Virtual planning as a resource for correcting severe facial asymmetry ­ case report / Planejamento virtual como recurso para correção de assimetria facial severa ­ relato de caso

A hiperplasia hemimandibular é responsável por prejuízos estéticos, funcionais, motores e psicossociais. Com etiologia incerta, ocorre frente ao desequilíbrio de fatores regulatórios de crescimento presentes na camada cartilaginosa do côndilo. O relato objetiva descrever a tomada de decisões baseada em exames complementares específicos aliados à adequada intervenção cirúrgica da lesão. Paciente gênero feminino, 33 anos de idade, compareceu à clínica particular com queixa principal de "face assimétrica", foi requerido uma avaliação cintilográfica objetivando e confirmando a interrupção do crescimento condilar, descartando a hipótese de Osteocondroma e condilectomia. Após preparo ortodôntico prévio, os exames tomográficos foram utilizados na criação de um protótipo que foi impresso após a realização dos movimentos ósseos planejados. Mediante à reconstrução, foi concluído que a assimetria presente não seria totalmente corrigida somente através da intervenção ortognática, sendo necessária também uma osteotomia removendo parte da base do corpo e ângulo mandibular, através da confecção de um guia de corte, promovendo à reanatomização sem a necessidade de acesso extra oral submandibular, evitando uma cicatriz em face feminina. Paciente encontra-se em pós-operatório de 60 meses, sem queixas e satisfeita. Portanto, é evidenciado cada vez mais a influência positiva que o planejamento virtual pode trazer aos profissionais na otimização dos resultados cirúrgicos.

Hemimandibular hyperplasia is responsible for aesthetic, functional, motor, and psychosocial impairments. With an uncertain etiology, it occurs due to the imbalance of regulatory growth factors present in the cartilaginous layer of the condyle. The report aims to describe decision-making based on specific complementary exams combined with the appropriate surgical intervention for the condition. A 33-year-old female patient presented at a private clinic with the main complaint of "asymmetric face." A scintigraphic evaluation was requested to objectively confirm the interruption of condylar growth, ruling out the hypothesis of Osteochondroma and condylectomy. After prior orthodontic preparation, tomographic exams were used to create a prototype that was printed after planned bone movements. Through the reconstruction, it was concluded that the existing asymmetry would not be entirely corrected through orthognathic intervention alone, necessitating also an osteotomy to remove part of the base of the body and mandibular angle. This was done through the creation of a cutting guide, allowing for reanatomization without the need for submandibular extraoral access, thus avoiding a scar on the female face. The patient is 60 months postoperative, with no complaints and satisfied. Therefore, the increasingly positive influence of virtual planning on optimizing surgical outcomes for professionals is evident.

Orofacial myofunctional condition of patients with facial trauma in different stages of recovery / Condição miofuncional orofacial de pacientes com trauma de face em diferentes etapas de recuperação

ABSTRACT Purpose: to describe the global orofacial myofunctional condition of patients presented with facial trauma and analyze postural and mobility aspects related to swallowing function at different stages of recovery. Methods: an analytical and cross-sectional study with 36 participants, aged 19 to 67 years, conducted in five stages (D1, D2, D3, D4, and D5), on the 8th to 60th day after trauma, using the adapted Orofacial Myofunctional Evaluation Protocol with Scores (OMES). Descriptive and inferential statistical analysis was performed using the paired Student's t-test or paired Wilcoxon test, and the Friedman test which compared the five evaluations. A 5% margin of error was used in the decision of the statistical tests. Results: in lip movements, the majority (69.4%) had severe inability. In tongue movements, the two related categories (imprecise and severe inability) had percentages of 52.8% and 41.7%, respectively. In jaw movements, the majority (83.3%) had severe inability. The median OMES score was lowest in D1 (29.00), followed by D2 (33.00), highest in D5 (46.00), and ranged from 39.50 to 41.00 in the other two evaluations, with significant differences between D1 and D3, D4 and D5, and D2 and D5. Conclusion: the orofacial myofunctional condition progressed, spontaneously and positively, throughout the evaluations. However, attention is needed from the professionals involved.

RESUMO Objetivo: descrever a condição miofuncional orofacial global de pacientes com traumatismos faciais e analisar aspectos posturais e de mobilidade relacionados à função deglutição em diferentes etapas de recuperação. Métodos: estudo analítico e transversal. 36 participantes, idade entre 19 e 67 anos. Realizada em cinco etapas (D1, D2, D3, D4 e D5): oitavo ao sexagésimo dia após trauma. Utilizou-se o Protocolo de Avaliação Miofuncional Orofacial com Escores (AMIOFE) adaptado. Foi realizada análise estatística descritiva e inferencial, utilizando os testes t-Student pareado ou teste Wilcoxon pareado e o teste de Friedman na comparação entre as cinco avaliações. A margem de erro utilizada na decisão dos testes estatísticos foi de 5%. Resultados: nos movimentos labiais a maioria (69,4%) tinha inabilidade severa. Nos movimentos da língua, as duas categorias relacionadas, falta de precisão e inabilidade severa, apresentaram percentuais de 52,8% e 41,7%, respectivamente. Na movimentação da mandíbula, a maioria (83,3%) apresentava inabilidade severa. No escore AMIOFE, a mediana foi menos elevada em D1 (29,00), seguida por D2 (33,00), mais elevada em D5 (46,00) e variou de 39,50 a 41,00 nas outras duas avaliações com diferenças significativas entre: D1 diferente de D3, D4 e D5 e D2 diferente de D5. Conclusão: houve evolução positiva espontânea da condição miofuncional orofacial ao longo das avaliações. Contudo, é necessária atenção dos profissionais envolvidos.

