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Fraturas da mandíbula por projétil de arma de fogo
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Resumo(s)
Tanto em ambiente militar como em ambiente civil, a violência mundial com recurso a armas de fogo é uma preocupante realidade. Atualmente, verifica-se que as regiões da cabeça e do pescoço são das mais atingidas pelos projéteis de arma de fogo (P.A.F.). Quando os P.A.F. atingem a mandíbula originam sobretudo fraturas de padrão cominutivo. Historicamente, o tratamento reconstrutivo desse tipo de lesões, tem sofrido inúmeras modificações na literatura. Relativamente ao seu tempo de reconstrução definitivo, há duas opiniões distintas: a reconstrução tardia vs a reconstrução imediata. Atualmente, a abordagem imediata é a mais adotada. Igualmente há controvérsia na literatura no que toca ao tipo de tratamento reconstrutivo a realizar. Classicamente, defendia-se a reconstrução com recurso a técnicas de redução fechada. Contemporaneamente, após o aparecimento das técnicas de redução aberta e fixação interna rígida (OR IF), a mentalidade alterou-se, e este passou a ser o padrão no tratamento das fraturas cominutivas da mandíbula. Assim, perante lesões tão destrutivas como as causadas pelos P.A.F. na mandíbula, importa escolher o método reconstrutivo que garanta a restauração estável da oclusão, a mobilidade articular e o resultado estético mais aceitável.
In both military and civilian environments, global violence using firearms is a worrying reality. It is verified that the region of the head and neck is the most affected by firearm projectiles (FP). When FP reach the mandible, they mainly cause comminuted pattern fractures. Historically, the reconstructive treatment of this type of lesions has undergone numerous modifications in the literature. Regarding its definitive reconstruction time, there are two distinct opinions: late reconstruction vs. immediate reconstruction. Currently, the immediate approach is the most adopted. There is also controversy in the literature regarding the type of reconstructive treatment to be performed. Classically, reconstruction was advocated using closed reduction techniques. At the same time, after the appearance of open reduction techniques and rigid internal fixation (OR IF), the mentality was altered, and this became the main treatment of comminuted fractures of the mandible. Thus, in the case of lesions as destructive as those caused by FP in the mandible, it is important to choose the best reconstructive method that guarantees both restoration of the occlusion with the pre-injury function and the most acceptable aesthetic result.
In both military and civilian environments, global violence using firearms is a worrying reality. It is verified that the region of the head and neck is the most affected by firearm projectiles (FP). When FP reach the mandible, they mainly cause comminuted pattern fractures. Historically, the reconstructive treatment of this type of lesions has undergone numerous modifications in the literature. Regarding its definitive reconstruction time, there are two distinct opinions: late reconstruction vs. immediate reconstruction. Currently, the immediate approach is the most adopted. There is also controversy in the literature regarding the type of reconstructive treatment to be performed. Classically, reconstruction was advocated using closed reduction techniques. At the same time, after the appearance of open reduction techniques and rigid internal fixation (OR IF), the mentality was altered, and this became the main treatment of comminuted fractures of the mandible. Thus, in the case of lesions as destructive as those caused by FP in the mandible, it is important to choose the best reconstructive method that guarantees both restoration of the occlusion with the pre-injury function and the most acceptable aesthetic result.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Fraturas da mandíbula Fraturas cominutivas Projétil de arma de fogo Cirurgia plástica