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AI is included in a lot of different systems. In facial surgery, there are some AI-based software programs oriented to diagnosis in facial surgery. This study aims to evaluate the capacity and training of models for diagnosis of dentofacial deformities in class II and class III patients using artificial intelligence and the potential use for indicating orthognathic surgery. The search strategy is from 1943 to April 2024 in PubMed, Embase, Scopus, Lilacs, and Web of Science. Studies that used imaging to assess anatomical structures, airway volume, and craniofacial positions using the AI algorithm in the human population were included. The methodological quality of the studies was assessed using the Effective Public Health Practice Project instrument. The systematic search identified 697 articles. Eight studies were obtained for descriptive analysis after exclusion according to our inclusion and exclusion criteria. All studies were retrospective in design. A total of 5552 subjects with an age range between 14.7 and 56 years were obtained; 2474 (44.56%) subjects were male, and 3078 (55.43%) were female. Six studies were analyzed using 2D imaging and obtained highly accurate results in diagnosing skeletal features and determining the need for orthognathic surgery, and two studies used 3D imaging for measurement and diagnosis. Limitations of the studies such as age, diagnosis in facial deformity, and the included variables were observed. Concerning the overall analysis bias, six studies were at moderate risk due to weak study designs, while two were at high risk of bias. We can conclude that, with the few articles included, using AI-based software allows for some craniometric recognition and measurements to determine the diagnosis of facial deformities using mainly 2D analysis. However, it is necessary to perform studies based on three-dimensional images, increase the sample size, and train models in different populations to ensure accuracy of AI applications in this field. After that, the models can be trained for dentofacial diagnosis.
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SUMMARY: Orthognathic surgery and rhinoplasty show synergy in terms of function and aesthetic results. The aim of this research is to analyze variables related to simultaneous orthognathic surgery and rhinoplasty and to discuss the surgical sequence. Male and female subjects between 18 and 45 years old were included in this research. Diagnosis related to nasal morphology (nasal tip bifid, rotate, square and others as well as the alae morphology and columella), facial deformity (sagittal and vertical deformity), type of surgery (rhinoplasty techniques and orthognathic techniques) and complications were included. The minimum follow-up was 12 months; Chi- Square and t test were used to define correlations, considering a value of p<0.05 for statistical significance. Class III facial deformity was observed in 40 % of subjects and class II facial deformity was present in 43 %. For the nasal deformities, the tip and nasal bridge were most prevalent; primary nasal deformity was observed in the 83 % of subjects and was significant more than secondary nasal deformity (p=0.042). Bimaxillary surgery was performed in 31 cases (88 %). In 10 cases a change of the original plan for rhinoplasty due to previous maxillary surgery was realized, mainly in class III facial deformity, with no statistical differences. Revision rhinoplasty was realized in 5 cases (14 %) and was not related to surgical variables; revision for orthognathic surgery was not necessary in this series. Rhinoplasty and orthognathic surgery simultaneously show low complications and predictable results. We can conclude that maxillary mandibular osteotomies and rhinoplasty could be performed safely. However, larger studies are necessary to understand the best choice and variables involved in simultaneous procedures and soft tissue response.
