Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis.

Orbital floor blowout fractures can result in a variety of signs and symptoms depending on the severity of the bone defect. Large defects often result in enophthalmos and restriction of ocular movement; yet the timing of surgery can be delayed up to two weeks with good functional outcomes. In contrast, an orbital trapdoor defect with entrapment of the inferior rectus muscle usually elicits pain with marked restriction of the upward gaze and activation of the oculocardiac reflex without significant dystopia or enophthalmos. When autonomic cardiac derangement is diagnosed along with an orbital floor fracture, it has been suggested that the fracture should be treated immediately. Otherwise, it will result in continued hemodynamic instability and muscular injury and may require a second surgery. This article reports the management of an unusual presentation of a trapdoor blowout orbital floor fracture surgery with oculocardiac response in an adult, with emphasis on its pathophysiology, management, and differential diagnosis.

Nasal Alar Pressure Ulcer After Orthognathic Surgery: Clinical Presentation and Preventive Recommendations.

Nasotracheal intubation is routinely used in patients undergoing oral and maxillofacial surgery when intermaxillary fixation is needed either intraoperatively or postoperative. Various complications can occur such as epistaxis, turbinectomy, retropharyngeal dissection, tympanites, and nasal alar pressure sores or necrosis, especially when there is a prolonged nasotracheal intubation. The first report of a nasal alar necrosis after prolonged nasotracheal intubation was published by Hatcher et al in 1968. Since then several reports of skin necrosis of the nasal alar region have been published and attributed to a prolonged operation or the technique used in tube placement. Pressure ulcers are a localized damage to the skin and underlying soft tissue and usually appear immediately after the procedure. They start with nonblanchable erythematous intact skin and can evolve to partial thickness loss of skin with exposed dermis and scab formation during the healing process. They may be painful and can cause a cosmetic problem for patients. The literature has several studies of nasal alar necrosis after nasotracheal intubation for head and neck reconstructive surgery, but there is no description of this complication after orthognathic surgery. This paper describes the occurrence of skin nasal alar necrosis following a bimaxillary jaw correction and highlights recommendations for its management and prevention.

Customizable template technique to harvest iliac crest bone graft for reconstructions of mandibular defects. / Técnica de template customizável para remoção de enxerto ósseo de crista ilíaca para reconstruções de defeitos mandibulares.

Bone graft harvesting from the anterior iliac crest is a good option for reconstructing mandibular defects after trauma or other diseases. In order to achieve optimal clinical results in reconstructive surgeries with bone grafts, accurate preoperative planning and prestigious surgical technique are paramount. Therefore, this paper describes the use of a customizable template that is indicated for obtaining free iliac bone block for immediate or late mandibular reconstructions following marginal or segmental defects. The template is based on a piece of malleable metal obtained from an aluminum beverage can. It is used transoperatively to demarcate the bone graft donor site, being especially useful because of the limited access to the inner table of the anterior ilium. The described customizable template has been shown as a useful tool to easily determine the size of the bone block to be harvested from the iliac region, improving surgical time and preventing removal of insufficient bone graft.

A remoção de enxerto da crista ilíaca anterior é uma boa opção para a reconstrução de defeitos mandibulares após ressecções por trauma ou outras doenças. Para obtenção de resultados clínicos de excelência em cirurgias reconstrutivas com enxertos ósseos, um planejamento pré-operatório preciso e uma refinada técnica cirúrgica são essenciais. Portanto, este artigo descreve o uso de um template customizável, que é indicado para obter bloco de osso ilíaco livre para reconstruções mandibulares imediatas ou tardias após defeitos marginais ou segmentares. O template é baseado em um fragmento de metal maleável obtido de uma lata de bebida de alumínio. Ele é utilizado no transoperatório para demarcar o sítio doador do enxerto ósseo e é especialmente útil devido ao acesso limitado à cortical interna da crista ilíaca. O template customizável tem se mostrado uma ferramenta de fácil aplicação para determinar o tamanho do bloco de enxerto a ser coletado da região ilíaca, otimizando o tempo cirúrgico e evitando a remoção insuficiente de enxerto ósseo.

