RESUMO
BACKGROUND: Surgery is the gold standard treatment of displaced olecranon fracture, but it presents a high rate of complications, especially in the elderly, including wound breakdown and fixation failure. Conservative treatment of these fractures has recently been proposed with good functional outcomes. The aim of this retrospective study was to compare the functional results and level of satisfaction of displaced olecranon fractures which were managed surgically or conservatively in geriatric patients. The rate of implant removal and reoperation in the surgical group were also calculated. MATERIALS AND METHODS: Sixteen and eleven patients aged ≥ 75 years (mean 83 and 86.2, respectively) with isolated Mayo IIA or IIB olecranon fracture were surgically and conservatively treated, respectively. All but 1 were females. Due to coronavirus pandemic, they were contacted by phone to validated clinical scores (QuickDASH, PREE and VAS), which were used to assess the outcome. RESULTS: At an average follow-up of 26.5 months in the conservative group and 53.1 in the surgical group (range 4-82), the mean Quick DASH was 11.67 and 11.2, respectively, while the mean PREE was 11.36 and 12.67, respectively. There was no significant difference in functional outcomes between the two groups, and all patients were satisfied. Seven complications occurred in the surgical cohort (33.3%), requiring reoperation in 4 cases (19%). CONCLUSIONS: Displaced olecranon fractures can successfully be treated conservatively in low-demand geriatric patients with good functional results and high satisfaction rate.
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Le Fort I osteotomy is the technique most applied worldwide in the treatment of dentoskeletal deformity involving the maxilla. Even though it is considered a very safe technique with good intra- and postoperative results, many complications have been described. This paper presents a case of carotid jugular fistula developed in a 22-year-old white male submitted to Le Fort I osteotomy for the treatment of anteroposterior maxillary deficiency, and discusses the possible aetiology and management of this serious complication.
Assuntos
Fístula Arteriovenosa/etiologia , Lesões das Artérias Carótidas/etiologia , Veias Jugulares/lesões , Osteotomia de Le Fort/efeitos adversos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Angiografia Cerebral , Diagnóstico Diferencial , Humanos , Masculino , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
The purpose of this study was to compare the mechanical resistance of three different plates used to treat fractures of the mandibular angle: a regular 4-hole plate, a longer 4-hole plate (both positioned using the Champy technique), and a 3-dimensional plate positioned over the oblique line. Three equal groups of replicas of human dentate mandibles made out of polyurethane resin were used (n=21 in each group). The force was applied perpendicular to the occlusal plane at a rate of 2mm/minute at three different points: the first molar on the sectioned side; the first molar on the contralateral side; and between the central incisors. This was followed by a resistance-to-load test. The two varying factors (type of plate and site-of-load application) were tested by analysis of variance, and probabilities of less than 0.05 were accepted as significant. There were no significant differences between the subgroups, or between the mean values of the different types of plates (p=0.925). The three types of plates showed similar mechanical behaviour, which showed that the 3-dimensional plates positioned over the oblique line can produce mechanical scores similar to those of conventional plates.
Assuntos
Placas Ósseas , Fixação de Fratura/instrumentação , Fraturas Mandibulares/cirurgia , Placas Ósseas/classificação , Humanos , Modelos AnatômicosRESUMO
This study evaluated the bite force, electromyographic activity, and mandibular mobility in patients undergoing surgery for facial fracture treatment that required a coronal approach. Ten men were divided into two groups: group I, coronal approach with pre-auricular extension (n=4, average age 34.5 years); group II, coronal approach (n=6, average age 24.8 years). The maximum bite force was measured using a dynamometer and mandibular mobility using a calliper. The electromyographic activity of the right masseter (RM), left masseter (LM), right temporal (RT), and left temporal (LT) muscles was evaluated using a Myosystem-Br1 apparatus. Patients were evaluated at 1, 2, 3, and 6 months after surgery. Data were analysed using the repeated measures test (SPSS 21.0; P≤0.05). Statistically significant differences were found for electromyographic activity at rest (group II: LM P=0.00), left laterality (group I: RT P=0.02; group II: RT P=0.04), and maximum voluntary contraction (group I: RM P=0.04 and RT P=0.04; group II: RM P=0.05, LM P=0.00, and LT P=0.01 and for maximum molar bite force in the right (group I, P=0.00; group II, P=0.01) and left (group II, P=0.01) molar regions. The subjects regained electromyographic activity, maximum bite force, and mandibular mobility throughout the period evaluated.
