe, this lesion in southeast Nigeria occurred more frequently in the maxilla than mandible.

Locally advanced orofacial malignancy: Synopsis of inoperable lesions at an urban tertiary health facility in Nigeria.

BACKGROUND: Locally advanced inoperable orofacial malignancies do present clinically, and constitute a significant public health burden worldwide. OBJECTIVE: To determine the prevalence and clinical characteristics of Stage IV locally advanced inoperable orofacial malignancies for consecutive patients. MATERIALS AND METHODS: A 24-year retrospective study was undertaken, and data obtained from hospital register, case files, and histopathological reports of patients were recorded in a proforma. The variables studied were age, sex, type of lesion and site, duration of lesion, tobacco/alcohol use, and socioeconomic status of the patients and clinical features of the lesions. RESULTS: Twenty-six patients presented, giving a prevalence of 11.2%. The most common lesion was adenoid cystic carcinoma, 23.1%. Males accounted for 18 (69.2%) cases and females, 8 (30.8%) giving a male to female ratio of 2.3:1. The ages ranged from 21 to 65 years, mean (SD) 48.6 (7.3) years. The gender distribution was clinically and statistically significant in favor of the males (P = 0.001). The patients were in the low socioeconomic class and 20 (76.9%) indulged in chronic use of tobacco and alcohol. The duration of the lesions ranged from 1.8 to 3.1 years. The maxilla/facial skin was the commonest site (46.2%). Clinically and statistically, the relativity of site distribution of lesions was significant (P = 0. 002). The clinical features occurred in combination resulting in an average of 10 symptoms and signs in each patient. CONCLUSION: The synopsis of these lesions shows that all have undergone metastasis; salivary gland malignancies were most common with maxilla as the commonest site.

Prevention of alveolar osteitis after third molar surgery: Comparative study of the effect of warm saline and chlorhexidine mouth rinses.

BACKGROUND: Chlorhexidine mouth rinses have a proven efficacy for the prevention of alveolar osteitis after third molar surgery. This study compares the efficacy of warm saline rinse, a component of postextraction instructions, with that of chlorhexidine in our institution over a period of 2 years. PATIENTS AND METHODS: Apparently healthy patients who were referred to the Oral Surgery Clinic of our institution, with an indication for surgical extraction of lower third molar were prospectively, consecutively, and uniformly randomized into warm saline and chlorhexidine groups. The experimental group (n = 50/100) were instructed to gargle twice daily with warm saline, whereas the chlorhexidine group (n = 50/100) were instructed to gargle with 0.12% chlorhexidine. Information on demographic, types and level of impaction, indications for extraction, and development of alveolar osteitis were obtained and analyzed. Comparative statistics were done using Pearson's Chi-square, Fisher's exact, or Mann-Whitney U-tests as appropriate. P <0.05 was considered statistically significant. RESULTS: The demographic, types and level of impaction as well as indications for extractions were comparable between the study groups (P > 0.05). The overall prevalence of alveolar osteitis was 5%. There was no statistically significant difference between application of warm saline and 0.12% chlorhexidine rinse with respect to the development of alveolar osteitis (P = 0.648). CONCLUSION: Warm saline mouth rinse is equally as effective as chlorhexidine mouth rinse, as prophylaxis against prevention of alveolar osteitis after third molar surgery.

Spontaneous bone regeneration after segmental mandibular resection: a retrospective study of 13 cases.

The aim of this study was to evaluate the clinical characteristics of cases of spontaneous bone regeneration of the mandible after segmental resection. This retrospective study covered a 23-year period and used data obtained from the hospital records; patient data were entered into a pro-forma questionnaire. Overall, the cases of 636 patients with mandibular lesions treated by segmental resection were reviewed; 13 (2.0%) had spontaneous bone regeneration. The time post-surgery at which bone regeneration was first noticed ranged from 9 to 17 weeks. Seven patients were male (53.8%) and six were female (46.2%), giving a male to female ratio of 1.2:1. The patients ranged in age from 16 to 51 years (mean 26.6±3.6 years). The periosteum was completely excised after resection in eight patients (61.5%), while it was partially preserved in five (38.5%). The younger the patient, the earlier the spontaneous bone regeneration occurred in the defect (P=0.001), particularly in those who had complete excision of the periosteum. Radiographically, the new bone formed was observed to have the same appearance as the cortical bone of the mandibular stumps, but lacked height. This study suggests that bone graft reconstructions may still be necessary for this group of patients who show spontaneous bone regeneration.

