RESUMO
INTRODUCTION: Maxillofacial fractures are associated with significant morbidity, loss of function and aesthetic sequelae, among others. Within mandibular fractures, mandibular condylar fractures are the most frequent. These can be treated by surgical treatment or conservative treatment (orthopedic). METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including 66 primary studies overall, of which six were randomized trials. We concluded surgical treatment of mandibular condyle fractures, compared to conservative treatment, is probably associated with less joint pain, less malocclusion and less lateral deviation in buccal opening.
INTRODUCCIÓN: Las fracturas maxilofaciales se asocian a importante morbilidad, pérdida de función y secuelas estéticas, entre otros. Dentro de las fracturas mandibulares, las fracturas de cóndilo mandibular son las más frecuentes. Estas pueden ser tratadas mediante un tratamiento quirúrgico (reducción abierta más estabilización con miniplacas de titanio) o un tratamiento conservador (ortopédico). MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyen 66 estudios primarios, de los cuales, seis corresponden a ensayos aleatorizados. Concluimos que, en comparación con el tratamiento conservador, el tratamiento quirúrgico en fracturas de cóndilo mandibular probablemente se asocia a menor dolor articular, menor maloclusión y menor desviación lateral en apertura bucal.
Assuntos
Côndilo Mandibular/lesões , Fraturas Mandibulares/terapia , Procedimentos Ortopédicos/métodos , Tratamento Conservador/métodos , Bases de Dados Factuais , Humanos , Fraturas Mandibulares/patologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
INTRODUCCIÓN: Las fracturas maxilofaciales se asocian a importante morbilidad, peÌrdida de función y secuelas esteÌticas, entre otros. Dentro de las fracturas mandibulares, las fracturas de cóndilo mandibular son las más frecuentes. Estas pueden ser tratadas mediante un tratamiento quirúrgico (reducción abierta más estabilización con miniplacas de titanio) o un tratamiento conservador (ortopédico). MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyen 66 estudios primarios, de los cuales, seis corresponden a ensayos aleatorizados. Concluimos que, en comparación con el tratamiento conservador, el tratamiento quirúrgico en fracturas de cóndilo mandibular probablemente se asocia a menor dolor articular, menor maloclusión y menor desviación lateral en apertura bucal.
INTRODUCTION: Maxillofacial fractures are associated with significant morbidity, loss of function and aesthetic sequelae, among others. Within mandibular fractures, mandibular condylar fractures are the most frequent. These can be treated by surgical treatment or conservative treatment (orthopedic). METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including 66 primary studies overall, of which six were randomized trials. We concluded surgical treatment of mandibular condyle fractures, compared to conservative treatment, is probably associated with less joint pain, less malocclusion and less lateral deviation in buccal opening.
Assuntos
Humanos , Procedimentos Ortopédicos/métodos , Côndilo Mandibular/lesões , Fraturas Mandibulares/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Bases de Dados Factuais , Tratamento Conservador/métodos , Fraturas Mandibulares/patologiaRESUMO
Multiple myeloma (MM) is a neoplasia characterized by the proliferation of plasmacytoid cells, which produce abnormal immunoglobulins. It frequently creates local and systemic complications such as pathologic fractures and renal disease. This article reports the case of a 70-year-old man presenting a pathologic fracture of the right mandibular angle secondary to a plasmocytoma. He had a history of a previous pathologic fracture of the left mandibular angle 13 years before that was treated elsewhere, but no documentation was available. Investigation revealed the disease to be a MM and evolution led to renal failure and death. Differential diagnosis is necessary for this kind of pathologic presentation because MM presents a survival rate of 5.7% in 5 years and mandibular involvement happens in the advanced stage of the disease.
