Facial Nerve Palsy Associated With Orthognathic Surgery.

The authors report a 25-year-old female who presented facial palsy after undergoing bimaxillary orthognathic surgery for retrognathism correction. Orthognathic surgery is a procedure used to treat dentofacial deformities which aims to achieve an adequate relationship between dental archs, improving function (such as chewing, breathing, and speaking) and facial aesthetics. Even though there are some complications that can occur during the intraoperative and postoperative periods like bleeding, tooth, soft-tissue damage, nerve damage, bad split, infection, and nonunion, facial nerve injuries are considered rare complications after this kind of surgical procedure. Despite being uncommon, rarely described, transient, and spontaneously resolved in almost all patients, facial nerve palsy is one of the most serious complications because it directly affects patient's quality of life and social interaction.

Transplante dentário autógeno: revisão de literatura e relato de caso clínico / Autogenous dental transplantation: literature review and clinical case report

Objetivo: o transplante dentário é uma técnica cirúrgica que consiste na movimentação cirúrgica de um dente, podendo ser vital ou tratado endodonticamente, o qual é submetido a uma avulsão do seu local de origem e implantado em outro alvéolo. Relato de caso: paciente do sexo masculino, 18 anos, normossistêmico, buscou atendimento no Serviço de Cirurgia e Traumatologia Bucomaxilofacial da Pontífica Universidade Católica do Rio Grande do Sul (PUCRS) apresentando cárie no dente 26. O plano de tratamento consistiu em realizar um autotransplante do dente 28 para o alvéolo do dente 26. Após 8 meses do transplante, o dente apresentava em boas condições periodontais avaliadas clinicamente e em exame radiográfico. Considerações finais: o transplante dentário autógeno pode ser uma opção viável para a substituição de molares ausentes ou com cáries extensas, como mostrado no presente caso clínico. (AU)

Objective: Dental transplantation is a surgical technique that consists of the surgical movement of an either vital or endodontically treated tooth, which is subjected to an avulsion from its place of origin and implanted in another socket. Case report: An 18-year-old male patient, normosystemic, attended the Oral and Maxillofacial Traumatology Surgery Service of PUCRS presenting a decayed tooth 26. The treatment plan consisted of the autotransplantation of tooth 28 to the alveolus of tooth 26. Eight months after the transplantation, the tooth presented satisfactory periodontal conditions by clinical and radiographic assessments. Final considerations: The autogenous dental transplantation may be a viable option for replacing absent molars or with extensive caries, as shown in the present clinical case. (AU)

Adipogenic Mesenchymal Stem Cells and Hyaluronic Acid as a Cellular Compound for Bone Tissue Engineering.

This study investigates the applicability of adipose mesenchymal stem cells (mADSCs) and hyaluronic acid (HA) as a cellular compound for bone tissue engineering. A critical bone defect was created on each femur of 25 rats in vivo, receiving the following 5 graft treatments: I-Control-defect; II-HA; III-mADSCs; IV-mADSCs+HA; and V-previously osteoinduced mADSCs+HA. Evaluation using microcomputed tomography, histomorphometry, and RT-PCR analysis was performed 23 days after implantation. Microcomputed tomography analysis indicated higher means of bone contact surface (BCS) and bone surface density (BSD) for the mADSCs+HA group compared with Control and the HA groups (P < 0.05). Histomorphometric findings showed higher means of bone regeneration in the mADSCs+HA compared with HA and Control groups (P < 0.05). The RT-PCR ratios showed no difference in type 1 collagen (Col1A) gene expression or osteopontin (OP) gene expression, whereas for the osteonectin gene (ON) higher means were found in the HA and mADSCs osteoin+HA groups (P < 0.05). These results suggest that a combination of HA and mADSCs without prior osteoinduction might be applicable for bone tissue regeneration.

Protocolo de Tratamento Orto-Cirúrgico da Má Oclusão de Classe II em paciente com Sindrome da Apnéia e/ou Hipoapnéia Obstrutiva do sono: relato de caso / Ortho-surgical treatment protocol for Class II malocclusion in a patient with obstructive sleep apnea and/or hypopnea syndrome: case report

