Rehabilitation Surgery for Peripheral Facial Nerve Injury after Facial Trauma.

Introduction Facial trauma can cause damage to the facial nerve, which can have negative effects on function, aesthetics, and quality of life if left untreated. Objective To evaluate the effectiveness of peripheral facial nerve direct end-to-end anastomosis and/or nerve grafting surgery for patients with facial nerve injury after facial trauma. Methods Fifty-nine patients with peripheral facial nerve paralysis after facial injuries underwent facial nerve rehabilitation surgery from November 2017 to December 2021 at Ho Chi Minh City National Hospital of Odontology. Results All 59 cases of facial trauma with damage to the peripheral facial nerve underwent facial nerve reconstruction surgery within 8 weeks of the injury. Of these cases, 25/59 (42.3%) had end-to-end anastomosis, 22/59 (37.3%) had nerve grafting, and 12/59 (20.4%) had a combination of nerve grafting and end-to-end anastomosis. After surgery, the rates of moderate and good recovery were 78.4% and 11.8%, respectively. All facial paralysis measurements showed statistically significant improvement after surgery, including the Facial Nerve Grading Scale 2.0 (FNGS 2.0) score, the Facial Clinimetric Evaluation (FaCE) scale, and electroneurography. The rate of synkinesis after surgery was 34%. Patient follow-up postoperatively ranged from 6 to > 36 months; 51 out of 59 patients (86.4%) were followed-up for at least 12 months or longer. Conclusion Nerve rehabilitation surgery including direct end-to-end anastomosis and nerve grafting is effective in cases of peripheral facial nerve injury following facial trauma. The surgery helps restore nerve conduction and improve facial paralysis.

Effectiveness of Elastic Therapeutic Tape in Reducing Edema, Pain and Trismus following Surgery for Facial Fractures: A Systematic Review and Meta-Analysis.

Facial fractures cause postoperative morbidity, including edema, pain, and trismus. Elastic therapeutic tapes are used for optimizing recovery. Background: The aim of the present systematic review and meta-analysis was to evaluate the effectiveness of elastic tape Kinesio taping (KT) in reducing postoperative morbidity in facial fractures surgeries. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. Searches were conducted in the Cochrane, Medline, Scopus, Embase and Web of Science databases using a pre-established search strategy. Results: A total of 811 studies were retrieved after the duplicates were removed, and only randomized clinical trials were included. Eight trials, involving 319 participants, were deemed eligible. One study solely investigated the effect on edema, while the others analyzed at least two of the variables of interest. Results from two RCTs, where qualitative analysis was applicable, suggest a potential reduction in edema in the KT group compared to the control group on the second (RR -0.55, 95% CI -0.89 to -0.22; p = 0.01; I2 = 0%) and third postoperative days (RR -0.71, 95% CI -1.01 to -0.40; p < 0.00001; I2 = 0%). Conclusions: KT is effective in controlling postoperative edema following surgery for facial fractures. However, the effects on pain and trismus should be explored further in studies with standardized methods.

Aplicaciones para dispositivos móviles de uso estomatológico / Mobile Device Applications to be Used in the Dentistry Field

Introducción: El uso de tecnologías móviles para apoyar el logro de los objetivos de salud tiene el potencial de influir y transformar la provisión de servicios mundialmente. Objetivo: Reflexionar sobre la utilidad de las aplicaciones para dispositivos móviles en las ramas estomatológicas. Comentarios principales: Las aplicaciones para dispositivos móviles tienen muchas ventajas: son constantemente accesibles, se pueden ajustar a las necesidades del usuario, pueden proporcionar comentarios personalizados, son más anónimas que el contacto cara a cara, pueden enviar recordatorios, y tienen un amplio alcance y características interactivas. Consideraciones globales: La utilidad de las aplicaciones para dispositivos móviles en las ramas estomatológicas es innegable. Esta variante tecnológica se ha impuesto como un arma valiosa dentro de los servicios de salud móvil en áreas como la promoción y la prevención de salud, la información a pacientes, la comunicación entre profesionales y el diagnóstico de entidades patológicas. Es una necesidad la búsqueda de la calidad en las que se creen y que se incorporen a la práctica de la profesión para potencializar los beneficios que ofrecen(AU)

Introduction: Using mobile technologies to support the achievement of health goals is very much likely to influence and transform service provision globally. Objective: To reflect on the usefulness of mobile device applications in the branches of dentistry. Key remarks: Mobile device applications have many advantages: they are accessible at any time, they can be adjusted to the user's needs, they provide personalized feedback, they are more anonymous than face-to-face contact, they can send reminders; in addition, they have a wide reach and interactive features. Global considerations: The usefulness of mobile device applications in the branches of dentistry is undeniable. This technological variant has established itself as a valuable weapon within mobile health services in areas such as health promotion and prevention, patient information, communication between professionals, and diagnosis of pathological entities. It is necessary to search for quality, creating and incorporating mobile device applications into the professional practice, in order to maximize the benefits that they offer(AU)

