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   2005| October-December  | Volume 12 | Issue 4  
    Online since February 19, 2016

 
 
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ARTICLES
Sero-prevalence of hepatitis B surface antigen (HBsAg) in pregnant women in Port Harcourt, Nigeria
CI Akani, AC Ojule, HC Opurum, AA Ejilemele
October-December 2005, 12(4):266-270
BACKGROUND/OBJECTIVE: Hepatitis B Virus (HBV) infection is a global public health problem and is endemic in Asia and Sub-Saharan Africa, including Nigeria. Vertical transmission of HBV infection is thought to be a major mode of transmission in endemic areas. This study was therefore undertaken to determine the sero-prevalence of Hepatitis B surface antigen (HBsAg) on pregnant women in Port Harcourt, Nigeria, in an effort to obtain baseline information on disease burden in this locality, in order to institute public health measures to reduce transmission.PATIENTS AND METHODS: Serial recruitment of 600 women attending the ante-natal clinic at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. HBsAg screening was done using a rapid ELISA Kit. RESULTS: 26(4.3%) of the 600 subjects tested positive to HBsAg. Blood transmission, dental manipulations, tattooing and circumcision were found not to be significant modes of transmission of HBV infection in Port Harcourt. CONCLUSION: There is an intermediate prevalence (4.3%) of HBV infection in pregnant women in Port Harcourt, Nigeria. The need to institute public health measures to reduce disease burden and transmission, including routine screening of all pregnant mothers for HBV infection and early passive/active immunisation of babies born to HBsAg--positive mothers is advocated.
[ABSTRACT]   Full text not available   
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Clinical features of goitres on the Nigerian Plateau
E Chuhwak, AE Ohwovoriole
October-December 2005, 12(4):245-249
To describe the prevalence, clinical types and aetiology of goitre among hospital patients on the Nigeria highland area of Plateau. Subjects, materials and methodology: Adult out-patients attending the medical, surgical and general outpatient clinics of the Jos University Teaching Hospital (JUTH) were prospectively examined for the presence of goitre. Goitrous patients were subjected to further evaluation. Goitre was graded according to the WHO (1979) criteria (grades 0 - 4) and characterised as to lobarity, nodularity, consistency, tenderness, mobility of overlying skin and presence of bruit as well as hormonal functional status.RESULTS: 3,000 outpatients were examined, 124 (4.1%) of which were goitrous. Of the goitrous patients 98 (84F, 14M) had full data to be eligible for further analysis. The goitrous patients were distributed according to goitre grade as follows: grade one 10 (10.2%), grade two 62 (63.3%), grade three 22 (22.5%) and grade four 4 (4.1%). Both right and left lobes were enlarged in 91 (92.9%) subjects. Enlargement was limited to the right lobe in one patient with 3 (3.1%) patients each showing goitre limited to the left lobe and the isthmus. Palpably nodular goitre was found in 21 (21.4%) patients while the large majority of 78.6% showed a diffuse enlargement. The goitre was firm in 55% of cases and soft in 27.5% of patients. Goitre was associated with thyrotoxicosis in 10 (10.2%) patients, carcinoma in 2(2.1%), thyroid cyst in 2(2.1%) and thyroiditis in 6(6.1%) patients. CONCLUSION: Goitre is common among out-patients on the Nigerian plateau, with a characteristic female preponderance. WHO grade 2 goitre is the most common form. Thyrotoxicosis is relatively common among the goitrous patients. Patients attending hospital in goitre-endemic areas should be routinely examined for thyroid enlargement and those found goitrous subjected to endocrine evaluation.
[ABSTRACT]   Full text not available   
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Knowledge and practice of cervical screening among female health workers in Sokoto, North Western Nigeria
EI Nwobodo, SA Malami
October-December 2005, 12(4):255-257
BACKGROUND: Several studies have shown the importance of health care professionals as predictors of the use of cervical cancer screening. AIMS: To determine the knowledge and utilisation of cervical cancer screening services in a cohort of subjects where awareness is naturally expected to be high. METHODS: A cross sectional questionnaire survey of 159 female health care providers in Usmanu Danfodiyo University Teaching Hospital Sokoto. The sample included doctors, nurses, pharmacists, laboratory scientists and medical social workers. RESULTS: Knowledge of cervical cancer screening is high among the respondents. However, only 4.4 % had availed themselves of the opportunity for the test. CONCLUSION: Health care providers should improve on opportunistic screening. It is necessary for a national screening policy to be formulated and implemented in Nigeria.
