Challenges in the management of cervicofacial necrotizing fasciitis in a developing economy: our experience

Background: Necrotizing fascitis is uncommon but a life threatening cervico-facial infection, which is characterized by aggressive spread of inflammation and necrosis of the tissues. In our environment clinical presentation is often late and patient's management at this stage is very challenging. We present the challenges in the management of this lesion as experience in our centres.Methods: We carried out clinical evaluation on the management and treatment options amongst the 11 patients that presented with cervicofacial necrotizing fascitis at two tertiary hospitals in South east, Nigeria over a 3-year period from 2012 to 2015. The focus was on the management challenges which include diagnosis, lack of modern facilities and treatment options, associated co- morbidities such as retroviral disease and diabetes mellitus, financial constraint and incessant industrial action by the medical and allied workforce.Result: There were 7 males (63.6%) and 4 females (36.7%) giving a male-to-female ratio of 1.8: 1 aged between 27 – 78 years with a mean of 57.4 ± 17.9 years. All presented as emergency and were hospitalized. Six (54.5%) were treated successfully with mortality rate of 9.1% (one patient) recorded. Four (36.4%) were lost to follow up., two of which were referred as a result of industrial action while the other 2 were discharged against medical advice.Conclusion: Patients often presents late and with limited options of treatment in a depressed economy treatment is often very challenging. Since poor oral hygiene is a modifiable risk factor, emphasis on oral health care should be a preventable measure.Keywords: Cervicofacial, Necrotizing fasciitis, Challenges, Management, Developing econom

Is prophylactic removal of impacted mandibular third molar justified in all patients? A prospective clinical study of patients 50 years and above

Background: The prophylactic extraction of asymptomatic impacted mandibular third molar is a contentious issue in dental practice.Objective: To evaluate symptomatic impacted mandibular third molars in patients 50 years and above, and determine the burden of the impaction on the adjacent second molar.Methods: This was a prospective clinical study over a three-year period. The diagnosis of impacted mandibular third molar and their associated pathology was made by clinical and radiological examination. The data obtained were age, sex, type of impaction, reason for surgical extraction, and the clinical condition of the adjacent second molar.Results: Patients 50 years and above were 33.4%, and those with impaction 22.8%, while the symptomatic cases were in 18.4% patients. The age of the patients ranged from 52 to 84 years with male: female ratio, 2.3:1. In all the asymptomatic impactions, the adjacent second molars were disease-free, whereas 73.6% of the adjacent second molar related to symptomatic cases were asymptomatic (P=0.001).Conclusion: This study showed that 15.9% of impactions in 18.4% of patients were symptomatic and required surgical ex- traction, whereas the burden of impaction on the adjacent second molar was 26.4%, and these required only preventive and restorative treatments.Keywords: Mandible, impaction, second molar, third molar, prognosis.

Is prophylactic removal of impacted mandibular third molar justified in all patients? A prospective clinical study of patients 50 years and above

Background: The prophylactic extraction of asymptomatic impacted mandibular third molar is a contentious issue in dental practice. Objective: To evaluate symptomatic impacted mandibular third molars in patients 50 years and above, and determine the burden of the impaction on the adjacent second molar. Methods: This was a prospective clinical study over a three-year period. The diagnosis of impacted mandibular third molar and their associated pathology was made by clinical and radiological examination. The data obtained were age, sex, type of impaction, reason for surgical extraction, and the clinical condition of the adjacent second molar. Results: Patients 50 years and above were 33.4%, and those with impaction 22.8%, while the symptomatic cases were in 18.4% patients. The age of the patients ranged from 52 to 84 years with male: female ratio, 2.3:1. In all the asymptomatic impactions, the adjacent second molars were disease-free, whereas 73.6% of the adjacent second molar related to symptomatic cases were asymptomatic (P=0.001). Conclusion: This study showed that 15.9% of impactions in 18.4% of patients were symptomatic and required surgical extraction, whereas the burden of impaction on the adjacent second molar was 26.4%, and these required only preventive and restorative treatments. DOI: https://dx.doi.org/10.4314/ahs.v19i1.55 Cite as: Anyanechi CE, Saheeb BD, UC O. Is prophylactic removal of impacted mandibular third molar justified in all patients? A prospective clinical study of patients 50 years and above. Afri Health Sci. 2019;19(1). 1789-1794. https:// dx.doi. org/10.4314/ ahs. v19i1.5

Ameloblastoma of the jaws in children: an evaluation of cases seen in a tertiary hospital in South-Eastern Nigeria

Background: Ameloblastoma is one of the most common benign odontogenic tumours in Nigeria. It is considered uncommon in children. Materials and methods: This is a retrospective study of pediatric patients with histopathological diagnosis of ameloblastoma seen over seven years at the Oral and Maxillofacial Surgery Department of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Relevant information was retrieved from patients’ records and data obtained were analysed using SPSS version 23, the chi-square test was used to compare qualitative variables, a p-value of <0.05 was considered as significant. Results: One hundred and thirty-six cases of ameloblastoma in all age groups were seen within the period. Thirty of the cases met the requirement. The mean age of the patients was 14.4 STD 2.03 (range from 10-17) years. Fourteen (46.7%) patients were male while 16 (53.3%) were female giving a ratio of 1:1.1. The duration of the lesion ranged from 3 months to 72 months (mean 15.07 months). Histologically, the follicular type (n=20, 66.7%) constitute the majority, while the clinical types were solid-multicystic (n=18, 60%) and unicystic (n=12, 40%). Enucleation was the treatment of choice in most (n=18, (60%)) of the patients. Conclusion: Ameloblastoma is relatively uncommon in children, especially those less than ten years of age. The solidmulticystic variety was the predominant type in the children studied. Most patients presented long after the onset of the tumour and enucleation with mechanical curettage produced satisfactory results in these patients. Keywords: Ameloblastoma, odontogenic tumour, children, resection, enucleation. Funding: None declare

Editorial: Orofacial cancer, an emerging menace with a changing trend

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