Ademola Abayomi Olaitan

Patient’s Self-Assessment of Social-Approval After Mandibulectomy with Disarticulation: the Necessity for Jaw Reconstruction Following Loss of Facial Symmetry in a Resource-Poor African Setting

ObjectiveMandibulectomy with disarticulation is usually carried out without reconstruction in Low-Income-Countries. Lower standards of living are usually acceptable and adapted to, in poor societies. This study compares patient’s self-assessment of social approval among reconstructed and non-reconstructed cases of mandibulectomy with disarticulation in a resource-poor African setting.Material and MethodThis questionnaire-based study documented patient’s self-assessment of social approval of themselves following mandibulectomy with disarticulation. 12 derived queries were administered on each patient, to test what they perceived of social acceptability of their facial features following mandibulectomy.ResultsAll 10 patients who underwent mandibular reconstruction reported that they felt confident engaging in all forms of social activity, while all 10 who had resection without reconstruction did not.ConclusionThe low social approval perceived by patients who have undergone mandibulectomy with disarticulation without reconstruction necessitates that surgeons must strive to reconstruct this anatomical region even under circumstances of severe resource-constraint. The culture in the third-world is not supportive of patients who have not undergone reconstruction following resection, in spite of being victims of all-pervading poverty.Level of EvidenceLevel IV, investigative study.

Strategy for Successful Management of Facial Keloid Using Triamcinolone Injection as Adjunct to Surgery.

The literature on keloids is replete with authors expressing frustration with treatment results. Triamcinolone is effective in shrinking keloids and preventing their recurrence following excision, if delivered successfully. Strategies for effective delivery of drug are presented: recommended needle size, use of metal syringe, slow injection to avoid skin rupture, and delayed withdrawal of needle after injection. The futility of expecting pedunculated keloids to be completely flattened by steroid injection alone is mentioned.

Primary reconstruction of a long-span hemimandibular defect using non-vascularized bone graft

Reconstruction with a vascularized bone graft is the gold standard for the reconstruction of a mandibular defect with a long span. This is, however, a mirage in a developing country with limited expertise and resources. A case of successful reconstruction of a long-span hemimandibular defect with non-vascularized bone graft and bridging plate is hereby presented. A 38-year-old patient had resection of the mandible from tooth no 31 to the mandibular condyle on the left, following a diagnosis of recurrent ameloblastoma. Primary reconstruction was carried out with corticocancellous non-vascularized bone graft from iliac crest and reconstruction plate bridging. Patient has been followed up for 4 years. There is relatively good facial symmetry, functional restoration and radiological evidence of new bone across the defect. Minor complications were recorded. Even though technological advancement has shown the superiority of vascularized bone graft over non-vascularized graft in the reconstruction of a long-span mandibular defect, the latter could still be an option in a resource-limited setting.