Surgery

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Management of cleft lip and palate in Nigeria: a survey
(Wolters Kluwer, 2018) Akinmoladun, V.; Ademola, S.; Olusanya, A.
Background: Clefts of the lip and/or palate are the most common congenital craniofacial defects and second only to club foot among all congenital anomalies. The management of this condition is resource intensive due to the multidimensional needs. This survey was carried out to ascertain the current state of cleft management in Nigeria with emphasis on training, scope of management, and assessment of treatment outcome. Materials and Methods: Structured questionnaires were administered to cleft surgeons based on professional and practitioners’ register and the result of literature search for cleft surgeons whose names may not appear in the registers. Results: A total of 69 returned questionnaires were analyzed. The highest number of surgeons was from southwest geopolitical region while the northeast had the least. Fifty-eight (84.1%) were specialists with the fellowships. Forty-seven had been cleft surgeons for <10 years. Majority undertook lip repair between 3 and 4 months while 50% did cleft palate at or more than 9 months. Millard rotation and advancement was used for lip repair by 91.2% and 44 employed the von Langenbeck technique for palatal repair. Forty-six respondents carried out nasal repair at the time of lip surgery with 44 doing this as closed rhinoplasty. Adhesive tapes were usually employed by 44 (63.7%) for managing the protruding premaxilla. Orthodontic evaluation was not usually part of the treatment plan of 34 respondents. Otology assessment and assessment of velopharyngeal competence were rarely done. Revision surgeries, alveolar bone grafting, rhinoplasties, and maxillary osteotomies were uncommon. Interdisciplinary team care approach was practiced by 54 (78.2%) respondents. Conclusion: Findings suggest an increase in the number of surgeons, but the training, scope, and standard of care remain relatively limited. Audit and assessment of the practice should also become points of emphasis.
An analysis of skin cancer in albinos in ibadan
(2015) Ademola S.A.
Context: Skin cancers are common among albinos living in Africa. Deleterious effect of ultraviolet rays from sunlight and nearness to the equator places the African Albinos at risk for skin cancer. Aims: This study aims to present skin cancers in albinos as seen by a plastic surgeon, sensitize the public to the magnitude of dangers that albinos are exposed to, highlight the challenges faced in their management and suggest strategies for improved outcomes. Settings and Design: A retrospective review of skin cancers among albinos was conducted at the University College Hospital, Ibadan, Nigeria. Methods and Material: The charts, operation and cancer registry records of all albinos referred to a plastic surgery division over a ten year period was reviewed. Demographic data and relevant information relating to skin lesions were extracted. Statistical Analysis: Descriptive analysis was done with the aid of statistical package for social sciences (SPSS) version 20. Results: Nineteen patients with fifty nine skin lesions comprising 13 males and 6 females were reviewed. Mean age of the patients was 33.6 (SD 12.8) years, 50% were unmarried, over 90% were Christians and 44% were not employed. The lesions were on the face in 84.6% while scalp and neck lesions were present in 36.8 and 31.6% of patients respectively. In 73.7% of the patients, the lesions were advanced. Basal cell carcinoma and squamous cell carcinoma were of equal proportion. Conclusions: Albinos in Nigeria should be exposed to public health intervention to reduce the incidence of skin cancers through targeted public health educational programmes; structured multicenter and population based research, surveillance, and improved access to healthcare.
Recruitment of yoruba families from nigeria for genetic research: experience from a multisite keloid study
(2014) Olaitan P.A; Odesina V; Ademola S.; Fadiora O.S; Oluwatosin O.M; Reichenberger E.J
Background: More involvement of sub-Saharan African countries in biomedical studies, specifically in genetic research, is needed to advance individualized medicine that will benefit non-European populations. Missing infrastructure, cultural and religious beliefs as well as lack of understanding of research benefits can pose a challenge to recruitment. Here we describe recruitment efforts for a large genetic study requiring three-generation pedigrees within the Yoruba homelands of Nigeria. The aim of the study was to identify genes responsible for keloids, a wound healing disorder. We also discuss ethical and logistical considerations that we encountered in preparation for this research endeavor. Methods: Protocols for this bi-national intercultural study were approved by the Institutional Review Board (IRB) in the US and the ethics committees of the Nigerian institutions for consideration of cultural differences. Principles of community based participatory research were employed throughout the recruitment process. Keloid patients (patient advisors), community leaders, kings/chiefs and medical directors were engaged to assist the research teams with recruitment strategies. Community meetings, church forums, and media outlets (study flyers, radio and TV announcements) were utilized to promote the study in Nigeria. Recruitment of research participants was conducted by trained staff from the local communities. Pedigree structures were re-analyzed on a regular basis as new family members were recruited and recruitment challenges were documented. Results: Total recruitment surpassed 4200 study participants over a 7-year period including 79 families with complete three-generation pedigrees. In 9 families more than 20 family members participated, however, in 5 of these families, we encountered issues with pedigree structure as members from different branches presented inconsistent family histories. These issues were due to the traditional open family structure amongst the Yoruba and by beliefs in voodoo or in juju. In addition, family members living in other parts of the country or abroad complicated timely and complete family recruitment. Conclusions: Organizational, logistics and ethics challenges can be overcome by additional administrative efforts, good communication, community involvement and education of staff members. However, recruitment challenges due to infrastructural shortcomings or cultural and religious beliefs can lead to significant delays, which may negatively affect study time lines and expectations of funding agencies.

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