Mercury hygiene and biomedical waste management practices among dental health-care personnel in public hospitals in Lagos State, Nigeria

BACKGROUND

Indiscriminate disposal of hospital wastes including mercury/amalgam wastes pose a serious threat to life and environment. There is a growing concern about biomedical waste (BMW) management among health care workers, however there are limited reports on BMW management by dental personnel in developing countries.

OBJECTIVES

This study investigated the level of knowledge of BMW, observance of proper mercury hygiene and BMW management practice among public dental personnel in Lagos State, Nigeria.

METHODS

A cross-sectional study regarding BMW management across public hospitals in Lagos State, Nigeria was conducted following institutional ethics committee approval. A self-administered questionnaire was utilized to obtain data from different facilities selected by purposive and simple random sampling techniques as applicable. The questionnaires were distributed among 437 respondents by convenience sampling. The resulting data were statistically tested using Chi-square and G-test with p-value < 0.05 indicating significant level.

RESULTS

Amongst 437 respondents, majority were females (62.5%) and the highest proportion fell within the age range of 25-34 years (44.4%). Only 17.2% of the respondents had good knowledge of BMW management/legislation and 4.1% had good BMW practice. Less than half (49.4%) of respondents disposed mercury-contaminated materials inside the trash and majority (92.2%) did not observe proper mercury hygiene. Significantly better mercury hygiene practices were observed in secondary facilities (p=0.040).

CONCLUSION

A minor proportion of public dental personnel had good knowledge and practice of proper mercury hygiene and BMW management. This shows there is an urgent need for training of health personnel on proper BMW handling and disposal in developing countries like Nigeria.

Dermatofibrosarcoma protuberans: clinicopathologic presentation in Nigerians

Introduction

Dermatofibrosarcoma protuberance (DFSP) is in general a rare low grade malignant sarcoma and possesses a tendency for local recurrence. It has a site predilection for the trunk. Occurrence in the facial area is extremely rare. Ample knowledge of its clinical, histological and biologic characteristics is vital for accurate and prompt recognition.

Methods

Over 13 years, clinicohistologic information of cases was retrieved. Histological and immunohistochemical re-evaluation were performed to re-confirm diagnosis. Data collected and analyzed with SPSS Statistics version 20 were presented as frequency tables, charts and proportions as appropriate.

Results

Of 191 soft tissue sarcomas, a total of 28 cases were diagnosed as DFSP (14.7%). Facial types occurred in 3 cases (1.6%). Tumour had age and site predilections for the 4^th decade and trunk respectively. There was an equal gender distribution among cases. Most common clinical presentation was in form of painless protruding nodular mass. General histologic presentation revealed cellular lesions composed of spindle to oval neoplastic cells arranged in a storiform pattern. Mitotic figures were rare. All cases showed positive expressions to CD34.

Conclusion

Facial DFSP is rare among Nigerians. Its clinical appearance may mimic other common benign lesions of the head and neck region often resulting in misdiagnoses. A comprehensive knowledge of its clinical and histologic presentations and biologic behavior, combined with its identification with the aid of advanced histologic and radiographic techniques results in prompt confirmatory diagnosis. Appropriate treatment should include adequate surgical excision techniques combined with adjuvant radiotherapy or chemotherapy.

A comparative clinical evaluation of the effect of preoperative and postoperative antimicrobial therapy on postoperative sequelae after impacted mandibular third molar extraction

OBJECTIVES

To compare the effect of preoperative and postoperative antibiotics therapy on postoperative sequelae after impacted mandibular third molar extractions.

MATERIAL AND METHODS

This was a prospective study conducted at Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospitalon consecutive patients with impacted third molar extractions for a 12 month period. Group I (n = 31) had administration of 1 gram of oral metronidazole and 1 gram of amoxicillin capsules 30 minutes preoperative and Group II (n = 31) had 500 milligrams of amoxicillin capsule 8 hourly and 400 milligrams of metronidazole tablets administered post operatively for 5 days. Pain, facial swelling and mouth opening assessment were done postoperatively and on days 1, 3 and 7.

RESULTS

The general pattern of postoperative pain, regardless of antimicrobial use revealed that pain increased from day 1 to day 3 postoperatively and began to decrease in intensity subsequently up to the seventh day. There was however a statistically significant difference (P = 0.0001) between the two groups on the 7th postoperative day with the subjects in Group I showing lower pain intensity. The mean difference of the facial width on days 1 and 3 was significant (P = 0.04 and P = 0.0001 respectively) with subjects in Group II having a reduced facial width compared to those in Group I.

