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Open Access
Assessment of predictors of treatment outcome among patient with bacteria odontogenic infection
(Unilag Press, 2018-08-28) Adamson, O.O.; Gbotolorun, O.M.; Odeniyi, O.; Oduyebo, O.O.; Adeyemo, W.L.
Despite the increasing availability of antimicrobial therapy and healthcare services, odontogenic orofacial infections remain a cause of admission and mortality of patients. Subjects who presented with bacterial odontogenic orofacial space infection and satisfied inclusion criteria were included. Incision and drainage/decompression was performed for all anatomic fascial spaces that were involved. All subjects received empirical antibiotics and MCS samples collected were cultured for aerobic and anaerobic organisms. There were 30 males and 25 females with a male-to-female ratio of 1.2:1. Of the 55 cases seen, majority (39) presented with abscess, 7 with Ludwig’s angina and 5 with necrotising fasciitis. Forty-two (76.4%) of specimen sent for MCS yielded positive culture for bacteria. Gram negative aerobes (25) were the most common bacteria and the least isolated were anaerobes (8). Overall, 52% of isolated organisms were sensitive to amoxicillin-clavulanate, 70% were sensitive to Ceftriaxone while 24% were resistant to both antibiotics. Subjects with clinical diagnosis of abscess or cellulitis were more likely to have a successful outcome without complications. The only significant predictors of outcome were haemoglobin level and number of spaces involved. Organisms involved in odontogenic infections were more sensitive to Ceftriaxone making it a better empirical antibiotic to Amoxicillin-clavulanate for severe odontogenic infections. Subjects with clinical diagnosis of abscess or cellulitis were more likely to have a successful outcome than those with necrotising fasciitis or Ludwig’s angina. Haemoglobin level and number of spaces involved were the only significant predictors of outcome. KEYWORDS: Bacterial, Odontogenic, Orofacial space, Infections, Sensitivity, Outcome
Open Access
Breast feeding practices among mothers of children with oro-facial cleft in an African cohort.
(Unilag Press, 2019, 2019-08-21) Adekunle, A.A.; Adamson, O.O.; James, O.; Adeyemo, W.L.; Ogunlewe, M.O.
Background The challenge of breastfeeding in infants with cleft lip is achieving a seal around the nipple, but this can still be achieved with some effort, a cleft of the palate on the other hand makes it difficult to achieve the required intra oral negative pressure to suck, making feeding more challenging in this population which may result in inadequate nutrient intake (Chen et al. 1990; Ize-Iyamu and Saheeb 2011; Miller 2011).There is limited literature from our environmentabout breastfeeding practices among mothers of babies with oro-facial cleft. Objective:The study was carried out toassess the breastfeeding practices among mothers of children born with oro-facial cleft. Methodology: This was a cross sectional descriptive study using an interviewer administered questionnaire. Sample population was all mothers of babies aged between 1 and 18 months with non -syndromic oro-facial cleft attending the cleft clinic of the department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-araba, Lagos. Result: A total of 65 mothers participated in the study. Initiation of breastfeeding was reported by majority (83%, n=54) of the mothers, however, only 18.5%(n=10) of this proportion continued exclusive breastfeeding. Inability of the babies to suck was reported by 46% (n=30) of the mothers as being the most important challenge in breast feeding. There was a significant correlation between type of cleft and challenge in breastfeeding (fishers exact P = 0.001). Sixty three percent (n= 41) of the mothers reported they received no counselling on overcoming challenges associated with feeding their babies with a cleft at the facility where they delivered. Sixty nine percent (n=45) reported they first received nutritional information from the cleft clinic at presentation. The most commonly adopted substitute for breastfeeding was the use of regular feeding bottles (n=24, 43.6%). Conclusion:Rate of initiation of breastfeeding for children with oro-facial cleft in this African cohort is higher than reported in other populations despite the low level of nutritional counselling of the mothers after delivery.
Open Access
Breastfeeding Practices Among Mothers of Children With Orofacial Clefts in an African Cohort
(SAGE JOURNALS, 2020-04-01) Adekunle, A.A.; Adamson, O.O.; James, O.; Ogunlewe, M.O.; Butali, A.; Adeyemo, W.L.
