Neuropathic pain following sagittal split ramus osteotomy of the mandible: prevalence, risk factors, and clinical course.

PURPOSE: To estimate the prevalence of, risk factors for, and clinical course of neuropathic pain (NPP) after sagittal split ramus osteotomy (SSRO) of the mandible in a large cohort of patients. MATERIALS AND METHODS: A retrospective cohort of all patients who underwent SSRO at 2 medical centers within Kaiser Permanente Northern California from January 2007 through September 2012 was assembled. Demographic, clinical, and surgical factors were abstracted from medical records and relevant comorbidities were identified. The prevalence of NPP in the cohort was calculated and the clinical signs, symptoms, temporal characteristics, and treatment response in affected patients were noted. RESULTS: The authors identified 1,778 patients who underwent SSRO and excluded 107 patients according to predefined criteria. The remaining 1,671 patients had a median age of 24 years (interquartile range, 19 to 35 yr) and 62.4% were women. Seven patients developed NPP after SSRO, which was an overall prevalence of 0.42%. All patients with NPP in this cohort were women and had a median age of 49 years. The risk factors for developing NPP after this surgery were older age (P = .0098), depression (P = .0100), and female gender. NPP developed an average of 30 days postoperatively (range, 18 to 56 days) and persisted for a median duration of 52 days (range, 30 to 69.5 days). All patients responded favorably to anticonvulsant (n = 6) or tricyclic (n = 1) medications, and no patients developed chronic postsurgical pain. CONCLUSIONS: NPP was an infrequent complication after SSRO, occurring in 1 of 238 patients in this cohort. The short duration and positive response to medication are reassuring findings. The results of this investigation highlight the need for prospective studies to further understand the spectrum of postoperative NPP.

Management of giant osteoma in the mandible associated with minor trauma: a case report.

BACKGROUND: Osteoma is a benign tumor of the bones, which can be classified as central or peripheral. The occurrence in the jawbones is uncommon, but when it occurs, there is a greater prevalence of the mandible. The etiology is still unknown, and the hypothesis of its development is debated. CASE PRESENTATION: A 35-year-old Caucasian man presenting a tumor lesion in the right jawbone that had been growing for 8 years sought medical service complaining of speaking impairment. According to the patient, the tumor appeared shortly after a minor trauma caused by tooth extraction. The diagnosis of the lesion was made through clinical, radiographic, and histological methods, and the surgical treatment was successful and satisfactory for the patient as well as the surgical team, despite a short follow-up. CONCLUSION: Etiopathogenesis of osteoma is not determined in the majority of cases. In the present report, it was possible to hypothesize the association between a minor trauma and the development of the tumor, reinforcing the reactive theory of tumor development. The uncommon location of the osteoma, as well the possibility of identifying the possible cause of the lesion, makes this case particularly interesting.

A 9-year retrospective study of dental trauma in Piracicaba and neighboring regions in the State of São Paulo, Brazil.

PURPOSE: The purpose of this study was to evaluate the occurrence of dentoalveolar trauma during a 9-year period in the Oral and Maxillofacial Surgery Division at Piracicaba Dental School, State University of Campinas in patients from the Piracicaba municipality and neighborhood regions in São Paulo, Brazil. PATIENTS AND METHODS: This retrospective epidemiologic study from January 1999 to December 2007 evaluated all patients who presented at the Oral and Maxillofacial Surgery Division at Piracicaba Dental School with sustained oral and maxillofacial traumatic injuries associated with dentoalveolar trauma. Information regarding age, gender, etiology, use of protective devices such seatbelts, crash helmets, and presence of facial fractures and general trauma, oral condition, stage of dentition, date of trauma, drug abuse, type, teeth affected, and classification of the trauma were gathered from the medical files. Descriptive analysis was conducted. RESULTS: In total, 2,785 patients were analyzed and 542 (19.46%) were included in this study. The male to female ratio was 2.81:1. Most patients presented with oral hygiene as regular (51.85%). Friday, Saturday, and Sunday were the most prevalent days. Smoking was the most common harmful habit analyzed (16.05%) followed by alcohol use (15.87%). Bicycle accidents (26.94%) were the most common cause, followed by falls (22.69%). With regard to protective devices, 31.51% of drivers were wearing seatbelts during the accidents and helmets were used by 84.38% of motorcycle drivers at the moment of injury. One hundred thirty-five facial fractures were associated with dental and dentoalveolar traumas, and the mandible was the facial bone most associated with dentoalveolar trauma. Upper and lower limbs were most frequently associated with general trauma, accounting for 140 (38.78%) and 111 (30.75%), respectively. CONCLUSION: This study shows that dentoalveolar trauma rates and patterns in the Piracicaba municipality and neighborhood regions in São Paulo are similar to other populations. The weekend is the period with the major incidence of dentoalveolar trauma. Alcohol consumption was linked with this type of trauma. Dentoalveolar trauma is involved in and closely related to severe maxillofacial trauma. The use of a helmet is as important as that of a seatbelt. More studies are necessary for a better knowledge and understanding when considering protocols and organization charts in emergency rooms.

