Effects of Water-Circulating Cooling Mask on Postoperative Outcomes in Orthognathic Surgery and Facial Trauma.

The purpose of this study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the efficacy of hilotherapy on postoperative pain, swelling, neurosensory impairment and patient satisfaction. The authors analyzed RCTs comparing the use of hilotherapy versus conventional cryotherapy or no cold treatment for orthognathic surgery and repair of facial trauma. The authors assessed the risk of bias and strength of evidence according to the Cochrane guidelines and GRADE rating system, respectively. Treatment effects were defined as weighted or standardized mean difference using the inverse variance method. Five RCTs were included. Postoperative pain and swelling in patients using hilotherapy were lower comparing to the control group in the postoperative day 2 (Pain: MD -1.75, CI 95% -2.69 to -0.81; Swelling: MD -21.16 mL, CI 95% -38.91 to -3.41) and in the final evaluation (Pain: MD -0.31, CI 95% -0.44 to -0.18; MD -4.45 mL, CI 95% -7.87 to -1.03). Patients reported higher satisfaction with hilotherapy, but no differences were found for neurosensory impairment. Current evidence suggests that hilotherapy is effective in reducing postoperative pain and swelling in orthognathic surgery and repair of facial fractures and may lead to improvements in patient satisfaction in the recovery phase.

Polineuropatia desmielinizante como manifestação inicial isolada de hanseníase: relato de caso / Demyelinating polyneuropathy as an isolated initial manifestation of leprosy: case report

RESUMO: Modelo do Estudo: Relato de caso. Importância do problema: No mundo, mais de três milhões de pessoas estão vivendo com deficiência física devido à hanseníase. O Brasil é o segundo país com o maior número de casos novos registrados.A magnitude e o alto risco de incapacidade mantêm a doença como problema de saúde pública. O diagnóstico de hanseníase em geral é simples. Porém, quadros com ausência de lesões cutâneas características, somente com alterações neurais, representam um desafio para o diagnóstico diferencial com outras doenças neurológicas. Comentários: Relatamos o caso de um paciente encaminhado ao serviço de neurologia com história clínica e eletroneuromiografia compatíveis com polineuropatia desmielinizante, sem qualquer lesão cutânea ao exame de admissão. O raciocínio clínico inicial foi direcionado para o diagnóstico das polineuropatias desmielinizantes inflamatórias adquiridas como Polineuropatia Desmielinizante Inflamatória Crônica (CIDP) e suas variantes. No entanto, após anamnese e exame físico detalhados, chamou a atenção a ausência do componente atáxico e a presença predominante de alterações sensitivas de fibra fina, espessamento de nervo e importante fator epidemiológico para hanseníase, motivando a suspeita e a in-vestigação desta enfermidade por meio da biópsia de nervo que foi sugestiva de hanseníase. Após três meses, em novo exame do paciente para biopsiar áreas de anestesia para reforçar o diagnóstico, observou-se o surgimento de extensas lesões levemente hipocrômicas no tronco e membros inferiores, cuja biópsia definiu o diagnóstico de hanseníase. (AU)

ABSTRACT: Study: Case report. Importance: Worldwide over three million people are living with disabilities due to leprosy. Brazil is the second country with the highest number of new cases registered. The magnitude and high risk of disability make the disease a public health problem. The diagnosis of leprosy can be simple. However, in the absence of skin lesions and with many possibilities of neurological impairment, diagnosis can become a challenge. Comments: We report the case of a patient referred to the neurology service with a clinical history and electrophysiological tests compatible with demyelinating polyneuropathy, without any skin lesion at admission examination. The initial clinical research was directed to the diagnosis of acquired inflammatory demyelinating polyneuropathies such as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)and its variants. However, after anamnesis and detailed physical examination, the absence of the ataxic component and the predominant presence of sensory alterations of fine fiber, nerve thickening and important epidemiological factor for leprosy,led to the suspicion and investigation of this disease by nerve biopsy that was suggestive of leprosy. After three months, in a new patient examination "to perform a biopsy in areas of anesthesia" to reinforce the diagnosis, there was the appearance of extensive slightly hypochromic lesions in the trunk and lower limbs, whose biopsy defined the diagnosis of leprosy.(AU)

rrigação com PVP-I em baixa concentração reduz os eventos inflamatórios após cirurgia de 3° molares inferiores: um ensaio clínico randomizado, triplo cego, placebo-controlado

Proposição: Avaliar o efeito da irrigação em feridas cirúrgicas oriundas da extração de terceirosmolares inferiores, com uma formulação de PVP-I, sobre os eventos inflamatórios. Métodos:Foi conduzido um ensaio clínico, randomizado, triplo-cego, boca dividida e placebo-controladoem pacientes submetidos as extrações dos 3˚ molare inferiores. Todos os voluntários foramalocados de maneira randômica para receber como substância irrigadora de PVP-I 0,5mg/ml oude SF 0,9% com a avaliação dos eventos inflamatórios. Uma amostra estimada de 30 sítioscirúrgicos por grupo foi requerida (80% de poder estatístico e 95% de nível de confiança)...

