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.

Remoção de um corpo estranho incomum decorrente de trauma orbital: relato de caso / Removal of an unusual strange body arising from orbital trauma: case report

Introdução: Trauma contuso e penetrante na região orbital pode ter um efeito devastador, tanto funcional quanto estético para a órbita e estruturas adjacentes. Uma inspeção meticulosa das pálpebras e do globo deve ser realizada e, se houver suspeita de retenção de um corpo estranho dentro dos tecidos moles orbitais, deve ser obtida uma tomografia computadorizada (TC). O objetivo do presente estudo foi relatar um caso clínico de trauma óculo-orbitário severo ocasionado por acidente com animal. Relato de caso: paciente de 22 anos do gênero masculino apresentou-se em um hospital de referência em trauma na cidade de Campina Grande-PB, com história de acidente com cavalo e colisão em cerca de madeira. A tomografia revelou que havia a presença de um corpo estranho (CE) de madeira que apresentava uma forma pontiaguda e proximidade com estruturas como músculos, vasos e nervos da órbita, além da presença de fratura no assoalho da órbita. Considerações finais: A presença de CE de madeira deve sempre ser investigada quando há trauma direto na cavidade orbitária, pois a madeira é áspera e contém uma grande quantidade de bactérias e parasitas. Sendo assim, deve ser removido o mais precocemente possível a fim de se evitar complicações infecciosas... (AU)

Introduction: Blunt and penetrating trauma to the orbital region can have a devastating effect, both functional and aesthetic for the orbit and adjacent structures. Meticulous inspection of the eyelids and the globe should be performed and, if a foreign body is suspected to be retained within the orbital soft tissues, a computed tomography (CT) scan should be obtained. The aim of the present study was to report a clinical case of severe oculo-orbital trauma caused by an accident with an animal. Case report: a 22-year-old male patient presented at a trauma referral hospital in the city of Campina Grande-PB, with a history of accident with a horse and collision on a wooden fence. The tomography revealed that there was the presence of a wooden foreign body (EC) that had a pointed shape and proximity to structures such as muscles, vessels and nerves in the orbit, in addition to the presence of a fracture in the orbit floor. Final considerations: The presence of wood CE should always be investigated when there is direct trauma to the orbital cavity, as the wood is rough and contains a large amount of bacteria and parasites. Therefore, it should be removed as early as possible in order to avoid infectious complications... (AU)

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

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

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

Fístula liquórica traumática com luxação de globo ocular: relato de caso / Management of globe luxation followed by traumatic liquoric fistula: case report

This report describes the only case in the literature of globe luxation due to traumatic cerebrospinal fluid fistula to the orbit caused by fire gun with ocular globe maintenance. E.N., female, white, 7 months, admitted with left orbitocranial injury by fire gun. Ocular globe luxation was detected with complete ocular motility restriction and absence of pupillary reflex in the left orbit. Computed tomography showed fracture of the medial orbital wall; bone fragments near the apex of the orbit and a stretched optic nerve. Surgical exploration was performed, showing liquor fistula through the ethmoid-sphenoid wall that was blocked with sponge (Gelfoam®) plus organic glue in the left orbit posterior wall, with immediate resolution of the proptosis and ocular integrity maintenance. Although controversial, maintenance of the ocular globe instead of enucleation was performed due to the integrity of the globe in this case. Despite the blindness, we considered the result to the proposed treatment excellent, once the maintenance of the ocular globe provides a good appearance and will contribute to an adequate facial bone development.

O presente estudo apresenta o único caso de luxação de globo ocular devido fístula liquórica traumática em vítima de trauma órbito-cerebral por projétil de arma de fogo com a preservação do globo ocular. E.N., feminino, branca, 7 meses, admitida com ferimento por projétil de arma de fogo em região órbito-craniana esquerda. Apresentava luxação de globo ocular esquerdo com restrição completa da motilidade ocular e reflexo fotomotor ausente à esquerda. À tomografia: fraturas da parede medial da órbita; fragmentos ósseos próximos ao ápice da órbita. Realizou-se exploração cirúrgica, evidenciando-se fístula liquórica através de fratura etmoido-esfenoidal a qual foi tamponada com esponja (Gelfoam®) e cola orgânica na parte posterior da parede medial da órbita esquerda, com regressão imediata da luxação do globo ocular, sendo o mesmo mantido íntegro. Embora controversa na literatura, optou-se pela preservação do globo ocular à enucleação, visto que o mesmo estava íntegro. Apesar da cegueira, consideramos um excelente resultado ao tratamento proposto, tendo em vista que a preservação do globo ocular provém uma boa aparência, favorecendo também o desenvolvimento ósseo da face.

