Causes of ma xillofacial patient mortality in a Nigerian tertiary hospital

BACKGROUND: An analysis of maxillofacial mortality was done in a Nigerian tertiary health care centre to determine the major causes of mortality and identify possible predisposing factors in our environment.MATERIALS AND METHODS: A retrospective analysis of mortality in maxillofacial surgery department of Aminu Kano Teaching Hospital from January 2005 to December 2014 was done. Data were analyzed using statistical package for social sciences (SPSS) version 15.0 (SPSS Inc, Chicago, IL).RESULTS: A mortality rate of 1.8% (46 deaths from 2,540 admissions) was recorded. There were 35 males (76.1%) and 11 (23.9%) females. The mean age of the deceased patients was 40.0±13.0 years. Orofacial infections (41.3%) and advanced (stage IV) orofacial malignancies (28.3%) accounted for most deaths.CONCLUSION: Fascial space infections and orofacial malignancies contribute largely to mortality in our setting. Late presentation was a major factor predisposing to mortality.Key Words: Audit, Maxillofacial Patient, Mortalit

A retrospective observational study of paediatric mandibular fractures: Demographics, pattern and challenges of management in a Nigerian population

Background: Paediatric mandibular fractures unlike adult mandibular fractures are said to be rare. When not recognised early, they may be associated with significant problems such abnormal mandibular growth. Materials and Methods: This was a retrospective observational study of paediatric patients with mandibular fractures presenting to a university teaching hospital from August 1999 to December 2019. Information sourced from patient's case notes and operating records included age, sex, aetiology, investigation, concomitant injuries, treatment and complications. The retrieved data were recorded in a personal computer, analysed with appropriate statistical tool and presented in tables and figures. Results: A total of 550 patients who presented with mandibular fractures within the period of the study constituted the study population. Of these, 84 (15.3%) occurred in the paediatric age group. The ages of the patients ranged from 1 to 17 years with a mean age of 10.3 ± 5.0 years and there was a gender ratio (male: female) of 1.9:1. Road traffic accident accounted for most mandibular fractures. The imaging modality used in assessing mandibular fractures was mainly plain radiography and treatment was administered in 60 (71.4%) patients, with closed reduction method (n = 45; 75.0%) being the most frequent technique used. The period of hospital stay ranged from 3 to 90 days with a mean of 16.8 days. Conclusion: Mandibular fractures in paediatric population were noted to be more common in males and the main aetiology was pedestrian-related road traffic accidents. There is a need for continual review of injury prevention strategies in the paediatric group

Orofacial Soft Tissue Reconstruction with Locoregional Flaps in a Health Resource-Depleted Environment: Experiences from Nigeria

Background Reconstruction of orofacial soft tissue defects is often challenging due to functional and aesthetic demands. Despite advances in orofacial soft tissue defect reconstruction using free flaps, locoregional flaps still remain an important option, especially in health resource-depleted environments. This retrospective study highlights our experiences in oral and maxillofacial soft tissue reconstruction using locoregional flaps. Methods A twenty-three years retrospective analysis of all patients managed in our department was undertaken. Information was sourced from patients' case notes and operating theater records. Data was analyzed using SPSS ver. 16 (SPSS Inc.) and Microsoft Excel 2007 (Microsoft). Results A total of 77 patients underwent orofacial soft tissue defect reconstruction within the years reviewed. Males accounted for 55 (71.4%) cases and trauma was the main etiological factor in 45 (58.4%) of the patients treated. When sites of defect were considered, the lip, 27 (32.1%), was the most frequent site followed by the nose, 17 (20.2%). Forehead flap, 51 (59.3%), was the most commonly used flap. Complications noted were tumor recurrences at the recipient bed in 3 (3.9%) cases, tumor occurrence at the donor site in 1 (1.3%) case and postoperative infection in 11 (14.3%) cases. Conclusions Locoregional flaps still have an important role in the rehabilitation of patients with orofacial soft tissue defects. They remain a vital tool in the armamentarium of the reconstructive surgeon, especially in health resource-depleted environments where advanced reconstructive techniques may not be feasible

Odontogenic Cervicofacial Infection in Pregnancy: A Need for Oral Care

Objective: During pregnancy, changes occur in the oral environment with gingivitis predominating. The development of odontogenic infections within the period of pregnancy may endanger the life of the mother as well as that of her unborn baby. Materials and methods: A retrospective observational study of cases of cervicofacial infection in women during pregnancy was conducted at the oral and maxillofacial surgery clinic of a northern Nigerian tertiary health care center from January 2006 to June 2018. Results: Seventy women were managed for cervicofacial infection during the period reviewed, out of which 20 women (28.6%) presented during pregnancy. Their mean age was 33.8 ± 9.35 years with a range of 20 to 55 years. The 30-39 years age bracket had the highest frequency (40%) and the mean duration of pregnancy at presentation was 24.9 ± 11.12 weeks with a range between 10 to 36 weeks. Majority (n=15, 75.0%) presented in the 3rd trimester. At presentation, the frequently involved fascial space was unilateral submandibular space (n=10; 50.0%), All the patients had incision/drainage/decompression on the dental chair under local anesthesia (2% lidocaine with 1:80,000 adrenaline). The mean length of hospital stay was 13.9 ± 6.2 days with a range of 6 to 26 days. The mortality rate was 15% (n=3 cases). Conclusion: There is a need for oral health evaluation in pregnant women during ante-natal visits to prevent these complications. Oral health education should also form part of teachings received by women both in the ante-natal and postnatal clinics

