covid
Buscar en
Medicina Universitaria
Toda la web
Inicio Medicina Universitaria Management of firearm facial fractures at the “Dr. José Eleuterio Gonzálezâ€...
Journal Information

Statistics

Follow this link to access the full text of the article

Scientific letter
Management of firearm facial fractures at the “Dr. José Eleuterio González”: University Hospital Case Report
I.Z. González-Vargas
Corresponding author
dr.iram.gzz@gmail.com

Corresponding author at: Servicio de Cirugía Plástica, Estética y Reconstructiva Hospital Universitario Dr. José Eleuterio González, Av. Gonzalitos esquina con Av. Francisco I. Madero s/n, Col. Mitras Centro, C.P. 64460 Monterrey, Nuevo León, Mexico. Tel.: +52 8183487656.
, M. García-Pérez, Y. Castro-Govea, C.E. Franco-Vazquez, A. Juárez-López de Nava, J.I. Fonseca-Sada
Plastic, Reconstructive and Aesthetic Surgery Service at the “Dr. José Eleuterio González” University Hospital, Monterrey, Nuevo León, Mexico
Read
4576
Times
was read the article
847
Total PDF
3729
Total HTML
Share statistics
 array:24 [
  "pii" => "S1665579616300527"
  "issn" => "16655796"
  "doi" => "10.1016/j.rmu.2016.03.005"
  "estado" => "S300"
  "fechaPublicacion" => "2016-04-01"
  "aid" => "66"
  "copyright" => "Universidad Autónoma de Nuevo León"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Medicina Universitaria. 2016;18:91-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1491
    "formatos" => array:3 [
      "EPUB" => 58
      "HTML" => 1112
      "PDF" => 321
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1665579616300576"
    "issn" => "16655796"
    "doi" => "10.1016/j.rmu.2016.05.002"
    "estado" => "S300"
    "fechaPublicacion" => "2016-04-01"
    "aid" => "71"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Medicina Universitaria. 2016;18:95-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 914
      "formatos" => array:3 [
        "EPUB" => 49
        "HTML" => 655
        "PDF" => 210
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific letters</span>"
      "titulo" => "Laparoscopic diaphragmatic plication for paralysis posterior to trauma&#46; Case report"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "95"
          "paginaFinal" => "97"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0020"
          "etiqueta" => "Figure 4"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr4.jpeg"
              "Alto" => 806
              "Ancho" => 990
              "Tamanyo" => 59197
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Post-op thoracic X-ray&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#46; Reyna-Sep&#250;lveda, F&#46; V&#225;squez-Fern&#225;ndez, &#193;&#46; Rodr&#237;guez-Brise&#241;o, C&#46; Montero-Cant&#250;, G&#46;E&#46; Mu&#241;oz-Maldonado"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Reyna-Sep&#250;lveda"
            ]
            1 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "V&#225;squez-Fern&#225;ndez"
            ]
            2 => array:2 [
              "nombre" => "&#193;&#46;"
              "apellidos" => "Rodr&#237;guez-Brise&#241;o"
            ]
            3 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Montero-Cant&#250;"
            ]
            4 => array:2 [
              "nombre" => "G&#46;E&#46;"
              "apellidos" => "Mu&#241;oz-Maldonado"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579616300576?idApp=UINPBA00004N"
    "url" => "/16655796/0000001800000071/v1_201608180032/S1665579616300576/v1_201608180032/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1665579616300515"
    "issn" => "16655796"
    "doi" => "10.1016/j.rmu.2016.03.004"
    "estado" => "S300"
    "fechaPublicacion" => "2016-04-01"
    "aid" => "65"
    "copyright" => "Universidad Aut&#243;noma de Nuevo Le&#243;n"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Medicina Universitaria. 2016;18:85-90"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1763
      "formatos" => array:3 [
        "EPUB" => 42
        "HTML" => 1273
        "PDF" => 448
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Evaluation of inter-batch variability in the establishing and quality control of glucose"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "85"
          "paginaFinal" => "90"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2089
              "Ancho" => 2250
              "Tamanyo" => 209062
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Work scheme within the glucose serum matrix&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Moya-Salazar, L&#46; Pio-D&#225;vila"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Moya-Salazar"
            ]
            1 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Pio-D&#225;vila"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579616300515?idApp=UINPBA00004N"
    "url" => "/16655796/0000001800000071/v1_201608180032/S1665579616300515/v1_201608180032/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>"
    "titulo" => "Management of firearm facial fractures at the &#8220;Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#8221;&#58; University Hospital Case Report"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "91"
