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OBJECTIVE: Determine the main complications of orthognathic surgery in patients with cleft lip and palate. METHODS: PubMed, LILACS, Cochrane, Embase, Scopus, and Google Scholar were systematically reviewed. Studies addressing the complications of orthognathic surgery in patients with cleft lip and palate were included. For the search, the strategy was used with the descriptors extracted from MeSH "Cleft Palate", "Orthognathic Surgery" and "Complications". The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in the included studies. Patients of any sex, age, and ethnicity with cleft lip and palate submitted to orthognathic surgery were included in this systematic review. The study followed the PRISMA 2020 standards and was registered in PROSPERO with protocol CRD42020195927. RESULTS: In the initial search, 1090 articles were found and after applying the inclusion and exclusion criteria, eleven studies were selected. The sample consisted of 629 patients who underwent Orthognathic Surgery, with an average age of 21.52 years. The majority of patients (390) presented unilateral transforamen proposals. In total, 150 complications were identified in the included studies, the most frequent being relapse of movement with 77 cases (51.3 %). Other reported, but less frequent, complications were gingival recession with root exposure, premaxillary mobility, intraoperative hemorrhage, fistulas and infection and velopharyngeal impairment. Most included studies did not have a control group, making meta-analysis unfeasible. Seven of the included studies presented a low risk of bias according to the NOS. CONCLUSIONS: Orthognathic surgery in cleft patients is a safe procedure, however it presents particularities and more complications when compared to a non-cleft patient. In this study, the most common complication found was the relapse, and the surgeon must be aware of this complication and others, and try to minimize its negative effects on the patient. We strongly recommend further investigations with detailed methodologies, control groups, well-described criteria for reported complications, and comprehensive sample characteristics to provide higher-quality evidence.
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OBJECTIVE: The objective of this overview is to evaluate the effectiveness of dental implants placed in patients who underwent radiotherapy for the treatment of head and neck cancer, as well as to assess the methodological quality of the included systematic reviews. METHODS: The study was conducted in four PubMed, Lilacs, Dare Cochrane and Google Scholar databases until July 2022, using the descriptors "Radiotherapy," "Dental implants," and "Head and Neck Cancer." RESULTS: 958 studies were found in the initial search and after applying the inclusion and exclusion criteria, fifteen systematic reviews were selected to compose this overview and had their methodological quality evaluated by the AMSTAR 2 tool. RESULTS: 24,996 implants in 5487 patients were evaluated with a rate of success rate of 86.2% in patients who underwent radiotherapy and 95.2% in patients who did not undergo radiotherapy. Only one of the systematic reviews was of high quality according to AMSTAR 2. CONCLUSION: Oral rehabilitation with dental implants in patients with a history of head and neck cancer undergoing radiotherapy is a valid therapy. However, given the level of evidence found, further studies with better design are necessary to provide greater confidence in the clinical decision.
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Implantes Dentários , Neoplasias de Cabeça e Pescoço , Humanos , Implantação Dentária Endóssea , Neoplasias de Cabeça e Pescoço/radioterapiaRESUMO
HIV pathogenesis affects TCD4+ lymphocytes, causing impairment of the immune system. Thus, the consequent immunological fragility of individuals with the disease and the absence of studies that serve as a guide for clinicians' decision-making make many healthcare professionals recognize it as a synonym of contraindication for oral rehabilitation treatments with dental implants.
