What are the Consequences of Incorrect Handling in the Treatment of Blunt-Cut Lip Injuries?

This study aimed report two cases of blunt-cut lip injury which occurred in postoperatory dehiscence. Patients were referred to the emergence attendance and the clinical examination revealed extensive laceration on the upper and lower lips of both patients, highly contaminated with asphalt residue. The affected regions were properly cleaned with saline and antiseptic solution, and, under local anesthesia, suturing was performed in layers in the muscle and oral mucosa region with 4-0 resorbable thread and in the skin region with 6-0 non-absorbable thread. Patients presented different levels of dehiscence on post-operatory evaluation. Thus, it was prescribed antibiotic and healing ointments for decontamination and improvement of the healing process. Third days post-operatory one of the patients presented a great healing of external lips and vermilion lip. However, the other patient presented aesthetic sequelae in the vermilion region of the lip, with a line of fibrosis and misalignment in the region, but not function sequelae. Thus, it was concluded that blunt injuries on the lip must strictly follow the established treatment protocols and must begin aiming for favorable results in the first intervention. Moreover, the postoperative care of the patient and the surgeon are as important as the procedure itself.

Management of Complications Related to Removal of the Buccal Fat Pad.

ABSTRACT: Removal of the buccal fat pad (BFP) is an important topic of discussion in the literature. Several studies have reported improvements in facial esthetics as a result of this technique. The BFP is close to vital structures, such as the facial nerve, parotid duct, and vessels. Injuries related to these structures may occur during the surgical procedure. This manuscript aimed to report and discuss 2 clinical cases of the complications after removal of the BFP. Besides the case presentation, a comprehensive review of the literature was also provided. The reported cases were 2 patients aged 31 and 38 years who were attended by the oral and maxillofacial surgery teams after a complication in the BFP surgery. The first case involved swelling due to Stensen's duct injury, and the second involved uncontrolled bleeding from the internal maxillary artery. Removal of the BFP must have precise indications. Complications may occur during or after surgery; hence, anatomical knowledge is fundamental to appropriate patient management.

Maxillary Alveolar Ridge Atrophy Reconstructed With Autogenous Bone Graft Harvested From the Proximal Ulna.

Atrophy of the alveolar ridge requires bone grafting at the implant site for rehabilitation of the masticatory function with dental implants. Despite the advances in the development of bone substitutes, autogenous bone graft remains the "criterion standard" because of its osteogenic, osteoinductive, osteoconductive potential, and non-immunogenic properties. However, harvesting of autogenous bone is not exempt from donor site morbidity. In this context, the use of autogenous bone derived from the proximal ulna might be a viable resource to obtain corticocancellous bone graft, as the harvesting from this donor site is associated with low morbidity. Thus, this article aimed to describe a case in which a maxillary sinus floor augmentation was performed by means of autogenous bone graft harvested from the proximal ulna, as the donor site. An appositional bone block graft harvested from the same region was used to augment the residual alveolar ridge. Clinically, healing proceeded uneventfully with no major complications. After 8 months, a proper amount of bone was found at the implant site, allowing a prosthetically driven implant insertion and subsequent implant-supported rehabilitation. Results were clinically and radiographically stable after a 3-year follow-up. The present case report suggested that proximal ulna as a donor site should be considered as a safe and reliable alternative for alveolar ridge augmentation. Besides the case presentation, a comprehensive review of the literature was also provided.

Short-Blunt Injury in Child Resulting From Pet Bite.

The frequency of accidents due to dog bite in children is high, and in the most cases, the child already knows the aggressor dog. Patient, 3 years, female, melanoderm, victim of pet dog attack on the right side of the face region. After the physical examination, conscious sedation was performed with the supplementation of oxygen by pediatrics and the suture by oral and maxillofacial surgeon, under local anesthesia with adrenergic vasoconstrictor, with internal points in the muscles using vicryl 4-0 and in the skin with 5-0 nylon; the lesser number of stitches were performed in the lower region of the wound, allowing spontaneous drainage spaces. The immediate wounds closure of dog bites on the face is safe, even in cases after several hours of the injury.

Cervicofacial Necrotizing Fasciitis and Drugs.

