Treatment of pediatric bilateral condylar fractures: A comprehensive analysis.

Pediatric bilateral condylar fractures (PBCF) is a rare clinical pathology, where the management is carried out with both conservative and surgical approaches. The purpose of this study was to analyze and compare these two treatment approaches and their associated long term complications in PBCF. An extensive literature review- through the search of online databases- was conducted to survey, collect, analyze and compare the reported outcomes of different treatment modalities for PBCF. The number of studies presenting PBCF case reports was 16, while the number of such retrospective studies included here was 19. Analyses of these studies revealed that the conservative treatment is preferred in PBCF patients younger than 12 years of age. Moreover, a composite approach where the open reduction and internal fixation (ORIF) is carried out for one side while the intermaxillary fixation (IMF) for the contralateral side is frequently reported for the management of PBCF cases; this approach appears effective in improving daily functioning of temporomandibular joint and reducing long term complications. Performing ORIF for one side while IMF for the contralateral side seems the most common treatment approach in PBCF. This study may help in rapid decision making for treatment selection of PBCF patients while minimizing the risk for late complications.

Comportamiento y gravedad del trauma maxilofacial en urgencia en el Hospital Universitario "General Calixto García" / Characteristics and Severity of Maxillofacial Trauma in the Emergency Room at General Calixto García University Hospital

Introducción: La región maxilofacial es vulnerable al trauma. Se utilizan herramientas para evaluar la gravedad del trauma maxilofacial. Objetivo: Caracterizar el comportamiento y gravedad del trauma maxilofacial en los pacientes atendidos en el servicio de urgencias de cirugía maxilofacial del Hospital Universitario "General Calixto García". Métodos: Se realizó un estudio observacional descriptivo transversal en pacientes que acudieron al servicio de urgencias de cirugía maxilofacial del Hospital Universitario "General Calixto García", desde septiembre de 2018 hasta marzo de 2021. El universo fue de 57 pacientes. Se aplicó la escala de severidad de lesiones faciales. Variables analizadas: edad, sexo, etiología, diagnósticos, exámenes complementarios, gravedad del trauma maxilofacial, procederes terapéuticos inmediatos. Resultados: Prevaleció la fractura mandibular como diagnóstico (66,7 por ciento). La etiología más frecuente fue la violencia interpersonal (29,8 por ciento). Predominó la gravedad leve del trauma maxilofacial (71,9 por ciento). La extracción de cuerpos extraños de la vía aérea, tracción lingual, inserción de cánula orofaríngea, intubación orotraqueal (5,3 por ciento), y sutura (64,9 por ciento), fueron los procederes terapéuticos inmediatos más utilizados. Conclusiones: Prevalecen los pacientes del sexo masculino y del grupo de edad de 19 a 30 años. Predomina la fractura mandibular como diagnóstico. Los exámenes complementarios más utilizados son, la tomografía computarizada, el hemograma completo y el coagulograma. Impera la violencia interpersonal como etiología. Prevalece la gravedad leve del trauma maxilofacial. Los procederes terapéuticos inmediatos más empleados son, extracción de cuerpos extraños de la vía aérea, tracción lingual, inserción de cánula orofaríngea, intubación orotraqueal y sutura(AU)

Introduction: The maxillofacial region is vulnerable to trauma. Tools are used to assess the severity of maxillofacial trauma. Objective: To characterize maxillofacial trauma and its severity in patients cared for at the maxillofacial surgery emergency department of General Calixto García University Hospital. Methods: A cross-sectional, descriptive and observational study was carried out in patients attending the maxillofacial surgery emergency department at General Calixto García University Hospital, from September 2018 to March 2021. The study universe was 57 patients. The facial injury severity scale was applied. The analyzed variables were age, sex, etiology, diagnoses, complementary examinations, severity of maxillofacial trauma, immediate therapeutic procedures. Results: Mandibular fracture prevailed as a diagnosis (66.7 percent). The most frequent etiology was interpersonal violence (29.8 percent). Mild severity of maxillofacial trauma predominated (71.9 percent). Extraction of foreign bodies from the airway, tongue traction, insertion of oropharyngeal cannula, orotracheal intubation (5.3 percent) and suturing (64.9 percent) were the most frequently used immediate therapeutic procedures. Conclusions: There is a prevalence of male patients and the age group 19 to 30 years. Mandibular fracture predominates as a diagnosis. The most frequently used complementary tests are computed tomography, complete blood count and coagulogram. Interpersonal violence prevails as an etiology. Mild severity of maxillofacial trauma prevails. The most commonly used immediate therapeutic procedures are extraction of foreign bodies from the airway, tongue traction, insertion of oropharyngeal cannula, orotracheal intubation and suturing(AU)

Preauricular anteroparotid transmasseteric approach of the mandibular condyle: The natural evolution after cervical dissections? An anatomical feasibility study.