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Infecções por HIV , Humanos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Contraindicações , Fatores de Risco , Pessoal de Saúde , Implantação DentáriaRESUMO
PURPOSE: Bone grafting is fundamental in the treatment of cleft patients, and several grafting materials have been used for this purpose. The objective of this study is to evaluate the effectiveness of autogenous bone graft from the chin in the reconstruction of cleft alveolus. METHODS: Searches were performed in six databases (PubMed, Scopus, Cochrane, LILACS, Embase, and Google Scholar) by two researchers individually until July 2022. This study was registered in the International Prospective Register of Systematic Reviews (CRD42021267954) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The predictor variable is reconstruction technique, grouped into three levels: autogenous genial grafts, other endochondral autogenous grafts, and bio- or tissue-engineered materials. The outcome variables were alveolar cleft healing rate and bone height. The secondary variables were complications that included infections, necrosis, paresthesia, and dehiscence. Data analysis included the risk of bias and assessment of the certainty of evidence by the risk of bias in nonrandomized studies of interventions and grading of recommendations, assessment, development, and evaluation tools, respectively. The meta-analysis was performed with heterogeneity based on random effects of I2 and 95% confidence. RESULTS: In the initial search, 4,833 articles were found, and 10 of them were included in this systematic review. The included studies were from six countries on three different continents, with a sample of 692 patients. It was observed that the chin bone graft (214 patients) when compared to the endochondral bone graft (386 patients) reduced by 0.42 [confidence interval 95% = 0.18, 0.95] times the prevalence of bone resorption (P = .040 and I2 = 70%) analyzed in radiographic images. Two studies evaluated the bone filling through computed tomography, and there was no statistically significant difference between the groups (P = .340, I2 = 0%). Only two studies had a low risk of bias. CONCLUSION: Based on a low certainty of evidence, the chin autogenous bone graft proved to be similar to the endochondral graft in the reconstruction of the cleft alveolar; however, the limited number of studies with high heterogeneity and an uncertain risk of bias decreased the strength of the results found in this systematic review. New controlled primary studies should be carried out with the purpose of safely determining the effectiveness of chin bone grafts for the reconstruction of cleft alveolar.
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Fissura Palatina , Cirurgia Plástica , Humanos , Transplante Ósseo/métodos , Queixo/cirurgia , Fissura Palatina/cirurgia , AlgoritmosRESUMO
PURPOSE: Surgery of impacted lower third molars may be associated with postoperative complications. The aim of this study is to determine whether piezoelectric surgery is effective in reducing pain, swelling, and trismus compared to conventional rotary instruments during extraction of impacted lower third molars. METHODS: For this systematic review, the searches were performed independently by 2 researchers. Randomized clinical trials that used the piezoelectric instrument for the removal of impacted lower third molars in humans were included. The predictor variable was the study group (piezo surgery vs rotary instruments). The main outcome was the analysis of postoperative pain, swelling, and trismus. Data analysis included risk of bias assessment (RoB 2 Cochrane) and meta-analysis with heterogeneity based on random effects I2 and 95% confidence interval. RESULTS: In the initial results, 956 articles were revised and after applying inclusion/exclusion criteria, the final sample was composed of 18 publications, all being randomized clinical trials. The results of this meta-analysis demonstrated a significant reduction in pain scores with a Cohen's d of -0.95 [CI 95% = -1.23 to -0.67] of high clinical impact (P < .001). In the piezo group there was a significant increase in mouth opening of 4.29 [CI 95% = 2.33 to 6.25] mm (P < .001). Regarding swelling, Tragus-Ang and Go-eye, both showed a significant reduction in the piezo group (P < .001). There was a significant increase of 7.32 [CI 95% = 4.40 to 10.24] minutes in the piezo group (P < .00001), and none of the studies showed a significant risk of bias. CONCLUSIONS: Piezo proved to be effective in reducing pain, swelling, and trismus in third molar surgeries even with longer surgical time, but due to the lack of standardization in primary studies regarding swelling, new, controlled and standardized studies should be carried out with the objective of proving the effectiveness of this therapeutic modality in the reduction of postoperative swelling.
