Nigerian Journal of Oral and Maxillofacial Surgery
Distraction Osteogenesis of the Mandible: Report of a case
Distraction osteogenesis is a relatively new modality for the management of asymmetric mandibles. It involves the gradual distraction of osteotomised segments of bone to produce bone lengthening at the site of osteotomy. The aim of this paper is to present a case of unilateral mandibular hypoplasia treated using distraction osteogenesis at Aminu Kano Teaching Hospital, Kano. A 12 year old boy with left sided mandibular hypoplasia was treated using distraction osteogenesis. A bi-directional distractor was used to increase both ramal height and mandibular corpus length. A distraction rate of 1mm per day with a 12 hourly rhythm of 0.5mm activation was done for both ramal and corpus lengthening. A gain of 10mm and 23mm in mandibular ramus height and corpus length respectively was achieved with improvement of the patient’s facial profile. There was no significant occlusal derangement at completion of treatment. Distraction osteogenesis remains a versatile treatment modality for the correction of skeletal deficiencies in the body including the mandible. There was also appreciable soft tissue growth accompanying bone lengthening
Copyright (c) 2025 Nigerian Journal of Oral and Maxillofacial Surgery
Pierre Robin Sequence: Review of Literature
Pierre Robin sequence is a condition with the typical triad of micrognathia or retrognathia, cleft palate (classically U-shaped but V-shaped may occur usually without cleft lip and glossoptosis. Originally described by St Hilaire in 1822, Pierre Robins published a case of an infant with the condition in 1926. Pierre Robin Sequence is called a sequence because the underdeveloped lower jaw commences a sequence of events which leads to the abnormal displacement of the tongue and consequence formation of a cleft palate. The condition presents with bearing, respiratory and feeding problems. In this review, the historical background, aetiopathogenesis, clinical presentation and the evaluation of the condition are described. The various methods of treatment and the complications are also discussed.
Facial Reconstruction with Bimaxillary Orthognathic Surgery: A case report
Symmetric facial appearance is an important determinant of facial aesthetics. Bimaxillary orthognathic procedures can be used to restore facial symmetry in complex facial deformities. We present a case of 30 year old female nurse who presented with obvious facial asymmetry involving both the maxilla and mandible bilaterally. The right maxilla and mandible were hypoplastic while the left side was hypertrophic. There was an associated maxillary occlusal canting. The patient underwent a bimaxillary orthognathic surgical procedure. Facial symmetry was achieved intra-operatively and was maintained post-operatively. A horizontal occlusal plane was achieved with an acceptable occlusion. Bimaxillary orthognathic surgery is an option for facial reconstruction in selected cases with skeletal discrepancies of both jaws. Adequate preoperative planning, investigations and preparation are imperative for successful treatment. The indications, patient preparation and procedures for bimaxillary orthognathic surgery were highlighted.
Comparison of two pain assessment tools in patients undegoing routine dental extraction
Background: There are numerous tools currently utilized for measuring pain and each has its advantages and constraints. The visual analogue scale (VAS) is considered to be a sensitive rating scale however the fact that it must be marked by the patient itself poses a problem to the physically challenged, the elderly and mentally ill patients. A new pain measurement scale; full cap test (FCT) is said to have the benefits of VAS without its practical problems. Objectives: To assess the validity of full cap test (FCT) as a pain measuring scale in routine dental extractions and compare the FCT with visual analogue scale (VAS). Materials and Method: A comparative study of two pain measuring tools in subjects undergoing intra-alveolar extractions. All consecutive subjects aged 18 years and above who presented for intra-alveolar extraction of permanent teeth under local anaesthesia. Preoperatively, subjects were asked to evaluate degree of pain experienced on a scale first and then Full Cap scale. Immediately after extraction, subjects were asked to evaluate degree of pain experienced during extraction using VAS and then Full Cap scale. The mean value of the pain experienced using either VAS or FCT was compared with Independent t-test. Cronbach's alpha and Pearson correlation analyses were used for reliability and correlation between the two pain measuring scales respectively. Results: A total of 100 subjects (male, 52; female 48) participated in the study with a mean age of 35.9 ± 15.9 years. Preoperative Mean VAS and FCT scores were 1.2 ± 1.5 and 1.5 ± 3.5 respectively (p=0.94). Mean VAS and FCT scores for pain during extraction was also not significant (VAS=1.5 ± 2.1, FCT=1.5 ± 2.2) (p=0.98). Both VAS and FCT had a high reliability coefficient (Cronbach’s α=0.99) and they were also well correlated (r=0.99). Conclusion:Mean VAS and FCT scores did not differ significantly, they were correlated, and they had a high reliability coefficient. FCT is a reliable pain measuring tool when compared with VAS in subjects undergoing intra-alveolar extraction. FCT correlates well with VAS scores. Therefore, FCT is recommended as a pain measuring tool in dental and maxillofacial research.
