Periodontal Diseases in Adult and Elderly Nigerians: A National Survey.

BACKGROUND: Periodontitis has been shown to have links with general health and increase the risk of complications of some systemic diseases now showing a rising prevalence with age. The rising proportion of the elderly globally, and a high prevalence of periodontal disease among older adults may significantly impact the need for oral health care services in the near future. This national survey was carried out to highlight the trend of periodontal diseases among adult and elderly Nigerians and make evidence-based recommendations for good management outcomes. MATERIALS AND METHODS: A national cross-sectional survey of periodontal diseases (using the CPITN Index) among adult (35-44-year-old) and elderly (65-74-year-old) Nigerians selected by multistage sampling method. RESULTS: Periodontal disease is prevalent among adults (96.5%) and elderly (97.6%) Nigerians, with the zonal prevalence approximating the national prevalence. Gingivitis is the prevalent periodontal disease type in these age groups, with a national prevalence of 86.8%, 67.6% respectively, and more in the South than the North for both adults (90.7%, 83%) and elderly (75.7%, 59.7%), respectively (p<0.005). Destructive Periodontitis prevalence in adult and elderly Nigerians is 9.5%, 29.9%, respectively (p<0.05), with the North being more affected than South for both adults (13.4%, 5.6%) and elderly (37%, 22.7%), respectively (p<0.05). There is also a significant rise in the occurrence of destructive periodontitis with age, nationally and in all the zones (p<0.05). CONCLUSION: There is a high prevalence of periodontal diseases in adult and elderly Nigerians. The outcome of the management of periodontal diseases in adults and the elderly is inter-dependent on best practices in both oral and general health care service provision.

CONTEXTE: La parodontite a été liée à la santé générale et à l'augmentation du risque de complications de certaines maladies systémiques, montrant maintenant une prévalence croissante avec l'âge. La proportion croissante de personnes âgées dans le monde et une prévalence élevée des maladies parodontales chez les personnes âgées pourraient avoir un impact significatif sur le besoin de services de santé bucco-dentaire dans un avenir proche. Cette enquête nationale a été réalisée pour mettre en évidence la tendance des maladies parodontales chez les adultes et les personnes âgées nigérianes et formuler des recommandations fondées sur des preuves pour de bons résultats en matière de gestion. MATÉRIEL ET MÉTHODES: Une enquête nationale transversale sur les maladies parodontales (utilisant l'indice CPITN) parmi les adultes (35-44 ans) et les personnes âgées (65-74 ans) nigérianes sélectionnées par méthode d'échantillonnage à plusieurs niveaux. RÉSULTATS: Les maladies parodontales sont prévalentes chez les adultes (96,5 %) et les personnes âgées (97,6 %) nigérianes, la prévalence zonale approchant la prévalence nationale. La gingivite est le type de maladie parodontale prédominant dans ces groupes d'âge, avec une prévalence nationale de 86,8 %, 67,6 % respectivement, et plus dans le Sud que dans le Nord pour les adultes (90,7 %, 83 %) et les personnes âgées (75,7 %, 59,7 %), respectivement (p<0,005). La prévalence de la parodontite destructrice chez les adultes et les personnes âgées nigérianes est de 9,5 %, 29,9 %, respectivement (p<0,05), le Nord étant plus touché que le Sud pour les adultes (13,4 %, 5,6 %) et les personnes âgées (37 %, 22,7 %), respectivement (p<0,05). On observe également une augmentation significative de l'occurrence de la parodontite destructive avec l'âge, nationalement et dans toutes les zones (p<0,05). CONCLUSION: Il existe une prévalence élevée des maladies parodontales chez les adultes et les personnes âgées nigérianes. Les résultats de la gestion des maladies parodontales chez les adultes et les personnes âgées dépendent des meilleures pratiques dans la prestation de services de santé bucco-dentaire et générale. MOTS CLÉS: Prévalence, Gingivite, Parodontite, Nationale, Enquête.

