Acesso transconjutival com cantotomia lateral para abordagem do completo orbito-zigomático-maxilar: relato de caso / Transconjutival access with side cantotomy to approach the orbito-zygomatic-maxillary complex: case report

Objetivo: relatar um caso clínico, embasando os aspectos relativos à técnica cirúrgica transconjutival com cantotomia lateral como tratamento para fratura de COZM. Relato de caso: Paciente, gênero masculino, compareceu ao Serviço de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Geral do Estado (HGE), vítima de acidente motociclístico, apresentando distopia ocular, degrau ósseo em rebordo infraorbitário direito, perda de projeção malar direita, abertura bucal limitada com desvio ipsilateral e distopia oclusal com sinais sugestivos de fratura do complexo-orbito-zigomático-maxilar direito, juntamente com fratura complexa da mandíbula. A abordagem cirúrgica para acessar o COZM contou com a técnica de incisão transconjuntival com cantotomia lateral para uma melhor visualização dos cotos ósseos fraturados. Considerações finais: a escolha por esse tipo de acesso resultou em uma abordagem cirúrgica bem-sucedida, proporcionando segurança na visualização do campo cirúrgico para posterior reabilitação do paciente, estabelecendo uma devolutiva estética e funcional, cicatriz imperceptível e consequentemente um melhor prognóstico para o paciente.(AU)

Objective: to report a clinical case, basing the aspects related to the transconjunctival surgical technique with lateral canthotomy as a treatment for COZM fracture. Case report: Patient, male gender, attended the Oral and Maxillofacial Surgery and Traumatology Service of the General Hospital of the State (HGE), victim of a motorcycle accident, presenting ocular dystopia, bone step in the right infraorbital ridge, loss of right malar projection, mouth opening limited with ipsilateral deviation and occlusal dystopia with signs suggestive of a fracture of the right orbito-zygomatico-maxillary complex along with a complex fracture of the mandible. The surgical approach to access the contoured COZM with the transconjunctival incision technique with lateral canthotomy for better visualization of the fractured bone stumps. Final considerations: the choice for this type of access resulted in a successful behavioral approach, providing security in the experience of the respiratory field for subsequent rehabilitation of the patient, establishing a devolutionary and functional aesthetics, imperceptible healing and, consequently, a better prognosis for the patient.(AU)

Fixação single-point com placa reabsorvível em fratura pediátrica: relato de caso / Single-point fixation with resorbable plate in pediatric fracture: case report

Introdução: As fraturas faciais pediátricas são geralmente decorrentes de traumas de alta energia e o seu tratamento está relacionado à fase do crescimento facial e do padrão do trauma ocorrido. A literatura atual descreve, com sucesso, a fixação de fraturas de zigoma com pouco deslocamento, utilizando apenas um ponto, seja ele na sutura frontozigomática ou no pilar zigomaticomaxilar, podendo ser associado ao uso de placas do sistema de fixação absorvível, principalmente, em pacientes em fase de crescimento. Este trabalho tem por objetivo relatar um caso de fratura de zigoma em paciente pediátrico tratado com placa e parafusos absorvíveis, utilizando o princípio de fixação em um único ponto. Relato de caso: Paciente de 06 anos de idade foi atendido em serviço de Cirurgia Bucomaxilofacial, cursando com ferimento cortocontuso em margem supraorbitária direita associada à presença de degrau palpável em região de sutura frontozigomática direita, o qual foi confirmado pela tomografia computadorizada, demonstrando leve deslocamento medial. O paciente foi submetido à redução aberta e fixação da fratura com material reabsorvível. Considerações finais: A utilização de fixação com placas reabsorvíveis em um único ponto tem sido um excelente aliado, porém não é indicado para fraturas com deslocamento significativo, instáveis e panfaciais... (AU)

Introduction: Pediatric facial fractures are usually consequence of high energy trauma and its treatment is related to the facial growth phase and the trauma itself. The current literature describes, successfully, the fixation of zygoma fracture with little displacement using the single point fixation, being on the frontozygomatic suture or on the zygomatic-maxillary buttress, which can be associated to the use of resorbable fixation system plates, especially in patients growing phase. The aim of this work is report a case of zygomatic fracture in a pediatric patient treated with plate and resorbable screws, using the principle of single-point fixation. Case Report: A 06-year-old patient, attended in the Oral and Maxillofacial Surgery Service, suffering from a cut-contusion wound on the right supraorbital margin associated with the presence of a palpable step in the region of the right frontozygomatic suture, which was confirmed by computed tomography, demonstrating slight medial displacement. The patient was underwent to open reduction and internal fixation of the fracture with resorbable material. Final considerations: The use of fixation with resorbable plates in a single-point has been an excellent approach, however it is not indicated for fractures with significant displacement, unstable and panfacial... (AU)