Anterior Temporomandibular joint dislocation: A report of three cases
Anterior temporomandibular joint (TMJ) dislocation is a distressing condition that can occur with everyday activities, mandibular manipulations, use of some medications and trauma. Diagnosis of this condition is made from a careful history and clinical examination complemented with imaging investigations. The treatment options available for anterior TMJ dislocations vary from conservative treatment to complex surgical procedures but there is still no consensus on the best treatment option. We report the presentation of anterior TMJ dislocation in three young men. Conservative treatment was successful in two but the third patient developed chronic recurrent dislocation that required bilateral eminectomy.
An audit of cT4a Head and Neck Cancer Treatment: A preliminary study from a Regional Head and Neck Unit
Background: Head and neck cancer (HNC) is the sixth commonest cancer worldwide, with oral and pharyngeal squamous cell carcinoma types constituting about 75% of these HNC group. Objective: To review the treatment of patients with cT4 HNC of the oral cavity, parotid gland, pharyngeal and laryngeal sites at a Regional Head and Neck Cancer Division. Materials and Methods: The entry data book and medical records of cancer patients treated at the regional head and neck cancer division of the University Teaching Hospital (L-ASUTH), Lagos were reviewed for the study. Patients’ data collated included: biodata, clinical and histopathological data, treatment and outcome. Results: A total of 12 patients met the inclusion criteria for this study. Of these, six (50%) were females and six (50%) were males. Histopathological types were: seven (58.3%) squamous cell, three (25.0%) mucoepidermoid, one (8.3%) adenocarcinoma and one (8.3%) mesenchymal carcinoma patients had clinical nodal metastasis. Six patients had N₀ (50%), one had (14.3%) N₁, five out of seven patients who exhibited clinical evidence of nodal metastasis underwent neck dissections (NDs) were performed able major reconstructive surgeries were carried out inclusive of four pectoralis major myocutaneous (PMMC), two radial forearm free flaps (RFFF), one delto-pectoral flap (DPF) and one temporalis tendon transfer (TTT). Conclusion: While the small sample size may not allow an inference conclusion from this study, surgery with adjuvant chemotherapy and radiotherapy improve the appropriate outcome of patients with cT4 HNC. Early presentation of patients and appropriate treatment modalities are important for good prognosis in these patients.
Pattern of Maxillofacial Fractures at a tertiary referral hospital in Sokoto, North-Western Nigeria
Background: Maxillofacial fractures constitute the bulk of oral and maxillofacial trauma services in developing countries globally and places heavy burden on the dwindling resources of hospitals of these countries. Objectives: The aim of this study was to describe the aetiology and pattern of maxillofacial fractures at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Materials and Methods: Thirty two patients that were diagnosed and treated in our centre between January 2012 and December 2012 were enrolled in the study. The diagnosis was based on clinical and radiographic examinations. The parameters recorded were aetiology, age, gender, site of fractures, treatment and complications. Results: Our patients' age ranged from 8 to 65 years (30.2 years ± 12.0). Ninety six point nine percent were males and 53.1% were in the 21-30 year group. Road traffic crash was the leading cause of injury (84.4%) mostly in commercial motorcycle riders and their pillion passengers. Approximately half of the fractures involved the mandible and the most common site was the parasymphysis (41.7%). Conclusion: The use of crash helmets, seat belts and adherence to traffic rules among road users must be promoted. It is imperative to move away from dependence on commercial cyclists and institute a functional public transport system. Paradigm shift from closed reduction to open reduction and internal fixation (ORIF) should be encouraged.
