Oral human papilloma virus infection among dental clinic attendees in Ibadan, Nigeria.

Background: Human papilloma virus (HPV) is associated with a subset of oropharyngeal squamous cell carcinoma and mouth or throat warts. However, there is currently limited information about oral HPV infections in Nigeria. Objective: This study aimed to provide information on the occurrence and circulating genotypes of HPV among patients attending three (one government and two private) dental clinics in Ibadan, Nigeria. Methods: An oral swab was collected from 231 dental clinic attendees in Ibadan between January 2016 and March 2017 and tested for HPV DNA by polymerase chain reaction targeting the E6/7 genes of the virus. Results: Twenty-three of the 231 swab samples were HPV DNA positive comprising 16 mono-infections and seven co-infections in 13 males and ten females. Genotype 16 was present in ten patients, genotype 6/11 in five, Genotype 18 and genotype 33 in four each, genotype 31 in three and genotype 39 in one. Twenty-one cases were high-risk HPV genotypes, while two were low-risk. Samples had co-infection and five had low risk type 6/11 either as single or as co-infection. Persons who had engaged in oral sex as well as those aged 21-30 years has significantly higher prevalence. Conclusion: This study showed that although HPV genotype 16 is the most common type among dental clinic attendees in Ibadan, other genotypes are also circulating and that oral sex is a risk factor for the infection. Therefore, introducing a multivalent HPV vaccine will reduce the risk of HPV-associated oropharyngeal carcinoma and other cancers in Nigeria.

Burdens and predictors of the Burden experienced by Family Caregivers of Patients with Oral and Maxillofacial Tumours.

Aim: There is a dearth of knowledge on the burden of family caregivers of patients with maxillofacial tumours in Nigeria. This burden may be influenced by racial peculiarities and the disease entity of the patient. The aim of this study is to assess and document the burdens and predictors of burdens experienced by family caregivers of patients with oral maxillofacial tumours presenting at a tertiary health facility in South Western Nigeria. Materials and Methods: A descriptive cross-sectional study that included 110 consenting family caregivers of patients diagnosed with oral and maxillofacial tumours. A semi-structured questionnaire was used to collect information on their sociodemographic characteristics and caregiving burden using the Zarit burden interview tool. Data were analysed using descriptive and inferential statistics with Statistical Package for Social Sciences version 21.0. Result: The most frequent group of caregivers was patients' children (32.0%), aged 30-39 years (28.2%), females (54.5%), with secondary education (41.8%), and traders (38.2%), who earned less than national minimum wage (55.5%). Majority (42.7%) experienced mild-to-moderate burden; coping strategy was mainly prayers (76.4%), while the greatest need expressed was financial assistance (93.6%). The significant predictors of caregiver burden were the presence of pain (adjusted odds ratio [AOR] = 2.961; 95% confidence interval [CI] = 1.165-7.526; P = 0.023) and severe clinical condition (AOR = 3.342; 95% CI = 1.133-9.853; P = 0.029). Conclusion: The most common category of the burden of family caregivers of patients with maxillofacial tumours was the mild-to-moderate category, and the most significant predictors were the presence of pain and severity of clinical condition. The greatest need expressed was financial assistance. Therefore, an emphasis on adequate pain control and alternate sources of funding may appreciably relieve the burden of family caregivers of patients with maxillofacial tumours.

Quality of life of patients surgically treated for ameloblastoma.

BACKGROUND: The surgical management of ameloblastoma can have a profound functional and psychological effect on a patient's quality of life (QoL). The aim of this study was to compare the pre- and post-operative QoL outcomes of patients requiring surgical treatment for ameloblastoma. PATIENTS AND METHODS: A total number of 30 patients were identified as fulfilling the criteria for this study. They included 18 males and 12 females, aged between 14 and 47 years with a mean of 27.3 years (standard deviation 10.2). Each patient completed a modified version of the University of Washington QoL questionnaire version 4, a day to surgery and postoperatively on the 7(th) day, 3 months, and 6 months. RESULTS: Following surgical treatment of patients for ameloblastoma, the QoL decreased immediately after surgery. It then gradually improved over time and exceeded the preoperative value at 6 months postoperatively. When analyzed with respect to location, posteriorly placed tumors had the best postoperative QoL outcome. Patients expressed concern more about their appearance preoperatively while postoperative concerns were mostly focused on their ability to chew. CONCLUSION: Significant improvement occurred in QoL scores following surgical management of ameloblastoma. The small sample size utilized in this study limits a definitive conclusion. A larger multicenter study is therefore recommended.

