Adebayo Aremu Ibikunle

A Comparative Clinical Evaluation of the Effect of Preoperative and Postoperative Antimicrobial Therapy on Postoperative Sequelae after Impacted Mandibular Third Molar Extraction

ABSTRACT Objectives To compare the effect of preoperative and postoperative antibiotics therapy on postoperative sequelae after impacted mandibular third molar extractions. Material and Methods This was a prospective study conducted at Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospitalon consecutive patients with impacted third molar extractions for a 12 month period. Group I (n = 31) had administration of 1 gram of oral metronidazole and 1 gram of amoxicillin capsules 30 minutes preoperative and Group II (n = 31) had 500 milligrams of amoxicillin capsule 8 hourly and 400 milligrams of metronidazole tablets administered post operatively for 5 days. Pain, facial swelling and mouth opening assessment were done postoperatively and on days 1, 3 and 7. Results The general pattern of postoperative pain, regardless of antimicrobial use revealed that pain increased from day 1 to day 3 postoperatively and began to decrease in intensity subsequently up to the seventh day. There was however a statistically significant difference (P = 0.0001) between the two groups on the 7th postoperative day with the subjects in Group I showing lower pain intensity. The mean difference of the facial width on days 1 and 3 was significant (P = 0.04 and P = 0.0001 respectively) with subjects in Group II having a reduced facial width compared to those in Group I. Conclusions This study suggested that the administration of preoperative or postoperative antibiotics showed no marked differences in the degree of postoperative sequaele that occur after impacted mandibular third molar extractions.

A prospective, single center analysis of satisfaction following cleft lip and palate surgeries in Southwest Nigeria

Objective: Aim of this study was to assess satisfaction with facial appearance and function following cleft lip and palate (CLP) surgeries. Materials and Methods: The surgical outcome of 70 consecutive patients who had CLP surgeries between October 2008 and December 2009 were prospectively evaluated at least 4 weeks postoperatively. Data collected included age, sex, type of cleft defects and type of surgery done, and postoperative complications. For cleft lip repair, the Pennsylvania lip and nose score was used to assess surgical outcome whereas the integrity of the closure was used for cleft palate repair. Results: A total of 70 subjects were enrolled in this study with 40 females (57.1%) and 30 males (42.9%) (female:male = 1.3:1). The age of the subjects at presentation ranged from 1 day to 26 years. Majority of the study group were infants 74.3% (52) and 25.7% (18) presented after age one. 19 (39.6%) of subjects were operated within the ages of 3 months for lip repair and 10 (45.5%) subjects after 18 months for palate repair. There was a good surgical outcome of 71.4% with an overwhelming parents/subjects satisfaction of 94.8% with the treatment outcome. Twelve cases (15.6%) in which surgical outcome was rated fair, the subjects or their parents were still very satisfied with the surgical outcome. Conclusions: There was a high patient satisfaction irrespective of treatment outcome. This satisfaction reflects not only the technical competence of the cleft surgeons, but also the dedicated performance of other supporting staffs of the hospital.

Airway management with submental orotracheal intubation in maxillofacial surgery: Our experience and literature review

Background and Aim: The challenge of the “shared airway” is a recurring predicament in maxillofacial surgeries. The need to have unfettered access to the nasal pyramid and oral cavity without jeopardizing the integrity of the airway during maxillofacial surgeries is vital. The use of submental intubation has been reported as an excellent adjunct in maxillofacial trauma surgery; however, few, if any, report exists on its use for massive facial tumors. This is a report of its use in varied scenarios including traumatic and neoplastic conditions. The aim of this study was to review the indications, complications, and outcomes of airway management using submental intubation in maxillofacial surgery at a tertiary hospital in Nigeria. Patients and Methods: Records were retrieved retrospectively over a period of 28 months (June 2013–October 2015). Data recorded included demographics, indications, and intraoperative and postoperative complications. Results: A total of eight patients were evaluated, all of whom had surgery under general anesthesia. All of them had conventional orotracheal intubation initially, which was then converted into the submental route. Two of them had intraoperative complications of raised airway pressure, however no postoperative complication was observed. Conclusions: Although it requires some surgical skill, submental intubation provides a reasonable substitute to other airway management techniques in certain patients. Its importance in patients with massive maxillofacial tumors was also highlighted along with other indications.