Dental Trauma in Adult and Elderly Nigerians: A National Survey.

BACKGROUND: Various studies on Traumatic Dental Injuries (TDI) have been carried out in different small localities and mostly among children and adolescents in Nigeria, but there has not been any national study to determine its prevalence. This national survey was carried out to understand the complexities of dental trauma epidemiology among adult and elderly Nigerians. MATERIAL AND METHODS: A national cross-sectional survey of TDI among adult and elderly Nigerians, following WHO recommendations. RESULTS: A total of 5,067 adults (35-44 years) and 4,680 elderly (65-74 years) Nigerians were examined, and the prevalence of dental trauma among the adult and elderly was 15.9 % and 22.1%, respectively. Gender comparison showed males were more affected than females in the North (p<0.05), while TDIs occurred more among females in Southern Nigeria (p<0.05). In Nigeria, Type 2 injuries were most prevalent among the adults and elderly (53.9% and 55.7%, respectively). Among the elderly, while Type 1 injuries were more common in the North, Type 2 injuries were more prevalent in Southern Nigeria (p<0.05). Types 3-10 injuries were more prevalent in the South (p<0.05). TDI 1,2 occurred more in the anterior teeth among adults (p<0.05) and in posterior teeth among the elderly, especially in Southern Nigeria (p<0.05); while TDI 3-10 affected mostly the anterior teeth in both age groups (p<0.05. CONCLUSIONS: The observed pattern of dental trauma among the adults and elderly Nigerians could reflect the diverse dietary and socio-cultural practices. Advocacy for prevention of, relevant education on, research into and improvement of access to treatments for dental trauma is recommended.

CONTEXTE: Diverses études sur les traumatismes dentaires (TDI) ont été menées dans différentes petites localités et principalement chez des enfants et des adolescents au Nigéria, mais aucune étude nationale n'a été menée pour déterminer sa prévalence. Cette enquête nationale a été menée pour comprendre les complexités de l'épidémiologie des traumatismes dentaires chez les Nigérians adultes et âgés. MATÉRIEL ET MÉTHODES: Une enquête nationale transversale sur le TDI parmi les Nigérians adultes et âgés, conformément aux recommandations de l'OMS. RÉSULTATS: Un total de 5 067 adultes (35 à 44 ans) et 4 680 personnes âgées (65 à 74 ans) Nigérians ont été examinés, et la prévalence des traumatismes dentaires chez les adultes et les personnes âgées était de 15,9% et 22,1%, respectivement. La comparaison entre les sexes a montré que les hommes étaient plus touchés que les femmes dans le Nord (p <0,05), tandis que les IDT se produisaient davantage chez les femmes du sud du Nigeria (p <0,05). Au Nigéria, les blessures de type 2 étaient les plus fréquentes chez les adultes et les personnes âgées (53,9% et 55,7%, respectivement). Chez les personnes âgées, alors que les blessures de type 1 étaient plus fréquentes dans le nord, les blessures de type 2 étaient plus fréquentes dans le sud du Nigéria (p <0,05). Les blessures de type 3 à 10 étaient plus fréquentes dans le Sud (p <0,05). Le TDI 1,2 s'est produit davantage dans les dents antérieures chez les adultes (p <0,05) et dans les dents postérieures chez les personnes âgées, en particulier dans le sud du Nigéria (p <0,05); tandis que le TDI 3-10 affectait principalement les dents antérieures dans les deux groupes d'âge (p <0,05). CONCLUSIONS: Le modèle observé de traumatisme dentaire chez les adultes et les Nigérians âgés pourrait refléter les diverses pratiques alimentaires et socioculturelles. Il est recommandé de plaider en faveur de la prévention, de l'éducation pertinente, de la recherche et de l'amélioration de l'accès aux traitements des traumatismes dentaires. MOTS CLÉS: Blessures dentaires traumatiques, types, dentaires, traumatismes, adultes, personnes âgées, Nigéria.

