Serum antioxidant vitamins and the risk of oral cancer in patients seen at a tertiary institution in Nigeria.

OBJECTIVES: Tobacco and alcohol are major risk factors of oral cancer, but nutritional deficiency may also contribute to development of oral cancer. This study compared serum antioxidant vitamin levels in oral cancer patients and controls in order to validate the role of vitamin deficiencies in the etiology of oral cancer. MATERIALS AND METHODS: Serum vitamin A, C, and E levels of 33 oral cancer patients and 30 controls at University College Hospital, Ibadan, Nigeria, were determined using standard methods. The data obtained were analyzed using the Student t-test, odds ratio, and logistic regression. RESULTS: Mean vitamin A, C, and E levels were significantly lower in oral cancer patients (P=0.022, P=0.000, and P=0.013 respectively). Risk of oral cancer was 10.89, 11.35, and 5.6 times more in patients with low serum vitamins A, C, and E, respectively. However, on logistic regression analysis, only low serum vitamin E independently predicted occurrence of oral cancer. CONCLUSIONS: The lower serum vitamin A, C, and E levels in oral cancer patients could be either a cause or an effect of the oral cancer. Further studies using a larger sample size and cohort studies with long-term follow-up of subjects are desirable.

Intra-oral squamous cell carcinoma in Nigerians under 40 years of age: a clinicopathological review of eight cases.

Intra-oral squamous cell carcinoma (SCC) is a disease commonly seen in patients aged 50 and above. A recent report on intra-oral SCC in the Nigerian population placed the mean age of occurrence for the disease at 50.7 years for male and 49.6 years for females. Age is recognized to be an important factor in the onset and outcome of diseases like cancer. The focus of this study was to conduct a clinicopathological review on the incidence, pattern of presentation, management and outcome of the disease in patients aged 40 years and below seen at the University College Hospital Ibadan, between 1980-1995. During the period under review the total number of cases of SCC was 104, out of which 8 (7.7%) occurred in patients aged 40 years and below. The figure is higher than that of 1-3% obtained in Caucasian studies. The 5 year survival rate of our patients was nil.

Mucoepidermoid carcinoma of the oral cavity.

There is presently no uniformly accepted grading system for mucoepidermoid carcinoma, largely due to a lack of consensus as to what criteria should be used to formulate histological grades. The present study was undertaken to determine the relationship between histological grade, clinical stage and survival in these neoplasms. Clinical and histological data from 34 patients with mucoepidermoid carcinoma were reviewed. Mucoepidermoid carcinoma was most common in the parotid gland (44.1%), while 25% of patients had tumors in the minor salivary glands. Low, intermediate, and high-grade neoplasms accounted for 61.7%, 26.5%, and 11.8% of tumors, respectively. There was a general trend towards increasing clinical aggressiveness with increasing histological grade. Similarly, postoperative tumor recurrences were marginally more common in high-grade than in low-grade mucoepidermoid carcinomas. However, both of these findings were statistically insignificant, mainly due to small sample size, late clinical presentation, poor clinical follow-up, incomplete management and incomplete records. These factors explain the relatively low survival figures in the present study, as compared to higher survival figures in white patients with mucoepidermoid carcinoma.

Pattern of occurrence of odontogenic cysts in Nigerians.

OBJECTIVE: To determine the relative frequency and histopathologic pattern of odontogenic cysts in a Nigerian population. DESIGN: Retrospective study of case notes and histologic reports and slides. SETTING: Teaching Hospital Ibadan, Nigeria. SUBJECTS: Seven hundred and fifteen patients seen between 1982 and 1996 with histologically confirmed oral lesions. RESULTS: Sixty five (8.8%) of all oral lesions during the study period were odontogenic cysts among which 61.9% were radicular, 19% dentigerous and 14.3% keratocysts. Other uncharacterised odontogenic cysts constituted 3.8%. The peak incidence was in the second decade (44.4%) while the mean ages of occurrence were 26.5, 12.8 and 29.3 years for the radicular, dentigerous and odontogenic keratocysts respectively. The overall sex incidence was almost equal (male to female ratio (1:1.1). The radicular and dentigerous cysts were more commonly seen in the maxilla while the odontogenic keratocysts were more in the mandible. CONCLUSION: There is need for more studies in African populations to establish the true pattern of odontogenic cysts.

Oral pyogenic granuloma: a review of 38 cases from Ibadan, Nigeria.

Thirty-eight cases of patients with histologically confirmed pyogenic granuloma of the oral cavity were treated at the University College Hospital Dental Centre during the period 1982-1993. The age of the patients at presentation ranged from 5 to 74 years (mean 33) and the male:female ratio was 1:1.2. The main site was the gingiva (n-29, 74%). The clinical presentation was generally similar to that in other studies except that most of the lesions were large. All 38 cases were treated by excision and there were no recurrences among those with adequate follow-up.

Osteomyelitis of the mandible associated with osteopetrosis: report of a case.

