During the past five years (August 1981 to March 1986), we applied 44 pectoralis major myocutaneous flaps (PM-MC flaps) for the purpose of intraoral and extraoral reconstruction following surgery in 43 cases of 01al cancer. Out of a total 44 flaps, 30 flaps resulted in complete survival and 13 flaps resulted in partial necrosis, while complete necrosis occurred in only one flap. In addition, we used the iliac bone graft with the PM-MC flaps on five patients in order to reconstruct the mandible, but two cases failed. We also used replantation of the lower margin of the mandible on five patients, and all were satisfactory. In 26 living patients, all but one had no dysphasia. About more than a half of them had moderate or severe dysfunction of chewing. We were able to make prosthesis for five out of 26 living patients as recorded till today. We have to think about how to fashion functionable dentures on severe cases postoperatively. The results of our experiences show that the PM-MC flaps provide a simple, reliable and versatile method of primary reconstruction on patients with oral cancer.
Six hundred and seventy-three school children from the age of 3 to 20 living in the urban and the rural areas of Nigeria were examined by the Joint Dental Epidemiological Survey in 1986. The survey was funded by the Grant-in Aid from the Japanese Ministry of Education, Science and Culture, and was conducted by both the Japanese survey team and the staff from the University of Ife, Ile-Ife, Nigeria. The periodontal state of the children was evaluated according to the Community Periodontal Index for Treatment Needs (CPITN) by WHO (1).
The prevalence of periodontal diseases was found to be 84.2% within the sample with a high occurrence of gingivitis and heavy deposits of calculus. However, there was little evidence of damage to the periodontal tissues. This can be attributed to the nature of their diet. The results suggested that there would be an increasing need for well-planned and organized public educational programs for the Nigerian children to promote better Oral hygiene coupled with parental involvement in the prevention at home.
One hundred eighty consecutive male patients, mean age of 64.6 years, who were referred to cardiac catheterization for the evaluation of aortic stenosis (AS), were studied using a noninvasive scoring system. The system is based upon 7 variables including: 1) LVH by ECG, 2) aortic valve calcium by chest x-ray, 3) loud ness of A2, 4) Q to peak of murmur, 5) T time of the carotid pulse, 6) LV ejection time and 7) LVH by echocardiography. The scoring system has a range from 0 to 16, and a score≧5 indicates severe AS (valve area ≦ 1.0 cm2). Eighteen patients had hemodynamic studies on two occasions. In 3 years progression of stenosis was evident by an increase in the mean aortic valve gradient from 23±3.4 mmHg to 44±4.2 mmHg (p<0.005).The aortic valve area decreased from 1.4±0.1 cm2 to 0.76±0.07 cm2 (p<0.005). Noninvasive scores increased in these patients from 2.1±0.5 to 7.6±1.0 (p<0.005). Fifty-one patients had repeated noninvasive studies. Twenty-two patients, who had mild AS at the initial evaluation, attained a score of ≧5 in 3 years, indicating probable progression to severe AS. The mean initial score was 2.3±0.4, and the score at the end of the mean follow-up period of 3 years was 8.0± 0.6 (p<0.005). It is concluded that progression of AS over a 3-year period in the elderly patients occurs frequently and progression can be estimated noninvasively.