Profile of Hospitalizations of Children and Adolescents Victims of Transport Accidents: A Retrospective Study

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.

Alcohol consumption and maxillofacial fractures in times of Covid-19: a cross-sectional study in a cuban university hospital / Consumo de alcohol y fracturas maxilofaciales en tiempos de Covid-19: un estudio transversal en un hospital universitario cubano

Introduction: The consumption of alcoholic beverages reduces the body's ability to deal with dangerous situations and exposes people to trauma. Objective: To determine the association between the consumption of alcoholic beverages and the characteristics of maxillofacial fractures treated at a Cuban university hospital in the context of COVID-19. Material and Methods: An observational, analytical, and cross-sectional study was carried out in the Maxillofacial Surgery unit at the "Carlos Manuel de Céspedes" General University Hospital during the year 2020. Prevalence ratios, 95% confidence intervals and p-values were obtained using generalized linear models. Results: In 58.23% of the cases, fractures were related to the consumption of alcoholic beverages. The fundamental etiology was interpersonal violence (47.75%), regardless of the consumption of alcoholic beverages. There was a prevalence of patients with nasal fractures (n=98; 55.06%), among which, 35.71% had consumed alcoholic beverages at the time of the trauma. Being male (p=0.005), the lack of university studies (p=0.007), the need for surgical treatment (p<0.001), the fractures of the zygomaticomaxillary complex (p=0.023), and the traumas that occurred during the weekends (p<0.001) or during the month of June (p=0.029) were factors associated with a higher frequency of fractures related to the consumption of alcoholic beverages. There was a lower frequency of fractures associated with alcohol consumption during the months of January (p=0.006) and March (p=0.001). Conclusion: Six out of ten cases were under the influence of alcoholic beverages. There was a greater number of young and male patients, mainly due to interpersonal violence.

Introducción: La ingestión de bebidas alcohólicas disminuye la capacidad del organismo para enfrentar situaciones de peligro y lo predispone a sufrir traumatismos diversos. Objetivo: Determinar la asociación entre el consumo de bebidas alcohólicas y las características de las fracturas maxilofaciales atendidas en un hospital universitario cubano en el contexto de la COVID-19. Material y Métodos: Estudio observacional, analítico y transversal realizado en el servicio de Cirugía Maxilofacial del Hospital General Universitario "Carlos Manuel de Céspedes" durante el 2020. Se obtuvieron razones de prevalencia, intervalos de confianza a 95% y valores p mediante modelos lineales generalizados. Resultados: En el 58.23% de los casos las fracturas se relacionaron con la ingestión de bebidas alcohólicas. La etiología fundamental fue la violencia interpersonal (47.75%), independientemente del consumo o no de bebidas alcohólicas. Predominaron los pacientes con fracturas nasales (n=98; 55.06%), en los que el 35.71% había consumido bebidas alcohólicas en el momento del trauma. El sexo masculino (p=0.005), la carencia de estudios universitarios (p=0.007), la necesidad de tratamiento quirúrgico (p<0.001), las fracturas del complejo cigomático-maxilar (p=0.023), los traumas sucedidos durante los fines de semanas (p<0.001) o durante el mes de junio (p=0.029) fueron factores asociados a una mayor frecuencia de fracturas relacionadas con el consumo de bebidas alcohólicas. Hubo menor frecuencia de fracturas asociadas a este consumo durante los meses de enero (p=0.006) y marzo (p= 0.001). Conclusión: Seis de cada diez casos estuvieron bajo los efectos de la ingestión de bebidas alcohólicas. Existió una mayor afectación de pacientes jóvenes, masculinos, a causa principalmente de la violencia interpersonal.

Tratamento cirúrgico de fratura Le Fort II: relato de caso / Surgical Treatment of Le Fort II Fracture: Case Report

Fraturas faciais geralmente resultam traumas, e podem ocorrer de forma isolada ou concomitante a outras lesões. O trauma na região facial resulta em danos não só em tecido ósseo, mas também em tecido mole e dentição, causando um prejuízo na função e na estética do paciente. Os acidentes automotores permanecem sendo uma das causas mais significativas de traumas faciais. As fraturas do terço médio da face incluem a maxila, zigoma e o complexo naso órbito etimoidal; podem ser classificadas em: fraturas Le Fort I, II ou III, fraturas do complexo zigomático maxilar, fraturas de arco zigomático ou fraturas naso órbito etimoidais. Elas podem ser unilaterais ou bilaterais, simétricas ou assimétricas. Este estudo objetiva-se em relatar o caso clínico de um paciente do sexo masculino, 31 anos, vítima de acidente automobilístico (carro/ anteparo). O paciente foi diagnosticado com fratura do tipo Le Fort II e nasal onde foi realizado o tratamento de redução e fixação interna rígida das fraturas de maxila e redução incruenta de fratura nasal, resultando em melhora da condição do paciente. As fraturas Le Fort são predominantemente causadas por colisões de alta energia. Portanto o tratamento é imprescindível para a devolução da função, estética e autoestima do paciente... (AU)

