Masseter muscle thickness three years after surgical correction of class III dentofacial deformity.

OBJECTIVE: To analyse the effect of integrated orthodontic treatment, orthognathic surgery and orofacial myofunctional therapy on masseter muscle thickness in patients with class III dentofacial deformity three years after orthognathic surgery. DESIGN: A longitudinal study was conducted on 13 patients with class III dentofacial deformities, denoted here as group P1 (before surgery) and group P3 (same patients 3 years to 3 years and 8 months after surgery). Fifteen individuals with no changes in facial morphology or dental occlusion were assigned to the control group (CG). Masseter muscle ultrasonography was performed in the resting and biting situations in the three groups. Data were analysed statistically by a mixed-effects linear model considering a level of significance of P < 0.05. RESULTS: Significantly higher values (P < 0.01) of masseter muscle thickness (cm) were detected in group P3 (right rest: 0.82 ± 0.16, left rest: 0.87 ± 0.21, right bite: 1 ± 0.22, left bite: 1.04 ± 0.28) compared to group P1 (right rest: 0.63 ± 0.19, left rest: 0.64 ± 0.15, right bite: 0.87 ± 0.16, left bite: 0.88 ± 0.14). Between P3 and CG (right rest: 1.02 ± 0.19, left rest: 1 ± 0.19, right bite: 1.18 ± 0.22, left bite: 1.16 ± 0.22) there was a significant difference on the right side of the muscle (P < 0.05) in both situations and on the left side at rest. CONCLUSION: The proposed treatment resulted in improved masseter muscle thickness in patients with class III dentofacial deformity.

Do foreign bodies migrate through the body towards the heart?

UNLABELLED: Fixation of foreign bodies (FB), in the mucosa, can favor its migration, giving origin to the popular saying: 'FB walk to the heart'. AIM: Describe the mechanisms involved in FB migration and how to diagnose them. METHODOLOGY: From a sample of 3,000 foreign bodies, during 40 years, we analyzed four which had extra-lumen migration. We analyzed clinical, radiologic, endoscopic and ultrasound data collected at the medical documentation service. RESULTS: Three clinical histories are presented, describing two fish bones and one piece of fish cartilage. FB shifting was analyzed in all of them. Migration started in the esophagus in two, one going to the aorta and the other to the neck area. In the other two, migration started in the pharynx, and the FB moved towards the prevertebral fascia and the other externalized in the submandibular region. The mechanisms and the risks posed to the patient, by FB migration, and the way to diagnose them are hereby discussed. CONCLUSIONS: The study allows us to determine that FB can move through the body but not towards the heart. The study also serves as a warning sign: in cases of prolonged histories of FB ingestion, imaging studies are mandatory before endoscopic examination.

Reconstruction of two mandible defects with one fibular flap.

The present report describes an original surgical procedure for the mandibular reconstruction of 2 different defects using a single fibular flap. In addition to the habitual osteotomies, we resected a bone fragment from the middle portion of the flap, with care taken to maintain the integrity of the pedicle throughout its extension to guarantee an adequate blood supply also for the distal portion of the bone flap used for the treatment of the smaller mandibular defect. This simple maneuver permitted the reconstruction of 2 mandibular regions with well-vascularized bone tissue using a single microsurgical flap.

Reconstruction of mandibular segmental defects using the guided-bone regeneration technique with polylactide membranes and/or autogenous bone graft: a preliminary study on the influence of membrane permeability.

PURPOSE: Bone maintenance after mandibular reconstruction with autogenous iliac crest may be disappointing due to extensive resorption in the long term. The potential of the guided-bone regeneration (GBR) technique to enhance the healing process in segmental defects lacks comprehensive scientific documentation. This study aimed to investigate the influence of polylactide membrane permeability on the fate of iliac bone graft (BG) used to treat mandibular segmental defects. MATERIALS AND METHODS: Unilateral 10-mm-wide segmental defects were created through the mandibles of 34 mongrel dogs. All defects were mechanically stabilized, and the animals were divided into 6 treatment groups: control, BG alone, microporous membrane (poly L/DL-lactide 80/20%) (Mi); Mi plus BG; microporous laser-perforated (15 cm(2) ratio) membrane (Mip), and Mip plus BG. Calcein fluorochrome was injected intravenously at 3 months, and animal euthanasia was carried out at 6 months postoperatively. RESULTS: Histomorphometry showed that BG protected by Mip was consistently related to larger amounts of bone compared with other groups (P

Effect of treatment of dentofacial deformity on masseter muscle thickness.

