Abordagem cirúrgica de fratura blow-out através de acesso transconjuntival: relato de caso / Surgical approach to blow-out fracture through transconjunctival access: case report

Introdução: a região orbitária é bastante suscetível a fraturas, devido a sua posição exposta e a ossos frágeis. As fraturas do tipo blow-out caracterizam-se pela fratura do assoalho orbitário com ou sem herniação de conteúdo para o seio maxilar, gerando consequências funcionais e estéticas. Relato do caso: paciente do sexo feminino, 48 anos de idade, vítima de queda da própria altura, compareceu ao Hospital Geral do Estado da Bahia com queixa de diplopia, apresentando fratura de assoalho de órbita direita. Foi programada uma abordagem transconjuntival e instalação de tela de titânio para reconstrução. Na alta hospitalar, a paciente negou diplopia, não apresentando prejuízos funcionais ou estéticos. Conclusão: o acesso transconjuntival possibilita uma adequada exposição do assoalho de órbita, para colocação de telas, deixando uma cicatriz imperceptível na conjuntiva. Apesar das vantagens, este acesso cirúrgico apresenta maior complexidade técnica, sendo pouco realizado pelos cirurgiões

Introduction: the orbital region is very susceptible to fractures due to its exposed position and fragile bones. Blow-out fractures are characterized by fractures of the orbital floor with or without herniation of contents to the maxillary sinus, generating functional and aesthetic consequences. Case report: a 48-year-old female patient, victim of a fall from her height, presented to the General Hospital of the State of Bahia complaining of diplopia, presenting with a fracture of the floor of the right orbit. A transconjunctival approach and installation of titanium mesh for reconstruction were scheduled. At hospital discharge, the patient denied diplopia, with no functional or aesthetic impairments. Conclusion: the transconjunctival approach allows adequate exposure of the orbital floor for mesh placement, leaving an imperceptible scar on the conjunctiva. Despite the advantages, this surgical approach presents greater technical complexity and is rarely performed by surgeons.

Actualización de la Epidemiología de Tratamientos Quirúrgicos Maxilofaciales en Hospital Público de Santiago de Chile: Estudio Comparativo - Retrospectivo de 4 Años / Epidemiological Update of Maxillofacial Surgical Treatments in a Public Hospital in Santiago de Chile: A Comparative Retrospective Study of 4 Years

La cirugía maxilofacial es una especialidad médico quirúrgica que se encarga tanto del diagnóstico como del tratamiento de enfermedades que afecta al territorio craneofacial. En Chile existen pocos estudios epidemiológicos en cirugía maxilofacial que describan con detalle el tipo de intervenciones realizadas más allá del trauma maxilofacial, y que además involucren el período por pandemia COVID-19. El objetivo del estudio fue actualizar la epidemiología de resolución quirúrgica bajo anestesia general en el Hospital San José de Santiago de Chile entre los años 2018 y 2021 y compararlo con el estudio realizado en mismo recinto entre los años 2007 y 2013. Se realizó un estudio retrospectivo con 607 pacientes. Se recopiló información de acuerdo a edad, género del paciente y tipo de intervención. Del total de intervenciones realizadas, 176 (29%) correspondieron a trauma maxilofacial y 431 (71%) a cirugías de etiología no traumática. Edad promedio de 38,7 años. Proporción entre el sexo masculino y femenino de 1,28:1. La fractura más frecuente fue la mandibular (59,66%), seguida de la orbito cigomática (23,86%) y la panfacial (4,55%). En las cirugías de etiología no traumática predominaron las intervenciones por dismorfosis dentofaciales (23,2%), seguido tumores de los maxilares (20,41%), lesiones orales (18,56%), defocaciones dentarias (16,24%), infecciones (8,81%), patologías de articulación temporomandibular (8,35%) y finalmente retiro de material de osteosíntesis (4.41%). Las intervenciones de etiología no traumática y la resolución de fracturas mandibulares fueron los procedimientos más realizados por la unidad. El conocimiento de estos datos y la comparación con el estudio anterior permite observar el cambio en la epidemiologia, que puede explicarse por la pandemia por COVID-19. Considerando lo anterior, ambos tipos de intervenciones deben ser abordadas de manera integral y con las condiciones adecuadas. Para ello es importante enfocar los recursos en esas áreas y desarrollar mayor entrenamiento en las mismas.

Maxillofacial surgery is a medical- surgical specialty that deals with both diagnosis and treatment of diseases affecting the craniofacial territory. In Chile there are few epidemiological studies in maxillofacial surgery that describe in detail the type of interventions performed beyond maxillofacial trauma, and that also involve the COVID-19 pandemic period. The aim of the study was to update the epidemiology of surgical resolution under general anesthesia at the Hospital San José in Santiago de Chile between 2018 and 2021 and to compare it with the study performed at the same hospital between 2007 and 2013. A retrospective study was performed with 607 patients. Information was collected according to age, patient gender and type of intervention. Of the total number of interventions performed, 176 (29%) corresponded to maxillofacial trauma and 431 (71%) to surgeries of non-traumatic etiology. Average age of 38.7 years. Male to female sex ratio of 1.28:1. The most frequent fracture was mandibular (59.66%), followed by orbito-zygomatic (23.86%) and panfacial (4.55%). In surgeries of non-traumatic etiology, interventions for dentofacial dysmorphosis predominated (23.2%), followed by tumors of the jaws (20.41%), oral lesions (18.56%), dental defocations (16.24%), infections (8.81%), temporomandibular joint pathologies (8.35%) and finally removal of osteosynthesis material (4.41%). Interventions of non-traumatic etiology and resolution of mandibular fractures were the procedures most performed by the unit. The knowledge of these data and the comparison with the previous study allows us to observe the change in epidemiology, which can be explained by the COVID-19 pandemic. Considering the above, both types of interventions should be approached in a comprehensive manner and with the appropriate conditions. To this end, it is important to focus resources in these areas and to develop more training in them.

Evidence gaps in orthognathic surgery, a Delphi study protocol

Aim: To assess the research gaps identified in a recent mapping review of orthognathic surgery through their evaluation by clinical experts, leading to a clinically relevant list of research gaps. This will guide future investigations of the topic, focusing on the outcomes of blood loss, infection, and relapse. Methods: The Delphi technique will be used to appraise the identified research gaps. The expert panel will include maxillofacial surgeons who regularly perform orthognathic surgery. Potential participants will be identified through various methods, including contact information from articles in the mapping review, nominations from peers, and social media platforms. Two rounds of surveys will be undertaken with Likert-type and open-ended questions to assess the clinical relevance of research gaps. For the second round, participants will receive a report of the results of the first round. Questions will be modified depending on the answers obtained in the first round. A consensus of 60% will be considered valid. Conclusions: Through this Delphi study, in a collaborative effort between researchers and clinical experts, a comprehensive understanding of the clinical relevance of research gaps in orthognathic surgery will be achieved. The outcomes will guide future investigations, ultimately improving the outcomes and practices in this field.

