Qualitative Assessment of Surgical Repair of Three Types of Unilateral Cleft Lip

Objective: To assess the effect of the three types of unilateral cleft lip (UCL) [cleft lip only, cleft lip and alveolus, and cleft lip alveolus and palate] on the outcome of the repair. Material and Methods: This study was a case series of effect of types of UCL on the outcome of the repair. Fifteen subjects each were in three UCL phenotypes groups. Evaluation of the scar, lip, and nose was done qualitatively by both parents/guardians and professionals using a modified form of the criteria described by Christofides et al. (2006). Results: In the assessment of the surgical scar, the parents found a difference between the three types of cleft in terms of texture, shape, and width of the scar and presence of columella deviation. The professional assessors, however, only found the three types of cleft to be different in the presence of alar flattening. Conclusion: Differences truly exist in the outcome of surgical repair of the three types of unilateral cleft lip, especially in the aesthetics of the nose and in the width and shape of the residual lip scar. Thus, it is important to consider this in the assessment of UCL repair because putting the subtypes together might have a negative impact on the assessment

Comparison of sensitivity of bacteria isolated in odontogenic infections to ceftriaxone and amoxicillin-clavulanate

Background: Odontogenic infections is a cause of mortality and morbidity in maxillofacial patients. This is largely due to resistance of organisms to antibiotics prescribed.Objectives: To isolate organisms involved in odontogenic infections and compare the sensitivity of the organisms to Ceftriaxone and Amoxicillin-Clavulanate.Methods: The causative organisms and antibiotic sensitivity were determined by the following steps: Aspiration of pus done with needle, sample of pus or exudate collected using sterile swab if aspiration was unsuccessful and specimen were placed in transport media (thioglycolatebroth) and sent immediately to microbiology laboratory for culture of organisms and antibiotic sensitivity.Results: Out of a total 55 samples taken for bacteriology, 42 (76.4%) yielded positive culture for bacteria. A total number of 21 bacteria species were identified from the positive cultures. Overall, 52% of isolated organisms were sensitive to amoxicillin-clavulanate, 70% were sensitive to Ceftriaxone while 24% were resistant to both antibiotics (Table 3). Ceftriaxone was statistically significantly more potent in inhibiting bacteria growth than amoxicillin-clavulanate (P =0.009).Keywords: Sensitivity of bacteria, odontogenic infections, ceftriaxone, amoxicillin-clavulanate

Comparison of sensitivity of bacteria isolated in odontogenic infections to ceftriaxone and amoxicillin-clavulanate

Background: Odontogenic infections is a cause of mortality and morbidity in maxillofacial patients. This is largely due to resistance of organisms to antibiotics prescribed. Objectives: To isolate organisms involved in odontogenic infections and compare the sensitivity of the organisms to Ceftriaxone and Amoxicillin-Clavulanate. Methods: The causative organisms and antibiotic sensitivity were determined by the following steps: Aspiration of pus done with needle, sample of pus or exudate collected using sterile swab if aspiration was unsuccessful and specimen were placed in transport media (thioglycolatebroth) and sent immediately to microbiology laboratory for culture of organisms and antibiotic sensitivity. Results: Out of a total 55 samples taken for bacteriology, 42 (76.4%) yielded positive culture for bacteria. A total number of 21 bacteria species were identified from the positive cultures. Overall, 52% of isolated organisms were sensitive to amoxicillin-clavulanate, 70% were sensitive to Ceftriaxone while 24% were resistant to both antibiotics (Table 3). Ceftriaxone was statistically significantly more potent in inhibiting bacteria growth than amoxicillin-clavulanate (P =0.009)

Multidisciplinary approach to genomics research in Africa:the AfriCRAN model

This article is an outcome of the African Craniofacial Anomalies Research Network (AfriCRAN) Human Hereditary and Health (H3A) grant planning meeting in 2012 in Lagos, Nigeria. It describes the strengths of a multidisciplinary team approach to solving complex genetic traits in the craniofacial region. It also highlights the different components and argues for the composition of similar teams to fast track the discovery of disease genes, diagnostic tools, improved clinical treatment and ultimately prevention of disease