Giant Aggressive Odontogenic Fibroma in a 15-month-old Female: Case Report and Review of Literature.

INTRODUCTION: Odontogenic fibroma (OF) is a rare benign tumor of mesenchymal odontogenic tissue with variable global incidence. Two variants comprising extraosseous /peripheral (POF) and intraosseous /central (COF) have been identified based on the anatomical origin of the tumor. OF isslow growing, and often asymptomatic with characteristic radiographic appearance of a unilocular or multilocular cyst frequently associated with unerupted or displaced teeth while histologically, varying amount of inactive odontogenic epithelium embedded in a mature relatively dense collagenous stroma is diagnostic. The absence of odontogenic epithelium does not exclude the diagnosis of odontogenic fibroma. CASE REPORT: A 15 months old female presented with 3 months history of left lower jaw swelling which showed aggressive growth following incisional biopsy. Parents said lesion was noticed for the first time as pinpoint on the submandibular area and was too small to warrant any worries. Initial radiograph revealed absence of bony involvement but the second showed evidence of bony involvement. An impression of soft tissue sarcoma was made and incisional biopsy was sent for pathological diagnosis which revealed peripheral odontogenic fibroma. The rapidity of growth following incisional biopsy bellied a benign lesion. CONCLUSION: An aggressive odontogenic fibroma with multifocal points in a 15months old girl.

INTRODUCTION: Le fibrome odontogène (FO) est une tumeur bénigne rare du tissu odontogène mésenchymateu dont l'incidence globale est variable. Deux variantes comprenant des fibromes extra-osseux /périphérique (POF) et intra-osseuse / centrale (COF) ont été identifiés en fonction de l'origine anatomique de la tumeur. La POF est à croissance lente, et souvent asymptomatique avec l'apparence radiographique caractéristique d'un kyste uniloculaire ou multiloculaire fréquemment associé à des dents non érigées ou déplacées alors que histologiquement, une quantité variable d'épithélium inactif noyé dans un stroma collagène mature relativement dense est le diagnostic. L'absence d'épithélium odontogène n'exclut pas le diagnostic de fibrome odontogène. RAPPORT DE CAS: Une femme de 15 mois a présenté un gonflement de la mâchoire inférieure gauche depuis 3 mois de gonflement de la mâchoire inférieure gauche qui a montré une croissance agressive après une biopsie incisionnelle. Les parents ont déclaré que la lésion avait été remarquée pour la première fois sur forme de point d'épingle dans la zone submandibulaire et était trop petite pour justifier une quelconque inquiétude. La radiographie initiale a révélé l'absence d'atteinte osseuse mais la seconde a montré des signes d'atteinte osseuse. Une impression de sarcome des tissus mous et une biopsie incisionnelle a été envoyée pour un diagnostic pathologique qui a révélé un fibrome odontogène périphérique. La rapidité de la croissance après la biopsie incisionnelle a fait croire à une lésion bénigne. CONCLUSION: Un fibrome odontogène agressif avec des points multifocaux chez une jeune fille de 15 mois. Mots clés: Fibrome odontogène, Périphérique, Central, Agressif.

Sonographic Diagnosis of Metastatic Cervical Lymph Nodes in Primary Orofacial Malignancies: Role of the Radiologist's Experience.

BACKGROUND: There is uncertainty surrounding the choice of a better imaging modality to detect metastases in cervical lymph nodes. The aim of this study is to examine the role of Ultrasound in the diagnosis of metastatic cervical lymph nodes in orofacial malignancies in a resource limited environment and the effect of the radiologist's experience in interpretation of the results. METHODS: Sixty patients with various histologically diagnosed orofacial malignancies and clinical evidence of cervical lymph nodes metastases were examined with ultrasound by a consultant and a trainee radiologist. Affected lymph nodes were subsequently biopsied and examined histologically. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 19 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2010 (Microsoft, Redmond, WA, USA). Test of statistical significance was set at 0.05. RESULTS: Ultrasonography examination by the consultant radiologist recorded a sensitivity of 80.0%, specificity of 57.1%, PPV of 77.5%, NPV of 60.0%, accuracy of 71.7% and a P value of 0.004. The trainee radiologist recorded a sensitivity of 69.2%, specificity 38.1%, PPV of 67.5%, NPV of 40.0%, accuracy of 58.3% and a P value of 0.566. CONCLUSION: Ultrasonography is useful in the diagnosis of metastatic cervical lymph nodes in orofacial malignancies and the interpretation and reliability of the results depend on the experience of the radiologist. Examination of patients should therefore be done and interpreted by an experienced radiologist.

