ABSTRACT
RESUMEN: Las fracturas mandibulares son parte importante del trauma maxilofacial presentando consecuencias funcionales y estéticas importantes si su manejo inicial es inadecuado o tardío. Estudios epidemiológicosde lesiones aportan en orientar esfuerzos y recursos parasuevaluación y manejo. Objetivo del estudio es caracterizar variables asociadas a pacientes con fracturas mandibulares, atendidos en la Unidad de Emergencia del Complejo Asistencial Barros Luco (CABL). Estudio retrospectivo fue realizado con los registros clínicos de pacientes atendidos entre enero 2018 y junio 2019 con diagnóstico de fractura mandibular. Se consignó sexo, edad, número de fracturas, localización anatómica, etiología, TRIAGE de entrada según ESI, presencia de TEC, medio de transporte al ingreso y comuna de procedencia. Los 57 Pacientes presentaron al menos una fractura mandibular, sexo masculino presentópredominio,edad promedio 31 años. Población entre 20 y 29 años fue más prevalente. 82 fracturas fueron consignadas siendo ángulo mandibular izquierdo la principal zona afectada (n=15, 18,3 %). 8 pacientes presentaron TEC, clasificados como ESI 3 y ESI 2. Demanda predominante fue de pacientes pertenecientes al SSMS (54,4 %). Los patrones etarios y localización de las fracturas encontrados coinciden con lo publicado previamente, con una disminución de brecha de casos entre hombres y mujeres, la asociación etiológica con estructuras anatómicas comprometidas y la presencia de TEC en casos de mayor severidad. Queda para analizar el porqué importante carga que presenta el CABL es de pacientes no pertenecientes a su jurisdicción (45,6 %). Incidencia y causas de fracturas mandibulares reflejan diversos patrones de comportamiento entre comunidades. Se reafirma como factor de riesgo la edad, sexo, observando una mayor prevalencia de fracturas enángulo mandibular izquierdo, asociado a patrones de comportamiento sociocultural. Sugerimos realizar correcciones metodológicas en investigaciones futuras con un proceso de estandarización de registro porlos profesionales encargados de consignar los registros clínicos.
ABSTRACT: Mandible fractures are an important part of maxillofacial trauma, presenting significant and management. The objective of the study is to characterize variables associated with patientswith mandibular fractures, treated in the Emergency Unit of the Barros Luco Assistance Complex (CABL). A retrospective study was performed with the clinical records of patients seen between January 2018 and June 2019 with a diagnosis of mandibular fracture. Sex, age, number of fractures, anatomical location, etiology, input TRIAGE according to ESI, presence of ECT, means of transport at admission and municipality of origin were recorded; 57 patients presented at least one mandibular fracture, male sex was predominant, with an average age of 31 years. 20 and 29 yearswas more prevalent. 82 fractures were reported, with the left mandibular angle being the main affected area (n = 15, 18.3 %). 8 patients presented ECT, classified as ESI 3 and ESI 2. The predominant demand was from patients belonging to the SSMS (54.4 %). The agepatterns and location of the fractures found coincide with that previously published, with a decrease in the gap in cases between men and women, the etiological association with compromised anatomical structures and the presence of ECT in cases of greater severity. It remains to analyze why the important burden presented by the CABL is of patients not belonging to its jurisdiction (45.6 %). Incidence and causes of mandibular fractures reflect diverse behavior patterns between communities. Age and sex are reaffirmed as a risk factor, observing a higher prevalence of left mandibular angle fractures, associated with sociocultural behavior patterns. We suggest making methodological corrections in future research with a registration standardization process by professionals responsible for recording clinical records.
