Mandibular reconstruction with TMJ prosthesis: management of osteomyelitis after orthognathic surgery (Case Report).

This case report presents a mandible reconstruction with temporomandibular joint (TMJ) prothesis for treatment of osteomyelitis infection following a bimaxillary orthognathic and genioplasty surgeries. The patient, a 41-year-old female, presented with facial pain, difficulty in opening her mouth, and mandibular deviation four months after the initial orthognathic surgery. During the four months, the patient had experienced two more surgerys post-operative for treatment of the complications. Examination revealed mobility between osteotomy segments of the right mandibular osteotomomie between body and ramus, and Computer Tomographic scan analysis revealed osteomyelitis and non-union within the osteotomy side of the right mandible from the previous surgery. Due to the advanced state of the disease and significant bone resorption, treatment was planned in two stages, involving bone debridement and then reconstruction with a custom made extended temporomandibular joint prosthesis. The patient had no postoperative complications and achieved satisfactory functional and aesthetic outcomes. This case emphasizes the importance of careful monitoring and prompt management of postoperative complications following orthognathic surgery to prevent rare but serious complications such as osteomyelitis.

Repeated adolescent pregnancy in Brazil from 2015 to 2019.

OBJECTIVE: The aim of this study was to assess the rate of repeated pregnancy in adolescence and its association with early marriage and education level. METHODS: This is a cross-sectional study conducted by searching the Live Births Data System. The study included all adolescents in the age group 10-19 years with live births from 2015 to 2019 (n=2,405,248), divided into three groups: G1: primiparas; G2: with 1 previous pregnancy; and G3: with two or more previous pregnancies. RESULTS: Total repeated pregnancies remained stable, along the years. In the age group 10-14 years, the decrease in the period was from 5.0 to 4.7%, whereas in the age group 15-19 years, it was from 27.8 to 27.3%. Being married or in a stable union increases by 96% the chance of repeated pregnancy in the age group 10-14 years (p<0.001; OR=1.96; 95% confidence interval [CI] 1.85-2.09). In the age group 15-19 years, the chance of repeated pregnancy among the married or in stable union increased 40% (p<0.001; OR=1.40; 95%CI 1.39-1.41)). Girls aged 10-14 years with an education level of<8 years had a 64% higher chance of repeated pregnancy (p<0.001; OR=1.64; 95%CI 1.53-1.75), and among those aged 15-19 years, there was a 137% higher chance of repeated pregnancy (p<0.001; OR=2.37; 95%CI 2.35-2.38). CONCLUSION: Repeated pregnancy in adolescence in Brazil remains very high over the years. There is an association between low education level and early marriage with repeated pregnancies in adolescence.

Repeated adolescent pregnancy in Brazil from 2015 to 2019

SUMMARY OBJECTIVE: The aim of this study was to assess the rate of repeated pregnancy in adolescence and its association with early marriage and education level. METHODS: This is a cross-sectional study conducted by searching the Live Births Data System. The study included all adolescents in the age group 10-19 years with live births from 2015 to 2019 (n=2,405,248), divided into three groups: G1: primiparas; G2: with 1 previous pregnancy; and G3: with two or more previous pregnancies. RESULTS: Total repeated pregnancies remained stable, along the years. In the age group 10-14 years, the decrease in the period was from 5.0 to 4.7%, whereas in the age group 15-19 years, it was from 27.8 to 27.3%. Being married or in a stable union increases by 96% the chance of repeated pregnancy in the age group 10-14 years (p<0.001; OR=1.96; 95% confidence interval [CI] 1.85-2.09). In the age group 15-19 years, the chance of repeated pregnancy among the married or in stable union increased 40% (p<0.001; OR=1.40; 95%CI 1.39-1.41)). Girls aged 10-14 years with an education level of<8 years had a 64% higher chance of repeated pregnancy (p<0.001; OR=1.64; 95%CI 1.53-1.75), and among those aged 15-19 years, there was a 137% higher chance of repeated pregnancy (p<0.001; OR=2.37; 95%CI 2.35-2.38). CONCLUSION: Repeated pregnancy in adolescence in Brazil remains very high over the years. There is an association between low education level and early marriage with repeated pregnancies in adolescence.

Potential Anticarcinogenic Effects From Plasma of Older Adults After Exercise Training: An Exploratory Study.

Aim: To evaluate the impact of exercise training plasma on in vitro prostate cancer cell viability and proliferation. Methods: PC3 prostate cancer cells were incubated with plasma obtained from young men with high and low physical fitness (PF) (high PF, n = 5; low PF, n = 5) and with the plasma collected from institutionalized older adults (n = 8) before and after multimodal exercise training. Cell viability and proliferation, mitochondria membrane polarization, reactive oxygen species (ROS) generation, and apoptosis were evaluated after the cell treatment with plasma. Systemic cytokines were evaluated in the plasma of institutionalized older adults submitted to an exercise training protocol. Results: Plasma from high-PF men lowers both cell viability and proliferation after the incubation time. PC3 cells also presented lower cell viability and diminished rates of cell proliferation after the incubation with post-training plasma samples of the older adults. The incubation of PC3 cells with post-training plasma of older adults depolarized the mitochondrial membrane potential and increased mitochondrial reactive oxygen species production. Post-training plasma did not change apoptosis or necrosis rates in the PC3 cell line. Multimodal exercise training increased the plasma levels of IL-2, IL-10, IFN-α, and FGF-1 and decreased TNF-α concentrations in institutionalized older adults. Conclusion: Adaptations in blood factors of institutionalized older adults may alter cell viability and proliferation by targeting mitochondrial ROS in a prostate cancer cell line.

