Profile of Facial Trauma Victims of Motorcycle Accidents Treated at a Hospital in Northeastern Brazil: A Prospective Study.

OBJECTIVE: To outline the profile of patients with facial trauma, victims of motorcycle accidents, treated at the Hospital da Restauração, Recife/PE, Brazil, from December 2020 to July 2021. METHODS: The collection was carried out through questionnaire and analysis of medical records. Data were analyzed descriptively, as well as Pearson's chi-square test or Fisher's exact test. RESULTS: Among the patients, 88.6% were male, 47.5% were between 18 and 29 years old, and 59.6% lived in rural areas; 72.15% of the victims used the motorcycle for work and 43.52% were working at the time of the accident. Most victims did not have a national motorcycle license (62%) and were not wearing a helmet at the time of the accident (60%), with 37.6% wearing a full-face helmet, 16.5% an open helmet, and 5.9% an articulated full-face helmet. Soft tissue injuries were the most prevalent. Zygomatic complex fractures were the most common facial fractures and were significantly associated with helmet use and type. CONCLUSIONS: Most victims of motorcycle accidents are young adult men, without a regular driver's license and residing in rural areas. Preventive and educational actions and continuous traffic inspections are necessary to minimize these accidents.

Effect of simvastatin topical use on alveolar bone after tooth extraction: a scoping review.

OBJECTIVES: Conducting a scoping review (SR) to assess scientific evidence for topical simvastatin's impact on alveolar bone regeneration and determine its level of support for clinical applications. MATERIALS AND METHODS: This SR followed the PRISMA-ScR and OSF registries protocol; systematic searching was conducted on MEDLINE/PubMed, Cochrane, Embase, Scopus, Web of Science, and LILACS, to identify relevant articles until June 2023. Inclusion criteria covered clinical trials, case series, prospective and retrospective studies, along with in vivo investigations, involving participants of any sex and age. RESULTS: Out of 1312 identified studies, 20 (9 in vivo, 11 RCTs) met inclusion criteria. RCTs focused on third molar extraction, in vivo on mandibular incisor surgery. The majority of RCTs employed a collagen sponge and a simvastatin concentration of 10mg; conversely, most in vivo studies favored polylactide-co-glycolide and a 2 mg simvastatin concentration. RCTs had 3-month follow-ups; in vivo, studies extended to 8 weeks. Seven RCTs assessed pain outcomes, simvastatin did not significantly affect pain in six studies. Among four RCTs on postoperative swelling, only two observed a significant increase in the simvastatin group. In general, positive bone formation and the absence of adverse effects directly linked to topical simvastatin were observed across the study models. CONCLUSIONS: Intra-alveolar simvastatin post-tooth extraction has been to be shown to be effective and safe for preserving alveolar bone, with varied concentrations and carriers, with no significant adverse effects. CLINICAL RELEVANCE: This review provides critical insights into the effects of simvastatin on alveolar bone regeneration, informing potential benefits and possible challenges associated with its post-extraction application. OSF REGISTRY PROTOCOL: osf.io/q3bnf.

Malignant hyperthermia in maxillofacial surgery: Literature review supported by case presentation.

OBJECTIVE: Malignant hyperthermia (MH) is characterized by a state of hypermetabolism after exposure to halogenated inhalational anesthetics or succinylcholine. The aims of this study were to carry out an updated review on the subject and report an illustrative case of MH in urgent maxillofacial surgery. MATERIAL AND METHODS: A search of the PubMed/MEDLINE database using the keyword "malignant hyperthermia" was performed including articles published over the last 11 years in English, Spanish or Portuguese. Exclusion criteria were similar presentations but not associated with MH and cases not related to the use of anesthetic drugs as a trigger of the condition. CASE REPORT: A 45-year-old man (75 kg, ASA status IE) with a negative family history for neuromuscular diseases, victim of a car accident with a facial fracture, underwent surgery under balanced general anesthesia and developed signs of MH 4 h after anesthesia induction. In our patient, the causative agent was sevoflurane and the diagnosis of MH was confirmed, subsequently, by muscle biopsy. RESULTS/DISCUSSION: Overall, 44 cases of MH were found. According to the recent literature, MH shows a male predilection (3:1) and the mean age of patients is 32.2 ± 22.2 years. The most frequently cited causative agents were sevoflurane (30.5%), isoflurane (22.2%), and sevoflurane + succinylcholine (13.8%). The most common clinical indicators included hypercarbia (88.8%), hyperthermia (86.1%), and tachycardia (63.8%). Dantrolene was administered in 24 cases. The outcome was favorable in 31 cases (86.1%). The in vitro muscle contracture test (IVCT) was performed in only 15 patients and all of them tested positive. In our patient, the causative agent was sevoflurane and the diagnosis of MH was confirmed by muscle biopsy. CONCLUSION: The mortality from MH is still high and an early clinical diagnosis and specific treatment with dantrolene are necessary for a favorable outcome. A complete understanding will allow better management of patients with MH. At present, the best management is to identify susceptible patients and to avoid triggering agents, combined with vigilant monitoring.

