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Background: The use of NVBG for mandibular defects seems to be gradually giving way for more advanced reconstructive techniques but it has the advantages of shorter operating time and lesser amount of blood loss. The aim of this study was to review the available data on the success and failure rates of use of NVBG and factors associated with failure., Method: Studies published from 1978 to 2014 regarding the use of NVBG were searched. Most important information was graft success and failure outcomes. Information on graft success with particular focus on large defects was extracted and the quality of papers was rated. Defects > 6cm were considered long defects., Results: Twenty publications were included in this review. The quality of the studies was low and there was high heterogeneity. All articles reported high graft success rates ranging from 67 to 100%. Success in defects > 6cm was considerable, the range was 72-100%. Three main factors were associated with failure; these were defect length, fixation method and infection. Infection contributed the highest complication rate which was 48.2%., Conclusion: NVBG seems to be appropriate for mandible reconstruction when there is vascular recipient bed and sufficient soft tissue cover and mucosal lining are achievable.

Background: Cleft lip and/or palate (CL/P) deformities are the most common congenital abnormalities of the orofacial structures. Affected individuals experience major clinical, functional, aesthetic and psychosocial impacts., Objectives: The aim of our study was to identify the perceptions, expectations and reactions of parents and caregivers to cleft lip and palate surgery., Materials and Methods: Interviewer administered questionnaires were used to collect data from parents/caregivers of patients with cleft lip and/or palate operated on by the cleft team at University of Port Harcourt Teaching Hospital., Results: Only three (2.8%) of the caregivers indicated that they knew the cause of CLP which they attributed to drugs, infections and contraceptives taken while about half of them admitted that they avoided taking these children to certain places. The participants were very concerned about the speech 15 (41.7%) and feeding 9 (25.0%) of the children. Most wanted the surgery performed in order to improve appearance 25 (69.5%), speech 8 (22.2%) and feeding 2 (5.6%). More than half of the parents/caregivers 21 (58.3%) expected excellent results from the surgery whilst 1 (2.8%) expected poor results. Most believed the surgery would indeed make a great difference in speech 14 (38.9%) and appearance 11 (30.6%). Majority, 30 (83%) were happy with the immediate outcome of the surgery and with their hospital experience 13, (36.1%)., Conclusions: This study revealed that most parents/caregivers of children with CLP believed this condition to be due to various factors and did not know the etiology. Expectations of the result of surgical repair of CLP surgery were high and their reactions were majorly positive.

The persistent view in the literature is that the relative frequency of ameloblastomas is higher in the black population than in Caucasians. The aim of this study was to determine the relative frequency of all odontogenic tumours (OT) in a 100% black population and to compare our findings with those of previous studies. A prospective study was undertaken of all patients presenting with OT to all 16 Nigerian departments of oral and maxillofacial surgery over a 4-year period. The following data were obtained: patient demographics, delay to presentation, extent of the lesion, and histological diagnosis. Six hundred and twenty-two cases were studied. A slight male preponderance was observed (male to female ratio 1.17:1). Patients ranged in age from 5 to 89 years, with a peak incidence in the third decade. The relative frequency of OT was 0.99 per million and that of ameloblastoma was 0.76 per million. Ameloblastoma was the most prevalent OT (76.5%), followed by adenomatoid odontogenic tumours (5.6%), odontogenic myxoma (4.5%), and keratocystic odontogenic tumours (KCOT) (3.1%). The relative frequency of ameloblastoma among Nigerians was not different from frequencies reported previously among Caucasian and Tanzanian black populations. KCOTs were, however, rarely diagnosed in Nigerians as compared to the white population in the Western world., (Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Different surgical procedures are utilized for treatment of various diseases of the posterior mandible depending on the type of disease, site, duration and age of the patient. A thorough knowledge of the anatomical relations of structures and adequate surgical skills are needed to minimize complications. The purpose of this study was to evaluate the indications and outcome of surgical techniques for diseases affecting the condyle and ramus of the mandibles., Patients and Methods: Data were retrieved from the case files of patients who had surgeries for diseases involving the ramus/condylar area of the mandible. The diagnosis/indications for surgery, procedure and postoperative outcomes were documented. Outcomes assessed were related to mouth opening, esthetics (appearance of scar and jaw symmetry) and function (occlusion, Jaw movements). Complications such as nerve dysfunction were documented. Paresthesia was tested by simple tactile stimulations., Results: There were a total of 27 procedures done either on the condyle or ramus in 23 (100%) patients between May 2006 and October, 2013. 16 procedures were done for tumors in 16 (69.6%) patients, 14 (60.9%) patients had Ameloblastoma, 1 (4.3%) had central neurofibroma and one had keratocystic odontogenic tumor, two procedures for unilateral condylar fractures in 2 (8.6%) patients, five procedures for ankylosis in 3 (13.0%) patients and four procedures were done for dislocation in 2 (8.6%) patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory., Conclusion: Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.

