Simultaneous Removal of Third Molars During a Sagittal Split Does Not Increase the Incidence of Bad Splits in Patients Aged 30 Years or Older.

PURPOSE: An increasing number of patients who are 30 years old or older have been presenting for orthognathic surgery, some of whom have impacted third molars. The purpose of our report was to review the incidence of bad splits in this age group, both with and without third molars (3Ms). MATERIALS AND METHODS: A retrospective cohort analysis of all patients who had undergone sagittal split osteotomy (SSO) who were 30 years old or older was performed. The inclusion criteria were age 30 years or older and performance of an SSO. Those with incomplete data or who were younger than 30 years old were excluded. A history and radiographic review was performed to find cases with a bad split that had occurred during the surgical procedures. The fractures were correlated with the presence or absence of the lower 3Ms, the degree of impaction of the 3Ms, and patient age and gender. For this aged sample, the variables of 3M presence and gender were analyzed using the Fisher exact test. For patient age, analysis of variance was applied, and for the degree of impaction, the Pearson test was used. All the tests used the level significance of 0.05%. RESULTS: Of the 220 patients who underwent SSO during the study period, 52 were older than 30 years (24%). Of these, 8 patients (15%) had had at least 1 3M present at surgery. Most of the patients had undergone sagittal splits without complications. A total of 3 patients had had bad splits in this sample, 1 of whom had a 3M present at surgery and 2 of whom did not. No association was found between the occurrence of a bad split and the variables studied, including the presence of a 3M (P = .089), degree of impaction (P = .074), age (P = .963), and gender (P = .266). CONCLUSIONS: From the results in this small subset of patients, 3Ms can be removed in patients older than 30 years concomitant with bilateral SSO.

Decision making in third molar surgery: a survey of Brazilian oral and maxillofacial surgeons.

This study was designed to evaluate the variations in decision making among Brazilian oral and maxillofacial surgeons (OMFS) and trainees in relation to third molar surgery. A survey on 18 diverse clinical situations related to the assessment and treatment of the third molar surgeries was conducted during the 20th Brazilian National OMFS meeting. Participants were divided into three groups according to their level of training. Another variable studied was length of experience. Correlation between the question answers and the variables was analysed using the chi-square test and the f test. The mean age of participants was 32.68 years, and their mean length of experience was 5.24 years. There were no statistical differences between the level of training and number of years of experience and the responses to 15 of the 18 questions on clinical situations. However, differences were found in responses to prophylactic extraction of asymptomatic third molars, use of non-steriodal anti-inflammatory drugs (NSAIDs) during the preoperative surgical period and the use of additional imaging to plan extractions. The group with shorter time of experience (3.8 ± 3.94 years) tended to recommend extractions of asymptomatic third molars more frequently compared with the more experienced surgeons (P = 0.041). More experienced surgeons used NSAIDs in the preoperative surgical period, whereas the majority of the youngest surgeons (4.1 ± 5.96 years of experience) did not (P = 0.0042). The certificated trained and in practice group tended to treat deep lower third molar impactions based on the findings of a panoramic radiograph, without obtaining additional imaging [cone beam computed tomography (CBCT)] before treatment (P = 0.0132). Decision making regarding third molar treatment differs according to the level of training and is influenced by the number of years of experience. Therefore, further continuous education programmes in this area are warranted to make recommendations regarding third molars consistent with the current literature.

Comparative finite element analysis of the biomechanical stability of 2.0 fixation plates in atrophic mandibular fractures.

PURPOSE: The objective of the present study was to conduct a computational, laboratory-based comparison of the biomechanical stability of 2.0 fixation locking plates with different profiles in Class III atrophic mandibular fractures using 3-dimensional finite element analysis. MATERIALS AND METHODS: Three-dimensional finite element models simulating Class III atrophic mandibular fractures were constructed. The models were divided into 4 groups according to plate thickness (1.0, 1.5, 2.0, and 2.5 mm). Fractures were simulated in left mandibular bodies, and 3 locking screws were used on each side of each fracture for fixation. Bite forces of approximately 63 N were simulated in the incisor and molar regions of the mandibles in finite element models. RESULTS: The level of compressive strain on the bone around the screw was within the physiological limit. No significant difference was observed in the displacement of bone segments in the fracture region. Von Mises stress was higher during simulated bites in the molar region for plates with thicknesses of 1.0 mm. Plate tension values were below the level required for permanent deformation or fracture in all models. The 2.5-mm-thick plate presented better biomechanical performance than all other plates. The 2.0-mm-thick plate also showed satisfactory results and adequate safety limits. CONCLUSION: Large-profile (2.0-mm-thick) locking plates showed better biomechanical performance than did 1.0- and 1.5-mm-thick plates and can be considered an alternative reconstruction plate for the treatment of Class III atrophic mandibular fractures.

