Mandibular defect reconstruction with nonvascularized iliac crest bone graft

Context: Reconstruction of mandibular defect is a challenge to the head and neck surgeon because of associated functional and esthetic problems. Our experience with the use of nonvascularized iliac crest bone graft is hereby reported.Aim: The aim was to report our experience with the use of nonvascularized iliac crest bone for mandibular defect reconstruction at University College Hospital, Ibadan. Nigeria.Settings and Design: A retrospective descriptive study was performed.Materials and Methods: Cases of mandibular reconstruction with iliac crest bone graft between January 2001 and December 2007 were included in this study. Grafts were secured with either a stainless steel wire or a titanium plate.Preoperative diagnosis, postoperative follow-up records including investigations, diagnosis of graft infection and subsequent treatment modalities were extracted from the available records.Statistical analysis used: Descriptive variables were analyzed with SPSS version 14.Results: A total of 47 patients had mandibular defect reconstruction with nonvascularized iliac crest block bone during the study period. Thirty-eight patients had graft secured with transosseous wire [NVIBw] while 9 had a titanium plate [NVIBp]. The male:female ratio was 26:21 while the mean age of the patients was 24.6±4.25 years. Ten patients (21.3%) developed persistent graft infection during the postoperative period. All cases of infection occurred in patients who had transosseous wiring and analysis showed that 60% of the infected grafts revealed mixed microbial isolates containing klebsiela spp, pseudomonas aeurogenosa, and e coli. Six (60%) of the infected grafts were removed as a result of unabated infection while 4 (40%) were successfully treated by exploration and pus drainage.Conclusions: Nonvascularized iliac crest bone graft provides an affordable and less technical choice for mandibular reconstruction with minimal complications in a resource-limited economy

NOMA: A Preventable “Scourge” of African Children

Noma is a serious orofacial gangrene originating intraorally in the gingival-oral mucosa complex before spreading extraorally to produce a visibly destructive ulcer. Although cases of noma are now rarely reported in the developed countries, it is still prevalent among children in third world countries, notably in sub-Sahara Africa, where poverty, ignorance, malnutrition, and preventable childhood infections are still common. This review summarizes historical, epidemiological, management, and research updates on noma with suggestions for its prevention and ultimate global eradication. The global annual incidence remains high at about 140,000 cases, with a mortality rate exceeding 90% for untreated diseases. Where the patients survive, noma defects result in unsightly facial disfigurement, intense scarring, trismus, oral incompetence, and social alienation. Although the etiology has long been held to be infectious, a definitive causal role between microorganisms cited, and noma has been difficult to establish. The management of noma with active disease requires antibiotics followed by reconstructive surgery. Current research efforts are focused towards a comprehensive understanding of the epidemiology, and further elucidation of the microbiology and pathogenesis of noma

Update in the technique of third molar surgery

No Abstract.Keywords: third molar, impaction; preoperative assessment; surgery Annals of Ibadan Postgraduate Medicine Vol. 1 (1) 2003: pp. 40-4

Temporomandibular joint ankylosis in south western Nigeria

Objective: To determine the relationship between the aetiological factors, duration of ankylosis and the types of ankylosis and to evaluate the outcome of different treatments modalities used.Design: Retrospective study of cases managed.Setting: University teaching hospital at Ibadan, Nigeria.Subjects Thirty six cases treated between 1982 and 1997.Results: Infection related aetidogical factors were 66.6% wbie trauma was 27.8%. The relationship between aetiological factors and type of ankylosis classified by anatomic site, was statistically significant. Results suggest that infection-related aetiological factors are likely to give rise to extracapsular ankylosis, while trauma results in intracapsular ankylosis. Twenty five per cent reported for treatment within 12 months of onset of ankylosis while 72.2% reported after 24 months. The relationship between ankylosis of 24 months duration and above, and classifcation of ankylasis according to tissue type was also significant (p<0.05) and suggests that ankylosis of such duration is likely to be bony or mixed fibrous and bony. Of the types of ankylosis, 77.8% bad bony components while 22.2% were of the fibrous variety. As regards treatment, interpositional arthroplasty with the masseter muscle produced results that were more consistent and satisfactory than gap arthroplasty.Conclusion: The aetiological factors and duration of ankylosis ifluenced the type of ankylosis

An Unusual Ocular Injury Following Facial Trauma: A Case Report

Objective: To report a case of an unusual ocular injury following a road traffic accident Materials and Methods: A case report of a sixty – year – old female patient seen by the authors. The literature on ocular injures following facial trauma is reviewed. Results: An eye globe initially confirmed missing from its socket on clinical examination and thought to have been avulsed during the accident was found laterally below the right zygomatic bone during wound debridement. The eye was relocated and mobilized and its vision improved over a month to 6/18. Conclusion: This case reinforces the importance of comprehensive investigations in the management of extensive cases of maxillofacial trauma. KEY WORDS: Unusual; ocular injury; facial trauma. Nigerian Journal of Clinical Practice Vol.6(1) 2003: 68-7