Maxillofacial Trauma in Ibadan/ Nigeria revisited: Challenges to Oral and Maxillofacial Surgery trainees. Which way forward?
In the 1980’s, the West African College of Surgeons and the National Postgraduate Medical College of Nigeria granted accreditation status to some major teaching hospitals in the West African Sub-region and Nigeria for the training of qualified doctors and dental surgeons. The objective was to produce specialists that would be able to meet the health needs of the country and the West African subregion as a whole. Before this time, specialists in Nigeria and other developed parts in the world like United Kingdom, Europe and United States of America. At the inception of the training programmes, the training institutions were well funded and had good infrastructures. The cost of medical care was affordable to the average patient and there were dedicated medical personnel. The number of patients was adequate for the training of the resident doctors at the end of the resident programme, it was certain that the trainee had obtained a sound training in the chosen specialty. However, currently, many factors are militating against the training of residents. These economic, political and social factors have negative effects on the training of residents and the specialty of Oral and Maxillofacial Surgery is not unaffected. The training of a resident in the management of maxillofacial injuries is a very important aspect of the training of a trainer maxillofacial surgeon. There is no doubt that early and exact management of maxillofacial injuries is very essential because of the location of these injuries because if improperly managed could lead to serious emotional and socio-psychological problem for the patient. In this article, the history of the residency programme in Nigeria and the West Africa, the current challenges faced with the training of a resident in maxillofacial traumatology are highlighted. The possible solutions to the problems are enumerated.
Ectrodactyly-Ectodermal Dysplasia-Clefting (EEC) Syndrome In A Nigerian Child
Ectrodactyly-Ectodermal dysplasia-Clefting (EEC) syndrome is a rare genetic disorder characterized by three cardinal signs, which are ectrodactyly, ectodermal dysplasia and orofacial clefts. We report a case of EEC syndrome in a 9-month-old Nigerian male. To the best of our knowledge, this is the first reported case in the University of Benin Teaching Hospital and probably in Nigeria.
External Carotid Artery Ligation: A Report Of Four Cases
External carotid artery ligation is an uncommon surgical procedure, although its use as a life saving measure either preemptively or in an emergent situation has been reported in literature. The cervico-orofacial region is highly vascularized, therefore surgeries involving this region may be occasioned by excessive hemorrhage. In addition, certain tumours of the cervico-orofacial region have a propensity for extreme hemorrhage, especially when large. Carotid blow out may also constitute an emergency that requires immediate remediation. We report 4 cases where ligation of the external carotid artery was done with the aim of controlling hemorrhage. The patients were aged 8-45 years, with a median age 21.5 years. One case of carotid blow out secondary to an infected mandibular fracture, two cases of ossifying fibroma and one case of osteogenic sarcoma were included in this study. Two of the patients had temporary external carotid artery ligation, while the others had permanent ligation. Subsequent reviews were satisfactory and no complication was recorded. Hemorrhagic shock is a formidable cause of mortality in our environment. Although other modes of controlling hemorrhage arising from maxillofacial surgeries / injuries exist, their availability/accessibility may be a challenge. External carotid artery ligation offers a relatively obtainable alternative to other techniques of hemorrhage control.
Care Of Maxillofacial Surgery In-Patients: Is There A Need For Post Basic Nursing Training In Maxillofacial Surgery?
