Effect of Oral and Maxillofacial Injuries on the Development of Post-Traumatic Stress Disorder: A Cross-Sectional Study

ABSTRACT Objective: To assess the influence of oral and maxillofacial trauma on the development of Post-Traumatic Stress Disorder (PTSD) and to determine the efficiency of the Impact of Event Scale-Revised (IES-R) as a diagnostic tool for detecting PTSD in patients with Oral and Maxillofacial injuries. Material and Methods: PTSD was assessed one month postoperatively by the diagnostic instrument, IES-R, to arrive at a provisional diagnosis. A structured clinician-administered PTSD Scale then assessed the patients for the Diagnostic and Statistical Manual of Mental Disorders-5th edition (CAPS-5) to establish a final diagnosis. The assessment of the severity of PTSD was done based on various types of oral and maxillofacial injuries. Results: The IES-R scale provisionally diagnosed 54 subjects with PTSD, out of which 42 were diagnosed to have PTSD by the CAPS-5 scale. Subjects with injuries involving the 'orbital complex,' those presenting with a perceptible scar in the maxillofacial region and with multiple avulsed/ luxated anterior teeth, showed a higher affinity to develop PTSD, and this was statistically significant. Conclusion: Higher levels of PTSD in patients with injuries to the maxillofacial region warrants correct diagnosis and detection, and hence the maxillofacial surgeon plays a vital role in this regard. The IES-R is a useful diagnostic tool to detect PTSD early.

Caracterización del trauma maxilofacial grave en dos servicios de urgencia de La Habana, Cuba / Characterization of severe maxillofacial trauma in two emergency departments in Havana, Cuba

RESUMEN Introducción: Las lesiones faciales pueden afectar la capacidad del paciente para comer, hablar e interactuar. Objetivo: Caracterizar el trauma maxilofacial grave en el servicio de urgencia del Hospital Universitario "General Calixto García" y "Miguel Enríquez", La Habana, Cuba. Métodos: Se realizó un estudio descriptivo transversal multicéntrico en los servicios de urgencia del Hospital Universitario "General Calixto García" y Hospital "Miguel Enríquez" de marzo 2017 a marzo 2019. Se estudió el universo de pacientes con diagnóstico de trauma maxilofacial grave. Las variables cualitativas fueron sexo, etiología, ingestión de bebidas alcohólicas y lesiones, y la cuantitativa fue edad. Se confeccionó una planilla de recolección de datos y la información se introdujo en una base de datos. Se emplearon números enteros, porcentajes y tablas estadísticas. Se buscó la asociación entre variables. Resultados: El sexo masculino constituyó un 80,6 por ciento. El grupo de edad más representado fue el de 18-30 años (33,3 por ciento), seguido por el de 31-40 (25,0 por ciento). En el 41,7 por ciento de los pacientes el trauma estuvo relacionado con accidentes del tránsito, y en el 30,6 por ciento con violencia interpersonal. En el 51,9 por ciento de los pacientes se detectó aliento etílico, con mayoría de los atendidos en el Hospital "Miguel Enríquez". Predominaron las heridas mayores de 2 cm, seguidas por las de menos de esa longitud (61,1 por ciento y 32,4 por ciento, respectivamente) y la fractura mandibular (51,9 por ciento). Conclusiones: Hubo predominio del sexo masculino y grupo de edades de 18-30; como principal etiología estuvieron los accidentes de tránsito, seguidos de la violencia interpersonal; las lesiones de tejidos blandos más frecuentes fueron las heridas mayores de 2 cm y las de tejidos duros, las fracturas mandibulares. Hubo una asociación significativa de la ingestión de bebidas alcohólicas en los pacientes tratados en el Hospital "Miguel Enríquez"(AU)

ABSTRACT Introduction: Facial injuries may affect patients' capacity to eat, speak and interact. Objective: Characterize severe maxillofacial trauma in the emergency departments of General Calixto García University Hospital and Miguel Enríquez Hospital in Havana, Cuba. Methods: A descriptive cross-sectional multicenter study was conducted in the emergency departments of General Calixto García University Hospital and Miguel Enríquez Hospital from March 2017 to March 2019. The study universe was patients diagnosed with severe maxillofacial trauma. The qualitative variables were sex, etiology, consumption of alcoholic beverages and injuries, whereas the quantitative variable was age. A data collection form was developed and the information was stored in a database. Data were expressed in whole numbers, percentages and statistical tables. A search was performed for the relationship between the variables. Results: Male sex constituted 80.6 percent of the sample. The best represented age group was 18-30 years (33.3 percent), followed by 31-40 (25.0 percent). In 41.7 percent of the patients the trauma was related to traffic accidents, and in 30.6 percent to interpersonal violence. Alcohol breath was detected in 51.9 percent of the patients, among them most of those cared for at Miguel Enríquez Hospital. There was a predominance of wounds larger than 2 cm, followed by wounds under that length (61.1 percent and 32.4 percent, respectively) and mandibular fracture (51.9 percent). Conclusions: A predominance was found of the male sex and the 18-30 years age group; the main etiology was traffic accidents, followed by interpersonal violence; the most common soft tissue injuries were wounds larger than 2 cm, whereas the most common hard tissue injuries were mandibular fractures. A significant association was found with consumption of alcoholic beverages among the patients treated at Miguel Enríquez Hospital(AU)

