Descending necrotizing mediastinitis: a clinical analysis based on 10 years of published data in China / 口腔疾病防治

Objective@#To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.@*Methods@#Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.@*Results@#The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.@*Conclusion@#The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.

Microbiological profile and antibiotic sensitivity of maxillofacial infections in an emergency hospital

Aim: To investigate the bacteriological profile of oral and maxillofacial infections and the pattern of sensitivity to a specific group of antibiotics in a reference emergency hospital in Brazil. Methods: This is a prospective cohort institutional study that studied patients affected by oral and/ or maxillofacial infections in a Brazilian emergency hospital, over a 12-month period, of different etiologies, through data collection, culture and antibiogram tests, and monitoring of the process of resolution of the infectious condition. The variables were analyzed using the chi-square and Mann-Whitney tests, using a significance level of 5%. Results: The sample consisted of 61 patients, 62.3% male. The mean age of participants was 34.3 years. Odontogenic infection was the most frequent etiology and the submandibular space was the most affected. The bacterial species Streptococcus viridans was isolated in 21.6% of cases. Levofloxacin, vancomycin and penicillin were the antibiotics with the highest frequency of bacterial sensitivity, while clindamycin and erythromycin showed the highest percentages of resistance. Conclusions: The results suggest that, among the most used antibiotics for the treatment of these infections, penicillin remains an excellent option of choice for empirical therapy

Recommendations for post-rehabilitation care of maxillofacial prostheses

Aim: This study aimed to review the scientific literature to describe the main care and hygiene protocols for different types of maxillofacial prostheses (MFP). Methods: A bibliographic search on the PubMed / Medline database using the following keywords: ["maxillofacial prosthesis" OR "ocular prostheses" OR "palatal obturators"] AND ["Cleaning" OR "disinfection"] AND ["care"] AND ["color stability"] OR ["denture cleansers" OR "cleansing agents"]. Articles addressing materials, cleaning and disinfection protocols, and care related to MFP were included. The following exclusion criteria were applied: no adequate methodology, incompatibility with the area of interest, and unavailability for reading in full. Results: The papers were grouped into the following topics: facial prostheses, ocular prostheses, maxillofacial intraoral prostheses, and retention systems. Conclusion: Despite the MFP changes over time, its degradation decreases upon following the recommendations and post-adaptation care. The guidelines for cleaning and disinfection must be individualized to guarantee the longevity of the prosthesis and the patient health

Reabilitação protética bucomaxilofacial: um estudo retrospectivo de base universitária / Maxillofacial prosthetic rehabilitation: an university-based retrospective study

A Prótese bucomaxilofacial (PBMF) é a especialidade da Odontologia que reabilita proteticamente pacientes com perda de estrutura na região da face. Entende-se por PBMFs aquelas utilizadas na reabilitação de pacientes que apresentam deformidades por etiologia congênita, traumática ou patológica. Objetivo: Avaliar retrospectivamente o perfil dos pacientes bem como as características das reabilitações protéticas realizadas em um Projeto de Extensão em Prótese Bucomaxilofacial de uma Universidade no sul do Brasil.Materiais e métodos:Foram analisados 90 prontuários de pacientes atendidos no período de agosto de 2017 a dezembro de 2018, e coletados os seguintes dados: gênero, cor/etnia, idade, etiologia da deformidade, tipo de prótese reabilitadora realizada e referenciamento do paciente ao Projeto. Resultados:Observou-se que pacientes do gênero masculino e cor branca foram os mais frequentemente reabilitados com a maioria dos tipos de prótese, com exceção da prótese nasal. A idade dos pacientes variou de 5 a 81 anos. A prótese ocular foi a mais confeccionada. A etiologia patológica foi a que mais exigiu tratamento reabilitador. Médicos e equipes hospitalares foram os que mais referenciaram pacientes para o Projeto de Extensão.Discussão: A maior prevalência de atendidos foi de pacientes do gênero masculino, etiologia patológica, com idade 60 anos ou mais, o que reforça a sobrevida das pessoas que são diagnosticadas com câncer e necessitam reabilitação bucomaxilofacial. Conclusão: A grande procura por atendimento no Projeto de Extensão em PBMF mostra uma carência desse serviço e poucas pesquisas para esclarecer o perfil do paciente que mais procura atendimento PBMF.

Bucomaxillofacial Prosthesis (BMFP) is a specialty of Dentistry that rehabilitates patients with loss of structure in the face region. BMFP are known to be used in the rehabilitation of patients who present deformities due to congenital, traumatic or pathological etiology. Aim:In retrospect, to assess the profile of patients, as well as the features of clinical cases of rehabilitations performed at the Buccomaxillofacial Prosthesis Extension Project, at the Faculty of Dentistry of the Universidade Federal do Rio Grande do Sul, UFRGS. Materials and methods:from August 2017 to December 2018, 90 charts were cataloged with the following data: gender, ethnicity, age, etiology of the deformity, type of rehabilitation prosthesis, how the patient came to the Project. Results:It was concluded that white male patients were the predominant group to be benefited with prosthesis. The age gap was from 5 to 81 years. Ocular prosthesis was the most prevalent one. The pathological etiology was the one that most required rehabilitation treatment. Doctors and hospital staff were the ones who most referred patients to the Project.Discussion:The prevalence of patients attended was male, pathological etiology, aged 60 years or more, which reinforces the survival of people who are diagnosed with cancer and need oral and maxillofacial rehabilitation. Conclusion:The great demand for care in the BMFP Extension Project shows a lack of this service and little research to clarify the profile of the patient who most seeks BMFP care.