Clinical characteristics and presentation of ameloblastomas: an 8-year retrospective study of 240 cases in Eastern Nigeria.

Our aim was to summarise the clinical characteristics and presentation of ameloblastomas in eastern Nigeria. We organised a retrospective study of 240 patients who presented with ameloblastomas to the Oral and Maxillofacial Surgery units of five specialist hospitals in the eastern states of Nigeria over an eight-year period (2004-2011). We analysed the casenotes, and categorised the cases by site of tumour, age, sex, and time of presentation. There were 117 men (49%) (mean (SD) age 43 (6.2) years) and 123 women (51%) (mean (SD) age 32 (4.7) years), a male:female ratio of 1:1.1. The largest age group was 20-39 years (n=102, 43%), and the most common site was the anterior mandible (n=140, 58%). Most of the patients presented late. Our results show that the most common site of ameloblastomas in Eastern Nigeria is the anterior mandible and that women are affected more than men, which is at variance with the results of most other studies.

Clinical Evaluation of the Efficacy of Arthocare Forte, a Chondro-Protective and Anti-Arthritic Drug in the Management of Bacterial Plaque-Induced Chronic Periodontitis.

BACKGROUND: Arthocare forte medication is made up of different constituents and the advantages offered by this disposition have not been explored in the management of chronic periodontitis. AIM: The aim was to assess the clinical response of bacterial plaque-induced generalized chronic periodontitis to arthocare medication, and the relationship of age and gender to the prevalence of chronic periodontal disease. SUBJECTS AND METHODS: This study was done at the Dental Surgery Clinic of the University of Calabar Teaching Hospital, Nigeria. It was a Prospective randomized controlled trial evaluating the effect of arthocare treatment on 81/162 patients with teeth mobility over a period of 5 years. All the patients (162) underwent root planing, and 81/162 (50%) were treated with arthocare for comparative analysis. The variables recorded were patient's age, gender, and degree of tooth mobility, periodontal pocket, and bleeding from the pocket after treatment. Statistical analysis was done using EPI INFO 7. RESULTS: Majority of the patients were between 46 and 75 years in both control (n = 59/81, 72.8%) and experimental groups (n = 52/81, 64.2%). There were 86/162 (53.1%) males and 76/162 (46.9%) females, giving a male-to-female ratio of 1.1:1. Seventy-seven patients (95.1%) in the experimental group had total remission in comparison to 32/81 (39.5%) in control group which was statistically significant (P < 0.001). CONCLUSION: The arthocare administered to patients in the experimental group speeds up the regenerative capacity and stability of the periodontium when compared with the control. Multicentre clinical trials are recommended to validate the use of arthocare forte in the treatment of generalized chronic periodontitis.

Management of extra-capsular temporo-mandibular joint ankylosis: does conservative approach to treatment have a role?

BACKGROUND: The conventional management of fibrous extracapsular temporo-mandibular joint (TMJ) ankylosis, a debilitating disease, is associated with surgical complications and financial burden on the patients. OBJECTIVE: To assess the outcome of conservative approach to the management of fibrous extracapsular TMJ ankylosis. PATIENTS AND METHODS: This is a prospective study of patients who presented at the Dental and Maxillofacial Surgery Clinic of the University of Calabar Teaching Hospital, Nigeria, during the period from January 1999 to December 2012 with a history of inability to open the mouth diagnosed as fibrous extracapsular TMJ ankylosis. RESULTS: Twenty-one subjects were treated and their ages ranged from 11 to 22 years with mean at 15.0 years. There were 13 (61.9 %) males and 8 (38.1 %) females with male: female ratio of 1.6:1. The aetiological factor that predisposed to formation of extracapsular TMJ ankylosis was facial trauma. There was no facial asymmetry and the side distribution of the affliction showed that 1 (4.8 %) was bilateral while 20 (95.2 %) were unilateral. Eight cases (38.1 %) were incomplete ankylosis while the rest (n = 13, 61.9 %) were complete. The shorter the duration of fibrous ankylosis and the greater the initial inter-incisal distance before treatment, the better the treatment outcome. CONCLUSION: The outcome of treatment suggests that the conservative approach to management of this condition was beneficial to these patients because they presented early. However, randomized controlled clinical trials are needed to validate this treatment option.

