Hospital Intervention in Severe Sinus Infection After Bone Graft.

This study presents the case of a patient who required antrostomy under general anesthesia to treat a sinus lift complication. The patient was a 43-year-old woman with no systemic abnormalities who underwent maxillary sinus lift surgery associated with mineralized bovine bone graft. The Schneiderian membrane was perforated during the procedure, and the rupture was treated with collagen membranes to close the wound and contain the biomaterial, preventing its dispersion. The patient developed a maxillary sinus infection 7 days after surgery. This infection was initially treated with 875 mg amoxicillin combined with 125 mg clavulanic acid. Although the initial infection did not worsen, the patient developed maxillary sinusitis. Thirty days after the onset of the initial infection, the patient underwent an intraoral surgery under local anesthesia to remove the biomaterial and clean the sinus cavity. Despite this procedure, maxillary ostial patency was still compromised, and antrostomy was performed endoscopically in a hospital setting under general anesthesia. This procedure resolved the sinus infection. Then, 12 months after hospitalization, the patient was treated with another sinus graft surgery without postoperative complications. The treatment of sinus infections caused by the graft surgery may require early and active intervention with antibiotics, graft removal, and antrostomy to prevent major complications.

Use of Calcium Phosphate Cement for Repairing Bone Defects: Histomorphometric and Immunohistochemical Analyses.

This study aimed to assess the repair of surgically created bone defects filled with blood clot, autogenous bone, and calcium phosphate cement, by histomorphometric and immunohistochemical analyses. Ten adult male rabbits were used. Three bone defects were prepared with an 8-mm diameter trephine bur in the parietal region of each animal and filled with blood clot (Group BC), autogenous bone (Group AB), and calcium phosphate bone cement (Group CPC). The animals were euthanized at 40 and 90 postoperative days. The sections were subjected to histomorphometric analysis of the new bone formed inside the calvarial defects and immunohistochemical staining to determine the expression of osteocalcin (OC), osteopontin (OP), and tartrate-resistant acid phosphatase (TRAP) proteins. Histomorphometric data were analyzed statistically by analysis of variance and Tukey's post hoc test at 5% significance level. In the results at 40 and 90 days, Group AB differed significantly from Group CPC regarding the area of newly formed bone. The immunohistochemical analysis revealed expression of OP, OC, and TRAP proteins in all groups. Group AB showed prevalence of OC and OP, and lower TRAP expression. Therefore, the calcium phosphate bone cement assessed in the present study did not accelerate the protein expression dynamics during bone healing, compared with the autogenous group.

Analysis of factors that influence quality of life of individuals undergoing treatment for mandibular fractures: A systematic review and meta-analysis.

OBJECTIVE: To address the factors that affect the quality of life (QoL) of individuals undergoing treatment for mandibular fractures. STUDY DESIGN: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the search strategy was constructed according to the Populations, Interventions, Comparison, Outcomes, and Study Design principle in the following databases: PubMed, Web of Science, Scopus, and EMBASE. Risk of bias assessment was performed with Risk Of Bias In Non-randomized Studies of Interventions and Cochrane Risk of Bias tool for randomized trials 2. RESULTS: Nineteen studies were included: 15 observational and 4 clinical trials. Mean age ranged from 28 to 39 years, with a higher proportion of males. The condyle was the main fracture location and traffic accident was the fracture cause. Treatment approaches were mostly open reduction (89.4%) and maxillomandibular fixation (63%). QoL measurements varied considerably with the General Oral Health Assessment Index (31.5%) and Oral Health Impact Profile-14 (21%) as the main instruments. Meta-analysis showed that open reduction and maxillomandibular fixation did not present significant differences to QoL (P = .39), but significant differences were observed with time (P < .00001). Other factors affected QoL, such as mental health, pain, socializing, appearance, and eating difficulties. CONCLUSIONS: Several factors, apart from the treatment approach, mentioned in this review seemed to affect the QoL of patients with mandibular trauma. Treatment choice should be based on well-stablished clinical criteria and on all other factors mentioned here.

