RESUMO
In addition to the clinical burden of trauma, the financial burden is an important aspect of care globally, especially for patients in low- and middle-income countries. The current retrospective review was done of data from January 2015 to December 2020 related to patients of oral maxillofacial trauma management in a tertiary care setting. Analysis of variance was used to determine the mean difference in the cost incurred depending upon the type of trauma and the number of bone plates used in fracture management. Pearson correlation was applied to explore any correlation involving patient age, aetiology and type of fracture, number of bone plates employed and the length of stay in the hospital. No statistically significant differences were noted in the cost among the different groups. The cost of care was significantly (p<0.001) correlated to the length of stay. Other variables, such as the type of fractures and the number of plates, had no significant impact (p>0.05).
Assuntos
Tempo de Internação , Traumatismos Maxilofaciais , Centros de Atenção Terciária , Humanos , Paquistão , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/economia , Estudos Retrospectivos , Centros de Atenção Terciária/economia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Traumatismos Maxilofaciais/economia , Traumatismos Maxilofaciais/terapia , Traumatismos Maxilofaciais/epidemiologia , Adulto Jovem , Adolescente , Placas Ósseas/economia , Fraturas Mandibulares/economia , Fraturas Mandibulares/terapia , Fraturas Mandibulares/cirurgia , Fixação Interna de Fraturas/economia , Fixação Interna de Fraturas/métodos , Idoso , Criança , Custos de Cuidados de Saúde/estatística & dados numéricos , Fraturas Maxilares/economia , Fraturas Maxilares/cirurgia , Fraturas Maxilares/terapiaRESUMO
Maxillofacial fractures (MFF) belong to the major modern medicine and public health concerns. The recovery from MFF is associated with a number of social problems. The patient's mood may be affected by the change in self-image and lack of satisfaction with life, in many cases leading to a deepening of mental health disorders, resulting in alcoholism, loss of job or conflicts in the area of family life. The aim of this study was to evaluate the quality of life of patients with MFF, with respect to demographic and medical variables. The mean age of the 227 patients was 36 years. The mandible was the most frequent MFF location (52.9%), followed by the zygomatic bone (30.8%) then the maxilla (16.3%). Bone fracture displacement occurred in 79.3% of patients. A comminuted fracture was found in 71% of patients. The quality of life of patients with MFF was significantly better in all analyzed domains 3 months after the end of hospitalization compared to the initial survey carried out shortly after implementation of the treatment. Among the demographic variables, older age had a statistically significant but weak positive association with the improvement of the quality of life of respondents in General health perception domain.
Assuntos
Fraturas Mandibulares/psicologia , Fraturas Maxilares/psicologia , Qualidade de Vida , Fraturas Zigomáticas/psicologia , Tratamento Conservador/métodos , Tratamento Conservador/psicologia , Feminino , Seguimentos , Fixação de Fratura/métodos , Fixação de Fratura/psicologia , Indicadores Básicos de Saúde , Hospitalização , Humanos , Masculino , Fraturas Mandibulares/terapia , Fraturas Maxilares/terapia , Fraturas Zigomáticas/terapiaRESUMO
BACKGROUND/AIM: Epidemiology of maxillofacial fractures (MFF) varies between populations. This study investigated the epidemiology of MFF treated at the Oral and Maxillofacial Surgery (OMFS) Unit, Hospital Universiti Sains Malaysia (USM). METHODS: A retrospective review of 473 medical records of patients with MFF treated from June 2013 to December 2015 was conducted. Information on demographic characteristics of patients, aetiology of injury, types of MFF, and treatment was obtained. Descriptive analysis, Pearson's chi-squared test, and multiple logistic regression analysis were conducted. The level of significance was set at 0.05. RESULTS: Most patients treated for MFF were males (82.2%), aged 30 and below (63.1%), and from Malay ethnic (97.4%). Road traffic accident was the most common cause of MFF (83.1%), with motorcycle accident accounting for most injuries (73.6%). Orbital wall fracture was the most frequent MFF type (51.2%). About half of MFF patients (51.4%) were treated conservatively. Patients aged more than 20 years old were at higher odds of sustaining orbital wall fracture (AOR= 1.76; 95% CI: 1.214-2.558; P= 0.003) but were at lower odds of sustaining mandibular fracture (AOR= 0.47; 95% CI: 0.315-0.695; P= 0.001) than patients who are 20 years old and younger. Helmet use among motorcyclists was significantly associated with the nasal, orbital wall, and maxillary sinus wall fractures (P= 0.006, 0.010, and 0.004, respectively). CONCLUSION: Motorcycle accident was the most common cause of MFF in Kelantan, Malaysia. Ages of patient and helmet use were associated with the type of MFF sustained. This study provides important information to facilitate the planning of MFF prevention strategies among motorcyclists and emphasizes the importance of using a helmet when riding a motorcycle.
