Homenagem ao Prof. Dr. Learreta / Tribute to Prof. Dr. Learreta / Homenaje al Prof. Dr. Learreta

Preito de gratidão ao Professor Dr. Jorge Alfonso Learreta. Nascido em Buenos Aires, Argentina, em 11/12/1949. Cursou Odontologia aos 17 anos. Seus conhecimentos em Histologia o fez ganhar uma bolsa de estudos para a França. Aqui estudou com cirurgiões renomados e voltou para Argentina. Especializou-se em Ortodontia e Ortopedia funcional em 1971. Tinha uma ampla rede de amigos e mestres em diversas partes do mundo. Começou a investir em tecnologia para estudar a ATM no início dos anos 90. Especializou-se em estudo das imagens e já em 1994, possuía casos com RNM antes e depois dos tratamentos, algo que veio a se tornar o padrão-ouro da sua filosofia. Homem estudioso, conhecedor de vasta literatura e de inteligência indescritível com grande poder de observação e raciocínio, vivenciou diversos problemas na Odontologia com soluções simples e geniais. O prof. Learreta é a definição de uma pessoa a frente de seu tempo que deixa um legado na odontologia da dor orofacial e seus ensinamentos foram além da neurofisiologia da ATM.

I offer gratitude to Professor Dr. Jorge Alfonso Learreta. Born in Buenos Aires, Argentina, on 12/11/1949. He studied Dentistry at the age of 17. His knowledge in Histology earned him a scholarship to France. Here he studied with renowned surgeons and returned to Argentina. He specialized in Orthodontics and Functional Orthopedics in 1971. He had a wide network of friends and teachers in different parts of the world. He began investing in technology to study the TMJ in the early 90s. He specialized in studying images and in 1994, he had cases with MRI before and after treatments, something that became the gold standard of his philosophy . A studious man, knowledgeable about vast literature and indescribable intelligence with great power of observation and reasoning, he experienced several problems in Dentistry with simple and ingenious solutions. The prof. Learreta is the definition of a person ahead of his time who leaves a legacy in orofacial pain dentistry and his teachings went beyond the neurophysiology of TMJ.

Ofrezco agradecimiento al Profesor Dr. Jorge Alfonso Learreta. Nacido en Buenos Aires, Argentina, el 11/12/1949. Estudió Odontología a los 17 años. Sus conocimientos en Histología le valieron una beca para Francia. Aquí estudió con reconocidos cirujanos y regresó a la Argentina. Se especializó en Ortodoncia y Ortopedia Funcional en 1971. Contaba con una amplia red de amigos y profesores en diferentes partes del mundo. Comenzó a invertir en tecnología para estudiar la ATM a principios de los 90. Se especializó en el estudio de imágenes y en 1994 tuvo casos con resonancia magnética antes y después de los tratamientos, algo que se convirtió en el estándar de oro de su filosofía. Hombre estudioso, conocedor de vasta literatura e inteligencia indescriptible con gran poder de observación y razonamiento, experimentó varios problemas en Odontología con soluciones simples e ingeniosas. El prof. Learreta es la definición de una persona adelantada a su tiempo que deja un legado en la odontología del dolor orofacial y sus enseñanzas fueron más allá de la neurofisiología de la ATM.

Evaluation of the Effects of Exogenous Melatonin in Zygomatic Complex Fractures.

Objective: The objective of this research was to evaluate the benefits of using exogenous melatonin in the preoperative period of patients with zygomatic complex fractures. Materials and methods: A randomized, triple-blind clinical trial of independent samples was carried out. The sample was divided into two groups: G1 (melatonin) and G2 (placebo). Interventions were standardized with 10 mg melatonin or placebo the night before surgery and 1 h before the start of surgery. The studied variables were level of salivary cortisol, level of anxiety, pain, and use of rescue analgesics. Descriptive and inferential statistical analysis was performed, with a margin of error considered as 5%. Results: A total of 14 patients were included, and after using the medication, the measurement of cortisol was reduced in the melatonin group (0.48 ± 0.25 to 0.43 ± 0.13 µg/100 ml) and increased in the placebo group (0.19 ± 0.12 to 0.23 ± 0.18 µg/100 ml). There was a reduction in the level of anxiety in the melatonin group and an increase in the placebo group. After two hours of surgery, the pain was statistically less in the melatonin group (4.50 ± 1.38) compared to the placebo group (6.17 ± 0.98). Six hours after surgery, pain showed regression in both groups. Patients in the placebo group (83.3%) used more rescue analgesics than melatonin group (33.3%) in the postoperative period. Conclusions: Thus, this research demonstrated that melatonin can be effective in reducing salivary cortisol and anxiety after medication, and patients in the melatonin group needed less rescue analgesics in the postoperative period.

