Obiechina Ae

Trends in the characteristics of maxillofacial fractures in Nigeria

PURPOSE The study purpose was to assess the changes in the pattern of maxillofacial fractures in 2 different study periods. PATIENTS AND METHODS We conducted retrospective study of 341 patients treated for maxillofacial fractures between January 1978 and December 1982 and a prospective study of 483 patients treated between January 1995 and December 1999 at the Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria. Data were collected on age, gender, etiologic factor, and site of injury. RESULTS The male-to-female ratio reduced in the second period by a factor of 2.0. Patients in the age groups of 21 to 30 years and older than 60 years increased by a factor of 1.8 and 2.9, respectively, in the second period. Assaults, falls, sporting injuries, and industrial accidents in the second period increased by a factor of 1.4, 1.5, 3.5, and 1.5, respectively. The ratio between road traffic accidents and other causes changed from 3.4:1 to 2.2:1 in the second period. Mandibular fractures increased by 2% in the second study period. CONCLUSION The data confirmed that although other etiologic factors are increasing in number, road traffic accidents remains the major etiologic factor of maxillofacial fractures in Nigeria. There is a need to enforce seat belt use, speed limit, and drink driving laws to reduce maxillofacial injuries caused by road traffic accidents; to organize preventive programs to minimize assaults, and to legislate the wearing of headgear by industrial workers.

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.

Mandibular defect reconstruction with nonvascularized iliac crest bone graft

CONTEXT Reconstruction of mandibular defect is a challenge to the head and neck surgeon because of associated functional and esthetic problems. Our experience with the use of nonvascularized iliac crest bone graft is hereby reported. AIM The aim was to report our experience with the use of nonvascularized iliac crest bone for mandibular defect reconstruction at University College Hospital, Ibadan. Nigeria. SETTINGS AND DESIGN A retrospective descriptive study was performed. MATERIALS AND METHODS Cases of mandibular reconstruction with iliac crest bone graft between January 2001 and December 2007 were included in this study. Grafts were secured with either a stainless steel wire or a titanium plate. Preoperative diagnosis, postoperative follow-up records including investigations, diagnosis of graft infection and subsequent treatment modalities were extracted from the available records. STATISTICAL ANALYSIS USED Descriptive variables were analyzed with SPSS version 14. RESULTS A total of 47 patients had mandibular defect reconstruction with nonvascularized iliac crest block bone during the study period. Thirty-eight patients had graft secured with transosseous wire [NVIBw] while 9 had a titanium plate [NVIBp]. The male:female ratio was 26:21 while the mean age of the patients was 24.6±4.25 years. Ten patients (21.3%) developed persistent graft infection during the postoperative period. All cases of infection occurred in patients who had transosseous wiring and analysis showed that 60% of the infected grafts revealed mixed microbial isolates containing Klebsiela spp, Pseudomonas Aeurogenosa, and E coli. Six (60%) of the infected grafts were removed as a result of unabated infection while 4 (40%) were successfully treated by exploration and pus drainage. CONCLUSIONS Nonvascularized iliac crest bone graft provides an affordable and less technical choice for mandibular reconstruction with minimal complications in a resource-limited economy.

Pattern of midface trauma with associated concomitant injuries in a Nigerian referral centre

Aim: The aim of this study was to determine the pattern of midface trauma with associated concomitant injuries seen in our environment. Methodology: This was a prospective analysis of trauma patients with midfacial injuries presenting at a referral center in South West Nigeria. In addition to socio-demographic data, the following information was also obtained: Mechanism of injuries, type of midfacial injuries, concomitant/associated injuries and treatment. Results: A total of 101 patients with midfacial injuries were involved. They were made up of 85 males and 16 females. The 20-29 year age group was mostly affected (44.6%) and the most common cause of midface injuries was road traffic accident (91.1%). The zygoma was fractured more than any other midfacial bone (46.0%). A total of 144 associated injuries were recorded among these patients, head and ocular injuries accounted for 49 (34%) and 35 (24.3%) respectively. The patients were mostly treated conservatively or by closed reduction. Conclusion: The rate of head and ocular injuries among patients with midfacial injury was high. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary approach is important for optimum management of these patients.

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.

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.