Retrospective evaluation of necrotizing fasciitis in university college hospital, Ibadan

Context: Cervicofacial necrotizing fasciitis (CNF), although a potentially fatal fulminant infection has been largely under‑reported in the dental literature.Aims: To report our experience with cases seen and treated at the University College Hospital, Ibadan, Nigeria.Settings and Design: A descriptive retrospective clinical study.Materials and Methods: A retrospective survey of cases treated between January 2002 and January 2007 was done. Diagnosis of CNF was established by fascia necrosis found on surgical exploration. Patients’ age, sex, medical status, etiology of infection, bacteriology, and treatment received and complications were reviewed.Statistical Analysis Used: SPSS version 15.Results: Of the 48 cases of cervicofacial infection admitted during the study period, only 12 cases of CNF were found. Male:Female ratio was 4:8. The mean age of patients was 58.83 ± 11.91 years while the age range was 42–83 years. Those that had immunocompromised medical conditions included three cases each of diabetes mellitus and chronic nutritional anaemia and one case of retroviral infection. Mixed bacterial isolates of anaerobes and enterobacteriaceae were found in 10 cases while beta hemolytic streptococci were the sole isolate in two cases. All patients had serial debridement combined with intravenous antibiotic medications. Complications included anterior chest wall infection in three patients and one case of pleural effusion. The only mortality occurred in the patient with retroviral infection.Conclusions: We advocate early recognition, surgical debridement and intensive medical care for treatment of CNF in order to reduce morbidity and mortality from this condition

Mandibular defect reconstruction with nonvascularized iliac crest bone graft

Context: Reconstruction of mandibular defect is a challenge to the head and neck surgeon because of associated functional and esthetic problems. Our experience with the use of nonvascularized iliac crest bone graft is hereby reported.Aim: The aim was to report our experience with the use of nonvascularized iliac crest bone for mandibular defect reconstruction at University College Hospital, Ibadan. Nigeria.Settings and Design: A retrospective descriptive study was performed.Materials and Methods: Cases of mandibular reconstruction with iliac crest bone graft between January 2001 and December 2007 were included in this study. Grafts were secured with either a stainless steel wire or a titanium plate.Preoperative diagnosis, postoperative follow-up records including investigations, diagnosis of graft infection and subsequent treatment modalities were extracted from the available records.Statistical analysis used: Descriptive variables were analyzed with SPSS version 14.Results: A total of 47 patients had mandibular defect reconstruction with nonvascularized iliac crest block bone during the study period. Thirty-eight patients had graft secured with transosseous wire [NVIBw] while 9 had a titanium plate [NVIBp]. The male:female ratio was 26:21 while the mean age of the patients was 24.6±4.25 years. Ten patients (21.3%) developed persistent graft infection during the postoperative period. All cases of infection occurred in patients who had transosseous wiring and analysis showed that 60% of the infected grafts revealed mixed microbial isolates containing klebsiela spp, pseudomonas aeurogenosa, and e coli. Six (60%) of the infected grafts were removed as a result of unabated infection while 4 (40%) were successfully treated by exploration and pus drainage.Conclusions: Nonvascularized iliac crest bone graft provides an affordable and less technical choice for mandibular reconstruction with minimal complications in a resource-limited economy

Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation-a randomised prospective clinical trial

<p>Abstract</p> <p>Background</p> <p>The zygoma plays an important role in the facial contour for both cosmetic and functional reasons; therefore zygomatic bone injuries should be properly diagnosed and adequately treated. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management and long-term follow up. The preference for open reduction and internal fixation of zygomatic fractures at three points has continued to grow in response to observations of inadequate results from two point and one point fixation techniques.</p> <p>The objectives of this study were to compare the efficacy of zygomatic bone after treatment with ORIF using 2 point fixation and ORIF using 3 point fixation and compare the outcome of two procedures.</p> <p>Methods</p> <p>100 patients were randomly divided equally into two groups. In group A, 50 patients were treated by ORIF using two point fixation by miniplates and in group B, 50 patients were treated by ORIF using three point fixation by miniplates. They were evaluated for their complications during and after surgery with their advantages and disadvantages and the difference between the two groups was observed.</p> <p>Results</p> <p>A total of 100 fractures were sustained. We found that postoperative complication like decreased malar height and vertical dystopia was more common in those patients who were treated by two point fixation than those who were treated with three point fixation.</p> <p>Conclusions</p> <p>Based on this study open reduction and internal fixation using three point fixation by miniplates is the best available method for the treatment zygomatic bone fractures.</p

