RESUMO
RESUMEN: Las ocurrencias de lesiones en la región oro-maxilofacial adquieren importancia debido a su complicada anatomía y fisiología, pudiendo resultar en deformidades faciales, adquiriendo interés cuando son causadas por un tercero, pudiendo traer repercusiones legales. El objetivo fue realizar un estudio transversal con el fin de estimar frecuencia y tipificación de lesiones oro-maxilofaciales que requirieron peritaje forense en el Servicio Médico Legal de Curicó, Chile. Se recopilaron datos encriptados de 79 fichas de pacientes entre 17-88 años que realizaron su constatación de lesiones en Servicio Médico Legal de Curicó, Chile, en el lapsus de un año. La frecuencia de lesiones con peritaje forense en la región oro-maxilofacial fue de un 25,82 %, provocada principalmente por mecanismo físico. En su mayoría efectuados a individuos del sexo masculino, con un rango etario de entre 20 a 40 años. La violencia interpersonal fue observada como el agente causal más frecuente de lesiones, seguida por accidentes de tránsito. Los sujetos periciados por violencia intrafamiliar, fueron en su totalidad mujeres. Las lesiones más recurrentes fueron fractura y contusión, dentro de ellas encontramos a fractura nasal como la más frecuente, seguida de herida contusa, herida por instrumento cortante, fractura maxilar y por último fractura dental. De la totalidad de las lesiones en estudio solo un tercio estuvieron confinadas exclusivamente en el territorio oro-maxilofacial.
ABSTRACT: Occurrences of lesions in the oromaxillofacial region acquire importance due to their complicated anatomy and physiology, which may result in facial deformities, acquiring interest when caused by a third party, and may have legal repercussions. The objective was to carry out a crosssectional study in order to estimate the frequency and typing of oro-maxillofacial injuries that required forensic expertise in the Legal Medical Service of Curicó, Chile. Encrypted data was collected from 79 records of patients between 17-88 years who made their findings of injuries in the Medical Legal Service of Curicó, Chile, in the lapse of one year. The frequency of injuries with forensic expertise in the oro-maxillofacial region was 25.82 %, caused mainly by physical mechanism. Mostly made to individuals of the male sex, with an age range of between 20 to 40 years. Interpersonal violence was observed as the most frequent causal agent of injuries, followed by traffic accidents. The subjects trained by intrafamily violence were all women. The most recurrent injuries were fracture and contusion, within which we found a nasal fracture as the most frequent, followed by a contusive wound, a cutting instrument wound, a maxillary fracture and finally a dental fracture. Of the totality of the lesions under study, only one third were confined exclusively in the oro-maxillofacial territory.
Assuntos
Humanos , Masculino , Feminino , Adulto , Odontologia Legal/métodos , Traumatismos Maxilofaciais/complicações , Chile , Epidemiologia Descritiva , Serviços Jurídicos/estatística & dados numéricosRESUMO
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)
Assuntos
Humanos , Masculino , Feminino , Assistência Ambulatorial , Traumatismos Maxilofaciais/complicações , Traumatismos Maxilofaciais/etiologia , Traumatismos Maxilofaciais/epidemiologia , Epidemiologia Descritiva , Estudos TransversaisRESUMO
INTRODUCTION: Treatment of maxillofacial injuries is complex and requires the establishment of a comprehensive and accurate diagnosis and correct treatment planning. OBJECTIVE: The objective of this case report was to describe the re-treatment of a 27-year-old woman who was involved in a severe car accident that resulted in the loss of five anterior teeth and alveolar bone, and whose previous orthodontic and surgical treatments had been unsuccessful. CASE REPORT: In this case, the space for the missing mandibular molar was reopened to allow for rehabilitation. The positions of the mandibular incisors were improved. The right mandibular canine was moved to the mesial, allowing for correction of the Class II canine relationship on that side, and implants were placed to replace the maxillary anterior teeth. CONCLUSION: Anterior aesthetic and functional rehabilitation using a multidisciplinary approach was essential to improve the patient's facial aesthetics, to obtain great improvement in function and to achieve occlusal stability after 2 years of follow-up.
