Impact of the COVID-19 on the epidemiology of maxillofacial fractures surgically treated in a Cuban university hospital / Impacto del COVID-19 en la epidemiología de las fracturas maxilofaciales tratadas quirúrgicamente en un hospital universitario cubano

Introduction: COVID-19 pandemic has had a significant impact on people's behavior. Aim: To evaluate the impact of the COVID-19 on the epidemiology of maxillofacial fractures surgically treated in a Cuban university hospital. Methods: This research involved a 4-year descriptive, comparative, retrospective and cross-sectional study. Patients surgically treated between March 1 and December 31, 2020 (COVID-19 period) were compared with those who had undergone surgery between the same date in the years 2017-2019 (non-pandemic period). Age, sex, residence, year, month, alcohol consumption at the time of trauma, etiology, fractures types, and number of fractures per patient were recorded. Results: A decline in patients with maxillofacial fractures in 2020 (n=25) was observed when compared to equivalent periods in the three previous years (2017: n=37; 2018: n=31; 2019: n=41), respectively, with an annual average reduction of 31.19 percent. Interpersonal violence was found to be the paramount etiological factor for maxillofacial fractures during the comparison periods (2017-2019); however, road traffic accident prevailed in the 2020 (n=12; 48 percent). There was a small increase in the number of alcohol-related fractures (56 percent in 2020 vs 46.34 percent, 41.94 percent, and 51.35 percent in 2019, 2018, and 2017, respectively). Conclusion: COVID-19 impacted on the epidemiology maxillofacial fractures surgically treated in this Cuban university hospital (AU)

Introducción: La pandemia de la COVID-19 ha tenido un impacto significativo en el comportamiento de la población. Objetivo: Evaluar el impacto de la COVID-19 en la epidemiología de las fracturas maxilofaciales tratadas quirúrgicamente en un hospital universitario cubano. Métodos: Esta investigación consistió en un estudio descriptivo, comparativo, retrospectivo y transversal de 4 años de duración. Se compararon los pacientes intervenidos quirúrgicamente entre el 1 de marzo y el 31 de diciembre de 2020 (periodo COVID-19) con los intervenidos entre la misma fecha en los años 2017-2019 (periodo no pandémico). Se registraron edad, sexo, residencia, año, mes, consumo de alcohol en el momento del traumatismo, etiología, tipos de fracturas y número de fracturas por paciente. Resultados: Se observó un descenso de pacientes con fracturas maxilofaciales en 2020 (n=25) en comparación con periodos equivalentes de los tres años anteriores (2017: n=37; 2018: n=31; 2019: n=41), respectivamente, con una reducción media anual del 31,19 poe ciento. Se observó que la violencia interpersonal fue el factor etiológico primordial de las fracturas maxilofaciales durante los periodos de comparación (2017-2019); sin embargo, el accidente de tráfico prevaleció en el 2020 (n=12; 48 por ciento). Hubo un pequeño aumento en el número de fracturas relacionadas con el alcohol (56 por ciento en 2020 frente a 46,34 por ciento, 41,94 por ciento y 51,35 por ciento en 2019, 2018 y 2017, respectivamente). Conclusiones: La COVID-19 impactó en la epidemiología de fracturas maxilofaciales atendidas quirúrgicamente en este hospital universitario cubano (AU)

Osteotomía Le Fort III modificada en un paciente no sindrómico / Modified Le Fort III osteotomy in a non-syndromic patient

Las discrepancias dento-esqueletales severas presentan un reto para el cirujano maxilofacial, existe una versatilidad de osteotomías para las diferentes anomalías del crecimiento y desarrollo, sin embargo, son pocas las que permiten mejorar la proyección malar. La osteotomía Le Fort III modificada fue utilizada en un principio en pacientes con algún síndrome craneofacial, pero actualmente es una alternativa útil para discrepancias severas en pacientes no sindrómicos, ya que permite un avance cigomático-maxilar, favorece la proyección malar y disminuye la exposición escleral con un número limitado de complicaciones. Se presenta el caso de un paciente masculino de 33 años con antecedente de fractura orbitocigomática y piso orbitario izquierda con una discrepancia dento-esqueletal severa, la que fue tratada mediante osteotomía Le Fort III modificada, osteotomías sagitales mandibulares para un avance máxilo-malar y retroceso mandibular respectivamente y una genioplastia de avance; logrando un resultado funcional y estético adecuado.

