•Metastasis in cancer progression leads to dismal outcomes and poor overall survival.•The chaotic and open structure of tumor blood vessels suggests that tumor intravasation may be passive.•Cancer has a multiplanar configuration.

Oral squamous cell carcinoma (OSCC) is the most common type of head and neck cancer, with a high mortality rate. There is growing evidence supporting a link between oral cancer and the microbiome. The microbiome can impact various aspects of cancer, such as pathogenesis, diagnosis, treatment, and prognosis. While there is existing information on bacteria and its connection to oral cancer, the fungi residing in the oral cavity represent a significant component of the microbiome that remains in its early stages of exploration and understanding. Fungi comprise a minuscule part of the human microbiome called the mycobiome. Mycobiome is ubiquitous in the human body but a weakened immune system offers a leeway space for fungi to showcase its virulence. The role of mycobiome as a colonizer, facilitator, or driver of carcinogenesis is still ambiguous. Reactivating the mycobiome that undergoes collateral damage associated with cancer treatment can be watershed event in cancer research. The coordinated, virulent, non-virulent behavior of the fungi once they reach a critical density must be hacked, considering its diagnostic, prognostic and therapeutic implications in cancer. This review highlights the diversity of the mycobiome and its potential role in oral cancer.

Background: Blood transfusion, a critical life-saving procedure, is associated with side effects such as fever. Objectives: To determine the pattern of distribution of transfused blood groups among patients with postoperative fever after major oral surgery. Patients and Methods: This is a 1-year prospective study of patients that developed fever after major oral and maxillofacial surgery, with or without receiving ABO blood transfusion. Criteria for inclusion include those booked for oral and maxillofacial surgery and without any serious medical conditions. The confounding variables evaluated were divided into clinical and demographic parameters. Both univariate and bivariate statistics were computed. Results: Of the 108 patients, 23 (21.3%) met the criteria for diagnosis of postoperative fever. The majority (82.6%) of the patients were within 40 years of age. There were 17 males and 6 females with a male-to-female ratio of 2.8:1. Majority (60.9%; P = 0.021) of the patients having benign and malignant tumors needed blood transfusion. The study showed 78.3% of patients developed fever after blood transfusion, whereas 21.7% who did not receive transfusion also had postoperative fever. Group O Rhesus D positive blood group was the most common type transfused (P = 0.01), mostly in patients who had malignant lesions, and transfusion was done mainly intraoperatively. The majority (73.9%) of the fever occurred in patients within 24 h after transfusion, lasting for 1 day (P = 0.01). Conclusion: A significant association between the transfusion of blood and the development of postoperative fever, as well as fever occurring more frequently with increased units of blood transfused, was noticed. The outcome suggests blood transfusion is a risk factor for postoperative fever in patients after major oral surgery.

BackgroundThe surgical treatment of ameloblastoma of the jaws remains contentious due to the variable recurrence rate amongst its variants, the tumor's local invasive behavior, and the lack of consensus among surgeons concerning the extent of resection in the contiguous healthy tissues.ObjectiveTo determine the recurrence rate of ameloblastoma and its association with the resection margins.Materials and methodsThis is a retrospective cohort study of the medical records of patients who underwent surgical resection of the jaws as the primary modality of treatment for ameloblastoma. Clinical data over the 26 years were analyzed for age, gender, site of the lesion, size, radiographic appearance, histopathological sub-type, and the incidence of recurrence post-treatment. Descriptive and bivariate statistics were computed.ResultsA retrospective audit of 234 cases was included in the study that was typical (solid/multicystic) ameloblastoma. The age of patients ranged from 20 to 66 years with a mean age of 33.4 ± 9.6 years, and a male-to-female ratio of 1.2: 1 (P = 0.52). The follicular and plexiform types accounted for the majority of histopathological variants (89.8%; P = 0.000). Overall, 6.8% of cases relapsed after the initial primary surgery. The rate of recurrence was high with a resection margin of 1.0 or 1.5 cm than 2.0 cm (P = 0.001). No case of recurrence was seen with a resection margin of 2.5 cm margin.ConclusionA low recurrence rate of 6.8% was noted in our series of cases. A wide 2.5 cm resection margin is recommended in the adjacent healthy tissues.