Enfoque clinicoterapéutico de las urgencias bucofaciales en pacientes atendidos en una institución de segundo nivel / Clinical and therapeutical approach of the oral and facial emergencies in patients assisted in a second level institution

Se realizó un estudio descriptivo y transversal de 9 932 pacientes, quienes presentaron urgencias bucofaciales, atendidos en el Cuerpo de Guardia de Cirugía Maxilofacial del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero del 2006 hasta diciembre del 2010, a fin de caracterizarles desde los puntos de vista clínico y terapéutico. Se halló una elevada incidencia de afectados con procesos patológicos agudos que constituyeron urgencias en el Servicio de Cirugía Maxilofacial, aunque solo 3,3 por ciento de ellos fueron hospitalizados. Hubo un predominio de pacientes con traumatismos de partes blandas, procesos inflamatorios sépticos agudos y procesos dolorosos de cabeza y cuello. La mayoría de los procederes quirúrgicos y ortopédicos se efectuaron en el cuerpo de guardia antes citado, lo cual pertenece a la categoría de cirugía menor y bajo régimen de atención ambulatoria

A descriptive and cross-sectional study of 9 932 patients who presented oral and facial emergencies, assisted in the Maxillofacial Surgery emergency room of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 2006 to December, 2010, in order to characterize them from the clinical and therapeutical points of view. It was found a high incidence of affected patients with acute pathological processes that constituted emergencies in the Maxillofacial Surgery Service, although just 3.3 percent of them were hospitalized. There was a prevalence of patients with soft parts trauma, acute septic inflammatory processes and painful processes of head and neck. Most of the surgical and orthopedic procedures were carried out in the emergency room above mentioned, which belong to the category of minor surgery and under ambulatory care

Fracturas del tercio medio facial / Midface fractures

Introducción: las fracturas del tercio medio facial plantean un problema médico grave en cuanto a su complejidad, frecuencia e impacto socioeconómico. Objetivo: realizar una revisión bibliográfica sobre sus consideraciones anatómicas, diagnóstico, clasificación, tratamiento y complicaciones de las fracturas del tercio medio facial. Métodos: se realizó una revisión bibliográfica en septiembre de 2016. Se evaluaron revistas de impacto de Web of Sciencies (25 revistas) y 2 libros. Se consultaron las bases de datos de MEDLINE, PubMed y ScieELO con los descriptores: maxillary fracture, treatment, lefort fracture. Se incluyeron artículos en idioma inglés, de los últimos 5 años. Se obtuvieron 98 artículos. El estudio se circunscribió a 40. Análisis e integración de la información: el tercio medio muestra debilidad anatómica al estar formado por huesos esponjosos, con múltiples suturas y poco protegidos. Existen múltiples clasificaciones de estas fracturas y el diagnóstico se basa en los hallazgos clínicos, siendo de importancia los oftalmológicos, que unidos a los de los medios auxiliares de diagnóstico, permiten escoger la modalidad terapéutica y evitar complicaciones. Conclusiones: las características anatómicas del tercio medio facial justifican la frecuencia y su repercusión de estas fracturas. El diagnóstico debe basarse en el interrogatorio, examen físico y los medios auxiliares de diagnóstico imaginológicos, fundamentalmente tomográficos. Al clasificar la fractura se puede establecer un plan de tratamiento basado en la valoración individual de cada caso con el objetivo de evitar complicaciones posteriores(AU)

Introduction: midface fractures are a serious medical problem due to their complexity, frequency and socioeconomic impact. Objective: conduct a literature review about the anatomical considerations, diagnosis, classification, treatment and complications of midface fractures. Methods: A literature review was conducted in September 2016. The evaluation included high impact journals from the Web of Science (25 journals) and 2 books. The databases MEDLINE, PubMed and SciELO were consulted, using the descriptors maxillary fracture, treatment, lefort fracture. Papers written in English in the last five years were included. Of the 98 papers obtained, the study considered 40. Data analysis and integration: the middle third of the face is characterized by anatomical weakness, since it is formed by scantily protected spongy bone with multiple sutures. There are many classifications for midface fractures, and diagnosis is based on clinical findings, particularly ophthalmological, which alongside those of auxiliary diagnostic devices, make it possible to choose the most appropriate therapeutic mode and prevent complications. Conclusions: the anatomical characteristics of the facial middle third justify the frequency and impact of these fractures. Diagnosis should be based on interrogation, physical examination and the use of auxiliary diagnostic imaging, mainly tomography. Upon classification of the fracture, a treatment plan may be devised based on individual assessment of each case to prevent future complications(AU)

