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

Treatment Failure in Osteoradionecrosis Involving the Mandible Following Enblock Resection of the Affected Bone: A Case Report

Osteoradionecrosis (ORN) of the jaws is a relatively common side effect of radiotherapy of head and neck tumours. It is a chronic condition that progresses slowly and does not tend to heal spontaneously. Irradiation brings about histological changes in hard and soft tissues, such as loss of ostoecytes, absence of osteogenic precussor cells, replacement of bone marrow by loose connective tissues and reduced expression of collagens and bone morphogenic protein by fibroblasts. Secondary lesions of these hypoxic tissues may then lead to an infection of the previously weakened bone and soft tissue and to development of a chronic, non-healing wound. Resection of bone without viable cells that remain around the area of resection will not facilitate revitalization. A case is presented of 35-year-old female with ORN of the mandible who presented with failure of wound healing following enblock resection of the affected part of bone. The possible causes of treatment failure and their management are discussed. Tanzania Medical Journal Vol. 23 (1) 2008: pp. 34-3

Studies on the Cleavage of Thiamine

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Types of minor oral surgical procedures performed on patients attending Muhimbili National Hospital, Dar es Salaam, Tanzania

Background: Minor oral surgical procedure is any intervention that does not penetrate a body cavity. The procedure does not involve general anaesthesia or respiratory assistance. Objectives: The aim of this study was to document types of minor oral surgical procedures performed on patients attending Muhimbili National Hospital (MNH) for a period of 5 years. Study design: This was a retrospective study based on the hospitaldata retrieved from February 2003 to February 2007. Study population: Patients who had undergone minor oral surgical procedures at the Department of oral surgery and oral pathology. Methodology: A sample of 850 patients was obtained from the treatment files of the patients who had undergone minor oral surgical procedures during the period of review. Demographic data and different procedures were recorded, entered into the computer and analysed using SPSS programme version 11. Results: Among 850 patients, who had undergone minor oral surgical procedures, 509 were males and 341 were females. Males (59.9%) were more treated compared to females (40.1%) and the most age groups treated were 21-30 and 31-40 with each group comprising 36.6% and 23.2% of minor oral surgical procedures respectively. The age groups 61-70, 71-80 and 81-90 were the least treated. Disimpaction (28.8%) was the commonest procedure which was performed followed by incisional biopsy (22.2%) and IMF (16.3%) while FNAC and enucleation were the least performed procedures. Conclusion: Most of the minor oral surgical procedures performed on patients at our centre were disimpaction, incisional biopsy, IMF and cystectomy. FNAC was the least performed procedure. The factthat this study is a retrospective study it does not provide a true picture of minor oral surgical procedures performed at our centre. Therefore, there is a need to conduct a prospective study. Key words: Oral surgical procedure Muhimbil

Surgery of wisdom teeth at Muhimbili National Hospital Dar es Salaam Tanzania

This was a retrospective study based on hospital data retrieved from files of patients who were treated at Muhimbili National Hospital (MNH ) for a period of 5 years (2007- 2003). The main objective of the study was to document on surgical removal of impacted wisdom teeth at MNH, Department of Oral Surgery/Pathology. All patients who had been treated and recorded in the files at the department were included in the study. Information regarding age, sex, wisdom tooth removed and location within the jaws were entered on a special data documentation form. The datawere entered into computer software and analyzed by using SPSS computer program. Out of the total 19671 patients who had undergone teeth extractions, about 644(3%) patients underwent surgical removal of impacted wisdom teeth. Of the 644 patients who underwent surgical removal of wisdom teeth, 303 (47.1%) were males and 341 (52.9%) were females. Their sex ratio (M: F) was1:1.13 and their age ranged from 17 to 60 years. The age groups 20-29 [48.1%] and 30-39 [25%] comprised majority of the patients who underwent disimpaction followed by age groups 11-19 [9.4%], 40-49 [11.8%] and 50-59 [5.2%]. Age group 60-69 [0.5%] had fewer patients. A high number of patient 613 [94.2%] with impacted wisdom teeth had their impactions located in the lower jaw whileonly a few number 31[4.8%] located in the upper jaw. The study concluded that majority of patients had their wisdom teeth removed during the age groups 20 – 29 years and 30 – 39 years and the mandible was more commonly affected than the maxilla. Also the study revealed that the prevalence of impacted third molar was low (3.3%) in this local population compared to what has been reported in other studies. The difference couldprobably be due to regional variation of the population and ethnic groups. However there is a need to conduct a prospective study in order to show the real picture of surgery of impacted wisdom teeth within this population.Key words: Wisdom tooth surgery, age, sex, locatio

Attitude and perception towards people living with HIV/AIDS among school students in Ngara town.

Objective: To determine the attitude and perception towards PLWHA among secondary school students in Ngara town.Study design: A descriptive cross sectional study.Study setting: The study was conducted in secondary schools in Ngara town.Study population: Form one to four students aged between 14and 21 years.Methodology: A descriptive cross section study which was carried out in secondary schools in Ngara District between August and September 2009. A total of 256 students were selected randomly from all secondary schools in Ngara town to participate in this study. Students were asked to sit in classrooms in which the researcher was introduced to them and explained the importance of the study and the confidentiality of the information they were supposed to give. Kiswahili version questionnaires were distributed to the selected participants to fill in the information they were asked. The information was entered into a computer and analysis was done using the computer software EPI info 2006.Results: Out of 256 participants, 145(56.6%) were males and 111(43.4%) were females aged between 14 and 21 with mean age of 17 [table 1]. The majority of respondents 240(93.8%) were ready to care for PLWHA, the reasons being they wanted to support them [table2]. Among those who were not ready to care for PLWH, 6(37.5%) feared to be infected [table 3]. Vast majority of participants 196(76.6%) rejected to keep secret while 60(23.4%) would like to keep secret if a family member would be infected [table 4]. Majority 154(60.2%) were ready to disclose [fig.1]. Most of respondents 160(62.5%) wanted to live with PLWHA when asked on what to be done to PLWHA [fig.2]Conclusion. The study found that there are still people who have negative perception and attitude towards PLWHA. However, the number of those with positive attitude and perception is increasing compared to the previous studies.Key words: Attitude, perception, people living with HIV/AID

Radio-Histologic Diagnostic Challenge in Ossifying Fibroma and Fibfous Dysplasia of the Jaws: A Case Report

This article reports a case of fibro-osseous lesion, which was clinically and radiologically, diagnosed as ossifying fibroma but histologically proved to be fibrous dysplasia. A 17- year- old boy presented with an 8- months history of a swelling on the left angle of the mandible which was firm with a normal overlying skin. Radiographic evaluation of the swelling showed a well defined radiopaque mass with extension to the ramus. Based on the history, clinical and radiographic features a diagnosis of ossifying fibroma was reached. However, intra- operatively no calcified mass was found within the swelling but rather diffuse heamorrhages of the spongiosa were found. Incisional biopsy was taken from which results showed a non-capsulated lesion containing multiple trabeculae of metaplastic bone dispersed in a reactive moderately cellular vascularised fibrous stroma that was consistent with the diagnosis of fibrous dysplasia. The radiographic and histological confusion surrounding the diagnosis of these lesions are discussed.The importance of a combined approach to diagnosis is emphasized.. Tanzania Medical Journal Vol. 23 (2) 2008: pp. 35-3