GUARD YOUR MOUTH AND '. . KEEP YOURSELF FROM . CALAMITY: THE RoLE OF THE ORAL AND MAXILLOFACIAL PATHOLOGIST BY PRQ.~ESSOROLUSEYI FOLAKE AJAYI .~- J PROFESSOR OLUSEYI FOLAKE AJAYI B.D.S (Lagos) MPH (Lagos), FMCDS (Nig.), FWACS (W.A) Professor of Oral and Maxillofacial Pathologist DO ATED 00 GUARD YOUR MOUTH AND KEEP YOURSELF FROM CALAMITY: THE ROLE OF THE ORAL AND MAXILLOFACIAL PATHOLOGIST An Inaugural Lecture Delivered at the University of Lagos J.F. Ade. Ajayi Auditorium on Wednesday, 18th September, 2024 By ,. "'- ~:~~-~~;~,~ PROFESSOR OLUSEYI FOLAKE AJAyr~i:.0.~>· B.D.S (Lagos) MPH (Lagos), FMCDS (Nig.), FWACS (W.A) Professor of Oral and Maxillofacial Pathologist Department of Dental College of Medicine University of Lagos, Akoka,Lagos Copyright © 2024, Oluseyi Folake Ajayi All rights resetved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the permission of the author and publisher. PROTOCOL The Vice Chancellor, The Deputy Vice Chancellor (Development Services), The Deputy Vice Chancellor (Management Services), The Deputy Vice Chancellor (Academic and Research), The Acting Registrar, The Bursar, The Librarian, The Provost, College of Medicine, The Dean, Faculty of Dental Sciences, Deans of other Faculties, Members of the University Senat~, Heads of Department, , Distinguished Academic and Professional colleagues, Distinguished non-teaching colleagues (Administrative and Technical), Your Lordships (Spiritual and Temporal), Dear Students (Past and Present), Gentlemen of the Press (Print and Electronic Media), Distinguished Guests, Ladies and Gentlemen. ISSN: 1119-4456 Published 2024 By PREAMBLE I welcome you all to my inaugural lecture titled "Guard Your Mouth and Keep Yourself from Calamity": The Role of a Maxillofacial Pathologist. University of Lagos Press and Bookshop Ltd Works and Physical Planning Unit Complex University of Lagos, Akoka, Yaba, Lagos, Nigeria UNILAG P. O. Box 132 E-mail: unilagpress@unilag.edu.ng Tel: 08092925635 Madam Vice Chancellor, I am immensely grateful to you for the approval given to me to stand before this audience today to deliver my inaugural lecture, as a Professor of Oral and Maxillofacial Pathology at the University of Lagos, University of First Choice and the Nation's Pride. This is the 26th in the 2023/2024 academic session. I thank God almighty for making this day a reality. iv Today's inaugural lecture is the 2nd in the history of the Department of Oral and Maxillofacial Pathology /Biology and is being delivered by the 1st female Oral and Maxillofacial Pathologist in Nigeria. This inaugural lecture provides an opportunity to introduce my field of expertise and share my academic and professional achievements with members of 1 the University community, colleagues, family, friends, students and the general public. A Decision Made Growing up my dad wanted me to be a lawyer and a diplomat. I quite liked the idea of being a diplomat because I love travelling and adventure but not a lawyer. My mum was a nurse, a very compassionate one too, I saw the way she helped people and I wanted to be a nurse like her when I grew up. This idea changed when I was at her station at Randle Health Centre, Surulere. There I saw how a young Doctor who just resumed was treated like royalty.A much older matron was asking him "Doctor, would you like some tea or coffee? Snacks?" I saw a cordial and respectful relationship between a doctor and a nurse. There and then I changed my mind and decided I wanted to be a Medical Doctor but as fate would have it and to cut a long story short, I ended up in Dentistry, thus, my journey in the dental profession began. My Journey into Oral & Maxillofacial Pathology I was inspired to pursue Oral Pathology for my postgraduate training because of the way Prof. Adeyemi Mosadomi (the father of Oral Pathology in Nigeria) delivered his lectures to my class without any notes. I was in awe and decided I wanted to be like him. The popular Bible of Oral Pathology, A Textbook of Oral Pathology by Schaffer, Hine and Levy became a novel for me and I started reading it the way I used to read Mills and Boon Novels (Fig 1, 2). 2 Fig.1 Prof.Adeyemi Mosadomi Fig.2A Textbookof Oral Pathology My Foray into Academia: I am grateful to the late Prof. Soga Sofola (may his soul rest in perfect peace), who met me on the corridor, in front of the office of the Dean of Basic Sciences and asked me "Dr. Ajayi when will you finish your residency training and join the College? The job is waiting for you". This was in 1994 at the peak of the brain drain to Saudi Arabia. I looked at him with surprise and I quickly answered "soon sir, very soon". Thus, the idea of going into academia was born, and I joined the Department of Oral Pathology and Biology in 1995. At first, there were three academic staff in the department (Prof. Tolu Odukoya, Dr. E. O. Taiwo and myself). Prof. Odukoya became the acting Dean and was later appointed in Lagos University Teaching Hospital (LUTH) as Director of Clinical Services and later Chief Medical Director. Soon after, Dr. Taiwo also left on sabbatical leave, leaving only yours truly in the Department with an adjunct lecturer, the late Dr. Mubarak Emmanuel. Dr. Taiwo came back from sabbatical leave in 2000 and, just as I was rejoicing, he resigned his appointment immediately. No sooner than I started work, I found myself, a neophyte, at the helm of affairs of both departments in the College and the Lagos University Teaching Hospital (LUTH), performing clinical and academic duties. The responsibility of teaching two