Tratamento cirúrgico de fratura de terço médio de face com uso da intubação submentual: relato de caso / Surgical treatment of fracture of the middle third of the face with the use of submental intubation: case report

A intubação submentual é uma derivação da técnica de intubação orotraqueal convencional. Esta derivação é utilizada principalmente com o intuito de evitar uma traqueostomia nos casos em que a intubação nasotraqueal e orotraqueal convencional estão contraindicadas. Este trabalho possui como objetivo relatar um caso clínico em que foi utilizada a intubação submentual em uma cirurgia de osteossíntese de fratura múltipla de terço médio de face.

Submental intubation is a derivation of the conventional orotracheal intubation technique. This type of intubation is mainly used to avoid a tracheostomy in cases where conventional nasotracheal and orotracheal intubation are contraindicated. This study aims to report a clinical case in which submental intubation was used in an osteosynthesis surgery for multiple fractures of the middle third of the face.

Injerto de tibia en defecto óseo postraumático en maxilar superior

Introducción: El ser humano siempre ha tratado de solucionar los defectos óseos en los maxilares, tanto para corregir defectos postraumáticos como para aportar tejido en lechos donde se colocarán implantes dentales. Objetivos: Demostrar las ventajas del uso del injerto de hueso autólogo de tibia en la reconstrucción de defectos postraumáticos de los maxilares. Presentación del caso: Paciente masculino de 21 años de edad, con trauma en el tercio medio facial debido a un golpe de alto impacto. Las fracturas produjeron deformidad traumática residual en el hemimaxilar derecho. El daño del contorno facial afectó la estética y la función masticatoria del paciente. Se intervino quirúrgicamente para colocar injerto autólogo de tibia en el área afectada. Conclusiones: Los injertos óseos autólogos constituyen una alternativa importante para el tratamiento rehabilitador en pacientes con deformidad traumática residual. Esta cirugía asegura la aceptación del injerto y una baja morbilidad en los pacientes.

Introduction: The human being has always tried to solve bone defects in the jaws, both to correct post-traumatic defects and to provide tissue in beds where dental implants will be placed. Objectives: To demonstrate the advantages of the use of autologous bone graft from the tibia in the reconstruction of post-traumatic defects of the maxillae. Case report: This was a 21-year-old male patient with trauma to the middle third of the face due to a high-impact blow. The fractures produced residual traumatic deformity in the right hemimaxilla. The damage to the facial contour affected the patient's aesthetics and masticatory function. Surgery was performed to place an autologous tibial graft in the affected area. Conclusions: Autologous bone grafts are an important alternative for rehabilitation treatment in patients with residual traumatic deformity. This surgery ensures graft acceptance and low patient morbidity.

Comportamiento y gravedad del trauma maxilofacial en urgencia en el Hospital Universitario "General Calixto García" / Characteristics and Severity of Maxillofacial Trauma in the Emergency Room at General Calixto García University Hospital

Introducción: La región maxilofacial es vulnerable al trauma. Se utilizan herramientas para evaluar la gravedad del trauma maxilofacial. Objetivo: Caracterizar el comportamiento y gravedad del trauma maxilofacial en los pacientes atendidos en el servicio de urgencias de cirugía maxilofacial del Hospital Universitario "General Calixto García". Métodos: Se realizó un estudio observacional descriptivo transversal en pacientes que acudieron al servicio de urgencias de cirugía maxilofacial del Hospital Universitario "General Calixto García", desde septiembre de 2018 hasta marzo de 2021. El universo fue de 57 pacientes. Se aplicó la escala de severidad de lesiones faciales. Variables analizadas: edad, sexo, etiología, diagnósticos, exámenes complementarios, gravedad del trauma maxilofacial, procederes terapéuticos inmediatos. Resultados: Prevaleció la fractura mandibular como diagnóstico (66,7 por ciento). La etiología más frecuente fue la violencia interpersonal (29,8 por ciento). Predominó la gravedad leve del trauma maxilofacial (71,9 por ciento). La extracción de cuerpos extraños de la vía aérea, tracción lingual, inserción de cánula orofaríngea, intubación orotraqueal (5,3 por ciento), y sutura (64,9 por ciento), fueron los procederes terapéuticos inmediatos más utilizados. Conclusiones: Prevalecen los pacientes del sexo masculino y del grupo de edad de 19 a 30 años. Predomina la fractura mandibular como diagnóstico. Los exámenes complementarios más utilizados son, la tomografía computarizada, el hemograma completo y el coagulograma. Impera la violencia interpersonal como etiología. Prevalece la gravedad leve del trauma maxilofacial. Los procederes terapéuticos inmediatos más empleados son, extracción de cuerpos extraños de la vía aérea, tracción lingual, inserción de cánula orofaríngea, intubación orotraqueal y sutura(AU)

