Perceptions, expectations, and reactions of caregivers to cleft lip and palate repair in a tertiary hospital.

Background: Cleft lip and/or palate (CL/P) deformities are the most common congenital abnormalities of the orofacial structures. Affected individuals experience major clinical, functional, aesthetic and psychosocial impacts. Objectives: The aim of our study was to identify the perceptions, expectations and reactions of parents and caregivers to cleft lip and palate surgery. Materials and methods: Interviewer administered questionnaires were used to collect data from parents/caregivers of patients with cleft lip and/or palate operated on by the cleft team at University of Port Harcourt Teaching Hospital. Results: Only three (2.8%) of the caregivers indicated that they knew the cause of CLP which they attributed to drugs, infections and contraceptives taken while about half of them admitted that they avoided taking these children to certain places. The participants were very concerned about the speech 15 (41.7%) and feeding 9 (25.0%) of the children. Most wanted the surgery performed in order to improve appearance 25 (69.5%), speech 8 (22.2%) and feeding 2 (5.6%). More than half of the parents/caregivers 21 (58.3%) expected excellent results from the surgery whilst 1 (2.8%) expected poor results. Most believed the surgery would indeed make a great difference in speech 14 (38.9%) and appearance 11 (30.6%). Majority, 30 (83%) were happy with the immediate outcome of the surgery and with their hospital experience 13, (36.1%). Conclusions: This study revealed that most parents/caregivers of children with CLP believed this condition to be due to various factors and did not know the etiology. Expectations of the result of surgical repair of CLP surgery were high and their reactions were majorly positive.

A prospective epidemiological study on odontogenic tumours in a black African population, with emphasis on the relative frequency of ameloblastoma.

The persistent view in the literature is that the relative frequency of ameloblastomas is higher in the black population than in Caucasians. The aim of this study was to determine the relative frequency of all odontogenic tumours (OT) in a 100% black population and to compare our findings with those of previous studies. A prospective study was undertaken of all patients presenting with OT to all 16 Nigerian departments of oral and maxillofacial surgery over a 4-year period. The following data were obtained: patient demographics, delay to presentation, extent of the lesion, and histological diagnosis. Six hundred and twenty-two cases were studied. A slight male preponderance was observed (male to female ratio 1.17:1). Patients ranged in age from 5 to 89 years, with a peak incidence in the third decade. The relative frequency of OT was 0.99 per million and that of ameloblastoma was 0.76 per million. Ameloblastoma was the most prevalent OT (76.5%), followed by adenomatoid odontogenic tumours (5.6%), odontogenic myxoma (4.5%), and keratocystic odontogenic tumours (KCOT) (3.1%). The relative frequency of ameloblastoma among Nigerians was not different from frequencies reported previously among Caucasian and Tanzanian black populations. KCOTs were, however, rarely diagnosed in Nigerians as compared to the white population in the Western world.

Epidermoid cyst of the tongue causing airway obstruction.

Epidermoid cyst occurring within the tongue is rare. The aim of this article is to discuss the management of an adult patient who presented with respiratory obstruction due to this congenital epidermoid cyst within the tongue. A 32-year-old male patient who was brought to the accident and emergency department of the University of Port Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria was presented. He came with a history of difficulty in breathing as a result of a slow growing swelling of the tongue which started from birth. There was associated pain, difficulty in speech and mastication as the swelling increased in size. Detailed physical examination, sonographic imaging and histopathology were carried out. On examination, patient was acutely ill-looking, in severe respiratory distress, febrile, mildly pale and dehydrated but anicteric. Extra-oral examination revealed mildly protruded upper and lower dento-alveolar arch as well splaying and recession of the anterior and posterior teeth of the upper arch. Intra-oral examination revealed moderately tender, fluctuant and grossly enlarged tongue obstructing the oro- and nasopharyx. A diagnosis of dermoid cyst was made and the patient was booked for surgery after resuscitation. Excision of the cyst was done under general anaesthesia/naso-tracheal intubation by an intra-oral approach. Ultrasound was able to give a thorough assessment of the cystic nature of the swelling while post-operative histopathology was used to confirm the specific type of teratoma. The relationship of the cyst to the intrinsic and extrinsic muscles of the tongue and mylohyoid muscle was relevant to the surgical approach to the lesion.

