Surgical planning in idiopathic scoliosis: app usability and utility / Planejamento cirúrgico na escoliose idiopática: usabilidade e utilidade de app / Planificación quirúrgica en escoliosis idiopática: usabilidad y utilidad del app

ABSTRACT: Objective: To evaluate the usability and usefulness of an application developed for surgical planning of scoliosis correction to measure the time spent on planning. Methods: Experimental, controlled, cross-sectional, and applied study. The application underwent a usability test using the SUS questionnaire, in addition to applying a questionnaire to assess its usefulness using the TAM utility perception model. Thirty-six volunteers were divided into three groups: residents, orthopedists from the Brazilian Society of Orthopedics and Traumatology (SBOT), and spine surgeons. Results: By applying the SUS questionnaire, the application obtained a score of 75.69, representing classification C on the Sauro and Lewis scale, the third best. The application's utility was considered good after evaluating the positive responses of the TAM model. On average, planning through the application was 20% faster than manual planning. Conclusion: The Scoliplan application proved useful and optimizes surgical planning in AIS, as it establishes a step-by-step standardization supported by the literature (Suk classification); it helps the user with uniform and reliable planning. Level of Evidence III; Diagnostic Studies.

RESUMO: Objetivo: Avaliar a usabilidade e utilidade de um aplicativo desenvolvido para planejamento cirúrgico de correção de escoliose, mensurar o tempo dispendido para o planejamento. Métodos: Estudo do tipo experimental, controlado, transversal e aplicado. O aplicativo foi submetido ao teste de usabilidade através do questionário SUS, além da aplicação de questionário para avaliar a utilidade deste pelo modelo de percepção de utilidade TAM. Participaram 36 voluntários que foram divididos em 3 grupos: residentes, ortopedistas da Sociedade Brasileira de Ortopedia e Traumatologia (SBOT) e cirurgiões de coluna. Resultados: Pela aplicação do questionário SUS, o aplicativo obteve escore de 75,69, valor que representa classificação C na escala de Sauro e Lewis, a terceira melhor. A utilidade do aplicativo foi considerada boa após avaliação das respostas positivas do modelo TAM. O planejamento através do aplicativo foi em média 20% mais rápido que o planejamento manual. Conclusão: o aplicativo Scoliplan mostrou-se útil e vem otimizar o planejamento cirúrgico em EIA, à medida que estabelece uma padronização de um passo a passo, apoiado na literatura (classificação de Suk), auxilia o usuário para um planejamento uniforme e confiável. Nível de Evidência III; Estudos Diagnósticos.

RESUMEN: Objetivo: Evaluar la usabilidad y utilidad de una aplicación desarrollada para la planificación quirúrgica de corrección de escoliosis, medir el tiempo empleado en la planificación. Métodos: Estudio experimental, controlado, transversal y aplicado. La aplicación se sometió a una prueba de usabilidad mediante el cuestionario SUS, además de aplicar un cuestionario para evaluar su utilidad mediante el modelo de percepción de utilidad TAM. 36 voluntarios fueron divididos en 3 grupos: residentes, ortopedistas de la Sociedad Brasileña de Ortopedia y Traumatología (SBOT) y cirujanos de columna. Resultados: Al aplicar el cuestionario SUS, la aplicación obtuvo un puntaje de 75,69, valor que representa la clasificación C en la escala de Sauro y Lewis, la tercera mejor. La utilidad de la aplicación se consideró buena tras evaluar las respuestas positivas del modelo TAM. La planificación a través de la aplicación fue en promedio un 20 % más rápida que la planificación manual. Conclusión: la aplicación Scoliplan demostró ser útil y viene a optimizar la planificación quirúrgica en AIS, ya que establece una estandarización paso a paso, respaldada por la literatura (clasificación de Suk), ayuda al usuario para una planificación uniforme y confiable. Nivel de Evidencia III; Estudios de Diagnósticos.

Photobiomodulation to Treat Necrotizing Fasciitis.

ABSTRACT: The spread of odontogenic infections associated with comorbidities, such as diabetes mellitus, can result in a potentially lethal complication, with rapid necrosis of the superficial fascia, necrotizing fasciitis. In this case report, a female patient, 52 years old, fasting blood glucose of 303 mg/dL with necrotizing fasciitis associated with type 2 diabetes mellitus in the left cervical-thoracic region. She was treated with antibiotics, cervicotomy, abscess drainage, and underwent 10 photobiomodulation sessions with 2 weekly applications of the red wavelength laser to correct tissue loss in the left cervical region. With the development of tissue healing, the formation of granulation tissue increased, absence of necrotic areas, contraction of the edges, and total wound repair. This case emphasizes the effectiveness of photobiomodulation to optimize healing and modulate the inflammatory pattern in the treatment of necrotizing fasciitis sequelae.

Early Reconstruction of Gunshot Mandible Fracture: A Modified Approach.