Mechanical and microstructural properties of fixation systems used in oral and maxillofacial surgery.

OBJECTIVES: This paper aims to evaluate in vitro the mechanical and microstructural properties of internal fixation systems used in oral and maxillofacial surgeries. MATERIALS AND METHODS: Four brands of internal fixation systems (screws and 4-hole straight plates) were selected and assigned to four groups: G1 Leibinger®, G2 Tóride®, G3 Engimplan®, and G4 Medartis®. The systems were submitted to Vickers hardness testing, metallographic and interstitial elements chemical composition analyses. Data were submitted to ANOVA and Tukey's test for statistical analysis. RESULTS: Plates in groups 1, 2, and 3 showed similar microstructure and mechanical properties, different from those in G4 revealing larger grains. In all groups, the screws showed similar microstructure, with uniform arrangement and size of grains; the screws showed higher hardness values than those observed for the plates. CONCLUSIONS: The results indicate that all materials tested are adequate for use in oral maxillofacial surgeries.

Management of Ossifying Fibroma in a Suspicious Case of Hyperparathyroid-Jaw Tumor Syndrome.

The purpose of this article is to report a case of ossifying fibroma in the mandible associated with hyperparathyroid-jaw tumor syndrome, in a 46-year-old Caucasian female, surgically resected and reconstructed with iliac crest bone, followed by implant placement. This is a rare syndrome with an autosomal dominant pattern, with the development of primary hyperparathyroidism mainly due to parathyroid adenomas. Fibro-osseous lesions in the jaws can be present and can also precede the development of the endocrine disorder. As renal abnormalities and uterine tumors can develop, an interdisciplinary approach is imperative for its diagnosis and management, due to the possibility of recurrence and potential for malignancy.

Mechanical and photoelastic analysis of four different fixation methods for mandibular body fractures.

OBJECTIVE: The aim of the present study was to compare four methods of fixation in mandibular body fractures. STUDY DESIGN: Mechanical and photoelastic tests were performed using polyurethane and photoelastic resin mandibles, respectively. The study groups contained the following: (I), two miniplates of 2.0 mm; (II) one 2.0 mm plate and an Erich arch bar; (III) one 2.4 mm plate and an Erich arch bar, and (IV) one 2.0 mm plate and one 2.4 mm plate. The differences between the mean values were analyzed using Tukey's test, the Mann-Whitney test and the Bonferroni correction. RESULTS: Group II recorded the lowest resistance, followed by groups I, IV and III. The photoelastic test confirmed the increase of tension in group II. CONCLUSION: The 2.4 mm system board in linear mandibular body fractures provided more resistance and the use of only one 2.0 mm plate in the central area of the mandible created higher tension.

Mechanical and photoelastic analysis of conventional screws and cannulated screws for sagittal split osteotomy fixation: a comparative study.

PURPOSE: The aim of the present study was to use mechanical and photoelastic tests to compare the performance of cannulated screws with solid-core screws in sagittal split osteotomy fixation. METHODS: Ten polyurethane mandibles, with a prefabricated sagittal split ramus osteotomy, were fixed with an L inverted technique and allocated to each group as follows: cannulated screw group (CSG), fixed with three 2.3-cannulated screws; and solid-core screw group (SCSG), fixed with three 2.3-solid-core screws. Vertical linear loading tests were performed. The differences between mean values were analyzed through T test for independent samples. The photoelastic test was carried out using a polariscope. RESULTS: The results revealed differences between the two groups only at 1 mm of displacement, in which the cannulated-screw revealed more resistance. Photoelastic test showed higher stress concentration close to mandibular branch in the solid-core group. CONCLUSIONS: Cannulated screws performed better than solid-core ones in a mechanical test at 1-mm displacement and photoelastic tests.

Assessment of the fixation of mandibular symphysis fractures using conical cannulated screws: mechanical and photoelastic tests.