Facial fractures usually result from trauma, and may occur in isolation or concomitantly with other injuries. Trauma in the facial region results in damage not only to bone tissue but also to soft tissue and dental elements, which causes a loss in the patient's function and esthetics. Automotive accidents remain one of the most significant causes of facial trauma. Fractures of the middle third of the face include maxilla, zygoma and the nasoorbitoethmoid; may be classified as: Le Fort I, II or III fractures, maxillary zygomatic complex fractures, zygomatic arch fractures, or nasoorbitoethmoid. They can be unilateral or bilateral, symmetrical or asymmetric. The present study aims to report the clinical case of a 31 years, male patient, victim of an automobile accident (car/fixed shield). The patient was diagnosed with le Fort II and nasal fracture, where the treatment of reduction and rigid internal fixation of maxilla fractures and reduction of nasal fracture were performed, resulting in improvement of the patient's condiction. Le Fort fractures are predominantly caused by high energy collisions. Therefore the treatment is essential for the return of the function, aesthetics and increase of the patient's self-esteem... (AU)

Effect of digital and 3D printing technology combined with non-vascularized ilium in repairing post-traumatic bone defect in maxillary anterior teeth area / 中华创伤杂志

Objective:To explore the effect of digital technology and 3D printing technology combined with non-vascularized ilium bone in repairing post-traumatic bone defect in maxillary anterior area.Methods:A retrospective case series study was performed to analyze clinical data of 8 patients with severe bone defect in maxillary anterior area after trauma admitted to First Affiliated Hospital of Zhengzhou University from June 2013 to January 2018. There were 6 males and 2 females, with the age of 18-43 years [(31.9±9.0)years]. The maxillary bone was reconstructed before surgery by employing digital technology. The intercept range of ilium was determined according to the best form of defect to be recovered. Then the model and guide plate was printed out by employing 3D print technology. The titanium mesh was prebended on the model. The bone was extracted and Onlay bone grafting was performed according to the guide plate. The implant restoration was performed 6 to 9 months after operation, and porcelain crown restoration was performed 4 to 6 months later. The iliac bone survival and postoperative complications were detected 6 months after bone grafting. The near-middle-far and vertical bone elevation of the alveolar ridge as well as bone elevation of lip palatal were measured before implantation. The condition around the implants was observed 6 months after porcelain crown restoration. The visual analogue score (VAS) was used to evaluate the pain after iliac bone transplantation and implantation. The implant stability coefficient (ISQ) was applied to assess the stability of the implants on the day and 4 months after operation.Results:All the patients were followed up for 24-48 months [(33.3±9.7)months]. Eight patients with non-vascularized iliums were all survived. There was one patient with mild infection after bone grafting and one patient with gingival inflammatory hyperplasia after implantation, both of whom were healed after treatment. There was no obvious peri-implant inflammation or absorption of the grafted bone. The increase in height of the alveolar on the mesial and distal bone, vertical bone and labial-palatal bone was 30.28-39.67 mm, 9.58-11.32 mm and 2.06-7.41 mm, respectively. All the implants showed good osseointegration. The VAS after implantation was (3.4±0.7)points, significantly alleviated compared with the preoperational level [(7.3±2.0)points] ( P<0.05). The ISQ was 84.4±1.9 at postoperative 4 months, showing no significant difference from that on the day after operation (72.9±1.4) ( P>0.05). Conclusions:In repair of severe bone defect in maxillary anterior area after trauma, the digital and 3D printing technology combined with non-vascularized ilium can improve the survival rate of bone grafts. The implant restoration after operation can reduce pain, restore the patients' facial appearance and achieve satisfactory oral physiological function.

Approach for naso-orbito-ethmoidal fracture

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.