Effects of osteoporosis on alveolar bone repair after tooth extraction: A systematic review of preclinical studies.

OBJECTIVE: This systematic review aimed to address whether the alveolar socket repair after a tooth extraction is impacted by an osteoporotic phenotype and propose methodological observations. DESIGN: A search strategy in MEDLINE/PubMed, EMBASE, Web of Science, and Scopus databases was performed. Quality assessment was carried out through the SYRCLE Risk of Bias tool. RESULTS: Out of the 1147 potentially relevant records, 25 met the inclusion criteria. Most of the studies were performed in rats, and ovariectomy (OVX) was the most frequent osteoporosis induction method. Histomorphometry, micro-computed tomography (microCT), and immunohistochemistry were the main bone repair evaluation methods. Most of the included studies (88 %) presented negative impacts of osteoporosis on the alveolar socket repair. Only three studies (12 %) showed no statistical differences among groups. Overall, most of the quality assessment categories presented a high percentage of unclear risk of bias due to insufficient information in the studies. CONCLUSIONS: The results indicated that an osteoporotic phenotype seems to impair alveolar socket repair after tooth extraction. However, there is still a lack of information and standardization. Therefore, further studies should consider the proposed methodological aspects regarding animal characteristics, OVX associated with a low calcium diet, waiting 8 weeks to osteoporosis induction, maxillary molars as the best option for tooth extraction, confirming and reporting OVX and osteoporosis success, and an appropriate method of repair analysis.

Tomographic Analysis of the Impact of Mandibular Advancement Surgery on Increased Airway Volume.

PURPOSE: This study aimed to quantify, using cone-beam computed tomography (CBCT) in patients who underwent a mandibular advancement surgery associated with genioplasty, three-dimensional changes in airway space and to evaluate whether these changes differ between men and women. MATERIALS AND METHODS: Preoperative and 8-month postoperative CBCT scans of 38 patients aged 18-45 years of either sex and any ethnicity who underwent mandibular advancement surgery associated with genioplasty were analyzed using the Xoran software (Xoran Technologies, Ann Arbor, MI, USA). The linear distances gonion-gnathion (Go-Gn) and condylion-menton (Co-Me) were obtained. Airway volume was measured using the Dolphin Imaging software, version 11.0. Then, data were tabulated and analyzed using Student's t-test. RESULTS: Mean patient age was 30.3 years; 39.47% were men and 60.63% were women. The mean Go-Gn distance was 72.05 mm before surgery and 78.56 mm after surgery, with a mean gain of 6.51 mm. The mean Co-Me distance was 113.47 mm before surgery and 119.89 mm after surgery, with a mean increase of 6.42 mm. Both differences were statistically significant. The mean volume of airway space was 17,272.92 mm3 before surgery and 24,173.74 mm3 after surgery, with a statistically significant mean increase of 6900.82 mm3. There was no statistically significant difference in mean volumetric gain between men (7566.69 mm3) and women (7456.69 mm3). CONCLUSION: Mandibular advancement surgery results in significant increase of airway space, and there is no difference in airway volume between men and women.

Magnetic Field Effects on Bone Repair after Calcium Phosphate Cement Implants: Histometric and Biochemistry Evaluation.

OBJECTIVE: This work evaluated histologic and biochemically the effect of magnetic field buried in bone repair after autogenous bone graft and calcium phosphate cement implants. METHODOLOGY: Bone defects with 5,0 mm of diameter in the cranium of Wistar mice were used to analyse. These mice were submitted to different interventions: autogenous bone graft and calcium phosphate cement implants, both with and without magnetic stimulation. Longitudinal and transversal histometric and biochemistry analysis were made in times of 15, 30 and 60 post-operative days. RESULTS: The histometric transversal analysis did not show significant differences in the bone repair between groups. Longitudinally, significant difference were found in the quantity of neoformed bone between the times 15 and 60 post-operative days in the autogenous bone graft group under magnetic stimulation. The alkaline phosphatase enzyme presented a higher activity in 30 post-operative days and the groups under magnetic stimulation presented reduced enzymatic activity in comparison to the other groups. CONCLUSION: The permanent and static magnetic field promoted significant differences in the neoformed bone in the groups autogenous bone graft.

