Comparison of Manual (2D) and Digital (3D) Methods in the Assessment of Simulated Facial Edema.

BACKGROUND: An edema assessment following dental surgeries is essential to improving the dental surgeon's technique and, consequentially, patient comfort. PURPOSE: Two-dimensional (2D) methods are limited in analyzing 3-dimensional (3D) surfaces. Currently, 3D methods are used to investigate postoperative swelling. However, there are no studies that directly compare 2D and 3D methods. The goal of this study is to directly compare 2D and 3D methods used in the assessment of postoperative edema. STUDY DESIGN AND SAMPLE: The investigators implemented a prospective, cross-sectional study with each subject serving as its own control. The sample was composed of dental student volunteers without facial deformities. PREDICTOR VARIABLE: The predictor variable is the method used to measure edema. After simulating edema, manual (2D) and digital (3D) techniques were used to measure edema. The manual method used direct facial perimeter measurements. The two digital methods were photogrammetry using a smartphone (iPhone 11, Apple Inc, Cupertino, California), and facial scanning with a smartphone application (Bellus3D FaceApp, Bellus3D Inc, Campbell, California) [3D measurements] MAIN OUTCOME VARIABLE: The coefficient of variation (CV) (CV = standard deviation /mean) was used to assess homogeneity of edema measurements. ANALYSIS: The Shapiro-Wilk and equal variance tests were applied to assess data homogeneity. Next, one-way analysis of variance was performed, followed by a correlation analysis. Finally, the data were submitted to Tukey's test. The statistical significance threshold was set at 5% (P < .05). RESULTS: The sample was composed of 20 subjects aged 18-38 years. The CV showed higher values using the manual (2D) method (47%; 4.88% ± 2.99), compared with the photogrammetry method (18%; 8.55 mm ± 1.52) and the smartphone application (21%; 8.97 mm ± 1.93). A statistically significant difference was observed between the manual method values and those of the other two groups (P < .001). There was no difference between the facial scanning and photogrammetry groups (3D methods) (P = .778) CONCLUSION AND RELEVANCE: Both digital measuring methods (3D) demonstrated greater homogeneity than the manual method in analyzing facial distortions caused by the same swelling simulation. Therefore, it can be affirmed that digital methods may be more reliable that manual methods for assessing facial edema.

Accuracy of Manual and Virtual Predictive Tracings in Patients Submitted to Orthognathic Surgery.

Cephalometric tracing done manually was considered gold standard for the cephalometric analysis in the last decades. The digital radiographs began to be commonly used in order to make that in a digital way. The objective was to define the accuracy of the predictive and final cephalometric tracings performed manually and virtually. The authors selected 20 patients submitted to bimaxillary orthognathic surgery. The data were collected from lateral cephalometric radiographs, in the preoperative and postoperative periods. The interest were: points, angles (Sella-Nasion to A point angle; Sella-Nasion to B point angle; Frankfurt plane to Mandibular plane angle; Frankfurt plane to occlusal plane angle; Upper and lower central incisors long axes angle; Incisor to Mandibular plane angle; Upper incisor axis to Sella-Nasion plane angle) distances (Co-A; Co-Gn). Data were submitted to the Shapiro-Wilk, analysis of variance, and Kruskal-Wallis tests. The measurement differences were compared using a t test. Descriptive statistics were performed in Excel 2013 and SPSS software, P <0.05 being considered significant. No statistically significant difference was found between the mean values predictive and postoperative of the angles and distances within the manual and digital groups. When comparing the means of the differences between the predictive values and the final values, only the 1:1 angle presented a statistically significant difference, indicating a greater accuracy of the digital predictive tracing for this measure. In conclusion, both methods for obtaining predictive tracings are accurate, which shows that clinical results can be successfully simulated by the most accessible technique.

An alternative approach for the surgical correction of unilateral crossbite.

