Cleft care in Nigeria: past, present, and future.

OBJECTIVE: To review the progress of orofacial cleft care in Nigeria and propose a viewpoint for the future. DESIGN: Review of the available literature on cleft care in Nigeria and survey of the status of ongoing cleft care in Nigerian centers. We employed a pretested self-administered questionnaire sent and returned through electronic mail. PARTICIPANTS: Coordinators of cleft care centers in Nigeria. MAIN OUTCOME MEASURES: Findings of literature search and responses to mailed questionnaires. RESULTS: Available literature suggests that the fate of orofacial cleft patients during the precolonial era in Nigeria remains unclear. However, there is evidence of surgical care delivery just before the end of the colonial era. We identified and contacted 39 existing cleft care delivery centers, of which 30 (76.9%) responded. The majority (69.2%) of the responding centers began cleft care delivery between 2006 and 2010; 73.3% have designated cleft clinic locations and 66.7% offer interdisciplinary care. All responding centers offer cheiloplasty, while 86.7% offer palatoplasty. Other aspects of cleft care are provided sparingly in most centers due to paucity of manpower. Challenges with hospital administration, securing bed and theater spaces, drug availability, and performing laboratory investigations were the common limitations reported. CONCLUSIONS: We advocate for improved cleft care delivery through removing administrative bottlenecks, fortifying existing centers, and mentoring younger colleagues for entry into underserved specialties. Concerted effort and international collaborations aimed at transforming some of the existing cleft centers to standard pediatric craniofacial centers are desirable.

Adolescent and adult cleft lip and palate, in Ile-Ife, Nigeria.

INTRODUCTION: Congenital cleft lip and palate (CLP) defects usually present in childhood, especially in places with available and affordable care. In Nigeria, their incidence is low but late presentation in Adult life have been reported. This article aims at reviewing adolescent and adult CLP patients in our center, with the advent of free and available care, and to document the patterns and management outcomes of these patients as an addition to existing literature on the subject of adult CLP. MATERIALS AND METHODS: A retrospective review of adolescent and adult CLP patients managed from May 2006 to April 2010. Demographic data as well as clinical information were retrieved from the hospital records and include the type of cleft deformity, surgical intervention prior to presentation, the type of surgery performed and postoperative outcomes. Some pertinent clinical photos were also reviewed. RESULTS: Adolescent and adults constituted 24% of the 137 patients, their age ranged from 13 to 76 years, with a mean, median and modal age of 28, 22 and 20 years respectively. Unilateral cleft of primary palate was commonest with female preponderance. Most never had surgery, others desired revision surgery or secondary procedures. The outcomes were satisfactory in the 37 procedures performed on 33 patients. CONCLUSION: A relatively high ratio of adolescent and adult clefts is observed. Most of them have never had surgical intervention. Some had failed surgical intervention prior to presentation. Satisfactory outcomes were achieved despite late intervention but failed initial intervention was associated with poorer outcomes.

A prospective study of two methods of closing surgical scalp wounds.

BACKGROUND AND OBJECTIVE: Scalp wounds are commonly closed in two layers, although single layer closure is feasible. This study prospectively compared the two methods of closing scalp wounds. METHODOLOGY: Patients with non-traumatic scalp wounds were allocated to either the single layer closure group or the multilayer closure group. We obtained relevant data from the patients. The primary outcome measures were wound edge related complications, rate of suturing and cost of sutures used for suturing. RESULTS: Thirty-one wounds were in the single layer closure group and 30 were in the multilayer closure group. Age range was 1-80 years. The most common indication for making a scalp incision was subdural hematoma, representing 27.8% of all the indications. The most common surgery was burr hole drainage of subdural hematoma. Polyglactin acid suture was used for the inner layer and polyamide -00- for the final layer in the multilayer closure group. Only the latter suture was used for the single layer closure method. Total cost of suturing per wound in the single layer closure group was N= 100 (0.70USD) and N= 800 (5.30USD) in the multilayer group. The mean rate of closure was 0.39 ± 1.89 mm/sec for single layer closure and 0.23 ± 0.89 mm/sec in multilayer closure. The difference was statistically significant. Wound edge related complication rate was 19.35% in the single layer closure group and 16.67% in the multilayer closure method group. The difference was not statistically significant (z: 0.00, p value: 1.000; Pearson chi-squared (DF = 1)= 0.0075, p = 0.0785). CONCLUSION: The study shows that closing the scalp in one layer is much faster and more cost effective compared to the multilayer closure method. We did not observe significant difference in the complication rates in the two methods of closure. Long-term outcome, especially cosmetic outcome, remains to be determined in this preliminary study.

