Análise epidemiológica das fraturas dos ossos da face em um hospital público no nordeste do Brasil / Análisis epidemiológico de las fracturas de los huesos de la cara en un hospital público del noreste de Brasil / Epidemiological analysis of face bone fractures in a public hospital in northeast Brazil

As fraturas dos ossos da região maxilofacial são ocorrências que podem se apresentar como quadros de urgência e/ou emergência na rotina das unidades de pronto atendimento e hospitais do mundo inteiro, principalmente em localidades com altos índices de violência interpessoal e infrações de trânsito. Um grande número de traumatismos na face, tanto em tecidos moles como duros acontece devido à enorme exposição e a pouca proteção desta região o que acarreta frequentemente lesões graves. Objetivo: O presente estudo tem como objetivo avaliar a prevalência das fraturas no complexo maxilofacial em uma unidade hospitalar pública, a partir de um estudo epidemiológico, sendo analisados os fatores relacionados a ocorrência do trauma, agente etiológico, distribuição das fraturas, gênero e idade dos indivíduos acometidos. Metodologia: O presente estudo do tipo transversal retrospectivo, onde foram avaliados 268 prontuários de pacientes diagnosticados com fraturas dos ossos da face atendidos no Hospital Regional Justino Luz, localizado na cidade de Picos, no estado do Piauí, Brasil, no período de janeiro de 2015 até janeiro de 2017, os prontuários foram analisados no setor de arquivo médico do HRJL. Resultados: os fatores etiológicos mais observados foram os acidentes motociclísticos, seguidos de agressão física e quedas da própria altura, o tipo de fratura mais comum foi a do Complexo Orbito-Zigomático-Maxilar (33,2%), seguido da Mandíbula (23,7%) e dos Ossos Próprios do Nariz (17%), sendo o gênero masculino o mais acometido por fraturas. Conclusão: a partir desse estudo podemos concluir que os acidentes motociclísticos configuram-se como o principal fator etiológico relacionado as fraturas de face, sendo o gênero, masculino o mais atingido e o tipo de fratura mais prevalente foi a fratura do Complexo Orbito-Zigomático-Maxilar... (AU)

Bone fractures in the maxillofacial region are occurrences that can present themselves as urgent and/or emergencies in the routine of emergency care units and hospitals around the world, especially in locations with high rates of interpersonal violence and traffic violations. A large number of injuries to the face, both in soft and hard tissue, occur due to the enormous exposure and poor protection of this region, which often leads to serious injuries. Objective: This study aims to assess the prevalence of fractures in the maxillofacial complex in a public hospital, based on an epidemiological study, analyzing the factors related to the occurrence of trauma, etiological agent, fracture distribution, gender, and age of patients affected individuals. Methodology: This retrospective cross-sectional study evaluated 268 medical records of patients diagnosed with fractures of the facial bones treated at the Justino Luz Regional Hospital, located in the city of Picos, in the state of Piauí, Brazil, in January 2015 until January 2017, the medical records were analyzed in the medical file sector of the HRJL. Results: the most observed etiological factors were motorcycle accidents, followed by physical aggression and fall from own height, the most common type of fracture was the Orbit-zygomatic-Maxillary Complex (33,2%), followed by the mandible (23,7%) and the nose bonés (17%), being the male gender the most affected by fractures. Conclusion: from this study, we can conclude those motorcycle accidents are the main etiological factor related to facial fractures, with the male gender being the most affected and the most prevalent type of fracture was the fracture of the orbit-zygomatic-maxillary complex... (AU)

Las fracturas óseas en la región maxilofacial son eventos que pueden presentarse como urgentes y/o emergencias en la rutina de las unidades de atención de emergencia y hospitales de todo el mundo, especialmente en lugares con altos índices de violencia interpersonal e infracciones de tránsito. Un gran número de lesiones en la cara, tanto en tejidos blandos como duros, se producen debido a la enorme exposición y escasa protección de esta región, lo que a menudo conduce a lesiones graves. Objetivo: Este estudio tiene como objetivo evaluar la prevalencia de fracturas en el complejo maxilofacial en un hospital público, a partir de un estudio epidemiológico, analizando los factores relacionados con la ocurrencia del trauma, agente etiológico, distribución de la fractura, sexo y edad de los pacientes afectados. Metodología: Este estudio transversal retrospectivo evaluó 268 historias clínicas de pacientes con diagnóstico de fracturas de los huesos faciales atendidos en el Hospital Regional Justino Luz, ubicado en la ciudad de Picos, en el estado de Piauí, Brasil, en enero de 2015 hasta enero de 2017. , las historias clínicas fueron analizadas en el sector de expediente médico del HRJL. Resultados: los factores etiológicos más observados fueron los accidentes de motocicleta, seguido de agresión física y caída de propia altura, el tipo de fractura más común fue el Complejo Órbita-cigomático-Maxilar (33,2%), seguido de la mandíbula (23,7 %) y la nariz bonés (17%), siendo el género masculino el más afectado por las fracturas. Conclusión: de este estudio podemos concluir que los accidentes de motocicleta son el principal factor etiológico relacionado con las fracturas faciales, siendo el género masculino el más afectado y el tipo de fractura más prevalente fue la fractura del complejo orbitario-cigomático-maxilar... (AU)

Fratura condilar em paciente pediátrico: um relato de caso condilar / Fracture in pediatric patient: a case report

