Mechanical Evaluation of Different Stable Internal Fixation Techniques of Sagittal Osteotomy in Mandibular Advance / Evaluación Mecánica de Diferentes Técnicas de Fijación Interna Estable de Osteotomía Sagital en Avance Mandibular

The mandibular advancements performed in orthognathic surgeries can be stabilized with several techniques when using stable internal fixation. This study aims to comparatively evaluate, in vitro, the mechanical strength in a polyurethane mandibular model for four fixation techniques for sagittal split ramus osteotomy mandibular. 60 samples were divided into 4 groups, with 15 units for each group: group A, group B, group C and group D. Advances of 5 mm were made for each subgroup and fixed with 2.0 mm system plates and monocortical screws in the replicas of human hemimandibles in polyurethane resin. The samples were submitted to mechanical tests of linear loading, being evaluated the peak load and peak deformation. Technique B presented higher peak load (Kgf) and techniques A and B presented higher peak strain (p<0.05). Technique D presented lower peak load and lower peak strain (p<0.05). It is concluded that the study based on the development of new techniques for fixation for sagittal osteotomy of the mandibular ramus is of great importance for the advancement of orthognathic surgery, provided by the technical innovation of more favorable plate models.

Los avances mandibulares realizados en cirugías ortognáticas pueden estabilizarse con varias técnicas cuando se utiliza fijación interna estable. Este estudio tuvo como objetivo evaluar comparativamente, in vitro, la resistencia mecánica en un modelo mandibular de poliuretano para cuatro técnicas de fijación para la osteotomía sagital de la rama mandibular. Se dividieron 60 muestras en 4 grupos, con 15 unidades para cada grupo: grupo A, grupo B, grupo C y grupo D. Se realizaron avances de 5 mm para cada subgrupo y se fijaron con placas de sistema de 2,0 mm y tornillos monocorticales en las réplicas de hemimandíbulas humanas en resina de poliuretano. Las muestras fueron sometidas a pruebas mecánicas de carga lineal, siendo evaluadas la carga máxima y la deformación máxima. La técnica B presentó mayor pico de carga (Kgf) y las técnicas A y B presentaron mayor pico de deformación (p<0,05). La técnica D presentó menor carga máxima y menor tensión máxima (p<0,05). Se concluye que el estudio basado en el desarrollo de nuevas técnicas de fijación para la osteotomía sagital de la rama mandibular es de gran importancia para el avance de la cirugía ortognática, proporcionada por la innovación técnica de modelos de placas más favorables.

Fratura complexa de teto de órbita associada disjunção traumática do complexo zigomático / Complex Orbit Roof Fracture Associated with Traumatic Disjunction of the Zygomatic Complex / Fractura Compleja del Techo de la Órbita Asociada a Disyunción Traumática del Complejo Cigomático

Objetivo: As fraturas do complexo zigomático-maxilar (CZM) constituem as principais fraturas do terço médio da face. O diagnóstico é complexo, por envolver uma área alternente sensorial e nobre da face. Portanto o tratamento não visa apenas devolver os contornos ósseos, mas também preservar as funções oculares. No presente caso paciente apresentou severo trauma facial associado a TCE com afundamento do frontal e teto de órbita. Relato de caso: Paciente do sexo masculino, 33 anos, vítima de queda da própria altura. No exame físico notou-se FCC extenso em região frontal, se estendendo para a região supra-orbital esquerda, blefaroedema periorbital esquerdo, com oclusão palpebral e distopia ocular. Escoriações em face e afundamento em região fronto parietal esquerda e perda de consciência. O diagnóstico apontou para fratura do complexo zigomático-maxilar associada a afundamento do osso frontal. Paciente submetido à osteossíntese das fraturas com por meio da ferida e complementado com acesso subciliar e caldwel luc. Foi alcançada boa reabilitação estética e funcional. Conclusão: Portanto, a redução aberta com fixação funcional estável com placas e parafusos segue sendo o padrão ouro para o tratamento de fraturas complexas do CZM. Sendo imperativo uma adequada redução e o reestabelecimento do continente orbitário... (AU)

Objective: Fractures of the zygomatic-maxillary complex are the main fractures of the middle third of the face. The diagnosis is complex, as it involves an alternating sensory and noble area of the face. Therefore, the treatment is not only aimed at restoring bone contours but also preserving ocular functions. In the present case, the patient presented severe facial trauma associated with TBI with frontal and orbital sinking. Case Report: Male patient, 33 years old, victim of a fall from standing height. Physical examination revealed extensive CCF in the frontal region, extending to the left supraorbital region, left periorbital blepharoedema, with eyelid occlusion and ocular dystopia. Excoriations on the face and sinking in the left fronto-parietal region and loss of consciousness. The diagnosis pointed to fracture of the zygomatic-maxillary complex associated with frontal bone sinking. Patient undergoing osteosynthesis of fractures through the wound and complemented with subciliary access and caldwell luc. Good aesthetic and functional rehabilitation were achieved. Conclusion: Therefore, open reduction with stable functional fixation with plates and screws remains the gold standard for the treatment of complex ZMC fractures. An adequate reduction and reestablishment of the orbiting continent is imperative... (AU)

Objetivo: Las fracturas del complejo cigomático maxilar son las principales fracturas del tercio medio de la cara. El diagnóstico es complejo, ya que involucra una zona sensorial y noble alternada de la cara. Por lo tanto, el tratamiento no solo está dirigido a restaurar los contornos óseos sino también a preservar las funciones oculares. En el presente caso, el paciente presentó trauma facial severo asociado a TCE con hundimiento frontal y orbitario. Caso Clínico: Paciente masculino, 33 años, víctima de caída desde altura de pie. A la exploración física destacaba FCC extensa en región frontal, con extensión a región supraorbitaria izquierda, blefaroedema periorbitario izquierdo, con oclusión palpebral y distopía ocular. Excoriaciones en la cara y hundimiento en la región fronto-parietal izquierda y pérdida del conocimiento. El diagnóstico apuntó a fractura del complejo cigomático-maxilar asociada a hundimiento del hueso frontal. Paciente con osteosíntesis de fractura a través de herida y complemento acceso subciliar y calwell luc. Se logró una buena rehabilitación estética y funcional. Conclusión: Por lo tanto, la reducción abierta con fijación funcional estable con placas y tornillos sigue siendo el estándar de oro para el tratamiento de fracturas CCM complejas. Es imperativo una adecuada reducción y restablecimiento del continente en órbita... (AU)

