Alcohol consumption and maxillofacial fractures in times of Covid-19: a cross-sectional study in a cuban university hospital / Consumo de alcohol y fracturas maxilofaciales en tiempos de Covid-19: un estudio transversal en un hospital universitario cubano

Introduction: The consumption of alcoholic beverages reduces the body's ability to deal with dangerous situations and exposes people to trauma. Objective: To determine the association between the consumption of alcoholic beverages and the characteristics of maxillofacial fractures treated at a Cuban university hospital in the context of COVID-19. Material and Methods: An observational, analytical, and cross-sectional study was carried out in the Maxillofacial Surgery unit at the "Carlos Manuel de Céspedes" General University Hospital during the year 2020. Prevalence ratios, 95% confidence intervals and p-values were obtained using generalized linear models. Results: In 58.23% of the cases, fractures were related to the consumption of alcoholic beverages. The fundamental etiology was interpersonal violence (47.75%), regardless of the consumption of alcoholic beverages. There was a prevalence of patients with nasal fractures (n=98; 55.06%), among which, 35.71% had consumed alcoholic beverages at the time of the trauma. Being male (p=0.005), the lack of university studies (p=0.007), the need for surgical treatment (p<0.001), the fractures of the zygomaticomaxillary complex (p=0.023), and the traumas that occurred during the weekends (p<0.001) or during the month of June (p=0.029) were factors associated with a higher frequency of fractures related to the consumption of alcoholic beverages. There was a lower frequency of fractures associated with alcohol consumption during the months of January (p=0.006) and March (p=0.001). Conclusion: Six out of ten cases were under the influence of alcoholic beverages. There was a greater number of young and male patients, mainly due to interpersonal violence.

Introducción: La ingestión de bebidas alcohólicas disminuye la capacidad del organismo para enfrentar situaciones de peligro y lo predispone a sufrir traumatismos diversos. Objetivo: Determinar la asociación entre el consumo de bebidas alcohólicas y las características de las fracturas maxilofaciales atendidas en un hospital universitario cubano en el contexto de la COVID-19. Material y Métodos: Estudio observacional, analítico y transversal realizado en el servicio de Cirugía Maxilofacial del Hospital General Universitario "Carlos Manuel de Céspedes" durante el 2020. Se obtuvieron razones de prevalencia, intervalos de confianza a 95% y valores p mediante modelos lineales generalizados. Resultados: En el 58.23% de los casos las fracturas se relacionaron con la ingestión de bebidas alcohólicas. La etiología fundamental fue la violencia interpersonal (47.75%), independientemente del consumo o no de bebidas alcohólicas. Predominaron los pacientes con fracturas nasales (n=98; 55.06%), en los que el 35.71% había consumido bebidas alcohólicas en el momento del trauma. El sexo masculino (p=0.005), la carencia de estudios universitarios (p=0.007), la necesidad de tratamiento quirúrgico (p<0.001), las fracturas del complejo cigomático-maxilar (p=0.023), los traumas sucedidos durante los fines de semanas (p<0.001) o durante el mes de junio (p=0.029) fueron factores asociados a una mayor frecuencia de fracturas relacionadas con el consumo de bebidas alcohólicas. Hubo menor frecuencia de fracturas asociadas a este consumo durante los meses de enero (p=0.006) y marzo (p= 0.001). Conclusión: Seis de cada diez casos estuvieron bajo los efectos de la ingestión de bebidas alcohólicas. Existió una mayor afectación de pacientes jóvenes, masculinos, a causa principalmente de la violencia interpersonal.

Redução aberta de fratura nasal: relato de caso / Open reduction of nasal fracture: case report / Reducción aberta de la fractura nasal: reporte de un caso

As fraturas nasais são de grande incidência dentre as fraturas faciais, podendo envolver também outras estruturas da face. O diagnóstico é baseado no exame físico, o qual muitas vezes é dificultado devido ao edema formado na região. A palpação dos contornos ósseos, verificação de presença de crepitação nasal, alterações de permeabilidade e assimetrias locais são algumas das alterações sugestivas de fraturas nasais. Além disso, a inserção do ligamento cantal medial pode ser perdida devido ao trauma ou devido ao deslocamento ósseo em que ele se encontra inserido. Exames de imagem, como radiografias e Tomografias Computadorizadas, são utilizados para a visualização das fraturas ósseas e planejamento cirúrgico. A redução aberta dos ossos nasais é indicada para fraturas de maior complexidade e cominuição, tendo em vista o adequado reposicionamento dos ossos, cartilagens e ligamentos deslocados. Assim, o objetivo deste estudo é relatar a redução aberta de uma fratura dos ossos nasais com perda de inserção do ligamento cantal medial direito, sob anestesia geral... (AU)

