A novel image-based retrieval system for characterization of maxillofacial lesions in cone beam CT images.

PURPOSE: The objective of medical content-based image retrieval (CBIR) is to assist clinicians in decision making by retrieving the most similar cases to a given query image from a large database. Herein, a new method for content-based image retrieval of cone beam CT (CBCT) scans is presented. METHODS: The introduced framework consists of two main phases: training database construction and querying. The goal of the training phase is database construction, which consists of three main steps. First, automatic segmentation of lesions using 3D symmetry analysis is performed. Embedding the prior shape knowledge of the 3D symmetry characteristics of the healthy human head structure increases the accuracy of automatic segmentation. Then, spatial pyramid matching is used for feature extraction, and the relative importance of each feature is learned using classifiers. RESULTS: The method was applied to a dataset of 1145 volumetric CBCT images with four classes of maxillofacial lesions. A symmetry-based analysis model for automatic lesion segmentation was evaluated using similarity measures. Mean Dice coefficients of 0.89, 0.85, 0.92, and 0.87 were achieved for maxillary sinus perforation, radiolucent lesion, unerupted tooth, and root fracture classes, respectively. Moreover, the execution time of automatic segmentation was reduced to 3 min per case. The performance of the proposed search engine was evaluated using mean average precision and normalized discounted cumulative gain. A mean average retrieval accuracy and normalized discounted cumulative gain of 0.90 and 0.92, respectively, were achieved. CONCLUSION: Quantitative results show that the proposed approach is more effective than previous methods in the literature, and it can facilitate the introduction of CBIR in clinical CBCT applications.

Fracturas del complejo cigomático / Fractures of the zygomatic complex

Introducción: El complejo cigomático maxilar con su convexidad prominente, es muy vulnerable a las lesiones. Objetivo: Abordar elementos actuales sobre el diagnóstico, clasificación, tratamiento y complicaciones de las fracturas del complejo cigomático. Métodos: Se realizó una revisión bibliográfica en septiembre de 2016. Se evaluaron revistas de impacto de Web of Sciencies (29 revistas) y 2 libros. Se consultaron las bases de datos de MEDLINE, PubMed y SciELO con los descriptores: zygomatic fracture, treatment, epidemiology. Se incluyeron artículos en idioma inglés, preferentemente de los últimos 5 años. Se obtuvieron 109 artículos. El estudio se circunscribió a 41. Análisis e integración de la información: El correcto diagnóstico basado en los hallazgos clínicos y medios auxiliares de diagnóstico, permite clasificar la fractura. La clasificación más empleada en nuestro medio es la de las Guías Prácticas de Estomatología. Las modalidades terapéuticas pueden incluir el tratamiento quirúrgico con el uso de métodos de fijación que permiten mayor o menor estabilidad. Las complicaciones pueden aparecer. Conclusiones: La proyección anatómica de los huesos malares justifica la incidencia de estas fracturas. El diagnóstico debe basarse en el interrogatorio, examen físico y los medios auxiliares de diagnóstico imaginológicos. La radiografía Waters es una buena opción de imagen. Al clasificar la fractura se establece un plan de tratamiento basado en la valoración individual de cada caso con el objetivo de evitar complicaciones posteriores(AU)

Introduction: Due to its prominent convexity, the zygomaticomaxillary complex is very vulnerable to injuries. Objective: Address current notions about the diagnosis, classification, treatment and complications of fractures of the zygomatic complex. Methods: A literature review was conducted in September 2016. The evaluation included high impact journals from the Web of Science (29 journals) and 2 books. The databases MEDLINE, PubMed and SciELO were consulted, using the search terms zygomatic fracture, treatment, epidemiology. Papers written in English were included, preferably from the last five years. Of the 109 papers obtained, the study considered 41. Data analysis and integration: Appropriate diagnosis based on clinical findings and the use of diagnostic aids allows classification of the fracture. The classification most commonly used in our environment is that of the Dental Practice Guidelines. Therapy modes may include surgery with fixation methods allowing greater or lesser stability. Complications may appear. Conclusions: The anatomical protrusion of malar bones accounts for the incidence of these fractures. Diagnosis should be based on interrogation, physical examination and the use of auxiliary diagnostic imaging. Waters radiography is a good imaging option. Upon classification of the fracture, a treatment plan is devised based on individual assessment of each case so as to prevent future complications(AU)

