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)

A retrospective study of isolated fractures of the alveolar process in the permanent dentition.

BACKGROUND/AIM: There is a lack of studies of fractures of the alveolar process (FAP). Only five were published in the last 50 years. The aim of this study was to analyze the risk of pulp necrosis and infection (PN), pulp canal obliteration (PCO), infection-related root resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) as well as to identify the possible risk factors for teeth involved in an isolated alveolar process fracture. In the second part, any late complications of the involved teeth were reported in patients who responded to a follow-up examination. MATERIAL AND METHOD: This study was a retrospective analysis of 126 patients with 329 traumatized permanent teeth treated in a regional dental trauma clinic. Follow-up examination was performed on 31 (24.6%) patients with 75 (22.8%) teeth. The risks of PN, PCO, RR, MBL, and TL were analyzed using the Kaplan-Meier method. Possible risk factors for PN (stage of root development, fracture position in relation to the root apex, concomitant injury, treatment delay, and antibiotics) were analyzed using univariate and multivariate Cox regression and generalized estimating equation. The level of significance was 5%. RESULTS: Pulp necrosis was observed in 43% of the teeth, and it was significantly associated with the presence of a concomitant injury and complete root formation. PCO was recorded in 2.8%, root resorption (RR, IRR, and ARR) in 4%, MBL in 8%, and TL in 0.6% of the teeth. Thirty-four percent of the teeth were assumed to have normal pulps, but they did not respond to pulp sensibility testing. At the follow-up examination, PN was found in 49%, PCO in 28%, RR (IRR and ARR) in 4%, MBL in 17%, and TL in 5%. Estimated risk after a 5-years follow up was as follows: PN: 48.2% (95% confidence interval (CI): 42.0-54.5), IRR: 7.2 (95% CI: 3.5-10.9), ARR: 33.0% (95% CI: 22.4-43.6), BL: 16.7% (95% CI: 9.6-23.8), TL: 4.0% (95% CI: 0.0-8.5). The following factors significantly increased the risk of PN: mature root development (hazard ratio [HR]: 7.50 [95% CI: 1.84-30.64], P=.005) and concomitant injury (HR: 2.68 [95% CI: 1.76-4.09], P<.001). In a logistic regression model, teeth with mature roots had a threefold risk of becoming non-responsive to pulp testing. CONCLUSION: Teeth involved in an isolated alveolar process fracture and managed with a conservative treatment approach appear to have a good prognosis. The most common complication was PN which did not negatively affect the survival of the teeth after root canal treatment.

Prognosis of teeth in the line of jaw fractures.

BACKGROUND/AIM: The decision as to whether teeth in the line of jaw fractures should be extracted or retained remains a controversial issue. The aim of this study was to assess the prognosis of teeth directly in the line of, and adjacent to, jaw fracture sites. MATERIALS AND METHODS: The study consisted of 50 patients with facial fractures in the dentate region, the diagnosis of which was made on the basis of clinical and radiographic examinations. A total of 124 teeth were present in 69 fracture sites (50 patients), of which 89 teeth were evaluated both, clinically (tooth mobility, pocket depth, pulp sensibility) and with periapical radiographs (degree of fracture displacement, marginal bone loss, root resorption). RESULTS: The results revealed that 61.9% of teeth in directly in the line of fractures showed no response to electric pulp testing compared with 48.9% teeth adjacent to fractures. The maximum frequency of non-responsive teeth was observed in Type I fractures followed by Type II fractures. Response to pulp tests was highly significant at postoperative 3- and 6-month periods (Wilcoxon's test). There was continuous reduction in the measurement for mean pocket depth at both test and control sites of teeth. The measurement of marginal bone levels of teeth in the line of fractures revealed a significant reduction (P < 0.01) from preoperative to postoperative 7-day period only. In teeth adjacent to fracture sites, the mean marginal bone levels of control site and test sites were not significant at any time interval. There was no difference in postoperative complications pertaining to whether the tooth at the fracture site was extracted or retained. CONCLUSIONS: Teeth in line of jaw fractures should not be removed on a prophylactic basis and should be followed up clinically and radiographically to determine any treatment needs.

