The COVID-19 pandemic and dental residency training in Nigeria.

INTRODUCTION: The COVID-19 pandemic has had wide-ranging effects on dental practice across the world. In particular, if has also affected the training of dental residents, who are specialists in training. Thus, the aim of this study was to assess the knowledge, perception and attitude of dental residents in Nigeria to the pandemic and its perceived impact on the dental residency training programme across the country. MATERIALS AND METHODS: This was a cross-sectional study of dental residents in teaching hospitals across Nigeria. Self-administered questionnaires were distributed to consenting participants through an online data collection platform (Google forms), between April and June 2020. Data were collected on sociodemographics, knowledge and awareness of coronavirus as well as impact of the pandemic. Data analysis was carried out with the Statistical Package for Social Sciences (SPSS) version 20. Level of significance was set at p-value < .05. RESULTS: A total of 104 dental residents participated in the study from ten residency training institutions in the country with a mean age of 35.65 ± 4.8 years. Almost all 98 (94.2%) of the residents showed a good knowledge of COVID 19. About two-thirds, 72 (69.2%) of the participants were mostly worried about COVID-19 affecting their residency training program 72 (69.2%), with their greatest source of worry being the risk of contracting the virus in the dental clinic. CONCLUSION: The dental residents had a very good knowledge of the epidemiology, diagnosis, prevention and treatment of COVID-19 and majority of them felt that it would affect their training residency programme.

Empathy among dental students in a Nigerian institution.

OBJECTIVES: To determine the reliability and validity of the Jefferson Scale of Empathy-Health Profession Students (JSE-HPS) version as a tool to measure the empathy levels in undergraduate dental students in Nigeria. METHODS: A cross-sectional study conducted from 15 December 2015 to 12 January 2016 among 234 undergraduate dental students of the University of Lagos, Nigeria. Participants were proportionately selected from the first to sixth year by systematic sampling technique. Data were collected with a self-administered JSE-HPS questionnaire with internal consistency determined by Cronbach's α-coefficient reliability test. Data were analysed with SPSS software. Exploratory factor analysis was used to test for the fundamental construct validity of the scale among the students. P values <0.05 were considered significant. RESULTS: The response rate of the respondents was 90.60% with 212 completed questionnaires with a mean age (SD) of 21.18 years (2.43) and internal reliability (Cronbach's α-coefficient) was 0.84. Factor analysis revealed "Compassionate Care," "Standing in Patients' Shoes" and "Perspective Taking" as first, second and third factors, respectively. The total mean empathy score (SD) was 104.01 (19.64). The mean empathy for females (SD) of 105.34 (17.31) was not significantly higher than the males (P = 0.08). There was a significant difference in empathy levels between the second- and the fourth-year students (P = 0.01). CONCLUSION: The mean JSE-HPS score was comparable to those reported for dental, medical and other health professions students and physicians. Thus, this study demonstrates the construct validity and reliability of the JSE-HPS for measuring empathy among Nigerian dental students.

Chronic rhinosinusitis and endoscopic sinus surgery.

Olfactory dysfunction is a major symptom reported by patients with chronic rhinosinusitis (CRS). Surgical treatment of this disease requires close surveillance of such dysfunction because of wide ranging implications for safety, quality of life, and impact on the flavor of foods and beverages. This review highlights key findings regarding the influences of endoscopic sinus surgery (ESS) on olfactory function across the unique presentations of CRS. Such findings provide information useful for informing patients of potential complications and for obtaining informed consent prior to surgical intervention. ESS has been shown to improve olfaction across all types of CRS as assessed through quantitative testing and subjective reports. The presence of nasal polyposis (NP) and eosinophilia have been identified as predictors of significant postoperative olfactory improvement. When indicated, judicious partial resection of the middle turbinate may result in improved olfactory function without a risk of long term complication. Careful attention to the olfactory cleft and frontal sinus recess are important in limiting olfactory complications by avoiding indiscriminate disruption of olfactory epithelium. Given the chronic nature of the disease, surveillance of olfactory function in patients with CRS is a lifelong activity that will evolve as emerging technologies become available.

An update regarding the treatment of nonallergic rhinitis.

