RESUMEN
AIM: This study evaluated records of patients with maxillofacial trauma due to interpersonal violence (IPV) being treated in the emergency room of a level I trauma center hospital in São Paulo, Brazil. MATERIAL AND METHODS: Data of patients with maxillofacial trauma due to IPV recorded between January 2019 and December 2019 were retrospectively examined. Personal data, days on which they experienced IPV, and the type of maxillofacial trauma sustained were extracted and statistically analyzed (p < .050). RESULTS: During the analysis, 1034 patients with maxillofacial trauma were identified; of these patients, 292 (28.2%) who experienced trauma due to IPV were included in this study. There was a mean age of 32.6 years and the most common type of trauma was soft tissue injuries (38.7%). Mandible and nose fractures were more prevalent in males and females, respectively. Our data, when compared with other studies on maxillofacial trauma due to IPV, showed a lower prevalence and male-to-female ratio, and a higher presence of dentoalveolar trauma. Additionally, our data when compared with studies on maxillofacial trauma due to other causes showed lower mean age and male-to-female ratios, and a higher occurrence of nose fractures differing from the predominance of mandibular fractures. CONCLUSION: Oral and maxillofacial surgeons must be able to suspect and identify cases due to IPV among their patients with trauma. With our results, although each case has its individuality, we can suggest that cases of maxillofacial trauma in young, female, and nasal fracture patients may be suspicious for IPV.
Asunto(s)
Fracturas Mandibulares , Traumatismos Maxilofaciales , Fracturas Craneales , Humanos , Masculino , Femenino , Adulto , Estudios Retrospectivos , Violencia , Brasil/epidemiología , Traumatismos Maxilofaciales/epidemiología , Traumatismos Maxilofaciales/etiología , Fracturas Craneales/epidemiología , Fracturas Craneales/etiología , Fracturas Mandibulares/etiología , Fracturas Mandibulares/complicaciones , Servicio de Urgencia en Hospital , Accidentes de TránsitoRESUMEN
Due to the anatomical proximity between the skull and the face, maxillofacial trauma can often cause injuries to cranial structures. Among these complications are carotid-cavernous fistulas (CCF), which are rare in maxillofacial trauma, although their etiology is usually traumatic. They are described as an atypical communication between the internal carotid artery and the cavernous sinus, which can generate a sudden change in the direction and distribution of blood flow between the brain and orbit. This paper aims to report a case of craniomaxillofacial trauma in which the patient evolved with diplopia, palpebral ptosis, and ophthalmoplegia of the left eye, diagnosed as traumatic CCF. The oral and maxillofacial surgery and traumatology team of the University Hospital of Western Paraná was observed these symptoms for the first time during post-operative follow-up after one day of surgery to repair mandibular fractures of the patient in question. With the identifying the signs and symptoms, a neurosurgery was requested for assessment and management. After clinical evaluation and imaging tests, they diagnosed the condition as CCF 5 days after the mandibular fractures and the patient was referred for treatment. Surgery was performed, in the same day, to resolve the CCF with the endovascularly by embolization with micromoles. The CCF was resolved and the patient continued on outpatient follow-up, progressing without sequelae from the CCF or mandibular fractures.
Asunto(s)
Fístula del Seno Cavernoso de la Carótida , Seno Cavernoso , Fracturas Mandibulares , Cirugía Bucal , Traumatología , Humanos , Fracturas Mandibulares/complicaciones , Fístula del Seno Cavernoso de la Carótida/diagnóstico , Fístula del Seno Cavernoso de la Carótida/cirugíaRESUMEN
BACKGROUND: Fractures of the atrophic mandible have been historically treated in various ways, from intermaxillary fixation to internal fixation, some cases require bone grafts. Besides, the Luhr classification serves as a guide to select the type of treatment. OBJECTIVE: To show the treatment of fractures in atrophic mandible with plates and screws, and the potential indications of bone graft in this type of fractures. METHOD: We presented a serie of 17 patients with atrophic mandible treated with plates and screws, some of them no blocked system and other with locked screws. For patients in luhr classes II and III cancellous bone grafts were used, looking for best osteogenic response, harvesting for the proximal third of the tibia. RESULTS: Postoperative progress was generally uneventful. Oral intake with purees was resumed 24 hours after surgery, as well as ambulation. Fracture healing at 6 months was seen in 17 patients. One patient died before the 6-month time point as the result of a stroke. Delayed union was diagnosed 3 months after surgery in another patient, who refused secondary treatment. CONCLUSIONS: Treatment of fractures in atrophic mandibles with plates and screws is a reliable procedure. Luhr classification provide useful guidance regarding the use of bone grafts for best osteogenic response in the fracture. This treatment allows a quick restart of the feeding by mouth and movilization of the patients.
