RESUMO
Gunshot wounds of the lower face are a challenge for the surgeon. Customized distraction osteogenesis (DO) is a well-established procedure for managing facial gunshot wounds. However, differences between the preoperative planning and postoperative outcomes are often noted. This multi-centre, retrospective study was performed to analyse the differences between the planning and outcomes for the lower third of the face, in patients undergoing the computer-assisted repair of mandible gunshot wounds using patient-specific distraction devices. Different planes and points were defined, and two distances (anteroposterior and intercondylar lengths) and an angle (inter-mandible body angle) were measured on the preoperative planning models and the postoperative models obtained from the computed tomography data. Twelve patient cases that met the study eligibility criteria were included. A significant difference between the planning and postoperative outcome was found for the anteroposterior length (6.6 mm shorter than the preoperative planning; P = 0.003). The differences in intercondylar length (P = 0.116) and inter-mandible body angle (P = 0.121) were not significant. This study revealed a difference between the planning and outcomes. Various factors such as scar tissue and muscle forces limit distraction and therefore lead to under-correction with insufficient projection.
Assuntos
Osteogênese por Distração , Ferimentos por Arma de Fogo , Humanos , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/cirurgia , Estudos Retrospectivos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Osteotomia/métodos , Osteogênese por Distração/métodos , Computadores , Estudos Multicêntricos como AssuntoRESUMO
Arteriovenous malformations (AVMs) are high-flow vascular lesions that does not regress spontaneously. They are located in the cranio-facial region in 50% of cases. Most of the time, the management of these lesions is a combination of surgery and vascular embolization. However, when the conditions are precarious, even without access to embolization, it's possible to treat some of those lesions with safety. We report four cases of patients suffering from cranio-facial AVM, treated exclusively by surgery during humanitarian missions.