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.

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.

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.

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.

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

Original research paper patterns of head injuries in fatal road traffic accidents in a rural district of Maharashtra- autopsy based study.

Road traffic accidents are the major causes of death worldwide. Head injury is the single most common cause of mortality in road traffic accidents; head being the most vulnerable part of the body. The present study was undertaken on 138 victims of road traffic accidents, died due to head injury to find out the patterns of head injuries, their age and sex distribution and site distribution of different types of fractures. The highest incidence was seen in age group of 21-30 years and males clearly outnumbered females. In the present study, most of the incidents occurred between 1200 to 1800 hours. The maximum number of victims (39.57%) died while on the way to hospital. The motor-cyclists were the commonest group of victims and trucks being the commonest offending vehicles. Intracranial haemorrhages were seen in 113 cases, skull fractures were found in 95 cases and injury to brain in 51 cases. Linear fracture of skull with basal fracture was the commonest type and temporo-parietal region was involved predominantly. Subdural haemorrhage was the commonest haemorrhage observed.

Pattern of fatal blunt head injury: A two year retrospective / prospective medico legal autopsy study.

The current study was conducted from 1 November 2002 to 31 October 2004 at Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai. A total of 189 victims of fatal blunt head injury were recorded and a complete medicolegal autopsy was conducted on each of these victims during this period. The postmortem study revealed that males were the most common victims with the highest number being in the age group of the third and fourth decades. Accidents were responsible for most of them, followed by homicidal deaths, with suicides recorded as the least. Of the accidents, railway accidents were responsible for the maximum number. The study revealed that the highest number of fatalities occurred during the peak hours of the day. The fissured fracture was the most common type of fracture observed. Among the specialized fractures of the base of the skull, type-1 hinge fracture was the most common. A combination of subdural and subarachnoid haemorrhages was the most common observation. Blunt cranio-cerebral injury was the primary cause of death in more than half of the victims

Epidemiología y resultado estético funcional de la reducción de la fractura nasal / Epidemiology and aesthetic and functional outcome in nasal bone fracture reduction

Introducción: Las lesiones faciales traumáticas más frecuentes son las fracturas nasales debido a la prominencia de la pirámide nasal. Existe cierto consenso en que cuanto antes se intente su reducción más posibilidades existen de obtener un resultado exitoso. Objetivo: Describir epidemiológicamente y evaluar los resultados funcionales y estéticos de las fracturas. Material y método: Se revisaron las fichas clínicas de los pacientes para describir los datos epidemiológicos, se realizó la encuesta SNOT-22 para evaluar los resultados funcionales y una encuesta cualitativa para la percepción estética de las reducciones. Resultados: De un total de 42 pacientes, predominó el sexo masculino 6:1, la edad promedio fue de 34,4 años. El 83,3 por ciento de la reducciones se realizó en policlínico con anestesia local y el procedimiento se realizó en promedio 8,6 días posfractura. Sobre el resultado funcional destaca la obstrucción nasal posreducción en 43,6 por ciento con un puntaje SNOT-22 promedio de 46,9 puntos y el 47,62 por ciento> consideró su resultado estético como peor. Discusión: Consideramos el resultado estético funcional como no satisfactorio, por lo que no sería inadecuado realizar cirugía de rinoseptoplastía inmediata o diferida para mejorar el resultado.

Introduction: Nasal fractures are the most common facial injuries because ol the prominence of the nose. There is some consensus that the sooner you try their reduction more likely is a successful outcome. Aim: Epidemiologically describe and evaluate functional and aesthetic results of nasal fractures. Material and method: We reviewed the medical records of patients to describe the epidemiológical data, perform the SNOT-22 survey to evaluate the functional results and a qualitative survey for aesthetic perception of the reductions. Results: Of a total of 42 patients, males predominated 6:1, average age was 34.4 years. 83.3 percent of the reductions took place in clinic with local anesthesia and the procedure was performed on average 8.6 days post-fracture. With regard to functional outcome highlights only nasal obstruction after reduction of 43.6 percent with a SNOT-22 scoring average of 46.9 points and 47.62 percent of patients considered a worse cosmetic outcome. Discussion: We believe that the functional and aesthetic result is not satisfactory, so we would recommend a septorhinoplasty immediate or detened for better results.

is high incidence of skull fracture associated with extradural hematoma in patients with head injury

