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

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

Initial Manifestation of Orbital Lymphomas: The Role of Early Diagnosis.

ABSTRACT: Orbital lymphoma is a rare condition with non-specific and variable clinical course. This features are the main obstacle for diagnosis and treatment. A 43-year-old female patient complaining of vision loss and hemiface paresthesia, Proptosis was noted associated with an expansive lesion involving the right temporal lobe and orbital region. Craniotomy was performed to allow orbital decompression and anatomopathogical analysis. Final diagnosis was Burkitt Lymphoma. Patient evolved to death after seven days. A 40-year-old male patient complaining excessive tearing and sight disturbance. Proptosis on the right eye was noticed. Extra-conal expansive lesion was observed. Final diagnosis was mucosa-associated lymphoid tissue lymphoma. Radio and chemotherapy protocol was initiated. In a 3 year follow-up, there are no signs of recurrence or ocular/orbital impairment. Maxillofacial surgeons should be aware of the initial clinical presentation and always include lymphoid neoplasms as a differential diagnosis in cases which acute functional alterations are present.

Dental surgical care in blood dyscrasias patients: an epidemiological study / Cuidados em cirurgias dentárias de pacientes com discrasias sanguíneas: um estudo epidemiológico

ABSTRACT Introduction: In Brazil, about 18.500 people have some kind of hereditary coagulopathy. In combination, the increase in life expectancy has led to an increasingly frequent presence of older people in medical offices. These patients make use of many drugs, including those that produce anticoagulant effects. The dentist should be aware about the impact of bleeding disorders during the approach of their patients, especially if invasive procedures are considered. Objective: To identify the most prevalent blood dyscrasias presented by patients covered by the Program of dental surgical care to patients with blood dyscrasias; to establish the presence of associated diseases and investigate the correlation between pre- and postoperative drug protocols and the occurrence of postoperative complications. Methods: This was an epidemiological retrospective cross-sectional study of medical reports used by the program. After the survey of defined variables, data were tabulated in Microsoft Excel ® software and evaluated using the chi-square and Fisher's exact tests. Results: One patient was identified as having Human Immunodeficiency Virus and 18 with Hepatitis C virus. There was a statistically significant difference between patients with haemophilia B and Hepatitis C. The administration of tranexamic acid as pre- and post-surgical protocol was the therapy of choice. Of the 11 patients with vWD, 7 of them received tranexamic acid as preoperative medication. Conclusion: The appropriate retention system for the patient depends on several factors, including indication, advantages and disadvantages, retention provided, aesthetics and clinical performance.

RESUMO Introdução: No Brasil, cerca de 18.500 pessoas apresentam algum tipo de coagulopatia hereditária. O aumento da expectativa de vida tem levado a uma presença cada vez mais frequente de idosos nos consultórios médicos. Esses pacientes fazem uso de diversos medicamentos, inclusive aqueles que produzem efeitos anticoagulantes. O dentista deve estar ciente do impacto dos distúrbios hemorrágicos durante a abordagem de seus pacientes, especialmente se procedimentos invasivos forem considerados. Objetivos: Identificar as discrasias sanguíneas mais prevalentes apresentadas pelos pacientes atendidos pelo Programa de assistência cirúrgica odontológica a pacientes com discrasias sanguíneas; estabelecer a presença de doenças associadas e investigar a correlação entre os protocolos medicamentosos pré e pós-operatórios e a ocorrência de complicações pós-operatórias. Métodos: Trata-se de um estudo epidemiológico retrospectivo transversal dos laudos médicos utilizados pelo programa. Após o levantamento das variáveis definidas, os dados foram tabulados no software Microsoft Excel ® e avaliados pelos testes qui-quadrado e exato de Fisher. Resultados: Um paciente foi identificado como portador do Vírus da Imunodeficiência Humana e 18 com Vírus da Hepatite C. Houve uma diferença estatisticamente significativa entre os pacientes com hemofilia B e hepatite C. A administração de ácido tranexâmico como protocolo pré e pós-cirúrgico foi a terapia de escolha. Dos 11 pacientes com vWD, 7 deles receberam ácido tranexâmico como medicação pré-operatória. Conclusão: O ácido tranexâmico foi o fármaco mais utilizado como medicamento para cirurgia oral sem. Não há associações entre os protocolos cirúrgicos e complicações pós-operatórias. Foi encontrada significância estatística entre Hemofilia B e hepatite C. Estudos futuros devem enfocar esta relação entre hemofilia e hepatite C.