Actualización de la Epidemiología de Tratamientos Quirúrgicos Maxilofaciales en Hospital Público de Santiago de Chile: Estudio Comparativo - Retrospectivo de 4 Años / Epidemiological Update of Maxillofacial Surgical Treatments in a Public Hospital in Santiago de Chile: A Comparative Retrospective Study of 4 Years

La cirugía maxilofacial es una especialidad médico quirúrgica que se encarga tanto del diagnóstico como del tratamiento de enfermedades que afecta al territorio craneofacial. En Chile existen pocos estudios epidemiológicos en cirugía maxilofacial que describan con detalle el tipo de intervenciones realizadas más allá del trauma maxilofacial, y que además involucren el período por pandemia COVID-19. El objetivo del estudio fue actualizar la epidemiología de resolución quirúrgica bajo anestesia general en el Hospital San José de Santiago de Chile entre los años 2018 y 2021 y compararlo con el estudio realizado en mismo recinto entre los años 2007 y 2013. Se realizó un estudio retrospectivo con 607 pacientes. Se recopiló información de acuerdo a edad, género del paciente y tipo de intervención. Del total de intervenciones realizadas, 176 (29%) correspondieron a trauma maxilofacial y 431 (71%) a cirugías de etiología no traumática. Edad promedio de 38,7 años. Proporción entre el sexo masculino y femenino de 1,28:1. La fractura más frecuente fue la mandibular (59,66%), seguida de la orbito cigomática (23,86%) y la panfacial (4,55%). En las cirugías de etiología no traumática predominaron las intervenciones por dismorfosis dentofaciales (23,2%), seguido tumores de los maxilares (20,41%), lesiones orales (18,56%), defocaciones dentarias (16,24%), infecciones (8,81%), patologías de articulación temporomandibular (8,35%) y finalmente retiro de material de osteosíntesis (4.41%). Las intervenciones de etiología no traumática y la resolución de fracturas mandibulares fueron los procedimientos más realizados por la unidad. El conocimiento de estos datos y la comparación con el estudio anterior permite observar el cambio en la epidemiologia, que puede explicarse por la pandemia por COVID-19. Considerando lo anterior, ambos tipos de intervenciones deben ser abordadas de manera integral y con las condiciones adecuadas. Para ello es importante enfocar los recursos en esas áreas y desarrollar mayor entrenamiento en las mismas.

Maxillofacial surgery is a medical- surgical specialty that deals with both diagnosis and treatment of diseases affecting the craniofacial territory. In Chile there are few epidemiological studies in maxillofacial surgery that describe in detail the type of interventions performed beyond maxillofacial trauma, and that also involve the COVID-19 pandemic period. The aim of the study was to update the epidemiology of surgical resolution under general anesthesia at the Hospital San José in Santiago de Chile between 2018 and 2021 and to compare it with the study performed at the same hospital between 2007 and 2013. A retrospective study was performed with 607 patients. Information was collected according to age, patient gender and type of intervention. Of the total number of interventions performed, 176 (29%) corresponded to maxillofacial trauma and 431 (71%) to surgeries of non-traumatic etiology. Average age of 38.7 years. Male to female sex ratio of 1.28:1. The most frequent fracture was mandibular (59.66%), followed by orbito-zygomatic (23.86%) and panfacial (4.55%). In surgeries of non-traumatic etiology, interventions for dentofacial dysmorphosis predominated (23.2%), followed by tumors of the jaws (20.41%), oral lesions (18.56%), dental defocations (16.24%), infections (8.81%), temporomandibular joint pathologies (8.35%) and finally removal of osteosynthesis material (4.41%). Interventions of non-traumatic etiology and resolution of mandibular fractures were the procedures most performed by the unit. The knowledge of these data and the comparison with the previous study allows us to observe the change in epidemiology, which can be explained by the COVID-19 pandemic. Considering the above, both types of interventions should be approached in a comprehensive manner and with the appropriate conditions. To this end, it is important to focus resources in these areas and to develop more training in them.

Mordedura humana em dorso nasal: relato de caso / Human bite on nasal dorsum: case report / Mordida humana en espalda nasal: reporte de caso

As lesões na face decorrentes de mordedura humana estão entre os tipos de trauma causados por violência interpessoal. Injúrias causadas nesta região podem gerar uma série de morbidades como perdas teciduais importantes, infecções, além de cicatrizes irreversíveis quando a ferida é passível de reparo, portanto, os cuidados pós-trauma devem visar à minimização de cura, além da funcionalidade, buscando o máximo de estética possível. Este trabalho tem como objetivo relatar um caso clínico de mordida humana em região de dorso nasal, com avulsão da ponta nasal, atendida no Hospital da Restauração Governador Paulo Guerra, Recife-PE, pelo serviço de Cirurgia Buco-Maxilo-Facial. Procedeu-se com reparo primário e antibioticoterapia profilática, no qual o resultado do tratamento foi considerado satisfatório, boa cicatrização tecidual e sem queixas funcionais e estéticas... (AU)

Injuries to the face resulting from human bite are among the types of trauma caused by interpersonal violence. The injuries caused in this region, can generate a series of morbidities such as major tissue loss, infection, and irreversible scarring when the wound is repairable, therefore, posttrauma care should aim to minimize healing, in addition to functionality, seeking maximum aesthetics as possible. This paper aims to report a clinical case of human bite in the nasal dorsum region, with avulsion of the nasal tip, attended at the Hospital da Restauração Governador Paulo Guerra, Recife-PE, by the service of Oral and Maxillofacial Surgery. It was proceeded with primary repair and prophylactic antibiotic therapy, in which the result of the treatment was considered satisfactory, good tissue healing and without functional and aesthetic complaints... (AU)

