Proposed grading system of unilateral cleft lip to predict surgical challenges.

Background: It is a common practice to subjectively categorize cleft lip deformities into narrow and wide cleft. The proposed grading of unilateral cleft lip can serve as a predictive factor of the difficulties to be encountered during repair and the expected outcome of surgery. Materials and Methods: This was a 5-years retrospective study of the records of 32 patients with unilateral cleft lip that presented to a single surgical unit. We grouped the patients based on the age at surgery. We calculated the alar base width ratios of the cleft to non-cleft sides, and this was used for grading. We graded the clefts using ratio of 1.00-1.50 for mild cleft, 1.51 to 2.00 for moderate cleft, 2.01-3.00 for severe cleft, and >3.00 for extensive cleft lip. Results: The youngest child was 1 month old, while the oldest was 50 years. Majority of the patients (17) were older than 2 years at the time of surgery. Only nine babies (28.1% of the patients) were able to have their surgery done within the age of 6 months. Those that had extensive unilateral cleft lip were 10 (31.3%). However, a total of 18 (56.3% of the patients) had cleft lips that were either mild or moderate grade. Conclusion: This grading of unilateral cleft lip helps in objective preoperative assessment of the severity and in predicting the difficulty expected during lip repair. It is also helpful in assigning clefts to trainees and in determining which patients should be referred to an experienced surgeon.

Pattern of malocclusion and caries experience in unrepaired cleft lip and palate patients in Enugu.

BACKGROUND: Clefts are common birth defects, usually accompanied by various malformations that include malocclusions, and may be associated with tooth decay. The aim of this study was to assess the malocclusion and caries status of the patients with unrepaired clefts who presented at the National Orthopaedic Hospital Enugu. SUBJECTS AND METHODS: A cross-sectional, descriptive study was conducted among patients with unrepaired cleft lip and/or palate that presented at the National Orthopaedic Hospital, Enugu between January 2009 and December 2011. Detailed records of 140 patients with cleft deformities who presented to the hospital within the study period were analyzed for the cleft pattern, whereas those patients above 6 years of age (52 patients) were analyzed for malocclusion using the Angle's classification of malocclusion. Assessment for dental caries according to WHO guidelines was made for all the patients. RESULT: There were 74 males and 66 females. Cleft lip with or without alveolus involvement had equal prevalence (47.1%) (66 patients) with combined cleft lip and palate; eight patients had isolated cleft palate (4.71%). Angle's class 1 malocclusion was statistically significantly higher than other classes (P = 0.000). Class I malocclusion was seen in 38 patients (73.1%), whereas class 111 was seen in 8 patients (15.4%) and class 11 in 6 patients (11.5%). Eight patients (100%) who developed class 111 malocclusion all had a hard palatal defect. Proclining of maxillary anterior teeth (increased overjet) was the most common orthodontic anomalies, reported in 25 patients (48.1%) (P = 0.002). Caries prevalence of 12.9% was observed in this study. Caries experience was statistically significantly higher in deciduous than permanent teeth (P = 0.002). CONCLUSION: The high prevalence of malocclusion in these cleft patients emphasizes the need for an interdisciplinary team approach and early inclusion of dental care especially oral hygiene to prevent tooth decays.

Prevalence of orofacial clefts in Nigeria.

Orofacial clefts are the most common malformations of the head and neck. In Africa, orofacial clefts are underascertained, with little or no surveillance system in most parts for clefts and other birth defects. A Nigerian craniofacial anomalies study, NigeriaCRAN, was established in 2006 to support cleft research specifically for epidemiological studies, treatment outcomes, and studies into etiology and prevention. We pooled data from seven of the largest Smile Train treatment centers in the six geopolitical zones in Nigeria. Data from September 2006 to June 2011 were analyzed and clefts compared between sides and genders using the Fisher exact test. A total of 2197 cases were identified during the study period, with an estimated prevalence rate of 0.5 per 1000. Of the total number of orofacial clefts, 54.4% occur in males and 45.6% in females. There was a significant difference (P = .0001) between unilateral left clefts and unilateral right clefts, and there was a significant difference (P = .0001) between bilateral clefts and clefts on either the left or right side. A significant gender difference (P = .03) was also observed for cleft palate, with more females than males. A total of 103 (4.7%) associated anomalies were identified. There were nine syndromic cleft cases, and 10.4% of the total number of individuals with clefts have an affected relative. The significant difference between unilateral clefts and the gender differences in the proportion of cleft palate only are consistent with the literature. The present study emphasizes the need for birth defects registries in developing countries in order to estimate the exact prevalence of birth defects including orofacial clefts.

Cleft Surgery Service at National Orthopaedic Hospital Enugu: impact of free treatment programme.

