Impact of COVID-19 on Management and Outcome of Cervicofacial Infections in a Maxillofacial Centre

INTRODUCTION

Cervicofacial infections (CFI) are life-threatening and constitute some of the common emergencies seen by the oral and maxillofacial surgeon on a regular basis. The COVID-19 pandemic resulted in reduced human activities for most of 2020 including the first worldwide lockdown. At the height of the pandemic, it was expected that the number of patients presenting with cervicofacial infections would drop as with most health conditions. The purpose of this study was to determine the impact of COVID-19 on the management and outcome of cervicofacial infections in a tertiary maxillofacial institution.

PATIENTS AND METHODS

A retrospective analysis of patients who presented at the Maxillofacial clinic with cervicofacial infections and were subsequently admitted into the ward during the lockdown (2020) was compared with those of the previous year (2019) and the year after (2021).

RESULTS

The total number of patients seen and admitted with cervicofacial infections in 2020 was 39(31.2%) which was lower than that seen the preceding year 48(38.4%) but higher than 38(30.4%) of the year after. 116 patients were treated while nine patients left hospital without treatment. All patients presented with extensive cervicofacial infections, involving more than three fascial spaces and were treated using parenteral antibiotics with surgical incision and drainage under local anesthesia. There were more deaths in 2020 (n=10) than in the preceding year (n=8) and the year after (n=7).

CONCLUSION

A high percentage of CFI was admitted during COVID-19 period compared to the previous and following years. Involvement of multiple fascial spaces was also noted.

Giant Ameloblastoma and the Risk of Recurrence: Experiences from a Tertiary Hospital

BACKGROUND

Ameloblastoma is an aggressive tumor of odontogenic epithelium that grows slowly with propensity for bone expansion. Sometimes it may grow to very large sizes also known as giant ameloblastoma (GA) which may affect function and even pose a threat to life.

OBJECTIVE

To present the pattern of presentation of GAs seen in a tertiary centre in Northern Nigeria.

PATIENTS AND METHODS

A retrospective study of patients seen with GA at the Oral and Maxillofacial Clinic of a tertiary health facility of Northern Nigeria between January 2006 to December 2019. All patients with complete documentation in the folder, theatre register and histopathologic records were recruited for the study. Data were analyzed using SPSS version 23.

RESULTS

GAs accounted for 30.2% (48) of all the ameloblastomas operated during the period with a male dominance of 62.5% (30), giving a ratio of 1.7:1(M:F). The age range was between 12 and 65 years with a mean age of 35.04years (±14.5) and the mandible was the most affected jaw compared to the maxilla (12.5%). Lesions with lowest and highest weight were found on the mandible (77g and 1640g respectively). The treatment most given was mandibulectomy (unspecified) with 20.0% followed by Rt and Lt mandibulectomies with 14.0% each.

CONCLUSION

GA was found to account for 30.2% of all lesions seen within the period under review, while the mandible was the most affected jaw bone.

Epidemiologic evidence linking oxidative stress and pulmonary function in healthy populations

Respiratory health in the general population declines regardless of the presence of pulmonary diseases. Oxidative stress has been implicated as one of the mechanisms involved in respiratory dysfunction. This review was to evaluate studies that relate oxidative stress factors with pulmonary function among the general population without prior respiratory illnesses. The search yielded 54 citations. Twenty-one studies qualified for incorporation in this review. Owing to the heterogeneity of the review, studies were discussed based on identified oxidative stress factors responsible for pulmonary dysfunction. Oxidative stress biomarkers, including gene polymorphisms of nuclear factor erythroid 2-related factor 2, heme oxygenase 1, glutathione S transferase, superoxide dismutase, and lipid peroxidation products were involved in lung function decline. In addition, the antioxidant status of individuals in reference to dietary antioxidant intake and exposure to environmental pollutants affected oxidative stress and pulmonary function, as indicated by forced expired volume in one second, forced vital capacity, and forced expiratory flow at 25%–75%_. This review indicated that oxidative stress is implicated in the gradual decline of lung function among the general population, and gene polymorphism along the antioxidant defense line and/or their interaction with air pollutants reduce lung function. Different polymorphic forms among individuals explain why the rate of lung function decline differs among people. Dietary antioxidants have respiratory health benefits in antioxidant gene polymorphic forms. Therefore, the genetic composition of an individual may be considered for monitoring and identifying people at risk of respiratory illnesses.

