Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil.

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.

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.

[Epidemiology of maxillofacial fractures due to traffic accidents in Medellin (Colombia)]. / Epidemiología de las fracturas maxilofaciales por accidente de tráfico en Medellín (Colombia).

OBJECTIVE: To characterize maxillofacial fractures due to traffic accidents in patients attending the Hospital Universitario San Vicente Fundación (Medellin-Colombia) from 1998 to 2010. METHODS: A descriptive study (n =1609) was carried out with information from the medical records of patients meeting the inclusion criteria established by the general objective of the study. The variables consisted of sex, age, year, type and number of fractures, and type of vehicle. A descriptive analysis of the variables was performed and the frequency of fractures due to traffic accidents was calculated according to year and sex. Crude and adjusted odds ratios (aOR) were estimated to establish associations among age, type of vehicle, and the presence of two or more fractures with stratification by sex. RESULTS: The frequency of maxillofacial fractures due to traffic accidents increased in 2007 (men: n=198, women: n=35) and decreased from 2008 to 2010 in both sexes. Fractures were more frequent in persons aged <35 years (80%) and in men (82%). The highest frequency of fractures was observed in motorists. Male users of motorcycles (aOR=1.41; confidence interval 95% [95%CI]: 1.02- 1.94) and bicycles (aOR=1.61; 95%CI: 1.01- 2.56) were more likely to report two or more fractures compared with pedestrians, after adjustment for other variables. CONCLUSIONS: Most maxillofacial fractures occurred in men and in motorists. Future studies should analyze other determinants affecting the epidemiology of maxillofacial fractures. Strategies should be designed to improve the use of protective elements and drivers' knowledge and practices.

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...

Fracture of the coronoid process, sphenoid bone, zygoma, and zygomatic arch after a firearm injury.

A rare case of fracture of the coronoid process, sphenoid bone, zygoma, and zygomatic arch caused by a firearm is described. A 25-year-old man was hit in the face with a bullet, resulting in restricted mouth opening, difficulty chewing, and pain when opening the mouth. The clinical examination revealed a perforating wound in the right parotid region. A computed tomographic scan revealed a comminuted fracture of the left coronoid process with the bullet stopping in the intact left coronoid process. Treatment was bilateral coronoidectomy associated with speech therapy and was successful. Details of the clinical signs, computed tomography, treatment, and follow-up are presented.

Surgical approaches and fixation patterns in zygomatic complex fractures.

The aim of this research was to analyze the surgical approaches and methods of rigid fixation used to treat zygomatic complex (ZC) fractures over a 10-year period. One hundred fifty-three patients who underwent surgery to treat ZC fractures between 1999 and 2008 were retrospectively evaluated. Demographic information, signs, and symptoms of the fractures, classification, surgical approaches, and methods of internal fixation were obtained from the medical records. The data were analyzed using statistical descriptive analysis and chi test (P < 0.05). The mean age of the sample was 31 years, and males were predominant (82.3%). In 60.1% of the patients, one surgical approach was used to treat the ZC fractures, whereas 2 surgical approaches were used in 24.8% of the patients. The zygomaticomaxillary buttress was fixed in 86.9% of the patients, followed by infraorbital rim fixation and zygomaticofrontal. There was a statistical significance between fracture displacement and surgical approach for the infraorbital rim (P < 0.0001) and zygomaticofrontal suture (P < 0.0001). Considering that adequate reduction and fixation should be performed and that we try to minimize the amount of scarring, the intraoral zygomaticomaxillary buttress approach is the first choice to treat ZC fractures. In cases of displacement bigger than 5 mm, approaches to 3 of 4 points of the ZC are mandatory to reduce the fractures. The infraorbital rim and zygomaticofrontal suture approaches are indicated to treat displaced fractures.

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%) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6%). 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% 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.

Maxillofacial injuries in a group of Brazilian subjects under 18 years of age

OBJECTIVE: The purpose of this study was to perform a clinical retrospective analysis of the etiology, incidence and treatment of selected oral and maxillofacial injuries in Brazilian children and adolescents. MATERIAL AND METHODS: This study was conducted during a 14-year period between 1986 and 2000. All patients were admitted to Hospital XV in the city of Curitiba, State of Paraná. Age, gender, monthly distribution, etiology, soft injuries, associated injuries, site of fractures and methods of treatment were reviewed. RESULTS: Of the total of 350 patients of all ages treated for facial injuries, 29.42% were within the age range of the study (0 to 18 years). Mean age was 10.61. Of the patients, 63.1% were male. The most common cause of injury was accidental falls (37.87%), followed by bicycle and motorcycle accidents (21.36%). Of the 103 patients, 88.34% had single injuries. Mandibular fractures were the most common and the condylar region was particularly affected. CONCLUSIONS: Facial trauma is a relatively common occurrence in children. The study indicates that fractures in children and adolescents differ quite considerably from an adult population.

