Incidencia de consultas por fracturas maxilofaciales en un servicio de urgencias odontológicas del Área Metropolitana de Buenos Aires / Incidence of consultations for maxillofacial fractures in a dental emergency department in the Metropolitan Area of Buenos Aires

Objetivo: Describir la incidencia, la causa, el patrón y el tratamiento de fracturas maxilofaciales en sujetos que solici- taron atención en un Servicio de Urgencias Odontológicas del Área Metropolitana de Buenos Aires. Materiales y métodos: Se analizaron las historias clíni- cas de los individuos que concurrieron al Servicio de Urgencias y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires (SUyOP) en el período compren- dido entre marzo de 2018 y diciembre de 2019. Se registró la fre- cuencia de consultas vinculadas con diagnóstico de algún tipo de fractura del esqueleto maxilofacial y en el caso de estos pacien- tes, se registraron sexo, edad, etiología, ubicación y tratamiento. Resultados: Durante el periodo evaluado asistieron al SUyOP un total de 13.919 pacientes por algún tipo de urgen- cia odontológica, entre los cuales 47 (0,33%) se presentaron con traumatismos en la región bucomaxilofacial; 39 fueron del sexo masculino (83%). En total fueron diagnosticadas 66 frac- turas. La edad media se extendió entre los 30 y los 51 años. Las fracturas se encontraron con mayor frecuencia en la mandíbu- la (95,45%). La agresión interpersonal fue la principal causa (53,19%). El tratamiento realizado con mayor frecuencia fue el bloqueo intermaxilar en el 57,44% de los pacientes. Conclusión: Las fracturas de maxilar inferior fueron las que se registraron con mayor frecuencia. Si bien estas fracturas no ponen en riesgo la vida del paciente, la falla en el diagnóstico y el tratamiento apropiados puede derivar en la pérdida de fun- ciones del sistema estomatognático, y desarrollar deformidades secundarias que requieren de un tratamiento más complejo (AU)

Aim: To describe the incidence, etiology, pattern and treat- ment of maxillofacial fractures in a dental emergency department of the Buenos Aires Metropolitan Area. Materials and methods: A study was conducted, re- cording sex, age, etiology, location and treatment of maxillofa- cial fractures in patients who visited the Emergency and Patient Orientation Service of the School of Dentistry of the University of Buenos Aires (SUyOP) from March 2018 to December 2019. Data were obtained from dental medical records. Results: During the evaluated period, a total 13,919 pa- tients visited the SUyOP for dental emergencies, of whom 47 (0.33%) presented with trauma in the oral-maxillofacial region, and 39 were male (83%). Age range was 30 to 51 years. Over- all, 66 fractures were diagnosed. Fractures were most frequent in the mandible (95.45%). Interpersonal aggression was the most prevalent cause (53.19%). The most frequent treatment was inter- maxillary fixation, which was performed in 57.44% of the cases. Conclusion: Fractures of the lower jaw were the most fre- quently reported. Although these fractures are not life-threaten- ing, failure to diagnose and treat them properly can lead to loss of function of the stomatognathic system and development of sec- ondary deformities requiring more complex treatment (AU)

Análise epidemiológica das fraturas dos ossos da face em um hospital público no nordeste do Brasil / Análisis epidemiológico de las fracturas de los huesos de la cara en un hospital público del noreste de Brasil / Epidemiological analysis of face bone fractures in a public hospital in northeast Brazil

As fraturas dos ossos da região maxilofacial são ocorrências que podem se apresentar como quadros de urgência e/ou emergência na rotina das unidades de pronto atendimento e hospitais do mundo inteiro, principalmente em localidades com altos índices de violência interpessoal e infrações de trânsito. Um grande número de traumatismos na face, tanto em tecidos moles como duros acontece devido à enorme exposição e a pouca proteção desta região o que acarreta frequentemente lesões graves. Objetivo: O presente estudo tem como objetivo avaliar a prevalência das fraturas no complexo maxilofacial em uma unidade hospitalar pública, a partir de um estudo epidemiológico, sendo analisados os fatores relacionados a ocorrência do trauma, agente etiológico, distribuição das fraturas, gênero e idade dos indivíduos acometidos. Metodologia: O presente estudo do tipo transversal retrospectivo, onde foram avaliados 268 prontuários de pacientes diagnosticados com fraturas dos ossos da face atendidos no Hospital Regional Justino Luz, localizado na cidade de Picos, no estado do Piauí, Brasil, no período de janeiro de 2015 até janeiro de 2017, os prontuários foram analisados no setor de arquivo médico do HRJL. Resultados: os fatores etiológicos mais observados foram os acidentes motociclísticos, seguidos de agressão física e quedas da própria altura, o tipo de fratura mais comum foi a do Complexo Orbito-Zigomático-Maxilar (33,2%), seguido da Mandíbula (23,7%) e dos Ossos Próprios do Nariz (17%), sendo o gênero masculino o mais acometido por fraturas. Conclusão: a partir desse estudo podemos concluir que os acidentes motociclísticos configuram-se como o principal fator etiológico relacionado as fraturas de face, sendo o gênero, masculino o mais atingido e o tipo de fratura mais prevalente foi a fratura do Complexo Orbito-Zigomático-Maxilar... (AU)