Comparison of two alar cinch base suture in orthognathic surgery: a randomized clinical trial.

Le Fort I osteotomy is widely used in orthognathic surgery to correct maxillary deformities. However, this osteotomy may be related with the increase of alar base width. The aims of the present study were to compare two alar cinch suture after Le Fort I osteotomy and observe which type presents a better result in controlling the enlargement of the alar base after maxillary repositioning in orthognathic surgery. A randomized clinical trial was carried out with 40 patients randomly assigned in two intervention groups: group 1 - patients submitted to internal suture and group 2 - patients submitted to external suture. Of the 40 patients, 65% were female and 35% were male. The mean age of the patients was 30,25 in group I and 28,6 in group II. There was an increase in the alar base width in both groups, with significant difference between the means (P < 0,001). It was possible to compare the evolution of the means of the alar base width between group I and group II. Thus, it was observed that the external technique (group II) better controlled alar base width after Le Fort I osteotomy. It was not possible to relate the enlargement of the alar cinch with maxillary movement performed (P > 0,05). Overall, alar base cinch suture is an essential component of Le Fort osteotomies to control the alar base width. In this study, the external technique was more effective when compared to the internal technique in controlling the enlargement of the alar base width.

Comparison of two alar cinch base suture in orthognathic surgery: a randomized clinical trial

Abstract Le Fort I osteotomy is widely used in orthognathic surgery to correct maxillary deformities. However, this osteotomy may be related with the increase of alar base width. The aims of the present study were to compare two alar cinch suture after Le Fort I osteotomy and observe which type presents a better result in controlling the enlargement of the alar base after maxillary repositioning in orthognathic surgery. A randomized clinical trial was carried out with 40 patients randomly assigned in two intervention groups: group 1 - patients submitted to internal suture and group 2 - patients submitted to external suture. Of the 40 patients, 65% were female and 35% were male. The mean age of the patients was 30,25 in group I and 28,6 in group II. There was an increase in the alar base width in both groups, with significant difference between the means (P < 0,001). It was possible to compare the evolution of the means of the alar base width between group I and group II. Thus, it was observed that the external technique (group II) better controlled alar base width after Le Fort I osteotomy. It was not possible to relate the enlargement of the alar cinch with maxillary movement performed (P > 0,05). Overall, alar base cinch suture is an essential component of Le Fort osteotomies to control the alar base width. In this study, the external technique was more effective when compared to the internal technique in controlling the enlargement of the alar base width.

Resumo A osteotomia Le Fort I é amplamente utilizada em cirurgia ortognática para corrigir as deformidades maxilares. No entanto, esse tipo de osteotomia pode estar relacionado ao aumento da largura da base alar. Os objetivos do presente estudo foram comparar duas técnicas de sutura da base alar após a realização da osteotomia Le Fort I, bem como observar qual tipo apresenta melhor resultado no controle do alargamento da base alar após o reposicionamento maxilar em cirurgia ortognática. Foi realizado um ensaio clínico randomizado com 40 pacientes alocados aleatoriamente em dois grupos de intervenção: grupo 1 - pacientes submetidos à técnica de sutura interna e grupo 2 - pacientes submetidos à técnica de externa. Dos 40 pacientes, 65% eram do sexo feminino e 35% do masculino. A média de idade dos pacientes foi de 30,25 no grupo I e 28,6 no grupo II. Houve aumento da largura da base alar em ambos os grupos, com diferença significativa entre as médias (P <0,001). Foi possível comparar a evolução das médias da largura da base alar entre o grupo I e o grupo II. Assim, observou-se que a técnica externa (grupo II) controlou melhor a largura da base alar após a osteotomia Le Fort I. Não foi possível relacionar o alargamento da base alar com o tipo de movimentação maxilar realizado (P> 0,05). No geral, a sutura da base alar é um componente essencial das osteotomias Le Fort para controlar o alargamento da base alar. Nesse estudo, a técnica externa foi mais eficaz quando comparada à técnica interna no controle do alargamento da largura da base alar.

Do Computerized Delivery Systems Promote Less Pain and Anxiety Compared to Traditional Local Anesthesia in Dental Procedures? A Systematic Review of the Literature.

PURPOSE: The aim of this study is to assess whether the use of computerized devices to deliver local anesthesia results in less pain and anxiety compared to traditional anesthesia in adult dental procedures. METHODS: This review was registered at PROSPERO (CRD 42021265046), based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was structured according to the PICO strategy. The studies were selected based on eligibility criteria, and data were collected by 1 author and reviewed by another. RESULTS: Nine of the 10 studies included were randomized controlled trials. Differences related to pain and anxiety were observed, which favored computerized techniques; however, caution should be exercised when interpreting these results due to differences in assessment methods. The studies used different local anesthetics, including 2% lidocaine, 4% articaine, or 3% mepivacaine with epinephrine diluted 1:80,000 to 1:200,000. A total of 560 patients were evaluated. CONCLUSIONS: Computerized anesthesia devices yielded better results than conventionally delivered anesthesia after qualitative evaluation. Nevertheless, conventional anesthesia is widely used, safe, and effective. Due to the heterogeneity among the included studies, it is strongly recommended that new randomized clinical trials using well-defined methodologies be performed to improve the quality of evidence regarding this topic.

