Severe odontogenic infections: a 5-year review of a major referral hospital in Ghana

Introduction: odontogenic infections are fairly common in healthcare settings. However, late presentations such as Ludwig's angina, facial cellulitis, necrotizing cervical fasciitis (NCF), among others could lead to mortality. In view of suggestions that the occurrence of severe, near-fatal odontogenic infections is declining, this study set out to determine the incidence of such severe odontogenic infections over the past 5 years at the Korle-Bu Teaching Hospital, a major referral centre in Ghana. Methods: a retrospective review was done, involving all patients with severe odontogenic infection, thereby requiring admission, per stated criteria at the Department of Oral and Maxillofacial Surgery (Dental clinic), Korle-Bu Teaching Hospital, in the period between July 2012 and July 2017. The cumulative incidence for the respective years were then computed for the years of review. Results: a total of 243 patients were included in the study. This consisted of 121 males and 122 females, with an average age of 42.9 years (SD = 16.6), ranging from 18 months to 91 years. Incidence proportions for the years of the review were 8.2, 8.9, 17.7, 17.9 and 27.7 people per 1000 cases of tooth-related infections for the respective years. With a fatality rate of 5.8%, the incidence of odontogenic infections among patients attending the outpatient Dental clinic of the hospital is 40.3%, while that of dentoalveolar abscess is 6.2%. Ludwig's angina was the commonest (52%) form of presentation of spreading odontogenic infection. Conclusion: this study highlights the importance of persisting severe, near-fatal odontogenic infections in Ghana. Not only is there a need to assess the public, professional and institutional strategies to management, but for more evidence-based studies in our local setting to aid in management

Tumours and tumour-like lesions of the lower face at Korle Bu Teaching Hospital, Ghana – an eight year study

<p>Abstract</p> <p>Background</p> <p>The oro-facial region including the jawbones, the maxilla and mandible and related tissues can be the site of a multitude of neoplastic conditions. These tumours have a predilection for the entire facial region; however, odontogenic tumours tend to affect the mandible more than the maxilla, especially, in West African children. We report results from a retrospective study spanning eight years on the frequency, clinical presentation, sites and character of lower face tumours seen in the main referral hospital in Ghana.</p> <p>Patients and methods</p> <p>Records of consecutive patients of all age and sex seen by the first author's team at the Department of Oral and Maxillofacial Surgery, Korle-Bu Teaching Hospital with tumours affecting the lower part of the face from January 1996 to December 2003 were retrieved, coded and entered into a database. The data were then analyzed by age, sex, presenting signs and symptoms, site of lesion, and their histology.</p> <p>Results</p> <p>A total of 394 patients with oro-facial swellings were retrieved from the registry out of which 210 had lower face tumour and tumour-like lesions. The complete data set was obtained for 171 patients, comprising 99 (58%) males and 72 (42%) females. The most common clinical presenting features were mandibular facial swelling (63%), intra-oral swelling (55%), pain (41%) and ulceration (29%). The tumours were predominantly found in the right (43%), anterior (19%) and left (18%) aspects of the lower face. The remainder making up 20% were found in the floor of the mouth, tongue and lips. Seventy eight (45.6%) of the patients presented with lesions that were classified as malignant of which 54 (62%) were diagnosed as squamous cell carcinoma (SCC). Sixty-two (36.3%) had benign odontogenic tumours and thirty-one (18.1%) had non-odontogenic tumour-like lesions. Fifty-four (62%) of malignant tumours were squamous cell carcinoma; 58 (93.6%) of the benign odontogenic tumours were classified as ameloblastoma. The mean age at presentation of all lesions was 40.4 years with over 50% of benign lesions in patients aged between 11 and 30 years. Malignant tumours were more commonly detected in patients between 41 and 70 years (63%).</p> <p>Conclusion</p> <p>Tumours and tumour-like lesions of the lower face comprising the mandible, tongue and adjacent structures are a diverse group of neoplasm and are seen commonly in practice of Maxillofacial surgery. Both malignant and benign tumours are seen in the Ghanaian population. In the present study, SCC and ameloblastoma were the commonest malignant and benign odontogenic tumours seen respectively; the two representing more than 65% of all tumours.</p

The complexity of interacting nutritional drivers behind food selection, a review of northern cervids

