Epidemiological analysis of 736 patients who suffered facial trauma in Brazil / Análisis epidemiológico de 736 pacientes que sufrieron trauma facial en Brasil

The etiology of facial fractures is directly related to the studied country, varying according to the socioeconomic, cultural condition of the population, besides the period of investigation. The objective of the present study is to evaluate the epidemiological characteristics of the prevalence, treatment modalities and complications rates of maxillofacial fractures in a hospital in the state of Espírito Santo, over a period of 5 years. A total of 428 patients presented a facial fracture, with a prevalence of males (436), with a mean age of 40 years. Regarding the number of fractures, 291 individuals suffered fractures only in the fixed skeleton, 97 only in the mandible, and 48 suffered fractures in both fixed and mandibular skeletons. The predominant anatomical site in fixed skeletal fractures was zygomatic complex (56.6 %), orbit (31.9 %) and nose (29.2 %); while in the mandible the condyle (33.8 %), body (17.9 %) and angle (13.1 %). The frequent etiology was falls, physical aggression, sports accidents. Regarding the type of treatment, in fixed skeleton 192 fractures were treated conservatively and 303 by surgery. Already in the mandible, the numbers were 43 and 143, respectively. In addition, 24 patients progressed with some type of complication in one or more operated sites. It is worth mentioning that epidemiological assessments provide important support in the creation of legislation in the attempt to reduce important for the establishment of clinical and research priorities, since risk factors and patterns of presentation can be identified. Accordingly in an attempt to reduce these rates.

La etiología de las fracturas faciales está directamente relacionada con el país estudiado, variando según la condición socioeconómica y cultural de la población, además del período de investigación. El objetivo del presente estudio fue evaluar las características epidemiológicas de la prevalencia, las modalidades de tratamiento y las tasas de complicaciones de las fracturas maxilofaciales en un hospital en el estado de Espírito Santo, durante un período de 5 años. Un total de 428 pacientes presentaron fractura facial, con una prevalencia de varones (436), con una edad media de 40 años. Con respecto al número de fracturas, 291 individuos sufrieron fracturas solo en el esqueleto fijo, 97 solo en la mandíbula y 48 sufrieron fracturas tanto en el esqueleto fijo como en el mandibular. El sitio anatómico predominante en las fracturas esqueléticas fijas fue el complejo cigomático (56,6 %), la órbita (31,9 %) y la nariz (29,2 %); mientras que en la mandíbula el cóndilo (33,8 %), el cuerpo (17,9 %) y el ángulo (13,1 %). La etiología frecuente fue caídas, agresión física, accidentes deportivos. En cuanto al tipo de tratamiento, en el esqueleto fijo se trataron 192 fracturas de forma conservadora y 303 mediante cirugía. Ya en la mandíbula, los números eran 43 y 143, respectivamente. Además, 24 pacientes progresaron con algún tipo de complicación en uno o más sitios operados. Cabe mencionar que las evaluaciones epidemiológicas brindan un apoyo importante en la creación de legislación en estos casos, para establecer prioridades clínicas y de investigación, debido a que se pueden identificar factores de riesgo y patrones de presentación. En consecuencia, en un intento de reducir estas tasas.

Reanimação estática do lábio inferior na paralisia facial como complicação de preenchimento / Static lower lip reanimation as a filler complication of facial paralysis

Procedimentos de rejuvenescimento facial substitutos da cirurgia tradicional tornaram-se cada vez mais populares para promover uma aparência jovial com procedimentos minimamente invasivos, como toxina botulínica injetável, preenchimento de tecidos moles e peelings químicos. No entanto, complicações podem ocorrer mesmo na presença de um injetor habilidoso e experiente. Apresentamos o caso de uma paciente submetida a reanimação labial estática usando retalho dermoadiposo para lesão do nervo facial direito após remoção de nódulos como complicação de preenchimento. A "abordagem modificada de bull horn" foi realizada para elevação do lábio superior em torno das asas nasais e columela e ao longo do sulco nasolabial direito. O retalho foi desepitelizado e obtido. Usando a ponta aberta de uma pequena cânula de lipoaspiração, a porção distal do retalho foi encapsulada e fixada diretamente em C-loop e foram utilizados pontos U, transfixando o retalho para o periósteo do arco zigomático. Nos três anos de seguimento não foram observadas complicações significativas e a paciente não relatou nenhuma limitação funcional ou insatisfação com o aspecto das cicatrizes no sulco nasolabial e ao redor das asas nasais e da columela.

Facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular to promote a youthful appearance with minimally invasive procedures such as injectable botulinum toxin, soft-tissue fillers, and chemical peels. Nevertheless, complications can occur even with an astute and experienced injector. Here we present the case of a patient who underwent static lip reanimation using a dermoadiposal flap for right facial nerve damage following nodule removal as a filler complication. A "modified bulls horn approach" to the upper lip lift was performed around the nasal wings and columella and along the right nasolabial fold. The flap was de-epithelized and harvested. Using the open tip of a small liposuction cannula, the distal portion of the flap was tunneled and fixed directly in a C-loop fashion using U stitches, transfixing the flap to the periosteum of the zygomatic arch. At 3 years follow-up, no significant complications were observed, and the patient reported no functional limitations or dissatisfaction with the scars in the nasolabial fold or around the nasal wings and columella.

Sequelas de queimadura em face: enxerto cutâneo autólogo mama-face, uma opção de tratamento. Relato de caso / Sequels of burns in the face: autologous skin graft breast-face, a treatment option. Case report

Introdução: As queimaduras constituem uma das lesões traumáticas mais graves e seu tratamento requer uma abordagem multidisciplinar, em que o papel do cirurgião plástico é fundamental. Restabelecer a função de proteção da pele, mas também recuperar a estética da área, queimada são objetivos desafiadores que o cirurgião plástico procura atingir. Relato de Caso: Paciente feminino de 27 anos submetida a mastopexia com inclusão de implantes, em que se aproveitou a pele retirada da mama para realizar um enxerto de espessura total em região mandibular e submentoniana para tratamento de cicatriz. A paciente teve uma integração completa do enxerto, sem evidenciar-se áreas de epidermólise. Os resultados estéticos foram excelentes, conseguindo a satisfação da paciente e melhoria das áreas discrômicas e hipertróficas cicatriciais. Conclusão: O enxerto autólogo a partir da pele da mama constitui uma boa alternativa para o tratamento de sequelas de queimaduras em face, possibilitando ótimos resultados estéticos.

Introduction: Burns are one of the most severe traumatic injuries and their treatment requires a multidisciplinary approach, where the role of the plastic surgeon is vital. The plastic surgeon is entrusted with the challenging goal of restoring the skin's protective function and simultaneously recovering the aesthetic aspect of the burnt area. Case report: A 27-year-old woman underwent a mastopexy with inclusion of implants, where the skin removed from the breast was used as a full-thickness graft in the mandibular and submental area for the treatment of a scar. The patient showed complete integration of the graft, and no areas of epidermolysis were observed. The aesthetic results were excellent, and the patient was completely satisfied; moreover, an improvement in the dyschromic and hypertrophic cicatricial areas was observed. Conclusion: An autologous graft using breast skin is a good alternative for the treatment of sequelae of burns on the face and provides excellent aesthetic results.

Ritidoplastia e paralisia facial: como lidar? / Facelift and Facial nerve injury: how to deal with?

Não é novidade para os cirurgiões plásticos, especialmente aos que se dedicam à cirurgia de face, que o nervo facial pode ser lesado virtualmente em qualquer cirurgia de ritidoplastia. Porém, apesar da importância contida nesse tema, não é tarefa simples encontrar na literatura artigos que abordem de forma objetiva a correlação entre lesão do nervo facial e cirurgia facial. Paralisias faciais, sejam elas completas ou não, podem se tornar situações potencialmente conflituosas na relação médicopaciente. Este artigo, portanto, visa propor de forma clara e sucinta, baseada na experiência dos autores, um guia de como evitar, identificar e tratar uma potencial lesão do nervo facial no contexto de uma cirurgia de face, em especial a ritidoplastia.

Is largely known that the facial nerve virtually can be injured in every facial lift. Even though its importance, it is difficult to find in the literature articles related to this theme. Complete or incomplete facial paralysis after a facial procedures, may become a very uncomfortable situation between the patient and the surgeon, that is why we propose in this article a guide which intends to help avoid, identify and manage a facial nerve injury in the event of a face lift. Identifying Facial palsy before the surgery: Intending to make the pre-op facial assessment as simple as possible, we suggest a systematic approach examination. Avoiding facial nerve injury during face lifting: Several technical details are discussed along the text aiming to minimize the risk of nerve damage during the surgical procedure. What to in the event of a post-operative facial palsy: The authors propose a logical approach to the facial palsy, suggesting a planning for diagnosis, classification of the lesion and a rational treatment for the injury. Conclusion: This article presents a guide showing some safe technical options to avoid nerve damage during rythidoplasty, how to identify the lesion and treat it if necessary.