Perfil epidemiológico do uso de sistemas de fixação pela Cirurgia e Traumatologia Buco-Maxilo-Faciais em um Hospital Universitário / Epidemiological profile of the use of fixation systems by Oral and Maxillofacial Surgery and Traumatology in a University Hospital / Perfil epidemiológico del uso de sistemas de fijación por Cirugía Oral y Maxilofacial y Traumatología en un Hospital Universitario

Introdução: O tecido ósseo é um tipo de tecido conjuntivo especializado, caracterizado pelo seu metabolismo dinâmico. Ao sofrer um trauma, podendo ser cirúrgico (como osteotomias) ou não cirúrgico, resultando em uma fratura, o osso passa por dois processos de cicatrização, primária e secundária. A primária é caracterizada pelo mínimo movimento entre os fragmentos, e ocorre na presença de estabilização, sendo muitas vezes a fixação interna (FI) responsável por isso. A secundária ocorre na presença de um gap entre os fragmentos ósseos, na ausência de estabilização. Ambas resultam em consolidação óssea, mas apenas a primeira garante recuperação precoce de função (como fala e mastigação) e da estética facial do paciente. Objetivos: O objetivo deste trabalho foi realizar um levantamento epidemiológico a respeito do uso dos sistemas de fixação interna utilizados pela Cirurgia e Traumatologia Buco-maxilo-faciais no Hospital Universitário da UFPI. Metodologia e Resultados: Pesquisa submetida e liberada pelo Comitê de Ética em Pesquisa do HU-UFPI com o número CAAE: 52493221.9.0000.8050. Foram coletados dados de 271 procedimentos registrados no sistema do hospital. Havendo 228 pacientes no total, 69 que realizaram cirurgia em outro estabelecimento de saúde, mas apresentando falha de FI com indicação de remoção; divididos em sub-áreas, 146 procedimentos foram de trauma de face, 40 de correção de deformidades dentofaciais, 28 de ressecção de tumores e 14 de cirurgia reconstrutiva. Os sítios anatômicos onde houve maior número de instalação e remoção de FI foram: mandíbula, complexo órbito-zigomático-maxilar e maxila. Cirurgia reconstrutiva foi a subárea que teve três abordagens com substituição de FI, sendo em todas o sítio anatômico a mandíbula. As principais falhas de FI encontradas foram infecção e exposição. Conclusão: Tem se mostrado uma tarefa difícil determinar as razões pelas quais um sistema de fixação deve ser removido, mesmo quando este apresenta falha. Não há consenso entre os cirurgiões sobre um protocolo de remoção de FI após o período de consolidação óssea ter passado, mas é sugerido por alguns remover as placas e parafusos após um período de 3 meses, a fim de evitar sensibilidade, palpabilidade e outras complicações, no entanto é necessário considerar a morbidade de um segundo procedimento... (AU)

Introduction: Bone tissue is a type of specialized connective tissue characterized by its dynamic metabolism. When suffering trauma, which can be surgical (such as osteotomies) or non-surgical, resulting in a fracture, the bone undergoes two healing processes, primary and secondary. The primary healing is characterized by minimal movement between fragments and occurs in the presence of stabilization, often with internal fixation (IF) responsible for this. The secondary one occurs in the presence of a gap between the bone fragments, in the absence of stabilization. Both result in bone consolidation, but only the first guarantees the early recovery of function (such as speech and chewing) and the patient's facial aesthetics. Objectives: The objective of this study was to realize an epidemiological survey regarding the use of internal fixation systems used by Oral and Maxillofacial Surgery at the University Hospital of UFPI. Methodology and Results: This research was submitted and released by the Research Ethics Committee of the HU-UFPI with the number CAAE: 52493221.9.0000.8050. Data were collected from 271 procedures registered in the hospital system. There were 228 patients in total, 69 who underwent surgery at another health facility, but with IF failure with an indication for removal; divided into sub-areas, 146 procedures were for facial trauma, 40 for correction of dentofacial deformities, 28 for tumour resection and 14 for reconstructive surgery. The anatomical sites where there was more installation and removal of FI were: mandible, orbital-zygomatic-maxillary complex and maxilla. Reconstructive surgery was the sub-area that had three approaches with IF replacement, in all of which the anatomic site was the mandible. The main IF failures found were infection and exposure. Conclusion: It has proved to be a difficult task to determine the reasons why plates and screws of a fixation system should be removed, even when it fails. There is no consensus among surgeons on a protocol for removing IF after the period of bone healing has passed, but it is suggested by some to remove the plates and screws after 3 months to avoid tenderness, palpability, and other complications, however it is necessary to consider the morbidity of a second procedure... (AU)

Introducción: El tejido óseo es un tipo de tejido conectivo especializado que se caracteriza por su metabolismo dinámico. Cuando se sufre un traumatismo, que puede ser quirúrgico (como las osteotomías) o no quirúrgico, que resulta en una fractura, el hueso sufre dos procesos de curación, primario y secundario. La curación primaria se caracteriza por un movimiento mínimo entre fragmentos y se produce en presencia de estabilización, a menudo con la fijación interna (FI) responsable de ello. El secundario ocurre en presencia de un espacio entre los fragmentos óseos, en ausencia de estabilización. Ambos dan como resultado la consolidación ósea, pero sólo el primero garantiza la recuperación temprana de la función (como el habla y la masticación) y la estética facial del paciente. Objetivos: El objetivo de este estudio fue realizar una encuesta epidemiológica sobre el uso de sistemas de fijación interna utilizados en Cirugía Oral y Maxilofacial en el Hospital Universitario de la UFPI. Metodología y Resultados: Esta investigación fue presentada y difundida por el Comité de Ética en Investigación del HU-UFPI con el número CAAE: 52493221.9.0000.8050. Se recogieron datos de 271 procedimientos registrados en el sistema hospitalario. Fueron 228 pacientes en total, 69 que fueron intervenidos quirúrgicamente en otro centro de salud, pero con fracaso del IF con indicación de retiro; divididos en subáreas, 146 procedimientos fueron de traumatismo facial, 40 de corrección de deformidades dentofaciales, 28 de resección de tumores y 14 de cirugía reconstructiva. Los sitios anatómicos donde hubo mayor instalación y remoción de FI fueron: mandíbula, complejo orbitario-cigomático-maxilar y maxilar. La cirugía reconstructiva fue la subárea que tuvo tres abordajes con reemplazo de IF, en todos los cuales el sitio anatómico fue la mandíbula. Las principales fallas de FI encontradas fueron la infección y la exposición. Conclusión: Ha demostrado ser una tarea difícil determinar las razones por las cuales se deben retirar las placas y tornillos de un sistema de fijación, incluso cuando falla. No existe consenso entre los cirujanos sobre un protocolo para retirar el IF una vez transcurrido el período de curación ósea, pero algunos sugieren retirar las placas y los tornillos después de 3 meses para evitar sensibilidad, palpabilidad y otras complicaciones, sin embargo es necesario. considerar la morbilidad de un segundo procedimiento... (AU)

