Evaluation of Influence of Arthroscopy on the Range of Mandibular Movements Based on Medical Records.

The Temporomandibular Joint Dysfunction Syndrome (TJDS) is a group of pathologies that affect the temporomandibular joint, mastication muscles, and attached structures, 1 of the leading causes of orofacial pain. Arthroscopy is a technique used as a method of treatment for TJSD. This was a retrospective cohort study, and data were collected from the medical records of patients with TJDS. The diagnosis of TJDS was established based on computed tomography and nuclear magnetic resonance imaging tests, and clinical examination. All patients, who underwent arthroscopy, were operated on by the same surgeon in 2020. The variables analyzed in this study were: maximum mouth opening, laterality, and protrusion of patients undergoing arthroscopy at time intervals of 30, 90 days, and 6 months after surgery. Data from anamnesis of the medical records and findings on clinical examination were used to verify whether there was any correlation with good postoperative evolution. Afterward, these data were compared and submitted to statistical analysis (Wilcoxon (nonparametric and paired) and Mann-Whitney (nonparametric, unpaired) tests) to verify the degree of correlation between them. It could be concluded that in this sample, arthroscopy reduced the degree of pain in patients, increased mouth opening amplitude, and did not influence laterality and protrusion. The use of previous medication was correlated with a slight decrease in postoperative pain; patients who had undergone previous orthodontic treatment showed better results regarding maximum mouth opening without pain; patients who had previously felt pain on professional palpation had greater maximum mouth opening with and without pain after arthroscopy, and patients with noise at professional auscultation had greater maximum mouth opening without pain. Further studies should be conducted, with larger samples, associated with complementary exams (computed tomography and nuclear magnetic resonance) before and after arthroscopy.

Importância das selfies para a identificação humana ­ relato de quatro casos periciais / Importance of selfies for human identification - four forensic case reports

A identificação humana é realizada por impressões digitais, prontuários odontológicos ou DNA. No entanto, nem sempre todos os processos estão disponíveis. No contexto da Odontologia Legal, o perito precisa estar atento nos casos em que há ausência de documentação odontológica, para buscar outros parâmetros que possam servir na identificação da pessoa desaparecida. Os sorrisos de pessoas desaparecidas em fotografias presentes nas redes sociais enviadas pela família podem ser analisados e utilizados para fins de identificação. O presente estudo relatou quatro casos nos quais foram utilizadas selfies postadas nas redes sociais de pessoas desaparecidas como subsídio para uma identificação humana positiva. A reprodutibilidade da posição do sorriso na fotografia AM foi um fator limitante devido ao posicionamento aleatório do operador que promove alterações na posição da cabeça e do braço, mas que não impediu a identificação das vítimas uma vez que características odontológicas individualizadoras foram evidenciadas nos exames AM e PM. O uso de selfies como fonte de informação para a identificação odontológica constitui técnica útil, vantajosa, confiável e de baixo custo, pois é acessível para todos os contextos sociais e econômicos

Human identification is performed by fingerprints, dental records or DNA. However, not all processes are always available. In the context of Forensic Dentistry, the expert needs to be alert in cases where there is no dental documentation, to look for other parameters that can serve in the identification of the missing person. The smiles of missing persons in photographs on social media sent by the family can be analyzed and used for identification purposes. The present study reported four cases in which selfies posted on social networks of missing persons were used as a subsidy for positive human identification. The reproducibility of the smile position in the AM photograph was a limiting factor due to the random positioning of the operator, which promotes changes in the position of the head and arm, but which did not prevent the identification of victims, since individualizing dental characteristics were evidenced in the AM and PM The use of selfies as a source of information for dental identification is a useful, advantageous, reliable and low-cost technique, as it is accessible to all social and economic contexts

Evaluation of the accuracy of virtual planning in bimaxillary orthognathic surgery: a systematic review.

The purpose of this research was to evaluate the accuracy of virtual planning in bimaxillary orthognathic surgery in bone by comparing the mean linear and angular measurements of the surgical plan with the actual surgical result. Electronic databases, MEDLINE via PubMed, Web of Science, SCOPUS, the Cochrane Library, grey literature, and the American clinical trials registry (www.ClinicalTrials.gov), were accessed as search engines. The studies consisted of publications on the assessment of accuracy in virtual planning in bimaxillary orthognathic surgery between 2010 and 2020. After application of the eligibility criteria, 26 articles were included, and their quality was evaluated using the methodological index for non-randomised studies (MINORS) tool and Cohen's kappa statistic in the MedCalc program (MedCalc Software Ltd). Evidence obtained by comparing the planning and surgical results, both in the maxilla and mandible, showed that there is great accuracy in virtual planning in bimaxillary orthognathic surgery.

