Tratamento cirúrgico de fraturas Le Fort I e Le Fort II em vítima de trauma por acidente motociclístico: relato de caso

O terço médio da face é funcional e esteticamente importante. De acordo com a classificação Le Fort, existem três níveis mais fracos desta região da face quando traumatizados a partir de uma direção frontal, sendo que os acidentes motociclísticos, atualmente, correspondem a causa de aproximadamente 29% destes traumas. O presente trabalho tem como objetivo relatar um caso clínico de tratamento cirúrgico de fraturas do tipo Le Fort I e Le Fort II em um paciente de 29 anos de idade, sexo masculino, vítima de acidente motociclístico, atendido no Hospital de Emergência e Trauma Senador Humberto Lucena (João Pessoa – PB). Ao exame físico observou-se mobilidade de maxila, degrau palpável em pilar zigomático e pilar canino, alteração oclusal com leve mordida aberta e degrau em rebordo infraorbitário direito, entretanto o paciente não apresentava nenhuma alteração ocular. Foi solicitada tomografia computadorizada como exame complementar para confirmação do diagnóstico e planejamento cirúrgico, o qual se deu como fratura Le Fort I e Le Fort II no lado direito. O paciente foi submetido à cirurgia sob anestesia geral para fixação dos pilares zigomático e canino através do acesso vestibular maxilar e rebordo infraorbitário através do acesso subciliar. Inicialmente foi feito o bloqueio maxilo – mandibular para a utilização da oclusão como ponto de referência, seguido da redução das fraturas e fixação com placas e parafusos do sistema 2.0. Sob acompanhamento pós – operatório o paciente apresentou retorno da oclusão dentro dos padrões de normalidade, recuperou a projeção da região zigomática fraturada e então recebeu alta. Descritores: Fraturas Ósseas; Fixação de Fratura; Traumatismos Faciais. Referências Organização das Nações Unidas no Brasil. Traumas matam mais que malária, tuberculose e AIDS, alerta OMS. Disponível em: <http://www.onu.org.br/traumas-matam-mais-que-malaria-tuberculose-e-aids-alerta-oms/>. Acesso em: 22 julho 2019 Ansari MH. Maxillofacial fractures in Hamedan province, Iran: a retrospective study (1987-2001). J Craniomaxillofac Surg. 2004;32(1):28-34. Kostakis G, Stathopoulos P, Dais P, Gkinis G, Igoumenakis D, Mezitis M, Rallis G. An epidemiologic analysis of 1,142 maxillofacial fractures and concomitant injuries. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(5 Suppl):S69-73. Li Z, Li ZB. Characteristic changes of pediatric maxillofacial fractures in China during the past 20 years. J Oral Maxillofac Surg 2008;66:2239-42. Fonseca RJ. Trauma Bucomaxilofacial 4. ed. Rio de Janeiro : Elsevier; 2015. Wulkan M, Parreira Junior JG, Botter DA. Epidemiologia do trauma facial. Rev Assoc Med Bras. 2005;51(5):290-95. Scherer M, Sullivan WG, Smith DJ Jr, Phillips LG, Robson MC. An analysis of 1,423 facial fractures in 788 patients at an urban trauma center. J Trauma. 1989;29(3):388-90. Cohen RS, Pacios AR. Facial and cranio-facial trauma: epidemiology, experience and treatment. F Med. 1995;111(suppl):111-16. de Birolini D, Utiyama E, Steinman E. Cirurgia de Emergência. São Paulo: Atheneu; 1997. Tessier P. The classic reprint: experimental study of fractures of the upper jaw. 3. René Le Fort, M.D., Lille, France. Plast Reconstr Surg. 1972;50(6):600-7. Buehler JA, Tannyhill RJ 3rd. Complications in the treatment of midfacial fractures. Oral Maxillofac Surg Clin North Am. 2003;15(2):195-212. Manson PN, Clark N, Robertson B, Slezak S, Wheatly M, Vander Kolk C, Iliff N. Subunit principles in midface fractures: the importance of sagittal buttresses, soft-tissue reductions, and sequencing treatment of segmental fractures. Plast Reconstr Surg. 1999;103(4):1287-306; Carr RM, Mathog RH. Early and delayed repair of orbitozygomatic complex fractures. J Oral Maxillofac Surg. 1997;55(3):253-8; 258-9.

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Epidemiology of Maxillo-Facial Trauma During COVID-19 Lockdown: Reports From the Hub Trauma Center in Milan

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520983119 ◽

2020 ◽

pp. 194338752098311

Author(s):

Gabriele Canzi ◽

Elena De Ponti ◽

Federica Corradi ◽

Roberto Bini ◽

Giorgio Novelli ◽

...

