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Postoperative morbidities following impacted lower third molar (M3) surgery is of concern. The influence of platelets concentrates on postoperative inflammatory sequelae of M3 is promising. However, the comparative efficacy of platelet-rich fibrin (PRF) to platelet-rich plasma (PRP) in ameliorating postoperative morbidities remains controversial.The study aimed to compare the bioactive effects of PRP and PRF on postoperative pain, swelling, and trismus after impacted M3 surgery.A randomized, parallel-group study of 50 subjects was designed. Preoperative and postoperative swelling, degree of mouth opening and pain were assessed on days 1, 3, and 7. Linear mixed model analysis was used to compare the effects of treatment, time-point assessment within the group, and treatment with time interaction.Interaction estimates show statistically significant pain reduction with PRF (p = 0.00, 95% CI [-0.95, -0.25]. Trismus based on a time-point assessment within the PRP and PRF groups was significantly reduced (p =0.01, 95% CI [0.06, 0.38]) and (p = 0.00, 95% CI [0.12, 0.44]) respectively. Facial swelling within the PRP and PRF groups were significantly decreased (p = 0.00, 95% CI [-0.30, -0.06]) and (p = 0.00, 95% CI [-0.37, -0.13) respectively. There were no statistically significant differences between the groups for trismus and swelling. Age was a significant predictor of trismus in both groups (p = 0.04, 95% CI [-0.07, -0.01]).PRF was more effective in reducing postoperative pain compared to PRP. Furthermore, the study shows that platelet concentrates positively modulate post-inflammatory sequelae of impacted M3 surgery.Les morbidités postopératoires consécutives à une chirurgie de la troisième molaire inférieure (M3) impactée sont préoccupantes. L’influence des concentrés plaquettaires sur les séquelles inflammatoires postopératoires de M3 est prometteuse. Cependant, l’efficacité comparative de la fibrine riche en plaquettes (PRF) et du plasma riche en plaquettes (PRP) dans l’amélioration des morbidités postopératoires reste controversée.L’étude visait à comparer les effets bioactifs du PRP et du PRF sur la douleur, l’enflure et le trismus postopératoires après une chirurgie M3 impactée.Une étude randomisée en groupes parallèles de 50 sujets a été conçue. Le gonflement préopératoire et postopératoire, le degré d’ouverture de la bouche et la douleur ont été évalués les jours 1, 3 et 7. Une analyse de modèle mixte linéaire a été utilisée pour comparer les effets du traitement, l’évaluation ponctuelle au sein du groupe et le traitement avec l’interaction temporelle.Les estimations d’interaction montrent une réduction statistiquement significative de la douleur avec le PRF (p = 0.00, IC à 95 % [–0.95, – 0.25]. Le trismus basé sur une évaluation ponctuelle dans les groupes PRP et PRF a été significativement réduit (p = 0.01, 95 % IC [0.06, 0.38]) et (p = 0.00, IC 95 % [0.12, 0.44]) respectivement Le gonflement du visage dans les groupes PRP et PRF a été significativement diminué (p = 0.00, IC 95 % [–0.30, –0.06 ]) et (p = 0.00, IC 95 % [–0.37, –0.13) respectivement. Il n’y avait pas de différences statistiquement significatives entre les groupes pour le trismus et le gonflement. L’âge était un prédicteur significatif du trismus dans les deux groupes (p = 0.04, 95 % IC [–0.07, –0.01]).Le PRF était plus efficace pour réduire la douleur postopératoire que le PRP. De plus, l’étude montre que les concentrés plaquettaires modulent positivement les séquelles postinflammatoires de la chirurgie M3 impactée.concentrés plaquettaires, douleur, gonflement, trismus, troisième molaire.

Ossifying fibroma (OF) is a benign tumor of the jaws, which belongs to the group of fibro-osseous lesions, and exhibits slowly progressive growth leading to jaw expansion with well-defined borders.To evaluate the clinical and radiological characteristics of OFs and their treatment.A 5-year retrospective study was done. The case notes of subjects were retrieved, analyzed, and evaluated. Relevant information about patients was categorized into bio-data, clinical, and radiological. The diagnosis of lesion was made histopathologically by the oral pathologist.Forty- five patients' case notes were retrieved and analyzed and the patients' age ranged from 2 to 70 years (mean 29.4 ± 16.9). Majority of the patients (55.5%; P = 0.23) were 10-29 years. There were 16 (35.6%) males and 29 (64.4%) females giving a male: female ratio of 1:1.8 (P = 0.01). The cross-sectional dimension of the tumors measured vertically and horizontally ranges from 1 cmThe prevalence of OF among the fibro-osseous lesions was 51.0% while against other benign lesions, it was 16.0%. In conclusion, contrary to most other reports across the globe, this lesion in southeast Nigeria occurred more frequently in the maxilla than mandible.

