Incidencia de consultas por fracturas maxilofaciales en un servicio de urgencias odontológicas del Área Metropolitana de Buenos Aires / Incidence of consultations for maxillofacial fractures in a dental emergency department in the Metropolitan Area of Buenos Aires

Objetivo: Describir la incidencia, la causa, el patrón y el tratamiento de fracturas maxilofaciales en sujetos que solici- taron atención en un Servicio de Urgencias Odontológicas del Área Metropolitana de Buenos Aires. Materiales y métodos: Se analizaron las historias clíni- cas de los individuos que concurrieron al Servicio de Urgencias y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires (SUyOP) en el período compren- dido entre marzo de 2018 y diciembre de 2019. Se registró la fre- cuencia de consultas vinculadas con diagnóstico de algún tipo de fractura del esqueleto maxilofacial y en el caso de estos pacien- tes, se registraron sexo, edad, etiología, ubicación y tratamiento. Resultados: Durante el periodo evaluado asistieron al SUyOP un total de 13.919 pacientes por algún tipo de urgen- cia odontológica, entre los cuales 47 (0,33%) se presentaron con traumatismos en la región bucomaxilofacial; 39 fueron del sexo masculino (83%). En total fueron diagnosticadas 66 frac- turas. La edad media se extendió entre los 30 y los 51 años. Las fracturas se encontraron con mayor frecuencia en la mandíbu- la (95,45%). La agresión interpersonal fue la principal causa (53,19%). El tratamiento realizado con mayor frecuencia fue el bloqueo intermaxilar en el 57,44% de los pacientes. Conclusión: Las fracturas de maxilar inferior fueron las que se registraron con mayor frecuencia. Si bien estas fracturas no ponen en riesgo la vida del paciente, la falla en el diagnóstico y el tratamiento apropiados puede derivar en la pérdida de fun- ciones del sistema estomatognático, y desarrollar deformidades secundarias que requieren de un tratamiento más complejo (AU)

Aim: To describe the incidence, etiology, pattern and treat- ment of maxillofacial fractures in a dental emergency department of the Buenos Aires Metropolitan Area. Materials and methods: A study was conducted, re- cording sex, age, etiology, location and treatment of maxillofa- cial fractures in patients who visited the Emergency and Patient Orientation Service of the School of Dentistry of the University of Buenos Aires (SUyOP) from March 2018 to December 2019. Data were obtained from dental medical records. Results: During the evaluated period, a total 13,919 pa- tients visited the SUyOP for dental emergencies, of whom 47 (0.33%) presented with trauma in the oral-maxillofacial region, and 39 were male (83%). Age range was 30 to 51 years. Over- all, 66 fractures were diagnosed. Fractures were most frequent in the mandible (95.45%). Interpersonal aggression was the most prevalent cause (53.19%). The most frequent treatment was inter- maxillary fixation, which was performed in 57.44% of the cases. Conclusion: Fractures of the lower jaw were the most fre- quently reported. Although these fractures are not life-threaten- ing, failure to diagnose and treat them properly can lead to loss of function of the stomatognathic system and development of sec- ondary deformities requiring more complex treatment (AU)

A tomada de decisão no uso de sistema de fixação absorvível em cirurgias bucomaxilofaciais: revisão sistemática / Decision making in the use of absorbable fixation system in maxillofacial surgery: a systematic review / Toma de decisiones en el uso de sistemas de fijación absorbibles en cirugías maxilofaciales: revisión sistemática