Objectives: To determine the prevalence of maxillofacial fractures associated with persistent CSF leak, and to assess its bearing on clinical outcomes of consecutive patients managed at our centre.Methods: This was a retrospective cross-sectional study. The medical records of patients over 11-year period were analysed for age, gender, etiology of injuries, duration between injury and presentation to the hospital, types of facial fracture and their treatments, treatment done to control CSF leak, and complication(s). Descriptive and bivariate statistics were computed.Results: Overall, 1473 patients were evaluated, 66 (4.5%) presented with craniofacial injuries associated with persistent CSF leak after 5 days of non-surgical treatment. Males (92.5%, P= 0.0000) and those in the 21 to 30 years age group (59.1 %, P= 0.01) were predominant. The most common (68.2%) type of fracture combination was Le Fort I, II and III, NOE, zygomatic complex and mandible. The commonest clinical presentation of CSF leak was rhinorrhea only, in 66.7% of patients (P= 0.001).Conclusions: This study shows that the prevalence of maxillofacial fractures associated with persistent CSF leak was low, which was 4.5% of patients that presented with persistent CSF leak and 84.9% of the cases resolved after treatment of the various maxillofacial fractures.

AbstractBackgroundApicectomy with retrograde filling has always been a viable treatment option for a tooth when conventional endodontic therapy is not indicated, impossible or unsuccessful.ObjectiveTo determine reasons for apicectomy with retrograde filling, dentitions affected, age and gender of the patients, including complication(s) 4 years after the procedures.Materials and MethodsThis is a 25‐year retrospective cohort study of consecutive patients treated in the study centre. Clinical symptoms and signs of morbidity and mortality of tooth‐like pain, tenderness to percussion and evidence of discharging sinus or fistula formation, swelling, tooth mobility and loss were recorded 4 weeks after the procedures. Descriptive and bivariate statistics were computed.ResultsA total of 567 procedures were done in 567 patients, 34 (6.0%) failed to meet the inclusion criteria. Consequently, of the 533 patients used for analysis, 58.4% were males whilst 41.6% are females with a male to female ratio of 1.4:1 (p = 0.04). A majority (94.2%) of the patients are in the age group of 17–46 years (p = 0.000). The indications for the procedures showed that failed root canal therapy (78.2%) was significant (p = 0.001). More cases were done in the maxillary anterior dentition (82.7%, p = 0.001), and 97.8% (p = 0.000) was treated successfully.ConclusionThis study shows that a significant majority of the patients were successfully managed, which suggests that the procedure is still an indication for the management of the conditions diagnosed.

BACKGROUND/AIM Treatment delays in the management of mandible fractures are often unavoidable and, as a result, the timing of treatment of mandibular fractures has remained a contentious issue in clinical practice as the optimal treatment delay for minimizing complications remains unknown. The aim of this study was to determine the rate and types of complications between two cohorts of patients designated as early and late treatment groups and estimate an optimal time threshold for treatment delay after closed reduction and maxillomandibular fixation. MATERIAL AND METHODS Demographic and clinical data were collected retrospectively about patients who were treated for isolated, unilateral, favorable, and compound mandibular body fractures between 1999 and 2019 to answer the question of whether treatment delay is an independent variable impacting post-operative mandible body fracture complications. Descriptive and bivariate statistics were computed. RESULTS One hundred and seventy subjects were evaluated (n = 87 in the control/early group and n = 83 in the study/late group). The mean time lapses from injury to treatment were: early (5.8 ± 0.4 days) and late (10.3 ± 0.7 days). The overall complication rate was 14.1%. However, the complication rates of the early and late groups were 13.8% and 14.5%, respectively, with no significant difference (p = 0.89). CONCLUSIONS There was no difference between early and late treatment groups. Treatment delay was not an independent variable impacting post-operative mandible body fracture complications if treatment is done between 3 and 12 days after the injury.

BACKGROUND: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. OBJECTIVE:To evaluate the clinical and radiological characteristics of OFs and their treatment. MATERIALS AND METHODS: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. RESULTS: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 cm2 to 420 cm2 (mean = 54.7 cm2 ± 82.9). There were 60% in the maxilla and 40% in the mandible (P = 0.014). Most of the lesions (68.9%; P = 0.01) showed patchy opacity and cotton wool appearances. Majority of the lesions were extirpated by enucleation alone (P = 0.01). CONCLUSION:The 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.

BACKGROUND:Locally advanced inoperable orofacial malignancies do present clinically, and constitute a significant public health burden worldwide. OBJECTIVE:To determine the prevalence and clinical characteristics of Stage IV locally advanced inoperable orofacial malignancies for consecutive patients. MATERIALS AND METHODS: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. RESULTS: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. CONCLUSION:The synopsis of these lesions shows that all have undergone metastasis; salivary gland malignancies were most common with maxilla as the commonest site.