Assuntos
Fraturas Espontâneas/diagnóstico , Fraturas Mandibulares/diagnóstico , Mieloma Múltiplo/diagnóstico , Idoso , Diagnóstico Diferencial , Evolução Fatal , Fraturas Espontâneas/patologia , Humanos , Masculino , Mandíbula/patologia , Fraturas Mandibulares/patologia , Mieloma Múltiplo/patologia , Estadiamento de Neoplasias , Insuficiência Renal/diagnósticoRESUMO
Extubation response can lead to cardiovascular and respiratory complications. Here, we aimed to evaluate the effect of ropivacaine injected via the trans-cricothyroid membrane on the extubation response. This prospective, double-blind, randomized study included 70 patients classified as American Society of Anesthesiologists status I-II, who required general anesthesia with nasotracheal intubation for maxillary and mandibular fracture surgery; patients were divided into the ropivacaine (20 mg) and dicaine (20 mg) groups. Both groups were injected via the trans-cricothyroid membrane. Mean arterial pressure (MAP), heart rate (HR), and incidence and severity of cough were recorded during intubation and extubation. During intubation, there was no significant intergroup difference in MAP or HR and no occurrence of coughing (P > 0.05). During extubation, MAP and HR were significantly lower in the ropivacaine group than the dicaine group (P < 0.05). The proportion of patients with no reports of cough was significantly higher in the ropivacaine group than in dicaine group (P < 0.05). The number of patients with grade 1 or 2 cough was significantly higher in the dicaine group than that in the ropivacaine group (P < 0.05). There was no significant intergroup difference in the rate of postoperative complications (P > 0.05). These results suggest that the administration of ropivacaine via trans-cricothyroid membrane injection can effectively inhibit the extubation response.
Assuntos
Amidas/administração & dosagem , Anestesia Geral , Fraturas Mandibulares/cirurgia , Fraturas Maxilares/cirurgia , Tetracaína/administração & dosagem , Adulto , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Injeções , Músculos Laríngeos , Masculino , Fraturas Mandibulares/patologia , Fraturas Maxilares/patologia , Pessoa de Meia-Idade , Estudos Prospectivos , Ropivacaina , Adulto JovemRESUMO
Introdução: Esta revisão qualitativa da literatura levantou publicações científicas internacionais sobre a funcionalidade do sistema miofuncional orofacial nos traumas faciais, por meio da base de dados PubMed. Método: O levantamento realizado limitou-se a seres humanos, de qualquer faixa etária, no idioma inglês, entre os anos de 2005 e 2011. As publicações sem acesso completo, repetidas por sobreposição das palavras chave, estudos de caso, revisões de literatura, cartas ao editor e as não relacionadas diretamente ao tema foram excluídas. Resultados: Foram identificados 831 estudos, sendo 14 dentro dos critérios estabelecidos. Notou-se que a avaliação mais frequente foi a da função mandibular e depois análise de tratamentos; ocorreu mais fratura no côndilo que ângulo mandibular; utilizou-se mais tratamento cirúrgico juntamente com o conservador, seguido pelo somente cirúrgico e finalmente somente conservador; a maior incidência de traumas faciais foi em adultos do sexo masculino; poucas pesquisas foram realizadas com crianças e grupo-controle; utilizaram-se mais avaliações da função mandibular e clínicas, na maioria pré e pós-cirurgia; a força de mordida e a área oclusal apresentaram melhora póstratamento, no entanto a assimetria mandibular permaneceu; os valores de abertura máxima da boca atingiram a normalidade, porém inferiores ao grupo-controle; houve persistência de alterações na mobilidade mandibular e dor, mesmo após o tratamento; e a terapia miofuncional melhorou o quadro de alterações. Conclusão: É necessário mais publicações sobre o tratamento fonoaudiológico baseado na abordagem miofuncional orofacial nos traumas faciais.