Introdução: As fraturas ósseas faciais são muito comuns em lesões de face, destacando-se as fraturas mandibulares. Para o tratamento delas é necessário haver um sistema de fixação a fim de restaurar o osso fraturado, sua forma e função. Objetivo: Identificar fatores influenciadores do uso de sistemas de fixação absorvíveis em cirurgias buco maxilo faciais. Material e método: Trata-se de uma revisão sistemática feita nas bases de dados MEDLINE, BBO e SciELO, no período de agosto de 2019 a setembro de 2020 nos portais da PubMed e BVS. Dentre os 322 achados e após utilização de filtros, leitura de títulos e resumos, foram incluídos 30 artigos para compor a revisão. Resultados: Os achados do estudo revelam existir uma série de fatores influenciáveis na escolha do melhor material, tais como: sua aplicação em pacientes pediátricos ou adultos, a palpabilidade das placas, a resistência, as principais medidas de satisfação, o envolvimento com doenças malignas, complicações e novidades que a literatura vem discutindo sobre o tipo de material. Conclusão: O uso de placas absorvíveis é aconselhado para uso pediátrico, pois minimizam as restrições ao crescimento, dispensam a necessidade de uma cirurgia secundária, reduzindo, assim, gastos hospitalares. Além disso, as placas biodegradáveis originam exames de imagem com menos artefatos, de modo que não comprometem diagnósticos em pacientes com neoplasias(AU)

Introduction: Facial bone fractures are very common in facial injuries, highlighting mandibular fractures. In order to treat them, it is necessary to have a fixation system in order to restore the fractured bone, its shape and function. Objective: To identify factors influencing the use of absorbable fixation systems in oral maxillofacial surgery. Material and method: This is a systematic review carried out in the MEDLINE, BBO and SciELO databases, from August 2019 to September 2020 in the portals of PubMed and VHL. Among the 322 findings and after using filters, reading titles and abstracts, 30 articles were included to compose the review. Results: The findings of the study reveal that there are a number of influential factors in the choice of the best material, such as: its application in pediatric or adult patients, the palpability of the plates, the resistance, the main measures of satisfaction, the involvement with malignant diseases, complications andthe main novelties that the literature has been discussing about the type of material. Conclusion: The use of absorbable plates is advised for pediatric use, because they minimize the restrictions to growth, dispense the need for a secondary surgery, thusreducing hospital expenses. Besides that, the biodegradable plates originate imaging exams with fewer artifacts, so that it does not compromise the diagnosis of patients with cancer(AU)

Introducción: Las fracturas de los huesos faciales son muy frecuentes en las lesiones faciales, especialmente las fracturas mandibulares. Para poder tratarlos es necesario disponer de un sistema de fijación con el fin de restaurar el hueso fracturado, su forma y función. Objetivo: Identificar los factores que influyen en el uso de sistemas de fijación absorbible en cirugía oral maxilofacial. Material y método: Se trata de una revisión sistemática realizada en las bases de datos MEDLINE, BBO y SciELO, de agosto de 2019 a septiembre de 2020 en los portales de PubMed y VHL. Entre los 322 hallazgos y luego de utilizar filtros, leer títulos y resúmenes, se incluyeron 30 artículos para componer la revisión. Resultados: Los hallazgos del estudio revelanque existen una serie de factores que influyen en la elección del mejor material, tales como: su aplicación en pacientes pediátricos o adultos, la palpabilidad de las placas, la resistencia, las principales medidas de satisfacción, la implicación con enfermedades malignas, complicaciones y las principales novedades que ha venido discutiendo la literatura sobre el tipo de material. Conclusión: Se recomienda el uso de placas absorbibles para uso pediátrico, ya que minimizan las restricciones de crecimiento, prescinden de la necesidad de cirugía secundaria, reduciendo así los gastos hospitalarios. Además, las placas biodegradables dan como resultado pruebas de imagen con menos artefactos, de modo que no comprometen el diagnóstico em pacientes con neoplasias(AU)

Occurrence and remission of loss of sensitivity of inferior alveolar nerve in mandibular fractures

ABSTRACT Purpose: to evaluate the occurrence of loss of sensitivity of the inferior alveolar nerve, and to monitor the remission of this change in patients with mandibular fractures subjected to surgical treatment. Methods: patients with mandibular fractures, surgically treated within one year, were prospectively evaluated. Data regarding etiology, fracture location, type and displacement, and surgical access, were obtained. The tactile and thermal tests were applied at eighteen points in the mental region, within a period of six months. Statistical tests were applied to compare the categories of variables and the period of observation (p ≤ 0.050). Results: during the study, 37 patients were included. There were 24 bilateral and 13 unilateral fractures. Sensory changes occurred in 56.8% of the patients in the preoperative period, in 83.8% of the patients, in the postoperative period, and 35.1% of the patients presented complete remission during the final period of the study. Conclusion: sensory changes occurred in about half of the patients, due to the fracture, increasing greatly in the postoperative period, with complete remission in about one third of the cases. The fracture type, degree of displacement and surgical access type influenced the occurrence of sensory alterations.