Relationship between the use and types of helmets with facial injuries - a prospective study / Relação entre o uso e os tipos de capacetes e os traumatismo faciais - um estudo prospectivo

ABSTRACT Introduction: many studies have demonstrated the benefits of helmet to prevent and reduce severity of injuries in motorcyclists. Objective: the aim of the present study was to evaluate a possible relationship between the use of different types of helmets and the occurrence of facial injuries among victims of motorcycle accidents, seen at Hospital da Restauração, Recife/PE, Brazil. Materials and methods: demographic and trauma data were collected from hospitalized motorcycle accident victims with facial injuries from December 2020 to July 2021. Pearsons chi-square test was used to assess association between two categorical variables using a margin of error of 5%. Results: among the participants, the average age was 33.46 years. The age group between 18 and 29 years was the most prevalent. Most participants were male. 60.0% of motorcyclists used helmets at the time of the accident and of this percentage 37.6% used fixed full-face helmet, 16.5% open-face helmet and the other 5.9% articulated full-face helmet. 62.7% of participants had facial fractures. Among the fractures, those of the zygomatic-orbital complex were the most common fracture and were significantly associated with the use of helmets, especially with open-face helmet. Conclusions: the use of helmets was associated with a lower number of facial fractures among patients who were victims of motorcycle accidents. Fracture of the zygomatic-orbital complex was related to the absence of a helmet at the time of the accident, as well as the use of open-face helmets.

RESUMO Introdução: muitos estudos têm demonstrado os benefícios do uso de capacete para prevenir e reduzir a gravidade das lesões em motociclistas. Objetivo: o objetivo do presente trabalho consistiu em avaliar uma possível relação entre o uso dos diversos tipos de capacete e a ocorrência do trauma facial entre vítimas de acidentes motociclísticos atendidos no Hospital da Restauração, Recife/PE, Brasil. Materiais e Métodos: os dados demográficos e referentes ao trauma foram coletados de vítimas de acidentes motociclísticos hospitalizados com lesões faciais durante o período de Dezembro de 2020 a Julho de 2021. O teste do qui-quadrado de Pearson foi utilizado para avaliar a relação entre duas variáveis categóricas utilizando uma margem de erro de 5%. Resultados: a idade média dos participantes foi 33,46 anos. A faixa etária entre 18 a 29 anos foi a mais prevalente. A maioria dos participantes eram do gênero masculino. 60,0% dos motociclistas utilizavam capacetes no momento do acidente e deste percentual 37,6% utilizavam capacete fechado, 16,5% capacete aberto e os outros 5,9% capacete escamoteável. 62,7% dos participantes tiveram fraturas faciais. Dentre as fraturas, as do complexo zigomático-orbitário foram as mais prevalentes e foram associadas com o uso de capacetes, especialmente os abertos. Conclusões: o uso de capacetes foi associado com um menor número de fraturas faciais entre os paciente vítimas de acidentes motociclísticos. A fratura do complexo zigomático-orbitário foi relacionada com a ausência de capacete no momento do acidente, bem como com o uso de capacetes abertos.

Assessment of satisfaction of patients submitted to bichectomy / Avaliação da satisfação dos pacientes submetidos à bichectomia

Objective: The aim this research was assess the level of satisfaction of patients undergoing bichectomy and its repercussions. Material and Methods: A cross-sectional and qualitative study, under protocol number 20707519.5.0000.5207, was carried out by applying a questionnaire to patients undergoing bichectomy, which made it possible to assess complaints, degree of postoperative satisfaction, satisfaction of family members, time required to perceive results, complications and adverse effects, intensity of postoperative pain, and possibility of being submitted to a new intervention. Results: The sample consisted of 30 patients, among them, 82% sought surgery for aesthetic reasons. Regarding the degree of satisfaction, the majority (70%) were very satisfied, followed by 13.3% who were satisfied, 10% considered normal, 3.3% were dissatisfied and 3.3% very dissatisfied. Regarding the opinion of friends and family, the majority were very satisfied with the result. The adverse effects found were mild, no permanent injury happened, and the pain was mild in the most majority of the sample. Conclusion: Thus, the most majority of patients were satisfied with the results, as well as their family and friends. The results were more evident between the second and third months. No major or permanent damage was observed, suggesting that it is a safe technique when performed well.(AU)