Clinical Parameters and Challenges of Managing Cervicofacial Necrotizing Fasciitis in a Sub-Saharan Tertiary Hospital.

INTRODUCTION: Necrotizing fasciitis is a severe soft tissue infection. In our environment, patients presenting with this infection are usually financially incapacitated and, therefore, their management can be challenging. This paper aimed to document the pattern and challenges encountered in the management of cervicofacial necrotizing fasciitis (CNF) in the University College Hospital, Ibadan. MATERIALS AND METHODS: Information such as biodata, site of infection, systemic conditions, widest span of defect, management provided, hospital stay, and outcome of management was prospectively collected on all patients with CNF who presented at the Department of Oral and Maxillofacial Surgery between January 2007 and December 2013. The patients were managed according to a devised protocol of antibiotic therapy, serial debridement and honey dressings. RESULTS: Twenty-four cases of CNF were seen. There were 9 males and 15 females while 70.9% of the patients belonged to the low socioeconomic class. The mean span of wound defect was 12.2 (±8.844) cm. The mean hospital stay was 27.8 (±23.1) days, and scar formation was the most common complication encountered. CONCLUSION: Our study represents the largest series of CNF from a Nigerian health facility presently. The management of necrotizing fascitis in the maxillofacial region poses a significant challenge to both the surgeon and the patient. However, the mortality rate of CNF in our center appears comparatively low.

Perioperative findings and complications of non-vascularised iliac crest graft harvest: The experience of a Nigerian tertiary hospital.

BACKGROUND: The reconstruction of a mandibular defect remains a significant challenge to the reconstructive surgeon. In developing countries like Nigeria, the required facilities and expertise for vascularised graft surgery are not readily available, thus mandibular defects are commonly reconstructed with non-vascularised bone grafts. The aim of this study is to describe the experience with the reconstruction of mandibular defects using non-vascularised iliac crest bone grafts (NVICBG) at a Nigerian tertiary hospital. PATIENTS AND METHODS: This was a descriptive longitudinal study in which data was prospectively collected from patients who had mandibular reconstruction secondary to benign lesions using NVICBG at the University College Hospital, Ibadan, over a 24-month period. Information recorded included demography, cause of mandibular defect, type of mandibular resection, span of defect, peri-operative data, recipient site complications and donor site complications. Patient satisfaction with facial aesthetic outcome was assessed with the use of visual analogue scale score. RESULTS: Twenty patients had mandibular resection and immediate reconstruction with NVICBG. The mean age was 31.61 (+/-11.05) years. Mean span of the defects was 10.65 (+/-2.88) cm. At the recipient site, two patients had extra-oral wound dehiscence and two patients had intra-oral wound dehiscence of which one patient had loss of the graft. Donor site complications noted were seromas and wound dehiscence. Eighteen patients had paraesthesia of the lateral femoral cutaneous nerve. All patients had temporary abnormal gait. The mean duration of abnormal gait was 2.11 weeks (SD +/-0.74). Majority of the patients were satisfied with the aesthetic outcome. CONCLUSION: NVICBG, though limited in its versatility has satisfactory aesthetic outcome with relatively few complications. It appears that this method of reconstruction can be used even for large mandibular defects contrary to perceptions of many reconstructive surgeons.

Management of fascial space infections in a Nigerian teaching hospital: A 4-year review.

