Postoperative nausea and vomiting in orthognathic surgery: systematic review and meta-analysis.

PURPOSE: Postoperative nausea and vomiting (PONV) is a frequently reported adverse event following orthognathic surgery. The aim of this work is to conduct a systematic review of the literature on the subject, and to discuss the role of maxillofacial surgeons and the steps that can be taken to prevent or control PONV in orthognathic surgery. METHODS: A systematic review was conducted according to the PRISMA guidelines, using the search strategy: (orthognathic AND (nausea OR vomiting)). The authors searched PubMed, Embase, Dimensions, Web of Science and Google Scholar databases, without any language restrictions. RevMan 5.4 was used to create a risk of bias graph and a forest plot. RESULTS: The included articles were classified as having a low risk of bias, despite the limited literature on the subject. Various measures have been reported to be beneficial in preventing or managing PONV, such as the use of dexamethasone, antiemetic drugs, gastric aspiration, and anesthetic blocks. Effective bleeding control and faster surgeries can also be helpful. CONCLUSIONS: Throat packs have not been found to be effective in preventing PONV. Although no definitive protocol has been established in the literature, the Enhanced Recovery After Surgery (ERAS) protocol could be a useful approach. Overall, a multimodal approach may be taken to prevent PONV, and further research is needed to establish definitive protocols.

Evolution of the treatment of severe odontogenic infections over 50 years: A comprehensive review.

Objectives: Severe odontogenic infections remain a challenge for maxillofacial surgeons. The aim of this work is to review the literature to provide an update of knowledge on the topic. Methods: A comprehensive review of articles in PubMed, Web of Science and Africa Journals Online was performed through searching for "severe odontogenic infections." No language restrictions were applied. Only articles pertaining to treatment options were retrieved. Articles from the past 50 years were included. Results: A total of 84 articles from 39 countries worldwide were included. Severe odontogenic infections are not unique to low- and middle-income countries but also pose challenges in developed countries. Surgical management and antibiotic therapy for this type of infection is discussed. Some immunocompromised patients have high risks of complications and mortality rates. A world map of publications on the topic is provided. Conclusions: Several important aspects of managing severe odontogenic infections are discussed. Predictors of severity in addition to recommended antibiotic choice have been debated. Diabetes mellitus is a poor predictor of the prognosis of odontogenic infections.

Efeito da laserfototerapia sobre a viabilidade de diferentes tipos celulares em cultura submetidos a diferentes concentrações do alendronato sódico e ácido zoledrônico / Effect of low level laser therapy on viability of different cell types submitted to different concentrations of sodium alendronate and zoledronic acid

Os bisfosfonatos (BFs) têm sido amplamente utilizados para o tratamento de doenças do metabolismo ósseo, principalmente na prevenção de metástases ósseas e na prevenção e tratamento da osteoporose. No entanto, existem efeitos colaterais indesejáveis sendo um deles, a indução da Osteonecrose dos Maxilares (Medication-Related Osteonecrosis of the Jaws - MRONJ), uma complicação de difícil tratamento e solução. Até o presente momento, não foi definida a fisiopatologia da MRONJ e nem estabelecido protocolo de tratamento eficaz para esta doença. Diversas terapias vem sendo descritas na literatura para o tratamento da MRONJ dentre elas a laserfototerapia. Assim sendo, os objetivos deste estudo foram: inicialmente avaliar in vitro o efeito de diferentes concentrações dos BFs mais empregados na atualidade (alendronato e ácido zoledrônico) na viabilidade de células envolvidas na reparação de lesões MRONJ (osteoblastos e fibroblastos); secundariamente estudar o efeito da fototerapia com laser de baixa potência sobre estas células previamente induzidas pelos BFs. Foram utilizados osteoblastos-símile da linhagem OSTEO 1 e fibroblastos de mucosa bucal humana da linhagem FMM1. Após terem sido submetidos aos testes de citotoxicidade expondo as células as concentrações de 1?M, 10?M e 100?M de alendronato sódico e 3?M, 5?M e 10?M de ácido zoledrônico por 24 horas, os grupos testes foram irradiados com laser de diodo no modo contínuo, puntual e de contato (InGaAIP, 660nm, 30mW, spot 0,028cm2 ) com duas densidades de energia diferentes 5J/cm2 (4,5s) e 10J/cm2 (9s)