Introduction: This qualitative literature review aims to highlight international scientific publications selected from the PubMed database that describe the changes in the function of the orofacial myofunctional system after facial trauma and the associated treatment outcomes. Methods: Studies published in English between 2005 and 2011 and including individuals of all age groups were included in this review. Publications that were not open access, studies appearing more than once because of overlapping keywords, case studies, literature reviews, letters to the editor, and studies that were not directly related to the subject were excluded. Results: A total of 831 studies were identified, 14 of which fulfilled the established criteria. Assessment of jaw function was the most frequent evaluation performed in the included studies, followed by the analysis of treatments. The incidence of condylar fractures was higher than that of mandibular angle fractures. The majority of cases were managed by surgery combined with conservative treatment, followed by surgery alone and conservative treatment alone. Adult men exhibited a higher incidence of facial trauma. Few studies included children or control groups. Further assessment of jaw and clinical functions before and after surgery revealed the following findings. The bite force and occlusal contact area improved after treatment, whereas mandibular asymmetry persisted even after surgery. The maximum mouth opening returned to normal after treatment, although the range of mouth opening was lower in patients with facial trauma than in controls. Persistent mobility in the mandibular teeth and pain were observed even after treatment. Myofunctional therapy resulted in an overall improvement in jaw function. Conclusions: Although the number of studies on facial trauma is increasing, few studies address the use and benefits of orofacial myofunctional therapy in this field. Further studies on orofacial myofunctional therapy combined with surgery and/ or conservative treatment for facial trauma are necessary.
Assuntos
Humanos , Masculino , Adulto , História do Século XXI , Ferimentos e Lesões , Sistema Estomatognático , Literatura de Revisão como Assunto , Estudos Retrospectivos , Terapia Miofuncional , Estudo de Avaliação , Face , Ossos Faciais , Traumatismos Faciais , Fraturas Maxilomandibulares , Fraturas Mandibulares , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/terapia , Sistema Estomatognático/cirurgia , Sistema Estomatognático/patologia , Terapia Miofuncional/efeitos adversos , Terapia Miofuncional/métodos , Face/cirurgia , Ossos Faciais/cirurgia , Ossos Faciais/lesões , Traumatismos Faciais/cirurgia , Fraturas Maxilomandibulares/cirurgia , Fraturas Maxilomandibulares/patologia , Fraturas Maxilomandibulares/terapia , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares/patologia , Fraturas Mandibulares/terapiaRESUMO
BACKGROUND: Methotrexate (MTX) is an anti-metabolite used in rheumatology and oncology. High doses are indicated for oncological treatment, whereas low doses are indicated for chronic inflammatory diseases. This study evaluated the effect of two MTX treatment schedules on the bone healing of the temporomandibular joint fracture in rats. METHODS: Seventy-five adult male Wistar rats were used to generate an experimental unilateral medially rotated condylar fracture model that allows an evaluation of bone healing and the articular structures. The animals were subdivided into three groups that each received one of the following treatments intraperitoneally: saline (1 mL/week), low-dose MTX (3 mg/kg/week) and high-dose MTX (30 mg/kg). The histological study comprised fracture site and temporomandibular joint evaluations and bone neoformation was evaluated by histomorphometric analysis. A biochemical parameter of bone formation was also assessed. RESULTS: When compared with saline, high-dose MTX delayed bone fracture repairs. In this latter group, after 90 days, the histological analysis revealed atrophy of the fibrocartilage and the presence of fibrous tissue in the joint space. The histomorphometric analysis revealed diminished bone neoformation. The alkaline phosphatase levels also decreased after MTX treatment. CONCLUSION: It was concluded that high-dose MTX impaired mandibular condyle repair and induced degenerative articular changes.