Keyword(s):

Interpersonal Violence ◽

Trauma Center ◽

Major Trauma ◽

Suicide Attempts ◽

Linear Trend ◽

Trauma Team ◽

Facial Trauma ◽

Facial Fractures ◽

Epidemiological Changes ◽

Systemic Symptoms

Study Design Retrospective study. Objective: Following SARS-CoV-2 pandemic break-out a lockdown period for the population and a reorganization of the Health System were needed. Hub-function Centers for time-dependent diseases were identified and Niguarda Hospital (Milan) was selected as main Regional Trauma Center. The purpose of our study is to report the experience of Niguarda Maxillofacial Trauma Team during this period, pointing out epidemiological changes in the presentation of trauma in comparison to the previous 3 years. Methods: Two hundred and sixteen patients were admitted to the Emergency Department from 8th March 2020 to 8th May 2020. One hundred and eighty-one had a diagnosis of Major Trauma and 36 had also facial fractures; 35 patients had isolated facial fractures. Data were compared to the activity during the same period in 2017-2019 and statistical analysis was carried out concerning demographic and clinical characteristics, trauma dynamics and positivity to COVID-19. Results: Cumulative curves of patients admitted because of Major Trauma describe a superimposable linear trend in years 2017-2019, while 2020 shows an increase from April 16th. Average age and number of more severe patients were higher than previous years. Epidemiological changes concerned road accidents, accidents involving pedestrians and cyclists, interpersonal violence, suicide attempts and domestic accidents. The incidence of facial fractures was confirmed through years and, according to its measured severity, 75% of patients required management. COVID-19 positivity without systemic symptoms didn’t influence the type of treatment. Conclusion: The COVID-19 lockdown offers a unique opportunity to study the reversal epidemiological effects on trauma.

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“AN ANALYSIS OF OPHTHALMIC INJURIES IN PATIENTS WITH MAXILLOFACIAL TRAUMA”

10.36106/ijsr/7102551 ◽

2021 ◽

pp. 81-83

Author(s):

Sharmila. S ◽

Abhilash Balakrishnan ◽

Saji Nair .A ◽

Ajith Kumar.K

Keyword(s):

Maxillofacial Surgery ◽

Maxillofacial Trauma ◽

Facial Trauma ◽

Oral And Maxillofacial Surgery ◽

Ocular Injury ◽

Age Group ◽

Facial Fractures ◽

Periorbital Oedema ◽

Maxillofacial Fractures ◽

Ocular Injuries

PURPOSE OFTHE STUDY: To estimate the proportion and types of ophthalmic injuries in patients with maxillofacial fractures PATIENTS AND METHODS: All patients with maxillofacial trauma, who came to the Department of Oral and Maxillofacial surgery Government Dental college Thiruvananthapuram from November 2020 to June 2021were included in this study. The information and data collected included age, sex, mechanism of injury, type of maxillofacial fracture and type of ophthalmic injury. RESULTS: Ocular injury was sustained by 209 patients out of which 180 (86.1%) were males and 29(13.9%)were females. The largest age group of patients associated with ophthalmic injuries were 30-39 years. The etiology of facial fractures or ocular injuries showed that road trafc accidents more frequently resulted in ocular injuries 66.5% followed by assault 18.7% and self fall 14.8%. Ophthalmic injuries occurred mostly in association with orbital fractures 33.5% followed by Zygomatico maxillary complex fracture 26.8%and Maxillary sinus fractures 24.4%. Periorbital oedema was the most common ophthalmic injury accounting for 46.4%of cases followed by Periorbital ecchymosis 35.4% and Subconjuntival haemorrhage 17.2%. CONCLUSION: Mid facial trauma commonly causes ophthalmic injuries of varying degrees. Prompt ophthalmic examination of all patients with mid facial trauma is mandatory to prevent any blinding complications

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Incidence, Etiology, and Patterns of Maxillofacial Fractures in Ain-Shams University, Cairo, Egypt: A 4-Year Retrospective Study

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1374061 ◽

2014 ◽

Vol 7 (3) ◽

pp. 224-232 ◽

Cited By ~ 9

Author(s):

Amr Mabrouk ◽

Hesham Helal ◽

AbdelRahman Mohamed ◽

Nada Mahmoud

Keyword(s):