Nasal fractures are of great incidence among facial fractures, and may also involve other facial structures. The diagnosis is based on physical examination, which is often hampered due to the edema formed in the region. Palpation of bone contours, checking for the presence of nasal crackling, changes in permeability and local asymmetries are some of the changes suggestive of nasal fractures. In addition, the insertion of the medial canthal ligament may be lost due to trauma or due to the bone displacement in which it is inserted. Imaging exams, such as radiographs and CT scans, are used for visualizing bone fractures and surgical planning. The open reduction of the nasal bones is indicated for fractures of greater complexity and comminution, in view of the appropriate repositioning of the bones, cartilage and dislocated ligaments. Thus, the aim of this study is to report the open reduction of a fracture of the nasal bones with loss of insertion of the right medial canthal ligament, under general anestesia... (AU)

Las fracturas nasales son de gran incidencia entre las fracturas faciales, y también pueden involucrar otras estructuras faciales. El diagnóstico se basa en el examen físico, que a menudo se ve obstaculizado por la inflamación que se forma en la región. La palpación de los contornos óseos, confirmación de la presencia de crepitantes nasales, alteraciones de la permeabilidad y asimetrías locales son algunas de las alteraciones sugestivas de fracturas nasales. Además, la inserción del ligamento cantal medial puede perderse debido a un traumatismo o al desplazamiento del hueso en el que se inserta. Las pruebas de imagen, como las radiografías y las tomografías computadorizadas, se utilizan para visualizar las fracturas óseas y planificar la cirugía. La reducción abierta de los huesos nasales está indicada para las fracturas de mayor complejidad y conminución, en vista del reposicionamiento adecuado de los huesos, cartílagos y ligamentos dislocados. Así, el objetivo de este estudio es relatar la reducción abierta de una fractura de los huesos nasales con pérdida de inserción del ligamento cantal medial derecho, bajo anestesia general... (AU)

Logistic Regression Analysis of the Mechanism of Blunt Brain Injury Inference Based on CT Images / 法医学杂志

OBJECTIVES@#To study the correlation between CT imaging features of acceleration and deceleration brain injury and injury degree.@*METHODS@#A total of 299 cases with acceleration and deceleration brain injury were collected and divided into acceleration brain injury group and deceleration brain injury group according to the injury mechanism. Subarachnoid hemorrhage (SAH) and Glasgow coma scale (GCS), combined with skull fracture, epidural hematoma (EDH), subdural hematoma (SDH) and brain contusion on the same and opposite sides of the stress point were selected as the screening indexes. χ2 test was used for primary screening, and binary logistic regression analysis was used for secondary screening. The indexes with the strongest correlation in acceleration and deceleration injury mechanism were selected.@*RESULTS@#χ2 test showed that skull fracture and EDH on the same side of the stress point; EDH, SDH and brain contusion on the opposite of the stress point; SAH, GCS were correlated with acceleration and deceleration injury (P<0.05). According to binary logistic regression analysis, the odds ratio (OR) of EDH on the same side of the stress point was 2.697, the OR of brain contusion on the opposite of the stress point was 0.043 and the OR of GCS was 0.238, suggesting there was statistically significant (P<0.05).@*CONCLUSIONS@#EDH on the same side of the stress point, brain contusion on the opposite of the stress point and GCS can be used as key indicators to distinguish acceleration and deceleration injury mechanism. In addition, skull fracture on the same side of the stress point, EDH and SDH on the opposite of the stress point and SAH were relatively weak indicators in distinguishing acceleration and deceleration injury mechanism.

Multiple Brain Abscesses by an Air Gun Shot: A Case Report

Introduction Low-velocity penetrating brain injury is not prevalent. In some conditions such as childhood, and with the penetration of a pellet in weak spots of skull, low-velocity penetrating brain injury is expected; however, high-velocity projectiles have also been reported as the cause of severe brain injuries. One of the complications of penetrating brain injury is infection, in which different types ofmicroorganisms play a role. The Streptococcus genus is the leading cause of abscess formation in nontraumatic patients. Multiple brain abscesses are not common. Case Presentation A 10-year-old boy with penetrating brain injury caused by an air gun pellet, who developed signs and symptoms of high intracranial pressure 18 days after the trauma. After the imaging scans and the detection of multiple brain abscesses and severe brain edema, prompt surgical intervention was performed for all three lesions in a single operation. The culture of a pus specimen was positive for Streptococcus species, and, with adequate antibiotic therapy, the patient was discharged from the hospital in good condition. Conclusion Brain injurywith air gun shot is not prevalent. The penetration of a low-velocity air gun pellet in weak points of the skull (such as the orbit, the squamous portion of the temporal bone, and the cranial suture), specially in children, can cause significant brain injuries.