Análise das vias aéreas superiores pós cirurgia ortognática bimaxilar: estudo retrospectivo / Upper airway analysis after bimaxillary orthognathic surgery: retrospective study / Análisis de la vía aérea superior después de la cirugía ortognática bimaxilar: estudio retrospectivo

Objetivo: O objetivo do presente estudo foi avaliar retrospectivamente as mudanças ocorridas nas vias aéreas superiores (VAS) pós cirurgia ortognática bimaxilar. Metodologia: A amostra compreendeu 14 pacientes, que foram divididos em dois grupos, conforme o tipo de movimentação realizada na cirurgia: grupo 1 (n = 6), avanço bimaxilar; grupo 2 (n = 8) cirurgia de avanço de maxila e recuo de mandíbula. Foram realizadas tomografias computadorizadas no pré-operatório (T0) e pós-operatório de 1 ano (T1). Através do software Dolphin Imaging procedeu-se a análise das VAS em três parâmetros: área total (AT), volume total (VT) e área axial mínima (AAM), que foram comparadas entre T0 e T1 em um mesmo grupos pelo Teste de Wilcoxon e entre grupos pelos Teste de Mann-Whitney (p < 0.05). Resultados: Ambos os grupos apresentaram aumento significativo de AT, VT e AAM entre T0 e T1. Contudo, essas variações foram estatisticamente maiores no grupo 1 quando comparadas ao grupo 2. Conclusão: As cirurgias bimaxilares promoveram o aumento da AT, VT e AAM das VAS e essas mudanças foram significativamente superiores nos pacientes submetidos ao avanço bimaxilar... (AU)

Objective: The objective of the present study was to retrospectively evaluate the changes that occurred in the upper airways (UAS) after bimaxillary orthognathic surgery. Methodology: The sample comprised 14 patients, who were divided into two groups, according to the type of movement performed in the surgery: group 1 (n = 6), bimaxillary advancement; group 2 (n = 8) maxillary advancement and mandibular setback surgery. Computed tomography scans were performed preoperatively (T0) and 1 year postoperatively (T1). Through the Dolphin Imaging software, the analysis of the UAS was carried out in three parameters: total area (TA), total volume (TV) and minimum axial area (MAA), which were compared between T0 and T1 in the same groups by the Wilcoxon Test and between groups by the Mann-Whitney test (p < 0.05). Results: Both groups showed a significant increase in TA, TV and MAA between T0 and T1. However, these variations were statistically higher in group 1 when compared to group 2. Conclusion: Bimaxillary surgeries promoted an increase in the TA, TV and MAA of the UAS and these changes were significantly higher in patients undergoing bimaxillary advancement... (AU)

Objetivo: El objetivo del presente estudio fue evaluar retrospectivamente los cambios ocurridos en las vías aéreas superiores (VAS) después de la cirugía ortognática bimaxilar. Metodología: La muestra estuvo compuesta por 14 pacientes, quienes fueron divididos en dos grupos, según el tipo de movimiento realizado en la cirugía: grupo 1 (n = 6), avance bimaxilar; grupo 2 (n = 8) cirugía de avance maxilar y retroceso mandibular. Las tomografías computarizadas se realizaron antes de la operación (T0) y 1 año después de la operación (T1). A través del software Dolphin Imaging se realizó el análisis de la VAS en tres parámetros: área total (AT), volumen total (VT) y área axial mínima (AAM), los cuales fueron comparados entre T0 y T1 en los mismos grupos por el Prueba de Wilcoxon y entre grupos por la prueba de Mann Whitney (p < 0,05). Resultados: Ambos grupos mostraron un aumento significativo de AT, VT y AAM entre T0 y T1. Sin embargo, estas variaciones fueron estadísticamente mayores en el grupo 1 en comparación con el grupo 2. Conclusión: Las cirugías bimaxilares promovieron un aumento de la AT, VT y AAM de las VAS y estos cambios fueron significativamente mayores en los pacientes sometidos a avance bimaxilar... (AU)

A cone-beam computed tomography study to assess anterior loop and other anatomic variations in mental foramen area in an iranian population / Un estudio de tomografía computarizada de haz cónico para evaluar el asa anterior y otras variaciones anatómicas en el área del foramen mentoniano en una población iraní

Purpose: This study aimed to determine the prevalence and length of the anterior loop (AL) of the inferior alveolar nerve, and evaluate the emergence direction of the mental nerve and the location of mental foramen in a group of Iranian patients. Material and Methods: This study was carried out on CBCT scans of 150 patients (57 males and 93 females; mean age 40.8 ±14.33 years). The presence and extent of the AL was determined in reconstructed images. The emergence path of the mental nerve was classified into three groups: anteriorly directed emergence, right-angled pattern of emergence, and posteriorly directed emergence. The location of mental foramen relative to adjacent premolars was determined. Results: AL was identified in 14.7% of the cases with a mean length of 1.39± 0.91 mm (range 0.25 to 3.50 mm). No significant differences were observed in the prevalence and extent of the AL between genders (p>0.05). The right-angled pattern of emergence was more dominant (43.7%). The most prevalent location of mental foramen was between the first and second premolars (68.3%). There was no significant association between the presence of AL with the path of emergence of the mental nerve (p=0.627) or the location of the mental foramen (p= 0.10 0). Conclusion: The prevalence of anterior loop was relatively low in the present sample (14.7%) with a length range of 0.25 to 3.5 mm. Due to the importance of this anatomic variation in implant surgery, it is suggested to carefully assess CBCT images before the surgical procedure to avoid neurosensory complications.