The management of victims of gunshot fractures is a challenge for surgeons, mainly due to the complexity of the injury itself and degree of bone comminution. The titanium functionally dynamic bridging plate has often been used in reconstructive surgery after mandibular fractures. The classic indication for bridge plate use is comminuted fractures with or without associated substance losses. The aim of this article is report the case of gunshot victim and to discuss the bridge plate technique utilized for treatment. A 21 years-old, melanoderma, male patient was victim of a firearm-related assault, with comminutive fracture of the mandibular body. The protocol for the bridging plate technique was performed. The patient is in postoperative follow-up of eight months, not present aesthetic or functional complaints, stable occlusion, satisfactory mouth opening and no clinical signs of infection.

Technique of the Buccal Fat Pad Flap as an Alternative for the Surgical Defect of Pleomorphic Adenoma.

Pleomorphic adenoma (PA) is the most common benign salivary gland neoplasm, and its malignant transformation rarely occurs. Diagnosis is based on clinical features of local or regional malignancy or distant metastasis, and histological identification of invasion and cellular atypia. Buccal fat pad, also called Bichat fat pad, is an excellent option to create tissue coverage over surgically treated areas, providing great blood supply. Thus, this study aims to report a surgical treatment of a patient who reported to the Oral and Maxillofacial Surgery and Traumatology service of a hospital in the city of Fortaleza, presenting a large lesion in the right side of the palate. Clinical examination revealed a nodular volume increase with smooth surface, sessile insertion, firm to palpation and coloration similar to the mucosa, no pain complaints, and 2 years of evolution. Orthopantomographic examination did not reveal alterations in the adjacent anatomical structures. After clinical and radiographic evaluation, an incisional biopsy was performed and histopathological diagnosis was PA. Patient was submitted to surgery for tumor excision with narrow surgical margins, including oral lining mucosa to reduce recurrence chances. In the same surgical act, after the excision of the lesion, the right buccal fat pad pedicle flap was sutured onto the residual mucosa in order to act as a framework for re-epithelialization of the palatal mucosa, phenomenon of metaplasia, and reduction of patient's morbidity. Surgical piece obtained was sent to anatomopathological study, confirming initial diagnosis. After 12-month follow-up, patient is esthetically and functionally rehabilitated, and satisfied with clinical and surgical plans executed.

Planning a total knee arthroplasty through an application for mobile devices: case report.

For decades, the main cause of failure in total knee arthroplasty (TKA) is still the malalignment of prosthetic components. The authors present a case of advanced knee arthrosis, treated by TKA. Preoperative planning was performed with a mobile application and the patient was submitted to primary TKA using an implant developed with inspiration from the theory of "modified GAP" with a rotated tibial tray. Neutral mechanical alignment of the lower limbs was obtained and the application proved to be viable regarding its proposed plan for this case.

Ao longo das décadas, a principal causa de insucesso em artroplastias totais do joelho (ATJ) continua a ser o mau alinhamento dos componentes protéticos. Os autores apresentam um caso de artrose avançada do joelho tratado por ATJ. O planejamento pré-operatório foi feito a partir de um aplicativo para dispositivos móveis e a paciente foi submetida à ATJ primária, com um implante desenvolvido com inspiração na teoria do "GAP modificado", com base tibial rotatória. O alinhamento mecânico neutro dos membros inferiores foi obtido e o aplicativo mostrou-se viável em sua proposta de planejamento para este caso.

Condyle Fractures: Impact of Surgical and Conservative Approaches on Oral Health.

The aim of this study is to assess the impact of oral health on the quality of life of patients who underwent conservative or surgical treatment for mandibular condylar fracture. A retrospective study was conducted, and 24 patients with condylar fracture were selected and underwent surgical or conservative treatment. Oral Health Impact Profile-14 (OHIP-14) was utilized to evaluate the patients. The angles of condylar fracture were measured in panoramic and Towne radiographs using the ImageJ software, and the results were compared to the results of the OHIP-14 questionnaire. Condylar fractures had a negative impact on the patients' quality of life in pretreatment assessment. After conservative and surgical treatments, the condylar fracture had a low impact on the patients' quality of life. Greater fracture alignment was obtained in patients treated by open reduction. A low level of correlation was observed between fracture alignment and changes in OHIP-14 of the patients studied. In conclusion, the study showed a significant improvement in the quality of life in the post-treatment period of the sample assessed. However, in patients selected for this study, no difference was found in the quality of life between the surgically and conservatively treated groups.

Evaluation of benefits and accuracy of a mobile application in planning total knee arthroplasties.

