An analysis of treatment outcome in traumatised anterior teeth with delayed presentation.

Introduction: This study was designed to analyse the treatment outcome of traumatized anterior teeth with delayed presentation among adult patients. Method: A longitudinal study carried out among adult patients with traumatized anterior teeth. Data was obtained by means of a pre-tested questionnaire consisting of history taking, clinical examination and record of treatment. Data collected was analysed using the Statistical Package for Social Science 21.0. Results: Out of 163 patients who sought treatment for traumatized anterior teeth, 102 presented a month or more after the traumatic incident giving a prevalence rate of 62.3% for delayed presentation. The main reason for seeking treatment was disfigured teeth. More than half (57.8%) of the participants presented with one or more complications. Evaluation revealed that 3 (2.7%) of the participants had failed restoration at 1-month recall and this was statistically significant. Conclusion: Delayed treatment has an implication on the type, complexity and cost of treatment. Evaluation after treatment for traumatized anterior teeth has to be done for a minimum of 3 months to ascertain optimal result. Oral health education should focus on the need to visit a dentist immediately after a traumatic episode with or without loss of dental hard tissue.

Determinants of Oral Diseases in the African and Middle East Region.

Oral health policies must be developed that emphasize the role of social determinants in health and oral diseases. The aim of this report is to review literature on determinants of oral diseases and apply the concepts to promoting oral health in the African countries in the African and Middle East region (AMER). Structural and proximal determinants of oral diseases are common to those affected by other noncommunicable diseases (NCDs). Oral diseases are also heavily affected by issues of politics, poor health behaviors, underdeveloped health systems, and low oral health literacy. Wide-scale poverty exists in populations in the AMER. Oral health promotion and preventive oral health programs should therefore be integrated with those for general health and use the common risk factor approach (CRFA). Attempts should be made to improve the daily living conditions and reduce the incline of the social gradient. Oral health practitioners should use the CRFA when dealing with determinants of oral diseases and in the design of preventive oral health programs. The detrimental effects of the social determinants of health may be ameliorated by involving both the individual and community. Interventions in health promotion programs in the AMER need more research on the epidemiology of oral diseases and the role played by the social determinants of oral diseases, especially with regard to poverty. The high levels of poverty and low gross domestic product in most countries in the African region make it difficult to fund high-quality, affordable, accessible oral health services.

Cleft care in Nigeria: past, present, and future.

OBJECTIVE: To review the progress of orofacial cleft care in Nigeria and propose a viewpoint for the future. DESIGN: Review of the available literature on cleft care in Nigeria and survey of the status of ongoing cleft care in Nigerian centers. We employed a pretested self-administered questionnaire sent and returned through electronic mail. PARTICIPANTS: Coordinators of cleft care centers in Nigeria. MAIN OUTCOME MEASURES: Findings of literature search and responses to mailed questionnaires. RESULTS: Available literature suggests that the fate of orofacial cleft patients during the precolonial era in Nigeria remains unclear. However, there is evidence of surgical care delivery just before the end of the colonial era. We identified and contacted 39 existing cleft care delivery centers, of which 30 (76.9%) responded. The majority (69.2%) of the responding centers began cleft care delivery between 2006 and 2010; 73.3% have designated cleft clinic locations and 66.7% offer interdisciplinary care. All responding centers offer cheiloplasty, while 86.7% offer palatoplasty. Other aspects of cleft care are provided sparingly in most centers due to paucity of manpower. Challenges with hospital administration, securing bed and theater spaces, drug availability, and performing laboratory investigations were the common limitations reported. CONCLUSIONS: We advocate for improved cleft care delivery through removing administrative bottlenecks, fortifying existing centers, and mentoring younger colleagues for entry into underserved specialties. Concerted effort and international collaborations aimed at transforming some of the existing cleft centers to standard pediatric craniofacial centers are desirable.

A Deep Learning System to Predict Epithelial Dysplasia in Oral Leukoplakia.