To compare the effects of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) on oral health-related quality of life (OHQoL) following impacted mandibular third molar (M3) surgery.A prospective, randomized study of 50 subjects was designed. Participants were divided equally into the PRP and PRF groups. The OHQoL was assessed using the OHQoL-UK instrument preoperatively and on postoperative days (PODS) 1, 3, and 7. Categorical variables were presented as frequencies and proportions. The linear mixed model analysis was used to determine the effects of PRF and PRP on overall OHQoL with respect to time, treatment, and treatment by time-point interaction. The analysis was also performed for the physical, social, and psychological domains.Fifty subjects were analyzed. The time-point assessment of the overall OHQoL was significant within the PRP and PRF groups (P-values of 0.01 and 0.000002, respectively). The time-point analysis was also significant in both study groups at all domain levels (P0.05). A comparison of treatment by time-point interaction for the overall OHQoL between the study groups was insignificant (P = 0.217). Treatment by time-point interaction for OHQoL between the study groups at social and psychological domain levels was insignificant, however, at the physical domain level, PRF had a significantly better effect on OHQoL (P = 0.016).The study showed that the overall OHQoL was not significantly different between the PRP and PRF groups after M3 surgery. However, PRF had a significant influence on OHQoL at the physical domain level.

There is uncertainty surrounding the choice of a better imaging modality to detect metastases in cervical lymph nodes. The aim of this study is to examine the role of Ultrasound in the diagnosis of metastatic cervical lymph nodes in orofacial malignancies in a resource limited environment and the effect of the radiologist's experience in interpretation of the results.Sixty patients with various histologically diagnosed orofacial malignancies and clinical evidence of cervical lymph nodes metastases were examined with ultrasound by a consultant and a trainee radiologist. Affected lymph nodes were subsequently biopsied and examined histologically. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 19 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2010 (Microsoft, Redmond, WA, USA). Test of statistical significance was set at 0.05.Ultrasonography examination by the consultant radiologist recorded a sensitivity of 80.0%, specificity of 57.1%, PPV of 77.5%, NPV of 60.0%, accuracy of 71.7% and a P value of 0.004. The trainee radiologist recorded a sensitivity of 69.2%, specificity 38.1%, PPV of 67.5%, NPV of 40.0%, accuracy of 58.3% and a P value of 0.566.Ultrasonography is useful in the diagnosis of metastatic cervical lymph nodes in orofacial malignancies and the interpretation and reliability of the results depend on the experience of the radiologist. Examination of patients should therefore be done and interpreted by an experienced radiologist.

Locally advanced inoperable orofacial malignancies do present clinically, and constitute a significant public health burden worldwide.To determine the prevalence and clinical characteristics of Stage IV locally advanced inoperable orofacial malignancies for consecutive patients.A 24-year retrospective study was undertaken, and data obtained from hospital register, case files, and histopathological reports of patients were recorded in a proforma. The variables studied were age, sex, type of lesion and site, duration of lesion, tobacco/alcohol use, and socioeconomic status of the patients and clinical features of the lesions.Twenty-six patients presented, giving a prevalence of 11.2%. The most common lesion was adenoid cystic carcinoma, 23.1%. Males accounted for 18 (69.2%) cases and females, 8 (30.8%) giving a male to female ratio of 2.3:1. The ages ranged from 21 to 65 years, mean (SD) 48.6 (7.3) years. The gender distribution was clinically and statistically significant in favor of the males (P = 0.001). The patients were in the low socioeconomic class and 20 (76.9%) indulged in chronic use of tobacco and alcohol. The duration of the lesions ranged from 1.8 to 3.1 years. The maxilla/facial skin was the commonest site (46.2%). Clinically and statistically, the relativity of site distribution of lesions was significant (P = 0. 002). The clinical features occurred in combination resulting in an average of 10 symptoms and signs in each patient.The synopsis of these lesions shows that all have undergone metastasis; salivary gland malignancies were most common with maxilla as the commonest site.

Background: Ludwig's angina is a potentially life-threatening condition characterized by bilateral cellulitis of the submandibular, submental, and sublingual spaces. Intravenous (I.V) penicillin G or amoxicillin-clavulanate (Augmentin) has been recommended for use as empirical management before obtaining culture and sensitivity results. Aim: The aim of this study was to compare the therapeutic efficacies and clinical outcomes of I.V benzylpenicillin with I.V Augmentin in the empirical management of Ludwig's angina. Methods: This was a prospective randomized clinical study carried out to measure the rate of swelling reduction (using the lobar rate, Adam's rate, and interincisal distance) and other clinical parameters among the two drug groups (I.V penicillin G and Augmentin). Descriptive summaries of variables were generated, and Student's t-test was used to compare the mean outcomes of the two groups. Results: A total of 26 individuals participated in the study, consisting of 46% (12) males and 54% (14) females. The participants ranged from 13 to 61 years with mean and median of 34.4 (±12.7) and 35 years, respectively. Only 8% of the cases of Ludwig's angina were not attributable to odontogenic factors, compared to 92% resulting from odontogenic causes. There was no significant difference in the efficacy of the two antibiotics used in this study. Conclusion: The efficacies and the clinical outcomes of the two antibiotics were similar. Benzylpenicillin is probably a suitable empirical alternative where Augmentin cannot be afforded, to reduce the mortality associated with the condition.