Assuntos
Perda do Osso Alveolar/reabilitação , Prótese Dentária Fixada por Implante , Arcada Parcialmente Edêntula/reabilitação , Adulto , Perda do Osso Alveolar/etiologia , Transplante Ósseo , Implantação Dentária Endóssea/métodos , Feminino , Humanos , Maxila , Traumatismos Maxilofaciais/complicações , Traumatismos Maxilofaciais/reabilitação , Traumatismos Dentários/reabilitaçãoRESUMO
Introducción: las fracturas del tercio medio facial plantean un problema médico grave en cuanto a su complejidad, frecuencia e impacto socioeconómico. Objetivo: realizar una revisión bibliográfica sobre sus consideraciones anatómicas, diagnóstico, clasificación, tratamiento y complicaciones de las fracturas del tercio medio facial. Métodos: se realizó una revisión bibliográfica en septiembre de 2016. Se evaluaron revistas de impacto de Web of Sciencies (25 revistas) y 2 libros. Se consultaron las bases de datos de MEDLINE, PubMed y ScieELO con los descriptores: maxillary fracture, treatment, lefort fracture. Se incluyeron artículos en idioma inglés, de los últimos 5 años. Se obtuvieron 98 artículos. El estudio se circunscribió a 40. Análisis e integración de la información: el tercio medio muestra debilidad anatómica al estar formado por huesos esponjosos, con múltiples suturas y poco protegidos. Existen múltiples clasificaciones de estas fracturas y el diagnóstico se basa en los hallazgos clínicos, siendo de importancia los oftalmológicos, que unidos a los de los medios auxiliares de diagnóstico, permiten escoger la modalidad terapéutica y evitar complicaciones. Conclusiones: las características anatómicas del tercio medio facial justifican la frecuencia y su repercusión de estas fracturas. El diagnóstico debe basarse en el interrogatorio, examen físico y los medios auxiliares de diagnóstico imaginológicos, fundamentalmente tomográficos. Al clasificar la fractura se puede establecer un plan de tratamiento basado en la valoración individual de cada caso con el objetivo de evitar complicaciones posteriores(AU)
Introduction: midface fractures are a serious medical problem due to their complexity, frequency and socioeconomic impact. Objective: conduct a literature review about the anatomical considerations, diagnosis, classification, treatment and complications of midface fractures. Methods: A literature review was conducted in September 2016. The evaluation included high impact journals from the Web of Science (25 journals) and 2 books. The databases MEDLINE, PubMed and SciELO were consulted, using the descriptors maxillary fracture, treatment, lefort fracture. Papers written in English in the last five years were included. Of the 98 papers obtained, the study considered 40. Data analysis and integration: the middle third of the face is characterized by anatomical weakness, since it is formed by scantily protected spongy bone with multiple sutures. There are many classifications for midface fractures, and diagnosis is based on clinical findings, particularly ophthalmological, which alongside those of auxiliary diagnostic devices, make it possible to choose the most appropriate therapeutic mode and prevent complications. Conclusions: the anatomical characteristics of the facial middle third justify the frequency and impact of these fractures. Diagnosis should be based on interrogation, physical examination and the use of auxiliary diagnostic imaging, mainly tomography. Upon classification of the fracture, a treatment plan may be devised based on individual assessment of each case to prevent future complications(AU)
Assuntos
Humanos , Literatura de Revisão como Assunto , Bases de Dados Bibliográficas/estatística & dados numéricos , Técnicas de Fixação da Arcada Osseodentária/efeitos adversos , Traumatismos Maxilofaciais/diagnóstico , Traumatismos Maxilofaciais/complicaçõesRESUMO
ABSTRACT Introduction: Treatment of maxillofacial injuries is complex and requires the establishment of a comprehensive and accurate diagnosis and correct treatment planning. Objective: The objective of this case report was to describe the re-treatment of a 27-year-old woman who was involved in a severe car accident that resulted in the loss of five anterior teeth and alveolar bone, and whose previous orthodontic and surgical treatments had been unsuccessful. Case report: In this case, the space for the missing mandibular molar was reopened to allow for rehabilitation. The positions of the mandibular incisors were improved. The right mandibular canine was moved to the mesial, allowing for correction of the Class II canine relationship on that side, and implants were placed to replace the maxillary anterior teeth. Conclusion: Anterior aesthetic and functional rehabilitation using a multidisciplinary approach was essential to improve the patient's facial aesthetics, to obtain great improvement in function and to achieve occlusal stability after 2 years of follow-up.