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Dente Serotino , Dente Impactado , Humanos , Dente Serotino/cirurgia , Trismo/prevenção & controle , Extração Dentária/métodos , Dor Pós-Operatória/prevenção & controle , Complicações Pós-Operatórias , Dente Impactado/cirurgia , Edema/etiologia , Edema/prevenção & controleRESUMO
OBJECTIVE: Verify the effectiveness of surgical repositioning of the premaxilla and its stabilization methods in patients with bilateral cleft lip and palate during mixed dentition. DESIGN: Systematic review. MATERIAL AND METHODS: The search was conducted in 7 databases (eg, Medline via PubMed; Scopus; Central Cochrane; LILACS; Embase, Web of Science; and Sigle via OpenGrey until August 2021), using the descriptors "premaxilla", "cleft Palate", and "bone transplantation". INCLUSION CRITERIA: Clinical trials and observational studies that have patients with bilateral cleft who had a need for superior/posterior repositioning of the premaxilla on mixed dentition; Studies in any language was evaluted whitout time restriction of publication. RESULTS: From 5572 records, 6 studies were included in the review with a total sample of 212 patients. Regarding the type of stabilization used in the premaxilla, the hybrid method (rigid and complementary semi-rigid stabilization) predominated, being observed in 184 patients (86.8%). A total of 17 failures were identified related to the surgical repositioning of the premaxilla, corresponding to 8% of the total number of surgeries. A meta-analysis of prevalence was performed, only with the retrospective studies. It was observed that the effectiveness rate of premaxilla repositioning was 92%, with a CI between 0.04 and 0.13, with all included studies showing a similar failure rate (0.08-0.09). The included studies also showed great homogeneity in this analysis (I2 = 0%; P = .75). CONCLUSION: Although there are several alternatives and techniques for repositioning and stabilizing the premaxilla, the statistical result did not differ between the different techniques.
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Fenda Labial , Fissura Palatina , Humanos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Dentição Mista , Estudos RetrospectivosRESUMO
The purpose of this systematic review was to define the effectiveness of palatally positioned dental implants placed in atrophic maxillae. Searches were performed in five databases including the gray literature, up to August 2021, by 2 independent reviewers, in order to answer the following research question: Is the palatal approach technique effective in the rehabilitation of atrophic maxillae? In the initial search, 1948 articles were found and after applying the inclusion and exclusion criteria, five studies were selected, none of which was a randomized clinical trial. A total of 681 implants were placed, 549 of them with a palatal approach and 132 at the alveolar crest, with an effectiveness of 98.38% and 99.5%, respectively, with no statistically significant difference between the groups. In assessing the risk of bias, only one of the studies had a low risk of bias. Implants installed with the palatal approach technique showed high effectiveness for rehabilitation of atrophic maxilla; however, few studies in the literature report this technique, requiring more controlled studies, and with less risk of bias, to confirm the results obtained in this systematic review.
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Implantes Dentários , Arcada Edêntula , Boca Edêntula , Humanos , Implantação Dentária Endóssea/métodos , Maxila/cirurgia , Arcada Edêntula/patologia , Arcada Edêntula/reabilitação , Arcada Edêntula/cirurgia , Prótese Dentária Fixada por Implante , Boca Edêntula/patologia , Atrofia/patologia , Resultado do Tratamento , Seguimentos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
INTRODUCTION: The purpose of this systematic review is to determine if the zirconia implants present better clinical results when compared to titanium implants. METHODS: Searches were conducted in 5 databases including, until March 2022, by 2 independent reviewers, according to the inclusion and exclusion criteria established in the study and according whit this question: Do zirconia dental implants present better clinical results than titanium dental implants? RESULTS: 3235 studies were initially found in the researched databases. 03 randomized clinical trials were included in this systematic review and meta-analysis. A total of 71 patients with 192 implants (87 titanium and 105 zirconia) were evaluated, showing an effectiveness of 87,4% and 78,1% respectively and there was no statistically significant difference in terms of survival rate in the meta-analysis (P = 0.70; I2 = 0%). Still in the meta-analysis, there was no statistically significant difference between titanium and zirconia implants in relation to the pink esthetich score or bleeding on probing, however, a favorable difference was observed for titanium in relation to marginal bone loss (P = 0.001; I2 = 0%). None of the studies evaluated had a low risk of bias. CONCLUSION: Oral rehabilitation with zirconia implants showed no advantages over titanium in this systematic review. However, the small number of studies included and the uncertain risk of bias may raise doubts in this interpretation and the results should be analyzed with caution. New studies with greater methodological rigor, follow-up time and number of interventions should be performed in order to safely determine the indication for the use of zirconia implants.
