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.

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.

Atividade anti-inflamatória, cicatrizan1te e antimicrobiana do extrato aquoso de aroeira-do-sertão a 20% (myracrodruon urundeuva fr. All.), aplicado em fraturas expostas induzidas em mandíbula de coelho / Anti-inflammatory, healing and antimicrobial properties of a 20% aqueous extract of aroeira-do-sertão (myracrodruon urundeuva fr.all.) applied to induced exposed fractures in rabbit jaws

A aroeira-do-sertão (Myracroduon urundeuva Fr. All), árvore da família Anacardiácea, é conhecida pelo seu uso popular com atividades anti-inflamatórias e cicatrizantes. Diante dessas qualidades, foram analisadas suas atividades, utilizando-se um modelo experimental em fraturas expostas, induzidas em mandíbula de coelhos. Foram utilizados trinta coelhos, brancos, da raça Nova Zelândia, machos, com peso variando entre 1700 a 2100g, distribuídos em dois grupos de quinze animais. os coelhos foram submetidos a tratamento cirúrgico, sob anestesia geral, para a realização de fratura do corpo mandibular direito, ficando exposta para cavidade bucal por um período de quatro horas. em todos os animais, foi realizada a coleta do material do foco de fratura para análise microbiológica. os animais foram distribuídos ao acaso, conforme o tratamento proposto: no grupo I, foram utilizados 300 ml da solução de extrato aquoso de aroeira a 20% para irrigação do foco de fratura, durante 5 minutos. No grupo II, foi utilizado soro fisiológico a 0,9%, no mesmo volume e no mesmo tempo do grupo I, para irrigação do foco de fratura. em todos os animais, foi realizada a redução da fratura com fixação interna rígida, utilizando-se miniplacas de titânio do sistema 1,5 mm. Foram realizados controles radiográficos do pós-operatório dos 7, 14 e 30 dias para análise da consolidação da fratura. os grupos foram redistribuídos em subgrupos conforme o dia de eutanásia em SG7, SG14 e SG30, quando foi realizada a remoção do bloco ósseo da região operada para análise histológica por meio do método de coloração do Tricrômico de Masson. os animais foram analisados do ponto de vista clínico, radiológico e histológico. Na análise clínica, foi verificado o aspecto da ferida cirúrgica. o grupo I (aroeira) mostrou resultado pouco significante na cicatrização da ferida, quando comparado com o grupo II. No aspecto radiológico, o grupo tratado com aroeira não apresentou efeitos significativos quanto à consolidação. Do ponto de vista histológico, houve uma redução da concentração de bactérias no foco da fratura, no grupo tratado com aroeira. o extrato aquoso de aroeira a 20% não tem efeito significativo na consolidação óssea de fraturas expostas induzidas em mandíbula de coelhos, no entanto houve benefício na cicatrização da ferida e uma diminuição significativa das colônias bacterianas no foco das fraturas.

The aroeira-do-sertão (Myracrodruon urundeuva Fr.All), a tree of the Anacardiceae family, is known for its popular use as an anti-inflammatory agent, owing to its healing properties, representing a good therapeutic option. To investigate these properties we analyzed an experimental model, using induced exposed fractures in rabbit jaws. Thirty white New Zealand male rabbits weighing between 1,700 and 2,100 g, divided into two groups of fifteen animals each were used. The rabbits underwent a surgical procedure under general anesthesia to fracture their right mandibular body, which remained exposed to the oral cavity for 4 hours. Material from the fracture site was collected for microbiological analysis. The animals were randomly distributed according to the treatment proposed. In Group I, 300 ml of 20% aqueous extract of Myracrodruon urundeuva was used for the irrigation of the focus of the fracture for 5 minutes. In Group II, the same volume of 0.9% saline solution was used as in Group I. All animals underwent fracture reduction with internal rigid fixation using 1.5 mm titanium mini-plates. Before euthanasia, postoperative radiographs were taken at 7, 14, and 30 days in order to analyze the healing of the fractures, after which the bone fragment from the region operated on was removed for histological analysis using the Masson Tricromic method. The animals were analyzed from the clinical, radiological and histological perspectives. In the clinical analysis the appearance of the surgical would was examined. Group I (Myracrodruon urundeuva) showed little improvement in healing when compared to Group II. Radiographically, Group II presented no significant effects on bone healing. Histologically, a decrease in bacterial concentration in the fracture was seen in Group I. It was concluded that a 20% Myracrodruon urundeuva aqueous extract has no significant effect on the healing of induced exposed fractures of rabbit jaws, but shows benefits in wound healing, significantly reducing the colonies of bacteria at the fracture site.

Oxigenoterapia hiperbárica na abordagem cirúrgica de paciente irradiado / Hyperbaric oxygen therapy in the surgical approach to an irradiated patient

Câncer é a terminologia dada a um conjunto de mais de cem doenças que têm em comum o crescimento desordenado de células. O tratamento do câncer pode ser feito através de cirurgia, radioterapia, quimioterapia ou transplante de medula óssea. Na região de cabeça e pescoço a radioterapia acarreta uma série de complicações no paciente, como a hipovascularização dos tecidos irradiados com reduzida demanda de oxigênio e células, havendo risco de ocorrer osteoradionecrose após a realização de exodontia, levando a necessidade de uma abordagem diferenciada desses pacientes. Das condutas terapêuticas adotadas para abordagem de pacientes irradiados, a oxigenoterapia hiperbárica é um recurso bem estabelecido, pois o princípio terapêutico dessa modalidade possibilita um adequando processo de reparação tecidual. Neste trabalho é relatado um caso clínico do uso da oxigenoterapia hiperbárica como procedimento adjuvante, antes e após exodontias múltiplas, numa paciente irradiada em região de cabeça e pescoço, obtendo-se sucesso com uma reparação cicatricial sem complicações.