Changing pattern in the treatment of mandibular fractures in North-Western Nigeria

Background: Maxillofacial fractures constitute a significant proportion of fractures seen at tertiary hospitals. Management of maxillofacial fractures is challenging and often associated with reduced quality of life among patients if not properly managed. This study was designed to analyze the trend in management of maxillofacial fractures at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwest Nigeria between 2011 and 2016. Materials and Methods: Data on the sociodemographic characteristics, etiology, type of fracture, and treatment done were retrieved. Data analysis was done with SPSS and comparisons were made using Chi-square and t-test. Statistical significance was set at P < 0.05. Results: A total of 341 fracture sites were observed in 201 patients, the majority were males giving a male to female ratio of 6.2:1. The overall modal age group at presentation was the 21–30 year age group accounting for 78 (36.3%) of all cases seen. Road traffic accident (RTA) was the principal etiological factor accounting for 137 (63.7%) of the fracture cases seen. The mandibular body and dentoalveolar sites were the most frequently occurring fracture sites on the mandible accounting for 69 (20.2%) and 42 (12.3%) of all fractures. A comparison of the etiological factors among groups of patients based on the year of presentation and gender was statistically significant (P = 0.02). A comparison of the mode of treatment (open reduction and internal fixation [ORIF] or closed reduction) among patients based on the year of treatment was statistically significant (P < 0.001). Conclusion: RTA remains the foremost cause of maxillofacial fractures in our environment. Despite a variety of challenges, ORIF is gradually being embraced as a viable mode of treatment in our center.

Orofacial Rhabdomyosarcoma: A 5-year Clinicopathologic Study from Sub-Saharan Africa

Background: Rhabdomyosarcoma (RMS) is an aggressive malignant neoplasm of mesenchymal origin. Its common sites of occurrence are the extremities and the genitourinary system, being less frequently seen in the orofacial region. There is paucity of literature, especially from sub-Saharan Africa on orofacial RMS. Materials and Methods: Records of all patients managed for orofacial RMS between January 2013 and November 2017 at the Department of Dental and Maxillofacial surgery of Usmanu Danfodiyo University Teaching Hospital were obtained. Data retrieved include sociodemographics, clinical features (including the tumor, node, and metastasis [TNM] stage and Intergroup RMS Study risk classification), histological type, and mode of treatment. Data were recorded and analyzed using IBM SPSS Statistics for Windows version 20 (Armonk, IBM Corp., NY, USA). Results: Twenty-one patients were included. There were 17 (81.0%) males and 4 (19.1%) females, giving a male-to-female ratio of 4.3:1. Age ranged from 2 to 76 years (mean [±standard deviation] of 15.8 [±16.8]). Majority of them belonged to the low socioeconomic group. The duration of the symptoms ranged from 2 to 9 months. The midface was the most commonly involved sites. Majority of the cases were nonparameningeal 14 (66.7%). Regional nodal metastasis was clinically present in 9 (42.9%) cases. Embryonal RMS was the most frequently encountered histological type (11 [52.4%]). Treatment was multimodal in 11 (52.4%) cases and 3 (14.1%) had recurrence. Conclusion: Orofacial RMS may occur in any age group although it may be more commonly seen in the first decade of life. Unimodal treatment may be successfully deployed in carefully selected cases. Prognosis remains poor in our climes.

Odontogenic orbital cellulitis causing blindness: A case report

Blindness secondary to odontogenic orbital cellulitis is a rarity. We report a case of a 38-year-old man who presented with facial swelling and orbital pain. Examination revealed right orbital purulent discharge, nil light perception in the right eye and the presence of a grossly carious ipsilateral maxillary molar. Investigations revealed no underlying systemic condition. Aggressive surgical and medical intervention was instituted, which resulted in disease resolution. However, vision in the right eye was not recovered. Dental infections may lead to blindness; therefore, dental infections should be promptly treated.

Tooth extraction: Pattern and etiology from extreme Northwestern Nigeria

Objective: Tooth extraction is a commonly performed procedure in dental clinics. It has been shown that the reasons for and pattern of tooth extraction vary across geographical regions. Few reports on the pattern of extraction among a semi-urban populace exist. To the best of our knowledge, there is no study on the pattern and reasons for tooth mortality from Sokoto, Northwestern Nigeria, which is a semi-urban region. Materials and Methods: A review of the records of patients that had tooth extraction at our center between January 2009 and January 2016, was done. Data such as the age, gender, type of tooth extracted, and reasons for extraction were retrieved and analyzed. Cross tabulations for age and gender were also made. The level of statistical significance was set at P < 0.05. Results: A total of 1167 extractions were performed in 984 patients. An age range of 18–107 years with a mean (±standard deviation) of 34.8 (13.3) was observed. Most of the patients were in the 21–30 years age group accounting for 35.7% of cases. Dental caries and its sequelae (DCS) (631, 54.1%) were the most common reasons for extraction, followed by periodontal disease (192, 16.5%). The difference in proportions of reasons for tooth extraction between the gender was statistically significant (P = 0.02; df = 24). The difference in the reasons for extraction among the age groups was statistically significant (P < 0.001; df = 132). Conclusion: DCS along with periodontal disease were the major reasons for extractions. These are largely preventable causes of tooth extraction; therefore, there is a need for commencement of far-reaching preventative actions.