RESUMO Introdução: o tratamento de danos bucomaxilofaciais é complexo e requer diagnóstico abrangente e preciso, além de um correto plano de tratamento. Objetivo: o objetivo deste relato de caso foi descrever o retratamento de uma paciente do sexo feminino, 27 anos de idade, envolvida em acidente automobilístico grave, que resultou na perda de cinco dentes, além de perda óssea alveolar na região anterior. Relato de caso: a paciente apresentava histórico de insucesso de tratamento ortodôntico e cirúrgico. No caso apresentado, o espaço referente aos molares inferiores ausentes foi reaberto, para possibilitar a reabilitação. Houve melhora no posicionamento dos incisivos inferiores. O canino inferior direito foi deslocado para mesial, possibilitando a correção da relação de Classe II intercaninos do mesmo lado. Implantes foram inseridos a fim de substituir os dentes superiores da região anterior. Conclusão: a reabilitação estética e funcional da região anterior, realizada por meio de uma abordagem multidisciplinar, foi fundamental para valorizar a estética facial da paciente, melhorar a função e promover estabilidade oclusal após dois anos de acompanhamento.
Assuntos
Humanos , Feminino , Adulto , Perda do Osso Alveolar/reabilitação , Arcada Parcialmente Edêntula/reabilitação , Prótese Dentária Fixada por Implante , Perda do Osso Alveolar/etiologia , Transplante Ósseo , Traumatismos Dentários/reabilitação , Implantação Dentária Endóssea/métodos , Maxila , Traumatismos Maxilofaciais/complicações , Traumatismos Maxilofaciais/reabilitaçãoRESUMO
Introducción: las fracturas maxilofaciales requieren tratamiento de urgencia y de un personal altamente calificado. Pueden aparecer complicaciones que ocasionen la pérdida de la vida del paciente. Objetivo: realizar una revisión bibliográfica sobre la atención al politraumatizado maxilofacial, enfatizando aspectos del soporte vital avanzado de trauma como el manejo del déficit neurológico, de la exposición del paciente y del control de la temperatura, anexos a la valoración primaria, valoración secundaria, tratamiento definitivo, lesiones asociadas, equipo multidisciplinario del trauma, traumatismos maxilofaciales con características distintivas, condiciones que influyen en el manejo del trauma y prevención. Métodos: se realizó una revisión bibliográfica entre diciembre de 2014 y enero de 2015. Se evaluaron revistas de impacto de Web of Sciencies (39), 1 cubana y 5 libros. Se consultaron las bases de datos de los sistemas MEDLINE, PubMed y SciELO. Se utilizaron como descriptores: maxilofacial trauma, advanced trauma life support, secondary survey, associated injuries, multidisciplinary team of trauma, prevention y sus equivalentes en español. Se incluyeron artículos en inglés y español, publicados preferentemente en los últimos 5 años. Se obtuvieron 141 artículos. El estudio estuvo circunscrito solo a 51, que enfocaban estas temáticas de forma más integral. Análisis e integración de la información: al analizar el comportamiento de los artículos atendiendo a su representatividad en las revistas científicas, encontramos que 5,9 por ciento correspondían a la Journal of Craniomaxillofacial Surgery. Conclusiones: es imprescindible que los cirujanos maxilofaciales que se desempeñan en la atención de emergencia puedan reconocer, diagnosticar y establecer el manejo básico de un traumatismo maxilofacial. La falta de diagnóstico y de correcto manejo puede conducir a la pérdida de funciones y al desarrollo de deformidades secundarias difíciles de corregir luego. Esta corrección también podría inducir resultados decepcionantes, que podrían comprometer la vida del paciente(AU)
Introduction: maxillofacial fractures require emergency treatment by highly qualified personnel. Complications may occur which may cause the death of the patient. Objective: carry out a bibliographic review about the care of maxillofacial polytrauma patients, highlighting the following aspects of advanced trauma life support: management of neurological deficit, exposure and temperature control, annexes to primary assessment, secondary assessment, definitive treatment, associated injuries, multidisciplinary trauma team, maxillofacial traumas with distinctive characteristics, conditions influencing trauma management and prevention. Methods: a bibliographic review was conducted from December 2014 to January 2015. The evaluation included high impact journals from the Web of