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Fraturas da mandíbula em idade pediátrica : a experiência de 15 anos de um hospital terciário
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Introdução e Objetivo: As fraturas mandibulares em crianças são as mais comuns entre as fraturas faciais na idade pediátrica. A abordagem médico-cirúrgica das fraturas maxilofaciais pediátricas é desafiante devido ao desenvolvimento do esqueleto ósseo intrínseco nesta fase etária. Para umcuidado eficaz que preserve a forma e a função da mandíbula após a lesãomaxilofacial, é fundamental compreender os mecanismos de lesão, os padrões de fratura, as modalidades de tratamento adotadas na abordagem das fraturas mandibulares pediátricas. Pretende-se fazer uma análise retrospetiva das características, da abordagem médico-cirúrgica, dos resultados e das complicações das fraturas mandibulares pediátricas tratadas cirurgicamente num Hospital terciário. Método: Foram revistos os processos clínicos e os registos operatórios de 78 doentes, com idades até aos 18 anos, com fraturas mandibulares tratadas cirurgicamente no Serviço de Cirurgia Plástica, Reconstrutiva e Estética do Hospital de SantaMaria, em Lisboa, Portugal, entre os anos de 2008 a 2023. Foramanalisados dados demográficos, clínicos, mecanismos da lesão, localização e tipo de fratura, lesões associadas, tipo de tratamento e complicações. Resultados: Foram identificadas 142 fraturas em 78 doentes. A razão feminino/masculino foi 3.6:1. A idade média foi de 12,24 anos. A maior parte dos doentes tinha entre 13 e 15 anos (32%). O côndilo foi a localização anatómicamais frequentemente fraturada (26,76%). Quarenta e dois doentes (53,84%) apresentaram 2 ou mais fraturas da mandíbula. Os acidentes de viação foram o mecanismo de lesão mais frequente de fratura (26,9%), seguido das quedas (24,4%). Foram documentadas 90 lesões associadas em 56 doentes (71,8%), sendo a região da cabeça e pescoço a mais afetada (43,59%). Emrelação ao tratamento, 29 doentes (37,18%) foramsubmetidos a redução aberta e fixação interna (ORIF), enquanto 27 doentes (34,62%) foram tratados com imobilização maxilo-mandibular (IMM). Adicionalmente, 17 doentes (21,79%) foram tratados de forma combinada com ORIF + IMMe 5 doentes (6,41%) foram tratados com ORIF + tratamento conservador. As placas absorvíveis foram utilizadas em 15 (29,41%) dos procedimentos de ORIF. A ORIF foi a modalidade de tratamento preferencial para fraturas de sínfise (80%), parassínfise (90,62%) e ângulo (84,62%), enquanto as fraturas condilianas e subcondilianas forammaioritariamente tratadas com IMM(81,58% e 87,5%, respetivamente). Treze doentes (16,66%) apresentaram complicações, sendo a falência do material de osteossíntese a complicação mais comum(29,41%). Conclusão: As fraturas mandibulares em crianças apresentam uma grande variedade de padrões de fratura, sendo os resultados do tratamento influenciados por diversos fatores, nomeadamente a idade da criança, o mecanismo da lesão e a modalidade terapêutica adotada. Este estudo realça a importância de compreender estes fatores para otimizar a abordagem clínica e cirúrgica, de modo a maximizar os resultados funcionais e estéticos para os doentes. Os resultados globais do tratamento foram positivos, evidenciando a eficácia da abordagem utilizada no tratamento das fraturas mandibulares pediátricas neste centro hospitalar. Para uma melhor caracterização da taxa de complicações, são necessários estudos prospetivos comumperíodo de acompanhamento mais longo.
