Impact of Anxiety on Health-Related Quality of Life and Symptoms of Burnout in Multi-Professional Residents in Brazil During the COVID-19 Pandemic.

We aimed to determine the prevalence of anxiety and to identify associated factors among multi-professional residents in Brazil during the early days of the COVID-19 pandemic. A cross-sectional study included a sample of 752 multi-professional residents selected by snowball technique. Symptoms of anxiety were measured by the Beck anxiety inventory scale (≥ 16 cut-off). We used WHOQOL-BREF to access the health-related quality of life and the Maslach Burnout Inventory to measure the burnout syndrome. PR and respective 95% confidence intervals (CI) were calculated using the Poisson regression model. The prevalence of anxiety was 41.2% (310/752). Some variables were strongly associated with anxiety: afraid of getting COVID-19; extra work demand during COVID-19 pandemic; sweating/wheezing/increased heart rate during work; feeling safe when using personal protective equipment at work, and psychological support from residence preceptors. Residents with symptoms of anxiety showed high emotional exhaustion at work (36.6 ± 9.6 vs. 24.7 ± 10.7, P = 0.001) and depersonalization (8.9 ± 6.0 vs. 5.6 ± 4.9, P = 0.001). Correlations coefficients between emotional exhaustion versus Physical WHOQOL-BREF and between emotional exhaustion versus Psychological WHOQOL-BREF were significantly lower among residents without anxiety (P = 0.027 and P = 0,03, respectively). The prevalence of anxiety was high and strongly associated with several variables, particularly with being afraid of getting COVID-19, the perception of workload, somatization (sweating, wheezing and increased heart rate during work), feeling unsafe when using personal protective equipment, and lack of psychological support from residence preceptors. Anxiety was associated with increased emotional exhaustion and depersonalization and low health-related quality of life during the COVID-19 pandemic in Brazil. Low WHOQOL-BREF environment domain, and high emotional exhaustion MBI domain increased the chances of presenting symptoms of anxiety.

Distraction Osteogenesis and Customized Temporomandibular Joint Prosthesis in the Reconstruction of a Large Mandibular Defect - A Case Report.

THE RATIONALE: Mandibular resections involve esthetic and functional impairment and impose a challenge during the reconstruction. This case report is a successful reconstruction with distraction osteogenesis (DO) and customized temporomandibular joint (TMJ) prosthesis. PATIENT CONCERNS: A 51-year-old male patient presented with a complaint of facial asymmetry, mastication, and speech difficulties. DIAGNOSIS: As the patient had undergone a hemimandibulectomy procedure 20 years ago, clinical examination showed facial asymmetry. Radiographic examination exhibited the defect and a radiopaque image representing Kirschner's wire. TREATMENT: DO by bone transport was performed, followed by dental implant and TMJ prosthesis placement. OUTCOMES: DO is a viable treatment option in resections, even when the defect was generated by an ancient injury. The follow-up is around 7 years after the osteogenic distraction, with no complaints and functional capacity. TAKE-AWAY LESSONS: The major challenge in mandibular reconstructions through DO is to reproduce the curve of the arch.

Odontogenic Keratocyst: Eight-Year Follow-Up After Conservative Treatment

ABSTRACT: This study aimed to describe the conservative surgical management of odontogenic keratocyst, comparing with clinical and demographic findings in the literature, based on a literature review, using the quality criteria established in the literature for clinical cases and case series. We searched for cases of keratocysts published in four databases. We selected cases of patients followed up at least one year after sugical treatment. We described the case of a patient who was asymptomatic, and the lesion was detected by routine radiographic examination. At the same surgical time, we enucleated the lesion, followed by curettage and drain installation. Currently, there are no signs of disease recurrence. We followed the CARE guidelines (Case Report Guidelines), in this report. Literature review disclosed 27 cases. Keratocyst was frequent in male-adult patients, and the mean follow-up time after surgery was 46.7 ± 28.1 months. The main clinical findings such as association with teeth, location, extension of lesion, and radiographic pattern corroborate the classic pattern of described cases reported by literature with a low general rate of recurrences. In conclusion, conservative treatment was successful for the clinical case described, over an eight-year follow-up. Most of the described studies did not show lesion recurrence after using the conservative surgical treatment. However, we draw attention to the importance of the long follow up period of our case.

