Medical Science: Updates and Prospects Vol. 10

Risk Factors and Incidence of Pharyngocutaneous Fistula

2026-06-02T11:33:23+00:00

Background: Pharyngocutaneous fistula remains a significant postoperative complication following total laryngectomy, contributing substantially to patient morbidity, prolonged hospital stay, delayed adjuvant therapy, and increased healthcare costs.

Objective: This study has been conducted to establish the incidence, risk factors, and their relation to the management of pharyngocutaneous fistula (PCF). Thorough knowledge of modifiable, possibly modifiable and non-modifiable risk factors is essential for the appropriate management of PCF.

Design and Setting: This is an Observational, Cross-sectional study which is conducted in the Department of Otolaryngology and Head-Neck Surgery of Bangladesh Medical University (BMU), the only functioning, service and research-oriented medical university of Bangladesh since 2006-2017.

Methods: All patients treated with Total laryngectomy for advanced laryngeal carcinoma and Total Thyroidectomy for advanced thyroid disease with extrathyroidal extension were included in this study.

Results: The duration of this study was 12 years (2006–2017). A total of 249 patients were included, of whom 48 (19.28%) developed PCF. Irradiated patients with multiple co-morbidities were more susceptible to developing PCF.

Conclusion: High occurrence of pharyngocutaneous fistula, mostly due to the advanced stage of disease, various levels of surgical expertise and post irradiated patients with multiple comorbidities.

Understanding Family Planning: Knowledge, Attitudes, and Practices among Married Women in Jalingo, Nigeria

2026-06-02T11:36:11+00:00

Background: Family planning is a cornerstone of maternal and child health improvement, fertility reduction, and socioeconomic development globally. In sub-Saharan Africa, where maternal mortality and unmet contraceptive need remain disproportionately high, access to and sustained use of family planning services are critical public health priorities. Nigeria bears a significant share of this burden, with national modern contraceptive prevalence rates among married women remaining well below regional targets. Despite growing policy commitments and programme investments, contraceptive uptake in many Nigerian states, particularly in the North-East geopolitical zone, continues to be constrained by complex sociodemographic, cultural, and behavioural determinants. Understanding the knowledge, attitudinal, and practice profiles of women at the primary healthcare level is therefore essential for designing contextually appropriate interventions.

Objective: The objective of this study is to assess the knowledge, attitudes, and practices (KAP) regarding family planning among married women attending Township Primary Healthcare Centre (PHCC), Jalingo, Taraba State, and to examine the influence of selected socio-demographic variables on these outcomes.

Methods: A descriptive cross-sectional survey was conducted among 359 married women of reproductive age attending Township PHCC, Jalingo, selected via simple random sampling. Data were collected using a structured, pretested, self-administered questionnaire comprising four sections: socio-demographic characteristics, knowledge of contraceptive methods and family planning benefits, attitudes toward family planning, and current contraceptive practice. Data were analysed using IBM SPSS; descriptive statistics (frequencies, percentages, means) summarised participant characteristics, while inferential statistics (chi-square tests) examined associations between socio-demographic variables and KAP outcomes. Statistical significance was set at p < .05.

Results: Most participants were within the reproductive age range of 20–39 years and had attained at least secondary-level education. Knowledge of family planning was high, with the majority demonstrating awareness of multiple contraceptive methods, their correct use, and associated health benefits. Attitudes toward family planning were predominantly positive; most respondents expressed support for contraceptive use, rejected religion-based misconceptions, and reported open communication with their spouses on reproductive health matters. Contraceptive practice was notably high, with 79.1% of participants reporting current use of at least one family planning method — a figure substantially exceeding national averages and indicative of relatively strong service uptake within this facility-based sample. Despite this, side effects, fear of adverse reactions, and sociocultural pressures — most notably spousal disapproval and community stigma — were identified as significant barriers to consistent and sustained contraceptive use. Inferential analysis demonstrated that educational attainment significantly predicted knowledge (p = .042), while attitude (p = .008) and marital status (p = .001) were significant predictors of contraceptive practice.

Conclusion: Knowledge of, attitudes toward, and practice of family planning among married women attending Township PHCC Jalingo are comparatively high relative to national benchmarks; however, sustained contraceptive use remains constrained by concerns about side effects, inadequate male partner engagement, and entrenched sociocultural barriers. These findings underscore the need for targeted, multi-level interventions that address side-effect misconceptions through evidence-based counselling, actively engage male partners in reproductive health education, and strengthen community mobilisation strategies. Health policymakers and primary healthcare providers in Taraba State and similar contexts should prioritise interventions that tackle sociocultural determinants of contraceptive discontinuation and promote equitable, informed reproductive decision-making among couples.

