{"id":7373,"date":"2026-08-25T06:00:00","date_gmt":"2026-08-25T06:00:00","guid":{"rendered":"https:\/\/www.belodonte.es\/?p=7373"},"modified":"2026-06-23T07:52:50","modified_gmt":"2026-06-23T07:52:50","slug":"traumatologia-facial-fractures-de-mandibula-pomuls-mes-frequents","status":"publish","type":"post","link":"https:\/\/www.belodonte.es\/ca\/traumatologia-facial-fractures-de-mandibula-pomuls-mes-frequents\/","title":{"rendered":"Traumatologia facial: fractures de mand\u00edbula i p\u00f2muls m\u00e9s freq\u00fcents"},"content":{"rendered":"\n

La traumatologia facial <\/strong>engloba el diagn\u00f2stic i tractament de les fractures que afecten els ossos de la cara, sent la mand\u00edbula i el complex zigom\u00e0tic-malar (els p\u00f2muls) dues de les localitzacions m\u00e9s freq\u00fcents en la pr\u00e0ctica cl\u00ednica. Accidents de tr\u00e0nsit, caigudes, agressions i traumatismes esportius s\u00f3n les causes m\u00e9s habituals.<\/p>\n\n\n\n

Con\u00e8ixer com es manifesten aquestes fractures i quin tractament requereixen ajuda a entendre per qu\u00e8 la valoraci\u00f3 per un cirurgi\u00e0 maxil\u00b7lofacial \u00e9s sempre necess\u00e0ria davant qualsevol traumatisme facial significatiu.<\/p>\n\n\n\n

Quines s\u00f3n les causes m\u00e9s freq\u00fcents de les fractures facials?<\/h2>\n\n\n\n

Els patrons de causalitat de les fractures facials varien segons el context sociodemogr\u00e0fic i geogr\u00e0fic, encara que les s\u00e8ries publicades a Espanya coincideixen a assenyalar els accidents de tr\u00e0nsit, les caigudes accidentals, les agressions interpersonals i els accidents esportius com les quatre causes principals.<\/p>\n\n\n\n

Els accidents de tr\u00e0nsit, especialment els que afecten motociclistes i ciclistes, generen amb freq\u00fc\u00e8ncia fractures d’alta energia amb patrons complexos i m\u00faltiples.<\/p>\n\n\n\n

Les caigudes s\u00f3n la causa predominant en la poblaci\u00f3 infantil i en persones grans.<\/p>\n\n\n\n

Les agressions interpersonals s’associen amb m\u00e9s freq\u00fc\u00e8ncia a fractures mandibulars i del ter\u00e7 mig facial en adults joves.<\/p>\n\n\n\n

I els traumatismes esportius, especialment en esports de contacte com el futbol, el b\u00e0squet, les arts marcials o el ciclisme, representen una proporci\u00f3 creixent dels casos atesos en els serveis d’urg\u00e8ncies maxil\u00b7lofacial.<\/p>\n\n\n\n

Com es manifesta una fractura de mand\u00edbula?<\/h2>\n\n\n\n

La mand\u00edbula \u00e9s l’os facial que amb m\u00e9s freq\u00fc\u00e8ncia es fractura, donada la seva posici\u00f3 prominent i la seva exposici\u00f3 als impactes directes.<\/p>\n\n\n\n

Els s\u00edmptomes caracter\u00edstics inclouen dolor intens localitzat que s’agreuja amb el moviment mandibular, maloclusi\u00f3 d’aparici\u00f3 sobtada (el pacient nota que les seves dents ja no encaixen com abans), dificultat o incapacitat per a obrir i tancar la boca amb normalitat, inflor i hematoma en la zona afectada, i en fractures que afecten l’angle mandibular o al cos, alteraci\u00f3 de la sensibilitat en el llavi inferior i el ment\u00f3 per afectaci\u00f3 del nervi dentari inferior.<\/p>\n\n\n\n