        "paginaFinal" => "94"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "I&#46;Z&#46; Gonz&#225;lez-Vargas, M&#46; Garc&#237;a-P&#233;rez, Y&#46; Castro-Govea, C&#46;E&#46; Franco-Vazquez, A&#46; Ju&#225;rez-L&#243;pez de Nava, J&#46;I&#46; Fonseca-Sada"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "I&#46;Z&#46;"
            "apellidos" => "Gonz&#225;lez-Vargas"
            "email" => array:1 [
              0 => "dr&#46;iram&#46;gzz&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "M&#46;"
            "apellidos" => "Garc&#237;a-P&#233;rez"
          ]
          2 => array:2 [
            "nombre" => "Y&#46;"
            "apellidos" => "Castro-Govea"
          ]
          3 => array:2 [
            "nombre" => "C&#46;E&#46;"
            "apellidos" => "Franco-Vazquez"
          ]
          4 => array:2 [
            "nombre" => "A&#46;"
            "apellidos" => "Ju&#225;rez-L&#243;pez de Nava"
          ]
          5 => array:2 [
            "nombre" => "J&#46;I&#46;"
            "apellidos" => "Fonseca-Sada"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Plastic&#44; Reconstructive and Aesthetic Surgery Service at the &#8220;Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#8221; University Hospital&#44; Monterrey&#44; Nuevo Le&#243;n&#44; Mexico"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author at&#58; Servicio de Cirug&#237;a Pl&#225;stica&#44; Est&#233;tica y Reconstructiva Hospital Universitario Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#44; Av&#46; Gonzalitos esquina con Av&#46; Francisco I&#46; Madero s&#47;n&#44; Col&#46; Mitras Centro&#44; C&#46;P&#46; 64460 Monterrey&#44; Nuevo Le&#243;n&#44; Mexico&#46; Tel&#46;&#58; &#43;52 8183487656&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 815
            "Ancho" => 1600
            "Tamanyo" => 227361
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Three-dimensional reconstruction of the left profile&#44; where the displacement of the maxilla and the alveolar jaw segment can be seen&#44; resulting in poor dental occlusion for the patient&#46; &#40;B&#41; Post-surgical image&#44; showing an adequate fragment reduction and dental occlusion&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Gunshot wounds produce devastating&#44; functional and aesthetical consequences in people&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> specifically those in the maxillofacial region&#46; These have become a challenge for plastic and maxillofacial surgeons due to facial deformities and large scars&#44; as well as the psychological implications which in consequence impact on the subject&#39;s image&#46; They may even compromise the patient&#39;s life&#44; since they compromise airway&#44; cause massive hemorrhage&#44; cranioencephalic and spinal cord trauma&#46; Hence the importance of an accurate surgical management&#44; aimed to preserve function and life&#44; thus facilitating the adequate development and quality of life after intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Initial management of patients with these types of wounds is resuscitation&#44; with special attention to the airway&#44; since bleeding and inflammation usually compromise it&#46; In order to accomplish this&#44; either orotracheal intubation or tracheostomy&#44; and subsequently entering to the reconstruction phase&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> Maxillofacial trauma due to firearms produce a situation of high complexity&#44; due to the significant bone and soft tissue loss&#44; which results in aesthetic and functional craniofacial deformities&#46; Gunshot wounds are often linked to panfacial fractures&#44; which involve high kinetic energy causing injuries of the adjacent tissues&#44; which in addition to compromise the patient&#39;s life&#44; produce severe posttraumatic deformities&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#8211;5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Clinical case</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present a 20-years-old female patient with no relevant past medical history&#44; who suffered a gunshot wound to the face with an entry hole in the left preparotideal region and an exit hole in the right cheek&#46; Upon her arrival to the emergency services at our unit&#44; reanimation was performed with pertinent imaging studies too&#46; Due to the bleeding and progressive respiratory deterioration a tracheostomy was performed in order to protect the airway&#46; The patient was assessed by the plastic surgery service where the following injuries were documented&#58; an entry wound with a defect of 3<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm in the left preparotideal region&#59; an exit wound with soft tissue avulsion of 3<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm in the right cheek region&#44; multiple injuries in the mucose of the hard palate with comminuted fracture&#59; a tongue injury of 13<span class="elsevierStyleHsp" style=""></span>cm from the tip of it with a front to back trajectory toward the base by its right lateral edge and finishing at the posterior third&#46; It was evident the lack of stability of the medial and inferior facial thirds due to the fractures present&#46; Imaging studies showed comminuted fractures of both maxillary bones with involvement of both inferior periorbital