Systematic mapping review of interventions to prevent blood loss, infection and relapse in orthognathic surgery.

BACKGROUND: This systematic mapping review aims to identify, describe, and organize the currently available evidence in systematic reviews (SR) and primary studies regarding orthognathic surgery (OS) co-interventions and surgical modalities, focusing on the outcomes blood loss, infection and relapse. MATERIAL AND METHODS: A comprehensive search strategy was performed to identify all SRs, randomized controlled trials and observational studies that evaluate surgical modalities and perioperative co-interventions in OS that evaluate the outcomes blood loss, infection and relapse, regardless of language or publication date. Searches were conducted in MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. In addition, grey literature was screened. RESULTS: 27 SRs and 150 primary studies fulfilled the inclusion criteria, 91 from SRs, and 59 from our search strategy. Overall, the quality of the SRs was graded as "Critically low," and only two SRs were rated as "High" quality. 11 PICO questions were extracted from SRs and 31 from primary studies, which focused on osteosynthesis methods, surgical cutting devices, use of antibiotics, and induced hypotension. In addition, evidence bubble maps for each outcome were created to analyze in a visual manner the existing evidence. CONCLUSIONS: Future primary and secondary high-quality research should be addressed focused on the eight knowledge gaps identified in this mapping review. We concluded that the evidence mapping approach is a practical methodology for organizing the current evidence and identifying knowledge gaps in OS, helping to reduce research waste and canalize future efforts in developing studies for unsolved questions.

Effect of antibiotic prophylaxis for preventing infectious complications following impacted mandibular third molar surgery. A randomized controlled trial.

BACKGROUND: The objective of this study was to determine the effect of antibiotic prophylaxis in preventing postoperative infections after extraction of impacted mandibular third molars. MATERIAL AND METHODS: A Parallel-group, randomized, blind, placebo-controlled trial was performed. 154 patients were randomly allocated to 2 groups; experimental (n=77) receiving 2g amoxicillin 1 hour prior to surgery and control (n=77) receiving placebo. Primary outcome was postoperative infections and secondary outcome was the need for rescue analgesia. RESULTS: 4.5% of patients developed postoperative infections, five patients of the control group (4 alveolar osteitis, 1 surgical site infection) and two of the experimental group (1 alveolar osteitis, 1 surgical site infection). Difference between groups was not statistically significant, RR=0.4 (95%CI 0.08-1.99, 𝘱=0.41) NNTB=26. Rescue analgesia intake was significantly higher in the control group (41 vs 18 patients of experimental group) RR=0.49 (95%CI 0.32-0.75, 𝘱<0.05) NNTB=3. CONCLUSIONS: The use of 2g amoxicillin 1 hour before surgery was not effective in significantly reducing the risk of postoperative infections from impacted mandibular third molars extraction, when compared to placebo. Nevertheless, antibiotic prophylaxis was associated with a reduced need for rescue analgesia.

Antiplatelet therapy in patients undergoing oral surgery: A systematic review and meta-analysis.

BACKGROUND: The number of patients under antiplatelet therapy (APT) continues to raise as current recommendations foster this practice. Although some recommendations to manage this treatment during oral surgery procedures exist, these have methodological shortcomings that preclude them from being conclusive. MATERIAL AND METHODS: A systematic review and meta-analysis of the best current evidence was carried out; The Cochrane Library, EMBASE and MEDLINE databases were searched for Randomized Controlled Trials (RCT) concerning patients undergoing oral surgery with APT, other relevant sources were searched manually. RESULTS: 5 RCTs met the Inclusion criteria. No clear tendency was observed (RR= 0.97 CI 95%: 0,41-2,34; p=0,09; I2= 51%), moreover, they weren't clinically significant. CONCLUSIONS: According to these findings and as bleeding is a manageable complication it seems unreasonable to undermine the APT, putting the patient in danger of a thrombotic event and its high inherent morbidity, which isn't comparable in severity and manageability to the former."

[Somatosensory trigeminal evoked potentials after gingival stimulation of the mental nerve. Normal values]. / Potenciales evocados somatosensoriales trigeminales tras la estimulación eléctrica gingival del nervio mentoniano. Valores normales.

