ABSTRACT
Abstract Third molar removal surgery usually comes accompanied by postoperative discomfort, which could be influenced by the surgical approach chosen. This scoping systematic review aimed at compiling the available evidence focused on the influence of flap design, including envelope flap (EF), triangular flap (TF), and modified triangular flap (MTF), on postoperative pain, swelling, and trismus, as primary outcome measures, and any result mentioning healing promotion or delay, as secondary outcome measure, after mandibular third molar extraction surgery. An electronic search, complemented by a manual search, of articles published from 1999 to 2020 was conducted in the Medline (PubMed), EMBASE and Web of Science databases including human randomized controlled trials, prospective, and retrospective studies with at least 15 patients. The risk of bias of the included studies was assessed either with the Cochrane's Risk of Bias tool or with the Newcastle-Ottawa scale. Every step of the review was performed independently and in duplicate. The initial electronic search recovered 2102 articles. After applying the inclusion criteria, 12 articles were included. For patient's perceived postoperative pain, TF and MTF frequently reported better results than EF. For swelling, the literature is divided, despite a trend favoring EF. For trismus, data showed that its occurrence is mostly associated with the duration of the surgery rather than with the chosen flap. For healing, the limited data is inconclusive. Finally, randomized studies showed a high risk of bias, whereas nonrandomized studies were mostly of good quality and low risk of bias. Although there was no clear consensus regarding the influence of different flap designs for third mandibular molar extraction on postoperative clinical morbidities; the surgeon's experience, estimated surgical difficulty, molar position and orientation, and surg ery duration should be considered when choosing among the different flap designs.
Subject(s)
Humans , Tooth, Impacted/surgery , Trismus/etiology , Pain, Postoperative/etiology , Postoperative Complications , Tooth Extraction/adverse effects , Prospective Studies , Retrospective Studies , Edema , Mandible , Molar , Molar, Third/surgeryABSTRACT
Abstract The effects of the number of photobiomodulation (PBM) sessions on the postoperative inflammatory process remain controversial. The current literature comparing single and repeated PBM sessions is limited. Objective This study aimed to compare the effects of single and repeated PBM sessions, applied at two different therapeutic wavelengths within the infrared spectrum, on postoperative inflammatory response after impacted third molar tooth extraction. Methodology This randomized, double-blind clinical study included 40 patients with bilateral impacted mandibular third molars (80 teeth). The patients were divided into two groups each including 20 subjects (40 teeth) to receive either single-session laser at 810 nm (20 teeth) and 940 nm (20 teeth) immediately after the surgery or repeated laser sessions at 810 nm (20 teeth) and 940 nm (20 teeth) (immediately after the surgery and on postoperative Day 1). Lasers at 940 nm (power density 0.5 Watt/cm2, energy density 4 J/cm2 for a time until the cumulative energy on the device screen reaches 50 J from 0 J, in continuous mode, spot size 2.8 cm2) and at 810 nm (power density 0.14 Watt/cm2, energy density 4 J/cm2, for 30 seconds, in continuous mode, spot size 2.1 cm2) were applied intra- and extra-orally. Pain, swelling, and trismus were evaluated postoperatively. Results No significant differences were determined between the groups on the evaluated parameters (p>0.05). Conclusion Within the study limitations, in PBM, the effects of 810 nm and 940 nm and those of single and repeated applications were similar regarding pain, swelling and trismus. Immediate postoperative PBM could be preferred to repeated applications performed by point application within a 24-hour period.