OBJECTIVE: The aim of this study was to use mechanical and photoelastic tests to compare the performance of cannulated screws with other fixation methods in mandibular symphysis fractures. STUDY DESIGN: Ten polyurethane mandibles were allocated to each group and fixed as follows: group PRP, 2 perpendicular miniplates; group PLL, 1 miniplate and 1 plate, parallel; and group CS, 2 cannulated screws. Vertical linear loading tests were performed. The differences between mean values were analyzed with the Tukey test. The photoelastic test was carried out using a polariscope. RESULTS: The results revealed differences between the CS and PRP groups at 1, 3, 5, and 10 millimeters of displacement. The photoelastic test confirmed higher stress concentration in all groups close to the mandibular base, whereas the CS group showed it throughout the region assessed. CONCLUSIONS: Conical cannulated screws performed well in mechanical and photoelastic tests.

Bilateral alloplastic prostheses for temporomandibular joint reconstruction in a patient with ankylosing spondylitis.

Ankylosing spondylitis (AS) or Bechterew disease is a chronic, usually progressive, systemic inflammatory joint disease, which predominantly affects the spine and sacroiliac joints. In these joints, early inflammatory changes are followed by lumbosacral pain and progressive restriction of spinal movement associated with radiologically visible intervertebral ossification. Peripheral joint involvement occurs in 10 to 30% of patients and shows a predilection for the shoulders, knees, ankles, feet, and wrists. Temporomandibular joint (TMJ) involvement has been described, and its reported frequency varies from 11 to 35%. However, ankylosis is uncommon with a single documented case utilizing an alloplastic prosthesis for total joint replacement. A case report of bilateral ankylosis of the jaw treated with alloplastic prostheses for total TMJ replacement using a Brazilian system in a patient with AS is presented.

Importance of occlusal plane reproduction on the semi-adjustable articulator in planning maxillary impactions for orthognathic surgery.

INTRODUCTION: The aim of this study was to evaluate whether a 6° counterclockwise change in occlusal plane inclination would produce significant modifications on the final result of a maxillary impaction and mandible advancement model surgery. MATERIALS AND METHODS: Four groups were used in this study, with ten identical maxillary casts and one mandibular cast mounted on the same semi-adjustable articulator, with the same malocclusion. The occlusal plane of the two control and study groups had an inclination of 13° and 7°, respectively. Preoperative and postoperative measures were performed using the Erickson platform and impactions of 6 and 10 mm were tested. To control these movements during model surgery, two splints were fabricated using another two maxillary and mandibular casts mounted with occlusal plane of 13°, simulating the proposed movement. RESULTS: The results were compared using the t test. Only the antero-posterior movement of the upper incisor was statistically significant for both study groups (p < 0.05), with a mean of 0.48 and 0.94 mm in the 10 and 6 mm impaction groups, respectively. DISCUSSION: This information means that if an error in the occlusal plane transference occur, it will not be clinically significant, because differences smaller than 1 mm does not have influence on soft and hard tissue final result.

Occurrence of dental avulsion and associated injuries in patients with facial trauma over a 9-year period.

INTRODUCTION: This retrospective study aimed to assess the occurrence of dental avulsions in patients with facial trauma over a 9-year period. MATERIALS AND METHODS: Data was collected from records of patients attended to at the Division of Oral and Maxillofacial Surgery at Piracicaba Dental School-State University of Campinas, Piracicaba (SP), Brazil. RESULTS: Two hundred three patients with 387 avulsed teeth were evaluated, the central incisors being the most common teeth involved (42 % of permanent and 61 % of primary teeth). Thirty-four percent of the cases occurred on weekends, mainly on Saturdays (20 %) and the distribution in relation to the time of year was similar with slight peaks in January. The most prevalent associated dentoalveolar injury was lateral luxation (26 %) and 19 % of the patients presented with an associated facial fracture. The most common sign presented was laceration (23 %), and the main symptoms found were pain (58 %). Associated general trauma was present in 139 patients (68 %), and the most prevalent was the upper limb (41 %). DISCUSSION: Special emphasis should be given not only to diagnosis and treatment of dental avulsion but for prevention, too. An understanding of the etiology, severity, and distribution of associated traumatic injuries can help for future studies and for an effective prevention of these injuries.

