Surgical Management of Oro-Facial Clefts at a Tertiary Care Hospital in a Resource-Limited Setting: A Tanzanian Experience

EAS Journal of Medicine and Surgery Pub Date : 2023-11-25 DOI:10.36349/easjms.2023.v05i10.007

Samson K. Ephraim, Cecilia Protas, Francis Tegete

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Abstract

Background: Orofacial clefts are the most common craniofacial anomalies in most parts of the world and its management remains a challenge to otorhinolaryngology, plastic/reconstructive, oral and maxillofacial surgeons practicing in resource limited countries. There is limited data on surgical management of these birth defects in Tanzania and Bugando Medical Centre (BMC) in particular. This study aimed to describe our own experience regarding the surgical management of orofacial clefts at BMC, a tertiary care hospital in Tanzania. Methods: This was a cross sectional study involving all children with orofacial clefts that were treated at BMC between February 2019 and June 2019. Results: A total of 98 patients with orofacial clefts were recruited. Males outnumbered males by a male to female ratio of 1.7:1. The majority of patients (64.3%) were within 12 months at presentation. The median ages at surgery in patients with cleft lip and those with cleft palate were 3 [IQR, 2 to 8] and 11(IQR, 7 to 18) months, respectively. Orofacial clefts in association with congenital anomalies were recorded in 5(5.1%) patients. More than half of patients (55.1%) had combined cleft lip and palate. Unilateral clefts, 77(78.5%) were more common and showed left side preponderance in 52(53.1%) patients. All patients underwent cleft surgery under general anesthesia. Millard rotation advancement flap repair and von-Langenbeck were the most common techniques of cleft lip and palate repair performed in 42(52.5%) and 30 (41.7%) patients, respectively. The overall complication rate was 14.3% and the most common postoperative complications were bleeding, palatal fistula, wound dehiscence and surgical site infections in 6(31.6%), 4(21.1%) and 3(15.8%) each respectively. No death was recorded in this study. Among the 98 patients operated, 79 were treated successfully giving an overall success rate of 80.6%. The success rate was significantly influenced by nutrition status (p= 0.010), co-existing con

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在资源有限的情况下，一家三级医院对口颚裂进行手术治疗：坦桑尼亚的经验

背景：在世界上大多数地区，颅面裂是最常见的颅面畸形，在资源有限的国家，颅面裂的治疗仍然是耳鼻喉科、整形外科、口腔颌面外科医生面临的一项挑战。在坦桑尼亚，尤其是在布干多医疗中心（BMC），有关这些先天缺陷手术治疗的数据非常有限。本研究旨在介绍我们在坦桑尼亚的一家三级医院--布干多医疗中心（BMC）进行口面裂手术治疗的经验。研究方法：这是一项横断面研究，涉及 2019 年 2 月至 2019 年 6 月期间在 BMC 接受治疗的所有口面裂患儿。研究结果共招募了98名口面部裂患者。男性多于女性，男女比例为 1.7:1。大多数患者（64.3%）发病时间在 12 个月以内。唇裂和腭裂患者的手术年龄中位数分别为 3 个月[IQR，2 至 8 个月]和 11（IQR，7 至 18 个月）。有 5 例（5.1%）患者的口腔颌面部裂伴有先天性畸形。半数以上（55.1%）的患者合并有唇腭裂。单侧唇裂 77 例（78.5%）较为常见，其中 52 例（53.1%）患者左侧唇裂较多。所有患者均在全身麻醉下接受唇裂手术。Millard旋转推进皮瓣修复术和von-Langenbeck是最常见的唇腭裂修复技术，分别有42（52.5%）和30（41.7%）名患者采用。总体并发症发生率为14.3%，最常见的术后并发症是出血、腭瘘、伤口裂开和手术部位感染，分别占6例（31.6%）、4例（21.1%）和3例（15.8%）。本研究中没有死亡记录。在 98 名接受手术的患者中，79 人获得成功治疗，总成功率为 80.6%。成功率受营养状况（p= 0.010）、并发症（p= 0.010）和其他因素（p= 0.010）的显著影响。

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EAS Journal of Medicine and Surgery

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