Caracterización sociodemográfica y clínica del trauma maxilofacial en un hospital de referencia de Bogotá / Clinical and sociodemographic characteristics of maxillofacial injuries in a tertiary hospital in Bogotá

Introducción: el trauma maxilofacial es un motivo de consulta frecuente, y puede llevar a daño funcional, estético y emocional. Existen estudios previos sobre su epidemiología, sin embargo, sabemos que esta cambia a través del tiempo porque está determinada por diversos factores. El objetivo de este estudio es describir las características del trauma maxilofacial en un hospital de referencia de Bogotá. Diseño: estudio observacional descriptivo. Metodología: Se revisaron historias clínicas de pacientes mayores de 18 años que ingresaron por urgencias a la Unidad de Cirugía Maxilofacial del Hospital San José entre el 2013 y 2017. Se calculó frecuencias absolutas y relativas para las variables cualitativas. Resultados: se obtuvieron 391 pacientes. La mayoría fueron hombres (76,3 %) entre los 30-49 años. Las causas más comunes son la violencia (36,8 %) y los accidentes de tránsito (25 %). Las fracturas más frecuentes fueron las de huesos propios nasales (52 %). De las fracturas mandibulares, las más prevalentes fueron las fracturas condilares y subcondilares, ángulo y cuerpo con 21,4 % cada una. El tratamiento más usado fue el manejo médico (52,9 %). Discusión: el trauma maxilofacial es una patología frecuente en hombres adultos jóvenes. Sin embargo, el tipo de fractura y etiología podría estar influenciado por factores como el sexo y la edad. La causa más común es la violencia y los accidentes de tránsito, las cuales son potencialmente prevenibles. Esto debe servir como referencia para incitar a la realización de medidas preventivas para estas situaciones.

Background: Nowdays, the maxilofacial injuries are a common cause for consultation in the emergency department. These kinds of fractures may cause functional, and emotional damage. There are many publication about the epidemiology of maxilofacial trauma. Nevertheless, this data can change through the time. The aim of this study was to describe the maxilofacial injuries in a tertiary hospital in Bogotá. Desing: observational study. Methods: We retrospectibly assessed 391 medical records from the department of maxilofacial surgery in our Hospital during the period between 2013 to 2017. We include patients over 18 years admitted in the emergency department, we exclude patients seeing in the outpatients clinic. All the cases were assessed according age, sex, etiology and type of the fractures, in addition, we analyzed the treatment modalities. Results: We recolected 391 medical records. The majority of the facial fractures were man (76.3 %) between 30 and 49 years old. The most common cause of maxilofacial fracture was violence (36.8 %). The most common fracture site was nasal bones (52 %). Within the mandibular fractures the most common was the condylar, subcondylar fracture and body (21 % each). 53 % of cases were treated with conservative methods. Conclusion: The maxilofacial injuries are a common in our service especially in young men. Moreover depending on the sex and age we could observed diferents etiologies and typess of fracture. Mostly of the cases were for violence reasons or traffic accidents, which are preventable causes. This information is importante for public health awarness and it can be use as a referral for prevental measures for this situations.

Massive Hemorrhage Facial Fracture Patient Treated by Embolization

Major maxillofacial bone injury itself can be life threatening from both cardiovascular point of view, as well as airway obstruction. Significant hemorrhage from facial fracture is an uncommon occurrence, and there is little in the literature to guide the management of these patients. We report a 73-year-old male driver who was transported to our hospital after a motor vehicle collision. The patient was hypotensive and tachycardic at presentation and required active fluid resuscitation and transfusion. The patient was intubated to protect the airway. All external attempts to control the bleeding, from packing to fracture reduction, were unsuccessful. Emergency angiogram revealed the bleeding to originate from terminal branches of the sphenopalatine artery, which were embolized. This was associated with cessation of bleeding and stabilization of vital signs. Despite the age and severity of injury, the patient recovered well and was discharged home at 3 months with full employment. In facial trauma patients with intractable bleeding, transcatheter arterial embolization should be considered early in the course of management to decrease mortality rate.

Endovascular Treatment to Stop Life-threatening Bleeding from Branches of the External Carotid Artery in Patients with Traumatic Maxillofacial Fracture

OBJECTIVE: The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures. MATERIALS AND METHODS: A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated. RESULTS: Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS (p = 0.016), lowest systolic blood pressure (p = 0.011), and lowest body temperature (p = 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused (p = 0.030), the number of units of fresh frozen plasma transfused (p = 0.013), and the time from arrival to groin puncture (p < 0.001) showed significant negative correlation with good clinical outcomes. CONCLUSION: It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.

