Surgically assisted maxillary expansion with or without pterygoid disjunction alters maxillomandibular positioning.

PURPOSE: This study aimed to analyze alterations in mandibular positioning after surgically assisted maxillary expansion (SARME) with and without pterygoid disjunction (PD). METHODS: Cone-beam computed tomography scans of 24 healthy individuals (18-45 years old) with transverse deficiency, superior to 5 mm, underwent SARME with or without PD. The aspects prospectively assessed were (1) alignment and position of the head (ITK-Snap and 3D Slicer software); (2) McNamara's and Steiner-Tweed-Wits' cephalometric analysis (Dolphin Imaging®); and (3) colorimetric evaluation based on 3D correspondence analysis (3D Slicer software). RESULTS: A decrease in 1-NA and 1-SN angles as well as an increased occlusal plane in both groups was observed. Superior-inferior and anteroposterior spatial displacements of the chin were statistically significant in the PD group. Altered colorimetric patterns were also observed in the PD group. CONCLUSIONS: This study found more evident tooth inclination in the group without PD; mandibular alterations were more evident in the PD group. Further studies with 3D analysis are strongly recommended for more comprehensive results.

Effect of thermal processing on the antigenicity of allergenic milk, egg and soy proteins.

The detection of allergenic proteins and the influence of processing on the structure and antigenicity of these proteins are relevant topics. Using commercial enzyme-linked immunosorbent assay kits, this study aimed to evaluate the degradation profiles of milk, egg and soy proteins during the processing of semisweet biscuits. The formulations were baked under different conditions according to a complete factorial experiment that included a three-level temperature factor and a six-level time factor. ß-lactoglobulin and egg white proteins were severely degraded, the degradation of casein was intermediate, and soy proteins were the most stable. Complete allergen protein degradation was found under only the extreme baking conditions, which resulted in products that were not sensorily acceptable. Residual levels of the proteins were detected after baking, indicating that this thermal processing reduced but did not eliminate the antigenicity of these proteins; thus, baking cannot be considered a strategy to protect allergic consumers.

Maxillofacial and dental-related injuries from a Brazilian forensic science institute: Victims and perpetrators characteristics and associated risk factors.

BACKGROUND: Trauma due to external causes represents one of the greatest challenges for public health services in different regions around the world. This study aimed to determine the prevalence of facial trauma, associated risk factors, and classification of body injuries in individuals who underwent forensic examination in a Brazilian center. MATERIAL AND METHODS: Data were collected at the Ceará State Forensic Medicine unit in a 12-year period. Sociodemographic data related to the etiological agent and lesions resulting from the bodily injury were recorded. RESULTS: Among 1,031 physical injury exams, physical aggression (p<0.001), male victims aged between 21 and 30 years (p<0.001), salaried workers (p<0.001), and soft tissue and dentoalveolar injuries were significant findings. Regarding aggression, domestic violence was prevalent (p<0.001), perpetrated by the victim's partner (p<0.001), using a blunt instrument during the aggression (p<0.001), and directly associated with soft tissue injury (p<0.001). In traffic accidents, the most common type was motorcycle accident (p<0.001), on weekdays (p=0.036), at nighttime (p=0.134), showing a significant association with bone fractures (p=0.001). CONCLUSIONS: Oral and maxillofacial injuries obtained from a Brazilian forensic science center were significantly associated with sociodemographic and etiological factors. Key words:Forensic dentistry, facial trauma, violence, public health.

RT-qPCR study of COX-1 and -2 genes in oral surgical model comparing single-dose preemptive ibuprofen and etoricoxib: A randomized clinical trialy.

BACKGROUND: This study aimed to evaluate the gene expression of cyclooxygenases (COXs) in an oral model of preemptive analgesia. MATERIAL AND METHODS: Gingival tissue was collected during extraction of lower third molars from a randomized, triple-blind, split-mouth and placebo-controlled study. The eligible patients were randomly sorted to receive a single dose either of ibuprofen 400mg, or etoricoxib 120 mg or a placebo, one hour prior to surgery. The temporal course of RNAm was evaluated for COX-1 and -2 by means of a quantitative polymerase chain reaction in real time (RT-qPCR) at time zero and 30 minutes after the surgical procedure began, and it was correlated with clinical parameters (pain and maximum mouth opening). RESULTS: There was a significant increase in COX-1 expression between T0 and T30 in ibuprofen (p=0.004) and etoricoxib (p=0.010) groups. As regards COX-2, there were increases from T0 to T30 in all groups (placebo, p=0.012; ibuprofen, p<0.001; etoricoxib, p<0.001). All groups showed a significant decrease in COX-2:COX-1 ratio from T0 to T30 (placebo, p=0.013; ibuprofen, p<0.001; etoricoxib, p=0.047). Experimental groups showed a significant correlation between COX-1 and COX-2 levels and clinical pain parameters. CONCLUSIONS: The present preemptive analgesia study concludes that COX-2 RNAm induction was directly linked to third molar-related tissue inflammation and that the relation between COX-1 and COX-2 levels were inversely proportional to the preemptively administered nonsteroidal anti-inflammatory drugs COX-2 selectivity. Key words:Preemptive analgesia, dental extraction, cyclooxygenases, real-time polymerase chain reaction.

