Profile of Hospitalizations of Children and Adolescents Victims of Transport Accidents: A Retrospective Study

Abstract Objective: To present the profile of hospitalizations due to transport accidents in individuals aged 0-19 years in a reference hospital for urgent and emergency traumatology care. Material and Methods: This retrospective study is grounded on analyzing medical records of children and adolescents hospitalized due to transport accidents in 2016 and 2017. The bivariate analyses included Chi-square and Fischer's exact tests and binary logistic regression, with a 5% significance level. Results: Four hundred and seventy-five (43.7%) of the 1,088 medical records investigated corresponded to transport accidents, and accidents involving motorcycles were the most frequent (68.3%), affecting adolescents (81.3%), while children were more involved in accidents as pedestrians (57.1%). Advancing age increases the likelihood of the outcome, with a significant association in the multivariate analysis (p<0.001). The mandible was most frequently affected in maxillofacial fractures. Conclusion: Transport accidents predominantly affect male adolescents, involving motorcycles, and the lower limbs are the most affected. The mandible was the most affected bone in maxillofacial fractures.

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.

Tratamento conservador de osteomielite em mandibula: relato de caso / Conservative treatment osteomyelitis in jaw: case report / Tratamiento conservador de osteomielita en mandible: reporte de caso

Introdução: As infecções nos ossos de face podem acometer os maxilares, geralmente a mandíbula, apresentando diversos fatores etiológicos, além de seu potencial multibacteriano. Embora tratamentos mais radicais possam ser uma escolha preferencial, meios conservadores podem surgir como alternativa afim de evitar tratamento mais agressivo aos pacientes. Relato de caso: Paciente do sexo feminino, 17 anos de idade, vítima de acidente náutico foi submetido a tratamento cirúrgico para osteossíntese de fratura complexa de mandíbula e após um período de 30 dias houve evolução de um quadro de osteomielite em região mandibular no qual foi preconizado tratamento conservador com antibioticoterapia e orientações de restrição de dieta líquida e pastosa. No período de proservação de 06 meses observou se melhora e regressão considerável do quadro infeccioso onde houve continuidade do acompanhamento de 01 ano sem sinais sugestivos de recidiva. Considerações Finais: O tratamento conservador deve ser considerado como importante alternativa nos casos de osteomielite nas complicações pós-operatórias de fixação de fraturas do complexo maxilo-mandibular... (AU)

Introduction: Infections is commonly affect in jaws and usually the mandibular bone present several etiological factors and in addition to their multibacterial potential. Although radical treatments may be preferred choices another treatments can be emerge as a new way to prevent treatment from becoming more aggressive to pacients. Case Report: A 17-year-old female patient victim of a nautical accident, underwent surgery treatment for complex fracture osteosynthesis and after a while appear osteomyelitis in mandibular bone in which conservative treatment was recommended with antibiotherapy and guidelines for restricting liquid and pasty diet. During 06 months improvement and considerable regression of the infect condition was observed with 01 year of preservation without signs of reccurrence. Final considerations: Conservative treatment should be considered na important alternative in cases of osteomyelitis in post operative complications of fixation of fractures in jaws... (AU)

Las infecciones en los huesos faciales pueden afectar el maxilar, generalmente la mandíbula, presentando varios factores etiológicos, además de su potencial multibacteriano. Aunque los tratamientos más radicales pueden ser una opción preferida, los medios conservadores pueden surgir como una alternativa para evitar un tratamiento más agresivo para los pacientes Caso clínico: Paciente de sexo femenino de 17 años, víctima de accidente náutico, sometida a tratamiento quirúrgico por osteosíntesis de una fractura compleja de mandíbula y al cabo de 30 días evolucionó una osteomielitis en la región mandibular en la que se Fue un tratamiento conservador con antibioticoterapia y se recomendaron pautas para restringir las dietas líquidas y pastosas. En el período de seguimiento de 06 meses, hubo una mejoría considerable y regresión de la condición infecciosa, donde hubo una continuación del seguimiento de 01 año sin signos sugestivos de recurrencia. Consideraciones finales: El tratamiento conservador debe considerarse como una alternativa importante en casos de osteomielitis en complicaciones postoperatorias de fijación de fracturas del complejo maxilomandibular... (AU)

Tratamento cirúrgico de fratura Le Fort II: relato de caso / Surgical Treatment of Le Fort II Fracture: Case Report

