Publications


Submitted

J, PROFCHINDIAMARK, KAVIN DRWAKOLI.  Submitted.  Koech KJ, Chindia ML, Wakoli KA, Gathece LW. Prevalence of oral lesions in HIV infection and their relationship with CD4 count at a Nairobi centre. African journal of oral health sciences,Vol 5 no2, 4-9.. African Journal of Oral Health Sciences,Vol 5 no2, 4-9. : Hekima III (1) 27-42 Abstract
Savanna ecosystems and origins of modern human behavior Hekima III (1) 27-42: (Journal of the Humanities and Social Sciences, University of Nairobi).

2012

Micha, CS, Chindia ML, Awange DO, Dimba EA.  2012.  Pattern of occurrence of jaw cysts and cyst-like lesions at the University of Nairobi Dental Hospital: A 10-year histopathologic audit. Abstractpattern_of_occurrence.pdf

Jaw cysts and cyst-like lesions cause facial deformity, destruction of dental tissues and af-fect 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 Uni-versity of Nairobi Dental Hospital. Material and Method: 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-patho- logical 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 odon- togenic 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 be-tween 1% and 3% of all the lesion entities. Conclu-sion: Keratocystic odontogenic tumours and den-tigerous cysts were the most common developmental odontogenic cysts diagnosed in the ten-year period.

Butt, FM, Ogengo J, Bahra J, Dimba EAO, Wagaiyu E.  2012.  19-year audit of benign jaw tumours and tumour-like lesions in a teaching hospital in Nairobi, Kenya. AbstractWebsite

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 pa-thology, 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 epithet- lial 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 conti-nent and can be useful in early detection and man-agement before they cause facial deformity.

Chindia, ML, Wagaiyu EG, ocholla Tom, Opondo F, Kihara E.  2012.  5-year audit of the range and volume of diagnostic radiographic services at the University of Nairobi Dental Hospital. AbstractWebsite

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: Retrospective survey involving manual examination of patient records at the Division of Dental and cranio-maxillo- facial 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 com- monest extraoral examination performed.

2011

Ogeng’o, J, Bahra J, Chindia ML, Butt FMA.  2011.  Pattern of odontogenic and nonodontogenic cysts. Abstract

The jaws are host to a variety of cysts due in large part to the tissues involved in tooth formation. Odontogenic cysts (OCs) are unique in that they affect only the oral and maxillofacial region. There are few studies from sub-Saharan Africa. This study was aimed at describing the pattern of various types of cysts in the oral and maxillofacial region in a Kenyan population. This was done at the Departments of Oral and Maxillofacial Surgery and Oral Medicine and Pathology, University of Nairobi Dental Hospital. This was a retrospective audit. All histopathologic records were retrieved from 1991 to 2010 (19 years) and were counted. The following information was extracted and recorded in a data sheet: age, sex, and the type of cystic lesions. There were 194 cysts (4.56%) diagnosed of 4257 oral and maxillofacial lesions. Of these, 64.4% were from male and 35.6% were from female patients with an age range of 1 to 70 years (mean, 23.76 [SD, 14.05] years; peak and median of 20 years). The most common OCs (57.2%) were dentigerous and radicular, whereas the most common nonodontogenic cyst (42.8%) was nasopalatine duct cyst. Other soft tissue cysts reported were epidermoid, branchial, thyroglossal, dermoid, and cystic hygroma. Oral and maxillofacial cysts are not uncommon in this population, the majority being the OC, dentigerous cyst, followed by the nonodontogenic cyst, nasopalatine cyst. The cysts are male predominant and occur 10 to 15 years earlier compared with those in the white population.

Chindia, M, Gathece L, Dimba EAO, Kamau MW, D.awange.  2011.  Clinico-histopathologic types of maxillofacial malignancies with emphasis sarcomas-A 10 Year Review. AbstractWebsite

Sarcomas are malignant neoplasms that occur anywhere in the human body. Though their occurrence in the head and neck region is rare vis-a-vis other malignancies, their presence is of tremendous concern due to their often grave prognosis. Objective: To determine the pattern of occurrence, histopathologic types of maxillofacial sarcomas and their proportion to other malignant neoplasms of this region based on archival material accumulated over 10 years (2000-2009). Design: A combined retrospective and prospective cross-sectional study. Setting: The University of Nairobi Dental Hospital (UNDH).
Subjects: All caseswithadiagnosisofsarcomaregisteredbetween2000-2009wereevaluated. Results: Of the 528 malignancies recorded over the ten-year period, 427 (80.9%) were of epithelial origin while 101 (19.1 %) were sarcomas. Patients with epithelial malignancies were older (54.16 ± 15.94 years) than patients with sarcomas (31.73 ± 16.78) with the differences having been statistically significant. Osteosarcoma was the most commonly occurring sarcoma (29.7%), followed by Kaposi's sarcoma (KS) (28.7%), fibrosarcoma (FBS) (18.8%), and rhabdomyosarcoma (RMS) (9.9%). Sarcomas peaked in the third decade with 70% occurring below the age of 40 years. The maxilla and the mandible were the most afflicted sites in the maxillofacial region accounting' for 52%. The patients on average presented to medical personel about nine months after noticing the lesion with the most frequent complaint having been swelling.
Conclusion: The present study confirms the relative rarity of maxillofacial sarcomas. It also provides data on the histopathologic types and demographic characteristics of maxillofacial sarcomas in a select Kenyan population. This information is a contribution to the comprehensive documentation of sarcomas that occur globally and is useful in the provision of baseline data upon which future prospective analytical protocols may arise.