Complete avulsion of the globe and the optic nerve: a case report.

Blunt trauma to the globe may cause rupture or avulsion of the globe with its attendant consequences. Traumatic avulsion of the globe and optic nerve are rare because of the protection offered by the bony socket and the resistance of the globe due to its pressure and the thickness of the nerve tissues. However, there are a few documented cases of avulsion of the globe and optic nerve in the literature. We report a case of traumatic avulsion of the left globe in a 38-year-old female Nigerian. Primary enucleation of the avulsed globe with insertion of orbital prosthesis was done.

Augmentation of craniofacial defects using alloplastic material.

BACKGROUND: Alloplastic materials are increasingly being used in augmentation of craniofacial defects because of its ready availability, good aesthetic outcome and absence of donor site morbidity. This paper highlights experience in the use of heat-cured acrylic in augmentation cranioplasty. SUBJECTS AND METHODS: The management of three patients with anterior skull defect who presented at the Dental and Maxillofacial Surgery Clinic of the Aminu Kano Teaching Hospital over a five-year period is presented. RESULTS: There was good aesthetic outcome in all the patients and no complications were recorded. CONCLUSION: Augmentation of craniofacial defects using customized prefabricated heat-cured acrylic provides patients with a durable, stable and structural repair of craniofacial defects with good aesthetic outcome.

Hypohidrotic (anhidrotic) ectodermal dysplasia in female twins.

Autosomal recessive hereditary ectodermal dysplasia (HED) has not been described in sub-Saharan Africa. It is acknowledged to be rarer than the occasionally reported x-linked and autosomal dominant variants. We report a pair of Nigerian female twins with family history and clinical features suggestive of recessive HED, thereby showing the existence of this rare form in sub-Saharan Africa.

Temporomandibular joint ankylosis in a Nigerian teaching hospital.

Twenty-six patients (12 males and 14 females) between two days and 41 years old with temporomandibular joint ankylosis were retrospectively reviewed. Thirty-three joints were involved; 19 unilateral and six bilateral. The aetiologies were trauma, 69.2%; infection, 15.4%; unknown, 11.5% and congenital, 3.9. The majority, 31 were intracapsular while the remaining two joints were extracapsular 51.6% were limited to the condyle, 32.2% extended to the coronoid process and the zygomatic, 9.7% extended to the sigmoid notch while the remaining 6.5% had maxillomandibular fusion. Tracheostomy (48%) was the most common mode of intubation. Gap arthroplasty was carried out in 20 joints while 11 joints had interposition arthroplasty. Postoperative complications were seven anterior open bite, three facial nerve weakness, three infections and two recurrences.

Challenges of airway management in a patient with temporomandibular joint ankylosis complicating forceps delivery--a case report.

Ankylosis of the temporomandibular joint following forceps delivery is a rare anomaly. The aetiopathogenesis involves wrongful application of the forceps or forceful closure of the forceps handle against the condyle with haemathrosis, organisation and subsequent ankylosis. Because of the lack of epidemiological data, there is little information about the true incidence and the management of this rare anomaly. The purpose of this presentation is to report the challenges encountered in the airway management of a six-year old female with right temporomandibular joint ankylosis following forceps delivery in a private hospital setting.

Primary head and neck cancers in North -Western Nigeria.

