Palatal Impalement Injury With Retained Foreign Body in a Child: Case Report and Literature Review

Impalement injuries are uncommon in the head and neck region, and when associated with the retained foreign body present a challenge to the clinician with regards to management. This type of injury may occasionally be associated with life-threatening complications or permanent disability. Therefore, clinicians involved in the management of head and neck trauma need to be constantly reminded of this uncommon type of injury and the different treatment options.This is a case report of impalement injury to the palate of a child by a hair weaving instrument. Clinical and plain radiographic examination was sufficient for foreign body localization. The foreign body was successfully extricated under local anaesthesia and conscious sedation using a simple conservative technique with no complications

Pygomelia with genitalia duplication at Treichville Teaching Hospital: two new cases

Pygomelia is a rare deformity (1/100 000) defined by the presence of one or more supernumerary members in the pelvic region. In this article, we report two new cases, including one that was successfully operated upon in our unit. The first case was characterized by the presence of two additional lower limbs postioned in the hypogastric region and a third vestigial epigastric upper limb associated with visceral deformations. Surgical treatment was successfully accomplished. The clinical examination of the second case objectified the third lower limb at the level of the left buttock with a rudimentary pelvis, a sacrococcygeal teratoma, and a genital duplication. The newborn child died during the investigations. The nosological limits of pygomelia are still poorly specified because it is similar to cases of duplication of the lower limbs and dipygus.Keywords: caudal duplication, dipygus, pygomeli

A revisit of oral and maxillofacial mortality from orofacial infections in a resource limited setting: Is there a need for a change in management protocol?

Background: Orofacial infections are communicable infections usually of odontogenic origin, they often present as rapidly spreading infection involving the fascial spaces of the head and neck. When they are not promptly and adequately intercepted, they may result in fatal outcomes. The common pathway to mortality in these patients is often airway compromise. The advent of antibiotics and improvement in quality of health care has been said to improve the success rate in the management of orofacial infections, however the findings from our setting showed that the mortality from orofacial infections have remained high.Objective: To report mortalities from patients managed for orofacial infections in our center, review our treatment protocol and ascertain the necessity for a change in management protocolDesign: A retrospective study Setting: Maxillofacial surgery department of Aminu Kano Teaching Hospital (AKTH) Kano, Kano state Nigeria.Subjects: All patients who died in our facility over a one hundred and thirty eight-month period (January 2005 – June 2016) following management of orofacial infectionsResults: A total of 115 (76 males, 39 females) maxillofacial admissions were recorded on account of orofacial infection during the period under review; of these 26 mortalities were recorded (22.6%). Male subjects constituted 19 cases while female subjects were 7 in number. The demised patients’ ages ranged from 19 years to 73 years with a mean age of 34.0 ± 12.0 years.Conclusion: Orofacial infections are potentially lethal; they constitute one of the commonest causes of mortality in maxillofacial surgery facilities. A standard care of early intervention, aggressive medical and surgical therapy has consistently provided the best results

Pattern of Ocular Involvement in Midface Injuries Seen at a Tertiary Care Hospital in Northern Nigeria

Aim: The aim of the study was to report the etiology, pattern, and spectrum of ocular injuries in patients with maxillofacial injuries seen at a tertiary care hospital in northern Nigeria.  Patients and Methods: This is a retrospective evaluation of the etiology, spectrum, and treatment of ocular injures seen in patients with midfacial fractures, who presented at Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria, a tertiary care hospital in northern Nigeria. Cases were seen at the oral and maxillofacial clinic for those presenting with midfacial fractures, whereas those presenting with ocular injuries due to midfacial injuries were referred from the ophthalmology department. Data were collected on their demographics, etiology of injuries, body part(s) involved, and treatment. Results: A total of 256 patients had midfacial injuries during the period, of which 219 patients had 357 associated ocular injuries. The age range was between 3 and 76 years. There were more males (83.8%) than females (16.2%), giving a male-to-female ratio of 5.2:1; the 21–30 years' age bracket was most frequently affected (38.4%). The predominant etiology of injuries was road traffic accidents (RTAs) (90.1%), followed by assault (4.9%). Zygomatic complex fractures (38.6%) and orbital wall fractures (24.7%) were the common midfacial injuries. There were 357 ocular injuries, giving a patient: injury ratio of 1:1.6, with subconjunctival hemorrhage (32.5%) and ruptured globe (20.0%) being common. Treatments performed were reduction and immobilization of midfacial fractures plus evisceration (32.0%), followed by reduction and immobilization of fractures alone (23.9%) and reduction and immobilization plus grafting of soft tissues (21.2%). Conclusion: Ocular injuries are quite common in patients with midfacial injuries, with a ratio of 1.6:1. RTA was the most common etiology, with zygomatic complex fractures as the most common midfacial injury. Subconjunctival hemorrhage was the most common ocular injury manifestation, with young adults (21–30 years of age) being most affected. Treatment often involved reduction and immobilization of midface fractures with evisceration and grafting of ocular tissues

