Temporomandibular joint disorders in skeletal class II patients referred to orthognathic surgery: A cross-sectional study.

OBJECTIVES: The aim of this study was to assess the prevalence of Temporomandibular Disorders (TMD) in subjects with skeletal class II dentofacial deformity referred for orthognathic surgery, as well as to elucidate its association with sociodemographic and psychosocial features. METHODS: This was a cross-sectional study using the Research Diagnostic Criteria for Temporomandibular Disorders. The sample comprised class II skeletal patients referred to an Oral and Maxillofacial Surgery center in the Brazilian Northeast. RESULTS: Seventy-three subjects were enrolled and completed the data collection, which consisted of a physical examination according to Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders and facial analysis. Women represented 82.2% of the sample. Among the assessed subjects, 68.5% were already undergoing orthodontic treatment, and the mean overjet of patients was 6.97 mm. The prevalence of TMD in this sample was 46.6%, with muscular disorders being the most common. Patients with an anteroposterior discrepancy greater than 7 mm showed a higher occurrence of TMD (p = 0.017). CONCLUSION: This study demonstrated a high prevalence of TMD in skeletal class II patients referred for orthognathic surgery, especially in those with a pronounced overjet, being Group I (muscular disorders) and Group III (degenerative disorders) the most prevalent.

Efficiency of maxillomandibular advancement for the treatment of obstructive apnea syndrome: a comprehensive overview of systematic reviews.

OBJECTIVES: To evaluate the efficiency of maxillomandibular advancement using aggregated individual patient data from multiple studies. MATERIALS AND METHODS: This overview was structured according to the PICO strategy. It adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist and was recorded on the international prospective register of systematic reviews (PROSPERO-CRD42020206135). Searches were conducted in the PubMed/MEDLINE, Scopus, Embase, Web of Science, LILACS, and Cochrane databases for studies published until January 1, 2021. Data from the included studies were collected by one author, while another reviewed the compilation. RESULTS: Twelve systematic reviews were included. The outcome measures studied were the apnea-hypopnea index, respiratory disturbance index, mean oxygen saturation, lowest oxygen saturation, sleepiness data, posterior air space, sella-nasion point A angle, sella-nasion point B angle, surgical success, and surgical cure in patients who underwent surgery. The AMSTAR scale presented moderate evaluations, with grades varying between 6 and 10 points. The Glenny scale revealed that the study selection did not include all languages. Only three reviews identified quality assessments conducted by at least two reviewers and only five related possible searches for unpublished data. CONCLUSIONS: Bimaxillary advancement surgery improved respiratory indicators, sleepiness data, and increased upper airway size. However, it is necessary to standardize the surgical criteria to establish measurable efficiency of the procedure. CLINICAL RELEVANCE: This overview makes a critical analysis of the results of the selected systematic reviews with the aim of presenting the most clinically relevant data on the maxillomandibular advancement for treating obstructive apnea syndrome, with a focus on improving respiratory, anatomical, and quality of life indices. There are no overviews that approach this theme from a well-structured perspective.

MORTALIDADE POR AFOGAMENTO EM CRIANÇAS MENORES DE 5 ANOS NO BRASIL: 2001 A 2010 / CHILDREN UNDER 5 YEARS MORTALITY BY DROWNING IN BRAZIL: 2001 A 2010 / MORTALIDAD POR AHOGAMIENTO EN NIÑOS MENORES DE 5 AÑOS EN BRASIL: 2001 A 2010

Anualmente, 400 mil pessoas morrem por afogamento no mundo, sendo as crianças abaixo de 5 anos as maiores vítimas. Este estudo objetivou descrever o perfil das crianças menores de 5 anos vítimas de afogamento no Brasil no período de 2001 a 2010. Foram realizadas análises descritivas e cruzamentos de variáveis. Os dados foram obtidos nas Declarações de Óbito registradas no Sistema de Informação de Mortalidade. As taxas de mortalidade foram calculadas e padronizadas pelo método direto. Os resultados apontaram a ocorrência, no período estudado, de 5.603 óbitos, predominantemente no sexo masculino, pardos, com um ano de idade. Houve decréscimo dos casos com o aumento da idade. Os meses com maior ocorrência foram os do verão e a maior e menor casuística para os anos de 2002 e 2010, respectivamente. A maior frequência foi no Nordeste e, quando especificado, em águas naturais. Concluiu-se que uma estratégia voltada para prevenir afogamento deve considerar a maior frequência em crianças de um ano completo, do sexo masculino e pardos, além de ocorrência no verão e na região Nordeste.

