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BACKGROUND: Exogenous factors occurring in the antenatal period could be contributory to the formation of orofacial cleft. This study sought to determine the antenatal events in mothers that may have contributed to orofacial cleft deformity of their children. METHODOLOGY: It was a prospective observational cross sectional study of consenting mothers of babies with orofacial cleft who met the inclusion criteria. The study instrument was a questionnaire. RESULTS: Seventy-two mothers participated in the study. Most of these mothers were below 35 years of age and more than half, 43 (59.7%) were of the low-intermediate socioeconomic status. Although majority, 70 (97.2) of the mothers had antenatal care, the mean gestational age at commencement of antenatal care was 4 months. Almost all, 69 (95.8%) mothers had ultrasound scans however the detection of the orofacial cleft was in only 2 (2.8%) mothers. The commonest medication taken was haematinics, 26 (36.1%). Herbal medication, 15 (20.8%) and antimalarial, 12 (16.7%) were the other drugs more frequently taken. The mean age of pregnancy at commencement of these medications was 3.6 months. CONCLUSION: Although uptake of antenatal service was common practice among mothers of babies with orofacial clefts in this study, no antenatal predisposing factors were identified.

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INTRODUCTION: Bilateral transverse facial cleft is the most common of the rare facial clefts and early presentation is a key element for successful management and prevention of possible complications like poor esthetics, speech and eating difficulties. Though several studies have documented reasons for late presentation, none has highlighted non-referral due to missed diagnosis by healthcare workers as a reason. CASE REPORT: A nine-year-old girl was brought by her parents to the Primary Oral Health Clinic on account of "very wide mouth" noticed at birth. The mother noticed the anomaly few hours after she gave birth to her and immediately pointed the attention of the nurses and birth attendants to it but they dismissed her concern. Subsequently, the mother took the girl to the maternity centre for routine immunization appointments, but none of the healthcare workers she encountered recognized the birth defect. The parents further reported that the girl received jests and abuses from her peers. A diagnosis of Isolated Bilateral Tessier number 7 cleft was made based on clinical examination findings. She was referred to a cleft centre where the repair was successfully carried out at no cost to the patient through the Smile-Train® sponsorship program. Subsequent follow-up visits to the primary healthcare clinic in the sixth and ninth month post-surgery revealed remarkable improvement in both patient's and parents'self-reported psycho-social wellbeing. CONCLUSION: This case report presents a rare presentation of delayed isolated congenital bilateral macrostomia because of healthcare workers failure to diagnose.

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The occurrence of cleft lip and palate anomaly can impact on an affected individual's quality of life. Cleft of the palate particularly significantly affects the production of speech. This article aims to describe the speech errors following palatoplasty procedures observed from cleft centres within Nigeria. Ability to produce high pressure sounds, frequencies of speech errors and speech intelligibility were analysed from data collated from five cleft centres. The speech services in these centres were provided in partnership with Smile Train, a nongovernmental organization based in the United States of America. Glottal stop was the commonest speech error while the speech intelligibility was considered mild in the majority of cases. This report serves as a form of preliminary overview of the speech pattern of individuals with repaired cleft palate in our environment.

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Syngnathia is a rare congenital anomaly that presents as fusion of the jaws. The aims of this study were to review the clinical profile of reported cases of syngnathia available in the literature with a view to suggesting a classification that may simplify the understanding of syngnathia and to propose an appropriate management protocol. A PubMed database search of articles published in English was conducted. Selected articles were analyzed according to year of publication, type of article, number of cases per article, patient biodata, description of syngnathia, and associated anomalies. Data were analyzed using IBM SPSS version 19; the level of statistical significance was set at P≤ 0.05. Cases were categorized according to a proposed classification, and a review of the management of congenital syngnathia from 153 previously reported cases (in 110 articles) was done to propose a treatment protocol based on the proposed classification model. The findings are presented under three headings: pre-surgical considerations, surgical (intraoperative) considerations, and post-surgical considerations. The proposed classification categorizes syngnathia into soft tissue union (type 1) and hard tissue union (type 2). These two types were found to have similar frequencies in the literature, while their management differed in terms of mode of anaesthesia and surgical approach.