Assuntos
Hospitais de Ensino/estatística & dados numéricos , Fraturas Mandibulares/epidemiologia , Fraturas Maxilares/epidemiologia , Acidentes de Trânsito , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Malásia/epidemiologia , Masculino , Fraturas Mandibulares/etiologia , Fraturas Mandibulares/terapia , Fraturas Maxilares/etiologia , Fraturas Maxilares/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
The oral and maxillofacial region has a complex regional anatomy including hard and soft tissues. Trauma in this region may affect the airway, cause potentially life threatening bleeding and head injuries. The senses of olfaction, sight and hearing can also be disrupted as well as a profound psychological impact following disfigurement. This oral and maxillofacial trauma update provides information on demographics, incidence, pathophysiology, diagnosis, fracture patterns and management of facial trauma. It also discusses the role of new advancements in the management of facial trauma.
Assuntos
Traumatismos Maxilofaciais/terapia , Fraturas Cranianas/terapia , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Criança , Feminino , Humanos , Incidência , Masculino , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/epidemiologia , Fraturas Mandibulares/terapia , Fraturas Maxilares/diagnóstico por imagem , Fraturas Maxilares/epidemiologia , Fraturas Maxilares/terapia , Traumatismos Maxilofaciais/diagnóstico por imagem , Traumatismos Maxilofaciais/epidemiologia , Pessoa de Meia-Idade , Havaiano Nativo ou Outro Ilhéu do Pacífico , Órbita/diagnóstico por imagem , Assunção de Riscos , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/epidemiologia , Cirurgia Bucal , Tomografia Computadorizada por Raios X , Adulto Jovem , Zigoma/diagnóstico por imagemRESUMO
We evaluated 78 patients who had intermaxillary fixation (IMF) of fractured mandibular condyles with arch bars and wires. Depending on whether the wires were bent apically or occlusally during placement of the arch bars, we randomly divided the patients into two groups (n=39 in each), then compared pain, satisfaction with oral hygiene, and complications between the groups at five to six weeks postoperatively when the arch bars were removed. Outcomes were significantly better in the occlusal group than in the apical group.
Assuntos
Fios Ortopédicos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Técnicas de Fixação da Arcada Osseodentária/instrumentação , Côndilo Mandibular/lesões , Fraturas Mandibulares/terapia , Fraturas Maxilares/terapia , Adolescente , Adulto , Parafusos Ósseos , Fios Ortopédicos/efeitos adversos , Falha de Equipamento , Feminino , Seguimentos , Humanos , Técnicas de Fixação da Arcada Osseodentária/efeitos adversos , Masculino , Má Oclusão/etiologia , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/cirurgia , Fraturas Maxilares/cirurgia , Pessoa de Meia-Idade , Dor , Medição da Dor , Satisfação do Paciente , Resultado do Tratamento , Adulto JovemRESUMO
Sports account for 3% to 29% of facial injuries and 10% to 42% of facial fractures. Fractures of the facial skeleton most commonly occur owing to interpersonal violence or motor vehicle crashes. Facial fractures from sporting activities has clearly decreased over time owing to better preventive measures. However, this decreasing trend is offset by the emergence of more dangerous sports activities, or "pushing the envelope" of traditional sports activities. Fractures can occur from contact between athletes, and between athletes and their surroundings. Football, soccer, hockey, and baseball most frequently are involved in sports-related cases of facial bone fracture.