La cirugía ortognática y la rinoplastia muestran sinergia en términos de resultados funcionales y estéticos. EL objetivo de esta investigación es analizar variables relacionadas con la cirugía ortognática y rinoplastia ejecutada de forma simultanea. Fueron incluidos hombres y mujeres entre 18 y 45 años de edad. EL diagnóstico fue en base a la morfología nasal (punta bífida, rotada, cuadrada u otras así como alteraciones del ala nasal y columela), deformidad facial (deformidad sagital y vertical), tipo de cirugía (técnica de rinoplastia y cirugía ortognática) y complicaciones asociadas. El seguimiento mínimo fue de 12 meses; se utilizo las prueba t test y chi cuadrado para definir relaciones estadísticas considerando un valor de p< 0,05 para obtener diferencias significativas. La deformidad clase III fue observada en el 40 % de los sujetos y la deformidad facial de clase II se presento en el 43 %. Para la deformidad nasal, las alteraciones de a punta nasal y nasal fueron mas prevalentes; la deformidad nasal primaria se presentó en el 83 % de los sujetos y fue significativamente mayor que la deformidad nasal secundaria (p=0,042). La cirugía bimaxilar se realizó en 31 casos (88 %); en 10 casos se realizó el cambio del plan quirúrgico inicial de la rinoplastia debido a cambios generados en la cirugía maxilar previa, mayormente en deformidad facial de clase III, sin presentar diferencias significativas. La rinoplastia de revisión fue realizada en 5 casos (14 %) y no fue relacionada con ninguna variable de tipo quirúrgica; la revisión de cirugía ortognática no fue realizada en ningún caso de esta serie. La rinoplastia y la cirugía ortognática simultanea mostraron bajas complicaciones y resultados predecibles. Se puede concluir que la osteotomía maxilo mandibular y la rinoplastia son seguras; sin embargo, estudios de mayor volumen son necesarios para entender la mejor opción y variables relacionadas con procedimientos simultáneos y la respuesta de tejidos blandos faciales.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Rinoplastia/métodos , Face/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Distribuição de Qui-Quadrado , Doenças Nasais/cirurgia , Seguimentos , Assimetria Facial/cirurgiaRESUMO
INTRODUCTION: Endoscopic vacuum therapy (EVT) is a novel technique for closing upper gastrointestinal (UGI) defects. Available literature includes single-center retrospective cohort studies with small sample sizes. Furthermore, evidence about factors associated with EVT failure is scarce. We aimed to assess the efficacy and safety of EVT for the resolution of UGI defects in a multicenter study and to investigate the factors associated with EVT failure and in-hospital mortality. METHODS: This is a prospective cohort study in which consecutive EVT procedures for the treatment of UGI defects from 19 Spanish hospitals were recorded in the national registry between November 2018 and March 2022. RESULTS: We included 102 patients: 89 with anastomotic leaks and 13 with perforations. Closure of the defect was achieved in 84 cases (82%). A total of 6 patients (5.9%) had adverse events related to the EVT. The in-hospital mortality rate was 12.7%. A total of 6 patients (5.9%) died because of EVT failure and 1 case (0.9%) due to a fatal adverse event. Time from diagnosis of the defect to initiation of EVT was the only independent predictor for EVT failure (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = 0.005). EVT failure (OR 24.5, 95% CI 4.5-133, P = 0.001) and development of pneumonia after EVT (OR 246.97, 95% CI 11.15-5,472.58, P = 0.0001) were independent predictors of in-hospital mortality. DISCUSSION: EVT is safe and effective in cases of anastomotic leak and perforations of the upper digestive tract. The early use of EVT improves the efficacy of this technique.
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Tratamento de Ferimentos com Pressão Negativa , Trato Gastrointestinal Superior , Humanos , Estudos Retrospectivos , Estudos Prospectivos , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa/métodos , Trato Gastrointestinal Superior/cirurgia , Fístula Anastomótica/cirurgia , Fístula Anastomótica/etiologia , Sistema de Registros , Resultado do TratamentoRESUMO
Medication-related osteonecrosis of the jaw (MRONJ) is defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS) as the presence of an exposed bone area in the maxillofacial region, present for more than eight weeks in patients treated with the use of antiresorptive or antiangiogenic agents, with no history of radiation or metastatic disease. Bisphosphonates (BF) and denosumab (DS) are widely used in adults for the management of patients with cancer and osteoporosis, and recently there has been an increase in their use in child and young patients for the management of disorders such as osteogenesis imperfecta (OI), glucocorticoid-induced osteoporosis, McCune-Albright syndrome (MAS), malignant hypercalcemia, and others. There are differences between case reports in adults compared to child and young patients related to the use of antiresorptive/antiangiogenic drugs and the development of MRONJ. The aim was to analyze the presence of MRONJ in children and young patients, and the relation with oral surgery. A systematic review, following the PRISMA search matrix based on the PICO question, was conducted in PubMed, Embase, ScienceDirect, Cochrane, Google Scholar, and manual search in high-impact journals between 1960 and 2022, publications in English or Spanish, including randomized and non-randomized clinical trials, prospective and retrospective cohort studies, cases and controls studies, and series and case reports. A total of 2792 articles were identified and 29 were included; all of them published between 2007 and 2022, identifying 1192 patients, 39.68% male and 36.24% female, aged 11.56 years old on average, using these drugs mainly for OI (60.15%); 4.21 years on average was the therapy time and 10.18 drug doses administered on average; oral surgery was observed in 216 subjects, reporting 14 cases of MRONJ. We concluded that there is a low presence of MRONJ in the child and youth population treated with antiresorptive drugs. Data collection is weak, and details of therapy are not clear in some cases. Deficiencies in protocols and pharmacological characterization were observed in most of the included articles.
