Decision making in third molar surgery: a survey of Brazilian oral and maxillofacial surgeons.

This study was designed to evaluate the variations in decision making among Brazilian oral and maxillofacial surgeons (OMFS) and trainees in relation to third molar surgery. A survey on 18 diverse clinical situations related to the assessment and treatment of the third molar surgeries was conducted during the 20th Brazilian National OMFS meeting. Participants were divided into three groups according to their level of training. Another variable studied was length of experience. Correlation between the question answers and the variables was analysed using the chi-square test and the f test. The mean age of participants was 32.68 years, and their mean length of experience was 5.24 years. There were no statistical differences between the level of training and number of years of experience and the responses to 15 of the 18 questions on clinical situations. However, differences were found in responses to prophylactic extraction of asymptomatic third molars, use of non-steriodal anti-inflammatory drugs (NSAIDs) during the preoperative surgical period and the use of additional imaging to plan extractions. The group with shorter time of experience (3.8 ± 3.94 years) tended to recommend extractions of asymptomatic third molars more frequently compared with the more experienced surgeons (P = 0.041). More experienced surgeons used NSAIDs in the preoperative surgical period, whereas the majority of the youngest surgeons (4.1 ± 5.96 years of experience) did not (P = 0.0042). The certificated trained and in practice group tended to treat deep lower third molar impactions based on the findings of a panoramic radiograph, without obtaining additional imaging [cone beam computed tomography (CBCT)] before treatment (P = 0.0132). Decision making regarding third molar treatment differs according to the level of training and is influenced by the number of years of experience. Therefore, further continuous education programmes in this area are warranted to make recommendations regarding third molars consistent with the current literature.

Nasal airway function after maxillary surgery: a prospective cohort study using the nasal obstruction symptom evaluation scale.

PURPOSE: To examine nasal airway function using a disease-specific quality-of-life survey instrument in subjects undergoing Le Fort I osteotomy without simultaneous rhinosurgical procedures. MATERIALS AND METHODS: We conducted a prospective cohort study of nasal airway function in consecutive Le Fort I osteotomy patients, who had not received simultaneous rhinosurgical procedures, between 2007 and 2008 at Kaiser Permanente Oakland Medical Center. We administered the Nasal Obstruction Symptom Evaluation (NOSE) survey before and 3 months after surgery. Clinical and radiographic examinations were performed, and the relevant medical and demographic factors were analyzed. RESULTS: The initial study sample comprised 55 patients, of whom 5 were excluded. Of the remaining 50 patients (median age 21 years, 60% women), the maxilla was advanced (median 4 mm, interquartile range 3 to 5) with minimal vertical change. During the follow-up period (median 5.5 months), significant improvement was seen in the NOSE scores for the cohort, with a median decrease of 10 units (P = .0005). Patients with moderate nasal obstruction (preoperative NOSE score >25) had the greatest improvement (P < .001). Those with severe nasal obstruction (preoperative NOSE score >50) improved, however, this did not reach statistical significance (P < .0625). The NOSE scores worsened in 10 patients; of these, 6 had minimal change. However, 4 had significant worsening, with 2 having symptomatic complaints. No predictor variables were identified in this small subgroup; however, individual case analyses revealed 1 subject with postoperative turbinate inflammation on the side of maxillary segmentalization and 1 had nasal septal buckling. CONCLUSIONS: Our overall findings have suggested that nasal airway function improved after maxillary advancement and that subjects with greater preoperative NOSE scores (>25) were more likely to experience relief of nasal obstructive symptoms.