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.

Assessment of satisfaction of patients submitted to bichectomy / Avaliação da satisfação dos pacientes submetidos à bichectomia

Objective: The aim this research was assess the level of satisfaction of patients undergoing bichectomy and its repercussions. Material and Methods: A cross-sectional and qualitative study, under protocol number 20707519.5.0000.5207, was carried out by applying a questionnaire to patients undergoing bichectomy, which made it possible to assess complaints, degree of postoperative satisfaction, satisfaction of family members, time required to perceive results, complications and adverse effects, intensity of postoperative pain, and possibility of being submitted to a new intervention. Results: The sample consisted of 30 patients, among them, 82% sought surgery for aesthetic reasons. Regarding the degree of satisfaction, the majority (70%) were very satisfied, followed by 13.3% who were satisfied, 10% considered normal, 3.3% were dissatisfied and 3.3% very dissatisfied. Regarding the opinion of friends and family, the majority were very satisfied with the result. The adverse effects found were mild, no permanent injury happened, and the pain was mild in the most majority of the sample. Conclusion: Thus, the most majority of patients were satisfied with the results, as well as their family and friends. The results were more evident between the second and third months. No major or permanent damage was observed, suggesting that it is a safe technique when performed well.(AU)

Objetivo: Avaliar o nível de satisfação dos pacientes submetidos à bichectomia, bem como correlacionar os resultados com algumas características clínicas. Material e Métodos: Foi realizado um estudo transversal e qualitativo, sob protocolo número 20707519.5.0000.5207, através da aplicação de um questionário a pacientes submetidos à bichectomia, o qual foi possível avaliar as queixas, o grau de satisfação pós-operatório, a satisfação dos familiares, o tempo para percepção dos resultados, as complicações e efeitos adversos, intensidade da dor pós operatória, e a possibilidade de ser submetido a nova intervenção. Além disso, as características demográficas da amostra (como sexo e idade) também foi registrada na ficha de avaliação. Resultados: A amostra foi composta por 30 pacientes, e desses, 82% buscaram a cirurgia por motivos estéticos. Sobre o grau de satisfação, a maioria (70%) ficou muito satisfeitos, seguidos por 13,3% que ficaram satisfeitos, 10% consideraram normal, 3,3% insatisfeitos e 3,3% muito insatisfeitos. Sobre a opinião dos amigos e familiares, a maioria ficou muito satisfeitos com o resultado. Os efeitos adversos encontrados foram leves, nenhuma lesão permanente foi encontrada, e a dor foi discreta na grande maioria da amostra. Com base na possibilidade de submeter-se a uma nova cirurgia, 70% ficaram satisfeitos e não fariam novamente. Conclusão: A grande maioria dos pacientes demonstrou-se satisfeitos com os resultados, bem como seus familiares e amigos. Os resultados foram mais evidentes entre o segundo e terceiro mês. Não foi observado qualquer dano importante ou permanente, sugerindo ser uma técnica segura quando bem executada. (AU)

Impacted maxillary third molar displaced to the infratemporal space: a critical review and case report.

