Two- and Three-Segment Surgically Assisted Rapid Maxillary Expansion: A Clinical Trial.

BACKGROUND: The literature shows no consensus on whether two- or three-segment surgically assisted rapid maxillary expansion is the best operative technique. METHODS: The present clinical trial was designed to compare the outcome of two- and three-segment osteotomy surgically assisted rapid maxillary expansion. Thirty-two adult patients with transverse maxillary deficiency greater than or equal to 5 mm were randomly assigned to two- and three-segment groups (n = 16). Dimensional and psychological assessments (Oral Health Impact Profile and Brazilian Orthognathic Quality of Life Questionnaire) were carried out before surgical intervention and at one of the following time points: completion of expansion, removal of expanding device, 6 months after completion of expansion, or 10 months after completion of expansion. Dimensional assessments for asymmetric expansion of the maxilla and for changes in the area and volume of the palatine vault were performed on digital data from tomographic and laser scanning with the aid of an engineering inspection software. RESULTS: No statistically significant differences were found in asymmetry or stability outcomes between groups. The psychological benefit provided by the three-segment technique did not spread through the domains of the quality-of-life questionnaires. CONCLUSIONS: The current findings suggest that three-segment surgically assisted rapid maxillary expansion outcomes do not exceed those obtained with its two-segment counterpart regarding symmetry of maxillary expansion and stability of area and volume of the palatine vault. Furthermore, psychological nuances evidenced in two- and three-segment groups with the tools used play a limited, short-lasting role, or a specific, more sensitive assessment tool needs to be developed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Soccer-related Facial Trauma: Multicenter Experience in 2 Brazilian University Hospitals.

BACKGROUND: Soccer is the most popular sport in Brazil and a high incidence of related trauma is reported. Maxillofacial trauma can be quite common, sometimes requiring prolonged hospitalization and invasive procedures. To characterize soccer-related facial fractures needing surgery in 2 major Brazilian Centers. METHODS: A retrospective review of trauma medical records from the Plastic Surgery Divisions at the Universidade Federal de São Paulo-Escola Paulista de Medicina and the Hospital das Clinicas-Universidade de São Paulo was carried out to identify patients who underwent invasive surgical procedures due to acute soccer-related facial fractures. Data points reviewed included gender, date of injury, type of fracture, date of surgery, and procedure performed. RESULTS: A total of 45 patients (31 from Escola Paulista de Medicina and 14 from Universidade de São Paulo) underwent surgical procedures to address facial fractures between March 2000 and September 2013. Forty-four patients were men, and mean age was 28 years. The fracture patterns seen were nasal bones (16 patients, 35%), orbitozygomatic (16 patients, 35%), mandibular (7 patients, 16%), orbital (6 patients, 13%), frontal (1 patient, 2%), and naso-orbito-ethmoid (1 patient, 2%). Mechanisms of injury included collisions with another player (n = 39) and being struck by the ball (n = 6). CONCLUSIONS: Although it is less common than orthopedic injuries, soccer players do sustain maxillofacial trauma. Knowledge of its frequency is important to first responders, nurses, and physicians who have initial contact with patients. Missed diagnosis or delayed treatment can lead to facial deformities and functional problems in the physiological actions of breathing, vision, and chewing.

Transverse effects after surgically assisted rapid maxillary expansion in the midpalatal suture using computed tomography.

Surgically assisted rapid maxillary expansion is the treatment of choice for correcting maxillary transverse deficiency in adults. Traditionally, the appliance for expansion is tooth-borne and tissue-tooth-borne devices (Hyrax and Haas). Although a number clinical and radiographic studies have evaluated the surgically assisted rapid maxillary expansion, only limited information is available to study the transverse movement of the midpalatal suture with computed tomography. Forty adult patients of both sexes, ranging in age from 18 to 38 years, with bilateral transverse maxillary deficiency were operated on. Twenty patients had Hyrax expander, and 20 had Haas expander. Under general anesthesia, subtotal Le Fort I osteotomy was performed including pterygomaxillary dysjunction. The width of the midpalatal suture opening was measured at the anterior edge of the midpalatal suture and at the junction of the midpalatal suture and palatal bones, using computed tomography in axial acquisition, obtained in the preoperative period and immediately after the end of expansion. A digital caliper was used to measure Haas and Hyrax distance on the central jackscrew preoperatively and postoperatively. The proportion between the midpalatal suture expansion and the amount of expansion on the jackscrew was evaluated. The mean of midpalatal suture opening and screw opening for Haas group was 5.19 and 8.78 mm, and for the Hyrax group, 5.85 and 8.51 mm, respectively. Both groups showed parallel-shaped separation of the midpalatal opening with no significant difference in the anterior and posterior portion. Midpalatal/jackscrews opening proportion was greater in the Hyrax group (69,2%) than in the Haas group (60%).

