OVERVIEW OF MAXILLOFACIAL TRAUMA, DEFINITIONS, EPIDEMIOLOGY, MANAGEMENT, AIRWAY, CIRCULATION, BLEEDING CONTROL, SYSTEMIC ANTIBIOTIC PROPHYLAXIS AND MAXILLOFACIAL SURGERY

Abstract

Introduction: Injuries to facial bones, orbits, and adjacent soft tissue structures are common. They are usually caused by motor vehicle accidents. Scientific evidence has shown that maxillofacial trauma is related to severe injuries, so a meticulous evaluation of the injuries should be performed because they can have a devastating sequelae. The treatment of these situations is complex and challenging, since in addition to compromising the esthetic aspect, it also compromises the function of multiple structures and also causes psychological damage.

Objective: to detail the current information related to maxillofacial trauma, definitions, epidemiology, management, airway, circulation, hemorrhage control, prophylaxis with systemic antibiotics and maxillofacial surgery.

Methodology: a total of 52 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 39 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: facial trauma, maxillofacial trauma, facial fractures, airway management in trauma, antibiotic prophylaxis, facial surgery.

Results: oral-maxillofacial trauma represents approximately 7.4 to 8.7% of medical emergencies. Male-female ratio of 4:1, the most frequent causes being traffic accidents, aggressions, falls, sports accidents and accidents at work. The anatomical sites usually affected by facial fractures are the mandible with 44.2 %, zygomatic complex with 32.5 %, nasal bones with 16.2 %. There is a 10 to 15% probability of presenting a cervical spine injury in unconscious individuals with severe maxillofacial trauma. The frequency of infection following maxillofacial fractures varies according to various findings, with results ranging from 0 to 62%.

Conclusions:  Trauma management has improved over time, decreasing mortality in the golden hour, however, there are still challenges in trauma management such as those presented in maxillofacial alterations in a polytraumatized individual. The importance of the totality of maxillofacial injuries is found in that they pose an immediate threat to life as a result of their proximity to both the airway and the brain. The approach to airway management in maxillofacial trauma is of utmost importance, so a patent or definitive airway must be maintained by means of orotracheal intubation, nasotracheal intubation and surgical airway. It is essential to have an adequate protocol for airway management in maxillofacial trauma, as well as to maintain control of circulation and possible bleeding. Currently the use of systemic antibiotic prophylaxis is an accepted procedure to reduce the risk of infection or clinical prevention strategy. Surgery in individuals with maxillofacial trauma, particularly those with full face fractures or severe complex comminuted fractures remains a challenge. Usually, maxillofacial trauma coexists with other injuries, which could imply not being able to perform early surgical correction, increasing the risk of leading to situations of infection, nonunion and malocclusion.