Cadaveric Study On Relation Of Extracranial Course Of Facial Nerve To Retromandibular Vein

Intimate knowledge of relation of facial nerve to retromandibular vein is vital in order to reduce the postoperative morbidity related to facial nerve injury during surgery. The present study is a descriptive observational study done by dissecting 50 cadavers (100 facial halves). The variations were documented and analysed. Retromandibular vein was related medial to facial nerve in 100% cadavers. These variations in relation of facial nerve to retromandibular vein can explain the different consequences of facial nerve injury, which may occur after various surgeries involving face. Therefore, knowledge of relation of facial nerve to retromandibular vein is essential, if the nerve is to be preserved during surgery.

Unveiling The Smile Traits: The Forensic Importance

Background- This cross sectional study was conducted to correlate the various smile characteristics such as- smile line, smile arcs, lip curvature, gingival exposure and maxillary central incisor exposure with gender in north Indian population. The study was conducted in department of Oral Pathology and Microbiology department at Shree BankeyMaterials and methods- Bihari Dental College & Research Centre, Uttar Pradesh, India. A total of 100 research participants were selected according to inclusion and exclusion criteria out of which 56 were males and 44 were females. To obtain the smile photographs, constant camera settings was used. The collected data were analyzed using Image-J software for sexual dimorphism and forensic identi?cation. Result-Results of this study showed, out of 100 individuals 73 individuals have average smile line followed by low smile line & high smile line. Out of 100 individuals, 67 individuals have have parallel smile arcs followed by ?ate smile arcs & reverse smile arcs. Out of 100 individuals 54 individuals have straight upper lip curvature followed by upward & downward upper lip curvature. Out of 100 individuals 48 have inter proximal gingival exposure followed by no gingival exposure & gingival exposure. Out of 100 individuals 57 individuals have 75% central incisor exposure. Out of 100 individuals 41 individuals showed square shaped incisors followed by rectangular shaped, round shape & triangular shape. Each individual's facial and dental features are unique, making them valuable in forensic dentistry for Conclusion- identi?cation. These distinct traits also play a crucial role in enhancing personalized treatments in aesthetic dentistry.

Reconstrução facial forense: padrões labiais para a população brasileira / Forensic facial reconstruction: lip patterns for the Brazilian population

Estudos vêm sendo desenvolvidos buscando parâmetros para que a reconstrução facial forense (RFF) seja mais próxima da realidade. Este estudo teve como objetivo verificar parâmetros labiais em 3 estratos etários considerando o sexo, estabelecendo três padrões labiais, para cada sexo. Para a condução do estudo foi utilizada uma amostra de tomografias computadorizadas de feixe cônico (TCFC) da região Centro-Oeste brasileira, de 109 exames, sendo 67 mulheres e 42 homens. Para o sexo feminino, o grupo 1 (n 15) de 15 a 21 anos com idade média de 16,61±4,42anos; o grupo 2 (n 32) de 22 a 39 anos, média 32,64±4,7 anos e o grupo 3 (n 20), acima de 40 anos com 52,14±6,62 anos. Já para o sexo masculino, o grupo 1 (n 15) com idade média de 17,53±2,114 anos; grupo 2 (n 21), 29,19±6,28 anos e grupo 3 (n 6), com 42,7±18,66 anos. Para a análise das imagens e mensurações, foi utilizado o software o Osirix MD, no qual 26 parâmetros foram avaliados. Foram encontradas diferenças nas dimensões das estruturas labiais entre os sexos e os grupos etários. A altura do vermelhão do lábio (Ls-Li), largura do lábio (ChL-ChR), altura do lábio superior (Sn-Sto) e distância entre os pontos Subnasal- Lábio superior (Sn-Ls) são parâmetros ligados ao sexo e entre os grupos etários. A altura do vermelhão sofreu maior alteração com a idade para ambos os sexos, reduzindo 29% nos homens e 11% nas mulheres, enquanto a largura do lábio aumentou 12% no sexo masculino e 9% no sexo feminino. Os parâmetros sofreram maior alteração entre os grupos etários 2 e 3. Alterações na morfologia labial e nas estruturas perilabiais tendem a ser mais evidentes no sexo feminino, enquanto o sexo masculino se demonstrou mais estável. O estabelecimento de padrões labiais pode facilitar e acelerar o processo de reconstrução facial forense.

Interesting Case of Pan facial Fracture

Background : Pan Facial Fractures to the facial region are common in Road Traffic Accidents. The association of fractures extending into the surrounding structures (Skull) should not be neglected. Duty Medical Officers should be aware of the life-saving initial management and stabilization of the patient in Pan Facial Fractures. Case Report : We report here an interesting case of Pan Facial Fracture and its management and outcome. Conclusion : Duty Medical Officers should be aware of Pan Facial Fractures. Increasing incidence of High- velocity injuries in Road Traffic Accidents causes a higher rate of Pan facial injuries in association with head injuries. Early reconstruction with the precision of facial bones injury and fractures with buttresses provides good results anatomically, surgically, functionally and cosmetically. With the establishment of advanced trauma care in all institutions in one state, it抯 mandatory to know about Pan Facial Fractures and their management.

