In maxillofacial surgery, head and neck reconstruction of surgical defects caused by oral cancer is considered a challenging problem. Till recently, most oral and pharyngeal defects were closed primarily using skin flaps or tubed-pedicle flaps of skin from the trunk such as forehead flap, deltopectoral flap, pectoralis major myocutaneous flap; however, these were associated with compromised aesthetic and functional results. The advent of microvascular free tissue transfer over the past two decades has helped us overcome these disadvantages and has enabled the ablative surgeon to undertake surgical procedures that could not have been attempted in the past. Innovations in the field of microsurgery have resulted in better techniques, microscopes, and microinstruments, which have made free flap harvesting much easier. This article will review the various techniques of microvascular anastomosis used in head and neck reconstruction and analyze the newer techniques and methods employed today. It also attempts to provide a brief gist of the various free flaps used in head and neck reconstruction and the ones most expedient in the surgeons' arsenal.

Background: Although recent studies suggest that there is rising proportion of cervical adenocarcinoma in most part of the world, there has been no formal study in our setting. We therefore undertook this review to document and evaluate the pattern in Kano, Northern Nigeria. Patients and Methods: This was a 10 year retrospective study from 2^nd January, 2002 to 31^st December, 2011 of all non-squamous cell malignancies diagnosed at the pathology department of Aminu Kano Teaching Hospital, Kano, Nigeria. Where necessary, new sections were made from formalin fixed, paraffin embedded blocks. Results: During the ten year study period, a total of 545 cervical cancers were diagnosed. Of these, 448 (82.2%) were squamous cell carcinomas and 17.8% were non-squamous malignancies. Out of the 97 non-squamous malignancies, adenocarcinoma was by far the most common. 52 (53.6%) were endometrioid type adenocarcinomas, while clear cell and mucinous variants comprised 12 (12.4%) and 6 (6.2%) respectively. Other carcinomas in this series were adenosquamous (10 cases), small cell (6 cases), adenoid cystic {3 cases}, undifferentiated (3 cases) and metastatic (1 case). There was only one sarcoma - a leiomyosarcoma. Patients ranged from 20 to 80 years (mean 48.30 ± SD 12.61 years) with the highest occurence in the 4^th–6^th decade age group. Conclusion: Non-squamous malignancies of the cervix comprised 17.8% of all invasive cervical cancers in Kano and adenocarcinomas were overwhelmingly preponderant. The study findings were consistent with most published reports in Nigeria and elsewhere. These malignancies were associated with high morbidity and mortality which necessitates data for health planning and policy decisions.

Background: Adequate acquaintance with urologic admissions and interventions offered to patients in a community over a span of time is an invaluable framework for capacity building and health care planning. We undertook a 3-year appraisal of admissions with interventions as a tool for further urologic capacity building at the Abubakar Imam Urology Centre Kano, Nigeria. Patients and Methods: Records of all the admissions between January 2012 and December 2014 were retrieved. The suitable data were extracted, analyzed, and displayed using the Statistical Package for the Social Sciences version 21. Results: One thousand five hundred and four patients were admitted and treated; male-to-female ratio was 13:1. The patient's mean age was 50.1 years (±23.3). The most common admitting diagnosis was benign prostatic hyperplasia (BPH) followed by urethral stricture then urolithiasis. Malignancies and congenital anomalies were 4^th and 5^th, respectively. The mean hospital stay was 9.77 (±6.1) days. Overall mortality recorded was 8.17%. Conclusion: The study recognized BPH and its complications as the dominating determinants of admissions and mortality, respectively. Heightened health awareness is required to subdue the strain of delayed complicated presentations to the center. The study underscores the need for further capacity building in the center to advance minimal hospital stay, morbidity, and mortality among the inpatients.

Background: Orbital floor fractures make up one of the most widely discussed clinical controversies of the maxillofacial region. Many have no major consequences if left untreated, however, some may result in unacceptable functional and cosmetic defects. We present our views regarding their diagnosis, treatment planning, and management. Patients and Methods: A postal survey was designed to assess the current concepts employed by the practicing oral and maxillofacial surgeons within the state of Kerala, India, regarding the management of these fractures, in the form of a tick box questionnaire. The questionnaire was formatted to include 18 closed questions divided into 5 different sections. The questionnaire was forwarded to 45 practicing oral and maxillofacial surgeons by post. Results: The response rate of the postal survey was 49%. Pre and postoperative prescription of antibiotics was practiced by 72% for 5-7 days. Sixty-three percent of the respondents used steroids while 81% wait for edema resolution before making the final decision to operate. All respondents relied on plain radiography and CT scanning for the final diagnosis and treatment planning. Most surgeons (63%) considered diplopia as the mostimportant ophthalmologic parameter determining the prognosis and the final treatment outcome. Conclusion: The following article discusses the results of this survey and reviews the past and current literature associated with these fractures. It can be very safely said that there is no real consensus regarding all the aspects of these injuries, with the management being mostly operator dependant.

