Pattern of Midface Trauma with Associated Concomitant Injuries in a Nigerian Referral Centre

Aim: The aim of this study was to determine the pattern of midface trauma with associated concomitant injuries seen in our environment. Methodology: This was a prospective analysis of trauma patients with midfacial injuries presenting at a referral center in South West Nigeria. In addition to socio‑demographic data, the following information was also obtained: Mechanism of injuries, type of midfacial injuries, concomitant/associated injuries and treatment. Results: A total of 101 patients with midfacial injuries were involved. They were made up of 85 males and 16 females. The 20‑29 year age group was mostly affected (44.6%) and the most common cause of midface injuries was road traffic accident (91.1%). The zygoma was fractured more than any other midfacial bone (46.0%). A total of 144 associated injuries were recorded among these patients, head and ocular injuries accounted for 49 (34%) and 35 (24.3%) respectively. The patients were mostly treated conservatively or by closed reduction. Conclusion: The rate of head and ocular injuries among patients with midfacial injury was high. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary approach is important for optimum management of these patients.Keywords: Concomitant injuries, midface trauma, multidisciplinary car

Implantation of silicon dioxide-based nanocrystalline hydroxyapatite and pure phase beta-tricalciumphosphate bone substitute granules in caprine muscle tissue does not induce new bone formation

Background: Osteoinductive bone substitutes are defined by their ability to induce new bone formation even at heterotopic implantation sites. The present study was designed to analyze the potential osteoinductivity of two different bone substitute materials in caprine muscle tissue. Materials and methods: One gram each of either a porous beta-tricalcium phosphate (β-TCP) or an hydroxyapatite/silicon dioxide (HA/SiO2)-based nanocrystalline bone substitute material was implanted in several muscle pouches of goats. The biomaterials were explanted at 29, 91 and 181 days after implantation. Conventional histology and special histochemical stains were performed to detect osteoblast precursor cells as well as mineralized and unmineralized bone matrix. Results: Both materials underwent cellular degradation in which tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells and TRAP-negative multinucleated giant cells were involved. The ß-TCP was completely resorbed within the observation period, whereas some granules of the HA-groups were still detectable after 180 days. Neither osteoblasts, osteoblast precursor cells nor extracellular bone matrix were found within the implantation bed of any of the analyzed biomaterials at any of the observed time points. Conclusions: This study showed that ß-TCP underwent a faster degradation than the HA-based material. The lack of osteoinductivity for both materials might be due to their granular shape, as osteoinductivity in goat muscle has been mainly attributed to cylindrical or disc-shaped bone substitute materials. This hypothesis however requires further investigation to systematically analyze various materials with comparable characteristics in the same experimental setting

Kimura’s disease in a Nigerian: Case report

Kimura’s disease (KD) is a chronic inflammatory disease presenting as multiple  subcutaneous swellings within the head and neck region. Aetiology has been suggested to be due to allergy or an immune response and it’s predominantly seen in young and middle-aged males. Histopathologically, hyperplasia of lymphoid tissue, with well-developed lymphoid follicles and marked infiltration of eosinophils are seen. KD is a relatively rare disease previously reported to be endemic in Asians of Chinese decent. However, they can constitute a diagnostic challenge where there is low index of suspicion. Therefore, we report a case of KD in an adult male Nigerian

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 tumours generally 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

PTCH-1 and MDM2 expression in ameloblastoma from a West African sub-population: Implication for chemotherapeutics

Introduction: Ameloblastoma is a slow growing, painless odontogenic swelling which can attain sizes that result in severe deformities of thecraniofacial complex. It is the most commonly encountered odontogenic tumor in Nigeria. Surgical intervention is currently the method of treatment; however identification of altered molecular pathways may inform  chemotherapeutic potential. The Protein Patched homolog 1 (PTCH-1)is overexpressed in ameloblastoma. Also, mutation in the MDM2 gene can reduce the tumor suppressor function of p53 and promote ameloblastoma growth. No study however has characterized the molecular profile of African cases of ameloblastoma with a view to developing chemotherapeutic alternatives. The objective was to characterize the PTCH-1 genetic profile of Ameloblastoma in Nigerian patients as a first step in investigating its potential for chemotherapeutic intervention.Methods: Twenty-eight FFPE blocks of ameloblastoma cases from Nigerian patients were prepared for antibody processing to PTCH-1 (Polyclonal  Anti-PTCH antibody ab39266) and MDM2 (Monoclonal Anti-MDM2 antibody (2A10) ab16895). Cytoplasmic brown staining was considered as positive for PTCH while nuclear staining was positive for MDM2.Results: Moderate and strong expressions for PTCH in ameloblast and stellate reticulum were 78.6% and 60.7% respectively. Only 3 (10.7%) cases expressed MDM2.Conclusion: The importance of our study is that it supports, in theory, anti-PTCH/SHH chemotherapeutics for Nigerian ameloblastoma cases andalso infers the possible additional use of anti-p53 agents

Osteocalcin, Azan and Toluidine blue staining in fibrous dysplasia and ossifying fibroma of the jaws