Maxillofacial injuries in a group of Brazilian subjects under 18 years of age

OBJECTIVE: The purpose of this study was to perform a clinical retrospective analysis of the etiology, incidence and treatment of selected oral and maxillofacial injuries in Brazilian children and adolescents. MATERIAL AND METHODS: This study was conducted during a 14-year period between 1986 and 2000. All patients were admitted to Hospital XV in the city of Curitiba, State of Paraná. Age, gender, monthly distribution, etiology, soft injuries, associated injuries, site of fractures and methods of treatment were reviewed. RESULTS: Of the total of 350 patients of all ages treated for facial injuries, 29.42% were within the age range of the study (0 to 18 years). Mean age was 10.61. Of the patients, 63.1% were male. The most common cause of injury was accidental falls (37.87%), followed by bicycle and motorcycle accidents (21.36%). Of the 103 patients, 88.34% had single injuries. Mandibular fractures were the most common and the condylar region was particularly affected. CONCLUSIONS: Facial trauma is a relatively common occurrence in children. The study indicates that fractures in children and adolescents differ quite considerably from an adult population.

Analysis of 185 maxillofacial fractures in the state of Santa Catarina, Brazil

A retrospective study was performed to assess maxillofacial fractures in patients treated at a public hospital from 2002 to 2006. The data collected included age, gender, etiology, type of injury, treatment modalities and period of treatment. Causes were grouped into seven categories: road traffic collisions, sports accidents, occupational accidents, gunshot fractures, falls, violence and other causes. The analyses involved descriptive statistics, the Chi-squared Test and the Fisher Exact Test. Records from 132 patients sustaining 185 maxillofacial fractures were evaluated. The mandible (54.6 percent) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6 percent). The mean age of the patients was 37.7 years, and the male:female ratio was 4.3:1. Most fractures occurred in adults with ages ranging from 18 to 39 years. A significant statistical relation was found between the age and the etiology of the trauma (p < 0.05), and between the number of fractured sites and the age of the patient (p < 0.05). Considering the age groups, accidents were the most frequent cause of maxillofacial fractures in the age group between 18 to 39 years, and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 to 59 years. Treatment was performed on the same day as the diagnosis in 44.7 percent of the patients. Open surgery with internal stable fixation was indicated for most of the patients. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Traffic road collisions were the main etiologic factor associated with maxillofacial trauma.

Reconstrucción de piso de orbita con malla de titanio en trauma de tercio medio facial / Orbital Floor reconstruction with titanium mesh for middle third fracture

El trauma maxilofacial es un área desafiante para cirujanos orales y maxilofaciales. En casos de fractura orbitaria, generalmente existirá un defecto óseo en alguna de sus paredes, determinando la necesidad de reconstrucción. La malla de titanio ofrece importantes ventajas para su manipulación e instalación, permitiendo la fácil adaptación en el lugar requerido. Nuestro objetivo es presentar una serie de caso con fracturas de complejo zigomático orbitario (CZO) y con fractura de complejo naso-orbito- tmoidal (NOE), donde la malla da titanio demostró ser efectiva en el manejo de la reconstrucción orbitaria.

Maxillofacial trauma is a challenge area for oral and maxilofacial surgeons. For orbital fracture, generally existing an osseous defect in some of orbital wall, determining the reconstruction necessity. Titanium mesh has importantadvantage for your manipulation and installation with easy adaptation in the selected place. Our objective was present a cases series with zygomatic complex fracture and with naso-orbito-ethmoidal fracture, when titanium mesh showing efficiency for the management of orbital reconstruction.

