Oral and Maxillofacial Surgery - Scholarly Publications

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    Open Access
    ALVEOLAR OSTEOTOMY FOR CORRECTION OF ANTERIOR OPEN BITE.
    (Pakistan Oral & Dent. Jr., 2002-12-01) Obisesan, B.O.; Nwoku, A.L.; Adeyemo, W.L.; Ogunsanwo, S.O.; Oluyadi, B.A.
    Changes in the intimate relationship of the jawbones lead to dentofacial deformities. Orthognathic surgical interventions attempt to return the hard and soft tissues to normal relationship and thereby enhance facial appearance in addition to improving function. Skeletal open bite is characterized by a noticeable vertical disproportion of the face with changes in the soft tissue and bone. Several suggestions for its correction have been made in the past; the original operation being described by Wassmund in 19357. This procedure is recommended in patients with marked anterior open bite and sound anterior teeth. The surgery is carried out in the upper first premolar region after which the anterior segment is repositioned.
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    Open Access
    Appropriateness of removal of impacted lower third molars. A 2- year audit at the Lagos University Teaching Hospital.
    (Nig Q J Hosp Med, 2003-01-01) Ladeinde, A.L.; Ogunlewe, M.O.; Adeyemo, W.L.; Bamgbose, B.O.
    Prophylactic removal of impacted third molars in the absence of specific medical and surgical conditions has generated a lot of controversy among oral and maxillofacial surgeons. The first attempt to create simple but effective guidelines to aid decision-making about removal of impacted third molars was made at a National Institute of Health Conference in the USA in 1979. In 1997, the Faculty of Dental Surgery of the Royal College of Surgeons of England published guidelines for the management of patients with impacted wisdom teeth and these guidelines were endorsed by the National Institute for Clinical Excellence (NICE) of England in March 2000. The purpose of this study was to assess whether these approved guidelines were being followed in considering impacted lower third molars for surgical extraction at the Oral and Maxillofacial Clinic of the Lagos University Teaching Hospital. A retrospective study of the 156 patients who had 160 impacted lower third molars surgically extracted between November 2000 and November 2002 was done. Patients’ records were reviewed for age, sex, and site, type and angulation of impaction, as well as reasons for surgical extraction. Most patients (66%) were in their third decade of life. Distoangular impaction was the most common (40.6%). The commonest reason for extraction was recurrent pericoronitis (62.5%). Only three (2%) extractions (one episode of pericoronitis and two asymptomatic lower impacted third molars) were considered unjustifiable based on the guidelines. Based on the result of this study, unjustifiable and prophylactic removal of impacted lower third molars was not a common practice in our clinic.
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    Open Access
    An unusual case of chronic osteomyelitis of the mandible.
    (Nigerian Journal of Health and Biomedical Sciences, 2003-01-01) Adeyemo, W.L.; Ladeinde, A.L.; Ogunlewe, M.O.; Bamgbose, B.O.
    Chronic osteomyelitis of the mandible subsequent to skin infection is extremely rare. A 7-year old school girl presented with a localized chronic suppurative osteomyelitis of the mandible of about 15 months duration, due to spread from skin infection. The patient was subsequently treated by surgical excision of the sinus tract, necrotic tissue, granulation tissue and specks of sequestra in the bony lesion as well as antibiotic therapy. Healing was uneventful.
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    Open Access
    Closure of oro-antral fistula with pedicled buccal fat pad. A case report and review of literature
    (Afr J Oral Health, 2004-01-30) Adeyemo, W.L.; Ogunlewe, M.O.; Ladeinde, A.L.; James, O.
    Objectives: Chronic oro-antral fistula following dental extraction is not uncommon. Application of pedicled buccal fat pad (BFP) in the repair of the fistula is rather uncommon in our environment. This article demonstrates the use of BFP in the repair of chronic oro-antral fistula. Methods: A case of a chronic oro-antral fistula of 5- year duration in a 56- year old man successfully repaired with pedicled buccal fat pad after unsuccessful several attempts with other local flaps is presented. A review of relevant literature using MEDLINE is also presented. Results: Complete epithelization of the pedicled BFP was observed after 4 weeks with no postoperative complication. Conclusion: Pedicled buccal fat pad is a reliable flap for the repair of oro-antral fistula. The easy mobilization of the BFP and its excellent blood supply and minimal donor site morbidity makes it an ideal flap. It should also be considered as a reliable back-up procedure in the event of failure of other techniques.
