RESUMO
La fractura orbitaria por estallido o fractura en "blow out" es una de las fracturas más comunes a nivel facial por lo que su importancia reside en saber identificarlas por el enmascaramiento clínico que podría o no, estar presente. Es de vital importancia complementar la valoración clínica con estudios de imagenología que confirmen las sospechas clínicas. De no hacerlo si el paciente no consulta a un servicio médico quirúrgico la pérdida de la capacidad funcional o la debilitación persistente en la salud ocasionada por la fractura no podrá ser validada en un Dictamen Médico Legal de Secuelas.
The orbital blow out fracture is one of the most common fractures at facial level, so its importance lies in knowing how to identify them due to the clinical masking that may or may not be present. It is of vital importance to complement the clinical evaluation with imaging studies to confirm the clinical suspicions. Otherwise, if the patient does not consult a surgical medical service, the loss of functional capacity or the persistent debilitation in health caused by the fracture cannot be validated in a Forensic Medical Report of Sequelae.
Assuntos
Humanos , Masculino , Adulto , Fraturas Orbitárias/diagnóstico , Diplopia , Traumatismos Faciais/diagnóstico por imagem , Costa Rica , Medicina LegalRESUMO
Abstract Objective: To present the profile of hospitalizations due to transport accidents in individuals aged 0-19 years in a reference hospital for urgent and emergency traumatology care. Material and Methods: This retrospective study is grounded on analyzing medical records of children and adolescents hospitalized due to transport accidents in 2016 and 2017. The bivariate analyses included Chi-square and Fischer's exact tests and binary logistic regression, with a 5% significance level. Results: Four hundred and seventy-five (43.7%) of the 1,088 medical records investigated corresponded to transport accidents, and accidents involving motorcycles were the most frequent (68.3%), affecting adolescents (81.3%), while children were more involved in accidents as pedestrians (57.1%). Advancing age increases the likelihood of the outcome, with a significant association in the multivariate analysis (p<0.001). The mandible was most frequently affected in maxillofacial fractures. Conclusion: Transport accidents predominantly affect male adolescents, involving motorcycles, and the lower limbs are the most affected. The mandible was the most affected bone in maxillofacial fractures.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Acidentes de Trânsito , Criança , Adolescente , Traumatismos Faciais/diagnóstico por imagem , Vítimas de Trânsito , Hospitalização , Distribuição de Qui-Quadrado , Modelos Logísticos , Prontuários Médicos , Análise Multivariada , Estudos Retrospectivos , Hospitais de Emergência , Fraturas MaxilaresRESUMO
Purpose: The purpose of this study is to evaluate surgical outcomes of facial fractures after the introduction of intraoperative radiology. Methods: An historic cohort of patients without intraoperative fluoroscopy (IOF) was compared with a prospective cohort of patients with IOF. Main outcomes were postoperative complications and reoperation rate. Results: There were 51 in the non-IOF group and 49 in the IOF group. In the group with IOF 10 patients required intraoperative revisions (20.46%). Overall postoperative complication rate was higher in the non-IOF group (25.49% vs. 6.12%) due to the significantly higher bone-related complication rate (15.69% vs. 2.04%). Reoperation rate was also higher in the non-IOF group (11.76% vs. 0%). Conclusion: This study demonstrates that IOF reduces bone-related complication and reoperation rate by allowing correction of surgical errors immediately during surgery.