CONCLUSIONS

This study suggested that the administration of preoperative or postoperative antibiotics showed no marked differences in the degree of postoperative sequaele that occur after impacted mandibular third molar extractions.

Prospective, randomized, open-label, pilot clinical trial comparing the effects of dexamethasone coadministered with diclofenac potassium or acetaminophen and diclofenac potassium monotherapy after third-molar extraction in adults

BACKGROUND

Patients who experience pain, swelling, and trismus after third-molar extraction are reported to experience a 3-fold higher rate of adverse effects (AEs) on quality of life compared with those who are asymptomatic after this surgery. Therefore, investigators emphasize the necessity for better control of this triad of sequelae. Steroids can reduce the risk for physiologic processes of inflammation, thereby suppressing the development of inflammation.

OBJECTIVE

The aim of this study was to compare the effects of dexamethasone 8 mg IM and diclofenac potassium (K) 50 mg PO, dexamethasone 8 mg IM and acetaminophen 1000 mg PO, and monotherapy with diclofenac K 50 mg PO on postoperative pain, swelling, and trismus after surgical removal of third molars.

METHODS

This prospective, randomized, open-label pilot study was conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos, Nigeria. Patients were randomly allocated to 1 of 3 treatment groups: concomitant treatment with dexamethasone 8 mg IM and diclofenac K 50 mg PO or acetaminophen 1000 mg PO, or monotherapy with diclofenac K 50 mg PO. Overall analgesic efficacy of the drug combinations was assessed for 7 days postoperatively using a 4-point categorical pain-intensity rating scale (0 = no pain; 1 = mild pain; 2 = moderate pain; and 3 = severe pain). Facial swelling was measured in 1 dimension on days 1, 2, and 7 after surgery using a tape measure placed from the tip of the tragus, to gonion, to the tip of the contralateral tragus, and trismus was assessed using interincisal mouth-opening ability, measured using a vernier-calibrated caliper on postoperative days 1, 2, and 7. Tolerability was assessed using direct questioning of the patients at follow-up visits.

RESULTS

A total of 150 patients (50 per treatment group) were included in the analysis (76 women, 74 men; mean [SD] age, 26.8 [5.04] years [range, 18-45 years]; 100% Nigerian). The proportion of patients reporting no pain on the pain-intensity rating scale was significantly higher in the group receiving dexamethasone and diclofenac K compared with that in the groups receiving dexamethasone and acetaminophen or diclofenac K monotherapy (44% vs 22% and 24%, respectively; both, P < 0.05). Facial swelling was significantly less with dexamethasone and diclofenac K or dexamethasone and acetaminophen compared with diclofenac K alone (day 1: P = 0.013 and P = 0.011, respectively; day 2: P = 0.002 and P = 0.004, respectively). However, trismus relief was statistically similar between the 3 treatment groups on postoperative days 1 and 2. No AEs or complications were recorded.

CONCLUSION

In this open-label pilot study, concomitant treatment with dexamethasone and diclofenac K provided significant relief of postsurgical pain and swelling compared with dexamethasone and acetaminophen or monotherapy with diclofenac K after third-molar extraction in these patients.

A classification system for recurrent ameloblastoma of the jaws--review of 30 cases in Nigerians

This paper reviewed the clinicopathologic presentation of recurrent ameloblastoma in 30 Nigerian patients at three tertiary referral centers with the sole objective of developing a classification system. Most recurrences occurred in patients in their 3rd decade of life (20-29years) and males were more frequently affected than females (1.5 to 1). Though enucleation resulted in the highest rate of recurrences (30%), hemi-mandibulectomy also resulted in a 20% recurrence rate. Majority of the recurrences occurred within 5 to 9 years after primary surgery. Most primary jaw sites of the lesion corresponded with the primary jaw sites of the recurrent tumor which in itself may be a reflection of inadequate primary treatment. The most frequent anatomic site of primary tumors that recurred was c4 (highest level of ramus involvement). The most frequent anatomic classification of the recurrent tumors was recurrence at one bone margin (Bla) and recurrence at intervening /adjacent soft tissues between the resected bone edges (Blc). Mandible to maxilla recurrence increases the likelihood of extension to the skull and brain.

Biologic, anatomic and clinical considerations in the management of the classic intraosseous ameloblastoma of the jaws

This paper reviews the types of surgical and nonsurgical treatment modalities that have been used to treat the classic intraosseous ameloblastoma of the jaws. The clinical, anatomic and biologic factors that may influence the clinicians' selection of a particular treatment modality were highlighted. Surgeons should be aware of these different modalities if they are to formulate a surgical treatment plan that is individualised to fit different clinical situations.