Bone fractures in the maxillofacial region are occurrences that can present themselves as urgent and/or emergencies in the routine of emergency care units and hospitals around the world, especially in locations with high rates of interpersonal violence and traffic violations. A large number of injuries to the face, both in soft and hard tissue, occur due to the enormous exposure and poor protection of this region, which often leads to serious injuries. Objective: This study aims to assess the prevalence of fractures in the maxillofacial complex in a public hospital, based on an epidemiological study, analyzing the factors related to the occurrence of trauma, etiological agent, fracture distribution, gender, and age of patients affected individuals. Methodology: This retrospective cross-sectional study evaluated 268 medical records of patients diagnosed with fractures of the facial bones treated at the Justino Luz Regional Hospital, located in the city of Picos, in the state of Piauí, Brazil, in January 2015 until January 2017, the medical records were analyzed in the medical file sector of the HRJL. Results: the most observed etiological factors were motorcycle accidents, followed by physical aggression and fall from own height, the most common type of fracture was the Orbit-zygomatic-Maxillary Complex (33,2%), followed by the mandible (23,7%) and the nose bonés (17%), being the male gender the most affected by fractures. Conclusion: from this study, we can conclude those motorcycle accidents are the main etiological factor related to facial fractures, with the male gender being the most affected and the most prevalent type of fracture was the fracture of the orbit-zygomatic-maxillary complex... (AU)

Las fracturas óseas en la región maxilofacial son eventos que pueden presentarse como urgentes y/o emergencias en la rutina de las unidades de atención de emergencia y hospitales de todo el mundo, especialmente en lugares con altos índices de violencia interpersonal e infracciones de tránsito. Un gran número de lesiones en la cara, tanto en tejidos blandos como duros, se producen debido a la enorme exposición y escasa protección de esta región, lo que a menudo conduce a lesiones graves. Objetivo: Este estudio tiene como objetivo evaluar la prevalencia de fracturas en el complejo maxilofacial en un hospital público, a partir de un estudio epidemiológico, analizando los factores relacionados con la ocurrencia del trauma, agente etiológico, distribución de la fractura, sexo y edad de los pacientes afectados. Metodología: Este estudio transversal retrospectivo evaluó 268 historias clínicas de pacientes con diagnóstico de fracturas de los huesos faciales atendidos en el Hospital Regional Justino Luz, ubicado en la ciudad de Picos, en el estado de Piauí, Brasil, en enero de 2015 hasta enero de 2017. , las historias clínicas fueron analizadas en el sector de expediente médico del HRJL. Resultados: los factores etiológicos más observados fueron los accidentes de motocicleta, seguido de agresión física y caída de propia altura, el tipo de fractura más común fue el Complejo Órbita-cigomático-Maxilar (33,2%), seguido de la mandíbula (23,7 %) y la nariz bonés (17%), siendo el género masculino el más afectado por las fracturas. Conclusión: de este estudio podemos concluir que los accidentes de motocicleta son el principal factor etiológico relacionado con las fracturas faciales, siendo el género masculino el más afectado y el tipo de fractura más prevalente fue la fractura del complejo orbitario-cigomático-maxilar... (AU)

Diagnostic properties of sensitivity changes in patients with maxillofacial fractures: a systematic review

Aim: Verify the accuracy of objective assessments compared to subjective tests in detecting changes in somatosensory perception in individuals affected by maxillofacial trauma. Methods: The review (PROSPERO n ° CRD42019125546) used the databases: MEDLINE, Cochrane, EMBASE, LILACS and other bibliographic resources. Prospective and retrospective studies that used objective and subjective methods of assessing facial sensitivity in maxillofacial fractures were included. There was no restriction on language or publication date. Risk of bias was assessed using the QUADAS-2. Data extraction and analysis were performed using a form developed for the study. Results: 21 studies were included. The clinical objective examination mainly includes assessments of: tactile sensitivity (95.24%) and nociceptive sensitivity (57.14%). The subjective assessment was based on the patient's report, spontaneously (61.90%), guided by structured questionnaires (33.33%) and/or using scales (9.52%) to measure the degree of impairment. In risk of bias assessment, were observed no adequate interpretation and classification of changes in subjective sensitivity, subject to inappropriate analysis of the data. In addition, the studies bring several instruments without standardization for assessing sensory modalities. Conclusion: The objective assessment is a complement to the subjective assessment, using the touch assessment as the main parameter in the profile of the facial peripheral integrity, associated or not with nociceptive assessment. Lack of consensus on the indication of specific instruments for testing is a limiting factor. Thus, based on the studies, is proposed a minimum battery of sensitivity assessment to obtain an overview of the patient's peripheral nervous situation

Fratura condilar em paciente pediátrico: um relato de caso condilar / Fracture in pediatric patient: a case report

As fraturas faciais em crianças são raras, já que os ossos faciais pediátricos têm maior elasticidade, menos pneumatização, tecido adiposo circundante mais espesso e mais estabilização da mandíbula e maxila pelos dentes não irrompidos. Em geral, lesões nos tecidos moles são mais comuns em crianças do que fraturas esqueléticas. Entre as fraturas faciais pediátricas, as fraturas da mandíbula são as mais comuns, sendo o côndilo a área mais acometida em pacientes pediátricos. O côndilo é considerado o principal centro de crescimento da mandíbula em crianças, assim é de suma importância a definição do tratamento adequado, pautado em diversos critérios de avaliação, com o intuito de erradicar possíveis complicações advindas da fratura condilar. Assim o objetivo deste estudo é relatar um caso de fratura de côndilo unilateral em uma criança, na qual realizou-se abordagem cirúrgica com fixação interna, afim de elucidar e discutir as possíveis condutas terapêuticas acerca de tratamentos a serem aplicados, visto que esses ainda são bastante controversos na literatura e os resultados das diversas condutas são os mais diversos, apresentando variados aspectos que interferem na evolução dos pacientes(AU)

