Titanium Mesh Exposure After Bone Grafting: Treatment Approaches-A Systematic Review.

Study Design: A systematic review according to PRISMA statement has been designed to answer the preliminary question: "In titanium mesh exposures, is there a treatment alternative which leads to an increased graft maintenance?" and fill the PICO assessment out. Objective: To review studies published in the past 20 years (1999-2019) in which mesh exposure has occurred, detecting the suitable approaches to treat exposure allowing the graft maintenance. Methods: Initial search on PUBMED, SCOPUS, and COCHRANE databases resulted in 777 articles, and hand-searching identified 6 articles. After removing duplicates and unrelated articles, eligibility criteria were applied, and 31 studies were selected (randomized clinical trials, retrospective/prospective clinical trials, and case series). Results: A total of 677 surgical sites and 225 cases of mesh exposure were identified. Eleven treatments have been identified. Chlorhexidine was the primary approach in 46% of cases, followed by oral hygiene instructions and follow-up with 22.5% of occurrences. In 21% of clinical situations, titanium mesh removal was the treatment of choice, associated with other measures (i.e., antibiotic prescription). There seems to be a consensus in cases of infection. When this complication was associated with tissue dehiscence, the primary treatment was mesh removal. The same does not occur when the site needs to be cleaned for long-term periods. Conclusion: In 2 decades of use of titanium meshes, the available treatments do not seem to have evolved, and there is not enough data to establish a guideline.

Nasal Septal Deviation After Surgically Assisted Rapid Maxillary Expansion.

Background and Aim: Surgically assisted rapid maxillary expansion (SARME) is a surgical technique widely used to correct deficiency of the transverse maxillary dimension. Although some studies investigated the effect of SARME on nasal and facial alterations, there is no evidence that correlates nasal septal deviation (NSD) to SARME as a possible postoperative sequel. The aim of this study is to address and quantify possible variations in the position of the nasal bony septum after SARME and identify any NSD as a postoperative outcome of this surgical technique. Patients and Methods: This is a retrospective study, conducted at the Department of Oral and Maxillofacial Surgery of the University Hospital of Araraquara (Unesp, faculty of dentistry), SP, Brazil. Twenty-nine patients who underwent SARME were studied; every patient was evaluated by cone-beam computerized tomography (CBCT) before (T0) and six months after surgery (T1), and we collected the variation of nasal septal position by measuring the distance between the bony septum and the nasal lateral wall. Our measurements were carried out at the level of the head, midpoint and tail of the inferior turbinate. Results: A mean NSD ranging from 0.4 to 1.2 mm was measured, and it is more pronounced at the anterior part of the bony septum. Twenty-seven patients (93.1%) presented minor changes in bony septum position; in 2 cases (6.8%), a significant NSD was found (p < 0.05). Conclusion: A variation of bony nasal septum position can be expected in any direction after SARME, and it is more pronounced at anterior portion.

How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters / Como a obesidade afeta a função nasal na apneia obstrutiva do sono: parâmetros anatômicos e volumétricos,

Abstract Introduction Obstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance. Objective This study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea. Methods The study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy. Results Analysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m2. Obese and non-obese groups were determined by using cut-off 30 kg/m2. In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p= 0.02), NOSE instrument (p= 0.033) and inferior turbinate hypertrophy (p= 0.036), with odds ratio 1.983 (95% IC 1.048 − 3.753). nasal septum deviation (p= 0.126) and nasal airway volume evaluation (p= 0.177) showed no significant results. Conclusion Obesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation. Level of Evidence 3b - Individual case-control study.

