Sunday Olusegun Ajike

Aetiology and presentation of ankylosis of the temporomandibular joint: report of 23 cases from Abuja, Nigeria.

Several studies have reviewed the management of ankylosis of the temporomandibular joint (TMJ), but only a few focused on the aetiology and clinical features. We retrospectively studied the aetiology and clinical features of patients with ankylosis of the TMJ who presented to the Maxillofacial Unit, National Hospital, Abuja, Nigeria, between 2004 and 2009. There were 13 male and 10 female patients, M:F ratio 1.3:1, age range 6-62, mean (SD) 20 (13) years. The aetiological factors were trauma (n=11) that comprised falls (n=6), untreated fractures of the zygomatic arch (n=4) and myositis ossificans (n=1); infection (n=9), that comprised cancrum oris (n=3) and ear infection (n=6); congenital or unknown (n=2), and coronoid hyperplasia (n=1). The maximum interincisal distance at presentation ranged from 0 to 25 mm (mean (SD) 6.7 (7.2) mm). Seventeen had facial deformities. The diagnoses recorded were as follows: left extracapsular ankylosis, (n=8); right intracapsular bony ankylosis, (n=6); left intracapsular bony ankylosis, (n=4); bilateral intracapsular bony ankylosis, (n=4), and bilateral intracapsular fibrous ankylosis (n=1). Extreme poverty was the main predisposing factor. There is a need for a concerted effort among healthcare providers, policy makers, and the world in general to eradicate poverty and improve healthcare to limit the incidence of ankylosis of the TMJ.

Multiple odontomas in the facial bones: A case report

A rare case of multiple compound odontoma involving the facial bones and erupting into the oral cavity of a 15-year-old Nigerian girl is presented. The unacceptable facial appearance and the surgical approach used makes this case worth reporting.

Ameloblastic Carcinoma: A Multicenter Nigerian Study

PURPOSE To obtain a national profile on the prevalence and management of ameloblastic carcinoma in Nigerians. MATERIALS AND METHODS Data were collected from the case files of patients with a histologic diagnosis of ameloblastic carcinoma from 4 tertiary referral centers in Nigeria from January 1980 to December 2008. RESULTS Twenty patients were seen within the study period. There were 11 male and 9 female patients, with a male-to-female ratio of 1.2:1. Their ages ranged from 16 to 85 years (mean +/- SD, 41.63 +/- 19.8 years). The duration of the lesion before presentation was 6 months to 4 years. Twelve cases occurred in the posterior mandible alone, 1 case occurred in the anterior mandible alone, and 4 cases involved the anterior and posterior mandible. The posterior part of the maxilla was involved in 3 cases. A majority of the cases (17) occurred de novo, and 3 patients presented with carcinoma ex-ameloblastoma. Treatment included surgical resection with or without neck dissection. Eight patients declined treatment after diagnosis. Surgery was planned for 12 patients, but 2 patients died of intractable bleeding episodes before surgery. Mandibulectomies and maxillectomies were performed for 10 patients. Follow-up was carried out for 5 patients. Recurrence ranged from 6 to 96 months after the first surgery. Overall deaths recorded involved 6 patients. Three patients died within 3 years after the initial surgery and 1 patient died about 8 years after the initial surgery. One patient is still alive and well 1 year after surgery. CONCLUSION Ameloblastic carcinoma is an uncommon malignancy. Most cases occur in the mandible and arise de novo. Early diagnosis and radical local excision remain the mainstay of treatment.

Audit of oral and maxillofacial surgical conditions seen at Port Harcourt, Nigeria.

BACKGROUND The worldwide pattern of oral and maxillofacial surgical conditions has been rarely reported despite its significance in head and neck medicine. The Niger Delta region comprises 9 of the 36 states in the Federal Republic of Nigeria. There are scanty reports on oral and maxillofacial surgical diseases from the region despite its 95% contribution to Nigerias oil-revenue. METHODS This retrospective survey of oral/maxillofacial surgical cases seen at a referral center in Port Harcourt, a city in the Niger delta region of Nigeria. RESULTS Between 2000 and 2004, our center offered specialized maxillofacial surgical services to 86 patients coming from 5 states in the Niger delta region. These patients made up 20% of all patients seen at the department within the period. There were 110 indications for surgical interventions. Most were complaints of trauma (46.4%). The rest were tumors and allied lesions (39.0%) and cysts (12.7%). Ratio of male to female patients was 1.7:1 while patients were aged between 9 and 85 years (mean 31.2 years, standard deviation +/- 15.4). Most (n? = ?63, 73%) had surgical treatment while a significant proportion (19%) defaulted. Seventy-nine surgical procedures were performed (69 primary and 10 secondary). Primary procedures included maxillo-mandibular fixation (31.9%) and enucleation of tumor/cyst (17.4%). While our series of 86 cases over 4 years appears low, there is likelihood that oral and maxillofacial surgical conditions are as common in the Niger Delta region as in other parts of Nigeria. There is scarcity of skilled manpower and equipments for the management of oral maxillofacial surgical conditions in the region. Health promotion activities are needed to improve awareness for early diagnosis of these conditions. Also, poverty alleviation measures need to be effective as defaults were often due to inability to pay for treatment. CONCLUSION In many parts of the Niger Delta region of Nigeria, oral and maxillofacial surgical diseases are not uncommon causes of morbidity. However, many parts of the region lack requisite manpower for prevention and curative health activities. Defaults from hospital treatment were due to preference for traditional (unorthodox) measures and financial inability. Poverty alleviation measures need to be stepped up while the state of medical infrastructure should be enhanced in the region.

