A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians

Introduction: Ameloblastoma is the most common odontogenic tumour in Nigeria. A definite geographic variation has been observed in the frequency of odontogenic tumors from different parts of the world. However, there is no study on the regional variations in Nigeria. Hence, this study was designed to document the ethnic and geographical distribution of jaw ameloblastoma in Nigeria.Methods: Archival data on ameloblastoma from 10 health facilities were obtained. Global Moran’s I detected geographic clustering in its distribution while Local Getis Ord indicated the location of ameloblastoma clusters. Chi-square tested associations between variables at 0.05 level of significance.Results: A total of 1,246 ameloblastoma cases were recorded in Nigeria. Besides substantial state variations, a South-North gradient was noticed in its distribution. Significant positive spatial autocorrelation was observed in the three major groups while ameloblas- toma hotspots were found in the SouthWestern and Northwestern Nigeria. The Igbos had a higher prevalence of ameloblastoma outside their home region than within.Conclusion: The study hypothesized that the geographical distribution of ameloblastoma in Nigeria is the result of all or one of the following:  the country’s tropical climate, migration patterns and health seeking behavior. Hopefully, these claims should lead to further enquiry on the underlying causes.Keywords: Ameloblastoma, ethnicity, spatial analysis, Nigeria

A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians

Introduction: Ameloblastoma is the most common odontogenic tumour in Nigeria. A definite geographic variation has been observed in the frequency of odontogenic tumors from different parts of the world. However, there is no study on the regional variations in Nigeria. Hence, this study was designed to document the ethnic and geographical distribution of jaw ameloblastoma in Nigeria. Methods: Archival data on ameloblastoma from 10 health facilities were obtained. Global Moran\u2019s I detected geographic clustering in its distribution while Local Getis Ord indicated the location of ameloblastoma clusters. Chi-square tested associations between variables at 0.05 level of significance. Results: A total of 1,246 ameloblastoma cases were recorded in Nigeria. Besides substantial state variations, a South-North gradient was noticed in its distribution. Significant positive spatial autocorrelation was observed in the three major groups while ameloblastoma hotspots were found in the SouthWestern and Northwestern Nigeria. The Igbos had a higher prevalence of ameloblastoma outside their home region than within. Conclusion: The study hypothesized that the geographical distribution of ameloblastoma in Nigeria is the result of all or one of the following: the country\u2019s tropical climate, migration patterns and health seeking behavior. Hopefully, these claims should lead to further enquiry on the underlying causes. DOI: https://dx.doi.org/10.4314/ahs.v19i1.44 Cite as: Adisa AO, Osayomi T, Effiom OA, Kolude B, Lawal AO, Soyele OO, et al. A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians. Afri Health Sci. 2019;19(1). 1677-1686. https://dx.doi.org/10.4314/ ahs. v19i1.4

Ameloblastoma: Our clinical experience with 68 cases

Introduction: In this environment, previous workers have reported on the challenges of managing large sized ameloblastoma of the jaws with less than adequate facilities. The aim of this review is to present the management of 68 cases of ameloblastoma with emphasis on surgical care. Materials and Methods: Retrospective survey of case notes of patients with histopathologic diagnosis of ameloblastoma (using the criteria of Barnes et al., 2005) seen between January 2006 and August 2010 at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria was undertaken. Data collected includes histopathological diagnosis, age, gender, clinical information on site of lesion, form of intubation and surgical procedure performed. Results: Out of 94 patients, 68 with histological diagnosis of ameloblastoma (59 mandibular and 9 maxillary) were operated within the study period. The remainder (26) was not treated in hospital. Among 68 patients treated, more were males (38) than females (30), giving a male to female ratio of 1.3:1. The age range was between 14 and 74 years (mean-standard deviation). The duration of the symptoms ranged from 7 months to 24 years, most were follicular ameloblastoma (n = 13) followed by acanthomatous type (n = 7). Endotracheal intubation was the most common (n = 55) followed by fiber optic laryngoscopy (n = 8). The surgical approach most used was extended Risdon with intraoral (n = 24) followed by extended Risdon with lip split and intraoral (n = 17). Segmental resection (en block) formed the bulk of our procedures (n = 22) followed by subtotal mandibulectomy (n = 16). Conclusion: The treatment of ameloblastoma remains controversial. Its destructive nature has left patients with wide defects difficult to reconstruct

Clinico-epidemiologic review of 91 cases of non-odontogenic sarcomas of the orofacial region in a Nigerian population

Introduction: Sarcomas are a rare group of malignant tumours. This study highlights important findings in 91 cases of nonodontogenic sarcomas of the orofacial region. Materials and Methods: Patients who presented with orofacial sarcoma at the Oral and Maxillofacial Surgery Department of a regional University Teaching Hospital between January 1997 and June 2017 were retrospectively studied. Excluded were cases of Kaposi and odontogenic sarcomas. Data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA). Results from descriptive statistics were represented in the form of charts. Results: A total of 91 cases were reviewed and consisted of 51 (56.0%) males and 40 (44.0%) females, with a male to female ratio of 1.3:1. The mandible (n = 47; 51.6%) and the maxilla (n = 26; 28.6%) were the major sites involved. Osteogenic sarcoma (n = 44; 48.4%) and rhabdomyosarcoma (n = 16; 17.6%) occurred more frequently. A total of 41 (45.1%) patients had surgery and the common hard tissue procedures were mandibulectomy (n = 26; 28.6%) and maxillectomy (n = 10; 11.0%). Discussion: Most recurrences were noted less than one year post treatment. There is a tendency for patients to present late and compliance with follow-up review is poor in this environment

