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1.
Rev Med Suisse ; 16(699): 1281-1286, 2020 Jul 01.
Artigo em Francês | MEDLINE | ID: mdl-32608584

RESUMO

Orbital fractures are frequent and can result in severe complications (visual impairment, diplopia and enophthalmos). Their management is challenging and remains controversial. Whereas immediate surgery is clearly indicated in children with trapdoor fractures associated with annoying diplopia and observational management is indicated in cases with no diplopia, a grey zone of therapy decisions concern a significant portion of cases. Surgical repair is not trivial and can be plagued by severe complications such as visual impairment, globe misplacement and diplopia. Thus, the final decision should be based on a meticulous analysis of clinical and imaging findings and a wise assessment of the risks and benefits of either therapeutic alternative.


Assuntos
Fraturas Orbitárias/diagnóstico , Fraturas Orbitárias/cirurgia , Diplopia/etiologia , Enoftalmia/etiologia , Humanos
2.
Chin J Dent Res ; 23(1): 51-55, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32232229

RESUMO

Orbital fracture and orbital floor reconstruction surgery is characterised by limited surgical exposure and high risks. Before the advent of digital technology, the design and implementation of the surgical scheme for orbital floor reconstruction surgery mainly depended on the intuitive understanding of imaging and the clinical experience of surgeons, with strong unpredictability and experience dependence. Surgical navigation systems with real-time positioning and imaging functions, when used in orbital reconstruction surgery, can detect the real-time intraoperative position, avoid risks, and assist in locating the reconstruction position to ensure the accuracy of orbital reconstruction, with the help of a preoperative surgical plan. Many studies have confirmed its effect. Unilateral orbital fracture and orbital floor reconstruction surgery is one of the earliest and most widely used surgical techniques in maxillofacial surgery. Experts from the Society of Oral and Maxillofacial Surgery, Chinese Stomatological Association have fully discussed and formulated this expert consensus on navigation-guided unilateral orbital fracture and orbital floor reconstruction techniques to standardise the clinical surgical procedures and promote its application.


Assuntos
Fraturas Orbitárias , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Assistida por Computador , Consenso , Humanos , Órbita
3.
Plast Reconstr Surg ; 145(4): 1001-1008, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221221

RESUMO

BACKGROUND: Nasoorbitoethmoid fractures commonly accompany midface fractures and may be underdiagnosed, resulting in incomplete reconstruction or inadequate treatment following facial trauma. To better understand the nasoorbitoethmoid fracture diagnosis and treatment tendencies, the authors analyzed concomitant nasoorbitoethmoid injuries in the setting of zygoma fractures. METHODS: The facial trauma database at a level I trauma center was evaluated. All patients with diagnosed zygoma fractures from June of 2011 to March of 2016 were assessed for a concomitant nasoorbitoethmoid injury. Documentation of these fractures in radiology, plastic surgery, and operative notes was recorded, as was the rate of nasoorbitoethmoid fracture surgical repair. RESULTS: The authors identified 339 eligible patients and completed retrospective analysis of computed tomographic images for their 356 zygoma fractures. The incidence of concomitant nasoorbitoethmoid fractures was 30.6 percent (109 of 356). Documentation rates of nasoorbitoethmoid fractures were 0 percent, 3.7 percent, and 8.3 percent in radiology, plastic surgery, and operative notes, respectively. The rate of surgical correction of nasoorbitoethmoid injuries was 22.9 percent (25 of 109). Of those fractures identified, 44.9 percent (49 of 109) were minimally displaced or nondisplaced. Subset analysis of only significantly displaced fractures yielded an incidence of 16.8 percent (60 of 356). Of significantly displaced fractures, documentation rates were 0 percent, 6.7 percent, and 16.8 percent in radiology, plastic surgery, and operative notes, respectively. The surgical repair rate of significantly displaced fractures was 31.7 percent (19 of 60). CONCLUSIONS: These findings suggest a high concomitance rate of nasoorbitoethmoid fractures with zygoma fractures and identify a tendency to underdocument and undertreat this injury pattern. Clinicians managing patients with midface trauma should have a high suspicion for nasoorbitoethmoid trauma. Plastic surgeons and radiologists should be better trained in identifying the nasoorbitoethmoid fracture pattern.


