Treatment of oral myiasis in a patient with implant-supported fixed prosthesis.

Oral myiasis is a rare parasitic disease that requires immediate treatment once diagnosed. However, no standard treatment protocol can be found in the literature. Through a clinical-surgical report, we present the case of an 82-year-old man with lesions extending through the vestibule and alveolar ridge of the maxilla on both sides, in addition to occupying a large part of the palate, with a considerable number of larvae. The patient was initially treated with a single dose of systemic ivermectin (6 mg orally) and topical application of a tampon soaked in ether. The larvae were then surgically removed and debridement of the wound was performed. A crushed tablet of ivermectin 6 mg was applied topically for 2 days, the remaining larvae were again mechanically removed, and the patient received intravenous antimicrobial therapy. Treatment with systemic and topical ivermectin combined with antibiotic therapy and debridement proved to be effective in treating oral myiasis.

Treatment of oral myiasis in a patient with implant-supported fixed prosthesis

ABSTRACT Oral myiasis is a rare parasitic disease that requires immediate treatment once diagnosed. However, no standard treatment protocol can be found in the literature. Through a clinical-surgical report, we present the case of an 82-year-old man with lesions extending through the vestibule and alveolar ridge of the maxilla on both sides, in addition to occupying a large part of the palate, with a considerable number of larvae. The patient was initially treated with a single dose of systemic ivermectin (6 mg orally) and topical application of a tampon soaked in ether. The larvae were then surgically removed and debridement of the wound was performed. A crushed tablet of ivermectin 6 mg was applied topically for 2 days, the remaining larvae were again mechanically removed, and the patient received intravenous antimicrobial therapy. Treatment with systemic and topical ivermectin combined with antibiotic therapy and debridement proved to be effective in treating oral myiasis.

Guided neural regeneration with autologous fat grafting and oxygen hyperbaric therapy.

The loss of continuity of the nerve structure interrupts the transmission of nerve impulses and leads to the disorganization of functional activities. Many methods, as the use of neurogenic factors, aid in the process of neural regeneration by accelerating or improving peripheral nerves neoformation. The adipose tissue is abundant in the human body, and it has presented promising results in the regeneration of peripheral nerves. We carried out a randomized controlled study in 9 months, using 45 male Wistar rats, 80 days old, and the sciatic nerve was chosen for analysis. The control animals were divided into three groups - Initial group (IG), Final group (FG), and denervated group (DG) - with seven animals each. The experimental groups, with twelve animals each, were polyethylene tube filled with fat (EGF) and polyethylene tube without filling (EGwf). All groups, except IG, were submitted to 10 sessions of hyperbaric oxygen treatment of 1h 45 min in alternating days. Functional evaluation by walking-track was assessed using the Catwalk XT® software and tissues were harvested and stained with 1% toluidine blue for histological analysis. Quantitative data were first analyzed with the Kolmogorov Smirnov normality test. Comparison between the four groups was analyzed by ANOVA followed by Tukey Test. We concluded that hyperbaric oxygen therapy had positive results on morphometric and functional parameters. However, no significant differences were found regarding the use of autologous fat graft.

Treatment of Complex Mandibular Body Fractures and Functional Reimplantation of the Maxillary Alveolar Fragment.

INTRODUCTION: This report aims at demonstrating the treatment of complex mandibular fracture functional reimplantation of the maxillary alveolar fragment (FRAF), denoting the possibility and feasibility of this reduction with an excellent prognosis. Case Report. Patient E.M.S, 25 years old, male, leucoderma, referred to the Emergency Room of our institute. He reported being a victim of physical aggression, occlusal alteration, limitation of mouth opening, sensibility loss in the mentalis region, right infraorbital, and denied visual alteration. On physical examination, during the inspection and palpation, the crackling was observed in the right mandibular region and apical displacement of the maxillary alveolar process, corresponding to elements 13, 14, and 15. CONCLUSION: The rigid fixation of the complex jaw fracture and alveolar maxilla process, through functional reduction, indicated satisfactory applicability, and favorable prognosis.

Treatment of Fracture Sequel in the Mandibular Angle Region.