The dento-skeletal severe discrepancies present a challenge for the maxillofacial surgeon, there is a versatility of osteotomies for the different growth and development anomalies, however, a few of them make possible to improve malar projection. The modified Le Fort III osteotomy was originally used in patients with some craniofacial syndrome, but now it is a useful alternative for severe discrepancies in non-syndromic patients, since it allows a zygomatic-maxillary advance, favors malar projection and reduces scleral exposure with a limited number of complications. The case of a 33-year-old male patient with a history of orbitozygomatic fracture and left orbital floor with a severe dento-skeletal discrepancy is presented, who was treated by modified Le Fort III osteotomy, mandibular sagittal osteotomies for maxillo-malar advancement and retrogression mandibular respectively and geniplasty for advance; achieving a suitable functional and aesthetic result.

Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil / Tempo de recuperação funcional após fraturas faciais: perfil e fatores associados em amostra de pacientes do sul do Brasil

ABSTRACT Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

RESUMO O entendimento da causa, da gravidade e do tempo decorrido para o restabelecimento das funções de lesões maxilofaciais pode contribuir para o estabelecimento de prioridades clínicas objetivando o efetivo tratamento e prevenção dos traumatismos de face. Assim, o objetivo deste estudo foi compreender quais os fatores associados ao restabelecimento das funções mastigatórias, oculares e nasais em vítimas de trauma de face, estimando o tempo para recuperação das funções, após o tratamento cirúrgico. Foram analisados 114 prontuários de pacientes atendidos no Hospital de Montenegro que compareceram às consultas de acompanhamento por até 180 dias. Para a análise do tempo para a recuperação, foi realizada a análise de sobrevida, seguida da análise de COX. Observou-se que metade dos pacientes recuperaram as funções em até 20 dias, sendo que o tempo médio para recuperação dos traumas no complexo zigomático-orbitário-malar-nasal foi de 11 dias e do complexo maxilo - mandibular de 21 dias (HR: 1,5 (0,99 - 2,3) p=0,055). Embora o restabelecimento das funções tenha atingido taxas elevadas após abordagem cirúrgicas, faz-se necessária a análise dos casos de insucessos bem como os impactos econômicos e as estratégias de prevenção associados aos traumas de face a fim de qualificar o serviço prestado à população.

Pólipos bucales como complicación de una fractura de la tuberosidad / Oral polyps as a complication of a tuberosity fracture

Introducción: la importancia de los senos maxilares se vuelve más clara cuando se entiende que los dientes son responsables del 10 al 12 por ciento de las sinusitis maxilares. Objetivo: caracterizar un caso de pólipos bucales como complicación de una fractura de la tuberosidad. Presentación del caso: se valora una paciente femenina de 62 años que refiere tener una bolita en la boca desde hace 3 semanas, que le ha ido en aumento. Al examen físico bucal encontramos un aumento de volumen en la región posterior maxilar izquierda. Al profundizar en el interrogatorio la paciente refiere que le realizaron una extracción de un molar en el área del aumento de volumen 6 meses atrás, que salió con un fragmento de hueso y que sentía que se le salía el aire, por lo que le suturaron en ese momento. Indicamos medios auxiliares de diagnóstico. Se llegó al diagnóstico de que se trataba el aumento de volumen de pólipos sinusales en una fístula bucoantral como complicación de una fractura de la tuberosidad antigua. Se decidió realizar tratamiento mediante la indicación de antimicrobiano, gotas nasales, inhalaciones, y la realización una técnica de Caldwell Luc, con eliminación de los pólipos presentes, más fistulectomía y cierre mediante colgajo vestibular deslizante. Se tomó muestra para biopsia que informó la presencia de una sinusitis crónica polipoide. Conclusiones: la cirugía bucal es de imprescindible conocimiento para todos los profesionales de la rama estomatológica. El caso presentado de pólipos bucales en una fístula bucoantral como complicación de una fractura de la tuberosidad, de infrecuente presentación en la clínica, contribuye a resaltar la importancia de realizar un correcto interrogatorio para determinar las herramientas diagnósticas y terapéuticas a emplear(AU)