PURPOSE OF REVIEW: The review presents some information on known options for treatment of nonallergic rhinitis (NAR) with introduction to new therapies. The merits and limitations of recent advancements in pharmacotherapy of this common problem are briefly discussed as well. RECENT FINDINGS: Intranasal corticosteroids are first-line therapy for NAR. Fluticasone propionate and beclomethasone remain the only topical corticosteroids approved for NAR. The use of azelastine - another first-line option - has also been found to be effective even though NAR is a nonallergic entity by definition. Combination of fluticasone propionate and azelastine is a promising option in achieving better symptom reduction. Coadministration of intranasal corticosteroid and topical decongestants is an attractive topic that requires additional safety studies before recommending treatment. Although promising, no scientifically valid recommendation can be made for treatment of NAR with capsaicin. Surgical options in patients with refractory NAR are limited. New studies demonstrate a lack of correlation between objective outcome of radiofrequency ablation of the inferior turbinate and subjective patient symptoms. SUMMARY: The heterogeneity in clinical presentation makes NAR treatment a daily challenge for otolaryngologists. The diversity of clinical studies with use of unique outcome measures limit systematic reviews which may be instrumental in providing strong recommendations.

An algorithmic approach to the evaluation and treatment of olfactory disorders.

PURPOSE OF REVIEW: To review the current evidence in diagnosing olfactory disorders and suggest an algorithmic approach to patients with relevant complaints. RECENT FINDINGS: New literature suggests that the incidence of olfactory loss increases with age. Age-associated olfactory loss is often multifactorial and requires careful history and physical exam. Psychophysical tests have a role in screening patients at risk for Parkinson's and Alzheimer's disease, but there is lack of evidence regarding timing and patient selection. Prediction of olfactory improvement in patients with chronic rhinosinusitis (CRS) is difficult with variable results from different studies. Olfactory training is suggested to be an emerging modality in patients with postinfectious olfactory loss. SUMMARY: There is no standard treatment for olfactory loss. Each patient must be approached individually based on the suspected cause. Patients with CRS may require medical management and surgical treatment for alleviation of their olfactory dysfunction.

Patient knowledge and perception of computed tomography scan in the management of chronic rhinosinusitis symptoms.

OBJECTIVES/HYPOTHESIS: The objective of this study was to report patients' knowledge and comfort level with computed tomography (CT) imaging for sinus disease and evaluate patient willingness to undergo empiric medical therapy (EMT) versus CT-directed therapy (CTDT). STUDY DESIGN: Prospective survey study. METHODS: A 22-item survey was administered to patients with nasal/sinus symptoms in a tertiary care rhinology clinic. Questions elicited patient demographics, imaging history, and knowledge/comfort regarding imaging-related radiation exposure. Patients were presented with the theoretical choice of EMT versus CTDT, given the expected positive predictive value, in chronic rhinosinusitis (CRS) management. RESULTS: Two hundred patients (52% female, age range 18-83 years) participated. Of these, 85% had symptoms for over 3 months. Only 91 patients (45.5%) were aware that CT imaging involved radiation exposure. Prior CT experience and past sinus surgery (P < .05), but not sex or education level, were associated with increased comfort with CT imaging. Most patients (78%) preferred CTDT over EMT. If a CT sinus was recommended, 77 patients (38.5%) had concerns, of which 26% identified radiation exposure as the leading concern. The majority (70%) were unsure about the relative radiation dose of a conventional CT. CONCLUSIONS: Patients with CRS symptoms prefer CTDT over EMT if a diagnosis cannot be established definitively using exam findings. Although most patients deferred to the physician regarding the decision to utilize CT imaging, there is low awareness of CT-related radiation exposure, and a significant minority of patients have radiation-related concerns with regard to medical imaging for nasal and sinus symptoms.

Lingual hamartoma associated with a cleft palate in a newborn.

A hamartoma is a benign malformation of native tissue that may occur in any area of the body. Hamartoma of the tongue is a rare developmental lesion. We describe the case of a pendulant lingual hamartoma in a 2-day-old girl that had not been identified on prenatal ultrasonography. We also review the utility of prenatal imaging options, the role of preoperative imaging, the mechanical relationship between lingual hamartoma and cleft palate, the histopathology of this tumor, surgical treatment, and emergency airway management.