Background. Dry socket is a global phenomenon. The purpose of the study was to investigate the incidence of dry socket in recent times in a Nigerian Tertiary Hospital. Methods. Patients who were referred for dental extractions were included in the study. The case files of patients were obtained and information retrieved included biodata, indication for extraction, number and type of teeth extracted, oral hygiene status, compliance to oral hygiene instructions, and development of dry socket. Results. One thousand, one hundred and eighty two patients with total of 1362 teeth extracted during the 4-year period of the study were analyzed, out of which 1.4% teeth developed dry socket. The mean age (SD) was 35.2 (16.0) years. Most of the patients who presented with dry socket were in the fourth decade of life. Mandibular teeth were affected more than maxillary teeth. Molars were more affected. Retained roots and third molars were conspicuous in the cases with dry socket. Conclusion. The incidence of dry socket in our centre was lower than previous reports. Oral hygiene status, lower teeth, and female gender were significantly associated with development of dry socket. Treatment with normal saline irrigation and ZnO eugenol dressings allowed relief of the symptoms.

Background: A study on the cephalic index was carried out on subjects from school students in Ogbia tribe of Bayelsa state in the Niger Delta region of Nigeria. This study determined the cephalic indices among the school students. In the present study, seven hundred subjects were randomly selected from secondary schools comprising 350 males and 350 females, respectively, with age range from 11-20 years, with both parents and grandparents of Ogbia tribe. The length and breadth of the head were measured using a spreading caliper from standard bony landmarks. The measurable point for head length was measured between the glabella and inions while the head breadth was the widest biparietal diameter. The cephalic index was head breadth divided by the head length and multiplied by 100. The result showed that the mean cephalic index was 76.56. Males had a cephalic index of 77.21, while females had a cephalic index of 76.50. Based on this study, 78.68% of individuals were mesocephalic, 11.4% dolichocephalic, 9.0% Brachycephalic, and 0.43% hyperbrachycephalic. This research showed that the school students have mesocephalic phenotype. The data from this research will be useful in anthropology, genetics, forensic medicine, and clinical practice.

Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will guide clinicians through units of blood required for each procedure. The aim of the study was to assess the amount of blood loss and duration of surgery. Methods. All cases of maxillofacial surgical procedures done under GA in the MFU theatre, from January 2007 to December 2013, were included in the study. Pre- and postoperative haematocrit values, number of units of whole blood requested and used, amount of blood loss, and duration of surgery were recorded. Results. 139 patients were analyzed, of which 75 (54.0%) were males and 64 (46.0%) were females. Fifty-six (40.3%) cases involved soft tissues. Eighty-three cases involved hard tissues. Age range was 2 months to 78 years; mean ± (SD) was 21.3 ± (18.5) years. Isolated unilateral cleft lip had the lowest mean value of estimated blood loss of 10.4 ± 10.8 mLs and also the lowest duration of surgery of 58 (76) minutes. There was no significant relationship between both parameters for cleft lip. Fractures of the mandible had mean blood loss of 352 mLs and duration was 175 min. Conclusion. In this study, there was significant relationship between estimated blood loss and duration of surgery for mandibular and zygomatic complex fractures.

Background. The actual basal bone height of the reconstructed mandible is relevant to achieve normal occlusal vertical dimension for the prosthesis fabricated. The purpose of the study was to determine the mean and baseline values of the occlusal vertical dimension and height of the mandibular basal bone in a Nigerian population. Method. Each participant was asked to bring the upper and lower teeth into contact, while the distance between the nasal sill and dimple on the lower lip was measured (OVD). The skin at lower border of the mandible was marked and the distance between this point and the landmark on the lower lip was measured, MBH. Result. 200 subjects were evaluated. Age range was 16-30 years, mean ± (SD), 21.6 ± (3.1) years. Males had mean ± (SD) of 42.10 ± (5.34) mm for OVD and females 39.72 ± (5.25) mm; acceptable baseline range of OVD for any population will be 34-48 mm (3.4-4.8) cm. All the males had a mean ± (SD), 30.54 ± (6.13) mm for MBH, and all the females 29.63 ± (5.23) mm. Acceptable baseline range of MBH for any population will be 24-37 mm (2.4-3.7) cm. Conclusion. To reconstruct the mandible and still maintain the OVD, heights of bone grafts must not be less than 2 cm or greater than 4 cm.