Intentional Replantation in Dentistry: From Last Resort to Clinical Viability

2026-06-02T11:40:32+00:00

Background: Intentional Replantation (IR) has historically been regarded as a last-resort procedure in Endodontics due to concerns regarding root resorption and ankylosis. However, advances in periodontal ligament biology, biomaterials, and microsurgical techniques have improved its clinical predictability.

Objective: The study intends to present a comprehensive chronological review of the literature on intentional tooth replantation, emphasising biological principles, clinical indications, technical evolution, and prognostic factors.

Methods: A narrative literature review was performed using PubMed and SciELO databases, including studies published between the 1980s and 2026, using “intentional tooth replantation" AND/OR "intentional replantation” as search terms. Classical reports, clinical studies, cohort analyses, systematic reviews, and meta-analyses were included. Studies with tooth replantation originated from dental trauma; in vitro and research with animal models were excluded.

Results: The literature demonstrates a progressive evolution of intentional replantation from an empirical and limited approach to a biologically driven and clinically reliable procedure. Contemporary evidence indicates survival rates ranging from approximately 80% to 90%, strongly associated with preservation of periodontal ligament viability, reduced extraoral time (less than 10 minutes), atraumatic handling, and appropriate apical sealing. The incorporation of bioceramic materials, magnification and advanced imaging techniques, such as cone beam tomography, has further enhanced treatment outcomes and predictability.

Conclusion: Intentional replantation is a biologically sound and clinically reliable therapeutic option when properly indicated and executed. It represents a conservative alternative to extraction and implant placement, particularly in patients where preservation of natural dentition is prioritised.

Successful Simultaneous Closed Management of Group VI Zygomatic and Unstable Parasymphysial Mandibular Fractures Without Open Reduction and Internal Fixation (ORIF): A Case Report

2026-06-02T11:45:37+00:00

Background: Mandibular fractures are the most common facial skeletal injuries, often resulting from high-energy trauma, with zygomatic fractures being the second most frequent midfacial injury. Combined fractures of the mandible and zygomaticomaxillary complex typically require open reduction and internal fixation (ORIF) according to most treatment guidelines. However, the question of when closed reduction may be sufficient in such combined injuries remains poorly defined in the literature.

Case Presentation: A 25-year-old healthy male presented after a high-velocity motor vehicle collision (dashboard injury) with a closed, unstable right parasymphysial mandibular fracture (Loukota Type C) and a right zygomatic fracture classified as Knight and North Group VI (complex). Clinical findings included malocclusion with anterior open bite, restricted mouth opening (interincisal distance 15 mm), right periorbital oedema and ecchymosis, conjunctival hyperemia, and infraorbital hypoesthesia (MRC Grade 2).

Management: Both fractures were managed simultaneously under general anaesthesia using only closed reduction techniques. The zygomatic fracture was reduced via a 3 mm percutaneous puncture using a Langenbeck bone hook, achieving an audible click and immediate release of the compressed mandibular condyle (mouth opening increased to 25 mm intraoperatively). The mandibular parasymphysial fracture was reduced by digital manipulation, followed by arch bar application and intermaxillary fixation with elastic traction. Total operative time was 30 minutes.

Results: Postoperative recovery was uneventful. At 2 weeks, mouth opening improved to 35 mm with stable Angle Class I occlusion and no open bite. Infraorbital hypoesthesia improved to Grade 1. By 6 months, mouth opening reached 42 mm, sensation returned to normal (Grade 0), and radiographic bone healing was confirmed. No complications (malunion, nonunion, diplopia, enophthalmos, infection) occurred. Patient satisfaction was 9/10.

Conclusion: Simultaneous closed reduction of a complex zygomatic fracture (Group VI) and an unstable parasymphysial mandibular fracture can achieve excellent functional and aesthetic outcomes without ORIF in carefully selected patients. The key criteria for success include minimal comminution, reducibility of fragments, intraoperative stability, restorable occlusion, and favourable patient factors (young age, non-smoker, good bone quality). This case challenges the automatic indication for open fixation and supports individualised, minimally invasive treatment planning in maxillofacial trauma.