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Implantes Dentários , Humanos , Titânio , Planejamento de Prótese Dentária , Falha de Restauração DentáriaRESUMO
STATEMENT OF PROBLEM: Whether oral rehabilitation with dental implants in patients with Down syndrome leads to an increased complication rate is unclear. PURPOSE: The purpose of this systematic review was to determine the effectiveness of dental implants placed in patients with Down syndrome and whether the condition is a risk factor or contraindication for dental implant placement. MATERIAL AND METHODS: Searches were conducted in 6 databases, including the non-peer-reviewed literature, up to February 2021 by 2 independent reviewers according to established inclusion and exclusion criteria to answer this question: Is Down syndrome a risk factor or contraindication for oral rehabilitation with dental implants? RESULTS: A total of 655 studies were initially found in the databases. Five were included in this systematic review, all of which were observational studies. A total of 50 patients with 186 implants were evaluated, with a reported effectiveness of 79.1%. The risk of bias assessment determined that 3 of the 5 studies had a high risk of bias. CONCLUSIONS: Treatment with dental implants in patients with Down syndrome is a suitable option, but more complications are to be expected than with patients without this condition. Controlled studies with better methodological design and less risk of bias should be developed to improve the scientific evidence for the treatment of these patients.
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Implantes Dentários , Síndrome de Down , Humanos , Implantação Dentária Endóssea , Síndrome de Down/complicações , Contraindicações , Fatores de RiscoRESUMO
The objective of this systematic review is to evaluate the effectiveness of low-level laser therapy in the treatment of herpes labialis. The searches were carried out independently by 2 researchers and the articles were selected through the electronic databases according to the inclusion and exclusion criteria previously established. Initially, 480 articles were found, of which 7 randomized clinical trials and 1 clinical trial were selected. In total, 928 patients were included. In the meta-analysis, the mean healing time for laser use was significant, showing a mean reduction of 1.37 [CI 95% = 0.92 to 1.82] days for tissue healing (p < 0.0001). In the meta-analysis to evaluate the time for crust formation, there was no significant difference between the groups and no significant reduction in the mean time for crust formation (p = 0.150). Only one of the selected studies had a low risk of bias. The use of low-level laser proved to be effective in the treatment of herpes labialis. However, due to the high risk of bias in the included studies, there is a need to carry out new standardized studies to prove the effectiveness of this therapy.
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Herpes Labial , Terapia com Luz de Baixa Intensidade , Fotoquimioterapia , Humanos , Herpes Labial/radioterapia , CicatrizaçãoRESUMO
The objective of this umbrella review was to determine the effectiveness of rhBMP-2 in the reconstructive surgery of cleft patients through an evaluation of bone filling and volume of newly formed bone in the cleft area. A systematic search was carried out in PubMed/ Medline, Scopus, Cochrane Database of Abstracts of Reviews of Effects (DARE), Latin American and Caribbean Health Sciences Literature (LILACS), and the System for Information on Grey Literature in Europe (SIGLE) via Open Grey, until June 2020. Risk of bias was assessed using the ROBIS tool. A total of 2739 articles were identified and, based on the inclusion and exclusion criteria, six were included for final evaluation. The bone filling rate was 74.23% in the rhBMP-2 group and 72.38% in the autogenous group. Regarding the risk of bias, none of the articles had a low risk, four had an uncertain risk, and two a high risk. The results of this umbrella review show that the studies had high and uncertain risks of bias, and high heterogeneity. There was a lack of evidence regarding the possible complications offered by this therapy. The recommendation to use BMP-2 for alveolar cleft reconstruction, especially in a paediatric population, should be viewed with caution. New primary studies are needed to assess this variable and safely determine the use of rhBMP-2 in reconstructive surgery for cleft patients.
