Florid cemento-osseous dysplasia: a report of two cases seen at The University College Hospital Ibadan

Florid cemento-osseous dysplasia (FCOD) is commonly seen in black women, but few cases have been reported in sub-Saharan Africa. This article presents two cases of FCOD seen at the University College Hospital Ibadan. Two women aged 70 and 60 years were initially diagnosed as chronic osteomyelitis but both were eventually diagnosed as florid cementoosseous dysplasia after radiological examination by orthopanthomogram. Diagnosis of florid cemento-osseous dysplasia is possible by clinical examination and the distinct radiological presentation, especially on orthopanthomogram and a biopsy may not be required.Keywords: Florid cemento-osseous dyplasia, women, Ibadan

Cystic Ameloblastoma: A Clinico-Pathologic Review

Objective: Cystic ameloblastoma represent 10-15% of all intra osseous ameloblastomas and appear to be less aggressive than the solid ameloblastomas. The aim of this study was to examine the clinico-pathologic characteristics of cystic ameloblastomas seen at a tertiary health care centre.Materials: All cases diagnosed as cystic ameloblastoma in the Oral Pathology Department of University College Hospital, Ibadan over a 10 year period were investigated for age, gender, location of lesion, treatment, and follow-up. The cases were classified as luminal, intraluminal or mural, based on Ackermann classification. The data was entered into the statistical package for the social sciences version 18 (SPSS 18) and results expressed as percentages.Results: Fifteen cystic ameloblastomas, representing 14.3% of a total of 105 ameloblastoma cases were seen. The mean age was 28.9(±14.5) years with 73.4% occurring in the second and third decades. The male:female ratio was 2:3. Fourteen (93.3%) of the lesions were in the mandible while only one (6.7%) was in the maxilla. The mural variant was the most common histological variant with 6(40%) cases while the luminal and intra-luminal had  4(26.7%) and 5(33.3%) respectively. The multilocular radiologic appearance was more common than the unilocular in this study (ratio 8:4). Cystic ameloblastoma with multilocular appearance occurred in a higher age group (mean age 31yrs) when compared with the unilocular type which had a mean age of 16.3years.Conclusion: This study shows similar findings with previous studies but shows a higher multilocular radiological appearance as compared to unilocular variant and no case of recurrence.Keywords: Cystic ameloblastoma, Clinico-pathologic review, Uni-locular, Multi-locula

Informed Consent In Surgery: An Audit Of Practice In Ile-ife, Nigeria

Objectives: This study was conducted to assess patients\' knowledge of their diagnoses and proposed surgical procedures before giving consent for such procedures in the various surgical units of Obafemi Awolowo University Teaching Hospitals Complex, (OAUTHC), Ile-Ife. Materials and Methods: A structured questionnaire was administered to 80 consecutive patients who had just undergone an elective major surgery in general surgery, gyneacology, orthopaedics and surgical subspecialty units of the hospital. Results: Sixty patients (75%) gave consent themselves, while other consents were obtained from close relations. Thirty-seven (46.25%) respondents were informed of the diagnoses and procedure by the unit consultants but no consultant was involved in the completion of the consent form. Seventy-five (93.75%) respondents had a knowledge of the diagnoses, 68(85%) understood the procedure but only 21(26.25%) knew any alternative to the procedure, 29(36.25%) knew at least one complication of the procedure and 12(15%) knew an option or complication of anaesthesia. Forty-five (56.25%) of the consent forms were properly filled while other forms had one error or another. Conclusion: Well structured and standardized method of obtaining informed consent from surgical patients should be adopted. While educating patients, the various alternatives to the procedure and possible complications should be carefully explained to the patients who should be carried along in decision making. Keywords: Informed consent, Surgical practice. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 206-21

