Impact of different anesthetic approaches on the outcomes of temporomandibular joint arthrocentesis: a systematic review.

PURPOSE: To assess the impact of different types of anesthesia on the outcomes of arthrocentesis of the TMJ. METHODS: Electronic databases were searched to identify peer-reviewed studies, followed by reference list search and further hand-searching. Randomized clinical trials and controlled studies were considered for inclusion when comparing at least two anesthetic approaches. The risk of bias was assessed using the Cochrane risk of bias tool. RESULTS: Of a total of 506 potentially eligible studies, only a randomized controlled clinical trial and an observational study were included. The former compared some outcomes of arthrocentesis under local and general anesthesia and the latter under sedation and general anesthesia. Moreover, both studies were judged as "high risk of bias." CONCLUSIONS: In general, there appears to be a slight trend toward better outcomes of arthrocentesis for internal TMJ derangements (Wilkes grades I to III) when performed under general anesthesia; however, given that the available evidence is remarkably limited and a high risk of bias was detected within the included studies, a definitive statement cannot be made.

Evaluation of the impact of preoperative use of dexamethasone and cyclobenzaprine in surgical extraction of lower third molars on trismus by electromyographic analysis.

PURPOSE: The aim of this study was to evaluate the influence of cyclobenzaprine and dexamethasone on ​the electrical activity of the masticatory muscles in patients who had undergone lower third molar surgery. METHODS: Thirty bilateral impacted lower third molars with indication of extraction were randomised into three groups: the control group, the dexamethasone, and the cyclobenzaprine group. To obtain muscular electrical activity and mouth opening, an electromyographic device was used at mandibular rest and maximum voluntary contraction and compared pre- and post-operatively. RESULTS: During muscle contraction, no significant difference was observed in the electromyographic records on the non-operated side. On the operated side, there was a reduction in electrical activity for both drugs pre-operatively and immediately post-operatively compared to the control group. All pharmacological agents promoted a higher mouth opening compared to control group. CONCLUSION: The results suggest that dexamethasone and cyclobenzaprine may be useful as an adjuvant in the prevention of motor dysfunctions in third molar surgery.

Prevalence of the systemic inflammatory response syndrome in patients who underwent orthognathic surgery.

PURPOSE: The systemic inflammatory response syndrome (SIRS) is the body's response to an insult, such as infection, trauma, burn, and surgical stress linked to several factors deemed potential for multiple organ failure if left untreated. Thus, the aim of this paper was a prospective study to examine the incidence of SIRS in postoperative patients who underwent orthognathic surgery from June/2013 to July/2016. METHODS: The sample consisted of 80 patients who underwent bimaxillary orthognathic surgery, with data on vital signs and white blood cell count collected preoperatively, and the same data collected in the immediate postoperative period, in addition to CO2 pressure in arterial blood by blood gas analysis. The data were tabulated and cases of SIRS (2 or more signs out of four pre-set signs) were identified within 24 h after surgery. RESULTS: From the sample of 80 patients, 26 (32.5% of total) patients had SIRS with higher incidence in females who are 40 years old. CONCLUSION: The incidence of patients who develop SIRS after orthognathic surgery is relatively high and we should pay attention to the possible complications that these cases can evolve.

Is dipyrone effective as a preemptive analgesic in third molar surgery? A pilot study.

PURPOSE: Studies on preemptive analgesia in maxillofacial surgery have shown several controversial clinical results, mainly due to the absence of a methodological standard, besides a wide variety of studied drugs. This study intended to answer the following hypothesis: Is the administration of dipyrone preemptively capable of decreasing trans- and postoperative pain in the third molar surgical extraction? METHODS: A pilot prospective double-blind placebo-controlled study was carried out with 25 patients submitted to the third molar surgical extraction at two moments, one side in each intervention. Dipyrone (1 g) was preemptively administered (study group) for the extraction of two third molars on the same side and, in a second surgical procedure, dipyrone (1 g) was administered in the immediate postoperative period (control group). Evaluated variables were the amount of anesthetic, pain perceived through the visual analogue scale (VAS) in transoperative and immediate postoperative periods, and over 12-h investigation period, analgesic consumption, duration of surgery, and time to rescue analgesia. RESULTS: The results were submitted to Student's t test and statistical differences were observed in transoperative (p < 0.05) and immediate postoperative (p < 0.01) periods, while the other studied variables did not present statistical differences. CONCLUSION: The preemptive administration of dipyrone decreased the perception of transoperative and immediate postoperative pain when compared to its use after surgery only.

