Ce Anyanechi

Honey and wound dehiscence: A study of surgical wounds in the mandibular bed

BACKGROUND There is a paucity of literature on the use of honey in wound healing after oral and maxillofacial surgical procedures. OBJECTIVE To evaluate the efficacy of the healing properties of Obudu honey in patients who developed wound dehiscence after segmental mandibular resections. PATIENTS AND METHODS This was a prospective study of 72 patients who had benign lesions of the mandible, and were treated by segmental mandibular resection, with the surgical wounds developing dehiscence. The subjects were randomized into two treatment groups of A (control, n = 36) and B (experimental, n = 36). Unlike the control, the wounds in the experimental group were dressed in honey after debridement. RESULTS The ages of the patients ranged from 21 to 73 years with a mean age of 46.3 ± 2.1 years while the male: female ratio was 3:1. There was no significant demographic difference about age ( P = 0.44) and gender (P = 0.38) between the two groups. The smaller the initial circumference of the surgical wound, the shorter the duration of healing and this was significant (P = 0.001) in either of the treatment groups. Numerically, more healing was completed in the first 5 weeks in subjects in the experimental group (n = 19, 52.8%) than the control (n = 13, 36.1%). However, the duration of healing between the subjects in the control and experimental groups at the end of 9 weeks showed no significant difference (P = 0.23). CONCLUSION Honey speeds up the healing of dehiscence wounds of resected mandible when used as dressing more than the control.

Maxillofacial tumors and tumor-like lesions in a Nigerian teaching hospital: an eleven year retrospective analysis

BACKGROUND This paper reviews the types, prevalence and demographic distribution of maxillofacial tumors, cysts and tumor-like lesions in a Nigerian population. METHODS A retrospective analysis of the medical records and histological reports of patients with oral and maxillofacial tumors and cystic lesions who presented to the Maxillofacial Unit of our institution over an eleven year period was undertaken. Information on demographics, histological diagnosis and clinical presentation were obtained and analyzed. A p value of less than 0.05 was considered significant. RESULTS A total o:f 146 patients, aged 5-70 years (mean 30.5± 12.9) were seen over the period of study. There were 96 males (65.8%) and 50 females (34.2%) giving a male to female ratio of almost 2:1. Benign tumors accounted for 124, 86.3% and malignant tumors (22, 13.7%). Ameloblastoma was the most prevalent benign tumor observed (53, 36.3%) while squamous cell carcinoma was the most common malignant tumor. The peak age of ameloblastoma was the fourth decade and squamous cell carcinomas the sixth and seventh decades of life. Jaw swellings were the most common presentation (98, 67.1%), followed by pain (23, 15.9). The duration of symptoms on presentation ranged from 1 to 96 months (mean 23.32 ±15.72) and this was not different for malignant or benign tumors (P=0.886). CONCLUSION Late presentation still remains the main challenging factor in the early detection and management of maxillofacial tumors in our environment. More awareness campaign is necessary, especially at the primary health care level, to educate the populace on the need for early presentation at treatment centers.

Temporomandibular joint ankylosis caused by condylar fractures: a retrospective analysis of cases at an urban teaching hospital in Nigeria

Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. This study aimed to analyze cases of mandibular condylar fracture complicated by TMJ ankylosis after treatment. A 16-year retrospective analysis was performed at the dental and maxillofacial surgery clinic of the study institution; patient data were collected from the hospital records and entered into a pro-forma questionnaire. It was found that 56/3596 (1.6%) fractures resulted in TMJ ankylosis. The age of patients with ankylosis ranged from 12 to 47 years. The age (P=0.03) and gender (P=0.01) distributions were significant, with most cases of ankylosis occurring in those aged 11-30 years (n=43/56, 76.8%). Fractures complicated by ankylosis were intracapsular (n=22/56, 39.3%) and extracapsular (n=34/56, 60.7%). Ankylosis increased significantly with the increase in time lag between injury and fracture treatment (P=0.001). Ankylosis was associated with concomitant mandibular (85.7%) and middle third (66.1%) fractures. Treatment methods were not significantly related to ankylosis (P=0.32). All cases of ankylosis were unilateral, and complete (n=36, 64.3%) and incomplete ankylosis (n=20, 35.7%) were diagnosed clinically. The incorporation of computed tomography scans and rigid internal fixation in the management of condylar fractures will reduce ankylosis.