Do you need to operate following recovery from complications of pediatric acute sinusitis?

OBJECTIVES: There are many studies that evaluate the role of surgery in the treatment of complications of pediatric acute sinusitis; however there are few studies, if any that report the incidence of surgery following recovery from acute complicated sinusitis. The goal of this study was to report the incidence and indications for surgical intervention after recovery from complications of pediatric acute sinusitis. METHODS: We reviewed the records of all children admitted to a tertiary care children's hospital between January 2005 and September 2010 with a diagnosis of sinusitis and an orbital or intracranial complication. Eighty-six patients met inclusion criteria. Charts were reviewed for type of complication, initial treatment (medical or surgical), type of procedure, secondary procedures, age, and comorbidities. Statistical analysis was completed using independent samples student t-tests and Mann-Whitney tests. RESULTS: A total of 86 patients with a mean age of 6.38 years (2 months to 18 years) were identified. Eighty patients had orbital complications while six presented with intracranial complications. Twenty-seven patients (31%) underwent sinus surgery during the acute phase of their illness whereas 59 patients (69%) were treated medically. After hospitalization and recovery for acute complicated sinusitis, surgery was performed on nine patients (mean age 4.86 years) within 1 month to 2 years post hospitalization. Of the nine patients who required secondary surgery following resolution of the initial complicated sinusitis, four patients were following initial surgical intervention and five patients had initially resolved their complication with medical therapy alone. Indications for subsequent surgery included failure of medical therapy for persistent rhinosinusitis (8 patients) and second complication (1 patient). CONCLUSIONS: This study suggests that following resolution of complicated pediatric rhinosinusitis, very few patients may need further surgical intervention. Subsequent intervention is best guided by clinical judgment, symptoms during outpatient clinic visits, and failure of medical therapy.

Surgical management of auricular infantile hemangiomas.

OBJECTIVE: To report our experience with surgical management of auricular infantile hemangiomas and reconstruction of the affected ear. DESIGN: Retrospective case series. SETTING: Dedicated Birthmarks and Vascular Anomalies Center in a tertiary pediatric hospital. PATIENTS: Ten patients with surgically treated, histopathologically confirmed auricular infantile hemangiomas. MAIN OUTCOME MEASURES: Outcomes of surgical management. RESULTS: The case series included 5 male and 5 female patients (age range, 4 months to 4 years). Indications for surgery were pain, bleeding, infection, and cosmetic deformity. Four patients had failed prior medical treatment, including pulsed dye laser, topical corticosteroids, and intralesional corticosteroids. Nine patients underwent single-stage resection. Otoplasty reconstruction was performed in 2 patients with hemangioma-induced deformities, while primary Z-plasty closure was performed in 2 patients with extensive lesions. No recurrence or complication has been reported to date. CONCLUSIONS: Most infantile hemangiomas do not require treatment. Surgical excision of auricular infantile hemangiomas at any phase is effective in preventing fibrofatty scarring, reducing cartilage deformities, and treating complicated cases or patients who have failed medical management. Surgical excision with Z-plasty reconstruction is a viable option that should be considered to limit postoperative deformities.

No need to fear evidence-based medicine.

Evidence-based medicine (EBM) aims to apply the best available evidence gained from the scientific method to clinical decision making. The notion seems noble in its purpose, yet there are some apprehensions and misconceptions among physicians, especially those in a predominantly surgical field such as facial plastic surgery. Developing a sophisticated understanding of the inherent biases and limitations of EBM will become increasingly important for the researcher and practicing surgeon as we strive to improve the rigor of our studies and produce noteworthy scientific evidence that improves the health outcomes for our patients.

Surgical treatment of infantile hemangioma in a multidisciplinary vascular anomalies clinic.