Necrotizing fasciitis (NF) is a devastating disease that typically affects immunocompromised patients, chronically debilitated patients or drug users, but can also affect healthy patients. Necrotizing fasciitis can rapidly produce septic shock and requires immediate surgical management of the necrotic tissue. It is a bacterial infection that progresses rapidly and has a high mortality generally caused by aerobic and anaerobic bacteria. The patient was immunocompromised and drug user. During treatment, a combination of broad-spectrum antibiotic therapy with Ciprofloxacin and Metronidazole, besides the use of activated charcoal dressing composed of carbonized fabric and impregnated with 0.15% silver nitrate enveloped by layer of fabric without activated carbon, chemical-mechanical debridement with hydrogen peroxide, 0.9% saline, and povidone iodine. According to the patient presented, for the treatment of NF there is a need for broad-spectrum antibiotic therapy associated with surgical debridement, use of activated charcoal for antiseptic compression and general intensive care.

Comparative Evaluation of Cell Viability Immediately After Osteotomy for Implants With Drills and Piezosurgery: Immunohistochemistry Analysis.

OBJECTIVE: To evaluate the effect of reusing drills and piezosurgery tips during implant osteotomy on immediate bone cell viability through immunohistochemical analysis. MATERIALS AND METHODS: Six male rabbits were divided into 2 groups and then divided into 5 subgroups-correspond to drills and tips used 10, 20, 30, 40, and 50 times, respectively. All animals received 10 osteotomies in each tibia, by use of the classic drilling procedure in one group (G1) and the piezosurgery device in the other group (G2). For immunohistochemical technique were utilized the osteoprotegerin, RANKL, osteocalcin, and caspase 3. Control procedures were performed by omitting the primary antibodies (negative control). RESULTS: Bone formation and resorption responses presented in more intense way during the piezosurgery. The expression of osteocalcin had become quite intense in piezosurgery groups, but with reduced immunostaining from the 30th osteotomy. The caspase 3 showed the viability of the osteoblast from the 20th osteotomy with piezosurgery and remained constant until the 50th. CONCLUSION: Piezosurgery provides greater osteoblastic cell viability than the system of conventional drilling. CLINICAL RELEVANCE: This study will provide data so that the authors can recycle the drills and tips for implant placement, thus enabling a better cell viability for osseointegration.

Oral Myiasis in a Patient With HIV Manifestations and Neurologic Toxoplasmosis Treated by Ivermectin.

Myiasis has been defined as a pathologic condition where dipterous larvae are lodged in mammalian hosts causing an infestation, which feeds on living or dead tissue for at least a certain period inside the host and develops itself as parasites. In humans, the most commonly affected sites are the nose, eyes, skin wounds, sinuses, lungs, ears, gut, gall bladder, vagina, nasal cavities, and rarely the mouth because the oral tissues are rarely exposed to the external environment. The etiology of oral myiasis is usually related to local factors such as poor oral hygiene, periodontal disease and labial incompetence, and systemic factors such as neurologic deficits.

Doxycycline and Autogenous Bone in Repair of Critical-Size Defects.

PURPOSE: The association of doxycycline (DOX) and autogenous bone on repair of critical-size defects was evaluated. MATERIALS AND METHODS: Fifty albino rats were divided into 5 groups (n = 10). A 5-mm diameter defect was treated with: control (CO)-blood clot; DOX in Natrosol (NAT)-10% gel; NAT-gel; particulate autogenous bone (PAB); and PAB + DOX - PAB associated with 10% DOX gel. The animals were euthanized at 4 and 8 weeks postoperatively. Histomorphometric analysis was performed to assess the percentage of new bone in the defect area. Statistical analysis of the results was performed using analysis of variance and the Tukey test (P < 0.05). RESULTS: The results showed that new bone formation was limited to the margins of the defect. At 4 and 8 weeks, the group PAB + DOX showed higher bone formation (38.59% and 47.86%, respectively), with statistical difference in comparison with the CO (19.52%) at 4 weeks and CO (18.80%), DOX (22.05%), and NAT (15.89%) at 8 weeks (P < 0.05). CONCLUSIONS: The association of 10% DOX with autogenous bone significantly improved bone healing in critical-size defects.

Diagnosis and Management of Cerebrospinal Fluid Leak in a Panfacial Fracture.

Cerebrospinal fluid fistula caused by head trauma is a potentially dangerous problem and precise localization and radical treatment are necessary. We present a case of a patient with Panfacial fracture caused by a motorcycle accident, resulting in a cerebrospinal fluid leakage. The correct diagnosis was realized by computed tomography and auxiliary tests. The successful treatment can be confirmed with the support of radionuclide cisternography examination.

Andy Gump Fracture of the Mandible in a Pediatric Patient.

