Reconstrucción maxilofacial de la región orbitaria / Maxillofacial reconstruction of the orbital region

La región orbitaria representa una unidad estética funcional muy importante en la región facial. Se presenta un trabajo retrospectivo de un período de 20 años (2000-2020) de actividad pública-privada en el tratamiento de patología tumoral y traumática de la región orbitaria. Analizamos en 580 casos operados, 184 oncológicos y 396 traumáticos, diferentes aspectos comunes que intervienen en el tratamiento reconstructivo de la región: abordajes, técnicas quirúrgicas, consideraciones anatomofuncionales, principios básicos en cirugía maxilofacial orbitaria y complicaciones, resaltando la importancia del manejo correcto de los tejidos regionales en su reconstrucción. La mejor posibilidad para el paciente de lograr un buen resultado es con una operación primaria correcta. Sus complicaciones son de difícil tratamiento

The orbital region represents a very important functional aesthetic unit in the facial region. A retrospective study of a 20-year period (2000- 2020) of public-private activity in the treatment of tumor and traumatic pathology of the orbital region is presented. We analyzed in 580 operated cases, 184 oncological and 396 traumatic, different common aspects involved in the reconstructive treatment of the region: approaches, surgical techniques, anatomofunctional considerations, basic principles in orbital maxillofacial surgery and complications, highlighting the importance of the correct management of regional tissues in their reconstruction. The best possibility for the patient to achieve a good result is with a correct primary operation. Its complications are difficult to treat

Evaluation of the effectiveness of arnica montana 6ch in the control of postoperative myalgia by isometric effort in dentistry

Arnica montana 6CH is a medicine indicated for inflammatory and painful conditions, especially in muscle structures. The RDC / TMD Axis II questionnaire is a validated tool for the diagnosis of Temporomandibular Muscle Dysfunction. Objective: This multicenter, randomized and controlled study, approved by Human or Animal Research Ethics Committee UniFOA -CAAE: 48680015.3.0000.5237 aimed to verify the clinical performance of Arnica montana 6CH in contractures and muscle pain triggered by isometric stress. Materials and Methods: 70 patients underwent prolongeddental treatment sessions, and they were selected after clinical examination and positive responses to the RDC / TMD questionnaire to confirm signs and symptoms of Temporomandibular Muscle Dysfunction at the first consultation. Randomly, Arnica montana 6CH was prescribed for 35 patients called group I, and placebo for 35 patients called group II, at a dose of 5 globules, 03 times a day, for 1 week. In the second endodontic consultation, after 15 days, a new clinical examination was performed at the beginning and end of the prolonged dental consultation with crossing of data from the RDC questionnaire, to monitor the prevalence of TMD muscle signs and symptoms. The data were tabulated and analyzed. Statistical analysis: The test t de Student was used for paired samples, significant at the level ≤ 0.05%. Results:Anamnetic data from the RDC questionnaire, 86% of the individuals in the GI had lower pain and muscle contracture rates in the second consultation, compared with 22% in the GII. Conclusion:The drug Arnica montana 6CH proved to be effective in preventing muscle changes and clinical symptoms resulting from isometric efforts with a statistically significant difference (p ≤ 0.05).

The effectiveness of the cold therapy (cryotherapy) in the management of inflammatory parameters after removal of mandibular third molars: a meta-analysis

Introduction: Cold therapy (cryotherapy) is a common procedure recommended by dental surgeons after surgical removal of thirdmolars, which is an invasive intervention that often deals with an expressive inflammatory response. Objective: To investigate whether cryotherapy interferes with clinical outcomes such as pain, edema, and trismus in the postoperative period of mandibular third molar surgeries. Data Synthesis: An electronic search was conducted in the OVID, PubMed, VHL, Science Direct, Cochrane Library, and Web of Science databases, through March 2018. The eligibility criteria included clinical trials that evaluated the effect of cryotherapy in at least one of the following variables: pain, swelling, and trismus. Two independent reviewers assessed the studies. The methodological quality of each article was analyzed. The search strategy resulted in 1,088 articles. Following the selection process, 11 studies were included in the systematic review and 4 of them in the meta-analysis. High risk of bias was found in most of the studies according to the Cochrane Handbook assessment. Patients receiving cryotherapy had less edema than patients in the control group at second day follow-up (mean difference [MD]: -0.94; 95%CI [-1.49; -0.39]). There were no statistically significant results when comparing trismus between experimental and control group (MD: 0.43; 95%CI [-0.34;1.20]). There were insufficient available data to support influences in postoperative pain. Conclusions: Cryotherapy applied on thefirstday aftermandibular third molar removal can manage edema in the patients.Well-designed randomized clinical trials to test the efficacy of cryotherapy after surgical removal of third molars are needed to justify its indication (AU)