Traumatic diseases of parotid gland and sequalae. Review of literature and case reports.

Parotid gland injuries are accompanied by a large number of sequelae. The aim of this paper is to highlight the importance of thorough management of these parotid glandinjuries especially at initial presentation in order to minimize the complications that accompany these injuries. A review of the aetiology and management of the existing cases of parotid gland injuries obtained from published journals and internet search as well as a report of two cases managed in our centre is presented in this paper. A total of about 70 cases in the previous literatures were reviewed of which assault was responsible for almost 90% of the cases. Sialoceles and fistulae were the main sequelae of these injuries. More than half of the cases (54%) were managed by conservative methods. Surgical drainage was done in about 44% cases; where the Stenson's ducts were accessible, primary repair was done. Excision of the gland was done in very few cases. The two cases managed in our centre were due to assault from broken bottles and road traffic accident respectively and both were managed by conservative methods. The first patient was a case of sialocele following the injury, which resolved within 3 weeks after the cyst formation with reduction in food intake, aspirations and external surgical drainage; while the second patient was a case of persistent fistula which healed after about 5 weeks following the trauma. Follow-up of both patients for about 3 months revealed no further leakage or accumulation of saliva. Management of these injuries involves a thorough understanding of the structure and function of the parotid gland and closely related tissues.

Metastatic carcinoma of the jaws: a review of literature.

INTRODUCTION: Although metastatic jaw lesions are rare, clinicians must be aware of occurrence and should include them in their catalogue of differential diagnoses with a view to requesting for useful investigations that will aid timely consult and available palliative interventions. The aim of this study is to review and analyze the epidemiological behaviour of jaw metastases that have been reported in literature. METHOD: The review was conducted at the Oral and Maxillofacial Department of the University of Port Harcourt Teaching Hospital. Information was obtained from articles written by various authors in Nigeria and other parts of the world and from the internet services provided by the Information and computer training centre of the University of Port Harcourt. A total of 31 articles were reviewed. The distribution, clinical manifestation at the secondary sites, investigations and treatment of the metastatic jaw diseases from the various primary sites were reviewed and documented. RESULT: A total of 890 cases were reviewed, males were 402 and females were 488. The age range was 13 to 75 years with a mean age 43 years. The mandible was involved more than the maxilla. In 30% of cases, there were no symptoms at the secondary sites, lesion were detected by radiographs and scintiscanning. Other patients presented with jaw/facial swelling and pain. The breast was the commonest primary site in females and the lung in males. Histopathology was used to confirm the metastatic lesions and 61% of them were found to be adenocarcinoma. Less than half of the cases were operable, and surgery of primary and secondary sites was combined with radiotherapy and chemotherapy in these cases. Prognosis was poor with varying survival rates. CONCLUSION: Despite the fact that metastases to the jaws are rare than other bones of the body, these may be the first indication of a malignancy elsewhere in the body and this necessitates that suspected jaw swelling should be thoroughly evaluated to expedite treatment.

Psychological effects of speech disorders in an adult patient with untreated cleft palate.

BACKGROUND: Cleft palate of the primary or secondary type, is accompanied with various devastating physical and psychological effects. The purpose of this case study was to highlight the psychosocial problems the patients with these defects encounter both at the initial and later stages oftheirlives. METHOD: The case study focused on the history and clinical examination of a 25-year-old, single, female patient who presented with hypernasality and misarticulation of speech secondary to an incomplete cleft of the secondary palate which was not treated. RESULTS: The patient was found to break down with tears in the process of discussion about her social life; she disclosed having problems with interacting with the society and especially with her male friends. Examination revealed a 5 centimeter (cm) long and 2 cm wide central defect involving the soft palate/uvula and causing a communication between the oral cavity/oropharnyx and nasal cavity/nasopharnyx. The patient was counseled and asked to come for surgery. However she has not come back since the day she came to our clinic. CONCLUSION: Speech defects in longstanding untreated clefts are not easily correctable and these have associated life-long impact on the quality of life of the patients, therefore, because some parents are afraid of surgical operations and may not want to subject the children to this treatment, this study will enlighten the clinicians to inform and emphasize to the parents/relations about these speech defects and psychological implications that will result if the children are not treated and even at the appropriate time.