Blefaroplastia: tratamiento de festones / Blepharoplasty: treatment of festoons

Introducción. Los pacientes con edema malar crónico, montículos malares y festones representan un desafío para el cirujano plástico, ya que la patología persiste aún después de la blefaroplastia inferior tradicional. Objetivo. El objetivo del trabajo es evaluar la efi cacia del lifting de tercio medio facial para el tratamiento de festones adquiridos, analizar el desarrollo de la técnica y evaluar complicaciones. Materiales y métodos. Desde mayo de 2022 a mayo de 2023, 17 pacientes fueron operados de blefaroplastia inferior transcutánea con lifting supraperióstico de tercio medio facial para tratamiento de festones malares adquiridos. Resultados. La edad media de la población del estudio fue de 61 años. La duración del procedimiento fue en promedio de 2 hs. El tiempo medio de seguimiento posoperatorio fue de 8 meses, sin evidencia de recurrencia de festones. Conclusiones. El lifting supraperióstico de tercio medio facial es una opción segura, reproducible y efi caz para el tratamiento de festones. Sin embargo, deben respetarse todos los pasos de la técnica para evitar así complicaciones y recidivas

Background. Festoons and malar mounds present a particular challenge to the plastic surgeon and commonly persist after the traditional lower blepharoplasty. Material and methods. From May 2022 to May 2023, 17 patients underwent preperiosteal midcheek lift by transcutaneous lower eyelid incision for acquired festoons treatment. Results. The average patient age was 61 years. The procedure took on average 2 hours, with a median follow-up of 8 months without evidence of recurrent festoons. Conclusion. Preperiosteal midcheek lift is a reproducible, reliable and eff ective procedure for festoons treatment. However, all surgical technique steps must be considered to avoid complications and recurrence of the disease.

Evaluación del aporte ecográfico en estética: hallazgos faciales que inciden en la terapéutica / Evaluation of the ultrasound contribution in aesthetics: facial findings that have an impact on therap

Resumen Introducción: La radiología, especialmente la ecografía, está ganando importancia en el campo de la medicina estética, facilitando la evaluación anatómica de los pacientes antes de procedimientos inyectables, ayudando en el diagnóstico de complicaciones y en la identificación de materiales de relleno. Existen variantes anatómicas que pueden aumentar el riesgo de complicaciones, además muchos pacientes no recuerdan qué materiales han sido inyectados previamente. Este trabajo busca evaluar la utilidad de la ecografía en la toma de decisiones terapéuticas y compartir la experiencia de los autores con pacientes entre 2021 y 2023. Objetivo: Describir los hallazgos ecográficos de una serie de pacientes que se realizaron ecografía facial Doppler por indicación de su médico estético y evaluar cómo incide en la toma de decisión terapéutica. Método: Este trabajo fue aprobado por el Comité de Ética. Estudio prospectivo descriptivo analítico de una cohorte de pacientes atendidos entre 2021 y 2023. Se incluyeron pacientes que se realizaron ecografía facial antes o después de un procedimiento inyectable. Se determinó cómo incidió la ecografía en la selección del tratamiento estético. Datos y variables se analizaron mediante Stata Statistical Software Release14 (College Station, TX: StataCorpLP). Resultados: Se estudiaron 83 pacientes, 53 se realizaron ecografía para planificar un procedimiento (grupo 1) y 30 por complicaciones (grupo 2). Del grupo 1, 24 (45,2%) no presentaban rellenos previos, 15 (28,3%) ácido hialurónico y 14 (26,4%) rellenos permanentes. Doce presentaron variantes anatómicas. Del grupo 2, 14 sufrieron complicaciones agudas y 16 crónicas. El informe ecográfico condicionó un cambio en la terapéutica del médico estético en el 74% de los pacientes. Conclusión: La ecografía facial otorgó información fundamental para la planificación de los tratamientos estéticos y condicionó un cambio en la conducta terapéutica en la mayor parte de la población estudiada.

Abstract Introduction: Radiology, especially ultrasound, is gaining importance in the field of aesthetic medicine, facilitating the anatomical evaluation of patients prior to injectable procedures, assisting in the diagnosis of complications, and identifying filler materials. There are anatomical variations that can increase the risk of complications, and many patients do not remember which materials have been injected previously. This work aims to evaluate the utility of ultrasound in therapeutic decision-making and to share the authors' experience with patients between 2021 and 2023. Objective: To describe ultrasound findings in patients that had a facial Doppler ultrasound study referred by an aesthetic physician and to evaluate how it influenced the therapeutic decision. Method: This study was approved by the institutional Ethics medical Committee. It is a prospective, descriptive, analytical study of a patient cohort assessed between 2021 and 2023. The study includes patients who had a facial ultrasound referred by their aesthetic physician, either before or after injectable treatments. The influence of ultrasound findings on treatment selections was considered. Data were analyzed using Stata Statistical Software Release 14 (College Station, TX: StataCorp LP). Results: A total of 83 patients were studied. Fifty-three patients underwent a facial ultrasound before planning an injectable treatment (group 1), while 30 patients underwent facial ultrasound due to complications related to injectables (group 2). In group 1, 24 patients (45.2%) had no previous fillers, 15 (28.3%) had hyaluronic acid fillers, and 14 (26.4%) had permanent fillers. Twelve patients (22.6%) presented anatomical variations. In group 2, 14 patients (46.6%) had acute complications and 16 (53.3%) had chronic complications. Based on these results, ultrasound findings changed the therapeutic decision in 74% of the cases (62 patients). Conclusion: Facial ultrasound provided crucial information for aesthetic treatment planning and altered the treatment approach in the majority of the patients studied.

