Management of Giant Craniofacial Ossifying Fibroma – Case Series Report

Although ossifying fibroma (OF) is a slow growing neoplasm, some lesions may behave aggressively reaching massive proportions that may demand special treatment. OF of the head and neck is most commonly described in the mandible and maxilla. A few isolated reports in the literature exhibit the rare existence of this lesion in the nasal bone, orbit, ethmoid sinus, sphenoidsinus, frontal sinus, temporal bone, and intracranial region. Three cases of massive OF of the midface with intracranial extension are reported. The management protocol of these lesions is presented and discussed.Key words: Cranial facial giant ossifying fibroma ; management protocol

Management of Mandibular Fracture in a Peripheral Health Setting with Limited Resources: A Case Report

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An Audit of 6 years of Oral and Maxillofacial Surgical Conditions admitted for Interventional Treatment at Muhimbili National Hospital, Dar es Salaam – Tanzania

Background: The world wide pattern of OMFS conditions has been rarely reported despite its significance in the head and neck medicine; maxillofacial trauma and tumors. The main objective of this study was to audit oral and maxillofacial surgical (OMFS) conditions admitted for interventional treatment at Muhimbili National Hospital. Methods: Patients presenting to the OMFS unit with oral and maxillofacial pathological conditions between January 2003 - January 2009 were studied prospectively. Data for analysis were obtained from the daily operation list and includes age, sex, location, diagnosis of the pathological lesion, surgical procedure and date of procedure. Results: During the study period, the unit offered specialized services to 454 patients. Among them, 222 were males and 232 females. The mean age of the patients was 31.7 and the range was 79 years. Patient aged 21-30 years were mostly affected. Of the pathological lesions attended, benign tumors were the most common 255(56.2%) followed by fractures 58(12.8%), cysts 46(10.1%), malignant tumors 36(7.9%) and chronic infections 17(3.7%). Of the 255 cases of benign tumors 155(60.8%) were located on the mandible and 64 (25.1%) on the maxilla. Malignant tumors were 36 cases in which 11(30.6%) were located on the mandible. Maxillofacial fractures accounted 58 cases in which 31(53.4%) cases were located on the mandible. Cysts were 46 cases of which 17(37%) were located on the floor of the mouth, 10(21.7%) on the mandible and 7(15.2%) on the maxilla. Tumor excision was the commonest procedure performed 119(26.2%), followed by Tumor excision + reconstruction 89(19.6%), ORIF+IMF 51(11.2%), Fistulectomy 45(9.9%), Tumor enucleation 45(9.9%), Wide surgical excision 27(5.9%), Sinusectomy 16(3.5%) and Sequestrectomy 15(3.3%). Conclusion: There is a significant burden of OMFS conditions attended at MNH. We suggest that the government enhance the state of medical infrastructure in the local hospitals in terms of manpower and facilities for the diagnosis and treatment of simpler OMFS disease as well as timely referral on to regional center for the more complex issues. This will reduce the burden of OMF conditions experienced by this hospital and improve OMF services country wide

The types, incidence and demographic distribution of benign oral and maxillofacial neoplasms among patients attending Muhimbili National Hospital in Tanzania, 2008-2013

Background: Pathological processes of oral and maxillofacial region are generally classified as benign or malignant based on specific histological criteria, including the presence or absence of necrosis, mitotic figures as well as basic understanding of the entity. The objective of this study was to determine the types, prevalence and demographic distribution of benign oral and maxillofacial tumours among patients treated at Muhimbili National Hospital in Tanzania.Methods: In this retrospective study, data on histological results of lesions of the oral and maxillofacial region were retrieved from the archives at the Department of Oral and Maxillofacial Surgery of Muhimbili National Hospital were analysed. The tumour type, age, sex, file number and histopathological diagnosis of the patient were recorded. The study covered a period of from January 2008 to December 2013. The top ten lesions with higher frequency of occurrence from January to were picked for analysis.Results: A total of 897 (males=388; females=509) histological results of patients with benign oral and maxillofacial lesions were obtained during the period under review. The age ranged from 0 to 88 years, mean age being 32.63 ± 17.1 while the age group of 20-29 and 30-39 were the most affected. A total of 136 different types of benign lesions were reported and ameloblastoma was the most common benign lesion (27.4%) followed by ossifying fibroma (18.7%), pyogenic granuloma (11.4%), pleomorphic adenoma (10.0%), and fibrous dysplasia (9.6%). Females were more affected than males, with a male to female ratio of 1:1.4 however the difference was statistically insignificant (p= 0.055).Conclusion: Ameloblastoma and ossifying fibroma were the most common oral and maxillo-facia neoplasms at Muhimbili National Hospital. The young age groups were the most affected by these lesions