2010

Sang, LK, Mulupi E, Akama MK, Muriithi JM, Macigo FG, Chindia ML.  2010.  Temporomandibular joint dislocation in Nairobi. Abstract

Despite the diverse conservative and surgical modalities for the management of temporomandibular joint (TMJ) dislocation and the controversy that surrounds them, very little has been done within the East-African setup in terms of highlighting and provoking greater interest in the epidemiology and management of TMJ dislocation. OBJECTIVE: To audit the pattern of occurrence, demographics, aetiology and enumerate the treatment modalities of TMJ dislocation at the oral and maxillofacial surgery division (OMFS) of the University of Nairobi Dental Hospital. DESIGN: Descriptive cross-sectional study. SETTING: University of Nairobi Dental Hospital (UNDH) from January 1995 to July 2005. RESULTS: Twenty nine patients had been diagnosed and managed for TMJ dislocation. Twenty (69%) were females and nine (31%) were males. Their ages ranged from 10-95 years with a mean of 42 years. The cases managed were primarily chronic in nature. The most common form being anterior TMJ dislocation, accounting for twenty-five (86.2%) cases. Trauma was implicated as an aetiology in only five (17%) of the cases while the remaining majority of twenty four (83%) cases were spontaneous. Amongst the causes of spontaneous TMJ dislocation, yawning was the most common accounting for fourteen cases (48.3%). Dislocations caused by trauma were found to be 12.6 times more likely to be associated with other injuries than spontaneous dislocations. Anterior TMJ dislocations were found to be 1.3 times more likely to be associated with absence of molars than posterior TMJ dislocations. Anatomical aberrations, as predisposing factors, were not a significant finding in this research. Eight (28%) of the cases were managed conservatively. Twenty one (72%) of the cases were managed surgically. The eminectomy was the most common technique with a 75% success rate. The highest incidence of TMJ dislocation occurs in the 3rd-5th decade with a female preponderance with bilateral anterior TMJ dislocation being the most common. Most of the cases were managed surgically with eminectomy being the preferred technique with the highest success rate. A study needs to be undertaken to determine reasons' why conservative modalities are least employed in the management of TMJ dislocation in our setup and what can be done about it.

Chindia, ML, Owibingire S, Moshi JR, Butt FMA.  2010.  Xeroderma pigmentosum: a review and case series. Abstract

Xeroderma pigmentosa (XP) is a condition inherited as an autosomal recessive trait and is characterized by photosensitivity, pigmentary changes, premature skin ageing and malignant tumour development resulting from the defect in DNA repair. The management of complications of XP, especially orofacial tumours entails an enormous surgical challenge to the clinicians. We present five cases of XP.

Chindia, ML, Odhiambo W, Gathece LW, Dimba EAO, Okumu SB.  2010.  Clinical features and types of paediatric orofacial malignant neoplasms at two hospitals in Nairobi, Kenya. AbstractWebsite

To evaluate the clinical features and histopathological types of orofacial malignant neoplasms in children. Patients and methods: The study involved patients aged 15years and below diagnosed with malignancy at two main referral hospitals in Kenya during the period from July, 2008 to December, 2008. A questionnaire and clinical examination chart were used to document data. Data analysis was done using SPSS 12.0 programme. Results: 65 children (44 males, 21 females) with ages ranging from 0.25 to 14years were evaluated. The main complaints were swelling 61 (94%) and visual disturbance 29 (45%). The mean duration of symptoms was 0.17-36 months. The commonest signs were leucocoria (white reflection from the retina) 23 (35%),proptosis 19(29%)and loss of vision 15 (23%).The commonest sites were orbit 30 (46%)and maxilla 11(17%).Most neoplasms were retinoblastoma 26 (40%),followed by 14(21%)cases of Burkitt's lymphoma (BL)and occurred in patients under 5 years ofage (40 cases) followed by 19cases in children aged 5-10 years. Conclusions: Overall, malignancies were more common in males than females with most having been diagnosed in children aged less than 10years. Retinoblastoma and BLwere the most common neoplasms. © 2011 European Association for Cranio-Maxillo-Facial Surgery.

Chindia, M, Butt FM, Kenyanya T, Rana F, Gathece LW.  2010.  An audit of ranulae occurring with the human immunodeficiency virus infecton.