Identificação humana pela Odontologia Legal no Instituto Médico Legal de Roraima (2014-18) / Human identification by Forensic Dentistry at Legal Medical Institute of Roraima (2014-18)

Objetivo: Trata-se de um estudo retrospectivo observacional transversal cujo objetivo foi realizar um levantamento das necropsias de corpos não identificados (íntegros, putrefeitos, esqueletizados, carbonizados ou segmentados) pela papiloscopia e odontologia legal entre o período de 2014 e 2018 no Instituto Médico Legal de Roraima. Material e método: Foi determinado o tipo de identificação: método primário (papiloscopia) ou secundário (odontologia legal); a causa jurídica da morte; a condição do corpo e o método mais utilizado para confronto. Resultados e Conclusão: 95,0% dos corpos com identidade desconhecida foram identificados pela odontologia; em 2018 a causa jurídica de morte com maior frequência foi o homicídio (54,3%), seguida dos acidentes de trânsito (18,3%) e; o prontuário odontológico ainda foi o método mais utilizado para confronto

Aim: This is a retrospective observational cross-sectional study whose objective was perform a research of unidentified bodies necropsies (integrate putrefied, skeletonized, carbonized or segmented) by papiloscopy and legal dentistry from 2014 to 2018 at Roraima Medical Legal Institute. Materials and Methods: Identification type was determined: primary method (papilloscopy) or secondary method (legal dentistry); the legal cause of death; body conditions and the most used method for confrontation. Results and Conclusion: 95.0% bodies with unknown identity were identified by dentistry; in 2018, the most frequent legal cause of death was homicide (54.3%), followed by traffic accidents (18.3%) and dental record was still the most used method for comparison

Dolphin software accuracy in soft tissue facial profile prediction of Class II patients in orthognathic surgery / Precisão de software Dolphin na predição do perfil facial de tecidos moles de pacientes Classe II submetidos a cirurgia ortognática

ABSTRACT Objective: The present study aimed to analyze the accuracy of the Dolphin Imaging 11.9® computer program in the surgical prediction of the soft tissue facial profile. Methods: The investigators designed and implemented a retrospective study. It was used a sample of 55 patients, being 14 males and 41 females, aged from 19 to 55 years old. All patients were subjected to surgery orthognathic bimaxillary combined with mentoplasty, in Class II facial profile - Angle. Patients' actual results were compared to the obtained up to a year and a half after the surgery procedure. The study was delineated in three phases. In the first phase, cephalometric preoperative radiographs were performed; in the second phase the postoperative cephalometries were made; in the third phase, the measurements of the soft profile of the virtual analysis were compared with the real post-surgical profile. The data was collected and subjected to statistical analysis in the "R" program, using the t test and ANOVA. Results: The results demonstrated that measures A' and Eis were underestimated in -0.15 ± 0. 52 mm and -0.47 ± 1.05 mm, respectively, while measures Pg' and ANL were overestimated at 0.76 ± 1.98 mm and 3.31 ± 3.60° respectively. There was no evidence of measures, Ls, Li and B', being different between real and virtual. Conclusions: The results of this study suggest that Dolphin 11.9® computer program complies with the function of preserving with reliability virtual surgical planning.

RESUMO Objetivo: O presente estudo teve como objetivo analisar a precisão do programa de computador Dolphin Imaging 11.9® na predição cirúrgica do perfil facial dos tecidos moles. Métodos: Os pesquisadores projetaram e implementaram um estudo retrospectivo. Utilizou-se uma amostra de 55 pacientes, sendo 14 do sexo masculino e 41 do sexo feminino, com idades entre 19 e 55 anos. Todos os pacientes foram submetidos à cirurgia ortognática bimaxilar combinada com mentoplastia, no perfil facial Classe II de Angle. Os resultados reais dos pacientes foram comparados com os obtidos até um ano e meio após o procedimento cirúrgico. O estudo foi delineado em três fases. Na primeira fase, foram realizadas radiografias cefalométricas pré-operatórias; na segunda fase, foram realizadas cefalometrias pós-operatórias; na terceira fase, as medidas do perfil mole da análise virtual foram comparadas com o perfil pós-cirúrgico real. Os dados foram coletados e submetidos à análise estatística no programa "R", utilizando o teste t e ANOVA. Resultados: Os resultados demonstraram que as medidas A 'e Eis foram subestimadas em -0,15 ± 0, 52 mm e -0,47 ± 1,05 mm, respectivamente; enquanto as medidas Pg' e ANL foram superestimadas em 0,76 ± 1,98 mm e 3,31 ± 3,60°, respectivamente. Não houve evidência de medidas, Ls, Li e B', sendo diferentes entre real e virtual. Conclusão: Os resultados deste estudo sugerem que o programa de computador Dolphin 11.9® cumpre a função de preservar com confiabilidade o planejamento cirúrgico virtual.