ABSTRACT
O côndilo mandibular apresenta-se como um dos locais mais comumente acometidos nas fraturas mandibulares, sendo, na maioria das vezes, decorrente de um trauma na região de sínfise ou de para-sínfise mandibular. A ptar pelo tratamento cirúrgico ou conservador é motivo de controvérsias, principalmente devido às diversas complicações pós-tratamento relatadas na literatura. Uma das principais indicações para a redução cirúrgica consiste na impossibilidade de estabelecer uma satisfatória oclusão dentária pelo tratamento conservador, geralmente associado às fraturas bilaterais. O sucesso do tratamento está relacionado a uma aderência cuidadosa nos princípios cirúrgicos e fisiológicos e em um acompanhamento pós-operatório rigoroso, aumentando a capacidade funcional a longo prazo e possibilitando uma menor incidência de complicações. Este trabalho objetiva relatar um caso clínico de redução cirúrgica de fratura bilateral de côndilo associada à fratura de corpo mandibular, enfocando, principalmente, os aspectos relacionados às indicações e complicações desse tipo de tratamento.
The mandibular condyle is presented as one of the most commonly sites involved in jaw fractures, most often due to trauma in the region of the mandibular symphysis. The choice of surgical or conservative treatment is a highly controversial issue, mainly due to the various post-treatment complications reported in the literature. One of the main indications for surgical reduction is the inability to establish a satisfactory dental occlusion by conservative treatment, usually associated with bilateral fractures. Successful treatment is related to a careful adherence to surgical and physiological principles with a rigid follow up, increasing the long-term functional capacity and allowing a lower incidence of complications. This study reports a case of surgical reduction of bilateral condyle fracture associated with fracture of the mandibular body, focusing on aspects related with indications and complications of this treatment.
ABSTRACT
Traumatic pseudoaneurysms in the head and neck region are very rare. Particularyly, pseudoaneurysms of the internal maxillary artery are known to be very rare. The authors report a 20-year old male who was diagnosed as having a pseudoaneurysm of the internal maxillary artery. The cause was assumed to be a mandible ramus fracture. When he visited our emergency room, we did not consider a pseudoaneurysm because of his other life-threatening conditions. Fortunately, he re-visited our hosipital before the aneurysm ruptured. He was diagnosed with angiography and was treated by using embolization with glue. The rupture of the pseudoaneurysm could have caused a life-threatening hemorrhage.
Subject(s)
Humans , Male , Adhesives , Aneurysm , Aneurysm, False , Angiography , Emergencies , Head , Hemorrhage , Mandible , Maxillary Artery , Neck , RuptureABSTRACT
El siguiente trabajo tiene por objetivo presentar la experiencia del equipo de Cirugía Maxilofacial del Hospital San José, para el manejo de las fracturas en mandíbulas atróficas, reportando el tratamiento médico-quirúrgico y evolución post operatoria de casos clínicos. Se presentan dos casos clínicos de pacientes de sexo femenino, con enfermedades sistémicas de base, edéntulas, con diagnóstico de fractura en mandíbula atrófica consecutivos a caídas de nivel. De los casos tratados, el equipo logró resultados satisfactorios, mediante un tratamiento integral para los pacientes con este tipo de fracturas, basado en protocolos actuales encontrados en la literatura. El tratamiento de elección para este tipo de fracturas corresponde a la reducción anatómica quirúrgica y fijación mediante placas y tornilos de osteosíntesis. Fundamentado por sus favorables resultados y a la rápida rehabilitación funcional del paciente. El manejo multidisciplinario es fundamental para tratar este tipo de pacientes, por la posible concomitancia de enfermedades de base que pudiesen poseer estos pacientes.
The objective of the present case report is to present the experience of the maxillofacial surgery team of the Hospital San Jose in the management of atrophic mandible fracture, through the medical-surgical treatment and post-operatory evolution of two clinical cases. We studied two women with systemic conditions, edentulous with a diagnosis of atrophic mandible fracture subsequent to fall injury. In all treated cases the surgical team achieved satisfactory results through an integral treatment of patients with this type of fracture, based on actual literature reported protocols. The treatment of choice for this type of fractures is an anatomical open reduction, by internal fixation with osteosynthesis plates and screws on the basis of favorable results and functional rehabilitation of patients. The multidisciplinary management is fundamental for treatment of this type of patient due to the concomitant systemic conditions of these patients.