Road Traffic ◽

Facial Trauma ◽

P Value ◽

Published Data ◽

Trauma Patients ◽

Cross Sectional ◽

Male Predominance ◽

The Past ◽

Maxillofacial Fractures ◽

Epidemiological Characteristics

Although there is a worldwide increase in maxillofacial trauma incidence; the pattern and etiology of these injuries varies from one country to another depending on socioeconomic, cultural, and environmental factors. This study aims to realize the epidemiological characteristics of maxillofacial fractures in our department. A retrospective cross-sectional study of all facial trauma patients admitted to our department during 2009 to 2012. Patients’ data including gender, age, etiology of trauma, the pattern and demographic distribution of fractures of maxillofacial skeleton, and associated injuries were analyzed and compared with previously published data. The chi-square test was used with a p value of less than 0.05, which was considered statistically significant. There is a significant increase in maxillofacial fractures incidence in the past 2 years than former ones. There is a male predominance with highest incidence in the age group of 20 to 40 years. Road traffic accident is the most common etiological factor followed by violence. There is increase in mandibular fracture incidence compared with midface. The significant increased incidence of maxillofacial fracture due to motor car accidents and assaults in the past 2 years reflects a behavioral change within the community.

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The alcoholic individual and facial trauma: a 3 years survey

International Surgery Journal ◽

10.18203/2349-2902.isj20205348 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4003

Author(s):

Manish Munjal ◽

Sonika Kanotra ◽

Shubham Munjal ◽

Parth Chopra ◽

Tullika Saggar ◽

...

Keyword(s):

Traffic Accidents ◽

Road Traffic ◽

Health Care Facilities ◽

Facial Trauma ◽

Trauma Patients ◽

Injury Incidence ◽

Le Fort ◽

Medical College ◽

Drunken Driving ◽

Le Fort I

Background: Road traffic accidents, under the influence of alcohol constitute a majority of patients in the emergency trauma services in tertiary health care facilities. The incidence of the same and the region predominantly involved was analysed.Methods: 61 subjects in the Otorhinolaryngology and Maxillofacial trauma services were studied, during a period of 2 years, at Dayanand medical college, Ludhiana, Punjab. In this prospective study the admission records were analysed in context to alcohol intake prior to the trauma.Results: The incidence of facial fractures, attributed to road-side accidents was the highest i.e. 72%. Other antecedent events were, assaults in 15%, fall from heights in 8% and due to sport injuries in 3.2%. 34% of our patients were under the influence of alcohol at the time of injury. Incidence of facial fracture in our series were fracture mandible, 39.3%, zygomatic 23.5%, Le Fort II 17.9% and nasoethmoid 12.3%. One case of Le Fort I, orbital and alveolar fracture was seen.Conclusions: Drunken driving in Punjab was behind one third i.e. 34% of the trauma patients in our casualty services.

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Tratamento de Fratura Le fort I em paciente jovem: relato de caso

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v8i2.3166 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Gabriel Mulinari-Santos ◽

Breno dos Reis Fernandes ◽

Bruno Coelho Mendes ◽

Sormani Bento Fernandes de Queiroz ◽

Juliana Zorzi Coléte ◽

...

Keyword(s):

Experimental Study ◽

Head And Neck ◽

Neck Surgery ◽

Sao Paulo ◽

Head And Neck Surgery ◽

São Paulo ◽

Le Fort ◽

Segmental Fractures ◽

Upper Jaw ◽

Le Fort I

Em seu estudo, René Le Fort caracterizou três tipos de padrões fratura: Le Fort I, II e III. Na Le Fort I, observou um traço de fratura transverso na maxila acima do ápice dos dentes. Com o aumento da força de intensidade nos traumas, os três padrões de fratura Le Fort, são cada vez mais improváveis de acontecer de forma isolada. Com isso, este trabalho tem como objetivo apresentar um caso clínico de uma fratura do tipo Le Fort I em um paciente jovem, tratada com placas de titânio nos pilares caninos e zigomáticos da maxila.Descritores: Traumatologia; Maxila; Fixação de Fratura.ReferênciasHupp JR, Ellis III E, Myron R. Cirurgia oral e maxilo facial –Tucker. 6. Ed; 2015.Bailey BJ. Head and Neck Surgery-Otolaryngology. Philadelphia: JB Lippincott Company; 2001.Tessier P. The classic reprint: experimental study of fractures of the upper jaw. I and II. René Le Fort, MD. Plast Reconstr Surg. 1972; 50(5):497-506.Tessier P. The classic reprint: experimental study of fractures of the upper jaw. 3. René Le Fort, MD, Lille, France. Plast Reconstr Surg. 1972;50(6):600-7.Cummings CW. Otolaryngology-Head and Neck Surgery. St. Louis, USA, Mosby Year Book,1993, vol. 1Philadelphia: JB Lippincott Company; 2001.Miniti A. Bento,R.F. Butugan, O. ORL Clínica e cirúrgica. São Paulo: Atheneu; 1993.Birolini D, Utiyama E, Steinman E. Cirurgia de Emergência. São Paulo, Atheneu; 1997.Juhl JH. Crummy AB. Paul and Juhl´s Essential of Radiologic Imaging; 1996.Manson PN, Clark N, Robertson B, Slezak S, Wheatly M, Vander Kolk C et al. Subunit principles in midface fractures: the importance of sagittal buttresses, soft-tissue reductions, and sequencing treatment of segmental fractures. Plast Reconstr Surg. 1999;103(4):1287-306.