courses and four levels of students 300L, 400L, 500L and 600L was placed solely on my shoulders, at the same time I had to take care of my husband and my children. It got to 3 a point where my husband looked at me and said "you will not make , \ me a widower." He bought tickets and sent the children and I away on holiday.Thank God he is alive today to witness his wife, a Professor of Oral and Maxillofacial Pathology deliver this inaugural lecture! To God be the glory!!! INTRODUCTION The Practice of Oral and Maxillofacial Pathology For unknown reasons, many people think dentistry is only a department, actually, there are ten specialties with sub-specialties in five departments. Oral and Maxillofacial Pathology is one of the specialties. The name Oral and Maxillofacial Pathology is a recent development. The International Association of Oral and Maxillofacial Pathology (IAOP) changed from Oral Pathology (which limits the scope of the specialty) to a more appropriate name that defines the extent of the area covered by the Oral Pathologist, the specialty was rechristened Oral and Maxillofacial Pathology. The specialty deals with the causes, processes, nature, identification, and management of diseases affecting the oral and maxillofacial region. The region extends from the frontal hairline above, to the hyoid bone below and laterally to the posterior part of the mandibular ramus, which includes the mouth ("oral cavity" or "stoma"), jaws ("maxillae" or "gnath") and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral region skin (Le. the skin around the mouth) (fig. 3, 4, 5. 6). This specialty is however different from Oral and Maxillofacial surgery which is involved with the surgical management of the diseases of the maxillofacial region, though the two specialties work closely together. 4 Fig 3. Oro-Facial Region Fig 4. The Mouth(Oral Cavity) Fig. 5 Temporal Mandibular Joint And Jaws Fig. 6 Major Salivary Glands The Oral and Maxillofacial Surgeons require the input of the Oral and Maxillofacial Pathologist in making appropriate decisions on the treatment plan for the patient. The key to any diagnosis is a thorough medical, dental, social and psychological history as well as assessing certain lifestyle risk factors that may be involved in disease processes. This is followed by a thorough clinical investigation which includes extra-oral and intra-oral hard and soft tissue examinations. There are many types of investigations utilised in the diagnosis of oral and maxillofacial 5 diseases. These include screening tests (blood, urine etc.), imaging (Radiographs, Cone Beam Computed Tomography scan (CBCT), Computed Tomography scan (CT), Magnetic Resonance Imaging (MRI) and Ultrasonography. Further investigations are often needed to arrive at a definitive diagnosis. This responsibility is placed on the Oral and Maxillofacial Pathologist who utilises biopsy and histopathologic techniques with the aid of the microscope. The Hematoxylin and Eosin stain (H & E) and various special stains, immunohistochemistry and molecular studies of the lesions are also used to aid diagnosis. Fine needle aspiration biopsy: - uses a thin needle and syringe to pull out cells, tissues and fluids from a suspicious lump or an abnormal area of the body. A biopsy is a surgical procedure that involves the removal of a piece of tissue sample from the tumour or lesion for examination under the microscope. Types of biopsies typically used for diagnosing oral and maxillofacial diseases are: Excisional biopsy: This method is indicated for growth that is clinically and seemingly non-cancerous (benign), and small in size (approximately 1 cm or less in diameter. The lesion is completely removed. Incisional biopsy: A small portion of the lesion or tumour is removed for examination. This method is useful for large lesions. If the tumour is deep inside the mouth or throat, the patient may be put to sleep before the procedure can be performed. Exfoliative cytology: A suspected area is gently scraped to collect a sample of cells for examination. These cells are placed on a glass slide and stained with dye so that they can be viewed under a microscope. If any cells appear abnormal, a deeper biopsy will be performed. Punch biopsy: - a small tube-shaped piece of tissue is removed using a sharp hollow circular instrument, the tissue is then checked under the microscope. 6 When the biopsy specimen is sent to the Oral and Maxillofacial Pathologist in a fixative, processed, made suitable for embedding in paraffin wax, sectioned and placed on glass slides. it is then stained with Haematoxylin and Eosin (H&E) to improve the visibility of the cell structures and be ready for viewing under the microscope. The Oral and Maxillofacial Pathologist views the slide and the findings are reported and sent to the Surgeons to plan treatment. Why Guard Your Mouth The Bible tells us that "Those Who Guard Their Mouth and Their Tongue Keep Themselves from Calamity" (Proverbs 21:23). In the course of this lecture, I will be discussing why you need to guard your mouth, when to guard your mouth, how to guard your mouth and the role of the Oral and Maxillofacial Pathologist in all this. I will also take you through some of my research contributions to knowledge. Several diseases can afflict the maxillofacial region and can lead to calamity if not prevented or attended to on time. These diseases involves the soft tissue or the bony regions. They are of diverse and varying aetiological and / risk factors, having sundry presentations, dissimilar diagnostic features and assorted outcomes. These diseases can be developmental, autoimmune, infective, metabolic, traumatic or neoplastic grouped according to the cause. The neoplastic diseases (tumour) may be life-threatening and can cause disfigurement or impair basic functions such as talking, swallowing, eating and breathing. Life-threatening or not, your mouth should be guarded!! A neoplastic disease is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the surrounding normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change. 