Facial fractures in children are rare, since pediatric facial bones have greater elasticity, less pneumatization,thicker surrounding adipose tissue and more stabilization of the jaw and jaw by unerupted teeth.In general, soft tissue injuries are more common in children than skeletal fractures.Among pediatric facial fractures, mandible fractures are the most common, with condyl being the most affected area in pediatric patients.The condyl is considered the main center of mandible growth in children, so it is of Paramount importance to define the appropriate treatment, based on several evaluationcriteria, in order to eradicate possible complications resulting from the condilar fracture.Thus, the aim of this study is to report a case of unilateral condyl fracture in a child, in which a surgical approach with internal fixation was performedin order to elucidate and discuss the possible therapeutic approaches about treatments to be applied, since these are still quite controversial in the literature and the results of the various behaviors are the most diverse,presenting several aspects that interfere in the evolution of patients(AU)

Manejo cirúrgico de fratura cominutiva de mandíbula por ferimento de arma de fogo: relato de caso / Surgical management of comminuted jaw fracture by firearms injury: case report

Os ferimentos por arma de fogo (FAF) são um grande problema de saúde pública. Na face, a mandíbula é o local de maior incidência, sendo a região de corpo mandibular a mais atingida e as lesões aos tecidos moles frequentemente a ela associadas. Em alguns casos, tais ferimentos apresentam-se de difícil resolução, sobretudo, em casos de fraturas cominutivas e lesões de tecidos moles com alta complexidade. Isso torna o atendimento desses pacientes um desafio para cirurgiões buco-maxilo-faciais. Desta forma, o objetivo deste artigo é relatar um caso de FAF em terço inferior da face, com comprometimento de tecidos moles e mandíbula, pela equipe de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Geral do Estado - Bahia. Paciente de 28 anos de idade, sexo feminino, vítima de FAF em terço inferior da face, por disparo acidental de espingarda. Ao exame clínico, pode-se observar ferimento perfuro-contuso em região de mandíbula e fratura cominutiva de corpo e ângulo mandibular à direita. A paciente foi submetida à cirurgia para remoção de fragmentos ósseos/corpos estranhos, fixação dos cotos com placa de reconstrução 2.4mm e sutura dos planos, em mesmo tempo cirúrgico, reestabelecendo a função da mandíbula. Portanto, devido à fisiopatologia variável dos FAF na mandíbula, não se indica um único padrão de tratamento para as fraturas cominutivas. Além disso, é indispensável o emprego de protocolos de limpeza cirúrgica imediata e antibioticoterapia nos casos com alto grau de cominuição, bem como, sugere-se realizar o tratamento definitivo o mais breve possível(AU)

Firearm injuries (FIs) are a major public health problem. On the face, the mandible is the place with the highest incidence of this trauma, with the mandibular body region being the most affected and the lesions to the soft tissues frequently associated with it. In some cases, such injuries are difficult to resolve, especially in cases of comminuted fractures and soft tissue injuries with high complexity. This makes the care of these patients a challenge for oral and maxillofacial surgeons. Thus, the objective of this article is to report a case of care for a FAF victim in the lower third of the face, with soft tissue and mandible involvement, by the Maxillofacial Surgery and Traumatology team at the Hospital Geral do Estado - Bahia. 28-year-old female patient, victim of FAF in the lower third of the face, due to acidental shotgun firing. On clinical examination, a perforated-blunt wound can be seen in the mandible region and comminuted fracture of the body and angle of the mandible on the right. The patient underwent surgery to remove bone fragments / foreign bodies, fix the stumps with a 2.4 mm reconstruction plate and suture the planes, at the same surgical time, reestablishing the function of the mandible. Therefore, due to the variable pathophysiology of FAF in the mandible, a single treatment pattern is not indicated for comminuted fractures. In addition, it is essential to use immediate surgical cleaning protocols and antibiotic therapy in cases with a high degree of comminution, as well as, it is suggested to carry out the definitive treatment as soon as possible(AU)

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.

Urgent surgical approach for comminuted mandible fracture and considerations regarding airway risk. Case report / Abordagem cirúrgica urgente para fratura cominutiva da mandíbula e considerações sobre o risco das vias aéreas. Relato de caso

Introduction: Jaw fractures are one of the most common sites of maxillofacial injuries. The location of the jaw makes it very vulnerable to direct impacts. The purpose of treatment is to restore aesthetic function. Case Report: The purpose of this report is to present a case of comminuted mandible fracture in a young male patient, treated urgently due to the need for maintenance of the airways, where fracture osteosynthesis surgery was submitted. Conclusion: The initial assessment of these trauma patients should follow the Trauma Life Support protocol, and structural damage should be investigated. Introduction: Jaw fractures are one of the most common sites of maxillofacial injuries. The location of the jaw makes it very vulnerable to direct impacts. The purpose of treatment is to restore aesthetic function. Case Report: The purpose of this report is to present a case of comminuted mandible fracture in a young male patient, treated urgently due to the need for maintenance of the airways, where fracture osteosynthesis surgery was submitted. Conclusion: The initial assessment of these trauma patients should follow the Trauma Life Support protocol, and structural damage should be investigated

Introdução: As fraturas de mandíbula são um dos locais mais comuns de lesões maxilofaciais. A localização da mandíbula a torna muito vulnerável a impactos diretos. O objetivo do tratamento é restaurar a função estética. Relato de Caso: O objetivo deste relato é apresentar um caso de fratura cominutiva de mandíbula em paciente jovem do sexo masculino, atendido com urgência devido à necessidade de manutenção das vias aéreas, onde foi submetido cirurgia de osteossíntese da fratura. Conclusão: A avaliação inicial desses pacientes com trauma deve seguir o protocolo do Suporte de Vida no Trauma, e devem ser investigados danos estruturais.