Immediate Dental Implant Placement After Removal of Complex Odontoma.

The aim of the authors was to report a clinical case about immediate implant placement after the removal of complex odontoma. A 35-year-old female patient presented to private service complaining about absence of lower right first premolar. The computed tomographic showed radiopaque attenuation, surrounded by a narrow radiolucency in the area of dental absence, suggesting a mineralized lesion. The surgical removal of lesion was performed by intraoral access with general anesthesia and the implant of 3.75 × 10 mm (Neodent) was placed with the aid of a surgical guide, following the drill sequence established by the manufacturer. No complications were observed after 1 year with the prosthetic rehabilitation.

[Transoral coronoidectomy: Technical note]. / Coronoïdectomie intra-orale: note technique.

INTRODUCTION: Among the skeletal causes of limited mouth opening, uni- or bilateral coronoid process hypertrophy, or Langenbeck disease, is the most frequent. It can be associated with an osteochondroma or a coronoid-malar bone conflict and is then called Jacob disease, an unilateral pathology. Treatment rests on coronoidectomy in both cases. This technique is illustrated via two cases, one Langenbeck and one Jacob disease. TECHNICAL NOTE: A transoral approach was performed. After subperiosteal dissection, the coronoid process was cleared. The process was than severed at its base by means of a burr, freed from its temporal muscular fibers and removed. Mouth opening improved peroperatively. The surgical procedure was completed by active long-term physiotherapy beginning immediately after surgery. DISCUSSION: Transoral coronoidectomy is a simple, quick and safe procedure. Extra-oral approaches present a high risk of facial nerve injury. In our first case, mouth opening improved from 24 to 36 mm after bilateral coronoidectomy and to 40 mm after physiotherapy. In our second case, mouth opening improved from 22 to 38 mm after unilateral coronoidectomy and to 43 mm after one year physiotherapy. Long-term post-operative physiotherapy is mandatory to get and maintain good results.

[Elaboration of health care quality criteria in maxillofacial surgery].

Criteria of quality of care in oral and maxillofacial surgery should reflect not only the quality of the repair functions of chewing, swallowing, breathing, speech, and should take into account the psycho-emotional condition of the patient; satisfaction of its appearance, quality cosmetic fill configuration of the face, tooth defects, smiles; adaptation to implants and dentures; their quality, the conditions and possibilities of their use. The application of the provisions of the international classification of functioning, disability and health in oral and maxillofacial surgery, is a condition that will allow to unify the approaches to the development of quality criteria of this type of medical care.

Reabilitação da maxila com implantes utilizando a técnica "All-on-Four" - otimizando a estética / Rehabilitation of the maxilla with implants using the technique

A reabilitação da maxila edêntula com uso de implantes normalmente é limitada pela pouca quantidade óssea, devido ao padrão de reabsorção óssea na região anterior e pela presença dos seios maxilares na região posterior. Na tentativa da resolução dessas condições des¬favoráveis, algumas técnicas cirúrgicas têm sido propostas: enxertos ósseos, fixações zigomáticas, implantes curtos e implantes inclinados. Uma alternativa conservadora é o All-on-Four. Os implantes dentais inicialmente foram concebidos para serem colocados em uma posição vertical. Com o avanço das técnicas cirúrgicas, pacientes desdentados totais, extrações recentes, volume mínimo, pobre qualidade óssea e necessidade de enxertos tornaram-se situações desafiadoras para os profissionais. Para essas situações ficou demonstrado que o implante distai inclinado poderia ser vantajoso, já que preserva estruturas anatômicas importantes, permitindo a colocação de implantes mais longos, com boa ancoragem e em ótima posição para suporte protético. O tratamento de pacientes desdentados usando o conceito All-on-Four permite a instalação de uma prótese total fixada imediatamente aos implantes no mesmo ato cirúrgico. Para isto, quatro implantes são utilizados: dois orientados axialmente colocados na região anterior e dois implantes inclinados distalmente colocados na região posterior. Nos implantes da região anterior são colocados abutments retos e na região posterior os angulados, os quais servirão de suporte para uma prótese total provisória com carga imediata.