Dental implants and orthodontic mini implants or temporary anchorage devices (TAD) have been used for tooth replacement and as adjuncts to orthodontic treatment in anchorage control and retraction of segments of teeth respectively. They are manufactured from various materials with titanium being the currently used material. The patients in our environment have diverse cultural acceptances and constraints with some prohibiting the use of certain materials in their oral cavity.The aim of this study therefore was to determine the existence of cultural constraints in the use of dental or orthodontic min-implants and compare them in the management of patients.Four groups of dental patients were selected to determine if cultural constraints exist. Groups 1 and 2 were patients with either anterior or posterior missing teeth requiring replacement with dental implants (implant group) or partial dentures (denture group), respectively. Group 3 were orthodontic patients requiring TAD (orthodontic group) and group 4 were patients with other dental problems and served as the control (normal group). Associations between frequencies, gender, educational, and cultural differences were evaluated with the Chi-square test. Significant values of P0.05 were applied where applicable.A total number of 192 participants were recruited for the study. Group 1 had the highest number of culturally constrained participants (n = 21, 10.9%). A significantly higher number from the group was seen (n = 11, 52.4%) among the African Traditional worshippers (ATR). Although a total number of 58 (30.2%) patients replaced their missing teeth, 37 (19.3%) utilized partial dentures in group 2 with no cultural constraints. Orthodontic implants were not rejected (n = 0, 0%) by all the four groups. Group 4 demonstrated a low level of constraints (n = 7, 4.2%). Of the four religious groups identified, ATR demonstrated the highest level of constraints with Christians and Muslims showing fewer constraints to the use of implants (n = 7, 33.3%) and (n = 2, 9.5%), respectively. Participants with the highest educational levels and social classes were more culturally constrained in the use of dental implants.Cultural constraints exist in the use of dental implants in our environment among African Traditional religion worshippers. There was, however, no cultural constraint to the use of orthodontic implants by any of the religious groups.

Background: This study was aimed at assessing the level of knowledge, attitude and practice of dental surgeons on human immunodeficiency virus (HIV) and hepatitis B virus (HBV) post-exposure prophylaxis (PEP).Methods: A descriptive, cross-sectional study was conducted among all the consenting dental surgeons at the University of Benin Teaching Hospital, Benin City, Nigeria, between May and July, 2015. The survey was carried out using a self-administered, anonymous, twenty-five item, and structured questionnaire.Results: A total of 40 (74.1%) males and 14 (25.9%) females responded in the study. The majority, 37 (68.5%), of the dental surgeons had inadequate knowledge about PEP. Majority of the dental surgeons, 44 (81.5%), had a good attitude towards PEP for HIV/HBV. From the study participants, 52 (96.3%) agreed on the importance of PEP for HIV/HBV in the work place. A high proportion of the respondents, 47 (87.0%), had been vaccinated against HBV. Among all of the respondents, 25 (46.3%) were exposed to H...

Background: Few studies are reported in the literature about the prevalence of disarticulation resection of the mandible, but little is known about the risk factors. This study is aimed at determining the prevalence and risk factors of disarticulation resection of the mandible. Patients and Methods: This was a retrospective study design for patients that had surgical resections of the mandible from January 2010 to July 2020 at the Department of Oral and Maxillofacial Surgery of a tertiary health facility in Nigeria. Collected data from the patients' case-notes were age, gender, level of education, place of residence, occupation, employment status, tobacco use, alcohol consumption, type of lesion, and type of resection performed. In the univariate analysis, the Chi-square test was used for analysis, while the binary logistic regression was used for multivariate analysis. All statistics were performed with SPSS version 21 (IBM Corps, Armonk, New York, USA). A value of P

Otitis media with effusion is common in children with cleft palate, and the aim of this study was to find out its incidence and risk factors in Nigerians. We prospectively studied 84 patients (42 with cleft palate and 42 control subjects); 27 were male and 15 female, who were age and sex matched with control subjects. The extent and size of the clefts were measured using a dental cast and Vernier calipers, and the otitis media was diagnosed with otoscopy and tympanometry. The mean (SD) age of the groups was 11 (7) months (range 1-33). Twelve children in the cleft group had otitis media compared with three in the control group. Infants and boys were more likely to be affected. There was a significant association between age (p=0.02), sex (p=0.01), and size of cleft (p=0.00). However, only the size of the cleft was confirmed to be an independent predictor, with children who had extremely wide clefts being more likely to develop otitis media than those with narrow clefts (OR=8.71, 95%CI=1.07 to 70.5).We conclude that the incidence of otitis media with effusion was higher among children with cleft palate than among those who did not have a cleft. Infants had a higher incidence than older children, and boys had a higher incidence than girls. Age, sex, and the size of the palatal cleft were significantly associated with otitis media, but not the extent of clefting.

