Malignant hyperthermia in maxillofacial surgery: Literature review supported by case presentation.

OBJECTIVE: Malignant hyperthermia (MH) is characterized by a state of hypermetabolism after exposure to halogenated inhalational anesthetics or succinylcholine. The aims of this study were to carry out an updated review on the subject and report an illustrative case of MH in urgent maxillofacial surgery. MATERIAL AND METHODS: A search of the PubMed/MEDLINE database using the keyword "malignant hyperthermia" was performed including articles published over the last 11 years in English, Spanish or Portuguese. Exclusion criteria were similar presentations but not associated with MH and cases not related to the use of anesthetic drugs as a trigger of the condition. CASE REPORT: A 45-year-old man (75 kg, ASA status IE) with a negative family history for neuromuscular diseases, victim of a car accident with a facial fracture, underwent surgery under balanced general anesthesia and developed signs of MH 4 h after anesthesia induction. In our patient, the causative agent was sevoflurane and the diagnosis of MH was confirmed, subsequently, by muscle biopsy. RESULTS/DISCUSSION: Overall, 44 cases of MH were found. According to the recent literature, MH shows a male predilection (3:1) and the mean age of patients is 32.2 ± 22.2 years. The most frequently cited causative agents were sevoflurane (30.5%), isoflurane (22.2%), and sevoflurane + succinylcholine (13.8%). The most common clinical indicators included hypercarbia (88.8%), hyperthermia (86.1%), and tachycardia (63.8%). Dantrolene was administered in 24 cases. The outcome was favorable in 31 cases (86.1%). The in vitro muscle contracture test (IVCT) was performed in only 15 patients and all of them tested positive. In our patient, the causative agent was sevoflurane and the diagnosis of MH was confirmed by muscle biopsy. CONCLUSION: The mortality from MH is still high and an early clinical diagnosis and specific treatment with dantrolene are necessary for a favorable outcome. A complete understanding will allow better management of patients with MH. At present, the best management is to identify susceptible patients and to avoid triggering agents, combined with vigilant monitoring.

Complications associated with submental liposuction: a scoping review

Background: Liposuction is one of the most commonly performed cosmetic procedures worldwide. Complications associated with submental liposuction are rare. However, when they occur they are significant and can cause disFiguring consequences. The objective of this study was evaluated complications from submentual liposuction in literature and description of clinical experience of complication after submentual liposuction. Material and Methods: At first, a scoping review was carried out online search with no time restrictions for complications after submental liposuction was performed in the databases Medline / PubMed, Embase, and Web of Science. The variables analyzed were: age, sex, type of esthetic procedure, anesthesia, complications, time after Procedure, treatment, follow-up care, and sequelae. Then, a case of a patient with submental hematoma after an aesthetic procedure for submental liposuction was described. Results: Firstly, 539 articles were selected, after application of the inclusion criteria, 4 studies were included. Most cases were female (8:1), with a mean age of 55.77 years. Postoperative complications were found, such as submental depression, submental edema, hypertrophic scar formation, scar contracture, cervical necrotizing fasciitis, Cervico-facial dystonia and transient facial nerve paralysis. The follow-up period for cases ranged from 3 to 12 months. The clinical case presented there was no sequelae. Conclusions: Submental liposuction requires the surgeon's attention. Anatomical knowledge, correct clinical and surgical management, diagnosis, and immediate approach to adverse situations are points that must be respected in this type of esthetic procedure to avoid more serious complications.(AU)

Análise de prontuários de pacientes com infecções odontogênicas atendidos no serviço hospitalar / Análisis de registros de pacientes con infecciones dentales atendidos en el servicio de hospital / Analysis of records of patients with dental infections care at the hospital service

Objetivo: O seguinte estudo é uma análise de prontuários para traçar um perfil epidemiológico de pacientes acometidos por infecções odontogênicas e/ou angina de Ludwig em um serviço hospitalar público. Metodologia: Foi realizado um estudo observacional de 37 prontuários com diagnóstico de infecção odontogênica e/ou Angina de Ludwig no Hospital da Restauração, na cidade do Recife, Pernambuco, entre os meses de julho a novembro de 2021. Resultados: Dos 37 prontuários, a maioria foi do sexo masculino (55%; n=20), a faixa etária mais acometida foi dos 18 aos 40 (45%; n=17); abaixo dos 10 anos foram acometidos 27% (n = 10). 21% (n = 8) foram internados e dos 37 prontuários, 13% (n = 5) evoluíram para Angina de Ludwig. Conclusão: O perfil mais acometido por infecções odontogênicas no período proposto foram pacientes do sexo masculino adultos e a internação não prevaleceu na maioria dos casos. O alto acometimento de crianças é um sinal de alerta, sugerindo uma atenção maior dos responsáveis. A angina de Ludwig acometeu menos da metade dos pacientes e a Ceftriaxona e o Metronidazol foram os antibióticos de escolha para a maioria dos casos... (AU)

