|Year : 2022 | Volume
| Issue : 2 | Page : 93-95
Mortality review in a maxillofacial center in Northern Nigeria
Benjamin Fomete1, Rowlan Agbara2, Modupeola Omotara A. Samaila3, Theophilus Ekhosuehi Agho1, Ernest A Ikekhuamen1
1 Department of Maxillofacial Surgery, Ahmadu Bello University Zaria, Nigeria
2 Department of Oral and Maxillofacial, Faculty of Dentistry, University of Jos, Nigeria
3 Department of Pathology, Faculty of Basic Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
|Date of Submission||20-Feb-2022|
|Date of Decision||26-Mar-2022|
|Date of Acceptance||19-Apr-2022|
|Date of Web Publication||23-Nov-2022|
Department of Maxillofacial Surgery, Ahmadu Bello University Zaria
Source of Support: None, Conflict of Interest: None
Context: Mortality pattern is an essential component in health delivery globally. It is an important medical appraisal that should be made regularly. Mortality in maxillofacial patients often results from co-morbidity from others diseases as seen in Ludwig's angina and advanced stage malignancies. Aim: To document the causes of maxillofacial mortalities during a 12-year period. Materials and Methods: An analysis of all cases of death recorded in the Department of Oral and Maxillofacial Surgery of a Nigerian tertiary health Centre from January 2006 to December 2018. Results: A total of 3255 oral and maxillofacial patients were seen during 12-year period. About 65 deaths were recorded accounting for 2.0% of all cases of which 69.2% were males, whereas 30.8% females. The age group most affected was 30 to 39 with 23.1% closely followed by 20 to 29 with 21.5%. Conclusion: Cervicofacial infection was the commonest causes of mortality in oral and maxillofacial surgery in our environment.
Keywords: Ludwig's angina, maxillofacial, mortality
|How to cite this article:|
Fomete B, Agbara R, A. Samaila MO, Agho TE, Ikekhuamen EA. Mortality review in a maxillofacial center in Northern Nigeria. Niger J Basic Clin Sci 2022;19:93-5
|How to cite this URL:|
Fomete B, Agbara R, A. Samaila MO, Agho TE, Ikekhuamen EA. Mortality review in a maxillofacial center in Northern Nigeria. Niger J Basic Clin Sci [serial online] 2022 [cited 2022 Nov 29];19:93-5. Available from: https://www.njbcs.net/text.asp?2022/19/2/93/361886
| Introduction|| |
Mortality pattern is an essential component in health delivery globally. It is an important medical appraisal that should be made regularly and readily available for audit of existing health care services. The health care system of any country requires adjustments mirroring the pattern of morbidity and mortality to ease the negative effects of prolong ill health and untimely death of grownups. Mortality in maxillofacial patients often results from co-morbidity from others diseases as seen in Ludwig's angina, severe brain injury following craniofacial trauma and advanced stage malignancies. Occasionally, intraoperative deaths may also occur from anesthetic or surgical complications.
Reports on the mortality rates from oral and maxillofacial patients in Nigeria are few and almost nonexistent in Northern Nigeria. This study is thus an audit of the maxillofacial mortality in a tertiary health care center in Northern Nigeria and aims to document the causes of maxillofacial mortalities during a 12-year period.
| Materials and Methods|| |
An analysis of all cases of death recorded in the Department of Oral and Maxillofacial Surgery of a Nigerian tertiary health Centre during a 12-year period (January 2006–December 2018). Relevant clinical data were obtained from deceased case notes, mortality forms and hospital registers from the accident and emergency (A and E), admission wards and operating theatre. Data collated included information on age, sex, clinical diagnosis, duration of admission, operation record, treatment received, complications from treatment or operation, co-morbidity, cause of death and point of demise in the admission ward, (A and E) or operating room.
The data were analyzed using statistical package for social sciences (SPSS) version 22.0 (SPSS Inc, Chicago, IL). About 10 patients were excluded for incomplete data. Approval for the study was given by the ethical committee of Ahmadu Bello University Teaching Hospital with ethical approval ABUTHZ/HREC/W35/2020 of 24th June 2020.
| Results|| |
A total of 3255 patients (in and out patients) were seen in the oral and maxillofacial surgery department during the 12-year period. About 65 deaths were recorded accounting for 2.0% of all cases of which 45 (69.2%) males, whereas 20 (30.8%) were females [Table 1]. The age group most affected was 30 to 39 with 23.1% closely followed by 20 to 29 with 21.5% [Table 1]. The clinical diagnoses included cervicofacial infection (CFI) 35 (53.8%) cases, neoplasms (malignant 19 (29.2%) and benign 3 (4.6%)) 22 cases, trauma 4 (6.2%) cases and surgery for malformation 3 (4.6%) cases [Table 2]. All the neoplastic cases had histology reports except one. The malignant cases were mainly carcinomas [Table 1]. Six patients had surgery (odontogenic tumour 3, cystic hygroma 1, macroglossia 1 and fibrosarcoma 1) and each had as cause of death either general anaesthetic or surgical complications. The CFI patients had incision and drainage under local anesthesia.
|Table 2: Diagnosis, clinical detail, treatment, risk/complications, frequency|
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The following co-morbid medical conditions were recorded: hypertension, diabetes, renal failure and anemia in 5, 9, 1 and 8 patients, respectively.
Overall, the average days spent on admission was 15.11 days with a range of 1 to 61 days, with the average post-surgery days being less than 24 hrs and stay in A and E was averagely 1.7 days (1 to 3 days).