ANTECEDENTES: Las fracturas en mandíbula atrófica han sido tratadas desde con fijación intermaxilar hasta con osteosíntesis. Pueden requerir injertos óseos. La clasificación de Luhr es una guía para orientar el tratamiento. OBJETIVO: Mostrar el tratamiento de fracturas en mandíbula atrófica con placas y tornillos y las posibles indicaciones de uso de injerto óseo en este tipo de fracturas. MÉTODO: Se presenta una serie de 17 pacientes con mandíbula atrófica fracturada tratada con placas y tornillos, algunas con sistemas no bloqueados y otros bloqueados. En las de clase II and III se aplicó injerto óseo esponjoso para mejorar la capacidad osteogénica. El injerto se tomó del tercio proximal de la tibia, previa evaluación radiológica. RESULTADOS: La evolución en general fue satisfactoria. Se inició la vía oral con papillas y los pacientes deambularon a las 24 h de posoperatorio. Se observó consolidación en 17 pacientes. Hubo una defunción por enfermedad vascular cerebral antes de 6 meses. Una paciente tuvo retardo de consolidación diagnosticado al tercer mes, pero no aceptó tratamiento secundario. CONCLUSIONES: El tratamiento de las fracturas mandibulares atróficas con placa y tornillos bajo concepto de carga absorbida es un procedimiento confiable. La clasificación de Luhr es útil para orientar la utilización de injerto óseo, buscando mejorar la capacidad osteogénica en la fractura. Este tratamiento permite un pronto reinicio de la vía oral, así como la movilización de los pacientes.
Asunto(s)
Arcada Edéntula , Fracturas Mandibulares , Humanos , Fracturas Mandibulares/cirugía , Fracturas Mandibulares/complicaciones , Arcada Edéntula/complicaciones , Arcada Edéntula/cirugía , Placas Óseas , Mandíbula/cirugía , Fijación Interna de Fracturas/métodosRESUMEN
Mandibular fractures are frequently diagnosed in trauma centres. Tympanic plate and mandibular fossa fractures can be associated with those fractures and can pass unnoticed if a careful evaluation and adequate imaging exam are not performed. This descriptive study was made to evaluate the incidence of condylar fractures associated with mandibular fossa and/or tympanic plate fractures in a large trauma hospital. Twenty-nine patients were diagnosed with such fractures between July/2019 and July/2020. A total of 81.5% of the patients were diagnosed with condylar fracture associated with tympanic plate fracture, 11.1% with a condylar fracture with mandibular fossa fracture, and 7.4% with condylar fracture associated with both tympanic plate and mandibular fossa fracture. Otorrhagia, trismus, malocclusion, and mouth opening deviation were the most observed clinical signs. Treatments performed were speech therapy, open reduction, and closed reduction. A total of 7.4% of the patients evolved with complications after the treatment. This study suggests that fractures of the tympanic plate and mandibular fossa may go unnoticed if an adequate imaging exam is not performed and rated by the surgeon. The early and corrected treatment prevents future sequelae, and a long-term follow up is essential.