Sagittal and vertical maxillary effects after surgically assisted rapid maxillary expansion (SARME) using Haas and Hyrax expanders.

The purpose of this study was to evaluate the effect of surgically assisted rapid maxillary expansion on the sagittal and vertical maxillary planes. Thirty-three adult patients aged between 18 and 40 years who required surgically assisted rapid maxillary expansion were included in this study. They were divided into two groups: the Haas type expander (16) and the Hyrax type expander (17). All patients were subjected to subtotal LeFort I osteotomy with pterygomaxillary disjunction. Lateral cephalometric radiographs were taken during the preoperative assessment (T1), soon after completion of the expansion (T2), and 4 months after the end of the expansion (T3). The following cephalometric measures were obtained in each of the three radiographs for all the patients: SNA, SN palatal plane, Frankfurt horizontal plane. NA, CF-A, CF-NA, Nperp-A, CF-A, Frankfurt horizontal plane-ANS, and Frankfurt horizontal plane-PNS. Statistically significant changes were observed in the cephalometric measures: SNA, Frankfurt horizontal plane, NA, Nperp-A in the patients in the Haas group, and CF-A in the patients in the Hyrax group, demonstrating anterior displacement of the maxilla. The cephalometric measures SN.palatal plane, CF-A, CF-NA, Frankfurt horizontal plane-ANS, and Frankfurt-PNS plane that evaluated vertical displacement did not show changes in either group. The surgically assisted rapid maxillary expansion caused anterior displacement of the maxilla in both groups, but only the Haas group had statistical significance. Neither the Haas group nor the Hyrax group showed vertical displacement of the maxilla. When Hyrax and Haas groups were compared, there were no statistically significant differences for sagittal and vertical changes.

Stability of the transverse dimension of the maxilla after surgically assisted rapid expansion.

The aim of this study was to evaluate the behavior of the transverse dimension of the maxilla after surgically assisted rapid expansion with and without using a transpalatal arch fixed retention. Sixty cast models of the maxilla and 60 posteroanterior radiographs from 30 adult subjects, 16 male subjects and 14 female subjects, were evaluated. The subjects were 18.1 to 53.2 years old (mean age, 27.3 years), had been submitted to surgically assisted rapid maxillary expansion, and were using the expansion appliance for four months. The subjects were randomly assigned into two groups of 15 subjects. One group, called the group with retention, received a transpalatal arch fixed retention and another group, which received no retention, was called the group without retention. The assessments were performed at two time points: at the removal of the expansion appliance (T1) and 6 months after the removal of the expansion appliance (T2). In the cast models, interpremolar distances (A-A1) and intermolar distances (B-B1) were measured and in the posteroanterior radiographs, maxillomandibular discrepancy was used. A reduction in the distances A-A1 (-0.76 mm) and B-B1 (-1.54 mm) was observed among the time points studied in the group without retention and this difference was statistically significant. In the group with retention, the difference between the time points T1 and T2 was not statistically significant. The assessment of the maxillomandibular difference showed an increase between the time points T1 and T2 in the group with retention (1.54 mm) and the group without retention (0.84 mm), which means a reduction in the maxillary width in the posteroanterior radiograph. In the comparison between the groups, the assessment of the cast models and the assessment of the posteroanterior radiograph showed no statistically significant difference in any of the variables studied.

