Actualización de la Epidemiología de Tratamientos Quirúrgicos Maxilofaciales en Hospital Público de Santiago de Chile: Estudio Comparativo - Retrospectivo de 4 Años / Epidemiological Update of Maxillofacial Surgical Treatments in a Public Hospital in Santiago de Chile: A Comparative Retrospective Study of 4 Years

La cirugía maxilofacial es una especialidad médico quirúrgica que se encarga tanto del diagnóstico como del tratamiento de enfermedades que afecta al territorio craneofacial. En Chile existen pocos estudios epidemiológicos en cirugía maxilofacial que describan con detalle el tipo de intervenciones realizadas más allá del trauma maxilofacial, y que además involucren el período por pandemia COVID-19. El objetivo del estudio fue actualizar la epidemiología de resolución quirúrgica bajo anestesia general en el Hospital San José de Santiago de Chile entre los años 2018 y 2021 y compararlo con el estudio realizado en mismo recinto entre los años 2007 y 2013. Se realizó un estudio retrospectivo con 607 pacientes. Se recopiló información de acuerdo a edad, género del paciente y tipo de intervención. Del total de intervenciones realizadas, 176 (29%) correspondieron a trauma maxilofacial y 431 (71%) a cirugías de etiología no traumática. Edad promedio de 38,7 años. Proporción entre el sexo masculino y femenino de 1,28:1. La fractura más frecuente fue la mandibular (59,66%), seguida de la orbito cigomática (23,86%) y la panfacial (4,55%). En las cirugías de etiología no traumática predominaron las intervenciones por dismorfosis dentofaciales (23,2%), seguido tumores de los maxilares (20,41%), lesiones orales (18,56%), defocaciones dentarias (16,24%), infecciones (8,81%), patologías de articulación temporomandibular (8,35%) y finalmente retiro de material de osteosíntesis (4.41%). Las intervenciones de etiología no traumática y la resolución de fracturas mandibulares fueron los procedimientos más realizados por la unidad. El conocimiento de estos datos y la comparación con el estudio anterior permite observar el cambio en la epidemiologia, que puede explicarse por la pandemia por COVID-19. Considerando lo anterior, ambos tipos de intervenciones deben ser abordadas de manera integral y con las condiciones adecuadas. Para ello es importante enfocar los recursos en esas áreas y desarrollar mayor entrenamiento en las mismas.

Maxillofacial surgery is a medical- surgical specialty that deals with both diagnosis and treatment of diseases affecting the craniofacial territory. In Chile there are few epidemiological studies in maxillofacial surgery that describe in detail the type of interventions performed beyond maxillofacial trauma, and that also involve the COVID-19 pandemic period. The aim of the study was to update the epidemiology of surgical resolution under general anesthesia at the Hospital San José in Santiago de Chile between 2018 and 2021 and to compare it with the study performed at the same hospital between 2007 and 2013. A retrospective study was performed with 607 patients. Information was collected according to age, patient gender and type of intervention. Of the total number of interventions performed, 176 (29%) corresponded to maxillofacial trauma and 431 (71%) to surgeries of non-traumatic etiology. Average age of 38.7 years. Male to female sex ratio of 1.28:1. The most frequent fracture was mandibular (59.66%), followed by orbito-zygomatic (23.86%) and panfacial (4.55%). In surgeries of non-traumatic etiology, interventions for dentofacial dysmorphosis predominated (23.2%), followed by tumors of the jaws (20.41%), oral lesions (18.56%), dental defocations (16.24%), infections (8.81%), temporomandibular joint pathologies (8.35%) and finally removal of osteosynthesis material (4.41%). Interventions of non-traumatic etiology and resolution of mandibular fractures were the procedures most performed by the unit. The knowledge of these data and the comparison with the previous study allows us to observe the change in epidemiology, which can be explained by the COVID-19 pandemic. Considering the above, both types of interventions should be approached in a comprehensive manner and with the appropriate conditions. To this end, it is important to focus resources in these areas and to develop more training in them.

