Osteoradionecrosis prevalence and associated factors: A ten years retrospective study

BACKGROUND: Osteoradionecrosis (ORN) is one of the most serious complications of head and neck radiotherapy and is considered a public health problem worldwide. This study aims to determine the prevalence and associated factors of ORN in patients undergoing radiotherapy for head and neck malignancy. MATERIAL AND METHODS: A cross-sectional retrospective study was conducted, in which all medical records of patients undergoing head and neck radiation in the period between 2006 to 2015 (10 years) were examined. Clinical and demographic data were extracted. Multivariate Poisson regression analysis with robust variance was employed to access the relationship between ORN and independent variables (p < 0.05; 95% CI). RESULTS: The sample comprised 413 medical records of patients undergoing radiotherapy. The prevalence of ORN was 9.7 %. Most participants were males (78.2%). The mean age of subjects was 55 years (± 14 years). The mandible was the main site of occurrence of ORN (85.0%). The following variables were associated with ORN: presence of oral mucositis (PR = 3.03; 95% CI: 1.30-7.03), history of smoking (PR = 0.23; 95% CI: 0.07-0.74), number of teeth removed before radiotherapy (PR = 1.06; 95% CI: 1.01-1.11) and visit to the dentist before radiation (PR = 0.08; 95% CI: 1.02-1.11). CONCLUSIONS: The prevalence of ORN was low and was associated with the presence of oral mucositis and the number of removed teeth before radiation. Visiting the dentist before radiotherapy and stopping smoking were protective factors for ORN

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

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

Occupational stress among Brazilian oral-maxillofacial surgeons

Purpose: The aim of the present study was to assess the stress level of oral-maxillofacial surgeons, based on theDemand-Control Model. Methods: A cross-sectional study was carried out with 128 oral-maxillofacial surgeonswho participated in the Brazilian Congress of Oral-Maxillofacial Surgery held in the city of Florianópolis, Stateof Santa Catarina, Brazil. Data was obtained using a questionnaire that incorporated the Demand-Control Model(Job Content Questionnaire), which evaluates psychosocial experiences at work. Information on age, genderand professional qualification was also collected. The data was displayed in contingency tables. The followingstatistical tests were used with a 5% level of significance: chi-square test and “Fisher exact test”. Results: Oralmaxillofacialsurgeons were classified according to the Demand-Control Model as follows: High Demand (28%),Low Demand (28%); Passive Work (27%), Active Work (16.4%). Conclusion: The majority of oral-maxillofacialsurgeons exercise their profession in unsatisfactory working conditions, as less than 1/3 of the population studiedworked under the ideal condition of low demand (AU)

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Submental intubation in oral maxillofacial surgery: Review of the literature and analysis of 13 cases

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Objectives: Various different methods of intubation are suitable for facial trauma cases. A choice often has to be made between orotracheal and nasotracheal when surgical access to the nasal or oral cavity is necessary. This work presents our current experience using submental intubation in the airway management of facial trauma patients.Study design: From July 2003 to February 2005, 13 sufferers from facial trauma benefited from submental intubation. All the patients were males and the ages ranged from 19 to 35 years (mean, 27 years).Results: In all the patients, the submental intubation permitted simultaneous reduction and fixation of all fractures and intraoperative control of the dental occlusion without interference from the tube during the operation. There was only one intra-operative complication, when the tracheal pressure increased as a result of deviation and compression of the tube. No post-operative complications were reported.Conclusion: Submental intubation is a simple, secure and effective procedure for operative airway control in major maxillofacial traumas (AU)