Propósito: Este estudio tuvo como objetivo determinar la prevalencia y la longitud del loop anterior (LA) del nervio alveolar inferior, y evaluar la dirección de emergencia del nervio mentoniano y la ubicación del foramen mentoniano en un grupo de pacientes iraníes. Material y Métodos: Este estudio se llevó a cabo en exploraciones de tomografía computarizada de haz cónico de 150 pacientes (57 hombres y 93 mujeres; edad media 40,8 ± 14,33 años). La presencia y extensión de la LA se determinó en imágenes reconstruidas. La vía de emergencia del nervio mentoniano se clasificó en tres grupos: emergencia dirigida anteriormente, patrón de emergencia en ángulo recto y emergencia dirigida posteriormente. Se determinó la ubicación del foramen mentoniano en relación con los premolares adyacentes. Resultados: Se identificó LA en el 14,7% de los casos con una longitud media de 1,39± 0,91 mm (rango 0,25 mm a 3,50 mm). No se observaron diferencias significativas en la prevalencia y extensión de la AL entre sexos (p>0,05). El patrón de emergencia en ángulo recto fue más dominante (43,7%). La localización más prevalente del foramen men-toniano fue entre el primer y segundo premolar (68,3%). No hubo asociación significativa entre la presencia de AL con la vía de emergencia del nervio mentoniano (p=0,627) o la ubicación del foramen mentoniano p=0,100).Conclusión: La prevalencia de asa anterior fue rela-tivamente baja en la presente muestra (14,7%) con un rango de longitud de 0,25 mm a 3,5 mm. Debido a la importancia de esta variación anatómica en la cirugía de implantes, se sugiere evaluar cuidadosamente las imágenes de tomografía computarizada de haz cónico antes del procedimiento quirúrgico para evitar complicaciones neurosensoriales.

Cisto ósseo simples: relato de 7 casos / Simple bone cyst: report of 7 cases / Quiste óseo simple: reporte de 7 casos

Introdução: O cisto ósseo simples (COS) é definido como uma cavidade intraóssea de etiologia desconhecida, desprovida de revestimento epitelial e vazia ou preenchida com líquido. Na região facial, o COS é mais comumente observado no corpo da mandíbula. Objetivo: O objetivo deste artigo é relatar uma série de casos de COS, discutindo aspectos relevantes das características clínicas e terapêutica adequada. Relato de caso: A série de casos demonstrou que a presença de lesões radiolúcidas assintomáticas nos maxilares, nos quais os diagnósticos clínico, laboratorial e imaginológico não foram conclusivos, a realização de uma biópsia é sempre indicada. Considerações finais: Os casos de múltiplas lesões de COS, ou quando estão associadas a displasias cemento-ósseas, uma abordagem cirúrgica torna-se imperiosa... (AU)

Introduction: Simple bone cyst (COS) is defined as an intraosseous cavity of unknown etiology, devoid of epithelial lining and empty or filled with fluid. In the facial region, COS is most commonly seen in the body of the mandible. Objective: The aim of this article is to re port a series of COS cases, discussing relevant aspects of the clinical characteristics and adequate treatment. Case report: The case series demonstrated that the presence of asymptomatic radiolucent lesions in the jaws, in which clinical, laboratory and imaging diagnoses were not conclusive, a biopsy is always indicated. Final considerations: In cases of multiple COS lesions, or when they are associated with cemento-osseous dysplasias, a surgical approach is imperative... (AU)

Introducción: El quiste óseo simple (COS) se define como una cavidad intraósea de etiología desconocida, desprovista de revestimiento epitelial y vacía o llena de líquido. En la región facial, la COS se observa con mayor frecuencia en el cuerpo de la mandíbula. Objetivo: El objetivo de este artículo es reportar una serie de casos de COS, discutiendo aspectos relevantes de las características clínicas y el tratamiento adecuado. Caso clínico: La serie de casos demostró que ante la presencia de lesiones radiotransparentes asintomáticas en los maxilares, en las que los diagnósticos clínicos, de laboratorio y de imagen no fueron concluyentes, siempre está indicada una biopsia. Consideraciones finales: En casos de múltiples lesiones de COS, o cuando se asocian a displasias cemento-óseas, es imprescindible un abordaje quirúrgico... (AU)

Tratamiento definitivo en traumatismo avulsivo de la región cérvico-facial: presentación de caso clínico / Definitive treatment in avulsive trauma of the cervico-facial region: clinical case report

Resumen Introducción: Las lesiones autoinfligidas por armas de fuego con cañón largo en la zona cérvico-facial no siempre logran consumar el suicidio y pueden ocasionar una herida avulsiva de esta región anatómica. Objetivo: Socializar los beneficios del tratamiento multidisciplinario inmediato en la atención al paciente con traumatismo facial complejo. Caso clínico: Paciente masculino de 60 años de edad con intento autolítico por arma de fuego, con pérdida importante de tejido a nivel mandibular y compromiso de la vía aérea. Resultados: Las distintas etapas de accionar quirúrgico se lograron en las primeras cuatro horas desde que sucedió el incidente. El paciente no presentó complicaciones posoperatorias ni necesidad de una nueva operación. Discusión: En la actualidad existe la tendencia a realizar tratamiento definitivo en un solo tiempo quirúrgico inicial. Conclusión: La intervención inmediata y protocolizada de las especialidades cirugía general, maxilofacial y cirugía plástica-reconstructiva en pacientes con heridas avulsivas de la región cérvico facial pueden lograr un tratamiento definitivo en un único tiempo quirúrgico y con resultados favorables.

Introduction: Self-inflicted injuries by long-barreled firearms in the cervico-facial area do not always succeed in consummating suicide and may result in an avulsive injury of this anatomical region. Aim: Socializing the benefits of the immediate multidisciplinary treatment in the medical care of patients with complex facial trauma. Clinical case: A 60-year-old male patient with an autolytic attempt by firearm, with loss of tissue at the mandibular level, as well as airway compromise. Results: The different stages of the surgical action were achieved during the first four hours since the incident occurred. The patient was discharged without the need for a new surgical procedure. Discussion: Currently there is e tendency to perform definitive treatment in a single initial surgical procedure. Conclusión: The immediate and protocolized intervention of specialties such as General Surgery, Maxillofacial and Plastic-Reconstructive Surgery in patients with avulsive wounds of the cervical-facial region can achieve a definitive treatment in a single surgical time and with favorable results.

