Acesso transconjutival com cantotomia lateral para abordagem do completo orbito-zigomático-maxilar: relato de caso / Transconjutival access with side cantotomy to approach the orbito-zygomatic-maxillary complex: case report

Objetivo: relatar um caso clínico, embasando os aspectos relativos à técnica cirúrgica transconjutival com cantotomia lateral como tratamento para fratura de COZM. Relato de caso: Paciente, gênero masculino, compareceu ao Serviço de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Geral do Estado (HGE), vítima de acidente motociclístico, apresentando distopia ocular, degrau ósseo em rebordo infraorbitário direito, perda de projeção malar direita, abertura bucal limitada com desvio ipsilateral e distopia oclusal com sinais sugestivos de fratura do complexo-orbito-zigomático-maxilar direito, juntamente com fratura complexa da mandíbula. A abordagem cirúrgica para acessar o COZM contou com a técnica de incisão transconjuntival com cantotomia lateral para uma melhor visualização dos cotos ósseos fraturados. Considerações finais: a escolha por esse tipo de acesso resultou em uma abordagem cirúrgica bem-sucedida, proporcionando segurança na visualização do campo cirúrgico para posterior reabilitação do paciente, estabelecendo uma devolutiva estética e funcional, cicatriz imperceptível e consequentemente um melhor prognóstico para o paciente.(AU)

Objective: to report a clinical case, basing the aspects related to the transconjunctival surgical technique with lateral canthotomy as a treatment for COZM fracture. Case report: Patient, male gender, attended the Oral and Maxillofacial Surgery and Traumatology Service of the General Hospital of the State (HGE), victim of a motorcycle accident, presenting ocular dystopia, bone step in the right infraorbital ridge, loss of right malar projection, mouth opening limited with ipsilateral deviation and occlusal dystopia with signs suggestive of a fracture of the right orbito-zygomatico-maxillary complex along with a complex fracture of the mandible. The surgical approach to access the contoured COZM with the transconjunctival incision technique with lateral canthotomy for better visualization of the fractured bone stumps. Final considerations: the choice for this type of access resulted in a successful behavioral approach, providing security in the experience of the respiratory field for subsequent rehabilitation of the patient, establishing a devolutionary and functional aesthetics, imperceptible healing and, consequently, a better prognosis for the patient.(AU)

Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil / Tempo de recuperação funcional após fraturas faciais: perfil e fatores associados em amostra de pacientes do sul do Brasil

ABSTRACT Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

RESUMO O entendimento da causa, da gravidade e do tempo decorrido para o restabelecimento das funções de lesões maxilofaciais pode contribuir para o estabelecimento de prioridades clínicas objetivando o efetivo tratamento e prevenção dos traumatismos de face. Assim, o objetivo deste estudo foi compreender quais os fatores associados ao restabelecimento das funções mastigatórias, oculares e nasais em vítimas de trauma de face, estimando o tempo para recuperação das funções, após o tratamento cirúrgico. Foram analisados 114 prontuários de pacientes atendidos no Hospital de Montenegro que compareceram às consultas de acompanhamento por até 180 dias. Para a análise do tempo para a recuperação, foi realizada a análise de sobrevida, seguida da análise de COX. Observou-se que metade dos pacientes recuperaram as funções em até 20 dias, sendo que o tempo médio para recuperação dos traumas no complexo zigomático-orbitário-malar-nasal foi de 11 dias e do complexo maxilo - mandibular de 21 dias (HR: 1,5 (0,99 - 2,3) p=0,055). Embora o restabelecimento das funções tenha atingido taxas elevadas após abordagem cirúrgicas, faz-se necessária a análise dos casos de insucessos bem como os impactos econômicos e as estratégias de prevenção associados aos traumas de face a fim de qualificar o serviço prestado à população.

