Odontogenic tumors in Nigerian children and adolescents- a retrospective study of 92 cases

BACKGROUND: Tumours arising from odontogenic tissues are rare and constitute a heterogenous group of interesting lesions. The aim of this study was to determine the relative frequency of odontogenic tumors (OT) among Nigerian children and adolescents 19 years or younger. PATIENTS AND METHODS: The histopathology records were retrospectively reviewed for all the tumors and tumor-like lesions of the oral cavity and the jaws seen in children and adolescents ≤ 19 years seen between January 1980 and December 2003. Hematoxylin and eosin-stained sections were re-evaluated and the diagnosis in each case was confirmed or modified according to World Health Organization (WHO) classification, 1992; and were subjected to analysis of age, sex, site of tumor and histopathologic type. RESULTS: A total of 477 tumors and tumor-like lesions were seen in patients ≤ 19 years during the period of the study. Of these, 92 (19.3%) were odontogenic tumors. Benign odontogenic tumors constituted 98.9% of the cases seen, while only 1 case (1.1%) of malignant variety was seen during the period. The mean (SD) age of patients was 14.9 (± 3.1) years (range, 4–19 years). Male-to-female ratio was 1:1; and mandible-to-maxilla ratio was 2.7:1. OT's were most frequently seen in patients aged 16–19 years (46.7%) and the least number (2.2%) were found in patients aged 0–5 years. Among nine histologic types of OT seen, ameloblastoma (48.9%), adenomatoid odontogenic tumor (19.6%) and odontogenic myxoma (8.7%) were predominant. Multicystic/solid and unicystic variants of ameloblastoma were diagnosed in 40 (89%) and 5 (11%) cases respectively. CONCLUSIONS: Odontogenic tumors are relatively common in children and adolescents in Nigeria. One out of every 5 children and adolescents with tumors and tumor-like lesions of oral cavity and the jaws seen in this study had a diagnosis of odontogenic tumor

Novel <i>IRF6 </i>mutations in families with Van Der Woude syndrome and popliteal pterygium syndrome from sub-Saharan Africa

Orofacial clefts (OFC) are complex genetic traits that are often classified as syndromic or nonsyndromic clefts. Currently, there are over 500 types of syndromic clefts in the Online Mendelian Inheritance in Man (OMIM) database, of which Van der Woude syndrome (VWS) is one of the most common (accounting for 2% of all OFC). Popliteal pterygium syndrome (PPS) is considered to be a more severe form of VWS. Mutations in the IRF6 gene have been reported worldwide to cause VWS and PPS. Here, we report studies of families with VWS and PPS in sub-Saharan Africa. We screened the DNA of eight families with VWS and one family with PPS from Nigeria and Ethiopia by Sanger sequencing of the most commonly affected exons in IRF6 (exons 3, 4, 7, and 9). For the VWS families, we found a novel nonsense variant in exon 4 (p.Lys66X), a novel splice-site variant in exon 4 (p.Pro126Pro), a novel missense variant in exon 4 (p.Phe230Leu), a previously reported splice-site variant in exon 7 that changes the acceptor splice site, and a known missense variant in exon 7 (p.Leu251Pro). A previously known missense variant was found in exon 4 (p.Arg84His) in the PPS family. All the mutations segregate in the families. Our data confirm the presence of IRF6-related VWS and PPS in sub-Saharan Africa and highlights the importance of screening for novel mutations in known genes when studying diverse global populations. This is important for counseling and prenatal diagnosis for high-risk families

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

Hemodynamic response after injection of local anesthetics with or without adrenaline in adult Nigerian subjects undergoing simple tooth extraction

Objective: This study was conducted to determine the changes in the blood pressure (BP) and the pulse rate (PR) of normotensive patients having dental extraction under the administration of 2% lignocaine local anesthetic with or without adrenaline. Materials and Methods: This prospective study was carried out on 325 consecutive normotensive patients who presented at the exodontia clinic of the Lagos University Teaching Hospital (LUTH), Lagos, Yoruba State, Nigeria from December 2004 to August 2005 for simple tooth extraction. The patients were randomly allocated into two groups according to the type of anesthetic solution employed. Group A had tooth extraction done under the administration of 2% lignocaine with adrenaline (1:80,000) while group B had tooth extraction done under the administration of 2% lignocaine local anesthetic without vasoconstrictor (plain lignocaine). Each patient had single tooth extracted. The following parameters were monitored in each of the surgical interventions: systolic blood pressure (SBP), diastolic blood pressure (DBP), and PR. Measurements were taken in the waiting room before surgery, during the surgery after local anesthesia, during tooth extraction, and 15 min after tooth extraction. Results: The sample consisted of 176 females and 149 males. Age range of the patients was 18-89 years with the mean age of 35.08 ± 15.60 years. The hemodynamic responses to lignocaine with adrenaline (1:80,000) and plain lignocaine essentially follow the same pattern in the study. There was no statistically significant difference between the measured parameters in the two groups after the administration of local anesthetics. Conclusion: This study, therefore, shows that there was no difference in the hemodynamic changes observed with the use of lignocaine with adrenaline or plain lignocaine during a simple tooth extraction in healthy adults

Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients

Background: The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV‑related oral lesions in paediatric Nigerian patients on HAART with those not on HAART. Materials and Methods: All patients aged 15 years and below attending the Infectious Disease Clinic of Aminu Kano Teaching Hospital with a diagnosis of HIV were consecutively examined in a cross‑sectional study over a 2‑year period. Information was obtained by history, physical examinations, HIV testing, and enumeration of CD+ T cells. The results are presented. A P‑value of &lt;0.05 was considered significant. Results: A total of 105 children comprising 63 males and 42 female who met the inclusion criteria participated in the study, mean age in months was 53.3±42.2, with a mean of 3.4±2.2 for male and 2.8±1.8 for female respectively. Oral lesions occurred in 61.9% of the children Overall, 22 (21.0%) had at least one oral lesion, 43 (41.0%) had multiple lesion. The most common lesion was oral candidiasis (79.1%). The angular cheilitis (43.8%) variant was most frequent. The mean CD4 counts were 1138 cells/mm3, 913 cells/mm3 and 629 cells/mm3 for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA: F=0.185, df=2, 80, 82, P=0.831. Patients on HAART comprised about 61.9% and these were found to have reduced risk for development of such oral lesions as angular cheilitis (OR=0.76; 95% CI=0.56‑1.02; P=0.03), pseudomembranous candidiasis (OR=0.71; 95% CI=0.54‑0.94; P=0.024) and HIV‑gingivitis (OR=0.59; 95% CI=0.46‑0.75; P=0.001). HAART had some beneficial but insignificant effect on development of HIV‑periodonttitis (OR=0.60; 95% CI=0.51‑0.70; P=0.09). The chances of occurrence of other oral lesions were not significantly reduced by HAART (Kaposi sarcoma, OR=1.24; 95% CI=0.31‑5.01; P=0.47, erythematous candidiasis, OR=1.13; 95% CI=0.62‑2.06). Conclusion: HIV‑related Oral lesions are frequently seen in HIV‑infected Nigerian children. Paediatric patients receiving HAART had significantly lower prevalence of oral lesions, particularly oral candidiasis and HIV‑gingivitis.Keywords: HIV/AIDS, Nigeria, oral manifestations, paediatricsNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 201

Frequency of homologous blood transfusion in patients undergoing cleft lip and palate surgery

Aim: The study aims to determine the frequency of homologous blood transfusion in patientsundergoing cleft lip and palate surgery at the Lagos University Teaching Hospital, Nigeria. Setting and Design: A prospective study of transfusion rate in cleft surgery conducted at the Lagos University Teaching Hospital, Nigeria. Material and Methods: One hundred consecutive patients who required cleft lip and palate surgery were recruited into the study. Data collected included age, sex and weight of patients, type of cleft defects, type of surgery done, preoperative haematocrit, duration of surgery, amount of blood loss during surgery, the number of units of blood cross-matched and those used. Each patient was made to donate a unit of homologous blood prior to surgery. Results: There were 52 females and 48 males with a mean age of 64.4 &#177; 101.1 months (range, 3-420 months). The most common cleft defect was isolated cleft palate (45&#x0025;) followed by unilateral cleft lip (28&#x0025;). Cleft palate repair was the most common procedure (45&#x0025;) followed by unilateral cleft lip repair (41&#x0025;). The mean estimated blood loss was 95.8 &#177; 144.9 ml (range, 2-800ml). Ten (10&#x0025;) patients (CL=2; CP=5, BCL=1; CLP=2) were transfused but only two of these were deemed appropriate based on percentage blood volume loss. The mean blood transfused was 131.5 &#177; 135.4ml (range, 35-500ml). Six (60&#x0025;) of those transfused had a preoperative PCV of &lt; 30&#x0025;. Only 4.9&#x0025; of patients who had unilateral cleft lip surgery were transfused as compared with 50&#x0025; for CLP surgery, 11&#x0025; for CP surgery, and 10&#x0025; for bilateral cleft lip surgery. Conclusions: The frequency of blood transfusion in cleft lip and palate surgery was 10&#x0025; with a cross-match: transfusion ratio of 10 and transfusion index of 0.1. A "type and screen" policy is advocated for cleft lip and palate surgery

Van der Woude syndrome: A review of 11 cases seen at the Lagos University Teaching Hospital

Background: Van der Woude syndrome (VWS), an autosomal dominant condition associated with clefts of the lip and/or palate and lower lip pits and is caused by mutations in interferon regulatory factor six gene. It is reported to be the most common syndromic cleft world-wide. Non-penetrance for the lip pit phenotype is found in at least 10% of affected individuals and those without the pits are phenocopies for non-syndromic clefting. The aim of this study is to present the phenotypic characteristic of VWS seen at the Lagos University Teaching Hospital (LUTH) cleft clinic. Materials and Methods: A review of cases of patients with VWS that attended the cleft lip and palate clinic at the LUTH Idi-Araba, Lagos, from January 2007 to December 2012 was conducted. Data analyses included sex of affected patients, types of cleft, presence of lower lip pits and history of lower lip pits/cleft in the family. Results: A total of 11 cases were seen during the period (male = 4; female = 7). Age at presentation ranged between 1 week and 12 years, with majority (n = 10) less than 2 years of age. Bilateral cleft lip and palate (BCLP) was seen in six patients, isolated soft palatal cleft (n = 3) and unilateral cleft lip and alveolus (n = 1) and cleft of hard and soft palate (n = 1). Bilateral lower lips were presented in 10 out of the 11 cases. The mother of the only patient without lip pits presented with bilateral lower lip pits. No family history of cleft/lip pits was elicited in 10 other cases. Conclusion: Most of the cases of VWS presented with BCLP and lower lip pits. Non-penetrance for the lip pits was seen in one out of 11 cases. Our study emphasizes the need to screen family members in all cleft cases, especially clinically diagnosed non-syndromic cases who may be VWS with no lip pits. Future studies are required to investigate the genetic causes of this syndrome in our population