Cambios en la vía aérea después de cirugía ortognática bimaxilar / Airway change after bimaxillary orthognathic surgery

RESUMEN: La cirugía ortognática se realiza en sujetos con algún tipo de alteración esqueletal. Los movimientos maxilo mandibulares tienen impacto en la vía aérea (VA) y este aspecto se debe incorporar en la planificación quirúrgica. El objetivo de esta investigación fue determinar los cambios generados en la VA después de realizada la cirugía ortognática. Se realizó un estudio piloto incluyendo 51 sujetos con deformidad facial de clase II y clase III; se incluyeron en base al estudio del ángulo ANB y el tipo de oclusión dentaria. Se realizaron estudios con tomografía de haz cónico identificando el volumen máximo en la vía área y las áreas mínimas y máximas; además se incluyó la posición del hueso hioide y la inclinación del plano mandibular para relacionar con la morfología de la VA; para definir significancia estadística se estableció un valor de p<0,05 incluyendo las pruebas T de student y T test. Los resultados indicaron que los sujetos clase II aumentaron significativamente el volumen y áreas máximas y mínimas de la VA; los sujetos de clase III esqueletal no presentaron diferencias significativas entre la etapa pre y post quirúrgica; el hueso hioides se presentó significativamente más anterior en ambos en casos de clase II y clase III. Es posible concluir que la VA mejora sustancialmente en sujetos con clase esqueletal facial tipo II y que se mantiene sin cambios en sujetos con clase facial tipo III.

SUMMARY: Orthognathic surgery is performed in subjects with some type of skeletal alteration. Maxillomandibular movements have an impact on the airway (AW) and this aspect must be included into surgical planning. The aim of this research is to determine the changes in the AW after orthognathic surgery. A pilot study was conducted including 51 subjects with class II and class III facial deformity; they were included using the ANB angle and the type of dental occlusion. Cone beam computed tomography were performed showing the maximum volume in the airway and the minimum and maximum areas; in addition, the position of the hyoid bone and the angle of the mandibular plane were included to relate it to the morphology of the AW; to define statistical significance, a value of p<0.05 was established, including the student's t-test and the t-test. The results showed that class II subjects significantly increased the volume and maximum and minimum areas of the AW; skeletal class III subjects did not presented significant differences between the pre- and post-surgical stage; the hyoid bone was in an anterior position in both class II and class III cases. It is possible to conclude that AW improves substantially in subjects with facial class II and remains unchanged in subjects with facial class III.

Correlation between cortical bone thickness at mini-implant insertion sites and age of patient

ABSTRACT Introduction: Orthodontic mini-implants (MI) are a reliable alternative to provide temporary orthodontic anchorage. Prior to miniscrew insertion, the best approach would be to evaluate each possible insertion site and measure the cortical bone thickness, and verify whether it would provide adequate primary stability. Objective: This study aimed to evaluate the difference in cortical bone thickness in areas of mini-implants insertion in patients of different ages, by means of cone beam computed tomography (CBCT). Methods: The sample of this retrospective study was composed of 123 CBCT scans, which were used to measure cortical bone thickness in the buccal and palatal inter-radicular space in the mesial region of the first permanent molars. These measures were compared by using the Student's t-test, ANOVA/Tukey tests, and Linear regression between male and female subjects, from 12 to 30 years old. Results: No significant difference was found in cortical bone thickness between sex, race and sagittal facial patterns. Significantly higher measurement values were observed in patients older than 12 years of age at all sites evaluated. The coefficient β at the adjusted linear regression analysis showed that at each increment in age, mean cortical thickness values increased by 0.06mm in the mandible, 0.03mm in the buccal region and 0.02mm in the palatal region of the maxilla. Conclusions: The increase in cortical bone thickness was positively associated with age; that is, the more advanced the patient's age was, the less chance there was of failure due to primary stability.

RESUMO Introdução: Os mini-implantes ortodônticos (MI) são uma alternativa confiável para fornecer ancoragem esquelética temporária. Antes da inserção do mini-implante, a melhor abordagem seria avaliar cada local de inserção possível, medir a espessura do osso cortical e verificar se proporcionaria uma adequada estabilidade primária. Objetivo: O presente estudo teve como objetivo avaliar a diferença na espessura do osso cortical em áreas de inserção dos mini-implantes em pacientes de diferentes idades, por meio da tomografia computadorizada de feixe cônico. Métodos: A amostra desse estudo retrospectivo foi composta por 123 tomografias computadorizadas de feixe cônico, que foram utilizadas para medir a espessura do osso cortical nos espaços inter-radiculares vestibular e palatino na região mesial dos primeiros molares permanentes. Essas medidas foram comparadas por meio dos testes t de Student, ANOVA/Tukey e regressão linear entre os sexos masculino e feminino, de 12 a 30 anos. Resultados: Não houve diferença estatisticamente significativa na espessura cortical, quando comparados sexo, cor da pele e padrão facial sagital. Foram verificadas medidas significativamente maiores em pacientes com idade superior a 12 anos em todos os sítios avaliados. O coeficiente β da análise de regressão linear ajustada mostrou que, a cada incremento da idade, os valores médios da espessura cortical aumentaram 0,06 mm na mandíbula, 0,03 mm na região vestibular e 0,02 mm na região palatina da maxila. Conclusão: O aumento da espessura do osso cortical teve associação positiva com a idade, ou seja, quanto mais avançada a idade do paciente, menor a chance de falha, devido à estabilidade primária.

