Pseudoaneurysm of the internal carotid artery presenting with massive (recurrent) epistaxes: a life-threatening complication of craniofacial trauma

Vascular lesions can be serious complications resulting of blunt or penetrating trauma(1,2). Internal carotid artery lesion is one of most serious and relatively frequent in all mechanisms of craniofacial trauma. Several clinical manifestations can occur as central neurologic and cranial nerves deficits as well as several degrees of bleeding (from mild symptomatic to fatal). Recurrent and massive epistaxis can occur after trauma due to pseudaoneurysms of the external and internal carotid artery (ICA)(3,4). Considering its life-threatening course, the assisting physician has a relatively narrow time to detect and treat these lesions.We present two cases of recurrent and massive epistaxis secondary to ICA pseudoaneurysm following blunt and perforating trauma. Evolution was fatal in the first case with delayed treatment and uneventfully in the second which was treated by occlusion of the pseudoaneurysm and ICA via endovascular intervention.

Multidisciplinary approach for crown-root fracture treatment after trauma: case report

The development of an accurate diagnosis and appropriate treatment plan can be a complex task, especially in cases of dentoalveolar trauma. The authors present a case report of crown-root fracture caused by trauma and highlight the importance of a multidisciplinary approach for the treatment. An eighteen year-old boy had a bicycle accident resulting in dental trauma. The upper right first molar showed a complicated crownroot fracture and the lower left second pre-molar showed an uncomplicated crown-root fracture. Endodontic treatment, controlled tooth extrusion, periodontal surgery for recovery of biological width, and porcelain crown and onlay restorations were performed. Esthetic and functional results were achieved. At the two-year follow-up it was observed that the tooth/onlay interface of the upper right first molar was stained and the onlay of the left lower second pre-molar was fractured. Therefore, the interface stained was repaired and a porcelain crown was made for the lower second premolar. The clinical case presented herein leads to the conclusion that a multidisciplinary treatment plan is extremely important for a proper resolution in cases of dentoalveolar trauma.

Trauma traqueal associado à fratura mandibular: relato de caso

Introduction: The mandibular injuries account for about 20% to 50% of cases of facial fractures. Some consider the jaw the second most commonly fractured bone of the skull, and is the only mobile bone of the facial framework, which results in decreased stability compared to the trauma. When one takes into account the degree of airway obstruction in patients with facial fractures, the problem becomes much more serious since it is one of the most troubling complications of trauma. Objective: the relevance of the topic is aimed to report a case of a patient victim of mandibular fracture associated with trauma to the trachea. Case report: Case report: Patient 24 years old patient with tracheal trauma concomitant mandibular fracture surgically treated in conjunction with the thoracic surgeon. After 5 months postoperatively, the patient is in good condition general, no complaints. Final comments: This form is observed that the key to proper treatment of tracheal trauma associated with facial fractures is the knowledge of the type of injury, and an accurate diagnosis multidisciplinary.

Multiple trauma in a 5 years child with a longitudinal follow up

Dental-alveolar trauma in the primary dentition associated with intra-cranial injuries is not common. This article reports the management of a complex trauma involving cranial trauma and multiple luxations and avulsions of primary teeth in a five-year old boy as a consequence of a horse kick. The treatment, including the hospital intervention and dentistry procedures, is described. The clinical outcomes are reported at a 5-year follow-up.

Opportunistic microorganisms in patients with head and neck trauma

The use of antimicrobial agents has facilitated the dissemination of multi-resistant microorganisms, compromising dental and medical treatment. The aim of this study was to evaluate the distribution of different opportunistic microbial species in patients who suffered head and neck trauma, under temporary maintenance in nosocomial environment, particularly intensive care units, on the occurrence of such microorganisms in the oral cavity of the patients. It was selected 38 patients subjected to head and neck traumas. After emergency surgical procedures, clinical samples of saliva, sub and supragingival biofilms and mucosal surfaces were collected at two different moments: just after stabilization of the patient and soon after patients’ release from medical units. The presence of opportunistic and superinfecting microorganisms was evaluated by culture on selective and non-selective media, and the presence of the family Enterobacteriaceae, as well as genera Enterococcus, Pseudomonas, and Staphylococcus was assessed by PCR. It was found that the use of antimicrobials, even for short periods of time was sufficient to facilitate colonization by microorganisms of the families Enterobacteriaceae and Pseudomonadaceae, as well as yeasts and enterococci. These results support the concept that medical and dental teams should make a periodically change of antimicrobials used in treatment protocols in hospital for head and neck trauma patients, in order to minimize dissemination of opportunistic or superinfecting microorganisms.

Reconstruction of maxillary ridge atrophy caused by dentoalveolar trauma, using autogenous block bone graft harvested from chin: a case report

Background Dentoalveolar trauma, especially when involving front teeth, negatively affect the patient’s life; in particular, tooth avulsion is a complex injury that affects multiple tissues, and no treatment option offers stable long-term outcomes. The aim of this study was to report a case of reconstruction of atrophic anterior alveolar ridge after tooth loss, performed with autograft harvested from the chin, and subsequent prosthetic rehabilitation with the use of an osseointegrated implant. Case report A 23-years-old Caucasian girl, presented an atrophic alveolar bone in the area of tooth 11, as a result of tooth resorption 10 years after a tooth reimplantation procedure. Reconstruction was performed with autogenous bone harvested from the chin. After 6-months healing period to allow autograft incorporation, a dental implant was inserted. After further 6- months, a screw-retained implant supported metal-ceramic prosthesis was fabricated. Results The prosthetic rehabilitation was successful, and after a follow-up period of 5 years, the achieved result was stable.Conclusion It can be concluded that the autogenous bone graft harvested from the chin, is a safe and effective option for alveolar ridge defects reconstruction, allowing a subsequent placement of a dental implant supporting a prosthetic restoration.