Cancer is the terminology applied to a set of more than one hundred diseases that have disorderly cell growth in common. The treatment of cancer can be performed by surgery, radiotherapy, chemotherapy, or bone marrow transplant. In the region of the head and neck, radiotherapy results in a series of complications in the patient, such as hypovascularization of the irradiated tissues, with reduced demand of oxygen and cells, and there is risk of the occurrence of osteoradionecrosis after tooth extraction, leading to the need for a differentiated approach to these patients. Of the therapeutic conduct adopted in the approach to irradiated patients, hyperbaric oxygen therapy is a well established resource, as the therapeutic principle of this modality enables the restoration of an adequate process of tissue repair. In this study, a clinical case is related, of the use of hyperbaric oxygen therapy as an adjuvant procedure, before and after multiple tooth extractions, in a patient irradiated in the head and neck region, obtaining success with cicatricial repair without complications.

Fracture of the coronoid and pterygoid processes by firearms: case report.

A rare case of fracture of the coronoid and the pterygoid process caused by firearms is described. A 28-year-old male was hit by a bullet in the face, resulting in restricted mouth opening, difficulty in chewing and pain when opening the mouth. Clinical examination revealed a perforating wound in the right parotid region and a similar wound on the left side of the same region. A CT scan showed comminuted fracture of the left coronoid process and bilateral comminuted fracture of the pterygoid processes. Treatment was conservative, speech therapy was conducted and it was successful. Details of the clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.

Fracture of the coronoid and pterygoid processes by firearms: case report

A rare case of fracture of the coronoid and the pterygoid process caused by firearms is described. A 28-year-old male was hit by a bullet in the face, resulting in restricted mouth opening, difficulty in chewing and pain when opening the mouth. Clinical examination revealed a perforating wound in the right parotid region and a similar wound on the left side of the same region. A CT scan showed comminuted fracture of the left coronoid process and bilateral comminuted fracture of the pterygoid processes. Treatment was conservative, speech therapy was conducted and it was successful. Details of the clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.

Um caso raro de fratura dos processos coronóide e pterigóide por arma de fogo é descrito. Paciente do sexo masculino, 28 anos de idade, foi atingido por projétil de arma de fogo na face, resultando em limitação na abertura da boca, dificuldade para mastigar e dor ao abrir a boca. Exame clínico revelou ferimento perfurante em região parotídea direita e ferida similar do lado esquerdo na mesma região. Tomografia computadorizada (TC) mostrou fratura cominutiva do processo coronóide esquerdo e fratura cominutiva bilateral dos processo pterigóides. O tratamento foi conservador, através de fonoterapia, obtendo-se sucesso. Uma descrição detalhada das características clínicas, radiológicas (TC com reconstrução 3D), tratamento e proservação do caso é apresentada.

Estudo comparativo entre seringas com e sem refluxo: avaliação in vitro de aspirações positivas / Comparative study in syringes with and without reflux: in vitro evoluation of positive aspirations

Na prática da Odontologia os cirurgiões-dentistas nem sempre têm consciência da necessidade da aspiração antes de qualquer anestesia, sendo este procedimento o que poderá prevenir sinais e sintomas conseqüentes à injeção intravascular inadvertida. Nesta pesquisa buscou-se avaliar in vitro a eficácia das seringas: Carpule sem refluxo, Carpule com refluxo da marca Duflexri e Safety Plus da Septodont. A amostra foi composta de 300 injeções, divididas em três grupos com dois sub-grupos de 50 infiltrações cada (tubetes em vidro e plástico). Ambas as seringas Carpule com refluxo e Safety Plus tiveram um percentual de 100% de aspirações positivas para o tubete de vidro e, 96% e 72% com o tubete de plástico, respectivamente. Na seringa Carpule sem refluxo foi evidenciado 88% de aspirações positivas para o tubete de vidro e, 36% para o tubete de plástico. Concluímos que, a visualização do filete é mais nítida no tubete de vidro, devido a sua transparência, ao contrário do tubete de plástico, o qual é opaco e, ainda, a necessidade da existência no mercado nacional de um sistema de seringas com refluxo fidedigno, que nos dê 100% de aspiração positiva quando testadas in vitro independente do tipo de tubete utilizado.

In practical of the Dentistry the dentists nor always have conscience of the necessity of the aspiration before any anesthesia. This procedure will prevent consequent signals and symptoms of inadvertent intravascular injection. In this in vitro research we evaluated the effectiveness of the syringes: Carpule without reflux, Carpule with reflux (Duflex) and Safety Plus (Septodont). The sample was composed of 300 injections, divided in three groups with two sub-groups of 50 infiltrations each (tubetes in glass and plastic). Both the syringes Carpule with reflux and Safety Plus had a percentage of 100% of positive aspirations for anesthetic cartridge of glass and, 96% and 72% with tubete of plastic, respectively. In the Carpule syringe without reflux, 88% of positive aspirations for anesthetic cartridge of glass were evidenced and, 36% for tubete of plastic. We conclude that, the visualization of thin thread is clearer in anesthetic cartridges of glass, which had its transparency, in contrast of anesthetic cartridge of plastic,which is cloudy and, still, the necessity of the existence in the national market of a trustworthy system of syringes with reflux, that gives 100% of positive aspiration when tested in vitro.