Mandibular reconstruction: a new defect classification system

This paper presents a new mandibular segmental defect classification system (La-Co-CE) with a view to highlight the complexity and difficulty of the reconstruction with free autogenous bone grafts which the most frequently used method for surgeons practicing in developing countries. We submit that defect classification systems will continue to remain relevant if surgeons are to is pre-operatively classify the envisaged operative difficulty and objectively compare the outcome postoperatively. Key words: Mandibular reconstruction, defect, classification

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

Ameloblastic carcinoma: Report of a case

Ameloblastic carcinoma is a rare epithelial odontogenic tumour of the jaws which exhibits cytological features of ameloblastoma and carcinoma. A case of ameloblastic carcinoma in a 52 year old male is reported. Clinical / histological characteristics of this tumour and current knowledge on the classification of odontogenic malignancies are discussed. The importance of including ameloblastic carcinoma in the differential diagnosis of persistent jaw swellings associated with toothache or mobility of teeth or failure of healing of extraction sockets is emphasized. Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 222-22

Oral manifestations of HIV/AIDS infection in Nigerian patients seen in Kano

Objective: To determine the pattern and prevalence of oral lesions in HIV-infected Nigerian patients seen in a referral centre. Design: Prospective hospital based study. Setting: Aminu Kano Teaching Hospital, Kano-a tertiary health institution servicing the entire north-western Nigeria. Subjects: 205 HIV infected individuals who consented to participate in the study. Method: All patients were interviewed and examined by at least two Dental Surgeons trained in diagnosis of oral manifestations of HIV. Data were captured on adapted WHO recording form for oral lesions associated with HIV, transferred and analyzed using MINITAB12.21 (U.S.A). Results: The age range was18-61 years (mean=33.7, S.D =8.0).The M: F =1.2:1; There was statistically significant difference (t=8.1, DF=201, P-value = 0.001) between mean age for males (37.3; S.D.=7.8years) and females (29.5; SD=5.9 years). Overall, 140 (68.3%) patients had at least one oral lesion. Most common lesion was candidosis (60.5%) and the pseudomembranous (45.4%) type was most frequent. Other lesions were HIV gingivitis (27.8%), hairy leukoplakia (14.2%), aphthous ulcer (9.8%), Kaposi's sarcoma (8.3%), melanin hyper-pigmentations (7.3%), herpes simplex infection (5.4%), HIV periodontitis (4.9%), parotid enlargement (1.9%) and HIV-NOMA (0.5%). The mean CD4 counts were 301, 268 and 289 for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA F=0.36 DF=2 P=0.7). Conclusion: Oral lesions are frequently seen in HIV-infected Nigerian patients and the pattern of occurrence is not markedly different from those reported from other African countries. Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 176-18

Transcription profiling reveals potential mechanisms of dysbiosis in the oral microbiome of rhesus macaques with chronic untreated SIV infection.

A majority of individuals infected with human immunodeficiency virus (HIV) have inadequate access to antiretroviral therapy and ultimately develop debilitating oral infections that often correlate with disease progression. Due to the impracticalities of conducting host-microbe systems-based studies in HIV infected patients, we have evaluated the potential of simian immunodeficiency virus (SIV) infected rhesus macaques to serve as a non-human primate model for oral manifestations of HIV disease. We present the first description of the rhesus macaque oral microbiota and show that a mixture of human commensal bacteria and "macaque versions" of human commensals colonize the tongue dorsum and dental plaque. Our findings indicate that SIV infection results in chronic activation of antiviral and inflammatory responses in the tongue mucosa that may collectively lead to repression of epithelial development and impact the microbiome. In addition, we show that dysbiosis of the lingual microbiome in SIV infection is characterized by outgrowth of Gemella morbillorum that may result from impaired macrophage function. Finally, we provide evidence that the increased capacity of opportunistic pathogens (e.g. E. coli) to colonize the microbiome is associated with reduced production of antimicrobial peptides

Odontogenic tumors and giant cell lesions of jaws - a nine year study

<p>Abstract</p> <p>Objectives</p> <p>A definite geographic variation has been observed in the frequency of odontogenic tumors and giant cell lesions of the jaws reported from different parts of the world. However, there are a few studies on these lesions, especially giant cell lesions, reported from India. Hence, this study was designed to provide a demographic data on the odontogenic tumors and giant cell lesions reported from our institute located in the city of Hyderabad. Hyderabad is the capital city of the southern state of Andhra Pradesh in India. A retrospective analysis of odontogenic tumors and giant cell lesions of jaws reported in our institute between the years 2000 and 2009 was done and this data was compared with previous reports from different parts of the world and India.</p> <p>Methods</p> <p>Biopsies of the lesions received between the years 2000 and 2009 were reviewed and patient's history, clinical, radiological and histopathological characteristics were analyzed.</p> <p>Results</p> <p>A total of 77 biopsies were received during the nine year study period. These lesions were more frequently seen in the males, in a younger age group and showed a predilection for the mandible. Most of them presented as radiolucent, slow growing and painless lesions. Ameloblastomas (71.4%) constituted the majority of odontogenic tumors while central giant cell granulomas (7.8%) constituted the majority of giant cell lesions.</p> <p>Conclusion</p> <p>These lesions showed a definite geographic variation with ameloblastomas being the most common odontogenic tumors and odontomas being relatively rarer lesions in our region.</p

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

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The relationship between maximal mouth opening agd age, height and weight in Nigerians.

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Pattern of odontogenic tumours in Nigeria: a review of the literature

Objective: Odontogenic tumours are lesions derived from the epithelial and/ or mesenchymal remnants of the tooth-forming apparatus. Various authors from different centres in Nigeria have at different times reported their experiences of the prevalence, clinical presentation and management of odontogenic tumours, but no effort till date had been made to harmonise all these works with a view to showing the true pattern of these tumours among Nigerians as a whole. This is what the present review article sets out to achieve.Method: All articles published in Nigeria on odontogenic tumours from 1969 to date were reviewed. These articles were sourced from online stores using the PUBMED and HINARI. Manual search of the references in these articles was also done to identify additional relevant articles not listed in the above sites.Result: Ameloblastoma was found to be the most reported odontogenic tumour, and has been described as the most frequently occurring odontogenic tumour in Nigeria. Although malignant variants of odontogenic tumours were well recognized, they were less reported in Nigeria than in the rest of the world. Peak age of occurrence for odontogenic tumoursgenerally was between the 3rd and the 4th decades with variations in male to female ratio based on the type of odontogenic tumour. Mandible was found to be favoured more than maxilla as the common site of occurrence. Late presentation for treatment was a common phenomenon in all studies reviewed.Conclusion: Odontogenic tumours remain a very common orofacial tomour in Nigeria and the literature is replete about studies from Nigeria. While large number of epidemiological studies exists, little efforts have been focused on management of patients to including challenges of reconstructive surgery and optimum prosthetic rehabilitation for improved  outcome and quality of life.Key words: Odontogenic tumours, literature review, Nigeri