Reabilitação com prótese bucomaxilofacial: revisão de literatura / Rehabilitation with maxillofacial prosthetics

A odontologia reabilitadora tem como um dos seus ramos a especialidade de Prótese Bucomaxilofacial (PBMF), que visa restaurar ou substituir estruturas perdidas na região facial e no sistema estomatognático artificialmente, podendo ser ou não removidos pelo paciente. O presente trabalho objetiva revisar a leitura a respeito da reabilitação com PBMF e a sua aplicabilidade na clínica odontológica. Os indivíduos com alguma perda de estrutura na região de cabeça e pescoço, devido a traumas físicos e/ou químicos, defeitos congênitos, doenças autoimunes, neoplasias, infecções e parasitas, são pacientes para os quais há a indicação da reposição da parte ausente. As reconstruções podem ser perdas intraorais (área da maxila, mandíbula), extraorais (oculopalpebral, ocular, nasal, facial extensa e auricular) ou conjugadas. Esse é um trabalho multidisciplinar, com especialistas de áreas abrangentes e todos os especialistas trabalham de forma conjunta. Pode-se concluir que, embora seja uma das especialidades mais nobres da odontologia, ainda é muito desconhecida por parte dos estudantes e profissionais das áreas da saúde e são próteses absolutamente fundamentais para a reabilitação e qualidade de vida dos indivíduos que tem a necessidade do uso da prótese PBMF(AU)

Rehabilitating dentistry has as one of its branches the specialty of Oral and Maxillofacial Prosthesis (PBMF), which aims to restore or replace structures lost in the facial region and in the stomatognathic system artificially, which may or may not be removed by the patient. The present study aims to review the reading about rehabilitation with PBMF and its applicability in dental clinic. Individuals with some loss of structure in the head and neck region, due to physical and/or chemical trauma, birth defects, autoimmune diseases, neoplasms, infections and parasites, are patients in whom there is an indication for replacement of the absent part. Reconstructions can be intraoral (maximal area, mandible), extraoral (oculopalpebral, ocular, nasal, extensive facial and auricular) or conjugated losses. It is a multidisciplinary work, with specialists from the comprehensive areas and that all specialists work together. It can be concluded that although it is one of the noblest specialties of dentistry, it is still very unknown to students and health professionals, and they are absolutely fundamental prostheses for the rehabilitation and quality of life of individuals who need the use the PBMFprosthesis(AU)

Interexaminer agreement between two dental specialties for the detection of bifid mandibular canal and accessory mental foramen in cone-beam computed tomography / Concordancia inter-examinador entre dos especialidades odontológicas para la detección del canal mandibular bífido y foramen mental accesorio en tomografía computarizada de haz cónico

Introduction: The aim of this study was to assess the agreement between oral and maxillofacial radiologists (OMFR) and oral and maxillofacial surgeons (OMFS) for the detection of bifid mandibular canal (BMC) and accessory mental foramen (AMF) using cone-beam computed tomography (CBCT). Material and Methods: This retrospective study involved 22 examiners (11 OMFR and 11 OMFS) who independently assessed 30 CBCT volumes from patients (n = 60 hemi-mandibles) under preoperative radiographic evaluation for implant placement. The examiners scored the presence of BMC and AMF in each hemimandible. The interexaminer agreements were assessed using Fleiss' kappa statistics. Results: For intra-examiner agreement, 40% of the sample was reevaluated. The interexaminer agreement between OMFR and OMFS was slight (0.12) for the detection of BMC and fair (0.24) for AMF. The agreement among OMFR for detection of BMC was fair (0.22), and it was slight among OMFS (0.15). The agreement among OMFR for detection of AMF was substantial (0.61), and among OMFS it was fair (0.22). Agreements between OMFR and OMFS were slight for BMC and fair for AMF, independently of the years of experience. Intraexaminer agreement ranged from 60% to 90% among OMFR and from 55% to 90% among OMFS. Conclusion: A slight and a fair agreement between OMFR and OMFS was found for the detection of BMC and AMF, respectively. In general, OMFR obtained higher agreement among themselves, mainly for detection of AMF.

Introducción: El objetivo de este estudio fue evaluar la con-cordancia entre los radiólogos orales y maxilofaciales (ROMF) y los cirujanos orales y maxilofaciales (COMF) para la detección del canal mandibular bífido (CMB) y el foramen mentoniano accesorio (FMA) mediante tomografía computarizada de haz cónico. CBCT). Material y Métodos: Este estudio retrospectivo involucró a 22 examinadores (11 ROMF y 11 COMF) que evaluaron de forma independiente 30 volúmenes CBCT de pacientes (n = 60 hemimandíbulas) bajo evaluación radiográfica preoperatoria para la colocación de implantes. Los examinadores puntu-aron la presencia de CMB y FMA en cada hemimandíbula. Los acuerdos entre examinadores se evaluaron utilizando las estadísticas kappa de Fleiss. Resultados: Por concordancia intraexaminador se reeva-luó el 40% de la muestra. El acuerdo entre examinadores entre ROMF y COMF fue ligero (0,12) para la detección de CMB y regular (0,24) para FMA. La concordancia entre ROMF para la detección de CMB fue regular (0,22) y leve entre COMF (0,15). El acuerdo entre ROMF para la detección de FMA fue sustancial (0,61), y entre COMF fue justo (0,22). Los acuerdos entre ROMF y COMF fueron leves para CMB y justos para FMA, independientemente de los años de experiencia. La concordancia entre examinadores varió del 60 % al 90 % entre ROMF y del 55 % al 90 % entre COMF. Conclusión: Se encontró un acuerdo leve y justo entre ROMF y COMF para la detección de CMB y FMA, respec-tivamente. En general, se obtuvo mayor acuerdo entre ROMF, principalmente para la detección de FMA.