Management of isolated mandibular body fractures in adults

Objective@#The mandible is the most common fractured craniofacial bone of all craniofacial fractures in the Philippines, with the mandibular body as the most involved segment of all mandibular fractures. To the best of our knowledge, there are no existing guidelines for the diagnosis and management of mandibular body fractures in particular. General guidelines include the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAOHNSF) Resident Manual of Trauma to the Face, Head, and Neck chapter on Mandibular Trauma, the American Association of Oral and Maxillofacial Surgeons (AAOMS) Clinical Practice Guidelines for Oral and Maxillofacial Surgery section on the Mandibular Angle, Body, and Ramus, and a 2013 Cochrane Systematic Review on interventions for the management of mandibular fractures. On the other hand, a very specific Clinical Practice Guideline on the Management of Unilateral Condylar Fracture of the Mandible was published by the Ministry of Health Malaysia in 2005. Addressing the prevalence of mandibular body fractures, and dearth of specific guidelines for its diagnosis and management, this clinical practice guideline focuses on the management of isolated mandibular body fractures in adults.@*Purpose@#This guideline is meant for all clinicians (otolaryngologists – head and neck surgeons, as well as primary care and specialist physicians, nurses and nurse practitioners, midwives and community health workers, dentists, and emergency first-responders) who may provide care to adults aged 18 years and above that may present with an acute history and physical and/or laboratory examination findings that may lead to a diagnosis of isolated mandibular body fracture and its subsequent medical and surgical management, including health promotion and disease prevention. It is applicable in any setting (including urban and rural primary-care, community centers, treatment units, hospital emergency rooms, operating rooms) in which adults with isolated mandibular body fractures would be identified, diagnosed, or managed. Outcomes are functional resolution of isolated mandibular body fractures; achieving premorbid form; avoiding use of context-inappropriate diagnostics and therapeutics; minimizing use of ineffective interventions; avoiding co-morbid infections, conditions, complications and adverse events; minimizing cost; maximizing health-related quality of life of individuals with isolated mandibular body fracture; increasing patient satisfaction; and preventing recurrence in patients and occurrence in others.@*Action Statements@#The guideline development group made strong recommendationsfor the following key action statements: (6) pain management- clinicians should routinely evaluate pain in patients with isolated mandibular body fractures using a numerical rating scale (NRS) or visual analog scale (VAS); analgesics should be routinely offered to patients with a numerical rating pain scale score or VAS of at least 4/10 (paracetamol and a mild opioid with or without an adjuvant analgesic) until the numerical rating pain scale score or VAS is 3/10 at most; (7) antibiotics- prophylactic antibiotics should be given to adult patients with isolated mandibular body fractures with concomitant mucosal or skin opening with or without direct visualization of bone fragments; penicillin is the drug of choice while clindamycin may be used as an alternative; and (14) prevention- clinicians should advocate for compliance with road traffic safety laws (speed limit, anti-drunk driving, seatbelt and helmet use) for the prevention of motor vehicle, cycling and pedestrian accidents and maxillofacial injuries.The guideline development group made recommendations for the following key action statements: (1) history, clinical presentation, and diagnosis - clinicians should consider a presumptive diagnosis of mandibular fracture in adults presenting with a history of traumatic injury to the jaw plus a positive tongue blade test, and any of the following: malocclusion, trismus, tenderness on jaw closure and broken tooth; (2) panoramic x-ray - clinicians may request for panoramic x-ray as the initial imaging tool in evaluating patients with a presumptive clinical diagnosis; (3) radiographs - where panoramic radiography is not available, clinicians may recommend plain mandibular radiography; (4) computed tomography - if available, non-contrast facial CT Scan may be obtained; (5) immobilization - fractures should be temporarily immobilized/splinted with a figure-of-eight bandage until definitive surgical management can be performed or while initiating transport during emergency situations; (8) anesthesia - nasotracheal intubation is the preferred route of anesthesia; in the presence of contraindications, submental intubation or tracheostomy may be performed; (9) observation - with a soft diet may serve as management for favorable isolated nondisplaced and nonmobile mandibular body fractures with unchanged pre - traumatic occlusion; (10) closed reduction - with immobilization by maxillomandibular fixation for 4-6 weeks may be considered for minimally displaced favorable isolated mandibular body fractures with stable dentition, good nutrition and willingness to comply with post-procedure care that may affect oral hygiene, diet modifications, appearance, oral health and functional concerns (eating, swallowing and speech); (11) open reduction with transosseous wiring - with MMF is an option for isolated displaced unfavorable and unstable mandibular body fracture patients who cannot afford or avail of titanium plates; (12) open reduction with titanium plates - ORIF using titanium plates and screws should be performed in isolated displaced unfavorable and unstable mandibular body fracture; (13) maxillomandibular fixation - intraoperative MMF may not be routinely needed prior to reduction and internal fixation; and (15) promotion - clinicians should play a positive role in the prevention of interpersonal and collective violence as well as the settings in which violence occurs in order to avoid injuries in general and mandibular fractures in particular.