Sciences (39 journals), as well as one Cuban journal and five books. The databases MEDLINE, PubMed and SciELO were consulted, using the search terms maxillofacial trauma, advanced trauma life support, secondary survey, associated injuries, multidisciplinary trauma team, prevention, and their Spanish counterparts. The review included papers in English and Spanish, preferably published the last five years. Of the 141 papers obtained, the reviewers selected the 51 which approached the study topics in a more comprehensive manner. Data analysis and integration: analysis of the representativeness of papers in scientific journals revealed that 5.9 percent corresponded to the Journal of Craniomaxillofacial Surgery. Conclusions: it is indispensable for emergency maxillofacial surgeons to be able to recognize, diagnose and determine the basic management of maxillofacial trauma. Lack of a diagnosis or inappropriate management may lead to the loss of functions and the development of secondary deformities difficult to correct in the future. Such correction could also lead to disappointing results which may risk the patient's life(AU)
Assuntos
Humanos , Cuidados de Suporte Avançado de Vida no Trauma/métodos , Traumatismos Maxilofaciais/terapia , Literatura de Revisão como Assunto , Bases de Dados Bibliográficas/estatística & dados numéricos , Traumatismos Maxilofaciais/complicaçõesRESUMO
The blowout fracture injuries are often associated with fractures of the zygomatic complex and other facial structures but can also occur in an isolated fashion. Isolated bilateral blowout fractures are uncommon and constitute a challenge with regard to both assessment and reconstruction. This article describes an uncommon case of isolated bilateral blowout fracture in a patient with extensive pneumatization of the maxillary sinuses.
Assuntos
Enfisema/etiologia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Maxilares/diagnóstico por imagem , Seio Maxilar/lesões , Traumatismos Maxilofaciais/complicações , Fraturas Orbitárias/etiologia , Ferimentos não Penetrantes/complicações , Adulto , Humanos , Masculino , Radiografia , ViolênciaRESUMO
Avulsion of the eye globe is a rare condition that is unexpected in maxillofacial trauma and results from severe trauma to the orbit and face. A search of the literature reveals very few reported cases. The present article reports a case of this singular, challenging condition and comments on several other related causes, pathophysiology mechanisms, risks, complications, and management.
Assuntos
Traumatismos Oculares/etiologia , Traumatismos Oculares/cirurgia , Traumatismos Maxilofaciais/complicações , Traumatismos Maxilofaciais/cirurgia , Acidentes de Trânsito , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Nervo Óptico/etiologia , Traumatismos do Nervo Óptico/cirurgiaRESUMO
Introduction: The aim of this paper is to show our experience in the management of intractable bleeding facial trauma during the past 10 years to determine its impact on our environment and outline the basic principles of treatment. Methods: A retrospective study of all patients with maxillofacial trauma and uncontrollable bleeding from 1999 to 2009. Inclusion criteria were oro-nasal bleeding secondary to maxi-llofacial trauma requiring emergency treatment by a specialist, without other associated lesions that could be a source of bleeding. We obtained demographic information, mechanism of injury, diagnosis of injury, hemodynamic status, type and timing of tamponade, definitive surgical treatment, results and evolution. Results: 21 patients in the study period, a true incidence of 0.002 percent. 7 patients (33.3 percent) with trauma naso-septal; 5 (23.8 percent) with panfacial fractures, and 7 (33.3 percent) with variable involvement of the upper and middle face. Nine patients (42.9 percent) had isolated facial injuries. Only 5 patients (23.8 percent) had hemodynamic compromise. Thirteen patients (61.9 percent) required posterior nasal packing with or without another procedure to control bleeding. Eight patients (38.1 percent) required early reduction and internal fixation as definitive treatment. Conclusions: Maxillofacial trauma uncontrollable bleeding is uncommon and rarely is the primary cause of hypovolemic shock. It should be suspected in patients with facial injuries from hours bleeding. The packing, suturing of wounds and reduce/OTS are the mainstays of early treatment.
