Postoperative nausea and vomiting in orthognathic surgery: systematic review and meta-analysis.

PURPOSE: Postoperative nausea and vomiting (PONV) is a frequently reported adverse event following orthognathic surgery. The aim of this work is to conduct a systematic review of the literature on the subject, and to discuss the role of maxillofacial surgeons and the steps that can be taken to prevent or control PONV in orthognathic surgery. METHODS: A systematic review was conducted according to the PRISMA guidelines, using the search strategy: (orthognathic AND (nausea OR vomiting)). The authors searched PubMed, Embase, Dimensions, Web of Science and Google Scholar databases, without any language restrictions. RevMan 5.4 was used to create a risk of bias graph and a forest plot. RESULTS: The included articles were classified as having a low risk of bias, despite the limited literature on the subject. Various measures have been reported to be beneficial in preventing or managing PONV, such as the use of dexamethasone, antiemetic drugs, gastric aspiration, and anesthetic blocks. Effective bleeding control and faster surgeries can also be helpful. CONCLUSIONS: Throat packs have not been found to be effective in preventing PONV. Although no definitive protocol has been established in the literature, the Enhanced Recovery After Surgery (ERAS) protocol could be a useful approach. Overall, a multimodal approach may be taken to prevent PONV, and further research is needed to establish definitive protocols.

Exploring the relationship between the number of systematic reviews and quality of evidence: an orthognathic surgery-based study.

OBJECTIVE: We analyzed the quality and quantity of systematic reviews (SRs) of orthognathic surgery, the most frequently published topic in maxillofacial surgery. STUDY DESIGN: We searched the PubMed database for SRs of orthognathic surgery with no restriction on the language of publication date. We assessed the certainty of evidence presented according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and the Leiden Manifesto using the Grading of Recommendations Assessment, Development, and Evaluation approach. We analyzed the data using descriptive statistics, Pearson´s correlation test, and linear regression. RESULTS: Of the 171 SRs evaluated, approximately one fifth presented evidence with a high level of certainty. The number of orthognathic surgery SRs has been increasing, and many SRs were published after very similar topics had already been published. There is no relationship between the impact factor and the certainty of evidence. CONCLUSIONS: An excessive number of SRs of orthognathic surgery are published, and many SRs are superfluous, simply reporting previous findings. Clinicians should not base treatment decisions solely on the evidence presented in SRs, and journal editors and reviewers should evaluate these SRs more critically, particularly when they address topics that have already been covered in the literature.

Should orthognathic surgery be performed in growing patients? A scoping review.

The aim of this study was to determine whether the benefits of orthognathic surgery in a growing individual outweigh its risks. A scoping review was performed according to the PRISMA-ScR guideline. A bibliographic search from MEDLINE, Cochrane Library and LILACS was conducted until February 1, 2022. Scientific publications which reported orthognathic surgery in individuals under 18 years of age were considered. Inclusion criteria were performed according to PICOS model: do individuals with dentofacial deformity submitted to orthognathic surgery with an immature skeleton other than waiting growth cessation have overall benefits over any possible pos-operative consequences? Predictor of interest was growth status and outcome variables were positive benefits or negative consequences related to orthognathic surgery. Two reviewers screened records independently, and any disagreement between them was resolved by a third reviewer. Eligible studies were compiled into an extraction data form and were verified for validity and reliability. Risk of bias between studies was carried out using Review Manager. A total of 15 articles were included in this scoping review, comprising retrospective studies (9), case reports (3), and surveys (3). The topics covered varied from assessment of the functional needs, role, quality of life after orthognathic surgery, impact on growth, relation with temporomandibular joint surgical treatments, minimal referral age for surgery by orthodontists and complex cranio-maxillofacial deformities. Due to the heterogeneity of the articles, it was not possible to perform a meta-analysis. Within the limitations of the study it seems that the existing evidence seems favorable towards the intervention, improving quality of life in growing individuals, even at the risk of a second surgery.

Which sports have a higher risk of maxillofacial injuries?