Hydrocolpos et hématocolpos par imperforation hymenale: prise en charge au CHU de Treichville

Les hydro et hématocolpos se définissent comme étant la rétention vaginale soit des secrétions cervicales et vaginales (hydrocolpos), retrouvée chez le nouveau-né et le nourrisson, soit des menstruations (hématocolpos) se constituant à la puberté dès les premières menstruations. L’étiologie principale est l’imperforation hyménale. Pathologie rare et notre but était de présenter les caractéristiques cliniques, paracliniques, thérapeutiques et évolutives ainsi que les difficultés diagnostiques rencontrées, surtout dans les cas d’hydrocolpos. Il s’est agit d’une étude rétrospective et descriptive qui s’est déroulée dans le service de chirurgie pédiatrique du CHU de Treichville sur une période de 10 ans allant de Janvier 2008 à Décembre 2017. Elle concernait toutes les patientes chez qui le diagnostic d’hydro ou hématocolpos avait été posé. Les variables étudiées ont été cliniques, paracliniques, thérapeutiques et évolutives. Nous avons colligé 11 dossiers d’enfant dont 5 cas d’hydrocolpos et 6 cas d’hématocolpos. L’âge moyen était de 12,4 jours dans les cas d’hydrocolpos avec des extrêmes de 0 à 37 jours, et de 13,83 ans dans les cas d’hématocolpos avec des extrêmes de 13 à 14 ans. Le motif de consultation était représenté par la rétention aigue d’urine dans 8 cas (72,7%), la distension abdominale dans 2 cas. La douleur pelvienne cyclique était retrouvée chez toutes les adolescentes, à savoir dans l’hématocolpos, associée à une absence de ménarche dans tous les cas. Le diagnostic de l’imperforation hyménale a été fait tardivement chez 3 patientes. L’échographie a été réalisée dans 100% des cas. Le traitement chirurgical à consisté en une hyménotomie chez toutes les patientes avec laparotomie et une stomie vaginale première dans respectivement 3 et 2 cas. L’évolution était simple dans 9 cas soit 81,8%. Les complications retrouvée étaient un cas de récidive d’hydrocolpos ayant nécessité une reprise d’hyménotomie et une occlusion sur bride. L’imperforation hyménale est une malformation rare et bénigne du tractus génital féminin. Le diagnostic surtout chez le nouveau-né et nourrisson est retardé du fait de la méconnaissance par les praticiens. Devant tout trouble urinaire, il faut y penser et faire systématiquement un examen de la vulve. Mots clés: hydrocolpos, hématocolpos, imperforation hyménale, hyménotomie English Abstract Hydrocolpos and hematocolpos are defined as vaginal retention cervical and vaginal secretions (hydrocolpos), in newborns and infants, or menstrual blood (hematocolpos) unadolescents at puberty. The commonest etilogi is an imperforate hymen. It is a rare pathology and thus aim was be to report on the clinical, paraclinical, therapeutic and evolutionary characteristics as well as the difficulties encountered, especially in case of hydrocolpos. It was a retrospective and descriptive study carried out the pediatric surgery department of the Teaching Hospital of Treichville, over a period of 10 years, from January 2008 to December 2017. It concerned all patients diagnosed with hydro or he matocolpos. Studied variables were clinical, paraclinical, therapeutic and outcom. We recorded 11 cases including 5 cases of hydrocolpos and 6 cases of hematocolpos. The mean age was 12.4 days for hydrocolpos and 13.83 years for hematocolpos ones. The presenting complaint was acute urine retention in 8 cases (72.72%), abdominal distention in 2 cases. Cyclic pelvic pain was found in all adolescents, with in hematocolpos, associated with an absence of menses in all cases. The diagnosis of imperforate hymen was done late in 3 patients. Ultrasound was performed in 100% of cases. Surgical treatment consisted of a hymenotomy in all patients with laparotomy and vaginal opening to the skin in 3 and 2 cases, respectively. The outcom was simple in 9 cases (81.82%). The complications recorded incloded a recurrence of hydrocolpos that required another hymenotomy and intestinal occlusion by adhesions. Imperforate hymen is a rare and benign malformation of the female genital tract. The diagnosis especially in the newborn and infant is delayed because of the ignorance of practitioners. it should be considered in case of any urinary disorder, it and confirmed by examination of the vulva. Keywords: hydrocolpos, hematocolpos, imperforate hymen, hymenotom