Fracturas del complejo cigomático / Fractures of the zygomatic complex

Introducción: El complejo cigomático maxilar con su convexidad prominente, es muy vulnerable a las lesiones. Objetivo: Abordar elementos actuales sobre el diagnóstico, clasificación, tratamiento y complicaciones de las fracturas del complejo cigomático. Métodos: Se realizó una revisión bibliográfica en septiembre de 2016. Se evaluaron revistas de impacto de Web of Sciencies (29 revistas) y 2 libros. Se consultaron las bases de datos de MEDLINE, PubMed y SciELO con los descriptores: zygomatic fracture, treatment, epidemiology. Se incluyeron artículos en idioma inglés, preferentemente de los últimos 5 años. Se obtuvieron 109 artículos. El estudio se circunscribió a 41. Análisis e integración de la información: El correcto diagnóstico basado en los hallazgos clínicos y medios auxiliares de diagnóstico, permite clasificar la fractura. La clasificación más empleada en nuestro medio es la de las Guías Prácticas de Estomatología. Las modalidades terapéuticas pueden incluir el tratamiento quirúrgico con el uso de métodos de fijación que permiten mayor o menor estabilidad. Las complicaciones pueden aparecer. Conclusiones: La proyección anatómica de los huesos malares justifica la incidencia de estas fracturas. El diagnóstico debe basarse en el interrogatorio, examen físico y los medios auxiliares de diagnóstico imaginológicos. La radiografía Waters es una buena opción de imagen. Al clasificar la fractura se establece un plan de tratamiento basado en la valoración individual de cada caso con el objetivo de evitar complicaciones posteriores(AU)

Introduction: Due to its prominent convexity, the zygomaticomaxillary complex is very vulnerable to injuries. Objective: Address current notions about the diagnosis, classification, treatment and complications of fractures of the zygomatic complex. Methods: A literature review was conducted in September 2016. The evaluation included high impact journals from the Web of Science (29 journals) and 2 books. The databases MEDLINE, PubMed and SciELO were consulted, using the search terms zygomatic fracture, treatment, epidemiology. Papers written in English were included, preferably from the last five years. Of the 109 papers obtained, the study considered 41. Data analysis and integration: Appropriate diagnosis based on clinical findings and the use of diagnostic aids allows classification of the fracture. The classification most commonly used in our environment is that of the Dental Practice Guidelines. Therapy modes may include surgery with fixation methods allowing greater or lesser stability. Complications may appear. Conclusions: The anatomical protrusion of malar bones accounts for the incidence of these fractures. Diagnosis should be based on interrogation, physical examination and the use of auxiliary diagnostic imaging. Waters radiography is a good imaging option. Upon classification of the fracture, a treatment plan is devised based on individual assessment of each case so as to prevent future complications(AU)

Bone fractures: assessment and management.

Severe dental traumatic injuries often involve the supporting bone and soft tissues. This article outlines the current concepts in the management of dentoalveolar fractures for the general dental practitioner with case reports to illustrate management principles and techniques.

Clinical characteristics and treatment of superolateral dislocation of the mandibular condyle.

The aim of this retrospective study was to investigate the clinical characteristics of superolateral dislocation of the mandibular condyle, and to review our experience of its treatment. Thirteen patients were included in this study. Demographic information and details of their original injury were analyzed by descriptive statistics and the treatment methods were summarized. These patients could be classified into three types: (1) unilateral dislocation with isolated condylar fracture (n=3); (2) unilateral dislocation with associated condylar fracture and other mandibular fracture (n=7); (3) bilateral dislocation with associated condylar fracture and other mandibular fracture (n=3). Treatment involved three main aspects: (1) relief of the condylar dislocation by manual manipulation or open reduction; (2) reduction of the medial condylar fragment and fixation with screws, or removal of the fragment if less than 50% of the condylar width; however, in one case with a tiny condylar fragment, this was left in situ; (3) management of the other associated mandibular fractures by open reduction and internal fixation (ORIF). Follow-up ranged from 6 to 20 months (average 13.69 months). Satisfactory functional outcomes were achieved in these cases. The results of this study indicate that superolateral dislocation of the condyle assumes many forms, and the treatment depends on the presence of fractures.

