Assessment of postoperative pain in patients undergoing temporomandibular joint arthroscopy with infiltration of dexamethasone disodium phosphate in different concentrations. A randomized controlled trial.

The main aim of this work was to evaluate the effect of intra-articular, sub-synovial steroid injections (IASSSI) with different doses during temporomandibular joint (TMJ) arthroscopy. Using a single-blind, randomized clinical trial, the investigators enrolled a sample of subjects who underwent TMJ arthroscopy with vs. without IASSSI for treating TMJ disorder (TMD). The predictor variable was the treatment group classified as no treatment (A - without IASSSI) or active treatments (IASSSI (B) with 2 mg or (C) 4-mg dexamethasone). Study medications were randomly assigned. Only subjects were blinded to treatment assignment. The main outcome variables included the following: 1) pain assessed up to postoperative day 30 with the McGill Pain Questionnaire and visual analog scale (VAS); 2) maximum mouth opening (MMO); and 3) analgesic and anti-inflammatory drug consumption. Other variables were demographic (age, sex) or pathologic (disease manifestations and classifications). Descriptive and bivariate statistics were computed. Statistical significance was set at p ≤ 0.5, one-tailed test of hypothesis. The sample comprised 36 patients (n = 12 per study group). In the active group with 4 mg corticosteroids, pain reduction measured by VAS (odds ratio [OR] = 0.18; p = 0.013) and McGill scale scores (OR = 0.15; p = 0.048) was significantly higher than in the control group. The McGill scale scores significantly decreased in both IASSSI groups, compared to the control group, at the final follow-up (all p < 0.012), and IASSSI was significantly associated with reduced analgesic consumption at postoperative days 7 and 14 (p = 0.003). However, there was no significant difference regarding MMO among the three groups. Within the limitations of the study, it seems that intra-articular, sub-synovial steroid injections (IASSSI) with 4 mg dexamethasone should be preferred whenever appropriate when pain relief is the priority of the procedure. Brazilian Registry of Clinical Trials (ReBec)- 28yb2g.

Impact of COVID-19 on maxillofacial surgery practice: a systematic review / Impacto da Covid-19 na prática da cirurgia bucomaxilofacial: uma revisão sistemática

Abstract Objectives: The aim of this systematic review was to evaluate the possible impacts of COVID-19 on oral and maxillofacial surgery practice, as well as the protocols employed by oral and maxillofacial surgeons to minimize the risks of contamination. Methods: Searches were performed in different databases up to 15 March 2021. Articles related to oral surgery dynamics within the context of the COVID-19 pandemic were included. The articles were considered eligible if they met the following inclusion criteria: observational studies that provided recommendations regarding maxillofacial surgery measures during the COVID-19 pandemic and that analyzed the risk of contamination of patients/professionals with SARS-CoV-2. Results: Seven studies met the inclusion criteria and were selected for the present systematic review. Demands for personal protective equipment increased significantly, with studies reporting the scarcity of fundamental equipment such as FFP2/N95 masks. Significant changes in the infrastructure of outpatient, surgical and inpatient units and in the care protocols themselves were observed. Conclusion: The COVID-19 pandemic particularly affected the routine of oral and maxillofacial surgery residents. Several additional recommendations for surgical practice or for the surgical team were evaluated and discussed, such as performing primarily urgent and emergency surgeries, remote patient care and screening, postponing elective surgeries, and new teaching methods in oral and maxillofacial surgery residency programs. In addition, screening of patients and of the surgery team for COVID-19 is strongly recommended.