Fixação single-point com placa reabsorvível em fratura pediátrica: relato de caso / Single-point fixation with resorbable plate in pediatric fracture: case report

Introdução: As fraturas faciais pediátricas são geralmente decorrentes de traumas de alta energia e o seu tratamento está relacionado à fase do crescimento facial e do padrão do trauma ocorrido. A literatura atual descreve, com sucesso, a fixação de fraturas de zigoma com pouco deslocamento, utilizando apenas um ponto, seja ele na sutura frontozigomática ou no pilar zigomaticomaxilar, podendo ser associado ao uso de placas do sistema de fixação absorvível, principalmente, em pacientes em fase de crescimento. Este trabalho tem por objetivo relatar um caso de fratura de zigoma em paciente pediátrico tratado com placa e parafusos absorvíveis, utilizando o princípio de fixação em um único ponto. Relato de caso: Paciente de 06 anos de idade foi atendido em serviço de Cirurgia Bucomaxilofacial, cursando com ferimento cortocontuso em margem supraorbitária direita associada à presença de degrau palpável em região de sutura frontozigomática direita, o qual foi confirmado pela tomografia computadorizada, demonstrando leve deslocamento medial. O paciente foi submetido à redução aberta e fixação da fratura com material reabsorvível. Considerações finais: A utilização de fixação com placas reabsorvíveis em um único ponto tem sido um excelente aliado, porém não é indicado para fraturas com deslocamento significativo, instáveis e panfaciais... (AU)

Introduction: Pediatric facial fractures are usually consequence of high energy trauma and its treatment is related to the facial growth phase and the trauma itself. The current literature describes, successfully, the fixation of zygoma fracture with little displacement using the single point fixation, being on the frontozygomatic suture or on the zygomatic-maxillary buttress, which can be associated to the use of resorbable fixation system plates, especially in patients growing phase. The aim of this work is report a case of zygomatic fracture in a pediatric patient treated with plate and resorbable screws, using the principle of single-point fixation. Case Report: A 06-year-old patient, attended in the Oral and Maxillofacial Surgery Service, suffering from a cut-contusion wound on the right supraorbital margin associated with the presence of a palpable step in the region of the right frontozygomatic suture, which was confirmed by computed tomography, demonstrating slight medial displacement. The patient was underwent to open reduction and internal fixation of the fracture with resorbable material. Final considerations: The use of fixation with resorbable plates in a single-point has been an excellent approach, however it is not indicated for fractures with significant displacement, unstable and panfacial... (AU)

Secuelas en pacientes con fracturas cigomáticas tratados con osteosíntesis semirrígida / Sequelae in patients with zygomatic fractures treated with semirigid osteosynthesis

Se realizó un estudio descriptivo, transversal y aleatorizado de 102 pacientes con fracturas del complejo cigomático, tratados con osteosíntesis semirrígida en el Servicio de Cirugía Maxilofacial del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero de 2005 hasta diciembre de 2011, con vistas a caracterizarles según variables demográficas y terapéuticas en las fases preoperatoria, intraoperatoria y posoperatoria. En la casuística predominaron los accidentes del tránsito como mecanismos causales de las lesiones (55,8 por ciento), la depresión de la eminencia cigomática y la presencia de escalones óseos palpables en el marco orbitario inferior y/o lateral como síntomas principales (92,1 por ciento, respectivamente), y la exposición escleral como complicación posoperatoria (55,2 por ciento), entre otros; asimismo, el valor del tiempo preoperatorio incrementó el riesgo de secuelas y la vía de acceso subciliar se asoció con un mayor riesgo de exposición escleral para el acceso al marco inferior y/o suelo orbitario. Por otra parte, tanto el enoftalmos como el hipoftalmos son de difícil solución y tienen una tendencia significativa de convertirse en secuelas posoperatorias

A descriptive, cross-sectional and randomized study of 102 patients with fractures of the zygomatic complex, treated with semirigid osteosynthesis in the Maxillofacial Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January, 2005 to December, 2011, aimed at characterizing them according to demographic and therapeutic variables in the presurgical, intrasurgical and postsurgical phases. In the case material there was a prevalence of traffic accidents as causal mechanisms of the lesions (55.8 percent), depression of the zygomatic eminence and presence of palpable bony steps in the lower and/or lateral orbitary edge as main symptoms (92.1 percent, respectively), and the scleral exhibition as postsurgical complication (55.2 percent), among others; also, the value of the presurgical time increased the risk of sequelae and the subciliary approach was associated with a higher risk of scleral exhibition for approaching to the lower edge and/or orbitary floor. On the other hand, either enophthalmos or hypophthalmos are of difficult solution and have a significant tendency of becoming postsurgical sequelae