Fraturas faciais geralmente resultam traumas, e podem ocorrer de forma isolada ou concomitante a outras lesões. O trauma na região facial resulta em danos não só em tecido ósseo, mas também em tecido mole e dentição, causando um prejuízo na função e na estética do paciente. Os acidentes automotores permanecem sendo uma das causas mais significativas de traumas faciais. As fraturas do terço médio da face incluem a maxila, zigoma e o complexo naso órbito etimoidal; podem ser classificadas em: fraturas Le Fort I, II ou III, fraturas do complexo zigomático maxilar, fraturas de arco zigomático ou fraturas naso órbito etimoidais. Elas podem ser unilaterais ou bilaterais, simétricas ou assimétricas. Este estudo objetiva-se em relatar o caso clínico de um paciente do sexo masculino, 31 anos, vítima de acidente automobilístico (carro/ anteparo). O paciente foi diagnosticado com fratura do tipo Le Fort II e nasal onde foi realizado o tratamento de redução e fixação interna rígida das fraturas de maxila e redução incruenta de fratura nasal, resultando em melhora da condição do paciente. As fraturas Le Fort são predominantemente causadas por colisões de alta energia. Portanto o tratamento é imprescindível para a devolução da função, estética e autoestima do paciente... (AU)

Facial fractures usually result from trauma, and may occur in isolation or concomitantly with other injuries. Trauma in the facial region results in damage not only to bone tissue but also to soft tissue and dental elements, which causes a loss in the patient's function and esthetics. Automotive accidents remain one of the most significant causes of facial trauma. Fractures of the middle third of the face include maxilla, zygoma and the nasoorbitoethmoid; may be classified as: Le Fort I, II or III fractures, maxillary zygomatic complex fractures, zygomatic arch fractures, or nasoorbitoethmoid. They can be unilateral or bilateral, symmetrical or asymmetric. The present study aims to report the clinical case of a 31 years, male patient, victim of an automobile accident (car/fixed shield). The patient was diagnosed with le Fort II and nasal fracture, where the treatment of reduction and rigid internal fixation of maxilla fractures and reduction of nasal fracture were performed, resulting in improvement of the patient's condiction. Le Fort fractures are predominantly caused by high energy collisions. Therefore the treatment is essential for the return of the function, aesthetics and increase of the patient's self-esteem... (AU)

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.

Tratamento de fratura órbito-zigomático-maxilar complexa decorrente de acidente motociclístico / Treatment of complex orbito-zygomatic-maxillary fracture due to motorcycle accident

Introdução: O complexo zigomático é a segunda estrutura mais fraturada do esqueleto facial em acidentes motociclísticos, perdendo em incidência, apenas, para fraturas de mandíbula. Fraturas de zigoma podem causar complicações oculares, parestesias na face, perda de projeção ântero-posterior, levando a defeitos ósseos que causam danos estéticos e funcionais ao paciente, se não forem tratados de forma correta. Relato de caso: A vítima de acidente motociclístico com trauma de face apresentou-se com queixas estéticas e funcionais, com diagnóstico conclusivo de fratura em complexo zigomático. Realizou-se um acesso hemicoronal com extensão endaural, o que permitiu a visualização das fraturas do arco zigomático direito e da região da sutura fronto-zigomática direita, acesso transconjutival para abordagem do rebordo infraorbitário e acesso intraoral para o pilar zigomático maxilar. As fraturas foram reduzidas e fixadas com placas e parafusos do sistema 1.5mm. Somente o pilar zigomático foi fixado com placas e parafusos de 2.0mm. Considerações Finais: Fraturas complexas do osso zigomático podem representar um verdadeiro desafio cirúrgico. Planejamento prévio por meio de exames de imagem adequados é fundamental para se definir o tipo de tratamento e os acessos cirúrgicos adequados... (AU)