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Proteína Morfogenética Óssea 2 , Fissura Palatina , Procedimentos de Cirurgia Plástica , Proteína Morfogenética Óssea 2/uso terapêutico , Transplante Ósseo/métodos , Criança , Fissura Palatina/cirurgia , Humanos , Ílio/transplante , Proteínas Recombinantes/uso terapêutico , Procedimentos de Cirurgia Plástica/métodosRESUMO
PURPOSE: Removal of impacted third molars can be associated with complications such as pain, edema, and trismus that can increase the morbidity of the procedure. The purpose of this study is to determine whether the Erbium: yttrium aluminum garnet (Er: YAG) laser is effective in reducing pain, swelling and trismus compared to rotary instruments in removing impacted lower third molars (3Ms). METHODS: For this systematic review, the searches were carried out independently by 2 researchers and the articles were selected according to the inclusion and exclusion criteria previously established. The predictor variable was the study group (Er: YAG laser versus rotary instruments). The main outcome was the analysis of post-operative pain, edema, and trismus after third molar extractions. Data analysis included the risk of bias evaluation (RoB 2 Cochrane) and meta-analysis with random effects I2 based heterogeneity and 95% confidence. RESULTS: In the initial results, 1,371 articles were found and 6 randomized controlled trials (RCT) were selected to compose this study. A total of 299 lower 3Ms were removed, 126 with the Er: YAG laser, 142 with a drill and 31 with a piezoelectric instrument. The results of this meta-analysis showed that in the laser group there was a significant reduction in edema (1.82 [CI95% = -3.06 to -0.57] cm (P = .004)) and complications (P = .0004), a slight reduction in pain after 2 days (P = .030) and there was no variation in trismus (P = .200) when compared to the drill group. The surgery and/or osteotomy time was shorter in the drill group. Only 1 study presented low risk of bias. CONCLUSIONS: The Er: YAG laser has been shown to be effective in reducing edema, pain and complications in impacted lower 3M surgeries. However due to the lack of standardization in Er: YAG laser therapy, new controlled and standardized studies should be performed with the aim of proving the efficacy of this therapeutic modality.
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Lasers de Estado Sólido , Dente Impactado , Edema/etiologia , Edema/prevenção & controle , Humanos , Lasers de Estado Sólido/uso terapêutico , Dente Serotino/cirurgia , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Extração Dentária/efeitos adversos , Dente Impactado/complicações , Dente Impactado/cirurgia , Trismo/etiologia , Trismo/prevenção & controleRESUMO
INTRODUCTION: There have been concerns that longstanding oral dryness secondary to Sjogren's syndrome may increase the risk of failure of dental implants. AIMS: The aim of the present study was to determine the level of methodological quality of systematic reviews that evaluated the effectiveness of dental implants in patients diagnosed with Sjogren's syndrome. METHODS AND RESULTS: Databases of PubMed/Medline, LILACS, Science Direct and Dare Cochrane to October 2020 were evaluated. A total of 833 articles were initially identified but following use of appropriate inclusion and exclusion criteria 4 papers were identified for detailed analysis. An eventual study sample comprised 722 implants placed in 189 patients with a 95.22% success rate, the minimum follow-up time was 45.2 ± 23.8 months and the maximum 125.5 months. The studies were assessed for their methodological quality by the AMSTAR 2 tool, in which 3 had critically low quality and one low quality. CONCLUSION: Oral rehabilitation with dental implants in patients with Sjogren's syndrome seems to have a high success rate; however, the low quality of relevant reports highlights the need for primary and secondary studies with better methodological design in order to reduce bias and provide reassurance for this treatment option.
