Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil / Tempo de recuperação funcional após fraturas faciais: perfil e fatores associados em amostra de pacientes do sul do Brasil

ABSTRACT Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

RESUMO O entendimento da causa, da gravidade e do tempo decorrido para o restabelecimento das funções de lesões maxilofaciais pode contribuir para o estabelecimento de prioridades clínicas objetivando o efetivo tratamento e prevenção dos traumatismos de face. Assim, o objetivo deste estudo foi compreender quais os fatores associados ao restabelecimento das funções mastigatórias, oculares e nasais em vítimas de trauma de face, estimando o tempo para recuperação das funções, após o tratamento cirúrgico. Foram analisados 114 prontuários de pacientes atendidos no Hospital de Montenegro que compareceram às consultas de acompanhamento por até 180 dias. Para a análise do tempo para a recuperação, foi realizada a análise de sobrevida, seguida da análise de COX. Observou-se que metade dos pacientes recuperaram as funções em até 20 dias, sendo que o tempo médio para recuperação dos traumas no complexo zigomático-orbitário-malar-nasal foi de 11 dias e do complexo maxilo - mandibular de 21 dias (HR: 1,5 (0,99 - 2,3) p=0,055). Embora o restabelecimento das funções tenha atingido taxas elevadas após abordagem cirúrgicas, faz-se necessária a análise dos casos de insucessos bem como os impactos econômicos e as estratégias de prevenção associados aos traumas de face a fim de qualificar o serviço prestado à população.

Abordaje transconjuntival en fracturas de piso orbitario: informe de 20 casos / Transconjunctival approach in orbital floor fractures: report of 20 cases

Objetivo: entre 2009 y 2011, utilizamos el abordaje transconjuntival en 20 pacientes, todos ellos con fracturas de piso orbitario, 17 de los cuales correspondían a traumatismos agudos y otros 3 a secuelas de fracturas. El objetivo del trabajo es analizar datos clínicos, radiográficos y evaluar las complicaciones mediatas e inmediatas de este abordaje, los resultados estéticos, funcionales, y la movilización o exposición de los materiales de reconstrucción. Caso clínico: se trataron 20 fracturas orbitarias que requerían resolución quirúrgica. En todos los casos se reconstruyó el piso orbitario con malla de titanio. Las complicaciones oftálmicas fueron transitorias y no hubo necesidad de reintervenir quirúrgicamente a ninguno de los pacientes. Conclusión: este abordaje permite un acceso quirúrgico efectivo del piso orbitario y de la pared orbitaria medial y facilita la reconstrucción sin generar alteración estética ni funcional del sistema de drenaje lagrimal.

Treatment and complications of orbito-zygomatic fractures / Tratamiento y complicaciones de las fracturas órbito-cigomáticas

The aim of the present study was to analyze the etiology, type and treatment employed in the orbito-zygomatic fractures (OZ). Also, postoperative complications are described and correlated with the type of treatment used. Fifty patients with OZ fractures were evaluated. Orbital fractures in which the zygomatic bone was not involved were excluded. Epidemiologic data and characteristics of treatment such as the type of material used for osteosynthesis, number of anatomical sites on which rigid internal fixation (RIF) was applied, surgical approaches and associated complications were recorded. The main causes of trauma were motorcycle and bicycle accidents, constituting 52 percent of the sample. The osteosynthesis system used was the 2.0 mm, except in four patients in whom the 1.5mm system was used for fixation at the infra-orbital rim. A total of 18 percent of the patients required reconstruction of the internal orbit and in all cases titanium mesh was used. 46 percent of the patients received RIF in three anatomical sites, most in the fronto-zygomatic suture, infra-orbital rim and zygomatic-maxillary buttress. The most frequent complication was paresthesia of the infra-orbital nerve (34 patients, 68 percent). Other findings were also discussed with the intent of better understanding the treatment of the OZ fractures...