borders&#59; fracture of the body of the left malar bone&#59; In the lower jaw&#44; a comminuted fracture at the right mandibular body with a parasinfisiary trace and an alveolar fragment avulsion &#40;which behave as a bone graft&#41;&#59; and also a palatine comminuted fracture was found&#46; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1A&#44; 2A and 3A</a>&#41;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Debridement of the cheek and preparotideal region&#39;s wounds was performed&#44; as well as primary closure by planes&#46; Primary closure of injuries in the mucose of the hard palate&#44; repair of lingual injury&#44; manual fracture reduction of hard palate with no fixation&#44; facial medial third reduction&#44; Erich arches placement&#44; inter-maxillary fixation&#44; and due to the lack of osteosynthesis material at the time of surgery&#44; the Milton Adams technique &#40;wire fixation from the intra-maxillary fixation to the fronto-malar union&#41; was used&#46; She was taken to intensive care unit&#44; and after the hemodynamic and ventilatoryr recovery&#44; she was moved to the plastic surgery floor area&#44; and eventually moved to an outpatient setting&#46; Four weeks after the first procedure&#44; she was programmed for open reduction and permanent fixation of the fractures with mini-plates and removal of the Milton Adams fixation&#46; A subciliary and gingivo-vestibular approach were used on both sides for zygomatic-malar and maxillary complex fixation&#44; with 1&#46;5 and 2&#46;0 rigid fixation systems and an open reduction and internal fixation for the jaw fracture was performed with a two 2&#46;0 mini-plates system&#46; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1B&#44; 2B and 3B</a>&#41;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During follow-up&#44; the patient presented a dento-alveolar fragment loss of the mandibular comminuted fracture &#40;the fracture previously mention as bone graft&#41;&#46; She remained with inter-maxillary fixation for a period of 6 weeks&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Facial fractures constitute a substantial percentage of admissions to the plastic surgery services&#46; At our hospital facial fracture incidence has risen due to the increase in firearm use and violence at our city&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">6&#44;7&#44;11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Over the last 15 years&#44; facial fracture treatment has suffered a significant evolution with the introduction of craniofacial approaches&#44; open reduction directly in the place of the fracture&#44; and early or immediate fixation&#44; combined with the utilization of pre-operative computed tomography for surgical planning as well as post-operative for fracture reduction assessment&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Surgical reconstruction phases in patients with gunshot wounds have been controversial&#46; Literature reports favor for a conservative approach&#44; treating soft tissue first&#44; then bone tissue&#46; On the other hand&#44; there are publications arguing a more aggressive intervention of involved structures&#44; in just one reconstruction phase&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> Today&#44; the most accepted approach is the ballistic wound reconstruction approach in phases proposed by Norman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> This approach includes the following phases&#58;&#40;1&#41; immediate stabilization of existing bone in anatomic positions&#44; &#40;2&#41; primary closure of existing soft tissue&#44; &#40;3&#41; periodic &#8220;second look&#8221; serial debridement procedures&#44; and &#40;4&#41; definitive early reconstruction of soft-tissue and bony defects&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In our patient&#39;s management we decided that due to the nature of the injury and the involvement of the airway&#44; once resolved&#44; and due to the characteristics of the wounds and the lack of stability of the medial and lower facial thirds&#44; a damage control surgery as an initial procedure because of the lack of osteosynthesis material at our facilities&#46; The four-week delay to perform the second procedure &#40;rigid systems of fixation placement&#41; was because it was the necessary period of time to get osteosynthesis material&#46; Finally&#44; it is worth to mention that in the first procedure due to the lack of osteosynthesis material&#44; after repair all soft tissue injuries&#44; we performed a rearrangement of both dental arches&#46; Due to the lack of stability of the middle and lower thirds&#44; the Milton-Adams technique allowed us to give some support&#46; By the time of the second surgery we found that the bone fragments of the middle third were in an acceptable position and with some stability&#44; which helped us considerably in the placement of the miniplates without need to manipulate the soft tissues excessively or make large bone movements to reduce the fragments&#44; making all of this procedure simpler that we could imagine&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Reduction and immediate rigid fixation of jaw fractures is not necessary in all patients&#44; as in this