Ludwig's angina in Nigeria: The disease of the poor and health inequality!

AIM: highlight the health inequality and identify opportunities to improve the care delivered to the patients who suffer from Ludwig's angina which could have national and international clinical impact. MATERIALS AND METHODS: Data was collected from three major oral and maxillofacial centers, in Nigeria including Benin, Lagos and Kano. A protocol was developed for data collection which included demographic details, socio-economic status, management of the air way, the associated morbidities and mortalities. RESULTS: Forty-nine were managed in Benin, 57 in Lagos and 66 in Kano. Diabetes was the most prevalent underlying systematic condition, affecting 21% of the Ludwig's angina patients in Lagos. Poverty was a common denominator, 90% of the patients from Kano were unemployed compared to 23% and 8% from Lagos and Benin respectively. For most of the patients, the airway was monitored. Incision and drainage were carried out in most of the cases at Benin and Lagos, but it was only considered in 50% of the cases in Kano. Mortality ranged from 4% in Benin to 12% in Lagos and it was as high as 19% in Kano. CONCLUSION: poor access to oral healthcare, unemployment and low socio-economic status are important predisposing factors of Ludwig's angina.

Unilateral Cleft Lip Repair: Assessment of Outcome of Olokun-Olaitan Vermillion Flap Approach.

This study aimed to assess the outcome of our novel free-hand approach. Numerous cleft lip repair techniques exist, all of which involve incisions on skin and excision of tissue. Unilateral cleft lip is the result of failure of migration of orofacial tissues in-utero. Cleft lip repair should ideally involve an approach that simulates nature by avoiding skin incision and tissue excision, as these are not known to occur in the normal natural sequence of events.Without incising skin or excising any tissue, vermillion flaps were raised exposing the muscular layer and edges of skin and mucosa. Similar tissue types were advanced and sutured across the cleft, replicating what should have occurred normally.All 28 patients (100%) treated using our technique had competent lips. Acceptable symmetry of the vermillion was achieved in 24 (85.7%) of the patients. Lip symmetry was judged to be acceptable in 22 (78.6%). Symmetry of the nose was acceptable in 18 (64.3%) of patients.The Olokun-Olaitan vermillion flap approach proved effective in the repair of unilateral cleft lip, as it compared very favorably with results obtained using Millard's technique.

Ranula Decompression Using Stitch and Stab Method: The Aluko Technique.

BACKGROUND: A ranula is a cystic lesion in the floor of the mouth, formed either as a retention cyst or pseudocyst as a result of extravasation of mucus in the surrounding tissue. It may be treated by micro-marsupialization, marsupialization or excision of lesion with or without the associated salivary gland. Marsupialization is usually achieved by cutting a slit and thereafter stitching the edges such that the epithelium of the exterior becomes continuous with that of the interior of a cyst. A stitch-and-stab technique of achieving patency of the created slit of marsupialized ranula is hereby presented. METHOD: A stitch and stab technique using four parallel consecutive strokes of the needle with attached polyglactin 910 suture material in alternately opposing directions was employed in treatment of 31 consecutive ranula patients. RESULTS: 100 % success was achieved using this technique in 31 ranulas. CONCLUSION: This stitch-and-stab technique for marsupialization has proven to be very successful. It is recommended for use by the general medical community, as it requires the Clinician to possess only minimal surgical skills. Bartholin's cyst can be so treated.

Strategy for Successful Management of Facial Keloid Using Triamcinolone Injection as Adjunct to Surgery.

The literature on keloids is replete with authors expressing frustration with treatment results. Triamcinolone is effective in shrinking keloids and preventing their recurrence following excision, if delivered successfully. Strategies for effective delivery of drug are presented: recommended needle size, use of metal syringe, slow injection to avoid skin rupture, and delayed withdrawal of needle after injection. The futility of expecting pedunculated keloids to be completely flattened by steroid injection alone is mentioned.