ABSTRACT
Fibrous dysplasia (FD) is part of a rare group of bone dysplasia. It exhibits benign behavior and can lead to osteolytic lesions, deformities, and fractures. The treatment is challenging, and accurate removal of the lesion is necessary to restore function and esthetics. Here we present two cases of FD where virtual planning with presurgical computed tomography (CT) was used for the production of a surgical guide for bone contouring. First, CT image reconstruction was performed to mirror the patient's original anatomy. Then, three surgical guides that determined the area and depth of bone wear were prepared and used in the relevant sequence during the actual surgeries, which were successfully performed in both patients. This technique is termed the template guide holes (TGH) technique. The findings from this report suggest that presurgical virtual planning and guide preparation allows direct and objective measurement of the level of bone wear and improves the functional and esthetic outcomes of surgery for FD. In particular, the TGH technique is safe and allows adequate preoperative surgical simulation, reduces the surgical duration, and increases the predictability of the final result.
Subject(s)
Humans , Male , Female , Child , Adult , Oral Surgical Procedures/methods , Plastic Surgery Procedures/methods , Craniofacial Fibrous Dysplasia/surgery , Four-Dimensional Computed TomographyABSTRACT
Abstract: The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Aged , Young Adult , Basal Cell Nevus Syndrome/surgery , Basal Cell Nevus Syndrome/classification , Odontogenic Cysts/surgery , Odontogenic Cysts/classification , Osteotomy/methods , Recurrence , Time Factors , Photography , Mandibular Diseases , Maxillary Diseases , Odontogenic Tumors/surgery , Odontogenic Tumors/classification , Chloroform/therapeutic use , Retrospective Studies , Risk Factors , Treatment Outcome , Risk Assessment , Acetic Acid/therapeutic use , Decompression, Surgical/methods , Ethanol/therapeutic use , Middle AgedABSTRACT
Few reports of intramuscular lipoma in the temporal region are seen in the literature. Because of its invasives characteristics, this neoplasm may be mistaken as a liposarcoma. Although image exams help in the differential diagnosis between benign and malignant lipomatous lesions, the histopathological exam is the only one capable of a definitive diagnosis. Total removal of the lesion is essential because the recurrence rate without complete excision may be as high as 62.5 %. A patient with an intramuscular lipoma located in the temporal region is presented along with the mentioned treatment. Great importance should be given to these uncommon lesions that may present as a challenge to professionals that work in the maxillofacial region.
Poucos relatos de lipoma intramuscular na região temporal são vistos na literature. Devido as suas características invasivas, essa neoplasia pode ser confundida com um lipossarcoma. Apesar de exames de imagem ajudarem no diagnóstico diferencial entre lesões lipomatosas benignas ou malignas, o exame histopatológico é o único capaz de diagnóstico definitivo. Remoção total da lesão é essencial pois a taxa de recidiva sem completa excisão pode ser de até 62,5%. Uma paciente com um lipoma intramuscular localizado na região temporal é apresentada com o devido tratamento da lesão. Grande importância deve ser dada a essas lesões incomuns que podem se apresentar como um desafio aos profissionais que atuam na região maxilofacial.
ABSTRACT
Embora enxertos ósseos convencionais resolvam grande parte das reconstruções mandibulares, a ausência deum leito receptor favorável à revascularização óssea, muitas vezes, limita sua aplicação. O advento de enxertosósseos vascularizados em retalhos microcirúrgicos elevou o índice de sucesso nessas reconstruções, permitindo o restabelecimento estético-funcional em casos de pobre prognóstico reconstrutivo. As vantagens desse tipo de enxerto incluem manutenção do volume ósseo transplantado, possibilidade de reconstrução de grandes defeitos teciduais em áreas irradiadas, possibilidade de reconstrução das partes moles com associaçãode ilhas cutâneas e possibilidade de osteotomias, para reproduzir o contorno mandibular. O presente trabalho revisa a literatura referente aos enxertos ósseos vascularizados, discorrendo sobre os princípios biológicos e cirúrgicos que fundamentam sua aplicação na reconstrução mandibular.
Although conventional bone grafts are the solution for most mandibular reconstructions, their application is oftenlimited by the lack of a recipient bed amenable to the revascularization of bone. The advent of vascularized bonegrafts in microsurgical flaps has raised the success rate in these reconstructions, allowing the aesthetic andfunctional recovery of patients with a poor reconstructive prognosis. The advantages of this type of graft include the maintenance of the amount of bone transplanted, the possibility of reconstructing large tissue defects inirradiated areas, the possibility of reconstructing soft tissue associated with cutaneous islands and the chances to reproduce the mandibular contour. The present study reviews the literature on vascularized bone grafts and discusses the biological and surgical principles that underlie its application in mandibular reconstruction.
Subject(s)
Bone Transplantation , Surgery, Oral/methods , Mandibular Injuries , RehabilitationABSTRACT
Embora enxertos ósseos convencionais resolvam grande parte das reconstruções mandibulares, a ausência de um leito receptor favorável à revascularização óssea muitas vezes limita sua aplicação. O advento de enxertos ósseos vascularizados em retalhos microcirúrgicos elevou o índice de sucesso nessas reconstruções, permitindo restabelecimento estético-funcional em casos de pobre prognóstico reconstrutivo. As vantagens desse tipo de enxerto incluem manutenção do volume ósseo transplantado, possibilidade de reconstrução de grandes defeitos teciduais em áreas irradiadas, possibilidade de reconstrução das partes moles com associação de ilhas cutâneas e possibilidade de osteotomias para reproduzir o contorno mandibular. O presente trabalho revisa a literatura referente aos enxertos ósseos vascularizados, discorrendo sobre os princípios biológicos e cirúrgicos que fundamentam sua aplicação na reconstrução mandibular
Subject(s)
Bone Transplantation , Surgery, Oral/methods , Mandibular Injuries , RehabilitationABSTRACT
É relatado o caso de um paciente do sexo masculino, de 40 anos de idade, com síndrome de apnéia do sono tipo obstrutivo, tratado por meio de aparelho dentário. Esta terapêutica, alvo de pesquisas recentes, visa, no caso aqui descrito, modificar a posiçäo da mandíbula e consequentemente da língua, aumentando o espaço aéreo posterior faríngeo. Cefalometria contribuiu na escolha do caso para uso de aparelho dentário pois evidenciou incremento do espaço aéreo posterior faríngeo atingindo dimensöes normais ao se realizar o deslocamente anterior da mandíbula. Controles clínico e polissonográfico mostraram reduçäo subjetiva da sonolência excessiva diurna e objetiva da severidade das apnéia e do ronco, leveando-os a níveis normais. Em seguimento realizado por 8 meses, a melhora manteve-se inalterada
Subject(s)
Humans , Male , Adult , Orthodontic Appliances , Sleep Apnea Syndromes/therapy , Blood Gas Monitoring, Transcutaneous , Cephalometry , Follow-Up Studies , Polysomnography , Sleep Stages , SnoringABSTRACT
No presente trabalho, os autores apresentam caso clínico de consolidaçäo viciosa de fratura bilateral de mandíbula. Apresentam uma breve revisäo da literatura e o planejamento e execuçäo da terapêutica cirúrgica, mostrando o "Follow-up" do paciente