Resumo Introdução A apneia obstrutiva do sono é consequência do colapso das vias aéreas superiores Qualquer região de obstrução nas vias aéreas superiores pode contribuir para o colapso da faringe. A obesidade e os distúrbios relacionados à obesidade desempenham um papel importante na apneia obstrutiva do sono e sua relação com o aumento da resistência das vias aéreas superiores. Objetivo Avaliar a relação entre a obesidade e as propriedades da cavidade nasal em pacientes com apneia obstrutiva do sono. Método O estudo foi feito retrospectivamente através da revisão de prontuários médicos de pacientes adultos. O instrumento de avaliação NOSE, do inglês nasal obstruction symptom evaluation, foi usado para avaliar a obstrução nasal. Os distúrbios respiratórios do sono foram avaliados através de exames polissonográficos. O volume nasal foi obtido por tomografia computadorizada e a reconstrução volumétrica das vias aéreas nasais. As alterações anatômicas nasais foram avaliadas por endoscopia nasal. Resultados A análise dos prontuários de 83 pacientes, entre os quais 54 eram do sexo masculino e 29 do feminino, encontrou um índice de massa corporal médio de 28,69 kg/m2. Os grupos obeso e não obeso foram determinados com o ponto de corte de 30 kg/m2. Na comparação entre os grupos, o grupo obeso apresentou correlação positiva e significante com o índice de apneia/hipopneia (p = 0,02), instrumento NOSE (p = 0,033) e hipertrofia da concha inferior (p = 0,036), com uma odds ratio de 1,983 (IC95%: 1,048 a 3,753). A avaliação do desvio do septo nasal (p = 0,126) e do volume das vias aéreas nasais (p = 0,177) não mostrou resultados significantes. Conclusão A obesidade correlacionou-se significantemente com a obstrução nasal subjetiva pela escala NOSE e hipertrofia de concha inferior em pacientes com apneia obstrutiva do sono. Não houve correlação com a avaliação do volume nasal. Nível de evidência 3b. Estudo de caso-controle individual.

How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters.

INTRODUCTION: Obstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance. OBJECTIVE: This study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea. METHODS: The study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy. RESULTS: Analysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m2. Obese and non-obese groups were determined by using cut-off 30 kg/m2. In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p = 0.02), NOSE instrument (p = 0.033) and inferior turbinate hypertrophy (p = 0.036), with odds ratio 1.983 (95% IC 1.048 - 3.753). nasal septum deviation (p = 0.126) and nasal airway volume evaluation (p = 0.177) showed no significant results. CONCLUSION: Obesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation. LEVEL OF EVIDENCE: 3b - Individual case-control study.

Bone formation after surgically assisted rapid maxillary expansion: comparison of 2 distraction osteogenesis protocols.

OBJECTIVE: The aim of this study was to compare bone formation between 2 distraction osteogenesis protocols by analyzing cone beam computed tomography (CBCT) scan data. STUDY DESIGN: In this retrospective study, the efficacy of 2 different surgically assisted rapid maxillary expansion protocols (group 1 [G1], 3 × 0.25 mm/d; group 2 [G2], 1 mm start followed by 2 × 0.25 mm/d) was analyzed using CBCT scans obtained at 3 time points: preoperatively (T0), immediately after surgery (T1), and 6 months after surgery (T2). Bone formation at T0, T1, and T2 was analyzed using the Dolphin Imaging 11 program. RESULTS: At T1, both groups had significantly higher bone volume than at T0 (G1, 135.6 vs 124.65 mm3, respectively; G2, 153.49 vs 118.9 mm3, respectively), with no significant difference between groups (P = .6). Moreover, bone density measured in the region of interest was similar between groups at all 3 time points; however, in both groups, bone density was significantly lower at T1 and T2 than at T0 (P < .01), with no difference between T1 and T2. CONCLUSIONS: Bone density between the incisors decreased with progressive distraction (i.e., increasing volume), regardless of the distraction protocol used; thus, both protocols can be used safely in clinical practice. Nevertheless, our results indicate that stress should not be applied to the incisors within 6 months of surgery, regardless of the protocol used. Surgeons and orthodontists should therefore consider immature bone formation and avoid using excessive force to close a diastema.

Orthodontic-surgical treatment of a patient with Marfan Syndrome and Obstructive Sleep Apnea Syndrome: a case report with a 9-year follow-up / Tratamento ortodôntico-cirúrgico de um paciente com Síndrome de Marfan e Síndrome da Apnéia Obstrutiva do Sono: relato de caso com 9 anos de acompanhamento

ABSTRACT Marfan's (MFS) syndrome is characterized by a defect in the connective tissue, which affects multiple organic systems. Therefore, the management of these patients requires a multidisciplinary approach. This case reports the orthodontic-surgical treatment of a patient who presented both Marfan's and obstructive sleep apnea syndrome. Patient had malocclusion, TMJ clicking, vertical maxillary excess, mandibular retrognathia, severe esthetic compromise, signs and symptoms of obstructive sleep apnea syndrome, as well as alterationsin joints, cardiovascular and respiratory systems. He was treated with bimaxillary surgery aimed to enhance esthetics, occlusion and address the obstructive sleep apnea syndrome. The clinical results show that a desirable functional occlusion was achieved and both patient's facial esthetics and quality of life were significantly improved. After a 9-year follow-up period, these pleasing features were maintained. The diagnosis and management of Marfan's patients is challenging and require multidisciplinary follow-up.