Dual support technique for pediatric palatal fracture: 1.5 mm transmucosal titanium plates along with acrylic splint backing.

Surgeons are always in a dilemma for the management of paediatric facial fractures due to distinctive nature of growing facial skeleton. The ultimate treatment goal for paediatric fractures should be as conservative as possible with least invasive surgical approach that will access the fracture and least invasive surgical fixation that will allow stable reduction and will prevent any growth disturbances. We are presenting a case of 4- year old with panfacial fracture managed according to this principle using transmucosal titanium plates with acylic splint for sagittal split of palate.

Dentoalveolar Fractures: New Orthodontic Protocol Proposal and Pilot Study.

The goal of fracture treatment that includes the dentoalveolar process is to obtain the anatomic bone healing and the pre-injury occlusion restoration with functional and aesthetic recovery, avoiding dental or periodontal lesions. Fractures activates, in the damaged tissue, the Regional Acceleratory Phenomenon, a physiological healing process that can also be activated during orthodontic overloads. Orthodontic treatment in the traumatized area could exploit this phenomenon in order to sustain the cellular activity.The aim of this study is to propose a treatment protocol for dentoalveolar fractures based on the use of orthodontics in order to sustain the physiological healing process known as Regional Acceleratory Phenomenon.The authors present 2 cases of an 18 year old woman and 23 year old man affected by dentoalveolar fracture. The operative protocol the authors applied foresaw three steps of treatment: orthodontic brackets application, surgery, orthodontic treatment.The patients showed complete healing at the 3 months follow-up and were treated up to 18 months for further orthodontic treatment.The operative protocol proposed by the Authors appears to be a rational choice since it allows a single orthodontic device to be an "active splinting system", with fast application time, good acceptance by the patient, low complications rate; moreover, it produces any planned dental movements for further orthodontic treatments.

Fixação funcionalmente estável no tratamento de sequela de fratura cominutiva de mandíbula por PAF / Functionally stable fixation in the treatment of comminuted jaw fracture by firearm projectile

Introdução: em traumas de alta energia por projéteis de arma de fogo (PAF), pode ocorrer a cominuição da mandíbula. Quando não identificadas ou tratadas de maneira equivocada, essas injúrias podem comprometer a saúde do indivíduo, com graves complicações estéticas e funcionais. Objetivo: o objetivo deste trabalho é relatar um caso de tratamento cirúrgico de sequela de ferimento por arma de fogo com fratura cominutiva em região de sínfise mandibular. Relato do caso: paciente procurou o serviço de cirurgia e traumatologia bucomaxilofacial após tratamento cirúrgico insatisfatório de fratura mandibular por PAF. Observou-se clinicamente mobilidade em manipulação, exposição óssea e drenagem purulenta. Na tomografia, observou-se gap ósseo, descontinuidade na base mandibular e material de osteossíntese inadequado. Foi proposta uma abordagem cirúrgica para instalação de placa de reconstrução do sistema 2.4 mm. Em acompanhamento pós-operatório, o paciente evoluiu com abertura bucal funcional e satisfatória, sem mobilidade nos fragmentos ósseos, arcabouço mandibular restabelecido e adequado posicionamento do material de fixação. Considerações finais: os casos de cominuição óssea apresentam características individuais que devem ser levadas em consideração em seu manejo. Nesses casos, a escolha do material de fixação é fundamental para o sucesso terapêutico e o uso de prototipagem soma para uma condução satisfatória do caso, garantindo menor tempo cirúrgico e melhor adaptação da placa. (AU)