Extended Orbital Exenteration: Proposal for Modification of Meyer and Zaoli’s Classification: Proposal modification of Meyer and Zaoli’s Classification

Background: The orbital exenteration classification by Meyer and Zaoli has become popular in the literature as a means whereby clinicians present exenteration procedures. Although Meyer and Zaoli’s classification is adopted in our practice Objective: To propose a modification of Mayer and Zaoli’s classification to accommodate cases of orbital exenteration where one or both eyelids will be spared. Methods: A retrospective study of cases of maxillary tumours treated with maxillectomy and orbital exenteration over a 13 years period (January 2005- December 2017) in a Nigerian tertiary health facility. Results: They were 14 maxillectomies with orbital exenteration out of 91 maxillectomies carried out within the study period. There were more males (71.4%) than females (28.6%) and the age range was between 5 to 72 years (mean of 42.57 years, the median age was 45 years). Based on Meyer and Zaoli’s classification of orbital exenteration, 5 cases were classed as type IV, nine cases, however, could not be classified as they met all other requirements for classification as type IV except for the eyelid preservation which cannot be accounted for in Meyer and Zaoli’s classification Conclusion: Modification of Mayer and Zaoli’s classification to accommodate orbital exenteration cases where one or both eyelids were spared will make it more complete and exhaustiv

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

A review of cleft lip and palate management: Experience of a Nigerian Teaching Hospital

Background: Cleft lip (CL) and palate (CLP) management is multidisciplinary. A cleft team was formed in a Nigerian Tertiary Hospital to address the health needs of cleft patients in the centre. Aim: This paper aims at documenting the Aminu Kano Teaching Hospital (AKTH) management protocol for orofacial clefts and also to review our experience with CLP surgeries performed at AKTH since our partnering with Smile Train. Materials and Methods: A retrospective review of all the cleft patients surgically treated from January 2006 to December 2014 under Smile Train sponsorship was undertaken. A descriptive narrative of the cleft team protocol was also given. Results: One hundred and fifty-five patients (80 males, 75 females) had surgical repairs of either the lip or palate. CL patients were 83 (53.55%), while CLP patients were 45 (29.03%) and isolated cleft palate patients were 27 (17.42%). Conclusion: The inclusion of various specialities in the cleft team is highly desirable. Poverty level amongst our patients frequently limits our management to surgical treatment sponsored by the Smile Train, despite the presence of other residual problems

Causes of maxillofacial patients mortality in a Nigerian tertiary hospital

Background. An analysis of maxillofacial mortality was done in a Nigerian tertiary health care centre to determine the major causes of mortality and identify possible predisposing factors in our environment. Materials and methods. A retrospective analysis of mortality in maxillofacial surgery department of Aminu Kano Teaching Hospital from January 2005 to December 2014 was done. Data were analyzed using statistical package for social sciences (SPSS) version 15.0 (SPSS Inc, Chicago, IL). Results. A mortality rate of 1.8% (46 deaths from 2,540 admissions) was recorded. There were 35 males (76.1%) and 11 (23.9%) females. The mean age of the deceased patients was 40.0±13.0years. Orofacial infections (41.3%) and advanced (stage IV) orofacial malignancies (28.3%) accounted for most deaths. Conclusion. Fascial space infections and orofacial malignancies contribute largely to mortality in our setting. Late presentation was a major factor predisposing to mortality

Paediatric jaw tumours: experiences and findings from a resource limited tertiary health care center

Introduction: primary maxillofacial tumors are uncommon in pediatric patients. When they do occur, the tissue damage caused directly alters facial growth, development as well as psycho-social evolution. This study was carried out to determine the pattern, sociodemographic characteristics and histologic peculiarities of paediatric jaw tumors in our environment. Methods: a retrospective hospital-based study where the case notes of children below the age of 14 years who presented with jaw tumors and tumor-like lesions from January 2014 to December 2018 were studied. Results: eighty-two patients were studied; patients aged 10-14 years had the highest representation. Mean time of presentation was 8 months with jaw swelling being the commonest presentation (84.1%). Majority of the fathers were in their 4th decade of life while most of the mothers were in their third decade of life and both parents possessed primary school certificate as their highest level of educational attainment. Fathers were mostly traders, while mothers were mostly full-time housewives. The maxilla and mandible were most commonly affected with the left side showing higher preponderance. Burkitt lymphoma (19 (23.2%)) and adenomatoid odontogenic tumor (14 (17.1%)) were the commonest lesions. When the tumor involved both the maxilla and the mandible, the tumor was most likely malignant. Conclusion: in our center, paediatric jaw tumors are commonest in male children with the 10-14 years´ age group most commonly affected. Burkitt lymphoma and adenomatoid odontogenic tumors were the commonest tumors. Early presentation must be encouraged since these tumors if presented early can be successfully treated