Aetiology, pattern and management of oral and maxillofacial injuries at Mulago National Referral Hospital: a ten-year audit

Abstract

BACKGROUND: Oral and Maxillofacial injuries (OMFIs) are commonly associated with general body injuries. The anatomical position of the region (the neurocranium and viscerocranium) makes it relatively more exposed than any other part of the body rendering it more prone to trauma. Injuries sustained in this area are often life-threatening as they may be associated with airway problems, feeding difficulties, cervical spine fractures and head injury. The resultant facial scarifications or deformities may cause esthetic problems that can lead to depression and socio-psychiatric disorders, like post traumatic stress disorder (PTSD).The degree of OMFIs largely depends on the aetiology and the activities the victim is involved in. The prognosis of the injured patient is dependent on both the initial emergency treatment and the eventual definitive treatment given to the victim. Both forms of treatment are dependent on availability of the necessary facilities and expertise in a given health facility that attends to the patient. OBJECTIVES: The objective of this study was to assess the aetiology, pattern and methods of management of Oral and Maxillofacial injuries seen at the Oral and Jaw injuries unit of Mulago , National Referral Hospital for a period of 10 years (2000-2009). The study was intended to assess the magnitude of Oral and Maxillofacial injury- patients managed at this unit. METHODOLOGY: The study design was retrospective descriptive and cross-sectional, carried out on medical records of patients who were managed for OMFIs at the Oral and Jaw Injuries unit of Mulago National Referral Hospital (MNRH) over a ten-year period. The study site was at the Oral and Jaw Injuries Unit. The non-probability (convenience) sampling method was used and a minimum sample size was determined by applying the formula for prevalence studies. "'"' XIV"'"' However, the sample size depended on the number of patients' records that met the inclusion criteria. A pre-designed data collection instrument was uti lised by calibrated research assistants and the principal investigator for data collection and windows SPSS version 17 was utili sed for data analysis with guidance of a biostastician. The results were presented in tables, graphs and pie- charts. RESULTS: A Total of 1203 patients' records met the inclusion criteria for this research study and out of these 990 (82.3%) were males and 213(17.7%) were females, the ratio of male: female eing 4.6: l. The age-group most affected by OMFIs was the 21-30- year- olds and road traffic injuries (RTIs) were responsible for 61% (n=735) of the injuries whereas Interpersonal violence (IPV) was responsible for 27.6% (n=332) being the second most prevalent aetiological factor followed by Accidental falls 12% (n=142) and Fircarrn'injuries (FAIs) 2.2% (n=27) respectively. In the present study it was also found that the most frequently injured part of the facial region was the lower part of the face which sustained 56% (n= 980) of all the OMFIs followed by midface 32% (n=560) and upper face 12% (n= 208). Isolated mandibular fractures were 62% of the skeletal injuries, whereas isolated mid-facial fractures involving the zygoma, zygomatic arches, maxilla and nasal bones were (24%). Pan-facial fractures accounted for 5.7% of all the Maxillofacial fractures. The most prevalent body injury associated with OMFls was found to be head injury which accounted for 60.8% of all the associated injuries. The main radiological investigation carried out was plain radiography and the definitive management comprised mainly of soft tissue repair (60.43%). The skeletal fractures were mainly managed by closed reduction (46.47%) whereas open reduction with internal fixation (ORIF) was done on a small percentage of the patients (4.0%). ~xv ~ CONCLUSION OMFls seen and managed at MNRH were mostly due to RTI and IPV, mainly affecting young males between 21 and 30 years old. The Patients presented with both STls and skeletal injuries, the mandible and the lower face generally being the most affected part. Patients presented with diverse associated injuries the head injury being the most prevalent among them. The main mode of management of the facial fractures was closed reduction which included intermaxillary fixation with both eyelet wires and arch bars. RECOMMENDATIONS Since most of these injuries were caused by road traffic injuries especially motorcycle accidents (MCAs), preventive measures to minimise their occurrence need to be put in place and enforced. Public education on observation of road traffic regulations targeting the most affected segment of society should be done. Prospective studies on the main aetiologies of OMFls like RTIs and IPV need to be done so as to establish their route causes and devise means of reducing their incidences.