ABSTRACT
INTRODUÇÃO: Fraturas zigomático-orbitárias são as mais comuns do terço médio da face. As principais causas de fraturas são os acidentes de trânsito, principalmente por motocicletas, e a violência interpessoal. Os princípios básicos para o tratamento das fraturas faciais são a redução e a fixação do foco fraturário. É fundamental que o acesso cirúrgico seja o mais direto e amplo possível. Pode ser utilizada abordagem subciliar e transconjuntival com cantotomia lateral. O objetivo deste estudo é avaliar e comparar as complicações, vantagens e desvantagens da abordagem transconjuntival com cantotomia lateral e o acesso subciliar convencional. MÉTODOS: Foram selecionados 15 pacientes nos quais as fraturas foram abordadas por meio de incisão subciliar e 15 pacientes nos quais as fraturas foram abordadas por incisão transconjuntival com cantotomia lateral e avaliadas a incidência de complicações com os dois métodos. Os dados foram analisados estatisticamente com o software SPSS 20.0. RESULTADOS: Foram operados 30 pacientes, metade com acesso subciliar e metade com acesso transconjuntival. Os traumas ocorreram mais frequentemente aos finais de semana. As complicações mais frequentes foram cicatriz aparente (26%), esclera aparente (23,3%) e ectrópio (20%). Ectrópio foi mais comum no grupo acima de 60 anos. CONCLUSÃO: Ambas as técnicas foram eficazes para correção das fraturas do complexo zigomático-orbitário. A técnica transconjuntival proporciona cicatrizes mais estéticas e menos estigmatizantes, constituindo hoje a primeira escolha do autor. A incidência global de complicações foi semelhante entre as duas técnicas. Ectrópio foi menos frequente com acesso transconjuntival.
INTRODUCTION: Orbitozygomatic fractures most commonly occur in the midface. The main causes of fractures are traffic accidents, mainly by motorcycles, and interpersonal violence. The basic principles for the treatment of facial fractures are the reduction and fixation of the fracture site. It is fundamental that the surgical access be the most direct and broad as possible. Either the subciliary approach or transconjunctival access with lateral canthotomy can be used. The objective of this study was to evaluate and compare the complications, advantages, and disadvantages of the transconjunctival approach with lateral canthotomy and conventional subciliary access. METHODS: We selected 15 patients in whom fractures were addressed through a subciliary incision and 15 patients in whom the fractures were addressed by using a transconjunctival incision with lateral canthotomy, and evaluated the incidence of complications with the two methods. The data were statistically analyzed by using the SPSS 20.0 software. RESULTS: Thirty patients were operated with the subciliary access in 15 patients and the transconjunctival access in the other 15. Trauma occurred more frequently on weekends. The most frequent complications were apparent scar (26%), apparent sclera (23.3%), and ectropion (20%). Ectropion was more common in the > 60-year age group. CONCLUSION: Both techniques were effective for the correction of fractures of the orbitozygomatic complex. The transconjunctival technique provides more esthetic and less stigmatizing scars. Hence, it is currently the author's first choice of treatment. The global incidence of complications was similar between the two techniques. Ectropion was less frequent with the transconjunctival access.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , History, 21st Century , Orbit , Skull Fractures , Zygoma , Zygomatic Fractures , Accidents, Traffic , Retrospective Studies , Plastic Surgery Procedures , Face , Facial Bones , Surgical Wound , Orbit/surgery , Skull Fractures/surgery , Zygoma/surgery , Zygomatic Fractures/surgery , Accidents, Traffic/statistics & numerical data , Plastic Surgery Procedures/methods , Face/surgery , Facial Bones/surgery , Surgical Wound/surgeryABSTRACT
Objective To study the method for early treatment and Ⅰ-stage repair of the acute facial and brain injuries and its significance. Methods A retrospective study was performed in 38 cases with acute cranial injury,who underwent early treatment and surgical repair of the cranial bone and/or dura defects with self-tissues,glue material and titanium net depending on individual conditions. Of all,33 cases (87%) received Ⅰ-stage repair. Antibiotic therapy was performed in all the cases after operation. Results All patients recovered with satisfactory regional appearance. No intracranial infection or rhinorrhea of cerebral spinal fluid occurred among them during the follow-up for from six months to 11 years. Conclusion For the acute facial and brain injuries,early treatment and Ⅰ-stage repair based on the injury site and injury severity can attain safe and effective results.