Clinical aspects of temporo-mandibular joint dislocation in Calabar, Nigeria

Background: Dislocation of the temporo mandibular joint (TMJ) dislocation does occur and patients seek early treatment because of the resultant facial deformity and inability of the mandible to function.Objective: The purpose of this study was to clinically evaluate clinical presentations, treatment and treatment outcomes of temporo-mandibular joint (TMJ) dislocation amongst 48 Nigerians who presented at the Dental and Maxillofacial Surgery Clinic, University of Calabar Teaching Hospital Calabar, South-South Nigeria.Methods: This was a prospective study of 48 Nigerians with TMJ dislocation. The emphasis was on their ages, gender, time of presentation, aetiology, type of TMJ dislocation with clinical features and the corrective treatment procedures and outcome of treatment. The data obtained were subjected to statistical analysis using EPI info 2000 version software.Results: There were 32 (66.7%) males and 16 (33.3%) females giving a male- to- female ratio of 2:1. Patients’ ages ranged from 19-79 years with mean age of 42.0 ± SD 3.4 years. The types of dislocation encountered were unilateral, bilateral, recurrent, non-recurrent, acute and chronic. The patients kept follow-up appointments and 43 (89.6%) had successful treatment outcome while five (10.4%) were unsuccessfully treated.Conclusion: Yawning and trauma are the main aetiological factors in TMJ dislocation. The treatment employed depends on the time of presentation and the frequency of occurrence of dislocation. It is hoped that this clinical evaluation will contribute to the understanding and management of this condition by the oral and maxillofacial surgeons.Keywords: Temporo-mandibular joint, dislocation, occurrence, treatment, Nigeria

Locally Advanced Orofacial Malignancy: Synopsis of Inoperable Lesions at an Urban Tertiary Health Facility in Nigeria

Background: Locally advanced inoperable orofacial malignancies do present clinically, and constitute a significant public health burden worldwide. Objective: To determine the prevalence and clinical characteristics of Stage IV locally advanced inoperable orofacial malignancies for consecutive patients. Materials and Methods: A 24‑year retrospective study was undertaken, and data obtained from hospital register, case files, and histopathological  reports of patients were recorded in a proforma. The variables studied were age, sex, type of lesion and site, duration of lesion, tobacco/alcohol use, and socioeconomic status of the patients and clinical features of the lesions. Results: Twenty‑six patients presented, giving a prevalence of 11.2%. The most common lesion was adenoid cystic carcinoma, 23.1%. Males accounted for 18 (69.2%) cases and females, 8 (30.8%) giving a male to female ratio of 2.3:1. The ages ranged from 21 to 65 years, mean (SD) 48.6 (7.3) years. The gender distribution was clinically and statistically significant in favor of the males (P = 0.001). The patients were in the low socioeconomic class and 20 (76.9%) indulged in chronic use of tobacco and alcohol. The duration of the lesions ranged from 1.8 to 3.1 years. The maxilla/facial skin was the commonest site (46.2%). Clinically and statistically, the relativity of site distribution of lesions was significant (P = 0. 002). The clinical features occurred in combination resulting in an average of 10 symptoms and  signs in each patient. Conclusion: The synopsis of these lesions shows that all have undergone metastasis; salivary gland malignancies were most common with maxilla  as the commonest site. Keywords: Inoperable, locally advanced, malignancy, orofacial, synopsi

Prevention of alveolar osteitis after third molar surgery: Comparative study of the effect of warm saline and chlorhexidine mouth rinses

Background: Chlorhexidine mouth rinses have a proven efficacy for the prevention of alveolar osteitis after third molar surgery. This study compares the efficacy of warm saline rinse, a component of postextraction instructions, with that of chlorhexidine in our institution over a period of 2 years.Patients and Methods: Apparently healthy patients who were referred to the Oral Surgery Clinic of our institution, with an indication for surgical extraction of lower third molar were prospectively, consecutively, and uniformly randomized into warm saline and chlorhexidine groups. The experimental group (n = 50/100) were instructed to gargle twice daily with warm saline, whereas the chlorhexidine group (n = 50/100) were instructed to gargle with 0.12% chlorhexidine. Information on demographic, types and level of impaction, indications for extraction, and development of alveolar osteitis were obtained and analyzed. Comparative statistics were done using Pearson’s Chi-square, Fisher’s exact, or Mann–Whitney U-tests as appropriate. P <0.05 was considered statistically significant.Results: The demographic, types and level of impaction as well as indications for extractions were comparable between the study groups (P > 0.05). The overall prevalence of alveolar osteitis was 5%. There was no statistically significant difference between application of warm saline and 0.12% chlorhexidine rinse with respect to the development of alveolar osteitis (P = 0.648).Conclusion: Warm saline mouth rinse is equally as effective as chlorhexidine mouth rinse, as prophylaxis against prevention of alveolar osteitis after third molar surgery.Keywords: Alveolar osteitis, chlorhexidine, prevention, warm salin

Mandibular fracture and complications associated with different treatment methods: Review of Literature.