A 45-year-old Nigerian housewife with chronic osteomyelitis associated with osteopetrosis is described and discussed. Haematological and radiographical investigations on routine admission led to the secondary diagnosis of osteopetrosis. To our knowledge, this is the first case of osteomyelitis of jaws associated with osteopetrosis reported in an African.

Kaposis sarcoma report of a case with exclusive oral involvement.

A case of Kaposis sarcoma presenting exclusively in the oral cavity is reported. Exclusive oral presentation of Kaposis sarcoma is considered extremely rare. At the U.C.H. Ibadan, a total of one hundred and two cases of Kaposis sarcoma were seen in the last 24 years. None of these presented exclusively or concomitantly in the oral cavity, until this case under review. The clinical and histological difficulties that were encountered in diagnosing this exclusive oral presentation are discussed. Literature review on possible pathogenesis is highlighted.

Reviewing trends in the incidence of cancrum oris in Ibadan, Nigeria.

The objective of this clinic based retrospective study was to review the trends in the incidence of cancrum oris at the Dental clinic of the University College Hospital, Ibadan, Nigeria. Records of children aged 1 to 16 years diagnosed as having cancrum oris between 1st of January 1986 to 31st December, 2000 were reviewed. Of the six thousand three hundred and ninety (6390) children seen within the period of study, 45 had cancrum oris with the modal age been 3-5 years and the mean age was 4.2 +/- 2.7 years. There was a declining trend in the proportion of children presenting with the disease at five yearly interval within the period of study, although malnutrition was still a common factor in all the children.

Lipoma of the oral cavity: clinicopathological review of seven cases from Ibadan.

This study provides documented basis of oral lipoma experience at the University College Hospital Ibadan. The study reviewed seven cases, seen over a period of 18 years. Peak age of occurrence way 40 years and above. The tongue, and cheek were the predominant sites while the overall incidence was 0.43%. Male to female ratio was 2.5:1. Surgical excision is the only treatment recommended in the present study and no recurrence was recorded in these case treated in this study.

Computerised planimetric and stereological analyses of histological and cytological parameters in dysplastic atrophic epithelium and carcinoma.

This report analysed two lesions, of the Oral cavity, (atrophic dysplastic epithelium and oral squamous cell carcinoma) using computerized planimetry and point counting stereological methods. Three cytological, and histological parameters were analysed at a time. Results indicate a significant difference between the cell size, and nucleocytoplasmic ratio's of the two lesions when analysed (P<0.0001). The nuclear area measurement did not differ when the figure for the two lesions were compared. Study confirms the efficacy of objective analyses of tissue pathology of the oral cavity.

Salivary gland neoplasms: a 21year review of cases seen at University College Hospital, Ibadan.

The present study updates the experience of salivary gland tumours in Ibadan. All cases of benign and malignant salivary gland neoplasms histologically diagnosed between 1975 and 1995 in the Oral Pathology Department and Cancer Registry of the University College Hospital, Ibadan were reviewed. Salivary gland neoplasms accounted for 3.5% of head and neck neoplasms, the majority (46.5%) occurring in the parotid, followed by the submandibular (18.1%) and palatal glands (10.7%). The ratio of benign to malignant neoplasms was 1.1 to 1. Mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common malignant neoplasms. There was a predilection of adenoid cystic carcinoma for the submandibular gland.

Osteomyelitis mimicking Paget's disease or a pagetoid phenomenon: a case report.

Osteomyelitis is an inflammatory infection of the bone marrow. When the maxillofacial region is involved the mandible is the preferred site in adults and the elderly. Maxillary involvement is usually seen in children with only few cases reported in adults. The disease occurs in stages, with some stages highly mimicking other diseases. Clinicians ought to be aware of the full biological course of osteomyelitis of the jaws to avoid mis-diagnosis or underdiagnosis.

Intra-oral squamous cell carcinoma in Ibadan: a review of 90 cases.

Squamous cell carcinoma (SCC) of the oral cavity is considered the commonest of all oral malignancies. Between the period January 1960 and December 1985, 385 cases of oral malignancies were histologically diagnosed at Ibadan; 102 out of these were SCC. There are very few up to date reports in the literature on the incidence of intra-oral carcinoma amongst the Nigerian population, particularly on intra-oral SCC. Therefore, this study analyzed the lesion's incidence according to sex, age, and site prevalence, and also compared the results with studies from other countries.

Factors associated with oro-facial injuries among children in Al-Baha, Saudi Arabia.