Reconstruction of maxillary ridge atrophy caused by sequela of dentoalveolar trauma with autogenous bone graft harvested from mentum

Dentoalveolar traumatisms, particularly those that affect the anterior teeth, interfere adversely in the patient s life.Among them, tooth avulsion is pointed out because it is characterized as a complex injury that affects multiple tissues, andbecause there is no effective treatment available for its resolution with a stable long-term outcome.Aim/Hypothesis: The aim of the present study was to relate a clinical case of complete reconstruction of atrophy of the alveolarbone corresponding to tooth 11, lost by tooth resorption 10 years after the tooth reimplantation procedure.Material and methods: Reconstruction was performed with autogenous bone harvested from the mentum donor site. Surgicalaccess began in the receptor area with a Newman mucoperiosteal incision using a scalpel blade 15 mounted in a scalpel handlefor detachment and exposure of the receptor site. Extensive bone resorption was observed in the vestibular-palatine direction,proved by the thinness of the receptor bed. Decorticalization of the vestibular bone plate was performed. After preparing thereceptor bed, and incision was made in the mucosa in the depth of the anterior vestibular fornix, then a perpendicular muscleperiostealincision to detach and exposure the donor area. The bone graft necessary for reconstruction of the donor area wasdelimited, followed by monocortical osteotomy and the monocortical graft was removed. The next stage was to perform shapingfor passive graft accommodation and fixation by means of two bicortical screws. After fixation of the graft the sharp angles wererounded off in order to avoid possible exposure and/or fenestrations of the reconstructed area, then the receptor and donor areawere sutured. After the 6-month period to allow incorporation of the autogenous graft, an osseointegrated dental implant wasinserted. At the end of the 6-month period of waiting for osseointegration to occur, the process of fabricating the screw-retainedmetal ceramic

Avaliação da movimentação dentária induzida após trauma de subluxação: estudo experimental em ratos

Objetivo: avaliar as alterações histológicas ocorridas na área periodontal de molares de ratos submetidos à movimentação dentária induzida (MDI), logo após um trauma intencional (subluxação). Métodos: quarenta ratos Wistar machos adultos (Rattus norvegicus albinus) foram selecionados. Os animais foram divididos em oito grupos (n = 5), de acordo com a combinação das variáveis: Grupo 1 – controle (sem trauma e sem MDI); Grupo 2 – MDI; Grupos 3, 4, 5 e 6 – grupos de trauma dentoalveolar correspondendo, respectivamente, para 1, 3, 8 e 10 dias após o trauma; Grupos 7 e 8 – os molares murinos foram submetidos a um impacto de 900cN e, de um e três dias após o evento trauma, o movimento do dente foi induzido. Os primeiros molares superiores dos animais foram movidos mesialmente durante sete dias, com uma mola fechada (50cN). Após período experimental de cada grupo, os animais foram sacrificados por overdose anestésica e as maxilas direitas foram removidas e processadas para análise histológica qualitativa. Resultados: nos animais dos grupos 3, 4, 5 e 6, as alterações histológicas não foram muito significativas. Consequentemente, o efeito do movimento dentário induzido logo após um evento de subluxação (grupos 7 e 8) foi muito semelhante ao descrito para o grupo 2. Conclusão: não houve diferença na qualidade do reparo periodontal quando a MDI foi aplicada aos dentes que sofreram um trauma de subluxação.

Utilização de SIG na sistematização de ocorrências de trauma no SAMU-192 das cidades de Feira de Santana BA e Rio Claro SP

Considering current technological progresses, they prove to be useful tools to be increasingly exploited in order to meet the population's needs. Generally, in Brazil, the Mobile Emergency Services (SAMU) tend to be limited to the management of incidents, which undermines the efficiency of these bodies. In this context, this final dissertation aims to present the use of Geographic Information Systems (GIS) for the SAMU in the cities of Feira de Santana BA and Rio Claro SP, integrating occurrences data related to trauma by cold weapon injuries, injury by gun, and assaults, in the period 2012-2013, as well as census data. The study was developed in stages that included obtaining data related to trauma events linked to urban violence, and statistical Census data (2010), provided by the Brazilian Institute of Geography and Statistics (IBGE). Regarding the GIS, the free software Quantum GIS (QGIS) was adopted for processing and spatializing data, assuming the districts as units of study, in the urban area of the cities analyzed. The resulting research products were presented in thematic maps format, which conducted to a comparative analysis of the occurrences related to traumas. The achieved results were satisfactory, and a database in GIS was developed, integrating occurrences data by Cold Weapon Injuries (FAB), Injury by Gun (FAF) and Assaults with census data, allowing the proper use and update of the system. Making a comparative analysis between the two cities, it was possible to establish that Rio Claro presents more occurrences when it comes to FAF, FAB and Aggression recorded at SAMU per 100,000 inhabitants than Feira de Santana. Thus, although Rio Claro's population is about three times smaller than Feira de Santana's, it can be said that Rio Claro is a more violent city, considering the factors analyzed. It is possible to infer that the use of GIS applied to the SAMU in medium-sized cities is feasible, and it has the advantage...