Caracterización de las fracturas nasales atendidas en el servicio de urgencias de cirugía maxilofacial de Bayamo / Characterization of nasal fractures treated in the maxillofacial surgery emergency service of Bayamo / Caracterização de fraturas nasais tratadas no pronto-socorro de cirurgia maxilofacial de Bayamo

RESUMEN La fractura nasal es la más frecuente entre las fracturas de los huesos faciales, pudiendo generar alteraciones estéticas importantes y a su vez determinar cambios en la funcionalidad, tratarlas de forma inmediata evita complicaciones al paciente. Con el objetivo de caracterizar las fracturas nasales atendidas en el servicio de urgencias de cirugía maxilofacial del hospital "Carlos Manuel de Céspedes" se realizó un estudio observacional descriptivo que incluyó todos los pacientes (105) que fueron atendidos ambulatoriamente con diagnóstico de fractura nasal reciente en el servicio de urgencias en el período de enero 2018 a diciembre del 2019. Las variables estudiadas fueron edad, sexo, procedencia, factores etiológicos, signos clínicos, clasificación según desplazamiento, exposición del foco de fractura y dirección del trauma. Se confeccionó una planilla de recolección de datos. Se emplearon números enteros, porcentajes y tablas estadísticas. Se siguieron los principios éticos para la investigación en humanos. La población más afectada se encontró entre los 20 y 29 años de edad, de procedencia urbana y del sexo masculino. Se encontró asociación entre el sexo y los factores etiológicos, predominando las agresiones físicas en hombres y las caídas casuales en mujeres. El principal signo clínico presente en los pacientes fue la epistaxis. Las fracturas nasales desplazadas, con desviaciones laterales y cerradas predominaron en ambos sexos.

ABSTRACT The nasal fracture is the most frequent among the fractures of the facial bones, being able to generate important aesthetic alterations and in turn determine changes in functionality, treating them immediately avoids complications for the patient. In order to characterize the nasal fractures treated in the maxillofacial surgery emergency service of the "Carlos Manuel de Céspedes" hospital, a descriptive observational study was carried out that included all the patients (105) who were seen outpatiently with a diagnosis of recent nasal fracture in the emergency department in the period from January 2018 to December 2019. The variables studied were age, sex, origin, etiological factors, clinical signs, classification according to displacement, exposure of the fracture site and direction of the trauma. A data collection sheet was prepared. Whole numbers, percentages and statistical tables were used. Ethical principles for human research were followed. The most affected population was between 20 and 29 years of age, of urban origin and male. An association was found between sex and etiological factors, predominantly physical aggression in men and accidental falls in women. The main clinical sign present in the patients was epistaxis. Displaced nasal fractures with lateral and closed deviations predominated in both sexes.

RESUMO A fratura nasal é a mais frequente entre as fraturas dos ossos faciais, sendo capaz de gerar alterações estéticas importantes e, por sua vez, determinar alterações na funcionalidade, tratando-as imediatamente evita complicações para o paciente. Com o objetivo de caracterizar as fraturas nasais atendidas no pronto-socorro de cirurgia maxilofacial do hospital Carlos Manuel de Céspedes, foi realizado um estudo observacional descritivo que incluiu todos os pacientes (105) que foram atendidos ambulatorialmente com diagnóstico de fratura nasal recente no pronto-socorro no período de janeiro de 2018 a dezembro de 2019. As variáveis estudadas foram idade, sexo, origem, fatores etiológicos, sinais clínicos, classificação segundo deslocamento, exposição do foco da fratura e direção do trauma. Um formulário de coleta de dados foi preparado. Foram utilizados números completos, percentuais e tabelas estatísticas. Foram seguidos princípios éticos para a pesquisa humana. A população mais afetada foi entre 20 e 29 anos, de origem urbana e do sexo masculino. Foi encontrada associação entre sexo e fatores etiológicos, com aagressão física predominante em homens e quedas casuais nas mulheres. O principal sinal clínico presente nos pacientes foi a epistaxe. Fraturas nasais deslocadas, com desvios laterais e fechados predominaram em ambos os sexos.

