The Hyrax appliance with tooth anchorage variations in surgically assisted rapid maxillary expansion: a finite element analysis.

PURPOSE: It is known that a correct transverse maxillary dimension is a key factor for a stable occlusion, which brings functional and esthetic benefits for the patient. In patients presenting maxillary atresia and the completion of bone growth, a highly recommended option for correction is the surgically assisted rapid maxillary expansion (SARME) associated with the Hyrax appliance. The objective of this study was to evaluate the influence of tooth anchorage variations of the Hyrax appliance in SARME through finite element analysis, evaluating which anchorage option might be associated with more effective orthopedic results with less undesired side effects. METHODS: Five different dental anchoring conditions for the Hyrax appliance were simulated through FE analysis applying premolars and molars as anchorage, having the same force applied by the activation of the Hyrax screw (0.5 mm) in all groups. The maxillary displacement results (axes X, Y, and Z) and generated stresses for both teeth and maxillary bone were calculated and represented using a color scale. RESULTS: All groups presented significant bone displacement and stress concentration on anchoring teeth, with the group presenting anchorage in the 1st and 2nd molars showing the greatest maxillary horizontal displacement (axis X) and suggesting the lowest tendency of dental vestibular inclination. CONCLUSIONS: Variations in dental anchorage might substantially affect the maxillary bone and teeth displacement outcome. The protocol for the Hyrax apparatus in SARME applying the 1st and 2nd molars as anchorage might generate less tilting and inclination of the anchoring teeth.

Avaliação retrospectiva de pacientes submetidos à lipoplastia facial: uma nova abordagem cirúrgica e análise subjetiva da satisfação do paciente / Retrospective evaluation of patients submitted to facial lipoplasty: a new surgical approach and subjective analysis of patient satisfaction

Introdução: Atualmente, a lipoplastia facial tem sido muito estudada, e isso se justifica em decorrência dos resultados estéticos, dentre eles a valorização da projeção do osso zigomático. Poucas técnicas cirúrgicas foram descritas, principalmente em relação ao resultado de satisfação e do acesso que é realizado para a remoção da bola de Bichat. Este estudo tem como objetivo realizar uma análise de banco de dados para avaliar a satisfação do procedimento de bichectomia pelos próprios pacientes, além de descrever uma abordagem cirúrgica distinta da encontrada na literatura. Metodologia: Foram selecionados 47 pacientes para o procedimento, sendo este realizado em nível ambulatorial, seguindo a mesma técnica cirúrgica em todos os pacientes, os quais foram acompanhados por 7, 14, 30 e 60 dias de pós-operatório, verificando-se o processo de cicatrização e dados referentes à satisfação em todas as consultas realizadas. Resultados: Mediante a técnica empregada, houve um bom número inicial de pacientes satisfeitos com a cirurgia, que aumentou gradativamente conforme o acompanhamento. Conclusões: Assim, confirma-se que a bichectomia é um procedimento seguro, com poucas complicações, devendo haver uma maior amplitude nas pesquisas que visem avaliar o grau de satisfação dos pacientes para atender melhor as suas expectativas... (AU)

Introduction: Facial lipoplasty has been widely studied today because of the aesthetic results provided, such as the enhancement of the ossozygomatic projection. Few surgical techniques have been described, mainly in regard to the satisfaction result and the access that is made for the removal of the bichat ball. The objective of the present study is to perform a database analysis to evaluate satisfaction of the bichectomy procedure by the patients themselves, in addition to describing a surgical approach distinct from that found in the literature. Methodology: 47 patients were selected for the procedure, and the procedure was performed on an outpatient basis, following the same surgical technique in all patients, which were followed for 7, 14, 30 and 60 postoperative days, and the healing process was verified and satisfaction data in all consultations. Results: As a result, it can be observed that by the technique employed, there was a good initial number of patients satisfied with the surgery, which increased gradually as the follow-up in the more returns. Conclusions: Thus, it is confirmed that bichectomy is a safe procedure, with few complications, and more research should be done to evaluate the degree of patient satisfaction to meet their expectations... (AU)

Temporal Muscle Flap as a Treatment of an Extensive Cleft Palate in an Adult Patient.

