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1.
Braz. j. oral sci ; 20: e211615, jan.-dez. 2021. tab
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1253932

RESUMO

Aim: Maxillofacial fractures occur frequently in the general population, and sports-related fractures represent some of these cases. However, few studies have been carried out in Brazilian populations aimed at sports-related maxillofacial fractures. This study assessed the demographic and fracture characteristics of patients with sports-related maxillofacial fractures who were seen at a Brazilian trauma care center. Methods: Medical records of patients with a history of sports-related maxillofacial fractures treated between January 2018 and December 2019 were retrospectively evaluated. Personal data, fracture characteristics, sport type, treatment performed and need for hospitalization were collected. The data were subjected to statistical analyses with likelihood ratio test using the Statistical Package for Social Sciences (SPSS) 25.0 (p ≤ 0.050). Results: Forty cases (4.96% of the total) of facial fractures were included. The mean age was 24.9 (± 9.8) years, with a predominance of males (92.5%). The use of protective equipment was rare. The most frequently involved sport modality was soccer (47.5%), followed by cycling (27.5%). The most frequent fracture location was nose (45%), followed by mandible (25%) and zygomatic complex (17.5%). Soccer was responsible for most nose fractures (61.1%), while cycling caused the majority of mandibular fractures (60%). Conservative treatment predominated (60%). There was only a significant difference between fracture location and the need for hospitalization (p = 0.021). Conclusion: Patients with sportsrelated maxillofacial fractures were typically young adult males, the injury was more often located in the nose and mandible and related to soccer or cycling. The use of protective equipment must be reinforced


Assuntos
Humanos , Masculino , Feminino , Traumatismos em Atletas , Fraturas Zigomáticas , Fraturas Ósseas , Fraturas Mandibulares , Osso Nasal
2.
Med Eng Phys ; 95: 111-116, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34479687

RESUMO

Osteotomies during rhinoplasty are usually based on the surgeon's proprioception to determine the number and the strength of the impacts. The aim of this study is to determine whether a hammer instrumented with a force sensor can be used to classify fractures and to determine the location of the osteotome tip. Two lateral osteotomies were realized in nine anatomical subjects using an instrumented hammer recording the evolution of the impact force. Two indicators τ and λ were derived from the signal, and video analysis was used to determine whether the osteotome tip was located in nasal or frontal bone as well as the condition of the bone tissue around the osteotome tip. A machine-learning algorithm was used to predict the condition of bone tissue after each impact. The algorithm was able to predict the condition of the bone after the impacts with an accuracy of 83%, 91%, and 93% when considering a tolerance of 0, 1, and 2 impacts, respectively. Moreover, in nasal bone, the values of τ and λ were significantly lower (p < 10-10) and higher (p < 10-4) than in frontal bone, respectively. This study paves the way for the development of the instrumented hammer as a decision support system.


Assuntos
Fraturas Ósseas , Rinoplastia , Humanos , Aprendizado de Máquina , Osso Nasal/cirurgia , Osteotomia
3.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 38(8): 783-786, 2021 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-34365625

RESUMO

OBJECTIVE: To carry out prenatal diagnosis for a fetus with absent nasal bone by using cytogenetic and molecular techniques. METHODS: Chromosomal karyotyping, single nucleotide polymorphism array (SNP-array) and fluorescence in situ hybridization (FISH) assays were applied for the diagnoses. Peripheral blood samples were also taken from the parents for chromosomal karyotyping and FISH analysis. RESULTS: The fetus was found to have a 46,XX,add(21)(p11.2) karyotype, and SNP-array has revealed a 11.3 Mb duplication at 21q22.12q22.3 (hg19: 36 762 648-48 093 361), which was confirmed by FISH. Both parents were found to be normal by chromosomal karyotyping and FISH analysis. The fetus was ultimately found to have a karyotype of 46,XX,der(21)t(21;21)(p11.2;q22.1), resulting a de novo partial trisomy of 21q22.1. CONCLUSION: Combined use of various techniques has enabled accurate prenatal diagnosis and genetic counseling for the fetus.


