Surgical treatment of a rare bilateral synovial chondromatosis.

Synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is an uncommon entity, mostly when the involvement is bilateral. The authors report a rare case of bilateral SC, with a follow-up of 13 months, and a literature review. A 60-year-old Caucasian woman, with the chief complaint of pain for 6 years in the bilateral pre-auricular region, had a progressive clacking and discomfort on the left side during mouth opening. The panoramic image was suggestive of SC. The bilateral lesion was surgically removed by direct access. Histopathological examination confirmed the clinical diagnosis of bilateral SC. This article shows the importance of a multidisciplinary approach for the early diagnosis and appropriate treatment. Also, it encourages the referral of such cases to professionals with a greater familiarity with this entity.

Surgical treatment of a rare bilateral synovial chondromatosis

Synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is an uncommon entity, mostly when the involvement is bilateral. The authors report a rare case of bilateral SC, with a follow-up of 13 months, and a literature review. A 60-year-old Caucasian woman, with the chief complaint of pain for 6 years in the bilateral pre-auricular region, had a progressive clacking and discomfort on the left side during mouth opening. The panoramic image was suggestive of SC. The bilateral lesion was surgically removed by direct access. Histopathological examination confirmed the clinical diagnosis of bilateral SC. This article shows the importance of a multidisciplinary approach for the early diagnosis and appropriate treatment. Also, it encourages the referral of such cases to professionals with a greater familiarity with this entity.

Anquilose da articulação têmporo-mandibular em criança: relato de caso clínico / Temporomandibular joint ankylosis in children: case report

Anquilose da articulação temporo mandibular (ATM) pode ser definida como a fusão das superfícies articulares da mandíbula com o crânio, resultando em severos problemas para seus portadores. Os fatores causais mais comuns são: trauma, infecção e doença sistêmica. Diversos sistemas de classificação têm sido propostos, dentre eles o estabelecido por Sawhney (1986), que divide essa patologia em 4 estágios. Diversas formas de tratamento têm sido empregadas, tais como artroplastia em gap, artroplastia interposicional e reconstrução articular. Kaban estabeleceu um protocolo de tratamento para pacientes pediátricos, muito utilizado na atualidade, apresentando boas taxas de sucesso. O objetivo do trabalho foi relatar um caso de uma criança com anquilose bilateral da ATM, tratada seguindo esse protocolo, com sucesso em seu objetivo de restaurar a função mandibular, apesar da possibilidade de procedimentos complementares futuros para finalização do caso.

Ankylosis can be defined as a fusion of the articular surfaces of the jaw to the skull, resulting in severe problems for its sufferers. The most common causal factors are trauma, infection and systemic disease. Several classification systems have been proposed, among them established by Sawhney (1986), which divides this disease into four stages. Several forms of treatment have been employed, such as gap arthroplasty, interpositional arthroplasty and joint reconstruction. Kaban established a treatment protocol for pediatric patients widely used today with good success rates. The aim of the study was to report a case of a child with bilateral ankylosis, treated according to this protocol with success in the goal to restore jaw function despite the possibility of future additional procedures for completion of the case.

The use of a bite fork to help mobilize the maxilla after downfracture during the Le Fort I osteotomy. A technical note.

INTRODUCTION: The Le Fort I osteotomy is indicated to reposition the maxilla in the surgical correction of dentofacial deformities. Although it is a known surgical step, like any surgical procedure, it can have complications and difficulties; among these, the initial mobility of the jaw is very common after completing all corticotomies. METHODS: The authors present a technique in which the bite fork is used as an auxiliary tool in maxilla downfracture, especially in cases of maxillary impaction where vertical space is created on the walls of the corticotomy. FINDINGS: As the bite fork acts as a scraper with a long leverage arm, an advantage would be the better distribution of forces along the corticotomy, minimizing the risk of bad fracture and facilitating maxillary downfracture movement.

Inicial nasal mucosa detachment using piezoelectric device in the Le Fort I osteotomy: A technical note.