Objetivo: El siguiente estudio es un análisis de historias clínicas para trazar un perfil epidemiológico de los pacientes afectados por infecciones odontogénicas y/o angina de Ludwig en un servicio hospitalario público. Metodología: Se realizó un estudio observacional en 37 historias clínicas con diagnóstico de infección odontogénica y/o Angina de Ludwig en el Hospital da Restauração, en la ciudad de Recife, Pernambuco, entre julio y noviembre de 2021. Resultados: De las 37 historias clínicas, la mayoría eran hombres (55%; n=20), el grupo de edad más afectado fue el de 18 a 40 años (45%; n=17); menores de 10 años, el 27% (n = 10) estaban afectados. El 21% (n = 8) fueron hospitalizados y de las 37 historias clínicas, el 13% (n = 5) progresó a Angina de Ludwig. Conclusión: El perfil más afectado por infecciones odontogénicas en el periodo propuesto fueron pacientes adultos del sexo masculino y no predominó la hospitalización en la mayoría de los casos. La alta participación de los niños es una señal de advertencia, lo que sugiere una mayor atención por parte de los responsables. La angina de Ludwig afectó a menos de la mitad de los pacientes y la ceftriaxona y el metronidazol fueron los antibióticos de elección en la mayoría de los casos... (AU)

Objective: The following study is an analysis of medical records to trace an epidemiological profile of patients affected by odontogenic infections and/or Ludwig's angina in a public hospital service. Methodology: An observational study was carried out on 37 medical records with a diagnosis of odontogenic infection and/or Ludwig's Angina at Hospital da Restauração, in the city of Recife, Pernambuco, between July and November 2021. Results: Of the 37 medical records, the most were male (55%; n=20), the age group most affected was from 18 to 40 (45%; n=17); under 10 years of age, 27% (n = 10) were affected. 21% (n = 8) were hospitalized and of the 37 medical records, 13% (n = 5) progressed to Ludwig's Angina. Conclusion: The profile most affected by odontogenic infections in the proposed period were adult male patients and hospitalization did not prevail in most cases. The high involvement of children is a warning sign, suggesting greater attention from those responsible. Ludwig's angina affected less than half of the patients and Ceftriaxone and Metronidazole were the antibiotics of choice for most cases... (AU)

Pulmonary metastasis of malignant ameloblastoma: case report and review / Metástase pulmonar de ameloblastoma malígno: revisão e relato de caso

ABSTRACT Despite being a benign tumor of the maxillofacial region, some cases of ameloblastoma can be categorized as malignant ameloblastoma (or metastasizing) when metastases occur. The aim of this study is to report a rare case of lung metastasis from mandibular ameloblastoma, in order to review its risk and analyze the main anatomic sites that can occur with this disease. The case of a 48-year-old woman is described. She presented a metastatic pulmonary ameloblastoma 7 years after the removal of a mandibular ameloblastoma. During routine exams, a tumor in the left lung was observed. It was asymptomatic, near to the mediastinum, measured 7x5.5 cm. Transthoracic needle biopsy revealed ameloblastoma with the same histological characteristics of the primary tumor. After radiotherapy, the patient presented regression of the tumor. The patient has been under follow-up for 5 years and there is no presence of tumor. Ameloblastoma is an aggressive tumor not only in the region of origin, but also in distant regions, mainly in cases of recurrence. Metastases can cause high rates of morbidity, a fact that requires early treatment.

RESUMO Apesar de ser um tumor benigno da região maxilofacial, alguns casos de ameloblastoma podem ser categorizados como ameloblastoma maligno (ou metastizante) quando ocorrem metástases. O objetivo deste trabalho é relatar um caso raro de metástase pulmonar de ameloblastoma mandibular, a fim de revisar seu risco e analisar os principais sítios anatômicos que podem ocorrer com esta doença. Descreve-se o caso de uma mulher de 48 anos. Ela apresentou um ameloblastoma pulmonar metastático 7 anos após a remoção de um ameloblastoma mandibular. Durante os exames de rotina foi observado tumor no pulmão esquerdo. Assintomático, próximo ao mediastino, medindo 7x5,5 cm. A biópsia transtorácica com agulha revelou ameloblastoma com as mesmas características histológicas do tumor primário. Após radioterapia, o paciente apresentou regressão do tumor. O paciente está em acompanhamento há 5 anos e não há presença de tumor. O ameloblastoma é um tumor agressivo não só na região de origem, mas também em regiões distantes, principalmente nos casos de recorrência. As metástases podem causar altas taxas de morbidade, fato que requer tratamento precoce.