Endovascular Treatment to Stop Life-threatening Bleeding from Branches of the External Carotid Artery in Patients with Traumatic Maxillofacial Fracture

OBJECTIVE: The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures. MATERIALS AND METHODS: A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated. RESULTS: Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS (p = 0.016), lowest systolic blood pressure (p = 0.011), and lowest body temperature (p = 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused (p = 0.030), the number of units of fresh frozen plasma transfused (p = 0.013), and the time from arrival to groin puncture (p < 0.001) showed significant negative correlation with good clinical outcomes. CONCLUSION: It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.

The Efficacy of Bioabsorbable Mesh in Craniofacial Trauma Surgery

BACKGROUND: The ultimate goal of craniofacial reconstructive surgery is to achieve the most complete restoration of facial functions. A bioabsorbable fixation system which does not need secondary operation for implant removal has been developed in the last decade. The purpose of this study is to share the experience of authors and to demonstrate the efficacy of bioabsorbable mesh in a variety of craniofacial trauma operations. METHODS: Between October 2008 and February 2015, bioabsorbable meshes were used to reconstruct various types of craniofacial bone fractures in 611 patients. Any displaced bone fragments were detached from the fracture site and fixed to the mesh. The resulting bone-mesh complex was designed and molded into an appropriate shape by the immersion in warm saline. The mesh was molded once again under simultaneous warm saline irrigation and suction. RESULTS: In all patients, contour deformities were restored completely, and bone segments were fixed properly. The authors found that the bioabsorbable mesh provided rigid fixation without any evidence of integrity loss on postoperative computed tomography scans. CONCLUSION: Because bioabsorbable meshes are more flexible than bioabsorbable plates, they can be molded and could easily reconstruct the facial bone in three dimensions. Additionally, it is easy to attach bone fragments to the mesh. Bioabsorbable mesh and screws is effective and can be easily applied for fixation in various craniofacial trauma reconstructive scenarios.

Surgical Methods of Zygomaticomaxillary Complex Fracture

BACKGROUND: Zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Zygoma fractures are classified according to Knight and North based on the direction of anatomic displacement and the pattern created by the fracture. In zygomaticomaxillary complex (ZMC) fracture many incisions (lateral eyebrow, lateral upper blepharoplasty, transconjunctival, subciliary, subtarsal, intraoral, direct percutaneous approach) are useful. We reviewed various approaches for the treatment of ZMC fractures and discussed about incisions and fixation methods. METHODS: A retrospective review was conducted of patients with ZMC fracture at a single institution from January 2005 to December 2014. Patients with single zygomatic arch fracture were excluded. RESULTS: The identified 694 patients who were admitted for zygomatic fractures from which 192 patients with simple arch fractures were excluded. The remaining 502 patients consisted of 439 males and 63 females, and total 532 zygomatic bone was operated. Orbital fracture was the most common associated fracture. According to the Knight and North classification the most frequent fracture was Group IV. Most fractures were fixated at two points (73%). CONCLUSION: We reviewed our cases over 10 years according to fracture type and fixation methods. In conclusion, minimal incision, familiar approach and fixation methods of the surgeon are recommended.

Uso do acesso retromandibular para tratamento de fratura bilateral de côndilo mandibular: relato de caso / Treatment of bilateral mandibular condylar fractures: a case report

O tratamento da fratura de côndilo mandibular é um assunto de muitas controvérsias na literatura sobre as indicações e contraindicações para o tratamento cirúrgico ou conservador. Além delas, dúvidas ainda permanecem sobre qual o melhor acesso cirúrgico para o tratamento desse tipo de fratura, quando se opta pelo tratamento cirúrgico (aberto). os acessos extrabucais, descritos na literatura para o tratamento das fraturas condilares, são: pré-auricular, submandibular, ritidectomia e retromandibular (hinds). o acesso intraoral, com o auxílio da endoscopia, também pode ser utilizado com a mesma finalidade. Por meio do relato de um caso clínico, os autores apresentam um caso de fratura de côndilo mandibular bilateral em que foi utilizado o acesso retromandibular para redução e fixação da fratura.

The treatment of a mandibular condylar fracture is a subject of much controversy in the literature regarding indications and contraindications to the surgical or conservative approach. In addition, many doubts remain regarding the optimal surgical approach for treating this type of fracture when the open technique is chosen. The extra-oral approaches described in the literature for the treatment of condylar fractures are the preauricular, submandibular, ritidectomy and retromandibular (hinds).The intra-oral access, with the aid of endoscopy, can also be used for the same purpose. In this clinical report, the authors present a case of bilateral mandibular condylar fracture in which the retromandibular approach was used for the reduction and fixation of the fracture.