Epidermoid cyst occurring within the tongue is rare. The aim of this article is to discuss the management of an adult patient who presented with respiratory obstruction due to this congenital epidermoid cyst within the tongue. A 32-year-old male patient who was brought to the accident and emergency department of the University of Port Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria was presented. He came with a history of difficulty in breathing as a result of a slow growing swelling of the tongue which started from birth. There was associated pain, difficulty in speech and mastication as the swelling increased in size. Detailed physical examination, sonographic imaging and histopathology were carried out. On examination, patient was acutely ill-looking, in severe respiratory distress, febrile, mildly pale and dehydrated but anicteric. Extra-oral examination revealed mildly protruded upper and lower dento-alveolar arch as well splaying and recession of the anterior and posterior teeth of the upper arch. Intra-oral examination revealed moderately tender, fluctuant and grossly enlarged tongue obstructing the oro- and nasopharyx. A diagnosis of dermoid cyst was made and the patient was booked for surgery after resuscitation. Excision of the cyst was done under general anaesthesia/naso-tracheal intubation by an intra-oral approach. Ultrasound was able to give a thorough assessment of the cystic nature of the swelling while post-operative histopathology was used to confirm the specific type of teratoma. The relationship of the cyst to the intrinsic and extrinsic muscles of the tongue and mylohyoid muscle was relevant to the surgical approach to the lesion.

Background: Virtually all the articles in literature addressed only a specific type of dislocation. The aim of this review was to project a comprehensive understanding of the pathologic processes and management of all types of dislodgement of the head of the mandibular condyle from its normal position in the glenoid fossa. In addition, a new classification of temporomandibular joint dislocation was also proposed., Method and Materials: A thorough computer literature search was done using the Medline, Cochrane library and Embase database. Key words like temporo-mandibular joint dislocation were used for the search. Additional manual search was done by going through published home-based and foreign articles. Case reports/series, and original articles that documented the type of dislocation, number of cases treated in the series and original articles. Treatment done and outcome of treatment were included in the study., Result: A total of 128 articles were reviewed out which 79 were found relevant. Of these, 26 were case reports, 17 were case series and 36 were original articles. 79 cases were acute dislocations, 35 cases were chronic protracted TMJ dislocations and 311 cases were chronic recurrent TMJ dislocations. Etiology was predominantly trauma in 60% of cases and other causes contributed about 40%. Of all the cases reviewed, only 4 were unilateral dislocation. Various treatment modalities are outlined in this report as indicated for each type of dislocation., Conclusion: The more complex and invasive method of treatment may not necessarily offer the best option and outcome of treatment, therefore conservative approaches should be exhausted and utilized appropriately before adopting the more invasive surgical techniques.