Conhecimento dos alunos e recém-formados sobre extração de terceiros molares inferiores / Knowledge of students and recent graduates about extraction of mandibular third molars / Conocimiento de estudiantes y recién graduados sobre extracción de terceros molares inferiores

Um procedimento cirúrgico frequentemente realizado em odontologia é a extração de terceiros molares. Seu germe dentário é o último a ser formado e devido a isso possuem maior impacção, principalmente os inferiores, o que torna a técnica cirúrgica mais complexa e com necessidade de planejamento prévio eficaz. Objetivo: Esta pesquisa avaliou o conhecimento dos alunos e recém-formados em odontologia a respeito das dificuldades inerentes a todo planejamento e técnica cirúrgica para extração de terceiros molares inferiores. Metodologia: Foi realizado um estudo transversal com uma análise descritiva sendo que os dados foram coletados através de um questionário online divulgado por mídias sociais para alunos dos cursos de graduação em Odontologia da cidade de Vitória e recém-formados de até 2 (dois) anos das mesmas instituições. Resultados: Foram respondidos 80 questionários e os resultados apontam um número de erros expressivos quando é levado em consideração que apenas três participantes acertaram 13 perguntas de uma total de 18. Conclusão: As instituições de ensino superior precisam aprimorar a grade curricular das disciplinas de cirurgia oral tanto na teoria quanto na prática clínica para que o aluno seja capaz de realizar com segurança tal procedimento... (AU)

A surgical procedure often performed in dentistry is the extraction of third molars. Their tooth germ is the last to be formed, and because of this they have greater impaction, especially the lower ones, which makes the surgical technique more complex and in need of effective prior planning. Objective: This research evaluated the knowledge of dental students and recent graduates regarding the difficulties inherent to all planning and surgical technique for extraction of mandibular third molars. Methodology: A cross-sectional study with descriptive analysis was carried out, and data were collected using an online questionnaire disseminated by social media to dental students and recent graduates of up to 2 (two) years of the same institutions. Results: 80 questionnaires were answered and the results shows a significant number of errors when taking into account that only three participants got 13 questions right out of a total of 18. Conclusion: Higher education institutions needs to improve the curriculum of oral surgery subjects both in theory and clinical practice so that students will be able to safely perform this procedure... (AU)

Un procedimiento quirúrgico frecuentemente realizado en odontología es la extracción de terceros molares. Tu germen dental es el último en formar-se, y por eso tienen mayor impacto, principalmente los inferiores, lo que hace más compleja la técnica quirúrgica y necesitados de una planificación previa eficaz. Objetivo: Esta investigación evaluó el conocimiento de los estudiantes y recién graduados en odontología sobre las dificultades inherentes a toda planificación y técnica quirúrgica para extracción de terceros molares inferiores. Metodología: Se realizó un estudio transversal con un análisis descriptivo y los datos se recopilaron mediante de un cuestionario en línea difundido por las redes sociales para los estudiantes de los cursos de graduados en Odontología da ciudad de Vitória y recién egresados de hasta 2 (dos) años de las mismas instituciones. Resultados: 80 cuestionarios fueron respondidos y los resultados apuntan a una serie de errores significativos cuando se tiene en cuenta que solo tres participantes acertaron 13 preguntas de un total de 18. Conclusión: Las instituciones de educación superior necesitan mejorar el plan de estudios de las disciplinas de cirugía oral tanto en la teoría como en la práctica clínica para que el estudiante pueda realizar este procedimiento de manera segura... (AU)

Artificial Intelligence-Based Diagnosis of Obstructive Sleep Apnea Syndrome: A Scoping Review / Diagnóstico Basado en Inteligencia Artificial para el Síndrome Obstructivo de Apnea del Sueño: Una Revisión de Alcance

SUMMARY: To diagnose obstructive sleep apnea syndrome (OSAS), polysomnography is used, an expensive and extensive study requiring the patient to sleep in a laboratory. OSAS has been associated with features of facial morphology, and a preliminary diagnosis could be made using an artificial intelligence (AI) predictive model. This study aimed to analyze, using a scoping review, the AI-based technological options applied to diagnosing OSAS and the parameters evaluated in such analyses on craniofacial structures. A systematic search of the literature was carried out up to February 2024, and, using inclusion and exclusion criteria, the studies to be analyzed were determined. Titles and abstracts were independently selected by two researchers. Fourteen studies were selected, including a total of 13,293 subjects analyzed. The age of the sample ranged from 18 to 90 years. 9,912 (74.56 %) subjects were male, and 3,381 (25.43 %) were female. The included studies presented a diagnosis of OSAS by polysomnography; seven presented a control group of subjects without OSAS and another group with OSAS. The remaining studies presented OSAS groups in relation to their severity. All studies had a mean accuracy of 80 % in predicting OSAS using variables such as age, gender, measurements, and/or imaging measurements. There are no tests before diagnosis by polysomnography to guide the user in the likely presence of OSAS. In this sense, there are risk factors for developing OSA linked to facial shape, obesity, age, and other conditions, which, together with the advances in AI for diagnosis and guidance in OSAS, could be used for early detection.