Chronic osteomyelitis in the lower extremity predisposing to the unusual formation of keloids.

Keloids commonly occur in black and pigmented races as well as in young adults, but rarely affect Caucasians and albinos. While they have a predilection for the upper trunk as well as the head and neck regions, they seldom occur in the lower limbs. A six-year-old boy presented with multiple fibrous nodular swellings of the right leg and a discharging sinus over the ankle. Closer evaluation revealed underlying chronic osteomyelitis complicated by multiple huge keloids over the leg and ankle. Associated chronic inflammation had resulted in the huge keloids. Our patient's age, site of occurrence and presentation were not typical. In the event that a keloid is presented in isolation, chronic osteomyelitis should be considered as a differential diagnosis, and a high index of suspicion is required in order to establish the diagnosis.

Laryngeal carcinoma: experience in Ile-Ife, Nigeria.

OBJECTIVES: This study aimed to determine the prevalent age, pattern of presentation, histopathology type, and outcome of management of laryngeal carcinoma in our environment. DESIGN AND SETTING: This was a 10-year retrospective study carried out at a teaching hospital. MATERIALS AND METHODS: Records of patients managed for laryngeal carcinoma from January 1994 to December 2004 were reviewed. Only 13 cases with tissue diagnosis were included in this review. The age, sex, occupation, presentation, use of cigarette and alcohol, investigations, histology, outcome of management, and duration of follow-up were extracted and analyzed. RESULTS: The patients had a mean age of 69.9 years (range 38-88 years) and a male-to-female ratio of 12:1. Histopathology was squamous cell carcinoma in all. Symptoms included hoarseness in voice and breathlessness in all, cough in 7 (53.8%), weight loss in 7 (53.8%), and otalgia in 6 (46.2%). Two patients indulged in alcohol and two were also regular cigarette smokers. All the patients presented with stage IV disease and in respiratory distress necessitating emergency tracheostomy. Seven (53.8%) patients had total laryngectomy plus postoperative radiotherapy while 2 (15.4%) had pharyngolaryngectomy, thyroidectomy, radical neck dissection plus postoperative radiotherapy and thyroxine supplement. Surgical complications included pharyngocutaneous fistula in 2 (15.4%) patients, pharyngeal stenosis, stomal stenosis, and hypocalcemia with hypothyroidism in 1 patient each. The fistulae were managed conservatively and prognosis was good despite late presentation. CONCLUSION: Laryngeal carcinoma mainly occurs in males. Presentation is late with hoarseness in voice and breathlessness in our community. Soft-tissue neck x-ray is a useful diagnostic tool. Scarce radiotherapy centers, ignorance, local taboo, poverty, and poor recognition by primary healthcare providers have a negative impact on its management. Laryngeal carcinoma should be excluded when managing elderly patients for bronchial asthma.

Laryngeal carcinoma: experience in Ile-Ife, Nigeria

Objectives: This study aimed to determine the prevalent age; pattern of presentation; histopathology type; and outcome of management of laryngeal carcinoma in our environment. Design and Setting: This was a 10-year retrospective study carried out at a teaching hospital. Materials and Methods: Records of patients managed for laryngeal carcinoma from January 1994 to December 2004 were reviewed. Only 13 cases with tissue diagnosis were included in this review. The age; sex; occupation; presentation; use of cigarette and alcohol; investigations; histology; outcome of management; and duration of follow-up were extracted and analyzed. Results: The patients had a mean age of 69.9 years (range 38-88 years) and a male-to-female ratio of 12:1. Histopathology was squamous cell carcinoma in all. Symptoms included hoarseness in voice and breathlessness in all; cough in 7 (53.8); weight loss in 7 (53.8); and otalgia in 6 (46.2). Two patients indulged in alcohol and two were also regular cigarette smokers. All the patients presented with stage IV disease and in respiratory distress necessitating emergency tracheostomy. Seven (53.8) patients had total laryngectomy plus postoperative radiotherapy while 2 (15.4) had pharyngolaryngectomy; thyroidectomy; radical neck dissection plus postoperative radiotherapy and thyroxine supplement. Surgical complications included pharyngocutaneous fistula in 2 (15.4) patients; pharyngeal stenosis; stomal stenosis; and hypocalcemia with hypothyroidism in 1 patient each. The fistulae were managed conservatively and prognosis was good despite late presentation. Conclusion: Laryngeal carcinoma mainly occurs in males. Presentation is late with hoarseness in voice and breathlessness in our community. Soft-tissue neck x-ray is a useful diagnostic tool. Scarce radiotherapy centers; ignorance; local taboo; poverty; and poor recognition by primary healthcare providers have a negative impact on its management. Laryngeal carcinoma should be excluded when managing elderly patients for bronchial asthma