Pediatric facial fractures from dog bites.

PURPOSE: To report a series of pediatric facial fractures associated with dog bites. METHODS: Retrospective review of all dog bite injuries to the face with facial fractures in children from January 1, 2003, to October 31, 2011, at Children's Hospital Colorado (Aurora, Colorado). Patient demographics, location and number of fractures, clinical course, surgical repair, and complications were recorded and analyzed using Excel statistical software. RESULTS: Seventeen of 1,201 (1.4%) children with dog bite injuries to the face also sustained facial fractures. The average age of patients was 3.9 ± 3.2 years and 53% were female. Thirty-five percent of patients presented with multiple facial fractures. The most common fracture involved the nasal bone (29%), while the remainder sustained fractures of the zygomatic arch, orbital rim, orbital floor, skull, mandible, maxilla, and/or sinuses. Of the 17 patients, 41% also sustained eyelid lacerations, 24% had injuries to the facial nerve, and 18% had canalicular lacerations. Fourteen of the 17 patients required surgical repair under general anesthesia. CONCLUSIONS: Although uncommon, facial fractures associated with dog bites are a significant source of morbidity, often requiring complex surgical repair. Severe injuries to the face from dog bites should be evaluated for possible fractures in addition to soft tissue injuries.

Traumatismos maxilofaciais em crianças e adolescentes em Campina Grande, Paraíba, Brasil / Maxillofacial traumatisms in children and adolescents in Campina Grande, Brazil

Objetivo: Avaliar os traumatismos maxilofaciais em crianças e adolescentes no município de Campina Grande, Paraíba, Brasil. Método: Estudo transversal com dados secundários, sendo a amostra composta por 941 prontuários de pacientes com idades entre 1 a 18 anos portadores de trauma facial atendidos no período de junho de 2007 a junho de 2009 em dois centros de trauma do município. As variáveis estudadas compreenderam: sexo, idade, etiologia, existência de fratura facial, osso acometido e trauma dentário. A análise estatística foi utilizou os testes do Qui-quadrado e Exato de Fisher com nível de significância de 5% (p menor que 0,05). O odds ratio (OR) com intervalo de confiança de 95% foi calculado (IC 95%). Todas as análises foram feitas com o software Epi Info 3.5. Resultados: A razão entre os sexos masculino e feminino foi de 2:1 e a faixa etária de maior acometimento foi a de 1 a 4 anos (28,5%). As quedas (40,6%) e os acidentes de transporte terrestre (20,1%) foram os agentes etiológicos mais prevalentes. Observou-se associação entre o sexo e a ocorrência de acidente de transporte (p=0,001; OR=1,85 [1,28-2,69]. Fraturas faciais foram verificadas em 15,8% das vítimas, existindo associação entre o sexo e a ocorrência de fratura facial (P=0,047; OR=1,5 [1,02-2,25]), predominando os ossos nasais (31,5%) e o zigomático (22,8%). Traumatismo dentário foi identificado em 10,2% das vítimas, não existindo diferença estatística entre o sexo e a presença de trauma dentário (P=0,356). Conclusão: Crianças de baixa idade são as vítimas mais comuns de traumatismos maxilofaciais, com a maioria dos casos ocorrendo nos finais de semana e as quedas e os acidentes de transporte terrestre constituindo-se nos principais agentes etiológicos.

Objective: To evaluate the maxillofacial traumatisms in children and adolescents in the city of Campina Grande, PB, Brazil. Method: This investigation was a cross-sectional study with secondary data and sample composed of 941 charts of 1-18-year-old patients with facial trauma treated between June 2007 and June 2009 at two trauma centers. The studied variables were: sex, age, etiology, existence de facial fracture, affected bone and dental trauma. Comparisons of data were evaluated statistically using the Chi-square and Fisher's Exact tests at a significance level of 5% (p less than 0.05). Odds ratio (OR) with confidence intervals to 95% were calculated (CI 95%). They were calculated using the Epi Info Software. Results: The male-to-female ratio was 2:1 and the 1-4-year-old age group was the most affected (28.5%). Falls (40.6%) and road transport accidents (20.1%) were the most prevalent etiologic agents. There was association between sex and occurrence of transport accident (p=0.001; OR=1.85 [1.28-2.69]). Facial fractures were verified in 15.8% of the victims, existing an association between sex and occurrence of facial fracture (p=0.047; OR=1.5 [1.02-2.25]), with predominance of nasal bones (31.5%) and zygomatic bone (22.8%). Dental trauma was identified in 10.2% of the victims, with no statistically significant difference between sex and the presence of dental trauma (p=0.356). Conclusion: Children at early age are the most frequent victims of maxillofacial traumatisms, with most cases occurring during weekends, and falls and road transport accidents being the main etiological agents.

