Exostose palatina bilateral em bebê / Exostosis palatina bilateral en bebé / Bilateral palatal exostosis in an infant

RESUMO Introdução: As exostoses são definidas como protuberâncias ósseas localizadas, de caráter benigno, sendo uma rara patologia em bebês. Objetivo: Relatar um caso de exostose palatina bilateral em um bebê melanoderma do sexo feminino de 1 ano e 4 meses de idade. Relato de caso: A criança compareceu a Clínica Escola de Odontopediatria, acompanhada de sua mãe, para avaliação odontológica. Durante a anamnese, o responsável queixou-se de atraso na irrupção dos dentes decíduos e presença de protuberância na arcada superior, sem sintomatologia dolorosa. Foi relatado que três membros da família também apresentavam essa mesma alteração na maxila ou mandíbula, possivelmente sugerindo um componente genético. Ao exame clínico intrabucal, verificou-se um aumento de volume ósseo bilateral plano localizado na maxila, na região lingual das tuberosidades palatinas, recoberto por mucosa bucal normal. A superfície era rígida à palpação e com bordas claramente definidas. O componente genético foi associado ao aspecto clínico da lesão, bem como o sexo e a etnia. O diagnóstico estabelecido foi exostose palatina bilateral. A biópsia e o tratamento ativo para remoção da patologia não se justificaram devido à pouca idade da criança, ausência de sintomatologia dolorosa e de interferências na alimentação, deglutição ou outra função bucal. A paciente foi acompanhada periodicamente e apresentou sequência de irrupção dos dentes decíduos normal. Conclusão: Embora a exostose palatina apresente baixa prevalência em crianças, é importante que o cirurgião-dentista tenha conhecimento para realizar seu correto diagnóstico e plano de tratamento(AU)

RESUMEN Introducción: Las exostosis son definidas como bultos óseos, de carácter benigno, y contituyen una infrecuente afección en bebés. Objetivo: Describir un caso de exostosis palatina bilateral en un bebé melanoderma del sexo femenino de 1 año y 4 meses de edad. Presentación del caso: La niña acudió a la Clínica Escuela de Odontopediatría, con su madre, para evaluación odontológica. Durante la anamnesis, la madre refiere retraso en la erupcíon de los dientes deciduos, además de la presencia de bultos en la arcada superior, sin dolores sintomáticos. Fue informado que tres familiares también presentaban la misma alteración en la maxila o mandíbula, posiblemente sugiriendo componente genético. El examen clínico intrabucal, verificó un aumento de volumen óseo bilateral plano ubicado en la maxila, en la región lingual de las tuberosidades palatinas, recubierto por una mucosa bucal normal. La superficie era rígida a la palpación y con bordes bien definidos. El componente genético fue asociado al aspecto clínico de la lesión, al igual que el sexo y la etnia. El diagnóstico establecido fue exostosis palatina bilateral. La biopsia y el tratamiento activo para la remoción de la afección no se pudieron justificar por la poca edad de la niña, ausencia de dolores sintomáticos, además de interferencias en la alimentación, deglución u otra función bucal. La paciente fue controlada periódicamente y presentó secuencia de irrupción de dientes deciduos normal. Conclusiones: Aunque la exostosis palatina sea infrecuente en niños, es importante que el cirujano dentista tenga conocimiento para realizar el correcto diagnóstico y el plan de tratamiento(AU)

ABSTRACT Introduction: Exostoses are localized bony lumps of a benign nature. They are an infrequent condition in infants. Objective: Present a case of bilateral palatal exostosis in a dark-skinned female infant aged one year and four months. Case presentation: The girl was brought by her mother to the Children's Dental Clinic for oral examination. During anamnesis, the mother referred to delay in the eruption of deciduous teeth and the presence of lumps on the upper arch without any painful symptom. She also reported that three relatives had the same alteration in their maxilla or mandible. Oral examination revealed a bilateral flat bony lump in the maxilla, in the lingual region of the palatal tuberosities, covered by normal oral mucosa. The surface was stiff to palpation with well defined borders. The genetic factor was associated to the clinical aspect of the lesion, as well as the sex and ethnicity of the patient. The diagnosis was bilateral palatal exostosis. Biopsy and active treatment for removal of the lesion were not justified due to the patient's age, absence of painful symptoms, and potential interference with feeding, swallowing and other oral functions. The patient was periodically followed-up and was observed to present a normal process of deciduous tooth eruption. Conclusions: Even though palatal exostosis is infrequent in children, it is important for dental surgeons to be knowledgeable about the topic so as to reach an appropriate diagnosis and treatment plan(AU)