Prevalence of Maxillofacial Trauma and use of Mouthguard by Student Athletes in São Luís, Northeastern Brazil

Objective:To estimate the prevalence of maxillofacial trauma (MT) during sporting activities and to compare the level of knowledge and use of mouthguard (MG) by athletes from the public andprivate school system of São Luís, MA, Brazil. Material and Methods:Cross-sectional study in which a target population composed of 416 competition student athletes aged between 10 and 20 years of both genders, basketball (n=100), handball (n=60), soccer (n=96), judo (n=11), karate (n=22) and volleyball (n=127) players were interviewed by a single examiner. A structured questionnaire containing six objective questions about history of MT, knowledge and use of MG was used. Data were statistically analyzed using the x2 test (α= 0.05). Results:A 26% prevalence of MT was observed in the study population. The knowledge of MG as a method for preventing injuries during sport practice was significant (p<0.05); however, its use by athletes was minimal. A difference in the use of MGby athletes from public and private schools was observed (p<0.05). Conclusion:It was concluded that more than one fourth of the study population was affected by some kind of MT, highlighting dichotomy between the knowledge of MG as prevention method and its non-use during sporting practice

Clinic-pathological study and comparative analysis of orofacial lesions in a brazilian population of children and adolescents

Objective:To describe the sample of Maxillofacial Complex (MFC) Lesions observed in a Brazilian service diagnostic reference for such lesions, and comparatively analyse observed data across the national and international literature. Material and Methods:Aliterature review of survey of MFC Lesions in Children and Adolescentes was performed. The keywords used were “Oral, Pathology” and “Child”, and 18 articles were selected. Then, we surveyed the biopsy archives of the Department of Pathology and Legal Medicine and the Oral Pathology Laboratory of the Federal University of Ceará recorded from 1994 to 2010. The inclusion criterion was patients whose age fell within the range of 0-16 years old. Results:From a total of 4,775 histological results, 499 (10.4%) were selected.Most lesions were diagnosed in female patients, and the prevalence increased with age. Benign lesions represented 90.4% of those reported; some patients had mucocele and inflammatory lesions, and malignant lesions accounted for 1.8% of all lesions reported. These data, compared to the selected articles, showed little similarity between populations at the international level. Conclusion:the evaluated population had significant differences compared to the articles reviewed. The international level of distribution has little influence on this prevalence, which indicates the necessity for performing more local surveys to establish reliable epidemiological profiles

Utility of Aspiration Cytology in the Evaluation of Oral and Maxillofacial Lesions

Background: Fineneedle aspiration cytology (FNAC) as a cheap diagnostic technique has helped reduce diagnostic turnaround time of pathological entities from different body sites. It is thus also important to evaluate its utility in the diagnosis of maxillofacial lesions in view of heterogeneity of morphological patterns noted for this site. Methodology: Cytology and corresponding histology reports for lesions from patients where both were available were compared for concordance between specific cytological diagnosis and final histological diagnosis. From these; sensitivity; specificity; positive predictive value and accuracy of FNAC were calculated. Result: Cytological diagnosis of maxillofacial lesions demonstrated a sensitivity; specificity; positive predictive value and accuracy of 100; 95.7; 97 and 98.2; respectively. The concordance of specific cytological diagnosis with final histological diagnosis was 85.5. Conclusion: This study concludes that FNAC is a cheap and diagnostically reliable technique for evaluation of maxillofacial lesions in a resource poor setting

Non-white people have a greater risk for maxillofacial trauma: findings from a 24-month retrospective study in Brazil

AIM: To identify the predominant causes and types of maxillofacial trauma in Brazil. METHODS: Reports of corporal trauma (7,536) between 2009-2010 in the Brazilian Institute of Forensic Medicine were analyzed as to the presence of maxillofacial traumas. Victims' demographic and trauma characteristics were recorded. RESULTS: Data were submitted to chi-square test and to multivariate Poisson regression. 778 reports referred maxillofacial trauma. Most victims were men (50.8%) around 27.6 years. Main causes were physical aggression (88.1%) and traffic accidents (6.7%). The most affected extraoral area was the middle third (60.7%). Risk for trauma in the middle third was significantly higher among patients aged 61-75 (RR 1.32), and non-white patients (black-skinned RR 1.21; brown-skinned RR 1.18); while falls were associated with trauma in the lower third (RR1.79). CONCLUSIONS: Violence was the main cause of maxillofacial trauma. Prevention of interpersonal violence may be a key element to prevent maxillofacial trauma.

Evaluation of the use of biomodels in sequelae of maxillofacial trauma / Evaluación de la utilización de biomodelo de secuelas de traumatismo maxilofacial

The use of rapid prototyping technology in Oral and Maxillofacial Surgery has been increasing in the last decade, allowing the management of biomodels from medical image processing as computed tomography in order to obtain a three dimensional model with the same geometric characteristics as the virtual one. The aim of this study is to present the use of biomodels for treatment of maxillofacial trauma sequelae with evaluation of clinical records in a period that varies from January 2000 to December 2010. For diagnosis and surgical planning of maxillofacial sequelae in this period, some 15 prototypes were used, allowing us to determine the treatment planning with more accuracy and to save operating room time.

