Cleft care in Nigeria: past, present, and future.

OBJECTIVE: To review the progress of orofacial cleft care in Nigeria and propose a viewpoint for the future. DESIGN: Review of the available literature on cleft care in Nigeria and survey of the status of ongoing cleft care in Nigerian centers. We employed a pretested self-administered questionnaire sent and returned through electronic mail. PARTICIPANTS: Coordinators of cleft care centers in Nigeria. MAIN OUTCOME MEASURES: Findings of literature search and responses to mailed questionnaires. RESULTS: Available literature suggests that the fate of orofacial cleft patients during the precolonial era in Nigeria remains unclear. However, there is evidence of surgical care delivery just before the end of the colonial era. We identified and contacted 39 existing cleft care delivery centers, of which 30 (76.9%) responded. The majority (69.2%) of the responding centers began cleft care delivery between 2006 and 2010; 73.3% have designated cleft clinic locations and 66.7% offer interdisciplinary care. All responding centers offer cheiloplasty, while 86.7% offer palatoplasty. Other aspects of cleft care are provided sparingly in most centers due to paucity of manpower. Challenges with hospital administration, securing bed and theater spaces, drug availability, and performing laboratory investigations were the common limitations reported. CONCLUSIONS: We advocate for improved cleft care delivery through removing administrative bottlenecks, fortifying existing centers, and mentoring younger colleagues for entry into underserved specialties. Concerted effort and international collaborations aimed at transforming some of the existing cleft centers to standard pediatric craniofacial centers are desirable.

Adolescent and adult cleft lip and palate, in Ile-Ife, Nigeria.

INTRODUCTION: Congenital cleft lip and palate (CLP) defects usually present in childhood, especially in places with available and affordable care. In Nigeria, their incidence is low but late presentation in Adult life have been reported. This article aims at reviewing adolescent and adult CLP patients in our center, with the advent of free and available care, and to document the patterns and management outcomes of these patients as an addition to existing literature on the subject of adult CLP. MATERIALS AND METHODS: A retrospective review of adolescent and adult CLP patients managed from May 2006 to April 2010. Demographic data as well as clinical information were retrieved from the hospital records and include the type of cleft deformity, surgical intervention prior to presentation, the type of surgery performed and postoperative outcomes. Some pertinent clinical photos were also reviewed. RESULTS: Adolescent and adults constituted 24% of the 137 patients, their age ranged from 13 to 76 years, with a mean, median and modal age of 28, 22 and 20 years respectively. Unilateral cleft of primary palate was commonest with female preponderance. Most never had surgery, others desired revision surgery or secondary procedures. The outcomes were satisfactory in the 37 procedures performed on 33 patients. CONCLUSION: A relatively high ratio of adolescent and adult clefts is observed. Most of them have never had surgical intervention. Some had failed surgical intervention prior to presentation. Satisfactory outcomes were achieved despite late intervention but failed initial intervention was associated with poorer outcomes.

A prospective study of two methods of closing surgical scalp wounds.

BACKGROUND AND OBJECTIVE: Scalp wounds are commonly closed in two layers, although single layer closure is feasible. This study prospectively compared the two methods of closing scalp wounds. METHODOLOGY: Patients with non-traumatic scalp wounds were allocated to either the single layer closure group or the multilayer closure group. We obtained relevant data from the patients. The primary outcome measures were wound edge related complications, rate of suturing and cost of sutures used for suturing. RESULTS: Thirty-one wounds were in the single layer closure group and 30 were in the multilayer closure group. Age range was 1-80 years. The most common indication for making a scalp incision was subdural hematoma, representing 27.8% of all the indications. The most common surgery was burr hole drainage of subdural hematoma. Polyglactin acid suture was used for the inner layer and polyamide -00- for the final layer in the multilayer closure group. Only the latter suture was used for the single layer closure method. Total cost of suturing per wound in the single layer closure group was N= 100 (0.70USD) and N= 800 (5.30USD) in the multilayer group. The mean rate of closure was 0.39 ± 1.89 mm/sec for single layer closure and 0.23 ± 0.89 mm/sec in multilayer closure. The difference was statistically significant. Wound edge related complication rate was 19.35% in the single layer closure group and 16.67% in the multilayer closure method group. The difference was not statistically significant (z: 0.00, p value: 1.000; Pearson chi-squared (DF = 1)= 0.0075, p = 0.0785). CONCLUSION: The study shows that closing the scalp in one layer is much faster and more cost effective compared to the multilayer closure method. We did not observe significant difference in the complication rates in the two methods of closure. Long-term outcome, especially cosmetic outcome, remains to be determined in this preliminary study.