[Computer-assisted reconstruction of the facial skeleton]. / Die computergestützte Gesichtsschädelrekonstruktion.

Injury to the facial skeleton may result not only in aesthetic but also functional deficits. Computer-assisted surgery promises predictable reconstructive results. In clinical routine the authors use the combination of preoperative planning, intraoperative navigation and intraoperative imaging to treat complex facial trauma. With preoperative planning the intended reconstructive results can be precisely preplanned and guided intraoperatively using navigational surgery. Intraoperative imaging achieves the final intraoperative validation. Using computer-assisted surgery dislocation and malformation of fragments and transplants can be avoided in facial reconstruction. This means reliable quality control of surgical outcome and the number of further surgeries can be reduced in this complex reconstructive surgery.

[Penetrating injuries in the face and neck region. Diagnosis and treatment]. / Penetrierende Gesichts- und Halsverletzungen. Diagnostik und Therapie.

Penetrating head and neck injuries often present with vascular lesions and airway compromise and may be life-threatening. Thus controlling bleeding and airway stabilisation take priority in emergency treatment. High-velocity projectiles, fragmentations from improvised explosive devices (IEDs) and shrapnel can cause severe tissue injury, representing a challenge for the head and neck surgeon. Since several organ structures, such as the eyes, midface, pharynx, larynx, trachea, esophagus, nerves, vessels and vertebral spine can be injured at the same time, patients should be referred to a specialized trauma center for interdisciplinary treatment following emergency treatment. High-speed ballistic injuries were once confined to the battle field and have been uncommon in Europe since World War II. For this reason, experience among civilian head and neck surgeons is at present limited. With the increased incidence of terrorism and the use of IEDs as the preferred weapon in terrorism it has become important for civilian head and neck surgeons to understand the role of ballistic injuries in mass casualty events. The present paper discusses current viewpoints in the diagnosis and treatment of penetrating head and neck injuries.

Management of trauma to supporting dental structures.

Teeth, periodontium, and supporting alveolar bone are frequently involved in trauma and account for approximately 15% of all emergency room visits. The cause of the dentoalveolar trauma varies in different demographics but generally results from falls, playground accidents, domestic violence, bicycle accidents, motor vehicle accidents, assaults, altercations, and sports injuries. Dentoalveolar injuries should be considered an emergency situation because successful management of the injury requires proper diagnosis and treatment within a limited time to achieve better outcomes.

Posttraumatic facial restoration: a philosophy of care.

Posttraumatic facial restoration requires the marriage of both aesthetic and reconstructive principles. An outline for the treatment of traumatic facial injuries is presented.

Fraturas odontomaxilares e mandibulares em eqüídeos tratados por diferentes técnicas de osteossíntese / Odontomaxillares and mandibularies fractures in equides treated with different osteosynthesis techniques

Oito eqüinos e um muar com fraturas odontomaxilares e mandibulares foram tratados com diferentes técnicas de osteossíntese modificadas, consistindo de cerclagens associadas ou não a bandas de tensão, placa de neutralização e pino intraosseo, sendo este aplicado com metodologia não encontrada na literatura consultada. Os procedimentos cirúrgicos nos eqüideos foram realizados com os animais em estação mediante contenção física, em brete, e química, com sedação ou neuroleptoanalgesia associada a bloqueios anestésicos regionais. Os animais apresentaram capacidade de mastigação e ingestão voluntária no pós-operatório imediato e recuperação óssea adequada.

Eight equines and one mule with odontomaxillaries and mandibularies fractures were treated with different osteosynthesis modified techniques, consisting of cerclages with or without tension bands, neutralization plates, and intraosseous pin applied by a methodology which was not found in the literature. The surgery procedures in equides were performed with the animals in stand position under physical contention, sedation, or neuroleptoanalgesy and regional nerve block. All animals were able to eat voluntarily in the immediate post-operatory time and had good bone recuperation.