7 Oro-facial neoplasms (tumours) can be broadly classified into Odontogenic and Non odontogenic tumours. Odontogenic tumours arise from remnants of tooth-forming structures and are unique to the oral cavity while non-odontogenic tumours arise from other tissues. Oro-facial tumours may be non-cancerous (benign) or cancerous (malignant). Non-cancerous tumours are slow growing and do not invade other tissues while the cancerous ones grow at a very fast rate and invade the surrounding tissues, they can move to distant sites. The non-cancerous (benign) lesions do not kill but can result in disfigurement of the jaws while the Cancerous (malignant) ones can result to death if not attended to on time. To a layman, all malignant (cancerous) Oro-facial tumours are known as "oral cancers". However, these "oral cancers" can arise from different tissues. Those arising from the oral and sinus mucosa, perioral skin, salivary glands and some arising from some parts of tooth Several diseases can afflict the maxillofacial region and can lead to calamity if not prevented or attended to on time. These diseases involve the soft tissue or the bony regions. They are of diverse and varying aetiological and I risk factors, having sundry presentations, dissimilar diagnostic features and assorted outcomes. These diseases can be developmental, autoimmune, infective, metabolic, traumatic or neoplastic grouped according to the cause. Those arising from oral and sinus mucosa, salivary glands and some parts of tooth forming structures are referred to as oral cancers, while sarcomas may arise from either bone, soft tissue, blood vessel or nerves. Lymph nodes tumours are referred to as lymphomas. I will be concentrating my lecture this evening on Orofacial cancers because they are the most destructive and can result in calamity if one is afflicted. Oral cancer is an abnormal mass of tissue that forms as a result of failure to respond to normal cellular regulatory mechanisms, they divide more than they should and the cells do not die when they should. 9 constitute the main life-threatening diseases apart from maxillofacial trauma that may be encountered in dental practice. Global occurrence shows that head and neck cancers constitute between 5% and 50% of all cancers, and the orofacial region has been reported to be a common site. In most parts of Europe and America, oral cancers account for 2-4% of all cancers, bu· in India and Sri Lanka, they are reported to account for up to 40% of all cancers. Oral carcinoma is the most common cancerous tumour of the orofacial region constituting over 50% of these lesions. Fig. 7.1.1 Global incidence rates of tumours of the oral cavity and oropharynx (all ages) in males. Age-standardised rates (ASR, world standard population) per 100,000 population and year. From J. Ferlay et aJ.Globocan 2000 {730}. Occurrence and Distribution of Orofacial Cancers Oral cancer is a growing health problem that is common in several regions of the world. It is the sixth most common malignancy in the world. When malignancy of the pharynx is included, they account for the third most common malignancy in the developing world. They 8 children. They tend to affect a considerably younger age group than carcinomas. There are numerous reports of orofacial tumours in children from various parts of the world. However, due to their rarity, reports focusing only on orofacial malignant tumours in children are scarce in the literature. In our study (Ajayi et al. 2007) to determine the relative frequency of orofacial malignant neoplasm in children and adolescents, we observed that malignant neoplasms constituted 13.3% of orofacial tumours and tumour-like lesions in children and adolescents, and carcinomas exclusively affected patients in the 2nd decade of life (10-19years) .• Fig. 7.2 Incidence and mortality rates for tumours of the oral cavity and pharynx (excluding nasopharynx), all ages, in males. Age- standardised rates (ASR, world standard population) per 100,000 population and year. From J. Ferlay et al., Globocan 2000 {730} The World Health Organisation (WHO) reported a low incidence of oral cancer in Africa (fig. 6.1, 6.2). There have been few reports published on malignant (cancerous) lesions of the orofacial region in African environment, with fewer reports still from Nigeria. Even in children, oral cancers are not that uncommon therefore, adults or children need to guard our mouths!! (Fig 8). This informed our review of 256 consecutive cases of primary malignant orofacial neoplasms seen over 12 years (1992-2003) at the Lagos University Teaching Hospital, Nigeria. We observed that malignant tumours constituted 18% of all the biopsies of orofacial lesions seen within the period. Epithelial malignant neoplasms (oral cancer) constituted 69% of malignant neoplasms seen. This suggests that oral cancers are not as uncommon as we think, so we need to guard our mouths. (Ajayi et at 2007) Fig. 8 Cancer in a child Salivary gland cancer There are three major salivary