OBJECTIVE: To evaluate the usefulness of an application when planning total knee arthroplasties (TKA), besides the accuracy when measuring the anatomical-mechanical femoral angle (AMFA), comparing, also, the time spent during planning a TKA manually and by using the application. METHODS: An interdisciplinary team involving health and computer science areas established activities in order to develop the application. After development, 24 physicians underwent an application usability test. Each one planned a primary total knee arthroplasty (TKA) initially, in a conventional manner and then by using the application. Data concerning AMFA measurement and time spent during planning were collected, in both manners. The Mann-Whitney and Wilcoxon tests were used to evaluate statistical significance related to angle and time. RESULTS: Users considered it important checking AMFA and drawing the bone cut lines orthogonal to the mechanical axis, when planning TKAs. They also assessed that the application could be useful for training surgeons and for specialists. There was no statistically significant difference between the AMFA, as measured by the application and by the conventional manner. The planning time was shorter when the application was used (39% of the time spent manually). CONCLUSIONS: The application has proved to be useful in planning TKAs and has revealed accuracy when measuring the AMFA when it was compared to the manual form of preoperative planning. The application was able to reduce planning time by more than half and it demonstrated reliability in measuring the AMFA.

OBJETIVO: Avaliar a utilidade de aplicativo no planejamento de artroplastias totais do joelho (ATJ), além da acurácia em relação à aferição do ângulo anatômico-mecânico femoral (AAMF), e comparar o tempo dispendido no planejamento de ATJ através da forma manual e do aplicativo. MÉTODOS: Uma equipe interdisciplinar das áreas de saúde e ciências da computação estabeleceu um fluxo de atividades, a fim de desenvolver um aplicativo. Após desenvolvido, 24 médicos participaram de um teste de utilidade desse. Cada usuário planejou uma cirurgia de ATJ, inicialmente, de forma convencional e, posteriormente, através do aplicativo. Foram coletados dados de aferição do AAMF e do tempo dispendido durante o planejamento entre as duas formas. Os testes de Mann­Whitney e Wilcoxon foram usados para avaliar a significância estatística entre os resultados de medição de ângulo e tempo. RESULTADOS: Os usuários julgaram importantes a aferição do AAMF e o traçado de linhas de corte ósseo ortogonais aos eixos mecânicos, no âmbito do planejamento de ATJ. Também avaliaram que o aplicativo poderia ser útil para cirurgiões em formação e especialistas. Não houve diferença estatisticamente significante entre o AAMF aferido através do aplicativo e da forma convencional. O tempo de planejamento foi menor quando o aplicativo foi usado (39% do tempo gasto pela forma manual). CONCLUSÕES: O aplicativo evidenciou-se útil no contexto de planejamento de ATJ, mostrou-se acurado quanto à medição do AAMF. Foi capaz de diminuir em mais da metade o tempo de planejamento, mostrou-se, mesmo assim, confiável quanto à medição do AAMF.

Comparative Evaluation of Cell Viability Immediately After Osteotomy for Implants With Drills and Piezosurgery: Immunohistochemistry Analysis.

OBJECTIVE: To evaluate the effect of reusing drills and piezosurgery tips during implant osteotomy on immediate bone cell viability through immunohistochemical analysis. MATERIALS AND METHODS: Six male rabbits were divided into 2 groups and then divided into 5 subgroups-correspond to drills and tips used 10, 20, 30, 40, and 50 times, respectively. All animals received 10 osteotomies in each tibia, by use of the classic drilling procedure in one group (G1) and the piezosurgery device in the other group (G2). For immunohistochemical technique were utilized the osteoprotegerin, RANKL, osteocalcin, and caspase 3. Control procedures were performed by omitting the primary antibodies (negative control). RESULTS: Bone formation and resorption responses presented in more intense way during the piezosurgery. The expression of osteocalcin had become quite intense in piezosurgery groups, but with reduced immunostaining from the 30th osteotomy. The caspase 3 showed the viability of the osteoblast from the 20th osteotomy with piezosurgery and remained constant until the 50th. CONCLUSION: Piezosurgery provides greater osteoblastic cell viability than the system of conventional drilling. CLINICAL RELEVANCE: This study will provide data so that the authors can recycle the drills and tips for implant placement, thus enabling a better cell viability for osseointegration.

Evaluation of benefits and accuracy of a mobile application in planning total knee arthroplasties / Avaliação de utilidade e acurácia de aplicativo móvel no planejamento de artroplastias totais do joelho

ABSTRACT Objective: To evaluate the usefulness of an application when planning total knee arthroplasties (TKA), besides the accuracy when measuring the anatomical-mechanical femoral angle (AMFA), comparing, also, the time spent during planning a TKA manually and by using the application. Methods: An interdisciplinary team involving health and computer science areas established activities in order to develop the application. After development, 24 physicians underwent an application usability test. Each one planned a primary total knee arthroplasty (TKA) initially, in a conventional manner and then by using the application. Data concerning AMFA measurement and time spent during planning were collected, in both manners. The Mann-Whitney and Wilcoxon tests were used to evaluate statistical significance related to angle and time. Results: Users considered it important checking AMFA and drawing the bone cut lines orthogonal to the mechanical axis, when planning TKAs. They also assessed that the application could be useful for training surgeons and for specialists. There was no statistically significant difference between the AMFA, as measured by the application and by the conventional manner. The planning time was shorter when the application was used (39% of the time spent manually). Conclusions: The application has proved to be useful in planning TKAs and has revealed accuracy when measuring the AMFA when it was compared to the manual form of preoperative planning. The application was able to reduce planning time by more than half and it demonstrated reliability in measuring the AMFA.