In maxillary Le Fort I type osteotomy the detachment of the nasal mucosa should be done carefully. Piezoelectric surgery contributed much to increase the safety of osteotomies, despite the initial advantage of minimizing the risk of injury in nervous tissue, mainly in bilateral sagittal split osteotomy; we use the piezoelectric device for the initial detachment of the nasal mucosa in the maxillary osteotomy.

Patterns of paediatric facial fractures in a hospital of São Paulo, Brazil: a retrospective study of 3 years.

The objective of this study is to analyze patterns of facial fractures in children treated at the Service of Oral and Maxillofacial Surgery of the Vila Penteado General Hospital (HGVP), in São Paulo, Brazil, in a period of 3 years. Between May 2008 and April 2011 the authors reviewed 110 records of patients under 12 years old with facial fractures. The following parameters were evaluated: age and sex distribution, aetiology of trauma, incidence and type of fractures, monthly distribution and treatment modality. Male-to-female ratio was 1.8:1, and the mean age was 8.13. The majority of the involved patients were aged between 6 and 12 years. The most prevalent cause was fall (58%) and nasal fractures were the most common type of fracture (69%). Monthly distribution was similar in all seasons. Of 110 patients, 69 (62%) were treated conservatively. The incidence of facial fractures in the area of study is high. The high incidence of nasal fractures should be a warning to maxillofacial surgeons, so that they are not overlooked. Safety programs should be installed in Brazil to increase public awareness and to decrease morbidity resulting from paediatric trauma.

Ultrasonographic evaluation of intramandibular ameloblastoma.

Ultrasonography (US) is the diagnostic tool of choice for evaluating soft tissue lesions in the head and neck region. It is an economic, noninvasive, easily performed exam and provides real-time images, without the exposure to ionizing radiation, and contrast media is not required. It is usually believed that bone tissue constitutes an obstacle for its utilization, due to the reflection of sonographic waves. A case of mandibular intraosseous cystic pathology is reported, with utilization of US for evaluating the content of the lesion and planning the surgical procedure.

Indicações de remoção de material de síntese no complexo maxilofacial: revisão sistemática de literatura / Indications for removal of synthesis material in maxillofacial complex: Systematic literature review

O objetivo desta revisão sistemática de literatura é avaliar indicações para remoção ou não do material de síntese utilizado no tratamento cirúrgico das fraturas da face. Utilizou-se para a revisão de literatura o índice ?Medline? com as palavras-chave ?facial fracture and miniplates removal?, onde foram encontrados 06 artigos publicados entre os anos de 1998 a 2007 e que apresentavam indicações para a remoção de material de síntese. As principais indicações para a remoção foram: infecção, dor, placas palpáveis e exposição. Concluiu-se que não existem estudos definitivos quanto a melhor conduta a ser tomada, cabendo ao cirurgião avaliar cada caso para definir qual a melhor conduta a ser tomada

The objective of this systematic literature review is to present justifications or not, and indications for the removal of plates and screws used in the treatment of facial fractures. It was used, for the literature revision, the index ?Medline? with the key-word ?facial fracture and miniplates removal?, we found 06 articles published from 1998 to 2007 that presented indications for the removal of synthesis material. The main indications for the removal were: infection, pain, palpable plates and plate exposure. The conclusion was that definitive studies, regarding the best conduct to be taken, still don?t exist. The surgeon must evaluate each case to define the best conduct to take

Bilateral lower second molar impaction in teenagers: an emergent problem?

The frequency of simultaneously impacted second and third molars in teenagers is increasing and becoming a common occurrence in adolescent oral surgery practice. The traditional treatment is the removal of the third molar by conventional access but repositioning of the surgical flap to the distal face of the first molar can predispose to complications such as pericoronitis and delayed healing of the attached gingiva. We present a case in which we use the germectomy approach to remove the impacted third molar for the eruption of the second molar through a vestibular incision. This incision offers excellent bone exposure and exit route for the third molar without disturbing the gingiva attached architecture on the distal face of the first molar providing good healing environment.