Análisis médico legal de la fractura de órbita por "blow out" o estallido: reporte de caso / Medical-legal analysis of blow out fracture of the orbit: case report

La fractura orbitaria por estallido o fractura en "blow out" es una de las fracturas más comunes a nivel facial por lo que su importancia reside en saber identificarlas por el enmascaramiento clínico que podría o no, estar presente. Es de vital importancia complementar la valoración clínica con estudios de imagenología que confirmen las sospechas clínicas. De no hacerlo si el paciente no consulta a un servicio médico quirúrgico la pérdida de la capacidad funcional o la debilitación persistente en la salud ocasionada por la fractura no podrá ser validada en un Dictamen Médico Legal de Secuelas.

The orbital blow out fracture is one of the most common fractures at facial level, so its importance lies in knowing how to identify them due to the clinical masking that may or may not be present. It is of vital importance to complement the clinical evaluation with imaging studies to confirm the clinical suspicions. Otherwise, if the patient does not consult a surgical medical service, the loss of functional capacity or the persistent debilitation in health caused by the fracture cannot be validated in a Forensic Medical Report of Sequelae.

Profile of Hospitalizations of Children and Adolescents Victims of Transport Accidents: A Retrospective Study

Abstract Objective: To present the profile of hospitalizations due to transport accidents in individuals aged 0-19 years in a reference hospital for urgent and emergency traumatology care. Material and Methods: This retrospective study is grounded on analyzing medical records of children and adolescents hospitalized due to transport accidents in 2016 and 2017. The bivariate analyses included Chi-square and Fischer's exact tests and binary logistic regression, with a 5% significance level. Results: Four hundred and seventy-five (43.7%) of the 1,088 medical records investigated corresponded to transport accidents, and accidents involving motorcycles were the most frequent (68.3%), affecting adolescents (81.3%), while children were more involved in accidents as pedestrians (57.1%). Advancing age increases the likelihood of the outcome, with a significant association in the multivariate analysis (p<0.001). The mandible was most frequently affected in maxillofacial fractures. Conclusion: Transport accidents predominantly affect male adolescents, involving motorcycles, and the lower limbs are the most affected. The mandible was the most affected bone in maxillofacial fractures.

Diagnostic Accuracy of Ultrasonography in the Assessment of Facial Fractures

Abstract Objective: To assess the diagnostic accuracy of Ultrasonography (USG) in diagnosing superficial facial fractures. Material and Methods: Patients visiting our facility with facial trauma and suspected fracture of the facial skeleton, those who had undergone CT scans, and conventional radiographic examinations and those who were conscious and cooperative were included in the study. All conventional radiographs, CT scans and ultrasound examinations were done during 0-20 days after trauma in all the patients Results: A total of 20 patients participated in our study, out of which 18 were male (90%) with a mean age of 34.4 years (range of 19-75 years). Eleven sites of the face were examined bilaterally in each patient, i.e., a total of 440 sites. Of these, 84 sites were found to be fractured according to the CT scan examination whereas conventional radiographs detected 59 and ultrasonography detected 74 fractures (of which 70 were true fractures, while 4 were false-positive results). The sensitivity and specificity of USG in all fracture sites were 83.33% and 98.88% respectively. The positive and negative predictive values were 94.59% and 96.17% respectively Conclusion: Ultrasound examination had a better sensitivity when compared to conventional radiography in detecting superficial facial fractures.

Manejo del trauma maxilofacial en la atención de urgencia por no especialistas / Management of facial injuries in the emergency room

Facial injuries are cause of consultation in emergency departments. The maxillofacial region contains several structures that are vital for life. Hence, an early assessment and management of facial injuries is important to avoid their consequential complications and eventual mortality. This article is a review of the literature about the emergency clinical assessment and management of traumatic facial injuries by non-specialists.

Role of two-dimensional computed tomography, multiplanar reconstruction and three dimentional computed tomography in the assessment of facial trauma

Computed tomography [CT] has become the primary imaging modality for diagnosis of facial fractures. Spiral CT further simplified diagnosis of facial trauma by allowing multiplanar reformations and three dimensional reconstructions while reducing patient motion and registration artifacts.To evaluate the role of helical CT and three dimensional reconstructions in diagnosis of different patterns of facial fractures. From June 2003 to February 2005, One hundred patients aging from 6-64 years [including 78 males and 22 females] presented with a variety of facial injuries were included in the study. All patients were referred to our CT unit from the emergency department, Suez Canal University Hospital, Ismailia. All cases underwent a spiral CT study then, the image data were manipulated and analyzed. Fracture detection by two dimensional computed tomography [2D CT] and multiplanar reconstruction [MPR] together was 100% [226 of 226 fractures], fracture detection by axial 2D CT alone was 220 of 226 fractures [97.3%] but fracture detection by 3D CT alone was 183 of 226 fractures [80.9%]. two cases of cribriform plate of ethmoidal bone fracture, one case of nasal septum fracture, one case of hard palate fracture, one case of orbital roof and one case with orbital floor fracture was done by coronal reformatted images and missed on axial 2D CT images. MPR was useful or determinant in 53 of 226 fractures [23.4%] of all fractures in comparison with direct axial 2D CT. Three dimensional computed tomography [3D CT] images alone never showed any more fractures than those seen on axial and coronal-reformatted images. Fracture detection was always superior by 2D CT but perception of fragment displacement and resulting disruption of facial symmetry was superior on 3D CT. the greatest advantage of multiplanar imaging is the improved depiction of skeletal injuries along a horizontal plane, paralleling that of axial scans. The depiction of fractures of cribriform plate of ethmoidal bone and orbital roof and floor was particularly useful from a clinical viewpoint. 3D CT images should be used as a useful complementary tool

Herida por proyectil de arma de fuego en un niño: presentación de un caso / Gunshot wound in a child: a case report

Se presenta la evolución de un paciente masculino de 10 años que sufrió una herida por proyectil de arma de fuego en el párpado superior izquierdo jugando con otro niño, lo que lo provocó una ptosis palpebral marcada. Se realizó estudio radiográfico preoperatorio donde se encontró el proyectil alojado en la pared orbitaria superior. Se constató una excelente evolución posoperatoria del paciente una vez intervenido quirúrgicamente(AU)

The evolution of a 10-year-old male patient who had a marked palpebral ptosis as a result of a wound made by a bullet in the left upper eyelid while playing with another child, is presented. A preoperative radiographic study was conducted and the projectile was found in the upper orbital wall. An excellent postoperative evolution was observed once the patient underwent surgery(AU)

An unusual case of a retained metallic arrowhead in the orbit and sphenoidal sinus.

A case of retained metallic arrowhead in orbit and sphenoidal sinus through an unusual route is reported. The eyeball was removed because of a possible risk of sympathetic ophthalmia.