Exérese de extenso cisto epidérmico em região submentoniana: relato de caso clínico / Excision of an extensive epidermal cyst in the submental region: clinical case report / Escisión de quiste epidérmico extenso en región submentoniana: reporte de caso clínico

O cisto epidérmico é um nódulo subcutâneo benigno, flutuante, com estruturas semelhantes a epiderme. Esse cisto encapsulado é preenchido por material liquido ou pastoso sendo sua localização mais comum em regiões da face, pescoço e tronco. Essas lesões caracterizadas por apresentarem um crescimento lento, indolor, assintomático e pequenos na maioria das vezes, dificilmente ultrapassando 5cm de diâmetro. O tratamento de escolha é a enucleação cirúrgica. Objetivo: O presente trabalho visa relatar um caso clínico de extenso cisto epidérmico na região submentoniana em um paciente do gênero masculino jovem, descrevendo os aspectos clínicos e histopatológicos da lesão e a abordagem realizada, bem como o pós-operatório. Relato de caso: Paciente gênero masculino, 18 anos, compareceu para atendimento com equipe e Bucomaxilofacial, apresentando a queixa de aumento de volume em região submentoniana, com evolução de aproximadamente 02 anos. O paciente foi submetido a exérese da lesão a qual foi realizada a analise anatomopatológica, cujo diagnóstico apresentou-se conclusivo para cisto epidérmico. Conclusão: O diagnóstico diferencial do cisto epidermoide pode variar em muitos casos da região acometida. Ressaltase a importância de um exame clínico minucioso e a necessidade de exames complementares para determinar o diagnóstico correto e, assim, promover um tratamento adequado... (AU)

Epidermoid cysts are benign subepidermal cysts that are fluctuant, presenting structures resembling skin appendages. This encapsulated cyst is filled with liquid or semi-liquid material commonly located on the face, neck and trunk. They are characterised by shows slow growth, painless, asymptomatic and not greater than 5 cm in most cases. The treatment consists of surgical enucleation of the lesion. Objective: To report a case of an extensive epidermoid cyst in the submental region of a young male, describing the approach and its clinical and histopathological aspects with post-op follow-up. Case report: 18 years-old male presents at the Maxillofacial Surgery Department, with the main complaint of swelling in the submental region, for the past 2 years. He underwent surgical excision of the lesion followed by pathological analyse, which returned positive for an epidermal cyst. Conclusion: The differential diagnosis of the epidermoid cyst can vary according to the region in which the lesion develops. It is important to conduct a thorough examination of the patient, and consider complemental tests to attempt the best management for better results... (AU)

El quiste epidérmico es un nódulo subcutáneo flotante benigno con estructuras similares a la epidermis. Este quiste encapsulado está lleno de material líquido o pastoso y se encuentra más comúnmente en la cara, el cuello y el tronco. Estas lesiones se caracterizan por ser de crecimiento lento, indoloras, asintomáticas y de pequeño tamaño en la mayoría de los casos, superando raramente los 5 cm de diámetro. El tratamiento de elección es la enucleación quirúrgica. Objetivo: Este estudio tiene como objetivo reportar un caso clínico de un quiste epidérmico extenso en la región submentoniana en un paciente masculino joven, describiendo los aspectos clínicos e histopatológicos de la lesión y el abordaje realizado, así como el postoperatorio. Reporte de caso: Paciente masculino, de 18 años de edad, acudió para asistencia con el equipo oral y maxilofacial, quejándose de tumefacción en la región submentoniana, con una evolución de aproximadamente 02 años. Al paciente se le realizó exéresis de la lesión, la cual se realizó por análisis anatomopatológico, cuyo diagnóstico fue conclusivo de quiste epidérmico. Conclusión: El diagnóstico diferencial de quiste epidermoide puede variar en muchos casos de la región afectada. Enfatiza la importancia de un examen clínico completo y la necesidad de exámenes complementarios para determinar el diagnóstico correcto y así promover un tratamiento adecuado... (AU)

Cervical necrotizing fasciitis caused by oral cavity infection: a case report considering therapeutic approach and its morphofunctional implications / Fascitis necrosante cervical causada por infección de la cavidad oral. Reporte de un caso considerando el abordaje terapéutico y sus implicaciones morfofuncionales

SUMMARY: Cervical necrotizing fasciitis (NF) is a rare complication of oral cavity infection with high morbi-mortality. Given its low prevalence, adequately reporting cases of NF, its therapeutic management, and associated morphofunctional modifications to the clinical and scientific community is pivotal. To that end, we herein describe a case of cervical NF in a 60-year-old patient with comorbidities and patient presented large, painful cervical swelling associated with a necrotic ulcer lesion in the anterior neck region. Intraoral examination indicated a periodontal abscess in the right mandibular area, while computed tomography indicated the lesion's extension from the right mandibular to the submandibular region. Following empirical intravenous antibiotic treatment, a broad surgical debridement was performed, and the foci of oral infection were removed. Debridement revealed communication between deep and superficial anatomical regions in the submandibular area, where we subsequently placed a Penrose drain. Biopsies showing acute inflammatory infiltrate associated with necrotic and hemorrhagic regions confirmed the diagnosis of NF. When an antibiogram revealed resistance to the empirical treatment, the antibiotic scheme was replaced with an adequate alternative. After a second debridement, we closed the defect with fascio-mucocutaneous advancement flaps with a lateral base while maintaining suction drainage. Having reacted positively, the patient was discharged 10 days after the operation. Despite an extensive morphofunctional change generated in the treated area, the patient showed no difficulties with breathing, phonation, swallowing, or mobilizing the area during control sessions. Altogether, this report contributes to the highly limited literature describing morphological aspects that can facilitate or delay the spread of infection or the morphofunctional disorders associated with the size and depth of surgical interventions for cervical NF, information that is relevant for the comprehensive, long-term prognosis of the treatment of NF.