The purpose of this study was to evaluate the reliability and reproducibility of a novel approach for base and neck fractures of the mandible. An anatomical study was conducted on 22 given to Science subjects. A rhytidectomy-like approach was performed, followed by a transmasseteric anteroparotid dissection. Measures were taken of the incision length and bone exposure at every step. The identification of a ramus of the facial nerve during dissection was noted. The subjects were classified according to their facial adiposity. A correlation coefficient was measured between incision length and bone exposure as well as morphotype and bone exposure. Statistical analysis was carried out using the Pearson method for linear correlation, and Chi2 test for further analysis. Adequate condylar exposure was always achieved in the area of interest (i.e. in the main localization of base and neck fractures). There was no correlation between the length of the cranial cutaneous backcut and the bone exposure horizontally (p = 0.3296) or vertically (p = 0.8382). There was no correlation between the total length of the incision and the bone exposure horizontally (p = 0.5171) or vertically (p = 0.8404). There was a significant correlation between the subjects' facial adiposity and the bone exposure horizontally and vertically (p<0.005). This approach allowed adequate bone exposure to the mandible base and neck, with a possible 90° angulation of instruments for optimal bone fixation. The incidence of facial nerve rami identification during dissection was similar to other approaches. The scarring was hidden. These results allowed us to propose this approach in a clinical study.

[Clinical application of disc reduction and anchorage for diacapitular condylar fracture with disc displacement].

Objective: To investigate the effectiveness of disc reduction and anchorage in treatment of diacapitular condylar fracture with disc displacement. Methods: Between June 2019 and June 2021, 20 patients (27 sides) with diacapitular condylar fractures with disc displacement were treated with disc reduction and anchorage combined with internal fixation. There were 15 males and 5 females with a median age of 40 years (range, 8-65 years). The fractures were caused by falling from height in 3 cases, traffic accident in 3 cases, and falling in 14 cases. Among them, there were 13 cases of unilateral fracture and 7 cases of bilateral fractures. Five sides were type A fractures and 22 sides were type B. There were 14 simple diacapitular condylar fractures, 12 diacapitular condylar fractures combined with mandibular chin fractures, and 1 diacapitular condylar fracture combined with mandibular angle fracture. The maximum opening was 5-20 mm (mean, 9.7 mm). The time from injury to operation was 4-20 days, with an average of 11.6 days. The postoperative imaging examination was performed to evaluate the reduction of fracture and disc. The maximum opening at 6 months after operation was recorded, and the clinical dysfunction index (Di) of Helkimo index was used to evaluate the temporomandibular joint function. Results: All incisions healed by first intention. All 20 patients were followed up 6-10 months (mean, 8 months). Postoperative imaging examination showed that 27 fractures were well reduced, of which 26 were anatomically reduced and 1 was basically reduced; the reduction of the temporomandibular joint disc was excellent in 25 sides, good in 1 side, and poor in 1 side, and the effective rate of disc reduction and anchorage was 96.3%. The occlusion relationship of the patient was stable and basically reached the pre-injury level, the incision scar was hidden, and the mouth opening significantly improved when compared with the preoperative level. The maximum mouth opening was 32-40 mm (mean, 36.8 mm) at 6 months after operation. Maximum opening was more than 35 mm in 17 cases. At last follow-up, joint function reached Di 0 grade in 8 sides, DiⅠ grade in 18 sides, and DiⅡ grade in 1 side. After operation, 2 cases of opening deviation, 1 case of joint click, and 2 cases of temporary disappearance of frontal striae on affected side occurred, which recovered to normal after symptomatic treatment. Conclusion: For diacapitular condylar fractures with disc displacement, it is necessary to adopt disc reduction and anchorage at the same time of fracture reduction and internal fixation, which can achieve good clinical results.

A clinical decision aid for patients with suspected midfacial and mandibular fractures (the REDUCTION-I study): a prospective multicentre cohort study.

