Benjamin I Akhiwu

Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients

Background: The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV-related oral lesions in paediatric Nigerian patients on HAART with those not on HAART. Materials and Methods: All patients aged 15 years and below attending the Infectious Disease Clinic of Aminu Kano Teaching Hospital with a diagnosis of HIV were consecutively examined in a cross-sectional study over a 2-year period. Information was obtained by history, physical examinations, HIV testing, and enumeration of CD+ T cells. The results are presented. A P-value of <0.05 was considered significant. Results: A total of 105 children comprising 63 males and 42 female who met the inclusion criteria participated in the study, mean age in months was 53.3±42.2, with a mean of 3.4±2.2 for male and 2.8±1.8 for female respectively. Oral lesions occurred in 61.9% of the children Overall, 22 (21.0%) had at least one oral lesion, 43 (41.0%) had multiple lesion. The most common lesion was oral candidiasis (79.1%). The angular cheilitis (43.8%) variant was most frequent. The mean CD4 counts were 1138 cells/mm3, 913 cells/mm3 and 629 cells/mm3 for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA: F=0.185, df=2, 80, 82, P=0.831. Patients on HAART comprised about 61.9% and these were found to have reduced risk for development of such oral lesions as angular cheilitis (OR=0.76; 95% CI=0.56-1.02; P=0.03), pseudomembranous candidiasis (OR=0.71; 95% CI=0.54-0.94; P=0.024) and HIV-gingivitis (OR=0.59; 95% CI=0.46-0.75; P=0.001). HAART had some beneficial but insignificant effect on development of HIV-periodonttitis (OR=0.60; 95% CI=0.51-0.70; P=0.09). The chances of occurrence of other oral lesions were not significantly reduced by HAART (Kaposi sarcoma, OR=1.24; 95% CI=0.31-5.01; P=0.47, erythematous candidiasis, OR=1.13; 95% CI=0.62-2.06). Conclusion: HIV-related Oral lesions are frequently seen in HIV-infected Nigerian children. Paediatric patients receiving HAART had significantly lower prevalence of oral lesions, particularly oral candidiasis and HIV-gingivitis.

Prospective study of the quality of life after treatment of mandibular fractures.

Health-related quality of life (QoL) has become increasingly important, but few studies have dealt with that of patients who have been treated for mandibular fractures. Our aim was to assess this. Patients with mandibular fractures (n=148) were studied prospectively and QoL after treatment was assessed using the General Oral Health Assessment Index (GOHAI). The male-female ratio was 8.3:1 and their ages ranged from 14 to 70 years. QoL after treatment of the fractures declined initially (on the first postoperative day) but thereafter improved steadily. There was no significant difference between the mean QoL of those treated by closed, and those treated with open, reduction. Limitations in the options of food to eat, and difficulty in chewing and swallowing, were identified as their most important concerns in the early postoperative period. The improvement in QoL after the first postoperative day was similar however the patients were treated.

A 14-Year Review of Craniomaxillofacial Gunshot Wounds in a Resource-Limited Setting

This study analyzed the prevalence, clinical characteristics, and management of civilian-type craniomaxillofacial gunshot wounds (CGSWs) seen over a 14-year period in a Northern Nigerian teaching hospital. A retrospective study of all hospital records relating to CGSWs from January 2000 to December 2013 was conducted to determine the prevalence of CGSWs. Information retrieved included site of injury, type of projectile, management protocol, as well as duration of hospitalization. A total of 46 admissions for CGSWs were recorded during the period under review from a total of 2,228 maxillofacial admissions. This gave a prevalence of 2.1% for CGSWs (95% confidence interval = 1.56–2.81). Sex distribution was 14.3:1 (M:F) with overall mean age of 32.9 ± 8.4 years. Average length of hospitalization was 17.7 (± 15.56) days. Management of CGSWs consisted of emergency care, preliminary intervention, definitive reconstruction, revisions, and rehabilitation. Conclusively, analysis of the yearly incidence of CGSWs showed that the incidence and severity increased within the past 2 years under review (18 cases, 39.13%; χ2 trend = 7.7, p = 0.006). This period was noted to correspond with heightened violence within the region mostly due to the acts of unknown gunmen and insurgents.

Congenital Heart Disease in Cleft Lip and Palate Patients: How Common Is the Association?:

Aims and Objectives: To determine the prevalence of congenital heart disease in patients with orofacial cleft in a Nigerian population. Materials and Methods: A retrospective review of all the case files of patients with orofacial cleft managed at the Dental and Maxillofacial Surgery unit of the Aminu Kano Teaching Hospital between 2007 and 2014. Data were analyzed using SPSS version 16. Results: A total of 133 patients with cleft lip and palate were seen during the period of study comprising 77 males and 56 females, giving an M:F ratio of 1:0.7. The age range was 15 days–36 years with a mean age of 6 years. There were five cases of congenital heart disease made up of two males and three females, giving a prevalence of 3.76 per cent. Conclusion: This study showed that the prevalence of congenital heart disease in patients with orofacial cleft was low. However, the need for routine echocardiography in all orofacial cleft patients especially children should not be overlooked.

Multidisciplinary approach to improving concordance in diagnosis of odontogenic tumors

Background: The diagnosis of benign odontogenic tumors (BOTs) may occasionally be fraught with problems. Diagnosis of BOTs includes joint consideration of clinical features observed, appearance on radiographs and histopathologic slides. Aim: The aim of this study therefore is to ascertain the level of concordance between preoperative and postoperative histopathological diagnoses of surgically treated BOT and highlight modalities that improve it. Materials and Methods: A retrospective review of all cases with postoperative histopathological reports of BOT seen at the Dental and Maxillofacial Surgery Department of Aminu Kano Teaching Hospital, Kano, Nigeria, from January, 2012 to December, 2013 was done. Demographic information, clinical, radiological (plain radiographs), preoperative incisional biopsy and postoperative excisional biopsy results were collated. The preoperative incisional biopsy and postoperative excisional biopsy results were analyzed for concordance. Results: Thirty-three cases of BOT were reviewed (male:female = 1.4:1). Age ranged from 11 to 70 years (mean = 32 ± 18.1 years). An overall concordance of 78.8% was observed between preoperative and postoperative biopsy results. Twenty-eight histology request cards were reviewed and this showed that 14.3% of specimens were <1 cm while complete clinical information was provided in 50% of cases. Conclusion: The interaction between the pathologist and other relevant specialties that are required for effective management of BOT may be best nurtured when clinico-pathologic conferences are made a routine practice.

Utility of aspiration cytology in the evaluation of oral and maxillofacial lesions

Background: Fineneedle aspiration cytology (FNAC) as a cheap diagnostic technique has helped reduce diagnostic turnaround time of pathological entities from different body sites. It is thus also important to evaluate its utility in the diagnosis of maxillofacial lesions in view of heterogeneity of morphological patterns noted for this site. Methodology: Cytology and corresponding histology reports for lesions from patients where both were available were compared for concordance between specific cytological diagnosis and final histological diagnosis. From these, sensitivity, specificity, positive predictive value and accuracy of FNAC were calculated. Result: Cytological diagnosis of maxillofacial lesions demonstrated a sensitivity, specificity, positive predictive value and accuracy of 100%, 95.7%, 97% and 98.2%, respectively. The concordance of specific cytological diagnosis with final histological diagnosis was 85.5%. Conclusion: This study concludes that FNAC is a cheap and diagnostically reliable technique for evaluation of maxillofacial lesions in a resource poor setting.