Hemorragia incoercible por trauma maxilofacial: experiencia del Hospital del Trabajador

introduction: the aim of this paper is to show our experience in the management of intractable bleeding facial trauma during the past 10 years to determine its impact on our environment and outline the basic principles of treatment. methods: a retrospective study of all patients with maxillofacial trauma and uncontrollable bleeding from 1999 to 2009. inclusion criteria were oro-nasal bleeding secondary to maxi-llofacial trauma requiring emergency treatment by a specialist, without other associated lesions that could be a source of bleeding. we obtained demographic information, mechanism of injury, diagnosis of injury, hemodynamic status, type and timing of tamponade, definitive surgical treatment, results and evolution. results: 21 patients in the study period, a true incidence of 0.002%. 7 patients (33.3%) with trauma naso-septal; 5 (23.8%) with panfacial fractures, and 7 (33.3%) with variable involvement of the upper and middle face. nine patients (42.9%) had isolated facial injuries. only 5 patients (23.8%) had hemodynamic compromise. thirteen patients (61.9%) required posterior nasal packing with or without another procedure to control bleeding. eight patients (38.1%) required early reduction and internal fixation as definitive treatment. conclusions: maxillofacial trauma uncontrollable bleeding is uncommon and rarely is the primary cause of hypovolemic shock. it should be suspected in patients with facial injuries from hours bleeding. the packing, suturing of wounds and reduce/ots are the mainstays of early treatment.