INTRODUCTION: Previous reports on free surgeries have tended to focus on the numbers of patients treated. Little has been documented on the impact on training hence this report. Such grants should positively impact training, patient outcome and volume of patients. METHODS: A retrospective review of all cleft surgeries carried out two years before and after the commencement of free surgical treatment at the hospital (from November 2004 to October 2008) was undertaken. The demographics were studied for both primary and revisional surgeries. The primary surgeons were noted. Excluded from the study are procedures to remove sutures. Simple arithmetic analysis was used. RESULTS: Seventy-three cleft procedures had been carried out before, while 168 procedures were carried out after October 2006. Eight patients aged over 15 years had lip repairs before while 42 patients over 15 years had lip repair after commencement. Fourteen procedures were carried out by three trainee surgeons before; while 29 procedures were carried out by nine trainees after October 2006. In 2005 an average of four procedures a month were undertaken; this increased by 2008 to eight. CONCLUSION: Free treatment positively impacts patient turnout and training, and are encouraged to improve the quality of healthcare in the country.

Burn disaster acute care management in a Nigerian hospital: any change 10 years after?

This study is derived from retrospective data from the management of a fire disaster involving nine students managed in the institution following a fire disaster at the female students' hostel. The average length of stay was 19 days. The total cost was $47.74 per day per patient.

Paediatric burn injuries in Enugu, South-East Nigeria: A 7-year multi-centre retrospective review.

Burn injuries contribute significantly to childhood morbidity and mortality. This study was designed to document the pattern of presentation and outcome of pediatric burn injury in Enugu. METHODS: All children with burn injuries over a 7-year period (June 2011 to May 2018) and were managed at three tertiary health institutions, were studied. Information including their socio-demographics, clinical features and treatment outcome were obtained and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0. RESULTS: 198 out of 201 records were available for analysis. Most (186; 93.9%) burn injuries occurred at home. Hot liquid (112; 56.7%) was the commonest cause of burn injury. A lot of substances were used topically for first aid, raw eggs (52; 31%) being the commonest. The outcome had significant association with cause of injury, depth of injury, total burn surface area (TBSA), and inhalation injury. Most were safely discharged home while a total of thirteen (6.6%) children died. LA50 was 54.87%, while the maximum TBSA salvaged was 65%. CONCLUSION: Burn injuries in children in this environment remain a serious challenge in the face of widespread lack of awareness regarding safe practices in handling hot and flammable items at home.

Genetic studies in the Nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders.

BACKGROUND: Orofacial clefts are the most common malformations of the head and neck, with a worldwide prevalence of 1 in 700 births. They are commonly divided into CL(P) and CP based on anatomic, genetic, and embryologic findings. A Nigerian craniofacial anomalies study (NigeriaCRAN) was set up in 2006 to investigate the role of gene-environment interaction in the origin of orofacial clefts in Nigeria. SUBJECTS AND METHODS: DNA isolated from saliva from Nigerian probands was used for genotype association studies and direct sequencing of cleft candidate genes: MSX1 , IRF6 , FOXE1, FGFR1 , FGFR2 , BMP4 , MAFB, ABCA4 , PAX7, and VAX1 , and the chromosome 8q region. RESULTS: A missense mutation A34G in MSX1 was observed in nine cases and four HapMap controls. No other apparent causative variations were identified. Deviation from Hardy Weinberg equilibrium (HWE) was observed in these cases (p = .00002). A significant difference was noted between the affected side for unilateral CL (p = .03) and bilateral clefts and between clefts on either side (p = .02). A significant gender difference was also observed for CP (p = .008). CONCLUSIONS: Replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the development of CL(P).

Blood pressure correlates in orthopaedic and plastic patients at a regional orthopaedic hospital in Nigeria.

BACKGROUND: Raised blood pressure is a significant surgical risk factor. Post operative complications are worse in both orthopaedic and plastic patients when there is associated hypertension. There has not been any known study on blood pressure variables in patients presenting at the National Orthopaedic Hospital Enugu, Nigeria. This informed the need for the authors to evaluate the blood pressure correlates in patients presenting at this hospital. METHODS: Patients attending the outpatient clinics of the hospital, between June 2003 and September 2004, were recruited into the study. Their biodata, demographic and clinical characteristics were recorded under standard conditions. Their blood pressure awareness indices, lifestyle habits and co-morbid conditions were evaluated. Structured questionnaires were used with self administered screening done. RESULTS: Two hundred and eighteen patients with mean age 41.4 (+/- 17.2) years, were screened, Fifty three percent of them were hypertensive, with 87% of these presenting as orthopaedic cases. While 68% irregularly or never checked their blood pressure, those who took alcohol had 54.5% among them, with hypertension. CONCLUSIONS: This study has shown a high prevalence of hypertension among patients presenting at the study centre. There is also a high degree of association between the lifestyle habits and level of blood pressure. The implications of this for surgical outcome are highlighted.

ORTHODONTIC NEEDS OF PATIENTS WITH CLEFT LIP AND PALATE IN ENUGU, FIVE YEARS POST REPAIR.