Fraturas maxilomandibulares no hospital de ensino: perfil epidemiológico e percepção dos usuários / Maxillomandibular fractures teaching hospital: epidemiological profile and perception of users

Investigar o perfil epidemiológico dos pacientes com fraturas no complexo maxilomandibular e compreender a percepção desses usuários quanto ao evento trauma maxilomandibular. Método: Adotou-se o método misto, mediante uma abordagem quanti-qualitativa. A coleta de dados foi realizada nos meses de julho a novembro de 2014, nos retornos dos usuários juanto ao serviço odontológico. Utilizou-se uma entrevista semi-estruturada, com informações sociodemográficas dos usuários e três perguntas norteadoras. O referencial metodológico utilizado foi a análise de conteúdo de Bardin e a Teoria Geral da Enfermagem de Orem. Resultados: Predominaram indivíduos do sexo masculino, jovens, vítimas de acidentes com veículos mootorizados, com fraturas na mandíbula. Conclusões: Os resultados encontrados neste estudo permitem considerar que os indivíduos, vítimas de trauma de face e bloqueio intermaxilar, apresentam déficit no autocuidado, sobretudo nos aspectos da higienização bucal e alimentação, além de comunicação verbal prejudicada, que pode comprometer ainda mais suas necessidades...

[A Case of Perioperative Hypokalemia and Hypertension due to Concomitant Use of Multiple Herbal Medicines].

A 72-year-old woman underwent surgery for a distal radius fracture with lower jaw fracture under general anesthesia. Preoperative laboratory data showed hypokalemia (3.1 mEq · l(-1)), hypertension, and leg edema. The suspected cause of all of these symptoms was the licorice component of the multiple herbal medicines which she was taking. In addition, the ephedra and aconite tuber components of the Maobushisaishinto were suspected to be contributing to the hypertension. She was therefore taken off all of her herbal medicines. The patient underwent regular blood tests and her potassium levels were replenished perioperatively. Hypokalemia was alleviated within the few days following surgery. Given the identity of the crude contents of the multiple herbal medicines in addition to the postoperative plasma renin activity and aldosterone, pseudoaldosteronism was suspected. When administering multiple herbal medicines, knowledge of the precise contents is critical. Clarification of the doses of licorice and ephedra capable of inducing hypokalemia and hypertension would also be helpful.

Dental trauma in patients with maxillofacial fractures.

PURPOSE: The purpose of this study was to analyze and evaluate the correlation between dental injuries and the pattern of maxillofacial fractures. The correlation with age, gender, trauma mechanism and type of maxillofacial fracture was also investigated. MATERIALS AND METHODS: From January 2000 to December 2009, 1131 patients with facial fractures were registered. Of these, 473 presented with associated dental trauma. The information and data collected and analyzed included: age, gender, mechanism of injury, type of facial fracture, type of dental injury, and the relationship between dental injury and facial fracture. RESULTS: Dental injury was sustained by 473 patients (41.8%), with a total of 2215 injured teeth. Of the 2215 injured teeth, 1191 (53.8%) were in the maxilla and 1024 (46.2%) in the mandible. Fall from a height had the highest risk of dental injuries (OR = 4.145, P = 0.002). The central incisor was the most injured tooth for both the maxilla (388, 36.2%) and mandible (284, 27.7%). The most common type of dental injury was avulsion (1070, 47.4%). More anterior teeth in the maxilla were of crown fracture, avulsion, and intrusion than that in the mandible, whereas more anterior teeth in the mandible were of subluxation and concussion than that in the maxilla. Dental injuries were more prone to occur in patients who sustained only symphysis fractures (OR = 2.817, P < 0.001), only 0.236-fold risk in patients who sustained only mandible angle fracture (P < 0.001). CONCLUSIONS: The occurrence of dental trauma is significantly related to the pattern and position of the maxillofacial fractures.