Introdução: A Síndrome de apnéia e/ou hipopnéia obstrutiva do sono (SAHOS) é caracterizada pela obstrução repetida das vias aéreas ou redução da respiração durante o sono. Esta síndrome é causada por colapso faríngeo contra aumento do esforço espiratório durante o sono. A SAHOS leva à deterioração da qualidade do sono associado à queixa de sonolência diurna excessiva e a efeitos desfavoráveis no sistema cardiovascular. Características orofaciais como retrognatismo mandibular e/ou associado a retrognatismo maxilar, má oclusão de Classe II, com ou sem mordida aberta, e diminuição das vias aéreas orofaríngeas fazem parte do seu quadro. Objetivo: Relato do tratamento ortocirúrgico de um paciente com 31 anos de idade com caraterísticas de SAHOS, má oclusão de Classe II, deficiência mandibular, mordida cruzada posterior e aberta anterior, diminuição da altura facial anteroinferior, aprofundamento do sulco mentolabial, pouca exposição do lábio inferior e nítido desequilíbrio facial. Relato e Resultados: Tratamentos não invasivos para SAHOS passam pelos dispositivos de pressão nasal contínua positiva nas vias aéreas ou aparelhos intra-bucais com o objetivo de manter a mandíbula em posição anteriorizada durante o sono. Nos tratamentos invasivos, a cirurgia de avanço mandibular evita a rotação no sentido anti-horário do complexo maxilomandibular com aumento do espaço orofaríngeo das vias aéreas médias e inferiores. Nas situações com grande impacto esquelético dentofacial associado ao grau de obstrução das vias aéreas será necessário um tratamento descompensatório ortocirúrgico, permitindo assim um restabelecimento respiratório e estético da face. Conclusão: O tratamento descompensatório com avanço cirúrgico bimaxilar foi responsável pela correção da má oclusão e aumento do espaço aéreo, contemplando a expectativa respiratória, funcional e estética.

Introduction: Obstructive sleep apnea and/or hypopnea syndrome (OSAHS) is characterized by repeated obstruction of the airway or reduction of breathing during sleep. This syndrome is caused by pharyngeal collapse against increased respiratory effort during sleep. SAHOS leads to deterioration of sleep quality associated with clinical complaints of excessive daytime sleepiness and unfavorable effects on the cardiovascular system. Orofacial features such as mandibular retrognathism and/or associated maxillary retrognathism, Class II malocclusion, with or without open bite and reduction of the oropharyngeal airway characterize this syndrome. Objective: It is reported an orthosurgical treatment of a 31 years old male patient, with OSAHS characteristics, Class II malocclusion, mandibular deficiency, posterior crossbite and anterior open bite, lower anterior facial height decrease, deepening of the labial sulcus, little exposure of the lower lip and unbalanced face. Report and Results: Non-invasive treatments for OSAHS pass through positive continuous nasal pressure devices in the airways or intra-oral appliances in order to maintain the mandible in an anterior position during sleep. In the invasive treatments protocol, mandibular advancement surgery prevents rotation in the anti-clockwise direction of the maxillomandibular complex with an increase in the oropharyngeal space of the middle and lower airways. In cases with great skeletal dentofacial impact associated with the degree of obstruction of the airway will be necessary an ortho-surgical decompensatory treatment, to allow a respiratory and aesthetic restoration of the face. Conclusion: The decompensatory treatment with bimaxillary surgical advancement corrected the malocclusion, increasing the air space contemplating the respiratory, functional and aesthetic expectation.

Use of Recombinant Human Bone Morphogenetic Protein-2 Associated With Lyophilized Bovine Bone in Reconstruction of Atrophic Maxilla.

Cases of severely atrophic edentulous maxilla require reconstruction techniques employing bone grafts to promote adequate bone dimension for the successful placement of dental implants for prosthetic rehabilitation that reestablishes the patient's function and aesthetics. This study aims to present a severely atrophic edentulous maxilla reconstruction with the off-label use of recombinant human bone morphogenetic protein type 2 (rhBMP-2) associated with lyophilized particulate bovine bone xenograft for the prosthetic rehabilitation with osseointegrable dental implants. The paper describes a case of severely atrophic edentulous maxilla in a 42-year-old woman referred to the dental school with complaint of failure in adaptating to the dentures. The patient reported 27 years of maxilla edentulism and consecutive treatment failures, so the proposed therapy was the reconstruction of the maxilla with an association of rhBMP-2 and lyophilized bovine bone xenograft for increasing bone volume and further prosthetic rehabilitation with osseointegrated dental implants. The present report illustrates a case of atrophic edentulous maxilla in which the off-label use of rhBMP-2 was successful and the patient's prosthetic rehabilitation could be concluded. The 8 dental implants received prosthetic functional load during 1 year of follow-up with no complications. Based on the case presented, the association between rhBMP-2 and a bovine bone xenograft could be considered a viable option for the reconstruction of atrophic edentulous maxilla. After a year of functional prosthetic load follow-up, the patient is asymptomatic and satisfactorily adaptated to the prosthesis, which restored her functional and aesthetic demands.

Primary Repair of a Complex Panfacial Fracture by Dog Bite.