Background: Fibrous dysplasia (FD) and ossifying fibroma (OF) are fibro-osseous lesions (FOLs) having several overlaps that may make final diagnosis difficult by hematoxylin and eosin (H/E) alone.Aim: This study seeks to detect any association between Azan and Toluidine blue staining as compared with osteocalcin in FD and OF diagnosis.Methods: Forty formalin fixed paraffin embedded (FFPE) blocks of FD and OF were prepared for Azan, Toluidine blue and osteocalcin staining. Brown staining of calcified structures was considered as positive for osteocalcin. Scoring for Azan and Toluidine blue was evaluated based on intensity and localization. Level of agreement of original and revised diagnosis was determined.Results: Six (40%) of 15 FD were corroborated by osteocalcin. Eight cases initially diagnosed as OF were revised to FD. There were 25 OF according to H/E, and 17 (68%) were validated by osteocalcin. Measure of agreement between histology and immunohistochemistry was 0.081; p = .608. Eleven (42.3%) OF expressed strong toluidine blue staining of the intervening fibrous connective tissue stroma while only 2 (14.2%) FD showed similar staining, this difference was statistically significant [p = .001].Conclusions: Histomorphometric analysis with Toluidine blue may reduce diagnostic errors of OF and FD.Keywords: Osteocalcin, Azan, Toluidine blue, Fibrous dysplasia, Ossifying fibrom

A population-based study of the epidemiology of oral squamous cell carcinoma in the Netherlands 1989-2018, with emphasis on young adults

There has been an increasing trend in oral squamous cell carcinoma (OSCC) in patients under 45 years of age. The aim of this study was to evaluate the burden of OSCC in the Netherlands between 1989 and 2018 among young adults (age 20–34 years) when compared to adults (age 35–44 years), and to describe the burden in older groups as well, utilizing cancer registry data to characterize incidence patterns by age, sex, and risk factors. A total of 18,963 cases of OSCC were reported. The overall incidence rate, as measured by annual percentage change (APC), increased significantly from 1989 to 2010 by 1.3% per year (95% confidence interval (CI) 0.9–1.7%) but decreased thereafter by −0.9% (95% CI −2.5% to 0.7%). Annual incidence increased significantly by 2.4% (95% CI 1.1–3.8%) for patients aged 20–34 years, while it decreased for those aged 35–44 years by −0.9% (95% CI −1.7% to 0.0%). In patients older than 60 years, incidence rates increased overall (60–74 years: APC 1.8%, 95% CI 1.5–2.1%; ≥75 years: APC 1.5%, 95% CI 1.2–1.9%). Overall, 66.5% of patients were smokers and 65.3% were alcohol consumers. The marked differences in incidence within the young age subgroups warrants further investigation to elucidate any likely disparity in biological process and clinical outcomes in these populations

Primary malignant oro-facial lesions: a review of cases in a tertiary institution in the Niger Delta

Background: Oro-facial malignancies are among major causes of morbidity and mortality the world over with varying incidence in different geographical locations.Aim: To review oro-facial malignancies seen at the University of Port Harcourt Teaching Hospital (UPTH) and to compare results with reports from other centres.Methods: All histologically diagnosed cancers of the oro-facial region seen at UPTH between 1st January 2008 and 31st December 2012 were retrospectively reviewed. Records of these patients were retrieved for age, gender, site of tumour occurrence, duration and the histological diagnosis. The data were analyzed with SPSS version 20 and summary statistics of frequency and central tendency were presented.Results: Malignant lesions constituted20.3% of biopsies received during the study period. The mean age of patients was 43.0 ± 20.6 years and gender distribution was 25 males to 19 females. Carcinomas occurred most, constituting 28 (63.6%) of the total, followed by sarcomas [10 (22.7%)] and lymphomas [6 (13.6%)]. Squamous cell carcinoma (43.0%) was the commonest of the carcinomas seen and rhabdomyosarcoma (40.0%) was the predominant sarcoma. All lymphomas were of the non-Hodgkin's type with Burkitt's lymphoma representing 50.0%. The mean age of occurrence of carcinomas was 52.5 ± 16.1 years, sarcomas 31.8 ± 13.4 years and lymphomas 17.7 ± 20.4 years.  Conclusion: Oro-facial cancers represented about a fifth of all histologically diagnosed lesions and affected males more. Carcinomas occurred most and patients above 40 years of age were mainly affected. Rhadomyosarcomas were the predominant sarcomas while all lymphomas were of the non-Hodgkin's type.Keywords: Head and neck cancer, Review, Niger Delt

Practice of standard precautions among community health officers in River State, Nigeria

No Abstract

Management of gunshot injuries to the maxillofacial region at University of Port Harcourt Teaching Hospital, Nigeria

Background: The management modalities for gunshot injuries differ slightly from conventional trauma. The purpose of this study was to document the pattern, mechanism and management outcome of gunshot injuries seen in our center. Method: Information regarding patients’ demographics, site and type of injury, tissue involved as well as presence of associated injuries was documented. Patients were categorized into two groups; those that sustained soft and hard tissue Injuries and those with only soft tissue injuries. Soft tissue injuries were classified as laceration, penetrating, perforating or avulsions. The presence of either entry and exit wounds or only entry wound was also examined. The investigations, treatment done and outcome of treatment were also documented. Result: A total of 20 patients presented with gunshot injuries within this period of study out of 132 patients with craniofacial trauma. Of the 20, 15 (75%) were males and females were 5(25%), 9(45%) had both soft and hard tissue injuries, 11(55%) cases had only soft tissue injuries. Age range was 8-55 years with mean (SD) of 29.7 (10.7) years. All injuries were confined either to the midface or the lower face. The bones of the midfacial region (zygomatic bone and, medial wall of the orbit, ethmoidal and nasal bones) were involved in 2(10%) patients and the lower jaw (mandible) was affected in 7(35%).The outcome of treatment was successful in 18(90%) and satisfactory in 17(85%) cases. Conclusion: Secondary repair is more relevant than delayed repair in portions of the face that have less sufficient blood supply that sustain gunshot injuries.Keywords: Gunshot, Injury, repair, MaxillofacialNigerian Journal of Plastic Surgery Vol. 9, No 2, September 201