Técnica de template customizável para remoção de enxerto ósseo de crista ilíaca para reconstruções de defeitos mandibulares / Customizable template technique to harvest iliac crest bone graft for reconstructions of mandibular defects

RESUMO A remoção de enxerto da crista ilíaca anterior é uma boa opção para a reconstrução de defeitos mandibulares após ressecções por trauma ou outras doenças. Para obtenção de resultados clínicos de excelência em cirurgias reconstrutivas com enxertos ósseos, um planejamento pré-operatório preciso e uma refinada técnica cirúrgica são essenciais. Portanto, este artigo descreve o uso de um template customizável, que é indicado para obter bloco de osso ilíaco livre para reconstruções mandibulares imediatas ou tardias após defeitos marginais ou segmentares. O template é baseado em um fragmento de metal maleável obtido de uma lata de bebida de alumínio. Ele é utilizado no transoperatório para demarcar o sítio doador do enxerto ósseo e é especialmente útil devido ao acesso limitado à cortical interna da crista ilíaca. O template customizável tem se mostrado uma ferramenta de fácil aplicação para determinar o tamanho do bloco de enxerto a ser coletado da região ilíaca, otimizando o tempo cirúrgico e evitando a remoção insuficiente de enxerto ósseo.

ABSTRACT Bone graft harvesting from the anterior iliac crest is a good option for reconstructing mandibular defects after trauma or other diseases. In order to achieve optimal clinical results in reconstructive surgeries with bone grafts, accurate preoperative planning and prestigious surgical technique are paramount. Therefore, this paper describes the use of a customizable template that is indicated for obtaining free iliac bone block for immediate or late mandibular reconstructions following marginal or segmental defects. The template is based on a piece of malleable metal obtained from an aluminum beverage can. It is used transoperatively to demarcate the bone graft donor site, being especially useful because of the limited access to the inner table of the anterior ilium. The described customizable template has been shown as a useful tool to easily determine the size of the bone block to be harvested from the iliac region, improving surgical time and preventing removal of insufficient bone graft.

Oral manifestations of Langerhans cell histiocytosis: A case series.

AIM: Langerhans cell histiocytosis (LCH) is an unusual proliferative disorder of bone marrow-derived histiocytes (Langerhans cells) that can produce focal or systemic manifestations. Oral manifestations of LCH can present as single or multiple lesions and can be a challenge in clinical practice. The aim of this paper is to present the clinicopathological features of a series of nine patients with oral involvement. METHODS AND RESULTS: The patient's age ranged from 2 to 63 years being five males and four females. The most common oral site involvement was the hard-palate mucosa. Ulceration was the main clinical feature. Only two patients showed clearly jawbone involvement. In eight out of nine patients, the diagnosis of LCH was established because of the oral manifestations. CONCLUSION: The recognition of the clinical features of LCH oral manifestation is important to avoid misdiagnosis and to the establishment of the correct treatment. Thus, dentists can play a vital role in the diagnosis of LCH since oral lesions may be the earliest manifestation and sometimes the only sign of the disease. Furthermore, oral lesions may be the early signs of disease reactivation or a multisystem disease indication.

Brown tumor: clinical findings of secondary hyperparathyroidism in patients with renal osteodystrophy.

A brown tumor, or osteoclastoma, is a nonneoplastic bony lesion associated with hyperparathyroidism and directly related to increased levels of parathyroid hormone. These tumors result from excessive osteoclastic activity. This article presents 3 cases of brown tumor localized in facial bones. The lesions were the result of secondary hyperparathyroidism associated with chronic renal failure. The patients were two 42-year-old men and a 39-year-old woman. All patients had been treated systemically by hemodialysis for more than 10 years. This article highlights the importance of proper diagnosis and management of dental patients presenting with a brown tumor.

Traumatic ulcerative granuloma with stromal eosinophilia of the palate showing an angiocentric/angiodestructive growth pattern.

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a benign, self-limiting lesion of the oral mucosa with unknown pathogenesis. A 65-year-old male patient presented with an ulcerative palate lesion, which on microscopic examination exhibited an exuberant polymorphic lymphoid proliferation, numerous eosinophils, and extensive vascular destruction. The atypical lymphoid cells infiltrating the medium-sized vessels showed positivity for CD3, CD30, and granzyme B, implicating an activated cytotoxic T-cell phenotype. The lesion diagnosed as TUGSE achieved complete resolution within 3 months. This unusual presentation has expanded the spectrum of oral CD30+ T-cell atypical infiltrates and must be distinguished from lymphomas showing angiocentric/angiodestructive growth pattern.