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OBJECTIVE: The objective was to review patients treated with maxillofacial prostheses in a Nigerian teaching hospital to assess the types of prostheses provided for them. METHODOLOGY: This was a retrospective study of patients treated with maxillofacial prostheses over a period of nine years. The socio-demographic data of the patients, types of defect, causes of defects, location of defect, types of maxillofacial prostheses and the indications for prostheses were obtained from the patients' case records. Case records with incomplete information were excluded. All data generated were analysed using the IBM SPSS version 20. Fisher's exact test was used to test for statistical significance. RESULTS: Case records of eighty-two patients treated with maxillofacial prostheses were reviewed. Forty-three (52.4%) of the patients were males while 39 (47.6%) were females. The age ranged from 6 to 76 years with the mean age being of 38.76 (SD±18.3) years. The majority, 58 (70.7%) of the patients were of lower social-economic class. Sixty-six (80.5%) patients had prostheses for maxillary defects, while only one (1.2%) patient had prosthesis for nasal defect. Twenty (30.3%) of the 66 patients that had maxillary defects had definitive obturators, while only three (4.5%) had all the three types of obturator. Surgical recession of tumours of the jaw was the major cause (85.4%) and mastication (70.7%) was the major indication for the prescription of obturators. CONCLUSION: The majority of the patients were of the lower social class and maxillary obturator was the major form of maxillofacial prostheses provided for patients in this study. Most of the defects are caused by surgical recession of tumours of the jaw and mastication was the major indication for the prescription of obturators.

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BACKGROUND: Learning environment has been described as crucial in determining the success of medical and dental education. Continuous evaluation of this environment will help in maximizing the learning opportunities of the training program. OBJECTIVE: To assess the resident doctors' perception of their learning environment at a teaching hospital in Nigeria. METHODS: The DREEM questionnaire was administered to participants undergoing residency training in the faculty of Dental Surgery at the University College Hospital, Ibadan. RESULTS: Thirty-nine resident doctors participated in the study (23 Males, 16 Females), mean age (±SD) was 35.7 (±4.22) ranging from 28 years to 46 years. Mean global score (±SD) was 105.3 (±26.8), 52.7%, out of a maximum of 200. The mean global score according to gender was significantly higher among males than females. The overall perception of the training environment by residents is more positive than negative and the male gender appears to have a more positive perception than the female gender. However, this perception is borderline as the environment was perceived as having many problems and residents' perception of their learning environment is mostly negative. Attention of the institution and trainers should be drawn to possibilities of combating the problem areas for better outcome of residency training in our environment.

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BACKGROUND: The UCH/Smile Train partnership, which offers free cleft surgeries to patients provides succor. OBJECTIVE: The objective of the study was to determine the state distribution of new patients presenting with cleft lip and palate, to The UCH. METHODS: A retrospective review of all new cleft patients presenting to The UCH between January 2012 and June 2015. The data obtained were their local government area of residence, age of the patients, gender of the patients and the type of cleft. Descriptive statistics was used to analyze the distribution of patients seen while Chi square test was used to analyze the influence of gender and laterality on the type of cleft. RESULTS: Sixty-seven eligible patients were seen within the study period. Majority (83.6%) of patients seen were from 14 of the 33 Local Government Areas (LGA's) in Oyo state. Patients were seen from LGA's in proximity to UCH. A few (16.4%) of the patients came from outside the state. Iwajowa, the LGA with the least number of patients (1.8%) was furthest from UCH. Left sided clefts were significantly more than bilateral or right-sided clefts (p=0.001). Most of the patients from Oluyole LGA had CP while no patient with CP was seen from Lagelu and Akinyele LGA's. CONCLUSION: There is the need to intensify cleft awareness programs. Further studies into the health habits, cultural beliefs and genetic profile of communities may explain some regional distribution of cleft types seen.

