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Akama, MK.  Submitted.  Current pattern of road traffic accidents, maxillofacial and associated injuries in Nairobi. Abstract

Objective: To describe the characteristics and pattern of maxillofacial and concomitant injuries sustained in Road Traffic Accidents (RTAs).
Study Area: Kenyatta National Hospital (KNH).
Study Design: A descriptive cross sectional study including all patients involved in RTAs
brought to casualty and dental departments of KNH as well as accident victims admitted to the
KNH mortuary over a four- month period from September 2004 to December 2004.
Results: A total of 482 people involved in RTAs were included in the study. Four hundred and
thirteen (85.7%) had non-fatal injuries whereas 69 (14.3%) had sustained fatal injuries.
Nonfatal injuries. The 21-30-year-old age group was the most affected. The male to female ratio
was 4:1. Day time injuries were recorded among 60.3% of the participants. The incidence of
RTAs was highest on Fridays. There were 245 (59.5%) pedestrians and 139 (33.7%) passengers
involved. Most accidents were caused by passenger service vehicles (matatu) which were
responsible for 256 (62%) casualties whereas private saloon cars were involved in 150 (36.3%)
cases. Non- use of safety belts was reported in 90 (56.6%) cases whereas over-speeding was
reported by 120 (29.1 %) casualties. Alcohol use by drivers was reported in 26 (6.3%) cases
whereas vehicle defects accounted for 62 (15%) cases.Three hundred and seventy (89.6%)
casualties had soft tissue injuries (STls) involving the craniofacial region with facial cuts being the
majority (69.2%). Two hundred and seventy three (66.1 %) incidents of other STls than those of
the head region were noted, the lower limbs accounting for 45.4% of these. Only 5.1% of the
casualties had fractures involving the maxillofacial skeleton. Skeletal injuries other than those
involving the maxillofacial region were found in 142 (34.1%) incidents. The lower limbs were
more affected with 61 (43%) incidents followed by the upper limbs (24.6%). Pedestrians were
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most involved in sustaining skeletal injuries than other categories of road users.
Fatal RTAs: Sixty nine (14.3%) of the 482 participants were fatally injured. The 21-30- year-old
age group was the most affected (20%). The male to female ratio was 3.3:1. Matatus and minibuses
were the leading cause of fatal accidents together having been responsible for 28 (40.6%) of
the accidents. Pedestrians (71.4%) were by far more involved than other categories of road users.
Most participants had multiple injuries with chest injuries having been the most common (50
cases). Fourty six (66.7%) victims had injuries to the head region with subdural haemorrhage
having been the commonest injury found at autopsy (47.8%). Injuries to the chest were found in
fifty (72.2%) victims whereas abdominal and limb injuries were recorded in 42 (60.9%) and 34
(49.3%) victims respectively. Head injury alone was the leading cause of death (37.7%) followed
by head and chest injuries combined (13.0%)
Conclusion: The majority of people involved in RTAs were in their third decade of life with
males having been the predominant group affected. Pedestrians were the leading casualties
amongst road users. Most of the accidents were caused by passenger service vehicles. The lower
limbs sustained most soft tissue and skeletal injuries compared to other anatomic sites other than
the craniofacial area. The leading cause of death was head injury.

2010

Sang, LK, Mulupi E, Akama MK, Muriithi JM, Macigo FG, Chindia ML.  2010.  Temporomandibular joint dislocation in Nairobi. Abstract

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.

2007

J, PROFCHINDIAMARK, KIRIAGO DRAKAMAMATHEW, W PROFGUTHUASYMON.  2007.  Akama MK, Chindia ML, Macigo FG, Guthua SW.Pattern of maxillofacial and associated injuries in road traffic accidents.East Afr Med J. 2007 Jun;84(6):287-95.. East Afr Med J. 2007 Jun;84(6):287-95.. : University of Nairobi. Abstract
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.

2005

J, PROFCHINDIAMARK, KIRIAGO DRAKAMAMATHEW.  2005.  Chindia ML, Akama MK, Awange DO.Ameloblastic fibroma at the University of Nairobi Dental Hospital.East Afr Med J. 2005 Aug;82(8):418-21.. East Afr Med J. 2005 Aug;82(8):418-21.. : University of Nairobi. Abstract
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.

2002

KIRIAGO, DRAKAMAMATHEW.  2002.  Akama MK, Chindia ML, Guthua SW, Nyong'o A.Extra-abdominal fibromatosis invading the mandible: case report.East Afr Med J. 2002 Jan;79(1):49-50.. East Afr Med J. 2002 Jan;79(1):49-50.. : University of Nairobi. Abstract
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.
KIRIAGO, DRAKAMAMATHEW.  2002.  Odhiambo WA, Guthua SW, Macigo FG, Akama MK.Maxillofacial injuries caused by terrorist bomb attack in Nairobi, Kenya.Int J Oral Maxillofac Surg. 2002 Aug;31(4):374-7.. Int J Oral Maxillofac Surg. 2002 Aug;31(4):374-7.. : University of Nairobi. Abstract
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.

2000

KIRIAGO, DRAKAMAMATHEW.  2000.  Akama MK, Guthua SW, Chindia ML.Pierre Robin Syndrome: case report.East Afr Med J. 2000 Jun;77(6):343-4.. East Afr Med J. 2000 Jun;77(6):343-4.. : University of Nairobi. Abstract
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.

1997

KIRIAGO, DRAKAMAMATHEW.  1997.  Elevated plasma levels of interleukin-6, interleukin-8, and granulocyte colony-stimulating factor during and after major abdominal surgery. J Clin Anesth. 1997 Jun;9(4):293-8.. J Clin Anesth. 1997 Jun;9(4):293-8.. : University of Nairobi. Abstract
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.

1996

KIRIAGO, DRAKAMAMATHEW.  1996.  Imipenem and cephem resistant Pseudomonas aeruginosa carrying plasmids coding for class B beta-lactamase. J Antimicrob Chemother. 1996 Mar;37(3):433-44.. J Antimicrob Chemother. 1996 Mar;37(3):433-44.. : University of Nairobi. Abstract
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.

1993

KIRIAGO, DRAKAMAMATHEW.  1993.  Occurrence and pattern of mandibular fractures at Kisii District Hospital, Kenya. East Afr Med J. 1993 Nov;70(11):732-3.. East Afr Med J. 1993 Nov;70(11):732-3.. : University of Nairobi. Abstract
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.

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