Las lesiones faciales producidas por mordeduras humanas se encuentran entre los tipos de traumatismos causados por la violencia interpersonal. Las lesiones causadas en esta región pueden generar una serie de morbilidades como la pérdida de tejidos importantes, la infección y la cicatrización irreversible cuando la herida es reparable, por lo tanto, los cuidados posttrauma deben tener como objetivo minimizar la cicatrización, además de la funcionalidad, buscando la máxima estética posible. Este trabajo tiene como objetivo reportar un caso clínico de mordedura humana en la región del dorso nasal, con avulsión de la punta nasal, atendido en el Hospital da Restauração Governador Paulo Guerra, Recife-PE, por el servicio de Cirugía Oral y Maxilofacial. Se procedió a la reparación primaria y a la terapia antibiótica profiláctica, en la que el resultado del tratamiento se consideró satisfactorio, con buena cicatrización de los tejidos y sin quejas funcionales y estéticas... (AU)

Evidence gaps in orthognathic surgery, a Delphi study protocol

Aim: To assess the research gaps identified in a recent mapping review of orthognathic surgery through their evaluation by clinical experts, leading to a clinically relevant list of research gaps. This will guide future investigations of the topic, focusing on the outcomes of blood loss, infection, and relapse. Methods: The Delphi technique will be used to appraise the identified research gaps. The expert panel will include maxillofacial surgeons who regularly perform orthognathic surgery. Potential participants will be identified through various methods, including contact information from articles in the mapping review, nominations from peers, and social media platforms. Two rounds of surveys will be undertaken with Likert-type and open-ended questions to assess the clinical relevance of research gaps. For the second round, participants will receive a report of the results of the first round. Questions will be modified depending on the answers obtained in the first round. A consensus of 60% will be considered valid. Conclusions: Through this Delphi study, in a collaborative effort between researchers and clinical experts, a comprehensive understanding of the clinical relevance of research gaps in orthognathic surgery will be achieved. The outcomes will guide future investigations, ultimately improving the outcomes and practices in this field.

Changes in the Craniomaxillofacial Growth and Development of Sprague Dawley Rats Subjected to Permanent Experimental Unilateral Nasal Obstruction / Cambios en el Crecimiento y Desarrollo Cráneo Maxilo Facial de Ratas Sprague Dawley Sometidas a Obstrucción Nasal Unilateral Experimental Permanente

SUMMARY: Breathing is considered a vital function dependent on factors such as adequate permeability of the nasal route, which is linked to physiological functions, intellectual processes, and craniofacial growth. The aim of this study was to determine the changes in the craniomaxillofacial growth and bone development of Sprague Dawley rats subjected to permanent experimental unilateral nasal obstruction. Twenty-four newborn rats were used, randomized, and divided into experimental and control groups. The right nostril was obstructed, and weight, length, and Lee's index measurements were recorded at 8 and 16 weeks. Craniomandibular x-rays were taken of each animal, obtaining linear neuro- and viscerocranial measurements. Then, a biochemical analysis was performed to measure the alkaline phosphatase concentration. The results were analyzed in the SPSS software, performing a descriptive analysis, using a t-test for independent samples, comparing basal, cephalometric, and biochemical characteristics between the control and experimental groups, considering a significance range of 5%. When comparing the experimental and control groups, the variables length, weight, and Lee's index presented no significant differences. In the x-ray analysis, at 8 weeks, the Co-L1 and Co-Mn measurements were reduced, whereas the Ba-So increased, with significant differences. At 16 weeks, the L1-O, Po-Ba, and E-Mu measurements decreased; however, Co-Gn registered a greater value with significant differences. The alkaline phosphatase levels fell significantly at week 16 in the experimental group. In conclusion, the reduction of permanent nasal respiratory flow is related to modifications in facial growth at 8 and 16 weeks and to the reduction of alkaline phosphatases at 16 weeks.

La respiración se considera una función vital, dependiente de factores como la permeabilidad adecuada de la vía nasal, vinculada con funciones fisiológicas, procesos intelectuales y crecimiento cráneofacial. El objetivo de este estudio fue determinar los cambios en el crecimiento y desarrollo óseo cráneo maxilo facial de ratas Sprague Dawley sometidas a obstrucción nasal unilateral experimental permanente. Se utilizaron 24 ratas macho neonatas, randomizadas y divididas en grupo control y experimental. Fue realizada obstrucción nasal de la narina derecha y realizadas mediciones de peso, longitud e índice de Lee a las 8 y 16 semanas. Se efectuaron radiografías cráneomandibulares a cada animal, obteniendo medidas lineales de neuro y viscerocráneo. Posteriormente se realizó análisis bioquímico, para medir la concentración de fosfatasa alcalina. Los resultados fueron analizados en el software SPSS, realizándose análisis descriptivo, empleando prueba T para muestras independientes comparando características basales, cefalométricas y bioquímicas entre los grupos control y experimental, considerando un umbral de significancia de 5 %. Al comparar los grupos control y experimental, las variables longitud, peso e índice de Lee no presentaron diferencias significativas. En el análisis radiográfico, a las 8 semanas, las medidas Co-L1 y Co-Mn presentaron reducción, mientras que Ba-So aumentó, con diferencias significativas. A las 16 semanas, las medidas L1-O, Po-Ba y E-Mu disminuyeron, sin embargo, Co-Gn registró un mayor valor, con diferencias significativas. Los niveles de fosfatasa alcalina disminuyeron significativamente en la semana 16 en el grupo experimental. En conclusión, la reducción de flujo respiratorio nasal permanente se relaciona con modificaciones del crecimiento facial a las 8 y 16 semanas y con la reducción de ALK en análisis a las 16 semanas.