Objetivo: Avaliar o nível de satisfação dos pacientes submetidos à bichectomia, bem como correlacionar os resultados com algumas características clínicas. Material e Métodos: Foi realizado um estudo transversal e qualitativo, sob protocolo número 20707519.5.0000.5207, através da aplicação de um questionário a pacientes submetidos à bichectomia, o qual foi possível avaliar as queixas, o grau de satisfação pós-operatório, a satisfação dos familiares, o tempo para percepção dos resultados, as complicações e efeitos adversos, intensidade da dor pós operatória, e a possibilidade de ser submetido a nova intervenção. Além disso, as características demográficas da amostra (como sexo e idade) também foi registrada na ficha de avaliação. Resultados: A amostra foi composta por 30 pacientes, e desses, 82% buscaram a cirurgia por motivos estéticos. Sobre o grau de satisfação, a maioria (70%) ficou muito satisfeitos, seguidos por 13,3% que ficaram satisfeitos, 10% consideraram normal, 3,3% insatisfeitos e 3,3% muito insatisfeitos. Sobre a opinião dos amigos e familiares, a maioria ficou muito satisfeitos com o resultado. Os efeitos adversos encontrados foram leves, nenhuma lesão permanente foi encontrada, e a dor foi discreta na grande maioria da amostra. Com base na possibilidade de submeter-se a uma nova cirurgia, 70% ficaram satisfeitos e não fariam novamente. Conclusão: A grande maioria dos pacientes demonstrou-se satisfeitos com os resultados, bem como seus familiares e amigos. Os resultados foram mais evidentes entre o segundo e terceiro mês. Não foi observado qualquer dano importante ou permanente, sugerindo ser uma técnica segura quando bem executada. (AU)

Feasibility of three-dimensional CT reconstruction in assessing mandibular fractures: a survey among oral surgeons and dental maxillofacial radiologists

Aim: Evaluation of the reliability of 3D computed tomography (3D-CT) in the diagnosis of mandibular fractures. Methods: A cross-sectional, quantitative and qualitative study was carried out, through the application of a questionnaire for 70 professionals in the area of Oral and Maxillofacial Surgery and Radiology. 3D-CT images of mandibular fractures were delivered to the interviewees along with a questionnaire. Participants answered about the number of traces, the region and the type of fracture. The correct diagnosis, that is, the expected answer, was based on the reports of a specialist in oral and maxillofacial radiology after viewing the images in the axial, sagittal and coronal sections. The resulting data from the interviewees was compared with the expected answer and then, the data was analyzed statistically. Results: In the sample 56.9% were between 22 and 30 years old, 52.8% were oral and maxillofacial surgeons (OMF), 34.7% were residents in OMF surgery and 12.5% OMF radiologists. Each professional answered 15 questions (related to five patients) and 50.8% of the total of these was answered correctly. Specialists in Oral and Maxillofacial Surgery and Traumatology correctly answered 53.9%. Interviewees with experience between 6 and 10 years correctly answered 58.2%. In identifying fracture traces, 46.1% of the questions were answered correctly. In terms of location, 5.6% of interviewees answered wrongly while 14.2% answered wrongly regarding classification. Conclusion: 3D computed tomography did not prove to be a reliable image for diagnosing mandibular fractures when used alone. This made necessary an association with axial, sagittal and coronal tomographic sections

Reconstruction of extensive sequel of frontal fracture: optimizing results / Reconstrução de extensa sequela de fratura frontal: otimizando resultados

Introduction: Fractures of the frontal bone correspond to 5 to 15% of all facial fractures. This type of fracture can lead to difficulties in restoring bone congruence and to postoperative secondary aesthetic problems. Objective: This paper aims to present a clinical case report of frontal bone fracture where a late reconstruction was performed using a titanium mesh with the aid of stereolithographic model prototyping. Case report: Female patient, 26 years old, with aesthetic sequelae in the upper third of the face after a motorcycle accident. The imaging exams showed a comminuted frontal bone fracture, as well as upper edge and right orbit ceiling involvement. The planning consisted of reconstruction of the affected area with the use of a titanium mesh pre-shaped in a stereolithographic model. The procedure was performed under general anesthesia and coronal access. After installation of the fixation material, pericranial flap rotation and suture of the surgical wound were performed. The patient progressed well, with considerable improvement in facial aesthetics. Conclusion: This paper reports the importance of good planning in cases of frontal bone fracture sequel, in which the use of model-shaped mesh in a stereolithographic model tends to optimize surgery, bringing aesthetic and psychosocial benefits. (AU)

Introdução: As fraturas do osso frontal correspondem de 5 a 15% de todas as fraturas faciais. Esse tipo de fratura pode levar a dificuldades na restauração da congruência dos ossos e a problemas secundários estéticos pós-operatórios. Objetivo: Este trabalho objetiva apresentar um relato de caso clínico de fratura do osso frontal onde foi realizada reconstrução tardia utilizando tela de titânio com auxílio da prototipagem de modelo estereolitográfico. Relato de caso: Paciente do sexo feminino, 26 anos, apresentando sequela estética em terço superior da face após acidente motociclístico. Os exames de imagem demonstraram fratura cominutiva em osso frontal, além de envolvimento de bordo superior e teto de órbita direita. O planejamento consistiu de reconstrução da área afetada com uso de tela de titânio pré-modelada em modelo estereolitográfico. O procedimento foi realizado sob anestesia geral e acesso coronal. Após instalação do material de fixação optou-se pela rotação de retalho de pericrânio e sutura da ferida cirúrgica. A paciente evoluiu bem, com melhora considerável da estética facial. Conclusão: Este trabalho relata a importância do bom planejamento em casos de sequela de fratura do osso frontal, no qual o uso de telas modeladas em modelo estereolitográfico tendem otimizar a cirurgia, trazendo benefícios estéticos e psicossociais. (AU)