El uso de tecnología de prototipado rápido en Cirugía Oral y Maxilofacial se ha incrementado en la última década, lo que permite la gestión de los biomodelos de procesamiento de imágenes médicas, como tomografía computarizada para obtener un modelo tridimensional con las mismas características geométricas del virtual. El objetivo de este estudio es presentar el uso de biomodelos para el tratamiento de las secuelas de un traumatismo maxilofacial con la evaluación de las historias clínicas en un período que varía entre enero de 2000 a diciembre de 2010. Para el diagnóstico y la planificación de la cirugía maxilofacial de las secuelas en este período, 15 prototipos fueron utilizados, lo que permite determinar la planificación del tratamiento con más precisión y para ahorrar tiempo de quirófano.

Traumatismos maxilofaciais em crianças e adolescentes em Campina Grande, Paraíba, Brasil / Maxillofacial traumatisms in children and adolescents in Campina Grande, Brazil

Objetivo: Avaliar os traumatismos maxilofaciais em crianças e adolescentes no município de Campina Grande, Paraíba, Brasil. Método: Estudo transversal com dados secundários, sendo a amostra composta por 941 prontuários de pacientes com idades entre 1 a 18 anos portadores de trauma facial atendidos no período de junho de 2007 a junho de 2009 em dois centros de trauma do município. As variáveis estudadas compreenderam: sexo, idade, etiologia, existência de fratura facial, osso acometido e trauma dentário. A análise estatística foi utilizou os testes do Qui-quadrado e Exato de Fisher com nível de significância de 5% (p menor que 0,05). O odds ratio (OR) com intervalo de confiança de 95% foi calculado (IC 95%). Todas as análises foram feitas com o software Epi Info 3.5. Resultados: A razão entre os sexos masculino e feminino foi de 2:1 e a faixa etária de maior acometimento foi a de 1 a 4 anos (28,5%). As quedas (40,6%) e os acidentes de transporte terrestre (20,1%) foram os agentes etiológicos mais prevalentes. Observou-se associação entre o sexo e a ocorrência de acidente de transporte (p=0,001; OR=1,85 [1,28-2,69]. Fraturas faciais foram verificadas em 15,8% das vítimas, existindo associação entre o sexo e a ocorrência de fratura facial (P=0,047; OR=1,5 [1,02-2,25]), predominando os ossos nasais (31,5%) e o zigomático (22,8%). Traumatismo dentário foi identificado em 10,2% das vítimas, não existindo diferença estatística entre o sexo e a presença de trauma dentário (P=0,356). Conclusão: Crianças de baixa idade são as vítimas mais comuns de traumatismos maxilofaciais, com a maioria dos casos ocorrendo nos finais de semana e as quedas e os acidentes de transporte terrestre constituindo-se nos principais agentes etiológicos.

Objective: To evaluate the maxillofacial traumatisms in children and adolescents in the city of Campina Grande, PB, Brazil. Method: This investigation was a cross-sectional study with secondary data and sample composed of 941 charts of 1-18-year-old patients with facial trauma treated between June 2007 and June 2009 at two trauma centers. The studied variables were: sex, age, etiology, existence de facial fracture, affected bone and dental trauma. Comparisons of data were evaluated statistically using the Chi-square and Fisher's Exact tests at a significance level of 5% (p less than 0.05). Odds ratio (OR) with confidence intervals to 95% were calculated (CI 95%). They were calculated using the Epi Info Software. Results: The male-to-female ratio was 2:1 and the 1-4-year-old age group was the most affected (28.5%). Falls (40.6%) and road transport accidents (20.1%) were the most prevalent etiologic agents. There was association between sex and occurrence of transport accident (p=0.001; OR=1.85 [1.28-2.69]). Facial fractures were verified in 15.8% of the victims, existing an association between sex and occurrence of facial fracture (p=0.047; OR=1.5 [1.02-2.25]), with predominance of nasal bones (31.5%) and zygomatic bone (22.8%). Dental trauma was identified in 10.2% of the victims, with no statistically significant difference between sex and the presence of dental trauma (p=0.356). Conclusion: Children at early age are the most frequent victims of maxillofacial traumatisms, with most cases occurring during weekends, and falls and road transport accidents being the main etiological agents.