Edentulous maxilla rehabilitation with use of implants is usually limited by low bone amount, due to the pattern of bone resorption at the anterior region and the presence of the maxillary sinus at the posterior region. In an attempt to resolve these unfavorable condi¬tions, some surgical techniques have been proposed: bone grafts, zygomatic fixtures, short implants and tilted implants. A conservative alternative is the AII-on-Four. The dental implants were initially designed to be placed in a vertical position. With the advancement of surgical techniques, edentulous patients, recent extractions, minimum volume, poor bone quality, and grafts requirement have become challenging situations for professionals. For these situations it has been observed that the tilted distal implant could be advantageous, since it preserves important anatomical structures, allowing placement of longer implants, good anchorage and great position for prosthetic support. The treatment of edentulous patients using AII-on-Four allows the installation of a denture immediately fixed on the implants in the same surgical act.For this, four implants are used: two axially oriented placed at the anterior region and two tilted distal implants placed at the posterior region. In the implants of the anterior region right abutments will be placed and at the posterior region angulated ones will support a provisional denture with immediate loading.

Fabrication of a hollow bulb prosthesis for the rehabilitation of an acquired total maxillectomy defect.

The prosthodontic rehabilitation of maxillary defects is a challenging and demanding task which requires careful pre-surgical and post-surgical planning. Maxillary defects can be congenital or acquired. Acquired defects include those following trauma or surgical treatment of benign or malignant neoplasms. A prosthodontist encounters problems such as absence of support, poor retention, and lack of prosthesis stability in treating these patients. The present case report describes a procedure to fabricate a definitive hollow bulb obturator prosthesis for the rehabilitation of a total maxillectomy defect.

[Facial allografts and oral rehabilitation]. / Allogreffes de la face et réhabilitation orale.

The main objective of facial allografts is functional. On this account, oral rehabilitation is pivotal. Two types of cases are possible. Firstly, the indication of facial allograft concerns only the soft tissues. If so, dental care is similar to the one of patients with an organ transplant. Dental implants are a priori contraindicated. A possible indication has to be discussed with the multidisciplinary team. Secondly, the indication is the one of a mandibular and/or maxillary reconstruction. The objective will be a total reconstruction. It could be performed immediately with the allotransplantation of a toothed mandible or maxillar, if the local status permits it. To date, among patients who have benefited from a toothed allotransplant, no tooth has been lost. The first cases have been operated in 2009. If donor teeth cannot be conserved with the allotransplant, the oral rehabilitation will have to be done ideally with adjunctive prostheses. It is rarely possible, for example because of the lack of crests. In case of impossibility, an implant-based rehabilitation can be discussed. One case has been performed with basal implants (cortically anchored disk-design implants) with a five-year follow-up without loosing any loss of implant or infection.

["Double barrel" free fibula flap and vascular risk. A national investigation in France]. / Lambeau libre de péroné en « double barre ¼ et risque vasculaire. Enquête nationale.

INTRODUCTION: The free fibula flap is the most commonly used flap for mandibular reconstruction thanks to its multiple advantages. Its main drawback is the thin width of the bone section. The "double barrel" fibula flap is a solution to this problem allowing reconstruction of both basilar and alveolar ridges for a stable prosthetic dental rehabilitation. The authors wanted to assess its use, in France, to evaluate its reliability, and to determine its indications. PATIENTS AND METHODS: The authors sent a questionnaire to the 25 French Maxillo-Facial University Hospital Departments. Questions concerned the surgical technique, its indications, and the operative results, between January 2002 and December 2007. RESULTS: Out of the 18 teams who answered, 16 used a free fibula flap for mandibular reconstruction but only seven used the double barrel technique, for a total of 24 double barrel reconstructions. Only one total necrosis was reported. The indications for double barrel fibula flap were nearly all for corpus reconstruction and the operating overtime was less than one hour. DISCUSSION: The international literature review analysis gives results which compare to French ones, with a weak rate of necrosis despite the intermediate rectangular ostectomy. This technique may be recommended especially since it does not increase the operative time much and it improves dental restoration.