Background: The management of concomitant gallbladder and common bile duct (CBD) stones is controversial. We study the outcomes of laparoscopic management of common bile duct (CBD) stones with stent placement and primary closure against T-tube drainage. Patients and Methods: A series of 31 patients (17 females and 14 males) aged between 30 and 55 years, who underwent biliary decompression after laparoscopic CBD exploration to treat choledocholithiasis, was studied retrospectively from May 2009 to December 2015. The results in patients with stent (11) were compared with those who had T-tube drainage (20). Results: Stent placement and T-tube drainage was achieved in all cases by choledochotomy after adequate clearance of CBD. No mortality was reported in our series. Patients with T-tube drainage had more morbidity and complications compared to stented patients. Stents were successfully removed in all cases in the postoperative follow up by endoscopy. Conclusions: Laparoscopic CBD stenting is a safe method in the treatment of selected patients of CBD stones who need biliary decompression. Because of lower morbidity and shorter hospital stay compared with T-tube drainage, it should be considered as the first approach whenever biliary decompression is needed after LCBDE.

Background: Locked intramedullary nailing for operative fixation of tibial and femoral shaft fractures has become the gold standard in the operative stabilization of these fractures. The results of these procedures from various centers have been quiet impressive and compares to that reported globally. The sustenance of these important procedures are however not without challenges, which is the main reason for reporting the experience from our institution. Patients and Methods: This is a prospective study involving 163 consecutive patients with closed tibial and femoral shaft fractures over a period of two years (June 2011 to May 2013). Parameters such as blood loss, postoperative wound infection, length of hospital stay, and fracture union were followed up. Results: One hundred and fifteen (70.6%) of the patients were males while 48 (29.4%) were females. Of the 176 operations, 136 (77.3%) were carried out for femoral shaft fractures whereas 40 (22.7%) were carried out for tibial shaft fractures. Thirty eight (21.6%) femurs and 14 (7.9%) tibiae had locked intramedullary nailing. Intraoperative blood loss was less than 250 ml in patients who had locked intramedullary nailing, and the average length of hospital stay was 10 and 16 days for those that had locked intramedullary nailing and plating, respectively. Forty-four (84.2%) fractures stabilized with locked intramedullary nail showing solid union at 16 weeks whereas only 32 (70%) and 55 (70%) of the fractures stabilized with Kuntscher nail and plate, respectively, showing solid union at 16 weeks. Conclusion: Our study suggests satisfactory outcome with locked intramedullary nailing for the operative fixation of tibial and femoral shaft fractures. The choice of implant to be used depends significantly on affordability by patients and to a lesser extent on surgeon's preference.

Background: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease. Because of obscure etiology and diagnosis, its management remains a challenge. Rareness and varied presentation of IGM makes it difficult to standardize treatment protocol. The aim of this study was to analyze the clinical presentations, imaging findings, clinical course, and management of patients who were treated for IGM. Patients and Methods: In this study, a retrospective review of 15 patients with IGM between January 2012 and December 2014 was performed based on clinical, radiological, and pathological findings; follow-up information and recurrence were obtained from records. Results: The median age of presentation was 30 years (age range: 24–42). All patients were married and parous with a history of breast feeding. Breast mass with or without skin changes was a symptom in all patients. While parenchymal heterogeneity, abscess, and mass were the findings of ultrasound, increased asymmetric density was the main finding of mammography. Wide local excision was performed in 7 (46.7%) patients and incisional biopsy with abscess drainage in 4 (26.7%) patients. Medical treatment was given to 4 (26.7%) patients. Median follow-up was 24 (range: 10–34) months. Eleven patients (73%) were recurrence free. Conclusions: Granulomatous mastitis often presents as a breast lump with or without skin changes. The diagnosis is done with pathological examination of the surgical specimen or biopsy. The main treatment should be guided according to the clinical presentation either surgical or medical or both.

Background: Pilonidal sinus disease (PNSD) is common among young adults. The diagnosis of disease is more often a clinical one, based on the patient's history and physical findings. Numerous treatment options, ranging from simple excision to extensive flap procedures, currently exist. However, hospital stay, missed days of work, recurrence rates, and surgeon's familiarity with the techniques are important factors in the choice of treatment modality. The aim of present study was to study the role of phenol application in the management of PNSD. Patients and Methods: In our study, we aimed to share the results of our patients who underwent treatment with local application of 80% phenol. After shaving from waist to mid-thigh posteriorly, 1 cc phenol was injected via sinus under local anesthesia. Results: In this study, all the 30 outpatients were male. The average age was 23.5 years. Complete cure was obtained in 24 (80%) patients. The mean number of days required for complete healing of sinus were 47.83 days. Four patients had nonhealing of sinus and two patients developed recurrence. Conclusion: This method of treatment is very simple and has acceptable relapse rates. It does not affect productive life of patient and does not need hospitalization. Thus, it could be considered as the first choice in the treatment of noncomplicated pilonidal sinus.

