Surgically assisted maxillary expansion with or without pterygoid disjunction alters maxillomandibular positioning.

PURPOSE: This study aimed to analyze alterations in mandibular positioning after surgically assisted maxillary expansion (SARME) with and without pterygoid disjunction (PD). METHODS: Cone-beam computed tomography scans of 24 healthy individuals (18-45 years old) with transverse deficiency, superior to 5 mm, underwent SARME with or without PD. The aspects prospectively assessed were (1) alignment and position of the head (ITK-Snap and 3D Slicer software); (2) McNamara's and Steiner-Tweed-Wits' cephalometric analysis (Dolphin Imaging®); and (3) colorimetric evaluation based on 3D correspondence analysis (3D Slicer software). RESULTS: A decrease in 1-NA and 1-SN angles as well as an increased occlusal plane in both groups was observed. Superior-inferior and anteroposterior spatial displacements of the chin were statistically significant in the PD group. Altered colorimetric patterns were also observed in the PD group. CONCLUSIONS: This study found more evident tooth inclination in the group without PD; mandibular alterations were more evident in the PD group. Further studies with 3D analysis are strongly recommended for more comprehensive results.

Maxillofacial and dental-related injuries from a Brazilian forensic science institute: Victims and perpetrators characteristics and associated risk factors.

BACKGROUND: Trauma due to external causes represents one of the greatest challenges for public health services in different regions around the world. This study aimed to determine the prevalence of facial trauma, associated risk factors, and classification of body injuries in individuals who underwent forensic examination in a Brazilian center. MATERIAL AND METHODS: Data were collected at the Ceará State Forensic Medicine unit in a 12-year period. Sociodemographic data related to the etiological agent and lesions resulting from the bodily injury were recorded. RESULTS: Among 1,031 physical injury exams, physical aggression (p<0.001), male victims aged between 21 and 30 years (p<0.001), salaried workers (p<0.001), and soft tissue and dentoalveolar injuries were significant findings. Regarding aggression, domestic violence was prevalent (p<0.001), perpetrated by the victim's partner (p<0.001), using a blunt instrument during the aggression (p<0.001), and directly associated with soft tissue injury (p<0.001). In traffic accidents, the most common type was motorcycle accident (p<0.001), on weekdays (p=0.036), at nighttime (p=0.134), showing a significant association with bone fractures (p=0.001). CONCLUSIONS: Oral and maxillofacial injuries obtained from a Brazilian forensic science center were significantly associated with sociodemographic and etiological factors. Key words:Forensic dentistry, facial trauma, violence, public health.

Maxillofacial Gossypiboma: Case Report, Review of the Literature, and Diagnosis Algorithm.

Gossypiboma is a retained surgical sponge and represents a rare complication with an uncertain incidence probably due to medical-legal implications. It is an iatrogenic condition solely due to human factors. While the medical literature has previously described cases of this entity after orthopedic, abdominal, otorhinolaryngology, and plastic surgery procedures, gossypibomas in oral and maxillofacial region are uncommon. It can mimic neoplasms or other injuries, which may promote a delayed diagnosis; thus, the differential diagnosis should be based on clinical history in each particular case. Although there are no pathognomonic features of gossypiboma in oral and maxillofacial region, the most common symptoms suggestive of persistent inflammation include pain, fever, swelling, surgical wounds that do not heal, and purulent drainage. The aim of this study was to report a maxillofacial gossypiboma misdiagnosed as third molar surgery-related odontogenic infection and a diagnosis algorithm.

Clinical investigation of gustatory and neurosensory alterations following mandibular third molar surgery: an observational prospective study.

OBJECTIVE: This study aimed to prospectively observe gustatory and neurosensory alterations following surgical removal of mandibular third molars. MATERIAL AND METHODS: A prospective clinical study was conducted with patients who required mandibular third molar extraction, recruited from the Division of Oral and Maxillofacial Surgery at the Federal University of Ceará (Brazil). Age, sex, and radiographic signs were recorded. The outcome variables were the presence or absence of gustatory and neurosensory alterations. The patients were observed preoperatively and at 7, 30, 90, and 180 days postoperatively by using gustatory and neurosensory tests. RESULTS: The response to sweet (p = 0.509) and sour (p = 0.078) stimulus did not alter significantly over time. The salty threshold significantly increased from the preoperative to 7- and 30-day postoperative periods, returning to baseline values at 90 days postoperatively (p = 0.038). The bitter threshold increased significantly from the preoperative to 7-day postoperative period, returning to baseline values at 30 days after surgery (p < 0.001). Regarding neurosensory evaluation, there was an altered response to stimulus at 7 days postoperatively in specific studied areas, returning to baseline values 30 days after surgery (p < 0.05). CONCLUSION: The present study shows that mandibular third molar removal was associated with slight sensory disturbances related to mechanical, tactile, and gustatory perception. Regarding the recovery period, all patients returned to normal function without intervention, over a period ranging from 30 to 90 days. CLINICAL RELEVANCE: This study highlighted the importance of a sensory evaluation following removal of third molars, notably regarding mechanical perception and gustatory threshold assessment.