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    Open Access
    Re: critical review on dry socket.
    (Elsevier, 2004-02-01) Adeyemo, W.L.
    I refer to the article ‘Contemporary view on dry socket (alveolar osteitis): a clinical appraisal of standardization, aetiopathogenesis and management: a critical review by Dr I. R. Blum’. I have personally observed through reading of published articles on the subject that there are a lot of inconsistency not only in diagnostic criteria but also in the study designs. So, I was expecting a systematic review (considered the highest level in the evidence hierachy), NOT a critical review. But, separating the ‘Wheat’ from the ‘chaff ’ was not possible according to Dr I. R. Blum, hence a quantitative systematic review (metaanalysis) was not possible.
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    Open Access
    Concurrent pleomorphic adenoma in parapharyngeal space and submandibular gland.
    (BMC, 2004-03-04) Ladeinde, A.L.; Adeyemo, W.L.; Bamgbose, B.O.; Ogunlewe, M.O.
    BACKGROUND: Pleomorphic adenoma in the parapharyngeal space either occurs de novo or as an extension from the deep lobe of the parotid gland. CASE PRESENTATION: A rare synchronous occurrence of pleomorphic adenoma in the parapharyngeal space and submandibular gland of a 48-year-old Nigerian male is reported. CONCLUSION: Pleomorphic adenoma concurrent in the parapharyngeal space and submandibular gland is very rare. A complete surgical excision of both tumors is the treatment of choice.
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    Open Access
    Etiology of dry socket: additional factors.
    (Elsevier, 2004-04-01) Adeyemo, W.L.
    I read with interest the article on dry socket (alveolar osteitis) in a recent issue of the Journal by Oginni et al (J Oral Maxillofac Surg 61:871-876, 2003).1 Despite the fact that dry socket is a consistent problem in our practice in Africa, few reports can be found in the international literature on the incidence of this common complication of dental extractions in the African population. According to the authors, most of the extractions (72%) that resulted in dry socket were carried out by less-experienced surgeons (house officers and undergraduate students). Less-experienced surgeons have been reported to cause more trauma during extractions than experienced surgeons.2 This is probably due to excessive trauma and intraoperative complications that are inflicted by the less experienced surgeons. Excessive trauma has been known to delay wound healing.3 Birn3 proposed that trauma during extraction damages the alveolar bone cells, causing inflammation of the alveolar bone marrow and the subsequent release of direct tissue activators into the alveolus, where they may precipitate fibrinolytic activity, thus playing a major role in the pathogenesis of alveolar osteitis. One important factor that was not evaluated in the report by Oginni et al,1 probably due to the nature of their study (retrospective), was the intraoperative complications (tooth fracture, alveolar bone fracture) during the extractions. Birn3 suggested that roots or bone fragments (remnants) remaining in the extraction wound could possibly cause alveolar osteitis.
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    Open Access
    Sigmund Freud: smoking habit, oral cancer and euthanasia.
    (Niger Postgrad Med J, 2004-04-04) Adeyemo, W.L.
    BACKGROUND: Sigmund Freud, the father of modern psychoanalysis had a well-known love of the cigar. The natural progression of this vice was the development of oral cancer for which he underwent a lengthy ordeal. An account is given in this article of Sigmund Freud's illness and care following the diagnosis of his oral cancer. The role of euthanasia and physician assisted suicide is also discussed. METHODS: A review of relevant literature on Sigmund Freud's illness, risk factors for oral cancer and euthanasia was undertaken. RESULTS: Sigmund Freud was a heavy smoker with a 20-cigar/day habit. In 1923, a diagnosis of squamous cell carcinoma of the palate was made, for which he underwent a lengthy ordeal which span a total of 16 years. During this period, he bluntly refused to quit smoking. Freud consulted many specialists (otolaryngologists, oral and maxillofacial surgeons, prosthodontists and general surgeons), during the course of his ordeal with oral cancer. He underwent 34 surgical procedures before his eventual death in 1939 through euthanasia. CONCLUSION: Continued indulgence in smoking and procrastination on the part of Freud, as well as mediocrity, negligence and incompetence on the part of the first surgeon that operated on Freud, could partly be responsible for his lengthy ordeal.
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    Open Access
    The rising incidence of maxillofacial injuries due to motorcycle ("Okada") crashes in Nigeria: A need for strict legislation
    (Afr J Trauma, 2004-05-01) Adeyemo, W.L.