Complicação pós-cirúrgica por extração de dente incluso: abscesso retrofaríngeo ­ relato de caso / Postoperative complications due to inclusive tooth extraction: retropharyngeal abscess ­ case report

A extração do terceiro molar é um procedimento comum dentro da área cirúrgica da odontologia e, como todo procedimento dessa natureza, está sujeito a intercorrências e complicações como hemorragias, trismo e infecções. Os abscessos de origem odontogênica são casos comumente encontrados nos atendimentos de urgências odontológicas e quando bem tratados geralmente evoluem com melhora do quadro, porém essa infecção pode evoluir com disseminação para espaços faciais e cervicais, acarretando piora do quadro e podendo levar o paciente a óbito. O objetivo desse relato é descrever um caso clínico de abscesso retrofaríngeo, por origem de foco odontogênico, ressaltando suas particularidades e a importância do diagnóstico precoce para controle e resolução do caso. Conclui-se que é importante uma rápida intervenção e acompanhamento multidisciplinar em um serviço de referência estruturado e capaz de fazer evoluir o caso com suporte e segurança (AU).

Third molar extractions are frequent procedures within the surgical area of dentistry and, like any procedure of this nature, these extractions are susceptible to intercurrences and complications such as hemorrhages, trismus and infections. Abscesses of odontogenic origin are common in dental emergency services. When well treated, they usually evolve with improvement of the condition, but these infections can also evolve with dissemination to facial and cervical spaces, leading to condition worsening and even death. The objective of this report is to describe a clinical case of a retropharyngeal abscess of odontogenic origin, highlighting its particularities and the importance of early diagnosis for the control and resolution of the case. It was concluded that a rapid intervention and multidisciplinary follow-up is important in a structured reference service capable of evolving the case with support and security (AU).

Estudo comparativo da ação do formocresol e glutaraldeído pós-pulpotomia: revisão de literatura / Comparative study between formocresol and glutaraldehyde in pulpotomy: literature review

As exposições pulpares ocasionadas por lesões de cárie ou traumas, na dentição decídua, frequentemente resultam na necessidade de pulpotomia, compreendida pela remoção do tecido que preenche a câmara pulpar - ou seja, polpa coronária - e proteção do remanescente radicular com um medicamento. Tal procedimento conservador pulpar está indicado em dentes decíduos que se encontrem em fase inicial do processo de rizólise ou, idealmente, naqueles em que tal processo ainda não tenha se iniciado, além dos que apresentarem características inflamatórias reversíveis, requisito básico para a manutenção da vitalidade pulpar. A presente investigação teve por objetivo contribuir para a decisão terapêutica acerca do uso do formocresol ou glutaraldeído como agentes químicos nas pulpotomias de dentes decíduos. A conclusão é que tanto o formocresol como o glutaraldeído não são fármacos totalmente biocompatíveis, no entanto a pulpotomia seguida do uso do glutaraldeído sugere ser superior àquela com formocresol, pois apresenta menor índice de reações pulpares indesejáveis, quando usado a 2% por tempo igual a 5 minutos

The pulps exposures caused by caries lesions or trauma, in deciduous teeth, frequently result in pulpotomy. Pulpotomy is the removal of the tissue that fills the camera pulp ­ that is to say, coronary pulp ­ and also the protection of the remaining root pulp with medication. This conservative procedure is recommended to deciduous teeth in the initial phase of the root reabsorption process or ­ even better ­ when the process hasn't occurred yet. Besides, they present reversible inflammatory characteristics, basic requirement to maintain the pulp vitality. The present study aims at determining if one should make therapeutic use of the formocresol or glutaraldehyde as chemical agents in the pulpotomy of deciduous teeth. The conclusion is that the formocresol as well as the glutaraldehyde are not totally innocuous materials. However, the pulpotomy with glutaraldehyde seems to present better results than that one, because it presents a lower rate of undesirable pulp reactions, when used at 2% for a 5-minute period.

Tratamento do granuloma central de células gigantes / Treatment of Central Giant Cell Granuloma