Oral dexamethasone decreases postoperative pain, swelling, and trismus more than diclofenac following third molar removal: a randomized controlled clinical trial.

PURPOSE: The aim of this study was to compare the anti-inflammatory potential of two pharmacotherapy protocols based on the parameters of pain, trismus, and swelling, after extraction of third molars. METHODS: Thirty patients selected with symmetrical impaction of third molars were submitted to surgical procedures in both sides in different times. For one group, dexamethasone was used for 3 days, and for another group diclofenac sodium was also used for the same period. The main variables analyzed were the visual analogue pain scale (VAS), but others were also analyzed such as swelling and trismus, which were submitted to statistical analysis. RESULTS: The results had no difference regarding the length of procedures (p = 0.986) and the pain in the immediate and 4-h postoperative period (p = 0.723 and 0.541). The rescue analgesic consumption was higher (p < 0.05) when using the protocol with diclofenac sodium. The variables mouth opening (p < 0.05) and swelling (p < 0.05) were significantly better when using the protocol with dexamethasone in the postoperative period. CONCLUSIONS: Medical protocol with the use of dexamethasone in the postoperative period was more effective in controlling pain, trismus, and swelling, after the extraction of third molars, when compared to diclofenac sodium.

Evaluation of cyclic and linear mechanical resistance of prebent and manually-bent plates used for maxillary advancement in orthognathic surgery.

The aim of the present study was to compare prebent and manually-bent plates used in maxillary advancement. The prebent plates were fixed in polyurethane blocks for the linear test and aluminium blocks for the cyclic test, and the manually-bent plates were fixed in polyurethane and aluminium blocks. The linear load tests were done using an Instron® 4411 mechanical testing machine and the cyclic test with an Instron® E3000 testing machine. The linear mechanical test showed that there was no significant difference between the plates. In the cyclic test the prebent plates reached the limit of 500000 cycles without fracturing whereas the manually-bent plate group fractured before reaching the limit of cycles (p=0.008). The decision to use prebent or manually-bent plates during operations should be influenced by the production of the bends and their consequent brittleness.

Abducens palsy after temporomandibular joint arthroscopy: a rare complication.

BACKGROUND: Arthroscopy of the temporomandibular joint (TMJ) is a minimally invasive and safe procedure; nevertheless, some accidents and complications have been described in the literature. CASE REPORT: The purpose of this article is to describe a case report of a patient that progressed to paralysis of the abducens nerve after a TMJ arthroscopy procedure.

Comparison of postoperative stability of three rigid internal fixation techniques after sagittal split ramus osteotomy for mandibular advancement.

INTRODUCTION: The aim of this investigation was to compare the skeletal stability of three different rigid fixation methods after mandibular advancement. MATERIAL AND METHODS: Fifty-five class II malocclusion patients treated with the use of bilateral sagittal split ramus osteotomy and mandibular advancement were selected for this retrospective study. Group 1 (n = 17) had miniplates with monocortical screws, Group 2 (n = 16) had bicortical screws and Group 3 (n = 22) had the osteotomy fixed by means of the hybrid technique. Cephalograms were taken preoperatively, 1 week within the postoperative care period, and 6 months after the orthognathic surgery. Linear and angular changes of the cephalometric landmarks of the chin region were measured at each period, and the changes at each cephalometric landmark were determined for the time gaps. Postoperative changes in the mandibular shape were analyzed to determine the stability of fixation methods. RESULTS: There was minimum difference in the relapse of the mandibular advancement among the three groups. Statistical analysis showed no significant difference in postoperative stability. However, a positive correlation between the amount of advancement and the amount of postoperative relapse was demonstrated by the linear multiple regression test (p < 0.05). CONCLUSION: It can be concluded that all techniques can be used to obtain stable postoperative results in mandibular advancement after 6 months.

Prevalence and treatment of dentofacial deformities on a multiethnic population: a retrospective study.