Novel <i>GREM1 </i>Variations in Sub-Saharan African Patients With Cleft Lip and/or Cleft Palate

Objective: Cleft lip and/or cleft palate (CL/P) are congenital anomalies of the face and have multifactorial etiology, with both environmental and genetic risk factors playing crucial roles. Though at least 40 loci have attained genomewide significant association with nonsyndromic CL/P, these loci largely reside in noncoding regions of the human genome, and subsequent resequencing studies of neighboring candidate genes have revealed only a limited number of etiologic coding variants. The present study was conducted to identify etiologic coding variants in GREM1, a locus that has been shown to be largely associated with cleft of both lip and soft palate. Patients and Method: We resequenced DNA from 397 sub-Saharan Africans with CL/P and 192 controls using Sanger sequencing. Following analyses of the sequence data, we observed 2 novel coding variants in GREM1. These variants were not found in the 192 African controls and have never been previously reported in any public genetic variant database that includes more than 5000 combined African and African American controls or from the CL/P literature. Results: The novel variants include p.Pro164Ser in an individual with soft palate cleft only and p.Gly61Asp in an individual with bilateral cleft lip and palate. The proband with the p.Gly61Asp GREM1 variant is a van der Woude (VWS) case who also has an etiologic variant in IRF6 gene. Conclusion: Our study demonstrated that there is low number of etiologic coding variants in GREM1, confirming earlier suggestions that variants in regulatory elements may largely account for the association between this locus and CL/P. </jats:sec

Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery

BACKGROUND: The apparent interactions between the mechanisms of action of non-steroidal anti-inflammatory drugs (NSAIDS) and steroids suggest that co-therapy may provide beneficial inflammatory and pain relief in the absence of side effects. The aim of the study was to compare the effect of co-administered dexamethasone and diclofenac potassium (diclofenac K) with diclofenac K alone on the postoperative pain, swelling and trismus after surgical removal of third molars. PATIENTS AND METHODS: A prospective randomized double-blind study was conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Nigeria. A total of 100 patients were randomly allocated to two treatment groups of dexamethasone (prophylactic 8 mg and postoperative 4 mg IV) and diclofenac K (50 mg Oral before and after surgery), and diclofenac K alone (as with first group). The overall analgesic efficacy of the drug combinations was assessed postoperatively by determination of pain intensity using a category rating scale. Facial swelling was measured using a tape measure placed from tragus to gonion to tragus, while interincisal mouth-opening of patients was measured using a vernier calibrated caliper pre-operatively and post-operatively. RESULTS: Co-administration of dexamethasone and diclofenac K was significantly superior to diclofenac alone for the relief of pain (P < 0.05), and facial swelling up to post-operative 48 hour (P < 0.05). However, there was no significant difference for trismus relief between the two medication protocols (P > 0.05). CONCLUSION: This study illustrates enhanced effects of co-administered dexamethasone and diclofenac K on short-term post-operative pain and swelling, compared to diclofenac potassium alone in third molar surgery

Psychological distress and perceived stress, among mothers of infants with orofacial clefts in a tertiary hospital in Lagos, Nigeria

