AFRICAN JOURNAL OF ORAL AND MAXILLOFACIAL PATHOLOGY AND MEDICINE
African Journal of Oral and Maxillofacial Pathology and Medicine (AJOMPM) aims to provide our readers with current research findings that will impact positively on the practice of Oral and Maxillofacial Pathology/Medicine, Forensic Odontology, Oral Biology and Oral/Maxillofacial Radiology worldwide. This current issue of the journal consists mostly of the research work presented at the Annual Scientific Conference of Nigerian Association of Oral and Maxillofacial Pathology and Medicine held in Enugu, Nigeria (May 2018). The journal manuscripts published include recent researches on the diagnosis of orofacial non-Hodgkin lymphoma and clinicopathologic patterns of fibro-osseous lesions. Additionally, studies on benign non-pleomorphic salivary gland tumours and odontogenic lesions associated with dentigerous cyst were presented. The patterns of presentation of patients with burning mouth syndrome and trigeminal neuralgia were published in this issue of the journal. Our readers will find these journal articles interesting. These articles are also available at the recently unveiled journal website.
OROFACIAL BIOPSIES IN PORT HARCOURT: A Review of 532 Cases seen over a 12-Year Period
Background Knowledge of the prevalence and distribution of orofacial lesions in a specific geographic region is important in diagnosis and treatment planning. This study aimed to determine the prevalence and distribution of biopsied orofacial lesions in Port Harcourt. Methods This retrospective study reviewed orofacial histopathology reports over 12 years, with data extracted from the histopathology reports. Lesions were categorized into non-neoplastic and neoplastic. The non-neoplastic lesions were grouped into inflammatory/reactive, cystic, and others, while the neoplastic lesions were divided into benign and malignant. The data were analyzed using SPSS version 23. p ≤ 0.05 was considered significant. Results A total of 566 orofacial biopsies were done during the period under review, of which 532 were analyzed. Non-neoplastic lesions accounted for 39.5%, and most of them were reactive/inflammatory lesions (62.9%). The mean age was 27.7 ± 17.1 years, and they were more common in the third decade, in females (57.6%), and in the mandible (29.0%). The most common non-neoplastic lesions were dentigerous cyst (8.1%) and pyogenic granuloma (7.9%). Neoplastic lesions accounted for 60.5% of orofacial biopsies, with a mean age of 34.9 ± 19.8 years, and a peak from the 2nd to 4th decades of life. They were more common in females (53.1%) and in the mandible (40.1%). Benign lesions (69.9%) were more common than malignant lesions. The most common benign odontogenic lesion was ameloblastoma (18.6%), whereas fibroma (4.5%) was the most common benign non-odontogenic lesion. Of the malignant lesions, carcinomas were by far the most frequent (68.0%), with squamous cell carcinoma (5.3%) being the most common. Conclusion Orofacial biopsies in Port Harcourt consist mainly of neoplastic lesions, with the most frequent lesions being ameloblastoma, dentigerous cyst, pyogenic granuloma and squamous cell carcinoma.
ISOLATED AGENESIS OF A MAXILLARY CENTRAL INCISOR: A case report and literature review
Background: Hypodontia is one of the most common developmental anomalies in humans. The most frequently missing tooth is the third molar. Agenesis of maxillary central incisors is extremely rare. Objective: This article reports a rare case of agenesis of the left maxillary central incisor in our practice, without any associated problems. Case Report: A 15-year-old girl who presented with agenesis of the maxillary left central incisor. There was no history of previous extraction of the upper left central incisor and no associated odontome, no systemic disease, or family history of oligodontia. The patient was generally well. Systemic examination was essentially normal. Intraoral examination showed that she had a full complement of teeth, except for the missing maxillary left central incisor. The standard occlusal radiograph of the patient revealed that the left maxillary central incisor was missing. Conclusion: The cause of the agenesis resulting in this rare condition is not clear, but may be due to inadequate secretion of some of the signaling molecules or localized absence of their receptors in the ectomesenchyme destined to differentiate into the left maxillary central incisor.