Temporomandibular joint ankylosis caused by condylar fractures: a retrospective analysis of cases at an urban teaching hospital in Nigeria.

Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. This study aimed to analyze cases of mandibular condylar fracture complicated by TMJ ankylosis after treatment. A 16-year retrospective analysis was performed at the dental and maxillofacial surgery clinic of the study institution; patient data were collected from the hospital records and entered into a pro-forma questionnaire. It was found that 56/3596 (1.6%) fractures resulted in TMJ ankylosis. The age of patients with ankylosis ranged from 12 to 47 years. The age (P=0.03) and gender (P=0.01) distributions were significant, with most cases of ankylosis occurring in those aged 11-30 years (n=43/56, 76.8%). Fractures complicated by ankylosis were intracapsular (n=22/56, 39.3%) and extracapsular (n=34/56, 60.7%). Ankylosis increased significantly with the increase in time lag between injury and fracture treatment (P=0.001). Ankylosis was associated with concomitant mandibular (85.7%) and middle third (66.1%) fractures. Treatment methods were not significantly related to ankylosis (P=0.32). All cases of ankylosis were unilateral, and complete (n=36, 64.3%) and incomplete ankylosis (n=20, 35.7%) were diagnosed clinically. The incorporation of computed tomography scans and rigid internal fixation in the management of condylar fractures will reduce ankylosis.

Honey and wound dehiscence: a study of surgical wounds in the mandibular bed.

BACKGROUND: There is a paucity of literature on the use of honey in wound healing after oral and maxillofacial surgical procedures. OBJECTIVE: To evaluate the efficacy of the healing properties of Obudu honey in patients who developed wound dehiscence after segmental mandibular resections. PATIENTS AND METHODS: This was a prospective study of 72 patients who had benign lesions of the mandible, and were treated by segmental mandibular resection, with the surgical wounds developing dehiscence. The subjects were randomized into two treatment groups of A (control, n = 36) and B (experimental, n = 36). Unlike the control, the wounds in the experimental group were dressed in honey after debridement. RESULTS: The ages of the patients ranged from 21 to 73 years with a mean age of 46.3 ± 2.1 years while the male: female ratio was 3:1. There was no significant demographic difference about age ( P = 0.44) and gender (P = 0.38) between the two groups. The smaller the initial circumference of the surgical wound, the shorter the duration of healing and this was significant (P = 0.001) in either of the treatment groups. Numerically, more healing was completed in the first 5 weeks in subjects in the experimental group (n = 19, 52.8%) than the control (n = 13, 36.1%). However, the duration of healing between the subjects in the control and experimental groups at the end of 9 weeks showed no significant difference (P = 0.23). CONCLUSION: Honey speeds up the healing of dehiscence wounds of resected mandible when used as dressing more than the control.

Complications of mandibular fracture: study of the treatment methods in calabar, Nigeria.

OBJECTIVE: The plethora of techniques available for the treatment of mandibular fractures suggests that there is controversy regarding their definitive outcome. The purpose of this study was to clinically study the complications associated with the different treatment methods of mandibular fractures at the University of Calabar Teaching Hospital (UCTH), Nigeria. METHODS: This was a three-year prospective study carried out at the Dental and Maxillofacial Clinic of the hospital. Patients who met the inclusion criteria had their data recorded in a proforma questionnaire. RESULTS: Out of the 256 patients studied, 17.2% developed complications. Complications were commoner (70.5%) between ages 21 and 50 years. Thirty-five (79.5%) were males while nine (20.5%) were females with a male:female ratio of 4.9:1. Following treatment by closed reduction, conservative and open reduction, 16.6%, 17.2% and 20.7% had complications, respectively. Whereas occlusal derangement was the most common complication, numbness of the cheek and lower lip was recorded following all treatment methods. CONCLUSION: Although the complications recorded in this patient population were managed during postoperative follow-up period, the methods of treatment available give good results, are cost-effective and patient compliance is good. This suggests that the older methods of treatment of mandibular fractures can still be used with reliability in contemporary dental practice.

Maxillofacial tumors and tumor-like lesions in a Nigerian teaching hospital: an eleven year retrospective analysis.

