Human bite injuries in the oro-facial region at the Muhimbili National Hospital, Tanzania

<p>Abstract</p> <p>Background</p> <p>Human bites in the maxillofacial region compromise function and aesthetics, resulting in social and psychological effects. There is paucity of information regarding human bite injuries in Tanzania. The aim of the study was to assess the occurrence, treatment modalities and prognosis of human bite injuries in the oro-facial region at the Muhimbili National Hospital Dar es Salaam, Tanzania.</p> <p>Methods</p> <p>In a prospective study the details of patients with human bite injuries in the oro-facial region who attended at the Department of Oral and Maxillofacial Surgery of the Muhimbili National Hospital between January 2001 and December 2005 were recorded. Data included information on age, sex, site, duration of the injury at the time of reporting to hospital, reasons, details of treatment offered and outcome after treatment.</p> <p>Results</p> <p>A total of 33 patients, 13 males and 20 females aged between 12 and 49 years with human bite injuries in the oro-facial region were treated. Thirty patients presented with clean uninfected wounds while 3 had infected wounds. The most (45.5%) frequently affected site was the lower lip. Treatment offered included thorough surgical cleansing with adequate surgical debridement and primary suturing. Tetanus prophylaxis and a course of broad-spectrum antibiotics were given to all the patients. In 90% of the 30 patients who were treated by suturing, the healing was uneventful with only 10% experiencing wound infection or necrosis. Three patients who presented with wounds that had signs of infection were treated by surgical cleansing with debridement, antibiotics and daily dressing followed by delayed primary suturing.</p> <p>Conclusion</p> <p>Most of the human bite injuries in the oro-facial region were due to social conflicts. Although generally considered to be dirty or contaminated they could be successfully treated by surgical cleansing and primary suture with a favourable outcome. Management of such injuries often need multidisciplinary approach.</p

Does surgical decompression in Ludwig's angina decrease hospital length of stay?

Ludwig's angina (LA) is an uncommon and potentially life-threatening condition of the upper aero-digestive tract that often requires the coordinated efforts of the surgical, anesthetic and intensive care teams to optimize management. The purpose of the present study was to investigate the documented clinical features and the surgical and airway management of LA at Alice Springs Hospital for the purpose of assessing surgical outcomes with particular reference to length of stay (LOS). Retrospective chart review from January 1998 to January 2008 examined patients admitted with LA at Alice Springs Hospital. Documented clinical features, interventions, and operative findings including floor of mouth swelling, Mallampati score, and airway compromise were collected. Outcomes, with particular respect to LOS, for those who received intravenous (IV) or inhalational induction and those that received awake fibre-optic intubations were compared. Of 30 patients with LA, 28 (93%) were managed with operative drainage with a LOS in the intensive care unit (ICU) of 2 days and a hospital LOS of 5 days. Seven received awake fibre-optic intubation and 21 had IV or inhalational anesthesia with none requiring tracheotomy. There was no statistical difference in LOS between those patients whose microbiological culture results showed no growth and those whose cultures had positive growth. Management was generally operative decompression with IV antibiotics. LOS is not affected by the presence or absence of culture positive infection. It is proposed that operative intervention is safe, effective, and is associated with shorter patient stays in the intensive care unit and the hospital overall

Early surgical intervention in severe acute pancreatitis: Central Australian experience.

Severe acute pancreatitis (SAP) is a disease associated with a high mortality and morbidity; however, many patients survive due to better understanding of the disease and multidisciplinary care. Those who do not respond to intensive care management with persistent multi-organ dysfunction still have a high mortality. There is a role for early surgical intervention in two subsets of critically ill patients: the first, with acute compartment syndrome (ACS) of the abdomen with persisting organ dysfunction despite medical measures to control intra-abdominal pressure; the second, being early infected pancreatic necrosis (IPN) with the presence of gas in the retroperitoneum. The current analysis is an 8-year (2005-2012) study. The data were collected prospectively by the Surgical Department in Alice Springs Hospital. Intensive care data were also sourced from ANZICS CORE (Australia and New Zealand Intensive Care Society and Centre for Outcome and Resource Evaluation) for ICU (intensive care unit) mortality comparison between ICUs of Australia and New Zealand with Alice Springs. There were 1163 episodes of acute pancreatitis with an annual incidence of 275 per 100?000. Of importance, 114 patients had SAP of whom 42 developed pancreatic necrosis. Eleven patients required surgical intervention. Five patients had decompressive laparotomies for ACS and six patients had laparotomies for IPN. The mortality of patients with SAP was 0%. The two subsets of patients with either ACS or early IPN require early surgical intervention either by decompressive laparotomy or open necrosectomy with laparostomy. The authors attribute improved survival in this cohort due to these interventions

Epidemic of stab injuries: an Alice Springs dilemma.

This study is unique in that it strives to unfold, perhaps for the first time, the problem of stab injuries and resultant significant mortality and morbidity within the Aboriginal population of Central Australia. Demographic features presented in the study are quite different from other published Australasian and overseas experiences. There were 1550 stab injury admissions to Alice Springs Hospital during a 7-year period (July 1998 to June 2005). Thirty-two patients were dead before arrival, and there were only three deaths in the hospital during the period of study. The most unique demographic feature was that 99.99% were Aborigines, 53% were women and the most common location of injury was in town camps and homes. The mean age of this population was 31 years, and the average length of stay in hospital was 3 days. The most common site of the stab injuries was the thigh with a total of 605 (38%). Stab injuries to the abdomen were significantly low with 68 (<1%). Twenty-one per cent (332) presented 24 h to 10 days after stabbing. Another 21% (335) absconded before the completion of treatment. Of the victims, 31% (481) were under the influence of alcohol. Twenty per cent (311) of the patients presented with repeat stabbings during the study period. Traditional punishment is still practised in Central Australia and thus explains the high number of thigh injuries. A particular pattern of traditional stab injuries was also noted; medial thigh to kill, posterior thigh to permanently disable and lateral thigh to punish. Rampant alcoholism and social and family breakdown are thought to be significant contributors to the high incidence of violence in Alice Springs. There were only five firearm traumas during this period, two were self-inflicted and three were accidental

The growing burden of injuries and trauma in Alice Springs.

In Alice Springs, assault and attempted homicide, self-harm and attempted suicide and transportation accidents contribute substantially to the burden of disease, especially among the aboriginal population who are poor and disadvantaged. While road traffic accidents and self-inflicted injuries are the leading causes of injury-related deaths worldwide, violence is a major factor in Alice Springs trauma. Violence accounted for more than half the annual trauma case load. Aboriginal Central Australians bear a disproportionate risk of injury and illness compared to their non-aboriginal counterparts. Rampant alcoholism and social and family breakdown are thought to be significant contributors to the high incidence of violence in Alice Springs. There were 2,800 trauma admissions to Alice Springs hospital in 2006 compared to 1,800 admissions in 2003. Geographical location often limits timeliness, access and level of health care available to rural and isolated regions of central Australia. Solutions to the trauma epidemic in our Remote indigenous population must look past the Emergency and Surgical Departments that care for the injured to the individual, community, environmental, social and economic factors that underpin the traumas. Traumatic injury and death maybe the most preventable of all health issues. While tremendous resources are spent caring for injured patients in hospital, less attention is paid towards gaining a better understanding of injury prevention