case&#46; Sometimes&#44; surgical management can be different&#44; placing interdental wire next to the fracture&#44; or the use of Erich arches&#44; which can afford a certain degree of stability&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> The decision to use a rigid fixation or a functionally stable fixation depends on the fracture itself&#44; and on the load-bearing capability of the adjacent bones&#46; Complex or comminuted fractures&#44; like in this case&#44; require rigid fixation&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> As a general rule&#44; intermaxillary fixation should always precede the placement of plates&#44; to ensure the adequate reduction of fragments&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">6&#44;12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Type-3 palatal &#40;comminuted&#41; fractures&#44; like those that the patient presented&#44; usually are treated with long intermaxillary fixation&#44; covered up with flaps if defects are present in that area&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The patient recovered well&#44; with adequate scarring of the soft tissues&#46; There were no secondary effects due to the palatal and the severe tongue injury&#46; After rehabilitation and removal of the interdental wire&#44; we could observe that the patient developed a synechia of the tongue toward a portion of the gum over the right jaw&#44; which was released with a local anesthesic&#46; Due to the kinetics of the wound and its involvement of multiple dental pieces&#44; many of them were lost&#44; including those in the dento-alveolar fragment&#44; which was reabsorbed due to a lack of irrigation of the same&#44; acting as a bone graft&#46; Nevertheless&#44; with the adequate alignment of both jaws&#44; the patient was recovered esthetically and functionally&#59; and in the interdental spaces that remain a removable dental prosthesis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Facial trauma caused by firearm guns are complex and difficult to manage&#46; Current treatment involves a variety of stagged procedures&#44; adhering to the protocols of management and treating each fracture as a unit&#46; With the advent of rigid fixation &#40;plates and screws&#41;&#44; patients results have improved notably&#44; and now we are able to help patients to return to their functional activities quickly&#44; and with a better social adaptation&#46; We would like to emphasize that&#44; despite the lack of the rigid fixation material at the beginning of the approach to the patient&#44; it was possible for us to obtain good results using basic principles for the management of complex facial fractures &#40;Erich arches and Milton Adams technique&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:8 [
        0 => array:3 [
          "identificador" => "xres719239"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec724469"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Clinical case"
        ]
        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        5 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusion"
        ]
        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflict of interest"
        ]
        7 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-09-30"
    "fechaAceptado" => "2016-01-26"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec724469"
          "palabras" => array:2 [
            0 => "Facial fractures"
            1 => "Gunshot wounds"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Gunshot wounds in the facial region produce important functional disabilities if they are not properly treated&#46; They may also cause an important effect in the social and psychological development of the patient because of the aesthetic problems that they produce&#46; This article presents a case of a 20 years-old female patient who was referred to our institution because of facial trauma secondary to a gunshot wound&#44; whose treatment consisted of multiple reconstructive surgeries in order to obtain an adequate&#44; functional and esthetic result&#46; Also&#44; we did a review of the bibliography in order to establish the proper management of the wounds found in these type of cases&#46;</p></span>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1284
            "Ancho" => 2667
            "Tamanyo" => 430335
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Three-dimensional reconstruction of cranial tomography&#46; A right jaw parasymphyseal fracture with avulsion of an alveolar fragment&#44; along with maxillary fracture&#44; a fracture in both malar regions and fractures at the bottom of both orbits can be seen&#46; &#40;B&#41; Post-procedure 3D reconstruction&#44; where the placement of plates and the reduction of fractures can be seen&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 815
            "Ancho" => 1600
            "Tamanyo" => 227361
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Three-dimensional reconstruction of the left profile&#44; where the displacement of the maxilla and the alveolar jaw segment can be seen&#44; resulting in poor dental occlusion for the patient&#46; &#40;B&#41; Post-surgical image&#44; showing an adequate fragment reduction and dental occlusion&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 782
