Estabilización y fijación de fracturas dentoalveolares asociadas a fracturas faciales mediante osteosíntesis transmucosa. A propósito de dos casos / Stabilization and fixation of dentoalveolar fractures asociated with facial fractures across transmucosal osteosynthesis. A propos of two cases

OBJETIVOS: Evaluar la estabilidad de osteosíntesis transmucosas, en casos de fracturas conminutas dentoalveolares, evitando la desperiostización de los fragmentos, para así mantener la vascularización de estos, favoreciendo la regeneración y pronóstico de las piezas dentarias y los segmentos óseos. MATERIALES Y MÉTODOS: Se realizó osteosíntesis transmucosa con placas de perfil delgado (0,5 y 0,7 mm dePuy Synthes - Matrix Midface Kit) para la reducción de fracturas de procesos alveolares en 3 localizaciones de 2 pacientes que en asociación presentaban fracturas faciales complejas tratadas con reducción abierta y fijación interna convencional. Además se instalaron férulas con alambres de acero de 0,5 mm en los dientes involucrados. RESULTADOS: Se logró una correcta reducción, corrección y fijación de los fragmentos y la conservación de dientes involucrados en las 3 localizaciones, observable tanto clínicamente como en las tomografías computarizadas a los 3 y 7 meses. Además, se retiraron las placas de osteosíntesis de forma ambulatoria y mediante anestesia local. CONCLUSIONES: La estabilización y fijación con placas transmucosas favorece la consolidación de los segmentos afectados sin afectar el aporte vascular. Sin embargo, este método puede considerarse una medida de asistencia a la reducción abierta con fijación interna, que sigue siendo la medida de primera elección

OBJECTIVES: To assess the stability of transmucosal osteosynthesis in cases of comminuted dentoalveolar fractures, avoiding the deperiostization of fragments to maintain their vascularization, favoring the regeneration and prognosis of dental pieces and bone segments. MATERIALS AND METHODS: Transmucosal osteosynthesis with low-profile plates (0.5 and 0.7 mm of Puy Synthes - Matrix Midface Kit) was performed to reduce fractures of alveolar processes in 3 locations of 2 patients, who in association had complex facial fractures treated with open reduction and conventional internal fixation. Furthermore, splints with 0.5 mm steel wires were installed on the teeth involved. RESULTS: A correct reduction, correction, and fixation of the fragments and the preservation of teeth involved in the 3 locations, observable both clinically and in CT scans at 3 and 7 months was achieved. Besides, the osteosynthesis plates were removed on an outpatient basis and by local anesthesia. CONCLUSIONS: Stabilization and fixation with transmucosal plates favors the consolidation of the affected segments without affecting the vascular supply. However, this method can be considered an open reduction assistance measure with internal fixation, which remains the first-choice measure

Types of Intermaxillary Fixation and Their Interaction With Palatine Fracture Reduction.

PURPOSE: To compare 3 types of intermaxillary fixation (IMF) and their behavior when subjected to tension forces in 3 study models with a palatine fracture feature. MATERIALS AND METHODS: An experimental study of 3 identical acrylic models was performed. All had the same palatine fracture pattern on the maxillary midline. All were reduced with different IMF methods (ie, direct interdental wiring, Erich arch bars, and self-tapping screws). Tension forces were applied to the study models to observe the fracture line behavior. RESULTS: IMF with direct interdental wiring did not cause significant separation of the fracture feature in the anterior or posterior sector. IMF with the Erich arch bars caused a 2-mm separation in the anterior sector and 0 mm in the posterior sector. The IMF with self-tapping screws caused a 3-mm separation in the anterior sector and 1 mm in the posterior sector. CONCLUSIONS: IMF using self-tapping screws resulted in the greatest separation of the fracture compared with the results with Erich arch bars and direct interdental wiring. IMF with self-tapping screws tended to displace the fracture lines by application of the vector furthest from the center of resistance.

Reconstruction of medial orbital wall using a retrocaruncular approach.