Because of the anterior disposition on the face and the fragility of the anatomy, the mandible is commonly affected in facial fractures, and the angle region represents 32% of the mandibular fractures; therefore, the objective of the paper was to present a proposal for late correction of the mandibular fracture already consolidated and with occlusal alteration. Patient J.C.P.R., 32, during anamnesis reported loss of sensibility in the mentalis region as well as unilateral posterior open bite for having been a victim of an automobile accident about 1 year and 3 months ago. Physical examination showed elevation in the right mandibular angle region due to the poor positioning of fractured stumps. It has been found that the patient suffered a simple fracture at the mandibular angle, but that had not been treated previously, and it was necessary to treat the fracture sequel. Refraction was performed with a new reduction and fixation through titanium plates and screws, showing that, even being late, the procedure to reduce the fracture sequela was effective, even with the correct functional occlusal adjustment.

PPE tube filled with autologous fat in the repair of peripheral nerve: a new proposal / Tubo PPE relleno con grasa autóloga en la reparación de los nervios periféricos: una nueva propuesta

This study proposes the use of a porous polyethylene (PPE) tube as the conductive element in the regeneration in the sciatic nerve sectioning and evaluates the use of fill with autologous fat. The subject was divided randomly into five groups, 3 control and 2 experimental (PPE tube graft with/ without autologous fat). Each group was selected for functional, histological and morphometric evaluation of the sciatic nerve. Functional analysis of the sciatic nerve occurred through the "footprint" values near -100 refer sectioned sciatic nerve, near 0 (zero) refer to control group. On histological analysis of the experimental groups lots of dense connective tissue replacing nerve tissue was observed. In morphometric analysis the group EGPGf got higher performance in all of variables. The use of PPE has shown promise in nerve regeneration with favorable results when associate with fat as a trophic factor in the regeneration.

Este estudio propone el uso de un tubo de polietileno poroso (PPE) como elemento conductor en la regeneración del nervio ciático seccionado y evaluar el uso de relleno con grasa autóloga. Al azar se formaron cinco grupos, 3 y 2 de control experimental (PPE prótesis tubular con / sin grasa autóloga). Cada grupo fue seleccionado para estudiar la forma funcional, histológica y evaluación morfométrica del nervio ciático. Un análisis funcional del nervio ciático se produjo a través de los valores de "huella", cerca de -100 se refiere al nervio ciático seccionado; cerca de 0 (cero) se refiere al grupo control. En el análisis histológico de los grupos experimentales se observó una gran cantidad de tejido conjuntivo denso que sustituye el tejido nervioso. En el análisis morfométrico, el grupo experimental de injerto de polietileno lleno de grasa (EGPGf) obtuvo un mayor rendimiento en todas las variables. El uso de PPE ha mostrado ser prometedor en la regeneración del nervio, con resultados favorables cuando se asocia con la grasa como un factor trófico en la regeneración.

Intubação submento-orotraqueal: estudo retrospectivo de 2 anos / Orotraqueal submental intubation: two years retrospective study

As lesões e mortes no trânsito configuram-se como um grande problema de Saúde Pública, determinando números elevados de pacientes politraumatizados. Muitos deles apresentam injúrias severas na face, tais como as fraturas panfaciais, em que se faz necessário um procedimento cirúrgico bucomaxilofacial. Em muitos desses casos, exista a impossibilidade de manutenção da via aérea oral ou nasal. A intubação submento-orotraqueal (ISMOT) torna-se um procedimento seguro e efetivo para o manejo das vias aéreas. Este trabalho tem como objetivo realizar um estudo epidemiológico, retrospectivo dos prontuários dos pacientes atendidos no Serviço de Cirurgia e Traumatologia Bucomaxilofacial do Hospital de Base de Bauru no período de janeiro de 2011 a janeiro de 2013. A prevalência da ISMOT foi de 2,36%. O gênero masculino foi o mais acometido, com 72%, e a faixa etária da terceira década de vida (42,85%). Em pacientes submetidos à ISMOT, a etiologia mais presente foram acidentes de trânsito (78,56%), sendo as fraturas de mandíbula associadas a fraturas nasais aquelas mais prevalentes (35,71%). Não foi verificada nenhuma complicação. A ISMOT é um procedimento cirúrgico importante para pacientes com fraturas severas da face, em que a intubação orotraqueal e anasotraqueal estão contraindicadas, apresentando baixa morbidez e um índice de complicações mínimo... (AU)