    In automobile crashes, the maxillofacial area is the most frequently injured region. It has been reported that road traffic crashes are the major causes of maxillofacial injuries in Nigeria. This is in contrast to reports from Europe, America and some countries in southern Africa where interpersonal violence is the major cause of maxillofacial injuries. The increase in the incidence of maxillofacial fractures from road traffic injuries (RTIs) in the 1970s and 1980s in Nigeria was attributed to the sudden increase in motor vehicle ownership in addition to inadequate and poor maintenance of intercity highways and non-compliance with the use of seat belts. Motorcycles popularly known in Nigeria as “Okada” have become a popular means of transportation in many communities in Nigeria. Although it has been observed in developed countries that motorcycles are less implicated in maxillofacial fractures due to RTIs, reports from urban and semi-urban centres in Nigeria show a striking increase in the number of maxillofacial fractures that resulted from motorcycle crashes. Table 1 shows the analysis of RTIs due to motor vehicles and motorcycles in four study periods in Ibadan, south west Nigeria. Between 1965 and 1995 in Ibadan the proportion of motorcycle-related maxillofacial injuries sustained by motorists in Ibadan (Table 1) seen between 1978 and 1982 could be attributed to economic oil boom period.
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    Open Access
    Management of giant ameloblastoma in an African environment-report of 2 cases.
    (Pakistan Oral & Dent. Jr., 2004-06-01) Obisesan, B.A.; Adeyemo, W.L.; Ladele, B.S.
    Ameloblastoma of the jaws is a relatively common neoplasm in African population. Although, it is slow growth in characteristics, occasionally the tumour can reach a considerable size (giant) often described in African term as "second head" due to delay in presentation. This delay in presentation is due to a combination of poor socioeconomic background and beliefs of the patients. Treatment of this condition is usually a challenge to the surgeon in a developing country with minimal surgical facilities. Two cases of "Giant ameloblastoma" of the mandible are presented to illustrate the management of this condition in our environment. The result of the surgery was satisfactory. The overall aesthetics, physical, emotional, psychological well being, as well as quality of life of our patients were greatly enhanced.
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    Open Access
    The use of buccal fat pad in oral reconstruction - a review.
    (Niger Postgrad Med J, 2004-09-01) Adeyemo, W.L.; Ladeinde, A.L.; Ogunlewe, M.O.; Bamgbose, B.O.
    AIM: The aim of this article is to review the applications of the buccal fat pad (BFP) in oral reconstruction, 25 years after its first use as a pedicled flap. MATERIALS AND METHODS: A computerized literature search was conducted for articles published from 1977-2002. Mesh phrases used in the search were: buccal fat pad, buccal fat pad and oral reconstruction. RESULTS: A total of 43 articles were selected for the review based on the criteria for the study. Thirty of these articles were clinical articles, 8 were anatomic studies, 2 were review articles, 1 was an experimental study and 2 discussion articles. Only 9 clinical articles were published prior to 1990, and between 1990 and 2002, a total of 21 clinical articles were published. Various application of BFP in oral reconstruction include closure of surgical defects following tumor excision, repair of surgical defects following excision of leukoplakia and submucous fibrosis, closure of primary and secondary palatal clefts, coverage of maxillary and mandibular bone grafts and lining of sinus surface of maxillary sinus bone graft in sinus lift procedure for maxillary augmentation. CONCLUSIONS: The easy mobilisation of the BFP and its excellent blood supply and minimal donor site morbidity makes it an ideal flap. The main advantages of BFP are ease of harvesting, simplicity, versatility, low rate of complications as well as quick surgical technique. The operation can be performed in one incision, affecting neither appearance nor function of the area.
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    Open Access
    Ameloblastoma: the most common odontogenic tumour?
    (Niger J Med, 2004-10-04) Adeyemo, W.L.
    Is Amelobalstoma the most common odontogenic tumour worldwide? This article examines the prevalence of ameloblastoma in different parts of the world, most especially in Africans and Americans
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    Open Access
    Odontogenic tumors in Nigerian children and adolescents- a retrospective study of 92 cases.
    (BMC, 2004-11-01) Ajayi, O.F.; Ladeinde, A.L.; Adeyemo, W.L.; Ogunlewe, M.O.