Comparação entre acesso transconjuntival com cantotomia lateral e acesso subciliar para tratamento das fraturas zigomáticoorbitárias / Comparison between transconjunctival access with lateral canthotomy and subciliary access for the treatment of orbitozygomatic fractures

INTRODUÇÃO: Fraturas zigomático-orbitárias são as mais comuns do terço médio da face. As principais causas de fraturas são os acidentes de trânsito, principalmente por motocicletas, e a violência interpessoal. Os princípios básicos para o tratamento das fraturas faciais são a redução e a fixação do foco fraturário. É fundamental que o acesso cirúrgico seja o mais direto e amplo possível. Pode ser utilizada abordagem subciliar e transconjuntival com cantotomia lateral. O objetivo deste estudo é avaliar e comparar as complicações, vantagens e desvantagens da abordagem transconjuntival com cantotomia lateral e o acesso subciliar convencional. MÉTODOS: Foram selecionados 15 pacientes nos quais as fraturas foram abordadas por meio de incisão subciliar e 15 pacientes nos quais as fraturas foram abordadas por incisão transconjuntival com cantotomia lateral e avaliadas a incidência de complicações com os dois métodos. Os dados foram analisados estatisticamente com o software SPSS 20.0. RESULTADOS: Foram operados 30 pacientes, metade com acesso subciliar e metade com acesso transconjuntival. Os traumas ocorreram mais frequentemente aos finais de semana. As complicações mais frequentes foram cicatriz aparente (26%), esclera aparente (23,3%) e ectrópio (20%). Ectrópio foi mais comum no grupo acima de 60 anos. CONCLUSÃO: Ambas as técnicas foram eficazes para correção das fraturas do complexo zigomático-orbitário. A técnica transconjuntival proporciona cicatrizes mais estéticas e menos estigmatizantes, constituindo hoje a primeira escolha do autor. A incidência global de complicações foi semelhante entre as duas técnicas. Ectrópio foi menos frequente com acesso transconjuntival.

INTRODUCTION: Orbitozygomatic fractures most commonly occur in the midface. The main causes of fractures are traffic accidents, mainly by motorcycles, and interpersonal violence. The basic principles for the treatment of facial fractures are the reduction and fixation of the fracture site. It is fundamental that the surgical access be the most direct and broad as possible. Either the subciliary approach or transconjunctival access with lateral canthotomy can be used. The objective of this study was to evaluate and compare the complications, advantages, and disadvantages of the transconjunctival approach with lateral canthotomy and conventional subciliary access. METHODS: We selected 15 patients in whom fractures were addressed through a subciliary incision and 15 patients in whom the fractures were addressed by using a transconjunctival incision with lateral canthotomy, and evaluated the incidence of complications with the two methods. The data were statistically analyzed by using the SPSS 20.0 software. RESULTS: Thirty patients were operated with the subciliary access in 15 patients and the transconjunctival access in the other 15. Trauma occurred more frequently on weekends. The most frequent complications were apparent scar (26%), apparent sclera (23.3%), and ectropion (20%). Ectropion was more common in the > 60-year age group. CONCLUSION: Both techniques were effective for the correction of fractures of the orbitozygomatic complex. The transconjunctival technique provides more esthetic and less stigmatizing scars. Hence, it is currently the author's first choice of treatment. The global incidence of complications was similar between the two techniques. Ectropion was less frequent with the transconjunctival access.

Radiographic and clinical evaluations of the zygomatico-maxillary complex fractures treated by 2. 0 miniplates system / Evaluaciones radiográficas y clínicas de fracturas del complejo cigomáticomaxilar tratadas por el sistema de mini placas 2. 0

The zygomaticomaxillary complex (ZMC) is the second highly incidental of facial fractures. According to the anatomical complexity, there are many reports in the literature about this trauma, mainly related to treatment for these fractures. With the purpose of evaluating clinically and radiographically the stability of unilateral zygomatic fractures treated by surgical reduction and fixed in two points by stable internal fixation, this research was proposed. Twenty patients with zygomatic fractures were evaluated and compared with twenty nonfractured patients. The results showed that there were no statistically significant differences among the obtained data, perimeter and area, of the treated and contra-lateral sides of the experimental group. When compared to the control group the differences were not statistically significant. We also performed a comparison of the distance between the nasal bone and zygomatic prominence in all groups the results were also satisfactory

