A comparison between 2D and 3D methods of quantifying facial morphology.

OBJECTIVES: Currently, two & three-dimensional (2D & 3D) imaging techniques have largely replaced the direct anthropometric method in the assessment of facial morphology, but the difference between the two techniques was not quantified. Therefore, the aim of this study was to compare and quantify (the difference between) the two techniques. MATERIALS AND METHODS: The faces of 150 subjects (75 males, 75 females) of northern Nigeria, predominantly Hausa ethnic group, were photographed (using digital camera) and scanned (using a 3D surface laser scanner). Facial dimensions were generated from the resulting virtual 2D and 3D models. Data were analyzed using R-statistic software & Paired sample t-test/Pearson correlation were conducted to compare the two methods and to quantify the level of closeness between the two measurements. RESULTS: Intraclass correlation coefficient (ICC) was very low (0.26) for the 3D and 2D measurements indicating the level of differences between the methods. Measurements taken with laser scanner were higher relative to the one taken by camera. The mean differences between the 3D and the 2D methods of quantifying facial morphology indicated a statistically significant positive difference. CONCLUSION: 2D and 3D anthropometry cannot be used interchangeably since there exists statistically significant variation between the two methods.

Prospective study of the quality of life after treatment of mandibular fractures.

Health-related quality of life (QoL) has become increasingly important, but few studies have dealt with that of patients who have been treated for mandibular fractures. Our aim was to assess this. Patients with mandibular fractures (n=148) were studied prospectively and QoL after treatment was assessed using the General Oral Health Assessment Index (GOHAI). The male-female ratio was 8.3:1 and their ages ranged from 14 to 70 years. QoL after treatment of the fractures declined initially (on the first postoperative day) but thereafter improved steadily. There was no significant difference between the mean QoL of those treated by closed, and those treated with open, reduction. Limitations in the options of food to eat, and difficulty in chewing and swallowing, were identified as their most important concerns in the early postoperative period. The improvement in QoL after the first postoperative day was similar however the patients were treated.

Overweight and obesity among patients attending a Nigerian oral surgery clinic: implications for oral surgical practice in Nigeria.

AIM: To determine the prevalence of overweight and obesity among patients attending oral and maxillofacial outpatient clinic of the Lagos University Teaching Hospital, Nigeria; and discuss the clinical and surgical implications that obesity has on the delivery of oral and maxillofacial surgical and anaesthetic care. METHODS: Consecutive patients presenting to the oral and maxillofacial surgery outpatient clinic at the Lagos University Teaching Hospital, Nigeria over a 4-month period (May-August 2004) were screened for age, sex, height and weight. All of the patients were treated for dentoalveolar surgical procedures (routine and surgical extractions), incisional and excisional biopsies, and enucleation under local anaesthesia. RESULTS: The BMIs of the studied patients ranged from 16.7 to 39.8 kg/m(2), with a mean of 24.6 +/- 4.5 kg/m(2). Prevalence of excess weight was 39.1%. Thirty-one (11.4%) patients were obese and 75 (27.7%) patients were overweight. A significant difference was observed in the BMIs of male and female patients (P=0.000). The age groups < 30 years had mean BMIs that were considered normal; whereas other age groups above 30 years had mean BMIs that were considered overweight. Prevalence of obesity increases with increasing age. Obese individuals were seen in all the age groups except those < 20 years. CONCLUSIONS: The prevalence of excess weight (overweight and obesity) in patients presenting in the studied oral and maxillofacial outpatient setting was 39.1%. Oral and maxillofacial surgeon needs to be aware of obesity-/overweight-related medical and surgical issues and take them into consideration when treating these patients.

Knowledge and perceptions of facial plastic surgery among a selected group of professionals in Lagos, Nigeria.

This was a questionnaire-based study among a selected group of professionals in Lagos, Nigeria to assess their knowledge, attitude and perceptions to facial plastic surgery. A well-structured questionnaire was administered to a group of professionals in the banking industry and the civil service. The respondents were asked if they had heard of 'facial plastic surgery' before and if they were familiar with some selected facial plastic surgery procedures. They were also asked if they had ever considered undergoing facial plastic surgery for any real/perceived facial abnormalities; if they knew any close relatives/friends who had undergone facial plastic surgery and if they considered the result satisfactory or not. A total of 130 respondents participated in the study; of these, 102 (78.5%) respondents had some knowledge of 'facial plastic surgery' while 28 (21.5%) respondents had no prior knowledge of facial plastic surgery. Fifty-five of the 102 respondents had some knowledge of liposuction of the face and neck. Nineteen of the 130 respondents expressed willingness to undergo facial plastic surgery for removal of facial wrinkles and excess fat on the cheeks and neck. Only 17 (13%) of the respondents had ever thought of undergoing facial plastic surgery; of these 17 respondents, nine claimed that their facial appearance was the main reason. Respondents with perceived facial abnormalities were more likely to undergo plastic surgery than those without perceived abnormalities (P=0.000). Twenty-four (18.5%) of the 130 respondents knew of a friend/close relative who had undergone facial plastic surgery before, and the majority (19 of the 24) considered the result of the surgery satisfactory. We conclude that most of the study participants had some knowledge of facial plastic surgery; however, only a few expressed willingness to undergo facial plastic surgery for removal of facial wrinkles and folds/fat on the cheeks and neck. The fact that only a few of the respondents knew someone who had undergone facial surgery may reflect the low level of availability of facial plastic surgery procedures in Nigeria.