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Sports-Related Pediatric Facial Trauma: Analysis of Facial Fracture Pattern and Concomitant Injuries

The Surgery Journal ◽

10.1055/s-0039-1697627 ◽

2019 ◽

Vol 05 (04) ◽

pp. e146-e149 ◽

Cited By ~ 2

Author(s):

Andrew A. Dobitsch ◽

Nicholas C. Oleck ◽

Farrah C. Liu ◽

Jordan N. Halsey ◽

Ian C. Hoppe ◽

...

Keyword(s):

Pediatric Population ◽

Skull Fracture ◽

Management Strategies ◽

Nasal Bone ◽

Fracture Pattern ◽

University Hospital ◽

Facial Trauma ◽

Facial Fractures ◽

Facial Skeleton ◽

Concomitant Injuries

Abstract Objective Sports-related injuries, such as facial fractures, are potentially debilitating and may lead to long-term functional and aesthetic deficits in a pediatric patient. In this study, we analyze sports-related facial fractures in the urban pediatric population in an effort to characterize patterns of injury and improve management strategies and outcomes. Methods Retrospective chart review was performed for all facial fractures resulting from sports injuries in the pediatric population at a level-1 trauma center (University Hospital, Newark, NJ). Results Seventeen pediatric patients were identified as having sustained a fracture of the facial skeleton due to sports injury. Mean age was 13.9 years old. A total of 29 fractures were identified. Most common fracture sites included the orbit (n = 12), mandible (n = 5), nasal bone (n = 5), and zygomaticomaxillary complex (n = 3). The most common concomitant injuries included skull fracture (n = 3), intracranial hemorrhage (n = 4), and traumatic brain injury (n = 4). One patient was intubated upon arrival to the emergency department. Hospital admission was required in 13 patients, 4 of which were admitted to an intensive care setting. Nine patients required operative intervention. Mean length of hospital stay was 2.4 days. No patients were expired. Conclusions Sports-related facial fractures are potentially debilitating injuries in the pediatric population. Analysis of fracture pattern and concomitant injuries is imperative to develop effective management strategies and prevention techniques.

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Avoiding occlusal derangement in facial fractures: An evidence based approach

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.118596 ◽

2013 ◽

Vol 46 (02) ◽

pp. 215-220 ◽

Cited By ~ 4

Author(s):

Derick Mendonca ◽

Deepika Kenkere

Keyword(s):

Fracture Line ◽

Occlusal Plane ◽

Facial Fractures ◽

Body Angle ◽

Adequate Care ◽

Maxillofacial Fractures ◽

Maxilla And Mandible ◽

Mandible Fractures ◽

Le Fort I ◽

Operating Surgeon

ABSTRACTFacial fractures with occlusal derangement describe any fracture which directly or indirectly affects the occlusal relationship. Such fractures include dento-alveolar fractures in the maxilla and mandible, midface fractures - Le fort I, II, III and mandible fractures of the symphysis, parasymphysis, body, angle, and condyle. In some of these fractures, the fracture line runs through the dento-alveolar component whereas in others the fracture line is remote from the occlusal plane nevertheless altering the occlusion. The complications that could ensue from the management of maxillofacial fractures are predominantly iatrogenic, and therefore can be avoided if adequate care is exercised by the operating surgeon. This paper does not emphasize on complications arising from any particular technique in the management of maxillofacial fractures but rather discusses complications in general, irrespective of the technique used.

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Burden of Maxillofacial Trauma at Level 1 Trauma Center

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1371539 ◽

2014 ◽

Vol 7 (2) ◽

pp. 126-130 ◽

Cited By ~ 9

Author(s):

Ruchi Pathak Kaul ◽

Sushma Sagar ◽

Maneesh Singhal ◽

Abhishek Kumar ◽

Jiten Jaipuria ◽

...