Assuntos
Fraturas Cranianas/diagnóstico , Zigoma/lesões , Adulto , Idoso , Diagnóstico Tardio , Osso Etmoide/lesões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osso Nasal/lesões , Osso Nasal/cirurgia , Fraturas Orbitárias/diagnóstico , Fraturas Orbitárias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Fraturas Cranianas/cirurgia , Adulto Jovem , Zigoma/cirurgia , Fraturas Zigomáticas/diagnóstico , Fraturas Zigomáticas/cirurgia
4.
J Craniofac Surg ; 31(3): e263-e266, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049903

RESUMO

BACKGROUND: Treatment of isolated blow-in orbital roof fractures is still debated due to their anatomical complexity and the potential ocular and neurological related injuries. Surgery is advised in symptomatic cases while there is still controversy regarding the preferred treatment for those patients asymptomatic. OBJECTIVE: To explore the suitability of a conservative management with close imaging follow-up in asymptomatic isolated blow-in orbital roof fractures. METHODS: A single-case experience has been integrated into a systematic review of the literature to support the discussion on this specific traumatic lesion. Studies written in English and pertaining adult human subjects were further filtered according to the following eligibility criteria: clear definition of fracture's pattern, absence of concomitant cranio-facial injuries requiring management, proper description of treatment timing and outcome. RESULTS: The literature regarding treatment of isolated orbital roof fractures is of poor quality partly due to the rarity of such lesions. A total of 4 studies limited to small case series with 13 patients in total discuss thoroughly management options and timing of treatment. In particular, displaced blow-in fractures were treated conservatively in 4 patients with only 2 benefitting from this approach. Our patient showed a spontaneous realignment of a posttraumatic blow-in orbital roof deformity and at 12-month follow-up conservative management appeared a safe and effective strategy. A short-term wait-and-see approach with aggressive follow-up imaging could probably represent a reasonable option for treatment of isolated blow-in orbital roof fractures without neurological or ocular symptoms. Since literature remains confined to limited case series, future multicenter studies adopting shared evaluation parameters would help in standardizing the indications for this subset of craniofacial injuries.


Assuntos
Traumatismos Faciais/diagnóstico por imagem , Fraturas Orbitárias/diagnóstico por imagem , Adulto , Tratamento Conservador , Traumatismos Faciais/cirurgia , Humanos , Masculino , Fraturas Orbitárias/cirurgia , Tomografia Computadorizada por Raios X
6.
J Craniofac Surg ; 31(2): 420-422, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32028360

RESUMO

OBJECTIVE: To investigate the occasion, method and effectiveness of the diplopic correction after the orbital fracture repair in Chinese patients with orbital fracture. METHODS: This was a retrospective observational study of 64 patients with remanent diplopia after the reconstructions of orbital fracture were studied between January 2014 and June 2017. The different cause, operational occasions, and surgical techniques analyzed. All patients were followed for 6 months after the surgeries. RESULTS: After treatment, 64 patients with III degree diplopia were all performed the operations on extraocular muscles. Different operation was selected to different patients according to the examinational results of the extraocular muscles and passive drawer test, including rectos retropulsion, suspension, excise, Jensen's connection, and fixation to periorbital membrane. During the surgery, 25 patients had no diplopia in mainly functional visual fields, while 15 patients still had III degree diplopia. After 6 months, 27 patients had no diplopia in mainly functional visual fields, while 13 patients still had II degree diplopia. Among these 13 patients with III degree diplopia, 7 patients had no the diplopia of primary position of eye, and 6 patients had the diplopia of primary position. These 6 patients were suggested to wear the triangular prisms for improvement of the diplopia. CONCLUSION: The operations should be selected according to the examining results about eye movements and diplopia before and during the surgeries. Reasonable operations could correct diplopia and improve the eye movements effectually.


Assuntos
Diplopia/etiologia , Fraturas Orbitárias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Movimentos Oculares , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
J Korean Med Sci ; 35(7): e57, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32080989

RESUMO

BACKGROUND: The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA. METHODS: We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software. RESULTS: The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011. CONCLUSION: We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.


Assuntos
Big Data , Ossos Faciais , Traumatismos Faciais , Fraturas Mandibulares , Fraturas Orbitárias , Interpretação Estatística de Dados , Ossos Faciais/lesões , Traumatismos Faciais/epidemiologia , Humanos , Fraturas Mandibulares/epidemiologia , Fraturas Orbitárias/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos
9.
J Craniofac Surg ; 31(3): e247-e248, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977691

RESUMO

A study of a 22-year-old male who was assaulted and sustained a left orbital floor blowout fracture was presented in this study. The orbital floor was repaired with a titanium-reinforced porous polyethylene implant. Two years postoperatively, the patient sustained repeated left orbital trauma. The orbital floor implant remained stable while the medial wall blew out.