RESUMEN: El objetivo de este estudio fue describir el tratamiento quirúrgico conservador del queratoquiste odontogénico, obedeciendo las pautas de CARE (Case Report Guidelines). Los hallazgos clínicos y demográficos en la literatura se compararon basándose en una revisión desarrollada a través de los Criterios de calidad establecidos en la literatura para casos clínicos y series de casos, donde se consultaron cuatro bases de datos para la investigación en salud. La lesión encontrada en el paciente del presente estudio fue detectada en un examen radiográfico de rutina, sin manifestaciones clínicas siendo tratada quirúrgicamente con abordaje conservador. El tratamiento con enucleación, curetaje e instalación de drenaje se instituyó al mismo tiempo quirúrgico y, actualmente, no muestra signos de recurrencia de la enfermedad. De los 27 casos utilizados en la revisión, la lesión predominó en pacientes hombres adultos,con un seguimiento medio de 46,7 ± 28,1 después de la cirugía. Los principales hallazgos clínicos como asociación con dientes, localización, patrón radiográfico y lesión extensa, corroboran el patrón clásico de presentación de la enfermedad descrito en el caso reportado. En conclusión, el tratamiento conservador fue exitoso para el caso clínico descrito, durante un seguimiento de ocho años. La mayoría de los estudios revisados no mostraron recurrencias con el tratamiento quirúrgico conservador empleado, sin embargo, se aconseja realizar un seguimiento a largo plazo.

Uso de corticoides por cirurgiões bucomaxilofaciais do Brasil / Use of corticoids by oral and maxillofacial surgeons in Brazil

Objetivo: verificar a frequência, os tipos e os momentos em que os corticoides são utilizados nos procedimentos como cirurgias de dentes inclusos, cirurgias de instalação de implantes, cirurgias reconstrutivas para implantes, cirurgias ortognáticas, cirurgias de trauma de face e cirurgias de patologias realizadas por especialistas em Cirurgia e Traumatologia Bucomaxilo-Facial (CTBMF) do Brasil. Métodos: O estudo foi realizado mediante uma pesquisa quantitativa em que se utilizou um questionário composto por 25 perguntas aplicado a 70 especialistas em Cirurgia e Traumatologia Bucomaxilofacial que compareceram a um evento científico do Colégio Brasileiro de Cirurgia e Traumatologia BucoMaxiloFacial. Resultados: a utilização de corticoides foi frequente em todos os procedimentos investigados no questionário, principalmente nas cirurgias ortognáticas em que 100% dos participantes confirmaram o uso. A variação nos regimes de uso de corticoides foi significativa. Constatou-se o uso de diferentes tipos de corticoides, sendo a dexametasona o fármaco que prevaleceu. Quanto às doses, percebeu-se, também, grande variação entre as respostas. Conclusão: em geral, os corticoides, da forma como são, frequentemente, administrados pelos cirurgiões bucomaxilofaciais nos diversos procedimentos cirúrgicos, parecem ser seguros, sobretudo no pré-operatório de cirurgias ortognáticas; porém, sua efetividade pós-operatória ainda é questionável.

Objective: to verify the frequency, types and moments that corticosteroids are used in procedures such as included teeth surgeries, implant installation surgeries, reconstructive implant surgeries, orthognathic surgeries, facial trauma surgeries and surgeries of pathologies performed by specialists in Oral Maxillofacial Surgery and Traumatology - Facial (CTBMF) from Brazil. Methods: The study was conducted through a quantitative survey using a questionnaire consisting of twenty-five questions applied to seventy specialists in Oral Maxillofacial Surgery and Traumatology - Facial who attended a scientific event of the Brazilian College of Oral Maxillofacial Surgery and Traumatology - Facial. Results: The use of corticosteroids was frequent in all procedures investigated in the questionnaire, mainly in orthognathic surgeries in which 100% of the participants confirmed the use. The variation in corticosteroids use regimes was significant. The use of different types of corticosteroids was detected, with dexamethasone being the drug that prevailed. As for the doses, there was also a great variation among the responses. Conclusion: In general, corticosteroids as they are often administered by oral maxillofacial surgeons in various surgical procedures seem to be safe especially in the preoperative period of orthognathic surgery, but their postoperative effectiveness is still questionable.