Facial symmetry evaluation after experimentally displaced condylar process fracture in methotrexate treated rats / Avaliação da simetria facial após fratura experimental com desvio do processo condilar em ratos tratados com metotrexato

PURPOSE: To investigate the facial symmetry of high and low dose methotrexate (MTX) treated rats submitted to experimentally displaced mandibular condyle fracture through the recording of cephalometric measurements. METHODS: One hundred male Wistar rats underwent surgery using an experimental model of right condylar fracture. Animals were divided into four groups: A - saline solution (1mL/week); B - dexamethasone (DEX) (0,15mg/Kg); C - MTX low dose (3 mg/Kg/week); D - MTX high dose (30 mg/Kg). Animals were sacrificed at 1, 7, 15, 30 and 90 days postoperatively (n=5). Body weight was recorded. Specimens were submitted to axial radiographic incidence, and cephalometric mensurations were made using a computer system. Linear measurements of skull and mandible, as well as angular measurements of mandibular deviation were taken. Data were subjected to statistical analyses among the groups, periods of sacrifice and between the sides in each group (α=0.05). RESULTS: Animals regained body weight over time, except in group D. There was reduction in the mandibular length and also changes in the maxilla as well as progressive deviation in the mandible in relation to the skull basis in group D. CONCLUSION: Treatment with high dose methotrexate had deleterious effect on facial symmetry of rats submitted to experimentally displaced condylar process fracture.

OBJETIVO: Avaliar a simetria facial de ratos tratados com metotrexato (MTX), em dose alta e baixa, submetidos à fratura experimental do processo condilar com desvio por meio de mensurações cefalométricas. MÉTODOS: Cem ratos Wistar machos foram submetidos a procedimento cirúrgico utilizando modelo experimental de fratura de côndilo do lado direito. Os animais foram distribuídos em quatro grupos: A - soro fisiológico (1mL/semana); B - dexametasona (DEX) (0,15mg/Kg); C - MTX baixa dose (3mg/Kg/semana); D - MTX alta dose (30mg/Kg). Os períodos de sacrifício foram de 1, 7, 15, 30 e 90 dias de pós-operatório (n=5). O peso dos animais foi documentado. Foram realizadas mensurações lineares da maxila e da mandíbula, bem como angulares do desvio mandibular. Os dados foram submetidos a análises estatísticas entre os grupos, períodos de sacrifício e entre os lados em cada grupo (α=0,05). RESULTADOS: Os animais recuperaram peso ao longo do tempo, exceto no grupo D. Houve redução no comprimento mandibular com alterações também na maxila e desvio progressivo da mandíbula em relação à base do crânio no grupo D. CONCLUSÃO: O tratamento com metotrexato em alta dose teve efeito deletério na simetria facial de ratos submetidos à fratura do processo condilar.

Biomechanical study of rigid internal fixation for maxillary LeFort Ⅰ fracture / 中华创伤杂志

Objective To biomechanically study the fixation stability of different numbers and shapes of the titanium miniplates (L-shaped and straight four-hole miniplates) in the treatment of maxillary LeFortⅠ fracture by using three-dimensional finite element method so as to provide reference for clinical treatment of the fractures. Methods Three-dimensional finite element model of maxillary LeFortⅠ fracture was established with four kinds of rigid internal fixation (RIF) methods to calculate the stress of the maxilla and the RIF as well as the displacement of the fracture segment under three kinds of occlusion.Then, the fixation stability of different methods was compared. Results Under the same occlusion condition, the decreasing order of the displacement of the fracture segment was the L-shaped plate fixation at both buttress of the maxillary and nasal maxillary zygomatic, the straight four-hole miniplates fixation at both buttress of the maxillary and nasal maxillary zygomatic, the L-shaped plate fixation at the zygomatic maxillary buttress and the L-shaped plate fixation at naso-maxillary buttress. Under the same fixation method, the decreasing order of the displacement of the fracture segment was molar occlusion, premolar oeclusion and incisor occlusion. Conclusions The fixation stability of the L-shaped plate fixation is better than the straight four-hole miniplate fixation for the treatment of LeFortⅠ fracture. Fixation at the zygomaticmaxillary buttress is better than at the naso-maxillary buttress. Use of only two miniplates to fix the LeFort Ⅰ fracture may not be stable. Molar occlusion is not good for fracture healing.