OBJECTIVES: Sports etiology is one of the most common causes of maxillofacial injuries. This work aimed to provide an up-to-date review of sports-related maxillofacial injuries. METHODS: An updated review was conducted on Pubmed and Google Scholar. No publication year and language restrictions were applied. Two different search strategies were performed, the first addressed which sports, generally associated with maxillofacial injuries, and the second search was conducted to determine the frequency of maxillofacial injuries associated with each sport individually. RESULTS: The first search returned 26 articles distributed across different sports, from different countries, and with varied age distribution. The second search displayed 85 articles on individual sports group. Papers were rated and categorized according by the sport associated to the reported injury. A useful sports risk scale for maxillofacial injuries has been developed. Peculiar themes from all participating sports were evaluated. The use of protective equipment and other preventive measures were highlighted. CONCLUSIONS: Some sports with ball and cycling can be considered riskier sports for maxillofacial injuries. Athlete education and the mandatory use of mouthguards, helmets, and eye protection, among other things, are crucial to prevent these injuries. Tailor-made mouthguards and protective masks, which are becoming cheaper, are in vogue. The Sports-related Maxillofacial Injuries Risk scale can be useful for athletes, athletic coaches, and maxillofacial surgeons.

Environmental Factors at the Periconceptional Period and the Occurrence of Cleft Lip and Palate in a Midwest Brazil Population: A Case-Control Study.

OBJECTIVE: To investigate the association between periconceptional environmental exposures and the occurrence of cleft lips and palates. METHODS: This case-control study analyzed 150 mothers of children with cleft lips and palates living in the same city as 250 mothers whose children did not present with this malformation (controls). Environmental exposure data were gathered through a questionnaire (Latin American Collaborative Study of Congenital Malformations methodology). RESULTS: Multivariate analysis revealed that monthly income below minimum wage, having another malformed child, other diseases in the first gestational trimester (urinary infection), use of pesticides in home gardens, and pesticide use in farms close to the home were risk factors associated with the malformation, whereas taking vitamins was a protective factor. CONCLUSION: Maternal and paternal exposure to pesticides is associated with cleft lip and palate in Mato Grosso State, Brazil.

The Relation between Maxillary Sinuses and Cleft Lip and Palate / A Relação Entre os Seios Maxilares e a Fissura Labiopalatina

Cleft lip and palate are anomalies of craniofacial development that require reparative surgery to provide considerable improvement in the individual's quality of life, but which can also have a negative impact on the maxilla development. The aim of this study was to understand the influence of surgical repair of cleft lip and palate on the volume of the maxillary sinus of these individuals. A narrative review was carried out using the scientific databases Pubmed and Scielo, where the articles selected by the abstract were fully read, categorized and critically analyzed. There are reports of high frequency of chronic sinusitis in patients with cleft lip and palate, especially children, that may be related to hypoplasia of the maxilla and lower volume of the maxillary sinus related to the cleft. In addition, these individuals are submitted to several surgical corrections that can also negatively influence the maxilla development due to tissue fibrosis, with suggestions for surgical techniques to reduce this interference. Thus, the patient with cleft lip and palate may present maxillary underdevelopment, which may result in hypoplasia of the maxillary sinus, and reparative surgeries can aggravate this complication. This review suggests some surgical techniques to reduce this interference, although there are few articles with clinical trials found in the literature that can explore these alternatives and correlate the results with current surgical protocols. (AU)

As fissuras labiopalatinas são anomalias de desenvolvimento craniofacial que necessitam de cirurgias reparadoras para proporcionar melhora considerável à qualidade de vida do indivíduo, mas que também podem repercutir negativamente no desenvolvimento da maxila. O objetivo deste estudo foi compreender a influência das cirurgias reparadoras de fissuras labiopalatais no volume do seio maxilar desses indivíduos. Foi realizada uma revisão narrativa pelas bases de dados científicos Pubmed e Scielo, de onde os artigos selecionados pelo abstract foram lidos na íntegra, categorizados e analisados criticamente. Há relatos de alta frequência de sinusite crônica em pacientes com fissuras labiopalatais, principalmente crianças, que podem estar relacionada a hipoplasia de maxila e menor volume do seio maxilar relacionado à fissura. Além disso, esses indivíduos são submetidos a diversas correções cirúrgicas que também podem influenciar negativamente o desenvolvimento da maxila devido a fibrose tecidual, havendo sugestões de técnicas cirúrgicas para diminuir essa interferência. Então, o paciente com fissuras labiopalatais pode apresentar hipodesenvolvimento maxilar podendo ter como consequência a hipoplasia do seio maxilar e as cirurgias reparadoras podem agravar essa complicação. Essa revisão sugere algumas técnicas cirúrgicas para diminuir essa interferência, embora existam poucos artigos com ensaios clínicos encontrados na literatura que possam explorar essas alternativas e correlacionar os resultados com os protocolos cirúrgicos atuais. (AU)

Reproducibility of a three-dimensional skeletal-based craniofacial orientation method for virtual surgical planning.

Inadequate craniofacial orientation of computed tomography (CT) scans can have significant implications in all three planes of space. The purpose of this study was to present the reproducibility of a 3-dimensional skeletal-based method of craniofacial orientation for virtual surgical planning. The protocol was defined by landmarks commonly used for cephalometry, and required identification of basion, nasion, right porion, and right orbitale, and navigation in all CT views (coronal, sagittal, and axial) for correction of yaw, roll, and pitch. Reproducibility of the method was assessed using eight CT scans that were randomly selected and anonymised. The observer group consisted of six oral and maxillofacial surgeons with varying levels of experience (resident or faculty) who performed craniofacial orientation according to the proposed method. Results were expected to be below 2° of variation, when overall accuracy as well as the influence of the academic level of the observers and symmetry of the evaluated anatomy, were considered as independent variables. Overall accuracy for all cases and for yaw, roll, and pitch were always below 2° of variation, without influence of level of experience and symmetry. Interobserver assessment was categorised as excellent in all instances, and intraobserver evaluation demonstrated consistency in the orientation of all axes. The proposed craniofacial orientation protocol presented in this study is easy to learn, applicable to computer-aided surgical planning, and can be performed by the non-technical clinician, resulting in excellent reproducibility and consistency.

Paracoccidioidomicose afetando a mucosa bucal: relato de caso / Paracoccidioidomycosis affecting the buccal mucosa: case report / Paracoccidioidomicosis con afectación de la mucosa oral: relato de caso

Introdução: A paracoccidioidomicose é uma infecção micótica sistêmica com manifestações pulmonares primária que podem apresentar lesões cutâneas e orais. É mais comum no Brasil e em alguns outros países da América Latina, representando um importante problema de saúde pública devido às suas características potencialmente fatais. Relato de caso: Trabalhador rural de 53 anos, fumante e etilista, apresentando lesão ulcerada de aspecto moriforme em mucosa bucal direita. Realizou-se biópsia incisional cujo laudo histopatológico foi de paracoccidioidomicose. O paciente foi encaminhado ao médico infectologista para tratamento por meio de itraconazol (200mg por dia) por 18 meses. Após 03 meses de tratamento já apresentava regressão da lesão. Considerações Finais: Portanto, o objetivo deste trabalho é enfatizar a importância do cirurgião-dentista no reconhecimento das lesões oral e realização da biópsia para o correto diagnóstico e manejo desta doença por meio de um relato de caso clínico... (AU)

Paracoccidioidomycosis is a systemic mycotic infection with primary pulmonary manifestations that can present cutaneous and oral lesions. It is more common in Brazil and some other Latin American countries, representing an important public health problem due to its potentially fatal characteristics. Case report: 53-year-old rural worker, smoker and drinker, presenting an ulcerated lesion with a moriform aspect in the right oral mucosa. An incisional biopsy was performed, and the histopathological report was of paracoccidioidomycosis. The patient was referred to the infectious disease physician for treatment with itraconazole (200mg per day) for 18 months. After 03 months of treatment, he already had regression of the lesion. Final Considerations: Therefore, the objective of this paper is to emphasize the importance of the dentist in recognizing oral lesions and performing a biopsy for the correct diag... (AU)

La paracoccidioidomicosis es una infección micótica sistémica con manifestaciones pulmonares primarias que pueden presentar lesiones cutáneas y bucales. Es más común en Brasil y algunos otros países de América Latina, lo que representa un importante problema de salud pública debido a sus características potencialmente fatales. Caso clínico: trabajador rural de 53 años, fumador y bebedor, con lesión ulcerada de aspecto moriforme en mucosa oral derecha. Se realizó biopsia incisional y el informe histopatológico fue de paracoccidioidomicosis. El paciente fue remitido al médico de enfermedades infecciosas para tratamiento con itraconazol (200 mg al día) durante 18 meses. Después de 03 meses de tratamiento, ya tenía regresión de la lesión. Consideraciones finales: Por lo tanto, el objetivo de este trabajo es enfatizar la importancia del odontólogo en el reconocimiento de las lesiones bucales y la realización de una biopsia para el correcto diagnóstico y manejo de esta enfermedad a través de la presentación de un caso clínico... (AU)

A Simple Method to Retract the Descending Palatine Neurovascular Bundle During Osseous Removal of Posterior Interferences in Le Fort I Osteotomy.

