Results of treatment of patients with midfacial fractures

Abstract

Background. Fractures of the bones of the facial skeleton, in particular the midface area, are one of the most frequent reasons for patients to apply to maxillofacial inpatient care, not only in Ukraine but also abroad. Along with more modern treatment technologies (osteosynthesis using titanium miniplates and minigrid for fixation bone fragments), methods of repositioning of fragments with subsequent tamponade of the maxillary sinus with iodoform tampon and without tamponade and fixation of fragments are used. A certain group of patients is treated conservatively, which is associated with their reluctance to undergo surgery, minimal displacement of fragments or minimal cosmetic and functional impairments. The purpose of the study. Comparative evaluation of the results of treatment of patients with fractures of the midface area by repositioning the fragments of the zygomatic-orbital complex without fixating the fragments and their subsequent fixation by tamponade of the maxillary sinus with iodoform tampon. Object and methods of research. The comparison was made of the results of treatment of 70 patients with fractures of the midface area, among which 13 patients were treated by the method of repositioning fragments of the zygomatic-orbital complex (ZOC) without fixation and without maxillary sinus tamponade, 29 patients underwent repositioning of ZOC fragments with subsequent fixation of fragments with iodoform tampon – the tamponade of the maxillary sinus was performed on the affected side. For comparison, the results of conservative treatment of 28 patients with fractures of the midface area were used. Results. It was found that the reliable (χ2=11.43; p<0.05) majority of patients (64%) sought treatment within 0-3 days after injury. 83-89% of patients who underwent repositioning of the fragments had fresh small-fragment fractures. The reliable (χ2=11.43; p<0.05) majority of them simultaneously had 3-4 sites of bone fractures of the midfacearea, hemosinus of varying degrees and paresthesia in the infraorbital area. In the majority of patients who underwent repositioning of bone fragments with and without tamponade (85% and 93%, respectively), the final displacements ranged from 3.1 to 6 mm. In patients treated conservatively, in most cases (93%) the displacements were greater than 3.1 mm, which remained after treatment. Conclusion. In the majority of patients treated with the studied methods, in the long term, the displacement of bone fragments remained, which had functional and cosmetic consequences. In all studied groups, a certain cosmetic effect was achieved over time, as evidenced by a reliable (χ2=160.9; p=0.00000) decrease in the indicator by the visual analogue scale .