Vertical transmission of HIV from 2007 to 2018 in a reference university hospital in Rio de Janeiro.

The aim of the study was to assess the factors associated with mother-to-child transmission (MTCT) of HIV. The study design is a retrospective cohort. The population consisted of 323 HIV-positive mothers and their newborns, attended at the Perinatal Nucleus/HUPE-UERJ, municipality of Rio de Janeiro, in the period of 2007-2018. The average age of mothers was 27 years (14-44), with 12.7% (41) of adolescents. The majority (66.8%) knew they were infected during pregnancy: 39.4% in the current pregnancy and 27.4% in a previous pregnancy. The incidence of MTCT was 2.7% in 2007-2009, 1% in 2010-2015 and 0 in 2016-2018. The viral load in the 3rd trimester of pregnancy was > 1.000 copies/mL or unknown in all mothers with positive newborns and in 19% (42/221) of mothers with negative newborns (p=0.003). The duration of antiretroviral use was > 4 weeks in 92.3% (264/286) of mothers with HIV-negative newborns and in 2 in the HIV-positive group (p=0.004). One of the 4 infected newborns and 2 of the negative ones did not use oral zidovudine (p=0.04). There was no association between amniorrhexis and MTCT (p=0.99), with the Apgar score in the 5th minute of life (p=0.96), with marital status (p=0.54), ethnicity (p=0.65), adolescence (p=0.42), mode of delivery (p=0.99), beginning of prenatal care (p=0.44) or with maternal comorbidities (p=0.48). The conclusion of the study points out that the main factors associated with MTCT are the elevated maternal viral load in the 3rd trimester, the time of use of ART and the non-administration of zidovudine for the newborns.

Bola de Bichat para tratamento de fístula buco-sinusal: relato de caso / Bichat ball for the treatment of buco-sinusal fistula: case report

Introdução: O seio maxilar possui íntima relação com os molares e, por esse motivo, após a extração desses elementos, pode ocorrer comunicação entre as cavidades bucais e sinusais. Quando o canal que possibilita a comunicação entre as cavidades é revestido por epitélio, chamamos de fístula buço-sinusal. O diagnóstico se dá por meio dos aspectos clínicos e radiográficos. O tratamento deve ser imediato, para que ocorra fechamento espontâneo. O objetivo deste trabalho é discutir um fechamento de Fístula Buco-Sinusal com tratamento expectante do seio maxilar e manejo cirúrgico associado à sinusite. Relato de caso: Homem, 33 anos, compareceu à FOP-UPE relatando incômodo ao ingerir alimentos e história de exodontia traumática do elemento 17 há 1 ano. Ao exame intra-oral, observou-se a presença da fístula na região da exodontia e, ao exame tomográfico, foi observada radiopacidade em seio maxilar, sugerindo fenestração óssea e sinusite, respectivamente. Iniciou-se antibioticoterapia e descongestionante nasal para sinusite e posterior cirurgia de fechamento da fístula buco-sinusal com uso da bola de Bichat. O manejo adequado é essencial no sucesso terapêutico da fístula. Além disso, a avaliação clínica e a radiográfica auxiliam na sua prevenção. Considerações Finais: Nosso caso concordou com a literatura, demonstrando que o uso da bola de Bichat é um método simples, conveniente e confiável para a reconstrução de defeitos intraorais de pequeno a médio porte... (AU)

Introduction: The maxillary sinus has a relation with the molars, for this reason, after extraction of these teeth can occur communication between buccal and sinus cavities. When the channel that allows the communication between the cavities is coated epithelium, we diagnose oroantral fistula. The diagnosis is made through clinical and radiographic aspects. Treatment should be immediate so that spontaneous closure occurs. The objective of this study is to discuss a closure of Buco-Sinus Fistula with expectant treatment of the maxillary sinus and surgical management associated with sinusitis. Case report: Man, 33 years old, attended FOP-UPE reporting discomfort when eating food and history of traumatic exodontia of element 17, 1 year ago. The intra-oral examination revealed the presence of the fistula in the region of the exodontia and at the tomographic examination radiopacity was observed in the maxillary sinus, suggesting bone fenestration and sinusitis, respectively. Antibiotic therapy and nasal decongestant for sinusitis and subsequent closure of the bucosinus fistula with Buccal Fat were started. Adequate management is essential for the therapeutic success of the fistula. In addition, clinical and radiographic evaluation helps to prevent. Final considerations: Our case corroborates the literature, showing that the use of the bichat ball is a simple, convenient and reliable method for the reconstruction of small to medium sized intraoral defects... (AU)