Evaluación del manejo del dolor de la patología facial y oral en un Servicio de Urgencias Pediátrico y tras el alta domiciliaria / Assessment of orofacial pain management in a pediatric emergency department and at home after discharge

Introducción. El manejo inadecuado del dolor es frecuente en Urgencias. El objetivo fue analizar el manejo del dolor de niños con patología infecciosa o traumática del área facial/oral en Urgencias y evaluar el cumplimiento y satisfacción sobre la analgesia prescrita al momento del alta. Población y métodos. Estudio transversal, observacional y analítico en niños que acudieron a Urgencias con patología infecciosa/traumática de la región facial/oral durante 2 meses. Se recogieron el manejo del dolor en Urgencias, la analgesia prescrita para el domicilio y, tras el contacto telefónico con los padres, el tratamiento realizado y su adecuación al dolor del niño. Resultados. Fueron incluidos 252 pacientes (edad media de 4,5 años, desvío estándar 3,89). En 8,7%, figuraba la evaluación del dolor en triaje y, en 3,6%, en el informe médico. Se administró analgesia en Urgencias al 41,3%. Al momento del alta, en un 13,9%, no se prescribió analgesia; en 25,4%, se prescribió pautada y, en 60,3%, a demanda. Los pediatras usaron más analgesia pautada que los cirujanos (34,4% vs. 16,5%, p < 0,01). En el domicilio, no administraron analgesia en el 39,3%; en un 36,1%, pautada y, en un 23%, a demanda. Existió escasa correlación entre la pauta al momento del alta y la administrada en el domicilio (kappa: 0,178). Se consideró la analgesia adecuada en el 84%, con más frecuencia en patología traumática que infecciosa (85,7% vs. 14,3%, p < 0,01). Conclusiones. Se observó escasa evaluación y tratamiento del dolor en Urgencias. La prescripción más usada fue a demanda en vez de pautada, al contrario de lo recomendado en las guías. El control analgésico fue mejor en patología traumática que infecciosa.

Introduction. An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge. Population and methods. Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered. Results. In total, 252patients (mean age: 4.5 years, SD: 3.89) were included. Pain assessment was recorded at the triage for 8.7%, and in the medical report, for 3.6%. Analgesia was administered to 41.3% in the emergency room. At discharge, no analgesia was prescribed to 13.9%; scheduled analgesia, to 25.4%; and as needed, to 60.3%. Pediatricians prescribed scheduled analgesia more frequently than surgeons (34.4% versus 16.5%, p < 0.01). At home, no analgesia was administered to 39.3%; scheduled analgesia, to 36.1%; and as needed, to 23%. There is little correlation between prescription at discharge and at home (Kappa: 0.178). Analgesia was considered adequate in 84% of cases, and was more frequent in trauma injuries than in infections (85.7% versus 14.3%, p < 0.01). Conclusions. Pain assessment and management was scarce in the emergency department. The most common prescription was as needed, contrary to what is recommended in the guidelines. Analgesic control worked better for trauma injuries than for infections.

Fatores associados às alterações fonoaudiológicas em vítimas de acidentes de motocicletas / Factors associated with speech-language disorders in motorcycle accident victims

RESUMO Objetivo Verificar fatores associados às alterações fonoaudiológicas em vítimas de acidentes motociclísticos. Método Trata-se de um estudo de corte transversal. Foram estudadas vítimas de acidentes motociclísticos assistidas no Hospital da Restauração entre junho e julho de 2014. Os dados foram coletados através da consulta dos prontuários e entrevistas direta com esses acidentados, no momento da internação e após a alta hospitalar. Para análise, foram estudadas as frequências simples, média e teste Quiquadrado de Pearson ou o teste Exato de Fisher. A margem de erro utilizada nas decisões dos testes estatísticos foi de 5% e os intervalos de confiança foram obtidos com confiabilidade de 95%. Resultados Foram estudados 99 indivíduos, sendo 90,9% do gênero masculino, com idade média de 32,7 anos. Constatou-se um alto percentual de condutores alcoolizados (42,3%) e não habilitados (51,5%). Os traumatismos cranianos estavam presentes em 30,3% dos casos. As áreas corporais mais afetadas foram os membros inferiores (71,7%), seguidos da região da cabeça e face (56,6%). Depois da alta hospitalar, 30,3% referiram queixa de alterações fonoaudiológicas e essas mostraram uma associação estatisticamente significativa com não habilitados (p=0,012) e colisões entre motos (p=0,004). Conclusão Verificou-se alto percentual de lesões em região de cabeça e face decorrentes dos acidentes, associadas principalmente à não habilitação para conduzir moto e colisões entre motocicletas, sugerindo que tais fatores podem agravar as lesões fonoaudiológicas.