Renal cell cancers are common and have a high rate of uncommon manifestations.A third of patients with renal cell carcinoma present first with features of metastasis.We report the case of a 43 year old woman presenting first to the ophthalmology clinic with a facial mass and to the urology clinic 2 months later.She thereafter had radical nephrectomy and subsequently, excision biopsy of the facial/ maxillary mass after initial evaluation.Histology of both specimen showed papillary renal cell cancer and clear cell papillary cancer, respectively.A consideration of renal cell cancer should be considered a strong differential when patients present with tumours of the head and neck, knowing that renal cancers can metastasize to virtually every part of the body.

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

Objective: To determine the frequency of symptomatic malpositioned mandibular third molars in elderly patients. Method: An analytic study of hospital records of elderly patients with symptomatic impacted mandibular third molars over 17 years was undertaken. Information on demographics, types of impaction, reasons for surgical extraction, and complications after treatment were obtained. Those who were asymptomatic would be excluded from analysis. Results: Altogether, 6214 impacted mandibular third molars were isolated in 5, 431 patients. However, 436 (7.0%) symptomatic impacted teeth were recorded in 436 (8.0%) patients and these were extracted, while the rest, 5778 (93.0%) were asymptomatic. Males were greater than females in the ratio of 1.1:1. The frequency of occurrence of mesio-angular and vertical impactions were significant (P= 0.001) compared with disto-angular and horizontal. Periodontal disease was 211 (48.4%) of the case in addition to dental caries and its clinical sequelae 203 (46.6%) were significant reasons for extractions (P=0.000). The common postoperative complications were alveolar osteitis and hypersensitivity of the adjacent molar 22(68.7%) which related to surgical extraction of disto-angular impactions (P= 0.001). Conclusions: This study showed the older the patient the less likely malpositioned mandibular third molar suggesting that majority of such impactions do not cause pathology after many years of their presence in the oral cavity. Prophylactic extraction of malpositioned mandibular third molars in all patients should be discouraged, but each case should be treated on merit or when symptomatic.

Background With recurrence of orofacial tumours and tumour-like lesions after surgical treatment, there is increased facial deformity, and the accompanying secondary surgery leads to further facial mutilation and impaired patients’ well-being. This study aimed to deter­mine the recurrent orofacial lesions after their surgical ablation, in addition to the demographics of patients, histopathological diagnosis, site of the lesion, duration between initial surgery and recurrence, and the corrective surgery. Methods A retrospective analysis of the medical records and histopathological reports of patients, who presented in the Oral and Maxillo­facial Unit of the institution over 15 years, was undertaken. Information on demographics, histopathological diagnosis, site of the lesion, duration between initial surgery and recurrence, and the corrective surgery were obtained. Results During this period, 368 patients that were treated had complete clinical data, while 27/368 (7.3%) presented with recurrent lesions. They were aged 6 to 59 years, with male-to-female distribution ratio of 1:1.3 (P= 0.3). The benign lesions accounted for 24 (88.9%, P=0.000) cases, while odontogenic tumours recurred (P=0.001) more than the other types of lesion. The lesions were seen more often in the mandible (P= 0.001), and the frequency of patients was highest in the 21-30 years age group (P= 0.02). Most of the recurrent cases were seen within 2 years after the initial surgery (85.2%, P= 0.001). Majority of the corrective surgeries were seg­mental mandibular resection (37.1%), hemi-mandibulectomy (25.9%) and hemi-maxillectomy (18.5%). Conclusions This study showed that 7.3% of the lesions recurred after initial ablative surgery. Benign lesions particularly ameloblastoma and fibromyxoma which are locally invasive constitute the majority of the cases that relapsed. A future prospective study will address the limitations of this study.

