Techniques for mandibular block anaesthesia - the practice of Nigerian dentists

Objective: To assess the knowledge and practices of Nigerian dentists in the use of alternative techniques for inferior alveolar nerve block. Method: A survey was conducted using a self administered structured questionnaire distributed among a cross-section of Nigerian dentists. Participants were to distinguish between four alternative methods of mandibular block anaesthesia namely; Gow-Gate block (GGB), Akinosi block (AB), Vazirani block (VB) and Retromolar block (RB). The questionnaire sought demographic information about participants, types of practice, when and how the dentists received formal teaching on these techniques, how often they used the techniques, and the reasons for conventional block failure they have encountered. Result: There were 273 respondents comprising 165 (60.4%) males and 105 (39.6%) females within the age range of 24-56 years (mean 34.4 + 6.8 years). Two hundred and forty nine (91.2%) respondents were aware of alternative methods of achieving IAN block but 45 (16.5%) employed alternative techniques in less than 5% of cases, 57 (20.9%) in 5-10% of cases and 12 (4.4%) in more than 10% of cases. Akinosi block was the preferred alternative (p = 0.045). Most of the alternative techniques were taught without clinical demonstrations. The relationship between years of experience and encounter with conventional block failure on one hand [p = 0.126] and experience and usage of alternative techniques [p= 0.063] were not statistically significant. The common causes of conventional block failure highlighted were aberrant anatomy (76.9%), local infection (67%), uncooperative patients (64.8%), trismus (59.3%) and poor technique (56%). Conclusion: There is a deficiency in the undergraduate curriculum of Nigeria Dental Schools with respect to training in dental anaesthesia. Majority use conventional nerve block routinely while alternative techniques are rarely employed

Paediatric surgical abdominal emergencies in a north central Nigerian centre

Background/objective Paediatric surgical abdominal emergencies (PSAEs) account for 2.4–3.1% of all paediatric admissions. The causes of PSAEs vary worldwide, and the management is challenging, often with unimaginably poor outcome if not carefully handled. The aim of this study was to determine the patterns and factors influencing the outcome of PSAE at a tertiary healthcare centre in Nigeria.Patients and methods The biodata, clinical features, perioperative findings and outcome of management of 100 consecutive children aged up to 12 years with confirmed PSAE were prospectively collected and analysed using SPSS 15.0 software, taking P-value to be < 0.05. Five children who had undergone an initial surgical intervention and those who were discharged against medical advice during care were excluded.Results The 100 children included in this study constituted 38.3% and 3.4% of the total paediatric surgical operations and paediatric admissions that took place during the study period, respectively. Their mean age was 4.6 ±0.469 years, and the male-to-female ratio was 2.5 : 1. About 64% of patients presented within the first 5 days of onset of symptoms with abdominal pain/distension and/or vomiting as chief complaint. Fourteen (63.7%) of patients with perforated typhoid ileitis presented after a week, whereas 10% presented with the same symptoms after 2 weeks. Mechanical intestinal obstruction was the most common cause of PSAE among neonates and infants, whereas peritonitis was the main presenting cause in late childhood (7–12 years). Only 54 patients underwent surgical intervention within 24 h of presentation. Twenty-four (24%) patients underwent surgical intervention after 48 h. The main causes of delay for surgical intervention were hospital logistics in 58 patients and lack of funds to procure drugs and consumables in nine patients. The overall median hospital stay was 10 days. Eighty-nine (89%) patients were discharged, whereas 11 (11%) died. Mortality was significantly higher in neonates and infants (P = 0.016) and in those with peritonitis (P = 0.008).Conclusion PSAE constitutes a large percentage of the paediatric surgical workload at our centre. Mechanical intestinal obstruction in neonates and infants is the leading cause. Aggressive resuscitation, accurate diagnosis, and prompt surgical intervention, in addition to provision of paediatric intensive care facilities, will assist in reducing morbidity and mortality among these children.Keywords: abdominal emergencies, acute abdomen, children, morbidity, mortalit

Monte Carlo (MC) Assessment of Structurally-Controlled Shallow Offshore “Teldomi” Reservoirs, Niger Delta, Nigeria - Inferences from 3D Seismic and Wireline Log Data

