Rowland Agbara

The forehead flap: a valuable option in resource depleted environment

Aim: Reconstruction of orofacial soft tissue defect is often challenging and this is more difficult in resource challenged environment. This retrospective study highlights our experience with the use of forehead flap to overcome some of the challenges of orofacial reconstruction in a resource depleted environment. Methods: A 23-year retrospective analysis of all patients who had orofacial defect reconstruction using forehead flap in our department was undertaken. Information was sourced from patient’s case notes and operating theatre records. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2007 (Microsoft, Redmond, WA, USA). Results: A total of 43 patients were managed within the period reviewed and consisted of 31 (72.1%) males and 12 (27.9%) females. Trauma 24 (55.8%) accounted for most defect and the lip was the commonest site of defect. Complete forehead flap was used in 31 (72.1%) of cases and when timing of defect repair is considered, delayed reconstruction was the preferred method. Postoperative complications was observed in 8 (18.6%) patients and consisted of failed flap in 2 (25.0%) patients, tumor recurrence in reconstructed site in 2 (25.0%) patients and tumor occurrence in forehead flap donor site in 1 (12.5%) patient. Conclusion: The forehead flap remains a reliable option in orofacial soft tissue defect reconstruction. It is easy to raise and can provide coverage for wide defects as far as the paramandibular and submandibular regions. Moreover, it does not require patient repositioning.

Cervicofacial infection in a Nigerian tertiary health institution: a retrospective analysis of 77 cases

Objectives Infection involving the orbit, zygomatic space, lateral pharyngeal space, or hemifacial and oral floor phlegmon is referred to as cervicofacialvinfection (CFI). When diagnosis and/or adequate treatment are delayed, these infections can be life-threatening. Most cases are the result of odontogenic infections. We highlight our experiences in the management of this life-threatening condition. Materials and Methods This was a retrospective study of patients who presented with CFI from December 2005 to June 2012 at the Oral and Maxillofacial Surgery Clinic or the Accident and Emergency Unit of Ahmadu Bello University Teaching Hospital (Zaria, Nigeria). The medical records of all patients who presented with either localized or diffuse infection of the maxillofacial soft tissue spaces were retrospectively collected. Data collected was analyzed using SPSS version 13.0 and are expressed as descriptive and inferential statistics. Results Of the 77 patients, 49 patients (63.6%) were males, a male to female ratio of 1:7.5. The ages ranged from two years to 75 years with a mean of 35.0±19.3 years, although most patients were older than 40 years. The duration of symptoms prior to presentation ranged from 6 to 60 days, with a mean of 11.0±9.4 days. More than 90% of the patients presented to the clinic within the first 10 days. The most commonly involved anatomical space was the submandibular space (n=29, 37.7%), followed by hemifacial space (n=22, 28.6%) and buccal space (n=7, 9.1%). Ludwig angina accounted for about 7.8% of the cases. Conclusion CFI most commonly involves the submandibular space, typically affects individuals with a low level of education, and is influenced by traditional medical practices. Despite improved health care delivery, CFI remains a significant problem in developing countries.

Temporomandibular joint dislocation: experiences from Zaria, Nigeria

Objectives Dislocation of the temporomandibular joint may occur for various reasons. Although different invasive methods have been advocated for its treatment, this study highlights the value of non-invasive treatment options even in chronic cases in a resource-poor environment. Materials and Methods A seven-year retrospective analysis of all patients managed for temporomandibular joint dislocation in our department was undertaken. Patient demographics, risk factors associated with temporomandibular joint dislocation and treatment modalities were retrieved from patient records. Results In all, 26 patients were managed over a seven-year period. Males accounted for 62% of the patients, and yawning was the most frequent etiological factor. Conservative treatment methods were used successfully in 86.4% of the patients managed. Two (66.7%) of the three patients who needed surgical treatment developed complications, while only one (5.3%) patient who was managed conservatively developed complications. Conclusion Temporomandibular joint dislocation appears to be associated with male sex, middle age, yawning, and low socio-economic status, although these observed relationships were not statistically significant. Non-invasive methods remain an effective treatment option in this environment in view of the low socio-economic status of the patients affected.