Survey of the reasons for dental extraction in Eastern Nigeria

Background: Extraction of teeth is the commonest surgical procedure carried out in the dental surgery setting. Aim: The purpose of this survey was to identify the causes of teeth extraction in Eastern Nigeria. Subjects and Methods: Record forms for entering data and a self-addressed return envelope were distributed to 100 dental surgeons in Eastern Nigeria using a simple random selection. Results: Seventy-one (71; 71/100) dentists responded to the request and the total extractions carried out were 3998. There were 1508 (37.7%) extractions in males and 2490 (62.3%) in females with male-to-female extraction ratio of 1:1.7. In both male and female gender, there were more teeth extractions between the ages of 11 and 30 years. Extractions were recorded more in the lower social class (47.6%; 1903/3998). There were more extractions in the permanent (85.0%; 3398/3998) than deciduous (15.0%; 600/3998). The commonest reasons for teeth extraction were caries (55.2%; 2208/3998). Conclusion: The result of this study shows that dental caries is the commonest reason for tooth extraction in Eastern Nigeria. It is hoped that the study will facilitate the development of treatment and preventive procedures relevant to the problems observed in this part of Nigeria, thus minimizing the loss of teeth and its expected adverse consequences.

Oral health among antenatal care attendees in Calabar, Nigeria

The objective of this study is to determine the oral health habits, awareness, oral health education and treatment needs among pregnant women who attend the antenatal clinics at the University of Calabar Teaching Hospital, Calabar, Nigeria. A total of 252 women at different stages of pregnancy responded to an interviewer-administered structured questionnaire. Of those, 238 (94.4%) of the respondents used toothbrush and toothpaste for oral cleaning, while 12 (4.8%) used a combination of toothbrush/toothpaste and local chewing sticks. Two (0.8%) adhered to the use of chewing sticks only. A total of 34 (13.5%) respondents were aware of and used dental services while pregnant; 18 (52.9%) of those who presented with dental complaints during pregnancy had bleeding gums. Based on the level of awareness of the need to attend a dental clinic during pregnancy (26.2%) and the percentage of respondents willing to have a dental examination during pregnancy (83.3%), it is recommended that oral health education be incorporated into the antenatal counselling of pregnant women in Nigeria.

Spontaneous bone regeneration after segmental mandibular resection: a retrospective study of 13 cases

The aim of this study was to evaluate the clinical characteristics of cases of spontaneous bone regeneration of the mandible after segmental resection. This retrospective study covered a 23-year period and used data obtained from the hospital records; patient data were entered into a pro-forma questionnaire. Overall, the cases of 636 patients with mandibular lesions treated by segmental resection were reviewed; 13 (2.0%) had spontaneous bone regeneration. The time post-surgery at which bone regeneration was first noticed ranged from 9 to 17 weeks. Seven patients were male (53.8%) and six were female (46.2%), giving a male to female ratio of 1.2:1. The patients ranged in age from 16 to 51 years (mean 26.6±3.6 years). The periosteum was completely excised after resection in eight patients (61.5%), while it was partially preserved in five (38.5%). The younger the patient, the earlier the spontaneous bone regeneration occurred in the defect (P=0.001), particularly in those who had complete excision of the periosteum. Radiographically, the new bone formed was observed to have the same appearance as the cortical bone of the mandibular stumps, but lacked height. This study suggests that bone graft reconstructions may still be necessary for this group of patients who show spontaneous bone regeneration.

Analysis of 46 cases of malignant jaw tumours in Calabar, Nigeria

Background: The occurrence and distribution of malignant jaw tumours differs across the globe because of differences in geographical, cultural, racial, and socioeconomic factors. The aim of this study was to determine the types and pattern of malignant jaw tumours in Calabar, located in South-South Nigeria. Materials and Methods: The histopathologic results, as well as demographic and clinical information of all consecutive patients diagnosed of having a malignant jaw tumour at the Oral and Maxillofacial Unit of University of Calabar Teaching Hospital, Calabar, Nigeria from January 2000 to December 2013 was retrospectively collected and analyzed. Results: A total of 46 (25.1%) out of the 180 cases of jaw neoplasms seen over the 14 year period were malignant. There was a slight male predominance with a ratio of 1.7:1 and the age ranged from 4 to 70 years, mean (standard deviation) 34.6 (4.56) years. The most common malignant lesion was squamous cell carcinoma (SCC) (n = 20; 43.5%), followed by Burkitt lymphoma (n = 8; 17.4%). The gender distributions of the lesions were significant, with more SCC seen in females in a ratio of 1.5:1 in relation to males. Osteosarcoma (n = 6; 13%) and rhabdomyosarcoma (n = 4; 8.7%) were observed only in males and females, respectively. About half of the lesions occurred in the mandible (47.8%). The age distribution of lesions was significant (P < 0.001), with SCC frequently seen in the sixth and seventh decades while Burkitt′s lymphoma and rhabdomyosarcoma were seen around the first decade. Clinical presentations ranged from swelling (n = 31), pain (n = 26), loosed teeth (n = 15), toothache (n = 11) to missing teeth (n = 9) among others and occurring either singly or in two or more combinations. The duration of symptoms on presentation ranged from 1 to 46 months, mean 21.7 (13.12) months and this was not different for male or female (P > 0.05). Conclusion: Oral cancer awareness campaign and advocacy is necessary to steer the awareness of the population on the need for regular dental visits, early recognition, and the dangers associated with late presentation of orofacial malignancy.

