Sistema miofuncional orofacial e trauma de face: revisão crítica da literatura / Changes in the orofacial myofunctional system after treatment for facial trauma: a critical review of the literature

Introdução: Esta revisão qualitativa da literatura levantou publicações científicas internacionais sobre a funcionalidade do sistema miofuncional orofacial nos traumas faciais, por meio da base de dados PubMed. Método: O levantamento realizado limitou-se a seres humanos, de qualquer faixa etária, no idioma inglês, entre os anos de 2005 e 2011. As publicações sem acesso completo, repetidas por sobreposição das palavras chave, estudos de caso, revisões de literatura, cartas ao editor e as não relacionadas diretamente ao tema foram excluídas. Resultados: Foram identificados 831 estudos, sendo 14 dentro dos critérios estabelecidos. Notou-se que a avaliação mais frequente foi a da função mandibular e depois análise de tratamentos; ocorreu mais fratura no côndilo que ângulo mandibular; utilizou-se mais tratamento cirúrgico juntamente com o conservador, seguido pelo somente cirúrgico e finalmente somente conservador; a maior incidência de traumas faciais foi em adultos do sexo masculino; poucas pesquisas foram realizadas com crianças e grupo-controle; utilizaram-se mais avaliações da função mandibular e clínicas, na maioria pré e pós-cirurgia; a força de mordida e a área oclusal apresentaram melhora póstratamento, no entanto a assimetria mandibular permaneceu; os valores de abertura máxima da boca atingiram a normalidade, porém inferiores ao grupo-controle; houve persistência de alterações na mobilidade mandibular e dor, mesmo após o tratamento; e a terapia miofuncional melhorou o quadro de alterações. Conclusão: É necessário mais publicações sobre o tratamento fonoaudiológico baseado na abordagem miofuncional orofacial nos traumas faciais.

Introduction: This qualitative literature review aims to highlight international scientific publications selected from the PubMed database that describe the changes in the function of the orofacial myofunctional system after facial trauma and the associated treatment outcomes. Methods: Studies published in English between 2005 and 2011 and including individuals of all age groups were included in this review. Publications that were not open access, studies appearing more than once because of overlapping keywords, case studies, literature reviews, letters to the editor, and studies that were not directly related to the subject were excluded. Results: A total of 831 studies were identified, 14 of which fulfilled the established criteria. Assessment of jaw function was the most frequent evaluation performed in the included studies, followed by the analysis of treatments. The incidence of condylar fractures was higher than that of mandibular angle fractures. The majority of cases were managed by surgery combined with conservative treatment, followed by surgery alone and conservative treatment alone. Adult men exhibited a higher incidence of facial trauma. Few studies included children or control groups. Further assessment of jaw and clinical functions before and after surgery revealed the following findings. The bite force and occlusal contact area improved after treatment, whereas mandibular asymmetry persisted even after surgery. The maximum mouth opening returned to normal after treatment, although the range of mouth opening was lower in patients with facial trauma than in controls. Persistent mobility in the mandibular teeth and pain were observed even after treatment. Myofunctional therapy resulted in an overall improvement in jaw function. Conclusions: Although the number of studies on facial trauma is increasing, few studies address the use and benefits of orofacial myofunctional therapy in this field. Further studies on orofacial myofunctional therapy combined with surgery and/ or conservative treatment for facial trauma are necessary.

Asphyxial death related to postextraction hematoma in an elderly man.

We here report an autopsy case of a man in his seventies who died from asphyxia due to compression of the trachea caused by postextraction bleeding after extraction of his left mandibular third molar by a dentist in private practice. On the morning after the tooth extraction, he had complained of dyspnea and became unconscious at home. Although he was brought to the emergency room by ambulance, he died 7 days later without regaining consciousness. Autopsy examination revealed that the lingual side of the alveolar bone was fractured at the extraction socket. Moreover, subcutaneous bleeding that extended from the extraction socket to the thyrohyoid ligament in the cervical region and deviation of the epiglottis due to the bleeding were observed. Histological findings revealed liver cirrhosis; there were no significant findings in other organs. On the basis of these findings, we concluded that alveolar bone fracture occurred during the extraction and that the bleeding spread to the cervical region. Thus, the patient had died from asphyxia resulting from airway obstruction caused by cervical subcutaneous bleeding derived from postextraction bleeding. We emphasize that tooth extraction may cause fatal complications in patients with bleeding tendencies, particularly in the elderly.