Redução transcutânea de fratura de seio frontal sob anestesia local: relato de caso / Transcutaneous reduction of fracture of frontal sinus under local anesthesia: a case report

As fraturas do osso frontal são um problema pouco comum, quando comparadas a outros tipos de fraturas faciais. Ocorrem em cerca de 2 a 15% dos traumas de face. O osso frontal localiza-se em uma área nobre, próxima a estruturas importantes, como os olhos e o nariz, com a função de proteger a porção fronto-encefálica. quando traumatizado, pode produzir lesões nessas estruturas, além de importantes deformidades estéticas faciais. Os principais agentes etiológicos são os acidentes ciclísticos e motociclísticos 44-85%, as agressões físicas e quedas, havendo um maior acometimento entre os pacientes jovens (20-30 anos) e do gênero masculino (66-91%). O exame clínico, associado a exames de imagens de boa qualidade, são essenciais para auxiliar no diagnóstico e tratamento desse tipo de fratura, pois fornecem dados quanto à severidade do trauma e ao envolvimento de outras fraturas faciais, o que influencia a modalidade de tratamento a ser adotado. Dentre as formas mais comuns de tratamento, estão as abordagens via acessos translesionais, supraciliares ou por incisões coronais. O presente trabalho tem o objetivo de abordar e discutir o tema com a apresentação de um caso clínico de fratura da parede anterior do seio frontal tratado sob anestesia local.

Frontal bone fractures are an unusual problem compared to other kinds of fracture of facial bones, occurring in approximately 2 to 15% of facial traumas. The frontal bone is in a prime area, adjoining important structures such as the eyes and nose, and has a protective function for the anterior cephalic portion. When traumatized, it can produce lesions in these structures, as well as major aesthetic facial deformities. The main etiological agents are cycling and motorcycle accidents (44-85%), physical aggressions, and falls, and there is a higher incidence among young patients (20-30 years) and males (66-91%).The clinical examination, in association with high quality imaging studies, is essential for the diagnosis and treatment of this type of fracture because they provide data on the severity of the trauma the involvement of other facial fractures, which influences the type of treatment to be employed. among the commonest forms of treatment are the supraorbital approach, translesional pressure or coronal incisions. The present study sets out to approach the subject through the presentation of a case of anterior wall fracture of the frontal sinus treated under local anesthesia.

Oral findings in patients with mucolipidosis type III.

Mucolipidosis type III is a rare, autosomal recessive disorder, which is part of a group of storage diseases as a result of inborn error of lysosomal enzyme metabolism. It is characterized by the gradual onset of signs and symptoms affecting the physical and mental development as well as visual changes, heart, skeletal and joint. Although oral findings associated with mucolipidosis type II have been extensively reported, there is a shortage of information on mucolipidosis type III. This paper presents radiological and histological findings of multiple radiolucent lesions associated with impacted teeth in the jaw of a 16 year-old youngster with mucolipidosis type III.

Oral findings in patients with mucolipidosis type III

Mucolipidosis type III is a rare, autosomal recessive disorder, which is part of a group of storage diseases as a result of inborn error of lysosomal enzyme metabolism. It is characterized by the gradual onset of signs and symptoms affecting the physical and mental development as well as visual changes, heart, skeletal and joint. Although oral findings associated with mucolipidosis type II have been extensively reported, there is a shortage of information on mucolipidosis type III. This paper presents radiological and histological findings of multiple radiolucent lesions associated with impacted teeth in the jaw of a 16 year-old youngster with mucolipidosis type III.

A mucolipidose tipo III é uma doença rara, autossômica recessiva, que faz parte de um grupo de doenças de depósito, decorrentes do erro inato do metabolismo das enzimas lisossômicas. Caracteriza-se pelo aparecimento progressivo de sinais e sintomas com repercussão no desenvolvimento físico e mental, bem como alterações visuais, cardíacas, esqueléticas e articulares. Apesar de achados bucais estarem bem relatados em associação à mucolipidose tipo II, esse artigo descreve achados radiográficos e histológicos de múltiplas lesões radiolúcidas, associadas a dentes inclusos nos maxilares, em uma jovem de 16 anos de idade com mucolipidose tipo III.