Las fracturas del complejo cigomaticomaxilar son las segundas más frecuente del territorio facial. De acuerdo con la complejidad anatómica, existen muchos informes en la literatura sobre este trauma, principalmente relacionadas con el tratamiento de estas fracturas. El propósito de esta investigación fue evaluar clínica y radiográficamente la estabilidad de las fracturas cigomáticas unilaterales tratadas por reducción quirúrgica y fijadas en dos puntos por fijación interna estable. Veinte pacientes con fracturas cigomáticas fueron evaluados y comparados con veinte pacientes sin fracturas. En el grupo experimental, los resultados mostraron que no hubo diferencias estadísticamente significativas entre los datos obtenidos del perímetro y el área de los lados tratados y contralaterales. Al comparar estos datos con el grupo de control las diferencias no fueron estadísticamente significativas. También se realizó una comparación de la distancia entre el hueso nasal y la prominencia cigomática en todos los grupos, estos resultados también fueron satisfactorios

Fracturas del complejo orbitomalar. Reporte de casos / Management of Zygomatic Bone fractures and orbital fractures: Report of cases

Las fracturas de malar representan el 78% del total y afectan al suelo de la orbita, seno maxilar y sutura cigomático malar. El hueso malar o cigomático, es el acolchado principal del esqueleto en la zona media de la cara, sus fracturas representan el 13 % de las fracturas cráneo faciales. Las fracturas del hueso cigomático se acompañan frecuentemente de fracturas de la órbita o de fracturas de la apófisis cigomética del temporal, por lo que algunos autores prefieren hablar de fracturas del complejo cigomático, abarcando otros huesos. Alrededor del 15% de los casos se asocian con lesiones oculares. Parestesias secundarias a fracturas se presentan en un 70% y 90% de los casos, de ellos el 25% persistirán por largo tiempo. Se presentan dos casos que concurrieron al servicio del Hospital, con fractura orbito-malar, por traumatismos deportivos. Se procedió a la reducción y fijación abierta con osteosíntesis

Malar bone fractures represent 78% of the total amount of fractures that affect the orbit floor, maxillary sinus and malar zygomatic suture. The malar and zygomatic bone, are those which constitute the primary padding in the center of the face, their fractures represent 13% of the craniofacial fractures. Zygoma fractures usually go along with orbit fractures or zygomatic process of temporal fractures, so that some authors prefer to talk about zygomatic complex, including others bones. Almost 15% of the cases are associated with ocular lesions. Secondary paresthesia and fractures represents 70% to 90% of the cases, 25% of them will persist during a long time. We'll show you two cases from our surgery department, the patient present orbitomalar fracture, due to sports trauma, the interventions consists in open reduction and fixation with osteosynthesis

comparison of scalp closure with staples, silk, prolene and vicryl following a gillie's temporal approach for malar / zygomatic complex fracture; a prospective study

This study compared the healing, the type of micro-organisms around the suture material, pain score during removal of suture I staple and cost of the closure material per patient. Sixty patients were allocated in 4 groups. Each group had 15 patients, aged 16 to 70 years of age with isolated fractured zygoma. They were prospectively randomly selected to have staple, silk, prolene or uicryl rapide for closure of their scalp incision. Patients returned at a week for staple or suture removal, a culture swab, pain score and evaluation of healing. Patients were then reviewed at 6 to 8 weeks time to re-evaluate the healing of the temple I scalp wound. The wounds in the first group were closed with staples, in the second group with silk, the third group with prolene and the fourth group with vicryl rapide. There were no differences in age, wound length, number of staples I sutures [3], or surgeon experience. There was no difference in wound healing or type of micro-organism around the staples I sutures. Staples resulted in shorter wound closure time but had a higher pain score on the removal [average 2.4 on a visual analogue scale]. Staple had a less growth of micro-organisms compared to other groups. The follow up rate was 100%. There was no cosmetic or significant complications problem in any group apart from wound breakdown, one in silk and one in the prolene group that both healed with minor scar formation. There was no difference in healing in all four groups but staples were easier and faster and had less micro-organisms growth around them. Staples are more expensive and more painful on removal when compared to other groups. The main advantage of vicryl rapide was that there was no need for removal and had comparable results. Silk had the same results as the other groups but is considerably cheaper when compared to the other materials