Assuntos
Consolidação da Fratura/efeitos dos fármacos , Imunossupressores/uso terapêutico , Côndilo Mandibular/efeitos dos fármacos , Fraturas Mandibulares/tratamento farmacológico , Metotrexato/uso terapêutico , Fosfatase Alcalina/análise , Fosfatase Alcalina/efeitos dos fármacos , Animais , Atrofia , Remodelação Óssea/efeitos dos fármacos , Reabsorção Óssea/patologia , Calo Ósseo/efeitos dos fármacos , Calo Ósseo/patologia , Cartilagem Articular/efeitos dos fármacos , Cartilagem Articular/patologia , Tecido Conjuntivo/efeitos dos fármacos , Tecido Conjuntivo/patologia , Modelos Animais de Doenças , Fibrocartilagem/efeitos dos fármacos , Fibrocartilagem/patologia , Imunossupressores/administração & dosagem , Injeções Intraperitoneais , Masculino , Côndilo Mandibular/lesões , Côndilo Mandibular/patologia , Fraturas Mandibulares/patologia , Metotrexato/administração & dosagem , Osteogênese/efeitos dos fármacos , Distribuição Aleatória , Ratos , Ratos Wistar , Articulação Temporomandibular/efeitos dos fármacos , Articulação Temporomandibular/lesões , Sobrevivência de Tecidos/efeitos dos fármacosRESUMO
PURPOSE: The objective of the present study was to conduct a computational, laboratory-based comparison of the biomechanical stability of 2.0 fixation locking plates with different profiles in Class III atrophic mandibular fractures using 3-dimensional finite element analysis. MATERIALS AND METHODS: Three-dimensional finite element models simulating Class III atrophic mandibular fractures were constructed. The models were divided into 4 groups according to plate thickness (1.0, 1.5, 2.0, and 2.5 mm). Fractures were simulated in left mandibular bodies, and 3 locking screws were used on each side of each fracture for fixation. Bite forces of approximately 63 N were simulated in the incisor and molar regions of the mandibles in finite element models. RESULTS: The level of compressive strain on the bone around the screw was within the physiological limit. No significant difference was observed in the displacement of bone segments in the fracture region. Von Mises stress was higher during simulated bites in the molar region for plates with thicknesses of 1.0 mm. Plate tension values were below the level required for permanent deformation or fracture in all models. The 2.5-mm-thick plate presented better biomechanical performance than all other plates. The 2.0-mm-thick plate also showed satisfactory results and adequate safety limits. CONCLUSION: Large-profile (2.0-mm-thick) locking plates showed better biomechanical performance than did 1.0- and 1.5-mm-thick plates and can be considered an alternative reconstruction plate for the treatment of Class III atrophic mandibular fractures.
Assuntos
Placas Ósseas , Análise de Elementos Finitos , Imageamento Tridimensional/métodos , Mandíbula/patologia , Fraturas Mandibulares/cirurgia , Idoso , Atrofia , Fenômenos Biomecânicos , Força de Mordida , Parafusos Ósseos , Simulação por Computador , Desenho Assistido por Computador , Tomografia Computadorizada de Feixe Cônico/métodos , Arco Dental/patologia , Módulo de Elasticidade , Desenho de Equipamento , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Processamento de Imagem Assistida por Computador/métodos , Incisivo/patologia , Fraturas Mandibulares/patologia , Músculos da Mastigação/patologia , Modelos Biológicos , Dente Molar/patologia , Estresse Mecânico , Propriedades de SuperfícieRESUMO
OBJECTIVE: This study analyses the different parts of the upper airway space and the changes in hyoid position. The results provide a clinical reference for developing timely and effective treatment programmes for patients with mandibular fractures caused by maxillofacial trauma. METHODS: Standard X-cephalometric measurements of the lateral skull of 210 subjects were taken. The subjects were divided into four fracture groups: condylar, mandibular angle, mandibular body, and parasymphyseal. RESULTS: The radiographs of the mandibular fracture groups were compared with the normal occlusion group to analyse the upper airway space and the changes in hyoid position. Different types of fractures have different effects on the upper airway space. Bilateral mandibular body fracture and the parasymphyseal fracture have a significant influence on the lower oropharyngeal and laryngopharyngeal airway spaces, with serious obstructions severely restricting the ventilatory function of patients. CONCLUSIONS: Fractures at different parts of the mandibular structure are closely related to the upper airway and hyoid position.