Review of skull base surgery in a Nigerian teaching hospital.

BACKGROUND AND OBJECTIVES: There is dearth of information on skull base surgery in Nigerians. This study was conducted to determine types of skull base lesions describe surgical approaches to the lesions and determine outcome of surgical management of the lesions over the study period. METHODS: We retrospectively reviewed the case notes of the patients who underwent skull base neurosurgical procedures between January 2001 and June 2007 in our centre. We obtained information on demography, clinical presentation, diagnosis, cranial computerised tomography findings, type of surgery, intraoperative findings and outcome of surgical management at the time of discharge from the hospital. RESULTS: Brain tumours were diagnosed in 28 patients, head injuries in 9 patients and one patient each had anterior encephalocele and frontal sinus mucocele. Eighteen patients had frontal craniotomy, three patients had temporal craniotomy and two patients had lateral rhinotomy in addition to bifrontal craniotomy. Two patients had frontoorbitotomy while retrosigmoid craniectomy was performed in one patient. Thirty three patients showed significant postoperative improvement at discharge. CONCLUSION: Brain tumour was the most common indication for skull base surgery in our centre. These tumours were mainly located in the anterior cranial fossa. Frontal craniotomy was the most common surgical approach. Non-availability of modern neurosurgical facilities confined us to the use of mainly traditional approaches. The availability of these facilities will assist in improving our management outcome in the future.

Burns in Nigeria: a review.

Burn injuries continue to be a major source of mortality and morbidity in low- and middle-income countries of the world, of which Nigeria is a part. Overview data on burn care in Nigeria are sparse but the available literature on burns and burn care in Nigeria was retrieved through Internet-based search engines, collated, and reviewed. Peculiarities of epidemiology, types of burn, pattern of injuries, complications, and outcome of burn care were reviewed. There were no broad-based overview statistical data on burns in Nigeria in all the articles reviewed. There was no documentation on the regionalization of care and there were no national databases. All reports on epidemiology were hospital-based. Flame is emerging as the predominant cause of burns, and burn injury is occurring increasingly away from the domestic setting. The severity of the injuries is also increasing. Deliberate burn injury remains a practice and a wide range of complications occur as burns sequelae in Nigeria. Several challenges militate against optimal care for burn victims. Burn injuries continue to contribute significantly to the burden of disease in Nigeria. There is a need for broad-based data collection systems. Avoidable complications are common and mortality remains high. Pooling of resources by regionalization of care could increase focus on burn prevention and improve the care of burn victims. Nongovernmental and governmental support to reduce the burden of burns is advocated.

Single versus two layer suturing for wound closure after inguinal hernia repair.

OBJECTIVE: Method of skin-subcutaneous closure after inguinal herniorrhaphy affects the operation time and immediate outcome of the wound. The study was aimed to assess the effects of a single layer closure of the skin and subcutaneous wound of inguinal herniorrhaphy, in contrast to the conventional two layer closure. DESIGN: Prospective randomized controlled trials. SETTING: Obafemi Awolowo University Teaching Hospital Ile-Ife, Osun State, Nigeria. PATIENTS AND METHOD: All adult patients attending surgical out patient clinic with uncomplicated inguinal hernia and had surgery, after randomization into two groups from June 2000 Dec 2005 were included in the study. One group had one layer - closure i.e. closure of skin and subcutaneous tissues together at once while the second group had two layer closure i.e. closure of skin and subcutaneous tissues separately. Duration of operation and complications were documented for comparison. RESULTS: One hundred and eighty wounds were studied in 160 patients; the extra wounds being from bilateral inguinal hernias. There were 93 wounds in group one (two layer closure) and 87 wounds in group two (one layer closure. There was no significant difference between healing of wounds and appearance of scars in both groups. The single layer closure group was, however, apparently quicker. (P= 0.006). CONCLUSION: The immediate outcome of the wound in both groups was similar. The medical personnel time was saved by closing the wound in single layer.