The aim of the present study was to use the scientific evidence found in a critical literature review as a basis to discuss the displacement of maxillary third molars to the infratemporal fossa in terms of anatomical and demographic characteristics and the treatment protocols used. In addition, this article reports a new clinical case of third molar displacement in a 19-year-old man. For the literature review, the Cochrane, Medline, Lilacs, and BBO databases were searched for relevant key words, and the selected articles were classified in accordance with their level of evidence according to the Oxford Centre for Evidence-Based Medicine criteria. Twenty-two articles were found, but only 13 were considered relevant and met the criteria for inclusion in this review. All of the articles were classified as Level 6b for scientific evidence (case reports). The maxillary left third molar was more commonly displaced to the infratemporal fossa (69.23%) than was the right third molar. Most of the molars exhibited complete root formation (53.84%), were multirooted (69.23%), and had fused roots (53.84%). During the procedures for removal of the displaced molars, either general or local anesthetic agents were used. Surgical access for molar removal was almost always intraoral, and no permanent postoperative complications were recorded. The time from tooth displacement until attempted surgical removal ranged from immediately to 24 years after the displacement. Both general dentists and oral and maxillofacial surgeons were responsible for the displacements.

Non-invasive joint decompression: An important factor in the regeneration of the bone marrow and disc recapture in temporomandibular arthropathies

BACKGROUND: This article aims to demonstrate the importance of the TMJ (Temporomandibular Joint) decompression in the treatment of degenerative processes and disc displacements, reporting two clinical cases treated with orthopedic and decompressive correction of TMJ. Material and METHODS: The studies reported in this article show patients with muscle and joint pain who were evaluated pre and post-treatment through MRI (Magnetic Resonance Irradiation) to follow-up bone marrow regeneration and TMJ disc placement. Transcutaneous electrical stimulation (TENS), measurement equipment and IO (Intraoral Orthotic) were used to evaluate and treat the patients. A critical review of literature has also been conducted to confront clinical outcomes. RESULTS: Marrow bone regeneration and disc placement were observed in both patients. CONCLUSIONS: The use of measurement equipment associated with TENS to find the correct rest position of the Jaw an the use of IO to decompress the TMJ was an effective way to promote bone marrow regeneration and disc placement, consequently improving function and quality of life

Autoimmune temporomandibular arthropathy: diagnostic considerations.

The etiology of degenerative processes of the temporomandibular joint (TMJ) remains unclear, as they could be the result of trauma, infection, or autoimmune disease. Improving the diagnosis of autoimmune disease, whether the TMJ is the primary site or secondarily affected by a systemic disease, is of fundamental importance in selecting treatment that will address the causes rather than just relieve the symptoms. The purposes of this article are to discuss autoimmunity as an etiologic factor in degenerative processes of the TMJ by presenting clinical cases and to highlight the importance of imaging and serologic examinations for diagnosis.

Evaluation of the plasmatic level of mepivacaine in different anatomical regions

BACKGROUND: To evaluate the serum level of the local anesthetic mepivacaine 3% without vasoconstrictor in patients who underwent procedures performed in the anterior and posterior maxilla, through a method of possible extraction to quantify it in human plasma by high performance liquid chromatography (HPLC). MATERIAL AND METHODS: This was a hybrid study consisting of 18 patients (7 females and 11 males) classified as ASA I, adults and with normal body mass index, submitted to procedures in the anterior region (group I) and posterior region of the maxilla (group II). For 40 minutes, five 6 ml blood samples were collected every 10 minutes after infiltrative injection in each region of the maxilla. Serum levels of the drug were obtained through HPLC. Blood pressure (BP) and heart rate (HR) were measured throughout the procedure. RESULTS: When compared to the general average of the concentrations of each group, significant values (p < 0.05) with greater absorption were observed for the anterior region of the maxilla (group I). There was no significant difference when comparing blood pressure (BP) and heart rate (HR) values. CONCLUSIONS: The concentrations found are safe for infiltrative anesthesia in the analyzed patients, there was a higher plasma level of the local anesthetic in the anterior region of the maxilla and there was no change in HR and BP in relation to the anesthetized area

Conservative treatment of an aggressive odontogenic tumor: a case report.