OBJECTIVE: To carry out a survey of breastfeeding practices and related challenges among mothers with orofacial cleft babies attending the cleft clinic of a tertiary health institution. METHODOLOGY: This was a cross-sectional descriptive study using an interviewer-administered questionnaire. Sample population was all mothers of babies aged between 1 and 18 months with nonsyndromic orofacial clefts attending the cleft clinic of a tertiary health institution in Nigeria. RESULT: A total of 65 mothers participated in the study. Initiation of breastfeeding was reported by the majority (83%, n = 54) of the mothers, and only 18.5% (n = 10) of this proportion continued exclusive breastfeeding. Inability of the babies to suck was reported by 46% (n = 30) of the mothers as being the most important challenge in breastfeeding. There was a significant correlation between the type of cleft and challenge in breastfeeding (Fisher exact P = .001). Sixty-three percent (n = 41) of the mothers reported they received no counseling on overcoming challenges associated with feeding their babies with a cleft at the facility where they delivered. Sixty-nine percent (n = 45) reported they first received nutritional information from the cleft clinic at presentation. The most adopted substitute for breastfeeding was the use of regular feeding bottles (n = 24, 43.6%). CONCLUSION: Rate of initiation of breastfeeding for children with orofacial clefts in this African cohort is higher than reported in other populations despite the low level of nutritional counseling of the mothers after delivery. KEYWORDS: breastfeeding; cleft lip; cleft palate
Open Access
Comparing the treatment outcomes of absorbable sutures, non-absorbable sutures and tissue adhesives in cleft lip repair – A systematic review.
(Sage Publishing, 2021-03-03) Egbunah, U.P.; Adamson, O.O.; Fashina, A.A.; Adekunle, A.A.; James, O.; Adeyemo, W.L.
Comparing the Treatment Outcomes of Absorbable Sutures, Nonabsorbable Sutures, and Tissue Adhesives in Cleft Lip Repair: A Systematic Review. https://doi.org/10.1177/1055665621996107. Abstract Objectives: To examine the literature and synthesize the available reports for the best possible option between absorbable, nonabsorbable, and tissue adhesives in cleft lip skin closure. Design: We conducted systematic searches for randomized controlled trials and controlled clinical trials in PubMed, Cochrane, Ovid Medline, and OpenGrey databases. Identified studies were retrieved and assessed for eligibility. All statistical analyses were done with Revman, version 5.4. Interventions: The intervention considered in this systematic review were techniques of cleft lip repair using resorbable sutures, nonabsorbable sutures, medical adhesives, or any combination of these. Outcome Measures: The primary outcomes assessed in the trials had to include any combination of the following: wound healing cosmesis and wound healing complications. While secondary outcomes considered were quality of life, direct and indirect costs to patients and health services, and participant satisfaction. Results: Only 6 studies met all inclusion criteria and were selected for qualitative analysis. A more favorable wound healing cosmesis was seen when nonabsorbable suture was used in cleft lip repair compared to absorbable sutures and tissue adhesives (CI, 0.65-4.35). This advantage was overshadowed by the significantly higher prevalence of postoperative complications when non-absorbable sutures are used. Conclusion: Although the results point to more favorable cosmesis with nonabsorbable sutures and an overall more favorable outcome with either absorbable sutures or tissue adhesives, the 6 selected studies were assessed at an unclear risk of bias; therefore, the results of this study should be interpreted with caution and regarded as low-certainty evidence. Keywords: absorbable suture, nonabsorbable suture, tissue adhesives, cleft lip repair, systematic review
Open Access
Comparison of sensitivity of bacteria isolated in odontogenic infections to ceftriaxone and amoxicillin-clavulanate
(Afr Health Sci, 2019-09-30) Adamson, O.O.; Adeyemi, M.O.; Gbotolorun, O.M.; Oduyebo, O.O.; Odeniyi, O.; Adeyemo, W.L.
Background: Odontogenic infections is a cause of mortality and morbidity in maxillofacial patients. This is largely due to resistance of organisms to antibiotics prescribed. Objectives: To isolate organisms involved in odontogenic infections and compare the sensitivity of the organisms to Ceftriaxone and Amoxicillin-Clavulanate. Methods: The causative organisms and antibiotic sensitivity were determined by the following steps: Aspiration of pus done with needle, sample of pus or exudate collected using sterile swab if aspiration was unsuccessful and specimen were placed in transport media (thioglycolatebroth) and sent immediately to microbiology laboratory for culture of organisms and antibiotic sensitivity. Results: Out of a total 55 samples taken for bacteriology, 42 (76.4%) yielded positive culture for bacteria. A total number of 21 bacteria species were identified from the positive cultures. Overall, 52% of isolated organisms were sensitive to amoxicillin-clavulanate, 70% were sensitive to Ceftriaxone while 24% were resistant to both antibiotics (Table 3). Ceftriaxone was statistically significantly more potent in inhibiting bacteria growth than amoxicillin-clavulanate (P =0.009).
Open Access
Congenital heart defects in orofacial cleft: A prospective cohort study
(Wolters Kluwer - Medknow, 2021-07-27) Erinoso, O.A.; James, O.; Sokunbi, O.J.; Adamson, O.O.; Adekunle, A.A.; Agbogidi, F.O.; Ogunlewe, A.O.; Ekure, E.N.; Adeyemo, W.L.; Ladeinde, A.L.; Ogunlewe, M.O.