Assuntos
Osso Nasal , Trissomia , Feminino , Humanos , Hibridização in Situ Fluorescente , Cariotipagem , Gravidez , Diagnóstico Pré-Natal , Trissomia/genética
4.
Biomed Res Int ; 2021: 5599949, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34124250

RESUMO

The growth and development of facial bones are closely related to each other. The present study investigated the differences in the nasomaxillary and mandibular morphology among different skeletal patterns. Cephalograms of 240 participants were divided into 3 groups based on the skeletal pattern (Class I, Class II, and Class III). The dimensions of nasomaxilla (nasal bone length, nasal ridge length, nasal depth, palatal length, and maxillary height) and mandible (condylar length, ramus length, body length, symphysis length, and entire mandibular length) were measured. One-way analysis of variance and Pearson's correlation test were used for statistical analysis. No significant differences were observed among the skeletal patterns in terms of nasal bone length, palatal length, maxillary height, or condylar length. Class II had a significantly shorter ramus, mandibular body, and entire mandibular length compared with those of Class I and Class III. Nasal ridge length exhibited a significant moderate correlated with nasal bone length (correlation coefficient: 0.433) and maxillary height (correlation coefficient: 0.535). The entire mandibular length exhibited a significant moderate correlated with ramus length (correlation coefficient: 0.485) and body length (correlation coefficient: 0.536). In conclusion, nasal and maxillary dimensions exhibited no significant difference among the 3 skeletal patterns. Mandibular body and entire mandibular lengths were significantly positively correlations with Class III skeletal patterns.


Assuntos
Cefalometria , Mandíbula/anatomia & histologia , Maxila/anatomia & histologia , Osso Nasal/anatomia & histologia , Adolescente , Adulto , Feminino , Humanos , Masculino
5.
Proc Inst Mech Eng H ; 235(7): 838-845, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33892610

RESUMO

Osteotomies are common surgical procedures used for instance in rhinoplasty and usually performed using an osteotome impacted by a mallet. Visual control being difficult, osteotomies are often based on the surgeon proprioception to determine the number and energy of each impact. The aim of this study is to determine whether a hammer instrumented with a piezoelectric force sensor can be used to (i) follow the displacement of the osteotome and (ii) determine when the tip of the osteotome arrives in frontal bone, which corresponds to the end of the osteotomy pathway. Seven New Zealand White rabbit heads were collected, and two osteotomies were performed on their left and right nasal bones using the instrumented hammer to record the variation of the force as a function of time during each impact. The second peak time τ was derived from each signal while the displacement of the osteotome tip D was determined using video motion tracking. The results showed a significant correlation between τ and D (ρ2 = 0.74), allowing to estimate the displacement of the osteotome through the measurement of τ. The values of τ measured in the frontal bone were significantly lower than in the nasal bone (p<10-10), which allows to determine the transition between the nasal and frontal bones when τ becomes lower than 0.78 its initial averaged value. Although results should be validated clinically, this technology could be used by surgeons in the future as a decision support system to help assessing the osteotome environment.


Assuntos
Osso Nasal , Rinoplastia , Animais , Modelos Animais de Doenças , Fenômenos Mecânicos , Osso Nasal/cirurgia , Osteotomia , Coelhos
6.
Ann Otol Rhinol Laryngol ; 130(10): 1148-1155, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33641434

RESUMO

OBJECTIVE: To describe the surgical technique of navigation-guided nasal osteotomies and assess feasibility of this technique for treating complex nasal bone deformities in reconstructive rhinoplasty. METHODS: A retrospective chart review was performed in order to identify patients who underwent computer-aided rhinoplasty from August 2014 to February 2017. Inclusion criteria were nasal bone deformities on computed-tomography (CT) that correlated with specific nasal complaints. All patients underwent computer-aided rhinoplasty with navigation-guided nasal osteotomies using a standard navigation system. Osteotomies were performed using real-time visualization on the navigation screen. Additional soft tissue procedures were performed as needed. Medical records were reviewed for presenting symptoms, radiologic and operative findings, and postoperative course. Cosmetic outcomes were subjectively based on patients' standard 6-view photo-documentation from pre- and post-operative timepoints. RESULTS: Twenty-one patients were included in the study; 8 were revision cases and 3 had mild-to-moderate hemifacial microsomia. Fifteen were completely closed procedures. No cases were opened because of inadequate visualization or difficulty accessing bony pathology. Mean (range) follow up was 98.6 (6-559) days. There were no intra-operative complications, unplanned admissions or re-admissions, or iatrogenic cosmetic complications (ie, "inverted V" or "saddle nose" deformities). Two patients required revision. One was after suffering nasal trauma within 4 weeks of initial rhinoplasty. The second underwent further correction of a deformity that required a costochondral graft. Both experienced good final results. CONCLUSIONS: Computer-aided rhinoplasty is safe and feasible for treating complex nasal deformities using standard navigation systems.