Estudo epidemiológico das fraturas faciais ocorridas na cidade de Montes Claros/MG / Epidemiology study of facial fractures in the city of Montes Claros/MG

Introdução: O trauma facial apresenta incidência crescente, principalmente devido ao aumento dos acidentes automobilísticos, que continuam sendo sua principal causa. Objetivo: Descrever o perfil dos traumas faciais e dos indivíduos traumatizados atendidos em 2006 e 2007. Métodos: Foram avaliadas as seguintes variáveis: gênero, faixa etária, localização da lesão, motivo do trauma, tipo de tratamento instituído, profissional que realizou o atendimento e a cidade de origem do paciente. Os dados foram coletados por meio de pesquisa em prontuários nos Hospitais Santa Casa de Misericórdia e Hospital Aroldo Tourinho. Uma análise descritiva foi realizada empregando o pacote SPSS v.12.0. Resultados: Observou-se que (81%) dos acidentados eram do gênero masculino. Os traumas mais comuns foram os mandibulares (45%), malar (22%) e maxila (16%). A maioria dos casos (73%) foi atendida pelo médico e o cirurgião-dentista atendeu (27%) dos acidentados. Os acidentes automobilísticos foram responsáveis pela maioria dos traumatismos (17%). Os pacientes eram, na sua maioria (49%), oriundos de Montes Claros/MG. Conclusão: O trauma facial acontece com freqüência e o acidente automobilístico é a principal causa.

Introduction: The facial trauma has presented an increasing occurrence, due especially to the growth of automobile accidents, which continue being its main cause. Objective: Tto describe the facial trauma and injured individual profile that were seen in 2006 and 2007. Methods: The following variables were assessed: gender, age, location of the lesion, the trauma reason, the kind of treatment, the professional who saw the patient and the city where the patient was from. The data were collected through a research in patients chats at Santa Casa de Misericórdia and Aroldo Tourinho Hospital. A descriptive analysis was carried out using the SPSS package v.12.0. Results: It was noticed that 81% of the injured were men. The most common trauma places were mandibular (45%), malar (22%) and maxilla (16%). A rate of 73% of the cases was seen by a doctor and 27% were seen by dental surgeon. The car accident was charged with the majority of the injuries (17%). Most patients were from Montes Claros/MG (49%). Conclusions: Facial trauma presented an increasing occurrence and automobile accidents was the main cause.

Análise epidemiológica das fraturas faciais em um hospital secundário / Epidemiological analysis of facial fractures in a secondary hospital

Introdução: Os traumas de face são diagnósticos frequentes no pronto-socorro. Suas causassão variadas, sendo as principais a violência e os acidentes de trânsito. Os dados epidemiológicossão importantes para o conhecimento do problema e para contribuir na realização demedidas preventivas, educacionais e técnicas. Objetivo: O objetivo do trabalho foi relatar aexperiência do autor no atendimento aos traumatismos de face em um hospital secundário eavaliar as características epidemiológicas durante os primeiros 37 meses do serviço. Método:Estudo observacional, prospectivo, longitudinal dos pacientes atendidos no Pronto-socorro,no período de 1 de março de 2004 a 30 de abril de 2007. Dados dos 136 pacientes do estudoforam registrados em protocolo específico. Resultados: Houve predomínio do sexomasculino (76%) e a idade média foi de 29,67 anos. As principais causas foram as quedas(27,8%) e a as agressões (26,3%). O nariz foi o local mais acometido (50% dos casos),seguido pelas fraturas do complexo órbito-zigomático (24,3%). Nas fraturas de mandíbula,o côndilo foi o local mais afetado (28,6%). A redução nasal com a pinça de Asch foi tratamentomais utilizado (40,2%), seguido das placas e parafusos nos outros tipos de fraturas(31,8%). O índice de complicações foi de 5,8%. O seguimento pós-operatório demonstrouíndice de satisfação dos pacientes de 85%. Conclusão: Os dados de incidência, tratamento ecomplicações obtidos estão de acordo com a literatura científica. Os dados epidemiológicosobtidos serão utilizados na implementação de medidas para a prevenção do trauma facial.

