Multicenter Pattern of Cleft Surgeries and Factors Associated with Late Primary Cleft Surgery in Nigeria.

Background: This study aimed to analyze multicenter patterns in cleft deformity surgeries and identify factors associated with the timing of primary cleft repair in Nigeria. Methods: A cross-sectional study of children managed for clefts from January 2009 to December 2020 at three Smile Train partner tertiary institutions situated in the east (Enugu), west (Ibadan), and northern (Jos) parts of the country using a prospectively collected database. Outcomes were the types of surgery performed, yearly volume of surgeries, methods of repair, and time of surgery (early versus late). Results: Of 1043 cleft surgeries, nearly half (45.7%) involved infants (<12 months). Primary repairs of the lip or palate were performed in 83.4% of cases, with 58.4% for lip repairs and 25.1% for palate repairs. The most common cleft lip repair method was a variant of Millard rotation advancement flap. Over the study years, there was a shift from von Langenbeck palatoplasty to methods such as Bardach's palatoplasty and intravelar veloplasty. Patients with bilateral cleft lip defects were significantly more likely (P < 0.001) to undergo early repairs compared with those with unilateral defects. Late primary cleft lip repairs were significantly (P < 0.001) more common in Enugu. Conclusions: This study highlights the variability in cleft surgery patterns in Nigeria. Late primary cleft surgeries were associated with less severe cleft lip or cleft palate and were more prevalent in Enugu, Southeastern Nigeria. The findings contribute valuable insights for optimizing surgical approaches and resource allocation in the management of cleft deformities in the region.

Management of unerupted anterior teeth an audit of treatment outcomes

Anterior teeth are valuable for aesthetics, speech and mastication . Their absence, impaction and/or delayed eruption create significant distress often leading to early presentation to the dental office. This study presents an audit of the management of impacted anterior teeth that presented at a tertiary level dental clinic. The periodontal outcomes of the aligned teeth were also reported. Methods : This is an observational study spanning a nine-year period. Demographic data, clinical presentation as well as post alignment dental and periodontal status of the impacted teeth were assessed. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 26. Fisher's exact test and paired samples T-test were used for categorical and continuous variables respectively. Significance was set at P < 0.05. Results: Twenty-eight (1.76%) cases presenting with failed eruption of thirty-two anterior teeth were found during the period under review. Eight patients were treated by extraction, orthodontic treatment and space closure or prosthetic replacement with a mean treatment time of 2.83 ± 2.66 years. Thirteen patients completed treatment by orthodontic alignment with mean alignment time of 1.4 ± 1.5 years and treatment time of 3.6 ± 2.5 years. There was significant difference in the post-operative root length of aligned teeth compared to their normal antimeres (p < 0.005). Conclusion: Patients with impacted anterior teeth presented later than was beneficial for spontaneous alignment of their teeth. The average 1.5mm loss of root length observed was not detrimental to the anatomical retention or function of the aligned teeth. There is need for more enlightenment with regards to early presentation for dental problems to avoid expensive and time-consuming treatments.

Burdens and predictors of the Burden experienced by Family Caregivers of Patients with Oral and Maxillofacial Tumours.

Aim: There is a dearth of knowledge on the burden of family caregivers of patients with maxillofacial tumours in Nigeria. This burden may be influenced by racial peculiarities and the disease entity of the patient. The aim of this study is to assess and document the burdens and predictors of burdens experienced by family caregivers of patients with oral maxillofacial tumours presenting at a tertiary health facility in South Western Nigeria. Materials and Methods: A descriptive cross-sectional study that included 110 consenting family caregivers of patients diagnosed with oral and maxillofacial tumours. A semi-structured questionnaire was used to collect information on their sociodemographic characteristics and caregiving burden using the Zarit burden interview tool. Data were analysed using descriptive and inferential statistics with Statistical Package for Social Sciences version 21.0. Result: The most frequent group of caregivers was patients' children (32.0%), aged 30-39 years (28.2%), females (54.5%), with secondary education (41.8%), and traders (38.2%), who earned less than national minimum wage (55.5%). Majority (42.7%) experienced mild-to-moderate burden; coping strategy was mainly prayers (76.4%), while the greatest need expressed was financial assistance (93.6%). The significant predictors of caregiver burden were the presence of pain (adjusted odds ratio [AOR] = 2.961; 95% confidence interval [CI] = 1.165-7.526; P = 0.023) and severe clinical condition (AOR = 3.342; 95% CI = 1.133-9.853; P = 0.029). Conclusion: The most common category of the burden of family caregivers of patients with maxillofacial tumours was the mild-to-moderate category, and the most significant predictors were the presence of pain and severity of clinical condition. The greatest need expressed was financial assistance. Therefore, an emphasis on adequate pain control and alternate sources of funding may appreciably relieve the burden of family caregivers of patients with maxillofacial tumours.