REGIONAL ODONTODYSPLASIA IN A NIGERIAN CHILD: A Case Report and Literature review
Background: Regional odontodysplasia also known as ‘ghost teeth’ is a rare developmental disorder whose aetiology is unknown. The suspected factors linked with the condition are trauma, infections etc. It affects both primary and permanent dentition with a female predilection, usually localized to one segment of the jaw and involved teeth appear yellowish-brown, with rough surfaces and are prone to fracture. Radiographically, enamel and dentine are thinner than normal and lack demarcation, pulp chambers are large with short roots. Managements of these cases should be based on esthetics and functional needs as well as the degree of involvement of the tooth. Objective: There is dearth of studies on this topic in Nigeria, hence we have decided to report this incidental finding of regional odontodysplasia seen in our center. Case report: A 6-year-old girl presented to the Paediatric clinic with complaint of pain from a tooth in the upper right quadrant. On examination, presence of mobile 55 that appeared yellowish with rough surfaces without any carious lesion. Radiograph showed lack of distinction between enamel and dentine, large pulp chamber with short roots of tooth 55 and unerupted 16. Management was extraction of affected tooth with of stainless-steel crown placement on 16 after eruption. Patient is still being monitored. Conclusion: Regional odontodysplasia although rare can present at any time. Management of regional odontodysplasia should be approached individualistically based on patient’s presenting complaint.
Papillion-Lefevre Syndrome: Clinical presentation and literature review
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A Review of the Malignant Potential of Oral Precancerous Lesions
Awareness of Forensic Odontology among Nigerian Dentists: A knowledge, attitude and practice study
PSYCHOGENIC OROFACIAL PAIN AMONG PATIENTS ATTENDING A TERTIARY HOSPITAL IN NIGERIA
OBJECTIVES: There is dearth of study reporting overall prevalence of psychogenic orofacial pain in our environment, and many aspects of such disorder are relatively unknown. The goal of this study was to show the overall prevalence of psychogenic orofacial pain and to determine the age and gender distribution of the various types of psychogenic orofacial pain in a Nigerian population. PATIENTS AND METHODS: This was a retrospective study conducted on patients suffering from psychogenic orofacial pain who were referred to the Department of Oral Pathology and Medicine, University of Benin Teaching Hospital, over a period of 4 years. The differential diagnosis was made on the basis of history, clinical examination, laboratory and radiographic investigations and by applying the criteria laid down by International Association for the Diagnosis of Pain. RESULTS: Out of a total of 1,019 patients seen during the study period, 57 (5.6%) cases of psychogenic orofacial pain were diagnosed. The males accounted for 36.8% (n=21), while the females accounted for 63.2% (n= 36) giving a ratio of 1:1.7. Majority of the patients were in the age group of 41 to 50 years. Analysis showed the patients were suffering from temporomandibular pain dysfunction syndrome (TMDS) 38 (66.7%), burning mouth syndrome (BMS) 9 (15.8%), atypical facial pain 6 (10.8%) and, atypical odontalgia 4 (7.0%) CONCLUSION: The overall prevalence of psychogenic orofacial pain was 5.6% in the population studied. TMDS was the most common type, followed by BMS and they occurred mostly in young adult female patients.
Saliva as an accessible Biological Maxtrix for Screening of Psychoactive and Therapeutic drugs
The Use of Garcinia Kola in the Treatment of Oral Candida Infection in HIV Patients
Odontogenic Tumours in Benin City, Nigeria: Analysis of 220 Cases and Review of Literature
OBJECTIVE: Recent reports suggest a high incidence of odontogenic tumours in Nigerians, particularly ameloblastoma. This study further evaluates the age, gender, duration, site of occurrence and various histopathologic types of odontogenic tumours in the South-South Nigerian population. METHOD: The patients’ case notes, biopsy reports and histopathology slides of 1298 diagnosed cases of orofacial lesions between January 1991 and April 2014 were retrospectively reviewed. Patients with odontogenic tumours were selected and the age, gender, duration, site and histopathologic types of the lesion were analyzed. RESULTS: Two Hundred and twenty (17.0%) of the patients had odontogenic tumours among the diagnosed orofacial lesions within the study period. The patients’ ages ranged from 7 to 73 years, with a mean age of 32 + 1.4 years and the peak age group was the 3rd decade of life (n=63, 28.6%). There were 114 (51.8%) males and 106 (48.2%) females, giving a ratio of 1.1: 1. The mean duration of the lesions on presentation was 43 + 5.6 months and posterior mandible was the commonest site (n=139, 63.2%) of the lesions. Ameloblastoma (n=167, 75.9%) was the most common histopathologic type of the odontogenic tumours, which was significantly associated with the posterior mandible (n=107, 48.6%) [p=0.000]. This was distantly followed by odontogenic myxoma (n=11, 5.0%). CONCLUSION: This study shows a high incidence of ameloblastoma and a lower overall incidence of odontogenic tumours in younger age groups with variable gender distribution and fairly similar site predilection of the various histopathologic types of odontogenic tumours compared to previous reports.
