Condylar resorption after orthognathic surgery: a systematic review / Reabsorción condilar después de cirugía ortognática: una revisión sistemática

The aim of this research was to evaluate the risk factors related to condylar resorption (CR) after orthognathic surgery. Was realized a systematic review with a search of the literature performed in the electronic databases PubMed, MedLine, Ovid, Cochrane Library for current evidence in the world literature as conducted, and relevant articles were selected in according to inclusion and exclusion criteria and the findings were compared. Eight papers, (follow-up 12 months to 69 months) were including. A sample of 2567 patient with mandible or bi maxillary surgery with an age range from 14 to 46 year old was observed. In 137 patients (5.3 percent) CR was observed , with a 97.6 percent (122) female. CR was related to 118 cases with mandibular deficiencies with high mandibular plane (advancement surgery). CR were present principally in bi maxillary surgery with a 103 cases (75.2 percent) and only two papers show any analysis to the relation with TMJ dysfunction. Current evidence in CR is poor but supports those female patients with mandibular deficiency and high mandibular plane angle submitted to bi maxillary surgery with change in occlusal plane (counterclockwise) are associated with condylar resorption after orthognathic surgery...

El objetivo de esta investigación fue evaluar los factores de riesgo asociados a reabsorción condilar (RC) posterior a cirugía ortognática. Fue realizada una revisión sistemática con una búsqueda de la literatura realizada en bases de dato electrónicos como PubMed, MedLine, Ovid, Cochrane Library buscando actual evidencia en la literatura mundial; artículos relevantes fueron seleccionados según los criterios de inclusión y exclusión, comparando sus resultados. Ocho artículos (tiempo de seguimiento de 12 a 69 meses) fueron incluidos. Se observó una muestra de 2567 pacientes con cirugía mandibular o bimaxilar con una edad de entre 14 y 46 años. En 137 pacientes (5,3 por ciento) se observó reabsorción condilar, siendo el 97,6 por ciento (122 casos) de sexo femenino. La RC fue observada n 118 casos de deficiencia mandibular con un plano mandibular alto (cirugía de avance mandibular). La RC estuvo presente principalmente en cirugías bimaxilares con 103 casos afectados (75,2 por ciento) y solo dos artículos evidenciaron análisis previo de disfunción de ATM. Actualmente la evidencia en RC es limitada pero fundamenta que mujeres con deficiencia mandibular y alto plano mandibular sometidas a cirugía bimaxilar con alteración del plano oclusal (giro horario) son asociadas a la reabsorción condilar después de la cirugía ortognática...

Influence of wrong determination of occlusal plane in maxillary advancement: a model surgery study

Aim: This study investigated whether an occlusal plane error of acquisition can influence on the treatment planning of maxillary advancement in double-jaw surgeries. Methods: Advancement of 8 and 4 mm were studied in different groups. For each group, 20 maxillary models were mounted by a 13-degree platform with superior articulator arm (control group) and other 20 models mounted with 7 degrees (study group). Intermediate splint was obtained by cast surgery performed in the control group. All the 40 maxillary models were remounted with this intermediate splint. Measurements in vertical and anteroposterior planes were accomplished pre- and postoperatively by digital caliper rule and Erickson’s platform. Results: Statistical analysis showed significant results in two planes. The alteration of occlusal plane from 13 degrees to 7 degrees modified the final result in vertical measurements: right molar from group of 4 mm advancement (p<0.0001) and left molar from two groups of advancement (p<0.0001); in anteroposterior measurements: maxillary incisor from 4 mm of advancement (p<0.005) and 8 mm of advancement (p<0.0001). Conclusions: Notwithstanding the importance of statistical findings, the result probably did not show clinical relevance in orthognathic surgery. Clinical studies addressing these concerns must be supplied in scientific literature.

Oral and maxillofacial surgery - Helmet and maxillofacial trauma: a 10-year retrospective study

Aim: The aim of the present study was to retrospectively evaluate the epidemiologic characteristicsof the prevalence, type and treatment modalities of maxillofacial trauma according to use ofhelmets by motorcyclists in traffic accidents. Methods: Data was collected from patients during a10-year period (1999-2009). Data recorded included demographic, etiology, diagnosis, type offracture, use of helmet, associated facial and general trauma, soft tissue lesions and treatmentmethods. Data analysis included a descriptive analysis, Chi-square test and Kruskal-Wallis test.Results: From 376 motorcycle crash victims, 260 had maxillofacial fractures with a male/femaleratio of 4:1 and a mean age of 26.1. Considering the helmet as a security device, 89 patients werenot wearing a helmet during the crash against 287 patients that were wearing it. One hundred andsixteen patients had soft tissue lesions, 80 of them wore a helmet at the moment of the crash and36 did not (p<0.05). The most frequently fractured facial bone was the zygoma (24%) followedby the mandible. Conclusions: Motorcycle accidents represented almost one third of all maxillofacialinjuries seen at this Oral and Maxillofacial Surgery Division, causing high morbidity. Educationalcampaigns, defensive driving and use of adequate helmets are necessary to decrease thenumber of facial injuries in such accidents.

Análise subjetiva de pacientes submetidos à cirurgia de enxerto ósseo autógeno de mento / Subjective analysis of patients submited to autogenous chin bone graft surgery

A técnica de realização de enxerto ósseo de mento tem sido muito utilizada em pacientes que não possuem altura ou espessura de rebordo alveolar. Esses pacientes têm as funções fisiológicas e a estética devolvidas através de enxerto, implante e adaptação de uma prótese. A pesquisa objetivou determi nar as sensações dos pacientes nos períodos pré, trans e pós-cirúrgico, e avaliar se os benefícios do enxerto superaram o desconforto durante a cirurgia, e se esses pacientes realizariam, novamente, o mesmo procedimento cirúrgico, caso fosse necessário. Segundo o relato dos pacientes, apesar da ocorrência de parestesia, dor pós-operatória e limitações nas atividades diárias, foi constatado que os pacientes compreenderam a importância dos procedimentos realizados, tiveram credibilidade na técnica e, conseqüentemente, aceitariam realizar novo procedimento cirúrgico, senecessário.