Aim: The aim of this study was to determine how some physical characteristics can be used to predict the occurrence of impacted mandibular third molars., Background: While the concept of prophylactic removal of the asymptomatic erupting or impacted mandibular third molar has generated much controversy over the years, new theories of therapeutic surgical removal of the erupting tooth and therapeutic agenesis of the tooth bud are emerging. However, there are a few studies that address the anthropometric factors that could predict an impacted mandibular third molar., Methods and Materials: The study included Nigerian patients of both genders who were at least 16 years of age. A total of 83 subjects participated in the study; there were 44 (53 percent) females and 39 (47 percent) males., Results: Eighty-one (97.6 percent) of the participants were between 16 and 23 years old, while 2 (2.4 percent) were between 30 and 39 years old, of which 44 (53 percent) were women and 39 (47 percent) were men. There were 38 (45.8 percent) cases of impaction and 45 (54.2 percent) cases of unimpacted third molar. The mean and standard deviation values of BMI for the two groups in males and females were 21.10±1.90, 22.40±2.70 and 22.00±2.40, 22.30±1.99 respectively, with no significant difference, p>0.05, CI 95%. The two determinant factors of impaction were mandibular length and the difference between alveolar arch length (p=0.04) and total teeth size. Both of these variables had significant inverse correlations with impaction values of p=0.04 and p=0.003, respectively. The prediction values were 59 percent for mandibular length and 81.9 percent for differences between mandibular length and teeth sizes, respectively. The synthesized prediction value by the two determinant factors is 75.6 percent.The subjects were divided into two categories: presence of impaction (Group 1) and absence of impaction (Group 2). Impaction of the mandibular third molar was assessed by clinical and radiographic evaluation. Body mass index (BMI) of each subject was determined by measuring the body weight (BW) and body height (BH), then dividing the weight of the body by the square of the height. The mandibular index (MI) was assessed by measuring the length and width of the mandible (MW). It was calculated by dividing the width of the mandible by the length of the mandible. The mandibular length (ML) consisted of the total teeth sizes of the three anterior teeth, the two premolars, and the first and second molars. These dimensions were measured with a divider/ruler and recorded. The anterior-posterior distance of the arch from the midline to the retromolar pad (alveolar arch length) also was measured., Conclusion: The prediction of mandibular third molar impaction was mainly dependent on two factors: the length of the mandible and the difference between arch length and total teeth size., Clinical Significance: Small mandible, small dental arch, and large teeth are risk factors that are strongly associated with the occurrence of impacted third molars.

Purpose: Odontogenic infections constitute a substantial portion of diseases encountered by oral and maxillofacial surgeons. Infections start from dental tissues and sometimes rapidly spread to contiguous spaces. The consequence is a fulminant disease with significant morbidity and mortality. The study was aimed at studying the pattern of spread, approach to management, and outcome of these infections at a Nigerian teaching hospital., Patients and Methods: A retrospective study of all patients with orofacial infections who presented to our center over an 18-month period was carried out. The medical records were reviewed to retrieve the following: age, gender, source of infection, anatomic fascial spaces involved, associated medical conditions, various treatment modalities, types of antibiotics administered, causative micro-organisms, length of stay in the hospital, and any complications encountered. Infections were classified into 2 categories: those that are confined to the dentoalveolar tissues belong to category I, and those that have spread into the local/regional soft tissue spaces and beyond belong to category II., Results: Odontogenic infections constituted 11.3% of the total oral and maxillofacial surgery cases. A total of 261 patients were treated for odontogenic infections. There were 146 female patients (59.8%) and 98 male patients (40.2%) in the first category, whereas the second category comprised 10 male patients (58.8%) and 7 female patients (41.2%). The fascial spaces involved, in descending order, were submasseteric in 10 (22.7%), submandibular in 9 (20.5%), and sublingual in 6 (13.6%). The causative micro-organisms commonly found were Klebsiella and Streptococcus spp. Incision and drainage were performed in the 17 cases with spreading infection. Amoxicillin, amoxicillin/clavulanate, and metronidazole were the most routinely administered antibiotics., Conclusions: Our experience shows that delay in presentation, self-medication, aging, male gender, and unusual causative agents are some of the factors associated with spread. Therefore efforts must be made to further improve public dental awareness., (Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Parotid gland injuries are accompanied by a large number of sequelae. The aim of this paper is to highlight the importance of thorough management of these parotid glandinjuries especially at initial presentation in order to minimize the complications that accompany these injuries. A review of the aetiology and management of the existing cases of parotid gland injuries obtained from published journals and internet search as well as a report of two cases managed in our centre is presented in this paper. A total of about 70 cases in the previous literatures were reviewed of which assault was responsible for almost 90% of the cases. Sialoceles and fistulae were the main sequelae of these injuries. More than half of the cases (54%) were managed by conservative methods. Surgical drainage was done in about 44% cases; where the Stenson's ducts were accessible, primary repair was done. Excision of the gland was done in very few cases. The two cases managed in our centre were due to assault from broken bottles and road traffic accident respectively and both were managed by conservative methods. The first patient was a case of sialocele following the injury, which resolved within 3 weeks after the cyst formation with reduction in food intake, aspirations and external surgical drainage; while the second patient was a case of persistent fistula which healed after about 5 weeks following the trauma. Follow-up of both patients for about 3 months revealed no further leakage or accumulation of saliva. Management of these injuries involves a thorough understanding of the structure and function of the parotid gland and closely related tissues.