Pseudoaneurysm of the Internal Carotid Artery After Craniofacial Traumatism: Series of Cases and Integrative Literature Review.

The present study aims to develop an integrative review about pseudoaneurysms after traumatic facial trauma, through the analysis of its etiology, type of fracture, signs and symptoms, time elapsed between the trauma and the exposure of signs and symptoms, and treatment performed in these cases. Furthermore into the report, there are 3 clinical cases that occurred in the Buccomaxillofacial Surgery and Traumatology service of Hospital da Restauração Recife/PE. The study was carried out in 2 phases, first, a digital research about post-traumatic craniofacial pseudoaneurysm was performed in the following databases "MEDLINE/PubMed," "Scielo" and "Scopus," in September 2019, with 5 articles being included. In the second, 3 cases of patients with high-impact facial trauma who developed pseudoaneurysm of the internal carotid artery were reported. The average age of the patients was 35.6 years, all patients were male (100%), the majority (60%) being victims of an automobile accident, 3 patients (60%) suffered craniofacial trauma and 2 (40%) had trauma only to the face, most of them had symptoms later on due to the trauma, in 80% of cases the therapy instituted was embolization. Cases of high-impact craniofacial traumas, which present epistaxis and/or ophthalmological alterations correlated to fractures, should be carefully evaluated, determining a better prognosis for the patient.

Management of chronic suppurative osteomyelitis in a patient with pycnodysostosis.

Pycnodysostosis is a rare bone dysplasia that causes changes in the facial skeleton. Osteomyelitis is common in patients with this syndrome, and, among the gnathic bones, the mandible is the most commonly affected. This case report describes the treatment of a 46-year-old woman with pycnodysostosis that was associated with chronic suppurative osteomyelitis of 5 years' duration. The patient had no intraoral focus of infection or history of tooth extraction that would explain the clinical findings of pain and a left-sided submandibular fistula. After the patient received 8 days of antibiotic therapy consisting of ceftriaxone and metronidazole, surgical access was achieved through the left submandibular region, and biopsy and curettage of the lesion and excision of the associated fistula were performed. At the 2-year follow-up examination, there was no evidence of lesion recurrence.

Do Type of Helmet and Alcohol Use Increase Facial Trauma Severity?

PURPOSE: Facial trauma caused by motorcycle accidents has become a major issue because of its high prevalence and morbidity, causing death and esthetic and functional sequelae in many individuals. This work evaluated helmet and alcohol use and severity of facial fractures in motorcyclists treated at public hospitals in Pernambuco, Brazil. PATIENTS AND METHODS: This prospective study was conducted from December 2016 to December 2018 and submitted to statistical and descriptive analysis. Variables such as gender, age, helmet use and type, previous accidents, and duration of hospitalization were collected. The Facial Injury Severity Scale was used to classify the facial fractures. The Alcohol Use Disorders Identification Test was used to verify alcohol dependence. RESULTS: The sample was composed of 455 patients. Most were male patients (90.8%) and were aged 18 to 29 years (54.5%). Of the patients, 36.5% reported no helmet use and 31.6% reported wearing an open helmet. Alcohol use was reported in 38.7% of the group. In 79.8% of the sample, alcohol use was classified as low risk. There was a greater likelihood of having severe facial trauma if patients were aged between 30 and 39 years and had harmful or at-risk alcohol use. These patients also tended to remain hospitalized for more than 10 days. No statistically significant relationship was found with the type of helmet. CONCLUSIONS: The individuals most affected by facial trauma were young male patients (aged 18 to 29 years). Patients aged 30 to 39 years with high-risk use and dependence on alcohol were more likely to have more complex facial trauma. The type of helmet used was not effective in reducing the severity of facial fractures.

Avaliação da harmonia da face mediante projeções faciais do mento / Evaluation of harmony of the face through facial projections of the men

Introdução: Identificar qual projeção do mento é ideal para compor um rosto harmônico, de acordo com a opinião de leigos e cirurgiões buco-maxilo-faciais (BMF), relacionando as variáveis: sexo, etnia(raça) e região de origem(local). Metodologia: Participaram do estudo 386 leigos e 198 cirurgiões BMF. Este estudo foi realizado por meio de um formulário que continha dezoito imagens da face com diferentes projeções do mento: nove do sexo masculino e nove do sexo feminino, tendo o público escolhido a imagem que mais o agradou. Resultados: Em relação à avaliação da imagem masculina, as categorias: grupo(leigos/cirurgiões), sexo masculino e feminino, regiões (Nordeste e Sudeste) e raça, os entrevistados leigos escolheram um mento retraído em relação à linha vertical verdadeira, semelhante à escolha dos cirurgiões. Em relação à imagem feminina, para as mesmas categorias do sexo masculino, as projeções protruídas de mento foram mais escolhidas, tanto para os leigos como para os cirurgiões. Entretanto, as subcategorias leigos da região Sudeste, leigos de raça branca e leigos do sexo masculino escolheram uma imagem feminina com projeções de mento mais retraída. Conclusões: A harmonia facial pode ser considerada subjetiva, pois engloba padrões pessoais de beleza; assim, os cirurgiões devem estar atentos às peculiaridades dos pacientes... (AU)