PURPOSE: To assess physical examination findings related to maxillofacial trauma to identify patients at risk of midfacial and mandibular fractures and then to construct a clinical decision aid to rule out the presence of midfacial and mandibular fractures in emergency department patients. METHODS: We performed a prospective multicentre cohort study in four hospitals in the Netherlands, including consecutive patients with maxillofacial trauma. Each patient received a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular traumas, respectively. Consequently, clinical decision aids were constructed with the focus being on ruling out the presence of midfacial and mandibular fractures, and diagnostic accuracy was calculated. RESULTS: A total of 993 consecutive patients were identified of whom 766 and 280 patients were suspected of midfacial and mandibular fractures, respectively. Midfacial fractures were diagnosed in 339 patients (44.3%), whereas mandibular fractures were observed in 66 patients (23.6%). The decision aid for midfacial trauma consisting of peri-orbital hematoma, epistaxis, ocular movement limitation, infra-orbital nerve paresthesia, palpable step-off and tooth mobility or avulsion, produced a sensitivity of 89.7 (86.0-92.5), a specificity of 42.6 (38.0-47.4), and a negative predictive value of 83.9% (78.4-88.2). The decision aid for mandibular trauma consisting of the angular compression test, axial chin pressure test, objective malocclusion, tooth mobility or avulsion and the tongue blade bite test resulted in a sensitivity of 98.5 (91.9-99.7), a specificity of 34.6 (28.5-41.2), and a negative predictive value of 98.7% (92.8-99.8). CONCLUSION: The constructed clinical decision aids for maxillofacial trauma may aid in stratifying patients suspected for midfacial and mandibular fractures to reduce unnecessary diagnostic imaging. CLINICAL TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov with the identifier NCT03314480.

A clinical decision aid to discern patients without and with midfacial and mandibular fractures that require treatment (the REDUCTION-II study): a prospective multicentre cohort study.

PURPOSE: To assess the diagnostic accuracy of physical examination findings and to construct clinical decision aids to discern emergency department patients without and with midfacial and mandibular fractures that require treatment. METHODS: A prospective multicentre cohort study was conducted in four hospitals in the Netherlands. Consecutive maxillofacial trauma patients were included whereupon each patient underwent a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular trauma, respectively. The primary outcome was the decision whether to treat during the emergency department stay or within 24 h of admission. The diagnostic accuracy was calculated for the individual physical examination findings and ensuing clinical decision aids with the focus being on detecting midfacial and mandibular fractures that require active treatment. RESULTS: A total of 766 midfacial trauma patients were identified of whom 339 (44.3%) had midfacial fractures. Of those, 74 (21.8%) required active treatment. A total of 280 mandibular trauma patients were identified of whom 66 (23.6%) had mandibular fractures. Of those, 37 (56.0%) required active treatment. The decision aid for midfacial trauma consisting of facial depression, epistaxis, ocular movement limitation, palpable step-off, objective malocclusion and tooth mobility or avulsion had a sensitivity of 97.3 (90.7-99.3), a specificity of 38.6 (35.0-42.3), and a negative predictive value of 99.3 (97.3-99.8). The decision aid for mandibular trauma consisting of mouth opening limitation, jaw movement pain, objective malocclusion and tooth mobility or avulsion resulted in a sensitivity of 100.0 (90.6-100.0), a specificity of 39.1 (33.2-45.4), and a negative predictive value of 100.0 (96.1-100.0). CONCLUSION: The clinical decision aids successfully identified midfacial and mandibular trauma patients requiring active fracture treatment and so may be useful in preventing unnecessary radiological procedures in the future. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov with the identifier NCT03314480.

Outcomes of functional treatment of condylar mandibular fractures with an articular impact: a retrospective study of 108 children.

INTRODUCTION: The treatment of fractures of the mandibular condylar process remains controversial, especially in children. The aim of this study was to assess the long-term clinical and radiographic outcomes of functional treatments for mandibular condylar fractures with an articular impact. MATERIALS AND METHODS: Young patients (< 15 years of age) presenting with either a unilateral or a bilateral mandibular fracture of the condylar process were included in this retrospective study. The clinical analysis focused on investigation of joint amplitudes at 1, 2, 6, 12, and 24 months after the beginning of the treatment, and at the end of their physical growth for the long-term study. Other clinical parameters included temporomandibular joint (TMJ) disorders and facial asymmetry. Photographs of patients and panoramic X-rays were assessed to identify any growth disorders at the end of the follow-up. RESULTS: One hundred and eight patients were included in this study, and 33 patients who were no longer undergoing mandibular growth at the time of the last follow-up were included in the long-term study. The mean age at the time of the trauma was 9.33 years, and the mean follow-up was 82.2 months. A significant improvement was observed in the maximal mouth opening (MMO), diduction, and propulsion in the first months after the trauma, reaching 44.31 mm (p < 0.0001), 10.50 mm (p = 0.0001), and 6.33 mm (p = 0.01), respectively, at 6 months. Three patients experienced a clinical posterior vertical insufficiency, one of which required a surgical procedure, while four patients exhibited a ramus asymmetry of up to 10 mm, albeit with no clinical consequences. One case of TMJ ankylosis was noted. CONCLUSION: Our study suggests that functional treatment is appropriate for fractures of the mandibular condyle with an articular impact in children, as it promotes mandibular growth and good functional recovery. Children have to be followed up, however, until completion of growth.

