Akinwale Adeyemi Efunkoya

Maxillomandibular distraction osteogenesis.

Background Distraction osteogenesis (DO) is a biologic process of new bone formation between the surfaces of bone segments that are gradually separated by incremental traction. It consists of 4 primary phases, namely, corticotomy and device placement, a latency period, active distraction, and consolidation. The objectives of the current study were to review DO as it applies to maxillomandibular defects and to share our clinical experience in the cases we have done. Methods A clinical narrative review of the literature was performed to evaluate the use and efficacy of maxillomandibular osteogenesis in maxillomandibular defects. A systematic search of the literature was performed using PubMed, with special interest in the history of DO and its application in dentistry and maxillofacial surgery. medical subject headings terms included surgical procedures, osteogenesis, distraction, and orthodontics. Two cases of maxillomandibular DO managed at the Aminu Kano Teaching Hospital (AKTH), Nigeria, were reported and discussed. Results Articles involving maxillary and midface distractions, bilateral distraction for airway obstruction, and distraction for hemifacial microstomia were all reviewed. In the first case reported, a unidirectional distractor was used to achieve simultaneous mandibular lengthening and maxillary occlusal correction. Gains of 10 mm in mandibular ramal height and 23 mm in corpus length were achieved in the second reported case, using a bidirectional distractor. The literature search revealed no previous Nigerian reports of maxillomandibular DO. Conclusions The DO is a viable and available treatment option for reconstructing maxillomandibular discrepancies and accompanying soft and hard tissue deficiencies.

Epidemiology of adult cleft patients in North-western Nigeria: our experience.

BACKGROUND/OBJECTIVE To review cleft lip and palate procedures over a three-year (2008-2010) partnership between the smile train and our organization, the Grasssroot Smile Initiative (GSI). METHOD A three-year retrospective study (2008-2010) involving 79 adult patients with clefts. RESULTS Seventy nine (14.4%) of 550 patients with orofacial clefts seen and treated within a three-year period were adults with age range of 17 to 81 years; mean 31.45 ± 13.09. Majority were between 20 and 39 years. There were 54 (68.4%) males and 25 (31.6%) females, with the male:female ratio of 2.2:1. Analysis of the cleft types/site revealed 35 (44.3%) lip alone, 22 (27.8%) lip and alveolus, 7 (8.9%) lip and palate and 15 (19%) palate alone. Seven (8.9%) of these patients had other relatives with clefts. Sources of information were friends and relatives; 33 (41.8%), radio; 18 (22.8%), charity organization/NGO; 13 (16.5%), hospitals/physicians; 5 (6.3%), and others; 10 (12.7%). 57 patients with lip clefts had surgery under local anesthesia while the remaining 22 patients were done under general anesthesia. All clefts of the lip were repaired using the Millard advancement rotational flap for complete cleft, simple straight line closure for incomplete and double layer closure for the palate. CONCLUSION The incidence of adult patients with orofacial cleft is not rare in our community, probably due to limited access to specialized health care facilities, poverty and ignorance. Furthermore, some of these patients are not aware that these facial defects can be repaired. The advent of the smile train organization and free services has resulted in this harvesting phenomenon.

Quality of life of patients surgically treated for ameloblastoma.

Background: The surgical management of ameloblastoma can have a profound functional and psychological effect on a patients quality of life (QoL). The aim of this study was to compare the pre- and post-operative QoL outcomes of patients requiring surgical treatment for ameloblastoma. Patients and Methods: A total number of 30 patients were identified as fulfilling the criteria for this study. They included 18 males and 12 females, aged between 14 and 47 years with a mean of 27.3 years (standard deviation 10.2). Each patient completed a modified version of the University of Washington QoL questionnaire version 4, a day to surgery and postoperatively on the 7th day, 3 months, and 6 months. Results: Following surgical treatment of patients for ameloblastoma, the QoL decreased immediately after surgery. It then gradually improved over time and exceeded the preoperative value at 6 months postoperatively. When analyzed with respect to location, posteriorly placed tumors had the best postoperative QoL outcome. Patients expressed concern more about their appearance preoperatively while postoperative concerns were mostly focused on their ability to chew. Conclusion: Significant improvement occurred in QoL scores following surgical management of ameloblastoma. The small sample size utilized in this study limits a definitive conclusion. A larger multicenter study is therefore recommended.

