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)

Comparison between resorbable plates vs. titanium plates for treatment of zygomatic fractures: a systematic review with meta-analysis.

PURPOSE: To compare resorbable plates with titanium plates for the fixation of zygomatic fractures, taking into account postoperative complications. METHODS: This systematic review followed the guidelines of PRISMA and the recommendations of the Cochrane Handbook and was registered in PROSPERO. The electronic search was performed in the Web of Science, PubMed, Virtual Health Library, and Cochrane Library databases and in the gray literature. The study selection and the data extraction were performed by three calibrated and independent researchers. The assessment of the risk of bias in the studies was performed using the Cochrane Risk of Bias Tool for clinical trials. Meta-analyses were performed using Review Manager Software version 5.3, using the Peto's Odds Ratios (PORs), and when I2 > 30, the random effect model was used. The evaluation of the quality of the evidence was carried out through GRADE. RESULTS: A total of 2651 studies were screened and only nine were included; 7 of which were used for quantitative assessment. The follow-up time for patients ranged from 6 months to 5 years. All studies showed a low risk of bias in the "incomplete outcome data" domain. The need for plate removal (POR: 0.11, 95% CI: 0.02 to 0.81, I2 = 0%) and dehiscence (POR 0.12, 95% CI 0.02 to 0.63, I2 = not applied) was lower for the group of patients who used resorbable plates than for titanium plates. CONCLUSION: There was no difference in the occurrence of infection, diplopia, or paresthesia between the fixation methods. Resorbable plates showed better postoperative clinical performance.

Trauma maxilofacial en el Servicio de Urgencias del Hospital Universitario "General Calixto García". 2016-2017 / Maxillofacial Trauma in the Emergency Service of General Calixto García University Hospital. 2016-2017

Introducción: La región maxilofacial es vulnerable a lesiones. En Cuba son escasos los estudios realizados sobre la atención en la urgencia dentro de la traumatología maxilofacial, por lo que surgió la motivación para realizar esta investigación. Objetivo: Caracterizar desde el punto de vista clínico-epidemiológico el trauma maxilofacial en el Servicio de Urgencias del Hospital General Calixto García en el período de junio 2016 a junio 2017. Material y Métodos: Se realizó un estudio descriptivo de corte transversal del universo de pacientes (2412 pacientes) atendidos en el Servicio de Urgencias del Hospital Universitario General Calixto García, desde junio del 2016 a junio del 2017; que tuvieron como diagnóstico trauma maxilofacial. Las variables empleadas fueron: grupos de edad, sexo, factor etiológico, tipo de lesión, conducta terapéutica. Resultados: En el estudio los pacientes con edades comprendidas entre 19 y 30 años representaron 41,0 por ciento; el sexo masculino 69,0 por ciento y los accidentes de tránsito 34,6 por ciento. Las lesiones de tejido duro más frecuentes fueron las fracturas nasales (13,9 por ciento); y de tejidos blandos las heridas puramente tegumentarias (82,1 por ciento). La colocación de vendajes se utilizó en 89,1 por ciento, y la sutura de heridas en 84,1 por ciento. Conclusiones: El comportamiento del trauma maxilofacial en el Servicio de Urgencias del Hospital Universitario General Calixto García, muestra que es predominante en hombres de edad intermedia y debido a accidentes de tránsito. Hay superioridad de lesiones de tejido blando y dentro de estas, de heridas puramente tegumentarias. La conducta conservadora, en su modalidad de colocación de vendaje, es la más empleada(AU)

Introduction: The maxillofacial region is vulnerable to injuries. In Cuba, few studies related to urgent care services have been carried out in maxillofacial traumatology, which led to an increase of motivation to conduct this research. Objective: To characterize maxillofacial trauma from a clinical and epidemiological point of view in patients treated in General Calixto García Hospital from June 2016 to June 2017. Material and Methods: A descriptive cross-sectional study was conducted with the universe of patients (2412 ones) that were treated in the Emergency Service of General Calixto García University Hospital with the diagnosis of maxillofacial trauma from June 2016 to June 2017. The variables used were: age groups, sex, etiological factor, type of injury, and therapeutic behavior. Results: In the study, the patients aged between 19 and 30 years represented 41.0 percent; the male sex 69.0 percent; and the traffic accidents 34.6 percent. The most frequent hard tissue injuries were nasal fractures (13.9 percent); and the soft tissue injuries were purely integumentary wounds (82.1 percent). Bandage placement was used in 89.1 percent, and wound suture in 84.1 percent. Conclusions: The behavior of the maxillofacial trauma in the Emergency Service of General Calixto García University Hospital, showed that it predominates in men of middle age due to traffic accidents. Soft tissue injuries were the predominant type of injuries, among them, the purely integumentary wounds. The conservative behavior in its modality of bandage placement was the most commonly used(AU)

Zygomatic arch fracture in a dog treated with Veterinary Cuttable Plate - case report / Fratura de arco zigomático em um cão tratado com placa veterinária cortável - relato de caso

The purpose of this paper is to describe a case of a right zygomatic arch fracture in a 5-year-old male Labrador Retriever diagnosed with aid of 3D Computed Tomography reconstruction. Because of the depressed fracture and interference with the eyeball, surgical repair of the right zygomatic arch fracture was performed with open reduction and stabilization with an 11-hole, 2.7mm Veterinary Cuttable Plate. Radiographs taken 60 days after surgery revealed that fracture healing occurred without complications with improved function and cosmetic appearance. Ninety days after surgery the patient was clinically discharged.(AU)