Maxillofacial Gossypiboma: Case Report, Review of the Literature, and Diagnosis Algorithm.

Gossypiboma is a retained surgical sponge and represents a rare complication with an uncertain incidence probably due to medical-legal implications. It is an iatrogenic condition solely due to human factors. While the medical literature has previously described cases of this entity after orthopedic, abdominal, otorhinolaryngology, and plastic surgery procedures, gossypibomas in oral and maxillofacial region are uncommon. It can mimic neoplasms or other injuries, which may promote a delayed diagnosis; thus, the differential diagnosis should be based on clinical history in each particular case. Although there are no pathognomonic features of gossypiboma in oral and maxillofacial region, the most common symptoms suggestive of persistent inflammation include pain, fever, swelling, surgical wounds that do not heal, and purulent drainage. The aim of this study was to report a maxillofacial gossypiboma misdiagnosed as third molar surgery-related odontogenic infection and a diagnosis algorithm.

Does surgically assisted rapid maxillary expansion associated with pterygomaxillary disjunction result in changes in mandibular position? A PROSPERO-compliant systematic review of the literature.

PURPOSE: This study aimed to assess the effect of surgically assisted rapid maxillary expansion (SARME) associated with pterygomaxillary disjunction (PD) on mandibular positioning. MATERIALS AND METHODS: A two-phase systematic review registered with the PROSPERO database was performed. Search strategies were developed for specific databases (PubMed, Scopus, Web of Science, COCHRANE, LILACS, and DOSS), including the gray literature (Open Gray, Google Scholar, and ProQuest). The methodological and evidential quality of the included studies were assessed. RESULTS: Among 680 studies, four were selected for inclusion. In general, a low risk of bias was observed. The studies included a total of 142 adults, and used imaging to perform linear measurements (preoperatively and postoperatively). The main outcomes were maxillomandibular transverse index (difference between effective mandibular width - distance between the left and right antagonist points - and maxillary width), sagittal (forward and backward) and vertical (impaction and extrusion) changes, dental show, chin projection, and altered mandibular position. CONCLUSION: Although the study demonstrated some mandibular position changes after SARME associated with PD, there is insufficient current evidence to support this result because of the potential study limitations related to the number of investigations chosen for inclusion. Further research is required to validate this finding.

Clinical investigation of gustatory and neurosensory alterations following mandibular third molar surgery: an observational prospective study.

OBJECTIVE: This study aimed to prospectively observe gustatory and neurosensory alterations following surgical removal of mandibular third molars. MATERIAL AND METHODS: A prospective clinical study was conducted with patients who required mandibular third molar extraction, recruited from the Division of Oral and Maxillofacial Surgery at the Federal University of Ceará (Brazil). Age, sex, and radiographic signs were recorded. The outcome variables were the presence or absence of gustatory and neurosensory alterations. The patients were observed preoperatively and at 7, 30, 90, and 180 days postoperatively by using gustatory and neurosensory tests. RESULTS: The response to sweet (p = 0.509) and sour (p = 0.078) stimulus did not alter significantly over time. The salty threshold significantly increased from the preoperative to 7- and 30-day postoperative periods, returning to baseline values at 90 days postoperatively (p = 0.038). The bitter threshold increased significantly from the preoperative to 7-day postoperative period, returning to baseline values at 30 days after surgery (p < 0.001). Regarding neurosensory evaluation, there was an altered response to stimulus at 7 days postoperatively in specific studied areas, returning to baseline values 30 days after surgery (p < 0.05). CONCLUSION: The present study shows that mandibular third molar removal was associated with slight sensory disturbances related to mechanical, tactile, and gustatory perception. Regarding the recovery period, all patients returned to normal function without intervention, over a period ranging from 30 to 90 days. CLINICAL RELEVANCE: This study highlighted the importance of a sensory evaluation following removal of third molars, notably regarding mechanical perception and gustatory threshold assessment.