[ABSTRACT]   Full text not available   
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The pregnant Rhesus negative Nigerian woman
TR Kotila, AA Odukogbe, MA Okunlola, O Olayemi, KA Obisesan
October-December 2005, 12(4):305-307
OBJECTIVE: Alloimmunisation to Rhesus D (RhD) is a major factor in perinatal morbidity and may result in the compromise of the woman's obstetric career. In Nigeria accurate population based studies to determine the prevalence of Rhesus negative women and the incidence of alloimmunisation are lacking, hence we undertook to study pregnancy outcome in Rhesus negative women. METHOD: We studied retrospectively sixty-seven RhD negative women over a two year period; information was obtained from the case-file of all pregnant women who presented to the ante-natal clinic and were identified as Rhesus negative. This was corroborated with the blood bank record over the same period. RESULT: Forty per cent of these were nulliparae with an average of 0.5 abortions. Only 20% had the blood groups of their husbands documented, and only four babies born to these women had their Rhesus group recorded. Six of the babies appeared to have been severely affected by Rhesus isoimmunisation. Three of these had an exchange blood transfusion (EBT); all who had an EBT had a satisfactory outcome. Out of the other three, there were two neonatal deaths and one fresh stillbirth. Fourteen babies had neonatal jaundice with a mean bilirubin level of 6 mg/dl, all of which were mainly unconjugated. Evidence for the administration of anti D was obtained in only three patients; all had one ampoule (dose in i.u and/or _g not stated) administered within 72 hr. CONCLUSION: This preliminary study has shown that isoimmunisation due to Rhesus incompatibility is poorly studied among Nigerian women with many questions unanswered; therefore there is an urgent need for a management protocol for this condition, which will include both the clinicians and the laboratory physicians.
[ABSTRACT]   Full text not available   
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Knowledge and perception of obstetric analgesia among prospective parturients at the Lagos University Teaching Hospital
CI Okeke, NA Merah, SU Cole, A Osibogun
October-December 2005, 12(4):258-261
BACKGROUND: Natural labour is painful. Such pain has little value and is potentially harmful to the parturient and foetus. OBJECTIVE: To assess knowledge, perceptions and acceptance of obstetric analgesia among prospective parturients. The effect of age, educational status and parity on the above variables was evaluated. DESIGN AND SETTING: Prospective cross-sectional study between October 2002 and April 2003 at the Lagos University Teaching Hospital (LUTH). PATIENTS AND METHODS: Patients attending ante-natal clinics voluntarily responded to a structured questionnaire which enquired patient's age, educational status and parity; knowledge, perceptions and acceptance of obstetric analgesia. The association between the variables was determined with the Pearson's Chi square test. RESULT: Four hundred and fifty patients of varying educational levels were studied. Only 175 (38.9%) knew of obstetric analgesia. There was a significant association between educational status and knowledge of obstetric analgesia (p = 0.000). Two hundred and ninety four patients (65.3%) would accept analgesia during labour of which 179 (60.9%) would leave the choice to the doctor to give them the "best available". There was no association between age, educational status and parity with acceptance (p > 0.05). Reasons for rejection included labour being a 'natural process' in 15.1%, faith in divine intervention 6.0% and concerns about side effects 3.1%. CONCLUSION: This study has revealed a dearth of knowledge and gross misconception about obstetric analgesia. With proper education, many patients will accept some form of analgesia during labour. There is an urgent need to commence standard obstetric analgesia services in our tertiary hospitals.
