Tratamiento quirúrgico o conservador para fracturas de cóndilo mandibular / Surgical or conservative treatment for mandibular condyle fractures

INTRODUCCIÓN: Las fracturas maxilofaciales se asocian a importante morbilidad, pérdida de función y secuelas estéticas, entre otros. Dentro de las fracturas mandibulares, las fracturas de cóndilo mandibular son las más frecuentes. Estas pueden ser tratadas mediante un tratamiento quirúrgico (reducción abierta más estabilización con miniplacas de titanio) o un tratamiento conservador (ortopédico). MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyen 66 estudios primarios, de los cuales, seis corresponden a ensayos aleatorizados. Concluimos que, en comparación con el tratamiento conservador, el tratamiento quirúrgico en fracturas de cóndilo mandibular probablemente se asocia a menor dolor articular, menor maloclusión y menor desviación lateral en apertura bucal.

INTRODUCTION: Maxillofacial fractures are associated with significant morbidity, loss of function and aesthetic sequelae, among others. Within mandibular fractures, mandibular condylar fractures are the most frequent. These can be treated by surgical treatment or conservative treatment (orthopedic). METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including 66 primary studies overall, of which six were randomized trials. We concluded surgical treatment of mandibular condyle fractures, compared to conservative treatment, is probably associated with less joint pain, less malocclusion and less lateral deviation in buccal opening.

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.

Pediatrics mandibular fractures: a study on the involvement of canine region

This study was conducted to compare the frequency of mandibular canine region fractures with fractures of other regions of mandible in patients with un-erupted canines at the Department of Oral and Maxillofacial Surgery, Abbasi Shaheed Hospital Karachi form January 2002 to March 2004. A Non Probability Convenience sample of all patients with age 6-12 years presenting with mandibular fracture were included. The sample was categorized into two groups: Age 6-9 years with un-erupted canines and Age 10-12 years with erupted canines. The fracture site parameter was categorized into two groups: Fractures in Canine Region and Fractures in other regions of the mandible. Total study sample was 76 subjects. Mean age of the subjects was calculated as 8.57 years [SD 1.94]. Male to Female ratio was 2.6:1. The most common cause of injury was recorded as fall 51.3% followed by road traffic accident 35.5%, assault and sports injuries accounted for 6.6%. The most common overall site of fracture was canine region 44.7%. In the age group [6-9 yrs] the fractures occurring in canine region were 51.3% and 15.8% in [9-12 years group]. Significant association was found to exist between the age groups [6-9 Years, 9-12 years] and fracture groups [canine region fractures, other region fractures] pvalue< 0.05. This study clearly demonstrates that mandibular fractures occur commonly in children in the region of un-erupted canines supporting the evidence of an area of weakness in the mandibular canine region, especially during the mixed dentition period

Incidência e tratamento inicial das fraturas mandibulares por arma de fogo na cidade do Rio de Janeiro / Incidence and initial treatment of the mandible fractures by gunshot in Rio de Janeiro city

Uma característica fartamente evidenciada em relaçäo à cidade do Rio de Janeiro é a violência, trazendo, em consequência, a mobilizaçäo de profissionais das diversas áreas. No campo da saúde säo os especialistas em traumatologia da face reconhecidos e destacados pela originalidade e qualidade de seus trabalhos, cuja divulgaçäo amplia-se na medida em que cresce mundialmente o interesse por trabalhos relacionados à medicina de guerra. Neste sentido, esta pesquisa acrescenta dados provocados por projétil de arma de fogo (PAF). Este estudo consta da análise de 67 prontuários de três dos maiores hospitais de emergência do Rio de Janeiro, Hospital Municipal Souza Aguiar, Miguel Couto e Salgado Filho, onde foram analisados dados referentes a regiäo acometida, o tratamento inicial instituído, bem como as complicaçöes pós-operatórias. Nos resultados obtidos o tratamento conservador foi preferido ao cirúrgico na maioria dos casos, além das complicaçöes pós-operatórias estarem mais frequentemente associadas a reduçäo cruenta das fraturas. Este estudo vem evidenciar a necessidade de um protocolo de atendimento ao traumatizado de face, assim como de maior conhecimento de balística e da fisiopatologia dos ferimentos por PAF, a fim de diminuir a morbidade por esse tipo de traumatismo