RESUMO A síndrome de Marfan (SMF) é caracterizada por um defeito no tecido conjuntivo que afeta múltiplos sistemas orgânicos. Portanto, o manejo desses pacientes requer uma abordagem multidisciplinar. Este artigo relata o tratamento ortodôntico-cirúrgico de um paciente com síndrome de Marfan e síndrome da apneia obstrutiva do sono (SAOS). Ele manifestava má oclusão, estalidos na ATM, excessovertical de maxila, retrognatismo mandibular, comprometimento estético severo, sinais e sintomas de síndrome da apneia obstrutiva do sono, além de alterações nas articulações, nos sistemas cardiovascular e respiratório. O tratamento incluiu cirurgia bimaxilar com o objetivo de melhorar a estética, a oclusão e tratar sua apneia obstrutiva do sono. Os resultados clínicos mostram que uma oclusãofuncional desejável foi alcançada e tanto a estética facial quanto a qualidade de vida do paciente foram significativamente melhoradas. Após um período de 9 anos de acompanhamento, essas características agradáveis foram mantidas. O diagnóstico e tratamento de pacientes com síndrome de Marfan é desafiador e requer acompanhamento multidisciplinar.

Atrophic Maxilla Reconstruction With Autogenous Iliac Graft and Guided Dental Implants.

Oral rehabilitation with osseointegrated implants is frequently the best alternative for replacement of lost teeth. Several techniques and materials allow achievement of excellent function and esthetics. In the case of maxillary or mandibular atrophy, extensive grafting may be necessary before implants can be properly placed. This is a case of maxillary reconstruction with autogenous iliac crest bone grafts, followed by placement of guided implants. After integration of the grafts, planning and insertion of implants allowed installation of an implant-supported prosthesis, recovering the morphology, function, and esthetics.

Dentofacial deformities and the quality of life of patients with these conditions: a comparative study.

OBJECTIVES: The aim of the present study was to evaluate the quality of life of patients with dentofacial deformities and of patients subjected to orthognathic surgery to compare their results with those of patients who have no dentofacial deformity by applying the Orthognathic Quality of Life Questionnaire (OQLQ). STUDY DESIGN: Three groups of patients were interviewed, and the OQLQ instrument was applied to them by one examiner. RESULTS: Results showed statistical differences between groups and suggested that patients with no deformity and those subjected to orthognathic surgery have better quality of life compared with those with facial deformity. CONCLUSIONS: Orthognathic surgery with the consequent dentofacial correction seems to have a positive effect on quality of life.

Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients, / Avaliação volumétrica de segmentos faríngeos em pacientes com apneia obstrutivado sono,

Abstract Introduction Obstructive sleep apnea occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea) reduction of the airflow and has intimate relation with changes in the upper airway. Cone Beam CT allows the analysis of the upper airway and its volume by three-dimensional reconstruction. Objective To evaluate a possible correlation between the volume of the upper airway and the severity of the obstructive sleep apnea. Methods A retrospective study was performed reviewing polysomnographic data and Cone Beam CT records of 29 patients (13 males and 16 females). The correlation between the volume of the nasopharynx, the oropharynx and the total superior pharynx with the AHI was assessed by Pearson's rank correlation coefficient. Results The obstructive sleep apnea severity division was: ten patients had severe, 7 had moderate, 6 had mild and 6 of them were healthy. The correlation between the nasopharynx, the oropharynx and the total superior pharynx volumes and the Apnea-Hypopnea-Index was respectively: −0.415 (p = 0.025), 0.186 (p = 0.334) and −0329 (p = 0.089). The Spearman's rank controlled by the Body Mass Index, the age and the gender was: −0.206 (p = 0.304), −0.155 (p = 0.439) and 0.242 (p = 0.284). Conclusion There is no correlation between the volume of the airway and the obstructive sleep apnea, assessed by Apnea-Hypopnea-Index and controlled by the Body Mass Index, the age and the gender. The volume of the upper airways as an isolated parameter did not correlate to the severity of the obstructive sleep apnea syndrome, and should be evaluated together with other factors.

