Oral squamous cell carcinoma in patients less than 40 years in a Nigerian population

Objectives: Oral cancer ranks amongst the sixth to eight most common cancers worldwide and exhibits a great variation in incidence among countries. Oral squamous cell carcinoma (OSCC) is rare in individuals less than 40 years of age, with occurrences averaging 4 to 6% in people less than 40 years. The aim of this study was to review the clinical and pathological characteristics of OSCC cases in patients less than 40 years of age in five tertiary health facilities in Nigeria.Methods:All OSCC in the period from 1970 to 2015 from case file records and biopsy reports were retrieved from the records of the five teaching hospitals, to obtain age, gender, location and histologic grades.Results: Ninety-seven (17.4%) cases of OSCC were diagnosed in patients less than 40 years of age. These included 58 males and 38 females giving a male: female ratio of 1.5:1. The mandibular mucosa with 27 (28.7%) cases was the most common site followed by the maxillary mucosa with 24 (25.5%) and palate with 14 (14.4%) cases. Only 5 (5.3 %) cases of OSCC occurred in the tongue. The well differentiated OSCC was the most common histological grade accounting for 48 (50.0 %) cases while the moderately differentiated and poorly differentiated OSCC accounted for 31 (32.3 %) and 17 (17.7 %) cases respectively.Conclusion: OSCC was relatively more common in patients less than 40 years of age in this study than those of previous studies from other regions and OSCC in patients less than 40 years of age was relatively rare in the tongue when compared with similar cohorts from other continents. Key words: oral squamous cell carcinoma; age less than 40; tongue; mandibular mucosa, Nigeri

Dysplastic Papilliferous Basaloid Ameloblastoma: Report of a Case

Papilliferous ameloblastoma is an uncommon histologic variant of ameloblastoma. About five cases have been reported in the English literature till date. All five showed squamous differentiation with keratin formation and were diagnosed as papilliferous keratoameloblastoma. The present lesionshows basaloid differentiation and mild dysplasia in addition to papilliferous projections, thus termed dysplastic papilliferous basaloid  ameloblastoma.  Ameloblastoma, the most common odostoma has not ceased to intrigue pathologists with its diverse histomorphological patterns. Therefore, we present this uncommon lesion in a 50 year old man with right mandibular swelling. Key words: Papilliferous, Basaloid, Ameloblastoma, Dysplastic, Nonhealing socket

A retrospective review of 61 cases of adenomatoid odontogenic tumour seen in five tertiary health facilities in Nigeria

Introduction: Adenomatoid odontogenic tumor (AOT) is a benign lesion originating from the dental lamina or its remnants. It is a relatively uncommon neoplasm representing about 3% of all odontogenic tumors. The aim of this study was to examine the clinical and radiological characteristics of AOTs in five major tertiary centres in Nigeria. Methods: Archival hospital-based data stores of five tertiary health facilities in Nigeria were accessed. Case files and biopsy records were retrieved to obtain relevant information. Data was collected according to a proforma for standardization and entered into and analysed using SPSS for Windows (version 20.0; SPSS Inc. Chicago, IL). Results: 61 (4.5%) cases of AOT were documented. The age range was 8-46 years with a mean age of 20.4±9.9 years. Male: Female ratio was 1:1.3. The anterior maxilla had 34 (55.8%) cases and the anterior mandible had 20 (32.8%) cases. 40 (65.6%) follicular cases, 20 (32.8%) extra-follicular cases and 1(1.6%) extraosseous case were found. 31 cases (61.1%) were associated with impacted teeth and the upper canine was involved in 19 (57.6%) cases. Conclusion: This study showed AOT to be more common in the maxilla, more in females, most often associated with impacted canines, however, the suggestion of AOT being a “Two third tumour” was not observed in this study

Cysts of the Oro-Facial region: A clinico-pathologic review of 403 Nigerian cases

Objectives: To review the types, frequency, distribution, treatment, and treatment outcome oforo-facial cysts seen at four tertiary health centres in southwestern  Nigeria and to categorise the cases using Lucas (1966), Killey and Kay (1968) and World Health Organization (WHO) (2005) classification protocols.Design: A decriptive retrospective studySetting: Tertiary hospitals across the south west zone of Nigeria.Main outcome measures: Treatment outcome of oro-facial cysts seen at four tertiary health centres in southwestern Nigeria and categorisation of the cases using Lucas (1966), Killey and Kay (1968) and World Health Organization (WHO) (2005) classification protocols.Results: The treatment modalities included marsupialisation, enucleation,  enucleation with peripheral osteotomy and surgical excision of non-epithelial cyst of the jaws. The follow-up period ranged from a minimum of six month to five years. Such follow-up consisted of examination and periapical or panoramic radiographs. All patients were without evidence of disease during the follow-up period and many of them were lost to follow up due to absence of diseased condition. Lucas  classification and WHO classification showed that inflammatory cysts were the most common accounting for 36%, developmental cysts represented 27%, 4% were non-epithelial while, 32.8%  were unclassifiable.Conclusion: The inflammatory jaw cyst is the most common type in southwest  Nigeria, occurs more in males compared to females and is more common in the mandible compared to the maxilla