Radiographic and clinical evaluations of the zygomatico-maxillary complex fractures treated by 2. 0 miniplates system / Evaluaciones radiográficas y clínicas de fracturas del complejo cigomáticomaxilar tratadas por el sistema de mini placas 2. 0

The zygomaticomaxillary complex (ZMC) is the second highly incidental of facial fractures. According to the anatomical complexity, there are many reports in the literature about this trauma, mainly related to treatment for these fractures. With the purpose of evaluating clinically and radiographically the stability of unilateral zygomatic fractures treated by surgical reduction and fixed in two points by stable internal fixation, this research was proposed. Twenty patients with zygomatic fractures were evaluated and compared with twenty nonfractured patients. The results showed that there were no statistically significant differences among the obtained data, perimeter and area, of the treated and contra-lateral sides of the experimental group. When compared to the control group the differences were not statistically significant. We also performed a comparison of the distance between the nasal bone and zygomatic prominence in all groups the results were also satisfactory

Las fracturas del complejo cigomaticomaxilar son las segundas más frecuente del territorio facial. De acuerdo con la complejidad anatómica, existen muchos informes en la literatura sobre este trauma, principalmente relacionadas con el tratamiento de estas fracturas. El propósito de esta investigación fue evaluar clínica y radiográficamente la estabilidad de las fracturas cigomáticas unilaterales tratadas por reducción quirúrgica y fijadas en dos puntos por fijación interna estable. Veinte pacientes con fracturas cigomáticas fueron evaluados y comparados con veinte pacientes sin fracturas. En el grupo experimental, los resultados mostraron que no hubo diferencias estadísticamente significativas entre los datos obtenidos del perímetro y el área de los lados tratados y contralaterales. Al comparar estos datos con el grupo de control las diferencias no fueron estadísticamente significativas. También se realizó una comparación de la distancia entre el hueso nasal y la prominencia cigomática en todos los grupos, estos resultados también fueron satisfactorios

Midfacial fractures: different trends in management

This study was undertaken to determine the anatomic distribution and different methods of treatment of midface fractures. Ninety-seven consecutive patients with midface fractures were treated at the Department of Oral and Maxillofacial Surgery, de, Montmorency College of Dentistry, Punjab Dental Hospital, Lahore during the year 2001-2002. A review of patients' records and radiographs were conducted. Data regarding anatomic site and treatment modalities were reviewed. The zygomatic bone was the most commonly involved [64.71%], followed by maxilla [28.43%], nasal bone [3.92%] and nasoethmoidal fractures [2.94%]. Le Fort I was the most common fracture. The maxillary fractures were mostly treated with suspension wiring [31%] while in Zygomatic complex [ZC] fractures Gillies' approach [37.9%] was the common method of management. The miniplates fixation was performed in 20.7% and 13.6% cases of maxillary and ZC fractures respectively

A comparison between radiography and ultrasonography in the diagnosis of zygomatic arch fracture.

A comparison between submentovertex view radiograph and real time ultrasonography in the diagnosis of zygomatic arch fractures. The materials are 6 patients with zygomatic arch fracture alone and 6 patients with combination of zygomatico-maxillary complex with arch fracture. In 34% of patients with zygomatico-maxillary complex with arch fracture. In 34% of patients with zygomatico-maxillary complex fractures, zygomatic arch fractures were confirmed by radiographs, in 66% of the cases the isolated arch fractures were confirmed by radiographs. In 100% of the cases ultrasonography confirmed arch fractures in both the sets of cases.

Management of post-traumatic orbito-zygomatic deformities

In this study, 20 patients with post-traumatic orbitozygomatic deformities were clinically and radiologically evaluated and surgical correction was tried for every patient using craniofacial techniques. The details of soft tissues and skeletal reconstruction as well as functional and aesthetic results were discussed. Postoperative complications occurred in 20% of the cases, the most severe being loss of vision. Craniofacial techniques allowed proper correction of the post traumatic orbitozygomatic deformities and provided acceptable functional and aesthetic results