Ho Olasoji

Genetic studies in the Nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders.

Background Orofacial clefts are the most common malformations of the head and neck, with a worldwide prevalence of 1 in 700 births. They are commonly divided into CL(P) and CP based on anatomic, genetic, and embryologic findings. A Nigerian craniofacial anomalies study (NigeriaCRAN) was set up in 2006 to investigate the role of gene-environment interaction in the origin of orofacial clefts in Nigeria. Subjects and Methods DNA isolated from saliva from Nigerian probands was used for genotype association studies and direct sequencing of cleft candidate genes: MSX1, IRF6, FOXE1, FGFR1, FGFR2, BMP4, MAFB, ABCA4, PAX7, and VAX1, and the chromosome 8q region. Results A missense mutation A34G in MSX1 was observed in nine cases and four HapMap controls. No other apparent causative variations were identified. Deviation from Hardy Weinberg equilibrium (HWE) was observed in these cases (p = .00002). A significant difference was noted between the affected side for unilateral CL (p = .03) and bilateral clefts and between clefts on either side (p = .02). A significant gender difference was also observed for CP (p = .008). Conclusions Replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the development of CL(P).

Prevalence of Orofacial Clefts in Nigeria

Orofacial clefts are the most common malformations of the head and neck. In Africa, orofacial clefts are underascertained, with little or no surveillance system in most parts for clefts and other birth defects. A Nigerian craniofacial anomalies study, NigeriaCRAN, was established in 2006 to support cleft research specifically for epidemiological studies, treatment outcomes, and studies into etiology and prevention. We pooled data from seven of the largest Smile Train treatment centers in the six geopolitical zones in Nigeria. Data from September 2006 to June 2011 were analyzed and clefts compared between sides and genders using the Fisher exact test. A total of 2197 cases were identified during the study period, with an estimated prevalence rate of 0.5 per 1000. Of the total number of orofacial clefts, 54.4% occur in males and 45.6% in females. There was a significant difference (P=.0001) between unilateral left clefts and unilateral right clefts, and there was a significant difference (P=.0001) between bilateral clefts and clefts on either the left or right side. A significant gender difference (P=.03) was also observed for cleft palate, with more females than males. A total of 103 (4.7%) associated anomalies were identified. There were nine syndromic cleft cases, and 10.4% of the total number of individuals with clefts have an affected relative. The significant difference between unilateral clefts and the gender differences in the proportion of cleft palate only are consistent with the literature. The present study emphasizes the need for birth defects registries in developing countries in order to estimate the exact prevalence of birth defects including orofacial clefts.

Ameloblastic Carcinoma: A Multicenter Nigerian Study

PURPOSE To obtain a national profile on the prevalence and management of ameloblastic carcinoma in Nigerians. MATERIALS AND METHODS Data were collected from the case files of patients with a histologic diagnosis of ameloblastic carcinoma from 4 tertiary referral centers in Nigeria from January 1980 to December 2008. RESULTS Twenty patients were seen within the study period. There were 11 male and 9 female patients, with a male-to-female ratio of 1.2:1. Their ages ranged from 16 to 85 years (mean +/- SD, 41.63 +/- 19.8 years). The duration of the lesion before presentation was 6 months to 4 years. Twelve cases occurred in the posterior mandible alone, 1 case occurred in the anterior mandible alone, and 4 cases involved the anterior and posterior mandible. The posterior part of the maxilla was involved in 3 cases. A majority of the cases (17) occurred de novo, and 3 patients presented with carcinoma ex-ameloblastoma. Treatment included surgical resection with or without neck dissection. Eight patients declined treatment after diagnosis. Surgery was planned for 12 patients, but 2 patients died of intractable bleeding episodes before surgery. Mandibulectomies and maxillectomies were performed for 10 patients. Follow-up was carried out for 5 patients. Recurrence ranged from 6 to 96 months after the first surgery. Overall deaths recorded involved 6 patients. Three patients died within 3 years after the initial surgery and 1 patient died about 8 years after the initial surgery. One patient is still alive and well 1 year after surgery. CONCLUSION Ameloblastic carcinoma is an uncommon malignancy. Most cases occur in the mandible and arise de novo. Early diagnosis and radical local excision remain the mainstay of treatment.

Awareness, knowledge and attitude on cleft lip and palate among antenatal clinic attendees of tertiary hospitals in Nigeria.

BACKGROUND Adequate knowledge and awareness of cleft lip and palate (CLP) deformity may help to counter the negative beliefs and attitudes toward the condition. The objective of this study was to assess the level of awareness, knowledge and attitude of women attending antenatal clinics about CLP. MATERIALS AND METHODS A cross-sectional descriptive study with the aid of a structured interview administered questionnaire was conducted among 200 women attending antenatal clinics in three Federal Government Teaching Hospitals in the Northern and Southwestern regions of Nigeria. The main outcome measure was the level of awareness and the mean cumulative knowledge score. RESULTS The mean age of the subjects was 28.9 ± 5.1 years (age range: 16-42 years). Half of the women (50.5%) reported that they had seen or heard about CLP. The mean cumulative knowledge score was 6.9, with only 19.8% having adequate knowledge. Many respondents had neither read an article on CLP nor participated in any public enlightenment program, and 31.5% indicated that they would like to know more about the condition. Level of educational attainment had a statistically significant effect on the level of awareness and knowledge on CLP, as more educated respondents tend to be more aware and knowledgeable ( P < 0.001). CONCLUSION There is need for increased public enlightenment/health education to increase awareness and subsequently help develop more positive attitudes toward children with CLP. Such programs should include distribution of pamphlets on CLP at clinics, especially antenatal clinics, media campaigns on radio, TV and newspaper as well as establishment of cleft support groups by the relevant governmental and professional organizations.