Para diagnosticar el Síndrome Apnea Obstructiva del Sueño (SAOS) se utiliza la polisomnografía, el cual es un costoso y extenso estudio que exige que el paciente duerma en un laboratorio. El SAOS ha sido asociado con características de la morfología facial y mediante un modelo predictivo de la Inteligencia Artificial (IA), se podría realizar un diagnóstico preliminar. El objetivo de este estudio fue analizar por medio de una revisión de alcance, las opciones tecnológicas basadas en IA aplicadas al diagnóstico del SAOS, y los parámetros evaluados en dichos análisis en las estructuras craneofaciales. Se realizó una búsqueda sistemática de la literatura hasta febrero del 2024 y mediante criterios de inclusión y exclusión se determino los estudios a analizar. Los títulos y resúmenes fueron seleccionados de forma independiente por dos investigadores. Se seleccionaron 14 estudios, incluyeron un total de 13.293 sujetos analizados. El rango edad de la muestra oscilo entre 18 y 90 años. 9.912 (74.56 %) sujetos eran de sexo masculino y 3.381 (25,43 %) eran de sexo femenino. Los estudios incluidos presentaron diagnóstico de SAOS mediante polisomnografía, siete estudios presentaron un grupo control de sujetos con ausencia de SAOS y otro grupo con presencia de SAOS. Mientras que los demás estudios, presentaron grupos de SAOS en relación con su severidad. Todos los estudios tuvieron una precisión media del 80 % en la predicción de SAOS utilizando variables como la edad, el género, mediciones y/o mediciones imagenológicas. no existen exámenes previos al diagnóstico por polisomnografía que permitan orientar al usuario en la probable presencia de SAOS. En este sentido, existen factores de riesgo para desarrollar SAOS vinculados a la forma facial, la obesidad, la edad y otras condiciones, que sumados a los avances con IA para diagnóstico y orientación en SAOS podrían ser utilizados para la detección precoz del mismo.

Morphometric Analysis of Stylomastoid Foramen and its Clinical Significance / Análisis Morfométrico del Foramen Estilomastoideo y su Importancia Clínica

SUMMARY: The stylomastoid foramen is located on the inferior surface of the petrous part of the temporal bone between the base of the styloid process and mastoid processes. Through the stylomastoid foramen the facial nerve completes its intracranial part. The aim of this study was to analyze the morphometric parameters, shape and position of the stylomastoid foramen on the skulls in Serbian population, and to correlate it with gender and body side. The study included 44 dry adult skulls (88 stylomastoid foramen). After we determined the gender, the skulls were photographed, and then distances of the stylomastoid foramen from various important landmarks of the skull base were measured in programme ImageJ. The shape and position of the stylomastoid foramen were also noted. The statistical significance was found in male skulls between right and left side in relation to parameter (P2) the shortest distance from the upper end of the anterior margin of the mastoid process (MP) to the center of stylomastoid foramen (CSMF), and on the left side for parameter (P6) the shortest distance between CSMF and the line passing through the tip of the MP in relation to gender. The most common shape of the stylomastoid foramen was round in 46 (52.27 %) cases, and most common position was on the line passing through the upper end of the anterior margin of both MP in 36 (40.91 %) and medially to the line connecting the tips of the MP and styloid process in 88 (100 %) cases. The results of this study will be useful for neurosurgeons during surgeries on the facial nerve trunk or anesthetics to give facial nerve block near the foramen and prevent its complications.

El foramen estilomastoideo se encuentra en la superficie inferior de la parte petrosa del hueso temporal entre la base del proceso estiloides y el proceso mastoides. A través del foramen estilomastoideo el nervio facial completa su parte intracraneal. El objetivo de este estudio fue analizar los parámetros morfométricos, la forma y la posición del foramen estilomastoideo en cráneos de población serbia y correlacionarlos con el sexo y el lado del cuerpo. El estudio incluyó 44 cráneos adultos secos (88 forámenes estilomastoideos). Después de determinar el sexo, se fotografiaron los cráneos y luego se midieron en el programa ImageJ las distancias del foramen estilomastoideo desde varios puntos importantes de la base del cráneo. También se observó la forma y posición del foramen estilomastoideo. La significación estadística se encontró en cráneos de hombres entre el lado derecho e izquierdo en relación al parámetro (P2) la distancia más corta desde el extremo superior del margen anterior del proceso mastoides (PM) hasta el centro del foramen estilomastoideo (CFM), y en el lado izquierdo para el parámetro (P6) la distancia más corta entre CFM y la línea que pasa por la punta del PM en relación al sexo. La forma más común del foramen estilomastoideo era redonda en 46 (52,27 %) casos, y la posición más común estaba en la línea que pasa por el extremo superior del margen anterior de ambos PM en 36 (40,91 %) y medialmente a la línea que conecta las puntas del PM y el proceso estiloides en 88 (100 %) casos. Los resultados de este estudio serán útiles para los neurocirujanos durante las cirugías en el tronco del nervio facial o los anestésicos para bloquear el nervio facial cerca del foramen y prevenir sus complicaciones.