Introduction: To identify which projection of the chin is ideal for compose a harmonic face according to the opinion of laypeople and oral maxillofacial surgeons, relating the variables: gender, ethnicity (race) and region of origin (local). Methodology: 386 lay people and 198 surgeons participated in the study. This study was carried out by means of a form. This form contained eighteen images of faces with different projections of the chin: nine males and nine females. So, the audience chose the image that most pleased them. Results: In relation to the evaluation of the male image. The categories: group (laymen/ surgeons), male and female, regions (northeast and southeast) and race, lay interviewee chose a retracted chin in relation to the true vertical line, similar to the surgeons' choice. In relation to the female image, for the same male categories, the protruding projections of the chin were more chosen, both for the laymen and for the surgeons. However, for the lay subcategories of the Southeast region, white laymen and male laymen, both chose a female image with more retracted chin projections. Conclusions: The facial harmony can be considered subjective since it includes personal standards of beauty, so surgeons must be attentive to the peculiarities of the patients... (AU)

Updated Review of Traumatic Dislocation of the Mandibular Condyle Into the Middle Cranial Fossa.

PURPOSE: Traumatic dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) is a rare event after maxillofacial trauma. Treatment may be performed with closed or open reduction (with or without craniotomy), and arthroplasty procedures might be necessary for long-standing cases. The aims of this study were to perform an integrative review of traumatic DMCCF cases reported in an electronic database and to report a case in which cerebrospinal fluid leakage occurred after open treatment. PATIENTS AND METHODS: The study was carried out in 2 phases. In the first part, an electronic search was undertaken in MEDLINE (via PubMed) in April 2018, with 52 articles being included. In the second, we report a case in which cerebrospinal fluid leakage occurred through the external auditory canal after open reduction of the mandibular condyle into the middle cranial fossa in a 22-year-old male patient, with a follow-up of 5 months. RESULTS: A total of 59 cases were included. Most patients were female patients (69%), the right condyle was mostly affected, and traffic accidents (53%) were the main etiology. Closed treatment was ideally performed within 2 weeks of intrusion. Open treatment was required for cases with 2 or more weeks of impaction. The types of open treatment were open reduction, condylectomy, condylotomy, and temporomandibular joint reconstruction with alloplastic implants. The glenoid fossa was reconstructed in 28 cases, and a temporalis muscle flap with or without bone grafts was the main choice. Despite the treatment option used, mandibular deviation during opening occurred in 41% of cases. Rare complications included persistent facial paralysis, persistent hearing loss on the affected side, increased cerebral contusion after reduction, and postoperative pneumocephalus. CONCLUSIONS: Cases of DMCCF require a multidisciplinary approach based on the expertise of both maxillofacial and neurologic surgeons. Close monitoring is extremely important to mitigate complications.

Avaliação da utilização do capacete e do risco de dependência para utilização de bebidas alcoólicas nos motociclistas internados no Hospital da Restauração / Evaluation of the helmet use and the risk of dependence for the use of alcoholic beverages in the motorcyclists in the Hospital da Restauração

O objetivo deste trabalho foi avaliar o uso do capacete e o risco de dependência para utilização de bebida alcoólica nos motociclistas internados no HR. A metodologia aplicada nessa pesquisa é de natureza epidemiológica, quantitativa, descritiva e prospectiva. As seguintes variáveis foram estudadas: sexo, idade, tipo de capacete, potência da moto, finalidade de uso, ossos e fraturas, complexidade das fraturas e risco de dependência do uso álcool. Foram analisados dados de 100 pacientes, dos quais o sexo mais acometido foi o masculino na faixa etária entre 18-29 anos; a potência da moto disparadamente mais procurada pelos pacientes encontra-se acima de 50 cc, tendo sido o tipo de capacete mais utilizado o integral com viseira, porém com uma deficiência muito grande na utilização de capacete pelos motociclistas; a maior finalidade para o uso da moto pelos pacientes foi para o trabalho. O osso mais fraturado foi o zigomático. A maioria dos pacientes foi classificada com uso de baixo risco do álcool na classificação do AUDIT... (AU)