Assuntos
Osso Nasal/cirurgia , Doenças Nasais/cirurgia , Osteotomia/métodos , Rinoplastia/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Feminino , Humanos , Masculino , Osso Nasal/diagnóstico por imagem , Doenças Nasais/diagnóstico , Satisfação do Paciente , Projetos Piloto , Adulto Jovem
7.
Cir. plást. ibero-latinoam ; 47(1): 81-86, ene.-mar. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-201911

RESUMO

INTRODUCCIÓN Y OBJETIVO: La fractura de huesos nasales es la fractura facial más frecuente. En relación a la cirugía, la técnica habitualmente empleada ante ella es la reducción cerrada bajo anestesia local o general. Presentamos nuestra experiencia en pacientes intervenidos de fractura de huesos nasales y valoramos el riesgo de reintervención en relación al tipo de técnica anestésica empleada. MATERIAL Y MÉTODO: Recopilamos datos de manera retrospectiva de pacientes intervenidos de reducción cerrada de fractura nasal en nuestro centro entre diciembre de 2014 y junio de 2019. Estudiamos la variable cualitativa analizada (la reintervención) con el test exacto de Fisher y las variables cuantitativas analizadas (días desde el traumatismo hasta cirugía y grados de desviación nasal) con el test U de Mann-Whitney. RESULTADOS: Incluimos 128 pacientes (91 hombres y 37 mujeres). La causa de fractura más frecuente fue la agresión, seguida por el traumatismo por caída y los deportes. Las fracturas por agresión se produjeron con mayor frecuencia los sábados y domingos entre las 3 y las 5 horas de la madrugada. Las fracturas por caída los lunes y martes a la 1 del mediodía. En 99 casos la cirugía se llevó a cabo en las primeras 24 horas, y en 29 pasado ese tiempo. Con respecto a la técnica anestésica, 9 pacientes fueron intervenidos bajo anestesia local, 24 bajo sedación y 95 bajo anestesia general. Tres de los intervenidos con anestesia local y 4 con anestesia general precisaron reintervención por mal resultado tras la primera cirugía. Ninguno de los pacientes intervenidos con sedación fue reintervenido. CONCLUSIONES: En nuestra experiencia, la reducción de la fractura nasal bajo sedación tiene buenos resultados, por lo que consideramos que es una buena alternativa en los casos de fractura nasal quirúrgica para reducir los efectos adversos de la anestesia general


BACKGROUND AND OBJECTIVE: Nasal bone fracture is the most frequent facial fracture. In relation to surgery, the most frequently employed technique is closed reduction under local or under general anesthesia. We present our experience with patients who underwent nasal bone fracture surgery and the risk of reintervention in relation to the type of anesthetic technique used. METHODS: Data were collected retrospectively of patients who underwent closed reduction of nasal fracture in our center between December 2014 and June 2019. Qualitative variable analyzed (reintervention) were studied with Fisher's exact test and the quantitative variables analyzed (days from trauma to surgery and degrees of nasal deviation) with the Mann-Whitney U test. RESULTS: One hundred and twenty-eight patients (91 men and 37 women) were included in the study. The most frequent cause of fracture was aggression, followed by falls and sports. Aggression fractures occurred most frequently on Saturdays and Sundays between 3 and 5 a.m. Fall fractures occurred most frequently on Mondays and Tuesdays at 1 p.m. In 99 cases the surgery was performed in the first 24 hours, while in 29 cases it was performed after that time. Regarding the anesthetic technique, 9 patients were operated under local anesthesia, 24 under sedation and 95 under general anesthesia. Three of the patients operated with local anesthesia and 4 with general anesthesia required reoperation because of poor results after the first surgery. None of the patients operated with sedation were reoperated. CONCLUSIONS: In our experience, nasal fracture reduction under sedation has good results making it a good alternative in cases of surgical nasal fracture reducing the deleterious effects of general anesthesia