Adaptable skull stand: An indigenous innovation.

The aim of this report is to describe the structure and advantages of an innovative and indigenous device, the adaptable skull stand, which serves the purpose of holding a skull model steady in a variety of positions without the need for an assistant.

Syngnathia.

Syngnathia is a congenital fusion of the upper and lower jaws. Its occurrence poses a significant challenge to feeding and its management is challenging to both the surgeon and the anaesthetist. Reports in the literature are mainly clinical reports or case series. To the knowledge of the authors and from the available literature, this is only the fourth report from Nigeria. The presentation and successful management of a Nigerian female neonate with congenital syngnathia is described and reviewed with literature.

Single-Stage Surgical Reconstruction of Posttraumatic Compound Complex Fronto-Basal Cranial Vault Fracture in a Resource-Limited Practice.

BACKGROUND: The extant literature on the surgical treatment of posttraumatic compound, complex frontal basal calvarial skull fracture suggests that this be a staged procedure. There are many socioeconomic constraints in low-resource regions of the world to the feasibility of this standard practice. METHODS: A single-stage operative procedure for the surgical treatment of these fractures in a neurosurgery practice in Nigeria is here annotated. In addition, an observational outcome analysis of this surgical technique in a prospective consecutive cohort of patients over a 6-year period is presented. RESULTS: Fourteen patients, all males, mean age 33.9 years (SD, 6.6) underwent this surgical procedure. Majority were late neurosurgical referrals, hence median time to surgery was 96 hours (range, 48-2160). Twelve patients (85.7%) had history of loss of consciousness, median duration of 34 hours; 7 (50%) had associated brain contusions; 6 (43%) significant pneumocephalus; and acute extradural and subdural haematoma in 4 and 2 patients respectively. The surgery was successful in all; 13 (93%) had normal outcome on the Glasgow outcome scale at hospital discharge; 12 have been followed up for 1 to 72 months, median 33. Seven of these were for 30 months or more. There was no patient of surgical site infection in the perioperative or the follow-up period to date. The aesthetic outcome was also acceptable. CONCLUSION: The pragmatic surgical technique herein annotated appears clinically and aesthetically effectual in the operative treatment of compound, complex frontal basal cranial vault fracture.

Clinical Parameters and Challenges of Managing Cervicofacial Necrotizing Fasciitis in a Sub-Saharan Tertiary Hospital.

INTRODUCTION: Necrotizing fasciitis is a severe soft tissue infection. In our environment, patients presenting with this infection are usually financially incapacitated and, therefore, their management can be challenging. This paper aimed to document the pattern and challenges encountered in the management of cervicofacial necrotizing fasciitis (CNF) in the University College Hospital, Ibadan. MATERIALS AND METHODS: Information such as biodata, site of infection, systemic conditions, widest span of defect, management provided, hospital stay, and outcome of management was prospectively collected on all patients with CNF who presented at the Department of Oral and Maxillofacial Surgery between January 2007 and December 2013. The patients were managed according to a devised protocol of antibiotic therapy, serial debridement and honey dressings. RESULTS: Twenty-four cases of CNF were seen. There were 9 males and 15 females while 70.9% of the patients belonged to the low socioeconomic class. The mean span of wound defect was 12.2 (±8.844) cm. The mean hospital stay was 27.8 (±23.1) days, and scar formation was the most common complication encountered. CONCLUSION: Our study represents the largest series of CNF from a Nigerian health facility presently. The management of necrotizing fascitis in the maxillofacial region poses a significant challenge to both the surgeon and the patient. However, the mortality rate of CNF in our center appears comparatively low.