Manejo cirúrgico de fratura cominutiva de mandíbula por ferimento de arma de fogo: relato de caso / Surgical management of comminuted jaw fracture by firearms injury: case report

Os ferimentos por arma de fogo (FAF) são um grande problema de saúde pública. Na face, a mandíbula é o local de maior incidência, sendo a região de corpo mandibular a mais atingida e as lesões aos tecidos moles frequentemente a ela associadas. Em alguns casos, tais ferimentos apresentam-se de difícil resolução, sobretudo, em casos de fraturas cominutivas e lesões de tecidos moles com alta complexidade. Isso torna o atendimento desses pacientes um desafio para cirurgiões buco-maxilo-faciais. Desta forma, o objetivo deste artigo é relatar um caso de FAF em terço inferior da face, com comprometimento de tecidos moles e mandíbula, pela equipe de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Geral do Estado - Bahia. Paciente de 28 anos de idade, sexo feminino, vítima de FAF em terço inferior da face, por disparo acidental de espingarda. Ao exame clínico, pode-se observar ferimento perfuro-contuso em região de mandíbula e fratura cominutiva de corpo e ângulo mandibular à direita. A paciente foi submetida à cirurgia para remoção de fragmentos ósseos/corpos estranhos, fixação dos cotos com placa de reconstrução 2.4mm e sutura dos planos, em mesmo tempo cirúrgico, reestabelecendo a função da mandíbula. Portanto, devido à fisiopatologia variável dos FAF na mandíbula, não se indica um único padrão de tratamento para as fraturas cominutivas. Além disso, é indispensável o emprego de protocolos de limpeza cirúrgica imediata e antibioticoterapia nos casos com alto grau de cominuição, bem como, sugere-se realizar o tratamento definitivo o mais breve possível(AU)

Firearm injuries (FIs) are a major public health problem. On the face, the mandible is the place with the highest incidence of this trauma, with the mandibular body region being the most affected and the lesions to the soft tissues frequently associated with it. In some cases, such injuries are difficult to resolve, especially in cases of comminuted fractures and soft tissue injuries with high complexity. This makes the care of these patients a challenge for oral and maxillofacial surgeons. Thus, the objective of this article is to report a case of care for a FAF victim in the lower third of the face, with soft tissue and mandible involvement, by the Maxillofacial Surgery and Traumatology team at the Hospital Geral do Estado - Bahia. 28-year-old female patient, victim of FAF in the lower third of the face, due to acidental shotgun firing. On clinical examination, a perforated-blunt wound can be seen in the mandible region and comminuted fracture of the body and angle of the mandible on the right. The patient underwent surgery to remove bone fragments / foreign bodies, fix the stumps with a 2.4 mm reconstruction plate and suture the planes, at the same surgical time, reestablishing the function of the mandible. Therefore, due to the variable pathophysiology of FAF in the mandible, a single treatment pattern is not indicated for comminuted fractures. In addition, it is essential to use immediate surgical cleaning protocols and antibiotic therapy in cases with a high degree of comminution, as well as, it is suggested to carry out the definitive treatment as soon as possible(AU)

La maloclusión clase III esquelética grave mediante abordaje primario de cirugía ortognática: informe de caso / Severe skeletal class III malocclusion by surgery-first orthognathic approach: a case report

Class III malocclusion is a relevant public health problem. The management of severe skeletal class III malocclusion in non-growing patients requires properly planned and well-executed orthognathic surgery by a team of at least an orthodontist and a maxillofacial surgeon. For these cases, there are two approaches to the surgery. One of them is the conventional three-stage method, which includes preoperative orthodontic treatment, orthognathic surgery, and postoperative orthodontic treatment. The other is the surgery-first orthognathic approach, which is performed without pre-surgical orthodontic treatment and should present some advantages compared to the conventional technique. However, at present, evidence on the management of class III malocclusion still needs to be expanded. In this paper, we present the management of a case of severe skeletal class III malocclusion by surgery-first orthodontic approach, based on the experience of the Tamil Nadu Government Dental College and Hospital, Chennai, India.

La maloclusión clase III es un problema de salud pública importante. El tratamiento de la maloclusión clase III esquelética grave en pacientes que no están en crecimiento, requiere una cirugía ortognática planificada de forma apropiada y bien ejecutada, por un equipo de al menos un ortodoncista y un cirujano maxilofacial. Para estos casos, existen dos enfoques para la cirugía: el método convencional de tres etapas, que incluye tratamiento de ortodoncia preoperatorio, cirugía ortognática y tratamiento de ortodoncia posoperatorio; y el abordaje primario de cirugía ortognática, que se realiza sin tratamiento de ortodoncia prequirúrgico y debe presentar algunas ventajas en comparación con la técnica convencional. Sin embargo, en la actualidad, las pruebas sobre el abordaje de la maloclusión clase III aún deben ampliarse. En este artículo, presentamos el abordaje de un caso de maloclusión clase III esquelética grave mediante el abordaje inicial con cirugía ortognática, basado en la experiencia del Hospital y Colegio Odontológico del Gobierno de Tamil Nadu, Chennai, India.