Introduction: in high energy traumas caused by firearm projectiles may occur comminutive mandibular fractures. When it is not identified or inappropriately treated, these injuries can compromisse the individual's health, with serious aesthetics and funcional complications. Objective: the aim of this study is report a case of surgical treatment of sequelae from firearm injury with comminutive fracture in the region of mandibular symphysis. Case report: patient sought the service of Oral and Maxillofacial Surgery and Traumatology after 1 month of unsatisfactory surgical treatment of a mandibular fracture caused by firearm projectile. Clinical examination revealed mobility to manipulation and bone exposure with purulent drainage. Computed tomography of the face shows bad fracture consolidation in the anterior region of the mandible with bone gap and discontinuity in the mandibular base and inadequate and poorly positioned osteosynthesis material. It was then proposed a new surgical approach with instalation of the reconstruction plate of 2.4mm locking system. In postoperative follow-up, the patient evolved with a functional and satisfactory mouth opening, with no mobility in bone fragments, restored mandibular framework and adequate positioning of the fixation material. Final considerations: the cases of comminutive bone fractures show particular features that should be considered in their handling. In these cases, the choice of the fixation material is critical to therapeutic success and the use of prototyping sum for a satisfactory conduction of the case, ensuring shorter surgical time and better adaptation of the plate.(AU)

No Need to Routinely Remove Titanium Implants for Maxillofacial Fractures.

PURPOSE: Titanium implants are typically used to fix maxillofacial fractures and their routine removal is a controversial topic in maxillofacial surgery. This study aimed to estimate the removal rate and risk factors associated with removal. MATERIALS AND METHODS: The authors designed and implemented a retrospective study. Adult patients who underwent open reduction and internal fixation with titanium implants for maxillofacial fractures were included and those who returned for implant removal were identified from January 2007 to December 2016. The predictor variables were gender, age, preoperative infection, injury time, trauma cause, and fracture site. The primary outcome variable was removal of titanium implants. Descriptive and bivariate statistics were computed. Kaplan-Meier survival methods were used to estimate rate of removal. Univariate and multivariate Cox proportional hazards models were used to identify risk factors associated with removal. RESULTS: Of 2,325 patients (1,890 men and 435 women; average age, ∼35.49 yr) registered in this study, 163 (7.01%) had their titanium implants removed and 1-, 2-, and 10-year removal rates were 3, 7, and 8%, respectively. The risk factors most closely associated with removal were preoperative infection, injury by a blow from an object, obsolete fracture, and female gender. CONCLUSIONS: Routinely removing titanium implants in patients with maxillofacial fracture is not necessary. When the risk factors listed earlier are present in these patients, follow-up should be scheduled more frequently.

In vitro and in vivo analysis of the biodegradable behavior of a magnesium alloy for biomedical applications.

The present study was designed to investigate the biodegradation behavior of Mg alloy plates in the maxillofacial region. For in vitro analysis, the plates were immersed in saline solution and simulated body fluid. For in vivo, the plates were implanted into the tibia, head, back, abdominal cavity, and femur and assessed at 1, 2, and 4 weeks after implantation. After implantation, the plate volumes and the formed insoluble salt were measured via micro-computed tomography. SEM/EDX analysis of the insoluble salt and histological analysis of the surrounding tissues were performed. The volume loss of plates in the in vitro groups was higher than that in the in vivo groups. The volume loss was fastest in the abdomen, followed by the head, back, tibia, and femur. There were no statistically significant differences in the insoluble salt volume of the all implanted sites. The corrosion of the Mg alloy will be affected to the surrounding tissue responses. The material for the plate should be selected based on the characteristic that Mg alloys are decomposed relatively easily in the maxillofacial region.

Antiresorptive drug-related osteonecrosis of the jaws, literature review and 5 years of experience.