OBJECTIVE: The objective of the present study was to determine the modifications in masseter muscle thickness before and after interdisciplinary orthodontic, oromyofunctional and surgical treatment of class III dentofacial skeletal deformities (DFSD). DESIGN: Fifteen patients with class III DFSD participated in the study, denoted P1 group before the interdisciplinary treatment and P2 group (same patients) 6-8 months after surgery. Fifteen individuals with no DFSD were used as the control group. Bilateral ultrasonography (US) of the masseter muscle under resting and biting conditions was performed in the three groups. RESULTS: There was a significant difference (P<0.01) for all muscles tested between the control, P1 and P2 groups, with greater thickness for controls, intermediate thickness for P2, and the lowest thickness for P1 in all situations evaluated. CONCLUSION: We conclude that there was an increase in masseter muscle thickness after surgical correction of DFSD accompanied by interdisciplinary treatment, although the values were still lower than those observed in the control group.

Effects of time of contact and concentration of caustic agent on generation of injuries.

OBJECTIVES: Solid caustic soda (CS) ingestion levels continue high in Brazil. The aggressiveness of a caustic agent depends, among other factors, on its concentration and time of contact with mucosa. However, the interdependence of these factors in the production of caustic lesion in the esophageal mucosa is not known, especially regarding CS as the strongest corrosive agent. We analyze the effects of concentration and time of contact on the aggressiveness of CS to the esophagus of live animals. STUDY DESIGN/METHODS: One milliliter of CS at concentrations between 1.83% and 73.33% was applied to rats. The solution was kept in contact with the mucosa for 10 to 120 minutes. Internal and external organ aspects were analyzed and the epithelium, submucosa, muscle layer, and adventitia were analyzed microscopically RESULTS: Epithelial necrosis was observed at all concentrations. Among the necrotic layers, the submucosa was observed starting at the 7.33% concentration, and the muscular layer and adventitia were observed at 14.66% concentration. Damage to the pulmonary parenchyma and trachea occurred at 33.66% after 10 minutes, and perforation of the esophagus was observed only after 120 minutes. After 10 minutes, important corrosive lesions installed in the esophageal layers, expanding in depth and superficial extension. The use of heparin had no effect on the production of lesions. CONCLUSIONS: Ten minutes were sufficient to provoke necrosis, and longer contact increased the area of necrosis. Solution concentration levels were more important in damage production: 1.83% was sufficient for epithelial necrosis, 7.33% caused submucosal necrosis, and 14.66% muscle and adventitia necrosis; 33.66% solutions caused lung and trachea damage after 10 minutes and esophageal perforation after 120 minutes.

Effect of mandibular titanium reconstructive plates on radiation dose.

BACKGROUND: The effects of the mandibular titanium alloy plates on the radiation-tissue interactions are not clearly defined. Photon beam radiation may be modified after striking a metal plate used to reconstruct the mandible after oncologic surgery. The purpose of this study was to determine, in a human mandible model, the effects of a titanium alloy plate on the radiation dose received at the bone/titanium (plate and screws) interface and bone/soft tissue interface. METHODS: We used an adult male human head and neck ex vivo model. A medical grade titanium alloy 6-hole plate, 2.4 mm, was fixed in the midline of the mandible. The mandible was then irradiated using 6 MV photon beams. Thermoluminescent dosimeters were used to measure the radiation doses anterior and posterior to the mandible. The experiment was then repeated without the plate and screws. RESULTS: The difference between the average doses received by the mandible reconstructed with plate/screws and a mandible without plate/screws was +2.1% at the buccal aspect of the mandible and +3.0% at the lingual aspect; respective P values were.741 and .323. Thus, these differences were not statistically significant. CONCLUSION: In this study, we did not observe any significant influence of titanium alloy plate/screws on the radiation doses received by tissues anterior or posterior to the mandible.

Endoscopically placed expandable metal tracheal stents for the management of complicated tracheal stenosis.

BACKGROUND: Metal stents have been advocated to manage complicated tracheal stenosis. OBJECTIVE: The purpose of this investigation is to review the effectiveness of endoscopic placement of tracheal expandable metal stents for complicated tracheal stenosis. METHODS: The charts of 6 patients who have undergone placement of metal expandable stents between 1998 and 2000 were reviewed. RESULTS: Initially, all patients enjoyed immediate palliation of symptomatic tracheal stenosis. Eventually, 4 patients developed significant granulation tissue and/or recurrent stenosis, requiring intervention within 6 months after placement of the stent. One patient required the removal of the stent and placement of a T-tube silicone stent. CONCLUSIONS: Metal stents provide temporary palliation for tracheal stenosis. Metal stents, however, are associated with a high incidence of obstruction with granulation tissue. Their use should be limited to a select group of patients with a short life expectancy (because of other comorbidities) or patients who are not good candidates for reconstructive surgery and/or who refuse or cannot tolerate a tracheotomy.