Keyword(s):

Trauma Center ◽

The Body ◽

Maxillofacial Trauma ◽

Etiologic Factor ◽

Mandibular Fractures ◽

New Delhi ◽

Maxillofacial Injuries ◽

Concomitant Injuries ◽

Female Ratio ◽

Maxillofacial Fractures

There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide. This study was performed to evaluate the pattern of maxillofacial fractures, associated injuries, and treatment used at Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India, between January 2007 and June 2010. The study provides basis for establishment of trauma as major etiology of maxillofacial injuries and planning for preventive strategies. A retrospective study of patients seen and treated at JPNATC, AIIMS, New Delhi, between January 2007 and June 2010 was performed. Data extracted from patient records included etiology, age, sex, types and sites of fractures, treatment modality, and concomitant injuries. There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (RTA) (56.8%) was the most common etiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 to 75 years (mean, 34.7 years) with a peak incidence in the third decade with a male-to-female ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615 (77%) and middle third 180 (23%). With regard to mandibular fractures, the body (29.6%) was the most common site, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%), and Lefort III (3.3%). Majority of the patients were treated by open reduction and internal fixation (70.6). Concomitant injuries were 84 (10.8%) with orthopedic injuries accounting for the majority (63.9%). Head injury was associated in 16.3% of cases. RTA was the major etiologic factor of maxillofacial injuries in our setting and the young adult males were the main victims. Henceforth, establishment of regionalized, efficient, and focused trauma centers in various parts of the country particularly for acute trauma should be emphasized. Also, the laws regarding the precautions such as seat belts, speed limits, and traffic rules must be observed strictly to reduce the incidence of RTA.

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Sphenoid Sinus and Sphenoid Bone Fractures in Patients with Craniomaxillofacial Trauma

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0033-1343778 ◽

2013 ◽

Vol 6 (3) ◽

pp. 179-186 ◽

Cited By ~ 4

Author(s):

Jorge Ernesto Cantini Ardila ◽

Miguel Ángel Rivera Mendoza ◽

Viviana Gómez Ortega

Keyword(s):

Trauma Center ◽

Sphenoid Sinus ◽

Bone Fractures ◽

High Energy ◽

Sphenoid Bone ◽

Facial Trauma ◽

High Morbidity ◽

Facial Fractures ◽

Facial Skeleton ◽

High Energy Trauma

Background and PurposeSphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures.MethodsWe retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson.DesignThis is a retrospective descriptive study.ResultsThe study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirty-eight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures.ConclusionsHigh-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case–control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures.

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THE ROLE OF MULTI DETECTOR COMPUTERIZED TOMOGRAPHY (MDCT) IN EVALUATION OF MAXILLOFACIAL FRACTURES.

10.36106/ijsr/3107810 ◽

2021 ◽

pp. 55-58

Author(s):

P. Mamatha ◽

V. Venkatarathnam ◽

R. Ramesh Kumar ◽

Hameed Arafath

Keyword(s):

Computerized Tomography ◽

Surgical Planning ◽

Nasal Bone ◽

Facial Trauma ◽

Facial Fractures ◽

Maxillofacial Region ◽

Number Of Patients ◽

Maxillofacial Fractures ◽

Classi Cation

Objective: The purpose of our study was to assess the role of Multidetector Computerized tomography in the evaluation of maxillofacial fractures and to describe the frequency and types of fractures that underwent CT scans. Subjects And Methods: The study included 50 patients suspected of facial trauma referred from the emergency unit from PESIMSR ,Kuppam. All patients were subjected to non contrast MDCT in axial cuts and images are transferred to workstation then coronal and sagittal reconstruction obtained. Results: There were 37 male and 13 female patients. The maximum number of patients fall into 21-40 years followed by 41 to 60 years .50 patients had total 170 fractures. It was found that the maxillary sinus is the most common to be fractured (found in 24 cases) followed by nasal bone (18) , zygomatic arch (17), mandible (13) ,greater wing of sphenoid (9), sphenoid sinus (8), frontal sinus (7) ,pterygoid plates (7), bony nasal septum (6) ,ethmoid sinus (3).Among complex facial fractures orbital fractures are the most frequent (found in 47 cases), followed by zygomatico-maxillary junction fractures (4) ,Tripod fractures( 4) , and Naso-orbito-ethmoid region fractures (3). Conclusion: Maxillofacial trauma is one of the most common emergency requiring accurate and early diagnosis. MDCT is useful diagnostic tool for the identication and classication of maxillofacial region fractures and aiding in surgical planning.

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