|Year : 2021 | Volume
| Issue : 1 | Page : 7-11
Prevalence and predictors of disarticulation resection of the mandibles in a Nigerian subpopulation
Ekaniyere Benlance Edetanlen, Birch Dauda Saheeb
Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
|Date of Submission||28-Sep-2020|
|Date of Decision||08-Dec-2020|
|Date of Acceptance||09-Dec-2020|
|Date of Web Publication||20-May-2021|
Dr. Ekaniyere Benlance Edetanlen
Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin City
Source of Support: None, Conflict of Interest: None
Background: Few studies are reported in the literature about the prevalence of disarticulation resection of the mandible, but little is known about the risk factors. This study is aimed at determining the prevalence and risk factors of disarticulation resection of the mandible. Patients and Methods: This was a retrospective study design for patients that had surgical resections of the mandible from January 2010 to July 2020 at the Department of Oral and Maxillofacial Surgery of a tertiary health facility in Nigeria. Collected data from the patients' case-notes were age, gender, level of education, place of residence, occupation, employment status, tobacco use, alcohol consumption, type of lesion, and type of resection performed. In the univariate analysis, the Chi-square test was used for analysis, while the binary logistic regression was used for multivariate analysis. All statistics were performed with SPSS version 21 (IBM Corps, Armonk, New York, USA). A value of P < 0.05 was considered significant. Results: A total number of 189 patients who presented for mandibular resections ranged in age from 13 to 75 years with a mean age of 41.4 ± 14.9 years. There were more males (63.5%) than females (36.5%) with M: F ratio of 1.7:1. More than half of the patients had disarticulation resection of the mandible, giving a prevalence of 64.0%. Alcohol consumption (P = 0.01) and the type of lesion (P = 0.00) were significantly associated with the prevalence of disarticulation resection of the mandibles. Only the type of lesion added to the predictive power of the risk factors (P = 0.03). The odontogenic keratocyst was 0.12 more likely to result in disarticulation resection of mandible than solid ameloblastoma. Conclusion: The prevalence of disarticulation resection of the mandible was 64.0%. The type of lesion in the mandible was a significant risk factor of the high prevalence of its disarticulation resection.
Keywords: Mandible, prevalence, resection, risk factors, surgery
|How to cite this article:|
Edetanlen EB, Saheeb BD. Prevalence and predictors of disarticulation resection of the mandibles in a Nigerian subpopulation. Niger J Exp Clin Biosci 2021;9:7-11
|How to cite this URL:|
Edetanlen EB, Saheeb BD. Prevalence and predictors of disarticulation resection of the mandibles in a Nigerian subpopulation. Niger J Exp Clin Biosci [serial online] 2021 [cited 2021 Oct 24];9:7-11. Available from: https://www.njecbonline.org/text.asp?2021/9/1/7/316529
| Introduction|| |
The mandible, which forms the lower third of the facial skeleton, is an important structure for mastication, deglutition, speech, and esthetic. The type of neoplastic or nonneoplastic lesions determines the type of resection for each lesion. While conservative resection of the mandible is associated with less morbidity, radical resection is not only associated with high morbidity but also compounded with reconstruction challenges that ultimately affect the quality of patients' life. Marginal resection by definition, maintains continuity of the mandible, whereas a segmental resection sacrifices continuity. A disarticulation resection is a type of segmental resection, in which the condylar articulation is sacrificed.
The mandible is commonly affected by either neoplastic or nonneoplastic lesions. Mandibular surgeries are frequently performed by oral and maxillofacial surgeons. These surgeries range from enucleations to resections. In developed countries, conservative mandibular surgeries are commonly carried out because the lesions are seen early, while in developing countries, radical surgery such as disarticulation is common because of the late presentation of the lesions. Other causes of late presentation that results in resection disarticulation may be financial constraints, lack of awareness, access to hospital facility, lack of facility, and expertise.,
Despite the increasing occurrence of mandibular disarticulation surgeries, it appears that only a few studies, on their prevalence are reported in the literature. With the scarcity of epidemiological studies on this topic, the risk factors of the prevalence of disarticulation resection of the mandible are unknown. It is the purpose of this study to determine the prevalence and risk factors of disarticulation resection of mandible among a Nigerian subpopulation in a tertiary hospital.
| Patients and Methods|| |
This was a retrospective study designed to document the patients that had surgical resections of the mandible from January 2010 to July 2020 at the Department of Oral and Maxillofacial Surgery of a tertiary hospital in Nigeria. This study was granted an exemption from the Ethics Review process by the institutional Review Board because of its negligible risks to the patients. The case-notes of the patients were retrieved from the Department of Information Management of the hospital. Collected data were age, gender, level of education, place of residence, occupation, employment status, tobacco use, alcohol consumption, type of lesion, and the type of resection performed. Exclusion criteria for the study included patients with incomplete records and those with mandibular surgeries other than surgical resections such as enucleation, marsupialization, or saucerization.