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Nariz/cirurgia , Rinoplastia/métodos , Osso Nasal/cirurgia , Redução Fechada/métodos , Traumatismos Faciais/cirurgia , Nariz/lesões , Osso Nasal/lesões , Fraturas Ósseas/cirurgia , Sedação Profunda/métodos , Estudos Retrospectivos , Traumatismos Faciais/etiologia
8.
Ann R Coll Surg Engl ; 103(4): 282-284, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682468

RESUMO

INTRODUCTION: Nasal fracture is a common form of ear, nose and throat (ENT) trauma with prompt referral required for assessment and potentially manipulation of nasal bones. The aetiology of nasal fracture is multifactorial, and injury occurs across all ages. Previous study has suggested a temporal relationship between nasal injury and major sporting events. METHODS: A total of 1966 adult patients with nasal injuries referred to emergency clinics across three London ENT centres between September 2016 and August 2019 were analysed. RESULTS: The majority of those referred were male (66.58%). Mean age at referral was 36.29±18.38 in males and 49.14±21.43 in females; 10.27% were 75 years and over. Incidence was highest during April-September 2018 (p=0.02). Mean incidence was higher in this period in the male 16-35 subgroup (p=0.039), with 53.1% of their injuries concentrated between Friday and Sunday. CONCLUSIONS: Most nasal injuries occurred in young males. Mean age at referral was higher in females, and there was slightly increased incidence in over-75s, predominantly females. This incidence could be due to increased longevity or greater tendency to injury in females of this age. The injury patterns across the week also differed, with males injured proportionately more at the weekend. Nasal injury referrals of young men increased around the 2018 summer period, coinciding with the 2018 FIFA World Cup. This lends support to the association between major sporting events and the incidence of nasal injury, particularly in young males.


Assuntos
Osso Nasal/lesões , Fraturas Cranianas/etiologia , Esportes , Violência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Fraturas Cranianas/epidemiologia , Fatores de Tempo , Adulto Jovem
9.
Ann R Coll Surg Engl ; 103(4): 272-277, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682473

RESUMO

INTRODUCTION: Aesthetic rhinoplasty remains a challenging procedure with high expectations and narrow tolerance for errors. Considerable training is required to achieve controlled and reliable results. Use of the Piezotome is gaining popularity for performing the nasal osteotomies, a key step in rhinoplasty, where it is reported to improve precision and predictability and to keep tissue damage to a minimum. We compare the outcomes of conventional osteotomy techniques to piezosurgery in human cadavers as undertaken by surgical trainees. MATERIALS AND METHODS: Seven human cadavers were used and a total of 14 osteotomies were performed. Conventional osteotomies and piezosurgery were carried out each on one side of the cadaver. A number of fragments and a blinded assessment of the accuracy of the osteotomy compared with the preprocedure skin markings were carried out by two experienced rhinoplasty surgeons. The Mann-Whitney test for statistical analysis was used. RESULTS: The mean number of fragments was 1.57 in the piezosurgery osteotomy and 2.14 using conventional osteotomies. Four of seven piezosurgery osteotomies achieved an accuracy within 1mm. The conventional osteotomies as performed by the trainees showed a significant mismatch of more than 3mm in three of seven of cases. Accuracy within 1mm was achieved in one of seven cases. DISCUSSION: Piezosurgery offers a safe, reliable and precise method of performing lateral nasal osteotomies. This human cadaver study shows a high accuracy of osteotomy and fewer comminuted fractures using this technique compared with conventional osteotomy techniques.


Assuntos
Osso Nasal/cirurgia , Osteotomia/métodos , Piezocirurgia/métodos , Rinoplastia/métodos , Humanos , Osteotomia/efeitos adversos , Osteotomia/instrumentação , Avaliação de Resultados em Cuidados de Saúde , Piezocirurgia/efeitos adversos , Piezocirurgia/instrumentação , Rinoplastia/efeitos adversos , Rinoplastia/instrumentação
10.
J Clin Ultrasound ; 49(6): 622-624, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33778969

RESUMO

Characteristic phenotypic features of 16p13.3 microduplication include impaired mental development, arthrogryposis-like musculoskeletal anomalies (club-feet, congenital hip dislocation, and camptodactyly of fingers and toes), facial dysmorphology, and at times congenital cardiac disease. Most of the described affected individuals have microduplications involving the CREBBP gene. Findings indicate this gene to be dosage-sensitive and likely involved in the phenotypes of 16p13.3 microduplication syndrome. We describe the incidental finding of 16p13.3 microduplication in a fetus with mid-trimester sonographic examination showing absent nasal bone and transient unilateral hydronephrosis.