An evaluation of patients' knowledge about perioperative information for third molar removal.

PURPOSE: Third molar removal is usually accompanied by a high degree of patient anxiety. Lack of knowledge about the procedure is a major contributor to this anxiety. The aim of this study was to investigate the perioperative perceptions of patients who underwent extraction of third molars to assess their concerns during the surgical experience. MATERIALS AND METHODS: Issues related to preoperative, intraoperative, and postoperative phases of the experience were assessed with the purpose of identifying the most frequent questions and misconceptions. Data were assessed to correlate the influence of previous experience with extraction(s) with the appropriate knowledge of third molar surgery, as well as knowledge variations as to the age and gender of the patients. RESULTS: The sample was composed of 67 patients (43 female patients and 24 male patients) divided into 2 groups: The first had some previous experience with extractions (25 patients), and the second had no experience (42 patients). The most frequent questions regarded the number of teeth to be extracted (65.4%), and the most prevalent misconception was about medications before surgery (28.4%). Patients with a previous history of dental extractions had more questions about use of medication before surgery (P = .03). Patients without previous experience with extraction had more concerns about anesthesia techniques (P = .02) or the number of teeth that would be removed during the same procedure (P = .02). Other questions and misconceptions were not different between these groups. CONCLUSIONS: Patients with a history of tooth extraction and those without it presented different patterns of knowledge about third molar surgery. Both groups of patients needed detailed perioperative instructions about the procedure. These results may provide oral and maxillofacial surgeons with useful information about patients' knowledge throughout the surgical process.

An in vitro evaluation of rigid internal fixation techniques for sagittal split ramus osteotomies: setback surgery.

PURPOSE: The aim of this study was to evaluate the biomechanical features of 3 different methods of rigid internal fixation for sagittal split ramus osteotomy for mandibular setback in vitro. MATERIALS AND METHODS: Sixty polyurethane replicas of human hemimandibles were used as substrates, simulating a 5-mm setback surgery by sagittal split ramus osteotomy. These replicas served to reproduce 3 different techniques of fixation, including 1) a 4-hole plate and 4 monocortical screws (miniplate group), 2) a 4-hole plate and 4 monocortical screws with 1 additional bicortical positional screw (hybrid group), and 3) 3 bicortical positional screws in a traditional inverted-L pattern (inverted-L group). After fixation, hemimandibles were adapted to a test support and subjected to lateral torsional forces on the buccal molar surface and vertical cantilever loading on the incisal edge with an Instron 4411 mechanical testing unit. Peak loadings at 1, 3, 5, and 10 mm of displacement were recorded. Means and standard deviation were analyzed using analysis of variance and Tukey test with a 5% level of significance, and failures during tests were recorded. RESULTS: Regardless of the amount of displacement and direction of force, the miniplate group always showed the lowest load peak scores (P < .01) compared with the other fixation techniques. The hybrid group demonstrated behavior similar to the inverted-L group in lateral and vertical forces at any loading displacement (P > .05). Molar load tests required more force than incisal load tests to promote the same displacement in the mandibular setback model (P < .05). CONCLUSION: For mandibular setback surgery of 5 mm, this study concluded that the fixation technique based on the miniplate group was significantly less rigid than the fixation observed in the hybrid and inverted-L groups. Mechanically, adding 1 bicortical positional screw in the retromolar region in the miniplate technique may achieve the same stabilization offered by inverted-L fixation for mandibular sagittal split ramus osteotomy setback surgery in vitro.

Familial case of oral white sponge nevus--a rare hereditary condition.

White sponge nevus (WSN) is an autosomal dominant skin disorder characterized by white, corrugated and diffuse plaques mainly affecting the oral mucosa. The condition has a high penetrance and variable expressivity, but familial reports are uncommon. This report presents a familial case of WSN in which two sisters are affected by the disorder.

Diagnosis and management of Bell's palsy.

Bell's palsy (BP) is an idiopathic peripheral facial nerve paralysis of sudden onset. Its most alarming symptom is unilateral facial weakness, which can result in the inability to close the eyelids, smile, or whistle. The pathogenesis of BP is controversial and is believed to be caused by inflammation of the facial nerve at the geniculate ganglion. Many viruses, especially herpes simplex and herpes zoster, have been suggested as initiators of this inflammatory process; however, this has not been proven. This report describes the case of a 14-year-old girl with right hemifacial palsy who sought treatment one month after the onset of palsy. The patient experienced a satisfactory recovery within 30 days of treatment and has maintained a stable physical outcome after 15 months of follow-up. Early treatment based on careful investigation of BP, with particular attention given to the differential diagnosis of BP, can improve the patient's function and esthetics.