RESUMO Objetivo: Avaliar a utilidade de aplicativo no planejamento de artroplastias totais do joelho (ATJ), além da acurácia em relação à aferição do ângulo anatômico-mecânico femoral (AAMF), e comparar o tempo dispendido no planejamento de ATJ através da forma manual e do aplicativo. Métodos: Uma equipe interdisciplinar das áreas de saúde e ciências da computação estabeleceu um fluxo de atividades, a fim de desenvolver um aplicativo. Após desenvolvido, 24 médicos participaram de um teste de utilidade desse. Cada usuário planejou uma cirurgia de ATJ, inicialmente, de forma convencional e, posteriormente, através do aplicativo. Foram coletados dados de aferição do AAMF e do tempo dispendido durante o planejamento entre as duas formas. Os testes de Mann-Whitney e Wilcoxon foram usados para avaliar a significância estatística entre os resultados de medição de ângulo e tempo. Resultados: Os usuários julgaram importantes a aferição do AAMF e o traçado de linhas de corte ósseo ortogonais aos eixos mecânicos, no âmbito do planejamento de ATJ. Também avaliaram que o aplicativo poderia ser útil para cirurgiões em formação e especialistas. Não houve diferença estatisticamente significante entre o AAMF aferido através do aplicativo e da forma convencional. O tempo de planejamento foi menor quando o aplicativo foi usado (39% do tempo gasto pela forma manual). Conclusões: O aplicativo evidenciou-se útil no contexto de planejamento de ATJ, mostrou-se acurado quanto à medição do AAMF. Foi capaz de diminuir em mais da metade o tempo de planejamento, mostrou-se, mesmo assim, confiável quanto à medição do AAMF.

Epidemiologia dos traumatismos de face em pacientes jovens no Estado do Ceará / Epidemiology of facial trauma in young patients in the State of Ceará

Objetivo: O objetivo deste trabalho foi analisar a prevalência de fraturas de ossos da face de crianças e adolescentes atendidas no Hospital Instituto Dr. José Frota, em Fortaleza- CE. Metodologia: Foi realizada a análise de prontuários dos pacientes internados no Instituto Dr. José Frota no período de janeiro de 2010 a dezembro de 2012, sendo avaliada a prevalência de fraturas de ossos da face quanto ao gênero, faixa etária, procedência, etiologia, tipo de tratamento e tempo médio de internação hospitalar. Resultados: Foram avaliados 119 prontuários. O gênero masculino foi acometido em 93 casos. Sessenta e seis pacientes foram provenientes de Fortaleza. A média de internação foi de 4,5 dias. O acidente motociclístico foi observado em 34 casos. Os ossos mais fraturados foram os ossos próprios do nariz seguidos das fraturas mandibulares. A redução incruenta foi realizada em65 casos e a redução cruenta em 44 casos. Conclusão: De acordo com a análise dos resultados foi possível concluir que os jovens com fraturas maxilofaciais têm sido tratados com técnicas menos invasivas, diminuindo desta forma o tempo de internação, com alto índice de sucesso e menores gastos hospitalares... (AU)

Objective: The aim of this study was to analyze the prevalence of fractures of the facial bones in children and adolescents treated at the Institute Dr. José Frota, Fortaleza - CE. Methodology: The analysis of medical records of patients admitted to the Institute Dr. José Frota from January 2010 to December 2012 was performed. Being assessed the prevalence of fractures of the facial bones as gender, age, origin, etiology, type of treatment, mean length of hospital stay.Results: 119 charts were evaluated. The male was involved in 93 cases. Sixty-six patients were from Fortaleza. The mean hospital stay was 4.5 days. The motorcycle accident was observed in 34 cases. Most broken bones were the very bones of the nose followed by mandibular fractures. A closed reduction was performed in 65 cases and open reduction in 44 cases. Conclusion: According tothe analysisof the resultsit was concludedthat young people withmaxillofacialfractureshavebeentreated withless invasive techniques, thereby decreasingthe length of stay, witha high success rateand lowerhospital costs... (AU)

Comparative study of the healing process when using Vicryl®, Vicryl Rapid®, Vicryl Plus®, and Monocryl® sutures in the rat dermal tissue.