2009

Koech, KJ, Chindia ML.  2009.  Presentation and management of cervicofacial necrotising fasciitis: report of nine cases. Abstract

Cervicofacial necrotising fasciitis (CNF) is an acute soft tissue infection that primarily involves the subcutaneous, adipose and fascial planes of the head and neck region. Secondary ischaemia of the skin results in widespread ulceration and suppuration. It is imperative that early diagnosis is made and judicious medical and surgical intervention instituted. We present a case series of patients with CNF diagnosed and managed at the division of oral and maxillofacial surgery of the Kenyatta National Hospital in Kenya.

Chindia, ML;, Wetende AM.  2009.  Hereditary Gingival Enlargement.
Awange, DO, Wakoli KA, Onyango JF, Chindia ML, Dimba EA, W GS.  2009.  Reactive localised inflammatory hyperplasia of the oral mucosa. Abstract

To document the histopathological pattern and distribution of reactive localised inflammatory hyperplastic lesions of the oral mucosa diagnosed at the University of Nairobi Dental Hospital over a 14 year period. DESIGN: A retrospective, cross-sectional descriptive study. SETTING: Division of Oral Pathology and Oral Medicine, histopathology laboratory, School of Dental Sciences, University of Nairobi. SUBJECTS: A total of 3135 oral biopsies were accessioned in the oral diagnostic histopathological Laboratory registry over a period of 14 years from March 1991 to December 2005. RESULTS: Three hundred and thirty three cases were histopathologically diagnosed as reactive inflammatory hyperplasias of the oral mucosa. This constituted 10.6% of the total oral biopsy specimens analysed during this period. Fibrous epulis was the most common histological sub-type with 129 cases (38.7%) followed by pyogenic granuloma with 94 (28.3%) cases. Six (1.8%) cases were peripheral giant cell granuloma and three cases (0.9%) were those of denture irritation hyperplasia. The age distribution ranged from 2 to 78 years (mean = 30.5 years) with a peak at 20-29 years. Gender distribution showed that 107 (32%) cases occurred in males and 226 (68%) cases females. Similar trends were observed in most of the histological sub-types. Fibrous epulis occurred in 41 male (31.8%) cases and in 88 (68.2%) females with an age range of 2 to 78 years (mean = 30.5 years). As for the pyogenic granuloma, 26 (27.7%) lesions occurred in males and 68 (72.3%) in females with an age range of 2 to 75 years (mean = 30.1 years). Among all the histopathological sub-types it was shown that 223 (67.0%) cases were fibrous, 104 (31.2%) vascular and six (1.8%) peripheral giant cell granuloma. Gingival lesions were the most common with 257 (77.2%) cases followed by 28 (8.4%) in the tongue, 16 (4.8%) lips, 15 (4.5%) cheek, six (1.8%) palate and the rest on the floor of the mouth and other mucosal sites. The duration of these lesions was recorded in 182 (54.7%) cases and ranged from 1 week to 16 years (mean = 1.8 years). Only 15 (4.5%) cases were reported to have recurred and all of them were gingival lesions. CONCLUSION: The present study has shown that the prevalence of reactive localised inflammatory hyperplasia (RLIHs) of the oral mucosa was 10.6% with fibrous epulis and pyogenic granuloma having been the most common histopathological sub-types predominantly affecting females. Although RLIHs are distinguished on clinical or histopatholocal grounds, it is important to appreciate that they are variations of the same basic process

Solomon, MM, Onyango JF, Nyabola LO, Opiyo A, Chindia ML.  2009.  Treatment interruption among head and neck cancer patients undergoing radical radiotherapy. Abstracttreatment_interruption_among_head_and_neck_cancer_patients.pdf

To determine the incidence of treatment interruption among head and neck cancer patients undergoing radical radiotherapy. Design: Prospective study Setting: Kenyatta National Hospital (KNH), Nairobi. Subjects: Twenty six (M=16, F=10) patients undergoing radiotherapy for head and neck cancer between March and June 2006. Main outcome measures: Frequency of radiation morbidities and treatment interuptions. Results: There were 26 patients consisting of 16 males and 10 females aged between 21 and 70 years (mean = 49.6 years). Among these patients 12 (46.2%) had tumours in the oral cavity, six (23.1%) had nasopharyngeal tumours, two (7.7%) had pharyngeal tumours, and six (23.1%) had laryngeal tumours. All tumours were primary carcinomas except two pharyngeal tumours which were metastatic. Among the 26 patients, 13(50%) completed the course of radiotherapy within the prescribed duration while another 13(50%) had treatment interruption. Of the 13 patients who had treatment interruption, one patient had a treatment gap of four days, seven patients had treatment gaps ranging between six and ten days, and five patients had treatment gaps of over ten days. The duration of treatment gaps ranged between four and 30 days. At the time of treatment interruption the cumulative radiation dose ranged from 22 to 58 Grey with a mean of 38 Grey (Mode = 44 Grey). The most common side effect was xerostomia (92%). This was closely followed by mucositis (88.5%), skin reactions (88.5%) dysphagia (84.5%) pain and suffering (76.9%). Loss of taste (61.5%), trismus (34.6%) and voice change (30.89%) were relatively less common. Conclusion: Our findings show that the probability of cancer control and cure among head and neck cancer patients treated at KNH could be severely eroded by treatment interruptions as a result of severe radiation morbidity.