Caso familiar de nevo branco esponjoso oral: uma rara condição hereditária / Familial case of oral white sponge nevus: a rare hereditary condition

O nevo branco esponjoso é uma desordem autossômica dominante, caracterizada por placas brancas difusas, rugosas, que afetam principalmente a mucosa bucal. A condição tem um alto grau de penetrância e expressividade variada, embora os relatos familiais sejam incomuns. Este artigo relata um caso familiar de nevo branco esponjoso em que duas irmãs são afetadas por esta condição.

White sponge nevus (WSN) is an autosomal dominant skin disorder characterized by white, corrugated and diffuse plaques mainly affecting the oral mucosa. The condition has a high penetrance and variable expressivity, but familial reports are uncommon. This report presents a familial case of WSN in which two sisters are affected by the disorder.

Pigmented villonodular synovitis of the temporomandibular joint: case report and review of the literature.

Pigmented villonodular synovitis (PVNS) is an aggressive proliferative lesion that usually involves the synovial tissues of big joints. To date, there are ∼52 cases of PVNS affecting the temporomandibular joint reported in the English-language literature, about one-third of them exhibiting intracranial involvement. We herein describe an additional case of PVNS of the temporomandibular joint with skull base invasion affecting a 26-year-old male patient and discuss its clinicopathologic features considering previously published cases. Histopathology and imaging evaluation are important for the diagnosis of PVNS, which should be included in the differential diagnosis of preauricular aggressive swellings.

Avaliação de traumatismos faciais por acidentes motociclísticos em Aracaju/SE / Evaluation of facial injuries from motorcycle accidents in Aracaju/SE

Diversos fatores podem estar relacionados à etiologia dos acidentes motociclísticos, destacando-se as características sócio-culturais da população estudada. Assim, foi desenvolvida uma pesquisa prospectiva, transversal e observacional com a finalidade de analisar estes traumatismos no Hospital de Urgência de Sergipe (HUSE), no período de 2008 a 2009. O estudo incluiu 145 pacientes, investigando-se dados pessoais, etiologia do acidente e regiões faciais e corporais acometidas. Houve prevalência de acidentados do gênero masculino (87,6 por cento), da cor parda (71,7 por cento) e na faixa etária de 21 a 30 anos (46,2 por cento). O maior número de acidentes ocorreu à noite e com o tempo seco (73,1 por cento) devido a desequilíbrio (78,6 por cento). Dentre as lesões de tecido mole, houve uma predominância da laceração (72,4 por cento). Os traumas dento-alveolares foram observados em 16,6 por cento dos pacientes e as fraturas, em 25,5 por cento dos acidentados. Foi observado que um grande número de pacientes não utilizava capacete, estava alcoolizado e sem habilitação específica para pilotar motocicleta. Isso evidencia a necessidade de uma maior atenção à educação dos condutores, melhor fiscalização e aplicação das leis de trânsito aos motociclistas e maior exposição pública das consequências desses acidentes, visando à redução da quantidade e intensidade de lesões corporais decorrentes desse meio de transporte.

Several factors may be related to the etiology of motorcycle accidents, especially the socio-cultural characteristics of the population studied. Thus, a prospective, cross-sectional and observational study was conducted in order to analyze injuries from motorcycle accidents in the Hospital de Urgência de Sergipe (HUSE) in the years 2008 and 2009. The study comprised 145 patients, information being collected on personal data, cause of accident and facial and other body regions affected. There was a prevalence of males (87.6 percent), dark-skinned individuals (71.7 percent) and ages ranging from 21 to 30 years (46.2 percent). The majority of accidents occurred at night in dry weather (73.1 percent), due to loss of balance (78.6 percent). Among the injuries of soft tissue, there was a predominance of lacerations (72.4 percent). Dento-alveolar injuries were observed in 16.6 percent of the patients and fractures in 25.5 percent of the injured patients. It was observed that a large number of patients had not been wearing a helmet, were drunk and without a license for riding a motorcycle. These data highlight the need for greater attention to the education of riders, better monitoring and enforcement of traffic laws and greater public exposure of the consequences of accidents in order to reduce the quantity and severity of injuries resulting from this means of transport.

