5-year audit of the range and volume of diagnostic radiographic services at the University of Nairobi Dental Hospital

Background: Dental and cranio-maxillofacial diagnostic imaging constitutes an invaluable tool in the accurate diagnosis and management of a diverse range of conditions and diseases that afflict the oral and cranio-maxillofacial region. In order to improve on any existing facility, periodic audit evaluation is paramount. In this way proper and relevant service delivery can be achieved. Objective: To evaluate the range and volume of dental and cranio-maxillofacial diagnostic radiographic services offered at the University of Nairobi Dental Hospital (UNDH) in Kenya over a 5-year period (2006-2010). Methods: Retro-spective survey involving manual examination of patient records at the Division of Dental and cra-nio-maxillofacial Radiology registry of the UNDH. Results: Over the study period, the range of diagnostic radiographic services offered comprised of both intra- and extra- oral examinations. The total volume of radiographs taken was 48,874 among which 41,980 (86%) were intraoral and 6894 (14%) extraoral views. Among the intraoral views, 74% were bitewing, 25% periapical and only 1% were occlusal diagnostic views. The majority (95%) of the extraoral projections consisted of panoramic views and only 5% constituted other techniques. The volume of radiographs was high from January to September while November and December had the lowest number of examination requests. Conclusion: Intraoral radiography was the commonest examination with bitewings having been the majority while the panoramic tomography was the commonest extraoral examination performed.

Pattern of occurrence of jaw cysts and cyst-like lesions at the University of Nairobi Dental Hospital: A 10-year histopathologic audit

Background: Jaw cysts and cyst-like lesions cause facial deformity, destruction of dental tissues and affect masticatory and phonation functions. These ad-versely erode patients’ psycho-social status;create low self-esteem and may change one’s facial identity and appearance. Objective: To determine the histo-pathologic characteristics, variants and demographic pattern of jaw cysts and cyst-like lesions at the University of Nairobi Dental Hospital. Material and Me-thod: This was an analytical and verification study that involved microscopic re-examination of all available incisional/excisional biopsy samples from January 2000 to December 2009 for histo-pathological diagnosis at the University of Nairobi Dental Hospital. Results: 187 jaw cysts and cyst-like lesions were diagnosed at the University of Nairobi Dental Hospital over the ten-year period. Keratocystic odontogenic tumours constituted 28%, dentigerous cysts 25%, nasopalatine duct cysts 19%, radicular cysts 15%, while calcifying odontogenic cysts comprised 4% of all the lesions. The rest of the lesions were between 1% and 3% of all the lesion entities. Conclusion: Keratocystic odontogenic tumours and dentigerous cysts were the most common developmental odontogenic cysts diagnosed in the ten-year period.

A 19-year audit of benign jaw tumours and tumour-like lesions in a teaching hospital in Nairobi, Kenya

Background: The diversity of benign jaw tumours may cause difficulty in a correct diagnosis and insti-tution of an appropriate treatment. Data on the prevalence of these tumours is scarce from the Afri-can continent. We present a 19-year audit of benign jaw tumours and tumour-like lesions at a University teaching hospital in Nairobi, Kenya. Methods: Histo-pathological records were retrieved and re-examined from the Department of Oral and Maxillofacial pathology, University of Nairobi from 1992 to 2011. The jaw tumours were classified according to the latest WHO classification. Results: During the 19-year audit, 4257 biopsies were processed of which 597 (14.02%) were jaw tumours within an age range of between 4 to 86 years. There was greater number of odontogenic tumours 417 (69.85%) than the bone related lesions 180 (30.15%). Of the odontogenic tumours, the epithetlial and in the bone related types, the fibro-osseous lesions were frequent. Conclusion: Ameloblastoma and ossifying fibroma were the most frequent tumours reported in this audit. The information regarding the prevalence of these tumours is scarce from the continent and can be useful in early detection and management before they cause facial deformity.

Utilization of Diagnostic Imaging in Dental and Maxillofacial Trauma in Selected Kenyan Hospitals

Background: Globally, much has changed in the imaging modalities available to investigate maxillofacial trauma. Nevertheless, the regional practice patterns are highly influenced by availability, affordability and accessibility of imaging services as well as competence in interpreting radiological images and the practice of defensive medicine. The aim was to assess the use of maxillofacial trauma imaging modalities as well as to document patterns of skeletal injuries at selected government-sponsored health facilities in Kenya. Material and Methods: A cross sectional study, done in three health facilities. Results: There were 137 (81.5%) males and 31 (18.5%) females with a mean of 27.73 ± 9.86 years. Commonest aetiology of trauma was interpersonal violence (80, 47.62%) and road traffic crashes (63, 37.50%). The total number of radiological examinations was 250 with a mean of 1.49 ± 0.99 examinations per patient. Plain film radiographs were more (210, 84%) than computed tomographic scans (39, 15.6%). Dental panoramic technique was the most (104, 61.9%) popular. Most participants experienced isolated fractures to the mandible (99, 58.9%) and midface (28, 16.7%). Conclusion: Dental panoramic radiography remained the imaging of choice for mandibular fractures which had the commonest occurrence. There is a shift from the traditional conventional skull radiography to computed tomography in the diagnosis of midfacial fractures. Judicious utilization and prompt provision of affordable services in dental panoramic and computed tomographic scanning at the study centers and other upcoming health facilities are paramount in ensuring timely diagnosis and management of maxillofacial injuries in Kenya.