Assuntos
Traumatismos em Atletas , Fraturas Cranianas , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Humanos , Fraturas Mandibulares/complicações , Fraturas Mandibulares/diagnóstico , Fraturas Mandibulares/terapia , Fraturas Maxilares/complicações , Fraturas Maxilares/diagnóstico , Fraturas Maxilares/terapia , Fraturas Orbitárias/complicações , Fraturas Orbitárias/diagnóstico , Fraturas Orbitárias/terapia , Volta ao Esporte , Fraturas Cranianas/complicações , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/terapia , Fraturas Zigomáticas/complicações , Fraturas Zigomáticas/diagnóstico , Fraturas Zigomáticas/terapiaRESUMO
INTRODUCTION: The use of intermaxillary fixation (IMF) in the treatment of faciomaxillary fractures is the key factor for reduction and immobilization. Various techniques of IMF have been described in the past and recently IMF screws have been introduced. This technique has various advantages, including ease of use, less time consumption, less trauma to the surrounding soft tissues, and relatively reduced risk of needle stick injury. This study evaluates the efficacy of IMF screws over arch bar IMF before definitive fixation of facial fractures. MATERIALS AND METHODS: This study is a randomized clinical study. Study population consists of 20 patients with mandibu-lar fractures requiring IMF with open reduction and reported to Department of Oral Surgery, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India between September 2012 and April 2015. Two groups were formed with 10 patients in each group. In the first group, IMF was achieved using the Erich's arch bar and wires. In the second group, IMF was achieved using self-tapping IMF screw. The patients were assessed for various parameters, such as the time required in minutes for the IMF stability of fixation, postoperative occlusion, postoperative pain, periodontal health, oral hygiene, and incidence of needle stick injury. RESULTS: All the cases had stable IMF in both groups. At the end of 14th day, overall oral hygiene was poor in group I and good in group II, significant statistically (p = 0.031). Iatrogenic injury to tooth was absent in group I and present in 1 case in group II, not significant statistically (p = 0.305). Average time taken for the IMF in group I was 74.9 minutes, with the range of 58 to 88 minutes, and in group II was 16.1 minutes, with the range of 11 to 22 minutes, which is highly significant statistically (p = 0.001). Needle stick injuries were taken as positive if glove perforation was present and these were reported in four cases in group I, whereas in group II, no case had incidence of needle stick injuries, which shows significant statistically (p = 0.025). CONCLUSION: After this study, we can conclude that IMF self-tapping screw is a proven useful technique of IMF. Intermaxillary fixation is a safe and less time-consuming method but with various shortcomings and complications, which the surgeon must be aware of while providing treatment. CLINICAL SIGNIFICANCE: Keywords: Erich's arch bar, Intermaxillary fixation, Self-tapping intermaxillary fixation screws.
Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Técnicas de Fixação da Arcada Osseodentária/instrumentação , Fraturas Mandibulares/cirurgia , Fraturas Maxilares/cirurgia , Cirurgia Bucal/instrumentação , Cirurgia Bucal/métodos , Adolescente , Adulto , Idoso , Fios Ortopédicos , Falha de Equipamento , Humanos , Índia , Complicações Intraoperatórias , Masculino , Fraturas Mandibulares/terapia , Fraturas Maxilares/terapia , Pessoa de Meia-Idade , Higiene Bucal , Resultado do Tratamento , Adulto JovemRESUMO
We synthesised methacrylate-terminated PLGA (HT-PLGA, 85:15 LA:GA, 169kDa), for potential use as an adhesively attached craniomaxillofacial fracture fixation plate. The in vitro degradation of molecular weight, pH and flexural modulus were measured over 6weeks storage in PBS at 37°C, with commercially available high (225kDa, H-PLGA) and low (116kDa, L-PLGA) molecular weight 85:15 PLGAs used as comparators. Molecular weights of the materials reduced over 6weeks, HT-PLGA by 48%, H-PLGA by 23% and L-PLGA by 81%. HT-PLGA and H-PLGA exhibited a near constant pH (7.35) and had average flexural moduli in excess of 6GPa when produced, similar to that of the mandible. After 1week storage both exhibited a significant reduction in average modulus, however, from weeks 1-6 no further significant changes were observed, the average modulus never dropped significantly below 5.5GPa. In contrast, the L-PLGA caused a pH drop to below 7.3 by week 6 and an average modulus drop to 0.6 from an initial 4.6GPa. Cell culture using rat bone marrow stromal cells, revealed all materials were cytocompatible and exhibited no osteogenic potential. We conclude that our functionalised PLGA retains mechanical properties which are suitable for use in craniofacial fixation plates.