Monte Carlo Simulation (MCS) was used to assess the properties of three structurally controlled reservoirs namely, Reservoir A, Reservoir B, and Reservoir C in the study area. Geologically plausible ranges specified by the mean and standard deviation values of the initial petrophysical parameters of gross pay volume (GPV), net-to-gross (NTG), porosity (POR), and hydrocarbon saturation (Sh) were estimated from six wells and 3D seismic data. The MC simulation consisted of the generation of independent random values, representing the uncertainties constrained by a random probability distribution. For each randomly simulated combination of these parameters, original-oil-in-place (OOIP) was simulated. This process was repeated ten thousand (10000) times for each parameter after which the cumulative distribution functions (CDFs) for the simulated parameters were constructed from which summary statistics, risks and uncertainties were determined at P10 (downside), P25, P50, P75 and P90 (upside). Between the downside and upside probabilities, the GPV would be more than 13000 acre feet but less than 141000 acre-feet; the NTG would be more than 0.43 but less than 0.84; the porosity could be as low as 6% but not more than 29%; the hydrocarbon saturation would be more than 36% but less than 100%. At any given percentile, Reservoir C contains more hydrocarbon than the other two reservoirs but has the highest uncertainty. The three reservoirs would have more than 16 million barrels at P10, but not more than 111.5 million barrels combined in-place oil volume at P90. The results obtained can guide optimal future development decision on the reservoirs in the study area and thus confirmed MC simulation as veritable uncertainty modelling tool. Keywords: Monte Carlo, Structural, 3D Seismic, Wireline Log, Reservoi

Cesarean section in Ahmadu Bello University Teaching Hospital Zaria, Nigeria: A five‑year appraisal

Objective: In 1985, the WHO recommended an optimum Cesarean section (CS) rate of 10–15% and stated that there was no justification for any region to have higher rates. The global increase in CS rate is causing concern and it is a major public health issue. Our objective is to appraise the CS intervention, observe trend, and proffer solutions.Materials and Methods: All relevant clinical data from the patients delivery records in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria over the period 2010–2014 were pooled and used to analyze the clinical information.Results: There were a total of 9,388 deliveries during the period out of which 2,254 were CS, giving a rate of 24.5%. The mean age and parity of the study groups were 30.6 ± 4.8 years and 1.9 ± 1.6, respectively. A total of 288 (12%) of them were done as elective. Most of the CS was done due to previous scar, pre‑eclamsia/eclampsia. The maternal mortality rate (MMR) during this period was 870/100000 live births, the CS‑related mortality was 339/100,000, and the perinatal mortality (PM) was 43.9/1000 live births.Conclusion: The CS rate, the MMR, and PM are all high and the indications show that alternative interventions can be used to reverse the ugly trend but there is a need for training.Key words: Cesarean section; rate; maternal mortality; perinatal mortality; indications; trend and training

Perioperative antibiotic therapy in orofacial cleft surgery. What is the consensus?

Clefts of the primary and secondary palate represent one of the commonest congenital anomaly for which surgical correction is required. The perioperative care of the patients varies widely across centers and among surgeons and range from preoperative swab of palatal clefts for microbiological studies to prophylactic and or therapeutic antibiotic care. These practices have economic implications especially in the Low and Middle Income Countries (LMIC) where the cost of care are borne directly by the parents. The clinical implications of indiscriminate antibiotic use may also include development of resistant strains and hypersensitivity reactions which may be life  threatening. Surgical site infections and its possible sequelae of dehiscence and fistulae is another concern for the surgeon and the patient. This review examines the microbiological pathogens, surgeon’s perspectives as well as the current evidences for the use of perioperative antibiotic therapy in orofacial cleft surgery and concludes with a need for a large multicenter randomized clinical trial to answer critical aspects of the subject

Concurrent Cemento-Osseous Dysplasia and Osteogenic Sarcoma: Report of Two Cases

Aim. Cemento-osseous dysplasia (COD) represents a rare group of benign fibroosseous disorders, while osteogenic sarcoma (OS) on the hand, is a malignant tumour of ominous prognosis. A combination of COD and OS is rare and sparsely reported in literature. There are only four reported cases known to the authors. The aim of this paper is to report additional cases of COD occurring concurrently with OS. Materials and Methods. The clinicoradiologic findings and histological analysis of mandibular lesions in two patients who reported at the Dental Centre of the University College Hospital, Ibadan, Nigeria, are presented. Results. The two patients were diagnosed of mandible osteosarcoma occurring concurrently with bilateral mandibular focal cemento-osseous dysplasia. Conclusion. The simultaneous occurrence of osteosarcoma and cemento-osseous dysplasia raises the question of whether COD has transformed into OS or a collision tumour has occurred and their simultaneous occurrence is just a coincidence

