MAXILLOFACIAL SOFT TISSUE INJURIES IN NAIROBI, KENYA.

OBJECTIVES: To determine the aetiological factors and pattern of occurrence of maxillofacial soft tissue injuries (MF-STIs) presenting at a Kenyan National Referral Hospital in Nairobi. DESIGN: A cross-sectional study. SETTINGS: The accident and emergency department of the Kenyatta National Hospital (KNH) between September 2009 and December 2009. SUBJECTS: Four hundred and twenty two patients treated for MF-STIs. RESULTS: The male to female ratio was 3.3:1. Motor vehicle accidents (MVA) were the leading cause of MF-STIs (44.6%) followed by interpersonal violence (IPV) (39.1%). MVA (50.0%) was the leading cause of MF-STIs in the less than 12-year-olds while falls from heights (58.3%) was the leading cause in under five-year-olds. IPV (48.1%) was the leading cause of facial fractures. There were no skeletal fractures observed in the under five-year-olds. Head injury (36%) and fractures of the long bones (52%) were the most common associated injuries. CONCLUSION: The leading causes of MF-STIs apparently differ from those of skeletal fractures.

AETIOLOGY, PATTERN AND MANAGEMENT OF ORAL AND MAXILLOFACIAL INJURIES AT MULAGO NATIONAL REFERRAL HOSPITAL.

OBJECTIVE: To establish the aetiology, pattern and methods of management of oral and Maxillofacial injuries (OMFIs) seen at the Oral and Jaw injuries unit of Mulago National Referral Hospital (MNRH) Kampala, Uganda, over a ten year period. DESIGN: A descriptive retrospective study. SETTING: Oral and jaw injury unit of Mulago National Referral Hospital, Kampala, Uganda. RESULTS: One thousand two hundred and three patient records met the inclusion. criteria. The age range was 1-90 years with a male: female ratio of 4.5:1. The age-group most affected was the 21-30-year-olds. Road traffic injuries (RTIs) were responsible for 61% (n = 735 of the injuries, interpersonal violence 27.6% (n = 332), accidental falls 12% (n = 142) and firearm injuries 2.2% (n = 27). Of the maxillofacial fractures (n = 1069) isolated mandibular fractures were 62%, isolated mid-facial fractures 24% whereas Pan-facial fractures accounted for 14%. CONCLUSION: The victims of OMFIs were mostly young men between 21 and 30 years of age. The main aetiological factors were road traffic injuries (RTIs) and interpersonal violence (IPV), while the lower third of the face was most often involved. Consistent with findings in other studies, RTI and IPV remain the two main causes of Maxillofacial injuries and public health measures targeting prevention should focus on these areas.

SURGICAL MANAGEMENT OF AGGRESSIVE SYNCHRONOUS JAW CENTRAL GIANT CELL GRANULOMA: CASE REPORT.

Central giant cell granuloma (CGCG) appears to be a lesion that is unique to the jaws. It is difficult to predict its aggressiveness. A rare case of synchronous CGCG of the mandible and maxillar in a 14-year old boy is presented.

Temporomandibular joint dislocation in Nairobi.

BACKGROUND: Despite the diverse conservative and surgical modalities for the management of temporomandibular joint (TMJ) dislocation and the controversy that surrounds them, very little has been done within the East-African setup in terms of highlighting and provoking greater interest in the epidemiology and management of TMJ dislocation. OBJECTIVE: To audit the pattern of occurrence, demographics, aetiology and enumerate the treatment modalities of TMJ dislocation at the oral and maxillofacial surgery division (OMFS) of the University of Nairobi Dental Hospital. DESIGN: Descriptive cross-sectional study. SETTING: University of Nairobi Dental Hospital (UNDH) from January 1995 to July 2005. RESULTS: Twenty nine patients had been diagnosed and managed for TMJ dislocation. Twenty (69%) were females and nine (31%) were males. Their ages ranged from 10-95 years with a mean of 42 years. The cases managed were primarily chronic in nature. The most common form being anterior TMJ dislocation, accounting for twenty-five (86.2%) cases. Trauma was implicated as an aetiology in only five (17%) of the cases while the remaining majority of twenty four (83%) cases were spontaneous. Amongst the causes of spontaneous TMJ dislocation, yawning was the most common accounting for fourteen cases (48.3%). Dislocations caused by trauma were found to be 12.6 times more likely to be associated with other injuries than spontaneous dislocations. Anterior TMJ dislocations were found to be 1.3 times more likely to be associated with absence of molars than posterior TMJ dislocations. Anatomical aberrations, as predisposing factors, were not a significant finding in this research. Eight (28%) of the cases were managed conservatively. Twenty one (72%) of the cases were managed surgically. The eminectomy was the most common technique with a 75% success rate. The highest incidence of TMJ dislocation occurs in the 3rd-5th decade with a female preponderance with bilateral anterior TMJ dislocation being the most common. Most of the cases were managed surgically with eminectomy being the preferred technique with the highest success rate. A study needs to be undertaken to determine reasons' why conservative modalities are least employed in the management of TMJ dislocation in our setup and what can be done about it.

Management of bilateral temporomandibular joint ankylosis in children: case report.