Assuntos
Materiais Biocompatíveis/química , Placas Ósseas , Ácido Láctico/química , Metacrilatos/química , Ácido Poliglicólico/química , Animais , Materiais Biocompatíveis/farmacologia , Materiais Biocompatíveis/uso terapêutico , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Módulo de Elasticidade , Fixação Interna de Fraturas , Concentração de Íons de Hidrogênio , Masculino , Fraturas Maxilares/terapia , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Ratos , Ratos Sprague-DawleyRESUMO
Severe dental traumatic injuries often involve the supporting bone and soft tissues. This article outlines the current concepts in the management of dentoalveolar fractures for the general dental practitioner with case reports to illustrate management principles and techniques.
Assuntos
Fraturas Maxilomandibulares/diagnóstico , Traumatismos Dentários/diagnóstico , Adolescente , Adulto , Processo Alveolar/lesões , Feminino , Seguimentos , Fixação de Fratura/métodos , Fraturas Cominutivas/terapia , Humanos , Incisivo/lesões , Fraturas Maxilomandibulares/terapia , Masculino , Fraturas Mandibulares/diagnóstico , Fraturas Mandibulares/terapia , Fraturas Maxilares/diagnóstico , Fraturas Maxilares/terapia , Planejamento de Assistência ao Paciente , Exame Físico , Radiografia Panorâmica , Contenções , Avulsão Dentária/terapia , Fraturas dos Dentes/terapia , Traumatismos Dentários/terapia , Reimplante Dentário/métodos , Alvéolo Dental/lesões , Adulto JovemRESUMO
OBJECTIVES: More than 50% of all children suffer a traumatic dental injury (TDI) during childhood. In many cases, dentists apply root canal treatment (RCT), which is performed on an average of 7-10 days after replantation. Our aim was to evaluate whether RCT is necessary in many cases, and whether revitalization of affected teeth is possible and measurable by visualization using 3T magnetic resonance imaging (MRI). MATERIAL AND METHODS: Seven healthy children with TDI were treated by repositioning of the affected teeth and reduction of alveolar process fractures followed by splinting. Two weeks after initial treatment, splints were removed. After 6 weeks, all children received 3-Tesla (3T), three-dimensional, high-resolution MRI with a 20-channel standard head and neck coil. The mean age of the children (male/female = 5:2) was 10.8 years (range, 8-17 years). In addition, all children received conventional dental examination for tooth vitality and dental sensitivity to cold and tenderness on percussion. RESULTS: 3T MRI provided excellent images that allowed fine discrimination between dental pulp and adjacent tooth. Using four in-house optimized, non-contrast-enhanced sequences, including panoramic reconstruction, the assessment and analysis of the dental pulp was sufficiently feasible. We could demonstrate reperfusion and thus vitality of the affected teeth in 11 sites. In one child, MRI was able to detect nonreperfusion after TDI of the affected tooth. MRI results were confirmed by clinical examination in all cases. As a consequence of this expectant management and proof of reperfusion and tooth vitality by 3T MRI, only one child had to be treated by RCT. CONCLUSION: 3T MRI is a very promising tool for visualization and detection in the field of dental and oromaxillofacial diseases. By using new 3T MRI sequences in children with TDI, we could demonstrate that RCT are not necessary in every case, and thus could prevent unnecessary treatment of children in the future. Larger studies should follow to confirm the potential benefit in clinical practice.