Background: Congenital heart defects (CHDs) are one of the most common associated anomalies in patients with an orofacial cleft (OFC). However, few studies have shown the association between cleft type and CHDs in our population. This study aimed to assess the prevalence of CHDs in a cohort of OFC patients at a tertiary health facility in Nigeria, as well as assess the risk of CHD by OFC type. Materials and Methods: This was a prospective study design. Patients with an OFC were consecutively enrolled at a single OFC treatment facility. All subjects were assessed by a paediatric cardiologist and had echocardiography done. They were categorised based on the presence of CHDs, as well as the OFC phenotypic type (cleft lip and/or alveolus, cleft lip and palate and cleft palate only). Statistical analysis was done using STATA version 14 (College Station, Texas), and significance was set at P < 0.05. Results: A total of 150 subjects enrolled in the study over a period of 2 years(2018–2020). The median age of subjects was 6 months(interquartile range: 2–24), and 54.7% were female. The prevalence of CHDs in the subjects reviewed was 30.7%. Based on the severity of CHDs, the majority presented with simple defects(95.6%). Overall, the most common presentation was patent foramen ovale (12.7%), followed by septal defects (8.0%). There was no significant association between cleft type and the odds of a CHD. Conclusion: The study reports a relatively high prevalence of CHDs in patients with OFC; however, there was no association between the risk of CHD by cleft type. Although a majority of CHDs may pose a low operative risk, cardiac evaluation is recommended for all cases of OFC to aid the identification of potentially high‑risk cases. Keywords: Cleft lip and palate, cleft lip, cleft palate, congenital heart defects, non-syndromic clefts, syndromic clefts
Open Access
Correlation Between Height and Impacted Third Molars and Genetics Role in Third Molar Impaction
(Springer, 2020-02-01) Adeyemo, W.L.; James, O.; Oladega, A.A.; Adamson, O.O.; Adekunle, A.A.; Olorunsola, K.D.; Tamara, B.; Butali, A.
Aim: This study sought to evaluate the relationship between height of an individual and presence of impaction of maxillary and mandibular third molars, and to determine the role of genetics in third molar impaction. Material and Methods: This was a case-control study, with cases consisted of 200 subjects with third molar impactions; and 200 controls without third molar impactions. Height of subjects was measured and saliva samples were collected from all the subjects. DNA was extracted from saliva samples. To investigate the role of selected genes in the aetiology of third molar impactions, Taqman Genotyping using SNPs identified for jaw growth, height and tooth agenesis was employed. Five candidate genes were investigated using 11 markers (SNPs). Results: The mean height of cases was significantly lower than that of the control subjects (P=0.04). No difference was found in allele frequency between cases and controls for 10 of the 11 SNPs. However, for rs6504591 the P-value was near significance (P= 0.07) with Odd Ratio of 2.131. Subjects with lower third molar impactions were significantly shorter than those who have fully erupted third molars. Conclusions: Subjects with lower third molar impactions were significantly shorter than those who have fully erupted third molars. We observed that individuals with third molar impaction tend to have T allele at the locus suggesting that the T allele at the locus may increase the risk for having an impacted third molar. The rs6504591 G/T variation on human chromosome 17 (WNT9B gene) appears to increase risk by 2 folds for impaction albeit with inability to detect significance due to small sample size. Keywords: Third molars; impactions; height; genetics; WNT9B https://rdcu.be/b03rq
Open Access
Evaluation of speech therapy outcome on patients with cleft lip and palate after surgical repair at LUTH
(FDS, CMUL, 2019-10-09) Ayelomi, O.I.; Adamson, O.O.; Babatunde, A.A.; James, O.; Adeyemo, W.L.; Ladeinde, A.L.; Ogunlewe, M.O.
Backgroud: Some patients have persisting speech deficiencies after cleft surgery. Speech therapy is often carried out in order to correct this problem. Aim: To evaluate the outcome of speech therapy in patients following cleft lip and palate surgery. Materials and methods: A retrospective review of medical records of post cleft surgery patients who had speech therapy from July 2018 - July 2019, at the Lagos University Teaching Hospital. The following information was obtained: demographics, type of cleft, speech defects, treatment objectives and strategies. Clefts were classified into cleft lip and palate, cleft palate, isolated cleft of soft palate and submucous cleft. A modified Accordi s speech assessment protocol was utilized. Statistical analysis was performed using Pearson s correlation coefficient to evaluate associations and outcomes. Result: Eighteen patients (13 female, 5 male) out of twenty-two were consistent with therapy, aged 4 to 21years, mean age was 8.0 ± 4.4 S.D. Two (11%) fall into Class I, nine (50%) into Class II and seven (39%) into Class III. Most patients above the age of 10years have a class of II or III, there was mild correlation between the age of patients and the Class obtained (correlation coefficient=0.2). Conclusion: Speech therapy improves speech intelligibility in cleft patients after surgery. Better response observed in adult patients may be due to better understanding of placement and techniques.