For the management of cleft palate, the surgical approach has been suggested at an early stage even in childhood, varying in the number of interventions. Once the interventions are not performed at appropriate times, such as sequences that may accompany specific psychological, functional, and aesthetic effects. Since it has been indicated, temporal muscle flap is a technique with satisfactory results for a resolution of extensive clef palate in adult patients. The purpose of this paper is reporting a case of temporal muscle flap in the soft and hard palate of an adult with a reconstruction of the donor area with a titanium mesh. A 37 year old male patient with cleft lip/palate, complained of difficulty in speech, chewing, swallowing, and breathing. Clinically, it was observed oroantral communication in the region of the hard and soft palate, with a previous cheiloplasty. A temporal rotation was planned to close the fissure for the treatment. The modified coronal approach was used. Temporal muscle traction and its interposition in the palate region were performed through the tunneling technique, and mass suturing was performed. After 3 years, he presented satisfactory results, with the improvement of the quality of life, as well as the area of exposure. In conclusion, since it has been indicated, temporal muscle flap is a technique with satisfactory results for a resolution of extensive cleft palate in adult patients.

The Role of Computed Tomography in Zygomatic Bone Fracture - A Case Report.

INTRODUCTION: The zygomatic complex is integral to the facial contour, protection of the eye and other facial structures, and dental occlusion. Its importance in facial function and aesthetics requires high quality outcomes of the treatment. CASE PRESENTATION: This paper reports the case of a 46-year-old man who had an occupational accident resulting in extensive facial trauma and zygomatic fractures. The patient presented with hyposphagma, palpable step in the area of the infraorbital rim, paresthesia of the right infraorbital nerve, flattening of zygomatic prominence, abrasion of the chin and nose, a 7-cm laceration in the midface region, ecchymosis in the palate, and alteration in the dental occlusion without limitation of mouth opening. Computed tomography (CT) confirmed the zygomatic complex fractures. The treatment was reduction and fixation with plates and screws. CT was used throughout the treatment period as an essential diagnostic tool for accurate fracture assessment and classification, formulation of the surgical plan, and postoperative evaluation. CONCLUSION: This case study illustrated the correct use of CT for improved and efficient treatment of traumatic injury of the zygoma, an anatomical area where restoration of function and aesthetics is challenging. The patient signed a written informed consent statement for publication.

Estudo comparativo do tratamento de fraturas de ângulo mandibular: análise retrospectiva de sete anos / Comparative study of mandibular angle fractures treatment: a seven years retrospective analysys

Introdução: Fraturas mandibulares apresentam alta incidência após traumas do complexo maxilomandibular, sendo a região goníaca uma das mais afetadas. Devido à biomecânica complexa da região, altos índices de complicações pós-operatórias estão relacionados às fraturas do ângulo mandibular. Objetivos: Avaliar o tratamento das fraturas de ângulo mandibular e comparar as taxas de complicações de duas técnicas diferentes de osteossíntese. Métodos: Análise retrospectiva de prontuários dos pacientes diagnosticados com fraturas de ângulo mandibular, atendidos no período de junho de 2007 a junho de 2014. Os pacientes foram divididos em grupo I (uma miniplaca) e grupo II (duas miniplacas). Informações sobre a etiologia do trauma, características da fratura, tratamento e complicações foram colhidas e analisadas por meio de frequência absoluta e relativa. Resultados: Foram incluídos 50 pacientes com 53 fraturas de ângulo mandibular. O tempo médio decorrido entre o trauma e o procedimento cirúrgico foi de 9,59 dias, e 29 pacientes apresentavam dentes associados às fraturas. O índice geral de insucesso foi de 28,31%, e as complicações mais prevalentes foram os distúrbios infecciosos e mobilidade interfragmentária. Conclusões: Não houve diferença no índice de complicações entre os grupos analisados, e essas taxas concordam com o descrito na literatura... (AU)

Introduction: Mandibular fractures are highly incidence in the maxillomandibular trauma, and the goniac region is one of the most affected. Due to complex biomechanics, high rates of postoperative complications are related to fractures of the mandibular angle. Objectives: To evaluate the treatment of mandibular angle fractures and compare the complication rates of two different techniques of osteosynthesis. Methods: Retrospective analysis of medical records of patients diagnosed with mandibular angle fractures from June 2007 to June 2014. The patients were divided into group I (one plate) and group II (two plates). Information on the etiology of trauma, fracture settings, treatment and complications were analyzed using absolute and relative frequency. Results: 50 patients with 53 mandibular angle fractures were included. The average time elapsed between trauma and surgery was 9.59 days and 29 patients had teeth associated with fractures.. The general failure rate was 28.31%, and the most prevalent complications were infectious disorders and interfragmentary mobility. Conclusions: There was no difference in the complication rate between the groups analyzed and these rates agree with that described in the literature... (AU)

Primary Repair of a Complex Panfacial Fracture by Dog Bite.

