Management of maxillofacial osteosarcomas in Kenya

Background: Though not common, maxillofacial osteosarcomas present a unique challenge in management due to a multitude of factors, such as difficulty in diagnosis and local complex anatomy, making surgical excision difficult as well as debate necessary on the usefulness of adjunct treatment modalities, such as chemotherapy and radiotherapy. Nonetheless, osteosarcomas are a significant health burden because of their high morbidity and mortality.Method: Retrospective cross-sectional study of records archived in the School of Dental Sciences, University of Nairobi. Results: 25 cases of maxillofacial sarcomas were seen over 26 years. Mean age of occurrence was 35.68 years with a preponderance for females (17 cases). The mandible was the most affected site, accounting for 18 cases.Discussion: The management of maxillofacial sarcomas in our setting presents significant challenges arising from multiple factors such as lack of standardised treatment protocol, late presentation of patients, diagnostic challenges and loss to follow-up.Keywords: Maxillofacial osteosarcomas, Management protocol, Keny

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

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 (

Metastatic bronchogenic carcinoma to the mandible

A case of a metastasis of adenocarcinoma of the lung to a secondary site in the mandible, in a 53-year-old woman, is presented. The patient complained of trismus, swelling and numbness over the left side of face for 8-weeks. Examination revealed limited left condylar mobility, a firm tender swelling the angle of the mandible and paresthesia of the left inferior alveolar nerve. Computed Tomography revealed an osteolytic lesion in the left angle and ascending ramal region suggestive of a malignant tumor. Her chest radiograph findings were of a diffuse homogenous opacification with ipsilateral pleural effusion pointing to a pneumonic process. Histology features were of moderately differentiated adenocarcinoma. A search for the primary included a bronchial biopsy which revealed, the primary lesion was from the lung. This rare case highlights the difficulty and challenges in making the diagnosis clinicians may encounter in establishing the primary site of metastatic disease. There is need to develop high index of suspicion with regards to metastasis to the Craniofacial and mandibular bones. Multidisciplinary team approach is recommended when dealing with such patients.Keywords: Bronchogenic Carcinoma, Metastasis, Mandibl

Aetiology, pattern and management of oral and maxillofacial injuries at Mulago National Referral Hospital

Objective: To establish the aetiology, pattern and methods of  management of oral and Maxillofacial injuries (OMFIs) seen at the Oral and Jaw injuries unit of Mulago National Referral Hospital (MNRH) Kampala, Uganda, over a ten year period.Design: A descriptive retrospective study.Setting: Oral and jaw injury unit of Mulago National Referral Hospital, Kampala, Uganda.Results: One thousand two hundred and three patient records met the inclusion criteria. The age range was 1-90 years with a male: female ratio of 4.5:1. The age-group most affected was the 21-30-year-olds. Road traffic injuries (RTIs) were responsible for 61% (n=735 of the injuries, interpersonal violence27.6% (n=332), accidental falls 12% (n=142) and firearm injuries 2.2% (n=27). Of the maxillofacial fractures (n=1069)isolated mandibular fractures were 62%, isolated mid-facial fractures 24% whereas Pan-facial fractures accounted for 14% .Conclusion: The victims of OMFIs were mostly young men between 21 and 30 years of age. The main aetiological factors were road traffic injuries (RTIs) and interpersonal violence (IPV), while the lower third of the face was most often involved. Consistent with findings in other studies, RTI and IPV remain the two main causes of Maxillofacial injuries and public health measures targeting prevention should focus on these areas

Orbito-Maxillofacial Cutaneous Anthrax

Background: Cutaneous anthrax is a zoonotic disease that spreads to humans primarily through exposure to infected animals, animal products or spore infested soil. Microbiological identification of cutaneous anthrax may be obscured by previous antibiotic use. Thorough history and clinical examination is therefore necessary in making a diagnosis. There is a paucity of reports about these infections in our region.Methods: Five cases are presented with a history of contact with animal or animal products and the typical appearance of skin lesions. Two cases were confirmed through microbiologic gram staining. All cases were treated with antibiotics and resolution of the initial cutaneous lesions was noted within three weeks.Conclusion: Thorough clinical history, examination and a high index of suspicion are paramount in making a diagnosis. Management with a combination of antibiotics ensures clinical resolution.Keywords: Anthrax, Orbital-Maxillofacial, Cutaneou