Occurrence and remission of loss of sensitivity of inferior alveolar nerve in mandibular fractures

ABSTRACT Purpose: to evaluate the occurrence of loss of sensitivity of the inferior alveolar nerve, and to monitor the remission of this change in patients with mandibular fractures subjected to surgical treatment. Methods: patients with mandibular fractures, surgically treated within one year, were prospectively evaluated. Data regarding etiology, fracture location, type and displacement, and surgical access, were obtained. The tactile and thermal tests were applied at eighteen points in the mental region, within a period of six months. Statistical tests were applied to compare the categories of variables and the period of observation (p ≤ 0.050). Results: during the study, 37 patients were included. There were 24 bilateral and 13 unilateral fractures. Sensory changes occurred in 56.8% of the patients in the preoperative period, in 83.8% of the patients, in the postoperative period, and 35.1% of the patients presented complete remission during the final period of the study. Conclusion: sensory changes occurred in about half of the patients, due to the fracture, increasing greatly in the postoperative period, with complete remission in about one third of the cases. The fracture type, degree of displacement and surgical access type influenced the occurrence of sensory alterations.

Fixação funcionalmente estável no tratamento de sequela de fratura cominutiva de mandíbula por PAF / Functionally stable fixation in the treatment of comminuted jaw fracture by firearm projectile

Introdução: em traumas de alta energia por projéteis de arma de fogo (PAF), pode ocorrer a cominuição da mandíbula. Quando não identificadas ou tratadas de maneira equivocada, essas injúrias podem comprometer a saúde do indivíduo, com graves complicações estéticas e funcionais. Objetivo: o objetivo deste trabalho é relatar um caso de tratamento cirúrgico de sequela de ferimento por arma de fogo com fratura cominutiva em região de sínfise mandibular. Relato do caso: paciente procurou o serviço de cirurgia e traumatologia bucomaxilofacial após tratamento cirúrgico insatisfatório de fratura mandibular por PAF. Observou-se clinicamente mobilidade em manipulação, exposição óssea e drenagem purulenta. Na tomografia, observou-se gap ósseo, descontinuidade na base mandibular e material de osteossíntese inadequado. Foi proposta uma abordagem cirúrgica para instalação de placa de reconstrução do sistema 2.4 mm. Em acompanhamento pós-operatório, o paciente evoluiu com abertura bucal funcional e satisfatória, sem mobilidade nos fragmentos ósseos, arcabouço mandibular restabelecido e adequado posicionamento do material de fixação. Considerações finais: os casos de cominuição óssea apresentam características individuais que devem ser levadas em consideração em seu manejo. Nesses casos, a escolha do material de fixação é fundamental para o sucesso terapêutico e o uso de prototipagem soma para uma condução satisfatória do caso, garantindo menor tempo cirúrgico e melhor adaptação da placa. (AU)

Introduction: in high energy traumas caused by firearm projectiles may occur comminutive mandibular fractures. When it is not identified or inappropriately treated, these injuries can compromisse the individual's health, with serious aesthetics and funcional complications. Objective: the aim of this study is report a case of surgical treatment of sequelae from firearm injury with comminutive fracture in the region of mandibular symphysis. Case report: patient sought the service of Oral and Maxillofacial Surgery and Traumatology after 1 month of unsatisfactory surgical treatment of a mandibular fracture caused by firearm projectile. Clinical examination revealed mobility to manipulation and bone exposure with purulent drainage. Computed tomography of the face shows bad fracture consolidation in the anterior region of the mandible with bone gap and discontinuity in the mandibular base and inadequate and poorly positioned osteosynthesis material. It was then proposed a new surgical approach with instalation of the reconstruction plate of 2.4mm locking system. In postoperative follow-up, the patient evolved with a functional and satisfactory mouth opening, with no mobility in bone fragments, restored mandibular framework and adequate positioning of the fixation material. Final considerations: the cases of comminutive bone fractures show particular features that should be considered in their handling. In these cases, the choice of the fixation material is critical to therapeutic success and the use of prototyping sum for a satisfactory conduction of the case, ensuring shorter surgical time and better adaptation of the plate.(AU)

Fracturas del complejo cigomático / Fractures of the zygomatic complex

Introducción: El complejo cigomático maxilar con su convexidad prominente, es muy vulnerable a las lesiones. Objetivo: Abordar elementos actuales sobre el diagnóstico, clasificación, tratamiento y complicaciones de las fracturas del complejo cigomático. Métodos: Se realizó una revisión bibliográfica en septiembre de 2016. Se evaluaron revistas de impacto de Web of Sciencies (29 revistas) y 2 libros. Se consultaron las bases de datos de MEDLINE, PubMed y SciELO con los descriptores: zygomatic fracture, treatment, epidemiology. Se incluyeron artículos en idioma inglés, preferentemente de los últimos 5 años. Se obtuvieron 109 artículos. El estudio se circunscribió a 41. Análisis e integración de la información: El correcto diagnóstico basado en los hallazgos clínicos y medios auxiliares de diagnóstico, permite clasificar la fractura. La clasificación más empleada en nuestro medio es la de las Guías Prácticas de Estomatología. Las modalidades terapéuticas pueden incluir el tratamiento quirúrgico con el uso de métodos de fijación que permiten mayor o menor estabilidad. Las complicaciones pueden aparecer. Conclusiones: La proyección anatómica de los huesos malares justifica la incidencia de estas fracturas. El diagnóstico debe basarse en el interrogatorio, examen físico y los medios auxiliares de diagnóstico imaginológicos. La radiografía Waters es una buena opción de imagen. Al clasificar la fractura se establece un plan de tratamiento basado en la valoración individual de cada caso con el objetivo de evitar complicaciones posteriores(AU)