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The aim of this research was to analyze the facial class, presence of malocclusion, and the mandibular plane and to relate this to the mandibular condyle position. A cross-sectional study in subjects under analysis for orthognathic surgery was done. The mandibular plane, the gonial angle, and the molar class were included to compare the coronal and sagittal position of the condyle and the joint space observed in the CBCT. The measurements were obtained by the same observer at an interval of two weeks. In addition, the Spearman test was performed to determine the correlation using a p value < 0.05 to observe any significant differences. Eighty-nine male and female subjects (18 to 58 years old, 24.6 ± 10.5) were included. In the coronal section, subjects with CIII had a greater mediolateral distance (MLD, p = 0.0001) and greater vertical distance (SID, p = 0.0001) than subjects with CII. In terms of the skeletal class and the mandibular plane, it was observed that subjects in the CII group had a greater mandibular angle (open angle) (p = 0.04) than the CII group and was related to the anterior position of the condyle. The most anterior condylar position was observed in the CII group (p = 0.03), whereas a posterior condylar position was significant in CIII subjects (p = 0.03). We can conclude that the sagittal position of the TMJ was related to the mandibular plane and the skeletal class showing a higher mandibular angle and most anterior position of the condyle in CII subjects and a lower mandibular angle and most posterior position of the condyle in CIII subjects. The implications for surgical treatment have to be considered.
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SUMMARY: The aim of this research was to evaluate the changes obtained with the mentoplasty technique in the increase of the airway imaging. A systemic review was performed using the parameters of the prism matrix, in the PubMed, Science Direct, Redalyc database, covering the years 1984 to 2019 with the use of defined inclusion criteria. The authors independently applied the selected parameter of data extraction, study selection and risk-to-bias assessment. A total of 1,251 articles were obtained among the 3 databases, of which 10 met the inclusion criteria. The variables studied were: type of research, sample size, sex, age, dento-skeletal diagnosis, airway classification, diagnosis of obstructive sleep apnea syndrome (OSAS), type of imaging evaluation, variables evaluated in the image, pre and post-operative values, surgical technique and type of fixation used, other surgical procedures applied, and complications. In the cases of linear evaluation with cephalometric analysis (9 articles) they used PAS (posterior airspace), MP-H (mandibular plane to the hyoid) and SNB (saddle-nasion-point B), and SCSA (section area as the most relevant points, smallest cross section) and VT (total volume) in the volumetric evaluations (2 articles). The average change in posterior airspace achieved by the cited authors is 4.2 mm with standard deviation of 1.4 mm with the use of advancement mentoplasty. The most widely used technique was mentoplasty with a horizontal osteotomy by 5 authors. Based on the research there is a positive relationship between the increase in the airway and the advancement mentoplasty procedure, however, more standardized studies associated with the way of measuring and evaluating the relationship between advancement and the airway are necessary.
RESUMEN: El objetivo de esta investigación fue evaluar los cambios obtenidos con la técnica de mentoplastia en el incremento de la via aérea. Una revisión sistemática fue realizada utilizando parámetros de la matriz prisma, en PubMed, Science Direct, Redalyc database, cubriendo los años 1984 a 2019 con criterios de inclusión definidos. Los autores aplicaron de forma independiente los parámetros de selección y extracción de datos, selección de estudios y riesgos de sesgo. Un total de 1251 artículos fueron obtenidos de las 3 bases de dato, donde 10 artículos cumplieron los criterios de inclusión. Las variables estudiadas fueron: tipo de investigación, tamaño de la muestra, genero, edad, diagnóstico dento esqueletal, clasificación de la vía aérea, diagnostico de síndrome de apnea del sueño (SAOS), tipo de evaluación de la imagen, variables evaluadas en la imagen en pre y postoperatorio, técnica quirúrgica y tipo de fijación utilizada, otros procedimientos quirúrgicos y complicaciones. En el caso de la evaluación linear con cefalometria (9 artículos), usaron PAS (posterior airspace), MP-H (plano mandibular hacia el hueso hioide) y SNB (silla turca-nasion- punto B) y SCSA (sección de puntos mas relevantes, menores transfversales) y el VT (volumen total) en las evaluaciones volumétricas (2 artículos). El promedio de cambio posterior de la vía aérea citado por autores fue de 4,2 mm con una desviación estándar de 1,4 mm con el uso de la mentoplastia de avance. La técnica mas habitual fue la mentoplastia con osteotomía horizontal (5 autores). Basados en esta investigación existe una relación positiva entre el incremento de la vía aérea y el avance con genioplastia; sin embargo, mas estudios estandarizados junto con medidas definidas y la evaluación correcta del avance y la vía área son necesarios.