Tratamiento quirúrgico de fracturas de cóndilo mandibular: reducción asistida por endoscopio como complemento al tratamiento convencional / Surgical treatment of mandibular condyle fractures: endoscope-assisted reduction as a complement to conventional treatment

Resumen Introducción: Las fracturas de cóndilo presentan una alta incidencia dentro de las fracturas de mandíbula. Son principalmente tratadas por reducción abierta y fijación interna mediante elementos de osteosíntesis (ORIF) o por reducción cerrada (CR) con fijación máxilo-mandibular (MMF). El tratamiento asistido por endoscopio de estas fracturas, ofrece una alternativa y complemento quirúrgico a las limitaciones que se pueden presentar en la ORIF clásica. Objetivo: Describir la técnica de reducción quirúrgica asistida por endoscopio mediante acceso transoral y acceso retromandibular, como complemento a la técnica quirúrgica convencional para el tratamiento de fracturas de cóndilo mandibular, evaluando criterios clínicos en una serie de casos operados por esta técnica. Materiales y Método: Estudio descriptivo de presentación de serie de casos de pacientes con fractura de cóndilo, tratados con reducción quirúrgica asistida por endoscopio mediante accesos transoral y retromandibular, entre los años 2017 y 2018. Resultados: De los siete pacientes operados, un 85,7% presentó una función mandibular normal, un 100% presentó una función motora neurológica facial normal y un 71,4% no presentó dolor posoperatorio en el control de los 6 meses. Todos los pacientes recuperaron la oclusión que tenían de forma previa a la fractura mandibular. No se reportaron casos que tuvieran la necesidad de reintervención quirúrgica. Conclusiones: La reducción quirúrgica asistida por endoscopio para las fracturas de cóndilo mandibular es una técnica que ofrece un complemento a la técnica quirúrgica convencional, permitiendo mayor visibilidad de las estructuras, menor morbilidad quirúrgica y complicaciones mínimas en relación a las técnicas convencionales descritas.

Introduction: Condyle fractures have a high incidence within jaw fractures. They are mainly treated by open reduction and internal fixation with osteosynthesis elements (ORIF), or by closed reduction (CR) with maxillomandibular fixation (MMF). Endoscopic-assisted treatment of these fractures offers an alternative and surgical complement to the limitations that can occur in classic ORIF. Aim: To describe the technique of endoscope-assisted surgical reduction using transoral access and retromandibular access, as a complement to the conventional surgical technique for the treatment of mandibular condyle fractures, evaluating clinical criteria in a series of cases operated by this technique. Materials and Method: Descriptive study of case series presentation of patients with condyle fracture, treated with endoscopic assisted surgical reduction by transoral and retromandibular access, between the years 2017 and 2018. Results: Of the seven patients operated on, 85.7% presented normal jaw function, 100% presented normal facial neurological motor function, and 71.4% presented no postoperative pain at the 6-month control. All patients recovered the occlusion they had prior to the mandibular fracture. There were no reported cases in need of surgical reintervention. Conclusions: Endoscope-assisted surgical reduction for mandibular condyle fractures is a technique that offers a complement to the conventional surgical technique, allowing greater visibility of the structures, less surgical morbidity and minimal complications in relation to the conventional techniques described.

Evaluation of in-house, haptic assisted surgical planning for virtual reduction of complex mandibular fractures.

PURPOSE: The management of complex mandible fractures, i.e. severely comminuted or fractures of edentulous/atrophic mandibles, can be challenging. This is due to the three-dimensional loss of bone, which limits the possibility for accurate anatomic reduction. Virtual surgery planning (VSP) can provide improved accuracy and shorter operating times, but is often not employed for trauma cases because of time constraints and complex user interfaces limited to two-dimensional interaction with three-dimensional data. METHODS: In this study, we evaluate the accuracy, precision, and time efficiency of the haptic assisted surgery planning system (HASP), an in-house VSP system that supports stereo graphics, six degrees-of-freedom input, and haptics to improve the surgical planning. Three operators performed planning in HASP on computed tomography (CT) and cone beam computed tomography (CBCT) images of a plastic skull model and on twelve retrospective cases with complex mandible fractures. RESULTS: The results show an accuracy and reproducibility of less than 2 mm when using HASP for virtual fracture reduction, with an average planning time of 15 min including time for segmentation in the software BoneSplit. CONCLUSION: This study presents an in-house haptic assisted planning tool for cranio-maxillofacial surgery with high usability that can be used for preoperative planning and evaluation of complex mandible fractures.