Open Access
Evaluation of the effect of TSH on the growth pattern of children with non-syndromic cleft lip and palate.
(IADR, Nigerian Chapter, 2021-12-15) Adamson, O.O.; Agbogidi, F.O.; Adekunle, A.A.; Ezenwa, B.; James, O.; Adeyemo, W.L.; Ladeinde, A.L.; Ogunlewe, M.O.
INTRODUCTION Congenital defect created by oro-facial clefts results in uncoordinated and ineﬀective intraoral suction. Thyroid hormones, along with insulin, growth hormone, glucocorticoids and other hormones, regulate body protein metabolism and have been closely linked to the processes involved in growth and development. This study evaluates the effect of TSH on the growth pattern of children with non-syndromic cleft lip and palate. METHOD All newborn babies at first presentation to the Lagos University Teaching Hospital cleft clinic from January 2019 - December 2020 were included in this study. Progressive weight, length and head circumference was taken every 3months over a 1-year period. At age 9 months, blood sample was taken from babies for TSH assay. Collected data was analysed with SPSS version 20. RESULTS There were thirty participants with 13 (43.3%) females and 17 (56.7%) males. The mean birth weight of patients was 3.4kg ± 0.6 S.D. The height of children in the first year is generally lower than that of National average of Nigeria for non cleft child of the same age, though the rate of growth is similar. All anthropometric measurements except mid-arm circumference have negative correlation with TSH value at 9-month, though all are not statistically significant. CONCLUSION Rate of growth generally of children with cleft lip and palate is slower than that of national average though there seems to be a catch-up by age 1. Rate of growth is not affected by the level of TSH in this study.
Open Access
Genetics of lower third molar impaction and its association with height of an individual
(Faculty of Dental Sciences Conference 2017, 2017-07-06) Adeyemo, W.L.; James, O.; Oladega, A.A.; Adamson, O.O.; Olorunsola, K.D.; Butali, A.
Aim: To evaluate the relationship between height and presence of impaction of third molars. To also determine the role of genetics in third molar impaction by correlation with candidate genes reported to be associated with height, jaw growth and tooth agenesis. Material and methods: Cases consisted of subjects with third molar impaction; and controls were those without third molar impactions. Height of subjects was measured in metres; and saliva samples were also collected from all subjects. DNA was extracted from saliva samples. Taqman Genotyping using SNPs identified for jaw growth, height and tooth agenesis was employed. A total of 5 candidate genes were investigated using 11 SNPs. We conducted case-control analyses to determine association using PLINK. For this test, we used P < 0.05 to denote significant association. Results: There were 200 cases and 200 controls. The mean height of cases (1.68 0 ±.09 metres) was significantly lower than that of the controls (1.70 ± 0.09 metres) (P=0.04). No difference was found in allele frequency between cases and controls for 10 of the 11 SNPs. However, for rs6504591 the P-value was near significance (P= 0.07) with Odd Ratio of 2.131. Conclusions: Subjects with lower third molar impactions were significantly shorter than those who have fully erupted third molars. The rs6504591 G/T variation on human chromosome 17 (WNT9B gene) appears to increase for impaction albeit with limited power to detect significance. This suggests that with an increase in sample size and adequate power, we will be able to detect significance for this gene. Keywords: Third molars; impactions; height; genetics; WNT9B
Open Access
Genome-wide scan for parent-of-origin effects in a sub-Saharan African Cohort with non-syndromic cleft lip and/or cleft palate (CL/P)
(Sage Publishing, 2021-08-12) Gowans, L.J.J.; Comnick, C.L.; Mossey, P.A.; Eshete, M.A.; Adeyemo, W.L.; Naicker, T.; Awotoye, W.A.; Petrin, A.; Adeleke, C.; Donkor, P.; Busch, T.; James, O.; Ogunlewe, M.O.; Li, M.; Olotu, J.; Hassan, M.; Adeniyan, O.A.; Obiri-Yeboah, S.; Arthur, F.K.N.; Agbenorku, P.; Oti, A.A.; Olatosi, O.; Adamson, O.O.; Fashina, A.A.; Zeng, E.; Marazita, M.L.; Adeyemo, A.A.; Murray, J.C.; Butali, A.