Resumo Objetivos: Avaliar os possíveis impactos da Covid-19 na prática da cirurgia bucomaxilofacial, bem como os protocolos empregados pelos cirurgiões bucomaxilofaciais para minimizar os riscos de contaminação. Método: Foram feitas buscas em diferentes bases de dados até 15 de março de 2021. Foram incluídos artigos relacionados à dinâmica da cirurgia oral no contexto da pandemia de Covid-19. Os artigos foram considerados elegíveis se atendessem aos seguintes critérios de inclusão: estudos observacionais que fornecessem recomendações sobre medidas de cirurgia bucomaxilofacial durante a pandemia de Covid-19 e que analisassem o risco de contaminação de pacientes/profissionais com SARS-CoV-2. Resultados: Sete estudos preencheram os critérios de inclusão e foram selecionados para a presente revisão sistemática. As demandas por equipamentos de proteção individual aumentaram significativamente, estudos relataram a escassez de equipamentos fundamentais, como máscaras FFP2/N95. Foram observadas mudanças significativas na infraestrutura das unidades ambulatoriais, cirúrgicas e de internação e nos próprios protocolos assistenciais. Conclusão: A pandemia de Covid-19 afetou particularmente a rotina dos residentes de cirurgia bucomaxilofacial. Diversas recomendações adicionais para a prática cirúrgica ou para a equipe cirúrgica foram avaliadas e discutidas, como a feitura de cirurgias prioritariamente de urgência e emergência, atendimento e triagem remota de pacientes, adiamento de cirurgias eletivas e novos métodos de ensino em programas de residência em cirurgia bucomaxilofacial. Além disso, a triagem de pacientes e da equipe cirúrgica para Covid-19 é fortemente recomendada.

Impact of COVID-19 on maxillofacial surgery practice: a systematic review.

OBJECTIVES: The aim of this systematic review was to evaluate the possible impacts of COVID-19 on oral and maxillofacial surgery practice, as well as the protocols employed by oral and maxillofacial surgeons to minimize the risks of contamination. METHODS: Searches were performed in different databases up to 15 March 2021. Articles related to oral surgery dynamics within the context of the COVID-19 pandemic were included. The articles were considered eligible if they met the following inclusion criteria: observational studies that provided recommendations regarding maxillofacial surgery measures during the COVID-19 pandemic and that analyzed the risk of contamination of patients/professionals with SARS-CoV-2. RESULTS: Seven studies met the inclusion criteria and were selected for the present systematic review. Demands for personal protective equipment increased significantly, with studies reporting the scarcity of fundamental equipment such as FFP2/N95 masks. Significant changes in the infrastructure of outpatient, surgical and inpatient units and in the care protocols themselves were observed. CONCLUSION: The COVID-19 pandemic particularly affected the routine of oral and maxillofacial surgery residents. Several additional recommendations for surgical practice or for the surgical team were evaluated and discussed, such as performing primarily urgent and emergency surgeries, remote patient care and screening, postponing elective surgeries, and new teaching methods in oral and maxillofacial surgery residency programs. In addition, screening of patients and of the surgery team for COVID-19 is strongly recommended.

The efficacy of mesenchymal stem cells in regenerating structures associated with the temporomandibular joint: A systematic review.

OBJECTIVES: The objective of this systematic review is to evaluate the role of mesenchymal stem cells in the regenerative treatment of temporomandibular joint resorption. DESIGN: Search strategies were performed in the following databases: PubMed/MEDLINE, EMBASE, Cochrane Collaboration Library, and Web of Science. Two independent reviewers selected the included articles using a two-phase process based on the eligibility criteria. The reviewers independently collected the required information from the included articles. The methodological quality of the selected studies was assessed individually. RESULT: In accordance with the inclusion and exclusion criteria, 703 studies were found and 8 articles were included. Thus, six studies using animal models and two human studies were included in this systematic review. CONCLUSION: Based on the data of our systematic review, the use of mesenchymal stem cells is a promising method for the repair and regeneration of temporomandibular joint components.

Self-medication Among Myofascial Pain Patients: A Preliminary Study.

