Normalization of the electromyographic signals of masticatory muscles during non-habitual chewing activity

There is no consensus on the most appropriate method for normalizing electromyography (EMG) signals from masticatory muscles during isotonic activity. Aim: To analyze the best method for data processing of the EMG signal of the masticatory muscles during isotonic activity (non-habitual chewing), comparing raw data and different types of normalization. Methods: This is a cross-sectional study. Women aged between 18 and 45 years were selected. Anthropometric data were collected (age, height, body mass index ­ BMI, masticatory preference) as well as EMG signal (root mean square ­ RMS) data for the anterior temporal and masseter bilaterally, and for the suprahyoid muscles, during isotonic (non-habitual chewing) and isometric tasks. EMG data were processed offline using Matlab® Software. The normalization of the EMG signal was carried out using the 2nd masticatory cycle, chosen at random, of the 20 cycles collected, the maximum RMS value, and the maximum voluntary contraction (MVC). To analyze the best method of data processing for the isotonic data, the coefficient of variation (CV) was calculated. Descriptive data analysis was adopted, using the mean and standard deviation. ANOVA with repeated measures was used to detect significant differences between the methods of normalization. Statistical significance was set at 5% (α<0.05). Results: The final sample of this research was composed of 86 women. The volunteers presented an average age of 27.83±7.71 years and a mean BMI of 22.85±1.91 Kg/m2. Regarding masticatory preference, 73.25% reported the right side, and 26.75% the left side. Considering the comparison between the methods, the %CV measure of the 2nd cycle showed the lowest variation coefficient during biting for all the muscles from the raw data, RMS Max, and MVC (p=0.001, p=0.003, and p=0.001 respectively). Conclusion: In conclusion, for non-habitual chewing activity, the results of this study recommend data processing using normalization with the second cycle during chewing

Maximum bilateral bite strength and RMS EMG for the diagnosis of myogenic TMD

Aim: The study aimed to evaluate the accuracy of the maximum bilateral molar bite force and the Root Mean Square (RMS) Electromyography (EMG) index of the masticatory muscles in the maximum bilateral molar bite (MMBMax) of women with myogenic Temporomandibular Disorder (TMD) and asymptomatic. Methods: This is a cross-sectional study, composed of 86 women allocated to the TMD Group (n=43) and Control Group (n=43) diagnosis through the Diagnostic Criteria for Temporomandibular Disorders. The maximum bilateral molar bite force was evaluated using a bite dynamometer and the RMS EMG index of the masticatory muscles (anterior temporalis, masseter) during 5 seconds of the MMBMax task. Student t-test was used for data comparison between accuracy of the bite force and RMS EMG of masticatory muscles during the MMBMax. Results: The maximum bilateral molar bite force showed high accuracy (AUC=0.99) for the diagnosis of women with myogenic TMD and asymptomatic women, and the RMS EMG index evaluated during the MMBMax showed a moderate level of accuracy for all masticatory muscles (AUC=0.70 to 0.75). Conclusion: The bilateral bite dynamometer with a surface EMG during bilateral bite can be used to diagnose TMD in young women

Patient safety culture assessment before and after safety huddle implementation / Evaluación de la cultura de seguridad del paciente antes y después de implementar el safety huddle / Avaliação da cultura de segurança do paciente antes e depois da implementação do safety huddle

ABSTRACT Objective: To identify whether safety huddle implementation enabled a change in patient safety culture. Method: Quasi-experimental research that assessed patient safety culture before and after safety huddle implementation. Results. The study revealed that 53.98% completed the two safety culture assessments, with 60.1% adherence from the nursing team, with a statistically significant difference in the second assessment regarding perception of patient safety and adverse events notified (p < 0.00). Regarding good practice indicators, a statistically significant difference (p < 0.00) was observed in item 43 and improvement in almost all dimensions in the second safety culture assessment. The huddles totaled 105 days, with 100% adherence from the nursing team. Regarding checklist items, all presented satisfactory responses (above 50%). Conclusion: Safety huddles proved to be an effective tool for communication between healthcare professionals and managers, demonstrating positive impacts on good practice indicators and most safety culture dimensions.

RESUMEN Objetivo: Identificar si la implementación del safety huddle permitió un cambio en la cultura de seguridad del paciente. Método: Investigación cuasiexperimental, que evaluó la cultura de seguridad del paciente antes y después de la implementación del safety huddle. Resultados: El estudio reveló que el 53,98% completó las dos evaluaciones de la cultura de seguridad, con un 60,1% de adherencia por parte del equipo de enfermería, con diferencia estadísticamente significativa en la segunda evaluación en cuanto a la percepción de seguridad del paciente y eventos adversos reportados (p < 0,00). En cuanto a los indicadores de buenas prácticas, se observó una diferencia estadísticamente significativa (p < 0,00) en el ítem 43 y una mejora en casi todas las dimensiones en la segunda evaluación de la cultura de seguridad. Los huddles totalizaron 105 días, con 100% de adherencia por parte del equipo de enfermería. En cuanto a los ítems del checklist, todos presentaron respuestas satisfactorias (por encima del 50%). Conclusión: Los safety huddles demostraron ser una herramienta eficaz para la comunicación entre los profesionales de la salud y los gerentes, demostrando impactos positivos en los indicadores de buenas prácticas y en la mayoría de las dimensiones de la cultura de seguridad.

RESUMO Objetivo: Identificar se a implementação do safety huddle possibilitou mudança na cultura de segurança do paciente. Método: Pesquisa quase-experimental, que avaliou a cultura de segurança do paciente antes e após a implementação do safety huddle. Resultados: O estudo revelou que 53,98% preencheram as duas avaliações da cultura de segurança, com 60,1% de adesão da equipe de enfermagem, com diferença estatisticamente significativa na segunda avaliação quanto à percepção da segurança do paciente e eventos adversos notificados (p < 0,00). Quanto aos indicadores de boas práticas, observou-se diferença estatisticamente significativa (p < 0,00) no item 43 e melhoria em quase todas as dimensões na segunda avaliação da cultura de segurança. Os huddles totalizaram 105 dias, com 100% de adesão da equipe de enfermagem. Quanto aos itens do checklist, todos apresentaram respostas satisfatórias (acima de 50%). Conclusão: Os safety huddles revelaram-se uma ferramenta eficaz para a comunicação entre profissionais de saúde e gestores, demonstrando impactos positivos nos indicadores de boas práticas e na maioria das dimensões da cultura de segurança.