Assuntos
Duplicação Cromossômica , Cromossomos Humanos Par 16/genética , Hidronefrose/genética , Osso Nasal/anormalidades , Segundo Trimestre da Gravidez , Feminino , Humanos , Masculino , Fenótipo , Gravidez , Ultrassonografia Pré-Natal
11.
Facial Plast Surg ; 37(1): 45-52, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33715148

RESUMO

Nasal dorsal preservation surgery was described more than 100 years ago, but recently has gained prominence. Our objective is to show the surgical technique, the main indications and counterindications, and the complications. It is a technique that does not cause the detachment of the upper lateral cartilage (ULC) from the nasal septum, and has the main following sequence: preparation of the septum and its resection can be at different levels (high or low, i.e., SPAR [septum pyramidal adjustment and repositioning] A or B); preparation of the pyramid; transversal osteotomy; lateral osteotomy(s); and septopyramidal adjustment. The result is a nose with a lower radix than the original, a deprojection of the nasal dorsum tending to maintain its original shape; an increase in the interalar distance (IAD) and enlargement of the nasal middle ⅓; and loss of projection of the nasal tip and roundness of the nostrils. Thus, the ideal candidate is the one who benefits from such side effects, that is: tension nose, that is, high radix with projected dorsum, projected anterior nasal septal angle (ANSA), narrow middle ⅓, narrow IAD, thin nostrils and straight perpendicular plate of the ethmoid (PPE), and, depending on the characteristics, the deviated nose. The counterindications are low radix, irregularities in the nasal dorsum, ANSA lower than rhinion, and a wide middle ⅓. And the main stigmas are: a nose with a very low radix, middle ⅓ enlarged, residual hump, and saddling of the supratip area. Other issues of this technique are: the shape of the radix; the need or not to remove PPE; wide dorsum; irregular dorsum; ANSA lower than rhinion; weak cartilages; long nasal bone; deviated PPE; and obsessive patient. We conclude that this is a great technique for noses with characteristics suitable to it; care must be taken with the stigmas it can cause.


Assuntos
Rinoplastia , Humanos , Osso Nasal , Cavidade Nasal , Septo Nasal/cirurgia , Nariz/cirurgia , Osteotomia , Rinoplastia/efeitos adversos
12.
Plast Reconstr Surg ; 147(2): 364-369, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565827

RESUMO

BACKGROUND: Rhinoplasty is the cosmetic procedure that is most difficult to master. Anatomical preservation should represent the main goal of rhinoplasty. One emerging tool appears to be erbium:yttrium-aluminum-garnet laser bone and cartilage reshaping. The authors developed a new small laser hand probe to perform what we called laser-assisted rhinoplasty. The authors evaluate the feasibility of the laser-assisted rhinoplasty and the aesthetic and functional result of laser-assisted rhinoplasty compared to classic rhinoplasty. METHODS: A total of 50 patients were enrolled and randomized into two cohorts: the first cohort of patients was submitted to classic rhinoplasty, and the second cohort to laser-assisted rhinoplasty. The laser beam was used to perform both the resection of the crura and the resection of the nasal hump and osteotomies. RESULTS: Laser-assisted rhinoplasty is a safe and reproducible technique. At a clinical assessment, lateral crura reshaping showed a visible step or excessive skin retraction in 12 percent of the classic rhinoplasty population with thick cartilage and/or thin skin, and this was not present in the laser-assisted rhinoplasty population at 12-month follow-up. The patient satisfaction rate was higher in the laser-assisted rhinoplasty population compared with standard open rhinoplasty. The authors also clinically noted a reduction in edema in the immediate postoperative period in the laser-assisted rhinoplasty population and a more rapid complete resolution of the swelling. CONCLUSION: The laser-assisted rhinoplasty technique is feasible and safe and has no major complication, and the aesthetic and functional results can be superimposed onto classic rhinoplasty but with a higher degree of intraoperative precision, higher patient satisfaction, a cleaner field, and less bleeding.


