Factors associated with root migration after lower third molar coronectomy - preliminary results / Fatores associados com a migração radicular após coronectomia de terceiros molares inferiores - resultados preliminares

Objective: The aim of this prospective study, with preliminary results, was to evaluate factors related with root migration after lower third molar coronectomy, especially radiographic bone density. Material and Methods:Twenty-two patients were submitted to 31 lower third molar coronectomies. Clinical and radiographic evaluation of all patients were performed preoperatively and at 7, 90 and 365 days postoperatively. Sociodemographic, clinical and radiographic data were collected. The root migration was analyzed by the distance from the tooth apex to the mandibular canal, and radiographic bone density above the remaining roots was obtained, both using the software Image J©.Results: After 1-year follow-up no patients showed paresthesia, symptoms or required reintervention, however all roots showed migration. The mean root migration was 2.66 mm at 90 days, and 3.37 mm at 365 days (p = 0.0007). The rate of migration was higher at the early postoperative period. The simple linear regression test between root migration and radiographic bone density was not significant (R=-0.173 and p=0.453; R=-0.045 and p=0.902; at 90 days and 365 days, respectively) as well as the analysis between root migration and other clinical and radiographic variables. Conclusion: It was possible to conclude, based on these preliminary results, that all roots showed migration during the follow-up period. The radiographic bone density increases and, consequently, the root migration rate diminishes within time, however none of the evaluated factors showed significant association with root migration. (AU)

Objetivo: O objetivo deste estudo prospectivo, com resultados preliminaraes, foi avaliar os fatores relacionados com a migração das raízes após corocetomia de terceiros molares inferiores, especialmente a densidade óssea radiográfica. Material e Métodos: Vinte e dois pacientes foram submetidos à 31 coronectomias de terceiros molares inferiores. Avaliação clínica e radiográfica de todos os pacientes foi executada no momento pré-operatório e aos 7, 90 e 365 dias pós-operatórios. Dados sociodemográficos, clínicos and radiográficos foram coletados. A migração das raízes foi analisada pela distância do ápice radicular ao canal mandibular, e a densidade óssea radiográfica foi mensurada acima dos remanescentes radiculares, usando o software Image J©.Resultados: Após 1 ano de acompanhamento, nenhum paciente apresentou parestesia, sintomatologia ou necessitou reintervenção, porém todas as raízes migraram. A média da migração radicular foi de 2,66mm aos 90 dias e de 3,37mm aos 365 dias (p=0,0007). A taxa de migração foi maior no pós-operatório inicial. O teste de regressão linear simples entre migração das raízes e densidade óssea radiográfica não foi significante (R=-0,173 e p=0,453; R=-0,045 e p=0,902; aos 90 e 365 dias, respectivamanete), assim como a análise entre migration radicular e outras variáveis clínicas e radiográficas. Conclusão: Foi possível concluir, com base nesses resultados prelimiares, que todas as raízes apresetaram migração durante o período de acomapanhamento. A densidade óssea radiográfica aumentou e, consequentemente, a taxa de migration radicular dimininiui com o tempo, porém nenhum dos fatores avaliados mostrou associação significante com a migração das raízes(AU)

What is the relapse after Le Fort I maxillary advancement in cleft lip and palate patients? A systematic review.

Le Fort I osteotomy is the most common procedure for maxillary advancement in cleft patients, and a significant relapse is expected in the postoperative period. This study purpose is to evaluate the maxillary relapse and associated factors in cleft lip and palate (CLP) patients submitted to standard Le Fort I advancement. This systematic review sought studies in PubMed, SCOPUS, and Cochrane and included papers that evaluated the maxillary relapse with at least 1-year postoperative period. The quality assessment was adapted following PRISMA statement. The initial electronic search found 345 papers, and the final selection included 10 studies. In total, 275 CLP patients were evaluated 198 had unilateral CLP and 41 had bilateral CLP. Isolated maxillary advancement was performed in 166 patients, while 109 had bimaxillary surgery. The mean relapse in horizontal and vertical plane was 1.2 mm (19.7%) and 1.0 mm (29.4%), respectively. In conclusion, a relapse after maxillary advancement in patients with CLP is expected, being higher in vertical plane. Patients with UCLP and those who underwent bimaxillary surgery had a higher relapse rate. Due to the miscellaneous data and methodologies, future prospective clinical trials should apply rigorous selection of CLP patients sample and methods for variable analysis to obtain more accurate results.