Short-range shotgun wounds of the craniomaxillofacial region are life-threatening and are as devastating as military rifle wounds.This study aimed to evaluate the pattern of presentation of craniomaxillofacial shotgun injuries, types of shotgun injuries, and the outcome of treatments in our environment.This is a prospective observational study. Materials and Methods: This is a prospective observational study conducted from February 2006 to March 2012. All patients with shotgun wounds to the craniomaxillofacial region were included in the study by convenient sampling method. Glezer's shotgun classification scheme was used to categorize the patients into short-, intermediate-, and long-range shotgun wounds. Data collected were analyzed using SPSS version 16.Descriptive statistics were used to calculate the data. Mean and standard deviation (SD) were calculated for all quantitative variables such as age. Frequency and percentages were presented for qualitative variables.A total number of 28 patients were seen. Ages ranged from 19 to 64 years with a mean (±SD) of 32.7 (±11.4) years. The two most commonly used shotguns were locally made pistol (25, 42.9%) and the cut-size gun (10, 35.7%) and the least commonly used was Dane gun (1, 3.6%). Close-range injury to the face was 17 (60.7%) while that of intermediate- and long-range injuries were 6 (21.1%) and 5 (17.9%), respectively.Wounds sustained from close-range shotguns to the face were the most common in this environment. The outcome of treatment was satisfactory when treated with conservative debridement and early reconstruction.

Background: Oral lesions have been reported to be early clinical features of HIV infection. Objective: The purpose of this study was to establish the prevalence of oral lesions in HIV Seropositive female patients and correlate the CD4 count with the appearance of oral lesions in the female patients attending Lagos University Teaching Hospital (LUTH) and University of Benin Teaching Hospital, Benin (UBTH). Methods: A prospective study was undertaken in 172 newly diagnosed adult HIV infected female patients (not on antiretroviral therapy), who attended the PEPFAR clinic at LUTH and the HIV Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria. They were assessed for oral lesions which were evaluated using EEC/WHO (2003) – Classification on the diagnostic criteria for oral lesions in HIV. Data were collected using an interviewer administered questionnaire. Following Oral examination undertaken, oral lesions were detected, recorded and Original Research Article

Post operative care of sutured wound is important after surgery. Sutured wounds within the oral cavity are kept clean through frequent rinses with either normal saline, chlorhexidine mouth rinses, hydrogen peroxide diluted with saline, or fresh tap water.The patients were randomised into 3 groups (A, B and C). The container used had 34 chlorhexidine, 34 warm saline and 32 warm water mouth rinses. The latter served as control. All selected patients had scaling and polishing done preoperatively when needed. All participants in each group did not receive antibiotics but received analgesics (paracetamol 1 g 8 h for 5 days,).There were 49 females and 51 males, in the age range between 18 and 50 years. Microorganisms were found to grow on sutures with streptococcus viridians predominating followed by staphylococcus epidermides. The effects of chlorhexidine, warm saline and warm tap water mouth washes were not statistically significant.Chlorhexidine, warm salt water and warm tap water averagely produced the same number of colony forming units of bacteria, which shows that the three different mouth washes are equally effective as post-operative mouth rinses after oral surgery.

Background: Oral lesions are common findings in human immunodeficiency virus (HIV) infection. The main factor associated with the development of oral lesions is damage to the immune system, specifically loss of CD4+ lymphocytes, which are involved in cell‑mediated immunity. Aim: This study was aimed to determine the association of oral lesions in HIV/acquired immune deficiency syndrome women patients with the level of immune suppression as measured by the CD4+ counts. Subjects and Methods: This was a prospective cross‑sectional study with a study population of 191 consecutive female patients seen at the University of Benin Teaching Hospital, Nigeria. Ethical clearance was obtained from the institution of study and informed consent was given by every participant. HIV sero‑status was determined for all patients. CD4+ count was analyzed for both the HIV+ and HIV– women with oral lesions. The relationships between oral lesions and CD4+ cell count were investigated. Result: About 56.0% (107/191) of the 191 women studied were HIV positive. Age range for the HIV positive women was 18‑50 years with a mean age (standard deviation) of 36 (9.2) years. The most common oral lesion observed in the HIV positive women was pseudomembranous candidiasis accounting for 34.6% (37/107). About 68.4% (67/98) of the oral lesions occurred at CD4+ count < 200 cells/ml. Chi‑square revealed statistically significant association between the presence of oral lesions and CD4+ count in HIV infected women (P = 0.03). Conclusion: As the CD4+ count was decreasing the presence of oral lesions was increasing in the study. The presence of pseudomembranous candidiasis was found to be significantly associated with CD4+ count level < 200 cells/ml. This association of oral candidiasis with CD4+ cell counts could be used as additional markers of immunosuppression and progression of HIV infection, particularly in a developing country like Nigeria where CD4+ count cannot be determined routinely.Keywords: CD4+ counts, Human immunodeficiency virus/Acquired immune deficiency syndrome positive women, Oral lesions