Intra-Operative Airway Management in Patients with Maxillofacial Trauma having Reduction and Immobilization of Facial Fractures.

BACKGROUND: Despite advancements in airway management, treatment of fractures in the maxillofacial region under general anesthesia remains a unique anesthetic challenge. We reviewed the pattern of airway management in patients with maxillofacial fractures and assessed those challenges associated with the different airway management techniques employed. MATERIALS AND METHODS: The anesthetic chart, theatre and maxillofacial operations records of patients who had reduction and immobilization of various maxillofacial fractures over a 2-year period were reviewed. Information obtained included the patient demographics, mechanisms of injury, types of fractures and details about airway management. Statistical Package for Social Sciences, SPSS version 17.0 was utilized for all data analysis. RESULTS: Fifty-one patients were recruited during the 2-year study period. Mask ventilation was easy in 80-90% of the patients, 80% had Mallampati three or four, while 4 (7.8%) had laryngoscopy grading of 4. There was no statistically significant difference between the fracture groups in terms of the laryngoscopy grading (P = 0.153) but there was statistical significant difference in the technique of airway management (P = 0.0001). Nasal intubation following direct laryngoscopy was employed in 64.7% of the patients, fiber-optic guided nasal intubation was utilized in only 7.8%. None of the patients had tracheostomy either before or during operative management. CONCLUSION: Laryngoscopic grading and not adequacy of mouth opening predicted difficult intubation in this group of patients in the immediate preoperative period. Despite the distortions in the anatomy of the upper airway that may result from maxillofacial fractures, nasal intubation following direct laryngoscopy may be possible in many patients with maxillofacial fractures.

Ameloblastic fibrosarcoma: Report of a case.

Ameloblastic fibrosarcoma (AFS) is a rare odontogenic malignancy with benign epithelial and malignant ectomesenchymal components. About 66 cases have been reported in the medical literature. We therefore report an additional case as well as a review of literature to add to the existing knowledge on this rare lesion.

Odontogenic tumours: A review of 266 cases.

OBJECTIVES: The aim of this study was to examine the relative frequency of odontogenic tumours at a tertiary hospital in Ibadan, as well as to study the various histologic types based on WHO 2005 classification and to compare results from this study with those of previous studies. STUDY DESIGN: The records of the Oral Pathology Department of University College Hospital were reviewed. Lesions diagnosed as odontogenic tumours were categorized into four groups based on WHO 2005 classification and were analyzed for age, sex and site using SPSS for Window (version 18.0; SPSS Inc. Chicago, IL) and frequency tables were generated. RESULTS: Two hundred and sixty six (41.7%) cases of odontogenic tumours were seen. The mean age of occurrence was 32.6 (±15.815) years (range3-82 years) and peak age was in the third decade of life. Eleven (4.1%) malignant odontogenic tumours were seen. Ameloblastoma with 65.4% of cases was the most common odontogenic tumour followed by fibromyxoma (14.7%), no case of odontoma was seen in this series. CONCLUSION: The findings were mostly similar to those of African and Asian series and showed variations from reports from the Americas. The reason for the disparity in African and American series needs further investigations. Key words:Odontogenic tumour, classification, Nigeria.

Appraisal of jaw swellings in a Nigerian tertiary healthcare facility.

