RESUMO
ABSTRACT To report one case of bleeding episodes after impacted teeth extractions had been performed in a patient with undiagnosed clotting disorder, describing a sequence of approaches for hemostasis up to the appropriated diagnosis and effective resolution. A male 16-year old patient with surgical indication to remove eight impacted teeth. After the surgery, there were bleeding episodes, being needed for hospital admission to keep on his physiological functions, blood pressure and heartbeat frequency regularly, to carry out laboratory blood tests, and to achieve hemostasis by using antifibrinolytics and blood products. After 24 hours, 11% of IX clotting factor was verified into bloodstream by specific blood test, being diagnosed with mild Hemophilia B. From the diagnosis, infusions of IX clotting factor were performed to the adequate resolution and recovery of the patient. The clinical conducts were efficient to keep on stable vital signs and achieving appropriate diagnosis. However, preventive behaviors should be applied in hemophilic patients in pre- or intra-operative, avoiding circumstances that can compromise health condition of the patient.
RESUMO Relatar um caso de episódios de sangramento após remoção de dentes inclusos em paciente com distúrbio de coagulação não diagnosticado, descrevendo uma sequência de condutas para hemostasia até o diagnóstico apropriado e resolução efetiva. Paciente do gênero masculino, 16 anos, com indicação de remoção de 8 dentes inclusos. Após a cirurgia, houve episódios de sangramento, sendo necessária sua internação para integridade das funções orgânicas básicas, realização de exames laboratoriais, controle hemodinâmico e tentativa de obtenção de hemostasia por meio de antifibrinolíticos e hemoderivados. Após 24 horas de internação, 11% do fator IX de coagulação foi verificado na corrente sanguínea por meio de exame específico, sendo o paciente diagnosticado com Hemofilia B de caráter leve. A partir do diagnóstico, infusões do fator deficiente foram realizadas para resolutividade adequada e recuperação do paciente. As condutas realizadas foram eficientes para manutenção dos sinais vitais até a hemostasia obtida após diagnóstico adequado. No entanto, as condutas preventivas devem ser aplicadas em pacientes hemofílicos no pré- ou trans-operatórios, evitando circunstâncias que podem comprometer o estado de saúde do paciente.
RESUMO
Dentofacial deformities (DFD) presenting mainly as Class III malocclusions that require orthognathic surgery as a part of definitive treatment. Class III patients can have obvious signs such as increasing the chin projection and chin throat length, nasolabial folds, reverse overjet, and lack of upper lip support. However, Class III patients can present different facial patterns depending on the angulation of occlusal plane (OP), and only bite correction does not always lead to the improvement of the facial esthetic. We described two Class III patients with different clinical features and inclination of OP and had undergone different treatment planning based on 6 clinical features: (I) facial type; (II) upper incisor display at rest; (III) dental and gingival display on smile; (IV) soft tissue support; (V) chin projection; and (VI) lower lip projection. These patients were submitted to orthognathic surgery with different treatment plannings: a clockwise rotation and counterclockwise rotation of OP according to their facial features. The clinical features and OP inclination helped to define treatment planning by clockwise and counterclockwise rotations of the maxillomandibular complex, and two patients undergone to bimaxillary orthognathic surgery showed harmonic outcomes and stables after 2 years of follow-up.
