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.

Labio-facial Necrotizing Fasciitis in a Young Patient.

ABSTRACT: Necrotizing fasciitis (NF) is an infection of the deeper tissues that results in progressive destruction of muscle fascia and overlying subcutaneous fat. It has a fast and destructive course. Moreover, it is related to immunosuppression and could be fatal. The aim of this study is to report a clinical case of a young patient, without immunosuppression, who developed NF evolution due to an erroneous diagnosis of abscess at the beginning of the disease. Patient was submitted to broad-spectrum antibiotic therapy and aggressive surgical treatment. Adequate treatment led to a satisfactory evolution in a short period of time. Early recognition and adequate treatment are essential for a favorable prognosis.

Le Fort I Down-Fracture for Management of Midface Tumors.

OBJECTIVE: To perform an integrative review associating current literature with a clinical series regarding the use of Le Fort I osteotomy for the removal of tumors located in the midface and central region of the skull base. METHODS: A systematic review was performed through the PubMed, SCOPUS, and Cochrane databases. In addition, 4 different patients operated using the above-cited technique are described in this study. RESULTS: Initially, 123 articles were found. After the removal of duplicates, and title and abstract reading, 27 articles were selected for data extraction. The Le Fort I surgical approach of tumors was performed in 183 patients. CONCLUSION: The Le Fort I surgical approach allows lesion exeresis with good visualization, low rates of recurrences and complications, and without aesthetic compromises for the patient.

Bone tissue formation around two titanium implant surfaces placed in bone defects filled with bone substitute material or blood clot: A pilot study.

OBJECTIVES: The objective of this study was to evaluate the peri-implant bone tissue formation around titanium implants with different surface treatments, placed in bone defects filled or not with bone substitute material (BSM). MATERIALS AND METHODS: Ten animals were divided into two groups according to implant surface treatment. In each tibia, a bone defect was created followed by the placement of one implant. On the left tibia, the defect was filled with blood clot (BC), and on the right tibia, the defect was filled with biphasic hydroxyapatite/ß-tricalcium-phosphate (HA/TCP) generating four subgroups: BC-N: blood clot and porous surface; BC-A: blood clot and porous-hydrophilic surface; HA/TCP-N: BSM and porous surface; HA/TCP-A: BSM and porous-hydrophilic surface. The animals were submitted to euthanasia 60 days after implant installation. After light-curing resin inclusion, the blocks containing the implant and the bone tissue were stained and evaluated by means of histomorphometry to assess the percentages of bone implant contact (% BIC). Data was normally distributed and the group differences were examined using the parametric tests of Two-Way ANOVA. RESULTS: The BC-A group presented the higher mean value of BIC (46.43%). The HA/TCP-A group presented the higher mean value of BIC. The porous-hydrophilic surfaces presented better results of BIC when compared to the porous surface in both conditions of defect filling. No statistically significant differences were found among all groups (95% confidence interval and P < .05). CONCLUSION: According to histomorphometric analysis, after 60-days in a rabbit model, hydrophilic and hydrophobic surfaces have the same behavior in the presence or absence of HA/TCP.

Large Anterior Oronasal Fistula Repair Using Pedicled Buccal Fat Pad and Fibroepithelial Tissue.

Oronasal fistula (ONF) is the most common complication after palatoplasty in patients with cleft lip and palate (CLP). When left untreated, it may negatively affect the quality of life, leading to development of other comorbidities. This study reports for the first time, the use of a portion of a hyperplasic tissue associated with pedicled buccal fat pad flap to repair a large anterior ONF in a 60-year-old man. The hyperplasic tissue may have developed due to the combination of a loose fitting upper denture and long-term use of dihydropyridine calcium channel blocker (amlodipine besylate). There is controversy in the literature about use of pedicled buccal fat pad flap in the anterior region. However, in this study, we report successful repair of a large anterior ONF using a portion of a fibroepithelial hyperplasic tissue associated with pedicled buccal fat pad flap.

Intranasal Ectopic Tooth in Adult and Pediatric Patients: A Report of Two Cases.

The aim of this study was to report two rare cases of ectopic tooth into the nasal cavity. The first case reports a 32-year-old female patient with the main complaint of having a tooth inside her nose. According to her, this condition causes pain and sporadic nosebleed. The patient had a facial trauma when she was 6 years old. The second case refers to an 8-year-old girl with left incomplete unilateral cleft lip and palate. The main complaint was left-sided nasal obstruction by a white hard mass. The treatment for both cases was surgical removal of the ectopic erupted tooth under general anesthesia. In conclusion, we can state that the surgical removal of intranasal tooth is a safe procedure and improves patient's quality of life.