Introduction: the importance of the maxillary sinuses becomes clearer when it is understood that the teeth are responsible for 10 to 12 percent of the cases of maxillary sinusitis. Objective: present a case of oral polyps as a complication of a tuberosity fracture. Case presentation: a 62-year-old female patient attends consultation with a lump in her mouth which she has had for three weeks, during which time it has grown larger. Physical examination reveals a growth in the left posterior maxillary region. During interrogation the patient explained that six months before she was removed a molar from the area of increased volume. The molar had come out with a bone fragment, and she had felt air escaping through the opening, so they sutured right away. We indicated auxiliary diagnostic means. Diagnosis was an increase in the volume of paranasal polyps in an oroantral fistula as a complication of a fracture of the former tuberosity. The treatment indicated was an antimicrobial, nose drops, vaporizations, and performance of a Caldwell Luc technique with removal of the polyps, plus fistulectomy and closure by sliding vestibular flap. A sample was taken for biopsy, which revealed the presence of chronic polypoid sinusitis. Conclusions: training in oral surgery is essential for all dental professionals. The case presented of oral polyps in an oroantral fistula as a complication of a tuberosity fracture, of infrequent clinical presentation, contributes to highlight the importance of proper interrogation to determine the diagnostic and therapeutic tools to be used(AU)

Radiographic and clinical evaluations of the zygomatico-maxillary complex fractures treated by 2. 0 miniplates system / Evaluaciones radiográficas y clínicas de fracturas del complejo cigomáticomaxilar tratadas por el sistema de mini placas 2. 0

The zygomaticomaxillary complex (ZMC) is the second highly incidental of facial fractures. According to the anatomical complexity, there are many reports in the literature about this trauma, mainly related to treatment for these fractures. With the purpose of evaluating clinically and radiographically the stability of unilateral zygomatic fractures treated by surgical reduction and fixed in two points by stable internal fixation, this research was proposed. Twenty patients with zygomatic fractures were evaluated and compared with twenty nonfractured patients. The results showed that there were no statistically significant differences among the obtained data, perimeter and area, of the treated and contra-lateral sides of the experimental group. When compared to the control group the differences were not statistically significant. We also performed a comparison of the distance between the nasal bone and zygomatic prominence in all groups the results were also satisfactory

Las fracturas del complejo cigomaticomaxilar son las segundas más frecuente del territorio facial. De acuerdo con la complejidad anatómica, existen muchos informes en la literatura sobre este trauma, principalmente relacionadas con el tratamiento de estas fracturas. El propósito de esta investigación fue evaluar clínica y radiográficamente la estabilidad de las fracturas cigomáticas unilaterales tratadas por reducción quirúrgica y fijadas en dos puntos por fijación interna estable. Veinte pacientes con fracturas cigomáticas fueron evaluados y comparados con veinte pacientes sin fracturas. En el grupo experimental, los resultados mostraron que no hubo diferencias estadísticamente significativas entre los datos obtenidos del perímetro y el área de los lados tratados y contralaterales. Al comparar estos datos con el grupo de control las diferencias no fueron estadísticamente significativas. También se realizó una comparación de la distancia entre el hueso nasal y la prominencia cigomática en todos los grupos, estos resultados también fueron satisfactorios

Airway management in a patient with Le Fort III Fracture

Maxillofacial fractures present unique airway problem to the anesthesiologist. Patients with LeFort III fractures are at great risk of requiring emergent airway control due to midface instability and oropharyngeal airway obstruction. We present a case where difficult intubation was managed with close cooperation between the anesthesiologist and the surgeon

Maxillofacial fractures in Hyderabad city: a 1-year study of 448 patients

This descriptive study assesses the cause, type, incidence and treatment modalities of maxillofacial fractures managed at our center during the 1-year of time period. Descriptive Study. This study was carried out at Department of Oral and Maxillofacial surgery Institute of Dentistry LUMHS, Jamshoro. A total 384 cases were studied. A detailed history, clinical examination was performed and finally diagnosis confirmed with the help of radiograph, at least two radiographs were taken. Records of patients enrolled who were either treated in the Emergency Room, Out-Patients Department or in the Ward. A numbers of parameters, including Age, gender, cause, type of injury and treatment provided were assessed. Out of 448 patients, 318 were male and 130 were female. Majority of patients belong to 3[rd] decade [21-30 years] of life. Road traffic accidents 56.91% accounted for the majority of cases of maxillofacial fractures followed by assault 10.49%, fall 19.86%, sports 4.68% Mandible was seen as the most commonly fractured bone 44% [287] followed by maxillary bone 23.92% [156], Zygomatic bone complex 18.40% [120] and majority of the bony maxillofacial injuries were treated by open reduction and internal fixation [ORIF]. Males of age group 21-30 years were more frequently involved in maxillofacial fractures. Road traffic accident was the most common cause of trauma in this part of the country, which requires proper implementation of traffic legislation use of helmet while riding the cycle or motor bike. Mandible was fractured in majority of cases; common treatment modality of maxillofacial fractures at our center was Maxillo-mandibular fixation with miniplates

Sialocele: An unusual case report and its management.