As fraturas faciais em crianças são raras, já que os ossos faciais pediátricos têm maior elasticidade, menos pneumatização, tecido adiposo circundante mais espesso e mais estabilização da mandíbula e maxila pelos dentes não irrompidos. Em geral, lesões nos tecidos moles são mais comuns em crianças do que fraturas esqueléticas. Entre as fraturas faciais pediátricas, as fraturas da mandíbula são as mais comuns, sendo o côndilo a área mais acometida em pacientes pediátricos. O côndilo é considerado o principal centro de crescimento da mandíbula em crianças, assim é de suma importância a definição do tratamento adequado, pautado em diversos critérios de avaliação, com o intuito de erradicar possíveis complicações advindas da fratura condilar. Assim o objetivo deste estudo é relatar um caso de fratura de côndilo unilateral em uma criança, na qual realizou-se abordagem cirúrgica com fixação interna, afim de elucidar e discutir as possíveis condutas terapêuticas acerca de tratamentos a serem aplicados, visto que esses ainda são bastante controversos na literatura e os resultados das diversas condutas são os mais diversos, apresentando variados aspectos que interferem na evolução dos pacientes(AU)

Facial fractures in children are rare, since pediatric facial bones have greater elasticity, less pneumatization,thicker surrounding adipose tissue and more stabilization of the jaw and jaw by unerupted teeth.In general, soft tissue injuries are more common in children than skeletal fractures.Among pediatric facial fractures, mandible fractures are the most common, with condyl being the most affected area in pediatric patients.The condyl is considered the main center of mandible growth in children, so it is of Paramount importance to define the appropriate treatment, based on several evaluationcriteria, in order to eradicate possible complications resulting from the condilar fracture.Thus, the aim of this study is to report a case of unilateral condyl fracture in a child, in which a surgical approach with internal fixation was performedin order to elucidate and discuss the possible therapeutic approaches about treatments to be applied, since these are still quite controversial in the literature and the results of the various behaviors are the most diverse,presenting several aspects that interfere in the evolution of patients(AU)

Correlation of Facial Injury Severity Scale (FISS) with Length of Stay, The Need for Surgery and The Involvement of Other Specialists in Maxillofacial Trauma Patients at H. Adam Malik General Hospital Medan

Background:Facial Injury Severity Severity Score (FISS) has been used to assess the severity of facial injuries. However, FISS scores as a useful predictor of length of stay and changes between FISS scores and injuries to other parts of the body have not evaluated. In this study, we want to know the relationship between FISS score as the clinical assessment of maxillofacial trauma with the length of stay, the need for surgery, and the involvement of other specialist elds.Method:This research was conducted using analytical research through a retrospective approach by looking at the medical records of patients who suffered maxillofacial trauma at H. Adam Malik General Hospital Medan from June to August 2019.Result :From a total of 43 patients included in the study, there were 22 mandibular fractures, with mandibular angulus (29.0%), parasymphysis (22.4%), and mandibular corpus (21.5%). Thirty subjects (69.8%) needed surgery, and xation of the fracture and subjects without intervention were 13 (30.2%). Patients who needed surgical intervention, the average time needed for hospitalization was 10.98 + 7.72 days (p = 0.007). The most collaboration found with neurosurgeons specialists, 39.53% of subjects who performed the surgery. A total of 55.8% of surgeries performed by a single operator from the plastic surgery department. Relationship between the length of stay with FISS, obtained for FISS> 3 (OR 14.37) (p = 0.01), meaning that patients with FISS> 3 are likely to stay longer for 14 times. Subsequent results related to the need for surgery obtained signicant results (OR = 8.26, p = 0.026). signicant (p = 0.059).Conclusion:A FISS score signicantly affects the length of stay for a maxillofacial trauma patient. FISS score also affects the involvement of other specialists in maxillofacial trauma patients but not statistically signicant.

Changing trends in maxillofacial trauma: A 15 years retrospective study in the Southern Part of Haryana, India

The aim is to analyze the pattern of maxillofacial injuries and treatment outcomes in the past 15 years (2002–2016). Materials and Methods: One thousand eight hundred and fifty patients from two tertiary referral center hospitals were studied retrospectively in which the age, sex, etiology, site of fracture, and treatment modality was recorded. Results: One thousand two hundred and twenty-eight males and 622 females were operated between 2002 and 2016. Mean age was 29 ± 17.2 years. Maximum incidence was seen in the age group of 16–30 years in males, whereas in females, the predominance of trauma was seen in both 16–30 and 31–45 age groups. Road traffic accidents were responsible for the majority of fractures (42.2%), followed by assaults (26.4), sports injuries (17.6%), and fall (10.7%). Maximum fractures were of the mandible (53.5%) followed by midface (25.6%) and panfacial trauma (20.8%). Nearly 53.6% of patients underwent open reduction, and internal fixation (ORIF), 34.2% managed by the closed method and 12.1% were kept under observation. Conclusion: This study verified a young male predominance, a shift toward more assault related fractures, especially in females. Mandibular fractures were the most common of all. Moreover, the changing trend toward ORIF in the past 15 years.

Fracturas panfaciales: Oportunidad de tratamiento / Panfacial fractures: Treatment tming and strategy