Laryngeal carcinoma: our experience at Obafemi Awolowo University Teaching Hospital complex, Ile-Ife, Nigeria.

OBJECTIVES: To determine the prevalent age, frequency, pattern ofpresentation, investigations and outcome of management of laryngeal carcinoma in our environment. DESIGN: 10 year retrospective study (January 1994 to December 2003). SETTING: Teaching hospital. SUBJECTS: 13 patients with tissue diagnosis managed for laryngeal carcinoma. MAIN OUTCOME MEASURES: The age, sex, occupation, presentation, use of cigarettes and alcohol, investigations, tissue diagnosis, outcome of management and duration of follow up were extracted from hospital records and analysed. RESULTS: The age of patients ranged 38 to 88 years (median 69, male: female ratio=12:1). The histopathology was squamous cell carcinoma in all. Common symptoms included hoarseness of voice and breathlessness in all the patients, cough and weight loss in seven patients and otalgia in six. Only one patient indulged in alcohol while two were regular cigarette smokers. All the patients presented in stage IV with respiratory distress necessitating emergency tracheostomy in all. Seven patients had total laryngectomy plus post-operative radiotherapy while two patients had pharyngo-laryngectomy, thyroidectomy and radical neck dissection plus post-operative radiotherapy and thyroxine supplement. Post operative complications included pharyngocutaneous fistula in two patients, pharyngeal stenosis, stoma stenosis, and hypocalcaemia with hypothyroidism in one patient each. The fistulae were management conservatively. Prognosis was good despite late presentation. CONCLUSION: Laryngeal carcinoma occurs predominantly in males. Presentation is late with hoarseness of voice and breathlessness in our community. Soft tissue neck X-ray is a useful diagnostic tool. Scarcity of radiotherapy centres, ignorance, local taboos, poverty and poor recognition by general medical practitioners negatively affected management of the patients. Laryngeal carcinoma should be excluded when managing elderly patients for bronchial asthma.

Isolated perineal burn contractures presenting with chronic intestinal obstruction: a case report.

Isolated perineal burns are rare and so are perineal contractures. Perineal contractures may however lead to intestinal obstruction, which is a more life-threatening complication. A six-yr-old boy presented with chronic intestinal obstruction following isolated perineal contracture due to a deliberate perineal burn injury to treat a febrile convulsion. The obstruction was successfully relieved using local flaps to release the perineal contracture. There is a need for meticulous care in perineal burns to avoid perineal contractures, which may result in chronic intestinal obstruction.

Incisional Hernia in Women: Predisposing Factors and Management Where Mesh is not Readily Available

Background:Aim: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria during a period when prosthetic mesh was not readily available. Patients and Methods: All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 18-60 months. Results: Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 (59.1); emergency exploratory laparotomy 6/44 (13.6); and elective surgeries 12/44 (27.3). Major associated risk factors were the use of wrong suture materials for fascia repair; midline incisions; wound sepsis; and overweight. Conclusion: For elective surgeries; reduction of weight should be encouraged when appropriate; and transverse incisions are preferred. Absorbable sutures; especially chromic catgut; should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases

The Naso-labial and lateral forehead flaps as a single stage: A case report and review of literature.

We present here the case of a patient with a major traumatic nasal loses who had a near-total nasal reconstruction as a single-stage procedure. A 35 year-old civil servant who was involved in a road traffic injury about two years before presentation. He sustained extensive and multiple facial injuries with complete loss of nasal cover and lining. Reconstruction was performed by using superiorly based, bilateral, nasolabial flaps to line the floor and the nasal septum, and a paramedian forehead flap for skin cover. The patient did well postoperatively and was discharged home on the 7(th) postoperative day. If the principles concerning cover, support, and lining are adhered to, excellent functional and aesthetic results can be achieved as we have obtained in our patient.

Reduction mammoplasty: the experience in Ile-Ife, Nigeria.