Evaluating the risk factors of inferior alveolar nerve injury following removal of the mandibular third molars / 中华口腔医学杂志

Objective: To evaluate the risk factors of inferior alveolar nerve injury (IANI) after surgical removal of the mandibular third molars (M3) and present a new risk scoring system to predict the probability of IANI. Methods: Patients who underwent extraction of M3 in the Stomatology Hospital, Zhejiang University School of Medicine from April 2017 to December 2019 were involved. The investigators enrolled a sample composed of 949 mandibular third molars. Prediction model was used for univariate and multivariate analysis of gender, age, M3, inferior alveolar canal (IAC), and the contact between M3 and IAC, to assess the risk factors of IANI. Combined with the risk factors determined by the outcomes of prediction model, the risk scoring system was constructed. The diagnostic performance of each cut-off score was examined to conduct a risk stratification of IANI risk scores. The predictive ability and reliability of the model were evaluated. Results: In prediction model, twenty nine cases (4.4%, 29/664) experienced postoperative IANI. Number of root (P<0.01), depth of impaction (P<0.05), contact between M3 and IAC (P<0.01) and their contact position (P<0.05) were statistically significant as contributing risk factors of IANI. Specifically, the incidence of temporary IANI was higher in those who aged under 25 years (P<0.001), while female suffer more permanent injury (P<0.05). Based on the IANI risk scoring system, patients were stratified into low-risk, middle-risk and high-risk groups at cutoff scores of 3 and 4. The area under the receiver operator characteristic curve of the risk scoring system were 0.81 [95%CI (0.70-0.90), P=0.002] and 0.80 [95%CI (0.68-0.92), P=0.007] towards good discrimination. Conclusions: Age, gender, number of root, depth of impaction, and contact between M3 and IAC were risk factors of IANI. IANI risk scoring system might help in preoperative assessment, recognition of high-risk cases and decision-making to reduce IANI.

A hierarchical vascularized engineered bone inspired by intramembranous ossification for mandibular regeneration / 国际口腔科学杂志·英文版

Mandibular defects caused by injuries, tumors, and infections are common and can severely affect mandibular function and the patient's appearance. However, mandible reconstruction with a mandibular bionic structure remains challenging. Inspired by the process of intramembranous ossification in mandibular development, a hierarchical vascularized engineered bone consisting of angiogenesis and osteogenesis modules has been produced. Moreover, the hierarchical vascular network and bone structure generated by these hierarchical vascularized engineered bone modules match the particular anatomical structure of the mandible. The ultra-tough polyion complex has been used as the basic scaffold for hierarchical vascularized engineered bone for ensuring better reconstruction of mandible function. According to the results of in vivo experiments, the bone regenerated using hierarchical vascularized engineered bone is similar to the natural mandibular bone in terms of morphology and genomics. The sonic hedgehog signaling pathway is specifically activated in hierarchical vascularized engineered bone, indicating that the new bone in hierarchical vascularized engineered bone underwent a process of intramembranous ossification identical to that of mandible development. Thus, hierarchical vascularized engineered bone has a high potential for clinical application in mandibular defect reconstruction. Moreover, the concept based on developmental processes and bionic structures provides an effective strategy for tissue regeneration.

Constructions of the scale of difficulty in the extraction of impacted mandibular third molars by using Delphi method / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the relevant indicators affecting difficulty in the extraction of impacted mandibular third molars and score difficulty of different operation and risk indicators, so as to build an intuitive and accurate scale to help operators make more accurate analysis and prediction of difficulty before the operation.@*METHODS@#Based on literature and the clinical review, the difficulty indicators of tooth extraction were summarized. Firstly, 10 doctors from Peking University School and Hospital of Stomatology who had been engaged in alveolar surgery for a long time established an expert nominal group, and then rated whether the summarized indicators needed to be retained in the form of face-to-face questionnaires. A level 1 and 2 item frame for evaluating difficulty in the tooth extraction was formed after discussion; Then Delphi method was used to send a questionnaire to 30 experts by e-mail. After two rounds of scoring and modification, the scale of difficulty in the extraction of impacted mandibular third molars was formed.@*RESULTS@#The recycling rate of two rounds of questionnaires was 100.0%, which showed that the experts were very enthusiastic about the study; The authority coefficients (Cr) of the two rounds of Delphi expert consultation were both 0.92, which showed that the results were representative and authoritative. After two rounds of grading and revision, the variable coefficient (CV) decreased and the Kendall's concordance coefficient (W) increased, which were statistically significant: In the first round, the CV was 0.24 and W was 0.56 (P < 0.001), and in the second, the CV was 0.19 and W was 0.72 (P < 0.001), which indicated that there was a good convergence among the expert opinions. Finally, a scale of difficulty in the tooth extraction containing 12 items at level A and 37 items at level B was formed, including operation difficulty indicators, risk difficulty indicators and common difficulty indicators.@*CONCLUSION@#Based on comprehensive literature retrieval, the study has put forward the concept that difficulty in the extraction of impacted mandibular third molars is composed of operation difficulty and risk difficulty. Using Delphi method, the long-term clinical experience and professional knowledge of experts are transformed into quantitative indicators as a scoring scale. The scale has certain representativeness and authority.

Una nueva alternativa para la localización y la recuperación de agujas fracturadas durante la anestesia odontológica. Presentación de técnica y caso clínico / A new alternative for locating and removing a needle fractured during dental anesthesia. Technique and case report

Objetivo: Describir en un caso clínico una nueva técni- ca para la localización y la remoción de agujas fracturadas du- rante la anestesia odontológica mediante planificación virtual. Caso clínico: Una paciente de género femenino de 52 años de edad concurre a la Cátedra de Cirugía y Traumatolo- gía Bucomaxilofacial I de la Facultad de Odontología de la Universidad de Buenos Aires y relata que dos meses atrás, durante la atención odontológica, se produjo la fractura de la aguja durante la anestesia troncular mandibular. Se realiza diagnóstico y planificación virtual para conocer la ubicación exacta de la aguja y se confecciona un modelo estereolito- gráfico y una guía quirúrgica individualizada para removerla. El uso de una guía quirúrgica individualizada y confeccio- nada mediante planificación virtual permitió ubicar la aguja tridimensionalmente y con mayor precisión en espacios pro- fundos y disminuir tiempos operatorios (AU)

Aim: To describe in a clinical case a new virtual plan- ning technique for locating and removing a fractured dental anesthetic needle. Clinical case: A 52-year-old patient visited the De- partment of Oral and Maxillofacial Surgery I (School of Dentistry, University of Buenos Aires) with a retained den- tal needle in the pterygomandibular space. The needle had fractured during inferior alveolar nerve block two months previously. Virtual diagnosis and planning were performed to locate the needle and a stereolithographic model and a customized surgical guide were prepared. The use of cus- tomized surgical guides prepared by virtual planning ena- bled precise location of the dental needle in deep spaces and reduced operating times (AU)