Treatment and complications of orbito-zygomatic fractures / Tratamiento y complicaciones de las fracturas órbito-cigomáticas

The aim of the present study was to analyze the etiology, type and treatment employed in the orbito-zygomatic fractures (OZ). Also, postoperative complications are described and correlated with the type of treatment used. Fifty patients with OZ fractures were evaluated. Orbital fractures in which the zygomatic bone was not involved were excluded. Epidemiologic data and characteristics of treatment such as the type of material used for osteosynthesis, number of anatomical sites on which rigid internal fixation (RIF) was applied, surgical approaches and associated complications were recorded. The main causes of trauma were motorcycle and bicycle accidents, constituting 52 percent of the sample. The osteosynthesis system used was the 2.0 mm, except in four patients in whom the 1.5mm system was used for fixation at the infra-orbital rim. A total of 18 percent of the patients required reconstruction of the internal orbit and in all cases titanium mesh was used. 46 percent of the patients received RIF in three anatomical sites, most in the fronto-zygomatic suture, infra-orbital rim and zygomatic-maxillary buttress. The most frequent complication was paresthesia of the infra-orbital nerve (34 patients, 68 percent). Other findings were also discussed with the intent of better understanding the treatment of the OZ fractures...

El objetivo del presente estudio fue analizar la etiología, tipo y tratamiento empleado en las fracturas órbito-cigomáticas (OC). Además, se describen y correlacionan las complicaciones postoperatorias con el tipo de tratamiento utilizado. Cincuenta pacientes con fracturas OC fueron evaluados. Las fracturas orbitarias en la que el hueso cigomático no participó fueron excluidas. Los datos epidemiológicos y las características de tratamiento, tales como el tipo de material utilizado para la osteosíntesis, número de sitios anatómicos en los que se aplicó la fijación interna rígida (FIR), enfoques quirúrgicos y complicaciones asociadas fueron registrados. Las principales causas de los traumas fueron accidentes de bicicleta y motocicleta, constituyendo el 52 por ciento de la muestra. El sistema de osteosíntesis utilizado fue de 2,0 mm, excepto en cuatro pacientes en los que se utilizó el sistema de 1,5 mm para la fijación en el borde infraorbitario. El 18 por ciento de los pacientes requirieron reconstrucción de la órbita interna y en todos los casos se utilizó malla de titanio. El 46 por ciento de los pacientes recibió FIR en tres sitios anatómicos, la mayoría en la sutura fronto-cigomático, borde infraorbitario y pilar cigomato-maxilar. La complicación más frecuente fue parestesia del nervio infraorbitario (34 pacientes, 68 por ciento). Otros hallazgos fueron discutidos con la intención de comprender mejor el tratamiento de las fracturas OC...

Reconstruction of bony facial contour deficiencies with polymethylmethacrylate implants: case report

Facial trauma can be considered one of the most serious aggressions found in the medical centers due to the emotional consequences and the possibility of deformity. In craniofacial surgery, the use of autologous bone is still the first choice for reconstructing bony defects or irregularities. When there is a shortage of donor bone or a patient refuses an intracranial operation, alloplastic materials such as polymethylmethacrylate (PMMA) can be used. The PMMA prosthesis can be pre-fabricated, bringing advantages such as reduction of surgical time, easy technical handling and good esthetic results. This paper describes the procedures for rehabilitating a patient with PMMA implants in the region of the face, recovering the facial contours and esthetics of the patient.

Estudio descriptivo del sistema hospitalario en relación a pacientes sometidos a tratamiento quirúrgico por trauma facial en el Hospital Hernán Henríquez Aravena de Temuco, Chile / Descriptive study of hospital system in relation to patients undergoing surgical treatment of facial trauma in the Hernan Henriquez Aravena Hospital of Temuco, Chile