PURPOSE: Bisphosphonate drug therapy provides benefits in the case of osteoporosis and carcinomas metastasizing to the bones, but it exposes patients to important side effects. The aim of this study was to investigate the incidence and the appropriate surgical treatment of bone lesions and fractures due to antiresorptive drug-related osteonecrosis of the jaws (ARONJ). METHODS: Patients presenting with osteonecrosis lesions of the jaw, who were referred to the Maxillo-Facial unit of the University of L'Aquila, were considered for inclusion. Grade of the lesion and treatment choice was recorded for each patient. Descriptive statistics were calculated and the data were analysed with Chi-squared tests. A representative case of a fracture reduction with a supra-periostal approach is reported. RESULTS: Among the 165 patients with ARONJ lesions, 112 were female and 53 were male. In total, 115 patients received intra-venous bisphosphonate therapy and 50 received oral bisphosphonate therapy. Five stage 2 lesions, three stage 2 lesions and two stage 3 lesions were not a consequence of dental procedures. Eighteen surgical bone excisions were performed and four pathological fractures were reduced. In one case (the reported one), the combined use of platelet-rich plasma and the supra-periostal approach leads to a successful 1-year follow-up. CONCLUSIONS: ARONJ lesions are a type of pathological bone disease affecting the jawbones. The pathology pathway remains a controversial and frequently discussed topic. A surgically conservative strategy seems to be the best way to assure a comfortable quality of life to those patients negatively affected by this condition.

Open reduction and internal fixation of palatal fractures using three-dimensional plates.

The maxilla is arguably the most anatomically intricate structure of the craniofacial skeleton, and the hard palate is an important bone that regulates the width and architecture of the face. The management of palatal fractures has long been a matter of debate, and varies with anatomical pattern and other injuries to the craniofacial skeleton. We have studied 18 palatal fractures during a five-year period that were treated using 3-dimensional rectangular plates placed across the palatal vault together with fixation of other fractures of the facial bones. Healing was satisfactory in all patients by 12weeks, with no complications. We think that open reduction and internal fixation of palatal fractures with 3-dimensional plates offers adequate stability with minimal complications.

Digital Diagnosis and Treatment Program for Maxillofacial Fractures: A Retrospective Analysis of 626 Cases.

PURPOSE: The purpose of this study was to evaluate the accuracy of the digital diagnosis and treatment program for maxillofacial fractures. MATERIALS AND METHODS: The data of 626 patients with maxillofacial fractures were analyzed retrospectively from January 2010 to August 2016. These patients were divided into 2 groups. In the experimental group, preoperative planning was conducted and transferred to patients with guiding templates and navigation according to the digital diagnosis and treatment program for maxillofacial fractures. In the control group, postsurgical planning was performed instead of preoperative planning. To assess the accuracy of the digital diagnosis and treatment program for maxillofacial fractures, preoperative planning and postoperative computed tomographic models were superimposed and imported to dedicated software (Geomagic Studio 13.0, Geomagic, Inc, Research Triangle Park, NC) to calculate the difference between the 2 models in the 2 groups. RESULTS: Results of the experimental set showed that the mean error between the preoperative planning model and the postoperative model ranged from 0.65 to 0.97 mm (average, 0.89 mm). For the control group, the mean error was 0.78 to 1.45 mm (average, 1.01 mm). Thus, the mean error of the experimental group was statistically lower than that of the control group (P < .0001). Postoperative analysis of the subjective evaluation of occlusion recovery showed that 92.13% of patients achieved good occlusion recovery in the experimental group compared with only 84.91% in the control group. The digital diagnosis and treatment program for maxillofacial fractures was more accurate. CONCLUSION: Aided by the digital diagnosis and treatment program, the accuracy for maxillofacial fractures was notably improved. To facilitate the application and promotion of digital technology, further modification of the complete digital diagnosis and treatment pathway for maxillofacial fractures is highly desired.

[Experimental study on accelerated healing of jaw fracture using gelatin sponge compound growth factor].

