ABSTRACT
Acidentes automobilísticos são os principais responsáveis pelas fraturas que acometem pelo menos dois dos terços da face, denominadas fraturas panfaciais ou complexas da face, trauma que necessita de tratamento cirúrgico reabilitador estético e funcional. Este trabalho tem como objetivo relatar um caso clínico de uma paciente vítima de acidente automobilístico com fraturas complexas no terço médio e superior de face. Paciente encaminhada ao serviço de urgência da especialidade Bucomaxilofacial do Hospital Angelina Caron, na cidade de Campina Grande do Sul/PR, para tratamento e conduta após receber atendimento para suporte básico de vida imediato no local do acidente. Através do exame clínico, físico e radiográfico na emergência hospitalar, obteve-se o diagnóstico de fratura complexa fronto-naso-orbitária, fratura dos ossos zigomáticos e fratura tipo Le Fort I completa. Como conduta e tratamento, foram planejadas redução e fixação das fraturas em uma única etapa cirúrgica. O acompanhamento clínico e radiográfico de longo prazo pode ser estabelecido. Concluiu-se que o correto atendimento primário, precisão no diagnóstico, planejamento para redução e osteossíntese dos segmentos fraturados e acompanhamento pós-operatório tanto clínico quanto radiográfico são requisitos essenciais para o sucesso do tratamento das fraturas panfaciais (AU).
Automobile accidents are the main cause for fractures affecting at least two thirds of the face, called panfacial or complex fractures of the face, requiring surgical, aesthetic and functional rehabilitation. This study aims to present a case report of a patient victim of car accident with complex fractures of the middle and upper third of the face. Patient was referred to the emergency department of Bucomaxillofacial specialty of Angelina Caron Hospital in the city of Campina Grande do Sul/PR for treatment and procedures, after receiving assistance for basic immediate life support at the accident site. Through clinical, physical, radiographic examinations, it was obtained the diagnostic of complex fronto-naso-orbital fracture, zygomatic bones fractures, and complete Le Fort I fracture. The procedures and treatment were planned with reduction and fixation in a single surgical step. Clinical and radiographic long-term follow-up was established. It was concluded that correct primary care, diagnosis precision, planning for reduction and osteosynthesis of the fractured segments and clinical and radiographic monitoring are essential requirements for the successful treatment of panfacial fractures.
Subject(s)
Humans , Female , Adult , Wounds and Injuries/rehabilitation , Accidents, Traffic , Facial Bones/injuries , Facial Injuries/surgery , Mandibular Fractures/diagnosis , Surgical Procedures, Operative , Brazil , Case Reports , Tomography, X-Ray Computed/instrumentation , Fractures, Comminuted , Fracture Fixation, Internal/methodsABSTRACT
Aim: To analyze gunshot wounds to the face, assessing the characteristics, immediate treatment,late treatment, complications and after effects. Methods: A retrospective observational study wascarried out involving 75 cases of victims of gunshot wounds to the face treated at the Oral andMaxillofacial Traumatology Unit of the Dr. Arthur Ribeiro de Saboya Hospital in the city of SãoPaulo (Brazil).Data analysis used the chi-square test with the level of significance set at 5% (p dd0.05). Results: There was a predominance of the 21-to-30-year-old age group (38.7%), malegender (92%) and wounds occurring due to assaults (37.3%). There was a predominance ofentry wounds on the left side of the face (58.5%). The most affected sites were the mandible(50.7%), maxilla (18.3%), zygomatic region (7.0%), eye socket (4.2%) and nose (1.4%).Comminuted fractures (88.2%) and simple fractures (10.3%) were recorded. No fracture occurredin 1.5% of the cases. The predominant treatment was rigid internal fixation (RIF) (57.2%),followed by exploratory surgery (23.2%) and conservative treatment (19.6%). Among thecases in which the RIF system was used, there was predominance in the mandible (64.0%). Thechi-square test revealed a significant correlation between the 2.4-mm RIF system and the mandiblein 48.0 % of cases. Conclusions: In conclusion, gunshot wounds tended to pierce the face,mainly affecting the mandible and caused comminuted fractures treated with rigid internal fixation.Immediate complications occurred in 25% of cases and after effects occurred in 11.7%.