Neurofibromatosis Type 1 in the Mandible

Helmet utilisation and its associated factors among motorcyclists in northern Ghana: an analytical cross-sectional survey

BACKGROUND

Motorcycle crashes are a major source of road traffic deaths in northern Ghana. Helmet use has been low. The last time it was formally assessed (2010), helmet use was 30.0% (34.2% for riders and 1.9% for pillion riders). We sought to determine the current prevalence of helmet use and its associated factors among motorcyclists in northern Ghana.

METHODS

Cross-sectional observations of motorcycle helmet use were conducted among 3853 motorcycle riders and 1097 pillion riders in the Northern Region at 12 different locations near intersections, roundabouts and motorcycle bays. Modified Poisson regression was used to assess the factors associated with helmet use.

RESULTS

The prevalence of helmet use was 22.1% overall: 26.7% among motorcycle riders and 5.7% among pillion riders. On the multivariable regression analysis, the prevalence of helmet use among motorcycle riders was 69% higher during the day compared with the night, 58% higher at weekend compared with weekday, 46% higher among males compared with females, but it was 18% lower on local roads compared with highways, 67% lower among young riders compared with the elderly and 29% lower when riding with pillion rider(s).

CONCLUSION

Despite small increases in motorcycle helmet use among pillion riders, helmet use has declined overall over the past decade. Immediate actions are needed to promote helmet use among motorcyclists in northern Ghana. This calls for a multisectoral approach to address the current low helmet use, targeting young riders, female riders, pillion riders, evening riding and riding on local roads.

Enchondroma of Anterior Maxilla: A Rare Entity

Enchondroma is a benign cartilaginous tumor composed of mature hyaline cartilage. Cartilaginous tumors are detected in a small percentage of cases in the craniofacial region. These tumors may have diverse presentations ranging from a simple enchondroma to a high-grade osteo or chondrosarcoma. In the maxilla, only 1 case of enchondroma has been reported in the literature to date, to the best of the authors' knowledge. Tumor's membranous development attributes to its occurrence usually in the cartilage-bearing areas of the jaws, like the condylar process of the mandible (Meckel's cartilage). This case report intends to present one case of enchondroma involving the left maxilla, which has no primary cartilage of its own.

Traumatic Frontal Sinus Fractures Management: Experience from High-Trauma Centre

Objective

Analysis of our traumatic brain injury data, reviewing current literatures and assessing planning valuable decision making in frontal sinus fracture for young neurosurgeons.

Methods

Hospital data base for head trauma was retrieved after board permission for retrospective analysis of cases admitted from 2010-2020. Patients with frontal sinus fractures and head trauma were identified according to a flow chart. Variables of the study included patients' demographics, mechanism of injury, incidence of cerebrospinal fluid (CSF) leakage, types of associated injuries, imaging findings and operative techniques.

Results

Three-hundred eighty two patients were eligible to be screened in our study and represented the sample size under investigations in the following sections, 206 (53.9%) of patients were treated conservatively while 176 patients (46.1%) were identified as having an indication for surgical intervention. Eighty-four percent of patients were males. The mean age was 36.2±9.4 years (14-86 years). Depressed skull fracture was commonly associated injury (17.61%). Leakage of CSF was found in 32.95% of patients.

Conclusion

Frontal sinus fracture is not an easy scenario. It harbors many proportions and deliver many varieties in which, deep understanding of anatomy, naso-frontal outflow tract status, CSF leakage and neurological injury are of important points in decision. Our institutional algorithm provide rapid, accessible and applicable treatment protocol for resident and young neurosurgeons which minimizes consultations of other specialties.

Craniofacial bone alterations in patients with neurofibromatosis type 1

Osseous manifestations of neurofibromatosis 1 (NF-1) occur in a minority of the affected subjects but may be because of significant clinical impairment. Typically, they involve the long bones, commonly the tibia and the fibula, the vertebrae, and the sphenoid wing. The pathogenesis of NF-1 focal osseous lesions and its possible relationships with other osseous NF-1 anomalies leading to short stature are still unknown, though it is likely that they depend on a common mechanism acting in a specific subgroup of NF-1 patients. Indeed, NF-1 gene product, neurofibromin, is expressed in all the cells that participate to bone growth: osteoblasts, osteoclasts, chondrocytes, fibroblasts, and vascular endothelial cells. Absent or low content of neurofibromin may be responsible for the osseous manifestations associated to NF-1. Among the focal NF-1 osseous anomalies, the agenesis of the sphenoid wing is of a particular interest to the neurosurgeon because of its progressive course that can be counteracted only by a surgical intervention. The sphenoid wing agenesis is regarded as a dysplasia, which is a primary bone pathology. However, its clinical progression is related to a variety of causes, commonly the development of an intraorbital plexiform neurofibroma or the extracranial protrusion of temporal lobe parenchyma and its coverings. Thus, the cranial bone defect resulting by the primary bone dysplasia is progressively accentuated by the orbit remodeling caused by the necessity of accommodating the mass effect exerted by the growing tumor or the progression of the herniated intracranial content. The aim of this paper is to review the neurosurgical and craniofacial surgical modalities to prevent the further progression of the disease by "reconstructing" the normal relationship of the orbit and the skull.

Craniofacial and oral alterations in patients with Neurofibromatosis 1

ABTSRACT

Neurofibromatosis type 1 (NF1) is one of the most common inherited syndromes. The literature on craniofacial alterations associated with NF1 has been limited and partially contradictory. This review is based on literature search and the results of the clinical study "Craniofacial and Oral Alterations and Speech in patients with Neurofibromatosis 1", carried out at the University of Turku and Turku University Hospital, Finland in 2006-2012. By the end of 2012, a total of 110 NF1 patients, 54 female and 56 male patients, were examined.A part of our results confirms pre-existing understanding, a part is contradictory to previous considerations based mainly on case reports, and some are entirely novel. Specifically, our results confirmed that enlargement the mandibular canal is the most common abnormality of the mandible in patients with NF1. It should be noted, however, that this finding does not require treatment. Caries was not a major problem. In fact, it was less frequent in NF1 patients compared to reference population. These findings abrogate some previous perceptions. Novel findings of our project include periapical cemental dysplasia in females; short jaws, a finding which usually does not affect bite; and immunohistological analysis of oral mucosal abnormalities. Pioneering study on speech showed that various deviations were very common: As many as 94% of the participants showed some alterations.To conclude, the awareness of craniofacial alterations common in NF1would help avoiding unnecessary and even harmful involvement, e.g. of periapical cemental dysplasia or enlarged mandibular canal which do not require treatment.