Assuntos
Osso Hioide/patologia , Côndilo Mandibular/lesões , Fraturas Mandibulares/patologia , Adolescente , Adulto , Cefalometria , Humanos , Osso Hioide/diagnóstico por imagem , Masculino , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/patologia , Fraturas Mandibulares/diagnóstico por imagem , Palato Mole/patologia , Radiografia , Adulto JovemRESUMO
BACKGROUND: Calcium channel blockers are effective antihypertensive agents, but they may affect many metabolic processes, including bone metabolism. PURPOSE: The aim of this study was to evaluate by radiographic, histologic, and biochemical analyses the effects of amlodipine on bone healing of a defect simulating a fracture in mandibular ramus of rats. METHODS: Fifty male Wistar rats were submitted to the same unilateral surgical procedure simulating a mandibular fracture. Experimental group received oral doses of amlodipine 0.04 mg/rat/day starting 12 days before procedure, while control group received water. Animals were sacrificed at 1, 7, 14, 30, and 90 days postoperatively. Numerical values were submitted to statistical analyses. RESULTS: Radiographic analysis showed larger radiolucent area into bone defect to the experimental group at the periods of 14 (p = 0.016), 30 (p = 0.009), and 90 (p = 0.028) days. In the histological analysis, the experimental group had a slight delay in the chronology of the repair process. In the histomorphometric analysis, the experimental group presented significant lowering of newly formed bone volume at 7 and 14 days periods (p = 0.049). There was a significant decrease of alkaline phosphatase levels in experimental group in the initial periods (p = 0.049). CONCLUSIONS: It was concluded that chronic use of amlodipine compromised bone neoformation in the repairing process of surgical defect in the mandibular ramus of rats, but no precluded occurrence of fracture consolidation.
Assuntos
Anlodipino/toxicidade , Anti-Hipertensivos/toxicidade , Bloqueadores dos Canais de Cálcio/toxicidade , Consolidação da Fratura/efeitos dos fármacos , Fraturas Mandibulares/patologia , Fosfatase Alcalina/metabolismo , Animais , Densidade Óssea/efeitos dos fármacos , Regeneração Óssea/efeitos dos fármacos , Reabsorção Óssea/patologia , Masculino , Ratos , Ratos WistarRESUMO
PURPOSE: The aim of the present study was to retrospectively evaluate the epidemiologic characteristics of the prevalence, type, and treatment modalities of condylar fractures of the mandible. PATIENTS AND METHODS: Data were collected from patients during an 8-year period (1999 to 2007). The data recorded included demographic data, etiology, diagnosis, type, dislocation, use of protective devices, state of the dentition, associated facial and general trauma, soft tissue lesions, treatment methods, and the interval between trauma and treatment. Data analysis included a descriptive analysis, chi(2) test, Fisher's exact test, t test, and Kruskal-Wallis test. RESULTS: During the 8-year period, 209 unilateral fractures and 54 bilateral fractures were treated, with a male/female ratio of 3.05:1 and a mean age of 28.4 years, for a total of 317 condylar fractures. Male gender was significantly associated with the presence of a condylar fracture (P < .05). The most common cause of condylar fractures was road traffic accidents (57.8%). Of the 317 fractures, 300 were classified as simple fractures, and 249 fractures were not displaced. Protective devices significantly decreased the number of condylar fractures occurring from road traffic accidents (P < .05). Symphysis fractures were significantly associated with both unilateral and bilateral fractures of the mandibular condyle (P < .05). Subcondylar displaced fractures were significantly associated with surgical treatment (P < .05). CONCLUSIONS: Young adults were involved in most of the accidents. Road traffic accidents were the main cause of condylar fractures. The mandatory use of safety helmets and seatbelts and education of those using the road are essential to decrease the number of facial fractures.