Analysis of 46 maxillofacial fracture victims in the 2008 Wenchuan, China earthquake.

PURPOSE: At 14:28 hours on May 12, 2008, a massive earthquake wracked most areas of Sichuan, China, causing catastrophic human loss. The aim of this study was to delineate the characteristics of victims with maxillofacial fractures in this disaster. PATIENTS AND METHODS: A descriptive analysis was conducted based on the medical records of earthquake maxillofacial injuries casualties transferred to West China Hospital of Stomatology, Sichuan University, after the earthquake. Data regarding demographic details, psychological status, patterns, anatomic sites, etiology, concomitant injuries, and management of earthquake maxillofacial fractures were evaluated. RESULTS: A total of 46 maxillofacial fracture patients' records of 28 (60.9%) males and 18 (39.1%) females were included in this study, with peak incidence (32.6%) in the elderly age group (older than 50 years). The most common etiology of earthquake maxillofacial fractures was building collapse (71.7%). The mandible (65.2%) was the most frequent site of the maxillofacial fracture, followed by the zygomatic complex (21.7%) and maxilla (13.0%). The most prevalent of maxillofacial fracture pattern was multiple and/or comminuted fractures (56.5%), which accounted for 72.7% (24/33) in building collapse injury group. There were 9 (19.6%) patients with significant concomitant injuries and the most common site of concomitant injuries was the head (4 cases) and extremity (4 cases). Four (8.7%) patients' maxillofacial fractures were treated conservatively, 16 (34.8%) underwent closed reduction and fixation, and 26 (56.5%) underwent open reduction and rigid internal fixation (RIF). Apart from 3 patients (6.5%) who showed infection, all patients with facial fractures achieved successful bony union with an acceptable occlusion and facial form. Additionally, it is noteworthy that all patients in our study presented the symptoms of posttraumatic stress disorder (PTSD). CONCLUSION: There is a variation of mechanism of injuries, age group, severity, patterns, concomitant injuries, and management of earthquake maxillofacial fractures. Knowledge of these characteristics provides useful strategies for patient care and prevention of further complications. A multidisciplinary and coordinated approach is important for optimum stabilization and ongoing treatment of victims of building collapse injury. The high percentage of PTSD confirms that psychologists should form an integral part of this multidisciplinary team.

The pattern of combined maxillofacial and cervical spine fractures.

PURPOSE: Prompt recognition of cervical fractures in patients with facial fractures is of prime importance, as failure to diagnose such injuries carries a significant risk of causing neurologic abnormalities, long-term disabilities, and even death. The aim of this retrospective case study is to describe the different patterns of combinations of maxillofacial and cervical spine (C-spine) injuries to provide guidance in diagnosis and care of patients with combined injuries. PATIENTS AND METHODS: The trauma directory of 1 academic institution was searched for records of 701 patients admitted with cervical spine fractures between January 2000 and June 2006. Patients who did not sustain a facial fracture in addition to their C-spine fracture were excluded. The search was narrowed to 44 patients (6.26%) who presented with combined C-spine and facial fractures. Descriptive statistics were performed in which the frequencies of the variables were presented and then exploration of the interaction between the different variables was carried out. RESULTS: A 6.28% incidence rate of combined C-spine and maxillofacial fractures is noted in this study. The most common cause of trauma was motor vehicle accidents (45.5%), followed by falls (36.4%). In regards to the types of maxillofacial fractures, 27.3% of the cases presented with isolated orbital fractures and 13.6% with isolated mandibular fractures. A total of 68.2% of the combined C-spine and facial fracture cases involved orbital fractures of some form. The most frequent level of C-spine fracture was isolated C2 fractures (31.8%) followed by isolated C4 and C6 fractures (6.8% each). When the mechanism of trauma were compared to the types of C-spine and maxillofacial fractures, falls were found to be the most frequent mechanism causing both isolated orbital and C2 fractures. CONCLUSION: The rule of presuming that all patients with maxillofacial fractures have an unstable C-spine injury should stand. This should be emphasized in patients with orbital fractures and we plead for a higher index of suspicion for C-spine injuries in such patients.

