A survey of facial nerve dissection techniques in benign parotid surgery among maxillofacial and ear, nose, and throat surgeons in Nigeria.

OBJECTIVE: The aim of the present study is to identify the facial nerve dissection technique routinely used during parotidectomy for benign parotid tumors by Nigerian Oral and Maxillofacial (OMF) and Ear, Nose, and Throat (ENT) Surgeons. MATERIALS AND METHODS: A questionnaire-based study was conducted among Oral and Maxillofacial and Ear, Nose, and Throat Surgeons in Nigeria, on their experience with antegrade and retrograde facial nerve dissection techniques in parotid surgery. The respondents were asked to indicate their choice of dissection techniques in revision parotidectomy, limited superficial parotidectomy, and in obese patients with large tumors. They were also asked to indicate if they routinely used perioperative facial nerve monitoring devices in parotid surgery for benign tumors. RESULT: About half (47.5%) of them routinely used the antegrade technique, while only a few (12.5%) used the retrograde technique. A large number of them (40%), however, used a combination of antegrade and retrograde routinely. Technical ease was the main reason for the choice of technique. The antegrade technique was the technique of choice by most respondents for revision parotidectomy (60%) and limited superficial parotidectomy (62%). However, the retrograde approach was the technique of choice by most of them (47%) in case of parotidectomy in obese patients with large tumors. The routine use of perioperative facial nerve monitoring devices is an uncommon practice among OMF and ENT surgeons in Nigeria. CONCLUSIONS: The antegrade approach for facial nerve dissection is the most common technique used in parotid surgery by Nigerian OMF and ENT surgeons. Nigerian surgeons need to consider the retrograde approach in selected cases of parotid surgery especially for localized tumors that are amenable to limited superficial parotidectomy. Inclusion of perioperative facial nerve monitoring devices is also advocated.

A survey of facial nerve dessection techniques in benign parotid surgery among maxillofacial and ear, nose, and throat surgeons in Nigeria

Objective: The aim of the present study is to identify the facial nerve dissection technique routinely used during parotidectomy for benign parotid tumors by Nigerian Oral and Maxillofacial (OMF) and Ear; Nose; and Throat (ENT) Surgeons. Materials and Methods: A questionnaire-based study was conducted among Oral and Maxillofacial and Ear; Nose; and Throat Surgeons in Nigeria; on their experience with antegrade and retrograde facial nerve dissection techniques in parotid surgery. The respondents were asked to indicate their choice of dissection techniques in revision parotidectomy; limited superficial parotidectomy; and in obese patients with large tumors. They were also asked to indicate if they routinely used perioperative facial nerve monitoring devices in parotid surgery for benign tumors. Result: About half (47.5) of them routinely used the antegrade technique; while only a few (12.5) used the retrograde technique. A large number of them (40); however; used a combination of antegrade and retrograde routinely. Technical ease was the main reason for the choice of technique. The antegrade technique was the technique of choice by most respondents for revision parotidectomy (60) and limited superficial parotidectomy (62). However; the retrograde approach was the technique of choice by most of them (47) in case of parotidectomy in obese patients with large tumors. The routine use of perioperative facial nerve monitoring devices is an uncommon practice among OMF and ENT surgeons in Nigeria. Conclusions: The antegrade approach for facial nerve dissection is the most common technique used in parotid surgery by Nigerian OMF and ENT surgeons. Nigerian surgeons need to consider the retrograde approach in selected cases of parotid surgery especially for localized tumors that are amenable to limited superficial parotidectomy. Inclusion of perioperative facial nerve monitoring devices is also advocated

Vestibular disorders among adults in a tertiary hospital in Lagos, Nigeria.

Dizziness is not an uncommon complaint in the Otolaryngological clinics among other symptoms. To a large number of practitioners, the treatment of dizziness remains the same irrespective of the etiology, i.e., anti-vertiginous drugs. The objective of this study was to document the evaluation, causes and treatment of vestibular disorders among our patients. The design includes descriptive prospective study conducted in the Oto-rhino-laryngology and Orthopedic Clinics of Lagos University Teaching Hospital, Lagos and Nigerian Army Audiological Centre, 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria. Adult patients referred to the audiology clinic for dizziness had detailed history obtained by using structured questionnaire. General physical and neuro-otological examinations were done. Clinical diagnoses were made on standardized criteria. The patients had hearing evaluation, videonystagmography (VNG) evaluation using infrared videonystagmography system. X-ray of the cervical spine and computerized tomogram scan of internal auditory meatus and brain when indicated were done. A total of 102 patients were seen with age range between 21 and 90 years. Thirty patients (29.4%) recorded average duration of episode of vertiginous attacks in seconds, 69 (67.6%) recorded within minutes to hours and 3 (2.9%) with no definite pattern. Clinical signs on neuro-otological examination were elicited on 39 (38.2%) of the patients while on VNG the vestibular subtest mainly caloric test was abnormal unilaterally and bilaterally in 47 (46.1%) while with the oculomotor subtests, smooth pursuit tests were abnormal in 5 (6.9%), saccade tests were abnormal in 8 (7.8%) and OPK were abnormal in 9 (8.8%). Peripheral vestibular disorders are common of which benign paroxysmal positional vertigo (BPPV) was seen in 29 (28.4%), Meniere's disease in 22 (21.6%), recurrent vestibulopathy in 20 (19.6%), cervical vertigo in 18 (17.6%), psychogenic vertigo in 2 (2%), vestibular schwannoma, barotraumas and drug-induced vertigo in 1 (1%), respectively, central vestibular disorders of vascular origin 2 (2%), vertebrobasilar insufficiency in 1 (1%), post-traumatic vertigo in 3 (3%) and unknown in 2 (2%). In conclusion, peripheral vestibular disorders are common of which BPPV is the most prevalent. Pre-referral anti-vertiginous medication is common among general practitioners. The practising ORL/Head neck surgeon and orthopedic surgeons must be conversant with the tools of diagnosis, differential diagnosis and treatment.