INTRODUCTION: The purpose of the present study was to retrospectively analyze patients with dentofacial deformities attending a reference center in a Brazilian educational institution who sought orthosurgical treatment. MATERIAL AND METHODS: The medical records of 251 patients who sought treatment from 2003 to 2011 at Piracicaba Dental School, State University of Campinas (Unicamp) were analyzed. The exclusion criteria were as follows: patients presenting syndromes and labiopalatal clefts; in addition, incomplete records were excluded from the study. RESULTS: The prevalence of dentofacial deformities was greater in women (60.93 %), as well as leukoderma patients (69.22 %). The main motivation for treatment was functional (52 %), followed by esthetics (27 %). As for skeletal pattern, class III was the most incident (55 %), followed by class II (29.5 %) and class I (15.5 %). Regarding the type of deformity, class I patients had predominantly maxillary atresia (53 %). In the case of class II patients, the main deformity was anteroposterior mandibular deficiency (89 %), and in class III, anteroposterior maxillary deficiency (51 %). DISCUSSION: The results of the present study suggest that the profile of patients bearing dentofacial deformities in this population is composed of mostly young women motivated by functional issues, and class III skeletal deformity is the most common.

Biomechanical strength analysis of mini anchors for the temporomandibular joint.

INTRODUCTION: The usage of mini anchors for the treatment of internal derangements of the temporomandibular joint (TMJ) is considered an innovative treatment, and it has presented excellent clinical results in the stabilization of the articular disc. This study aimed to evaluate, through mechanical tensile testing, the resistance of mini anchors for TMJ articular disc repositioning. MATERIALS AND METHODS: Ten thermoplastic polymer poly-ether-ether-ketone (PEEK) mini anchors were tested in artificial polyurethane blocks with a pullout test in a mechanical Instron™ machine, model 4411. The mini anchors were pulled out until failure and the force and displacement were recorded for each specimen. A small standard deviation was noted, which indicated reproducibility. RESULTS: The findings indicate that Cillen™ mini anchors presented a mean force at failure up to 46.1 N with similar values in the scientific literature. Nevertheless, further studies should be conducted for a comparison of PEEK mini anchors with other commercially available anchors, in addition to studies related to PEEK, a scarcely known material in the dentistry field.

Nasotracheal tube wire support: a safety device in maxillofacial surgery technical note after five years of experience.

A well fixed endotracheal tube is essential for safety during general anesthesia. In maxillofacial surgeries, securely fixing a nasotracheal tube in place has always been problematic. The aim of this article is to describe a simple but effective technique to fasten the nasotracheal tube using a wire support that allows a full range of head movement without interference in the surgical field. During the last 5 years, this device was successfully used in almost two hundred patients with very few complications.

Biomechanical analysis on diferente fixation techniques for treatment of mandibular body fractures

Aim: To biomechanically analyze two fixation techniques in polyurethane hemi-mandibular bodyfractures, using a universal testing machine. Methods: The study employed 10 polyurethanehemi-mandible replicas, which simulated simple fractures of the mandibular body, divided into twogroups: one group comprised 5 hemi-mandibles with two 2.0 mm system plates in the tension andcompression zones, while the other group contained 5 hemi-mandibles with an Erich bar and a2.0 mm system plate in the tension and neutral zones, respectively. Data were analyzed statisticallyby the Student’s t-test (α=0.05) Results: The test results indicated that the fixation using 2.0 mmsystem plates offered significantly more resistance to the loads and presented significantly largerdisplacement compared to the fixation using just one 2.0 mm system plate and the Erich bar.Conclusions: It may be concluded that the use of two plates in the 2.0 mm system had greatermechanical strength than a single 2.0 mm plate combined with an Erich bar. Clinically, it is knownthat both techniques can provide good results, but patients receiving the combination of Erich barand one plate are required to be more cooperative during the postoperative period, especiallywith respect to the prescribed diet in order to avoid failures in this system.

A comparative evaluation of the hybrid technique for fixation of the sagittal split ramus osteotomy in mandibular advancement by mechanical, photoelastic, and finite element analysis.

OBJECTIVE: This study evaluated the mechanical characteristics and stress distribution of the hybrid technique fixation of the sagittal split ramus osteotomy. STUDY DESIGN: In the mechanical test, 10 polyurethane replicas of human hemimandibles of each group were submitted to linear loading test. For the photoelastic evaluation, 3 hemimandible replicas of photoelastic resin were subjected to photoelastic analysis. In the finite element analysis, 3 computer models simulated the displacement and the results of maximum principal stress were analyzed. RESULTS: The results of this study demonstrated that the fixation technique with 3 bicortical screws presented better mechanical resistance and stress distribution pattern when compared with the hybrid technique that, on the other hand, presents better results in comparison with a miniplate and monocortical screws. CONCLUSIONS: The results suggest that the hybrid technique increased the resistance and improved stress distribution of miniplate/monocortical screw fixation, maintaining most of the advantages of this technique.