Utilização e percepção da tomografia computadorizada de feixe cônico por especialistas em cirurgia e traumatologia bucomaxilofacial para avaliação de terceiros molares inferiores impactados / Use and perception of cone beam computed tomography by oral & maxillofacial surgeons for impacted lower third molars evaluation

Objetivo: conhecer o perfil demográfico e as características que levam à solicitação de tomografia computa-dorizada de feixe cônico (TCFC) pelos especialistas em Cirurgia e Traumatologia Bucomaxilofacial (CTBMF) do estado do Rio Grande do Sul, para diagnóstico e planejamento cirúrgico de terceiros molares inferiores (3MI) impactados. Métodos: foram enviados questionários eletrônicos para todos os especialistas em CTBMF do RS. O questionário compreendia perguntas demográficas, clínicas e imaginológicas. O teste Qui-Quadra-do foi utilizado para verificar a associação entre as variáveis. Resultados: 115 questionários foram respondi-dos.O exame mais solicitado foi a panorâmica (95%). A TCFC foi solicitada por 50 especialistas (30 utilizam software). Localização do canal mandibular, dilaceração radicular e reabsorção do segundo molar são os aspectos mais avaliados na TCFC (P < 0,05); já o contato da raiz com o canal mandibular foi dito ser avaliado nos dois exames. Complicações permanentes foram relatadas por 21 especialistas, associadas a profissionais com maior tempo de graduação e/ou especialização (P < 0,05), mas não com o tipo de exame solicitado (P > 0,05). Na percepção dos especialistas, a TCFC tem papel importante em casos de alta complexidade. Con-clusão: a panorâmica ainda é o exame mais utilizado para avaliação de 3MI impactados pelos especialistas em CTBMF do RS, porém a TCFC tem sido solicitada para complementação do diagnóstico e planejamento e como meio de segurança jurídica do profissional.(AU)

Objective: to recognize the demographic profile and the characteristics that lead to the request of cone beam computed tomography (CBCT) by Oral & Maxillofacial (OMF) Surgeons in the state of RS for the diagnosis and surgical planning of impacted lower third molars (3LM). Methods: electronic questionnaires were sent to all OMF surgeons in RS. The questionnaire comprised demographic, clinical, and imaging questions. The chi-square test was used to verify the association between variables. Results: 115 questionnaires were answered. The most requested exam was the panoramic (95%). CBCT was requested by 50 specialists (30 use software). Localization of the mandibular canal, root dilaceration, and resorption of the second molar are the most evaluated aspects in the CBCT (P <0.05); the contact of the root with the mandibular canal was said to be evaluated in both exams. Permanent complications were reported by 21 OMF surgeons, and were related to the time of graduation and/or specialization (P < 0.05), but not to the type of exam (P > 0.05). In the OMF surgeons' perception, the CBCT has an important role in cases of high complexity. Conclusion: panoramic radiograph still is the most used exam for the assessment of impacted 3LM by OMF surgeons in RS, however, CBCT has been requested to complement the diagnosis and treatment plan, and as a means of professional legal security.(AU)

Accesibilidad en la Cirugía y Traumatología Buco Máxilo Facial al Hospital "Dr. José Penna" de Bahía Blanca / Accessibility in oral and maxillofacial surgery to the hospital "dr. José penna" from Bahía Blanca

Introducción: La Cirugía y Traumatología Buco-Máxilofacial (CyTBMF) es una especialidad de la Odontología. La Región Sanitaria 1 (RS1), Ministerio de Salud de la Provincia de Buenos Aires) tiene una Unidad de CyTBMF en el Hospital Interzonal General "Dr. José Penna" de Bahía Blanca. Se estudiaron cuatro patologías Buco-Máxilofaciales severas (PBMFS): traumatología, cáncer bucal, infección bucal severa y el niño nacido Fisurado Labio Alvéolo Palatino. Objetivo: Realizar un diagnóstico de accesibilidad de pacientes sin obra social. Métodos: Estudio híbrido con diseño descriptivo, encuesta a Secretarios de Salud de la RS1, relevamiento de protocolos de derivación y estudio ambispectivo. Resultados: En 2018, el 59,1% de los casos recibidos en la UCYTBMF fueron del Hospital Penna y el 40,9% fueron derivados. En 2019, el porcentaje fue 65,8% y 34,2%, respectivamente. Se registraron demoras en la solicitud de turno, desde el momento del trauma o diagnóstico: en 2018 fueron 2/22 (9,1%), atribuibles a la búsqueda de Tratamiento Adecuado; en 2019 fueron 11/38 (28,9%) por Acceso al Servicio. Conclusiones: El conocimiento de protocolos y contactos formales es endeble. Se recomienda optimizar el flujo de derivación hacia el Hospital " Dr. José Penna", y asegurar la contrarreferencia.

Introduction: Oral and Maxillofacial Surgery (OMS) is a specialty of Dentistry. Health Region 1 (RS1, Ministry of Health of Buenos Aires State) has a OMS Unit at the Interzonal General Hospital "Dr. José Penna" from Bahía Blanca. Four severe oral and maxillofacial pathologies were studied: trauma; oral cancer; severe oral infection; and the child born Cleft Lip and Palate. Objective: of the work was to evaluate the accessibility of patients with public health coverage. Methods: Hybrid study with descriptive design (survey of RSI Health Secretaries, survey of referral protocols) and ambispective study. Results: In 2018, 59.1% of the cases received at the OMS Unit were from Hospital "Dr. Jose Penna", and 40.9% were derived. In 2019, the percentage was 65.8% and 34.2%, respectively. Delays were recorded in the shift request, from the moment of the trauma or diagnosis: in 2018 they were 2/22 (9.1%), attributable to the search for Adequate Treatment; in 2019 they were 11/38 (28.9%) for Access to Service. Conclusions: the knowledge of protocols and formal contacts is weak. It is recommended to optimize the referral flow to Hospital "Dr. José Penna", and to ensure the counter-reference.