Factors Associated With the Complexity of Facial Trauma.

INTRODUCTION: Facial fractures have their incidence, etiology, clinical presentation, and features influenced by variables such as economic, cultural, and demographic factors. A large number of these fractures require simple or more complex approaches, and it becomes important to understand their clinical and epidemiological profile and factors associated with the fracture event and surgical indication. OBJECTIVE: The objective of this research is to analyze the clinical and epidemiological profile of surgical fractures and their associations with causal factors such as alcohol consumption, day of the incident, and nonuse of helmet for motorcycle accidents. METHOD: A retrospective study was conducted with collection of data from medical records of patients operated for facial fractures at the Hospital Regional of Cariri, state of Ceara, the Northeast of Brazil. Records from 2012 to 2014 were acquired highlighting sex, age, occupation, etiology, anatomical sites of fractures, and surgeries of varying complexities for single or multiple fractures. The day of the event, report or signs of alcohol consumption, and the use of helmets in motorcycle accidents were named associated factors. RESULTS: As a result the authors had a total of 624 cases of surgical facial fractures. Out of these, 546 (87.5%) were male and the majority of them presented between 20 and 30 years of age (40.5%). It was also observed that as an etiological factor motorcycle accidents led to more cases of surgical facial fractures, with 357 cases (62.1%), followed by physical aggression with 72 cases (12.5%). CONCLUSIONS: It can be concluded that there is a high prevalence of surgical facial fractures in male patients between 20 and 30 years of age, caused by motorcycle accidents, and that there was a strong association between the consumption of alcohol, failure to wear a helmet, and the presence of surgical facial multiple fractures.

Evaluation of different therapeutic Carnoy's formulations on hard human tissues: A Raman microspectroscopy, microhardness, and scanning electron microscopy study.

PURPOSE: To evaluate different therapeutic Carnoy's solution formulations on hard human tissues. MATERIALS AND METHODS: An in vitro study was performed with human teeth (n = 36) and bone fragments (n = 18), randomly divided into two experimental groups (Group I = Carnoy solution with chloroform; Group II = Carnoy solution without chloroform) and a control group (saline solution). The groups were subdivided into pre-conditioning, post-conditioning, and post-conditioning with saline washing. Raman microspectroscopy, Knoop microhardness test, and scanning electron microscopy with energy dispersive X-ray spectroscopy were used. RESULTS: There was demineralization of dental structures regarding mineral/matrix and carbonate/phosphate ratios (GI versus GII, p < 0.05). The presence of chloroform resulted in a statistically significant reduction of the teeth surface microhardness (p = 0.036), but not exceeding 0.01 µm. Both GI and GII showed significant structural changes by using scanning electron microscopy with energy dispersive X-ray spectroscopy. CONCLUSION: Carnoy's solution altered the organic and inorganic matrix of the human calcified specimens analyzed in vitro, and its effect was more pronounced when chloroform was present.

Use positional screws for Le Fort I osteotomy fixation: technical note.

In recent years, several studies related to fixation systems have been published, but few suggest any variations of the Le Fort I osteotomy technique, and the use of plates and screws placed along the canine and zygomatic pillar are common. The 20-year-old patient with Crouzon syndrome presented with severe hypoplasia of the maxillary, mandibular prognathism, and class III facial pattern. The patient underwent orthognathic surgery and high Le Fort I osteotomy with the fixation of eight positional screws. The aim of this paper is to describe a different technique for the fixation in high maxillary osteotomies, which can be used in specific cases.

Educational Utilization of Microsoft Powerpoint for Oral and Maxillofacial Cancer Presentations.

Electronic presentations have become useful tools for surgeons, other clinicians and patients, facilitating medical and legal support and scientific research. Microsoft® PowerPoint is by far and away the most commonly used computer-based presentation package. Setting up surgical clinical cases with PowerPoint makes it easy to register and follow patients for the purpose of discussion of treatment plan or scientific presentations. It facilitates communication between professionals, supervising clinical cases and teaching. It is often useful to create a template to standardize the presentation, offered by the software through the slide master. The purpose of this paper was to show a simple and practical method for creating a Microsoft® PowerPoint template for use in presentations concerning oral and maxillofacial cancer.

Does the Preemptive Use of Oral Nonsteroidal Anti-inflammatory Drugs Reduce Postoperative Pain in Surgical Removal of Third Molars? A Meta-analysis of Randomized Clinical Trials.

The purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n=420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n=298, P=.2227, odds ratio: 2.30, 0.60-8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.

Postoperative hemostatic efficacy of gauze soaked in tranexamic acid, fibrin sponge, and dry gauze compression following dental extractions in anticoagulated patients with cardiovascular disease: a prospective, randomized study.

