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The second stage traumatism of the face by optimizing the diagnosis and treatment of nasal bones fractures


Author: Dumitru Hîţu
Degree:doctor of medicine
Speciality: 14.00.21 - Stomatology
Year:2004
Scientific adviser: Dumitru Şcerbatiuc
doctor habilitat, professor
Scientific consultant: Ion Ababii
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:
Scientific council:

Status

The thesis was presented on the 1 December, 2004
Approved by NCAA on the 23 December, 2004

Abstract

Adobe PDF document – 0.31 Mb / in romanian

Keywords

Nasal bones fractures, functional disturbances, determination of the degree of displacement on the lateral plane of the fractured nasal bones fragments, determination of the place of fracture, exoendonasal fixative, appreciation of the nasal respiration

Summary

Traumatism in the last decade became a pandemic becoming a socio-medical problem. The anatomotopographic specific features determining the median line position and the prominence of the nose, the big fragility of the bones, the small dimensions, the close relations with the bones of the skull predispose in advance to a significant incidence of the nasal bones fracture. This incidence differs from one source to another but according to the date of the otorynolaryngologists, such fractures are on the first place.

The removing of the fractured fragments lead to various functional troubles: aesthetics, respiration, olfactive sensitivity, trouble of the speech paranasal secretion and lacrimonasal duct cleaning.

During the period of 1998 – 2003, there were admitted 1107 patients which consist 31,62% of the treated number of the department at the Republican Centre of Oral and Maxillo-Facial Surgery in Chişinău, and the incidence of such fractures is increasing gradually. Of the 692 patients with fractures of the nasoethimoidal complex, 18,35% had fracture wothout displacement and being open 63,29% of cases had displacement. In 15,75% of the cases, the fractures of the nasoethmoidal complex have been isolated and in 84,24% the nasal traumatism is associated.

To solve the aims of the given work some special investigations were used: determination of the displacement degree of the fractured fragments of a lateral plan and the determination (fixing) of the fracture’s place, the essessment of the nasal respiration, the revealing of the smell within the fractures of the middle part of the face.

In order to determine the place of the fracture, the degree of displacement of the fractured fragments from lateral plan and the impairment of the olfactive sensitivity, there were examined 75 patients with fractures of the nasal bones before and after the surgery which were treated in oromaxillo- facial departament.

For this sake we used our methods and devices. To study the nasal respiration troubles, we examined 68 patients before and after surgical treatment we used a universal pneumotahograf with ah integrator.

The actual study proves comaratively the efficiency of the modern methods of diagnosing and treatment, designating two lots to be assessed (a study lot - 38 patients and a control lot a 37) but asssisted through various ways of surgical acces - immobilization of the fractured fragments by applying the exoendonasal fixer - for the study lot and reated by methods of fixation with endonasal tents - for the reference lot.

The obtained date have been analized statistically according to usual methods of biological study according to Fischer – Student criteria, Wilcocson - for conjugated paies, and Man – Witni for small groups.

The determination of the place of fracture with the help of a radiological examination and of the grid, varies with an average of 4,8 cm, and permits to apply the elevator with exactness during.

The establishing of the degree of displacement of the fractured nasal fragments with an average of deviation of 18° from the median line of the face, showsthe tactics of treatment in patients with fractures of the nasal bones.

The assessment of the smell impairment and of nasal respiration of the patients withfractures of the nasal bones, allows the estimation of functional disorders to estabilish the diagnosis and the situation in dynamics of the injured.

The elaboration of surgical – orthopedical methods in treating of patients with fractures of nasal bones leads to the improvement of aesthetic and functional results.

The establishing of functional (disorders) problems and the using of nasal fixator increases the quality of recovery of patients with fractures of the nasalethmoid complex and of the average part of the face, ensuring an early refunctionalization of the facial surface and diminishing the complications of the given traumatism.