The mandibular fractures in pediatric patients are rare, and they can need a fast and safe treatment. We present a case of a pediatric patient with "Andy Gump" fracture, resulting in a retrognathic mandible, distress to breathe, and functional discomfort to the patient caused by a cycling accident. The treatment was successful with the fast release of airway path and use of titanium plates to fix the fracture.

Evaluation of the Osteoinductive Effect of PDGF-BB Associated With Different Carriers in Bone Regeneration in Bone Surgical Defects in Rats.

PURPOSE: Extensive bone defects in maxillofacial region can be corrected with autograft. However the disadvantages of this type of therapy lead to the search for new bone substitutes. Thus, we evaluated the biological behavior and osteoinductive platelet-derived growth factor type BB (PDGF-BB) associated with different carriers, by histological analysis and immunohistochemical histometric critical defects performed in rat calvaria. MATERIALS AND METHODS: Critical defects were created with 5-mm diameter calvaria of rats. Each defect was randomly divided into 8 experimental groups, evaluated at 15 and 30 postoperative days for histomorphometry and immunohistochemistry. RESULTS: The results showed new bone formation in all groups, independent of postoperative time. At 30 days, the beta-tricalcium phosphate matrix (TCP) group just did not differ from bone matrix mineralized bovine (BIO) group in the new bone formation (P = 0.1403). In none of the groups' analyzed biomaterials, growth factor stimulated increase in bone formation (P > 0.05). CONCLUSION: With the methodology used, the growth factor associated with the tested biomaterials did not induce new bone formation.

The Importance of Correct Diagnosis of Crocodile Tears Syndrome.

The excessive unilateral tearing as a result of gustatory stimuli is a characteristic of crocodile tears syndromes. The aim of this study is to report 2 cases of Frey and crocodile tears syndromes, considering diagnosis, monitoring, and selection of appropriate treatment. A 74-year-old female patient presented with a history of Bell palsy, tearing on left eye at the moment of chewing, and absence of pain. The patient opted only for periodic case monitoring because the symptoms presented by the syndrome did not bother her, which made any invasive procedure unnecessary, and with the closed diagnosis she may be reassured and really know what was happening to her. So scientific divulgations about this syndrome should be made in order to increase the knowledge of dentists and oral and maxillofacial surgeons, because it is a rare syndrome and easily diagnosed. Due to the low knowledge in Brazil, the patient of this report had to wait about 9 years to get a diagnosis.

Unsuccessful Treatment of Atrophic Mandible Fracture by Use of Improper Materials.

Fractures of atrophic mandibles are present on the day by day of buccomaxillofacial surgeons. Mandible atrophy occurs due to tooth loss, which over time induces bone resorption leading to a fragile and susceptible to fracture structure. This paper reports the case of a patient victim of face trauma resulting in atrophic mandible fracture with treatment failure through the use of shared load miniplate. Therefore, a new treatment was performed with miniplate of system 2.4 along with bone graft. After 6 months, the patient was rehabilitated with implant-supported prosthesis installation. It is concluded that for successful treatment of atrophic mandible fractures, the use of rigid plates is necessary, allowing an excellent rehabilitation of the stomatognathic system.

Surgical treatment of severe frontal bone fracture.

Craniofacial trauma can lead to several complications. The combined fractures of anterior and posterior walls of the frontal bone are almost always followed by lesions in nasofrontal orifices and disruption of nasofrontal ostia or ducts, a significant factor for the development of early and late complications after sinus fractures. This article reports a case of trauma patient, who underwent neurological evaluation and at first showed good general condition. Computed tomography noted fracture of the anterior and posterior walls of the frontal sinus and small foci of pneumocephalus in the cerebral cortex. The patient was monitored periodically and 9 days after trauma showed increased areas of pneumocephalus in prefrontal cortex, cerebrospinal fluid draining, and large dura mater lesion, with signs of necrosis and inflammation (meningitis). The necrotic tissues were removed, and dura mater was repaired through the approximation with resorbable wire polyglactin 910 5-0, oxidized cellulose application, and bonding with human fibrin sealant (fibrinogen, thrombin, and calcium chloride). Sinusectomy, frontal sinus, and nasofrontal duct obliteration with pedicled pericranium flap were performed. Tomographically, a reanatomization was noted in frontal region, and a 12-month follow-up showed no complication. The use of fibrin glue to repair dura mater lacerations, as well as the pedicle pericranium flap for frontal sinus and nasofrontal duct obliteration, is an efficient method for treating fractures of the frontal bone.