Knowledge and practice of alternatives to the conventional inferior dental block amongst dentists in Lagos

BACKGROUND

The conventional inferior alveolar nerve block (IANB) has been used for mandibular anaesthesia for many years. It is associated with a number of complications including failure of anaesthesia. Alternative techniques were therefore developed for the mandibular anaesthesia.

OBJECTIVE

This study is to evaluate the knowledge and practice of alternatives to the conventional inferior alveolar nerve block (IANB) amongst dentist in government owned hospitals in Lagos, Nigeria.

METHODS

Self administered questionnaires to assess the knowledge and practice of alternatives to the conventional inferior dental block for mandibular anaesthesia were sent to dentists in clinics situated in General hospitals and Teaching hospitals in Lagos. The information recorded included demographics (age and sex), institution of practice, and length of practice. The knowledge and practice of alternatives to the conventional IANB were also recorded.

RESULTS

Of the 90 questionnaires sent out, only 66 (73.3%) were returned. Most respondents 43 (65.5%) practiced in the tertiary institutions. All respondents used the conventional IANB as their primary technique. Difficulty to achieve anaesthesia due to trismus 22 (34.4%) and pain on injection 20 (32.3%) were the most common complications/difficulty associated with the IANB. Forty (60.6%) of the respondent practiced the Akinosi/Varzirani technique (AVT) as a secondary technique while only 1 had ever attempted the Gow-Gate technique (GGT). Both the knowledge and practice of the alternative techniques had a statistically significant relationship to both formal training and primary training institution (P < 0.05).

CONCLUSION

Formal training in the use of alternative techniques to the IANB in achieving mandibular anaesthesia was a very important factor that determined the practice and knowledge of these techniques. Although the IANB was still the primarychoice for all of our respondents, there are claims by a lot of the respondents that with more formal training the alternatives will used more regularly.

The sensitivity, specificity and accuracy of fine needle aspirational cytology in the diagnosis of oro-facial neoplasms at Lagos University Teaching Hospital, Nigeria

OBJECTIVE

The aim of the study is to compare the efficacy of fine needle aspirational cytology (FNAC) with open surgical biopsy in the diagnosis of orofacial tumours in patients seen at the Dental Centre of Lagos University Teaching Hospital from May 2005-May 2006.

PATIENTS AND METHODS

Fine needle aspiration was performed on all patients scheduled for open surgical biopsy at the Oral and Maxillofacial clinic of the hospital before the open surgical biopsy was done. Forty six patients whose final histological diagnoses were oro-facial neoplasms were involved in this study. Sensitivity, specificity and accuracy for fine needle aspirational cytology were calculated.

RESULTS

The sensitivity, specificity and accuracy of fine needle aspirational cytology in the diagnosis of oro-facial tumours were 95%, 95.8% and 95.5%, respectively. The false positive and false negative rates were 5% and 4.2%, respectively.

CONCLUSION

The high sensitivity, specificity and accuracy of fine needle aspirational cytology reported in this preliminary study suggest that the test may have a place in the management of oro-facial tumours. However, when the result of fine needle aspirational cytology is not in agreement with the clinical diagnosis, especially in suspected malignancy, open surgical biopsy should be performed.

The role of preoperative and intraoperative variables in predicting post operative complications after impacted mandibular third molar exodontia

OBJECTIVES

The aim of this prospective study was to investigate the role of pre and Intra operative variables in predicting postoperative complications after removal of impacted Mandibular third molars.

PATIENTS AND METHODS

87 patients who required 90 surgical extractions of impacted Mandibular teeth were involved in the study. Radiological and clinical data were taken preoperatively. Intra operative difficulty and complications were recorded. Postoperative complications were also recorded.

RESULTS

Increasing body mass index (BMI), depth from point of elevation and occlusal level of teeth were significantly associated (P < 0.05) with the occurrence of postoperative complications. The Intra operative difficulty and Intra operative complications were both statistically significantly associated with postoperative complications (P < 0.05).

CONCLUSIONS

The BMI, depth of point of elevation and occlusal level of teeth are important preoperative predictors of postoperative complications. Also important are the frequency of intra operative complication and the duration of surgery in the removal of impacted teeth. Specific intra operative complications were however not as helpful in predicting specific postoperative complications in this study.

Miniplate osteosynthesis of mandibular fractures at the Lagos University Teaching Hospital

OBJECTIVE

To report the clinical outcome of the treatment of mandibular fractures with miniplate osteosynthesis alone, at Lagos University Teaching Hospital (LUTH).