A model to predict postoperative complications for otorhinolaryngology and maxillofacial surgery procedures in elderly patients.

PURPOSE: All kinds of ear, nose, and throat and maxillofacial surgery (ENT/MFS) procedures are being increasingly performed in the elderly although old age is a major risk factor for increased postoperative complications. With only scarce evidence on the topic, surgeons are asked to critically evaluate their procedures' indications and outcomes to balance the treatment risks and benefits. Our primary aim was to identify predictive factors for surgical outcomes in this setting and to create a predictive model for a tailored risk assessment. METHODS: We analyzed a case series of 435 patients from an institutional clinical database at our academic tertiary care center. Multivariate logistic regression was used to identify all possible covariates and nomograms using stepwise backward method were generated. The performance was assessed by calibration curves and c-index. RESULTS: Overall complication rate was 18.3% within the first 30 days and the need for re-intervention was 5.9%. For those under general anesthesia, we identified specific risk factors and developed three risk-predicting models of overall, early, and late complications. All of the nomograms showed satisfactory accuracy with a c-index of 0.83, 0.75, 0.86, and 0.82, respectively. CONCLUSION: Using clinical preoperative variables, we constructed a model for predicting major adverse events in ENT/MFS patients. In our experience, patients over 65 showed a non-negligible risk for postoperative complications depending on several factors. Such tools might help in decision-making, by increasing the risk-awareness of clinicians, to better address peri-operative and post-operative care of these patients.

The high sub-mandibular approach: Our experience about 496 procedures.

INTRODUCTION: The potential drawbacks of surgical approaches to neck and base fractures of the mandibular condyle (visible scare, facial nerve injury) are still considered by many surgeons as a brake for open reduction and internal fixation. The aim of our study was to analyze the results in terms of access, scare quality and complications that could be noticed in a 12 years period of time with the use of the high sub-mandibular approach (HSMA) we first described in 2006 for the surgical treatment of neck and base fractures. MATERIAL AND METHOD: All the files of patients operated on for condylar neck and base fractures approached by mean of a HSMA between January 2006 and December 2018 in our department and containing information concerning age, sex, type of fracture, kind of osteosynthesis material, operating time, name of the surgeon, postoperative complication linked to the approach, scare quality at 6 months follow-up at least were included. The skin incision and the dissection planes followed the original publication of Meyer et al. in 2006. RESULTS: 434 patients (sex ratio: 2.06, mean age: 32, 496 approaches) met the inclusion criteria. Following the AO classification, 21.2% of the fractures were classified as neck fractures and 78.8% as base fractures. 97.6% of all fractures were stabilized by mean of a 3D plate (TCP® plate, Medartis, Basel-CH), the remaining ones by mean of a combination of 1.2, 1.5 and 2.0 straight plates. Mean operating time was 40minutes per side. Patients were operated on by senior surgeons in 71.7% of the cases and by trainees under supervision for the others. Concerning the complications linked to the approach, we noticed 11 (2.2%) temporary (0 definitive) paresis of the facial nerve, 1 (0.2%) hematoma and 1 (0.2%) abscess that both needed revision. Scare was hypertrophic or considered as unaesthetic by the patient in 5 cases (1%). DISCUSSION: The HSMA, if performed as initially described, is a safe and quick procedure compared to other cutaneous approaches. It gives access to all base fractures and to most of neck fractures. The very low rate of facial nerve complications is mainly explained by the plane by plane dissection making it very easy to avoid the facial nerve branches or to check them when encountered. The HSMA is particularly suited to the use of TCP plates as the upper holes of these plates, placed horizontally, are easy to reach from below. The HSMA is therefore still our preferred cutaneous approach to the condylar process.