Subject(s)
Humans , Tooth, Impacted/surgery , Low-Level Light Therapy , Pain, Postoperative/prevention & control , Tooth Extraction/adverse effects , Trismus/etiology , Trismus/prevention & control , Double-Blind Method , Edema/etiology , Edema/prevention & control , Molar, Third/surgeryABSTRACT
RESUMO Objetivo Analisar, por meio da comparação entre a abertura máxima mandibular, a efetividade de programa terapêutico miofuncional oral em pacientes com câncer de boca ou orofaringe submetidos à radioterapia adjuvante. Método Estudo prospectivo envolvendo cinco pacientes adultos e cinco idosos em pós-operatório de cirurgia de boca/orofaringe que aguardavam início da radioterapia ou até a quinta sessão. No início e no final do programa, os participantes tiveram suas medidas de abertura máxima mandibular mensuradas por meio de paquímetro e foram selecionados cinco exercícios - dois de mobilidade e três de tração mandibular - com controle presencial durante oito semanas, perfazendo um total de dez semanas. Dados descritivos e a comparação das medidas pré e pós-fonoterapia por meio do teste de Wilcoxon foram considerados na análise dos dados. Resultados Dez pacientes finalizaram o programa terapêutico (duas mulheres e oito homens), com média de idade de 58,4 anos, mediana de 57,0 anos. Apresentaram média de abertura máxima mandibular de 31,6 ± 11,7 mm antes do tratamento e 36,4 ± 8,0 mm no pós-terapia (p=0,021). Conclusão O programa terapêutico miofuncional oral proposto promoveu aumento da abertura máxima vertical da mandíbula de pacientes submetidos à radioterapia e/ou quimioterapia adjuvante para tratamento de câncer de boca e orofaringe.
ABSTRACT Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.
Subject(s)
Humans , Male , Female , Adult , Aged , Radiation Injuries/rehabilitation , Trismus/rehabilitation , Oropharyngeal Neoplasms/radiotherapy , Statistics, Nonparametric , Myofunctional Therapy/methods , Radiation Injuries/physiopathology , Speech Therapy/methods , Trismus/etiology , Trismus/physiopathology , Oropharyngeal Neoplasms/physiopathology , Pilot Projects , Prospective Studies , Reproducibility of Results , Treatment Outcome , Exercise Therapy/methods , Middle Aged , Mouth/radiation effects , Mouth/physiopathologyABSTRACT
La atención dental debe acompañar a los pacientes que reciben terapia contra el cáncer de cabeza y cuello debido a que existen efectos secundarios relacionados con la radioterapia y un mal estado bucal, así como secuelas por la cirugía ablativa. Los principales efectos desarrollados por la radioterapia incluyen xerostomía y mucositis, seguidos por trismus, caries por radiación y osteorradionecrosis. Para disminuir el riesgo de desarrollar estos padecimientos es necesaria la visita alcirujano dentista previa al tratamiento para realizar los procedimientos bajo los requerimentos de un paciente con cáncer y hacer la toma de decisiones ante dientes cariados, restauraciones extensas, enfermedad periodontal o dientes posteriores inaccesibles para una higiene diaria. Sin embargo, puede ser desafi ante llevar a cabo estas tareas en el corto periodo entre el diagnóstico del paciente y el inicio de su tratamiento. De igual manera los pacientes que han terminado el tratamiento deberán ser atendidos con consideraciones especiales por la posibilidad de desarrollar osteorradionecrosis...
Subject(s)
Humans , Male , Female , Dental Care for Chronically Ill/methods , Drug-Related Side Effects and Adverse Reactions , Mouth Diseases/etiology , Neoplasms/complications , Radiotherapy/adverse effects , Dental Caries/etiology , Mucositis/etiology , Oral Manifestations , Osteoradionecrosis/etiology , Xerostomia/etiology , Trismus/etiologyABSTRACT
Antecedentes: La cirugía del tercer molar inferior retenido es unprocedimiento de rutina en la práctica de la cirugía bucal. Varias complicaciones surgen como resultado de esta intervención quirúrgica. Entre las más frecuentes se encuentran: dolor, infl amación, trismo, hemorragia, equimosis, alveolitis, infección, parestesia y dificultad para comer. Objetivos: El propósito de este estudio fue evaluar la incidencia de complicaciones postoperatorias en la cirugía del tercer molar inferior retenido en pacientes de la Unidad Académica deOdontología de la Universidad Autónoma de Nayarit a fin de tenerlas en cuenta y tomar las respectivas precauciones, ya sea para tratar de evitarlas en lo sucesivo o bien, para reconocerlas y darles tratamiento. No se incluye dolor, infl amación ni trismo. Material y métodos: Este estudio fue longitudinal y prospectivo de siete días consecutivos y de 30 días en total en 38 pacientes entre 16 y 38 años de edad. Se evaluaron las complicaciones postoperatorias relacionadas con la cirugía del tercer molar inferior. Resultados: Participaron 38 pacientes; 29 del género femenino (76.3 por ciento) y 9 del masculino (23.7 por ciento) de entre 16 y 38 años, con un promedio de edad de 23.16 ± 5.2 años. La complicación más frecuente fue la difi cultad para masticar seguida de equimosis...