Introduction: The maxillofacial region is vulnerable to trauma. Tools are used to assess the severity of maxillofacial trauma. Objective: To characterize maxillofacial trauma and its severity in patients cared for at the maxillofacial surgery emergency department of General Calixto García University Hospital. Methods: A cross-sectional, descriptive and observational study was carried out in patients attending the maxillofacial surgery emergency department at General Calixto García University Hospital, from September 2018 to March 2021. The study universe was 57 patients. The facial injury severity scale was applied. The analyzed variables were age, sex, etiology, diagnoses, complementary examinations, severity of maxillofacial trauma, immediate therapeutic procedures. Results: Mandibular fracture prevailed as a diagnosis (66.7 percent). The most frequent etiology was interpersonal violence (29.8 percent). Mild severity of maxillofacial trauma predominated (71.9 percent). Extraction of foreign bodies from the airway, tongue traction, insertion of oropharyngeal cannula, orotracheal intubation (5.3 percent) and suturing (64.9 percent) were the most frequently used immediate therapeutic procedures. Conclusions: There is a prevalence of male patients and the age group 19 to 30 years. Mandibular fracture predominates as a diagnosis. The most frequently used complementary tests are computed tomography, complete blood count and coagulogram. Interpersonal violence prevails as an etiology. Mild severity of maxillofacial trauma prevails. The most commonly used immediate therapeutic procedures are extraction of foreign bodies from the airway, tongue traction, insertion of oropharyngeal cannula, orotracheal intubation and suturing(AU)

Estabilização zigomática e retalho de avanço facial lateral em canino filhote / Zygomatic stabilization and lateral facial advancement flap in a puppy dog

O trauma é frequentemente relatado na rotina clínica de pequenos animais, podendo gerar fraturas de componentes ósseos e lesões de tecidos moles adjacentes. No presente trabalho, objetivou-se relatar o caso de um canino, macho, sem raça definida, de sete meses de idade, vítima de trauma craniomaxilofacial decorrente de mordedura, diagnosticado com fratura e deslocamento de osso zigomático, além de importante laceração de pele. O tratamento estabelecido baseou-se no debridamento da ferida, estabilização cirúrgica de arco zigomático com fios de Nylon e na sutura dos ferimentos de pele causados. Em um segundo tempo cirúrgico, foi realizada enucleação e recobrimento do defeito na órbita com malha cirúrgica de polipropileno, além de remoção de tecido exuberante e confecção de retalho subdérmico de avanço facial lateral para recobrimento do defeito cutâneo. A complicação evidenciada na primeira intervenção cirúrgica foi a deiscência das suturas de pele, enquanto no segundo tempo cirúrgico, não houve sinais de complicações. No pós-operatório, o paciente apresentou evolução clínica satisfatória, recebendo alta médica 21 dias após o segundo procedimento cirúrgico realizado. Tendo em vista a adequada evolução clínica, bem como os reduzidos efeitos colaterais, sugere-se que a conduta clínica e técnicas cirúrgicas adotadas para tratamento do paciente em questão foram efetivas.

Trauma is frequently reported in the small animal clinics, and can lead to fractures of cranial bone components and injuries to the adjacent soft tissues. In the present study, the objective was to report the case of a seven-month-old male mongrel dog, that had a craniomaxillofacial trauma resulting from a bite, characterized by zygomatic bone fracture and displacement, in addition to a major skin laceration. The stablished treatment was based on wound debridement, surgical stabilization of the zygomatic arch with nylon threads and in the suturing of skin wounds. In a second surgical procedure, enucleation was performed and a surgical polypropylene mesh was applied to cover the orbital defect, exuberant tissue was removed and a subdermal advancement flap was used to cover the skin defect. The complication observed in the first surgical intervention was dehiscence of the skin sutures, while in the second surgical procedure, there were no signs of complications. Postoperatively, the patient had a satisfactory clinical recovery, being discharged 21 days after the second surgical procedure. Considering the adequate clinical evolution and the reduced complications, it issuggestedthat the clinical conduct and surgical techniques adopted for the treatment of the patient in question were effective.

The effects of treatment timing on the management of patients with multiple facial fractures and on the self-perception of TMD recovery.