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Humanos , Faringe/anatomia & histologia , Queixo/anatomia & histologia , Mentoplastia , Avanço Mandibular , Mandíbula/anatomia & histologiaRESUMO
BACKGROUND: Although esophagogastroduodenoscopy (EGD) is the standard procedure for the diagnosis of gastric cancer (GC), some GCs are missed. There are no published data on the missed rate of GC in Spain. AIMS: To determine the frequency and characteristics of missed GCs and assess the quality of the EGD in a specific population with GC. METHODS: Records of all patients diagnosed with gastric adenocarcinoma between 2012 and 2016 in a defined geographic area were reviewed. Missed GC was defined as a case with a prior negative EGD for cancer. Quality indicators from the prior EGDs were measured. RESULTS: From 212 cases of GC, 25 cases were excluded. Seventeen out of 187 patients had a prior EGD (9.1%). Twelve of those 17 missed GC had a prior EGD with some abnormal findings. In 6 of them, biopsies were taken. Survival was no different between patients with missed and non-missed GC. Quality indicators that failed to meet standards were recording time, image documentation, and a protocol of biopsies. CONCLUSIONS: Missed GC in an EGD in a defined population in Spain is not uncommon (9.1%). The endoscopist is an important factor in missed GC due to lack of adequate detection and sampling error. Compliance with performance of quality indicators could reduce missed GC.
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Erros de Diagnóstico/estatística & dados numéricos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidade , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
BACKGROUND: Self-management of chronic conditions, such as cancer or diabetes, requires the coordination of care across multiple care settings. Current patient-centered, hospital-based care initiatives, including bedside nursing handoff and multidisciplinary rounds, often focus on provider information exchange and roles but fall short of the goals of participatory medicine, which recognize the right of patients to partner in their own care and play an active role in self-management. OBJECTIVE: This study aimed to elicit Spanish-speaking Hispanic patients' perspectives on the exchange and sharing of information during hospitalization. METHODS: This exploratory pilot study incorporated a qualitative descriptive approach by using Spanish language focus groups, posthospitalization, to determine patient-identified information needs during hospitalization. RESULTS: Participants preferred paper-based Spanish language medical information. Doctors and nurses were key information providers and communicated with participants verbally, usually with the assistance of a translator. Participants expressed a desire to be informed about medication and treatments, including side effects and why there were changes in medication during hospitalization. In addition, they expressed interest in knowing about the progress of their condition and when they could expect to go home. Emotional readiness to receive information about their condition and prognosis was identified as an individual barrier to asking questions and seeking additional information about their condition(s). CONCLUSIONS: Overall, participants shared positive experiences with providers during hospitalization and the usefulness of self-care instructions. Language was not recognized as a barrier by any of the participants. Nevertheless, future research on the influence of emotional readiness on the timing of medical information is needed.