BACKGROUND: Fascial space infections of the head and neck region, usually odontogenic in origin, are routinely treated as an out-patient procedure. Untreated or rapidly spreading odontogenic infections can be potentially life threatening. The present study is a review of patients with orofacial infections who required emergent incision and drainage in the maxillofacial unit of our institution. The need for early presentation is highlighted. MATERIALS AND METHODS: This is a retrospective study of patients with orofacial space infections between January 2007 and December 2010. Patients' case files were retrieved and demographic as well as clinical characteristics were obtained and analyzed. A P value of <0.05 was considered significant. RESULTS: A total of 53 patients with fascial space infection were seen over the period of study. Of the 41 patients reviewed, males accounted for 26 (63.4%) and females 15 (36.6%). Their ages ranged from 4 months to 80 years (mean 32.8± 18.3 years). There was no statistical difference between the mean age of male and female patients (t=-962, P=0.342). Submandibular space was the most frequently involved single space and accounted for 43.9% of the cases. This was followed by multiple space involvement (Ludwig angina) which accounted for 36.6%. Buccal space and submasseteric space infection represented 7.3% each. Sources of infections were of odontogenic origin in 92.7% of cases and were unknown in the remaining 7.3%. The outcome was satisfactory with complete resolution in 48.8% of cases. Resolution with some morbidities in the form of persistent limitation of mouth opening, orocutaneus fistula, and necrotising fascitis were seen in an almost equal proportion of 46.3% of cases. The outcome was observed to be significantly associated with the presence of underlying systemic conditions (χ(2) =21.66; r=0.73; P=0.0001), time of presentation (χ(2) =12.28; r=0.55; P=0.002), and age (χ(2) =54.48; r=0.69; P=0.0001). CONCLUSION: Fascial space infections of the head and neck region, though potentially life threatening, can be prevented by regular dental visits. Early recognition and treatment of established cases are necessary to prevent considerable morbidity and mortality, especially in older patients with an underlying systemic condition.

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.

Relative impact of patient characteristics and radiographic variables on the difficulty of removing impacted mandibular third molars.

AIM: The aim of this study was to assess the relative contributions of patient characteristics and radiographic variables to the difficulty of extraction of impacted mandibular third molars in a Nigerian population. METHODS AND MATERIALS: Seventy-nine consecutive patients undergoing mandibular third molar extractions were recruited for this prospective cohort study. Specific patient characteristics and radiographic variables were recorded. All extractions were performed under local anesthesia by the same oral surgeon, and the surgical difficulty was assessed based on the duration of surgery. RESULTS: Body weight (BW) (P=0.009) and body surface area (BSA) (P=0.004) were the significant patient characteristics while tooth impaction depth (P=0.002), number of roots (P=0.035), and tooth angulation (P=0.003) were the significant radiographic variables associated with surgical difficulty using a univariate analysis. A multiple linear regression model was constructed with these variables using surgical difficulty as the dependent variable. Radiographic factors were found to be the more important determinants of surgical difficulty with the depth of impaction (P=0.038) being the singular most important factor. CONCLUSION: Although the difficulty of surgical removal of impacted lower third molars is dependent on BW, BSA, impaction depth, tooth angulation, and the number of roots, radiographic variables were of greater importance with impaction depth being the most important single factor.

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.

Trends in the characteristics of maxillofacial fractures in Nigeria.

PURPOSE: The study purpose was to assess the changes in the pattern of maxillofacial fractures in 2 different study periods. PATIENTS AND METHODS: We conducted retrospective study of 341 patients treated for maxillofacial fractures between January 1978 and December 1982 and a prospective study of 483 patients treated between January 1995 and December 1999 at the Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria. Data were collected on age, gender, etiologic factor, and site of injury. RESULTS: The male-to-female ratio reduced in the second period by a factor of 2.0. Patients in the age groups of 21 to 30 years and older than 60 years increased by a factor of 1.8 and 2.9, respectively, in the second period. Assaults, falls, sporting injuries, and industrial accidents in the second period increased by a factor of 1.4, 1.5, 3.5, and 1.5, respectively. The ratio between road traffic accidents and other causes changed from 3.4:1 to 2.2:1 in the second period. Mandibular fractures increased by 2% in the second study period. CONCLUSION: The data confirmed that although other etiologic factors are increasing in number, road traffic accidents remains the major etiologic factor of maxillofacial fractures in Nigeria. There is a need to enforce seat belt use, speed limit, and drink driving laws to reduce maxillofacial injuries caused by road traffic accidents; to organize preventive programs to minimize assaults, and to legislate the wearing of headgear by industrial workers.