Introduction and Objective: Pediatric mandible fractures are the most common pediatric facial fracture. Pediatric maxillofacial fractures present unique challenges due to the evolving facial skeleton and varyingmechanisms of injury. A comprehensive understanding of the causes, fracture patterns, and treatment outcomes is crucial for effective patient care. We aim to conduct a retrospective analysis of the characteristics, medical-surgical approach, outcomes, and complications of pediatric mandibular fractures treated surgically at a tertiary hospital. Methods: We conducted a retrospective analysis of clinical records of 78 pediatric patients, aged 18 years or younger, who underwent surgical treatment for mandibular fractures at the Department of Plastic, Reconstructive and Aesthetic Surgery of SantaMaria Hospital, Lisbon, Portugal, spanning the period from 2008 to 2023. Demographic data, fracture characteristics, injury mechanisms, associated injuries, treatment methods, complications and follow-up were systematically collected and analyzed. Results: A total of 142 fractures in 78 patients were identified. The male-to-female ratio was 3.6:1. The mean age was 12,24 years. The largest age group comprised those aged between 13 and 15 years, representing 32% of the patients. The condyle was the most frequently fractured site (26,76%). Forty-two patients (53,84%) had 2 or more mandible fractures. The most common mechanism of injury was motor vehicle accidents (26,9%), followed by falls (24,4%). There were 90 associated injuries documented in 56 patients (71.8%), with the head and neck region being the most affected (43.59%). Regarding treatment, 29 patients (37,18%) underwent open reduction and internal fixation (ORIF), while 27 patients (34,62%) were treated with maxillomandibular fixation (MMF). Additionally, 17 patients (21,79%) underwent both MMF and ORIF procedures, while 5 patients (6,41%) were managed with a combination of ORIF and conservative treatment. Absorbable plating was utilized in 15 (29,41%) of the ORIF procedures. ORIF emerged as the preferred approach for symphysis (80%), parasymphysis (90,62%), and angle (84,62%) fractures, whereas condylar and subcondylar fractures were typically managed withMMF (81,58% and 87,5% respectively). Thirteen patients (16,66%) experienced complications, with hardware failure being themost common issue (29,41%). Conclusion: Pediatric mandibular fractures pose significant clinical challenges, with varying patterns and outcomes influenced by age,mechanism of injury, and treatment modality. This study emphasizes the importance of understanding these factors to optimizemanagement strategies and improve patient outcomes. In this study, overall treatment outcomes were positive, highlighting the efficacy of chosen interventions in addressing pediatricmandibular fractures in this center. To better characterize the complication rate, prospective studieswith a longer follow-up period are needed.
Introduction and Objective: Pediatric mandible fractures are the most common pediatric facial fracture. Pediatric maxillofacial fractures present unique challenges due to the evolving facial skeleton and varyingmechanisms of injury. A comprehensive understanding of the causes, fracture patterns, and treatment outcomes is crucial for effective patient care. We aim to conduct a retrospective analysis of the characteristics, medical-surgical approach, outcomes, and complications of pediatric mandibular fractures treated surgically at a tertiary hospital. Methods: We conducted a retrospective analysis of clinical records of 78 pediatric patients, aged 18 years or younger, who underwent surgical treatment for mandibular fractures at the Department of Plastic, Reconstructive and Aesthetic Surgery of SantaMaria Hospital, Lisbon, Portugal, spanning the period from 2008 to 2023. Demographic data, fracture characteristics, injury mechanisms, associated injuries, treatment methods, complications and follow-up were systematically collected and analyzed. Results: A total of 142 fractures in 78 patients were identified. The male-to-female ratio was 3.6:1. The mean age was 12,24 years. The largest age group comprised those aged between 13 and 15 years, representing 32% of the patients. The condyle was the most frequently fractured site (26,76%). Forty-two patients (53,84%) had 2 or more mandible fractures. The most common mechanism of injury was motor vehicle accidents (26,9%), followed by falls (24,4%). There were 90 associated injuries documented in 56 patients (71.8%), with the head and neck region being the most affected (43.59%). Regarding treatment, 29 patients (37,18%) underwent open reduction and internal fixation (ORIF), while 27 patients (34,62%) were treated with maxillomandibular fixation (MMF). Additionally, 17 patients (21,79%) underwent both MMF and ORIF procedures, while 5 patients (6,41%) were managed with a combination of ORIF and conservative treatment. Absorbable plating was utilized in 15 (29,41%) of the ORIF procedures. ORIF emerged as the preferred approach for symphysis (80%), parasymphysis (90,62%), and angle (84,62%) fractures, whereas condylar and subcondylar fractures were typically managed withMMF (81,58% and 87,5% respectively). Thirteen patients (16,66%) experienced complications, with hardware failure being themost common issue (29,41%). Conclusion: Pediatric mandibular fractures pose significant clinical challenges, with varying patterns and outcomes influenced by age,mechanism of injury, and treatment modality. This study emphasizes the importance of understanding these factors to optimizemanagement strategies and improve patient outcomes. In this study, overall treatment outcomes were positive, highlighting the efficacy of chosen interventions in addressing pediatricmandibular fractures in this center. To better characterize the complication rate, prospective studieswith a longer follow-up period are needed.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Fraturas mandibulares pediátricas Pediátria Crianças Adolescentes Trauma maxilofacial Open-reduction and internal fixation (ORIF) Imobilização maxilomandibular (IMM)