INTRODUCTION: Various types of sutures are available in the market with different constitutions. However, there is a lack of research to assess and quantify the behavior of these materials. RESOURCES AND MATERIALS: This study comes benchmark wires polyglactin 910 (Vicryl®), irradiated polyglactin 910 (Vicryl Rapid®), polyglactin 910 treated with triclosan (Vicryl Plus®), and poliglecaprone 25 (Monocryl®). For this, we used 40 rats that were divided into two groups, underwent two skin incisions longitudinal 2-cm long. In Group A, simple interrupted sutures using irradiated polyglactin 910 on the right and left side of polyglactin 910, and in group B, polyglactin 910 with triclosan on the right and the left poliglecaprone 25 were made. At 2, 7, 14, and 28 days after surgery, the ten animals were killed per period, and the samples were processed for histomorphologic and histometric analysis. CONCLUSIONS: The results demonstrated that the wire poliglecaprone 25 showed better biological response, with less inflammatory infiltrates and rapid organization of connective tissue.

Tracionamento ortodôntico-cirúrgico para caninos superiores impactados: revisão crítica e sugestão de protocolo / Surgical-orthodontic traction for impacted maxillary canines: a critical review and suggested protocolc

Maxillary canine impaction is a common occurrence, especially in the palate, despite sufficient space in the arch for tooth alignment. A proper approach requires knowledge of different specialties of dentistry, such as orthodontics, surgery, radiology, and periodontology, which are generally not centered on a single professional. The causes for canine impaction may be either generalized or localized, and the diagnosis should be made through specific clinical and radiographic examination. The prognosis of surgical–orthodontic treatment depends on the position of the canine in relation to the neighboring teeth and height of the alveolar process, in addition to careful surgical technique, considering that there are risks involved, such as ankylosis, loss of tooth vitality, root resorption of the involved tooth and adjacent teeth, and damage to supporting tissues. Given the important role played by impacted maxillary canines, their traction is the treatment of choice in orthodontically treated patients. The present study reviews the literature on important factors to be considered when approaching impacted canines, such as therapeutic possibilities, their advantages and disadvantages.

A impactação de caninos superiores é uma ocorrência freqüente, especialmente na região palatina, ainda que na presença de espaço suficiente para seu alinhamento na arcada. A abordagem exige conhecimentos de diferentes especialidades da odontologia, tais como a ortodontia, cirurgia, radiologia e periodontia e que, em geral, não se centram em um único profissional. Pode ser causada por fatores de ordem geral ou local, sendo que seu diagnóstico deve ser realizado por meio de exames clínico e radiográfico específicos. O prognóstico do tratamento ortodôntico–cirúrgico ira depender da posição do canino em relação aos dentes vizinhos e da sua altura no processo alveolar, além de técnica cirúrgica cuidadosa, haja vista que envolve riscos, como: anquilose, desvitalização, reabsorção radicular do dente envolvido e dos dentes adjacentes e dano aos tecidos de suporte. Em virtude das importantes funções desempenhadas pelos caninos inclusos superiores, o seu aproveitamento através do tracionamento é o tratamento de eleição nos pacientes assistidos ortodonticamente. O presente trabalho traz uma revisão bibliográfica acerca de importantes fatores a serem considerados na abordagem dos caninos impactados, tais como as possibilidades terapêuticas, suas vantagens e desvantagens.

Reconstrução de maxila severamente atrófica via enxerto ósseo autógeno de calota craniana: descrição de técnica / Reconstruction of severely atrophic maxillary using calvarial autogenous bone graft: technical description

As reconstruções ósseas são tradicionalmente realizadas por meio de enxertos autógenos coletados de áreas doadoras intra e extrabucais, visando o restabelecimento do arcabouço perdido para posterior reabilitação implantoprotética. A calota craniana tem sido estudada como excelente opção em grandes atrofias, com baixa incidência de reabsorções, bem como de complicações e morbidade mínima. O tempo de hospitalização é curto, com baixo nível de dor, pequena limitação funcional e cicatriz imperceptível. A microarquitetura da calota craniana é predominantemente cortical com a presença de fatores de crescimento que evidenciam sua capacidade osteogênica, osteoindutora e osteocondutora acarretando baixa porcentagem de reabsorção e alta previsibilidade quando comparada a crista do ilíaco. Lacerações durais, hemorragias extra e subdurais, fístulas liquóricas e lesões cerebrais tem sido minimizadas em virtude do desenvolvimento da técnica cirúrgica. A delimitação da camada diploica, preservando a cortical interna do crânio, antes da realização das osteotomias no leito doador, possibilitou a diminuição de acidentes e complicações. O objetivo deste artigo foi apresentar nota técnica e discutir aspectos relativos à aplicação do osso de calota craniana na reconstrução de maxilas severamente atróficas, visando à reabilitação oral com implantes osseointegráveis.