Oral Amelanotic Melanoma

Malignant melanomas of the mucosal regions of the head and neck are extremely rare neoplasms accounting for less than 1% of all melanomas.Approximately half of all head and neck melanomas occur in the oral cavity. Less than 2% of all melanomas lack pigmentation, in the oralmucosa however, up to 75% of cases are amelanotic. No etiologic factors or risk factors have been recognized for oral melanomas. Some authors have suggested that oral habits and selfmedication may be of etiological significance. Oral melanoma is rare but it is relatively frequent in countries like Japan, Uganda, and India. It is rarely identified under the age of 20 years. In Australia where cutaneous melanomas are relatively common primary melanoma of the oral mucosa is rare.The surface architecture of oral melanomas ranges from macular to ulcerated and nodular. The lesion is said to be asymptomatic in the earlystages but may become ulcerated and painful in advanced lesions. The diagnosis of amelanotic melanoma is more difficult than that of pigmented lesions. The neoplasm consists of spindle-shaped cells with many mitotic figures and no cytoplasmic melanin pigmentation. Immunohistochemistry using S-100, HMB-45, Melan-A and MART-1 will help in establishing the correct diagnosis.Radical surgery with ample margins and adjuvant chemotherapy are appropriate management protocol for malignant melanoma. Oral melanoma is associated with poor prognosis but its amelanotic variant has even worse prognosis because it exhibits a more aggressive biology and because of difficulty in diagnosis which leads to delayed treatment.Keywords: amelanotic melanoma, oral cavit

Palatal rugae as a tool for human identification

Objective: This study was conducted to assess the accuracy of palatal rugae as a tool for human identification and to determine factors that may limit accuracy. This will serve as a potential basis for advising national health policy formulation on human identification as forensic rugoscopy is unexplored in sub.Saharan Africa.Materials and Methods: One hundred consenting participants were  recruited; impressions of the upper jaws were taken and cast with dental stone. All the teeth on the models were trimmed off to prevent  identification by tooth morphology and the models were coded. Five uncalibrated dentists independently pair.matched the models based on the pattern of the palatal rugae.Results: The overall accuracy for all 50 paired models ranged from 72 to 96%, while the percentage correct match for each of the 50 paired models range from 40-100%. All the examiners properly matched 60% of the models. Conclusion: Rugoscopy is a useful technique for human identification due to the unique rugae pattern in every individual. However, without the aid of ancillary aids, visual inspection alone can be challenging. Clinical relevance: This study provides useful information on an additional clinical technique relevant for human identification.Key words: Forensic, human, identification, palatal rugae, rugoscopy, Ibadan, Nigeri

Open hemorrhoidectomy under local anesthesia for symptomatic hemorrhoids; our experience in Ile –Ife, Nigeria

Background: Ligation-excision hemorrhoidectomy is considered the gold-standard treatment for prolapsed hemorrhoids. The procedure is commonly done under general or regional anesthesia. This study is aimed to assess the feasibility and tolerability of open – hemorrhoidectomy under local anaesthesia in our setting.Methods: This is a prospective study carried out in Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria, over a 5-year period. All consenting adult patients with prolapsing hemorrhoids were offered Milligan – Morgan hemorrhoidectomy under local anesthesia. They were assessed for tolerance and complications.Results: More than 95% of patients tolerated the procedure with manageable complications.Conclusions: Open excisional hemorrhoidectomy under local anesthesia is feasible, safe and well tolerated in our environment and may encourage early presentation of patients with piles to hospital.Keyword: Open hemorrhoidectomy, local anesthesia, Nigeria

PTCH-1 and MDM2 expression in ameloblastoma from a West African sub-population: Implication for chemotherapeutics