A post traumatic parotid sialocele is an acquired lesion that arises from extravasation of saliva into glandular or periglandular tissues secondary to disruption of the parotid duct or parenchyma. Facial trauma and surgery in the parotid region are the most common causes of this rare condition. This paper presents an unusual incidence of post traumatic parotid sialocele after Le-Fort II fracture reduction and its management by relatively simple and cost-effective technique which can be carried out in routine dental surgery suite. The results achieved justify our recommendation of scalp vein cannula for the treatment of sialocele in clinical practice.

Aportes y modificaciones de técnicas quirúrgicas en cirugía craneofacial pediátrica / Contributions and modifications of surgical techniques in pediatric craniofacial surgery

Las deformidades craneofaciales se deben en su mayoría a alteraciones del crecimiento y desarrollo, traumatismos y neoplasias. Con el objetivo de describir el tratamiento quirúrgico integral de estas y las modificaciones y aportes realizados a las técnicas craneofaciales tradicionales, se realizó un estudio descriptivo transversal en 46 pacientes tratados por el equipo interdisciplinario de cirugía craneofacial del Hospital Pediátrico Universitario Juan M Márquez, en el período comprendido entre mayo de 2003 a marzo de 2007. La edad promedio de los pacientes intervenidos fue de 6,3 años. Se realizó una veintena de técnicas quirúrgicas. La más utilizada fue la suturectomía coronal con hemiavance en antifaz y craneoplastia frontal, para el 15,2 por ciento; seguida de la suturectomía coronal con avance en antifaz y craneoplastia frontal, para el 10,9 por ciento. El 8,9 por ciento de los pacientes necesitó osteotomía Le Fort III para distracción del tercio medio. Los aportes introducidos fueron: la plicatura radiada de la duramadre con bipolar en el 75,0 por ciento de los craneotomizados, incisión puntiforme de la duramadre para descomprimir hipertensión encefálica transoperatoria o retraer encéfalo para osteotomías de base de cráneo en el 64,3 por ciento de los craneotomizados; fractura en tallo verde a nivel del pterium, en el colgajo en antifaz para las técnicas de Marshall, usada en el 83,3 por ciento de los braquicéfalos o plagiocéfalos; el avance sólo del lado afectado en el 100 por ciento de las plagiocefalias, con modificación de la técnica de Marshall, entre otras, para un total de 9 modificaciones a los procederes quirúrgicos. Hubo ausencia de complicaciones asociadas a éstas, con más de 2 años de evolución posoperatoria(AU)

Most of he craniofacial deformities are caused by development and growth alterations, traumata and neoplasms. To describe the integral surgical treatment of above deformities and the modifications and contributions carried out to traditional craniofacial techniques, a cross-sectional and descriptive study was conducted in 46 patients seen by the craniofacial surgery multidisciplinary staff from Juán Manuel Máquez University Children Hospital from May, 2003 to March, 2007. Mean age of the patients operated on was of 6.3 years. Twenty Surgical tehniques were performed where the more used was he coronal suturectomy with a mask hemi-advance and frontal cranioplasty for the 15.2 percent, followed by the coronal suturectomy with the two above techniques for te 10.9 percent. The 8.9 percent of patients need LeFort III osteotomy for distraction of half-third. The contributions included: radiate plication of dura mater with the bipolar type in the 75,0 percent of craniotomy patients, punctiform incision of dura mater to decompress a transoperative encephalic hypertension or to retract the encephalon for osteotomies on skull base in the 64,3 percent of craniotomy patients, greenstick fracture at level of pterion in the mask flap for the Marshal's techniques used in the 83,3 percent of the brachycephalous or plagiocephaly with advance only of inolved side in the 100 percent of plagiocephalies with a modification of Marshall's technique among others, for a total o 9 modifications to surgical procedures. There weren't complications associated with these procedures and more than two years of posoperative cours(AU)

Análise epidemiológica das fraturas faciais em um hospital secundário / Epidemiological analysis of facial fractures in a secondary hospital