Resumo Introdução A Apneia Obstrutiva do Sono ocorre por colapso recorrente das vias aéreas superiores durante o sono, resultando em redução total (apneia) ou parcial (hipopneia) do fluxo aéreo, tendo relação estreita com alterações nas vias aéreas superiores. A TC de feixe cônico permite a análise da via aérea superior e seu volume através da reconstrução tridimensional. Objetivo Avaliar uma possível correlação entre o volume da via aérea superior e a gravidade da apneia obstrutiva do sono. Método Realizou-se um estudo retrospectivo, com revisão de dados polissonográficos e registros de TC de feixe cônico de 29 pacientes (13 do sexo masculino e 16 do sexo feminino). A correlação entre o volume total da nasofaringe, a orofaringe e a faringe superior com o IAH (Índice de Apneia-Hipopneia) foi avaliada pelo coeficiente de correlação de Pearson. Resultados A divisão por gravidade da Apneia Obstrutiva do Sono foi: dez pacientes apresentaram apneia na forma severa, 7 apresentaram apneia moderada, 6 tinham a forma leve e 6 estavam saudáveis. A correlação entre a nasofaringe, a orofaringe e os volumes da faringe superior e o Índice de Apneia-Hipopneia foram respectivamente: -0,415 (p = 0,025), 0,186 (p = 0,334) e -0329 (p = 0,089). A classificação de Spearman controlada pelo Índice de Massa Corporal, idade e sexo foi: -0,206 (p = 0,304), -0,155 (p = 0,439) e 0,242 (p = 0,284). Conclusão Não há correlação entre o volume da via aérea e a apneia obstrutiva do sono, avaliada pelo índice de apneia-hipopneia e controlada pelo índice de massa corporal, idade e sexo. O volume das vias aéreas superiores como parâmetro isolado não se correlacionou com a gravidade da síndrome da apneia obstrutiva do sono, e deve ser avaliado em conjunto com outros fatores.

Rabdomyosarcoma of the Mandible: An Uncommon Clinical Presentation.

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

Effects of surgically assisted rapid maxillary expansion on mandibular position: a three-dimensional study.

BACKGROUND: This study aimed to evaluate three-dimensional changes in mandibular position after surgically assisted rapid maxillary expansion (SARME). METHODS: A retrospective study was carried out with tomographic records of 30 adult patients with maxillary transverse deficiency who underwent SARME. Cone beam computed tomography scans were obtained preoperatively (T1), after expansion (T2) and 6 months after expansion (T3). Mandibular landmarks were measured with respect to axial, sagittal, and coronal planes. Repeated measures ANOVA was used for statistical analysis. RESULTS: Clockwise rotation and lateral displacement of the mandible were observed immediately after SARME. However, mandibular displacements tended to return close to their initial values at T3. CONCLUSIONS: Clockwise rotation and lateral shift of the mandible are transient effects of SARME.

Enfisema subcutâneo abrangendo os espaços temporal, orbital, bucal, submandibular e cervical após cirurgia para extração de terceiro molar / Subcutaneous emphysema envolving temporal, orbital, buccal, submandibular and cervical spaces after third molar surgery

Enfisema subcutâneo é uma complicação bem estabelecida de trauma ou infecção com pneumonia ou tuberculose, que tem incluído o aumento da pressão intrabucal no local de uma lesão da mucosa ou a provisão de ar comprimido em uma ferida. A incidência desse tipo de complicação tem aumentado consideravelmente, desde a introdução de peças de mão em alta rotação, usadas em cirurgias de terceiro molar. Este artigo tem como objetivo apresentar um relato de caso de um paciente do gênero masculino que foi submetido à cirurgia para remover o terceiro molar superior direito, com a ajuda de peça de mão em alta rotação, desenvolvendo um enfisema subcutâneo dos espaços fasciais no pós-operatório imediato. As imagens da tomografia computadorizada revelaram a presença de enfisema com dissecção do espaço periorbitário com envolvimento das pálpebras superior e inferior, espaços temporal e bucal, estendendo-se para a região submandibular, sublingual e cervical. A partir da descrição desse caso, os autores propõem uma forma de tratamento, evidenciando os meios de diagnóstico e prevenção dessa complicação... (AU)