Exploration of surface glycoprotein to design multi-epitope vaccine for the prevention of Covid-19

Stimulation and generation of T and B cell-mediated long-term immune response are essential for the curbing of a deadly virus such as SAR-CoV-2 (Severe Acute Respiratory Corona Virus 2). Immunoinformatics approach in vaccine design takes advantage of antigenic and non-allergenic epitopes present on the spike glycoprotein of SARS-CoV-2 to elicit immune responses. T cells and B cells epitopes were predicted, and the selected residues were subjected to allergenicity, antigenicity and toxicity screening which were linked by appropriate linkers to form a multi-epitope subunit vaccine. The physiochemical properties of the vaccine construct were analyzed, and the molecular weight, molecular formula, theoretical isoelectric point value, half-life, solubility score, instability index, aliphatic index and GRAVY were predicted. The vaccine structure was constructed, refined, validated, and disulfide engineered to get the best model. Molecular binding simulation and molecular dynamics simulation were carried out to predict the stability and binding affinity of the vaccine construct with TLRs. Codon acclimatization and in silico cloning were performed to confirm the vaccine expression and potency. Results obtained indicated that this novel vaccine candidate is non-toxic, capable of initiating the immunogenic response and will not induce an allergic reaction. The highest binding energy was observed in TLR4 (Toll-like Receptor 4) (−1398.1), and the least is TLR 2 (−1479.6). The steady rise in Th (T-helper) cell population with memory development was noticed, and IFN-g (Interferon gamma) was provoked after simulation. At this point, the vaccine candidate awaits animal trial to validate its efficacy and safety for use in the prevention of the novel COVID-19 (Coronavirus Disease 2019) infections.

Laboratory diagnosis of COVID-19 in Africa: availability, challenges and implications

The COVID-19 infection has been a matter of urgency to tackle around the world today, there exist 200 countries around the world and 54 countries in Africa that the COVID-19 infection cases have been confirmed. This situation prompted us to look into the challenges African laboratories are facing in the diagnosis of novel COVID-19 infection. A limited supply of essential laboratory equipment and test kits are some of the challenges faced in combatting the novel virus in Africa. Also, there is inadequate skilled personnel, which might pose a significant danger in case there is a surge in COVID-19 infection cases. The choice of diagnostic method in Africa is limited as there are only two available diagnostic methods being used out of the six methods used globally, thereby reducing the opportunity of supplementary diagnosis, which will further lead to inappropriate diagnosis and affect the accuracy of diagnostic reports. Furthermore, challenges like inadequate power supply, the method used in sample collection, storage and transportation of specimens are also significant as they also pose their respective implication. From the observations, there is an urgent need for more investment into the laboratories for proper, timely, and accurate diagnosis of COVID-19.

REVIEW OF DENTISTRY IN WEST AFRICA- CHALLENGES AND PROSPECTS

Oral health as an integral component of overall health is provided by dental professionals (Dental surgeons/stomatologists, hygienists, dental nurses, technicians, community extension workers). Oral diseases in West Africa are dominated by gum/periodontal diseases, dental caries, orofacial trauma, cancrum oris/noma and oral cancer. Human resources and infrastructure for oral health services in West Africa are skewed towards the urban areas where the rich live, while the rural poor have relatively little or no human resources and infrastructure. The development of human resources for oral health started much later than for other health services in West Africa. In all countries, the training of dentists at undergraduate level started after independence. In Nigeria, postgraduate training in dental surgery took off more than 10 years after the graduation of the first set of undergraduate dental surgeons. To meet contemporary realities for improved dental services with a substantial reduction of all oral health diseases in the region, there is need to review the 1998 WHO health strategies.

