Neural tumours of the head and neck

Objective: To document the pattern of occurrence of all primary neural tumours arising in the neck and craniofacial region over the period 1982 to 1991.Design: A retrospective study.Setting: Cancer Registry, Nairobi, Kenya.Results: Out of the 289 cases who were identified to have had whole body neural tumours, 225(77.8%) had the lesions distributed in the neck and craniofacial area. While 80% of the neoplasms located in this region were retinoblastomas (mainly occurring in the age group 0to 4 years), other lesion types occurred in small numbers thus: neurofibromas comprised 12.4%, Schwannomas four per cent, neuroblastomas and neuromas each 0.4%; and extracranial gliomas 2.7%. Overall, the male to female ratio was 1:1 and the site distributionrevealed that over 90% of the lesions afflicted the upper face.Conclusion: Neural tumours of the neck and craniofacial region appear generally rare in this population as has been shown elsewhere

Evaluation and histological maturation characteristics of fibrous dysplasia and ossifying fibroma: a case series

Background: Fibrous dysplasia (FD) and ossifying fibroma (OF) are benign fibro-osseous lesions (FOLS) that are generally considered to be separate entities distinguishable by histologic and radiographic features. The histological maturation of these lesions involves an initial fibrous state, an intermediate mixed and a final mineralised stage.Objective: To correlate the mineralisation of OF and FD with the duration of the lesion.Design: A retrospective histopathological analysis of archival material including sixteen cases documented over a three-year period was performed to distinguish FD from OF.Setting: The relevant data of FOLs diagnosed as OF and FD were retrieved from the archival records of the Departments of Oral Surgery/Oral Pathology and Histopathology/Morbid Anatomy, Muhimbili University of Health and Allied Sciences.Results: Remarkably, in this series, none of the FD and OF lesions occurred in patients aged below 10 or over 50 years. The histopathological comparison of the various nonmineralised components in both the lesions in relation to lesion age-maturity was not statistically significant (P>0.05).Conclusion: The histopathological ratio of the mineralised to  non-mineralised components may not be directly indicative of the maturity of both OF and FD

Sarcoma of the head and neck at Kenyatta National Hospital

Objective: To determine the pattern of occurrence of sarcomas afflicting the neck and craniofacial region.Design: A retrospective study (1982-1991).Setting: Cancer Registry, Kenyatta National Hospital, Nairobi, Kenya.Method: Examination was performed of the cancer records in the registry over the period 1982 to 1991 inclusive. Histopathological types of the sarcomas were then analysed to indicate the numbers that occurred per year; and also the pattern of occurrence accordingto age groups, gender and site.Results: Of the 10,897 whole body neoplasms, 985 were sarcomas. Among these sarcomas, 160 (16%) were located in the neck and craniofacial region. The histopathological types of the neoplasms included Kaposi’s sarcoma (39%), osteosarcoma (23%), rhabdomyosarcoma (21 %), fibrosarcoma (13%), chondrosarcoma (two per cent), malignant fibrous histiocytoma (one per cent) and dermatofibrosarcoma protuberans (one per cent).Conclusion: The results of this investigation, in concordance with those of other series worldwide, indicate that the various sarcomas afflicting the neck and craniofacial area are generally rare

Management Of Bilateral Temporomandibular Joint Ankylosis In Children: Case Report

Long standing temporomandibular joint (TMJ) ankylosis may cause severe facial deformity and growth retardation as well as psychological problems when it occurs in children. Different kinds of opinion have been advanced as regards its management. This article discusses the aetiology and management of bilateral TMJ ankylosis in form of a case report in a patient with severe facial deformity, malocclusion and retarded growth following bilateral TMJ ankylosis secondary to trauma. The patient was successfully managed by placement of costochondral grafts and interpositionalarthroplasty with partial temporal myofascial flaps. Good mouth opening was achieved and subsequent follow-ups showed improved mandibular and general body growth as well as psychosocial performance. The aim of this paper is to discuss the management challenges posed by bilateral TMJ ankylosis

Morphometric parameters of Kenyan adult mandibles

Background: The mandible has a horizontal U-shaped body which is continuous at it posterior end with a pair of vertical rami forming the lower part of the facial skeleton. Knowledge of mandibular dimension is an important consideration during the selection of appropriate reconstruction techniques.Objectives: To determine the morphometric parameters in Kenyan adult mandible and to relate them to those of a sample of reconstruction plate and screw.Design: A descriptive cross-sectional study.Setting: The National Museums of Kenya, Nairobi and the Department of Human Anatomy, University of Nairobi.Subjects: Intact whole adult mandibles (n=82) were obtained from the National Museums of Kenya, Nairobi and the Department of Human Anatomy, University of Nairobi.                                                    Results: The average length of the mandible in males for the right and left sides was 98.6 mm and 100.5 mm respectively while for the females this was 92.2 mm and 94.5 mm respectively. The average height of the rumus of the mandible in male for the right and left sides was 57.40 mm and 58.07 mm respectively while for female this was 51 .81 and 52.20 respectively. Significant differences were noted among the curved length and heights of the mandible between male and females (p<0.05). Significant difference between the right and left side of the mandible were noted (p<0.05) as well as between the length of the mandible and the length of the reconstruction plate (p<0.05). There were no significant difference in the thickness of the mandible between males and females and; between the left and right sides of the mandible with averages of 13.94 mm at the symphysis, 11.00 mm at the canine 10.33 at the mental foramen 11.06 at the bifurcation of the first molar, 12.36 mm at the bifurcation of the secend molar 8.62 mm at the level of the anterior ramus, 5.41 mm at gonion and 5.89 mm at the midpoint of the rums (p>0.05) with strong positive correlations. Significant differences were,however noted between the thicknesses of the body and ramus of the mandible and the sizes of the screws (p<0.05).Conclusion: The baseline parameters of the mandibles for Kenyans can be used in the selection of appropriate reconstruction plates and screws