Mandibular fracture sometimes is associated with complications which influence its prognosis. Aspects of the complications of mandibular fracture investigated are those emanating from the methods of treatment employed in its management. Such methods of treatment include conservative, closed reduction with intermaxillary fixation and open reduction with inter-maxillary fixation or rigid internal fixation. It is expected that with improvement in the knowledge of this condition and its management protocols complications will be reduced to the barest minimum. But, this is not so as there are many confounding variables that influence treatment outcome. This paper examined those complications associated with the various treatment methods and recommends that the older methods of treatment like closed reduction technique and transosseous wire osteosynthesis are still relevant in the current day practice.Keywords: Mandible, fracture, treatment methods, complications.  &#160

Ankylosis of the mandible: a study of 32 cases.

Objectives: The aim of this study was to clinically evaluate ankylosis of the mandible amongst 32 Nigerians who presented at the Dental & Maxillofacial Surgery clinic, University of Calabar Teaching Hospital Calabar, southsouth Nigeria. Methods: We carried out a prospective study on the 32 patients with mandibular ankylosis. The focus was on the ages at onset of limitation in mouth opening, time of presentation for treatment, gender, aetiological factors, clinical features, radiographical findings, type of ankylosis, anaesthetic technique, surgical treatment, complications, results and follow-up review. The data obtained were subjected to statistical analysis using EPI Info 2000 version software Results: There were 18 (56.3%) males and 14(43.7%) females giving a male-to-female ratio of 1.3:1. Patients’ ages ranged from 3.5 years to 54 years with mean age of 34 + SD 6.4 years. All the patients complied with the follow-up appointments as scheduled within the first one year after commencement of treatment. Six (20.0%) absconded thereafter, while 7 (29.2%) had varying reductions of interincisal distance achieved at surgery. No relapse of ankylosis was recorded. Conclusion: Trauma and infection are the main aetiological factors in temporo-mandibular joint ankylosis. The technique of surgery and conservative treatment employed in each case depended on the site, extent, and type of ankylosis. There was no relapse in all the cases treated. It is expected that this effort would further increase the understanding in the management- of this disabling condition among oral & maxillofacial surgeons.Keywords: Ankylosis, mandible, temporomandibular joint, Nigeria

Occupational Stress in Dental Practice amongst Government-employed and Private Dental Practitioners in Eastern Nigeria: A comparative survey

Objectives: The aim of this study is to compare the level of occupational stress amongst government-employed and private dental practitioners in eastern Nigeria. Materials and methods: A total of 62 questionnaires were randomly distributed among government-employed and private practicing dental surgeons with five years and above working experience in eastern Nigeria. The information collected included: years of practice; mode of remuneration; causes of stress during clinical practice; signs of onset of stress; reactions of individual practitioner during stress condition; and patient’s management during practitioner’s stressful moment. Fifty-seven questionnaires were returned anonymously representing 92% response rate, these were used in the data analysis. Results: Forty-two (73.3%) out of the 57 respondents were government employed dental practitioners while 15 (26.7%) were in full private practice. Thirty-three (78.5%) government-employed respondents, indicated patients’ management and type of clinical procedures as the main cause of their stress. Staff and practice management were the main cause of stress amongst all 15 respondents in full private practice. It was also observed that most dental surgeons (73.3%) in full private practice were affected by time pressure and environmental factor. Irritability and impatience was high (69%) among government-employed practitioners compared to (26.7%) among private practitioners. Conclusion: Our findings showed that private dental practitioners experience more stress in dental practice than government-dental practitioners in our environment. This could be explained in terms of time pressure, environmental factor and remunerations. This calls for an establishment of more government owned dental centers, government employment and good remuneration for dental surgeons to reduce the level of occupational stress in our daily dental practice. Keywords: Occupational stress; Dental practice; Government-employed and Private dental practitioners; Eastern Nigeri