Introduction The successful management of surgical patients requires a team of well trained personnel including surgeons, nurses and other ancillary staff. The evolution of specialization in the field of surgery has led to concomitant specialization in nursing care beyond the basic nursing training. In Nigeria, this is typified in Ophthalmology, Otorhinolaryngology, Plastic surgery, Orthopaedics and Gynaecology. Statement of the Problem Continuous increase in surgical skill base in maxillofacial surgery in Nigeria, especially in the areas of microvascular reconstructive surgery, orthognathic surgery, distraction osteogenesis and temporomandibular joint surgeries necessitate attendant improvement in maxillofacial nursing care. Presently in Nigeria, in-patient maxillofacial surgical care is attended to by general nurses or specialized nurses in otorhinolaryngology and ophthalmology. These groups of nurses have limited knowledge and understanding of the orofacial region and may encounter varying degree of challenges in the nursing care of maxillofacial in-patients. At present, the Dental Surgery Assistants (DSA) who have some level of dental education and assist the oral and maxillofacial surgeon during out-patient surgical procedures have no role in the management of maxillofacial surgical in-patients as they are only trained to assist the dental surgeons in the clinics. There is therefore a need for advocacy to make a case for the post basic training of personnel providing maxillofacial nursing services and care. Conclusion The level of care received by maxillofacial surgical in-patient is at present that offered by general nurses and at best, that provided by post basic nurses from allied surgical specialties. Nurses or dental surgery assistants with post basic training in maxillofacial care would ideally be best suited to provide sound nursing care of maxillofacial in-patients.
An Epidemiological Study Of Mandibular Fractures In Benin-City, Nigeria
Introduction: The mandible is the bone of the lower third of the face. The mobility of the mandible, presence of teeth and its prominence makes it prone to fracture. Despite abundant reports about the incidence, diagnosis, and treatment of mandibular fracture in literature, there is limited knowledge about the specific type or pattern of mandibular fractures in Benin-City, Nigeria. Materials and Methods: This is an observational epidemiological study conducted at the University of Benin Teaching Hospital, Benin-City, Nigeria between January 2013 and June 2014. The diagnoses of mandibular fractures were made based on clinical history, signs and symptoms, and a correct interpretation of plain radiographs. Relevant radiographs used include postero-anterior view of the jaws, skull, right and left oblique lateral views of the mandible, and panoramic view. All patients (managed as in-patient or out-patient) with clinical and radiological diagnosis of mandibular fractures were recruited into the study. Results: More males (57.0%) than females sustained mandibular fractures. Most patients (39.2%) were in their third decade of life, whereas only 1.3% of the study population was aged over sixty years. The implicated aetiologies included motor vehicle accidents (MVA), inter-personal violence, falls, sporting activities and gunshot. MVA contributed (52; 65.8%) of the cases to emerge as the major cause of mandibular fractures. The single most implicated cause of MVA was failed brakes, accounting for 28 (53.9%) of all 52 cases resulting from MVA. The reason(s) for MVA could not be ascertained in 2 (3.9%) cases. Conclusion: Males are more prone to mandibular fractures. Individuals in their third decade of life are the most likely to sustain a mandibular fracture while MVA remains a major cause of mandibular fractures in patients presenting at Benin-City.
Clinical Pattern And Distribution Of Cleft Deformity Seen In Two Northern Nigerian Hospitals
Introduction A retrospective study was conducted at two referral hospitals under the smile train project for a 4-year period (January 2012 to December 2015) to determine the hospital-based epidemiology of cleft lip and palate in Northern Nigeria. The objective of this study was to establish the frequency, laterality, age at presentation and gender distribution of cleft lip and palate seen at the two Northern Nigerian hospitals. Materials and Methods Cleft lip and/or palate records were obtained from patient files from the Medical Record Departments of University of Maiduguri Teaching Hospital (UMTH) and Mercy land Specialist Hospital (MSH), both in Maiduguri, Borno State. Information obtained included age at presentation, sex, cleft type and laterality. In addition, presence of associated congenital anomalies or syndromes were also recorded. Results A total of 811 cases of non-syndromic and 15 (2%) syndromic cleft cases were seen during the period of the study. A wide age range at presentation was observed (1 month - 65 years) with about 69.7% of all cleft cases presenting within the first decade of life. The average age of presentation was 7.1 years. Males were more predominant in all age groups. The most common cleft type was unilateral cleft lip only (UCL) constituting 77% of all cleft deformities. The distribution of clefts by side showed a preponderance of the left side (60.8%). The association between cleft type and laterality was statistically significant (p = 0.048). Conclusion This study observed that unilateral cleft lip was the most common presentation in Northern Nigerian children.