Background: Impacted lower third molar surgery is a routine pro-cedure in the practice of oral surgery. However, there are various complications associated with the extraction of impacted mandibular third molars, the most common being pain, swelling, trismus, hemor-rhaging, ecchymosis, dry socket, infection, paresthesia, and diffi culty with chewing. Objectives: The aim of this study was to evaluate the incidence of postoperative complications following impacted lower third molar surgery in patients at the Academic Unit of Dentistry of the Autonomous University of Nayarit, so as to ensure these are taken into account and that the respective precautions are taken, either by attempting to avoid them in the future or to recognize and treat them. Pain, infl ammation and trismus are not analyzed in this paper. Material and methods: A longitudinal prospective study of 38 patients between the ages of 16 and 38 years old (with an average age 23.1) was carried out over seven consecutive days, with follow up examination performed at 15 and 30 days. The postoperative complications associated with lower third molar surgery were assessed. Results: 38 patients took part; 29 females (76.3%) and 9 males (23.7%) between the ages of 16 and 38 years, with a mean age of 23.16 ± 5.2 years old. The most common complication was diffi culty with chewing followed by ecchymosis...
Subject(s)
Humans , Male , Adolescent , Adult , Female , Young Adult , Postoperative Complications/classification , Tooth, Impacted/surgery , Tooth Extraction/adverse effects , Molar, Third/surgery , Age and Sex Distribution , Dry Socket/etiology , Ecchymosis/etiology , Oral Hemorrhage/etiology , Longitudinal Studies , Mexico , Masticatory Muscles/physiopathology , Prospective Studies , Paresthesia/etiology , Data Interpretation, Statistical , Trismus/etiologyABSTRACT
La hipertrofia del proceso coronoides mandibular es una patología rara, progresiva y de etiología desconocida, que se caracteriza por el desarrollo exagerado del proceso coronoides determinando aumento en su tamaño, resultando en una progresiva y dolorosa limitación de la apertura bucal. La hipomovilidad mandibular es un síntoma presente en diversas enfermedades y asociarla a una causa específica requiere exámenes clínicos e imagenológicos minuciosos. La tomografía computarizada cone-beam tiene el potencial de ofrecer informaciones complementarias superiores a las radiografías convencionales. Además, elimina superposiciones, ofrece alta resolución de imagen, lo que ayuda no solo el diagnóstico, sino también la planificación del procedimiento quirúrgico. Presentamos un caso de paciente de sexo masculino que acudió a la consulta para evaluación de trismus. No presentaba dolor, solo incomodidad por limitación progresiva de apertura bucal. Mediante el examen físico, solo se observó la limitación de apertura bucal. Aunque los movimientos de lateralidad y protrusión eran posibles, estaban muy limitados. Se realizó examen de tomografía computarizada cone-beam, que evidenció imagen compatible con hipertrofia bilateral del proceso coronoides mandibular.
The hypertrophy of the mandibular coronoid process is a rare condition, progressive and of unknown etiology, characterized by the over development of the coronoid process determining their size increased, resulting in progressive and painful limitation of mouth opening. The mandibular hypomobility is a present symptom in several diseases and associates it to a specific cause requires detailed clinical and imaginologic examination. The cone-beam computed tomography has the potential to provide complementary informations above than conventional radiography. It also has the advantage of eliminate overlaps, provide high resolution image, helping not only in diagnosis, but also in planning the surgical procedure. Here we report a case of male patient, who appeared at the clinic for an evaluation of a trismus. He had no pain, only discomfort for progressive limitation of mouth opening. On physical examination, only a limited mouth opening has been found. Although the movements of laterality and protrusión were posible, they were very limited. Cone-beam computed tomography examination was performed, that showed an image compatible with bilateral hypertrophy of the mandibular coronoid process.