Treatment of hyperplasia of the coronoid process of the mandible in adults: analysis of 42 literature reports and illustrative case / Tratamento da hiperplasia do processo coronoide de mandibular em adultos: análise de 42 relatos da literatura e caso ilustrativo

ABSTRACT Objective: The objective of this research was to review the literature, compare different methods of surgical treatment for coronoid hyperplasia and report a clinical case of unilateral coronoid hyperplasia treated by coronoidectomy with intraoral access. Methods: A critical review of the literature was performed by selection of papers published in the last 20 years on the treatment of coronoid in adults in the PubMed, Medline, Scielo and Lilacs databases, with the terms coronoid hyperplasia OR coronoid elongation AND treatment OR management. The data was extracted for analysis. Results: twenty-four articles were selected. It included 42 patients, among them 69% were male patients and 81% were bilaterally affected. The age group with the highest prevalence was the people in the 20's and 30's. Sixty-nine percent of the patients were treated with coronoidectomy and 26.2% with coronoidotomy. The majority (83.3%) with intraoral access. No cases had surgical complications reported, and 71.4% underwent physiotherapy after surgery. Regarding the results, 83.3% were considered satisfactory, 11.9% were unsatisfactory. Conclusion: The great majority of the cases that brought significant results in the improvement of the pre and postoperative mouth opening were treated by coronoidectomy, proving to be an efficient and safe surgical treatment for the coronoid hyperplasia.

RESUMO Objetivo: O objetivo deste estudo foi revisar a literatura e comparar diferentes métodos de tratamento cirúrgico para hiperplasia do coronoide, além de relatar um caso clínico de hiperplasia coronoide unilateral tratada por coronoidectomia pelo acesso intraoral. Métodos: A revisão eletrônica crítica da literatura foi feita selecionando artigos publicados nos últimos 20 anos sobre o tratamento da hiperplasia do coronoide em adultos nas bases de dados PubMed, Medline, Scielo e Lilacs com os termos coronoid hyperplasia OR coronoid elongation AND treatment OR management. Os dados foram extraídos para análise. Resultados: Foram selecionados 24 artigos. Incluindo um total de 42 pacientes, dentre eles 69% eram pacientes do sexo masculino e 81% foram acometidos bilateralmente. O grupo etário com a maior prevalência compreendeu de 20 a 30 anos. Sessenta e nove por cento dos pacientes foram tratados com coronoidectomia e 26,2% com coronoidotomia, a maioria (83,3%) com acesso intra-oral. Nenhum caso teve complicações cirúrgicas relatadas e 71,4% foram submetidas à fisioterapia após a cirurgia. Em relação aos resultados, 83,3% foram considerados satisfatórios, e 11,9% insatisfatórios. Conclusão: A grande maioria dos casos que trouxeram resultados significativos na melhora da abertura bucal pré e pós-operatória foram tratados pela coronoidectomia, demonstrando ser um tratamento cirúrgico eficiente e seguro para a hiperplasia do coronoide.

Solução de Carnoy no tratamento de ceratocisto / Carnoy's solution in treatment of keratocyst

Introdução: O objetivo do trabalho é relatar um caso de ceratocisto associado à impactação dentária, o qual foi tratado com descompressão, seguido de enucleação da lesão e utilização de solução de Carnoy. Relato de caso: Paciente do sexo masculino, 14 anos, encaminhado para avaliação de lesão encontrada após exame imaginológico de rotina. O mesmo demonstrou extensa lesão radiolúcida localizada na região de ângulo e ramo da mandíbula, com presença do elemento 48 intralesional próximo a basilar. Foi realizado biópsia incisional e instalação de dispositivo de descompressão no mesmo tempo cirúrgico, o qual o resultado histopatológico foi de ceratocisto. Após 6 meses com o dispositivo, observou-se diminuição da lesão e melhora no posicionamento do dente incluso. Frente a boa resposta à descompressão, decidiu-se pela enucleação total da lesão, exodontia dos dentes 47 e 48, curetagem rigorosa e tereapia adjuvante com aplicação da solução de Carnoy. O paciente evoluiu bem, neoformação óssea na área operada e encontra-se em acompanhamento há 6 meses, sem sinais de recidiva. Considerações finais: O uso da descompressão cirúrgica em lesões císticas mandibulares minimiza os danos as estruturas circunvizinhas, riscos de fratura patológica e lesão nervosa. Em função das altas taxas de recidiva, a terapia adjuvante após a enucleção é imprescindível para essa lesão, sendo a aplicação da solução de Carnoy uma das técnicas com melhores resultados. Dessa forma, para aumentar a taxa de sucesso e minimizar as sequelas, o planejamento cirúrgico dos ceratocistos mandibulares extensos deve ser feito de forma criteriosa e cuidadosa... (AU)