Management of subcondylar fracture by intraoral approach.

Condylar fracture osteosynthesis is nowadays commonly practiced, but only a few studies report the intraoral approach with angulated devices. Subcondylar fractures with little or lateral displacement can be treated using an intraoral approach with satisfactory results. The advantages of this approach are the absence of visible scars, the avoidance of facial nerve injury inherent to the extraoral approach, quick access to the fracture, and a reduced risk of infection. The authors report a case of subcondylar fracture treated through an intraoral approach. Despite the considerable lateral dislocation of the condyle, treatment consisted of the reduction of the fracture and osteosynthesis with a trapezoidal condylar plate using an intraoral surgical approach.

Cheilitis glandularis and actinic cheilitis: differential diagnoses - report of three unusual cases.

A variety of pathological conditions of diverse etiologies may involve the lips. Cheilitis glandularis (CGL) is a rare disorder of unknown etiology characterized by inflammation of the minor salivary glands of the lower lip. The aim of this paper is to compare the diagnosis and treatment of two cases of CGL at an early age (one in a child and the other in a young adult with mental retardation) with the diagnosis and treatment of actinic cheilitis, which is much more prevalent than CGL in tropical countries.

Correlation of the radiographic and morphological features of the dental follicle of third molars with incomplete root formation.

The objective of this study was to determine the correlation of the radiographic and morphological features of the dental follicle of unerupted third molars with incomplete root formation. A cross-sectional study was carried out with 56 patients (105 teeth) aged 13 to 24 years. Panoramic radiography was used to determine the stage of root formation to locate and measure pericoronal radiolucency. The width of the dental follicle ranged from 0.0 to 4.0 mm, the distal face being the one most frequently involved, and stage 7 of root formation showing the highest incidence. An inactive enamel reduced epithelium and inactive epithelium remnant also showed a high incidence. Dense connective tissue showed a high incidence, chronic inflammation was infrequent and calcification was a common finding. There was a significant association between the progression of the rhizogenesis and the transformation of the enamel reduced epithelium into a stratified squamous epithelium. No significant association was found between rhizogenesis and the other morphological findings or between the latter and the width of the pericoronal space. It was concluded that there was no clinically significant correlation between the radiographic and morphological features. Every asymptomatic unerupted third molar should be followed up and the follicular tissue analyzed.

Simultaneous removal of third molars and completion of a sagittal split osteotomy: effects of age and presence of third molars.

OBJETIVES: The risk of removal of third molars (M3) during a sagittal split osteotomy (SSO) is controversial. The purpose of this study was to review our experience with removal of mandibular M3 during versus before SSO. STUDY DESIGN: A chart and radiographic review was completed in all patients who underwent an SSO from April 2010 until September 2014. The presence or absence of M3, degree of impaction, age, sex, and occurrence of bad splits were noted. The variables were analyzed using the Pearson χ(2), ANOVA, and Fisher's exact tests set to a significance of 5%. RESULTS: For the 215 patients, the mean age was 23.28 years with an increase in the incidence of bad splits in older patients (P = .013). Sixty-six (30.70%) of them had at least 1 M3 present at the time of surgery. There were 6 (2.79%) bad splits. Paradoxically, looking at the occurrence of bad splits and presence of third molar, when the data were analyzed by the number of patients undergoing the procedure, there was slight evidence of a difference (P = .073), but when the data were analyzed by the surgical site, there was a statistically significant association (P = .05). CONCLUSION: The discrepancy between the 2 ways of analyzing the data may be related to there being double the number of observations when analyzed by surgical site and thus the analysis being more powerful.