Multicenter epidemiological study of maxillofacial trauma: a one-year retrospective- descriptive assessment of 1356 cases in a colombian metropolitan region / Estudio epidemiológico multicéntrico de trauma maxilofacial: evaluación retrospectiva-descriptiva de un año, de 1356 casos en una región metropolitana de Colombia

Background: This retrospective study was conducted to identify the epidemiological profile and treatment modalities linked to the maxillofacial trauma (MFT) managed in the Maxillofacial Surgery Departments of seven hospital centers in Antioquia, Colombia. Material and Methods: Clinical records with specific attention to sociodemographic characteristics, mechanisms of injury, type of MFT, location of injuries, and treatment modalities of MFT were collected from January to December 2017. Descriptive analyses using Pearson's chi-square tests were performed. Results: A total of 1356 records were retrieved. Males were significantly more affected, with a male-to-female ratio of 3.85:1. The most susceptible age group involved was young adults (18 to 40 years). A low percentage of alcohol (9.3%) and drugs consumption (2.5%) was recorded. Most common causes of MFT were road traffic accidents (RTA), falls, and interpersonal violence (IPV). Most injuries involved both soft and hard tissues followed by hard tissues and isolated open soft tissue injuries. Among fractures, the middle third was the most commonly affected site and the utmost method of treatment was open reduction and internal fixation. Conclusion: Within the limitations of the evidence available, this study has demonstrated that the gender, age stratum, and etiological factors, such as RTA, falls, and IPV, but no alcohol and/or psychoactive substances consumption, may have a significant influence on the prevalence, patterns, and treatment modalities of MFT in this sample population.

Antecedentes: Este estudio retrospectivo se realizó para identificar el perfil epidemiológico y las modalidades de tratamiento vinculados al Trauma Maxilofacial (TMF) atendido en los Servicios de Cirugía Maxilofacial de siete centros hospitalarios de Antioquia, Colombia. Material y Métodos: Se recopilaron historias clínicas con atención específica a las características sociodemográficas, mecanismos de lesión, tipo de TMF, ubicación de las lesiones y modalidades de tratamiento de TMF de enero a diciembre de 2017. Análisis descriptivos utilizando el chi-cuadrado de Pearson fueron realizados. Resultados: Se recuperaron un total de 1356 registros. Los hombres se vieron significativamente más afectados, con una relación hombre-mujer de 3,85:1. El grupo de edad más susceptible involucrado fue el de los adultos jóvenes (18 a 40 años). Se registró un bajo porcentaje de consumo de alcohol (9,3%) y drogas (2,5%). Las causas más comunes de TMF fueron los accidentes de tránsito (ADT), las caídas y la violencia interpersonal (VIP). La mayoría de las lesiones involucraron tejidos blandos y duros, seguidas de tejidos duros y lesiones abiertas aisladas de tejidos blandos. Entre las fracturas, el tercio medio fue el sitio afectado con mayor frecuencia y el método de tratamiento más utilizado fue la reducción abierta y la fijación interna. Conclusion: Dentro de las limitaciones de la evidencia disponible, este estudio ha demostrado que el género, el estrato etario y los factores etiológicos, como ADT, caídas y VIP , pero no el consumo de alcohol y/o sustancias psicoactivas, pueden tener una influencia significativa en la la prevalencia, los patrones y las modalidades de tratamiento de TMF en esta poblaión muestral.

Etiologia do trauma facial: uma análise aprofundada entre 2016 e 2019 em Florianópolis/SC / Etiology of facial trauma: an in-depth analysis of cases occurred in Florianópolis, SC from 2016 to 2019

Introdução: Pensando em melhoria na saúde das populações, é indispensável para as equipes de CTBMF e gestores de saúde o conhecimento dos perfis epidemiológicos. O objetivo desse estudo foi estratificar etiologias, ossos mais afetados e possíveis padrões recorrentes entre 2016 e 2019, contabilizá los, analisá-los e então fundamentar sistemas de gestão e ferramentas de melhorias a fim de aumentar eficiência operacional da cadeia de saúde. Métodos: Trata-se de um estudo transversal descritivo que analisou 233 pacientes vitimados com trauma facial e necessitaram de abordagem cirúrgica entre dezembro de 2016 e dezembro de 2019 no Hospital Governador Celso Ramos. Resultados: Ao total de 447 fraturas, 85,83% ocorreram no sexo masculino. A média de idade foi 32,42 e o grupo etário mais acometido o de 21 aos 30 anos. Etiologia mais prevalente foi agressão física, representando 42% dos pacientes. Em comparação com os anos, houve uma tendência preocupante de ascensão nos índices. Conclusões: Os níveis de violência impressionam. Este trabalho direciona um alerta sobre danos graves evitáveis relacionados a agressões e acidentes de trânsito. É imperativo que as gestões públicas desenvolvam políticas no intuito de mitigar riscos e desperdício de recursos, assegurando tratamento, reabilitação e sobretudo prevenção eficaz... (AU)