BACKGROUND: This paper reviews the types, prevalence and demographic distribution of maxillofacial tumors, cysts and tumor-like lesions in a Nigerian population. METHODS: A retrospective analysis of the medical records and histological reports of patients with oral and maxillofacial tumors and cystic lesions who presented to the Maxillofacial Unit of our institution over an eleven year period was undertaken. Information on demographics, histological diagnosis and clinical presentation were obtained and analyzed. A p value of less than 0.05 was considered significant. RESULTS: A total o:f 146 patients, aged 5-70 years (mean 30.5± 12.9) were seen over the period of study. There were 96 males (65.8%) and 50 females (34.2%) giving a male to female ratio of almost 2:1. Benign tumors accounted for 124, 86.3% and malignant tumors (22, 13.7%). Ameloblastoma was the most prevalent benign tumor observed (53, 36.3%) while squamous cell carcinoma was the most common malignant tumor. The peak age of ameloblastoma was the fourth decade and squamous cell carcinomas the sixth and seventh decades of life. Jaw swellings were the most common presentation (98, 67.1%), followed by pain (23, 15.9). The duration of symptoms on presentation ranged from 1 to 96 months (mean 23.32 ±15.72) and this was not different for malignant or benign tumors (P=0.886). CONCLUSION: Late presentation still remains the main challenging factor in the early detection and management of maxillofacial tumors in our environment. More awareness campaign is necessary, especially at the primary health care level, to educate the populace on the need for early presentation at treatment centers.

A review of 156 odontogenic tumours in Calabar, Nigeria.

BACKGROUND: Odontogenic tumours occur in our environment and because of late treatment, cause considerable disabilities. OBJECTIVE: To review cases of odontogenic tumours in our centre in order to obtain a baseline data and subsequently compare the results with that obtained elsewhere. PATIENTS AND METHODS: Using hospital case files and register, we carried out a 15-year retrospective study of odontogenic tumours at the Dental and Maxillofacial Clinic, University of Calabar Teaching Hospital, Nigeria. The data documented include age, gender, duration of lesion, type of tumour, socio-economic class, type of surgery, and complaints during follow-up reviews. RESULTS: Majority of the patients (n=49, 31.4%) were in the third decade of life. There were 85 (54.5%) males and 71 (45.5%) females, giving male to female ratio of 1.2:1. There was a significant association between the type of odontogenic tumour and the age of occurrence (p=0.000). The longer the duration of symptoms before presentation, the larger the tumours (p=0.000). The benign odontogenic tumours were 151 (96.8%), ameloblastoma (n=74, 47.4%) being the commonest. Jaw resection (54.5%) was the predominant treatment. Majority (58.0%) of the complications following treatment were Facial deformity, malocclusion and impaired mastication. CONCLUSION: Majority of the patients was in the lower socio-economic class, presented late for treatment and a few with aesthetic and functional impairment returned for secondary surgery. The intervention of agencies of government and non-governmental organizations is required to assist these patients if we are to accomplish the core healthcare system values in our environment.

A review of 156 Odontogenic Tumours in Calabar; Nigeria

Background: Odontogenic tumours occur in our environment and because of late treatment; cause considerable disabilities. Objective: To review cases of odontogenic tumours in our centre in order to obtain a baseline data and subsequently compare the results with that obtained elsewhere. Patients and methods: Using hospital case files and register; we carried out a 15-year retrospective study of odontogenic tumours at the Dental and Maxillofacial Clinic; University of Calabar Teaching Hospital; Nigeria. The data documented include age; gender; duration of lesion; type of tumour; socio-economic class; type of surgery; and complaints during follow-up reviews. Results: Majority of the patients (n=49; 31.4) were in the third decade of life. There were 85 (54.5) males and 71 (45.5) females; giving male to female ratio of 1.2:1. There was a significant association between the type of odontogenic tumour and the age of occurrence (p=0.000). The longer the duration of symptoms before presentation; the larger the tumours (p=0.000). The benign odontogenic tumours were 151 (96.8); ameloblastoma (n=74; 47.4) being the commonest. Jaw resection (54.5) was the predominant treatment. Majority (58.0) of the complications following treatment were Facial deformity; malocclusion and impaired mastication. Conclusion: Majority of the patients was in the lower socio-economic class; presented late for treatment and a few with aesthetic and functional impairment returned for secondary surgery. The intervention of agencies of government and non-governmental organizations is required to assist these patients if we are to accomplish the core healthcare system values in our environment

Knowledge and utilization of computer-software for statistics among Nigerian dentists.