Introduction: Due to its prominent convexity, the zygomaticomaxillary complex is very vulnerable to injuries. Objective: Address current notions about the diagnosis, classification, treatment and complications of fractures of the zygomatic complex. Methods: A literature review was conducted in September 2016. The evaluation included high impact journals from the Web of Science (29 journals) and 2 books. The databases MEDLINE, PubMed and SciELO were consulted, using the search terms zygomatic fracture, treatment, epidemiology. Papers written in English were included, preferably from the last five years. Of the 109 papers obtained, the study considered 41. Data analysis and integration: Appropriate diagnosis based on clinical findings and the use of diagnostic aids allows classification of the fracture. The classification most commonly used in our environment is that of the Dental Practice Guidelines. Therapy modes may include surgery with fixation methods allowing greater or lesser stability. Complications may appear. Conclusions: The anatomical protrusion of malar bones accounts for the incidence of these fractures. Diagnosis should be based on interrogation, physical examination and the use of auxiliary diagnostic imaging. Waters radiography is a good imaging option. Upon classification of the fracture, a treatment plan is devised based on individual assessment of each case so as to prevent future complications(AU)

Fratura cominutiva de mandíbula por fogos de artifício: relato de caso / Comminuted mandible fracture by firework: a case report

As fraturas mandibulares são comuns na rotina dos serviços de Cirurgia e Traumatologia Buco-maxilo-facial. Embora sejam raras, as fraturas ocasionadas por fogos de artifício merecem atenção devido ao poder de destruição. O presente trabalho tem como objetivo relatar um caso de fratura mandibular cominutiva, com perda de substância dos tecidos duros e moles da face e cavidade oral. Nesse caso, foi preciso celeridade ao tratamento cirúrgico de urgência, para assegurar as vias aéreas do paciente e, em seguida, reconstruir as áreas destruídas, tendo todo o cuidado em relação ao acompanhamento do caso devido aos riscos de infecção e possíveis sequelas... (AU)

The mandible fractures are common in routine of Oral & Maxillofacial Surgery services. However, the ones occasioned by fireworks are rare. Nevertheless, they deserve attention because of the their destruction power. The present study aims to report a case of comminuted mandible fracture, with loss of substance from hard and soft tissues from the face and mouth. In this case, emergency surgery was urgently needed, to ensure the airways and then to rebuild the destroyed areas, paying attention to the follow-up of the case because of the high risk of infection and possible complications... (AU)

Long Term Follow-up of Children with Facial Asymmetry: A Case Report / 대한소아치과학회지

Mandibular fractures occur with high incidence among various fractures in maxillofacial region in children. Jaw fractures in children should be approached differently than in adults because bone growth continues throughout childhood. As far as displacement of the fragment is not severe, or if it is condyle that is fractured, closed reduction and additional intermaxillary fixation can be considered. Functional exercise is also required to prevent ankylosis of temporomandibular joint.Several complications, particularly malocclusion and facial asymmetry due to growth disturbances, can occur after condylar fractures. If growth disturbances take place after mandibular fractures, catch-up growth may occur in some patients, thus, periodic observation is necessary. In case of persistent growth disturbances, functional devices may be used to prevent severe facial asymmetry.This case report describes the long-term follow-up of two patients with facial asymmetry after mandibular fracture.

Prevalencia de hallazgos compatibles con material de osteosíntesis en radiografías panorámicas / Prevalence of fidings compatible with osteosynthesis material in panoramic radiographs

Resumen: Objetivo: Determinar la prevalencia de hallazgos compatibles con material de osteosíntesis en radiografías panorámicas, en el centro radiológico de la Universidad Católica de Cuenca en el periodo 2015 - 2016. Materiales y métodos: la metodología utilizada fue con un enfoque cuantitativo, descriptivo, observacional y retrospectivo. La población de este estudio se conformó por todo el universo de las radiografías panorámicas depositadas en la base de datos del centro radiológico de la Universidad Católica de Cuenca, Facultad de Odontología en el periodo 2015 - 2016 que suman un total de 3.243 radiografías, de las cuales fueron excluidas las radiografías panorámicas digitales que se han tomadas fuera del corte focal, radiografías tomadas con una técnica inadecuada, radiografías cefálicas, radiografías oclusales y radiografías digitales que se encontraron repetidas en la base de datos o con datos incompletos del paciente que no se pueda definir la edad o el sexo al que corresponden, siendo un total de 117 radiografías digitales excluidas. Resultados: se evidencio que existe una mínima prevalencia de hallazgos radiográficos compatibles con materiales de osteosíntesis en el centro radiológico de la Universidad Católica de Cuenca, representado con un 0,2% correspondiente a 7 pacientes, siendo más prevalente en la mandíbula y maxilar superior en igual proporción y siendo menos frecuente en el cóndilo mandibular representado por un 0,03%. Todos estos estudios arrojaron que se presentaba en paciente de 34 años de edad promedio, con una desviación estándar de 15 años; sin embargo, no se encontró diferencia significativa entre los dos sexos antes mencionados.

Abstract: Objective: To determine the prevalence of fidings compatible with osteosynthesis material in panoramic radiographs, at the radiological center of the Catholic University of Cuenca, in the period 2015-2016. Materials and methods: the methodology used was with a quantitative, descriptive, observational and retrospective approach. The population for this study consisted of the whole collection of panoramic radiographs deposited in the database of the Catholic University of Cuenca, Faculty of Dentistry, radiological center in the period 2015 - 2016, totaling 3.243 radiographs, from which were excluded digital panoramic radiographs that were taken outside the focal section, radiographs taken with an inadequate technique, cephalic radiographs, occlusal radiographs and digital radiographs that were found repeated in the database or with incomplete patient data that could not defie the age or sex to which they corresponded, giving a total of 117 excluded digital radiographs. Results: it was shown that there is a minimal prevalence of radiographic fidings compatible with osteosynthesis materials in the radiological center of the Catholic University of Cuenca, represented by 0.2% corresponding to 7 patients, being more prevalent in the mandible and upper maxilla in equal proportion and being less frequent in the mandibular condyle, represented by 0.03%. All these studies showed that it presented in patients of average age 34 years, with a standard deviation of 15 years; however, no signifiant difference was found between males and females.