Survey of Management of Children With Cleft Lip and Palate in Teaching and Specialist Hospitals in Nigeria

Objective A national survey was conducted to obtain an overall view of the current management of children with cleft lip and/or palate in Nigeria. Method Questionnaires were sent to 44 identified cleft surgeons in all teaching and specialist hospitals in Nigeria. Results A total of 38 respondents returned completed questionnaires. The findings are as follows: (1) a majority of the surgeons (68.4%) are “low-volume operators,” undertaking 10 or fewer new cleft repairs annually; (2) 86.8% of the surgeons repair cleft lip at 3 to 4 months of age, and the most common (71%) unilateral cleft lip repair method is the rotation-advancement technique; (3) 50% of the surgeons use straight line repair for bilateral cleft lip; (4) a majority (79%) of the respondents close the soft and hard palates as a single procedure; 47.3% of respondents use the von Langenbeck technique, 21.1% use the double-opposing Z-plasty and 21.1%, the palatal pushback; (5) in the management of protruding premaxilla, 52.6% of the respondents choose adhesive tape; (6) procedures such as alveolar bone grafting, rhinoplasty, and surgical treatment for velopharyngeal incompetence are rarely done as part of cleft management; and (7) the interdisciplinary team approach is practiced by 21% of respondents. Conclusions Issues are raised regarding the current organization of cleft services. We hope the findings of this study will provide preliminary information needed for the eventual establishment of standard cleft management for children with cleft lip and palate deformity in Nigeria.

A survey of facial nerve dissection techniques in benign parotid surgery among maxillofacial and ear, nose, and throat surgeons in Nigeria

OBJECTIVE The aim of the present study is to identify the facial nerve dissection technique routinely used during parotidectomy for benign parotid tumors by Nigerian Oral and Maxillofacial (OMF) and Ear, Nose, and Throat (ENT) Surgeons. MATERIALS AND METHODS A questionnaire-based study was conducted among Oral and Maxillofacial and Ear, Nose, and Throat Surgeons in Nigeria, on their experience with antegrade and retrograde facial nerve dissection techniques in parotid surgery. The respondents were asked to indicate their choice of dissection techniques in revision parotidectomy, limited superficial parotidectomy, and in obese patients with large tumors. They were also asked to indicate if they routinely used perioperative facial nerve monitoring devices in parotid surgery for benign tumors. RESULT About half (47.5%) of them routinely used the antegrade technique, while only a few (12.5%) used the retrograde technique. A large number of them (40%), however, used a combination of antegrade and retrograde routinely. Technical ease was the main reason for the choice of technique. The antegrade technique was the technique of choice by most respondents for revision parotidectomy (60%) and limited superficial parotidectomy (62%). However, the retrograde approach was the technique of choice by most of them (47%) in case of parotidectomy in obese patients with large tumors. The routine use of perioperative facial nerve monitoring devices is an uncommon practice among OMF and ENT surgeons in Nigeria. CONCLUSIONS The antegrade approach for facial nerve dissection is the most common technique used in parotid surgery by Nigerian OMF and ENT surgeons. Nigerian surgeons need to consider the retrograde approach in selected cases of parotid surgery especially for localized tumors that are amenable to limited superficial parotidectomy. Inclusion of perioperative facial nerve monitoring devices is also advocated.

Feedback after continuous assessment: An essential element of students' learning in medical education.

Sir, Regarding the philosophy and goals at all levels of education in Nigeria, section 1, paragraph 9(g) of the National Policy on Education (revised 2004) stated that, “educational assessment and evaluation shall be liberalized by their being based in whole or in part on continuous assessment (CA) of the progress of an individual.”[1] In line with this recommendation, CA of students is requirements in contemporary undergraduate medical and dental education in Nigeria. Assessment is said to be continuous when it is regular, cumulative, and comprehensive. CA of learners’ (often referred to as test or in‐course assessment) can therefore be defined as a mechanism whereby the final conclusion about learners’ achievement in all domains of learning in a particular subject systematically takes account of all performances during a specified period of time.

Pattern of tooth loss in Nigerian children: A national survey

Abstract Aim To determine the causes of tooth loss among Nigerian Children. Methods The study was cross sectional. Study population consisted of 557 children aged 1 to 16 years from six tertiary hospitals from each of the six geopolitical zones of the country as well as the Federal Capital Territory (FCT), Abuja. The reasons for extractions of teeth in the children for a period of twelve months were obtained including the age, gender and the type of tooth/teeth extracted. Results Seven hundred and fifty teeth were extracted for various reasons during the study period. Majority (55.5%) were extracted because of dental caries, 22.8% for orthodontic reasons, 12.0% for trauma and 6.3% for periodontal disease. More primary teeth (52.7%) were extracted than the permanent teeth in the children. Dental caries was the major cause of extraction of teeth in the south south, south east, north east, north central and the north west zones. While in the south west zone it was malocclusion. In the FCT, periodontal disease was the main reason for extraction of teeth. Conclusion Dental caries is still the major cause of tooth loss with the mandibular first permanent molar being the tooth mostly affected. Periodontal disease as a cause of tooth loss in children is on the decrease while there is an increase in orthodontic reasons and trauma.