Salivary flow rate, buffer capacity, and urea concentration in adolescents with type 1 diabetes mellitus.

BACKGROUND: The objective of the study was to analyze salivary flow rate, urea concentration, and buffer capacity in adolescents with type 1 diabetes mellitus (type 1 DM) in two different stages. METHODS: This study was performed on adolescents (14-19 years), allocated between two groups: type 1 DM group comprised 32 adolescents with type 1 DM, and non-type 1 DM group comprised 32 nondiabetics. The adolescents in type 1 DM group were evaluated at a baseline (T0) and after 15 months (T1), and those in non-type 1 DM group were only evaluated at T0. Diabetic status was determined by glycosylated hemoglobin (GHb) and capillary glucose tests. Measurement of salivary flow was performed by means of stimulated saliva (SSFR) collection. The buffer capacity (BC) was determined, and analysis of urea salivary concentration was performed using the colorimetric method. RESULTS: At T0, there were significant differences between diabetics and nondiabetics for SSFR and BC (p<0.05). In diabetics, SSFR was 0.790 mL/min in T0 and 0.881 mL/min in T1 (p>0.05). BC at T0 was 4.8, and at T1, it was 3.9 (p=0.000). Urea concentration mean value had a significant decrease at T1 (28.13) compared with T0 (34.88) (p=0.013). There was a negative correlation between SSFR and urea salivary concentration at both T0 (r=-0.426, p≤0.05) and T1 (r=-0.601, p≤0.01). CONCLUSIONS: In adolescents with type 1 DM, hyposalivation at T0 was associated with an increase in urea salivary concentration. At T1, hyposalivation was associated with a reduction in BC, and an increase in salivary urea.

Computer guided surgery in the maxillary esthetic zone / Cirurgia guiada por computador em área estética da maxila

ABSTRACT This clinical report describes the implant rehabilitation for the treatment of pathological roots resorption due to inadequate orthodontic movement in prosthetic space reduced by means of load and immediate implants, computer-guided surgery and use of the own tooth crown in a 21-year-old-patient. The atraumatic exodontics of the right and left upper lateral incisors was performed, and then immediate placement of osseointegrated implants using the computer guided surgery technique. The crown teeth itself was used in the immediate aesthetic and functional rehabilitation. Completion of the treatment resulted in a functional and aesthetic successful outcome and a 27 months follow-up presented uneventful. The procedures included in this complex rehabilitation treatment in the esthetic zone were appropriate and essential for the maintenance of the soft and hard tissues contour and thickness ensuring the excellence in rehabilitation.

RESUMO Este relato de caso clínico descreve a reabilitação com implantes para o tratamento da reabsorção radicular patológica devido à movimentação ortodôntica inadequada em espaço protético reduzido, por meio implante imediato e carga imediata, pela técnica da cirurgia guiada por computador e uso da própria coroa dentária, em paciente de 21 anos. A exodontia atraumática dos incisivos laterais superiores direito e esquerdo foi realizada, em seguida realizou-se a instalação imediata dos implantes osseointegráveis, utilizando a técnica de cirurgia guiada por computador. Os próprios dentes da coroa foram usados na reabilitação estética e funcional imediata. A conclusão do tratamento resultou em sucesso funcional e estético com acompanhamento de 27 meses sem intercorrências. Os procedimentos incluídos neste complexo tratamento de reabilitação na zona estética foram adequados e essenciais para a manutenção do contorno e espessura dos tecidos moles e duros garantindo a excelência na reabilitação.

Impairment of energy metabolism in hippocampus of rats subjected to chemically-induced hyperhomocysteinemia.

