Eminectomia para tratamento de luxação recidivante da ATM / Eminectomy for treatment of recurrent TMJ dislocation

Introdução: A luxação da articulação temporomandibular ocorre quando a cabeça da mandíbula se movimenta para fora da fossa articular, fazendo com que a superfície posterior da cabeça da mandíbula fique à frente da eminência articular. Quando ocorrem episódios frequentes, essa condição é referida como luxação recidivante. Embora existam diferentes tratamentos, a eminectomia apresenta-se como uma opção cirúrgica com resultados satisfatórios e prognóstico favorável. Relato de caso: Este trabalho relata o caso de uma paciente com quadro severo de luxações recidivantes associadas à distonia muscular, tratada cirurgicamente por eminectomia. A paciente apresenta acompanhamento de 36 meses, estável, sem sintomatologia ou novos episódios de luxação. A abordagem multidisciplinar apresenta um alto índice de sucesso, e procedimentos cirúrgicos devem ser considerados quando procedimentos clínicos falham. Considerações finais: A eminectomia mostra bons resultados no tratamento da luxação recidivante de ATM, com chances mínimas de recidiva ou danos articulares. Após a cirurgia, os pacientes mostram uma boa função articular... (AU)

Introduction: Dislocation of the temporomandibular joint occurs when the jaw head moves out of the joint fossa causing the posterior surface of the jaw head to be ahead of the joint eminence. When they occur in frequent episodes, this condition is referred like relapsing dislocation. Although there are different treatments, eminectomy presents as a surgical option with satisfactory results and favorable prognosis. Case report: This paper reports the case of a patient with severe recurrent dislocations associated with muscular dystonia, treated through surgical treatment of eminectomy associated with a clinical treatment protocol. The patient has a 36-month followup, stable, without symptoms or new episodes of dislocation. The multidisciplinary approach has a high success rate and surgical procedures should be considered when clinical procedures fail. Final considerations: Eminectomy shows good results in the treatment of recurrent TMJ dislocation, with minimal chances of recurrence or joint damage. After surgery, patients show good joint function... (AU)

Desenvolvimento de caminhar espinal em cães paraplégicos com fraturas e luxações vertebrais toracolombares / Development of spinal walking in paraplegic dogs with thoracolumbar spinal fractures/luxations

Fraturas e luxações vertebrais (FLV) toracolombares estão dentre as afecções neurológicas mais frequentes na neurologia veterinária. São um dos distúrbios mais graves e desafiadores, devido ao elevado risco de paralisia permanente, levando muitos animais a serem submetidos à eutanásia, devido ao prognóstico desfavorável nos animais que perderam a nocicepção. Objetivou-se descrever as bases neurofisiológicas responsáveis pelo desenvolvimento do caminhar espinal e analisar, em 37 cães acometidos por FLV toracolombares, os dados referentes à taxa de recuperação dos animais com e sem nocicepção. Naqueles sem nocicepção, analisou-se ainda a frequência dos animais que desenvolveram caminhar espinal e o período médio para seu aparecimento. Em relação ao grau da lesão a as taxas de recuperação, 14/37 animais (37,8%) possuíam nocicepção, no qual a taxa de recuperação da deambulação voluntaria e das funções viscerais foi de 100%. Enquanto que 23/37 animais (62,1%) perderam a nocicepção, no qual nenhum recuperou a deambulação voluntária, ocorrendo morte por causas diversas em sete destes. Dos 16 animais sem nocicepção sobreviventes e que foram submetidos ao tratamento conservativo ou cirúrgico, cinco (31,25%) readquiriram a capacidade de caminhar (tempo médio de 115 dias) sem recuperar a nocicepção, sendo esta deambulação involuntária atribuída ao caminhar espinal. De acordo com os resultados desta pesquisa, o parâmetro isolado da perda da nocicepção não deve desencorajar a realização da terapia, pois em cães paraplégicos com FLV toracolombares, há possibilidade de ocorrer desenvolvimento de deambulação involuntária.(AU)

Thoracolumbar vertebral fractures and luxations (VFL) are one of the most common neurological disorders in veterinary neurology and one of the most serious and challenging disorders due to the high risk of permanent paralysis, leading many dogs to be euthanized without treatment due to the reports of unfavorable prognosis about ambulation in animals that lost nociception. This study aimed to describe the neurophysiologic bases responsible for the development of the spinal walking and examine in 37 dogs affected with thoracolumbar VFL, data relating to the recovery rate of animals with and without nociceptionIn those without nociception was analyzed the frequency of the spinal walking animals that developed for its appearance, and the average period was established. Regarding the degree of injury to recovery rates, 14/37 dogs (37.8%) had nociception, in which the rate of recovery of voluntary ambulation was 100%. While 23/37 dogs (62.1%) lost the nociception, where no voluntary ambulation was regained ambulation, occurred death from various causes in seven of these. From 16 dogs without nociception and survivors who underwent conservative or surgical treatment, five (31.25%) regained the ability to walk without regaining nociception; this was attributed to spinal walking, where the average time for their development was 115 days. According to the results of this study, the single parameter of loss of the nociception should not discourage the therapy, as paraplegic dogs with thoracolumbar VFL can develop involuntary ambulation.(AU)