Correlational study of impacted and non-functional lower third molar position with occurrence of pathologies.

BACKGROUND: Lower third molar (M3) eruption is unpredictable. The purpose of this study was to correlate radiographic position of M3 on a preexistent film with the current clinical, histopathological, and radiographic findings. METHODS: A retrospective cohort study was performed. The sample was collected from a database of patients covered by Medical Fund of Brazilian Army. Radiographs were obtained a minimum of 5 years prior to the presurgical visit and after their clinical exam. The primary outcome variables were the teeth positions using Pell and Gregory/Winter classifications on panoramic X-rays. Those variables were analyzed at both the beginning (T0) and end of the study (T1). Clinical assessments and histopathological study of the thirds that were extracted were performed only at T1. Correlation between the teeth positions were related to the clinical, histopathological, and radiographic parameters using statistical analysis tests with significance set at p < 0.05. RESULTS: Twenty-six patients with 49 M3 were assessed over 10 months. Mean age was 14.92 years at T0 and 21.87 years at T1. The average time between T0 and T1 was 6.77 years. A significant relationship (p = 0.024) was found between the presences of root resorption on the second molar if M3 presented in an IB horizontal position at T1. There was also a significant correlation (p = 0.039) between dental crowding of the anterior lower teeth with IIIB position at T0 and if the patient finished orthodontic treatment without lingual retainers. CONCLUSIONS: Lower M3 in position IIIB seen in a teenager and IB seen in an adult is more likely to have negative consequences and should be followed closely.

Surgical complications after implant placement.

Placement of dental implants in the maxillofacial region is routine and considered safe. However, as with any surgical procedure, complications occur. Many issues that arise at surgery can be traced to the preoperative evaluation of the patient and assessment of the underlying anatomy. In this article, the authors review some common and uncommon complications that can occur during and shortly after implant placement. The emphasis of each section is on the management and prevention of complications that may occur during implant placement.

The nasal lift technique for augmentation of the maxillary ridge: technical note.

Placement of dental implants in a severely resorbed anterior maxillary alveolar ridge is limited by the fact that implants may penetrate the nasal cavity. However, when the maxilla shows unusual anatomical changes, reconstruction with implants can be a challenge. Options to increase the bone in this region to permit placement of implants include: maxillary onlay bone graft, Le Fort I interpositional bone graft, and augmentation of the nasal floor, which is a procedure where only the piriform rim and the anterior nasal spine are exposed through an intraoral approach. In our case we modified this to what we call the nasal lift technique, which is a combination of turbinectomy followed by lifting of the anteroposterior nasal floor through a lateral window using autogenous bone or bone substitutes to augment the space.

Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: results of a multicentre study.

BACKGROUND: This multicentre study aimed to investigate long-term radiographic and functional results following the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach. METHODS: Twenty-nine patients with a total of 32 condylar fractures were evaluated. The patients were investigated prospectively based on the following variables: age, sex, aetiology, side, location and classification of the fracture, degree of displacement, associated fractures, surgical approach, oral health status, type of osteosynthesis plate, duration of surgery, mouth-opening, complications, and duration of follow-up. RESULTS: The fractures were classified as subcondylar (n = 25) or condylar neck (n = 7). Mean patient age was 36.38 ± 16.60 years. The median duration of postoperative follow-up was 24.39 ± 13.94 months. No joint noise, weakness of the facial nerve, joint pain, or muscle pain was observed. An additional retromandibular approach was necessary to enable the treatment of one subcondylar fracture with medial displacement. CONCLUSION: Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results with the advantages of the absence of visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture.

