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.
Hypertensive patient in the surgical ward - what the Surgeon should do
(2004) Akute, O. 0; Olubowale, 0. 0|; Aghahowa, M. E; Afolabi., A. 0
Two cases of hypertension are presented to emphasize the need for the surgeons to pay adequate attention to these purely medical conditions that may have a devastating adverse effect on the outcome of surgery. The article also highlights the serious constraints that still characterize the management of these patients in this part of the world. The ideal situation is a multi-disciplinary approach involving the Surgeon, the Physician and the Anaesthetist. The surgeon must not confine himself to the technical aspect of the surgery alone. The hypertension must be controlled whether the patient presents with an elective or emergent surgical condition and anti-hypertensive medication must be continued up till the time ofsurgery and at times intra-operatively. It is not only unnecessary hut also potentially dangerous to withdraw anti-hypertensives before anaesthesia. The main goal of the surgically amenable secondary hypertension is to remove the cause ofter adequate control of the hypertension in preparation for surgery. Patient however must be made to understand that the hypertension may not be "cured" and the anti-hypertensive medication may have to be continued post-operatively particularly if the hypertension is long established before patient presents. Local and/or regional blocks are to be preferred to general anaesthesiafor peripheral lesions and even then it is still preferable to have the hypertension controlled.

Surgery

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