Saulo Ellery Santos

A Comparison of Motorcycle and Bicycle Accidents in Oral and Maxillofacial Trauma

PURPOSE The aim of this study was to present a large series of motorcycle- and bicycle-related traumas to the face in an attempt to identify the injury pattern in motorcyclists and bicyclists. PATIENTS AND METHODS Data were collected from patients during a 10-year period (1999 through 2009), which included demographic data, diagnosis of facial fractures, use of protective devices, dentoalveolar trauma, and facial soft tissue injuries. RESULTS There were 556 patients with bicycle accidents and 367 with motorcycle accidents. Men were involved in 79% (436) of bicycles accidents and 82% (299) of motorcycle accidents. Young male patients were more frequent in bicycle and motorcycle accidents. Two hundred fifty bicyclists showed 311 maxillofacial fractures. Two hundred twenty-one motorcyclists showed 338 maxillofacial fractures. Motorcycle accidents caused multiple fractures in more patients. Seventy-six percent of motorcyclists were using helmets at the time of the accidents, whereas 6% of cyclists were using helmets. Motorcyclists showed a larger number of lacerations, whereas bicyclists showed a larger number of abrasions. Avulsion was the most common dentoalveolar injury for these accident types. Hospital stays were 3.8 days for motorcyclists and 1.3 days for bicyclists. CONCLUSIONS The high-impact collisions typically observed in motorcycle accidents is directly related to larger percentages of soft tissue lacerations and facial fractures. The low-impact trauma that is observed in bicycle accidents is more commonly associated with soft tissue abrasion, hematoma, and dentoalveolar fractures. This stresses the need for compulsory legislation for helmet use with face-guards for cyclists and motorcyclists. It is important to take measures to alert the public regarding the severity of injuries likely to occur in bicycle- and motorcycle-related accidents and ways to prevent them.

A 9-Year Retrospective Study of Dental Trauma in Piracicaba and Neighboring Regions in the State of São Paulo, Brazil

PURPOSE The purpose of this study was to evaluate the occurrence of dentoalveolar trauma during a 9-year period in the Oral and Maxillofacial Surgery Division at Piracicaba Dental School, State University of Campinas in patients from the Piracicaba municipality and neighborhood regions in São Paulo, Brazil. PATIENTS AND METHODS This retrospective epidemiologic study from January 1999 to December 2007 evaluated all patients who presented at the Oral and Maxillofacial Surgery Division at Piracicaba Dental School with sustained oral and maxillofacial traumatic injuries associated with dentoalveolar trauma. Information regarding age, gender, etiology, use of protective devices such seatbelts, crash helmets, and presence of facial fractures and general trauma, oral condition, stage of dentition, date of trauma, drug abuse, type, teeth affected, and classification of the trauma were gathered from the medical files. Descriptive analysis was conducted. RESULTS In total, 2,785 patients were analyzed and 542 (19.46%) were included in this study. The male to female ratio was 2.81:1. Most patients presented with oral hygiene as regular (51.85%). Friday, Saturday, and Sunday were the most prevalent days. Smoking was the most common harmful habit analyzed (16.05%) followed by alcohol use (15.87%). Bicycle accidents (26.94%) were the most common cause, followed by falls (22.69%). With regard to protective devices, 31.51% of drivers were wearing seatbelts during the accidents and helmets were used by 84.38% of motorcycle drivers at the moment of injury. One hundred thirty-five facial fractures were associated with dental and dentoalveolar traumas, and the mandible was the facial bone most associated with dentoalveolar trauma. Upper and lower limbs were most frequently associated with general trauma, accounting for 140 (38.78%) and 111 (30.75%), respectively. CONCLUSION This study shows that dentoalveolar trauma rates and patterns in the Piracicaba municipality and neighborhood regions in São Paulo are similar to other populations. The weekend is the period with the major incidence of dentoalveolar trauma. Alcohol consumption was linked with this type of trauma. Dentoalveolar trauma is involved in and closely related to severe maxillofacial trauma. The use of a helmet is as important as that of a seatbelt. More studies are necessary for a better knowledge and understanding when considering protocols and organization charts in emergency rooms.

Skeletal stability after inferior maxillary repositioning without interpositional graft

True vertical maxillary deficiency is a characteristic of short face syndrome. In these patients, inferior repositioning of the maxilla (IRM) is indicated to improve facial aesthetics and function, but this procedure has been described as the most unstable. The aim of this study was to evaluate the long term, post surgical stability of IRM, fixed with four 2.0mm L-shaped miniplates, without any type of graft. A cephalometric study was performed, analysing linear measurements (anterior nasal spine, the A point, top of the incisor, top of the buccal-mesial cusp of the first molar, and posterior nasal spine on an X-Y coordinate system) traced immediately preoperatively, immediately postoperatively and at least 6 months post operatively. Eight young adult patients who underwent IRM were studied. The average results of this study were: surgical movement of 4.65 mm at I point, 5.32 mm at anterior nasal spine (ANS) point, and 4.70 mm at A point and relapses of 1.60 mm (35%), 2.23 mm (43%) and 2.10 mm (46%), respectively. It was concluded, that IRM using this type of internal rigid fixation without graft is unstable.

A Rare Case of Mediastinal and Cervical Emphysema Secondary Mandibular Angle Fracture: A Case Report

Subcutaneous emphysema in the head and neck is a well-known clinical entity usually associated with trauma to the facial bones and dentoalveolar surgery. Cervical, retropharyngeal, and mediastinal emphysema is a more severe manifestation associated with traumatic injuries to the facial bones and aerodigestive tract and is associated with potentially severe and even life-threatening complications. Mandibular fracture as a cause of mediastinal emphysema is rare, with only 4 cases having been reported in the literature. Mediastinal and cervical emphysema has been described after other maxillofacial injuries such as zygomaticomaxillary complex fractures, orbital blow-out fractures, naso-orbito-ethmoid fractures, and isolated maxillary sinus fractures. Iatrogenic emphysema has been reported and includes the use of air turbine dental drills, CO2 laser, O2 cryomachine, air abrasive system, endotracheal/ entilation in patients after dental surgical proceures, and endodontic treatment. Pneumomediastinum has been documented after orthognathic surgery and acute, transient episodes of respiratory bstruction, such as that produced by the Valsalva aneuver, violent coughing, and emesis.

Sagittal Osteotomy for the Removal of Deeply Impacted Mandibular Molars: A Presentation of Series of Cases

Sagittal osteotomy was primarily described as a treatment for prognathism and retrognathia. It has been rarely reported as an option for the removal of deeply impacted tooth. The principal indication of this approach is when the tooth is deeply impacted on the mandibular ramus or body and it presents intimate relationship between its root and inferior alveolar neurovascular bundles. In this article the author related three rare cases of lower third molar included. Because of the unusual deeply position of these, the SRRO surgery technique was realized to remove them. Sagittal split ramus osteotomy (SSRO) is technically safe and allows the removal of teeth in situations of deeply impacted mandibular ramus, angle or body with minimal trauma in a short time.