Jaw fractures diagnosed and treated at Malmö University Hospital: a comparison of three decades.

The aim was to report the distribution, frequency and aetiology of jaw fractures in patients treated at the University Hospital, Malmö, 1993-2003 and to compare two previous studies from 1952-1962 and 1975-1985. In 1993-2003, 461 patients, 137 women (mean age 42 years; range 15-82) and 324 men (mean age 28 years; range 17-59) were diagnosed and treated. Women were significantly older than men (P<0.001). The most frequent cause of jaw fractures was falls in women (45%). In men, interpersonal violence (46%) was most common followed by road traffic accidents (RTAs) (24%) mostly involving bicycles (14%). The frequency of falls in women and men was significantly different (P<0.001) as was the difference between violence in men and women (P<0.001). The proportion of fractures caused by RTAs was significantly higher in 1952-1962 than in 1993-2003 (P<0.001). There was a significant increase in the proportion of fractures caused by violence between the two studies (P=0.007). In 1993-2003 the proportion of fractures in women due to falls was significantly higher than in 1952-1962 (P=0.006). Violence has replaced RTAs as the main cause for jaw fractures in men; for women falling is the commonest cause.

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.

Polylactide/polyglycolide copolymer in bone defect healing in humans.

This pilot study aims to evaluate the healing of a large defects in the human jawbone filled with a Poly-Lactide-co-Glycolide (PLG) polymer (Fisiograft) by means of clinical, radiological and histological methods and to compare the results with those of platelet-rich plasma (PRP) clot or autologous bone (AB) fillings. Bone cysts, where previous non-surgical treatments failed to promote healing, underwent surgery. Nineteen consenting male patients were randomly split into three groups, packed with PRP, AB or PLG. A core biopsy was performed 4 and 6 months after surgery. All treated defects showed clinical, radiological and histological progresses over time. AB provided the best clinical and histological performance and PLG had overlapping outcomes; PRP filling was statistically different. Six months after surgery, bone activities were enhanced in sites treated with PLG and fairly good with PRP. Additionally, PLG showed some new lamellar formations. In conclusion, outcomes were best with AB graft, but suitable results were achieved using PLG to promote healing of severe bone defects. PLG shows only a delayed regenerative capability but does not require a secondary donor site.

An unusual fatal injury due to tyre burst: a case report.

A 20 year-old male driver of a heavy duty crane, employed in an industry located in an industrial area on the outskirts of Delhi was fatally injured while repositioning an ill-fitted locking rim of a crane tyre (Fig. 1). The inner tube of the crane tyre had accidentally burst, dislodging the loose iron-locking rim, which hit the individual with a great force resulting in multiple injuries. He died on his way to the hospital.

Intraoral acrylic splints for maxillofacial fracture repair.

Maxillofacial fractures in dogs and cats occur secondary to vehicular trauma, falls, kicks, gunshots, and fights with other animals. Pathologic mandibular fracture may occur secondary to periodontal disease, neoplasia, and metabolic diseases. The primary objective for repair of maxillofacial fractures in small animals is return to normal function. Therefore, it is necessary to maintain occlusal alignment while providing adequate stability for bony union. Basic principles of maxillofacial fracture repair include anatomic reduction and restoration of occlusion, application of a stable fixation to neutralize negative forces on the fracture, gentle handling of soft tissues, avoidance of iatrogenic dental trauma, extraction of diseased teeth within the fracture line, and minimizing excessive soft tissue elevation. This review article will describe the application of intraoral acrylic splints for maxillofacial fracture repair.