Outcomes after mandibular third molar coronectomy / Desfechos após coronectomia de terceiros molares inferiores

ABSTRACT Coronectomy is an alternative technique to mandibular third molar removal to avoid inferior alveolar nerve impairment. It is indicated in cases where the dental roots are in close relationship with the nerve which results in a higher risk of damage and paresthesia. The coronectomy technique is considered a safe method to prevent inferior alveolar nerve injury, however it shows particular postoperative outcomes as migration and exposure of the retained roots, and possibility of additional intervention. The aim of this case series is to describe four different outcomes from coronectomy, in patients treated by the same protocol. The outcomes ranged from asymptomatic to migration, infection and root removal. Although the variety of outcomes, none of the patients showed inferior alveolar nerve impairment. Therefore, the main objective of coronectomy was reached.

RESUMO A coronectomia é uma técnica alternativa à extração de terceiros molares inferiores para a prevenção de lesão ao nervo alveolar inferior. É indicada em casos em que as raízes dentárias estão em íntimo contato com o nervo alveolar, resultando em um maior risco de lesão, e consequentemente parestesia. A técnica de coronectomia é considerada um método seguro para prevenção de lesões ao nervo alveolar inferior, entretanto pode apresentar desfechos pós-operatórios singulares, incluindo a migração e exposição dos remanescentes radiculares, além da possibilidade de intervenções adicionais. O objetivo desta série de casos é descrever quatro desfechos diferentes da técnica de coronectomia, em pacientes tratados por meio de um único protocolo. Os desfechos pós-operatórios apresentados variaram entre casos assintomáticos até migração das raízes, infecção e necessidade de remoção do remanescente radicular. Entretanto, apesar da variedade de desfechos, nenhum dos pacientes apresentou lesão ao nervo alveolar inferior. Desta forma, conclui-se que o objetivo principal da técnica foi alcançado apesar dos diferentes desfechos.

Horizontal ridge augmentation using xenogenous bone graft-systematic review.

PURPOSE: This study aimed to perform a systematic review about the use of xenogenous bonegraft in horizontal ridge augmentation to answer the following question: In implant patients, treated with xenografts for horizontal ridge augmentation, what would be the outcomes in terms of bone gain, bone resorption, implant survival, and complication rates? METHODS: The main search was performed at PubMed, Cochrane, and Scopus databases, and found 2610 articles. After selection and duplicate removal, 29 studies were included in the final review. The collected data were sample size, number and type of graft, site, horizontal gain, resorption rate, and complications. RESULTS: A total of 610 patients were submitted to 853 bone grafts, both in the maxilla and mandible. Most studies (n = 26) used particulate grafts, isolated or associated with autogenous bone, and covered by collagen membrane or titanium mesh. The mean of horizontal bone gain was 4.44 mm. In addition, the augmented ridges allowed placement of 1325 successful dental implants. The complication rate was 7.85%, and membrane exposure was the most reported complication. CONCLUSIONS: Although the autogenous bone graft remains as the gold standard for alveolar reconstruction, this review suggests that xenogenous bone graft is a feasible alternative for horizontal bone augmentation.

What Are the Parameters for Reoperation in Mandibular Third Molars Submitted to Coronectomy? A Systematic Review.