Assuntos
Necrose da Polpa Dentária/diagnóstico por imagem , Polpa Dentária/fisiologia , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Traumatismos Dentários/complicações , Adolescente , Processo Alveolar/lesões , Anatomia Transversal/métodos , Criança , Polpa Dentária/irrigação sanguínea , Polpa Dentária/diagnóstico por imagem , Diagnóstico Precoce , Feminino , Seguimentos , Humanos , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Fraturas Maxilares/terapia , Tratamento do Canal Radicular , Contenções , Avulsão Dentária/terapia , Traumatismos Dentários/terapia , Reimplante Dentário/métodosRESUMO
BACKGROUND: The epidemiology of facial injuries varies in different countries and geographic zones. Population concentration, lifestyle, cultural background, and socioeconomic status can affect the prevalence of maxillofacial injuries. Therefore, in this study, we evaluated the maxillofacial fractures epidemiology and treatment plans in hospitalized patients (2012-2014) which would be useful for better policy making strategies. MATERIAL AND METHODS: In this retrospective study, the medical records of 386 hospitalized patients were evaluated from the department of maxillofacial surgery at Bahonar Hospital of Kerman, Iran. The type and cause of fractures and treatment plans were recorded in a checklist. For data analysis, ANOVA, t-test, Chi-square, and Fisher's exact test were performed, using SPSS version 21. RESULTS: The majority of patients were male (76.5%). Most subjects were within the age range of 20-30 years. Fractures were mostly caused by accidents, particularly motorcycle accidents (MCAs), and the most common site of involvement was the mandible (parasymphysis). There was a significant association between the type of treatment and age. In fact, the age group of 16-59 years under went open reduction internal fixation (ORIF) more than other age groups (P=0.02). Also, a significant association was observed between gender and the occurrence of fractures (P=0.01). CONCLUSIONS: Considering the geographic and cultural indices of the evaluated population, it can be concluded that patients age and gender and trauma causes significantly affect the prevalence of maxillofacial traumas and fracture kinds and treatment plans.
Assuntos
Fraturas Maxilares/epidemiologia , Fraturas Maxilares/terapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemAssuntos
Ossos Faciais/lesões , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/terapia , Comportamento Cooperativo , Humanos , Comunicação Interdisciplinar , Fraturas Maxilares/classificação , Fraturas Maxilares/diagnóstico , Fraturas Maxilares/terapia , Osso Nasal/lesões , Fraturas Cranianas/classificação , Tomografia Computadorizada por Raios XAssuntos
Implantes Dentários , Côndilo Mandibular/lesões , Fraturas Mandibulares/terapia , Maxila/cirurgia , Adolescente , Processo Alveolar/lesões , Aumento do Rebordo Alveolar/métodos , Implantação Dentária Endóssea/métodos , Prótese Dentária Fixada por Implante , Prótese Parcial Temporária , Terapia por Exercício , Feminino , Seguimentos , Humanos , Técnicas de Fixação da Arcada Osseodentária , Fraturas Maxilares/terapia , Planejamento de Assistência ao Paciente , Amplitude de Movimento Articular/fisiologia , Avulsão Dentária/terapia , Extração Dentária , Fraturas dos Dentes/terapiaAssuntos
Complicações Intraoperatórias/terapia , Fraturas Maxilares/terapia , Dente Molar/cirurgia , Extração Dentária/efeitos adversos , Fios Ortopédicos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Fraturas Maxilares/diagnóstico , Fraturas Maxilares/etiologia , Seio Maxilar/lesões , Dente Serotino/cirurgia , Fístula Bucoantral/cirurgia , Técnicas de Sutura , Alvéolo Dental/lesõesRESUMO
In this study, we investigated cases of mal fracture occurring during the split-crest procedure. In all subjects (six patients), the free cortical bone segment caused by the mal fracture was carefully maintained in the lateral position without fixation using a titanium plate or screw. On pre- and postoperative multiplanar reconstruction CT, the average total alveolar increase was 5.0 mm in the lower portion 1 mm from the top of the alveolar ridge, and the average total alveolar increase in the lower portion 11 mm from the top of the alveolar ridge was 2.2 mm. A total of 11 dental implants were placed immediately at the same time as the split-crest procedure, while three dental implants were placed after a waiting period of 4-11 months from bone augmentation. During an average follow-up of 27.8 months, there were no complications or cases of failed implants. Consequently, among the patients who experienced mal fracture during the split-crest technique, a sufficient volume of alveolar bone was obtained without the need for rigid fixation of the free bone segment, and the dental implants placed within the area of the mal fracture showed a good prognosis.