Objective: Nonsyndromic cleft lip and/or cleft palate (NSCL/P) have multifactorial etiology where genetic factors, gene-environment interactions, stochastic factors, gene-gene interactions, and parent-of-origin effects (POEs) play cardinal roles. POEs arise when the parental origin of alleles differentially impacts the phenotype of the offspring. The aim of this study was to identify POEs that can increase risk for NSCL/P in humans using a genome-wide dataset. Methods: The samples (174 case-parent trios from Ghana, Ethiopia, and Nigeria) included in this study were from the African only genome wide association studies (GWAS) that was published in 2019. Genotyping of individual DNA using over 2 million multiethnic and African ancestry-specific single-nucleotide polymorphisms from the Illumina Multi-Ethnic Genotyping Array v2 15070954 A2 (genome build GRCh37/hg19) was done at the Center for Inherited Diseases Research. After quality control checks, PLINK was employed to carry out POE analysis employing the pooled subphenotypes of NSCL/P. Results: We observed possible hints of POEs at a cluster of genes at a 1 mega base pair window at the major histocompatibility complex class 1 locus on chromosome 6, as well as at other loci encompassing candidate genes such as ASB18, ANKEF1, AGAP1, GABRD, HHAT, CCT7, DNMT3A, EPHA7, FOXO3, lncRNAs, microRNA, antisense RNAs, ZNRD1, ZFAT, and ZBTB16. Conclusion: Findings from our study suggest that some loci may increase the risk for NSCL/P through POEs. Additional studies are required to confirm these suggestive loci in NSCL/P etiology. Keywords: epigenetics; gene–environment interactions; nonsyndromic cleft lip and/or cleft palate; parent-of-origin effects; sub-Saharan Africans.
Open Access
Genomic analyses in African populations identify loci for cleft palate
(Oxford Academic, 2019-03-15) Butali, A.; Mossey, P.A.; Adeyemo, W.L.; Eshete, M.A.; Gowans, L.J.J.; Busch, T.; Jain, D.; Yu, W.; Huan, L.; Laurie, C.C.; Laurie, C.A.; Nelson, S.; Li, M.; Sanchez-Lara, P.A.; Magee, W.P.; Magee, K.S.; Auslander, A.; Brindopke, F.; Kay, D.M.; Caggana, M.; Romitti, P.A.; Mills, J.L.; Audu, R.; Onwuamah, C.; Oseni, G.O.; Owais, A.; James, O.; Olaitan, P.B.; Aregbesola, B.S.; Braimah, R.O.; Oginni, F.O.; Oladele, A.O.; Bello, S.A.; Rhodes, J.; Shiang, R.; Donkor, P.; Obiri-Yeboah, S.; Arthur, F.K.N.; Twumasi, P.; Agbenorku, P.; Plange-Rhule, G.; Oti, A.; Ogunlewe, M.O.; Oladega, A.A.; Adekunle, A.A.; Erinoso, A.O.; Adamson, O.O.; Elufowoju, A.A.; Ayelomi, O.I.; Hailu, T.; Hailu, A.; Demissie, Y.; Derebew, M.; Eliason, S.; Romero-Bustillous, M.; Lo, C.; Park, J.; Desai, S.; Mohammed, M.; Abate, F.; Abdur-Rahman, L.O.; Anand, D.; Saadi, I.; Oladugba, A.V.; Lachke, S.A.; Amendt, B.A.; Rotimi, C.N.; Marazita, M.L.; Cornell, R.A.; Murray, J.C.; Adeyemo, A.A.
Orofacial clefts are common developmental disorders that pose significant clinical, economical and psychological problems. We conducted genome-wide association analyses for cleft palate only (CPO) and cleft lip with or without palate (CL/P) with ~17 million markers in sub-Saharan Africans. After replication and combined analyses, we identified novel loci for CPO at or near genome-wide significance on chromosomes 2 (near CTNNA2) and 19 (near SULT2A1). In situ hybridization of Sult2a1 in mice showed expression of SULT2A1 in mesenchymal cells in palate, palatal rugae and palatal epithelium in the fused palate. The previously reported 8q24 was the most significant locus for CL/P in our study, and we replicated several previously reported loci including PAX7 and VAX1.
Open Access
The impact of COVID-19 pandemic on cleft care services at a tertiary health facility in Nigeria
(Sage Publishing, 2021-10-11) Sabo, V.Y.; James, O.; Adamson, O.O.; Otoghile, B.; Adeyemo, W.L.; Ladeinde, A.L.; Ogunlewe, M.O.