La fascitis necrosante (FN) cervical es una rara complicación de una infección proveniente de la cavidad bucal asociada a una alta morbimortalidad. Por lo anterior, es fundamental informar a la comunidad clínica y científica los casos de FN, su manejo terapéutico y las modificaciones morfofuncionales asociadas. Se describe un caso de FN cervical en una paciente de 60 años quien presentó una gran tumefacción dolorosa asociada a una lesión ulcerosa necrótica en la región anterior del cuello. El examen intraoral mostró un absceso periodontal en el área mandibular derecha y la tomografía computarizada mostró la extensión de la lesión hacia la región submandibular. Tras el tratamiento antibiótico empírico, se realizó un desbridamiento quirúrgico extenso y se extirparon los focos de infección oral. El desbridamiento reveló comunicación entre las regiones anatómicas profundas y superficiales del área submandibular, donde se colocó un drenaje Penrose. Las biopsias mostraron un infiltrado inflamatorio agudo asociado con regiones necróticas y hemorrágicas, confirmando el diagnóstico de FN. El antibiograma reveló resistencia al tratamiento empírico, por lo que el esquema antibiótico se sustituyó. Tras un segundo desbridamiento, se cerró el defecto con colgajos de avance fascio-mucocutáneos de base lateral manteniendo drenaje aspirativo. El positivo progreso del paciente permitió su alta 10 días después. Aun cuando se generó una gran modificación morfofuncional en el área tratada, la paciente no presentó dificultades para respirar, hablar, deglutir o movilizar el área cervical intervenida durante las sesiones de control. Este informe contribuye a la limitada literatura que describe los aspectos morfológicos que pueden facilitar o retrasar la propagación de la FN y las consecuencias asociadas a los trastornos morfofuncionales provocadas por el tamaño y profundidad de las intervenciones quirúrgicas requeridas por la FN, información relevante para el pronóstico integral a largo plazo del tratamiento de la FN.

Complicaciones postoperatorias en fractura de órbita: experiencia en el Hospital del Trabajador de Santiago

Objetivo: Describir la experiencia del equipo de cirugía maxilofacial del Hospital del Trabajador en el manejo de las fracturas de órbita. Materiales y Método: Estudio retrospectivo de 42 pacientes consecutivos operados por fractura de órbita en el Servicio de Cirugía Maxilofacial del Hospital del Trabajador entre enero de 2016 y diciembre de 2017. Se tabularon datos demográficos, información del trauma, tipo de fractura, fracturas asociadas, tratamiento y seguimiento. Resultado: De los 42 pacientes, la mayoría eran hombres (73,8%) con edad promedio de 40 ± 12,24 años. Los principales síntomas al ingreso fueron equimosis (64,3%), edema periocular (54,8%), hemorragia subconjuntival (33,3%) y diplopía (26,2%). La pared orbitaria más frecuentemente afectada fue el piso de la órbita (85,7%). Las fracturas se presentaron de forma aislada en 35,7% de los casos y asociada a otra fractura de la cara en 64,3%. Post cirugía, la tasa de complicación fue de 16,7%, producto de diplopía y enoftalmos leves que solo requirieron tratamientos conservadores para su resolución. Discusión: La baja tasa de complicaciones se debe a la experiencia del equipo médico con un seguimiento a largo plazo, la medición de volúmenes orbitarios, imagenología intraoperatoria, utilización de malla prefabricada y asistencia endoscópica. Conclusiones: Un adecuado diagnóstico y evaluación son fundamentales para el tratamiento de la fractura de órbita. Los datos demográficos, las características de las fracturas y las complicaciones descritas fueron muy similares a lo reportado por otras experiencias, mientras que la tasa de complicaciones fue menor.

Aim: To describe the experience of the Maxillofacial Surgical team of Hospital del Trabajador de Santiago in the management of orbital fractures. Materials and Methods: Retrospective study of 42 patients operated consecutively between January of 2016 and November of 2017 at Hospital del Trabajador de Santiago by the Maxillofacial Surgery team due to orbital fracture. The demographic data was tabulated and then a comparison between isolated and combined orbital fractures was made. Results: Of 42 patients most were men (73.8%) with an average age of 40±12.24 years. At admission the main symptoms were ecchymosis (64.3%), periorbital edema (54.8%), subconjunctival hemorrhage (33.3%) and diplopia (26.2%). The most frequently affected orbital wall was the floor (85.7%). Isolated fractures accounted for 35.7% of the cases and those associated with other facial fractures for 64.3%. The postoperative complication rate was 16.7% due to diplopia and enophthalmos. Both complications were mild and only required conservative management. Discussion: The low complication rate might be due to the experience of the surgical team in the management of orbital fractures, long-term following, orbital volume measurements, intraoperative imaging, the use of prefabricated mesh and endoscopic guidance. Conclusión: An adequate diagnosis and evaluation are fundamental for orbital fracture treatment. Demographic data, fracture characteristics and the complications described were similar to those reported by other studies, while the rate of complications was lower than those experiences.

Application of digital 3D printed model combined with case-based learning in practice teaching of oral and maxillofacial surgery / 中华医学教育探索杂志

Objective:To investigate the application effect of the combined teaching model of digital 3D printed model and Tencent conference in case-based learning (CBL) teaching of oral and maxillofacial surgery.Methods:A total of 80 undergraduates in the classes of 2015 and 2016 were selected from School of Stomatology, Qingdao University. The students in the class of 2015 received traditional teaching, and those in the class of 2016 received the combined CBL teaching model of 3D printed model and Tencent conference. A questionnaire survey was used to evaluate the teaching effect, and theoretical examination was used to assess comprehensive abilities of the two groups. SPSS 24.0 was used to perform the chi-square test and the t-test. Results:There was no significant difference in the degree of satisfaction with teaching between the combined CBL teaching model of 3D printed model and Tencent conference and the traditional teaching model ( P>0.05), and both models were generally recognized and accepted by students. The experimental group had a significantly higher score than the control group (94.05±4.16 vs. 86.10±3.37, P<0.05). Conclusion:The combined teaching model of digital 3D printed model and Tencent conference integrates the advantages of the Internet and digital information and thus provides a certain reference for the teaching methods for other majors in stomatology.

Effect of a care bundle on prevention of nasal pressure injury in patients with nasotracheal intubation undergoing oral and maxillofacial surgery under general anesthesia / 中国实用护理杂志

Objective:To investigate the effect of care bundles on prevention of nasal medical device-related pressure injury in patients with nasotracheal intubation undergoing oral and maxillofacial surgery under general anesthesia.Methods:This was a retrospective study. Using the convenient sampling method, patients with a surgical time more than 4 hours and a surgical grade of 3 or 4, with nasotracheal intubation undergoing oral and maxillofacial surgery under general anesthesia from Hospital of Stomatology, Sun Yat-sen University were selected. A total of 96 patients from July to December 2019 were in the control group, and 99 patients from July to December 2020 were selected as the observation group. The control group was treated with routine nursing measures, the observation group was subjected to a nursing care bundle. The incidence of nasal pressure injury was observed after the operation, 24, 48, 72 hours after the nasotracheal intubation was removed, and patients′ satisfaction score was compared.Results:The incidence of nasal pressure injury in the control group was 6.25% (6/96). None of the patients in the observation group had any pressure injury, which was significantly lower than the control group (Fisher exact probability method, P=0.013). The satisfaction scores in the observation group was significantly higher than that in the control group (26.88 ± 1.94 vs 24.71 ± 3.33), the difference was statistically significant ( t=-5.54, P<0.01). Conclusions:The care bundle can effectively prevent the occurrence of nasal pressure injury in patients undergoing oral and maxillofacial surgery with nasotracheal intubation and improve patient satisfaction.