In the descriptive statistics, the continuous variables were summarised in range, means, and standard deviations, while the categorical variables were done in frequencies and percentages. For the inferential statistics, the patient's age, gender, level of education, place of residence, occupation, employment status, alcohol consumption, tobacco use, and the type of lesion were considered as predictors while the presence of disarticulation resection was taken as outcome variables. The outcome variable was dichotomized as “Yes” or “No.” In the univariate analysis, the Chi-square test was used for analysis while the binary logistic regression was used for multivariate analysis. All statistics were performed with SPSS version 21 (IBM Corps, Armonk, New York, USA). A P value of less than 0.05 was considered significant.
| Results|| |
A total number of 189 patients presented for mandibular resections in the study. They ranged in age from 13 to 75 years with a mean age of 41.4 ± 14.9 years. [Table 1] shows the characteristics of the patients in the study. Majority of the patients were younger than 45 years. There were more males (63.5%) than females (36.5%) with a male: female ratio of 1.7:1. Most of the patients (65.6%) lived in rural areas. Fifty-eight (30.7%) patients did not have any form of formal education [Table 1]. The rates of tobacco use and alcohol consumption by patients in the study were 7.40% and 6.30%, respectively. Almost two-thirds (62.4%) of the patients had unskilled occupation. Less than one-third (23.3%) of the patients that presented for resection of the mandibles were not employed. Majority (24.9%) of the patients had mandibular resections due to solid ameloblastoma, which was closely followed by odontogenic keratocyst (18.0%), as shown in [Table 1]. More than half of the patients had resection with disarticulation of the temporal mandibular joint giving a prevalence of 64.0%, while few (8.50%) of the patients had marginal resection of the mandible [Table 1].
The univariate analysis of the relationship between variables in the study and prevalence of disarticulation resection of the mandible is shown in [Table 2]. The alcohol consumption (P = 0.01) and indications for mandibular resections (P = 0.00) were significantly associated with the prevalence of disarticulation resection of the mandibles [Table 2]. The multivariate analysis of the relationship between variables and prevalent disarticulation resection of the mandible is presented in [Table 3]. Only the type of lesion added to the predictive power of the risk factors (P = 0.03). The odontogenic keratocyst was 0.12 more likely to result in disarticulation resection of mandible than solid ameloblastoma [Table 3].
|Table 2: Univariate analysis of relationship between variables and prevalence of disarticulation resection of mandible (n=189)|
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|Table 3: Multivariate analysis of relationship between variables and prevalence disarticulation|
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| Discussion|| |
Disarticulation resection of the mandible has been shown to be a common oral and maxillofacial surgical procedure in this study. A little more than two-third of oral and maxillofacial surgeries in our center being disarticulation resection (64.0%) is quite significant. This finding is higher than that reported in previous studies., In the US, Carlson, in an 8-year period, reported a prevalence of 5% while that reported by Akinmoladun et al., in a 5-year case series in Western Nigeria was 24.7%. The prevalence reported in the present study and that of Akinmoladun et al., both in Nigeria, are higher than that reported in the US by Carlson. The difference can be explained by the delayed presentation and poor level of oral health awareness as well as poverty.
As reported in previous studies,,,, disarticulation resection is preponderant in patients less than 45 years. This could be related to the increased cellular activities of the odontogenic remnants in younger patients. A wide variety of benign and malignant neoplastic conditions, as well as nonneoplastic diseases, necessitate surgical resection of the mandible. In the present study, the indications for resections were mainly neoplastic with a few inflammatory conditions. Odontogenic lesions, mainly ameloblastoma and odontogenic keratocyst, are the main reasons for resection. Tumors of odontogenic origin were reported to be more common among the African population and this could be the reason why most patients seen in the study had more of ameloblastoma compared to nonodontogenic tumors. The type of lesions in the mandible was a significant risk factor of the prevalence of its disarticulation resection. Odontogenic keratocyst was a significant predictor of disarticulation resection. This could be related to the anteroposterior growth pattern characteristic of odontogenic keratocyst.
Although alcohol consumption was associated with the high prevalence of disarticulation in the study, it was not a significant risk factor. There could be several likely reasons for the association between alcohol consumption and the prevalence of disarticulation resection of the mandible. The consumption of alcohol has been reported to increase pain threshold and most alcoholics are characterized by the phenomenon of “internalization” or “adaptation” by which an individual learns to live with the condition.