INTRODUCTION: The mandible and maxilla can be the site of myriads of lesions that may be categorized as neoplastic, cystic, reactive and infective or inflammatory. Literature reviewing jaw swellings in an amalgamated fashion are uncommon, probably because aetiologies for these swellings are varied. However, to appreciate their relative relationship, it is essential to evaluate the clinico-pathologic profile of jaw swellings. The aim of this appraisal is to describe the array of jaw swellings seen at our hospital from 1990 to 2011, to serve as a reference database. MATERIAL AND METHODS: Biopsy records of all histologically diagnosed cases of jaw swellings seen at the department of Oral Pathology, University College Hospital between January 1990 and December 2011 were retrieved, coded and inputted into SPSS version 20. Data on prevalence, age, sex, site and histological diagnosis were analysed descriptively for each category of jaw swellings. All patients below 16 years were regarded as children. RESULTS: A total of 638 jaw swellings were recorded in the 22-year study period. The Non Odontogenic Tumours (NOT) were the commonest, accounting for 46.2% of all jaw swellings. Odontogenic Tumours (OT) formed 45% of all adult jaw swelling while it formed 25.2% in children and adolescents. Ameloblastoma was the commonest while the most common NOT was ossifying fibroma (OF). Chronic osteomyelitis of the jaws was about 6 times commoner in adult females than males and mostly involved the mandible. The most common malignant jaw swelling was Burkitts' lymphoma (BL) that was about 7 times more in children than adults. Osteogenic sarcoma was the most common malignancy in adults. CONCLUSION: Jaw swellings are extensively varied in types and pattern of occurrence. This study has categorized jaw swellings in a simple but comprehensive fashion to allow for easy referencing in local and international data acquisition and epidemiological comparison. Key words:Jaw swellings, odontogenic, Nigeria.

Condylar disarticulation; analysis of 20 cases from a nigerian tertiary centre.

BACKGROUND: A disarticulation resection is a variant of mandibular segmental resection in which the condylar articulation is sacrificed. Indication varies from primary condylar lesions to jaw conditions involving the condyle. AIM: This retrospective analysis was carried out to highlight the pattern of disarticulation resections carried out in our centre over a five-year period. MATERIALS AND METHODS: Cases of mandibular resection were identified from the operation book. The medical records of patients who had disarticulation resection were then retrieved and analyzed for demography, indications for disarticulations, methods of reconstruction and complications. RESULTS: A total of 20 cases of disarticulation with complete records were obtained, this constituted 24.7% of total mandibular resections in the department. There were 9 males and 11 females with a male: female ratio of 1:1.2. The age ranged between 13 and 59 years with a mean of 30.4 years (std. 12.0). Sixteen patients received autogenous bone graft; two were stabilized using Steinman's pins and two with reconstruction plates. One bone graft and one reconstruction plate were removed because of infection and exteriorization respectively. Condyle was not replaced in any case. Outcomes were satisfactory but jaw deviation on opening was a common complaint in all cases. CONCLUSION: Condylar disarticulation accounts for a considerably high percentage of mandibular resection in our centre. Non vascularized immediate bone grafting without actual joint reconstruction was common. No disarticulation was carried out for traumatic reasons.

Oral squamous cell carcinoma, socioeconomic status and history of exposure to alcohol and tobacco.

Oral squamous cell carcinoma, traditionally a disease of elderly men with a history of chronic exposure to the carcinogenic effects of tobacco and alcohol, is presently being more frequently diagnosed both in a younger patient population and in those not exposed to these carcinogenic substances. At our center, most patients with oral squamous cell carcinoma are not involved in the use of tobacco or alcoholic beverages and are mainly of a low socioeconomic class. This hospital-based case-control study was designed to assess if the risk of developing intraoral squamous cell carcinoma in Ibadan, Nigeria, was associated with the use of tobacco, alcohol, or socioeconomic status. Medical records of patients with histological diagnosis of squamous cell carcinoma of the oral cavity at the University College Hospital, Ibadan, between January 1990 and December 2008 were analyzed. Only 26% of patients gave a positive history of exposure to tobacco, alcohol, or both; of this number, 20.3% used tobacco, while 18.8% consumed alcohol and 13% used both. Although 24.6% of the cases were of high socioeconomic class, there was no significant difference in the distribution of oral cancer patients in the 2 socioeconomic classes. This study revealed an important deviation from expected amongst the oral squamous cell carcinoma patients diagnosed at Ibadan, thus raising the possibility of a different etiology for oral cancer in our population and the need for research focused on identifying possible risk factors.