Background: This study assessed the impact of COVID-19 Pandemic on cleft care services at a Nigerian tertiary health facility and the adaptations made during and after the population quarantine period. Methodology: A prospective and retrospective survey of all patients with orofacial cleft who had cleft surgeries, orthodontic interventions, and speech therapy in isolation or any of the combination was carried out. The survey period was divided into pre-COVID-19 lockdown period, the COVID-19 lockdown period, and the post-COVID-19 lockdown period with each of the periods spanning 4 months. The data which include: number of cleft clinic attendance, number of cleft surgical procedures, orthodontic interventions, and speech therapy session were retrieved from patients’ case records in the cleft and orthodontic clinics. The data was also reported for each period and represented as numbers and percentages. The trend of cleft services was plotted as line graphs and the impact of the COVID-19 pandemic on cleft care services is said to be significant when P value is <.005. Result: During the COVID-19 Lockdown period, there was a 66% drop in level of cleft clinic attendance, 78% drop in cleft surgeries, 78% drop in Orthodontic interventions, and a 58% drop in the number of Speech Therapy sessions. After the Lockdown period, the clinic attendance increased by a 190%, cleft surgeries rose by more than 10-fold, and the orthodontic interventions increased 10-fold. The speech therapy sessions dwindled further by 6% during the post-COVID-19 Lockdown period. The drop in cleft care service during the study period was significant (P = .001). The post Lockdown surge in cleft care services was also statistically significant (P = .001). Conclusion: The COVID-19 pandemic significantly altered the volume of cleft care services but also with a significant rebound post-lockdown period.
Open Access
Management of Oro-facial Cleft in Nigeria: Review of One Centre Experience.
(Wolters Kluwer - Medknow, 2020-12-23) James, O.; Adekunle, A.A.; Adamson, O.O.; Agbogidi, O.F.; Adeyemo, W.L.; Butali, A.; Ladeinde, A.L.; Ogunlewe, M.O.
Introduction: Orofacial clefts (OFCs) are among the most common craniofacial developmental abnormalities worldwide and a significant cause of childhood morbidity and mortality. This study aimed to identify patterns of patient presentation, treatment approaches, and changes in our overall cleft care service between 2007 and 2019. Methods and Methodology: A retrospective review of patients managed at a tertiary health facility in Nigeria of all OFC cases operated between 2007 and 2019 was done using the postintervention data retrieved from the Smile Train database. Data of all OFC cases operated within the period were analyzed using the Statistical Package for the Social Sciences. Descriptive statistics were performed using the Statistical Package for the Social Sciences version 20.0. Results: A total number of 740 OFC surgeries were performed in 565 patients, consisting of 269 females (48.2%) and 289 males (51.8%). The majority (63%) of the patients presented before the age of 2 years. Thirty‑seven percent presented with cleft lip and alveolus, 27.1% with cleft palate only, and 36.7% with cleft lip, alveolus, and palate. Primary cleft lip repair was the most performed surgery (n = 320, 43.2%), the mean age at repair was 2.1 years. Since 2017, additional services such as speech therapy, mixed dentition orthodontics, and nutritional support were added to services provided to our cleft patients. Fifteen patients have undergone speech assessment and three have completed speech treatment. Eight patients have undergone mixed dentition stage orthodontic treatment. Discussion: Our services have evolved from simply providing surgical care to comprehensive care with a multidisciplinary team approach and provision of a wide range of services including nutritional counseling, pediatric care, orthodontic services, and speech therapy. We believe these will improve the overall well‑being of our patients while we continue to improve on services based on clinical research outcomes.
Open Access
Missense Variants Within GJB2 Gene Locus and the Risk of Hearing Defects in Non-syndromic Cleft Lip and Palate.
(Wolters Kluwer, 2021-06-30) Adeyemo, W.L.; James, O.; Bamigboye, B.A.; Akinola, M.D.; Adamson, O.O.; Nkemijika, B.N.; Ibikunle, A.A.; Ogunlewe, M.O.; Ladeinde, A.L.; Butali, A.
Aim: The aim of the study was to investigate the role of variants in GJB2 gene in the etiology of hearing defects in non-syndromic cleft lip/palate. Method: Saliva samples were obtained from cases (subjects with orofacial clefts) and control (subjects without orofacial clefts) who consented to the study. Deoxyribonucleic acid (DNA) was extracted using standardized protocol at Butali Lab (Iowa, IA). Primers for the coding region of GJB2 was designed using Primer 3 (http://bioinfo.ut.ee/primer3-0.4.0/) and optimized in the Butali lab using a gradient polymerase chain reaction to determine the annealing temperature for each primer set (forward and reverse). We measured the DNA concentration using Qubit and XY genotyping done for quality control. A concentration of 5 ng/μL of DNA was used for Sanger sequencing. Results: A total of 150 subjects were sequenced (66 cases; 84 controls). Mutations in GJB2 gene were detected in 2 individuals with cleft palate. We found p.Arg165Trp variant in 1 case and p.Leu81Val variant in the second case. Although p.Arg165Trp was predicted to be either benign or tolerated by SIFT/POLYPHEN, the single nucleotide change from C>T, that is, CGG>TGG leads to a premature stop codon preventing the protein formation. The p.Leu81Val variant was predicted to be probably damaging/ deleterious. Conclusions: The present study implicates variants in the GJB2 gene in the etiology of hearing defects in non-syndromic cleft lip and palate in the Nigerian population. Screening for variations in GJB2 gene is important for genetic counseling especially in high-risk families.
