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Orofacial Infections in Kenya: A Retrospective Study

Kimathi Denis Mutwiri1, Elizabeth Dimba2, Bernard Mua Nzioka3

1 School of Dental Sciences, University of Nairobi

2 Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dental Sciences, University of Nairobi

3 Department of Periodontology /Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi.

Correspondence to: Mr. Kimathi Denis Mutwiri, Email: deniskim371@gmail.com

Received: 09 January 2020; Revised: 13 May 2020; Accepted: 29 May 2020; Available online: 21 June 2020

 

Abstract

Background: Orofacial infections are either odontogenic or non-odontogenic in nature. The clinical spectrum of these infections is diverse. This study aimed to describe the presentation and management of patients presenting with orofacial infections at Kenyatta National Hospital (KNH). Materials and Methods: This was a retrospective study based on clinical records of patients treated for orofacial bacterial infections at KNH from January 2016 to December 2018. Data on the following study variables were obtained and analyzed: demographic data, clinical presentation, diagnosis, management, and treatment outcome. Results: 214 clinical records were studied. Male to female ratio was 1.4:1 with age range of 3 months to 78 years (mean=27.0 years). Swelling (96.30%, n=206) was the most common symptom, next was pain (58.90%, n=123). The most common source of infection was odontogenic (60.30%, n=129) in nature. Permanent teeth (57.00%, n=122) were more commonly involved than deciduous teeth (2.80%, n=6). In both dentitions, the mandibular posterior teeth were the most commonly involved, Ludwig’s angina (30.84%, n=66) and submandibular abscess (25.23%, n=54) were the most common clinical diagnoses of orofacial bacterial infection. The commonly used treatment modality was a triad of extraction of the associated tooth, incision and drainage, and antibiotic therapy. These management modalities resulted in favorable treatment outcomes (92.50%, n=198) in most cases. Conclusion: Orofacial infections can occur among all sociodemographic groups. These infections are potentially life-threatening if not diagnosed early and managed promptly. Multidisciplinary teams are required to manage the severe morbidity and mortality of advanced orofacial infections.

 

Keywords: Orofacial infections, Odontogenic, Abscess, Ludwig’s angina

Ann Afr Surg. 2021; 18(1): 45-51

DOI: http://dx.doi.org/10.4314/aas.v18i1.9

Conflicts of Interest: None

Funding: None

© 2021 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction

Orofacial infections are a common presenting complaint in medical and dental offices, and sometimes, in severe cases, hospital emergency departments. Infections of the mouth and associated structures can be classified as odontogenic and non-odontogenic in nature (1). Odontogenic infections originate within the tooth or associated fungi or viruses and are characteristically caused by bacteria. Mucosal infections by bacteria account for most of the oral non-odontogenic infections (2). The primary causes of orofacial infections are non-vital teeth, pericoronitis, dental procedures, periodontal disease and infected cysts. Rarer causes include trauma, salivary gland and lymph node lesions (3).

The clinical spectrum of orofacial infections is diverse, ranging from localized and indolent conditions to life-threatening conditions. Once established, the pathophysiological course of a given infectious process varies. This depends on the virulence and number of organisms, host resistance and the local anatomy of the involved area (1). Local anatomy is an important factor as infection spreads through tissue planes in the path of least resistance, through blood or lymphatics. Spread of infection in the orofacial region may lead to airway obstruction, septicemia or intracranial spread (3). The morbidity and mortality related to these orofacial infections depend on the site of involvement and the degree of spread to the other tissues (4).

Accurate diagnosis of orofacial infections is important for timely treatment and for public health management. It is therefore important that health care workers are fully aware of the sociodemographic characteristics of patients presenting with orofacial infections, presentations of various orofacial bacterial infections, teeth and anatomical sites frequently involved for timely and appropriate management of these patients to prevent life-threatening complications associated with these infections.

No studies are known investigating the pattern of orofacial infections in the Kenyan population. The aim of this study was to describe the presentation and management of patients presenting with orofacial infections at Kenyatta National Hospital (KNH). Information from this study will help in the management of cases and provide data for future planning of treatment protocols.

Materials and Methods

The study setting is a specialized maxillofacial unit in a tertiary referral hospital. This was a retrospective study covering the period between January 2016 and December 2018. Ethical approval to carry out this research was obtained from the University of Nairobi and the National Hospital Ethics Research and Standards Committee (Approval number–UP103/02/2019). Permission to use patients’ records was sought from the relevant authorities at Kenyatta National Hospital.

Convenience sampling was used to retrieve clinical records of patients treated for orofacial infections at KNH during the study period.

Data on the following study variables were obtained using data collection forms and analyzed: demographic data, clinical presentation, diagnosis, management and treatment outcome (discharge or death).

Analysis used SPSS version 23 and Microsoft Excel 2013. Frequency tables were used to present data.

 

Results

Three hundred clinical records were identified for review: 226 clinical records were retrieved and 74 were missing. Of the 226 clinical records retrieved, 12 had incomplete data and were excluded from the study. 214 clinical records were therefore included in the analysis. 

Sociodemographic characteristics

Two hundred and fourteen patient records were reviewed: 127 male (59.3%) and 87 female (40.7%), age range 3 months to 79 years, with a mean age of 27.0 years. The modal ages for patients with orofacial bacterial infections were between 20 and 29 years (39.46%). Most patients had informal employment (33.6%, n=72) or were dependents (31.8%, n=38); 38 patients (17.8%) were formally employed.