Facial fractures due to dog attacks have an unknown incidence rate. To date, only 41 cases of canine bite trauma in a pediatric patient, associated with facial fracture, have been reported in the literature. As major species of involving dogs are the American pitbull terrier and rottweiler. Due to the intense kinematics of this trauma, the treatment becomes complex. Thus, attention to the primary repair of such complex lesions ensures satisfactory results, which is the focus of this discussion. The purpose of this review was to analyze how different ways to approach this type of trauma in children for clarification or correct management. In addition, we address the treatment plan of a complex case of panfacial fracture by a canine bite in a 4-year-old patient. According to a review addressed, the main involved are orbit, nasal, and zygomatic. Antibiotic therapy is indicated for infected bite wounds and wounded considerations at risk of infection, with high complexity and when involving important structures such as bones, vessels, and joints. The state of tetanus immunization and the risk of rabies infection should be routinely addressed in the management of the bite wound.

Does lag screw fixation of condylar fractures result in adequate stability? A finite element analysis.

The great incidence and controversies related to the diagnosis, treatment, surgical accesses, and type of osteosynthesis materials confer an outstanding role to condylar fractures among facial fractures. Plate configurations, with diverse formats and sizes, may be used to surgically resolve condylar fractures. With the purpose of improving the advantages and minimizing the disadvantages of fixation techniques, the neck screw was developed aiming at the needed stabilization to render a correct fixation through a system of dynamic compression. This is achieved by increasing the contact between the fractured bone stumps, as well as assisting at the time of fracture reduction. The present paper aims at comparing the fixation and stability of mandibular condylar fractures using the neck screw and an overlaid "L"-shaped-4-hole-2 mm plate on the one hand, with a system in which the neck screw and the "L"-shaped plate form a single structure, having been joined by a welded point, on the other hand. The results with the neck screw are satisfactory, and, thus, it is an alternative for the reduction and fixation of fractures of the mandibular condyle, whether or not a plate is joined to the structure, provided it is correctly prescribed and with adequate surgical sequence and technique.

Giant Peripheral Temporomandibular Osteoma With Immediate Reconstruction of Mandible.

Osteoma is a benign osteogenic tumor, which is characterized the slow-growing proliferation of compact or cancellous bone. The etiology of the lesion is not well established. Among the hypotheses, the following are related: a traumatic factor, infectious processes, or true neoplasm due to the origin of cartilaginous cells. It can present at any age, usually in young adult individuals, with equal prevalence in both sexes. The clinical characteristics of the peripheral osteoma are represented by slow asymptomatic growth, which leads to swelling and, thus, facial asymmetry. When it is related to the mandibular condyle, this growth can cause functional impairment, such as malocclusion, temporomandibular joint dysfunction, and even limited mouth-opening owing to ankylosis.

Mandibular osteonecrosis induced by bisphosphonates in a carrier of chronicle kidney disease / Osteonecrosis mandibular inducida por bifosfonatosen un portador de enfermedad renal crónica

he bisphosphonates are synthetic substances of inorganic pyrophosphate that havebeen the basis of treatment of patients with osteolytic diseases, such as multiple myeloma, malignanthypercalcemia, Paget's disease, or patients with bone metastases. Its main pharmacological effect is inhibitionof bone resorption caused by osteoclasts, which have a reduced function. Their adverse effects are infrequentbut include pyrexia, impaired renal function, hypocalcemia, and more recently, maxillo-mandibular ostenecroseinduced bofosfonatos. In this report we describe a clinical case of jaw osteonecrosis induced by bisphosphonatesin patient with chronic kidney disease and the treatment protocol performed

Los bisfosfonatos son sustancias sintéticas de pirofosfato inorgánico que han sido la base del tratamiento de pacientes con enfermedades osteolíticas, como mieloma múltiple, hipercalcemia maligna, enfermedad de Paget o pacientes con metástasis ósea. Su principal efecto farmacológico es la inhibición dela resorción ósea causada por osteoclastos, que tienen una función reducida. Sus efectos adversos son infrecuentes, pero incluyen pirexia, deterioro de la función renal, hipocalcemia y, más recientemente, indujo inducido por bicosfonatos maxilomandibular. En este informe se describe un caso clínico de osteonecrosis mandibular inducida por bifosfonatos en pacientes con enfermedad renal crónica y el protocolo de trata-miento realizado.

Assessment of the Postoperative Stability of Mandibular Orthognathic Surgery for Correction of Class III Skeletal Malocclusion.

