A classification system for recurrent ameloblastoma of the jaws--review of 30 cases in Nigerians.

This paper reviewed the clinicopathologic presentation of recurrent ameloblastoma in 30 Nigerian patients at three tertiary referral centers with the sole objective of developing a classification system. Most recurrences occurred in patients in their 3rd decade of life (20-29years) and males were more frequently affected than females (1.5 to 1). Though enucleation resulted in the highest rate of recurrences (30%), hemi-mandibulectomy also resulted in a 20% recurrence rate. Majority of the recurrences occurred within 5 to 9 years after primary surgery. Most primary jaw sites of the lesion corresponded with the primary jaw sites of the recurrent tumor which in itself may be a reflection of inadequate primary treatment. The most frequent anatomic site of primary tumors that recurred was c4 (highest level of ramus involvement). The most frequent anatomic classification of the recurrent tumors was recurrence at one bone margin (Bla) and recurrence at intervening /adjacent soft tissues between the resected bone edges (Blc). Mandible to maxilla recurrence increases the likelihood of extension to the skull and brain.

The sensitivity, specificity and accuracy of fine needle aspirational cytology in the diagnosis of oro-facial neoplasms at Lagos University Teaching Hospital, Nigeria.

OBJECTIVE: The aim of the study is to compare the efficacy of fine needle aspirational cytology (FNAC) with open surgical biopsy in the diagnosis of orofacial tumours in patients seen at the Dental Centre of Lagos University Teaching Hospital from May 2005-May 2006. PATIENTS AND METHODS: Fine needle aspiration was performed on all patients scheduled for open surgical biopsy at the Oral and Maxillofacial clinic of the hospital before the open surgical biopsy was done. Forty six patients whose final histological diagnoses were oro-facial neoplasms were involved in this study. Sensitivity, specificity and accuracy for fine needle aspirational cytology were calculated. RESULTS: The sensitivity, specificity and accuracy of fine needle aspirational cytology in the diagnosis of oro-facial tumours were 95%, 95.8% and 95.5%, respectively. The false positive and false negative rates were 5% and 4.2%, respectively. CONCLUSION: The high sensitivity, specificity and accuracy of fine needle aspirational cytology reported in this preliminary study suggest that the test may have a place in the management of oro-facial tumours. However, when the result of fine needle aspirational cytology is not in agreement with the clinical diagnosis, especially in suspected malignancy, open surgical biopsy should be performed.

Knowledge and practice of alternatives to the conventional inferior dental block amongst dentists in Lagos.

BACKGROUND: The conventional inferior alveolar nerve block (IANB) has been used for mandibular anaesthesia for many years. It is associated with a number of complications including failure of anaesthesia. Alternative techniques were therefore developed for the mandibular anaesthesia. OBJECTIVE: This study is to evaluate the knowledge and practice of alternatives to the conventional inferior alveolar nerve block (IANB) amongst dentist in government owned hospitals in Lagos, Nigeria. METHODS: Self administered questionnaires to assess the knowledge and practice of alternatives to the conventional inferior dental block for mandibular anaesthesia were sent to dentists in clinics situated in General hospitals and Teaching hospitals in Lagos. The information recorded included demographics (age and sex), institution of practice, and length of practice. The knowledge and practice of alternatives to the conventional IANB were also recorded. RESULTS: Of the 90 questionnaires sent out, only 66 (73.3%) were returned. Most respondents 43 (65.5%) practiced in the tertiary institutions. All respondents used the conventional IANB as their primary technique. Difficulty to achieve anaesthesia due to trismus 22 (34.4%) and pain on injection 20 (32.3%) were the most common complications/difficulty associated with the IANB. Forty (60.6%) of the respondent practiced the Akinosi/Varzirani technique (AVT) as a secondary technique while only 1 had ever attempted the Gow-Gate technique (GGT). Both the knowledge and practice of the alternative techniques had a statistically significant relationship to both formal training and primary training institution (P < 0.05). CONCLUSION: Formal training in the use of alternative techniques to the IANB in achieving mandibular anaesthesia was a very important factor that determined the practice and knowledge of these techniques. Although the IANB was still the primarychoice for all of our respondents, there are claims by a lot of the respondents that with more formal training the alternatives will used more regularly.

