Cirurgia ortognática: assimetria facial e a limitação do planejamento manual com articulador semi-ajustável Acon (ASA) - correção com planejamento virtual (3D) / Orthognathic surgery: facial asymmetry and the limitation of manual planning with the semi-adjustable Arcon (ASA) articulator ­ correction with virtual (3D) planning

Introdução: os casos de assimetria facial são considerados os de maior complexidade dentro do âmbito da cirurgia Buco-Maxilo-Facial, devido a alteração esquelético-morfológica nos três planos do espaço (Pitch, Yaw e Roll). Estes planos foram trazidos do posicionamento de uma aeronave no espaço para o mundo da cirurgia, mais especificamente ao planejamento virtual, para romper as limitações do planejamento manual e a plataforma de Erickson, usados durante décadas para correção não só de casos simples envolvendo movimentos puros dos ossos, como também assimetrias. Hoje é sabido que o planejamento manual ainda é usado, porém, vem caindo em desuso devido as suas limitações. A cirurgia virtual vem ganhando muito espaço e se superando a cada dia. Objetivo: relatar um caso de cirurgia ortognática em que a paciente era portadora de assimetria facial, planejada de forma manual (tradicional) e os erros encontrados após 04 anos, levando a uma re-operação baseada em planejamento virtual.

Introduction: the cases of facial asymmetry are considered the most complex within the scope of oral and maxillofacial surgery due to skeletal-morphological changes in the three planes of space (Pitch, Yaw and Roll). These plans were brought from the position of an aircraft in space to the world of surgery, specifically the virtual planning to break the limitations of manual planning and Erickson platform, used for decades to fix not only simple cases involving purê bone's movements as well as asymmetries. Today it is known that manual planning is still used, however, it has fallen into disuse because of its limitations. Virtual surgery is gaining a lot of space and surpassing every day. Objective: this article aims to report a case of orthognathic surgery in which the patient had facial asymmetry, planned manually (traditional) and the errors found after 04 years, leading to a virtual planning-based re-operation.

Fusão de imagem 3D do complexo craniomaxilofacial – ferramenta para simulação virtual do tratamento ortodôntico-ortognático / Fusion of 3D image of cranio-maxillofacial complex: tool for virtual simulation of orthodontic-orthognathic treatment

O objetivo deste estudo foi analisar, através de um relato de caso, a contribuição da técnica de fusão de imagem para o planejamento cirúrgico e a realização das goteiras prototipadas aplicadas à cirurgia ortognática. Paciente do gênero masculino, CML, 19 anos de idade, com Classe III esquelética e assimetria facial com subdesenvolvimento maxilar e deficiência vertical da maxila, teve o plano de tratamento estabelecido após moldagem intraoral. Os modelos foram enviados para a digitalização a laser 3D que contém duas câmeras e sistema de movimento tri-axial. A tomografia computadorizada cone beam CT, as imagens em 3D faciais e os modelos 3D digitais fundiram-se para fazer uma cirurgia virtual 3D, que simulou o tratamento proposto. A simulação cirúrgica 3D com fusão de imagem visa não somente aumentar a precisão da cirurgia em si e sua previsibilidade, mas também reduzir as complicações cirúrgicas.

The aim of this study was to examine, through a case report, the contribution of image fusion technique for the surgical planning and production of prototype trays applied to orthognathic surgery. A male patient, CML, 19 years old, with skeletal Class III and facial asymmetry by maxillary underdevelopment assisted by a vertical height of the maxilla. The treatment plan was established after intraoral molding. The models were sent to the digital scanning laser 3D that it contains 2 cameras and tri-axial movement system. The cone beam computed tomography, facial 3D images and digital 3D models were merged to make a virtual 3D surgery, which simulated the proposed treatment. The surgical simulation 3D with image fusion aims not only to increase the accuracy of the surgery itself and its predictability, but also to reduce surgical complications.

Risk factors for maxillofacial injuries in a Brazilian emergency hospital sample

BACKGROUND: Maxillofacial injuries occur in a significant number of trauma patients. Epidemiological assessments are essential to reaffirm patterns, identify new trends and develop clinical and research priorities for effective treatment and prevention of these injuries. OBJECTIVE: The aim of this study was to identify the epidemiological profile and risk factors associated with maxillofacial trauma treated at a referral emergency hospital for the Public Health System in the State Capital of Goiás, Brazil. MATERIAL AND METHODS: A cross-sectional study was designed including 530 patients with maxillofacial trauma, 76 percent male, with a mean age of 25.5±15.0 years. Data were collected between May 2003 and August 2004 over weekly shift-working periods. RESULTS: The main causes of trauma were traffic accidents (45.7 percent) and physical assaults (24.3 percent), and differences in etiological factors were identified according to gender (p<0.001). The distribution of patients according to age and etiology showed significant differences for traffic accidents (p<0.01), physical assaults (p<0.001), falls (p<0.001) and sport injuries (p<0.01). In the multinomial logistic regression analysis (R² = 0.233; p<0.05), age was associated with injury in traffic accidents and falls (p<0.01), sports-related accidents were associated with males (p<0.05), and alcohol consumption with assaults and traffic accidents (p<0.001). Facial soft tissue lesions were found in 98 percent of patients and facial fractures in 51 percent. CONCLUSIONS: The significant association of maxillofacial trauma with young males and alcohol consumption reinforces the need for educational strategies and the development of policies for the prevention and reduction of associated damage in this specific risk group.