Chronic osteomyelitis in the lower extremity predisposing to the unusual formation of keloids.

Keloids commonly occur in black and pigmented races as well as in young adults, but rarely affect Caucasians and albinos. While they have a predilection for the upper trunk as well as the head and neck regions, they seldom occur in the lower limbs. A six-year-old boy presented with multiple fibrous nodular swellings of the right leg and a discharging sinus over the ankle. Closer evaluation revealed underlying chronic osteomyelitis complicated by multiple huge keloids over the leg and ankle. Associated chronic inflammation had resulted in the huge keloids. Our patient's age, site of occurrence and presentation were not typical. In the event that a keloid is presented in isolation, chronic osteomyelitis should be considered as a differential diagnosis, and a high index of suspicion is required in order to establish the diagnosis.

Burns in Nigeria: a review.

Burn injuries continue to be a major source of mortality and morbidity in low- and middle-income countries of the world, of which Nigeria is a part. Overview data on burn care in Nigeria are sparse but the available literature on burns and burn care in Nigeria was retrieved through Internet-based search engines, collated, and reviewed. Peculiarities of epidemiology, types of burn, pattern of injuries, complications, and outcome of burn care were reviewed. There were no broad-based overview statistical data on burns in Nigeria in all the articles reviewed. There was no documentation on the regionalization of care and there were no national databases. All reports on epidemiology were hospital-based. Flame is emerging as the predominant cause of burns, and burn injury is occurring increasingly away from the domestic setting. The severity of the injuries is also increasing. Deliberate burn injury remains a practice and a wide range of complications occur as burns sequelae in Nigeria. Several challenges militate against optimal care for burn victims. Burn injuries continue to contribute significantly to the burden of disease in Nigeria. There is a need for broad-based data collection systems. Avoidable complications are common and mortality remains high. Pooling of resources by regionalization of care could increase focus on burn prevention and improve the care of burn victims. Nongovernmental and governmental support to reduce the burden of burns is advocated.

Isolated perineal burn contractures presenting with chronic intestinal obstruction: a case report.

Isolated perineal burns are rare and so are perineal contractures. Perineal contractures may however lead to intestinal obstruction, which is a more life-threatening complication. A six-yr-old boy presented with chronic intestinal obstruction following isolated perineal contracture due to a deliberate perineal burn injury to treat a febrile convulsion. The obstruction was successfully relieved using local flaps to release the perineal contracture. There is a need for meticulous care in perineal burns to avoid perineal contractures, which may result in chronic intestinal obstruction.

Challenges in management of chronic suppurative otitis media in a developing country.

BACKGROUND: In developing countries, the rate of complications from chronic suppurative otitis media is still high, due to factors associated with poverty. This study aimed to determine the prevalence of chronic suppurative otitis media and associated complications. PATIENTS AND METHODS: We prospectively studied all patients presenting with chronic suppurative otitis media to the ear, nose and throat unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, over a two-year period. RESULTS: One hundred and sixty new cases of chronic suppurative otitis media were seen. These constituted 11.1 per cent of all new cases and 21.5 per cent of all otological cases seen. About half (51.7 per cent) of these patients were younger than 15 years. Most patients were from rural areas and had been previously managed by unlicensed, untrained practitioners. Complications were mostly seen in children. Intracranial complications were seen in 10 (6.3 per cent) cases; this was associated with a high mortality rate. CONCLUSION: This study found that, in Nigeria, a developing country, 'safe' chronic suppurative otitis media was not without serious problems. Provision of adequate health facilities may reduce such problems.

Pattern of intestinal obstruction in a semiurban Nigerian hospital.

INTRODUCTION: Intestinal obstruction remains one of the commonest causes of acute abdomen worldwide. The pattern of intestinal obstruction varies from one place to another. We report the pattern of intestinal obstruction observed in a semi urban Nigerian hospital over a 5 year period. MATERIALS AND METHODS: Records of patient admitted and managed for intestinal obstruction between April 2001 and April 2006 at the federal medical centre, Owo, Southwestern Nigeria, were reviewed. Demographic data as well as parameters relating to the symptoms, duration, onset, type, diagnosis, intraoperative findings, as well as postoperative outcomes were retrieved. All data was entered into a personal computer and analyzed using SPSS for windows version 11. RESULTS: A total of 95 patients were managed during the period. The mean age was 39 years. The male:female ratio was 1.8:1. Adhesive intestinal obstruction was the commonest cause of symptoms in 44%, followed by volvulus in 14% and external hernias in 11% of the patients. A correct preoperative diagnosis was made in over 70% of the patients. Out of those with adhesive obstruction, 75% had a previous abdominal or groin operation while 57% had surgical exploration for failed conservative management. The mean duration of hospital stay was 6 days and the overall mortality rate was 20%. CONCLUSION: Adhesive intestinal obstruction is the commonest cause in this semi-urban population which was studied. Obstructed hernia is becoming increasingly less common as a cause of intestinal obstruction.

