Lateral Proboscis (Elephant Tusk) with Orofacial Clefts: A Report of a Rare Case.

Lateral proboscis is a rare congenital anomaly. Lateral proboscis is a rare craniofacial malformation characterized by a rudimentary tubular, nose-like structure occurring in association with a wide spectrum of other anomalies. We presented a seven-month-old girl's lateral proboscis, cleft lip, and palate. Proboscis was excised by an elliptical incision, and the cleft was repaired at the same surgery.

Epidemiology of adult cleft patients in North-western Nigeria: our experience.

BACKGROUND/OBJECTIVE: To review cleft lip and palate procedures over a three-year (2008-2010) partnership between the smile train and our organization, the Grasssroot Smile Initiative (GSI). METHOD: A three-year retrospective study (2008-2010) involving 79 adult patients with clefts. RESULTS: Seventy nine (14.4%) of 550 patients with orofacial clefts seen and treated within a three-year period were adults with age range of 17 to 81 years; mean 31.45 ± 13.09. Majority were between 20 and 39 years. There were 54 (68.4%) males and 25 (31.6%) females, with the male:female ratio of 2.2:1. Analysis of the cleft types/site revealed 35 (44.3%) lip alone, 22 (27.8%) lip and alveolus, 7 (8.9%) lip and palate and 15 (19%) palate alone. Seven (8.9%) of these patients had other relatives with clefts. Sources of information were friends and relatives; 33 (41.8%), radio; 18 (22.8%), charity organization/NGO; 13 (16.5%), hospitals/physicians; 5 (6.3%), and others; 10 (12.7%). 57 patients with lip clefts had surgery under local anesthesia while the remaining 22 patients were done under general anesthesia. All clefts of the lip were repaired using the Millard advancement rotational flap for complete cleft, simple straight line closure for incomplete and double layer closure for the palate. CONCLUSION: The incidence of adult patients with orofacial cleft is not rare in our community, probably due to limited access to specialized health care facilities, poverty and ignorance. Furthermore, some of these patients are not aware that these facial defects can be repaired. The advent of the smile train organization and free services has resulted in this harvesting phenomenon.

Spontaneous bone regeneration following mandibular resection for odontogenic myxoma.

Spontaneous bone regeneration is an uncommon condition following traumatic or iatrogenic bone loss. The factors responsible for its occurrence are yet to be fully elucidated. This report presents spontaneous bone regeneration following mandibular resection for a giant odontogenic myxoma in a 16-years-old Nigerian male. New bone formation was observed at the postoperative fourth week and has continued for one year after. Likely factors that favor this occurrence are critically examined. The advantages of spontaneous bone regeneration in resource-poor settings include low biologic and economic costs as compared to bone grafting.

Aetiology and presentation of ankylosis of the temporomandibular joint: report of 23 cases from Abuja, Nigeria.

Several studies have reviewed the management of ankylosis of the temporomandibular joint (TMJ), but only a few focused on the aetiology and clinical features. We retrospectively studied the aetiology and clinical features of patients with ankylosis of the TMJ who presented to the Maxillofacial Unit, National Hospital, Abuja, Nigeria, between 2004 and 2009. There were 13 male and 10 female patients, M:F ratio 1.3:1, age range 6-62, mean (SD) 20 (13) years. The aetiological factors were trauma (n=11) that comprised falls (n=6), untreated fractures of the zygomatic arch (n=4) and myositis ossificans (n=1); infection (n=9), that comprised cancrum oris (n=3) and ear infection (n=6); congenital or unknown (n=2), and coronoid hyperplasia (n=1). The maximum interincisal distance at presentation ranged from 0 to 25 mm (mean (SD) 6.7 (7.2) mm). Seventeen had facial deformities. The diagnoses recorded were as follows: left extracapsular ankylosis, (n=8); right intracapsular bony ankylosis, (n=6); left intracapsular bony ankylosis, (n=4); bilateral intracapsular bony ankylosis, (n=4), and bilateral intracapsular fibrous ankylosis (n=1). Extreme poverty was the main predisposing factor. There is a need for a concerted effort among healthcare providers, policy makers, and the world in general to eradicate poverty and improve healthcare to limit the incidence of ankylosis of the TMJ.

Ameloblastic carcinoma: a multicenter Nigerian study.

PURPOSE: To obtain a national profile on the prevalence and management of ameloblastic carcinoma in Nigerians. MATERIALS AND METHODS: Data were collected from the case files of patients with a histologic diagnosis of ameloblastic carcinoma from 4 tertiary referral centers in Nigeria from January 1980 to December 2008. RESULTS: Twenty patients were seen within the study period. There were 11 male and 9 female patients, with a male-to-female ratio of 1.2:1. Their ages ranged from 16 to 85 years (mean +/- SD, 41.63 +/- 19.8 years). The duration of the lesion before presentation was 6 months to 4 years. Twelve cases occurred in the posterior mandible alone, 1 case occurred in the anterior mandible alone, and 4 cases involved the anterior and posterior mandible. The posterior part of the maxilla was involved in 3 cases. A majority of the cases (17) occurred de novo, and 3 patients presented with carcinoma ex-ameloblastoma. Treatment included surgical resection with or without neck dissection. Eight patients declined treatment after diagnosis. Surgery was planned for 12 patients, but 2 patients died of intractable bleeding episodes before surgery. Mandibulectomies and maxillectomies were performed for 10 patients. Follow-up was carried out for 5 patients. Recurrence ranged from 6 to 96 months after the first surgery. Overall deaths recorded involved 6 patients. Three patients died within 3 years after the initial surgery and 1 patient died about 8 years after the initial surgery. One patient is still alive and well 1 year after surgery. CONCLUSION: Ameloblastic carcinoma is an uncommon malignancy. Most cases occur in the mandible and arise de novo. Early diagnosis and radical local excision remain the mainstay of treatment.

Ameloblastoma in Nigerian children and adolescents: a review of 79 cases.

PURPOSE: To descriptively review the clinicopathologic presentation and management of ameloblastoma in Nigerian children and adolescents and compare this with previous reports in the literature. METHODS AND MATERIALS: Data were collected from the case files of patients managed at 4 tertiary referral centers in Nigeria. RESULTS: Out of a total of 360 patients with a diagnosis of ameloblastoma, 79 were under 20 years of age at presentation (21.9%). Only 2.5% of the patients were under 10 years of age. The male-female ratio was 1.3 to 1 with a peak age incidence of 15 years in males and 17 years in females. All the tumors were intraosseous and the majority (94.9%) were situated in the mandible. The most common morphologic type was solid multicystic ameloblastoma (82.3%). The majority (66.2%) had a multilocular radiographic presentation. In most patients (57.3%), the symphysial region of the mandible was involved by the tumor. However, exclusively anterior tumors constituted only 15.2% of the cases, while tumors involving anterior and posterior jaw regions constituted 41.1%. Resection was the predominant (72.2%) form of surgical management. CONCLUSION: Ameloblastoma in Nigerian children and adolescents exhibit some peculiar clinical features: these include the predominance of males, and of the solid multicystic morphologic type. In addition, there is site predilection for the symphysial region of the mandible. Radical surgical resection remains the predominant form of treatment. Therefore, varying degrees of interference with facial growth will be present in these children.

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.