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.

Epidemiological, Clinical and Therapeutic Issues of Epulis at Campus University Teaching Hospital of Lomé: About 33 Cases

Introduction: The epulis is a hyperplastic tumor-like of the gingival or cheek mucosa that would be due to inflammatory reactions. Its pathogenesis remains incompletely understood. It appears to be common in Africa, but no study has been conducted in Togo. Our purpose was to describe epidemiological, clinical and therapeutic aspects of the epulis at the Campus University Teaching Hospital in Lomé. Patients and methods: This was a retrospective descriptive study on 33 cases at the Odontostomatology Department, from January 1st, 2014 to December 31st, 2016. Results: The prevalence of epulis was 0.88%. The average age of the patients was 36.92 years old. The most affected age group was 20 - 29 years old (30.30%). The sex ratio was 0.57. Low education and poor socio-economic conditions were found to be predisposing factors. Mucous swelling was the main reason for consultation. A local irritative factor was found in more than half of the cases. The preferred seat was gum (63.63%). Inflammatory epulis was found in 36.36% of cases. Biopsy-excision was performed in 96.96% of patients, with a cure without sequelae in 100%. Conclusion: The epulis is a rare benign affection of the gum. Its favoring factors are mechanical or infectious local irritation, or hormonal factors. His diagnosis is essentially clinical, but requires histological confirmation to distinguish it from other serious tumors. Biopsy-excision is the main treatment. No sequelae are observed in all patients of our series.

Mandibular Fractures at Sylvanus Olympio Teaching Hospital: About 153 Cases

Introduction: Mandibular fractures have epidemiological and therapeutic characteristics that vary from one region to another. The aim of our work was to report the particularities of this pathology in Lomé. Material and Methods: We analyzed retrospectively the records of 153 patients admitted for mandibular fractures in the ENT and Head and Neck and Maxillofacial Surgery Department of the Sylvanus Olympio Teaching Hospital in Lomé, between 2010 and 2015. Age, sex, etiology, topography and the therapeutic modalities were the parameters of study. Results: The prevalence of mandibular fractures was 15% with a sex ratio of 9.2. The average age was 33.5 +/- 11.4 years with extremes of 7 years and 67 years. The etiology was marked by the predominance of road accidents (RA) in 63.3% followed by accidents at work in 14.4% and 80.4% motorcyclists involved. Unifocal fractures were found in 68.6% and the parasymphyseal region was the most affected (47%) followed by the corpus (17.7%). The osteosyntheses were performed in 71.9% and intermaxillary fixation in 13.7%. The sequelae were noted in 12 patients (tooth loss, paresthesia in the lower dental nerve area). Discussion: Our results are superimposable with publications in developing countries. Mandibular fractures remain as the prerogative of young men of the 2nd and 3rd decades. However, treatment using modern methods (screw plate osteosynthesis) is still dependent on socioeconomic status.