PURPOSE: Coronectomy is an alternative technique to conventional lower third molar removal that aims to decrease inferior alveolar nerve impairment. The purpose of this study was to identify factors associated with reoperation after mandibular third molar coronectomy. MATERIALS AND METHODS: This systematic review sought scientific articles in the MEDLINE (PubMed), Scopus (Elsevier), and Cochrane Library databases. Studies that evaluated reoperation after coronectomy and reported a minimum follow-up of 6 months were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) quality assessment of the included articles was performed, and the following data were analyzed: demographic characteristics, reason for reoperation, and time from coronectomy to reoperation. The data were subjected to descriptive analysis. RESULTS: The initial search yielded 362 studies and 15 were included in the final review. In total, 1,664 patients and 2,062 teeth underwent coronectomy. Most patients were women (60.58%). The follow-up period for reoperation ranged from 6 months to 10 years and the mean time until the second procedure was 10.4 months (quartile 1, 3; quartile 3, 8.5). Only 105 teeth (5.1%) were reoperated on. The main reasons for reoperation were root exposure (53.33%), infection (10.47%), pain (9.52%), and enamel residual (9.52%). In the PRISMA quality evaluation, only 1 article presented a low risk of bias. CONCLUSIONS: Reoperation after mandibular third molar coronectomy was low (cases, ∼5%); the main reasons for reoperation were residual root exposure and symptomatology. Owing to the possibility of late exposure or symptomatology, a follow-up longer than 6 months is recommended until root exposure or the end of the migration process.

Comparison of Imaging Softwares for Upper Airway Evaluation: Preliminary Study.

The interest about upper airway evaluation has increased lately. Therefore, many softwares have been developed aiming to improve and facilitate the analysis of airway volume. The objective of this study was to compare two different softwares packages, Mimics and Dolphin, in their accuracy and precision in upper airway space measurements. Preoperative cone beam computed tomography scans of nine nonsyndromic patients submitted to surgically assisted rapid maxillary expansion were included in this study. The imaging exams were converted to DICOM (digital imaging and communications in medicine) files and imported to the softwares. The mean volume for the Dolphin group (G1) was 10.791 cm 3 (SD = 4.269 cm 3 ) and for the Mimics group (G2) was 10.553 cm 3 (SD = 4.564 cm 3 ). There was no statistically significant difference between the two groups ( p = 0.105).

Maxillary osteomyelitis associated with osteopetrosis: Systematic review.

Osteopetrosis is a rare condition which presents increased bone density and deficient bone remodeling. The consequential complications include cranial nerve impairment due compression, bone fractures, and osteomyelitis. Maxillary osteomyelitis is uncommon even in osteopetrosis patients. This is a systematic review of the literature regarding the management and outcomes of maxillary osteomyelitis in patients with autosomal dominant osteopetrosis (ADO) type II. A case of this specific pathology is reported. There are 18 cases of maxillary osteomyelitis associated with ADO type II reported in the literature. The mean age of the patients reported was 33.5 (SD 15.9) years, and the male:female ratio was 1:1. Antibiotic therapy was variable, and amoxicillin with clavulanic acid was the main choice (33.33%). Surgery or sequestrectomy was performed in 88.89% of the studies. Complete healing was achieved in only 44.4% of cases. The treatment protocols remain controversial and often do not lead to complete healing. In the case that we report, complete healing was achieved after prolonged antibiotic therapy, hyperbaric oxygen therapy, and partial resection. In conclusion, the management of maxillary osteomyelitis in ADO type II patients is challenging, and complete resolution of the process is dependent on multiple interventions.

Double unilateral, bilateral, and multiple mandibular fractures: an observational study.