To determine the correlation of skull fracture with extradural hematoma in head injury patients presenting to a tertiary care hospital in Pakistan. This descriptive study was carried out at Shifa International Hospital, Islamabad from January 2002 to January 2007. All patients who were operated for extradural hematoma during the study period were included in the study. Standard skull X-rays were done and type and location of fractures were noted on X-rays, CT scan and per-operatively. The incidence of skull fracture associated with extradural hematoma in various age groups was noted. The results were analyzed using SPSS version 14.0. A total of 110 patients underwent surgery for extradural hematoma. A linear fracture was demonstrated in 60 patients and a depressed skull fracture in 15 patients. Another 8 patients who did not have radiologically visible fracture were found to have a fracture line per-operatively. Thus, a total of 83 [75%] patients had skull fracture. There was no statistically significant difference in the incidence of skull fracture in various age groups. There is a strong association of skull fracture to extradural hematoma, however, a normal X-ray does not exclude extradural hematoma

Maltrato infantil: rol del estudio radiológico / Child abuse: role of radiologic study

El MI es desafortunadamente frecuente y nuestro país no es la excepción. Se presenta en todos los niveles socioeconómicos, religiones, culturas y representa un desafío diagnóstico para el clínico y para el radiólogo. El rol de la radiología es crucial para su detección. Los padres son los principales causantes de MI y generalmente se excusan en accidentes comunes del hogar, por lo que debe tenerse un alto grado de sospecha. Los hallazgos radiológicos deben correlacionarse con los mecanismos del traumatismo e injuria entregados en la historia clínica. Las lesiones óseas se pueden producir en cualquier parte del cuerpo, pero hay cierto tipo de lesiones y localizaciones (fracturas metafisiarias, fracturas costales posteriores, fractura primera costilla, escápula, apófisis espinosas, esternales y fracturas en diferentes etapa de cicatrización) que deben aumentar la sospecha diagnóstica. Ante la sospecha de MI debe solicitarse un estudio completo de imágenes, incluyendo fundamentalmente estudio radiológico del esqueleto y TAC de cerebro o del resto del cuerpo si es necesario. Sólo con una alta sospecha y un adecuado estudio, será posible detectar y proteger a éstos niños víctimas de maltrato.

Fracture of the coronoid and pterygoid processes by firearms: case report

A rare case of fracture of the coronoid and the pterygoid process caused by firearms is described. A 28-year-old male was hit by a bullet in the face, resulting in restricted mouth opening, difficulty in chewing and pain when opening the mouth. Clinical examination revealed a perforating wound in the right parotid region and a similar wound on the left side of the same region. A CT scan showed comminuted fracture of the left coronoid process and bilateral comminuted fracture of the pterygoid processes. Treatment was conservative, speech therapy was conducted and it was successful. Details of the clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.

Um caso raro de fratura dos processos coronóide e pterigóide por arma de fogo é descrito. Paciente do sexo masculino, 28 anos de idade, foi atingido por projétil de arma de fogo na face, resultando em limitação na abertura da boca, dificuldade para mastigar e dor ao abrir a boca. Exame clínico revelou ferimento perfurante em região parotídea direita e ferida similar do lado esquerdo na mesma região. Tomografia computadorizada (TC) mostrou fratura cominutiva do processo coronóide esquerdo e fratura cominutiva bilateral dos processo pterigóides. O tratamento foi conservador, através de fonoterapia, obtendo-se sucesso. Uma descrição detalhada das características clínicas, radiológicas (TC com reconstrução 3D), tratamento e proservação do caso é apresentada.

Seating position, seat belt wearing, and the consequences in facial fractures in car occupants

INTRODUCTION: Trauma caused by traffic accidents is among the main etiologies involved in the occurrence of facial fractures throughout the world. However, the trauma mechanisms involved are different according to the location where the study was performed, due to different conditions of development, legislation, and culture. A retrospective study was done between February 2001 and July 2006, with the purpose of determining the epidemiology and the mechanisms involved in the occurrence of facial fractures among car occupants in the metropolitan area of São Paulo. METHODS: Data were collected from 297 patients admitted with facial fractures to the emergency room of the Hospital das Clínicas, São Paulo University Medical School. Within this period, 151 individuals had been involved in traffic accidents, among which 56 (37.08 percent) were inside passenger cars. These were grouped based on the seating position that they were occupying at the time of the accident and the wearing of seat belts. Data concerning the number and location of fracture lines were obtained from the different groups, and a fracture/patient index (F/P I) was calculated to compare and make reference to the impact energy among these groups, for subsequent analysis and discussion. RESULTS: 323 fracture lines occurred among 56 patients who were car occupants. By applying the F/P I, we obtained higher values in the group of rear-seat passengers who were not wearing seat belts (7.23 fractures per patient), followed by the group of drivers not wearing seat belts (6.33 fractures per patient), the group of front-seat passengers not wearing seat belts (5.58 fractures per patient), the group of drivers wearing seat belts (5.54 fractures per patient) and, finally, the group of front-seat passengers wearing seat belts (4.00 fractures per patient). None of the rear-seat passengers was wearing seat belts. CONCLUSION: The data collected indicate that the driver position shows a high...