Assuntos
Fixação de Fratura/métodos , Côndilo Mandibular/lesões , Fraturas Mandibulares/epidemiologia , Fraturas Mandibulares/patologia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ciclismo/estatística & dados numéricos , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Feminino , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Humanos , Incidência , Masculino , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Cintos de Segurança/estatística & dados numéricos , Razão de Masculinidade , Estatísticas não Paramétricas , Adulto JovemRESUMO
The purpose of this study was to compare by qualitative histology the efficacy of rigid internal fixation with titanium system and the Lacto Sorb system in mandibular fractures in rabbits. Thirty male adult rabbits Oryctolagus cuniculus were used. Unilateral mandibular osteotomies were performed between the canine and first premolar. The animals were divided into two groups: for Group I-rigid internal fixation was performed with titanium system 1.5 mm (Synthes, Oberdorf, Switzerland), with two screws of 6 mm (bicortical) on each side of the osteotomy. For Group II-rigid internal fixation was performed with PLLA/PGA system 1.5 mm (Lacto Sorb, WLorenz, Jacksonville, FL, USA). The histological analysis evaluated the presence of inflammatory reaction, degree of bone healing and degree of resorption of the Lacto Sorb screws. The results of both fixation systems were similar, only with a small difference after 15 and 30 days. In Group I a faster bony healing was noted. But after 60 days, bony healing was similar in both groups. It is concluded that both PLLA/PGA and titanium plates and screws provide sufficient strength to permit mandibular bone healing. The resorption process of PLLA/PGA osteosynthesis material did not cause acute or chronic inflammatory reaction or foreign body reaction during the studied period.
Assuntos
Implantes Absorvíveis , Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fraturas Mandibulares/cirurgia , Titânio , Animais , Materiais Biocompatíveis/química , Parafusos Ósseos , Desenho de Equipamento , Células Gigantes/patologia , Ácido Láctico/química , Masculino , Fraturas Mandibulares/patologia , Osteoblastos/patologia , Osteócitos/patologia , Osteogênese/fisiologia , Osteotomia , Ácido Poliglicólico/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Polímeros/química , Coelhos , Fatores de Tempo , Titânio/química , Cicatrização/fisiologiaRESUMO
Unilateral, rotated subcondylar fractures were surgically induced in young rats under general anaesthesia. A decrease in body weight was observed in the fractured animals, with recovery at the end of the experimental period. A tendency of deviation of the mandible to the fracture side was noticed on axial radiographs, but without significant difference between experimental and sham-operated animals. Histological data initially demonstrated acute inflammation along the articular capsule and adjacent muscle fibres. Within 2 weeks, exuberant callus formation occurred. Neither devitalized bone ends nor intra-articular granulation tissue were seen. After 1 month, the temporomandibular joint presented characteristics of normality, with the condylar process centralized into the temporal fossa, interposed by the articular disc. These results were preserved after 3 months. We concluded that rotational subcondylar fractures in young rats heal by callus formation, with simultaneous and prompt repositioning of the condyle.
Assuntos
Côndilo Mandibular/lesões , Fraturas Mandibulares/fisiopatologia , Animais , Artrite/patologia , Peso Corporal , Remodelação Óssea , Calo Ósseo/fisiologia , Cartilagem/patologia , Assimetria Facial/patologia , Seguimentos , Consolidação da Fratura , Crescimento , Processamento de Imagem Assistida por Computador , Cápsula Articular/patologia , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/patologia , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/patologia , Fibras Musculares Esqueléticas/patologia , Miosite/patologia , Osteoblastos/patologia , Radiografia , Distribuição Aleatória , Ratos , Ratos Wistar , Rotação , Estatística como Assunto , Estatísticas não Paramétricas , Articulação Temporomandibular/patologia , Disco da Articulação Temporomandibular/patologiaRESUMO
