Manejo de la vía aérea mediante intubación submental en fracturas maxilofaciales / Airway management by submental intubation in maxillofacial fractures

La intubación submentoniana es útil en procedimientos quirúrgicos en donde la intubación nasotraqueal está contraindicada y la intubación orotraqueal no es ideal debido a la fijación intermaxilar. Este informe describe dos pacientes masculinos que se presentaron al Hospital Nacional Rosales, en el servicio de Cirugía Maxilofacial de El Salvador, con historia de sufrir accidente de tránsito. El primer caso evidenció al examen radiológico fractura simple y desplazada de sínfisis mandibular, fractura simple huesos propios nasales y desviación del tabique nasal. El segundo caso es un paciente con fractura de sínfisis y doble cóndilo mandibular que presentaba imposibilidad a la apertura bucal. A través de la técnica del cirujano maxilofacial Hernández Altemir (España), el tubo endotraqueal atraviesa una incisión extraoral en la región submentoniana del suelo de la boca, para poder practicar reducción abierta de fracturas faciales, logrando adecuada oclusión, con mínimos cuidados posoperatorios y con una cicatriz estética. Al terminar la cirugía, la posición del tubo endotraqueal regresa a su posición original y el paciente evoluciona satisfactoriamente

Submental intubation is useful in surgical procedures where nasotracheal intubation is contraindicated and orotracheal intubation is not ideal due to intermaxillary fixation. This report describes two male patients who presented to the Rosales National Hospital, in the Maxillofacial Surgery service of El Salvador, with a history of suffering a traffic accident. The first case showed a simple and displaced fracture of the mandibular symphysis, simple nasal bone fracture and deviation of the nasal septum on radiological examination. The second case is a patient with a symphysis fracture and a double mandibular condyle that presented an inability to open the mouth. Through the technique of the maxillofacial surgeon Hernández Altemir (Spain), the endotracheal tube passes through an extraoral incision in the submental region of the floor of the mouth, in order to perform open reduction of facial fractures, achieving adequate occlusion, with minimal postoperative care and with an aesthetic scar. At the end of the surgery, the position of the endotracheal tube returns to its original position and the patient evolves satisfactorily

Gross anatomy of the intrinsic muscles of the scapular and humeral joint regions in crab-eating fox (Cerdocyon thous, Linnaeus 1776) / Anatomia macroscópica dos músculos intrínsecos das regiões escapular e da articulação do úmero de cachorro-do-mato (Cerdocyon thous, Linnaeus 1776)

The crab-eating fox (Cerdocyon thous) is a wild canid with a wide distribution in South America that is susceptible to traumas due to road kills - an event in which some specimens can survive. Therefore, anatomical studies in their thoracic limbs may be a base for rehabilitation. Six dead specimens were donated by Wildlife Rescue Centre of CORPOCALDAS (Environmental Authority of the Department of Caldas in Colombia), which were then filled with silicone rubber via the common carotid artery, and later fixed with formaldehyde through the external jugular vein. One male was dissected in fresh, and after a week, the others were dissected on the scapular and humeral joint regions. The intrinsic muscles of these regions in the crab-eating fox were homologous to domestic dog, with similar characteristics in terms of shape, origin, insertion, innervation and arterial blood supply. However, the crab-eating fox did have some differences, such as its supraspinatus muscle being conformed by two bellies and attached into the articular capsule of the humeral joint in same manner as the subscapularis muscle, thus conferring greater stability to the humeral. However, the clinical and surgical approaches that must be performed in this region may be homologous to the domestic dog.

Cachorro-do-mato (Cerdocyon thous) é um canideo selvagem amplamente distribuído na América do Sul, susceptível a traumatismos por atropelamentos em rodovias, eventos nos quais alguns animais podem sobreviver. Portanto, estudos anatômicos em seus membros torácicos podem servir como base para sua reabilitação. Seis espécimes mortos foram doados pelo Centro de Resgate de Vida Selvagem da Corporación Autónoma Regional para el Desarrollo de Caldas - CORPOCALDAS, os quais foram preenchidos com borracha de silicone pela artéria carótida comum, e depois fixados com formaldeído através da veia jugular externa. Um macho foi dissecado a fresco e após uma semana, os outros foram dissecados nas regiões da articulação escapular e umeral. Os músculos intrínsecos dessa região no cachorro-do-mato eram homólogos às dos cães domésticos, com características semelhantes na forma, origem, inserção, inervação e suprimento de sangue arterial. No entanto, o cachorro-do-mato apresenta algumas diferenças, como músculo supraespinhal conformado por duas cabeças e unidos na cápsula articular da articulação umeral, da mesma forma que o músculo subescapular, características essas que devem conferir maior estabilidade à articulação do úmero. Apesar disso, as abordagens clínicas e cirúrgicas realizadas nesta região podem ser homólogas ao cão doméstico.

Uso de plasma rico en plaquetas en la práctica clínica / Platelet rich plasma in the clinical practic

En los últimos 10 años se ha estado hablando con relación a los beneficios terapéuticos de la terapia con plasma rico en plaquetas (PRP) y su aplicación en distintas áreas de la salud como la odontología, la ortopedia, la cirugía vascular y la medicina estética entre otras (1-4). El uso del PRP como herramienta terapéutica se sustenta en la presencia de múltiples factores de crecimiento dentro de los gránulos alfa de las plaquetas, entre los que se encuentran el factor de crecimiento derivado de plaquetas, factor de crecimiento transformante beta, factor plaquetario 4, interleuquina 1, factor de angiogénesis derivado de plaquetas, factor de crecimiento vascular endotelial, factor de crecimiento epidérmico, factor de crecimiento endotelial derivado de plaquetas, factor de crecimiento epitelial, factor de crecimiento similar a la insulina, osteocalcina, osteonectina, fibrinógeno, vitronectina, fibronectina y trombospondina 1 (5).

In the last 10 years, the therapeutic benefits of platelet-rich plasma (PRP) therapy and its application in different areas of health such as dentistry, orthopedics, vascular surgery and aesthetic medicine have been discussed among others (1-4). The use of PRP as a therapeutic tool is supported by the presence of multiple growth factors within the alpha granules of platelets, among which are platelet-derived growth factor, transforming growth factor beta, platelet factor 4, interleukin 1, platelet-derived angiogenesis factor, vascular endothelial growth factor, epidermal growth factor, platelet-derived endothelial growth factor, epithelial growth factor, insulin-like growth factor, osteocalcin, osteonectin, fibrinogen, vitronectin, fibronectin and thrombospondin 1 (5).

Traumatismo maxilofacial asociado a neumomediastino y enfisema de cuello. Revisión de la literatura y fisiopatología / Maxillofacial trauma associated with pneumomediastinum and neck emphysema. Revision of literature and pathophysiology

La extensión de un enfi sema facial sin neumotórax, hacia el cuello o el mediastino, secundario a un traumatismo maxilofacial, es de baja frecuencia. En la literatura se encuentran pocos casos referidos y su presencia obliga a descartar la ruptura de vísceras cérvico-tóraco-abdominales. De un total de 744 pacientes con traumatismo facial ingresados en el Sanatorio del Norte de San Miguel de Tucumán, desde octubre de 1996 a septiembre de 2001, 57 pacientes presentaron enfi sema facial, 4 asociados a fractura de mandíbula, 3 a traumatismos faciales cerrados y 50 a fracturas faciales del tercio medio y superior (maxilar superior, senos paranasales, malar, órbita, arco cigomático y frontal). De estos últimos, 3 que tenían fractura del seno maxilar, cursaron con enfi sema de cuello y uno de ellos además con enfi sema mediastinal. Se relata la evolución clínica, diagnósticos diferenciales, conducta terapéutica y teorías de la diseminación del aire hacia el mediastino. Se realiza, además, una revisión bibliográfi ca

The extension of the facial emphysema without pneumothorax, toward neck or the mediastinum area, secondary to a traumatism maxillofacial, it is low frequency. In the literature they are few referred cases and their presence forces to discard viscera rupture of the neck, thorax or abdominal region. About a total of 744 patients with facial traumatism entered in the Sanatorium del Norte, of San Miguel of Tucumán, from October of 1996 to September of 2001, 57 patients presented facial emphysema, 4 associated to jaw fracture, 3 at closed facial traumatisms and 50 to facial fractures of the upper third of facial region (maxillary superior, paranasal sinus, orbit, zigomatic bone, zigomatic arch and frontal bone). Three patients had fracture of maxillary sinus and neck emphysema, one of them also developed pneumomediastinum. The clinical evolution is related, diff erential diagnoses, therapeutic and theories of the dissemination of the air toward the mediastinum. Bibliographical revision is preformed in this presentation