Avaliação da cultura de segurança do paciente em um hospital geral* / Patient safety culture assessment in a general hospital / Evaluación de la cultura de seguridad del paciente en un hospital general

Objetivo: avaliar cultura de segurança do paciente (CSP) na perspectiva da equipe multiprofissional atuante em um hospital geral. Método: estudo transversal com abordagem quantitativa, a partir da aplicação da versão eletrônica brasileira do instrumento Hospital Survey on Patient Safety Culture da Agency for Healthcare Research and Quality. A coleta de dados ocorreu em agosto de 2022 por meio do E-questionário de CSP. Resultados: responderam ao questionário 236 profissionais da enfermagem, médicos e equipe multiprofissional. Das 12 dimensões da CSP avaliadas, destacaram-se sete com percentual entre 63,3% e 95%, consideradas fortes, uma com 50% de positividade, indicando uma dimensão em crescimento, e quatro com percentuais abaixo, com 50% de respostas positivas apontadas como áreas fracas. Conclusão: foi possível avaliar a CSP no ambiente hospitalar e perceber as dimensões fortes, fracas e aquelas em crescimento. Progredir nessa prática é desafiador para as equipes que buscam uma organização confiável.

Objective: to assess patient safety culture (PSC) from the perspective of the multidisciplinary team working at a general hospital. Method: this a cross-sectional study with a quantitative approach, based on the application of the Brazilian electronic version of the Hospital Survey on Patient Safety Culture from the Agency for Healthcare Research and Quality. Data collection took place in August 2022 through E-questionário de PSC. Results: a total of 236 nursing professionals, doctors and multidisciplinary teams responded to the questionnaire. Of the 12 PSC dimensions assessed, seven stood out with percentages between 63.3% and 95%, considered strong, one with 50% positivity, indicating a growing dimension, and four with lower percentages, with 50% of positive answers identified as weak areas. Conclusion: it was possible to assess PSC in the hospital environment and perceive the strong, weak and growing dimensions. Progressing in this practice is challenging for teams looking for a reliable organization.

Objetivo: evaluar la cultura de seguridad del paciente (CSP) desde la perspectiva del equipo multidisciplinario que trabaja en un hospital general. Método: estudio transversal, con enfoque cuantitativo, utilizando la versión electrónica brasileña del instrumento Hospital Survey on Patient Safety Culture del Agency for Healthcare Research and Quality. La recopilación de datos se realizó en agosto de 2022 mediante el cuestionario electrónico CSP. Resultados: respondieron al cuestionario 236 profesionales de enfermería, médicos y equipos multidisciplinares. De las 12 dimensiones del CSP evaluadas, siete destacaron con un porcentaje entre 63,3% y 95%, considerada fuerte, una con 50% de positividad, indicando una dimensión en crecimiento, y cuatro con porcentajes más bajos, con un 50% de respuestas positivas identificadas como áreas débiles. Conclusión: fue posible evaluar la PSC en el ambiente hospitalario y percibir las dimensiones fuertes, débiles y crecientes. Avanzar en esta práctica es un desafío para los equipos que buscan una organización confiable.

Strength of scapular elevation in women with TMD and asymptomatic women - a cross-sectional study

Temporomandibular disorder (TMD) is recognized for its high prevalence, presenting characteristic signs and symptoms. Cervical spine pain is present in 70% of diagnosed TMD cases. Aim To verify if women with TMD present changes in isometric muscle strength in the scapula elevation. Methods This is an observational, cross-sectional study. Thirty-five women, aged 22.89±2.04 years, were divided into the TMD group (TMDG), diagnosed with TMD according to the DC/TMD, and control group (CG), with asymptomatic individuals. The volunteers accessed a online link by the smartphone in order to answer questions on personal data, the Fonseca Anamnestic Index (FAI), Neck Disability Index (NDI), and Masticatory preference. In all participants, evaluation of the force of the scapula elevation muscles was performed, using a load cell model MM-100 (Kratos® SP, Brazil). Data were analyzed descriptively using the maximum, mean, and standard deviation and a two-way ANCOVA test was applied for all variables. A significance level of 5% was considered. Results There were no statistically significant differences between the TMDG and CG for the maximal and mean muscle strength of scapular elevation. There were statistically significant differences in FAI (p <0.001*) between the CG and the TMDG. Conclusion Based on the results, it was not possible to confirm the hypothesis that women diagnosed with TMD present lower isometric strength during scapular elevation (right/left).

Anatomical control of the lower nasal width in Le Fort I osteotomy / Control anatómico del ancho nasal inferior en osteotomía Le Fort I

SUMMARY: The aim of this research is to show a simple technique to obtain control in the alar base width in Le Fort I osteotomy. The technique was used in eighteen patients submitted to maxillary impaction and/or advancements (≥ 3 mm). Inter-alar width, alar base width and right/left nostril were studied before surgery and 6 months of follow-up. Data were reported as means and standard deviations; statistical analysis was realized by t test considering a p-value <0.05. Left nostril was modified 0.33 ± 1.03 mm, right nostril was modified 0.39 ± 0.98 mm after 6 months and inter-alar width show a decrease of 0.17 ± 1.15 mm. No statistical differences were observed between the preoperative and the postoperative measurements. Our results show this technique as effective in to obtain a stable position in nasal width.

RESUMEN: el objetivo de esta investigación es presentar una técnica simple para obtener el control en el ancho de la base alar en la ejecución de una osteotomía de Le Fort I. La técnica fue usada en 18 sujetos sometidos a cirugía maxilar de ascenso y/o avance maxilar mayor (≥ 3 mm). El ancho inter-alar, el ancho de la base alar y el orificio nasal derecho e izquierdo fueron estudiados antes de la cirugía y seis meses después de la misma. Los datos fueron presentados en promedios y desviación estándar; el análisis estadístico fue realizado utilizando el t test considerando un valor de p <0,05. El orificio izquierdo fue modificado en 0,33 ± 1,03 mm, el orificio izquierdo fue modificado en 0,39 ± 0,98 mm des- pués de 6 meses y el ancho inter alar mostro una reducción de 0,17 ± 1,15 mm. No se observaron diferencias estadísticas entre las mediciones obtenidas previo a la cirugía y después de la cirugía. Nuestros resultados muestran que la técnica es efectiva para obtener una posición estable del ancho nasal.