Pattern of Midface Trauma with Associated Concomitant Injuries in a Nigerian Referral Centre

Aim: The aim of this study was to determine the pattern of midface trauma with associated concomitant injuries seen in our environment. Methodology: This was a prospective analysis of trauma patients with midfacial injuries presenting at a referral center in South West Nigeria. In addition to socio‑demographic data, the following information was also obtained: Mechanism of injuries, type of midfacial injuries, concomitant/associated injuries and treatment. Results: A total of 101 patients with midfacial injuries were involved. They were made up of 85 males and 16 females. The 20‑29 year age group was mostly affected (44.6%) and the most common cause of midface injuries was road traffic accident (91.1%). The zygoma was fractured more than any other midfacial bone (46.0%). A total of 144 associated injuries were recorded among these patients, head and ocular injuries accounted for 49 (34%) and 35 (24.3%) respectively. The patients were mostly treated conservatively or by closed reduction. Conclusion: The rate of head and ocular injuries among patients with midfacial injury was high. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary approach is important for optimum management of these patients.Keywords: Concomitant injuries, midface trauma, multidisciplinary car

Appraisal of jaw swellings in a Nigerian tertiary healthcare facility

Introduction: The mandible and maxilla can be the site of myriads of lesions that may be categorized as neoplastic, cystic, reactive and infective or inflammatory. Literature reviewing jaw swellings in an amalgamated fashion are uncommon, probably because aetiologies for these swellings are varied. However, to appreciate their relative relationship, it is essential to evaluate the clinico-pathologic profile of jaw swellings. The aim of this appraisal is to describe the array of jaw swellings seen at our hospital from 1990 to 2011, to serve as a reference database. Methodology: Biopsy records of all histologically diagnosed cases of jaw swellings seen at the department of Oral Pathology, University College Hospital between January 1990 and December 2011 were retrieved, coded and inputted into SPSS version 20. Data on prevalence, age, sex, site and histological diagnosis were analysed descriptively for each category of jaw swellings. All patients below 16 years were regarded as children. Results: A total of 638 jaw swellings were recorded in the 22-year study period. The Non Odontogenic Tumours (NOT) were the commonest, accounting for 46.2% of all jaw swellings. Odontogenic Tumours (OT) formed 45% of all adult jaw swelling while it formed 25.2% in children and adolescents. Ameloblastoma was the commonest while the most common NOT was ossifying fibroma (OF). Chronic osteomyelitis of the jaws was about 6 times commoner in adult females than males and mostly involved the mandible. The most common malignant jaw swelling was Burkitts' lymphoma (BL) that was about 7 times more in children than adults. Osteogenic sarcoma was the most common malignancy in adults. Conclusion: Jaw swellings are extensively varied in types and pattern of occurrence. This study has categorized jaw swellings in a simple but comprehensive fashion to allow for easy referencing in local and international data acquisition and epidemiological comparison

A Rare Case of Salmonella typhi Meningitis in an Eleven Month Old Infant: A Case Report

Non-typhoidal Salmonella are infrequent causes of childhood meningitis. Most reports of Salmonella typhi meningeal infections are confined to neonates. A rare instance of S. typhi in an otherwise healthy eleven month old infant is being reported.Keywords: Salmonella typhi, meningitis, infant

Hemangiomatous ameloblastoma: report of a case

Hemangiomatous ameloblastoma is a rare variant of ameloblastoma with only a few cases reported in the English literature. This is a report of a 42 year old man with a recurrent mandibular neoplasm who had r epeated surgical interventions. Clinical and radiographic examinations were not significantly different from other regular variants of ameloblastoma. Microscopic examination however revealed islands of cuboidal and columnar cells arranged in a pallisaded pattern with a central area of squamous metaplasia and stellate reticulum-like cells. There were multiple vascular channels containing red blood cells within the stellate reticulum-like areas. Surgical resection of the mandibular mass was done with immediate reconstruction. It may be concluded that repeated surgical interventions may be a possible etiology for the development of hemangiomatous ameleblastoma