Introduction: The objective of this study is to report a case of keratocyst associated with dental impaction, which was treated with decompression, followed by enucleation lesion and Carnoy solution. Case report: Male patient, 14 years old, referred for evaluation of lesion found after routine imaging. He showed extensive radiolucent lesion located in the region of the angle and branch of the mandible, with the presence of the intralesional element 48 near the basilar. An incisional biopsy was performed and a decompression device was installed during surgical time and the histopathological result was keratocyst. After 6 months of observation a reduction of the lesion and improvement in the positioning of the tooth even were noticed. Given the good response to decompression, it was decided to complete the enucleation of the lesion, extraction of teeth 47 and 48, rigorous curettage and adjuvant therapy with Carnoy's solution. Followed up for 6 months, patient evolved well creating a new bone formation in the operated area with no signs of relapse. Final considerations: The use of surgical decompression in cystic mandibular lesions minimizes damage to surrounding structures, pathological fracture risks, and nerve damage. Because of the high rates of recurrence, keratocysts require adjuvant therapy after enucleation and Carnoy's solution is one of the best performing techniques. Thus, to increase success rate and minimize sequelae, the surgical planning of extensive mandibular keratocysts should be done carefully and judiciously... (AU)

Apicotomia associada ao tracionamento ortocirúrgico em dente com dilaceração radicular / Apicotomy associated with orto-surgical treatment in tooth with a root dilaceration

Introdução: A apicotomia é uma técnica, que vem sendo utilizada em dentes com dilaceração radicular acentuada, com o intuito de liberar a porção do dente impactada e, dessa forma, permitir seu reposicionamento na arcada dentária. Este trabalho tem como objetivo apresentar um relato de caso clínico do manejo ortocirúrgico de tracionamento ortodôntico associado à apicotomia em dente incluso com dilaceração radicular acentuada. Relato de caso: O paciente foi encaminhado para o serviço de bucomaxilofacial para exodontia do elemento incluso após insucesso de tracionamento ortocirúrgico, em que se verificou, ao exame radiográfico periapical, dente incluso com dispositivo ortodôntico e dilaceração radicular importante. Diante disso, realizou-se, sob anestesia local, a apicotomia e instalação do dispositivo ortodôntico. O paciente evoluiu bem, e, após 8 meses, o elemento dentário encontrava-se em posição oclusal e em função mastigatória. Considerações finais: Assim, a técnica da apicotomia mostra-se eficaz como alternativa ao insucesso do tracionamento ortodôntico tradicional, sendo uma técnica mais conservadora que a exodontia, necessitando de conhecimento teórico e domínio técnico do profissional... (AU)

Introduction: Apichotomy is a technique that has been used in teeth with severe root laceration in order to release the impacted tooth portion and thus allow its repositioning of the tooth in the dental arch. The aim of this paper is to present a clinical case report of orthosurgical orthodontic traction management associated with apichotomy in an included tooth with severe root laceration. Case report: The patient was referred to the Oral and Maxillofacial Service for extraction of the included element after ortho-surgical traction failure, which was verified by periapical radiographic examination, tooth included with orthodontic device and significant root laceration. Thus, under local anesthesia, apichotomy and orthodontic device installation were performed. The patient progressed well, and after 8 months the dental element was in occlusal position and in masticatory function. Final considerations: Thus, the apichotomy technique is effective as an alternative to the failure of traditional orthodontic traction, being a more conservative technique than extraction and requiring theoretical knowledge and technical mastery of the Professional... (AU)

Remoção de dente deslocado para espaço submandibular: relato de caso / Removal of displaced tooth into submandibular space: a case report

Introdução: A exodontia é um dos procedimentos mais realizados nos consultórios odontológicos, e as complicações podem surgir, principalmente, quando não existem exames de imagem no pré-operatório ou quando se usa força inadequada durante o procedimento. Dentes molares inferiores podem se deslocar para o espaço submandibular durante as exodontias, e , apesar de ser considerada uma complicação rara, o paciente pode evoluir com dor, trismo e, em casos mais graves, para infecção com envolvimento cervical. Relato de caso: O presente artigo tem como objetivo relatar o caso de um paciente com infecção crônica em região cervical após tentativa, sem sucesso, de remoção de um molar inferior cujo fragmento dentário havia sido deslocado para o espaço submandibular durante o procedimento cirúrgico. O tratamento de escolha foi a fistulectomia e a remoção cirúrgica do dente sob anestesia geral pelo acesso extraoral submandibular de Risdon, seguido de divulsionamento delicado até localização e remoção do corpo estranho deslocado. O paciente foi acompanhado clinicamente, por 3 meses, evoluindo bem, sem queixas e sem observação de recidiva do processo infeccioso. Considerações Finais: Deslocamento dentário para o espaço submandibular é um acidente, que pode ocorrer com qualquer profissional, razão por que é de extrema importância o conhecimento da prevenção e do tratamento dessa complicação... (AU)