Introduction: Although metastatic jaw lesions are rare, clinicians must be aware of occurrence and should include them in their catalogue of differential diagnoses with a view to requesting for useful investigations that will aid timely consult and available palliative interventions. The aim of this study is to review and analyze the epidemiological behaviour of jaw metastases that have been reported in literature., Method: The review was conducted at the Oral and Maxillofacial Department of the University of Port Harcourt Teaching Hospital. Information was obtained from articles written by various authors in Nigeria and other parts of the world and from the internet services provided by the Information and computer training centre of the University of Port Harcourt. A total of 31 articles were reviewed. The distribution, clinical manifestation at the secondary sites, investigations and treatment of the metastatic jaw diseases from the various primary sites were reviewed and documented., Result: A total of 890 cases were reviewed, males were 402 and females were 488. The age range was 13 to 75 years with a mean age 43 years. The mandible was involved more than the maxilla. In 30% of cases, there were no symptoms at the secondary sites, lesion were detected by radiographs and scintiscanning. Other patients presented with jaw/facial swelling and pain. The breast was the commonest primary site in females and the lung in males. Histopathology was used to confirm the metastatic lesions and 61% of them were found to be adenocarcinoma. Less than half of the cases were operable, and surgery of primary and secondary sites was combined with radiotherapy and chemotherapy in these cases. Prognosis was poor with varying survival rates., Conclusion: Despite the fact that metastases to the jaws are rare than other bones of the body, these may be the first indication of a malignancy elsewhere in the body and this necessitates that suspected jaw swelling should be thoroughly evaluated to expedite treatment.

Background: Cleft palate of the primary or secondary type, is accompanied with various devastating physical and psychological effects. The purpose of this case study was to highlight the psychosocial problems the patients with these defects encounter both at the initial and later stages oftheirlives., Method: The case study focused on the history and clinical examination of a 25-year-old, single, female patient who presented with hypernasality and misarticulation of speech secondary to an incomplete cleft of the secondary palate which was not treated., Results: The patient was found to break down with tears in the process of discussion about her social life; she disclosed having problems with interacting with the society and especially with her male friends. Examination revealed a 5 centimeter (cm) long and 2 cm wide central defect involving the soft palate/uvula and causing a communication between the oral cavity/oropharnyx and nasal cavity/nasopharnyx. The patient was counseled and asked to come for surgery. However she has not come back since the day she came to our clinic., Conclusion: Speech defects in longstanding untreated clefts are not easily correctable and these have associated life-long impact on the quality of life of the patients, therefore, because some parents are afraid of surgical operations and may not want to subject the children to this treatment, this study will enlighten the clinicians to inform and emphasize to the parents/relations about these speech defects and psychological implications that will result if the children are not treated and even at the appropriate time.

Purpose: To determine the accuracy, sensitivity, specificity and prediction values of ultrasound as a means of diagnosis of cervico-facial soft tissue swellings., Materials and Methods: We carried out ultrasonographic evaluation of 76 consecutive cases of cervico-facial soft tissue swellings that presented at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria from August 2002 to November 2003. The patients' demographics and relevant clinical information were obtained. Ultrasonographic evaluation was done using the B-mode transcutaneous ultrasonic imaging device with a transducer frequency of 5MHz. All the lesions were subjected to histopathological examination., Results: There were 43(56.6%) males and 33(43.4%) females whose ages ranged from 2 weeks to 70 years (mean +/- SD; 22 +/- 19.7 years). Histologically, tumours constituted the highest percentage of swellings (35.5%), followed by cysts (26.3%). Males were more predominant in all classes of swellings except benign tumours. The accuracy of ultrasound in the diagnosis of pleomorphic adenoma was 80% and 100% for both adenocarcinoma and hemangioma. It was also 100% for majority of the cysts and HIV associated salivary gland swellings. The sensitivity of ultrasound in the diagnosis of pleomorphic adenoma was 80% and 100% for adenocarcinoma, hemangioma, all the cysts and HIV associated swellings. Ultrasound was also 100% specific in the diagnosis of monomorphic adenoma and hemangioma., Conclusion: Ultrasound is a useful diagnostic tool for cervicofacial soft tissue swellings. The accuracy of diagnosis is enhanced by the characteristics of the probe and the experience of the sonologist.