PROFESSIONAL EXPERIENCES, TRAINING ATTITUDES AND EXPECTATIONS OF RESIDENTS IN DENTISTRY: A NATIONWIDE SURVEY

BACKGROUND

Worldwide, it has been acknowledged that feedback from students and trainees is important for evaluation of training. However, there is limited data on the professional experiences, expectations and attitude of residents in dentistry to their training.

AIM

This study aimed to analyse the professional experiences, expectations, and attitudes of dentistry residents to training in Nigeria.

DESIGN OF THE STUDY

Cross-sectional study.

SETTING

All the accredited Nigerian Teaching Hospitals with dental surgeons undergoing residency training in any of the 10 specialties examined in West Africa.

METHODOLOGY

The study was conducted through a self- administered closed anonymous 46-items questionnaire adapted from that used for general surgery residents in the United States of America. The collected data included various aspects of the technical, human and professional domains of the expectations, attitudes and perceptions of dental residents to their training. Data from the questionnaires were collated and entered into Microsoft Excel version 10, 2002 (Microsoft, Redmond, WA, USA) and processed using STATA software (StataCorp LLC, Texas, USA). Categorical variables were calculated as proportions and percentages with 95% corresponding intervals. χ2 - test was used to analyse the association between selected demographic characteristics and some of the responses. Fischer's exact test was done where necessary. Statistical significance was set at p≤0.05 and tests were two- sided.

RESULTS

Nigeria has 11 accredited training institutions for residency in dentistry, of which 214 residents participated representing 93% of the estimated total. Most were males (133, 65.2%) with male to female ratio of 1.9:1. Residents aged between 30-34 years of age made up 41.5% while 77.4% were married. Close to one third (31.8%) were residents in oral and maxillofacial surgery. Residents expressed low level of satisfaction with the quality of residency training (64, 30.3%; 95% CI 24.5-36.9) and believe that they had appropriate level of operating skill from their training (96, 45.3%; 95% CI 38.6-52.1). Few agreed that the training programme had adequate support structures for struggling residents (64, 30.3%; 95% CI 24.5-36.9) but many (105, 65.2%; 95% CI 57.5-72.2) felt the residency programme took too long. More males (31.8%) than females (14.9%) expressed satisfaction with the level of didactic teaching during the residency programme with statistically significant difference (p=0.032). Orthodontic residents expressed the greatest approval (54.5%) for the support structures put by the training programme for struggling residents, while the least were in oral medicine (12.5%) with high statistically significant difference (p=0.014). The level of support from faculty/departmental member to struggling resident was felt to be most adequate by those who had passed the primaries exam (69.5%) with statistically significant difference from other residents (p= 0.021).

CONCLUSION

Overall, this study showed that Nigerian dentistry residents had low level of satisfaction with the quality of their training indicating the need for a holistic review of the training curriculum and conduct of trainers. There is need to reinforce motivating and tackle demotivating factors identified in this study to improve the response of dentistry residents to their training as these would improve the value of competency assessments undertaken by the postgraduate colleges while sustaining interest in the profession for the interest of the wider society.

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.

Perception and practice of contraception among male soldiers in Sobi barracks, Ilorin, Nigeria

BACKGROUND

There is a popular belief among the general population that Nigerian soldiers tend to have large families but this has not been substantiated with evidence-based research. The Nigerian military health authority implements female-targetted contraception strategies, with less focus on their husbands; who are the dominant fertility determinants.

OBJECTIVE

To determine the perception and practice of contraception among male soldiers of Sobi Cantonment, Ilorin, Nigeria, with a view to instituting male-targeted contraceptive/family planning strategies.