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Implantes Dentários , Síndrome de Sjogren , Contraindicações , Humanos , Fatores de Risco , Revisões Sistemáticas como AssuntoRESUMO
The treatment of mandibular fractures by gunshot ranges from late conservative repair to more aggressive early repair in a single stage. Treatments that preserve bony architecture as much as possible should be used, minimising patient morbidity and the complexity of future surgeries. The purpose of this study was to use a systematic review to determine which method of treatment was most effective for mandibular fractures by gunshot. Searches were conducted on Medline via PubMed, Scopus, Central Cochrane, and Sigle via Open Grey up to August 2019. Four studies were eligible to this systematic review, considering the previously establish inclusion and exclusion criteria. A total of 211 patients were evaluated. The mandibular body was the region more fractured followed by the symphyseal/parasymphyseal region. The closed treatment with intermaxillary fixation (IMF) was the most used followed by open surgery with internal rigid fixation (IRF) and external fixator. Considering the total adverse effects, the meta-analysis showed no statistically significant difference between the IMF and IRF groups (p=0.840), but IMF showed five times less infection and IRF six times less malunion. The algorithm was delineated from the types of injuries by gunshot, proposing forms of treatment from initial stabilisation to functional rehabilitation with implant-supported prostheses. The treatment of mandibular fractures by gunshot remains a challenge for surgeons. There was a statistically significant prevalence of success in the IRF group, however this group was also associated with a higher index of infection than the IMF group. New studies with high methodological quality and larger numbers of participants are needed to offer more safety for surgeons who treat patients with mandibular fractures by gunshot.
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Fraturas Mandibulares , Algoritmos , Fixação Interna de Fraturas , Humanos , Técnicas de Fixação da Arcada Osseodentária , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/cirurgia , Resultado do TratamentoRESUMO
Introdução: Todo tipo de trauma facial requer uma avaliação detalhada, a fim de compreender o histórico da lesão e possíveis sequelas. O trauma óculo-orbital não está entre as lesões mais frequentes na epidemiologia do trauma facial, embora esteja associado a altos índices de morbidade e sequelas graves, sendo necessário um acompanhamento multidisciplinar. O objetivo do presente estudo foi relatar um caso clínico de trauma óculo-orbitário severo ocasionado por arma de fogo. Relato do caso: Paciente de 19 anos foi atendido em um serviço de cirurgia bucomaxilofacial, vítima de trauma por arma de fogo, com a presença de um objeto metálico incomum na órbita esquerda e região temporal. Exame clínico e tomografia computadorizada foram realizados, confirmando uma trajetória extracraniana do objeto. O paciente foi submetido à cirurgia sob anestesia geral, e o objeto foi removido pelo orifício de entrada na região orbitária esquerda. Após avaliação oftalmológica, as funções do olho esquerdo não puderam ser recuperadas. Considerações Finais: O diagnóstico correto e o tratamento rápido são imperativos para restaurar a função e a estética agradável na região traumatizada... (AU)
Introduction: Any type of facial trauma requires a detailed evaluation in order to understand lesion history and possible sequelae. Oculoorbital trauma is not between the most frequent injuries within facial trauma epidemiology, although, it is associated to high morbidity rates and severe sequelae, so that a multidisciplinary follow-up is necessary. To report a clinic case of severe oculo-orbital trauma caused by firearm. Case Report: Patient, 19 years-old, attended the oral and maxillofacial surgery service victim of trauma by gunshot with the presence of an unusual metallic object in the left orbit and temporal region. Clinical exam and computed tomography scan were performed, confirming an extra-cranial trajectory of the object. Patient was submitted to surgery under general anesthesia and the object was removed through the entrance orifice in the left orbital region. After ophthalmologic evaluation, functions of the left eye could not be recovered. Final considerations: Correct diagnosis and rapid treatment are imperative to restore function and pleasant esthetics in the traumatized region... (AU)
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Humanos , Masculino , Adulto , Órbita , Lobo Temporal , Ferimentos e Lesões , Ferimentos por Arma de Fogo , Traumatismos Oculares , Remoção , Traumatismos Faciais , Corpos Estranhos , TomografiaRESUMO