Sialolito gigante em ducto de Wharton: um caso distinto e revisão da literatura / Giant sialolith in Wharton's duct: case report and literature review

A sialolitíase é uma condição clínica relativamente comum, caracterizada pela obstrução da glândula salivar ou de seu ducto excretor por um cálculo, o qual recebe a denominação de sialolito. Pode ocorrer em qualquer faixa etária, apresentando leve predileção pelo gênero masculino e afeta, principalmente, a glândula submandibular. O diagnóstico é realizado pela correlação entre achados clínicos e radiográficos, sendo as radiografias oclusal e panorâmica as mais adequadas para este fim. Os sialolitos geralmente apresentam tamanho menor que 1 cm, mas raramente podem medir mais que 1,5 cm, os quais são denominados de sialolitos gigantes. O presente artigo relata um caso raro de sialolito gigante situado na região anterior do ducto de Wharton, o qual foi removido cirurgicamente por via intraoral, através de incisão no soalho bucal. O tratamento instituído mostrou-se adequado visto que após 8 meses de acompanhamento, o paciente evoluiu de maneira satisfatória... (AU)

The sialolithiasis is a relatively common clinical condition characterized by obstruction of the salivary gland or its excretory duct by a calculus, which receives the name of sialolith. It can occur in any age group, with a slight predilection for masculine gender and affects mainly the submandibular gland. The diagnosis is made by the correlation between clinical and radiographic findings, and occlusal and panoramic radiographs are the most suitable for this purpose. The sialoliths usually feature size less than 1 cm, but can rarely measure more than 1.5 cm, which are called giant sialoliths. This article reports a rare case of giant sialolith located in the anterior region of Wharton's duct, which was removed surgically by intraoral via through of incision in the mouth floor. The treatment was adequate because after 8 months follow up, the patient progressed satisfactorily... (AU)

Fratura parassinfisária em Mulher Vítima de Violência Doméstica: Relato de Caso / Parasymphyseal fracture in women victims of domestic violence: a case report

O trauma facial pode ser considerado uma das agressões mais devastadoras encontradas em centros de trauma devido às consequências emocionais, à possibilidade de deformidade e, também, ao impacto econômico que esses traumas causam em um sistema de saúde. Trata-se de um trauma de abrangência multidisciplinar, envolvendo, principalmente, as especialidades de traumatologia, oftalmologia, cirurgia plástica, maxilofacial e neurocirurgia¹. Sendo a mandíbula o único osso da face que apresenta mobilidade, e o restante fazendo parte do esqueleto fixo da face, a sua fratura não passa jamais despercebida, pois é bastante dolorosa, dor essa que piora muito com os movimentos mastigatórios, fonatórios e, até, movimentos respiratórios, havendo, às vezes, queixas de assimetrias faciais4. Das fraturas mandibulares, a parassinfisária é a que ocorre na região compreendida entre a linha média mandibular e uma linha vertical na distal do canino. Dentre as opções de tratamento, a fixação interna rígida apresenta as vantagens de proporcionar reduções com maior precisão e estabilidade; eliminação da necessidade de bloqueio maxilo-mandibular (BMM); reabilitação e restabelecimento mais rápido da função e a função em pós-operatório imediato22. Este trabalho teve como objetivo realizar um relato de caso acerca de uma cirurgia para redução e fixação de uma fratura parassinfisária em uma vítima de violência, utilizando-se o sistema de miniplacas 2.0 e parafusos.

Facial trauma can be considered one of the most devastating attacks encountered in trauma centers because of its emotional consequences, the possibility of deformity and also the economic impact on a health care system caused by this kind of trauma. It is a trauma requiring a multidisciplinary approach, involving mainly the specialties of traumatology, ophthalmology, plastic surgery, maxillofacial surgery and neurosurgery¹. As the mandible is the only bone of the face that has mobility, since the other bones are all are part of the fixed facial skeleton, the fracture never goes unnoticed because it is very painful, a pain that worsens with the movements of mastication and phonation and even respiratory movements and, sometimes, complaints of facial asymmetry4. Of the mandibular fractures, the parasymphyseal fracture is the one that which occurs inthe region between the mandibular midline and a vertical line distal to the canine tooth. Among the treatment options, rigid internal fixation has the advantage of providing more precise cuts and stability, eliminating the need for intermaxillary fixation, faster rehabilitation and restoration of function, and function in the immediate postoperative period22. The aim of this study was to present a case report of surgery for the reduction and fixation of a parasymphyseal fracture in a victim of violence, using the 2.0 miniplate system and screws.