Ocorrência de injúrias orofaciais em praticantes de esportes de luta / Orofacial injuries in combat sports practitioners

Objetivo: Analisar a ocorrência de lesões orofaciais em praticantes de esportes de luta. Método: Realizou-se um estudo transversal, descritivo-analítico, com abordagem indutiva e técnica de pesquisa a observação direta extensiva. A amostra do tipo não probabilística foi composta por 85 praticantes de esportes de luta matriculados em academias de Campina Grande-PB. Os dados foram coletados mediante a aplicação de um questionário composto por perguntas abertas e fechadas, dicotômicas e de múltipla escolha. As variáveis analisadas foram: sexo, idade, número e tipo de esporte praticado, importância e uso do protetor bucal, tipo de protetor bucal (pré-fabricado, termoplástico ou confeccionado pelo cirurgião-dentista), ocorrência de lesão associada à prática esportiva, região acometida e injúria na cavidade bucal. Os dados foram apresentados por meio da estatística descritiva. Para a análise bivariada utilizou-se os testes Exato de Fisher e Qui-quadrado (p menor que 0,05%). Resultados: A maioria dos atletas eram homens (76,5%), sendo a média de idade de 27,4 anos (±8,7). Quanto ao número de esportes, observou-se que a maioria fazia um único esporte de luta (90,6%). No que concerne ao tipo de esporte, verificou-se um predomínio do boxe (46,2%), seguido do Jiu-Jitsu (25,8%). A quase totalidade dos indivíduos (95,3%) afirmou conhecer a importância dos protetores bucais, porém apenas 41,7% relataram utilizá-lo, durante a prática esportiva existindo diferença estatisticamente significante entre o uso e o sexo do atleta (P=0,023). O tipo de protetor bucal mais utilizado foi o termoplástico (51,4%). Com relação à ocorrência de lesões nas distintas regiões do corpo, 43,5% afirmaram ter sofrido injúrias, existindo associação entre o sexo e a presença de lesão (P=0,002). Lesões na cavidade bucal foram reportadas por 16,5% dos praticantes, sendo todos do sexo masculino, existindo, portanto, associação estatisticamente significante entre o sexo e a presença de lesões na cavidade bucal (P=0,016). Conclusão: Há um predomínio do sexo masculino entre os atletas de esportes de luta, porém nem todos fazem uso dos protetores bucais durante a prática esportiva, apesar da alta ocorrência de injúrias nas regiões da cabeça e face. As lesões na cavidade bucal apresentaram uma baixa frequência nesses desportistas.

Objective: The purpose of this study was to evaluate the occurrence of orofacial injuries among combat sports practitioners. Method: A cross-sectional descriptive-analytical study was conducted in a sample of 85 combat sports practitioners from fitness gyms in the city of Campina Grande, PB, Brazil. The data were collected using a questionnaire applied to the participants and referred to gender, age, type and number of the practiced sports, importance and use of mouthguard, type of mouthguard, occurrence of injuries related to sports practice, affected region, and oral injury. The data were processed by Epi Info 3.5.1 software and presented by descriptive statistics. Fisher's exact and chi-square tests were employed for bivariate analysis (p less than 0.05). Results: Most athletes were men (76.5%) and the mean age was 27.4 ± 8.7 years. The prevailing sports practices were boxing (46.2%) and jiu-jitsu (25.8%). Only 41.7% of the interviewers used a mouthguard during sports practice and there was a statistically significant difference for its use between the genders (p=0.023). Thermoplastic mouthguard was the most frequently used type (51.4%). Occurrence of diverse injuries in different regions of the body was reported by 43.5% of the subjects, with a statistically significant association between gender and presence of injury (p=0.002). Oral injuries were reported by 16.5% of the practitioners, all of them male, with a statistically significant association between gender and presence of oral injuries (p=0.016). Conclusion: Mouthguard is not properly used by combat sports practitioners, in spite of the high rate of injuries in the head and face region. There was a low frequency of oral injuries among these athletes.

Traumatología máxilo facial: diagnóstico y tratamiento / Maxillo facial traumatology: diagnosis and treatment

El trauma máxilo facial corresponde a todas las lesiones de origen traumático que afectan al macizo facial, incluyendo tejidos óseos, blandos y las estructuras alveolo dentarias. El trauma en el territorio facial representa uno de los problemas de salud más importantes a nivel mundial, particularmente por su alta prevalencia, diversidad etiológica y alta morbilidad. Reflejándose en importantes alteraciones funcionales y estéticas, que determinan un alto costo social y económico. El diagnóstico y tratamiento del trauma máxilo facial debe realizarse de forma oportuna por un profesional competente, para minimizar las secuelas de esta patología. En el presente artículo se revisan, a modo general, los principales diagnósticos de trauma máxilo facial incluyendo el traumatismo alveolo dentario, con sus respectivos manejos y tratamientos de urgencia.

The maxillo facial trauma corresponds to all injuries of a traumatic origin that affects the facial components, including bones and soft tissues and the alveolo dental structures. The trauma in the facial area represents one of the most important problems of health at a world wide level, particularly for its high prevalence, etiologic diversity and high morbidity. Being reflected as an important functional and aesthetic alteration, that can determine a high social and economic cost. The diagnosis and treatment of the maxillo facial trauma must be realized in an opportune form by a competent professional to diminish the sequels of this patology. In this article they are reviewed, in a general way, the main diagnosis of maxillo facial trauma including alveolar dental traumatism, with its respective handlings and emergency treatments.