Introdução: Os traumas de face são diagnósticos frequentes no pronto-socorro. Suas causassão variadas, sendo as principais a violência e os acidentes de trânsito. Os dados epidemiológicossão importantes para o conhecimento do problema e para contribuir na realização demedidas preventivas, educacionais e técnicas. Objetivo: O objetivo do trabalho foi relatar aexperiência do autor no atendimento aos traumatismos de face em um hospital secundário eavaliar as características epidemiológicas durante os primeiros 37 meses do serviço. Método:Estudo observacional, prospectivo, longitudinal dos pacientes atendidos no Pronto-socorro,no período de 1 de março de 2004 a 30 de abril de 2007. Dados dos 136 pacientes do estudoforam registrados em protocolo específico. Resultados: Houve predomínio do sexomasculino (76%) e a idade média foi de 29,67 anos. As principais causas foram as quedas(27,8%) e a as agressões (26,3%). O nariz foi o local mais acometido (50% dos casos),seguido pelas fraturas do complexo órbito-zigomático (24,3%). Nas fraturas de mandíbula,o côndilo foi o local mais afetado (28,6%). A redução nasal com a pinça de Asch foi tratamentomais utilizado (40,2%), seguido das placas e parafusos nos outros tipos de fraturas(31,8%). O índice de complicações foi de 5,8%. O seguimento pós-operatório demonstrouíndice de satisfação dos pacientes de 85%. Conclusão: Os dados de incidência, tratamento ecomplicações obtidos estão de acordo com a literatura científica. Os dados epidemiológicosobtidos serão utilizados na implementação de medidas para a prevenção do trauma facial.

Background: Facial traumas are frequently diagnosed within an emergency hospital. Theircauses vary and the most prevalent are interpersonal violence and traffic accidents. Epidemiologicaldata is important to understand the problem and to propose technical, preventiveand teaching issues. Purpose: The goal of this study was to show the author’s experience withfacial trauma in a small hospital and evaluate the first 37 months of this service. Methods:It was an observational, prospective, longitudinal study of the patients from the emergencyfrom March 1, 2004 to April 30, 2007. Data from the 136 patients were registered in a specificprotocol. Results: There was a male predominance (76%) and the mean age was 29.67years. The main causes were falls (27.8%) and interpersonal violence (26.3%). The nosewas the most affected location with 50% of the cases, followed by orbitozygomatic complex(24.3%). In the mandible fractures the condile was the most affected location (28.6%). Nasalclosed reduction with Asch forceps was the most utilized treatment (40.2%), followed byminiplates and screws for the other fracture locations (31.8%). Complications were presentin 5.8% of the cases. Follow up of the patients has shown a satisfaction rate of 85%. Conclusion:Incidence, treatment and complication data obtained are according to the literature.Epidemiological data collected will be useful to take measures to prevent facial trauma.

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.

Management of facial trauma in children: A case report.

Children are uniquely susceptible to cranio facial trauma because of their greater cranial mass to body ratio. Below the age of 5, the incidence of pediatric facial fractures in relation to the total is very low ranging from 0.6-1.2%. Maxillo-facial injuries may be quite dramatic causing parents to panic and the child to cry uncontrollably with blood, tooth and soft tissue debris in the mouth. The facial disfigurement caused by trauma can have a deep psychological impact on the tender minds of young children and their parents. This case report documents the trauma and follow up care of a 4-year-old patient with maxillofacial injuries.

Surgical treatment of Le Fort fractures in Ban Pong Hospital: two decades of experience.

A retrospective study of 64 patients with maxillary fracture of Le Fort type who were treated at the Surgical Department, Ban Pong Hospital, Ratchaburi, Thailand during the past 21 years (September 1st, 1979 - August 31st, 2000) is presented. Most of the patients were male (84.4%). Patients mainly affected were in the third decade of life (54.7%) with an age range of 13-65 years old. The etiology of the fracture was mostly related to road traffic accidents (90.6%). The most common type was Le Fort II fracture (54.7%), followed by associated facial bone injury were mandible (47.4%) and associated other organ injuries were fractures elsewhere (50.0%). Open reduction with intermaxillary fixation and maxillary suspension were the treatments of choice and the results were considered to be successful with only mild post-operative complications.