Introdução: O complexo zigomático é a segunda estrutura mais fraturada do esqueleto facial em acidentes motociclísticos, perdendo em incidência, apenas, para fraturas de mandíbula. Fraturas de zigoma podem causar complicações oculares, parestesias na face, perda de projeção ântero-posterior, levando a defeitos ósseos que causam danos estéticos e funcionais ao paciente, se não forem tratados de forma correta. Relato de caso: A vítima de acidente motociclístico com trauma de face apresentou-se com queixas estéticas e funcionais, com diagnóstico conclusivo de fratura em complexo zigomático. Realizou-se um acesso hemicoronal com extensão endaural, o que permitiu a visualização das fraturas do arco zigomático direito e da região da sutura fronto-zigomática direita, acesso transconjutival para abordagem do rebordo infraorbitário e acesso intraoral para o pilar zigomático maxilar. As fraturas foram reduzidas e fixadas com placas e parafusos do sistema 1.5mm. Somente o pilar zigomático foi fixado com placas e parafusos de 2.0mm. Considerações Finais: Fraturas complexas do osso zigomático podem representar um verdadeiro desafio cirúrgico. Planejamento prévio por meio de exames de imagem adequados é fundamental para se definir o tipo de tratamento e os acessos cirúrgicos adequados... (AU)
Introduction: The zygomatic complex is the second part of the facial skeleton that most fracture incidence after motorcycle accidents, in losing only chip fractures of the mandible bone. Zygoma fractures can cause eye complications, paresthesias in the face, loss of anteroposterior projection, leading to bone defects that cause cosmetic and functional damage to the patient, if not treated properly. Case report: The victim of a motorcycle accident with facial trauma presented with aesthetic and functional complaints, with a conclusive diagnosis of fracture in a zygomatic complex. A hemi-coronal approach with endaural extension was performed, which allowed the visualization of fractures of the right zygomatic arch and right fronto-zygomatic suture region, transconjutival access to approach the infraorbital ridge and intraoral access to the zygomatic pillar. jaw. Fractures were reduced and fixed with 1.5mm system plates and screws. Only the zygomatic abutment was fixed with 2.0mm plates and screws. Final Considerations: Complex zygomatic bone fractures can represent a real surgical challenge. Prior planning through appropriate imaging exams is critical to defining the type of treatment and appropriate surgical access... (AU)
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Humanos , Masculino , Adulto , Zigoma , Fraturas Zigomáticas , Fixação Interna de Fraturas , Arcada Osseodentária , Fraturas Maxilares , Suturas , Ferimentos e Lesões , Osso e Ossos , Acidentes de Trânsito , MandíbulaRESUMO
The reconstruction of mandible is a challenge with regard to aesthetic and reconstructive demands. The etiology of mandibular fractures is variable, trauma, pathology, bone infections. There are many materials that provide an excellent form of rehabilitation for these defects, where the autogenous graft presents important characteristics that favor a greater success rate. Furthermore, the rapid prototyping method is quite interesting, because it brings a series of advantages to the surgeon, like reducing the operative time, among others. The purpose of the present article is to describe a clinical case of a patient with mandible bone defect caused by gunshot perforation, treated through iliac crest bone graft with planning through rapid prototyping. The mandibular reconstruction can present a real challenge for the surgeon. Biomodels should be required in complex cases because they help to decrease surgical time and to increase the predictability of the procedure.
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Ílio/transplante , Traumatismos Mandibulares/cirurgia , Reconstrução Mandibular/métodos , Ferimentos por Arma de Fogo/cirurgia , Humanos , Masculino , Duração da Cirurgia , Adulto JovemRESUMO
