Pilot study of new statistical models for prognostic factors in short term survival of oral cancer.

Background: Survival times of oral cancer are poorly documented in Nigeria. This is partly due to poor documentation and limited investigations to elicit sufficient prognostic factors. In this study, we applied a new statistical model for survival times of oral cancer patients considering limited prognostic factors. Methods: A total of 29 cases of Oral cancer patients with stage I to IV invasive primary oral cancer treated at the University of Port Harcourt, Nigeria between 2008 and 2015 were used to generate prognostic models. Profiled prognostic factors include age, stage of tumor development, habitus, and treatment modalities. The baseline statistical distributions considered were Exponential, Weibull, Lognormal and Log-logistic distributions. The Chi-Square test was considered for the suitability of the model chosen. A comparison of the model performance was done using the Akaike Information Criterion (AIC). Results: Seventeen (58.6%) of the oral cancer patients were males and 12(41.4%) were females within the age range of 19 and 73 years. Sixteen (55.2%) of the patients were censored while 13(44.8%) were not censored. The estimated median survival time (MST) for the males was 29.50 months while that of the female was 7 months. Four parametric statistical models were tested and all identified tumor stage [cTNM stage (p= 0.000)] and treatment modality (p= 0.000) as more important predictors of survival. The models were then compared, using the Akaike Information Criterion (AIC) to determine the model best fit for the data. The model with the lowest AIC and so considered the best was the Weibull Statistical Model (WSM) with AIC= 100.76. Conclusions: This study suggests that the Weibull survival model is the best fit for estimating oral cancer survival times especially where only limited prognostic factors are available. Larger studies are required to validate the findings of this pilot.

Evaluation of Surgical Glove Perforation and Sharps Injury in Oral and Maxillofacial Surgery.

Introduction: The risk of exposure to infections during surgery is partly mitigated by gloving. However, perforation can reduce the effectiveness of gloving as a barrier to exposure. This study aimed at investigating the frequency of surgical glove perforation and factors predictive of these in our oral and maxillofacial surgical practice. Materials and Methods: The study was carried out at the National Hospital and the University of Abuja Teaching Hospital, Abuja, Nigeria. Consenting patients requiring oral surgical interventions were consecutively recruited into the study. Similarly, surgeons and their assistants who consented to the study were also enlisted in the study. At the end of every surgical procedure, gloves used by the surgeons and the assistants were tested for perforation. Variables investigated included the rate of perforations, the influence of the type of gloving, single versus double gloving, type of anaesthesia, and duration of surgery on rates. Results: At a minimum of three operators per procedure, a total of 154 participants were involved in the study and 895 gloves were used. The number of glove perforations was 117(13.1%) with 82 (70.1%) involving the surgeons. There were 58/117 (49.6%) cases of perforation involving the dominant hand. Forefinger glove perforation accounted for 62 (52.9%) cases. Wire-related perforations were 72 (61.5%). Overall, nine cases of percutaneous injury were recorded. Duration of operation and double gloving were the predictive factors for perforations. Conclusion: Risk of sharps injury was relatively high due to the high incidence of glove perforation.

COVID-19 outbreak and dental health care provision in Nigeria: a national survey.

BACKGROUND: The impact of the COVID-19 pandemic on the world is unprecedented, posing greater threats to vulnerable healthcare systems, especially in developing countries. This study aimed to assess the knowledge of dental healthcare providers in Nigeria about the disease and evaluate their responses to the preventive measures necessitated by COVID-19. METHODS: This was an online self-administered questionnaire-based study conducted among dentists practicing in Nigeria. A message containing the link to the survey was sent widely via social medial platforms and electronic mails to dentists practicing in Nigeria. The data collection was done between the 2nd of June and 3rd of July 2020. RESULTS: A total of 314 responses was recorded. Fever was the most specified generalized symptom (97.5%), while the use of masks (100%), hand hygiene (99.7%), social distancing (97.7%) and surface cleaning (99.4%) were the most commonly employed general preventive methods. The main identified risk of transmission in the clinic was aerosol generating procedures (98.7%). CONCLUSION: The general knowledge of dental personnel in our study population appears to be adequate on the common clinical features of COVID-19 but less adequate regarding the less common features. The COVID-19 pandemic has also modified some aspects of dental service delivery but more needs to be done in this regard. Preventive measures against the transmission of COVID-19 in dental practice settings include proper utilization of teledentistry, clinical triage, preprocedural 1% hydrogen peroxide oral rinses, and the use of appropriate Personal Protective Equipment (PPE) which should always be encouraged.