Assuntos
Edema/diagnóstico , Terapia a Laser/métodos , Osteotomia/métodos , Complicações Pós-Operatórias/diagnóstico , Rinoplastia/métodos , Adolescente , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Edema/etiologia , Estética , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Terapia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Osso Nasal/cirurgia , Cartilagens Nasais/cirurgia , Osteotomia/efeitos adversos , Osteotomia/instrumentação , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Rinoplastia/efeitos adversos , Rinoplastia/instrumentação , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
13.
Oral Maxillofac Surg ; 25(3): 389-393, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33415687

RESUMO

PURPOSE: The primary objective of this study is to delineate the data on maxillofacial trauma in rugby utilizing the National Electronic Injury Surveillance System (NEISS) database. Specifically, we want to establish the prevalence of facial rugby injuries in terms of age, mechanism of injury, and degree of injury in order to develop ways to limit facial trauma in the future. METHODS: The NEISS database was accessed in February 2020 in order to identify adult patients (> 19 years of age) presenting to the emergence department (ED) for rugby-related head and facial injuries from the previous 10 years (2009-2018). Descriptive statistics were organized and presented. Chi-squared testing (χ2) was performed to compare categorical variables, and ANOVA was performed to compare continuous variables. RESULTS: A total of 507 patients (national estimate = 18,952) from 2009 to 2018 were identified as appropriate for study inclusion. The most common injuries were those to the facial region including the eyelid, eye area, and nose (59.4%). The most frequently encountered facial fracture while playing rugby was the nasal bone (58.6%). Overall, 98.4% of patients who presented to the ED with rugby injuries were treated and released, 1.2% were admitted or observed, and 0.4% left against medical advice. CONCLUSIONS: When evaluating a patient with a rugby-related injury, one should expect injuries to the eyelid, eye area, or nose. The most common fracture pattern will most likely be nasal bone. Despite these injuries, the vast majority of patients will be treated and released.


Assuntos
Traumatismos Faciais , Futebol Americano , Traumatismos Maxilofaciais , Fraturas Cranianas , Adulto , Serviço Hospitalar de Emergência , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/etiologia , Humanos , Traumatismos Maxilofaciais/epidemiologia , Osso Nasal
14.
Rev Col Bras Cir ; 48: e20202581, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470368

RESUMO

Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.


Assuntos
Ossos Faciais/lesões , Fixação Interna de Fraturas , Fraturas Mandibulares/cirurgia , Fraturas Maxilares/cirurgia , Osso Nasal/cirurgia , Fraturas Orbitárias/cirurgia , Fraturas Cranianas/cirurgia , Fraturas Zigomáticas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Ossos Faciais/cirurgia , Feminino , Humanos , Masculino , Fraturas Mandibulares/epidemiologia , Fraturas Mandibulares/etiologia , Fraturas Maxilares/epidemiologia , Fraturas Maxilares/etiologia , Pessoa de Meia-Idade , Osso Nasal/lesões , Fraturas Orbitárias/epidemiologia , Fraturas Orbitárias/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fraturas Cranianas/epidemiologia , Fraturas Cranianas/etiologia , Análise de Sobrevida , Adulto Jovem , Fraturas Zigomáticas/epidemiologia , Fraturas Zigomáticas/etiologia
15.
J Craniofac Surg ; 32(1): e103-e106, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32675761

RESUMO

ABSTRACT: In addition to precautions taken with perioperative surgical techniques, nasal packing and external nasal splinting are frequently employed to ensure the stability of the nasal bones following osteotomies performed during rhinoplasty. However, despite these precautions, nasal bone fragments, generally caused by trauma or healing problems, can approach the midline, progress in a posterior direction and heal with malunion in an infractured manner. Since cavities on the infractured side can result in asymmetries and/or airway narrowing, revision osteotomy is required to correct these problems. Subsequent potential recurrent infractures caused by nasal fragments can easily be prevented with late-absorbed sutures passing through the neighboring holes and opening near the osteotomy lines. This technique would be useful for both primary and secondary rhinoplasty, but especially in secondary rhinoplasty operations. (Level of Evidence: Level IV).