[ABSTRACT]   Full text not available   
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Cancer of the cervix
AO Olatunji, AO Sule-Odu
October-December 2005, 12(4):308-311
Cases of cancer of the cervix histologically diagnosed at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between January 1991 and December 2000 were reviewed. There was 1,912 total gynaecological admissions during that period and 56 histologically diagnosed cancer of the cervix for an incidence of 2.9%. The mean age at occurrence of the cancer was 51.7 + 12.4 years. It was more common in grandmultiparous women and major presenting complaints were abnormal vaginal bleeding, (64.3%) watery discharge (25.0%) and postcoital bleeding (7.1%). Histologically, 96.4% has squamous cell carcinoma of varying degree of differentiation and most (78.6%) presented in the advanced stages. Majority (80.4) were referred for radiotherapy at either Lagos University Teaching Hospital or University College Hospital, Ibadan. Only 5.4% of cases were treated by radical hysterectomy. Measures to reduce the incidence and morbidity would include mass education of the sexually active women to have cervical smear regularly and also to report symptoms early so as to diagnose the invasive disease in the early stages.
[ABSTRACT]   Full text not available   
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Pattern of cerebral malaria in children at the Lagos University Teaching Hospital
FE Lesi, SU Nwosu, AG Mafe, MT Egri-Okwaji
October-December 2005, 12(4):275-279
Cerebral malaria is one of the most lethal forms of malaria. Given that malaria is a constantly evolving disease, it is therefore necessary to document patterns of presentation even in the same centre over a period of time.OBJECTIVE: To document the prevalence and pattern of cerebral malaria in children. DESIGN: Cross-sectional descriptive study of children with cerebral malaria attending the emergency room of the Lagos University Teaching Hospital. Age, sex, month at which diagnosis was made, associated clinical features, condition at discharge and mortality were assessed. RESULTS: Cerebral malaria was documented in 107/3309 (3.2%) children. There was an equal male:female ratio. Cerebral malaria occurred most frequently between July and September and in children between 2 and 2.9 years. A total of 79/107 (73.8) recovered fully at discharge, 9/107 (8.4%) recovered with some neurological sequelae while 19/107 (17.8%) died. Coma score on admission was significantly lower among those who died compared with those who survived (p = 0.001). Clinical signs observed in these children were seizures-88/107 (82.2%), pallor-75/107 (70.1%), jaundice-55/107 (51.4%) and hepato-splenomegaly-18 (16.8%). However, decerebrate posturing was the only clinical sign associated with a fatal outcome OR, 11.47 (p = 0.009). CONCLUSION: This study shows that cerebral malaria still remains a problem of the under fives with unacceptably high mortality. The clinical significance of decerebrate posture as an indicator of mortality would require further evaluation.
[ABSTRACT]   Full text not available   
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Assault cases in Maiduguri metropolis: A comparative study of police and accident and emergency units' records
HO Olasoji, A Tahir, U Na'Aya
October-December 2005, 12(4):286-288
BACKGROUND: Information on the incidence of assault cases such as armed robbery, fights and house burglaries in most Nigerian cities are usually based on data collected from police records with little or no attempt to tap medical sources of information. OBJECTIVE: The aim of this study was therefore to compare the rate of recording of assault cases in the Maiduguri metropolitan area by the police at the Maiduguri central police station and the Accident and Emergency unit (A and E) of the University of Maiduguri Teaching Hospital. Possible reasons why assault victims report or do not report to the police before seeking for treatment was also investigated. METHOD: All victims of assault who attended the A and E unit of the hospital over a one year period (2002-2003) were interviewed and relevant data collected in a prepared form. Findings were compared with the record of assault cases within the same period at the Maiduguri central police station. RESULT: 185 patients presented at A and E with body injuries due to assault during period of study. 108 (58%) informed the police before attending hospital, out of which majority (38.9%) claimed an 'instinctive reaction to do so' as the reason for informing the police. A significant proportion (61%) of those that did not inform the police claimed that the feeling that 'nothing will come out of it' as the reason. Only 41% of cases reported to the police were recorded. There was a tendency by the police to record cases where gun was used or the victim was a female. CONCLUSION: The true picture of violence in most Nigerian cities can better be assessed by collecting data from both the relevant A and E department as well as from the police. The need for the populace to develop confidence and trust in the police cannot be overemphasised.
[ABSTRACT]   Full text not available   
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Sexual behaviour, perception of HIV/AIDS and condom use among commercial motorcylists in Benin City.