Postoperative hemostatic efficacy of gauze soaked in tranexamic acid, fibrin sponge, and dry gauze compression following dental extractions in anticoagulated patients with cardiovascular disease: a prospective, randomized study.

INTRODUCTION: Oral anticoagulants are widely prescribed drugs. Interruption of anticoagulant therapy prior to oral surgery has been an issue of great controversy. The purpose of this study was to evaluate the incidence of bleeding complications after dental extractions in patients on anticoagulant therapy (warfarin) in whom different local hemostatic methods were used. MATERIAL AND METHODS: Patients using warfarin and requiring extractions of at least two teeth were screened to participate in this prospective, randomized study. Extraction sites were considered as sampling units (statistically representative sample size) and were allocated to one of the three study groups (G1-4.8% tranexamic acid; G2-fibrin sponge; and G3-no local hemostatic agents). RESULTS: Eighty-four extraction sites were obtained from patients with mitral valve prolapse (47.4%), prosthetic cardiac valve (23.7%), venous thromboembolism (21.1%), and pulmonary embolism (5.2%). International normalized ratio (INR) values ranged between 2.1 and 3.1 (mean 2.51 ± 0.1). Postoperative bleeding was observed in four surgical sites (p < 0.001) and was mainly in older patients (p = 0.005). DISCUSSION: The three local hemostatic protocols were similarly effective in controlling postoperative bleeding in patients undergoing anticoagulant therapy with warfarin. The majority of teeth could be extracted with minimal problems in patients with cardiovascular diseases receiving treatment with anticoagulant therapy.

The use of Le Fort I Approach in the resection of an extensive ossifying fibroma.

INTRODUCTION: Ossifying fibroma (OF) is a well-defined benign neoplasm characterized by slow growth and predilection for the posterior mandible site, usually treated by conservative surgical approaches. In this context, Le Fort I Approach (LFIA) has been increasingly used providing good visualization and an easy access to the lesion. It also allows removal of the lesion quickly. Although there are case reports using LFIA for the management of benign neoplasms, odontogenic cysts and tumors of the middle third of face, to our knowledge, only one article describes the use of surgical LFIA for OF of the maxilla. Thus, the objective of this study was to report the second paper on the use of horizontal osteotomy of the maxilla in the resection of an extensive OF and conduct a brief literature review on this surgical approach. CASE REPORT: The following case report describes a 33-year-old man who was diagnosed with OF. Oral examination showed a painless swelling of hard consistency, covered by normal mucosa in edentulous alveolar ridge of the maxillary posterior region of the right side. Tomographic slices revealed that the image with mixed density had a centrifugal growth, with expansion of the buccal and lingual cortical with an upper displacement of the maxillary sinus. The patient was admitted to the hospital for surgical resection of the lesion via LFIA. Satisfactory functional results were obtained after 18-month follow-up period. In addition, no recurrence or clinical complaints were noted. DISCUSSION: LFIA shall be considered as a feasible option when planning surgery for removal of extensive benign lesions located in midfacial region because it is a predictable technique and routinely performed by the oral and maxillo-facial surgeons.

Changes in morphology of long bone marrow tissue of rats submitted to cryotherapy with liquid nitrogen.

PURPOSE: To study the main effects of local use of liquid nitrogen on bone marrow tissue in rats. METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for one or two minutes, intercalated with periods of five minutes of passive thawing. The animals were sacrificed after one, two, four and 12 weeks and the specimens obtained were analyzed histomorphologically. RESULTS: In the second experimental week of one-minute protocol, histological degree of inflammation obtained a mean score of one (mild), ranging from 0 (absent or scarce) and two (moderate) (Kruskal-Wallis test p=0.01). In the second experimental week of two-minute protocol, degree of inflammation to the medullar tissue obtained an average score of two (Kruskal-Wallis test p=0.01). CONCLUSION: The degree of inflammation of the bone marrow tissue was higher in protocol of three applications of two minutes compared to protocol of three applications of one minute.

Changes in morphology of long bone marrow tissue of rats submitted to cryotherapy with liquid nitrogen / Alterações na morfologia do tecido medular de ossos longos de ratos submetido à crioterapia com nitrogênio líquido

PURPOSE: To study the main effects of local use of liquid nitrogen on bone marrow tissue in rats. METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for one or two minutes, intercalated with periods of five minutes of passive thawing. The animals were sacrificed after one, two, four and 12 weeks and the specimens obtained were analyzed histomorphologically. RESULTS: In the second experimental week of one-minute protocol, histological degree of inflammation obtained a mean score of one (mild), ranging from 0 (absent or scarce) and two (moderate) (Kruskal-Wallis test p=0.01). In the second experimental week of two-minute protocol, degree of inflammation to the medullar tissue obtained an average score of two (Kruskal-Wallis test p=0.01). CONCLUSION: The degree of inflammation of the bone marrow tissue was higher in protocol of three applications of two minutes compared to protocol of three applications of one minute.