Assuntos
Implantes Dentários , Mandíbula/cirurgia , Fraturas Mandibulares/terapia , Fraturas Maxilares/terapia , Adulto , Idoso , Enxerto de Osso Alveolar , Perda do Osso Alveolar/cirurgia , Feminino , Humanos , Masculino , Doenças Mandibulares/cirurgia , Fraturas Mandibulares/etiologia , Osteotomia Mandibular/métodos , Fraturas Maxilares/etiologia , Pessoa de Meia-Idade , PrognósticoAssuntos
Fraturas Ósseas/terapia , Fraturas Maxilares/terapia , Traumatismo Múltiplo/terapia , Médicos , Transporte de Pacientes , Aceleração , Acidentes , Adulto , Pressão do Ar , Algoritmos , Aviação , Serviços Médicos de Emergência , Fraturas do Fêmur/terapia , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Traumatismo Múltiplo/fisiopatologia , Pelve/lesões , Respiração Artificial , Tomografia Computadorizada por Raios XRESUMO
Panfacial fractures involve trauma to the lower, middle, and upper facial bones and often require a team approach for management. Early and complete restoration of preinjury facial contours and function should be the goal of the oral and maxillofacial surgeon and the prosthodontist. When the intraoral landmarks are lost, overall facial anatomic landmarks can be used to restore the oral cavity. A patient with complex clinical panfacial fractures, including a vertically and horizontally malpositioned native alveolar bone and severe facial asymmetry, is presented. A functional and esthetic rehabilitation was successfully accomplished by using a partial removable dental prosthesis retained with telescopic crowns and magnetic attachments in the maxilla and osseointegrated implants to support a definitive dental prosthesis in the mandible.
Assuntos
Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Prótese Total Inferior , Prótese Parcial Removível , Traumatismos Faciais/reabilitação , Procedimentos Cirúrgicos Pré-Protéticos Bucais/métodos , Projeto do Implante Dentário-Pivô , Implantação Dentária Endóssea/métodos , Implantação Dentária Endo-Óssea Endodôntica/métodos , Retenção em Prótese Dentária , Assimetria Facial/etiologia , Assimetria Facial/terapia , Ossos Faciais/lesões , Traumatismos Faciais/complicações , Traumatismos Faciais/terapia , Fixação de Fratura/métodos , Humanos , Masculino , Fraturas Mandibulares/reabilitação , Fraturas Mandibulares/terapia , Fraturas Maxilares/reabilitação , Fraturas Maxilares/terapia , Pessoa de Meia-Idade , Resultado do Tratamento , Dimensão Vertical , Fraturas Zigomáticas/reabilitação , Fraturas Zigomáticas/terapiaRESUMO
El objetivo de este estudio fue realizar un análisis retrospectivo de la etiología, incidencia, uso de dispositivos de seguridad, tipo y severidad de las fracturas, tratamiento y complicaciones de los traumatismos del tercio medio facial en una población pediátrica e adolescente del Estado de São Paulo. La muestra fue seleccionada a partir del análisis de historias clínicas de 2986 pacientes víctimas de traumatismos faciales atendidos entre 1999 y 2008 por el Área de Cirugía Buco-Maxilo-Facial de la Facultad de Odontología de Piracicaba, Universidad Estatal de Campinas, Estado de São Paulo-Brasil. Durante este periodo, 757 pacientes menores de 18 años fueron víctimas de traumatismos maxilofaciales. De éstos, 138 pacientes presentaron 148 fracturas nasales y de tercio medio. Los adolescentes fueron el grupo etario más afectado, mientras que el género masculino fue el de mayor prevalencia. Los accidentes ciclísticos se constituyeron en la principal etiología (21.7%). El tratamiento conservador fue utilizado en la gran mayoría de los casos (118 pacientes, 85.5%). Veinte pacientes (14.5%) recibieron tratamiento quirúrgico y solo un caso de complicación pos-operatoria fue reportado. La incidencia de traumatismos y fracturas del tercio medio fue alta en la región de estudio. Los accidentes ciclísticos y las agresiones físicas fueron los principales factores etiológicos, siendo el género masculino predominante en todos los grupos etarios evaluados. Las fracturas nasales y del complejo zigomático orbitario fueron las más prevalentes, mientras que el tratamiento conservador fue instituido en la gran mayoría de los casos