PURPOSE: Double and multiple mandibular fractures are associated to high morbidity and functional damage. This study aimed to evaluate the characteristics and outcomes of double unilateral, bilateral, and multiple mandibular fractures. METHODS: A 7-year observational retrospective analysis was performed, and the injury-related data were collected from the medical records. Statistical analysis was performed using Fisher's exact test (p < 0.05). RESULTS: In this period, 283 patients showed mandibular fractures. Of them, 83 (29.7%) had double or multiple mandibular fractures and were included in the study. Double bilateral fractures were more prevalent than multiple or double unilateral. Multiple fractures presented significant association with the combination of load-bearing and load-sharing fixation protocols. Most cases (94.0%) applied at least one type of internal fixation system. However, there was a positive association between condylar fractures and non-surgical treatment (p < 0.01). Moreover, mandibular body fractures were associated with load-bearing fixation (p < 0.01). In 56 cases, no complications were observed (67.5%). Complications were divided into treatment failure (10.8%) and transitory or minor complications (21.7%). There was no statistical association between complications and fracture pattern, fracture-tooth relation, and treatment modality. CONCLUSION: Double and multiple mandibular fractures represented almost one third of all mandibular fractures, and regardless to treatment protocol, there was no difference about complications. Moreover, although a considerable complication rate was found, most of them were minor or transitory.

Buccal fat pad removal to improve facial aesthetics: an established technique?

BACKGROUND: Buccal fat pad (BFP) is a singular structure between the facial muscles. Its removal may enhance the zygomatic prominences resulting in an inverted triangle of beauty. OBJECTIVE: The aim of this study was to perform a systematic review of literature about BFP removal for facial aesthetic improvement. In order to answer the following research question: What are the indications, complication types and rates, surgical techniques and outcomes of the technique?. MATERIAL AND METHODS: The initial search in Pubmed, Scopus, and Cochrane databases recognized 220 articles. The final review included eight of them. None of the included studies were clinical trials. RESULTS: BPF removal was performed by intraoral incision or associated with the face lift procedure. In 71 patients submitted to the procedure and evaluated about complications, only 8.45% presented minor complications. Parotid duct and facial nerve injuries were not found. No study evaluated facial aging and long-term effects, therefore the harmless effect of the procedure to those features is not clear. CONCLUSIONS: Although it is not a novel procedure, there is a lack of information about long-term outcomes. Thus, controlled clinical studies should be performed to achieve adequate clinical evidence of those aspects

Análise retrospectiva dos traumatismos buco-maxilo-faciais em Pelotas, RS, em um período de 10 anos / A 10-year retrospective analysis of maxillofacial trauma in Pelotas-RS

Introdução: Traumatismos buco-maxilo-faciais apresentam alta prevalência na população e resultam em comprometimento estético e funcional. Fatores sociodemográficos influenciam no tipo, na severidade e etiologia dessas lesões. O objetivo deste estudo foi identificar o perfil dos traumatismos buco-maxilo-faciais atendidos em um serviço de urgência e emergência. Métodos: Foi realizada a análise retrospectiva dos prontuários atendidos em um período de 10 anos, coletando-se as variáveis: idade, gênero, diagnóstico, etiologia e sítio anatômico. Os dados foram avaliados pelo teste qui-quadrado (p≤0,05). Resultados: Foram incluídos 11.779 prontuários, verificando-se prevalência de pacientes do gênero masculino (69,3%) entre 0 e 9 anos (29,8%) e entre 20 e 29 anos (19,8%). Ainda, lacerações representaram 59,8% dos casos; o sítio acometido foi perióbita (18,6%), e a principal etiologia quedas, 30,9%. O teste qui-quadrado demonstrou associação entre todos os pares de variáveis. É verificada a associação de quedas e colisões em crianças, agressão e acidentes de trânsito em adultos e quedas em idosos. Ainda, observaram-se traumatismos alvéolo dentários em crianças e fraturas em adultos. Conclusão: O perfil dos atendimentos é representado por homens, crianças vítimas de quedas e colisões com lacerações em terço médio e adultos, vítimas de agressão ou acidente de trânsito com lacerações ou fraturas em terço médio facial... (AU)

