Etiological spectrum, injury characteristics and treatment outcome of maxillofacial injuries in a Tanzanian teaching hospital

Chalya, Mchembe Mabula, Mabula, Kanumba, Gilyoma

Description

Maxillofacial injuries pose a therapeutic challenges to trauma, maxillofacial and plastic surgeons practicing in developing countries. This study was carried out to determine the etiology, injury characteristics and management outcome of maxillofacial injuries at our teaching hospital. Patients and Methods A prospective hospital based study of maxillofacial injury patients was carried out at Bugando Medical Centre from November 2008 to October 2009. Data was collected using a structured questionnaire and analyzed using SPPS computer software version 11.5. Results A total of 154 patients were studied. Males outnumbered females by a ratio of 2.7:1. Their mean age was 28.32 ± 16.48 years and the modal age group was 21-30 years. Most injuries were caused by road traffic crushes (57.1%), followed by assault and falls in 16.2% and 14.3% respectively. Soft tissue injuries and mandibular fractures were the most common type of injuries. Head/neck (53.1%) and limb injuries (28.1%) were the most prevalent associated injuries. Surgical debridement (95.1%) was the most common surgical procedures. Closed reduction of maxillofacial fractures was employed in 81.5% of patients. Open reduction and internal fixation was performed in 6.8% of cases. Complications occurred in 24% of patients, mainly due to infection and malocclusion. The mean duration of hospital stay was 18.12 ± 12.24 days. Mortality rate was 11.7%. Conclusion Road traffic crashes remain the major etiological factor of maxillofacial injuries in our setting. Measures on prevention of road traffic crashes should be strongly emphasized in order to reduce the occurrence of these injuries.

Sujets

• Etiology
• Tanzania

Informations

• Publié par: biomed
• Publié le: 01 janvier 2011
• Nombre de lectures: 11
• Langue: English