Effect of Oral and Maxillofacial Injuries on the Development of Post-Traumatic Stress Disorder: A Cross-Sectional Study

ABSTRACT Objective: To assess the influence of oral and maxillofacial trauma on the development of Post-Traumatic Stress Disorder (PTSD) and to determine the efficiency of the Impact of Event Scale-Revised (IES-R) as a diagnostic tool for detecting PTSD in patients with Oral and Maxillofacial injuries. Material and Methods: PTSD was assessed one month postoperatively by the diagnostic instrument, IES-R, to arrive at a provisional diagnosis. A structured clinician-administered PTSD Scale then assessed the patients for the Diagnostic and Statistical Manual of Mental Disorders-5th edition (CAPS-5) to establish a final diagnosis. The assessment of the severity of PTSD was done based on various types of oral and maxillofacial injuries. Results: The IES-R scale provisionally diagnosed 54 subjects with PTSD, out of which 42 were diagnosed to have PTSD by the CAPS-5 scale. Subjects with injuries involving the 'orbital complex,' those presenting with a perceptible scar in the maxillofacial region and with multiple avulsed/ luxated anterior teeth, showed a higher affinity to develop PTSD, and this was statistically significant. Conclusion: Higher levels of PTSD in patients with injuries to the maxillofacial region warrants correct diagnosis and detection, and hence the maxillofacial surgeon plays a vital role in this regard. The IES-R is a useful diagnostic tool to detect PTSD early.

The ability of orthodontists and maxillofacial surgeons in predicting spontaneous eruption of mandibular third molar using panoramic serial radiographs

ABSTRACT Objective: To evaluate the skill of orthodontists and oral/maxillofacial surgeons (OMFS) in providing a prognosis of mandibular third molars spontaneously erupted, through follow-up panoramic analysis. Methods: 22 orthodontic patients treated without extraction, presenting spontaneously erupted mandibular third molars (n = 44) were analyzed through panoramic serial radiographs. The first panoramic radiograph was obtained just after orthodontic treatment (PR1), in patients aging from 13 to 19 years. A second panoramic radiograph (PR2), was obtained in average two years later. The radiographs were randomly analyzed by 54 specialists, 27 orthodontists and 27 OMFS, to obtain the opinion about the approach to be adopted to these teeth in PR1. Then, another opinion was collected by adding a serial radiograph (PR1+2). Results: The concordance of the answers was moderate for OMFS (Kappa 0.44; p< 0.0001) and significant for orthodontists (Kappa 0.39; p< 0.0001). In the analysis of the first radiograph (PR1) of the spontaneously erupted molars, OMFS indicated extraction in 44.5% of cases, while orthodontists indicated in 42%, with no difference between groups (p= 0.22). In PR1+2 analysis, orthodontists maintained the same level of extraction indication (45.6%, p= 0.08), while surgeons indicated more extractions (63.2%, p< 0.0001). Conclusions: Orthodontists and OMFS were not able to predict the eruption of the third molars that have erupted spontaneously. Both indicated extractions around half of the third molars. A follow-up analysis, including one more radiograph, did not improve the accuracy of prognosis among orthodontists and worsened for OMFS.

RESUMO Objetivo: Avaliar a habilidade de ortodontistas e cirurgiões bucomaxilofaciais (CBMF) em propor um prognóstico para terceiros molares inferiores. Métodos: Foram analisados 22 pacientes tratados ortodonticamente sem extração, cujos terceiros molares inferiores irrompidos espontaneamente (n= 44) foram avaliados por meio de radiografias panorâmicas seriadas. A primeira radiografia foi obtida logo após o tratamento ortodôntico (RX1), entre 13 e 19 anos de idade. A segunda radiografia (RX2) foi avaliada dois anos depois, em média. As radiografias foram analisadas aleatoriamente por 54 especialistas, 27 ortodontistas e 27 CBMFs, para obter sua opinião sobre a abordagem a ser adotada na RX1. Em seguida, outra opinião foi coletada adicionando-se a segunda radiografia seriada (RX1+2). Resultados: A concordância das respostas foi moderada para os CBMFs (Kappa = 0,44; p< 0,0001) e significativa para os ortodontistas (Kappa = 0,39; p< 0,0001). Após analisar apenas a primeira radiografia (RX1) dos molares antes deles irromperem espontaneamente, os CBMFs indicaram extração em 44,5% dos casos; enquanto os ortodontistas, em 42%, sem diferença entre os grupos (p= 0,22). Na análise de RX1+2, os ortodontistas mantiveram o mesmo nível de indicação de extração (45,6%, p= 0,08), enquanto os cirurgiões passaram a indicar mais extrações (63,2%, p< 0,0001). Conclusões: Ortodontistas e CBMFs não foram capazes de predizer a erupção de terceiros molares por meio da análise de uma única radiografia panorâmica, indicando extrações em cerca da metade dos terceiros molares examinados. Uma análise de acompanhamento, incluindo mais uma radiografia, não melhorou a precisão do prognóstico entre os ortodontistas, e piorou entre os CBMFs.