The following cause of death were recorded in 56 patients. Cardiac arrest (23; 41.1%), respiratory compromise (25; 44.6%) and shock (8; 14.3%) [Table 1].
With reference to the point of death, 39 (60.0%) died in the ward, 22 (33.8%) in the A and E and 4 (6.2%) in the operating room. About 84.3% spent less than 10 days (on admission) before dying.
| Discussion|| |
The mortality prevalence in this study was 2.0% and comparable with the 1.8% reported from Kano though slightly higher. This could be because of the fact that the period of our study is 12 years, whereas theirs was 10 years. This rate is also significantly higher than the 0.0021% in Peshawer, Pakistan even though theirs was a 3-year study.
There were more males 69.2% than females in the ratio of 2.25:1; M: F. This agrees with Omeje et al. in Kano Nigeria. This is, however, different from Fahd et al. where all their patients were males. The age group mostly affected was 30 to 39 years closely followed by 20 to 29 years. These age groups have the greatest risks and are the socioeconomic (active groups) group of the nation. It is also the period of greatest risk.
CFI was the cause of death in 53.8% cases. CFI is known as infection involving the fascial spaces of the face and the neck and when there is delay in the diagnosis and treatment, such infection can be life threatening. CFI patients are medical emergencies and usually present in A and E unit of the hospital. Infection of these anatomical spaces are graded as low, moderate or severe infection depending on the proximity to the airway. The severe forms could be represented by Ludwig's angina, descending neck infections, and can easily lead to death,, empyema thoracis and even cavernous sinus thrombosis. The frequency of 53.8% was quite higher than the 39.1% reported in Kano. This difference may be attributable to several factors of late hospital presentation, poor finances, use of traditional practices and self-medication. Omeje et al. observed substandard medication in their study as the major reason for high mortality in CFI. This is quite common in our developing setting.
Malignancies were responsible for death in 29.2% cases. This is comparable with other studies though doubling the 14.28% recorded by Fahd et al. Our patients had either recurrent or advanced inoperable diseases and had chemotherapy. Only two patients (fibro sarcoma and adenoid cystic carcinoma cases) died intraoperatively. All but one of the patients with malignancy had histological diagnosis. Twelve patients did not receive chemotherapy because of funding, ignorance, sociocultural and religious beliefs. These factors are also responsible for late presentation. The hospital is the center of excellence for oncology and radiotherapy and may account for the high rate of malignancies recorded because of referrals from all over the country.
Surgery done such as resection for benign odontogenic tumors accounted for 4.6% (3 cases) mortality in this study, with 1 intraoperative and 2 postoperative deaths. The tumor size and anesthetic techniques are paramount to surgical success as both the surgeon and anesthetist share the same surgical area. One of the mortality was because of anesthetic complication, whereas the other two were extubated too early before patient's recovery of airway control. This usually happens when the patient has had anterior mandibular resection, subtotal or total mandibular resection.
Surgeries for malformation accounted for 4.6% mortality cases. All were postoperative cases because of either blocked in situ endotracheal or tracheostomy tube or obstruction to the airway secondary to edema. Trauma [Table 1] caused 6.2% of death that was similar to the other authors and much lower than the 71.42% recorded by Fahd et al.
| Conclusion|| |
CFI and malignancies (recurrent or advanced) constituted the commonest causes of mortality in oral and maxillofacial surgery in our environment. Early hospital presentation for treatment and surgical intervention reduces the attendant morbidity and mortality of these diseases. The prevalent conditions should also inform improve health care management and policy.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ogunmola JO, Oladosu YO, Olamoyegun MA, Ayodele LM. Mortality pattern in adult accident and emergency department of a tertiary health centre situated in a rural area of developing country. J Dent Med Sci 2013;5:12-5.
Omejea KU, Amole IO, Osunde OD, Efunkoya AA, Atanda AT. Causes of maxillofacial patient mortality in a Nigerian tertiary hospital. South Sudan Med J 2016;9:4-7.
Fahad Q, Muslim K, Bushra M, Qiam UD. Assessing the mortality rate of patients in a maxillofacial Surgical unit. J Khyber Coll Dent 2012;3:2-6.
Fomete B, Agbara R, Osunde OD, Ononiwu CN. Cervicofacial infection in a Nigerian tertiary health institution: A retrospective analysis of 77 cases. J Korean Assoc Oral Maxillofac Surg 2015;41:293-8.
Flynn Thomas R. Principles of management of odontogenic infections. In: Miloro M, Ghali GE, Larsen P, Waite P, editors. Peterson's Principle of Oral and Maxillofacial Surgery. 2nd
ed. London, Hamilton: BC Decker Inc.; 2004. p. 277-93.
Osunde OT, Anyanechi CE, Etim BA, Fomete B. Demographic and clinical characteristics of patients presenting with Cervico-Facial Cellulitis at the University of Calabar Teaching Hospital, Nigeria. Cross River J Med 2017;1:15-24.
Fomete B, Agbara R, Adebayo ET, Osunde OD, Adeola DS. An epidemiological study of 270 cases of carcinomas of the head and neck region in a Nigerian tertiary health care facility. Egypt J Ear Nose Throat Allied Sci 2017;18:251-5.
Fomete B, Adebayo ET, Ogbeifun JO. Ameloblastoma: Our clinical experience with 68 cases. J Orofac Sci 2014;6:17-24. [Full text]
[Table 1], [Table 2]