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Dental-skeletal anomalies are treated by combining orthodontic treatment with orthognathic surgery. This mainly involves performing sagittal osteotomy of the mandibular branch. This technique offers many advantages, but its main disadvantage is paraesthesia of the inferior alveolar nerve. There are several treatments focused on promoting neurological recovery, one of which is low intensity laser. The aim of this study was to make a clinical evaluation of the efficacy of low intensity laser therapy in the neurosensory recovery of tissues after sagittal osteotomy of the mandible. A group of twelve patients with the need of surgical correction of their dental-skeletal anomaly underwent orthognathic surgery with bilateral mandibular sagittal osteotomy. Patients were treated unilaterally and blinded with a low intensity infrared GaAlAs laser of 808nm, and compared with the contralateral site as a control group, following the course of the inferior dental nerve. The parameters used were of 100mW of power, irradiation of 3.6W/cm2, 2.8J of energy per point, an energy density of 100J/cm2, to 28s in each point with a distance of 1cm between points. The treatment included two sessions per week with a minimum of 10 sessions, starting 48h after surgery. Mechanical and thermal evaluations were performed in the first, fourth, seventh and tenth sessions. A significant improvement was observed in the subjective response of the patients on the treated side. The treatment of neurosensory disorders with low-intensity infrared laser has been shown to be effective in accelerating recovery, providing greater patient comfort, and presenting advantages over other existing methods (AU)
Las anomalías dentoesqueléticas son tratadas combinando el tratamiento de ortodoncia con la cirugía ortognática, principalmente, mediante la osteotomía sagital de rama mandibular. Esta técnica ofrece muchas ventajas, pero dentro de sus principales desventajas se encuentra la parestesia del nervio dentario inferior. Existen varios tratamientos enfocados a promover la recuperación neurológica y uno de ellos es el tratamiento con láser de baja intensidad. Esta investigación tuvo como objetivo hacer una evaluación clínica de la eficacia de la terapia con láser de baja intensidad en la recuperación neurosensorial de los tejidos tras la osteotomía sagital de la mandíbula. Un grupo de 12 pacientes con necesidad de corrección de su anomalía dentoesquelética fueron intervenidos con cirugía ortognática mediante la osteotomía sagital de rama mandibular bilateral. Los pacientes fueron tratados en el postoperatorio de manera unilateral y ciega con láser infrarrojo de baja intensidad de 808nm, medio activo de gaaias, y comparados con el lado contralateral como control, siguiendo el recorrido del nervio dentario inferior. Los parámetros utilizados fueron de 100 mW de potencia, irradiación de 3,6 W/cm2, 2,8 J de energía por punto, una densidad de energía de 100 J/cm2, a 28 s en cada punto con una distancia de 1cm entre puntos, 2 sesiones por semana, con un mínimo de 10 sesiones a partir de las 48 horas después de la cirugía. Se realizaron evaluaciones mecánicas y térmicas en la primera, cuarta, séptima y décima sesión. Se observó una mejora significativa en la respuesta subjetiva de los pacientes en el lado tratado. El tratamiento de los trastornos neurosensoriales con el láser de baja intensidad de infrarrojos ha demostrado ser eficaz en la aceleración de la recuperación, proporciona una mayor comodidad al paciente y presenta ventajas sobre otros métodos existentes (AU)
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Humanos , Osteotomia/reabilitação , Terapia a Laser/métodos , Parestesia/reabilitação , Parestesia , Cirurgia Ortognática/métodos , Deformidades Dentofaciais/reabilitação , Deformidades Dentofaciais/cirurgia , Transtornos de Sensação/complicações , Transtornos de Sensação/reabilitaçãoRESUMO
Objective. To analyze the results of an epidemiological study of mandibular fractures treated in a population of the city of Sao Paulo, Brazil. Materials and Methods. The population included patients treated by a Department of Oral and Maxillofacial Surgery and Traumatology from January 2008 to September 2010, diagnosed with mandibular fractures. The variables analyzed for the study were gender, age, etiology, clinical signs and symptoms, type of treatment, and postoperative condition. Results. A total of 171 patients and a total of 269 mandible fractures were diagnosed, with the majority being the males (84.8%), between the 2nd and 3rd decade of life. The mandibular condyle was the most affected region (32.04%), followed by the mandibular angle (23.38%). The postoperative edema was the most evident clinical sign, and the treatment of choice was the reduction and internal fixation with titanium mini-plates in all cases. Conclusion. The treatment of mandibular fractures should be aimed at restoring the occlusion and mastication function, with surgery being the most indicated treatment, using reduction and internal fixation with the use of a plates and screws system based on the experience of the authors. Knowledge of surgical techniques and methods of reduction and fixation of fractures, and periodic monitoring allow these patients to receive the appropriate treatment (AU)