Hecks disease: A series of Nigerian cases

Heck’s disease is a rare viral disease of the oral mucosa. It occurs mostly in children of diverse ethnic groups and in various geographical locations. In Nigeria, only 4 cases of Heck’s disease have been previously reported. We report additional 8 cases to add to knowledge on this entity. Five of the cases reported in this study are siblings from the same family. The male to female ratio was 1.7:1, the mean age at presentation was 5.8 years, the most significantly affected site was the lower labial mucosa and females had higher predilection for total mucosae involvement

Molecular genetics of cleft lip and palate: A review

No Abstract

Kimura’s disease in a Nigerian: Case report

Kimura’s disease (KD) is a chronic inflammatory disease presenting as multiple  subcutaneous swellings within the head and neck region. Aetiology has been suggested to be due to allergy or an immune response and it’s predominantly seen in young and middle-aged males. Histopathologically, hyperplasia of lymphoid tissue, with well-developed lymphoid follicles and marked infiltration of eosinophils are seen. KD is a relatively rare disease previously reported to be endemic in Asians of Chinese decent. However, they can constitute a diagnostic challenge where there is low index of suspicion. Therefore, we report a case of KD in an adult male Nigerian

Crepe bandage in the management of soft tissue limb abscesses

Objective: To determine the necessity of continuous gauze packing of abscess cavities following incision and drainage of limb abscesses.Methods: Limb abscesses managed between January, 2001 and December, 2005 were prospectively studied. The wounds were packed for the first 24hrs for heamostasis after which the limbs were randomized into two groups. The first group had daily wound dressing with packing of the abscess cavity while the second group had daily dressing of the stoma only with external crape bandaging of the abscess cavity. The wounds were inspected weekly for healing and complications. Analysis was done using SPSS 13.0. The level of significance was put at p < 0.05Results: Eighty-seven limbs were studied in 33 patients, 19 were in the right upper limb, 16 in the left upper limb, 23 in the left lower limb and 29 in the right lower limb. The mean duration for the gauze packed wounds to heal was 7.0 ±1.08 weeks while the bandaged wound took 5.2 ± 1.71 weeks to heal. This was statistically significant (p < 0.000).Conclusion: Continuous wound packing in limb abscesses after the first 24hrs should be avoided. External crepe bandaging of the abscess cavity achieve faster healing

Indirect inguinal hernia: the implication of occupation in a semi-urban centre

Inguinal hernia is the commonest anterior abdominal wall hernia and increased intra-abdominal pressure is one of the risk factors of inguinal hernia formation. The objective of this study was to determine the effect of occupation on types of indirect inguinal hernia and its associated posterior wall defect in adult male patients in a semi-urban hospital. This was a prospective descriptive hospital based study conducted between February 2004 and February 2006 among ninety-two adult male patients. Patients were classified into three work groups based on their exposure to heavy lifting: the unskilled, the artisan and the professional. Types of indirect inguinal hernia were classified intra-operatively based on distal extent of fundus of the hernia sac into: bobunocoele, funicular and inguinoscrotal and their associated posterior wall defects was classified using Nyhus classification. All data were analysed using SPSS version 15 for windows with level of significance put at p < 0.05 for nonparametric tests. There were 38 Unskilled, 18 Artisan and 36 Professional. Comparing levels of occupation with types of indirect inguinal hernia was not statistically significant (x2 = 1.09, df = 2; p = 0.580). However, comparing levels of occupation with the posterior wall defect was statistically significant (x2 = 7.48; df = 2; p = 0.024); follow-up tests evaluating pairwise differences between the three levels of occupation and the posterior wall defect only show significant difference between the Unskilled and the Professional (p = 0.008). Levels of occupation in our environment appears unrelated to the types of indirect inguinal hernia, however, it has an influence on the degree of posterior wall defect in the Unskilled. There is a need to evaluate the optimal convalescent period in this group of workers post surgery, to allow for adequate wound healing before returning to active work; especially, where tension repair is still the main modality of treatment

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries