Orthognathic surgery in a patient with von Willebrand disease: case report

Aim: This study aims to report the perioperative management of a patient with von Willebrand disease (vWd) who underwent orthognathic surgery. The report follows the guidelines of the Case Report Guidelines (CARE) and focuses on the steps taken to prevent bleeding during the surgical procedure. Methods: A 39-year-old female patient with skeletal Class III was treated with maxillary advancement and mandibular setback. Despite normal test results for ristocetin cofactor activity, measures were taken to prevent bleeding, including atraumatic surgical techniques, use of antifibrinolytic medication, induced hypotension during anesthesia, and preparation of blood products for transfusion during trans and postoperative periods if needed. In the end, these measures were not required. Results: The patient did not experience any bleeding during the surgical procedure or postoperative period, demonstrating the effectiveness of the measures taken to manage their blood dyscrasia. Two years after the surgery, the patient had satisfactory aesthetic and functional results and no evidence of relapse. Conclusion: Thus, this case report demonstrates that vWd does not prevent largescale oral and maxillofacial surgeries such as orthognathic surgery as long as proper precautions are taken pre-, intraand postoperatively

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.

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.