Estudio radiográfico prospectivo de la reparación ósea en sínfisis mandibular posterior a la remoción ósea de mentón / Radiographic prospective study of osseous repair in mandibular symphysis after chin bone remove

El retiro de hueso de sínfisis mandibular ha sido utilizado ampliamente para diferentes procedimientos reconstructivos maxilofaciales. El objetivo de esta investigación fue establecer la existencia de la reparación ósea en el defecto creado en sínfisis debido al retiro de hueso. Treinta pacientes (22 mujeres, 8 hombres) de entre 21 y 65 años fueron operados para retirar hueso de mentón que fue posteriormente aplicado en reconstrucción ósea alveolar; las cirugías fueron realizadas por dos cirujanos maxilofaciales y los pacientes fueron evaluados con telerradiografías en la etapa preoperatoria, postoperatoria inmediata (PIn) y postoperatoria tardía (PTar), donde se realizaron medidas horizontales y verticales del defecto óseo; los valores fueron estudiados con la prueba t de Student con valor de p<0,05. Luego del retiro óseo se observó un defecto vertical promedio de 12,80+/-1,99 y horizontal de 8,33+/-1,77; luego de un año, se obtuvo una disminución de 32,8 por ciento en el sentido vertical y 50,3 por ciento horizontal, presentando significancia estadística en relación al PIn. Se concluye que existe reparación ósea del defecto originado en sínfisis siendo próximo al 30 por ciento-50 por ciento en la evaluación de un año posterior a la cirugía.

Bone harvest of mandibular symphysis has been used in maxillofacial reconstruction procedures. The aim of this research was to establish the presence of bone repair into osseous defect caused by removal of bone. Thirty patient s, 2 female and 8 male, ranging between 21 and 65 years of age underwent surgery for chin bone harvest and alveolar reconstruction. The surgery was performed by two maxillofacial surgeons and the patients were evaluated with lateral radiography in the pre-operatory stage, in early post-operatory and in late post-operatory stages. Horizontal and vertical measures of bone defect were realized; the dates were analyzed by Student t test with a value of p<0.05. After bone harvest, a vertical defect of 12.80 +/-1.99 was observed and a horizontal defect of 8.33 +/- 1.77 was observed. After one year the defect decreased to 32.8 percent in vertical evaluation, and 50.3 percent in the horizontal evaluation with a statistical significance (p<0.05) in relation to the early post-operatory stage. Therefore, we conclude that in bone repair of mandibular symphysis defect is close to 30 ­ 50 percent in a one-year follow-up.

Cervicofacial pain associated with Eagle's syndrome misdiagnosed as trigeminal neuralgia.

BACKGROUND: Eagle's syndrome is characterized by the symptoms of recurrent throat pain, pharyngeal foreign body sensation, dysphagia, referred otalgia, and neck pain. The treatment for Eagle's syndrome can be pharmacologically, surgically, or both. The surgical management consists of two major procedures: the transoral approach or the extraoral-cervical approach. CASE REPORT: A 64-year-old patient with a severe cervical pain on the left side was evaluated with no defined diagnosis. During physical examination, an elongated styloid process could be palpated and with CT scan image, the Eagle's syndrome diagnosis was done. The patient was successfully submitted to surgical resection of the elongated styloid process on the left side by an extraoral-cervical approach. After 6 months follow-up, the patient referred no symptom after the surgical treatment. CONCLUSION: The extraoral/cervical approach is a safe alternative that achieves adequate treatment of Eagle's syndrome.

Mandibular buccal bifurcation cyst: a case report and literature review.

The mandibular buccal bifurcation cyst is a cystic lesion occurring on the buccal surface of the permanent mandibular first molar in 6- to 8-year-old children. The purpose of this article was to present a case report of an 8-year-old with a radiolucent area on the permanent mandibular left first molar, with clinical, radiological, and histological characteristics compatible with the pathological entity mentioned. The treatment adopted in this case was enucleation without extraction. The patient is still under observation without any sign of recurrence.

Aspergillosis of the maxillary sinus associated with a zygomatic implant.