Homocystinuria is an inherited metabolic disease biochemically characterized by tissue accumulation of homocysteine (Hcy). Mental retardation, ischemia and other neurological features, whose mechanisms are still obscure are common symptoms in homocystinuric patients. In this work, we investigated the effect of Hcy administration in Wistar rats on some parameters of energy metabolism in the hippocampus, a cerebral structure directly involved with cognition. The parameters utilized were 14CO2 production, glucose uptake, lactate release and the activities of succinate dehydrogenase and cytochrome c oxidase (COX). Chronic hyperhomocysteinemia was induced by subcutaneous administration of Hcy twice a day from the 6th to the 28th day of life in doses previously determined in our laboratory. Control rats received saline in the same volumes. Rats were killed 12 h after the last injection. Results showed that Hcy administration significantly diminished 14CO2 production and glucose uptake, as well as succinate dehydrogenase and COX activities. It is suggested that impairment of brain energy metabolism may be related to the neurological symptoms present in homocystinuric patients.

In vivo and in vitro effects of homocysteine on Na+, K+-ATPase activity in parietal, prefrontal and cingulate cortex of young rats.

In the present study we determined the effect of chronic administration of homocysteine on Na+,K+-ATPase activity in synaptic membranes from parietal, prefrontal and cingulate cortex of young rats. We also studied the in vitro effect of homocysteine on this enzyme activity and on some oxidative stress parameters, namely thiobarbituric acid-reactive substances (TBA-RS) and total radical-trapping antioxidant potential (TRAP) in the same cerebral structures. For the in vivo studies, we induced elevated levels of homocysteine in blood (500 microM), comparable to those of human homocystinuria, and in brain (60 nmol/g wet tissue) of young rats by injecting subcutaneously homocysteine (0.3-0.6 micromol/g of body weight) twice a day at 8 h intervals from the 6th to the 28th postpartum day. Controls received saline in the same volumes. Rats were killed 12 h after the last injection. Chronic administration of homocysteine significantly decreased (50%) Na+,K+-ATPase activity in parietal, increased (36%) in prefrontal and did not alter in cingulate cortex of young rats. In vitro homocysteine decreased Na+,K+-ATPase activity and TRAP and increased TBA-RS in all cerebral structures studied. It is proposed that the alteration of Na+,K+-ATPase and induction of oxidative stress by homocysteine in cerebral cortex may be one of the mechanisms related to the neuronal dysfunction observed in human homocystinuria.

Inhibition of Na+, K+-ATPase activity in rat striatum by guanidinoacetate.

The aim of this work was to investigate the effect of guanidinoacetate (GAA), the principal metabolite accumulating in guanidinoacetate methyltransferase (GAMT)-deficiency, on Na(+), K(+)-ATPase, Mg(2+)-ATPase and acetylcholinesterase (AChE) activities in striatum of young rats. We also studied the kinetics of the inhibition of Na(+), K(+)-ATPase activity caused by guanidinoacetate. Guanidinoacetate did not alter acetylcholinesterase and Mg(2+)-ATPase activities, but significantly inhibited Na(+), K(+)-ATPase activity. The apparent K(m) and V(max) of Na(+), K(+)-ATPase for ATP as substrate were 0.20mM and 0.82nmol inorganic phosphate (Pi) released per min per mg of protein, respectively. K(i) value was 7.18mM, and the inhibition was of the uncompetitive type. The results also showed a competition between guanidinoacetate and argininic acid (AA), suggesting a common binding site for the guanidino compounds (GC) on the enzyme. It is proposed that Na(+), K(+)-ATPase inhibition by guanidinoacetate may be one of the mechanisms involved in the neuronal dysfunction observed in GAMT-deficiency and in other diseases which accumulate guanidinoacetate.

Training in inhibitory avoidance causes a reduction of Na+,K+-ATPase activity in rat hippocampus.