Assuntos
Traumatismos Oculares/diagnóstico por imagem , Fraturas Orbitárias/diagnóstico por imagem , Humanos , Masculino , Fraturas Orbitárias/cirurgia , Polietileno , Porosidade , Recidiva , Titânio , Adulto Jovem
11.
J Craniofac Surg ; 31(1): e82-e84, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31634313

RESUMO

A 76-year-old man presented with 1 day history of eyelid swelling and decreased vision on the left side. History reveals nose blowing the night prior to the occurrence of the symptoms. Initial examination of the left eye showed decreased visual acuity, increased intraocular pressure, and limited ocular motility with presence of air bubbles under the bulbar conjunctiva. Imaging studies showed medial orbital wall fracture with severe emphysema. The patient was observed for a week and no active surgical intervention was performed. Thereafter, spontaneous resolution of symptoms was observed. Eyelid swelling, dramatic improvement in visual acuity, intraocular pressure, and extraocular movements were noted.


Assuntos
Nariz , Fraturas Orbitárias/cirurgia , Enfisema Subcutâneo/cirurgia , Idoso , Humanos , Masculino , Muco , Fraturas Orbitárias/diagnóstico por imagem , Fraturas Orbitárias/etiologia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Transtornos da Visão/etiologia , Acuidade Visual
12.
Int J Oral Maxillofac Surg ; 49(5): 678-685, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31587822

RESUMO

In orbital reconstruction, the acquired position of an orbital implant can be evaluated with the aid of intraoperative navigation. Feedback of the navigation system is only obtained after positioning of the implant: the implant's position is not tracked in real time during positioning. The surgeon has to interpret the navigation feedback and translate it to desired adjustments of the implant's position. In a previous study, a real-time implant-oriented navigation approach was introduced and the system's accuracy was evaluated. In this study, this real-time navigation approach was compared to a marker-based navigation approach in a preclinical set-up. Ten cadavers (20 orbital defects) were reconstructed twice, by two surgeons (total: 80 reconstructions). Implant positioning was significantly improved in the real-time implant-oriented approach in terms of roll (2.0° vs. 3.2°, P=0.03), yaw (2.2° vs. 3.4°, P=0.01) and translation (1.3mm vs. 1.8mm, P=0.005). Duration of the real-time navigation procedure was reduced (median 4.5 min vs. 7.5 min). Subjective appreciation of the navigation technique was higher for real-time implant-oriented navigation (mean 7.5 vs. 9.0). Real-time implant-oriented navigation feedback provides real-time, intuitive feedback to the surgeon, which leads to improved implant positioning and shortens duration of the navigation procedure.


Assuntos
Implantes Dentários , Fraturas Orbitárias , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Assistida por Computador , Cadáver , Humanos
13.
Int J Oral Maxillofac Surg ; 49(4): 483-490, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31402077

RESUMO

The aim of this study was to examine the accuracy of three dimensionally (3D) printed models of the bony orbit derived from magnetic resonance imaging (MRI) for the purpose of preoperative plate bending in the setting of orbital blowout fracture. Retrospective computed tomography (CT) and MRI data from patients with suspected orbital fractures were used. Virtual models were manually generated and analysed for spatial accuracy of the fracture margins. 3D-printed models were produced and orbital fan plates bent by a single operator. The plates were then digitized and analysed for spatial discrepancy using reverse engineering software. Seven orbital blowout fractures were evident in six orbits. Analysis of the virtual models revealed high congruence between blowout fracture margins on CT and MRI (n=7, average deviation 0.85mm). Three zygomaticomaxillary complex fractures were seen, for which MRI did not demonstrate the same accuracy. For plates bent to the 3D-printed models of blowout fractures (n=6), no significant difference was found between those bent to CT versus those bent to MRI when compared for average surface and average border deviation (Wilcoxon signed rank test). Orbital blowout fractures can be defined on MRI with clinically acceptable accuracy. 3D printing of orbital biomodels from MRI for bending reconstructive plates is an acceptable and accurate technique.