Maxillofacial trauma in children: Association between age and mandibular fracture site.

PURPOSE: To describe the association between age and location of facial fractures in the pediatric population. MATERIALS AND METHODS: A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) from the 2016 Kids' Inpatient Database (KID) in children aged ≤18 years was conducted. International Statistical Classification of Diseases, 10th Revision (ICD-10) codes were used to extract facial fracture diagnoses. Logistic regression was used to evaluate and compare the contribution of various demographic factors among patients who had different types of facial fractures. RESULTS: A total of 5568 admitted patients were identified who sustained any type of facial bone fracture. Patients who had facial fractures were significantly more likely to be male (68.2% versus 31.8%; p<0.001) and were older with a mean age of 12.86 years (95% confidence interval [CI]: 12.72-12.99). Approximately one-third of patients with a facial fracture had a concomitant skull base or vault fracture. Maxillary fractures were seen in 30.9% of the cohort while mandibular fractures occurred in 36.9% of patients. The most common mandibular fracture site was the symphysis (N=574, 27.9% of all mandibular fractures). Condylar fractures were more common in younger children while angle fractures were more common in teenagers. Regression analysis found that age was the only significant contributor to the presence of a mandibular fracture (ß=0.027, p<0.001) and race was the only significant contributor to maxillary fractures (ß=-0.090, p<0.001). CONCLUSIONS: Facial fractures increase in frequency with increasing age in children. The mandible was the most commonly fractured facial bone, with an age-related pattern in fracture location.

Horizontal fracture of anterior mandible.

A 33-year-old male patient reported to us with the history of assault. The patient was cooperative and oriented, with no sign of head injury. He was assaulted with an axe over the mandible. The patient is having posteroanterior view radiographs of the mandible suggesting isolated horizontal fracture of the anterior mandible. Under general anaesthesia, this unusual fracture was treated by open reduction and internal fixation with a three-dimensional plate and miniplates. The case was managed successfully without any postoperative complications.

High-Resolution Maxillofacial Computed Tomography Is Superior to Head Computed Tomography in Determining the Operative Management of Facial Fractures.

BACKGROUND: Computed tomography of the head (CTH) and maxillofacial bones (CTMF) can be performed concurrently, but CTMF is frequently ordered separately, after facial fractures identified on CTH scans. This study aims to evaluate whether obtaining additional CTMF after CTH changes operative management of patients with facial trauma. MATERIALS AND METHODS: A retrospective chart review was performed of all patients with facial trauma who presented to our level 1 trauma center between January 2009 and May 2019. CTH and CTMF were reviewed for each patient. Fracture numbers and patterns were compared to determine if CTMF provided additional information that necessitated change in management, based on predetermined criteria. RESULTS: A total of 1215 patients were assessed for facial trauma. Of them, 899 patients underwent both CTH and CTMF scans. CTH identified 22.7% less fractures than CTMF (P < 0.001); specifically, more orbital, nasal, naso-orbito-ethmoid, zygoma, midface, and mandible fractures (P < 0.001). Of all patients 9.2% (n = 83) of patients with nonoperative fractures on CTH were reclassified as operative on CTMF; 0.6% (n = 5) with operative patterns on CTH were reclassified as nonoperative on CTMF, and 18.1% (n = 163) experienced a changed in their operative plan though operative fractures were seen on both imaging modalities. Additional findings seen on CTMF delegated change in the operative plan in 27.9% (n = 251) of cases. CONCLUSIONS: CTMF scans are necessary to determine operative intervention. As CTH and CTMF are constructed from the data, physicians should consider ordering both scans simultaneously for all patients with facial trauma to limit radiation exposure, control costs, and avoid delays in care.

Analysis of blunt cerebrovascular injury in pediatric trauma.