BACKGROUND: Reported epidemiological studies on oro-facial cancers in Nigeria over the last four decades showed nonstandardized inclusion criteria and an overlap of study periods, resulting in conflicting findings. OBJECTIVE: To document the pattern of reportable primary head and neck cancers in North-Western Nigeria and analyse Methods: A review of both clinical and histopathology records of head and neck cancers diagnosed by histopathology at the ABUTH, Zaria, was undertaken. Socio-demographic information and history of cancer management, which followed the pattern of the Minimum Cancer Dataset developed by the British Association of Head and Neck Oncologists, were retrieved from pathology and medical records of patients diagnosed of cancers of the head and neck at the hospital from January 1972 to December 2002. RESULTS: A total of 2611 cases were diagnosed, 730 (28%) occurred in children, 1775 (68%) in adults, with 64% occurring at or below 40 years of age. The eye, 564(21.6%) and the mouth, 251(9.6%) were the most commonly affected sites. Carcinomas (55%), lymphomas (23%) and retino-blastomas (10%) were the most common cancers. Cancers of viral origin constituted 18% of head and neck cancers and AIDS-defining cancers were 6%. A significant increase was noted in the occurrence of conjunctival squamous cell carinoma (SCC) and Non-Hodgkins Lymphoma NHL when comparing the periods pre- and post- advent of HIV/ AIDS in Nigeria in 1986. Comparing the two periods, there was a reduction in the ages of occurrence of conjunctival SCC; Non-Hodgkins Lymphoma (NHL), Kaposis sarcoma (KS) and nasopharyngeal carcinoma, a rise in the occurrence of nasopharyngeal carcinoma and a significant drop in the occurrence of Burkitt lymphoma. CONCLUSION: Reduced age at presentation and the rising prevalence of several virus-associated cancers suggests the role of immuno-suppression in the pathogenesis of these cancers. Further studies into nutritional and viral epidemiology in the population are desirable as the implication for prevention and public health policies are profound.

Congenital bilateral fusion of the maxillomandibular alveolar processes with craniosynostosis: report of a rare case.

A rare congenital anomaly of maxillomandibular fusion with pectus excavatum and craniosynostosis in a neonate is presented. The child was kept alive by nasogastric tube feeding. A modification of classification of syngnathia is proposed. The aetiopathogenesis and difficulty in management in our environment are discussed.

Audit of oral and maxillofacial surgical conditions seen at Port Harcourt, Nigeria.

BACKGROUND: The worldwide pattern of oral and maxillofacial surgical conditions has been rarely reported despite its significance in head and neck medicine. The Niger Delta region comprises 9 of the 36 states in the Federal Republic of Nigeria. There are scanty reports on oral and maxillofacial surgical diseases from the region despite its 95% contribution to Nigeria's oil-revenue. METHODS: This retrospective survey of oral/maxillofacial surgical cases seen at a referral center in Port Harcourt, a city in the Niger delta region of Nigeria. RESULTS: Between 2000 and 2004, our center offered specialized maxillofacial surgical services to 86 patients coming from 5 states in the Niger delta region. These patients made up 20% of all patients seen at the department within the period. There were 110 indications for surgical interventions. Most were complaints of trauma (46.4%). The rest were tumors and allied lesions (39.0%) and cysts (12.7%). Ratio of male to female patients was 1.7:1 while patients were aged between 9 and 85 years (mean 31.2 years, standard deviation +/- 15.4). Most (n? = ?63, 73%) had surgical treatment while a significant proportion (19%) defaulted. Seventy-nine surgical procedures were performed (69 primary and 10 secondary). Primary procedures included maxillo-mandibular fixation (31.9%) and enucleation of tumor/cyst (17.4%). While our series of 86 cases over 4 years appears low, there is likelihood that oral and maxillofacial surgical conditions are as common in the Niger Delta region as in other parts of Nigeria. There is scarcity of skilled manpower and equipments for the management of oral maxillofacial surgical conditions in the region. Health promotion activities are needed to improve awareness for early diagnosis of these conditions. Also, poverty alleviation measures need to be effective as defaults were often due to inability to pay for treatment. CONCLUSION: In many parts of the Niger Delta region of Nigeria, oral and maxillofacial surgical diseases are not uncommon causes of morbidity. However, many parts of the region lack requisite manpower for prevention and curative health activities. Defaults from hospital treatment were due to preference for traditional (unorthodox) measures and financial inability. Poverty alleviation measures need to be stepped up while the state of medical infrastructure should be enhanced in the region.