Background and Objective: A postextraction comparative (cohort) study was carried out to determine whether the number of teeth extracted has an effect on salivary cortisol and by extension on stress.Subjects and Methods: Sixty‑three consecutive patients comprising 27 males (42.9%) and 36 females (57.1%) with a male: female ratio of 1:1.3, divided into two groups of A and B with a mean age of 25.8 ± 4.9 years, and age range of 18–37 years took part in the study. Fifty (79.4%) of them in group A (22 males and 28 females) each had a tooth extracted while 13 (20.6%) in group B (5 males and 8 females) had two teeth removed. One ml of resting saliva was collected from each patient 10 minutes after the procedure and analyzed for cortisol. All extractions and sample collections were done between 10 am and 2 pm to standardize the study and control for the diurnal variation of cortisol. Statistical analysis of the generated data was performed by using Student’s t‑test on SPSS version 17.0. The level of significance was set at 0.05 with P < 0.05 regarded significant.Result: The result showed mean salivary cortisol level of 12.914 ± 2.4684 ng/ml for group A and 12.108 ± 1.7192 ng/ml for group B though not statistically significant (P > 0.05). Females had more extractions in the two groups when compared with males. Male gender had a statistical significance difference (P < 0.05).Conclusion: This study shows that the number of teeth extracted did not have effect on mean salivary cortisol, as a result two teeth extraction does not impart more stress to the patient when compared with one, and as such no additional adjuvant stress relieving measures are needed in two teeth extractions.Keywords: Extraction, number of teeth, salivary cortisol, stress

We aimed to determine the contributory percentage of histopathologic diagnoses of routine biopsies and to ascertain the possible indicators for histopathologic examination to confirm the clinical diagnosis of periradicular lesions of extracted teeth.This was a prospective study carried out over a period of 8 months on patients who had single tooth extraction and routine histopathologic examination of recoverable periradicular tissues from extracted teeth.A total of 136 patients participated in this study. There was a male/female incidence ratio of 3:2 and most of the patients with histopathologically diagnosed lesions were within the first, second, and third decades of life (n = 49, 36.0%). Seventy-five (55.2%) cases had histopathologically diagnosed periradicular lesions, which were mostly periapical abscess (n = 30, 22.8%) and inflammatory (periapical) granuloma (n = 23, 16.9%). Some clinical and radiologic features were associated significantly with histopathologic diagnosis of some periradicular lesions (P.05). There also was a significant correlation of clinical diagnosis with histopathologic diagnosis of inflammatory (periapical) granuloma, periapical abscess, chronic osteomyelitis, and Burkitt's lymphoma (P.05).This study shows a higher contributory percentage of histopathologic diagnoses after routine biopsies, compared to previous reports from selected biopsies of periradicular lesions. We identified clinical indicators for predicting possible histopathologic diagnosis of some periradicular lesions, in particular, those that predict possible histologic diagnosis of neoplastic periradicular lesions.

The use of intermaxillary fixation to treat jaw fractures is a procedure still widely carried out in third world countries either because of the unavailability of miniplates to treat jaw fractures or due to their expensive nature. The purpose of this study was to determine the effects of intermaxillary fixation on ventilatory functions of adult Nigerians so as to establish baseline data for future comparisons in Africans.One hundred and forty-eight subjects comprising 120 (81%) males and 28 (19%) females were studied. Their age ranged from 18 to 60 years with a mean age of 24 years. The patients' pulmonary function tests were done using a vitalograph spirometer to measure FEV(1) and FVC immediately postoperatively, 7 days postoperatively, immediately after removal of IMF, and on the 7th day of IMF removal. The mean values of the FEV(1) and FVC at 7 days postoperatively were significantly higher than the values obtained immediate postoperatively (p0.001). The FEV(1) and FVC values obtained immediate postoperatively and 7 days postoperatively were significantly lower than the values obtained immediately after removal of the wires (p0.001).The results also show that there was a further increase of the mean values of FEV(1) and FVC on the 7th day of wires removal.It was observed that there was a reduction of pulmonary function values due to airway obstruction following IMF. The reduction was 5.7% to 8.9% in males, and 5.0% to 6.9% in females compared to the normal values established for adult Nigerians. In addition, the average of the mean FVC values immediately postoperatively and 7 days postoperatively were 87.9% and 90.9% for males and 91.7% to 93.6% for females respectively of their normal values obtained from the FVC values on the 7th day of wire removal.