Reconstrução de fratura panfacial cominuta ­ relato de caso / Reconstruction of panfacial fracture - case report

RESUMO: Modelo de estudo: Relato de Caso. Importância do problema: As fraturas panfaciais recebem essa denominação quando os terços faciais apresentam fraturas concomitantes. Com frequência, essas lesões estão relacionadas a danos importantes aos tecidos moles, cominuição e perda de segmentos ósseos e/ou dentários, que podem gerar má oclusão e graves deformidades faciais, visto que etiologia de tal condição se deve à acidentes de alta dissipação de energia. O tratamento das fraturas panfaciais com o uso de fixação interna rígida permite restaurar as funções mastigatórias, bem como os contornos faciais. Comentários: O objetivo desse trabalho é relatar a reconstrução de uma fratura panfacial, envolvendo a mandíbula e com elevado grau de cominuição do complexo zigomático orbitário e do arco zigomático, em uma paciente do sexo feminino, em que acesso hemicoronal e retromandibular foram escolhidos para reconstrução e reestruturação do complexo facial. Conclusão: O correto manejo das fraturas panfaciais, é um dos grandes desafios do cirurgião buco maxilo facial, visto o nível de dificuldade para reestabelecer de maneira satisfatória as condições estéticas e funcionais existentes previamente ao trauma. Diferentes sequências de tratamento vêm sendo propostas, podendo ser utilizadas com sucesso após análise adequada do caso clínico e correta indicação. (AU)

ABSTRACT: Study model: Case Report. Importance of the problem: Panfacial fractures receive this designation when the facial thirds have concomitant fractures. Frequently, these lesions are related to important soft tissue damage, comminution, and loss of bone and/or dental segments, which may lead to malocclusion and severe facial deformities, since the etiology of such condition is due to accidents of high energy dissipation. The treatment of the panfacial fractures with the use of rigid internal fixation allows restoring the masticatory functions, as well as the facial contours. Comments: This study aimed to report the reconstruction of a panfacial fracture, involving the mandible and with a high degree of comminution of the zygomatic or zygomatic arch, in a female patient, whose hemicoronal and retromandibular access were chosen for reconstruction and restructuring of the facial complex. Conclusion: The correct management of panfacial fractures is one of the greatest challenges of the maxillofacial surgeon, given the level of difficulty to satisfactorily reestablish the aesthetic and functional conditions existing before the trauma. Different treatment sequences have been proposed to be used successfully after adequate analysis of the clinical case and correct indication. (AU)

Análisis de concordancia de tres clasificaciones de terceros molares mandibulares retenidos / Agreement analysis of three mandibular third molar retention classifications

Resumen Introducción: Las clasificaciones de Pell y Gregory y de Winter son básicas en la categorización de terceros molares; la clasificación de Sánchez Torres es usada en México, pero no había sido evaluada previamente. Objetivo: Evaluar el grado de acuerdo en la valoración radiográfica de terceros molares mandibulares impactados, con el empleo de tres clasificaciones: Pell y Gregory, Winter y Sánchez Torres. Método: Estudio observacional, descriptivo, de concordancia interobservador, que incluyó a 10 cirujanos orales y maxilofaciales y 10 residentes en formación, quienes registraron la categorización radiográfica de terceros molares mandibulares (izquierdos y derechos) de acuerdo con las clasificaciones de Pell y Gregory, Sánchez Torres y Winter. Se evaluó el grado de acuerdo entre observadores mediante la prueba de kappa de Fleiss. Resultados: La clasificación de Pell y Gregory obtuvo el menor grado de acuerdo (kappa = 0.05 y 0.185), seguida de la clasificación de Sánchez Torres (kappa = 0.125 y 0.326); el mejor valor lo obtuvo la clasificación de Winter, con kappa = 0.28 y 0.636 para cirujanos orales y maxilofaciales y residentes en formación, respectivamente. Conclusión: La clasificación de Winter mostró un grado de acuerdo aceptable (moderado) para categorizar terceros molares mandibulares en los residentes en formación.

Abstract Introduction: Pell & Gregory and Winter classifications are basic in third molar categorization; Sánchez-Torres classification is used in Mexico, but it has not been previously evaluated. Objective: To assess the degree of agreement in the radiographic evaluation of impacted mandibular third molar with the use of three classifications: Pell & Gregory, Winter and Sánchez-Torres. Method: Observational, descriptive, inter-observer degree of agreement study that included 10 oral and maxillofacial surgeons and 10 training residents, who recorded the radiographic categorization of third mandibular molars (left and right) according to Pell and Gregory, Sánchez-Torres and Winter classifications. Inter-observer degree of agreement was assessed with Fleiss' kappa test. Results: Pell and Gregory classification obtained the lowest degree of agreement (kappa = 0.05 and 0.185), followed by Sánchez-Torres classification (kappa = 0.125 and 0.326); Winter had the best agreement, with kappa = 0.28 and 0.636 for oral and maxillofacial surgeons and training residents, respectively. Conclusion: The Winter classification showed an acceptable (moderate) degree of agreement to classify mandibular third molars by training residents.