Introduction: Exodontia is one of the most commonly performed procedures in dentistry, and complications can arise, especially when there is no preoperative imaging exams or when inadequate force is used during the procedure. Lower molar teeth may move into the submandibular space during the exodontia, and although it is considered a rare complication, the pacient may feel pain, trismus, and in more severe cases may evolve to infection with cervical involvement. Case report: This present article aims to report a case of a patient with chronic infection in the cervical region after an unsuccessful attempt of removing a lower molar, in which the dental fragment was moved to the submandibular space during the surgical procedure. The treatment of choice was a fistulectomy and the surgical removal of the tooth under general anesthesia by Risdon submandibular extraoral approuch, followed by delicate divulsion to the location and removal of the foreign body displaced. The case was followed clinically for 3 months, evolving well, without complaints and recurrence of the infectious process. Final considerations: Dental displacement to the submandibular space is an accident that can occur under any professional care, so it is extremely important to know the prevention and treatment of this complication... (AU)

Apicectomia no tratamento de reabsorção radicular causada por terceiro molar incluso: relato de caso / Apicoectomy in the treatment of radicular resorption caused by third molar impacted: case report

Introdução: A presença dos terceiros molares pode trazer consequências para estruturas em sua volta de acordo com sua posição e profundidade intraóssea, sendo o principal método terapêutico, para a reabsorção radicular externa, a eliminação da causa. Dessa forma, o presente trabalho tem como objetivo relatar um caso de apicectomia associada ao tratamento endodôntico como alternativa de preservação de segundo molar, com reabsorção radicular causada pelo terceiro molar impactado. Relato do caso: Paciente do sexo masculino procurou atendimento para consulta odontológica preventiva, e, após exame radiográfico de rotina, observou-se inclusão horizontal do elemento 38 e imagem sugestiva de reabsorção severa da raiz distal do dente 37, a qual foi confirmada após tomografia computadorizada de feixe cônico. O plano de tratamento consistiu em tratamento endodôntico prévio do dente 37, exodontia do dente 38 e apicectomia distal do dente 37. O paciente evoluiu bem, sem intercorrências e com manutenção da função e estética do elemento envolvido. Considerações Finais: A reabsorção da raiz distal do segundo molar inferior em função do terceiro molar impactado não é tão incomum, e para reabsorções mais severas, o tratamento endodôntico prévio com MTA seguido da apicectomia tem-se demonstrado uma combinação eficaz, com bom prognóstico e resultados satisfatórios... (AU)

Introduction: The presence of third molars may have consequences for structures around them according to their position and intraosseous depth, and the main therapeutic method for external root resorption is elimination of the cause. Thus, the present study aims to report a case of apicectomy associated with endodontic treatment as an alternative for the preservation of the second molar with root resorption caused by impacted third molar. Case report: A male patient sought care for a preventive dental visit, and after a routine radiographic examination, a horizontal inclusion of the element 38 was observed and an image suggestive of severe resorption of the distal root of the tooth 37, which was confirmed after computed tomography cone-bean. The treatment plan consisted of prior endodontic treatment of tooth 37, extraction of tooth 38 and distal apicoectomy of tooth 37. The patient progressed well, without intercurrences and with maintenance of the function and esthetics of the involved element. Final Considerations: Resorption of the distal root of the second lower molar in consequence of impacted third molar is not uncommon, and for more severe resorptions, previous endodontic treatment with MTA followed by apicectomy has shown an effective combination with good prognosis and satisfactory results... (AU)

Microneurorrhaphy of the mentonian nerve during the removal of a giant odontoma / Microneurorrafia do nervo mentoniano durante a remoção de um odontoma gigante

ABSTRACT The aim of this article is to describe a surgical technique of option in the treatment of large tumors in jaw whose risk of accidental rupture of the mental nerve presents increased by the report of a patient with mandibular giant case of odontoma. The option for intraoral access, intentional sectioning of the mentonian nerve, followed by resection of the tumor and the installation of fixation material, which in turn was followed by microneurorraphy. A surgical microscope was used to perform microneurorrhaphy of the mentonian nerve with Nylon 8-0 wire. The evolution of the patient was satisfactory, with no complaints or complications. A mechanical assessment for torque and pressure was conducted using wire with a diameter of 1.0mm and 2.5mm, respectively. The sensitivity of the patient's lower lip returned to normal within 120 days of the surgery. Significant enucleations or resections in the mandible involves a great risk of accidental nervous rupture, with permanent sequelae. In these cases, the intentional section of the mentonian nerve, followed by microneurorrhaphy, is a viable option, particularly in young patients. The results of this procedure tend to be more predictable than accidental nervous ruptures.

RESUMO O objetivo deste artigo é descrever uma técnica cirúrgica de opção no tratamento de grandes tumores na mandíbula cujo risco de ruptura acidental do nervo mental apresenta aumento pelo relato de uma paciente com extenso odontoma complexo em corpo mandibular. A opção foi pelo o acesso intraoral, corte intencional do nervo mentoniano, seguida da ressecção do tumor e da instalação de material de fixação, que por sua vez foi seguida pela microneurorrafia do nervo mentoniano. Um microscópio cirúrgico foi utilizado para realizar microneurorrafia do nervo mentoniano com fio Nylon 8-0. A evolução do paciente foi satisfatória, sem queixas ou complicações. Uma avaliação mecânica para torque e pressão foi realizada usando fio com um diâmetro de 1,0 mm e 2,5 mm, respectivamente. A sensibilidade do lábio inferior do paciente voltou ao normal dentro dos 120 dias da cirurgia. Enucleações significativas ou ressecções na mandíbula envolvem um grande risco de ruptura nervosa acidental, com seqüelas permanentes. Nestes casos, a seção intencional do nervo mentoniano, seguida de microneurrafia, é uma opção viável, particularmente em pacientes jovens. Os resultados deste procedimento tendem a ser mais previsíveis do que as rupturas nervosas acidentais.

