Ezekiel Taiwo Adebayo

Analysis of the pattern of maxillofacial fractures in Kaduna, Nigeria

There are considerable differences in the reported worldwide pattern of maxillofacial fractures. In the more developed countries of Europe, violence followed by road crashes are the predominant causes while in the developing world the causative factors are reversed with most being the result of road crashes. Interestingly, recent data indicated a 3:1 male:female ratio worldwide. Between 1991 and 2000, 443 cases of maxillofacial fractures were seen at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Road crashes were responsible for 246 cases (56%) followed by falls, 24% (n=108). In a previous report from this centre in 1980, 241 fractures were seen each year, so our lower rate of 44 cases a year is because the number of centres for the treatment of such injuries in Nigeria has increased. There has also been a fourfold increase in the number of women with facial fractures in this largely Moslem population, which reflects their greater exposure during the past 20 years. More patients were seen with mandibular than middle-third fractures, because more of the latter died. This shows that while more centres for treatment are available for patients with maxillofacial trauma, the lack of enforcement of legislation on the use of seat belts, drunken driving and inadequate emergency medical care have continued to cause considerable mortality and morbidity from these injuries in Nigeria. It is also difficult to compare data among centres because of inconsistent terminology.

Delayed soft tissue recurrence after treatment of ameloblastoma in a black African: Case report and review of the literature

INTRODUCTION Ameloblastoma is rare worldwide. Delayed treatment can result in significant morbidity from facial deformity and infiltration of adjacent tissues. Mortality can occur from invasion of vital structures in the head and neck, super infection, recurrent and even distant metastases. Recurrence after radical treatment is not common. CASE REPORT This paper presents a case of soft issue recurrence in the chin 21 years after radical resection of the mandible for ameloblastoma. The iliac crest bone grafted to the site was not involved in the tumour recurrence. Conclusion. Radical surgical resection is accepted treatment for solid/multicystic ameloblastoma. However, the surgical review should be for life as recurrence can occur after a long interval.

Spontaneous bone regeneration following mandibular resection for odontogenic myxoma.

Spontaneous bone regeneration is an uncommon condition following traumatic or iatrogenic bone loss. The factors responsible for its occurrence are yet to be fully elucidated. This report presents spontaneous bone regeneration following mandibular resection for a giant odontogenic myxoma in a 16-years-old Nigerian male. New bone formation was observed at the postoperative fourth week and has continued for one year after. Likely factors that favor this occurrence are critically examined. The advantages of spontaneous bone regeneration in resource-poor settings include low biologic and economic costs as compared to bone grafting.

Facial cleft with Amelia: a Nigerian case report.

Clefts of the lip and palate are the most common serious congenital anomalies in orofacial region. However, the occurrence of associated defects in the limbs is quite rare. This report presents a 12-week-old male child born with unilateral left cleft lip and palate, absence of the upper left arm and forearm, and fusion of both big and middle toes and absence of the entire small toe on the left foot. The repairs of lip and palate defects were done at 6 and 19 months of age while parents were referred for rehabilitation to ameliorate absence of upper left arm. We discuss the challenges of management of defects in a developing economy, issues of acceptance of children born with defects amenable to surgery and the benefit of parental education on the care of the child.

MANAGEMENT OF SALIVARY GLAND TUMORS IN A NIGERIAN TERTIARY INSTITUTION

BACKGROUND The salivary glands consist of three major paired glands (the parotid, submandibular and sublingual) as well as numerous minor salivary glands, situated mostly in the oral cavity but also found in the pharynx, larynx, trachea, and sinuses. Tumours of salivary glands show a wide variety of pathologic types varying from benign to malignant. More salivary gland tumours are benign than malignant. PATIENTS AND METHODS Data for this study were obtained from retrospective survey of case notes of all patients with Salivary gland tumours seen at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Shika, Zaria between January 2003 and August 2013. RESULTS There were 135 patients 73 (54.1%) females and 62 (45.9%) males within the age range of 2.5 to 80 years (41.85 years). Thirty nine (28.9%) were benign while 96 (71.1%) were malignant. Major salivary glands were involved in 60.7% of tumours; the rest 39.3% involved minor salivary glands. Pleomorphic adenoma (86.7%) formed the bulk of benign tumours while adenoid cystic carcinoma (47.5%) was the predominant malignant tumour of salivary glands. Of 135 patients (n=,57.1% had surgery in our institution and were followed up. Those with malignancy also benefited from radiotherapy, chemotherapy or palliative oncology treatment. CONCLUSION Management of salivary glands tumours in our environment is a challenge due to late presentation and the size of the tumour.