Assuntos
Traumatismos Faciais/cirurgia , Fluoroscopia , Fixação de Fratura , Cuidados Intraoperatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Reoperação/estatística & dados numéricos , Fraturas Cranianas/cirurgia , Adulto , Idoso , Traumatismos Faciais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Erros Médicos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fraturas Cranianas/diagnóstico por imagem , Resultado do TratamentoRESUMO
Abstract Objective: To assess the diagnostic accuracy of Ultrasonography (USG) in diagnosing superficial facial fractures. Material and Methods: Patients visiting our facility with facial trauma and suspected fracture of the facial skeleton, those who had undergone CT scans, and conventional radiographic examinations and those who were conscious and cooperative were included in the study. All conventional radiographs, CT scans and ultrasound examinations were done during 0-20 days after trauma in all the patients Results: A total of 20 patients participated in our study, out of which 18 were male (90%) with a mean age of 34.4 years (range of 19-75 years). Eleven sites of the face were examined bilaterally in each patient, i.e., a total of 440 sites. Of these, 84 sites were found to be fractured according to the CT scan examination whereas conventional radiographs detected 59 and ultrasonography detected 74 fractures (of which 70 were true fractures, while 4 were false-positive results). The sensitivity and specificity of USG in all fracture sites were 83.33% and 98.88% respectively. The positive and negative predictive values were 94.59% and 96.17% respectively Conclusion: Ultrasound examination had a better sensitivity when compared to conventional radiography in detecting superficial facial fractures.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Ferimentos e Lesões , Ultrassonografia/instrumentação , Sensibilidade e Especificidade , Traumatismos Faciais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/instrumentação , Índia/epidemiologiaRESUMO
Facial injuries are cause of consultation in emergency departments. The maxillofacial region contains several structures that are vital for life. Hence, an early assessment and management of facial injuries is important to avoid their consequential complications and eventual mortality. This article is a review of the literature about the emergency clinical assessment and management of traumatic facial injuries by non-specialists.
Assuntos
Serviço Hospitalar de Emergência , Traumatismos Faciais/diagnóstico por imagem , Traumatismos Faciais/terapia , Administração dos Cuidados ao Paciente/métodos , Traumatismos Faciais/fisiopatologia , Humanos , Escala de Gravidade do FerimentoRESUMO
Facial injuries are cause of consultation in emergency departments. The maxillofacial region contains several structures that are vital for life. Hence, an early assessment and management of facial injuries is important to avoid their consequential complications and eventual mortality. This article is a review of the literature about the emergency clinical assessment and management of traumatic facial injuries by non-specialists.
Assuntos
Humanos , Administração dos Cuidados ao Paciente/métodos , Serviço Hospitalar de Emergência , Traumatismos Faciais/terapia , Traumatismos Faciais/diagnóstico por imagem , Escala de Gravidade do Ferimento , Traumatismos Faciais/fisiopatologiaRESUMO
A 34-year-old woman with severe craniofacial trauma, which included eversion of the entire frontal bone, survived with high-quality functional and cosmetic results as a consequence of efficient and aggressive action by emergency technicians and physicians. Early preliminary steps of craniofacial reconstruction provided a structural foundation that facilitated this outcome.
Assuntos
Traumatismos Faciais/diagnóstico por imagem , Traumatismos Faciais/cirurgia , Fraturas Ósseas/cirurgia , Osso Frontal/lesões , Osso Frontal/cirurgia , Procedimentos de Cirurgia Plástica , Adulto , Traumatismos Faciais/etiologia , Feminino , Fraturas Ósseas/etiologia , HumanosRESUMO