METHOD

30 patients who presented with 41 mandibular fractures at the Lagos University Teaching Hospital between May 2005 and June 2006 were selected for treatment with miniplate osteosynthesis according to the principles of Champy et al. They were grouped according to the time lapsed from injury to treatment as: early (< 24 hours), delayed (> 24 hours - < 7 days) and "late" (> or = 7 days) osteosynthesis groups. Data collected included: age and gender distribution, the aetiology of trauma, site of fractures, pre and postoperative body weight and interincisal distance and postoperative complications.

RESULTS

Only 28 of the 30 selected patients received miniplate osteosynthesis and were therefore included in the final analysis. In 25 of these patients (89%) miniplate osteosynthesis without maxillomandibular fixation (MMF) was used. In 3 patients (11%), supplementary MMF was combined with miniplate osteosynthesis. The male - female ratio was 5:1 and the most frequently affected age group was the 20 - 29 years age group (53%). The most frequent cause of fracture was fight and assault. The body of the mandible was the most fractured site. 14 patients (50%) each were classified as delayed and "late" osteosynthesis respectively. The time lapsed before patients attained a postoperative mouth opening of 35mm was 5 weeks while it took 6 weeks to regain lost weight. 46.4% of the patients had postoperative complications; the most frequent complication was malocclusion (23.3%). Patients in the late osteosynthesis group had a higher complication severity score (2.3) than those in the delayed osteosynthesis group (1.5).

CONCLUSION

This study suggests that most of the mandibular osteosynthesis in our environment would be delayed or "late" and would develop higher complication rate.

Minor salivary gland tumours in a Nigerian hospital: a retrospective review of 146 cases

PURPOSE

This is a retrospective study of the location, diagnosis, sex and age distribution and treatment of minor salivary glands tumours of the upper aero digestive tract in Lagos, Nigeria.

MATERIAL AND METHODS

Case files and radiographs of patients treated over a 24-year period were reviewed.

RESULTS

These tumours constituted 40.4% of all salivary gland tumours in the series. The majority (62.3%) of these tumours was malignant, and the most common malignant tumour was mucoepidermoid carcinoma (19.2%). However, pleomorphic adenoma (34.2%) was the most common tumour overall. Both benign (67.2%) and malignant (23.9%) tumors were most frequently located in the palate. Both sexes were equally affected (Male-female ratio 1 to 1), but a higher proportion of benign tumours were found in the palate of females (75%) than their male counterparts (64%). Patients with adenoid cystic carcinoma were significantly older at presentation than those with pleomorphic adenoma and adenocarcinoma (P < 0.05).

CONCLUSION

These findings show that majority of these tumours were malignant (62.3%), though pleomorphic adenoma was the most common tumour. They also confirm the high predilection of pleomorphic adenoma (61.8%) for the palate of Black Africans.

Assessment of factors associated with surgical difficulty in impacted mandibular third molar extraction

PURPOSE

The aim of this prospective study was to investigate radiologic and clinical factors associated with increased difficulty in the removal of impacted mandibular third molars. We also aimed to form an index to measure the difficulty of removal of the impacted molars preoperatively.

PATIENTS AND METHODS

A total of 87 patients who required 90 surgical extractions of impacted mandibular third molars from November 2003 to May 2004 were involved in the study. Radiologic and clinical data were taken preoperatively. All extractions were performed under local anesthesia by a single operator. Surgical difficulty was measured by the total intervention time.

RESULTS

Increased surgical difficulty was associated with increasing age and body mass index. It was also associated with the curvature of roots of the impacted tooth and the depth from point of elevation (P < .05).

CONCLUSION

Both clinical and radiologic variables are important in predicting surgical difficulty in impacted mandibular third molar extractions.

Impacted mandibular third molars: Presentationn and postoperative complications at the Lagos University Teaching Hospital

AIM

Surgical extraction of impacted Mandibular third molar is one of the commonest dentoalveolar surgeries. This study aims to investigate the pattern of presentation of impacted Mandibular third molars, the indications for extraction and the post operative complications after this procedure at the Lagos University Teaching Hospital.

PATIENTS AND METHODS

A prospective study of patients who required surgical extraction of impacted Mandibular third molars between October 2003 and May 2006 at the Lagos University Teaching Hospital (LUTH) was carried out. Data collected included Patients' age, sex, indication for extraction, tooth/teeth extracted. Also collected were the types of impactions and surgical morbidity (postoperative complications). The data collected were evaluated using the SPSS for windows (version 11.0: SPSS Inc, Chicago, IL) descriptive analysis was used as appropriate.

RESULTS

Three hundred and thirty one (331) Mandibular third molars were extracted from 329 patients. The ages ranged from 17 to 55 years with a mean of 26.63 (+/- 7.39). There were 153 males and 176 females; with male to female ratio was 1:1.15. Recurrent Pericoronitis was the most common indication for extraction (209 extractions; 63.1%), while the mesioangular impaction was the most common angulation (117 impactions; 53.4%). 47 (14.2%) of the extractions had postoperative complications and dry socket which occurred in 25 (53.2%) cases was most common.