Annually, 400,000 people die from drowning in the world, being children under 5 years the greatest victims. This study aims to describe the drowning deaths over this population in Brazil between 2001 and 2010. Descriptive analysis and variables crossings were performed. Data was obtained from death certificates of the Mortality Information System. Mortality rates were calculated and standardized by the direct method. The results pointed out, in the period, 5603 deaths, the majority of the victims were one-year old mulatto boys. It was observed that drowning rates decrease with increase of age. Deaths occurred more in the summer, with highest and lowest rates in 2002 and 2010, respectively. Most drownings occurred in the northeast region and, when specified, in natural water. In conclusion, any strategy to prevent drowning must consider the higher frequency of one-year old mulatto males, during summer in the northeast region.

Cada año 400 mil personas mueren por ahogamiento en el mundo, siendo los menores de 5 años las principales víctimas. Este estudio tiene como objetivo describir las muertes por ahogamiento en esta población en Brasil entre 2001 y 2010. Se realizaron análisis descriptivos y cruzamiento de variables. Los datos de este estudio se obtuvieron en las declaraciones de muertes registradas en el Sistema de Información de Mortalidad durante los años 2001 a 2010. Las tasas de mortalidad se calcularon y estandarizadas por el método directo. Los resultados apuntaron que durante el período de estudio ocurrieron 5603 muertes, la mayoría eran varones, pardos, con un año de edad. Los casos fueron disminuyendo a la medida que la edad fue aumentando. La mayor frecuencia de casos se presentó en el Nordeste, y más específicamente, en aguas naturales. Los meses donde se presentó el mayor número de casos fueron los de verano, la mayor y menor casuística para los años de 2002 y 2010 respectivamente. Se llegó a la conclusión de que una estrategia para prevenir ahogamientos debe considerar la mayor frecuencia de los niños hasta un año de edad, varones y pardos, además de la ocurrencia durante el verano en la Región Nordeste.

Cryosurgery as an Option for the Treatment of Vascular Lesions of the Oral Cavity.

Cryosurgery is a treatment modality consisting in the destruction of tissue by the application of extremely low temperatures. This causes irreversible damage to cellular metabolism, leading to tissue destruction within minutes, a mechanism that may be beneficial when used in diseased tissues. Because cryosurgery is effective, simple, and easy to perform, it has been used in the treatment of lesions in both medical and dental fields. This technique provides many advantages, such as easy operation, absence of intraoperative bleeding, and low infection rate. We report the case of a patient with a hemangiomatous lesion of the oral cavity who was treated with liquid nitrogen spray cryosurgery, with successful results at 18-month follow-up.

Nevoid Basal Cell Carcinoma Syndrome: A Long-Term Study in a Family.

We present a family case series with 10 individuals having nevoid basal cell carcinoma syndrome (NBCCS) with a 10-year follow-up. All articles published in the literature between 1967 and 2011 on familial Gorlin-Goltz syndrome in any language were surveyed to determine the mapping of cases per country of occurrence of this disease. All patients in the present series were presented with calcification of the falx cerebri, mild hypertelorism, and frontal bossing. Odontogenic keratocystic tumors, palmar and plantar pits, and multiple basal cell carcinomas occurred in 90, 40, and 20%, respectively, of the patients. One of the patients died of skin cancer. Diagnosis of odontogenic keratocyst tumors was confirmed by histopathological examination. NBCCS is a rare autosomal dominant cancer predisposition syndrome; it is important to recognize it when a patient has multiple odontogenic keratocyst tumors because life-long monitoring is essential for patient management.

Management of subcondylar fracture by intraoral approach.

Condylar fracture osteosynthesis is nowadays commonly practiced, but only a few studies report the intraoral approach with angulated devices. Subcondylar fractures with little or lateral displacement can be treated using an intraoral approach with satisfactory results. The advantages of this approach are the absence of visible scars, the avoidance of facial nerve injury inherent to the extraoral approach, quick access to the fracture, and a reduced risk of infection. The authors report a case of subcondylar fracture treated through an intraoral approach. Despite the considerable lateral dislocation of the condyle, treatment consisted of the reduction of the fracture and osteosynthesis with a trapezoidal condylar plate using an intraoral surgical approach.