Is the Erich arch bar the best intermaxillary fixation method in maxillofacial fractures? A systematic review

BACKGROUND: Intermaxillary fixation is used to achieve proper occlusion during and after oral and maxillofacial fracture surgery. The aim of this systematic review was to compare Erich arch bar fixation with other intermaxillary fixation methods in terms of the operating time, safety during installation, oral health maintenance and occlusal stability. MATERIAL AND METHODS: An electronic online search was conducted of the Scirus, PubMed, Ovid, Cochrane Library and VHL databases. A clinical trial dating from the inception of the data bases until August 2013 was selected. Studies that compared Erich arch bars with other intermaxillary fixation methods in patients older than 18 years-old were included. The studies were assessed by two independent reviewers. The methodological quality of each article was analyzed. RESULTS: Nine hundred and twenty-five manuscripts were found. Seven relevant articles were analyzed in this review. The risk of bias was considered moderate for four studies and high for three clinical trials. CONCLUSIONS: There is not enough evidence to conclude that the Erich arch bar is the best intermaxillary fixation method in cases of oral and maxillofacial fractures

The mandibular symphysis as a starting point for the occlusal-level reconstruction of panfacial fractures with bicondylar fractures and interruption of the maxillary and mandibular arches: report of two cases.

Panfacial fractures represent a challenge, even for experienced maxillofacial surgeons, because all references for reconstructing the facial skeleton are missing. Logical reconstructive sequencing based on a clear understanding of the correlation between projection and the widths and lengths of facial subunits should enable the surgeon to achieve correct realignment of the bony framework of the face and to prevent late deformity and functional impairment. Reconstruction is particularly challenging in patients presenting with concomitant fractures at the Le Fort I level and affecting the palate, condyles, and mandibular symphysis. In cases without bony loss and sufficient dentition, we believe that accurate fixation of the mandibular symphysis can represent the starting point of a reconstructive sequence that allows successful reconstruction at the Le Fort I level. Two patients were treated in our department by reconstruction starting in the occlusal area through repair of the mandibular symphysis. Both patients considered the postoperative facial shape and profile to be satisfactory and comparable to the pre-injury situation.

Analysis of temporomandibular joint ankylosis caused by condylar fracture in adults.

PURPOSE: To analyze the main causes of temporomandibular joint (TMJ) ankylosis from condylar fracture in adults through a retrospective study. MATERIALS AND METHODS: The history and computed tomographic (CT) scans of patients diagnosed with ankylosis caused by mandibular condyle fracture treated in a closed fashion from 2010 to 2012 were reviewed in the department of oral surgery. According to the relation between the stump of the ramus and the TMJ fossa, condylar fractures were divided into 3 grades: grade 0, in which the ramus stump is in the fossa but without contact to it; grade 1, in which the stump of the ramus is in the fossa and attached to it; and grade 2, in which the stump of the ramus is laterally displaced out of the fossa. Other factors, such as type of condylar fracture, displacement of the fractured fragment, position of the disc, and the presence of concomitant mandibular fractures, also were analyzed for ankylosis development. RESULTS: Of the 51 patients diagnosed with TMJ ankylosis, 13 patients (24 ankylosed joints) had full CT scans from injury to ankylosis, which showed that all condylar fractures were intracapsular fractures (ICFs), with sagittal fractures comprising 70%. Regarding the relation between the stump of the ramus and the TMJ fossa, no joints were classified as grade 0 (0%), 10 joints were classified as grade 1 (41.7%), and 14 joints were classified as grade 2 (58.3%). All discs were displaced with the fracture fragment, and the posterolateral retrodiscal tissue was torn. Among the condyle fractures leading to ankylosis, 77% featured symphysis fractures with widening of the mandibular arch. CONCLUSION: The relation between the ramus stump and the TMJ fossa plays an important role in the prognosis of condylar fracture. Grade 0 is less likely to cause ankylosis; grade 1 is more likely to cause ankylosis and is the relative indication for surgery; and grade 2 is the strongest predictor of ankylosis and is the absolute indication for surgery. Other risk factors are sagittal ICFs and combined mandibular fractures with widening of the mandibular arch.

