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Annals of African Medicine, Vol. 3, No. 2, 2004, pp. 66-68 SINO - NASAL SURGERY IN THE SUB-SAHARAN AFRICA: A CRITICAL APPRAISAL B. M Ahmad, *M. B. Sandabe, and *A. M. Kodiya Department of Otorhinolaryngology (Ear, Nose and Throat),
College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria and
*Department of Ear, Nose and Throat, University of Maiduguri Teaching Hospital,
Maiduguri, Nigeria Code Number: am04017 ABSTRACT Background: Sino - nasal surgery poses a great
challenge to practicing ear, nose and throat surgeons in the sub-Saharan Africa
where facilities are inadequate and most patients are distantly located from
the few hospitals available in this region. Key words: Nasal surgery, intranasal antrostomy, nasal polypectomy INTRODUCTION The lining of the nose and the paranasal sinuses is continuous and act as one unit, 1, 2 therefore pathological changes in the nose are usually accompanied by similar findings in the sinuses to a large extent. It is implied here that nasal surgery also includes the surgery of the paranasal sinuses. Although computerized tomographic (CT) scanning is now the best measure of imaging the sinuses, 3 in the developing countries plain X-rays of the sinuses still has a place where CT scanning is not available or unaffordable. 4 Various surgeries are performed for various nasal conditions as elective or emergency situations. In the tropical countries indication for such surgeries are mainly due to infective conditions. 5-7 Patients with malignant conditions present at advanced stages of the diseases 8 where surgery is performed to obtained biopsy and for palliation. Here we present 79 cases who had nasal surgery from our center. MATERIALS AND METHODS This study included the patients seen at the ear, nose and throat (ENT) clinic or the accident and emergency department of the university of Maiduguri teaching hospital (UMTH) and had their surgeries under general anesthesia (G.A) from January 1997 to December 2001. Information on patients was extracted from the operation register in the main theatre and other details of surgeries from patients’ files. Only patients operated under G.A. were considered for the study. RESULTS A total of 79 patients were operated under G.A. within the study period. Forty-three (54.4%) were males and 36 (45.6%) were females; with male to female ratio of 1.2:1. Their ages range from 3 months to 68 years. The highest number of surgeries was performed in the year 2000, which was closely followed by that of 2001. This is shown in table 1. The most common indication for surgery was infection/ allergy accounting for 62% of all cases, whereas the next common indication was tumour in 20.3%. The least indication for surgery was the congenital anomaly group in only 6.3%. This is shown in table 2. Among the infection/allergy subgroup, examination under anesthesia (EUA) of the nose and intranasal antrostomy was the most common procedure performed constituting 63.3%; this was followed by procedures like nasal polypectomy in 32.7% and partial turbinectomy in 26.5%. External fronto-ethmoidectomy and Caldwell-Luc’s operation constituted 12.2% and 8.2% respectively. This is shown in table 3. It is important to note that some patients had more than one procedure. Table 1: Yearly sino-nasal
operations 1997-2001
Table 2: Reasons for sino - nasal surgery
Table 3: Surgeries for sino - nasal infection / allergy
One patient may have more than
one procedure DISCUSSION Nasal diseases are quite common ranging from “common cold” to malignant neoplasms. In our study, 79 patients had surgery with a slight male preponderance. This figure is rather low, but delays in seeking remedies in the hospital due to high cost of hospitalization in a predominantly peasant population could be a factor. The highest numbers of surgeries were performed in the 2000. The previous years were riddled with several industrial actions embarked upon by various hospital workers as well as the shortage of trained personnel greatly affected services. Sixty two percent of the patients had surgery to remedy their infective/allergic conditions. Earlier study in the region showed that rhinosinusitis constituted a public health problem. 4 This is as a result of peculiar weather conditions of low humidity, dust and high wind velocity in the region. Intranasal antrostomy, nasal polypectomy, partial turbinectomy and proof puncture under GA were some of the commonly performed procedures. Chukuezi 7 reported on nasal polyposis where all the patients had nasal polypectomy with certain patients treated with antral washout and Caldwell-Luc’s operation. Few patients had Caldwell-Luc’s operation in our report. This could be due to difference in sample size. External fronto-ethmoidectomy constituted 12.2% of the surgeries performed in the infection/allergy subgroup in this report. They were all performed in patients with fronto-ethmoidal mucocoeles using Foley’s catheter as a short-term drainage procedure as described by Ijaduola. 6 Earlier report on mucocoeles showed that fronto-ethmiodal mucocoeles were the most common types of paranasal sinus mucococeles in this environment. 5 Only 20.3% of the total surgeries were carried out due to malignancies. Most of these surgeries were biopsies as well as few maxillectomies. Antral malignancies progress slowly masquerading as rhinosunusitis delaying referral and early diagnosis. Singh et al 8 made similar observation on late presentation leading to ineffective management. Most of the trauma cases have associated facial/head injuries. Primary nasal trauma patients necessitating surgery under GA are few in our report. However, the need for effective road network and communication system to enable such patient reach hospital in time is highly advocated. Apart from such difficulties, some patients prefer seeking alternative home remedies. Those patients finally come to hospital with fulminant sepsis and facial disfigurement. Congenital anomalies were also few, such as atresia of the anterior nares and unilateral choanal atresia. Most of the difficulties leading to late reporting can be corrected. Since most of the patients are either peasants or traders with low income, medical insurance policies need to be instituted by government at various levels of health care. Certain beliefs that alternative remedies are better can be rectified through health education and community participation. Industrial action, until recent, was a major impediment in the health sector; adequate incentives, proper placement and dialogue should help prevent future occurrence. REFERENCES
Copyright 2004 - Annals of African Medicine |
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