Nerve Morbidity after Mandibular Third Molar Surgery: A Prospective Study of Two Cohorts of Patients

Background: The surgical extractions of impacted mandibular third molars are sometimes associated with nerve morbidity. Objective: To determine the incidence of nerve morbidity after mandibular third molar surgery and compare the complications from the inferior alveolar and lingual nerves in two cohorts of patients. Patients and methods: This prospective study was an investigation of two cohorts of patients within duration of four years. The sample size was composed of 212 subjects, made up of 28 patients who had their impacted third molars in close contact with the inferior alveolar canal and 184 patients that did not have their molars in contact. The predictor variables were age, gender, type of impaction, indications for extraction, difficulty index and duration of surgery. The outcome variable was the development of neuro-sensory complication(s) after treatment. Descriptive and bivariate statistics were computed and the P value was set at 0.05. Results: There was no significant relationship between the predictor variables in the two groups. The result showed that 6/212 (2.8%) patients complained of numbness of the ipsilateral lower lip and part of the cheek. Out of this 4/28 (14.3%) were in those that had their molars in close contact with inferior alveolar canal while 2/184 (1.1%) were cases that didn’t make contact. No complication occurred that was related to the lingual nerve. Conclusion: Nerve morbidity occurred after third molar surgery and the incidence is commoner in cases where the third molar made contact with inferior alveolar canal.

The Clinical Presentation of Odontogenic Myxoma of the Jaws: A 22-Year Retrospective Analysis

Background: Odontogenic Myxoma (OM) affects the jaws, and is characterized by high recurrence rate after treatment. Objective: To evaluate the clinical characteristics and treatment outcome of OM that presented in our center. Materials and Methods: A 22-year retrospective study was performed at the Dental and Maxillofacial Surgery Clinic of the study institution; patients’ data were collected from the hospital records and entered into a pro-forma questionnaire. Results: Overall, 643 patients with oro-facial lesions were evaluated and 38/643 (5.9%) were diagnosed with OM. There were 22 (57.8%) males and 16 (42.2%) females with male to female ratio of 1.4:1. Majority (n=30, 78.9%) of the patients were between 21-40 years (p=0.001). Patients presented late and this increased with decreased socio-economic status (p=0.001), whereas the higher the socio-economic status, the smaller were the sizes of the tumor (p=0.001). Majority 33 (86.8%) occurred in the mandible and the tumors were centrally located in the jaws. The longer the duration of tumor, the more the presenting clinical symptoms (p=0.001). Radiologically, 32 (84.2%) cases showed multi-locular radiolucency. The tumors were treated by wide excision, and the greater the sizes of the surgical defects, the more the co-morbidities (p= 0.001). Post-operatively, 10.5% patients had recurrence of the tumor whereas 5.3% spontaneous bone regeneration (SBR). Conclusion: The clinical characteristics and treatment outcome of OM observed is similar to previous reports except that males were affected more than females. Late presentation is the main challenging factor in the early diagnosis and management of this tumor in our environment.

Prevention of alveolar osteitis after third molar surgery: Comparative study of the effect of warm saline and chlorhexidine mouth rinses

Background: Chlorhexidine mouth rinses have a proven efficacy for the prevention of alveolar osteitis after third molar surgery. This study compares the efficacy of warm saline rinse, a component of postextraction instructions, with that of chlorhexidine in our institution over a period of 2 years. Patients and Methods: Apparently healthy patients who were referred to the Oral Surgery Clinic of our institution, with an indication for surgical extraction of lower third molar were prospectively, consecutively, and uniformly randomized into warm saline and chlorhexidine groups. The experimental group (n = 50/100) were instructed to gargle twice daily with warm saline, whereas the chlorhexidine group (n = 50/100) were instructed to gargle with 0.12% chlorhexidine. Information on demographic, types and level of impaction, indications for extraction, and development of alveolar osteitis were obtained and analyzed. Comparative statistics were done using Pearsons Chi-square, Fishers exact, or Mann–Whitney U-tests as appropriate. P <0.05 was considered statistically significant. Results: The demographic, types and level of impaction as well as indications for extractions were comparable between the study groups (P > 0.05). The overall prevalence of alveolar osteitis was 5%. There was no statistically significant difference between application of warm saline and 0.12% chlorhexidine rinse with respect to the development of alveolar osteitis (P = 0.648). Conclusion: Warm saline mouth rinse is equally as effective as chlorhexidine mouth rinse, as prophylaxis against prevention of alveolar osteitis after third molar surgery.