Biologic; Anatomic and Clinical Considerations in the Management of the Classic Intraosseous Ameloblastoma of the Jaws

This paper reviews the types of surgical and nonsurgical treatment modalities that have been used to treat the classic intraosseous ameloblastoma of the jaws. The clinical; anatomic and biologic factors that may influence the clinicians' selection of a particular treatment modality were highlighted. Surgeons should be aware of these different modalities if they are to formulate a surgical treatment plan that is individualised to fit different clinical situations

The role of preoperative and intraoperative variables in predicting post operative complications after impacted mandibular third molar exodontia.

OBJECTIVES: The aim of this prospective study was to investigate the role of pre and Intra operative variables in predicting postoperative complications after removal of impacted Mandibular third molars. PATIENTS AND METHODS: 87 patients who required 90 surgical extractions of impacted Mandibular teeth were involved in the study. Radiological and clinical data were taken preoperatively. Intra operative difficulty and complications were recorded. Postoperative complications were also recorded. RESULTS: Increasing body mass index (BMI), depth from point of elevation and occlusal level of teeth were significantly associated (P < 0.05) with the occurrence of postoperative complications. The Intra operative difficulty and Intra operative complications were both statistically significantly associated with postoperative complications (P < 0.05). CONCLUSIONS: The BMI, depth of point of elevation and occlusal level of teeth are important preoperative predictors of postoperative complications. Also important are the frequency of intra operative complication and the duration of surgery in the removal of impacted teeth. Specific intra operative complications were however not as helpful in predicting specific postoperative complications in this study.

Miniplate osteosynthesis of mandibular fractures at the Lagos University Teaching Hospital.

OBJECTIVE: To report the clinical outcome of the treatment of mandibular fractures with miniplate osteosynthesis alone, at Lagos University Teaching Hospital (LUTH). METHOD: 30 patients who presented with 41 mandibular fractures at the Lagos University Teaching Hospital between May 2005 and June 2006 were selected for treatment with miniplate osteosynthesis according to the principles of Champy et al. They were grouped according to the time lapsed from injury to treatment as: early (< 24 hours), delayed (> 24 hours - < 7 days) and "late" (> or = 7 days) osteosynthesis groups. Data collected included: age and gender distribution, the aetiology of trauma, site of fractures, pre and postoperative body weight and interincisal distance and postoperative complications. RESULTS: Only 28 of the 30 selected patients received miniplate osteosynthesis and were therefore included in the final analysis. In 25 of these patients (89%) miniplate osteosynthesis without maxillomandibular fixation (MMF) was used. In 3 patients (11%), supplementary MMF was combined with miniplate osteosynthesis. The male - female ratio was 5:1 and the most frequently affected age group was the 20 - 29 years age group (53%). The most frequent cause of fracture was fight and assault. The body of the mandible was the most fractured site. 14 patients (50%) each were classified as delayed and "late" osteosynthesis respectively. The time lapsed before patients attained a postoperative mouth opening of 35mm was 5 weeks while it took 6 weeks to regain lost weight. 46.4% of the patients had postoperative complications; the most frequent complication was malocclusion (23.3%). Patients in the late osteosynthesis group had a higher complication severity score (2.3) than those in the delayed osteosynthesis group (1.5). CONCLUSION: This study suggests that most of the mandibular osteosynthesis in our environment would be delayed or "late" and would develop higher complication rate.

Minor salivary gland tumours in a Nigerian hospital: a retrospective review of 146 cases.

PURPOSE: This is a retrospective study of the location, diagnosis, sex and age distribution and treatment of minor salivary glands tumours of the upper aero digestive tract in Lagos, Nigeria. MATERIAL AND METHODS: Case files and radiographs of patients treated over a 24-year period were reviewed. RESULTS: These tumours constituted 40.4% of all salivary gland tumours in the series. The majority (62.3%) of these tumours was malignant, and the most common malignant tumour was mucoepidermoid carcinoma (19.2%). However, pleomorphic adenoma (34.2%) was the most common tumour overall. Both benign (67.2%) and malignant (23.9%) tumors were most frequently located in the palate. Both sexes were equally affected (Male-female ratio 1 to 1), but a higher proportion of benign tumours were found in the palate of females (75%) than their male counterparts (64%). Patients with adenoid cystic carcinoma were significantly older at presentation than those with pleomorphic adenoma and adenocarcinoma (P < 0.05). CONCLUSION: These findings show that majority of these tumours were malignant (62.3%), though pleomorphic adenoma was the most common tumour. They also confirm the high predilection of pleomorphic adenoma (61.8%) for the palate of Black Africans.

Impacted mandibular third molars: presentation and postoperative complications at the Lagos University Teaching Hospital.