Beyond patient reported pain: perfusion magnetic resonance imaging demonstrates reproducible cerebral representation of ongoing post-surgical pain.

Development of treatments for acute and chronic pain conditions remains a challenge, with an unmet need for improved sensitivity and reproducibility in measuring pain in patients. Here we used pulsed-continuous arterial spin-labelling [pCASL], a relatively novel perfusion magnetic-resonance imaging technique, in conjunction with a commonly-used post-surgical model, to measure changes in regional cerebral blood flow [rCBF] associated with the experience of being in ongoing pain. We demonstrate repeatable, reproducible assessment of ongoing pain that is independent of patient self-report. In a cross-over trial design, 16 participants requiring bilateral removal of lower-jaw third molars underwent pain-free pre-surgical pCASL scans. Following extraction of either left or right tooth, repeat scans were acquired during post-operative ongoing pain. When pain-free following surgical recovery, the pre/post-surgical scanning procedure was repeated for the remaining tooth. Voxelwise statistical comparison of pre and post-surgical scans was performed to reveal rCBF changes representing ongoing pain. In addition, rCBF values in predefined pain and control brain regions were obtained. rCBF increases (5-10%) representing post-surgical ongoing pain were identified bilaterally in a network including primary and secondary somatosensory, insula and cingulate cortices, thalamus, amygdala, hippocampus, midbrain and brainstem (including trigeminal ganglion and principal-sensory nucleus), but not in a control region in visual cortex. rCBF changes were reproducible, with no rCBF differences identified across scans within-session or between post-surgical pain sessions. This is the first report of the cerebral representation of ongoing post-surgical pain without the need for exogenous tracers. Regions of rCBF increases are plausibly associated with pain and the technique is reproducible, providing an attractive proposition for testing interventions for on-going pain that do not rely solely on patient self-report. Our findings have the potential to improve our understanding of the cerebral representation of persistent painful conditions, leading to improved identification of specific patient sub-types and implementation of mechanism-based treatments.

Current practice in dental oncology in the U.K.

UNLABELLED: The clinical management of cancer patients, particularly where it affects the head and neck, may result in short- and long-term complications. Specialist management of the dental sequelae of cancer is often recognized nowadays by the term'Dental Oncology' Members of the dental team play a vital role in preventing and promptly managing such complications and all dental professionals should have a sound understanding and knowledge of the oral implications of cancer therapy and their management, and the contribution of this to the patient's quality of life. CLINICAL RELEVANCE: This article offers the dental team an overview of the impact of cancer therapy and strategies for preventing and managing the oral side-effects of cancer therapy prior to, during, and beyond cancer treatment.

Terapeutica interdisciplinaria para la resolución del mucocele / Interdisciplinary therapeutic resolution of the mucocele

El mucocele es un pseudoquiste de la mucosa bucal originada en las glándulas salivales menores. Constituye el problema benigno más frecuente de las glándulas salivales durante la infancia. Se presenta como un nódulo indoloro, color blanco azulado, de forma redondeada, tamaño variable, aspecto translúcido, fluctuante y firme. En la mayoría de los casos se encuentra inducido por un trauma local menor, como puede ser mordedura del labio, succión o maloclusión dentaria, o por un traumatismo facial con ruptura del conducto excretor de la glándula salival, seguido de extravasación de la mucina en los tejidos blandos circundantes. El tratamiento de preferencia para esta lesión es la escisión quirúgica, cuya técnica detallaremos en el presente trabajo. Si, por el contrario, sólo se drena, hay frecuencia elevada de recidivas. Es de suma importancia determinar la causa primaria que ha originado el trauma para realizar un tratamiento interdisciplinario cuando sea necesario para, de esta forma, evitar reincidencias. La intervención fonoaudiológica está indicada en los casos de mucocele por hábito de succión labial y el tratamiento ortodóntico-ortopédico cuando se determina como causa primaria una maloclusión dentaria. El abordaje integral del mucocele, permite la resolución de todas las causas que podrían haberlo originado y, además, el aporte de las diversas disciplinas otorga calidad a la terapéutica desde un enfoque completo e integrador