Open Access
Necrotizing fasciitis: A five years review of cases seen at the Lagos University Teaching Hospital
(FDS, CMUL 2019, 2019-10-09) James, O.; Anorue, E.I.; Adamson, O.O.; Adeyemi, M.O.; Adekunle, A.A.; Ladeinde, A.L.; Ogunlewe, M.O.; Adeyemo, W.L.
Background: Cranio-facial necrotizing (CFN) fasciitis of the head and neck is a bacterial infection characterized by spreading along fascia planes and subcutaneous tissue. This results in tissue necrosis and may lead to death. It is commonly triggered by odontogenic or pharyngeal infections. Aim: To retrospectively review cases seen in our center to determine the factors that might affect the outcome Patient and methods: This was a five years retrospective study of patients presenting with necrotizing fasciitis, treated at the Department of Oral and Maxillofacial Surgery, LUTH from 2014 to 2018. The medical records were reviewed for: aetiology, trigger factors and sites of infection, clinical manifestations, underlying medical condition, type of surgical treatment, medical and surgical complications, length of hospital stay and outcome of treatment. Results: Twenty –three patients with head and neck necrotizing fasciitis were treated during the study period. There were 11 males and 12 females in this group. The average age was 43 years, with age range between 22 and 84 years. Triger factor in most cases was odontogenic infection (18, 78.3%) while the upper part of the neck was the most prevalent site of presentation. Clinical presentations were a rapidly progressing painful neck swelling, fever, ulceration and trismus. Sixteen patients (69.5%) had no significant comorbidity. The other 7 patients (30.4%) had at least one significant comorbidity: diabetes (5 patients, (21.7%), malnutrition (2, 8.7%), alcoholism (2, 8.7%). All cases received early and aggressive medical treatment followed by serial surgical debridement. Sixteen cases were treated on outpatient bases. The duration of hospital stay for those admitted ranged from 4 to 34 days . Conclusion: Maintaining a high index of suspicion is crucially important for diagnosing CNF. Early diagnosis, timely resuscitation, and aggressive surgical debridement are the key to a successful clinical Necrotizing fasciitis requires early diagnosis and management to improve prognosis. Keywords: Necrotising, fasciitis, odontogenic, infection
Open Access
Presentation and Management of Atypical Orofacial Clefts: A Single-Institution Experience for 13 Year Period
(Sage Publishing, 2021-11-17) James, O.; Sabo, V.Y.; Adamson, O.O.; Otoghile, B.; Adekunle, A.A.; Adeyemo, W.L.; Ladeinde, A.L.; Ogunlewe, M.O.
Objective This study reviews the craniofacial clefts that presented at a Nigerian tertiary health facility, highlighting our experience with the pattern of presentation and surgical care of these patients. Design A retrospective review of the smile train database and medical records of all individuals who had been diagnosed with any of the Tessier craniofacial clefts and managed between 1st January 2007 and 31st December 2020 was done. The data were presented as numbers and percentages of cases. Setting The cleft clinic of a tertiary health facility and a major cleft referral center in South-West Nigeria. Results Forty-five patients with craniofacial clefts were managed over the study period. 15.6% had associated syndromes, 2.2% had a family history of similar craniofacial cleft and 11% had a history of a possible teratogen. There were 21 (46.7%) middle clefts, 14(31.1%) lateral clefts and 10(22.2%) oblique clefts. The most common type of cleft was Tessier 0 while the Tessier 6 was the least common type. The median age at surgery was 10 months for male and 5months for female subjects, 15.3% complication rate was found in this study. Four patients had revision surgeries to correct residual deformities in this study. Conclusion The diverse presentations and occurrence of the rare craniofacial clefts present complex aesthetic and functional problems that require individualized often multidisciplinary care. The execution of a properly planned treatment will reduce complications and the need for revision surgeries.
Open Access
Retrospective study of the clinicopathologic factors of recurrent Ameloblastoma of the jaws
(2019-10-09) James, O.; Adamson, O.O.; Fashina, A.A.; Adeyemi, M.O.; Agbogidi, F.O.; Adekunle, A.A.; Adeyemo, W.L.; Ladeinde, A.L.; Ogunlewe, M.O.
