V.I. Ugboko

Clinicopathological analysis of histological variants of ameloblastoma in a suburban Nigerian population

BackgroundThis study was carried out to establish the relative incidence and provide clinico-pathologic information on the various histological types of ameloblastoma seen at the Obafemi Awolowo University Teaching Hospital complex, Ile-Ife in order to provide a baseline data which will be of significance to the pathologist and clinician.MethodsClinico-pathologic data on a total of 77 histologically diagnosed cases of ameloblastoma archieved at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife over a 15 year period were obtained and analysed descriptively.ResultsFollicular ameloblastoma was the most common histological type (50 cases, 64.9%), followed by plexiform ameloblastoma (10 cases, 13.0%). 4 (5.2%) cases of desmoplastic and 3 (3.9%) cases of acanthomatous ameloblastoma were seen while the basal cell variant accounted for 2 (2.6%) cases. Only 1 case of the unicystic type was seen. Some of the 77 cases presented as a mixture of two or more histological types. Ameloblastoma occurred over an age range of 11 to 70 years with a peak age incidence in the 3rd decade.ConclusionThis study provides a baseline data on variants of ameloblastoma as obtained in a suburban Nigerian population. Since variants of ameloblastoma differ in biologic behaviour, the data collected in this study provides clinicopathologic information which is of significance to the pathologist and clinician.

Can Autologous Platelet-Rich Plasma Gel Enhance Healing After Surgical Extraction of Mandibular Third Molars?

PURPOSE This investigation assesses the effect of platelet-rich plasma (PRP) gel on postoperative pain, swelling, and trismus as well as healing and bone regeneration potential on mandibular third molar extraction sockets. PATIENTS AND METHODS A prospective randomized comparative clinical study was undertaken over a 2-year period. Patients requiring surgical extraction of a single impacted third molar and who fell within the inclusion criteria and indicated willingness to return for recall visits were recruited. The predictor variable was application of PRP gel to the socket of the third molar in the test group, whereas the control group had no PRP. The outcome variables were pain, swelling, and maximum mouth opening, which were measured using a 10-point visual analog scale, tape, and millimeter caliper, respectively. Socket healing was assessed radiographically by allocating scores for lamina dura, overall density, and trabecular pattern. Quantitative data were presented as mean. Mann-Whitney test was used to compare means between groups for continuous variables, whereas Fischer exact test was used for categorical variables. Statistical significance was inferred at P < .05. RESULTS Sixty patients aged 19 to 35 years (mean: 24.7 ± 3.6 years) were divided into both test and control groups of 30 patients each. The mean postoperative pain score (visual analog scale) was lower for the PRP group at all time points and this was statistically significant (P < .05). Although the figures for swelling and interincisal mouth opening were lower in the test group, this difference was not statistically significant. Similarly, the scores for lamina dura, trabecular pattern, and bone density were better among patients in the PRP group. This difference was also not statistically significant. CONCLUSION The PRP group recorded reduced pain, swelling, and trismus as well as enhanced and faster bone healing compared with those in the control. Hence the study showed that topical application of PRP gel has a beneficial effect in enhancing socket healing after third molar surgery.

Genetic studies in the Nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders.

Background Orofacial clefts are the most common malformations of the head and neck, with a worldwide prevalence of 1 in 700 births. They are commonly divided into CL(P) and CP based on anatomic, genetic, and embryologic findings. A Nigerian craniofacial anomalies study (NigeriaCRAN) was set up in 2006 to investigate the role of gene-environment interaction in the origin of orofacial clefts in Nigeria. Subjects and Methods DNA isolated from saliva from Nigerian probands was used for genotype association studies and direct sequencing of cleft candidate genes: MSX1, IRF6, FOXE1, FGFR1, FGFR2, BMP4, MAFB, ABCA4, PAX7, and VAX1, and the chromosome 8q region. Results A missense mutation A34G in MSX1 was observed in nine cases and four HapMap controls. No other apparent causative variations were identified. Deviation from Hardy Weinberg equilibrium (HWE) was observed in these cases (p = .00002). A significant difference was noted between the affected side for unilateral CL (p = .03) and bilateral clefts and between clefts on either side (p = .02). A significant gender difference was also observed for CP (p = .008). Conclusions Replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the development of CL(P).

Prevalence and causes of fractured permanent incisors in 12-year-old suburban Nigerian schoolchildren

The aim of the study was to assess the prevalence and causes of traumatic dental injuries to the permanent dentition of 12-year-old school children in Ile-Ife, a suburban population in the south west of Nigeria. A dental trauma cross-sectional survey was carried out through clinical examination of upper and lower permanent incisors and interviews with 415 (212 boys, 203 girls) 12-year-old children attending private and public secondary schools in Ile-Ife, in 2004/2005 by one calibrated examiner. Garcia-Godoys classification was used. The prevalence of traumatic dental injuries was 12.8%. There was no statistical difference in the prevalence between boys and girls P > 0.05. The most common cause of injuries was falls (49.1%), followed by traffic accidents (13.2%), collision against objects or people (11.3%) and misuse of teeth 9.4%. The commonest type of injury was enamel fracture alone (9.9%), followed by enamel-dentine fracture (4.8%). Majority of the accidents occurred at home (60.4%), followed by school (26.4%). The prevalence of traumatic dental injuries was on the increase among suburban Nigerian children in Ile-Ife and it has a potential to be considered an emerging public health problem.