Epidemiologia dos traumas de face do serviço de cirurgia plástica e queimados da Santa Casa de Misericórdia de São José do Rio Preto / Epidemiology of facial trauma at the plastic surgery and burns service of the Santa Casa de Misericórdia de São José do Rio Preto

Introdução: O trauma é um dos principais problemas de saúde pública em todos os países, sendo os que acometem a região facial muito frequentes. O presente trabalho objetiva avaliar dados epidemiológicos de pacientes que sofreram trauma de face com fratura. Métodos: Estudo epidemiológico realizado por meio dos prontuários de 92 pacientes. Foram selecionados indivíduos com trauma facial de qualquer intensidade, no período de janeiro de 2009 a janeiro de 2013, e agrupados de acordo com a etiologia e a localização das fraturas. Os dados coletados foram apresentados em valores absolutos e porcentagens. Resultados: Houve prevalência de pacientes do sexo masculino. A etiologia do trauma de face mais encontrada foi a violência interpessoal, observada na maioria dos grupos, exceto naquele acima de 45 anos, cuja predominância etiológica foi de queda e acidente de automóvel. A incidência das causas variou de acordo com a faixa etária: < 18 anos, de 19 a 25 anos, de 26 a 35 anos, de 36 a 45 anos e > 45 anos. Setenta e cinco por cento das fraturas de mandíbula foram unilaterais e 25%, bilaterais. O tratamento cirúrgico de fixação com placas foi o mais utilizado. No nosso estudo, catorze pacientes apresentaram complicação pós-cirúrgica. Conclusão: Há necessidade de um atendimento sistematizado para os traumas faciais. A variação na faixa etária encontrada entre os pacientes estudados demonstra que o trauma facial abrange indivíduos em qualquer idade, embora seja maior entre os jovens. Acreditamos que o presente estudo epidemiológico possibilitará a melhora da qualidade no atendimento aos pacientes com trauma facial.

Introduction: Trauma is a major public health problem in all countries, and injuries involving the facial region are very common. This study aims to assess the epidemiological data of patients who suffered facial trauma with fracture. Methods: Epidemiological study conducted on 92 patient records. Individuals with facial trauma of any intensity presenting between January 2009 and January 2013 were selected and grouped according to the etiology and location of fractures. Data were presented as absolute values and percentages. Results: There was a higher prevalence of male patients. The most frequent cause of facial trauma was interpersonal violence in most groups, except for those over 45 years old, for whom the predominant causes were falls and car accidents. The frequency of the causes varied according to age: <18 years, 19-25 years old, 26-35 years old, 36-45 years and> 45 years. Seventy-five percent of mandibular fractures were unilateral and 25% bilateral. Surgical fixation with plates was the most common treatment. In our study, fourteen patients had postoperative complications. Conclusion: There is a need for systemized care for facial trauma. The variation in the age range found among the studied patients demonstrates that facial trauma includes individuals of any age, although it is more common among young people. We believe that this epidemiological study will enable the improvement of the quality of care for patients with facial trauma.

Fraturas nasais: uma opção de tratamento / Nose fracture: a treatment option

As fraturas dos ossos próprios nasais são comuns, pelo fato deste ocupar posição de destaque na face. O diagnóstico dessas fraturas é basicamente clínico, embora tomadas radiográficas e (ou) tomográficas possam auxiliar. Este trabalho objetivou apresentar caso clínico de fratura dos ossos próprios nasais em indivíduo do sexo masculino, vítima de queda da laje, que foi tratada através de dispositivos pré-fabricados, feitos a partir de frasco de soro fisiológico e sonda nasogástrica, permitindo boa patência das vias aéreas e perfeita estabilização dos fragmentos ósseos. O tratamento das fraturas dos ossos próprios nasais pode, de acordo com a literatura, ser sob anestesia geral ou local, ocorrendo bons resultados em ambos. Contudo, a importância de se manter as vias aéreas e o contorno ósseo nasal por meio de splints, atualmente, é imprescindível, aumentando a quantidade de oxigênio circulante e diminuindo as chances de sinusopatias no pós-operatório. Nesse consenso, a associação de dispositivos pré-fabricados, mantendo a permeabilidade das vias aéreas e o contorno ósseo nasal, é mandatório.