Comparison of application of three dimensional microscope and optical microscope in oral and maxillofacial vascular anastomosis / 口腔疾病防治

Objective@#To investigate the application value of 3D microscope in vascular anastomosis in oral and maxillofacial surgery, to provide a reference for clinicians. @*Methods @#Eighty-seven cases of free flap reconstruction in oral and maxillofacial surgery were retrospectively included, including 30 cases in the 3D microscope group and 57 cases in the optical microscope group. The differences in intraoperative vascular anastomosis time, postoperative flap survival rate and doctor evaluation scores between the 3D microscope group and the optical microscope group were compared and statistically analyzed, and the feasibility of using three-dimensional microscope in surgery was evaluated. @*Results @#The arterial anastomosis time was (26.53±3.83) min/root in the 3D microscope group and (24.88 ± 2.97) min/root in the optical microscope group, and the difference was statistically significant (P<0.05). The venous anastomosis time was (30.68 ± 3.51) min/root in the three-dimensional microscope group and (28.70 ± 2.91) min/root in the optical microscope group, and the difference was statistically significant (P<0.05). There was no significant difference in the survival rate of flaps between the 3D microscope group (n = 28, 93.33%) and the optical microscope group (n = 53, 92.98%) (P>0.05). The doctor's evaluation scores of visual fatigue, training and learning, operative difficulty index, image sharing in the three-dimensional microscope group were higher than those in the optical microscope group, and the differences were statistically significant (P<0.05). @* Conclusion @# 3D microscope has good reliability and safety in surgery, a strong sense of three-dimensionality, and the convenience of teaching and training. It can be well applied to vascular anastomosis in oral and maxillofacial surgery.

Treatment of dentofacial deformities secondary to condylar hyperplasia / 华西口腔医学杂志

Dentofacial deformities secondary to condylar hyperplasiais a kind of disease presenting facial asymmetry, malocclusion, temporomandibular joint dysfunction, and other symptoms caused by non-neoplastic hyperplasia of the condyle. The etiology is still unknown, and currently, pre- and post-operative orthodontics accompanied by orthognathic surgery, temporomandibular joint surgery and jawbone contouring surgery are the main treatment methods. A personalized treatment plan was developed, considering the active degree of condyle hyperplasia, the severity of the jaw deformity, and the patient's will, to correct deformity, obtain ideal occlusal relationship, and regain good temporomandibular joint function. Combined with the author's clinical experience, the etiology, clinical and imageological features, treatment aims, and surgical methods of condylar hyperplasia and secondary dentofacial deformities were discussed in this paper.

Estrategia de superación para desarrollar la competencia didáctica de los profesores de Cirugía Maxilofacial

Introducción: la educación médica superior requiere su propia didáctica, que permita la construcción del aprendizaje de los estudiantes. Por ello, los profesores de las diferentes especialidades médicas deben adquirir competencias profesionales pedagógicas, en especial la didáctica. Objetivo: diseñar una estrategia de superación para el desarrollo de la competencia didáctica de los profesores de la especialidad de Cirugía Maxilofacial. Materiales y métodos: el estudio se clasificó como investigación-acción, de tipo cualitativo-cuantitativo, y se realizó entre enero y septiembre de 2022. Se trabajó con 15 profesores de la especialidad de Cirugía Maxilofacial. La estrategia fue diseñada en cuatro etapas (diagnóstico, planeación, implementación y evaluación). Se utilizaron métodos teóricos y empíricos, en especial, el experimento. Los procedimientos estadísticos usados fueron las pruebas chi cuadrado de McNemar, la de Wilcoxon y el alfa de Cronbach. Resultados: se evaluó la competencia didáctica de los profesores y las dimensiones que la integran (conocimientos, habilidades, capacidades y motivaciones), arrojando un incremento significativo desde el punto de vista estadístico, con una buena confiabilidad de los instrumentos aplicados. Conclusiones: la estrategia permite determinar las pautas esenciales o relaciones que enriquecen la teoría de las ciencias de la educación médica, desde el posgrado, ofreciendo coherencia lógica interna a los procesos que se aplican en la estrategia y posibilitando que los profesores de la especialidad de Cirugía Maxilofacial logren mejorar la competencia didáctica.

Introduction: higher medical education requires its own didactics, which allows the construction of student learning. For this reason, teachers of the different medical specialties must acquire professional pedagogical competences, especially didactics. Objective: to design an improvement strategy for the development of the didactic competence of the professors of the specialty of Maxillofacial Surgery. Materials and methods: the study was classified as action-research, of a qualitative-quantitative type, and was carried out between January and September 2022. The authors worked with 15 professors from the specialty of Maxillofacial Surgery. The strategy was designed in four stages (diagnosis, planning, implementation and evaluation). Theoretical and empirical methods were used, especially the experiment. The statistical procedures used were McNemar's chi square, Wilcoxon's and Cronbach's alpha tests. Results: the didactic competence of the teachers and the dimensions that comprise it (knowledge, skills, abilities and motivations) were evaluated, showing a significant increase from the statistical point of view, with a good reliability of the applied instruments. Conclusions: the strategy makes it possible to determine the essential guidelines or relationships that enrich the theory of medical education sciences, from the postgraduate level, offering internal logical coherence to the processes that are applied in the strategy and enabling professors of the specialty of Surgery Maxillofacial manage to improve the didactic competence.

Impact of COVID-19 on maxillofacial surgery practice: a systematic review / Impacto da Covid-19 na prática da cirurgia bucomaxilofacial: uma revisão sistemática

Abstract Objectives: The aim of this systematic review was to evaluate the possible impacts of COVID-19 on oral and maxillofacial surgery practice, as well as the protocols employed by oral and maxillofacial surgeons to minimize the risks of contamination. Methods: Searches were performed in different databases up to 15 March 2021. Articles related to oral surgery dynamics within the context of the COVID-19 pandemic were included. The articles were considered eligible if they met the following inclusion criteria: observational studies that provided recommendations regarding maxillofacial surgery measures during the COVID-19 pandemic and that analyzed the risk of contamination of patients/professionals with SARS-CoV-2. Results: Seven studies met the inclusion criteria and were selected for the present systematic review. Demands for personal protective equipment increased significantly, with studies reporting the scarcity of fundamental equipment such as FFP2/N95 masks. Significant changes in the infrastructure of outpatient, surgical and inpatient units and in the care protocols themselves were observed. Conclusion: The COVID-19 pandemic particularly affected the routine of oral and maxillofacial surgery residents. Several additional recommendations for surgical practice or for the surgical team were evaluated and discussed, such as performing primarily urgent and emergency surgeries, remote patient care and screening, postponing elective surgeries, and new teaching methods in oral and maxillofacial surgery residency programs. In addition, screening of patients and of the surgery team for COVID-19 is strongly recommended.