Introduction: Maxillofacial injuries have high prevalence in the population and may result in aesthetic and functional impairment. Sociodemographic factors may influence the type, severity and etiology. The aim of this study is to identify the maxillofacial trauma profile in an Urgency and Emergency Service. Methods: A 10-year retrospective analysis was performed and the variables age, gender, diagnosis, etiology and anatomical site were collected. The data was evaluated by chi-square test (p≤0,05). Results: 11.779 records were included and was observed prevalence of male patients (69,3%) between 0 and 9 years (29.8%) and 20 and 29 years (19.8%). Lacerations represented 59.8% of cases, the most affected site was periorbital region (18.6%), and the main etiology was falls (30.9%). Chi-square test demonstrate correlation between all variables. There were association of falls and collisions in children, aggression and traffic accidents in adults, and falls in elderly. Dental trauma occurred in children and facial fractures in adults. Conclusion: The profile of maxillofacial trauma is represented by men, children with lacerations in midface due falls and collisions, and adults with lacerations or fractures due to aggression or traffic accident... (AU)

Three-Dimensional Printed Model and Transantral Endoscopy to Orbital Fracture Repair.

Orbital fractures are high prevalent and result in several complications such as diplopia, muscular entrapment, visual impairment, and enophthalmos. The goal of orbital reconstruction is to restore orbital anatomy, volume, and globe symmetry. This case report aims to describe the use of transantral endoscopy and 3D printed model for treatment of an orbital floor fracture. A 54-year-old woman presented orbital floor fracture with diplopia and extraocular muscle entrapment. The surgical treatment was performed using a standard titanium mesh bended over 3D printed model, and transantral endoscopy to verify fracture extension and implant adaptation. The postoperative evaluation demonstrates correction of diplopia and ocular motility restriction. Computed tomography scan showed reestablishment of the orbital anatomy. The association of transantral endoscopy and 3D printed models is a feasible technique to improve orbital reconstruction.

Modified Approach to Central Giant Cell Lesion.

This case report discusses a modified technique for treatment of a central giant cell lesion (CGCL) in children, where a recontouring procedure is performed prior to the treatment with intra lesional corticosteroid. We discuss the advantages of this less invasive technique, specially considering the early age of the patient and its bone growth, as well as the conservative approach for lesions in those cases. The treatment of an 8-year-old female patient exhibiting CGCL in anterior region of mandible with bone expansion is described. The procedure was performed using blade #15 and rongeur forceps, in order to obtain an adequate jaw contour. Two weeks later, drug treatment started with triamcinolone 10mg/ml diluted in 0.5% bupivacaine without vasoconstrictor agent, 1:1 ratio, for eight sessions. There were no complications in surgery and postoperative period. In 3-year follow-up, anatomical preservation is present with no signs of recurrence.

Measurement of pharyngeal segments in Obstructive Sleep Apnea / Mensuração dos segmentos faríngeos na Apneia Obstrutiva do Sono

Objective: Obstructive Sleep Apnea (OSA) occurs by recurrent collapse of the upper airway during sleep. It results in complete (apnea) or partial (hypopnea) reduction of airflow and has intimate relation with the upper airway anatomy. Cephalometric analysis has been used to quantify airway dimensions. The aim of this study is evaluate the correlation between the anteroposterior dimension of the upper airway and the severity of obstructive sleep apnea. Material and Methods: A retrospective analysis was performed reviewing polysomnographic data (AHI) and anteroposterior cephalometric measurements of pharynx subregions: nasopharynx, oropharynx, hypopharynx. Results: The sample consisted of 30 patients. The mean body mass index was 29.60 kg/m2 and the average age was 46.8 years. Nine patients presented severe OSA, seven had moderate OSA, seven had mild OSA, and seven were healthy. The Pearson's correlation index between the anteroposterior dimension of the nasopharynx, oropharynx and hypopharynx and AHI was respectively -0.128 (p=0.517), -0.272 (p=0.162) and -0.129 (p=0.513). Conclusion: The correlation between anteroposterior linear dimension of the airway and OSA severity, assessed by AHI, was not positive. As an isolated parameter it did not correlate to the severity of the obstrucive sleep apnea syndrome and should be evaluated in conjunction with other factors. (AU)