CONCLUSION

The pattern of presentation of impacted Mandibular third molars is similar to earlier reports. The morbidity is however higher than the average value in the literature, it however does not seem to increase with increasing age.

Malignant orofacial neoplasms in children and adolescents: a clinicopathologic review of cases in a Nigerian tertiary hospital

OBJECTIVE

The aim of the study was to determine the relative frequency of orofacial malignant neoplasm in children and adolescents.

METHODS

A retrospective review of malignant orofacial tumours in children and adolescents <or=19 years from January 1992 to December 2003 from the records of the Department of Oral Pathology and Biology of the Lagos University Teaching Hospital, Nigeria was carried out. All the cases were analysed for age, gender, site distribution and histologic types.

RESULTS

A total of 353 tumours and tumour-like lesions of the orofacial region were seen in patients <or=19 years during the period of the study. Of these, 47 (13.3%) were malignant tumours. This represented 3.3% (47 out of 1431) of all the tumours and tumour-like lesions seen during the period. The mean age (S.D.) of patients was 11.0 (+/-4.5) years (range, 2.5-19 years). Male-to-female ratio was 2.9:1. Burkitt's lymphoma (38.3%) was the most frequent malignant tumours. Lymphomas (53.2%) were the most common malignancy, followed by sarcomas (36.2%) and carcinomas (10.6%). Carcinomas exclusively affected patients in the 2nd decade of life and were predominantly glandular carcinomas. Osteosarcoma and rhabdomyosarcoma were the most common sarcomas. Burkitt's lymphoma (72%) occurring mostly in the first decade of life was the most common lymphoma.

CONCLUSIONS

Malignant neoplasm constituted 13.3% of orofacial tumours and tumour-like lesions in children and adolescent in our centre. In agreement with previous reports from Africa, Burkitt's lymphoma is the most common malignant tumour and carcinoma is relative rare in this age group.

Primary malignant neoplasms of orofacial origin: a retrospective review of 256 cases in a Nigerian tertiary hospital

A retrospective review of cases histologically diagnosed as malignant lesions of the orofacial region in 1992-2003 from the records of the Department of Oral Pathology and Biology, Lagos University Teaching Hospital, Nigeria was carried out. All cases were subjected to analysis of age, gender, site distribution and histologic types. Malignant tumours constituted 18% of all the biopsies of orofacial lesions seen within the period. The mean age of patients was 42.2+/-21.5 years (range: 2.5-85). There were 177 (69%) epithelial tumours of which squamous cell carcinoma was predominant, 47 (18%) sarcomas and 32 (13%) lymphomas. Squamous cell carcinoma (44%) was the most common malignant orofacial tumour. Osteosarcoma (32%) and Burkitt's lymphoma (56%) was the predominant sarcoma and lymphoma, respectively. Patients with a histologic diagnosis of carcinoma were older than those with sarcomas and lymphomas (P<0.01), and those with a histologic diagnosis of malignant lymphoma were significantly younger than those with sarcomas (P<0.01). Almost 25% of patients with carcinomas were below the age of 40 years. Malignant orofacial tumours are not uncommon in the studied environment, with a sizable proportion of carcinomas occurring before the age of 40 years.

Cultural and religious components in Nigerian parents' perceptions of the aetiology of cleft lip and palate: implications for treatment and rehabilitation

The present study was conducted to find out the perceptions of mothers from two Nigerian ethnic groups who had children with cleft lip and palate (CLP) about the aetiology of the defect. Mothers of 16 children with CLP from the Yoruba ethnic group who attended the maxillofacial clinic of the Obafemi Awolowo University teaching hospital in southern Nigeria and 20 children with CLP from the Hausa/Fulani ethnic group who attended the maxillofacial clinic of the University of Maiduguri teaching hospital in northeastern Nigeria were interviewed over an 8-month period. We used standardised interviews including questions with ethnographic components to allow us to collect information about traditional beliefs about clefts. Interviews were recorded on tape for later analysis. Thirteen of the 16 parents from the Yoruba group attributed the aetiology of CLP to supernatural forces (evil spirits and ancestral spirits), while 16 of the 20 Hausa/Fulani parents attributed it to the "will of God". Twelve of 16 Yoruba parents had consulted traditional healers for treatment before coming to the hospital. Various plants and animal products were used to treat clefts and 10 of the Yoruba parents were referred to the hospital for further treatment by the traditional healers. Cultural and religious factors seem to have an important role in the explanations, labels and treatment that followed the birth of a child with CLP in this environment. There is a need for greater collaboration and sharing of information between modern medical practitioners and traditional healers.