Biological Profile and Pathological Causes of Mortality of Teeth used for Teaching Oral Biology to Dental Students in a Tertiary Institution
Human Papilloma Virus-16 in Benign Oral Mucosa Lesions: A possible risk factor for oral mucosal malignancy
PEMPHIGUS VULGARIS: A case report and literature review
OBJECTIVE: This paper reports a case of pemphigus vulgaris (PV) in a young adult male affecting the oral mucosa to highlight the importance of early diagnosis and treatment of this lesion CASE REPORT: A 33 years old student presented with a six week history of multiple ulcers in the oral cavity. Intra-oral examination revealed multiple irregular shaped ulcers with erythematous floor on the soft palate, buccal mucosa, anterior pillar of fauces, ventral surface of the tongue and floor of the mouth. An initial diagnosis of erythema multiforme was made. Investigations with full blood count, retroviral screening and fasting blood sugar showed normal findings. A definitive diagnosis of pemphigus vulgaris was made following histopathological examination. The initial treatment administered were Prednisolone tablets 60mg/day for one week, then the dose was stepped down to 40mg daily for a week. Triamcinolone dental paste was applied topically twice daily for 2 weeks. The oral lesion improved drastically and the dose of prednisolone was further stepped down to 20mg daily in 2 weeks. There was an exacerbation of the oral lesions at a dose of 20mg daily of prednisolone, hence the daily dose was adjusted to 60mg daily for 4 weeks at which the oral lesions started improving. The patient has been on maintenance dose of prednisolone of 30 mg/day and Dexamethasone 1 mg dissolved in 10 ml of water as mouth rinse daily for 5 months. CONCLUSION: This study reported a case of PV involving the oral mucosa found in a young adult male. Early diagnosis and treatment of the oral lesions with local and systemic steroid resulted in remission within 6 months.
Xeroderma Pigmentosum: Difficulty with management of a case in Tropical Africa
Learning Environment in a Nigerian Dental School: Students' Perception
Biological Basis for Root Dilaceration: Prevalence and Clinical Significance
A Clinico-Pathologic Patterns of Orofacial Carcinoma in a Nigerian Population
Prevalence of Human Papilloma Virus in Clinico-Histologic types of Ameloblastoma seen in Lagos University Patients Teaching Hospital
SPINDLE CELL TUMOR OF THE MAXILLA: AN ADULT-TYPE FIBROSARCOMA OR A STORIFORM UNDIFFERENTIATED PLEOMORPHIC SARCOMA?
OBJECTIVE: Spindle cell neoplasms of the jaws include a heterogenous cluster that could pose diagnostic difficulty. CASE REPORT: A 44-year old woman with left maxillary swelling had histology showing monomorphic fusiform to spindle cells and few mildly pleomorphic cells arranged in a vague herringbone, cartwheel and storiform patterns. Also seen were few foci of epithelioid-like cells and ‘staghorn’ pattern of vascular channels. Histology differentials included: Fibrosarcoma (adult type), Malignant Peripheral Nerve Sheet Tumor, Hemangiopericytoma, Spindle-cell type angiosarcoma, Synovial sarcoma, Epithelioid sarcoma and Spindle-cell Malignant Melanoma and storiform Undifferentiated Pleomorphic Sarcoma. Immunohistochemistry was done using the antibodies: CD34, CD45, myogenin, synaptophysin, cytokeratin AE1/AE3, desmin, melan-A and vimentin. Vimentin was positive (++) while all others were negative. The final diagnosis was strongly suggestive of intra osseous adult-type fibrosarcoma, mostly based on morphological features than immunohistochemical distinction. CONCLUSION: This case highlights one of the difficulties faced in the process of diagnosis by resource-limited facilities. The patient has not presented for any intervention (due to financial challenges) as at the time of this manuscript documentation and submission.