BACKGROUND: Blunt cerebrovascular injury (BCVI) occurs in <1% of pediatric patients. The two principal screening criteria for BCVI in children are the Utah and McGovern Score with motor vehicle accident (MVA) considered to be a predictor for BCVI. We sought to confirm previously reported risk factors and identify novel associations with BCVI in pediatric patients. METHODS: The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for patients younger than 16 years presenting after blunt trauma. A multivariable logistic regression was used to determine risk of BCVI. RESULTS: From 69,149 pediatric patients, 109 (<0.2%) had BCVI. The median age was 13 years, and the median Injury Severity Score was 25. More than half the patients were involved in MVAs (53.2%) and had a skull base fracture (53.2%). Factors independently associated with BCVI include skull base fracture (odds ratio [OR], 3.84; 95% confidence interval [CI], 2.40-6.14; p < 0.001), cervical spine fracture (OR, 3.15; 95% CI, 1.91-5.18; p < 0.001), intracranial hemorrhage (OR, 3.11; 95% CI, 1.89-5.14; p < 0.001), Glasgow Coma Scale score of 8 or less (OR, 2.11; 95% CI, 1.33-3.54; p = 0.003), and mandible fracture (OR, 1.99; 95% CI, 1.05-3.84; p = 0.04). Motor vehicle accident was not an independent predictor for BCVI (p = 0.07). CONCLUSION: In the largest analysis of pediatric BCVI to date, skull base fracture had the strongest association with BCVI. Other associations to pediatric BCVI included cervical spine and mandible fracture. Motor vehicle accident, previously identified to be associated with BCVI, was not an independent risk factor in our analysis. A future multicenter study incorporating newly identified variables in a scoring system to screen for BCVI is warranted. LEVEL OF EVIDENCE: Level IV (Prognostic/Epidemiologic).

Combined Use of Specially-Designed Digital Surgical Guides and Pre-Formed Reconstruction Plate to Treat Bilateral Mandibular Fracture.

This paper describes the application of a modified digital surgical guide, an occlusal template and a pre-formed reconstruction titanium plate in the open reduction and internal fixation of a bilateral mandibular fracture. Bilateral mandibular fracture is a commonly encountered simple type of fracture. However, even for an experience surgeon, achieving precise treatment remains a challenge due to the movable temporomandibular joint, unstable fractured segments, the difficulty in forming a reconstruction plate, and the lack of an effective stabilizing and locating device. In this case, the surgeon used a specially-designed modified guide together with a reconstruction plate and an occlusal template to treat a bilateral mandible fracture, effectively improving the accuracy and the medical outcome of the operation, saving operation time and reducing postoperative complications.

Mandibular condyle fractures: A diagnosis with controversial treatment.

BACKGROUND: Over the years, the treatment to be chosen for the resolution of condylar fractures has been discussed with great concern. Treatment depends on the type and location of the fracture, as well as other associated factors such as facial injuries and concurrent diseases. AIM OF THE STUDY: The aim of the study was to make a review of the different criteria to establish a diagnosis and treatment to resolve mandibular condyle fractures, according to the evolution of the years and what this entails. DISCUSSION: Management of condylar fractures remains controversial among surgeons. However, as time goes by and as comparative and analytical studies are carried out within the issue, parameters and criteria are established to facilitate the decisions taken regarding the management and treatment of condylar fractures. CONCLUSION: Condylar fractures must be managed according to the clinical and case presentation.

ANTECEDENTES: A lo largo de los años se ha discutido con gran preocupación el tratamiento que hay que escoger para la resolución de las fracturas condilares. Este depende del tipo y la localización de la fractura, así como de otros factores asociados, como las lesiones faciales y las enfermedades concomitantes. OBJETIVO: Hacer una revisión de los diferentes criterios para establecer un diagnóstico y un tratamiento para la resolución de las fracturas del cóndilo mandibular, de acuerdo con la evolución de los años y lo que esto conlleva. DISCUSIÓN: El manejo de las fracturas condilares sigue siendo controvertido entre los cirujanos. Sin embargo, a medida que pasa el tiempo y se realizan estudios comparativos y analíticos sobre el tema, se establecen parámetros y criterios para facilitar las decisiones tomadas en relación con el manejo y el tratamiento de las fracturas condilares. CONCLUSIÓN: Las fracturas condilares deben ser manejadas según la clínica y la presentación del caso.

Intracranial Approach for Retrieval of the Condylar Head After Avulsion into the Middle Cranial Fossa.

BACKGROUND: Dislocation of the mandibular condyle into the middle cranial fossa is a rare injury that can be seen after facial trauma. Early identification of condyle dislocation into the middle cranial fossa was difficult until the development of computed tomography, and diagnosis was often significantly delayed after the initial trauma. CASE DESCRIPTION: We present a rare case of a young woman who presents after a mechanical fall resulting in facial trauma with an avulsion condyle fracture with dislocation of the mandibular condyle into the middle cranial fossa. CONCLUSIONS: To our knowledge, this complete avulsion of the condyle into the middle cranial fossa requiring an intracranial approach for condylectomy is extremely rare. We discuss the surgical management options for reduction and fixation accomplished in a multidisciplinary approach involving neurosurgery and oral maxillofacial surgery.