Com o objetivo de discutir as principais formas de tratamento do granuloma central de células gigantes(GCCG), foi realizada uma pesquisa nas bases de dados BBO, LILACS, Scielo (BIREME), Medline e Pubmed à procura de artigos científicos que trouxessem informações a respeito da administração de calcitonina, interferon e corticoesteróides no tratamento do GCCG. O GCCG é uma lesão proliferativa não-neoplásica, que tem sido reportada como a segunda lesão mais ocorrente nos ossos maxilares, logo após os cistos odontogênicos na mandíbula. Apresenta crescimento predominantemente lento, bem circunscrito e assintomático, sendo geralmente diagnosticado através de exame radiográfico de rotina. Essa patologia apresenta comportamento agressivo, expandindo corticais e apresentando considerável grau de recidiva. Os aspectos clínicos,radiográficos e histológicos não são patognomônicos, sendo a etiologia ainda muito discutida entre os autores.O tratamento de eleição para essa lesão é curetagem simples ou ressecção em bloco. No entanto, em pacientes adultos, jovens e crianças, principalmente quando portadores de lesões extensas, o efeito mutilante que esse tipo de tratamento pode acarretar deve ser levado em consideração. Nesses casos, uma extensa reconstrução para restabelecer a forma e a função é necessária. Há alternativa de tratamento não-cirúrgico, como injeções intralesionais de corticoesteróides, administração de interferon e calcitonina.

Avaliação das alterações sistêmicas de pacientes submetidos a exodontias de terceiros molares inferiores sob o efeito da Lidocaína a 2 por cento com adrenalina 1: 100.000 / Evaluation of system changes of patients submittes to lower third molar extration under the effect of Lidocaine 2 per cent with adrenaline 1: 100.000

Introdução: Este estudo teve por objetivo analisar o efeito da Lidocaína 2 por cento com adrenalina 1:100.000 (Alphacaine - DFL) sobre a pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), pressão arterial média (PAM), freqüência cardíaca (FC) e saturação de oxigênio (Sp02)' de pacientes jovens, saudáveis, classificados como ASA I com indicação de exodontia de terceiros molares inferiores. Material e Métodos - Foram avaliados 84 pacientes monitoriiados com oxímetro de pulso e aferição da pressão arterial em quatro instantes: exame clínico, pré-anestesia, pós-anestesia e após o procedimento cirúrgico. Resultados - Alterações sistêmicas estatisticamente significantes da PAS, PAD e FC, sendo positivas (aumento) para PAS e FC e negativa (diminuição) para PAD foram observadas. As variações da PAM e Sp02 não foram estatisticamente significantes (>0,05). Conclusão - A Lidocaína 2 por cento com adrenalina I: 100.000 é um anestésico local seguro quando respeitada a qualidade de fabricação da solução anestésica e individualização da dose para cada paciente.

Analgesia preemptiva em cirurgias de terceiros molares inferiores: estudo piloto / Preemptive analgesia in molar third surgery: a pilot study

Objetivo: Nesta pesquisa buscou-se avaliar, através de um estudo piloto, do tipo ensaio clínico aleatório, duplo-cego, de amostras pareadas, a eficácia da analgesia preemptiva da Nimesulida 100 mg em exodontias de terceiros molares inferiores bilaterais. Métodos: A amostra foi composta por 06 pacientes, que necessitavam exodontias de terceiros molares inferiores em ambos os lados homólogos, de forma que fizeram parte de dois conjuntos-amostra: um teste e um controle que receberam Nimesulida 100 mg e medicação placebo respectivamente, uma hora antes da cirurgia. A avaliação da dor pósy operatória imediatamente após a cirurgia e nos 07 dias de pós-operatórios foi realizada através da utilização da escala visual analógica (EVA). Resultados: As médias da dor foram correspondentemente mais elevadas quando o paciente utilizou Placebo do que a Nimesulida 100 mg; as médias diminuíram da avaliação inicial para a avaliação com 07 dias com pequenas oscilações entre os dias intermédios. Conclusões: Na análise do pós-operatório imediato, desta amostragem, a Nimesulida 100 mg foi mais eficaz no combate à dor no pós-operatório imediato, sinalizando efeito preemptivo desta medicação.

Purpose: The aim of this study was to evaluate the preemptive analgesia efficacy of Nimesulide 100 mg in bilateral lower third molar surgery by means of an analytical pilot study in the form of a randomized, double-blind, paired sample clinical trial. Methods: The study population consisted of 6 patients who needed removal of symmetrical lower third molar on the right and left sides. Patients were distributed in a two sample-set: one test and the other control, who were given Nimesulide 100 mg and placebo, respectively, one hour before each procedure. Postoperative pain was evaluated through a visual analog scale 01AS) in me immediate postoperative period and at 07 days. Results: Pain means were correspondingly higher when patients used Placebo rather than Nimesulide 100 mg on the immediately after surgery; means diminished between the initial evaluation and that made at 7 days with few oscilations in the intervining period. Conclusions: On analysis of the immediate postoperative period, Nimesulide 100 mg was more effecrive in alleviating imediate postoperative pain, thereby demonstrating the preemptive analgesia effect of this medication.