Maduración dentaria en jovenes venezolanos estimada mediante el método de demirjian y colaboradores / Dental maturation in venezuelan young estimated though demirjian et al method

El objetivo de este trabajo fue estudiar la maduración dentaria en jóvenes venezolanos estimada mediante el método de Demirjian y cols. Se analizaron 284 radiografías panorámicas de pacientes de ambos sexos con edades cronológicas entre 8- 20 años. Se estudio la maduración dentaria de los 7 dientes inferiores izquierdos de acuerdo a los estadios del método de Demirjian y cols. y se calculó la edad dentaria. Se obtuvieron la media y la desviación estándar de la edad cronológica (EC) y la ED, la media de la EC a la cual se observaron los diferentes estadios de maduración y diferencias de medias entre la EC y la ED calculada. Al comparar las medias de las edades cronológicas en las que se observaron los estadios de maduración dentaria, las hembras tuvieron un desarrollo más avanzado que los varones. Se evidencio que el 100% de madurez dentaria, comienza a alcanzase alrededor de lo 13-14 años en la muestra estudiada. Contrastando la media de la EC con la ED, pudo verificarse que en ambos sexos, existe una consistente subestimación de la edad a partir de los 16 años, por ello en una submuestra de los grupos 8-16 se obtuvieron las diferencias de media entre la EC y ED, y se encontró una sobrestimación de la edad, estadísticamente significativa (-0,66 ±1,14 varones; -0,40± 1,38 hembras). Los datos del presente trabajo podrían ser utilizados como referencia de la maduración dentaria de los individuos de la muestra...

The aim of the present investigation was to study the dentaria maturation of Venezuelan young estimated though Demirjian´s et al. method. Two hundred and eighty four dentaria panoramic radiographs from patients of both sexes, with chronological ages between 8-20 years, were analyzed. Dentaria maturation of the 7 left lower teeth was calculated, according to the stages proposed by Demirjian et al. and dentaria age was calculated (DA) following the method of the author. Mean values and standard deviation of the chronological age (CA) and DA, by age group, mean of the CA to which different stages of maturation were observed and mean differences between the CA and the DA, were calculated. When comparing the mean chronological ages witch the dentaria maturation stages were observed; females had more advanced development than males. It was noticed that 100% of dentaria maturity, was reached out around 13-14 years in the studied sample. Contrasting mean CA with DA, it could be confirmed that in both sexes, there is a consistent underestimation of age from 16 years, so in a subsample of 8-16 groups mean differences between the EC and ED were obtained, and found an statistically significant overestimation of age (males -0.66 ± 1.14, females -0.40 ± 1.38). The data presented here could be used as a reference for dentaria maturation of the individuals in the sample...

An analysis of etiological factors for traumatic mandibular osteomyelitis.

OBJECTIVE: The aim of this study was to analyze the factors that were associated with the development of osteomyelitis during the treatment of mandibular fractures. MATERIAL AND METHODS: The data of 3188 patients with mandibular fractures treated during 2002-2009 were analyzed. Traumatic osteomyelitis of the mandible was diagnosed in 207 patients. The background factors of complications were studied and compared with the control group (100 patients) not having complications after treatment of mandibular fractures. The data of clinical, roentgenologic, microbiological, and immunological investigations were analyzed. A logistic regression model was developed to identify the factors for osteomyelitis development. RESULTS: The treatment in 6.5% of patients was complicated with osteomyelitis; 88.5% of these patients were men, and more than 80% of patients were younger than 50 years. In 86.8% of cases, Staphylococcus species were isolated, with Staphylococcus aureus accounting for 69.1% of cases. The following factors were found to be associated with osteomyelitis development: immunity dysfunction, caries-affected teeth at the fracture line, mobile fractured bones, bone fixation after more than 7 days following trauma, healthy teeth at the fracture line, insufficient bone reposition, and bone fixation after 3-7 days following trauma. CONCLUSION: Comparative analysis of factors influencing the treatment results revealed a great importance of immunological and dental status and microflora at the affected site. Insufficient or late reposition and fixation of fractured bone fragments play a significant role in the healing process.

Correction of malocclusion by anterolateral osteotomy in a traumatized maxilla.