Resumo Objetivos: Avaliar os possíveis impactos da Covid-19 na prática da cirurgia bucomaxilofacial, bem como os protocolos empregados pelos cirurgiões bucomaxilofaciais para minimizar os riscos de contaminação. Método: Foram feitas buscas em diferentes bases de dados até 15 de março de 2021. Foram incluídos artigos relacionados à dinâmica da cirurgia oral no contexto da pandemia de Covid-19. Os artigos foram considerados elegíveis se atendessem aos seguintes critérios de inclusão: estudos observacionais que fornecessem recomendações sobre medidas de cirurgia bucomaxilofacial durante a pandemia de Covid-19 e que analisassem o risco de contaminação de pacientes/profissionais com SARS-CoV-2. Resultados: Sete estudos preencheram os critérios de inclusão e foram selecionados para a presente revisão sistemática. As demandas por equipamentos de proteção individual aumentaram significativamente, estudos relataram a escassez de equipamentos fundamentais, como máscaras FFP2/N95. Foram observadas mudanças significativas na infraestrutura das unidades ambulatoriais, cirúrgicas e de internação e nos próprios protocolos assistenciais. Conclusão: A pandemia de Covid-19 afetou particularmente a rotina dos residentes de cirurgia bucomaxilofacial. Diversas recomendações adicionais para a prática cirúrgica ou para a equipe cirúrgica foram avaliadas e discutidas, como a feitura de cirurgias prioritariamente de urgência e emergência, atendimento e triagem remota de pacientes, adiamento de cirurgias eletivas e novos métodos de ensino em programas de residência em cirurgia bucomaxilofacial. Além disso, a triagem de pacientes e da equipe cirúrgica para Covid-19 é fortemente recomendada.

Queiloplastia de Castañón: una técnica viable y efectiva en la reconstrucción parcial del labio inferior / Castañón Cheiloplasty: a viable and effective technique in the partial reconstruction lower lip

Introducción: Para el tratamiento del carcinoma epidermoide labial existen varias modalidades terapéuticas, pero la cirugía constituye la primera elección. Numerosas técnicas han sido descritas para el manejo de lesiones que afectan más de un tercio del labio inferior. Sin embargo, la selección de alguna en particular depende del cumplimiento de los principios reconstructivos de esta unidad. Objetivo: Ejemplificar los beneficios de la utilización de la queiloplastia de Castañón, para la reconstrucción labial parcial, en un paciente con carcinoma epidermoide de labio inferior. Presentación de caso: Se presenta un paciente masculino de 68 años de edad, con antecedentes de hábito de fumar y alcoholismo, que acudió a consulta de Cirugía Oncológica de Cabeza y Cuello por presentar lesión localizada en bermellón de labio inferior. Se realizó biopsia, mediante incisión, que informó un carcinoma epidermoide moderadamente diferenciado. Se estudió como un T2N0M0, etapa II y se trató quirúrgicamente mediante queilectomía subtotal y reconstrucción con técnica de Castañón. Conclusiones: Se presentó el caso clínico de un paciente con carcinoma epidermoide de labio inferior, entidad patológica de alta incidencia. La cirugía constituyó la única modalidad de tratamiento utilizada. Una vez realizada la resección quirúrgica de la lesión, se reconstruyó el defecto, para lo que se utilizó la queiloplastia descrita por Castañón, opción útil para lograr el cumplimiento de los principios estéticos y funcionales(AU)

Introduction: For the treatment of labial squamous cell carcinoma there are several therapeutic modalities, but surgery is the first choice. Numerous techniques have been described for the management of lesions affecting more than a third of the lower lip. However, the selection of any particular one depends on the fulfillment of the reconstructive principles of this unit. Objective: Exemplify the benefits of using Castañón cheiloplasty for partial lip reconstruction in a patient with squamous cell carcinoma of the lower lip. Case presentation: A 68-year-old male patient with a history of smoking and alcoholism was presented, who went to the Head and Neck Oncological Surgery consultation for presenting a lesion located in vermilion of the lower lip. An incisional biopsy reported moderately differentiated squamous cell carcinoma. It was studied as a T2N0M0, stage II and was treated surgically by subtotal cheilectomy and reconstruction with Castañón technique. Conclusions: The clinical case of a patient with squamous cell carcinoma of the lower lip, a pathological entity of high incidence, was presented. Surgery was the only treatment modality used. Once the surgical resection of the lesion was performed, the defect was reconstructed, for which the cheiloplasty described by Castañón was used, a useful option to achieve compliance with the aesthetic and functional principles(AU)

Guia prático de uso da centrífuga IntraSpin® para a obtenção de fibrina rica em plaquetas / Practical guide for using the IntraSpin® centrifuge to obtain platelet-rich fibrin

Obter corretamente a Fibrina Rica em Plaquetas (PRF) depende da execução de cada etapa de maneira protocolada. Nesse sentido, no Laboratório Associado de Pesquisa Clínica (LPCO), da Faculdade de Odontologia da Universidade Federal Fluminense (FO-UFF) é utilizado o sistema IntraSpin® de centrifugação do sangue coletado, que caracteriza o segundo passo para preparo deste material autólogo. O objetivo do presente trabalho é realizar uma descrição prática do correto manuseio da Centrífuga IntraSpin para garantir a obtenção do PRF e sua efetiva aplicabilidade clínica.

Obtaining Platelet Rich Fibrin (PRF) correctly depends on the execution of each step in a protocol manner. In this sense, at the Associated Clinical Research Laboratory (LPCO), of the Faculty of Dentistry in the Federal Fluminense University (FO-UFF) the IntraSpin® centrifugation system is used in the collected blood, that characterizes the second step to prepare this autologous material. The objective of this present work is to make a practical description of the correct handling of the IntraSpin Centrifuge to guarantee the PRF's biocompatibility and its effective clinical applicability.