Craniofacial injuries by firearms projectiles: An analysis of 868 deaths in the five regions of Brazil.

Firearms injuries have a legal and medico-legal importance, and are especially lethal when they reach the craniofacial regions of the victim. The present study aims to identify the characteristics of craniofacial lesions resulting from firearm projectiles, to register the most affected craniofacial regions by this type of injury and to verify the demographic profile of the victims. A retrospective study was carried out on the autopsy records produced in the first semester of 2015, in five Institutes of Legal Medicine in Porto Velho, situated in the cities of João Pessoa, Vitória, Porto Alegre and Brasília. Data extracted included sex, skin color and age of the victim, craniofacial region reached, shooting distance, shape and size of the injuries and manner of death (homicide, suicide or accident). Based on the 868 reports analyzed, it was possible to observe 1700 entrance lesions of firearm projectiles in craniofacial regions. Among cases of known manner of death, homicides were the most frequent (97.0%). It was observed a higher frequency of male victims (93.3%), mixed race (62.0%), between the ages of 12 and 29 years (59.4%). In all cases considered as suicide or accident there was only one entrance wound, but in 82.8% of the homicides there were multiple gunshot wounds. The craniofacial most affected regions were temporal (25.2%) and occipital (19.8%). The most common sites of projectiles exit were the temporal (25.3%) and parietal (16.1%). All cases of suicide were related to contact shot (69.2%) or close-range shot (30.8%), and among the homicides the distant range shots were more frequent (54.0%). The shape of entrance wounds was mostly circular (56.8%) and oval (31.3%), and among the exit injuries, the lesions were irregular (43.3%) and starry (24.1%). The entrance wounds showed smaller sizes than the exit lesions (p < 0.0001). The data obtained are useful for guiding research that takes into account craniofacial trauma caused by firearm projectiles, makes it possible to compare this data with those of other countries and can base investigative conclusions based on the analyzes discussed in the present work.

Application and validation of Diagnose Sexuelle Probabiliste V2 tool in a miscegenated population.

The hip bone (os coxae) is the skeletal element that presents the greatest level of sexual dimorphism. Therefore, methods involving the analysis of the os coxae provide the most accurate sex estimation, and DSP2 (Diagnose Sexuelle Probabiliste v.2) is one of the most accurate tools used in this identification. The goal of this study is to apply and validate DSP2 in the identification of 103 os coxae (53 male and 50 female) belonging to a Brazilian-identified skeletal collection. Differences between sexes were statistically significant for all measurements, except for the acetabulo-symphyseal and spino-auricular lengths. From the 103 os coxae analyzed, there was a 9.43% error in male individuals and a 14% error in females. The results revealed that DSP2 can be applied to Brazilian-mixed populations with a good index of accuracy, although at a lower accuracy than other population samples. This study also clearly demonstrates that metric variation of the os coxae is extremely useful in sex estimation and reinforces the notion that pelvic sexual dimorphism is not population-specific.

Computational Approach to Identify Different Injuries by Firearms.

Complications arise in the analysis of gunshot wounds to the maxillofacial region, when neither the projectile nor the gun is found at the crime scene. We simulated 5- and 15-cm firing distances at a human mandible to investigate the external morphology of entrance wounds based on fire range. The ammunition models, .40-caliber S&W, .380-caliber, and 9 × 19-mm Luger, were constructed with free-form NURBS surfaces. In a dynamic simulation, projectiles were fired against mandibular body 3D model at 5 and 15 cm. All entrance wounds presented oval aspect. Maximum diameter and von Mises stress values were 16.5 mm and 50.8 MPa, both for .40-caliber S&W fired at 5 cm. The maximum energy loss was 138.4 J for .40 S&W fired at 15 cm. In conclusion, the mandible was most affected by .40-caliber S&W and morphological differences were observable in holes caused by different incoming projectile calibers fired at different distances.

