Use of oral mucoperiosteal and Pterygo-masseteric muscle flaps as interposition material in surgery of temporomandibular joint ankylosis: a comparative study

Background: The most common complication of surgery for the release of temporomandibular joint (TMJ) ankylosis is relapse of the ankylosis. To prevent re‑ankylosis, a variety of interpositional materials have been used. Aim: The aim was to compare the surgical outcome of oral mucoperiosteal flap, not hitherto used as interpositional material, with pterygo‑masseteric muscles flap after surgical release of TMJ ankylosis. Subjects and Methods: This was a prospective randomized study of all consecutive patients treated for the release of complete TMJ bony ankylosis, from January 2003 to December 2012, at the Oral and Maxillofacial unit of our institution. The patients were randomized into two groups: The pterygo‑masseteric group comprises 22 patients while the oral mucoperiosteal group had 23 patients. Information on demographics, clinical characteristics, and postoperative complications over a 5 year follow‑up period were obtained, and analyzed using the statistical package for social sciences (Statistical Package for the Social Sciences version 13, Chicago, IL, USA). A P < 0.05 was considered significant. Results: The age of the patients ranged from 15 to 28 mean 20.3 (3.35) years while the duration of ankylosis ranged from 2 to 16 mean 5.1 (3.4) years. The baseline demographic (gender; P = 0.92; side; P = 0.58) and clinical characteristics in terms of etiology (P = 0.60) and age (P = 0.52) were comparable in both treatment groups. All the patients presented with complete bony TMJ ankylosis with a preoperative inter‑incisal distance of <0.5 cm. The intraoperative mouth opening achieved ranged from 4 cm to 5 cm, mean 4.6 (0.27) cm and this was not different for either group (P = 0.51). The patients were followed up postoperatively for a period ranging from 3 to 5 years, mean 3.4 (0.62) years. The mouth opening decreased, over the period of postoperative review, from the initial range of 4–5 cm to 2.9–3.6 cm, and this was not different in both groups (P = 0.18). Conclusion: This study suggests that oral mucoperiosteal flap could be an option in the choice of interpositional materials in surgery of TMJ ankylosis.Keywords: Ankylosis, Interpositional materials, Temporomandibular join

Management of Odontogenic Fibromyxoma in Pediatric Nigerian Patients: A Review of 8 Cases

Odontogenic fibromyxoma (OFM) is a benign, locally invasive and aggressive nonmetastasizing neoplasm of jaw bones. They are considered relatively rare and known to be derived from embryonic mesenchymal elements of dental origin. Treatment of OFM depends on the size of the lesion and on its nature and behavior. Varying treatment modalities ranging from curettage to radical excision have been documented.Aim; This paper is a review of management of 8 pediatric patients with histologically diagnosed OFM at a Nigerian tertiary health care facility. This was a retrospective study of all patients aged 15 years and below who presented to the Oral and Maxillofacial Surgery Clinic of Aminu Kano Teaching Hospital, Kano, over a 5‑year period (January 2008 to December 2012), with a histologic diagnosis of OFM. The information obtained included patients’ demographics, as well as their clinical characteristics such as the anatomical site and side of lesions. Other information collated included presenting features, the onset of symptoms, type of treatment carried out, as well as treatment outcome. The data were analyzed and the results presented as frequencies and percentages. Among the 8 patients with OFM, more males (n = 5/8; 62.5%) were affected than females (n = 3/8; 37.5%). The mandible (n = 5/8; 62.5%) was the most frequent site of occurrence, and the anterior mandible was the most favored location (n = 4/8; 50%). Seven patients had excision of the lesion with peripheral ostectomy of the underlying bone while only one patient had a bone resection. These patients have been followed up for at least 1 year, and no recurrence was observed throughout the follow‑up period. OFM causes gross facial disfigurement and may result in the destruction of the entire jaw bone; the impact of which may be grave for a growing child. Prompt surgical intervention and follow‑up have proven to be adequate management protocol.Keywords: Odontogenic fibromyxoma, Odontogenic tumor, Pediatri

Management of inflammatory complications in third molar surgery: A review of the literature