Aim: To determine whether the frequency of Temporomandibular myofascial dysfunction (TMD) differs in patients treated for different mandibular and zygomatic fractures. Materials and Methods: This was a 9-year prospective study. The diagnosis of TMD was based on standard diagnostic criteria and was made during follow-up reviews of patients after the treatment of the fractures. Additional information obtained from the patients and their case files were age, gender, site of fracture (s), and treatment methods. One-way analysis of variance was used to compare the presence of TMD among the study groups. Results: Overall, 42/587 (7.2%) patients were diagnosed with TMD between 2.3 and 4.7 years after treatment commenced. Patients who presented with TMD were those treated for isolated zygomatic (n = 5/42, 11.9%), isolated condylar (n = 7/63, 10.0%), and multiple mandibular (n = 30/475, 6.3%) fractures, which was significant (P = 0.01) in favor of those treated for isolated zygomatic and isolated condylar fractures. Patients who were treated for unilateral zygomatic complex/arch(P == 0.001), unilateral intracapsular condyle (P = 0.001), and parasymphyseal/body/angle/condyle (P = 0.01) fractures also had higher frequencies of TMD. Conclusions: Patients who were treated for isolated zygomatic or condylar fractures had higher frequencies of TMD than those with multiple mandibular fractures. Future research work needs to be directed toward the description of the pathogenesis of the different types of TMD symptoms so that more information can be gathered on the natural course of the disorders and identify the risk factors for pain persistence and chronicity.

BACKGROUND: The use of dental drill during extraction of impacted mandibular third molars lead to production of aerosol, fear in some patients and this necessitates the need for an alternative instrument. OBJECTIVE: To compare the treatment outcome in two cohorts of patients after surgical extraction of symptomatic mesio-angularly impacted mandibular third molars. PATIENTS AND METHODS: Apparently healthy subjects who presented to the oral and maxillofacial surgery clinic of our institution, with an indication for surgical extraction of symptomatic mesio-angularly impacted mandibular third molar were assessed. Those classified as Pell and Gregory class 2 ramus relationship, class A and B depth, with favourable root morphology were uniformly randomized into dental drill and Crane pick elevator groups. Information on demographics, reasons for extraction, trismus, swelling, pain and complaints during follow-up were obtained and statistically analyzed. RESULTS: Overall 86 subjects, evenly distributed between the two groups were studied. Post-operative mean for trismus, swelling and pain were lower on the 3rd day in those treated with Crane pick elevator than dental drill. However, by the 7th day, the results were the same as the trismus, swelling and pain resolved clinically, without complication. CONCLUSION: Crane pick dental elevator could serve as a useful substitute to dental drill in the extraction of mild mesioangularly impacted mandibular third molars.

Background: The fractures of the mandible are common facial injuries, and their consequences have remained a burden in dental and oral surgery practice. To review patients with mandibular fractures at our institution over a 4-year time frame of 10 years apart between 1997–2000 and 2011–2014 and compare the trends in the number of cases. Materials and Methods: The hospital register and case notes of the patients with mandibular fractures were retrospectively reviewed to obtain relevant information concerning the socio-demographic data and clinical characteristics of the fractures. Results: There was a reduction in the number of patients and fractures when the 2011 study (168 patients and 239 fractures) was compared with the 1997 study (358 patients and 474 fractures), and this was significant (P = 0.001). Road traffic accidents were the most common cause of fractures; motorcycle-related traffic accidents were more frequent in the years 1997–2000 (n = 128, 35.7%) than that in the years 2011–2014 (n = 11, 6.6%); vehicular road traffic accidents were more common in the years 2011–2014 (n = 123, 73.2%) than that in the years 1997–2000 (n = 153, 42.7%), and these were significant (P = 0.001). Mandibular fractures were more of isolated fractures and less associated with concomitant injuries in the 2011 study than that in the 1997 study (P = 0.001). There was a significant reduction of complications in the 2011 study (P = 0.001). Conclusion: This study has shown that the frequency of mandibular trauma has changed significantly over the past decade, which may be explained in terms of the ban on the use of motorcycle for public transportation.

BACKGROUND:Breastfed babies have a better chance of improved oral and dental health than their counterparts that were artificially-fed.OBJECTIVE:To assess the knowledge and attitude of postnatal mothers on the benefits of breastfeeding in prevention of oral and dental diseases.MATERIALS AND METHODS:A cross - sectional descriptive survey of 206 mothers attending the postnatal clinic of the University of Calabar Teaching Hospital, Calabar on the knowledge and attitude of breastfeeding in prevention of oral diseases in infants.RESULTS:Initiation of breastfeeding was early within 3 days of childbirth in 90.3% of mothers. The lack of awareness or knowledge of specific childhood dental/oral disorders prevented by breastfeeding by majority (89.3%) of the respondents was statistically significant. Actual willingness to breastfeed baby for longer periods after instruction on specific oral health benefits of breastfeeding was elicited in 180 (87.4%) mothers.CONCLUSION:There is a need to improve the knowledge of specific benefits of breastfeeding in prevention of dental diseases. This calls for education of the health professionals beside the dental practitioners who handle the mothers for themselves to be aware.FUNDING:The study was funded by the authors.