INTRODUCTION: Oral anticoagulants are widely prescribed drugs. Interruption of anticoagulant therapy prior to oral surgery has been an issue of great controversy. The purpose of this study was to evaluate the incidence of bleeding complications after dental extractions in patients on anticoagulant therapy (warfarin) in whom different local hemostatic methods were used. MATERIAL AND METHODS: Patients using warfarin and requiring extractions of at least two teeth were screened to participate in this prospective, randomized study. Extraction sites were considered as sampling units (statistically representative sample size) and were allocated to one of the three study groups (G1-4.8% tranexamic acid; G2-fibrin sponge; and G3-no local hemostatic agents). RESULTS: Eighty-four extraction sites were obtained from patients with mitral valve prolapse (47.4%), prosthetic cardiac valve (23.7%), venous thromboembolism (21.1%), and pulmonary embolism (5.2%). International normalized ratio (INR) values ranged between 2.1 and 3.1 (mean 2.51 ± 0.1). Postoperative bleeding was observed in four surgical sites (p < 0.001) and was mainly in older patients (p = 0.005). DISCUSSION: The three local hemostatic protocols were similarly effective in controlling postoperative bleeding in patients undergoing anticoagulant therapy with warfarin. The majority of teeth could be extracted with minimal problems in patients with cardiovascular diseases receiving treatment with anticoagulant therapy.

Dental trauma: knowledge and attitudes of community health workers.

BACKGROUND: The international literature emphasizes the importance of evaluating the knowledge of different groups such as teachers, students, dentists, physicians, parents, and athletes regarding dental injuries. In Brazil, community health workers are professionals who can reach a wide variety of people and who have a marked influence on prevention and health promotion strategies. The objective of this study was to investigate the knowledge and attitudes of community health workers regarding dental trauma. METHODS: A questionnaire consisting of 19 questions divided into 3 parts was applied: demographic characteristics, knowledge, and attitudes. Data from 206 respondents were analyzed using descriptive statistics and logistic regression models. RESULTS: Approximately 28% of the participants reported to have been called to assist individuals with dental trauma. Only 42 subjects had received education on dental injuries, with 34 of them being instructed by a dentist. In cases of tooth avulsion, only 1.9% of the health workers reported that they would search for the tooth and reimplant it. The most frequently indicated storage media for avulsed teeth were nonphysiological media (69.42%). CONCLUSIONS: The educational level of the community health workers somehow influenced their knowledge (P < 0.001) and attitude (P = 0.016) regarding dental injuries. Educational programs for this group are needed to improve the management of traumatic dental injuries.

Unusual complication after genioplasty.

Facial beauty depends on shape, proportion, and harmony between the facial thirds. The chin is one of the most important components of the inferior third and has an important role on the definition of facial aesthetic and harmony in both frontal and lateral views. There are 2 principal therapeutic approaches that one can choose to treat mental deformities, alloplastic implants, and mental basilar ostectomy, also known as genioplasty. The latest is more commonly used because of great versatility in the correction of three-dimensional deformities of the chin and smaller taxes of postoperative complications. Possible transoperative and postoperative complications of genioplasty include mental nerve lesion, bleeding, damage to tooth roots, bone resorption of the mobilized segment, mandibular fracture, ptosis of the lower lip, and failure to stabilize the ostectomized segment. The study presents 2 cases of displacement of the osteotomized segment after genioplasty associated with facial trauma during postoperative orthognathic surgery followed by rare complications with no reports in the literature.

Effects of mepivacaine 2% with epinephrine in the cardiovascular activity of patients undergoing third molar surgery: a prospective clinical study.

BACKGROUND: Cardiovascular effects of epinephrine, especially on blood pressure (BP) and heart rate (HR), have been well documented. When present in dental local anesthetic solutions, epinephrine concentration ranges from 5 to 20 µg/mL. Doses less than 200 µg are recommended to be clinically safe. OBJECTIVES: This study investigated the effects of the anesthetic solution of mepivacaine (2%) with epinephrine (10 µg/mL) in cardiovascular activity (HR and BP). METHODS: Twenty-six patients underwent outpatient surgery for the removal of 2 unilateral (group I, n = 15) or 4 (group II, n = 11) third molars in a single session, being injected 5.4 and 10.8 mL of anesthetic solution, equivalent to 54 and 108 µg of epinephrine, respectively. The cardiovascular activity was monitored by cardioscope during the experimental period of 2 hours. Heart rate and BP were measured at the intervals of 0, 5, 10, 15, 20, 30, 40, 60, 90, and 120 minutes after anesthetic injection. RESULTS: After application of 2-way analysis of variance test, comparison between groups was not statistically significant for HR (P = 0.1388), systolic BP (P = 0.0228), and diastolic BP (P = 0.9846). However, patients from group II presented significantly greater sway in HR (P < 0.0001), systolic BP (P = 0.0169), and diastolic BP (P < 0.0001) in the course of 2 hours. CONCLUSIONS: Blood pressure did not present significant alterations after a local injection of 54 or 108 µg of epinephrine during surgery to remove 2 or 4 third molars. Although without significance, HR was more elevated in the 108-µg dose of epinephrine during the removal of 4 third molars.