Resección transoral de la apófisis estiloides por síndrome de Eagle: caso clínico / Transoral resection of the stiloyd process for Eagle síndrome: case report

El síndrome de Eagle está caracterizado por una elongación o una curvatura medial excesiva de la apófisis estiloides o por una calcificación del ligamento estilohioideo que puede provocar dolor cervicofacial o síntomas neurológicos por la compresión de los vasos o nervios del cuello. El tratamiento más eficaz es el quirúrgico y consiste en la resección de la apófisis estiloides; puede ser realizado por vía externa o mediante un abordaje transoral. Se describe el caso clínico de un paciente con síndrome de Eagle que fue tratado con éxito mediante un abordaje transoral, sin amigdalectomía y con asistencia de endoscopios. (AU)

Eagle syndrome is characterized by an elongation or excessive medial curvature of the styloid process or calcification of the stylohyoid ligament that can cause cervicofacial pain or neurological symptoms due to compression of the vessels or nerves of the neck. The most effective treatment is surgical and consists of resection of the styloid process, it can be performed by externally or through a transoral approach.The clinical case of a patient with Eagle syndrome who was successfully treated by a transoral approach, without tonsillectomy and with the assistance of endoscopes, is described. (AU)

Acesso extraoral para tratamento cirúrgico de fratura de mandíbula atrófica: relato de caso / Extraoral access for surgical treatment of atrophic jaw fracture: case report

Introdução: Por sua posição na face, a mandíbula é frequentemente atingida pelos traumas, surgindo em algumas estatísticas como o osso fraturado com maior incidência em face. Em fraturas de mandíbulas atróficas o tratamento conservador, com fixação intermaxilar não costuma ser uma opção viável pela falta de dentes e pequena área de contato ósseo existente. Dessa forma, a redução aberta e fixação interna estável tem sido o tratamento de escolha sempre que a condição do paciente permitir. Objetivo: relatar um caso de osteossíntese de fratura de mandíbula atrófica por acesso extraoral. Relato de caso: Paciente 64 anos, faioderma, sexo feminino, procurou o serviço de Cirurgia e Traumatologia Bucomaxilofacial da Universidade Federal da Bahia apresentando traumatismo facial por queda da própria altura, referindo severas queixas álgicas espontâneas em região mandibular. Ao exame físico notou-se edentulismo total em ambas as arcadas, edema, hematoma e degrau ósseo á palpação em região de corpo de mandíbula a direita, alémde mobilidade atípica a manipulação da mandíbula. Ao exame de imagem notou-se sinais de fratura em corpo mandibular direito e côndilo esquerdo. O tratamento instituído foiconservador para a fratura de côndilo e cirúrgico para a fratura de corpo, o acesso foi extraoral ea fixação rígida foi realizada com placa e parafusos dos dispositivos Load-Bearing. Considerações finais: A paciente não apresentou quaisquer déficits funcionais pós-procedimento cirúrgico, sendo o tratamento abertocom fixação interna estável bastante promissor por restabelecer a união de focos fraturados e deslocados, proporcionando estabilidade da fratura e conforto imediato para a paciente(AU)

Introduction: Due to its position on the face, the jaw is frequently affected by trauma, appearing in some statistics as the fractured bone with a higher incidence in the face. In fractures of atrophic jaws, conservative treatment, with intermaxillary fixation, is not usually a viable option due to the lack of teeth and small area of existing bone contact. Thus, open reduction and stable internal fixation have been the treatment of choice whenever the patient's condition permits. Objective: to report a case of osteosynthesis of atrophic mandible fracture through extraoral access. Case report: Patient 64-year-old, female, sought the service of Maxillofacial Surgery and Traumatology at the Federal University of Bahia presenting facial trauma due to falling from his own height, referring to severe spontaneous pain complaints in the mandibular region. On physical examination, total edentulism was noted in both arches, edema, hematoma and bone step on palpation in the right jaw body region, in addition to atypical mobility in the jaw manipulation. On imaging examination, signs of fracture were noted in the right mandibular body and left condyle. The treatment instituted was conservative for condyle fracture and surgical for body fracture, access was extraoral and rigid fixation was performed with plate and screws of the Load-Bearing devices. Final considerations: The patient did not presente any functional deficits after the surgical procedure, and the open treatment with stable internal fixation is very promising for restoring the union of fractured and displaced foci, providing fracture stability and immediate comfort for the patient(AU)

Perfil dos casos de traumas bucomaxilofaciais de vítimas de violência interpessoal atendidas em um hospital de referência do Nordeste / Profile of bucomaxillofacial trauma cases of interpersonal violence victims treated in a reference hospital of the Northeast

A violência interpessoal tem se configurado como um grave problema social e de saúde pública, em que lesões na região bucomaxilofacial são importantes consequências. O objetivo desse estudo foi analisar o perfil das vítimas de violência interpessoal que tiveram lesões na região maxilofacial e foram atendidas no hospital da Restauração em Recife, Pernambuco-Brasil durante o ano de 2017. Foi realizada uma pesquisa retrospectiva e exploratória baseada nas informações contidas nos prontuários do hospital e em seguida foi utilizado o software Statistical Package for the Social Sciences (SPSS) para análise das medidas descritivas. No período de um ano foram encontrados 455 prontuários, de forma que 87,9% corresponderam ao sexo masculino e 12,1% ao feminino. Do total, 34,9% tinham idade entre 20-29 anos e 43,3% foram vítimas de força corporal/espancamento. O tipo de trauma mais frequente foi fratura dos ossos maxilofaciais (45,3%). Outrossim, o dia e horário mais comum de atendimento foi o domingo (23,1%) no período noturno (58,2%). Homens jovens com traumas dos ossos maxilofaciais foi o principal perfil encontrado no estudo, sendo necessário o fortalecimento de políticas públicas a fim de evitar o aumento de casos nessa população... (AU)