Dental Radiology: A Critical Review of Diagnostic Applications, Radiation Safety and Emerging Technologies

2026-06-04T11:26:50+00:00

Dental radiology provides the diagnostic foundation for a broad spectrum of clinical decisions in oral health care, from the detection of early approximal caries to the three-dimensional planning of complex surgical procedures. Over the past three decades, the discipline has undergone substantial transformation: the transition from conventional film-based image receptors to digital platforms, and subsequently to volumetric three-dimensional imaging via cone-beam computed tomography (CBCT), has fundamentally expanded diagnostic capability while simultaneously intensifying scrutiny of radiation safety practices. At the forefront of an emerging technological wave, artificial intelligence (AI) and machine learning are beginning to reshape the interpretation of dental radiographic data, offering the prospect of improved diagnostic consistency and enhanced workflow efficiency, though the evidence supporting their clinical deployment remains incompletely established. Despite major advances in dental imaging technologies, significant gaps remain regarding evidence-based clinical justification, radiation safety optimisation, standardised regulatory guidance, and the real-world applicability of emerging artificial intelligence and advanced imaging systems.

This chapter presents a critical narrative review of the principal diagnostic applications of dental radiography across intraoral, panoramic, and CBCT modalities; evaluates the evidence base for radiation protection principles, dose estimation, and clinical guidelines; and critically appraises the scientific evidence for emerging technologies including AI-assisted image analysis, optical coherence tomography (OCT), three-dimensional digital workflow integration, and dental magnetic resonance imaging (MRI). Literature was identified through comprehensive searches of multiple academic and field-specific databases covering publications from 2000 to 2026, supplemented by selected pre-2000 foundational studies. The review identifies persistent evidence gaps, particularly regarding prospective outcome data for AI-assisted diagnosis and population-level dosimetric studies for newer CBCT acquisition protocols. It further highlights inconsistencies in the application of radiographic guidelines across clinical settings and underscores the need for more rigorous evaluation frameworks as emerging technologies enter routine practice. The chapter concludes that while dental radiology has advanced considerably in technical sophistication, translating those advances into uniformly safe, equitable, and evidence-based diagnostic practice remains a substantive and ongoing challenge for the profession. Future research should prioritise multicentre prospective clinical trials, longitudinal radiation exposure assessments, externally validated AI models, and internationally harmonised imaging protocols to support safer, more evidence-based, and clinically generalisable implementation of advanced dental imaging technologies.

Burden of Infectious Keratitis in Sub-Saharan Africa: Microbiology, Delayed Detection, and Education Gaps

2026-06-05T08:11:45+00:00

Introduction: Infectious keratitis (IK) is a major cause of preventable corneal blindness, disproportionately affecting populations in sub-Saharan Africa (SSA). Its prognosis is strongly influenced by delayed diagnosis and treatment, which contribute to severe complications such as corneal perforation, endophthalmitis, and irreversible vision loss. Clinical outcomes are further shaped by a distinct microbiological profile, healthcare access limitations, and gaps in patient management.

Aims: This review aims to synthesise current knowledge on microbiological issues, factors contributing to delayed diagnosis, and the potential role of therapeutic patient education (TPE) in improving clinical outcomes for IK in SSA.

Methods: A narrative review of the literature was conducted by consulting the PubMed and Google Scholar databases and institutional archives (HAL, DUMAS). Keywords included ‘infectious keratitis,’ ‘corneal ulcer,’ ‘sub-Saharan Africa,’ ‘fungal keratitis,’ ‘delayed diagnosis,’ and ‘patient therapeutic education.’ Relevant articles published up to January 2026, dealing with the epidemiology, aetiology, diagnosis and management of IK in SSA, were included.

Results: The literature confirms that SSA has a high incidence of IK, with a marked predominance of fungal keratitis (FK), often linked to agricultural trauma. The spectrum of pathogens responsible for infectious keratitis in sub-Saharan Africa differs significantly from that observed in high-income countries. Bacterial pathogens, particularly Pseudomonas aeruginosa and Staphylococcus aureus, also remain prevalent. Delayed diagnosis is a major multifactorial problem, fuelled by socio-economic and geographical barriers, the use of self-medication and traditional medicines, and limited diagnostic capabilities (lack of access to corneal scraping and culture). Although recognised as a potential lever for improving compliance and prevention, ETP remains largely unstructured and undocumented in the region. An effective response to infectious keratitis in sub-Saharan Africa requires the implementation of an integrated care model built on three interdependent pillars: strengthening primary healthcare capacity for early recognition and referral, expanding access to timely and reliable microbiological diagnosis, and systematically institutionalising therapeutic patient education across all levels of the health system to improve prevention, adherence, and clinical outcomes.

Conclusion: Infectious keratitis in sub-Saharan Africa is a major public health problem, characterised by high incidence, a microbiological profile dominated by post-traumatic fungal and bacterial infections, and devastating visual consequences. This narrative review of the literature has highlighted the interconnected factors that explain the severity of this condition in the region. Delayed consultation, fuelled by geographical, economic and socio-cultural barriers, as well as the frequent use of dangerous traditional eye medicines, is the main determinant of poor prognosis.