El trauma maxilofacial conforma una serie de lesiones que involucran tejidos óseos y blandos, provocando alteraciones funcionales y estéticas. El objetivo de este trabajo es determinar el perfil de pacientes que son sometidos a tratamiento quirúrgico por trauma maxilofacial en los pabellones del Hospital Regional de Temuco. De la base de datos del centro de estadísticas del Hospital Regional Hernán Henríquez Aravena, se obtuvieron un total de 145 sujetos con trauma maxilofacial entre los años 2008 y 2009. De la misma base de datos se obtuvieron los datos con los que se determinó la frecuencia según año, etnia, sexo, edad, sistema de previsión, mes, jornada, servicio, diagnóstico de fractura, manejo de tejidos blandos y tratamiento. En este estudio se encontraron 28 casos no diagnosticados (19,3 por ciento), 35 fracturas de cigomático (24,1 por ciento), 17 fracturas de piso de orbita (11,7 por ciento), 22 fracturas de otros huesos del cráneo (15,2 por ciento), 21 fracturas de mandíbula (14,5 por ciento), 11 fracturas múltiples faciales (7,6 por ciento), 3 fracturas de base de cráneo (2,1 por ciento) y 8 otros (5,5 por ciento). Como conclusión podemos decir que las fracturas de cigomático es la más prevalente. Respecto al tratamiento más realizado en el trauma es la reducción con osteosíntesis múltiple.

Maxillofacial trauma constitutes a series of injuries involving bone and soft tissues, causing functional and aesthetic alterations. The aim of this study is to determine the profile of patients subject surgical treatment for maxillofacial trauma in the halls of the Regional Hospital in Temuco. From the central database of statistics Hernan Henriquez Aravena Regional Hospital we obtained a total of 145 patients with maxillofacial trauma between 2008 and 2009. In the same database the data was obtained to determine the frequency by year, ethnicity, sex, age, form of payment, month, day, service, diagnosis of fracture, soft tissue management and treatment. In this study we found 28 cases diagnosed (19.3 percent), 35 fractures of zygomatic (24.1 percent), 17 orbital floor fractures (11.7 percent), 22 fractures of other bones of the skull (15, 2 percent), 21 fractures of the mandible (14.5 percent), 11 multiple facial fractures (7.6 percent), 3 fractures of the skull base (2.1 percent) and 8 others (5.5 percent). In conclusion we can say that zygomatic fractures is the most prevalent, and treatment performed most frequently is the reduction with multiple fixations.

Avaliação da abordagem palpebral subtarsal no tratamento cirúrgico das fraturas zigomático-orbitais / Evaluation of palpebral subtarsal approach in surgical treatment of orbito-zigomatic fractures

OBJETIVO: avaliar as complicações, vantagens e desvantagens da abordagem subtarsal quando utilizada para exposição da borda infra-orbital e do assoalho da órbita em fraturas zigomático-orbitais. MÉTODOS: Estudo retrospectivo de 41 incisões subtarsais empregadas em 39 pacientes com fraturas do complexo zigomático e/ou do assoalho da órbita do tipo blow-out, no período de janeiro de 2002 a dezembro de 2006. RESULTADOS: As complicações observadas foram conjuntivite, epífora e cicatriz aparente em seis (14,6 por cento), cinco (12,2 por cento) e dois (4,9 por cento) dos casos, respectivamente. Não houve presença de ectrópio, entrópio ou esclera aparente nos pacientes reavaliados. CONCLUSÃO: As principais vantagens dessa abordagem são os resultados estéticos e funcionais associados aos benefícios trans-operatórios.

OBJECTIVE: To evaluate the complications, advantages and disadvantages of the subtarsal approach when used to exposure the orbital rim and orbital floor in orbitozygomatic fractures. METHODS: Retrospective study of the 41 subtarsal incisions that were used in 39 patients with fractures of the zygomatic complex and/or orbital floor, of blowout type, between January 2002 and December 2006. RESULTS: The observed complications were conjunctivitis, epiphora and noticeable scar, in six (14,6 percent), five (12,2 percent) and two (4.9 percent) of the cases, respectively. There was no ectropion, entropion or scleral show in the patients reevaluated. CONCLUSIONS: The main advantages of this approach are the esthetic result together with the transoperative benefits.

