Trauma pediátrico facial

Trauma craneofacial pediátrico:Casos de reto de trauma facial infantil


Pediatric craniofacial trauma: challenging pediatric cases-craniofacial trauma.
Dufresne CR, Manson PN.
Craniomaxillofac Trauma Reconstr. 2011 Jun;4(2):73-84.
Abstract
The pediatric population, as well as the adult population, is subject to similar injuries and traumatic events involving the craniofacial skeleton. Although less frequent than adult injuries, the craniofacial injuries sustained by children are considered separately in textbooks and the literature because of the special unique problems associated with their treatment and the effects they might have on growth and development that can arise as a result of their management. Some of the more challenging cases that I have seen involve the very young with cranial bone fractures and cranial base fractures and those that involve the nasal and/or orbital-ethmoidal areas in young children and their secondary reconstruction. Some of these types of cases are not always clearly and thoroughly addressed in textbooks or articles because of their infrequent occurrence. Often, surgeons differ in approaches to treatment because of certain anatomic or physiological factors specifically related to childhood, facial growth, and the timing of treatment. Some of the cranial and facial developmental malformations seen in older children or adults can be attributed to trauma sustained in early childhood. This is because trauma may have a deleterious effect on the growth and development of facial structures in the postnatal life similar to that seen resulting from a genetic mutation.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193303/pdf/cmtr04073.pdf


Lesiones faciales pediátricas: su manejo


Pediatric facial injuries: It's management.
Singh G, Mohammad S, Pal US, Hariram, Malkunje LR, Singh N.
Department of Oral and Maxillofacial Surgery, C.S.M. Medical University, Lucknow, India.
Natl J Maxillofac Surg. 2011 Jul;2(2):156-62.
Abstract
BACKGROUND: Facial injuries in children always present a challenge in respect of their diagnosis and management. Since these children are of a growing age every care should be taken so that later the overall growth pattern of the facial skeleton in these children is not jeopardized.
PURPOSE: To access the most feasible method for the management of facial injuries in children without hampering the facial growth. MATERIALS AND METHODS: Sixty child patients with facial trauma were selected randomly for this study. On the basis of examination and investigations a suitable management approach involving rest and observation, open or closed reduction and immobilization, trans-osseous (TO) wiring, mini bone plate fixation, splinting and replantation, elevation and fixation of zygoma, etc. were carried out. RESULTS AND CONCLUSION: In our study fall was the predominant cause for most of the facial injuries in children. There was a 1.09% incidence of facial injuries in children up to 16 years of age amongst the total patients. The age-wise distribution of the fracture amongst groups (I, II and III) was found to be 26.67%, 51.67% and 21.67% respectively. Male to female patient ratio was 3:1. The majority of the cases of facial injuries were seen in Group II patients (6-11 years) i.e. 51.67%. The mandibular fracture was found to be the most common fracture (0.60%) followed by dentoalveolar (0.27%), mandibular + midface (0.07) and midface (0.02%) fractures. Most of the mandibular fractures were found in the parasymphysis region. Simple fracture seems to be commonest in the mandible. Most of the mandibular and midface fractures in children were amenable to conservative therapies except a few which required surgical intervention.

http://www.njms.in/text.asp?2011/2/2/156/94471


http://www.njms.in/temp/NatlJMaxillofacSurg22156-7391945_203159.pdf





Intubación endotraqueal urgente en trauma pediátrico


Emergency endotracheal intubation in pediatric trauma.
Nakayama DK, Gardner MJ, Rowe MI.
Department of Pediatric Surgery, Children's Hospital, Pittsburgh, PA 15213-2583.
Ann Surg. 1990 Feb;211(2):218-23.
Abstract
The purpose of this study was to determine the effectiveness and associated problems of emergency intubation in 605 injured infants and children admitted to the Children's Hospital of Pittsburgh in 1987. We identified 63 patients (10.4%) undergoing endotracheal intubation at the scene of injury, at a referring hospital or in our emergency department. Injuries were to the head (90.5%), abdomen (12.7%), face (11.1%), chest (6.3%), neck (3.2%); or were orthopedic (19%) or multiple (39.7%). Indications for intubation included coma (74.6%), shock (28.6%), apnea (22.2%), and airway obstruction (3.2%). Of 16 complications (25.4%), 13 were immediately life threatening: right mainstem intubation (5), massive barotrauma (2), failure of adequate preoxygenation (2), esophageal intubation (1), attempt at nasotracheal intubation in an open facial fracture (1), and extubation during transport (1). Three were late complications: vocal cord paresis (2) and subglottic stenosis (1). Airway complications led to PO2 less than 90 mm Hg in 7 of 12 on first ABG, compared to 9 of 44 in uncomplicated cases (p less than 0.05). Intubation attempts at the scene of injury were more often multiple, unsuccessful, and associated with airway complications. All four complication-associated fatalities were life-threatening scene complications. Nearly one half (44.4%, 28 of 63) had one of the following problems in respiratory management: major airway complication, PaO2 less than 90, or PaCO2 greater than 45 on either the first or second ABG after arrival at our emergency department. Head injury with coma is the most common setting for emergency intubation. Airway complications are common, and are more frequent in treatment attempt at the scene. Despite endotracheal intubation, injured children in our series remain at high risk for hypoxemia, elevated arterial PCO2, and major airway complications, all of which contribute to secondary brain injury.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357967/pdf/annsurg00168-0118.pdf





Manejo de la vía aérea pediátrica. ¿Qué hay de nuevo?
Paediatric airway management: What is new?
Ramesh S, Jayanthi R, Archana SR.
Indian J Anaesth [serial online] 2012 [cited 2012 Nov 28];56:448-53.
http://www.ijaweb.org/article.asp?issn=0019-5049;year=2012;volume=56;issue=5;spage=448;epage=453;aulast=Ramesh




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org