Preemptive analgesia-related gene and protein expression in third molar surgeries under non steroidal anti-inflammatory drug protocols: A PROSPERO-registered systematic review of clinical studies

BACKGROUND: This study aimed to review translational studies focusing on third molar removal surgeries through a systematic analytical approach. MATERIAL AND METHODS: A PROSPERO-registered systematic review (CRD42017060455) was conducted following the PRISMA statement to summarize current knowledge on gene expression in third molar surgeries. A search was performed in PubMed's Medline and Scopus databases, without date or language restrictions, using the logical expression {[(Third molar) OR (preemptive) OR (cyclooxygenase inhibitors) OR (acute inflammation) AND (gene expression)]}. RESULTS: All studies included in the analysis evaluated gene expression in a third molar extraction model, using the preemptive analgesia methodology in seven investigations. The sample analyzed was obtained from gingival tissue biopsy (n=4), blood (n=1), transudate (n=1) and gingival tissue biopsy/transudate (n=1). There were differences with respect to evaluated genes, drug protocol, sample studied, and method for evaluating gene expression. CONCLUSIONS: Third molar surgeries were found to be associated with different COX-related gene expression patterns. Although inflammatory events following the surgical procedure are associated with COX isoforms, data from preemptive analgesia studies are scarce, especially from studies correlating gene expression and clinical parameters. In the future, from a clinical perspective, identifying the molecular targets of a drug based on individual gene expression may be helpful to delineate specific third molar, surgery-related, preemptive analgesia protocols

Lesión bucal relacionada con relleno dérmico / Dermal filler-related oral lesion

Introduction: Oral adverse reactions related to natural dermal fillers may originate from infiltration techniques, giving rise to swellings, nodule formation doe to local material entrapment, or displacement or migration of the material used. Objective: describe a case of orofacial foreign body reaction in an elderly patient. Case report: a 65-year-old woman was referred for oral evaluation complaining of an intraoral lesion present for 15 days. Intraoral examination revealed a mobile nodule in the lower lip left portion. After the initial consultation, incisional biopsy was performed under local anesthesia and the surgical specimen was sent for histopathological analysis. Intraoral examination revealed a soft mobile nodule in the lower lip left portion. Clinical pathological and Raman microspectroscopy analysis led to a final diagnosis of calcium hydroxyapatite dermal filler-related reaction. Conclusions: this case reinforces the possibility of dermal filler-related mucosal tissue reactions in oral cavity soft tissues(AU)

Introducción: las reacciones adversas bucales relacionadas con rellenos dérmicos naturales pueden originarse a partir de técnicas de infiltración, lo que ocasiona inflamaciones, formación de nódulos por atrapamiento de material local o desplazamiento o migración del material usado. Objetivo: describir un caso de reacción a cuerpo extraño bucofacial en un adulto mayor. Presentación del caso: una mujer de 65 años de edad fue remitida para evaluación bucal por presentar una lesión intrabucal durante 15 días. El examen intrabucal reveló un nódulo móvil en la porción izquierda del labio inferior. Después de la consulta inicial, se realizó una biopsia incisional bajo anestesia local y se envió la muestra quirúrgica para su análisis histopatológico. El examen intrabucal reveló un nódulo móvil suave en la porción izquierda del labio inferior. El análisis clínico-patológico y de la micro-espectroscopia de Raman condujeron a un diagnóstico final de reacción de hidroxiapatita cálcica relacionada con el relleno dérmico. Conclusiones: este caso refuerza la posibilidad de reacciones cutáneas relacionadas con los rellenos dérmicos en los tejidos mucosos de la cavidad bucal(AU)

Lesión bucal relacionada con relleno dérmico / Dermal filler-related oral lesion

Introduction: Oral adverse reactions related to natural dermal fillers may originate from infiltration techniques, giving rise to swellings, nodule formation doe to local material entrapment, or displacement or migration of the material used. Objective: describe a case of orofacial foreign body reaction in an elderly patient. Case report: a 65-year-old woman was referred for oral evaluation complaining of an intraoral lesion present for 15 days. Intraoral examination revealed a mobile nodule in the lower lip left portion. After the initial consultation, incisional biopsy was performed under local anesthesia and the surgical specimen was sent for histopathological analysis. Intraoral examination revealed a soft mobile nodule in the lower lip left portion. Clinical pathological and Raman microspectroscopy analysis led to a final diagnosis of calcium hydroxyapatite dermal filler-related reaction. Conclusions: this case reinforces the possibility of dermal filler-related mucosal tissue reactions in oral cavity soft tissues(AU)