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.

Epidemiology of adult cleft patients in North-western Nigeria: our experience.

BACKGROUND/OBJECTIVE To review cleft lip and palate procedures over a three-year (2008-2010) partnership between the smile train and our organization, the Grasssroot Smile Initiative (GSI). METHOD A three-year retrospective study (2008-2010) involving 79 adult patients with clefts. RESULTS Seventy nine (14.4%) of 550 patients with orofacial clefts seen and treated within a three-year period were adults with age range of 17 to 81 years; mean 31.45 ± 13.09. Majority were between 20 and 39 years. There were 54 (68.4%) males and 25 (31.6%) females, with the male:female ratio of 2.2:1. Analysis of the cleft types/site revealed 35 (44.3%) lip alone, 22 (27.8%) lip and alveolus, 7 (8.9%) lip and palate and 15 (19%) palate alone. Seven (8.9%) of these patients had other relatives with clefts. Sources of information were friends and relatives; 33 (41.8%), radio; 18 (22.8%), charity organization/NGO; 13 (16.5%), hospitals/physicians; 5 (6.3%), and others; 10 (12.7%). 57 patients with lip clefts had surgery under local anesthesia while the remaining 22 patients were done under general anesthesia. All clefts of the lip were repaired using the Millard advancement rotational flap for complete cleft, simple straight line closure for incomplete and double layer closure for the palate. CONCLUSION The incidence of adult patients with orofacial cleft is not rare in our community, probably due to limited access to specialized health care facilities, poverty and ignorance. Furthermore, some of these patients are not aware that these facial defects can be repaired. The advent of the smile train organization and free services has resulted in this harvesting phenomenon.

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.

Change in the pattern of paediatric maxillofacial fractures seen in Kaduna, Northern Nigeria.

Trauma is the leading cause of morbidity and mortality among children worldwide. 1 However, in comparison with adults, maxillofacial fractures in children are relatively uncommon due to physiological and environmental factors. Between 4% and 12% of all maxillofacial fractures occur in children. 2-5 The reasons for the wide disparity in incidence rates include differences in age limit of the pediatric population studied, types of injuries classified and the socio-economic status of the population which influences access to health care facilities. Nigeria, like many developing countries in Africa has witnessed tremendous socio-economic and demographic changes in the past 20years. This has altered the pattern of some health conditions. Since the last published series on pediatric maxillofacial fractures from our center in 1980, 2 to our knowledge no recent review from our center has been presented. This is important as our center was the first oral/maxillofacial care center in northern Nigeria and remains an important tertiary care facility in the region. The aim of this report was to evaluate the current pattern of maxillofacial fractures in the urban Northern Nigerian pediatric population as seen at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria for comparison with other Nigerian and international records. A retrospective survey of cases of maxillofacial fractures seen between 1991 and 2000 at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, and Kaduna, Nigeria was undertaken. Children aged 15 years and below were selected out for further study. Materials reviewed include case notes, radiological reports and theater records. Information retrieved for analyses were age, sex, cause of fracture, site (s) of facial fracture, associated injuries and treatment. Poor return for follow-up made it impossible to review complications. Mandibular fractures were classified as anterior that is, between the canine teeth, posterior – from canine to end of occlusion, angle, ramus, condyle, dentoalveolar and coronoid types. Middle third fractures were classified as Le Fort type, Zygomatic complex and nasal complex types. Out of 443 cases of maxillofacial fractures seen within the study period, 21 (4.7%) were children aged 15years and below. There was a bimodal peak age of incidence at ages 9-10years old (n = 7, 33.3%) and 13-15years old (n = 8, 38%). The mean age of the children was 11.5 ± 2.6years (median age 11years) with no child below 6years of age. There were 15 males and 6 females. The main etiological factors were falls 12, road crashes 6, and fights 2. A total of 29 maxillofacial fractures were seen in the 21 patients giving a fracture to patient ratio of 1.4:1. Five patients (24%) had fractures of the middle-third and mandible but fractures most were mandibular only (14, 66%) while the rest were in the middle-third of the face alone (10). Treatment of cases is shown in Table 1. No associated injuries were recorded in the 21 children with maxillofacial fractures seen in this study.

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.

Anaesthesia for cleft lip surgeries in a resource poor setting: techniques, outcome and safety

Introduction Cleft lip and palate is one of the more common congenital malformation and the most common craniofacial anomalies in children. The treatment is expensive and requires specialised care. Access to this care in middle and low income countries is compounded by socioeconomic status of patients and their relation and also the inadequacy of expertise in medical personnel and infrastructure. Objective: the study aimed to review the techniques of anaesthesia used in a low resource setting in terms of the techniques, outcome, and safety. Methods This is a retrospective review of 79 cases done in a resource poor setting. Information regarding the patients, surgeries and modes of anaesthesia were retrieved from the case notes. Results A total of 62 patients were operated with incomplete cleft accounting for 37 (59.7%), complete 23(37.1%), and 2 (3.2%) as bilateral. Forty-six (74.2%) of patients had their surgery done with ketamine anaesthesia without endotracheal intubation, 14 (22.6%) had regional anaesthesia and 2 patients (3.2%) had general anaesthesia with endotracheal intubation. Conclusion This study demonstrates that with careful planning and expertise, cleft lip repair can be done safely in resource poor setting.