Ludwig’s angina: an analysis of sixteen cases in a suburban Nigerian tertiary facility.

Objective: To document the prevalence and management of Ludwig’s angina in a suburban population. Methods: All consecutive cases of Ludwig’s angina seen and managed at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria between 1988 and 2002. Results: There were 16 cases with 10 males and 6 females whose ages ranged from 8 to 75 years; mean+ SD; 43.8 + 19.9 years. Symptom duration ranged from one day to three weeks; mean + SD; 6.4 + 4.9 days of the onset of illness. Odontogenic infection was the commonest etiologic factor in 12 cases (75%) and 4 of these were attributed to post dental extraction sepsis. Seven patients had underlying disease such as diabetes mellitus, lobar pneumonia, severe anaemia and mental retardation. The commonest was diabetes mellitus in 4 cases. Microbiological investigations showed a polymicrobial nature of the infection with Staphylococcus aureus (6 cases) out of 11 patients that had the examination. Treatment involved high doses of broad-spectrum parenteral antibiotics, immediate surgical drainage under local and general anaesthesia in 14 (75%) and single patients respectively. This was in addition to extraction of involved tooth/teeth where applicable. The complications recorded in 5 cases (31.3%) were septicaemia, mediastinitis, empyema thoracic, necrotising fasciitis, laryngeal spasm and renal failure. Mortality occurred in 4 cases (25%). Conclusions: Ludwig’s angina is a serious disease and late presentation remains a typical feature. Associated co-morbid condition is common. Prompt clinical evaluation and definitive care will considerably improve its prognosis and reduce the high mortality associated with the condition Key words: Ludwig’s Angina, Suburban Population, Tertiary Facility

Reasons for late presentation of cleft deformity in northeastern Nigeria

Cleft lip and palate is the commonest congenital deformity of the orofacial region. It is generally accepted that the surgical operations of cleft lip and palate should be done early in life. Indeveloping countries, a significant number of these patients present for treatment in late childhood and in some instances as adults. The precise reasons for this will most certainly vary from culture to culture, but the common reasons may be quite similar in many countries Method: Fifty-two patients with facial clefts who presented late at the University of Maiduguri Teaching Hospital within a 2-year period were assessed by interviewing either the parents, relations or even the patients themselves. Result: The reasons for late presentation were financial constraint (46%), lack of knowledge of availability of cleft services (40%), far distance from cleft centre (8%), cultural beliefs (4%) and fear of surgery(2%). Conclusion: The result of this study revealed financial constraint and lack of knowledge of availability of cleft services as prominent reasons why majority of patients with cleft deformity presents late. Adequate funding of cleft care from both government and non-governmental organisations, providing primary health care workers with information regarding the availability of cleft services and improved public enlightenment programme would reduce the rate of late presentation in Nigeria and other developing countries

Oral mucosa grafts for urethral reconstruction

Background: Urethral reconstruction has continued to present formidable and enormous challenges for urologic, paediatric and plastic surgeons as diverse opinions have been expressed on the quality and type of ideal substitution material. This literature review is aimed at drawing attention of surgeons to the versatile nature of oral mucosal grafts. Methods: A review of the utilization of oral mucosa in urethral reconstruction was made. Structured Medline search was performed looking at all aspects of utilization of oral mucosa including mucosal harvest, donor site morbidity and outcome. Results: The unique demands of the urethra set a high standard for autogenous graft substitutes; hence literature reports reveal that split and full thickness skin grafts from the scrotum, penis, extragenital sites (ureter, saphenous vein, appendix, colon, medial upper arm, neck, lateral chest, abdomen, bladder mucosa) and more recently oral mucosa have been used. Unlike other tissues, oral mucosa grafts are flexible, easy to harvest and trim and have an excellent microvasculature favorable for graft-taking. Furthermore, the natural moist location of the oral mucosa in the oral environment favours its easy adaptability in the urethral passage thus giving good long-term results. However, there are reports of complications at the donor site with the commonest being anaesthesia or paraesthesia of the cheek or lips. Regional variations of the oral mucosa, length of the graft required, the decision to close or leave donor site open and harvesting technique are some of the factors suggested to account for differences in donor site morbidity. Conclusion: Oral mucosal graft is a versatile urethral substitute with excellent outcome. It is becoming the gold standard for urethral substitution