Herpes zoster infection of the maxilla: Case report

Herpes zoster is an acute viral infection of the dorsal root ganglia of the spinal cord or the extramedullary cranial nerve ganglia.’ Previous reports have shown that the condition is attributable to reactivation of latent varicella zoster virus in the dorsal root ganglia after an earlier attack of chicken pox.” Herpes zoster infection @IZI) is predominantly a disease of the middle-aged and elderly. From 5 to 10 cases per 1,000 persons are seen between the sixth and eighth decades of life”; less than 5% of attacks occur in persons younger than 10 years of age.4,5 Approximately 8% of patients admitted to the hospital with HZ1 have an underlying disease such as leukemia, Hodgkin disease, myelomatosis, or carcinomatosi.s.3 Attacks also may be precipitated by surgical stress, immunosuppressive therapy, physical trauma, and radiation therapy.*@ Characteristically, the condition presents as a painful unilateral vesicular rash, usually restricted to the distribution of a sensory nerve. The trunk (especially T3 to L3) and the trigcminal area are most commonly affected.359 A rare form without vesicular eruption also has been documented.1° Perhaps the most significant complication of HZ1 is postherpetic neuralgia”; others include motor nerve palsy, optic neuropathy, blindness, encephalitis, and cutaneous calcinosis.12-15 Alveolar bone necrosis in association with HZ1 of the maxillary nerve is a rare phenomenon.‘” In this report, such an uncommon complication of maxillary herpes roster is presented.

Health-related quality of life in Nigerian patients with facial trauma and controls: a preliminary survey

We examined the health-related quality of life (HR QoL) of patients with facial trauma and compared it with that of healthy controls; temporal changes in HR QoL of patients over 12 weeks compared with baseline values; and whether the risk of depression could be identified by baseline HR QoL. For 26 months we recruited 126 consecutive patients with facial injuries and 126 age and sex-matched healthy controls for the study. Enrollment criteria included age 18 years and over, Glasgow coma scale score on admission of 12 and over, and duration of stay of more than 24 hours. HR QoL was measured using the 26-item World Health Organization Quality of Life Questionnaire (WHO QoL-Bref), and depression was measured with the Hospital Anxiety and Depression Scale (HADS). Scores in all domains of the WHO QoL-Bref (physical, psychological, social relations, and environment) were considerably reduced in injured patients compared with controls. During follow up there were improvements only in the domains of physical health and environment, but not in psychological health. There was a significant reduction in the HR QoL domain of social relationships with time. The regression equation for all four QoL domains as predictors was significantly related to depression scores throughout the study period. Patients with facial injuries are at risk of poor QoL after trauma. There was a high incidence of depression throughout the follow-up period, and poor QoL at baseline predicted depression during follow-up.

Osteolipoma of the palate: Report of a case and review of the literature

Oral lipomas, though rare, predominantly affect the buccal mucosa, tongue, and lips. The occurrence of lipomas in the palate is extremely rare. Osteolipoma is a very rare histological variant of lipoma accounting for less than 1% of all cases. Although a few cases involving the soft palate have been reported, there is only one reported case of osteolipoma of the hard palate in the English-language literature and it was a congenital osteolipoma associated with a cleft palate in a 6-year-old male child. This paper aims to describe an additional case uniquely located in the hard palate of an adult female.

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.

Reconstruction of mandibular defects using nonvascularized autogenous bone graft in Nigerians

Objectives: The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria. Patients and Methods: A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patients′ records. This information include patients′ demographics (age and sex) as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications. Result: There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ± standard deviation (SD) 12.9 and for females 35.0 ± SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%). Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients) and postoperative wound infection (eight patients) were the most common complications recorded. Conclusion: The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care contributed to the good outcome.

Unusual foreign bodies in the orofacial soft tissue spaces: A report of three cases

The ingestion and inhalation of foreign bodies with their associated morbidity and mortality have been widely reported in the literature. However, reports on foreign body impaction in the orofacial region are comparatively fewer. Three unusual cases of foreign body impaction into the buccal and submasseteric spaces are presented. The three patients were adults and they presented with history of painful facial swelling associated with limited mouth opening. Plain skull radiographs revealed the foreign bodies within the facial soft tissue spaces in two patients while it was not helpful in the third patient. Surgical explorations of the left buccal, left submasseteric and the right buccal spaces led to the retrieval of the foreign bodies. Prompt diagnosis and surgical removal of such foreign bodies will greatly minimize the associated complications which may include; cellulitis, facial abscess, allergic reactions, necrotizing fasciitis and osteomyelitis.