Correção estética em paciente portador de exostose frontal: relato de caso / Aesthetic correction in patients with frontal exostose: case report

Introdução: Exostoses são protuberâncias ósseas benignas e calcificadas, geralmente surgindo na região cortical dos ossos, cuja etiologia ainda não é bem definida. Clinicamente, são lesões fixas, indolores que apresentam crescimento lento. Em geral, nenhum tratamento para exostose frontal é sugerido, à exceção de acometimento funcional, estético, com repercussão social do paciente, em função da fisionomia desarmônica. Nesses casos, é indicada a exérese da lesão. Objetivo: Relatar um caso clínico de exostose em região frontal. Relato do caso: Paciente do sexo feminino, 30 anos, com queixa estética em terço superior da face. Ao exame físico, foi constatado um crescimento ósseo assintomático, em região frontal. Na tomografia computadorizada, ficou evidente aumento da espessura da tábua óssea externa do osso frontal. Foram realizadas osteotomias e osteoplastias da região. Estudo histopatológico dos fragmentos removidos confirmou a hipótese diagnóstica de exostose do osso frontal. Resultados: A paciente teve uma evolução satisfatória, e no 30º dia foi detectada a correção da assimetria facial. O acompanhamento segue há 6 meses, sem sinal de recidiva. Conclusão: Exostose do osso frontal, muitas vezes, não requer tratamento cirúrgico, porém pode causar agravos estéticos e comprometimento emocional. Sendo assim, normalmente recomenda se a correção da assimetria presente e melhores resultados estéticos... (AU)

Introduction: Exostosis are benign and calcified bony protuberances, usually arising in the cortical region of bones, whose etiology is not well defined. Clinically, these lesions are fixed, painless and slow growing. In general, no treatment for frontal exostosis is suggested, except for functional, aesthetic involvement, with social repercussion of the patient, due to the disharmonious physiognomy. In such cases, surgical excision is indicated. Objective: Report a clinical case of exostosis in frontal region. Case report: Womenkid patient, 30 years old, with aesthetic complaint in the upper third of the face. Upon physical examination, asymptomatic bone growth was observed in the frontal region. Computed tomography revealed an increase in the thickness of the external bone of the frontal bone. Performing osteotomies and osteoplasties of the region. A histopathological study of the fragments removed confirmed the diagnostic hypothesis of frontal bone exostosis. Results: The patient had a satisfactory evolution and on the 30th day the facial asymmetry correction was detected. Follow-up has been ongoing for 6 months, with no sign of relapse. Conclusion: Exostosis of the frontal bone often does not require surgical treatment, however it can cause aesthetic damage and emotional impairment. Therefore, it is usually recommended to correct the asymmetry present and better aesthetic results... (AU)

Tratamento cirúrgico de cisto epidermoide em região submandibular: relato de caso / Surgical treatment of epidermoid cyst submandibular region: case report

Os cistos epidermoides são cistos de desenvolvimento, benignos, cutâneos ou intraósseos, sendo atípicos na face. Podem crescer em qualquer parte do corpo, porém apenas 7% deles estão localizados na região da cabeça e pescoço. Surgem a partir da implantação traumática do epitélio ou aprisionamento de restos epiteliais durante a fusão embrionária. Comumente são lesões assintomáticas, de crescimento lento e, dependendo da extensão, podem causar alterações estéticas significativas. O exame microscópico revela uma cavidade limitada por epitélio escamoso estratificado, similar à epiderme, como também uma camada de células granulares bem desenvolvidas, com o lúmen preenchido por ortoceratina degenerada. O tratamento de escolha é a remoção cirúrgica completa da lesão através da enucleação de toda a cápsula cística. Este artigo tem como objetivo demonstrar o tratamento cirúrgico de um paciente portador de cisto epidermoide em região submandibular, bem como discutir suas características clínicas e cirúrgicas... (AU)

Epidermoid cysts are developing cysts, benign, cutaneous or intraosseous, and atypical in the face. They can grow on any part of the body, but only 7% of them are located in the head and neck, and 1.6% occurs in the oral cavity, accounting for 0.01% of all cysts of the oral cavity. These cysts arise from the traumatic implantation of epithelium or entrapment of epithelial debris during embryonic fusion. They are usually asymptomatic lesions, slow growth and depending on the extent can cause significant cosmetic changes. Microscopic examination revealed a limited cavity by stratified squamous epithelium resembling the epidermis, but also a well-developed layer of granular cells, with the lumen filled with degenerated ortoceratina. The treatment of choice is the complete surgical removal with enucleation of the entire cystic capsule. This article aims to demonstrate the surgical treatment of an epidermoid cyst patient with a submandibular region and discuss their clinical and surgical characteristics... (AU)