A Simple Method to Retract the Descending Palatine Neurovascular Bundle During Osseous Removal of Posterior Interferences in Le Fort I Osteotomy.

ABSTRACT: For accurate repositioning of the maxilla in Le Fort I osteotomy, bone removal around the descending palatine neurovascular bundle and maxillary tuberosity is frequently required. Such task can be challenging due to the high vascularity of the region, which is the most common site of hemorrhage during removal of bony interferences. Although a rare occurrence, ligation of the descending palatine artery in cases of intraoperative vascular damage can be related to the development of aseptic necrosis. This article reports a simple technique for retraction and protection of the descending palatine neurovascular bundle during bony removal related to a posterior maxillary impaction, which can be easily reproduced in orthognathic selected cases.

A Simple Method of Transoperative Maxillomandibular Fixation in Pediatric Facial Fractures.

ABSTRACT: Maxillomandibular fixation in pediatric facial fractures is quite challenging to be achieved, especially in mid-mixed dentition. Traditional well established intermaxillary devices have a lot of limitations in these patients. This article presents a case of a 9-year-old female patient with a displaced mandibular fracture in which orthodontic buttons were used for transoperative maxillomandibular fixation followed by internal fixation after adequate occlusion reestablishment and fracture reduction. The method showed high efficacy and celerity, allowing the success of treatment, with satisfactory evolution of the patient.

Harpoon Suicide Attempt: A Dramatic Experience of the Multidisciplinary Approach.

ABSTRACT: Craniofacial harpoon injuries are extremely rare, especially when caused by attempted suicide. The approach to surgical removal becomes dependent on the characteristics of the device, with or without barbs on the spear, and its path, which presents with significant changes between accidents and suicide attempts. This report presents the successful treatment carried out in a dramatic case of harpoon suicide attempt. The approaches to complete and cautious removal of the spear from the occipital region, reconstruction of the orbital cavity, evisceration of the left eyeball due to amaurosis and psychiatric follow-up were successful, which allowed the restoration of the patient's physical and mental health.

Algorithm for Treatment of Supernumerary Nasal Tooth.

ABSTRACT: The presence of a tooth in the nasal cavity is a rare condition. There is an even more rare association, which is the presence with the mineral's deposition and formation of rhinoliths. This report shows a case of rare nasal tooth associated with rhinolithiasis and describes its surgical treatment based on an algorithm. The diagnosis was made by endoscopy with the aid of computed tomography, followed by surgical endoscopy excision. The algorithm and the proposed treatment was successful in its execution and the patient presents no complaints or complications at 3 years after surgery.

Management of Unicistic Ameloblastoma in a Young Patient: Reducing Social Consequences.

ABSTRACT: Ameloblastoma is an odontogenic tumor of significant clinical relevance, aggressive and locally invasive. Although the posterior region of the mandible is more frequently affected, lesions observed in the maxilla should receive special attention due to the risk of expansion to the nasal, paranasal and orbital structures. This report shows a successful case of a maxillary ameloblastoma treated by combining therapies in a young patient. The treatment strategy adopted to reduce and redefine the lesion dimensions enabled enucleation in a safe way, without destruction of adjacent noble structures. It also allowed complementary approach with peripheral ostectomy and sclerosing agent, efficiently, without evidence of recurrence or complications after 2 years.

Three-Dimensional Analysis of the Skull Base of Individuals With Cleft Lip and Palate.

AIMS: Identify variations of skull base measurements in individuals with dentofacial deformities associated or not with cleft lip and palate and compare the results with individuals without dentofacial deformities. METHODS AND RESULTS: The individuals were categorized into three different groups: dentofacial deformity without cleft malformation, dentofacial deformity associated with cleft lip and palate, and without facial deformity. The inclusion criteria were individuals over 18 years of age, without any intervention involving facial bones or structures of interest for the study and field of view encompassing from the glabella to the hyoid bone. Poor quality CT scans or lack of adequate medical records were considered exclusion criteria. In the analysis by computerized tomography using the Dolphin Imaging Software, the length determined by the Ba-S and S-N lines was evaluated, as well as the Ba-S-N angle formed by landmarks. RESULTS: The length of S-N was not statistically different between the groups, the Ba-S length and the Ba-S-N angle demonstrated statistical difference. CONCLUSION: There was statistically significant difference in the morphometry of the (Ba-S) between groups (FS) and (C). This suggests that the standard values for cephalometric analyzes involving these structures, especially to determine the treatment planning, should be used with caution.

Orbital Trapdoor Facture in Child: More Predictable Outcomes and Less Consequences.