This study showed a retrospective analysis of the etiology, incidence, use of safety devices, type and severity of fractures, treatment and complications of midface trauma in a pediatric and adolescent population of São Paulo - Brazil. We analyzed 2986 medical records of facial trauma patients treated by the Division of Oral and Maxillofacial Surgery Piracicaba Dental School, State University of Campinas, São Paulo - Brazil between 1999 and 2008. During this period, 757 patients under 18 were identified and 138 had 148 nasal and midface fractures. The adolescents were the most affected age group, male gender being the most prevalent. The most common injury causes were bicycle accident (21.74%) and violence (19.6%). Conservative treatment was used in the majority of cases (118 patients, 85.5%). Twenty patients (14.5%) received surgical treatment and only one case of postoperative complication was reported. The incidence of trauma and middle third fractures in pediatric and adolescents patients was high in the study area, being the main etiological factors the bicycle accidents and violence. The male were most affected in all age groups tested. Nasal fractures and zygomatic complex were most prevalent, while conservative treatment was instituted in most cases
Assuntos
Humanos , Masculino , Adolescente , Feminino , Pré-Escolar , Criança , Fraturas Maxilares/terapia , Odontopediatria/métodos , Traumatismos Faciais/etiologia , Traumatismos Faciais/terapia , Traumatismos Maxilofaciais/terapia , Assistência Odontológica para Crianças/métodosRESUMO
A comprehensive study of adverse outcomes after pediatric facial fractures has not been published. This study aimed to determine the incidence and classify adverse outcomes after facial fractures in children while reporting our early results. A retrospective chart review was performed on facial fracture patients identified in the Craniofacial Trauma Database of the Children's Hospital of Pittsburgh and seen in follow-up from 2003 to 2007. An Adverse Outcome Classification Scheme was developed: type 1, outcomes resulting from the fracture; type 2, outcomes resulting from fracture treatment; and type 3, outcomes resulting from the interaction between the fracture, its treatment, and subsequent growth and development. Fisher exact or χ analyses were completed. A total of 177 pediatric facial fracture patients were identified with 13.3 months of average follow-up. Mean age was 9.8 years (range, 0.4-18.7 y). Of these patients, 41.8% underwent surgery and 57 patients (32.2%) had adverse outcomes (type 1, 14.1%; type 2, 11.3%; and type 3, 15.8%); 26.3% of these had multiple adverse outcomes. Isolated fractures resulted in fewer adverse outcomes and fewer multiple adverse outcomes compared with combined fractures (26.6% versus 45.3%, P = 0.015; 4% versus 18.9%, P = 0.002). Patients treated operatively exhibited more types 1, 2, and 3 and multiple adverse outcomes compared to those treated conservatively (P < 0.01). In our pediatric cohort, 32.2% of patients had an adverse outcome. With longer follow-up and growth and development studies, we will likely see an increase in the incidence of type 3 adverse outcomes. We recommend, whenever possible, conservative treatment of pediatric facial fractures.