The pattern of oral and maxillofacial injuries among patients attending Muhimbili national hospital, Dar es salaam, Tanzania

Abstract

Objective: To determine the pattern of oral and maxillofacial injuries among patients attended at the Muhimbili National Hospital, Dar es Salaam, Tanzania. Study design: Descriptive cross-sectional hospital based study. Setting: The study was done at oral and maxillofacial surgery firm and emergency medicine department of Muhimbili National Hospital (MNH). Study population: All patients who attended the Oral and Maxillofacial Surgery firm and Emergency Medicine departments of MNH for treatment of oral and maxillofacial injuries during the period of the study and consented were included in the study. Methodology: An interview of the patients with oral and maxillofacial injuries was done through structured questionnaire to obtain relevant information from the patient. Social-demographic information (age, sex, address, education level and marital status), patient’s main complaint, type of injury, place where injury took place, cause of injury, general condition of patient immediately after injury and afterwards and the time interval from injury to reporting to hospital were recorded. Clinical findings were recorded as follows: type of injury, site of injury, single or multiple, soft tissue or hard tissue injury. Soft tissue injuries were categorized as bruises, abrasions, cut wound, contusion, lacerations, avulsions, and burn. Hard tissue injury was categorized as fracture of facial bones such as nasal bone, maxilla, mandible, zygoma, frontal palatal and orbital bones. Accompanying injuries to the TMJ were also recorded. Radiological investigations including plain skull radiography (posterior anterior view, Water’s view, submental vertex view), orthopantomograph and where necessary a computed tomography (CT) were ordered. The interpretation of the radiological investigations was done by the principal investigator with the assistance of an experienced clinician and was recorded in a special form as fracture or no fracture, site and type of fracture. Treatment offered and treatment outcomes were also recorded. For admitted patients the number of days spent in hospital was recorded against the type of injury and treatment done. The data was entered into computer and analysis was done using Statistical Package for Social Sciences programme (SPSS) Version 15. Association of maxillofacial injury parameters vii (demographic factors, aetiology, treatment and complications) and type of injuries was evaluated using Chi –square test (X2). Significant level p<0.05 was used to draw out conclusion. Results A total of 137 patients, 123 (89.8%) males and 14 (10.2%) females with the male- female ratio of 9:1 were included in this study. The age range was from 4 to 70 years with a mean age of 30.13 years. The 21-30 and 31-40 years age groups were the most affected. Road traffic accidents (RTA) were the most (64.2%) common causes of oral and maxillofacial injuries. The most common soft tissue injury was laceration in 63 (26.9%) patients followed by bruises in 57 (24.4%) and cut wounds in 54 (23.1%). Ninety-three patients (67.9%) had sustained fractures of either the mandible, mid face or both and of those 93 patients who sustained fracture, most had mandibular fractures 42 (45.2%). All patients received basic resuscitation procedures, for stabilization of the patient. Almost all (97.8%) patients with oral and maxillofacial injuries were given analgesics for pain control and prophylaxis antibiotics (96.4%). Surgical wound debridement and wound suturing were the most (62.8% and 53.3% respectively) common treatment for soft tissue injuries, while intermaxillary or mandibulomaxillary fixation was the most (51%) common hard tissue injuries treatment. A total of 27 (19.7%) patients suffered some complications after treatment. Infection was the most (59.3%) common complication followed by malunion (33.3%). Conclusion This study showed that road traffic accidents were the most common cause of maxillofacial injuries. Assaults/interpersonal violence were the second most common cause of maxillofacial trauma. These findings should alert the authorities, particularly the government and the road safety commission to the need for improvement of our roads, enforcement of existing traffic laws, and improvement of socio-economic conditions of the general population.