Introduction: Ameloblastoma is a slow growing, painless odontogenic swelling which can attain sizes that result in severe deformities of thecraniofacial complex. It is the most commonly encountered odontogenic tumor in Nigeria. Surgical intervention is currently the method of treatment; however identification of altered molecular pathways may inform  chemotherapeutic potential. The Protein Patched homolog 1 (PTCH-1)is overexpressed in ameloblastoma. Also, mutation in the MDM2 gene can reduce the tumor suppressor function of p53 and promote ameloblastoma growth. No study however has characterized the molecular profile of African cases of ameloblastoma with a view to developing chemotherapeutic alternatives. The objective was to characterize the PTCH-1 genetic profile of Ameloblastoma in Nigerian patients as a first step in investigating its potential for chemotherapeutic intervention.Methods: Twenty-eight FFPE blocks of ameloblastoma cases from Nigerian patients were prepared for antibody processing to PTCH-1 (Polyclonal  Anti-PTCH antibody ab39266) and MDM2 (Monoclonal Anti-MDM2 antibody (2A10) ab16895). Cytoplasmic brown staining was considered as positive for PTCH while nuclear staining was positive for MDM2.Results: Moderate and strong expressions for PTCH in ameloblast and stellate reticulum were 78.6% and 60.7% respectively. Only 3 (10.7%) cases expressed MDM2.Conclusion: The importance of our study is that it supports, in theory, anti-PTCH/SHH chemotherapeutics for Nigerian ameloblastoma cases andalso infers the possible additional use of anti-p53 agents

Relations of the neck of groin hernia to pubic tubercle

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Wound Complications Following Laparoscopic Surgery in a Nigerian Hospital

Background: Different complications may occur at laparoscopic port sites. The incidence of these varies with the size of the ports and the types of procedure performed through them. Objectives: The aim was to observe the rate and types of complications attending laparoscopic port wounds and to identify risk factors for their occurrence. Patients and Methods: This is a prospective descriptive study of all patients who had laparoscopic operations in one general surgery unit of a University Teaching Hospital in Nigeria between January 2009 and December 2012. Results: A total of 236 (155 female and 81 male) patients were included. The laparoscopic procedures include 63 cholecystectomies, 49 appendectomies, 62 diagnostic, biopsy and staging procedures, 22 adhesiolyses, six colonic surgeries, eight hernia repairs and 22 others. Port site complications occurred in 18 (2.8%) ports on 16 (6.8%) patients including port site infections in 12 (5.1%) and hypertrophic scars in 4 (1.7%) patients, while one patient each had port site bleeding and port site metastasis. Nine of 11 infections were superficial, while eight involved the umbilical port wound. Conclusion: Port site complications are few following laparoscopic surgeries in our setting. We advocate increased adoption of laparoscopic surgeries in Nigeria to reduce wound complications that commonly follow conventional open surgeries.Keywords: Laparoscopy, Nigeria, wound complication

Calcifying epithelial odontogenic tumour-case series from five Nigerian Teaching Hospital

Background: Calcifying epithelial odontogenic tumour (CEOT) also known as Pindborg’s tumour is a relatively rare odontogenic neoplasm of epithelial derivationthat constitutes about 0.4-3% of all intraosseous odontogenic tumours.Objectives: To document all cases of CEOT encountered in five tertiary centres in Nigeria and their clinical, radiologic and histologic characteristics.Design: A retrospective study.Setting: Tertiary Dental Facilities in Lagos, Ibadan, Ife, Port Harcourt and Zaria (all in Nigeria) were involved in the study.Subjects: All odontogenic tumours (OTs) in the period from 1970 -2014. Case file records and biopsy reports were retrieved from the records of the five Teaching Hospitals, to obtain age, gender, location, size, clinical symptoms, pathological reports and radiographic description.Results: Out of a total of 1369 OTs, 20 (1.5%) cases of CEOT were reported. CEOT had a male to female ratio of 1.9:1, with mandible: maxilla ratio of 1.5:1 and the most common location being the premolar /molar region in the mandible. Nine (45%) cases appeared radiolucent while 11(55%) cases had mixed radio density. The mean diameter for mixed radio-dense lesions (4.83±2.99) was higher than that for radiolucent lesions (2.75±1.17) and the difference was statistically significant (p=0.049).Conclusion: CEOT is a rare tumour representing 1.5% of OTs. CEOT presents with some subtle geographic differences in its demography, however, further studies are required to investigate if these differences are coincidental or genetically  determined