To assess the stability of mandible position after orthognathic surgery for correction of class III skeletal malocclusion. Twenty adult males, aged 18 to 40 years, with Angle class III skeletal malocclusion underwent preoperative orthodontic treatment for elimination of dental compensations followed by combined maxillomandibular surgery with rigid internal fixation. Lateral cephalograms from each patient, obtained in the natural head position before surgery, immediately after surgery, and at 6-month follow-up, were retrieved from the files of the Pontifical Catholic University of Rio Grande do Sul outpatient Oral and Maxillofacial Surgery clinic and compared. Comparison of craniometric landmark measurements showed that the precision of mandibular setback was compromised in the horizontal plane, with a mean mandibular relapse of 37.75% at point B and 45.85% at point Pg. Improved intercuspation and adaptation of the musculature to the new position of the jaws after orthognathic surgery lead to counterclockwise rotation of the mandible, ultimately displacing the mandible more anteriorly than desired.

Comparison of Neck Screw and Conventional Fixation Techniques in Mandibular Condyle Fractures Using 3-Dimensional Finite Element Analysis.

PURPOSE: To compare the mechanical stress on the mandibular condyle after the reduction and fixation of mandibular condylar fractures using the neck screw and 2 other conventional techniques according to 3-dimensional finite element analysis. MATERIALS AND METHODS: A 3-dimensional finite element model of a mandible was created and graphically simulated on a computer screen. The model was fixed with 3 different techniques: a 2.0-mm plate with 4 screws, 2 plates (1 1.5-mm plate and 1 2.0-mm plate) with 4 screws, and a neck screw. Loads were applied that simulated muscular action, with restrictions of the upper movements of the mandible, differentiation of the cortical and medullary bone, and the virtual "folds" of the plates and screws so that they could adjust to the condylar surface. Afterward, the data were exported for graphic visualization of the results and quantitative analysis was performed. RESULTS: The 2-plate technique exhibited better stability in regard to displacement of fractures, deformity of the synthesis materials, and minimum and maximum tension values. The results with the neck screw were satisfactory and were similar to those found when a miniplate was used. CONCLUSION: Although the study shows that 2 isolated plates yielded better results compared with the other groups using other fixation systems and methods, the neck screw could be an option for condylar fracture reduction.

Modified submandibular access for open reduction and internal rigid fixation in condylar fractures.

PURPOSE: The purpose of the present study was to describe a surgical technique for treatment of condylar fractures through the modified submandibular access, by means of a small incision in the mandibular angle that promotes a dissection between the parotideomasseteric and the transmasseteric fascia in a quick way and with low morbidity. Fixation may be made with plates and screws according to the technique prescribed by the surgeon. METHODS: Owing to the high incidence and importance of condylar fractures, various therapeutic methods have been described and may be divided into conservative and surgical methods. Various open surgical techniques are recommended in the treatment of mandibular condylar fractures, and the methods of internal rigid fixation and surgical accesses vary. The techniques that offer an adequate treatment of these fractures with shorter surgical time very often remain matters of controversy among surgeons. The procedure must guarantee maximum safety for the facial nerve and must provide a good cosmetic outcome, besides providing a suitable surgical field. RESULTS: A modified submandibular access is a safe and reproducible procedure providing excellent functional results. This procedure has been routinely performed in our department.

Reduction and fixation of mandibular condylar fractures with neck screw.

PURPOSE: The purpose of the present study is to describe a surgical technique for the treatment of condylar fractures using an intramedullary screw. MATERIALS AND METHODS: The treatment of these fractures remains very controversial. At the time of the choice of the surgical treatment, a wide range of accesses and of techniques of reduction and fixation is used, depending on the type of the fracture, the experience of the surgeon, and aesthetical issues. Among the difficulties posed by this type of fracture is the correct repositioning of the fractured condylar portion for which we have developed a technique that uses a neck screw, with intramedullary insertion. Because this is a round-headed screw, it is necessary to install a plate, which may be straight or "L" shape, and is placed perpendicular and superjacent to the screw so that it does not allow the rotation of the condylar portion. RESULTS: Neck screw can be used, resulting in satisfactory stability, for the reduction and fixation of these fractures.