Oral leukoplakia (OL) has an inherent disposition to develop oral cancer. OL with epithelial dysplasia (OED) is significantly likely to undergo malignant transformation; however, routine OED assessment is invasive and challenging. This study investigated whether a deep learning (DL) model can predict dysplasia probability among patients with leukoplakia using oral photographs. In addition, we assessed the performance of the DL model in comparison with clinicians' ratings and in providing decision support on dysplasia assessment. Retrospective images of leukoplakia taken before biopsy/histopathology were obtained to construct the DL model (n = 2,073). OED status following histopathology was used as the gold standard for all images. We first developed, fine-tuned, and internally validated a DL architecture with an EfficientNet-B2 backbone that outputs the predicted probability of OED, OED status, and regions-of-interest heat maps. Then, we tested the performance of the DL model on a temporal cohort before geographical validation. We also assessed the model's performance at external validation with opinions provided by human raters on OED status. Performance evaluation included discrimination, calibration, and potential net benefit. The DL model achieved good Brier scores, areas under the curve, and balanced accuracies of 0.124 (0.079-0.169), 0.882 (0.838-0.926), and 81.8% (76.5-87.1) at testing and 0.146 (0.112-0.18), 0.828 (0.792-0.864), and 76.4% (72.3-80.5) at external validation, respectively. In addition, the model had a higher potential net benefit in selecting patients with OL for biopsy/histopathology during OED assessment than when biopsies were performed for all patients. External validation also showed that the DL model had better accuracy than 92.3% (24/26) of human raters in classifying the OED status of leukoplakia from oral images (balanced accuracy: 54.8%-79.7%). Overall, the photograph-based intelligent model can predict OED probability and status in leukoplakia with good calibration and discrimination, which shows potential for decision support to select patients for biopsy/histopathology, obviate unnecessary biopsy, and assist in patient self-monitoring.

Effects of maxillomandibular fixation and rigid internal fixation on pulmonary function in patients with mandibular fractures.

Closed reduction and maxillomandibular fixation (MMF) is associated with airway obstruction. The ventilatory effect of open reduction and rigid internal fixation (ORIF) as an alternative treatment has not been determined. The aim of this study was to compare the effects of MMF and ORIF on pulmonary function (PF) in patients with mandibular fractures. Using a computer-generated simple randomization protocol, 40 eligible participants were allocated to MMF and ORIF treatment groups. PF tests were done preoperatively and at 24hours, 1, 6, and 7 weeks postoperative in all participants in both groups, using a portable office spirometer (Spirobank G). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, and peak expiratory flow rate (PEFR) were determined. At 6 weeks postoperative, PF tests were performed after the release of MMF. PF tests in the MMF and ORIF groups were similar preoperatively. At 24hours postoperative, FEV1/FVC was significantly lower in the MMF group than in the ORIF group (p<0.001). Values of FEV1 (p=0.022), FEV1/FVC (p=0.001) and PEFR (p<0.001) were significantly lower in the MMF group than in the ORIF group at 1 week postoperative. While MMF negatively impacted on PF, ORIF had no adverse effect on PF.

Changing pattern of maxillofacial fractures in a sub-urban nigerian teaching hospital.

OBJECTIVES: To ascertain the current pattern of facial fractures presenting in the Obafemi Awolowo University Teaching Hospital (OAUTH) and compare this with two earlier reports from the same institution. PATIENTS AND METHODS: All patients presenting with facial bone fractures at the OAUTH between January 1996 and December 2004 were included in the study. Information obtained were patients' demographics, date, cause, site and type of injury. The interval before presentation in the hospital was documented. Data was analysed and compared with two earlier studies carried out in the same institution. RESULTS: 451 patients (351 males and 100 females) presented with 632 facial bone fractures between January 1996 and December 2004. This shows a greater female involvement compared with earlier studies. Similar to earlier studies, majority of the patients (39.7%) were aged 21-30 years however, more cases occurred in the first decade of life in the present study than in the previous. Road traffic crashes remained the leading cause of fractures (74.7%), followed by fight/assaults (8.0%). There was a significantly higher prevalence of motorcycle related crashes and gunshot injuries. While the incidence of mandibular fractures declined, a statistically significant increase was observed for fractures of the middle face specifically Le Fort 1 and zygomatic complex fractures. CONCLUSIONS: Facial bone fractures appear to be on the increase in the studied location. More females and younger children are involved now. Road traffic crashes accounted for most facial bone fractures but violence related causes are on the increase.

Effect of Demographic Variables on Cytomegalovirus Antibody Seropositivity among Prospective Blood Donors in Jos, Nigeria.