Clinical applications of bioabsorbable materials in zygomatico-orbital fractures: 7 years experience

A retrospective study to review the clinical outcome and stability of biodegradable materials for the fixing zygomatico-orbital fractures using two different methods. One hundred and seven consecutive patients with zygomatico-orbital fractures during the period of January 2001 to December 2007 were treated using PDLLA Martin biodegradable hardware. They were included into two groups. Study group 1 [n=45] in which predrilling and tap was done before screw insertion. Study group 2[n=62] where sonicweld pin were used. It was done in accordance with the development of new hardware.Treatment outcome and complications recorded for both groups. In group 1, forty-two [93.4%] patients had uneventful healing while three [6.6%] patients developed mild soft tissue reaction. Seventy-two plates and 300 tapped screws used. Fifty-five [18.4%] screws were broken and 4[5.6%] plates replaced for margin shear. In group 2, 62 patients had seventy fractures were treated using 570 sonic weld pins and 135 plates. There were 2[1.5%] plates replaced due to excessive bending and 10[1.7%] screws improperly welded. Biodegradable osteosynthesis materials can be safely used for treatment of zygomatico-orbital factures with minimal postoperative complications and can replace titanium hardware

Analysis of 185 maxillofacial fractures in the state of Santa Catarina, Brazil

A retrospective study was performed to assess maxillofacial fractures in patients treated at a public hospital from 2002 to 2006. The data collected included age, gender, etiology, type of injury, treatment modalities and period of treatment. Causes were grouped into seven categories: road traffic collisions, sports accidents, occupational accidents, gunshot fractures, falls, violence and other causes. The analyses involved descriptive statistics, the Chi-squared Test and the Fisher Exact Test. Records from 132 patients sustaining 185 maxillofacial fractures were evaluated. The mandible (54.6 percent) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6 percent). The mean age of the patients was 37.7 years, and the male:female ratio was 4.3:1. Most fractures occurred in adults with ages ranging from 18 to 39 years. A significant statistical relation was found between the age and the etiology of the trauma (p < 0.05), and between the number of fractured sites and the age of the patient (p < 0.05). Considering the age groups, accidents were the most frequent cause of maxillofacial fractures in the age group between 18 to 39 years, and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 to 59 years. Treatment was performed on the same day as the diagnosis in 44.7 percent of the patients. Open surgery with internal stable fixation was indicated for most of the patients. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Traffic road collisions were the main etiologic factor associated with maxillofacial trauma.

Técnica del Gancho de Ginestet en el tratamiento de las fracturas del componente cigomático-maxilar / Ginestet hook technique in the treatment of the component zygomatic-maxilla fracture

Las fracturas del esqueleto facial constituyen un pilar fundamental dentro del contenido de trabajo de la Cirugía Máxilo Facial, existiendo varias técnicas quirúrgicas para lograr un restablecimiento funcional y estético de los lesionados en corto período. Con el propósito de demostrar la eficacia de la técnica de Gancho de Ginestet en el tratamiento de las fracturas del componente Cigomático-Maxilar, se revisaron las historias clínicas de 380 pacientes con el diagnóstico de fractura del componente Cigomático- Maxilar ingresados en el Hospital Universitario Faustino Pérez de Matanzas, en el período comprendido entre los años 1996–2006, tratados con diferentes técnicas quirúrgicas. Se analizaron los resultados estéticos y funcionales, la estadía general y post operatoria, así como las complicaciones presentadas. Se comprobó que el Gancho de Ginestet fue la técnica quirúrgica más utilizada, con ella se obtuvieron los mejores resultados y con menor tiempo de estadía y complicaciones. Se recomienda continuar utilizando esta técnica y generalizarla a otros hospitales.

The fractures of the facial skeleton constitute a fundamental column inside the work content of the Maxilla.Facial Surgery, existing different surgery techniques to obtain a functional and aesthetical re-establishment of the injuries in a short period of time. With the purpose to demonstrate the efficiency of this technique, the Clinic History of 380 patients were reviewed in the University Hospital Faustino Pérez from Matanzas in the period between the years of 1996-2006, which were treated with different surgical techniques. The aesthetical and functional results were analyzed, the general training and post surgery and the complications presented. It was proved that the most used technique was the Ginestet Hook one, the best results were obtained with it. It is recomended to keep using this technique and to take it to other hospitals.