Experience with prosthetic reconstruction of ear defects at LUTH, Lagos, Nigeria.

AIM: The aim of the article is to report our experience with prosthetic reconstruction of ear defects in Nigerians. MATERIALS AND METHODS: A review of all consecutive cases of alloplastic (prosthesis) reconstruction of auricular defects was conducted at the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital. Data collected included age and sex of patients, aetiology of defects, site of defects (left or right), lost tissue (partial or total), material used for the fabrication, and mode of retention of the prosthesis. RESULTS: A total of 33 consecutive patients who had prosthetic reconstruction of auricular defects during the period were included. The male-to-female ratio was 3.7: 1. Six cases (18.2%) were congenital defects and 27 (81.8) cases were acquired defects. Three (50%) of the congenital cases were microtia. Majority (63%) of the acquired cases were due to road traffic crashes. Total loss of the auricle was recorded in 22 (66.7%) patients. Of the patients with partial loss of the auricle, pinna was the major structure lost in 5 patients while pinna +lobe were lost in another 5 patients. Silicone elastomers was the most frequently used material for the fabrication of auricular prostheses (29 patients). The most frequently used retention method was silastic medical grade adhesive. CONCLUSIONS: Prosthetic option is a valuable technique for the reconstruction of ear defect. The primary indication for prosthetic reconstruction of ear defect in the present study is acquired ear deformity; mainly due to road traffic crashes.

Surgery of parotid gland tumours in lagos: a 12 year review.

BACKGROUND/AIM: Tumours of the parotid gland are not common. Parotid tumours can pose a challenge both in diagnosis and treatment. Various factors contribute to the management difficulties of parotid tumours for the Head neck surgeon. The aim of the study is to determine the presentation and management of parotid tumours requiring surgery at the Burns and Plastic and Otolaryngology (ORL) units of the hospital. MATERIALS AND METHODS: This is a retrospective study carried out at the Lagos University Teaching Hospital from January 1994- December 2005. The medical case notes were reviewed for information on age, sex, clinical presentation, surgical management, histological diagnosis and outcome. RESULTS: A total of 58 patients with parotid tumours were seen with ages ranging from 25-65 years. Male to Female ratio was 1.4:1. Forty-two (72.4%) presented with firm preauricular swelling, 1.7% as dumb bell tumour and post surgical recurrence tumour respectively, 6.8% as tail of parotid tumour and 3.5% as bilateral disease. 93.13% had superficial parotidectomy. Histological diagnosis confirmed 65.5% as pleomorphic adenoma, 20.72% as carcinomas of which adenoidcystic and mucoepidermoid tumours were the commonest,3.45% as lymphoma and 1.7% as Sjogrens syndrome, oxyphil and Warthins tumour respectively. Immediate post surgical facial nerve palsy was seen in 69% and recovery was seen in 62% within 3-9months. Post surgical radiotherapy was given to 8.6%. CONCLUSION: The commonest parotid salivary gland tumour requiring surgery is pleomorphic adenoma, presenting as a pre-auricular mass and the commonest post- surgical complication was facial nerve palsy involving the mandibular branch. A good knowledge of the surgical anatomy of the gland, clinical behaviour and biologic nature of the tumours will ensure better surgical management.

Otolaryngologic manifestations of gastro-oesophageal reflux disease in Lagos.