S Adeoye
October-December 2005, 12(4):262-265
OBJECTIVE: This study aims to evaluate the perception of HIV/AIDS, condom use and the sexual behaviour of commercial motorcyclists in Benin-city, Edo State. DESIGN: A questionnaire based study involving consecutive 160 male commercial motorcyclists. SETTING: The study was conducted in three randomly selected major motorcycle parks in Benin-city. The three parks were selected using a multi stage random sampling technique. In each of the selected parks, consecutive motorcyclists were interviewed until a total of 160 respondents had been interviewed. RESULTS: One hundred and fifty-two (95%) of the respondents were acquainted with the subject of HIV/AIDS, but only 140(87%) believed that the disease actually existed. Sixty-six per cent of the respondents had multiple sexual partners while 26% of the subjects had been treated for a sexually transmitted infection. Of the 54 (34%) men who believed the disease had a cure, 46% and 32% felt that the cure was herbal and spiritual respectively. Although 106 of the men (66%) acknowledged the preventive function of the condom in the spread of HIV/AIDS and other sexually transmitted infections, only 45% used the condom regularly with sexual partners. Sixty-two per cent of the respondents would submit themselves to voluntary HIV screening though none had gone for voluntary screening. CONCLUSION: The study suggests that the sexual behaviour of the commercial motorcyclist and a scarcity of information expose him to increased risk of HIV/AIDS infection and other sexually transmitted infections.
[ABSTRACT]   Full text not available   
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Helicobacter pylori and the pathogenesis of gastroduodenal disease: Implications for the management of peptic ulcer disease.
O Rotimt, DA Nduduba, FM Otegbeye
October-December 2005, 12(4):289-298
The discovery of Helicobacter pylori has changed our understanding of the pathophysiology of peptic ulcer disease. An estimated one billion people harbour the organism worldwide but the highest prevalence is found in developing countries with up to 80% of people infected. The most favoured modes of transmission are faeco-oral and oral-oral. The mechanisms of H pylori-induced gastroduodenal disease include the provocation of local inflammatory reaction with the release of toxic cytokines, elevation of gastrin concentration and cytotoxic epithelial injury from the activity of urease and other enzymes produced by the bacterium. However, a large proportion of infected persons have no disease or are asymptomatic thereby suggesting that there may be other factors apart from H pylori infection necessary for ulcer formation. The simple finger prick test, a variant of serology and the newly developed ELISA-based Faecal Antigen Test hold the ace for large-scale epidemiological studies. The eradication of H pylori is now a very important goal of treatment of gastric and duodenal ulcers. Most H pylori eradication regimens combine anti-secretory agent, usually a proton pump inhibitor or H2-receptor antagonist and two antibiotics (usually, Clarithromycin and Amoxycillin or Metronidazole). Emergence of antibiotic resistance is worrisome but a quadruple therapy that incorporates bismuth may be used if the triple therapy fails.
[ABSTRACT]   Full text not available   
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Surgical lymph node biopsies in University of Ilorin Teaching Hospital, Ilorin, Nigeria
BA Ojo, MO Buhari, SA Malami, MB Abdulrahaman
October-December 2005, 12(4):299-304
BACKGROUND: To determine the diagnostic value of lymph-node biopsy, commonest causes of lymph node enlargement requiring biopsy and the usual nodes involved. METHODS: A retrospective study of 169 lymph node biopsies representing 97% of lymph node biopsies and 3.2% of total biopsies specimen received at Pathology Department of University of Ilorin Teaching Hospital Ilorin, Nigeria over a 5 year period was undertaken. RESULTS: Tuberculous lymphadenitis (38%) and metastatic nodal involvement (25%) were the commonest causes of lymph node enlargement. Generalised lymphadenopathy occurred in 105 (62%) patients while localised enlargement was seen in 64{38%) of cases. The commonest sites of localised lymphadenopathy were axillary (38%), cervical (32%), inguinal (8%), and submandibular (8%). While axillary lymph node enlargements were mostly associated with tumour metastasis, cervical node enlargements were mostly associated with tuberculosis. Supraclavicular lymphadenopathy has the highest risk of malignancy. CONCLUSION: The result shows that tuberculous lymphadenitis and metastatic nodal malignancies are the commonest causes of lymph node enlargement in our environment. Reasons for this include the often involvement of lymph nodes in tuberculous infections {as lymphadenitis constituted the most frequent form of extra pulmonary tuberculosis} and cancer's metastasis. With an effective and nationwide immunisation against tuberculosis, health education on HIV infection coupled with early screening and detection of malignancies in generals, we hope this trend will change in the future. Lymph node biopsy remains an important and valuable diagnostic tool in evaluation of lymph node enlargement as it allows for the architecture of the gland to be viewed thereby given an accurate and concise diagnosis with very minimal risk to the patient.