Estimated incidence and Prevalence of noma in north central Nigeria, 2010-2018: A retrospective study.

BACKGROUND: Noma is a spreading and fulminant disease believed to be native to Sub-Saharan Africa over the last decade and associated with low socioeconomic status of citizens of the region. Within this noma belt, most epidemiological reports regarding the disease have emanated from the north western region of Nigeria. However, our indigenous surgical mission encountered a substantial number of cases of noma and post-noma defects noteworthy of epidemiological representation across north central Nigeria. METHODS: All noma cases encountered within the 8-year study period were included and divided based on clinical signs into acute and sequelae groups. Incidence estimation was based on acute/recently active cases and was calculated using the statistical method proposed by the WHO Oral Health Unit (1994). Period prevalence of noma was calculated considering the population at risk in the zone. FINDINGS: A total of 78 subjects were included in the study with age ranging from 2-75 years. Twelve subjects (15.4%) presented with acute disease while 66 (84.6%) had various forms of post-noma defects. The estimated incidence of noma in the north central zone was 8.3 per 100000 with a range of 4.1-17.9 per 100000 across various states. Period prevalence of noma which incorporated all cases seen within the study period was 1.6 per 100000 population at risk. CONCLUSION: Although noma may be more prevalent in the north western region of Nigeria, substantial number of cases occurs within the north central zone which calls for deliberate public awareness campaign on disease risk factors and prevention, and education of primary health-care providers.

Prevalence of dental caries and oral hygiene status of a screened population in Port Harcourt, Rivers State, Nigeria.

OBJECTIVES: The study was designed to determine the prevalence of dental caries and partial edentulism, in addition to assessing the oral hygiene status and restorative care among adults in a community-based outreach program in Port Harcourt. MATERIALS AND METHODS: A cross-sectional study was conducted among adults who participated in oral health screening program, which took place in Alakahia and Obigbo rural communities in Port Harcourt, Rivers State, Nigeria. After a brief oral health education, clinical examination was conducted and the diagnosis of caries was made based on the guidelines laid down by World Health Organization. Prevalence of caries was measured using decayed missing and filled teeth (DMFT) index, and oral hygiene status was assessed using the OHI-S. The restorative index [(F/F + D) ×100] was also calculated and the sociodemographic factors of the subjects were noted. Chi-square test, independent t-test and descriptive statistic were employed for analysis. RESULTS: One fifty-five females (53.8%) and 133 males (46.2%) attended the events and their mean age was 29.3 ± 10.5 years. About one-third of the participants (35.1%) presented with dental caries. The mean DMFT for the whole group was 0.67 ± 2.0. The restorative index for the subjects was 26.8%. The oral hygiene status of most of the participants was fair. This was significantly better in females than in males (P = 0.002). CONCLUSION: Although about one-third of the participants had dental caries, only a quarter of them had received restorative care. Most of the respondents had fair and poor oral hygiene, this suggests the need to educate and motivate the community toward adopting and maintaining positive oral health attitudes and practices.

Analysis of Road Traffic Crashes-Related Maxillofacial Injuries Severity and Concomitant Injuries in 201 Patients Seen at the UCH, Ibadan.

The objective of this study was to determine the prevalence of road traffic crashes (RTC)-related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, the types of maxillofacial injuries, and concomitant injuries sustained were recorded. Severity of maxillofacial injury was determined using the maxillofacial injury severity scale (MFISS), while the severity of concomitant injuries was based on the ISS. Correlations between types and severity of maxillofacial injury and types and severity of concomitant injury were conducted to determine the predictability of concomitant injuries based on maxillofacial injury severity. Data were processed using SPSS Statistical software (SPSS, version 20.0 for windows, IBM SPSS Inc, Chicago, IL). Maxillofacial injuries constituted 25.4% of RTC-related admission by the Accident and Emergency Department. A total of 151 (75.1%) patients who presented with concomitant injuries participated in the study. Eighty-one (53.6%) sustained injuries to more than one body region. Head injury was the commonest (99, 65.6%) concomitant injury, followed by orthopedic injury (69, 45.7%). Increasing severity of maxillofacial injury showed a positive correlation with increasing ISS. Also, positive correlation was noted with increasing severity of maxillofacial injury and presence of polytrauma (p = 0.01), traumatic brain injury (p = 0.034), and eye injuries (p = 0.034). There was a high prevalence of maxillofacial injuries in victims of RTC. There was a high incidence of concomitant injuries noted with these maxillofacial injuries. Significantly, this study showed a direct relationship between the severity of maxillofacial injury and head, ocular and polytrauma. This study further emphasizes the need for thorough examination of patients presenting with RTC-related maxillofacial injuries.