Objective: The surgical treatment of benign locally invasive lesions of the mandible can have deleterious effects on a patient’s quality of life (QOL). To evaluate and compare the QOL in two cohort groups of patients who underwent mandibular resection for benign locally invasive lesions of the mandible. Methods: This was a seven year prospective study using the modified University of Washington Quality of life (UW-QOL) Questionnaire, version 4. The two cohorts studied were those that were rehabilitated, and those not rehabilitated. The questionnaire was administered to the patients at 18 months after marginal mandibular and segmental mandibular resections respectively. Statistical analysis was performed using EPI INFO 7 software package and level of significance was set at p

Background : Various treatment modalities have been employed in the management of facial fractures, including transosseous wiring using stainless steel wire. Transosseous wires used in fixing maxillofacial fractures gradually undergo disintegration leading to the release of nickel into the blood. Aim : To investigate the serum level of nickel in patients treated with stainless steel transosseous wires. Methods : This was a prospective study carried out over a period of nine months in the Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Nigeria. The study involved 101 subjects, 77 males and 24 females (male: female ratio of 3:1) who had maxillofacial fractures. The age of the subjects ranged between 10 and 70 years. Blood samples were collected at four different periods from each patient before the insertion of 0.5mm transosseous wires, at one, three and six months. Results : The results showed differences in the amounts of nickel released from transosseous wire during different periods of treatment. There was increase in nickel level in the first month (0.46 ± 0.09μg/l), reaching its highest levels in the sixth month (0.68 ± 0.06 μg/l). Conclusion : Transosseous wiring using 0.5mm stainless steel wire release measurable amount of nickel into patients’ serum. The serum level of nickel in the patients in this study was comparable to the values found in healthy individuals, showing that the patients did not attain toxic serum levels for nickel within the period of study. It is however recommended that transosseous wires should not be removed within six months. Key Words : Serum nickel; facial bone; fracture; stainless steel wire; transosseous; maxillofacial surgery.

We measured changes in the salivary concentrations of cortisol as an index of stress, and to find out if patients were stressed during routine intra-alveolar dental extractions. A total of 126 patients (63 experimental and 63 controls) matched for age and sex with a mean (SD) age of 26 (5) years (range 18–40) were recruited. Samples of saliva from patients whose glands had not been stimulated were collected twice from the study group (30 minutes before, and 10 minutes after, the procedure) and once from the control subjects. All samples were collected between 10.00 and 14.00 hours to standardise the method and control for the diurnal variation of cortisol. There was a slight but not significant increase in the mean salivary concentration of cortisol between the preoperative samples (mean (SD) 12.3 (1.5) ng/ml and the postoperative samples 12.8 (2.3) ng/ml in the study group) and the control 8.7 (1.0) ng/ml. However, there was no difference between the sexes. The study highlights a simple but effective way of evaluating stress in patients having intra-alveolar dental extraction, and emphasises the invaluable role of salivary cortisol in the evaluation of stress (particularly in our environment).

To compare the use of the 810nm diode laser with conventional surgery in the management of soft tissue mucogingival problems associated with orthodontic treatment.Orthodontic patients requiring different soft tissue surgical procedures were randomly assigned to receive conventional surgery or soft tissue diode laser, (wavelength 810 nm).Parameters documented include the type of anaesthesia used, intra and post operative pain, bleeding, the use of scalpel and sutures. The chi-squared test was used to test for significance at 95% confidence level. Probability values (p-values) less than 0.05 were regarded as significant.Only 2(16.7%) of the procedures carried out with the soft tissue laser required infiltration anaesthesia compared to 10 (90.9%) with conventional surgery and this was significant (P0.001). Post operative pain was significantly reduced in all cases treated with the diode laser (P0.001). There was also a significant difference (P0.05) in post operative bleeding in all cases treated with the diode laser. No sutures were used in all soft tissue cases managed with the diode laser and this was significant (P0.001). There was no statistically significant difference in treatment time in the use of the laser compared with conventional surgery.Orthodontic patients treated with the diode laser required less infiltration anaesthesia, had reduced bleeding during and after surgery, rapid postoperative haemostasis, elimination of the need for sutures and an improved postoperative comfort and healing.

Background: Studies from Nigeria have documented different reasons for tooth mortality and regular follow-up studies to determine any changes in reasons and pattern among Nigerians appears not to be common. The purpose of this study was to determine the reasons and pattern of tooth mortality among Nigerians and the changes that might have occurred after 38 years of the first report. Materials and Methods: The case records of patients seen at the Oral Surgery clinic of the University of Benin Teaching Hospital between March 2007 and February 2008 were retrieved from the Medical Records Department and analyzed for age, gender, reasons for extraction, tooth extracted, frequency of extraction, and mode of extraction. Results: A total of 990 patients were referred for exodontia and 1050 teeth were extracted from 397 (40.1%) males and 593 (59.9%) females of age 14--89 years. The reasons for extraction include caries and its sequelae (n = 905, 86.2%), periodontal disease (n = 69, 6.6%), trauma (n = 41, 3.9%), orthodontics (n = 24, 2.3%), failed endodontics (n = 5, 0.5%), prosthetics (n = 4, 0.4%), pericoronitis (n = 2, 0.2%). The most frequently extracted teeth were the lower right first molars (n = 109, 10.4%) and the lower left first molars (n = 95, 9.0%), respectively. Molar teeth (n = 830, 79.0%) were more frequently extracted while canines (n = 13, 1.2%) were the least. The lower molars were more commonly extracted (n = 479, 45.6%) followed by upper molars (n = 351, 33.4%). The age range of 21-30 years was more commonly referred for extraction with the most frequently extracted teeth being the lower left first molars (n = 32, 3.0%) in females and (n = 27, 2.7%) in males, respectively. Conclusion: Tooth mortality in Nigerians is significantly associated with dental caries and its sequelae especially in younger patients.