            "Ancho" => 1600
            "Tamanyo" => 196423
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Three-dimensional reconstruction of the right profile&#44; where the displacement of the maxilla and the alveolar jaw segment can be seen&#44; resulting in poor dental occlusion for the patient&#46; &#40;B&#41; Post-surgical image&#44; showing an adequate fragment reduction and dental occlusion&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:12 [
            0 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Facial gunshot wounds&#58; a 4-year experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Hollier"
                            1 => "E&#46;P&#46; Grantcharova"
                            2 => "M&#46; Kattash"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/joms.2001.20989"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Oral Maxillofac Surg"
                        "fecha" => "2001"
                        "volumen" => "59"
                        "paginaInicial" => "277"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11243609"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Panfacial fractures&#58; organization of treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;L&#46; Markowitz"
                            1 => "P&#46;N&#46; Manson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Plast Surg"
                        "fecha" => "1989"
                        "volumen" => "16"
                        "paginaInicial" => "105"
                        "paginaFinal" => "114"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2924486"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contemporary issues in facial gunshot wound management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Y&#46; Kaufman"
                            1 => "P&#46; Cole"
                            2 => "L&#46; Hollier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SCS.0b013e31816ae4a8"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Craniofac Surg"
                        "fecha" => "2008"
                        "volumen" => "19"
                        "paginaInicial" => "421"
                        "paginaFinal" => "427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18362720"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Panfacial fractures&#58; analysis of 33 cases treated late"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; He"
                            1 => "Y&#46; Zhang"
                            2 => "E&#46; Ellis III"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.joms.2007.06.625"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Oral Maxillofac Surg"
                        "fecha" => "2007"
                        "volumen" => "65"
                        "paginaInicial" => "2459"
                        "paginaFinal" => "2465"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18022469"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Concomitant injuries in patients with panfacial fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Follmar"
                            1 => "M&#46; DeBruijn"
                            2 => "A&#46; Baccarani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TA.0b013e3181492f41"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2007"
                        "volumen" => "63"
                        "paginaInicial" => "831"
                        "paginaFinal" => "835"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18090013"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Facial fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;E&#46; Sharabi"
                            1 => "J&#46;C&#46; Koshy"
                            2 => "J&#46;F&#46; Thornton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PRS.0b013e318200cb2d"
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "2011"
                        "volumen" => "127"
                        "paginaInicial" => "25e"
                        "paginaFinal" => "34e"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21285753"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based medicine&#58; mandible fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;T&#46; Morrow"
                            1 => "T&#46;D&#46; Samson"
                            2 => "W&#46; Schubert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PRS.0000000000000717"
                      "Revista" => array:7 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "2014"
                        "volumen" => "134"
                        "paginaInicial" => "1381"
                        "paginaFinal" => "1390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25415101"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204506708671"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-energy ballistic and avulsive facial injuries&#58; classification&#44; patterns&#44; and an algorithm for primary reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Clark"
                            1 => "B&#46; Birely"
                            2 => "P&#46;N&#46; Manson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "1995"
                        "volumen" => "98"