ABSTRACT Purpose To investigate factors associated with speech-language disorders in victims of motorcycle accidents. Methods This is a cross-sectional study. Victims of motorcycle accidents studied were treated at Hospital da Restauração between June and July 2014. The data were collected by consulting the records and direct interviews with these, at admission and after discharge. For analysis were raised single frequencies, average and chi-square test or Fisher's exact test. The margin of error used in the statistical tests was 5%, and the intervals were obtained with 95% reliability. Results 99 individuals were studied, 90.9% male, the mean age of 32.7 years. It found a high percentage of 42.3% of drunk drivers and 51.5% were not enabled. The Head Injuries were present in 30.3% of cases. The most affected body area were the lower limbs (71.7%), followed by the head and face region (56.6%). It was also found that 30.3% had complaints of speech pathology after hospital discharge and a statistically significant association between speech therapy complaint and not enabled (p=0.012) and collisions between bikes (p=0.004). Conclusion There was a high percentage of lesions in the head and face resulting from accidents, associated mainly not eligible to drive bike and collisions between motorcycles, suggesting that these factors can aggravate injuries speech therapy

Fractura aislada de pared medial de órbita / Isolated orbital medial wall fracture

Abstract Background: Orbital floor fractures are a common finding in facial trauma and may be accompanied by medial orbital wall fracture in 7 to 53% of the cases. Isolated medial wall fractures are rare and usually asymptomatic, being detected as incidental findings. case report: We report a 75 years old female consultingin the emergency room due to a left orbital trauma. An orbital CAT scan identified a fracture of the medial orbit wall that did not require treatment.

Resumen Introducción: Las fracturas del suelo de la órbita son habituales en los traumatismos faciales y entre un 7 y un 53% de los casos se asocian con fracturas de la pared medial. Pero las fracturas aisladas de la pared medial son infrecuentes y la mayoría asintomáticas, siendo un hallazgo habitualmente incidental. Sin embargo, ciertos signos de alarma (limitación de la movilidad del recto medial, siendo habitual que aparezca de forma retardada por isquemia del músculo debido al atrapamiento) pueden plantear una cirugía urgente. Descripción del caso: Presentamos un caso de una paciente de 75 años que acude al Servicio de Urgencias de nuestro hospital remitida por médico de atención continuada por traumatismo sobre órbita izquierda. A la exploración presenta importante hematoma periorbitario y malar, sin alteraciones visuales. En TC orbitaria se identifica fractura de la pared medial de la órbita que, en ausencia de clínica acompañante, no requiere tratamiento alguno.

Análise de lesões orofaciais registradas no Instituto Médico-Legal de São Luís (MA), no período de 2011-2013 / Analysis of orofacial injuries recorded in the Forensic Medicine Institute of São Luís (MA), from 2011 to 2013

Introdução: Os traumas são causas comuns de morbidades e mortalidade da população mundial. Um dos mais prevalentes é o bucomaxilofacial, pois a face é uma região muito exposta e pouco protegida.Traumas faciais podem resultar em lesões de tecidos moles e fraturas ósseas, causando graves complicações e até danos irreversíveis, e seu autor deve ser enquadrado corretamente segundo a legislação brasileira. Objetivo: Analisar o perfil das vítimas, as causas, as características das lesões orofaciais, bem como o profissional responsável pela perícia e a classificação da lesão de acordo com o artigo 129 do Código Penal Brasileiro. Método: Foram analisados laudos emitidos por médicos e odontolegistas do Instituto Médico Legal da cidade de São Luís (MA), no ano de 2011 à 2013 de vítimas acometidas por lesões orofaciais. Resultados: Os resultados demonstraram que o sexo masculino foi omais atingido (55,4%), a faixa etária mais envolvida foi 20-29 anos (40,3%), a etiologia principal foi agressão física (73,4%), a lesão mais frequente foi escoriação (25,3%) e a região mais acometida da facefoi a orbitária (26%). O profissional que mais emitiu laudos foi o médico-legista (90,8%). Das lesõesorofaciais qualificadas (39,8%), 23,0% resultaram em debilidade da função mastigatória, 4,5% emdebilidade da função mastigatória e estética e 22,3% em deformidade permanente. Conclusão: Conclui-seque é grande o número de lesões orofaciais registradas no IML de São Luís e que essas lesões foram avaliadas mais criteriosamente pelo odontolegista, ressaltando-se, com isso, a fundamental atuação desse profissional nas perícias dessa natureza.