glands located on each side of the face, parotid (in front of the ear), submandibular (below the lower jaw posteriorly) and sublingual (in the floor of the mouth, anteriorly) and numerous minor salivary glands found almost in every part of the mouth except the gingiva and anterior part of tHe roof of the mouth. Oral cancer in children: Oral carcinoma is an age-related disease, and only about 3-5% of head and neck tumors occur in children. In contrast, sarcomas of the orofacial region are reported to be less common than carcinomas in 10 11 Clinical presentation of Orofacial Tumours It is important for us to know how these lesions present so that we may guard our mouths and avert calamities. Orofacial neoplasms may present as inconspicuously as red or white patches (Fig. 10.1, Fig. 10.2) or simply as nodules (Fig ..10.3) ?r ulcers (Fig.10.S) Whereas others may be noticed as sw~lhng (Fig. 10.6) lumps or masses in the mouth. In some case~, a pati~nt may present in the clinic with loosening of the teeth, bleeding or discharge. There may be pain or numbness or tingling sens~tion i~ the fa.ce, jaw,. or mouth, enlarged lymph nodes in the neck or Jaw, diffi?Ulty In sp~aklng or swallowing, foul odour from the mouth or nose, faclal def~rmlty and weight loss due to tumour load, difficulty in eating or swallowing. These ulcers may resemble traumatic ulcers. Please note that any ulcer that does not heal within two weeks is suspicious. When th.e tumour affects the sinuses, it presents as a stuffy nose or chronic sinusitis. Fig 9.1 Carcinoma of Parotid salivary gland Fig. 5 Major Salivary Glands Even though Salivary gland lesions are relatively uncommon in the general populace, they account for a huge number of oral pathologic biopsies. These lesions are either neoplastic, inflammatory, immunopathologic, or cystic. In our audit of salivary gland lesions in Lagos, we observed that malignant salivary gland tumours were more prevalent than benign tumours. (Ajayi et ai, 2017; Adeyemo et ai, 2009) Carcinomas of these glands can present as either a swelling or ulcer in front of the ear, below the jaw and inside the floor of the mouth (Fig 9.1, 9.2). Most of the submandibular salivary gland pathoJogies that necessitated surgical excision, in our institution, were malignant (Adeyemo WL et al 2008). This is another reason why you should guard your mouth!! Fig 9.2 Carcinoma of submandibular salivary gland It is essential to consult a professional if any of these symptoms persist or worsen over time, as ear1y detection and .. treatment significantly impact treatment outcomes, and prevent calamities. 1312 Fig. 10.1 Red Patch Fig. 10.2 White Patch Fig.10.5 Ulcer carcinoma of Tongue Fig.10.6 Palatal ulcer Fig.10.4 Nodular lesion 14 Fig. 10. Gingival Swelling Role of the Oral Maxillofacial Pathologist Oral and Maxillofacial Pathologists play a crucial role in determining conclusively the type of tumour being assessed and by doing so predict how a disease may progress. Sometimes the lesion appears non-cancerous clinically but when viewed under the microscope it is actually cancerous. Take as an example, Adenocystic Carcinoma, which is the most common salivary gland carcinoma in Nigeria. It is a slow-growing tumour with a high recurrence and mortality rate and clinically mimics a non-cancerous tumour, but histologically is aggressive and cancerous. The tumour has been shown to display three histologic patterns, namely the cribriform, solid, and tubular. Histologic variants present variable aggression. The solid histologic variant is said to have the worst prognosis. When the Maxillofacial Pathologist provides this information to the surgeon, he can determine the type, extent, and treatment outcomes. We investigated the association of histologic variants of adenoid cystic carcinoma with its clinical aggression in cases from Nigeria Using Perzine, Spiro and van Weert criteria with slight modification. Clinical aggression was speculated based on the 0/ Estimated Growth Rate (EMTGR) for each tumour. We observed that the most common histologic variant is the predominantly cribriform no solid (PCNS) pattern (40.7%). In both major and minor glands, there was an association between the histologic variant and estimated 15 growth rate respectively. However, we found out that the trend of clinical aggression of histological variants based on estimated growth rate varies depending on the type of salivary gland (major vs. minor) (Ajayi et al. 2019). The Oral and Maxillofacial Pathologist not only makes a diagnosis based on the histologic type but also the histologic grade and the stage of the tumour. A grading system exists for different cancers and understanding it is crucial for determining the appropriate treatment and predicting the treatment outcome. For example, a diagnosis of carcinoma-in-situ (Le. cancer within the outer layer of tissue, no invasion of surrounding tissue) in oral squamous cell carcinoma (OSCC) is known to have a very good outcome and a total cure can be achieved. The well-differentiated tumour (Le. where the cancerous tissue appears similar to normal tissue) in which the tumour has invaded the surrounding tissue has a better treatment outcome than the poorly differentiated OSCC in which the tumour tissue does not resemble the normal anymore. In our study in Lagos, Nigeria we reported the poorly differentiated OSCC was the most common subtype (47.6%), followed by well-differentiated (32.6%) and moderately differentiated (19.7%) subtypes. Fig. 11.1 Carcinoma in situ Fig 11.2 Well differentiated