An ameloblastoma is a polymorphic, benign, locally invasive tumor made up of odontogenic epithelium, clinically characterized by slow, progressive, painless growth. There are reports in the literature on the treatment of ameloblastomas with aggressive mural invasion through resections, in order to minimize recurrence. However, different approaches may be used at the bone level, such as curettage combined with a chemical fixative (Carnoy's solution), cryotherapy, or thermal cauterization. The findings of this case report demonstrate that the use of Carnoy's solution following the enucleation of a unicysticameloblastoma with mural invasion may be a treatment alternative with a low rate of recurrence, as well as a reduced rate of postoperative complications, a reduction in costs, and preservation of both esthetics and function.

Manifestações maxilomandibulares de interesse odontológico nos pacientes portadores de displasia cleidocraniana. Relato de um caso clínico / Maxillomandibular dental manifestations of interest in patients with dysplasia cleidocraniana. Report of a clinical case.

A Displasia Cleidocraniana é uma anomalia rara, que tem como características principais a aplasia ou hipoplasia clavicular, retardo na ossificação craniana, atresia maxilar, retardo na erupção dentária e presença de supranumerários. Tendo isso em vista, o presente relato se propõe a descrever o caso de um paciente do sexo masculino de 55 anos que compareceu ao ambulatório de Cirurgia Buco-Maxilo-Facial da Universidade Federal de Pernambuco (UFPE), com o intuito de se submeter à reabilitação protética implanto-suportada. Foi indentificada, após avaliação imaginológica, a presença de 31 dentes inclusos e lesão radiolúcida, compatível com cisto dentígero, associada a 4 destes. Para o tratamento da lesão e preservação da funcionalidade nervosa, foi instituída a utilização de dispositivo de descompressão. O presente relato apresenta como características relevantes a exposição de uma síndrome rara e aspectos marcantes, bem como a exposição da necessidade de um maior conhecimento por parte dos profissionais de saúde, de forma a se evitar um diagnóstico tão tardio.

The Cleidocranial dysplasia is a rare anomaly that has as main features the clavicular hypoplasia or aplasia, delayed ossification, maxillary hypoplasia, delayed tooth eruption and the presence of supernumerary tooth. The present case report describes the case of a 55 years old male patient who was evaluated at the Oral and Maxillofacial service of the Federal University of Pernambuco (UFPE) in order to undergo an implant-supported prosthesis rehabilitation. Were found, after an image evaluation, the presence of 31 impacted teeth and a radiolucent lesion, compatible with dentigerous cyst that of in proximity with 4 teeth. Regarding lesion treatment, aiming to the preservation of nerve function, was established the placement of a decompression device. This report presents relevant characteristics, as the exposure of a rare syndrome with striking aspects, as well as exposure of the need for greater awareness on the part of health professionals in order to avoid a delayed diagnosis.

Evaluation of changes in nasal airway in patients having undergone surgically assisted maxillary expansion.

INTRODUCTION: Surgically assisted maxillary expansion (SAME) is used to treat transverse maxillary discrepancies. The effect of this technique on the nasal airway has been the subject of a large number of studies. OBJECTIVE: The aim of the present study was to identify changes in the nasal airway in patients having undergone SAME. MATERIALS AND METHODS: A prospective study was carried out on a sample of 10 patients having undergone SAME who agreed to participate in all phases of the study. Data acquisition involved a questionnaire, Glatzel mirror, and computed tomography measurements in both the preoperative and postoperative periods. RESULTS: Nasal width increased in all patients following SAME (mean increase: 1.29 mm). The mean opening of the intermaxillary space was 5.30 mm. The postoperative nasal airway was larger in 8 patients (80%), with a mean increase of 0.30 cm(2) (18.52%). A significant overall increase (P < 0.05) in the nasal valve angle occurred in the postoperative period. The use of the Glatzel mirror revealed a smaller area of condensation in the postoperative period in only 1 patient. CONCLUSIONS: The nasal airway underwent a positive change following surgically assisted maxillary expansion. Moreover, the nasal valve angle is suggested as a new parameter for the analysis of this improvement.

Hydrogel of polysaccharide of sugarcane molasses as carrier of bone morphogenetic protein in the reconstruction of critical bone defects in rats.