A viabilidade e efetividade do acesso subciliar no tratamento cirúrgico de fraturas do complexo zigomaticomaxilar: relato de caso clínico / An alternative management in fractures of zigomaticomaxillary complex using a subciliary incision: case report

As fraturas do complexo zigomático-maxilar são as segundas mais comuns de todas as fraturas faciais. Mais especificamente as etiologias com maior incidência são os eventos como agressão física, acidente automobilístico ou queda de própria altura. Sendo assim, é de suma importância que, diante de informações obtidas no exame clínico, juntamente com exames de imagem, obtenha-se o diagnóstico correto, para que seja elaborado um plano de tratamento adequado. Dessa forma, quando o tratamento cirúrgico com fixação interna estável é determinado, a incisão subciliar se faz presente como uma opção para expor a região fraturada. Assim, com conhecimentos sobre anatomia cirúrgica orbitária, vantagens, desvantagens e complicações (tais como o aumento da exposição da esclera e o ectrópio) e domínio da técnica, o cirurgião apresenta condições de realizar seu tratamento cirúrgico em pacientes vítimas de trauma maxilofacial em terço médio de face, mais especificamente em fraturas do complexo zigomaticomaxilar. Este trabalho vem expor um caso clínico, em que serão abordados detalhes e informações que tornam o referido acesso uma opção realmente viável no tratamento do tipo de fratura em questão... (AU)

Fractures of the zygomatic-maxillary complex are the second most prevalent among facial fractures. More specifically, etiologies of higher incidence are physical aggression, car accidents or fall from one's own height. It is of great importance to obtain an accurate diagnosis, regarding clinical exam information, in addition to imaging exam, in order to elaborate a proper treatment plan. Thereby, once surgical treatment with stable internal fixation is determined, subciliary incision is an option to expose the fractured area. Thus, knowledge concerning surgical anatomy of orbital area, advantages and disadvantages, complications (such as increased scleral exposition and ectropion), and surgical experience, enables surgical treatment of victims of maxillofacial trauma involving midface region, more specifically, fractures of the zygomatic-maxillary complex. This study reports a clinical case, its details and information, which makes subciliary approach a viable option for this type of fractures... (AU)

Perfil Epidemiológico dos Pacientes com Fraturas / Epidemiological Profile of Patients with Fracture

Introdução: Os acidentes motociclísticos estão entre as causas mais frequentes de traumatismos faciais. O fato de a motocicleta ser um veículo leve e de fácil condução e o descumprimento à legislação atual contribuem para o aumento da incidência e da gravidade dessas fraturas. Metodologia: Foram entrevistados 123 pacientes, momento em que foram colhidas as seguintes variáveis: Dependentes: Faixa etária, gênero, local de procedência, uso de capacete, se havia ingerido bebida alcoólica antes do acidente, se possuia habilitação para motocicleta, ossos faciais fraturados e lesões em outras áreas do corpo. As fraturas faciais bem como as fraturas em outras áreas do corpo foram diagnosticadas após exame clínico e imaginológico. Resultados: Houve uma predominância de indivíduos do gênero masculino (85,4%) e de pacientes provenientes de cidades do interior do estado do Ceará (61,8%). Fraturas múltiplas da face ocorreram em 49,6% dos pacientes pesquisados. A maioria dos pacientes não utilizavam capacetes ou não possuíam habilitação (75,6% e 73,2%, respectivamente.), e 38,2% haviam ingerido bebida alcoólica antes do acidente. Foi observado ainda que 20.3% dos pacientes apresentavam fraturas em outros ossos do corpo que não a face. Conclusão: Observa-se que os acidentes motociclísticos correspondem a uma grande parcela das fraturas faciais e que a maior parte desses acidentes estão associados ao descumprimento da legislação... (AU)

Introduction: motorcycle accidents are among the most common causes of facial trauma. The fact that the motorcycle be a light vehicle and within easy driving and breach the current legislation contribute to the increased incidence and severity of these fractures. Methodology: We interviewed 123 patients, at which the following variables were collected: Dependents: age range, gender, place of origin, helmet use, if had been drinking before the accident, it has qualified for motorcycle, fractured facial bones and lesions in other areas of the body. Facial fractures and fractures in other areas of the body were diagnosed after clinical examination and imaginologic. Results: There was a predominance of male (85.4%) and patients from cities in the state of Ceará (61.8%). Multiple facial fractures occurred in 49.6% of patients surveyed. Most patients did not use helmets or had no qualifications (75.6% and 73.2% respectively.) And 38.2% had been drinking before the accident. It was also observed that 20.3% of patients had fractures in other bones of the body other than the face. Conclusion: It is observed that motorcycle accidents account for a large portion of facial fractures and that most of these accidents are associated with the breach of the legislation... (AU)

A case of bisphosphonate-related osteonecrosis of the jaw with a particularly unfavourable course: a case report

Bisphosphonates are drugs used to treat osteoclast-mediated bone resorption, including osteoporosis, Paget disease, multiple myeloma, cancer-related osteolysis, and malignant hypercalcemia. The use of these drugs has increased in recent years as have their complications, especially bisphosphonate-related osteonecrosis of the jaw (BRONJ), which more frequently affects the mandible. Here we report a case of BRONJ with a particularly unfavorable course due to cervical inflammation that developed into necrotizing fasciitis, followed by multiorgan involvement leading to septic shock and death.

