Complex maxillofacial trauma caused by Wild Animals in Kenya
Guthua, Symon W.
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Although the incidence of maxillofacial injuries caused by wildlife in Kenya is not known, it is estimated to be 2 to 5%. In Kenya, the tourism industry is the main source of foreign revenue. Therefore, the country invests a substantial amount of money in promoting tourism and improvement of the country's parks/game reserves. On rare occasions, some of the wild animals will leave their natural habitat, within the confines of the national parks, and pose a threat to the people living in the neighbourhood. The animals particularly implicated include lions, buffalos, hippopotamus, leopards and hyenas. Material and method: Within a period of 4 years, seven patients aged between 22 and 35 years, mean age 28 years, were referred for management of overwhelming maxillofacial injuries caused by wild animals. The injuries involved the upper face, midface and lower face. The midface was more involved than the rest of the face. The most common injuries diagnosed were crushing and mutilation types of injuries. Apart from the oro-maxillofacial region, upper extremities were commonly involved. Results: The duration before presentation ranged from 6 hours to 6 days. One of the patients, Female aged 35 years, was evacuated late and presented with severe tissue necrosis and irreversible damage of the right eyeball. Management comprised of surgical toilet, debridement and primary repair or crushing injuries. Mutilated injuries required repeated debridement and staged reconstruction of the defects. The latter injuries were particularly caused by lions and leopards and secondarily hyenas. Tetanus toxoid was administered to all the patients, whereas antirabies vaccination was given only to patients with mutilation injuries. Conclusions: In assessment of patients with severe maxillofacial injuries caused by wild animals, a similar approach to that of patients with multiple injuries caused by motor vehicle accidents should be employed. Meticulous examination, life support measures and relevant surgical procedures should be instituted immediately to minimize morbidity and mortality arising from these injuries