Injuries to the face may cause long-term defects both aesthetic and functional consequences when the treatment is delayed, inadequate or absent. The varieties of osteotomy techniques are applied to improve posttraumatic malposition of the maxillofacial bones and occlusal function. In this article, a 21-year-old female involved in a traffic accident presented a severe deformity in maxilla and treated by anterolateral osteotomy is presented.

Detection of jaw and root fractures using cone beam computed tomography: a case report.

The aim of this case report is to demonstrate jaw and root fractures using a combination of cone beam CT (CBCT), CT and conventional radiographs. In this presentation a 23-year-old female patient who was referred to our dental clinic with a severe facial trauma is reported. The patient was initially examined by a general dentist and a fracture in the mandibular right canine region was diagnosed on the CT images. Once referred to our clinic, the raw CT images were re-evaluated by three maxillofacial radiologists in the Oral Diagnosis and Radiology Department. Two new fracture lines that were not reported on the original CT analysis were diagnosed among the raw CT images. More detailed information was obtained about dentoalveolar fractures with CBCT compared with CT and conventional radiography.

A comprehensive classification of mandibular fractures: a preliminary agreement validation study.

This study evaluates a comprehensive classification system for mandibular fractures based on imaging analysis. The AO/ASIF scheme, defining three fracture types (A, B, C), three groups within each type (e.g. A1, A2, A3) and three subgroups within each group (e.g. A1.1, A1.2, A1.3) with increasing severity from A1.1 (lowest) to C3.3 (highest) was used. The mandible is divided into two vertical units (I and V), two lateral horizontal units (II and IV) and one central unit (III) comprising the symphyseal and parasymphyseal region. Type A fractures are non-displaced, type B are displaced and type C are multifragmentary/defect injuries. Groups and subgroups are further defined in the classification system. Two classification sessions using semi-automatic software with 7 and 9 surgeons were performed to evaluate 100 fracture cases in the first session and 50 in the second. Inter-observer reliability and individual rater's accuracy were evaluated by kappa coefficient and latent class analysis, respectively. The analysis of inter-observer agreement for the detailed coding showed kappa coefficients around 0.50 with higher agreement among raters in the vertical units. This system allows standardization of documentation of mandibular fractures, although improvement in the definition of categories and their application is required.

Clinician variability in characterizing mandible fractures.

PURPOSE: This study evaluated variability in the clinical parameters commonly used to characterize mandible fractures. PATIENTS AND METHODS: Inter-rater reliability of 18 oral and maxillofacial surgeons was assessed using radiographs of 22 cases of mandible fractures. Raters were asked to evaluate each case based on several parameters including number, location, and displacement of the individual fractures and severity of the composite injury. To evaluate intra-rater reliability, selected cases were reviewed at a second session by a subgroup of these surgeons. Tests of concordance used to quantify measurement reliability included the interclass correlation coefficient and multiple-rater kappa statistics. RESULTS: Inter-rater agreement on the number of constituent fractures ranged from excellent for simpler fractures to poor for complex gunshot injuries. Even within raters, the range of interclass correlation for complex injuries was only 0.33 to 0.42 between the 2 assessments. Clinicians appeared to be better at delineating coronoid, condyle, ramus, and angle fractures; symphyseal and canine region fractures had lower inter- and intrarater agreement. Tests of concordance showed moderate to excellent reliability when fracture displacements were expressed in millimeters, but only fair reliability when displacements were expressed as categories. Even when the clinicians concurred on displacement measurements, a large overlap was observed in their categorization of these displacements. Despite the differences in the assessment of individual parameters, the high intrarater reliability coefficient (0.78) indicated that the individual clinicians had a high internal consistency in their assignment of summary severity scores. Multiple regression analysis revealed the number of constituent fractures, the type of fracture, and amount of fracture displacement (millimeters) to be significant predictors of clinician ratings of injury severity. CONCLUSIONS: The clinician variability underscores the difficulties involved in trauma description and scoring. The study identifies some sources of clinician variability and emphasizes the need to standardize the characterization of mandible fractures by using explicit guidelines.