Objetivo: A Apneia Obstrutiva do Sono (SAHOS) ocorre por um colapso recorrente da via aérea superior durante o sono. Isto resulta na redução completa (apneia) ou parcial (hipopneia) do fluxo de ar, e apresenta relação íntima com a anatomia das vias aéreas superiores. A análise cefalométrica tem sido utilizada para quantificar as dimensões das vias aéreas. O objetivo deste estudo foi avaliar a correlação entre a dimensão anteroposterior da via aérea superior e a gravidade da SAHOS. Material e Métodos: Foi realizada a análise retrospectiva dos dados polissonográficos (IAH) e medidas cefalométricas anteroposteriores das sub-regiões da farínge: nasofaringe, orofaringe e hipofaringe. Resultados: A amostra foi composta por 30 pacientes. O índice médio de massa corporal foi de 29,60 kg/m2 e a média de idade foi de 46,8 anos. Nove pacientes apresentaram SAHOS grave, 7 SAHOS moderada, 7 SAHOS leve e 7 eram saudáveis. O índice de correlação de Pearson entre a dimensão anteroposterior da nasofaringe, orofaringe e hipofaringe com IAH foi -0,128 (p=0,517), -0,272 (p=0,162) e -0,1229 (p=0,513), respectivamente. Conclusão: A correlação entre a dimensão linear anteroposterior da via áerea e a gravidade da SAHOS, avaliada por meio da IAH, não foi positiva. Como parâmetro isolado, a análise cefalométrica não foi correlacionada com a severidade da SAHOS e portanto, deve ser avaliada em conjunto com outros fatores. (AU)

Comparação do índice de infecção pós-operatória em fraturas mandibulares lineares com o uso de profilaxia antibiótica / Comparison of postoperative infection rate in linear mandibular fractures using antibiotic prophylaxis

Introdução: Infecções pós-operatórias representam a maior complicação no tratamento de fraturas mandibulares. A utilização de profilaxia antibiótica diminui os índices de infecção, entretanto sua manutenção após o procedimento cirúrgico é controversa na literatura. Objetivo: Comparar o índice de infecção pós-operatória no tratamento de fraturas mandibulares lineares com ou sem profilaxia antibiótica pós-operatória. Metodologia: Foi realizada uma análise retrospectiva transversal para verificar a presença de infecção pós-operatória. Trinta prontuários de pacientes portadores de fraturas mandibulares lineares, tratados por meio de acesso intrabucal e fixação interna estável, foram selecionados e divididos em dois grupos com 15 prontuários cada: pacientes que realizaram apenas profilaxia antibiótica pré-operatória e pacientes que realizaram profilaxia antibiótica pré e pós-operatória por seis dias. Resultado: Foram observadas cinco infecções, sendo três no grupo que realizou apenas profilaxia pré-operatória e duas no grupo que fez uso de antibiótico após o procedimento. Conclusão: Em fraturas mandibulares lineares, a utilização de antibiótico pós-operatório não reduziu o índice de infecções significantemente.

Introduction: Postoperative infections are a major complication in the treatment of mandibular fractures. The use of antibiotic prophylaxis decreases infection rates; however, the maintenance after the surgical procedure is controversial in the literature. Objective: To compare the rates of postoperative infection in the treatment of linear mandibular fractures with or without postoperative antibiotic prophylaxis. Methodology: A retrospective transversal study was performed to analyze for the presence of postoperative infection. Thirty medical records of patients with mandibular fractures, treated by intraoral access and internal fixation were selected and divided into two groups with 15 records each: Patients who only underwent preoperative antibiotic prophylaxis, and patients who underwent pre- and postoperative antibiotic prophylaxis for six days. Result: There were five postoperative infections, three in the group under preoperative prophylaxis and two in the group receiving antibiotics after the procedure. Conclusion: Postoperative antibiotics did not reduce the infection rate in linear mandibular fractures.