Antecedentes: las lesiones panfaciales son aquellas que involucran al menos dos de los tres segmentos faciales: frontal, tercio medio, tercio inferior o mandíbula. Este tpo de fracturas se acompaña comúnmente (18 a 45%) de lesiones en otras partes, como el neurocráneo, la columna cervical y el globo ocular. Objetivos: describir sus causas más frecuentes, las áreas faciales más afectadas, el momento y la oportunidad adecuados para iniciar la secuencia del tratamiento en 58 pacientes con lesiones panfaciales tratados en la División de Cirugía Plástica del Hospital Cosme Argerich entre los años 2000 y 2010. Material y métodos: de 720 pacientes con traumatismo facial, 68 (9,4%) presentaron fracturas pan-faciales; no obstante, el seguimiento de la evolución hasta los 2 años posoperatorios fue hecho en 58 (8%) pacientes, quienes fueron incluidos en este estudio. Resultados: las áreas más afectadas fueron las órbitas y la nariz (68%), el malarcigoma (60%), el maxilar superior (42%) y la mandíbula (28%). El cráneo estuvo directamente involucrado en 6 pacientes (15%). En todos los casos el método de tratamiento consistó en: 1) exploración a cielo abierto; 2) reducción y fijación de las fracturas con osteosíntesis mediante placas y tornillos, 3) reemplazo de huesos conminutados con autoinjertos óseos y material no biológico. Según el epicentro de las fracturas y las alteraciones estructurales faciales, la reconstrucción se inició desde el tercio superior hacia el inferior en 38 pacientes y en los 30 restantes de abajo hacia arriba. Conclusión: la biomecánica básica es obtener la recomposición de la línea media, mantener el ancho facial y la proyección lateral de la cara. Los resultados fueron aceptables en 48 casos (85%) y no aceptables en 9 (15%), teniendo en cuenta la recuperación de las formas y armonías faciales, las deformidades estéticas, las secuelas funcionales, las complicaciones y la complejidad de operaciones secundarias correctivas.

Background: panfacial fractures are those that involve at least two of the three facial segmentis: frontal, medial third and jaw o mandibular area. Concomitant injuries (18 to 45%) afecting the ocular globe, endocranium and cervical spine are associated with panfacial lesions. Objectives: to describe the most frequent causes, facial areas involved and the right tming to initate the treatment sequence in 58 patentis with panfacial injuries treated at the Plastic Surgery Division of the Cosme Argerich Hospital. Material and methods: between 2000 to 2010, 720 patentis with facial trauma were treated. Of them, 68 (9,4%) presented panfacial fractures and 58 were included in this study. Results: the most afected areas were orbit and nose (68%); zygoma-malar (60%); maxilla (42%) and jaw (28%). The cranium was directly involved in 6 patentis ) (15%). The reconstructive method used in all cases was; 1. Open fracture expositon; 2. Reducton and fxaton by means of plates and screws; 3. Replacement of the comminuted bones with iliac autograf and no biologic material. According to the epicenter of the fracture and structural alteraton, the reconstructon was done from superior to inferior thirds (up-botom), 38 patentis; and from inferior to superior third (botom-up), 30 patentis, respectively. Conclusions: the Results were acceptable in 48 cases (85%) and inadequate in 9 (9%) according to facial harmony, aesthetic deformity, functonal sequels, complicatons and severity of secondary corrective operatons. The basic biomechanic needs were to obtain the recompositon of the midline, maintain the facial width and the lateral projecton of the face.

The application of tracheal intubation by the endoscopic-assisted mouth floor-submandibular approach for the general anesthesia and operation of craniofacial multiple fractures / 实用口腔医学杂志

Objective:To investigate the application of tracheal intubation by the endoscopic-assisted mouth floor-submandibular approach(EAMFA) for general anesthesia and the operation of craniofacial multiple fractures.Methods:8 patients with complex craniofacial fractures and associated with the contraindication of nasal trachea cannula underwent EAMFA general anesthesia and operation.Blood pressure(BP),saturation of blood oxygen(SPO2),heart rate(HR) and electrocardiogram(ECG) were monitored timely.Results:The intubation and anesthesia were successfull in all patients;BP,SPO2,HR and ECG were normal in all operation procedure in the patients.No complication was observed.Conclusion:EAMFA is an effective anesthesia approach for the surgical treatment of craniofacial multiple fractures.

Estudio de fracturas de malar, maxilar y mandíbula de los egresos hospitalarios del 2010 a 2015 en la Caja Costarricense de Seguro Social

El objetivo del presente estudio descriptivo es determinar la prevalencia de fracturas malares, maxilares y mandibulares en los pacientes internados en hospitales de la Caja Costarricense de Seguro Social durante los años 2010 al 2015, analizando su relación con edad, sexo y variables epidemiológicas de tiempo, lugar y persona. Se registró un total de 2.729 casos, seleccionados bajo los diagnósticos de fracturas según la Clasificación Estadística Internacional de Enfermedades CIE-10. Dentro de los resultados obtenidos un 40,7 % de las fracturas se relacionó con malares y maxilares vs 59,3%en mandíbula. La causa o etiología más común fue agresión (39%), traumatismo accidental (36%) y accidentes de transporte (24%), se observó mayor prevalencia en el grupo etario de 20 a 59 años con una tasa de 85,02 por 100.000 hab. La distribución de fracturas de acuerdo al sexo fue de 9.1% en mujeres y 90.9% en hombres, con una razón de 10 hombres por cada mujer. Esta problemática produjo al sistema de salud un total 36 años de estancia hospitalaria y 39 años de incapacidad. Es de interés para los tomadores de decisiones en salud conocer el impacto que tiene este tipo de lesiones en la morbilidad de la población al ser un problema de salud pública.

The objective of this research is to determine the prevalence of malar, maxillary and mandibular fractures in patients of the Social Security Hospitals during the years 2010 to 2015 analyzing the relationship between age, sex and epidemiological variables of time, place and person. A total of 2729 cases diagnoses selected under fractures diagnose according to the International Classification of Diseases ICD-10. Among the results a 40.7% of the fractures was recorded in the malar and maxillary area versus a 59.3% in the jaw area. The most common cause or etiology was assault (39%), accidental injury (36%) transport accidents (24%), higher prevalence was observed in the age group of 20-59 years with a rate of 85,02 per 100,000 inhabitants. The distribution of fractures according to sex was 9.1% in women and 90.9% in men, with a ratio of 10 men for each woman. This problem caused the social health system an average 36 years of hospital stay and 39 years of disability. It is of interest to health policy authorities to know the impact of these injuries on the morbidity of the population because it´s a public health problem.