Orbital trapdoor fractures are characterized by tissue entrapment between the fractured bone fragment and the remnant of the orbital floor. This entrapment can result in immediate local and systemic complications and poor outcomes when approached late. This article presents the case of an orbital floor fracture in a child with dystopia, pain, edema and entrapment of the inferior rectus muscle and consequent limitation of ocular motility. The strategy proposed in the early approach to orbital floor reconstruction and release of incarcerated tissue allowed the patient to achieve satisfactory results without morbidity, as compared to the outcomes of corrective sequel surgery.

Strategy for Optimizing Airway Volume With Genioglossal Advancement Using Cutting Guide in the Treatment of Obstructive Sleep Apnea.

The genioglossus advancement muscle is a technique used to treat obstructive sleep apnea and depends on the precise location of the muscle insertion into the geniotubercle. The aim of this article was to present a case report about a 38-year-old male patient with obstructive sleep apnea even after undergoing uvulopalatopharyngoplasty and mentoplasty. A maxillo-mandibular advancement and genioglossus was proposed, for this a virtual planning of the surgical guide was done using a specialized software. The great advantage is to reduce the osteotomy by focusing precisely on the insertion of the muscle. The cutting guide facilitated the surgical procedure in all aspects and brought safety.

Lip Synechia Resulting From Toxic Epidermal Necrolysis: A Rare Condition.

Toxic epidermal necrolyses represent a severe epidermolytic reaction characterized by cutaneous erythema and target lesions affecting >30% of the body surface, skin, and mucous membranes. Ulcerative lesions on the labial mucosa may evolve during healing, resulting in rare complications, such as lip adhesions. This report shows the successful treatment of a lip synechia resulting from the healing of mucosal lesions in a patient with toxic epidermal necrolysis caused by the use of Lamotrigine and Ibuprofen. Although the treatment of the presented lip synechia was simple, this sequela can be avoided by measures such as hydration, hygiene and lip lubrication.

Strategy for the Treatment of Zygomatic-Coronoid Ankylosis.

Zygomatic-coronoid ankylosis is a rare complication in maxillofacial trauma. Currently, less of 30 cases reported in the literature. The aim of this study was to report a case of zygomatic-coronoid ankylosis after trauma. A 26-year-old male, with zygomatic-coronoid ankylosis after 7 years of facial trauma, was treated by intraoral bilateral coronoidectomy. However, the literature continues to discuss the best approach, intraorally or extraorally. This study observed that the intraoral approach was easily performed and without complications.

Technical Strategy of Bone Graft Augmentation in the Anterior Maxilla.

Bone graft augmentation in the anterior maxilla has a high successful rate. However, suture dehiscence and consequent bone graft exposure can compromise and fail this procedure. Therefore, this article presents a new strategy of closure technique to guarantee the bone graft augmentation. The sutures occur in muscular and mucous planes to avoid suture tension, thus decreasing complications of bone graft augmentation in the anterior maxilla.

Strategy of Mandibular Central Arch Reconstruction After Firearm Injury.

Gunshot wounds can cause extensive destruction of soft tissue and bone, and the maxillofacial region is often affected. The reconstructive treatment is complex due to the difficulty to reestablish the central arch mandibular contour and volume. Moreover, the goal is to avoid postoperative infections and obtain bone graft neovascularization. Therefore, this report shows a clinical case of a patient presenting mandibular deformity with a mandibular central arch discontinuity caused by a firearm injury. The strategy to the reconstructive treatment as performed with a condensed and stabilized particulate autogenous bone graft was essential and effectiveness. After 1 year, it was obtained a satisfactory result to the patient.

Evaluation of Two Beta-Tricalcium Phosphates with Different Particle Dimensions in Human Maxillary Sinus Floor Elevation: A Prospective, Randomized Clinical Trial.

This study aimed to compare two beta-tricalcium phosphates with different particle sizes in human maxillary sinuses lifting. The immunolabeling of cells for RUNX2 and VEGF were performed to evaluate the osteoblast precursor cells and the vascular formation after 6 months of bone repair. Ten maxillary sinuses were grafted with autogenous bone graft (Group 1), 10 were grafted with ChronOs® (Group 2), and 10 were grafted with BETA-TCP® (Group 3). After 6 months of bone healing, biopsies were obtained to assess the new bone formed by histomorphometric and immunohistochemical evaluation for RUNX2 and VEGF. The mean bone formation for Group 1 was 51.4 ± 17.4%. Group 2 presented 45.5 ± 9.9%, and Group 3 conferred 35.4 ± 8.0% of new bone formation. The RUNX2 offered low for Groups 1 and 2 with high cellular activity for osteoblast in Group 3. The VEGF immunolabeling was moderate for Groups 1 and 2 and intense for Group 3. In conclusion, it was possible to show that the bone substitutes evaluated in the present study presented suitable outcomes for bone regeneration, being an alternative for the autogenous bone graft in maxillary sinus bone height reconstruction.

