ABSTRACT
BACKGROUND: Many surgical techniques have been described for the repair of macrostomia. However, most were designed for the repair of unilateral macrostomia. Most reports of repairs involved small numbers of patients. This has not allowed for evaluation of complications and comparison of various techniques. OBJECTIVE: This study describes a modification of an older technique designed for unilateral macrostomia. Details of the operative technique used for the repair are described, along with the principles underlying the various steps. MATERIALS AND METHODS: This study involves 13 patients operated for macrostomia using the same surgical technique. The patients were seen at a recent screening and mass surgery exercise for patients with orofacial and craniofacial deformities. RESULTS: Eleven patients had bilateral macrostomia; two had unilateral macrostomia. No anesthetic or surgical complications occurred in any of the patients. All patients tolerated the procedure well. Oral continence and acceptable facial symmetry were restored in all patients, with minimal scarring.
Subject(s)
Macrostomia/surgery , Child , Child, Preschool , Female , Humans , Infant , Macrostomia/epidemiology , Male , Mass Screening , Nigeria/epidemiology , Treatment OutcomeABSTRACT
Lyells syndrome also called Toxic epidermal necrolysis is the extreme form of idiosyncratic drug reaction that is called Steven Johnsons Syndrome: The condition results in an extensive loss of the skin with mucous membrane involvement. Lyells syndrome has been induced by many agents. The commonest agent in the literature being sulphonamides. However, in our search of the medical literature there was no report of dihydroarthemisinin as a cause of Lyells syndrome. We report three patients seen at two tertiary health institutions with Lyells syndrome after treatment for malaria with dihydroarthemisinin. This resulted from administration of dihydroarthemisinin with chloroquine in two patients and dihydroarthemisinin with Amodiaquine in one patient. The first patient was a seven year old child who developed 90% cutaneous involvement and died from hemorrhagic shock. The second was a 28 old female that developed a 76% body surface involvement and died from septicemia. The third patient was a pregnant 37 year old woman that developed 52% body involvement and died from septic shock. In these patients the earliest symptoms were not recognized and there was considerable delay before referral. In view of the recent WHO recommendation ofArthemisinin Combination Treatment (ACT) for malaria, we expect more cases of Steven Johnson Syndrome and Lyells syndrome from ACT treatment. The aim of this report is to raise the awareness of clinicians to this potentially fatal complication.
Subject(s)
Antimalarials/adverse effects , Artemisinins/adverse effects , Stevens-Johnson Syndrome/etiology , Adult , Child , Female , Humans , Male , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/therapyABSTRACT
BACKGROUND: A retrospective study of the presentation, etiology, and prognosis of non-burn epidermal loss managed at the Lagos University Teaching Hospital Nigeria over a 12-year period. MATERIALS AND METHODS: Admission records of patients managed for non-burn skin loss were retrieved from the medical records. Demographic details of the patients, the initial diagnosis, final diagnosis, treatment and outcome of treatment was noted. RESULTS: A total of 23 patients were identified, 17 (74%) had idiosyncratic drug reactions. Of this 17, 6 (26%) had Steven Johnson Syndrome, 6 (26%) had Steven Johnson Syndrome/toxic epidermal necrolysis while 5 (22%) presented with toxic epidermal necrolysis. Three of the five patients with toxic epidermal necrolysis died. The age range of patients with idiosyncratic adverse drug reactions was 2-28 years, mean, 10.18+/-1.44 years and male to female ratio of 1:1.83. The body surface area involved ranged from 8 to 78%; mean 26.65+/-6.08%. The agents suspected for the reactions were Co-trimoxazole (41.2%) and combination of Co-trimoxazole, and Fansidar (17.6%). Other conditions seen were two (9%) Staphylococcal Scalded Skin Syndrome, three (13%) had Necrotizing Faciitis, one of whom was HIV positive and died. One (4%) patient presented with pemphigus vulgaris. The presentation and management of the patients was discussed.