Fraturas naso-órbito-etmoidais: estudo epidemiológico descritivo / Nasal-orbital-ethmoidal fractures: a descriptive epidemiological study

A fratura naso-órbito-etmoidal (NOE) é um tipo raro de fratura, de difícil tratamento e com resultados estéticos e funcionais diretamente relacionados ao momento e ao tipo de cirurgia instituída. Suas principais características clínicas são: liquorréia, telecanto traumático, oftalmoplegia, enoftalmo, diplopia, ptose palpebral, crepitação dos segmentos ósseos fraturados, epistaxe, assimetria facial e deformidade do dorso nasal. Realizou-se um estudo retrospectivo em que foram avaliados os prontuários de 42 pacientes portadores de fraturas naso-órbito-etmoidais, atendidos e tratados no Setor de Cirurgia Bucomaxilofacial da Santa Casa de São Paulo, no período de janeiro de 1987 a março de 2002. A metodologia e os resultados são discutidos, com ênfase às características demográfico-sociais. As conclusões são: o grupo de risco para as fraturas NOE é composto por indivíduos do gênero masculino, da raça branca, da faixa etária dos 21 aos 40 anos, envolvidos em acidentes automobilísticos; as características clínicas mais comuns são o telecanto traumático e o enoftalmo, e a principal lesão associada é o traumatismo craniano

Naso-orbito-ethmoid fracture is a rare kind of fracture, with complex treatment and with aesthetic and functional results directly related to the moment and type of utilized surgery. Its main clinical characteristics are: cerebrospinal rhinohrea, traumatic telechantus, ophthalmoplegy, enophtalmus, diplopy, upper eyelid ptosis, fractured bone segments crepitation, epistaxis, facial assimetry and root nasal deformity. Fourty-two files were retrospectively evaluated on patients with naso-orbito-ethmoid fractures, received and treated at the Oral and Maxillofacial Surgery Sector at São Paulo Santa Casa, within the period from January 1987 to March 2002.The methodology and results are discussed, with emphase on the demographic-social characteristics. The conclusions are: the risk group for NOE fractures is composed by white men, among 21- 40 years old, involved in traffic accidents: the most common clinic characteristics are traumatic telecanthus and enophtalm and the main associated lesion is the cranial traumatism

Unilateral blindness as a complication of nasal septoplasty: case report

Cegueira como complicação de septoplastia nasal é uma ocorrência devastadora com apenas poucos casos relatados na literatura. Na maioria destes casos, a perda visual foi atribuída a embolismo retiniano após injeção intra-arterial de substâncias no corneto nasal. Este trabalho documenta um caso de cegueira unilateral completa decorrente de trauma direto do nervo óptico durante uma septorrinoplastia aparentemente sem intercorrências. Oftalmologistas e otorrinolaringologistas devem portanto estar cientes da possibilidade da ocorrência desta complicação.

A Case of Air-bag Associated Severe Ocular Injury

Air-bags have received widespread support as an effective means of enhancing automotive safety, and they are becoming more common as standard automobile equipment on many cars. Although air-bag induced ocular injuries are rare, they present a serious concern because of the possibility of permanent damage or visual impairment. To date, most reports have investigated ocular injury from high velocity motor vehicle accidents and reports of ocular injury from low speed motor vehicle accidents have been rare. We describe a patient who sustained severe ocular injury, including periorbital fracture, hyphema, vitreous hemorrhage, and choroidal rupture of the macular area, due to an inflated air-bag in a low speed motor vehicle accident.

Complicaçöes da cirurgia microendoscópica naso-sinusal / Complications of microendoscopic naso-sinusal surgery

Os autores apresentam uma atualizaçäo sobre as complicaçöes da cirurgia microendoscópica naso-sinusal

Blowout de la pared de la órbita / Blowout of the orbital wall

Se presenta el caso clínico de un paciente de 21 años de edad con fractura de la pared interna de la órbita, con objeto de hacer resaltar las características clínicas de este cuadro y recordar los mecanismos que explican la producción de las mismas

Fracturas de órbita. Revisión de 36 casos / Orbital fractures. A review of 36 cases

