Prevalence and features of maxillofacial injuries in adult trauma patients undergoing head computed tomography scan at Mulago Hospital

Abstract

Introduction: Maxillofacial injuries are on the rise in Uganda. Traffic accidents are among the main etiologic factors of maxillofacial injuries; they are the reasons of 34.42% to 90.15% of all the skeletal and soft tissues injuries of the face. The maxillofacial injuries remain a serious clinical problem because of the complexity of this anatomical region. CT is the gold standard imaging modality for maxillofacial injury. Objective: To establish the prevalence and features of maxillofacial injuries in adult trauma patients undergoing head CT scan at Mulago hospital. Methodology: This was a retrospective study, from 1st January 2013 to 31st December 2013. Data were obtained through a retrospective review of the images of 1200 adult trauma patients who underwent head CT scans at Mulago hospital. The data extraction tools were entered electronically using Epi data version 2b database and later exported to SPSS version 20 (SPSS Inc., Chicago, IL, USA) for statistical analysis. Comparison of proportions was done using a chi-square test and the Fisher’s exact test. Results were then presented in the form of percentages, pie charts, frequency distribution tables and bar graphs. Results: Prevalence of MFI in adult patients was 34.75%. Among 417 patients with MFI, 284 patients (68.80%) had maxillofacial fractures only, 103 patients (24.10%) had both maxillofacial fractures and soft tissue injuries and 30 patients (7.2%) suffered isolated soft tissue injuries. Within the study sample, frontal and maxillary fractures (upper and middle face) were significantly more common than mandibular fractures (lower face). Of the 417 patients with maxillofacial injuries, most (49%) were aged between 18-27 years. The median age of male patients was 28 (range = 18-73) years while the median age of female patients was 27.5 (range = 18-80) years. There was no significant difference in these age differences (p > 0.05). Majority of the patients with maxillofacial injuries were male 92% (357/387) while only 8% (30/387) were female patients. Male to female ratio was 10.1: 1. Road traffic accidents (43%) were the main cause of maxillofacial fractures. Conclusion: The prevalence of MFI in adults is 34.75%. Males are more prone to MFI than female. The young adults (18–27 years) are the main victims. RTA is the most common cause of MFI. Single most affected isolated bone is the frontal bone (23 %) and 30 patients (7.2%) suffered isolated soft tissue injuries. Recommendations: Gadgets like helmet, air-bag and non lacerating windscreens should be recommended to reduce MFI in addition to enforcement of the road safety rules. Only seven patients had Le Fort fractures, so there is need for an acceptable and sensitive CT based classification for MFI. A bigger prospective study would be more informative. Key Words: Maxillofacial injuries, prevalence and features, road traffic accidents, CT scans.