Facial fractures due to dog attacks have an unknown incidence rate. To date, only 41 cases of canine bite trauma in a pediatric patient, associated with facial fracture, have been reported in the literature. As major species of involving dogs are the American pitbull terrier and rottweiler. Due to the intense kinematics of this trauma, the treatment becomes complex. Thus, attention to the primary repair of such complex lesions ensures satisfactory results, which is the focus of this discussion. The purpose of this review was to analyze how different ways to approach this type of trauma in children for clarification or correct management. In addition, we address the treatment plan of a complex case of panfacial fracture by a canine bite in a 4-year-old patient. According to a review addressed, the main involved are orbit, nasal, and zygomatic. Antibiotic therapy is indicated for infected bite wounds and wounded considerations at risk of infection, with high complexity and when involving important structures such as bones, vessels, and joints. The state of tetanus immunization and the risk of rabies infection should be routinely addressed in the management of the bite wound.

Does lag screw fixation of condylar fractures result in adequate stability? A finite element analysis.

The great incidence and controversies related to the diagnosis, treatment, surgical accesses, and type of osteosynthesis materials confer an outstanding role to condylar fractures among facial fractures. Plate configurations, with diverse formats and sizes, may be used to surgically resolve condylar fractures. With the purpose of improving the advantages and minimizing the disadvantages of fixation techniques, the neck screw was developed aiming at the needed stabilization to render a correct fixation through a system of dynamic compression. This is achieved by increasing the contact between the fractured bone stumps, as well as assisting at the time of fracture reduction. The present paper aims at comparing the fixation and stability of mandibular condylar fractures using the neck screw and an overlaid "L"-shaped-4-hole-2 mm plate on the one hand, with a system in which the neck screw and the "L"-shaped plate form a single structure, having been joined by a welded point, on the other hand. The results with the neck screw are satisfactory, and, thus, it is an alternative for the reduction and fixation of fractures of the mandibular condyle, whether or not a plate is joined to the structure, provided it is correctly prescribed and with adequate surgical sequence and technique.

Giant Peripheral Temporomandibular Osteoma With Immediate Reconstruction of Mandible.

Osteoma is a benign osteogenic tumor, which is characterized the slow-growing proliferation of compact or cancellous bone. The etiology of the lesion is not well established. Among the hypotheses, the following are related: a traumatic factor, infectious processes, or true neoplasm due to the origin of cartilaginous cells. It can present at any age, usually in young adult individuals, with equal prevalence in both sexes. The clinical characteristics of the peripheral osteoma are represented by slow asymptomatic growth, which leads to swelling and, thus, facial asymmetry. When it is related to the mandibular condyle, this growth can cause functional impairment, such as malocclusion, temporomandibular joint dysfunction, and even limited mouth-opening owing to ankylosis.

Bone Substitutes in Le Fort I Osteotomy to Promote Bone Union and Skeletal Stability.

Maxillary advancement by Le Fort I osteotomy has become the standard procedure to restore function and facial esthetics, correct skeletal and occlusal discrepancies, and treat obstructive sleep apnea in patients with facial deformities. Incomplete ossification between the bone segments at the jaw osteotomy site has proven to be a major problem in these patients. There are several studies in the literature that address orthognathic surgery, but only a limited number that discuss the use of graft materials in maxillary osteotomy. Bone grafts were introduced in recent decades in order to promote and improve bone union and prevent the formation of gaps. This study will discuss the results obtained using bone substitutes in orthognathic surgery for maxillary advancement and maxillary repositioning with Le Fort I osteotomy, in a clinical report and a literature review, covering the main indications and specifying the type of material used and the stability of the surgical procedure postoperatively.

Assessment of the Postoperative Stability of Mandibular Orthognathic Surgery for Correction of Class III Skeletal Malocclusion.

To assess the stability of mandible position after orthognathic surgery for correction of class III skeletal malocclusion. Twenty adult males, aged 18 to 40 years, with Angle class III skeletal malocclusion underwent preoperative orthodontic treatment for elimination of dental compensations followed by combined maxillomandibular surgery with rigid internal fixation. Lateral cephalograms from each patient, obtained in the natural head position before surgery, immediately after surgery, and at 6-month follow-up, were retrieved from the files of the Pontifical Catholic University of Rio Grande do Sul outpatient Oral and Maxillofacial Surgery clinic and compared. Comparison of craniometric landmark measurements showed that the precision of mandibular setback was compromised in the horizontal plane, with a mean mandibular relapse of 37.75% at point B and 45.85% at point Pg. Improved intercuspation and adaptation of the musculature to the new position of the jaws after orthognathic surgery lead to counterclockwise rotation of the mandible, ultimately displacing the mandible more anteriorly than desired.

Comparison of Neck Screw and Conventional Fixation Techniques in Mandibular Condyle Fractures Using 3-Dimensional Finite Element Analysis.