Interpersonal violence has been configured as a serious social and public health problem in which injuries on the maxillofacial region are important consequences. This study aimed to analyze the profile of interpersonal violence victims who had maxillofacial injuries and were treated at Hospital Da Restauração in Recife, Pernambuco-Brazil during 2017. A retrospective and exploratory research was conducted based on information from the medical records of the hospital and then the Statistical Package for the Social Sciences (SPSS) Software was used for descriptive measures analysis. In the period of one year, 455 medical records were found, in which 87,9% corresponded to male and 12,1% to female. Of the total, 34,9% were aged between 20-29 years old and 43,3% were victims of physical strength/beating. The most frequent type of trauma was fracture of the maxillofacial bones (45,3%). Otherwise, the most common day and time of treatment at the hospital was on Sundays (23,1%) and in the evening (58,2%). Young men with trauma on the maxillofacial bones was the main profile found in this study, requiring the strengthening of public policies to avoid the increase in cases in this population... (AU)

Evolución hacia la era digital de la cirugía ortognática: experiencia en un centro universitario / Evolution towards the digital era of orthognatic surgery: experience in a university center

Resumen Introducción: La incorporación de tecnologías en la práctica quirúrgica, ha cambiado la forma de enfrentar el proceso quirúrgico. Objetivo: Describir la experiencia de los últimos 9 años, en cirugía ortognática, con la incorporación de la cefalometría 3D. Materiales y Método: Se realizó una revisión retrospectiva de pacientes operados de cirugía ortognática durante el período enero de 2011 a agosto de 2018. Se registraron datos demográficos, quirúrgicos, tipo de planificación quirúrgica, complicaciones y resultados a largo plazo. Resultados: 21 pacientes requirieron cirugías ortognáticas. Se realizaron 16 cirugías bimaxilares (76%), 3 cirugías de avance maxilar superior (14%) y 2 cirugías de osteotomía sagital de rama (10%). Las principales etiologías fueron: 67% maloclusión clase III (n = 14), 28% maloclusión clase II (n = 6) y 5% desviación mandibular (n = 1). La planificación prequirúrgica virtual fue utilizada en 11 pacientes (52%). La tasa de complicaciones Clavien-Dindo > III fue 4,8% (n = 1). Conclusiones: En nuestra experiencia, las técnicas de cirugía ortognática son seguras. Las complicaciones de la serie fueron escasas y bien toleradas por los pacientes. Durante los últimos años y, de acuerdo a los avances tecnológicos, la incorporación de la planificación quirúrgica virtual 3D favoreció el desarrollo de la cirugía ortognática en nuestro centro.

Introduction: Technological advances have been incorporated into cranio-maxillo-facial surgery changing the clinical practice of surgeons. Aim: The aim of this article is to describe our experience in orthognatic surgery in the last 9-years, with the incorporation of 3D cephalometry. Materials and Method: A retrospective chart review was performed from January 2011 to August 2018 on patients undergoing Orthognatic Surgery. Demographic and surgical data, type of surgical planning, complications and long-term results were recorded. Results: A total of 21 patients underwent orthognatic surgery. Average age was 28 years (DE 8.1), 11 men (52.3%) and 10 women (47.61%). The principal surgeries performed were: 16 (76%) bimaxillary, 3 maxillary advancement surgery 3 (14%) and bilateral sagital split osteotomy 2 (10%). Ethiologies were: 14 patients (this 67%) with malocclusion class III, 6 patients (28%) with malocussion class II, and 1 patient (5%) with mandibular deviation. Virtual 3D presurgical planning was used in 11 patients (52%). The total of complications Clavien-Dindo > III was 4.8% (n = 1). None patient required reoperation. Satisfaction rate with the procedure was high. Conclusions: Based on our experience, orthognatic surgery techniques are safe. The complication rate was lower and well tolerated by patients. The introduction of virtual planning provided a better scenario to develop maxillo-facial surgery.

Ameloblastoma em região anterior de mandíbula / Ameloblastoma anterior de la mandíbula / Anterior mandibular ameloblastoma

Introdução: O ameloblastoma é uma neoplasia benigna, mas localmente invasiva, geralmente diagnosticada na quarta e quinta décadas, com relação à localização em 80 porcento dos casos, o tumor está na mandíbula e 20 porcento na maxila. É classificada histopatologicamente como células foliculares, plexiformes, acantomatosas, granulares e basais. O ameloblastoma desmoplásico foi reclassificado como subtipo histológico. Radiograficamente, pode ser mostrado de maneira unicística ou multicística, onde geralmente é descrito como favos de mel ou bolhas de sabão. Objetivo: O objetivo deste trabalho é relatar um caso de ameloblastoma com características clínicas e de imagem incomuns, enfatizando a importância diagnóstico correto como estratégia para garantir tratamento adequado e melhor prognóstico da doença. Apresentação do caso: Paciente branca, 72 anos, moradora da cidade de Itabaiana-Sergipe, queixou-se do aumento de volume na região da mandíbula anterior de desenvolvimento lento. Ela foi encaminhada ao do Campus do Hospital Universitário Prof. João Cardoso Nascimento, Aracaju / Sergipe. A tomografia computadorizada mostrou uma área multilocular hipodensa, localizada na região anterior da mandíbula, e uma biópsia incisional realizada juntamente com exames de imagem, o seguinte diagnóstico de ameloblastoma folicular foi concluído com uma extensa área de degeneração cística. Decidiu-se realizar uma cirurgia para remover completamente a lesão em centro cirurgico, formou-se uma extensa aloja ossea, por isso foi decidido aplicar em sua extensão a solução de Carnoy. Conclusões: Este relato é altamente relevante por apresentar um caso que contradiz os fatos existentes e aumenta a importância de se fazer um diagnóstico correto, é importante enfatizar que, embora o comportamento das lesões que afetam a cavidade oral seja bem conhecido, é extremamente importante estuda-las(AU)