This study was prompted by the dearth of injury data among children in Saudi Arabia. Data were collected prospectively on all children 0-15 years who presented to the King Fahad Hospital at Al Baha with oro-facial injuries over a period of five consecutive years. These records were analyzed for age, gender, seasonal distribution, cause, location and types of injuries. The mean age of the injured children was 6.2 +/- 3.7 years. Falls, motor vehicle accidents followed by direct blunt trauma were responsible for over 97 percent of all oro-facial injuries in children, and over 60 percent of all injuries were due to falls. The forehead, eye, periorbital areas and the mouth accounted for about two-thirds of all injury sites. Most injuries 356 (75.3%) occurred during the summer months while only 117 (24.7%) occurred during the winter months. The difference was significant (P<0.0001). The large majority of injuries, which occurred in children under the age of 6 years, took place at home, while road traffic accidents were the commonest cause of injury in the older children 6 years and above. Following logistic regression analysis, age (6 years and under) was associated with increased risk of injury while the winter months were associated with a lower risk. In addition, the study found no statistically significant difference in the prevalence by sex. Having a safe home environment, health education programmes directed towards the caretakers of young children and legislation in support of seat belts will go a long way towards reducing injuries among children in this community. A multi-disciplinary clinical management approach is envisaged due to the different injury sites and facilities would need to be equipped to take care of all types of oro-facial injuries.

Fractures of the facial skeleton in Tabuk North West Armed Forces Hospital: a five year review.

A five-year review of nine hundred and eighty maxillofacial injuries seen and treated at the Armed Forces Hospital, Tabuk, Saudi Arabia is presented. The dominant age group range was 21-30 years. There were almost twice as many maxillary fractures as mandibular fractures. The most common aetiology was road traffic accidents (RTA), followed by sport traumas. Facial lacerations and contusions followed by neurologic and orthopaedic injuries were the most common concomitant injuries.

Effects of some risk factors and immunodeficiencies on the periodontium--a review.

The possible role systemic factors might play in initiating or modifying the progress of periodontal disease has been a controversial issue for some time. Gingivitis is initiated by microbial plaque deposits on the dento-gingival interface but progression to periodontitis is modified by several environmental, behavioural, biological and health care variables. The importance of the immune system in modifying the host response to plaque is well established and as such, the immune system is a risk factor for human and animal periodontal disease. This paper reviews the modifying risk factors for periodontal disease and examines the periodontal manifestations of subjects with primary and acquired immuno-deficiencies.

Prevalence of pregnancy related oral granuloma in a Nigerian population group and the possible role of contraceptives.

A clinicopathological survey on pregnancy related tumours was carried out on 400 randomly selected pregnant Nigerian women. Fifteen (15) cases of pregnancy granuloma or 'epulis gravidanum' were found. Of these subjects, 287 representing 71.8 percent were on birth control before conception, while 113 or 28.2 percent were not. Nine (9) cases of pregnancy tumour were found in the group on birth control pills and six (6) in the group not on birth control representing an incidence of 3.1 and 5.3 percent respectively. Literature review indicate a general incidence of between 0-2.5 percent. Five of the granuloma regressed post partum, while ten were excised. Patients were followed 1-2 years post partum and no recurrence was recorded, even in patients who have re-commenced on contraceptives.

Oral cancer awareness and prevalence of risk behaviours among dental patients in South-western Nigeria.

The present study, based in a tertiary hospital in South western Nigeria, assessed cancer awareness among patients seeking dental treatment. A specially designed questionnaire was used to collect information on the knowledge, beliefs and habits of those attending the dental hospital within a designated period of the year. Almost 61% of the respondents had post-secondary education. The level of oral cancer awareness was remarkably high (72%), but this was low compared to awareness about occurrence of cancer in other parts of the body (89.9%). Awareness was found to be closely associated with educational status. The study also revealed that 50% had previous information on oral cancers from mass media as against 20.1% who were informed through health care professionals. Almost half of the study sample recalled episodes of previous oral ulceration and of these, greater than 50% indulged in either self medication (38.1%) or no medication at all (18.4%). The prevalence of alcohol consumption and smoking habits among the respondents was low being, 16.3% and 4.2% respectively. The lack of association, in this study, between oral cancer incidence and the known risk behaviours, is an obvious indication for investigation into other predisposing factors such as nutrients, genetic predisposition and the role of chronic infections. Perhaps one or more of these might be more relevant in this environment.

Congenital insensitivity to pain: report of two cases.

Congenital indifference or insensitivity to pain (CIP) is a rare syndrome. It mimics a number of other syndromes categorized under peripheral sensory neuropathies, often making early diagnosis difficult. Two cases from the middle east are presented, highlighting possible diagnostic, and management difficulties.

Paediatric oral surgical pathology service in an African population group: a 10 year review.

The records of the Oral Pathology Services of the University College Hospital Ibadan Dental Centre contains data on 2264 biopsies between 1986-1996. There were 561 biopsies on patients aged 1-16 years representing 16.2% of total. Case notes and radiographs (where available) were retrieved and analysed for diagnosis, sex, age and site. For convenience, tissue pathology was compartmentalised into, Neoplasm (benign and malignant), cysts, and inflammatory/reactive. Neoplasm constitutes the highest with 47.6%, followed by inflammatory/reactive 27.6% and cystic lesions at 24.8%. A significant preference for male over female was noted and the mandible was also the site of preference for most of the lesions.