O uso de Picibanil (OK-432) no tratamento do linfangioma de cabeça e pescoço / The use of Picibanil (OK-432) for treatment of lymphangioma in the head and neck

Introduçäo e Objetivo: O Linfangioma Cérvico-Facial (LCF) é geralmente um tumor volumoso, envolvendo estruturas importantes da face e do pescoço. A terapia habitualmente recomendada é a retirada cirúrgica, porém, esta é geralmente seguida de seqüelas importantes, causando deformidade da regiäo. Com o objetivo de avaliarmos uma terapêutica alternativa, analisamos a eficiência do Picibanil (OK 432) no tratamento de LCF em crianças. Forma de Estudo: Clínico retrospectivo. Material e Método: Estudo retrospectivo de seis crianças com diagnóstico de LCF tratadas com OK-432 no HCFMRP-USP no período de 1997 a 2001. Foram analisadas as seguintes características dos LCF: dimensöes, tipos de cistos e volume aspirado. Avaliamos, também, o número de aplicaçöes de OK 432 com os respectivos intervalos de tempo utilizados, sua evoluçäo, intercorrências e o resultado final do tratamento. Resultados: Os LCFs apresentavam de oito a 15cm em seu maior diâmetro, na ocasiäo da primeira consulta, sendo o tipo de cisto mais freqüentemente encontrado o tipo macro cisto. O volume de liquido aspirado variou de dois a 60 ml e o número de aplicaçöes de uma a cinco vezes em intervalos variáveis de um mês a um ano. Em todos os pacientes ocorreu regressäo da massa tumoral, sendo que em três houve o desaparecimento total do LCF. A única intercorrência observada foi febre em media de 38.2º C em todos pacientes. Conclusäo: O OK 432 é uma droga segura, eficaz e que pode ser utilizada como medida de primeira escolha no tratamento do LCF

Influence of esophageal motility on esophageal speech of laryngectomized patients.

After laryngectomy for treatment of cancer of the larynx, the patient may have vocal rehabilitation by esophageal speech. Some patients fail to achieve the esophageal speech due to reasons involving surgery, radiotherapy, and psychological alterations. Our hypothesis is that the esophageal motility alterations consequent to laryngectomy may be involved in the failure to achieve esophageal speech. Using manometry with continuous perfusion, we studied the esophageal motility of 25 laryngectomized patients, 10 of them able to produce esophageal speech and 15 unable to produce esophageal speech, and 40 asymptomatic normal volunteers. The lower esophageal sphincter (LES) pressure was measured by the rapid pull-through method and the upper esophageal sphincter (UES) pressure by the station pull-through method. The contractions were measured at 5, 10, and 15 cm above the LES after the subjects performed 10 swallows with a 5-mL bolus of water. By comparing volunteers and laryngectomized patients, we found a lower UES pressure, lower amplitude of contractions, and increased percentage of simultaneous contractions in laryngectomized patients (p < 0.05). There was no difference between patients able and unable to produce esophageal speech in LES and UES pressure, esophageal contraction duration and velocity, or in the percentage of failed and simultaneous contractions. The esophageal contraction amplitude was lower in patients who acquired esophageal speech than in patients who did not (p < 0.05 at 10 cm from LES). We conclude that there are esophageal motility alterations in laryngectomized patients but only the decrease of esophageal contraction amplitude seems to be associated with the acquisition of esophageal speech.

Suporte nutricional a pacientes com câncer de cabeça e pescoço com dieta quimicamente definida por via enteral / Nutritional support to patients with head and neck cancer with chemically defined enteral feeding

A desnutriçäo protéico-enegética é um sério problema que se associa freqüentemente ao câncer e, particularmente, aos de cabeça e pescoço. No presente trabalho, descreve-se a evoluçäo clínico-nutricional de vinte pacientes com doença maligna da cabeça e pescoço que foram sumbmetidos a suporte nutricional enteral com dieta quimicamente definida (aminoácidos, sacarose, vitamina, eletrólitos e elementos traços). A duraçäo do suporte variou entre 12 133 dias, abrangendo o período de hospitalizaçäo para o tratamento cirúrgico. A avaliaçäo da eficiência do suporte foi realizada usando-se a variaçäo dos parâmetros antropométricos e laboratoriais. Os resultados observados demonstram uma média de ganho de pêso de 3.7kg. O ganho de peso que deveu, aparentemente, ao aumento de massa adiposa e massa muscular (prega triciptal: admissäo - 7.03 mm, alta 8.4 mm; circunferência muscular: admissäo - 21.85 cm, alta - 22.72 cm). Näo foram observadas diferenças significativas nos níveis de albumina sérica, capacidade total de ligaçäo ao ferro e contagem de linfócitos. Esses resultados evidenciam que o suporte nutricional agressivo a pacientes com câncer de cabeça e pescoço representa um instrumento terapêutico de valor no combate à desnutriçäo, especialmente no grupo submetido a cirurgias extensas