PURPOSE: To compare the mechanical stress on the mandibular condyle after the reduction and fixation of mandibular condylar fractures using the neck screw and 2 other conventional techniques according to 3-dimensional finite element analysis. MATERIALS AND METHODS: A 3-dimensional finite element model of a mandible was created and graphically simulated on a computer screen. The model was fixed with 3 different techniques: a 2.0-mm plate with 4 screws, 2 plates (1 1.5-mm plate and 1 2.0-mm plate) with 4 screws, and a neck screw. Loads were applied that simulated muscular action, with restrictions of the upper movements of the mandible, differentiation of the cortical and medullary bone, and the virtual "folds" of the plates and screws so that they could adjust to the condylar surface. Afterward, the data were exported for graphic visualization of the results and quantitative analysis was performed. RESULTS: The 2-plate technique exhibited better stability in regard to displacement of fractures, deformity of the synthesis materials, and minimum and maximum tension values. The results with the neck screw were satisfactory and were similar to those found when a miniplate was used. CONCLUSION: Although the study shows that 2 isolated plates yielded better results compared with the other groups using other fixation systems and methods, the neck screw could be an option for condylar fracture reduction.

Modified submandibular access for open reduction and internal rigid fixation in condylar fractures.

PURPOSE: The purpose of the present study was to describe a surgical technique for treatment of condylar fractures through the modified submandibular access, by means of a small incision in the mandibular angle that promotes a dissection between the parotideomasseteric and the transmasseteric fascia in a quick way and with low morbidity. Fixation may be made with plates and screws according to the technique prescribed by the surgeon. METHODS: Owing to the high incidence and importance of condylar fractures, various therapeutic methods have been described and may be divided into conservative and surgical methods. Various open surgical techniques are recommended in the treatment of mandibular condylar fractures, and the methods of internal rigid fixation and surgical accesses vary. The techniques that offer an adequate treatment of these fractures with shorter surgical time very often remain matters of controversy among surgeons. The procedure must guarantee maximum safety for the facial nerve and must provide a good cosmetic outcome, besides providing a suitable surgical field. RESULTS: A modified submandibular access is a safe and reproducible procedure providing excellent functional results. This procedure has been routinely performed in our department.

Reduction and fixation of mandibular condylar fractures with neck screw.

PURPOSE: The purpose of the present study is to describe a surgical technique for the treatment of condylar fractures using an intramedullary screw. MATERIALS AND METHODS: The treatment of these fractures remains very controversial. At the time of the choice of the surgical treatment, a wide range of accesses and of techniques of reduction and fixation is used, depending on the type of the fracture, the experience of the surgeon, and aesthetical issues. Among the difficulties posed by this type of fracture is the correct repositioning of the fractured condylar portion for which we have developed a technique that uses a neck screw, with intramedullary insertion. Because this is a round-headed screw, it is necessary to install a plate, which may be straight or "L" shape, and is placed perpendicular and superjacent to the screw so that it does not allow the rotation of the condylar portion. RESULTS: Neck screw can be used, resulting in satisfactory stability, for the reduction and fixation of these fractures.

Plasma rico em plaquetas e sua aplicabilidade na cirurgia e traumatologia bucomaxilofacial

O presente estudo teve como objetivo realizar uma revisão da literatura sobre as possíveis vantagens no uso do plasma rico em plaquetas (PRP) na cirurgia e traumatologia bucomaxilofacial. Foram abordados temas referentes à função das plaquetas e sobre os fatores de crescimento oriundos dessas células. É relatado também um caso clínico de sequela de fratura mandibular tratado cirurgicamente e utilizado o PRP como coadjuvante na cicatrização óssea .

Dental findings in GAPO syndrome: case report

This article reports the case of a young female adult with GAPO syndrome who presented as a peculiar dental finding unerupted primary and permanent dentitions, which resembled total anodontia on clinical examination. A cephalometric analysis was performed to investigate the alterations in facial bone development. This is the 9th GAPO syndrome case reported in a Brazilian patient.

Este artigo relata o caso de um jovem paciente, gênero feminino, portadora da síndrome de GAPO, apresentando impacções dos dentes decíduos e permanentes, sugerindo anodontia total no exame clínico. Foi realizada uma análise cefalométrica para investigar as alterações no desenvolvimento ósseo facial. Este é o nono caso descrito no Brasil

Análise cefalométrica: um novo padrão / Cephalometrics analysis: a new model

Esse estudo apresenta uma nova estruturação dos dados cefalométricos agrupando-os num modelo denominado padrão UFRGS. A efetividade deste modelo foi testado utilizando-se 55 telerradiografias de perfil e comparando-se o desempenho diagnóstico com os padrões USP e Ricketts, avaliando-se os fatores não coincidentes com estes cefalogramas, que foram: a relação das bases apicais com a base anterior do crânio na USP; e a posição inclinação dos incisivos inferiores com o Ricketts. Na realização destas comparações utilizou-se medidas complementares a fim de torná-las mais fidedignas. Os resultados mostraram a confiabilidade do padrão UFRGS na estruturação do diagnóstico