Proximal Tibial Cancellous Bone Grafting In Mandibular Reconstruction: Experience From Sokoto, Northwest Nigeria
Introduction Use of proximal tibia as a donor site has been applied in reconstruction of maxillofacial defects. Cancellous bone graft is available for harvest from the medial and lateral aspects of the proximal tibia. Knowledge of important anatomic landmarks can be used preoperatively to allow for safe dissection and harvest of autogenous bone from the proximal tibia. The purpose of this study was to highlight our experience with the use of proximal tibial cancellous bone graft in the reconstruction of oral and maxillofacial defects and to evaluate donor site morbidity following its harvest. Material and methods The medial and lateral approaches to proximal tibia were described with detailed landmarks and anatomic relationship as reported by Benninger B et al. A review of patients who underwent this technique at Usmanu Danfodiyo University Teaching Hospital, Sokoto in a 2- year period is reported. Results A total of 12 patients were seen during the review period. There were 6 males and 6 females aged 23-50 years. Eight (66.7%) cases had medial approach, 2 (16.6%) cases had lateral approach and 2 (16.6%) cases had combined approach. Complications observed at donor sites were excessive immediate postoperative bleeding and unsightly scarring. Conclusion The medial and lateral proximal tibial bone are useful sites for obtaining cancellous bone graft. Choice of approach in the harvest of proximal tibial bone should be patient specific, giving due consideration to the volume of bone required, desire for early ambulation and presence of underlying systemic disease that may impair wound healing (e.g. diabetes mellitus).
Passing the Surgical Baton: What We Learn from the Masters
Massive Anterior Chest Wall Abscess Complicating Impacted Mandibular Third Molar Infection- A Case Report
Purulent material from odontogenic infection can occasionally burrow deeply and spread from the initial origin of the infection to fascial spaces or planes far from the oral cavity like the mediastinum or retropharyngeal region. However, abscess collection in the anterior chest wall as a complication of odontogenic infection is uncommon. We report a rare case of massive anterior chest wall abscess arising from odontogenic infection involving an impacted mandibular third molar in a 40-year-old Nigerian female. Incision and drainage of the abscess and extraction of the offending tooth were done consecutively. Patient’s management was severely hampered by the inability to afford the cost of investigations and treatment. However, despite this constraint there was remarkable recovery. She was followed up for 8 months without any adverse event or recurrence.
Tetralogy Of Fallot: A Case Report And Dental Considerations
Tetralogy of Fallot (TOF) is not a commonly encountered case in dental practice. We report an 8-year old boy with Tetralogy of Fallot, who was referred to our clinic from the Paediatric Cardiology clinic on account of retained primary teeth. Examination revealed plethoric conjunctiva, bilateral finger and foot clubbing, hyper-pigmented skin rashes and central cyanosis. Intraoral cyanosis of the gingiva, tongue and oral mucosa, retained lower deciduous central incisors, lingually placed permanent lower incisors were observed. Patient had successful dental extractions with adequate antibiotic prophylaxis, pre-oxygenation and oxygen saturation monitor. Post-operative condition and follow up were uneventful.
Orbital Infection Of Odontogenic Origin: A Report Of Two Unusual Cases
Orbital infection of odontogenic origin is rare. Both preseptal cellulitis and orbital cellulitis occur more commonly in the pediatric population. A common cause of preseptal and orbital cellulitis is extension of infection from the paranasal sinuses. This article presents two unusual cases of orbital cellulitis and preseptal cellulitis (periorbital cellulitis) following odontogenic infections, seen in adult patients. The clinical presentation, treatment and the treatment outcome of the two cases are hereby highlighted.