Mucormycoses: serious complication of high-dose corticosteroid therapy for traumatic optic neuropathy.

Mucormycosis is harmless to a healthy person, but can cause opportunistic infections in immunocompromised patients, and once it has invaded internal organs is frequently fatal. Traumatic optic neuropathy is a rare complication of maxillofacial trauma. Management is controversial, and there are no treatment guidelines in the literature. The main methods of treatment of this condition employed today are high-dose corticosteroids and surgical optic nerve decompression, either alone or in combination. In this case, the patient was in good health, but received high-dose corticosteroids for 2 weeks, which temporarily diminished immune response and permitted the development of mucormycosis.

Etiology and management of posttraumatic malocclusions.

AIM: To establish the etiology of complications in patients undergoing treatment of maxillofacial trauma and justify the treatment of choice. METHODS: Four patients with posttraumatic occlusal irregularities comprised the subjects. RESULTS: Posttraumatic malocclusion has a complex etiology. The evaluation of the pretraumatic occlusal relationship is useful but not always possible. Anatomic repositioning of the fracture should be performed as soon as possible. Patients whose fractures are treated via maxillomandibular fixation who do not receive surgical reduction of a posttraumatic fracture have a greater possibility of later developing more severe dental and skeletal malocclusions. In cases treated via maxillomandibular fixation, Ivy loops should be avoided. CONCLUSION: When treating patients with maxillofacial trauma, care should be taken to counterbalance possible obstacles. This will result in a satisfactory posttraumatic occlusal scheme, without the need for orthodontic treatment or a second surgery.

Traumatic displacement of teeth into maxillary sinus cavity: an unusual dentoalveolar fracture.

We present an unusual dentoalveolar fracture case who had displacement of teeth into maxillary sinus cavity. This patient was 15 years old. He had oral bleeding and lost teeth after falling from the top of a building. Examination of maxillofacial region showed that there were left maxillary teeth lost, alveolar fracture, gingival bleeding and laserations. Maxillofacial bones were found intact. Canine, both premolars and the first molar teeth on left maxilla were lost. Pantomographic evaluation viewed two teeth in the left maxillary sinus. In addition, computerized tomography clearly showed oroantral fistula, alveolar fracture and teeth into maxillary sinus. Extraction of teeth from sinus cavity was performed as well as repair of oroantral fistula and alveolar fracture. This patient is thought that dentoalveolar injury may be more serious than expected according to the oral examination and it requires careful evaluation, even if dentoalveolar trauma does not pose a significant morbid risk.

Fracturas maxilofaciales en individuos chilenos / Maxillofacial fractures in chilean subjects

Las fracturas orales y maxilofaciales representan un 6 por ciento a 8 por ciento de las fracturas óseas corporales. Estas lesiones son de complejo manejo y exigen un diagnóstico precoz, certero y preciso. El Hospital Regional Hernán Henríquez Aravena, de la ciudad de Temuco, no posee cirujanos orales y maxilofaciales en los equipos de urgencia inmediata, de forma que los ingresos son realizados por otros profesionales. En un año de seguimiento se realizaron 34.931 consultas medico-legales en el Servicio de Urgencia del Hospital Regional Hernán Henríquez Aravena. De esas consultas se escogió una muestra representativa de 742 sujetos de quienes se obtuvo información general y de las lesiones en particular. Se obtuvo también asociación estadística mediante la prueba Chi Cuadrado. Seis por ciento de las consultas en el Hospital Regional Hernán Henríquez Aravena fueron asociadas a fracturas maxilofaciales, donde el grupo con más consultas fueron el de los menores de 20 años. Del total muestral, el 64.4 por ciento correspondió a sujetos del sexo masculino, manteniendo una relación hombre:mujer de 3.1:1; sin embargo, esta relación aumento su diferencia en sujetos mayores de 15 años. El 31.1 por ciento de las consultas fueron causadas por agresiones, mientras que 24.4 por ciento fueron asociadas a las caídas. La principal zona de fractura fue el complejo orbito-naso-etmoidal con un 55.6 por ciento y las fracturas dentoalveolares con un 22.2 por ciento. Existió asociación estadísticamente significativa entre edad, sexo, agresión, fracturas mandibulares y fracturas dentoalveolares (p < 0.05). Los datos reflejan la alta prevalencia de fracturas maxilofaciales en la comuna de Temuco, Chile, siendo similar a lo que ocurre en otras partes del mundo. El grupo de los jóvenes es el de principal consulta donde las agresiones juegan un papel fundamental. Con el presente estudio descriptivo creemos que se justifica plenamente la presencia de cirujanos orales y maxilofaciales en...