The Diagnosis and Management of Facial Bone Fractures.

Appropriate medical care for a patient with a facial fracture can not only optimize aesthetic outcomes but also prevent the potential morbidity and mortality of delayed treatment. In this article, we focus on the clinical presentations, physical examination findings, diagnostic imaging, consultations, and follow-up that patients with facial fractures need related to their emergency department management. Specifically, we address the nuances of evaluating frontal, orbital, nasal, maxillofacial, and mandibular fractures.

Comportamiento del trauma maxilofacial grave / Behavior of severe maxillofacial trauma

Introducción: El conocimiento de la causa, gravedad y distribución del trauma facial y las lesiones concomitantes puede ayudar en la optimización del tratamiento inicial. Objetivo: Caracterizar el trauma maxilofacial grave en el servicio de urgencia del Hospital Universitario General Calixto García de 2015-2016. Métodos: Se realizó un estudio descriptivo y transversal en el Hospital Universitario General Calixto García, de 2015-2016. El universo lo constituyeron los pacientes que acudieron al servicio de urgencias con diagnóstico de politrauma maxilofacial y trauma maxilofacial grave. Las variables cualitativas fueron sexo, etiología, ingestión de bebidas alcohólicas y lesiones, y la variable cuantitativa fue edad. Se confeccionó una planilla de recolección de datos y la información se introdujo en una base de datos. Se emplearon números enteros, porcentajes y tablas estadísticas. Se siguieron los principios éticos para la investigación en humanos. Resultados: El sexo masculino constituyó un 73 por ciento. El grupo de edad más representado fue el de 18-30 años (32,4 por ciento), seguido por el de 31-40 y 41-50 (21,6 por ciento y 14,9 por ciento respectivamente). En el 44,6 por ciento de los pacientes el trauma estuvo relacionado con accidentes del tránsito, y en el 32,4 por ciento con violencia interpersonal. En el 50 por ciento de los pacientes se detectó aliento etílico. Predominaron las heridas mayores de 2 cm, seguidas por las de menos de esa longitud (52,7 por ciento y 28,4 por ciento, respectivamente) y la fractura mandibular (29,7 por ciento). Conclusiones: Hubo un predominio del sexo masculino y del grupo de edad de 18-30; la principal etiología fue el accidente de tránsito, seguida de la violencia interpersonal; las lesiones de tejidos blandos más frecuentes fueron las heridas mayores de 2 cm y las de tejidos duros: fracturas mandibulares. La mitad de los pacientes habían ingerido bebidas alcohólicas(AU)

Introduction: Understanding the cause, severity and distribution of facial trauma and concomitant lesions may help in the optimization of initial treatment. Objective: To characterize severe maxillofacial trauma in the emergency department of General Calixto García University Hospital from 2015-2016. Methods: A descriptive and cross-sectional study was carried out at General Calixto García University Hospital, from 2015-2016. The study population was constituted by patients who presented to the emergency department with a diagnosis of maxillofacial polytrauma and severe maxillofacial trauma. We used the following qualitative variables: sex, etiology, drinking of alcohol and lesions. We used the quantitative variable of age. A data collection form was prepared and the information was entered into a database. Whole numbers, percentages and statistical tables were used. Ethical principles for human research were followed. Results: Males accounted for 73 percent. The most represented age group was 18-30 years (32.4 percent), followed by the 31-40 and 41-50 groups (21.6 percent and 14.9 percent, respectively). In 44.6 percent of the patients the trauma was associated to traffic accidents. In 32.4 percent of the patients, the trauma was associated to interpersonal violence. Ethyl breath was detected in 50 percent of the patients. Predominating wounds were larger than 2 cm, followed by those of less than that length (52.7 percent and 28.4 percent, respectively) and mandibular fracture (29.7 percent). Conclusions: There was a predominance of males and the age group of 18-30 years. The main etiology was traffic accident, followed by interpersonal violence. The most frequent soft-tissue lesions were wounds greater than 2 cm. The most frequent hard-tissue lesions were mandibular fractures. Half of the patients had consumed alcohol(AU)

Comportamiento del trauma maxilofacial grave / Behavior of severe maxillofacial trauma