2008

Kenyanya, AO, Chindia ML, Njiru AK.  2008.  Pleomorphic salivary adenoma in the dorsum of the tongue: a case report.
J, PROFCHINDIAMARK.  2008.  Combined chemical micro-abrasion and bleaching technique in the management of enamel flourotic stains. Journal of The Kenya Dental Association (JKDA) Vol 1. No.1: 23-27. : Hekima III (1) 27-42 Abstract
Objective: To remove or modify fluorotic enamel stains using a combined chemical micro-abrasion and bleaching technique. Design: An in-vivo study was carried out. A sample of 21 participants was randomly selected from patients presenting with brown staining due to flourosis as the chief complaint. Eighty nine teeth were selected based on the Thylstrup-Fejerskov Index [TFI] with a score of 4 as the acceptable maximum. Only upper anterior teeth were included in the study. Setting: The study was undertaken at the University Of Nairobi Dental Hospital, Kenya. Subjects: Patients with an expressed need for treatment of their discoloured teeth who consented to a clearly demonstrated treatment procedure constituted the sample. Results: Enamel discolouration was removed or modified yielding a uniform colour and lustre depending on the initial depth of the stain. All patients appreciated the colour change. Conclusion: A combined chemical micro-abrasion and bleaching technique is a feasible treatment modality in selected cases of enamel fluorosis.
W, PROFGUTHUASYMON, J PROFCHINDIAMARK.  2008.  Odhiambo WA, Guthua SW, Chindia ML, Macigo FG.Pattern and clinical characteristics of firearm injuries.East Afr Med J. 2008 Mar;85(3):107-12.. East Afr Med J. 2008 Mar;85(3):107-12.. : Hekima III (1) 27-42 Abstract
OBJECTIVE: To determine the pattern and characteristics of patients admitted with firearm injuries (FAIs) and establish the morbidity and mortality associated with these injuries. DESIGN: Retrospective cross-sectional study. SETTING: Kenyatta National Hospital (KNH), January 2004 to December 2005. SUBJECTS: All patients admitted with physically evident firearm injury. RESULTS: There were a total of 717 patients recorded with FAIs constituting 0.6% of the total number of patients seen in the casualty. Of these, 421 (58.7%) were admitted and treated as in- patients. A firearm was used in 6.7% of the 6300 assault cases recorded in 2004 and in 9.7% of the 3079 cases recorded in 2005. The increase from 6.7% in 2004 to 9.7% in 2005 was statistically significant (p < 0.05). There were 370 (87.9%) males and 49 (11.6%) females giving a male to female ratio of 7.5:1. The mean age was 29.7 +/- 10.9 years with a range of 3 to 66 years. At least 262 (62.2%) of the 421 admitted FAI casualties were treated under general anaesthesia (GA). The average duration of operation per patient was 2 +/- 1.5 hours. CONCLUSION: FAIs are on the increase and affect all age groups but is largely a disease of a young male adult in the 3rd and 4th decade of life. Mortality is higher with increasing age while female victims are fewer but on average six years younger than males. The lower extremities are the commonest target among the survivors. However, abdominal wounds tend to be the most lethal, accounting for greater mortality.
J, PROFCHINDIAMARK.  2008.  Butt FM, Chindia ML, Rana F, Machigo FG.Pattern of head and neck malignant neoplasms in HIV-infected patients in Kenya.Int J Oral Maxillofac Surg. 2008 Sep 8.. Int J Oral Maxillofac Surg. 2008 Sep 8.. : Hekima III (1) 27-42 Abstract

HIV-infected patients face a greater risk of developing malignant disease. The most commonly reported neoplasms of the head and neck region include Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL). There is also an increased risk of oral squamous cell carcinoma (SCC). A descriptive cross-sectional study including HIV-infected patients with neoplastic and non-neoplastic lesions was conducted. Of the 200 participants, 116 (58%) were male and 84 (42%) female with an age range of 18-61 years (mean 37 years). The females were significantly younger (mean 33 years) than the males (mean 37 years) (t test; 2.57; P<0.05 [0.001]). The prevalence of neoplastic lesions in this study was 27%; 37 (68%) patients had KS, 9 (17%) had SCC, 7 (13%) had NHL and 1 (2%) had Burkitt's lymphoma. More females than males presented with lesions of KS and SCC compared with NHL. The youngest patient presented with SCC at 18 years (mean 35.7 years), followed by KS at 23 years (mean 36.3 years) and NHL at 33 years (mean 43.9 years). Most study participants (97%) were in stage III/IV of the disease and the remaining 3% in stage II. In this study, the most common malignant neoplasms were KS, SCC and NHL, manifesting in a younger age group than in the non-HIV group of patients.