OBJECTIVE: To investigate the effects of time on the orofacial functions and on the self-perception of temporomandibular disorders (TMD) recovery in a population of patients with multiple facial fractures. METHODS: Orofacial functions and self-perception of TMD recovery was verified in patients with midface and/or lower face fractures. Patients were divided according to the time between fracture reduction and the clinical assessments: 0-1 month (Group 1), 1-3 months (Group 2), and 15 >3 months (Group 3). RESULTS: Patients in Group 1 presented a greater compromise of swallowing and mastication when compared to patients with older fractures (p = 0.015), whereas patients in Group 3 presented a poorer TMD recovery (TMJ pain: p = 0.010 and tinnitus: p = 0.004). CONCLUSION: Delays in functional treatments involving the myofunctional orofacial system have a negative impact on the recovery of essential orofacial functions and on TMD symptoms..

Perfil epidemiológico das fraturas de face: uma revisão de literatura / Epidemiological profile of face fractures: a literature review

As fraturas de face são um problema de saúde pública que afeta a qualidade de vida dos indivíduos que sofreram esse agravo. Sabendo-se da importância dos estudos epidemiológicos para o enfrentamento desse problema, este trabalho teve como objetivo traçar o perfil epidemiológico das fraturas de face, contribuindo assim, para a elaboração de políticas públicas mais eficazes e tratamento adequado. Para isso foi ralizada uma revisão de literatura nas principais bases de dados, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrievel System Online (MEDLINE) e Bibliografia Brasileira de Odontologia (BBO) através da Biblioteca Virtual em Saúde (BVS) e diretamente pela interface da Literature Analysis (PubMed/MEDLINE), nos últimos 20 anos, contemplando populações, culturas e faixas etárias heterogêneas. Observou-se que o sexo masculino foi o mais acometido e sua incidência foi maior entre os jovens, as principais etiologias foram às agressões físicas e os acidentes de transito sobretudo com o envolvimento de motocicletas associado ao uso de álcool e drogas. Os ossos nasais e a mandíbula foram as estruturas que sofreram mais fraturas e o tratamento mais utilizado foi a redução fechada. Neste contexto, faz-se necessário medidas ao combate às desigualdades sociais e desemprego, incentivo à educação e intensificação das leis de trânsito.

Face fractures are a public health problem that affects the quality of life of individuals who have suffered this condition. Knowing the importance of epidemiological studies to face this problem, this study aimed to outline the epidemiological profile of facial fractures, thus contributing to the development of more effective public policies and adequate treatment. For this, a literature review was carried out in the main databases, Latin American and Caribbean Literature in Health Sciences (LILACS), Medical Literature Analysis and Retrievel System Online (MEDLINE) and Brazilian Bibliography of Dentistry (BBO) through the Library Virtual Health (VHL) and directly through the Literature Analysis interface (PubMed / MEDLINE), in the last 20 years, covering heterogeneous populations, cultures and age groups. It was observed that the male gender was the most affected and its incidence was higher among young people, the main etiologies were physical aggressions and traffic accidents, especially with the involvement of motorcycles associated with the use of alcohol and drugs. The nasal bones and the mandible were the structures that suffered the most fractures and the most used treatment was closed reduction. In this context, measures are needed to combat social inequality and unemployment, encourage education and intensify traffic laws.

Caso clínico: Anestesia en trauma facial con vía aérea comprometida / Case report: Compromise airway and orofacial trauma

INTRODUCTION: Facial trauma constitutes a challenge in perioperative management, since this anatomical zone possesses com- plex vital structures such as important vessel and nerve bundles, as well as the beginning of the upper airway. That is why an injury in this region requires rapid and effective diagnosis and management since ventilation can be seriously compromised by airway obstruction, either due to the object of trauma, or inflammatory reaction and edema; bruises, burns, or direct breaka- ge. The vascular lesion can cause profuse bleeding, as well as aspiration of blood and fragments of tissues that were injured. Choosing the anesthesia technique is usually a challenge when a priori structures such as the mouth and nose are compromised. METHOD: A clinical case and bibliographic review are presented. CONCLUSION: Regional facial and neck anesthesia techniques together with adequate sedation are an alternative in the initial management of mild facial trauma.

INTRODUCCIÓN: El trauma facial constituye un reto en el manejo perioperatorio, ya que esta zona anatómica posee complejas estructuras vitales como paquetes vasculares y nerviosos, así como el inicio de la vía aérea superior. Es por ello que toda lesión en esta región requiere de un diagnóstico y manejo rápido y eficaz, puesto que la ventilación puede comprometerse gravemente por obstrucción de la vía aérea, ya sea por el objeto del trauma, reacción inflamatoria y edema; hematomas, quemaduras o rotura directa. La lesión vascular puede ocasionar sangrado profuso, así como aspiración de sangre y fragmentos de los tejidos que fueron lesionados. Elegir la técnica anestésica suele ser un reto cuando a priori estructuras como la boca y nariz se encuentran comprometidas. MÉTODO: Se presenta un caso clínico y revisión bibliográfica. CONCLUSIONES: Las técnicas de anestesia regional de cara y cuello junto a sedación adecuada son una alternativa en el manejo inicial del trauma facial leve.