Uma característica fartamente evidenciada em relaçäo à cidade do Rio de Janeiro é a violência, trazendo, em consequência, a mobilizaçäo de profissionais das diversas áreas. No campo da saúde säo os especialistas em traumatologia da face reconhecidos e destacados pela originalidade e qualidade de seus trabalhos, cuja divulgaçäo amplia-se na medida em que cresce mundialmente o interesse por trabalhos relacionados à medicina de guerra. Neste sentido, esta pesquisa acrescenta dados provocados por projétil de arma de fogo (PAF). Este estudo consta da análise de 67 prontuários de três dos maiores hospitais de emergência do Rio de Janeiro, Hospital Municipal Souza Aguiar, Miguel Couto e Salgado Filho, onde foram analisados dados referentes a regiäo acometida, o tratamento inicial instituído, bem como as complicaçöes pós-operatórias. Nos resultados obtidos o tratamento conservador foi preferido ao cirúrgico na maioria dos casos, além das complicaçöes pós-operatórias estarem mais frequentemente associadas a reduçäo cruenta das fraturas. Este estudo vem evidenciar a necessidade de um protocolo de atendimento ao traumatizado de face, assim como de maior conhecimento de balística e da fisiopatologia dos ferimentos por PAF, a fim de diminuir a morbidade por esse tipo de traumatismo
Assuntos
Humanos , Masculino , Feminino , Fraturas Mandibulares/patologia , Ferimentos por Arma de Fogo/classificação , Ferimentos por Arma de Fogo/terapia , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Armas de Fogo , Armas de Fogo/classificação , Incidência , Fraturas Mandibulares/classificação , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares/terapia , Ferimentos por Arma de Fogo/cirurgiaRESUMO
Healing of the displaced condylar process fracture was analysed by means of an experimental model using adults rats. Displaced fractures of the right condylar process were achieved under general anaesthesia. Histological data initially demonstrated neutrophilic exudation along the articular capsule and adjacent muscle fibres. One week later, devitalized bone areas at the fracture site, as well as proliferation of cartilaginous and osseous tissue were observed. Subsequently, exuberant callus formation and a decrease in the inflammatory process occurred. After 3 months, the condylar process presented characteristics of normality and was centralized into the temporal fossa, with interposition of the articular disc. These results indicate that experimentally induced, displaced condylar process fractures heal by callus formation with simultaneous repositioning of the condyle.
Assuntos
Consolidação da Fratura , Côndilo Mandibular/patologia , Fraturas Mandibulares/patologia , Animais , Calo Ósseo/patologia , Ratos , Fatores de TempoRESUMO
Este trabalho faz uma revisão na literatura dos últimos 12 anos sobre as técnicas de tratamento cirúrgico da osteomielite mandibular infecciosa em pacientes com fraturas de mandíbula. Procuramos enfocar as técnicas cirúrgicas para resolução da patologia osteomielite e métodos de reconstrução dos defeitos ósseos na mandíbula decorrentes do curso ou do tratamento da doença. Foram revisados também os métodos de fixação dos segmentos mandibulares fraturados envolvidos na osteomielite. A conclusão foi de que os métodos cirúrgicos de tratamento e/ou reconstrução mandibular após o estabelecimento da osteomielite mandibular infecciosa em pacientes com fraturas mandibulares são diversos e dependem das particularidades de cada caso
Assuntos
Humanos , Odontologia , Fraturas Mandibulares , Osteomielite , Fraturas Mandibulares/complicações , Fraturas Mandibulares/patologia , Fraturas Mandibulares/cirurgia , Osteomielite/diagnóstico , Osteomielite/cirurgiaRESUMO
Most fractures of the mandible can be managed conservatively. This report is a retrospective evaluation of the clinical and radiological results in 17 patients with 21 dislocated fractures submitted to open reduction and fixation, employing steel wires and maxillomandibular fixation. Follow-up ranged from 7 to 55 months, (mean 29.5). Functional assessment showed good opening movements (mean 41.9 mm). There were no cases of ankylosis, pain, or paralysis of the facial nerve. Radiological assessment was normal when the lateral pterygoid muscle was maintained adherent to the fractured proximal segment. Radiological signs of bone resorption occurred when the fractured segment was detached from the lateral pterygoid muscle. In our opinion, dislocated condylar process fractures can be managed surgically and with steel wire ligatures and maxillomandibular fixation. Whenever possible, the lateral pterygoid muscle should be inserted into the fractured proximal segment, i.e. as an osteomuscular flap.