Tratamento Cirúrgico de fratura de seio frontal / Surgical Treatment of Frontal Sinus Fracture

O Seio Frontal está localizado no osso Frontal, em uma região muito importante da face. É uma cavidade óssea pneumática, que tem forma triangular, com a maior porção no assoalho da órbita. Cerca de 4% da população não apresenta o Seio Frontal. As fraturas do Seio Frontal são originadas a partir de acidentes de grande intensidade, como os causados por acidentes com veículos automotores ou agressões importantes e normalmente estão associadas às fraturas de terço médio da face, principalmete as do complexo Naso-orbito-Etmoidal e as do complexo Zigomático. Esse tipo de fratura representa de 5 a 15% de todas as fraturas da face, podendo causar transtornos funcionais e estéticos muito importantes ao paciente, com alguns sinais e sintomas característicos. Exames complementares são fundamentais para o correto diagnóstico e planejamento cirúrgico. Vários tratamentos têm sido propostos, de acordo com a classificação das fraturas. Dentre os acessos mais utilizados, estão o acesso coronal, acesso transcutâneo e endoscopia. Todos têm excelentes resultados, quando bem indicados, devendo-se respeitar a técnica cirúrgica adequada, a expectativa e o grau de cooperação do paciente, a possibilidade de acompanhamento pós-operatório para proservação e conclusão do caso clínico de maneira satisfatória.

The frontal sinus is located in the frontal bone in an important region of the face. It is a pneumatic triangular-shaped bone cavity, the largest portion of which is on the floor of the orbit. About 4% of the population do not have a frontal sinus. Frontal sinus fractures are caused by accidents of great intensity, such as those caused by cars or physical aggression and are usually associated with fractures of the midface, particularly the naso-orbit-ethmoid and zygomatic complex. This kind of fracture, which has a number of characteristic signs and symptoms, represents 5 to 15% of all facial fractures, and can cause the patient very severe aesthetic and functional disorders. Investigations are essential for an accurate diagnosis and surgical planning. Several treatments have been proposed, according to the classification of the fractures. The main approaches to this fracture are the coronal and transcutaneous and endoscopy. All have excellent results when well indicated, with due consideration for the correct surgical technique, the expectation of success, the degree of cooperation of the patient and the possibility of postoperative follow-up to preservation and conclusion of the clinical case satisfactorily.

Transplante dental - relato de um caso clínico / Dental transplantation - report of a clinical case

Introdução: Apesar de ter sido realizado por vários anos, sempre com o objetivo de salvar dentes considerados perdidos, os transplantes dentais na era modernativeram sua evolução. Para esse tratamento, observam-se alguns pré-requisitos importantes, como a preservação ou não do saco dentário, a importância da seleção do germe dental, a ausência de reação inflamatória no alvéolo receptor, além do grau de desenvolvimento do germe dental. Relato de caso: Paciente melanoderma,15 anos, do gênero feminino, com lesão de furca no elemento dental 36. Após análise de todos os critérios e indicações, realizou-se transplante autógeno do elemento dental 38 para o alvéolo do elemento dental 36. Conclusões: Os transplantes dentais, quando corretamente indicados, e quando respeitados os princípios de técnica cirúrgica, apresentam taxas elevadas de sucesso, evitando alterações de oclusão ao paciente.

Acadêmicos e profissionais da odontologia estão preparados para salvar vidas? / Are dentistry students and professionals prepared to save lives?

Introdução: O cirurgião-dentista enfrenta, no cotidiano de seu trabalho, o risco de se deparar com eventos emergenciais que envolvam a saúde geral. A emergência é definida como uma situação em que não pode haver uma protelação no atendimento, o qual deve ser imediato. Objetivos: Verificar se os profissionais e estudantes de odontologia estão preparados para numa eventualidade, diante de uma parada cardiorrespiratória, realizar com eficiência as manobras de ressuscitação cardiorrespiratória, evitando consequências indesejadas, que podem levar à morte do paciente. Métodos: Os dados foram obtidos mediante questionário elaborado para avaliar o nível de conhecimento sobre a sequência correta das manobras de ressuscitação cardiorrespiratória, aplicado aos alunos de graduação do segundo ao quinto ano e de pós-graduação da universidade. Foram distribuídos 142 questionários, juntamente com um termo de consentimento livre e esclarecido. Resultados: Constatou-se que apenas 15% dos entrevistados emitiram respostas consideradas corretas e houve 85% de respostas erradas. Conclusões: O cirurgião-dentista deve estar preparado para uma situação de emergência, evitando consequências indesejadas, tal como a morte do paciente. O índice de acertos foi muito baixo. As técnicas de ressuscitação cardiorrespiratória devem ser revisadas continuadamente, num período inferior a um ano, pois a maior parte dos alunos de todos os grupos pesquisados não assimilou de forma correta a técnica ou a esqueceu em razão da falta de treinamento prático ou da baixa incidência dessa emergência.