Conebeam computed tomography (CBCT): the new vista in oral and maxillofacial imaging.

Cone beam computed tomography (CBCT) has the potential to reduce the size and cost of CT scanners. This emerging technology produces images with isotropic sub-millimeter spatial resolution with high diagnostic quality, short scanning times of about 10-30 seconds, and radiation dosages of up to 15 times lower than those of conventional CT scans. It is ideally suited for dedicated dentomaxillofacial CT scanning. This technology provides dental practitioners with complete solution for performing specific diagnostic and clinical tasks, including implant planning, temporomandibular joint evaluation, facial fractures, dentoalveolar surgery, orthognathic surgery and periodontal surgery. CBCT is capable of providing a 3-dimensional representation of the maxillofacial hard tissues with minimal distortion. The objective of this article is to highlight the clinical applications of CBCT to oral and maxillofacial surgeons and other dental specialists in Nigeria.

Levels of evidence of published articles in major Nigerian medical journals: a critical appraisal.

In modern day medical practice, "rules of evidence" have been established to grade clinical and research findings according to strength. The aim of this study is to describe the current pattern of publications in 5 major Nigerian medical journals in terms of levels of evidence. Five major peer-review medical journals (Nigerian Q J Hosp Med, Nigerian Post grad Med J, West African J Med, African J Med Med Sci, and Nigerian J Clin Pract) published in Nigeria were included in the study. All articles published in 2005 and 2006 were accessed, classified into four levels of evidence, and pattern of publications was described. All eligible 580 published articles were analysed. None (0%) achieved level I evidence, 15 (3%) were level II, 47 (8%) level III, and 258 (44%) level IV; and the majority (n = 260, 45%) of the published were classified as non-evidence. There were more evidence articles in indexed journals than in non-indexed one (P = 0.000). Among the 260 non-evidence articles there were 97 (37.3%) case reports, 28 (10.8%) non-systematic review articles, 30 (11.5%) animal studies, 6 (2.3%) laboratory studies, 3 (1.1%) technical notes and 94 (36.1%) were classified as others (KAP studies, reports, guidelines, questionnaire-based studies). The general level of evidence of articles published in the five major medical journals in the 2-year period 2005-2006 was low as only 11% of articles were levels II and III. There is a need to improve on the quality and funding of medical research in Nigeria in order to promote better patient care.

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.

Evidence-based dental practice: part I. Formulating clinical questions and searching for answers.

Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences. Evidence-based care is now regarded as the "gold standard" in health care delivery worldwide. EBD involves tracking down the available evidence, assessing its validity and relevance, and then using the "best" evidence to inform decisions regarding care. Although, the concept of evidence-based dentistry is not new, however, anecdotal evidence suggests that the awareness of this concept among Nigerian dental practitioners is low. This first of three articles on evidence-based dental practice discusses the historical background of evidence-based medicine/evidence-based dentistry, how to formulate clear clinical questions and how to track down (search) the available evidence in the literature databases.

Evidence-based dental practice: Part II. Levels and quality of evidence, and research designs.

The ability to make a sound clinical decision is based largely on the quality of evidence and the practitioner's ability to evaluate this evidence. Clinical evidence are categorized and ranked according to the strength of their freedom from the various biases that beset medical research. Randomized controlled trials (RCTs) are the "gold standard" by which all clinical research is judged. Systematic reviews/meta-analysis of randomized controlled trials where available are considered the highest level in the evidence hierarchy (clinical questions related to therapy or interventions). However, this hierarchy of evidence can not answer all clinical questions especially the ones regarding diagnosis, aetiology or prognosis. For questions related to diagnosis, prognosis or causation, other study designs such as longitudinal studies, cohort studies or case-control studies are more appropriate. The present article discusses the levels and quality of evidence, and basic concepts of clinical research design in evidence-based dental practice based on review of existing literature.

Evidence-based dental practice: part III. Critical appraisal of the literature, relevance and application of the evidence.