Introducción: las reacciones adversas bucales relacionadas con rellenos dérmicos naturales pueden originarse a partir de técnicas de infiltración, lo que ocasiona inflamaciones, formación de nódulos por atrapamiento de material local o desplazamiento o migración del material usado. Objetivo: describir un caso de reacción a cuerpo extraño bucofacial en un adulto mayor. Presentación del caso: una mujer de 65 años de edad fue remitida para evaluación bucal por presentar una lesión intrabucal durante 15 días. El examen intrabucal reveló un nódulo móvil en la porción izquierda del labio inferior. Después de la consulta inicial, se realizó una biopsia incisional bajo anestesia local y se envió la muestra quirúrgica para su análisis histopatológico. El examen intrabucal reveló un nódulo móvil suave en la porción izquierda del labio inferior. El análisis clínico-patológico y de la micro-espectroscopia de Raman condujeron a un diagnóstico final de reacción de hidroxiapatita cálcica relacionada con el relleno dérmico. Conclusiones: este caso refuerza la posibilidad de reacciones cutáneas relacionadas con los rellenos dérmicos en los tejidos mucosos de la cavidad bucal(AU)

Evaluation of different therapeutic Carnoy's formulations on hard human tissues: A Raman microspectroscopy, microhardness, and scanning electron microscopy study.

PURPOSE: To evaluate different therapeutic Carnoy's solution formulations on hard human tissues. MATERIALS AND METHODS: An in vitro study was performed with human teeth (n = 36) and bone fragments (n = 18), randomly divided into two experimental groups (Group I = Carnoy solution with chloroform; Group II = Carnoy solution without chloroform) and a control group (saline solution). The groups were subdivided into pre-conditioning, post-conditioning, and post-conditioning with saline washing. Raman microspectroscopy, Knoop microhardness test, and scanning electron microscopy with energy dispersive X-ray spectroscopy were used. RESULTS: There was demineralization of dental structures regarding mineral/matrix and carbonate/phosphate ratios (GI versus GII, p < 0.05). The presence of chloroform resulted in a statistically significant reduction of the teeth surface microhardness (p = 0.036), but not exceeding 0.01 µm. Both GI and GII showed significant structural changes by using scanning electron microscopy with energy dispersive X-ray spectroscopy. CONCLUSION: Carnoy's solution altered the organic and inorganic matrix of the human calcified specimens analyzed in vitro, and its effect was more pronounced when chloroform was present.

Factors Associated With the Complexity of Facial Trauma.

INTRODUCTION: Facial fractures have their incidence, etiology, clinical presentation, and features influenced by variables such as economic, cultural, and demographic factors. A large number of these fractures require simple or more complex approaches, and it becomes important to understand their clinical and epidemiological profile and factors associated with the fracture event and surgical indication. OBJECTIVE: The objective of this research is to analyze the clinical and epidemiological profile of surgical fractures and their associations with causal factors such as alcohol consumption, day of the incident, and nonuse of helmet for motorcycle accidents. METHOD: A retrospective study was conducted with collection of data from medical records of patients operated for facial fractures at the Hospital Regional of Cariri, state of Ceara, the Northeast of Brazil. Records from 2012 to 2014 were acquired highlighting sex, age, occupation, etiology, anatomical sites of fractures, and surgeries of varying complexities for single or multiple fractures. The day of the event, report or signs of alcohol consumption, and the use of helmets in motorcycle accidents were named associated factors. RESULTS: As a result the authors had a total of 624 cases of surgical facial fractures. Out of these, 546 (87.5%) were male and the majority of them presented between 20 and 30 years of age (40.5%). It was also observed that as an etiological factor motorcycle accidents led to more cases of surgical facial fractures, with 357 cases (62.1%), followed by physical aggression with 72 cases (12.5%). CONCLUSIONS: It can be concluded that there is a high prevalence of surgical facial fractures in male patients between 20 and 30 years of age, caused by motorcycle accidents, and that there was a strong association between the consumption of alcohol, failure to wear a helmet, and the presence of surgical facial multiple fractures.