Protocols for management of oral complications of chemotherapy and/or radiotherapy for oral cancer: Systematic review and meta-analysis current

BACKGROUND AND OBJECTIVES: Considering the high possibility of dentist consult a patient with oral complications of chemotherapy and/or radiotherapy for oral cancer because of the advances in this area, this study aims to systematically review the literature to identify and suggest effective and safe protocols for the managements of oral complications in oncology patients. MATERIAL AND METHODS: The systematic review was designed by PICO and PRISMA including eligibility and exclusion criteria; the source of information and search strategy in PubMed according MeSH: «Mouth Neoplasms and Radiotherapy» and «Mouth Neoplasms and Drug Therapy» the period from 2010 to 2015; selection and data collection of study was carried form blind and independently by two researchers; risk of bias and methodological quality: ensured by the PEDro scale; synthesis of data: of oral complications were evaluated by adapted version of associative direction classification proposed by Costigan and collaborators; and data analysis was performed by the meta-analysis of BioEstat program (5.0) in the included studies. RESULTS: 2,700 articles found, 2,371 were selected after removal of duplicate and elected 40 full-text articles. Of these, only 06 articles were included in the systematic review with exclusion of others, per obtain punctuation ≥ 7 with high methodological quality for synthesis of the managements of oral complications. Since 05 articles were associated with low risk of bias composing the protocols suggestive for managements and the meta-analysis in odds ratio (0.916) to cure and relative risk (1.049) for the development of oral mucositis and pain. CONCLUSIONS: The protocols suggestive for managements of oral mucositis and pain with MuGard - mucoadhesive hydrogel; PerioAid Tratamiento(R) antiseptic mouthrinse with chlorhexidine and cetylpyridinium chloride; Episil(R) plus benzydamine - bioadhesive oromucosal gel; 0,03% of Triclosan mouthwash Colgate Plax; and Diode Laser Therapy of low-level are safe for oncology patients applied according to adopted clinical parameters

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.

Therapeutic Approach to Pulp Canal Calcification as Sequelae of Dental Avulsion.

Tooth avulsion represents the most complicated dental injury, and the classic treatment is tooth replantation. The most common sequelae are pulp canal calcification (PCC) and pulp necrosis. The presence of pulp necrosis after PCC is reported in up to 30% of the cases and is a challenge due to the difficulty of endodontic treatment. This case report describes the surgical treatment of a replanted tooth presenting PCC and periapical pathology eight years after the trauma. An endodontic surgery was performed to remove the apical granuloma, to prepare the apical root, and to seal the apical region with an endodontic cement. In a three-year follow-up, there was an absence of inflammatory signs and symptoms or apical lesion. This report shows the importance of close follow-up after dentoalveolar injuries. After the initial dental trauma and its consequences to pulpal tissues, the executed procedures allowed a favourable outcome.

Porous Polyethylene Implant as Aesthetic Complement in Orthognathic Surgery.

Porous polyethylene implants have been used as an alternative in the treatment of patients with zygomatic and paranasal projections deficiency. These implants promote a facial rejuvenating effect due to the attenuation of the nasal and chin prominences. The advantages of porous polyethylene include biocompatibility, dimensional stability, easy adaptation and fixation, low complication rate, and its availability in different sizes and shapes. A 27-year-old woman presenting vertical deficiency associated with midface hypoplasia was treated with orthognathic surgery. Clockwise rotation and genioplasty were performed. In order to improve facial aesthetics, porous polyethylene implants were placed in the paranasal area, optimizing the facial contour with the correction of the midface projection.

