Three-dimensional evaluation of superior airway space after orthognathic surgery with counterclockwise rotation and advancement of the maxillomandibular complex in Class II patients.

OBJECTIVE: The aim of this study was to assess changes in the superior airway space (SAS) in Class II patients undergoing orthognathic surgery with counterclockwise rotation of the maxillomandibular complex (MMC). STUDY DESIGN: A total of 23 patients (15 females and 8 males; mean age, 33 years) with symptoms of respiratory disease (mouth breathing) were studied. The patients were subjected to computed tomography analyses at two time intervals: T1 (preoperatively) and T2 (postoperative minimum of 6 months). The computed tomography images were exported to Dolphin Imaging 11.5 software to measure the surface area, minimum axial area, and volume of the SAS. RESULTS: The surgery (including a median mandibular advancement of 14 mm with an average rotation of 8 degrees) significantly increased the static SAS, with mean postoperative increases of 178 mm(2) in SA, 76.67 mm(2) in minimum axial area, and 10118.5 mm(3) in volume. A significant increase was also observed in the three-dimensional airspace following orthognathic surgery, which provided a greater permeability of the SAS in Class II patients. CONCLUSIONS: This confirmed the efficacy of this technique in the treatment of respiratory disorders.

An unusual pleomorphic adenoma / Adenoma pleomórfico não usual

Pleomorphic adenoma is the most common neoplasm in major and minor salivary glands. It constitutes approximately 90% of all benign salivary gland lesions and the parotid is the most affected location. When the minor salivary glands are affected, it mostly occurs at the junction of the hard and soft palates. The diagnosis is complex because of the great histological variety and biological behavior of this tumor, a histopathological examination being essential. The recommended treatment is surgical excision. For lesions located superficially in the parotid gland, superficial parotidectomy - identifying and preserving the facial nerve - is necessary. Lesions in the palate or gums sometimes demand a margin of safety, being excised below the periosteum, including the overlying mucosa. With correct surgical removal, the prognosis is excellent. The aim of this study is to report a case of an unusual minor salivary gland pleomorphic adenoma in the hard palate, describing the most important aspects of this pathology.

O adenoma pleomórfico é a neoplasia mais comum entre os tumores das glândulas salivares maiores e menores. Constitui aproximadamente 90% de todas as lesões benignas das glândulas salivares e a parótida é a mais acometida. A junção dos palatos duro e mole é o sítio de predileção mais comum, quando as glândulas salivares menores são atingidas. O diagnóstico é complexo devido a grande variedade histológica e comportamento biológico deste tumor, sendo imprescindível a realização do estudo histopatológico. O tratamento de escolha é a excisão cirúrgica. Para as lesões localizadas no lobo superficial da parótida é recomendada a parotidectomia superficial com a identificação e preservação do nervo facial. As lesões do palato ou gengiva por vezes podem exigir margem de segurança, sendo geralmente excisadas abaixo do periósteo, incluindo a mucosa sobrejacente. Com a remoção cirúrgica adequada, o prognóstico é excelente. O presente trabalho tem como objetivo relatar um caso de adenoma pleomórfico não usual de glândula salivar menor no palato duro, em região posterior direita, além de descrever os aspectos mais importantes dessa patologia.

Delimitação morfométrica para o corte horizontal da osteotomia sagital no ramo da mandíbula / Morphometric delimitation for the horizontal cut of the sagittal osteotomy in the mandibular ramus

A osteotomia sagital do ramo mandibular é, provavelmente, a técnica cirúrgica mais utilizada para correção de deformidades mandibulares esqueléticas. Entretanto, algumas complicações podem ocorrer, tais como, fratura desfavorável, lesão do feixe vásculo-nervoso alveolar inferior, trauma na articulação temporomandibular e recidivas. Apesar dos riscos iminentes, a literatura científica carece de dados morfométricos que venham a fundamentar uma prática cirúrgica mais segura e precisa. O objetivo deste trabalho foi o de determinar a altura de fusão das corticais medial e lateral do ramo da mandíbula, definindo parâmetros para a realização do corte horizontal (osteotomia medial) na técnica de osteotomia sagital do ramo mandibular. Foram utilizadas 40 hemi-mandíbulas de adultos sul-americanos, ambos os sexos, seccionadas com cortes verticais nos terços anterior e médio do ramo. Os resultados mostraram a necessidade de se respeitarem os limites de altura 3,5mm (sexo masculino) e 5,5mm (sexo feminino), a partir da junção da língula com a face medial do ramo mandibular, para a prática da osteotomia medial.

The sagittal split osteotomy of the mandibular ramus is probably the most commonly employed surgical technique for the correction of skeletal mandibular deformities. However, a number of complications may occur, such as unfavorable fracture, injury to the inferior alveolar vasculonervous bundle, trauma in the temporomandibular joint and recurrence. Despite the imminent risks, the scientific literature is lacking in morphometric data that could lay the basis for a safer and more accurate surgical technique. The purpose of this study was to determine the heights of the medial and lateral cortical fusion of the mandibular ramus, defining parameters for performing the horizontal section (medial osteotomy), using the sagittal split osteotomy of the mandibular ramus technique. Forty hemijaws of South American adults of both sexes were vertically sectioned at the anterior and medium third of the ramus. The results demonstrated the need to respect the height limits (3.5 mm in males and 5.5 mm in women) from the junction of the lingual with the medial surface of the mandibular ramus when a medial osteotomy is to be performed.