Odontogenic Cervicofacial Infection in Pregnancy: A Need for Oral Care

Objective: During pregnancy, changes occur in the oral environment with gingivitis predominating. The development of odontogenic infections within the period of pregnancy may endanger the life of the mother as well as that of her unborn baby. Materials and methods: A retrospective observational study of cases of cervicofacial infection in women during pregnancy was conducted at the oral and maxillofacial surgery clinic of a northern Nigerian tertiary health care center from January 2006 to June 2018. Results: Seventy women were managed for cervicofacial infection during the period reviewed, out of which 20 women (28.6%) presented during pregnancy. Their mean age was 33.8 ± 9.35 years with a range of 20 to 55 years. The 30-39 years age bracket had the highest frequency (40%) and the mean duration of pregnancy at presentation was 24.9 ± 11.12 weeks with a range between 10 to 36 weeks. Majority (n=15, 75.0%) presented in the 3rd trimester. At presentation, the frequently involved fascial space was unilateral submandibular space (n=10; 50.0%), All the patients had incision/drainage/decompression on the dental chair under local anesthesia (2% lidocaine with 1:80,000 adrenaline). The mean length of hospital stay was 13.9 ± 6.2 days with a range of 6 to 26 days. The mortality rate was 15% (n=3 cases). Conclusion: There is a need for oral health evaluation in pregnant women during ante-natal visits to prevent these complications. Oral health education should also form part of teachings received by women both in the ante-natal and postnatal clinics

Orofacial Soft Tissue Reconstruction with Locoregional Flaps in a Health Resource-Depleted Environment: Experiences from Nigeria

Background Reconstruction of orofacial soft tissue defects is often challenging due to functional and aesthetic demands. Despite advances in orofacial soft tissue defect reconstruction using free flaps, locoregional flaps still remain an important option, especially in health resource-depleted environments. This retrospective study highlights our experiences in oral and maxillofacial soft tissue reconstruction using locoregional flaps. Methods A twenty-three years retrospective analysis of all patients managed in our department was undertaken. Information was sourced from patients' case notes and operating theater records. Data was analyzed using SPSS ver. 16 (SPSS Inc.) and Microsoft Excel 2007 (Microsoft). Results A total of 77 patients underwent orofacial soft tissue defect reconstruction within the years reviewed. Males accounted for 55 (71.4%) cases and trauma was the main etiological factor in 45 (58.4%) of the patients treated. When sites of defect were considered, the lip, 27 (32.1%), was the most frequent site followed by the nose, 17 (20.2%). Forehead flap, 51 (59.3%), was the most commonly used flap. Complications noted were tumor recurrences at the recipient bed in 3 (3.9%) cases, tumor occurrence at the donor site in 1 (1.3%) case and postoperative infection in 11 (14.3%) cases. Conclusions Locoregional flaps still have an important role in the rehabilitation of patients with orofacial soft tissue defects. They remain a vital tool in the armamentarium of the reconstructive surgeon, especially in health resource-depleted environments where advanced reconstructive techniques may not be feasible

Pattern of Ocular Involvement in Midface Injuries Seen at a Tertiary Care Hospital in Northern Nigeria

Aim: The aim of the study was to report the etiology, pattern, and spectrum of ocular injuries in patients with maxillofacial injuries seen at a tertiary care hospital in northern Nigeria.  Patients and Methods: This is a retrospective evaluation of the etiology, spectrum, and treatment of ocular injures seen in patients with midfacial fractures, who presented at Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria, a tertiary care hospital in northern Nigeria. Cases were seen at the oral and maxillofacial clinic for those presenting with midfacial fractures, whereas those presenting with ocular injuries due to midfacial injuries were referred from the ophthalmology department. Data were collected on their demographics, etiology of injuries, body part(s) involved, and treatment. Results: A total of 256 patients had midfacial injuries during the period, of which 219 patients had 357 associated ocular injuries. The age range was between 3 and 76 years. There were more males (83.8%) than females (16.2%), giving a male-to-female ratio of 5.2:1; the 21–30 years' age bracket was most frequently affected (38.4%). The predominant etiology of injuries was road traffic accidents (RTAs) (90.1%), followed by assault (4.9%). Zygomatic complex fractures (38.6%) and orbital wall fractures (24.7%) were the common midfacial injuries. There were 357 ocular injuries, giving a patient: injury ratio of 1:1.6, with subconjunctival hemorrhage (32.5%) and ruptured globe (20.0%) being common. Treatments performed were reduction and immobilization of midfacial fractures plus evisceration (32.0%), followed by reduction and immobilization of fractures alone (23.9%) and reduction and immobilization plus grafting of soft tissues (21.2%). Conclusion: Ocular injuries are quite common in patients with midfacial injuries, with a ratio of 1.6:1. RTA was the most common etiology, with zygomatic complex fractures as the most common midfacial injury. Subconjunctival hemorrhage was the most common ocular injury manifestation, with young adults (21–30 years of age) being most affected. Treatment often involved reduction and immobilization of midface fractures with evisceration and grafting of ocular tissues