Volumetric and cephalometric evaluation of the upper airway of class III patients submitted to maxillary advancement / Avaliação volumétrica e cefalométrica da via aérea superior em pacientes classe III submetidos a avanço de maxila

Introduction: Anteroposterior maxillary deficiency can be associated with a decrease of upper airway volume. Maxillary advancement can improve the upper airway space. Aim: To correlate cephalometric (2D) and volumetric (3D) measurements of the upper airway in class III patients treated by maxillary advancement. Material and method: This retrospective transversal study was performed in ten adult patients submitted to maxillary advancement for correction of class III deformity secondary to maxillary anteroposterior deficiency. The Cone beam tomography files included in the medical records were used: (T1) pre-operative and (T2) 6 to 8 months postoperative. The DICOM files were imported and reconstructed for volumetric and cephalometric evaluation of the upper airway, as divided into nasopharynx, oropharynx and hypopharynx (Arnett & Gunson FAB Surgery). Result: Age ranged from 26 to 55 years with a mean of 36.3±9.2 years. There were no statistically significant differences for cephalometric and volumetric parameters of the three pharyngeal regions between T1 and T2 periods. This was due to the small amount of maxillary advancement necessary to correct the maxillary deformity in the studied patients (4.7±1.89mm). The correlation between area and volume was not statistically significant only for preoperative measurements of the nasopharynx (r=0.30, p=0.40). It was significant for the other regions and evaluation periods (p<0.05). Conclusion: Small maxillary advancements do not result in significant increases in airway dimensions.

Introdução: A deficiência anteroposterior da maxila pode estar associada com a diminuição do volume da via aérea superior. O avanço de maxila por resultar em um aumento do espaço aéreo superior. Objetivo: Correlacionar mensurações cefalométricas (2D) e volumétricas (3D) da via aérea superior em pacientes classe III tratados por meio de avanço maxilar. Material e método: Este estudo retrospectivo transversal foi realizado em dez pacientes adultos submetidos ao avanço de maxila para correção de deficiência anteroposterior de maxila e deformidade classe III. Foram incluídos os dados de tomografias computadorizadas Cone beam em dois períodos: pré-operatório (T1) e pós-operatório de 6 a 8 meses (T2). Os arquivos DICOM foram importados e reconstruídos para avaliação volumétrica e cefalométrica da via aérea superior, dividida em nasofaringe, orofaringe e hipofaringe (Arnett & Gunson FAB Surgery). Resultado: A idade variou de 26 a 55 anos, com média de 36,3±9,2 anos. Não foram verificadas diferenças estatisticamente significantes para os parâmetros cefalométricos e volumétricos das três regiões da faringe entre os períodos T1 e T2. Este resultado ocorreu devido à pequena quantidade de avanço maxilar (4,7±1,89mm) necessário para a correção da deformidade na amostra. A correlação entre área e volume não foi estatisticamente significante apenas para as mensurações pré-operatórias da nasofaringe (r=0,30; p=0,40). Nas outras regiões e períodos a correlação foi estatisticamente significante (p<0,05). Conclusão: Avanços maxilares de pequenas dimensões não resultam em um aumento significativo das dimensões da via aérea superior.

Maxillary Sinus Mucocele as a Late Complication in Zygomatic-Orbital Complex Fracture.

This article presents an unusual case of maxillary sinus mucocele as a late complication of zygomatic-orbital complex fracture, 23 years after the initial treatment. The patient was referring diplopia and decreased visual acuity with signs of dystopia, proptosis, and epiphora. Computed tomographic scan revealed an expansive lesion in the maxillary sinus with surrounding bone erosion and displacement of the eyeball. Treatment option was excisional biopsy and orbital floor reconstruction with titanium mesh restoring the appropriate orbital position. We propose that in the case of postoperative ophthalmological sequelae of facial fractures involving paranasal sinuses, mucocele should be considered in the differential diagnosis.