ABSTRACT: For accurate repositioning of the maxilla in Le Fort I osteotomy, bone removal around the descending palatine neurovascular bundle and maxillary tuberosity is frequently required. Such task can be challenging due to the high vascularity of the region, which is the most common site of hemorrhage during removal of bony interferences. Although a rare occurrence, ligation of the descending palatine artery in cases of intraoperative vascular damage can be related to the development of aseptic necrosis. This article reports a simple technique for retraction and protection of the descending palatine neurovascular bundle during bony removal related to a posterior maxillary impaction, which can be easily reproduced in orthognathic selected cases.

Three-Dimensional Analysis of the Skull Base of Individuals With Cleft Lip and Palate.

AIMS: Identify variations of skull base measurements in individuals with dentofacial deformities associated or not with cleft lip and palate and compare the results with individuals without dentofacial deformities. METHODS AND RESULTS: The individuals were categorized into three different groups: dentofacial deformity without cleft malformation, dentofacial deformity associated with cleft lip and palate, and without facial deformity. The inclusion criteria were individuals over 18 years of age, without any intervention involving facial bones or structures of interest for the study and field of view encompassing from the glabella to the hyoid bone. Poor quality CT scans or lack of adequate medical records were considered exclusion criteria. In the analysis by computerized tomography using the Dolphin Imaging Software, the length determined by the Ba-S and S-N lines was evaluated, as well as the Ba-S-N angle formed by landmarks. RESULTS: The length of S-N was not statistically different between the groups, the Ba-S length and the Ba-S-N angle demonstrated statistical difference. CONCLUSION: There was statistically significant difference in the morphometry of the (Ba-S) between groups (FS) and (C). This suggests that the standard values for cephalometric analyzes involving these structures, especially to determine the treatment planning, should be used with caution.

Periodontal Findings in Children and Adolescents with Cleft Lip and/or Palate: A Case-Control Study.

Purpose: The purpose of this study was to evaluate periodontal disease and oral biofilm in children and adolescents with cleft lip and/or palate (CLP). Methods: A total of 118 individuals aged six to 18 years, with CLP (n equals 60) and without CLP (n equals 58), were evaluated according to plaque index (PI), gingival bleeding index (BI), clinical attachment level (CAL), and probing pocket depth (PPD). Gingivitis and periodontitis were also diagnosed. Samples of subgingival oral biofilm were collected, and genomic DNA was extracted for oral microbial analysis. Aggregatibacter actinomycetemcomitans, Tannerela forsythia, Porphyromonas gingivalis, and Streptococcus oralis were identified and quantified by qPCR using Taqman primers and probes. Results: PI, BI, CAL, and PPD were statistically higher in the CLP group. Gingivitis was observed in 52 percent and 29 percent (P<0.001) and mild periodontitis was observed in 48 percent and 22 percent (P<0.001) of the CLP and control groups, respectively. When the permanent dentition group was evaluated, a greater occurrence of mild periodontitis was observed in the CLP group (P<0.001). The level of A. actinomycetemcomitans (P<0.001), P. gingivalis (P<0.001), and T. forsythia (P<0.001) was statistically higher in the subgingival biofilm of the CLP group. Conclusions: The presence of cleft lip and/or palate negatively affects oral hygiene and levels of periodontopathogens in oral biofilm. In addition, clinical and microbiological results highlight the importance of early assessment of young people with cleft lip and/or palate and the permanent dentition to prevent periodontal disease.

The Usefulness of a Facial Digital Biobank for Ameloblastoma Resection and Fracture Fixation - A Case Report.