El objetivo del presente estudio fue analizar la etiología, tipo y tratamiento empleado en las fracturas órbito-cigomáticas (OC). Además, se describen y correlacionan las complicaciones postoperatorias con el tipo de tratamiento utilizado. Cincuenta pacientes con fracturas OC fueron evaluados. Las fracturas orbitarias en la que el hueso cigomático no participó fueron excluidas. Los datos epidemiológicos y las características de tratamiento, tales como el tipo de material utilizado para la osteosíntesis, número de sitios anatómicos en los que se aplicó la fijación interna rígida (FIR), enfoques quirúrgicos y complicaciones asociadas fueron registrados. Las principales causas de los traumas fueron accidentes de bicicleta y motocicleta, constituyendo el 52 por ciento de la muestra. El sistema de osteosíntesis utilizado fue de 2,0 mm, excepto en cuatro pacientes en los que se utilizó el sistema de 1,5 mm para la fijación en el borde infraorbitario. El 18 por ciento de los pacientes requirieron reconstrucción de la órbita interna y en todos los casos se utilizó malla de titanio. El 46 por ciento de los pacientes recibió FIR en tres sitios anatómicos, la mayoría en la sutura fronto-cigomático, borde infraorbitario y pilar cigomato-maxilar. La complicación más frecuente fue parestesia del nervio infraorbitario (34 pacientes, 68 por ciento). Otros hallazgos fueron discutidos con la intención de comprender mejor el tratamiento de las fracturas OC...

Maxillofacial injuries in a group of Brazilian subjects under 18 years of age

OBJECTIVE: The purpose of this study was to perform a clinical retrospective analysis of the etiology, incidence and treatment of selected oral and maxillofacial injuries in Brazilian children and adolescents. MATERIAL AND METHODS: This study was conducted during a 14-year period between 1986 and 2000. All patients were admitted to Hospital XV in the city of Curitiba, State of Paraná. Age, gender, monthly distribution, etiology, soft injuries, associated injuries, site of fractures and methods of treatment were reviewed. RESULTS: Of the total of 350 patients of all ages treated for facial injuries, 29.42% were within the age range of the study (0 to 18 years). Mean age was 10.61. Of the patients, 63.1% were male. The most common cause of injury was accidental falls (37.87%), followed by bicycle and motorcycle accidents (21.36%). Of the 103 patients, 88.34% had single injuries. Mandibular fractures were the most common and the condylar region was particularly affected. CONCLUSIONS: Facial trauma is a relatively common occurrence in children. The study indicates that fractures in children and adolescents differ quite considerably from an adult population.

Estudio descriptivo de los accesos quirúrgicos utilizados en el tratamiento de fracturas del complejo zigomático orbitario / Descriptive study of surgical approach for zygomatic complex fractures

El objetivo del presente estudio fue evaluar los accesos quirúrgicos utilizados para el abordaje del complejo zigomático orbitario (CZO) y arco zigomático (AZ). Fue diseñado un estudio de tipo retrospectivo, evaluando las fichas clínicas de pacientes atendidos entre el 1 de Abril del año 1999 y el 31 de Diciembre del año 2008. Fueron estudiadas variables sociodemográficas y características de la fractura, tales como presencia de más de una fractura facial y desplazamiento del fragmento óseo. Se realizo un estudio descriptivo de los diferentes accesos quirúrgicos utilizados y cuando fue necesario se estudió la asociación estadística con la prueba chi-cuadrado para variables nominales, estableciendo significancia si p<0,05. Ciento cincuenta y tres pacientes fueron sometidos a tratamiento quirúrgico de fractura de CZO con 251 accesos quirúrgicos. El acceso más efectuado fue el intrabucal, seguido del acceso subciliar y supraciliar. Siempre existió mayor utilización de accesos para pilar zigomaticomaxilar, seguidos por accesos para reborde infraorbitario y sutura frontozigomática, con pocas diferencias entre ellos. No fue posible encontrar asociación estadística entre las variables estudiadas y la cantidad de accesos para el tratamiento quirúrgico de fracturas de CZO. Los accesos quirúrgicos deben responder a las necesidades individuales de cada caso, intentando obtener indicaciones precisas, más que preferencias individuales de cada cirujano.