Compelling evidence has indicated the involvement of Na(+),K(+)-ATPase in the mechanisms of synaptic plasticity. In the present study, we investigated the effect of inhibitory avoidance training on Na(+),K(+)-ATPase activity, at different times after training, in the rat hippocampus. Male adult Wistar rats were trained in a step-down inhibitory avoidance task and compared to those submitted to isolated footshock (0.4 mA) or placed directly onto the platform. Na(+),K(+)-ATPase activity decreased, by 60%, in hippocampus of rats sacrificed immediately after the isolated footshock, as well as immediately (0 min) and 6 h after training; this effect was not present 24 h after training. We also verified that enzyme activity was not altered in rats killed after just being on the platform. These findings suggest that Na(+),K(+)-ATPase activity may be involved in the memory consolidation of step-down inhibitory avoidance in the hippocampus.

Fratura condilar em criança de 4 meses: relato de caso / Condylar fracture in a 4-month-old-child: case report and literature review

Objetivo: apresentar um relato de caso clínico de uma criança de 4 meses de idade que sofreu uma fratura do côndilo após queda e foi submetida a tratamento conservador, discutindo aspectos que determinaram a opção por esta conduta. Relato de caso: paciente apresentava, no exame clínico, discreto edema na região do mento e não apresentava limitação da abertura bucal. Devido a estes achados clínicos e à idade do paciente, mesmo com imagem tomográfica evidenciando a fratura condilar, optou-se pela realização de tratamento conservador e acompanhamento clínico do paciente. Considerações finais: a decisão da conduta terapêutica deve ser baseada em exames físicos, clínicos e imaginológicos do paciente. Em pacientes muito jovens, como o relatado neste caso, é preciso ter cautela com a indicação dos procedimentos a serem realizados, pois é um paciente que está em intenso desenvolvimento e crescimento. O acompanhamento em longo prazo da manutenção de movimentação fisiológica da articulação temporomandibular do paciente também é fundamental para que se tenha sucesso no tratamento escolhido, evitando-se patologias como a anquilose ou outras alterações que dificultem uma abordagem mais conservadora ou minimamente invasiva. (AU)

Objective: the present study report a clinical case of a 4-month-old child who suffered a condyle fracture after falling and submitted to a conservative treatment, discussing issues that determined the option for this management. Case report: patient presented, on clinical examination, mild edema in the ment region and did not presented limitation of the oral opening. Due to these clinical findings and the patient's age, even with a tomographic image evidencing the condylar fracture, we chose to perform conservative treatment and clinical follow-up of the patient. Final considerations: the therapeutic management decision should be based in patient's physical, clinical and imaging examinations. In very young patients, as reported here, care should be taken to indicate the procedures to be performed, as it is a patient who is in intense development and growth. Long-term follow-up of the maintenance of the physiological movement of TMJ is also fundamental for the success of the treatment, avoiding pathologies such as ankylosis or other changes that hinder a more conservative or minimally invasive approach. (AU)

Tratamento cirúrgico da limitação de abertura bucal causada por hiperplasia do processo coronoide: relato de caso / Surgical treatment for mouth opening limitation caused by coronoid process hyperplasia: case report

A hiperplasia do processo coronoide é uma condiçãoincomum de etiologia desconhecida que se apresentaclinicamente por meio da limitação de abertura bucal enão possui sintomatologia dolorosa durante a aberturae o fechamento bucal. Objetivo: relatar e discutir, pormeio de um caso cirúrgico, o tratamento da limitaçãode abertura bucal causada por hiperplasia bilateral doprocesso coronoide. Relato de caso: paciente do sexofeminino, com 11 anos de idade, foi encaminhada paraatendimento devido à dificuldade de mastigação emfunção da limitação de abertura bucal, sem históricode trauma em face ou na região articular. O exame tomográficoevidenciou o alongamento bilateral do processocoronoide, fazendo com que ele colidisse com oarco zigomático durante a abertura bucal e causasse otravamento. O tratamento proposto foi a coronoidectomiabilateral com acesso cirúrgico intraoral, obtendono pós-cirúrgico imediato um ganho na abertura bucal.Considerações finais: a coronoidectomia é uma abordagemcirúrgica de fácil acesso por via intraoral, poucotraumática e eficaz no tratamento de pacientes com hiperplasiado processo coronoide. (AU)