Facial Trauma Prevalence from Traffic Accidents in the City of Cuenca - Ecuador, 2017 / Prevalencia de Trauma Facial por Accidentes de Tránsito en el Año 2017 en la Ciudad de Cuenca-Ecuador

Trauma is defined as physical damage by the use of external force towards the human body. (Salazar et al., 2019). The etiology of facial trauma is multifactorial. Contusions caused by traffic accidents constitute the eighth cause of death worldwide. The aim of this study is to determine the prevalence of facial trauma due to vehicular accidents in 2017, and its relationship with age, gender and frequency in the level of emergency care at Vicente Corral Moscoso (VCMH) and José Carrasco Arteaga (JCAH) hospitals. In this way, real statistical information will be registered related to the degree of trauma, main causes and initial management, providing elements for the planning and execution of new studies, thus establishing prevention measures in the city of Cuenca. This is a retrospective descriptive study, carried out with data collection and authorized analysis of cases of patients diagnosed with facial trauma due to vehicular accidents who attended VCMH and JCAH emergency units in Cuenca Ecuador, in 2017. Variables were analyzed: hospital operating units, gender, age, type of facial trauma distribution, type of vehicle and ethylic status. The total prevalence of facial trauma due to vehic ular accidents in the city of Cuenca in 2017 was 3.34 % from which, the male gender exceeded the female group, representing a 69.76 %, being the 20 to 44-year-old-group more prevalent with a 57.56 %. Panfacial trauma predominated representing a 28.48 %. The kind of vehicle which was commonly used up to a 65.69 % was an automobile. Ethyl breath was detected in 38 % of the patients. A predominance of Panfacial trauma was evidenced in the male sex and in the age group of 20-44. The kind of vehicle which was commonly used was the automobile. Ethyl status was verified in 4 of 10 patients.

El trauma es definido como un daño físico por el empleo de fuerza externa, hacia el cuerpo. (Salazar et al.). La etiología del trauma facial es multifactorial. Las contusiones causadas por accidentes de tránsito, constituyen la octava causa de muerte a nivel mundial. El objetivo de este estudio es determinar la prevalencia de trauma facial por accidente vehicular en el año 2017, y su relación con; la edad, género y frecuencia en el nivel de atención de urgencias en los hospitales Vicente Corral Moscoso (HVCM) y José Carrasco Arteaga (HJCA). De esta forma se registrará información estadística real en relación al grado de trauma, sus causas principales y manejo inicial proporcionando elementos para la planificación y ejecución de nuevos estudios, estableciendo así, medidas de prevención en la ciudad de Cuenca. Este es un estudio descriptivo retrospectivo, realizado con la recopilación de datos y el análisis autorizado de los casos de pacientes diagnosticados con trauma facial por accidente vehicular que acudieron a la unidad de urgencias del HVCM y HJCA, Cuenca Ecuador, en el año 2017. Fueron analizadas las variables: unidad operativa hospitalaria, distribución de género, edad, tipo de trauma facial, tipo de vehículo y estado etílico. La prevalencia total de trauma facial por accidente vehicular en la ciudad de Cuenca en el año 2017 fue de 3.34% de los cuales, el sexo masculino supera al grupo femenino representando el 69.76 %, siendo el grupo etario de 20 a 44 años el más prevalente con 57.56 %. Predominó el trauma panfacial, representando un 28.48 %. El vehículo de uso común fue el automóvil en un 65.69 %. En el 38 % de los pacientes se detectó aliento etílico. Se evidenció predominio del sexo masculino y del grupo de edad entre 20-44; predominó el trauma panfacial. El vehículo de uso frecuente fue el automóvil. En 4 de 10 pacientes se comprobó estado etílico.

Factors Associated With Violence Against Women and Facial Trauma of a Representative Sample of the Brazilian Population: Results of a Retrospective Study.

STUDY DESIGN: Violence against women is a challenge in public health. It involves women of all ages, socioeconomic statuses, cultures, and religions. OBJECTIVE: The objective of this study was to perform an epidemiological survey of facial trauma among women who experienced physical aggression by an intimate partner. METHODS: Electronic medical records from a public tertiary referral hospital for trauma in the Brazilian state of Espírito Santo were analyzed between 2013 and 2018. RESULTS: Patients were most commonly between 20 and 29 years of age (33.9%), and 50% of the patients were of mixed race. When separated by days of the week, facial trauma was most commonly inflicted on Sundays (24.2%) and on Saturdays (22.6%). Of the 62 women included in the study, 47 had facial fractures, and 7 had more than 1 concomitant fracture. Forty of the total fractures (72.7%) were on the middle and upper thirds of the face, while 15 fractures (27.3%) were on the lower third of the face. The most commonly observed signs and symptoms of these injuries were edema (56.5%), periorbital ecchymosis (35.5%), deviated nasal dorsum (22.6%), and hematoma (16.1%). CONCLUSIONS: Facial trauma may be considered an important marker of attempted femicide. Health care professionals must be aware of and attentive to this correlation, since many cases of attempted femicide go unnoticed or are attributed to another etiology.