Duas irradiações com intervalo de 6 horas entre cada uma delas foram executadas. A viabilidade celular foi determinada utilizando o ensaio de redução do MTT, e a atividade de fosfatase alcalina dos osteoblastos foi avaliada utilizando ensaio de ponto final. Os resultados obtidos foram submetidos à análise estatística ANOVA 1 critério complementado por Tukey (p<0,05). Foi possível concluir que: as concentrações de 100?M e 10?M do alendronato sódico foram tóxicas para os osteoblastos e fibroblastos em cultura. As concentrações de 3?M, 5?M e 10?M do ácido zoledrônico foram tóxicas para os osteoblastos e fibroblastos a longo prazo (48h e 72h). A atividade da fosfatase alcalina nos osteoblastos foi afetada por todas as concentrações de ácido zoledrônico testadas (3?M, 5?M e 10?M). Nos parâmetros aqui aplicados a LPT não teve efeito sobre a atividade da fosfatase alcalina das células tratadas com o alendronato de sódio ou ácido zoledrônico. E a laserfototerapia de baixa potência nos parâmetros utilizados nesse estudo não foi capaz de reverter a toxicidade dos bisfosfonatos testados, independentemente das concentrações destas substâncias

Bisphosphonates (BPs) have been widely used for treating bone metabolism diseases, especially for prevention of bone metastasis and osteoporosis. However, there are undesirable side effects and one of them, the induction of Osteonecrosis of the Jaw (Medication-Related Osteonecrosis of the Jaws - MRONJ), a complication of difficult treatment and solution. Until now the pathophysiology and an effective treatment protocol for MRONJ have not been established. Various therapies have been described in the literature for the treatment of MRONJ including laserphototherapy. The objectives of this study were to evaluate the effect of different concentrations of two BPs used today (alendronate and zoledronic acid) on the viability of cells involved in the repair of MRONJ lesions (osteoblasts and fibroblasts); and to study the effect of phototherapy with low power laser on these cells previously treated with referred BPs. After being submitted to cytotoxicity testing by exposing the cells to concentrations of 1?M, 10?M and 100?M of sodium alendronate and 3?M, 5?M and 10?M of zoledronic acid for 24 hours, the test groups were irradiated with diode laser in continuous mode, punctual and contact (InGaAIP, 660nm, 30mW, spot 0,028cm2) with two different energy densities 5 J/cm2 (4,5s) and 10J/cm2 (9s)

Two irradiations with an interval of 6 hours between each of them were performed. Cell viability was determined using the MTT reduction assay, and the alkaline phosphatase activity of osteoblasts was evaluated using the end point assay. The results were submitted to statistical analysis using ANOVA 1 criteria complemented by Tukey (p <0.05). It was possible to conclude that: concentrations of 100?M and 10?M of alendronate were toxic to osteoblasts and fibroblasts in culture. The concentrations of 3?M, 5?M and 10?M of zoledronic acid was toxic to osteoblasts and fibroblasts in long-term (48h and 72h). The activity of alkaline phosphatase in osteoblasts was affected by all the zoledronic acid concentrations tested (3?M, 5?M and 10?M). In the LPT parameters applied here had no effect on alkaline phosphatase activity of the cells treated with the sodium alendronate or zoledronic acid. And low power laserphototherapy, in the parameters used in this study, was unable to reverse the toxicity of bisphosphonates tested, irrespective of the concentrations of these substances

Fatores determinantes para formação e, ou manutenção da papila peri-implantar: revisão de literatura / Factors for formation and, or maintenance of peri implant papilla: literature review