Myositis ossificans circumscripta of the supra-orbital region: a case report.

Myositis ossificans circumscripta is a pathological condition characterized by formation of bony tissue within the skeletal muscles following repeated trauma. A case of myositis ossificans circumscripta of the supra-orbital region in a 25-year-old man is presented and the pertinent literature is reviewed. To the best our knowledge this benign lesion has not been reported previously in the orbital region the world literature. Clinically the patient presented with a swelling and proptosis of the right eye. Radiologically there was a rounded opacity with well defined margin. Lesion was initially misdiagnosed as a fibro-osseous lesion; however microscopic examination indicated matured myositis ossificans. Lesion was excised via a bicoronal flap. Careful clinical, radiological and pathologic evaluation is required to make this uncommon diagnosis in an unusual location such as the supra-orbital region to avoid unnecessary surgical mutilation of the patient.

Non-syndromal, true congenital ankylosis of the temporomandibular joint: a case report.

A case of a six-week old boy with bilateral congenital fibrous intra-articular ankylosis of the temporomandibular joint is presented The literature is reviewed and limitations to management are highlighted.

A survey of temporomandibular joint dislocation: aetiology, demographics, risk factors and management in 96 Nigerian cases.

A retrospective study of 96 cases of temporomandibular joint dislocation was undertaken. Patients' ages ranged from 9 to 85 years (mean+/-SD, 35.3+/-17.4 years) and peak incidence was at 20-29 years. Mean duration was 7.9 weeks (range, 1h to 3 years). Acute, chronic and recurrent dislocations were seen in 46 (47.9%), 29 (30.2%) and 21 (21.9%) patients, respectively. Males dominated in all three categories but this was not statistically significant (P = 0.8). Excessive mouth opening while yawning (44 cases) was the commonest cause of dislocation, followed by road traffic accidents (13 cases). Ten patients (10.4%) had an underlying systemic disease, the commonest being epilepsy (four cases); those with acute dislocation recorded the highest incidence of underlying illness. Bilateral anterior (86 cases) dislocations were the most frequent. Of the 96 patients, 89 (92.7%) were available for treatment. Manual reduction with or without anaesthesia proved effective for 38/45 acute, 5/24 chronic and 14/20 recurrent cases. Chronic dislocations were treated mainly by surgical osteotomy (13/24). Vertical subsigmoid and oblique ramus osteotomies were the commonest surgical techniques recorded. Treatment was satisfactory for all patients surgically handled except for one case of anterior open bite postoperatively. This study has shown that excessive mouth opening while yawning is the commonest cause of temporomandibular joint dislocation in Nigerians, and conservative approaches to management remain quite effective irrespective of the duration and clinical subtype. The best choice of surgical technique should be determined by proper clinical evaluation and the need to avoid or minimize postoperative morbidity.

Spectrum of oral and maxillofacial surgical procedures in Kano, Nigeria.