KNOWLEDGE OF MEDICAL SPECIALISTS ON ORAL MANIFESTATIONS OF SYSTEMIC SCLEROSIS IN A TERTIARY HEALTHCARE CENTRE IN NIGERIA
OBJECTIVE: Due to the heterogeneous manifestation and multiple organ affectation associated with systemic sclerosis, a multidisciplinary management approach has been advocated. The aim of this study was to evaluate the level of knowledge of some medical specialists on oral manifestations of systemic sclerosis and the need for interdisciplinary/multidisciplinary collaboration with dentists in a tertiary hospital in the management of patients with this condition. METHODS: This study was conducted at the University of Benin Teaching Hospital, Edo State. Data was collected using a self administered questionnaire with a cover paged informed consent form and was distributed among some medical specialists in the departments of internal medicine, family medicine, mental health and ophthalmology. The information collected was analyzed using statistical package for social sciences SPSS for windows version 23.0 software (SPSS Inc. Chicago, IL, USA). RESULTS: A total of 80 questionnaires were distributed among the physicians in UBTH, of which 50 were completely answered and returned, giving a response rate of 62.5%. Of these 50 respondents, 27 (54.0%) were male and 23 (46.0%) were female. On the grading of the oral manifestation of SSc knowledge, 19(34%) no knowledge, 12(24%) had poor knowledge, 9(18%) had 10(20%) had good knowledge. A total of 24 (48.0%) of the respondents strongly agreed while 18(36%) agreed for a multidisciplinary management with a dentist. CONCLUSION: A good number of medical specialists from on this study had insufficient to poor knowledge of oral manifestations of systemic sclerosis. This has made collaboration with the dentist almost absent. A multidisciplinary collaborative interaction is encouraged to prevent worsening oral manifestations associated with systemic sclerosis.
PRIMARY SJÖGREN’S SYNDROME: CLINICOPATHOLOGIC REVIEW OF 20 CASES USING THE ACR/EULAR CRITERIA
OBJECTIVE: Sjögren’s Syndrome (SS) is a systemic autoimmune disorder that may present a diagnostic challenge in low and middle income settings. The American College of Rheumatologists (ACR) and European League against Rheumatism (EULAR) in 2016 developed diagnostic criteria. However, a dearth of literature exists on the clinico-pathologic pattern and the diagnostic criteria used to diagnose primary Sjögren’s syndrome in Nigeria. METHODOLOGY: This is a single-center retrospective review of 20 cases seen at the Oral Medicine clinic that underwent an evaluation for suspected primary Sjogren’s Syndrome (pSS). We report the clinical and histopathology of the 20 cases, and evaluated these cases based on the diagnostic criteria by the ACR/EULAR. RESULTS: The survey revealed a series of 20 cases. There were 14 females and 6 males with F: M ratio of 2.3:1. The study participants were from 18 to 78 years, with a mean age of 46.9 (± 15.9). Of all the cases reviewed, about 35% (n=7) met the ACR/EULAR criteria, and oral symptoms of dry mouth, 19(95%), was the most common symptom seen. Symptoms of persistent dry eyes and a feeling of gritty sensations in the eyes were equally common symptoms in the ocular region in 9(45%). Atypical symptoms in form of cough and sore throat resulting from dry mucosa were also reported in 15% (n=3) of cases reviewed. CONCLUSION: Oral symptoms appear to be relatively common in the cases reviewed, while the ACR/EULAR criteria confirmed diagnosis in a third of the cases evaluated.