Fractures of the zygomatic complex occur worldwide and are a component part of injuries that can be sustained in the maxillofacial region. The objective was to analyze the clinical presentation and management ofzygomatic complex fractures.This was a prospective study carried out over a period of five years at the University of Calabar Teaching Hospital, Nigeria. Data documented were patients' age, gender, time of presentation, cause and type of fracture, associated head and maxillofacial injuries, clinical features, types of plain radiographs, treatment methods, duration of follow-up and complications.Majority of the patients (n = 81, 63.3%) were in their third and fourth decades of life while the male to female ratio was 20.3:1. Road traffic accident (n = 111, 86.7%) was the most common cause of fracture. Fractures of the zygomatic complex alone (n = 105, 82.0%) were more common than isolated fractures of the arch (n = 13, 10.2%) and combined fractures of the zygomatic complex and arch (n = 10, 7.8%).While multi-disciplinary approach to treatment is important, majority of the fractures were treated by simple elevation and transosseous wire osteosynthesis. Delay in presentation, associated injuries and non-availability of mini-plating technique contributed to the development of complications.

Background: Surgical audit is a normal part of surgical practice. Earlier reports on the availability of oral and maxillofacial surgical services in Nigeria showed limited number of centres and shortage of specialists. Objective: To determine the pattern of oral and maxillofacial surgical diseases in order to establish the local demographic data base and subsequently structure service delivery on evidence-based disease profile. Materials and methods: A retrospective study using the admission registers and folders of cases treated in the oral and maxillofacial unit in the period of January 2005 to December 2010 in a Nigerian teaching hospital. Results: Within the period, 7948 patients were seen and17.0% needed oral and maxillofacial surgical treatment. Ratio of male to female subjects was 4:1, whereas the age of subjects ranged from one-83 years with mean age at 38.7±10.6 years. Both congenital (0.8%) and acquired (99.2%) cases were recorded. Subjects that had acquired conditions were categorized into traumatic (67.1%) and non-traumatic (32.1%). The commonest aetiological factor (79.1%) causing disease was road traffic accident. The common treatments were intermaxillary fixation (54.8%) and resection (7.5%), whereas the complications were limitation in mouth opening, 22.1% and facial deformity, 19.5%. Conclusion: The commonest indication for consultation was trauma, and since resources for care are scarce in Nigeria, the focus should be to reduce the disease burden by prevention. Keywords: Audit, Demographic pattern, Oral, Maxillofacial, Trauma.

Mucosal affectation may be a direct cytotoxic or cytostatic effect of methotrexate.To highlight the diagnostic procedure and treatment intervention erythema multiforme complicating methotrexate-induced allergic stomatitis.The patient was a 60-year-old man suffering from stomatitis that rapidly developed into erythema multiforme. The patient had been prescribed methotrexate to treat rheumatoid arthritis. The patient presented with painful ulceration of the vermillion border of the upper and lower lips covered with necrotic tissues. We made a tentative diagnosis of methotrexate induced allergic stomatitis. On the patient's second visit to the clinic, the lesion had developed into crusted and haemorrhagic ulceration with erythematous patches on the lips. The patient was now complaining of weakness, fever and occasional seizure attack. Examination of the upper and lower extremities revealed bilateral bullous eruptions. The definitive diagnosis was that of erythema multiforme complicating methotrexate induced allergic stomatitis. withdrawal of the methotrexate yielded positive result with complete resolution of the lesions after 12 days of drug withdrawal.Early diagnosis of adverse drug reactions is essential for effective treatment, to avoid untoward systemic complications.

