RESUMO
ABSTRACT Pathological mandibular fractures are fractures induced by pathologies affecting the mandible's base or those resulting from forces that would typically be tolerable if the bone were not compromised by an underlying condition. These fractures often present complex clinical scenarios owing to the compromised bone integrity caused by the pathology, which impedes resolution. Systemic changes may also diminish the capacity for bone neoformation, significantly limiting therapeutic options. Therefore, this study aimed to provide a comprehensive review of the published scientific literature and present clinical cases related to the treatment and prevention of pathological mandibular fractures. A literature review was conducted, focusing on case reports indexed in the MEDLINE and SCIELO databases using specific keywords as descriptors. The search yielded ten articles, which described the etiopathogenesis, classified as infectious, idiopathic, benign pathology, malignant pathology, and iatrogenic. The literature suggests that prioritizing surgery to address the underlying local pathology is crucial. Managing the remaining bone defect optimally may necessitate multiple surgical interventions. Furthermore, preventive measures should be implemented in potential iatrogenic cases. Notably, fractures of malignant, idiopathic, hereditary, and metabolic etiologies may indicate the initial manifestation of diseases.
RESUMO As fraturas patológicas mandibulares são aquelas provocadas por patologias que envolvem a base da mandíbula ou que ocorrem por forças de carga que seriam toleradas de forma normal caso o osso não fosse enfraquecido subjacentemente. Os pacientes com fraturas patológicas de mandíbula tendem a apresentar situações clínicas complexas, com limitação ou comprometimento ósseo causado pela patologia que dificulta a sua resolução bem como diminuição da capacidade de neoformação óssea pelas alterações de ordem sistêmica que podem restringir significativamente as alternativas terapêuticas. Desta forma, o objetivo do presente trabalho é revisar a literatura científica publicada e apresentar casos clínicos sobre tratamento e prevenção de fratura patológica mandibular. Uma revisão de literatura foi realizada a partir de relatos de caso indexados nas bases de dados MEDLINE e SCIELO com palavras-chave utilizadas de acordo com seus descritores específicos. A pesquisa resultou em dez artigos descrevendo como etiopatogenia causas classificadas como de origem infecciosa, idiopática, patologia benigna, patologia maligna e iatrogenia. A literatura preconiza que a cirurgia para o tratamento da patologia local seja a prioridade e que o defeito ósseo remanescente seja administrado da melhor maneira que o caso permitir, podendo ser corrigido em mais de um tempo cirúrgico. Os possíveis casos iatrogênicos devem ter condutas preventivas. Fraturas de etiologia maligna, idiopática, hereditária e metabólica apresentam a possibilidade de sinalização da primeira manifestação das doenças.
RESUMO
The purpose of this study was to analyze the pacing strategy and its affective consequences during self-paced cycling time trials (TT) performed at different severity of hypoxia. Eight competitive cyclists performed five 30 min self-paced TTs at their best performance in the following conditions: 1) normobaric normoxia (NNSL); 2) normobaric hypoxia under two simulated altitudes: 2000 m (NH2000) and 3500 m (NH3500) and 3) normobaric hypoxia but the cyclists were deceived and thought to be at sea level for 2000 m (DecNH2000) and 3500 m (DecNH3500). Power Output (PO), oxygen uptake (VO2), and blood lactate concentration ([La]) were recorded to assess exercise intensity and physiological adaptations. The rate of perceived exertion (RPE) and pleasure were measured with a CR10 Borg scale to evaluate the affective load (AL). PO and VO2 decreased with the severity of hypoxia but no significantly difference on performance was measured between deceived and real conditions, except for pacing strategy. The started intensity depends on the exercise expectations, but PO was rapidly adjusted with the physiological constraints and the rate of increase of RPE. Finally, AL did not reach maximal values so that the athletes sustained a physiological and emotional reserve to perform a final spurt.