Atención a pacientes con heridas maxilofaciales producidas por armas de fuego / Care of patients presenting with maxillofacial wounds by firearms

Los traumatismos y fracturas maxilofaciales ocasionan deformidades difíciles de ocultar por ser la cara la porción más visible del cuerpo. Este trabajo tuvo como objetivo documentar la atención a un grupo de pacientes con heridas maxilofaciales producidas por arma de fuego, que fueron atendidos por la brigada médica cubana del Hospital Al-Waheda de Maabar (República de Yemen). Se analizó un grupo de 9 pacientes con heridas maxilofaciales, atendidos en el Hospital Al-Waheda de Maabar, perteneciente a la Universidad de Thamar (Yemen), entre los años 2006 y 2008. Se recogieron los datos siguientes: nombre y apellidos edad, sexo, lesión principal, lesiones asociadas y tipo de tratamiento, así como la evolución de los pacientes. El método estadístico empleado fue el cálculo porcentual. Entre las principales lesiones tratadas se encontraron las fracturas mandibulares, nasales y dentoalveolares, para cuyo tratamiento se siguieron las normas de los protocolos establecidos para la atención de este tipo de afección. Los resultados fueron excelentes en todos los pacientes y hubo una rápida recuperación en todos los casos. Se obtuvieron muy buenos resultados estéticos y funcionales. Al comparar el estado preoperatorio y posoperatorio de los pacientes, se demostró la importancia de la atención integral del equipo de profesores cubanos(AU)

Traumatisms and maxillofacial fractures cause deformities difficult to hide because of the face of the more visible portion of the body. The aim of present paper is to document the care to group of patients presenting with maxillofacial wounds caused by firearms, treated by the Cuban medical brigade of Thamar University Al-Waheda Hospital of Maabar (Republic of Yemen). A group of 9 patients presenting with maxillofacial wounds caused by firearms treated in above mentioned hospital between 2006 and 2008. Following data were collected: full name, age, sex, leading lesion, lesions associated with the type of treatment, as well as the patient's course. Statistical method used was the percentage calculation. Among the firsts lesions treated were the mandibular, nasal and dentoalveolar fractures and its treatment the following guidelines of protocols established for care of this type of affection. Results were excellent in all patients and there was a fast recovery in all cases as well as goods aesthetic and functional results. Comparing the preoperative and the postoperative stage of patients it was possible to demonstrate the significance of integral care of the staff of Cuban professionals(AU)

Estimativa de custo direto de lesões traumáticas maxilofaciais em crianças e adolescentes em um hospital público do Município de São Paulo / Direct cost estimate of maxillofacial trauma injuries in children and adolescents admited in a public hospital in São Paulo

O presente estudo procurou obter uma estimativa dos custos diretamente ligados ao atendimento de lesões traumáticas maxilofaciais em crianças e adolescentes, comparados com a população adulta acometida do mesmo agravo, bem como o perfil sociodemográfico da população atendida em um Hospital Público do Município de São Paulo, Brasil, com o título de fornecer evidências para avaliação do dano em perícias odontolegais. Material e Método. Os dados dos prontuários foram colhidos no período de janeiro de 2002 a dezembro de 2008 dos pacientes atendidos no serviço de Cirurgia Buco-Maxilofacial de um hospital do Município de São Paulo. As variáveis classificatórias foram descritivamente apresentadas em tabelas de contingência contendo frequências absolutas (n) e relativas (%). A associação entre elas foi avaliada com o teste Qui-quadrado ou teste da razão de verossimilhança. Para a análise dos custos diretos foram utilizados os valores de referência da Tabela do Sistema de Informações de Tratamento Ambulatorial do Sistema Único de Saúde - SIA-SUS do ministério da Saúde. Resultados. Dos 1.200 casos analisados, 419 preencheram os requisitos da pesquisa. O grupo caso obteve 108 registros (faixa etária até 19 anos), e os demais foram classificados, como grupo controle (acima de 20 anos de idade). O grupo caso apresentou uma incidência de 1,5% ao ano de lesões traumáticas, e a média de idade no grupo caso foi de 14,35±4,76 e no grupo controle foi de 33,65±11,73 anos de idade. Em relação ao sexo predominaram os indivíduos do sexo masculino em ambos os subgrupos. O tipo de tratamento cirúrgico prevaleceu em ambos os subgrupos, e o tempo de internação em dias foi cerca de duas vezes maior no grupo controle em relação ao grupo caso, entretanto as complicações foram mais frequentes no grupo caso em relação ao grupo controle. Os tipos de lesões mais frequentes no grupo caso foram as fraturas nasais/dentárias, seguidas das fraturas e mandíbula, e que no grupo controle o quadro inverteu-se. A distribuição de custos teve o maior número de casos na faixa de custos até R$ 500,00 em ambos os subgrupos amostrais. A frequente de ocorrência de complicações foi significativamente maior no grupo caso, em relação ao grupo controle, da mesma forma que os retornos ambulatoriais foram também significativamente maiores neste grupo. Conclusões: a distribuição de custos teve o maior número de casos na faixa de custos até R$ 300,00 em ambos os subgrupos amostrais; esses custos foram calculados com base no repasse de verbas da Tabela de Valores do Sistema Único de Saúde, onde não está discriminado o custo dos honorários profissionais. A valoração do dano nas atividades periciais deve considerar, além dos custos diretamente envolvidos com o atendimento do traumatizado, as consequências para suas atividades diárias especialmente quando se trata de criança ou adolescentes cuja função social ainda está por se definir.