BACKGROUND: Self-medication has been reported as an option which people choose to relieve the suffering of conditions that cause pain, however, this could delay the correct diagnosis and therapy. OBJECTIVE: The aim of the present study was to determine the prevalence of self-medication among patients with Temporomandibular Disorder (TMD), and to analyze correlations with the severity of the disease. METHODS: A prospective study was conducted with patients who had been diagnosed with TMD. The patients were submitted to anamnesis and a physical examination. This research also used the Fonseca`s Anamnestic Index (FAI) and a questionnaire that was developed specifically for this study, containing questions related to the first health professional contacted and self-medication. The data were analyzed using comparative and correlative analysis (Version 18.0 of SPSS software), with the level of significance set at p<0.05. RESULTS: Thirty-four patients were included, with a prevalence of females (91.2%) and a mean age of 39.76 years. Half of the patients claimed to have chosen their own medications at time, especially analgesics. Sodium dipyrone was used by 12 of the participants. Dentists were the most commonly contacted health professionals (55.5%). No correlation was found between self-medication and the severity of TMD according to the FAI. Furthermore, the time period between the onset of symptoms and the first consultation was not affected by self-medication. CONCLUSION: Self-medication seems to be highly prevalent among patients with TMD, although this practice does not seem to alter the severity of the disease.

Surgical management of mandibular ameloblastoma and immediate reconstruction with nonvascularized bone graft and hyperbaric oxygen therapy / Tratamiento quirúrgico de ameloblastoma mandibular y la reconstrucción inmediata con injerto oseo libre y terapia con oxígeno hiperbárico

Extensive resection of tumor often results in bone and soft tissue defects that cause functional and esthetic consequences. The reconstructive surgery is extremely important for the rehabilitation of these patients. The purpose of this study is to report on the use of Hyperbaric Oxygen therapy (HBO) in the case of a large ameloblastoma treated with segmental resection and reconstructed immediately with nonvascularized bone graft (NVBGs) from iliac crest. A 41-year-old woman was referred to our department because of paresthesia of the inferior alveolar nerve and history of swelling in the molar and ramus region of the left mandible. Panoramic radiograph depicting well-defined multilocular radiolucency extending from second pre-molar region to the left ramus region. An incisional biopsy confirms the diagnosis of solid ameloblastoma. The treatment of choice was segmental mandibular resection and immediate mandibular reconstruction using NVBGs from iliac crest, followed by removal of internal fixation and placement of dental implants with immediate loading. The patient received preoperative HBO (a 90-min session at 2.2-2.4 atmospheres, five times per week for two weeks, for a total of up to 10 sessions). Postoperative HBO (10 further 90-min sessions) was administered within 2weeks. The patient received rehabilitation with a mandibular implant-supported fixed complete dental prosthesis. The present study showed successful management of mandibular ameloblastoma that associated extensive surgery, immediate reconstruction with NVBGs from iliac crest, hyperbaric oxygen therapy and dental implants. These combined procedures allowed removal of lesion and reestablishment of mandibular contour and function.

La resección extensa de un tumor a menudo da lugar a defectos del hueso y de los tejidos blandos, que causan consecuencias funcionales y estéticas. La cirugía reconstructiva es extremadamente importante para la rehabilitación de estos pacientes. El propósito de este estudio fue informar sobre el uso de la terapia de oxígeno hiperbárico (HBO) en un caso de un ameloblastoma de gran tamaño, tratado con resección segmentaria y reconstruido inmediatamente con injerto óseo no vascularizado (IONV) de la cresta ilíaca. Una mujer de 41 años fue derivada a nuestro servicio por parestesia del nervio alveolar inferior e historia de hinchazón en la región molar y ramina de la mandíbula izquierda. Radiografía panorámica que muestra una radiolucencia multilocular bien definida que se extiende desde la segunda región pre-molar hasta la región de la rama izquierda. Una biopsia incisional confirma el diagnóstico de ameloblastoma sólido. El tratamiento de elección fue la resección mandibular segmentaria y la reconstrucción mandibular inmediata mediante IONV de cresta ilíaca, seguido de la eliminación de la fijación interna y la colocación de implantes dentales con carga inmediata. La paciente recibió OHB preoperatoria (una sesión de 90 minutos a 2.2-2.4 atmósferas, cinco veces por semana durante dos semanas, para un total de hasta 10 sesiones). La OHB postoperatoria (10 sesiones adicionales de 90 minutos) se administró en 2 semanas. La paciente recibió rehabilitación con una prótesis dental fija con implante mandibular. El presente estudio mostró un manejo exitoso del ameloblastoma mandibular asociado a una cirugía extensa, reconstrucción inmediata con IONV de cresta ilíaca, oxigenoterapia hiperbárica e implantes dentales. Estos procedimientos combinados permitieron la extirpación de la lesión y el restablecimiento del contorno y la función mandibular.