Perfil epidemiológico de fraturas mandibulares tratadas na Universidade Federal de São Paulo: Escola Paulista de Medicina / Epidemiological profile of mandible fractures treated at the Federal University of São Paulo: Paulista Medical School

OBJETIVO: As fraturas mandibulares podem levar a grandes prejuízos estéticos, funcionais e financeiros e suas características epidemiológicas têm sofrido alterações em diversas localidades. Para detectar estas mudanças, foi realizado este estudo, cujo objetivo foi comparar os dados de pacientes com fraturas mandibulares atendidos no Hospital São Paulo (UNIFESP-EPM) no período de junho de 1999 a março de 2002 aos de pacientes atendidos de janeiro de 1991 a março de 1996. MÉTODOS: Foram comparados o sexo e faixa etária mais acometidos, locais mais fraturados do osso, lesões associadas, tratamento e complicações de 98 pacientes com fratura de mandíbula, atendidos pelo Setor de Cirurgia Craniofacial da Disciplina de Cirurgia Plástica UNIFESP-EPM no período de junho de 1999 a março de 2002 aos mesmos dados de 166 pacientes atendidos de janeiro de 1991 a março de 1996. RESULTADOS: O sexo e a faixa etária mais acometidos ainda são os mesmos. Os acidentes de transporte, como principais causas de fraturas mandibulares, foram substituídos pelas agressões. Houve diminuição de lesões associadas e de fraturas múltiplas na mandíbula, provavelmente associadas à mudança etiológica. O local mais acometido continua sendo o corpo. O tratamento mais utilizado nos dois grupos foi a fixação com miniplaca, e o número de complicações diminuiu, provavelmente devido à melhora do padrão de atendimento. CONCLUSAO: Houve mudanças nas características epidemiológicas das fraturas mandibulares na população de São Paulo e o conhecimento das mesmas possibilita a instituição de medidas preventivas e de tratamento adequadas.

[Epidemiological profile of mandible fractures treated at the Federal University of São Paulo-Paulista Medical School]. / Perfil epidemiológico de fraturas mandibulares tratadas na Universidade Federal de São Paulo-Escola Paulista de Medicina.

BACKGROUND: Mandible fractures can result in esthetic, functional and financial problems and their epidemiological patterns have changed in many locations. This study was carried out to detect these changes, aiming to compare data of patients with mandible fractures treated at the Sao Paulo Hospital (UNIFESP-EPM) from June 1999 to March 2002 with data of patients treated from January 1991 to March 1996. METHODS: Information on most affected gender and age, most often fractured mandible segment, associated injuries, treatment and complications of 98 victims of mandible fracture admitted from June 1999 to March 2002 were compared to the same data of 166 patients treated from January 1991 to March 1996. RESULTS: the most affected gender and age ranges remain the same. Aggressions surpassed traffic accidents as the main etiology. Incidence of associated injuries and multiple fractures in the mandible decreased, a fact probably related to the change in etiology. The most affected segment is still the body of the mandible. The most used type of treatment in both samples was internal rigid fixation with miniplates and the number of complications decreased, due to the higher standard of patient care. CONCLUSION: Mandible fractures in the São Paulo population have undergone epidemiological changes and this knowledge enables local authorities to establish adequate measures for prevention and treatment.

Surgical treatment of the fractured and dislocated condylar process of the mandible / Tratamento cirurgico da fratura e deslocamento do processo condilar da mandibula

Most fractures of the mandible can be managed conservatively. This report is a retrospective evaluation of the clinical and radiological results in 17 patients with 21 dislocated fractures submitted to open reduction and fixation, employing steel wires and maxillomandibular fixation. Follow-up ranged from 7 to 55 months, (mean 29.5). Functional assessment showed good opening movements (mean 41.9mm). There were no cases of ankylosis, pain, or paralysis of the facial nerve. Radiological assessment was normal when the lateral pterygoid muscle was maintained adherent to the fractured proximal segment. Radiological signs of bone resorption occurred when the fractured segment was detached from the lateral pterygoid muscle. In our opinion, dislocated condylar process fractures can be managed surgically and with steel wire ligatures and maxillomandibular fixation. Whenever possible, the lateral pterygoid muscle should be inserted into fractured proximal segment, i.e. as an osteomuscular flap

Critical assessment of adipose tissue graft

The authors report on the evaluation of adipose tissue grafts, including clinical and experimental aspects. The methods of hervesting, treatment and injection of this type of graft are elucidated. The detrimental effect of physiological solutions on cellular membranes and the local inflammatory reaction of the receptor tissues are discussed