El Objetivo. Analizar los resultados de un estudio epidemiológico de las fracturas mandibulares tratadas en una población de la ciudad de Sao Paulo, Brasil. Materiales y Métodos. La población incluyó a pacientes tratados por un Departamento de Cirugía Oral y Maxilofacial y Traumatología desde enero 2008 hasta septiembre 2010, con diagnóstico de fracturas mandibulares. Las variables analizadas para el estudio fueron: sexo, edad, etiología, signos clínicos y síntomas, el tipo de tratamiento y la condición post-operatoria. Resultados. Un total de 171 pacientes fueron diagnosticados de fracturas mandibulares y un total de 269 fracturas, siendo los varones, el género más afectado (84,8%), entre la segunda y tercera década de la vida, el cóndilo mandibular fue la región más afectada (32,04%), seguido por el ángulo de la mandíbula (23,38%). El edema postoperatorio fue el signo clínico más evidente y el tratamiento de elección fue la reducción y fijación interna con miniplacas de titanio en todos los casos. Conclusión. El tratamiento de fracturas mandibulares debe estar dirigida para restaurar la función de la oclusión y la masticación, siendo la cirugía el tratamiento más indicado, a través de la reducción y fijación interna con el uso de placas y tornillos de sistema basados en la experiencia de los autores Conocimiento de las técnicas quirúrgicas y los métodos de reducción y fijación de fracturas y el seguimiento periódico de los pacientes permiten un tratamiento adecuado para estos pacientes (AU)
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Adolescente , Adulto , Idoso de 80 Anos ou mais , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Fraturas Mandibulares/epidemiologia , Côndilo Mandibular/lesões , Complicações Pós-Operatórias/epidemiologia , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/tendências , Fraturas Mandibulares/terapia , Titânio/uso terapêutico , Complicações Pós-Operatórias/prevenção & controleRESUMO
La toxina botulínica ha sido señalada recientemente en la literatura como una opción de tratamiento para la corrección de la sonrisa gingival. Este reporte de caso relata la experiencia de los autores en un caso de sonrisa gingival asociada a 4 mm de exposición gingival e hipermovilidad de la musculatura elevadora del labio superior, tratado con el uso de toxina botulínica. Controles periódicos y evaluaciones de la exposición gingival fueron realizados mensualmente tras la aplicación. El tratamiento con toxina botulínica de tipo A puede ser considerado como una posible alternativa de tratamiento en este tipo de casos (AU)
Botulinum toxin has recently been reported in the literature as a treatment option for the correction of the gummy smile. This case report describes the experience of the authors in a case of gingival smile associated with 4 mm of gingival exposure and hyper mobility of the elevator muscle of the upper lip treated with the use of botulinum toxin. Regular checks and assessments of the gingival exposure were performed monthly after the application. Treatment with botulinum toxin type A can be considered as a possible alternative of treatment in this type of cases (AU)
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Adulto , Feminino , Humanos , Sorriso , Toxinas Botulínicas Tipo A/uso terapêutico , Estética Dentária , Anormalidades da Boca/tratamento farmacológico , Má Oclusão/tratamento farmacológico , Expressão FacialRESUMO
Introducción. Cuando un paciente se encuentra politraumatizado, involucrando fracturas serias en la región maxilofacial, así como en la base del cráneo, se opta por realizar una traqueostomía con el fin de permitir un abordaje simultáneo para los diferentes tercios faciales afectados. La intubación submental ofrece una alternativa a dicho manejo de la vía aérea, significando menor riesgo para el paciente por su seguridad y versatilidad en el manejo de las fracturas nasales y el establecimiento de la oclusión. Materiales. Un total de 30 pacientes con diferente afección de los tercios faciales (superior, medio e inferior) fueron tratados por nuestro equipo, llevando a cabo una intubación submental para mantener la vía aérea. Las fracturas afectaban los huesos nasales y la oclusión dentaria. Resultados. En todos los casos se logró una adecuada reducción de las fracturas nasales y obtención de la oclusión dental correcta, sin presentar eventualidades durante o después de la intubación mencionada. Conclusiones. La intubación submental es una buena alternativa para poder tratar adecuadamente a los pacientes politraumatizados con afección de la cavidad nasal y oral sin tener que realizar una traqueostomía en casos que no la requieran (AU)