Introducción: El objetivo del presente trabajo es mostrar nuestra experiencia en el manejo de la hemorragia incoercible por trauma facial durante los últimos 10 años, para determinar su incidencia y delinear los principios básicos del tratamiento. Material y Método: Estudio retrospectivo de todos los pacientes con hemorragia incoercible por trauma maxilofacial entre 1999 y 2009. Criterios de inclusión fueron hemorragia oro-nasal secundaria a traumatismo maxilofacial, sin otras lesiones asociadas que pudieran ser fuente de hemorragia, que requirió de tratamiento de urgencia por un especialista. Se obtuvo información demográfica, mecanismo de injuria, diagnóstico del traumatismo, estado hemodinámico, tipo y momento del tratamiento especializado, tratamiento quirúrgico definitivo, resultados y evolución. Resultados: 21 pacientes en el período de estudio, con incidencia real de 0,002 por ciento. Destacan 7 pacientes (33,3 por ciento) con trauma nasoseptal, con o sin heridas faciales; 5 (23,8 por ciento) con fracturas panfaciales; 7 (33,3 por ciento) con compromiso variable del tercio superior y medio de la cara. Nueve pacientes (42,9 por ciento) presentaron lesiones faciales aisladas. 5 pacientes (23,8 por ciento) presentaron compromiso hemodinámico. Trece pacientes (61,9 por ciento) necesitaron un taponamiento nasal posterior, asociado o no a otro procedimiento para el control de la hemorragia. Ocho pacientes (38,1 por ciento) necesitaron reducción y osteosíntesis precoz como tratamiento definitivo. Conclusiones: La hemorragia incoercible por trauma maxilofacial es poco frecuente y rara vez es la causa primaria de shock hipovolémi-co. Se la debe sospechar especialmente en pacientes con lesiones faciales que llevan horas con sangrado, aún de poca cuantía, pero persistente. El taponamiento, sutura de heridas y reducción/OTS precoz son los pilares de su tratamiento.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Hemorragia/etiologia , Hemorragia/terapia , Traumatismos Maxilofaciais/complicações , Emergências , Epistaxe/etiologia , Epistaxe/terapia , Fixação Interna de Fraturas , Hemorragia Bucal/etiologia , Hemorragia Bucal/terapia , Hemorragia/epidemiologia , Incidência , Estudos Retrospectivos , Traumatismos Maxilofaciais/terapiaRESUMO
The aim of this retrospective research was to establish the association between variables for the surgical treatment of zygomatic complex (ZC) fractures. In a 10-year period, 532 patients were examined for ZC fractures. The medical records of patients were analyzed to obtain information related to sociodemographic characteristics, trauma etiology, sign and symptoms of patients, and surgical or nonsurgical treatment. Statistical analysis was performed using χ test with statistical significance of P < 0.05. Most fractures were sustained by subjects between 21 and 40 years of age (55.8%), being principally men (80.1%), and 153 patients underwent surgery (28.8%). Surgical treatment of ZC fractures was statistically associated to the presence of other facial fractures (P = 0.004), alteration of occlusion (P = 0.0001; probably due to jaw fractures), presence of the comminuted fractures (P = 0.0002), and infraorbital nerve sensory disturbances (P = 0.003). A mixture of complex variables can be associated to surgical treatment; however, variables as comminuted fracture and alteration of occlusion were associated to surgical treatment indications.