Patterns of Maxillofacial Injures Caused by Motorcycle Accidents

Abstract Introduction Motorcycles are used as a common means of transportation, and motorcycle accidents are responsible for a major portion of trauma injuries. Objectives The purpose of this study was to analyze the patterns of facial injuries in motorcyclists, to evaluate the types of injuries, and to investigate if the accidentrelated factors had any impact on the characteristics of the injuries. Methods This retrospective observational study included 74 patients with maxillofacial injuries following motorcycle-related accidents. Investigated data were divided into four main categories: sociodemographic, accident-related, injury-related, and treatment-related. Results All the patients were males with a mean age (±SD) of 25.03 (±9.986) years. Most accidents (n = 44, 59.4%) occurred in the evening. Most of the patients (n = 40, 54%) were traveling on motorcycle models that had maximum speed of over 120 km/h. Furthermore, 15 patients (18.9%) were under the influence of alcohol during the crashes and only one patient was wearing a helmet. Fractures of the maxillofacial bones were observed in 50 (67.5%) crash victims; 24 of them (48%) had middle third fractures, 11 (22%) had mandibular fractures, and 15 patients (30%) presented with a combination of lower, middle, and upper third fractures. Conclusion Almost all patients were not wearing helmets at the moment of the crash. The most common fractured site was the maxilla. The majority of the patients received surgical treatment. Increased enforcement of safety measures for riders and raising awareness about the dangers of motorcycle crashes are required measures to improve traffic safety and, ultimately, population health.

Cranioplastia do Osso Frontal com a Utilização de Implantes Customizados através de Protótipo 3D: Relato de Caso / Frontal Bone Cranioplasty using Customized Implants through a 3D Prototype: Case Report

A cranioplastia para os tratamentos de defeitos ósseos cranianos tem como o seu principal objetivo a reconstrução tridimensional e funcional da calota craniana. As cirurgias assistidas por computador (CAS) vem sendo utilizadas desde os anos 90 de forma eficiente e trazendo melhorias e otimização nas abordagens cirúrgicas craniofaciais reconstrutivas, principalmente em grandes defeitos ósseos. Este relato de caso clínico aborda o planejamento virtual e de tecnologia CAD/CAM na reconstrução craniofacial secundária com a utilização de polimetilmetacrilato (PMMA). Paciente de sexo masculino, 48 anos, apresentava dois defeitos ósseos em região frontal com deiscência da pele para dentro do seio frontal. Foi realizada uma tomografia computadorizada com cortes de 1mm e convertidos em um modelo 3D do osso frontal e no molde do defeito ósseo em tamanho real. Para abordagem dos defeitos ósseos, houve a participação de um neurocirurgião para o tratamento em dura-máter, cranialização do seio frontal e obliteração do ducto naso-frontal, sendo finalizada pela equipe de cirurgia bucomaxilofacial. Após a cirurgia, foi realizado um exame tomográfico sendo observados uma perfeita adaptação entre a prótese e os contornos ósseos e um ótimo contorno anatômico do osso frontal, tornando-se satisfatório ao planejamento cirúrgico inicial. A utilização de um planejamento virtual e do sistema CAD/CAM resultou em uma maior previsibilidade e maior segurança ao procedimento de reconstrução craniofacial além de redução do tempo transoperatório. O material utilizado, o PMMA, apresentou-se como um material de fácil manipulação, baixo custo e com perfeita adaptação aos contornos ósseos.

Cranioplasty for the treatment of cranial bone defects has as its main objective the three-dimensional and functional reconstruction of the skull. Computer-assisted surgeries (CAS) have been used since the 1990s efficiently and bring improvements and optimization in reconstructive craniofacial surgical approaches, especially in large bone defects. This clinical case report addresses virtual planning and CAD/CAM technology in secondary craniofacial reconstruction using polymethylmethacrylate (PMMA). A 48-year-old male patient had two bone defects in the frontal region with skin dehiscence into the frontal sinus. A computed tomography was performed with 1mm slices and converted into a 3D model of the frontal bone and in the mold of the bone defect in real size. To address the bone defects, a neurosurgeon was involved in the treatment of dura mater, cranialization of the frontal sinus, and obliteration of the nasofrontal duct, and was completed by the oral and maxillofacial surgery team. After the surgery, a tomographic exam was performed, and a perfect adaptation between the prosthesis and the bone contours and a great anatomical contour of the frontal bone were observed, making it satisfactory to the initial surgical planning. The use of virtual planning and the CAD/CAM system resulted in greater predictability and greater safety for the craniofacial reconstruction procedure, as well as a reduction in the perioperative time. The material used, PMMA, presented itself as a material of easy manipulation, low cost, and with perfect adaptation to bone contours.Keywords: PMMA, Bone transplantation, Maxillofacial Prosthesis, Cranioplasty, Customized implants.

Experiencia en la introducción de resultados científicos desde la formación doctoral / Experience in the introduction of scientific results from the doctoral training i: en

Durante estos años, condicionados por los efectos de una pandemia y la situación económica global, la incorporación oportuna de los resultados científico-técnicos es necesidad y responsabilidad de la comunidad científica. En este trabajo se expone una experiencia en la introducción de resultados científicos desde la formación doctoral, dirigida al área de la atención inicial al paciente con traumatismo maxilofacial. La importancia de esta práctica radica en los aportes social, científico y profesional y en la formación de recursos humanos para lograr la transformación y el mejoramiento de la realidad.