This case report aims to describe a modified surgically assisted rapid palatal expansion technique to treat an asymmetrical posterior crossbite with no mandibular shift without causing an interincisal diastema. A clinical patient with an asymmetrical crossbite, large tooth-size-arch length, and Bolton discrepancy is used to illustrate the modified technique. Instead of traditional osteotomies, in this technique, the osteotomy is done between the maxillary right canine and lateral incisor (connecting the piriform aperture to the alveolar process) along with a unilateral LeFort I osteotomy. The expansion forces are produced by the activation of a conventional hyrax appliance. The skeletal unilateral crossbite was corrected without major changes to the opposite side and without causing an anesthetic diastema between the maxillary central incisors. A mandibular incisor extraction produced the space needed to treat the tooth size-arch length and corrected the Bolton discrepancy. This allowed a successful treatment of the problems initially presented by the patient.

The Interplay of Raloxifene and Sonochemical Bio-Oss in Early Maxillary Sinus Bone Regeneration: A Histological and Immunohistochemical Analysis in Rabbits.

The study aimed to assess the efficacy of using Raloxifene with ultrasonic processing to enhance Bio-Oss®, a bone graft substitute, for maxillary sinus bone height reconstruction. A total of 24 rabbit maxillary sinuses were distributed into three groups, each receiving different treatments: Bio-Oss® only, sonicated Bio-Oss, and sonicated Bio-Oss® with Raloxifene. Surgical procedures and subsequent histomorphometric and immunohistochemistry analyses were conducted to evaluate the bone formation, connective tissue, and remaining biomaterial, as well as the osteoblastic differentiation and maturation of collagen fibers. Results indicated that the sonicated Bio-Oss® and Bio-Oss® groups showed similar histological behavior and bone formation, but the Raloxifene group displayed inflammatory infiltrate, low bone formation, and disorganized connective tissue. The statistical analysis confirmed significant differences between the groups in terms of bone formation, connective tissue, and remaining biomaterial. In conclusion, the study found that while sonicated Bio-Oss® performed comparably to Bio-Oss® alone, the addition of Raloxifene led to an unexpected delay in bone repair. The findings stress the importance of histological evaluation for accurate bone repair assessment and the necessity for further investigation into the local application of Raloxifene. Future research may focus on optimizing bone substitutes with growth factors to improve bone repair.

Sverzut Nasotracheal Tube Support Device: Ergonomic Management and Airway Safety in Cervicomaxillofacial Surgery.

Nasotracheal intubation is the preferred route for general anesthesia maintenance in patients undergoing maxillofacial surgery or dental procedures. However, compression of the tracheal tube may cause superficial necrosis of the nasal wing and deformation of the external nose. Thus, proper fixation of the tracheal tube during nasotracheal intubation is important for the patient's safety as well as that of the medical staff. Recently, a nasotracheal tube support device has been developed; thus, in this study, the aim was to present and describe the Sverzut nasotracheal tube support device and discuss the advantages of its use during nasal intubation in cervicomaxillofacial surgery. Findings from this study show that the Sverzut nasotracheal tube support device can contribute to the stabilization of the nasotracheal tube and all its connectors, aiding in the maintenance of the airway patency and minimizing the complications related to this type of intubation.

Which Histometric Analysis Approach Is More Reliable for Assessing Histological Bone Tissue Samples?

This study aims to evaluate the grid of Merz and ImageJ methods for histometric quantification, verifying which is more reliable and defining which is most suitable based on the time required to perform. Thirty histological samples of maxillary sinuses grafted with xenografts were evaluated using an optical light microscope attached to an image capture camera and connected to a microcomputer. The images were digitalized and recorded as a TIFF image, and the new bone formation was evaluated using the grid of Merz and ImageJ. The Bland-Altman analysis was used to identify the agreement between the methods and determine suitable future research options. The timing of the quantification was also performed to identify a possible advantage. The mean value for the quantification analysis timing for the grid of Merz was 194.9 ± 72.0 s and for ImageJ was 871.7 ± 264.4, with statistical significance between the groups (p = 0.0001). The Bland-Altman analysis demonstrated a concordance between the methods, due to the bias being next to the maximum concordance (-1.25) in addition to the graphic showing the scattering points next to the mean of differences and inside of limits of agreement. Thus, it was demonstrated that the grid of Merz presents reliable outcomes and advantages over the ImageJ methodology regarding the time spent to contour the areas of interest.

Harpoon Suicide Attempt: A Dramatic Experience of the Multidisciplinary Approach.