A CLINICOPATHOLOGIC EVALUATION AND ANALYSIS OF 56 CASES OF MUCOEPIDERMOID CARCINOMA USING GRADING SYSTEMS
OBJECTIVE: Mucoepidermoid carcinoma (MEC) is the most common malignant epithelial salivary gland tumour and histologically it presents with varying proportions of epidermoid, mucous, and intermediate cells. This study aims to describe the clinicohistological features of MEC managed at Lagos University Teaching Hospital (LUTH) and compare two quantitative histologic grading systems for MEC. METHODS: The study examined previously diagnosed cases of MEC between 1980 and 2018 in LUTH. Data on age, sex and site were retrieved from the archives. Cases were categorized according to Armed Forces Institute of Pathology (AFIP) and modified Brandwein (MB) criteria. Data analysis was done using SPSS Windows version 21.0. RESULTS: Of the 56 cases of MEC studied 30 (53.4%) were males and 26 (46.6%) were females (1.15:1). The minor glands were the most frequently involved site with 43 (76.8%) cases. There was a significant difference between the mean age of patients with minor salivary glands (45.3±19.6) MEC and major glands (27.9±21.4) MEC, (P=0.007). High grade tumours were the most common histological type in both the AFIP 31 (55.4%) and MB 35 (62.5%) systems. For the MB criteria, there was a significant association (P=0.021) between the occurrences of high grade MEC in the minor salivary glands. CONCLUSION: In this study, MEC had an almost equal sex predilection and was more common in minor salivary glands. The MB grading system uncovers more MECs as high-grade tumours than the AFIP system. Appropriate grading of MEC is an indispensable part of good case management.
IMMUNOHISTOCHEMICAL EXPRESSION OF KI-67 AND P63 IN AMELOBLASTOMA, ODONTOGENIC KERATOCYST AND DENTIGEROUS CYST
OBJECTIVE: The aim of this study was to evaluate the immunohistochemical expressions of Ki-67 and P63 in the epithelial component of ameloblastoma, OKC and DC, and to determine if there is any correlation between the expressions of Ki-67 and P63 in these lesions. METHODS: A total of 10 ameloblastoma, 4 odontogenic keratocyst and 9 dentigerous cyst were utilized. Archival tissue blocks were retrieved and processed for immunohistochemistry using the Avidin Biotin immunoperoxidase method. The primary antibody utilized was mouse monoclonal anti-Ki67 and anti-P63 (Novocastra®, 1:100 dilution). Visualization was achieved using diaminobenzidine (DAB) solution. Stained sections were counterstained using Haematoxylin, dehydrated using ascending grades of alcohol, cleared in xylene and cover-slipped using DPX as mountant. They were then viewed under a microscope for colour reaction. Data was entered into a spreadsheet and analyzed using Kruskal Wallis test. Correlation between Ki-67 and P63 was done using Spearman’s rank correlation coefficient test. P-values ≤ 0.05 were considered statistically significant. All statistical analysis was done using IBM SPSS version 23. RESULTS: Immunohistochemical expression of Ki-67was seen in 100% of OKCs, 70% of ameloblastomas and 44.4% of dentigerous cysts. For P63, there was positive immunohistochemical expression in 50% of ameloblastomas, 25% of odontogenic keratocysts and in 11.1% of dentigerous cysts. However, the differences in expression of these two markers in these lesions was not statistically significant. Spearman’s rank correlation coefficient test showed that there was no statistically significant correlation between the expression of Ki 67 and p63 in ameloblastoma (σ = 0.541, P = 0.106), odontogenic keratocyst (σ = -0.333, P = 0.667) and dentigerous cyst (σ = 0.530, P = 0.142). CONCLUSION: The pattern of expression of Ki-67 and P63 by ameloblastoma, odontogenic keratocyst and dentigerous cyst appears to follow the clinical aggressiveness of the lesions, with no correlation of the expression of these two markers.
DENTINOGENESIS IMPERFECTA: A Case Report and Review of Literature
BACKGROUND: One of the commonest hereditary disorders of dentine formation is dentinogenesis imperfecta (DI). It is inherited in an autosomal dominant fashion thus affecting the formation and mineralization of dentine, which makes the teeth prone to attrition and fracture. Early diagnosis and treatment is recommended to prevent or mitigate further deterioration of occlusion and teeth, and to improve esthetics. OBJECTIVE: A report of a case of dentinogenesis imperfecta type II who presented on account of sequelae of the dental anomaly, to highlight the importance of early diagnosis and treatment of the condition. CASE REPORT: A case report of a 14-year-old female presenting with dentinogenesis imperfecta with clinical and radiological evidence. There were associated (i) acute apical periodontitis of tooth 46, (ii) longitudinal crown root fracture of tooth 36 secondary to occlusal trauma. Both teeth were extracted; her 26, 27, 37 and 47 were billed for stainless steel crown placement and acrylic jacket crown for 11, 21, 31 and 41. CONCLUSION: Early diagnosis and treatment of DI is recommended to prevent or intercept deterioration of the teeth and occlusion, and thus improve aesthetics. Long term follow-up is imperative to prevent developing complications and adjust the treatment to the changes in the dentition and occlusion.