Assuntos
Força de Mordida , Eletromiografia , Ossos Faciais/lesões , Mandíbula/fisiopatologia , Fraturas Cranianas/fisiopatologia , Adulto , Ossos Faciais/cirurgia , Humanos , Masculino , Músculo Masseter/fisiopatologia , Músculos da Mastigação , Movimento/fisiologia , Recuperação de Função Fisiológica , Fraturas Cranianas/cirurgia , Músculo Temporal/fisiopatologia , Adulto JovemRESUMO
The aim of this in vitro study was to evaluate the mechanical resistance of a 2.0-mm titanium system applied to the mandibular angle, either with or without continuity of the inferior border of the mandible. Polyurethane mandibles were used as substrates and divided into two groups: unfavourable and favourable to treatment. A single cut was made through the retromolar region, simulating an angle fracture either unfavourable or favourable to treatment. In addition, a small fragment of the inferior border of the mandible was removed in some of the mandibles, creating a discontinuity. The fragments were stabilized in accordance with the technique of Champy et al. The substrates were adapted to a universal mechanical testing machine and submitted to a constant load applied at three different points; load values were obtained at three different moments of displacement: 1mm, 2mm, and fixation failure. The value of the tip dislocation at final displacement was obtained. When the load was applied at the first molars, regardless of the side, no statistically significant difference was observed between the groups. When the load was applied at the central incisors, a statistically significant difference was observed at fixation failure in the unfavourable to treatment group, with better results in the subgroup with continuity of the inferior border of the mandible compared to the subgroup without continuity. Discontinuity of the inferior border of the mandible did not decrease the mechanical resistance of the fixation.
Assuntos
Fixação Interna de Fraturas/instrumentação , Fixadores Internos , Fraturas Mandibulares/cirurgia , Fenômenos Biomecânicos , Humanos , Técnicas In Vitro , Modelos Anatômicos , Poliuretanos , Desenho de Prótese , Estresse Mecânico , TitânioRESUMO
The objective of this study was to compare the bone repair along a mandibular body osteotomy stabilized with 2.0 mm absorbable and metallic systems. 12 male, adult mongrel dogs were divided into two groups (metallic and absorbable) and subjected to unilateral osteotomy between the mandibular third and fourth premolars, which was stabilized by applying two 4-hole plates. At 2 and 18 weeks, three dogs from each group were killed and the osteotomy sites were removed and divided equally into three parts: the upper part was labelled the tension third (TT), the lower part the compression third (CT), and the part between the TT and CT the intermediary third (IT). Regardless of the treatment system, union between the fragments was observed at 18 weeks and the CT showed more advanced stages of bone repair than the TT. Histometric analysis did not reveal any significant differences among the 3 parts or systems in the distance between bone fragments at 2 weeks. Although at 18 weeks the proportions of newly formed bone did not differ among TT, IT and CT, significantly enhanced bone formation was observed in all sections for the metallic group. The patterns of repair were distinct between treatments.
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Materiais Biocompatíveis , Fixadores Internos , Mandíbula/cirurgia , Metais , Osteotomia , Animais , CãesRESUMO
This manuscript reports an uncommon case of inferior third molar facial abscess with purulent secretion drainage through the left external acoustic meatus. The patient's left external acoustic meatus was filled with a purulent secretion observed on a CT scan. He underwent surgery to drain the facial abscess. Despite facial abscesses being routine occurrences, the literature does not contain many case reports of odontogenic facial abscesses with drainage via the external acoustic meatus. These situations occur in two possible ways: multiple fissures in the anterior wall of the cartilaginous portion of the external acoustic meatus; and congenital defects that are occasionally present in the anterior-superior aspect of the external acoustic meatus, known as the foramen of Huschke, which allow communication between the external acoustic meatus and mandibular fossa. These defects may also predispose the patient to the spread of the infection or tumour from the external auditory canal to the infratemporal fossa and vice versa. No otological sequelae were observed in this case. The authors conclude that the hypothesis of bone malformation cannot be excluded, and affirm that any facial abscess requires appropriate and immediate treatment for adequate resolution, by removing the causal factor and providing systemic support.
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Abscesso/diagnóstico , Meato Acústico Externo/anormalidades , Doenças Mandibulares/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Adulto , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Drenagem , Dor de Orelha/diagnóstico , Seguimentos , Humanos , Masculino , Dente Serotino/cirurgia , Supuração , Osso Temporal/anormalidades , Irrigação Terapêutica , Extração DentáriaRESUMO
The purpose of this study was to compare, by mechanical in vitro testing, a 2.0-mm system made with poly-L-DL-lactide acid with an analogue titanium-based system. Mandible replicas were used as a substrate and uniformly sectioned on the left mandibular angle. The 4-hole plates were adapted and stabilized passively in the same site in both groups using four screws, 6.0mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side; first molar at the contralateral side; and between the central incisors. At 1mm of displacement, no statistically significant difference was found. At 2mm displacement, a statistically significant difference was observed when an unfavourable fracture was simulated and the load was applied in the contralateral first molar and when a favourable fracture was simulated and the load was applied between the central incisors. At the failure displacement, a statistically significant difference was observed only when the favourable fracture was simulated and the load was applied on the first molar at the plated side. In conclusion, despite more failure, the poly-L-DL-lactic acid-based system was effective.