The coronoid process hyperplasia is an unusual condition of unknown etiology that is presented clinically through mouth opening limitation, without painful symptoms during mouth opening and closure. Objective: to report and discuss, through a surgical case, the treatment of mouth opening limitation caused by bilateral coronoid process hyperplasia. Case report: female patient, 11 years old, referred due to chewing difficulty by mouth opening limitation. No history of trauma in the face or joint area. The tomographic examination showed the bilateral elongation of the coronoid process, causing it to collide with the zygomatic arch during mouth opening, which caused locking. The treatment proposed was bilateral coronoidectomy with intraoral surgical access, which enhanced mouth opening at the immediate postoperative period. Final considerations: coronoidectomy is a surgical approach with easy intraoral access, non-traumatic, and effective in the treatment of patients with coronoid process hyperplasia. (AU)

Cirurgia ortognática para tratamento da síndrome de apneia obstrutiva do sono: relato de caso

Objetivo: ilustrar, por meio de um caso clínico, os benefíciosdo tratamento da síndrome de apneia obstrutivade sono (Saos) por intermédio da cirurgia ortognáticabimaxilar, com o uso de biomateriais de reconstrução.Relato de caso: paciente encaminhado para avaliaçãode discrepância maxilomandibular em relação àbase do crânio e para avaliação de queixa de roncointenso durante a noite e intenso cansaço diurno. Apósavaliação e exames complementares, o paciente foidiagnosticado com apneia obstrutiva do sono; assim,foi realizada a cirurgia de avanço bimaxilar como terapêuticaresolutiva para o caso. Considerações finais:a Academia Americana de Medicina do Sono (AAMS)define Saos como uma doença que se caracteriza porepisódios repetitivos de obstrução total (apneia) ou parcial(hipopneia) das vias aéreas superiores durante osono. A cirurgia de avanço bimaxilar se apresenta comouma das melhores opções terapêuticas para os pacientescom essa síndrome. A cirurgia ortognática, incluindoseus diversos procedimentos, provoca importantesmudanças nas diferentes zonas das vias aéreas faríngeas.A cirurgia ortognática de avanço bimaxilar commentoplastia de avanço foi eficaz, em longo prazo, notratamento da Saos, e o uso simultâneo de biomateriaisde substituição óssea aumenta a estabilidade óssea primária,acelera o processo de reparo ósseo e diminui amorbidade pós-operatória.

Diagnóstico diferencial de tumores de glândulas salivares maiores

Objetivo: o objetivo deste estudo é abordar e discutir, por meio de um relato de caso, aspectos clínicos e imaginológicos capazes de estabelecer o diagnóstico diferencial das lesões tumorais de glândulas salivares maiores. Relato de caso: o presente estudo discute, com um relato de caso clínico, o diagnóstico diferencial de glândulas salivares maiores em que um paciente relatou um aumento de volume, com diagnóstico médico inicial de linfadenopatia cervical crônica causada por histórico de infecções recorrentes na garganta. Sendo assim, a conduta inicial realizada por um médico-cirurgião de cabeça e pescoço foi a preservação do caso. Porém, após nova reavaliação e exames complementares solicitados pela equipe de cirurgia bucomaxilofacial devido à insistência dos familiares, foi cogitada a hipótese diagnóstica de adenoma pleomórfico de glândula submandibular. Em consequência, foi realizada a cirurgia para acesso e remoção da lesão, e esta foi enviada para diagnóstico histopatológico, que permitiu concluir que se tratava de adenocarcinoma de glândula submandibular. Considerações finais: o diagnóstico diferencial é fundamental na determinação da escolha de tratamento dessas neoplasias, uma vez que, além da conduta terapêutica diferente, as lesões malignas podem gerar metástases em outras partes do corpo, tornando o prognóstico de sobrevida do paciente menos positivo. O correto diagnóstico, associado a uma terapêutica adequada e, principalmente, ao diagnóstico precoce do tipo de lesão, propicia uma melhor qualidade de vida ao paciente acometido por uma neoplasia maligna de glândula salivar maior.