Rationale: Ameloblastoma often requires complex facial treatments such as resection and reconstruction, which can be aided using three-dimensional resources towards improved surgical planning, reduction of surgical time, and customization. Patient Concerns: A 51-year-old patient, concerned about submandibular volumetric increase discovered performing imaging exams to install dental implants. Diagnosis and Treatment: Diagnosed with ameloblastoma, he underwent uneventful partial mandibular resection and placement of prebent mandibular reconstruction plate. Four months later, following a motorcycle accident, a deflection of the plate and mandibular fracture was observed. Using the initial prototyping, a new reconstruction plate was customized and surgically placed to reduce the mandibular fracture, with adequate titanium plate adaptation to the remaining bone and maintenance of aesthetic mandibular contour. Outcomes and Take-away Lessons: The current digital dentistry resources, such as computed tomography and intraoral scan, can be recovered and used as a backup of recorded anatomy anytime in future, providing a long-lasting facial digital biobank.

Management of Unicistic Ameloblastoma in a Young Patient: Reducing Social Consequences.

ABSTRACT: Ameloblastoma is an odontogenic tumor of significant clinical relevance, aggressive and locally invasive. Although the posterior region of the mandible is more frequently affected, lesions observed in the maxilla should receive special attention due to the risk of expansion to the nasal, paranasal and orbital structures. This report shows a successful case of a maxillary ameloblastoma treated by combining therapies in a young patient. The treatment strategy adopted to reduce and redefine the lesion dimensions enabled enucleation in a safe way, without destruction of adjacent noble structures. It also allowed complementary approach with peripheral ostectomy and sclerosing agent, efficiently, without evidence of recurrence or complications after 2 years.

In-House Three-Dimensional Printing Workflow for Face Shield During COVID-19 Pandemic.

From the beginning of the year 2020, the world was affected by a coronavirus disease (COVID-19) pandemic, caused by SARS-CoV-2, leading to a shortage of personal protective equipment (PPE) at a global level, and thus generating exposure of health professionals to this extremely contagious virus. Within this context, the present work seeks to present an alternative for the production of face shields "face shields," in which it recommends its production "in house" through 3D printing, in principle initiated by Prusa Research, where we download your project of support of facial protectors, proceeding with printing through the 3D printer Gtmax3D Core H5. The authors produced a face shield in ABS, in a total time of 3 hours and 44 minutes. Thus, the model presented proved to be feasible, at a low cost, adding to the list of possibilities to produce inputs necessary to maintain the fight against this epidemic.

Influence of Parental Exposure to Risk Factors in the Occurrence of Oral Clefts.

STATEMENT OF THE PROBLEM: Non-syndromic cleft lip and palate are the most frequent craniofacial abnormalities in humans. The genetic, environmental and behavioral factors involved in this malformation must be clarified in different parts of the globe in the view of implementing preventive measures. PURPOSE: To analyze the influence of parental exposure to risk factors on the occurrence of oral clefts. MATERIALS AND METHOD: A case-control study was conducted with 150 mothers of oral cleft children paired by the children's gender to 300 mothers of children without congenital anomalies from Mato Grosso, Brazil, for the study of the variables: gender and race/color of the children; parental educational level; age; number of pregnancies; prenatal care; obesity; stress; diabetes; hypertension; use of medications, alcohol and illicit drugs; smoking and exposure to ionizing radiation during the first trimester of pregnancy. The results were analyzed in relation to the chances possibility of each variable for the occurrence of oral cleft through the bivariate and multivariate analysis by applying the model of logistic regression. RESULTS: Passive smoking, obesity, exposure to ionizing radiation and use of antibiotics were associated with the presence of clefts. The use of folic acid and analgesics were identified as preventive factors. The father's low educational level was found as a risk factor, while the black race/color was a preventive factor; nevertheless these variables were not associated in the multivariate analysis. CONCLUSION: The results reinforce the need to follow up the pregnant women, especially in the first trimester of pregnancy, in order to control the identified risk factors. Considering the factors associated with occurrence of oral clefts and those associated with its prevention, it is possible to apply specific health promotion measures during pregnancy, which can result in the reduction of oral clefts' occurrence.

A clinical-based protocol of diagnosis of temporomandibular joint open lock and treatment with arthrocentesis.