ABSTRACT: Craniofacial harpoon injuries are extremely rare, especially when caused by attempted suicide. The approach to surgical removal becomes dependent on the characteristics of the device, with or without barbs on the spear, and its path, which presents with significant changes between accidents and suicide attempts. This report presents the successful treatment carried out in a dramatic case of harpoon suicide attempt. The approaches to complete and cautious removal of the spear from the occipital region, reconstruction of the orbital cavity, evisceration of the left eyeball due to amaurosis and psychiatric follow-up were successful, which allowed the restoration of the patient's physical and mental health.

Algorithm for Treatment of Supernumerary Nasal Tooth.

ABSTRACT: The presence of a tooth in the nasal cavity is a rare condition. There is an even more rare association, which is the presence with the mineral's deposition and formation of rhinoliths. This report shows a case of rare nasal tooth associated with rhinolithiasis and describes its surgical treatment based on an algorithm. The diagnosis was made by endoscopy with the aid of computed tomography, followed by surgical endoscopy excision. The algorithm and the proposed treatment was successful in its execution and the patient presents no complaints or complications at 3 years after surgery.

Orbital Trapdoor Facture in Child: More Predictable Outcomes and Less Consequences.

Orbital trapdoor fractures are characterized by tissue entrapment between the fractured bone fragment and the remnant of the orbital floor. This entrapment can result in immediate local and systemic complications and poor outcomes when approached late. This article presents the case of an orbital floor fracture in a child with dystopia, pain, edema and entrapment of the inferior rectus muscle and consequent limitation of ocular motility. The strategy proposed in the early approach to orbital floor reconstruction and release of incarcerated tissue allowed the patient to achieve satisfactory results without morbidity, as compared to the outcomes of corrective sequel surgery.

Lip Synechia Resulting From Toxic Epidermal Necrolysis: A Rare Condition.

Toxic epidermal necrolyses represent a severe epidermolytic reaction characterized by cutaneous erythema and target lesions affecting >30% of the body surface, skin, and mucous membranes. Ulcerative lesions on the labial mucosa may evolve during healing, resulting in rare complications, such as lip adhesions. This report shows the successful treatment of a lip synechia resulting from the healing of mucosal lesions in a patient with toxic epidermal necrolysis caused by the use of Lamotrigine and Ibuprofen. Although the treatment of the presented lip synechia was simple, this sequela can be avoided by measures such as hydration, hygiene and lip lubrication.

Maxillofacial Manifestation of a Giant Dimension Cranial Osteoma.

Osteoma is the most frequent benign tumor in the craniomaxillofacial region. The most common initial manifestation is facial pressure or headache.The clinical examination showed increased volume in the right supraorbital region, asymmetry of the orbital contour, exophthalmia, dystopia, proptosis and clinical restraint of ocular movement for supraversion. The lesion measured approximately 4 cm in diameter with irregular contour. Osteotomy was performed with saw surrounding the tumor, with aid of a surgical piezo on the orbital medial wall.The result of histopathological examination was osteoma. The patient is 2.5 years postoperatively and so far without complications.

Strategy for the Treatment of Zygomatic-Coronoid Ankylosis.

Zygomatic-coronoid ankylosis is a rare complication in maxillofacial trauma. Currently, less of 30 cases reported in the literature. The aim of this study was to report a case of zygomatic-coronoid ankylosis after trauma. A 26-year-old male, with zygomatic-coronoid ankylosis after 7 years of facial trauma, was treated by intraoral bilateral coronoidectomy. However, the literature continues to discuss the best approach, intraorally or extraorally. This study observed that the intraoral approach was easily performed and without 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.

Prospective and Randomized Evaluation of ChronOS and Bio-Oss in Human Maxillary Sinuses: Histomorphometric and Immunohistochemical Assignment for Runx 2, Vascular Endothelial Growth Factor, and Osteocalcin.