Tratamento cirúrgico das fraturas subcondilianas por via intrabucal: relato da técnica / Surgical treatment of subcondylar fracture through intra-oral approach: techinical note

As fraturas subcondilianas ainda são um tópico bastante controverso na literatura devido à falta de evidência científica quanto ao melhor método de tratamento. Em relação aos acessos cirúrgicos, o retromandibular e o pré-auricular são os mais utilizados. Com o desenvolvimento de instrumentos, como afastadores específicos e perfuradores em 900 (contra-ângulo), a fixação de placas na região posterior de mandíbula tornou-se viável por via intrabucal através de visão direta. Essa abordagem apresenta vantagens, como a ausência de cicatrizes visíveis e da possibilidade de lesão do nervo facial, inerentes à abordagem extrabucal, além do acesso rápido à fratura e do menor risco de infecção. A limitação do campo cirúrgico e a dificuldade da redução de fraturas com deslocamento medial são as principais desvantagens do acesso intrabucal, sendo estas, geralmente, tratadas pelos acessos extrabucais, o qual propicia um campo cirúrgico mais direto. O objetivo deste trabalho é descrever o tratamento cirúrgico das fraturas subcondilianas por via intrabucal.

Subcondylar fractures is still a very controversial topic in the literature for the lack of scientific evidence concerning the best method of treatment. Regarding the surgical approaches, the pre-auricular and retromandibular are the most used. With the development of instruments such as specific retractors and 900screwdriver, fixation of the plate at the posterior mandibular region became possible by means of intra-oral direct vision. This approach has advantages as the absence of visible scars and the possibility of facial nerve injury inherent in the extra-oral approach, as well as quick access to fracture and reduced risk of infection. The limitation of the surgical field and the difficulty of reducing fractures with medial displacement are the main disadvantages of intra-oral access, which are often treated by extra-oral access, which provides a more direct surgical field. The aim of this study is to report the treatment ok subcondylarfracturesthrough intra-oral approach.

Estudo clínico-patológico de mixomas odontogênicos / Clinico-pathologic study of odontogenic myxoma

INTRODUÇÃO: o mixoma é uma neoplasia benigna incomum, que surge da porção ectomesenquimal do aparato odontogênico, sendo classificado como tumor odontogênico. OBJETIVOS: realizar um levantamento dos mixomas odontogênicos diagnosticados no Laboratório de Patologia Cirúrgica de uma Faculdade de Odontologia, no período de 1991 a 2007, analisando as variáveis clínicas: idade, sexo, cor da pele, sintomatologia do paciente, localização anatômica e aspecto radiográfico da lesão, além das variáveis microscópicas: características celulares, tipo de matriz tumoral e presença de restos epiteliais odontogênicos. METODOLOGIA: através de um estudo retrospectivo, os dados foram analisados pelas fichas de encaminhamento, laudos e lâminas dos arquivos e tabulados segundo estatística descritiva. RESULTADOS: os mixomas odontogênicos representaram 0,3% do total de 4.299 laudos anátomo-patológicos e 1,89% dos tumores odontogênicos. Dentre os mixomas, 69,2% ocorreram em adultos, 53,8%, em homens, 61,5%, em leucodermas, 53,8%, na maxila, sendo 69,2% assintomáticos, e 38,5%, com aspecto radiolúcido. A matriz tumoral apresentou-se mista em 53,8%, com células fusiformes, ovaladas e estreladas em todos os casos e com ausência de restos epiteliais odontogênicos em 76,9%. CONCLUSÃO: os mixomas odontogênicos são neoplasias benignas de ocorrência incomum entre os tumores odontogênicos, o que justifica a divergência na literatura quanto à prevalência de alguns aspectos clínicos e microscópicos do tumor devendo, para tanto, serem desenvolvidos novos estudos.