The mucocele is a pseudocyst of the oral mucosa arising in minor salivary glands. This entity is the most common salivary glands problem in childhood. It presents as a painless, round, bluish white nodule of translucent and fluctuating appearance and variable size. Most of the cases are induced by local trauma, such as bite of the lower lip or a facial trauma with rupture of the excretory duct of the salivary gland, followed by extravasation of mucin into the surrounding soft tissues. The treatment of choice for mucocele is surgical excision that will be herein detailed. If it is just drained, there will be high possibilities of recurrence. It is very important to establish the primary cause of the trauma for an interdisciplinary treatment if necessary, and thus avoidance of recurrence. Speech therapy intervention is indicated in mucoceles caused by lip sucking habit, and orthodontic-orthopedic treatment for those situations where dental malocclusion is determined as the primary cause. Addressing the different pathologies in an integral way, allows the resolution of all the causes that could have originated them, and the contribution of various disciplines also provides quality therapy from a complete and integrated approach

Functional outcomes of fibula and osteocutaneous forearm free flap reconstruction for segmental mandibular defects.

OBJECTIVE/HYPOTHESIS: To demonstrate that the osteocutaneous radial forearm free flap provides equivalent functional outcomes and improved morbidity compared to the fibular free flap in mandibular reconstruction. STUDY DESIGN: Retrospective review. METHODS: There were 168 patients requiring free flap reconstruction of segmental mandibular defects between January 2001 and December 2008. Mean follow-up was 31 months for fibula free flap (FFF) (n = 117) and 20 months for osteocutaneous radial forearm free flaps (OCRFFF) (n = 51), reflecting an increasing use of forearms. RESULTS: OCRFFF were more commonly used in older patients (mean 63.7 years vs. 59 years, P = .03). The majority (96.2%) of reconstruction was for malignant pathology. Flap failure was 3.4% for the fibula group and 3.9% in the forearm group. Malunion was infrequent (2.0% OCRFFF, 6.0% FFF, P = .26). Donor site complications were higher in the FFF group (4.3%) versus none in the OCRFF group (P = .13). Despite a high rate of long-term survival in this patient population (75% at 5 years for carcinoma), dental implants were rarely placed (2.3% of patients) and were more common in forearm than fibula free flaps. Functional outcomes demonstrated no significant difference between groups with respect to oral diet (FFF 72.6% vs. OCRFFF 79.1%, P = .49) or retained enterogastric feeding tube (20.9% OCRFFF vs. 27.4% FFF, P = .49). CONCLUSIONS: Osteocutaneous radial forearm flaps provide comparable functional outcomes with less morbidity compared to fibula free flaps for selected segmental mandibulectomy defects. The overall dental implantation rate was low and more commonly performed in osteocutaneous radial forearm flaps compared to fibula flaps.

Finite element method analysis of stress distribution to supporting tissues in a Class IV Aramany removable partial denture (Part II: bone and mucosal membrane).