squamous cell carcinoma 16 Fig 11.3 Poorly differentiated squamous cell carcinoma When the biopsy specimen is sent to the Oral Maxillofacial Pathologist it is processed. This involves the tissue being fixed in formal saline and made suitable for embedding in paraffin wax, sectioned and placed on glass slides, stained with Haematoxylin and Eosin (H&E) to improve the visibility of the cell structures ready for viewing under the microscope. The Oral and Maxillofacial Pathologist views the slide, the findings are reported and sent to the surgeons to plan treatment. Sometimes there is an initial difficulty in histopathologic diagnosis using the Hematoxylin & Eosin stain (H&E). The Oral and Maxillofacial Pathologist may have to resort to other techniques like Immunohistochemistry and Molecular sfudies. Immunohistochemistry uses special markers which help the pathologist to be sure that a tumour is actually cancer and not something else. It is a special test that says, "Yes, this is cancer"!! or "No it is not cancer"!! This technique identifies the type of cancer, detects changes in the genes of cancer, in addition, it can provide insight to the source of the tumour. It also predicts the outcome and prognosis (how well someone will do after treatment. This is important because it helps to plan the best course of action. Some lesions share similar microscopic features, to prevent wrong diagnosis in such cases and to avoid wrong treatment, Immunohistochemistry may be required. Ajayi et al. 2018, reported a case that emphasised the need for immunohistochemistry (fig 9.1, 9.2, 9.3) in the confirmatory diagnosis of salivary duct carcinoma, a tumour 17 that resembles invasive ductal carcinoma of the breast. This is important because breast carcinoma may spread (metastasis) to the jaws and salivary duct carcinoma can metastasize to the breast. Making it crucial to confirm diagnosis. A. Prevention Many studies have shown that the wide variation in the occurrence of oral cancers across the world can be partly explained by the difference in prevalence of the major risk factors in different geographic areas and also between genders. The cause of most orofacial tumours remains obscure. It is multifactorial and genetic predisposition has been suggested. While environmental predisposing factors such as viral infection such as human papillomavirus, is strongly linked to the cause of oral cancer, alcohol use and tobacco use have also been strongly associated, smoked foods, very hot foods, spicy foods, Fig. 12.3 Photomicrograph of SDC shows positive reaction to EMA (H&E X 40) Molecular studies also help diagnose, classify, and predict treatment outcomes for oral and maxillofacial tumors. They go deeper from the cellular level to the molecular level. They detect chromosomal mutations (changes) and losses. Fie 12.1: Photomlcrolrllph of SOC 5how neoplastlc epithelial cells prollferlltlnl from ductal Eplth 11 I IInlOl (H&E X 40) HOW CAN YOU GUARD YOUR MOUTH AND KEEP YOURSELF FROM CALAMITY? A. Prevention: lifestyle changes. B. Early detection: • Self-examination and • Awareness and Mass screening (toluidine blue) C. Early presentation: D. Avoidance of quacks. Rill.1: Photomlcroiraph of SDC show n.oplastlc plthellal eaUs proliferatlnl from ductal Epithelial t nlnl (H&EX40) [ Ft 12.2: Photomtcr~raph Of SDC show positive reaction to HER2 (H&E X 40 18 19 --------- B. Early detection: • Self-examination Certain conditions can precede the development of oral cancers, known as precancerous lesions. They can present as white lesions (lesions that cannot be rubbed off) which resembles oral thrush, called leukoplakia (fig.14.1.1, 14.1.2), red lesion- Erythroplakia (fig. 14.2), hyperplastic Candidiasis (due to candida infection) (fig. 14.3), Nicotinic keratosis (due to tobacco use) (fig 14.4), Lichen planus (fig 14.5), White sponge naevus (fig 14.6), submucous fibrosis (fig. 14.7). Regular self-examination in front of the mirror and dental checks can help detect oral cancer early when it is more. treatable. dl t ry deficiencies, trauma, betel nut chewing (common cause in Indi ), chronic irritation, poor oral hygiene, mould infected groundnut, rack cocaine and industrial pollution, have been implicated. Predisposing factors Oral Precancerous Lesions Fig. 13 Fig.14.1.1 Leucoplakia However, several steps can be taken to protect one's mouth and reduce the risk of developing oral cancer. A change in lifestyle and avoidance of environmental predisposing factors is advocated. Maintenance of good oral hygiene, regular dental checks and a healthy diet is also advised. Vaccination against Human papillomavirus (HPV), and protection from ultraviolet radiation will help prevent the development of oral cancer. Because of genetic predisposition there is a need to know your family history and be vigilant. By following these preventive measures, one can significantly reduce the risk of developing oral cancer and the calamities that may follow. Remember, prevention is better than cure. Fig. 14.2 Erythroplakia 20 Fig. 14.1.2 Leucoplakia Fig. 14.3 Hyperplastic candidiasis 21 Together with my collaborators, we carried out a study into the pattern of precancerous oral epithelial lesions in a selected population in Nigeria (Agbaje et al 2012). This is to investigate the prevalence and distribution of precancerous lesions to obtain pilot data useful in planning oral health care policy in Nigeria. Biopsies were done to confirm clinical diagnosis and the presence of epithelial dysplasia, carcinoma in situ or invasive