Introduction: The zygomatic complex is the second part of the facial skeleton that most fracture incidence after motorcycle accidents, in losing only chip fractures of the mandible bone. Zygoma fractures can cause eye complications, paresthesias in the face, loss of anteroposterior projection, leading to bone defects that cause cosmetic and functional damage to the patient, if not treated properly. Case report: The victim of a motorcycle accident with facial trauma presented with aesthetic and functional complaints, with a conclusive diagnosis of fracture in a zygomatic complex. A hemi-coronal approach with endaural extension was performed, which allowed the visualization of fractures of the right zygomatic arch and right fronto-zygomatic suture region, transconjutival access to approach the infraorbital ridge and intraoral access to the zygomatic pillar. jaw. Fractures were reduced and fixed with 1.5mm system plates and screws. Only the zygomatic abutment was fixed with 2.0mm plates and screws. Final Considerations: Complex zygomatic bone fractures can represent a real surgical challenge. Prior planning through appropriate imaging exams is critical to defining the type of treatment and appropriate surgical access... (AU)

Use of neuron-specific enolase to predict mild brain injury in motorcycle crash patients with maxillofacial fractures: A pilot study / 中华创伤杂志(英文版)

PURPOSE@#Mild traumatic brain injury (TBI) is common but accurate diagnosis and its clinical consequences have been a problem. Maxillofacial trauma does have an association with TBI. Neuron-specific enolase (NSE) has been developed to evaluate neuronal damage. The objective of this study was to investigate the accuracy of NSE serum levels to detect mild brain injury of patients with sustained maxillofacial fractures during motor vehicle accidents.@*METHODS@#Blood samples were drawn from 40 healthy people (control group) and 48 trauma patients who had sustained isolated maxillofacial fractures and mild brain injury in motor vehicle accidents. Brain injuries were graded by Glasgow Coma Scale. In the trauma group, correlations between the NSE serum value and different facial fracture sites were also assessed.@*RESULTS@#The NSE serum level (mean ± SD, ng/ml) in the 48 patients with maxillofacial fractures and mild TBI was 13.12 ± 9.68, significantly higher than that measured in the healthy control group (7.72 ± 1.82, p < 0.001). The mean NSE serum level (ng/ml) in the lower part of the facial skeleton (15.44 with SD 15.34) was higher than that in the upper facial part (12.42 with SD 7.68); and the mean NSE level (ng/ml) in the middle-and lower part (11.97 with SD 5.63) was higher than in the middle part (7.88 with SD 2.64).@*CONCLUSION@#An increase in NSE serum levels can be observed in patients sustained maxillofacial fractures and mild brain injury.

A retrospective computed tomography analysis of maxillary fractures and the clinical outcomes of their unreduced parts

BACKGROUND: Some parts of a maxillary fracture—for example, the medial and posterior walls—may remain unreduced because they are unapproachable or hard to deal with. This study aimed to investigate the self-healing process of unreduced maxillary membranous parts of fractures through a longitudinal computed tomography (CT) analysis of cases of unilateral facial bone injuries involving the maxillary sinus walls.METHODS: Thirty-two patients who had undergone unilateral facial bone reduction surgery involving the maxillary sinus walls without reduction of the medial and posterior walls were analyzed in this retrospective chart review. Preoperative, immediate postoperative, and 3-month postoperative CT scans were analyzed. The maxillary sinus volume was calculated and improvements in bone continuity and alignment were evaluated.RESULTS: The volume of the traumatized maxillary sinuses increased after surgery, and expanded significantly by 3 months postoperatively (p< 0.05). The significant preoperative volume difference between the normal and traumatized sides (p= 0.024) resolved after surgery (p> 0.05), and this resolution was maintained at 3 months postoperatively (p > 0.05). The unreduced parts of the maxillary bone showed improved alignment and continuity (in 75.0% and 90.6% of cases, respectively), and improvements in bone alignment and bone continuity were found to be correlated using the Pearson chi-square test (p= 0.002).CONCLUSION: Maxillary wall remodeling through self-healing occurred concomitantly with an increase in sinus volume and simultaneous improvements in bone alignment and continuity. Midfacial surgeons should be aware of the natural course of unreduced fractured medial and posterior maxillary walls in complex maxillary fractures.