Osteonecrose mandibular associada ao uso de bisfosfonatos tratada com plasma rico em fibrina leucocitária: relato de caso

Bisfosfonatos são antiabsortivos que agem especificamentesobre a atividade dos osteoclastos. Uma complicaçãograve do seu uso é a osteonecrose dos maxilares,definida como uma área de exposição óssea na regiãomaxilofacial sem resolução espontânea por um períodode no mínimo oito semanas em pacientes com históricode uso de compostos bisfosfonatos, mas que não foramsubmetidos à radioterapia na região de cabeça e pescoço.Tratamentos conservadores são recomendados, masos resultados da literatura são controversos e nem sempreefetivos. Por isso, novas abordagens, como o usodos concentrados plaquetários, têm sido sugeridas. Sãoprodutos autólogos que contém altas concentrações defatores de crescimento e que atuam como moléculasde adesão celular, acelerando o reparo ósseo. Objetivo:descrever, por meio de relato de caso, o uso do plasmarico em fibrina e leucocitária (L-PRF) como forma detratamento da osteonecrose mandibular. Relato do caso:paciente do gênero feminino, 79 anos, diagnosticadacom osteonecrose mandibular associada ao uso de bisfosfonatos,tratada por meio de cirurgia convencionalassociando curetagem óssea e rotação de retalho, massem sucesso. Então, foi submetida à modificação detécnica cirúrgica, associando o uso de plasma rico emfibrina leucocitária (L-PRF), a fim de acelerar o processode reparo ósseo e garantir a cicatrização dos tecidosmoles. Considerações finais: o uso de L-PRF como tratamentoda osteonecrose mandibular estimula o reparoósseo e acelera a cicatrização dos tecidos moles, sendouma alternativa eficaz de tratamento.

Cirugía de elevación del seno asociada con pseudoquiste antral y mucocele / Sinus lifting surgery associated with antral pseudocyst and mucocele

Introducción: pseudoquistes y quistes verdaderos de los maxilares son contraindicaciones para cirugías de aumento de volumen óseo en la región posterior de la maxila. Objetivo: describir dos casos de pacientes con transtornos en los senos maxilares (pseudoquiste y quiste verdadero del maxilar) en senos maxilares neumatizados que necesitaban reconstrucción ósea, para posterior rehabilitacion con implantes oseointegrados. Presentación de casos: se presentan dos casos clínicos en que la planificación quirúrgica consistió en la remoción de la lesión y simultánea elevación del suelo del seno maxilar. En el primer caso, pseudoquiste antral, se procedió a la aspiración del contenido quístico previamente a la elevación de la membrana de Schneider. En el segundo caso, quiste verdadero del seno maxilar, se realizó la remoción completa de la lesión quística. En ambos casos no hubo perforación de la membrana, y el hueso bovino inorgánico fue utilizado como material de relleno. La instalación de los implantes fueron después de 7 meses de la cirugía de elevación de seno. Los controles clínicos y tomográficos mostraron adecuada oseointegración de los implantes y ausencia de recidiva y/o restos de la lesión. Conclusiones: el quiste verdadero del seno maxilar causa la destrucción de las paredes óseas y debe ser removido previamente a las cirugías de elevación sinusal. Ningún tratamiento es indicado para el pseudoquiste antral, teniendo claro que la lesión no representa necesariamente una contraindicación para la elevación de la membrana sinusal y colocación de injerto óseo para implantes. Mientras tanto, la aspiración previa de contenido líquido del pseudoquiste evita posibles complicaciones infecciosas posoperatorias(AU)