Se revisaron retrospectivamente 36 pacientes, de 17 a 78 años, con fracturas orbitarias debidas a accidentes automovilísticos en 80 por ciento y el resto por asaltos o accidentes caseros. Hubo fracturas de órbita aislada en 19 casos y 17 tenian otra fractura facial agredada. Había fractura del piso orbitario, sola o en combinación en 31 casos. Los síntomas mas frecuentes fueron deformidad facial y diplopia; un paciente tuvo pérdida de visión por una esquirla de hueso en el nervio óptico. Las vías de abordaje quirúrgico variaron de acuerdo a las lesiones; en orden de frecuencia fueron subciliar, tranconjuntival solo en lesiones menores del piso y tipo Lynch para exposiciones mas amplias. en lesiones del arco cigomático y/o la sutura cigometicofrontal, se abordo por la cola de la ceja o por vía coronal. El defecto del piso orbitario se reparó en los casos menores con injertos de cartílago; los mayores, o que involucraran la pared interna, con malla de titanio. Las fracturas del borde orbitario inferior o de la sutura frontociomática se fijaron con micro o miniplacas. Hubo cuatro pacientes con complicaciones. En tres pacientes quedó enoftalmos residual y en uno persistió deformidad facial en la zona malar. No se observó ningún rechazo a los materiales de fijación

Características de las fracturas del reborde supraorbitario / Characteristic of supraorbital ridge fractures

Se realizó un estudio tranversal que abarcó el quinquenio 1984 a 1988 en el Hospital "Saturnino Lora" de Santiago de Cuba, donde ingresaron 41 pacientes en quienes se comprobó el diagnóstico de fractura del reborde supraorbitario. Se pudo constatar que los accidentes automovilísticos y las agresiones físicas fueron las principales causas de estas fracturas, cuyos signos sugerentes son la depresión y defecto óseo del reborde orbitario superior, proptosis, desplazamiento inferior del ojo, la ptosis del párpado superior y la diplopía vertical. Las lesiones craneofaciales que más se asociaron resultaron ser las fracturas cigomáticas, frontales y del cráneo, y las asociadas y abiertas se observaron con más frecuencia. El procedimiento quirúrgico a cielo abierto fue el método preferido en estos casos

Fraturas do osso malar e de órbita / Orbital and malar bone fractures

Fraturas do osso malar e de órbitas, frequentes em acidentes da vida moderna, foram estudadas em 156 pacientes, a maioria dos quais eram homens, entre 20 a 40 anos, vítimas de acidentes automobilísticos, quedas e agressöes. Dificuldade em diagnosticar fraturas que apresentam poucas evidências clínicas säo comentadas e traçam-se consideraçöes sobre os sinais, sintomas e alteraçöes. Para isto, orienta-se para a exploraçäo minuciosa de qualquer evidência de fratura. Devido a frequentes lesöes oftalmológicas associadas, é aconselhado o exame oftalmológico sistemático. No tratamento foram utilizadas tanto técnica conservadora, com uso de gancho, quanto técnica cirúrgica, usando osteossíntese com fio de aço. Säo comentados aspectos das diversas terapêuticas utilizadas

The missing eyeball--CT evaluation (a case report).

A case of blow out fracture of the medial wall and floor of the orbit with herniation of the eyeball into the ethmoid sinus diagnosed on CT scan is reported. To the best of our knowledge there is no previous report of prolapse of eyeball into the ethmoid sinus.

Uso del cartílago de concha y ácido poliglicólico (dexon) en la reconstrucción de las fracturas del piso de la órbita / Use of the concha cartilage and polyglycolic acid (dexon) in the reconstruction of the orbital floor fractures

Se utilizó cartílago de concha auricular en la reparación de las fracturas del piso de la órbita en 10 pacientes atendidos en el lapso de un año en el Hospital Universitario de Caracas y Centro Privado. Obtuvimos resultados satisfactorios desde el punto de vista cosmético y funcional, no presentándose hasta el momento ninguna complicación. En tres de estos pacientes se utilizó el ácido poligliocólico (Dexon) en la reparación de pequeñas fracturas del piso de la órbita y para la síntesis del periostio orbital, con buenos resultados