Caracterización de las fracturas nasales atendidas en el servicio de urgencias de cirugía maxilofacial de Bayamo / Characterization of nasal fractures treated in the maxillofacial surgery emergency service of Bayamo / Caracterização de fraturas nasais tratadas no pronto-socorro de cirurgia maxilofacial de Bayamo

RESUMEN La fractura nasal es la más frecuente entre las fracturas de los huesos faciales, pudiendo generar alteraciones estéticas importantes y a su vez determinar cambios en la funcionalidad, tratarlas de forma inmediata evita complicaciones al paciente. Con el objetivo de caracterizar las fracturas nasales atendidas en el servicio de urgencias de cirugía maxilofacial del hospital "Carlos Manuel de Céspedes" se realizó un estudio observacional descriptivo que incluyó todos los pacientes (105) que fueron atendidos ambulatoriamente con diagnóstico de fractura nasal reciente en el servicio de urgencias en el período de enero 2018 a diciembre del 2019. Las variables estudiadas fueron edad, sexo, procedencia, factores etiológicos, signos clínicos, clasificación según desplazamiento, exposición del foco de fractura y dirección del trauma. Se confeccionó una planilla de recolección de datos. Se emplearon números enteros, porcentajes y tablas estadísticas. Se siguieron los principios éticos para la investigación en humanos. La población más afectada se encontró entre los 20 y 29 años de edad, de procedencia urbana y del sexo masculino. Se encontró asociación entre el sexo y los factores etiológicos, predominando las agresiones físicas en hombres y las caídas casuales en mujeres. El principal signo clínico presente en los pacientes fue la epistaxis. Las fracturas nasales desplazadas, con desviaciones laterales y cerradas predominaron en ambos sexos.

ABSTRACT The nasal fracture is the most frequent among the fractures of the facial bones, being able to generate important aesthetic alterations and in turn determine changes in functionality, treating them immediately avoids complications for the patient. In order to characterize the nasal fractures treated in the maxillofacial surgery emergency service of the "Carlos Manuel de Céspedes" hospital, a descriptive observational study was carried out that included all the patients (105) who were seen outpatiently with a diagnosis of recent nasal fracture in the emergency department in the period from January 2018 to December 2019. The variables studied were age, sex, origin, etiological factors, clinical signs, classification according to displacement, exposure of the fracture site and direction of the trauma. A data collection sheet was prepared. Whole numbers, percentages and statistical tables were used. Ethical principles for human research were followed. The most affected population was between 20 and 29 years of age, of urban origin and male. An association was found between sex and etiological factors, predominantly physical aggression in men and accidental falls in women. The main clinical sign present in the patients was epistaxis. Displaced nasal fractures with lateral and closed deviations predominated in both sexes.

RESUMO A fratura nasal é a mais frequente entre as fraturas dos ossos faciais, sendo capaz de gerar alterações estéticas importantes e, por sua vez, determinar alterações na funcionalidade, tratando-as imediatamente evita complicações para o paciente. Com o objetivo de caracterizar as fraturas nasais atendidas no pronto-socorro de cirurgia maxilofacial do hospital Carlos Manuel de Céspedes, foi realizado um estudo observacional descritivo que incluiu todos os pacientes (105) que foram atendidos ambulatorialmente com diagnóstico de fratura nasal recente no pronto-socorro no período de janeiro de 2018 a dezembro de 2019. As variáveis estudadas foram idade, sexo, origem, fatores etiológicos, sinais clínicos, classificação segundo deslocamento, exposição do foco da fratura e direção do trauma. Um formulário de coleta de dados foi preparado. Foram utilizados números completos, percentuais e tabelas estatísticas. Foram seguidos princípios éticos para a pesquisa humana. A população mais afetada foi entre 20 e 29 anos, de origem urbana e do sexo masculino. Foi encontrada associação entre sexo e fatores etiológicos, com aagressão física predominante em homens e quedas casuais nas mulheres. O principal sinal clínico presente nos pacientes foi a epistaxe. Fraturas nasais deslocadas, com desvios laterais e fechados predominaram em ambos os sexos.

Abordagem multidisciplinar no tratamento de incisivo lateral com fratura oblíqua e lesão periapical: relato de caso clínico / Multidisciplinary approach in the treatment of lateral incisor with oblique fracture and periapical injury: clinical case report

Casos de fraturas dentárias oblíquas muitas vezes possuem um prognóstico desfavorável, geralmente com indicação da extração do elemento dental. O presente artigo visou relatar o tratamento do caso clínico de um paciente do sexo masculino, 12 anos, que compareceu à Unidade de Saúde Bucal do Hospital Universitário de Brasília com encaminhamento de extração do dente 12, apresentando fratura oblíqua que se estendia subgengivalmente na face vestibular. O trauma havia ocorrido há três anos e o paciente havia sido submetido a diversas intervenções endodônticas, apresentando no momento da consulta inicial por nossa equipe uma lesão periapical extensa. Após a realização da anamnese, exame clínico e radiográfico, foi adotada uma abordagem multidisciplinar conservadora com a manutenção do dente e a realização da enucleação da lesão periapical por meio de intervenção cirúrgica e posterior reabilitação. Em uma mesma sessão, foi realizada a obturação do conduto com cone de guta percha e cimento sealer 26 e a cirurgia parendodôntica juntamente com a apicoplastia. Uma semana após a intervenção cirúrgica foi realizada restauração classe IV com resina composta baseada no enceramento dos modelos de diagnóstico montados em articulador. Com base em uma avaliação criteriosa e multidisciplinar, foi possível adotar uma abordagem conservadora no caso em questão, com a manutenção e reabilitação de um dente permanente em um paciente jovem, evitando a indicação de exodontia(AU)

Cases of oblique dental fractures often have an unfavorable prognosis, usually with the indication of extraction of the dental element. The present article aimed to report the treatment of the clinical case of a 12-year-old male patient, who attended the Oral Health Unit of the Hospital Universitário de Brasília with a referral for extraction of tooth 7, presenting an oblique fracture that extended subgingivally on the labial surface. The trauma had occurred three years ago and the patient had undergone several endodontic interventions, presenting an extensive periapical lesion at the time of the initial consultation by our team. After anamnesis, clinical and radiographic examination, a conservative multidisciplinar approach was adopted with the maintenance of the tooth and the enucleation of the periapical lesion through surgical intervention and subsequente rehabilitation. In the same session, the conduit was filled with gutta-percha cone and sealer cement 26 and parendodontic surgery was performed together with apicoplasty. One week after the surgical intervention, class IV restoration was performed with composite resin based on the waxing of the diagnostic models mounted on an articulator. Based on a careful and multidisciplinary evaluation, it was possible to adopt a conservative approach in the case in question, with the maintenance and rehabilitation of a permanent tooth in a young patient, avoiding the indication of extraction(AU)

Epidemiología de la Infección Maxilofacial, tratada quirúrgicamente en el Hospital de Urgencia Asistencia Pública: 5 años de revisión / Epidemiology of Maxillofacial Infection, surgically treated in the Public Assistance Emergency Hospital: 5 years of review

Introducción: Infecciones moderadas, severas y/o profundas del territorio maxilofacial (ITM) constituyen un desafío de gran relevancia en los centros hospitalarios de alta complejidad. Objetivo: Actualizar esta epidemiología de resolución quirúrgica bajo anestesia general, en pabellón central tratado en el Hospital de Urgencia Asistencia Pública (HUAP) durante el período comprendido entre diciembre de 2014 a diciembre de 2019 y compararla con la realidad de otros centros hospitalarios de alta complejidad en Chile y en el extranjero. Materiales y Método: Estudio retrospectivo que analizó los protocolos operatorios de los pacientes intervenidos quirúrgicamente por ITM, en pabellón central, bajo anestesia general, en un período de 60 meses. Las variables analizadas fueron edad, género, espacio anatómico comprometido y presentación clínica. Resultados: Se realizaron 291 procedimientos quirúrgicos, para 452 infecciones. La edad promedio de los pacientes fue 38 años, con predominio del sexo masculino (57,3%); el rango de edad más afectado fue entre los 30-39 años (26,1%); el espacio submandibular fue el más comprometido (29,5%). Discusión: Los resultados expuestos concuerdan con estudios a nivel nacional e internacional. Conclusión: Resulta necesario continuar la investigación epidemiológica para establecer políticas de prevención y tratamiento eficientes en relación a cada servicio y en conjunto a nivel de salud pública.