Malignant orofacial neoplasms in Lagos, Nigeria

OBJECTIVES

To analyse general differences in age, gender, anatomic location of the various histological types of malignant neoplasm involving the oral and maxillofacial region at a tertiary referral centre in Nigeria and to compare this with reports in the literature.

DESIGN

Retrospective analysis.

SETTING

A tertiary referral centre in Lagos, Nigeria.

SUBJECTS

All patients with a histological diagnosis of malignancy were included provided the final surgical histology reports as well as the biopsy reports were available for review.

RESULTS

Squamous cell carcinoma (SCCA) with a peak age incidence in the 6th decade of life and a male to female ratio of 1.65 to 1 was the most common cancer (42.8%). Males with SCCA (mean = 48.7 years) were relatively younger than females (mean = 58.8 years). Eighteen percent of patients with SCCA were below 40 years at presentation and males were predominantly affected at a ratio of 5.2:1. Majority of the SCCA (75%) were well/moderately well differentiated. However, in patients below 40 years, 45.9% had poorly differentiated SCCA. The Most commonly affected sites for SCCA were the maxillary antrum (36.7%), mandibular gingiva/ alveolus (23.0%) and tongue (12.04%). Patients who presented with antral SCCA were relatively younger (mean = 48.9 years) than those who had SCCA involving the mandibular gingiva/ alveolus (mean = 57.1 years) as well as floor of mouth (mean = 56.3 years). Furthermore, males with antral SCCA were younger than their female counterparts. Similarly, males who had mandibular gingiva/ alveolus SCCA (mean = 48.4 years) were younger than their female counterparts (mean = 62.8 years). Majority of the glandular carcinomas (GLDCAs) arose from minor salivary glands (63.0%). Thirty seven per cent of these patients were below 40 years at presentation. Females who had antral GLDCA (mean = 32.4 years) were relatively younger than their male counterparts (mean = 49 years). Most of the patients who presented with sarcoma were below 40 years (77.4%) and males were younger (22. 8 years) than females (mean = 35.4 years).

CONCLUSIONS

The proportion of orofacial cancers that is SCCA in Nigerians is relatively low because of a relatively high proportion of GLDCA and Burkitt's lymphoma. A relatively high proportion of patients with SCCA were below 40 years at presentation. They were predominantly males who presented with poorly differentiated tumours.

Ameloblastoma: analysis of 207 cases in a Nigerian teaching hospital

OBJECTIVE

The aim of the study was to review all the cases of ameloblastoma seen at the Oral and Maxillofacial Surgery Clinic of the Lagos University Teaching Hospital, Nigeria, between 1980 and 2003.

METHODS AND MATERIALS

In this retrospective study, case files and biopsy reports of new cases of ameloblastoma covering a 24-year period were retrieved and analyzed for sex, age on presentation, histologic type, and site distribution.

RESULTS

A total of 207 cases of ameloblastoma were seen in the given period. One hundred and ninety-eight (95.7%) were benign, and 9 (4.3%) were malignant. A male-to-female ratio of 1.1:1 was found. The average ages on presentation for ameloblastoma and ameloblastic carcinoma were 31.67 and 46.44 years, respectively. The lesion was found to be more common in the premolar-molar region of the mandible. The most common histologic type was follicular ameloblastoma (25.1%). Nine (4.3%) cases of ameloblastic carcinoma were also reported.

CONCLUSIONS

Ameloblastoma with a predilection for the posterior mandibular region is relatively common in our environment. Sex and site distributions are similar to previous reports in the literature.

Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery

BACKGROUND

The apparent interactions between the mechanisms of action of non-steroidal anti-inflammatory drugs (NSAIDS) and steroids suggest that co-therapy may provide beneficial inflammatory and pain relief in the absence of side effects. The aim of the study was to compare the effect of co-administered dexamethasone and diclofenac potassium (diclofenac K) with diclofenac K alone on the postoperative pain, swelling and trismus after surgical removal of third molars.

PATIENTS AND METHODS

A prospective randomized double-blind study was conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Nigeria. A total of 100 patients were randomly allocated to two treatment groups of dexamethasone (prophylactic 8 mg and postoperative 4 mg IV) and diclofenac K (50 mg Oral before and after surgery), and diclofenac K alone (as with first group). The overall analgesic efficacy of the drug combinations was assessed postoperatively by determination of pain intensity using a category rating scale. Facial swelling was measured using a tape measure placed from tragus to gonion to tragus, while interincisal mouth-opening of patients was measured using a vernier calibrated caliper pre-operatively and post-operatively.

