The publication by Chiacchio et al. is an observational, retrospective and descriptive study about maxillofacial traumas treated at Hospital Militar Central of the City of Buenos Aires, that shows an excellent experience in the management of fractures mainly caused by traffic collision in young people¹.

Let us recall that maxillofacial trauma, defined by the authors as “the injury of tissues and organs from acute or chronic transmission of energy affecting the bones of the face, determined by the upper, middle and lower thirds of the face” is a very serious healthcare issue in all aspects due to its high incidence, especially in young people, often causing serious functional and cosmetic abnormalities, and even avoidable loss of lives besides the costs for the healthcare system during its treatment^2-4. On occasions, management is carried out in stages, prolonging the definitive recovery over time. Although maxillofacial fractures may be due different etiologies, almost all of them could be avoided if preventive measures were more actively promoted. Traffic collisions, street fighting, ground-level falls, gunshot injuries and work accidents are the main causes of maxillofacial trauma⁴.

The above-mentioned study describes the conventional management, as intermaxillary fixation, use of screws, titanium plates and meshes, and surveillance when required. Osteoconductive material was used in 80% of the patients. There were no reports of cases treated with biodegradable material. The approaches used were the usual ones or those of choice for most surgeons, as coronal and external ciliary for upper-third fractures, subciliary for orbital floor fractures, superior vestibular for middlethird fractures and inferior vestibular for mandibular body fractures. The Risdon approach was used for fractures of the mandible body, angle and ramus¹.

As in any trauma, the initial management is of utmost importance to achieve the best results. This was not mentioned by the authors in the statistical analysis of their results, so it should be noted that standardization at this stage in referral centers is important to prevent avoidable adverse aftereffects in the long-term. Based on the results obtained, it can be inferred they adequately managed this aspect. Besides the basic principles of ATLS in the initial assessment of trauma patients, a computed tomography scan, if possible equipped with multiple rows of detectors, should be performed for an adequate evaluation and to plan the correct treatment. This management, which we strongly support³, was used by the treating team in their case series. The rate of complications reported was 11%⁵, and most of them were mild infections that could be treated easily, although the main etiology was contaminated wounds. Although the principles of trauma management apply to all patients, it is worth mentioning that the third of the face involved is different in pediatric patients (under 12 years): the lower and upper thirds are more affected than the middle third due to the lack of development of the maxillary sinuses at this age, and dentoalveolar involvement is also more prevalent. In this age range, the use of biodegradable material is preferred over meshes and titanium due to the lack of development (growth) of the bones of the face^6,7. The discussion is open without significant differences in the long-term. The study does not mention this age range, probably because the authors do not deal with pediatric population.

The authors’ series coincides with those of many publications where middle third involvement reaches the highest percentage, but there may also be variability according to geographic regions or types of healthcare centers that provide trauma care^4,5. Our working environment in the private healthcare system in inland Argentina is not a referral center for traffic collisions, so our statistics are more related with the lower third combined with the middle third as a result of street fighting and ground-level falls probably as a result of fights⁸.

I consider that the publication of these series is very important, since an appropriate initial management of trauma and its complications results in a final outcome consistent with the complexity that can be caused by the cosmetic and functional aftereffects when management is inadequate, especially in the young population, which is the most affected. This should also contribute to raise awareness and intensify prevention programs to reduce an etiology that can be avoided in most cases.