Prof. Ozoemene Ndubuisi Obuekwe, Professor of oral and maxillofacial surgery delivered the 192nd inaugural lecture series of the University Of Benin at the Akin Deko Auditorium Ugbowo Campus on the 22nd June 2017 with a topic: navigating the maxillofacial wilderness.
Present at the event are the vice chancellor of the University Prof.F.F.O. Orumwense (FNSE),
DVC Academic Prof E.P Iribhogbe, DVC administration Prof. J.O Ehirobo, the school Librarian Dr. Evelyn Idiodi, Deans, Directors, Professor Emeritus, Professors, top government functionaries, staffs, great student of the University and Family members.The lecture which witnesses the unprecedented attendance had the topic which focused on a surgeon’s journey by Orofacial clefts, mainly cleft lip and palate (CL/P) and trauma constitute a reasonable bulk of the workload in the Department of Oral and Maxillofacial Surgery. Apart from a toothache, they are some of the main reasons why patients seek admission and treatment.
Navigation: To find the right way to deal with a difficult or complicated situation (Oxford dictionary).
Wilderness: A confusing multitude or mass; an indefinitely great number or quantity (Merriam-Webster dictionary)
Oral and Maxillofacial Surgery (OMS): This is a specialty of dentistry that deals with the diagnosis and treatment of many diseases (congenital or acquired), injuries and defects in the head, neck, face, jaws, the hard and soft tissues of the oral (mouth) and maxillofacial (jaws and face) region.
It is an internationally recognized surgical specialty.
In Nigeria and other countries like United States of America, Canada, India, Brazil, Sweden and Israel it is domiciled in dentistry primarily.
In the, UK, Australia and most of Europe, it is recognized as both a specialty of medicine and dentistry and a dual degree in medicine and dentistry is compulsory.
For one to become an oral and maxillofacial surgeon in Nigeria, you would need a Bachelor of Dental Surgery (BDS) degree (six years) and then undergo 6 years residency/postgraduate training, passing the necessary examinations.
The treatment and rehabilitation of a patient with cleft lip and palate (CL/P) include the following:
- Many of the appealing features of plastic surgery
- The need to understand the aetiopathogenesis of the anomaly
- Being a member of an interdisciplinary diagnosis and treatment team (McCarthy, Cutting, Hogan, 1990).
In ancient times many congenital anomalies were considered to be evidence of an evil spirit in the afflicted child. Such children were often removed from the tribe or unit and left to die in the surrounding wilderness. Unfortunately, this is still the belief in some parts of Nigeria today. Our study on the knowledge and cultural beliefs about the etiology and management of orofacial clefts in Nigeria’s major ethnic groups involved respondents from 34 of Nigeria’s 36 states.
Techniques for repair of orofacial clefts
- For clefts of the lip
- The straight line repair – still suitable for incomplete clefts.
- The rectangular flap technique (Le Mesurier, 1949).
- The triangular flap technique (Tennison, 1952).
- The rotation- advancement flap technique (Millard, 1958).
ladies and gentlemen, he said he will like to commence this navigation chronologically, from our youngest patients. These are children born with cleft lip and palate.
The cause of this problem is multifactorial, ranging from genetics to an interplay of genetics and environmental factors.
While the surgical techniques for the treatment of cleft lip and palate were evolving, therapy of associated problems has advanced to a point where presently teams of specialists have been formed to manage the total problem which can no longer be realistically handled by one or two specialties.
This is thought to be responsible for CL/P in 10% of cases. Family studies show that there is a significant increase of CL/P among relatives of CL/P patients. Also, the chances of having a child with CL/P from parents who are free from the disease rises from 4.4% to about 9% after two affected children have been born. This figure rises to over 16% if an affected parent has other affected near–relatives (Curtis, Fraser, Warburton, 1961).
- Maternal cigarette smoking
Of all the environmental factors that have been investigated, maternal ACTIVE cigarette smoking is the one most consistently associated with CL/P. Oral cleft risks attributable to smoking are as high as 20% (Chung et al., 2000). In our studies, none of the mothers admitted having smoked actively Of relevance here is first-trimester smoking. With the increasing adoption of a Western lifestyle, our young ladies should note this
- Passive cigarette smoke exposure: This is a situation where the individual does not smoke but is in an environment filled with cigarette smoke.
In our study, 89% of mothers belonged to the low socio-economic group and were most likely to cook with firewood. They were also likely to cook in poorly ventilated kitchens.
Therefore, they are more likely to inhale large amounts of smoke. This, we postulated, could be an environmental cause of cleft lip and palate.
Many drugs have been implicated in the etiology of cleft lip and palate.
As a rule, unnecessary drugs should be avoided during pregnancy, more so in the first trimester. However, dietary supplements like folic acid, vitamins, iron, etc may be prescribed during antenatal care.
The classes of drugs that have been implicated include:
- Anticonvulsants/antiepileptic drugs
- Corticosteroids/Immunosuppressant drugs
- Antibiotics– Co-trimoxazole (Septrin®)
- Benzodiazepines– Diazepam (popular valium 5®)
- Recreational drugs– cannabis, cocaine, amphetamine, and Ketamine
Regarding the maxillofacial region, trauma can involve:
- The soft tissues.
- The hard tissues (bones and teeth)
Aetiology (How is the maxillofacial region injured?):
- Being part of the body, the injury mechanism is not any different but has its own peculiarities. Typically, maxillofacial trauma as seen in this environment is related to:
- Road traffic accidents
- Interpersonal violence
- Industrial trauma
In conclusion, he said Cleft lip and palate is a condition with known risk factors that pregnant women ought to be aware of and therefore take necessary precautions. However, in the event that a baby is born with CL/P, specialists are available to manage the condition. is a leading cause of injury, disability, and death in our environment. The government should consider free treatment for patients with cleft lip and palate.
There should be continuous public enlightenment about cleft lip and palate particularly in areas with high prevalence of the condition. Existing legislation regarding vehicular traffic should be enforced to reduce the carnage on our roads. Emergency Medical Services should be established nationwide to provide vital pre-hospital care to victims of maxillofacial trauma and other emergencies.
The vice chancellor Prof. F.F.O. Orumwense (FNSE) appreciated the lecturer for the research work and a well-delivered lecture. He thereafter decorated Prof. Ozoemene Ndubuisi Obuekwe, with a medal to usher him into the honor roll of the University of Benin Inaugural Lecturers