PURPOSE: To evaluate the benefit of using carriers such as the biopolymer gel (hidrogel of polysaccharide of sugarcane molasses) associated with the bone morphogenetic proteins (BMP's) in the repair of critical bone defects in calvaria of Wistar rats. METHODS: Forty-two rats were submitted to a surgical calvaria bone defects. These animals were divided into two experimental groups, positive control group and negative control group. The Group I the calvaria defect was filled up with biopolymer gel, biological membrane, BMP and lyophilized graft. The Group II was treated with biopolymer gel, BMP and lyophilized graft. And the group III (positive control group) was treated with BMP, lyophilized graft and biological membrane. In the negative control group (Group IV) a defect was made in the rat calvaria and the animals were sacrificed immediately after the surgery. The animals of experimental groups and positive control group were slaughtered after subsequent periods of 90 and 180 days. In these periods, the histological analysis and image assessment by cone bean tomographic imaging were obtained. RESULTS: There was highest bone tissue formation with statistically significant results in the groups that associated biopolymer gel and membrane (Group I), followed by the group III (BMP, lyophilized graft and biological membrane). The lower bone formation occurred in the group not using the sugarcane biopolymer gel (Group II). The radiolucent areas of the analyzes of 180 days among the groups studied were respectively, 14.98 mm(2), 26.65 mm(2) and 35.81 mm(2). CONCLUSION: The biopolymer gel showed to be an excellent bone morphogenetic protein carrier, probably by facilitating the controlled release of these proteins in the process of bone repair.

Hydrogel of polysaccharide of sugarcane molasses as carrier of bone morphogenetic protein in the reconstruction of critical bone defects in rats

PURPOSE: To evaluate the benefit of using carriers such as the biopolymer gel (hidrogel of polysaccharide of sugarcane molasses) associated with the bone morphogenetic proteins (BMP's) in the repair of critical bone defects in calvaria of Wistar rats. METHODS: Forty-two rats were submitted to a surgical calvaria bone defects. These animals were divided into two experimental groups, positive control group and negative control group. The Group I the calvaria defect was filled up with biopolymer gel, biological membrane, BMP and lyophilized graft. The Group II was treated with biopolymer gel, BMP and lyophilized graft. And the group III (positive control group) was treated with BMP, lyophilized graft and biological membrane. In the negative control group (Group IV) a defect was made in the rat calvaria and the animals were sacrificed immediately after the surgery. The animals of experimental groups and positive control group were slaughtered after subsequent periods of 90 and 180 days. In these periods, the histological analysis and image assessment by cone bean tomographic imaging were obtained. RESULTS: There was highest bone tissue formation with statistically significant results in the groups that associated biopolymer gel and membrane (Group I), followed by the group III (BMP, lyophilized graft and biological membrane). The lower bone formation occurred in the group not using the sugarcane biopolymer gel (Group II). The radiolucent areas of the analyzes of 180 days among the groups studied were respectively, 14.98 mm², 26.65 mm² and 35.81 mm². CONCLUSION: The biopolymer gel showed to be an excellent bone morphogenetic protein carrier, probably by facilitating the controlled release of these proteins in the process of bone repair.

Reconstrução mandibular com prótese de resina acrílica após ressecção de ameloblastoma. Relato de caso e avaliação da qualidade de vida / Mandibular reconstruction with an acrylic resin prosthesis after resection of an ameloblastoma: a case report and review of quality of life