RESULTS

Co-administration of dexamethasone and diclofenac K was significantly superior to diclofenac alone for the relief of pain (P < 0.05), and facial swelling up to post-operative 48 hour (P < 0.05). However, there was no significant difference for trismus relief between the two medication protocols (P > 0.05).

CONCLUSION

This study illustrates enhanced effects of co-administered dexamethasone and diclofenac K on short-term post-operative pain and swelling, compared to diclofenac potassium alone in third molar surgery.

Odontogenic tumors: A review of 319 cases in a Nigerian teaching hospital

OBJECTIVE

This study sought to determine the relative frequency of odontogenic tumors in a Nigerian population and to compare these data with previous reports.

STUDY DESIGN

Records of patients seen at the Lagos University Teaching Hospital between January 1980 and December 2003, with histologic diagnosis of odontogenic tumors (based on World Health Organisation classification, 1992), were analyzed.

RESULTS

Odontogenic tumors constituted 9.6% of all the biopsies of oral and jaw lesions seen within the period under study. Three hundred and eight (96.6%) were intraosseous, and 11 (3.4%) were peripheral (peripheral odontogenic fibroma=7; peripheral myxoma=3; peripheral ameloblastoma=1). The mean age of patients was 29.9+/-15.6 years (range, 4-85 years). Among these cases, 96.6% of the tumors were benign and 3.4% were malignant. Ameloblastoma with predilection for the mandible was the most frequent odontogenic tumor (63%), followed by adenomatoid odontogenic tumor (AOT) (7.5%), myxoma (6.5%), calcifying epithelial odontogenic cyst (5.3%), and odontogenic fibroma (5.3%). More cases of malignant odontogenic tumors were seen than cases of calcifying epithelial odontogenic tumor and odontomas. The mean ages of patients with AOT, ameloblastic fibroma, and odontoma were significantly lower than those with ameloblastoma ( P<.05). No significant difference was found between the mean ages of patients with benign odontogenic tumors and those with malignant odontogenic tumors ( P=.058).

CONCLUSIONS

Odontogenic tumors, especially ameloblastoma, are not considered rare among Nigerians, whereas odontoma, regarded as the most frequent odontogenic tumor in North and South America, is rare.

Changing picture of facial fractures in northern Nigeria

This was a prospective study that aimed to find out the current pattern of facial fractures in northern Nigeria and to see if changes in the socioeconomic conditions in Nigeria during the past 20-30 years have affected the aetiology, sex and age distribution of the patients, and type of facial fractures. The setting was the maxillofacial unit of the University of Maiduguri Teaching Hospital, which is the only referral centre for facial trauma in north-eastern Nigeria, serving a population of about 30 million people. All 306 patients were treated for facial fracture between January 1996 and December 1999. Most of the patients (126/306, 41%) were in the age range 21-30 years and the male to female ratio was 2.19:1. The main causes of the fractures were assault (n = 147, 48%) followed by road traffic accidents (n = 111, 36%). Other aetiological factors such as falls, and sports or industrial accidents accounted for the remaining cases. Of the assault-related injuries 102 (33%) were the result of armed robbery and 45 (15%) the result of fights, mainly on the farms. The mandible was the most common site of fractures (n = 273, 89%) and most of the mandibular fractures were in the body of the mandible. Only 44/306 patients (14%) reported to the hospital within the first 24 hours after injury. Changing socioeconomic conditions are associated with an increase in assault-related facial fractures, but the predominantly affected age group, sex and site of fracture remain relatively constant.

Plunging ranula: a report of two cases

Plunging ranula, a rare differential diagnosis of cervicofacial masses is presented in two Nigerian patients. The authors highlight the pathophysiology and treatment methods of this condition. It is suggested that clinicians be aware of the various modes of presentation and natural history of the disease to facilitate prompt diagnosis and appropriate treatment.

Malignant neoplasms of the maxillary antrum in Nigerians

OBJECTIVE

To highlight the presentation of antral cancers in Nigerians.

PATIENTS AND METHODS

Hospital records of all patients with a histologically diagnosed antral cancer who presented at the Lagos University Teaching Hospital (a tertiary referral centre) over a 16 year period were analysed.