Introdução: a papila interproximal, entre outros requisitos, é considerada fundamental para o sucesso estético nas próteses sobre implantes. Método: o presente artigo é uma revisão da literatura baseada em periódicos publicados de 1984 a 2011, disponíveis nos bancos de dados da LILACS e da MEDLINE. Foram selecionados 21 artigos com o objetivo de evidenciar os fatores determinantes para formação e/ou manutenção da papila peri-implantar, tais como distância ideal entre dente e implante, entre implantes, sua posição supra ou infraóssea e a distância necessária do ponto de contato à crista óssea. Conclusão: concluiu-se que a distância ideal entre dente e implante é de 2mm, e a entre implantes é de 3mm, haja vista que a altura da papila gengival é sustentada pela formação do espaço biológico. Quanto ao posicionamento do implante (supra ou infraósseo), não foram relatadas diferenças quanto à formação da papila. Por fim, a altura determinante para a formação da papila do ponto de contato da coroa à crista óssea deve ser de até 5mm.

The interproximal papilla, among other requirements, is considered essential for success in aesthetic prostheses on implants. This article is based on a review of literature in journals from 1984 to 2011 in Lilacs and Medline. 21 articles were selected in order to highlight the factors determining the formation and / or maintenance of peri-implant papilla, such as distance between tooth and implant, implants between his position and the bone above or below the required distance from the contact point to the crest marrow. Concluded that the distance between tooth implant is 2 mm, between the implant and the implant is 3 mm, whereas the height of the gingival papilla formation is sustained by biological space. Regarding the positioning of the implant, bone supra or infra, no differences were reported as the papilla formation. And the height of the papilla determining the formation of the contact point to the bone crest crown should be up to 5 mm.

Coronectomia de terceiro molar inferior / Inferior third molar coronectomy

A técnica da coronectomia, também conhecida como odontectomia parcial intencional, foi 9 desenvolvida para minimizar o risco de lesão ao nervo alveolar inferior quando o terceiro molar a incluso e impactado apresenta raízes em relação de proximidade com o canal mandibular. É uma técnica controversa e tem ganhado muito espaço na literatura contemporânea da especialidade, com estudos clínicos randomizados e revisões sistemáticas que consigam comprovar a n evidência de sucesso na prevenção de traumatismos nervoso. O artigo apresenta um caso clínico s que descreve o diagnóstico radiográfico e tomográfico, a técnica da coronectomia utilizada, o controle pós-operatório e uma breve discussão da literatura.

Coronectomy or intentional partial odontectomy is an operatory maneuver developed to minimize traumatisms to the mandibular nerve when an impacted or non erupted third molar's presents great proximity to the alveolar nerve. It is a controversial technique although literature a has been increasing its attention in the last few years. Many randomized clinical studies and systematic reviews have been published in order to state clinical evidence on trauma prevention of e the alveolar nerve. This article presents a case report describing the radiographic and tomography diagnoses, coronectomy technical details, postoperative follow-up and a brief literature discussion.

Importância dos tratamentos complementares na terapêutica cirúrgica do tumor odontogênico queratocísitico / Importance of complementary treatment for the surgical therapy of the keratocystic odontogenic tumor

Tratamentos complementares como excisão tegumentar; ostectomia periférica e aplicação da solução de Carnoy minimizam a recorrência do tumor odontogênico queratocístico após a ecérese conservadora por enucleação ou curetagem, embora sejam desconsiderados por alguns cirurgiões. O artigo revisa as técncias citadas e relata a combinação delas em dois casos dessa neoplasia odontogência, mostrando resultado efetivo em acompanhamento mínimo de cinco anos.

Surgical management of dentigerous cyst and keratocystic odontogenic tumor in children: a conservative approach and 7-year follow-up.