Parry Romberg Syndrome with its Oral Manifestations- Report of a Case.

Introduction: Parry Romberg syndrome (PRS) which is also called as progressive facial hemiatrophy is a development craniofacial anomaly. It is a very rare condition that slowly and progressively affects one side of the face as well as one side of the body with loss of soft and hard tissues Case presentation: A 47 year old female reported to our Department of Oral and Maxillofacial Surgery with a chief complaint of pain in her lower left back tooth region and front tooth region since two weeks. On examination it was typical to classic Parry Romberg Syndrome. Management and prognosis: Osteomyelitis was addressed with curettage and sequestrectomy of the affected site with antibiotic therapy. Treatment largely is based on cosmetic corrections as the patient exhibits immense psychological trauma as this happens over the course of the patients life. Conclusion: The etiology is unknown although certain resources mention its relation to autoimmune conditions. It is associated with different systemic manifestations including craniofacial, ophthalmic and neurologic abnormalities. A multidisciplinary approach is mandated in such patients to enhance their quality of life

Topsy turvy in the line of fire

In literature there are several schools of thoughts regarding the tooth present in line of fracture. Some supports the preservation to tooth and others in contrast against to the preservation of the tooth. A case of mandibular fracture with a tooth in the fracture line is presented in this paper. Removal of tooth done followed by reduction under G.A with 1 month postoperative follow-up. Different authors supporting different treatment plan for tooth in fracture line. It depends on case whether to remove the tooth or preserve. There are several pro and cons for both the treatment plan discussed in this paper.

Fractura de seno frontal: reporte de caso clínico / Fratura do seio frontal: relato de caso clínico / Frontal sinus fracture: clinical case report

Introducción: Las fracturas del seno frontal, representando del 5% al 15% de las lesiones faciales traumáticas. La tomografía computarizada sin contraste es esencial para el diagnóstico. Clasificadas en cinco tipos según su trayectoria, la elección del tratamiento quirúrgico se basa en factores como ubicación, desplazamiento, integridad del tracto de salida del seno frontal y lesiones asociadas. Los objetivos de la intervención quirúrgica incluyen tratar fugas de líquido cefalorraquídeo, proteger estructuras intracraneales y prevenir complicaciones tardías como meningitis y osteomielitis frontal. Descripción del caso clínico: Paciente masculino de 26 años de edad, remitido al Hospital Vicente Corral Moscoso para valoración y manejo de trauma facial. A los 7 días de su ingreso bajo anestesia general balanceada se realizó el procedimiento quirúrgico que consistió en reducción más fijación con malla frontal más cinco tornillos de la fractura de la pared anterior del seno frontal derecho. Conclusiones: Se sugiere un enfoque multidisciplinario con neurocirujano y cirujano maxilofacial para tratar fracturas faciales superiores. El tratamiento actual considera la afectación de la tabla posterior, la permeabilidad del tracto de salida del seno frontal y el desplazamiento de la tabla anterior. Se prioriza el manejo temprano para proteger estructuras intracraneales, restaurar la función del seno frontal y prevenir complicaciones... (AU)

Introdução: Fraturas do seio frontal, representando 5% a 15% das lesões faciais traumáticas. A TC sem contraste é essencial para o diagnóstico. Classificada em cinco tipos de acordo com sua trajetória, a escolha do tratamento cirúrgico baseia-se em fatores como localização, deslocamento, integridade da via de saída do seio frontal e lesões associadas. Os objetivos da intervenção cirúrgica incluem o tratamento de fístulas liquóricas, proteção de estruturas intracranianas e prevenção de complicações tardias, como meningite e osteomielite frontal. Relato de caso clínico: Paciente do sexo masculino, 26 anos, encaminhado ao Hospital Vicente Corral Moscoso para avaliação e manejo de trauma facial. Sete dias após a internação, sob anestesia geral balanceada, foi realizado o procedimento cirúrgico que consistiu na redução mais fixação com tela frontal mais cinco parafusos da fratura da parede anterior do seio frontal direito. Conclusões: Sugere-se uma abordagem multidisciplinar com neurocirurgião e cirurgião maxilofacial para tratar fraturas faciais superiores. O tratamento atual considera o envolvimento da mesa posterior, a patência da via de saída do seio frontal e o deslocamento anterior da mesa. O manejo precoce é priorizado para proteger as estruturas intracranianas, restaurar a função do seio frontal e prevenir complicações... (AU)