                        "paginaInicial" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A 162 case review of palatal fracture&#58; management strategy from a 10-year experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;H&#46; Chen"
                            1 => "T&#46;Y&#46; Wang"
                            2 => "P&#46;K&#46; Tsay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PRS.0b013e3181706edc"
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "2008"
                        "volumen" => "121"
                        "paginaInicial" => "2065"
                        "paginaFinal" => "2073"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18520897"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Manejo de fractura panfacial secundaria a herida por arma de fuego de alta velocidad&#46; Reporte de caso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Fonnegra"
                            1 => "G&#46;L&#46;A&#46; Sabogal"
                            2 => "S&#46;J&#46;A&#46; V&#233;lez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Fac Med"
                        "fecha" => "2009"
                        "volumen" => "17"
                        "paginaInicial" => "155"
                        "paginaFinal" => "163"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A retrospective analysis of facial fracture etiologies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Erdmann"
                            1 => "K&#46;E&#46; Follmar"
                            2 => "M&#46; Debruijn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SAP.0b013e318133a87b"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Plast Surg"
                        "fecha" => "2008&#44; April"
                        "volumen" => "60"
                        "paginaInicial" => "398"
                        "paginaFinal" => "403"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18362568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is the use of arch bars or interdental wire fixation necessary for successful outcomes in the open reduction and internal fixation of mandibular angle fractures&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;B&#46; Bell"
                            1 => "D&#46;M&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.joms.2008.05.370"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Oral Maxillofac Surg"
                        "fecha" => "2008"
                        "volumen" => "66"
                        "paginaInicial" => "2116"
                        "paginaFinal" => "2122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18848111"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/16655796/0000001800000071/v1_201608180032/S1665579616300527/v1_201608180032/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "55397"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Scientific letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/16655796/0000001800000071/v1_201608180032/S1665579616300527/v1_201608180032/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579616300527?idApp=UINPBA00004N"
]
Article information
ISSN: 16655796
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 11 6 17
2024 October 37 5 42
2024 September 46 10 56
2024 August 35 2 37
2024 July 36 6 42
2024 June 19 4 23
2024 May 21 8 29
2024 April 31 12 43
2024 March 37 10 47
2024 February 33 5 38
2024 January 49 7 56
2023 December 54 18 72
2023 November 96 7 103
2023 October 104 15 119
2023 September 62 8 70
2023 August 42 11 53
2023 July 63 8 71
2023 June 50 9 59
2023 May 82 18 100
2023 April 57 8 65
2023 March 40 4 44
2023 February 51 7 58
2023 January 48 8 56
2022 December 51 7 58
2022 November 49 15 64
2022 October 49 7 56
2022 September 42 5 47
2022 August 64 23 87
2022 July 26 10 36
2022 June 31 14 45
2022 May 53 15 68
2022 April 35 13 48
2022 March 52 18 70
2022 February 26 8 34
2022 January 64 5 69
2021 December 64 6 70
2021 November 46 8 54
2021 October 47 9 56
2021 September 55 13 68
2021 August 51 12 63
2021 July 26 7 33
2021 June 32 12 44
2021 May 39 11 50
2021 April 213 14 227
2021 March 54 10 64
2021 February 21 8 29
2021 January 38 11 49
2020 December 42 5 47
2020 November 32 7 39
2020 October 30 3 33
2020 September 26 11 37
2020 August 22 3 25
2020 July 22 7 29
2020 June 22 7 29
2020 May 30 9 39
2020 April 28 3 31
2020 March 23 13 36
2020 February 20 5 25
2020 January 24 4 28
2019 December 28 9 37
2019 November 9 11 20
2019 October 23 2 25
2019 September 24 1 25
2019 August 21 3 24
2019 July 26 9 35
2019 June 49 11 60
2019 May 119 44 163
2019 April 74 27 101
2019 March 16 2 18
2019 February 21 5 26
2019 January 6 4 10
2018 December 14 6 20
2018 November 24 7 31
2018 October 31 8 39
2018 September 35 3 38
2018 August 9 7 16
2018 July 16 3 19
2018 June 14 7 21
2018 May 6 6 12
2018 April 7 2 9
2018 March 18 0 18
2018 February 9 0 9
2018 January 7 2 9
2017 December 12 0 12
2017 November 16 4 20
2017 October 8 3 11
2017 September 8 2 10
2017 August 17 13 30
2017 July 15 4 19
2017 June 24 14 38
2017 May 30 16 46
2017 April 26 7 33
2017 March 25 26 51
2017 February 59 5 64
2017 January 17 2 19
2016 December 34 6 40
2016 November 52 6 58
2016 October 50 12 62
2016 September 44 8 52
2016 August 29 3 32
2016 July 4 3 7
Show all

Follow this link to access the full text of the article