PURPOSE: Arthrocentesis of the temporomandibular joint (TMJ) is a minimally invasive surgical procedure that provides good clinical results such as the improvement of jaw movements. It also helps to balance the synovial liquid viscosity and relieve TMJ pain by the washout of inflammatory components from the upper compartment. The purpose of this study is to report a case series of patients submitted to a clinical-based protocol of diagnosis of TMJ joint open lock and treatment with arthrocentesis. MATERIAL AND METHODS: Patients suffering from a recurrent unilateral open lock of the TMJ were submitted to one arthrocentesis of the affected TMJ and all of them reported that the open lock was caused by daily stomatognathic activities. To decide the arthrocentesis as the initial treatment of these patients, the authors followed a rational protocol of diagnosis. RESULTS: Ten patients were included in the present study. No complications occurred during arthrocentesis. Immediately, 1 week, 1 month, and 6 months after arthrocentesis, patients did not suffer from open lock or disc click anymore. They also reported no more pain because it was strictly related to the disc click. CONCLUSIONS: All patients of the present study improved from the open lock and disc click of the affected TMJ for 6 months after arthrocentesis. The clinical-based protocol of diagnosis of TMJ open lock reported in the present study, followed by the treatment with arthrocentesis is a reasonable, low-cost, and safe method to treat patients with the acute open lock.

Ankyloglossia Superior Associated With Moebius Syndrome: A Case Report.

Ankyloglossia superior is an exceedingly rare congenital condition that consists of a connection between the tongue and hard palate. This abnormality is considered part of the ankyloglossia superior syndrome when found with other malformations such as limb deformities, gastrointestinal malformation, and cleft palate. Ankyloglossia superior can also be associated with other known syndromes. We have presented the case of a female infant born with multiple malformations, including partial agenesis of the feet and hands, micrognathia, a lack of expression of the facial muscles, convergent strabismus, mouth opening limitation, and tongue-palate adhesion. The patient's presenting diagnosis was ankyloglossia superior associated with Moebius syndrome. Computed tomography revealed the extent of the ankyloglossia superior and the loss of integrity of the palatal shelf. Surgical release of the ankyloglossia superior was performed with the patient under general anesthesia. Multiple management challenges were encountered postoperatively. To the best of our knowledge, ankyloglossia superior presenting in conjunction with Moebius syndrome had not been formally described in a case report.

The Influence of Vasoconstritor Use in Local Anesthesia in Individuals with Chronic Renal Failure / A Influência do Uso de Vasoconstritor na Anestesia Local em Indivíduos com Insuficiência Renal Crônica

Individuals with chronic renal failure (CRD) undergo hemodialysis to compensate for systemic-based disease and often develop systemic arterial hypertension (SAH). Such individuals, when needing dental treatment, carry with them the consideration of which type of anesthetic to be used in clinical and surgical interventions. The objective of this study was to evaluate the action of anesthetics with vasoconstrictor (AwV) and without vasoconstrictor (AoV) in individuals with chronic renal failure. Research subjects needed dental treatment, with dental restorations, on the right and left lower dental arch in premolars and / or molars, thus receiving the model of a split-mouth clinical study. In a randomized study, each side of the mandible was subjected to an anesthetic infiltration with only one 1.8 mL tube in two different moments with a minimum interval of 7 days (for one moment with AwV and another AoV moment). The parameters of oxygen saturation (SaO2), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured 5 minutes before anesthesia, 5, 15 and 30 minutes after anesthesia. The results found in this study showed statistical difference only in SaO2 in the time of 5 minutes after the anesthesia in comparison of the AwV and AoV group, this same result was obtained when only those individuals who, besides nephropathies, had a diagnosis of SAH, were evaluated. The findings of this study highlight the safety of the use of anesthetics, with or without vasoconstrictors since in small amounts, in individuals with CRF with or without associated SAH. (AU)