AIM: Surgical extraction of impacted Mandibular third molar is one of the commonest dentoalveolar surgeries. This study aims to investigate the pattern of presentation of impacted Mandibular third molars, the indications for extraction and the post operative complications after this procedure at the Lagos University Teaching Hospital. PATIENTS AND METHODS: A prospective study of patients who required surgical extraction of impacted Mandibular third molars between October 2003 and May 2006 at the Lagos University Teaching Hospital (LUTH) was carried out. Data collected included Patients' age, sex, indication for extraction, tooth/teeth extracted. Also collected were the types of impactions and surgical morbidity (postoperative complications). The data collected were evaluated using the SPSS for windows (version 11.0: SPSS Inc, Chicago, IL) descriptive analysis was used as appropriate. RESULTS: Three hundred and thirty one (331) Mandibular third molars were extracted from 329 patients. The ages ranged from 17 to 55 years with a mean of 26.63 (+/- 7.39). There were 153 males and 176 females; with male to female ratio was 1:1.15. Recurrent Pericoronitis was the most common indication for extraction (209 extractions; 63.1%), while the mesioangular impaction was the most common angulation (117 impactions; 53.4%). 47 (14.2%) of the extractions had postoperative complications and dry socket which occurred in 25 (53.2%) cases was most common. CONCLUSION: The pattern of presentation of impacted Mandibular third molars is similar to earlier reports. The morbidity is however higher than the average value in the literature, it however does not seem to increase with increasing age.

Primary malignant neoplasms of orofacial origin: a retrospective review of 256 cases in a Nigerian tertiary hospital.

A retrospective review of cases histologically diagnosed as malignant lesions of the orofacial region in 1992-2003 from the records of the Department of Oral Pathology and Biology, Lagos University Teaching Hospital, Nigeria was carried out. All cases were subjected to analysis of age, gender, site distribution and histologic types. Malignant tumours constituted 18% of all the biopsies of orofacial lesions seen within the period. The mean age of patients was 42.2+/-21.5 years (range: 2.5-85). There were 177 (69%) epithelial tumours of which squamous cell carcinoma was predominant, 47 (18%) sarcomas and 32 (13%) lymphomas. Squamous cell carcinoma (44%) was the most common malignant orofacial tumour. Osteosarcoma (32%) and Burkitt's lymphoma (56%) was the predominant sarcoma and lymphoma, respectively. Patients with a histologic diagnosis of carcinoma were older than those with sarcomas and lymphomas (P<0.01), and those with a histologic diagnosis of malignant lymphoma were significantly younger than those with sarcomas (P<0.01). Almost 25% of patients with carcinomas were below the age of 40 years. Malignant orofacial tumours are not uncommon in the studied environment, with a sizable proportion of carcinomas occurring before the age of 40 years.

Cultural and religious components in Nigerian parents' perceptions of the aetiology of cleft lip and palate: implications for treatment and rehabilitation.

The present study was conducted to find out the perceptions of mothers from two Nigerian ethnic groups who had children with cleft lip and palate (CLP) about the aetiology of the defect. Mothers of 16 children with CLP from the Yoruba ethnic group who attended the maxillofacial clinic of the Obafemi Awolowo University teaching hospital in southern Nigeria and 20 children with CLP from the Hausa/Fulani ethnic group who attended the maxillofacial clinic of the University of Maiduguri teaching hospital in northeastern Nigeria were interviewed over an 8-month period. We used standardised interviews including questions with ethnographic components to allow us to collect information about traditional beliefs about clefts. Interviews were recorded on tape for later analysis. Thirteen of the 16 parents from the Yoruba group attributed the aetiology of CLP to supernatural forces (evil spirits and ancestral spirits), while 16 of the 20 Hausa/Fulani parents attributed it to the "will of God". Twelve of 16 Yoruba parents had consulted traditional healers for treatment before coming to the hospital. Various plants and animal products were used to treat clefts and 10 of the Yoruba parents were referred to the hospital for further treatment by the traditional healers. Cultural and religious factors seem to have an important role in the explanations, labels and treatment that followed the birth of a child with CLP in this environment. There is a need for greater collaboration and sharing of information between modern medical practitioners and traditional healers.

Malignant orofacial neoplasms in Lagos, Nigeria.