The aim of this study is to provide evidence for the quantitative assessment of injury in forensic dentistry investigation, thorough the estimate of costs directly linked to the care of maxillofacial trauma lesions in children and adolescents, compared to adults who suffered the same injuries, as well as trace a social demographic profile of the patients admited in a public hospital in São Paulo. Material and Method. The hospital chart data were collected from january 2002 to december 2008 and the charts belonged to patients cared for by the Buco-Maxillofacial Surgery Department of a hospital in São Paulo. Classification variables were described in contingency tables which comprise absolute (n) and relative (%) frequencies. Their association was assessed using the chi-square test. reference prices from the Ambulatory Care Price Bable, provided by the Unified Health system (SIA-SUS), the govermment managed Public Health System in Brazil, were used to determine direct costs. Outcome: out the 1200 cases analyzed, 419 matched the requisites of this survey. The casegroup comprised 108 cases (up to 19 years old) and the other 311 were classified as the control group (above 20 years old). The incidence rate of trauma lesions as of 1,5% per year in the case group and the average age was of 14,35±4,76 while in the control group, the average age was 33,65±11,73. Male individuals prevailed in both groups and so did the surgical treatment. The number of days of hospital stay was about twice as big in the control group in relation to the case group. Complications, however, were more frequent in the case group. The most frequent winds of lesion in the case group were the dental or nasal fractures. Followed by jaw fractures, and this was directly opposite to what happened in the control group. The Unified Health System (SUS) reimbursed treatments of up to 500 reais in both group. The frequency of complications and retums to the Ambulatory Care facilities were significantly higher in the case group.

Traumatismo maxilofacial e sua possível associação com lesão na coluna cervical / Maxillofacial Trauma and its Possible Association with Cervical Spine Lesion

O estudo objetiva avaliar dados de prevalência do traumatismo maxilofacial e sua associação com lesão cervical. Foram estudados retrospectivamente 50 pacientes internados, com traumatismo maxilofacial, no maior hospitalde urgência e emergência do estado de Sergipe, durante 2002/2003. Foram analisadas as seguintes variáveis:gênero, idade, etiologia, prevalência do traumatismo maxilofacial associado à lesão na coluna cervical,localização da lesão cervical e evolução clínica. Os resultados mostram que houve maior incidência do gênero masculino (94%), na terceira década de vida (32%), sendo acidente automobilístico o principal fator etiológico(52%). A associação entre trauma maxilofacial e lesão cervical aconteceu em dois casos (4%), ocorrendo fratura entre os segmentos C5/C6 e C6/C7, que evoluíram sem seqüelas. A incidência da associação do traumatismo maxilofacial com lesão cervical, apesar de ser baixa, é extremamente importante, pois esse tipo de associação é responsável por elevados índices de morbimortalidade

Lesões bucais: concordância diagnóstica na Faculdade de Odontologia de Pernambuco / Buccal lesions: disgnostic agreement in the Pernambuco Dentistry College

O presete trabalho objetiva realizar um estudo retrospectivo das lesões bucais e analisar o nível de concordância entre os diferentes diagnósticos clínicos, cirúrgico e histopatológico, diagnosticados no Laboratório de Patologia Bucal da Faculdade de Odontologia da Universidade de Pernambuco no período de 1991 a 1998. Foram analisadas 915 requisições e laudos dos arquivos e notificados os dados referentes ao paciente, às lesões e diagnósticos. Os resultados totalizaram 54 lesões, sendo a hiperplasia fibroepitelial inflamatória, nevus, granuloma piogênico, processo inflamatório crônico inespecífico, cisto periapical, mucocele, papiloma, hoperceratose, carcinoma basocelular e granuloma periapical, os diagnósticos mais prevalentes (64%). O gênero feminino, a raça branca e a faixa etária entre 10 e 39 anos foram os achados mais prevalentes. Dentre as áreas anatômicas a derme facial (15,2%), rebordos alveolares e gengiva (13,2%) e mucosa labial (11,1%) foram as mais afetadas. A biópsia excisional foi a técnica mais executada (67%), sendo os diagnósticos clínicos e histopatológico coincidentes em 52%. Verifica-se que informações completas sobre o paciente, a lesão e seu mauseio são parâmetros fundamentais que complementam e contribuem para uma conduta diagnóstica e terapêutica adequadas e que os diagnósticos clínicos e cirúrgicos são, especialmente, relevantes no estabeleciemnto do diagnóstico final.