Fractures of the nasal bones (FNB) are common because of the important position occupied by the nose in the face. The diagnosis of FNB is essentially clinical, but radiographs and/or CT may be helpful. This study sets out to present a clinical case of a nasal bone fracture in a male, a victim of the fall of a concrete slab. The fracture was treated by prefabricated devices, made from a flask of saline solution and a nasogastric tube, allowing a good patency of the airways and perfect stabilization of the bone fragments. The treatment of nasal bone fractures can, according to the literature, be performed under general or local anesthesia, both of which produce good results. However, the importance of maintaining the airways and nasal bone contour by means of splints, currently, is essential to increase the amount of oxygen circulating and decrease the chances of postoperative sinusitis. The combination of prefabricated devices, maintaining airway permeability and the nasal bone contour, is of fundamental importance.

The Efficacy of Ultrasonography in Identifying Fracture Patterns of Nasal Bone

PURPOSE: The purpose of this study was to know whether ultrasonography is proper diagnostic tool for decision of treatment method or not, as compared the efficacy of US in allowing identifying fracture patterns of nasal bone with that of CT. MATERIALS AND METHODS: Fifty patients with nasal trauma were investigated prospectively by CT and US. According to CT and ultrasonographic findings, each case of nasal bone injury were rated as grade 1 (nasal injury but not fracture), grade 2 (simple fracture without displacement), grade 3 (unilateral simple fracture with displacement), grade 4 (bilateral simple fractures with displacement), and grade 5 (bilateral comminuted fractures with depression). Assessment for ultrasonographic method were defined as overestimations or underestimation according to whether the nasal fracture had been assigned a higher or lower grade at the review of the findings of CT. The correlation between the results of CT and ultrasonography were measured. RESULTS: In ultrasonographic estimation of grade of 50 cases of nasal bone injuries, there were correctly graded in 42 cases, overestimated in 5 cases, underestimated in 3 cases. In allowing accurate grading of nasal bone injury, images of nasal ultrasonography correlated closely with those of CT (r = 0.796). CONCLUSION: Nasal ultrasonography is a reliable method that allows appropriate grading of nasal bone injury and would be a useful first line imaging method in providing the detail necessary for proper management of patients with mild simple nasal bone injury.

Fraturas nasais em esportes: sua ocorrência e importância / Nasal fracture in sports: its occurrence and importance

Introdução: O aumento do número de participantes nas mais variadas modalidades desportivas e de praticantes em recinto fechado trouxe também um aumento significativo de traumas orofaciais nos esportes, principalmente fraturas nasais, que ocupam o terceiro lugar em ocorrência em todas as modalidades desportivas. Objetivo e revisão de literatura: Trazer conhecimento das causas, da ocorrência e da importância da fratura nasal no esporte, já que é de responsabilidade do cirurgião-dentista confeccionar meios de proteção bucomaxilofaciais nos esportes, área em que a Odontologia do Esporte vem se sedimentando. Conclusão: Um afastamento prolongado do atleta acarreta a ele grande prejuízo físico e psicológico, assim como prejuízo financeiro para seu clube. Deve-se ter atenção para meios de proteção para o atleta.

Introduction: The increasing number of participants in various sports, mainly those practiced indoors, brought a significant increase of orofacial injuries in sports, especially nasal fractures, which rank third in incidence in all sports. Objective and literature review: To study the causes, occurrence and importance of nasal fracture in sports, as providing ways of protecting the maxillofacial area in sports is the responsibility of the dentist, area in which Sports Dentistry is establishing itself. Conclusion: A long athlete withdrawal carries great physical and psychological damage, as well as financial loss to his club. Attention in providing ways of protection for the athlete is required.

Analysis on Effectiveness of Three Dimensional Facial Computed Tomography in Diagnosis of Nasal Fractures