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

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Pattern of Assault-induced Oral and Maxillofacial Injuries in Ado-Ekiti, Nigeria

Background: Assault, though a major cause of maxillofacial injuries in the developed nations, has not been adequately investigated among Nigerian population. This study aimed to analyze the pattern of maxillofacial injuries caused by assault in our institution.Methods: A descriptive clinical survey of patients with assault-induced oral and maxillofacial injuries presenting to our maxillofacial surgery clinic/emergency ward was carried out. Demographic data and pattern of injuriesobtained from patients’ record and department trauma databasewere analyzed. Results: 156 patients presented with oral and maxillofacial injuries between October 2009 and December 2010. Thirty-four cases were due to assault and male to female ratio was 1.8:1. The mean age of the patients was 21.4±6.26 years (age range 2–48 years). 23.6% (n=8) of the injuries were due to domestic violence between spouses while 35.3% (n=12) resulted from fight. Students unrest and armed robbery attack accountedfor six cases each (17.7%, n=6), while there were two cases due tochild battering. 64.3% (n=22) of the injuries sustained involved soft tissues while 35.7% involved hard tissues. Contusion was the most common isolated soft tissue injury accounting for 56% (n=10) while dentoalveolar fracture was the most encountered hard tissue injury (62.5%, n=16). Conclusion: There is need for preventive strategies to reduce the incidence of assault-induced maxillofacial injuries.Keywords: Assault, oral and maxillofacial injuries, patter

Temporomandibular joint ankylosis in south western Nigeria

Objective: To determine the relationship between the aetiological factors, duration of ankylosis and the types of ankylosis and to evaluate the outcome of different treatments modalities used.Design: Retrospective study of cases managed.Setting: University teaching hospital at Ibadan, Nigeria.Subjects Thirty six cases treated between 1982 and 1997.Results: Infection related aetidogical factors were 66.6% wbie trauma was 27.8%. The relationship between aetiological factors and type of ankylosis classified by anatomic site, was statistically significant. Results suggest that infection-related aetiological factors are likely to give rise to extracapsular ankylosis, while trauma results in intracapsular ankylosis. Twenty five per cent reported for treatment within 12 months of onset of ankylosis while 72.2% reported after 24 months. The relationship between ankylosis of 24 months duration and above, and classifcation of ankylasis according to tissue type was also significant (p&lt;0.05) and suggests that ankylosis of such duration is likely to be bony or mixed fibrous and bony. Of the types of ankylosis, 77.8% bad bony components while 22.2% were of the fibrous variety. As regards treatment, interpositional arthroplasty with the masseter muscle produced results that were more consistent and satisfactory than gap arthroplasty.Conclusion: The aetiological factors and duration of ankylosis ifluenced the type of ankylosis

An Unusual Ocular Injury Following Facial Trauma: A Case Report

Objective: To report a case of an unusual ocular injury following a road traffic accident Materials and Methods: A case report of a sixty – year – old female patient seen by the authors. The literature on ocular injures following facial trauma is reviewed. Results: An eye globe initially confirmed missing from its socket on clinical examination and thought to have been avulsed during the accident was found laterally below the right zygomatic bone during wound debridement. The eye was relocated and mobilized and its vision improved over a month to 6/18. Conclusion: This case reinforces the importance of comprehensive investigations in the management of extensive cases of maxillofacial trauma. KEY WORDS: Unusual; ocular injury; facial trauma. Nigerian Journal of Clinical Practice Vol.6(1) 2003: 68-7