Subject(s)
Humans , Male , Adult , Mandibular Diseases/pathology , Mandibular Diseases , Cone-Beam Computed Tomography/methods , Hypertrophy , Trismus/etiologyABSTRACT
Radiotherapy, alone or associated with surgery or chemotherapy, produces a significant increase in cure rates for many malignancies of the head and neck region. However, high doses of radiation in large areas, including the oral mucosa, may result in several undesired reactions that manifest during or after the completion of therapy. The multidisciplinary management is the best alternative to minimize or even prevent such reactions, and the dentist has a fundamental role in this context. This paper reviews the literature related to the main oral sequelae from head and neck radiotherapy and establishes clinical oral management protocol for these irradiated patients.
Subject(s)
Humans , Head and Neck Neoplasms/radiotherapy , Mouth Mucosa/radiation effects , Oral Health/standards , Radiation Injuries/complications , Dental Caries/etiology , Dental Caries/prevention & control , Radiation Injuries/therapy , Salivary Glands/radiation effects , Trismus/etiologyABSTRACT
A rare case of fracture of the coronoid and the pterygoid process caused by firearms is described. A 28-year-old male was hit by a bullet in the face, resulting in restricted mouth opening, difficulty in chewing and pain when opening the mouth. Clinical examination revealed a perforating wound in the right parotid region and a similar wound on the left side of the same region. A CT scan showed comminuted fracture of the left coronoid process and bilateral comminuted fracture of the pterygoid processes. Treatment was conservative, speech therapy was conducted and it was successful. Details of the clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.
Um caso raro de fratura dos processos coronóide e pterigóide por arma de fogo é descrito. Paciente do sexo masculino, 28 anos de idade, foi atingido por projétil de arma de fogo na face, resultando em limitação na abertura da boca, dificuldade para mastigar e dor ao abrir a boca. Exame clínico revelou ferimento perfurante em região parotídea direita e ferida similar do lado esquerdo na mesma região. Tomografia computadorizada (TC) mostrou fratura cominutiva do processo coronóide esquerdo e fratura cominutiva bilateral dos processo pterigóides. O tratamento foi conservador, através de fonoterapia, obtendo-se sucesso. Uma descrição detalhada das características clínicas, radiológicas (TC com reconstrução 3D), tratamento e proservação do caso é apresentada.
Subject(s)
Adult , Humans , Male , Fractures, Comminuted/etiology , Mandibular Fractures/etiology , Skull Fractures/etiology , Sphenoid Bone/injuries , Wounds, Gunshot/complications , Exercise Therapy , Firearms , Follow-Up Studies , Facial Pain/etiology , Musculoskeletal Manipulations , Mastication/physiology , Parotid Gland/injuries , Speech Therapy , Trismus/etiologyABSTRACT
Dor e trismo podem revelar-se como complicações pós-operatórias comuns advindas da cirurgia de remoção de terceiros molares inferiores. A pesquisa teve como objetivo principal avaliar o grau de abertura bucal e dor pós-operatória em pacientes submetidos à remoção de terceiros molares inferiores em uma Clínica de Cirurgia Buco-Dental de Adultos (CBDA), no Centro Especializado em Odontologia û Centro, Fortaleza, em 2004. Os dados foram coletados mediante três instrumentos de pesquisa e analisados estatisticamente. Dentre os resultados mais relevantes, destacamos a presença de vários graus de limitação de abertura de boca e dor pós-operatória. Ainda, pudemos concluir que a sintomatologia dolorosa pós-operatória tem um caráter subjetivo; contudo há necessidade de ampliarmos o estudo para este adquirir validade externa.
Subject(s)
Humans , Pain, Postoperative/etiology , Molar, Third/surgery , Trismus/etiologySubject(s)
Adult , Humans , Hypokalemia/complications , Male , Paralysis/etiology , Trismus/etiologyABSTRACT
Se reviso las historias clínicas de 76 pacientes con tétanos del adulto. Los factores asociados significativamente a los casos severos o muy severos fueron: una edad mayor o igual a 70 años, un periodo de incubación menor o igual a 7 dias, un tiempo de enfermedad menor igual a 4 dias y una puerta de entrada quirúrgica. se evaluo tres clasificaciones de pronóstico diferentes. Debido al tamaño pequeño de la muestra, los resultados de letalidad encontrados tienen intervalos de confianza muy amplios, lo que no permite detectar diferencias significativas en la letalidad entre las tres clasificaciones. Consideramos que la clasificación que toma en cuenta el tiempo de enfermedad y la presencia de espasmos, es la mas simple y facil de reproducir en el medio urbano y urbano-marginal