Introduction: Traumas are common causes of morbidities and mortality in world's population. Maxillofacialtrauma is one of the most prevalent, because face is very exposed and unprotected. Facial trauma canresult in soft tissue injuries and bone fractures, causing serious complications and even permanen tdamages, making necessary the appropriate legal framework of attackers. Objective: To analyze theprofile of the victims, reason and the characteristics of orofacial lesions recorded in Forensic MedicineInstitute data, São Luís (MA), Brazil, between years of 2011 to 2013, as well as the professional responsible for expertise (doctors and dentists) and classifications in accordance with Article 129 of theBrazilian Penal Code. Methods: It were analyzed reports issued by doctors and dentistry in the period of2011 to 2013, for affected patients with orofacial injuries. Results: Results showed that male sex was themost affected (55,4%), age most involved was 20-29 years (40,3%), the main etiology was physicalaggression (73,4%), the most common injury was abrasion (25,3%) and the region most affected was theorbital (24,9%). The professional that issued more reports was the coroner (90,8%). Between the qualifiedorofacial lesions (39,8%), 23,0% resulted in weakness of masticatory function, 4,5% in weakness ofmasticatory function and aesthetics and 22,3% in permanent deformity. Conclusion: It was concluded that the number of orofacial injuries registered in the IML of São Luís data was great and these lesions wereevaluated more critically by forensics dentists, requiring their presence of this professional.

Epidemiologia da fratura de face de pacientes atendidos no pronto socorro de cirurgia plástica do Distrito Federal / Epidemiology of patients with facial fractures treated by the plastic surgery team in an emergency room in the Federal District of Brazil

Introdução: O trauma permanece como uma das principais causas de morbidade e mortalidade, no mundo ocidental, entre os adultos jovens. A prevalência de lesões traumáticas na face é alta devido à enorme exposição dessa região e a sua pouca proteção. Objetivo: Avaliar a etiologia, a idade, o gênero, a localização, os sintomas e o tipo de tratamento das vítimas de traumas de face dos atendidos no Hospital Regional da Asa Norte (HRAN), Brasília, Distrito Federal. Método: Trata-se de um estudo retrospectivo, realizado no pronto socorro do HRAN-DF, visando avaliar o perfil epidemiológico de vítimas de trauma de face, no período do 2° semestre de 2012. Resultados: O estudo compreendeu 46 pacientes, destacando-se o gênero masculino, com 32 pacientes (69,56%). Quanto à causa, predominou a agressão física, em ambos os sexos, com 22 casos (47,82%), seguida pelas quedas, com 11(23,91%). As quedas foram as causas predominantes das lesões em crianças, mas se verificou a participação cada vez maior da agressão física como mecanismo de trauma facial com o aumento da idade. A principal faixa etária foi de 21 a 30 anos, compreendendo 43,47% dos casos. O nariz foi o local mais acometido nas fraturas de face, correspondendo a 62,96% dos casos. O tempo médio de internação foi de dois dias e o tempo entre o primeiro atendimento e a operação foi de seis dias. Conclusão: O perfil epidemiológico do paciente com fratura de face é de um jovem, do gênero masculino, vítima de agressão física, com fratura de nariz e quadro clínico desse tipo de lesão e submetido a redução fechada.

Introduction: Trauma remains a major cause of morbidity and mortality amongst young adults in the Western world. The prevalence of traumatic lesions on the face is especially high, as the facial area is generally exposed with little protection. Objective: To evaluate the etiology, age, sex, location, symptoms, and the type of treatment given to victims of facial trauma treated at the North Wing Regional Hospital (NWRH), Brasilia, Federal District. Method: This was a retrospective study conducted in the emergency room of the NWRH to evaluate the epidemiological profile of patients with facial trauma who presented during the 2nd half of 2012. Results: The study included 46 patients, of which 32 patients (69.56%) were male. Physical aggression was the prevailing cause in both sexes with 22 cases (47.82%), followed by falls with 11 (23.91%). Falls were the predominant cause of injuries in children. Physical aggression as a mechanism for facial trauma became more common with age. The main age group affected was the 21 to 30 years group, comprising 43.47% of cases. The nose was the most commonly affected bone in facial fractures, with nasal fractures occurring in 62.96% of cases. The mean hospital stay was two days and the mean time between the first visit and the operation was six days. Conclusion: The predominant epidemiological profile of a patient with facial fracture is that of a young male, victim of physical aggression, presenting with a nasal fracture and a clinical picture of this type of injury, and treated with closed reduction.

Giant sialocele following facial trauma

Injuries in the parotid and masseter region can cause serious impairment secondary to damage of important anatomical structures. Sialocele is observed as facial swelling associated with parotid duct rupture due to trauma. The aim of this paper is to report a case of a giant traumatic sialocele in the parotid gland, secondary to a knife lesion in a 40-year-old woman. Conservative measures could not promote clinical resolution and a surgical intervention for the placement of a vacuum drain was selected. Under local anesthesia, a small incision was performed adjacent to parotid duct papilla, followed by muscular divulsion and draining of significant amount of saliva. An active vacuum suction drain was placed for 15 days, aiming to form a new salivary duct. This technique was shown to be a safe, effective and low-cost option, leading to complete resolution and no recurrence after 28 months of follow up.