Asunto(s)
Cóndilo Mandibular , Fracturas Mandibulares , Humanos , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/terapia , Hueso Temporal , Incidencia , Fijación Interna de Fracturas/métodos , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Humanos , Adulto , Trastornos Somatosensoriales/etiología , Fracturas Mandibulares/complicaciones , Nervio Mandibular/fisiopatología , Remisión Espontánea , Estudios Prospectivos , Fracturas Maxilomandibulares/cirugíaRESUMEN
In pediatric patients with mandible fractures and concomitant cervical spine injury (CSI), treatment strategies may occasionally compete: condylar fractures require functional therapy with range of motion exercises of the temporomandibular joint (TMJ), while CSI requires neck immobilization. The authors report the case of a child presenting with bilateral condylar head fractures, a right parasymphyseal fracture, and concomitant CSI treated with cervical collar immobilization, who ultimately developed TMJ ankylosis. Here, the authors review mandibular condylar fracture management and suggest an approach for the pediatric patient presenting with condylar fractures and concomitant CSI requiring immobilization. To preserve range of motion at the TMJ, it is critical to prevent external restriction by prolonged cervical collar use. Instead, these patients benefit from a protocol utilizing conventional halo or noninvasive, pinless halo cervical spine stabilization. Without limitation of the TMJ, condylar fracture rehabilitation and healing may proceed unhindered.
Asunto(s)
Anquilosis/prevención & control , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/diagnóstico por imagen , Traumatismos del Cuello/diagnóstico por imagen , Traumatismos Vertebrales , Trastornos de la Articulación Temporomandibular/prevención & control , Niño , Protocolos Clínicos , Humanos , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Fracturas Mandibulares/complicaciones , Traumatismos del Cuello/complicaciones , Factores de Riesgo , Columna VertebralRESUMEN
BACKGROUND: Over the years, the treatment to be chosen for the resolution of condylar fractures has been discussed with great concern. Treatment depends on the type and location of the fracture, as well as other associated factors such as facial injuries and concurrent diseases. AIM OF THE STUDY: The aim of the study was to make a review of the different criteria to establish a diagnosis and treatment to resolve mandibular condyle fractures, according to the evolution of the years and what this entails. DISCUSSION: Management of condylar fractures remains controversial among surgeons. However, as time goes by and as comparative and analytical studies are carried out within the issue, parameters and criteria are established to facilitate the decisions taken regarding the management and treatment of condylar fractures. CONCLUSION: Condylar fractures must be managed according to the clinical and case presentation.
ANTECEDENTES: A lo largo de los años se ha discutido con gran preocupación el tratamiento que hay que escoger para la resolución de las fracturas condilares. Este depende del tipo y la localización de la fractura, así como de otros factores asociados, como las lesiones faciales y las enfermedades concomitantes. OBJETIVO: Hacer una revisión de los diferentes criterios para establecer un diagnóstico y un tratamiento para la resolución de las fracturas del cóndilo mandibular, de acuerdo con la evolución de los años y lo que esto conlleva. DISCUSIÓN: El manejo de las fracturas condilares sigue siendo controvertido entre los cirujanos. Sin embargo, a medida que pasa el tiempo y se realizan estudios comparativos y analíticos sobre el tema, se establecen parámetros y criterios para facilitar las decisiones tomadas en relación con el manejo y el tratamiento de las fracturas condilares. CONCLUSIÓN: Las fracturas condilares deben ser manejadas según la clínica y la presentación del caso.
Asunto(s)
Fijación Interna de Fracturas/métodos , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/cirugía , Adolescente , Adulto , Factores de Edad , Niño , Toma de Decisiones Clínicas , Humanos , Maloclusión/prevención & control , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/diagnóstico , Complicaciones Posoperatorias/prevención & control , Recuperación de la Función , Estudios RetrospectivosRESUMEN
Abstract The surgical management of firearm injuries to the zygomaticomaxillary complex is a topic that needs to be addressed with much care. The complications that can arise during treatment, as well as the potential residual problems that can appear, lead to the need of recognizing these injuries as a maxillofacial treatment challenge. The infraorbital zone is the second most common area of injury in the face, accounting for up to 45% of midfacial fractures. The case presented is of a 54 year old man affected by the backward firing of a gun rifle that caused an oblique impaction towards the posterior lateral inferior side of the infraorbital complex. He was rapidly stabilized with an antibiotic and analgesic scheme, yet presented the following: a comminute fracture of the orbit floor with consequent communication towards the maxillary sinus, a non-displacing fracture of the frontomalar suture, a non-displacing fracture of the zygomatic arch and a lesion with loss of osseous tissue in the petrous region of the temporal bone. Rigid fixation followed stabilization, and the area was covered with a titanium mesh. Occasional tinnitus and photopsia were reported by the patient upon return, yet all other evaluated factors were in order. There have been different forms of management described in the literature, and it is recognized that each patient has different needs, therefore each case must be closely evaluated, so it is approached in the most appropriate manner.