[ABSTRACT]   Full text not available   
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What impressions do medical students of the University of Benin have about anaesthesia and anaesthesiologists?
OP Adudu
October-December 2005, 12(4):250-254
A survey on the impressions 500 level medical students of the University of Benin have about anaesthesia and anaesthesiologists was carried out from May to August 1999. The survey showed the mean age of the students to be 25.3 years and a male to female ratio of 3:1. The study also showed that 170 (82.5%) of the students were unaware of the scope of anaesthesia before the posting. After the posting, this figure decreased to 58 (34.5%) (chi2 = 11.7, p < 0.05, df = 2). Approximately same number of females (71.1%) and males (72.3%) had low awareness (unaware and limited awareness) about the scope of anaesthesia. However, more males (16.9%) were fully aware about anaesthesia and anaesthesiologists than female students (9.4%). Similarly, 76 (54.3%) of the students knew that anaethesiologists were doctors before the posting. This figure improved to 109 (85.2%) after the posting and was statistically significant. Interest in the specialty was exhibited by only 2 (2%) of the students before the posting and 21 (25%) of them became interested during and 4 (5%), after the posting in anaesthesia. The impressions had by those uninterested in anaesthesia include the unchallenging, non-lucrative and stereotyped nature of the specialty. It also included the dependency of the specialty on other specialties and that it attracted dull, lazy doctors whose job was unrecognized. This study's findings suggest the need for better exposure of medical students to anaesthesia to increase awareness and for the specialty to grow.
[ABSTRACT]   Full text not available   
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Haematological parameters in sickle cell anaemia patients with and without splenomegaly
MA Durosinmi, L Salawu, YA Ova, OO Lawal, OA Fadiran
October-December 2005, 12(4):271-274
BACKGROUND: The aim is to investigate the clinical and haematologic effects of persistent splenomegaly (PS) and splenectomy in a population of Nigerians with sickle cell anaemia (SCA). MATERIALS AND METHODS: SCA patients attending the Haematology clinic of the OAUTHC, Ile-Ife, were examined physically and haematologically. Patients with PS were compared with age and sex-matched controls without splenomegaly. Foetal haemoglobin (HbF), packed cell volume (PCV), reticulocyte count and the frequency of blood transfusion were noted for both groups. The clinical effects of splenectomy were documented in three patients who underwent the procedure because of symptomatic massive splenomegaly (> or = 10 cm). RESULTS: Seventy-one patients, 40 males and 31 females, aged 16-48 (median, 21) years were studied. Nineteen (26.8%) had PS ranging from 3-22 cm (mean +/- SD = 9.4 +/- 4.4 cm; median = 7 cm). Ten of these had massive splenomegaly (spleen > or = 10 cm) varying from 10-22 cm (mean +/- SD = 12.3 +/- 3.8 cm; median = 12 cm). No significant differences were found between the mean values of HbF, PCV, reticulocyte count, frequencies of pain crisis, transfusion requirement, weights and heights in SCA with PS and age-sex matched controls without PS. Annual transfusion requirement showed a mild negative correlation with splenic size (r = -0.06), which was not statistically significant (p = 0.882). Significant haematologic improvement was confirmed in the 3 patients who underwent elective splenectomy for splenomegaly-induced hypersplenism. CONCLUSIONS: We conclude that massive persistent splenomegaly is a recognised cause of significant morbidity in SCA patients as evident in the patients that underwent splenectomy. However, where it is mild to moderate, PS may not have significant adverse effect on the overall clinical picture of the disorder.