Background: Arrival of a child with cleft lip or palate is characterized by mixed feelings in the parents. The aim of the study was to determine the magnitude of psychological distress, attributional beliefs on causation, perceived stress symptoms in mothers of infants with cleft lip and palate. Subjects and Methods: Questionnaires about causal beliefs (MCA), the General health questionnaire-version 12 and Perceived stress Scale (PSS) were administered to mothers of babies with cleft lip and palate. Results: Psychological distress was noted in 12 (23.1%) of the cases. On the PSS scale, 9 (17.9%) of the mothers had the perception of more than average stress. A higher proportion of mothers with more than average perceived stress had combined cleft lip and palate (66.7%). Many mothers (n = 43, 82.7%) had no understanding of the cause of their childs deformity. There was a significant relationship between the presence of Psychological distress and the mothers perception of stress (P < 0.005). Thirty-eight (73%) of mothers who had cleft babies admitted to subjective feelings of misery and depression in relation to coping with the deformity and this was significantly associated with the experience of psychological distress (P = 0.016) with 9 (75%) of them having suggestive scores on the GHQ. Also among these mothers those who reported more perceptions of stress also seemed to endorse more subjective feelings of depression (P < 0.05). Conclusion: Mothers of babies with cleft lip and palate can go through difficult emotions that make them perceive their role as being stressful. This has implications on their overall emotional wellbeing. Early maternal mental health screening, health education explaining causation are useful strategies that can be embedded in protocols to help promote both maternal and child mental health in this special population group

Open access publishing: A review of publications originating from a medical college in Nigeria

Background: Open Access (OA) publishing has gained tremendous acceptance in academic publishing over the last decade. This paper reviews the number and trend of OA publishing of research papers originating from College of Medicine University of Lagos (CMUL), Nigeria. Materials and Methods: A computerized literature search of PubMed for all published articles originating from CMUL between 1976 and 2013 was conducted. The search phrase used was "College of Medicine University of Lagos". The search was conducted on March 30, 2013. All articles tagged "Free article" or "Free PubMed article" were selected. Results: A total of 1255 articles appeared in PubMed between 1976 and 2013 (37 years). At the first level of screening, 162 articles were identified as "Open Access". Second level of screening to eliminate articles not originating from CMUL identified 124 articles. Only 15 OA articles were published between 1976 and 2000 (24 years), 11 articles appeared as "Open Access" journals between 2001 and 2005 (5 years), 44 between 2006 and 2010 (5 years), and 54 articles were published between 2011 and 2013. Twenty-four of these articles were published in Nigerian OA Journals, and the remaining articles (100) in foreign journals. Conclusions: OA publishing is becoming popular among researchers at CMUL. This trend has been observed worldwide. Nigerian researchers are advised that while going along with the worldwide trend, they should however, be aware of predatory OA journals and publishers. The criteria for determining predatory OA publishers can be accessed via: www.scholarlyoa.com/publishers

Oral health-related quality of life following third molar surgery in an African population

Introduction: Surgical extraction of impacted mandibular third molars is often associated with sequelae such as postoperative pain, facial edema, and limitation in mouth opening ability. These sequelae may result in changes in the patients' lifestyle and quality of life (QoL). Aim: The aim of this study was to evaluate the effect of surgical extraction of impacted mandibular third molars on patients' QoL in the immediate postoperative period (7 days). Materials and Methods: Ethical approval for this study was obtained from the Health Research and Ethics committee of the Lagos University Teaching Hospital. A total of 124 individuals with impacted mandibular third molars, who satisfied the inclusion criteria and consented to participate in this study, were included. The Oral Health Impact Profile-14 (OHIP-14) QoL questionnaire was used to assess QoL. QoL was assessed preoperatively (baseline) and on postoperative days (PODs) 1, 3, and 7. Maximal interincisal mouth opening, facial width, and pain were also reviewed at all evaluation points. Data analysis was done using the Statistical Package for Social Sciences (SPSS) for Windows (version 16.0, Chicago, IL, USA). Results: A total of 124 individuals were included in the final analysis. An age range of 18–51 years with a mean (±standard deviation) of 28.5 (7.4) years was observed. A male to female ratio of 1:1.5 was observed. The most frequently encountered type of impaction was the mesioangular impaction 51 (41.1%) and recurrent pericoronitis was the principal reason for extraction 53 (42.7%). The severity of the sequelae (pain, trismus, and facial edema) was maximal on the first POD. Patients' overall QoL deteriorated sharply on the first POD and subsequently improved. Conclusion: Surgical extraction of mandibular third molars is associated with worsening of patients' postoperative QoL in the immediate postoperative period. Prospective patients should be informed about this, and ways of reducing this untoward effect should be explored