Mechanical comparison of two internal rigid fixation systems used for fixing facial fractures (an in vitro study) / Comparación mecánica de dos sistemas de fijación interna rígida utilizados en la fijación de fracturas faciales (estudio in vitro)

ABSTRACT Introduction: the use of titanium miniplates is the gold standard in the treatment of facial fractures. A Colombian company has developed a system of osteosynthesis miniplates for the treatment of facial fractures, which was chemically and mechanically compared with an imported system. Methods: comparative in-vitro tests were carried out to analyze the chemical composition and the biomechanical behavior of the national and imported systems. A sample of 36 items was selected, including 24 miniplates and 12 screws, in order to mechanically assess their materials by means of tensile and flexural tests for the plates and torque strength tests for the screws, and to perform a microscopic analysis of the chemical composition of the plates of both brands by means of scanning electron microscopy (SEM) and Energy Dispersive Spectroscopy (EDS). Results: The findings showed that there are no major differences in terms of the chemical composition and the biomechanical behavior of the implants of both brands (national and imported) when assessing plates and screws separately. Conclusions: the results showed a higher content of titanium in the material of national plates; however, the mechanical properties of both brands are very similar. Taking into account the material′s biomechanical characteristics, either system is a good choice when selecting a device for rigid internal fixation of facial fractures.

RESUMEN Introducción: el uso de miniplacas de titanio representa el estándar de oro en el tratamiento de las fracturas faciales. Una empresa colombiana desarrolló un sistema de miniplacas de osteosíntesis para el tratamiento de fracturas faciales, el cual fue comparado química y mecánicamente con un sistema importado. Métodos: se realizaron pruebas in vitro comparativas para analizar la composición química y el comportamiento biomecánico del sistema nacional y del importado. Se seleccionó una muestra total de 36 elementos de prueba, de los cuales 24 eran miniplacas y 12 tornillos, con el fin de evaluar el material mecánicamente por medio de pruebas de tracción y flexión para las placas y pruebas de resistencia al torque para los tornillos, y realizar un análisis microscópico y de la composición química de las placas de ambas marcas por medio de Microscopía Electrónica de Barrido (SEM) y Energy Dispersive Spectroscopy (EDS). Resultados: los hallazgos mostraron que no existen grandes diferencias en cuanto a la composición química y el comportamiento biomecánico entre los implantes de ambas marcas (nacional e importado), al evaluar las placas y los tornillos por separado. Conclusiones: los resultados mostraron un mayor contenido de titanio en el material de las placas nacionales; sin embargo, se encontró que las propiedades mecánicas de ambas marcas son muy similares. Teniendo en cuenta las características biomecánicas del material, cualquiera de los dos sistemas es una buena alternativa en el momento de elegir un dispositivo para la fijación interna rígida de fracturas faciales.

Levantamento epidemiológico das fraturas faciais no Hospital Regional de Urgência e Emergência de Presidente Dutra - MA / Epidemiological survey of facial fractures in the Hospital Regional of Urgency and Emergency of President Dutra - MA

Objetivo: este trabalho tem por finalidade determinar a prevalência das Fraturas Faciais, tratadas no Hospital Regional de Urgência e Emergência de Presidente Dutra; Assim classificando-o em gênero, faixa etária, localizações anatômicas mais atingidas e fator etiológico. Foi realizada uma análise epidemiológica das informações contidas nos prontuários dos 552 pacientes que foram atendidos pela equipe de Cirurgia e Traumatologia Buco-maxilo-facial no Hospital Regional de Urgência e Emergência de Presidente Dutra, na cidade de Presidente Dutra-Maranhão. Desses foi observada uma maior ocorrência no gênero masculino com 456 (82%), e a faixa etária mais acometida foi de 21 a 30 anos com 231 (42%), que pode ser atribuída ao maior acesso dos jovens à motocicleta, sendo o fator etiológico mais prevalente com 309 (62%), e a região mais atingida foi mandíbula e zigomático, com 177 (33%) e 146 (27%) respectivamente. Constataram-se, por meio dos dados, que os jovens do sexo masculino são os mais atingidos, e a motocicleta, o maior fator causal. Assim os dados sugerem um alerta aos órgãos públicos e à população, uma maior fiscalização e conscientização dos motociclistas quanto ao risco de acidentes e possíveis consequências... (AU)

This study aims to determine the prevalence of Facial Fractures treated in the Regional Hospital Emergency and Emergency Presidente Dutra. So classifying it in gender, age, most affected anatomical locations and etiology. An epidemiological analysis of the information contained in the medical records of 552 patients who were treated by the staff of Surgery and Traumatology Oral and maxillofacial at Regional Hospital Emergency and Emergency Presidente Dutra, in the city of Presidente Dutra-Maranhão was performed. These were observed a higher occurrence in males with 456 (83%) and the most affected age group was 21-30 years, with 231 (42%), which can be attributed to greater access for young motorcycle, which was the factor etiological more prevalent with 309 (62%), and the most affected region was jaw and zygomatic, with 177 (33%) and 146 (27%) respectively. It is found from the data that the young men are the most affected and the largest motorcycle causal factor, therefore the data suggest a warning to public agencies and the public greater oversight and awareness of motorcyclists on the inherent risk of accidents and possible consequences... (AU)

Trauma maxilofacial: avaliação de 1385 casos de fraturas de face na cidade de Passo Fundo - RS / Maxillofacila Trauma: Evaluation os 1385 Cases of Fracture of Face