Lesões na região parotídea e massetérica podem causar danos importantes secundariamente à injúrias de estruturas anatômicas nobres. A sialocele é observada como um aumento de volume facial associado a ruptura do ducto parotídeo devido a trauma. O objetivo deste artigo é relatar um caso de sialocele parotídea gigante traumática, por arma branca, em uma paciente de 40 anos de idade. Em virtude do insucesso de medidas conservadoras de tratamento, uma intervenção cirúrgica por meio de instalação de um dreno à vácuo foi proposta. Sob anestesia local, uma pequena incisão foi realizada adjacente ao ducto da papila parotídea, seguida de divulsão do plano muscular e drenagem de quantidade significativa de saliva. Um dreno à vácuo foi instalado e mantido por 15 dias objetivando formar um novo ducto salivar. Esta técnica se mostrou segura, efetiva e de baixo custo, proporcionando a completa resolução do caso; não sendo observada recidiva em acompanhamento de 28 meses.

Prosthodontist contribution in treating post-burn hypertrophic facial scars.

The formation of hypertrophic scars is common following healing of the burn wound, particularly in children. The face is one of the areas of the body most frequently affected by burns. Scar formation as a result of burn wounds leads to contraction of the formed granulation tissue, which causes both aesthetic and functional impairment for the patient. Scarring has major psychological and physical repercussions. Scarring on the face and visible regions of the body can be very distressing for the patient. Prevention of scars involves early and continuous use of a compressive orthesis. However, their efficacy is often limited to the facial region because of the contours of this area of body. This paper describes a clinical case of post-burn hypertrophic scars treated with silicone gel sheeting applied with pressure under custom made auto-polymerizing resin stent.

Angioembolización selectiva: un valioso adyuvante en la estrategia de control de daños en heridas faciales por proyectil de arma de fuego: informe de un caso / Selective angioembolization: a valuable adjunct in damage control strategies applied to facial gunshot wounds: case report

Introducción: La angioembolización selectiva es una alternativa no quirúrgica para controlar el sangrado facial traumático. Caso clínico: Informamos el caso de un paciente con herida facial por proyectil de arma de fuego tratado con angioembolización selectiva como adyuvante al control de daños, con lo que se logró detener la hemorragia. Conclusiones: La angioembolización selectiva es un valioso adyuvante en la detención del sangrado facial traumático.

BACKGROUND: Selective angioembolization (SAE) is a nonsurgical alternative for controlling traumatic facial bleeding. CLINICAL CASE: We report a case of a patient who sustained a facial gunshot wound. The patient was treated with SAE as an adjuvant to damage control, leading to the arrest of hemorrhage. CONCLUSIONS: SAE is a valuable adjuvant in arresting traumatic facial bleeding.

Lesões faciais em pacientes pediátricos de 1 a 4 anos de idade: um estudo retrospectivo / Facial injuries in 1to 4 year-old paediatric patients: a retrospective study

Lesões faciais em crianças são menos frequentes do que em adultos, particularmente durante os cinco primeiros anos de vida. O objetivo deste estudo retrospectivo foi estabelecer as características das lesões maxilofaciais em crianças de um a quatro anos de idade atendidas no Setor de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Humberto Lucena de João Pessoa, Paraíba, no período de janeiro de 2002 a maio de 2006. Informações referentes à idade, sexo, etiologia, presença de lesão maxilofacial e trauma dentário foram coletadas. Os dados foram analisados através do programa Epi-Info e foi investigada a associação significativa entre as variáveis por meio dos testes qui-quadrado e Exato de Fisher, considerando-se o valor para rejeição da hipótese nula de p < 0,05. Os resultados mostraram maior predomínio do sexo masculino (57,1%). A maioria das lesões foi causada por quedas (45,0%), seguidas por atropelamentos (4,1%). Muitos pacientes apresentavam lesões nos tecidos moles da face (65,3%) e traumatismo dentário (38,8%). Verificou-se associação estatisticamente significativa entre a presença de fratura facial e a ausência de lesão de tecido mole (p = 0,015). As fraturas faciais em crianças são menos comuns do que lesões em tecidos moles. Como ambas as injúrias podem ser extensas e possuir potencial para ocasionar danos funcionais, estéticos e psicossociais no desenvolvimento infantil, é bastante importante avaliar cada etapa de realização do tratamento.