Introduction: To think over population health improvement, it is all-important that OMFS teams and health managers have knowledge on epidemiological profiles. The aim of this study was to stratify etiologies, the most affected bones and possible recurrent patterns between 2016 and 2019, and based on the records and analyses of the cases, develop management systems and improvement tools to increase the healthcare chain operational efficiency. Methods: It is a cross-sectional study that examined 233 patients who suffered maxillofacial trauma and needed a surgical approach between December 2016 and December 2019 at the Hospital Governador Celso Ramos. Results: From a total of 447 fractures, 85.83% occurred in males. Mean age was 32.42 years, and the predominant injured individuals were between 21 and 30 years old. The most prevalent etiology was physical aggression, representing 42% of the patients. In the comparison of the years, there was a worrying upward trend in violence rates. Conclusions: The levels of violence are impressive, alarming. This work places red flag alert on serious preventable injuries caused by physical violence and traffic accidents. It is imperative that public administrations develop policies designed to mitigate risks and resource wastes, ensuring treatment, rehabilitation and, above all, effective prevention... (AU)

Parameterized Analysis of Craniocerebral Injury Caused by Fist / 法医学杂志

Objective Based on the theory of biomechanics, the finite element method was used to study the injury characteristics of different parts of brain hit by fist with different force and to predict the risk of craniocerebral injury, in order to provide reference for actual medical protection and forensic identification. Methods The finite element model of fist was constructed by using DICOM data modeling method and related software, and the effective mass and speed of fist were used to represent the kinetic energy of fist, and combined with human finite element model THUMS 4.02, the characteristics of craniocerebral injury caused by frontal and lateral blows were parametrically simulated. Results The probability of direct death from a blow to the head was low, but as fist power increased, so did the risk of craniocerebral injury. The characteristics of craniocerebral injury were also significantly different with the different fist hitting head locations. When the frontal area was attacked, the maximum equivalent stress of skull was 122.40 MPa, while that of brain tissue was 4.31 kPa. When the temporal area was attacked, the maximum equivalent stress of skull was 71.53 MPa, while that of brain tissue was 7.09 kPa. Conclusion The characteristics and risks of skull fracture and brain tissue injury are different when different parts of the brain are hit by fist. When the frontal area is hit, the risk of skull fracture is significantly higher than when the temporal area is hit. The risk of brain tissue injury is the opposite. The position with the highest probability of skull fracture is generally the place where the skull is directly impacted, and with the conduction of stress waves, it will spread to other parts of the skull, while the position with the highest risk of brain tissue injury is not the place where the brain is directly impacted.

Retrospective Analysis on Traumatic Rupture of Intracranial Internal Carotid Artery in 11 Cases / 法医学杂志

Objective To retrospectively analyze the characteristics of the traumatic rupture of intracranial internal carotid artery in order to provide reference for forensic expertise examination and identification. Methods A total of 11 autopsy cases of traumatic rupture of intracranial internal carotid artery were collected. The gender, age, cause of injury, blood loss on the scene, location of internal carotid artery rupture, hardening degree of the rupture of the wall, brain injury, blood ethanol content and cause of death were also recorded. Results All 11 cases died on the scene, of which 7 died from traffic accidents, 2 falls from height and 2 from bare handed injuries. None of the 11 victims suffered serious head and body surface injury. The internal carotid artery rupture in the 9 cases of traffic injury and fall from height injury occurred in the cavernous segment. In all these cases, there were transverse fractures of the middle cranial fossa with the carotid sulcus involved, and minor intracranial hemorrhage and brain contusion. In 2 cases of bare handed injuries, internal carotid artery rupture occurred in the ophthalmic artery segment, accompanied by fatal intracranial hemorrhage and diffuse axonal injury, but no skull fracture. All 11 cases showed full-thickness rupture of the vessel wall, and the long axis of the wounds was perpendicular to those of the artery. Conclusion The incidence of intracranial internal carotid artery rupture in high-energy trauma events such as traffic accidents and high falls deserves attention. Injuries of the cavernous segment or ophthalmic segment might be more common. The main injury mechanism of intracranial internal carotid artery rupture might be that the blood vessels were pulled and the bone fragments caused damage.

