Naso-Orbito-Ethmoid Fractures: Perspective and Practices of Nigerian Surgeons

Objective: The study was to appraise the level of expertise in the management of Naso-Orbito-Ethmoid (NOE) fractures and to provide recommendation for necessary improvement in an African population.Materials and Methods: A questionnaire was designed and electronically mailed to Nigerian Oral & Maxillofacial surgeons, Plastic and Reconstructive surgeons, and Ear, Nose and Throat surgeons to assess their perspectives and practices in the diagnosis and management of NOE fractures. Further administration of questionnaire was done at the AO (Association of Osteosynthesis) principle course in Lagos, January, 2010. Information generated were coded and processed with statistical package for Social Sciences version 15.0, Chicago Illinois, USA.Results: The questionnaire was delivered to 214 surgeons, there were 112 respondents out of which 78 expressed no interest in the management of NOE fractures and 34 had interest and so completed the questionnaire.Diagnosis is largely based on plain radiographs; only 22 surgeons perform NOE trauma surgery, majority (63.9%) use existing laceration or more conservative approaches like Lynch or open sky incisions. Mini and micro-plates are employed by only 31.8% of the surgeons. Bone grafting is rarely performed but when required, the iliac crest is preferred. Repair of the nasolacrimal duct system is rarely done.Conclusion: The management of NOE fractures in Nigeria, falls short of the current best evidence in the world literature. International collaboration for improvement is recommended.Keywords: nasoethmoid complex, diagnosis, treatment, complication

The practices and effects of tooth mutilation in a Nigerian rural population

Objective: The study was carried out to investigate the practices and effect of tooth mutilation in two rural communities in Nigeria.Method: A structured questionnaire was administered on subjects in two rural communities in the Niger-Delta area of Nigeria. The questionnaire was used to collect demographic information of the subject and the reasons for, methods of tooth mutilation and its effects on the oral health of participants were recorded. Data obtained were coded and computerizedanalysis was performed using SPSS version 17.0.Result: A total of 37 (36.3%) participants out of 102 patients who visited the dental clinic during the free dental care mission completed the questionnaire. There were 9 (24.3%) male and 28 (75.3%) female in two communities of Okorenkoko and Agudama. Most of the participants received information concerning this act through family members or friends with various reasons given for engaging in this act. Also, various deleterious effects of tooth mutilation was found with 25 (67.6%) experiencing pain during the process, 12 (32.4%) noticed progressive tooth discolouration while 8 (21.6%) experienced signs of infection witheither pus discharge or upper lip swelling or both.Conclusion: Rural dwellers, irrespective of level of education are still indulging in mutilatory practices to the dental tissues and on the long run, most mutilated teeth, would most likely become symptomatic and may result into extraction worse sequelae.Keywords: Tooth mutilation, rural communities, Nigeri

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.Keywords: Inferior alveolar nerve block, local anaesthesia, techniques, dental educatio

Zygomatico-orbital fractures a case report

Background: Zygomatico-orbital fracture is one of the delicate maxillofacial fractures. The diagnosis and decision- making in respect of the appropriate line and techniques of management is extensively discussed in the world literature. However, in Nigeria, reports on the incidence and management of Zygomatico-orbital fractures are rare.Objective: To present 2 cases of zygomatico-orbital fractures treated at the University of Port-Harcourt Teaching Hospital.Method: The diagnosis and management of 2 patients who wereinvolved in road traffic accidents are presented and discussed.Patient 1 had extensive soft tissue laceration in association with anobvious markedly displaced zygomatico-orbital fracture and wastreated under GA less than 24 hours after injury. Patient 2 had aclosed zygomatico-orbital fracture which was detected radiographically and was treated 1 week post injury.Results: The different clinical pictures in the two cases are related to the mechanism of injury and the technicalities involved in diagnosis and treatments as well as the short term outcome of treatment are discussed.Conclusion: There is paucity of reports on the management ofzygomatico-orbital fractures in Nigeria. More reports are desirablefor comparison of experiences from different centers. In the casespresented the impact of peculiar clinical presentation on treatmentdecisions is exemplified

Incidence and risk factors for nerve injuries in mandibular third molar surgery

No Abstract

Maxillo-Mandibular Fixation: Utility and Current Technique in Modern Practice

No Abstract

Knowledge and perception of preclinical dental students about the dental training profession: A comparative study of two dental schools in Nigeria

No Abstract

Pattern of cleft lip and palate deformities and associated anomalies in a selected Nigerian population