Background: The first pregnancy marks a transition into motherhood and influences the number of children a woman bears throughout her reproductive period, and consequently the size, composition, and future growth of the population in a community. The aim of this survey was to determine the average age at first pregnancy among primigravidae attending antenatal clinic in Aminu Kano Teaching Hospital, Kano. Patients and Methods: This was a retrospective study among women who booked for antenatal care at Aminu Kano Teaching Hospital over a 1 year period. Data were retrieved from case files and analyzed using the Statistical Package for the Social Sciences, version 17 (SPSS Inc., Chicago, IL, USA). Result: The mean age at first pregnancy was 23.9 ± 4.27 years. Teenage women accounted for 10.2% of the total population. Majority of the women were Hausas (71.8%), Muslims (86.1%), unemployed (80.9%), and had formal education (92.4%). Ethnicity (Hausas versus other tribes), religion (Islam versus Christianity) and occupation (employed versus unemployed) were not statistically associated with the age at first pregnancy above teenage age group (X²= 2.578, P = 0.108; X² = 1.788, P = 0.181; X² = 3.350, P = 0.067, respectively). However, formal education was statistically associated with average age at first pregnancy (X²= 13.486, P = 0.001). Conclusion: The age at first pregnancy was found to be 23.9 ± 4.27 years. This was within the recommended age of 20–35 years. Women with formal education were more likely to delay the age at first pregnancy until after teenage years. Formal education will certainly contribute to reducing maternal mortality and morbidity associated with teenage pregnancies.

Background: Varicosities of lower limb is one of the most common medical condition and a lot of treatment modalities are available for the same. However, none of them is superior to the other. We compare the effectiveness of surgery versus foam sclerotherapy in the treatment of varicose veins based on the diameter of the veins. Patients and Method: One hundred patients with primary great saphenous vein incompetence with treatment over a period of 17 months were included. Depending on the diameter of the vein, they are divided into two groups <5 mm and >5 mm, and then assigned to either ultrasound-guided foam sclerotherapy or surgical stripping with high ligation. Result: Surgery and sclerotherapy in both groups resulted in reduction in both venous disability score and venous clinical severity score. Conclusion: In patients with vein diameter <5 mm, foam therapy is as good as surgery, however, in >5 mm, surgery is more effective than sclerotherapy.

Background: Surgical repair of hypospadias has taxed the skills of surgeons the world over. One-stage repair is preferable because it decreases operative trauma, allows use of virgin unscarred tissue, decreases number of hospitalizations, and hence is more economical than two-stage repairs. During the last 7 years, the author has managed 200 cases of hypospadias and their complications in a tertiary care service hospital. This study aimed to evaluate the outcomes of using modified onlay island flap technique in the repair of hypospadias with a narrow urethral plate. Patients and Methods: In this prospective study conducted between June 2008 and June 2015, we performed modified onlay island flap procedure for the repair of hypospadias with a narrow urethral plate – less than 7 mm. This technique was used for all types of hypospadias with minimal or no chordee except penoscrotal. We did not require any tunica plication in our study. Results: Two hundred patients with age ranging from 3 years to 10 years (average 5 years) underwent modified onlay island flap repair; all had a narrow urethral plate of less than 7 mm; 30 (15%) had mild chordee. Meatus was located in coronal in 10 (5%) cases, subcoronal in 120 (60%), midpenile in 50 (25%), and proximal penile in 20 (10%) patients. Chordee was corrected with degloving only in 30 (15%) patients. Complications were meatal stenosis in none and urethrocutaneous fistula in 10 (5%) patients. Mean follow-up duration was 12 months. Conclusion: This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula, along with good aesthetic outcome.

Cervical myomas arise from the smooth muscle cells of the cervix accounting for 2% of all uterine leiomyomas. This is a case report of a 31-year-old lady who presented with a white, watery vaginal discharge, and a 6-hour history of protrusion per vaginam. Examination revealed a progressively increasing mass protruding per vaginam. She underwent a vaginal myomectomy, and a leiomyoma 13 × 12 × 7 cm with areas of necrosis was removed. She did well postoperatively. Vaginal myomectomy is an effective procedure for patients with huge leiomyomas.

Ascaris lumbricoides is a large parasite that infests the human bowel, especially in regions with poor environmental sanitation in the tropics. Meckel's diverticulum is mainly an asymptomatic congenital intestinal anomaly. Rarely, it becomes symptomatic when it is associated with complications such as diverticulitis, perforation, and bleeding. It may be associated with a heavy worm load. We report a case of 7-year-old female child with intestinal obstruction and incidental finding of Meckel's diverticulum with gangrenous bowel.

Cut throat injury is a potentially life threatening emergency often encountered by ear, nose, and throat surgeons. In recent years, there has been increasing incidence of violence as well as severe injuries from armed robbers and insurgents using sharp knives in Northern Nigeria. The use of knives as a weapon for armed robbery when applied to the neck often results in fatal consequences because of the potential for injury to vital structures. Early appropriate interventions often reduce the morbidity and mortality associated with cut throat injuries. We present a report of a successfully managed case of severe cut throat with complete transection of the larynx and muscles of the posterior neck resulting in near decapitation inflicted using a sharp knife during a robbery incident. Securing airway in the early management of patient with cut throat injury is very important. There is a need for patient and meticulous repair of damaged structures. This may reduce the morbidity and mortality associated with such cases.