The purpose of the study was to analyze and describe the retrocaruncular approach to access medial orbital wall. A retrospective analysis was performed in patients referred for the treatment of orbital fractures between January 1st 2011 and July 31st 2017. The study included patients over 18 years old with isolated fractures of the medial orbital wall or combined with the orbital floor who underwent a transconjunctival approach with retrocaruncular extension and lateral canthotomy, and with a minimum follow-up of 6 months. Patients with fractures to the roof and/or lateral orbital wall were excluded. From a total of 319 orbits, 30 medial wall fractures were treated using a retrocaruncular approach, transconjunctival extension and lateral canthotomy. 7 of them were pure medial wall fractures and 23 were combined with orbital floor. Except for one case that required delayed reconstruction with customized orbital implant, all orbital reconstructions were successful in the first surgery. Only one patient developed a conjunctival granuloma in relation to the caruncle. No others patients had complications. This study concluded that this approach is a successful access for surgical treatment of medial orbital wall fractures because of their broad visibility without damaging structures, allowing adequate orbital reconstruction and excellent aesthetic results.

Correlation Between the Posterior Mandibular Width and the Lingual Gap Caused by Symphyseal Fractures Using a Virtual Model.

PURPOSE: The objective was to determine the dimensional impact, on the occlusal and articular level, of the gap produced in the lingual plate from symphyseal fractures, correlated with the dimensional change in the posterior mandibular width. MATERIALS AND METHODS: We performed an observational experimental study based on 30 computed tomography scans of patients treated by the Maxillofacial Surgery Service, Hospital Clínico Mutual de Seguridad, Santiago, Chile, between 2012 and 2016. The inclusion criteria were jaws without evidence of fractures or pathology, with an absence of orthodontic appliances, and with complete dentition to the first mandibular molar. By use of Digital Dental Service 3-dimensional planning software (DDS-Pro; Digital Dental Service, London, UK), a vertical mandibular fracture was made, leaving lingual gaps of 1, 2, and 3 mm, and the dimensional changes were recorded with regard to the posterior facial width. RESULTS: The mandibular height did not vary with regard to the lingual gap; the mandibular length was inversely proportional to the lingual gap; and the intermolar, intergonial, and intercondylar distances were directly proportional to increases in the lingual gap. CONCLUSIONS: The larger the lingual gap, the shorter the mandibular length and the larger the mandibular transverse dimensions. Special attention must be paid to the occlusal and articular level.

Uso de fluoroscopia intraoperatoria en el tratamiento de fracturas aisladas de arco cigomático. Ensayo clínico aleatorizado / Use of intraoperative fluoroscope in the treatment of isolated zygomatic arch fractures: a randomized clinical trial

Objetivo. La reducción de la fractura aislada de arco cigomático (FAAC) es, habitualmente, realizada a distancia mediante un abordaje temporal de Gillies. No se recomienda una reducción abierta por la gran morbilidad y complicaciones asociadas. Sin embargo, al realizar una reducción cerrada, es muy difícil precisar si fue satisfactoriamente realizada. El objetivo de este trabajo es determinar si la adquisición de imágenes intraoperatorias con un arco en C para evaluar la reducción de FAAC es una técnica útil en el tratamiento de dichas fracturas. Métodos. Nuestra hipótesis es que utilizar un arco en C para adquirir imágenes intraoperatorias reduce la necesidad de una segunda cirugía. Entre los años 2009 y 2012, 50 pacientes que fueron diagnosticados con FAAC y que requerían tratamiento quirúrgico fueron distribuidos aleatorizadamente en 2 grupos: 25 pacientes en un grupo experimental en que se realizaba reducción de la fractura y corroboración inmediata de un adecuado resultado con arco en C intraoperatoriamente y 25 pacientes en un grupo control en que se realizaba reducción de la fractura con imagen de control posterior a la cirugía. Resultados. Los resultados mostraron que no hubo diferencias significativas entre ambos grupos (p=0,05). Sin embargo, existió la ventaja de poder reducir de nuevo la fractura inmediatamente si el resultado no era satisfactorio en el grupo experimental. Conclusión. A pesar de que los resultados no son estadísticamente significativos, los autores recomiendan realizar imágenes intraoperatorias en aquellas zonas de las que no se tiene certeza de la reducción (AU)