OBJECTIVE: To explore the role and mechanism of drug delivery systems using growth factor combined with gelatin sponge on accelerating the healing of jaw fracture and to seek better treatment of accelerating the maxillofacial fracture. METHODS: About 100 µg recombinant human bone morphogenetic protein (BMP)-2 was completely dissolved in 1 mL recombinant bovine basic fibroblast growth factor (bFGF), and the solution (40 µL) was dropped in gelatin sponge (0.5 cm×0.5 cm×1.0 cm). Then, it was freeze dried and prepared into bFGF/BMP/gelatin sponge delivery systems. The mandibular fracture model on two sides were prepared in 12 New Zealand rabbits and randomly divided into two groups. The left side was the control group, which was only fixed with titanium plates. The right side was the experimental group, in which bFGF/BMP/gelatin sponge delivery systems were put under the titanium plates. General observation, X-ray, and histological examination were taken at 2, 4, and 12 weeks after surgery. RESULTS: After 2 weeks, more fibrous tissues were seen between the fracture ends in the experimental group than in the control group. After 4 weeks, fibrous fracture callus were seen in the fracture gap in the experimental group. The ingrowths of fibrous tissue and blood vessels were seen in the control group. The fracture healing of the experimental group was significantly faster than the control group at 2 and 4 weeks. After 12 weeks, the experimental and control groups all healed completely. CONCLUSIONS: bFGF/BMP/gelatin sponge can accelerate and improve fracture healing; thus, it has better clinical application prospect.

Open reduction and internal fixation: Screw injury - Retrospective study.

BACKGROUND/AIMS: Open reduction and internal fixation (ORIF) is a standard surgical procedure in jaw trauma and in orthognathic surgery. Insertion of screws is a significant risk for accidental tooth root injury with varying outcomes. Contrary evidences are found in literature due to a variety of study designs. This study was undertaken to address the lacunae and possibly estimate the difference in occurrence of tooth damage during or after ORIF between trauma and planned osteotomies. MATERIALS AND METHODS: In this retrospective study, the data of ORIF in either trauma or orthognathic surgery fulfilling inclusion and exclusion criteria were collected and analyzed. RESULTS: There were 1632 patients fulfilling the inclusion and exclusion criteria and formed the study group, of which 663 were in orthognathic surgery, of whom 210 had bimaxillary orthognathic surgery. In the trauma group, 358 patients had fractures involving both jaws whereas 272 had maxilla alone and 339 had mandibular fractures alone. On comparing the outcome, of the 9073 screws studied, 93.40% were not involved in any contact with the teeth, 6.3% were in category of potential hits (near apices or the root surfaces), and only 0.28% had evidence of root damage with the screws. It is observed that molar and premolar had a significant difference in terms of the type of surgery (P ≤ 0.05) whereas canine (P = 0.75) and incisor (P = 0.67) showed no statistical difference. CONCLUSION: ORIF when used as mentioned is a safe way for the management of fractures. The incidence of root injury is not uncommon but can be avoided with careful planning and execution.

Epidemiología de las fracturas maxilofaciales tratadas quirúrgicamente en el Servicio Maxilofacial de Bayamo: 5 años de revisión / Epidemiology of maxillofacial fractures treated surgically in the Maxillofacial service of Bayamo: 5-years-revision

Se ha reportado en muchos países la incidencia y prevalencia del trauma maxilofacial, con diferencias entre los distintos estudios debido a factores socioculturales. Se realizó un estudio de corte transversal entre los años 2011 y 2015, con el objetivo de conocer la epidemiología de las fracturas maxilofaciales. Se registraron todos los pacientes con fracturas que acudieron al servicio de cirugía maxilofacial del Hospital Carlos M. de Céspedes, que requirieron una reducción quirúrgica. Se recopiló información de acuerdo con edad y género del paciente, tipo de fractura, localización y fecha de la intervención. El total de pacientes fue de 262, sumando un total de 302 fracturas. El promedio de edad para datos agrupados fue de 33,7 años (DE 12,1). La relación hombre-mujer fue de 9:1. Del total de intervenciones realizadas (n= 302) un 51.6 por ciento correspondieron a las fracturas cigomático malar, seguida por la de mandíbula 22 por ciento. Este estudio muestra características similares a otros estudios en cuanto a población afectada(AU)