BACKGROUND: The use of computer soft ware for generation of statistic analysis has transformed health information and data to simplest form in the areas of access, storage, retrieval and analysis in the field of research. This survey therefore was carried out to assess the level of knowledge and utilization of computer software for statistical analysis among dental researchers in eastern Nigeria. METHOD: Questionnaires on the use of computer software for statistical analysis were randomly distributed to 65 practicing dental surgeons of above 5 years experience in the tertiary academic hospitals in eastern Nigeria. The focus was on: years of clinical experience; research work experience; knowledge and application of computer generated software for data processing and stastistical analysis. RESULT: Sixty-two (62/65; 95.4%) of these questionnaires were returned anonymously, which were used in our data analysis. Twenty-nine (29/62; 46.8%) respondents fall within those with 5-10 years of clinical experience out of which none has completed the specialist training programme. Practitioners with above 10 years clinical experiences were 33 (33/62; 53.2%) out of which 15 (15/33; 45.5%) are specialists representing 24.2% (15/62) of the total number of respondents. All the 15 specialists are actively involved in research activities and only five (5/15; 33.3%) can utilize software statistical analysis unaided. CONCLUSION: This study has i dentified poor utilization of computer software for statistic analysis among dental researchers in eastern Nigeria. This is strongly associated with lack of exposure on the use of these software early enough especially during the undergraduate training. This call for introduction of computer training programme in dental curriculum to enable practitioners develops the attitude of using computer software for their research.

Prognosis of teeth in the line of mandibular fracture: 5-year clinical and radiological follow-up.

OBJECTIVE: The purpose of this article is to highlight our experience with the prognosis of teeth retained in the line of mandibular fracture after treatment of the fracture. PATIENTS AND METHODS: A prospective evaluation of 62 patients with 200 teeth in the line of mandibular fracture seen and treated at the Dental and Maxillofacial Clinic, University of Calabar Teaching Hospital, Calabar south-south Nigeria between 2005 and 2009 was carried out. The focus was on 96 teeth in the line of mandibular fracture retained after reduction and immobilization of the fracture by closed reduction technique. The clinical and radiological follow-up period of patients ranged between six months and 3.5 years. RESULTS: Majority of the patients 33 (53.2%) were in their third decade of life. The age of patients' ranged, from seven to 48 years with a mean of 24 +/- 2.3 years, There were 48 (77.4%) males and 14 (22.5%) females giving a male-to-female ratio of 3.4:1. One hundred and four teeth (52%) out of the 200 were extracted during treatment of the fracture. Of the remaining 96 teeth, 25 (26.0%) were anterior teeth while 71 (73.9%) were posterior. Twenty-four (25.0%) of the teeth in the line of fracture developed complications. Of those teeth involved with complications 10 (41.7%) were incisors and canine while 14 (58.3%) premolars and molars. Hypersensitivity and discolouration were the predominant complications. CONCLUSION: Appropriate case selection and thorough clinical and radiological assessment is required to reduce the rate of complications of teeth left in-situ in the mandibular fracture line after treatment. The various complications in this study were managed successfully.

Survey of the reasons for dental extraction in eastern Nigeria.

BACKGROUND: Extraction of teeth is the commonest surgical procedure carried out in the dental surgery setting. AIM: The purpose of this survey was to identify the causes of teeth extraction in Eastern Nigeria. SUBJECTS AND METHODS: Record forms for entering data and a self-addressed return envelope were distributed to 100 dental surgeons in Eastern Nigeria using a simple random selection. RESULTS: Seventy-one (71; 71/100) dentists responded to the request and the total extractions carried out were 3998. There were 1508 (37.7%) extractions in males and 2490 (62.3%) in females with male-to-female extraction ratio of 1:1.7. In both male and female gender, there were more teeth extractions between the ages of 11 and 30 years. Extractions were recorded more in the lower social class (47.6%; 1903/3998). There were more extractions in the permanent (85.0%; 3398/3998) than deciduous (15.0%; 600/3998). The commonest reasons for teeth extraction were caries (55.2%; 2208/3998). CONCLUSION: The result of this study shows that dental caries is the commonest reason for tooth extraction in Eastern Nigeria. It is hoped that the study will facilitate the development of treatment and preventive procedures relevant to the problems observed in this part of Nigeria, thus minimizing the loss of teeth and its expected adverse consequences.