Resumen El manejo quirúrgico de las lesiones por armas de fuego al complejo cigomaticomaxilar representa una situación compleja en la práctica maxilofacial que debe ser abordada con extrema cautela, debido a las complicaciones que pueden surgir durante el tratamiento y los potenciales problemas residuales. La zona infraorbitaria es la segunda área más común de lesiones en la cara, representando hasta 45% de las fracturas mediocraneales. El presente caso es de un masculino de 54 años de edad, que sufrió trauma ocasionado por la parte trasera de un rifle de caza que causó un impacto en sentido oblicuo hacia el lado lateral inferior del complejo infraorbitario. El paciente fue estabilizado con esquema antibiótico y analgésico, el diagnóstico fue: fractura cominuta del piso de la órbita, con consecuente comunicación al seno maxilar, fractura no desplazada de la sutura frontomalar, fractura no desplazada del arco cigomático, y lesión con pérdida de tejido óseo en la región petrosa del hueso temporal. El tratamiento quirúrgico consistió en reducción de las fracturas y fijación rígida de las estructuras. Al control post operatorio el paciente refirió acufenos y fotopsia ocasional, no presentando otras alteraciones. Se ha descrito en la literatura diferentes abordajes para el manejo de estos traumatismos, sin embargo cada caso debe ser individualizado y evaluado de forma minuciosa para que éste, sea el adecuado.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Fracturas Craneales/complicaciones , Heridas por Arma de Fuego/complicaciones , Cigoma/cirugía , Fracturas Mandibulares/complicacionesRESUMEN
Facial fractures can be potentially fatal in polytraumatized patients due to retropositioning tissues to upper airway obstruction. In the first aids, this situation can be reversed using a tracheostomy procedure to break out the airways. However, fractures leading to airway obstruction are rare and according to Richards Classification can be classified into 5 types. The purpose of this article is to report a clinical patient with a bilateral condylar and mandibular symphysis fractures that resulted in airway obstruction and severe mandibular rear projection.
Asunto(s)
Obstrucción de las Vías Aéreas , Fracturas Mandibulares/complicaciones , Adulto , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/cirugía , Humanos , Masculino , Traqueostomía , Adulto JovenRESUMEN
Facial nerve has great functional and aesthetic importance to the face, and damage to its structure can lead to major complications. This article reports a clinical case of neuroanastomosis of the facial nerve after facial trauma, describing surgical procedure and postoperative follow-up. A trauma patient with extensive injury cut in right mandibular body causing neurotmesis of the VIIth cranial nerve and mandibular angle fracture right side was treated. During surgical exploration, the nerve segments were identified and a neuroanastomosis was performed using nylon 10-0, after reduction and internal fixation of the mandibular fracture. Postoperatively, an 8-month follow-up showed good evolution and preservation of motor function of the muscles of facial mime, highlighting the success of the surgical treatment. Nerve damage because of facial trauma can be a surgical treatment challenge, but when properly conducted can functionally restore the damaged nerve.