Removal of a Solitary Synovial Chondromatosis of the Temporomandibular Joint Using Arthroscopy.

The diagnosis of synovial chrondromatosis of temporomandibular joint (TMJ) requires a combined assessment consisting of clinical, radiologic, and histopathologic examinations. The purpose of this study is to report in 1 patient the removal of a single large cartilaginous nodule floating in the upper joint compartment using arthroscopy. A 30-year-old woman was referred to our department complaining about pain in preauricular area and restricted mouth opening. Imaging of magnetic resonance reveals anterior disc displacement and right joint effusion. Arthroscopy of TMJ was performed for diagnosis and treatment. During the arthroscopy a large loose body was identified and removed with a biopsy forceps; lavage was conducted with ringer solution. Hyaluronic acid was injected in TMJ at surgery, 1 and 3 months after surgery. Postoperative magnetic resonance imaging showed articular disc on position and no effusion. The patient was followed up of 1 year without sign and symptoms. Arthroscopic procedure of TMJ was effective in diagnosis and removal of a solitary loose body of synovial chrondromatosis. Viscosupplementation appers to offer benefits in controlling pain and functional improvements.

Smoking Modulates Gene Expression of Type I Collagen, Bone Sialoprotein, and Osteocalcin in Human Alveolar Bone.

PURPOSE: Previous animal studies have shown the negative impact of smoking on bone-to-implant contact, and in humans, a decrease in bone density and implant survival over time. However, the effect of smoking on the human alveolar bone regarding the expression of bone-related markers is unknown. Therefore, the aim of this study was to evaluate the influence of smoking on the gene expression of molecules of bone metabolism in alveolar bone tissue from sites designed to receive dental implants. MATERIALS AND METHODS: Biopsy specimens of alveolar bone were collected from smokers (n = 19) and nonsmokers (n = 19) from areas planned to receive dental implants. Gene expression of tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-ß, osteoprotegerin (OPG), type I collagen (COL-I), bone sialoprotein (BSP), and osteocalcin (OCN) was quantified by quantitative real-time polymerase chain reaction using glyceraldehyde-3-phosphate dehydrogenase as a reference gene. The results were assessed using multiple regression analysis, with a significance level of 5%. RESULTS: Multiple regression analysis indicated that smoking negatively affected mRNA expression of BSP and OCN and positively altered the expression of COL-I (P < .05) despite age, gender, and arch. Moreover, regression analysis did not show a significant correlation between smoking habit and mRNA levels of TNF-α, TGF-ß, and OPG (P > .05). CONCLUSION: These results support the hypothesis that some bone markers in alveolar tissue are modulated by smoking, which could explain the negative impact of smoking on bone healing.

Oral cancer: potentially malignant lesions and statistics of diagnosed cases in the municipality of Santo André-SP / Câncer bucal: lesões potencialmente malignas e estatística dos casos diagnosticados no município de Santo André-SP

Objective - The purpose of the study was to review the literature and to determine the incidence of potential malignant lesions and oral cancer according to gender, ethnicity, age and anatomical site, diagnostic hypothesis and final diagnosis. Methods - A total of 252 patients were evaluated at the Municipal Center Hospital of Santo André, Center for Dental Specialties and to the Campaigns for Oral Cancer Prevention promoted by the Paulista Association of Dentist Surgeons (APCD) from Santo André municipality (São Paulo- Brazil). Information about ethnicity, age, gender, anatomical location of injury, possible diagnosis and final diagnosis were analyzed. Results - It was observed a predominance of males, age between 5th and 6th decades of life and Caucasian ethnicity, respective with the potentially malignant lesions in the oral cavity. The lower lip, tongue and floor of mouth were the most affected anatomical sites. Conclusions - The oral cancer in the present study presented: higher prevalence in Caucasians, higher prevalence in males, predominance in the 5th and 6th decade of life with average age of 57.98 years old, predominant anatomical site was the lower lip followed by tongue, floor of the mouth, alveolar border and retromolar trigone.