INTRODUÇÃO: Os traumatismos devidos a acidentes de trânsito estão entre as principais etiologias na ocorrência de fraturas de face em todo o mundo. No entanto os mecanismos de trauma são diferentes, conforme o local onde o estudo foi realizado, devido a condições de desenvolvimento, legislação e cultura 1, 2, 3, 4. Com o objetivo de se conhecer a epidemiologia e os mecanismos envolvidos na ocorrência de fraturas de face em ocupantes de automóveis na região metropolitana de São Paulo, foi realizado um estudo retrospectivo entre Fevereiro de 2001 e Julho de 2006. MÉTODO: Foram coletados dados de 297 pacientes admitidos com fraturas de face na sala de emergência do HC-FMUSP. Destes, 151 indivíduos estiveram envolvidos em acidentes de trânsito sendo que 56 (37,08 por cento) estavam dentro de automóveis. Estes últimos foram agrupados baseados na posição em que estavam sentados no veículo no momento do acidente e no uso de cintos de segurança. Dados referentes ao número e localização dos traços de fratura foram obtidos nos diferentes grupos e um índice Fraturas/Paciente (IF/P) foi idealizado para comparar e avaliar o impacto nesses grupos, e para posteriormente serem analisados e discutidos. RESULTADO: Ocorreram 323 traços de fraturas nos 56 pacientes ocupantes de carros. Aplicando-se o IF/P obtivemos maiores valores no grupo de passageiros do banco traseiro sem cinto de segurança (7,23 fraturas/ paciente), seguido pelo grupo de motoristas sem cinto de segurança (6,33 fraturas/ paciente), passageiros dianteiros sem cinto de segurança (5,58 fraturas/ paciente), motoristas com cinto de segurança (5,54 fraturas/ paciente) e por último o grupo de passageiros dianteiros com cinto de segurança (4,00 fraturas/ paciente). Nesta amostragem, não houve ocupante do banco traseiro com cinto de segurança. CONCLUSÃO: Baseado nos dados dos pacientes e nos resultados do índice foi realizada uma análise comparando-se a incidência de fraturas de face em diferentes...

Cirurgia das fraturas do seio frontal: estudo epidemiológico e análise de técnicas / Surgery of frontal sinus fractures: epidemiologic study and evaluation of techniques

O trauma do seio frontal não é raro, correspondendo a 8 por cento das fraturas faciais. Pode afetar a lâmina anterior e/ou posterior, com ou sem envolvimento do ducto nasofrontal. Tem alto potencial para complicações e seu manejo ainda é controvertido em algumas situações. OBJETIVO: Apresentar a epidemiologia, o diagnóstico e tratamento clínico e cirúrgico de 24 pacientes com fratura do seio frontal. MATERIAL E MÉTODOS: Estudo retrospectivo, não randomizado, de 24 pacientes com fratura de seio frontal operados no Hospital das Clínicas da Faculdade de Medicina de Botucatu, São Paulo, Brasil. RESULTADOS: Dos 24 pacientes, 16 tinham fraturas da lâmina externa e 8, da lâmina interna e externa. Em 2 casos havia lesão do ducto nasofrontal. Vinte (83,4 por cento) pacientes tiveram fraturas faciais associadas e em 13 (54,2 por cento) foram observadas complicações intracranianas. A incisão em asa de borboleta, abaixo da sobrancelha, foi empregada na maioria dos casos cirúrgicos com bom resultado estético. Fixação dos fragmentos ósseos com diferentes materiais (fio de aço, mononylon, miniplacas de titânio) e, se necessário, reconstrução da tábua anterior com material aloplástico ou osso parietal. CONCLUSÃO: A causa principal das fraturas do seio frontal é acidente com veículos. O tratamento depende de sua complexidade, pois comumente há lesões cranioencefálicas associadas. As técnicas cirúrgicas utilizadas são as incisões, retalho bicoronal ou na sobrancelha, infra-orbital (em asa de borboleta), associadas à cirurgia endoscópica em casos de infecção fístula liquórica e complicações orbitárias.