Observational study of patients with occipital condyle fracture at a brazilian referral trauma center / Estudo observacional de pacientes com fratura de côndilo ocipital em centro de referência em trauma no brasil

ABSTRACT Objective: to evaluate the clinical-epidemiological characteristics, treatment, and evolution of patients with occipital condyle fracture (OCF) at one of the largest referral trauma centers in Latin America. Methods: this was a retrospective observational study of OCF identified from trauma cases admitted between December 2011 and December 2019 by the neurosurgery team at a Type 3 trauma center. Results: a total of twenty-eight occipital condyle fractures were identified in twenty-six patients. The incidence was less than 0.2% per year and more common in male patients (4:1 ratio) involved in traffic accidents. The mean age was 42.08 years. Anderson and Montesano type II and Tuli type 1 were the most frequent (67.9% and 89.3%, respectively) and no case presented C0-C1-C2 instability. All patients were treated with a cervical collar for 3 to 6 months. About 65% of the patients exhibited good progression (Glasgow Outcome Scale equal to 4), and the severity of traumatic brain injury was the main determinant for negative outcomes. Conclusion: the findings of this study are in accordance with available literature data. The use of external stabilization with a cervical collar is reinforced for the treatment of stable lesions, even when these are bilateral. Assessment of the patients' follow-up results in the studied sample may contribute with useful information for the treatment of occipital condyle fractures.

RESUMO Objetivo: avaliar o perfil clínico-epidemiológico, o tratamento e a evolução de pacientes com fraturas do côndilo occipital (FCO) em um dos maiores centros especializados em trauma na América Latina. Método: este é um estudo observacional retrospectivo de FCO identificadas em casos de trauma que foram atendidos no período de Dezembro de 2011 a Dezembro de 2019 pela equipe de trauma de centro de trauma Tipo 3. Resultados: um total de vinte e oito fraturas do côndilo occipital foram identificadas em 26 pacientes. A incidência foi inferior a 0.2% ao ano e mais comum em pacientes do sexo masculino (proporção 4:1) envolvidos em acidentes de trânsito. A idade média foi de 42.08 anos. O Tipo II de Anderson e Montesano e o Tipo 1 de Tuli foram os mais frequentes (67.9% e 89.3%, respectivamente) e nenhum caso teve instabilidades C0C1C2. Todos os pacientes foram tratados com colar cervical por período de 3 a 6 meses. Cerca de 65% dos pacientes apresentaram boa evolução (Escala de Resultados de Glasgow maior ou igual a 4), e a gravidade da lesão cerebral foi o principal determinante para os resultados negativos. Conclusão: os achados deste estudo são similares a dados disponíveis na literatura. O uso de colar cervical para estabilização externa é reforçado para o tratamento de lesões estáveis, mesmo quando bilaterais. A avaliação dos resultados do acompanhamento dos pacientes na amostra estudada pode contribuir com informações úteis para o tratamento de fraturas de côndilo occipital.

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.

Sistemática en el Tratamiento Quirúrgico de las Fracturas Panfaciales Aplicado a un Caso Clínico De Alta Complejidad / Systematic in the Surgical Treatment of Panfacial Fractures Applied to a Highly Complex Clinical Case

RESUMEN: Las fracturas panfaciales son aquellas que afectan de forma simultánea al tejido óseo de dos o más tercios del rostro. El manejo inicial de estos pacientes es resolver o estabilizar las urgencias médico - quirúrgicas que puedan presentar, debido a que la gran mayoría de estas fracturas están asociadas a traumatismos de alta energía cinética, las que determinan la presencia de lesiones concomitantes que pueden comprometer la vida del paciente. El tratamiento quirúrgico de las fracturas panfaciales puede abarcar desde la intervención quirúrgica inicial de control de daños, estabilización, reducción y fijación quirúrgica de los segmentos fracturados mediante osteosíntesis hasta intervenciones mediatas para la reconstrucción de los tejidos afectados por el traumatismo. Para el tratamiento de las fracturas panfaciales existe una sistemática quirúrgica que tiene por objeto contener y/o minimizar daños agudos y permitir una reducción morfológica y funcional. Reportamos un caso clínico de fractura panfacial cuyo tratamiento siguió esta sistemática terapeútica.