Epidemiología de Tratamientos Quirúrgicos Maxilofaciales en un Hospital Público en Santiago de Chile: Estudio Retrospectivo de 5 Años / Epidemiology of Maxillofacial Surgical Treatments in a Public Hospital in Chile: A 5-Year Retrospective Study

Pocos estudios epidemiológicos en cirugía maxilofacial describen en forma detallada las características de los pacientes y los tipos de intervención realizadas. El objetivo de este estudio fue conocer la epidemiología de las intervenciones quirúrgicas maxilofaciales realizadas bajo anestesia general en el Hospital Clínico San José. Se realizó un estudio retrospectivo con 599 pacientes entre los años 2007 y 2013. Se recopiló información de acuerdo a edad, género del paciente y tipo de intervención. Del total de intervenciones realizadas, 335 (56%) correspondieron a trauma maxilofacial y 264 (44%) a cirugías de etiología no traumática. Edad promedio de 38 años. Proporción entre el sexo masculino y femenino de 2,05:1. La fractura más prevalente fue la mandibular con un 49,8%, luego la orbitocigomatica 28,3%, panfacial 13,7%, huesos de órbita 2,98%, Le Fort 2,7%, cigomático 2,1% y nasoorbitoetmoidal con 0,43%. En tanto las cirugías de etiología no traumática, infecciones 12,1%, tumores 12%, dismorfosis cráneofacial 11,8%, exodoncias múltiples en pacientes con desórdenes neurológicos 2,3%, reconstrucciones estéticas 2,1%, patologías de articulación temporomandibular 1,6%, distintas lesiones orales 1,1%, displasias 0,3% y retiro de osteosíntesis 0,3%. La reducción y fijación con osteosíntesis de fracturas faciales fueron los procedimientos más realizados por la unidad. El conocimiento de estos datos permite saber en qué áreas enfocar el presupuesto del departamento, y en que se requiere mayor especialización. Además de mostrar la necesidad de mayor número de horas de pabellón requeridos.

Few epidemiological studies in maxillofacial surgery describe in detail the characteristics of patients and types of intervention undertaken. The aim of this study was to determine the epidemiology of maxillofacial surgical procedures performed under general anesthesia at the Clinical Hospital San José. A retrospective study, which included 599 patients, was carried out between 2007 and 2013, according to information obtained on age, patient sex and type of intervention. Of the total procedures performed, 335 (56%) were maxillofacial trauma and 264 (44%) were non-traumatic surgeries. Average age was 38 years old. Ratio between male and female was 2.05:1. The most prevalent was mandibular fracture with 49.8%, subsequently orbito zigomatic fractures with 28.3%, panfacial with 13.7%, orbital bones 2.98%, Le Fort 2.7%, and zygomatic bone 2.1% and naso orbitoetmoidal with 0.43%. In both non traumatic surgeries the following was reported, infections 12.1%, tumors, 12%, craniofacial dysmorphosis 11.8%, multiple extractions in patients with neurological disorders 2.3%, aesthetic reconstructions 2.1%, temporomandibular joint disorders 1.6%, various oral lesions 1.1%, dysplasias 0.3% and osteosynthesis withdrawal 0.3%. Most frequent procedures performed were reduction and osteosynthesis fixation of facial fractures. Knowledge of these data provides information as to which areas to focus the department's budget on, areas in which greater specialization is required, and reinforcing the need for requirement of additional hours in the operating room.

A Simple Technique to Fabricate a Facial Moulage with a Prefabricated Acrylic Stock Tray: A Clinical Innovation.

An accurate facial moulage helps in understanding the orientation and proper position of the facial prosthesis relative to other facial landmarks even in the absence of the patient. To make impression for fabricating facial moulage previously described techniques in literature made use of elastomeric impression material, alginate, and dental plaster directly over the patient's face to obtain the moulage which have their own disadvantages. Taking these into consideration a novel clinical technique is described herein to fabricate an acrylic stock tray for making accurate impression and to support the impression material while setting and pouring.