Pattern of Maxillofacial Injuries in Patients With Traumatic Head Injury at the Kenyatta National Referral and Teaching Hospital in Nairobi, Kenya

Abstract

Background: Maxillofacial and traumatic head injuries are a major cause of morbidity and mortality worldwide. The causes of these injuries vary and are attributable to motor vehicle and cycle crashes, fall from heights and interpersonal violence, among others. There is a paucity of hospital studies in the East African region reporting on the pattern of these combined injuries occurring concurrently. Research methodology: Study objective: The aim of this study was to assess the incidence and pattern of concurrent occurrence of maxillofacial injuries (MFIs) and traumatic head injury (THI). Study design: A cross-sectional descriptive prospective study Study area and population: Study was undertaken at the Kenyatta National hospital’s accident and emergency, maxillaofacial surgery, neurosurgical and the ICU units. Study duration was 3 months where 336 patients after giving consent and who sustained concomitant maxillofacial and traumatic head injury participated. Data analysis and presentation: Convenience sampling and quantitative data was collected using a specially designed questionnaire. Data analysis was done using the statistical package for social sciences (SPSS). Results: Three hundred and thirty six patients were enrolled in the study. The patients’ age ranged from 2.8 – 69.0 years. The majority of the patients were aged 21 – 30 years (133, 39.6%) followed by those aged 31 – 40 years (111, 33.0%). There were more males affected than females at a ratio of 8.3:1. The most common aetiology of injury was road traffic crashes (RTC) and motorcycles crashes 186 (55.4%). Drivers were mainly involved at 170(50.6%). The most common MFI involved the mid face 188 (56%). In the upper face zone, frontal bone fractures (27.2%) were the commonest. Orbital fractures constituted the commonest (23.2%) injuries of the mid-face component while the zygoma with zygomatic arch injuries at (14.8%) comprised the commonest zygomatic complex fractures. In the lower face zone, parasymphyseal mandibular fractures (20.2%) were the commonest. The most common head injury characteristic sign was loss of consciousness (63.6%). Cases of mild Glasgow Coma Scale (GCS) were found to have been at 317 (94.3%). Skull vault fractures constituted 86 (25.6%) of the injuries while patients who had basilar fractures were 7 (2.1%). The xiv commonest intracranial injury comprised of diffuse lesions at 264 (78.6%) with concussions having been the commonest at 256 (78%). Among the focal lesions, the commonest lesion was epidural hemorrhage at 31 (68.9%). Seven classification patterns of MFIs in THI were observed and arbitrarily developed from the data which ranged from Type 1A to Type 7C combined injury patterns. Conclusion: There was a significant number of MFIS among patients with THI, with the commonest gender affected having been male and age group 21-30year olds. Commonest aetiology of injury was RTC and involving motorcycle drivers. The developed classification of combined injuries is a useful practical and simple system that may be used in case diagnosis and treatment planning. Recommendations: Based on the high incidence rate and observed trauma patterns in concurrent MFIs and THI, specialized institutions should review existing multidisciplinary management protocols to provide for adequate resource allocation in the care and management of combined injuries. There is a great need for continuous education and public health policies on road accidents in order to prevent and reduce incidence of MFIs and THI among the males of 21-30 years age group especially those using motorcycles. The developed classification of combined injuries should be considered as a possible mode of classification of MFIs in THI. Future studies involving multiple centers and larger sample sizes may be conducted to improve on present study findings, limitations and injury classification methodology.