Knowledge And Scope Of Local Anaesthetic Use Among Nigerian Dentists
Background: To ensure excellent pain management, many local anaesthetic agents (LAA) are available in dentistry. These agents have varying properties that bestow on them comparative advantages for various dental procedures and in patients with specific medical needs. Consequently, it is desirable for dentists to be duly informed of available LAA and use them appropriately in patient care. This survey was designed to know if Nigerian dentists avail themselves of the variety of LAA available and determine their unmet LAA needs, if any. Materials And Methods: An online survey with the aid of Google form was conducted. The web-link to the form was delivered through the email addresses of Nigerian dentists. Two reminder emails were sent at monthly intervals to improve response rate. Specific items assessed include awareness, knowledge, use, factors affecting pattern of use and unmet need of LAA. Results: The response rate was 25.8%. Almost all surveyed dentists (98.2%) used LAA routinely in practice; but this was only lidocaine in 87.5% of the respondents. The near-exclusive use of lidocaine was because it was the only agent available to 93.6% of respondents. Dentists with higher education and longevity in practice were more likely to have used other agents. Fifty-four (47.4%) respondents have unmet anaesthetic agents needs. The agent most desired, for its long duration of action, but reportedly unavailable was bupivacaine. Conclusion: Nigerian dentists predominantly use only lidocaine because of its availability. However, many of them expressed need for other LAA especially the long acting bupivacaine.
Structure And Outcome Of The First Basic Surgical Skill Course In Oral And Maxillofacial Surgery In A Low Income Country
Background: Acquisition of basic surgical skills is fundamental to achieve safety and proficiency in the practice of all surgical specialties. Despite the apparent benefits of basic surgical skills courses, these have not been incorporated into oral and maxillofacial training in low-income countries like Nigeria. Objectives: This paper presents the structure and outcome of the first basic surgical skills course in oral and maxillofacial surgery organized by the West African College of Surgeons at University College Hospital, Ibadan, Nigeria using locally adapted materials. Methods: The course was a two-day programme with seven sessions: theatre room routine, surgical knot tying, wiring techniques, osteosynthesis, suturing techniques, third molar surgery and vessel ligation procedure. Each of the sessions consisted of a short instructional lecture and a practical session. The course was assessed based on pre- and post-tests and participants’ perception of the course. Mean scores were compared using student t-test. Statistical significance was set at p<0.05. Results: Twenty junior residents participated in the course, 10 males and 10 females with a mean age of 34.4 (SD ± 3.717) years. The mean scores of the pre- and post-tests were statistically significant with p = 0.000 and 0.014 for the theory and practical sessions respectively. The course was given an overall mean score of 8.68 (SD ± 0.820) out of a maximum of 10 points. Conclusion: OMS BSS is a valuable course that has a significant impact on skills acquisition in oral and maxillofacial surgery.
Penetrating Craniomaxillofacial Arrow Injuries: A 14-year Review of Epidemiology, Clinical Presentation and Management at a UK Northern Nigerian Tertiary Facility
Background: This study sought to assess the presentation of craniomaxillofacial arrowy injuries (CAIs) at the Department of Oral and Maxillofacial Surgery, Aminu Kano Teaching Hospital (AKTH) and to highlight the management protocol we adopted. Methods: Using a proforma, information on all patients who presented at the Accident and Emergency unit (A&E) of AKTH with CAIs over a 14-year period (April 2002 - March 2016) was retrieved. These were pooled and the data was analyzed using SPSS version 21 (SPSS statistical software package version 21). Results: 36 patients were admitted from the A&E unit of AKTH with CAIs. They were predominantly males (Male:Female = 5:1). The period prevalence was 1.6%, with the commonest aetiologies being armed robbery attacks (52.8%) and communal clashes (27.8%). Orbital injuries were the commonest presentation (n=11, 30.5%) followed by transpharyngeal injuries (n=8, 22%). Physical examination with intraoral assessment and trajectory analysis of the arrow head assisted in the determination of perioperative management needs. These needs include: appropriate preparation for a variety of potential operative morbidity; imaging: specialty involvement; surgical approach an requirement for fibre-optic assess during intubation. Conclusion: The management of CAIs is a challenge for all specialties involved in the management of penetrating head and neck trauma. We encourage collaboration among participating practitioners for a morbidity free outcome of management. Modification of extraction approach may be necessary in a few selected cases.
A Contemporary Oral & Maxillofacial Surgeon in Nigeria: Wither Art Thou?