Assuntos
Rinoplastia , Humanos , Osso Nasal/cirurgia , Nariz , Osteotomia , Polidioxanona/química , Suturas
16.
Laryngoscope ; 131(6): 1398-1403, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33009831

RESUMO

OBJECTIVES/HYPOTHESIS: The aims of this study were to evaluate the diagnostic test features of bedside ultrasonography in pediatric patients with nasal trauma and to investigate whether it is a preferable alternative method to conventional radiography (CR). STUDY DESIGN: Cross-sectional prospective study. METHODS: This prospective study was conducted from March 1, 2019, through November 1, 2019. Thirty-one patients under the age of 18 years who had nasal trauma were consecutively included. CR and ultrasonographic imaging tests were investigated in patients with clinical indications for nasal bone fracture. The sensitivity, specificity, and accuracy of ultrasonography and CR were calculated with respect to detecting nasal fractures according to the gold standard method. RESULTS: Participants were between 3 and 16 years old and the median age was 8 (5-13) years. Nasal bone fracture was clinically detected in 18 patients. While 13 of these fractures were detected with ultrasonography, only 11 were also detected with CR. The sensitivity and specificity of ultrasonography and CR in detecting nasal fractures were 72.2% (95% confidence interval [CI]: 46.5-90.3) and 76.9% (95% CI: 46.2-95.0) for ultrasonography and 61.1% (95% CI: 35.8-82.7) and 69.2% (95% CI: 38.6-90.9) for CR. CONCLUSIONS: According to the results of this study, ultrasonography may be used with confidence as a first imaging method in the investigation of nasal fractures, particularly with consideration for avoiding the effects of radiation as much as possible. Our findings point to the next step of conducting trials with a greater number of patients in order to define the diagnostic test features of ultrasonography in pediatric patients. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:1398-1403, 2021.


Assuntos
Osso Nasal/diagnóstico por imagem , Osso Nasal/lesões , Sistemas Automatizados de Assistência Junto ao Leito , Fraturas Cranianas/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Estudos Prospectivos , Radiografia/métodos , Sensibilidade e Especificidade
17.
Aesthetic Plast Surg ; 45(3): 1140-1149, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33098046

RESUMO

BACKGROUND: Rhinoplasty is one of the most widely conducted and challenging types of aesthetic surgical operations, and dorsal hump reduction is a commonly performed aesthetic surgery among Caucasian patients. Dorsal hump resection is traditionally conducted by removing the dorsal nasal bone and cartilage. The push-down and let-down techniques are used for dorsal preservation in dorsal hump reduction operations. Different patients require different approaches to achieve the best results in terms of aesthetic appearance and functionality. OBJECTIVES: In the present research, the author describes two novel approaches that combine the push-down and let-down techniques for appropriate patients. METHODS: The records of 45 patients (40 females and 5 males) were assessed, and those who were eligible for the present approaches were included. The author defined two approaches in which the push-down and let-down techniques were used simultaneously (mix-down methods). All patients included in the study completed the Rhinoplasty Outcome Evaluation (ROE) questionnaire before surgery and at their one-year follow-up appointment. RESULTS: The median ROE scores were 60.1 points before surgery and 92.2 points one year after surgery; this difference was statistically significant (p<0.001). CONCLUSIONS: The present study is the first to demonstrate the beneficial effects of combining the push-down and let-down techniques in a selected patient population. These new approaches will improve both cosmetic and functional outcomes and allow surgeons to choose the best option for patients who are eligible for these mix-down approaches. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Rinoplastia , Estética , Feminino , Humanos , Masculino , Osso Nasal , Resultado do Tratamento
18.
Orthod Craniofac Res ; 24 Suppl 1: 5-12, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33237624

