Babatunde O. Akinbami

Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporomandibular joint dislocation

BackgroundVirtually all the articles in literature addressed only a specific type of dislocation. The aim of this review was to project a comprehensive understanding of the pathologic processes and management of all types of dislodgement of the head of the mandibular condyle from its normal position in the glenoid fossa. In addition, a new classification of temporomandibular joint dislocation was also proposed.Method and materialsA thorough computer literature search was done using the Medline, Cochrane library and Embase database. Key words like temporo-mandibular joint dislocation were used for the search. Additional manual search was done by going through published home-based and foreign articles. Case reports/series, and original articles that documented the type of dislocation, number of cases treated in the series and original articles. Treatment done and outcome of treatment were included in the study.ResultA total of 128 articles were reviewed out which 79 were found relevant. Of these, 26 were case reports, 17 were case series and 36 were original articles. 79 cases were acute dislocations, 35 cases were chronic protracted TMJ dislocations and 311 cases were chronic recurrent TMJ dislocations. Etiology was predominantly trauma in 60% of cases and other causes contributed about 40%. Of all the cases reviewed, only 4 were unilateral dislocation. Various treatment modalities are outlined in this report as indicated for each type of dislocation.ConclusionThe more complex and invasive method of treatment may not necessarily offer the best option and outcome of treatment, therefore conservative approaches should be exhausted and utilized appropriately before adopting the more invasive surgical techniques.

Spread of Odontogenic Infections in Port Harcourt, Nigeria

PURPOSE Odontogenic infections constitute a substantial portion of diseases encountered by oral and maxillofacial surgeons. Infections start from dental tissues and sometimes rapidly spread to contiguous spaces. The consequence is a fulminant disease with significant morbidity and mortality. The study was aimed at studying the pattern of spread, approach to management, and outcome of these infections at a Nigerian teaching hospital. PATIENTS AND METHODS A retrospective study of all patients with orofacial infections who presented to our center over an 18-month period was carried out. The medical records were reviewed to retrieve the following: age, gender, source of infection, anatomic fascial spaces involved, associated medical conditions, various treatment modalities, types of antibiotics administered, causative micro-organisms, length of stay in the hospital, and any complications encountered. Infections were classified into 2 categories: those that are confined to the dentoalveolar tissues belong to category I, and those that have spread into the local/regional soft tissue spaces and beyond belong to category II. RESULTS Odontogenic infections constituted 11.3% of the total oral and maxillofacial surgery cases. A total of 261 patients were treated for odontogenic infections. There were 146 female patients (59.8%) and 98 male patients (40.2%) in the first category, whereas the second category comprised 10 male patients (58.8%) and 7 female patients (41.2%). The fascial spaces involved, in descending order, were submasseteric in 10 (22.7%), submandibular in 9 (20.5%), and sublingual in 6 (13.6%). The causative micro-organisms commonly found were Klebsiella and Streptococcus spp. Incision and drainage were performed in the 17 cases with spreading infection. Amoxicillin, amoxicillin/clavulanate, and metronidazole were the most routinely administered antibiotics. CONCLUSIONS Our experience shows that delay in presentation, self-medication, aging, male gender, and unusual causative agents are some of the factors associated with spread. Therefore efforts must be made to further improve public dental awareness.

Dry Socket: Incidence, Clinical Features, and Predisposing Factors

Background. Dry socket is a global phenomenon. The purpose of the study was to investigate the incidence of dry socket in recent times in a Nigerian Tertiary Hospital. Methods. Patients who were referred for dental extractions were included in the study. The case files of patients were obtained and information retrieved included biodata, indication for extraction, number and type of teeth extracted, oral hygiene status, compliance to oral hygiene instructions, and development of dry socket. Results. One thousand, one hundred and eighty two patients with total of 1362 teeth extracted during the 4-year period of the study were analyzed, out of which 1.4% teeth developed dry socket. The mean age (SD) was 35.2 (16.0) years. Most of the patients who presented with dry socket were in the fourth decade of life. Mandibular teeth were affected more than maxillary teeth. Molars were more affected. Retained roots and third molars were conspicuous in the cases with dry socket. Conclusion. The incidence of dry socket in our centre was lower than previous reports. Oral hygiene status, lower teeth, and female gender were significantly associated with development of dry socket. Treatment with normal saline irrigation and ZnO eugenol dressings allowed relief of the symptoms.

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.

Pattern of presentation and management of orofacial and neck soft tissue tumors in a Nigerian tertiary health center - a preliminary study

Background: The purpose of this study was to document the pattern of presentation and management of orofacial and neck soft tissue tumors seen in a Nigerian tertiary health center. Method: Lesions included were hamartomas, benign and malignant tumors. The extent of spread based on the involvement of either the skin, subcutaneous, mucosa alone or in combination was noted. Involvement was determined based on clinical assessment. Histopathological examination of the lesions was reviewed. Treatment offered and outcome was also documented. Result: A total of 60 patients with tumors of the orofacial and neck soft tissues were managed in our hospital. Males constituted 33 (54.6%) and females were 27 (45.4%). Age range was 6 months to 66 years and mean age (SD) was 35.4 (15.1) years. Surgical excision was done for all hamartomas and benign tumors. Conclusion: Aesthetic and functional outcome was satisfactory in all the patients except for a case of malignant schwannoma with multiple recurrences.