Purpose. Isolated zygomatic arch fractures (IZAF) are habitually reduced at a distance, via a temporal approach. Open reductions are not recommended due to the associated morbidity and complications. However, performing closed reductions makes it difficult to determine whether it was done satisfactorily. This study aims to determine whether the acquisition of intraoperative images with a C-arm to evaluate IZAF reductions is a useful technique in treating such fractures. Methods. Our hypothesis is that acquiring intraoperative images with a C-arm reduces the need for a second surgery. Between 2009-2012, 50 patients who were diagnosed with IZAF requiring surgery were randomly distributed into 2 groups: 25 patients in the experimental group, where fracture reduction was performed and immediately corroborated intraoperatively for an adequate result using a C-arm; 25 patients were assigned to a control group where the fracture reduction was controlled with post-surgery imaging. Results. The results did not reveal significant differences between both groups (P=.05). Nevertheless, the experimental group had the advantage of being able to immediately reduce the fracture again if the result was unsatisfactory. Conclusions. Despite the fact that the results are not statistically significant, the authors recommend undertaking an intraoperative imaging analysis in areas where we are not certain of the reduction (AU)

Acceso retrocaruncular para la reconstrucción de la pared medial de la órbita / Retrocaruncular approach to orbital medial wall reconstruction

Objetivo. Realizar un análisis retrospectivo de la utilización del acceso retrocaruncular para abordar las reconstrucciones orbitarias de la pared medial. Adicionalmente, la técnica para realizar este acceso es descrita. Material y método. La muestra fue seleccionada de la población derivada al Servicio de Cirugía Maxilofacial del Hospital Clínico Mutual de Seguridad C.Ch.C (Santiago, Chile) para el tratamiento de fracturas orbitarias producto de traumatismo entre el 1 de enero del 2011 y el 31 de diciembre del 2014. Criterios de inclusión: mayores de 18 años con fracturas aisladas de pared medial de órbita o combinadas con piso orbitario, uni o bilaterales, con indicación quirúrgica, abordadas mediante acceso retrocaruncular y con un seguimiento mínimo de 6 meses. Criterios de exclusión: fractura de techo y/o pared lateral de la órbita. Resultados. Ciento sesenta y ocho órbitas fueron operadas durante el periodo indicado; 27 órbitas con fracturas de pared medial abordadas mediante acceso retrocaruncular con extensión transconjuntival y cantotomía lateral fueron incluidas en este estudio; 6 de ellas eran fracturas de pared medial puras y las 21 restantes combinadas con piso. Exceptuando un caso que requirió reconstrucción tardía con implante de titanio customizado, todas las reconstrucciones de órbita fueron exitosas en la primera cirugía. Salvo un paciente que desarrolló un granuloma conjuntival en relación con la carúncula, ningún paciente tuvo complicaciones en relación con el acceso retrocaruncular. Conclusiones. La técnica para el acceso retrocaruncular presentada otorga un seguro, amplio y directo acceso a la pared medial para realizar reconstrucción de la órbita, obteniendo óptimos resultados estéticos y funcionales con mínimas complicaciones (AU)

Objective. To present a retrospective analysis of the use of retrocaruncular approach to access medial orbital wall reconstruction. Additionally, the technique for performing this access is described. Material and method. The sample for this study was chosen from the population of patients referred to the Maxillofacial Surgery Service at the Hospital Clínico Mutual de Seguridad C.Ch.C (Santiago, Chile) for the treatment of orbital fractures between 1st of January 2011 and 31st of December 2014. Subjects eligible for study inclusion had age ≥18, either isolated medial orbital wall fractures or combined with floor fractures, uni or bilateral, with surgical indication, accessed with retrocaruncular approach and 6 month of follow up at least. Exclusion criteria: roof and/or lateral orbital wall fractures. Results. Between January 2011 and December 2014, a total of 168 orbits were treat. 27 orbits with medial wall fractures were accessed with retrocaruncular approach with transconjunctival extension and lateral canthotomy and were included in this study. Of them, 6 were pure medial wall fractures and 21 combined with floor fractures. Except for one case that required delayed reconstruction with customized orbital implant, all orbital reconstructions were successful in the first surgery. Except for a patient who developed a conjunctival granuloma in relation to the caruncle, no patients had complications related to retrocaruncular access. Conclusiones. The retrocaruncular approach presented allows asafe, wide and direct access for repairing medial orbital wall fractures with optimal aesthetics results and minimal functional complication (AU)

Implantes dentales en pacientes adultos postrauma dentoalveolar. Estudio descriptivo / Dental implants in adults after dentoalveolar injuries. Descriptive study