ABSTRACT: Panfacial fractures affect bone tissue in two or more thirds of the face simultaneously. The initial management of these patients is to resolve or stabilize the medical-surgical emergencies that they may present. Most of these fractures are associated to trauma of high kinetic energy, which determine the presence of concomitant inju- ries that can compromise the life of the patient. The surgical treatment of panfacial fractures may include from the initial surgical intervention of damage control, stabilization, reduction and surgical fixation of fractured segments through osteosynthesis, to mediate the reconstruction of tissues affected by the trauma. For the treatment of panfacial fractures there is a surgical approach that aims to contain and/or minimize acute damage and allow for morphological and functional reduction. We report a clinical case of panfacial fracture whose treatment followed this therapeutic approach.

Treatment of naso-orbito-etmoidal Type III fracture in adolescents: case report / Tratamiento de la fractura naso-orbito-etmoidal Tipo III en adolescentes: relato de un caso

The naso-orbito-ethmoidal region is composed of delicate bones and when fractured may result in significant aesthetic-functional impairment. Diagnosis through clinical and imaging findings is extremely important for surgical planning. This study aims to report a case of type III fracture of the naso-orbito-ethmoidal region. Patient D.R.S., female, 13 years old, attended the emergency department of Hospital dos Fornecedores de Cana de Piracicaba (HFCP) - SP with complaint of pain in the fronto-nasal region and respiratory distress after trauma in face of baseball bat. Physical examination showed edema and short blunt injury in the region of the nasal dorsum and frontal region, bilateral periorbital hematoma, hyposphagma in right eye and traumatic telecanthus. When analyzing the computed tomography, it was observed fracture of the nasal bones, also affecting the medial wall of the orbit. The procedure was osteosynthesis of the fractures and reconstruction of the nasal dorsum. The fracture traces were exposed from coronal access, reduction of fractures and use of calvarial bone graft for nasal dorsum reconstruction. The fracture and the graft were fixed with plates of 1,6mm. Postoperative computed tomography analysis showed good graft positioning, but there was still a slight sinking of the left lateral wall of the nose. In a second moment another surgical intervention was done to reduce this wall and an internal containment device was installed. Currently the patient is in a state of observation and a follow-up period of 665 days. In cases of complex nasoorbito-ethmoidal fractures early diagnosis and treatment is essential to minimize sequelae and provide a better aesthetic and functional result.

La región etmoidal nasoorbital está compuesta de huesos delicados y, cuando se fractura, puede provocar una lesión estética-funcional significativa. El diagnóstico mediante hallazgos clínicos y de imagen es de suma importancia para la planificación quirúrgica. El paciente D.R.S., mujer, 13 años, leucoderma, asistió al servicio de emergencia del Hospital de Proveedores de Caña de Azúcar de Piracicaba quejándose de dolor en la región frontal-nasal y dificultad para respirar después de un traumatismo en la cara con un palo. El examen físico reveló edema y lesión contundente en el dorso nasal y la región frontal, hematoma periorbitario bilateral, hiposfagma del ojo derecho y telecanto traumático. Al analizar la tomografía computarizada se observó fractura de los huesosnasales en libro abierto, afectando también la pared medial de la órbita. El enfoque aplicado fue la osteosíntesis de fracturas y la reconstrucción del dorso nasal. Los rastros de fractura se expusieron del abordaje coronal, se redujeron las fracturas y se usaron injertos de casquete para reconstruir el dorso nasal. La fractura y el injerto se fijaron con placas de sistema de 1,6 mm y se realizó la cantopexia de los ligamentos cantales mediales. Se requirió cirugía reparadora secundaria para la corrección de la pared lateral de la nariz, que persistió en el postoperatorio. Actualmente el paciente se encuentra en un estado de conservación y período de seguimiento de 665 días. En casos de fracturas nasoorbitales-etmoidales complejas, el diagnóstico y el tratamiento tempranos son esenciales para minimizar las secuelas y proporcionar un mejor resultado estético y funcional.

Abordagem de fratura panfacial em emergência: relato de caso / Emergency panfacial fracture approach: case report

Objetivo: O presente estudo consiste em relatar o caso clínico de um paciente com fratura panfacial e abordagem cirúrgica de emergência para realização de fixação interna rígida e sua reabilitação. Descrição do Caso: Paciente do gênero masculino, 46 anos, vítima de acidente automobilístico, deu entrada no serviço de emergência do Hospital Geral do Estado da Bahia (HGE-BA) cursando com múltiplas fraturas em face. Foi planejada abordagem, sob anestesia geral e intubação orotraqueal com derivação submentual, em razão de fratura de base anterior de crânio, fratura dos ossos próprios nasais e necessidade de bloqueio maxilomandibular no transcirúrgico. Paciente acompanhado no pós-operatório, evoluindo com projeção facial satisfatória, oclusão estável, boa permeabilidade nasal e sem deformidade dentofacial. Conclusão: As fraturas panfacias são desafiadoras, e seu planejamento cirúrgico deve ser estabelecido visando o posicionamento adequado dos fragmentos fraturados e a preservação das estruturas anatômicas faciais, devolvendo função e garantindo o mínimo de sequelas para o paciente(AU)