PURPOSE: The aim of this study was to compare ChronOS (ß-tricalcium phosphate), Bio-Oss, and their addition to an autogenous bone graft in a 1:1 ratio in human maxillary sinus bone augmentation. MATERIALS AND METHODS: Thirty maxillary sinuses were divided in 5 groups: group 1 included 6 maxillary sinuses grafted with autogenous bone graft alone; group 2 included 6 maxillary sinuses grafted with ChronOS; group 3 included 6 maxillary sinuses grafted with ChronOS and autogenous bone graft in a 1:1 ratio; group 4 included 6 maxillary sinuses grafted with Bio-Oss; and group 5 included 6 maxillary sinuses grafted with Bio-Oss and autogenous bone graft in a 1:1 ratio. The number of samples for each group was determined by the statistical power test. RESULTS: The median areas of new bone formation in groups 1, 2, 3, 4, and 5 were 121,917.0, 83,787.0, 99,295.0, 65,717.0, and 56,230.0 µm2, respectively. Statistically significant differences were found between groups 3 and 5, groups 1 and 4, and groups 1 and 5 (P < .05). The median areas of remaining biomaterial were 2,900.5, 5,291.0, 2,662.0, 56,258.5, and 64,753.5 µm2 in groups 1, 2, 3, 4 and 5, respectively. Statistically significant differences occurred between groups 1 and 5, groups 3 and 5, and groups 2 and 5 (P < .05). Areas of connective tissue were 67,829.0 ± 22,984.6 µm2 in group 1, 97,445.9 ± 18,983.3 µm2 in group 2, 88,256.0 ± 21,820.5 µm2 in group 3, 65,501.8 ± 6,297.6 in group 4, and 70,203.2 ± 13,421.3 µm2 in group 5. CONCLUSIONS: ChronOS combined with autogenous bone graft presented a behavior similar to that of autogenous bone graft alone. However, the groups treated with Bio-Oss showed immuno-labeling results indicating maturation of grafted bone.

Mandibular Reconstruction by Osteogenic Distraction Due to Two Different Injuries.

Varied factors, whether intrinsic or extrinsic, may lead to a decrease in the bone volume of the jaws. Trauma and pathology can be listed as examples of such factors. The aim of this study is to present the osteogenic distraction technique as alternative to augmentation of low mandibular bone volume caused by different etiologies. The first case reports a mandibular marginal resection of ameloblastoma and the second one reports a male patient presenting mandibular fracture sequelae. Both cases were treated according to the osteogenic distraction technique. Several factors have influence on the decision of treatment management of these conditions. Although autogenous bonegraft is considered criterion standard for alveolar reconstruction, its high rates of resorption and the morbidity associated to donor sites lead surgeons to seek for other surgical alternatives such as osteogenic distraction. Therefore, it also aims to expose the advantages and benefits of this technique as well as the satisfactory results achieved.

In vivo evaluation of cp Ti implants with modified surfaces by laser beam with and without hydroxyapatite chemical deposition and without and with thermal treatment: topographic characterization and histomorphometric analysis in rabbits.

OBJECTIVE: We aimed to assess the surfaces of commercially pure titanium implants (cp Ti) with modified surfaces by laser beam (LS) with and without hydroxyapatite (HA) deposition, without (HAB) and with (HABT) thermal treatment. Furthermore, we have compared them with implants with surfaces modified by acid treatment (AS) and with machined surfaces (MS) utilizing histomorphometric and descriptive histologic analyses. MATERIAL AND METHODS: Surface topography characterization was analyzed by scanning electron microscopy (SEM), X-ray energy-dispersive spectroscopy (EDX), and surface roughness (Ra) before implant installation. Forty-five rabbits received seventy-five implants in their left and right tibias and were randomly divided into five groups (n = 5 implants per group): (1) cp Ti implant modified by LS, (2) cp Ti implant modified by laser beam associated with HA deposition without heat treatment (HAB), (3) cp Ti implant modified by laser beam associated with HA deposition with heat treatment (HABT), (4) cp Ti implant with modified surface by means of acid treatment (Master Porous) commercially available (AS), and (5) cp Ti implant with MS commercially available. After 30, 60, and 90 days, the animals were euthanized and the implants and surrounding bone were removed and prepared by a non-decalcified histological process. The percentage of bone-to-implant contact (BIC) and the bone area fraction occupancy (BAFO) between the first three threads was evaluated to the higher cortical region. RESULTS: BIC (%) was statistically superior (p < 0.001) on the LS (69.36 ± 7.91, 71.67 ± 8.79, and 79.69 ± 3.3), HAB (73.22 ± 3.75, 69.48 ± 1.89, and 75.7 ± 4.62), and HABT (65.41 ± 5.51, 71.3 ± 2.5, and 79.68 ± 5.01) compared with AS (49.15 ± 5.76, 41.94 ± 2.85, and 57.18 ± 7.81) and MS (36.69 ± 7.24, 52.52 ± 2.75, and 51.31 ± 6.96) in the 30, 60, and 90-day periods, respectively. BAFO (%) of HAB at 30 days (90.17 ± 6.24) was statistically superior (p < 0.01) to all the other groups. At 60 and 90 days, BAFO of LS (87.17 ± 5.9 and 87.99 ± 2.52), HAB (85.95 ± 3.93 and 82.17 ± 3.65), and HABT (83.27 ± 1.44 and 88.67 ± 2.67) was higher than the AS (77.49 ± 5.83 and 76.42 ± 5.98) and MS (74.01 ± 4.68 and 73.81 ± 4.91). CONCLUSIONS: Collectively, our data indicate that the modified surfaces LS, HAB, and HABT favored the interaction between bone and implant and increased bone formation. In addition, HAB showed higher biological behavior favoring the osseointegration. CLINICAL RELEVANCE: Our study provides evidence that LS, HAB, and HABT-modified surfaces improved bone-to-implant contact and increased bone formation around osseointegrated implants compared to conventional machined implants favoring the osseointegration process.