Background: Pain, swelling and trismus are common complications associated with third molar surgery. These complications have been reported to have an adverse effect on the quality of life of patients undergoing third molar surgery. Objective: To review the different modalities of minimizing inflammatory complications in third molar surgery. Methods: A medline literature search was performed to identify articles on management of inflammatory complications in third molar surgery. Standard textbooks of Oral and Maxillofacial Surgery were also consulted and some local scientific publications on the subject were reviewed. Results: Methods ranges from surgical closure techniques, use of drains, physical therapy and pharmacological means. Studies reviewed have shown that no single modality effectively minimizes postoperative pain, swelling and trismus without undesirable effects. Conclusion: Inflammatory complications after third molar surgery still remains an important factor in quality of life of patients at the early postoperative periods. Oral surgeons should be aware of the different modalities of alleviation of these complications to make postoperative recovery more comfortable for patients.Keywords: management, inflammatory complications, third molar surgery, reviewAfrican Health Sciences 2011; 11(3): 530 - 53

Maxillofacial tumors and tumor-like lesions in a Nigerian teaching hospital: an eleven year retrospective analysis

Background: This paper reviews the types, prevalence and demographic distribution of maxillofacial tumors, cysts and tumor-like lesions in a Nigerian population. Methods: A retrospective analysis of the medical records and histological reports of patients with oral and maxillofacial tumors and cystic lesions who presented to the Maxillofacial Unit of our institution over an eleven year period was undertaken. Information on demographics, histological diagnosis and clinical presentation were obtained and analyzed. A p value of less than 0.05 was considered significant. Results: A total o:f 146 patients, aged 5-70 years (mean 30.5+ 12.9) were seen over the period of study. There were 96 males (65.8%) and 50 females (34.2%) giving a male to female ratio of almost 2:1. Benign tumors accounted for 124, 86.3% and malignant tumors (22, 13.7%). Ameloblastoma was the most prevalent benign tumor observed (53, 36.3%) while squamous cell carcinoma was the most common malignant tumor. The peak age of ameloblastoma was the fourth decade and squamous cell carcinomas the sixth and seventh decades of life. Jaw swellings were the most common presentation (98, 67.1%), followed by pain (23, 15.9). The duration of symptoms on presentation ranged from 1 to 96 months (mean 23.32 +15.72) and this was not different for malignant or benign tumors (P=0.886). Conclusion:Late presentation still remains the main challenging factor in the early detection and management of maxillofacial tumors in our environment. More awareness campaign is necessary, especially at the primary health care level, to educate the populace on the need for early presentation at treatment centers

Management of inflammatory complications in third molar surgery: A review of the literature

Background: Pain, swelling and trismus are common complications associated with third molar surgery. These complications have been reported to have an adverse effect on the quality of life of patients undergoing third molar surgery. Objective: To review the different modalities of minimizing inflammatory complications in third molar surgery. Methods: A medline literature search was performed to identify articles on management of inflammatory complications in third molar surgery. Standard textbooks of Oral and Maxillofacial Surgery were also consulted and some local scientific publications on the subject were reviewed. Results: Methods ranges from surgical closure techniques, use of drains, physical therapy and pharmacological means. Studies reviewed have shown that no single modality effectively minimizes postoperative pain, swelling and trismus without undesirable effects. Conclusion: Inflammatory complications after third molar surgery still remains an important factor in quality of life of patients at the early postoperative periods. Oral surgeons should be aware of the different modalities of alleviation of these complications to make postoperative recovery more comfortable for patients.Keywords: management, inflammatory complications, third molar surgery, reviewAfrican Health Sciences 2011; 11(3): 530 - 53

Mandibular Fractures: Demographic and Clinical Characteristics

Background: Statistics relating to mandibular fractures vary and is influenced by socioeconomic, cultural and environmental factors prevailing in any given region.Objectives: The present study was aimed at determining the demographic and clinical characteristics of mandibular fractures at Aminu Kano Teaching Hospital, Kano over an 18-months period.Methods: Patients of all age groups that presented with mandibular fractures were consecutively examined. Information on epidemiologic and clinical characteristics were obtained and analyzed. P= 0.05 was considered significant.Results: Of the 113 patients who fulfilled the inclusion criteria, 87.6% were males and 12.4% were females. Ages of participants ranged from 5 to 70 years. Mean age for males was 27.88 ± 9.98 while it was 27.14 ± 19.37 for females (p>0.05). Overall more males (87.60%) sustained fractures than females (12.40%). Motorcycle - related accidents was responsible for 61.06% of mandibular fractures. Only 23.08% of patients with road traffic- related accidents used any form of protective measures. The commonest site of fractures was parasymphysis (46.90%).Conclusion: Motorcycle-related accident is the main cause of mandibular fractures in this part of the globe. There is need to enforce existing road traffic legislation aimed at reducing the morbidity associated with mandibular fractures.Keywords: Mandibular fractures, Pattern