O trauma é considerado a principal causa de óbito nos primeiros 40 anos de vida, sendo responsável por maior redução nos anos produtivos quando comparado às doenças cardíacas e câncer juntos. Este trabalho teve como finalidade identificar o quadro epidemiológico da traumatologia facial na região de Passo Fundo - RS. O estudo avaliou 1385 prontuários de pacientes que foram atendidos por trauma dos ossos faciais no Hospital São Vicente de Paulo (HSVP), considerado centro referencial de saúde no interior do Rio Grande do Sul, especialmente para a região nordeste do estado. Dos prontuários avaliados, pacientes do gênero masculino com faixa etária entre a terceira e a quarta décadas foram os mais acometidos. O osso facial mais acometido foi a mandíbula e o acidente automobilístico foi a etiologia mais prevalente seguido da agressão física que também se apresentou relevante. Os dados obtidos com este estudo reforçam a importância da cirurgia buco-maxilo-facial e contribuem para trabalhos preventivos em campanhas municipais, especialmente em educação para o trânsito e violência urbana... (AU)

Tauma is considered the leading cause of death in the first 38 years of life, accounting for a greater reduction in the productive years when compared to heart disease and cancer together. This study aimed to identify the epidemiological picture of facial trauma in the region of Passo Fundo-RS. The study examined records of 1385 patients who were treated for trauma of the facial bones in Sao Vicente de Paulo Hospital (HSVP), considered a reference health center in Rio Grande do Sul, especially for the northeastern state. Evaluated the medical records of male gender was the most predominant. The age group most affected was the third and fourth decade and the bone most commonly fractured was the mandible. Motor vehicle accidents were the most prevalent etiology of physical aggression that followed also presented relevant. The data obtained from this study will enable, and reinforce the importance of expertise, attention to the main etiological factors of fractures of facial bones, in order to target preventive work that can be used in traffic and urban violence education... (AU)

Incidental finding of co-existing life-threatening pathology during facial trauma assessment

Paediatric facial traumas are often accompanied by other intracranial and non-head injuries. Use of Computed Tomography (CT) has increased diagnostic accuracy when compared to plain radiographs alone. Coexisting anomalies can sometimes be a chance finding from the imagings and this highlights the need of a formal reporting by a radiologist. We report a case of a traumatic unilateral condylar fracture with a coexisting life-threatening abnormality detected from careful assessment of the imagings.

Fracturas mandibulares en el hospital universitario "General Calixto García" 2010-2011 / Mandibular fractures in university hospital "General Calixto García" 2010-2011

Introducción: la mandíbula sufre frecuentemente traumas y sus fracturas son unas de las más comunes en la región maxilofacial. Objetivo: describir las frecuencias de las fracturas mandibulares en el Servicio de Cirugía Maxilofacial del Hospital Universitario "General Calixto García". Material y métodos: se realizó un estudio prospectivo, descriptivo. La muestra estuvo constituida por 50 pacientes, seleccionados del total de pacientes con fracturas mandibulares, quienes acudieron al Servicio de Cirugía Maxilofacial del Hospital Universitario "General Calixto García" en el período noviembre 2010-octubre 2011. Los pacientes se sometieron a interrogatorio, examen clínico e imagenológico para su diagnóstico. Se utilizaron las variables edad, sexo, etiología, tipo de tratamiento y complicaciones postoperatorias. Resultados: pacientes con edades comprendidas entre 18 a 27 años (34%) fueron los más afectados; género masculino (80%) y la agresión física constituyó el principal factor etiológico (34%). Se encontró que el tratamiento quirúrgico fue el más empleado (58%) y la maloclusión resultó la complicación postoperatoria más corriente (57,1%). Conclusiones: las fracturas mandibulares se presentaron fundamentalmente en hombres, en edades intermedias y causadas por la agresión física. Se emplearon comúnmente el tratamiento quirúrgico y la maloclusión dentaria fue la complicación postoperatoria más frecuente.

Introduction: the jaw suffers frequently traumatic lesions and its fractures are some of the most common in the maxillofacial region. Objective: it came true this study with the objective of describing the frequent of the mandibles fractures in the Maxillofacial Surgery's service at the University Hospital General Calixto García. Material and methods: it came true a prospective study, descriptive. The sign was constituted for 50 patients, selected candidates of the total of patients with mandibles fractures that resorted to Maxillofacial Surgery's service. University Hospital General Calixto García. Period November 2010 - October 2011. The patients submitted to interrogation, clinical exam and imagenologic for theirs diagnosis. They appraised the variables age, sex, etiology, method of treatment and postoperative complications. Results: the patients with ages understood among 18 to 27 years ( 34 % ) were the more affected; masculine gender ( 80 % ) and physical aggression constituted the principal etiological factor ( 34 % ) .It found that the surgical treatment was the more employee ( 58 % ) and the malocclusion proved to be the postoperative complication plus ordinary ( 57.1 % ). Conclusions: the mandibles fractures show up fundamentally in men, in intermediates ages and caused for physical aggression. It used commonly the surgical treatment and the dental malocclusion was the postoperative complication more frequent.

Treatment and complications of orbito-zygomatic fractures / Tratamiento y complicaciones de las fracturas órbito-cigomáticas

The aim of the present study was to analyze the etiology, type and treatment employed in the orbito-zygomatic fractures (OZ). Also, postoperative complications are described and correlated with the type of treatment used. Fifty patients with OZ fractures were evaluated. Orbital fractures in which the zygomatic bone was not involved were excluded. Epidemiologic data and characteristics of treatment such as the type of material used for osteosynthesis, number of anatomical sites on which rigid internal fixation (RIF) was applied, surgical approaches and associated complications were recorded. The main causes of trauma were motorcycle and bicycle accidents, constituting 52 percent of the sample. The osteosynthesis system used was the 2.0 mm, except in four patients in whom the 1.5mm system was used for fixation at the infra-orbital rim. A total of 18 percent of the patients required reconstruction of the internal orbit and in all cases titanium mesh was used. 46 percent of the patients received RIF in three anatomical sites, most in the fronto-zygomatic suture, infra-orbital rim and zygomatic-maxillary buttress. The most frequent complication was paresthesia of the infra-orbital nerve (34 patients, 68 percent). Other findings were also discussed with the intent of better understanding the treatment of the OZ fractures...