The research literature on food selection by large herbivores is extensive. Still, we are generally lacking in our knowledge of the influence of potentially interacting chemical contents of the food. We made a qualitative review of a systematic literature search of studies that empirically link chemical contents of food to the food selection by northern cervids (genera Alces, Capreolus, Cervus, Dama, Odocoileus, Rangifer). We found that although the majority of the 98 relevant studies measuring any given food constituent (energy, protein, fiber, minerals, plant secondary metabolites) provided support for it acting as a driver of food selection (in either a negative or positive way), there was little support for the traditional hypotheses of maximization or limitation of any single constituent. Rather, because of the animals’ need to acquire an appropriate intake of several constituents at the same time, our review highlights how new empirical stud- ies need to focus on several food constituents in synchrony: (1) Study designs should capture sufficient variation in the content of food constituents in order to tease apart their many co-variations; and (2) insights about nutritional drivers may be lost if one uses only composite currencies such as crude energy, crude fiber, ash, or tannins, which may mask contrasting selection patterns of the lumped constituents. Season had an apparent influence on the selection of some food constituents, particularly various fiber frac- tions. In contrast, our review revealed a lack of evidence that cervids more strongly select for protein in summer than they do in winter. Our overall conclusion of the review is that interacting chemical contents of food make the nutritional value of a given food type into a varying entity. To better elucidate this varia- tion, we need new technologies that non-invasively capture nutrient intake of free-ranging animals, across seasons.The complexity of interacting nutritional drivers behind food selection, a review of northern cervidspublishedVersio

Primary Impression for an Edentulous Patient

This multimedia-based module is part of a series designed for students to assist in preparation for clinical examinations in dentistry. This module explores basic guidelines in dentistry for making primary impression for an edentulous patient. This module has been internally reviewed by a cross-disciplinary committee within University of Ghana prior to releasing as an Open Educational Resource.http://deepblue.lib.umich.edu/bitstream/2027.42/133172/1/medical_african_health_oer_network-dentistry-primary_impression_for_an_edentulous_patient-October12.zi

Placement of Orthodontic Separators

This multimedia-based module is part of a series designed for students to assist in preparation for clinical examinations in dentistry. This module demonstrates how orthodontic separators are placed. This series has been internally reviewed by a cross-disciplinary committee within University of Ghana prior to releasing as an Open Educational Resource.http://deepblue.lib.umich.edu/bitstream/2027.42/133161/1/medical_african_health_oer_network-dentistry-placement_of_orthodontic_separators-October12.zi

Examination of the Dental Patient

This multimedia-based module is part of a series designed for students to assist in preparation for clinical examinations in dentistry. This module explores basic guidelines for examining a dental patient. This module has been internally reviewed by a cross-disciplinary committee within University of Ghana prior to releasing as an Open Educational Resource.http://deepblue.lib.umich.edu/bitstream/2027.42/133139/1/medical_african_health_oer_network-dentistry-examination_of_the_dental_patient-October12.zi

Examination of the Edentulous Patient

This multimedia-based module is part of a series designed for students to assist in preparation for clinical examinations in dentistry. This module explores basic guidelines in dentistry for examining an edentulous patient. This module has been internally reviewed by a cross-disciplinary committee within University of Ghana prior to releasing as an Open Educational Resource.http://deepblue.lib.umich.edu/bitstream/2027.42/133150/1/medical_african_health_oer_network-dentistry-examination_of_the_edentulous_patient-October12.zi

A suspected dental cellulitis leading to diagnosis of both herpes zoster ophthalmicus and HIV

AbstractHerpes zoster ophthalmicus and HIV are serious health problems. We report a case of a 37-year-old woman who presented to the Korle-Bu Teaching Hospital with dyspnea and facial cellulitis, and a diagnosis 5 days prior of dental cellulitis made at a district hospital. Investigations revealed that the facial cellulitis was secondary to herpes zoster infection involving the ophthalmic division of the left trigeminal nerve. The patient responded well to oral acyclovir but developed postherpetic neuralgia. During the course of treatment, she was also diagnosed to be HIV-1 positive and was referred for further management. This case represents a unique report in which the patient presented to the hospital with symptoms of cellulitis suggestive of underlying dental infection but was later diagnosed with both herpes zoster ophthalmicus and an underlying HIV infection. Atypical presentations of herpes zoster can occur in HIV/AIDS. Signs of herpes zoster infection with cellulitis should alert the clinician that the patient may have a possible underlying immunosuppressive disease. The population must be educated regarding the importance of early presentation and careful compliance with treatment as well as regular follow-ups