Indications and outcome of mandibular condylar and ramus surgeries.

BACKGROUND: Different surgical procedures are utilized for treatment of various diseases of the posterior mandible depending on the type of disease, site, duration and age of the patient. A thorough knowledge of the anatomical relations of structures and adequate surgical skills are needed to minimize complications. The purpose of this study was to evaluate the indications and outcome of surgical techniques for diseases affecting the condyle and ramus of the mandibles. PATIENTS AND METHODS: Data were retrieved from the case files of patients who had surgeries for diseases involving the ramus/condylar area of the mandible. The diagnosis/indications for surgery, procedure and postoperative outcomes were documented. Outcomes assessed were related to mouth opening, esthetics (appearance of scar and jaw symmetry) and function (occlusion, Jaw movements). Complications such as nerve dysfunction were documented. Paresthesia was tested by simple tactile stimulations. RESULTS: There were a total of 27 procedures done either on the condyle or ramus in 23 (100%) patients between May 2006 and October, 2013. 16 procedures were done for tumors in 16 (69.6%) patients, 14 (60.9%) patients had Ameloblastoma, 1 (4.3%) had central neurofibroma and one had keratocystic odontogenic tumor, two procedures for unilateral condylar fractures in 2 (8.6%) patients, five procedures for ankylosis in 3 (13.0%) patients and four procedures were done for dislocation in 2 (8.6%) patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory. CONCLUSION: Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.

Pattern, severity, and management of cranio-maxillofacial soft-tissue injuries in Port Harcourt, Nigeria.

BACKGROUND: The pattern of craniofacial soft-tissue injuries occurring either in isolation or in association with fractures vary in different societies and is multiply influenced. The effects are enormous because of the prominence of the face; therefore, the purpose of this study was to document any changing pattern, severity and management of these craniofacial injuries in our center. PATIENTS AND METHOD: Cranio-maxillofacial region was classified into upper, middle and lower face. The cause, type, and site of the injuries were documented. Gunshot injuries were further categorized as penetrating, perforating or avulsions. Further, classification of injuries into mild, moderate, and severe was carried out based on multiple factors. RESULT: A total of 126 patients with soft-tissue injuries presented to our hospital out of which 85 (67.5%) were males and 41 (32.5) were females. The age range of the patients was between 10 months and 90 years with a mean ± SD of 26.4 ± 15.5 years. Road traffic accident was the most common etiology of which vehicular accidents constituted 50 (54.9%) and the motorcycle was 2 (2.2%). Assault contributed 16 (17.6%) while cases due to gun shots were 13 (14.3%). A total of 19 (15.1%) patients had associated head injuries, 11 (8.7%) patients had craniofacial fractures involving any of the bones while 3 (2.4%) patients had limb fractures and 2 (1.6%) patients had rib fractures. There were 51 (41.8%) cases classified as mild injuries, 37 (30.3%) cases as moderate injuries and 24 (19.7%) cases as severe injuries. Total of 126 cases managed, 121 (96.0%) received primary closure of the wounds while 5 (4.0%) received delayed closure under general anesthesia.

Evolution and trends in reconstructive facial surgery: an update.

Surgical correction of congenital and acquired facial deformities has transcended the primitive era of using non biologic materials to current attempts at own face growing through biotechnology. A summative account of this trend is still lacking in the literature. The objective of this article is to present an update on current knowledge in the strides to achieve functionally and aesthetically perfect facial reconstruction. It highlights the impact of advancements in 3D imaging, stereolithographic biomodelling, microvascular surgical tissue transplantation and tissue biotechnology in the surgical efforts to solve the problems of facial disfigurement whether congenital or acquired.

Giant macroglossia with persistent nonocclusion in a neonate.