Bilateral Coronoid Hyperplasia in a 43-Year-Old Patient Treated With Intraoral Coronoidectomy.

The mandibular coronoid hyperplasia can be classified as a congenital or development change of the temporomandibular joint. This condition occurs due to a no-neoplasic growth of the coronoid process to the infratemporal fossa. Thus, this part of the bone impacts in the posterior face of the zygomatic bone causing limitation of the mouth opening. The aim of this paper is to report a clinical case of a 43-year-old male with mouth-opening limitation 28 years ago. After clinical and computed tomographic examinations, he was diagnosed with bilateral mandibular coronoid hyperplasia. The treatment proposed was a bilateral coronoidectomy by intraoral approach. In a 1-month postoperative period, the patient reported improvement of the painful complaints and mouth opening. After 1 year, the patient recovered the mouth opening improving his quality of life and there were no more complaints.

Management of Blowout Fracture With Support of Video Endoscopy in a Pediatric Patient.

Pure orbital fractures have the tendency to occur on medial wall and orbital floor; because these points are more fragile, the endoscopy can be utilized for accomplishing the task of repositioning the herniated content, as well as serving as an additional tool, helping to view the orbital defects through a transantral approach. The presented case is a female patient, 12 years old, who was diagnosed as having a pure blowout fracture, on right orbital floor, type trapdoor, with orbital content herniated toward the maxillary sinus. It was realized that a surgical procedure for reduction of orbital content through video endoscopy, via antral, allowed a great viewing of soft and hard structures, checking the positioning of implants and its relation with the orbital cavity, enabling installing through a small surgical access and minimum detachment, and favoring postoperative recovery.

Dental Infection and Pregnancy: the Lack of Treatment by the Dental Professional Evolving to a Complex Maxillofacial Infection.

Infections of the maxillofacial complex caused by caries disease are common in dental practice. The professionals have to have technical knowledge to treat it at the onset of the condition and avoid the spread to deep anatomical spaces of face and neck, which can implicate in a risk of patients' life.In Brazil, current dental professionals usually denied oral surgical treatments in patients with some clinical conditions, not because of fear to resolve it but for lack of knowledge to treat it. An example of these conditionals is pregnancy. It is well known that during the pregnancy period, the patient can be treated in the correct period of gestation. Early diagnosis is crucial for effective therapy in serious infections. The treatment has to be crucial during pregnancy because of the potentially fatal situation that the disease can create to the pregnant woman and the fetus.The aim of this article is to demonstrate a case of dental caries in a pregnant patient, which was evaluated by other professionals and had the treatment denied, evolving to a serious maxillofacial infection.

Lipoma on the Lower Lip.

Lipoma is a benign tumor of fat tissue, found frequently in subcutaneous tissues. However, oral manifestations are relatively rare. The present patient illustrates the successful treatment of a lipoma treated by complete excision of the lesion. A female patient, 75 years old, presenting lesion in the right oral vestibule where excisional biopsy was performed. The professional must diagnose this type of injury as soon as possible and treat it so that it does not take large proportions, which can result in esthetic and functional sequelae to the patient.