The purpose of this work was to evaluate the use of helmet and the risk of addiction to the use of alcoholic beverage in motorcyclists admitted at the HR hospital. The methodology applied in this research is epidemiological, quantitative, descriptive and prospective. The following variables were studied: gender, age, type of helmet, motor power, purpose of use, bones and fractures, fracture complexity and risk of dependence on alcohol use. Data from 100 patients were analyzed, in which male was the most affected gender in the age group 18-29 years old; The motorcycle's power most frequently sought by the patients is above 50 cc and the type of helmet most used was the integral with visor, but with a great deficiency in the use of helmets by the motorcyclists; The major purpose for motorcycle use by patients was to work. The most fractured bone was the zygomatic. The majority of patients were classified as having been included in the use of alcohol risk in the AUDIT classification... (AU)

Alcohol abusive use increases facial trauma?

BACKGROUND: Trauma is among the main death causes and morbidity in the world and is often related to the use of alcohol and its abuse has reached massive proportions, no matter if the country is developed or not, being considered as public health problem. Since there are very few randomized and prospective studies in literature about the association of facial trauma and the use of alcohol, this study aims to investigate the impact of alcohol use in facial trauma. MATERIAL AND METHODS: This was a prospective and cross sectional study, involving facial trauma patients attended at Oral Maxillofacial Surgery Division of a State Hospital. Variables included patient's profile, trauma etiology, facial region involved, type of injury and treatment and days of hospitalization. AUDIT test was applied to identify risks and damages of alcohol use and chemical dependence. Absolute distribution, uni and mutilvaried percentages were made for data evaluation. Pearson's qui-squared and Fisher's Exact tests were also used. RESULTS: One hundred patients were evaluated. The patient's mean age was 33.50 years-old, 48% had between 17 and 29 years old, 28% had 30 to 39, and 24% 40 or more. Most of them were male (86%). The most frequent etiology was traffic accident (57%), the extraoral area was most committed (62%), the most frequent type of injury was fractures (78%) and the most affected bone was the mandible (36%). More than half of the patients (53%) had surgical treatment. 38% had their discharge from hospital right after the first attendance. The AUDIT most frequent answer was 'moderate use' (46%) and use at risk (39%). There was significant difference between the use of alcohol (AUDIT) and hematoma (0.003) and number of days of hospitalization (p = 0.005). CONCLUSIONS: In this study it was not observed association between alcohol consumption using the AUDIT and trauma etiology, but patient victims of traffic accidents were classified as with risk in the scale. Most of the trauma were caused by traffic accidents using motorcycles and occurred in young aged men

Avaliação do trauma da face sob as perspectivas do Código Penal e das inovações trazidas com a Lei Maria da Penha / Evaluation of facial trauma from the perspective of the Penal Code and the innovations resulting from the Maria da Penha Act: a case report

Objetivo: Analisar os traumas da face sob a ótica do Código Penal Brasileiro caracterizando as qualificadoras da lesão corporal em decorrência de violência doméstica, artigo 129 do Código Penal, e de suas alterações com a Lei Maria da Penha. Metodologia: Um caso de violência contra a mulher foi relatado e, partindo deste caso, foi realizada uma discussão com base na legislação brasileira vigente, referente ao tema. Conclusão: Conclui-se que mesmo com todas essas mudanças na legislação, o Brasil avançou muito pouco. A violência domestica contra a mulher ainda tem muito a ser vencida, até mesmo por estar ligada a um fator cultural muito forte e difícil de desprender na sociedade... (AU)

Obective: To analyze facial traumas from the perspective of the Brazilian Penal Code, characterizing the bodily injury caused by domestic violence, Article 129 of the Penal Code, and its changes resulting from the Maria da Penha Act. Methodology: A case of violence against a woman was reported, which served as the starting point for a discussion on the current Brazilian legislation on the issue. Conclusion: It was concluded that despite all the changes in the legislation, Brazil has made very little progress in this area. Much remains to be done in the fight against domestic violence targeting women, particularly since the latter involves a strong cultural factor that is difficult to eliminate from Brazilian society... (AU)

Juvenile psammomatoid ossifying fibroma with massive mandibular involvement.

Juvenile psammomatoid ossifying fibroma (JPOF) is a histologic variant of an ossifying fibroma. While an ossifying fibroma varies in appearance, it consists of fibrocellular tissue and mineralized material. JPOF is a rare benign lesion; however, it can be extended locally and mimic a malignant tumor. It is considered a specific clinicopathologic entity, due to its occurrence in children and adolescents, the presence of psammomas, and its purported tendency for local aggressive growth and recurrence. It commonly affects the maxilla, nasal cavity, paranasal sinuses, and ethmoid region. This article describes a rare, aggressive case of a large JPOF that led to the total destruction of the mandible.