Intra-myocardial Bullet causing heart block in a patient with multiple gunshot wounds: Case Report

Elective removal of intra-myocardial bullet remains a controversial subject. A non-operative approach has been recommended as appropriate for a stable asymptomatic patient. In the presence of complications such as bleeding, perforation leading to cardiac tamponade, thrombus formation, embolization, rhythm disturbances and infections, surgical removal may be advised. We present a patient who survived multiple gunshot wounds with a bullet lodged in the wall of the left ventricle of the heart. Details of the injuries sustained, operative removal of the bullet and the challenges that ensued are illustrated

Reactive Localised Inflammatory Hyperplasia Of The Oral Mucosa

Objective: To document the histopathological pattern and distribution of reactive localised inflammatory hyperplastic lesions of the oral mucosa diagnosed at the University of Nairobi Dental Hospital over a 14 year period.Design: A retrospective, cross-sectional descriptive study.Setting: Division of Oral Pathology and Oral Medicine, histopathology laboratory, School of Dental Sciences, University of Nairobi.Subjects: A total of 3135 oral biopsies were accessioned in the oral diagnostic histopathological Laboratory registry over a period of 14 years from March 1991 to December 2005.Results: Three hundred and thirty three cases were histopathologically diagnosed as reactive inflammatory hyperplasias of the oral mucosa. This constituted 10.6% of the total oral biopsy specimens analysed during this period. Fibrous epulis was the most common histological sub-type with 129 cases (38.7%) followed by pyogenic granuloma with 94 (28.3%) cases. Six (1.8%) caseswere peripheral giant cell granuloma and threecases(0.9%) were those of denture irritation hyperplasia. The age distribution ranged from 2 to 78 years( mean=30.5 years) with a peak at 20-29 years. Gender distribution showed that 107 (32%) cases occurred in males and 226 (68%) cases females. Similar trends were observed in most of the histological sub-types. Fibrous epulis occurred in41 male (31.8%) cases and in 88 (68.2%) females with an age range of 2 to 78 years ( mean = 30.5 years). As for the pyogenic granuloma, 26 (27.7%) lesions occurred in males and 68 ( 72.3%) in females with an age range of 2 to 75 years ( mean = 30.1 years). Among all the histopathological sub-types it was shown that 223 (67.0%) cases were fibrous, 104 (31.2%) vascular and six (1.8%) peripheral giant cell granuloma. Gingival lesions were the most common with 257 (77.2%) cases followed by 28 (8.4%) in the tongue, 16(4.8%) lips, 15 (4.5%) cheek, six (1.8%) palate and the rest on the floor of the mouthand other mucosal sites. The duration of these lesions was recorded in 182 (54.7%) cases and ranged from 1 week to 16 years (mean=1.8 years).Only 15 (4.5%) cases were reported to have recurred and all of them were gingival lesions.Conclusion: The present study has shown that the prevalence of reactive localised inflamatory hyperplasia (RLIHs) of the oral mucosa was 10.6% with fibrous epulis and pyogenic granuloma having been the most common histopathological sub-types predominantly affecting females. Although RLIHs are distinguished on clinical or histopatholocal grounds, it is important to appreciate that they are variations of the same basic process

Oral hygiene practices and risk of oral leukoplakia

Objective: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. Design: Case control study. Setting: Githongo sublocation in Meru District. Subjects: Eighty five cases and 141 controls identified in a house-to-house screening.Results: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the “don't brush” group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1 .4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). Conclusion: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes. East African Medical Journal Vol. 83(4) 2006: 73-7

Chondrosarcoma of the temporomandibular joint

No Abstract. African Journal of Oral Health Sciences Vol. 5 (1) 2007: pp. 8-1