Excessive enlargement of the tongue, macroglossia, is a well-recognised clinical condition which can pose significant social and health problems. We report a case of a neonate who was born with a tongue grossly enlarged to the point of inability to feed and deformation of the jaw. Despite surgical reduction of the tongue to normal size, there was a persistent nonocclusion of the mouth, making sucking impossible. Physiotherapy did not help and our experience with neonatal jaw osteotomy is limited. We wonder if a prenatal aspiration of the tongue cyst could have forestalled this jaw deformation.

Evidence-based dentistry in a developing economy - the Nigerian example.

BACKGROUND: Evidence-based dentistry (EBD) is becoming popular all over the world with the increasing global involvement of dental practitioners in the debates on the relevance or otherwise of EBD. However, very little has been known on the evolutionary trend of EBD in the developing countries of the world. AIMS AND OBJECTIVES: This pilot study was designed to assess the state of EBD in the accredited dental schools in Nigeria as an example of a developing economy. METHODOLOGY: An electronic search was conducted for articles on the subject of EBD emanating into the world dental literature from Nigeria as a measure of activities in the field of EBD in the country. Further investigation was done by way of interviews of faculty members and resident doctors in the four fully accredited dental schools in Nigeria. The subject of the interview was premised around the evaluation of activities in the field of EBD. RESULTS: Only 6 relevant articles were found in the search. The interviews however revealed an increasing awareness but low level of knowledge of the principles of EBD in the dental schools. Major obstacles were infrastructural limitations and lack of personal motivations. The enthusiasm of the younger faculties and resident doctors was notable. CONCLUSION: It was obvious that EBD is yet to assume the desired momentum in the 21(st) century in Nigeria. It is however gladdening that there is a promising future for EBD with the rising enthusiasm noted among the younger generation of clinicians.

Spread of odontogenic infections in Port Harcourt, Nigeria.

PURPOSE: Odontogenic infections constitute a substantial portion of diseases encountered by oral and maxillofacial surgeons. Infections start from dental tissues and sometimes rapidly spread to contiguous spaces. The consequence is a fulminant disease with significant morbidity and mortality. The study was aimed at studying the pattern of spread, approach to management, and outcome of these infections at a Nigerian teaching hospital. PATIENTS AND METHODS: A retrospective study of all patients with orofacial infections who presented to our center over an 18-month period was carried out. The medical records were reviewed to retrieve the following: age, gender, source of infection, anatomic fascial spaces involved, associated medical conditions, various treatment modalities, types of antibiotics administered, causative micro-organisms, length of stay in the hospital, and any complications encountered. Infections were classified into 2 categories: those that are confined to the dentoalveolar tissues belong to category I, and those that have spread into the local/regional soft tissue spaces and beyond belong to category II. RESULTS: Odontogenic infections constituted 11.3% of the total oral and maxillofacial surgery cases. A total of 261 patients were treated for odontogenic infections. There were 146 female patients (59.8%) and 98 male patients (40.2%) in the first category, whereas the second category comprised 10 male patients (58.8%) and 7 female patients (41.2%). The fascial spaces involved, in descending order, were submasseteric in 10 (22.7%), submandibular in 9 (20.5%), and sublingual in 6 (13.6%). The causative micro-organisms commonly found were Klebsiella and Streptococcus spp. Incision and drainage were performed in the 17 cases with spreading infection. Amoxicillin, amoxicillin/clavulanate, and metronidazole were the most routinely administered antibiotics. CONCLUSIONS: Our experience shows that delay in presentation, self-medication, aging, male gender, and unusual causative agents are some of the factors associated with spread. Therefore efforts must be made to further improve public dental awareness.

Assessment of difficulty in third molar surgery--a systematic review.

PURPOSE: The aim of this review was to identify the most important variables that determine surgical difficulty of impacted third molar extractions by their consistent showing in previous studies. MATERIALS AND METHODS: Electronic library search for current evidence in the world literature was conducted, and relevant articles were selected, scrutinized, and the findings were compared. RESULTS: Seven articles were most relevant, and the results of the comparison of the selected articles showed that demographic variable, age; operative variables: surgeon procedure type and number of teeth extracted; and ratiographic variable, depth angulation; and root morphology, are the most consistent determinants of difficulty. CONCLUSION: Current evidence is in support of 3 categoreis of variables strongly associated with surgical diffulty of impacted third molars. The most important variables in each of these categories have been identified.

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.