Comparative Evaluation of Bone Repair with Four Different Bone Substitutes in Critical Size Defects.

This study evaluated the osteoconductive potential of four biomaterials used to fill bone defects. For this, 24 male Albino rabbits were submitted to the creation of a bilateral 8 mm calvarial bone defect. The animals were divided into four groups-bovine hydroxyapatite, Bio-Oss® (BIO); Lumina-Bone Porous® (LBP); Bonefill® (BFL); and an alloplastic material, Clonos® (CLN)-and were euthanized at 14 and 40 days. The samples were subjected to histological and histometric analysis for newly formed bone area. Immunohistochemical analysis for Runt-related transcription factor 2 (Runx2), vascular endothelial growth factor (VEGF), and osteocalcin (OC) was performed. After statistical analysis, the CLN group showed greater new bone formation (NB) in both periods analyzed (p < 0.05). At 14 days, the NB showed greater values in BIO in relation to LBP and BFL groups; however, after 40 days, the LBP group surpassed the results of BIO (p < 0.001). The immunostaining showed a decrease in Runx2 intensity in BIO after 40 days, while it increased for LBP (p < 0.05). The CLN showed increased OC compared to the other groups in both periods analyzed (p < 0.05). Therefore, CLN showed the best osteoconductive behavior in critical defects in rabbit calvaria, and BFL showed the lowest osteoconductive property.

Estudo clínico randomizado e prospectivo do aumento ósseo vertical em enxertos sinusais maxilares realizados com o beta-tricálcio fosfato de fase pura / Prospective randomized clinical study of vertical bone augmentation in maxillary sinus grafts performed with pure phase beta-tricalcium phosphate

O objetivo deste estudo foi avaliar o aumento ósseo vertical em seios maxilares preenchidos com o ß-TCP em duas granulações de diferentes dimensões e comparar o seu comportamento biológico ao do osso autógeno. Três grupos de 06 seios maxilares: (G1) correspondente ao osso autógeno, (G2) ß-TCP com partículas de 0,5 mm a 0,7 mm e (G3) ß-TCP com 0,1 mm a 0,5 mm foram avaliados por meio de análise histomorfométrica e imunoistoquímica após 6 meses do preenchimento sinusal. A neoformação óssea em G1, G2 e G3 foi de respectivamente 78,442 µm2, 71,283 µm2 e 64,508 µm2, sem diferença estatisticamente significante (p=0,314). A maior área de tecido conjuntivo foi observada em G3, com 124,265 µm2, seguido por G2, 112,993 µm2 e G1, 112,652 µm2 com ausência de diferença estatística na comparação dos grupos (p=0,366). A área de biomaterial remanescente foi observada em G2 com 9,268 µm2, seguido por G3, 6,021 µm2, e G1, 1,195 µm2, sendo ausente a diferença estatística entre os grupos (p=0,120). A imunomarcação para RUNX2 apresentou-se leve em G1 e G2 e moderada a intensa em G3, enquanto para VEGF foi moderada em G1 e G2 e pouco mais intensa em G3. Conclui-se que o ß-TCP nas diferentes granulações mostrou-se osteocondutor e pode ser utilizado com critérios, em pequenos defeitos, em substituição ao osso autógeno(AU)

The aim of this study was to evaluate the vertical bone increase in maxillary sinuses filled with ß-TCP in two granulations of different dimensions and to compare their biological behavior to that of autogenous bone. Three groups of 06 maxillary sinuses were evaluated: (G1) corresponding to autogenous bone, (G2) ß-TCP with particles from 0.5 mm to 0.7 mm and (G3) ß-TCP with 0.1 mm to 0.5 mm were evaluated through histomorphometric and immunohistochemistry analysis 6 months after sinus filling. Bone neoformation in G1, G2 and G3 was respectively 78.442 µm2, 71.283 µm2 and 64.508 µm2, with no statistically significant difference (p=0.314). The largest area of connective tissue was observed in G3, with 124.265 µm2, followed by G2, 112.993 µm2 and G1, 112.652 µm2, with no statistical difference in the comparison of groups (p=0.366). The remaining biomaterial area was observed in G2 with 9.268 µm2, followed by G3, 6.021 µm2, and G1, 1.195 µm2, with no statistical difference between groups (p=0.120). The immunostaining for RUNX2 was mild in G1 and G2 and moderate to intense in G3, while for VEGF it was moderate in G1 and G2 and slightly more intense in G3. It is concluded that ß-TCP in the different granulations proved to be osteoconductive and can be used with criteria, in small defects, to replace the autogenous bone(AU)