Ameloblastoma: Our clinical experience with 68 cases

Introduction: In this environment, previous workers have reported on the challenges of managing large sized ameloblastoma of the jaws with less than adequate facilities. The aim of this review is to present the management of 68 cases of ameloblastoma with emphasis on surgical care. Materials and Methods: Retrospective survey of case notes of patients with histopathologic diagnosis of ameloblastoma (using the criteria of Barnes et al., 2005) seen between January 2006 and August 2010 at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria was undertaken. Data collected includes histopathological diagnosis, age, gender, clinical information on site of lesion, form of intubation and surgical procedure performed. Results: Out of 94 patients, 68 with histological diagnosis of ameloblastoma (59 mandibular and 9 maxillary) were operated within the study period. The remainder (26) was not treated in hospital. Among 68 patients treated, more were males (38) than females (30), giving a male to female ratio of 1.3:1. The age range was between 14 and 74 years (mean-standard deviation). The duration of the symptoms ranged from 7 months to 24 years, most were follicular ameloblastoma (n = 13) followed by acanthomatous type (n = 7). Endotracheal intubation was the most common (n = 55) followed by fiber optic laryngoscopy (n = 8). The surgical approach most used was extended Risdon with intraoral (n = 24) followed by extended Risdon with lip split and intraoral (n = 17). Segmental resection (en block) formed the bulk of our procedures (n = 22) followed by subtotal mandibulectomy (n = 16). Conclusion: The treatment of ameloblastoma remains controversial. Its destructive nature has left patients with wide defects difficult to reconstruct.

Myositis Ossificans Circumscripta of the Supra-orbital Region: A Case Report

Myositis ossificans circumscripta is a pathological condition characterized by formation of bony tissue within the skeletal muscles following repeated trauma. A case of myositis ossificans circumscripta of the supra-orbital region in a 25-year-old man is presented and the pertinent literature is reviewed. To the best our knowledge this benign lesion has not been reported previously in the orbital region the world literature. Clinically the patient presented with a swelling and proptosis of the right eye. Radiologically there was a rounded opacity with well defined margin. Lesion was initially misdiagnosed as a fibro-osseous lesion; however microscopic examination indicated matured myositis ossificans. Lesion was excised via a bicoronal flap. Careful clinical, radiological and pathologic evaluation is required to make this uncommon diagnosis in an unusual location such as the supra-orbital region to avoid unnecessary surgical mutilation of the patient.

Giant neurofibrolipoma of the tip of the tongue: case report and review of the literature.

Neurofibrolipoma is a very rare benign oral tumor with other synonyms such as neural fibrolipoma, perineural lipoma and intraneural lipoma. A 50 years old female presented with a massive swelling of the tongue of 6 years duration. The tumor was attached to the mucosa of the tip of the tongue, disturbing mastication and speech. On excision, histopathology revealed neurofibrolipoma. This case report shows the atypical presentation of neurofibrolipoma and the challenges of its management.

Myositis ossificans of the platysma mimicking a malignancy: a case report with review of the literature.

The two main forms of myositis ossificans are congenital and acquired. Either form is rare in the head and neck region. The acquired form is often due to trauma, with bullying as a fairly common cause. This report of myositis ossificans of the platysma in an 11-year-old female patient emphasizes the need for a high index of suspicion in unexplainable facial swellings in children and the benefit of modern investigative modalities in their management.

Ameloblastic carcinoma of the maxilla: a report of two cases and a review of the literature

Ameloblastic carcinoma is a malignant form of ameloblastoma defined by histological evidence of malignancy in primary, recurrent, or metastatic tumor. Such a tumor is rare, and the maxilla is an unusual site. Due to its rarity, the characteristics of this tumor in the maxilla have not been well described. Case 1: A 55-year-old, ill-appearing Nigerian male presented to our center with left maxillary swelling of seven-year duration. The swelling had been slow-growing and painless until one year prior, when the growth became rapid and was coupled with severe pain. The swelling affected both oral function and facial esthetics, and the patient reported difficulty breathing. There was a maxillary, ulcerated swelling extending from teeth 12 to 18 and blocking the left nostril. The involved teeth were moderately mobile. Case 2: A 32-year-old male farmer presented with recurrent right maxillary swelling of six-year duration. Prior to this episode, he had undergone surgery for ameloblastoma (follicular type). The present swelling was fungating through the skin and protruding into the right nostril. Ameloblastic carcinoma is an aggressive odontogenic tumor that requires aggressive surgical treatment.