Analysis of the frontal sinus morphology and the titanium plates shape in skull fracture for human identification / Análisis de la morfología del seno frontal y la forma de la placa de titanio en fractura de cráneo para la identificación humana

Human identification can be performed by several methods, as anatomical structures of the facial skeletal and individuals signals. The aim of this study was to report a case of human identification from the morphological evaluation of the frontal sinus and the presence of titanium plates in skull after examination of Postero Anterior (PA) radiographs ante and postmortem. In 2008 a skull was found on a highway. Later, an alleged victim was found , who disappeared in late 2007. The skull showed postmortem teeth lost, presence of round hole in the right supra-orbital region, consistent with lesion caused by gunshot. It was also noted the presence of a miniplate of bone fixation in the form of inverted "T" in several locations of the nasal bones and bone remodeling signals in the face. PA radiograph of the skull was performed for the purpose of comparison with the X-rays provided by antemortem family. By overlapping radiographic images, there was similarity between the characteristics presented by the skull and found the alleged victim, as the frontal sinus, shape and height of the orbits, and miniplate fixation of bone with the same shape and size, not leaving no doubt that the radiographs belong to the same individual.

La identificación humana puede realizarse por varios métodos, entre ellos a partir de estructuras anatómicas del esqueleto facial y del reconocimiento de señales individuales. El objetivo de este estudio fue reportar un caso de identificación humana mediante la evaluación morfológica del seno frontal y la presencia de placas de titanio en el cráneo después del examen con radiografías posteroanteriores (PA) ante y post mortem. En 2008, se encontró un cráneo en una carretera. Más tarde, se encontró una presunta víctima, que desapareció a finales de 2007. El cráneo mostró dientes perdidos post mortem, la presencia de un orificio redondeado en la región supraorbital derecha, en consonancia con lesiones causadas por arma de fuego. También se observó la presencia de una miniplaca de fijación ósea en forma de "T" invertida en varios lugares de los huesos nasales y señales de remodelación ósea en la cara. La radiografía posteroanterior del cráneo se realizó con el propósito de comparación con los rayos X antemortem proporcionados por la familia. Por superposición de imágenes radiográficas, hubo similitud entre las características que presentó el cráneo y las de la presunta víctima, ya que el seno frontal, la forma y la altura de las órbitas, y la fijación de la miniplaca de hueso presentaron la misma forma y tamaño, no dejando ninguna duda de que las radiografías pertenecían a la misma persona.

Risks and complications in surgically assisted rapid maxillary expansion / Riscos e intercorrências na expansão rápida de maxila cirurgicamente assistida

Rapid maxillary expansion is generally contra-indicated in patients with incomplete bone formation, and is only used as an alternative in those with advanced skeletal age. In young patients, Haas and Hyrax expanders are indicated and are chosen according to requirements. In adults, an application of orthodontic-surgical techniques allows correction of transversal and other deformities, offering very acceptable and predictable results while increasing the maxillary arch perimeter to correct the posterior crossbite. However, there have been reports of related complications, such as significant hemorrhage, gingival recession, root resorption, devitalization of teeth, sinus infection, oculomotor nerve paralysis, and orbital compartment syndrome. Maxillofacial surgeons should be aware of such possible complications and that patients are fully informed. This study reviews available literature and presents a case of surgical treatment, with the aim of reviewing complications occurring during the orthognathic surgery for opening the midpalatal suture.

A expansão rápida da maxila cirurgicamente assistida é contra-indicada, na maioria dos casos, em pacientes com maturidade óssea incompleta,sendo indicada apenas àqueles pacientes com idade óssea avançada. A cirurgia aumenta o perímetro do arco maxilar, corrigindo as mordidas cruzadas. Nos pacientes jovens, são usados aparelhos expansores do tipo Haas e Hyrax, escolhidos de acordo com as necessidades de cadapaciente. Nos adultos, as aplicações das técnicas ortodôntico-cirúrgicas, possibilitam a correção de deformidades transversais, com uma previsibilidade bastante aceitável e, com poucos relatos de complicações. Complicações como hemorragia significativa , recessão gengival, reabsorção radicular, desvitalização de dentes, sinusite, paralisia do nervo oculomotor, e síndrome do compartimento orbital foram descritas.Cirurgiões maxilofaciais devem estar cientes de tais complicações e que os pacientes devem estar plenamente informados. Este estudo, revisa aliteratura disponível e apresenta um caso de tratamento cirúrgico, com a finalidade de, expor as possíveis complicações da cirurgia ortognática.