Assuntos
Órbita , Fraturas Orbitárias , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Impressão Tridimensional , Estudos Retrospectivos
14.
J Craniofac Surg ; 31(1): 204-206, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31369502

RESUMO

PURPOSE: We employed intraoperative tarsorrhaphy depending on the degree of edema to treat moderate conjunctival chemosis during orbital fracture repair surgery. METHODS: This is a retrospective case review of 1367 patients (1384 eyes) who underwent orbital fracture repair surgery by a transconjunctival approach. All cases of moderate conjunctival chemosis during surgery were included and were divided into 2 groups. In one group, intraoperative tarsorrhaphy was performed immediately the chemosis reached a moderate degree and the conjunctiva was incarcerated by the lower eyelid margin; once severe chemosis developed, stitches were added to cover all of the prolapsed conjunctiva with a palpebral margin. In the second group, moderate chemosis was treated with bandage pressure without stitches even after appearance of severe chemosis. The time course of conjunctival edema was recorded. RESULTS: The incidence of moderate conjunctival chemosis in orbital reconstruction surgery by the transconjunctival approach was 9.4%. The average time for resolution of moderate chemosis in the tarsorrhaphy group (3.5 ±â€Š1.4 days) was obviously shorter than in the bandage group (6.2 ±â€Š1.9 days). The incidence of severe chemosis in the intraoperative tarsorrhaphy group (14.1%) was significantly lower than in the bandage group (31.8%). Overall, the total duration of severe chemosis in the tarsorrhaphy group was obviously shorter than that of the bandage group. CONCLUSION: Intraoperative tarsorrhaphy was a highly effective method of treating moderate chemosis and preventing severe conjunctival chemosis during orbital fracture repair surgery.


Assuntos
Doenças da Túnica Conjuntiva/cirurgia , Pálpebras/cirurgia , Fraturas Orbitárias/cirurgia , Adolescente , Adulto , Doenças da Túnica Conjuntiva/etiologia , Edema/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos , Fraturas Orbitárias/complicações , Estudos Retrospectivos , Suturas , Adulto Jovem
15.
Ann Otol Rhinol Laryngol ; 129(5): 456-461, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31833378

RESUMO

OBJECTIVE: Options for the management of orbital floor fractures continue to evolve offering both potential advantages as well as higher costs. To date, the effect of implant choice on the cost associated with the repair of orbital floor fractures has not been studied. METHODS: A retrospective review at a tertiary care, level I trauma center examining all adult, uncomplicated orbital floor fractures that underwent open reduction and internal fixation from 2013 to 2016. Patients with concurrent operative facial fractures were excluded. The main outcomes were overall cost of care from injury to last follow-up and operating room-related costs. Costs were determined using computerized records of charges as well as the hospital Charge Description Master. Kruksal-Wallis rank sum tests were used to analyze for differences between groups. RESULTS: Twenty-eight patients fulfilled the inclusion criteria. Eight different stock, non-patient specific, implants were used for repair. The cost of individual types of implants ranged from $70.25 to $7 718.00. Total cost of care per patient across all implant types averaged $35 585.57 (range $25 586.26 to $49 985.74, P = .34). Operation-related charges accounted for the vast majority (94.4%) of the total cost of care. One complication occurred requiring operative re-positioning of the implant with an additional $13 042.41 in charges. CONCLUSIONS: In the setting of uncomplicated orbital floor fractures, surgeons should select an implant that allows them to carry out the repair in a safe, timely fashion. Additional large-scale studies would help to further delineate cost differences.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Orbitárias/cirurgia , Próteses e Implantes/economia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Custos e Análise de Custo , Feminino , Fixação Interna de Fraturas/economia , Humanos , Masculino , Fraturas Orbitárias/economia , Desenho de Prótese , Procedimentos Cirúrgicos Reconstrutivos/economia , Estudos Retrospectivos
16.
J Craniofac Surg ; 31(2): 400-403, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31842071

RESUMO

Orbital blow out fracture is a common disease in emergency department and a delay or failure in diagnosis can lead to permanent visual changes. This study aims to evaluate the ability of an automatic orbital blowout fractures detection system based on computed tomography (CT) data.Orbital CT scans of adult orbital blowout fractures patients and normal cases were obtained from Shanghai Ninth People's Hospital between January and March 2017. The region of fractures was annotated using 3D Slicer. The Inception V3 convolutional neural networks were constructed utilizing the Python programming language with PyTorch as the framework to extract high dimension features from each slice in a CT scan. These extracted features are processed through a XGBoost model to make the final differentiation of fracture cases and nonfracture ones. Accuracy, receiver operating characteristics, and area under the curve were evaluated.This study used 94 CT scans diagnosed with orbital blowout fractures and 94 healthy control cases. The automatic detection system showed accuracy of 92% in single-image classification and 87% in patient level detection. The area under the receiver operating characteristic curve was 0.9574.Using a deep learning-based automatic detection system of orbital blowout fracture can accurately detect and classify orbital blowout fractures from CT scans. The convolutional neural networks model combined with an accurate annotation system could achieve good performance in a small dataset. Further studies with large and multicenter data are required to refine this technology for possible clinical applications.