Isolated intra-oral granular cell tumor: report of two cases and review of the literature

Granular cell tumor (GCT) is a relatively uncommon lesion occurring in almost any part of the body, including the orofacial region. The tongue and the buccal mucosa are common intra oral sites. Although aggressive and malignant variants of this neoplasm have been described, most GCTs are benign. The histogenesis of the lesion still remains unknown. However, histochemical and ultra-structural studies propose the origin of the lesion from Schwann cells, striated muscle, mesenchymal cells, histiocytes and epithelial cells. The tumor generally occurs in middle-aged or older adults. The lesion is typically seen as an uninflamed asymptomatic mass measuring about two cm in diameter with reddish surface coloring. As most granular cell tumors are benign, surgical excision of the lesion is the treatment of choice. In this study, 2 oral GCT cases are presented, corresponding to 2 male patients, with a mean age of 27 years and a mean time of evolution of the lesions of 8 months. Both lesions were located on the tongue. Differential diagnoses include fibrous hyperplasia, minor salivary gland tumor, condyloma acuminatum and neurilemmoma. In all the cases a resection with safety margins of the lesions was carried out under local anesthesia. The samples were fixed and processed for histopathological study. The main clinical pathology and diagnostic features of this neoplasm are reviewed and discussed.

O tumor de celulas granulares (TCG) e uma lesao relativamente incomum que pode acometer qualquer parte do corpo, incluindo a regiao buco-maxilo-facial. A lingua e a mucosa bucal sao localizacoes intraorais comuns. Embora casos de transformacoes malignas e agressividade terem sido descritos, a maioria dos TCG sao benignos. A histogenese desta lesao continua desconhecida. No entanto estudos de imunohistoquimica e ultraestruturais sugerem que a lesao se origina das celulas de schwann, musculatura estriada, celulas mesenquimais, histiocitos e celulas epiteliais. O tumor geralmente ocorre na meia idade ou em pacientes idosos. A lesao e tipicamente vista como uma massa assintomatica nao inflamatoria que mede cerca de dois centimetros de diametro com uma superficie de coloracao avermelhada. A maioria dos tumores de celulas granulares sao benignos cuja excisao cirurgica e o tratamento de escolha. Neste estudo, 2 casos orais de TCG sao apresentados sendo ambos em pacientes do sexo masculino, com media de idade de 27 anos e tempo medio de evolucao da lesao de 8 meses. A localizacao de ambas as lesoes foi o dorso da lingual. O dignostico diferencial incluiu a hiperplasia fibrosa, tumor de glandulas salivares menores, condiloma aculminado e neiurilenoma. Em todos os casos a resseccao com margens de seguranca foi realizado sob anesthesia local. As amostras foram fixadas e processadas para o estudo histopatologicos. As principais caracteristicas clinicopatologicas e de disgnostico foram revisadas e discutidas.

Effects of demineralized bone matrix and a 'Ricinus communis' polymer on bone regeneration: a histological study in rabbit calvaria.

The aim of the present study was to histologically analyze the effects of bovine and human demineralized bone matrix and a Ricinus communis polymer on the bone regeneration process. Two surgical bone defects were created in rabbit calvaria, one on the right and the other on the left side of the parietal suture. Eighteen rabbits were divided into three groups. In Group I, the experimental defect was treated with bovine demineralized bone matrix, Group II with human demineralized bone matrix, and in Group III, the experimental cavity was treated with polyurethane resin derived from Ricinus communis oil. The control defects were filled with the animals' own blood. The animals were sacrificed after 7 and 15 weeks. Histological analysis revealed that in all groups (control and experimental), bone regeneration increased with time. The least time required for bone regeneration was noted in the control group, with a substantial decrease in the thickness of the defect. All materials proved to be biologically compatible, but polyurethane resorbed more slowly and demonstrated considerably better results than the demineralized bone matrices.

Oral and maxillofacial myiasis associated with epidermoid carcinoma: a case report.

Myiasis is a term derived from the Greek word "myia", meaning invasion of vital tissue of humans or other mammals by fly larvae. The deposited eggs develop into larvae, which penetrate deep structures causing adjacent tissue destruction. It is an uncommon clinical condition, being more frequent in underdeveloped countries and hot climate regions, and is associated with poor hygiene, suppurative oral lesions, alcoholism and senility. Its diagnosis is made basically by the presence of larvae. This paper reports a case of oral and maxillofacial myiasis involving 273 larvae in a patient with epidermoid carcinoma without physical or neurological deficiency. The patient's management was antisepsis, larval removal and general care, before death after three months.