Nasal septum deviation and inferior nasal concha bone hypertrophy in class III facial deformity / Desviación del septum nasal e hipertrofia de la concha nasal inferior en deformidad facial clase III

SUMMARY: The aim of this research was to analyze the morphology of the nasal septum and inferior nasal concha bone in class III facial deformities prior to orthodontic treatment in orthognathic surgery candidates. 40 subjects were included in this research. The inclusion criteria were an Angle class III, negative overjet and SNA angle less than 80º. Patients with facial asymmetry, facial trauma or who had undergone maxillofacial or ENT procedures were excluded. CBCT images were obtained for all the patients and the nasal septum deviation, morphology of inferior nasal concha bone and ostium of the maxillary sinus were analyzed and related to the complexity of the facial deformity expressed by the ANB angle and dental relations. The measurement was standardized by ICC and the data was analyzed using a chi square test and Spearman's coefficient with a p value < 0.005 for statistical significance. Nasal septal deviation was observed in 77.5 %. The deviation angle was 13.28º (±4.68º) and the distance from the midline to the most deviated septum was 5.56 mm (±1.8 mm) with no statistical relation to the complexity of the facial deformity. The deviated nasal septum showed inferior nasal concha bone hypertrophy on the concave side of the nasal septum deviation (p=0.049). The open or closed condition of the maxillary sinus ostium was not related to any conditions in the septum or complexity of the facial deformity. Inferior nasal concha bone hypertrophy could be related to nasal septal deviation. The nasal condition in a class III facial deformity could not differ from the general population; careful in orthognathic surgery as to be assume in the Le Fort I Osteotomy and nasal approach related to nasal septum deviation and inferior nasal concha bone.

RESUMEN: El objetivo de esta investigación fue analizar la morfología del septum y la concha nasal inferior en sujetos con deformidad facial clase III previo al tratamiento de ortodoncia preparatorio para cirugía ortognática. Fueron incluidos 40 sujetos en esta investigación. Los criterios de inclusión fueron la de presentar una clase III de Angle, overjet negativo y ángulo SNA menor que 80º. Sujetos con asimetría facial, trauma facial o quienes presentaron algún tipo de procedimiento maxilofacial o de otorrinolaringología fueron excluidos. Tomografía computadorizada cone beam (CBCT) fueron obtenidas para todos los sujetos donde le morfología del septum nasal, morfología de la concha nasal inferior y el ostium del seno maxilar fueron analizados y relacionados con la complejidad de la deformidad facial expresada como ángulo ANB y relaciones dentales. Las medidas fueron estandarizadas por el ICC y los datos fueron analizados utilizando la prueba chi cuadrado y coeficiente de Spearman con un valor de p<0,05 para obtener relaciones significativas. La desviación del septum nasal se observó en el 77,5 %; el ángulo de desvío fue de 13,28º (±4,68º) y la distancia de desvío del septum desde la línea media fue de 5,56 mm (±1,8 mm) sin diferencias estadísticas en relación a la complejidad de la deformidad. El desvío de septum nasal demostró hipertrofia de la concha nsal inferior en el lado cóncavo del septum desviado (p=0,049). La condición de ostium abierto o cerrado no fue relacionado con ninguna condición del septum nasal o complejidad de la deformidad facial. La hipertrofia de la concha nasal inferior se relacionó con el desvío de septum nasal. La condición nasal en deformidad facial de clase III no es diferente de la observada en la población general; cuidados deben ser realizados en cirugía ortognática para el desarrollo de la osteotomía de Le Fort I y aproximación nasal en relación al desvío de septum y probable alteración de la concha nasal inferior.

Relación Transversal, Vertical y Sagital en Sujetos con Deformidad Facial Candidatos a Cirugía Ortognática / Transverse, Vertical and Sagittal Relationship in Subjects with Facial Deformity Candidates for Orthognathic Surgery

RESUMEN: El objetivo de este estudio fue evaluar la relación entre la clase esqueletal sagital y las condiciones transversales o verticales en sujetos con deformidad facial sin presencia de asimetría facial; Se realizó un análisis cefalomét rico de la clase esqueletal sagital, transversal y vertical en 115 sujetos con indicaciones de cirugía ortognática. Se consideró algunos datos del análisis cefalométrico de Steiner y el análisis cefalométrico de Ricketts en sentido sagital para determinar la clase esqueletal facial. A nivel transversal se determinó la dimensión transversal facial, dimensión transversal maxilar y dimensión transversal mandibular. A nivel vertical se determinó la dimensión vertical oclusal y dimensión vertical total. Al comparar las mediciones transversales y verticales entre sujetos de sexo femenino y masculino, se observó que los hom- bres presentaban mayores dimensiones que las mujeres (p=0,0001) en todos los análisis realizados. Los sujetos clase III presentaron mayor dimensión transversal facial (p=0,0002) y transversal mandibular (p=0,001) que los sujetos clase II. Además, se observó que los sujetos clase III presentaban mayor dimensión vertical total (p=0,002) que los sujetos clase II; Es posible concluir que existe características faciales transversales y verticales que se pueden relacionar con la posición sagital de las estructuras maxilo-mandibulares.

ABSTRACT: The aim of this study is to evaluate the relationship between sagittal skeletal class and transverse or vertical conditions in subjects with facial deformity without presence of facial asymmetry; A comparative study was conducted between the results of the cephalometric analysis of the sagittal, transverse and vertical skeletal class in 115 subjects with indications for orthognathic surgery. The Steiner cephalometric analysis in the sagittal direction was used to determine the facial skeletal class and the Ricketts cephalometric analysis in the sagittal analysis. At the transverse level it was determined the facial transverse dimension, maxillary transverse dimension and mandibular transverse dimension. At a vertical level it is determined the occlusal vertical dimension and total vertical dimension. When comparing cross-sectional and vertical measurements between female and male subjects, it was observed that male subjects presented greater dimensions than female subjects (p=0.0001). Class III subjects present greater facial transverse dimension (p=0.0002) and mandibular transverse dimension (p=0.001) than class II subjects. Also, it was observed that class III subjects had a greater total vertical dimension (p=0.002) than class II subjects; It is possible to conclude that there are facial characteristics transverse and vertical that can be related with the sagittal position of the maxillo-mandibular structures.