INTRODUCTION: Myxoma is an uncommon benign neoplasm originating in the ectomesenchymal portion of the odontogenic system, being classified as an odontogenic tumor. OBJECTIVES: To conduct a survey of the odontogenic myxomas diagnosed at the Laboratory of Surgical Pathology of a school of dentistry between 1991 and 2006, analyzing the following clinical variables: age, sex, skin color, patient symptomatology, anatomic localization and radiographic appearance of the lesion, in addition to the following microscopic variables: cell characteristics, type of tumor matrix and presence of odontogenic epithelial nests. METHODOLOGY: The data were analyzed by means of a retrospective study that included the patient referral cards, histopathology results and slides tabulated using descriptive statistics. RESULTS: Odontogenic myxomas accounted for 0.3% of the 4,299 anatomopathological results and 1.89% of the odontogenic tumors. Of the myxomas, 69.2% occurred in adults, 53.8% in men, 61.5% in white individuals, 53.8% in the maxilla, 69.2% of which were asymptomatic and 38.5% with a radiolucent appearance. The tumor matrix was mixed in 53.8%, presenting fusiform, oval, stellate cells in all cases and an absence of odontogenic epithelial nests in 76.9%. CONCLUSION: Odontogenic myxomas are benign tumors of rare occurrence among the odontogenic tumors, which accounts for divergent reports in the literature regarding the prevalence of some clinical and microscopic features of the tumor, evidencing the need for further studies.

Cirurgia do lábio inferior descrição de técnica e relato de caso / Surgery of the lower lip technique and report of a case

O lábio inferior é uma das regiões da face que é acometida por uma variedade de patologias de diferentes etiologias que vão desde lesões de origem auto-imune até neoplasias malignas diretamente relacionadas a hábitos dos pacientes. As modalidades de tratamento destas patologias têm sido estudadas e são praticadas por cirurgiões buco-maxilo-faciais e por cirurgiões de cabeça e pescoço os quais, frente a estas, poderão tratá-las de maneira conservadora ou radical. As abordagens conservadoras vão desde os aplainamentos por plastias até a excisão de lesões em cunha, enquanto as radicais correspondem às grandes ressecções com rotação de retalhos para reconstrução. O objetivo deste trabalho é o de descrever uma técnica cirúrgica aplicada ao lábio inferior bem como a descrição de um caso em que se procedeu ao aplainamento (plastia do vermelhão) do lábio através da modificação da técnica descrita.

A influência do laser de baixa intensidade na redução de edema, dor e trismo no pós-operatório de cirurgia de terceiros molares inferiores inclusos: resultado preliminar com 13 casos / The Influence of the Laser in the Edema Reduction, Pain and Trismo in the After-surgical one of Third Molar Enclosed Inferiors: Preliminary results with 13 Cases

OBJETIVO: O objetivo deste trabalho foi fazer uma avaliação da eficácia na utilização do laser como meio auxiliar na diminuição da morbidade pós-operatória relacionadas a dor, edema e trismo, dos pacientes submetidos a cirurgias para extração de terceiros molares inferiores inclusos. MÉTODOS: Foi realizado um estudo comparativo, pareado, duplo-cego onde em um lado do paciente foi realizada a exodontia e feitas aplicações com laser de arseniato de gálio com comprimento de onda de 904 nm, tempo ajustado pelo aparelho e densidade de energia de 6 Jcm2. Estas aplicações foram feitas no pré-operatório, no pós-operatório imediato, após 24 horas e com 48 horas. Foram realizadas duas aplicações pontuais consecutivas em pontos pré-definidos. A região intra-oral, também é submetida à terapia com aplicações próximo ao alvéolo envolvido, no pré-operatório com densidade de energia de 6 Jcm2 e no pós operatório imediato, na região adjacente ao retalho e a sutura, com uma densidade de energia de 7 Jcm2. Nas exodontias do lado oposto foram feitas aplicações placebo. Para análise dos dados foram obtidas distribuições absolutas e percentuais das variáveis nominais ou em categorias e as medidas estatísticas: média, mediana e desvio padrão (técnicas de estatística descritiva) para as variáveis numéricas e foi utilizado os teste t-Student pareado. Para comparação do edema entre os dois lados (controle e experimental) utilizaram-se medidas antropométricas lineares, em que se determinou as diferenças entre as avaliações no pós-operatório com 48 e 72 horas em relação à avaliação do pré-operatório. A pesquisa foi realizada com 13 pacientes. O nível de significância para a tomada de decisões dos testes estatísticos foi de 5,0% (0,05). RESULTADOS: Com relação à dor, o lado tratado com laser (experimental) mostrou uma diminuição estatisticamente significante da dor a partir do segundo dia maior que o lado controle...