BACKGROUND: Orthodontists play an integral role in the management of cleft lip and palate anomaly. This study looks at the frequency of anomalies amenable to orthodontics in patients who have had surgery and the effect of early or late surgical intervention. METHODOLOGY: Patients aged 0-5 years with cleft of the lip and/or palate who were operated on by the plastic surgeon at the Good Shepherd Specialist Hospital, Enugu between 1st July 2011 and 30th June 2014, were recalled after a minimum of five years post-surgery and examined to determine the absence or presence of dental anomalies, amenable to orthodontic treatment, which have arisen since surgical repair. Descriptive statistics and t-test were used for data analysis and significance was at 0.05. RESULTS: Thirty-one children were operated upon in the period under review. Seventeen had timely (three months or less) lip repair. Seven had timely palate repair (18 months or less). Thirteen patients were successfully recalled, 12 had cleft lip repair while one had cleft palate repair. Repair was timely in 10 (83.3%) of the 12 that had lip repair with a mean frequency of four dental anomalies, while the two (16.7%) that had late repair had a mean frequency of five dental anomalies and this was not statistically significant (P value=0.711). The only isolated cleft palate patient successfully recalled had a late repair. All 13 patients had at least four dental anomalies amenable to orthodontics. Hypoplastic maxilla were the most commonly occurring (eight patients, 61.54%) dental anomaly amenable to orthodontic treatment. None of the patients had a clinically visible supernumerary tooth. Out of 13 patients reviewed, sis were males with a mean frequency of four dental anomalies while seven were females, also with a mean frequency of four dental anomalies. This was not significant (P-value=0.553). CONCLUSION: There is need for the long term Orthodontic follow up of cleft lip and palate patients. The orthodontic management of dental anomaly should, therefore, be central in the planning and treatment of patients with cleft lip and palate.

OUTCOMES OF CLEFT PALATE SURGERIES AT THE NATIONAL ORTHOPAEDIC HOSPITAL, ENUGU, NIGERIA: NOVEMBER 2008 - NOVEMBER 2013.

BACKGROUND: Despite an increase in the number of palatoplasty procedures at the National Orthopaedic Hospital Enugu (NOHE) sequel to a partnership with Smile Train, no reports on subsequent outcomes have been published. We investigated the speech outcomes and rates of fistula formation, the relationship between introduction of solids and incidence of post-operative oronasal fistulae and the benefits of post-operative honey licks. OBJECTIVE: To determine the outcome of palatal repairs performed at our center in relation to the timing and nature of post-operative feeds. METHOD: This was a cohort study of patients who had palatoplasty over a five-year period and were subsequently followed up for a maximum period of 9 years. The patient's present condition, timing of first feeds, onset of solid feeds, honey licks, frequency of wound dehiscence, fistula formation, and speech outcomes were assessed. The evaluation for a fistula was made from two weeks after the surgery by a senior resident in plastic surgery. Analysis was done using SPSS version 21.0 and p value set at <0.05. RESULTS: A total of 115 surgeries: 90 primary cleft palate repairs, 6 combined cleft lip and palate surgeries and 19 secondary cleft palate repairs were done. Male to female ratio was 1:1.3. Age range of patients was 6 weeks to 36 years. Timing of introduction of solid meals significantly affected incidence of repair breakdown; and 58% had normal to near-normal speech. CONCLUSIONS: Licking honey was associated with fewer wound breakdowns. Early return to solid feeds is associated with a higher incidence of wound breakdown following palate repair.

Presentation of trauma at the National Orthopaedic Hospital Enugu: a pilot study.

This prospective study spanning three months was undertaken to provide insight to trauma care including intervention times in this centre. Improved organization of trauma care is needed urgently for improved outcomes.

Preliminary reports of autologous blood transfusion in a plastic surgery unit.

We commenced autologous blood transfusion at the plastic surgery unit of the National Orthopaedic Hospital, Enugu, Nigeria in January 2001. Forty-three patients who have so far had autologous blood transfusion up to June 2004 are reviewed. Autologous blood was found to be cheaper than homologous blood with no untoward reactions. We conclude that autologous blood is safe, cheap and should be considered in elective surgical cases.

Cleft lip and palate repair: the experience from two West African sub-regional centres.

Compliance with primary surgical treatment in people with cleft lip and palate is a well-known problem, especially in developing countries fraught with poverty and ignorance. Different protocols of treatment exist. In this paper, we retrospectively review a cohort from two centres, with a discussion on the outcome and its implications. The records of all patients with cleft lip and palate seen in the National Orthopaedic Hospital, Enugu, Nigeria, from January 1993 to December 1999, were sought, and all available case notes reviewed retrospectively. This included new cases seen in the period, and also cases operated during this period. Follow up took place until January 2005, when the data were collated. The records of all such patients seen at Ladoke Akintola University Teaching Hospital Osogbo, Nigeria, from September 2004 to June 2006 were also collated and analysed. During this period, 102 patients were seen (93 at Enugu and nine at Osogbo). Fifteen had isolated cleft palate, 42 had isolated cleft lip and 45 had combined cleft lip and palate. Presentation time ranged from 1 day to 43 years. The palate was not repaired in 20 people after lip repair; two patients with cleft lip and palate completely defaulted; and only one person with isolated cleft palate failed to undergo surgery in this period. Two patients in Osogbo absconded. The West African sub-region has a high drop out rate after lip repair.