O objetivo deste trabalho é descrever um caso de fratura do arco zigomático direito em um Labrador Retriever, macho, de cinco anos de idade, diagnosticado com reconstrução 3D de tomografia computadorizada. Devido à depressão da fratura e à interferência com o globo ocular, reparação cirúrgica da fratura do arco zigomático direito foi realizada com redução aberta e estabilização com uma placa veterinária cortável de 2,7mm e 11 orifícios. As radiografias realizadas 60 dias após a cirurgia revelaram que a consolidação óssea ocorreu sem complicações, com melhor funcionalidade e aparência estética. Noventa dias após a cirurgia, o paciente teve alta clínica.(AU)

Zygomatic arch fracture in a dog treated with Veterinary Cuttable Plate - case report / Fratura de arco zigomático em um cão tratado com placa veterinária cortável - relato de caso

The purpose of this paper is to describe a case of a right zygomatic arch fracture in a 5-year-old male Labrador Retriever diagnosed with aid of 3D Computed Tomography reconstruction. Because of the depressed fracture and interference with the eyeball, surgical repair of the right zygomatic arch fracture was performed with open reduction and stabilization with an 11-hole, 2.7mm Veterinary Cuttable Plate. Radiographs taken 60 days after surgery revealed that fracture healing occurred without complications with improved function and cosmetic appearance. Ninety days after surgery the patient was clinically discharged.(AU)

O objetivo deste trabalho é descrever um caso de fratura do arco zigomático direito em um Labrador Retriever, macho, de cinco anos de idade, diagnosticado com reconstrução 3D de tomografia computadorizada. Devido à depressão da fratura e à interferência com o globo ocular, reparação cirúrgica da fratura do arco zigomático direito foi realizada com redução aberta e estabilização com uma placa veterinária cortável de 2,7mm e 11 orifícios. As radiografias realizadas 60 dias após a cirurgia revelaram que a consolidação óssea ocorreu sem complicações, com melhor funcionalidade e aparência estética. Noventa dias após a cirurgia, o paciente teve alta clínica.(AU)

Escala de severidade de trauma facial e complexidade do tratamento / Facial injury severity scale and treatment complexity

O objetivo foi avaliar se a Escala de Severidade de Trauma Facial (FISS), proposta por Bagheri em 2006, pode predizer necessidade de intervenção em centro cirúrgico, tempo de internação hospitalar e necessidade de atuação de outras especialidades médicas. Foram levantados dados nos prontuários de pacientes vítimas de trauma de face de um hospital público terciário, entre janeiro de 2009 a dezembro de 2015, relativos à idade, gênero, comorbidades, hábitos, história do trauma maxilofacial, etiologia, presença e localização de fraturas e lacerações, assim como tipo de tratamento executado e hospitalização. Foi aplicado um escore para cada paciente de acordo com a FISS. O modelo de regressão logística multinominal foi ajustado e todas as análises foram realizadas pelo pacote estatístico "Statistical Package for Social Science" (SPSS) versão 17.0 da IBM. A amostra final foi composta por 469 prontuários com média de idade de 31,38 ± 14,13 anos. Acidentes de trânsito foram a causa mais frequente (41,2%) seguido de violência interpessoal (29,4%). O osso mais fraturado foi a mandíbula (32,9%), sendo o ângulo mandibular a região mais acometida (29,0%). Pacientes que relatam uso de álcool e aqueles com FISS > 5 apresentam, respectivamente, o dobro e 18 vezes mais chances de necessitarem intervenção em centro cirúrgico. O tempo médio de internação foi 8,14 dias ± 6,02, com significância estatística de maior período de internação para pacientes tabagistas (p < 0,0001). Aqueles com FISS > 5 possuíram maiores chances de ficar mais de 3 dias internados (p = 0,01) e aqueles com algum tipo de comorbidade, mais chances de necessitarem de apoio de outras especialidades (p = 0,022), assim como aqueles com FISS > 5 têm 6,6 vezes mais esta necessidade (p < 0,0001). Maiores valores de FISS podem ser usados como um indicador de predisposição de tempo de internação hospitalar, maiores chances de pacientes serem submetidos a procedimentos cirúrgicos e destes pacientes terem necessidade de acompanhamento por outras especialidades médicas durante seu período de internação.

The objective was to evaluate whether the Facial Injury Severimty Scale (FISS), proposed by Bagheri in 2006, can predict the need for operating room interventions, the length of hospital stay and the need for treatment by other specialties. Data were collected in patients' records of those suffering from maxillofacial trauma admitted to a tertiary hospital between January 2009 and December 2015, regarding age, gender, comorbidities, habits, history of maxillofacial trauma, etiology, presence and location of fractures and lacerations and the type of treatment performed and hospitalization. Each patient received a score, according to FISS. Multinomial logistic regression model was adjusted and all analyzes were performed by the statistical package "Statistical Package for Social Science" (SPSS) version 17.0 IBM. Final sample consisted of 469 medical records with a mean age of 31.38 ± 14.13 years. Traffic accidents were the most frequent cause of facial trauma (41.2%) followed by interpersonal violence (29.4%). The most fractured bone was mandible (32.9%), with and mandibular angle, the most affected region (29.0%). Patients reporting alcohol use and those with FISS > 5 present, respectively, twice and 18 times more likely to require intervention in an operating room. Mean length of hospital stay was 8.14 days ± 6.02, with a longer hospitalization period for smokers (p < 0.0001). Patients with FISS > 5 were more likely to be hospitalized for more than 3 days (p = 0.01) and those with some comorbidity, more likely to require support from other specialties (p = 0.022), as well as those with FISS > 5 were 6.6 times more likely to need other specialties (p <0.0001). Higher FISS values can be used as an indicator of predisposition to hospitalization time, greater chances of patients being submitted to surgical procedures and of these patients needing follow-up by other medical specialties during their hospitalization period.

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.