Subcutaneous emphysema is a well-established complication of trauma or infection pneumonia and tuberculosis, which have included increasing the intraoral pressure at a site of the mucosal lesion or compressed air supply on a wound. The incidence of this complication has increased considerably since the introduction of handpieces used in high rotation in third molar surgery. This article aims to present a case report of a male patient who underwent surgery to remove the superior right third molar, with the help of handpiece at high speed, developing a subcutaneous emphysema fascial spaces in post-operative period. The images of computed tomography revealed the presence of emphysema with dissection of the periorbital space involving the upper and lower eyelids, temporal, buccal space, extending to the submandibular, sublingual and neck. From the description of this case, the authors propose a form of treatment, showing the means of diagnosis and prevention of this complication... (AU)

Bone grafting for alveolar ridge reconstruction. Review of 166 cases.

OBJECTIVE:: to investigate the predictive factors of failure in bone grafts for alveolar ridge augmentation and implant surgery. METHODS:: we reviewed the charts of 166 patients operated between 1995 and 2014. A total of 248 grafting procedures were performed. We submitted the data to the binomial test at 5% significance. RESULTS:: grafts to gain width of the alveolar ridge (65.32%) were more frequent than sinus lifting (p<0.0001) and the number of grafts to the posterior maxilla (48.8%) was greater than in other regions (p<0.01); 6.04% of the grafts were lost. The losses in anterior (p<0.0309) and posterior (p<0.0132) maxilla were higher than in the mandible. There were 269 ​​implants installed in the grafted areas, of which only 4.83% were lost. The number of implants lost (4.51%) in areas of onlay grafts was not statistically higher than those placed after sinus lifting (2.63%, p<0.2424). Losses were greater in the anterior (53.85%) and posterior (38.46%) maxilla than in the mandible (p<0.031). Regarding patients' age, 76.92% of the lost grafts (p<0.006) and 80% of the lost implants (p<0.001) were installed in patients over 40 years. CONCLUSION:: failure rate was higher both for grafts and dental implants in the maxilla and in patients over 40 years of age. OBJETIVO:: investigar os fatores preditivos de falhas em enxertos ósseos para aumento do rebordo alveolar e cirurgia de implantes. MÉTODOS:: os prontuários de 166 pacientes, operados entre 1995 e 2014, foram revistos. Um total de 248 enxertos foi realizado. Os dados foram submetidos ao teste binomial a 5% de significância. RESULTADOS:: os enxertos para ganho em espessura do rebordo alveolar (65,32%) foram mais frequentes do que levantamentos de seio maxilar (p<0,0001) e o número de enxertos para a região posterior da maxila (48,8%) foi maior do que em outras regiões (p<0,01). Foram perdidos 6,04% dos enxertos. As perdas em maxila anterior (p<0,0132) e posterior (p<0,0309) foram maiores do que na mandíbula. Foram instalados 269 implantes nas áreas enxertadas e apenas 4,83% perdidos. O número de implantes perdidos (4,51%) em áreas de enxertos em bloco não foi estatisticamente maior do que na área de seios maxilares enxertados (2,63%) (p<0,2424). As perdas foram maiores na região anterior (53,85%) e posterior (38,46%) da maxila em relação a mandíbula (p<0,031) e, 76,92% dos enxertos (p<0,006) e 80% dos implantes perdidos (p<0,001), foram instalados em pacientes com mais de 40 anos de idade. CONCLUSÃO:: maior taxa de falhas foi observada para enxertos e implantes dentários realizados em maxila e em pacientes com mais de 40 anos de idade.

Aggressive Osteoblastoma in the Maxilla: Unusual Lesion in the Craniofacial Skeleton.

Osteoblastomas are benign bone tumors, which are unusual in the craniofacial skeleton, being most often observed in the axial skeleton and long bones. The most common site in the maxillofacial region is the mandible and the involvement of the maxilla and paranasal sinuses is extremely rare. Although it is a benign lesion, the aggressive variant raises concerns due to its huge local destructive potential and tendency to relapse. In this clinical case, an aggressive osteoblastoma is described in a 7-year-old patient. The lesion was large and fully involved the left maxilla, including the maxillary sinus and the nasal cavity. Recurrent volume increase was observed 2 months following enucleation of the lesion and en bloc resection of the maxillary segment was performed. Histological and immunohistochemical evaluation associated with clinical and imaging findings allowed to define the tumor as an aggressive variant of osteoblastoma and not osteosarcoma, despite the aggressive behavior. The patient recovered well and no relapses were observed after 12 months following maxillary resection.

Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients.

INTRODUCTION: Obstructive sleep apnea occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea) reduction of the airflow and has intimate relation with changes in the upper airway. Cone Beam CT allows the analysis of the upper airway and its volume by three-dimensional reconstruction. OBJECTIVE: To evaluate a possible correlation between the volume of the upper airway and the severity of the obstructive sleep apnea. METHODS: A retrospective study was performed reviewing polysomnographic data and Cone Beam CT records of 29 patients (13 males and 16 females). The correlation between the volume of the nasopharynx, the oropharynx and the total superior pharynx with the AHI was assessed by Pearson's rank correlation coefficient. RESULTS: The obstructive sleep apnea severity division was: ten patients had severe, 7 had moderate, 6 had mild and 6 of them were healthy. The correlation between the nasopharynx, the oropharynx and the total superior pharynx volumes and the Apnea-Hypopnea-Index was respectively: -0.415 (p=0.025), 0.186 (p=0.334) and -0329 (p=0.089). The Spearman's rank controlled by the Body Mass Index, the age and the gender was: -0.206 (p=0.304), -0.155 (p=0.439) and 0.242 (p=0.284). CONCLUSION: There is no correlation between the volume of the airway and the obstructive sleep apnea, assessed by Apnea-Hypopnea-Index and controlled by the Body Mass Index, the age and the gender. The volume of the upper airways as an isolated parameter did not correlate to the severity of the obstructive sleep apnea syndrome, and should be evaluated together with other factors.

Bone grafting for alveolar ridge reconstruction. Review of 166 cases. / Enxerto ósseo para reconstrução óssea alveolar. Revisão de 166 casos

ABSTRACT Objective: to investigate the predictive factors of failure in bone grafts for alveolar ridge augmentation and implant surgery. Methods: we reviewed the charts of 166 patients operated between 1995 and 2014. A total of 248 grafting procedures were performed. We submitted the data to the binomial test at 5% significance. Results: grafts to gain width of the alveolar ridge (65.32%) were more frequent than sinus lifting (p<0.0001) and the number of grafts to the posterior maxilla (48.8%) was greater than in other regions (p<0.01); 6.04% of the grafts were lost. The losses in anterior (p<0.0309) and posterior (p<0.0132) maxilla were higher than in the mandible. There were 269 ​​implants installed in the grafted areas, of which only 4.83% were lost. The number of implants lost (4.51%) in areas of onlay grafts was not statistically higher than those placed after sinus lifting (2.63%, p<0.2424). Losses were greater in the anterior (53.85%) and posterior (38.46%) maxilla than in the mandible (p<0.031). Regarding patients' age, 76.92% of the lost grafts (p<0.006) and 80% of the lost implants (p<0.001) were installed in patients over 40 years. Conclusion: failure rate was higher both for grafts and dental implants in the maxilla and in patients over 40 years of age.

RESUMO Objetivo: investigar os fatores preditivos de falhas em enxertos ósseos para aumento do rebordo alveolar e cirurgia de implantes. Métodos: os prontuários de 166 pacientes, operados entre 1995 e 2014, foram revistos. Um total de 248 enxertos foi realizado. Os dados foram submetidos ao teste binomial a 5% de significância. Resultados: os enxertos para ganho em espessura do rebordo alveolar (65,32%) foram mais frequentes do que levantamentos de seio maxilar (p<0,0001) e o número de enxertos para a região posterior da maxila (48,8%) foi maior do que em outras regiões (p<0,01). Foram perdidos 6,04% dos enxertos. As perdas em maxila anterior (p<0,0132) e posterior (p<0,0309) foram maiores do que na mandíbula. Foram instalados 269 implantes nas áreas enxertadas e apenas 4,83% perdidos. O número de implantes perdidos (4,51%) em áreas de enxertos em bloco não foi estatisticamente maior do que na área de seios maxilares enxertados (2,63%) (p<0,2424). As perdas foram maiores na região anterior (53,85%) e posterior (38,46%) da maxila em relação a mandíbula (p<0,031) e, 76,92% dos enxertos (p<0,006) e 80% dos implantes perdidos (p<0,001), foram instalados em pacientes com mais de 40 anos de idade. Conclusão: maior taxa de falhas foi observada para enxertos e implantes dentários realizados em maxila e em pacientes com mais de 40 anos de idade.