Introduction. When a patient has multiple injuries, involving serious fractures in the maxillofacial region and base of skull, a tracheostomy is often performed to approach the different affected facial thirds simultaneously. Submental intubation offers an alternative to this type of airway management, involving a decreased risk for the patient due to its safety and versatility in treating nasal fractures and re-establishment of dental occlusion. Materials. A total of 30 patients with different degrees of involvement of the facial thirds (superior, middle and inferior) were treated by our team, performing a submental intubation to maintain the airway. These fractures affected nasal bones and dental occlusion. Results. In all cases we accomplished an adequate reduction of nasal fractures and obtained an accurate dental occlusion, with no incidents during or after this intubation. Conclusions. Submental intubation is a good alternative to treat multiple injury patients who have nasal and oral cavities involvement, avoiding the use of tracheostomy in cases that do not need it (AU)
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Adulto , Feminino , Humanos , Masculino , Intubação/instrumentação , Intubação , Cirurgia Bucal/tendências , Cirurgia Bucal , Osso Nasal/lesões , Osso Nasal/cirurgia , Osso Nasal , Má Oclusão/complicações , Má Oclusão/cirurgia , Má Oclusão , Osso Nasal/fisiopatologia , Oclusão Dentária , Intubação/tendências , Traqueostomia/instrumentação , Traqueostomia/métodos , Traqueostomia/tendênciasRESUMO
PURPOSE: The purpose was to conduct focus groups with Hispanic employees to obtain input into adaptation of previous DSME interventions for use as a workplace diabetes prevention program. METHODS: From a list of interested Hispanic employees who attended a local health fair (n = 68), 36 were randomly selected to participate in focus groups held during supper mealtime breaks. An experienced bilingual moderator directed the sessions, using interview guidelines developed by the research team. RESULTS: Participants' ages ranged from 22 to 65 years (mean = 50.4, n = 36, SD = 10.7), 7 males and 29 females attended, and 53% had type 2 diabetes mellitus (T2DM). Employees expressed a keen interest in diabetes classes and recommended a focus on preparing healthier Hispanic foods. Primary barriers to promoting healthier lifestyles were work schedules; many employees worked 2 part-time or full-time jobs. Administrators and direct supervisors of the employees were highly supportive of a workplace diabetes prevention program. CONCLUSIONS: The consistent message was that a workplace program would be the ideal solution for Hispanic employees to learn about diabetes and healthy behaviors, given their busy schedules, family responsibilities, and limited resources. If found to be effective, such a workplace program would be generalizable to other service employees who have disproportionate diabetes rates.
Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Hispânico ou Latino/psicologia , Saúde Ocupacional/etnologia , Serviços Preventivos de Saúde/métodos , Local de Trabalho/psicologia , Adulto , Idoso , Assistência à Saúde Culturalmente Competente , Diabetes Mellitus Tipo 2/etnologia , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Objetivo. Analizar los resultados de un estudio epidemiológico de las fracturas nasales tratadas en un hospital de la zona sur de São Paulo, para mejorar la secuencia de tratamiento. Materiales y métodos. Se evaluaron los pacientes ingresados en un hospital privado que forma parte de la Residencia de Cirugía Maxilofacial, de enero de 2008 a octubre de 2010 con diagnóstico de fractura nasal. Los factores analizados para la elaboración del estudio fueron: sexo, edad, etiología, manifestaciones clínicas, tipo de tratamiento y poscondiciones operatorias. Resultados. Como etiología, 22 casos de accidentes de motocicletas, 18 accidentes de tráfico, 38 casos de agresión física, 27 de caída, 23 traumatismo deportivo y 10 casos de accidentes de trabajo. La edad de la mayoría de los pacientes afectados osciló entre 21 y 30 años, con la mayoría del sexo masculino (112 casos). La manifestación clínica más frecuente es el sangrado y edema en el dorso nasal. En 93 casos, los pacientes recibieron reducción quirúrgica sin sangre, con taponamiento nasal asociada con fijación externa con yeso. Conclusión. Este estudio proporciona datos básicos sobre las fracturas nasales, importantes para el abordaje terapéutico y la planificación, así como la mejora en la organización y el cuidado de estos pacientes, y la misma puede servir como un parámetro entre los diversos servicios hospitalarios para proporcionar una mejora continua en el servicio y la rutina quirúrgica (AU)