Asunto(s)
Traumatismos del Nervio Facial/etiología , Nervio Facial/diagnóstico por imagen , Parálisis Facial/etiología , Fijación Interna de Fracturas/efectos adversos , Fracturas Mandibulares/cirugía , Procedimientos Neuroquirúrgicos/métodos , Adolescente , Traumatismos del Nervio Facial/diagnóstico , Traumatismos del Nervio Facial/cirugía , Parálisis Facial/diagnóstico , Parálisis Facial/cirugía , Femenino , Fijación Interna de Fracturas/métodos , Humanos , Mandíbula/cirugía , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/diagnóstico , Procedimientos de Cirugía PlásticaRESUMEN
Fraturas faciais foram provocadas principalmente por acidentes de trânsito (37,3%), e por agressões físicas (33%), vitimando predominantemente pacientes do gênero masculino (83,7%).Ocorreram mais frequentemente na faixa etária entre 21 e 30 anos (38,2%). A frequência de homens e mulheres vitimados entre a primeira e a terceira décadas de vida foi bastante similar.As fraturas mandibulares isoladas foram significativamente predominantes (48%), seguidas pelas zigomáticas (19,7%) e pelas nasais (19,7%). As agressões físicas foram mais frequente mente responsáveis pelas fraturas mandibulares, zigomáticas, nasais, maxilares e frontais, enquanto as fraturas pan faciais e Le Fort resultaram mais frequentemente de acidentes de trânsito.
Facial fractures were mainly caused by traffic accidents (37.3%) and physical abuse (33%), victimizing mostly male patients (83.7%). Occurred more frequently in the age group between21 and 30 years (38.2%). The frequency of men and women victimized between the first and third decades of life was very similar. Isolated mandibular fractures were significantly predominant(48%), followed by zygomatic (19.7%) and the nose (19.7%). The assaults were mostoften responsible for mandibular fractures, zygomatic, nasal, maxillary and frontal, while the panfaciais fractures and Le Fort resulted more often aciteeth transit.
Asunto(s)
Humanos , Masculino , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/estadística & datos numéricos , Fijación Interna de Fracturas , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/prevención & control , Fracturas Maxilares/complicaciones , Fracturas Maxilares/prevención & control , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico , Fracturas Óseas/prevención & controlRESUMEN
Six cases of mandibular fractures associated with severe periodontal disease that had been treated by mandibulectomy, due to intense bone loss, were evaluated retrospectively. The dogs were mainly older, small breed dogs that had suffered a traumatic event. Four dogs had a bilateral mandibulectomy and 2 a unilateral mandibulectomy.
Mandibulectomie pour le traitement de fractures associées à une maladie parodontale grave. Six cas de fractures mandibulaires associées à une maladie parodontale grave qui avaient été traités à l'aide d'une mandibulectomie, en raison d'une perte osseuse intense, ont été évalués rétrospectivement. Les chiens étaient pour la plupart âgés et de petite race et ils avaient été victimes d'un traumatisme. Quatre chiens avaient subi une madibulectomie bilatérale et 2 une mandibulectomie unilatérale.(Traduit par Isabelle Vallières).
Asunto(s)
Enfermedades de los Perros/cirugía , Fracturas Mandibulares/veterinaria , Osteotomía Mandibular/veterinaria , Enfermedades Periodontales/veterinaria , Animales , Enfermedades de los Perros/etiología , Perros , Femenino , Masculino , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/cirugía , Osteotomía Mandibular/métodos , Enfermedades Periodontales/complicacionesRESUMEN
The objective of this retrospective study was to evaluate some epidemiological characteristics, surgical treatment methods, and complications of cases involving mandibular fractures. Records from 119 patients treated for mandibular fractures between January 2006 and December 2011 were analyzed. We find mandibular fractures mostly affect Caucasian (72.2%) men (80.7%). The mean age of the patients was 28.1 years. Road traffic accidents (RTA) caused the most fractures (49.5%), followed by physical violence, including gunshot wounds (21%). Motorcycle accidents were the most common cause of RTA (76.2%). The most affected mandibular regions were the parasymphysis (26.9%) and the mandible angle (25.1%). Both surgical and nonsurgical treatments were applied (90.4% and 9.6%, respectively). The most common surgical approach was the intraoral (64.9%), using the 2.0-mm fixation system (88.0%). Complications such as postoperative infections, malocclusion, and paresthesia occurred in 36 patients (30.2%). This research revealed interesting features about the etiology of mandibular fractures that were mostly associated with RTA. Severity of the trauma and noncompliance of the patients were factors that contributed to the development of postoperative complications.