Prospective study of the quality of life after treatment of mandibular fractures.

Health-related quality of life (QoL) has become increasingly important, but few studies have dealt with that of patients who have been treated for mandibular fractures. Our aim was to assess this. Patients with mandibular fractures (n=148) were studied prospectively and QoL after treatment was assessed using the General Oral Health Assessment Index (GOHAI). The male-female ratio was 8.3:1 and their ages ranged from 14 to 70 years. QoL after treatment of the fractures declined initially (on the first postoperative day) but thereafter improved steadily. There was no significant difference between the mean QoL of those treated by closed, and those treated with open, reduction. Limitations in the options of food to eat, and difficulty in chewing and swallowing, were identified as their most important concerns in the early postoperative period. The improvement in QoL after the first postoperative day was similar however the patients were treated.

A 14-Year Review of Craniomaxillofacial Gunshot Wounds in a Resource-Limited Setting

This study analyzed the prevalence, clinical characteristics, and management of civilian-type craniomaxillofacial gunshot wounds (CGSWs) seen over a 14-year period in a Northern Nigerian teaching hospital. A retrospective study of all hospital records relating to CGSWs from January 2000 to December 2013 was conducted to determine the prevalence of CGSWs. Information retrieved included site of injury, type of projectile, management protocol, as well as duration of hospitalization. A total of 46 admissions for CGSWs were recorded during the period under review from a total of 2,228 maxillofacial admissions. This gave a prevalence of 2.1% for CGSWs (95% confidence interval = 1.56–2.81). Sex distribution was 14.3:1 (M:F) with overall mean age of 32.9 ± 8.4 years. Average length of hospitalization was 17.7 (± 15.56) days. Management of CGSWs consisted of emergency care, preliminary intervention, definitive reconstruction, revisions, and rehabilitation. Conclusively, analysis of the yearly incidence of CGSWs showed that the incidence and severity increased within the past 2 years under review (18 cases, 39.13%; χ2 trend = 7.7, p = 0.006). This period was noted to correspond with heightened violence within the region mostly due to the acts of unknown gunmen and insurgents.

Postoperative complications from primary repair of cleft lip and palate in a semi-urban Nigerian teaching hospital.

Background: This paper seeks to investigate the incidence of short-term postoperative complications in children and adult patients undergoing primary surgery of cleft lip and palate. Patients and Methods: One hundred and fifteen patients consisting of children (below 12 years) and adult (12 years and above) who were operated for both cleft lip and palate within a 2-year period at the University of Maiduguri Teaching Hospital were reviewed postoperatively at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year intervals, respectively. The complications encountered within the periods of the review were recorded. Results: One hundred and twenty surgeries were performed on 115 patients (85 children 30 Adults). A total of 43 complications (31 in children and 12 in adults) were recorded over the study period. Eighteen (41.9%) of these complications were noticed in unilateral cleft lip repair, while 12 (27.9%) and 13 (30.2%) complications were observed in bilateral cleft lip and cleft palate surgeries, respectively. A higher complication rate (72.0%) was recorded in children compared with adults. Major complications (13.9%) were, however, observed more in adults than children. Conclusion: Although every surgeon attempts to prevent complications during surgery, they may still occur. The high complication rate observed in our study may be due to a small sample size. General complications observed among children are due to cross infection during a hospital stay, contributing immensely to the higher rate of complications in children. Moreover, this may be reduced by short hospital stay following surgery. We also advocate early contact with children with cleft, and early surgical intervention in other to prevent some of the major complications encountered in adult patients.

A review of cleft lip and palate management: Experience of a Nigerian Teaching Hospital.