carcinoma. We found out that more women attended the clinic during the period of study than men. Men, please take care of yourselves. We also found a prevalence of 0.9% of oral precancerous lesions in the population screened and these occurred more frequently in men over 40 years of age. The hard palate was the most frequently involved site followed by the buccal mucosa, lower lip, floor of the mouth, retromolar region, maxillary gingiva, upper lip and ventral surface of the tongue. More than 25% of the precancerous lesions had the tendency to undergo malignant transformation. The result also showed that mass screening should be focused on persons over 40 years of age. ;>Ieasevisit your dentists regularly to avoid calamity. • Awareness Campaign and Mass Screening Early diagnosis is crucial in avoiding the calamity of orofacial cancers. Awareness campaigns and mass screening will aid in early detection and are vital for the prevention of orofacial tumours Fig. 14.5 Lichen Planus Mass screening can be done using the following methods: 1. Toluidine blue- a basic metachromatic nuclear dye that stains nuclear materials of cancerous lesions. It is a simple, inexpensive and sensitive chair side test and can be used for mass screening. (Agbaje et aI2011). 2. Chemiluscent vizilite: a chemiluscent method that uses light followed by toluidine blue application for vital tissue stain, produced by Zila laboratories. 3. Veloscope: a method that uses a device that emits blue light to examine different tissue fluorescence produced by Led Dental. 4. Oral COx: this uses a brush biopsy to collect oral cells for examination under microscope for signs of epithelial dysplasia produced by Oral COx laboratories. C. Early Presentation: Early presentation is of the essence in the management of orofacial tumours to avoid the possible calamities (complications) that might arise as a result of delayed treatment. 22 Quite often patients present late to the clinics either out of lack of awareness, fear of surgery, or because of the cost of treatment. Calamities That May Result from Late Presentation: - • Mortality-High risk of death • Facial disfigurement-impacting self-esteem and quality of life. • Functional impairment -Speech, swallowing, and chewing, and overall well-being. • Pain, suffering discomfort, and emotional distress. • Treatment complication --dry mouth, taste changes, and oral infections. • Recurrence. • Impact on daily life, relationships, and overall quality of life. 23 • inancial burden. • Emotional trauma can lead to anxiety, depression, and post- traumatic stress disorder (PTSD). • Late detection- reduces treatment effectiveness and increasing calamity severity. you for giving me that opportunity. Since then, together with my colleagues we have been involved in numerous trainings of trainers (TOT) on this pedagogical method of teaching in the College of Medicine. I have been a resource person in TOTs by MEPIN and BRAINS. e. During my sabbatical leave to Kano, I carried the gospel of the case-based learning method to the Faculty of Dentistry, Bayero University, Kano, where it was embraced. D. Avoidance of quacks: It is advised to seek treatment from qualified professionals, visits your dentist to avoid calamity the lack of awareness, financial constraints and ignorance often drives people to visits quacks and non- professionals. f. I co-authored a chapter on fibro-osseous lesions of the jaws in the textbook Fundamentals of Oral Maxillofacial Pathology and Medicine. Other Contributions to Knowledge a. I have supervised 10 postgraduate dissertations and to God be the glory, all of whom are holding various administrative positions and one of them is a professor today and is the current Dean of Faculty of Dental Sciences, University of Port Harcourt. Other Contributions to Medical Education outside the University I was a visiting lecturer at the Faculty of Dental Surgery, University of Port Harcourt (2009 to 2011). I was a visiting lecturer at the Faculty of Dental Surgery, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana (2011 to 2018). To the glory of God, four of the students I mentored are currenUy undergoing postgraduate training in oral pathology in various countries. b. I was appointed as one of the pioneer coordinators of the Medical Education Development Unit (MEDU) of the College (2011-2024). The MEDU helped to revise and redesign the old Medical and Dental curriculum of the College into the new student-centered 'SPICCES' curriculum of which the second set is currently in the final year. c. Chairman of Dental Education Committee of the Faculty of Dental Sciences from 2014 to date d. In 2013, I, along with 3 others, was trained in the case-based learning method- a student centred approach where students read and discuss complex situations, applying their knowledge to each scenario. This method helps students better develop critical thinking and analytical skills. The training was sponsored by MEPIN, with madame Vice Chancellor serving as the principal investigator. Madam Vice Chancellor, I thank 24 25 was held in lbaoan when Prof. Lawoyin was elected President and I the Vice President. I subsequently became the first female president. The African Journal of Oral and Maxillofacial Pathology and Oral Medicine was launched during my tenure as President under the distinguished chairmanship of no less than our very own lady of many 1st. Prot Folashade Ogunsola, then Provost of College of Medicine. I have been a reviewer for some Learned Journals Service to the University I