Les fractures del c\u00f2ndil mandibular (la part de la mand\u00edbula que articula amb el crani) s\u00f3n especialment freq\u00fcents i poden cursar amb dolor preauricular, limitaci\u00f3 de l’obertura bucal i desviaci\u00f3 de la mand\u00edbula cap al costat afectat en obrir la boca.<\/p>\n\n\n\n

Quines caracter\u00edstiques t\u00e9 una fractura del complex zigom\u00e0tic-malar?<\/h2>\n\n\n\n

L’os zigom\u00e0tic (el p\u00f2mul) i la seva uni\u00f3 amb la resta de l’esquelet facial formen el complex zigom\u00e0tic-malar, una de les localitzacions m\u00e9s freq\u00fcents de fractura despr\u00e9s d’un traumatisme facial d’impacte lateral.<\/p>\n\n\n\n

Els s\u00edmptomes caracter\u00edstics inclouen l’aplanament visible del p\u00f2mul (asimetria facial evident en comparar tots dos costats de la cara), l’equimosi periorbit\u00e0ria (hematoma al voltant de l’ull) i subconjuntival, la limitaci\u00f3 de l’obertura bucal quan la fractura afecta l’arc zigom\u00e0tic i aquest comprimeix el m\u00fascul temporal o el proc\u00e9s coronoides de la mand\u00edbula, l’alteraci\u00f3 de la sensibilitat en la galta i el llavi superior per afectaci\u00f3 del nervi intraorbitari, i en els casos que afecten el s\u00f2l de l’\u00f2rbita, la diplopia (visi\u00f3 doble) per atrapament dels m\u00fasculs extraoculars o l’enoft\u00e0lmia (enfonsament del globus ocular) quan hi ha p\u00e8rdua de volum orbitari significativa.<\/p>\n\n\n\n

Quines proves d’imatge s’utilitzen per al diagn\u00f2stic?<\/h2>\n\n\n\n

El diagn\u00f2stic de les fractures facials es basa fonamentalment en proves d’imatge despr\u00e9s d’una exploraci\u00f3 cl\u00ednica detallada.<\/p>\n\n\n\n

La tomografia computada (TC) facial amb reconstrucci\u00f3 tridimensional \u00e9s la prova d’elecci\u00f3 en la majoria dels traumatismes facials significatius, ja que permet valorar amb precisi\u00f3 la localitzaci\u00f3, el despla\u00e7ament i la comminuci\u00f3 (fragmentaci\u00f3) de la fractura, aix\u00ed com descartar lesions associades en estructures ve\u00efnes com l’\u00f2rbita, els sins paranasals o la base del crani.<\/p>\n\n\n\n

L’ortopantomografia (radiografia panor\u00e0mica) continua sent \u00fatil en fractures mandibulars a\u00efllades de baixa energia, especialment per a valorar la relaci\u00f3 de la l\u00ednia de fractura amb les arrels dentals i el nervi dentari inferior.<\/p>\n\n\n\n

En traumatismes facials d’alta energia, la valoraci\u00f3 conjunta amb altres especialistes (oftalmologia, neurocirurgia, otorrinolaringologia) \u00e9s freq\u00fcent, donada la proximitat anat\u00f2mica d’aquestes estructures.<\/p>\n\n\n\n

Com es tracten aquestes fractures?<\/h2>\n\n\n\n

El tractament dep\u00e8n del tipus de fractura, la seva localitzaci\u00f3, el grau de despla\u00e7ament i l’edat i les necessitats funcionals del pacient.<\/p>\n\n\n\n

Les fractures mandibulars no despla\u00e7ades o m\u00ednimament despla\u00e7ades poden tractar-se de manera conservadora amb bloqueig intermaxil\u00b7lar (immobilitzaci\u00f3 dels maxil\u00b7lars mitjan\u00e7ant arcs i el\u00e0stics durant diverses setmanes) en casos seleccionats, encara que la tend\u00e8ncia actual afavoreix el tractament quir\u00fargic amb osteos\u00edntesi (plaques i caragols de titani) que permet una recuperaci\u00f3 funcional m\u00e9s r\u00e0pida i una rehabilitaci\u00f3 oral preco\u00e7.<\/p>\n\n\n\n

