Analysis of masseter and temporal muscles during surgical extraction of impacted third molars.

With the aim of contributing to the discussion on stomatognathic system dysfunction after surgical procedures, this study compared the electromyographic activity of the superficial masseter and temporal masticatory muscles before, during, and after impacted mandibular third molar extractions. Muscular activity was recorded presurgery, transsurgery, immediately postoperatively, and on postoperative days 7, 15, and 30. Twenty patients requiring extraction of impacted mandibular third molars were selected and evaluated. In 20 patients who underwent mandibular third molar extractions, electromyography showed no alterations in muscle tone, and no statistically significant differences were observed in the left and right temporal and masseter muscles at any of the experimental periods at either mandibular rest or isometric contraction position. However, the degree of mouth opening increased 11.76% from pretreatment to 30 days after surgery. These results may reflect the shorter, careful extraction procedure performed by the surgeon.

Cervical necrotizing fasciitis of odontogenic origin in a diabetic patient complicated by substance abuse.

Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridement. Necrosis in the platysma muscle was verified by histopathologic analysis. Reconstructive surgery was performed after suppressing the infection, and the wound was closed with an autologous skin graft. The patient had a long hospital stay, in part because the substance abuse led to a difficult recovery. The principles of early diagnosis, aggressive surgical debridement, broad-spectrum antibiotic therapy and intensive supportive care in the treatment of CNF were confirmed in the present case. It was concluded that given the occurrence of CNF in the presence of diabetes mellitus and abuse of substances such as alcohol and tobacco, the health care professional should consider a stronger response to treatment and longer hospitalization.

Cervical Necrotizing Fasciitis of Odontogenic Origin in a Diabetic Patient Complicated by Substance Abuse

Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridement. Necrosis in the platysma muscle was verified by histopathologic analysis. Reconstructive surgery was performed after suppressing the infection, and the wound was closed with an autologous skin graft. The patient had a long hospital stay, in part because the substance abuse led to a difficult recovery. The principles of early diagnosis, aggressive surgical debridement, broad-spectrum antibiotic therapy and intensive supportive care in the treatment of CNF were confirmed in the present case. It was concluded that given the occurrence of CNF in the presence of diabetes mellitus and abuse of substances such as alcohol and tobacco, the health care professional should consider a stronger response to treatment and longer hospitalization.

A fasceíte necrotizante cervical (FNC) é uma infecção rara de tecidos moles, potencialmente fatal, caracterizada por necrose no tecido subcutâneo e fascia com progressão rápida. Um caso de FNC de origem odontogênica em um paciente diabético, complicado por dependência alcoólica e abuso de tabaco, é relatado junto a uma revisão da literatura. O procedimento de emergência compreendeu hidratação, administração de colóide, controle glicêmico e antibioticoterapia de amplo espectro, seguido de debridamento cirúrgico agressivo. Necrose no músculo platisma foi verificada por análise histopatológica. Cirurgia reconstrutiva foi feita após resolução da infecção e a ferida foi fechada com enxerto dérmico autógeno. O paciente teve um longo período de internação hospitalar, em parte devido ao abuso de substâncias, o que levou a uma recuperação difícil. Os princípios de diagnóstico imediato, debridamento cirúrgico agressivo, antibioticoterapia de amplo espectro e cuidados em terapia intensiva no tratamento da FNC foram confirmados no presente caso. Foi concluído que diante da ocorrência de FNC na presença de diabetes mellitus e de abuso de substâncias como álcool e tabaco, o profissional assistente deve considerar uma resposta mais difícil ao tratamento e maior tempo de internação.