Odontología en el deporte: ¿sólo un protector bucal?: [Editorial] / Sports dentistry: just a mouthguard deal?: [Editorial]

Muchas veces se interpreta que entre los odontólogos y los deportistas media sólo un protector bucal. Hoy se considera que la odontología es tan importante como la nutrición y la psicología, las cuales integran el equipo médico de entidades deportivas, sobre todo en los ámbitos de alto rendimiento y profesionalismo. La odontología que se practica a los deportistas no difiere de la que se presta a cualquier otro paciente. Las prácticas odontológicas dependen, en todo caso, de las características propias de esa población, las que determinan una atención diferenciada o adaptada. Nuestra tarea abarca la prevención, el diagnóstico y el tratamiento de las distintas patologías y lesiones. La actuación en el área de la atención primaria de la salud nos conecta con deportistas, lo cual aporta experiencias que guían nuestras acciones. En cuanto a los protectores bucales, necesarios en los deportes de contacto, existen diferentes tipos, espesores y características que se adaptan al deporte en cuestión y a la edad de quien lo practica; y también existen diferentes procedimientos para su confección. Por todo esto, debemos apuntar a que los pacientes acudan a nosotros, en lugar de adquirir directamente en los comercios los dispositivos que pueden no ser apropiados.

Many times, it is believed that a mouthguard is all thatseparates athletes from dentists. Dentistry is nowadays consideredto play an important role in medical support of high performance sport teams as well as nutrition or psychologyand more so in professional practice. Dental care providedto athletes is obviously not different from that performed inregular patients.The difference is given by the distinctive features presentedby them, which will require treatment adapted to their specialneeds. As dentists, we also know that our work includesprevention, diagnosis and subsequent treatment of differentlesions and pathologies. Since our field of action is withinprimary health care, an initial consultation with the athletewill provide the information that will guide our counseling, treatment, and regular controls. Regarding physical contact sports where a mouthguard might be indicated, differenttypes, thicknesses and materials are available as well as different processing techniques. All of these possibilities can beused to motivate athletes for dental consultation leading themto avoid standard devices that are sold in sport stores.

Tratamiento de fracturas mandibulares / Treatment of mandibular fractures

Las fracturas y secuelas mandibulares son de difícil resolución en el ámbito de la cirugía maxilofacial, sus componentes hacen que su reducción no solo sea anatómica, sino también funcional. El objetivo de este artículo es realizar una revisión de los conocimientos más actuales en el tratamiento de fracturas y secuelas mandibulares y la presentación de un caso de secuela de trauma mandibular. El trata-miento de estas fracturas ha ido cambiando durante los últimos años, sirviéndose de nuevas tecnologías para lograr una mejor reducción a través de elementos de osteosíntesis, que propician abordajes más pequeños y con menor comorbilidad. Así el los nuevos sistemas de placas de titanio como miniplacas, placas de reconstrucción o autobloqueantes brindan excelentes resultados en traumas de alta energía con reducciones anatómicas más estables. La tecnología a través de sistemas de reconstrucción 3D y TAC intraoperatorios han logrado mejores resultados en la resolución de estos traumas.

Treatment of mandibular fractures and their sequelae are difficult to resolve in the maxillofacial surgery field, their components cause that reduction must not only be anatomic, but functional as well. The aim of this article is to present a review about actual knowledge in mandibular fracture treatmentand report a case of mandibular trauma. The treatment of these fractures has been changing through theyears; the new technologies achieve better reduction with the osteosynthesis systems, which results inreduced approaches and lesser morbidity. Presently, titanium plates systems like mini-plates, reconstruction plates or blocking plates offer excellent results in high energy traumas through anatomic and stable reductions. The technology of 3D reconstruction systems and intra-operatory CT accomplishes better results in trauma treatment.

Intubação submentoniana nas fraturas complexas do terço médio facial û relato de caso / Submental intubation in complex fractures of midface û case report

A intubação submentoniana é uma técnica segura, eficaz e que apresenta sucesso comprovado no manejo das vias aéreas de pacientes com traumatismo facial. Está indicada em casos de fratura de terço médio de face, em que há necessidade de realização do bloqueio maxilomandibular com manipulação da oclusão dental e da pirâmide nasal transoperatória. A técnica consiste na realização de uma incisão de 2 centímetros de extensão, na região submentoniana, paralela à borda inferior da mandíbula, seguida de divulsão romba dos tecidos e a passagem do tubo através do acesso. É uma técnica que apresenta excelentes resultados, menor morbidade quando comparada à traqueostomia e as complicações são raras. O presente trabalho apresenta um caso clínico-cirúrgico de um paciente com fratura complexa do terço médio facial, que foi submetido ao tratamento cirúrgico aberto e a intubação submentoniana foi utilizada com sucesso para a manutenção das vias aéreas.

The submental intubation is a safe technique, effective and has proven success in handling the airways of patients with facial trauma. It is indicated in cases of midfacial fractures that require maxillo-mandibular block with manipulation of dental occlusion and nasal bone transoperative. The technique consists of making an incision of 2 cm, in the submental region, parallel to the lower border of the mandible, followed by blunt dissection of the tissue and passing the tube through the access. It is a technique that shows excellent results with rare complications, and has lower morbidity when compared to tracheostomy. This paper presents a clinical-surgical case of a patient with complex midface fracture who underwent open surgical treatment and the submental intubation was successfully used for maintenance of the airways.