Evaluation and histological maturation characteristics of fibrous dysplasia and ossifying fibroma: a case series

Background: Fibrous dysplasia (FD) and ossifying fibroma (OF) are benign fibro-osseous lesions (FOLS) that are generally considered to be separate entities distinguishable by histologic and radiographic features. The histological maturation of these lesions involves an initial fibrous state, an intermediate mixed and a final mineralised stage.Objective: To correlate the mineralisation of OF and FD with the duration of the lesion.Design: A retrospective histopathological analysis of archival material including sixteen cases documented over a three-year period was performed to distinguish FD from OF.Setting: The relevant data of FOLs diagnosed as OF and FD were retrieved from the archival records of the Departments of Oral Surgery/Oral Pathology and Histopathology/Morbid Anatomy, Muhimbili University of Health and Allied Sciences.Results: Remarkably, in this series, none of the FD and OF lesions occurred in patients aged below 10 or over 50 years. The histopathological comparison of the various nonmineralised components in both the lesions in relation to lesion age-maturity was not statistically significant (P>0.05).Conclusion: The histopathological ratio of the mineralised to  non-mineralised components may not be directly indicative of the maturity of both OF and FD

Etiology, pattern and outcome of management of facial lacerations in Dar es Salaam, Tanzania

Background: Facial laceration is amongst the commonly encountered soft tissue injury in the care of the traumatized patients, and its optimal treatment is important for minimizing subsequent complications. This study aimed at determining the etiology, pattern, and outcome of management of facial lacerations among patients attended at Muhimbili National Hospital, Tanzania. Methods: This was a four months’ prospective study of all consecutive patients with facial lacerations who were attended in the department of oral and maxillofacial surgery of the Muhimbili National Hospital (MNH). The variables examined included socio-demographic characteristics, etiology of a facial laceration, prior management before referral to MNH, and the outcome of treatment. The data were analysed using IBM SPSS statistics for windows version 22 (Armonk, NY: IBM Corp) software. Results: Seventy-six patients with facial lacerations were included in the study. The male to female ratio was 8:1. The age of the patients ranged from 16 to 57 years, with a mean age of 31.63 ± 10.02 years. Motor traffic crashes (51, 67.1%), violence (18, 23.7%) and falls (7, 9.2%) were the etiological factors. The commonest affected facial esthetic zones were forehead (25, 32.9%), and the upper lip (24, 31.6%). The majority (60%) of wounds that were sutured/repaired in other health facilities prior to referral to MNH had a poor approximation of wound edges. Scarring was the commonest complication. Conclusion: Facial laceration affected males eight times more than females. Road traffic crash was the most common etiological factor. The forehead was the most frequently affected facial esthetic zone. The majority of patients treated in other health facilities prior to referral to a tertiary hospital had poorly approximated wound edges. Scarring was the most common complication of facial lacerations

Coping strategies adopted by small-scale farmers in Tanzania and Kenya to counteract problems caused by storage pests, particularly the Larger Grain Borer

Final Technical Report, Project R 6952 (1 May 1997 - 31 December 1998)

Biomimetic remineralization of acid etched enamel using agarose hydrogel model [version 1; referees: 2 approved]