served as Coordinator of the department for six consecutive years (August 1999 - July 2005), in the first instance and became Acting Head (2005-2007), then, August 2010 - July 2012, 2018- 2022, and became Professor and Head 2023-date. I was a Course adviser (1999-2016). I was Sub-dean, FDS, (August 2015--- July 2017), Member of Board of Medilag Consult I have served on several other committees. Service to Lagos University Teaching Hospital: During the period of my headship in the college, I was also head of the department at the Lagos University Teaching Hospital. CONCLUSION Madam Vice Chancellor, distinguished ladies and gentlemen, during the time allotted for this presentation, I have given an account of my sojourn in the field of Oral and Maxillofacial Pathology in this great University, University of First Choice and the Nation's Pride. I have discussed the various calamities that can significantly impact an individual's quality of life, self-esteem, and overall health, espoused the role of the Oral and Maxillofacial Pathologist emphasising the importance of preventive care, early detection, and timely treatment in oral health. I was a visiting lecturer at the Faculty of Dentistry, Bayero University, Kano (2014 to 2020). Again, to the glory of God one of the students is currently in my department and another in Aminu Kano Teaching Hospital for the postgraduate training in Oral and Maxillofacial Pathology. The idea of forming the Nigerian Association of Oral and Maxillofacial Pathology and Oral Medicine was first conceived by me. The first AGM 26 27 28 29 I Ye disaJssed some of my scientific research findings, which are based on my experiences in teaching, oral and maxillofacial pathology practices, researchand other services Ihave contributedto in my area of specialty. RECOMMENDATION: 1. Regular self-examination for lumps or colour changes in the mouth and regular visits to the dentist every 6 months is recommended. 2. Oral health awareness and mass oral screening focused on personsover 40 years of age. 3. Lifestyle changes to avoid risk factors such as tobacco use, alcohol use and consumptionof high-risk diet 4. Inclusion of treatment of oral cancer care and subsidy in the National Health InsuranceScheme. 5. Unbundlingand mergingof Oral and MaxillofacialPathology,Oral Medicine, Oral Radiology and Oral Diagnosis units, to form the Department of Diagnostic Sciences and conform with what is obtained across other Faculties in Nigeria, and across West Africa. ACKNOWLEDGEMENT: First, I acknowledge God almighty without whom I would not be standing here today. I give him thanks and praise. He knew me, surnamed me, shepherded and guided me to this day. Without Him, there is no me. To Him be all glory, honour and praise for keeping me in good health and making me who I am. Madam Vice Chancellor you are both a destiny builder and a destiny helper. You've been a great sister, friend, encourager and supporter. I pray that the God whom you serve will not leave or forsake you; he will continue to give you wisdom and grant you favour and grace in Jesus' name. Thank you for being you. I acknowledge and thank our amiable Deputy Vice Chancellors, Prof. Atsenuwa, Prof. Bola Oboh, Prof. LO Chukwu, the University Registrar, the Librarian and the Bursar. I use this opportunity to thank Prof. Familoni, immediate past Deputy Vice Chancellor, academic and research and Prof. Ben Oghojiafor, immediate past, Deputy Vice Chancellor administration. Thank you for your support and encouragement I appreciate the Provost, College of Medicine Prof. Wale Oke, Past Provosts-Prof. Lesi, Prof Sade Ogunsola, Prof. Wole Atoyebi, Prof. Elesha, Prof Abudu, Prof. Tolu Odugbemi and Late Prof. Soga Sofola. Every single one of you has impacted my life and my success story cannot be complete without you. I thank the Chief Medical Director, Lagos University Teaching Hospital Prof. WL Adeyemo (a great scientist and researcher) and his management team, all past CMDs- Prof Bode, Prof Akin Osiboqun-rny teacher @ MPH, Prof. Odukoya my teacher and mentor. You all are appreciated. The current Deputy Provost, Prof Odebiyi, the College secretary, Dr. Obafemi-Moses, Director of Finance, Mr. Akinade. I thank you all for your prompt attention always. I use this opportunity to appreciate the Immediate past deputy provost Prof. Ebuehi, the Deputy College 30 secretaries and all college staff. I thank the past college secretaries, Mrs. Funmi Oyebolu, Dr. Mrs. Taiye Ipaye and Bar. Azeez, Esquire for your kindness to me. I thank the current Dean-Prof. Gbotolorun, Immediate past Dean, Prof. DaCosta, Prof. Oyinkan Sofola, Prof. Godwin Arotiba, Late Prof Savage, Prof. Jelili Akinwande, Prof. Mrs. Sote, Prof. Tolu Odukoya and Prof. Sonny Jeboda. Thank you, sir. Prof. Mike Isiekwe- facilitated my going to the University of Newcastle Upon Tyne (UK), thank you very much Prof. You all allowed God to use you for my success story. I appreciate you all greatly. God bless you mightily. I also wish to thank Prof. J.v. Soames of the University of New Castle- Upon Tyne and his wife Mrs. Joan Soames. I express my sincere appreciation to all my teachers, from Methodist Primary School, Surulere, through Methodist Girls High School and College of Medicine. Thank you all for giving me a solid foundation in life. Special thanks to Prof. and Mrs. Adeyemi Mosadomi for their encouragement All my research collaborators, I thank you all. Time and space will not allow me to mention every name but I must single out Prof. Ladeinde and his twin sister from