OBJECTIVE: Somatosensory evoked potentials were recorded following unilateral stimulation of the mental nerve in the gum of 100 healthy volunteers aged between 17 and 22 years. METHODS AND RESULTS: Responses were recorded until 100 ms with electrodes placed over the scalp (C5/C6) referenced to central frontal (Fz). In 10 subjects, simultaneous recordings were made in masticatory and facial muscles to detect possible muscle artefacts. Stimulation was effected using a specially-designed stimulator adaptable to each individual. Contralateral responses consisted of four very constant deflexions (N12, P19, N26 and P35) forming a W-shaped complex of mean duration 31.27 ms. Tables of normality were compiled for latencies and amplitudes with confidence intervals of 99.8% reliability. Constancy of deflexions, stability of response (by serial studies), and possible sexual differences were also studied. Muscle artefacts were ruled out, and the participation of the mental nerve in the genesis of the responses was confirmed. CONCLUSION: We consider the proposed method a reliable alternative to other procedures used to obtain TEPs.

Tratamiento quirúrgico o conservador para fracturas de cóndilo mandibular / Surgical or conservative treatment for mandibular condyle fractures

INTRODUCCIÓN: Las fracturas maxilofaciales se asocian a importante morbilidad, pérdida de función y secuelas estéticas, entre otros. Dentro de las fracturas mandibulares, las fracturas de cóndilo mandibular son las más frecuentes. Estas pueden ser tratadas mediante un tratamiento quirúrgico (reducción abierta más estabilización con miniplacas de titanio) o un tratamiento conservador (ortopédico). MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyen 66 estudios primarios, de los cuales, seis corresponden a ensayos aleatorizados. Concluimos que, en comparación con el tratamiento conservador, el tratamiento quirúrgico en fracturas de cóndilo mandibular probablemente se asocia a menor dolor articular, menor maloclusión y menor desviación lateral en apertura bucal.

INTRODUCTION: Maxillofacial fractures are associated with significant morbidity, loss of function and aesthetic sequelae, among others. Within mandibular fractures, mandibular condylar fractures are the most frequent. These can be treated by surgical treatment or conservative treatment (orthopedic). METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including 66 primary studies overall, of which six were randomized trials. We concluded surgical treatment of mandibular condyle fractures, compared to conservative treatment, is probably associated with less joint pain, less malocclusion and less lateral deviation in buccal opening.

[Central lipoma of the mandible. A new case]. / Lipome central de la mandibule. Une nouvelle observation.

Lipomas are benign neoplasms affecting many organs of the body with adipose tissue. As a bone central lesion they represent less than 1% of all lipomas. In the literature lipomas are reported in different bones: calcaneum, ribs, fibula, phalanges, ulna, frontal and parietal bone. In the jaws 8 cases have been reported, most of them representing radiographic findings the clinician diagnosing cyst or tumor, specially odontogenic tumor. No preference has been reported for any gender, age or race but the condition appears after the fourth decade. We report a case of central lipoma in the mandible with the clinical, radiological and histopathological findings and discuss its origin.

[Ultrasonography: a complement to sialography in recurrent chronic childhood parotitis]. / L'échographie: un complément à la sialographie dans les parotidites récurrentes chroniques infantiles.

The objective of this research is to compare the ultrasonographic (USG) and sialographic contributions for the diagnosis of Recurrent Parotitis in Childhood (RPC). Bilateral USG of the parotid gland was performed among 16 children with RPC and 16 healthy children. The image of the normal parotid glands was compared with the image of the parotid gland with RPC. A pathologic USG pattern for RPC was obtained which consisted in a homogeneous, micronodular parenchyme with a diffuse increase density, sometimes with multiples hypoechogenous areas, that were considered solid hypoechogenous nodules suggesting inflammatory nodes. A glandular contour finely granulated was described with normal peri-parotidareas and with aponeurotic-muscular planes. Then 16 USG of the parotid gland of the children with RPC were compared with 16 Sialography previous obtained. The possibilities of diagnosis of the disease with both techniques was not different (p > 0.05). When the clinic was correlated with the USG it was possible to obtain parameters of severity of the glandular damage and to visualise the degree of changes of the parenchyma of each child with RPC. In some cases, bilateral damage was observed in children with clinical unilateral symptoms. The USG was performed in children in the acute phase of disease, visualising the microabscess in the gland and confirming the previous diagnosis. Finally, it was possible to conclude the utility of USG in the study of the disease. Being a not invasive exam, harmless, unpainfully echography, was easily accepted by the child. Also, we obtain information not only about the diagnosis of the disease, but also about the severity, prognosis, treatment and follow-up of the infant patients.

Successful treatment of antimony-resistant visceral leishmaniasis with liposomal amphotericin B in patients infected with human immunodeficiency virus.

We describe two cases of visceral leishmaniasis in patients infected with human immunodeficiency virus (HIV); both cases were resistant to antimony compounds but were cured with liposomal amphotericin B, with no significant toxicity. A review of the previous reported cases of antimony-resistant visceral leishmaniasis in HIV-infected patients confirmed the effectiveness of treatment with liposomal amphotericin B, which directly targets infected macrophages and reaches high levels in plasma and tissue.