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BACKGROUND: Operating theatre time management is a constant source of tension among the healthcare professionals responsible for the use of the facility. It is important that all effort should be geared at optimal utilization of available resources and minimization of waste. AIM: To appraise time management, frequency and duration of surgical procedures, frequency and determinants of blood transfusion in oral and maxillofacial surgery. DESIGN OF THE STUDY: Prospective clinical study. SETTING: The University College Hospital, Ibadan. Nigeria. METHODOLOGY: This was a cross-sectional study of consecutive patients who had maxillofacial surgical procedures. Information was collected on number of cases scheduled per list, number of cases done per list, each patient's biodata, time intervals between patient arrival and departure from operating theatre, route and duration of intubation, type of surgical procedure, surgical time, preoperative and postoperative packed cell volume estimations, volume of blood loss and the frequency and volume of blood transfusions. RESULTS: The main points of delay were identified as the patient wait at the theatre reception and in the operating suite before intubation. Mandibulectomy procedures were the longest procedures with approximately five (5) hours, followed by maxillectomy with four (4) hours and maxillofacial trauma with three and a half (3.5) hours. Maxillectomy procedures had highest transfusion probability. The surgical time and the estimated blood loss significantly determined whether a patient would be transfused or not. The nasotracheal was the commonest route of intubation while cleft surgeries were the most frequent procedures performed followed by trauma surgeries. Majority of the patients were not transfused and two units of blood was the most frequent transfused volume for a patient. CONCLUSION: The main areas of delay have been identified as patients' waiting periods before the surgical procedures. The reasons why these delays occur need to be investigated and addressed to have an optimally functional facility. Reservation of blood for maxillofacial surgical procedures should be based on the anticipated need for blood transfusion for the particular procedure.

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BACKGROUND: The maxillofacial region has a complex anatomy and is replete with orifices and tissue dead spaces which could harbor foreign bodies. It is important to identify a foreign body impaction when it occurs, as it can be a source of persistent pain, infection and suppuration, it could also further migrate to adjacent regions of the body. The aim of this study is to report the clinical presentation, the prevalence, diagnosis, management and outcome of maxillofacial foreign body impaction in Ibadan, Nigeria. METHODOLOGY: This is a prospective clinic based epidemiological study carried out at the Department of Oral and Maxillofacial surgery, University College hospital, Ibadan, Nigeria. Data of all the patients presenting with foreign body impaction department from January 2008 to July 2013 were recorded into a proforma. The data which included demographics, type of foreign body impaction, predisposing factors, clinical presentation, diagnosis, treatment provided and outcome were analyzed using IBM SPSS version 19. RESULTS: A total of 5571 patients presented in the clinic during the study period with 16 of the patients presenting with foreign body impaction in the maxillofacial region prevalence rate of 0.29% There were 8 (50%) males and 8 (50%) females with male/female ratio of 1:1.The age ranged from .. to .. with a mean age of 21.89+/-17.047years. Iatrogenically displaced tooth 4 (25%) was the commonest foreign body impacted in the maxillofacial region while the submandibular region 3 (18.8%) was the commonest site. Majority 6 (40%) of the patients had retrieval of the foreign body under local anaesthesia. CONCLUSION: Foreign body impactions in the maxillofacial region are not common and are varied in nature. Their management is straightforward when they are impacted in an accessible and superficial site otherwise their diagnosis could be difficult and their management more challenging.

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BACKGROUND: Ameloblastoma is a benign odontogenic tumour which is locally infiltrative and may cause severe craniofacial deformities. Its epidemiology, clinical and histologic configurations are replete in local and international literature, but data about its gross surgical patterns and treatment outcome in Nigeria is sparse. We therefore describe the clinical, gross surgical configuration, histopathologic features and the outcome of management seen at a Nigerian tertiary hospital. METHODS: Records of all histologically diagnosed Ameloblastoma from January 2000 to December 2011 at the University College Hospital, Ibadan, Nigeria, were retrieved from the departments of Oral and Maxillofacial Surgery and Oral Pathology. Patients' biodata, clinical, radiographical, gross surgical and histological features of the tumours, type of treatment, mode of jaw reconstruction and post-surgical follow up period data were documented. RESULTS: One hundred and sixty-three ameloblastomas were diagnosed during the study period, only 92 had complete records and were therefore included in the study. The mean age was 34.2 years (+/- 14.25) and the male to female ratio was 1:1.1. Majority of the patients were in the low socioeconomic class (67.4%). Majority of the patients (76.5%) had segmental jaw resection and reconstruction was done mainly with non-vascularised iliac crest grafts. The gross surgical configurations were described as solid, cavitated and cystic. CONCLUSION: Despite the locally aggressive nature of ameloblastoma, patients presented late for treatment and majority of them had segmental jaw resection as a mode of treatment. Three gross surgical configurations of the specimens were described.