Presença de corpo estranho no complexo buco-maxilofacial: relato de 2 casos / Presence of foreign body in complex maxillo-facial: report of 2 cases

The operations of foreign bodies is one of the most diverse chapters of Traumatology and Surgery Maxillo- Facial, a fact explained by the different types of materials and ways they are accidentally included in the Complex Maxillo-Facial. Beyond Iatrogenic of the projectiles by firearms, daggers, knives, shards of glass, stone, tooth, wood, can become lodged in the soft and hard tissues of the face. The management and prognosis depend on the composition of the foreign body, location and presence or absence of infection. Metallic objects and glass are the most frequent and well tolerated, whereas organic elicit an inflammatory reaction, which may lead to serious complications. In the preoperative identification, and physical examination, it uses conventional radiographs, computed tomography, nuclear magnetic resonance imaging and ultrasonography. The removal of the foreign body is usually a challenge for surgeons Maxillo-Facial, because often, the difficulty of access and the presence of vital structures in the region. The objective of this study is to report a 2 of cases on foreign body present in Complex Maxillo-Facial and evaluate care for the prevention of complications by the presence of foreign bodies... (AU)

As cirurgias dos corpos estranhos é um dos capítulos mais diversificados da Cirurgia e Traumatologia Buco- Maxilo-Facial, fato este explicado pelos diferentes tipos de materiais e maneiras que estes são incluídos acidentalmente no Complexo Buco-Maxilo-Facial. Além das Iatrogenias, os projéteis por arma de fogo, punhais, facas, fragmentos de vidro, de pedras, de dente, de madeira, podem alojar-se nos tecidos moles e duros da face. A conduta e o prognóstico vão depender da composição do corpo estranho, localização e presença ou não de infecção. Objetos metálicos e de vidro são os mais frequentes e bem tolerados, ao passo que os orgânicos causam maior reação inflamatória, podendo levar a sérias complicações. Na identificação pré-operatória, além do exame físico, utiliza-se exames radiográficos convencionais, Tomografia Computadorizada, Ressonância Nuclear Magnética e ultrassonografia. A remoção do corpo estranho geralmente é um desafio para os cirurgiões Buco-Maxilo-faciais, devido, muitas vezes, a dificuldade de acesso e a presença de estruturas vitais na região. O objetivo deste trabalho é relatar 2 casos sobre corpo estranho presentes no Complexo Buco-Maxilo-Facial, bem como avaliar os cuidados referentes à prevenção de complicações pela presença de corpos estranhos... (AU)

Is a 5 mm rat calvarium defect really critical?

PURPOSE: To evaluate bone regeneration in critical defects in the rats' calvarium. METHODS: Eighteen rats Wistar were divided into three groups of six animals each according to the time of evaluation (15, 30 and 60 days). One calvarium defect of 5 mm was made in the parietal bone of each animal under general anesthesia. After the time of evaluation, the animals were killed, when the bone was histological studied and classified according to the type of tissue found: fibrosis or bone. RESULTS: The results showed that in the group of 15 days, in five animals there was only fibrosis. In the group of 30 days, the process of regeneration was growing and in four animals was found bone, in three with partial filling and in the other one with complete filling of the defect. In the group of 60 days, out of the three animals with bone, two had a complete filling of the defect. CONCLUSIONS: There was no bone regeneration in critical defects in 15 days. There was regeneration in the most part of the animals in 30 and 60 days.

Is a 5 mm rat calvarium defect really critical? / Um defeito de 5 mm em calota craniana de rato é realmente critico?

PURPOSE: To evaluate bone regeneration in critical defects in the rats' calvarium. METHODS: Eighteen rats Wistar were divided into three groups of six animals each according to the time of evaluation (15, 30 and 60 days). One calvarium defect of 5mm was made in the parietal bone of each animal under general anesthesia. After the time of evaluation, the animals were killed, when the bone was histological studied and classified according to the type of tissue found: fibrosis or bone. RESULTS: The results showed that in the group of 15 days, in five animals there was only fibrosis. In the group of 30 days, the process of regeneration was growing and in four animals was found bone, in three with partial filling and in the other one with complete filling of the defect. In the group of 60 days, out of the three animals with bone, two had a complete filling of the defect. CONCLUSIONS: There was no bone regeneration in critical defects in 15 days. There was regeneration in the most part of the animals in 30 and 60 days.