Objetivo. Realizar un estudio descriptivo y retrospectivo para analizar el éxito de la rehabilitación dentaria con o sin aumento óseo alveolar. Materiales y métodos. Se realizó un estudio retrospectivo mediante la revisión de historias clínicas de pacientes que concurrieron al Servicio de Cirugía Máxilofacial del Hospital Clínico Mutual de Seguridad, Chile, en el período de 3 años (enero 2003 - diciembre 2005). Resultados. Un total de 135 pacientes ingresaron al estudio en los cuales se instalaron 246 implantes dentales. Se registraron 8 pérdidas de implantes en el seguimiento. Conclusiones. En este estudio se presenta un protocolo establecido y se establece la necesidad de un diagnóstico detallado para planificar la rehabilitación mediante implantes dentales posterior a un trauma con un equipo multidisciplinario (AU)

Objectives. Conduct a retrospective study to analyse the success of dental implant treatment with or without bone ridge augmentation. Materials and methods. A retrospective study was made by reviewing medical records of patients who attended the Maxillofacial Surgery Service of Hospital Mutual de Seguridad, Chile. In the period of three years (January 2003 - December 2005). Results. There were a total of 135 patients with 246 dental implants indications. 8 cases with dental implant loss where registered. Conclusions. This study presents a proposal protocol, and establishes the need of a detail diagnosis to design the post-traumatic implant rehabilitation treatment with a multidisciplinary team (AU)

The Imaging Appearance of Sinus Mycetoma: A Case Series / El Aspecto Imagenológico del Micetoma Sinusal: Serie de Casos

Sinus mycetoma is a dense accumulation of hyphae that form a rounded mass within the mucosal confines of a paranasal sinus. The aim of this study was to present a case series of three patients with maxillary sinus mycetoma and to describe their radiographic presentations. Three cases are presented. The first two, a 44-year-old woman and an 88 year-old man, both diabetics, were referred to maxillofacial treatment by other specialties. They both had a bad odor of unknown origin on the facial level and their respective computerized tomographies revealed a unilateral opacification of the maxillary sinus with a region of greater radio-opacity. The third case is a 31-year-old woman with a history of a severe facial trauma who had undergone surgery and for whom orthognathic surgery had been planned to correct side effects. In addition to the orthognathic surgery, the removal of the lesion that appeared opacified in the pre-surgery scan was planned. She showed opacification of the maxillary sinus and during the intraoperative stage, tissue of a whitish-gray appearance was detected on the maxillary sinus. The lesion was completely removed and the result of the histopathological study was sinus mycetoma. The patients evolved favorably and the symptomatology disappeared completely. The growing occurrence of mycetoma and the lack of information on it make publicizing this pathology fundamental so it can be considered as a differential imaging, clinical, and pathological diagnosis and in that way receive adequate and opportune treatment.

El micetoma sinusal es una patología de origen fúngico, que afecta a pacientes inmunocomprometidos, capaz de desorientar en su diagnóstico por su clínica y expresión imagenológica particular. El objetivo de este estudio es presentar una serie de tres casos con micetoma en el seno maxilar y describir su presentación imagenológica. Se presentan tres casos. Los dos primeros, una mujer de 44 años y un hombre de 88 años, ambos diabéticos y derivados a atención maxilofacial por otras especialidades. Coincidía un mal olor expelido de origen desconocido a nivel facial y en sus respectivas tomografías computarizadas se observó velamiento unilateral del seno maxilar con una zona de mayor hiperdensidad. El tercer caso corresponde a una mujer de 31 años con antecedente de trauma facial severo operado, a la cual se le planificó cirugía ortognática para corregir secuelas. En conjunto con la cirugía ortognática, se planificó la biopsia excisional de una lesión hiperdensa que se presentó en el escáner pre-quirúrgico; en el intraoperatorio se pesquisó tejido de aspecto blanquecino grisáceo en el seno maxilar. A todos los pacientes se les realizó la exéresis total de la lesión y el estudio histopatológico dio como resultado micetoma sinusal. Los pacientes evolucionaron favorablemente, desapareciendo por completo la sintomatología. La creciente incidencia del micetoma y el desconocimiento sobre el mismo hacen que sea fundamental la difusión de esta patología para ser considerada como diagnóstico diferencial clínico y patológico, y realizar así un tratamiento adecuado y oportuno.