OBJECTIVES: To analyse general differences in age, gender, anatomic location of the various histological types of malignant neoplasm involving the oral and maxillofacial region at a tertiary referral centre in Nigeria and to compare this with reports in the literature. DESIGN: Retrospective analysis. SETTING: A tertiary referral centre in Lagos, Nigeria. SUBJECTS: All patients with a histological diagnosis of malignancy were included provided the final surgical histology reports as well as the biopsy reports were available for review. RESULTS: Squamous cell carcinoma (SCCA) with a peak age incidence in the 6th decade of life and a male to female ratio of 1.65 to 1 was the most common cancer (42.8%). Males with SCCA (mean = 48.7 years) were relatively younger than females (mean = 58.8 years). Eighteen percent of patients with SCCA were below 40 years at presentation and males were predominantly affected at a ratio of 5.2:1. Majority of the SCCA (75%) were well/moderately well differentiated. However, in patients below 40 years, 45.9% had poorly differentiated SCCA. The Most commonly affected sites for SCCA were the maxillary antrum (36.7%), mandibular gingiva/ alveolus (23.0%) and tongue (12.04%). Patients who presented with antral SCCA were relatively younger (mean = 48.9 years) than those who had SCCA involving the mandibular gingiva/ alveolus (mean = 57.1 years) as well as floor of mouth (mean = 56.3 years). Furthermore, males with antral SCCA were younger than their female counterparts. Similarly, males who had mandibular gingiva/ alveolus SCCA (mean = 48.4 years) were younger than their female counterparts (mean = 62.8 years). Majority of the glandular carcinomas (GLDCAs) arose from minor salivary glands (63.0%). Thirty seven per cent of these patients were below 40 years at presentation. Females who had antral GLDCA (mean = 32.4 years) were relatively younger than their male counterparts (mean = 49 years). Most of the patients who presented with sarcoma were below 40 years (77.4%) and males were younger (22. 8 years) than females (mean = 35.4 years). CONCLUSIONS: The proportion of orofacial cancers that is SCCA in Nigerians is relatively low because of a relatively high proportion of GLDCA and Burkitt's lymphoma. A relatively high proportion of patients with SCCA were below 40 years at presentation. They were predominantly males who presented with poorly differentiated tumours.

Plunging ranula: a report of two cases.

Plunging ranula, a rare differential diagnosis of cervicofacial masses is presented in two Nigerian patients. The authors highlight the pathophysiology and treatment methods of this condition. It is suggested that clinicians be aware of the various modes of presentation and natural history of the disease to facilitate prompt diagnosis and appropriate treatment.

Changing picture of facial fractures in northern Nigeria.

This was a prospective study that aimed to find out the current pattern of facial fractures in northern Nigeria and to see if changes in the socioeconomic conditions in Nigeria during the past 20-30 years have affected the aetiology, sex and age distribution of the patients, and type of facial fractures. The setting was the maxillofacial unit of the University of Maiduguri Teaching Hospital, which is the only referral centre for facial trauma in north-eastern Nigeria, serving a population of about 30 million people. All 306 patients were treated for facial fracture between January 1996 and December 1999. Most of the patients (126/306, 41%) were in the age range 21-30 years and the male to female ratio was 2.19:1. The main causes of the fractures were assault (n = 147, 48%) followed by road traffic accidents (n = 111, 36%). Other aetiological factors such as falls, and sports or industrial accidents accounted for the remaining cases. Of the assault-related injuries 102 (33%) were the result of armed robbery and 45 (15%) the result of fights, mainly on the farms. The mandible was the most common site of fractures (n = 273, 89%) and most of the mandibular fractures were in the body of the mandible. Only 44/306 patients (14%) reported to the hospital within the first 24 hours after injury. Changing socioeconomic conditions are associated with an increase in assault-related facial fractures, but the predominantly affected age group, sex and site of fracture remain relatively constant.

Malignant neoplasms of the maxillary antrum in Nigerians.

OBJECTIVE: To highlight the presentation of antral cancers in Nigerians. PATIENTS AND METHODS: Hospital records of all patients with a histologically diagnosed antral cancer who presented at the Lagos University Teaching Hospital (a tertiary referral centre) over a 16 year period were analysed. RESULTS: 28.7% of orofacial cancers and 12.6% of head and neck cancers were located in the antrum. 54.1% were squamous cell carcinoma, 27.4% were minor mucus gland carcinoma and 14.8% were mesenchymal cancers. Males were more frequently affected (ratio 1.7 to 1) and were relatively younger (peak age = 4th decade) than females (peak age = 6th decade). Males who had squamous cell carcinoma (x = 47.5 +/- 18.8 years) were relatively younger than their female counterparts (x = 57.2 +/- 13.8 years). But females with minor mucus gland carcinoma were relatively younger (x = 34.2 +/- 19.5 years) than males (x = 49.1 +/- 17.9 years). All patients had facial swelling at presentation and the most frequent initial symptom was toothache (36.2%). Fifty-two percent had prior treatment and the most common was an extraction of a molar tooth (50%). Two-thirds of the patients were of low socio-economic status. CONCLUSION: Antral cancer constituted sizeable proportion of orofacial and head and neck cancers in Nigerians. Clinicians need to maintain a high index of suspicion in cases of maxillary molar toothache or mobility of obscure aetiology. Predisposing aetiologic factors of this disease peculiar to our environment need to be further investigated.