The incidence and prevalence of maxillofacial trauma has been reported in many countries, with differences between the different studies due to sociocultural factors. A cross-sectional study was conducted between 2011 and 2015, with the aim of knowing the epidemiology of maxillofacial fractures. All the patients with fractures who attended the maxillofacial surgery service of the Carlos M. de Céspedes Hospital, who required a surgical reduction, were registered. Information was collected according to the patient's age and gender, type of fracture, location and date of intervention. The total number of patients was 262, totaling 302 fractures. The average age for pooled data was 33.7 years (SD 12.1). The male-female ratio was 9: 1. Of the total number of interventions performed (n = 302), 51.6 percent corresponded to malar zygomatic fractures, followed by mandible 22 percent. This study shows characteristics similar to other studies in terms of affected population(EU)

Tratamiento de fracturas mandibulares / Treatment of mandibular fractures

Las fracturas y secuelas mandibulares son de difícil resolución en el ámbito de la cirugía maxilofacial, sus componentes hacen que su reducción no solo sea anatómica, sino también funcional. El objetivo de este artículo es realizar una revisión de los conocimientos más actuales en el tratamiento de fracturas y secuelas mandibulares y la presentación de un caso de secuela de trauma mandibular. El trata-miento de estas fracturas ha ido cambiando durante los últimos años, sirviéndose de nuevas tecnologías para lograr una mejor reducción a través de elementos de osteosíntesis, que propician abordajes más pequeños y con menor comorbilidad. Así el los nuevos sistemas de placas de titanio como miniplacas, placas de reconstrucción o autobloqueantes brindan excelentes resultados en traumas de alta energía con reducciones anatómicas más estables. La tecnología a través de sistemas de reconstrucción 3D y TAC intraoperatorios han logrado mejores resultados en la resolución de estos traumas.

Treatment of mandibular fractures and their sequelae are difficult to resolve in the maxillofacial surgery field, their components cause that reduction must not only be anatomic, but functional as well. The aim of this article is to present a review about actual knowledge in mandibular fracture treatmentand report a case of mandibular trauma. The treatment of these fractures has been changing through theyears; the new technologies achieve better reduction with the osteosynthesis systems, which results inreduced approaches and lesser morbidity. Presently, titanium plates systems like mini-plates, reconstruction plates or blocking plates offer excellent results in high energy traumas through anatomic and stable reductions. The technology of 3D reconstruction systems and intra-operatory CT accomplishes better results in trauma treatment.

A Review of Hard Palate Fracture Repair Techniques.

PURPOSE: Hard palate trauma is a relatively infrequent occurrence compared with other craniofacial injuries. Several techniques of hard palate fracture repair have been described. To date, there is no consensus on the optimal management of this type of fracture. The purpose of this study was to compile and analyze studies describing hard palate fracture repair techniques with outcomes data. MATERIALS AND METHODS: A systematic review of the Medline, Scopus, and Web of Science databases was performed for articles describing hard palate fracture repair techniques. RESULTS: Eight articles were ultimately included in the review. Of the collective 310 fractures reported, postoperative malocclusion occurred in 21 of 235 cases (8.9%) and other complications occurred in 13 of 299 cases (4.3%). The most important variability in technique was the method of palatal vault stabilization. Three studies described wiring techniques, 3 described internal fixation techniques, and 2 described external fixation techniques. Studies describing internal fixation techniques reported higher rates of wound complications. Proponents of rigid internal fixation believe that this technique provides better fracture reduction. External fixation techniques appear to impart low rates of wound complications, but their overall effectiveness remains in question. CONCLUSIONS: Hard palate fractures are associated with high rates of malocclusion and wound complications. The most established methods of palatal vault stabilization are closed reduction with wiring and internal plate fixation. Depending on the fracture type, patient comorbidities, and associated injuries, either technique might be preferable in a given circumstance.

Application of IMF screws to assist internal rigid fixation of jaw fractures: our experiences of 168 cases.