Assuntos
Rede Nervosa , Fraturas Orbitárias/diagnóstico por imagem , Adulto , Humanos , Tomografia Computadorizada por Raios X
17.
J Craniomaxillofac Surg ; 47(12): 1943-1951, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812308

RESUMO

BACKGROUND: Performing accurate anatomical reconstruction is a challenging task in the treatment of internal orbital floor fractures. Compared with traditional transcutaneous incisions, endoscopic transmaxillary approaches have the advantage of avoiding complications related to external scars, and provide direct access to the orbital floor. Autogenous bone provides the ideal material for defect reconstruction, but determination of the correct size and shape of the graft is crucial for a stable support. This study introduces a new protocol for the treatment of internal orbital floor fractures that combines endoscopy, virtual reality, and 3D printing. The authors also investigated the impact of computer-aided surgery (CAS) on the overall accuracy of reconstruction in aiming to achieve the triple objective of restoring anatomy, volume, and function. MATERIALS AND METHODS: Fourteen patients with orbital floor fractures were recruited for this study. High-resolution CT scans provided appropriate imaging for detailed orbital floor defect visualization. A virtual reconstruction of the orbital floor defect was developed and a 3D printed template was fabricated to provide intraoperative guidance in the graft harvesting phase, according to the orbital defect. Virtual analyses were conducted to evaluate the accuracy of reconstruction both in terms of graft size and graft orientation. RESULTS: Postoperative CT scans showed that in all cases orbital floor reconstruction was successfully performed, resulting in restoration of the correct globe position. No intraoperative complications occurred. Correspondence of graft size was evaluated using color-coded maps and RMSE, while comparison of angular measurements allowed the authors to relate simulated and actual reconstruction. CONCLUSIONS: Orbital floor reconstruction performed via transmaxillary endoscopy is a safe technique, which allows for detailed visualization of the fracture rim, avoids external scars, and permits an easier reduction of the prolapsed orbital content into the overlying orbital cavity. Virtual planning plays an important role in defining the appropriate geometry of the bone graft and establishing the optimal reconstruction strategy. Our preliminary results indicate that virtual planning and 3D printing should become part of an integrated protocol for the endoscopic treatment of orbital floor fractures.


Assuntos
Endoscopia/métodos , Órbita/diagnóstico por imagem , Fraturas Orbitárias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cirurgia Assistida por Computador , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Orbitárias/diagnóstico por imagem , Impressão Tridimensional , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
20.
Br J Oral Maxillofac Surg ; 57(10): 1126-1130, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31708223

RESUMO

The aim of this study was to examine the pattern of equine-related maxillofacial trauma that required operative treatment in patients who presented to a level-one trauma centre in Melbourne between 2011 and 2016. A total of 28 patients (16 female and 12 male, median (range) age 31 (16-76) years) were identified from a database of all operatively managed maxillofacial trauma cases, and data were collected on demographics, mechanisms and patterns of injury, and management. The most common mechanism was kicking (n=16), which was also the most likely to result in multiple injuries. Half the patients sustained an injury to the midface only, with naso-orbitoethmoidal (NOE) and orbital fractures being the most common fractures. Of the total fractures (those that did and did not require an operation), 44/54 were managed with internal fixation. Exactly half the patients were treated as inpatients and half as outpatients, and despite a longer total duration of hospital stay for inpatients, the postoperative period was the same in both. Many horse-related maxillofacial injuries were sustained by young women, and the midface was most commonly affected. More injuries overall were sustained while unmounted (particularly by kicks) than by falls.


Assuntos
Cavalos , Traumatismos Maxilofaciais , Traumatismo Múltiplo , Fraturas Orbitárias , Fraturas Cranianas , Adolescente , Adulto , Idoso , Animais , Feminino , Humanos , Masculino , Traumatismos Maxilofaciais/etiologia , Pessoa de Meia-Idade , Fraturas Orbitárias/etiologia , Estudos Retrospectivos , Fraturas Cranianas/etiologia , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
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