Bone reconstructions are traditionally conducted with autogenous grafts harvested from intra- or extra-oral donor sites to reestablish the lost bone volume for further implant-prosthetic rehabilitation. The calvarial bone has been studied as an excellent donor site in large atrophic situations, presenting low resorption rates, as well as complications and minimal morbidity. The hospitalization time is short, with low pain levels, short functional limitations, and invisible scars. The skull microarchitecture is predominantly cortical in the presence of growth factors that demonstrate their osteogenic, osteoinductive, and osteoconductive abilities resulting in low resorption rate and high predictability when compared to the iliac crest. Dural lacerations, extra and subdural bleeding, cerebrospinal fluid leakage, and brain damage have been minimized due to the development of surgical technique. The delimitation of diploe, preserving the internal skull cortex before osteotomy at the donor made it possible to reduce accidents and complications. The aim of this paper is to show a technical and to discuss aspects of the use of calvarial bone in the reconstruction of severely atrophic maxilla for oral rehabilitation with osseointegrated implants.

Evaluation of bone heating, immediate bone cell viability, and wear of high-resistance drills after the creation of implant osteotomies in rabbit tibias.

PURPOSE: The purpose of this study was to evaluate the influence of reusing high-resistance drills on bone heating, immediate bone cell viability, and drill wear after performing implant osteotomies in rabbit tibias. MATERIALS AND METHODS: Two hundred sequential implant osteotomies were created in the superior tibial cortex of 12 White male rabbits. Six groups were established (G1 to G6) according to the number of osteotomies performed with each drill (0, 10, 20, 30, 40, and 50). Drilling began with a spear drill, followed by 2.0-mm, 2.8-mm, 3.0-mm, and 3.15-mm helical drills. The receptor beds were collected for immunohistochemical analysis, thermal changes were quantified, and the drills were subjected to scanning electron microscopy analysis. RESULTS: A high degree of correlation between drill wear and number of osteotomies was observed (Pearson correlation coefficient, r = 0.984). Spear drills underwent twice as much deformation as helical drills. The bone heating analysis concluded that there was no statistically significant relationship between the number of osteotomies and bone heating (P > .05), but there were greater thermal changes during drilling with the spear drill than during drilling with helical drills (ratio 3:1). Immunohistochemical analysis showed a physiologic balance of osteoprotegerin and RANKL (receptor activator of nuclear factor κB ligand) immunolabeling in all groups; however, there was greater immunolabeling of all proteins in group G6 (50 osteotomies). CONCLUSIONS: The tested drills did not cause significant bone heating after being reused 50 times; however, they caused more tissue trauma in the 50th osteotomy. Worn drills that are reused may be expected to cause excessive damage to the bone tissue and could adversely affect the osseointegration process.

Instalação imediata de obturador palatino após ressecção de carcinoma espinocelular - Relato de caso / Immediate installation of palatal obturator after squamous cell carcinoma resection - Case report

As grandes ressecções para o tratamento de tumores na face e na cavidade oral geralmentecausam diversos transtornos para os pacientes, que vão desde alterações estéticas, queprejudicam o convívio social normal, até grandes alterações funcionais, que dificultama boa evolução clínica do paciente. Abordagens cirúrgicas para remoção de tumoresmalignos da região de cabeça e pescoço, dependendo da extensão do tumor e do seugrau de invasividade, podem trazer diversos tipos de comorbidades para o paciente, taiscomo: disfonia, disfagia, dispnéia, dentre outras. Este artigo tem o objetivo de relataro caso de um paciente de 73 anos, sexo masculino, portador de extenso carcinomaespinocelular envolvendo todo o palato duro e parte dos assoalhos de cavidade nasal eseio maxilar esquerdo que foi submetido à maxilectomia e instalação de um obturadorpalatino imediatamente após a ressecção, com objetivo de diminuir o tempo de retorno àdeglutição, isolar a cavidade nasal da cavidade oral no pós-operatório imediato, evitar avoz anasalada e proteger as estruturas cruentas.

Large resections for treatment of tumors in the face and oral cavity often cause variousdisorders for patients, ranging from cosmetic changes that affect the normal social life tomajor functional changes that difficult the good clinical evolution of the patient. Surgicalapproaches for resection of malignant tumors of the head and neck depending on theextent of the tumor and its degree of invasion can provide various types of comorbiditiesfor the patient, such as dysphonia, dysphasia, dyspnea, and others. This article aims toreport the case of a 73 year-old-male, suffering from extensive squamous cell carcinomainvolving the hard palate and part of the floors of the nasal cavity and left maxillary sinuswho underwent maxillectomy and installation of a palatal obturator immediately afterresection, aiming to reduce the turnaround time for swallowing, isolate the nasal cavityfrom the oral cavity in the immediate postoperative period, avoiding the nasal voice andprotecting the exposed anatomical structures.