Incidência de lesöes cervicais näo cariosas em estudantes de odontologia e sua relaçäo com aspectos oclusais / The incidence of non-carious cervical lesions in dental students and its relationship with occlusal conditions

Foram avaliados, por um período de 3 anos, 40 estudantes de odontologia, com idades variando entre 16 e 22 anos, para verificar a presença de lesöes cervicais näo cariosas e sua relaçäo com alguns aspectos oclusais. Os resultados, que sugeriram a existência de uma relaçäo entre o desenvolvimento das lesöes e a presença de hábitos oclusais parafuncionais, indicaram que: (1) dos 40 estudantes analisados, 29 apresentaram pelo menos um dente com lesäo cervical näo cariosa, com uma incidência de 11 novos estudantes com lesöes no período de avaliaçäo; (2) de 1131 dentes avaliados, 121 apresentaram lesöes cervicais näo cariosas com, uma incidência de 57 novos dentes com lesöes no período de avaliaçäo; (3) os primeiros molares inferiores, os primeiros pré-molares inferiores, os segundos pré-molares inferiores e os primeiros molares superiores foram os dentes mais atingidos pela ocorrência das lesöes; (4) dos 121 dentes com lesöes, 105 (86,8 por cento) apresentavam facetas de desgaste, indicativas de hábitos oclusais parafuncionais, sendo que a presença prévia de facetas de desgaste nos dentes que desenvolveram novas lesöes pôde ser comprovada do ponto de vista estatístico

[Proposal of a new topographic classification of mandibular fractures]. / Proposition d'une nouvelle classification topographique des fractures de la mandibule.

There has been a certain amount of confusion in publications concerning fractures of the mandible due to the lack of consensus on classification. Starting with the embryological, anatomic, biomechanical, pathogenic and epidemiological features of these fractures, we propose a new terminology and a new distribution of the units and subunits of the mandible in traumatology. The main point is to incorporate the angle subunit into the ramus unit.

Relationship of difficult forceps delivery to dental arches and occlusion.

This study examined the relationship between the extensive use of forceps procedures during delivery and later occlusal characteristics. The work uses data collected in National Collaborative Perinatal Research Project (USA), in which more than 60,000 pregnancies and the children's health were followed by regular medical tests and examinations. Of these, a subsample of 2,074 children participated in dental examinations, including the production of dental casts with wax bites to register occlusion. A total of 84 children, 55 boys and 29 girls, were coded as having undergone difficult or very difficult forceps deliveries. A control group was matched by age, sex, race, and site of dental examination. The results show a significant increase in asymmetric molar occlusion (P < 0.005) and canine relations (P < 0.001) in the study group. The sagittal length of the mandibular arch was increased in the difficult forceps delivery group (P < 0.01). In conclusion, difficult forceps procedures are associated with a later asymmetric occlusion.

Ectopic eruption of a maxillary canine following trauma.

Traumatic events at an early age may lead to developmental dental anomalies and ectopic tooth eruption. A case is reported in which a traumatic injury at two months of age resulted in the development of supernumerary teeth in the upper right premaxillary region. The maxillary canine ectopically erupted or transposed into the space left by the missing central incisor and eliminated the need for a prosthesis in this region.

[Fractures of the mandible. A critical study of repair procedures]. / Les fractures de la mandibule. Etude critique des procédés de réparation.

Based on their personal experience of 110 patients operated on for mandibular trauma, the authors analyse the results of the various techniques used. Screwed micro-plates may be very useful but only complete the therapeutic arsenal of the surgeon. In fact classical methods continue to provide satisfactory results. Poorer results may occur with fractures which combine involvement of the articular surfaces with a lesion of the body of the mandible.

Oral complications associated with neonatal oral tracheal intubation: a critical review.

This paper summarizes and evaluates the oral complications associated with orotracheal intubation in neonates. The palatal defect resulting from orotracheal intubation is best described as palatal grooving, rather than clefting since no oral nasal communication has been demonstrated. Palatal grooving may be caused by the inhibition of the molding tongue forces on the lateral palatine shelves. The incidence of palatal grooving increases with duration of intubation and reportedly resolves following extubation. However, posterior cross-bites, high palatal vaults, and poor speech intelligibility have been reported in children who previously have been intubated. Impingement of an orotracheal tube on the alveolus rather than on the palate may cause alveolar grooving which can cause dilaceration of primary teeth. Bilateral linear enamel hypoplasia in premature neonates is caused by an interruption in amelogenesis from intrauterine disturbances. However, gross unilateral incisal enamel hypoplasia in children who have been intubated is probably due to traumatic intubation. Avoiding excessive pressure on the maxillary alveolus during intubation is suggested. An appliance is available which secures oral tubes and protects the palate and alveolus.