OBJETIVO: Avaliar a regeneração óssea de defeitos críticos em calota craniana de ratos. MÉTODOS: Foram utilizados 18 ratos Wistar que foram distribuídos em três grupos de acordo com o tempo de avaliação (15, 30 e 60 dias). Na calota craniana desses animais foi realizado defeito de 5mm, após anestesia geral prévia. Após o tempo de avaliação, os animais foram submetidos à eutanásia e a calota foi enviada para estudo histológico, quando foi classificada de acordo o tecido encontrado: fibroso ou ósseo. RESULTADOS: Diante dos achados deste estudo, pode-se observar que para o grupo de 15 dias na maioria dos animais, n=5, foi encontrado apenas fibrose. Com o passar do tempo de avaliação, no grupo de 30 dias, o processo de reparo foi evoluindo e em quatro animais já foi encontrado osso, sendo em três com preenchimento parcial e em um completo. No grupo de 60 dias, o processo praticamente permaneceu o mesmo, onde em três animais foi encontrado osso, e, desses, em dois o preenchimento foi completo. CONCLUSÕES: Não houve regeneração óssea do defeito crítico para o período de avaliação de 15 dias. Houve regeneração óssea em grande parte dos animais para o período de avaliação de 30 e 60 dias.

Evaluation of fixation techniques with titanium plates and Kirschner wires for zygoma fractures: preliminary study.

OBJECTIVE: The aim of the present study was to assess the quality of treatment using two reduction and fixation techniques for zygoma fractures. PATIENTS AND METHODS: A randomized clinical trial was carried out involving a sample of 10 patients with Knight and North type III, IV and V zygoma fractures divided into two groups. One group underwent the closed reduction technique and fixation with Kirschner wire and the other group underwent the open reduction technique and fixation with titanium plates. The groups were submitted to subjective evaluation based on the patient's perception of areas of deformity and paresthesia as well as the measurement of range of mouth opening and pain upon mouth opening in the preoperative (T0) and postoperative (T1) periods. The assessment of bone reduction quality was performed using quantifiable points (lateral wall of the orbit, anteroposterior projection of the zygoma and ocular globe projection), measured based on tomographic images. RESULTS: Seventy percent of the patients remained with paresthesia and 20% remained with the complaint of deformity at T1. Mouth opening range increased in both groups at T1. In the overall sample, mean total disjunction of the lateral wall of the orbit and the difference in the anteroposterior projection of the zygoma were reduced between T0 and T1 (4.36 mm to 1.25 mm and 6.94 mm to 2.86 mm, respectively). There was also a reduction in ocular globe projection in both groups between T0 and T1. CONCLUSIONS: Both techniques achieved adequate reduction of zygoma fractures in the postoperative period.

Injúrias penetrantes da face: relato de caso e revisão da literaura / Facial penetrating injuries: a case report and review of the literature

as injúrias penetrantes na face e no crânio apresentam alta morbidade entre as vítimas de violência e vem apresentado aumento do número de casos. a importância da interpretação do mecanismo trauma pela equipe médica em conjunto com os profissionais forenses, podem fornecer dados esclarecedores sobre a natureza da agressão, quando acidental ou homicida. O presente trabalho discute um caso de violência com trauma em face através de objeto perfurante associado de estrangulamento.

Penetrating injuries to the face and skull have high morbidity among victims of violence and the number of cases has been increasing. The interpretation of the trauma mechanism by the medical team together with the legal professionals is important as it can provide insightful information on the nature of the aggression, whether accidental or homicidal. This paper discusses a case of violence with trauma to the face caused by a perforating object associated with strangulation.

Prevalência de Fraturas do Côndilo Mandibular Associadas à Presença ou Ausência de 3o Molar Inferior em Imagens Ortopantomográficas / Prevalence of Mandibular Condylar Fractures associated with the Presence or Absence of the Lower Third Molar On Orthopantomographic Imaging

Objetivo: O estudo propõe verificar a prevalência de fraturas condilares associadas à presença ou ausência de 3o molar inferior. Metodologia: A amostra foi composta de 86 ortopantomografias de pacientes com fratura condilar, originária de 516 laudos e imagens. O levantamento envolveu os anos de 2003 a 2007. Os dados de identificação radiográfica e história clínica de fratura condilar foram avaliados e anotados. As radiografias panorâmicas dos maxilares existentes nos arquivos foram avaliadas. A análise destas se deu por meio do programa IMAGE J para obtenção da localização e angulação do terceiro molar inferior e mediante as classificações de Pell e Gregory e Winter. Resultados: O terceiro molar inferior estava presente em 69,8% das fraturas do côndilo mandibular; a presença do terceiro molar inferior erupcionado teve maior influência nos três tipos de fratura do côndilo mandibular; a fratura condilar mais encontrada foi a subcondilar, seguida da fratura de colo e, em menor expressão, da fratura de cabeça do côndilo mandibular; os dados revelam que, para os três tipos de fratura condilar, há uma maior relação com a posição mesioangular da classificação de Winter. Quanto à classificação de Pell e Gregory em relação às fraturas de cabeça do côndilo mandibular, houve uma distribuição equânime das posições A1, A2 e B3, as demais posições sido encontradas na amostra; em relação às fraturas de colo e subcondilares, houve maior relação com a posição B2 da classificação de Pell e Gregory. Conclusão: Não houve relação estatisticamente significativa entre a presença ou ausência de terceiro molar inferior incluso ou mesmo sua posição e a existência de fratura condilar.