Orbital abscess after facial trauma

This paper reports a rare case of acute severe orbital abscess manifested 2 days after a facial trauma without bone fracture in a 20-year-old Afro-American female. The symptoms worsened within the 24 h prior to hospital admission resulting in visual disturbances such as diplopia and photophobia. The clinical findings at the first consultation included fever, periorbital swelling and redness, ptosis, proptosis and limitation of ocular movements upwards, downwards, to the right and to the left. Computed tomography scan showed proptosis with considerable soft tissue swelling on the left side and no fracture was evidenced in the facial skeleton, including the zygomatic-orbital complex. After hospital admission and antibiotic therapy intravenously the patient was conducted to the operation room and submitted to incision and drainage under general anesthesia. The orbit was approached thorough both eyelids and the maxillary sinus was reached only through the Caldwell-Luc approach. The postoperative period was uneventful and the rapid improvement of symptoms was remarkable. Visual acuity and ocular motility returned to the normal ranges within 2 days after the surgical intervention. After 12 postoperative days, the patient presented with significative improvement in the ptosis and proptosis, and acceptable scars.

Este artigo apresenta um caso de abscesso agudo em cavidade orbitária, após 2 dias de trauma facial, sem a presença de fratura óssea, ocorrido em uma mulher da raça negra com 20 anos de idade. Os sintomas se intensificaram nas últimas 24 h com o desenvolvimento de distúrbios visuais do tipo diplopia e fotofobia. Durante exame clínico foi constatado a presença de febre, edema e eritema periorbitário, ptose, proptose e limitação de movimentação ocular para cima, baixo, lado direto e esquerdo. A tomografia computadorizada evidenciava proptose associada a edema considerável, dos tecidos moles no lado esquerdo da face, sem fratura do complexo zigomático-orbitário. A internação hospitalar e o início da antibioticoterapia endovenosa foram realizados, e o tratamento cirúrgico de incisão e drenagem do abscesso sob anestesia geral foi conduzido, sendo realizado por meio de incisão na pálpebra superior e inferior para acesso a cavidade orbitária e por acesso de Caldwell-Luc para o seio maxilar. No pós-operatório imediato foi observada rápida melhora dos sintomas inicialmente relatados pela paciente. Após 2 dias da intervenção cirúrgica foi observado melhora na movimentação ocular e na acuidade visual, retornando ao normal. No décimo segundo dia pós-operatório, a paciente apresentou melhora significativa com relação à ptose palpebral e a proptose, com adequado processo de cicatrização.

Dynamic commissural splint.

Microstomia, an abnormally small oral orifice, can manifest as a sequela of burns involving the oral and perioral tissues due to contraction of the tissues and hypotonia of the circumoral musculature. Regardless of the etiology, scar contracture results in deformities that produce esthetic and functional impairment. Changes in the circumoral anatomy prevent optimal dental care and maintenance of good oral hygiene. The anatomic changes may detrimentally alter eating, speech, and mandibular motion. Prosthetic treatment involves providing physical resistance to scar contracture by maintaining the oral commissures in their normal relationship by means of a splint. This article describes a method to fabricate a dynamic commissural splint and describes its use in two cases.

Ocular complications in head and facial injuries: a retrospective study

To assess the prevalence of ocular injury and its severity among the trauma patients admitted with head and facial injuries [which may be missed as the priority is given to save the life of the patient]; and to develop guidelines for the optimum ophthalmology referral in such cases. The medical records of 134 patients who were admitted to the trauma intensive care unit of Hamad General Hospital with head and facial injury, during a one year period from 1/1/2005 to 31/12/2005, were reviewed. Presence of ocular trauma, its severity and the ophthalmology referral were noted. Visual outcome, periocular signs and relevant radiological findings were also recorded. Among the 134 charts reviewed, 94% were males. Head injury was the commonest [69.4%], followed by combined head and facial injury [27.6%]. Fifty-two [38.8%] cases were found to have either ocular or periocular signs. Twenty [14.9%] were found to have both. Among the 52, four patients [7.7%] lost vision completely in one eye and in one case [1.9%] visual acuity was reduced to hand movements in one eye. Fifteen [28.8%] patients had serious ocular complications and 32 [61.5%] patients had transient ocular or periocular signs. Among the 52 patients only 22 [42.3%] received ophthalmology referral. In all patients with head and facial injury, visual acuity, colour vision and ocular motility should be assessed as soon as the general condition permits. Patients with ocular or periocular signs and those with radiological evidence of orbital or periorbital fractures should be referred to an ophthalmologist without delay

Cutaneous sporotrichosis of face: polymorphism and reactivation after intralesional triamcinolone.

