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.

Pattern of gunshot injuries as seen at the National Orthopaedic Hospital, Enugu: January 1999 December 2004.

BACKGROUND: Civilian gunshot injuries are common in our environment. Hospitalisation for this appears to be on the increase especially around the periods of general elections, but studies on the peri-election pattern are lacking. This report examines the pattern of gunshot injuries seen at an apex trauma centre spanning the periods of two general elections. PATIENTS AND METHODS: This hospital based retrospective study reviewed all admissions into the trauma unit of the National Orthopaedic Hospital, Enugu over six years (January 1999 December 2004). The sources of data were the trauma unit admission registers, nurses' report books, and the case notes of the patients. Simple arithmetic analysis was used. RESULTS: Of 6,765 trauma admissions in the period, gunshot injuries accounted for 306 (4.5%). In 1999 and 2003 they accounted for 6% and 8% of all trauma admissions respectively The overall pattern over the six year period shows the incidence rises from January to a peak in May However in the election year 1999, a progression in incidence immediately following May (the month of hand-over) rising to a peak in August was noted. CONCLUSION: A definite increase in presentation of gunshot injuries exist in the years of general elections.