O ameloblastoma multicístico é uma lesão de origem odontogênica, que acomete, principalmente, pacientes entre a terceira e a quinta década de vida. Apesar de ser um tumor benigno, muitas vezes, apresenta-se com comportamento agressivo, o que pode exigir intervenções terapêuticas radicais. Casos de ressecções extensas podem representar a perda de uma grande porção de segmento ósseo, produzindo graves sequelas estéticas e funcionais, além da diminuição da qualidade de vida do doente. A reconstrução mandibular representa um importante estágio na reabilitação de pacientes submetidos à exérese de tumores extensos. A utilização de próteses de titânio se traduz numa alternativa confiável, mas ainda inacessível à grande maioria dos pacientes devido ao seu alto custo. Para tanto, o estudo de materiais alternativos viáveis se faz necessário. Nosso trabalho apresenta o caso de um paciente do sexo masculino, 56 anos, que compareceu ao ambulatório de CTBMF do Hospital da Restauração, com queixa de dor e aumento de volume em hemiface direita há mais ou menos dois anos, sendo submetido à hemimandibulectomia após firmado diagnóstico de ameloblastoma musticístico e reabilitação imediata feita por prótese personalizada, confeccionada em resina acrílica. As necessidades do paciente percebidas e o ganho em qualidade de vida foram analisados antes e após o tratamento por meio da aplicação do questionário "perfil de impacto de saúde bucal" (Oral Health Impact Profile - OHIP-14), por se tratar de um dos instrumentos mais amplamente utilizados na avaliação da qualidade de vida. A utilização de materiais alternativos na reabilitação de pacientes, como a resina acrílica, traduz-se numa alternativa segura, rápida e com menor custo, podendo levar ao paciente funcionalidade satisfatória, numa melhora considerável em sua qualidade de vida em todos os âmbitos.

The multicystic ameloblastoma is an odontogenic lesion that mainly affects patients aged 20 to 49 years. Despite being a benign tumor it often presents an aggressive behavior that may require radical interventional therapy. Cases of extensive resections may represent the loss of a large portion of bone segment, producing severe aesthetic and functional sequelae, in addition to a diminished quality of life for the patient. Mandibular reconstruction represents an important stage in the rehabilitation of patients undergoing resection of large tumors. The use of titanium prostheses is a clinically reliable alternative, but is still inaccessible to most patients due to its high cost. It is therefore necessary to examine the use of affordable alternative materials. This paper presents a case of a 56-year-old male patient who came to the outpatient clinic of Oral and Maxillofacial Surgery of Hospital Restauração, complaining of pain and swelling on the right hemiface for about two years. The patient underwent a hemimandibulectomy following the diagnosis of ameloblastoma, followed by immediate rehabilitation with a custom prosthesis made of acrylic resin. The perceived needs of the patient, and the gain in quality of life were assessed before and after treatment using the questionnaire Oral Health Impact Profile - OHIP-14, because it is one of the most widely used instruments in the assessment of quality of life. The use of alternative materials such as acrylic resin in the rehabilitation of patients represents a safe, rapid and low-cost alternative option that may afford the patient a satisfactory functionality and a considerable improvement in quality of life in all areas.

Sialocele como Complicação de Acesso Retromandibular: Relato de Caso / Sialocele as a complication of the retromandibular approach: a case report

A sialocele é o acúmulo de extravasamento salivar numa cavidade subcutânea, ocorrendo, principalmente, após, um episódio traumático ou infeccioso no parênquima da glândula parótida, lesão do ducto parotídeo ou estenose ductal com subsequente dilatação. A realização do correto diagnóstico e o tratamento imediato das lesões traumáticas da glândula parótida tornam-se importantes para evitar complicações. Várias modalidades de tratamento são mencionadas na literatura, e a escolha dependerá do tempo de evolução desde a lesão à região acometida. O presente caso envolve um paciente do gênero masculino vítima de acidente motociclístico que evoluiu com uma sialocele pós-operatória devido à abordagem retromandibular para redução cruenta de fratura condilar. O tratamento realizado foi a instalação de um cateter provisório, criando um novo trajeto para secreção da glândula parótida.

The condition known as sialocele is an accumulation of salivary extravasation in a subcutaneous cavity occurring mainly after a traumatic or infectious episode in the parenchyma of the parotid gland, a parotid duct injury or stenosis with subsequent ductal dilatation. The correct diagnosis and treatment of traumatic lesions of the parotid gland are important in order to avoid complications. Several treatment options are mentioned in the literature and the choice will depend on the time elapsed since injury and the affected region. The patient in the case reported is a male victim of a motorcycle accident who developed a postoperative sialocele due to the use of the retromandibular approach for open reduction of a condylar fracture. The treatment performed was the insertion of a temporary catheter creating a new pathway for secretion of the parotid gland.