Combined Pulmonary Fibrosis and Emphysema (CPFE): A Review of Pathogenesis, Clinical Characteristics, Management and Prognosis

2026-06-05T08:16:34+00:00

Combined pulmonary fibrosis and emphysema (CPFE) is a rare but increasingly recognised condition characterised by the simultaneous coexistence of both upper lobe predominant emphysema and diffuse pulmonary fibrosis mainly in the lower lobe. The exact pathogenetic mechanisms underlying the development of CPFE remain unclear. The condition is most commonly observed in current or former heavy smokers. In patients with CPFE, spirometry findings may be normal or show only mild abnormalities. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and total lung capacity (TLC) are usually within normal limits or only slightly reduced. High-Resolution Computed Tomography (HRCT) has a pivotal role in diagnosis. Pulmonary function test showed relatively preserved lung volumes and reduced diffusing capacity of the lung for carbon monoxide (DLCO). Development of pulmonary hypertension (PH) is largely attributed to morbidity in patients with CPFE, which is the principal prognostic factor for this condition. Despite growing recognition, the natural history and optimal management strategies for CPFE are not well established. This review summarises current knowledge on the pathogenesis, clinical characteristics, management, and prognostic factors of CPFE. Future studies are required to ascertain the aetiology, morbidity, mortality and management of CPFE, with or without PH, and also to delineate more precisely the boundaries between IPF and patients with CPFE syndrome.

Role of Frozen Section in Diagnosis of Fungal Infection

2026-06-05T08:18:30+00:00

Background: Fungal infections are among the most dangerous infectious diseases, and their diagnosis is often challenging. Delays in diagnosis can postpone treatment and endanger patient survival. Mucormycosis became increasingly common during the COVID-19 pandemic. Histopathology remains the gold standard for diagnosis, and fungal culture is confirmatory, but both are time-consuming. Frozen sections offer rapid intraoperative diagnosis, enabling early management.

Aim: This study aims to evaluate the utility and diagnostic accuracy of frozen section in detecting Mucormycosis, to determine the age groups commonly affected, and to identify any associated comorbidities.

Materials and Methods: This prospective study was conducted over 18 months (January 2021 – June 2022) in the Department of Pathology of a tertiary care hospital. Seventy-six patients with suspected mucormycosis, whose specimens underwent both frozen section and formalin-fixed paraffin-embedded (FFPE) histopathological examination, were included. Frozen sections were performed using a cryostat at −20°C to −30°C. Sections were stained with hematoxylin and eosin using a rapid method and examined microscopically. Reports were delivered intraoperatively within 20–25 minutes to guide surgical management. The remaining tissue was processed for standard histopathology.

Result and Analysis: Among the 76 specimens, 56 (74%) were positive for fungus on frozen section, identified by aseptate broad hyphae with right-angle branching. Of the 20 frozen section-negative specimens, 6 were found to be positive on FFPE histopathology (false negatives), and 1 frozen section-positive specimen was negative on FFPE (false positive). The diagnostic performance of frozen sections showed a sensitivity of 91%, specificity of 93.7%, accuracy of 91.5%, positive predictive value (PPV) of 98%, and negative predictive value (NPV) of 70%.

Conclusion: Frozen section is a highly useful and rapid diagnostic tool for mucormycosis, with high sensitivity and specificity. The assessment of margins of the lesions by the frozen section intraoperatively during debridement is very important for further management of the patient.

Prepubertal Urethral Mucosal Prolapse Presenting as Vaginal Bleeding: A Case Report Emphasising Awareness and Early Diagnosis

2026-06-08T09:42:33+00:00

Urethral mucosal prolapse is a rare benign condition that is often misdiagnosed by clinicians and associated with fear of sexual assault by parents. It occurs in both children and postmenopausal women. The aetiology is unknown, but several theories have been proposed, including genetic factors and intrinsic urethral abnormalities such as increased urethral mobility and poor attachment between the inner longitudinal and outer circular smooth muscle layers of the urethra. The condition may be asymptomatic; however, the most common presentation is vaginal bleeding associated with a periurethral mass. This chapter reports a case of urethral mucosal prolapse in a 6-year-old pupil who presented with vaginal bleeding, for which the parents thought she was sexually assaulted in school; to buttress the need for sensitisation on urethral mucosal prolapse in schools and during community outreaches. Vaginal examination revealed a well-circumscribed doughnut-shaped fleshy mass at the external urethral meatus, for which a diagnosis of urethral mucosal prolapse was made. Although surgery is indicated in some cases, she was managed medically with topical oestrogen cream, and the symptoms resolved. Prepubertal urethral mucosal prolapse is a benign condition and often misdiagnosed; early diagnosis and management will allay parental fears and prevent sequelae. There is a need to create awareness of this condition in schools, particularly through school health programmes, so that teachers and students can recognise it. Community sensitisation by healthcare professionals, including during parent–teacher meetings, is also important. Increasing awareness among the public will improve early recognition and management of this condition.