Caracterización sociodemográfica y clínica del trauma maxilofacial en un hospital de referencia de Bogotá / Clinical and sociodemographic characteristics of maxillofacial injuries in a tertiary hospital in Bogotá

Introducción: el trauma maxilofacial es un motivo de consulta frecuente, y puede llevar a daño funcional, estético y emocional. Existen estudios previos sobre su epidemiología, sin embargo, sabemos que esta cambia a través del tiempo porque está determinada por diversos factores. El objetivo de este estudio es describir las características del trauma maxilofacial en un hospital de referencia de Bogotá. Diseño: estudio observacional descriptivo. Metodología: Se revisaron historias clínicas de pacientes mayores de 18 años que ingresaron por urgencias a la Unidad de Cirugía Maxilofacial del Hospital San José entre el 2013 y 2017. Se calculó frecuencias absolutas y relativas para las variables cualitativas. Resultados: se obtuvieron 391 pacientes. La mayoría fueron hombres (76,3 %) entre los 30-49 años. Las causas más comunes son la violencia (36,8 %) y los accidentes de tránsito (25 %). Las fracturas más frecuentes fueron las de huesos propios nasales (52 %). De las fracturas mandibulares, las más prevalentes fueron las fracturas condilares y subcondilares, ángulo y cuerpo con 21,4 % cada una. El tratamiento más usado fue el manejo médico (52,9 %). Discusión: el trauma maxilofacial es una patología frecuente en hombres adultos jóvenes. Sin embargo, el tipo de fractura y etiología podría estar influenciado por factores como el sexo y la edad. La causa más común es la violencia y los accidentes de tránsito, las cuales son potencialmente prevenibles. Esto debe servir como referencia para incitar a la realización de medidas preventivas para estas situaciones.

Background: Nowdays, the maxilofacial injuries are a common cause for consultation in the emergency department. These kinds of fractures may cause functional, and emotional damage. There are many publication about the epidemiology of maxilofacial trauma. Nevertheless, this data can change through the time. The aim of this study was to describe the maxilofacial injuries in a tertiary hospital in Bogotá. Desing: observational study. Methods: We retrospectibly assessed 391 medical records from the department of maxilofacial surgery in our Hospital during the period between 2013 to 2017. We include patients over 18 years admitted in the emergency department, we exclude patients seeing in the outpatients clinic. All the cases were assessed according age, sex, etiology and type of the fractures, in addition, we analyzed the treatment modalities. Results: We recolected 391 medical records. The majority of the facial fractures were man (76.3 %) between 30 and 49 years old. The most common cause of maxilofacial fracture was violence (36.8 %). The most common fracture site was nasal bones (52 %). Within the mandibular fractures the most common was the condylar, subcondylar fracture and body (21 % each). 53 % of cases were treated with conservative methods. Conclusion: The maxilofacial injuries are a common in our service especially in young men. Moreover depending on the sex and age we could observed diferents etiologies and typess of fracture. Mostly of the cases were for violence reasons or traffic accidents, which are preventable causes. This information is importante for public health awarness and it can be use as a referral for prevental measures for this situations.

Approach for naso-orbito-ethmoidal fracture

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.

Clinical usefulness of fixation of absorbable implants with cyanoacrylate in comminuted fractures of the maxilla

BACKGROUND: The open reduction of craniofacial bone fractures requires internal fixation using metal plates and screws, which have been considered the gold standard. However, metal implants pose a risk of palpation, protrusion, and foreign body reaction, and they may require an additional operation for removal. Recently, good results have been reported for absorbable implants which complement the disadvantages of metal implants. This study presents the results of using absorbable mesh, plates, and screws with cyanoacrylate for more accurate and firmer fixation of comminuted fractures of the maxilla. METHODS: In total, 235 patients underwent operations for comminuted fractures of the maxilla. From January 2012 to December 2014, absorbable mesh and screws were used in 114 patients, while from January 2015 to December 2017, absorbable mesh, plates, and screws with cyanoacrylate were used in 121 patients. Open reduction of the bone fragments was performed, after which absorbable implants were accurately molded and fixed by screws. RESULTS: All patients underwent postoperative computed tomography scans, which showed highly accurate reduction and firm fixation in the patients who underwent procedures using absorbable implants, screws, and cyanoacrylate. There were no postoperative complications or cases of abnormal facial contour. CONCLUSION: When absorbable implants and screws are used for maxillary fractures, no additional surgery to remove the metal plate is required. In addition, the use of cyanoacrylate enables accurate and firm fixation of the tiny bone fragments that cannot be fixed with screws.

A 30-year neglected foreign body mimicking a maxillary fracture

A-50-year-old male patient presented with complaint of tenderness on the left malar area after traffic accident. Our first impression on him was zygomatic fracture, we did radiologic work-up and physical examination on him. But, on the computed tomography scan, there was no fracture or discontinuity on his facial bone. The computed tomography scan was revealed a 4-cm long foreign body in left maxillary sinus with a large amount of fluid collection. After thorough history taking from him, we reveal the patient had a history of trauma 30 years back on the left zygomatic area with a chopstick. The foreign body was removed via transoral approach with the endoscopic assist. There was no complication after operation.