Copyright (c) 2025 Nigeria Journal of Oral and Maxillofacial Surgery
Congenital Granular Cell Epulis in a New Born: A Case Report
Congenital granular cell epulis (CGCE) is a rare congenital soft tissue lesion which was first described in 1871. Its widest dimension ranges from few millimetres to several centimetres and may cause obstruction to feeding and breathing. We present a case of six days old female with large pedunculated soft tissue mass measuring about 45mm by 30mm on the maxillary alveolar ridge in the right canine region. A clinical diagnosis of CGCE was made and this was confirmed histologically after surgical excision under general anaesthesia.
A Retained Intra-Orbital Foreign Body Secondary to an Industrial Accident: A Case Report
The term intra-orbital foreign body refers to an object that lies within the orbit but outside the globe. Lodgement of such foreign bodies usually occurs after a high velocity injury such as gunshots or industrial accidents. We present a case of a retained intra-orbital foreign body secondary to an industrial accident (precisely a step-down electric transformer explosion) in a 33 year-old Nigerian male. To the best of our knowledge, this is the first reported case in the University of Benin Teaching Hospital and probably in Nigeria.
Pattern of Orofacial Clefts: A Study of 673 Cases in Northcentral Nigeria
Background: Orofacial cleft prescntacion has been shown to have geographical variation. The objective of this study was to determine the pattern of orofacial cleft presentation in Northcentral, Nigeria. Materials and Methods: We studied orofocial cleft patients seen in the Nigerian Northcentral zone between 2011 and 2017, at University of Abuja Teaching Hospital as well as during outreach programmes by Cleft and Facial Deformity Foundation. Information retrieved from patients' notes included age at presentation, gender, gestation period, type of cleft, family history of cleft and associated abnormalities. Data collected was analyzed using Statistical Package for the Social Sciences (SPSS) version 23 (SPSS Inc, Chicago IL, USA). Results: A total of 673 patients were included in the study. Cleft ratio recorded was Cleft Lip (CL); 56.6%, Cleft lip & Palate (CLP); 19.0% and Cleft Palate (CP}; 12.5%. There were 85 unilateral complete cleft palate (UCLP) and 43 bilateral cleft lip and palate (BCLP) with ratio UCLP:BCLP of 2:1. Unilateral cleft lip was higher than bilateral cleft lip in the ratio of 8.7:1. Forty four (6.5%) patients had a positive family history of cleft lip and/or palate, 4.2% had associated abnormalities and 5.3% had atypical facial clefts. Conclusion: Pattern of cleft presentation is similar to earlier reports, including adult cleft. Significant findings included high percentage of isolated cleft palate as well as unilateral cleft lip being nine times commoner than bilateral cleft lip. Awareness creation and access to surgery , offered by outreach programs have the potential of reducing adult cleft.
Media Labio-Mandibular Glossotomy (MLG) in Oropharyngeal Tumor Excision: The Experience of a Tertiary Care Center in Northern Nigeria
Background: Surgical management of oropharyngeal lesions are usually challenging for head and neck surgeons due to poor access and particularly in large tumors where the need for uneventful tumor delivery and haemostasis cannot be met due to tumor inaccessibility. However, median labio-mandibular glossotomy (MLG) is a viable option to access these lesions in all sections. This study highlighted the benefits of the MLG approach in providing surgical access to oropharyngeal tumors with respect to haemostasis and ease of tumor extirpation. Aim: To review the management of 14 oropharyngeal tumors excised via MLG in a Nigerian maxillofacial centre and show the benefits and outcome of this surgical approach with emphasis on ease of access and haemostasis in the tumors managed. Methods: This is a 5 year (January 2011 - December 2015) retrospective analysis of 14 patients with oropharyngeal tumors whose management required an MLG. Results: Nine male and five female patients aged 12-55 years were successfully managed during the study period. The patients were followed up between two and five years and there was no evidence of recurrence in all the patients managed. Conclusion: MLG provided sufficient exposure for en-bloc excision of oropharyngeal lesions measuring up to 12 cm in its widest diameter. Easy tumor delivery and satisfactory control of haemorrhage makes the procedure excellent. Moreover, no specialized equipment was necessary, making it suitable in poorly resourced head/ neck and maxillofacial facilities.