Functional and Selective Neck Dissection (IIa) Following Squamous Cell Carcinoma of the Plate

Background: Neck dissection has been an adjunct surgical procedure in the management of malignancies affecting the head and neck region. Radical neck dissection was the original surgical procedure for the treatment of regional neck metastases. The aim of this paper is to report the management of a female patient with regional neck metastases from squamous cell carcinoma affecting the hard palate.Methods: A case report of a 60-year-old patient with squamous cell carcinoma of the palate who later manifested with an enlarged unilateral cervical lymph node ten weeks after surgery on the primary site. A functional and selective neck dissection in which the accessory nerve; internal jugular vein and sternocleidomastoid muscle were preserved and only the lymph node at the IIa level was removed was carried out under local anaesthesia.Results: The malignant ulcer on the palate was excised and the neck was dissected to remove the clinically enlarged lymph node. These procedures were uneventful and patient was referred for post- operative radiotherapy for possible residual tumours.Conclusion: There is need to reduce the morbidity and mortality associated with the radical neck dissection and this has led to the use of various levels of selective neck dissections as in the case presented

Applications of ultrasonography in the diagnosis of soft tissue swellings of the cervicofacial region.

PURPOSE: To determine the accuracy, sensitivity, specificity and prediction values of ultrasound as a means of diagnosis of cervico-facial soft tissue swellings. MATERIALS AND METHODS: We carried out ultrasonographic evaluation of 76 consecutive cases of cervico-facial soft tissue swellings that presented at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria from August 2002 to November 2003. The patients' demographics and relevant clinical information were obtained. Ultrasonographic evaluation was done using the B-mode transcutaneous ultrasonic imaging device with a transducer frequency of 5MHz. All the lesions were subjected to histopathological examination. RESULTS: There were 43(56.6%) males and 33(43.4%) females whose ages ranged from 2 weeks to 70 years (mean +/- SD; 22 +/- 19.7 years). Histologically, tumours constituted the highest percentage of swellings (35.5%), followed by cysts (26.3%). Males were more predominant in all classes of swellings except benign tumours. The accuracy of ultrasound in the diagnosis of pleomorphic adenoma was 80% and 100% for both adenocarcinoma and hemangioma. It was also 100% for majority of the cysts and HIV associated salivary gland swellings. The sensitivity of ultrasound in the diagnosis of pleomorphic adenoma was 80% and 100% for adenocarcinoma, hemangioma, all the cysts and HIV associated swellings. Ultrasound was also 100% specific in the diagnosis of monomorphic adenoma and hemangioma. CONCLUSION: Ultrasound is a useful diagnostic tool for cervicofacial soft tissue swellings. The accuracy of diagnosis is enhanced by the characteristics of the probe and the experience of the sonologist.

Applications of ultrasonography in the diagnosis of soft tissue swellings of the cervicofacial region

Purpose: To determine the accuracy; sensitivity; specificity and prediction values of ultrasound as a means of diagnosis of cervico-facial soft tissue swellings. Materials and methods: We carried out ultrasonographic evaluation of 76 consecutive cases of cervico-facial soft tissue swellings that presented at the Obafemi Awolowo University Teaching Hospital Complex; Ile-Ife; Nigeria from August 2002 to November 2003. The patients' demographics and relevant clinical information were obtained. Ultrasonographic evaluation was done using the B-mode transcutaneous ultrasonic imaging device with a transducer frequency of 5MHz. All the lesions were subjected to histopathological examination. Results: There were 43(56.6) males and 33(43.4) females whose ages ranged from 2 weeks to 70 years (mean + SD; 22 + 19.7 years). Histologically; tumours constituted the highest percentage of swellings (35.5); followed by cysts (26.3). Males were more predominant in all classes of swellings except benign tumours. The accuracy of ultrasound in the diagnosis of pleomorphic adenoma was 80and 100for both adenocarcinoma and hemangioma. It was also 100for majority of the cysts and HIV associated salivary gland swellings. The sensitivity of ultrasound in the diagnosis of pleomorphic adenoma was 80and 100for adenocarcinoma; hemangioma; all the cysts and HIV associated swellings. Ultrasound was also 100specific in the diagnosis of monomorphic adenoma and hemangioma. Conclusion: Ultrasound is a useful diagnostic tool for cervicofacial soft tissue swellings. The accuracy of diagnosis is enhanced by the characteristics of the probe and the experience of the sonologist