Introduction: maxillary pseudocysts and true cysts are contraindications for bone volume augmentation surgery in the posterior maxillary region. Objective: describe two cases of patients with maxillary sinus disorders (pseudocyst and true cyst) in pneumatized maxillary sinuses requiring bone reconstruction with a view to eventual rehabilitation with osseointegrated implants. Case presentation: two clinical cases are presented in which surgical planning consisted in lesion removal and simultaneous maxillary sinus floor elevation. In the first case, antral pseudocyst, aspiration was performed of the cystic content before elevation of the Schneiderian membrane. In the second case, true cyst of the maxillary sinus, total removal of the cystic lesion was performed. Membrane perforation did not occur in either case. Inorganic bovine bone was used as filler in both. Implantation was performed 7 months after sinus lifting surgery. Clinical and tomographic examination showed adequate implant osseointegration and absence of recurrence and/or lesion remnants. Conclusions: true maxillary sinus cysts cause bone wall destruction, and should be removed before performing sinus lifting surgery. No treatment is indicated for antral pseudocyst, for the lesion does not necessarily constitute a contraindication for sinus membrane lifting and bone graft placement for implantation. On the other hand, previous aspiration of the liquid content of the pseudocyst prevents possible postoperative infectious complications(AU)

Reabilitação dentária e reconstrução mandibular com retalho microvascularizado de fíbula / Dental rehabilitation and mandibular reconstruction with microvascularized fibular flap

Introdução: O tratamento do ameloblastoma mandibular, um tumor odontogênico benigno, é controverso para suas variantes patológicas (uni ou multicístico). Curetagem e amplas ressecções ósseas ocasionam defeitos ósseos que comprometem estética e função do paciente. Relato de caso: Paciente 48 anos, gênero masculino, submetido à ressecção segmentar de mandíbula devido a ameloblastoma multicístico em região de sínfise e para sínfise foi reabilitado funcional e esteticamente com implantes dentários após reconstrução mandibular com enxerto ósseo microvascularizado de fíbula. Conclusão: O retalho microvascularizado de fíbula foi eficaz na reconstrução mandibular após ressecção de ameloblastoma e, quando associado a implantes dentários, permitiu reabilitação estomatognática e melhora estética significativas... (AU)

Introduction: Treatment of mandibular ameloblastoma, a benign odontogenic tumor, is controversial for its pathological variants (single or multicystic). Curettage and bone resections lead to large bone defects that compromise the aesthetics and function of the patient. Case report: Patient 48 years, male, underwent segmental resection of the jaw due to multicystic ameloblastoma in symphysis region. It was functionally and aesthetically restored with dental implants after mandibular reconstruction with micro- vascularized fibular bone graft. Conclusion:The microvascularized fibular flap was effective in mandibular reconstruction after amelobastoma resection and, when associated with dental implants, allowed stomathognatic rehabilitation and significant aesthetic improvement... (AU)

Utilização de prototipagens em cirurgia e traumatologia bucomaxilofacial: relato de casos

Apresentar as possibilidades da utilização da prototipagem (biomodelos) em cirurgia e traumatologia bucomaxilofacial por meio do relato de casos clínicos. Relato de casos: o presente estudo abrange três situa- ções clínicas, sendo o primeiro caso o de um paciente com osteorradionecrose associado à fratura patológica devido à evolução do quadro de osteólise, sendo realizada a ressecção do segmento e a adaptação da placa de reconstrução no biomodelo. O segundo caso relata a presença de um ameloblastoma multicístico, abrangendo a sínfise, a para-sínfise e o corpo da mandíbula, sendo utilizada a prototipagem para adaptação da placa cirúrgica de reconstrução. No último relato, a paciente foi diagnosticada com Tumor Epitelial Calcificante, desde a linha média da maxila até a fossa pté- rigo-maxila do lado esquerdo. Por intermédio do uso de biomodelos, foi possível confeccionar uma prótese total implantossuportada que realizasse o vedamento do defeito ósseo. Considerações finais: é notável que o uso de biomodelos é auxiliar no planejamento e na execução cirúrgica, expandindo alternativas de tratamento que possibilitem a reabilitação do paciente com técnicas cirúrgicas mais eficazes, com menor morbidade e maior rapidez cirúrgica.