Objetivo - O trabalho apresentado tem como objetivo realizar revisão de literatura e quantificar estatisticamente a incidência das lesões potencialmente malignas e do câncer bucal, sua incidência quanto a etnia, faixa etária, gênero, localização anatômica, hipótese de diagnóstico e diagnóstico final. Métodos - Foram estudados 252 pacientes, atendidos no Centro Hospitalar Municipal de Santo André, Centro de Especialidades Odontológicas e 1ª a 8ª Campanhas de Prevenção do Câncer Bucal - APCD Santo André. Informações sobre etnia, faixa etária, gênero, localização anatômica das lesões, hipóteses de diagnóstico e diagnóstico final, foram analisados estatisticamente.Resultados - Houve predomínio do gênero masculino, faixa etária entre a 5ª e a 6ª décadas de vida, etnia branca, o lábio inferior, língua e assoalho bucal foram os locais anatômicos mais acometidos. Conclusões - Diante do presente estudo concluiu-se que o câncer bucal apresentou: maior prevalência pela etnia branca, maior prevalência no gênero masculino, tendência ao predomínio pelas 5ª e 6ª décadas de vida e a média de idade foi de 57,98 anos, quanto à localização anatômica, predomínio no lábio inferior, seguido da língua, assoalho bucal, rebordo alveolar e trígono retromolar.

Morotes de corte ultra sônico, uma nova tecnologia para auxiliar as expansões rápidas da maxila assistida cirurgicamente / Ultrasound device for cutting bone: a new technology to help surgically assisted rapid maxillary expansion

A atresia maxilar é uma deformidade dentofacial que causa uma má oclusão pela diminuição da arcada maxilar no sentido transversal em relação à mandíbula. Uma das técnicas para o auxílio no tratamento ortodôntico dessa deformidade é a expansão rápida da maxila assistida cirurgicamente (ERMAC), na qual uma cirurgia para realização de osteotomias maxilares permite a expansão ortodôntica subsequente. Este artigo apresenta a aplicação da piezoeletricidade nesse tipo de cirurgia, apontando suas vantagens: osteotomias mais delicadas, com maior controle pelo operador, menor risco de danos aos tecidos moles e, consequentemente, melhor recuperação pós-operatória

The maxillary atresia is a dentofacial deformity that causes a malocclusion by reducing the maxillary arch dimension in relation to the mandible. One of the techniques to aid in orthodontic treatment of the deformity is the rapid expansion of maxilla surgically assisted, in which a surgery to perform maxillary osteotomies allows subsequent orthodontic expansion. This article presents the application of piezoelectricity in this type of surgery, pointing out its advantages: more delicate osteotomies, with greater control by the operator, less risk of damage to soft tissues and thus improved postoperative recovery

Fratura unilateral do arco zigomático em ratos jovens após diferentes períodos / Unilateral fracture of the zygomatic arch in young rats after different periods

Foi realizada uma avaliaçäo do comportamento da fratura unilateral do arco zigomático em ratos jovens, após diferentes períodos, bem como seus possíveis efeitos no crescimento facial, através de mensuraçöes cefalométricas. Fratura no lado direito, com desvio medial, foi obtida em ratos com um mês de idade. Os animais foram sacrificados após períodos de um dia, uma semana, duas semanas e um mês. As mensuraçöes foram realizadas por meio de um sistema de computador, com o emprego de radiografias. O comportamento observado foi de tendência de retorno do arco zigomático à sua posiçäo original. Foi verificada diferença significante para a profundidade da fossa infratemporal entre os lados direito e esquerdo, näo havendo diferença significante para as distâncias entre o arco zigomático e a mandíbula, bem como entre o plano mediano do crânio e os incisivos inferiores. Entre os tempos de análise, houve diferença significante para a distância entre o arco zigomático e a mandíbula, bem como entre o plano mediano do crânio e o corpo da mandíbula, indicando uma tendência de desvio da mandíbula