The goal of the maxillofacial surgeon is to correct facial deformity while eradicating surgical diseases, prevent recurrence or complication and restore function. The aim of this paper is to review the surgical procedures carried out in a new tertiary teaching hospital. A retrospective study of patients with maxillofacial surgical diseases seen at the Department of Dental and Maxillofacial Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria, between 2001 and 2003, was conducted. A total of 87 patients had various (primary and secondary) surgical procedures during the period under review. There were 51 males and 36 females, a male to female ratio of 1:0.61 with an age range of 3 days to 90 years and a mean age of 34.5 years. The majority of the patients were in the lower socio-economic group. Reduction and immobilization of the jaw fractures (n = 21, 23.3%) was the most common, followed by transosseous wiring (n = 12, 13.3%). The most common complications were malocclusion (n = 14, 29.8%) and facial defects (n = 12, 25.5%). Reduction and immobilization, and tumour surgery of the jaws seem to be the most common surgical procedures while osteotomy was the least. Reduction and immobilization with simple arch bars appeared to be very effective, more so when the patients could not afford more modern methods of treatment. Reconstructive surgeries of ablated jaws are advocated in view of the devastating aesthetic and psychosocial effects that these have on the patients.

Multiple odontomas in the facial bones. A case report.

A rare case of multiple compound odontoma involving the facial bones and erupting into the oral cavity of a 15-year-old Nigerian girl is presented. The unacceptable facial appearance and the surgical approach used makes this case worth reporting.

Tumours and tumour-like lesions of the oral and perioral structures of Nigerian children.

One hundred and fifty-eight children less or equal to 15 years were isolated from a retrospective 20-year (1979-1998) survey of oral and perioral tumours and tumour-like lesions in Nigeria. These children represent 16.8% of the cases seen. Lesions of children less or equal to 15 years were benign non-odontogenic (n = 70, 44.3%), benign odontogenic (n = 41, 25.9%) and malignant (n = 47, 27.7%). Predominantly Children between 11 and 15 years (n = 89, 56.3%) were afflicted and the male to female ratio was 1.4 to 1.0. Sites recorded were the jawbones, cheeks, gingival, forearm, testis and the spleen. The ratio of malignant lesions in Nigerian and African children appears to be higher than in the Caucasian population (2.4:1).

Facial injuries caused by animals in northern Nigeria.

We did a retrospective survey of 34 patients who sustained facial injuries after animal associated incidents and presented to three Nigerian teaching hospitals. There were 27 male (79%) and 7 female patients, whose ages ranged from 6 to 40 years. Sixteen (47%) were less than 15 years. Cows (n=14), camels (n=9), and donkeys (n=6) were the most commonly involved. Three dog bites were seen. Knocks from cows' horns (n=9) were the predominant mechanism of injury, followed by falls (n=8) and kicks (n=7). There were many facial lacerations and fractures, and the cheek (n=14), forehead (n=13), and chin (n=10) were the most common sites of soft tissue injury. All injuries were considered to be contaminated irrespective of the duration of the injury. Treatment consisted of thorough debridement and irrigation, primary closure where feasible, and secondary reconstruction in others. All patients were given prophylactic broad-spectrum antibiotics. Overall, outcome was satisfactory except for a few cases of scar formation, facial nerve palsy, and partial laryngeal stenosis. Associated injuries were recorded in nine cases (27%), with rupture of the globe in three patients (9%). One patient died of associated abdominal injuries after being trampled by a herd of cattle. There is a need for adequate protective measures to forstall animal-related incidents that could result in severe facial and other injuries.

A study of orofacial bacterial infections in elderly Nigerians.

This retrospective study was designed to determine the pattern of occurrence, and principles of management of orofacial bacterial infections in elderly Nigerians. Ninety-two patients aged 55-90 years (mean +/- SD 62.4 +/- 7.5 years), were admitted into the study (male:female ratio 1.1:1). The origin of orofacial infection was predominantly odontogenic and the lower face was three times more commonly involved. The percentage of patients with underlying systemic disease was 16.2%. Patients with underlying disease had a 3.5 times greater risk of developing orofacial infections. Similarly, a significant correlation was demonstrated between both sexes of patients with orofacial infections and underlying illness (P < 0.05). There was a general delay before presenting for treatment (average 19.5 weeks) and the mortality rate was 3.3%. The study findings demonstrate that a significant relationship exists between elderly Nigerians with orofacial infections and systemic disease.