Giant Epulis of the Gum and Palate Area: A Case Report in Stomatology Department at LoméUniversity Teaching Hospital

Introduction: Epulis is a pseudotumor very common in women. If neglected, it can reach a considerable volume. The marginal gingiva is very involved in the tumor either in isolation or with periodontal and alveolar bone. The epulis sits classically on the vestibular gum, rarely on the palatal side. We report a case of palatal giant epulis which posed a diagnostic problem. Case report: This was a 50-year-old patient with a large tumor occupying the entire oral cavity and pushing all nearby organs. This lesion had been evolving for ten years, with a tendency to gradually increase of its volume. The orthopantomogram revealed the destruction of the underlying alveolar bone without signs of tumor invasion. Surgical excision was performed, removing all the tumor in the vicinity of the nasopalatine vascular pedicle. The pathological examination concludes with an inflammatory epulis. Conclusion: The epulis is a benign tumor of the gum, circumscribed, localized preferentially at the neck of one or two contiguous teeth. It occurs more in women, with a predilection for the vestibular side, rarely the palatal side. In the absence of appropriate treatment it can lead to a large tumor, posing a diagnostic problem and causing functional or aesthetic discomfort. Complete surgical excision with histological examination remains the solution. Healing without sequelae is the rule.

Mandibular Sequela Noma: Metal Plate Repair Associated with a Submental Flap, about One Case

Introduction: Noma is a severe and mutilating gangrenous stomatitis of the orofacial sphere, starting on periodontal side. It is rare and occurs mainly in children that land is weakened by malnutrition. We report a case of mandibular sequela noma requiring plastic surgery. Clinical case: This was a 7-year-old patient with moderate acute malnutrition. She was referred from a peripheral care facility for gangrene of the left cheek, communicating the oral cavity with the outside, through an orostoma. This lesion had been evolving for two months, with a tendency towards progressive destruction of the soft tissues of the cheek and the mandibular bone. The neck and facial CT-Scan demonstrated destruction of the mandibular bone exposed on the left side, without signs of tumor invasion. After correction of nutritional status and local infection, the patient was treated with a metal plate recovered by sub-mental flap. Conclusion: Noma is a severe gangrenous stomatitis that transforms patients’ faces into ghosts by destroying soft tissues and underlying bone planes. The management of his sequelae is surgical, sometimes using complex techniques of plastic surgery.

Labio-Jugal Squamous Cell Carcinoma on HIV Site: Surgical Excision and Reconstruction with a Musculocutaneous Flap of the Pectoralis Major: A Case Report

Introduction: Malignant skin tumors are very frequent lesions, induced by sustained sun exposure. Cutaneous squamous cell carcinoma is a dangerous cancer of the skin. It’s more frequent in white people than black people. Squamous cell carcinomas sometimes pose a real problem of local reconstruction after their removal. Reconstructions may involve the production of regional pedunculated flaps to repair the loss of substance. We report the case of a labio-jugal squamous cell carcinoma in an HIV-positive patient. The excision of the tumor required repair by a musculocutaneous flap of the pectoralis major. The aim of this paper is to show the dangerousness of that cancer, the particularity of its location around the mouth. We also want to call for a reflection about the recurrence of that disease on HIV infection ground, despite correct resection. Clinical Case: This was a 47-year-old HIV-positive patient on antiretroviral therapy (ARVs), treated 23 years ago for pulmonary tuberculosis. He presented with an ulcerated lower lip wound extending to the right labial commissure, right cheek, and the right lateral third of the upper lip. This lesion had progressed for about 6 months without a tendency to spontaneous healing. There was no palpable lymphadenopathy, especially in the cervicofacial region. The biopsy of the lower labial lesion concluded that it was a differentiated, mature, infiltrating squamous cell carcinoma. The craniofacial CT scan did not note any regional tumor invasion. We indicated tumor excision, functional lymph node dissection, and reconstruction by a flap of the pectoralis major muscle. The operative procedure was performed under general anesthesia. The edge cuts after carcinoma removal were healthy. Three months later, the patient is seen again with a local right submandibular recurrence. Radiotherapy was offered to him. Discussion: Squamous cell carcinomas are frequent in sub-Saharan Africa with preferential localization to oropharynx and oral cavity. More and more viral infections such as HIV, HBV and HCV are implicated in the occurrence of squamous cell carcinomas of the ENT and neck and facial sphere. HIV appears to be a contributing factor in young populations. Multidisciplinary management with anti-infective treatment coupled with new therapies could reduce the risk of recurrence and metastases.

Naso-Labio-Palatine Clefts: Humanitarian Care in Togo

Introduction: The management of nasolabial-palatal clefts in precarious environments is one of the topics most addressed by many humanitarian missions, especially in Africa and Asia. The aim of our study was to propose a humanitarian and not expensive care to the patients presenting with facial clefts during the fairgrounds in disadvantaged areas. Patients and Method: We carried out a prospective study on 32 patients who were operated with very limited means during the mobile clinics inside Togo during the year 2013. These patients were followed over a period of one year after their surgery. Included in our series were native patients with facial clefts, who had no means of managing their condition, and who therefore needed humanitarian support. We have reported the clinical history of some patients to illustrate our results. Results: Our study included 32 children, including 15 boys and 17 girls, with a sex ratio of around 1. The average age of patients was 5 years, with extremes of 6 months and 13 years. We performed 13 clefts (including 12 unilateral clefts and 1 bilateral cleft), 17 clefts palate (including 12 unilateral clefts and 5 bilateral clefts), and 2 velar clefts. We described the clinical history of a few patients in this humanitarian setting and showed the surgical results obtained.

Orbital Floor Fractures: Epidemiological, Clinical and Therapeutical Study at Sylvanus Olympio University Teaching Hospital in Loméabout 51 Cases

Introduction: Orbital floor fractures are a significant pathology among maxillofacial injuries. They can cause oculomotor, sensory, and sometimes esthetic disorders. The goal of this study was to determine the epidemiological profile of orbital floor fractures and show their clinical and therapeutic approach in Lomé. Patients and method: This was a descriptive retrospective study of orbital floor fractures collected in the ENT and maxillofacial surgery department of Sylvanus Olympio University Hospital in Lomé over 8 years (January 1, 2011 to December 31, 2018). Results: We reviewed 63 cases of orbital floor fractures out of 552 cases of facial trauma. According to the inclusion and non-inclusion criteria, we retained 51 cases. The hospital frequency of orbital floor fractures was 9.24% of facial fractures. The average age of the patients was 35 ± 10.34 years. Males were predominant (ratio = 7.5). The main etiology was road accidents (92.16%). Ophthalmological signs were dominated by vertical diplopia (31.37%), limited eye movement (25.49%), and enophthalmia (29.41%). The sensory sign was dominated by suborbital hypoesthesia (13.73%). Surgical treatment was performed in 86.27% of patients. The average intervention time was 17.84 ± 12.69 days after the trauma. The main approach was the subciliary route (65.91%). The surgical procedures consisted of muscle and fat removal (20.45%) and orbital floor repair by mesh plate (50%). The average length of hospitalization was 9.63 ± 5.23 days. Surgical site infection was the main postoperative complication observed in 3.92% of patients. The main sequelae were diplopia (4.55%), suborbital hypoesthesia (4.55%), and enophthalmos (4.55%). Conclusion: Orbital floor fractures are mainly due to road accidents. Management must be multidisciplinary and adequate in order to avoid irreversible functional and/or morphological sequelae. Their prevention consists of effective combat of road accidents.