Introduction: Fractures of the frontal sinus, representing 5% to 15% of traumatic facial injuries. Non-contrast CT is essential for diagnosis. Classified into five types according to their trajectory, the choice of surgical treatment is based on factors such as location, displacement, integrity of the frontal sinus outflow tract and associated injuries. The goals of surgical intervention include treating cerebrospinal fluid leaks, protecting intracranial structures, and preventing late complications such as meningitis and frontal osteomyelitis. Clinical case report: 26-year-old male patient, referred to the Vicente Corral Moscoso Hospital for evaluation and management of facial trauma. Seven days after admission, under balanced general anesthesia, the surgical procedure was performed, which consisted of reduction plus fixation with frontal mesh plus five screws of the fracture of the anterior wall of the right frontal sinus. Conclusions: A multidisciplinary approach with neurosurgeon and maxillofacial surgeon is suggested to treat upper facial fractures. Current treatment considers posterior table involvement, frontal sinus outflow tract patency, and anterior table displacement. Early management is prioritized to protect intracranial structures, restore frontal sinus function, and prevent complications... (AU)

Le Fort fractures: a review

Rene Le Fort proposed 3 classifications to determine the type of facial fracture based on the main facial lines with the least resistance, these being the places where facial fractures are most located. These fractures occur mainly because of high-velocity impact mechanisms. Le Fort fractures are difficult to manage and at the same time challenging, although it is not a common pathology, it is potentially lethal, and its initial approach and resuscitation are critical in the first hours. As in any other trauma, an initial evaluation must be carried out exhaustively and following the ABC, which mainly includes evaluation of the airway, breathing and circulation. Once a facial fracture is suspected, its extension and location must be determined through images such as x-ray or computed tomography. CT being the gold standard. Once the patient is stabilized, reconstructive surgery will be the indicated approach in most cases, with the main objective being the restoration of occlusion, direct exposure and manual reduction of the fractures, reconstruction of the medial and lateral bone buttresses, restoring the projection of the face and restore the width of the maxillary arch, nose and orbit. In general, some of the most frequently described postoperative complications are hemorrhage, infection, foreign body reaction, malunion, among others; however, these will vary depending on their classification.

Rejuvenecimiento quirúrgico facial, deep plane facelift y procedimientos complementarios / Deep plane facelift

El tratamiento del envejecimiento facial debe ser tratado en su conjunto. Elegimos la técnica DPFL (Deep Plane Facelift) por ser la más efectiva en el tratamiento del tercio medio e inferior, la liberación de los ligamentos de retención facial permite una reposición vertical sin energía en los tejidos. La no deslaminación del complejo SMAS-Platisma conforma un colgajo compuesto de mayor estabilidad en las suturas y mayor trofismo cutáneo. Como procedimientos complementarios incluimos el lifting fronto-temporal extendido con incisión mínima, blefaroplastia, lipofilling facial, lifting de labio, rinoplastia, lobuloplastia auricular y cuello profundo. Esta sinergia quirúrgica optimiza el resultado siendo más natural y armónico, conservando la fisonomía de los 10 a 15 años anteriores de los pacientes, hecho observado en fotografías.

The treatment of facial aging must be treated as a whole. We chose the DPFL (Deep Plane Facelift) technique because it is the most eff ective in the treatment of the middle and lower 1/3, the release of the facial retaining ligaments allows a vertical repositioning without energy in the tissues. The non-delamination of the SMAS-Platysma complex forms a composite fl ap with greater suture stability and greater skin trophism. As complementary procedures we include the extended fronto-temporal lift with minimal incision, blepharoplasty, facial lipofi lling, lip lift, rhinoplasty, auricular lobuloplasty, deep neck. This surgical synergy optimizes the result being more natural and harmonic, preserving the physiognomy of 10 to 15 years ago of the patients, fact observed in photographs.

Deep plane facelift extendido. Técnica de disección diseñada para lograr el máximo reposicionamiento de la región centrofacial, definición del contorno del cuello y la línea mandibular / Extended deep plane face lift. Dissection technique designed to achieve maximum repositioning of the centrofacial region, defi nition of the contour of the neck and jaw line

El lifting de plano profundo es una técnica de rejuvenecimiento facial que nos permite lograr resultados altamente satisfactorios aun en casos de difícil resolución. El conocimiento detallado de la anatomía facial es de primordial importancia para su aprendizaje y perfeccionamiento. Es una técnica que insume mayor tiempo operatorio, ya que requiere una adecuada liberación de ligamentos faciales y cervicales para la correcta movilización de los tejidos y su reposicionamiento sin tensión, pero al mismo tiempo es segura y confi able.

Deep plane lifting is a rejuvenation technique. facial treatment that allows us to achieve highly satisfactory even in cases of diffi cult resolution. He met Detailed understanding of facial anatomy is of primary importance importance for your learning and improvement. It is a technique that requires more operating time, since it requires adequate release of ligaments facial and cervical for the correct mobilization of the tissues and their repositioning without tension, but at the same time time is safe and reliable.

Reanimación facial: experiencia mediante métodos estáticos y dinámicos / Facial reanimation: experience using static and dynamic methods

La parálisis facial periférica es una condición que impacta negativamente en la calidad de vida y psiquis de los pacientes. Se aborda como una afección relativamente frecuente, con diversas causas, con un manejo multidisciplinario para su tratamiento. Se presenta un estudio retrospectivo de cuatro pacientes femeninas que sufrieron parálisis facial periférica crónica, causada por cirugías previas. Se emplearon técnicas estáticas y dinámica para su tratamiento, incluyendo una nueva técnica estática no descrita anteriormente para parálisis faciales basada en el lifting de tercio medio de plano profundo. Se evaluó la satisfacción de los pacientes mediante el cuestionario FACE Q pre- y posoperatorio, mostrando resultados positivos en ambos grupos de tratamiento. Se destaca la importancia de la kinesiología motora en el proceso de rehabilitación. Demostramos la efi cacia de técnicas accesibles y de bajo costo, así como la introducción exitosa de técnicas más complejas, como la transferencia muscular con anastomosis nerviosa.