Cisto residual ectópico em associação a corpo estranho: relato de caso / Ectopic residual cyst in association a foreign body: case report

Introdução: O cisto residual é uma lesão de origem inflamatória, associada a uma falta de curetagem adequada do alvéolo de um dente que mostrou lesão inflamatória periapical. Quando não existe fonte de estímulo, tende a regredir, acometendo, frequentemente, o sexo masculino de idade média avançada e com um ou mais dentes extraídos. Relato de caso: Este trabalho tem como intuito apresentar um relato de caso de um paciente do sexo masculino com 69 anos de idade que procurou a Clínica Escola de Odontologia do Centro Universitário CESMAC, com uma fístula de drenos ativos na região anterior de maxila, sem abaulamento ou crescimento dos tecidos circundantes. Ao exame clínico intrabucal, foi observado ausência de todos os dentes superiores, com fístula e drenagem ativa, sem abaulamento das corticais. O exame radiográfico panorâmico mostrou presença de lesão radiolúcida, unilocular, circunscrita por halo radiopaco semelhante a cisto residual. A biópsia excisional foi conduzida com remoção da raiz residual, além de corpos estranhos introduzidos pelo paciente. Considerações Finais: Diante do exposto, deve-se dar importância ao assunto para alertar o cirurgião-dentista quanto ao correto diagnóstico diferencial das lesões ósseas com associação clínica, radiográfica e histopatológica, possibilitando o tratamento adequado e evitando a permanência e crescimento da lesão... (AU)

Introduction: The residual cyst is a lesion of inflammatory origin associated with a lack of adequate curettage of the alveolus of a tooth that showed periapical inflammatory lesion. When there is no source of stimulation, it tends to regress. It frequently affects males from middle to advanced age and with one or more extracted teeth. Case report: This case report a male patient, 69 year old who sought out the Clinical School of Dentistry of the Centro Universitário CESMAC, with a fistula of active drains in the anterior region of the maxilla, without bulging or growth of the surrounding tissues. Intraoral buccal examination showed absence of all upper teeth, with fistula and active drainage without cortical bulging. Panoramic radiographic examination showed the presence of a radiolucent, unilocular lesion, circumscribed by radiopaque halo as a cystic residue. Excisional biopsy was performed with residual root removal in addition to the wooden barb introduced by the patient. Final considerations: In view of the above, it was developed as a reference for the dental surgeon's warning regarding the differential diagnosis of the lesions with the clinical, radiographic and histopathological association, allowing adequate treatment and remaining and lesion growth... (AU)

Cervical-thoracic necrotizing fasciitis of odontogenic origin in a diabetic patient: a case report.

Necrotizing fasciitis (NF) is a severe bacterial infection with rapid and aggressive progression. The infection generally affects individuals with comorbid conditions that lead to immunologic and microvascular deficiencies. It is characterized by necrosis of tissues, mainly in the extremities, trunk, and perineum, and is rarely found in the head and neck. This case report describes the course of NF in a 55-year-old man, highlighting diagnosis, surgical treatment, drug therapy, and supportive measures. The patient, who had chronic alcoholism, systemic arterial hypertension, a smoking habit, and decompensated diabetes (glucose level of 490 mg/dL), was admitted to the hospital with a volume increase in the cervical and thoracic areas with a duration of about 7 days. He presented with fever, dyspnea, and inflammatory signs bilaterally in the submandibular, submental, and superior thoracic regions as well as severe trismus. The patient underwent a surgical procedure to drain the infectious process and to place drains. The patient developed cutaneous necrosis in the cervical and superior thoracic regions, diagnosed as NF. Surgical debridement of all affected tissue was performed. After resolution of the infection, the patient underwent skin grafting with a satisfactory outcome.

Florid Cemento-Osseous Dysplasia Simultaneous the Chronic Suppurative Osteomyelitis in Mandible.

INTRODUCTION: The florid cemento-osseous dysplasia is an uncommon condition nonneoplastic, of unknown cause with higher prevalence in melanodermic women, limited the maxillary bones, is characterized by the presence of dispersed and diffuse radiopaque calcifications, constituted of bone and dense cemento; however, when the bone is infected it induces the suppuration and formation of osseous sequestra, thus resulting in an osteomyelitis frame. CLINICAL REPORT: The patient was attended in a Dental Specialties Center in the state of Alagoas, Brazil, presenting on clinical examination edema and extra oral fistula with pus drainage in hemiface submandibular of the right side. Radiographically it was possible to observe area of sclerosis and osseous sequestra involving the right side region of the mandible body, and it increases zones of the bone density. In association with clinical data and complementary diagnosis examinations, the option of treatment adopted was the complete removal of the bone fragment, followed by adaptation and plate fixation and titanium screws to reduce the risk of mandibular fracture. OBJECTIVE: The aim of the present paper was to relate a clinical patient of florid cemento-osseous dysplasia simultaneous the chronic suppurative osteomyelitis, highlighting their clinical, radiographic, and histological characteristics, as well as their diagnosis and treatment.