    BACKGROUND: Tumours arising from odontogenic tissues are rare and constitute a heterogenous group of interesting lesions. The aim of this study was to determine the relative frequency of odontogenic tumors (OT) among Nigerian children and adolescents 19 years or younger. PATIENTS AND METHODS: The histopathology records were retrospectively reviewed for all the tumors and tumor-like lesions of the oral cavity and the jaws seen in children and adolescents
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    Open Access
    Acutely inflamed socket: A post-extraction healing complication-clinical observation in 2 patients.
    (Pakistan Oral & Dent. Jr., 2004-12-01) Adeyemo, W.L.; Ogunlewe, M.O.; Ladeinde, A.L.
    Acutely inflamed socket as a complication of extraction socket wound healing is a very rare clinical entity worldwide. We report 2 patients with acutely inflamed socket following non-surgical extraction of permanent teeth. One of the patients had a positive history of hypertrophic I keloid scar.
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    Open Access
    An unusual presentation of palatal pleomorphic adenoma-a case report.
    (Pakistan Oral & Dent. Jr., 2004-12-01) Obisesan, B.A.; Adeyemo, W.L.
    An unusual presentation of primary palatal pleomorphic adenoma in a 30-year-old Nigerian woman, extending through the parapharyngeal space to the submandibular space, simulating concurrent primary lesions from both the palate and submandibular gland lesion is presented. The surgical challenge arising from the extension into the parapharyngeal and submandibular space is also highlighted.
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    Open Access
    Bone grafts for jaw augmentation procedures: anterior versus posterior iliac crest.
    (Elsevier, 2004-12-01) Adeyemo, W.L.
    Cortico-cancellous bone graft is considered the material of choice for jaw augmentation because of its rich cellularity, its rapid revascularization, and its potential to induce new bone formation. Several donor sites have been advocated, but the iliac crest is still considered the golden standard for the procedure. However, the choice between the anterior and posterior iliac crest as the preferred site for harvesting has been a subject of debate. NKENKE et al. in a recent issue of the journal compared the morbidity of harvesting of bone grafts from anterior iliac crest with that of posterior iliac crest for preprosthetic augmentation procedures. The authors and others have reported that the posterior approach yields a larger graft volume and has a lower post operative morbidity rate. In addition, the authors reported that by post-operative day thirty, there was no statistically significant difference in pain and thermal sensitivity test (PATH test), and visual analogue scale (VAS) between the anterior or posterior approaches; and also no gait disturbance could be observed in both groups of patients. Based on these findings, they concluded that the posterior iliac crest should be taken into account even for less extensive augmentation procedures. I feel that these findings, however, do not justify their conclusion.
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    Open Access
    Odontogenic tumors: a review of 319 cases in a Nigerian teaching hospital.
    (Elsevier, 2005-02-01) Ladeinde, A.L.; Ajayi, O.F.; Ogunlewe, M.O.; Adeyemo, W.L.; Arotiba, G.T.; Bamgbose, B.O.; Akinwande, J.A.
    OBJECTIVE: This study sought to determine the relative frequency of odontogenic tumors in a Nigerian population and to compare these data with previous reports. STUDY DESIGN: Records of patients seen at the Lagos University Teaching Hospital between January 1980 and December 2003, with histologic diagnosis of odontogenic tumors (based on World Health Organisation classification, 1992), were analyzed. RESULTS: Odontogenic tumors constituted 9.6% of all the biopsies of oral and jaw lesions seen within the period under study. Three hundred and eight (96.6%) were intraosseous, and 11 (3.4%) were peripheral (peripheral odontogenic fibroma=7; peripheral myxoma=3; peripheral ameloblastoma=1). The mean age of patients was 29.9+/-15.6 years (range, 4-85 years). Among these cases, 96.6% of the tumors were benign and 3.4% were malignant. Ameloblastoma with predilection for the mandible was the most frequent odontogenic tumor (63%), followed by adenomatoid odontogenic tumor (AOT) (7.5%), myxoma (6.5%), calcifying epithelial odontogenic cyst (5.3%), and odontogenic fibroma (5.3%). More cases of malignant odontogenic tumors were seen than cases of calcifying epithelial odontogenic tumor and odontomas. The mean ages of patients with AOT, ameloblastic fibroma, and odontoma were significantly lower than those with ameloblastoma ( P<.05). No significant difference was found between the mean ages of patients with benign odontogenic tumors and those with malignant odontogenic tumors ( P=.058). CONCLUSIONS: Odontogenic tumors, especially ameloblastoma, are not considered rare among Nigerians, whereas odontoma, regarded as the most frequent odontogenic tumor in North and South America, is rare.