Avaliação cefalométrica e tridimensional das vias aéreas superiores posteriores após avanço maxilo-mandibular / Cephalometric and tridimensional avaliation of posterior airway space after maxillomandibular advancement

Objetivo: O objetivo deste estudo é avaliar comparativamente as alterações cefalométricas e tridimensionais das vias aéreas de pacientes submetidos à cirurgia ortognática de avanço maxilo-mandibular. Material e Métodos: Foram selecionados 20 pacientes com deformidade dento-facial de classe II, com deficiência maxilomandibular que foram submetidos à cirurgia de avanço maxilo-mandibular. Os pacientes tiveram um período pós-operatório de no mínimo 6 meses. Foram realizadas tomografias computadorizadas de feixe cônico nos períodos pré-operatório (T1), pósoperatório imediato, até quinze dias após a cirurgia (T2) e pós-operatório tardio, pelo menos 6 meses após a cirurgia (T3). Foi realizada a quantificação linear, de área e de volume das vias aéreas superiores posteriores, e comparado com o movimento real alcançado com a técnica cirúrgica dos dois tempos pós-operatórios. Resultados: Nos resultados, o movimento de avanço maxilo-mandibular proporcionou um ganho de vias aéreas em todas as análises, com diferença estatisticamente significativa entre os períodos T2 e T1, e T3 e T1, com um valor de p<0,05. No entanto, ao comparar os períodos T2 e T3, houve uma diferença estatisticamente significativa para as análises de área e de volume, comprovando uma recidiva parcial do ganho em via aérea alcançado em T2. Conclusões: Finalmente, podemos concluir que o avanço maxilo-mandibular é uma técnica cirúrgica que proporciona um ganho linear, de área e volume de vias aéreas superiores posteriores nos períodos pós-operatório imediato e após seis meses, no entanto, o ganho em vias aéreas apresenta uma recidiva parcial em períodos tardios. Também pudemos concluir que a avaliação de vias aéreas através de uma análise cefalométrica linear pode trazer resultados limitados quando comparados aos estudos de área e volume dessa região anatômica

Objective: The purpose of this study is to quantify cephalometric and tridimensional alterations of the posterior airway space of patients undergoing orthognathic surgery of maxillomandibular advancement. Material and Methods: 20 patients were standardized selected with dentofacial deformity of class II, with maxillomandibular deficiency, treated by maxillomandibular advancement. The minimal postoperative period was 6 months. Cone-Beam Computed Tomography were performed in 3 distinct periods of the treated patients, preoperative (T1), immediate postoperative period, until 15 days after surgery (T2), and late postoperative period, at least 6 months after surgery. The posterior airway space were quantified in each period of each patient, and the results were compared with the real movement achieved with the surgical technique employed. Results: In the results, the maxillomandibular advancement promoved an increase on posterior airway space of each patient, in all the analysis performed, with a significantly statistic difference between T2 and T1, and between T3 and T1, p<0,05. However, there was a statistic difference between T2 and T3 in the area and volume analysis, what means that the airway space comes narrow after 6 months when compared with the immediate postoperative period. Conclusions: Finally, the maxillomandibular advancement performed a great linear, area and volume increase in posterior airway space in immediate and late postoperative period, however, there is a partial loss of the increased space after 6 months. Also the linear analysis of airway spaces has limited results when compared with area and volume analysis

Avaliação cefalométrica e tridimensional das vias aéreas superiores posteriores após avanço maxilo-mandibular / Cephalometric and tridimensional avaliation of posterior airway space after maxillomandibular advancement

Objetivo: O objetivo deste estudo é avaliar comparativamente as alterações cefalométricas e tridimensionais das vias aéreas de pacientes submetidos à cirurgia ortognática de avanço maxilo-mandibular. Material e Métodos: Foram selecionados 20 pacientes com deformidade dento-facial de classe II, com deficiência maxilomandibular que foram submetidos à cirurgia de avanço maxilo-mandibular. Os pacientes tiveram um período pós-operatório de no mínimo 6 meses. Foram realizadas tomografias computadorizadas de feixe cônico nos períodos pré-operatório (T1), pósoperatório imediato, até quinze dias após a cirurgia (T2) e pós-operatório tardio, pelo menos 6 meses após a cirurgia (T3). Foi realizada a quantificação linear, de área e de volume das vias aéreas superiores posteriores, e comparado com o movimento real alcançado com a técnica cirúrgica dos dois tempos pós-operatórios. Resultados: Nos resultados, o movimento de avanço maxilo-mandibular proporcionou um ganho de vias aéreas em todas as análises, com diferença estatisticamente significativa entre os períodos T2 e T1, e T3 e T1, com um valor de p<0,05. No entanto, ao comparar os períodos T2 e T3, houve uma diferença estatisticamente significativa para as análises de área e de volume, comprovando uma recidiva parcial do ganho em via aérea alcançado em T2. Conclusões: Finalmente, podemos concluir que o avanço maxilo-mandibular é uma técnica cirúrgica que proporciona um ganho linear, de área e volume de vias aéreas superiores posteriores nos períodos pós-operatório imediato e após seis meses, no entanto, o ganho em vias aéreas apresenta uma recidiva parcial em períodos tardios. Também pudemos concluir que a avaliação de vias aéreas através de uma análise cefalométrica linear pode trazer resultados limitados quando comparados aos estudos de área e volume dessa região anatômica.