The Naso-labial and lateral forehead flaps as a single stage: A case report and review of literature.

We present here the case of a patient with a major traumatic nasal loses who had a near-total nasal reconstruction as a single-stage procedure. A 35 year-old civil servant who was involved in a road traffic injury about two years before presentation. He sustained extensive and multiple facial injuries with complete loss of nasal cover and lining. Reconstruction was performed by using superiorly based, bilateral, nasolabial flaps to line the floor and the nasal septum, and a paramedian forehead flap for skin cover. The patient did well postoperatively and was discharged home on the 7(th) postoperative day. If the principles concerning cover, support, and lining are adhered to, excellent functional and aesthetic results can be achieved as we have obtained in our patient.

Informed consent in surgery: an audit of practice in Ile-Ife, Nigeria.

OBJECTIVES: This study was conducted to assess patients' knowledge of their diagnoses and proposed surgical procedures before giving consent for such procedures in the various surgical units of Obafemi Awolowo University Teaching Hospitals Complex, (OAUTHC), Ile-Ife. MATERIALS AND METHODS: A structured questionnaire was administered to 80 consecutive patients who had just undergone an elective major surgery in general surgery, gyneacology, orthopaedics and surgical subspecialty units of the hospital. RESULTS: Sixty patients (75%) gave consent themselves, while other consents were obtained from close relations. Thirty-seven (46.25%) respondents were informed of the diagnoses and procedure by the unit consultants but no consultant was involved in the completion of the consent form. Seventy-five (93.75%) respondents had a knowledge of the diagnoses, 68(85%) understood the procedure but only 21(26.25%) knew any alternative to the procedure, 29(36.25%) knew at least one complication of the procedure and 12(15%) knew an option or complication of anaesthesia. Forty-five (56.25%) of the consent forms were properly filled while other forms had one error or another. CONCLUSION: Well structured and standardized method of obtaining informed consent from surgical patients should be adopted. While educating patients, the various alternatives to the procedure and possible complications should be carefully explained to the patients who should be carried along in decision making.

Reduction mammoplasty: the experience in Ile-Ife, Nigeria.

BACKGROUND: Reduction mammoplasty is a frequently performed aesthetic surgical procedure in the female adolescent and adult Caucasian population. We reviewed the cases of reduction mammoplasty performed at the Obafemi Awolowo University teaching hospital, (OAUTH), Ile-Ife. PATIENTS AND METHODS: A retrospective review of all patients who have had reduction mammoplasty at the OAUTH over a 20 year period was carried out. RESULT: Ten patients requested reduction mammoplasty during the period. Two patients declined surgery while one required, and was treated by chemotherapy. Seven patients had surgery. Outcomes were uniformly satisfactory. CONCLUSION: We conclude that request for reduction mammoplasty in our surgical practice is uncommon. Request for purely cosmetic reasons is even rarer. Most patients had massive breast enlargements with physical symptoms and gross disfigurement with or without an underlying breast disease which was the usual reason for presentation.

Burn safety knowledge in adult nigerians.

Burn injuries remain a global problem even though they are largely preventable. Adequate knowledge is essential to good burn safety practices. This aids prevention and minimizes severity when burn injuries occur. The purpose of this study was to determine the level of burn safety knowledge among literate adult Nigerians in Ile-Ife and Ilesa, South-western Nigeria. We elicited a paucity of burn safety knowledge in the population studied, but a high level of formal education corresponded to a higher degree of burn safety knowledge. There is a need to introduce burn safety education into the school curriculum at all levels of education in order to increase burn safety awareness.

Internal hernia through the broad ligament presenting with acute on chronic intestinal obstruction: A case report.

BACKGROUND: Internal hernias are rare. Their occurrence through the broad ligament is one of the rarest forms. We present a report of a 45 year Nigerian female with acute on chronic intestinal obstruction due to an internal hernia of the broad ligament. METHODS: Patients case notes and a review of relevant literature using manual library and Medline search was used. RESULTS: A 45-year-old multiparous woman presented with a ten-year history of features of partial intestinal obstruction, and no previous abdominal surgery. Examination revealed right iliac fossa tenderness and a plain abdominal radiograph showed air fluid levels. Conservative management was not successful and laparatomy confirmed an internal hernia of the right broad ligament which was repaired with satisfactory outcome. CONCLUSION: This report is to highlight the fact that though rare, internal hernia should be considered in the differential diagnosis of intestinal obstruction.