Fixação funcionalmente estável no tratamento de sequela de fratura cominutiva de mandíbula por PAF / Functionally stable fixation in the treatment of comminuted jaw fracture by firearm projectile

Introdução: em traumas de alta energia por projéteis de arma de fogo (PAF), pode ocorrer a cominuição da mandíbula. Quando não identificadas ou tratadas de maneira equivocada, essas injúrias podem comprometer a saúde do indivíduo, com graves complicações estéticas e funcionais. Objetivo: o objetivo deste trabalho é relatar um caso de tratamento cirúrgico de sequela de ferimento por arma de fogo com fratura cominutiva em região de sínfise mandibular. Relato do caso: paciente procurou o serviço de cirurgia e traumatologia bucomaxilofacial após tratamento cirúrgico insatisfatório de fratura mandibular por PAF. Observou-se clinicamente mobilidade em manipulação, exposição óssea e drenagem purulenta. Na tomografia, observou-se gap ósseo, descontinuidade na base mandibular e material de osteossíntese inadequado. Foi proposta uma abordagem cirúrgica para instalação de placa de reconstrução do sistema 2.4 mm. Em acompanhamento pós-operatório, o paciente evoluiu com abertura bucal funcional e satisfatória, sem mobilidade nos fragmentos ósseos, arcabouço mandibular restabelecido e adequado posicionamento do material de fixação. Considerações finais: os casos de cominuição óssea apresentam características individuais que devem ser levadas em consideração em seu manejo. Nesses casos, a escolha do material de fixação é fundamental para o sucesso terapêutico e o uso de prototipagem soma para uma condução satisfatória do caso, garantindo menor tempo cirúrgico e melhor adaptação da placa. (AU)

Introduction: in high energy traumas caused by firearm projectiles may occur comminutive mandibular fractures. When it is not identified or inappropriately treated, these injuries can compromisse the individual's health, with serious aesthetics and funcional complications. Objective: the aim of this study is report a case of surgical treatment of sequelae from firearm injury with comminutive fracture in the region of mandibular symphysis. Case report: patient sought the service of Oral and Maxillofacial Surgery and Traumatology after 1 month of unsatisfactory surgical treatment of a mandibular fracture caused by firearm projectile. Clinical examination revealed mobility to manipulation and bone exposure with purulent drainage. Computed tomography of the face shows bad fracture consolidation in the anterior region of the mandible with bone gap and discontinuity in the mandibular base and inadequate and poorly positioned osteosynthesis material. It was then proposed a new surgical approach with instalation of the reconstruction plate of 2.4mm locking system. In postoperative follow-up, the patient evolved with a functional and satisfactory mouth opening, with no mobility in bone fragments, restored mandibular framework and adequate positioning of the fixation material. Final considerations: the cases of comminutive bone fractures show particular features that should be considered in their handling. In these cases, the choice of the fixation material is critical to therapeutic success and the use of prototyping sum for a satisfactory conduction of the case, ensuring shorter surgical time and better adaptation of the plate.(AU)

Intraoral Approach for Surgical Treatment of Psammomatoid Juvenile Ossifying Fibroma.

Psammomatoid juvenile ossifying fibroma (PJOF) is a rare benign tumor that usually affects the paranasal sinuses, orbit, and skull. In most cases, extensive incisions are necessary for full access to the tumor site. The aim of this paper is to report a case of extensive PJOF in which an intraoral surgical approach was performed with complete excision of the tumor. A female patient, 18-year old had a deforming volume increase in the region of the left facial middle third with an approximate evolution time of 2 years. She complained of headache, epiphora in the left eye, and total obstruction of the left nostril. Extraoral examination showed facial asymmetry with dystopia, ocular proptosis, and considerable sclera exposition of the left eye. Tomography examination showed a mixed aspect lesion on the left side of the face, well delimited. The intraoral surgical approach was chosen for the excision of the lesion. Under general anesthesia and nasotracheal intubation, total resection was performed, followed by exodontia of the directly involved teeth. In the definitive histopathological examination, the diagnosis was confirmed. The patient is currently with 2 years and 6 months of postoperative follow-up and has good healing of intraoral surgical wounds and stable occlusion. Extraoral examination showed harmonic projection of the facial middle third, but still with excessive exposure of the sclera of the left eye due to the defect in the orbital floor. The surgical treatment of PJOF was possible by intraoral approach, even taking into account the limitations of the access and the complexity of the anatomy of the facial bones involved.

Virtual Surgical Planning and One-Stage Treatment of Active Hemimandibular Hyperplasia.