Inhibition of ectopic calcification of glutaraldehyde crosslinked collagen and collagenous tissues by a covalently bound diphosphonate (APD).

Calcification of collagen-derived prosthesis, such as glutaraldehyde crosslinked porcine heart valves or heart valves assembled out of bovine pericardium, presents a major clinical problem. Their subcutaneous implantation into young rats provides us with a reproducible method of assessing this form of ectopic calcification. Long-term implantation is essential, since some materials which do not calcify within the first month frequently exhibit a delayed calcific response. Crosslinked pericardium is much more likely to calcify than crosslinked tendon or reconstituted crosslinked pepsin extracted bovine type I collagen. The covalent binding of a diphosphonate to collagen and collagen-rich tissues can prevent calcification. The binding of this diphosphonate and its ability to inhibit calcification can be enhanced by increasing the number of amino groups on the collagen molecule. The degree of calcification is inversely related to the number of diphosphonate molecules covalently bound to collagen. Under standard conditions, chemical modifications appear to occur primarily on the surface of the collagen fibrils, as evidenced by the relationship between the number of molecules of APD bound and fibril diameter. The bound diphosphonate seems to interfere with crystal growth and prevent the formation of highly insoluble hydroxyapatite on the surface and interstices of the collagen fibrils.

An examination of factors affecting the instability of Saccharomyces cerevisiae glucan synthetase in cell free extracts.

Yeast beta(1--3) glucan synthetase is stimulated and stabilized by EDTA. Sucrose protects the enzyme from self-inactivation. Preincubation of cell free extracts at low sucrose concentrations indicates a slow transition of the enzyme towards dissociation. Transition kinetics at 30 degrees C and 0 degrees C in the presence and in the absence of sucrose are interpreted assuming that a subunit is thermolabile in the free state and that sucrose increases its stability. Magnesium is deleterous for glucan synthetase in cell-free extracts. Chaotropic agents inactivate glucan synthetase according to their capacity to solubilize and depolymerize biological compounds. Fluoride plays a special role in the activation of glucan synthetase. Its action appears to be dependent on the presence of GTP (or other nucleotides). The role of all these agents on the activity and stability of the enzyme is interpreted in a unified scheme.

Purification and characterization of a phenoloxidase (laccase) from the lignin-degrading basidiomycete PM1 (CECT 2971).

A new lignin-degrading basidiomycete, strain PM1 (= CECT 2971), was isolated from the wastewater of a paper factory. The major ligninolytic activity detected in the basidiomycete PM1 culture supernatant was a phenoloxidase (laccase). This activity was produced constitutively in defined or complex media and appeared as two protein bands in native gel electrophoresis preparations. No enzyme induction was found after treatment with certain potential laccase inducers. Laccase I was purified to homogeneity by gel filtration chromatography, anion-exchange chromatography, and hydrophobicity chromatography. The enzyme is a monomeric glycoprotein containing 6.5% carbohydrate and having a molecular weight of 64,000. It has an isoelectric point of 3.6, it is stable in a pH range from 3 to 9, and its optimum pH is 4.5. The laccase optimal reaction temperature is 80 degrees C, the laccase is stable for 1 h at 60 degrees C, and its activity increases with temperature. Spectroscopic analysis revealed that the enzyme has four bound copper atoms, a type I copper, a type II copper, and a type III binuclear copper. The amino-terminal sequence of the protein is very similar to the amino-terminal sequences of laccases from Coriolus hirsutus and Phlebia radiata.

Beta-glucanases in the yeast Cryptococcus albidus var. aerius. Production and separation of beta-glucanases in asynchronous cultures.

beta-Glucanases were detected in cell-free extracts of the yeast Cryptococcus albidus var. aerius when grown on glucose as the sole carbon source. The production of beta-glucanases was followed in log-phase cells and stationary-phase cells; the maximal production of beta-(1 leads to 3) and beta-(1 leads to 6) glucanases takes place respectively in log-phase and stationary-phase cells. The results show that there are marked differences in the elution profiles on Sephadex G-50 of fractions containing beta-glucanase from cells grown for 12, 24, 48, 72, and 96 h. The possibility either of replacement changes in fractions containing beta-glucanase activity or of a different synthesis of each beta-glucanase during the growth of the yeast is discussed. The results suggest that all fractions containing beta-glucanases hydrolyze both beta-(1 leads to 3) and beta-(1 leads to 6) linkages. Evidence in support of the conclusion that a low molecular form of beta-glucanase has a molecular weight of 2100 +/- 100 is also shown.