During these years, conditioned by the effects of a pandemic and the global economic situation, the opportune incorporation of the scientific technical results is necessity and responsibility of scientific community. An experience in the introduction of scientific results from the doctoral training, directed to the area of initial care to the patient with maxillofacial traumatism, is presented in this work. The importance of this practice resides in the social, scientific, professional contributions and in the formation of human resources to achieve the transformation and improvement of reality.

Cervical necrotizing fasciitis caused by oral cavity infection: a case report considering therapeutic approach and its morphofunctional implications / Fascitis necrosante cervical causada por infección de la cavidad oral. Reporte de un caso considerando el abordaje terapéutico y sus implicaciones morfofuncionales

SUMMARY: Cervical necrotizing fasciitis (NF) is a rare complication of oral cavity infection with high morbi-mortality. Given its low prevalence, adequately reporting cases of NF, its therapeutic management, and associated morphofunctional modifications to the clinical and scientific community is pivotal. To that end, we herein describe a case of cervical NF in a 60-year-old patient with comorbidities and patient presented large, painful cervical swelling associated with a necrotic ulcer lesion in the anterior neck region. Intraoral examination indicated a periodontal abscess in the right mandibular area, while computed tomography indicated the lesion's extension from the right mandibular to the submandibular region. Following empirical intravenous antibiotic treatment, a broad surgical debridement was performed, and the foci of oral infection were removed. Debridement revealed communication between deep and superficial anatomical regions in the submandibular area, where we subsequently placed a Penrose drain. Biopsies showing acute inflammatory infiltrate associated with necrotic and hemorrhagic regions confirmed the diagnosis of NF. When an antibiogram revealed resistance to the empirical treatment, the antibiotic scheme was replaced with an adequate alternative. After a second debridement, we closed the defect with fascio-mucocutaneous advancement flaps with a lateral base while maintaining suction drainage. Having reacted positively, the patient was discharged 10 days after the operation. Despite an extensive morphofunctional change generated in the treated area, the patient showed no difficulties with breathing, phonation, swallowing, or mobilizing the area during control sessions. Altogether, this report contributes to the highly limited literature describing morphological aspects that can facilitate or delay the spread of infection or the morphofunctional disorders associated with the size and depth of surgical interventions for cervical NF, information that is relevant for the comprehensive, long-term prognosis of the treatment of NF.

La fascitis necrosante (FN) cervical es una rara complicación de una infección proveniente de la cavidad bucal asociada a una alta morbimortalidad. Por lo anterior, es fundamental informar a la comunidad clínica y científica los casos de FN, su manejo terapéutico y las modificaciones morfofuncionales asociadas. Se describe un caso de FN cervical en una paciente de 60 años quien presentó una gran tumefacción dolorosa asociada a una lesión ulcerosa necrótica en la región anterior del cuello. El examen intraoral mostró un absceso periodontal en el área mandibular derecha y la tomografía computarizada mostró la extensión de la lesión hacia la región submandibular. Tras el tratamiento antibiótico empírico, se realizó un desbridamiento quirúrgico extenso y se extirparon los focos de infección oral. El desbridamiento reveló comunicación entre las regiones anatómicas profundas y superficiales del área submandibular, donde se colocó un drenaje Penrose. Las biopsias mostraron un infiltrado inflamatorio agudo asociado con regiones necróticas y hemorrágicas, confirmando el diagnóstico de FN. El antibiograma reveló resistencia al tratamiento empírico, por lo que el esquema antibiótico se sustituyó. Tras un segundo desbridamiento, se cerró el defecto con colgajos de avance fascio-mucocutáneos de base lateral manteniendo drenaje aspirativo. El positivo progreso del paciente permitió su alta 10 días después. Aun cuando se generó una gran modificación morfofuncional en el área tratada, la paciente no presentó dificultades para respirar, hablar, deglutir o movilizar el área cervical intervenida durante las sesiones de control. Este informe contribuye a la limitada literatura que describe los aspectos morfológicos que pueden facilitar o retrasar la propagación de la FN y las consecuencias asociadas a los trastornos morfofuncionales provocadas por el tamaño y profundidad de las intervenciones quirúrgicas requeridas por la FN, información relevante para el pronóstico integral a largo plazo del tratamiento de la FN.

Complicaciones postoperatorias en fractura de órbita: experiencia en el Hospital del Trabajador de Santiago

Objetivo: Describir la experiencia del equipo de cirugía maxilofacial del Hospital del Trabajador en el manejo de las fracturas de órbita. Materiales y Método: Estudio retrospectivo de 42 pacientes consecutivos operados por fractura de órbita en el Servicio de Cirugía Maxilofacial del Hospital del Trabajador entre enero de 2016 y diciembre de 2017. Se tabularon datos demográficos, información del trauma, tipo de fractura, fracturas asociadas, tratamiento y seguimiento. Resultado: De los 42 pacientes, la mayoría eran hombres (73,8%) con edad promedio de 40 ± 12,24 años. Los principales síntomas al ingreso fueron equimosis (64,3%), edema periocular (54,8%), hemorragia subconjuntival (33,3%) y diplopía (26,2%). La pared orbitaria más frecuentemente afectada fue el piso de la órbita (85,7%). Las fracturas se presentaron de forma aislada en 35,7% de los casos y asociada a otra fractura de la cara en 64,3%. Post cirugía, la tasa de complicación fue de 16,7%, producto de diplopía y enoftalmos leves que solo requirieron tratamientos conservadores para su resolución. Discusión: La baja tasa de complicaciones se debe a la experiencia del equipo médico con un seguimiento a largo plazo, la medición de volúmenes orbitarios, imagenología intraoperatoria, utilización de malla prefabricada y asistencia endoscópica. Conclusiones: Un adecuado diagnóstico y evaluación son fundamentales para el tratamiento de la fractura de órbita. Los datos demográficos, las características de las fracturas y las complicaciones descritas fueron muy similares a lo reportado por otras experiencias, mientras que la tasa de complicaciones fue menor.