The oral and maxillofacial trauma represent a 6% to 8% approximately of the body fractures. These injuries are of complex handling and demand an accurate and precise diagnosis. The Hernán Henríquez Aravena Regional Hospital, of Temuco city, does not have oral and maxillofacial surgeons in the immediate urgency staff, so that first approach to handle those patients is made by other clinicians. After one year, a total of 34,931 consultations were made in the Urgency Service at the Hernán Henríquez Aravena Hospital. Of them, a representative sample of 742 subjects was chosen from which general information and the kind of injuries was obtained. Statistical association with the Chi - Square test was obtained. Six percent of the consultations in the Hernán Henríquez Aravena Regional Hospital were associated to maxillofacial fractures. 64.4% of the sample corresponded to male subjects. The relation man to woman was 3.1:1, displaying a greater difference in patients aged over 15 years. Of the total of sample, the group with more consultations was those aged below 20 years and the 31,1% of the consultations were caused by aggressions, whereas 24,4% were associated to falls. The main zone of fracture was related to the orbit nose etmoidal complex with 55,6% and dental fractures with a 22.2%. Statistically significance association was found between age, sex, aggression, mandible and dental fractures (p < 0,05) The data reflect the high prevalence of maxillofacial fractures in Temuco, Chile, similar to other parts of the world. The group of young people is the one of main consultation where the aggressions play a fundamental roll. With the present descriptive study we think that the presence of oral and maxillofacial surgeons in the urgency staff of the Hernán Henríquez Aravena Regional Hospital, Temuco, Chile is justified totally.

Surgical root restoration after external inflammatory root resorption: A case report.

External inflammatory root resorption after a jaw fracture is rare. This report describes a case of extensive external root resorption in the middle third of the root of a mandibular right canine after a mandibular fracture involving the tooth socket. Because of delayed treatment and damage to the root caused by a surgical screw, root canal treatment was performed followed by surgical intervention. The resorptive defect was debrided and part of the root was rebuilt with conventionally setting restorative glass ionomer cement. Postoperative follow-up revealed complete healing.

Clinical update: a nonhealing fractured mandible.

Bisphosphonates have shown significant clinical benefit in reducing skeletal fractures in patients with multiple myeloma or bone: penicillin VK 500 mg or amoxicillin 500 mg; both 4 times daily (QID) initially and twice daily (BID) for maintenance, If penicillin allergic: 1. Clindamycin 150 to 300 mg QID. 2. Vibramycin 100 mg once daily (QD). 3. Erythromycin ethylsuccinate 400 mg 3 times daily (TID). 4. Antifungals when required: 5. Nystatin oral suspension 5 to 15 mL QID or 100,000 IU/mL. 6. Mycelex troches (clotrimazole 10 mg) x 5/day. 7. Fluconazole 200 mg initially, then 100 mg QD. 8. Other potential systemic antifungals include itraconazole or ketoconazole. 9. Antivirals, if required: 10. Acyclovir 400 mg BID. 11. Valacyclovir hydrochloride 500 mg to 2g BID.