Asunto(s)
Fracturas Mandibulares/etiología , Fracturas Mandibulares/cirugía , Accidentes de Tránsito , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Niño , Femenino , Fijación Interna de Fracturas/métodos , Humanos , Técnicas de Fijación de Maxilares , Masculino , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Violencia , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/cirugía , Adulto JovenRESUMEN
El trauma maxilofacial en la población pediátrica difiere del trauma en el adulto debido al potencial de crecimiento facial, el menor tamaño de los huesos, la mayor rapidez de regeneración de los tejidos, la presencia de dentición decidua o mixta y la dificultad en el manejo de conducta. Específicamente, el tratamiento de las fracturas mandibulares en niños es controversial y complicado porque puede tener un efecto negativo en el crecimiento mandibular, en la movilidad de la articulación temporomandibular y en el desarrollo y crecimiento de los gérmenes dentales, particularmente en la etapa de dentición decidua o mixta. Entre las opciones de tratamiento que reporta la literatura se incluyen el manejo conservador, el cerrado y el quirúrgico. El propósito del presente caso es relatar la complicación y manejo quirúrgico definitivo de la fractura mandibular desfavorable en un niño de 5 años de edad (dentición decidua) con material de osteosíntesis semirrígido no reabsorbible...
Maxillofacial trauma in the pediatric population differs from trauma in adults because of facial growth potential, smaller bones, faster tissue regeneration, deciduous or mixed dentition and the difficulties managing their behavior. Specifically , treatment of pediatric mandibular fractures is controversial and complicated because it can have a negative effect on mandibular growth, temporomandibular joint mobility, development and growth of tooth germs, particularly at the stage of deciduous or mixed dentition. Among the treatment options reported in the literature, conservative management, close reduction and surgery are included. The purpose of this report is to describe the complication and definitive surgical management of an unfavorable mandibular fracture in a five years old child, in primary dentition, with nonabsorbable material rigid osteosynthesis...
Asunto(s)
Humanos , Preescolar , Fijación Interna de Fracturas , Fracturas Mandibulares/cirugía , Fracturas Mandibulares/complicacionesRESUMEN
BACKGROUND: Temporomandibular joint (TMJ) ankylosis is an extremely disabling affliction that causes problems in mastication, digestion, speech, appearance, and hygiene. The disease also has an impact on the psychological development of the patients. CASE REPORT: A 49-year-old male patient came to our unit with complaint of restriction in his alimentation and of mouth opening. In the anamnesis, the patient reported that this limitation began 11 years ago, soon after a serious car accident that caused trauma on the face. In the clinical examination, the patient's mouth opening was 1 mm, and there was satisfactory occlusion. He was diagnosed with bilateral temporomandibular joint (TMJ) ankylosis after an imaging examination. DISCUSSION: In order to confirm the post-traumatic etiology of the anquilose, we got the medical records from the hospital where the patient received the first treatment. The records, at that time, reported facial trauma with bilateral condylar fracture and comminuted symphyseal fracture which was reduced and fixed followed by maxillomandibular fixation that remained for 45 days. After collecting all the information needed for diagnosis, surgical treatment was proposed through arthroplasty. The patient was placed on immediate post-operative jaw physiotherapy, and 12 months after surgery, his mouth opening improved to 35 mm. Thus, in our case, ankylosis may have been developed as a sequel of the mandibular fractures.