Reconstruçäo do complexo zigomático-maxilar com enxerto autógeno de crista ilíaca: relato de caso clínico / Reconstruction of the zygomatic-maxillary complex with iliac crest autogenous graft: case report

Os métodos apropriados para o tratamento de fraturas do complexo zigomático-maxilar têm sido discutidos amplamente. Entretanto, é consenso geral que fraturas com grande grau de deslocamento, associadas a perdas de tecido ósseo, implicam, necessariamente, numa intervençäo cirúrgica onde a fixaçäo das regiöes fraturadas e a reconstruçäo óssea estäo indicadas. Os autores relatam o caso clínico de um paciente de 20 anos de idade, vítima de acidentes motociclístico, que apresentou fratura cominutiva do complexo zigomático- maxilar, tendo perda de substância óssea na regiäo infra-orbitária e pilares zigomático e canino, que foram reconstruídos com enxerto autógeno de crista ilíaca anterior

Avaliaçäo da estabilidade das fraturas maxilares tratadas com reduçäo cirúrgica e fixaçäo interna rígida / Assesment of stability of maxillary fratures treated by open reduction and rigid internal fixation

Foi avaliado clínica e radiograficamente, 35 pacientes que sofreram fraturas da maxila em qualquer nível, tratadas através de fixaçäo interna rígida. Dentre estes, 19 que dispunham de telerradiografias padronizadas, receberam análise cefalométrica para verificaçäo da estabilidade maxilar. Os resultados demonstraram que a fixaçäo rigida foi excepcionalmente estável, com diferenças de posiçäo óssea de em média de 0,2mm, entre o pós-operatório imediato e pós-operatório a longo prazo (mínima de 6 meses). A fratura maxilar mais freqüente foi a combinaçäo le Fort I/II(51 por cento), seguida da combinaçäo le Fort I/II/III(28,5 por cento). O traumatismo crânio-encefálico associado ocorreu em 71 por cento dos pacientes. A incidência de fraturas associadas do osso frontal foi alta, tendo ocorrido em 20 por cento dos pacientes. Fístula liquórica ocorreu em 25,7 por cento dos casos. A incidência de fraturas da coluna cervical foi de 2,8 por cento

Indicaçäo de exploraçäo e reparaçäo do assoalho da órbita nas fraturas do complexo zigomático-maxilar / Indications of exploration and repair of the orbital floor in fractures of the maxillozygomatic complex

Pacientes com fraturas dos ossos da face que comprometem a regiäo orbital podem apresentar complicaçöes tardias, como distropia ocular, enoftalmo ou diplopia, decorrentes de lesöes do assoalho da órbita com herniaçäo de conteúdo orbital para o seio maxilar. Os dados clínicos e radiológicos na fase aguda do trauma säo, muitas vezes, insuficientes para indicar ou näo a reparaçäo da lesäo. OBJETIVO. Analisar a indicaçäo de reparaçäo do assoalho orbital mediante exploraçäo sistemática desta regiäo, por ocasiäo do tratamento cirúrgico das fraturas, comparando o achado cirúrgico com os dados clínicos pré-operatórios, assim como avaliar as complicaçöes da técnica utilizada. MÉTODO. Foram estudados, retrospectivamente, 112 pacientes portadores de fratura unilateral do complexo zigomático-maxilar, submetidos a tratamento cirúrgico, quando se realizou a reduçäo e fixaçäo das fraturas sob visäo direta, exploraçäo sistemática do assoalho orbital e sua reparaçäo, quando indicada, com enxerto autógeno de cartilagem auricular. RESULTADOS. A reparaçäo do assoalho orbital foi indicada em 46,4 por cento dos casos, mediante exploraçäo cirúrgica. A diplopia pré-operatória estava presente em 26,6 por cento dos pacientes e o enoftalmo foi observado em 3,3 por cento dos casos, na fase aguda do trauma. Dentre os pacientes portadores de diplopia pré-operatória, 60 por cento apresentavam indicaçäo de reparaçäo e 40 por cento näo necessitaram de reparaçäo, mediante avaliaçäo cirúrgica. Dentre os pacientes que näo aprsentavam diplopia pré-operatória, 36,2 por cento tiveram indicaçäo de reparaçäo do assoalho orbital. Näo foram observadas complicaçöes graves com a técnica utilizada. CONCLUSAO. A exploraçäo do assoalho da órbita representa uma manobra complementar ao tratamento das fraturas do complexo zigomático-maxilar e permite o diagnóstico preciso de lesöes com indicaçäo de reparaçäo. A alta incidência de lesöes com indicaçäo de reparaçäo (46,4 por cento) e a ausência de complicaçöes graves da técnica empregada permitem a proposiçäo de sua utilizaçäo em todos os casos de fratura do complexo zigomático-maxilar