Objective. To analyze the results of an epidemiological study of nasal fractures treated in a private hospital in the center of the city of São Paulo, Brazil. Material and method. The population included in the study were patients admitted to one of the hospitals of the Residence-Department of Oral and Maxillofacial Surgery and Traumatology, from January-2008 to October-2010 diagnosed with nasal fracture. Factors analyzed for the study were gender, age, etiology, clinical signs, symptoms, type of treatment, and post-operative condition. Results. As regards the etiology, 22 cases were associated with motorcycle accidents, 18 car accidents, 38 cases of assault, 27 cases described injuries after falling from their own height, 23 cases of sport injury, and 10 cases for accidents at work. The patients most affected were between the ages of 21 to 30 years; with a majority of male patients (112 cases).The most common clinical manifestations were epistaxis and swelling in the nasal dorsum. In 93 cases, the patients underwent closed surgical reduction, associated with nasal packing and external fixation. Conclusion. This study presents fundamental information regarding nasal fractures, emphasizing the surgical approach and surgical planning. It is also important to take into account the importance of organizing the attendance sequence of these patients, considering these protocols and procedures as an option for other hospitals to improve their routine protocols for these types of trauma (AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Osso Nasal/lesões , Cavidade Nasal/lesões , Ossos Faciais/lesões , Nariz/lesões , Nariz/cirurgia , Nariz , Traumatologia/métodos , Traumatologia/estatística & dados numéricosRESUMO
La luxación del cóndilo mandibular con impactación en la fosa craneal media es un proceso poco frecuente apenas se dispone de estudios publicados. Los autores describen el primer caso publicado de luxación y fractura unilateral combinadas, tratado y reconstruido con la implantación de una prótesis temporomandibular. Se describen la conducta prequirúrgica y la postura médica de los equipos de neurocirugía, radiología y cirugía oral y maxilofacial. Se proporcionan detalles de las evaluaciones de los 2 primeros an os postoperatorios, incluidos la abertura máxima interincisal, función articular, habla, sintomatología dolorosa y alimentación del paciente (AU)
The dislocation of the mandibular condyle in the middle cranial fossa is a rare condition with few reports in the literature. The authors described the first case reported of unilateral dislocation and fracture treated and reconstructed with a Temporo mandibular joint prostheses. Pre-surgical conduct, medical positions of the Neurosurgery, Radiology and Oral and Maxillofacial teams are described. Also, two years post-operative evaluations are detailed, including information regarding maximum interincisal opening, function, speech, pain and diet of the patient (AU)
Assuntos
Humanos , Feminino , Adulto , Articulação Temporomandibular , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/cirurgia , Côndilo Mandibular/cirurgia , Côndilo Mandibular , Côndilo Mandibular/lesões , Côndilo Mandibular/fisiopatologia , Próteses e Implantes , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares , Traumatismos Mandibulares/complicações , Traumatismos Mandibulares/cirurgia , Traumatismos MandibularesRESUMO
En la actualidad la clonación posee dos ramas bien definidas: la reproducción del organismo mediante la copia de su genoma y la finalidad terapéutica, que incluye la clonación de órganos y tejidos usados generalmente para el trasplante de órganos dañados por otros en buenas condiciones. El presente trabajo tiene como objetivo explicar las diferentes posturas científicas, legales y sociales sobre la clonación, de manera que puedan ser usadas como herramientas del profesional de la salud en sus investigaciones y dilucidar cómo la bioética enfoca la clonación de forma negativa o ilícita, por las implicaciones sociales y morales que presupone. La clonación terapéutica es considerada importante e interesante desde el punto de vista científico y ético, ya que puede conducir a resolver varios problemas de salud
Today the cloning has two well-defined branches: the reproduction of the Agency through its genome copy and therapeutic purpose including cloning organs and tissues used generally for transplant organs damaged by others in good condition. This paper aims to explain the different positions scientific, legal and social on cloning so can be used as tools for health care research and clarify how bioethics focusing on negative or unlawful way by the social and moral implications presupposes cloning. Therapeutic cloning is considered important and interesting from the point of view scientific and ethical, which can lead to solve various problems of health