About chin (genioplasty) surgery / Sobre cirugía del mentón (genioplastía)

Facial harmony is the consequence of a proper balance between all facial structures. The identification and classification of morphologic characteristics that detract from facial harmony is most effectively accomplished by clinical examination. The maintenance of the ratios between the facial thirds, correct spatial bone position and soft tissues accommodation are all factors that directly contribute in a balanced facial profile. The chin, likewise, contributes significantly in facial balance, mainly in the profile view. Expressive changes on chin position are associated with the perception of strong or delicate characters. Thus, over the years, a series of studies has been constructed focusing on mandibular osteotomies techniques that enable changes in chin position: advances, setback, extrusion, intrusion, widening, narrowing and asymmetry. This study aims to address historical and technical aspects of genioplasty; associating patient's condition with the surgical techniques that can be applied for correction of chin deformities.

La armonía facial es la consecuencia del balance entre las estructuras facial. La identificación y clasificación de las características morfológicas que están acompañando la armonía facial son mas efectivas al realizar un estudio de análisis facial. La obtención de promedios entre los tercios, corrección especial de la posición del hueso y la acomodación de los tejidos blandos son factores directamente involucrados en el balance del perfil. El mentón, contribuye significativamente en este balance. Cambios expresivos en la posición del mentón son asociados con la percepción de características fuertes o delicadas. Durante los años, una serie de estudios han sido desarrollados enfocándose en las osteotomías mandibulares y técnicas capaces de alcanzar los cambios en la posición del mentón: avances, retrocesos, extrusiones, ensanchamientos, estrechamientos y asimetrías. Este estudio pretende orientar las condiciones históricas y técnicas respecto de la genioplastia; la asociación de las características del paciente con la técnica quirúrgica pueden ser aplicadas para la corrección de las deformidades.

Stability as a key factor for bone repair in nonunion of mandibular osteotomy / Estabilidad como factor clave en la reparación de la nonunión de la osteotomía mandibular

Stability is necessary to ensuring proper bone repair after osteotomies and fractures. The aim of this research was to analyze how the repair of pseudoarthrosis sites was affected by different conditions in related to soft tissue. An experimental study was designed with 18 New Zealand rabbits. Six study groups were formed. An osteotomy was performed on the mandibular body of each animal and muscle was installed at the osteotomy site to model pseudoarthrosis. Fixation by surgery was then carried out, using plates and screws. The animals were submitted to euthanasia after 21, 42 and 63 days to make a descriptive comparison of the histological results. No animal was lost during the experiment. In all the samples, bone formation was observed with different degrees of progress. Defects treated with or without removal of the tissue involved in pseudoarthrosis presented comparable bone repair, showing that stability of the bone segments allows the repair of adjacent tissue. In some samples cartilaginous tissue was associated with greater bone formation. Stabilization of the fracture is the key in bone repair; repair occurs whether or not the pseudoarthrosis tissue is removed.

La estabilidad de las osteotomías y de las fracturas son fundamentales para asegurar la adecuada reparación ósea; el objetivo de esta investigación fue analizar la reparación presente en sitios de pseudoartrosis realizando la limpieza de la zona previo a la fijación o manteniendo el tejido de la nounión en el mismo lugar durante la osteosíntesis. Se diseñó un estudio experimental incluyendo 18 conejos de raza Neozelandesa. Se formaron 6 grupos de estudios a quienes se relizó una osteotomía en el cuerpo mandibular y posterior instalación de músculo en el lugar de la osteotomía para fabricar un modelo de pseudoartrosis. En cirugía posterior se fijó con placa y tornillos. Se realizaron eutanasias a los 42 y 63 días para comparar los resultados de forma descriptiva mediante estudio histológico. No fue perdido ningún animal durante el experimento. En todas las muestras evaluadas se observó formación ósea en diferentes niveles de avance; defectos tratados con o sin el retiro del tejido involucrado en la pseudoartrosis presentaron una condición de reparación ósea comparables, determinando que la estabilidad de los segmentos óseos permite la reparación del tejido adyacente. El tejido cartilaginoso se presentó en algunas muestras asociadas a sectores con mayor presencia de formación ósea. La estabilización de la fractura es clave en la reparación ósea; la reparación se produce manteniendo o retirando el tejido presente en la pseudoartrosis.

Cutaneous Fistula Associated with Salivary Calculi in the Parotid Gland: Report of a Rare Case / Fístula cutánea asociada a cálculos salivales en la glándula parótida: reporte de un caso raro / Fístula Cutânea Associada a Cálculos Salivares na Glândula Parótida: Relato de Caso Raro

Abstract The formation of calcific concretions in the salivary duct or glands is a common disorder, but parotid calculi represent only a small proportion of all salivary calculi. This case describes a rare coexistence of a cutaneous fistula with salivary stones located in the superficial lobe of the parotid gland that was removed under local anesthesia. This patient provides illustration of the difficulty there may be in establishing the diagnosis of parotid calculus. We believe that the report of this rare case will help health professionals, reinforcing the importance of proper diagnosis based on clinical and imaging evaluations.

Resumen La formación de concreciones calcificadas en el conducto salival o glándulas es un trastorno común, pero los cálculos de la parótida representan una pequeña parte de los cálculos salivares. Nosotros describimos este raro caso de la presencia de una fístula de piel asociada a un cálculo salivar del lóbulo superficial de la glándula parótida que foi removido sobre anestesia local. Este reporte muestra la dificultad que puede existir para establecer el diagnóstico del cálculo de la parótida. Creemos que el informe de este caso raro ayudará a los profesionales de la salud, reforzando la importancia de un diagnóstico adecuado basado en evaluaciones clínicas y de imágenes.