Purpose: The present study consists in reporting the clinical case of a patient with panfacial fracture, with an emergency surgical approach to perform rigid internal fixation for patient rehabilitation. Case description: A 46-year-old male patient, victim of an automobile accident, was admitted to the emergency department of the Hospital Geral do Estado da Bahia (HGE-BA), attending multiple fractures in the face. The approach was planned under general anesthesia and orotracheal intubation with submental shunt, due to anterior skull fracture, fracture of the nasal bones and the need for maxillomandibular block in the trans-surgical. Patient followed postoperatively, evolving with satisfactory facial projection, stable occlusion, good nasal permeability, and no dentofacial deformity. Conclusions: Panfacial fractures are challenging, and their surgical planning must be established aiming at the adequate positioning of fractured fragments and preservation of facial anatomical structures, restoring function and ensuring a minimum of sequelae for the patient(AU)

Alternativas de tratamento para reconstrução de osso frontal: uma série de casos / Treatment alternatives for frontal bone reconstruction: a series of cases

Objetivo: este artigo se propõe a discutir as diferentes modalidades de tratamento de fraturas de osso frontal, demonstradas em uma série de casos clínicos. Relato de casos: três pacientes de gênero variado e com diferentes etiologias de trauma, foram submetidos à cranioplastia, devido a fraturas das corticais externa e interna do osso frontal (além de fixação de outras fraturas de face, em dois dos casos). Nessa série, são apresentados tratamentos com uso de prótese customizada de polimetilmetacrilato, idealizada sobre um protótipo, reconstrução da bossa frontal a partir de telas de titânio e ainda redução óssea com fixação por meio de placas e parafusos. Em todos os casos apresentados, os resultados estéticos e funcionais foram satisfatórios. Considerações finais: baseado no que foi discutido, entendemos que o planejamento deve ser realizado de forma individual e a decisão por qualquer técnica vai depender da gravidade e da extensão da fratura. Para tanto, é necessária uma avaliação criteriosa do caso em questão.(AU)

Objective: This study aims to discuss the different treatment modalities of frontal bone fractures presented in a series of clinical cases. Case report: Three patients of different genders and with different trauma etiologies were subjected to cranioplasty due to fractures of the external and internal cortical of the frontal bone (besides the fixation of other facial fractures, in two of the cases). This series presents treatments using a custom polymethylmethacrylate prosthesis designed on a prototype, the reconstruction of the frontal vault from titanium meshes, and bone reduction with fixation using plates and screws. In all cases presented, the aesthetic and functional results were satisfactory. Final Considerations: The study discussions allow understanding that planning should be performed individually and the decision for any technique will depend on the severity and extent of the fracture. Therefore, a careful assessment of the case in question is required.(AU)

Role of computed tomography scan in assessment of skull fracture patterns among motorcycle road traffic accident patients in South Western Nigeria

Background: Commercial motorcycling is a common means of transportation in Nigeria, and motorcycle road traffic accidents (MCRTAs) are commonly associated with multiple skull fractures. Cranial computed tomography (CT) scan is the standard imaging modality of patients with head injury. Aim: The aim of this study is to describe the pattern of skull fractures on cranial CT scan in patients with head injury following MCRTA. Patients and Methods: This was a descriptive cross-sectional study conducted at the University College Hospital, Ibadan, between June and October 2016. Noncontrast cranial CT scan was performed on 190 patients who presented with head injury following MCRTAs. Results: Over half (n = 59.8%) of the patients were within the ages of 20­39 years with a mean age of 33 ± 14.37 years. A total of 183 patients did not use crash helmet at the time of accident, out of which 168 (n = 88.4%) sustained skull fractures. Six different skull fracture patterns were identified on cranial CT scan of these patients. The most common fracture pattern seen was the combined calvarial, facial, and base of skull fractures representing 22.1% while the least fracture pattern was the base of skull fracture (n = 4.7%). Most of the patients with calvarial fractures were without helmet at the time of injury (n = 98.3%) compared to 1.7% of patients who wore helmet at the time of injury. This was statistically significant (P = 0.040). Conclusion: This study further underscores the usefulness of cranial CT scan in identifying and evaluating patients with skull fractures following MCRTA in our environment, thus guiding proper medical and surgical management of such patients in a low-resource setting

Prevalence and pattern of basal skull fracture in head injury patients in an academic hospital

