Azuka Raphael Njokanma, Olawunmi Adedoyin Fatusi, Olufemi Kolawole Ogundipe, Olujide Olusesan Arije, Ayodele Gbenga Akomolafe, Olasunkanmi Funmilola Kuye. JKAOMS 2022;48:371-81. https://doi.org/10.5125/jkaoms.2022.48.6.371

Background: This report describes treatment outcome following delayed miniplate osteosynthesis (MPO) of maxillofacial fractures. Materials and Methods: The records of patients who underwent delayed MPO of facial fractures from January 2011 to December 2014 at the Oral and Maxillofacial surgery Unit of the Federal Medical Centre, Owo, Nigeria were retrospectively reviewed. Data retrieved were age, gender, etiology of trauma, site of fractures, and time lapse from injury to treatment. Follow-up at postoperative intervals consisted of clinical and radiographic examinations. Outcome variables such as wound infection, wound dehiscence, malocclusion, hardware failure, fracture stability, and neurosensory disturbance were recorded. Results: Thirty-one patients with 52 facial fractures were treated. There were 18 (58.1%) mandibular, 8 (25.8%) maxillary fracture while 5 (16.1%) fractures occurred in both jaws. All patients had a stable fixation and normal healing. Thirteen complications occurred in 11 patients representing 35.5% of the total. Malocclusion and wound infection were the most common complication. More complications occurred in late treatment group. Conclusion: MPO with or without postoperative intermaxillary fixation is effective in the delayed facial fracture. Treatment delay may increase the incidence of complications.

Background: The Post-Operative Symptom Severity (Posse) score is useful in the assessment of patients after third molar surgery. Objective: To evaluate patients' perceptions of quality of life after surgical extraction of an impacted mandibular third molar by comparing their Post-operative Symptom Severity (PoSSe) scores at Post-operative Weeks (POW) 1 and 4. Methods: Seventy patients (age 18 to 35 years) at the Out-Patient Department were enrolled in a prospective study prior to surgical removal of third molars. Each patient was given a PoSSe questionnaire to be completed at POW 1 and POW 4. The scale assessed recovery in seven key domains on patients’ subjective feeling about pain, eating, speech, sensation, appearance, sickness and interference with daily activities. Results: All but one patient returned completely filled questionnaires. The mean age of the study population was 25.7 ± 4.5 years. The mean PoSSe score at POW 1 and POW 4 were 35.0 ± 7.2 and 33.2 ± 6.9 respectively with statistically significant difference (p = 0.010). The PoSSe score was higher among males compared to females at POW 1 (37.2 ± 7.6 vs 33.5 ± 6.6) and also higher among males at POW 4 (33.8 ± 9.4 vs 32.7 ± 4.6). Conclusion: The severity of symptoms was perceived to be worse at POW 1 when compared to POW4 but the symptoms were still severe at POW4. There is a need for surgeons need to pay more attention to management of symptoms in the post-operative intermediate period.

Background: The psychological problems associated with facial trauma may sometimes pose additional health concerns for the injured patient. Understanding the gaps in the Oral and Maxillofacial surgeons’ (OMFS) awareness of patient in need of specialist mental health intervention is important in ensuring holistic care for the trauma patient. Objectives: To determine the knowledge, practices and self-assessed level of competence of Nigerian Oral maxillofacial surgeons/trainees regarding psychological problems associated with facial trauma and to determine their perceived need for training in assessment of psychological consequences following facial trauma. Methods: A cross-sectional study was conducted in which a web-based structured questionnaire was sent to Oral and maxillofacial surgeons and trainees. Results: Majority of respondents (85.2%) had encountered psychological problems in patients who have sustained facial trauma. Half (50.6%) of OMFS / trainees had high level of knowledge regarding psychological problems associated with facial trauma; depression, anxiety, post-traumatic stress disorder, body image disorder and acute stress syndrome were the five most common trauma related psychological problems mentioned. More respondents reported low level of competence in conducting mental state examination when compared to other skill sets. In-unit counselling was reported as the method of intervention by majority (69.1 %), followed by referral to the mental health specialists (17.3%). More than one third (40.7%) of OMFS were extremely interested in undergoing additional training in the psychological assessment of patients who have sustained facial trauma. Conclusion: Nigerian Oral and maxillofacial surgeons frequently encounter psychological problems in patients with traumatic facial injuries. Notwithstanding their perceived self-assessed low level of competence in psychological assessment of trauma patients, objective assessment revealed a relatively high level of knowledge of psychological problems that can affect the facial trauma patient with many indicating a high perceived need for additional training in the psychological assessment of facial trauma patient. There is a need for incorporating psychological assessment into the management to ensure holistic care of trauma patients. Keywords: Maxillofacial trauma; psychological problems; Nigeria.