Recomendaciones para la Categorización y Manejo de Pacientes con Traumatismos Faciales Durante Pandemia por COVID-19 (SARS-CoV-2). Revisión de la Literatura / Recommendations for the Categorization and Management of Patients with Facial Trauma During a COVID-19 (SARS-CoV-2) Pandemic: literature Review

El Trauma facial como tal constituye un problema de relevancia en los centros hospitalarios de alta complejidad debido a las consecuencias funcionales y estéticas que pueden conllevar. Es por eso la necesidad de un diagnóstico, respuesta asertiva y manejo adecuado de éstos y más en los tiempos de una pandemia como el COVID-19. Se revisaron diferentes protocolos respecto a la categorización y manejo de esta patología tomando en cuenta la situación pandémica que nos afecta. El objetivo de este artículo es presentar y acercar estos protocolos, y así, lograr ser un aporte a los distintos profesionales dedicados a tratamientos del trauma facial a nivel hospitalario respecto a las medidas de seguridad tanto con todo el personal como con los pacientes.

Facial trauma constitutes itself a problem of relevance in highly complex hospital centers, due to the functional and aesthetic consequences that it may entail. That is why diagnosis is needed, as an assertive response and proper management of it, mostly in times of a pandemic disease like COVID-19. Different protocols were reviewed, regarding the categorization and management of this pathology, taking into account the pandemic situation that affects us. The objective of this article is to present and bring these protocols closer together, and then, be a contribution to the different professionals dedicated to facial trauma treatments at hospital centers, regarding the safety measures with the staff and also its patients.

The marks of gunshot wounds to the face.

INTRODUCTION: This article deals with the occurrence of health problems due to gunshot wounds to the face among military police officers, in the metropolitan region of Rio de Janeiro, who were submitted to surgery at the Oral and Maxillofacial Surgery and Traumatology Clinic of Hospital Central da Polícia Militar. OBJECTIVE: To identify the profile of patients submitted to surgery as a result of gunshot wounds, the anatomical distribution of maxillofacial fractures, the identified sequelae and complications, the health specialties involved in the rehabilitation of these patients, and to discuss the social, emotional and work performance-related effects of work among these subjects. METHODS: A retrospective epidemiological study was carried out based on secondary data from military police officers who were submitted to surgery at Hospital Central da Polícia Militar due to gunshot wounds from June 2003 to December 2017. RESULTS: During the study period, 778 surgeries were performed in the operating room by the Oral and Maxillofacial Surgery and Traumatology service at Hospital Central da Polícia Militar, 186 of which were due to gunshot wounds (23.9%). All patients were males and the mean age 34.7 years. Bone segment loss was the most common sequela. Facial esthetic impairment and reports of insomnia were the most often identified late consequences of impact on health and social life. Regarding the occupational impacts of the sustained injury, the mean time away from work due to medical leave for the treatment of maxillofacial injuries was 11.7 months. CONCLUSION: The treatment of gunshot wounds patients with facial injuries requires multiple surgical interventions and their rehabilitation requires the involvement of different health specialties. Further studies are needed to qualitatively analyze the impact of this type of facial trauma on the patients' lives and their social consequences.

Tratamento de fraturas múltiplas da face associadas a ferimento extenso: relato de caso / Reconstruction of multiple face fractures associated with extensive injury: case report

As fraturas panfaciais acometem concomitantemente os terços superior, médio e inferior da face, decorrentes de acidentes automobilísticos, arma de fogo, atropelamento, agressão física, entre outros. Essas fraturas geralmente envolvem osso frontal, zigomático, maxila, mandíbula e ossos nasais, necessitando assim, fixação interna rígida através do uso de miniplacas e parafusos com o propósito de estabilizar as estruturas fraturadas, dar suporte aos tecidos moles e evitar deformidades estéticas da face. O objetivo deste trabalho é relatar o manejo cirúrgico de um caso clinico atendido em um hospital público de Salvador/BA, no qual a vítima apresenta ampla laceração na face e fratura exposta do terço médio da face. O tratamento executado sob anestesia geral foi redução dos cotos ósseos fraturados, fixação com miniplacas e parafusos, reconstrução imediata dos tecidos moles acometidos(AU)