Healing process of autogenous bone graft in spontaneously hypertensive rats treated with losartan: an immunohistochemical and histomorphometric study.

PURPOSE: Hypertension is a major risk factor for cardiovascular diseases, which has been related to such changes as gradual bone loss and a decrease in bone mass index. The cellular and molecular mechanisms that involve hypertension and osteoporosis are not fully understood. Many patients have high blood pressure, controlled or uncontrolled, and may use at least 1 antihypertensive drug, and an understanding of the interference of hypertension with bone healing is very important when considering oral rehabilitation with implants and bone grafts. This study investigated the interference of hypertension in bone metabolism during the repair process of autogenous bone grafting and analyzed the influence of losartan, an antihypertensive drug and angiotensin II receptor antagonist, through histometric and immunohistochemical analyses by examining the protein expressions of osteocalcin, osteoprotegerin, receptor activator of nuclear factor-κB, receptor activator of nuclear factor-κB ligand, tartrate-resistant acid phosphatase, vascular endothelial growth factor, and platelet endothelial cell adhesion molecule. MATERIALS AND METHODS: The groups studied include 24 normotensive Wistar rats and 24 spontaneously hypertensive rats divided into groups treated and not treated with losartan. Rats were subjected to block bone graft surgery in the mandible and were sacrificed at 7, 14, and 28 days. RESULTS: Histometric analysis was performed to evaluate the amount of bone tissue formed at the interface of the recipient bed and bone graft. The total area of formed bone tissue was outlined and calculated. Immunohistochemical analysis was semi-quantitative and the significance of the differences between groups regarding the percentage of newly formed bone tissue interface and protein expression were determined by ANOVA analysis of variance and Kruskall-Wallis followed by Tukey test or Holm Sidak to detect differences between groups. The results were considered statistically significant when P<.05. CONCLUSION: The untreated hypertensive rats showed a delay in the repair of autogenous bone block grafts compared with untreated Wistar rats. Furthermore, the use of losartan for lowering blood pressure in these animals was shown to improve the healing process, despite not showing important statistical differences.

Central giant cell granuloma in pediatric maxilla: surgical management.

Central giant cell granuloma (CGCG) is an intraosseous lesion consisting of fibrous cellular tissue that contains multiple foci of hemorrhage, multinucleated giant cells, and occasional trabeculae of woven bone. An 8-year-old boy presented himself complaining of a painless swelling in the left maxilla that had started 1 year. Computed tomography (CT) scan confirmed a poorly defined multilocular radiolucent lesion in the left maxilla crossing the midline. The patient underwent enucleation through an intraoral approach of the lesion. The biopsy revealed multinucleated giant cells in a fibrous stroma. A CT was taken approximately 1 year postoperatively. There was no clinical or radiographic evidence of recurrence. Therefore, surgical treatment of CGCG can be performed, trying to preserve the surrounding anatomic structures, which can be maintained in case the lesion does not show an aggressive clinical behavior, avoiding large surgical defects which are undesirable in children.

Isolated bilateral blowout fracture with extensive pneumatization of the maxillary sinuses.

The blowout fracture injuries are often associated with fractures of the zygomatic complex and other facial structures but can also occur in an isolated fashion. Isolated bilateral blowout fractures are uncommon and constitute a challenge with regard to both assessment and reconstruction. This article describes an uncommon case of isolated bilateral blowout fracture in a patient with extensive pneumatization of the maxillary sinuses.

Piezosurgery applied to implant dentistry: clinical and biological aspects.

Piezosurgery is a new and modern technique of bone surgery in implantology. Selective cutting is possible for different ultrasonic frequencies acting only in hard tissues (mineralized), saving vital anatomical structures. With the piezoelectric osteotomy technique, receptor site preparation for implants, autogenous bone graft acquistition (particles and blocks), osteotomy for alveolar bone crest expansion, maxillary sinus lifting, and dental implant removal can be performed accurately and safely, providing excellent clinical and biological results, especially for osteocyte viability. The aim of this review was, through literature review, to present clinical applications of piezosurgery in implant dentistry and outline their advantages and disadvantages over conventional surgical systems. Moreover, this study addressed the biological aspects related to piezosurgery that differentiate it from those of bone tissue approaches. Overall, piezosurgery enables critical operations in simple and fully executable procedures; and effectively, areas that are difficult to access have less risk of soft tissue and neurovascular tissue damage via piezosurgery.