Maxillofacial injuries in a group of Brazilian subjects under 18 years of age.

OBJECTIVE: The purpose of this study was to perform a clinical retrospective analysis of the etiology, incidence and treatment of selected oral and maxillofacial injuries in Brazilian children and adolescents. MATERIAL AND METHODS: This study was conducted during a 14-year period between 1986 and 2000. All patients were admitted to Hospital XV in the city of Curitiba, State of Paraná. Age, gender, monthly distribution, etiology, soft injuries, associated injuries, site of fractures and methods of treatment were reviewed. RESULTS: Of the total of 350 patients of all ages treated for facial injuries, 29.42% were within the age range of the study (0 to 18 years). Mean age was 10.61. Of the patients, 63.1% were male. The most common cause of injury was accidental falls (37.87%), followed by bicycle and motorcycle accidents (21.36%). Of the 103 patients, 88.34% had single injuries. Mandibular fractures were the most common and the condylar region was particularly affected. CONCLUSIONS: Facial trauma is a relatively common occurrence in children. The study indicates that fractures in children and adolescents differ quite considerably from an adult population.

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.

Epidemiologia das fraturas zigomáticas: uma análise de 10 anos / Zygomatic fractures epidemiology: a 10-year-analysis

Devido a sua localização e projeção no complexo maxilofacial, o osso zigomático apresenta elevado índice de fratura comparando-o às demais fraturas dos ossos da face. Estudos epidemiológicos sempre são de grande importância para o cirurgião BucoMaxiloFacial, pois fornecem dados pelos quais se pode traçar o perfil das fraturas faciais e analisar a efetividade dos métodos de tratamento empregados. No presente trabalho foi realizado um levantamento epidemiológico retrospectivo de 10 anos dos pacientes atendidos no Hospital Infantil Maria Lucinda que apresentavam fratura do complexo zigomático. A amostra foi composta por 153 pacientes portadores de fratura do complexo zigomático, onde foram analisados comparativamente os indicadores gênero, faixa etária, etiologia do trauma e localização topográfica da fratura. Os resultados obtidos mostraram o gênero masculino como o mais acometido (83,6%), a faixa etária de 21 a 40 anos (71,2%) mais freqüente, tendo como causa principal a queda da própria altura (39,9%) e o osso zigomático esquerdo como a localização mais afetada (49,7%).

Incidência e etiologia das fraturas faciais na regiäo de Araraquara / Incidence and aetiology of facial fractures in the contry of Araraquara

O propósito deste trabalho é analisar as incidências e etiologias das fraturas faciais na regiäo de Araraquara. Entre janeiro de 1994 e dezembro de 1996 foram avaliados 990 pacientes, sendo que 509 apresentavam fraturas faciais. A mandíbula é o osso mais comumente lesado (35,04 por cento), seguida pelo nariz (22,13 por cento), zigoma (19,89 por cento), maxila (7,24 por cento), fraturas alvéolo-dentárias (5 por cento), arco zigomático (4,34 por cento), fraturas naso-órbito-etimoidais (3,42 por cento), e frontal (2,89 por cento). A maior fonte etiológica säo os acidentes automobilísticos/automotores (65,22 por cento), seguidos pelas agreçöes físicas (21,80 por cento), esportes/quedas (11 por cento), acidentes de trabalho (0,98 por cento)

Fraturas do zigoma: análise crítica de 240 casos consecutivos / Zygoma fractures. Critical analysis of 240 consecutive cases

O presente trabalho analisa 240 pacientes atendidos durante o período de março/83 a março/93 no Serviço de Cirurgia Maxilo-Facial do hospital de Ipanema-RJ, com fraturas recentes ou tardias do complexo órbito-zigomático. O presente trabalho enfatiza aspéctos variados como os agentes etiológicos dentre os quais acidentes automobilístico e agressåo física se destacaram e analisa técnicas cirúrgicas utilizadas em nosso Serviço, para tratamento deste grupo de pacientes. Com relaçåo aos resultados, concluímos que nos casos de fraturas com deslocamento a maioria delas pode ser adequadamente reduzida exclusivamente através da incisåo endoral vestibular de Caldwell-Luc ou combinada com a incisåo subpalpebral. As sequelas do osso zigomático com afundamento sem trismo foram tratadas na maioria das vezes por nós com enxertos de costela ou implante de hidroxiapatita. Com relaçåo aos tipos de fixaçåo utilizados para as fraturas nåo estáveis após a reduçåo, utilizamos de preferência fio de aço nº 0 reservando para situaçÆes de exceçåo a fixaçåo rígida com miniplacas de titâneo