RESULTS

28.7% of orofacial cancers and 12.6% of head and neck cancers were located in the antrum. 54.1% were squamous cell carcinoma, 27.4% were minor mucus gland carcinoma and 14.8% were mesenchymal cancers. Males were more frequently affected (ratio 1.7 to 1) and were relatively younger (peak age = 4th decade) than females (peak age = 6th decade). Males who had squamous cell carcinoma (x = 47.5 +/- 18.8 years) were relatively younger than their female counterparts (x = 57.2 +/- 13.8 years). But females with minor mucus gland carcinoma were relatively younger (x = 34.2 +/- 19.5 years) than males (x = 49.1 +/- 17.9 years). All patients had facial swelling at presentation and the most frequent initial symptom was toothache (36.2%). Fifty-two percent had prior treatment and the most common was an extraction of a molar tooth (50%). Two-thirds of the patients were of low socio-economic status.

CONCLUSION

Antral cancer constituted sizeable proportion of orofacial and head and neck cancers in Nigerians. Clinicians need to maintain a high index of suspicion in cases of maxillary molar toothache or mobility of obscure aetiology. Predisposing aetiologic factors of this disease peculiar to our environment need to be further investigated.

The adenomatoid odontogenic tumor: an analysis of 57 cases in a black African population

PURPOSE

This study analyzed the findings in a large series of adenomatoid odontogenic tumors (AOT) in Nigerians.

PATIENTS AND METHODS

Hospital records of all cases of AOT diagnosed at three teaching hospitals were reviewed and analyzed.

RESULTS

Most of the tumors were intraosseous (central) (98.3%) and of the follicular type (75%). Females were more frequently affected than males (1.4:1), and patients in their second decade of life were most frequently affected (75%). Patients with follicular AOT were relatively younger (15.2 +/- 5.6 years) than those with extrafollicular tumors (20.9 +/- 13.8 years). However, males who presented with extrafollicular tumors (14.6 +/- 3.9 years) were relatively younger than their female counterparts (24.9 +/- 16 years). The maxilla was affected nearly twice as often as the mandible (1.8:1), and the canine tooth was frequently embedded in the tumor (76.9%). Although follicular tumors were most frequently located in the maxilla (76.3%), extrafollicular tumors were more commonly found in the mandible (69.2%).

CONCLUSION

The distribution of this tumor in black Africans does not appear to be substantially different from that reported in caucasians.

Salivary gland neoplasms in Lagos, Nigeria

This 14 year retrospective clinico-statistical analysis of 237 salivary gland neoplasms in Lagos, Nigeria, was undertaken with a view to providing further insights into the presentation of this disease in Africans. These neoplasms constituted 10.0% of all head and neck neoplasms, and were most frequently situated at the parotid gland (32.1%), the palate (24.9%) and the submandibular gland (19.4%). While parotid squamous cell carcinoma affected more males (41.2%) than females (4.7%) (P = 0.03); parotid mucoepidermoid carcinoma affected more females (53.3%) than males (11.8%) (P = 0.0149). Furthermore, labial salivary gland tumours affected more females (6.8%) than males (1.7%) (P = 0.05). At presentation, patients with palatal tumours were relatively more advanced in age (Peak = 6th decade) than those with parotid and submandibular tumours (Peak = 3rd decade). Males presenting with pleomorphic adenoma were relatively younger than their female counterparts. This is especially true of palatal pleomorphic adenoma. The recurrence rate for benign tumours was 4.8%. Majority of patients with malignant tumours (83.9%) had significant local extension, regional or distant metastasis at presentation. In twenty-nine percent of these patients with cancer, the disease was controlled for 1-5 years of follow-ups. However, a quarter of these patients with cancer defaulted the planned treatment regime because they could not afford the cost of treatment or they opted for traditional medical care.

A study of orofacial tumors in Nigerian children

PURPOSE

This study evaluated the type and distribution of tumors in the orofacial tissues of black African children.

PATIENTS AND METHODS

The hospital records of all patients aged 15 years or younger, who presented at the Lagos University Teaching Hospital (a tertiary referral center) with a histologically confirmed orofacial tumor over a 13-year period were analyzed.

RESULTS

One-fifth of all orofacial tumors during the study period occurred in the pediatric age-group. The male-female ratio was 1.4 to 1 and 11- to 15-year-olds were most frequently affected. Benign tumors (59.8%) were more prevalent than malignant tumors (40.2%). Overall, 18.4% of the tumors were of odontogenic origin, 42.5% were benign nonodontogenic tumors, and 39.1% were malignant nonodontogenic tumors. The anterior part of the mandible was frequently involved by ameloblastoma, which was the most common odontogenic tumor (6.3%). Most of the benign nonodontogenic tumors were of mesenchymal origin (46%), and most were located in soft tissues (59.5%). Burkitt's lymphoma (22.4%) was the most common malignant nonodontogenic tumor.

CONCLUSION

The observed differences in tumor type and distribution in this study compared with previous studies may be attributable to genetic and geographic differences in the populations studied.