Associated anomalies in cleft lip and palate: analysis of 811 consecutive patients

Introduction: Clefts are common birth defects and may be associated with oro-facial congenital anomalies. It has not been established if specific types of anomalies are frequently related with clefts, or which organ is most commonly affected. This study aimed to assess the prevalence of associated anomalies in consecutive cleft lip and palate patients treated at two referral centres in Northern Nigeria.Methods: Cleft lip and palate at two referral hospitals in Northern Nigeria from January 2012 to December 2015 were studied. Data were analysed using Statistical Package for Social Sciences (SPSS) version 16.Results: A total of 811 cleft lip and palate patients were managed. Fifty-five percent (447) were male and 45% (364) were female while 71% (578) were children and 29% (233) were adults. The prevalence of associated anomalies was 11.5%. The most common associated anomaly among cleft patients was facial anomaly (64% of cleft patients). Associated anomalies were most prevalent in patients with isolated cleft palate. Hypertelorism was the commonest type of facial anomaly recorded.Conclusion: Our study showed a low incidence of associated anomalies with a higher incidence in isolated cleft palate cases.Key Words: Cleft lip, Cleft Palate, Associated Facial Anomaly, Congenital anomal

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

Associated anomalies in cleft lip and palate: Analysis of 811 consecutive patients

Introduction: Clefts are common birth defects and may be associated with oro-facial congenital anomalies. It has not been established if specific types of anomalies are frequently related with clefts, or which organ is most commonly affected. This study aimed to assess the prevalence of associated anomalies in consecutive cleft lip and palate patients treated at two referral centres in Northern Nigeria. Methods: Cleft lip and palate at two referral hospitals in Northern Nigeria from January 2012 to December 2015 were studied. Data were analysed using Statistical Package for Social Sciences (SPSS) version 16. Results: A total of 811 cleft lip and palate patients were managed. Fifty-five percent (447) were male and 45% (364) were female while 71% (578) were children and 29% (233) were adults. The prevalence of associated anomalies was 11.5%. The most common associated anomaly among cleft patients was facial anomaly (64% of cleft patients). Associated anomalies were most prevalent in patients with isolated cleft palate. Hypertelorism was the commonest type of facial anomaly recorded. Conclusion: Our study showed a low incidence of associated anomalies with a higher incidence in isolated cleft palate cases

Management of fascial space infections in a Nigerian teaching hospital: A 4-year review

Background: Fascial space infections of the head and neck region, usually odontogenic in origin, are routinely treated as an out-patient procedure. Untreated or rapidly spreading odontogenic infections can be potentially life threatening. The present study is a review of patients with orofacial infections who required emergent incision and drainage in the maxillofacial unit of our institution. The need for early presentation is highlighted. Materials: This is a retrospective study of patients with orofacial space infections between January 2007 and December 2010. Patients’ case files were retrieved and demographic as well as clinical characteristics were obtained and analyzed. A P value of <0.05 was considered significant. Results: A total of 53 patients with fascial space infection were seen over the period of study. Of the 41 patients reviewed, males accounted for 26 (63.4%) and females 15 (36.6%). Their ages ranged from 4 months to 80 years (mean 32.8 ± 18.3 years). There was no statistical difference between the mean age of male and female patients (t=-962, P=0.342). Submandibular space was the most frequently involved single space and accounted for 43.9% of the cases. This was followed by multiple space involvement (Ludwig angina) which accounted for 36.6%. Buccal space and submasseteric space infection represented 7.3% each. Sources of infections were of odontogenic origin in 92.7% of cases and were unknown in the remaining 7.3%. The outcome was satisfactory with complete resolution in 48.8% of cases. Resolution with some morbidities in the form of persistent limitation of mouth opening, orocutaneus fistula, and necrotising fascitis were seen in an almost equal proportion of 46.3% of cases. The outcome was observed to be significantly associated with the presence of underlying systemic conditions (X2=21.66; r=0.73; P=0.0001), time of presentation (X2=12.28; r=0.55; P=0.002), and age(X2=54.48; r=0.69; P=0.0001). Conclusion: Fascial space infections of the head and neck region, though potentially life threatening, can be prevented by regular dental visits. Early recognition and treatment of established cases are necessary to prevent considerable morbidity and mortality, especially in older patients with an underlying systemic condition.Keywords:Fascial space, infections, NigeriaNigerian Medical Journal | Vol. 53 | Issue 1 | January-March | 201

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 World-wide prevalence of 1/700 births. They are commonly divided into CL(P) and CP based on anatomical, genetic and embryological findings. A Nigerian craniofacial anomalies study “NigeriaCRAN” was set up in 2006 to investigate the role of gene-environment interaction in the etiology of orofacial clefts in Nigeria. SUBJECTS AND METHODS: DNA isolated from saliva from the Nigerian probands was used for genotype association studies and direct sequencing on the 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 hap map controls. No other apparent etiologic variations were identified. A deviation from HWE was observed in the cases (p= 0.00002). There was a significant difference between the affected side for unilateral CL (p=0.03) and, between bilateral clefts and clefts on either side (p=0.02). A significant gender difference was also observed for CP (p=0.008). CONCLUSIONS: The replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the etiology of CL(P)