Resumo A formação de concreções calcificadas no ducto ou nas glândulas salivares é um distúrbio comum, mas os cálculos na parótida representam só uma pequena parte dos cálculos salivares. Nós descrevemos este raro caso de uma fístula cutânea associada a um cálculo salivar do lobo superficial da glândula parótida que foi removido sob anestesia local. Este reporte mostra a dificuldade que podemos ter na hora de diagnosticar o cálculo da parótida. Acreditamos que o relato desse caso raro ajudará os profissionais da saúde, reforçando a importância do diagnóstico adequado baseado em avaliações clínicas e por imagem.

Delay of neuropathic pain sensitization after application of dexamethasone-loaded implant in sciatic nerve-injured rats

Neuroimmune interactions underlying the development of pain sensitization in models of neuropathic pain have been widely studied. In this study, we evaluated the development of allodynia and its reduction associated with peripheral antineuroinflammatory effects induced by a dexamethasone-loaded biodegradable implant. Chronic constriction injury (CCI) of the sciatic nerve was performed in Wistar rats. The electronic von Frey test was applied to assess mechanical allodynia. The dexamethasone-loaded implant was placed perineurally at the moment of CCI or 12 days after surgery. Dorsal root ganglia (DRG; L4-L5) were harvested and nuclear extracts were assayed by Western blot for detection of nuclear factor (NF)-κB p65/RelA translocation. Dexamethasone delivered from the implant delayed the development of allodynia for approximately three weeks in CCI rats when the implantation was performed at day 0, but allodynia was not reversed when the implantation was performed at day 12. NF-κB was activated in CCI rat DRG compared with naïve or sham animals (day 15), and dexamethasone implant inhibited p65/RelA translocation in CCI rats compared with control. This study demonstrated that the dexamethasone-loaded implant suppresses allodynia development and peripheral neuroinflammation. This device can reduce the potential side effects associated with oral anti-inflammatory drugs.

Immunoglobulin G4-related disease of the maxillofacial region: a rare case / Enfermedad relacionada con inmunoglobulina G4 en el área maxilofacial: un caso raro

IgG4-related disease is a systemic, multifocal, immune-mediated disorder that can affect multiple organs and may present as a tumor, with rare cases described in the maxillofacial region. A female patient, 53 years old, presenting tumor-like mass in the right mandibular region. Magnetic resonance imaging suggested well circumscribed nodular lesion adjacent to the branch / body of the mandible, extending posteriorly to the masseter muscle. During the surgical procedure of excision, a lesion was observed adhering to the right masseter muscle, but it was possible to remove it completely. Histopathological and immunehistochemical analysis suggested diagnosis of IgG4-related disease, furthermore, IgG4 serum count was increased. Actually, the patient continues on periodical followups in our service and by other specialties. Can be concluded that precise diagnosis of this pathology depends on many factors, being challenging and the treatment involves multidisciplinary evaluation due to the possibility of involvement of several other organs.

La enfermedad relacionada con IgG4 es una condición sistémica, multifocal, mediada por una alteración de la respuesta inmune que puede afectar diferentes órganos o puede presentarse como un tumor, raramente descrito en el área maxilofacial. Se describe el caso de una paciente de sexo femenino de 53 años de edad, presentando una masa tumoral en el ángulo mandibular derecho. La resonancia magnética sugirió un área nodular bien delimitada adyacente al cuerpo mandibular y extendida posteriormente hasta el musculo masetero. Durante la escisión quirúrgica, la lesión se presentaba adherida al musculo de forma lateral siendo posible el retiro total de la lesión. El estudio histopatológico e inmunohistoquimico determinó el diagnóstico de enfermedad relacionada con IgG4 presentando un conteo de igG4 aumentado. Actualmente, la paciente continua con seguimiento por la especialidad. Se puede concluir que el diagnóstico preciso de esta patología depende de algunos factores; el tratamiento debe ser multidsciplinario debido a la inclusión de diferentes órganos en la enfermedad.

Comparison of instruments used to select and classify patients with temporomandibular disorder / Avaliação de instrumentos utilizados para selecionar pacientes com disfunção temporomandibular

The aim of the present study was to identify the relationship among instruments used to screen and diagnose temporoman dibular disorders (TMD). A retrospective study was conducted using medical records of patients with temporomandibular disorder who had visited the institution for initial assessment between January and December 2015. Medical history and physical examination data were collected, particularly those focusing on the diagnosis of TMD and TMJ (temporomandibular joint) function. The following instruments were used to assess the severity of the TMD signs and symptoms: the Fonseca Anamnestic index (FAI), the Helkimo index (HI), the American Association of Orofacial Pain Questionnaire (AAOPQ) and the Jaw Symptom & Oral Habit Questionnaire (JSOHQ). Thirtyeight patient records were included, with prevalence of women (84.6%) and mean age 37.42 ± 14.32 years. The patients who were classified as having severe TMD by the FAI exhibited more positive responses on the AAOPQ (6.25 ±1.42; oneway ANOVA F=15.82), with a statistically significant difference when compared to patients with mild TMD (3.0 ±1.22; p<0.01). A positive correlation (r=0.78; p<0.01) was found between the number of positive responses on the AAOPQ and the sum of the JSOHQ scores. Patients who were classified with severe TMD on the FAI exhibited higher scores on the JSOHO (18.58 ±4.96/ oneway ANOVA F=14.43), with a statistically significant difference when compared to patients with moderate (12.08 ±5.64; p<0.01) and mild TMD (7.46 ±4.89; p<0.01). Conclusion: In the study sample, there was consistency among the instruments used to differentiate patients with severe and mild TMD. The selection of instruments should be rational, in order to improve the quality of the results (AU)