Comparison of the Stability of Mandibular Sagittal Osteotomy Fixation between Two Types of Titanium Miniplates: A Biomechanical Study in Sheep Mandibles.

This study aimed to compare the biomechanical stability of the fixation of mandibular sagittal split osteotomy of the ramus by two types of titanium miniplates in sheep mandibles. Seven preserved sheep mandibles with similar weight and size were selected, dissected with complete removal of soft-tissue structures, and sectioned in their midline. After performing sagittal split osteotomy, 5 mm of advancement was standardized and samples were divided into two groups according to the type of titanium miniplate (GI = seven hemimandibles were fixed with straight titanium miniplate, GII = seven hemimandibles were fixed with L-shaped titanium miniplates), and then subjected to compressive load. The means (standard deviation) of the compressive load and extension values were 70.68 N (22.26) and 63.36 mm (15.60) to straight miniplates, and 78.80 N (32.54) and 70.55 mm (5.42) to L-shaped miniplates. After comparison and statistical analysis, the results showed no significant difference between the two types of titanium miniplates.

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.

Rabdomyosarcoma of the Mandible: An Uncommon Clinical Presentation.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. Most patients present with a mass in the head and neck region, urogenital region, or with distal extremity involvement. The authors describe a challenging case of a 6-year-old male patient presenting with mandibular RMS. The clinical/radiographic/tomographic evaluations classified the tumor as an advanced stage (stage IV), with a mass of 6.0 cm involving the left side of the mandible and parotid region. The biopsy revealed round, spindled, and pleomorphic cells with hyperchromatic nuclei and rare larger rhabdomyoblasts with eosinophilic cytoplasm. The diagnosis was of embryonal RMS. The patient was referred for treatment with cycles of chemotherapy; however, pulmonary and bone marrow metastasis were identified. Radiotherapy and local surgery with microvascular reconstruction were performed later; however, the patient died after a few months. Early diagnosis is critical for a good prognosis and cure of patients with RMS. Correct diagnosis considering also the histological subtype is important for adequate treatment, which according to the literature is not uniform probably because of the rarity of this neoplasm.

Endoscopic Removal of Displaced Sagittal Intracapsular Condylar Fracture.

Fractures involving the mandibular condyle are among the most common fractures of facial bones and still generate great discussion concerning therapeutic issues. Several factors have influence on the decision of treatment management of these fractures. In some patients, even when there is displacement of fractured fragments, the choice for conservative treatment is made. However, the removal of the condyle fragment may be required. In the oral surgery scope, endoscopy is a procedure used in many areas, and can be helpful to improve the visualization of surgical sites with difficult access. The endoscopic surgery brings benefits to patient such as no scar or minimal scar, lower risk to nerve damage, and decreased of surgical trauma and bleeding. In addition, according to surgeon experience, the surgery may become more dynamic. The aim of this study is to present an endoscopic technique associated with a transoral approach to remove a displaced sagittal intracapsular condyle fragment. Furthermore, to expose the advantages and benefits of this technique as well as the satisfactory results achieved.

Enucleação associada à solução de Carnoy no tratamento de tumor odontogênico ceratocístico / Enucleation associated to Carnoy's solution on treatment of keratocistic odontogenic tumor

Tumor Odontogênico Ceratocístico (TOC) é classificado como uma lesão intraóssea benigna, de origem odontogênica. Apresenta comportamento biológico agressivo e alta taxa de recidiva. Por sua heterogeneidade clínica e histológica, gera controvérsias em relação ao tipo de tratamento. Técnicas, como marsupialização, descompressão, enucleação, ou mesmo, ressecção cirúrgica, são algumas opções de tratamento, podendo associar com outras formas de terapias. O presente trabalho tem por objetivo relatar o caso de um paciente do gênero masculino que apresentava lesão osteolítica na região posterior direita da mandíbula, diagnosticada como tumor odontogênico ceratocístico. O tratamento proposto foi enucleação associada à aplicação de solução de Carnoy. Após 4 anos de pós-operatório, a técnica cirúrgica associada à terapia química mostrou-se eficaz, apresentando resultados satisfatórios. O paciente segue em acompanhamento, sem referir queixas álgicas e funcionais, além de não apresentar alterações estéticas... (AU)