Background: Ameloblastomas are benign, locally aggressive, polymorphic neoplasms of proliferating odontogenic epithelial origin. Clinically, ameloblastoma appears as an aggressive odontogenic tumour, often asymptomatic and slow growing, with no evidence of swelling. Aim: To retrospectively review recurrent ameloblastomas cases during a 10-year period and to determine the recurrence rate of ameloblastoma and clinicopathologic factors involved in recurrence. Methodology: Records of clinicopathologically diagnosed and treated cases of recurrent ameloblastoma for a period of 10 years (2008 –2018) were obtained from the Department of Oral and Maxillofacial surgery, LUTH. Information derived include patients’ demographics, initial diagnosis, previous surgery done, year of recurrence, localisation of tumor and histologic diagnosis of recurrent tumor. Results: During the period of this study (2009-2018), 247 ameloblastoma cases were treated during the of which 32 (12%) were recurrent cases. 19 (59.4%) were females while 13 (40.6%) were males. Male to female ratio is 1:1.5. The ages ranges from 11- 60 with a mean of 37.03±12.57. Recurrence was more observed in the mandible 26 (81.3%) than the maxilla 4 (12.5%) and craniofacial region 2 (6.3%). The number of years for recurrence to occur ranges from 1-30 years with median of 4 years and interquartile range of 7.75. Most recurrence occurs between 3-5 years (40.6%) followed by 1-2 years (25%) of initial surgery. Conclusion: The recurrence rate after conservative treatment was higher than that after radical treatment. The choice of treatment should be adapted to the macroscopic and histological characteristics of each tumour.
Open Access
Risks of congenital cardiovascular anomalies in patients with non-syndromic orofacial cleft: A preliminary case-control study
(Wolters Kluwer - Medknow, 2020-11-21) James, O.; Erinoso, O.A.; Adamson, O.O.; Sokunbi, O.J.; Agbogidi, F.O.; Adekunle, A.A.; Ogunlewe, A.O.; Ekure, E.N.; Adeyemo, W.L.; Ladeinde, A.L.; Ogunlewe, M.O.
Background: Orofacial clefts (OCs) are one of the most common craniofacial anomalies and are reported to be associated with congenital cardiovascular anomalies (CCAs). However, there is paucity of data in African populations on the risk of CCAs in OC patients compared to the general population. Aims: This study aims to determine the odds of congenital cardiovascular anomalies in patients with OC compared to the general population. Subjects and Methods: A case‑control study design was used. Case subjects were non‑syndromic OC subjects, while controls were non‑syndromic subjects without OC. All subjects were thoroughly assessed by a pediatric cardiologist for CCAs; and grouped by OC phenotypic type (cleft lip and/or alveolus, cleft lip and palate, cleft palate only and Tessier cleft). Statistical analysis was done using STATA version 14 (College Station, Texas), and significance was placed at P value ≤0.05. Results: A total of 120 subjects (60 cases and 60 controls) were enrolled in the study. In total, 23.3% of the subjects had CCAs. Among the case group, 40% had CCAs compared to 6.7% in the control group. Patent foramen ovale (18.3%) and atrial septal defects (10.0%) were the most common type of CCAs in cases, respectively. Further, cases had significantly higher odds of CCAs compared to controls (OR: 9.3; CI: 2.8, 39.4). Conclusions: Our finding reveals that the odds of CCAs are significantly higher in patients with OC than the general population. Future studies could assess the effect of CCAs on surgical outcome.
Open Access
Variant Analyses of Candidate Genes in Orofacial Clefts in Multi-Ethnic Populations
(Wiley, 2021-06-01) Li, M.; Olotu, J.; Buxo-Martinex, C.J.; Mossey, P.A.; Anand, D.; Busch, T.; Alade, A.; Gowan, L.J.J.; Eshete, M.; Adeyemo, W.L.; Naicker, T.; Awotoye, W.O.; Adamson, O.O.; James, O.; Ogunlewe, M.O.; Marazita, M.L.; Adeyemo, A.A.; Murray, J.C.; Butali, A.
Objectives Cleft lip with/without cleft palate and cleft palate only are congenital birth defects where the upper lip and/or palate fail to fuse properly during embryonic facial development. Affecting ~1.2/1000 live births world-wide, these orofacial clefts impose significant social and financial burdens on affected individuals and their families. Orofacial clefts have a complex etiology resulting from genetic variants combined with environmental covariates. Recent genome-wide association studies and whole-exome sequencing for orofacial clefts identified significant genetic associations and variants in several genes. Of these, we investigated the role of common/rare variants in SHH, RORA, MRPL53, ACVR1, and GDF11. Materials and Methods We sequenced these five genes in 1255 multi-ethnic cleft lip with/without palate and cleft palate only samples in order to find variants that may provide potential explanations for the missing heritability of orofacial clefts. Rare and novel variants were further analyzed using in-silico predictive tools. Results 19 total variants of interest were found, with variant types including stop-gain, missense, synonymous, intronic, and splice-site variants. Of these, 3 novel missense variants were found, one in SHH, one in RORA, and one in GDF11. Conclusion This study provides evidence that variants in SHH, RORA, MRPL53, ACVR1, and GDF11 may contribute to risk of orofacial clefts in various populations.

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