O objetivo deste estudo foi identificar a relação entre os instrumentos utilizados para selecionar e diagnosticar os pacientes com disfunção temporomandibular (DTM). Foi realizado um estudo retrospectivo utilizando prontuários odontológicos de pacientes atendidos devido a dor e disfunção na articulação temporomandibular, que haviam procurado a instituição para uma avaliação inicial entre janeiro e dezembro de 2015. Foram coletados dados da história médica e do exame físico, particularmente aqueles que se concentraram no diagnós tico de DTM. Os seguintes instrumentos foram utilizados para avaliar a gravidade dos sinais e sintomas da DTM: o índice anamnésico de Fonseca (FAI); O índice Helkimo (HI); o questionário da Associação Americana de Dor Orofacial (AAOPQ) eo Questionário de Sintomas e Hábitos Orais (JSOHQ). Foram incluídos trinta e oito prontuários de pacientes, com prevalência de mulheres (84,6%) e idade média de 37,42 ± 14,32 anos. Os pacientes que foram classificados com DTM severa pela FAI apresentaram maior número de respostas positivas no AAOPQ (6,25 ± 1,42; ANOVA F = 15,82), com diferença estatisticamente significativa em comparação com pacientes com DTM leve (3,0 ± 1,22; p < 0,01). Foi encontrada uma correlação positiva (r = 0,78; p <0,01) entre o número de respostas positivas no AAOPQ e a soma dos escores no JSOHQ. Os pacientes que foram classificados com DTM severa na FAI exibiram pontuações mais altas no JSOHO (18,58 ± 4,96 / ANOVA F = 14,43), com diferença estatisticamente significativa quando comparados a pacientes com DTM média (12,08 ± 5,64; p <0,01) e leve (7,46 ± 4,89; p <0,01). Na amostra estudada, houve congruência entre os instrumentos utilizados para diferenciar os pacientes com DTM grave e leve. A seleção de instrumentos deve ser racional, a fim de melhorar a qualidade dos resultados (AU)

Potential donor sites of the parietal for bone grafting and its relationship to the cephalic index / Sitios donantes potenciales del hueso parietal para injerto óseo y su relación con el índice cefálico

The purpose of the present study was to chart the thickness of the parietal bone and establish its relationship with the cephalic index and sex aiming at improving current knowledge and guidance for obtaining calvarial bone auto-graft material. Both left and right parietal bones of 150 skulls of adult human cadavers classified as either dolicho-, meso-, or brachicephalic, and as either male or female had their thickness measured at 3 levels ­ superior (S), middle (M) and inferior (I) ­ and at 3 points ­ anterior (a), middle (m) and posterior (p) ­ in each level, all evenly laid out. No relevant differences in thickness whether comparing sex or cephalic index was evidenced. The thickest measurements were found at points located at superior and middle levels in middle and posterior positioning ­ Sm, Sp, Mm and Mp ­ with median values ranging from about 5.5mm to 7.13mm. At inferior level and posterior positioning, thickness median values ranged from 4.71 to 5.84mm. Safer harvesting of bone graft material occurs in Sm, Sp, Mm and Mp areas of the parietal bone. Only exceptionally should Ip domain be used, whereas Sa, Ia and Im regions should be considered non-donor sites.

El propósito del estudio fue medir el grosor del hueso parietal y establecer su relación con el índice cefálico y el sexo, con el objetivo de mejorar el conocimiento actual y la orientación para el auto-injerto de material óseo. Fueron estudiados huesos parietales, tanto izquierdos como derechos, de 150 cráneos de cadáveres humanos adultos, de hombres y mujeres, clasificados como dolico-, meso- o braquicefálico; el espesor fue medido en 3 niveles: superior (S), medio (M) e inferior (I) - y en 3 puntos - anterior (a), medio (m) y posterior (p) - en cada nivel, todas uniformemente establecidas. No se observaron diferencias relevantes en el grosor a nivelrespecto del sexo o el índice cefálico. Las mediciones más gruesas se encontraron en los puntos situados en los niveles superior y medio, y en posiciones medias y posteriores - Sm, Sp, Mm y Mp - con valores medianos que oscilaban entre aproximadamente 5,5 mm y 7,13 mm. En el nivel inferior y posicionado posterior, los valores medianos del espesor oscilaron entre 4,71 y 5,84 mm. La recolección más segura del material de injerto óseo ocurre en las áreas Sm, Sp, Mm y Mp del hueso parietal. Sólo excepcionalmente se debe utilizar el dominio Ip, mientras que las regiones Sa, Ia e Im deben considerarse sitios no donantes.

Qualidade de Vida de Enfermeiros do Serviço de Atendimento Móvel de Urgência com Dupla Jornada de Trabalho / Nurses' Life Quality of Mobile Urgency Service with Double Work Shift

Objetivou-se descrever a qualidade de vida de enfermeiros do Serviço de Atendimento Móvel de Urgência com Dupla Jornada de Trabalho. Trata-se de um estudo exploratório e descritivo realizado de julho a agosto de 2015 com enfermeiros do Serviço de Atendimento Móvel de Urgência em Sobral ­ Ceará. Para coleta das informações foi usado o questionário validado Whoqol-Bref. Os dados foram apresentados, de forma descritiva, e discutidos de acordo com a literatura pertinente sobre o assunto. O estudo mostrou que quase a metade dos profissionais não está satisfeita com a qualidade de suas vidas. Contudo, no domínio físico, se mostraram bem fisicamente, no psicológico se mostraram positivos nos sentimentos negativos, quanto à ansiedade. Nas relações sociais, os enfermeiros estavam satisfeitos e no domínio do meio ambiente, eles demonstraram opiniões divididas entre satisfeitos e insatisfeitos e enfatizaram os riscos que estão sujeitos nas ocorrências. Portanto, o enfermeiro, em qualquer serviço em que atua, merece apoio, respeito e valorização, neste sentido é preciso políticas que promovam saúde, previnam doenças com vistas a melhor qualidade de vida. (AU)

The purpose of this study was to describe the nurses' life quality at the Double Emergency Mobile Service work shift. This is an exploratory and descriptive study carried out from July to August 2015 with nurses from the Mobile Emergency Care Service in Sobral - Ceará. To collect the information, the validated Whoqol-Bref questionnaire was used. The data were presented descriptively and discussed according to relevant literature on the subject. The study showed that nearly half of professionals are not satisfied with the their lives quality. However in the physical domain, they were physically well, in the psychological, they were positive regarding their feelings and negative when it comes to anxiety. In social relationships, nurses were satisfied and in the environmental domain, they demonstrated divided opinions between satisfied and unsatisfied and emphasized the risks that they are subject in the occurrences. Therefore, the nurse, in any service in which he / she works, deserves support, respect and appreciation, in this sense it is necessary policies that promote health, prevent diseases with a view to a better life quality. (AU)