Background: Odontogenic Myxoma (OM) affects the jaws, and is characterized by high recurrence rate after treatment. Objective: To evaluate the clinical characteristics and treatment outcome of OM that presented in our center. Materials and Methods: A 22-year retrospective study was performed at the Dental and Maxillofacial Surgery Clinic of the study institution; patients’ data were collected from the hospital records and entered into a pro-forma questionnaire. Results: Overall, 643 patients with oro-facial lesions were evaluated and 38/643 (5.9%) were diagnosed with OM. There were 22 (57.8%) males and 16 (42.2%) females with male to female ratio of 1.4:1. Majority (n=30, 78.9%) of the patients were between 21-40 years (p=0.001). Patients presented late and this increased with decreased socio-economic status (p=0.001), whereas the higher the socio-economic status, the smaller were the sizes of the tumor (p=0.001). Majority 33 (86.8%) occurred in the mandible and the tumors were centrally located in the jaws. The longer the duration of tumor, the more the presenting clinical symptoms (p=0.001). Radiologically, 32 (84.2%) cases showed multi-locular radiolucency. The tumors were treated by wide excision, and the greater the sizes of the surgical defects, the more the co-morbidities (p= 0.001). Post-operatively, 10.5% patients had recurrence of the tumor whereas 5.3% spontaneous bone regeneration (SBR). Conclusion: The clinical characteristics and treatment outcome of OM observed is similar to previous reports except that males were affected more than females. Late presentation is the main challenging factor in the early diagnosis and management of this tumor in our environment.

Background: Osteotomy of the bone surrounding mesio-angularly impacted tooth is part of the surgical procedure required for their extraction and has evolved in contemporary practice from the use of mallet/chisel to dental drill. Objective: To describe the extractions of mesio-angularly impacted mandibular third molars using Crane pick dental elevator for the osteotomy procedure. Materials and Methods: This was a prospective clinical study of patients done at the Oral and Maxillofacial Surgery Clinic of our institution, over three years period. With gentle, controlled, downward force, bone was removed with Crane pick elevator to expose the mesio-angularly impacted tooth cervical line, creating buccal and distal troughs that were linked and made in cancellous bone. The clinical variables evaluated were age, gender, and reason(s) for extraction, duration of treatment/osteotomy, degree of postoperative trismus and swelling, and complaints during follow-Up. Results: The ages of the 74 patients studied ranged from 18-63 years with mean age of 32.6± 2.8 years. Majority (83.8%) were in the age category of 16-45 years (P=0.001). The duration of the surgery from incision to placement of the last suture ranged from 12.8 to 17.1 minutes with mean 14.3±1.4 minutes. The duration of the osteotomy including the delivery of the tooth from their sockets ranged from 3.2 to 7.4 minutes with mean 5.3±0.7 minutes. The younger the patient's age, the shorter the osteotomy procedure (P=0.001). Conclusion: This study showed that certain mesio-angularly impacted mandibular third molars can be extracted using only Crane pick elevator.

BACKGROUND:Chlorhexidine mouth rinses have a proven efficacy for the prevention of alveolar osteitis after third molar surgery. This study compares the efficacy of warm saline rinse, a component of postextraction instructions, with that of chlorhexidine in our institution over a period of 2 years. PATIENTS AND METHODS:Apparently healthy patients who were referred to the Oral Surgery Clinic of our institution, with an indication for surgical extraction of lower third molar were prospectively, consecutively, and uniformly randomized into warm saline and chlorhexidine groups. The experimental group (n = 50/100) were instructed to gargle twice daily with warm saline, whereas the chlorhexidine group (n = 50/100) were instructed to gargle with 0.12% chlorhexidine. Information on demographic, types and level of impaction, indications for extraction, and development of alveolar osteitis were obtained and analyzed. Comparative statistics were done using Pearson's Chi-square, Fisher's exact, or Mann-Whitney U-tests as appropriate. P <0.05 was considered statistically significant. RESULTS:The demographic, types and level of impaction as well as indications for extractions were comparable between the study groups (P > 0.05). The overall prevalence of alveolar osteitis was 5%. There was no statistically significant difference between application of warm saline and 0.12% chlorhexidine rinse with respect to the development of alveolar osteitis (P = 0.648). CONCLUSION:Warm saline mouth rinse is equally as effective as chlorhexidine mouth rinse, as prophylaxis against prevention of alveolar osteitis after third molar surgery.