BACKGROUND: The use of a specially designed implant to be anchored in the zygomatic bone has been proposed in the literature as an alternative to bone grafting in the prosthetic rehabilitation of the severely resorbed maxilla, an option that has few postoperative complications. However, some complications can arise, such as the fungal infection the authors describe in this article. CASE DESCRIPTION: The authors report a case of aspergillosis of the maxillary sinus after zygomatic implant placement. Twelve months after placement of the implant, the patient returned with symptoms of sinusitis, and a computed tomographic scan showed failure in zygomatic implant osseointegration and a radiopaque mass in the left maxillary sinus. The implant was removed, as was a friable brownish-yellow mass from the sinus. Histopathological analysis revealed a noninvasive hyphal mass compatible with Aspergillus. At a 12-month follow up, the patient experienced no recurrence of fungal sinusitis. CONCLUSION AND CLINICAL IMPLICATIONS: Zygomatic implant placement is a safe surgical procedure. Nevertheless, postoperative maxillary sinus infections by bacteria, virus and fungus can occur and therefore need to be considered in the diagnosis of infection in the vicinity of dental and maxillofacial implants.

Barotrauma pulmonar durante anestesia geral para procedimento cirúrgico de traumatismo facial / Pulmonary barotrauma during general anesthesia for facial trauma surgical procedure

Um dos possíveis traumas que pode acometer o paciente durante a anestesia geral é o chamado barotrauma, cuja origem for a partir de um pneumotórax hipertensivo. Esse tipo de trauma pode trazer graves riscos ao paciente, se não for rapidamente identificado e tratado. Dessa forma, o objetivo desse artigo é o de apresentar um relato de caso, apresentando as condutas de diagnóstico e terapêuticas que foram adotadas bem como fazer uma revisão da literatura sobre o tema.

One of the possible injuries that may affect the patient during general anesthesia is known as barotrauma, which originates from a hypertension pneumothorax. This type of trauma may represent a serious risk to the patient if it is not promptly identified and treated. In view of this, the aim of this article is to report a case of hypertension pneumothorax, its diagnosis and treatment, as well to review the literature on this subject.

Comparative biomechanical and photoelastic evaluation of different fixation techniques of sagittal split ramus osteotomy in mandibular advancement.

PURPOSE: The aim of the present study was to comparatively evaluate the resistance and tension areas created after load incidence in different varieties of sagittal split ramus osteotomy fixation techniques. MATERIALS AND METHODS: Fifty synthetic polyurethane hemimandible replicas were subjected to linear loading tests to evaluate 4 fixation techniques of the sagittal split ramus osteotomy using 2-mm system plates and screws. The hemimandibles were fixed with three 90 degrees linear screws, three 60 degrees linear screws, 3 screws in a reversed L arrangement, and one titanium miniplate. Each group was subjected to linear loading using an Instron 4411 servohydraulic mechanical testing unit. The load peak value and peak displacement were measured. Another 4 hemimandible replicas were made of photoelastic resin and subjected to photoelastic analysis after linear loading with a 3-mm displacement. RESULTS: The results of the mechanical tests showed statistically significant differences between the fixation groups. The linear 90 degrees fixation and the reversed L arrangement presented with greater loading resistance, followed by the linear 60 degrees fixation and miniplates. In relation to the stress distribution in the photoelastic analysis, the fringes were concentrated near the osteotomy and to the lower part of the mandible in the linear 90 degrees -screw system and reversed L arrangement. In the case of the linear 60 degrees screws, most fringes were located around and between the screws. In the case of the miniplates, the fringes were concentrated around the screws near the osteotomy and more distally. CONCLUSION: Under the conditions tested, the linear 90 degrees and reversed L arrangements provided the most favorable behavior.

Distraction osteogenesis of iliac bone graft as a reconstruction after central giant cell granuloma curettage.

This case report describes a successful aesthetic and functional reconstruction of a patient who had severe maxilla bony deficiency as a result of excision of central giant cell granuloma. Initially, the lesion was curetted plus peripheral ostectomy. The defect was reconstructed with iliac bone graft in a second step, with both surgeries performed under general anesthesia. Six months after second step, later vertical distraction osteogenesis was performed on the grafted maxilla to obtain a satisfactory bony height. Distraction osteogenesis can be a good alternative for the reconstruction of bone deficiencies associated to bone graft; however, it should be not done as first treatment in the severe pathologic jaw defects.