Aim: To describe the experience of the Maxillofacial Surgical team of Hospital del Trabajador de Santiago in the management of orbital fractures. Materials and Methods: Retrospective study of 42 patients operated consecutively between January of 2016 and November of 2017 at Hospital del Trabajador de Santiago by the Maxillofacial Surgery team due to orbital fracture. The demographic data was tabulated and then a comparison between isolated and combined orbital fractures was made. Results: Of 42 patients most were men (73.8%) with an average age of 40±12.24 years. At admission the main symptoms were ecchymosis (64.3%), periorbital edema (54.8%), subconjunctival hemorrhage (33.3%) and diplopia (26.2%). The most frequently affected orbital wall was the floor (85.7%). Isolated fractures accounted for 35.7% of the cases and those associated with other facial fractures for 64.3%. The postoperative complication rate was 16.7% due to diplopia and enophthalmos. Both complications were mild and only required conservative management. Discussion: The low complication rate might be due to the experience of the surgical team in the management of orbital fractures, long-term following, orbital volume measurements, intraoperative imaging, the use of prefabricated mesh and endoscopic guidance. Conclusión: An adequate diagnosis and evaluation are fundamental for orbital fracture treatment. Demographic data, fracture characteristics and the complications described were similar to those reported by other studies, while the rate of complications was lower than those experiences.

Tomographic evaluation of mandibular buccal shelf in patients with different vertical growth pattern / Evaluación de la placa ósea mandibular en pacientes con diferente patrón de crecimiento vertical

The purpose of this research was the tomographic evaluation of the Mandibular Buccal Shelf (MBS) in orthodontic patients with different vertical growth pattern. An observational, descriptive, cross-sectional and retrospective study was conducted. Tomographic images of patients aged 14 to 40 years were observed and a database was formed with those that met the inclusion criteria. The sample size was 10 for each group according to vertical growth pattern (hypodivergent, normodivergent and hyperdivergent). Then four zones of frequent insertion of extralveolar mini-screws were selected in the MBS, taking as a reference the mesial and distal roots of the first and second mandibular molar. When comparing the characteristics of MBS between vertical growth patterns, between sexes and hemiarchs, no statistically significant differences were found. However, when the characteristics of MBS were compared according to the reference root, it was found that there were statistically significant differences. The vestibular area to the distal root of the second mandibular molar presented the highest values in terms of angulation, height and thickness. There are no significant differences in the bone characteristics of MBS according to vertical growth patterns, sexes or hemiarchs. Angulation, height and thickness progressively increase from the vestibular bone of the mesial root of the first mandibular molar to the distal root of the second molar.

El propósito de esta investigación fue la evaluación tomográfica de la placa ósea mandibular (POM) en pacientes de ortodoncia con diferente patrón de crecimiento vertical. Se realizó un estudio de tipo observacional, descriptivo, transversal y retrospectivo. Se observó imágenes tomográficas de pacientes de 14 a 40 años de edad y se formó una base de datos con las que cumplían los criterios de selección. El tamaño de muestra fue de 10 para cada grupo según patrón de crecimiento vertical (hipodivergentes, normodivergentes e hiperdivergentes). Luego se seleccionaron cuatro zonas de inserción frecuente de minitornillos extralveolares en la POM, tomando como referencia las raíces mesial y distal del primer y segundo molar mandibular. Al realizar la comparación de las características de la POM entre patrones de crecimiento vertical, entre sexos y hemiarcadas no se encontraron diferencias estadísticamente significativas. Sin embargo, cuando se comparó las características de la POM según la raíz de referencia se encontró que había diferencias estadísticamente significativas. La zona vestibular a la raíz distal de la segunda molar mandibular presento los mayores valores en cuanto angulación, altura y grosor. No existen diferencias significativas en las características óseas de la POM según patrones de crecimiento vertical, sexos o hemiarcadas. La angulación, la altura y el grosor aumenta progresivamente desde el hueso vestibular de la raíz mesial del primer molar mandibular hacia la raíz distal del segundo molar.

Reabilitação com prótese bucomaxilofacial: revisão de literatura / Rehabilitation with maxillofacial prosthetics

A odontologia reabilitadora tem como um dos seus ramos a especialidade de Prótese Bucomaxilofacial (PBMF), que visa restaurar ou substituir estruturas perdidas na região facial e no sistema estomatognático artificialmente, podendo ser ou não removidos pelo paciente. O presente trabalho objetiva revisar a leitura a respeito da reabilitação com PBMF e a sua aplicabilidade na clínica odontológica. Os indivíduos com alguma perda de estrutura na região de cabeça e pescoço, devido a traumas físicos e/ou químicos, defeitos congênitos, doenças autoimunes, neoplasias, infecções e parasitas, são pacientes para os quais há a indicação da reposição da parte ausente. As reconstruções podem ser perdas intraorais (área da maxila, mandíbula), extraorais (oculopalpebral, ocular, nasal, facial extensa e auricular) ou conjugadas. Esse é um trabalho multidisciplinar, com especialistas de áreas abrangentes e todos os especialistas trabalham de forma conjunta. Pode-se concluir que, embora seja uma das especialidades mais nobres da odontologia, ainda é muito desconhecida por parte dos estudantes e profissionais das áreas da saúde e são próteses absolutamente fundamentais para a reabilitação e qualidade de vida dos indivíduos que tem a necessidade do uso da prótese PBMF(AU)