BACKGROUND: Cytomegalovirus, otherwise called human herpes virus type 5, is a transfusion transmissible pathogen responsible for significant morbidity and mortality among various groups of individuals with damaged or impaired host immunity. Although it has a worldwide distribution, the infection is thought to be more widespread in developing countries where certain demographic factors and living conditions are thought to be responsible for the observed increased prevalence of this infection. OBJECTIVES: The aim of this study is to evaluate the effect of living conditions, using certain selected demographic parameters, on CMV seropositivity, among blood donors in Jos. PATIENTS AND METHODS: A total of 200 prospective blood donors who presented for bleeding were recruited consecutively into the study. Questionnaire was used to obtain the personal, educational, social and demographic data of donors. Screening for CMV antibodies was performed on each serum sample using ELISA kit ("DIALAB", Austria) (www.dialab.at). RESULTS: The relationship between the extent of crowding and CMV status of donors was statistically significant, p<0.05. Other studied donor demographic parameters (source of drinking water, place of abode and type of toilet facility) did not statistically influence donor CMV status, p>0.05. CONCLUSION: Our study showed that overcrowding was the most significant factor that statistically influenced donor CMV status in Jos, Nigeria. There is, therefore, an urgent need for concerted effort to handle the problem of overcrowding in developing countries and Nigeria in particular.

Loss-of-Function GRHL3 Variants Detected in African Patients with Isolated Cleft Palate.

In contrast to the progress that has been made toward understanding the genetic etiology of cleft lip with or without cleft palate, relatively little is known about the genetic etiology for cleft palate only (CPO). A common coding variant of grainyhead like transcription factor 3 ( GRHL3) was recently shown to be associated with risk for CPO in Europeans. Mutations in this gene were also reported in families with Van der Woude syndrome. To identify rare mutations in GRHL3 that might explain the missing heritability for CPO, we sequenced GRHL3 in cases of CPO from Africa. We recruited participants from Ghana, Ethiopia, and Nigeria. This cohort included case-parent trios, cases and other family members, as well as controls. We sequenced exons of this gene in DNA from a total of 134 nonsyndromic cases. When possible, we sequenced them in parents to identify de novo mutations. Five novel mutations were identified: 2 missense (c.497C>A; p.Pro166His and c.1229A>G; p.Asp410Gly), 1 splice site (c.1282A>C p.Ser428Arg), 1 frameshift (c.470delC; p.Gly158Alafster55), and 1 nonsense (c.1677C>A; p.Tyr559Ter). These mutations were absent from 270 sequenced controls and from all public exome and whole genome databases, including the 1000 Genomes database (which includes data from Africa). However, 4 of the 5 mutations were present in unaffected mothers, indicating that their penetrance is incomplete. Interestingly, 1 mutation damaged a predicted sumoylation site, and another disrupted a predicted CK1 phosphorylation site. Overexpression assays in zebrafish and reporter assays in vitro indicated that 4 variants were functionally null or hypomorphic, while 1 was dominant negative. This study provides evidence that, as in Caucasian populations, mutations in GRHL3 contribute to the risk of nonsyndromic CPO in the African population.

Signs and symptoms of temporomandibular disorders in Nigerian adult patients with and without occlusal tooth wear.

OBJECTIVES: The purpose of this study was to investigate the prevalence of signs and symptoms of temporomandibular disorders in Nigerian patients with and without occlusal tooth wear, and to relate the signs and symptoms with the severity of occlusal tooth wear. METHODS: One hundred and fifty patients with occlusal tooth wear, and 100 control subjects participated in this study (mean age 40.8 +/- 12.2 years, range 18-65 years). Exclusion criteria included patients and subjects with more than one missing opposing pair of premolars or molars, restorations covering the entire incisal edge, canine cusps and occlusal surfaces of premolars and molars. The severity of occlusal wear was assessed using the tooth wear index (TWI) designed by Smith and Knight (1984). Chi-square test was used to compare the differences in signs and symptoms of TMD. P < 0.05 was defined as significant. RESULTS: Although more females reported pain than males the difference was not statistically significant (p = 0.05). Except for impaired range of movement, tooth wear patients and controls differ significantly with respect to the variables; pain report, pain on palpation, TMJ sound and deviation on opening (p < 0.001). Patients with mean occlusal TWI score of > or =3 differ significantly from those with TWI score < or =2 with respect to pain on palpation and TMJ sound (p < 0.001). CONCLUSIONS: Posterior occlusal wear (mean TWI scores of 3 or 4) was significantly associated with pain on palpation and TMJ sound. Hence there may be a clinically relevant risk of TMD among Nigerian patients with occlusal tooth wear.

Attitude of Nigerian surgical residents towards trauma care.