METHODOLOGY

A cross-sectional survey of 334 male soldiers using multistage sampling technique and pre-tested interviewer administered questionnaires.

RESULTS

The respondents' approval of contraception (73.6%) and willingness to discuss it with their spouses/partners (71.6%) were high. Fear of wives/partner's sexual promiscuity (55.7%), cultural and religious beliefs (43.2%), fear of the side effects of contraceptives (29.5%) and the desire for more children (21.6%) were reported reasons for the non-approval of contraception. The prevalence of contraceptive use among the respondents was low (12.3%). There was a significant relationship between the respondents' educational level and contraceptive use (p< 0.05).

CONCLUSION

The study revealed a high approval and willingness to discuss contraception with their spouses/partners but low contraceptive use.

Challenges of airway management in a patient with temporomandibular joint ankylosis complicating forceps delivery--a case report

Ankylosis of the temporomandibular joint following forceps delivery is a rare anomaly. The aetiopathogenesis involves wrongful application of the forceps or forceful closure of the forceps handle against the condyle with haemathrosis, organisation and subsequent ankylosis. Because of the lack of epidemiological data, there is little information about the true incidence and the management of this rare anomaly. The purpose of this presentation is to report the challenges encountered in the airway management of a six-year old female with right temporomandibular joint ankylosis following forceps delivery in a private hospital setting.

Pattern of prescription drug use in Nigerian army hospitals

BACKGROUND

Most health expenditure of developing countries is on drugs and medical sundries but inappropriate use of such resources is common. To our knowledge, only few studies have been done in Africa on this issue , with inadequate consideration of the sociological context of the knowledge, attitude and practice of the prescribers especially doctors. This study presents the pooled data of the pattern of prescription drug use from three Nigerian Army hospitals using some WHO criteria, and the knowledge and attitude underlying doctors' prescribing practices in these hospitals.

METHODS

Retrospective cross-sectional survey of one year (March 2006-February 2007). Systematic random sample of general out patient case notes from three hospitals were collected using WHO criteria. The knowledge, attitude and practice survey of doctors at each study site towards the concept of rational drug use (RDU) were assessed using a self-administered questionnaire.

RESULTS

Data collected from 660 case notes showed that average number of drugs per encounter was 2.8 while 49.3% of drugs were prescribed in the generic form. An average of 28.1% of patients encountered antibiotics. From the knowledge, attitude and practice survey, it is evident that 90.5% of 74 prescribers were aware of the existence of national essential drugs list but 58.1% of them did not use it as basis of prescriptions. In describing types of medicines preferred, 56.7% of prescribers claimed they prescribed a mixture of generic and branded drugs. Only 12.1% of prescribers could accurately detail the 5 steps of rational prescribing.

CONCLUSION

The pattern of prescription drug use in Nigerian Army hospitals is unsatisfactory. It is characterised by high number of drugs per prescription, high rate of antibiotic usage and unscientific prescription by doctors. There is a need for further education and research on rational drug use among prescribers in Nigerian military health facilities.

A baseline study of drug prescribing practices in a Nigerian military hospital

BACKGROUND

In many developing countries, drug costs form an important portion of government and household expenditure. Also, improper use of drugs is a major health hazard and increases treatment costs. However, while the problem of irrational use of drugs is worldwide, it has not been adequately studied especially in developing countries such as Nigeria. Military facilities provide health care services to an important segment of both the military and civil population.

METHODS

The aim of this study was to evaluate drug prescribing practices at a Nigerian military hospital (Military Hospital, Ikoyi, Lagos) and to make recommendations for its improvement. Using WHO rational drug use (RDU) criteria, prescribing and facility care indicators were studied using case notes of general out patients seen between March 2006 and February 2007. Also, a knowledge, attitude and practice (KAP) study of prescribers and dispensers at the hospital to complement the study of indicators was also undertaken.