another mother, Prof Ogunlewe and Prof. Wasiu Lanre Adeyemo. You all are the greatest and best. Special thanks to Prof. Gbenga Ogunlewe, Prof. Folake Oredugba, and Prof. Ranti da-Costa for your help during the preparation of this lecture. I also thank Prof. Obiechina former Dean, Faculty of Dentistry, Uniport), Dr. Francis Adu-Ababio, my classmate and friend, Dean at Faculty of Dentistry. KNUST, Kumasi, Ghana, and Prof. Adebola, former Dean at Faculty of Dentistry, Bayero University for their invitation to help in training in their various faculties. You're all appreciated. I must also appreciate Prof. Omitola, current Dean, of Faculty of Dentistry, of the University of Port Harcourt, my mentee, for his encouragement always. Prof. Adebola, thank you for welcoming me to Kano for my Sabbatical leave. The Kano Crew, the current 31 Dean, Prof. Tunde Bamgbose, thank you all for always welcoming me warmly into your midst. I appreciate all my colleagues at the National Postgraduate College, the former Registrar Medical and Dental Council of Nigeria, Dr. Sanusi, you're all appreciated. Association of Oral and Maxillofacial Pathologists (African group and Nigerian Group). fhank you. I thank my colleagues in the Department of Oral and Maxillofacial Pathology/Biology, Prof. Jumoke Effiom, Dr. Dunni Ogundana, Dr. Abdul-Warith Akinshipo, all resident doctors, past and present who have passed through the department. All Technical and administrative staff, past and present who have worked with me in the department, in both LUTH and CMUL, thank you very much. Your support, dedication and cooperation, particularly when I was the only academic staff on ground, made my work easier. Members of the inaugural lecture planning committee, thank you very much. To all my colleagues in the faculty, thank you for your love and your kindness and for making the faculty a family. Subdean Emeritus, Prof. Omolara Uti. I appreciate all staff, LUTH and CMUL Residents, House Officers, Administrative, Technical and Nursing- of the Faculty of Dental Sciences. All dental students at CMUL thank you. I acknowledge and appreciate myoid Girls, Methodist Girls High School family ably led by Major General Tilewa Amusu. I appreciate my Medilag 85 set, thank you. BDS Alumni, thank you. MDCAN LUTH branch thank you. 32 I acknowledge my Lord Bishops here present, Bishop Odedeji, Lagos West and Bishop Oludipe of Ijebu Diocese. Thank you very much for gracing this occasion. The Vicar, Parish Council and members of the Church of Pentecost, Anglican Communion, FESTAC town. I must single out the Christian Ladies Friendly Society (CLFS). Parish Council St Andrews Anglican Church Makun-Omi. All my Friends and well-wishers, Prof. Amund, Prof, Ojikutu and Prof. Oye Adeniran. Time will not permit me to name you all one by one. Those online, thank you for your time. I thank my paternal family, the Ogunpolus, of Makun-omi, Ogun- Waterside LG, my maternal farnily-fhe Ewukalas of Efire, Oqun- waterside LG and all my wonderful nephews, nieces and cousins, thank you for your encouragement and love. My late parents Mr. Daniel Ogunpolu and Mrs. Abigail Ogunpolu, who laid a very solid foundation upon which blocks have been placed to produce the inaugural lecturer of today I am eternally grateful. If you can hear me, Daddy, Mummy, I say the biggest thank you. Mrs. Abigail Ogunpolu 33 Mr. Daniel Ogunpolu I thank all my wonderful siblings Funmilayo, Bukonla, Durojaiye, Omotola, Olaitan, Kemi, Gbenga and their spouses. Distinguished Ladies and gentlemen, I appreciate you all for honouring my invitation to this inaugural lecture. My late brother Mr. Kehinde Ogunpolu and my late sisters Mrs. Toyin Fajobi and Mrs. Olabisi Leke-Adenuga, may you continue to rest in peace Please remember, those who guard their mouth and tongue keep themselves from calamity. Visit your Dentist regularly. I thank you all for your time and attention. To the Ajayi's, I thank you for accepting me into your family as one of you. Your show of love, support and cooperation has been amazing. God bless you all. You've never been in-laws but family. The Olakanmis (PANAFISM) I thank you for giving me a son and accepting my daughter as yours. As Niniola our granddaughter used to say, Grandma Abuja and Grandma Lagos are best friends. This bond of love will never be broken in Jesus' name. God has blessed me with many children. Fruits of my womb-Ololade, Oladimeji and Abisola, you have been amazing, I thank you very much and my beloved son, Pharm. Olamide Olakanmi. I have a quiver full of children, Kayode, Dayo, Deji, Tosin and Temitope I am grateful to God for the stability, peace of mind and unity we all have shared. Thank you. I am proud of you all. My grandchildren, you give me so much joy. I just want to say I love you. Finally, I especially wish to sincerely thank my husband, my friend, the love of my life, my prayer partner. Thank you so much. I thank God for bringing us together 39 years ago and keeping us till this day. Thank you for being my editor and joining me in the night vigil to complete this lecture. Thank you for setting high standards for the children to follow and thank you for being there for all of us. God bless you and renew your strength. Madam Vice Chancellor, I have come to the end of my lecture. 34 35 REFERENCES: 1. Adeyemo WL, Ajayi OF, Anunobi CC, Ogunlewe MO, Ladeinde AL, Omitola OG, Abdulkareem FB. Submandibular gland excision: A clinicopathologic review of cases in a Nigerian Teaching Hospital. 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