Background: Cleft lip (CL) and palate (CLP) management is multidisciplinary. A cleft team was formed in a Nigerian Tertiary Hospital to address the health needs of cleft patients in the centre. Aim: This paper aims at documenting the Aminu Kano Teaching Hospital (AKTH) management protocol for orofacial clefts and also to review our experience with CLP surgeries performed at AKTH since our partnering with Smile Train. Materials and Methods: A retrospective review of all the cleft patients surgically treated from January 2006 to December 2014 under Smile Train sponsorship was undertaken. A descriptive narrative of the cleft team protocol was also given. Results: One hundred and fifty-five patients (80 males, 75 females) had surgical repairs of either the lip or palate. CL patients were 83 (53.55%), while CLP patients were 45 (29.03%) and isolated cleft palate patients were 27 (17.42%). Conclusion: The inclusion of various specialities in the cleft team is highly desirable. Poverty level amongst our patients frequently limits our management to surgical treatment sponsored by the Smile Train, despite the presence of other residual problems.

Anaesthesia for cleft lip surgeries in a resource poor setting: techniques, outcome and safety

Introduction Cleft lip and palate is one of the more common congenital malformation and the most common craniofacial anomalies in children. The treatment is expensive and requires specialised care. Access to this care in middle and low income countries is compounded by socioeconomic status of patients and their relation and also the inadequacy of expertise in medical personnel and infrastructure. Objective: the study aimed to review the techniques of anaesthesia used in a low resource setting in terms of the techniques, outcome, and safety. Methods This is a retrospective review of 79 cases done in a resource poor setting. Information regarding the patients, surgeries and modes of anaesthesia were retrieved from the case notes. Results A total of 62 patients were operated with incomplete cleft accounting for 37 (59.7%), complete 23(37.1%), and 2 (3.2%) as bilateral. Forty-six (74.2%) of patients had their surgery done with ketamine anaesthesia without endotracheal intubation, 14 (22.6%) had regional anaesthesia and 2 patients (3.2%) had general anaesthesia with endotracheal intubation. Conclusion This study demonstrates that with careful planning and expertise, cleft lip repair can be done safely in resource poor setting.

Congenital Heart Disease in Cleft Lip and Palate Patients: How Common Is the Association?:

Aims and Objectives: To determine the prevalence of congenital heart disease in patients with orofacial cleft in a Nigerian population. Materials and Methods: A retrospective review of all the case files of patients with orofacial cleft managed at the Dental and Maxillofacial Surgery unit of the Aminu Kano Teaching Hospital between 2007 and 2014. Data were analyzed using SPSS version 16. Results: A total of 133 patients with cleft lip and palate were seen during the period of study comprising 77 males and 56 females, giving an M:F ratio of 1:0.7. The age range was 15 days–36 years with a mean age of 6 years. There were five cases of congenital heart disease made up of two males and three females, giving a prevalence of 3.76 per cent. Conclusion: This study showed that the prevalence of congenital heart disease in patients with orofacial cleft was low. However, the need for routine echocardiography in all orofacial cleft patients especially children should not be overlooked.

Multidisciplinary approach to improving concordance in diagnosis of odontogenic tumors

Background: The diagnosis of benign odontogenic tumors (BOTs) may occasionally be fraught with problems. Diagnosis of BOTs includes joint consideration of clinical features observed, appearance on radiographs and histopathologic slides. Aim: The aim of this study therefore is to ascertain the level of concordance between preoperative and postoperative histopathological diagnoses of surgically treated BOT and highlight modalities that improve it. Materials and Methods: A retrospective review of all cases with postoperative histopathological reports of BOT seen at the Dental and Maxillofacial Surgery Department of Aminu Kano Teaching Hospital, Kano, Nigeria, from January, 2012 to December, 2013 was done. Demographic information, clinical, radiological (plain radiographs), preoperative incisional biopsy and postoperative excisional biopsy results were collated. The preoperative incisional biopsy and postoperative excisional biopsy results were analyzed for concordance. Results: Thirty-three cases of BOT were reviewed (male:female = 1.4:1). Age ranged from 11 to 70 years (mean = 32 ± 18.1 years). An overall concordance of 78.8% was observed between preoperative and postoperative biopsy results. Twenty-eight histology request cards were reviewed and this showed that 14.3% of specimens were <1 cm while complete clinical information was provided in 50% of cases. Conclusion: The interaction between the pathologist and other relevant specialties that are required for effective management of BOT may be best nurtured when clinico-pathologic conferences are made a routine practice.