Penetrating Craniomaxillofacial Arrow Injuries: A 14-year Review of Epidemiology, Clinical Presentation and Management at a UK Northern Nigerian Tertiary Facility

Abstract

Background: This study sought to assess the presentation of craniomaxillofacial arrowy injuries (CAIs) at the Department of Oral and Maxillofacial Surgery, Aminu Kano Teaching Hospital (AKTH) and to highlight the management protocol we adopted.

Methods: Using a proforma, information on all patients who presented at the Accident and Emergency unit (A&E) of AKTH with CAIs over a 14-year period (April 2002 - March 2016) was retrieved. These were pooled and the data was analyzed using SPSS version 21 (SPSS statistical software package version 21).

Results: 36 patients were admitted from the A&E unit of AKTH with CAIs. They were predominantly males (Male:Female = 5:1). The period prevalence was 1.6%, with the commonest aetiologies being armed robbery attacks (52.8%) and communal clashes (27.8%). Orbital injuries were the commonest presentation (n=11, 30.5%) followed by transpharyngeal injuries (n=8, 22%). Physical examination with intraoral assessment and trajectory analysis of the arrow head assisted in the determination of perioperative management needs. These needs include: appropriate preparation for a variety of potential operative morbidity; imaging: specialty involvement; surgical approach an requirement for fibre-optic assess during intubation.

Conclusion: The management of CAIs is a challenge for all specialties involved in the management of penetrating head and neck trauma. We encourage collaboration among participating practitioners for a morbidity free outcome of management. Modification of extraction approach may be necessary in a few selected cases.