Ipsilateral Synchronous Manifestation of an HIV-Infection Associated Plunging Ranula and Sublingual Salivary Gland Sialocoele: A Review and Case Report

Plunging ranula is a rare lesion and even more in HIV-infected patients. There has been only one case documented in a 15-year old that had the vertical form HIV-infection. We report a plunging ranula occurring simultaneously with a sublingual salivary gland sialocoele as two separate lesions in an HIV-infected female patient.Keywords: Ranula, salivary glands  

Pattern And Clinical Characteristics Of Firearm Injuries

Objective: To determine the pattern and characteristics of patients admitted with firearm injuries (FAls) and establish the morbidity and mortality associated with these injuries. Design: Retrospective cross-sectional study. Setting: Kenyatta National Hospital (KNH), January 2004 to December 2005. Subjects: All patients admitted with physically evident firearm injury. Results: There were a total of 717 patients recorded with FAIs constituting 0.6% of the total number of patients seen in the casualty. Of these, 421 (58.7%) were admitted and treated as in- patients. A firearm was used in 6.7% of the 6300 assault cases recorded in 2004 and in 9.7% of the 3079 cases recorded in 2005. The increase from 6.7% in 2004 to 9.7% in 2005 was statistically significant (

Morbidity And Quality Of Life Among Head And Neck Cancer Patients Treated With Radical Radiotherapy

Objectives: To determine the relative frequency of acute radiation morbidity and their perceived effect on quality of life among head and neck cancer patients treated with radical radiotherapy.Design: A cross-sectional study.Setting: Kenyatta National Hospital, Nairobi.Subjects: Thirty eight patients comprising 28 males and 10 females with ages ranging between 21 and 69 years were evaluated.Results: Most of the tumours occurred in the nasopharynx (38.6%). The rest of the tumours were equally divided between the oral cavity and larynx (31.6%). All tumours except two were carcinomas. The two exceptions were a glomus tumour and a malignant melanoma. The patients had received doses of radiotherapy ranging between 58.5 Grey and 75.5 Grey. Of the 38 patients, 22 (53%) completed their treatment in the prescribedtime while 16 (47%) had treatment interruption on account of radiation morbidity. The cumulative radiation done at the time of interruption ranged between 20 and 46 Grey. The most frequent symptom was dryness of the mouth while the most troublesome symptom was difficulty in tasting foods. The quality of life (QOL) did not vary by age, gender or tumour site. Patients who had treatment interruption had a better QOLthan those who did not.Conclusion: This study provides information that should aid in communicating with the head and neck cancer patients scheduled for radiotherapy and in the design of preventive and interventional strategies aimed at enhancing patient support and rehabilitation

Clinico-histopathologic types of maxillofacial malignancies with emphasis on sarcomas: A 10-year review

Background: Sarcomas are malignant neoplasms that occur anywhere in the human body. Though their occurrence in the head and neck region is rare vis-a-vis other malignancies, their presence is of tremendous concern due to their often grave prognosis.Objective: To determine the pattern of occurrence, histopathologic types of maxillofacial sarcomas and their proportion to other malignant neoplasms of this region based on archival material accumulated over 10 years (2000-2009).Design: A combined retrospective and prospective cross-sectional study.Setting: The University of Nairobi Dental Hospital (UNDH).Subjects: All cases with a diagnosis of sarcoma registered between 2000-2009 were evaluated.Results: Of the 528 malignancies recorded over the ten-year period, 427 (80.9%) were of epithelial origin while 101 (19.1%) were sarcomas. Patients with epithelial malignancies were older (54.16 ± 15.94 years) than patients with sarcomas (31.73 ± 16.78) with the differences having been statistically significant. Osteosarcoma was the most commonlyoccurring sarcoma (29.7%), followed by Kaposi’s sarcoma (KS) (28.7%), fibrosarcoma (FBS) (18.8%), and rhabdomyosarcoma (RMS) (9.9%). Sarcomas peaked in the third decade with 70% occurring below the age of 40 years. The maxilla and the mandible were the most afflicted sites in the maxillofacial region accounting for 52%. The patients on averagepresented to medical personel about nine months after noticing the lesion with the most frequent complaint having been swelling.Conclusion: The present study confirms the relative rarity of maxillofacial sarcomas. It also provides data on the histopathologic types and demographic characteristics of maxillofacial sarcomas in a select Kenyan population. This information is a contribution to the comprehensive documentation of sarcomas that occur globally and is useful in theprovision of baseline data upon which future prospective analytical protocols may arise

Maxillofacial soft tissue injuries in Nairobi, Kenya

Objectives: To determine the aetiological factors and pattern of occurrence of maxillofacial soft tissue injuries (MF-STIs) presenting at a Kenyan National Referral Hospital in Nairobi.Design: A cross-sectional study.Settings: The accident and emergency department of the Kenyatta National Hospital (KNH) between September 2009 and December 2009.Subjects: Four hundred and twenty two patients treated for MF-STIs.Results: The male to female ratio was 3.3:1. Motor vehicle accidents (MVA) were the leading cause of MF-STIs (44.6%) followed by interpersonal violence (IPV) (39.1%). MVA (50.0%) was the leading cause of MF-STIs in the less than 12- year-olds while falls from heights (58.3%) was the leading cause in under five-year-olds. IPV (48.1%) was the leading cause of facial fractures. There were no skeletal fractures observed in the under five-year-olds. Head injury (36%) and fractures of the long bones (52%) were the most common associated injuries.Conclusion: The leading causes of MF-STIs apparently differ from those of skeletal fractures