Introducción: El conocimiento de la causa, gravedad y distribución del trauma facial y las lesiones concomitantes puede ayudar en la optimización del tratamiento inicial. Objetivo: Caracterizar el trauma maxilofacial grave en el servicio de urgencia del Hospital Universitario General Calixto García de 2015-2016. Métodos: Se realizó un estudio descriptivo y transversal en el Hospital Universitario General Calixto García, de 2015-2016. El universo lo constituyeron los pacientes que acudieron al servicio de urgencias con diagnóstico de politrauma maxilofacial y trauma maxilofacial grave. Las variables cualitativas fueron sexo, etiología, ingestión de bebidas alcohólicas y lesiones, y la variable cuantitativa fue edad. Se confeccionó una planilla de recolección de datos y la información se introdujo en una base de datos. Se emplearon números enteros, porcentajes y tablas estadísticas. Se siguieron los principios éticos para la investigación en humanos. Resultados: El sexo masculino constituyó un 73 por ciento. El grupo de edad más representado fue el de 18-30 años (32,4 por ciento), seguido por el de 31-40 y 41-50 (21,6 por ciento y 14,9 por ciento respectivamente). En el 44,6 por ciento de los pacientes el trauma estuvo relacionado con accidentes del tránsito, y en el 32,4 por ciento con violencia interpersonal. En el 50 por ciento de los pacientes se detectó aliento etílico. Predominaron las heridas mayores de 2 cm, seguidas por las de menos de esa longitud (52,7 por ciento y 28,4 por ciento, respectivamente) y la fractura mandibular (29,7 por ciento). Conclusiones: Hubo un predominio del sexo masculino y del grupo de edad de 18-30; la principal etiología fue el accidente de tránsito, seguida de la violencia interpersonal; las lesiones de tejidos blandos más frecuentes fueron las heridas mayores de 2 cm y las de tejidos duros: fracturas mandibulares. La mitad de los pacientes habían ingerido bebidas alcohólicas(AU)

Introduction: Understanding the cause, severity and distribution of facial trauma and concomitant lesions may help in the optimization of initial treatment. Objective: To characterize severe maxillofacial trauma in the emergency department of General Calixto García University Hospital from 2015-2016. Methods: A descriptive and cross-sectional study was carried out at General Calixto García University Hospital, from 2015-2016. The study population was constituted by patients who presented to the emergency department with a diagnosis of maxillofacial polytrauma and severe maxillofacial trauma. We used the following qualitative variables: sex, etiology, drinking of alcohol and lesions. We used the quantitative variable of age. A data collection form was prepared and the information was entered into a database. Whole numbers, percentages and statistical tables were used. Ethical principles for human research were followed. Results: Males accounted for 73 percent. The most represented age group was 18-30 years (32.4 percent), followed by the 31-40 and 41-50 groups (21.6 percent and 14.9 percent, respectively). In 44.6 percent of the patients the trauma was associated to traffic accidents. In 32.4 percent of the patients, the trauma was associated to interpersonal violence. Ethyl breath was detected in 50 percent of the patients. Predominating wounds were larger than 2 cm, followed by those of less than that length (52.7 percent and 28.4 percent, respectively) and mandibular fracture (29.7 percent). Conclusions: There was a predominance of males and the age group of 18-30 years. The main etiology was traffic accident, followed by interpersonal violence. The most frequent soft-tissue lesions were wounds greater than 2 cm. The most frequent hard-tissue lesions were mandibular fractures. Half of the patients had consumed alcohol(AU)

Management and Outcome of Maxillofacial Trauma in a 9-Week-Old Dog.

This case report describes diagnosis, treatment, and outcome of maxillofacial trauma in a 9-week-old shih tzu. In addition to an open left mandibular body fracture and a right condylar process fracture, there were several relatively stable and minimally displaced right maxillary fractures. The torn soft tissues associated with the left mandibular body fracture were sutured closed, and a tape muzzle was placed. Due to sufficient fracture healing at the 2-week recheck examination, the tape muzzle was removed. The 6-week reexamination confirmed continued healing and recovery. Anesthesia was performed at the 5.5-month reexamination when the dog was 8 months old, revealing the presence of persistent deciduous teeth, linguoverted, malformed, and partially erupted permanent teeth, and asymmetric skeletal malocclusion (in addition to the breed-specific mandibular mesioclusion). Persistent deciduous teeth and linguoverted and malformed permanent teeth were extracted to allow for normal opening and closing of the mouth without traumatic occlusion. Long-term follow-up is recommended in juvenile dogs with maxillofacial injuries in order to prevent, recognize, and treat dental complications resulting from the trauma.