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Implantes Absorvíveis , Materiais Biocompatíveis/química , Placas Ósseas , Parafusos Ósseos , Fixação de Fratura/instrumentação , Ácido Láctico/química , Fraturas Mandibulares/cirurgia , Polímeros/química , Titânio/química , Fenômenos Biomecânicos , Arco Dental/patologia , Falha de Equipamento , Humanos , Incisivo/patologia , Fixadores Internos , Mandíbula/patologia , Teste de Materiais , Modelos Anatômicos , Dente Molar/patologia , Poliésteres , Poliuretanos/química , Estresse MecânicoRESUMO
This retrospective study evaluated the epidemiology, treatment and complications of mandibular fracture associated, or not associated, with other facial fractures, when the influence of the surgeon's skill and preference for any rigid internal fixation (RIF) system devices was minimized. The files of 700 patients with facial trauma were available, and 126 files were chosen for review. Data were collected regarding gender, age, race, date of trauma, date of surgery, addictions, etiology, signs and symptoms, fracture area, complications, treatment performed, date of hospital discharge, and medication. 126 patients suffered mandibular fractures associated, or not, with other maxillofacial fractures, and a total of 201 mandibular fractures were found. The incidence of mandibular fractures was more prevalent in males, in Caucasians and during the third decade of life. The most common site was the condyle, followed by the mandibular body. The therapy applied was effective in handling this type of fracture and the success rates were comparable with other published data.
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Fraturas Mandibulares/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Criança , Pré-Escolar , Queixo/lesões , Queixo/inervação , Ossos Faciais/lesões , Feminino , Seguimentos , Fixação de Fratura/estatística & dados numéricos , Humanos , Incidência , Estudos Longitudinais , Masculino , Côndilo Mandibular/lesões , Fraturas Mandibulares/classificação , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Transtornos de Sensação/epidemiologia , Fatores Sexuais , Fraturas Cranianas/epidemiologia , Fumar/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To assess and to follow along the time-span of ICU stay the process of resources allocation and utilization. DESIGN: Prospective study. PATIENTS: A cohort of 778 patients consecutively admitted to 7 multipurpose general ICU in the Milano area were enrolled in a survey of the daily performed interventions/procedures. MEASUREMENTS AND MAIN RESULTS: The majority of diagnostic procedure/interventions were performed during the first two days. The number and quality of interventions were transferred into points obtaining a score system in non-monetary units. The resource allocation process shows a regular trend in the sub-intensive patients who were only monitorized. On the contrary the 258 patients who were intensively treated and survived show a phase of high resource-consumption (about 30 daily points: roughly twice the score of monitorized patients) then followed by a post-intensive phase with a resource consumption resulting in a daily score absolutely equal to the sub-intensive patients. The intensive patients who die show a significantly higher score than survived patients. Both daily and cumulative scores do not show differences among different type of patients. CONCLUSION: The evaluation of the process of resources allocation, even if in non-monetary units enables the knowledge of the trend of ICU costs and allows the elaboration of the appropriate budget mechanism.
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Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Estudos de Coortes , Análise Custo-Benefício , Humanos , Itália , Tempo de Internação , Projetos Piloto , Estudos Prospectivos , Resultado do TratamentoRESUMO
The electroencephalographic changes of 12 patients submitted to anaesthesia with low dosages of propofol (4-2 mg/kg/h + fentanyl) for peripheral vascular surgery have been studied. The standard induction dose of propofol was 2 mg/kg for all the patients. The EEG recording was carried out during the whole length of anaesthesia and the EEG changes were analysed during induction and maintenance phases. During surgical anaesthesia it was always easy to read EEG and also to detect eventual cerebral suffering. On the basis of our results we can suggest this anesthesiologic technique for surgery (for example: carotid surgery) requiring a continuous monitoring of the cerebral function during intra and postoperative phases.
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Anestesia , Eletroencefalografia , Propofol , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The authors have assessed the hypotensive response to the intravenous administration of urapidil bolus, during intra-operative hypertensive crises, in 42 patients undergoing general anaesthesia for surgery. Twenty-two of these patients underwent major vascular surgery and were monitored through catheters introduced into the radial and pulmonary arteries, to study the haemodynamic changes induced by urapidil. A significant reduction was observed in these values: systolic and diastolic arterial pressure, systolic and diastolic pulmonary pressure, pulmonary wedge pressure and systemic vascular resistance. A non-significant reduction was observed in central venous pressure and pulmonary vascular resistance. Heart rate and cardiac output remained unchanged. Systolic arterial pressure decreased 12% from the baseline in 81% of patients. The transient action of urapidil bolus in some cases (55%) suggests the need for urapidil infusion.