SOLITARY PLASMACYTOMA: Report of a Rare Occurrence in the Mandible
BACKGROUND: Very little has been reported regarding plasmacytomas in the oral and maxillofacial region and studies cited were mostly in foreign literature apart from two cases from Nigeria Objective: The dearth of publications in African literature informed the need to report a rare case of solitary plasmacytoma of the mandible in a 52-year-old male patient CASE REPORT: A 52-year-old male patient that presented at our institution with an eight-month history of painless swelling of the left mandible associated with difficulty in chewing. Histology diagnosed Non Hodgkin lymphoma but immunohistochemical studies revealed tumour cells with strong expression of CD138 and confirmed a diagnosis of solitary plasmacytoma (SPB). The patient was treated with palliative radiotherapy 30Gy in 10 fractions over two weeks. CONCLUSION: SPB of jaw most commonly presents clinically as a painless swelling, and radiographically as multilocular radiolucency with ill-defined borders. Diagnosis of the SPB depends on the microscopic evidence of plasma cell proliferation and absence of any other bone involvement. Ancillary techniques such as immunohistochemistry play an important role in distinguishing SPB from other haematological diseases
CRANIOFACIAL AND DENTAL MANIFESTATIONS OF CROUZON’S SYNDROME: A Review of Literature and Report of an Illustrative Case
OBJECTIVE: This is a report a case of Crouzon Syndrome in a 5 year-old female and review the literature on the presentation and management of this rare craniofacial anomaly. CASE REPORT: A 5-year-old girl presented with complaints of head swelling and protrusion of the eyes associated with relative prominence of the lower jaw and decreased growth of the mid face about 9 months after birth. Based on clinical and radiological findings, a diagnosis of Crouzon’s syndrome was made. CONCLUSION: There is a need for the development of a craniofacial team at this center and other African center in view of the increasing incidence of this anomaly. The patient in the case report did not receive any intervention in view of resource limitation despite her urgent need for intra- cranial decompression.
MALIGNANT OROFACIAL TUMOURS AMONG ETHNIC IGBOS AT A TERTIARY HOSPITAL IN ENUGU
BACKGROUND: To study the geographical distribution of malignant orofacial tumours seen at the University of Nigeria Teaching Hospital Enugu, among ethnic Igbos in Nigeria distributed over five states with 95 local government areas. METHODS: A Seven-year (2012-2018) retrospective study of native Igbo patients who presented at the Oral and Maxillofacial Pathology Unit of University of Nigeria Teaching Hospital, Enugu. Records of all identified as Igbo in the biopsy forms were analysed to obtain their age, gender, location, histologic diagnosis, local government area, and state of origin. RESULTS: Ninety-six malignant orofacial tumours were diagnosed by histological methods among native Igbo patients presenting at the hospital. The male to female ratio was 1.6 to 1.0. The overall mean age was 49.1 ± 19.2 years, and the malignant tumour observed were: oral mucosal carcinomas (41.7%), salivary carcinomas (18.8 %), sarcomas (15.6 %), odontogenic carcinomas 9.4 %, haematolymphoid malignancies 8.3 %, vascular malignancies 3.1 % and metastatic tumours 3.1 %. The most common specific orofacial malignancies were squamous cell carcinoma (41.6 %), and Igbos from Enugu State (54.2 %) had the highest incidence of orofacial malignancies, with the highest prevalence in the local government area of Enugu-South (11.5%). The Pearson correlation of orofacial malignant tumour with age was -0.297, with a p value of 0.003 indicating an inverse relationship. CONCLUSION: Igbo patients who presented at the tertiary hospital had similar prevalent orofacial malignancies as those reported in other regional Nigerian studies. The geographic distribution of the lesions showed that the highest prevalence of cases was from those with closer proximity to the state and local government area where the dental facilities were located.