Panfacial fractures affect concomitantly the upper, middle, lower third of the face, resulting from automobile accidents, firearms, hit-and-run, physical aggression, among others. These fractures usually involve frontal bone, zygomatic, maxilla, jaw and nasal bones, thus requiring rigid internal fixation through the use of miniplates and screws in order to stabilize fractured structures, support soft tissues avoiding aesthetic face deformities. The objective of this work is to report the surgical management of a clinical case attended in a public hospital in Salvador/BA, in which the victim has wide laceration of the face and exposed fracture of the middle third of the face. Treatment performed under general anesthesia was reduction of fractured bone stumps, fixation with miniplates and screws, immediate reconstruction of the affected soft tissues(AU)

Tratamento tardio de fratura do complexo zigomático-orbitário com uso de fixação interna rígida / Late treatment of the zygomatic-orbital complex fracture with rigid internal fixation

RESUMO: As fraturas do complexo zigomático-orbitário são bastante frequentes devido a sua localização e projeção na face, podendo gerar grandes transtornos funcionais e estéticos ao paciente. O osso zigomático é essencial na configuração da face, sendo a principal estrutura formadora do terço médio dela. Os traumas que mais frequentemente provocam fraturas do complexo zigomático-orbitário são agressões físicas, acidentes de trânsito e esportivos. O tipo de fratura, tempo decorrido, a severidade e o envolvimento de outras estruturas faciais influenciam a modalidade de tratamento a ser empregado. O presente trabalho apresenta um caso clínico de fratura do complexo zigomático-orbitário esquerdo, diagnosticada tardiamente, e tratada por meio de osteotomia, redução e fixação em três pontos com placas e parafusos do sistema 1.5, e reconstrução do assoalho orbitário com tela de titânio. (AU)

ABSTRACT: Fractures of the zygomatic-orbital complex are quite frequent due to their location and projection on the face, which can cause major functional and aesthetic disorders to the patient. The zygomatic bone is essential in the configuration of the face, being the main forming structure of the middle third of it. The traumas that most often cause fractures of the zygomatic-orbital complex are physical aggression, traffic accidents, and sports. The type of fracture, elapsed time, severity, and the involvement of other facial structures influence the type of treatment to be employed. The present work presents a clinical case of fracture of the left zygomatic-orbital complex, diagnosed late, and treated by osteotomy, reduction, and fixation in three points with 1.5 system plates and screws, and reconstruction of the orbital floor with titanium mesh. (AU)

Caracterização de lesões bucomaxilofaciais decorrentes de agressão física: diferenças entre gênero / Characterization of oral maxillofacial lesions resulting from physical aggression: differences between genders

Resumo Em países desenvolvidos, a violência é a principal causa de lesões bucomaxilofaciais (LBMF). No Brasil, há poucas evidências sobre tais lesões. Objetivou-se caracterizar as LBMF resultantes de agressão física em uma capital do nordeste brasileiro e analisar diferenças entre gêneros. Foram investigados 15.847 laudos do Instituto Médico Legal de São Luís/MA, ocorridos em 2012. Coletaram-se dados socioeconômicos, demográficos e características das LBMF. Utilizaram-se os testes Qui-quadrado e Exato de Fisher para avaliar diferenças entre gêneros. Dos casos periciados, 1977 eram LBMF. Vítimas do sexo feminino, com 20-59 anos de idade, cor parda, sem companheiro e empregadas foram mais afetadas. Lesões do tipo equimose, nas regiões bucinadora e labial, decorrentes do uso de instrumentos contundentes, ocasionando debilidade funcional permanente foram mais incidentes em mulheres (P < 0,05), ao passo que fratura dental, ferida contusa e perfurocontusa, decorrentes de instrumentos cortantes e perfurocontundentes, ocasionando deformidade permanente, incapacidade ocupacional e perigo de vida, em homens (P < 0,05). Conclui-se que a incidência de LBMF decorrente de agressão física é alta em São Luís, MA, e, embora as mulheres sejam mais acometidas, as LBMF em homens são mais severas.

Abstract In developed countries, violence is the main cause of oral maxillofacial (OMF) injuries. In Brazil, there are scant records of such lesions. The scope of this study was to detail the OMF injuries resulting from physical aggression in a capital of the Brazilian northeast and analyze gender differences. The Forensic Medicine Institute of São Luís, state of Maranhão, featured 15,847 reports, which occurred in 2012, and they were investigated. Socioeconomic, demographic data and OMF characteristics were analyzed. The Chi-square and Fisher's Exact tests were applied to assess gender differences. Of the cases examined, 1977 were OMF. Female victims, aged 20-59, dark-skinned, without a partner and maids were the most affected. Ecchymosis-type lesions, in the mouth and lip regions arising from the use of blunt instruments, causing permanent functional impairment, were the most prevalent in women (P < 0.05), whereas dental fracture and contusion arising from sharp instruments causing permanent deformity, occupational disability, and threat to life were detected in men (P < 0.05). The conclusion drawn is that the incidence of OMF due to physical aggression is high in São Luís, state of Maranhão, and although women are the most affected, the OMF in men are more severe.