Postoperative malocclusion after maxillofacial fracture management: a retrospective case study / 대한악안면성형재건외과학회지

PURPOSE: Various complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture. MATERIALS AND METHODS: In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors’ department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery. RESULTS: One patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration. CONCLUSIONS: Considering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40902-018-0167-z) contains supplementary material, which is available to authorized users.

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)

Management of Le Fort I fracture

Among the classification of maxillary fracture, the Le Fort classification is the best-known categorization. Le Fort (1901) completed experiments that determined the maxilla areas of structural weakness which he designated as the “lines of weakness”. According to these results, there are three basic fracture line patterns (transverse, pyramidal and craniofacial disjunction). A transverse fracture is a Le Fort I fracture that is above the level of the apices of the maxillary teeth section, including the entire alveolar process of the maxilla, vault of the palate and inferior ends of the pterygoid processes in a single block from the upper craniofacial skeleton. Le Fort fractures result in both a cosmetic and a functional deficit if treated inappropriately. In this article, authors review the management of a Le Fort I fracture with a case-based discussion.

Avaliação de sensibilidade objetiva versus sensibilidade subjetiva após fraturas de zigoma / Sensitivity assessment objective versus objective after fracture of zygoma

Introdução: Cirurgiões bucomaxilofaciais frequentemente tratam fraturas do complexo zigomaticofacial e, com isso, os sinais e sintomas auxiliam o profissional a estabelecer o diagnóstico e a conduta frente a cada caso. A presença de alteração de sensibilidade é um sintoma frequente neste tipo de trauma. Objetivo: Avaliar comparativamente a presença e as alterações de sensibilidade subjetiva e sensibilidade objetiva após fraturas de zigoma. Metodologia: Foram selecionados 14 pacientes com fraturas unilaterais de zigoma. A sensibilidade subjetiva foi avaliada por meio de um questionário e a sensibilidade objetiva, mensurada por meio do monofilamento de Semmes-Weinstein. Resultado: Os resultados mostraram alteração de sensibilidade em 13 pacientes (92,84%); destes, oito pacientes (57,13%) apresentaram alterações de ordem subjetiva e dez (71,42%), de ordem objetiva. Alterações concomitantes de sensibilidade subjetiva e sensibilidade objetiva foram encontradas em cinco pacientes (35,71%). Afetados exclusivamente por um tipo de alteração de sensibilidade somaram oito pacientes (57,13%); destes, cinco pacientes (35,71%) apresentaram somente alterações objetivas e três pacientes (21,42%), apenas alterações subjetivas. A única queixa de sensibilidade subjetiva encontrada foi a hipoestesia, com sete casos (50%). Conclusão: As alterações de sensibilidade são frequentemente encontradas após fraturas de zigoma, existindo uma forte correlação entre a perda da percepção subjetiva e a perda da sensibilidade objetiva; porém, ocorre predominância de alterações de ordem objetiva.

Introduction: Maxillofacial surgeons often treat zygomatic facial complex fractures, therefore, signs and symptoms of these fractures help establish the diagnosis and the procedure for every case. The presence of sensibility alteration is a common symptom in this type of trauma. Objective: This study evaluated comparatively the presence and changes of subjective and objective sensitivity after zygomatic fractures. Methodology: Fourteen patients were selected with unilateral fractures of zygomatic. Subjective sensitivity was evaluated through a questionnaire and objective sensitivity measured by the Semmes-Weinstein monofilament. Result: The results shows sensibility alteration was found in 13 patients (92.84%), of these, 8 patients (57.13%) had changes of subjective order and 10 (71.42%) of objective order. Concomitant changes in subjective and objective sensitivity were found in 5 patients (35.71%). Patients affected only by one type of sensibility alteration totaled 8 patients (57.13%); of these, 5 patients (35.71%) had only objective alterations and 3 patients (21.42%) only subjective sensitivity alterations. The only complaint of subjective sensitivity was hypoesthesia in 7 cases (50%). Conclusion: The sensitivity changes are often found after zygomatic fractures there is a strong correlation between the loss of subjective perception and objective, however, especially the changes in the objective order.