[ABSTRACT]   Full text not available   
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Improving attitude towards elderly people: Evaluation of an intervention programme for caregivers
IS Abdulraheem, DB Parakoyi
October-December 2005, 12(4):280-285
There is yet no specific Government policy on care of the elderly in Nigeria despite increase in its awareness as well as the number of people reaching old age. This study was carried out to assess the attitude of caregivers in seven out of the eleven wards in Ilorin metropolis. The caregivers consisted of daughters (44.4%), sons (18.3%), family-relation (24.6%), employees (1.4%), neighbors (4.5%) and community members (6.8%). The data collection toll was a structured questionnaire consisting of three parts designed to determine the socio-demographic characteristics, general and specific attitude to the care of the elderly. Effect of Health Education on attitude of caregivers concerning the care of the elderly was also evaluated. Based on the scoring system, the attitude of the caregivers was found to be fairly positive and after the Health Education intervention, a significant improvement in the attitude of caregivers was recorded. The Mean (SD) score increased significantly from 78.4 +/- (14.6) pre-intervention to 96.8 +/-(15.2), post-intervention, p-value < 0.05. Religious teaching (35.9%), traditional/customary obligation (28.7%) and personal feeling (21.1%) were the most influencing factors of attitude of caregivers towards the care of the elderly. The influence of educational status of caregivers on where the elderly should be taken care of was found to be non statistically significant (p > 0.05). Gender had overall positive effect on attitudinal measurement. The deduction from this study is that care of the elderly is still being valued despite lack of specific government policy and support. The negative attitude of caregivers to institutional care may be difficult to change through health education intervention because care of the elderly at home is still being greatly valued in this country as it is seen as a responsibility of children and other family members. Institutional care is also considered as an abomination and irresponsibility by some caregivers
[ABSTRACT]   Full text not available   
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Ocular morbidity from sickle cell disease in a Nigerian cohort
OE Babalola, CO Wambebe
October-December 2005, 12(4):241-244
Sickle cell Retinopathy is increasingly being recognised as a cause of significant ocular morbidity and blindness in Africa south of the Sahara. This study looked for retinopathy in a cohort of 90 Nigerians with Sickle Cell Disease (SCD).METHOD: The cohort consisted of black Nigerians from the Hausa-Fulani, Ibo and Yoruba, as well as other minority ethnic groups resident in the Federal Capital Territory aged between 5-36 yr. 88 patients were SS and only 2 SC. RESULTS: SCD related posterior lesions were seen in 22 patients (24%). Of these, 19 cases (21%) had Non Proliferative Sickle Retinopathy (NPSR) while 5 (5.6%) had Proliferative Sickle Retinopathy (PSR) in various stages of development, and 2 had both PSR and NPSR. Patients with PSR are at risk of blindness from vitreous haemorrhage and tractional retinal detachment. A 14-year-old male with arterio-venous anastomosis was the youngest with PSR while the most advanced PSR lesion was a sea fan in a 25-year-old female. CONCLUSIONS: standard treatment consisting of photocoagulation and/or vitrectomy is not available in many eye centres in sub-Saharan Africa and steps need to be taken to improve this situation. The role of anti-sickling remedies, if any, is the subject of ongoing investigations. Our findings with NIPRISAN, a phytomedicinal preparation currently undergoing trials, will be reported subsequently.
[ABSTRACT]   Full text not available   
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Surgical management of a large complex odontoma of the mandibular angle-ramus region through intra-oral buccal approach--A case report
MO Ogunlewe, WL Adeyemo, AL Ladeinde, BO Bamgbose, OF Ajayi
October-December 2005, 12(4):312-315
Large complex odontomas of the jaws are rare. A report of a large complex odontoma of the mandibular angle-ramus region enucleated through intra-oral buccal approach is presented. A review of the literature on different modalities of treatment is also undertaken. A large expansile complex odontoma of the angle-ramus region of the mandible was excised through an intraoral buccal approach under general anaesthesia. Recovery and immediate post-operative period were uneventful. There was no altered sensation in the distribution of the inferior alveolar nerve and lingual nerve; and wound healing was satisfactory. Post-operative radiograph 2 years after the operation showed satisfactory bone regeneration. Intraoral buccal approach to large complex odontomas of the angle-ramus region of the mandible is a relatively safe procedure with minimal complication.
[ABSTRACT]   Full text not available   
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