OBJECTIVE: To investigate the attitude of some Nigerian surgical residents to trauma care. SUBJECTS AND METHOD: Surgical residents from three tertiary care facilities located in South Western Nigeria completed a structured questionnaire, which contained twelve questions directed at eliciting their attitude to trauma care. RESULTS: Fifty-four residents completed the questionnaire. Majority of them were males (88.9%) and aged =30 years (96.3%). Over half (55.6%) were junior residents and one third each had stayed for <2 years, >2-4 years and >4 years respectively in training. Specialties represented included Oral and maxillofacial surgery, General surgery, Orthopaedic surgery, Ophthalmology, Otorhinolaryngology, Urology and Cardio thoracic unit. Only 9.3% and 13.0% of them had received training in the ACLS and ATLS respectively. However, most trainees displayed moderate (42.6%) to major (46.3%) interest in care of the injured judging by the time in future practice hoped to be dedicated to trauma care. Most trainees considered trauma care a rewarding, gratifying and essential aspect of all surgeons practice. At the same time, majority felt it is stressful, time consuming and disrupts a lot of routine activities. CONCLUSION: The studied group displayed a high level of interest in the care of the injured and willingness to devote quality time to this despite the fact that trauma care was considered stressful and time consuming. A need to review our training curriculum to ensure that ATLS and ACLS are incorporated early in the training was observed.

The use of thromboembolic prophylaxis by surgeons: A multicentre Nigerian study.

BACKGROUND: Despite the well known contributions of deep vein thrombosis and pulmonary embolism to perioperative deaths, these major causes of morbidity and mortality appear not to be given adequate attention by surgeons in our environment. OBJECTIVE: To study the practice of thromboembolic prophylaxis among surgeons in some sub-specialties in three Nigerian tertiary institutions. MATERIALS AND METHODS: A structured questionnaire was used to collect information from consultants in the surgical sub-specialties on the use of thromboembolic prophylaxis in their practice. RESULTS: Fifty nine adequately completed questionnaires were returned. Of this, only 28 (47.5%) used prophylaxis routinely in major surgeries. Use was most frequent in orthopaedics and least in ophthalmology and otorhinolaringology. Subcutaneous heparin was the most commonly employed agent and the most important indication for prophylaxis was a previous history of thromboembolism. CONCLUSION: The results obtained suggest low use of prophylaxis. Evidenced-based guidelines are available on antithrombotic and thrombolytic therapy with the benefits outweighing risks, burdens and costs. Therefore greater attention should be paid to antithrombotic measures by all the surgical sub-specialties and patients stratified according to risk.

PROFESSIONAL EXPERIENCES, TRAINING ATTITUDES AND EXPECTATIONS OF RESIDENTS IN DENTISTRY: A NATIONWIDE SURVEY.

BACKGROUND: Worldwide, it has been acknowledged that feedback from students and trainees is important for evaluation of training. However, there is limited data on the professional experiences, expectations and attitude of residents in dentistry to their training. AIM: This study aimed to analyse the professional experiences, expectations, and attitudes of dentistry residents to training in Nigeria. DESIGN OF THE STUDY: Cross-sectional study. SETTING: All the accredited Nigerian Teaching Hospitals with dental surgeons undergoing residency training in any of the 10 specialties examined in West Africa. METHODOLOGY: The study was conducted through a self- administered closed anonymous 46-items questionnaire adapted from that used for general surgery residents in the United States of America. The collected data included various aspects of the technical, human and professional domains of the expectations, attitudes and perceptions of dental residents to their training. Data from the questionnaires were collated and entered into Microsoft Excel version 10, 2002 (Microsoft, Redmond, WA, USA) and processed using STATA software (StataCorp LLC, Texas, USA). Categorical variables were calculated as proportions and percentages with 95% corresponding intervals. χ2 - test was used to analyse the association between selected demographic characteristics and some of the responses. Fischer's exact test was done where necessary. Statistical significance was set at p≤0.05 and tests were two- sided. RESULTS: Nigeria has 11 accredited training institutions for residency in dentistry, of which 214 residents participated representing 93% of the estimated total. Most were males (133, 65.2%) with male to female ratio of 1.9:1. Residents aged between 30-34 years of age made up 41.5% while 77.4% were married. Close to one third (31.8%) were residents in oral and maxillofacial surgery. Residents expressed low level of satisfaction with the quality of residency training (64, 30.3%; 95% CI 24.5-36.9) and believe that they had appropriate level of operating skill from their training (96, 45.3%; 95% CI 38.6-52.1). Few agreed that the training programme had adequate support structures for struggling residents (64, 30.3%; 95% CI 24.5-36.9) but many (105, 65.2%; 95% CI 57.5-72.2) felt the residency programme took too long. More males (31.8%) than females (14.9%) expressed satisfaction with the level of didactic teaching during the residency programme with statistically significant difference (p=0.032). Orthodontic residents expressed the greatest approval (54.5%) for the support structures put by the training programme for struggling residents, while the least were in oral medicine (12.5%) with high statistically significant difference (p=0.014). The level of support from faculty/departmental member to struggling resident was felt to be most adequate by those who had passed the primaries exam (69.5%) with statistically significant difference from other residents (p= 0.021). CONCLUSION: Overall, this study showed that Nigerian dentistry residents had low level of satisfaction with the quality of their training indicating the need for a holistic review of the training curriculum and conduct of trainers. There is need to reinforce motivating and tackle demotivating factors identified in this study to improve the response of dentistry residents to their training as these would improve the value of competency assessments undertaken by the postgraduate colleges while sustaining interest in the profession for the interest of the wider society.