Tratamiento del codo de niñera en el primer nivel de atención de salud / Treatment of the nursemaid'elbow at the primary health care

El codo de niñera es una entidad de consulta frecuente en el primer nivel de atención que cubre población pediátrica, por lo tanto, es fundamental para los médicos, así como para el resto del personal de salud, conocer los conceptos actuales sobre el mecanismo de trauma y patología, para poder reconocer apropiadamente, mediante un buen diagnóstico basado en historia clínica, presentación clínica y examen físico, la presencia de una lesión de subluxación de la cabeza del radio por deslizamiento del ligamento anular, para aplicar de forma oportuna las técnicas adecuadas de reducción y valorar la evolución, evitando el uso de radiografías para no exponer innecesariamente a radiación a este tipo de pacientes.

The nursemaid's elbow is a frequent reason for consultation in the primary health care dealing with the pediatric population. It is then fundamental for the physicians and the rest of the health staff to learn about the present concepts on the mechanism of trauma and pathology in order to properly identify it through good diagnosis based on the medical history, the clinical presentation and the physical exam and presence of subluxation of the radial head due to annular ligament displacement, to timely apply the adequate reduction techniques and to assess the progress, avoiding the use of X-rays that unnecessarily exposes this type of patients to radiations.

Prevalencia de traumatismos dentoalveolares en pacientes infantiles del complejo asistencial Dr. Sótero del Río / Prevalence of dental trauma of infants attended at Dr. Sótero del Río Hospital

En el presente estudio descriptivo de incidencia, 604 niños menores de 15 años fueron examinados y atendidos en la Clínica de Odontopediatría del Complejo Asistencial Dr. Sotero del Río, con diagnóstico de Traumatismo Dentoalveolar (TDA), desde Enero a Diciembre del 2010. El propósito de este estudio fue caracterizar los TDA de acuerdo a la clasificación de Andreasen y Andreasen, determinar su frecuencia y distribución estacional, tipo y número de dientes afectados, distribución de género y edad, lugar de ocurrencia y causa. Para ambas denticiones, en conjunto, más de dos dientes comprometidos presentaron una frecuencia de 58.77 por ciento. Los análisis se dividieron por dentición y hubo 636 dientes definitivos y 414 temporales. En dentición definitiva se observó una mayor frecuencia en Mayo (15.36 por ciento), Abril (13.02 por ciento) y Noviembre (13.02 por ciento). Las fracturas coronarias no complicadas son las más frecuentes (40.88 por ciento) y los dientes más afectados fueron los incisivos centrales maxilares (77.66 por ciento). Los niños sufren más TDA que las niñas (64.97 por ciento). La mayor frecuencia de TDA para ambos géneros es a los 8 años. La principal causa fue caídas en el colegio (46.87 por ciento). En dentición temporal se observó mayor cantidad de casos en primavera-verano (53.74 por ciento). Siendo más frecuente en los meses Noviembre y Febrero (30.84 por ciento). Subluxación fue el diagnostico más frecuentes con un 39.61 por ciento. Los dientes más afectados fueron los incisivos centrales maxilares en un 82.13 por ciento. El género masculino fue el más afectado (62.56 por ciento). La edad en que se observó mayor frecuencia de TDA fueron los 2 años. La principal causa fue caídas en la casa (29.07 por ciento).

In this incidence descriptive study 604 infants less than fifteen years of age were examined and attended at the Pedodontic Clinic from Dr. Sótero del Río hospital with a diagnostic of dental trauma between January and December 2010. The purpose of this research protocol was to characterize dental trauma according to the Andreasen and Andreasen classification, and also to determine their frequency, seasonal distribution, type and number of the affected teeth, place of occurrence and trauma´s cause. All diagnostics were divided by dentition, 636 were from permanent and 414 from deciduous dentition. For both dentitions trauma in two teeth and more were in a frequency of 58.77 percent. On permanent dentition a mayor frequency of trauma was observed in May (15.36 percent), April (13.02 percent) and November (13.02 percent). The most frequent trauma was uncomplicated crown fracture (40.88 percent) and the most frequent teeth affected were the upper central incisors (77.66 percent). Boys suffered more trauma than girls (64.97 percent). The highest frequencies of trauma for both genders occurred at eight years of age. The main causes of traumas were: falls at school (46.87 percent). On deciduous dentition a mayor frequency of trauma was observed in spring and summer (53.74 percent) where November and February concentrated the highest rates (30.84 percent). Sub-luxation was the most frequent diagnostic at 39.61 percent. The most frequent teeth affected were also the upper central incisors at 82.13 percent. Boys also suffered more trauma than girls (62.56 percent). The highest frequencies of trauma for both genders occurred at two years of age. The main cause was home falls (29.07 percent).