Objective: The purpose of this study is to quantify cephalometric and tridimensional alterations of the posterior airway space of patients undergoing orthognathic surgery of maxillomandibular advancement. Material and Methods: 20 patients were standardized selected with dentofacial deformity of class II, with maxillomandibular deficiency, treated by maxillomandibular advancement. The minimal postoperative period was 6 months. Cone-Beam Computed Tomography were performed in 3 distinct periods of the treated patients, preoperative (T1), immediate postoperative period, until 15 days after surgery (T2), and late postoperative period, at least 6 months after surgery. The posterior airway space were quantified in each period of each patient, and the results were compared with the real movement achieved with the surgical technique employed. Results: In the results, the maxillomandibular advancement promoved an increase on posterior airway space of each patient, in all the analysis performed, with a significantly statistic difference between T2 and T1, and between T3 and T1, p<0,05. However, there was a statistic difference between T2 and T3 in the area and volume analysis, what means that the airway space comes narrow after 6 months when compared with the immediate postoperative period. Conclusions: Finally, the maxillomandibular advancement performed a great linear, area and volume increase in posterior airway space in immediate and late postoperative period, however, there is a partial loss of the increased space after 6 months. Also the linear analysis of airway spaces has limited results when compared with area and volume analysis.

Use of titanium mesh for reconstruction of extensive defects in fronto-orbito-ethmoidal fracture.

Traumatic injuries treatment of the fronto-naso-orbito-ethmoidal region has been one of the most challenging treatments within maxillofacial surgery, particularly of extensive orbital defects, very common in this type of pathologic condition. A 48-year-old man involved in a car collision presented an extensive bilateral fracture of the orbit medial wall, nasal bones, the nasal septum, and the frontal anterior table. The clinical and tomographic findings concluded the diagnosis of a maxilla and fronto-naso-orbito-ethmoidal fracture. Among the variety of biomaterials, the titanium mesh was elected because of the extension and magnitude of the bone defect, obtaining this way esthetic and functional results with better prognosis.

A cirurgia pré-protética para Torus Palatino: relato de caso / The pre-prosthetic surgery for Palatine Torus: a case report

O torus palatino é uma alteração de desenvolvimento comum, localizada na linha média do palato duro. Sua etiologia é incerta, podendo ser associado alterações funcionais, fatores genéticos e características raciais. Sua incidência varia de acordo com grupos étnicos, idade e geralmente acomete o sexo feminino. Normalmente esse nódulo ósseo intra oral não apresenta sintomatologia dolorosa, todavia a sua remoção é freqüentemente indicada quando há trauma recorrente, interferência nos processos de fonação, deglutição, mastigação, no posicionamento normal da língua, ou para correção de deformidades ósseas que prejudiquem a adaptação de prótese...

The palatine torus is a usual developmental disturbance, located in the midline of the hard palate. Its etiology is uncertain and may be associated with functional changes, genetic factors and racial characteristics. Its incidence varies according to ethnic groups, age and usually affects females. Normally this intra-osseous oral nodule presents no painful symptoms, but its removal is often required when there is recurrent trauma, interference in the processes of speech, swallowing, chewing, in the normal positioning of the tongue, or to correct bone deformities that affect the adaptation of prosthesis...

Reabilitação bucal imediata após maxilectomia parcial: relato de caso / Immediate oral rehabilitation after partial maxillectomy: a case report

O tratamento cirúrgico dos tumores da maxila e regiões adjacentes é realizado por meio de maxilectomia total ou parcial. No entanto, o defeito cirúrgico gerado por esse tipo de tratamento leva a muitos comprometimentos clínicos e psicológicos do paciente maxilectomizado. A reabilitação bucal imediata por meio de prótese com obturador palatino pós-maxilectomia leva a uma otimização do pós-operatório imediato desse paciente, reabilitando suas funções estomatognáticas imediatamente após o tratamento cirúrgico e evitando sequelas psicossociais para este paciente. O presente trabalho tem o objetivo de relatar o caso de um paciente submetido à maxilectomia parcial para o tratamento de extenso adenoma pleomórfico de glândulas salivares menores localizado em palato, com uma evolução de 03 anos, que recebeu reabilitação imediata por meio da técnica supracitada. O trabalho também discute a importância clínica da técnica e os ganhos em qualidade de vida e função estomatognática para o paciente.

The surgical treatment of tumors of maxillary and adjacent tumors is performed by me ans of total or partial maxillectomy. However, the surgical defect resulting from this kind of treatment leads to considerable clinical and psychological impairment for the patient undergoing maxillectomy. Immediate oral rehabilitation using a surgical obturator minimizes postoperative complications, restoring oral function immediately after surgery and avoiding psychosocial sequelae for the patient. The purpose of this study is to report the case of a partial maxillectomy in a patient presenting an extensive pleomorphic adenoma of minor salivary glands located on the palate, which had progressed over three years, and which was given immediate rehabilitation using the above-mentioned technique. The study also discusses the clinical importance of the technique and the resulting benefits for the patient as regards quality of life and oral function.