Occupational group, educational level, marital status and deleterious habits among individuals with maxillofacial fractures: retrospective study

Background: To investigate the occupational profile, educational level, marital status and deleterious habits to the health of patients with maxillofacial fractures of a population of northeastern Brazil. Material and Methods: A retrospective study of patients records admitted to the Division of Oral and Maxillofacial Surgery at the Walter Cantídio University Hospital (Fortaleza, Brazil) who sustained maxillofacial fractures was conducted in the period between 2006 and 2015. Results: A total of 338 patients rendered 355 fractures. Males were the most affected (p <0.001), with prevalence in the third decade of life (p <0.001). There was a predominance of motorcycle accidents (p <0.001), home workers (p <0.001), low educational status (p = 0.032), and no cigarette use (p <0.001) or alcohol (p = 0.023). Fractures of the zygomatic-orbital complex were the most prevalent in the sample (p <0.001). Conclusions: The sociodemographic profile exerted a significant influence on the epidemiological profile of maxillofacial fractures in a Brazilian population during the study period (AU)

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Effects of Pterygomaxillary Separation on Skeletal and Dental Changes After Surgically Assisted Rapid Maxillary Expansion: A Single-Center, Double-Blind, Randomized Clinical Trial.

PURPOSE: Surgically assisted rapid maxillary expansion (SARME) is a procedure routinely performed to correct transverse maxillary deformities and can be performed with or without pterygomaxillary disjunction (PD). The aim of the present study was to measure the effect of the amount of expansion and stability of SARME with or without PD. PATIENTS AND METHODS: We designed and implemented a double-blind, randomized clinical trial. The patients were randomly assigned to 2 groups: group 1, SARME without PD; and group 2, SARME with PD. Cone-beam computed tomography scans were performed at 3 points: baseline (T0), after maxillary expansion (T1), and at the end of the retention period (T2). Dental and bone expansion and dental inclination at the maxillary canine and first molar regions were assessed. Two-way repeated measures analysis of variance was used to evaluate the differences between the 2 groups at the 3 evaluation periods (T0, T1, and T2), using a level of significance of P < .05. RESULTS: A total of 24 patients underwent maxillary surgical expansion (group 1, n = 12; and group 2, n = 12). Both techniques promoted a significant transverse dental expansion in the first molar at T2 (with PD, 5.4 mm; vs without PD, 6.4 mm; change, -6.18 mm to 1.48 mm). However, no statistically significant differences were observed between the 2 groups. The tipping molars at T2 remained at a higher level in the SARME, no PD group than in the SARME, PD group (with PD, 2.3°; vs no PD, 4.6° for 3 teeth; change, -12.72° to 5.57°; and with PD, 1.6° vs without PD, 3.6° for 14 teeth; change, -9.96° to 9.83°). CONCLUSIONS: SARME with and without PD is a reliable method for obtaining maxillary expansion, with slight differences in the patterns of skeletal and dental alterations.

Use positional screws for Le Fort I osteotomy fixation: technical note.

In recent years, several studies related to fixation systems have been published, but few suggest any variations of the Le Fort I osteotomy technique, and the use of plates and screws placed along the canine and zygomatic pillar are common. The 20-year-old patient with Crouzon syndrome presented with severe hypoplasia of the maxillary, mandibular prognathism, and class III facial pattern. The patient underwent orthognathic surgery and high Le Fort I osteotomy with the fixation of eight positional screws. The aim of this paper is to describe a different technique for the fixation in high maxillary osteotomies, which can be used in specific cases.

Educational Utilization of Microsoft Powerpoint for Oral and Maxillofacial Cancer Presentations.

Electronic presentations have become useful tools for surgeons, other clinicians and patients, facilitating medical and legal support and scientific research. Microsoft® PowerPoint is by far and away the most commonly used computer-based presentation package. Setting up surgical clinical cases with PowerPoint makes it easy to register and follow patients for the purpose of discussion of treatment plan or scientific presentations. It facilitates communication between professionals, supervising clinical cases and teaching. It is often useful to create a template to standardize the presentation, offered by the software through the slide master. The purpose of this paper was to show a simple and practical method for creating a Microsoft® PowerPoint template for use in presentations concerning oral and maxillofacial cancer.

Does the Preemptive Use of Oral Nonsteroidal Anti-inflammatory Drugs Reduce Postoperative Pain in Surgical Removal of Third Molars? A Meta-analysis of Randomized Clinical Trials.

The purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n=420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n=298, P=.2227, odds ratio: 2.30, 0.60-8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.