Surgical Treatment of Blow-out Fracture: A New Perspective.

The present work aims to report 2 clinical cases of the use of current technologies for the treatment of orbital fractures. The cases are of patients who were victims of car accidents and who developed a blow-out orbital fracture. Clinically, they presented periorbital ecchymosis, blepharoedema, enophthalmos, and ophthalmoplegia and, therefore, underwent surgical reconstructive treatment. For both cases, preoperative computed tomography and biomodel impression of the orbits were performed. The modeling of the titanium mesh covering the defect in the biomodel that would be used in the surgery was performed. In the intraoperative period of reduction and fixation of the fracture with the titanium mesh, optics were used to better visualize the posterior defect, as well as computed tomography to ensure that the entire affected area was reconstructed. Both patients were followed up in the postoperative period and evolved without clinical and functional complaints.

Persistent Necrotizing Mediastinitis after Dental Extraction.

Mediastinitis is a rare, progressive, and destructive infectious process due to cervical or odontogenic infections, which, if not diagnosed early, may lead to several complications, including airway involvement and even an imminent risk of death. Herein, we report an unusual case of a 37-year-old male with a bilateral submandibular hard swelling after the left third molar extraction. After surgical intervention with submandibular drainage and antibiotic therapy, the infection persisted without explanation, since the patient was not hypertensive, did not have diabetes mellitus or sexually transmitted infections such as HIV or syphilis, and did not smoke or drink alcoholic beverages. A thoracic surgeon then intervened, treating the mediastinitis surgically by drainage, thus obtaining a significant improvement of the patient's health. Mediastinitis is a serious condition. Clinicians and maxillofacial surgeons should be alert to make an immediate diagnosis and select the appropriate treatment in order to prevent worsening of the patient's clinical condition.

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.

Comparative study of hemodynamic changes caused by diazepam and midazolam during third molar surgery: a randomized controlled trial.

The aim of the present study was to compare hemodynamic changes using midazolam 7.5 mg and diazepam 10.0 mg during the surgical removal of symmetrically positioned third molars. A prospective, randomized, double-blind, clinical trial was carried out involving 120 patients divided into three groups: Group 1 (diazepam and placebo), Group 2 (midazolam and placebo), and Group 3 (diazepam and midazolam). Each subject underwent two surgeries on separate occasions under local anesthesia. The following parameters were assessed at five different times (T0, T1, T2, T3, and T4): systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP, respectively); heart rate (HR); oxygen saturation (SpO(2)); rate pressure product (RPP); and pressure rate quotient (PRQ). Statistically significant differences were found regarding heart rate at T2 and T3 (p < 0.005) in Group 2, with a higher rate occurring during midazolam administration. Moreover, significant differences in rate pressure product were found at T2, T3, and T4 in this group, with higher values also occurring during midazolam administration. In Group 3, significant differences in diastolic blood pressure were found at T3 and T4, with higher values occurring during diazepam administration, whereas a higher heart rate occurred at T3 with midazolam. Midazolam 7.5 mg and diazepam 10.0 mg exert an influence on some hemodynamic parameters without perceptible clinical changes in healthy patients undergoing lower third molar surgery.

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.

Hemodynamic changes comparing lidocaine HCl with epinephrine and articaine HCl with epinephrine.

BACKGROUND: The aim of the present study was to analyze hemodynamic changes after the administration of either 2% lidocaine with epinephrine 1:100,000 (L100) or 4% articaine with epinephrine 1:200,000 (A200) in the surgical removal of symmetrically positioned lower third molars. METHODS: A prospective, randomized, double-blind, clinical trial was carried out involving 43 patients. Each patient underwent 2 surgeries on different occasions-one under local anesthesia with L100 and the other with A200. The following parameters were assessed at 4 different times: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product (RPP); and pressure rate quotient (PRQ). RESULTS: No hypertensive peak was observed in systolic, diastolic, and mean blood pressure at any evaluation time. Moreover, the type of anesthetic solution did not affect diastolic blood pressure, oxygen saturation or PRQ during the surgeries. Statistically significant differences between groups were detected with regard to heart rate and RPP (P < 0.05). CONCLUSIONS: The epinephrine concentration (1:100,000 or 1:200,000) and local anesthetic solutions used (2% lidocaine or 4% articaine) influenced hemodynamic parameters without perceptible clinical changes in healthy patients undergoing lower third molar removal.

