Pattern, Clinical Presentation and Management of Mandibular Fractures among Motorcycle Crash Victims Attended At Muhimbili National Hospital, Dar-Es-Salaam, Tanzania

Abstract

Objective: To determine the pattern, clinical presentation and management of mandibular fractures among motorcycle crash victims attended at Muhimbili National Hospital, Tanzania. Study design: This was a descriptive cross-sectional hospital-based study. Setting: This study was conducted at the Oral and Maxillofacial Surgery and Emergency Medicine Departments as well as in Oral and Maxillofacial Surgery wards 23 and 24 of the Muhimbili National Hospital (MNH). Study population: All patients who attended at the Oral and Maxillofacial Surgery Department, Emergency Medicine Department and those admitted in wards 23 and 24 of the Muhimbili National Hospital with oral and maxillofacial injuries following motorcycle crashes. Methodology: All patients with oral and maxillofacial injuries were interviewed using specially designed structured questionnaire. The interview enquired about sociodemographic information, place where injury took place, time of injury, factors related to crash occurrence, safety measures, whether a victim was a rider, passenger or pedestrian. Later, the patients were clinically examined and details of the examination included clinical presentation, type and site of maxillofacial fracture and site of mandibular fracture. Radiological investigations included plain radiography and computed tomography (CT) where necessary to confirm the fracture. The findings were recorded on a designed clinical form. Data was entered into a computer and analyzed using SPSS programme version 20.0. The obtained data was coded, cleaned and transformed by recording and grouping. Descriptive analysis included computation of percentages, frequency of occurrence, mean and cross tabulations of variables of interest. Inferential analysis included computation of Chi-Square test to compare proportions for possible association. A p-value of <0.05 was used as a cutoff level for significance. Results: A total of 178 patients, who included 155 (87.1%) males and 23 (12.9%) females with a male-to-female ratio of 6.7:1 were included in this study. The age range was from 9 to 54 years with a mean age of 27.06 ±6.66 years. The age groups 21-30 and 31-40 years were the most affected. Unavailability of road signs reported by 99 (55.6%) participants contributed to significant proportion of the motorcycle crashes. Most common mechanism of injury was motorcycle-motor vehicle collisions 66 (37.1%), followed by motorcyclemotorcycle collision 56 (31.5%). The motorcyclists (61.2%) sustained injuries than the passengers (31.5%). The peak time for injury was at night 86 (48.3%), followed by evening hours 48 (27%), midday 26 (14.6%) and morning hours was the least affected 18 (10.1%). The most common site of mandibular fracture was the symphysis 65 (36.5%) followed by the parasymphysis 55 (30.9%), condyle 45 (25.3%) and the angle 40 (22.5%). The commonest combination of mandibular fractures included the symphysis and condyle 23 (12.9%) followed by the symphysis and angle 11 (6.2%). Almost 98.3% of the patients received pain management and 97.2% were prescribed with prophylactic antibiotics. Surgical wound debridement and suturing was done in 42.1% and 48.3% respectively for the soft tissue injuries. Most patients with mandibular fractures were treated by closed reduction (eyelet wiring, arch bars with IMF), 90 (50.6%) and only 38 (21.3%) were treated by open reduction and internal fixation. Conclusion: Mandibular fractures were more common in males than females with the majority being 21- 30 years of age followed by 31-40 years. The low socioeconomic status, unavailability of road signs, alcohol consumption and non-use of helmets or use of open helmets makes the mandible vulnerable to fractures during motorcycle crash. The most fractured anatomical site was symphysis and the commonest combinations of mandibular fractures included symphysis and condyle followed by body and angle. Findings from this study called for a need to educate the public, drivers, the road traffic department, road safety department, policy makers and health service providers on the need for road maintenance, provision of road signs, and strict enforcement of the existing traffic laws and improvement of the socioeconomic condition of the general population.