Estudio descriptivo de los accesos quirúrgicos utilizados en el tratamiento de fracturas del complejo zigomático orbitario / Descriptive study of surgical approach for zygomatic complex fractures

El objetivo del presente estudio fue evaluar los accesos quirúrgicos utilizados para el abordaje del complejo zigomático orbitario (CZO) y arco zigomático (AZ). Fue diseñado un estudio de tipo retrospectivo, evaluando las fichas clínicas de pacientes atendidos entre el 1 de Abril del año 1999 y el 31 de Diciembre del año 2008. Fueron estudiadas variables sociodemográficas y características de la fractura, tales como presencia de más de una fractura facial y desplazamiento del fragmento óseo. Se realizo un estudio descriptivo de los diferentes accesos quirúrgicos utilizados y cuando fue necesario se estudió la asociación estadística con la prueba chi-cuadrado para variables nominales, estableciendo significancia si p<0,05. Ciento cincuenta y tres pacientes fueron sometidos a tratamiento quirúrgico de fractura de CZO con 251 accesos quirúrgicos. El acceso más efectuado fue el intrabucal, seguido del acceso subciliar y supraciliar. Siempre existió mayor utilización de accesos para pilar zigomaticomaxilar, seguidos por accesos para reborde infraorbitario y sutura frontozigomática, con pocas diferencias entre ellos. No fue posible encontrar asociación estadística entre las variables estudiadas y la cantidad de accesos para el tratamiento quirúrgico de fracturas de CZO. Los accesos quirúrgicos deben responder a las necesidades individuales de cada caso, intentando obtener indicaciones precisas, más que preferencias individuales de cada cirujano.

The aim of this research was to evaluated the surgical approach for zygomatic complex and zygomatic arch fracture. Was doing a retrospective study, evaluating clinical charts of patients with treatment between April 1 of 1999 and December 31, 2008. Were study sociodemographic variables, type and quantitative fracture and displacement of osseous fragment. A descriptive analysis was do it surgical approach used and when was necessary, realized a statistical analysis with Chi-Square test for nominal variables, with p<0.05 for significant statistic. One hundred fifty tree patients was surgically treated for ZC fracture, doing 251 surgical approach. More realized approach was intraoral, follow for subciliary and superciliary approach. Always exist more approach for zygomatimaxillary pillar, follow to infraorbitary rim and frontozygomatic suture, with a little difference. Was not possible show statistic association between de variables and the quantity of surgical approach for ZC fractures. Surgical approach was response to individual necessity, obtained certain indications more than surgeon preferences.

Analysis of 185 maxillofacial fractures in the state of Santa Catarina, Brazil

A retrospective study was performed to assess maxillofacial fractures in patients treated at a public hospital from 2002 to 2006. The data collected included age, gender, etiology, type of injury, treatment modalities and period of treatment. Causes were grouped into seven categories: road traffic collisions, sports accidents, occupational accidents, gunshot fractures, falls, violence and other causes. The analyses involved descriptive statistics, the Chi-squared Test and the Fisher Exact Test. Records from 132 patients sustaining 185 maxillofacial fractures were evaluated. The mandible (54.6 percent) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6 percent). The mean age of the patients was 37.7 years, and the male:female ratio was 4.3:1. Most fractures occurred in adults with ages ranging from 18 to 39 years. A significant statistical relation was found between the age and the etiology of the trauma (p < 0.05), and between the number of fractured sites and the age of the patient (p < 0.05). Considering the age groups, accidents were the most frequent cause of maxillofacial fractures in the age group between 18 to 39 years, and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 to 59 years. Treatment was performed on the same day as the diagnosis in 44.7 percent of the patients. Open surgery with internal stable fixation was indicated for most of the patients. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Traffic road collisions were the main etiologic factor associated with maxillofacial trauma.

Acesso transnasal para marsupialização de cisto naso-labial: relato de caso / Transnasal Approach to Marsupialization of the Nasolabial Cyst: Report of Case

O cisto naso-labial é cisto não odontogênico raro e de evolução lenta que, dependendo do tamanho, pode causar assimetria facial. O tratamento do cisto naso-labial comumente, e com sucesso, se dá por enucleação cística com acesso intra-oral. Existe um potencial risco de formação de uma fístula oro-nasal na enucleação cística por acesso intra-oral, devido à proximidade desse cisto com a mucosa nasal. A marsupialização por via nasal pode ser uma opção no tratamento do cisto naso-labial com menor risco de formação de fístula oro-nasal. O presente artigo relata um caso de cisto naso-labial tratado por marsupialização com acesso via transnasal

The nasolabial cyst is a rare nonodontogenic cyst of slow progression which, depending on its size, can cause facial asymmetry. It is commonly and successfully treated by enucleation, using an intra-oral approach. There is a potential risk of an oronasal fistula when this modality of treatment is employed, owing to the proximity of the cyst to the nasal mucosa. Transnasal marsupialization can be an option in the treatment of the nasolabial cyst as there is a lower risk of formation of an oronasal fistula. The present paper reports a case of nasolabial cyst treated by marsupialization, using a transnasal approach

Manejo gengival em maxilas totalmente reconstruídas por enxertos e implantes / Gingival management in totally reconstructed maxilla by grafts and implants-case report

Os tecidos moles desempenham um importante papel para o resultado das cirurgias com implantes. Várias técnicas estão reportadas na literatura para aumentar a quantidade de gengiva ceratinizada ao redor dos implantes. Este artigo apresenta uma técnica de avanço do retalho palatal realizada durante a cirurgia de reabertura dos implantes em maxilas totalmente edêntulas reconstruídas com blocos de crista ilíaca.

Protocolo cirúrgico para extração de germes de terceiros molares inferiores / Surgical protocol for extraction of lower third molar germs

A remoção de terceiros molares é uma intervenção cirúrgica comum em cirurgia bucomaxilofacial e, como qualquer procedimento, é passível de complicações. A criação e a permanência de um defeito periodontal no segundo molar adjacente podem causar a perda desse dente a longo prazo, portanto, novas técnicas de incisão e osteotomia devem ser avaliadas para minimizar ou mesmo evitar essa complicação. Este artigo propõe um protocolo de conduta para a remoção de terceiros molares capaz de facilitar a técnica e reduzir o tempo de cirurgia. Além disso, a técnica reduz o risco de formação de defeitos na região dos segundos molares, devido à modificação na incisão e na remoção óssea reduzida na distal do segundo molar.

Reconstrução de mandíbula severamente reabsorvida usando a técnica da tenda de tecido mole – Relato de caso / Severely atrophic mandible reconstruction using the soft tissue matrix technique - Case report

As técnicas de reconstrução óssea na mandíbula são muito usadas para permitir a reabilitação com implantes. A mandíbula severamente reabsorvida (6 mm ou menos) ainda permanece como um desafio em razão das taxas de insucesso e risco de fratura mandibular. Os autores apresentam um caso de reconstrução de mandíbula severamente reabsorvida usando a técnica da tenda de tecido mole com a colocação simultânea de implantes na região anterior de mandíbula.

Management of mandibular basilar fracture as a complication of tumor surgery

Fracture of the mandible basilar bone after a conservative resection of an ameloblastoma is an unusual postoperative complication and poorly cited in literature, since the radical resection is the most common treatment used for this condition. We present a case dealing with this complication, showing a technique for mandibular reconstruction that creates good results in five years of follow-up.