Presentation and Management of Atypical Orofacial Clefts: A Single-Institution Experience for 13 Year Period.

This study reviews the craniofacial clefts that presented at a Nigerian tertiary health facility, highlighting our experience with the pattern of presentation and surgical care of these patients.A retrospective review of the smile train database and medical records of all individuals who had been diagnosed with any of the Tessier craniofacial clefts and managed between 1st January 2007 and 31st December 2020 was done. The data were presented as numbers and percentages of cases.The cleft clinic of a tertiary health facility and a major cleft referral center in South-West Nigeria.Forty-five patients with craniofacial clefts were managed over the study period. 15.6% had associated syndromes, 2.2% had a family history of similar craniofacial cleft and 11% had a history of a possible teratogen. There were 21 (46.7%) middle clefts, 14(31.1%) lateral clefts and 10(22.2%) oblique clefts. The most common type of cleft was Tessier 0 while the Tessier 6 was the least common type. The median age at surgery was 10 months for male and 5months for female subjects, 15.3% complication rate was found in this study. Four patients had revision surgeries to correct residual deformities in this study.The diverse presentations and occurrence of the rare craniofacial clefts present complex aesthetic and functional problems that require individualized often multidisciplinary care. The execution of a properly planned treatment will reduce complications and the need for revision surgeries.

Functional Outcome of Staged Reconstruction of Blast Injury of the Hand.

The purpose of this study is to describe the details of initial care, reconstruction and rehabilitation of blast injury to the hand of an adult scavenger staff of a recycling plant from an IED and determine the functional outcome of the treatment in terms of restoration of prehension of the hand. A detailed chronology of the clinical evaluation of a Nigerian adult admitted on the 14th of August, 2018 with blast injury to his left hand, the initial and subsequent care he received (while both on admission and after discharge) and the outcome of the treatment: return of prehension and time taken by patient to return to work. This patient was resuscitated and had initial care which comprised of serial debridement and fixation of fractures. Subsequent care he had included: wound resurfacing with thoraco-abdominal flap and glabrous skin grafting, digit stump refashioning of injured hand. Rehabilitation was achieved by meticulous physiotherapy and patient regained adequate prehensile function and returned to work within three months of discharge. Follow up at 16months showed tremendous improvement of function of the hand. A carefully executed care plan is rewarded with a good functional outcome (restoration of prehension of the injured hand and return to work) especially when treating a patient with a complex injury like blast injury to the hand.