Histologia e fisiologia do enxerto ósseo autógeno: revisão de literatua / Histology and physiology of of the autogenous bone graft: review of the literature

Inúmeras técnicas de reconstrução óssea são propostas, seja pela necessidade de quantidade e qualidade óssea, ou por melhor estética para a colocação de implantes. O enxerto autógeno de áreas doadoras intra-bucais, entre elas, é comprovadamente uma das técnicas mais realizadas hoje em Implantodontia (Triplett & Schow, 1996, Widmark et. 1996, Dinato & Polido, 2001). Assim, é de suma importância conhecer as estruturas básicas do desenvolvimento biológico e função do tecido ósseo. Concluindo, o objetivo será estudar a literatura científica a respeito da histologia e fisiologia do osso, bem como a incorporação dos enxertos ósseos autógenos.

A lot of techniques of reconstruction bone are propose, device the necessity or because the quality and quantitative bone, or to improve the esthetic in the place of implantations. The autogenous bone of the intra-oral gift area, between then, one of the main techniques today in Implantology (Triplett & Schow23, 1996, Widmark et al. 199624, Dinato & Polido, 20016). So, is very important to know the basic estructures of biology desenvelopment and the function of bone tissue. Concluding, the purpose will be study the cientific literature of histology and bone physiology, as well the incorporation mechanisms of the autogenous grafts.

A prospective study of dentoalveolar trauma at the Hospital das Clínicas, São Paulo University Medical School

PURPOSE: This prospective study evaluated the profile of patients with dentoalveolar trauma assisted at the emergency room of the Oral and Maxillofacial Trauma and Surgery Service at the Hospital das Clínicas, São Paulo University Medical School (Brazil). METHODS: A prospective study by a questionnaire applied during the first attendance of those patients, in a period of eight months. RESULTS: The collected data were statistically analyzed. It was observed that 4.7 percent of the patients that sought treatment at the Service had sustained dentoalveolar trauma and among these 74 percent were male. The most affected individuals were children aged 0 to 5 years and fall was the most prevalent etiologic factor. Avulsion and coronal/crown-root fractures were the most common types of dentoalveolar traumatic injures. As the age increases, the most common etiologic factors are traffic accidents and physical assault. CONCLUSION: The incidence of dentoalveolar trauma decreased with age and the main etiologic factors in adult patients were traffic accidents and physical assault.

PROPOSIÇÃO: Avaliar o perfil dos pacientes, com traumatismo dento-alveolar, atendidos no Pronto-Socorro do Serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Brasil). MÉTODOS: Foi realizado um estudo prospectivo, através de um questionário aplicado, durante o primeiro atendimento desses pacientes, em um período de oito meses. RESULTADOS: Os dados obtidos foram analisados estatisticamente e verificou-se que dos pacientes atendidos 4,7 por cento apresentavam traumatismo dento-alveolar, e destes, 74 por cento eram do gênero masculino; as crianças de 0 a 5 anos eram as mais acometidas, a etiologia mais comum foi a queda; e o tipos de traumas mais freqüentes foram a avulsão e fratura dental. A medida que a idade avança os fatores etiológicos mais comuns são os acidentes de trânsito e as agressões físicas. CONCLUSÃO: A incidência de trauma de dentoalveolar diminuiu com a idade e o principal fator etiologico nos pacientes adulto foi acidentes de tráfico e agressão física.

Fatores etiológicos das mutilações buco-maxilo-faciais em pacientes atendidos no serviço de prótese buco da FOP/UPE / Etiologic factors of bucomaxilofacial mutilations in patients attended in the Bucomaxilofacial prosthesis clinic from the Dental School of Pernambuco

Esta pesquisa objetivou determinar os fatores etiológicos mais frequentes das mutilações buco-maxilo-faciais, encontrados em pacientes atendidos no Serviço de Prótese Buco-Maxilo-Facial da Faculdade de Odontologia de Pernambuco, verificando as variáveis: gênero, faixa etária, etiologia, região facial mais atingida e tipos de próteses confeccionadas. A metodologia consistiu em um estudo retrospectivo de 256 prontuários do referido serviço para verificar os objetivos propostos na pesquisa. Diante dos resultados encontrados pode-se concluir que, o gênero mais acometido pelas lesões foi o masculino com 58,2 por cento em relação a 41,8 por cento do feminino; a faixa etária mais prevalente foi entre pacientes maiores de 45 anos; os fatores etiológicos mais frequentes foram: congênitos com 5,1 por cento; adquirido traumático intencional 39,8 por cento; adquirido traumático acidental 26,6 por cento; patológica infecciosa 21,1 por cento e patológica neoplásica com 7,4 porcento. As regiões faciais mais afetadas pela mutilação e os tipos de próteses confeccionados foram: ocular 87,4 por cento; óculo-palpebral 6,3 por cento; regiões internas 4,3 por cento e facial extensa 2,0 por cento.