Surgical management of mandibular ameloblastoma and immediate reconstruction with nonvascularized bone graft and hyperbaric oxygen therapy / Tratamiento quirúrgico de ameloblastoma mandibular y la reconstrucción inmediata con injerto oseo libre y terapia con oxígeno hiperbárico

Extensive resection of tumor often results in bone and soft tissue defects that cause functional and esthetic consequences. The reconstructive surgery is extremely important for the rehabilitation of these patients. The purpose of this study is to report on the use of Hyperbaric Oxygen therapy (HBO) in the case of a large ameloblastoma treated with segmental resection and reconstructed immediately with nonvascularized bone graft (NVBGs) from iliac crest. A 41-year-old woman was referred to our department because of paresthesia of the inferior alveolar nerve and history of swelling in the molar and ramus region of the left mandible. Panoramic radiograph depicting well-defined multilocular radiolucency extending from second pre-molar region to the left ramus region. An incisional biopsy confirms the diagnosis of solid ameloblastoma. The treatment of choice was segmental mandibular resection and immediate mandibular reconstruction using NVBGs from iliac crest, followed by removal of internal fixation and placement of dental implants with immediate loading. The patient received preoperative HBO (a 90-min session at 2.2-2.4 atmospheres, five times per week for two weeks, for a total of up to 10 sessions). Postoperative HBO (10 further 90-min sessions) was administered within 2weeks. The patient received rehabilitation with a mandibular implant-supported fixed complete dental prosthesis. The present study showed successful management of mandibular ameloblastoma that associated extensive surgery, immediate reconstruction with NVBGs from iliac crest, hyperbaric oxygen therapy and dental implants. These combined procedures allowed removal of lesion and reestablishment of mandibular contour and function.

La resección extensa de un tumor a menudo da lugar a defectos del hueso y de los tejidos blandos, que causan consecuencias funcionales y estéticas. La cirugía reconstructiva es extremadamente importante para la rehabilitación de estos pacientes. El propósito de este estudio fue informar sobre el uso de la terapia de oxígeno hiperbárico (HBO) en un caso de un ameloblastoma de gran tamaño, tratado con resección segmentaria y reconstruido inmediatamente con injerto óseo no vascularizado (IONV) de la cresta ilíaca. Una mujer de 41 años fue derivada a nuestro servicio por parestesia del nervio alveolar inferior e historia de hinchazón en la región molar y ramina de la mandíbula izquierda. Radiografía panorámica que muestra una radiolucencia multilocular bien definida que se extiende desde la segunda región pre-molar hasta la región de la rama izquierda. Una biopsia incisional confirma el diagnóstico de ameloblastoma sólido. El tratamiento de elección fue la resección mandibular segmentaria y la reconstrucción mandibular inmediata mediante IONV de cresta ilíaca, seguido de la eliminación de la fijación interna y la colocación de implantes dentales con carga inmediata. La paciente recibió OHB preoperatoria (una sesión de 90 minutos a 2.2-2.4 atmósferas, cinco veces por semana durante dos semanas, para un total de hasta 10 sesiones). La OHB postoperatoria (10 sesiones adicionales de 90 minutos) se administró en 2 semanas. La paciente recibió rehabilitación con una prótesis dental fija con implante mandibular. El presente estudio mostró un manejo exitoso del ameloblastoma mandibular asociado a una cirugía extensa, reconstrucción inmediata con IONV de cresta ilíaca, oxigenoterapia hiperbárica e implantes dentales. Estos procedimientos combinados permitieron la extirpación de la lesión y el restablecimiento del contorno y la función mandibular.

Mandibular foramen location and lingula height in dentate dry mandibles, and its relationship with cephalic index / Localización del foramen mandibular y altura de la língula mandibular en mandíbulas dentadas secas, y su relación con el índice cefálico

The mandibular foramen and its lingula is a major landmark when administering anesthetic or performing surgical procedures. The objective of this study was to determine whether the topological features of the mandibular foramen (MF) and lingula varied in mandibles from skulls of different cephalic indexes. The location of the mandibular foramen referred to the longitudinal borders of the mandibular ramus (MR), height of the foramen (Hf) referred to the occlusal line of the second molar, and the height of the lingula (Hl) were determined in a total of one hundred and five dry mandibles from skulls identified as dolicho- meso- and brachycephalic. On average MF in brachycephalic mandibles was closest to the anterior border of MR. Hf in brachy-, meso- and dolichocephalic mandibles were -0.22 mm, -4.04 mm and -4,01mm, respectively. The lingula in brachycephalic specimens was considerably shorter (0.78 mm) than in dolichocephalic ones (1.84 mm). Inferior alveolar nerve block should be carried out using shorter needles, inserting it 4mm above the occlusion level of the molar teeth. The ramus of brachicephalic mandibles were significantly less wide those of dolicho- and mesocephalic ones. If the height of the lingula is to be used as a reference to judge the level of the medial horizontal cut to carry out sagittal split ramus osteotomy, special attention should be given to the patient's cephalic index.

El foramen mandibular y la língula son los puntos anatómicos más importantes a considerar en la administración de anestesia troncular o la realización de procedimientos quirúrgicos en la mandíbula. El objeivo fue determinar si las características topológicas del foramen mandibular (FM) y la língula mandibular presentan variaciones en las mandíbulas de cráneos con diferentes índices cefálicos. Fueron utilizados 105 mandíbulas secas, pertenecientes a cráneos identificados como dolico, meso y braquicéfalos. En cada caso, se relacionaron la ubicación del FM con los márgenes longitudinales de la rama mandibular (RM) y la altura del foramen (Af) con la línea oclusal del segundo molar. Además, se determinó la altura de la língula (Al). En promedio, el FM de mandíbulas braquicefálicas se encontró más cerca del margen anterior de la RM. La Af en mandíbulas braqui, meso y dolicocéfalas fue de -0,22 mm, -4,04 mm y -4,01 mm, respectivamente. La língula mandibular en muestras braquicefálicas, fue considerablemente más corta (0,78 mm) que en las dolicocéfalas (1,84 mm). El bloqueo del nervio alveolar inferior debe llevarse a cabo usando agujas cortas, insertándolas 4 mm por encima del nivel de oclusión de los dientes molares. La rama de las mandíbulas braquicefálicas fueron significativamente menos anchas que en cráneos dolico y mesocefálicos. Si la altura de la língula mandibular se utilizará como referencia para determinar el nivel del corte medial horizontal para realizar la osteotomía sagital de la rama mandibular, se debe dar especial atención al índice cefálico del paciente.

