Surgical Decompression of the Orbit due to Frontal Bone and Roof of the Orbit Fractures - A Case Report.

Trauma in the face region has a very varied etiology and can be associated with several important structures. Isolated fractures in the orbit region correspond to about 4 to 16% of all facial fractures and this incidence increases to 30 to 55% if we take into account fractures that expand to extraorbital regions. The present clinical report aims to describe the case of a male patient, 21-years-old, victim of a motorcycle accident with facial trauma and traumatic brain injury due to frontal collision. Clinical and imaging examinations showed multiple fractures in the face with herniation of brain mass to the orbital region and consequent extrusion of the eyeball. Surgical procedures were performed to reduce and fix fractures and multidisciplinary treatment aimed at preserving vision and brain integrity. Thus, the surgical approach and the multidisciplinary treatment led to an excellent prognosis attested by the one-year postoperative period.

Violência contra mulher relacionada ao trauma de face / Violence against women related to face trauma

A violência urbana no Brasil se tornou uma questão de saúde pública. Ela está presente no cotidiano de cada brasileiro, produzindo um grande número de vítimas, sequelas físicas e emocionais. O trauma bucomaxilofacial é um trauma ocorrido na face que pode ter extensão e acometer o cérebro, olhos, dentição e seios da face, podendo levar a deformidades permanentes. A notificação da violência doméstica pelos dentistas contribui para o dimensionamento epidemiológico do problema, permitindo o desenvolvimento de programas e ações específicas. O objetivo do trabalho foi relacionar a incidência do trauma da face em mulheres com a violência e da necessidade de notificação compulsória por parte dos dentistas. Este estudo analisou os eventos de violência urbana através dos traumas maxilofaciais deles decorrentes em diversos artigos tornados públicos. Teve como conclusão que violência interpessoal e os acidentes de trânsito foram os principais fatores etiológicos dos traumas faciais, sendo responsáveis pela maioria dos casos tratados cirurgicamente nos hospitais estudados na discussão deste trabalho. Quando os dados são tratados separadamente por gênero, a violência interpessoal é mais frequente em mulheres. Os dentistas têm a obrigação de notificar os casos de violência doméstica pelo parceiro íntimo que tomam conhecimento durante o atendimento, o descumprimento desta obrigação pode leva-lo à responder legal e eticamente pela omissão.(AU)

Urban violence in Brazil has become a public health issue. It is present in the daily life of each Brazilian, producing a large number of victims, physical and emotional sequels. Maxillofacial trauma is a type of trauma that occurs on the face and head. The number of maxillofacial traumas may be associated with the exposure of this region of the body in cases of traffic accidents or an attempt to disfigure the face of the victims of aggression, urban violence, face trauma, trauma in women and compulsory notification. Notification of domestic violence by dentists contributes to the epidemiological dimension of the problem, allowing the development of specific programs and actions. The objective of this study was to compare the incidence of face trauma in women with violence and the need for compulsory notification by dentists. This study analyzed the events of urban violence through the maxillofacial traumas resulting from several articles made public. It was concluded that interpersonal violence and traffic accidents were the main etiological factors of facial trauma, being responsible for the majority of the cases treated surgically in the hospitals studied in the discussion of this work. When data are treated separately by gender, interpersonal violence is more frequent in women. Dentists have an obligation to report cases of domestic violence by the intimate partner who becomes aware during the care, failure to comply with this obligation may lead them to respond legally and ethically to the omission.(AU)

The use of reformatted Cone Beam CT images in assessing mid-face trauma, with a focus on the orbital floor fractures.

BACKGROUND AND AIM: This study aims at evaluating the reliability on specific multi-planar cone beam computer tomography (CBCT) reconstruction in the orbital floor fractures. METHODS: CBCT examination of the mid-face fractures area involving the floor of the orbit was performed in a number of 93 trauma patients by two independent radiologists. Both radiologists assessed the axial, coronal and sagittal sections and also the oblique coronal and sagittal extracted sections evaluating the location of the orbital fractures, its size and displacement, the involvement of the infra-orbital foramen, herniation of fat or muscle within the maxillary sinus, the overall type of the fracture and the implication of lateral or medial orbital wall. We also registered the section that provided better confidence of both examiners in visualizing the fracture of the orbit floor and the presence of herniated soft tissue, on different reformatted sectioning. RESULTS: The presence of pure fracture of the orbital floor was detected in 11% of patients. The association of the orbital fractures with the zygomatic fractures was identified in the majority of the patients. In 86% of patients the displacement of the floor of the orbit was visualized, and in almost 30% of cases more than 50% of the orbital floor was involved in the fracture. Regarding the confidence between examiners, they were more confident using the oblique sagittal CBCT reformatted images for fracture detection and bone displacement evaluation, as for the soft tissue herniation the oblique coronal sections provided the highest level of confidence. CONCLUSION: Mid-face trauma involves the orbital floor in the majority of situations. CBCT allows to obtain oblique images extracted from the three dimensional (3D) data that provide high confidence level in assessing pure orbital floor fractures.

Trends of maxillofacial fractures in the Garhwal Himalayas at Government Medical College, Srinagar, Uttarakhand.

CONTEXT: Evaluation of Maxillofacial fractures in hilly region of Garhwal Himalyas and its relation with age, gender, anatomical location, seasonal variation and treatment provided. AIMS: The aim of the present study is to analyze the pattern of maxillofacial fractures in the Garhwal Himalayan region of India and to compare the results with similar studies in India and the rest of the world. SETTINGS AND DESIGN: This was a prospective study conducted on 102 patients with 128 facial fractures. MATERIALS AND METHODS: This study was conducted on 102 patients who were admitted for the treatment of maxillofacial fractures in the Department of Dentistry at Government Medical College, Srinagar, Uttarakhand, India. STATISTICAL ANALYSIS USED: All analyses were performed using Chi-square test and level of significance. RESULTS: Peak incidence was noted in the second to fourth decades of life. Male: female ratio was 4:1. Road traffic accident was the main etiology (42.2%), followed by fall (37.2%) and assault (11.8%). Among other etiology of injury, distinguishing feature was bear bite, which was only seen in winters causing 5.9% of total injury. Fall was reported high in females whereas road traffic accident in males. Mandible was fractured in 73.5% of patients while mid-face in 26.5% of patients. Open reduction with internal fixation was the choice of treatment in 60.8% of cases. Nearly 79.4% of patients were treated under local anesthesia. The mean duration of hospitalization was (standard deviation 5.2 days) 5.3 days. CONCLUSIONS: Road traffic accidents still remain the main cause of maxillofacial fractures in developing countries such as India. In hilly area, road traffic accident can be minimized by better wide roads with guide walls/parapet, strict law enforcement for overspeed, overload, and to use seat belts while driving, and use of helmet while riding two-wheeler. Open reduction internal fixation remains the first choice of treatment in facial fractures due to early return of function with minimal morbidity and better nutritional status in patients compared to closed reduction.