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BACKGROUND/OBJECTIVE: There are pieces of evidence suggesting that oxidative stress and immune responses play significant roles in the etiopathogenesis of some malignant diseases. Also increased oxidative stress in patients with certain cancer may result from changes in the levels of certain trace elements. Therefore antioxidants either in the form of trace metals or enzymes are important tools in the study of these conditions. This study aimed at measuring the level of oxidative stress in the head and neck cancer patients by using plasma total antioxidant potential and the plasma level of some antioxidant trace metals. MATERIALS AND METHODS: Twenty cases of head and neck squamous cell carcinoma recruited from the Oral and Maxillofacial surgery and Radiotherapy clinics of the University College Hospital, Ibadan were included in the study. While total antioxidant status was measured by ferric reducing antioxidant power (FRAP) assay of Benzie and Strain (1996), the plasma trace metals were assayed by atomic absorption spectrophotometry. RESULT: The total antioxidant potential was significantly reduced in the study group when compared with controls. Zinc, iron, and selenium were also found to be significantly lower in the study group compared with controls. CONCLUSION: The result suggests a state of oxidative stress in the head and neck cancer patients with likely impact on disease process and treatment outcome.

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INTRODUCTION: The term "maxillectomy" has been used to describe a variety of surgical procedures for a spectrum of diseases involving a diverse anatomical site. Hence, classifications of maxillectomy defects have often made communication difficult. This article highlights this problem, emphasises the need for a uniform system of classification and suggests a classification system which is simple and comprehensive. METHODS: Articles related to this subject, especially those with specified classifications of maxillary surgical defects were sourced from the internet through Google, Scopus and PubMed using the search terms maxillectomy defects classification. A manual search through available literature was also done. The review of the materials revealed many classifications and modifications of classifications from the descriptive, reconstructive and prosthodontic perspectives. RESULTS: No globally acceptable classification exists among practitioners involved in the management of diseases in the mid-facial region. There were over 14 classifications of maxillary defects found in the English literature. CONCLUSION: Attempts made to address the inadequacies of previous classifications have tended to result in cumbersome and relatively complex classifications. A single classification that is based on both surgical and prosthetic considerations is most desirable and is hereby proposed.

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INTRODUCTION: Foreign body impaction within the maxillofacial region is not an uncommon occurrence. Imaging of such objects is of paramount importance to their retrieval in order to assess their relation to vital structures as well as avoid disruption of such structures while retrieving the foreign bodies. We report a case of wooden foreign body which traversed the maxillofacial region, imaging of which posed a significant challenge. METHODS: A sixteen year old female presented with a wooden foreign body impaction following a road traffic accident. Challenges in the course of investigation and events during the surgical retrieval of the foreign body are described. RESULT: An unusual case of foreign body impaction transecting the right orbit, right antrum and the pharynx is presented. The inability of both Computed Tomographic scan and Ultra Sound scan to identify the path and relations of the impacted foreign body was also discussed. CONCLUSION: Computed Tomography and Ultrasonography may not be sufficient to delineate the path and relations of an impacted foreign body especially if the nature of the foreign body is not metallic.

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Aim. Cemento-osseous dysplasia (COD) represents a rare group of benign fibroosseous disorders, while osteogenic sarcoma (OS) on the hand, is a malignant tumour of ominous prognosis. A combination of COD and OS is rare and sparsely reported in literature. There are only four reported cases known to the authors. The aim of this paper is to report additional cases of COD occurring concurrently with OS. Materials and Methods. The clinicoradiologic findings and histological analysis of mandibular lesions in two patients who reported at the Dental Centre of the University College Hospital, Ibadan, Nigeria, are presented. Results. The two patients were diagnosed of mandible osteosarcoma occurring concurrently with bilateral mandibular focal cemento-osseous dysplasia. Conclusion. The simultaneous occurrence of osteosarcoma and cemento-osseous dysplasia raises the question of whether COD has transformed into OS or a collision tumour has occurred and their simultaneous occurrence is just a coincidence.

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INTRODUCTION: Haemangiomas are developmental vascular abnormalities and more than 50% of these lesions occur in the head and neck region, with the tongue, buccal mucosa, lips and palate most commonly involve. They are considered as harmatomas rather than true neoplasms Factors such as patient's age, size and site of lesion and the proximity of lesion to vital structure are paramount in the determination of the therapeutic approach 7 surgical excision, cryotherapy, injection of feeder vessels with sclerosants and embolization of the blood vessels. CASE REPORT: We report the management of cavernous haemangioma of the tongue in a 38 year old man using intra-tumoral ligation (The Popescu Procedure) and injection of sclerosant under general anaesthesia. RESULT: The efficacy of this method lies in the fact that it obstructs the vascular channels to and from the entire tumour mass leading to progressive atrophy of the vascular endothelia, fibrous hyperplasia and the substitution of the angiomatous tissues by a fibroconnective tissue mass which initially appears excessive but remodels and produces an acceptable appearance which can be further improved by plastic surgery. CONCLUSION: The procedure was well tolerated and the patient made excellent recovery. It is recommended in our centre where facilities for technologically demanding methods are not available.

