Pattern and management of paediatric cranio-maxillofacial traumatic injuries seen at the Kenyatta National Hospital Over A 6-month period

Abstract

Introduction Trauma is among the leading causes of death in all age groups except those above 60 years, according to the WHO. Noteworthy, trauma patterns and aetiology differ among various age groups and geographical regions. It is estimated that approximately 11.3 % of all paediatric emergency room visits are due to facial trauma. Studies on paediatric craniomaxillofacial (CMF) trauma in Kenya are few and are presented as part of general CMF trauma. Objective The main objective of this study was to prospectively determine the pattern and management of paediatric CMF trauma at the main teaching and referral hospital in Kenya over a 6-month period. Materials & Methods This was a cross-sectional descriptive study carried out at Kenyatta National Hospital between April and September 2016. A data collection form was used to document the age, gender, aetiology and pattern of CMF trauma and associated injuries. In addition, management protocols prescribed for these injuries were documented. Results Seven hundred and five (705) physically injured children and adolescents presented to KNH during the 6-month study period and among these, 210 (29.8 %) had craniomaxillofacial injuries with a mean age of 7.4 years (SD= 5.6 years). Accidental falls (44 %) were the main cause of CMF injuries followed by motor vehicle crashes (22 %). Interpersonal violence (IPV) had a statistically significant association with the age of the child, mostly affecting older children with a mean age of 13.2 years (SD= 5.3 years); xi ANOVA (F=14.34, df=4, p< 0.0001). IPV was also more likely to be a cause of CMF in boys than girls (c2 = 10.485, df=4, p=0.0330). Among sixty-six children (31.4%, n=210) who presented with a total of 116 facial fractures, mandibular fractures were the most common with 50 (42.7 %) fractures affecting the mandible. The mandibular condyle was the most likely anatomic region of the mandible to sustain fractures with 32 % of mandibular fractures occurring in this site (n=50). Management of facial fractures was predominantly conservative or through closed reduction (79 %) with 14 patients (21 %, n=66) managed through ORIF. ORIF was more likely to be used in older children (mean age =11.0 years, SD= 5.5) and those with mandibular fractures (50%, n=14) or panfacial fractures (35.7 %, n=14). Conclusion Accidental falls were the main cause of paediatric CMF trauma followed by road traffic crashes. Cranio-maxillofacial injuries constituted approximately a third (29.8 %) of all paediatric injuries recorded in this study with the mandible being the most fractured facial bone, with its condylar process being the most fractured region. ORIF for paediatric facial fractures was more likely to be prescribed for older children and in particular those with mandibular fractures or panfacial fractures. Recommendation Since we have found that accidental falls and road traffic crashes are probably the leading causes of paediatric cranio-maxillofacial trauma in Kenya, preventive measures to reduce the paediatric trauma burden should focus on reducing the occurrence of falls and road traffic accidents