BACKGROUND: Reduction mammoplasty is a frequently performed aesthetic surgical procedure in the female adolescent and adult Caucasian population. We reviewed the cases of reduction mammoplasty performed at the Obafemi Awolowo University teaching hospital, (OAUTH), Ile-Ife. PATIENTS AND METHODS: A retrospective review of all patients who have had reduction mammoplasty at the OAUTH over a 20 year period was carried out. RESULT: Ten patients requested reduction mammoplasty during the period. Two patients declined surgery while one required, and was treated by chemotherapy. Seven patients had surgery. Outcomes were uniformly satisfactory. CONCLUSION: We conclude that request for reduction mammoplasty in our surgical practice is uncommon. Request for purely cosmetic reasons is even rarer. Most patients had massive breast enlargements with physical symptoms and gross disfigurement with or without an underlying breast disease which was the usual reason for presentation.

Burn safety knowledge in adult nigerians.

Burn injuries remain a global problem even though they are largely preventable. Adequate knowledge is essential to good burn safety practices. This aids prevention and minimizes severity when burn injuries occur. The purpose of this study was to determine the level of burn safety knowledge among literate adult Nigerians in Ile-Ife and Ilesa, South-western Nigeria. We elicited a paucity of burn safety knowledge in the population studied, but a high level of formal education corresponded to a higher degree of burn safety knowledge. There is a need to introduce burn safety education into the school curriculum at all levels of education in order to increase burn safety awareness.

Predictive factors for birth trauma in southwestern Nigeria

Birth trauma is a significant cause of neonatal morbidity and mortality. This prospective study determined the predictive factors for birth trauma as seen in a Nigerian university teaching hospital. This was a prospective descriptive evaluation of birth trauma at Wesley Guilds Hospital, Ilesa over three years. Semi-structured questionnaire was used to collect data on the age, gender, pattern of presentation, place and mode of delivery, level of birth attendants, and treatment offered. Outcome measures were factors predisposing to birth trauma. A total of 137 neonatal hospital admissions with birth related complaints were recorded between 10th December, 2002 and 9th December 2005, out of which 119(86.8%) patients had 121 birth injuries (Males: Females= 1.4: 1). The mean age was 6 ± 4.1 (range: 1-31) day. Non skeletal injuries included cephalohaematoma 30(24.8%), genital bruises/abrasion 4(3.3%), subconjuctiva haemorrhage 2(1.7%), subdural haemorrhage 1 (0.8%), nasal necrosis 1(0.8%), Erb`s`palsy 31(25.6%) and Klumpke`s palsy 2(1.7%). Skeletal injuries were mainly bone fractures 50(41.3%)with 2(1.7%)mortality. Ante natal care/delivery, level of birth attendants, mode of delivery, fetal distress, and emergency caesarian section were among the factors that determined birth trauma. The prevalence of birth trauma is high in southwestern Nigeria. The predictive factors are easily identifiable in the perinatal period; early recognition could reduce significantly birth trauma

Successful separation of two pairs of conjoined twins in Ile Ife, Nigeria: case reports.

Conjoined twins are rare phenomena occurring in one in 1 in 50,000 live births. Successful surgical separation of conjoined twins is a major undertaking requiring careful planning by a multidisciplinary team. Reports of seperation of joined twins in developing countries like Nigeria are rare. Ten cases of conjoined twins were separated between 1936 and January 2003 (including the authors two new cases). There were five omphalopagus, two pygopagus, two heterpagus and one ishiopagus twins. Three underwent emergency separation with 83.3% mortality while seven underwent elective seperation with 64.3% survival. The overall mortality rate was 50%. Despite the absence of advanced technological resource selected group of conjoined twins can be successfully separated in a developing country like Nigeria. An improvement in facilities and availability of trained personnel in likely to be associated with improved outcome.

Isolated bilateral upper lid coloboma--a case report.

BACKGROUND: Congenital upper lid colobomas may be associated with ocular and systemic anomalies. This paper reports an isolated bilateral upper lid coloboma. METHOD: A report of a case of bilateral upper lid coloboma with discussion of relevant literature. RESULTS: A 5-month old healthy baby girl presented with isolated bilateral upper lid coloboma. The coloboma was as large as two thirds of each upper lid with symblepharon. She had no other associated congenital anomalies reported by various workers. The upper lid defect in each eye was repaired in two stages. She had a flap from the lower lid using the lid switch technique and flap separation 2 weeks after the first surgery, in a combined surgery by a plastic surgeon and ophthalmologists. A good functional and cosmetic result was achieved from the treatment. The patient was discharged five days after the second surgery. CONCLUSION: This case shows that lid coloboma could be an isolated problem in a child. Early and appropriate surgical intervention is necessary for good visual and functional outcome.