Aetiology, occurrence and clinical characteristics of maxillofacial soft tissue injuries treated at a major teaching and referal hospital in Nairobi

Abstract

Introduction: Maxillofacial soft tissue injuries (MF-STls) are often neglected or trivialized compared to fractures, yet these injuries negatively impact both on function and esthetics. There is a psychological aspect associated with the injury secondary to the patient's concern regarding permanent scarring and subsequent facial disfigurement or dysfunction. Hence, cosmetic outcome is the single most important aspect of care to the patient. The aetiology of maxillofacial injuries in general differs from one country to another because of socio-economic, cultural and environmental factors. Interpretation of these surveys based on aetiology is difficult because of the variation in the classification of injuries that are used. Periodic review of epidemiological data on trauma highlights 'the health burden of such hazards hence the need for baseline information upon. which the evaluation of future trends can be done. There is paucity of such data in Kenya. Study Objective: To describe the aetiology, occurrence and the clinical characteristics of MF- STls and the immediate intervention modalities. Material and Method: The study setting was at the Kenyatta National hospital (KNH) accident and emergency (A&E) department and the Oral and Maxillofacial clinic. This was a descriptive cross-sectional study. All consecutive patients who presented with MF-STls to the A&E department at the KNH over the study period from 15t September 2009 to ao" December 2009 were evaluated. A pre-designed questionnaire was completed for all patients with MF-ST,ls who required the attention of a maxillofacial specialist. IX Results: During the 4-month study, 422 patients were attended to for MF injuries. Patients who sustained craniofacial injuries constituted 32.7% of all trauma patients attending the A & E Department among whom 345 (81.7%) had STls, whereas 77 (18.2%) had facial fractures in isolation and 113 (26.7 %) had facial fractures in combination with MF-STls. The male to female ratio was 3.3: 1. Motor vehicle accidents (MVA) were the leading cause of MF-STls (44.6%) followed by interpersonal violence (IPV) (39.1%). MVA (50.0%) was the leading cause of MFSTls in the less than 12- year-olds while falls from heights (58.3%) were the leading cause in under 5- year-olds. The most frequent types of MF-STls were simple lacerations which constituted 40.2%, whereas multiple lacerations constituted 29.2%. Abrasions constituted 20.5% while avulsions constituted 3%. The upper face was the anatomical site that was injured most (27.4%)...Tongue injuries constituted 17.6% of all the injuries to special areas. There were no skeletal fractures observed in the under 5- year-olds. Conclusions: MVA and IPV were the principal causes of the MF-STls which heavily outnumbered MF skeletal fractures. Males were more afflicted than females. Remarkably, lacerations were the commonest types of MF-STls whereas orthopaedic and head injuries were the more commonly associated systemic injuries. Most wounds treated were uncomplicated and were managed by dental interns and maxillofacial residents.