Keratocystic odontogenic tumor is classified as a benign intraosseous and odontogenic lesion. It presents an aggressive biological behavior and great tendency to relapse. Also, it is a pathology that is noteworthy due to its clinical and histological heterogeneity. This diversity reflects on controversies in defining the adequate treatment for these lesions, opting for surgical techniques such as marsupialization, enucleation or resection, even associate with other conservative treatment. By upgrading the knowledge of cell biology, development of diagnostic tests and the improvement of surgical techniques, the treatment of oral diseases suffered major changes in recent decades, making it safer and leading to more predictable results. This study aims to report the case of a male patient, suffering from osteolytic lesion in the posterior mandible, diagnosed as keratocystic odontogenic tumor, which was treated by enucleation associated to application of Carnoy's solution, which is an alternative treatment already described. After 4 years follow-up, proposed treatment has been shown efficient presenting satisfactory results. Patient remains accompanied with no pain and functional complaints as well as no aesthetics alterations... (AU)

Extra-Oral Excision of a Buccal Fat Pad Lipoma.

Lipomas and its variants are common soft tissue tumors, and however occur infrequently in the oral and maxillofacial region. Their incidence in the oral cavity is low among all oral lesions. Oral lipoma is yellowish and soft to palpation, and histologically can be mistaken by other lipoma variants. The aim of this study is to report a case of a lipoma located at the buccal fat pad which was removed through an extra-oral access. A 43-year-old male is presenting an augmentation in the right buccal region, being a soft consistency mobile lesion with 1.5 cm of diameter, asymptomatic, and 2 years of growing. Computed tomography scan showed hypodensity compatible with adipose tissue. The lesion was removed through an extra-oral access. The lipoma described in this clinical report had an unusual location and once the lesion was very superficial an extra-oral access was the first treatment option despite the fact that was a benign tumor.

Surgical Resolution of Bilateral Hypertrophy of Masseter Muscle Through Intraoral Approach.

Masseter muscle hypertrophy is an untypical anomaly with no definite cause and its diagnosis is easily completed through physical examination and imaging examinations. In some cases, patient may report signs and symptoms of well-localizated pain. However, it is generally asymptomatic and patient's chief complaint is about esthetic because of facial asymmetry. In this case, surgery is carefully indicated. The aim of this article is to report a case of a male patient with no painful and functional complaints but an important unease over his facial asymmetry. Patient underwent surgery involving bilateral resection of mandibular angles and unilateral resection of masseter muscle through intraoral approach. Surgical approaches and techniques rely heavily on surgeon. There are few reports in the literature about this anomaly, but those available present several techniques. The surgeon's dexterity and knowledge become extremely important, whereas this procedure is essentiallyesthetic.

The relevance of dental surgeon on Gorlin-Goltz syndrome.

Multiple odontogenic keratocysts could be linked to different conditions. Then, to achieve the correct diagnosis whether their presence is associated to a syndrome, some criteria must be followed. The present study aims to report a case of a 21 years-old male patient whose was referred with several radiolucent lesion on the maxilla-mandibular complex. The lesions were biopsied and the diagnosis of the histological exam hypothesized as odontogenic keratocyst. After complete evaluation, others abnormalities were also found such as calcification of falx cerebri, palmar and plantar pits, and multiple basal cell on feet. The patient was diagnosed with Gorlin-Goltz syndrome and was referred to other medical specialties to adequate follow-up. Dental surgeon represents an important role on correct diagnosis of the Gorlin-Goltz syndrome and could avoid further complications.

The Importance of Early Diagnosis of Retrobulbar Hemorrhage.

Midface fractures usually affect the orbital cavity. This trauma may result in severe and rare consequences such as retrobulbar hemorrhage. This condition requires immediate diagnosis and early intervention to avoid blindness. The treatment usually requires evaluation of an oral and maxillofacial surgeon. This patient report aims to describe a facial trauma resulting in blindness after 4 days. An 83-year-old woman fell and hit her face on the floor. The initial evaluation only found a contusion on her left orbit, and an ophthalmologic examination was not made. After 72 hours, the patient searched for the oral and maxillofacial surgeon, showing blindness of her left eye. Despite the treatment, the vision was not recovered. Blindness can become irreversible 90 minutes after trauma, and this condition must be treated as an emergency.