El objetivo del presente estudio fue analizar la etiología, tipo y tratamiento empleado en las fracturas órbito-cigomáticas (OC). Además, se describen y correlacionan las complicaciones postoperatorias con el tipo de tratamiento utilizado. Cincuenta pacientes con fracturas OC fueron evaluados. Las fracturas orbitarias en la que el hueso cigomático no participó fueron excluidas. Los datos epidemiológicos y las características de tratamiento, tales como el tipo de material utilizado para la osteosíntesis, número de sitios anatómicos en los que se aplicó la fijación interna rígida (FIR), enfoques quirúrgicos y complicaciones asociadas fueron registrados. Las principales causas de los traumas fueron accidentes de bicicleta y motocicleta, constituyendo el 52 por ciento de la muestra. El sistema de osteosíntesis utilizado fue de 2,0 mm, excepto en cuatro pacientes en los que se utilizó el sistema de 1,5 mm para la fijación en el borde infraorbitario. El 18 por ciento de los pacientes requirieron reconstrucción de la órbita interna y en todos los casos se utilizó malla de titanio. El 46 por ciento de los pacientes recibió FIR en tres sitios anatómicos, la mayoría en la sutura fronto-cigomático, borde infraorbitario y pilar cigomato-maxilar. La complicación más frecuente fue parestesia del nervio infraorbitario (34 pacientes, 68 por ciento). Otros hallazgos fueron discutidos con la intención de comprender mejor el tratamiento de las fracturas OC...

Fratura facial em ciclista profissional: relato de caso / Facial fracture in a professional cyclist: a case report

O ciclismo é um esporte de velocidade, comumente associado a traumas agudos, como fraturas. Em razão de os modelos tradicionais de capacetes geralmente não oferecerem proteção contra traumas maxilo-faciais o ciclista fica vulnerável a sofrer fraturas de face, principalmente em terço médio e inferior. O objetivo deste trabalho é apresentar um caso de fratura isolada do complexo zigomático orbitário em ciclista profissional, tratado com redução aberta e osteossíntese com placa e parafusos por meio do acesso em região de sutura fronto-zigomática e rebordo infraorbitário, com retorno ao esporte na quinta semana de pós-operatório.

Cycling is a speed sport commonly associated with acute trauma such as fractures. Because traditional models of helmets usually do not offer protection against maxillofacial trauma, the cyclist is liable to suffer facial fractures, especially in the midface and lower face. The aim of this paper is to present a case of isolated fracture of the zygomatic-orbital complex in a professional cyclist, treated with open reduction and internal fixation with plate and screws through the infrapalpebral and superciliary access, who returned to his sport in the fifth postoperative week.

Estudio descriptivo del sistema hospitalario en relación a pacientes sometidos a tratamiento quirúrgico por trauma facial en el Hospital Hernán Henríquez Aravena de Temuco, Chile / Descriptive study of hospital system in relation to patients undergoing surgical treatment of facial trauma in the Hernan Henriquez Aravena Hospital of Temuco, Chile

El trauma maxilofacial conforma una serie de lesiones que involucran tejidos óseos y blandos, provocando alteraciones funcionales y estéticas. El objetivo de este trabajo es determinar el perfil de pacientes que son sometidos a tratamiento quirúrgico por trauma maxilofacial en los pabellones del Hospital Regional de Temuco. De la base de datos del centro de estadísticas del Hospital Regional Hernán Henríquez Aravena, se obtuvieron un total de 145 sujetos con trauma maxilofacial entre los años 2008 y 2009. De la misma base de datos se obtuvieron los datos con los que se determinó la frecuencia según año, etnia, sexo, edad, sistema de previsión, mes, jornada, servicio, diagnóstico de fractura, manejo de tejidos blandos y tratamiento. En este estudio se encontraron 28 casos no diagnosticados (19,3 por ciento), 35 fracturas de cigomático (24,1 por ciento), 17 fracturas de piso de orbita (11,7 por ciento), 22 fracturas de otros huesos del cráneo (15,2 por ciento), 21 fracturas de mandíbula (14,5 por ciento), 11 fracturas múltiples faciales (7,6 por ciento), 3 fracturas de base de cráneo (2,1 por ciento) y 8 otros (5,5 por ciento). Como conclusión podemos decir que las fracturas de cigomático es la más prevalente. Respecto al tratamiento más realizado en el trauma es la reducción con osteosíntesis múltiple.

Maxillofacial trauma constitutes a series of injuries involving bone and soft tissues, causing functional and aesthetic alterations. The aim of this study is to determine the profile of patients subject surgical treatment for maxillofacial trauma in the halls of the Regional Hospital in Temuco. From the central database of statistics Hernan Henriquez Aravena Regional Hospital we obtained a total of 145 patients with maxillofacial trauma between 2008 and 2009. In the same database the data was obtained to determine the frequency by year, ethnicity, sex, age, form of payment, month, day, service, diagnosis of fracture, soft tissue management and treatment. In this study we found 28 cases diagnosed (19.3 percent), 35 fractures of zygomatic (24.1 percent), 17 orbital floor fractures (11.7 percent), 22 fractures of other bones of the skull (15, 2 percent), 21 fractures of the mandible (14.5 percent), 11 multiple facial fractures (7.6 percent), 3 fractures of the skull base (2.1 percent) and 8 others (5.5 percent). In conclusion we can say that zygomatic fractures is the most prevalent, and treatment performed most frequently is the reduction with multiple fixations.