Dentigerous cyst (DC) is one of the most common odontogenic cysts of the jaws and rarely recurs. On the other hand, keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst (OKC), is considered a benign unicystic or multicystic intraosseous neoplasm and one of the most aggressive odontogenic lesions presenting relatively high recurrence rate and a tendency to invade adjacent tissue. Two cases of these odontogenic lesions occurring in children are presented. They were very similar in clinical and radiographic characteristics, and both were treated by marsupialization. The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth. At 7-years of follow-up, none of the cases showed recurrence.

Surgical management of dentigerous cyst and keratocystic odontogenic tumor in children: a conservative approach and 7-year follow-up

Dentigerous cyst (DC) is one of the most common odontogenic cysts of the jaws and rarely recurs. On the other hand, keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst (OKC), is considered a benign unicystic or multicystic intraosseous neoplasm and one of the most aggressive odontogenic lesions presenting relatively high recurrence rate and a tendency to invade adjacent tissue. Two cases of these odontogenic lesions occurring in children are presented. They were very similar in clinical and radiographic characteristics, and both were treated by marsupialization. The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth. At 7-years of follow-up, none of the cases showed recurrence.

Osteonecrose maxilar associada ao uso de bisfosfonatos / Bisphosphonate-related osteonecrosis of the jaw

Os bisfosfonatos (BFs) têm sido indicados para o tratamento de doenças do metabolismo ósseo. Atualmente, seu emprego terapêutico aumentou e, com ele, os efeitos adversos, dos quais um dos mais importantes é a indução da osteonecrose dos maxilares, uma complicação de difíceis tratamento e solução. Até o presente, não se sabe ao certo qual é o mecanismo de desenvolvimento da osteonecrose dos maxilares induzida por bisfosfonatos (ONMB), nem qual deve ser o tratamento estabelecido perante essa manifestação. Apesar de a literatura apresentar formas variadas de tratamento, não existe um protocolo definido. Apresentamos uma revisão sobre a ONMB, enfocando sua etiopatogenia e as formas reportadas de tratamento.

Bisphosphonates (BPs) have been used for the management of bone metabolic diseases. Currently their therapeutic use has increased, as also have their adverse effects, one of the most important being the bisphosphonate-related osteonecrosis of the jaw (BRONJ), a complication of difficult treatment and solution. Until now, the physiopathology of BRONJ remains unclear, and its treatment is uncertain. Although the literature provides several treatment options, there is no defined protocol. We present a review about BRONJ, focusing on its pathogenesis and its reported forms of treatment.

Bisphosphonate-related osteonecrosis of the jaw.

Bisphosphonates (BPs) have been used for the management of bone metabolic diseases. Currently their therapeutic use has increased, as also have their adverse effects, one of the most important being the bisphosphonate-related osteonecrosis of the jaw (BRONJ), a complication of difficult treatment and solution. Until now, the physiopathology of BRONJ remains unclear, and its treatment is uncertain. Although the literature provides several treatment options, there is no defined protocol. We present a review about BRONJ, focusing on its pathogenesis and its reported forms of treatment.

Nodular lymphocyte predominance Hodgkin lymphoma of the parotid gland: a case report.

The parotid is the most frequent site of primary salivary gland tumors. Lymphomas represent 0.2 to 0.8% of all malignant parotid tumors. Primary Hodgkin lymphoma of the parotid gland is rare with few cases reported in literature. The nodular lymphocyte predominance Hodgkin lymphoma (HL) is considered a particular clinical and histopathological subtype of HL. It has never been reported in the parotid gland since its incorporation in the 2001 World Health Organization Classification. The authors describe a case of a 32-year-old male who sought medical attention because of a one-year history of right cheek enlargement. A parotid nodule was submitted to a fine needle aspiration biopsy which disclosed a suspected lymphoproliferative disorder. A surgical dissection of the parotid gland was performed and an enlarged intraparotid lymph node measuring 4cm in its longest axis was excised, preserving the parotid gland integrity as well as the facial nerve. The pathological examination disclosed the diagnosis of nodular lymphocyte predominance Hodgkin lymphoma in this lymph node within the parotid gland. The treatment was completed with local radiotherapy and the 5-year follow up was uneventful.