2007

W, GS, Macigo FG, Chindia ML, Akama MK.  2007.  Pattern of Maxillofacial and associated injuries in road traffic accidents. Abstract

Road Traffic Accidents (RTAs) are a major cause of morbidity and mortality in Kenya. Victims may suffer multiple injuries including maxillofacial injuries. In most developing countries RTAs are the leading cause of maxillofacial injuries. In an attempt to reduce RTAs, the government of Kenya has enacted a legislation requiring mandatory fitting of speed governors and safety belts by pdssenger service vehicles. Objective: To describe the characteristics and pattern of maxillofacial and associated injuries sustained in road traffic accidents. Design: A cross-sectional study. Setting: Kenyatta National Hospital (KNH). Subjects: All patients involved in RTAs brought to casualty and the dental department of KNH as well as accident victims admitted to the KNH mortuary over a four- month period from September 2004 to December 2004. Results: Four hundred and thirteen (85.7%) had non-fatal injuries whereas 69 (14.3%) had sustained fatal injuries. Males in the 21-30-year age group were the most affected. Most accidents occurred during weekends with pedestrians being the leading casualties in 59.5% and 71.4% of non-fatal and fatal cases respectively, Most accidents were caused by passenger service vehicles (matatus) which were responsible for 62% and 40.6% of non-fatal and fatal injuries respectively. Non-use of safety belts was reported in 56.6% of the cases who suffered non-fatal injuries. In the non-fatal category 89.6% of the casualties had soft tissue injuries (5TIs) involving the craniofacial region with facial cuts being the majority (69.2%). Two hundred and seventy three (66.1%) incidents of other STIs than those of the head region were noted, the lower limbs accounting for 45.4% of these. Only 5.1% of the casualties with non-fatal injuries had fractures involving the maxillofacial skeleton. Skeletal injuries other than those involving the maxillofacial region were found in 142 (34.1 %) incidents. In the fatal category head injury alone was the leading cause of death accounting for 37}% of the cases followed by head and chest injuries combined which were responsible for 13% of the cases. Conclusion: Injuries to the maxillofacial skeleton appear to be uncommon in this series. Pedestrians in their third decade of life are most affected with passenger service vehicles being responsible in the majority of the cases. Recommendations: Interventional programmes targeting pedestrians and those in the third and fourth decades of life should be enacted.