Variation in the repair of a rib graft used for mandibular reconstruction after 20 years / Variación en la reparación de un injerto costal utilizado para reconstrucción mandibular después de 20 años

Mandibular reconstruction has been used in the last 100 years as a safe, effective and stable technique. Various types of grafts have been used, including the autogenous rib graft; the normal repair of this type of graft has been defined in some studies although some observations have been made indicating low predictability of the growth of this bone. The aim of this study was to report the case of a patient with a rib graft for mandibular reconstruction where after 20 years cartilaginous tissue was observed exclusively in the absence of bone tissue. A 61-year-old female patient presented in the Oral and Maxillofacial Surgery Service for dental implants. The patient had a history of 4 previous mandibular reconstructions; imaging showed no alterations to the normal evolution of a graft. However, the intraoral access contained softer tissue than the normal bone, and thus the implant installation was abandoned. Histopathological analysis revealed the formation of collagenous tissue and cartilage, chondrocytes island conditions characteristic of cartilaginous tissue in the absence of mineralization and cancellous bone. This led to the conclusion that repair conditions can vary based on specific and general factors as yet under discussion.

La reconstrucción mandibular ha sido utilizada en los últimos 100 años como una técnica segura, eficaz y estable. Diversos tipos de injertos se han utilizado siendo el auto trasplante de hueso costal uno de ellos; la normal reparación de este tipo de injertos ha sido definida en algunas investigaciones aunque se han realizado otras observaciones indicando baja predictibilidad del crecimiento de este hueso; el objetivo de esta investigación es reportar un caso de una paciente portadora de injerto costal para reconstrucción de mandíbula donde después de 20 años se observó exclusivamente tejido cartilaginoso en ausencia de tejido óseo. Una paciente del sexo femenino, 61 años se presentó al Servicio de Cirugía Oral y Maxilofacial para ser tratada con implantes dentales; la paciente presentaba historia de 4 reconstrucciones mandibulares previas; los estudios de imagen se presentaban sin alteraciones a la condición normal de la evolución. Sin embargo, al acceso intraoral se observó un tejido más blando que el hueso normal, abortándose la instalación del implante. El análisis histopatológico reveló la formación de tejido colágeno y cartílago, condrocitos en lagunas y condiciones características de tejido cartilaginoso en ausencia de mineralización y trabeculado óseo.Se concluye que las condiciones de reparación pueden variar en base a factores específicos y generales aun en discusión.

Mandibular condyle repair after partial condylectomy in patients with active condylar hyperplasia / Reparación de cóndilos mandibulares después de condilectomía parcial por hiperplasia condilar activa

The different aspects of unilateral condylar hyperplasia have been studied and continue to be controversial; nevertheless, treatment based on condylectomy has been established as part of the working protocol. The aim of this investigation was to identify the bone repair observed in surgically treated condyles after 1 year using cone beam computed tomography (CBCT). Nine subjects were included in this study (6 female and 3 male) with an average age of 18.5 years. They had been diagnosed with active unilateral condylar hyperplasia using SPECT, clinical follow-up of progressive facial asymmetry and CBCT. Patients underwent exclusive condylectomy surgery with a piezoelectric system without disc replacement, orthognatic surgery or any other type of adjunct surgical procedure. Later, they were treated orthodontically for dental compensation or as preparation for orthognatic surgery. A CBCT was performed in the first postoperative month and after 1 year from the surgery to analyze variables. The CBCT at 1 month showed a clear and distinct slice of the condyle without defects or irregularities; the distance from the condylar remnant to the articular fossa reached 8.5 mm in the most extreme case. After 1 year, condylar bone remodeling was observed, with areas of lateral and superior curvature and characteristics of normal condyles, with cortical bone present and a maximum distance of 4.5 mm from the condylar fossa. In conclusion, condylar repair and remodeling can be obtained in these types of surgeries and the morphology of resected condyles after 1 year is quite close to normal macroscopic anatomy.

La hiperplasia condilar unilateral ha sido estudiada en diferentes aspectos y continua siendo controversial; aun así, el tratamiento en base a condilectomía se establece como parte del protocolo de trabajo. El objetivo de esta investigación es reconocer la reparación ósea observada en cóndilos operados después de 1 año mediante tomografía computadorizada cone beam (TCCB). Nueve sujetos fueron incluidos en este estudio (6 sexo femenino y 3 sexo masculino) con una edad promedio de 18,5 años; en ellos se realizó el diagnóstico de hiperplasia condilar unilateral activa mediante estudio de SPECT, seguimiento clínico de la asimetría facial progresiva y TCCB. Se realizó la cirugía de condilectomía exclusiva con sistema piezoeléctrico sin reposición de disco, cirugía ortognática u otro tipo de procedimiento quirúrgico adjunto; posteriormente, los pacientes fueron tratados ortodoncicamente para compensación dentaria o para preparación previa a cirugía ortognática. Se realizó TCCB dentro del primer mes postquirúrgico y después de 1 año de realizada la cirugía para análisis de variables. Se observó en la TCCB de 1 mes un corte nítido y neto del cóndilo, sin defectos o irregularidades; la distancia desde el remanente condilar hasta la fosa articular llegó hasta 8,5 mm en el caso máximo. Después de 1 año, se observo remodelación ósea condilar, con áreas de curvatura lateral y superior características de cóndilos normales, con presencia de hueso cortical y con una distancia máxima de 4,5 mm desde la fosa condilar. Se puede concluir que la reparación y remodelación condilar es viable de obtenerse en este tipo de cirugías y que la morfología de cóndilos resecados después de 1 año es bastante próxima de la anatomía macroscópica normal.