OBJECTIVE: (1) Discuss indications for surgical treatment of infantile hemangioma (IH); (2) describe outcomes, management of complications and long term surveillance of surgically treated IH. STUDY DESIGN: Retrospective. SUBJECTS AND METHODS: The charts of children seen in a dedicated vascular anomalies center at a tertiary pediatric hospital were reviewed. RESULTS: Out of 1012 patients diagnosed with IH over 27 months, 92 patients, predominantly caucasian female, with an average age of 36 months, underwent surgery for 94 lesions. Head and neck lesions accounted for 67% of the population and 51 lesions were located on the face. Surgical indications included bleeding, functional impairment, ulceration and cosmetic disfigurement. Mean surface area was 7.75 cm². Although lesions requiring additional procedures were larger (median 5.5 cm²) than single-stage excisions, this difference was not statistically significant (P=0.09). Head and neck lesions were more likely to require multiple modality treatment (P=0.003). There was no identified objective criteria to predict head and neck lesions that are more likely to be associated post-operative complications. CONCLUSIONS: Most IH do not require treatment. The majority of infantile hemangioma occurred on the head and neck. When significant functional impairment, ulceration, bleeding, cosmetic deformity is encountered or anticipated, surgical therapy can be performed at any clinical phase with few complications and favorable outcomes.

Diagnosis and treatment of deep neck space abscesses.

OBJECTIVE: To review our experience with deep neck abscesses and identify unique trends in our patient population. STUDY DESIGN: Case series with chart review. SUBJECTS AND METHODS: Evaluation of patients with deep neck space abscesses between 2001 and 2006. Peritonsillar abscess, superficial craniocervical infection, and salivary gland infections were excluded from selection of study population. A total of 106 cases were reviewed. RESULTS: Dental infections were the most common cause of deep neck abscesses (49.1%). Comorbidities included substance abuse (53.7%), psychiatric illness (10.4%), hypertension (9.4%), head and neck cancer (6.6%), and diabetes mellitus (5.7%). All patients received systemic antibiotics, eight patients required tracheotomy, 85 patients underwent surgical drainage in the operating room, and 11 had bedside drainage. Median and lower quartile of time in hospital was 2 and 3 days, respectively, whereas upper quartile was 4 days (range, 1 to 27 days). Patients with comorbidities or concurrent illness tended to stay longer (P<0.05, Mann-Whitney test). There were six complications and no mortality. CONCLUSION: Substance abuse and poor orodental hygiene are important predisposing factors to deep neck abscesses. Appropriate management continues to favor a combination of early surgical drainage and systemic antibiotics.

Surgical debridement and adjunctive hyperbaric oxygen in cervical necrotizing fasciitis.

OBJECTIVE: To review our management of cervical necrotizing fasciitis (CNF) with the use of adjunctive hyperbaric oxygen therapy (HBO). STUDY DESIGN: Case series with chart review. SUBJECTS AND METHODS: Evaluation of ten patients with CNF between 2001 to 2006. RESULTS: There were five male and six female patients. Mean age was 43 +/- 11 years. Eight cases resulted from an odontogenic source. Comorbidities included diabetes mellitus, hypertension, and substance abuse. All patients had computed tomography scans performed, received intravenous antibiotics, and underwent surgical debridement. Eight patients underwent surgery within 24 hours. The average number of debridements was 2.2 +/- 0.8. Hospitalization was twice as long for diabetic patients (15.5 +/- 8.16 days) compared with nondiabetic patients (7.5 +/- 1.6 days, P = 0.029). Nine patients had HBO therapy. Combined data revealed a possible decrease in length of hospitalization with HBO therapy (P < 0.001). No mortality was documented. CONCLUSION: In addition to early and aggressive medical management and surgical debridement, this study suggests that HBO therapy is a beneficial adjunct by potentially decreasing length of hospitalization. Randomized trials are still needed to demonstrate its efficacy.

Secreting jugulotympanic paraganglioma with venous involvement into the thorax.

Paragangliomas are highly vascular tumors that arise from chief cells in extra-adrenal paraganglia of the autonomic nervous system. Jugulotympanic paragangliomas involve the middle ear and jugular fossa. Secreting jugulotympanic paragangliomas with thoracic extension are rare. We report a case with unexpected involvement of the internal jugular vein. Otolaryngologists should be aware that the jugulotympanic paragangliomas traverse variable anatomic pathways. Multiple imaging options, including magnetic resonance venography, are useful and should include the neck for definitive characterization of tumor anatomy. Patients with refractory hypertension and masses suspicious for paraganglioma should be examined for functional tumors.