Traumatologia facial Gregorio Sánchez Aniceto Servicio de Cirugía Oral y Maxilofacial Hospital Universitario 12 de Octubre Madrid 1600 AC : Egipto “‘Alguien con una fractura en su mandíbula, sobre la cual se ha inflingido una herida (cid:1) y de ello tiene unas fiebres’ Una condición para no ser tratada(cid:1)” From Breasted translation of the Edwin Smith papyrus 460 AC: Grecia •  Maxilares vendados juntos para dar estabilidad HHiippppooccrraatteess ppiiccttuurree •  Tiras de cuero cartaginés pegadas a la cara alrededor de segmentos fracturarios From F Adams, Genuine Works of Hippocrates, 1849. Suspension externa “Both upper jaw bones were loosened from their connections(cid:1) Both upper jaw bones were held fast and pressed against each other at a high level by means of a quickly assembled apparatus.” Von Graefe cranio-maxillary suspension device Siglo XX SSSSSSSSSSSSSSSSSSSSSSooooooooooooooooooooooouuuuuuuuuuuuuuuuurrrrrrrrrrrrrrcccccccccccccccccccceeeeeeeeeeeeeeeeeeee:::::::::::::: KKKKKKKKKKKKKKKKKKaaaaaaaaaaaaazzzzzzzzzzaaaaaaaaaaaaannnnnnnnnnnnnnnnnjjjjjjjjjjjjjjjjjjjjjjiiiiiiiiiiiiiiiiiiaaaaaaaaaaaaaaaaaaaannnnnnnnnnnnn aaaaaaaaaaaannnnnnnnnnnnnnnndddddddddddddddd CCCCCCCCCCooooooooooonnnnnnnnnnnvvvvvvvvvvveeeeeeeeeerrrrrrrrrrssssssssssseeeeeeee...... TTTTTTTThhhee SSuurrggiiccaall TTrreeeeeeeeeeeeaaaaaaaaattmmeennnnnnnnnnnnnttttttttttttttt ooooooooooooff FFaaccccccccccccciiiiiiiiiiiiiiiaaaaaaaaaaaaaaaaaallllllllllll IIIIIIIIIIIIIIIIIIIIIIIIInnnnnnnnnnnnnnnnnnnnnnnnjjjjjjjjjjjjjjjjjjjjjjjjuuuuuuuuuuuuuuuuuuuurrrrrrrrrrrrrrrrrrrrrrrriiiiiiiiiiiiiiiiiiiiiieeeeeeeeeeeeesssssss........ PPPPPPPPPPPPPPPPP..........111111111111166666666666666663333333333,,,,,,,,,,, 1111111111111111888888888888888888888888888888888....... 1111111111111111999999999999999944444444444444444444999999999999999999...... PPPPPPPPPPPPPPPPllllllllllllllaaaaaaaaaaaasssssssssstttttttttttteeeeeeeeeeerrrrrrrrrrrr cccccccccaaaaaasssssssssstttttttt fffffffffoooooooorrrrrrrr LLLLLLLLLLLLLLLLLLLLLLLLLLeee FFoorrtt,, ZZMMCC rreedduuuuuuuuuccccccttiioonnnnnnnnnnssssssss “Osteosíntesis” craneomaxilofacial Traumatismos faciales 1501 patients / 165 days Traffic •  Men (68%) 25% Domestic Women (32%). 40% 5% Assault 20% others •  MVA : 598 patients (38%) •  32 years (medium age) 29% Facial fractures •  Sánchez Aniceto G: Doctoral Thesis. Univ. Complutense (1993) Traumatismos faciales •  Aislados 75% •  Trauma asociado 25 % Traumatismos faciales •  Baja energía •  Alta energía Caida de 7 metros = 30 kms/h