Several rehabilitation methods of mandibular defects are reported in the literature., While vascularised bone graft is commonly done as standard in the developed countries, mandibular plate and nonvascularized bone grafts is currently practised in Nigeria. All patients studied had reconstruction of the mandibular defect with reconstruction plates and none had postoperative complication during a 12-month follow-up. This study bears the limitations of all retrospective studies and it appears to be the first to determine the risk factors associated with the high prevalence of disarticulation resection of the mandible.
| Conclusion|| |
This study shows that the prevalence of disarticulation resection of the mandible was 64.0%. The type of lesion in the mandible and its characteristics were significant risk factors of the high prevalence of disarticulation resection of the mandible. If patients present early, the lesions would be detected early and this would obviate the risk of aggressive mandibular surgeries such as disarticulation resections.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Han L, Zhang X, Guo Z, Long J. Application of optimized digital surgical guides in mandibular resection with vascularised fibula flaps: Two case reports. Medicine 2020:99:35(E21942).
Ibikunle AA, Taiwo AO, Braimah RO. A 5-year audit of major maxillofacial surgeries at usmanu danfodiyo university teaching hospital, Nigeria. BMC Health Serv Res 2018;18:416-22.
Adekeye EO, Apapa DJ. Complications and morbidity following surgical ablation of the jaws. West Afr J Med 1987;6:193-200.
Genden EM, Rinaldo A, Jacobson A, Shaha AR, Suárez C, Lowry J, et al.
Management of mandibular invasion: When is a marginal mandibulectomy appropriate? Oral Oncol 2005;41:776-82.
Diana W, Stefan H, Christol H. Influence of marginal and segmental mandibular resection on the survival rate in patients with squamous cell carcinoma of the inferior parts of the oral cavity. J Cranio Maxillofac Surg 2004;32:318-23.
Obiadazie AC, Adeola DS, Ononiwu CN. Mandibular resection: A prospective analysis of morbidity and mortality in Zaria, Nigeria. J Med Med Sci 2012;3:616-21.
Braimah RO, Ibikunle AA, Abubakar U, Taiwo AO, Oboirien M, Adejobi FA, et al.
Mandibular reconstruction with autogenous non-vascularised bone graft. Afr Health Sci 2019;19:2768-77.
Kataoka T, Akagi Y, Kagawa C, Sasaki R, Okamoto T, Ando T, et al.
A case of effective oral rehabilitation after mandibular resection. Clin Case Rep 2019;7:2143-8.
Goh BT, Lee S, Tideman H, Stoelinga PJ. Mandibular reconstruction in adults: A review. Int J Oral Maxillofac Surg 2008;37:597-605.
Akinmoladun VI, Olusanya AA, Olawole WO. Condylar disarticulation; analysis of 20 cases from a nigerian tertiary centre. Niger J Surg 2012;18:68-70.
] [Full text]
Carlson ER. Disarticulation resections of the mandible: A prospective review of 16 cases. J Oral Maxillofac Surg 2002;60:176-81.
Bak M, Jacobson AS, Buchbinder D, Urken ML. Contemporary reconstruction of the mandible. Oral Oncol 2010;46:71-6.
Mehta RP, Deschler DG. Mandibular reconstruction in 2004: An analysis of different techniques. Curr Opin Otolaryngol Head Neck Surg 2004;12:288-91.
Politi M, Costa F, Robiony M, Rinaldo A, Ferlito A. Review of segmental and marginal resection of the mandible in patients with oral cancer. Acta Otolaryngol 2000;120:569-79.
O'Brien CJ, Adams JR, McNeil EB, Taylor P, Laniewski P, Clifford A, et al.
Influence of bone invasion and extent of mandibular resection on local control of cancers of the oral cavity and oropharynx. Int J Oral Maxillofac Surg 2003;32:492-7.
Ord RA, Sarmadi M, Papadimitrou J. A comparison of segmental and marginal bony resection for oral squamous cell carcinoma involving the mandible. J Oral Maxillofac Surg 1997;55:470-7.
Rao LP, Shukla M, Sharma V, Pandey M. Mandibular conservation in oral cancer. Surg Oncol 2012;21:109-18.
Van Gemert TM, van Es JJ, van Cann EM, Koole R. Non-vascularised bone graft for segmental reconstruction of the mandible – A Reappraisal. J Oral Maxillofac Surg 2009;67:1446-52.
Adulyanon S, Vourapukjaru J, Sheiham A. Oral impacts affecting Daily Performance in a low dental disease Thai population. Community Dent Oral Epidemiol 1996;24:385-9.
[Table 1], [Table 2], [Table 3]