C-arm as intraoperative control in reduction of isolated zygomatic arch fractures: a randomized clinical trial.

PURPOSE: Isolated zygomatic arch fractures (IZAFs) are habitually reduced at a distance, via a temporal approach. Open reductions are not recommended due to the associated morbidity and complications. However, performing closed reductions makes it difficult to determine whether it was done satisfactorily. This study aims to determine whether the acquisition of intraoperative images with a C-arm to evaluate IZAF reductions is a useful technique in treating such fractures. METHODS: Our hypothesis is that acquiring intraoperative images with a C-arm reduces the need for a second surgery. Between 2009 and 2012, 50 patients who were diagnosed with IZAF requiring surgery were randomly distributed into two groups: 25 patients were in the experimental group, where fracture reduction was performed and immediately corroborated intraoperatively for an adequate result using a C-arm, and 25 patients were assigned to a control group where the fracture reduction was controlled with post-surgery imaging. RESULTS: The results did not reveal significant differences between both groups (p = 0.5). Nevertheless, the experimental group had the advantage of being able to immediately reduce the fracture again if the result was unsatisfactory. CONCLUSIONS: Despite the fact that the results are not statistically significant (p = 0.5), the authors recommend undertaking an intraoperative imaging analysis in areas where we are not certain of the reduction.

Fracturas faciales en un centro de referencia de traumatismos nivel I. Estudio descriptivo / Facial fractures in a Chilean trauma center. A descriptive study

Objetivo: Recopilar información del traumatismo maxilofacial, específicamente en pacientes adultos, en el periodo de 3 años en un centro chileno de referencia de traumatismos. Materiales y métodos: Se realizó un estudio descriptivo retrospectivo en todos los casos de fracturas faciales que asistieron al Servicio de Cirugía Maxilofacial del Hospital Clínico Mutual de Seguridad C.Ch.C., Santiago de Chile, en el periodo de 3 años (enero de 2009-diciembre de 2011). Fueron analizadas las variables y distribución de género, edad, tipo, frecuencia de cada fractura y causa del traumatismo. Resultados: La población estudiada consistió en 283 pacientes, 259 (91,5%) hombres y 24 (8,5%) mujeres con un promedio de edad de 40,5 (SD: ± 20,5) años. En 499 sitios de fractura las fracturas cigomáticas fueron la localización más prevalente en ambos géneros (48%), seguidas de las fracturas orbitarias (27,2%) y en tercer lugar las fracturas mandibulares (21,2%). La parte de la cara más afectada fue el tercio medio. Los traumatismos por accidente de tránsito fueron la causa más común (39,2%); la gran mayoría de estos fueron por accidente automovilístico. Discusión: Los resultados mostrados en este artículo están en línea con la literatura, y el análisis de este reporte provee importante información para el diseño de planes de prevención de riesgos, especialmente para desarrollar medidas en el área del tránsito (AU)

Objectives: The aim of the present descriptive study was to record data on maxillofacial trauma in working adults in a 3 year-period in a reference trauma center in Chile. Materials and methods: A descriptive study was conducted on cases of maxillofacial fractures treated in the Maxillofacial Surgery Unit of the Hospital Clínico Mutual de Seguridad, Santiago de Chile, over a 3-year period. Frequency, type and cause of injury, as well as age and gender distribution were analyzed. Results: The study population consisted of 283 patients, 259 (91.5%) males and 24 (8.5%) females with a mean age of 40.5 (SD: ± 20.5) years. In 499 fracture sites Zygomatic fractures were the most prevalent location of the 499 fracture sites, in both males and females (48%), followed by orbital fractures (27.2%), and jaw fractures (21.2%). The most common affected part of the face was isolated mid-facial fractures. Traffic-accident-related fractures were the most common cause (39.2%), with the largest proportion of these involving a car accident. Discussion: The results presented are in line with other studies and the analysis of this report provides important data for the design of plans for injury prevention, especially for measures in road traffic (AU)

Use of onabotulinumtoxinA in post-traumatic oromandibular dystonia.