BACKGROUND: Fronto-orbital advancement for nonsyndromic craniosynostosis has been thought to injure frontal sinus buds, lead to chronic sinus disease, and influence final forehead shape. This study investigates the effect of fronto-orbital advancement in infancy on subsequent frontal sinus volume, morphology, and disease. METHODS: The authors conducted a retrospective review of nonsyndromic craniosynostosis patients treated with fronto-orbital advancement in infancy with a head computed tomographic scan obtained at age 7 to 18 years. Facial trauma patients served as age-matched controls. Frontal sinus characteristics were determined using three-dimensional reconstructions. RESULTS: The study included 33 nonsyndromic craniosynostosis patients who underwent fronto-orbital advancement (n = 20 unicoronal; n = 13 metopic) and 20 control patients. The incidence of at least unilateral pneumatization was 94 percent for fronto-orbital advancement subjects and 95 percent for control subjects. Mean frontal sinus volumes for unicoronal synostosis, metopic synostosis, and control groups were 3427 ± 2294, 4576 ± 3510, and 4157 ± 3963 mm, respectively (p = 0.598). Asymmetry scores were as follows: unicoronal synostosis, 56 ± 35 percent; metopic synostosis, 36 ± 33 percent; and control, 23 ± 24 percent (p = 0.010). Unicoronal subjects displayed prominent asymmetry, with increased pneumatization on the unaffected side. Frontal sinus volume correlated with age at computed tomography but not with age at fronto-orbital advancement. Interrater reliability was 0.997. One fronto-orbital advancement subject and zero control subjects demonstrated computed tomographic evidence of frontal sinus disease. CONCLUSIONS: Frontal sinus volume, morphology, and disease do not differ significantly between control subjects and nonsyndromic craniosynostosis subjects following fronto-orbital advancement, but subtle differences such as increased asymmetry in the unicoronal synostosis group can be appreciated. Further research with syndromic craniosynostosis patients undergoing multiple procedures may help elucidate the association between surgical disruption and frontal sinus development. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Assuntos
Craniossinostoses/cirurgia , Osso Frontal/cirurgia , Seio Frontal/patologia , Órbita/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Transplante Ósseo , Estudos de Casos e Controles , Cefalometria , Criança , Traumatismos Faciais/diagnóstico por imagem , Traumatismos Faciais/cirurgia , Testa/patologia , Seio Frontal/diagnóstico por imagem , Sinusite Frontal/diagnóstico por imagem , Sinusite Frontal/etiologia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Lactente , Tamanho do Órgão , Osteotomia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Procedimentos de Cirurgia Plástica/efeitos adversos , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
Facial beauty depends on shape, proportion, and harmony between the facial thirds. The chin is one of the most important components of the inferior third and has an important role on the definition of facial aesthetic and harmony in both frontal and lateral views. There are 2 principal therapeutic approaches that one can choose to treat mental deformities, alloplastic implants, and mental basilar ostectomy, also known as genioplasty. The latest is more commonly used because of great versatility in the correction of three-dimensional deformities of the chin and smaller taxes of postoperative complications. Possible transoperative and postoperative complications of genioplasty include mental nerve lesion, bleeding, damage to tooth roots, bone resorption of the mobilized segment, mandibular fracture, ptosis of the lower lip, and failure to stabilize the ostectomized segment. The study presents 2 cases of displacement of the osteotomized segment after genioplasty associated with facial trauma during postoperative orthognathic surgery followed by rare complications with no reports in the literature.
Assuntos
Acidentes por Quedas , Traumatismos Faciais/cirurgia , Mentoplastia/métodos , Complicações Pós-Operatórias/cirurgia , Adulto , Traumatismos Faciais/diagnóstico , Traumatismos Faciais/diagnóstico por imagem , Feminino , Humanos , Osteotomia de Le Fort/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia , Reoperação , Adulto JovemRESUMO
Panfacial fractures usually refer to simultaneous facial fractures, which affect the upper, middle, and lower thirds of the face. The management of panfacial fracture is complex because of the lack of reliable landmarks. Literature has shown many approaches for management of panfacial fractures. Every segment of bone has a precise function in the repair. Therefore, the "bottom-up and outside-in" sequence is the most widely used approach in the management of panfacial fractures. These facial fractures present remarkable challenges for both experienced and inexperienced surgeons. This article aimed to report a case of a panfacial fracture (mandibular condylar and symphysis fractures associated with an atypical Le Fort III fracture) in a 48-year-old man. The patient was successfully treated using bottom-up and outside-in sequence by accessing all facial injuries. Postoperatively, radiograph examination revealed good reduction and fixation of titanium plates, and physical examination revealed good functional and esthetic outcomes.