Mandibular traumas by gunshot. A systematic review with meta-analysis and algorithm of treatment.

The treatment of mandibular fractures by gunshot ranges from late conservative repair to more aggressive early repair in a single stage. Treatments that preserve bony architecture as much as possible should be used, minimising patient morbidity and the complexity of future surgeries. The purpose of this study was to use a systematic review to determine which method of treatment was most effective for mandibular fractures by gunshot. Searches were conducted on Medline via PubMed, Scopus, Central Cochrane, and Sigle via Open Grey up to August 2019. Four studies were eligible to this systematic review, considering the previously establish inclusion and exclusion criteria. A total of 211 patients were evaluated. The mandibular body was the region more fractured followed by the symphyseal/parasymphyseal region. The closed treatment with intermaxillary fixation (IMF) was the most used followed by open surgery with internal rigid fixation (IRF) and external fixator. Considering the total adverse effects, the meta-analysis showed no statistically significant difference between the IMF and IRF groups (p=0.840), but IMF showed five times less infection and IRF six times less malunion. The algorithm was delineated from the types of injuries by gunshot, proposing forms of treatment from initial stabilisation to functional rehabilitation with implant-supported prostheses. The treatment of mandibular fractures by gunshot remains a challenge for surgeons. There was a statistically significant prevalence of success in the IRF group, however this group was also associated with a higher index of infection than the IMF group. New studies with high methodological quality and larger numbers of participants are needed to offer more safety for surgeons who treat patients with mandibular fractures by gunshot.

Remoção de corpo estranho na região óculo-orbitária. Um caso incomum / Removal of foreign body in the oculo-orbital region. An unusual case

Introdução: Todo tipo de trauma facial requer uma avaliação detalhada, a fim de compreender o histórico da lesão e possíveis sequelas. O trauma óculo-orbital não está entre as lesões mais frequentes na epidemiologia do trauma facial, embora esteja associado a altos índices de morbidade e sequelas graves, sendo necessário um acompanhamento multidisciplinar. O objetivo do presente estudo foi relatar um caso clínico de trauma óculo-orbitário severo ocasionado por arma de fogo. Relato do caso: Paciente de 19 anos foi atendido em um serviço de cirurgia bucomaxilofacial, vítima de trauma por arma de fogo, com a presença de um objeto metálico incomum na órbita esquerda e região temporal. Exame clínico e tomografia computadorizada foram realizados, confirmando uma trajetória extracraniana do objeto. O paciente foi submetido à cirurgia sob anestesia geral, e o objeto foi removido pelo orifício de entrada na região orbitária esquerda. Após avaliação oftalmológica, as funções do olho esquerdo não puderam ser recuperadas. Considerações Finais: O diagnóstico correto e o tratamento rápido são imperativos para restaurar a função e a estética agradável na região traumatizada... (AU)

Introduction: Any type of facial trauma requires a detailed evaluation in order to understand lesion history and possible sequelae. Oculoorbital trauma is not between the most frequent injuries within facial trauma epidemiology, although, it is associated to high morbidity rates and severe sequelae, so that a multidisciplinary follow-up is necessary. To report a clinic case of severe oculo-orbital trauma caused by firearm. Case Report: Patient, 19 years-old, attended the oral and maxillofacial surgery service victim of trauma by gunshot with the presence of an unusual metallic object in the left orbit and temporal region. Clinical exam and computed tomography scan were performed, confirming an extra-cranial trajectory of the object. Patient was submitted to surgery under general anesthesia and the object was removed through the entrance orifice in the left orbital region. After ophthalmologic evaluation, functions of the left eye could not be recovered. Final considerations: Correct diagnosis and rapid treatment are imperative to restore function and pleasant esthetics in the traumatized region... (AU)

Treatment of comminutive fractures by firearm projectiles with adapted wrist external fixator.

INTRODUCTION: Facial and mandibular aggression with gunshot wound (GSW) is highly complex and represents a challenge for the assistant surgical team because in addition to the inherent lethal potential, they have the capacity for destruction and mutilation caused by the high kinetic energy conferred to the firearm projectile. Among these lesions, comminutive mandibular fractures are difficult to treat because the anatomical planes are distorted, soft tissues are in severe disarrangement, and bone fragments are without periosteum, which, if opted for an open treatment, with internal fixation, favor the development of soft tissue infections, osteomyelitis, and suture dehiscence. The treatment of comminuted mandibular fractures with external fixator, widely used during the Second World War, represents a modality of treatment that minimizes the risks of failure, since it allows stabilization of the fractured mandible with minimal aggression to the soft tissues. OBJECTIVES: The objective of this study is to report three cases where surgical procedures were performed to treat comminuted mandible fractures with the adaptation of specific external orthopedic fixator for wrist.