RESULTS

Based on systematic sample of 180 case notes collected over the study period, the average number of drugs per encounter was higher (3.0 +/- 1.5) than other African values. Also, 43.8% of drugs were prescribed using their generic names which is low. A high number of patients were prescribed antibiotics (27.8%) and injections (23.9%). From the KAP study of 29 respondents, only one (3.4%) was not aware of the existence of the Essential Drug List (EDL) while 50.0% claimed ownership of a copy of the EDL. Few (13.9%) respondents, could accurately detail the 5 steps in issuing a prescription.

CONCLUSION

This study revealed gaps between the actual level of knowledge of prescribers/dispensers about RDU and actual practice. The need for further studies and focused interventions are outlined.

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 Nigeria's 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.

Congenital bilateral fusion of the maxillomandibular alveolar processes with craniosynostosis: report of a rare case

A rare congenital anomaly of maxillomandibular fusion with pectus excavatum and craniosynostosis in a neonate is presented. The child was kept alive by nasogastric tube feeding. A modification of classification of syngnathia is proposed. The aetiopathogenesis and difficulty in management in our environment are discussed.

Non-syndromal, true congenital ankylosis of the temporomandibular joint: a case report

A case of a six-week old boy with bilateral congenital fibrous intra-articular ankylosis of the temporomandibular joint is presented The literature is reviewed and limitations to management are highlighted.

A survey of temporomandibular joint dislocation: aetiology, demographics, risk factors and management in 96 Nigerian cases

A retrospective study of 96 cases of temporomandibular joint dislocation was undertaken. Patients' ages ranged from 9 to 85 years (mean+/-SD, 35.3+/-17.4 years) and peak incidence was at 20-29 years. Mean duration was 7.9 weeks (range, 1h to 3 years). Acute, chronic and recurrent dislocations were seen in 46 (47.9%), 29 (30.2%) and 21 (21.9%) patients, respectively. Males dominated in all three categories but this was not statistically significant (P = 0.8). Excessive mouth opening while yawning (44 cases) was the commonest cause of dislocation, followed by road traffic accidents (13 cases). Ten patients (10.4%) had an underlying systemic disease, the commonest being epilepsy (four cases); those with acute dislocation recorded the highest incidence of underlying illness. Bilateral anterior (86 cases) dislocations were the most frequent. Of the 96 patients, 89 (92.7%) were available for treatment. Manual reduction with or without anaesthesia proved effective for 38/45 acute, 5/24 chronic and 14/20 recurrent cases. Chronic dislocations were treated mainly by surgical osteotomy (13/24). Vertical subsigmoid and oblique ramus osteotomies were the commonest surgical techniques recorded. Treatment was satisfactory for all patients surgically handled except for one case of anterior open bite postoperatively. This study has shown that excessive mouth opening while yawning is the commonest cause of temporomandibular joint dislocation in Nigerians, and conservative approaches to management remain quite effective irrespective of the duration and clinical subtype. The best choice of surgical technique should be determined by proper clinical evaluation and the need to avoid or minimize postoperative morbidity.

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.

Tumours and tumour-like lesions of the oral and perioral structures of Nigerian children

One hundred and fifty-eight children less or equal to 15 years were isolated from a retrospective 20-year (1979-1998) survey of oral and perioral tumours and tumour-like lesions in Nigeria. These children represent 16.8% of the cases seen. Lesions of children less or equal to 15 years were benign non-odontogenic (n = 70, 44.3%), benign odontogenic (n = 41, 25.9%) and malignant (n = 47, 27.7%). Predominantly Children between 11 and 15 years (n = 89, 56.3%) were afflicted and the male to female ratio was 1.4 to 1.0. Sites recorded were the jawbones, cheeks, gingival, forearm, testis and the spleen. The ratio of malignant lesions in Nigerian and African children appears to be higher than in the Caucasian population (2.4:1).