Introducción: El ameloblastoma es una neoplasia benigna pero localmente invasiva, generalmente diagnosticada en las décadas cuarta y quinta. En el 80 por ciento de los casos el tumor está localizado en la mandíbula y el 20 por ciento, en el maxilar. Se clasifica histopatológicamente en folicular, plexiforme, acantomatoso, células granulares y células basales. El ameloblastoma desmoplásico se ha reclasificado como un subtipo histológico. Radiográficamente se puede mostrar de forma unicista o multiquística, donde generalmente se describe como panales o pompas de jabón. Objetivo: Describir un caso de ameloblastoma con características clínicas y de imagen poco comunes. Presentación del caso: Paciente blanca, de 72 años, que vivía en la ciudad de Itabaiana-Sergipe, se quejó del aumento de volumen (de desarrollo lento) en la región de la mandíbula anterior. La tomografía computarizada mostró un área hipodensa, multilocular, ubicada en la región mandibular anterior. Se realizó una biopsia incisional, además de los exámenes por imágenes. Se diagnosticó ameloblastoma folicular con un área extensa de degeneración quística. Se decidió realizar una cirugía de extirpación completa de la lesión, luego de la extracción de la misma se formó un alojamiento óseo circular, por lo que se decidió aplicar la solución de Carnoy. Conclusiones: Este informe tiene una gran relevancia porque presenta un caso que contradice los hechos existentes y plantea la importancia de hacer un diagnóstico correcto. Aunque el comportamiento de las lesiones que afectan la cavidad oral es bien conocido, es extremadamente importante continuar estudiándolas(AU)

Introduction: Ameloblastoma is a benign but locally invasive neoplasm generally diagnosed in the fourth and fifth decades of life. Its location is the mandible in 80 percent of the cases and the maxilla in 20 percent. Histopathologically, it may be classified as follicular, plexiform, acanthomatous, granular cells or basal cells. Desmoplastic ameloblastoma has been further classified as a histological subtype. Radiographically, it presents as either unicystic or multicystic, in which case it resembles a honeycomb or soap bubbles. Objective: Describe a case of ameloblastoma with uncommon clinical and imaging characteristics. Case presentation: A white female 72-year-old patient from the city of Itabaiana, Sergipe, presented with increased volume (of slow development) in her anterior mandibular region. Computed tomography revealed a hypodense, multiloculated area in the anterior mandibular region. Incisional biopsy and imaging tests were performed. The diagnosis was follicular ameloblastoma with a broad area of cystic degeneration. It was decided to perform total excision of the lesion. A circular bone housing was formed, which was treated with Carney's solution. Conclusions: The present report is of great relevance, since a case is described which contradicts the existing facts and points to the importance of making a correct diagnosis. Although the behavior of oral cavity lesions is well known, it is extremely important to continue to study them(AU)

Assessment of the quality of life of mandibular ameloblastoma patients after reconstruction with double-barrel fibula flap / 中华耳鼻咽喉头颈外科杂志

Objective: To analyse the quality of life of patients receiving repair of bone defect with folded fibula flap after removal of mandibular ameloblastoma. Methods: The case data of 39 patients with ameloblastoma admitted to the First Affiliated Hospital of Zhengzhou University from August 2013 to April 2016 were retrospectively analysed, including 21 males and 18 females, from 18 to 58 years old. 3D printing and digital technology were used in flap preparation before surgery in all patients. The folded fibular flaps were used to repair mandibular defects and the implants were placed between 6-9 months after surgery. The short form-36 health survey questionnaire (SF-36) and the university of Washington quality of life questionnaire (UW-QOL) were applied to evaluate the quality of life of patients before surgery and at 6 months and 24 months after surgery. The higher the score, the better the condition. SPSS 20.0 was adopted for statistical analysis. Results: The SF-36 survey showed that the mean score of body role before surgery (72.4±11.7) was significantly higher than that at 6 months after surgery (39.6±11.1, t=23.580, P<0.05) or that at 24 months after surgery (59.8±6.4, t=8.358, P<0.001). Compared with the preoperative mean scores of Physical Pain (73.0±11.0), General Health (73.4±10.4) and Health Changes (79.2±3.9) before surgery, the mean scores Physical Pain (53.1±7.7), General Health (53.5±7.5) and Health Changes (63.9±11.7) at 6 months after surgery were decreased significantly respectively (t=13.068, 13.756 and 10.880, respectively, all P<0.05), but the mean scores Physical Pain (78.8±14.0), General Health (80.9±12.6) and Health Changes (84.4±4.6) at 24 months after surgery were increased significantly respectively (t=-2.904, -4.027 and -7.586, respectively, all P<0.05), with significant differences in the mean scores of Physical Pain, General Health and Health Changes between 6 and 24 months after surgery (t=-14.241, -16.490, -14.294, respectively, all P<0.001). The UW-QOL survey showed that the mean scores of chewing, language and taste functions decreased at 6 months after surgery (53.1±6.7, 53.0±7.7 and 62.2±9.9, respectively), but improved at 24 months after surgery (67.9±3.9, 63.9±2.9 and 68.4±11.1, respectively), with statistically significant difference (t=-16.765, -11.675 and 2.498, respectively, all P<0.001). Conclusion: The application of folded fibula flaps to repair bone defects after sugery of mandibular ameloblastoma can better meet the needs of language and chewing functions and improve the quality of life of patients.

Classification of Patients by Occlusal Condition

ABSTRACT Objective: To propose a classification of patients by occlusal condition and its apparent validation. Material and Methods: This cross-sectional analytical study was divided into two phases. In the first, a trained examiner divided the patients into four groups according to the proposed classification of this design: Type 1 patient - completely dentate individuals; Type 2 - partially edentulous individuals with occlusal stability; Type 3 - partially edentulous individuals with no occlusal stability; Type 4 - completely edentulous individuals. In this phase, 122 patients were analyzed with an instrument developed for this experiment. Results: All patients in the sample of this research were classified in some division of the proposed instrument. In the second phase, the apparent validation of the classification was conducted by three judges, who obtained an excellent agreement with the allocation of patients in one of the types according to the indication of the first examiner (Kappa = 85%). Conclusion: It is evident that the classification presents reliability, ease of visualization, good conditions for interprofessional communication, and it can be used in dental clinical practice to assist in the study and integrated planning of clinical cases.