Avaliação da utilização do capacete e do risco de dependência para utilização de bebidas alcoólicas nos motociclistas internados no Hospital da Restauração / Evaluation of the helmet use and the risk of dependence for the use of alcoholic beverages in the motorcyclists in the Hospital da Restauração

O objetivo deste trabalho foi avaliar o uso do capacete e o risco de dependência para utilização de bebida alcoólica nos motociclistas internados no HR. A metodologia aplicada nessa pesquisa é de natureza epidemiológica, quantitativa, descritiva e prospectiva. As seguintes variáveis foram estudadas: sexo, idade, tipo de capacete, potência da moto, finalidade de uso, ossos e fraturas, complexidade das fraturas e risco de dependência do uso álcool. Foram analisados dados de 100 pacientes, dos quais o sexo mais acometido foi o masculino na faixa etária entre 18-29 anos; a potência da moto disparadamente mais procurada pelos pacientes encontra-se acima de 50 cc, tendo sido o tipo de capacete mais utilizado o integral com viseira, porém com uma deficiência muito grande na utilização de capacete pelos motociclistas; a maior finalidade para o uso da moto pelos pacientes foi para o trabalho. O osso mais fraturado foi o zigomático. A maioria dos pacientes foi classificada com uso de baixo risco do álcool na classificação do AUDIT... (AU)

The purpose of this work was to evaluate the use of helmet and the risk of addiction to the use of alcoholic beverage in motorcyclists admitted at the HR hospital. The methodology applied in this research is epidemiological, quantitative, descriptive and prospective. The following variables were studied: gender, age, type of helmet, motor power, purpose of use, bones and fractures, fracture complexity and risk of dependence on alcohol use. Data from 100 patients were analyzed, in which male was the most affected gender in the age group 18-29 years old; The motorcycle's power most frequently sought by the patients is above 50 cc and the type of helmet most used was the integral with visor, but with a great deficiency in the use of helmets by the motorcyclists; The major purpose for motorcycle use by patients was to work. The most fractured bone was the zygomatic. The majority of patients were classified as having been included in the use of alcohol risk in the AUDIT classification... (AU)

Airway management through submental derivation: a safe and easily reproduced alternative for patients with complex facial trauma.

OBJECTIVES: Airway management in patients with panfacial trauma is complicated. In addition to involving facial lesions, such trauma compromises the airway, and the use of intermaxillary fixation makes it difficult to secure ventilation by usual approaches (nasotracheal or endotracheal intubation). Submental airway derivation is an alternative to tracheostomy and nasotracheal intubation, allowing a permeable airway with minimal complications in complex patients. MATERIALS AND METHODS: This is a descriptive, retrospective study based on a review of medical records of all patients with facial trauma from January 2003 to May 2015. In total, 31 patients with complex factures requiring submental airway derivation were included. No complications such as bleeding, infection, vascular, glandular, or nervous lesions were presented in any of the patients. RESULTS: The use of submental airway derivation is a simple, safe, and easy method to ensure airway management. Moreover, it allows an easier reconstruction. CONCLUSION: Based on these results, we concluded that, if the relevant steps are followed, the use of submental intubation in the treatment of patients with complex facial trauma is a safe and effective option.

The epidemiology of mandibular fractures in Caracas, Venezuela: Incidence and its combination patterns.

BACKGROUND/AIM: As reported in the literature by several authors, there is a great variation between countries in terms of etiology and patterns of mandibular fractures. The aim of this study was to determine the incidence of mandibular fractures at the Oral and Maxillofacial Surgery Unit, "Dr. Domingo Luciani" Hospital, Venezuela, during the period January 2010 to March 2013. MATERIALS AND METHODS: A retrospective study was conducted to assess the etiology of trauma, age group, gender, anatomic distribution of injury, and combination patterns by reviewing patients records. RESULTS: There were 334 patients with 522 mandibular fractures averaging 1.56 fractures per patient. Eighty-five percent of the patients were males with an overall male: female ratio of 6.15:1. The highest occurrence of trauma was in the 20-29 years (43.4%) age group. The etiology most frequently observed was motorcycle traffic accidents in 94 patients (28.1%), and the parasymphysis region was the most common location with 144 (27.6%) fractures. Almost half (48.8%) of the injuries were combined mandibular fractures with 29 different combinations, and the most common was a mandibular body fracture + parasymphysis fracture (22.1%). CONCLUSION: Mandibular fracture is a common facial injury with variable incidence and etiology across gender and age range. The findings of this study are similar to other studies and provide important clinical information that will assist in the treatment planning of these types of injuries.