Background: Facial traumas are frequently diagnosed within an emergency hospital. Theircauses vary and the most prevalent are interpersonal violence and traffic accidents. Epidemiologicaldata is important to understand the problem and to propose technical, preventiveand teaching issues. Purpose: The goal of this study was to show the author’s experience withfacial trauma in a small hospital and evaluate the first 37 months of this service. Methods:It was an observational, prospective, longitudinal study of the patients from the emergencyfrom March 1, 2004 to April 30, 2007. Data from the 136 patients were registered in a specificprotocol. Results: There was a male predominance (76%) and the mean age was 29.67years. The main causes were falls (27.8%) and interpersonal violence (26.3%). The nosewas the most affected location with 50% of the cases, followed by orbitozygomatic complex(24.3%). In the mandible fractures the condile was the most affected location (28.6%). Nasalclosed reduction with Asch forceps was the most utilized treatment (40.2%), followed byminiplates and screws for the other fracture locations (31.8%). Complications were presentin 5.8% of the cases. Follow up of the patients has shown a satisfaction rate of 85%. Conclusion:Incidence, treatment and complication data obtained are according to the literature.Epidemiological data collected will be useful to take measures to prevent facial trauma.

Análise da concordância intra e inter-observadores na detecção das fraturas da face por meio da tomografia computadorizada / Intra and interobservers concordance analysis of face fractures detection through computed tomography

Introdução: A face está sujeita a agressões externas, encontrando-se em uma região propícia a ferimentos leves e graves, através de acidentes automobilísticos, esportivos, além de agressões, sendo a primeira zona de impacto do organismo a sofrer determinadas injúrias. A Traumatologia apresentou um importante desenvolvimento na área diagnóstica, com grandes avanços na tecnologia de obtenção de imagens para diagnóstico das fraturas faciais, como o desenvolvimento de novas técnicas de tomografia computadorizada como exame complementar no tratamento dos pacientes vítimas de traumas faciais. Objetivos: Avaliar a importância da tomografia computadorizada de face como meio diagnóstico dos traumatismos faciais através da análise de concordância intra e inter-observadores na detecção de fraturas da face por em pacientes vítimas de traumatismos faciais. Métodos: Para realização da análise de concordância foram utilizados 40 exames de tomografias computadorizadas de 40 pacientes vítimas de trauma facial atendidos entre os anos de 2000 e 2006. Os exames foram apresentados a dois observadores, em duas películas tomográficas para cada paciente observado, sendo uma contendo apenas cortes coronais e a outra com cortes axiais e foram interpretadas, com o objetivo de identificar a concordância intra e inter-observadores para a detecção das fraturas da face em dois intervalos diferentes (inicial e final ou A e B), com diferença de 30 dias do período inicial (A) para o período final(B). Para a análise da concordância intra e inter-observadores foi empregado o Índice Kappa (K) de Cohen (1960). Resultados: A eqüidade de valores encontrados nos dois intervalos de observação (A e B) reproduziu uma concordância considerada excelente para os observadores 1 e 2. Devido ao fato de que todos os valores serem exatamente iguais nos dois intervalos para o observador 1 e 2, mas diferentes entre eles, não se aplicou o índice Kappa para a análise intra-observadores 1 e 2. Na análise de...

Introduction: The face is subject to external aggressions since it is very liKely to minor as well as serious injuries. Such injuries can happen in a car accident or when practicing sports besides aggressions, because it is the first zone of impact of the organism bound to suffer certain injuries. The Traumatology presented an important development in the diagnostic area by achieving a significant breaKthrough in obtaining images for diagnosis of facial fractures, such as the development of new computerized tomography techniques as a complementary examination in the treatment of patients suffering from facial trauma. Objectives: To assess the importance of computed tomography of face as a means of diagnosing facial injuries through the analysis of concordance intra and inter-observers in the detection of fractures of the face of patients suffering from facial injuries. Methods: In order to do the concordance analysis 40 computed tomography scans were used from 40 patients victims of facial trauma attended between 2000 and 2006. The 40 computed tomography of face were presented to 2 observers, in two tomographic films for each patient observed, one containing only coronal sections and the other with axial images. Then they were interpreted, to identify the intra and inter observers concordance for the detection of fractures of the face in two different intervals (initial and final or A and B), with a thirty-day difference of the initial period (A) and the final period (B). For the analysis of the inter and intra-observers? concordance, the index Kappa (K) form Cohen (1960) was used. Results: The equality of values found in both intervals of observation (A and B) reproduced a concordance considered excellent for the observers 1 and 2. Due to the fact that all values are exactly equal in both intervals for observer 1 and 2, but different between them, the Kappa index was not applied for the analysis intra-observer 1 and 2. In the analysis of inter-observer...