Koech, KJ, Chindia ML, Njiru AK.  2007.  Primary inter-osseous adenoid cystic carcenoma of the mandible.
Chindia, ML, A. WK, Limo AK, Dimba EAO, Gichana J.  2007.  audit of oral diseases at a Nairobi center 2004 - 2005.
J, PROFCHINDIAMARK.  2007.  Butt FM, Chindia ML, Rana FS, Ashani A.Cheilitis glandularis progressing to squamous cell carcinoma in an hiv-infected patient: case report.East Afr Med J. 2007 Dec;84(12):595-8.. East Afr Med J. 2007 Dec;84(12):595-8.. : Hekima III (1) 27-42 Abstract
Cheilitis glandularis (CG), is a rare inflammatory minor salivary gland disease affecting the lower lip. The hallmarks of which include progressive enlargement and eversion of the lower labial mucosa resulting in the obliteration of the mucosal-vermillion interface. A case is presented of a 47-year-old HIV-infected woman who initially manifested clinical features of CG with a typical histopathology picture of a non-specific sialadenitis while a second biopsy performed six months later revealed well differentiated squamous cell carcinoma (SCC). She is symptom free one year following excision and radiotherapy treatment.
J, PROFCHINDIAMARK, KIRIAGO DRAKAMAMATHEW, W PROFGUTHUASYMON.  2007.  Akama MK, Chindia ML, Macigo FG, Guthua SW.Pattern of maxillofacial and associated injuries in road traffic accidents.East Afr Med J. 2007 Jun;84(6):287-95.. East Afr Med J. 2007 Jun;84(6):287-95.. : Hekima III (1) 27-42 Abstract
BACKGROUND: Road Traffic Accidents (RTAs) are a major cause of morbidity and mortality in Kenya. Victims may suffer multiple injuries including maxillofacial injuries. In most developing countries RTAs are the leading cause of maxillofacial injuries. In an attempt to reduce RTAs, the government of Kenya has enacted a legislation requiring mandatory fitting of speed governors and safety belts by passenger service vehicles. OBJECTIVE: To describe the characteristics and pattern of maxillofacial and associated injuries sustained in road traffic accidents. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital (KNH). SUBJECTS: All patients involved in RTAs brought to casualty and the dental department of KNH as well as accident victims admitted to the KNH mortuary over a four- month period from September 2004 to December 2004. RESULTS: Four hundred and thirteen (85.7%) had non-fatal injuries whereas 69 (14.3%) had sustained fatal injuries. Males in the 21-30-year age group were the most affected. Most accidents occurred during weekends with pedestrians being the leading casualties in 59.5% and 71.4% of non-fatal and fatal cases respectively. Most accidents were caused by passenger service vehicles (matatus) which were responsible for 62% and 40.6% of non-fatal and fatal injuries respectively. Non-use of safety belts was reported in 56.6% of the cases who suffered non-fatal injuries. In the non-fatal category 89.6% of the casualties had soft tissue injuries (STIs) involving the craniofacial region with facial cuts being the majority (69.2%). Two hundred and seventy three (66.1%) incidents of other STIs than those of the head region were noted, the lower limbs accounting for 45.4% of these. Only 5.1% of the casualties with non-fatal injuries had fractures involving the maxillofacial skeleton. Skeletal injuries other than those involving the maxillofacial region were found in 142 (34.1%) incidents. In the fatal category head injury alone was the leading cause of death accounting for 37.7% of the cases followed by head and chest injuries combined which were responsible for 13% of the cases. CONCLUSION: Injuries to the maxillofacial skeleton appear to be uncommon in this series. Pedestrians in their third decade of life are most affected with passenger service vehicles being responsible in the majority of the cases. RECOMMENDATIONS: Interventional programmes targeting pedestrians and those in the third and fourth decades of life should be enacted.
J, PROFCHINDIAMARK.  2007.  BUTT FMA, VAGHELA VP, CHINDIA ML. Correlation of CD4 counts and CD4/CD8 ratio with HIV-infection associated oral manifestations. East African Medical Journal 2007; 84: 383-388.. Journal of The Kenya Dental Association (JKDA) Vol 1. No.1: 23-27. : Hekima III (1) 27-42 Abstract
Objective: To remove or modify fluorotic enamel stains using a combined chemical micro-abrasion and bleaching technique. Design: An in-vivo study was carried out. A sample of 21 participants was randomly selected from patients presenting with brown staining due to flourosis as the chief complaint. Eighty nine teeth were selected based on the Thylstrup-Fejerskov Index [TFI] with a score of 4 as the acceptable maximum. Only upper anterior teeth were included in the study. Setting: The study was undertaken at the University Of Nairobi Dental Hospital, Kenya. Subjects: Patients with an expressed need for treatment of their discoloured teeth who consented to a clearly demonstrated treatment procedure constituted the sample. Results: Enamel discolouration was removed or modified yielding a uniform colour and lustre depending on the initial depth of the stain. All patients appreciated the colour change. Conclusion: A combined chemical micro-abrasion and bleaching technique is a feasible treatment modality in selected cases of enamel fluorosis.
J, PROFCHINDIAMARK.  2007.  BUTT FMA, CHINDIA ML, WAKOLI KA. Problems in Diagnosing Odontogenic Myxoma: Case Report. East African Medical Journal 2007; 84: 141-145.. Journal of The Kenya Dental Association (JKDA) Vol 1. No.1: 23-27. : Hekima III (1) 27-42 Abstract
Objective: To remove or modify fluorotic enamel stains using a combined chemical micro-abrasion and bleaching technique. Design: An in-vivo study was carried out. A sample of 21 participants was randomly selected from patients presenting with brown staining due to flourosis as the chief complaint. Eighty nine teeth were selected based on the Thylstrup-Fejerskov Index [TFI] with a score of 4 as the acceptable maximum. Only upper anterior teeth were included in the study. Setting: The study was undertaken at the University Of Nairobi Dental Hospital, Kenya. Subjects: Patients with an expressed need for treatment of their discoloured teeth who consented to a clearly demonstrated treatment procedure constituted the sample. Results: Enamel discolouration was removed or modified yielding a uniform colour and lustre depending on the initial depth of the stain. All patients appreciated the colour change. Conclusion: A combined chemical micro-abrasion and bleaching technique is a feasible treatment modality in selected cases of enamel fluorosis.