Background: Minimally invasive dentistry aims to prevent progression of caries and treats non-cavitated lesions through non-invasive approaches to preserve the integrity of tooth structure. The aim of this research was to investigate the possible biomimetic effect of agarose hydrogel in remineralizing a human demineralized enamel model. Methods: Mandibular third molars were distributed into three groups (G1, G2 and G3) according to the follow up time (2, 4 and 6 days respectively). Caries like lesion was prepared by applying 37% phosphoric acid gel for 1 minute and then remineralization was performed through applying agarose hydrogel on the demineralized surfaces. The specimens were placed in phosphate solution at 37˚C for 2, 4 & 6 days. Scanning electron microscope (SEM), surface microhardness (SMH) and surface roughness analysis (SR) were performed to assess the regenerated tissue. Results: SEM revealed mineral depositions on the demineralized enamel surface that increased in density by time resulting in a relatively smooth surface in G3. SR and SMH analysis revealed significant differences between the remineralized enamel surfaces of different groups (p< 0.00001) with the highest SR in G1 and the highest SMH in G3. Conclusions: Agarose hydrogel application is a promising approach to treat early carious lesion. Further studies are needed to clarify the stability of agarose hydrogels in clinical application

The incursion, persistence and spread of peste des petits ruminants in Tanzania: Epidemiological patterns and predictions

Peste des petits ruminants virus, which causes a severe disease in sheep and goats, has only recently been officially declared to be present in Tanzania. An epidemiological study was carried out between September 2008 and October 2010 to investigate the incursion, persistence and spread of the virus in Tanzania. The investigation involved serosurveillance, outbreak investigation and computation of epidemiological indices such as the effective reproductive number, persistence and the threshold level for vaccination. Field and molecular epidemiological techniques were applied to isolate, characterise and trace the origin of the virus in Tanzania. A total of 2182 serum samples from goats and 1296 from sheep from 79 villages across 12 districts were investigated. Village-level prevalence of infection was variable (0.00% – 88.00%) and was higher in pastoral than in agro-pastoral villages. The overall antibody response to the virus was 22.10% (CI 95% = 20.72% – 23.48%). About 68.00% and 73.00% of seropositive goats and sheep, respectively, did not show clinical signs. The proportion of seropositive animals differed significantly (p ≤ 0.001) between age groups, sex and farming practices. Real-time polymerase chain reaction results showed that the isolated strains belong to lineage III, whose origin is in East Africa and the Middle East. This indicates that one of the northern neighbouring countries is most likely the source of infection. The computed overall effective reproductive number, the threshold level of vaccination necessary to eradicate the disease and persistence were 4.75% and 98.00%, respectively. These estimates indicate that achieving elimination of the peste des petits ruminants virus from pastoral flocks will require significant effort and development of highly effective intervention tools

Pattern of mandibular fractures and helmet use among motorcycle crash victims in Tanzania

Background: The maxillofacial structures are commonly affected in motorcycle crashes, with the mandible being one of the most frequently fractured bones. Helmets have been shown to have a protective effect in preventing maxillofacial injuries, however, its effect on the occurrence of mandibular fractures is not very well established. Objectives: To evaluate the pattern of mandibular fractures among motorcycle crash victims in Tanzania, and determine the role of helmets in occurrence of mandibular fractures among the motorcyclists. Methodology: This was a 6-months prospective, cross-sectional study that recruited motorcycle crash victims who reported with mandibular fractures following motorcycle crash at Muhimbili National Hospital. A specially designed questionnaire was used for data collection. For purpose of analysis, the Statistical Package for Social Sciences software version 20 was used. Results: The study included a total of 132 participants of whom majority were male (120, 90.9%). The peak age incidence was 21-40 years in 76.5% of the victims. More than half (89, 67.4%) of the victims were riders during the crash. Helmet use was reported in 42.3% of the victims, and majority (67.3%) were usinghalf-face helmets. The symphysis region was the frequently fractured anatomical location (50, 37.9%). More than half of the victims had multiple site involvement, with higher odds observed in individuals wearing half-face helmets. Conclusion: Young males were affected ten times more than females. Most of the victims were riders during the crash. The symphysis region was the frequently fractured anatomical site. There was no difference in occurrence of mandibular fractures between those who wore and those who did not wear helmets during the crashes. However, the severity of mandibular fractures was dependent on the type of helmet used