Injuries and traffic deaths are characterized as a major public health problem determing a large number of polytrauma patients. Many of them have severe injuries on the face, such as panfactials fractures where it is necessary an oral and maxillofacial surgical procedure. In many of these cases there is the impossibility of maintaining the oral or nasal airway. The submental intubation(ISMOT), intubation becomes a safe and effective procedure for airway management. This paper aims to performing an epidemiological retrospective of patients treated at the Surgery and Traumatology Maxillofacial the Base Hospital of Bauru from January 2011 to January 2013. The prevalence of ISMOT was 2.36 %. Male gender was the most affected, with 72 %, and the age of the third decade of life (42.85 %). In patients undergoing ISMOT, the etiology was more present traffic accidents (78.56 %), and fractures of the jaw associated with nasal fractures those most prevalent (35.71 %). There was no any complication. The ISMOT is a major surgical procedure for patients with severe fractures of the face, where oro tracheal intubation and nasotracheal intubation are contraindicated, with low morbidity and complication rate minimum... (AU)

Enxerto com tubo de polietileno poroso preenchido com gordura autóloga no reparo de nervo periférico associado com protocolo de imersão em câmara hiperbárica / Graft with porous polyethylene rod filled with autologous adipocytes in peripheral nerve repair associated with immersion in hyperbaric chamber

Os nervos periféricos são extensões do sistema nervoso central e responsável pela interação das atividades entre as extremidades, em suas funções sensitivas e motoras. São vulneráveis aos mesmos tipos de traumas que afetam outros tecidos: contusão, compressão, esmagamento, estiramento, avulsão e laceração. As lesões de nervos periféricos situam-se entre as mais incapacitantes que acometem indivíduos em idade produtiva, em face dos múltiplos aspectos concernentes às sequelas deste tipo de afecção. Desta forma, a interrupção de continuidade da estrutura do nervo, como no caso da neurotmese, por algum tipo de trauma, resulta na interrupção de transmissão dos impulsos nervosos e na desorganização de suas atividades funcionais. Por meio da utilização da microcirurgia foi possível desenvolver técnicas reparadoras que vão desde simples neurorrafia término-terminal até sofisticados procedimentos cirúrgicos com a utilização de enxertos de nervos, veias e artérias invertidas, tubos sintéticos de materiais variados, tais como silicone e polietileno. Outro aspecto que intriga pesquisadores de todo mundo é a utilização de fatores neurogênicos capazes de acelerar ou melhorar a regeneração de nervos periféricos. A gordura autóloga tem sido continuamente referenciada pela sua abundante oferta, no próprio sitio cirúrgico, apresentando resultados promissores, visto que a adventícia dos vasos é constituída por tecido conjuntivo frouxo, rico em adipócitos. Assim, em um trauma, os neuritos oriundos do coto proximal do nervo lesado, ficam diretamente em contato com esses adipócitos. Seguindo este raciocínio, e com base em trabalhos anteriores onde foi usada veia preenchida com músculo esquelético a fresco como enxerto, decidiu-se testar a possibilidade de crescimento axonal por meio de enxerto com tubo de polietileno preenchido por tecido adiposo autólogo associado a protocolo de imersão em câmara hiperbárica, por meio de um estudo Randomizado Controlado...