2006

J, PROFCHINDIAMARK.  2006.  Chindia ML.Facing the burden of malignant orofacial neoplasia.East Afr Med J. 2006 Mar;83(3):61.. East Afr Med J. 2006 Mar;83(3):61.. : Hekima III (1) 27-42 Abstract
No abstract available. PMID: 16771100 [PubMed - indexed for MEDLINE]
J, PROFCHINDIAMARK.  2006.  Kassim BA, Noor MA, Chindia ML.Oral health status among Kenyans in a rural arid setting: dental caries experience and knowledge on its causes.East Afr Med J. 2006 Feb;83(2):100-5.. East Afr Med J. 2006 Feb;83(2):100-5.. : Hekima III (1) 27-42 Abstract
OBJECTIVE: To determine the dental caries experience and knowledge on the causes and preventive measures for dental diseases. DESIGN: A community based cross-sectional descriptive study. SETTING: Elwak sub-district hospital, North Eastern Province, Kenya. SUBJECTS: One hundred and forty one adults who presented themselves during a dental check up at a sub-district hospital and gave written consent. MAIN OUTCOME MEASURES: Dental caries status and knowledge on its causes and preventive measures. The importance of outreach programmes in obtaining information as well as helping to alleviate the pain and suffering caused by dental diseases among communities living in remote areas is also revealed. RESULTS: Of the one hundred and forty one individuals, who were included in the study, 63.1% were women and 36.9% were men. Their ages ranged between 18 and over 65 years. 41.1% were in the 18-24-year age bracket. Regarding the oral health knowledge, 43% did not know any causes of dental diseases while 36%, 17% and 12% knew that diet, "dirt" on teeth and bacteria were possible causes, respectively. Fifty percent did not know any preventive measures for dental diseases while the rest indicated abstention from the consumption of sugary foods; and only 0.8% mentioned use of fluoridated toothpaste as a preventive measure for dental caries. 56.7% of the subjects were caries free. The mean DMFT for all ages was 3.4. Of those with caries 72.1% were women. CONCLUSION: There is a low level of oral health awareness and a moderately high level of dental caries experience in this community with women apparently carrying the biggest burden of dental caries.
J, PROFCHINDIAMARK, W PROFGUTHUASYMON.  2006.  Mutave R, Chindia ML, Guthua SW.Post-operative re-construction of dentoalveolar tissue and the mandible and maxillae using prosthetic therapy.East Afr Med J. 2005 Jun;82(6):311-3. East Afr Med J. 2005 Jun;82(6):311-3. : Hekima III (1) 27-42 Abstract
OBJECTIVE: To determine the range of ablative surgery and rehabilitative procedures performed on maxillofacial structures. DESIGN: A retrospective descriptive study. SETTING: University of Nairobi Dental Teaching Hospital. SUBJECTS: Patients operated on at the institutions theatre, and followed up at the University of Nairobi Dental Teaching Hospital Oral Surgery Outpatient Clinic during the period February 1996, August 1998. RESULTS: Forty four patients underwent ablative surgery during the study period. Complete records were available for 38 patients, 27 females and 11 males aged 10 to 79 years (mean 32.6 years). Surgical procedures performed included: partial mandibulectomy, marginal mandibular resection, subtotal maxillectomy, sequestrectomy and enucleation. Six (15.8%) patients who underwent mandibular resection had rigid bone plating. Five (13.2%) patients who had maxillary involvement were given surgical obturators post-operatively with one receiving a complete denture after full recovery. A total of 22 (57.9%) patients who would have reaped benefits from prostheses therapy received none. Individual patient follow-up periods ranged from seven days for two patients who had cyst enucleation to two years for three cases with ameloblastoma, and two cases with squamous cell carcinoma. CONCLUSION: It is concluded that prosthetic rehabilitation of patients undergoing extensive surgery at the University of Nairobi Dental Teaching Hospital is largely inadequate.
J, PROFCHINDIAMARK, ELIZABETH DRDIMBA.  2006.  Aden A, Dimba EA, Ndolo UM, Chindia ML.Socio-economic effects of khat chewing in north eastern Kenya.East Afr Med J. 2006 Mar;83(3):69-73.. East Afr Med J. 2006 Mar;83(3):69-73.. : Hekima III (1) 27-42 Abstract
BACKGROUND: The khat habit is a widespread phenomenon which has in the past two decades spread to parts of Western Europe and North America from Eastern Africa and the Arabian Peninsula. Although khat has been identified as one of the most commonly abused substances in Kenya, restrictions on cultivation, trade and usage have been non-existent since its legalisation in 1977. OBJECTIVE: To describe the socio-economic effects of khat chewing in Ijara District in the North Eastern Province of Kenya. DESIGN: Cross sectional study. SETTING: Ijara District, North Eastern Kenya. SUBJECTS: Fifty respondents were interviewed. RESULTS: Eighty eight percent of the respondents were khat chewers, and the majority (80%) had family members who engaged in the khat habit. There was a general lack of education on the negative effects of khat chewing. Due to reported mood changes and withdrawal symptoms when not chewing khat, many respondents used more than half of their domestic budgets on khat, but few (28%) perceived this as a waste of resources. Fifty four percent of khat chewers typically started the habit during the day, implying a waste of time for productive work. However, only 40% of the persons interviewed admitted that the drug affected work performance negatively. The khat habit was associated with strain on family relationships, anti-social behaviour and health effects such as insomnia. CONCLUSION: In spite of the negative socio-economic impact of khat in Ijara District, khat consumption remains a widespread habit.