Fracturas faciales en pacientes menores de veinte años atendidos en la Unidadde Cirugía Maxilofacial y Estomatología del Hospital San Vicente de Paúl y la Facultad de Odontología de la Universidad de Antioquia entre los años 1998 y 2007 / Facial fractures in patients under the age of twenty years of age admitted at the Maxillofacial Surgery and Stomatology Unit of Hospital Universitario San Vicente de Paúl, between the years 1998-2007

Introducción: el propósito de este estudio fue encontrar la incidencia de fracturas de huesos faciales en pacientes menores de veinte años admitidos en la Unidad de Cirugía Maxilofacial y Estomatología del Hospital Universitario San Vicente de Paúl y de la Facultad de Odontología de la Universidad de Antioquia, Medellín, ejecutando un análisis descriptivo retrospectivo. Métodos: se presenta un estudio de 651 pacientes de veinte años de edad o menos, tratados con un total de 1.173 fracturas de huesos faciales durante un periodo de diez años entre 1998 y 2007, considerando la edad, sexo del paciente, tipo y localización común de las fracturas, etiología del trauma, tratamiento empleado, lesiones asociadas y la estancia hospitalaria. Los pacientes se dividieron en cuatro grupos de edad diferentes para su estudio. Resultados: se encontró que la mayoría de las fracturas faciales se presentaron en los varones. La etiología más frecuente de las fracturas de huesos faciales en niños fueron los accidentes de tránsito en motocicleta y las caídas, en todos los grupos de edad. La región del cóndilo mandibular fue el principal sitio comprometido seguido por las fracturas parasinfisiarias, y la fractura Le Fort III fue la menos común. El abordaje de tratamiento más comúnmente utilizado fue la combinación de terapias. Conclusiones: estos resultados documentan que los caracteres etiológicos y la incidencia de fracturas de huesos faciales en pacientes pediátricos incrementó con la edad. Las diferencias observadas deberían tenerse presentes en otros estudios relacionados con fracturas faciales en pacientes pediátricos.

Introduction: the purpose of this study was to determine the incidence of facial bone fractures in patients under the age of twenty years of age admitted at the Department of Maxillofacial Surgery and Stomatology at Hospital Universitario San Vicente de Paúl and the University of Antioquia, Medellín, by means of a descriptive retrospective analysis. Methods: six hundred fifty-one patients younger than 20 years of age who were treated for a total of 1173 facial bone fractures during a ten-year period between 1998 and 2007, were studied by age, gender, type and common locations of the fractures, etiology of the injury, method of treatment, associated injuries, and the length of hospitalization. The patients were divided into four different age groups. Results: it was found that the majority of facial fractures are found in males. Motorcycle accidents and falls were the two main causes of facial bone fractures in all age groups. The mandibular condyle region was the major injured site followed by fractures of the parasymphysis, and Le Fort III type was the least common fracture. The most common treatment approach used was the combined therapy. Conclusion: these results document that the etiological characters and incidence of facial bone fractures in pediatric patients increased with age. The differences observed should be taken into consideration in studies concerning facial fractures in pediatric patients.

Manejo del trauma facial: una guía práctica / Initial management of maxillofacial trauma: a practice guidelines

El trauma en general, y el facial en particular, han tenido un aumento en su frecuencia durante los últimos años. Constituye un reto para los médicos que se desempeñan en urgencia en cuanto a su manejo inicial, y un difícil problema para los especialistas que se desempeñan en esta área. Todo profesional que se enfrenta a estos pacientes debe tener los conocimientos necesarios de evaluación clínica, estudiode imágenes, tratamiento inicial, y la capacidad de efectuar una adecuada priorización en la resolución del trauma facial, en el contexto de la presencia de lesiones de otros sistemas y órganos. En este artículo revisaremos los principios básicos del manejo inicial del trauma máxilo facial.

In general, trauma, specifically facial trauma has increased in number of cases during the last years. This field is a challenge for emergency doctors in its inicial management, and a difficult task for profesionals related to this specialty.For profesionals dealing with these patients an adecuate training in clinical evaluation is a must, as well as, management of initial and advanced knowledge for proper diagnosis. Also, a list priorities when deciding over facial treatment in the context of several other wounds and damaged organs should be mastered.

OsiriX, visor DICOM útil para procesar imágenes tomográficas de fracturas faciales / OsiriX, a useful tool for processing tomographic images in patients with facial fracture

Introducción: El programa de código abierto OsiriX para MAC OS X® se presenta como una herramienta útil en el manejo de imágenes tomográficas para el diagnóstico y planificación preoperatoria en pacientes con fracturas del esqueleto facial. Material y métodos: Se realizó tomografía axial a 124 pacientes con fracturas faciales en el Servicio de Cirugía Maxilofacial y Reconstructiva del Hospital de Traumatología y Ortopedia Lomas Verdes. La información tomográfica en formato DICOM fue grabada en discos compactos y analizada en una computadora portátil Macintosh® con el programa OsiriX. Se realizó reconstrucción multiplanar y tridimensional y se compararon los hallazgos transoperatorios con la imágenes. Resultados: El 96.5 % de las imágenes coincidió con las reconstrucciones en el programa; solo 3.5 % presentó algún grado de discordancia por distorsiones en el estudio, secundarias a la presencia de proyectiles de arma de fuego y arcos férula de Erich. Conclusiones: Basados en los resultados, el programa OsiriX es una herramienta útil para el diagnóstico y planificación preoperatoria en pacientes con fracturas faciales. Además, evita la pérdida de información en el proceso de selección de las imágenes por el personal de radiología.