IMMUNOHISTOCHEMICAL EXPRESSION OF MMP2 & TIMP2 IN AMELOBLASTOMA AND THEIR IMPLICATIONS IN BIOLOGIC BEHAVIOUR OF THE TUMOUR
of odontogenic epithelium characterized by local invasiveness, propensity for facial deformity, and a high rate of recurrence. Matrix metalloproteinases (MMPs) are proteolytic enzymes that play a central role in the regulation of extracellular matrix complemented by Tissue Inhibitors of Matrix metalloproteinases (TIMPs). MMP-2 has been closely associated with ameloblastoma invasion. TIMP2 acts as a specific inhibitor of MMP-2 or may be involved in its activation. AIM: To determine and compare the relative immunohistochemical expressions of MMP2 and TIMP2 proteins in the clinical types of ameloblastoma. METHODS: Formalin-fixed paraffin embedded (FFPE) tissue blocks of 50 ameloblastoma cases were sectioned and stained with antibodies for MMP-2 and TIMP-2. Immunohistochemical staining of stromal and tumour cells were assessed to obtain a combined score of proportion and intensity of staining. Proportion of cases with positive expression of MMP2 and TIMP2 were determined. Mean score and ratios of these proteins were compared within the biological types using the Independent sample t- test. RESULTS: In all the clinical types of ameloblastoma, the mean MMP-2 expression was higher than the mean expression of the inhibitor, TIMP-2. There was no significant difference in the expression of MMP-2 in both the conventional and unicystic types. TIMP2 expression was significantly higher in the unicystic type than in conventional type (p=0.02). However, MMP2:TIMP2 was significantly higher in the conventional type than in unicystic type (p = 0.01). CONCLUSION: TIMP-2 is a better predictor of the degree of invasiveness of the clinical types of ameloblastoma than MMP-2. MMP2: TIMP2 ratio also explains the effect of TIMP-2 on MMP-2 and indicates invasiveness in the biologic types of ameloblastoma than MMP-2 alone.
CHALLENGES OF DENTAL MANAGEMENT OF SJOGREN’S SYNDROME IN A NIGERIAN PATIENT: A CASE REPORT AND REVIEW OF LITERATURE
BACKGROUND: Sjögren’s syndrome is a slowly progressive inflammatory disorder that involves the exocrine glands (lacrimal glands and salivary glands) leading to the dryness of the eyes and mouth. It is a rare condition that is seen commonly in females of the middle age. OBJECTIVE: To present challenges encountered during the management of oral symptoms in a patient with Sjögren’s syndrome. CASE REPORT: A 46-year-old female Nigerian Patient who presented with bilateral facial swelling with complaint of dry eyes, dry mouth, and knee joint pain. Investigations done using sialography with contrast medium of the left parotid and Schirmer’s test of both eyes were diagnostic of Sjögren’s syndrome. Proper treatment could not be instituted until about one year after the patient’s initial presentation due to the non-availability of the required medications in the country. CONCLUSION: Poor access to the recommended medications for the treatment of patients with Sjogren’s syndrome poses a challenge to the clinician, rendering such patients helpless and unsatisfied.
A CASE REPORT OF MARFAN’S SYNDROME AND A REVIEW OF THE LITERATURE
BACKGROUND: Marfan’s syndrome is an autosomal dominant, multisystemic disorder of the connective tissue with variable inheritance patterns. Its cardinal features affect mostly the cardiovascular, ocular and skeletal systems. It is panethnic with no sex predilection and may be diagnosed prenatally, at birth, childhood or well into adulthood. OBJECTIVE: This article aimed at enlightening dental professionals on the presentation and early recognition of patients with Marfan’s syndrome. CASE REPORT: An 11-year old female previously undiagnosed of any syndrome, presented to the dental clinic with a resolving dental abscess on tooth 26 and dental caries of 16, 36 and 46. She showed features of skeletal disproportion, arachnodactyly (long slender fingers with prominent finger joints), flat feet and pectus carinatum (pidgeon chest). Facial examination revealed a convex profile and elongated face, there was no dental crowding. Her dental abscess was managed by extraction with antibiotic cover while other carious lesions were restored. She was then referred to an ophthalmologist and a cardiologist for further examinations and investigations, which revealed she had features of Marfan syndrome. CONCLUSION: This case report demonstrates the early recognition of signs and symptoms of this syndrome and the referral of the patient to other professionals for management to prevent severe life threatening complications associated with the syndrome.