AIM: One of the most important issues in the design of removable partial dentures (RPD) is the location of retentive arms to provide sufficient support. This is a critical factor in patients with less supporting tissue and abutment teeth. Patients classified as Class IV Aramany need special attention in this area of RPD design to minimize the stress distribution in bone and mucosal membrane. Using the finite element method, the aim of this study was to analyze the distribution stress to supporting tissues when a Class IV Aramany RPD is worn. The data presented in this report are the effects of the stress on bone and mucosal membranes. Results on teeth and the periodontal ligament have been previously reported. METHODS AND MATERIALS: Three dimensional finite element models were constructed using normal dimensions. Exact physiology and morphology of teeth and the remaining palate were simulated to that of a maxillectomy patient. Three RPD designs with circumferential cast retainers were examined: buccal retention and palatal reciprocation (P1); palatal retention and buccal reciprocation (P2); and buccal and palatal retention (P3). After completion of the models and remaining palate, each RPD design was loaded under 53N and stress was applied in three different directions: vertical to the posterior teeth (premolar and first molars) of the RPD (F1); at a 33 masculine angle to the posterior teeth (premolar and first molars) of the RPD (F2); and vertically on the anterior teeth (central incisors) of the RPD (F3). The stress distribution in the RPD models on cortical and cancellous bone and the mucosal membrane was analyzed using von Mises criterion. RESULTS: The maximum tension in cortical bone (70.84 Mpa) was observed when a 53N force was applied in a vertical direction to posterior teeth (F2) using buccal and palatal retention (P3). Minimum tension (15.73 Mpa) in cortical bone was observed using the F3 load on the P2 design. Similar results were seen in cancellous bone, with the highest stress (8.01 Mpa) observed using F2 load on the P3 design and the lowest stress (3.04 Mpa) observed using the F3 load on the P2 design. For mucosal membrane, the maximum (3.57 Mpa) and minimum (3.05 Mpa) stress was observed using the F3 load on the P3 design and the F1 load on the P2 design, respectively. The average stress in all RPD designs was 3 Mpa. CONCLUSION: The design demonstrating the least tension in cortical and cancellous bone and mucosal membrane was the P2 design, a RPD with palatal retention and buccal reciprocation. CLINICAL SIGNIFICANCE: Palatal retention and buccal reciprocation (P2 design) is recommended for patients with maxillofacial RPDs.

Interim obturator retained by an extraoral device: a clinical report.

This clinical report presents the treatment of an unfavorable bilateral maxillary defect with the use of an extraoral device to hold an interim obturator in place during tissue healing and maturation.

Management considerations in reconstruction of postablative defects of the mandible: vertical distraction of a scapular bone flap and removable lip support: a case report.

OBJECTIVE: To describe vertical distraction osteogenesis of a scapular flap and removable lip support for oral rehabilitation after surgical creation of an ablative defect of the mandible. CASE REPORT: A 70-year-old man who was diagnosed with squamous cell carcinoma of the left lower gingiva underwent segmental mandibulectomy for tumor ablation and reconstruction with a scapular bone flap. To augment bone height of this flap, vertical distraction osteogenesis was performed. After denture fabrication, a removable lip support was placed between the implant-supported denture and the lower lip. RESULTS: The bone height of the scapular bone flap increased by 9 mm. Implants with adequate length could be placed in the distracted bone. The lip support was effective. Two years after masticatory loading, the implants remained stable. CONCLUSION: Vertical distraction osteogenesis of the scapular bone flap was suitable to facilitate postoperative functional and esthetic restoration after tumor resection. A removable lip support was also useful as a supplementary tool for oral rehabilitation.

Importance of patient's cooperation in surgical treatment for oral submucous fibrosis.

PURPOSE: The aim of this study was to investigate the results of surgical treatment for oral submucous fibrosis (OSF) in patients who did or did not cooperate with the rehabilitation regimen. PATIENTS AND METHODS: There were 54 patients who had surgical treatment of trismus caused by OSF. Split-thickness skin grafts were used to repair surgical defects after surgery on the fibrous bands. According to postoperative collaboration in the rehabilitation regimen, patients were defined as non-cooperative patients (group I) and cooperative patients (group II). Group I (n = 28) and group II (n = 26) were analyzed separately for changes in preoperative, intraoperative, and postoperative interincisal distances (ID) for at least 6 months after surgery. RESULTS: The mean preoperative ID was 18.9 mm (range, 8 to 25 mm) in group I and 18 mm (range, 7 to 25 mm) in group II. The intraoperative ID increased to an average of 39 mm in group I and 38.5 mm in group II. The mean final follow-up ID was 22 mm in group I and 36.1 mm in group II. When evaluating the changes of ID, only a statistically significant difference was found at final visit between groups. CONCLUSIONS: In our study, we found the patient's cooperation is the primary requirement for success in the treatment of OSF.