Long standing temporomandibular joint (TMJ) ankylosis may cause severe facial deformity and growth retardation as well as psychological problems when it occurs in children. Different kinds of opinion have been advanced as regards its management. This article discusses the aetiology and management of bilateral TMJ ankylosis in form of a case report in a patient with severe facial deformity, malocclusion and retarded growth following bilateral TMJ ankylosis secondary to trauma. The patient was successfully managed by placement of costochondral grafts and interpositional arthroplasty with partial temporal myofascialflaps. Good mouth opening was achieved and subsequent follow-ups showed improved mandibular and general body growth as well as psychosocial performance. The aim of this paper is to discuss the management challenges posed by bilateral TMJ ankylosis.

Pattern of maxillofacial and associated injuries in road traffic accidents.

BACKGROUND: Road Traffic Accidents (RTAs) are a major cause of morbidity and mortality in Kenya. Victims may suffer multiple injuries including maxillofacial injuries. In most developing countries RTAs are the leading cause of maxillofacial injuries. In an attempt to reduce RTAs, the government of Kenya has enacted a legislation requiring mandatory fitting of speed governors and safety belts by passenger service vehicles. OBJECTIVE: To describe the characteristics and pattern of maxillofacial and associated injuries sustained in road traffic accidents. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital (KNH). SUBJECTS: All patients involved in RTAs brought to casualty and the dental department of KNH as well as accident victims admitted to the KNH mortuary over a four- month period from September 2004 to December 2004. RESULTS: Four hundred and thirteen (85.7%) had non-fatal injuries whereas 69 (14.3%) had sustained fatal injuries. Males in the 21-30-year age group were the most affected. Most accidents occurred during weekends with pedestrians being the leading casualties in 59.5% and 71.4% of non-fatal and fatal cases respectively. Most accidents were caused by passenger service vehicles (matatus) which were responsible for 62% and 40.6% of non-fatal and fatal injuries respectively. Non-use of safety belts was reported in 56.6% of the cases who suffered non-fatal injuries. In the non-fatal category 89.6% of the casualties had soft tissue injuries (STIs) involving the craniofacial region with facial cuts being the majority (69.2%). Two hundred and seventy three (66.1%) incidents of other STIs than those of the head region were noted, the lower limbs accounting for 45.4% of these. Only 5.1% of the casualties with non-fatal injuries had fractures involving the maxillofacial skeleton. Skeletal injuries other than those involving the maxillofacial region were found in 142 (34.1%) incidents. In the fatal category head injury alone was the leading cause of death accounting for 37.7% of the cases followed by head and chest injuries combined which were responsible for 13% of the cases. CONCLUSION: Injuries to the maxillofacial skeleton appear to be uncommon in this series. Pedestrians in their third decade of life are most affected with passenger service vehicles being responsible in the majority of the cases. RECOMMENDATIONS: Interventional programmes targeting pedestrians and those in the third and fourth decades of life should be enacted.

Ameloblastic fibroma at the University of Nairobi Dental Hospital.

OBJECTIVE: To document the occurrence of cases of ameloblastic fibroma. DESIGN: A retrospective study. SETTING: The Division of Oral Pathology and Oral Medicine histopathology laboratory at the Faculty of Dental Sciences, University of Nairobi, January 1991 to December 2000. RESULTS: Seven complete records of histopathologically confirmed cases of ameloblastic fibroma were identified. There were four male and three female cases with an age range of 10 to 22 years (mean=14 years). Remarkably, six of the cases had lesions in the molar regions of the mandible with a single case with a maxillary molar area lesion. One of the cases had the neoplasm associated with an unerupted tooth. From the clinical notes all the patients were managed by meticulous enucleation and curettage of the lesions. After follow up periods ranging from several months to eight years no recurrences had been recorded. CONCLUSION: Evidently ameloblastic fibroma is an uncommon neoplasm as noted in the earlier literature. Although the lesions can be quite extensive at the time of diagnosis, the recurrence rate appears to be relatively low if the neoplasms are meticulously extirpated.

Extra-abdominal fibromatosis invading the mandible: case report.

Extra-abdominal fibromatosis (desmoid tumour) is a rare aggressive neoplasm with a tendency to infiltrate local structures but rarely metastasises or undergoes spontaneous malignant transformation. The treatment of choice is surgery, however, recurrences have been reported even after wide-field resection. This article presents a case of extra-abdominal fibromatosis that had extensively invaded the mandible.

Maxillofacial injuries caused by terrorist bomb attack in Nairobi, Kenya.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

Pierre Robin Syndrome: case report.

A case of a female neonate with Pierre Robin Syndrome with frequent cyanotic episodes and feeding difficulties which could not be adequately managed by positioning and oral airway placement is presented. Tongue-anterior mandible fusion procedure was performed with satisfactory results.

Occurrence and pattern of mandibular fractures at Kisii District Hospital, Kenya.

A retrospective study of the hospital records revealed that 39 cases of mandibular fractures presented at Kisii District Hospital during a two-year period. 27 cases were due to interpersonal violence while road traffic accidents and accidental falls accounted for 9 and 3 of the cases respectively. The male ratio was 2.9:1. Majority (26 cases) of the patients were aged between 20 and 39 years. The commonly involved fracture site was the left body of the mandible accounting for 20 of the fractures.