Objective: The study sets out to verify the prevalence of condylar fractures associated with the presence or absence of the lower third molar. The sample consisted of 86 orthopantomograms of patients with a condylar fracture from 516 reports and images. The survey covered the years 2003 to 2007. The data concerning the radiographic identification and clinical history of condylar fracture were evaluated and recorded. The panoramic radiographs of the maxillae existing in the files were assessed. The analysis of the latter was conducted using the IMAGE J software for obtaining the location and angulation of the lower third molar in accordance with the classifications of Pell & Gregory and Winter. Results: The lower thirdmolar was present in 69.8% of the mandibular condylar fractures; the presence of an erupted lower third molar was most influential in the three types of mandibular condylar fracture; the most commonly found condylar fracture was the subcondylar, followed by fracture of the neck and, to a lesser extent, fracture of the head of the mandibular condyle; the data demonstrate that for all three types of condylar fracture there is a closer relationship with the mesioangular position in the Winter classification; and, as regards the Pell & Gregory classification with fractures of the head of the mandibular condyle, there was an equal distribution of the A1, A2 and B3 positions, the other positions not being found in the sample; with relation to neck and subcondylar fractures, there was a closer relationship with position B2 of the Pell & Gregory classification. Conclusion: There were no statistically significant associations between the presence or absence of an impacted lower third molar or even its position and the existence of a condylar fracture.

Microbiota da Secreção Conjuntival em Portadores de Prótese Ocular / Microorganisms in Conjuctival Secretion in Patients with Ocular Prosthesis

Objetivo: Avaliar a flora microbiana bem como infecções de cavidades anoftálmicas de pacientes e resposta dos microrganismos a diversos antibióticos. Pacientes e Métodos: Onze pacientes usuários de prótese ocular foram convidados à consulta para avaliação da presença de infecção clínica bem como à realização da coleta da secreção conjuntival. A secreção foi colhida através de swab estéril que foi introduzido na conjuntiva e embebido na secreção. Esse material foi submetido à cultura com antibiograma, além de coloração pelo método de Gram, e, dessa forma, foram identificados os principais microrganismos. Dados epidemiológicos e clínicos foram anotados em ficha de avaliação. Resultados: Dos onze pacientes atendidos, a maior pertencia ao gênero masculino (07). A média das idades foi de 40,3 anos. Oito pacientes apresentaram má higiene da prótese e da cavidade anoftálmica. Dor não foi relatada por nenhum deles. Os microorganismos patogênicos mais comumente encontrados foram Stafilococus Aureus (05 pacientes), Klebsiella (03 pacientes) e Pseudomonas Aeruginosa (01 paciente). Dois pacientes apresentaram culturas negativas. A gentamicina foi efetiva contra os microorganismos de 89% das amostras positivas. 78% das amostras positivas foram sensíveis tanto à gentamicina quanto à ciprofloxacina. Ceftriaxona foi ativo contra microorganismos de 05 pacientes. Conclusão: Não foi encontrada infecção clínica nas cavidades anoftálmicas dos pacientes, entretanto microorganismos patológicos estavam presentes em sua maioria.

Purpose: The aim of the present study was to assess microbial flora, infection of anophthalmic sockets and the response of microorganisms to different antibiotics among patients with ocular prostheses. Patients and Methods: Eleven patients with ocular prostheses participated in an assessment of clinical infection and the collection of conjunctival secretion. For such, a sterile swab was introduced into the conjunctiva and soaked in the secretion. This material was submitted to culturing with an antibiogram and Gram staining to identify the main microorganisms. Epidemiological and clinical data were recorded. Results: Seven of the 11 patients analyzed were male and mean age was 40.3 years. Eight patients exhibited poor hygiene of the prosthesis and anophthalmic socket. No patients reported any pain. The most frequent pathogenic microorganisms were Staphylococcus Aureus (5 patients), Klebsiella (3 patients) and Pseudomonas Aeruginosa (1 patient). Two patients had negative cultures. Gentamicin was effective against the microorganisms in 89% of the positive samples, whereas 78% of the positive samples were sensitive to both gentamicin and ciprofloxacin. Ceftriaxone was effective against microorganisms in five patients. Conclusion: No cases of clinical infection were found in the anophthalmic sockets of the patients analyzed. However, pathogenic microorganisms were found in the majority of patients.