Retrospective analysis of a case series of patients with traumatic injuries to the craniocervical junction / Análise retrospectiva de série de casos com lesões traumáticas da junção craniocervical

ABSTRACT Objective To evaluate the correlation between the treatment, the characteristics of the lesions and the clinical outcome of patients with traumatic injuries to the craniocervical junction. Methods This was a retrospective study of patients treated conservatively or surgically between 2010 and 2013 with complete data sets. Results We analyzed 37 patients, 73% were men with mean age of 41.7 years. Of these, 32% were submitted to initial surgical treatment and 68% received conservative treatment. Seven (29%) underwent surgery subsequently. In the surgical group, there were seven cases of odontoid type II fractures, two cases of fracture of posterior elements of the axis, one case of C1-C2 dislocation with associated fractured C2, one case of occipitocervical dislocation, and one case of combined C1 and C2 fractures, and facet dislocation. Only one patient had neurological déficit that improved after treatment. Two surgical complications were seen: a liquoric fistula and one surgical wound infection (reaproached). In the group treated conservatively, odontoid fractures (eight cases) and fractures of the posterior elements of C2 (five cases) were more frequent. In two cases, in addition to the injuries of the craniocervical junction, there were fractures in other segments of the spine. None of the patients who underwent conservative treatment presented neurological deterioration. Conclusion Although injuries of craniocervical junction are relatively rare, they usually involve fractures of the odontoid and the posterior elements of the axis. Our results recommend early surgical treatment for type II odontoid fractures and ligament injuries, the conservative treatment for other injuries.

RESUMO Objetivo Avaliar a correlação entre o tratamento, as características das lesões e o resultado clínico em pacientes com lesões traumáticas na junção craniocervical. Métodos Estudo retrospectivo de pacientes maiores de 18 anos tratados de forma conservadora ou cirúrgica, entre 2010 e 2013. Resultados Foram analisados 37 pacientes, 73% eram do sexo masculino e a média de idade foi de 41,7 anos. Inicialmente 32% dos pacientes foram submetidos a tratamento cirúrgico, e 68% foram submetidos a tratamento conservador. Sete pacientes (29%) do grupo conservador foram submetidos posteriormente à cirurgia. No grupo cirúrgico, houve sete casos de fratura de odontóide tipo II, dois casos de fratura de elementos posteriores do áxis, um caso de luxação C1-C2, um caso de deslocamento occipito-cervical e um caso de fraturas de C1 e C2 e luxação facetária. Um paciente apresentava déficit neurológico, melhorando após o tratamento. Houve duas complicações pós-cirúrgicas, uma fístula liquórica e uma infecção de ferida operatória (reabordada). No grupo conservador, predominaram as fraturas do odontóide (oito) e dos elementos posteriores de C2 (cinco). Em dois casos, havia também fraturas em outros segmentos da coluna. Nenhum dos pacientes deste grupo apresentou deterioração neurológica. Conclusão As lesões da junção craniocervical são raras, sendo mais frequentes as fraturas do odontóide e dos elementos posteriores do áxis. Nossos resultados recomendam o tratamento cirúrgico precoce para os pacientes com fraturas do odontóide tipo II e lesões ligamentares, e tratamento conservador para os demais pacientes.

Development of management to injuries of the central nervous system

At the University of Miami [Miami, Florida, United States of America] Dr. Barth A. Green [Chairman of the Department of Neurological Surgery] has developed "The Miami Project to Cure Paralysis" from hence designated as the "Project." The "Project" has three major research components: 1] Prevention, 2] Treatment, and 3] Rehabilitation

Lesions nerveuses en chirurgie buccale et implantaire a la mandibule: etiopathogenie, prevention, et traitement

Nerve injuries are among the most fearful complications occurring during surgical procedures in the mandible because of their symptoms and their long and often irreversible evolution. The inferior alveolar nerve as the lingual, mylohyoid and buccal ones can be injured following different surgical procedures [wisdom tooth extractions, Cyst enucleation, implant surgery ']. The surgeon, aided by different means of diagnosis put at his disposal, must appreciate their anatomy before any surgical procedure in their region. Thus, the dental radiology along with the emergence of modern techniques [dentascan, scanora '] must guide the surgical thechnique in order to prevent nerve injuries which lead to the emergence of clinical and functional signs very disabling to the patient. Managing these complications is very important in order to help the patient recover his altered sensations. The diagnosis is often evident in the presence of parestehsia or the chin, lingual or buccal level. The prognosis depends on the type of injury and on the medicinal or surgical therapeutic attitude