This article reports 3 cases of melanin pigmented lesions among 75 histologically diagnosed periradicular lesions of extracted teeth. Case 1 was a 25-year old male who presented with one week history of toothache involving a tender carious left mandibular second molar tooth (37), with periapical radiolucency and diagnosed clinically as acute apical periodontitis. The lesion was diagnosed histologically (using Haematoxylin and Eosin) as periapical granuloma, while histochemical examination (using Masson-Fontana technique) showed the presence of round/oval shaped melanin pigmented macrophages (melanophage) in the lesion. Case 2 was a 54-year old male with one week history of toothache associated with tender carious right maxillary first molar tooth (16) with periapical radiolucency. A clinical diagnosis of acute apical periodontitis was made, but histological and histochemical examination showed a melanin pigmented periapical granuloma with spindle shaped melanophage. Case 3 was a 28-year old female who presented with 4 days history of toothache, involving the tender left mandibular first molar tooth (36). The lesion had periapical radiolucency and a clinical diagnosis of acute apical periodontitis. On examination histologically and histochemically, the lesion was diagnosed as an intraosseous melanocytic naevi with dark-brown nests of round naevus cells. In conclusion, this article shows the rarity of melanin pigmented periradicular lesions in the jaws. The cases reported suggest that the trigger for formation of melanin-pigmented cells in the periradicular lesions may be related to the acute phase of the lesions. Further study is recommended to determine if the remnants of the migratory neural crest cells are the precursors of melanin-pigmented cells in the periradicular region.

Mandibular fracture is an important surgical condition in our environment and elsewhere in the world.The purpose of this study is to clinically determine the most common sites of the mandible prone to fracture.This two-year prospective study was carried out at the Dental and Maxillofacial clinic, University of Calabar Teaching Hospital, Nigeria, in 2007 and 2008.One hundred and seventy four patients' ages between six to 70 years (mean 28.7 ± 5.3 years) were studied. One hundred and forty two (81.6%) of them were males and 32 (18.4%) females, with a male/female ratio of 4.4:1.Road traffic accident significantly (χ2 = 17.1607, P = 0.0087) accounted for 139 (79.9%) of the fractures. There were 244 fracture sites in the 174 patients, with the body of the mandible being significantly (χ2 = 21, P = 0.0008) affected than other sites in fracture (n = 115, 47.1%). However, 96 (39.3%) and 132 (54.1%) of the fractures occurred on the right and left sides of the mandible respectively. Most patients had single (44.3%) and double (31.6%) fractures and this finding was significant (χ2 = 60.9314, P = 0.0000). The patients encountered were fully (62.6%) and partially dentate (37.4%). The fractures were successfully treated by conservative method, closed reduction and open reduction techniques.This study shows that the tooth-bearing portion, body, left and right sides of the mandible are most commonly prone to fracture when multiple aetiologies are considered.

Mandibular fracture sometimes is associated with complications which influence its prognosis. Aspects of the complications of mandibular fracture investigated are those emanating from the methods of treatment employed in its management. Such methods of treatment include conservative, closed reduction with intermaxillary fixation and open reduction with inter-maxillary fixation or rigid internal fixation. It is expected that with improvement in the knowledge of this condition and its management protocols complications will be reduced to the barest minimum. But, this is not so as there are many confounding variables that influence treatment outcome. This paper examined those complications associated with the various treatment methods and recommends that the older methods of treatment like closed reduction technique and transosseous wire osteosynthesis are still relevant in the current day practice.Keywords: Mandible, fracture, treatment methods, complications.

Twenty-two patients with haemangiomas of the oro-facial region who presented at the department of Oral and Maxillofacial Surgery, UBTH, were studied. There was a preponderance of females (72.7%) over males (27.3%) and most (59.1%) patients were in the 11-31-year age group, with a median age of 25.0 years. Facial swelling was the commonest associated clinical features (81.8%) and in 91% of cases, the lesions readily yielded blood on aspiration. Soft tissue and bony lesions were encountered with equal frequencies. Sclerotherapy was the commonest mode of treatment (63.7%). Non-availability of advanced imaging techniques and limited treatment options were the major constraints to the management of these lesions. Keywords : Haemangiomas, maxillofical region Annals of Biomedical Science Vol. 1 (1) 2002: pp. 18-22

There are psychiatric disorders in dentistry, which because of lack of recognition have not been well documented. Some of the disorders pose management difficulties to the dentist because he is not trained to recognise them. For instance disorders that have psychological or multifactorial aetiology, which tend to characterise mental illness are not well treated. Pain is the commonest reason for the patient to visit the dentist. If the pain is non-organic, the diagnosis and management pose a problem to the dentist. Most pains that arise from psychological illness exist in association with personality and neurotic disorders. These disorders include dentophobia, stress, bruxism and more severe conditions associated with behavioural problems or dysfunctions. The dentist ought to be trained in rudimentary Psychiatry to be able to recognise and determine when psychiatric referral is necessary. We therefore, advocate the teaching of Psychiatry to dental students, which would focus predominantly on their needs. Keywords : Mental Health, Problems, Dentistry Annals of Biomedical Science Vol. 1 (1) 2002: pp. 1-10

A case of congenital bilateral ranula in a one-week-old male baby is reported. At presentation the cyst measured 3.5 x 2.5 cm but did not interfere with feeding. Initial marsupialisation resulted in recurrence of the cyst. It was subsequently re-excised completely together with the associated sublingual salivary gland. The cyst has not recurred six months after treatment. The usually large size of the cyst and its bilateral presentation makes this an interesting case.