Introdução: Os acidentes motociclísticos estão entre as causas mais frequentes de traumatismos faciais. O fato de a motocicleta ser um veículo leve e de fácil condução e o descumprimento à legislação atual contribuem para o aumento da incidência e da gravidade dessas fraturas. Metodologia: Foram entrevistados 123 pacientes, momento em que foram colhidas as seguintes variáveis: Dependentes: Faixa etária, gênero, local de procedência, uso de capacete, se havia ingerido bebida alcoólica antes do acidente, se possuia habilitação para motocicleta, ossos faciais fraturados e lesões em outras áreas do corpo. As fraturas faciais bem como as fraturas em outras áreas do corpo foram diagnosticadas após exame clínico e imaginológico. Resultados: Houve uma predominância de indivíduos do gênero masculino (85,4%) e de pacientes provenientes de cidades do interior do estado do Ceará (61,8%). Fraturas múltiplas da face ocorreram em 49,6% dos pacientes pesquisados. A maioria dos pacientes não utilizavam capacetes ou não possuíam habilitação (75,6% e 73,2%, respectivamente.), e 38,2% haviam ingerido bebida alcoólica antes do acidente. Foi observado ainda que 20.3% dos pacientes apresentavam fraturas em outros ossos do corpo que não a face. Conclusão: Observa-se que os acidentes motociclísticos correspondem a uma grande parcela das fraturas faciais e que a maior parte desses acidentes estão associados ao descumprimento da legislação... (AU)
Introduction: motorcycle accidents are among the most common causes of facial trauma. The fact that the motorcycle be a light vehicle and within easy driving and breach the current legislation contribute to the increased incidence and severity of these fractures. Methodology: We interviewed 123 patients, at which the following variables were collected: Dependents: age range, gender, place of origin, helmet use, if had been drinking before the accident, it has qualified for motorcycle, fractured facial bones and lesions in other areas of the body. Facial fractures and fractures in other areas of the body were diagnosed after clinical examination and imaginologic. Results: There was a predominance of male (85.4%) and patients from cities in the state of Ceará (61.8%). Multiple facial fractures occurred in 49.6% of patients surveyed. Most patients did not use helmets or had no qualifications (75.6% and 73.2% respectively.) And 38.2% had been drinking before the accident. It was also observed that 20.3% of patients had fractures in other bones of the body other than the face. Conclusion: It is observed that motorcycle accidents account for a large portion of facial fractures and that most of these accidents are associated with the breach of the legislation... (AU)
Assuntos
Humanos , Masculino , Feminino , Acidentes de Trânsito , Fraturas Ósseas , Fraturas Maxilomandibulares/epidemiologia , Ferimentos e Lesões , Acidentes , Face , Fraturas Múltiplas , Dispositivos de Proteção da CabeçaRESUMO
O ameloblastoma é um tumor odontogênico benigno, localmente agressivo, com predileção pela região posterior de mandíbula. Acredita-se que se origina de remanescentes do aparelho de formação dentária, semelhante ao desenvolvimento do órgão do esmalte. Não há clara preferência por gênero, sendo mais prevalente entre a terceira e quinta décadas de vida. O ameloblastoma tem sido classificado em quatro tipos: unicístico, sólido/multicístico, desmoplásico e periférico. O tipo sólido pode apresentar algumas variantes histológicas, sendo as mais comuns a folicular e a plexiforme. Dentre as formas de tratamento, a excisão cirúrgica ampla com margens de segurança é o método de tratamento preferido. Recomenda-se um acompanhamento de mais de 10 anos com intervalos regulares após tratamento cirúrgico apropriado O objetivo deste trabalho é relatar o caso de um paciente portador de extenso ameloblastoma em região posterior de mandíbula, tratado a partir da ressecção da lesão com aposição de uma placa reconstrutiva do sistema lock. No momento, o paciente se encontra em acompanhamento pós-operatório de um ano sem sinais de recidiva. A partir deste trabalho pôde-se concluir que o tratamento realizado se mostrou adequado, no entanto um maior período de acompanhamento se faz necessário para indicar a cura do paciente
Ameloblastoma is a benign odontogenic tumor, locally aggressive being more found in posterior region of mandible. It is believed that it is originated from remnants of the dental formation apparatus, such as the developing enamel organ. There is no clear predilection by gender, being most prevalent between the third and fifth decades of life. Ameloblastoma has been classified into four types: unicystic, solid/multicystic, desmoplastic and peripheral. The solid type can present some histological variants, being most common follicular and plexiform types. Among treatment forms, wide surgical excision with safe margins is the preferred method of treatment. It is recommended a follow of more than 10 years, with regular intervals after the proper treatment. The aim of this study is to report a case of a patient showing large ameloblatoma in posterior region of mandible treated with resection of the lesion and the position of a reconstructive plate of the locking system. At the moment, a year follow up patient showed no signs of recurrence. From this study it could be concluded the performed treatment showed itself suitable, however, a longer period of follow is necessary to indicate the patient's cure