Hemimandibular hyperplasia was first described in 1836 by Adams as a disorder that causes condylar hyperplasia, deforming facial asymmetry and has an unknown etiology. The objective of this study was to report a patient with surgical correction through orthognathic surgery and high condilectomy for the treatment of hemimandibular hyperplasia. The patient complained of pain and cracking in the right temporomandibular joint region and was dissatisfied with the aesthetic appearance of the face. Virtual planning was done for bimaxillary orthognathic surgery and preparation of prototyped surgical guides. Stereolithographic models were used for the preparation of the acrylic guides of the osteotomies for the high condilectomy and the contour of the mandibular base. Orthognathic surgery resulted in the maxillary repositioning with correction of the inclination of the occlusal plane, reduction of the height of the ramus and right mandibular body and class I dental attachment. Mandibular contour osteotomy was performed with acrylic guide in the basilar. The condilectomy was performed by endaural access. In 2-year follow-up, there are no signs of recurrence.

Manejo de fratura bilateral de mandíbula através de fixação interna rígida pela técnica de Champy ­ relato de caso / Management of bilateral mandibular fracture through rigid internal fixing by Champy technique ­ case report

As fraturas de mandíbula são as mais comuns no campo da Cirurgia e Traumatologia Bucomaxilofacial. Acometem cerca de 42,5% dentre os traumas faciais. O método a ser escolhido para o tratamento depende de diversos fatores, como o deslocamento e a cominuição dos fragmentos ósseos, a presença de má oclusão, a ação muscular local, a idade do paciente e a habilidade do cirurgião. Este trabalho tem por objetivo relatar um caso de fratura bilateral de mandíbula em corpo esquerdo e ângulo direito, tratado através de fixação interna rígida e técnica de Champy. Esta abordagem mostrou-se eficaz e segura neste tratamento, além de evitar cicatrizes antiestéticas e lesões às estruturas adjacentes. Um resultado pós-operatório de 3 meses é apresentado (AU).

Mandibular fractures are the most common in the field of Buccomaxillofacial Surgery and Traumatology. The prevalence rate is about 42.5% of facial traumas. The method of choice for the treatment depends on several factors, such as displacement and comminution of the bone fragments, presence of malocclusion, local muscular action, the age of the patient and the surgeon's skill. This paper aims to report a case of bilateral mandibular fracture in the left body and right angle treated through rigid internal fixation and the Champy technique. This approach proved to be effective and safe in this treatment, besides avoiding unsightly scars and lesions on adjacent structures. A 3-month postoperative result is presented (AU).

Líquen plano oral: um relato de caso / Oral lichen planus: a case report

O líquen plano oral é uma doença crônica sistêmica comum, que se caracteriza por ser mucocutânea, autoimune, porém de etiologia incerta. O objetivo do presente trabalho é o de relatar um caso clínico com diagnóstico precoce e tratamento imediato, bem como acompanhamento de sua evolução. Foi descrito o caso de uma paciente do serviço de Traumatologia Buco-Maxilo-Facial do Hospital Universitário Oswaldo Cruz ­ HUOC. O teste para hepatite C se mostrou negativo para a paciente-alvo de nosso estudo e não há traços de transformação maligna nas lesões, considerando o acompanhamento clínico de 6 meses. O líquen plano oral necessita de diagnóstico preciso, para que a implementação de uma correta conduta terapêutica possa ser realizada... (AU)

Oral lichen planus is a common chronic systemic disease characterized as a mucocutaneous, autoimmune but of uncertain etiology. The aim of this study was to report a case with early diagnosis, prompt treatment and a six-month follow-up. It described the case of a patient of Buco-Maxillofacial Service of the University Hospital Oswaldo Cruz - HUOC. The test for hepatitis C was negative for the patient and no traces of malignant transformation lesions was found, taking into account the clinical six-month follow-up. Oral lichen planus requires an accurate diagnosis for the implementation of a correct approach therapy... (AU)

Enamel-Renal-Syndrome: case report.

AIMS: to describe a case in which dental changes were observed and investigation proceeded to consider Enamel-Renal-Syndrome (ERS), a rare disorder that associates amelogenesis imperfecta with nephrocalcinosis. CASE REPORT: an 11-year-old male patient upon intraoral examination revealed generalized gingival hyperplasia, a few teeth were absent clinically and the remaining ones were yellowish-brown in color. The enamel alterations were suggesting of amelogenesis imperfecta. Unerupted teeth with increased pericoronal spaces, suggesting hyperplasic follicles or dentigerous cysts and an enamel with lower thickness and density were observed in the panoramic radiography. The patient was referred for an assay to investigate mucopolysaccharidosis; however, it was negative. A renal ultrasound showed bilateral nephrocalcinosis and laboratory exams, including calcium, phosphate, and creatinine levels were below the average. An incisional gingival biopsy showed numerous round to ovoid basophilic calcifications in the connective tissue. The final diagnosis was ERS. CONCLUSION: Dentists should refer patients with similar clinical presentation for renal ultrasound evaluation in order to rule out the possible diagnosis of ERS.