Les fractures del complex zigom\u00e0tic-malar amb despla\u00e7ament significatiu requereixen reducci\u00f3 quir\u00fargica oberta i fixaci\u00f3 interna amb plaques, sovint a trav\u00e9s d’incisions intraorals o periorbit\u00e0ries que minimitzen les cicatrius visibles.<\/p>\n\n\n\n

Les fractures que afecten el s\u00f2l de l’\u00f2rbita amb atrapament muscular o p\u00e8rdua significativa de volum orbitari requereixen reconstrucci\u00f3 amb materials espec\u00edfics (malles de titani o materials reabsorbibles) per a restaurar l’anatomia i prevenir seq\u00fceles visuals permanents.<\/p>\n\n\n\n

Quines seq\u00fceles poden derivar-se d’un tractament tard\u00e0 o inadequat?<\/h2>\n\n\n\n

Les fractures facials no tractades o tractades de manera inadequada poden generar seq\u00fceles funcionals i est\u00e8tiques significatives i, en molts casos, de dif\u00edcil correcci\u00f3 posterior.<\/p>\n\n\n\n

La consolidaci\u00f3 d’una fractura mandibular en mala posici\u00f3 provoca maloclusi\u00f3 permanent que pot requerir cirurgia ortogn\u00e0tica correctiva complexa mesos o anys despr\u00e9s.<\/p>\n\n\n\n

Les fractures orbit\u00e0ries no tractades a temps poden generar diplopia permanent o enoft\u00e0lmia de dif\u00edcil correcci\u00f3 secund\u00e0ria. Les fractures del complex zigom\u00e0tic no redu\u00efdes correctament deixen asimetries facials permanents.<\/p>\n\n\n\n

Per aquest motiu, davant qualsevol sospita de fractura facial despr\u00e9s d’un traumatisme, la valoraci\u00f3 per un cirurgi\u00e0 maxil\u00b7lofacial en les primeres 24 a 48 hores \u00e9s fonamental, ja que la majoria de les t\u00e8cniques de reducci\u00f3 i fixaci\u00f3 obtenen millors resultats com m\u00e9s aviat millor es realitzen, abans que s’inici\u00ef el proc\u00e9s de consolidaci\u00f3 en una posici\u00f3 incorrecta.<\/p>\n\n\n\n

Si has sofert un cop facial amb inflor, dolor persistent, canvis en la mossegada o asimetria visible, no esperis que el dolor remeti per si sol. Una fractura facial no tractada a temps pot deixar seq\u00fceles que s\u00ed que s\u00f3n evitables amb el diagn\u00f2stic adequat. Contacta amb nosaltres.<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

La traumatologia facial engloba el diagn\u00f2stic i tractament de les fractures que afecten els ossos de la cara, sent la mand\u00edbula i el complex zigom\u00e0tic-malar (els p\u00f2muls) dues de les localitzacions m\u00e9s freq\u00fcents en la pr\u00e0ctica cl\u00ednica. Accidents de tr\u00e0nsit, […]<\/p>\n","protected":false},"author":3,"featured_media":7372,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[32],"tags":[],"class_list":["post-7373","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cirugia-oral"],"yoast_head":"\nTraumatologia facial: fractures de mand\u00edbula i p\u00f2muls m\u00e9s freq\u00fcents - Cl\u00ednica Belodonte<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.belodonte.es\/traumatologia-facial-fracturas-de-mandibula-pomulos-mas-frecuentes\/\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Traumatologia facial: fractures de mand\u00edbula i p\u00f2muls m\u00e9s freq\u00fcents - Cl\u00ednica Belodonte\" \/>\n<meta property=\"og:description\" content=\"La traumatologia facial engloba el diagn\u00f2stic i tractament de les fractures que afecten els ossos de la cara, sent la mand\u00edbula i el complex zigom\u00e0tic-malar (els p\u00f2muls) dues de les localitzacions m\u00e9s freq\u00fcents en la pr\u00e0ctica cl\u00ednica. 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