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OBJECTIVES: This study was carried out to compare the efficacy of preoperative single bolus antibiotics with a 5 day- postoperative antibiotic regimen in reducing pain, swelling, and trismus, surgical site infection (SSI) and alveolar osteitis (AO) after third molar surgery. PATIENTS AND METHODS: A randomised experiment was done involving eighty-four patients. The patients were divided into two groups consisting of 42 patients each. A preoperative group was given an oral bolus of 2g amoxycillin capsules and 1g metronidazole tablets one hour before extraction, while those in the postoperative group were given a five-day regimen oral 500mg amoxycillin capsules thrice daily and 400mg metronidazole tablets thrice daily. The occurrence of postoperative pain, swelling, trismus, SSI and AO were compared between the groups. RESULTS: Seventy-nine patients completed the study; 38 patients in the preoperative group and 41 patients in the postoperative group. There was no difference between the groups in respect of the inflammatory complications. The four cases of AO occurred in the preoperative group. CONCLUSION: Single bolus antibiotic prophylaxis should be adequate for most cases of third molar surgery as the degree of degree of postoperative pain, swelling and trismus was similar in both groups. The use of single bolus antibiotic prophylaxis would also help reduce the cost of treatment in developing countries as well as reduce the risk of development of resistant strains. However, a five-day postoperative antibiotic regimen is advised in patient with risk factors for AO.

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Ameloblastoma is the most common odontogenic tumour. The tumour has been described as a benign but locally invasive polymorphic neoplasm. Hybrid lesions have been described, which combine histological features of desmoplastic and conventional ameloblastoma. The hybrid ameloblastoma is rare and only few cases have been reported worldwide. We present two cases seen from a review of 195 ameloblastoma cases seen over a ten year period. The cases presented with clinical features of the conventional ameloblastoma such as bucco-lingual bone expansion and multilocular radiololucency. Larger clinical series of hybrid ameloblastoma need to be reviewed in order to better characterize the clinical behaviour, aggressiveness and prognosis of this rare variant of ameloblastoma.

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Polymorphous low grade adenocarcinoma (PLGA) is an uncommon tumour that affects minor salivary glands mainly. It was known to be clinically benign and histologically polymorphic; sometimes misdiagnosed as pleomorphic adenomas, monomorphic adenomas, malignant pleomorphic adenomas, adenoid cystic carcinomas and adenocarcinoma not otherwise specified. More information about PLGA is cumulating in the current literature with new evidences suggesting that the tumour may not be as indolent as it was previously thought. A thorough understanding of the clinical and histological behaviour of the lesion has serious implications in management. Here, a case of lower lip lesion with suspected lung metastasis is reported to exemplify how the clinical behaviour of the lesion may affect management.

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SUMMARY: Many factors affect the difficulty of endotracheal intubation some of which are related to the condition of the patients. A few assessment tools have been developed to predict intubation difficulty but none is all inclusive thereby being inadequate for comprehensive and accurate evaluation. We assessed the usefulness of four categories of predictive variables namely; the LEMON score, Demographic indices, Tumour site and Intraoral Position of tumour (IOP), in predicting intubation difficulty among a group of patients with orofacial tumours. By statistical analysis, a significant correlation between predictions by LEMON score and actual intubation difficulty was observed while neck mobility (P=0.28) and Mallampati scores (P=0.49) were the most important criteria in the scoring system. Significant association was also observed with demographic indices and difficulty whereby the Optimal Interincisal Distance (OID) had the greatest impact (P=0.048). There was no difference in the difficulty posed by the different sites and intraoral positions of tumours in this study. We therefore suggest the adoption of the LEMON score and consideration of the demographic indices when assessing patients with orofacial tumours for intubation difficulty. Three important variables should be given greater value, these are, neck mobility, Mallampatti score and optimal interincisal distance.

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A case of accidental displacement of a mandibular molar tooth into adjacent submandibular space during routine extraction by a general practitioner is reported. The localization and surgical retrieval of the displaced tooth is described, post-operative period was uneventful and salient lessons for the practitioners highlighted.

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