Rehabilitating dentistry has as one of its branches the specialty of Oral and Maxillofacial Prosthesis (PBMF), which aims to restore or replace structures lost in the facial region and in the stomatognathic system artificially, which may or may not be removed by the patient. The present study aims to review the reading about rehabilitation with PBMF and its applicability in dental clinic. Individuals with some loss of structure in the head and neck region, due to physical and/or chemical trauma, birth defects, autoimmune diseases, neoplasms, infections and parasites, are patients in whom there is an indication for replacement of the absent part. Reconstructions can be intraoral (maximal area, mandible), extraoral (oculopalpebral, ocular, nasal, extensive facial and auricular) or conjugated losses. It is a multidisciplinary work, with specialists from the comprehensive areas and that all specialists work together. It can be concluded that although it is one of the noblest specialties of dentistry, it is still very unknown to students and health professionals, and they are absolutely fundamental prostheses for the rehabilitation and quality of life of individuals who need the use the PBMFprosthesis(AU)

Maxillofacial Fractures in Pondicherry, India: An Eight?Year Single Centre Retrospective Study

Background: The purpose of the present study was to analyze the etiology, incidence, pattern, and treatment modalities of patients with maxillofacial fractures treated at the Department of Dentistry of a medical college in Pondicherry during the period between June 2011 and June 2019. Materials and Methods: A retrospective epidemiological study of 277 patients treated for maxillofacial fractures between June 2011 and June 2019 was performed. Data regarding age, gender, etiology, site of the fracture, time of injury, presence of associated injuries, treatment modalities, and complications were recorded. Results: A total of 491 maxillofacial fractures were seen in 277 patients. These were 261 males (94.2%) and 16 females (5.8%) with a male to female ratio of 16.3:1. Most of the patients 79.8% were in the age group of 11 to 40 years. Most common cause of injury was Road Traffic Collisions (RTCs; 62.1%), followed by fall (20.2%), assault (14.4%) and others (3.3%). Fractures of the mandible (52.3%) and zygomatic complex (18.9%) were the most common maxillofacial fractures reported in our study. 196 patients sustained associated injuries with a prevalence of soft tissue injury (61.2%). Majority of fractures were treated with open reduction and internal fixation (ORIF; 71.9%) of patients followed by closed reduction (17.7%) and observation only (10.4%). Postoperative complications were presented in 16.8% of the patients in the study. Conclusion: RTC is the commonest cause of maxillofacial injury with a male predominance in our study. Mandibular and zygomatic complex fractures were the most common. ORIF remains the preferred method of treatment.

Rol del protesista en el equipo multidisciplinario para el manejo del paciente con cáncer de cabeza y cuello

La denominación de carcinomas de cabeza y cuello o tracto aerodigestivo superior, supone un agrupamiento de neoplasias que comparten elementos comunes como etiología, epidemiología, histología, evolución clínica, procedimientos diagnósticos, enfoques terapéuticos y medidas de seguimiento. El objetivo del presente trabajo es identificar la evidencia científica respecto al tratamiento multidisciplinario del paciente con cáncer de cabeza y cuello y el rol que desempeña el protesista. Para ello, se realizó una búsqueda de literatura disponible en las bases de datos electrónicas PubMed, Medline, Cochrane, Hinari y SciELO. Se encontró que el tratamiento de estas lesiones malignas requiere de un equipo conformado por diferentes especialistas, como otorrinolaringólogo, cirujano de cabeza y cuello, cirujano maxilofacial, odontólogo oncológico, protesista, psiquiatra y psicólogo, nutricionista y rehabilitador, para optimizar el tratamiento de estos pacientes mediante la decisión colectiva.

The designation of carcinomas of head and neck or high aero-digestive tract, supposes a grouping of neoplasia that share common elements like etiology, epidemiology, histology, clinical evolution, diagnostic procedures, therapeutic approaches and follow-up measures. The aim of this paper is to identify the scientific evidence regarding the multidisciplinary treatment of the patient with cancer of head and neck and the role played by the prosthodontist. To this end a literature search was conducted in the electronic databases PubMed, Medline, Cochrane, Hinari and SciELO. It was found that the treatment of these malignant lesions requires a team consisting of different specialists, such as otolaryngologist, head and neck surgeon, maxillofacial surgeon, oncologic dentist, prosthodontist, psychiatrist and psychologist, nutritionist and rehabilitator, to optimize the treatment of these patients through a collective decision.

Anterior Teeth Measurement among Subjects in the University of Port Harcourt as a Sex Indicator and Aid to Maxillofacial Reconstruction

Background: The aim of this study is to determine sexual dimorphism using anterior teeth measurements and its use as an ancillary tool for sexual determination. Methods:In this study, the measurements of the anterior teeth were carried out on one hundred and forty students (80M: 60F) of the University of Port-Harcourt ranging from 15-30 years. The mesiodistal diameter of the central and lateral incisors, right and left canines and their inter-canine distance were measured. These measurements were done with the aid ofa digital Vernier caliper. Also, the percentages of sexual dimorphism were calculated. The values were subjected to statistical analysis.Results:The mean mesiodistal central incisor (MDCI) value for males was 9.78 ± 0.47mm while that of the females was 9.29±0.46mm. The mean mesiodistal lateral incisor (MDLI) value for males was 7.80 ±0.54mm while that of the females was 7.40±0.54mm. The mean mesiodistal right canine (MDRC) value for males was 7.43±0.49mm while that of the females was 7.04±0.40mm. The mean mesiodistal left canine (MDLI) value for males was 7.39±0.51mm while that of the females was 7.03±0.55mm. The mean mandibular inter-canine distance (MICD) value for males was 33.73±1.15mm while that of the females was 32.23±0.98mm. They were all statistically significantat p<0.05.Conclusion:It can be concluded that the incisors and the canines are useful tools in sex determination. The data obtained can be useful in maxillofacial reconstructive surgery