Avaliação da harmonia da face mediante projeções faciais do mento / Evaluation of harmony of the face through facial projections of the men

Introdução: Identificar qual projeção do mento é ideal para compor um rosto harmônico, de acordo com a opinião de leigos e cirurgiões buco-maxilo-faciais (BMF), relacionando as variáveis: sexo, etnia(raça) e região de origem(local). Metodologia: Participaram do estudo 386 leigos e 198 cirurgiões BMF. Este estudo foi realizado por meio de um formulário que continha dezoito imagens da face com diferentes projeções do mento: nove do sexo masculino e nove do sexo feminino, tendo o público escolhido a imagem que mais o agradou. Resultados: Em relação à avaliação da imagem masculina, as categorias: grupo(leigos/cirurgiões), sexo masculino e feminino, regiões (Nordeste e Sudeste) e raça, os entrevistados leigos escolheram um mento retraído em relação à linha vertical verdadeira, semelhante à escolha dos cirurgiões. Em relação à imagem feminina, para as mesmas categorias do sexo masculino, as projeções protruídas de mento foram mais escolhidas, tanto para os leigos como para os cirurgiões. Entretanto, as subcategorias leigos da região Sudeste, leigos de raça branca e leigos do sexo masculino escolheram uma imagem feminina com projeções de mento mais retraída. Conclusões: A harmonia facial pode ser considerada subjetiva, pois engloba padrões pessoais de beleza; assim, os cirurgiões devem estar atentos às peculiaridades dos pacientes... (AU)

Introduction: To identify which projection of the chin is ideal for compose a harmonic face according to the opinion of laypeople and oral maxillofacial surgeons, relating the variables: gender, ethnicity (race) and region of origin (local). Methodology: 386 lay people and 198 surgeons participated in the study. This study was carried out by means of a form. This form contained eighteen images of faces with different projections of the chin: nine males and nine females. So, the audience chose the image that most pleased them. Results: In relation to the evaluation of the male image. The categories: group (laymen/ surgeons), male and female, regions (northeast and southeast) and race, lay interviewee chose a retracted chin in relation to the true vertical line, similar to the surgeons' choice. In relation to the female image, for the same male categories, the protruding projections of the chin were more chosen, both for the laymen and for the surgeons. However, for the lay subcategories of the Southeast region, white laymen and male laymen, both chose a female image with more retracted chin projections. Conclusions: The facial harmony can be considered subjective since it includes personal standards of beauty, so surgeons must be attentive to the peculiarities of the patients... (AU)

Neuromonitorización intraoperatoria del nervio facial: a propósito de un caso / Intraoperative neuromonitoring of the facial nerve: a case report

Introdução: A preservação do nervo facial (NF) é uma das principais preocupações do cirurgião durante o tratamento aberto das fraturas mandibulares, uma vez que uma lesão nessa estrutura anatômica pode causar sequelas estéticas e funcionais permanentes. A existência de variações anatômicas (anastomoses e ramificações incomuns) aumenta o risco de danos no NF, mesmo nas mãos de cirurgiões experientes. O neuromonitoramento intraoperatório tem-se mostrado um grande aliado para evitar lesões nos ramos nervosos que podem estar envolvidos na área cirúrgica. Considerando a escassez desse assunto na literatura referente à cirurgia maxilo-facial, objetivamos demonstrar o uso da técnica de neuromonitoração do NF durante o acesso submandibular para o tratamento da fratura bilateral do ângulo mandibular. Relato de caso: No presente relato de caso, as abordagens cirúrgicas de ambos os lados não apresentaram danos permanentes ao NF. Esse resultado assim como a literatura sugerem que o neuromonitoramento intraoperatório proporciona maior segurança durante a realização de abordagens cirúrgicas, nas quais os ramos do nervo facial estão envolvidos, reduzindo, assim, o risco de sequelas nervosas. Considerações Finais: Esse recurso pode ser de grande auxílio no treinamento hospitalar ao longo do processo de formação de cirurgiões bucomaxilofaciais... (AU)

Introduction: Facial nerve (FN) preservation is one of the surgeon's major concerns during the open treatment of mandibular fractures since an injury to this anatomical structure can cause permanent aesthetic and functional sequelae. The existence of anatomical variations (anastomosis and unusual branching) increases the risk of FN damage even in the hands of experienced surgeons. Intraoperative neuromonitoring has proven to be a great ally to avoid injury to the nerve branches that may be involved in the surgical area. Considering the scarcity of this subject in the maxillofacial surgery literature, we aimed to demonstrate the use of the FN neuromonitoring technique during the submandibular approach for the treatment of bilateral mandibular angle fracture. Case report: In the present case report, the surgical approaches of both sides presented no permanent damage to the FN. Results: This result, as well as previous literature, suggests that intraoperative neuromonitoring provides greater safety during the performance of surgical approaches in which the facial nerve branches are involved and thus, reduces the risk of nerve sequelae. Final considerations: This resource can be of special assistance in teaching hospitals throughout the training process of maxillofacial surgeons... (AU)

Facial plastic surgery faculty turnover: survey of academic facial plastic surgeons and department chairs

Introduction: The turnover and inability to consistently retain academic facial plastic surgeons is an issue that many academic departments of otolaryngology face. In addition to the financial costs of staff turnover and gaps in patient care, insufficient exposure of residents to key surgical procedures is a significant problem for residency programs. Objective: To identify themost important reasons that lead faculty members to leave an academic facial plastic surgery (FPS) practice as well as features that may be associated with retention of FPS faculty. Methods: Members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and the Association of Academic Departments of Otolaryngology (AADO) were administered an anonymous, online survey. For both groups, we evaluated demographic factors, reasons for choosing academic careers, contributors to faculty turnover, as well as strategies for retention. The frequency of the responses was analyzed. Results: A total of 11.3% (135/1,200) of facial plastic surgery faculty responded to the faculty survey, with 59.1% (68/115) of current, academic surgeons participating, and a total of 16.7% (20/120) of department chairs responded to the chairs' survey. If a faculty member had left/was to leave, more control over practice was the most common reason between the two respondent groups. Of the fivemost important ways to increase faculty retention, more control over practice was the number one reason. Conclusion: Chairs and facial plastic surgery faculty should strive to agree upon the amount of control over the academic practice to lead to higher retention, better patient care, and continued resident education (AU)