Ocorrência de acidentes pérfuro-cortantes em um Curso de Odontologia / Accidents cutting and piercing in a School of Dentistry

Objetivo: Avaliar o índice de ocorrências e as características dos acidentes, notificados, envolvendo materiais pérfuro-cortantes em alunos, funcionários e professores, no período entre 2000 e 2005 na Clínica Odontológica da Faculdade de Odontologia da Universidade de São Paulo. Métodos: Foi realizado levantamento das fichas de notificações de ocorrências de acidentes, considerando o material que provocou oacidente, o período do dia da ocorrência, a disciplina em que ocorreu e a conduta clínica executada no pronto atendimento. Foram ainda considerados, quando disponíveis, os resultados dos exames laboratoriais do acidentado e do paciente fonte. Resultados: Os dados avaliados mostraram 40 notificações de acidentes, sendo que 39 notificações foram envolvendo alunos de graduação e um funcionário. O instrumento que mais provocou acidente foi a agulha de anestesia e o maior número desses acidentes aconteceu na disciplina de Cirurgia. Entretanto, 50% das fichas não apresentavam as informações completas o que impediu uma avaliação epidemiológica mais apurada. Conclusão: Os dados obtidos permitiram concluir que o índice de ocorrência de acidentes foi extremamente baixo considerando o número de atendimentos clínicos realizados no período e levanta-se a hipótese de que muitos casos não foram notificados.

Objective: To assess the occurrence and characteristics of the reported accidents with perforating-cutting materials involving students, staff and faculty members, between 2000 and 2005 at the Dental Clinic of the School of Dentistry of the University of São Paulo. Methods: A survey of the records of reported occurrences of accidents was made, considering the material that caused the accident, time of day of the occurrence, the discipline in which it occurred, and clinical conduct adopted in the emergency room. When available, the results of the laboratory exams of the accident victim and the source patient were also taken into consideration. Results: The data assessed showed there were 40 accident reports, of which 39 reports involved undergraduate students and 1 staff member. The instrument that caused most accidents was the anesthetic needle and largest number of these accidents occurred in the Surgery discipline. However, 50% of the records did not present complete information, which prevented a more accurate epidemiological assessment. Conclusion: The data obtained led to the conclusion that the rate of accidents is extremely low considering the number of clinical attendances provided in the period and raises the hypothesis that many cases were not reported.

Correlação da impactação de terceiros molares com a ausência de dentes / Relationship of third molar impaction with the absence of teeth

A literatura relata que a freqüência de impactação dos terceiros molares vem aumentando na população. Este trabalho teve como objetivo pesquisar, por meio de radiografias panorâmicas, o estado de impactação óssea dos terceiros molares com relação a ausência ou não de outros dentes no hemiarco correspondente. Foram incluídas radiografias que apresentassem pelo menos um terceiro molar, que foram classificados em dentes com ou sem impactação óssea, e divididos em: Grupo 1, terceiros molares que apresentavam ausência de um ou mais dentes no seu hemiarco; e Grupo 2, que não apresentavam ausência de dentes. O Grupo 1 também foi subdividido de acordo com o tipo de dente ausente (segundo molar, primeiro molar e pré-molar e/ou dente anterior). Ao total, foram incluídas 802 radiografias com 2.219 terceiros molares. As análises estatísticas dos resultados revelaram que os terceiros molares do Grupo 1 apresentaram menor freqüência de impactação óssea quando comparados aos do Grupo 2. Além disso, foi observado que quanto mais próximo do terceiro molar estava localizada a ausência, maior foi a influência dessa no estado de impactação. Foi possível concluir que a ausência de dentes foi correlacionada à diminuição de impactação dos terceiros molares.