Prevalência de lesões bucais cancerosas e cancerizáveis em pacientes ambulatoriais atendidos no FBHC de 2006 a 2007 / Prevalence of oral precancerous and cancerous lesions in outpatients assited at FBHC from 2006 to 2007

O propósito deste trabalho foi o de estudar retrospectivamente os prontuários de pacientes assistidos no serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial Dr. João de Andrade Garcez da Fundação de Beneficência Hospital de Cirurgia, em Aracajú - SE, no período de junho de 2006 a junho de 2007, visando identificar a prevalência de lesões cancerizáveis, além de visualizar a correlação com os fatores de risco do câncer nesta população. De um total de trezentos e noventa e quatro prontuários incluídos na pesquisa, a proporção de homem mulher foi de 1:1. Destes, 9 homens e 2 mulheres apresentaram diagnóstico de câncer de boca. A lesão neoplásica mais frequente foi o carcinoma de células escamosas (9 casos). Além destes, foram identificados um paciente portador de melanoma bucal e um paciente portador de um adenocarcinoma metastático de origem prostática. A frequência de lesôes consideradas cancerizáveis foi de 7 registros de casos de leucoplasia, 2 de líquem plano, 4 de queilite actínica e 2 de hiperplasia por prótese mal-adaptada. Em relação aos fatores de risco presentes, o tabagismo apareceu em 81,8% dos casos, e o alcoolismo estava presente em 63,6% dos casos totais de neoplasia. Desta forma, este estudo visou contribuir para a avaliação do risco de câncer no estado de Sergipe, sugerindo o desenvolvimento de políticas de saúde adequadas para cada região do Brasil, a fim de controlar esta doença, já que os costumes e a exposição aos fatores de risco variam de um lugar para o outro.

The use of natural products in dentistry is a viable and effective alternative in preventing and fighting the incidence of mouth cancer as increased considerably and, still today, is a problem of public health around the world. The purpose of this study was to study retrospectively dental charts of patients attended at the Division of Oral and Maxillofacial Surgery, Dr. João de Andrade Garcez, in Aracajú, from June de 2006 to june of 2007, aiming to identify the prevalence of cancerous and precancerous lesions, beyond to correlate the risk factors of cancer in this population. From a total of there hundred and ninet four dental files assessed, it was observed that the ratio man: woman was 1:1. Of these, 9 men and 2 women had presented diagnosis of mouth's cancer. The most frequent cancerous lesion was the scamous cell carcinoma (9 patients). Beyond these, it was found one patient of buccal melanoma and one patient of a metastatic adenocarcinoma of prostate origin. Of these, the frequency of injuries was considered cancerizáveis records of 7 cases of leukoplakia, lichen planus of 2,4 and 2 actinic cheilitis of hyperplasia by mal-adjusted prosthesis. According to the risk factors, smoking appeared in 81,8% of the cases, and alcoholism was present in 63,6% of the total cases of cancer. In such a way, this study aimed to cooperate for the evaluation of risk cancer in the State of Sergipe, being suggested the development of politics of public health for each region of Brazil, in order to control this illness, after all, the culture and exposition to the risk factors vary from one place to another.

Myofibroma of the oral cavity. A rare spindle cell neoplasm.

Myofibroma is an uncommon spindle cell neoplasm rarely found in oral cavity. Typically, this lesion is seen in neonates and infants with few cases reported in adults patients. In the oral cavity, myofibroma occurs within the submucosal or intramuscular tissue and has a predilection by the tongue, buccal mucosa and lips. Microscopically, a typical biphasic pattern can be observed. Misdiagnosis included benign and malignant spindle cell lesions of nerve tissue or smooth muscle origin, such as neurofibroma, leiomyoma and sarcomas. Thus, immunohistochemical staining is a useful tool to identify the nature of neoplastic cells and to reach an accurate diagnosis. An immunohistochemical panel consisting of antibodies to vimentin, SMA, HHF-35, S-100p and desmin must be achieved. In most cases, positivity for vimentin, SMA and HHF-25 can be observed. Our report describes a solitary myofibroma of the tongue of a 23-year-old man with emphasis in clinical, histopathological and immunohistochemical features of this lesion.