Surgical treatment of mandibular condyle fracture with bicortical screws: case report

Introduction: Mandibular condyle fractures are, of all facial fractures, those with the greatest controversies in relation to its conduct. Patient systemic condition, location and displacement degree of the fracture, mouth opening amplitude, and occlusion alteration are some factors that influence on the decision on conservative or surgical treatment. Pain, mandibular movement limitation, altered dental occlusion, and facial asymmetry are signs and symptoms that indicate condylar fracture. The surgical treatment consists of surgical fracture reduction and subsequent fixing through titanium miniplates and/or screws. Objective: The aim of this study was to report the case of a patient who had parasymphyseal fracture associated with left mandibular condyle fracture, presenting limited excursive movements of the jaw, pain in function, altered dental occlusion, and bruising on chin region. Case report: Due to the type of fracture and patient systemic condition, we decided to open reduction of fractures and stable internal fixation. Conclusion: At 12-month follow-up, the patient showed significant improvement in both clinical and functional condition, demonstrating the effectiveness of the treatment method and technique.

Análise por Elementos Finitos das Forças Mastigatórias em uma Placa de Reconstrução Mandibular / Assessment of masticatory forces in a mandibular reconstruction titanium plate through finite element analysis

Ressecção cirúrgica é um tratamento radical de algumas patologias que acometem a mandíbula e suas estruturas associadas. A técnica baseia-se na remoção total da lesão com uma margem de segurança em toda a sua dimensão, podendo ser ela marginal ou parcial. A escolha dá-se pela proximidade da extensão da lesão com a margem inferior da mandíbula. Em situações de ressecção mandibular parcial, remove-se parcialmente a margem inferior da mandíbula o que, posteriormente, dificulta a reobtenção da estética e funcionalidade do aparelho estomatognático, sendo a área reconstruída com uma placa de reconstrução óssea. A análise de elementos finitos (AEF) é uma forma de análise matemática, que se fundamenta na divisão de uma estrutura em um número finito de pequenas áreas, denominado de elementos finitos. A essa divisão dá se o nome de "malha". Em geral, a AEF possui a capacidade de modelar matematicamente estruturas, tornando-se possível a aplicação de forças em qualquer ponto e/ou direção. Dessa forma, conseguem-se dados sobre a deformação e o grau de tensão inicial, sendo possível, assim, representar situações in vivo, expressando condições compatíveis com o real. O trabalho visa analisar e simular as tensões geradas pelas forças mastigatórias, com o uso de elementos finitos, em simulação de uma mandíbula reconstruída com placa e parafusos de titânio, após sua ressecção parcial... (AU)

Surgical ressection is a radical treatment of some pathologies that affect the mandible and its structures. The technique is based on total removal of the lesion with a safe margin in all extension of the bone. Partial mandible resection results in a difficult to obtain the aesthetic and functionality of the stomatognathic system. In such cases, is recommended a titanium plate commonly used to mandibular reconstruction. Finite Element Analysis (FEA) is a form of math analysis which is based on division of a structure in a finite number of small areas. In general, FEA has the ability to mathematically model structures making possible applying forces in any point and/ or direction. Thereby, it can bring forth datas of displacement and tension being possible representing in vivo situation. This study aims to analyze and simulate the tensions generated by the masticatory forces, using FEA in a mandibular reconstruction with titanium plate after partial resection... (AU)

Clinical and radiographic evaluation of maxillary central incisors exposure in patients undergoing maxillary advancement.

INTRODUCTION: Patients with dentofacial deformities may undergo orthodontic or orthodontic-surgical treatment. Both modalities can affect esthetics. OBJECTIVE: This study aims to evaluate clinical and radiographic changes in exposure of maxillary central incisors occurring after orthognathic surgery for maxillary advancement. METHODS: A total of 17 patients who underwent orthognathic surgery for maxillary advancement between September, 2010 and July, 2011 were selected. Exposure of maxillary central incisors was evaluated clinically and by lateral cephalograms. Measurements were taken one week before and three months after surgery. Data were paired in terms of sex, age, nasolabial angle, height and thickness of the upper lip, the amount of maxillary advancement, clinical exposure and inclination of maxillary central incisor by statistical tests (CI 95%). RESULTS: After maxillary advancement, incisor clinical exposure had increased even with relaxed lips and under forced smile. Moreover, there was a mean increase of 23.33% revealed by lateral cephalograms. There was an inverse correlation between upper lip thickness and incisors postsurgical exposure revealed by radiographic images (p = 0.002). CONCLUSIONS: Significant changes in the exposure of maxillary central incisors occur after maxillary advancement, under the influence of some factors, especially lip thickness.