A 10-Year Retrospective Analysis of 64 Cases of Cystic Lesions of the Oral and Maxillofacial Region in a Nigerian Tertiary Hospital

Objectives: Orofacial cysts are broadly divided into odontogenic and nonodontogenic types, epithelial or non-epithelial, and developmental or inflammatory in origin. The odontogenic cyst is an osseous-destructive lesion that most commonly affects the jaw. It is formed by activation of odontogenic cell rests entrapped within the bone or gingival tissue of the jaws, such as the epithelial remains of Malassez, the dental lamina (cell rests of Serres), or the enamel organ. Methods: We performed a retrospective study of all histologically diagnosed cysts of the orofacial region seen at the Maxillofacial clinic of the Ahmadu Bello University Teaching Hospital, Nigeria, between January 2003 and December 2012. Results: Over the 10-year study period, 64 cases of cystic lesions of the orofacial region were seen in 1162 pathological specimens, representing 5.5%. Of these, there were 35 (54.7%) lesions in males and 29 (45.3%) in females giving a M:F ratio of 1.2:1. The age of the patients ranged from 4–64 years old (mean = 26.3 years). Dentigerous cyst (n = 21; 32.8%) was the most predominant lesion followed by periodontal (n = 12; 18.8%) and radicular cysts (n = 10; 15.6%). Conclusions: Cysts of the orofacial region are common in this environment and like previous studies from Nigeria odontogenic cysts are not uncommon, the most predominant being dentigerous cysts

The forehead flap: a valuable option in resource depleted environment

Aim: Reconstruction of orofacial soft tissue defect is often challenging and this is more difficult in resource challenged environment. This retrospective study highlights our experience with the use of forehead flap to overcome some of the challenges of orofacial reconstruction in a resource depleted environment.Methods: A 23-year retrospective analysis of all patients who had orofacial defect reconstruction using forehead flap in our department was undertaken. Information was sourced from patient’s case notes and operating theatre records. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2007 (Microsoft, Redmond, WA, USA).Results: A total of 43 patients were managed within the period reviewed and consisted of 31 (72.1%) males and 12 (27.9%) females. Trauma 24 (55.8%) accounted for most defect and the lip was the commonest site of defect. Complete forehead flap was used in 31 (72.1%) of cases and when timing of defect repair is considered, delayed reconstruction was the preferred method. Postoperative complications was observed in 8 (18.6%) patients and consisted of failed flap in 2 (25.0%) patients, tumor recurrence in reconstructed site in 2 (25.0%) patients and tumor occurrence in forehead flap donor site in 1 (12.5%) patient.Conclusion: The forehead flap remains a reliable option in orofacial soft tissue defect reconstruction. It is easy to raise and can provide coverage for wide defects as far as the paramandibular and submandibular regions. Moreover, it does not require patient repositioning

Anaesthesia for Maxillofacial Surgeries: A 10 Year Review in ABUTH Zaria

Background: Maxillofacial surgeries pose lots of challenges to the attending anaesthetist especially as regards emergency airway management. The anaesthetist must be conversant with the techniques and appliances of managing both anticipated and unanticipated difficult airway.Objective: To present a retrospective review of the anaesthesia for 952 cases of maxillofacial surgeries treated over a period of ten years (2006 - 2015) in Ahmadu Bello University Teaching Hospital (ABUTH) Shika-Zaria, Nigeria.Methodology: After obtaining ethical approval from the hospital Ethics Committee, data were sourced from the clinical records of 952 cases of maxillofacial surgeries in ABUTH. All the patients had pre-anaesthetic assessment by the attending anaesthetist and informed consents were taken. Decision for the intubation technique was based on airway assessment by Mallampati classification, thyromental distance and atlanto-axial mobility. All patients were premedicated with intravenous atropine 10mcg/kg on the operating table.Results: Our findings identified fractures as the most common injury suffered by the patients, affecting 264 patients (27.7%), followed by ameloblastoma 168 patients (17.6%). Patients who had foreign body in the nostril were 10 (1.1%), while 165 (17.3%) were unclassified cases. Nasal intubation with direct visualization of vocal cords occurred most frequently (62.9%), followed by fibre-optic intubation (24.9%). Oral intubation was carried out in 44 (4.6%) patients, while tracheostomy was performed in 72patients (7.6%). In 281patients with anticipated difficult airway, fibre-optic intubation was attempted in all cases with asuccess rate of 84.7%.Conclusion: Difficult airway in maxillofacial surgeries is common anddemands special attention. Time of surgery should be carefully planned allowing reduction of anaesthetic morbidity and mortality.Key words: Difficult airway, Premedication, Anaesthetic plans, Fibre-optic intubation, Tracheostomy