Traumas faciais: estudo retrospectivo de 1190 casos na região de Araçatuba / Facial injuries: a retrospective study of 1190 cases in the region of Araçatuba

Introdução: As populações apresentam variações na epidemiologia de fraturas faciais de acordo com a área geográfica, condição socioeconômica e cultural, época e injúria. Objetivo: Avaliar e determinar a ocorrência dos traumas faciais - fraturas mandibulares (FM), nasais (FN), zigomáticas (FZ), do seio frontal (FF), traumatismos dento alveolares (TDA) e ferimentos por arma de fogo (FAF) - em pacientes atendidos pelo serviço de Cirurgia e Traumatologia da Faculdade de Odontologia de Araçatuba - UNESP. Métodos: Foi realizado o estudo dos prontuários de pacientes admitidos no intervalo de 1999 a 2005. Resultados: Dentre os 4112 pacientes atendidos durante o período, 1190 (29%) apresentaram os traumas selecionados no estudo, dos quais 913 (76,7%) eram do gênero masculino e 277 (23,3%) do feminino. A faixa etária mais acometida foi de 21 a 25 anos (17%), sendo as causas mais freqüentes: agressão física (17,6%), acidentes ciclísticos (16,6%) e acidentes motociclísticos (15,8%). A fratura nasal foi o trauma mais freqüente (26,89%), seguida das fraturas do zigomático (25,38%), TDA (22,35%), fraturas mandibulares (21,26%), do seio frontal (2,78%) e os FAF (1,34%). Setenta e dois por cento dos casos foram tratados cirurgicamente. Conclusões: O trauma facial ocorreu com mais freqüência no gênero masculino, na faixa etária entre 21 e 25 anos, em consequência de agressão física e a fratura nasal foi a injúria mais prevalente.

Introduction: General population have variations in the epidemiology of facial fractures, according to geographical areas, socioeconomic and cultural differences, season and type of injury. Objective: To evaluate and determinate facial trauma incidence - mandible fractures (MF), nasal fractures (NF), zygomatic (ZF), the frontal sinus (FS), alveolar dental trauma (ADT) and injuries by a firearm (FA) - in patients seen at the Department of Surgery and Integrated Clinics, Dental School Araçatuba, São Paulo State University (UNESP), Araçatuba, SP, Brazil. Methods: A retrospective study of medical charts of patients admitted between 1999 to 2005 was performed. Results: Among the 4112 patients evaluated during this period, 1190 (29%) showed the selected traumas for this study, of whom 913 (76.7%) were mem and 277 (23.3%) were women. The most affected age group was from 21 to 25 (17%), whereas the most frequent causes were: physical aggression (17.6%), cycling accidents (16.6%), and motorcycle accidents (15.8%). The most frequent trauma was nasal fracture (26.89%), followed by zygomatic fractures (25.38%), ADT (22.35%), mandible fractures (21.26%), the frontal sinus (2, 78%) and the FA (1.34%). Seventy two percent of the cases were treated surgically. Conclusions: The facial trauma occurred more in men between the ages of 21 and 25, as a result of physical aggression and nasal fracture was the most prevalent injury.

Non-operative treatment of maxillary fracture by elastic traction / 解放军医学杂志

Objective To explore and estimate a new non-operative treatment of maxillary fracture with elastic traction for the purpose of early treatment and on-spot first aid. Methods 12 patients, who were suffer from maxillary fracture including Lefort Ⅰ, Ⅱ, Ⅲ fracture, zygomatico-maxillary complex fracture and nasomaxillary complex fracture within the past 2 or 3 weeks,were treated by closed tractive reduction with a patent craniomaxillary tractive device, a non-operative manner instead of surgical open reduction and rigid internal fixation. The devices were placed after dental splints had been ligated, and the traction force was adjusted depending on the extent of maxillary displacement and patient’s endurance. In general, the displaced maxilla could be pulled upwards, downwards, forward, leftward and rightward. For fallen maxilla, a special plate was placed on upper teeth and palate in order to push up the whole maxillary fragments. By adjusting the position of maxillary bar, the displacement could be reduction and correction. The elastic rubber loops were placed between dental splint and headframe, then the reduction of maxilla was accomplished. After reduction, external fixation such as intermaxillary fixation and craniomnetal bandage were used for maintenance. Results Tractive times of those 12 patients lasted from 2 days to 7 days, with an average of 4 days. After the non-operative trative reduction, satisfactory functional and cosmetic results were achieved with normal occlusion and facial contour in all patients. No obvious complications were found. Conclusion For fresh maxillary fracture except comminuted and impacted fracture, this new non-operative tractive treatment could be an ideal treatment rather than surgical open reduction.