Peripheral facial paralysis is a condition that negatively impacts the quality of life and psyche of patients. It is addressed as a relatively frequent condition with various causes, managed through a multidisciplinary approach for its treatment. A retrospective study is presented involving four female patients who suff ered from chronic peripheral facial paralysis caused by previous surgeries. Both static and dynamic techniques were used for their treatment, including a new static technique not previously described for facial paralysis based on deep plane midface lifting. Patient satisfaction was evaluated using the FACE Q questionnaire pre- and post-operatively, showing positive results in both treatment groups. The importance of motor kinesiology in the rehabilitation process is highlighted. We demonstrate the effi cacy of accessible and low-cost techniques, as well as the successful introduction of more complex techniques, such as muscle transfer with nerve anastomosis.

Rejuvenecimiento facial y láser de dióxido de carbono / Facial rejuvenation and carbon dioxide laser

El envejecimiento facial es multifactorial, la piel muestra el paso del tiempo a través de manchas, poros dilatados, arrugas, fl acidez y otras alteraciones. Si al momento de realizar un rejuvenecimiento facial no se rejuvenece también la piel, el resultado nunca será armónico o coherente. Actualmente la mejor herramienta para el rejuvenecimiento facial integral es el láser de dióxido de carbono. Si lo combinamos con el uso de microagujas y la aplicación de plasma rico en plaquetas, potenciaremos aún más los resultados

Facial aging is multifactorial, the skin shows prevents aging through spots, pores, wrinkles, gas, fl accidity and other situations. If at the time of perform facial rejuvenation we do not rejuvenate the skin, the result will never be harmonious or coherent. To this day, the best tool for refacial rejuvenation is the carbon dioxide laserand if we associate it with the use of microneedles and applications of rich plasma we are going to enhance the result

IMPACTO DA PANDEMIA DE COVID-19 NO AUMENTO DAS URGÊNCIAS POR DISFUNÇÕES TEMPOROMANDIBULARES: UM ESTUDO TRANSVERSAL / IMPACT OF THE COVID-19 PANDEMIC ON THE INCREASE IN EMERGENCIES FOR TEMPOROMANDIBULAR DYSFUNCTIONS: A CROSS-SECTIONAL STUDY

A COVID-19 é uma doença que apresenta um largo espectro clínico que varia de quadros totalmente assintomáticos a quadros graves de infecção pulmonar. O isolamento social recomendado pelas autoridades sanitárias, apesar de necessário para impedir a disseminação da doença, pode ter repercutido negativamente na saúde mental da população, gerando aumento do número de casos de ansiedade, depressão e outros transtornos psicológicos. Neste contexto, a disfunção temporomandibular (DTM), uma doença de caráter multifatorial, entre eles o fator psicológico, pode ter sido agravada após o início da pandemia. O objetivo deste estudo foi verificar se houve ou não o agravamento dos sintomas de DTM no período de pandemia, e quais foram eles. A pesquisa foi realizada em pacientes atendidos na Clínica de DTM da Odontoclínica Central da Marinha (OCM), situada da cidade do Rio de Janeiro-RJ, Brasil. Foi realizado um estudo transversal retrospectivo através da coleta de dados em 784 prontuários eletrônicos, de pacientes a partir de 12 anos, antes da pandemia, em 2019, e durante a pandemia, em 2020, de acordo com os critérios de elegibilidade. Os resultados obtidos, através de análises estatísticas, revelaram agravamento dos sintomas de DTM no período pandêmico. Houve aumento em consultas de emergência e em quadros de dores musculoarticulares. Concluiu-se que o agravamento dos sintomas de DTM pode estar associado à repercussão negativa da pandemia na saúde mental dos pacientes da OCM.

COVID-19 is a disease that has a wide clinical spectrum that ranges from completely asymptomatic conditions to severe pulmonary infection. The social isolations recommended by health authorities, despite being necessary to prevent the spread of the disease, may had have a negative impact on the mental health of the population with an increase in the number of cases of anxiety, depression and other psychological disorders. In this context, temporomandibular dysfunction (TMD), a multifactorial disease that including the psychological factor, may have worsened after the start of the pandemic period. The aim of this study was to verify whether there was a worsening of TMD symptoms during the pandemic period and what they were. The research was carried out on patients treated at the TMD clinic of Odontoclínica Central da Marinha (OCM), located in the city of Rio de Janeiro-RJ, Brazil. A retrospective cross-sectional study was carried out by collecting data from 784 electronic medical records of patients aged of 12 and over, before the pandemic, in 2019, and during the pandemic, in 2020, according to the eligibility criteria. The results obtained through statistical analyses revealed a worsening of TMD symptoms during the pandemic period. There was an increase in emergency consultations and cases of muscle and join pain. The worsening of TMD symptoms might be associated with the negative impact of the pandemic on the mental health of OCM patients.