BACKGROUND/AIM: Gastro-oesophageal reflux disease(GERD) is not an uncommon disease in Nigeria. The otolaryngologic (ORL) symptoms associated with GERD are varied. In the management of patients with ORL symptoms and disease, GERD is often not considered as a differential diagnosis The aim of this study is to identify patients with ORL complications of GERD from patients with ORL disease who have symptoms that mimic GERD using defined criteria in the light of limited diagnostic facilities. MATERIALS/METHODS: A prospective study was conducted over a two year period at Lagos University Teaching Hospital Lagos and two private Otolaryngology clinics,within Lagos, among patients who presented primarily with laryngeal and pharyngeal symptoms . They were evaluated using structured questionnaire for duration of regurgitation, heartburn ,symptoms of peptic ulcer disease, clinical examination, esophagogastro - duodenoscopy findings and outcome of laryngopharyngeal symptoms following anti-reflux therapy. RESULTS: A total of 92 patients were evaluated over a two year period .ORL diseases and symptoms at presentation were chronic laryngitis, chronic pharyngitis, globus pharyngeus, globus and chronic laryngitis, laryngeal carcinoma, cricopharyngeal spasm and throat hawking. History of symptoms of peptic ulcer disease and regurgitation was obtained in 47.8% and 65.2% respectively. Endoscopic findings revealed oesophageal reflux with gastroduodenits in 4.3%, Non specific gastritis in 17.4%, duodenal ulcer in 56.4%, and normal findings in 21.7%. Patients were treated medically with antacids, H2 antagonists, proton pump inhibitors and were followed up for 9-12 months. GERD was diagnosed in 4 (4.34%), 68 (73.9%) were diagnosed as non erosive reflux disease (NERD) and 20 (21.74%) with probable acid related problem that will need further evaluation . Following anti-reflux therapy 68 (73.9%) had disappearance of their laryngopharygeal symptoms for up to a year. ORL complications of GERD/NERD was seen in 72 (78.3%). CONCLUSION: GERD should be a differential diagnosis in patient with pharyngeal and laryngeal symptoms not associated with sinus disease in the presence or absence of positive peptic ulcer disease or regurgitation and the management should be multidisciplinary.

Communication disorders in Nigerian children.

BACKGROUND/AIM: Communication disorders have been acknowledged as a major public health issue because they compromise early childhood development, restrict vocational attainment and undermine the economic well being of the society. The aim of this study is to determine the pattern of communication disorders among children in a developing country and the requisite intervention services. MATERIALS AND METHODS: This prospective study was conducted in Lagos University Teaching Hospital, Lagos between January 2002 and June 2003 among children aged 6 months to 15 years that presented in the audiology clinic of the hospital with communication disorders. All the patients had neurological, otolaryngological, audiological and speech evaluations. RESULTS: A total of 184 patients were seen during the period out of whom 136 (74%) were between the ages of 6-47 months. Hearing impairment was documented in 120 (65.2%) children, speech disorders in 56 (30.4%), rhinolalia 2.2% and stuttering 2.2%. Of those with hearing impairment, 70% had delayed speech and language. Among children with speech disorders 78.6% had specific language impairment (SLI). Aetiological factors recorded for the communication disorders were seizures 10.9%, measles 8.7% meningitis 8.7%, birth asphyxia 6.5%, otitis media with effusion (OME) 4.3%, kernicterus 4.3%, congenital deformity 4.3%, ototoxicity 2.2%, cerebral palsy 2.2%, and undetermined causes 47.9%. CONCLUSION: Hearing impairment is the commonest communication disorder. Early detection and appropriate follow up is recommended for all children in their first year of life. The role of parents and caregivers in seeking early help should be strengthened while capacity building for the training of more audiologists and speech therapists should be pursued rapidly.

Post irradiation hearing loss in head/neck patients in Lagos; Nigeria

A prospective study was conducted at Lagos University Teaching Hospital on patients with malignancies of the head and neck region treated with external beam irradiation type and severity of hearing loss. Each patient had a preirradiation and post irradiation pure tone audiogram at 3 weeks; 8 weeks and 6 months. Following completion of radiotherapy serial post irradiation audiogram threshold was compared with pre-treatment threshold. An increase of 10 dB HL (decibel hearing level) or greater was considered significant. Radiation dose ranged from 45-55Gy in twenty to twenty-five fractions per weeks over four to five weeks treatment. Patients that received chemotherapy as adjunctive to therapy during the period of the study were excluded. A total of 40 patients (80 ears) completed the audiological follow up out of ninety four patients seen during the study period .Age ranged between 4-79 years. The tumor site distribution showed 20

Prognostic factors in the management outcome of carcinoma of the larynx in Lagos.

This is a retrospective analysis on the prognostic factors in the management outcome of clinically and histologically diagnosed carcinoma of larynx seen in Lagos University Teaching Hospital between 1996-1999. Various prognostic factors have been documented as determinants on the probable outcome of carcinoma of the larynx, such as duration of symptoms, smoking, medical status of the patient, degree of differentiation, size and site of tumour and presence of cervical lymph node. Thirty-six patients between 1996-1999 were reviewed, with a male to female ratio of 11:1, and peak age group of occurrence in 50-59 years, majority (86.12%) of which were non-smokers who presented in varied degrees of airway obstruction necessitating pre-treatment tracheostomy in 70% of the patients with more than 50% presenting within 3-6 months of onset of initial symptom. The tumours were staged clinically and histology revealed well differentiated T3 glottic tumour without any clinically palpable neck node in more than 50% of the patients which should predict a better outcome. But the interplay of many prognostic variables like pre-treatment tracheostomy and its attendant complications, supposed biological aggressive tumour in a non-smoker, coupled with treatment biased by patients, high costs of treatment, logistics and poor follow up compliance, resulted in poor outcome of our management.