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    Open Access
    Van Der Woude syndrome: variable penetrance of a novel mutation (p.Arg 84Gly) of the IRF6 gene in a Turkish family.
    (Int J Mol Med, 2005-02-01) Item, C.B.; Turhani, D.; Thurnher, D.; Yerit, K.; Sinko, K.; Wittwer, G.; Adeyemo, W.L.; Frei, K.; Erginel-Unaltuna, N.; Watzinger, F.; Ewers, R.
    Van der Woude syndrome (VWS) is an autosomal dominant disorder characterized by clefts of the lip and/or palate (CL+/-P), lip pits, bifid uvula and hypodontia. Mutations of the interferon regulatory factor 6 gene (IRF6) have been recently described in patients with VWS. The entire 9 exons of the IRF6 gene in two brothers of Turkish origin clinically diagnosed with Van der Woude syndrome and four healthy family members were screened for mutations using a newly established denaturing gradient gel electrophoresis (DGGE) method. A novel heterozygous mutation in exon 2 (DNA binding region) of the IRF6 gene, p.Arg84Gly, was found in both brothers with VWS and in their clinically asymptomatic mother. Our results suggest a dominant negative effect of the p.Arg84Gly mutation in the VWS of both patients. Non-penetrance of this mutation is suggested in the mother of the patients.
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    Open Access
    Gene therapy in the management of oral cancer: a review of recent developments.
    (Niger Postgrad Med J, 2005-03-01) Ladeinde, A.L.; Ogunlewe, M.O.; Adeyemo, W.L.; Bamgbose, B.O.
    AIMS: This article reviews the present body of knowledge regarding the principle, transfer techniques, therapeutic strategies, clinical applications and limitations of gene therapy in the management of oral squamous cell carcinoma. MATERIALS AND METHODS: Scientific publications on gene therapy between 1990 and 2003 were selected for the purpose of the review. These include clinical articles, experimental studies and review articles. RESULTS: Viruses are the commonly used transfer system for the delivery of gene therapy. The viral vectors commonly used are: retroviruses, adenoviruses, herpesviruses, and adenoassociated viruses (AAV). Transfection of cancer cells in vivo with gene therapy is done by intralesional injection, and sometimes by topical application. Phase I and II clinical trials have established the safety and clinical efficacy of gene therapy in the treatment of oral squamous cell carcinomas in humans, especially in combination with chemotherapy or radiotherapy. Phase III clinical trials and studies of the use of gene therapy as an adjuvant following surgery are presently underway. CONCLUSIONS: Gene therapy represents a new and innovative approach to the treatment of oral cancer especially in recurrent disease and adjuvant treatment. Oral squamous cell carcinoma is especially an attractive tumour target due to its frequent genetic mutations and accessibility for intra-tumoural administration of gene therapy. However, gene therapy has not yet been shown to be suitable for systemic delivery in cancer patients, hence the control of regional and metastasis is presently difficult.
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    Open Access
    Are sterile gloves necessary in nonsurgical dental extractions?
    (Elsevier, 2005-07-01) Adeyemo, W.L.; Ogunlewe, M.O.; Ladeinde, A.L.; Bamgbose, B.O.
    PURPOSE: The aim of the study was to compare the incidence of healing complications of extraction socket with the use of sterile or clean nonsterile gloves during nonsurgical dental extractions. MATERIAL AND METHODS: This was a randomized prospective study conducted at the exodontia clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (Nigeria), between October 2002 and January 2003. Patients who were referred for nonsurgical extractions of permanent teeth and who satisfied the inclusion criteria into the study were randomly allocated into 2 groups. One group had their extractions performed with the surgeon wearing a pair of sterile gloves and the second group had their extractions performed with the surgeon wearing a pair of clean nonsterile gloves. Two hundred sixty-nine patients who had 301 teeth extracted and satisfied the inclusion criteria for socket healing assessment were assessed for postoperative socket healing. RESULTS: Three different types of socket healing complications were identified (dry socket, acutely inflamed socket, and acutely infected socket). A total of 32 patients (11.9%) developed socket healing complications. Nineteen of 122 patients in the sterile glove group and 13 of 147 patients in the clean nonsterile glove group developed socket healing complications (P = .09). CONCLUSION: The study confirmed that the use of sterile surgical gloves offers no advantage over clean nonsterile gloves in minimizing extraction socket healing complications following dental extraction. Therefore, nonsurgical dental extraction can be safely performed with the surgeon wearing clean nonsterile gloves.