OBJETIVO: Investigar os principais efeitos do uso local de nitrogênio líquido sobre o tecido medular ósseo em ratos. MÉTODOS: As diáfises femorais de 42 ratos Wistar foram expostas a três aplicações sequenciais locais de nitrogênio líquido por um ou dois minutos, intercaladas por períodos de cinco minutos de degelo espontâneo. Os animais foram sacrificados após uma, duas, quatro e 12 semanas e os espécimes obtidos foram analisados histomorfologicamente. RESULTADOS: Na segunda semana experimental do protocolo de um minuto, o grau histológico de inflamação obteve um escore médio de um (leve) variando entre 0 (ausente ou escarço) a dois (moderado) (Teste de Kruskal-Wallis p=0.01). Na segunda semana experimental do protocolo de dois minutos, o grau histológico de inflamação do tecido medular obteve um escore máximo de dois (moderado) (Teste de Kruskal-Wallis p=0.01). CONCLUSÃO: O grau de inflamação do tecido medular ósseo foi maior no protocolo de três aplicações de dois minutos comparado ao protocolo de três aplicações de um minuto.

Ránulas intraorales en una población brasileña: estudio retrospectivo del empleo de la marsupialización modificada / Intraoral ranulas in a brazilian population: a retrospective study of the use of modified marsupialization

Las ránulas son seudoquistes resultantes de la extravasación salival de las glándulas sublinguales. Diversos tratamientos han sido empleados, no obstante, la marsupializaión se ha demostrado es el método más utilizado. La modificación de la técnica convencional, haciendo un taponamiento con gasas medicadas, presenta bajos índices de recurrencia, mientras su aplicación cuidadosa. El objetivo de este trabajo fue evaluar los resultados obtenidos por el empleo de la técnica de marsupialización modificada en los casos de ránulas intraorales diagnosticadas en el Servicio de Estomatología de la Facultad de Odontología de la Universidade Federal do Ceará, entre marzo de 1999 a diciembre de 2010, y comparar estos datos con estudios previamente reportados en la literatura. Los datos, tras su colecta, fueron tabulados y analizados estadísticamente (SPSS, versión 17.0). Del total de 2.103 biopsias, 17 (0.8%) correspondieron a ránulas intraorales, con edad comprendida entre 10 y 34 años de edad (media de 22,9 años), siendo 82,4 mujeres y 17,6 hombres. El tamaño de las lesiones varió entre 0,3 y 4 cm, con un promedio de aproximadamente 1,8 cm. La técnica de marsupialización modificada empleada en 13 pacientes, presentó un solo caso de recidiva. Otras dos recurrencias fueron observadas cuando se utilizó la técnica de la extirpación de la lesión, usada en cuatro casos. Nuestros resultados mostraron que la marsupialización, con cambio de la técnica convencional, es un método conservador eficaz, aunque no estadísticamente significativo (p>0,05), debiendo ser elegido como primera opción en el tratamiento de ránulas intraorales, con tasas reducidas de recurrencia.

Ranulas are pseudocysts as a result of salivary extravasation of the sublingual glands. Various treatments have been used, however, has been shown marsupialization the most used. The modification of the conventional technique, carefully filling of the lesion with gauze soaked in nitrofurazone (Furacin ®), have low rates of recurrence. The aim of this study was to evaluate the results obtained using the technique of marsupialization modified in the treatment of intraoral ranulas diagnosed in the Service of Stomatology, Faculty of Dentistry at the Universidade Federal do Ceará, from March 1999 to December 2010, and compare these data with previously reported studies in the literature. The data, after collection, were tabulated and statistically analyzed (SPSS, version 17.0). Of the total of 2,103 biopsies, 17 (0.8%) were intraoral ranulas, aged between 10 and 34 years of age (mean 22.9 years), with 82.4 men and 17.6 women. The lesion size ranged from 0.3 to 4 cm, with an average of about 1.8 cm. Modified marsupialization technique used in 13 patients, presented a single case of recurrence. Two other recurrences were observed when using the technique of surgical excision, used in four cases. Our results showed that marsupialization, with change of the conventional technique is an effective conservative approach, although not statistically significant (p> 0.05), must be chosen as first choice in the treatment of intraoral ranulas, with reduced rates of recurrence.

Worldwide incidence of odontogenic tumors.

PURPOSE: The objective of the study was to determine the relative frequency of odontogenic tumors (OTs) in the world population, directing an epidemiologic profile to these lesions. METHODS: Was conducted a search in epidemiologic studies involving OTs that are listed by PubMed and Ovid, EMBASE, and Cochrane Library, embracing the period from January 1960 to January 2010, to verify their incidence worldwide. We identified 195 articles, of which 19 articles were selected, considering the location, age, sex, histologic type, and World Health Organization classification. RESULTS: A total of 8544 OTs were found. The results showed a low frequency of malignant OTs in selected works. The most frequent tumor was ameloblastoma (39.6%), followed by odontoma (20.1%) and the newly included keratocystic OT (13.8%). CONCLUSIONS: These OTs are uncommon lesions in world population, and malignant OTs are very rare. The relative frequency of different kinds of OTs, the age, and the sex distribution show a marked geographic variation in incidence of those lesions. This was particularly notable in the ameloblastomas and odontoma, with the incidences being relatively well and weighted showing similar values to an average when compared with previous studies.