Miíase maxilofacial: relato de casos / Maxillofacial myiasis: case report

Introdução: A miíase é uma afecção produzida pela infestação de larvas de moscas em pele e outros tecidos, sendo mais frequente nos países subdesenvolvidos e tropicais. Além disso, quando diagnosticada e tratada tardiamente pode levar o paciente a óbito. Objetivo: Há várias formas de tratamento descritas e a escolha da terapia varia a cada caso, segundo o número de larvas e o tecido envolvido. O intuito deste trabalho é relatar dois casos clínicos de miíase envolvendo a região maxilofacial, demonstrando a eficiência e a segurança da terapia escolhida. Relato de caso: Dois pacientes foram tratados através da remoção mecânica das larvas com auxílio de pinça e administração, por via oral, de antiparasitário (Ivermectina 12mg, dose única). Observou-se uma redução total de larvas nas feridas sem nenhuma intercorrência significativa. Conclusão: A remoção mecânica das larvas associada com Ivermectina em dose única é uma opção viável para o tratamento de miíase na região maxilofacial.

Introduction: Myiasis is a condition caused by infestation of fly larvae on skin and other tissues, being more frequent in underdeveloped and tropical countries. In addition, when diagnosed and treated late, it can lead to death. Objective: there are several forms of treatment described, the choice of therapy varies according to the number of larvae, and the tissue involved. The purpose of this paper is to report two clinical cases of myiasis involving the maxillofacial region, demonstrating the efficiency and safety of the therapy chosen. Case report: Two patients were treated by mechanical removal of the larvae using clamp and oral administration of antiparasitic (Ivermectin 12mg, single dose). A total reduction of worm larvae was observed with no significant intercurrence. Conclusion: The mechanical removal of larvae associated with single dose Ivermectin is a viable option for the treatment of myiasis in the maxillofacial region.

Manejo de ferimento extenso em terço médio da face / Extensive injury management in middle face chapter

Os ferimentos faciais variam nas suas características clínicas e complexidade, podendo gerar desde consequências emocionais, devido à possibilidade de deformidade, até o impacto econômico sobre o sistema de saúde, exigindo assim uma avaliação individualizada para cada caso. Deste modo, o objetivo deste trabalho é relatar o tratamento de lesão extensa no terço médio de face atendido pela Equipe de Cirurgia e Traumatologia Bucomaxilofacial do Hospital da Restauração, Recife-PE. Paciente de 42 anos de idade, gênero masculino, apresentando amplo ferimento em face com exposição de todo o terço médio. No exame, constatou-se o envolvimento da região nasal com deslocamento de tegumento e exposição de cartilagem. Foi realizado o tratamento cirúrgico sob anestesia local, com infiltração de lidocaína associado a epinefrina 1:10000,além da administração de vacina antitetânicae do uso de antibióticos endovenoso durante internamento. Após 08 meses de acompanhamento, o mesmo se encontra com estética favorável e narinas pérvias. O tempo do tratamento inicial e a qualidade da primeira intervenção são fatores primordiais para um bom resultado... (AU)

Facial injuries vary in their clinical characteristics and complexity, and can have since emotional consequences, due to possibility of deformities, to economic impacts on health systems, what requires an individualized assessment for each case. The aim of this work is to report the treatment of an extensive lesion on middle third of the face, treated by the maxillofacial surgery and traumatology team of Hospital da Restauração, Recife-PE. A 42-year-old male patient, presenting a wide facial wound with exposure of the entire middle third. In the exam, it was found the involvement of the nasal region with displacement of the integument and exposure of cartilage. Surgical treatment was performed under local anesthesia, with infiltration of lidocaine associated with epinephrine 1:10,000, in addition to the administration of tetanus vaccine and the use of intravenous antibiotics during hospitalization. After 8 months of follow-up, he has a favorable aesthetic and clear nostrils. The time of the initial treatment and the quality of the first intervention are essential factors for a good result... (AU)

Uso de una aplicación para registrar información sobre pacientes estomatológicos desde la perspectiva de los cirujanos dentales / The use of an application to record information on Dentistry patients from the perspective of dental surgeons

Dental records are complex documents and not all dental surgeons have been careful to fill them correctly. On the other hand, a number of apps for professional support has been observed on the market aimed at healthcare. The purpose of this study was to show how dental surgeons have noticed the technology of mobile devices and how it would help in their work routine by analysing an application for recording patient information. This study was exploratory, qualitative, descriptive, and transversal, with data obtained through a semi-structured interview with open-ended questions applied to ten dental surgeons who have downloaded the App OdontoExame as study population. The answers were analysed by the content analysis technique. The results showed that this technology could be useful in storing information. Besides, 90 percent of respondents stated that the application would help in clinical practices, while 10 percent considered such a technology still limited to this function(AU)

Los registros estomatológicos son documentos complejos y no todos los cirujanos dentales han sido cuidadosos al llenarlos correctamente. Por otra parte, un conjunto de aplicaciones de apoyo profesional han aparecido en el mercado, las que están dirigidas a la atención médica. El propósito del presente estudio es mostrar cómo los cirujanos dentales han notado la presencia de la tecnología de dispositivos móviles y cómo esta los podría ayudar en su trabajo diario, a partir del análisis de una aplicación para el registro de información de los pacientes. Se trata de un estudio exploratorio, cualitativo, descriptivo y transversal, basado en datos obtenidos mediante una entrevista semiestructurada con preguntas abiertas dirigidas a una población de diez cirujanos dentales que han descargado la aplicación OdontoExame. Las respuestas se analizaron aplicando la técnica de análisis de contenidos. Los resultados mostraron que esa tecnología puede ser útil para almacenar información. El 90 por ciento de los encuestados plantearon que la aplicación podría ser útil en la práctica clínica, mientras que el 10 por ciento consideró que esta aún estaba limitada a esa función(AU)