The clinical presentation and management of zygomatic complex fractures in a Nigeria Teaching Hospital.

BACKGROUND: Fractures of the zygomatic complex occur worldwide and are a component part of injuries that can be sustained in the maxillofacial region. The objective was to analyze the clinical presentation and management ofzygomatic complex fractures. METHODS: This was a prospective study carried out over a period of five years at the University of Calabar Teaching Hospital, Nigeria. Data documented were patients' age, gender, time of presentation, cause and type of fracture, associated head and maxillofacial injuries, clinical features, types of plain radiographs, treatment methods, duration of follow-up and complications. RESULTS: Majority of the patients (n = 81, 63.3%) were in their third and fourth decades of life while the male to female ratio was 20.3:1. Road traffic accident (n = 111, 86.7%) was the most common cause of fracture. Fractures of the zygomatic complex alone (n = 105, 82.0%) were more common than isolated fractures of the arch (n = 13, 10.2%) and combined fractures of the zygomatic complex and arch (n = 10, 7.8%). CONCLUSION: While multi-disciplinary approach to treatment is important, majority of the fractures were treated by simple elevation and transosseous wire osteosynthesis. Delay in presentation, associated injuries and non-availability of mini-plating technique contributed to the development of complications.

Survey of the Reasons for Dental Extraction in Eastern Nigeria

Extraction of teeth is the commonest surgical procedure carried out in the dental surgery setting. Aim: The purpose of this survey was to identify the causes of teeth extraction in Eastern Nigeria. Subjects and Methods: Record forms for entering data and a self-addressed return envelope were distributed to 100 dental surgeons in Eastern Nigeria using a simple random selection. Results: Seventy-one (71; 71/100) dentists responded to the request and the total extractions carried out were 3998. There were 1508 (37.7) extractions in males and 2490 (62.3) in females with male-to-female extraction ratio of 1:1.7. In both male and female gender; there were more teeth extractions between the ages of 11 and 30 years. Extractions were recorded more in the lower social class (47.6; 1903/3998). There were more extractions in the permanent (85.0 ; 3398/3998) than deciduous (15.0 ; 3398/3998) than deciduous (15.0; 600/3998). The commonest reasons for teeth extraction were caries (55.2; 2208/3998). Conclusion: The result of this study shows that dental caries is the commonest reason for tooth extraction in Eastern Nigeria. It is hoped that the study will facilitate the development of treatment and preventive procedures relevant to the problems observed in this part of Nigeria; thus minimizing the loss of teeth and its expected adverse consequences

Maxillofacial injuries in Calabar south-south, Nigeria: a 5 year study of jawbone fractures.

OBJECTIVES: The aim of this study is to highlight the overall uniqueness of the pattern of presentation of maxillofacial injuries seen at the Department of Oral and Maxillofacial Surgery of the University of Calabar Teaching Hospital, Calabar south-south Nigeria between January 2000 and December 2004 and to share our experience in terms of occurrence, seasonal fluctuations and the adequacy of treatment methods in our environment. MATERIALS AND METHODS: Case notes of all. the 200 maxillofacial trauma patients were retrieved, examined and analyzed with regards to age, gender and cause of injury, socio-demographic data, diagnosis, pattern of presentation, distribution and treatment. RESULTS: A male-to-female ratio of 3.65:1 was obtained. Out of the 200 patients the highest incidence of injury was in the 20-30 year age group 85 (n=85; 42.5%). The major causes of injuries were motorcycle (n=74; 37%), vehicle (n=62; 31.5%) and assault (n=40; 20%). Six (3%) river-related or boat accidents were recorded. Industrial and sports related accidents contributed the least (n=5; 2.5%). CONCLUSION: Road traffic accident had the highest proportion of the entire maxillofacial injuries with more males affected than females. Seasonal distribution showed a bimodal peak variation of May-June and September-January. This paper calls for the reinforcement of measures for the prevention of automobile accident and the establishment of more maxillofacial specialist centers with modern equipment for effective management of maxillofacial injuries.