Evolución histórica de la prótesis bucomaxilofacial en Camagüey

Introducción: Los principios en que se sustenta el proceso revolucionario cubano y su Sistema Nacional de Salud, es tratar de dar solución a las necesidades de la población y Cuba dentro de sus limitaciones de desarrollo, ha producido cambios en las condiciones de salud, a través de su política estatal. Objetivo: Describir la evolución histórica de la prótesis bucomaxilofacial en la provincia Camagüey. Métodos: Se realizó una revisión de la de literatura, para recopilar los datos de la historia de la prótesis bucomaxilofacial. Se ejecutó una búsqueda de la literatura en las bases de datos Pubmed, Medline, Cochrane, SciELO, Hinari y prensa escrita donde se expusieran las evidencias disponibles sobre los antecedentes de prótesis bucomaxilofacial en Cuba y en la provincia Camagüey. Resultados: En Cuba la prótesis maxilofacial antes del triunfo revolucionario prácticamente no se realizaba. El 14 de junio de 1999 se crea la Red Asistencial Nacional de Rehabilitación de la Cara y Prótesis Bucomaxilofacial y en el año 2001 el Programa de Rehabilitación de la Cara y Prótesis Bucomaxilofacial, con una cobertura para todos los pacientes del país con esta necesidad de atención. En Camagüey con la creación en abril de 1975 de la consulta multidisciplinaria de Estomatología se inició la atención a los pacientes con defectos bucomaxilofacial. Esto permitió rehabilitar en esos momentos a estos enfermos con los recursos disponibles. Conclusiones: El análisis y las valoraciones realizadas determinaron que la prótesis en la provincia Camagüey ha tenido un gran desarrollo tanto asistencial como docente e investigativo, aunque no se cuenta con un servicio dedicado a la prótesis bucomaxilofacial, se han realizados labores de rehabilitación a pacientes con estos defectos, que le han permitido recuperar la estética, el estado psíquico funcional con alto grado de aceptación y satisfacción y el logro de su reincorporación a la vida social.

Introduction: The principles on which the Cuban revolutionary process and its National Health System are based, is to try to provide a solution to the needs of the population, and Cuba within its development limitations, has produced changes in health conditions, through of its state policy. Objective: To describe the historical evolution of the bucomaxillofacial prosthesis in Camagüey. Methods: A review of the literature was carried out to collect the data on the history of the bucomaxillofacial prosthesis. A search of the literature was carried out in the Pubmed, Medline, Cochrane, SciELO, Hinari and written press databases where the available evidence on the history of oral-maxillofacial prostheses in Cuba and in the Camagüey province was exposed. Results : In Cuba, before the revolutionary triumph, maxillofacial prostheses were practically not performed. On June 14, 1999, the National Assistance Network for the Rehabilitation of the Face and Bucomaxillofacial Prosthesis was created, and in 2001 the Program for the Rehabilitation of the Face and Bucomaxillofacial Prosthesis, with coverage for all patients in the country with this need for care. In Camagüey, with the creation in April 1975 of the multidisciplinary Dentistry consultation, care began for patients with oral-maxillofacial defects. This made it possible to rehabilitate these patients at that time with the resources available. Conclusions: The analysis and the evaluations carried out determined that the prosthesis in Camagüey province has had a great development in terms of care, teaching and research, although there is no service dedicated to oral and maxillofacial prostheses, rehabilitation work has been carried out on patients with these defects, which have allowed them to recover their aesthetics, their functional mental state with a high degree of acceptance and satisfaction, and the achievement of their reincorporation into social life.

Craniofacial morphology of patients with unilateral cleft lip and palate at two stages of skeletal maturation

Abstract The aim of this retrospective cross-sectional investigation was to perform a 3D analysis of craniofacial morphology of patients with unilateral cleft lip and palate (UCLP) at two stages of skeletal maturation. Cone-beam computed tomography (CBCT) scans of 52 UCLP patients (34 prepubertal; 18 pubertal) were collected from an outpatient referral center for the treatment of craniofacial deformities. In total 15 multiplanar craniofacial landmarks were identified, 3D virtual surface models were created, and 13 variables were measured to assess the 3D Euclidean distances between landmarks and spatial position of the landmarks in the projected X, Y and Z components. Maxillary and mandibular pitch (clockwise, counterclockwise) rotation relative to the cranial base was also evaluated. The significance level was set at 5%. Maxillary retrusion value relative to the cranial base was higher and statistically significant greater (p = 0.028) in pubertal (SNA, 77.4° ± 6.2; N-ANS Y, 3.3 mm ± 3.1) than in prepubertal patients (SNA 81.0° ± 5.2; N-ANS Y, 5.8 mm ± 2.7). The posterior cranial base length (S-Ba Y) was significantly longer (p = 0.013) in pubertal (20.7 mm ± 3.4) than in prepubertal patients (18.4 mm ± 2.7). The upper facial height (N-ANS Z) was significantly greater (p = 0.01) in pubertal (46.9 mm ± 4.5) than in prepubertal patients (43.4 mm ± 3.0). Prepubertal and pubertal UCLP patients presented distinct patterns of craniofacial morphology, mainly in the sagittal component of the maxilla and in the posterior cranial base length. Pubertal patients had greater maxillary retrusion and posterior cranial base length.