The peripheral nerves are extensions of the central nervous system and are responsible for the sensory and motor functions of the limbs. These nerves are vulnerable to the same types of traumas that affect other tissues: contusion, compression, crushing, stretching, avulsion, and laceration. Amongst the most disabling kinds of injuries that affect working-age individuals are those of the peripheral nerves; due to the multifaceted characteristics of the aftereffects of the injury. The break in continuity of the nerve structure due to trauma, as in the case of neurotmesis, results in the disruption of the transmission of nerve impulses and the disorganization of their functions. Through the use of microsurgery, it was possible to develop reconstructive techniques that range from a simple end-to-end neurorrhaphy to sophisticated surgical procedures that utilize nerve grafts, inverted veins and arteries, and synthetic rods of varied materials such as silicone or porous polyethylene. Another aspect that intrigues researchers around the world is the utilization of neurogenic factors capable of accelerating or improving the regeneration of peripheral nerves. Autologous fat has been a constant reference in this field of surgery due to its abundant supply at the surgical site itself. The results are promising, as the adventitia of vessels consists of loose connective tissue rich in adipocytes. Thus in a trauma, the neurites derived from the proximal stump of the damaged nerve are in direct contact with these adipocytes. Following this reasoning, and based on previous studies where veins grafted with fresh skeletal muscle were used, we decided to conduct a randomized controlled study to test the possibility of axonal growth by means of grating with a polyethylene rod filled with autologous adipocytes associated with immersion in a hyperbaric chamber. In an attempt to recover the sciatic nerve, a rod 12 mm in length, with a diameter of 0.25 mm, and with pores...

Mandibular metastasis of adenocarcinoma from prostate cancer: case report according to epidemiology and current therapeutical trends of the advanced prostate cancer.

Prostate cancer represents the most frequent non-cutaneous neoplasia in males. This type of neoplasia can develop peculiar patterns of evolution, presenting, in many cases, precocious relapses and metastasis. Bone metastasis in the mouth is extremely rare, and represents 1% of all malignant mouth neoplasias. The aim of the present study is to report a clinical case of bone metastasis in the mandibular region associated with a tumoral prostate adenocarcinoma, as well as to discuss connected aspects about diagnosis, prognosis and integrated treatment of this condition.

Mandibular metastasis of adenocarcinoma from prostate cancer: case report according to epidemiology and current therapeutical trends of the advanced prostate cancer

Prostate cancer represents the most frequent non-cutaneous neoplasia in males. This type of neoplasia can develop peculiar patterns of evolution, presenting, in many cases, precocious relapses and metastasis. Bone metastasis in the mouth is extremely rare, and represents 1% of all malignant mouth neoplasias. The aim of the present study is to report a clinical case of bone metastasis in the mandibular region associated with a tumoral prostate adenocarcinoma, as well as to discuss connected aspects about diagnosis, prognosis and integrated treatment of this condition.

Ameloblastic carcinoma, primary type: case report, immunohistochemical analysis and literature review.

Ameloblastic carcinoma (AC) is a rare malignant odontogenic neoplasm with scarce reported cases in the literature and it can be confused with benign ameloblastoma (AM). This study reports a case of AC, and presents a literature review of AC classified into primary type (ACPt) or secondary type (ACSt) by the World Health Organization (WHO). The review addressed 31 cases published in the English literature between the years 2005 and 2011. The majority of cases were ACSt. The mandible was the most common site of occurrence for both AC types. All patients who died of their disease had ACSt. Tumors with plexiform pattern, hyperchromatism, mitosis and necrosis were associated with a higher ratio of histories of recurrence and death by disease, as well as the tumors with clear cells, especially in the ACSt. ACSt appeared to correlate with recurrence and mortality. The histological features may have different prognostic importance depending on the AC type.

Ocular reconstruction after zygomatic complex fracture with retention of a foreign body.

Facial injuries with the retention of foreign bodies inside the tissues, both in soft and hard ones, can cause major functional and aesthetic damage. Among the different etiological agents, cutting tools, fragments of a firearm, the splinter of wood, steel, or iron, launched by misuse, or even caused by defects in equipment, are the main cause of these injuries. The aim of this study was to discuss the peculiarity of the multidisciplinary approach in caring of a 33-year-old man, victim of an accident at work, by the rupture of an emery disc and consequent penetration of the fragments in violation of the tissues in the orbital and zygomatic region of the left side, with perforation of the eyeball and orbital-zygomatic fracture. Urgent treatment consisted of debridement of wounds, bleeding control, removal of foreign bodies, fracture reduction with rigid internal fixation, and suture, performed by the oral and maxillofacial surgical team. Reconstruction of orbital tissues by the ophthalmology team consisted of suture of the injuries. About 1 month after the trauma, phthisis bulbi was noted, and the patient underwent a new procedure under general anesthesia for eye evisceration and installation of an alloplastic prosthesis associated with the homogenous sclera. Facial harmony was restored, especially in aesthetics and function of the zygomatic-orbital complex.