Perception of oral and maxillofacial surgery specialty among physicians in Sokoto, Northwest Nigeria

Background: Oral and maxillofacial surgery (OMS) evolves from the anatomical region within the head and neck region. Contrary to common belief, its scope does not start and end with teeth. This study is to assess the awareness of physicians in Sokoto, Northwest Nigeria, about the scope of practice of OMS. Materials and Methods: This is a prospective cross-sectional study carried out during annual general meeting of the Nigerian Medical Association in Sokoto. This is the largest gathering of physicians in the state. Data were stored and analyzed using IBM SPSS Statistics for Windows version 20 (IBM Corp., Armonk, NY, USA) and results presented in simple descriptive statistics and frequencies only. Results: One hundred and twenty-five questionnaires of the 150 distributed were returned and analyzed with a response rate of 83.3%. The analysis showed that there is high awareness of the respondents about the scope of oral and maxillofacial surgeons (OMFS) in facial bone fracture, jaw deformities, orofacial tumors, and temporomandibular joint ankylosis (81.0%, 88.1%, 88.1%, and 82.5%) respectively. There is, however, low awareness about its scope in sinus problems, cleft lip and palate, and esthetic facial surgery (9.5%, 12.7%, and 14.3%) respectively. Conclusion: The awareness of the scope of OMS practices needs to be increased among physicians, especially in cleft lip and palate, sinus problems, and esthetic facial surgeries. It is imperative as OMFS specialty to raise awareness of our specialty among physicians.

Management of 159 cases of acute cancrum oris: Our experience at the noma children hospital, Sokoto

Background: Cancrum oris (Noma) is a rapidly progressive gangrenous infection of the oral cavity and its surrounding structures, which typically results in destruction of both soft and hard tissues. It requires urgent intervention, especially while still in the acute phase. We present an overview of our experience in the management of acute cancrum oris at the Noma children hospital, which is a regional referral center for such cases in Nigeria. Materials and Methods: This was a retrospective study of 159 patients managed for acute cancrum oris at the Noma children hospital, Sokoto, Nigeria. Early recognition of the disease, baseline investigations, identification of underlying disease/diseases, resuscitation of the patient, and institution of specific treatment were done. Results: The age range was 1–33 years with a mean (±standard deviation [SD]) of 3.5 (3.23) years. The male:female ratio was 1:1.2. Comorbidities were observed in 148 (93.1%) patients. The most commonly seen comorbidities observed were measles and protein–energy malnutrition, which were seen in 75 (47.2%) and 67 (42.1%) cases, respectively. The mean (±SD) hemoglobin of 8.59 (±2.9) g/dl and 11.38 (±1.5) g/dl were recorded on admission and at discharge, respectively. Leukocytosis of >12,000 cells/mm3 was observed in all patients. The electrolyte urea/creatine results were generally within normal range, while serum urea was raised in 52 (32.7%) patients. The duration of admission was for an average of 13 days. A mortality rate of 18.2% was observed. Conclusion: Acute cancrum oris requires urgent management. For successful management, patients should be evaluated for underlying diseases and systemic causes of immunosuppression.

Ludwig's angina: Analysis of 28 cases seen and managed in Sokoto, Northwest Nigeria

Objectives: To determine the prevalence, seasonal presentation, and management of Ludwig′s angina in Northwest Nigerian Tertiary Health Facility. Patients and Methods: Cases of Ludwig′s angina that presented and managed by the Dental and Maxillofacial Surgery Unit of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between 2013 and 2015 were retrieved. Data were stored and analyzed using IBM SPSS (IBM Corp., Armonk, NY, USA) Statistics for windows version 20. Results: Over the review period, 36 patients presented with clinical features of Ludwig′s angina. Only 28 cases were analyzed and 8 cases had incomplete data and were excluded from the analysis. Of the 28 patients, 23 (82.1%) were males while 5 (17.9%) were females with a male: female ratio of 4.6:1. The mean age of the sample was 32.3 ΁ 11.6, range 18-60 years. A majority of the patients were in low socioeconomic group with 11 (39.3%) patients being peasant farmers. Odontogenic infection was responsible for the disease in 27 (96.4%) cases while only 1 (3.6%) case was idiopathic. Of those with odontogenic etiology, 18 (64.3%) were due to sequelae of caries. Microbiology, culture, and sensitivity in few cases revealed Streptococcus species, Pseudomonas aeruginosa, and Staphylococcus aureus. Most of the cases recorded no bacterial growth after 24 h incubation period. Twenty-five patients (89.3%) survived the disease while 3 (10.7%) died. Conclusions: Management of Ludwig′s angina in a resource- and personnel-scarce setting can be very challenging. Early surgical decompression, aggressive empirical antibiotics, and nutritional support have contributed to the low mortality in our series.