Hemodynamic changes comparing 2% lidocaine and 4% articaine with epinephrine 1: 100,000 in lower third molar surgery.

BACKGROUND: An increase in blood pressure during dental treatment has been investigated with regard to potential medical risks since previous studies suggest that dental procedures may cause stress to the patient and, consequently, the cardiovascular system. The aim of the present study was to analyze hemodynamic changes following the administration of either 2% lidocaine (L100) or 4% articaine (A100) (both with epinephrine 1:100,000) in the surgical removal of symmetrically positioned lower third molars. METHODS: A prospective, randomized, double-blind, clinical trial was carried out involving 47 patients. Each patient underwent 1 surgery at each of 2 appointments--one under local anesthesia with L100 and the other with A100. The following parameters were assessed at 4 different times: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product; and pressure rate quotient. RESULTS: No hypertensive peak was observed in systolic, diastolic, and mean blood pressure at any evaluation time. Moreover, the type of anesthetic solution did not affect diastolic blood pressure, heart rate, or oxygen saturation during the surgeries. The pressure rate quotient was the only parameter to exhibit statistically significant differences between groups at different evaluation times (P < 0.05). CONCLUSIONS: The hemodynamic parameters evaluated in third molar surgery with 2% lidocaine and 4% articaine (both with epinephrine 1:100,000) did not show significant differences.

Peripheral osteoma bilateral of the mandible without association with Gardner syndrome.

Periosteal osteoma is a rare benign pathologic lesion in the jaws and the mandible is the anatomic region most frequently involved. Elective treatment consists of surgical excision. The aim of this report was to report a rare case of bilateral periosteal osteoma involving the mandible--a painless, firm, and well-circumscribed lesion, with more bony prominence on the left than on the right side. The patient had no history of facial trauma or systemic changes that could intervene with the progression of the lesion. It was diagnosed as a periosteal osteoma, and surgical excision was performed. No recurrence after 4 years of follow-up was demonstrated. Surgical excision of the periosteal osteoma was demonstrated to be a useful technical strategy that simplifies and accelerates the surgical procedures and probably contributes to establish harmony of the jaws. Periodical clinical and radiographic follow-ups after surgery are advised.

Histomorphometric evaluation of calcium phosphate bone grafts on bone repair.

UNLABELLED: Because of its biocompatibility and osteoconductive properties, calcium-phosphate cement has been used as bone surrogate. OBJECTIVE: The purpose of this study was to do a histomorphometric comparison of bone regeneration using hydroxyapatite biphasic ceramic, calcium-phosphate cement and autogenous bone graft. STUDY DESIGN: Prospective and laboratorial experiment. MATERIALS AND METHODS: Two 5mm in diameter cavities (left and right--test and control) were made in the parietal bone of 72 rats. The GI, GII, GIII and GIV test cavities were filled with calcium-phosphate cement, biphasic ceramic hydroxyapatite, autogenous bone graft and blood. The animals were killed at 30, 60 and 90 days and the specimens underwent histomorphometric analysis. RESULTS: The results showed that autogenous bone graft treated defects had significantly more new bone at 30 days compared to other test groups. Within 60 and 90 days, bone formation was more significant in the test groups GI, GII and GIII; GI and GII encompassed larger areas. Throughout the evaluation periods, GII tests showed more bone formation when compared to GI. CONCLUSIONS: Biomaterials depicted a significantly increase in bone content, when compared to autogenous bone graft, concerning bone regeneration.