PURPOSE: Post-traumatic oromandibular dystonia (PTOD) is a disorder whose symptoms can include bruxism, muscle pain, and involuntary muscle contraction, among others. The use of onabotulinumtoxinA (ObT-A) is helpful in controlling the symptoms of patients with PTOD. The aim of this study was to evaluate the use of ObT-A in the treatment of PTOD. MATERIALS AND METHODS: In this prospective case-series study, the population consisted exclusively of patients diagnosed with PTOD, without distinction by age or gender, from January 2007 to December 2010. The patients were diagnosed with PTOD and treated with ObT-A infiltration (primary predictor) at the Department of Maxillofacial Surgery at the Hospital Clínico Mutual de Seguridad (Santiago, Chile). The primary outcome variables were bruxism, muscle pain, and involuntary muscle contraction. The data were obtained through questionnaires registered in tables at each control. Systat 13.1 was used for statistical analysis. The statistical test used to compare patients' evolution over time was the test of signs. RESULTS: Thirty male patients 18 to 65 years old diagnosed with PTOD were treated with ObT-A infiltrations. The signs and symptoms associated with oromandibular dystonia (bruxism, muscle pain, and involuntary muscle contraction) were decreased in all patients after ObT-A infiltrations. CONCLUSIONS: The positive results and the absence of complications recommend the use of the infiltration protocol presented in this study for the treatment of PTOD.

Fracturas radiculares en pacientes adultos: propuesta de tratamiento actual / Root fractures in adults patients: Current treatment proposal

Objetivo: El objetivo de este estudio fue ver la prevalencia y la evolución del tratamiento en las fracturas radiculares en pacientes adultos laboralmente activos que sufrieron un trauma dentoalveolar y presentar un protocolo de tratamiento distinto basándose en el pronóstico a largo plazo según nuestros porcentajes de éxito. Materiales y métodos: Se realizó una revisión retrospectiva de los casos de trauma dentoalveolar y específicamente de fracturas radiculares que acudieron a la Unidad de Cirugía Maxilofacial del Hospital Clínico Mutual de Seguridad (Santiago Chile) durante un an˜ o en el periodo de mayo de 2009 hasta mayo de 2010. Resultados: Se registró un total de 894 casos, de los cuales 56 (6,3%) casos tuvieron el diagnóstico de fractura radicular. Hasta el momento de la revisión todos los implantes presentaron una tasa de éxito del 100% a diferencia del tratamiento endodóntico en conjunto con la ferulización semirrígida que mostró un 20% de éxito. El 80% restante resultó en una pérdida dentaria y posterior rehabilitación con implante dental. Conclusiones: Nosotros pensamos que la reposición dentaria después de una fractura radicular mediante implantes dentales es una excelente opción y que debe ser recomendada (AU)

Objective: The aim of this study is to observe the prevalence, etiology, diagnosis, treatment and outcome of root fractures in adult patients who suffered a dentoalveolar trauma. We present a different treatment protocol for root fractures in adult patients, according to our success rates, as well as the prognosis and long-term outcomes. Materials and methods: In a retrospective study was conducted by reviewing the records of all patients with dentoalveolar trauma and root fractures between May 2009 and May 2010 in the Department of Oral and Maxillofacial surgery, Hospital Mutual de Seguridad C.Ch.C., Santiago de Chile. Results: A total of 894 dentoalveolar trauma cases were recorded, of which 56 (6.3%) were root fractures. In terms of outcome, implants had a 100% success rate to the date, instead root canal treatment and flexible splint showed only a 20% of success, because 80% progressed to tooth loss and dental implant. Conclusions: We believe that dental replacement of tooth loss after root fracture by dental implant is an excellent option and should be recommended (AU)

Histiocitosis de células de Langerhans crónica focal, granuloma eosinófilo: reporte de un caso / Langerhans cell histiocitosis, eosinophilic granuloma: report of a case

Bajo el nombre de histiocitosis de células de Langerhans se agrupan tres entidades patológicas con fines pronósticos y terapéuticos. La histiocitosis de Langerhans crónica focal o granuloma eosinófilo (GE) es la más benigna y localizada de estas tres patologías. Esta entidad patológica debe ser tratada, ya que se asocia a signos y síntomas como el aumento de volumen y el dolor, así como también se han descrito casos de fractura patológica asociada a este tipo de lesiones. Existen distintas modalidades de tratamiento y todas han demostrado efectividad y bajos porcentajes de recurrencia. Presentamos el reporte de un caso clínico y una alterantiva de tratamiento para este tipo de lesiones