Enxerto com tubo de polietileno poroso preenchido com gordura autóloga no reparo de nervo periférico: uma nova proposta

Os nervos periféricos são extensões do sistema nervoso central e responsáveis pela interação das atividades das extremidades, em suas funções sensitiva e motora. São vulneráveis aos mesmos tipos de traumas que afetam outros tecidos: contusão, compressão, esmagamento, estiramento, avulsão e laceração. Desta forma, a interrupção de continuidade da estrutura do nervo, por algum tipo de trauma, resulta na interrupção de transmissão dos impulsos nervosos e na desorganização de suas atividades funcionais. Para tanto, em vista da evolução tecnológica e o desenvolvimento de equipamentos mais sofisticados, a microcirurgia vem ganhando cada vez mais espaço no campo da investigação experimental referente a recuperação de nervos periféricos lesionados. Em uma secção simples, sem perda tecidual, a neurorrafia denominada término-terminal apresenta bons resultados, contudo, quando ocorre perda de tecido nervoso ou, não se têm mais os cotos distais do nervo, outras técnicas devem ser empregadas, até porque, não se pode de modo algum tencionar o nervo numa tentativa de coaptá-lo novamente. Várias técnicas de tubulização utilizando-se materiais biológicos e não biológicos, para criar um meio por onde ocorrerá a regeneração nervosa já foram ou ainda estão sendo testados com resultados insatisfatórios sob o aspecto funcional.É sabido que em um trauma sem perda tecidual, numa neuropraxia, por exemplo, o nervo recupera espontaneamente de forma satisfatória. É sabido também que em um feixe vásculo-nervoso, o nervo periférico encontra-se em íntimo contato com a adventícia de artérias e veias. A adventícia dos vasos é constituída por tecido conjuntivo frouxo, rico em adipócitos. Assim, em um trauma, os neuritos oriundos do coto proximal do nervo lesado, ficam diretamente em contato com esses adipócitos. Seguindo este raciocínio, e com base em trabalhos anteriores onde foi usada veia preenchida com músculo esquelético a fresco como enxerto...

Peripheral nerves are extensions of the central nervous system and are responsible for the interaction of the activities of the extremities in their sensory and motor function. They are vulnerable to these types of injuries that affect other tissues: contusion, compression, crush, stretch, tear and avulsion. Thus, the interruption of continuity of the nerve structure, due to some sort of trauma, results in the interruption of transmission of nerve impulses and disruption of their functional activities. Therefore, in view of technological evolution and development of more sophisticated equipment, microsurgery is gaining more space in the field of experimental research concerning the recovery of injured peripheral nerves. In a single section, without loss of tissue, called the end-terminal neurorrhaphy was also good, however, when there is loss of nervous tissue or, if not longer have the distal nerve stumps, other techniques must be employed, because, in any circumstance the nerve should be tensioned as an attempt to coaptation again. Several techniques of tubing, using biological materials and non-biological means to create a place where nerve regeneration have been or are still being tested with unsatisfactory results in the functional aspect. It is known that in a trauma without loss of tissue, a neuropraxia, for example, the nerve recovers spontaneously and satisfactorily. It is also known that in a neurovascular bundle, the peripheral nerve is in close contact with the adventitia of arteries and veins. The adventitia of the vessels is composed of loose connective tissue rich in adipocytes. Thus, in trauma, the neurites from the proximal stump of injured nerve, are directly in contact with these adipocytes. Following this reasoning, and based on previous work where it was used vein filled with fresh skeletal muscle as a graft, decided to test the possibility of axonal growth by grafting polyethylene tube filled with autologous adipose tissue...