Evidence-based dentistry involves defining a question focused on a patient-related problem and searching for reliable evidence to provide an answer. Once potential evidence has been found, it is necessary to determine whether the information is credible and whether it is useful in one's practice by using the technique of critical appraisal. This article discusses the guidelines that have been developed to guide clinicians in assessing the validity and the relevance of published studies (randomized control trials, systematic reviews, cohort studies and case-control studies). The concept and tools of "critical appraisal" of published research works were developed by the evidence-based medicine group at McMaster University, Canada.

Surgical management of a large complex odontoma of the mandibular angle-ramus region through intra-oral buccal approach--A case report.

Large complex odontomas of the jaws are rare. A report of a large complex odontoma of the mandibular angle-ramus region enucleated through intra-oral buccal approach is presented. A review of the literature on different modalities of treatment is also undertaken. A large expansile complex odontoma of the angle-ramus region of the mandible was excised through an intraoral buccal approach under general anaesthesia. Recovery and immediate post-operative period were uneventful. There was no altered sensation in the distribution of the inferior alveolar nerve and lingual nerve; and wound healing was satisfactory. Post-operative radiograph 2 years after the operation showed satisfactory bone regeneration. Intraoral buccal approach to large complex odontomas of the angle-ramus region of the mandible is a relatively safe procedure with minimal complication.

Gene therapy in the management of oral cancer: a review of recent developments.

AIMS: This article reviews the present body of knowledge regarding the principle, transfer techniques, therapeutic strategies, clinical applications and limitations of gene therapy in the management of oral squamous cell carcinoma. MATERIALS AND METHODS: Scientific publications on gene therapy between 1990 and 2003 were selected for the purpose of the review. These include clinical articles, experimental studies and review articles. RESULTS: Viruses are the commonly used transfer system for the delivery of gene therapy. The viral vectors commonly used are: retroviruses, adenoviruses, herpesviruses, and adenoassociated viruses (AAV). Transfection of cancer cells in vivo with gene therapy is done by intralesional injection, and sometimes by topical application. Phase I and II clinical trials have established the safety and clinical efficacy of gene therapy in the treatment of oral squamous cell carcinomas in humans, especially in combination with chemotherapy or radiotherapy. Phase III clinical trials and studies of the use of gene therapy as an adjuvant following surgery are presently underway. CONCLUSIONS: Gene therapy represents a new and innovative approach to the treatment of oral cancer especially in recurrent disease and adjuvant treatment. Oral squamous cell carcinoma is especially an attractive tumour target due to its frequent genetic mutations and accessibility for intra-tumoural administration of gene therapy. However, gene therapy has not yet been shown to be suitable for systemic delivery in cancer patients, hence the control of regional and metastasis is presently difficult.

The use of buccal fat pad in oral reconstruction - a review.

AIM: The aim of this article is to review the applications of the buccal fat pad (BFP) in oral reconstruction, 25 years after its first use as a pedicled flap. MATERIALS AND METHODS: A computerized literature search was conducted for articles published from 1977-2002. Mesh phrases used in the search were: buccal fat pad, buccal fat pad and oral reconstruction. RESULTS: A total of 43 articles were selected for the review based on the criteria for the study. Thirty of these articles were clinical articles, 8 were anatomic studies, 2 were review articles, 1 was an experimental study and 2 discussion articles. Only 9 clinical articles were published prior to 1990, and between 1990 and 2002, a total of 21 clinical articles were published. Various application of BFP in oral reconstruction include closure of surgical defects following tumor excision, repair of surgical defects following excision of leukoplakia and submucous fibrosis, closure of primary and secondary palatal clefts, coverage of maxillary and mandibular bone grafts and lining of sinus surface of maxillary sinus bone graft in sinus lift procedure for maxillary augmentation. CONCLUSIONS: The easy mobilisation of the BFP and its excellent blood supply and minimal donor site morbidity makes it an ideal flap. The main advantages of BFP are ease of harvesting, simplicity, versatility, low rate of complications as well as quick surgical technique. The operation can be performed in one incision, affecting neither appearance nor function of the area.

Concurrent pleomorphic adenoma in parapharyngeal space and submandibular gland.

BACKGROUND: Pleomorphic adenoma in the parapharyngeal space either occurs de novo or as an extension from the deep lobe of the parotid gland. CASE PRESENTATION: A rare synchronous occurrence of pleomorphic adenoma in the parapharyngeal space and submandibular gland of a 48-year-old Nigerian male is reported. CONCLUSION: Pleomorphic adenoma concurrent in the parapharyngeal space and submandibular gland is very rare. A complete surgical excision of both tumors is the treatment of choice.