Extrait

Chalya et al. Journal of Trauma Management & Outcomes 2011, 5:7
http://www.traumamanagement.org/content/5/1/7
RESEARCH Open Access
Etiological spectrum, injury characteristics and
treatment outcome of maxillofacial injuries in a
Tanzanian teaching hospital
1* 2† 1† 1† 1†Phillipo L Chalya , Mabula Mchembe , Joseph B Mabula , Emanuel S Kanumba and Japhet M Gilyoma
Abstract
Background: Maxillofacial injuries pose a therapeutic challenges to trauma, maxillofacial and plastic surgeons
practicing in developing countries. This study was carried out to determine the etiology, injury characteristics and
management outcome of maxillofacial injuries at our teaching hospital.
Patients and Methods: A prospective hospital based study of maxillofacial injury patients was carried out at
Bugando Medical Centre from November 2008 to October 2009. Data was collected using a structured
questionnaire and analyzed using SPPS computer software version 11.5.
Results: A total of 154 patients were studied. Males outnumbered females by a ratio of 2.7:1. Their mean age was
28.32 ± 16.48 years and the modal age group was 21-30 years. Most injuries were caused by road traffic crushes
(57.1%), followed by assault and falls in 16.2% and 14.3% respectively. Soft tissue injuries and mandibular fractures
were the most common type of injuries. Head/neck (53.1%) and limb injuries (28.1%) were the most prevalent
associated injuries. Surgical debridement (95.1%) was the most common surgical procedures. Closed reduction of
maxillofacial fractures was employed in 81.5% of patients. Open reduction and internal fixation was performed in
6.8% of cases. Complications occurred in 24% of patients, mainly due to infection and malocclusion. The mean
duration of hospital stay was 18.12 ± 12.24 days. Mortality rate was 11.7%.
Conclusion: Road traffic crashes remain the major etiological factor of maxillofacial injuries in our setting. Measures
on prevention of road traffic crashes should be strongly emphasized in order to reduce the occurrence of these
injuries.
Keywords: Maxillofacial injuries etiology, injury characteristics, treatment outcome, Tanzania
Introduction coordinated management between emergency physicians
The maxillofacial region occupies the most prominent and surgical specialists in otolaryngology, trauma sur-
position in the human body and rendering it vulnerable gery, plastic surgery, ophthalmology, and oral and maxil-
to injuries quite commonly [1]. Maxillofacial injuries are lofacial surgery [3,4]. Maxillofacial injuries can occur as
commonly encountered in the practice of emergency an isolated injury or may be associated with multiple
medicine and are often associated with high morbidity injuries to the head, chest, abdominal, spinal and extre-
resulting from increased costs of care and varying mities [5].
The etiology of maxillofacial injuries varies from onedegrees of physical, functional and cosmetic disfigure-
ment [2]. It is estimated that more than 50% of patients country to another and even within the same country
withtheseinjurieshavemultipletraumarequiring depending on the prevailing socioeconomic, cultural and
environmental factors [2,6,7]. The relationship between
alcohol consumption and maxillofacial injuries is well
* Correspondence: [e-mail] known [2,8,9].
† Contributed equally
1 The common etiologies of maxillofacial fractures,Department of Surgery, Weill-Bugando University College of Health
Sciences, Mwanza, Tanzania across the world, are road traffic accidents, falls,
Full list of author information is available at the end of the article
© 2011 Chalya et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.Chalya et al. Journal of Trauma Management & Outcomes 2011, 5:7 Page 2 of 6
http://www.traumamanagement.org/content/5/1/7
assaults, firearm injury, sports and industrial accidents the A&E department these patients are admitted in their
[10-12]. Road traffic accident is reported to be the lead- respective surgical wards or ICU after definitive
ing cause of maxillofacial fractures in developing coun- treatment.
tries [7,8,11,13], while interpersonal violence is the During this study, all maxillofacial injury patients seen
leading cause in developed countries [10]. The causes at the A&E department were, after informed written
and pattern of maxillofacial injuries reflect trauma pat- consent, consecutively recruited into the study. Patients
terns within the community and, as such, can provide a who died before initial assessment and those without
guide to the design of programmes geared toward pre- next of kin to consent were excluded from the study.
Ethical approval to conduct the study was obtainedvention and treatment [12].
Maxillofacial injuries involve soft and hard tissues from the WBUCHS/BMC joint institutional ethic review
injuries of face extending from frontal bone superiorly committee before the commencement of the study.
to mandible inferiorly and vary from soft tissue lacera- Information relevant to the study was obtained from
tions to complex fractures of maxillofacial skeleton [11]. the patient directly; when this was not possible, collat-
The pattern of these injuries depends on the mechanism eral history was obtained from either the police or rela-
of mechanism of injury, magnitude and direction of tives attending to the patients.
impact force and anatomical site [2,7,11]. All maxillofacial bony injuries were diagnosed by con-
The management of injuries to the maxillofacial com- ventional and panoramic radiographs. Advanced imaging
plex remains a challenge for oral and maxillofacial sur- techniques like computed tomography and magnetic
geons, demanding both skill and a high level of resonance imaging were not used due to patients’ finan-
expertise [13,14]. Open reduction and internal fixation cial constraints and their unavailability.
of maxillofacial fractures has been reported to results in Data were collected using a pre-tested questionnaire.
a patient with a satisfactory facial appearance and Data collected included: patient’s demographic data,
restoration of function [14]. However, in resource-lim- cause of injury, type of injury, time of injury, place of
ited countries like ours, lack of expertise and facilities injury, status of prehospital care, mode of arrival in the
for open reduction and internal fixation and late presen- hospital, associated injuries, severity of injury (GCS &
tation are a major problem in achieving acceptable cos- ISS), treatment modalities and outcome of treatment (i.
metic outcomes in maxillofacial trauma patients. e. post-operative complications, length of hospital stay
The vast majority of maxillofacial injuries are preven- and mortality). The causes of injury were classified as
table; therefore, preventive strategies targeting at the road traffic accidents (RTAs), assault, falls, burn, sport
etiology of these injuries is important in order to reduce related, animal bite and gunshot. The anatomic location
their occurrence. A clear knowledge of injury character- of the mandibular fractures was classified according to
istics and treatment outcome is vital in order to achieve Ivy and Curtis [15], while the maxillary fractures were
acceptable functional and cosmetic outcomes. classified as Lefort I, II, and III [16].
The aim of this study was to describe our own experi- Data collected were analyzed using the statistical pack-
ences in the management of maxillofacial injuries out- age for social sciences (SPSS) for Windows version 11.5.
lining the etiological spectrum, injury characteristics and Datawassummarizedinformofproportionsandfre-
treatment outcome of these injuries in our local setting. quency tables for categorical variables. Means, median
The study provides basis for establishment of treatment and standard deviation were used to summarize contin-
guideline and planning for preventive strategies. uous variables. A p-value of less than 0.05 was consid-
ered statistically significant.
Patients and Methods
In this prospective hospital based study, all consecutive Results
maxillofacial injury patients admitted to the Accident & During the period under study, a total of 154 patients
Emergency department of Bugando Medical Centre were enrolled. 112 (72.7%) patients were males and
(BMC) over a one-year period from November 2008 to females were 42 (27.3%) with a male to female ratio of
October 2009 were included. BMC is the only referral 2.7:1. Their ages ranged from 6 to 71 years with a mean
and teaching hospital in Mwanza, a city located in the of 28.32 ± 16.48 years. The modal age group was 21-30
north-western part of Tanzania along the shore of Lake years. The majority of patients were unemployed (63.6%,
Victoria. It is a teaching hospital for Weill-Bugando n = 98) and most of them had either primary or no for-
University College of Health Sciences and has the bed mal education (66.2%, n = 102).
capacity of 1000. Thevastmajorityofinjuries(77.9%,n=120)were
Trauma patients are first seen at the A&E department unintentional and the remaining 34 (22.1%) were inten-
where resuscitation is carried out according to tional injuries mainly due to assault and interpersonal
Advance