Indivíduos com insuficiência renal crônica (IRC) em geral são submetidos à hemodiálise para compensação da doença de base sistêmica e frequentemente desenvolvem a hipertensão arterial sistêmica (HAS). Tais indivíduos, ao necessitarem de tratamento odontológico, levam consigo a ponderação de qual tipo de anestésico a ser utilizado em intervenções clínicas e cirúrgicas. O objetivo deste estudo foi avaliar a ação de anestésicos com vasoconstritor (ACV) e sem vasoconstritor (ASV) em indivíduos com insuficiência renal crônica. Os indivíduos da pesquisa tinham necessidade de tratamento odontológico, com restaurações dentárias, no arco dentário inferior direito e esquerdo em pré-molares e/ou molares, recebendo assim o modelo de estudo clínico de boca dividida. De forma aleatória, os hemiarcos inferiores foram submetidos, em dois diferentes momentos com intervalo mínimo de 7 dias, a infiltração anestésica com apenas um tubete de 1,8 mL (para um momento com ACV e outro momento ASV). Foi feita aferição dos parâmetros de saturação de oxigênio (SaO2), frequência cardíaca (FC), pressão arterial sistólica (PAS) e diastólicas (PAD), 5 minutos antes da anestesia, 5, 15 e 30 minutos após a anestesia. Os resultados encontrados neste estudo demonstraram diferença estatística apenas na SaO2 no tempo de 5 minutos após a anestesia em comparação do grupo ACV e ASV, esse mesmo resultado foi obtido quando avaliados apenas os indivíduos que, além de nefropatas, apresentavam diagnóstico de HAS. Os achados deste estudo ressaltam a segurança do uso de anestésicos, com ou sem vasoconstritores desde que em pequenas quantidades, em indivíduos com IRC com ou sem HAS associada. (AU)

Surgical Treatment of Odontogenic Keratocyst with Application of Carnoy's Solution: Case Report / Tratamento Cirúrgico de Queratocisto Odontogênico com Aplicação de Solução de Carnoy: Relato de Caso

Odontogenic cysts are benign non-neoplastic lesions that originate from epithelial cells Arachnida-Araneae) community in the process of the teeth development. Among them, the odontogenic keratocyst is a developmental cyst characterized by its epithelium of parakeratinized stratified and aggressive squamous cells as well as infiltrative behavior. Thus, the objective of this study was to describe a clinical case of surgical treatment of odontogenic keratocysts in a 52-year-old female patient, who presented for the treatment of a large lesion in a region of the left mandibular body and angle. After incisional biopsy and installation of a decompression device, the histopathological diagnosis of odontogenic keratocyst was obtained. Subsequently to a period of 9 months with the decompression device in place, a decrease of the lesion was noticed, thus allowing intervention to be performed the excision of the lesion. Thus, the patient was subjected, under general anesthesia, to enucleation of the lesion as the main treatment, with complementary maneuvers of peripheral ostectomy and application of Carnoy solution over the remaining bone bed. After an outpatient follow-up of 16 months, no signs of recurrence of the lesion were observed. The proposed treatment was efficient in removing the keratocyst with minimal surgical morbidities. In conclusion, the treatment protocol was effective and conservative in the surgical management of the lesion, allowing rapid recovery and return of the function.(AU).

Cistos odontogênicos são lesões benignas não-neoplásicas que tem por origem células remanescentes epiteliais do processo de formação do órgão dental. Dentre elas, o queratocisto odontogênico é um cisto de desenvolvimento caracterizado por seu epitélio de células escamosas estratificadas paraqueratinizadas, pelo comportamento agressivo e infiltrativo. Sendo assim, o objetivo desse estudo foi descrever um caso clínico de tratamento cirúrgico do queratocisto odontogênico em uma paciente do gênero feminino de 52 anos de idade, que compareceu para o tratamento de uma lesão de grande porte em região de corpo e ângulo mandibulares à esquerda. Após biópsia incisional e instalação de um dispositivo descompressivo, obteve-se o diagnóstico histopatológico de queratocisto odontogênico. Posteriormente a um período de 9 meses com o dispositivo de descompressão em posição, notou-se uma diminuição da lesão, permitindo assim a execução de intervenção para exérese da lesão. Assim, a paciente foi submetida, sob anestesia geral, à enucleação da lesão como tratamento principal, com manobras complementares de ostectomia periférica e aplicação de solução de Carnoy sobre o leito ósseo remanescente. Após um acompanhamento ambulatorial de 16 meses, não foi observado nenhum sinal de recorrência da lesão. O tratamento proposto foi eficiente em remover o queratocisto com as mínimas morbidades cirúrgicas. Concluindo, o protocolo de tratamento foi efetivo e conservador no manejo cirúrgico da lesão, permitindo rápida recuperação e retorno da função. (AU).