Importância clínica do diagnóstico de fratura da crista alveolar nos procedimentos de expansão rápida de maxila assistida cirurgicamente / Clinical importance of alveolar crest fracture diagnosis on the surgically assisted rapid maxillary expansion

A expansão rápida da maxila assistida cirurgicamente (ERMAC) tem sido cada vez mais utilizada no tratamento de pacientes portadores de deficiências transversais de maxila, após a fase de crescimento. Durante o trans-operatório, podem ocorrer dos tipos de fraturas na crista óssea alveolar entre os incisivos centrais superiores: a fratura simétrica e a assimétrica. A utilização de um protocolo de ativação do parafuso expansor, após a cirurgia, sem levar em consideração as particularidades da fratura da crista alveolar pode resultar em complicações tardias como: mobilidade dentária, criação de defeitos ósseos permanentes e prejuízo estético do sorriso. Sendo assim, é importante reconhecer o tipo de fratura, por meio de diagnósticos acessíveis como as técnicas de radiografia periapical e oclusal, para estabelecer uma melhor conduta em relação ao período, tipo ou quantidade de ativação pós-operatória do parafuso expansor.

Intimate partner violence: implications for critical care nursing.

IPV presents a serious health risk to many women. Emergency and critical care nurses are in a prime position for identification of and intervention with these women. Careful assessment and recognition of symptoms and conditions associated with IPV helps nurses to identify victims and potential victims. Building a trusting and supportive environment, where women feel comfortable disclosing abuse, precedes effective intervention. Nursing practice can incorporate the myriad resources and successful programs to provide victims with quality care. Before discharge from the critical care unit or ED, nurses can help women to identify their risk and plan for safety. Effective nursing care in IPV combines the traditional critical care nursing skills synergistically with provision for the biopsychosocial needs of patients.

[Tooth and jaw injuries following violence--diagnosis and treatment in emergency department]. / Tann- og kjeveskader etter vold--diagnostikk og behandling på legevakten.

Research over the last decade has confirmed that facial injuries caused by violence occur most frequently among young males, often under the influence of alcohol, and less frequently in women and children following domestic violence. Evidence of injuries may be used in court or in claims for compensation, and must be carefully documented. Facial asymmetry, deviation of the mandible in opening, altered occlusion and/or abrasions under the chin may be indications of jaw fractures; such patients are referred to oral surgery units for further treatment. Lacerations and ulceration in the oral mucous membrane should be treated as skin wounds. A fractured tooth should be referred to a general dental practitioner. Luxated teeth should be carefully replaced and immediately referred to a dentist for fixation. Completely avulsed teeth should immediately be replaced, preferably at the site of the accident, or immediately upon arrival at the clinic. Prompt referral to a dental practitioner for follow-up treatment is essential for the success of replantations. Additional documentation of the injury may be provided by photographs, radiographs and drawings. The letter of referral to the dentist should contain the following information: data on the patient, the circumstances, clinical findings, treatment performed and prescriptions given, together with advice given to the patient.

A management strategy for palatal fractures: a 12-year review.

Fractures of the palate are frequently associated with the more common and well-described Le Fort fractures. Palatal fractures may present diagnostic and exposure challenges and, if not satisfactorily treated, will result in occlusal problems after surgery. From 1986 through 1998, 116 complex maxillary fractures were treated at the authors' center. Among these, 13 patients were diagnosed with fracture of the palate. Patients with gunshot wounds to the face were excluded from the present study. Open reduction and internal fixation of the palatal fractures were achieved through elevation of the entire palatal mucoperiosteal flap to avoid late hardware exposure. This paper presents a unique approach to visualizing the whole bony palatal surface for accurate reduction and internal fixation of fractures.

Fractures of the maxilla.

A basic understanding of midface fractures is essential for those involved in the initial evaluation, emergency and general management, diagnosis, specialty consultation, and maxillofacial surgery of patients with fractures of the maxilla. To achieve the goal of restoring proper form and function to the upper jaw and face, one must be able to recognize, diagnose, and treat maxillary fractures. This requires knowledge of the anatomy and physiology of the midface, as well as modalities of evaluation and treatment. Each of these topics are summarized in this paper.