Snake bite envenomation in tongue.

Snake bite envenomation has considerable medical importance because of its frequency and severity. An updated standardization of diagnosis and treatment conduct is essential. At no time did the patient develop respiratory insufficiency, neurotoxicity, or renal failure. Tongue damage rapidly resolved after early and aggressive treatment. The preserved tongue remained well perfused and viable, and tongue mobility was good. The aim of the present study was to describe a rare case of snake bite envenomation in the tongue, emphasizing risk factors, the patient's clinical evolution, and the importance of early, multidisciplinary treatment.

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.

Manifestações orais e maxilofaciais secundárias à bulimia nervosa: uma revisão sistemática / Oral and maxillofacial manifestations secondary to bulimia nervosa: a systematic review

Introdução: A bulimia nervosa é um tipo de transtorno alimentar (fortemente associado à questão do padrão de beleza corporal contemporâneo) que atinge cerca de 1 a 2% da população, com maior prevalência no gênero feminino, apresentando uma gama de alterações importantes e características que acometem a região oral e maxilofacial.Objetivo: Realizar uma revisão da literatura a cerca das publicações sobre as manifestações bucomaxilofaciais secundárias à bulimia nervosa, demonstrando as alterações mais comuns e alertando o cirurgião-dentista para o diagnóstico precoce da doença. Método: 54 artigos científicos indexados (Medline, Lilacs, Scielo e Ibecs) sobre: bulimia nervosa, odontologia, erosão dentária e saúde bucal, entre 2005 e 2010, sofreram leitura crítica para aquisição de informações contidas de interesse ao estudo. Os artigos poderiam ser de revisão da literatura, relato de caso, série de casos ou pesquisa clínica. Foram excluídos aqueles artigos que não discorreram nem citaram pelo menos uma manifestação maxilofacial secundária a bulimia nervosa. Os resultados foram tabulados e estatisticamente tratados de forma descritiva. Resultados: Com base nos critérios de inclusão e exclusão, 31 artigos que falavam especificamente a cerca das manifestações bucomaxilofaciais secundárias à bulimia nervosa foram selecionados. Pôde-se notar um elevado número de publicações envolvendo revisões de literatura em comparação às pesquisas clínicas. O perfil epidemiológico dos pacientes revelou as mulheres adultas jovens como grupo de risco, associado às mais prevalentes manifestações como: erosão e sensibilidade dental, aumento no índice de cárie, mucosite, queilite e gengivite. Conclusão: As manifestações bucomaxilofaciais secundárias à bulimia nervosa podem acometer em graus variados as estruturas duras e moles desta região anatômica. Dentre todas as alterações, a erosão dental foi a mais prevalente em tecido duro e a mucosite em tecido mole.

Introduction:Bulimia nervosa is an eating disorder (strongly associated with the contemporary beauty standard body) that affects about 1 to 2% of the population, often female and aged younger. This disorder induces several important changes in the oral and maxillofacial region. Objective: To review the literature about the oral and maxillofacial manifestations secondary to bulimia nervosa, showing the most common changes and alerting the dentist to early diagnose. Method: 54 scientific articles indexed (Medline, Lilacs, Scielo and Ibecs) about: bulimia nervosa, dentistry, dental erosion and oral health, between 2005 and 2010, suffered critical analysis to acquire interest information for the study. The articles could be review, case report, case series and clinical research. Those article that didn't cite at least one oral or maxillofacial manifestation secondary to bulimia nervosa were excluded. The results were tabulated and statistically treated descriptively. Results: According to inclusion and exclusion criteria, 31 articles about oral and maxillofacial manifestations secondary to bulimia nervosa were selected, and the most publications were literature review. The epidemiological profile showed that the young adult women are a risk group. Erosion and tooth sensitivity, increase rates caries, mucositis, cheilitis and gingivitis were more prevalent clinical manifestations. Conclusion: Oral and maxillofacial manifestations secondary to bulimia nervosa may involve hard and soft structures of this anatomical region. Of all the changes, the dental erosion was more prevalent in the hard tissue and mucositis was more prevalent in the soft tissue.

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.