Aparelho extrabucal como recurso auxiliar para alinhamento e nivelamento no tratamento orto-cirúrgico de má oclusão Classe III esquelética / Headgear as an aid of alignment and leveling for skeletal Class III orthodontic surgical approach

Quando bem indicado, o tratamento ortodôntico cirúrgico consiste na abordagem ideal para adultos portadores de má oclusão Classe III esquelética. Para potencializar os resultados estéticos decorrentes da cirurgia ortognática, a fase de alinhamento e nivelamento do arco superior deve ser realizada com o mínimo de inclinação e projeção, ou até mesmo, retroinclinação dos incisivos superiores. No período pré-cirúrgico, a força extrabucal bilateral de 150 gF foi aplicada por 12 meses aos primeiros molares superiores de um paciente colaborador, do gênero masculino, 22 anos de idade, portador de má oclusão Classe III esquelética, para promover controle da inclinação mesial e da projeção dos dentes superiores. Os parâmetros oclusais requeridos para a translação cirúrgica das bases ósseas foram obtidos sem a necessidade de extrações, permitindo que o tempo total de tratamento fosse de 37 meses, tendo o paciente mostrado estabilidade no acompanhamento por 3 anos após remoção do aparelho. Esses achados mostram que apesar de depender grandemente da colaboração dos pacientes, quando bem indicado, o aparelho extrabucal consiste em uma alternativa para promover as descompensações dentárias no período pré-cirúrgico, a fim de possibilitar a correção cirúrgica das más oclusões Classe III esqueléticas

When well indicated, the orthodontic surgical approach is the ideal treatment mean for Skeletal Class III adult patients. To improve facial esthetic results from orthognatic surgery, the leveling and alignment of maxillary dental arch must be achieved with minimal inclination and projection or even retro-inclination of anterior upper teeth. During a pre-surgical phase of 12 months, headgear bilateral force of 150 g/F was applied to the upper molars of a 22 years old male compliant patient with Class III skeletal malocclusion, to provide an upper teeth control of mesial tipping and projection during alignment and leveling. The ideal occlusal parameters required for surgical procedure were achieved without dental extractions permitting a total treatment period of 37 months. The outcomes remained stable over 3 years follow up after the removal of the appliance. The results indicate that, although headgear use depends greatly on patient compliance, when well indicated it is an interesting alternativetopromote dentaldecompensationon pre-surgical period, in order to allow surgical correction of skeletal Class III malocclusion

Complicações patológicas associadas a terceiros molares não irrompidos / Pathological complications associate the third molar not impacted

O objetivo deste trabalho foi caracterizar, a partir do exame radiográfico, a distribuição de terceiros molares não irrompido (TMNI) e as alterações patológicas associadas a estes dentes. Foram examinados 59 pacientes e 102 TMNI. Destes 44,1 por cento se encontravam na maxila e 55,8 por cento na mandíbula. 78,4 por cento apresentavam inclusão submucosa e 21,5 por cento estavam em situação intra-óssea. Em relação a profundidade da oclusão, 35,2 por cento estavam em alto nível oclusal e 29,4 por cento em profundo nível oclusal. O espaço para irrupição foi considerado suficiente em 15,6 por cento dos casos, reduzido em 54,9 por cento e sem espaço em 29,4 por cento dos casos. O espaço pericoronário foi considerado normal em 94,1 por cento dos casos e aumentado em 5,8 por cento dos casos. Reabsorção do dente incluso ou do segundo molar foi observada em apenas 2 por cento dos casos. A altura do osso alveolar foi considerada normal em 42 por cento dos casos, ligeiramente reduzida em 46 por cento e severamente reduzida em 9,8 por cento dos casos. 23,5 por cento dos casos apresentavam dilaceração radicular. O percentual de alterações patológicas consideradas como indicação para extração (aumento do espaço pericoronário, reabsorção do segundo ou terceiro molar e perda severa de osso na distal do segundo molar) foi de 17,6 por cento