RESUMO

OBJECTIVES: Greater advancement of the maxilla can be achieved with skeletal-anchored facemasks (SAFM) using miniplates than with conventional tooth-borne facemasks (TBFM). The purpose of this study was to compare the effects of TBFM and SAFM on midfacial soft tissue and nasal bone up to two years after treatment. SETTINGS AND SAMPLE POPULATION: Sixty-seven growing patients with Class III malocclusions were treated with facemasks. They were divided into a SAFM group with 31 subjects (average age 11.1 years) and a TBFM group with 36 subjects (average age 11.0 years). MATERIALS AND METHODS: Cephalometric analysis was conducted using linear and angular midfacial measurements. Lateral cephalograms were taken initially (T0), after treatment (T1) and at two years post-treatment (T2). Significance was assessed between the two groups. RESULTS: Comparing changes in the midfacial area between the SAFM and TBFM groups during the traction period (T0-T1), angular measurements such as SNOr (1.34°), nasolabial angle (4.20°), nasal angles 1 and 2 (1.23°, 2.14°) and linear measurements such as Prn, Sn, A' distance (approximately 2 mm) increased significantly more in the SAFM group. Over the entire treatment period (T0-T2), the changes in SNOr (1.33°), nasolabial angle (6.54°), nasal angles 1 and 2 (1.45°, 2.99°) and Prn, Sn, A' distance (approximately 2 mm) remained significant (P < .05). CONCLUSIONS: In the treatment of growing patients with Class III malocclusions with maxillary deficiency, it was possible to achieve significantly greater advancement in the midfacial area with SAFM treatment than with TBFM treatment. This significant difference was well maintained at two years post-treatment.


Assuntos
Má Oclusão Classe III de Angle , Procedimentos de Ancoragem Ortodôntica , Cefalometria , Criança , Aparelhos de Tração Extrabucal , Humanos , Má Oclusão Classe III de Angle/diagnóstico por imagem , Má Oclusão Classe III de Angle/terapia , Máscaras , Maxila/diagnóstico por imagem , Osso Nasal/diagnóstico por imagem , Técnica de Expansão Palatina
19.
J Clin Ultrasound ; 49(1): 3-7, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32521052

RESUMO

PURPOSE: To evaluate the outcomes of fetuses diagnosed with absent nasal bone in the second trimester. METHODS: This prospective, observational study included all fetuses who were diagnosed at or referred to our fetal medicine center with an absent nasal bone from 16 weeks onwards from November 2017 to December 2019. Amniocentesis for fetal karyotype and microarray was offered to all women. Women who opted not to undergo invasive testing were also followed up and neonatal outcome noted. RESULTS: 26 fetuses were eligible for inclusion in the study. 8 (30.8%) out of these were diagnosed with aneuploidy: 7 with trisomy 21 and one with trisomy 18. All fetuses with aneuploidy had additional ultrasound abnormality and/or high risk on biochemical screening. CONCLUSIONS: Isolated absent nasal bone in the second trimester with prior low risk on combined screening performed by certified sonographers is unlikely to be associated with Down syndrome.


Assuntos
Síndrome de Down/diagnóstico , Osso Nasal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Amniocentese , Aneuploidia , Feminino , Humanos , Cariotipagem , Osso Nasal/anormalidades , Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos
20.
J Oral Maxillofac Surg ; 79(4): 894.e1-894.e5, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33359106

RESUMO

PURPOSE: Nasal bone fracture is a common maxillofacial injury, which is usually managed under local anesthesia because it is fast and effective but painful. We designed this study to see if pre-emptive analgesia with acetaminophen can reduce the pain associated with nasal bone reduction under local anesthesia. PATIENTS AND METHODS: This was a triple-blind, randomized clinical trial. Our sample was patients with nose fracture (eligible for closed reduction) who presented to our nasal fracture clinic and they were divided into 2 arms. Medication was randomly delivered via packages, and the surgeon, patients, and data analyzer were all blind to the intervention. Demographic data along with the visual analog scale pain scores (1 to 10 score from least to most severe pain) during local anesthesia, during reduction, and 24 hours after reduction were recorded, then analyzed using χ2, nonparametric Mann-Whitney test, and correlation analysis. RESULTS: One hundred participants were divided into 2 arms (placebo or acetaminophen 500-mg tablet 45 minutes before reduction). The patients were mostly men (74%), and the most common mechanism was involvement in a fight (30%). Pain scores, as well as surgeon satisfaction analysis, returned no statistical difference between the 2 groups. Correlation analysis was performed, and the only factor for pain severity during reduction was the number of tries needed. CONCLUSIONS: Acetaminophen pretreatment did not add analgesia any more than that of placebo. Its use before reduction of nasal bone fracture is not justified.


Assuntos
Analgesia , Analgésicos não Narcóticos , Acetaminofen/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Método Duplo-Cego , Humanos , Masculino , Osso Nasal , Dor Pós-Operatória
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