BACKGROUND: OsiriX, a Mac OS X-based open source program, is presented as a useful tool to process tomographic images for diagnosis and preoperative planning in patients with facial fractures. METHODS: CT scans were performed on 124 patients with facial fractures treated at the Department of Maxillofacial and Reconstructive Surgery of the Hospital de Traumatología y Ortopedia "Lomas Verdes" in Mexico City. Information obtained was recorded in DICOM format in CDs and processed in a Macintosh laptop with OsiriX software, doing multiplanar and 3D reconstructions. Surgical findings were compared to the images obtained by the software. RESULTS: Of the surgical findings, 96.5% matched with the OsiriX images. Only 3.5% of the OsiriX images were not consistent because of distortion or artifacts in the CT due to firearm projectiles and Erich arch bars near the involved area. CONCLUSIONS: Based on the results obtained, the authors consider that the OsiriX software is a useful tool for diagnosis and preoperative planning in patients with facial fractures. Furthermore, it prevents the loss of information due to the process of image selection by the radiology staff.

O uso das reconstruções tomográficas tridimensionais no diagnóstico do trauma facial: relato de três casos e revisão da literatura / The use of three-dimensional tomographic reconstructions in the diagnosis on facial trauma: report of three cases and literature review

As fraturas do complexo maxilofacial exigem uma compreensão tridimensional detalhada do padrãodo dano. A avaliação radiográfica adequada do paciente é a base para o planejamento da cirurgia reparadora. Para a efetivação das manobras cirúrgicas que envolvem esse tipo de trauma, a anatomia e o diagnóstico por imagem exercem importante papel. As imagens tridimensionais são especialmente úteis ao cirurgião porque permitem a representação panorâmica do complexo facial e da fratura, o que facilita o planejamento do tratamento. O presente trabalho visa a relatar umaapresentação de três casos clínicos, bem como uma revisão de literatura, discutindo sobre a utilização das reconstruções tomográficas tridimensionais no diagnóstico do trauma facial.

Fractures on the maxillofacial complex demand a detailed threedimensionalcomprehension of the damaged area. A correct radiographic evaluation is essential for the planning of the repair surgery. The surgical maneuvers involving this type of trauma dependon the knowledge of anatomy and an image diagnosis. The threedimensionalimages are especially important for the surgeons due to the fact that they allow a panoramic representation of the facialcomplex and of the fracture, facilitating the treatment planning. This study aims to report three clinical cases, as well as a literature review, discussing the utilization of three-dimensionaltomography reconstructions on the diagnosis of the facial trauma.

Fracturas maxilofaciales y factores asociados en derechohabientes del IMSS Campeche, México: Análisis retrospectivo 1994-1999 / Maxilofacial Fractures and Associated Factors in Campeche Mexico, Instituto Mexicano del Seguro Social Medical Insurance Policyholders: Retropsective Analysis 1994-1999

Objetivo: determinar la prevalencia y distribución de fracturas maxilofaciales (FMs) en derechohabientes del Instituto Mexicano del Seguro Social (IMSS) Campeche. Material y métodos: estudio transversal con datos de pacientes atendidos en el departamento de Cirugía Oral y Maxilofacial (enero-1994 a diciembre-1999) del IMSS Campeche. Se utilizaron registros diarios, libretas de programación quirúrgica y expedientes de 1611 pacientes para determinar la presencia de FMs la edad, el sexo y la calidad del asegurado. FI análisis se realizó en STATA 7 utilizando X². Se calcularon razones de momios (RM) con intervalos de confianza al 95% (1C95%). Resultados: la prevalencia de FMs fue de 9.4%. la media de edad fue de 31.04 ± 15.49 años. El mayor porcentaje de FMs fueron las Dentó alveolares (26.3%), seguida de las del ángulo mandibular (20.4%) y de las del cuerpo mandibular (13.2%). El sexo masculino estuvo fuertemente asociado a la presencia de FMs (RM=6.1; 1C95% 4.08,9.12). los grupos de edad con mayor asociación a FMs fueron los de 41-50 (RM=3.30 1C95% 1.57, 6.96) y el de 31-40 (RM=2.871C95%1.53, 5.55). los trabajadores presentaron una asociación superior (RM=6.25 1C95% 3.21,13.56) a los otros grupos de asegurados. Conclusiones: las características epidemiológicas de FMs fueron similares a las reportadas en la literatura especializada. Se observó principalmente en hombres y en los grupos de edad intermedia. los patrones de fracturas en los pacientes estudiados fueron diferentes según el grupo de edad al que pertenecían.

Objective: To determine prevalence, distribution, and associated factors of maxillofacial fractures (MFs) among third-party insurance plan patients. Method: A cross-sectional and descriptive study with data of patients from Oral and Maxilofacial Surgery Department (January 1994 to December-1999) at the Instituto Mexicano del Seguro Social in Campeche, Mexico, was carried out. Daily registries, surgical programming lists' and charts off 611 patients were used to determine presence of MFs, age, sex, and status of the insured. Analysis was made in STATA 7 using X². Odds ratio (OR) with confidence intervals to 95% were calculated (1C9 5%). Results: The prevalence of MFs was 9.4%. The age average was 31.04 +15.49 years old. The major percentage of MFs were dentoalveolar fractures (26.3%), followed by mandibular angle (20.4%) and mandibular body (13.2%). Being a male was strongly associated with presence of MFs (OR=6. 1; 1C95% 4.08, 9.12). The groups of age with greater association to MFs were those of 41-50 (RM-3.30 1C 95% 1.57, 6.96) and those of 31-40 (RM=2.87 1C95% 1.53,5.55). The workers-category displayed a superior association (RM=6.251C 95% 3.21, 13.56) to the other groups of the insured category. Conclusions: The epidemiologic characteristics of MFs were similar to those reported in the specialized literature. Appearing mainly in men and intermediate age groups ages. The patterns of fractures in the studied patients were different according to the age group to which they belonged.