O uso de implantes de compósito bioativo de biocerâmica em matriz polimérica na reconstrução do complexo zigomático orbitário: novas perspectivas em biomateriais / Bioceramic and polymeric bioactive composite implants in orbit zygomatic complex reconstruction: a new prospect for biomaterials

OBJETIVO: Avaliar o uso de implantes de compósito de matriz polimérica e biocerâmica na reconstrução do complexo zigomático orbitário e seu comportamento através de variáveis clínicas e tomográficas em seis pacientes. MÉTODOS: Foram selecionados seis pacientes portadores de deformidades faciais secundárias a fraturas órbito-zigomáticas graves (n=3) e a seqüelas da radioterapia e enucleação decorrentes do tratamento de retinoblastoma na infância. Este estudo foi submetido a avaliação e aprovação pelo Comitê de Ética em Pesquisa envolvendo seres humanos da Universidade Federal de Minas Gerais, instituição aonde a pesquisa vêm sendo desenvolvida (ETIC203/04). RESULTADOS: Em um ano de acompanhamento após a implantação do material demonstraram ausência de reações inflamatórias locais. Os achados tomográficos demonstraram bom posicionamento do implante, não ocorrendo migrações ou deslocamentos, ausência de coleções ou reações de partes moles peri-implante e manutenção da projeção das partes moles suprajacentes ao implante na região da deformidade preexistente. CONCLUSÃO: Os compósitos têm demonstrado bons resultados para a reconstituição do esqueleto craniofacial. O biomaterial utilizado neste estudo alia biocompatibilidade à tecnologia nacional ampliando as possibilidades da sua utilização a menor custo.

PURPOSE: To evaluate through clinical and tomographic parameters implant behavior in orbital zygomatic reconstruction in six patients. METHODS: The subjects for this preliminary study consisted of six anophthalmic socket patients (3 patients presented residual orbital zygomatic deformities after complex facial fractures and 3 patients presented orbital zygomatic retraction after enucleation and radiotherapy to treat retinoblastoma in infancy). These deformities were surgically corrected with this composite implant. This study was approved and authorized by the Universidade Federal de Minas Gerais Ethical Committee for Research in Human Subjects (ETIC 203/04). Clinical data and tomographic images were utilized to assess the outcome of this study. RESULTS: There were no complications and tomographic findings revealed no implant reactions or migration and a good maintenance of soft tissue projection in the operated areas was achieved. Success of outcome in this preliminary study were encouraging. CONCLUSION: This study will be continued enrolling a larger sample and longer follow-up. Composite biomaterials have presented a good outcome in facial reconstructive surgery. The composite implants in this group have a good biocompatibility and combined with national technology can reduce costs providing more possibilities to many more patients.

Fractura órbito-malar: su resolución quirúrgica / Orbito-zygomatic fracture: its surgical resolution

Un buen abordaje y esqueletización en casos de fracturas órbito-malares complejas aseguran una buena reconstrucción tridimensional y anatómica de la región a tratar. Se presenta el caso de un paciente masculino de 35 años, determinándose el grado real de desplazamiento por medios tomográficos y su resolución con abordajes combinados y osteosíntesis rígidas internas, siguiendo la metodología actual.

Midfacial fractures: different trends in management

This study was undertaken to determine the anatomic distribution and different methods of treatment of midface fractures. Ninety-seven consecutive patients with midface fractures were treated at the Department of Oral and Maxillofacial Surgery, de, Montmorency College of Dentistry, Punjab Dental Hospital, Lahore during the year 2001-2002. A review of patients' records and radiographs were conducted. Data regarding anatomic site and treatment modalities were reviewed. The zygomatic bone was the most commonly involved [64.71%], followed by maxilla [28.43%], nasal bone [3.92%] and nasoethmoidal fractures [2.94%]. Le Fort I was the most common fracture. The maxillary fractures were mostly treated with suspension wiring [31%] while in Zygomatic complex [ZC] fractures Gillies' approach [37.9%] was the common method of management. The miniplates fixation was performed in 20.7% and 13.6% cases of maxillary and ZC fractures respectively

Management of facial trauma in children: A case report.

Children are uniquely susceptible to cranio facial trauma because of their greater cranial mass to body ratio. Below the age of 5, the incidence of pediatric facial fractures in relation to the total is very low ranging from 0.6-1.2%. Maxillo-facial injuries may be quite dramatic causing parents to panic and the child to cry uncontrollably with blood, tooth and soft tissue debris in the mouth. The facial disfigurement caused by trauma can have a deep psychological impact on the tender minds of young children and their parents. This case report documents the trauma and follow up care of a 4-year-old patient with maxillofacial injuries.