Asunto(s)
Anquilosis/etiología , Anquilosis/cirugía , Cóndilo Mandibular/lesiones , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/cirugía , Trastornos de la Articulación Temporomandibular/etiología , Trastornos de la Articulación Temporomandibular/cirugía , Anquilosis/diagnóstico , Artroplastia/métodos , Fijación de Fractura/métodos , Humanos , Masculino , Fracturas Mandibulares/diagnóstico por imagen , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Radiografía Panorámica , Reoperación , Trastornos de la Articulación Temporomandibular/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
The purpose of this retrospective study was to evaluate contributing factors in patients requiring surgical retreatment of mandibular fractures. Of all the patients with mandibular fractures who were treated using internal fixation at a trauma hospital over a seven-year period, 20 patients (4.7%) required a second surgery and thus composed the “reoperated” group. The control group comprised 42 consecutive patients with mandibular fractures who were treated at the same clinic and who healed without complications. Medical charts were reviewed for gender, age, substance abuse history, dental condition, etiology, location of fracture, degree of fragmentation, fracture exposure, teeth in the fracture line, associated facial fractures, polytrauma, time elapsed between trauma and initial treatment, surgical approach and fixation system. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0; descriptive statistics and the chi-squared test were used to determine differences between groups. Significant differences in substance abuse (p = 0.006), dental condition (p < 0.001), location of fracture (p = 0.010), degree of fragmentation (p = 0.003) and fracture exposure (p < 0.001) were found. With regard to age and time elapsed between trauma and initial treatment, older patients (31.4 years, SD = 11.1) and a delay in fracture repair (19.1 days, SD = 18.7) were more likely to be associated with reoperation. It was concluded that substance abuse, age, dental condition, location of fracture, degree of fragmentation, fracture exposure and the time between trauma and initial treatment should be considered contributing factors to the occurrence of complications that require surgical retreatment of mandibular fractures.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Adulto Joven , Técnicas de Fijación de Maxilares , Fracturas Mandibulares/cirugía , Complicaciones Posoperatorias/cirugía , Distribución de Chi-Cuadrado , Intervalos de Confianza , Fracturas Mandibulares/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Reoperación/estadística & datos numéricos , Factores Sexuales , Factores de Tiempo , Resultado del TratamientoRESUMEN
The purpose of this retrospective study was to evaluate contributing factors in patients requiring surgical retreatment of mandibular fractures. Of all the patients with mandibular fractures who were treated using internal fixation at a trauma hospital over a seven-year period, 20 patients (4.7%) required a second surgery and thus composed the "reoperated" group. The control group comprised 42 consecutive patients with mandibular fractures who were treated at the same clinic and who healed without complications. Medical charts were reviewed for gender, age, substance abuse history, dental condition, etiology, location of fracture, degree of fragmentation, fracture exposure, teeth in the fracture line, associated facial fractures, polytrauma, time elapsed between trauma and initial treatment, surgical approach and fixation system. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0; descriptive statistics and the chi-squared test were used to determine differences between groups. Significant differences in substance abuse (p = 0.006), dental condition (p < 0.001), location of fracture (p = 0.010), degree of fragmentation (p = 0.003) and fracture exposure (p < 0.001) were found. With regard to age and time elapsed between trauma and initial treatment, older patients (31.4 years, SD = 11.1) and a delay in fracture repair (19.1 days, SD = 18.7) were more likely to be associated with reoperation. It was concluded that substance abuse, age, dental condition, location of fracture, degree of fragmentation, fracture exposure and the time between trauma and initial treatment should be considered contributing factors to the occurrence of complications that require surgical retreatment of mandibular fractures.
Asunto(s)
Técnicas de Fijación de Maxilares , Fracturas Mandibulares/cirugía , Complicaciones Posoperatorias/cirugía , Adulto , Distribución de Chi-Cuadrado , Intervalos de Confianza , Femenino , Humanos , Masculino , Fracturas Mandibulares/complicaciones , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Trauma to the mandible often causes condylar fracture. This article reports the conservative treatment of a 10-year-old girl with a unilateral condylar fracture, highlighting the diagnostic aspects involved and the strategy used. The conservative approach used for this patient-bionator followed by full fixed orthodontic appliances-provided adequate esthetic and functional results. The outcomes throughout the 7-year follow-up and the remodeling process of the condyle observed in the panoramic radiographs proved the success of this treatment.