Digital Orthodontics: An Integrated Review of Intraoral Scanning, CAD/CAM Appliance Fabrication, and Virtual Treatment Planning in Contemporary Clinical Practice

2026-06-08T13:40:04+00:00

Digital technologies have fundamentally transformed orthodontic diagnosis, treatment planning, and appliance fabrication over the past two decades. Intraoral scanners now provide three-dimensional digital impressions that rival and, in certain contexts, surpass the accuracy of conventional alginate and polyvinylsiloxane impressions, whilst simultaneously improving patient comfort and clinical efficiency. Computer-aided design and computer-aided manufacturing systems have enabled the production of clear aligners, custom-milled brackets, thermoformed retainers, and three-dimensionally printed auxiliaries with previously unattainable precision. Concurrently, virtual treatment planning platforms integrate cone-beam computed tomography data, digital dental models, and facial photographic records into comprehensive patient-specific simulations that support both routine malocclusion management and complex orthognathic surgical planning. Artificial intelligence algorithms now assist clinicians in cephalometric landmark identification, treatment outcome prediction, and automated appliance design. This narrative review synthesises the current evidence base underpinning each of these domains, evaluates clinical efficacy and accuracy data, and critically appraises integration challenges, interoperability limitations, and unresolved questions concerning treatment outcomes. A structured search strategy was conducted for literature published between January 2000 and March 2026. Search strings combined Medical Subject Headings (MeSH) terms and free-text keywords using Boolean operators. The literature consistently demonstrates that digital workflows confer measurable clinical advantages in impression accuracy, chair time, and patient satisfaction, yet significant evidence gaps remain regarding long-term orthodontic outcomes compared with conventional approaches. The review concludes by identifying priorities for future clinical research, including the need for large-scale prospective trials and standardised reporting frameworks for digital orthodontic interventions.

Biomechanical Principles and Clinical Limitations of Clear Aligner Therapy: A Critical Appraisal of Evidence from the Last Decade

2026-06-10T11:20:33+00:00

Clear aligner therapy (CAT) has fundamentally altered the landscape of contemporary orthodontic practice, offering patients an aesthetic and removable alternative to conventional fixed appliance systems. Despite its widespread global adoption, considerable debate persists regarding the biomechanical adequacy of thermoplastic aligners in producing predictable, complex tooth movements and achieving occlusal outcomes comparable to those of traditional bracket-and-wire mechanics. This review critically appraises peer-reviewed evidence published predominantly between 2015 and 2025, drawing on prospective clinical trials, systematic reviews, finite element analyses, in vitro mechanical studies, and comparative cohort investigations to evaluate the biomechanical principles and clinical limitations of CAT. A narrative review approach was adopted due to the heterogeneity of the clear aligner therapy literature. A comprehensive search of multiple electronic databases was conducted.

The cumulative evidence indicates that CAT demonstrates reasonable efficacy for mild-to-moderate crowding, simple tipping movements, and space closure in non-extraction cases. Its performance, however, is demonstrably compromised in scenarios requiring precise root torque control, rotation of cylindrical teeth, reliable vertical dimension management, and true bodily molar distalization. The viscoelastic properties of thermoplastic polymer materials—particularly time-dependent force decay—impose fundamental constraints on force delivery, and attachment design has emerged as a critical but imperfectly standardised determinant of treatment accuracy. Patient compliance with wear instructions remains a central confounding variable with direct and non-trivial biomechanical consequences, whilst comparative data consistently suggest that fixed appliances retain advantages in achieving ideal final occlusal quality, especially in complex malocclusion presentations.

Periodontal tissue responses appear broadly favourable with CAT relative to fixed appliances, and the risk of orthodontically induced root resorption may be marginally lower, though the evidence base requires strengthening. The management of retention following aligner therapy follows principles broadly analogous to those of fixed appliance treatment, with no established evidence for superior post-treatment stability. Emerging materials science, artificial intelligence-assisted treatment planning, and improved staging protocols continue to narrow some of these documented gaps, yet fundamental clinical limitations persist. A rigorous, evidence-informed understanding of the indications and limitations of CAT is essential for appropriate case selection, realistic patient counselling, and high-quality treatment delivery.