The adenomatoid odontogenic tumor: an analysis of 57 cases in a black African population.

PURPOSE: This study analyzed the findings in a large series of adenomatoid odontogenic tumors (AOT) in Nigerians. PATIENTS AND METHODS: Hospital records of all cases of AOT diagnosed at three teaching hospitals were reviewed and analyzed. RESULTS: Most of the tumors were intraosseous (central) (98.3%) and of the follicular type (75%). Females were more frequently affected than males (1.4:1), and patients in their second decade of life were most frequently affected (75%). Patients with follicular AOT were relatively younger (15.2 +/- 5.6 years) than those with extrafollicular tumors (20.9 +/- 13.8 years). However, males who presented with extrafollicular tumors (14.6 +/- 3.9 years) were relatively younger than their female counterparts (24.9 +/- 16 years). The maxilla was affected nearly twice as often as the mandible (1.8:1), and the canine tooth was frequently embedded in the tumor (76.9%). Although follicular tumors were most frequently located in the maxilla (76.3%), extrafollicular tumors were more commonly found in the mandible (69.2%). CONCLUSION: The distribution of this tumor in black Africans does not appear to be substantially different from that reported in caucasians.

Salivary gland neoplasms in Lagos, Nigeria.

This 14 year retrospective clinico-statistical analysis of 237 salivary gland neoplasms in Lagos, Nigeria, was undertaken with a view to providing further insights into the presentation of this disease in Africans. These neoplasms constituted 10.0% of all head and neck neoplasms, and were most frequently situated at the parotid gland (32.1%), the palate (24.9%) and the submandibular gland (19.4%). While parotid squamous cell carcinoma affected more males (41.2%) than females (4.7%) (P = 0.03); parotid mucoepidermoid carcinoma affected more females (53.3%) than males (11.8%) (P = 0.0149). Furthermore, labial salivary gland tumours affected more females (6.8%) than males (1.7%) (P = 0.05). At presentation, patients with palatal tumours were relatively more advanced in age (Peak = 6th decade) than those with parotid and submandibular tumours (Peak = 3rd decade). Males presenting with pleomorphic adenoma were relatively younger than their female counterparts. This is especially true of palatal pleomorphic adenoma. The recurrence rate for benign tumours was 4.8%. Majority of patients with malignant tumours (83.9%) had significant local extension, regional or distant metastasis at presentation. In twenty-nine percent of these patients with cancer, the disease was controlled for 1-5 years of follow-ups. However, a quarter of these patients with cancer defaulted the planned treatment regime because they could not afford the cost of treatment or they opted for traditional medical care.

A study of orofacial tumors in Nigerian children.

PURPOSE: This study evaluated the type and distribution of tumors in the orofacial tissues of black African children. PATIENTS AND METHODS: The hospital records of all patients aged 15 years or younger, who presented at the Lagos University Teaching Hospital (a tertiary referral center) with a histologically confirmed orofacial tumor over a 13-year period were analyzed. RESULTS: One-fifth of all orofacial tumors during the study period occurred in the pediatric age-group. The male-female ratio was 1.4 to 1 and 11- to 15-year-olds were most frequently affected. Benign tumors (59.8%) were more prevalent than malignant tumors (40.2%). Overall, 18.4% of the tumors were of odontogenic origin, 42.5% were benign nonodontogenic tumors, and 39.1% were malignant nonodontogenic tumors. The anterior part of the mandible was frequently involved by ameloblastoma, which was the most common odontogenic tumor (6.3%). Most of the benign nonodontogenic tumors were of mesenchymal origin (46%), and most were located in soft tissues (59.5%). Burkitt's lymphoma (22.4%) was the most common malignant nonodontogenic tumor. CONCLUSION: The observed differences in tumor type and distribution in this study compared with previous studies may be attributable to genetic and geographic differences in the populations studied.