2005

J, PROFCHINDIAMARK.  2005.  Muriithi HM, Masiga MA, Chindia ML.Dental injuries in 0-15 year olds at the Kenyatta National Hospital, Nairobi.East Afr Med J. 2005 Nov;82(11):592-7.. East Afr Med J. 2005 Nov;82(11):592-7.. : Hekima III (1) 27-42 Abstract
OBJECTIVE: To determine the pattern of occurrence of dental injuries in the 0-15 year-olds. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Five hundred and five patient records with dental injuries were retrieved and analysed. RESULTS: A total of 505 patient records with dental injuries were retrieved and analysed. Most of the injuries were recorded in the year 1999 (22.2%). Boys were more affected (63.0%) than girls (37.0%). The main presenting complaint recorded was pain (75.8%).The majority of the patients (69.5%) presented for treatment during the same day or the day after trauma. Falls were the leading cause of injuries (73.5%). Most injuries involved two teeth (47.1%) and the maxillary central incisors were the most affected teeth both in the primary (67.5%) and permanent (64.0%) dentitions. Luxation injuries were the most common type of dental trauma with 47.5% occurring in the permanent teeth and 77.3% in the primary teeth. The main radiographic investigation performed was intraoral periapical views (52.9%) following which dental extraction (34.4%) was the main treatment modality offered. CONCLUSION: Prospective cross-sectional studies to determine the prevalence of dental injuries are needed. Furthermore improving the knowledge of dental practitioners through continuing dental education programmes would help in updating them on current trends in managing these injuries.
J, PROFCHINDIAMARK, KIRIAGO DRAKAMAMATHEW.  2005.  Chindia ML, Akama MK, Awange DO.Ameloblastic fibroma at the University of Nairobi Dental Hospital.East Afr Med J. 2005 Aug;82(8):418-21.. East Afr Med J. 2005 Aug;82(8):418-21.. : Hekima III (1) 27-42 Abstract
OBJECTIVE: To document the occurrence of cases of ameloblastic fibroma. DESIGN: A retrospective study. SETTING: The Division of Oral Pathology and Oral Medicine histopathology laboratory at the Faculty of Dental Sciences, University of Nairobi, January 1991 to December 2000. RESULTS: Seven complete records of histopathologically confirmed cases of ameloblastic fibroma were identified. There were four male and three female cases with an age range of 10 to 22 years (mean=14 years). Remarkably, six of the cases had lesions in the molar regions of the mandible with a single case with a maxillary molar area lesion. One of the cases had the neoplasm associated with an unerupted tooth. From the clinical notes all the patients were managed by meticulous enucleation and curettage of the lesions. After follow up periods ranging from several months to eight years no recurrences had been recorded. CONCLUSION: Evidently ameloblastic fibroma is an uncommon neoplasm as noted in the earlier literature. Although the lesions can be quite extensive at the time of diagnosis, the recurrence rate appears to be relatively low if the neoplasms are meticulously extirpated.

2004

Osundwa, MT, Chindia ML, W GS, Awange DO, Onyango.  2004.  Squamous Odontogenic Tumour-like Gingival proliferations Occurring with Dentigerous Cysts and Amelogenesis Imperfecta. Abstract

To determine the range of ablative surgery and rehabilitative procedures performed on maxillofacial structures. DESIGN: A retrospective descriptive study. SETTING: University of Nairobi Dental Teaching Hospital. SUBJECTS: Patients operated on at the institutions theatre, and followed up at the University of Nairobi Dental Teaching Hospital Oral Surgery Outpatient Clinic during the period February 1996, August 1998. RESULTS: Forty four patients underwent ablative surgery during the study period. Complete records were available for 38 patients, 27 females and 11 males aged 10 to 79 years (mean 32.6 years). Surgical procedures performed included: partial mandibulectomy, marginal mandibular resection, subtotal maxillectomy, sequestrectomy and enucleation. Six (15.8%) patients who underwent mandibular resection had rigid bone plating. Five (13.2%) patients who had maxillary involvement were given surgical obturators post-operatively with one receiving a complete denture after full recovery. A total of 22 (57.9%) patients who would have reaped benefits from prostheses therapy received none. Individual patient follow-up periods ranged from seven days for two patients who had cyst enucleation to two years for three cases with ameloblastoma, and two cases with squamous cell carcinoma. CONCLUSION: It is concluded that prosthetic rehabilitation of patients undergoing extensive surgery at the University of Nairobi Dental Teaching Hospital is largely inadequate

2003

J, PROFCHINDIAMARK.  2003.  NDUNG'U PM GATHECE LW, CHINDIA ML. Reasons to study Dentistry: Presentattitudes and Career goals among University of Nairobi Dental students. African Journal of Oral Health Sciences. 2003.. African Journal of Oral Health Sciences. 2003. : Hekima III (1) 27-42 Abstract
OBJECTIVE: To determine the pattern of occurrence of dental injuries in the 0-15 year-olds. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Five hundred and five patient records with dental injuries were retrieved and analysed. RESULTS: A total of 505 patient records with dental injuries were retrieved and analysed. Most of the injuries were recorded in the year 1999 (22.2%). Boys were more affected (63.0%) than girls (37.0%). The main presenting complaint recorded was pain (75.8%).The majority of the patients (69.5%) presented for treatment during the same day or the day after trauma. Falls were the leading cause of injuries (73.5%). Most injuries involved two teeth (47.1%) and the maxillary central incisors were the most affected teeth both in the primary (67.5%) and permanent (64.0%) dentitions. Luxation injuries were the most common type of dental trauma with 47.5% occurring in the permanent teeth and 77.3% in the primary teeth. The main radiographic investigation performed was intraoral periapical views (52.9%) following which dental extraction (34.4%) was the main treatment modality offered. CONCLUSION: Prospective cross-sectional studies to determine the prevalence of dental injuries are needed. Furthermore improving the knowledge of dental practitioners through continuing dental education programmes would help in updating them on current trends in managing these injuries.

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