Introduction: Moderate, severe or deep infections of the maxillofacial territory (IMT) are a relevant problem in hospital centres. Objective: To demonstrate and update the epidemiology of IMT´s with surgical resolution under general Anesthesia in mayor operating rooms at the Public Assistance Emergency Hospital (HUAP) during the period from December 2014 to December 2019, and to compare it with the epidemiological reality of other hospital centres in Chile and abroad. Materials and Method: A retrospective study analyzed the operative protocols of patients for 60 months. Studied variables were age, sex, compromised anatomical space and clinical presentation. Results: 291 surgical procedures were performed to resolve 452 infections. The average age of the operated patients was 38 years, with a slight predominance of the male gender (57.3%); the most affected age range was between 30 and 39 years (26.1%); the submandibular space was the most compromised (29.5%). Discussion: The exposed results agree with studies carried out at national and international level. Conclusion: It is necessary to continue an epidemiological investigation in order to establish efficient prevention and treatment policies for each service and altogether to unify public health statistics.

Retiro de elementos de osteosíntesis en trauma maxilofacial / Osteosynthesis elements removal in maxillofacial trauma

Resumen Objetivo: Analizar la prevalencia y los factores en la remoción de elementos de osteosíntesis (OTS) de pacientes tratados quirúrgicamente debido a fracturas maxilofaciales. Materiales y Método: Estudio retrospectivo descriptivo, donde fueron incluidos todos los pacientes con diagnóstico de fractura maxilofacial y tratados mediante reducción abierta y fijación interna rígida en un intervalo de 10 años, en el Servicio de Cirugía Oral y Maxilofacial en el Hospital Clínico Mutual de Seguridad (HCMS). Resultados: En un total de 807 pacientes intervenidos, con un rango etario entre 22-66 años, fueron utilizados 2.421 OTS. Entre ellos, 58 pacientes (7,2%) fueron sometidos a un segundo procedimiento quirúrgico, retirándose un total de 129 OTS (5,3%). La principal causa de retiro fue infección (41,1%), comúnmente de carácter tardío. El tercio inferior facial fue el más afectado, específicamente, la zona parasinfisiaria. El 39% fue retirado antes de los 12 meses de posicionados. Conclusiones: El retiro de OTS, posterior a trauma maxilofacial tiene una baja prevalencia. El sitio más afectado es el hueso mandibular y la mayoría se retira dentro de los primeros 12-24 meses. La etiología es variable, sin embargo, la infección se mantiene como una de las principales. Los hallazgos sugieren que no sería recomendable realizar este procedimiento de forma universal para todos los pacientes.

Aim: To analyse the prevalence and factors regarding to osteosynthesis elements (OTS) removal from patients surgically treated due to maxillofacial fractures. Materials and Method: Retrospective study in which all patients with diagnosis of maxillofacial fractures and treated with open reduction and internal rigid fixation were included, in an interval of 10 years, in the Maxillofacial Surgery Service of HCMS. Results: In 807 surgically treated patients, with an age between 22-66 years, 2.421 OTS were used. Among them, 58 patients (7.2%) underwent a second surgical procedure, with a total of 129 OTS removed (5.3%). The main cause of removal was infection (41.1%), commonly of a chronic nature. The lower third of the face was the most affected, specifically, the parasymphysis region. 39% of OTS were withdrawn before 12 months. Conclusions: OTS removal after maxillofacial trauma has a low prevalence, the most affected site is the mandibular bone, within the first 12-24 months. The aetiology is variable, however, infection remains one of the main. The findings suggest that it would not be advisable to perform this procedure universally for all patients.

Síndrome de pterigium poplíteo: abordaje desde la cirugía maxilofacial pediátrica

RESUMEN Introducción: El síndrome de pterigium poplíteo es una enfermedad autosómica dominante poco frecuente que resulta de una mutación en el gen IRF6 (1q32.2-q32.3). Objetivo: Notificar a la comunidad médica sobre el diagnóstico de una paciente con el síndrome de pterigium poplíteo. Presentación del caso: Se presenta el caso de una niña de 4 meses de edad atendida en el Hospital Pediátrico Universitario de Cienfuegos "Paquito González Cueto", con solución de continuidad que se extiende desde el labio superior hasta el paladar blando, así como otras alteraciones a nivel genital, con ausencia de labios mayores y menores y una banda fibrótica (pterigium) en el miembro inferior izquierdo que da la impresión de un miembro corto en comparación con el derecho. Desde la especialidad de cirugía maxilofacial pediátrica, tras haber diagnosticado una fisura de labio y paladar bilateral completa, se realizaron los procederes protocolizados para este tipo de pacientes, que incluyen correcciones quirúrgicas de las malformaciones bucofaciales. Conclusiones: En esta ocasión, se pudo corroborar que por muy rara que puedan ser algunas entidades, las mismas pueden presentarse, por lo que debemos tenerlas presentes al plantear los diferentes diagnósticos diferenciales, para así, tratarlas adecuadamente.

ABSTRACT Introduction: Popliteal pterygium syndrome is a rare autosomal dominant disease resulting from a mutation in the IRF6 gene (1q32.2-q32.3). Objective: Inform the medical community about the diagnosis of a patient with popliteal pterygium syndrome. Case Presentation: The case of a 4-month-old girl treated at "Paquito González Cueto" University Pediatric Hospital of Cienfuegos is presented, with continuity solution that extends from the upper lip to the soft palate, as well as other alterations at the genital level, with the absence of labia majora and minora and a fibrotic band (pterygium) in the left lower limb that gives the impression of a short limb in comparison with the right. From the specialty of pediatric maxillofacial surgery, after having diagnosed a fissure of the lip and complete bilateral palate, the protocolized procedures were carried out for this type of patients, which include surgical corrections of orofacial malformations. Conclusions: On this occasion, it was possible to corroborate that no matter how rare some entities may be, they can be presented, so we must keep them in mind when raising the different differential diagnoses, in order to treat them properly.