Oa Akadiri

Assessment of Difficulty in Third Molar Surgery—A Systematic Review

PURPOSE The aim of this review was to identify the most important variables that determine surgical difficulty of impacted third molar extractions by their consistent showing in previous studies. MATERIALS AND METHODS Electronic library search for current evidence in the world literature was conducted, and relevant articles were selected, scrutinized, and the findings were compared. RESULTS Seven articles were most relevant, and the results of the comparison of the selected articles showed that demographic variable, age; operative variables: surgeon procedure type and number of teeth extracted; and ratiographic variable, depth angulation; and root morphology, are the most consistent determinants of difficulty. CONCLUSION Current evidence is in support of 3 categoreis of variables strongly associated with surgical diffulty of impacted third molars. The most important variables in each of these categories have been identified.

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.

Polymorphous Low Grade Adenocarcinoma: Literature Review and Report of Lower Lip Lesion with Suspected Lung Metastasis

Polymorphous low grade adenocarcinoma (PLGA) is an uncommon tumour that affects minor salivary glands mainly. It was known to be clinically benign and histologically polymorphic; sometimes misdiagnosed as pleomorphic adenomas, monomorphic adenomas, malignant pleomorphic adenomas, adenoid cystic carcinomas and adenocarcinoma not otherwise specified. More information about PLGA is cumulating in the current literature with new evidences suggesting that the tumour may not be as indolent as it was previously thought. A thorough understanding of the clinical and histological behaviour of the lesion has serious implications in management. Here, a case of lower lip lesion with suspected lung metastasis is reported to exemplify how the clinical behaviour of the lesion may affect management.

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.

Clinical and echocardiographic findings in an African pediatric population of cleft lip/palate patients: A preliminary report

Background: Every congenital structural defect in the body represents an inborn error in morphogenesis and may affect one or more systems and Orofacial clefts are one of the commonest birth defects. Objective: Cleft lips and/or palate are frequently associated with other congenital anomalies including cardiovascular. Methods: All pediatric orofacial cleft patients presenting for free treatment during a surgical outreach at the University of Port Harcourt Teaching Hospital were examined by the pediatric cardiologist, pedodontist, oral and maxillofacial surgeon, and anesthetist. Results: Of the 20 patients studied, three (15%) had congenital heart disease (CHD), 1 (5%) had skeletal anomaly and one of the children with CHD had an ileo-vaginal hernia (digestive and urogenital system anomaly). Conclusions: The most common associated congenital abnormality was CHD in 15% of children.

Giant macroglossia with persistent nonocclusion in a neonate

Excessive enlargement of the tongue, macroglossia, is a well-recognised clinical condition which can pose significant social and health problems. We report a case of a neonate who was born with a tongue grossly enlarged to the point of inability to feed and deformation of the jaw. Despite surgical reduction of the tongue to normal size, there was a persistent nonocclusion of the mouth, making sucking impossible. Physiotherapy did not help and our experience with neonatal jaw osteotomy is limited. We wonder if a prenatal aspiration of the tongue cyst could have forestalled this jaw deformation.

Evolution and trends in reconstructive facial surgery: an update.

Surgical correction of congenital and acquired facial deformities has transcended the primitive era of using non biologic materials to current attempts at own face growing through biotechnology. A summative account of this trend is still lacking in the literature. The objective of this article is to present an update on current knowledge in the strides to achieve functionally and aesthetically perfect facial reconstruction. It highlights the impact of advancements in 3D imaging, stereolithographic biomodelling, microvascular surgical tissue transplantation and tissue biotechnology in the surgical efforts to solve the problems of facial disfigurement whether congenital or acquired.

Predictive variables for difficult intubations in oral and maxillofacial surgery

SummaryMany factors affect the difficulty of endotracheal intubation some of which are related to the condition of the patients. A few assessment tools have been developed to predict intubation difficulty but none is all inclusive thereby being inadequate for comprehensive and accurate evaluation. We assessed the usefulness of four categories of predictive variables namely; the LEMON score, Demographic indices, Tumour site and Intraoral Position of tumour (IOP), in predicting intubation difficulty among a group of patients with orofacial tumours. By statistical analysis, a significant correlation between predictions by LEMON score and actual intubation difficulty was observed while neck mobility (P=0.28) and Mallampati scores (P=0.49) were the most important criteria in the scoring system. Significant association was also observed with demographic indices and difficulty whereby the Optimal Interincisal Distance (OID) had the greatest impact (P=0.048). There was no difference in the difficulty posed by the different sites and intraoral positions of tumours in this study. We therefore suggest the adoption of the LEMON score and consideration of the demographic indices when assessing patients with orofacial tumours for intubation difficulty. Three important variables should be given greater value, these are, neck mobility, Mallampatti score and optimal interincisal distance.

Indications and outcome of mandibular condylar and ramus surgeries

Background: Different surgical procedures are utilized for treatment of various diseases of the posterior mandible depending on the type of disease, site, duration and age of the patient. A thorough knowledge of the anatomical relations of structures and adequate surgical skills are needed to minimize complications. The purpose of this study was to evaluate the indications and outcome of surgical techniques for diseases affecting the condyle and ramus of the mandibles. Patients and Methods: Data were retrieved from the case files of patients who had surgeries for diseases involving the ramus/condylar area of the mandible. The diagnosis/indications for surgery, procedure and postoperative outcomes were documented. Outcomes assessed were related to mouth opening, esthetics (appearance of scar and jaw symmetry) and function (occlusion, Jaw movements). Complications such as nerve dysfunction were documented. Paresthesia was tested by simple tactile stimulations. Results: There were a total of 27 procedures done either on the condyle or ramus in 23 (100%) patients between May 2006 and October, 2013. 16 procedures were done for tumors in 16 (69.6%) patients, 14 (60.9%) patients had Ameloblastoma, 1 (4.3%) had central neurofibroma and one had keratocystic odontogenic tumor, two procedures for unilateral condylar fractures in 2 (8.6%) patients, five procedures for ankylosis in 3 (13.0%) patients and four procedures were done for dislocation in 2 (8.6%) patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory. Conclusion: Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.

Amniotic band syndrome in a Nigerian cleft patient: A case report

Amniotic band syndrome is a set of congenital malformations ranging from minor constriction rings and lymphedema of the digits to complex, bizarre multiple congenital anomalies that are attributed to amniotic bands that stick, entangle, and disrupt fetal parts. The most commonly associated anomalies include amputations, constriction bands, syndactyly, craniofacial defects, and club feet. A case of amniotic band syndrome involving limb anomalies and orofacial cleft deformity in a Nigerian child is reported.