Intermaxillary fixation (IMF) screws were first introduced to achieve IMF as a kind of bone borne appliance for jaw fractures in 1989. Because this method can overcome many disadvantages associated with tooth borne appliance, IMF screws have been popularly used for jaw fractures since then. From March 2011 to February 2014, we treated 168 cases with single or multiple jaw fractures by open reduction and a total of 705 IMF screws were intraoperatively applied in all the cases to achieve IMF and maintain dental occlusion as an adjuvant to open reduction. The numbers, implantation sites and complications of IMF screws were retrospectively analyzed. In our experience, we found that IMF screws were important to assist open reduction of jaw fractures but their roles should be objectively assessed and the reliability of open reduction and internal rigid fixation must be emphasized. Much attention should be paid when implanting.

Revisão de 150 casos de fratura de mandíbula entre os anos de 2010 e 2013 no Hospital Universitário Cajuru - Curitiba, PR / Review of 150 cases of mandible fracture between 2010 and 2013 at the Cajuru University Hospital, Curitiba, PR

Introdução: As fraturas mandibulares correspondem ao segundo tipo de lesões faciais mais frequentes na maioria dos estudos. Contudo, os dados epidemiológicos desta fratura podem variar conforme o país, o mecanismo de trauma e a época em que foram avaliadas, uma vez que são influenciadas por fatores culturais, tecnológicos, ambientais e socioeconômicos. Consistem em importante fator de custo e morbidade. Delinear o perfil epidemiológico dos casos de fratura de mandíbula tratados no Hospital Universitário Cajuru no período entre 2010 e 2013. Método: Foi realizado um estudo retrospectivo, observacional e descritivo de 236 pacientes internados no Hospital Universitário Cajuru, no período de janeiro de 2010 a julho de 2013, diagnosticados com fratura de mandíbula. Foram incluídos no trabalho apenas os pacientes que apresentavam os prontuários contendo informações completas, totalizando 150 pacientes. Resultados: Dos 150 prontuários analisados, encontrou-se prevalência das fraturas de mandíbula no sexo masculino, média de idade de 29,9 anos. Em relação ao mecanismo de trauma, as mais comuns foram a agressão interpessoal (36,7%), acidentes automobilísticos (36,7%), ferida por arma de fogo (16%). Com relação ao tratamento, o uso de placa e parafuso foi a forma mais realizada (111 pacientes). Conclusões: As fraturas de mandíbula são causadas principalmente por agressão interpessoal, são mais incidentes em homens e jovens. As fraturas múltiplas estão presentes em quase metade dos pacientes. Nas fraturas únicas, a região do côndilo e parassínfise foram, ambas, as mais acometidas. O tratamento cruento foi o mais empregado, sendo a reconstrução com placa de titânio a forma mais comum.

Introduction: Mandible fractures are the second most frequent type of facial injury according to most studies. However, the epidemiological data on mandible fractures may vary between countries, or according to the trauma mechanism and the period of injury evaluation, owing to the influence of cultural, technological, environmental, and socioeconomic factors. This type of trauma comprises an important cost and morbidity factor. The aim of this study was to outline the epidemiological profile of mandible fractures treated at the Cajuru University Hospital from 2010 to 2013. Methods: A retrospective, descriptive, observational study was performed with 236 patients hospitalized in the Cajuru University Hospital, from January 2010 to July 2013, in whom mandible fracture was diagnosed. Only patients with complete records were included in the study, resulting in a total of 150 patients. Results: From the 150 records analyzed, it was found that mandible fractures were more prevalent in males, and the average age of patients was 29.9 years. Concerning the trauma-causing mechanisms, the most common were interpersonal violence (36.7%), traffic accidents (36.7%), and wounds caused by firearms (16%). Plate and screw fixation was the most frequently used treatment (111 patients). Conclusions: Mandible fractures were mainly caused by interpersonal violence, and were more frequent in young males. Multiple fractures were present in almost half of the patients. In single fractures, the condyle and parasymphysis regions were the most affected. Open treatment was most commonly performed, with reconstruction with a titanium plate being the most common approach.