Background: Cleft Lip and / or Palate (CL/P) is one of the major human orofacial congenital malformations seen in live births. Port Harcourt is a city in the South- South region of Nigeria for which there is a dearth of data on these deformities. The aim of this paper is to assess the pattern of CL/P deformities and associated anomalies in an understudied Nigerian population. Methodology: This is an observational study of the pattern, dental and occlusal features, skeletal deformities, and hearing as well as speech problems associated with CL/P. The subjects were recruited from among the beneficiaries of a corrective surgical outreach at the University of Port Harcourt Teaching Hospital in April 2010. Data collection was by oral interview and clinical examination. The information elicited was recorded in a structured questionnaire prior to the corrective surgery. Descriptive analysis of data was performed using SPSS version 17. Results: A total number of 36 subjects were studied, including 19 males and 17 females. Age range was 0.21-28 years, with a mean of 8.8 (8.2) years. Eight (22.6%) subjects were below age one year. Twenty five percent had Cleft Lip (CL) 33.3% had Cleft Palate (CP), and 41.7% had Cleft lip and palate. Cleft palate was more common in females. Dental/occlusal anomalies found in subjects were notably, anomalies of number structure and position. Speech and hearing defects were observed in 61.1% and 19.4% of the subjects respectively. Conclusion: The relative prevalence of different cleft patterns complies with previous reports in Nigeria. Also, different reported types of dental and occlusal anomalies were noted, tooth rotations being the commonest. Late presentation for surgical correction was observed in this population.Key words: Cleft lip and palate, dental and occlusal anomalies, congenital malformation

Orbital surgery – a two year audit of practice in a craniofacial centre

Background: The surgical techniques and materials used in orbital reconstructive surgery vary widely. The choice of methodand material for a given case often depend on the preferences and experience of the surgeon. Periodic audit of practice isdesirable to evaluate the successes and failure in a center and to compare experiences with other centers.Objective: This study was undertaken to review the indications, surgical approaches, methods and materials used for orbitalreconstruction/recontouring and the incidence and type of complications of the surgery at our centre.Materials and method: The clinic database was explored to retrieve the records of patients who had orbital surgery betweenMay 1, 2005 and April 30, 2007. The required information were retrieved and tabulated to review the current indications,techniques and outcome of orbital surgery at the center.Result: There were 11 patients involved in the audit including 9 males and 2 females within the age range of 10-60 years, meanage of 25.6 + SD 13.1 years. Trauma was the most frequent indication for surgery, the coronal and transconjunctiva approach tothe orbits were favoured and cranial bone graft and Goretex were the preferred materials for reconstruction. Ocular and nonocular postoperative complications were observed. Many of the patients involved had delayed primary or secondary interventionin which case the quality of treatment outcome was affected and further operations were required to correct residual symptomsand complicationsConclusion: Although, there are many complex techniques and esoteric materials being employed worldwide, the approach inthis center is a simplistic one with preference for autogeneous calvarial bone graft and use of Gore-Tex where alloplastic materialwas considered adequate. These principles have been adopted with considerable success

Indications and Outcome of Mandibular Condylar and Ramus Surgeries

Background: Different surgical procedures are utilized for treatment of various diseases of the posterior mandible depending on the type of disease, site, duration and age of the patient. A thorough knowledge of the anatomical relations of structures and adequate surgical skills are needed to minimize complications. The purpose of this study was to evaluate the indications and outcome of surgical techniques for diseases affecting the condyle and ramus of the mandibles. Patients and Methods: Data were retrieved from the case files of patients who had surgeries for diseases involving the ramus/condylar area of the mandible. The diagnosis/indications for surgery, procedure and postoperative outcomes were documented. Outcomes assessed were related to mouth opening, esthetics (appearance of scar and jaw symmetry) and function (occlusion, Jaw movements). Complications such as nerve dysfunction were documented. Paresthesia was tested by simple tactile stimulations. Results: There were a total of 27 procedures done either on the condyle or ramus in 23 (100%) patients between May 2006 and October, 2013. 16 procedures were done for tumors in 16 (69.6%) patients, 14 (60.9%) patients had Ameloblastoma, 1 (4.3%) had central neurofibroma and one had keratocystic odontogenic tumor, two procedures for unilateral condylar fractures in 2 (8.6%) patients, five procedures for ankylosis in 3 (13.0%) patients and four procedures were done for dislocation in 2 (8.6%) patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory. Conclusion: Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.Keywords: Condyle, indications, outcome, ramus, surgerie