Trauma óseo máxilo facial / Maxillo facial bone trauma

Se presenta la experiencia personal del autor en el diagnóstico y tratamiento en 65 pacientes con fractura maxilofaciales desde el año 1979 a la fecha que ingresaron a los Servicios de Urgencia del Hospital Regional y Hospital de la Mutual de Seguridad de Antofagasta. Las causas más frecuentes fueron accidentes del trabajo, agresión u accidentes del tránsito. La frecuencia mayor correspondió a los varones. Las fracturas predominantes fueron las mandibulares y las de malar. Se efctuaron 160 procedimientos con resultados satisfactorios en lo estético y funcional con un bajo número de complicaciones. En su tratamiento se utilizó instrumental y equipos al alcance de cualquier servicio quirúrgico del país

Características de las fracturas del reborde supraorbitario / Characteristic of supraorbital ridge fractures

Se realizó un estudio tranversal que abarcó el quinquenio 1984 a 1988 en el Hospital "Saturnino Lora" de Santiago de Cuba, donde ingresaron 41 pacientes en quienes se comprobó el diagnóstico de fractura del reborde supraorbitario. Se pudo constatar que los accidentes automovilísticos y las agresiones físicas fueron las principales causas de estas fracturas, cuyos signos sugerentes son la depresión y defecto óseo del reborde orbitario superior, proptosis, desplazamiento inferior del ojo, la ptosis del párpado superior y la diplopía vertical. Las lesiones craneofaciales que más se asociaron resultaron ser las fracturas cigomáticas, frontales y del cráneo, y las asociadas y abiertas se observaron con más frecuencia. El procedimiento quirúrgico a cielo abierto fue el método preferido en estos casos

Contribuiçäo ao estudo das fraturas do complexo zigomático e reconstruçäo do assoalho orbital / Contribuition for study the fractures of the zigomatic complex and the orbital floor reconstruction

No presente trabalho foi estudado as fraturas do complexo zigomático e do assoalho orbital, dando ênfase a reconstituiçäo deste último. Fizemos uma breve resenha histórica, uma revisäo de literatura abordando a anatomia da regiäo, os tipos de fraturas que ocorrem, sua incidência, classificaçäo, sinais e sintomas, estudo das fraturas isoladas do assoalho da órbita e o tratamento dessas fraturas com reconstituiçäo do assoalho. Revisamos as estatísticas mensais do Serviço de Odontologia do Hospital Souza Aguiar no período de janeiro de 1976 a dezembro de 1986, no que concerne as fraturas do complexo zigomático e do terço médio da face, em que, houve comprometimento concomitante deste. Foi enfocado o tipo de anestesia empregado e o tipo de material empregado para a reconstituiçäo do assoalho orbital (folha de silicone reforçada). Revisamos o número dessas fraturas tratadas ano a ano durante os 11 anos citados num total de 951 fraturas do complexo zigomático e 165 fraturas do terço médio da face. O enxerto de silicone em lâmina reforçada de espessura conveniente, mostrou-se um excelente material para este tipo de reconstituiçäo corroborando a tendência de ser material preferencial na Gran Bretanha (1980) e nos Estados Unidos da América (1987)

Fraturas do osso malar e de órbita / Orbital and malar bone fractures

Fraturas do osso malar e de órbitas, frequentes em acidentes da vida moderna, foram estudadas em 156 pacientes, a maioria dos quais eram homens, entre 20 a 40 anos, vítimas de acidentes automobilísticos, quedas e agressöes. Dificuldade em diagnosticar fraturas que apresentam poucas evidências clínicas säo comentadas e traçam-se consideraçöes sobre os sinais, sintomas e alteraçöes. Para isto, orienta-se para a exploraçäo minuciosa de qualquer evidência de fratura. Devido a frequentes lesöes oftalmológicas associadas, é aconselhado o exame oftalmológico sistemático. No tratamento foram utilizadas tanto técnica conservadora, com uso de gancho, quanto técnica cirúrgica, usando osteossíntese com fio de aço. Säo comentados aspectos das diversas terapêuticas utilizadas