The aim of this research was to evaluated the surgical approach for zygomatic complex and zygomatic arch fracture. Was doing a retrospective study, evaluating clinical charts of patients with treatment between April 1 of 1999 and December 31, 2008. Were study sociodemographic variables, type and quantitative fracture and displacement of osseous fragment. A descriptive analysis was do it surgical approach used and when was necessary, realized a statistical analysis with Chi-Square test for nominal variables, with p<0.05 for significant statistic. One hundred fifty tree patients was surgically treated for ZC fracture, doing 251 surgical approach. More realized approach was intraoral, follow for subciliary and superciliary approach. Always exist more approach for zygomatimaxillary pillar, follow to infraorbitary rim and frontozygomatic suture, with a little difference. Was not possible show statistic association between de variables and the quantity of surgical approach for ZC fractures. Surgical approach was response to individual necessity, obtained certain indications more than surgeon preferences.

Analysis of 185 maxillofacial fractures in the state of Santa Catarina, Brazil

A retrospective study was performed to assess maxillofacial fractures in patients treated at a public hospital from 2002 to 2006. The data collected included age, gender, etiology, type of injury, treatment modalities and period of treatment. Causes were grouped into seven categories: road traffic collisions, sports accidents, occupational accidents, gunshot fractures, falls, violence and other causes. The analyses involved descriptive statistics, the Chi-squared Test and the Fisher Exact Test. Records from 132 patients sustaining 185 maxillofacial fractures were evaluated. The mandible (54.6 percent) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6 percent). The mean age of the patients was 37.7 years, and the male:female ratio was 4.3:1. Most fractures occurred in adults with ages ranging from 18 to 39 years. A significant statistical relation was found between the age and the etiology of the trauma (p < 0.05), and between the number of fractured sites and the age of the patient (p < 0.05). Considering the age groups, accidents were the most frequent cause of maxillofacial fractures in the age group between 18 to 39 years, and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 to 59 years. Treatment was performed on the same day as the diagnosis in 44.7 percent of the patients. Open surgery with internal stable fixation was indicated for most of the patients. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Traffic road collisions were the main etiologic factor associated with maxillofacial trauma.

Fractura órbito-malar: su resolución quirúrgica / Orbito-zygomatic fracture: its surgical resolution

Un buen abordaje y esqueletización en casos de fracturas órbito-malares complejas aseguran una buena reconstrucción tridimensional y anatómica de la región a tratar. Se presenta el caso de un paciente masculino de 35 años, determinándose el grado real de desplazamiento por medios tomográficos y su resolución con abordajes combinados y osteosíntesis rígidas internas, siguiendo la metodología actual.

Fraturas zigomático - obrigatórias / Fractures of the zigomatic - orbital region

O objetivo deste trabalho foi realizar um levantamento bibliográfico sobre a epidemiologia, principais meios de diagnóstico e de tratamento de fraturas zigomático - orbitárias, com o intuito de definir a postura adequada que o cirurgião bucomaxilo-facial deve apresentar diante deste tipo de traumatismo. A revisão realizada levou à conclusão que, diante de pacientes com este tipo de lesão, é de suma importância uma anamnese criteriosa, para o correto estabelecimento dos exames complementares a serem solicitados, a fim de permitir o plano de tratamento adequado

Bone injuries during delivery.

Bone injuries during the process of delivery were studied among 34, 946 live born babies over a 11 period. There were 35 cases of bone injuries giving an incidence of 1 per 1,000 live births. Clavicle was the commonest bone fractured (45.7%) followed by humerus (20%), femur (14.3%) and depressed skull fracture (11.4%) in the order of frequency. There was one case each of orbital fracture, epiphyseal separation of lower end of femur and dislocation of elbow joint. Lack of antenatal care, malpresentation often leading to obstructed labour and operative deliveries were found to be risk factors for bone injuries. Meconium stained liquor and birth asphyxia were more commonly associated with bone injuries than control cases. Cases with injuries had longer hospital stay and higher mortality. Improving the health infrastructure at the peripheral level with early identification of high risk mothers and their appropriate management can bring down the incidence of bone injuries.