Epidermoid Cyst of the Tongue Causing Airway Obstruction

Epidermoid cyst occurring within the tongue is rare. The aim of this article is to discuss the management of an adult patient who presented with respiratory obstruction due to this congenital epidermoid cyst within the tongue. A 32-year-old male patient who was brought to the accident and emergency department of the University of Port Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria was presented. He came with a history of difficulty in breathing as a result of a slow growing swelling of the tongue which started from birth. There was associated pain, difficulty in speech and mastication as the swelling increased in size. Detailed physical examination, sonographic imaging and histopathology were carried out. On examination, patient was acutely ill-looking, in severe respiratory distress, febrile, mildly pale and dehydrated but anicteric. Extra-oral examination revealed mildly protruded upper and lower dento-alveolar arch as well splaying and recession of the anterior and posterior teeth of the upper arch. Intra-oral examination revealed moderately tender, fluctuant and grossly enlarged tongue obstructing the oro- and nasopharyx. A diagnosis of dermoid cyst was made and the patient was booked for surgery after resuscitation. Excision of the cyst was done under general anaesthesia/naso-tracheal intubation by an intra-oral approach. Ultrasound was able to give a thorough assessment of the cystic nature of the swelling while post-operative histopathology was used to confirm the specific type of teratoma. The relationship of the cyst to the intrinsic and extrinsic muscles of the tongue and mylohyoid muscle was relevant to the surgical approach to the lesion.

Reconstruction of Continuity Defects of the Mandible with Non-vascularized Bone Grafts. Systematic Literature Review

Background The use of NVBG for mandibular defects seems to be gradually giving way for more advanced reconstructive techniques but it has the advantages of shorter operating time and lesser amount of blood loss. The aim of this study was to review the available data on the success and failure rates of use of NVBG and factors associated with failure. Method Studies published from 1978 to 2014 regarding the use of NVBG were searched. Most important information was graft success and failure outcomes. Information on graft success with particular focus on large defects was extracted and the quality of papers was rated. Defects > 6cm were considered long defects. Results Twenty publications were included in this review. The quality of the studies was low and there was high heterogeneity. All articles reported high graft success rates ranging from 67 to 100%. Success in defects > 6cm was considerable, the range was 72–100%. Three main factors were associated with failure; these were defect length, fixation method and infection. Infection contributed the highest complication rate which was 48.2%. Conclusion NVBG seems to be appropriate for mandible reconstruction when there is vascular recipient bed and sufficient soft tissue cover and mucosal lining are achievable.

Maxillofacial Fractures: Etiology, Pattern of Presentation, and Treatment in University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Objective. To retrospectively analyze the pattern of presentation and modalities of management of maxillofacial fractures in our center. Methods. The medical records of all the patients who sustained maxillofacial fractures presenting to a major referral hospital in Niger Delta region of Nigeria were retrieved and reviewed. The data collected was analyzed using SPSS statistical package. Results. Eighty-six patients presented with 135 maxillofacial fractures during the period under review. A male to female ration of 3 : 1 was recorded and patients in their third decade of life were mostly affected (46.5%). Road traffic accident (RTA) was the commonest etiology accounting for 46.5% whereas assault was second (19.8%). The mandible was the most frequently fractured bone (59.3%) followed by the zygoma (18.5%). The main stay of treatment was closed reduction with IMF (40.4%). Conclusion. Treatment modalities for maxillofacial fractures in our center have not witnessed any significant changes. Effort should be made to ensure the availability of miniplates to ensure adequate treatment for all categories of our patients.

Measurement of cephalic indices in older children and adolescents of a Nigerian population.

Background. A study on the cephalic index was carried out on subjects from school students in Ogbia tribe of Bayelsa state in the Niger Delta region of Nigeria. This study determined the cephalic indices among the school students. In the present study, seven hundred subjects were randomly selected from secondary schools comprising 350 males and 350 females, respectively, with age range from 11–20 years, with both parents and grandparents of Ogbia tribe. The length and breadth of the head were measured using a spreading caliper from standard bony landmarks. The measurable point for head length was measured between the glabella and inions while the head breadth was the widest biparietal diameter. The cephalic index was head breadth divided by the head length and multiplied by 100. The result showed that the mean cephalic index was 76.56. Males had a cephalic index of 77.21, while females had a cephalic index of 76.50. Based on this study, 78.68% of individuals were mesocephalic, 11.4% dolichocephalic, 9.0% Brachycephalic, and 0.43% hyperbrachycephalic. This research showed that the school students have mesocephalic phenotype. The data from this research will be useful in anthropology, genetics, forensic medicine, and clinical practice.

Is routine antibiotic prescription following exodontias necessary? A randomized controlled clinical study

The importance of routine antibiotics following exodontias should not be addressed in isolation but in conjunction with other factors. Information obtained included patient bio-data, oral hygiene status, tooth extracted, type of exodontias (routine or surgical) and duration of extraction ( than 10 min). Randomized patients for extractions were divided into two groups, method of randomization and allotment of patients were done by blind masking. Selection of group was done by picking closed ballot papers which had been designated as 1 or 2, 1-signifies no antibiotic and 2-signifies antibiotic prescription. The first group was given antibiotics following extraction and second group which served as the control were not given antibiotics. There were a total of 262 patients that had exodontias within the study period, 104 (39.7%) males and 158 (60.3%) were under the age range 15 to 96 years, and mean (standard deviation) of 35.2 (14.6) years. There were 162 (61.8%) patients in the first group and 100 (38.2%) patients in the second group (no antibiotics), 95 (36.3%) patients in the second group had non-traumatic extractions and 5 had traumatic extractions. 45 patients in second group had extractions that lasted more than 10 min. Out of 240 (91.6%) routine extractions done, 96 (36.6%) were in the second group and of 22 (8.4%) surgical extractions, 4 (1.5%) were in the second group. This study showed that routine antibiotic used was not necessary following all exodontias procedures, and variables such as type of extraction, difficulty of extraction and adherence to post operative instructions were important associated factors that determined the occurrence of postoperative complications. The registration number of this trial is PACTR201408000861302. Registered with the Pan-African Clinical Trial Registry. Key words: Exodontia, complications, antibiotics, associated factors.