Perfil epidemiológico dos pacientes portadores de fraturas de face / Epidemiological profile of patients with facial fractures

Fraturas faciais foram provocadas principalmente por acidentes de trânsito (37,3%), e por agressões físicas (33%), vitimando predominantemente pacientes do gênero masculino (83,7%).Ocorreram mais frequentemente na faixa etária entre 21 e 30 anos (38,2%). A frequência de homens e mulheres vitimados entre a primeira e a terceira décadas de vida foi bastante similar.As fraturas mandibulares isoladas foram significativamente predominantes (48%), seguidas pelas zigomáticas (19,7%) e pelas nasais (19,7%). As agressões físicas foram mais frequente mente responsáveis pelas fraturas mandibulares, zigomáticas, nasais, maxilares e frontais, enquanto as fraturas pan faciais e Le Fort resultaram mais frequentemente de acidentes de trânsito.

Facial fractures were mainly caused by traffic accidents (37.3%) and physical abuse (33%), victimizing mostly male patients (83.7%). Occurred more frequently in the age group between21 and 30 years (38.2%). The frequency of men and women victimized between the first and third decades of life was very similar. Isolated mandibular fractures were significantly predominant(48%), followed by zygomatic (19.7%) and the nose (19.7%). The assaults were mostoften responsible for mandibular fractures, zygomatic, nasal, maxillary and frontal, while the panfaciais fractures and Le Fort resulted more often aciteeth transit.

Absorbable Plate-Related Infection after Facial Bone Fracture Reduction

Absorbable plates are used widely for fixation of facial bone fractures. Compared to conventional titanium plating systems, absorbable plates have many favorable traits. They are not palpable after plate absorption, which obviates the need for plate removal. Absorbable plate-related infections are relatively uncommon at less than 5% of patients undergoing fixation of facial bone fractures. The plates are made from a mixture of poly-L-lactic acid and poly-DL-lactic acid or poly-DL-lactic acid and polyglycolic acid, and the ratio of these biodegradable polymers is used to control the longevity of the plates. Degradation rate of absorbable plate is closely related to the chance of infection. Low degradation is associated with increased accumulation of plate debris, which in turn can increase the chance of infection. Predisposing factors for absorbable plate-related infection include the presence of maxillary sinusitis, plate proximity to incision site, and use of tobacco and significant amount of alcohol. Using short screws in fixating maxillary fracture accompanied maxillary sinusitis will increase the rate of infection. Avoiding fixating plates near the incision site will also minimize infection. Close observation until complete absorption of the plate is crucial, especially those who are smokers or heavy alcoholics. The management of plate infection is varied depending on the clinical situation. Severe infections require plate removal. Wound culture and radiologic exam are essential in treatment planning.

Massive Hemorrhage Facial Fracture Patient Treated by Embolization

Major maxillofacial bone injury itself can be life threatening from both cardiovascular point of view, as well as airway obstruction. Significant hemorrhage from facial fracture is an uncommon occurrence, and there is little in the literature to guide the management of these patients. We report a 73-year-old male driver who was transported to our hospital after a motor vehicle collision. The patient was hypotensive and tachycardic at presentation and required active fluid resuscitation and transfusion. The patient was intubated to protect the airway. All external attempts to control the bleeding, from packing to fracture reduction, were unsuccessful. Emergency angiogram revealed the bleeding to originate from terminal branches of the sphenopalatine artery, which were embolized. This was associated with cessation of bleeding and stabilization of vital signs. Despite the age and severity of injury, the patient recovered well and was discharged home at 3 months with full employment. In facial trauma patients with intractable bleeding, transcatheter arterial embolization should be considered early in the course of management to decrease mortality rate.

Endovascular Treatment to Stop Life-threatening Bleeding from Branches of the External Carotid Artery in Patients with Traumatic Maxillofacial Fracture

OBJECTIVE: The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures. MATERIALS AND METHODS: A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated. RESULTS: Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS (p = 0.016), lowest systolic blood pressure (p = 0.011), and lowest body temperature (p = 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused (p = 0.030), the number of units of fresh frozen plasma transfused (p = 0.013), and the time from arrival to groin puncture (p < 0.001) showed significant negative correlation with good clinical outcomes. CONCLUSION: It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.