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.

Comparative study of the therapeutic effect of a systemic analgesic and transcutaneous electrical nerve stimulation (TENS) on post-IMF trismus and pain in Nigerian patients.

OBJECTIVES: To compare the therapeutic effect of paracetamol and Transcutaneous Electrical Nerve Stimulation (TENS), on post-Intermaxillary Fixation (IMF) trismus, and pain in some Nigerian patients. PATIENTS AND METHODS: Twenty patients treated for mandibular fractures with IMF were randomly selected into two groups of ten patients each. After the release of IMF, they were started on jaw exercises with the aid of wooden spatulae to overcome trismus due to muscle spasm. Patients in Group I underwent jaw exercises before and after TENS therapy which lasted for 30 minutes while those in Group II had jaw exercises before and 30 minutes after ingestion of 100 mg of paracetamol. Their inter-incisal distances were recorded pre and post intervention. RESULTS: Analysis of the data showed that for both therapeutic interventions, there was an appreciable gain in mouth-opening which was more prominent for patients with unusual difficulty in mouth-opening initially. However, a comparison between the mean improvements produced by TENS and analgesic revealed no significant difference between the two groups. CONCLUSION: Both the TENS therapy and paracetamol provided similarly appreciable differences in inter-incisal distances (mouth-opening) after their applications.

A prospective epidemiological study on odontogenic tumours in a black African population, with emphasis on the relative frequency of ameloblastoma.

The persistent view in the literature is that the relative frequency of ameloblastomas is higher in the black population than in Caucasians. The aim of this study was to determine the relative frequency of all odontogenic tumours (OT) in a 100% black population and to compare our findings with those of previous studies. A prospective study was undertaken of all patients presenting with OT to all 16 Nigerian departments of oral and maxillofacial surgery over a 4-year period. The following data were obtained: patient demographics, delay to presentation, extent of the lesion, and histological diagnosis. Six hundred and twenty-two cases were studied. A slight male preponderance was observed (male to female ratio 1.17:1). Patients ranged in age from 5 to 89 years, with a peak incidence in the third decade. The relative frequency of OT was 0.99 per million and that of ameloblastoma was 0.76 per million. Ameloblastoma was the most prevalent OT (76.5%), followed by adenomatoid odontogenic tumours (5.6%), odontogenic myxoma (4.5%), and keratocystic odontogenic tumours (KCOT) (3.1%). The relative frequency of ameloblastoma among Nigerians was not different from frequencies reported previously among Caucasian and Tanzanian black populations. KCOTs were, however, rarely diagnosed in Nigerians as compared to the white population in the Western world.

Patients' attitudes to wearing of gloves by dentists in Nigeria.

OBJECTIVE: To evaluate patient's attitudes to the use of gloves by dentists. DESIGN: This consisted of a four-item questionnaire administered to 445 consecutive patients attending our dental clinic. SETTING: . Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria. SUBJECTS: Four hundred and forty five patients above the age of fifteen years attending the dental clinic for the first time. RESULTS: Majority of the patients were in the 20-30 year age group and over 93% had formal education. Most of the respondents (88.8%) stated that glove wearing was essential and over 63% considered that glove wearing protected both the operator and the patient. Whilst about one-third of respondents would attend for treatment when gloves were not worn, 81.3% felt that gloves should be changed after each patient. There were statistically significant differences (p<0.05) in responses in relation to age-groups and educational attainment, however no sex differences (p>0.05) were reported. CONCLUSION: This survey showed a high level of awareness by patients on the use of gloves by dentists. It also found that age-groups and levels of educational attainment influenced patients attitude to glove use.