BACKGROUND AND OBJECTIVES: Accurate diagnosis of nasal fracture is difficult in many cases. Some reports showed that threedimensional facial computed tomography (3-D facial CT) is more effective than conventional facial computed tomography (conventional CT) in the diagnosis of nasal fracture. The purpose of this study is to prospectively evaluate the effectiveness of 3-D facial CT in diagnosis of nasal fracture. MATERIALS AND METHODS: From July 1, 2006 to January 31, 2007, 85 patients (83 men and 2 women, ranging in age from 29 to 46 years) visited the Armed Forces Capital Hospital within 2 weeks from nasal trauma. All patients prospectively underwent physical examination, lateral nasal bone view, Water's view, conventional CT, and 3-D CT. If any of definite crepitus on physical examination, or if definite fracture line on simple X-ray, or on conventional CT or on 3-D CT was found according to Hwang's criteria, that patient was confirmed to have nasal bone fracture. The diagnostic values of conventional CT and 3-D CT methods were analyzed by Pearson's chi-square test. RESULTS: Out of 85 trauma patients, 71 patients were diagnosed as having nasal bone fractures with the most common causes being, in the order of frequency of oc-currence, sports injuries and with other causes of blows, military training, works, and traffic accident. 28 patients showed nasal septal displace-ment or fracture. Conventional CT and 3-D CT were equally effective and had diagnosed 70 out of 71 fractures (98.6% of positive predictive value) and determined to be more effective than simple X-ray which had diagnosed only 50 fractures (70.4% of positive predictive value)(p=0.000). In the evaluation of nasal septum, conventional CT was proved to be more effective than 3-D CT since it diagnosed all 28 nasal deviation or fractures cases (100%) whereas 3-D CT diagonosed only 23 cases out of 28 (82.1%)(p=0.000). CONCLUSION: 3-D CT is not more effective than conventional CT in the diagnosis of nasal bone fracture. Moreover, conventional CT is better than 3-D CT in the diagnosis of nasal septal displacement or septal fracture.

Closed Reduction of Nasal Bone Fracture Under the Mask Ventilation Anesthesia Using Oral Airway

PURPOSE: The majority of nasal fractures have been treated by closed reduction. And they were manipulated under local anesthesia or general anesthesia. Under the local anesthesia, patients can feel the pain and fear, so general anesthesia through the endotracheal intubation became popularized recently to treat the nasal fracture. But it has still the drawbacks of postanesthetic complication. Therefore, under the mask ventilation anesthesia using oral airway, we tried to manipulate the nasal fracture. METHODS: From July 2007 to November 2007, we worked with fifty patients that were manipulated the nasal fracture. Fifty patients were divided into two groups, general anesthesia with the endotracheal intubation group(n=25) and the mask ventilation using oral airway group(n=25). We checked up the anesthesia time, postanesthetic complication, postoperative aesthetic & functional problem of nose in two groups. RESULTS: In total operation time and sore throat frequency among the postoperative anesthetic complications, there was statistically significant difference between the mask ventilation group and the endotracheal intubation group(p0.05). And no patients complained of postoperative nasal complication such as septal deviation, septal perforation, nasal obstruction and hump nose in two groups. CONCLUSION: Through the mask ventilation using oral airway, we could reach satisfactory results in the anesthetic time and postanesthetic complication.

The Clinical and Radiological Evaluation of Results about Closed Reduction for Children with Nasal Bone Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It has generally been accepted that closed reduction is the management of nasal fracture in children. But proper management is still confusing and clinical and radiological evaluation about long term results have yet to be determined. The purpose of this study is to determine which closed reduction method for nasal bone fractures in children is effective when considering clinical and radiological aspects. MATERIALS AND METHOD: We analysed the medical records of 35 children with nasal bone fractures up to the age of 15, who were operated by closed reduction between 2000 and 2002. We evaluated postoperative satisfaction of doctors and patients and postoperative CT scan score (Motomura et al 2001) of 14 children over more than at least 2 postoperative years. RESULTS: A peak incidence ages ranged from 13 to 15 years. The most frequent cause was sports injuries. The degree of postoperative satisfaction and postoperative CT scan score was favorable. CONCLUSION: In management of nasal fracture in children, closed reduction is effective and satisfactory when clinical and radiological aspects are considered.

A study on three-dimensional reconstruction of nasal fractures by spiral computed tomography in comparison with roentgenography in medicolegal expertise / 中国法医学杂志

Objective To investigate the advantages of three-dimensional (3-D) reconstruction of nasal fractures with spiral computed tomography (CT) in comparison with roentgenography in medico-legal expertise. Methods CT scanning was performed in 32 cases with complex nasal fractures by Somatom Balance on 2mm/2mm scan. The images were reconstructed with maximum intensity projection (MIP), multi-plannar reconstruction (MPR), shaded surface display (SSD), and volume rendering (VR) mode and compared with roentgenographic images. Result Nasal fractures evaluated by roentgenography were detected to be false-positive in 3 cases and misdiagnosed fracture type in 6 cases as re-evaluated by 3-D reconstruction. Conclusion 3-D reconstruction images are of advantages over roentgenographic images in evaluation of broken bone fragments, displacement, fracture type for clinical diagnosis and medicolegal expertise.