Clinical and radiographic evaluation of maxillary central incisors exposure in patients undergoing maxillary advancement

Abstract Introduction: Patients with dentofacial deformities may undergo orthodontic or orthodontic-surgical treatment. Both modalities can affect esthetics. Objective: This study aims to evaluate clinical and radiographic changes in exposure of maxillary central incisors occurring after orthognathic surgery for maxillary advancement. Methods: A total of 17 patients who underwent orthognathic surgery for maxillary advancement between September, 2010 and July, 2011 were selected. Exposure of maxillary central incisors was evaluated clinically and by lateral cephalograms. Measurements were taken one week before and three months after surgery. Data were paired in terms of sex, age, nasolabial angle, height and thickness of the upper lip, the amount of maxillary advancement, clinical exposure and inclination of maxillary central incisor by statistical tests (CI 95%). Results: After maxillary advancement, incisor clinical exposure had increased even with relaxed lips and under forced smile. Moreover, there was a mean increase of 23.33% revealed by lateral cephalograms. There was an inverse correlation between upper lip thickness and incisors postsurgical exposure revealed by radiographic images (p = 0.002). Conclusions: Significant changes in the exposure of maxillary central incisors occur after maxillary advancement, under the influence of some factors, especially lip thickness.

Resumo Introdução: pacientes portadores de deformidades dentofaciais podem submeter-se a tratamento ortodôntico ou ortodôntico-cirúrgico. Ambos podem modificar a estética do paciente. Objetivo: esse estudo tem por objetivo avaliar, clinicamente e radiograficamente, as mudanças na exposição dos incisivos centrais superiores em pacientes submetidos à cirurgia ortognática de avanço de maxila. Métodos: foram selecionados 17 pacientes submetidos à cirurgia ortognática de avanço maxilar no período de setembro de 2010 a julho de 2011. A exposição dos incisivos centrais superiores foi avaliada clinicamente e por meio de radiografias cefalométricas em norma lateral. Essas medidas foram tomadas uma semana antes e três meses depois da cirurgia. Os dados foram, por meio de testes estatísticos (CI 95%), correlacionados por sexo, idade, ângulo nasolabial, altura e espessura do lábio superior, quantidade de avanço maxilar, exposição clínica e inclinação dos incisivos centrais superiores. Resultados: após o avanço maxilar, houve um aumento da exposição clínica dos incisivos tanto com o lábio superior relaxado quanto sob sorriso forçado. Além disso, obteve-se um aumento médio de 23,33% na exposição dos incisivos nas radiografias cefalométricas em norma lateral. Houve correlação inversa entre a espessura do lábio superior e a exposição pós-cirúrgica dos incisivos nas imagens radiográficas (p = 0,002). Conclusão: mudanças significativas na exposição dos incisivos centrais superiores ocorrem após o avanço maxilar, sob influências de certos fatores, especialmente a espessura do lábio superior.

Pharyngeal airspace in patients undergoing orthognathic surgery for mandibular advancement

Aim: To evaluate the increase of pharyngeal airway space (PAS) in patients undergoing mandibular advancement. Methods:A retrospective cross-sectional study was performed in thirteen patients who underwent mandibular advancement and were evaluated by cephalometric tracing in pre and postoperative lateral radiographs. In cephalometric tracing, the PAS was assessed by measuring the distance from the lower portion of the soft palate to the posterior pharyngeal wall (UP-PHW) and from the tongue base to the posterior pharyngeal wall (TB-PHW). Results:Patients' age ranged from 22 to 42 years with an average of 28.54 ± 2.23 years. A preoperative mean of 9.20 ± 4.56 mm in the UP-PHW measure and 10.53 ± 5.84 mm in the TB-PHW measure were obtained. The mean values found for those measurements in the postoperative period were 11.61 mm and 13.95 mm, respectively. There was an average increase of 2.4 mm in the UP-PHW and of 2.95 mm in the TB-PHW. The mean mandibular advancement in evaluated patients was 5 mm. There was no statistical correlation between PAS increase and the amount of mandibular advancement for UP-PHW (p=0.058) and TB-PHW (p=0.53), as there was no such correlation either between PAS increase and the age of patients for UP-PHW (p=0.16) and TB-PHW (p=0.26). A greater effect of the retrolingual dimension in mandibular advancement was observed, with an average increase of 24.52% while in the retropalatal dimension an average increase of 20.75% was obtained. Conclusions:Surgical advancement of the mandible increases the size of the pharyngeal airway space.