An investigation into the relationship between mandibular third molars and angle fractures in Nigerians.

We examined the relationship between the presence or absence of mandibular third molars and angle fractures in Nigerians between January 1976 and July 1997. Information was obtained from patients' case records and radiographs.A total of 490 patients were seen during the study period, 408 of whom (83%) had their third molars present, and 76 of whom had angle fractures. Road traffic accidents (n =304, 62%) were the main cause of the fractures. Of these, 44 (14%) had angle fractures compared with 14/75 (19%) patients in whom the mechanism of injury was a fight or assault.Sixty-five of the 408 patients whose third molars were present (16%) had angle fractures, as did 11/82 (13%) who did not have third molars (p =0.57). Of the 77 patients whose lower third molars were not erupted, 24 (31%) had angle fractures compared with 52/331 (16%) in whom the lower third molars were erupted (p =0.002). These findings suggest that angle fractures are uncommon in this population because of their particular mechanism of injury. In addition, the presence of a lower third molar does not necessarily predispose to fractures of the angle of the mandible. However, angle fractures are more likely to occur in people with unerupted lower third molars than in those in whom they have erupted.

Facial dog bites in Southwestern Nigerian children: an analysis of eight cases.

This paper analyses the prevalence, pattern and treatment outcome of eight cases of facial dog bite in Nigerian children seen and managed at the Obafemi Awolowo University Teaching Hospital's Complex, a tertiary hospital located in Southwestern Nigeria. During the study period of 18 months (July 1996-December 1997), a total of 174 cases of facial soft tissue injuries in children were managed, two of which resulted in rabies and death of the patients. Based on the findings of this analysis, we suggest that unprovoked facial dog bites inflicted by familiar domestic dogs may be complicated by rabies. Ignorance about the risk of uncompleted treatment, financial constraints and scarcity of the vaccine may be implicated in the outcome. The need to improve community knowledge of rabies and the availability and affordability of rabies vaccine are highlighted.

Necrotising fasciitis of the head and neck: a review of the literature.

Necrotising fasciitis is a severe life threatening bacterial infection of the fascial planes which is relatively rare in the head and neck region. The hallmark of the disease is selective necrosis of the fascia overlying skin and adjacent vasculature. Primary odontogenic infection due to aerobes and obligate anaerobes and trauma amongst other factors, are frequently responsible for this condition. Similarly, affected individuals often have an underlying systemic disease, the most common of which is diabetes mellitus. Treatment usually involves appropriate antimicrobial therapy, control of systemic disease, thorough surgical debridement, gamma globulin administration and hyperbaric oxygen where facilities exist. Significant morbidity and mortality attends necrotising fasciitis when treatment is delayed due to toxaemia, dehydration and severe biochemical disturbances. Prompt diagnosis, adequate resuscitation, thorough and frequent surgical debridement remains the cornerstone to a successful outcome.

Postoperative complaints following impacted mandibular third molar surgery in Ile-Ife, Nigeria.

An investigation into the pattern of complaints lodged by patients after impacted mandibular third molar surgery was done in a Nigerian teaching hospital over a period of 3 years. One hundred and twenty seven records were retrieved. Pericoronitis (71.2%), pulpitis (17.6%) and periodontitis (11.2%) were the reasons for surgery. No third molar surgery was done for prophylactic or orthodontic reasons. Sixty-one complaints were lodged by 49 (38.6%) patients on day 1, and 37 complaints by 35 patients on day 7. These complaints were verified by the findings of the examining clinician. Pain, swelling and trismus were the commonest complaints. A significant association (P = 0.042) was found between patients' complaints on the first postoperative day and the drug combination given. Similarly, there was a significant relationship (P = 0.0055) between the type of analgesics prescribed and the presence of postoperative pain. No significant relationship was however found between the complaints and patients' age, indication for extraction, impaction type and method of impacted tooth removal. Although the findings of this retrospective study are limited in their comparability, they suggest the need for an appraisal of pain management in patients undergoing mandibular third molar surgery in our hospital. Consequently, there should be a reduction in complaint rate thereby making selective review appointment on the first postoperative day feasible.