Etiologia e incidência das fraturas faciais em adultos e crianças: experiência em 513 casos / Etiology and incidence facial fractures in children and adults

O trauma facial apresenta incidência crescente nas últimas quatro décadas, principalmente devido ao aumento dos acidentes automobilísticos e da violência urbana, que continuam sendo as principais causas desses traumatismos em indivíduos jovens. OBJETIVO: Estudar as características da população vítima de trauma facial através das variáveis sexo, idade, profissão, tipo de fratura e suas causas. FORMA DE ESTUDO: clínico retrospectivo com coorte transversal. MAETERIAL E MÉTODO: Estudo retrospectivo por consulta a prontuários de 513 pacientes vítimas de trauma facial. RESULTADOS: Houve maior incidência de trauma de face em homens (84,9 por cento), brancos (82,7 por cento) e com idade média de 29 anos. Quanto à profissão, estudantes (16,6 por cento) e pedreiros (11,2 por cento) foram os mais acometidos. A mandíbula foi o local mais afetado (35 por cento), seguido do zigoma (24 por cento) e do nariz (23 por cento), sendo que a maioria dos pacientes tinha fratura única de face (81,5 por cento). Dentre as causas, destacaram-se os acidentes automobilísticos (28,3 por cento), agressões (21 por cento) e as quedas acidentais (19,5 por cento). CONCLUSÕES: Os acidentes automobilísticos continuam sendo a principal causa de trauma de face, principalmente de fraturas múltiplas devido à grande transmissão de energia cinética.

Etiology and patterns of facial fractures in Al-Ain united arab emirates

A retrospective analysis of all clinical and radiological records of two hundred and seventy-nine [279] patients, admitted with facial fractures over a six year period, has been carried out to evaluate the trends in the etiology and patterns of facial fractures in Al-Ain, United Arab Emirates [U.A.E.]. The majority of facial fractures were found in 16 to 20 year old males. Road traffic accident [60%] was the most common cause, while assault accounted for 6% of the cases. In comparison with other studies, patients in the present study sustained more extensive facial fractures, as well as higher number of associated injuries. The severity of injuries observed is attributed to the predominance of road traffic accidents as the major cause and the absence of an obligatory seat belt law

Traumatic hematomas of the posterior cranial fossa.

The objective of this study was to find out the result of treatment and the factors which can predict the outcome of traumatic hematomas of the posterior cranial fossa. Twenty two patients with traumatic hematomas of the posterior cranial fossa from 1,500 patients with traumatic intracranial hematomas were analyzed. There were fourteen male and eight female patients. The most common etiology was a motor vehicle accident. About 90 per cent of the patients had a direct injury to the occipital region. Ninety per cent of the patients had an occipital skull fracture or diastatic fracture of the lambdoid suture. The overall mortality rate was about 38 per cent. Patients having pure epidural hematoma had zero mortality. By contrast, patients suffering epidural hematoma with associated intracranial hematoma had 20 per cent mortality. Intracerebellar hematoma led to 60 per cent mortality. Glasgow Coma Scale (GCS) before operation was used to predict the patients' outcome. Ninety per cent of the patients who had a GCS between 13 and 15 had a good recovery. By contrast, only 30 per cent of the patients who had a GCS below 9 had a good recovery. Statistical analysis showed that the GCS value of below 9 predicted the poor outcome for the patients.

Fratura com afundamento craniano em crianças com menos de dois anos de idade / Depressed skull fractures in children under 2 years of age

As fraturas com afundamento da calota craniana (FAC) säo relativamente frequentes e seu tratamento neurocirúrgico está bem estabelecido, porém pouca atençäo tem sido dada a esta patologia na faixa etária de 0 a 2 anos de idade. Este estudo baseia-se na análise retrospectiva de 43 pacientes com FAC e idade entre 0 e 2 anos. As principais causas da FAC foram as quedas, seguidas pelos atropelamentos. A maioria apresentava FAC tipo I, isto é, aquela na qual o osso deprimido permanece conectado à calota craniana. Tratamento cirúrgico foi instituído em 69,8 por cento dos casos. A incidência de lesöes encefálicas associadas foi mais baixa do que a relatada na literatura

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