Evaluation of Nasal Obstruction in Various Sagittal Skeletal Deformity of Jaws.

Nasal obstruction (NO) is a common symptom present in 25% of the general population, which significantly interferes with the quality of life. The different facial profiles and malocclusion patterns could be associated with the degree of NO. In order to evaluate the nasal function in patients with different facial morphology patterns, the authors developed a prospective study in which 88 patients from a dentofacial deformities center were included. These patients were submitted to fibrorhinoscopy (Mashida, ENT PIII) with a 3.2-mm cannula under topical anesthesia to evaluate septal deviation, inferior and medium turbinates, and pharyngeal tonsils. The 88 patients included in the study were divided into 3 groups according to the classification of the facial profile, distributed as follows: 32 class I, 28 class II, and 28 class III; the data collected was statistically analyzed by analysis of variance and the results are shown. The patients included in this study presented similar prevalence of NO with the reduction of airway function efficiency. Although it was not a statistically different, the group II presented higher mean Nasal Obstruction Syndrome Evaluation scores.

Reconstruction of orbital floor defects assisted by transantral endoscopy.

PURPOSE: The goal of orbital reconstruction is to restore anatomy, volume, and function. In extensive orbital floor defects, the visualization of the posterior area is limited through inferior eyelid incisions. The use of endoscope may improve the treatment; however, it is a high-sensitivity technique. The aim of this case series is to describe the combination of inferior eyelid incision with transantral endoscopy for treatment of extensive orbital floor defects. METHODS: Three patients were submitted to orbital reconstruction, and the postoperative CT scans were evaluated to analyze the orbital volume and anteroposterior globe position. Surgical treatment was performed using subciliary inferior palpebral approach to explore the orbital floor and placement of the titanium mesh and an intraoral antrostomy for endoscopy to magnification of the surgical field and adaptation of the mesh. RESULTS: Postoperative CT scan analysis shows that all treatments restored orbital volume and globe position without compression or damage of the optical nerve. CONCLUSION: The use of endoscope allowed the precise visualization of the posterior region of the orbit and adaptation of the titanium mesh.

Mandibular angle fractures: a comparative study between one- and two-plate fixation.

BACKGROUND/AIM: The mandibular angle fracture is a challenging fracture to manage. Over time, the literature has shown many types of treatment modalities and different kinds of internal fixation. The aim of this study was to evaluate the outcomes and complications of mandibular angle fractures managed by Champy's technique and two-plate fixation, over a period of 20 years. MATERIAL AND METHODS: The files of 149 patients with 155 angle fractures fulfilled the inclusion criteria and were chosen for this study. Data were collected regarding gender, age, race, date of trauma, addictions, etiology, signs and symptoms, fracture management, and complications. RESULTS: Prevalence was higher in males (82%), Caucasians (62%), and during the third decade of life (62%). Mean age was 26.5 years. The main cause was interpersonal violence, and the mean follow-up period was 232 days. The main signs and symptoms were pain, edema, and mouth-opening restriction. The most often associated fracture involved the mandibular condyle, and the most common complication was infection. CONCLUSION: There was no difference between the two modalities of treatment. However, the one-plate fixation technique had fewer complications.

Surgical treatment of cementoblastoma associated with apicoectomy and endodontic therapy: Case report.

This case report describes the surgical removal of cementoblastoma associated with apicoectomy and endodontic therapy. The patient, an 18-year-old man, presented pain in the region of the mandibular body on the right side. On clinical exam, bone expansion was observed in the region at the bottom of the vestibular sulcus, pain on palpation, slight extrusion of tooth 46 with presence of pulp vitality. Radiographic exams demonstrated the presence of a radiopaque area and discrete radiolucent halo associated with the root of tooth 46, suggesting the diagnosis of cementoblastoma. Endodontic treatment of tooth 46 was performed and exeresis of the lesion by apicoectomy. Twelve months after the first surgery, recurrence of the lesion was observed, and a new apicoectomy was necessary, this time up to the middle third of the root. Clinical radiographic control 12 mo after the second surgical intervention demonstrated absence of signs and symptoms, radiographic repair, with tooth 46 shown to be fully functional.