Cirugía y traumatología bucomáxilofacial en la red hospitalaria chilena / Maxilofacial surgery in the Chilean healthcare network

RESUMEN: Argumentando la existencia de listas de espera de cirugía bucal y máxilofacial, los Ministerios de Salud y Educación chilenos deciden crear un profesional de menores competencias que el cirujano bucal y máxilofacial existente, cuya formación dure un año y se desempeñe en la atención primaria de salud. Decretan la especialidad de Cirugía Bucal, comprometiendo la calidad y seguridad de la atención, exponiendo a los enfermos a eventos adversos de impredecibles desenlaces, afectando la calidad de vida de éstos o provocando eventualmente un desenlace fatal. El objetivo del presente estudio es establecer el número de cirujanos bucales y máxilofaciales formados en el país, conocer cuantos se desempeñan en hospitales públicos y su distribución en los servicios de salud, así como también evaluar si se cumplen las condiciones de infraestructura necesarias para desarrollar la especialidad según la normativa vigente. Consideramos que éstos son datos fundamentales al momento de modificar políticas públicas. La metodología propuesta es un estudio descriptivo de corte transversal, realizando una encuesta dirigida a los jefes de los servicios odontológicos de la red hospitalaria pública del país, destinada a obtener información del prestador individual e institucional en cada centro de la red. Se concluye que existe una cantidad suficiente de especialistas formados y en vías de formación para atender las necesidades de la población. La evidencia muestra que faltan cargos e infraestructura, por lo que la medida adoptada por el MINSAL respecto a la creación de la especialidad de Cirugía Bucal obedece a un error diagnóstico desde el punto de vista del prestador individual e institucional, originado por la ausencia de un estudio técnico que evalúe la red hospitalaria del país.

ABSTRACT: Arguing the existence of waiting lists in oral and maxillofacial surgery, the chilean Ministries of Health and Education decided to create a professional less skilled than the existing oral and maxilofacial surgeon, whose training lasts one year and works in primary care health. They established the specialty of Oral Surgery, compromising the quality and safety of care, exposing patients to adverse events with unpredictable outcomes, affecting their quality of life or eventually causing a fatal outcome. At the time of this study there is no record of the number of oral and maxillofacial surgeons trained in our country, it is unknown how many are working in public hospitals and their distribution in health services, as well as whether there is the necessary infrastructure to develop the specialty under current regulations. We made a descriptive transversal study, conducting an interview aimed to obtain information from individual and institutional providers to know the reality of the specialty in the public health network. It is concluded that there is a sufficient number of specialists trained and in training to meet the needs of the population. The evidence shows missing possitions and infrastructure, so that the action taken by the Health Ministry regarding the creation of the specialty of Oral Surgery is due to a misdiagnosis from the point of view of an individual and institutional provider, caused by the absence of a technical study to assess the country’s hospital network.

The influence of sagittal position of the mandible in facial attractiveness and social perception

ABSTRACT OBJECTIVE: This study aims at comparing the perception of orthodontists, maxillofacial surgeons, visual artists and laypersons when evaluating the influence of sagittal position of the mandible - in lateral view - in facial attractiveness; at a job hiring; and in the perception of socioeconomic profile. METHODS: A black male, a white male, a black female and a white female with harmonic faces served as models to obtain a facial profile photograph. Each photograph was digitally manipulated to obtain seven facial profiles: an ideal, three simulating mandibular advancement and three simulating mandibular retrusion, producing 28 photographs. These photographs were evaluated through a questionnaire by orthodontists, maxillofacial surgeons, visual artists and laypersons. RESULTS: The anteroposterior positioning of the mandible exerted strong influence on the level of facial attractiveness, but few significant differences between the different groups of evaluators were observed (p < 0.05). CONCLUSIONS: The profiles pointed as the most attractive were also pointed as more favorable to be hired to a job position and pointed also as having the best socioeconomic condition.

RESUMO OBJETIVO: a presente pesquisa teve por objetivo comparar a percepção de ortodontistas, cirurgiões bucomaxilofaciais, artistas visuais e leigos ao avaliar a influência do posicionamento sagital da mandíbula, em vista lateral, na atratividade facial; na contratação para um emprego; e na percepção do perfil socioeconômico. MÉTODOS: um homem negro, um homem branco, uma mulher negra e uma mulher branca com faces harmoniosas serviram como modelos para obtenção de fotografias do perfil facial. Cada fotografia obtida foi digitalmente manipulada para a obtenção de sete perfis faciais: um ideal, três simulando avanço mandibular e três simulando retrusão mandibular, originando 28 fotografias. Essas fotografias foram avaliadas, por meio de um questionário, por quatro grupos de avaliadores: ortodontistas, cirurgiões bucomaxilofaciais, artistas visuais e leigos. RESULTADOS: o posicionamento anteroposterior da mandíbula exerceu forte influência sobre o grau de atratividade facial, porém foram observadas poucas diferenças significativas entre os diferentes grupos de avaliadores (p < 0,05). CONCLUSÕES: os perfis apontados como mais atraentes foram, também, os mais apontados como favoráveis à contratação para um emprego e os mais apontados como aqueles que aparentavam melhor condição socioeconômica.