Oral mucosa grafts for urethral reconstruction

Background: Urethral reconstruction has continued to present formidable and enormous challenges for urologic, paediatric and plastic surgeons as diverse opinions have been expressed on the quality and type of ideal substitution material. This literature review is aimed at drawing attention of surgeons to the versatile nature of oral mucosal grafts. Methods: A review of the utilization of oral mucosa in urethral reconstruction was made. Structured Medline search was performed looking at all aspects of utilization of oral mucosa including mucosal harvest, donor site morbidity and outcome. Results: The unique demands of the urethra set a high standard for autogenous graft substitutes; hence literature reports reveal that split and full thickness skin grafts from the scrotum, penis, extragenital sites (ureter, saphenous vein, appendix, colon, medial upper arm, neck, lateral chest, abdomen, bladder mucosa) and more recently oral mucosa have been used. Unlike other tissues, oral mucosa grafts are flexible, easy to harvest and trim and have an excellent microvasculature favorable for graft-taking. Furthermore, the natural moist location of the oral mucosa in the oral environment favours its easy adaptability in the urethral passage thus giving good long-term results. However, there are reports of complications at the donor site with the commonest being anaesthesia or paraesthesia of the cheek or lips. Regional variations of the oral mucosa, length of the graft required, the decision to close or leave donor site open and harvesting technique are some of the factors suggested to account for differences in donor site morbidity. Conclusion: Oral mucosal graft is a versatile urethral substitute with excellent outcome. It is becoming the gold standard for urethral substitution

A clinicopathological study of lipomas of the head and neck

Background: Lipoma of the head and neck region are fairly common. Methods: This twelve year retrospective study evaluated thirty-nine cases of head and neck lipomas in Nigerians. Results: They constituted 14.4% of benign tumours of the head and neck region and 17.6% of total body lipomas seen within the study period. There were two peaks in the age distribution with patients in the fifth and seventh decades of life recording the highest number of cases. More males were affected with a male-female ratio of 2:1. Most cases (33.3%) were seen in the neck, followed by the scalp (23.1%). Only one intra oral case presenting on the tongue was recorded. The two patients with multiple lipomas were negative for associated systemic disease. Two histological variants were seen (conventional and fibrolipoma). Conclusion: Tumours of adipose tissue are common head and neck neoplasms. While conventional lipomas are the commonest histological variants, the diagnosis of these lesions may be arrived at from clinical presentations supplemented with histological examinations. Treatment by surgical excision (lipectomy) produces satisfactory results. (Nig J Surg Res 2003; 5; 12 – 17) Key words: Head and neck, lipoma

Orofacial Injuries in Eclamptic Nigerians

A retrospective review of one hundred and seventy three cases of eclampsia seen between 1994 and 2002 was conducted. Twenty one patients (12.1%) whose ages ranged from 18 to 35 years sustained orofacial injuries during the course of their eclamptic fits. Lacerations and bruises on the tongue, gingivae and lips accounted for injuries in all the patients. Temporomandibular joint dislocation was also recorded in one patient. Tongue lacerations were mainly due to tongue biting. Forceful insertion of objects during convulsive episodes was responsible for the bruises and deep lacerations at the ventral surface of the tongue in two patients. Two patients died from severe and uncontrolled bleeding complicated by renal failure and aspiration pneumonia from lacerations on the tongue and gingivae. Vigorous campaign should be carried out to encourage antenatal care attendance by pregnant mothers so that potential cases of eclampsia could be nipped in the bud before progressing to frank eclampsia. Furthermore, additional injuries usually inflicted on pregnant women by anxious relatives from forceful insertion of unpadded objects as mouth props should be discouraged through public health promotional campaigns. Obstetricians should be aware of the possibility of these injuries in an unconscious eclamptic patient and their life-threatening consequences if not promptly diagnosed and managed. The need to seek appropriate and early dental or maxillofacial consultation where such injuries are suspected and where services are available is imperative. (Afr J Reprod Health 2004; 8[3]:147-151