One-stage treatment of hemimandibular hyperplasia.

Hemimandibular hyperplasia (HH) is a rare, self-limiting process manifesting between the first and third decades of life. HH causes facial asymmetry and derangement of the occlusion. Management involves resection of the condylar head and orthognathic surgery. This paper describes the case of a 38-year-old woman with spontaneous onset HH over a span of approximately 30 years. The condition was managed with resection of the condyle with simultaneous orthognathic surgery. The patient is currently satisfied with her appearance and function, and there are no signs of recurrence after 2 years.

Conservative treatment of comminuted mandibular fracture involving maxillomandibular fixation with miniplates.

Bars and steel wires are the most commonly used methods to achieve maxillomandibular fixation, although there are numerous alternatives described for this same purpose. In cases of edentulous candidates for the conservative treatment of facial fractures, none of the conventional methods can be instituted for maxillomandibular fixation. Fixation in such cases is achieved with the aid of the total dentures of the patient or the confection of splints, but these methods lead to eating and oral hygiene problems. This article reports the case of an edentulous patient with a comminuted mandible fracture treated with a rarely described technique in which intermaxillary fixation was achieved with titanium miniplates.

Repercussions of surgically assisted maxillary expansion on nose width and position of septum and inferior nasal conchae.

The aim of the present study was to assess the clinical and radiographic repercussions of surgically assisted maxillary expansion on the septum, nasal cavity and nasal conchae. The sample was made up of 15 patients with skeletal maturity (9 females and 6 males between 16 and 45 years of age) and maxillary transverse deficiency. Assessments were performed through anterior rhinoscopy and frontal cephalometric radiographs on three occasions: (T0) preoperative period, (T1) locking of the expander and (T2) six months following the locking procedure. An increase was observed in the basal portion of the pyriform aperture and distances between the lateral wall of the basal portion of the pyriform aperture and the septum. The radiographic exam revealed that the nasal septum did not undergo any statistically significant change in its position. Moreover, no significant changes in the position of the nasal septum or nasal conchae were detected throughout the three evaluation times. The results suggest that surgically assisted maxillary expansion is capable of widening the basal portion of the pyriform aperture, with little repercussion on the anterior position of the nasal septum and inferior nasal conchae.

Horizontal maxillary osteotomy approach for resection of juvenile nasopharyngeal angiofibroma.

Juvenile angiofibroma is a benign fibroangiomatous tumor of relatively rare occurrence, developing most frequently in male adolescents. It has local characteristics of aggressiveness and expansion. The treatment of choice is surgical excision. In this article, the advantages and disadvantages of the surgical technique using the Le Fort I osteotomy are described, and the literature correlated with 2 case reports.

Patient's perception of the events during and after osteogenic alveolar distraction.

OBJECTIVE: The aim of the study was to evaluate the patient s perception of the events during and after an osteogenic alveolar distraction (OAD) procedure MATERIALS AND METHODS: A total of fifty-five (55) osteogenic alveolar distraction (OAD) procedures were performed in fifty (50) patients, who then were asked to answer ten (10) questions related to the treatment. Six (6) questions made reference to predefined values in a Visual Analogical Scale (VAS), three (3) questions could be answered by a predetermined answer, and only one (1) question had a free answer. RESULTS: In 76% of cases, the patient s description of the sensation felt during the surgery was good and bearable; 84% of the patients didn t feel pain after surgery. 4% of the patients felt pain during the activation period and 58% of the patients described the sensation during the activation period as pressure, felt most commonly, at the end of the period, and for about 20 minutes (66.6 %). In these cases the most frequently used analgesic was Paracetamol. Also, 46% expressed having had some difficulty to activate the device, with 10% of them in need of extra help. The presence of the activation rod caused discomfort in 52%. Finally, 78% of the patients treated with OAD would undergo this procedure again if it was necessary. A bone graft was performed in 27 out of the 50 treated patients, with 70% of them describing the bone graft surgery as more painful than the OAD. CONCLUSION: The OAD technique had a high degree of acceptance among the treated patients, however, some details as the interference of the activation rod continue to disturb them. The acceptance of the OAD technique is much better when compared with bone graft surgery technique as a second treatment.