Background: Basal skull fractures (BSFs) have been reported to be a major cause of morbidity and mortality in the literature, particularly in young male patients. However, there are limited data available on the aetiology, prevalence and patterns of such observed in South Africa. Objectives: To evaluate the prevalence and pattern of BSF in head injury patients referred to Dr George Mukhari Academic Hospital, Gauteng, South Africa. Methods: Patients of all ages with head injuries were considered for the study, and those who met the inclusion criteria were scanned using a 128-slice multidetector helical computed tomography (CT) machine after obtaining consent. Data were prospectively obtained over a 6-month period, interpreted on an advanced workstation by two readers and statistically analysed. Results: The prevalence of BSF in this study was found to be 15.2%. The majority of patients (80.5%) were under 40 years old, with a male to female ratio of 3:1. The most common aetiology of BSF was assault, which accounted for 46% of cases. The middle cranial fossa was the most frequently fractured compartment, while the petrous bone was the most commonly fractured bone. There was a statistically significant association between head injury severity and BSF, and between the number of fracture lines and associated signs of BSF (p < 0.001). The sensitivity of clinical signs in predicting BSF was 31%, while specificity was 89.3% (p = 0.004). Conclusion: The prevalence and pattern of BSF found were consistent with data from previously published studies, although, dissimilarly, assault was found to be the most common aetiology in this study

Fibreoptic intubation in airway management: a review article

Since the first use of the flexible fibreoptic bronchoscope, a plethora of new airway equipment has become available. It is essential for clinicians to understand the role and limitations of the available equipment to make appropriate choices. The recent 4th National Audit Project conducted in the United Kingdom found that poor judgement with inappropriate choice of equipment was a contributory factor in airway morbidity and mortality. Given the many modern airway adjuncts that are available, we aimed to define the role of flexible fibreoptic intubation in decision-making and management of anticipated and unanticipated difficult airways. We also reviewed the recent literature regarding the role of flexible fibreoptic intubation in specific patient groups who may present with difficult intubation, and concluded that the flexible fibrescope maintains its important role in difficult airway management.

Neuro-ophthalmic Analyses of Head Trauma Patients

PURPOSE: To investigate the types and clinical features of neurological diseases after head trauma. METHODS: From March 2010 to December 2018, a total of 177 patients were enrolled in this study. We retrospectively reviewed the clinical features of neurological ophthalmic diagnoses and frequencies, the types of head injuries, and the prognoses. RESULTS: Cranial nerve palsy was the most common (n = 63, 35.6%), followed by traumatic optic neuropathy (n = 45, 25.4%), followed by optic disc deficiency, ipsilateral visual field defect, Nystagmus, skewing, ocular muscle paralysis between nuclei, and Terson syndrome. Neuro-ophthalmic deficits occurred in relatively strong traumas accompanied by intracranial hemorrhage or skull fracture. However, convergence insufficiency and decompensated phoria occurred in relatively weak trauma such as concussion. The prognoses of the diseases were poor (p < 0.05) for traumatic optic neuropathies and visual field defects. The prognoses of neurological diseases were poor if accompanied by intracranial hemorrhages or skull fractures (p < 0.05). CONCLUSIONS: After head trauma, various neuro-ophthalmic diseases can occur. The prognosis may differ depending on the type of the disease, and the strength of the trauma may affect the prognosis.

Restoration of the Fronto-Orbital Buttress with Primary Bone Fragments / 대한신경손상학회지

OBJECTIVE: Forehead deformities are often caused by lack of treatment or incorrect restoration of the frontal buttress, so the underlying frontal buttress should be restored to its previous position to ensure that the previous forehead contour is restored in cases of complex depressed skull fractures. However, since brain injuries from skull fractures could have fatal consequences, the clinical concern in primary surgery has been to save the patient's life, and cosmetic concerns have always been secondary. We retrospectively reviewed fronto-orbital fracture patients who underwent primary restoration with primary bone fragments or an alloplastic implant and compared the surgical outcomes of autologous bone (group 1) and artificial materials (group 2). METHODS: A retrospective review was conducted of 47 patients with fronto-orbital fractures between March 2012 and January 2018. The patients underwent primary reconstruction with primary bone fragments or an alloplastic implant. The surgical results were evaluated by the incidence of infection and cosmetic satisfaction of patients. RESULTS: Infections occurred in one patient (5%) in group 1 and in two patients (15.3%) in group 2, which was not a statistically significant difference. In contrast, at 6 months after surgery, patient satisfaction showed a statistically significant between-group difference (group 1: 4.32 points, group 2: 3.54 points, p=0.001). CONCLUSION: Primary reconstruction using fractured bone fragments is an effective and preferable method that could result in better surgical outcomes than restoration using an alloplastic implant.