Prehospital Self-treating of Orofacial Swelling: Observed Clinical Presentation of Patients

Abstract

Objective: To assess the type of self-pretreatment instituted among patients with orofacial swelling before presentation.

Methods: An observational study; population included all facial swellings that received self-intervention by patients before hospital visit to the Oral and Maxillofacial unit of Edo Specialist hospital. There were no exclusions.

Results: 131 patients met inclusion criterion, 60% females. Age was 3 to 85 years; majority of patients (25%, n=33) was between 10-19 years of age. Odontogenic lesions accounted for 79% (104) of facial swellings. Duration of intervention varied from one day to 10 years; significantly, one to 6 days was recorded for 55% for all categories of intervention- 78%(18/23) of patients using pharmaceutical fell into this category-. This was followed by 15% at up to 2 weeks duration. Intervention was pharmaceutical only for 18%(23), non-pharmaceutical in 45%(61) and 37% (47) combined both. Most frequently used pharmaceutical intervention was antibiotics 19% (26); 24% (31) utilized analgesic but 9(7%) of them used it topically and warm salt mouth bath was used by 13%(17). Thermotherapy, the topical application of moist heat soaked cloth in direct contact to orofacial skin and intraoral mucosa accounted for 34% (45) of non-pharmaceutical intervention followed by therapeutic balm massage by 31% (41). Two percent (3) each, removed worms or had incisions before hospital visit.

Observed effect on clinical presentation was extensibility of orofacial soft tissues resulting in diffuse soft swelling in 30% (39) extra-orally; fleshy soft mucosa swelling intraorally in 7.6%(10) and intraoral white tissue in 9% (12) patients.

Conclusion: Age was significantly associated with self-medication, peaking at the 10 to 19 years age group. Non-pharmaceutical agents were utilized more and for much longer. The use of pharmaceutical agents although shorter-terminating at 4 months- was continuous while the much longer utilization of the non-pharmaceutical agents lasting up to 10 years was intermittent. Overall, majority of patients rendered self-treatment for less than one week

Over-zealous use of interventions across all categories resulted in alteration of orofacial skin and mucosa in some patients. Noted effects on orofacial mucosa and skin varied from ulceration, whitish lesion and distension giving rise to alarming intraoral and extraoral distention.

Keywords: pre-hospital self -treatment, tissue extensibility, thermotherapy.