[The effect of splints on the status of the hard dental tissues and periodontium in patients with jaw fractures]. / Vliianie shin na sostoianie tverdykh tkanei zubov i parodonta u bolnykh s perelomami cheliustei.

Effects of metal splints on the hygienic status of the oral cavity and status of dental hard tissues and the periodontium were studied in 30 patients with fractures of the jaws during the first days after treatment with splints and in the postimmobilization period. Sixty-seventy days after the splints were removed, the hygienic status of the oral cavity was worse than in normal subjects; moreover, the intensity of caries increased and the periodontal status deteriorated.

Palatal fractures: classification, patterns, and treatment with rigid internal fixation.

A classification of palatal fracture types is developed from patterns observed on CT scans, and success with open reduction techniques is correlated with fracture pattern. The six palatal fracture types are as follows: I, anterior and posterolateral alveolar; II, sagittal; III, parasagittal; IV, para-alveolar; V, complex; and VI, transverse. Associated fractures were LeFort I (100 percent), LeFort II and III (55 percent), mandible (48 percent), and dental (55 percent). Large segment, sagittally oriented palatal fractures could be stabilized with rigid internal fixation. Complete rigid fixation of the palate consists of (1) roof of mouth, (2) pyriform or alveolar, and (3) four LeFort I buttress stabilization. Comminuted palatal fractures were managed by standard LeFort I and alveolar buttress fixation, palatal splinting, and intermaxillary, fixation. If complete rigid fixation was employed in the palate in type II, III, and IV fractures, a palatal splint was avoided in 60 percent of these cases. Rigid internal fixation is therefore concluded to facilitate the treatment of certain types of palatal fractures by reduced length of intermaxillary fixation and avoidance of palatal splinting.

Fractures of the maxillofacial region in children.

83 children with maxillofacial fractures have been analyzed according to, aetiology, age, sex, type, and site of fractures. The results showed a high male to female ratio. Mandibular fractures were the commonest, in the condylar region in particular. The commonest causes in descending order were falls, bicycle accidents and at play.

Rigid stabilization of sagittal fractures of the maxilla and palate.

Rigid stabilization of sagittal fractures of the palate is described that utilizes plate and screw fixation in the palatal vault. Accurate reduction of facial width is obtained, and stability is significantly enhanced. An existing laceration or a longitudinal incision in the palatal mucoperiosteum provides exposure for maxillary adaption plate application. The transpalatal reduction should be supplemented by fixation at the piriform aperture, the zygomaticomaxillary and nasomaxillary buttresses, and by the use of an arch bar. Since slower bone healing may be observed following palatoalveolar fractures, the occlusion must be observed for deviation throughout a full 16-week period even though early motion and soft diet are permitted. Removal of the plate and screws in the roof of the mouth is sometimes required and utilizes local anesthesia.

Direct and indirect bone healing after operative fracture treatment.

The knowledge of the entire spectrum of differing healing patterns should help the surgeon to judge the progress of fracture healing. To be able to recognize an abnormal course and deviating patterns will help the surgeon to avoid risks and to improve the mechanical and biologic conditions necessary for successful fracture treatment.

Efeitos locais do tamponamento nasal: pesquisa de lesöes e regeneraçöes em Rattus Norvegicus Albinus / Local effects of nasal packing: research of lesions and regenerations using Rattus Norvegicus Albinus

A nossa pesquisa foi elaborada com a finalidade de verificar os efeitos do tamponamento nasal em ratos, usando-se fio de algodäo vaselinado. Trabalhamos com 33 ratos, que foram divididos em vários grupos. No primeiro grupo (A) procuramos determinar possível traumatismo em virtude da técnica adotada. O segundo grupo (B) introduzimos o tampäo, que permaneceu por um período de 1 a 5 dias, com a finalidade de comprovar alteraçöes; o terceiro grupo (C) teve por finalidade o estudo da regeneraçäo das lesöes relativas à variaçöes de tempo nos períodos de 5, 10, 15 e 20 dias, tempos pré-determinados para tal verificaçäo. Em todos os grupos o tampäo permaneceu por 5 dias