Cutaneous sporotrichosis, a subcutaneous mycotic infection is caused by the saprophytic, dimorphic fungus Sporothrix schenckii. It commonly presents as lymphocutaneous or fixed cutaneous lesions involving the upper extremities with facial lesions being seen more often in children. The lesions are polymorphic. The therapeutic response to saturated solution of potassium iodide is almost diagnostic. We describe a culture-proven case of cutaneous sporotrichosis of the face mimicking lupus vulgaris initially and basal cell carcinoma later, who did not tolerate potassium iodide and failed to respond to treatment with fluconazole. The patient had reactivation of infection following an infiltration of the scar with triamcinolone acetonide injection. Various other aspects of these unusual phenomena are also discussed.

Ocular motor nerve palsy: a clinical and etiological study.

PURPOSE: To clinically describe cases of ocular motor nerve palsy and to determine the possible causes. MATERIALS AND METHODS: Thirty-one consecutive patients with ocular motor nerve palsies were investigated. All underwent complete ophthalmological, as well as neurological, otorhinolaryngological and general examination. Computerised tomography (CT)-scan of the brain and complementary laboratory tests were obtained from each participant. RESULTS: Paralysis of the sixth (38.4%) and the third (35.3%) cranial nerve were the most common. The Lees screen test was found to be very sensitive, confirming the diagnosis of ocular motor nerve palsy, even in cases with minimal manifestations. Complete ptosis and full mydriasis were mostly seen in isolated cases of the third cranial nerve palsy. The majority of eyes (63.2%) with third cranial nerve palsy had pupil sparing. Overall, an etiological diagnosis was made in 93.5% of cases. The common causes were vascular conditions (25.8%), otorhinolaryngologic diseases (19.7%) and trauma (12.9%). CT scan failed to reveal any abnormality in 54.8% of cases. CONCLUSION: Patients with ocular motor nerve palsy should be carefully examined in close collaboration with other specialists, especially where sophisticated, complementary investigations are impossible.

Epistaxis in Chiang Mai University Hospital.

OBJECTIVES: Epistaxis is a common otolaryngologic emergency, and can be severe or even fatal. The causes can be from local or systemic illnesses. The aim of this study was to review and analyze the general and specific data causes, management and results of epistaxis in patients admitted in Chiang Mai University Hospital. MATERIAL AND METHOD: A retrospective study by reviewing charts of new epistaxis inpatients, admitted to Chiang Mai University Hospital between January 2001 and July 2004, was done. RESULTS: From 55 cases reviewed, 41 were males (74.5%) and 14 females (25.5%). The mean age was 46.98 +/- 17 years (12-87 years). The peak of prevalence was between January and April. The average length of hospital stay was 6.2 +/- 3.8 days, (1-17 days). The most common cause of epistaxis was hypertension (32.72%) followed by tumor, local trauma and coagulopathy, subsequently. About 18 per cent of the patients had more than one cause of the illness. According to the bleeding site, 33 patients (60%) had anterior bleeding, 14 (25.45%) had posterior bleeding, and the rest had non-identifiable bleeding sites. There were 5 abnormalities from 52 patients (9.6%) tested for clotting profile. A bout one third of the patients received more than one type of procedure, while 2 patients (3.6%) treated by a local hospital before being transfered, were observed with successful outcome. CONCLUSION: The most common and preventable causes of epistaxis in this review are hypertension and facial and paranasal sinus injuries. The other common curable cause is tumor Otolaryngologists and general physicians should find out the causes and know characteristics of the patients and diseases, especially in their own area of practice in order to be able to perform optimal management.

Management of life threatening hemorrhage from facial fracture.

Persisted bleeding from facial fractures after nasal packing or direct pressure is not common, however if it happens, the mortality rate is very high. The study of the treatment for this group of surviving patients was made to find the guideline for management of these patients. From the period of 1 January 1993 to 31 December 2002, 3756 cases of facial fractures were treated at the Trauma Center, Faculty of Medicine, Siriraj Hospital. There were 14 life-threatening hemorrhage cases and 9 patients survived. They were 3 Le Fort fracture, 2 nasal fracture, 1 mandibular fracture and 3 multiple facial fractures. Repacking of nasal cavities was performed and was able to stop bleeding successfully in 2 cases. Three cases required operation and 3 cases had angiography and embolization. One case still bled after operation and needed angiography and embolization. The present study shows that the adequacy of nasal packing or wound compression should be evaluated first. Early operation could stop bleeding in nearly half of the cases. Angiography and embolization can be used alone or adjunct to the operation to control bleeding with good result.