Transconjunctival Surgical Access With Modified Aesthetic Lateral Canthotomy.

ABSTRACT: Displaced fractures of the zygomatic bone that require surgical treatment are accessed transcutaneously but these accesses to the skin can cause a hypertrophy scar in patients with this predisposition. This paper indicates a modification in the lateral canthotomy that aim to minimize the hypertrophic scar in the treatment of zygomatic fracture.

Neurological manifestations and pathophysiological mechanisms of Covid-19

Background - Severe acute respiratory syndrome coronavirus-2 is a novel, highly infectious coronavirus and the etiologic agent of Covid-19. The course of Covid-19 can range from mild flu-like symptoms to severe, life-threateningsymptoms, especially when comorbidities are present. Increasing studies have reinforced the association between SARS-CoV-2 and various neurological manifestations, although the pathophysiological mechanisms remain uncertain. Objective - The aim of this paper was to briefly describe current findings on the relationship between SARS-CoV-2 pathophysiology and major CNS and Peripheral Nervous System (PNS) manifestations.Methods and Material - This work consists of a literature review based on the study of academic papers. To this end, the Pubmed platform was used to search for scientific articles, using the keywords: covid-19, coronavirus, physiopathology, neuronal symptoms. Results - out of 114,660 articles found, 94 were selected for this review. Conclusions - Periodic reviews collaborate in the constant updating and summarization of findings. Understanding the pathophysiology of SARS-CoV-2 on the SN and the link between the systems may lead to earlier and earlier diagnoses of neurological involvement, guide therapeutic management, prevent sequelae, and preserve lives(AU)

Influence analysis of cleft type and supernumerary teeth eruption in the prognosis of bone graft in patients with cleft palate.

OBJECTIVE: The aim of this study was to investigate the influence of cleft type and supernumerary tooth eruption on the treatment of palatal clefts with alveolar bone grafts. MATERIALS AND METHODS: In this article, medical records of 40 patients with palatal clefts and associated supernumerary teeth who were treated with alveolar bone grafting in the Hospital for Craniofacial Anomalies Rehabilitation were assessed. The patients were studied to assess the influence of supernumerary teeth and the cleft severity on the prognosis of the alveolar bone graft. RESULTS: Forty medical records were included in the assessment. When the teeth in the cleft had an anatomic shape close to canine, we called them precanine. When they were very small or malformed, we called them anomalous lateral incisors. The teeth studied showed good prognoses and were more expressive in the preforaminal clefts (87.5%) than in the transforaminal ones (62.5%). Moreover, the transforaminal clefts presented a higher percentage in satisfactory and poor prognoses (37.5%). The authors found that supernumerary teeth influenced the maintenance of alveolar bone graft height and that transforaminal clefts presented a worse prognosis than preforaminal clefts.

Análise microbiológica da exposição das roscas dos implantes osseointegráveis no seio maxilar de ovelhas / Microbiological analysis of the exposure of threads of osseointegrableimplants in the maxilar sinus of the sheep

Objetivo - O objetivo desse trabalho é avaliar a alteração microbiológica com a exposição de expiras de implantes dentários dentro do seio maxilar. Materiais e métodos – O experimento se passa por duas etapas onde foram utilizadas oito ovelhas. Na primeira fase foram realizados swabs nos seios maxilares por via extra oral imediatamente seguida pela colocação de um implante em cada seio maxilar pela mesma via. No lado direito o implante tinha a superfície tratada e do lado esquerdo a superfície foi usinado. Na segunda etapa, realizada três meses após a primeira, o swab na mucosa foi refeito e foi realizado um esfregaço na superfície do implante com um microbrush estéril. Os meios de cultura utilizados foram: ágar sangue, ágar chocolate, ágar Mac Conkey, ágar sal manitol e ágar Sabouraud. A análise estatística foi realizada com os testes T student, binomial e Exato de Fisher. Resultados – Na primeira etapa a amostra apresentou 37.5% dos seios com crescimento positivo passando para 50% na segunda etapa e com 80% dos implantes inseridos colonizados por microrganismos. Após três meses da colocação dos implantes houve uma proliferação de Staphylococcus aureus e um crescimento significativo de leveduras (test T student, p = 0.0413) com edema importante da mucosa do seio maxilar apesar de não apresentar nenhum sinal clínico de infecção, dois implantes usinados não osseointegraram. Não houve diferença significativa entre os implantes usinados e com superfície tratada na colonização de microrganismos. Conclusão - A exposição de implantes ao seio maxilar propicia uma proliferação de Staphilococcus aureus e fungos e não houve diferença entre implantes de superfície tratada com implantes usinados na colonização de microrganismos

Aim - The purpose of this study is to evaluate the microbiological changes with exposure expiras of dental implants in the maxillary sinus. Materials and methods - The experiment goes through two stages where eight sheep were used. In the first phase swabs were performed in the maxillary sinuses for pathway extra orally immediately followed by the placement of an implant in each maxillary sinus via the same pathway. On the right side the implant had the treated surface and the left surface has been machined. In the second stage, performed three months after the first, the in the mucosa swab was redone and a smear was performed at the implant surface with a sterile microbrush. The culture media used were blood agar, chocolate agar, MacConkey, mannitol salt agar and Sabouraud agar. Statistical analysis was performed using the Student t test, Fisher and Binomial. Results - In the first stage of the study showed 37.5% of breasts with positive growth rising to 50% in the second stage and 80% of the placed implants colonized by microorganisms. Three months after implant placement has been a proliferation of Staphylococcus aureus and significant growth of yeasts (student t test, p = 0.0413) with significant edema of the mucosa of the maxillary sinus despite not presenting any clinical signs of infection, two machined implants do not osseointegraram. There was no significant difference between the machined surface implants and treated with the colonization of microorganisms. Conclusion - Exposure of implants to the maxillary sinus provides a proliferation of Staphylococcus aureus and fungi and there was no difference between the treated surface machined in the colonization of microorganisms implants

Análise microbiológica da exposição das roscas dos implantes osseointegráveis no seio maxilar de ovelhas / Microbiological analysis of the exposure of threads of osseointegrableimplants in the maxilar sinus of the sheep

O objetivo desse trabalho é avaliar a alteração microbiológica com a exposição de expiras de implantes dentários dentro do seio maxilar. Materiais e métodos – O experimento se passa por duas etapas onde foram utilizadas oito ovelhas. Na primeira fase foram realizados swabs nos seios maxilares por via extra oral imediatamente seguida pela colocação de um implante em cada seio maxilar pela mesma via. No lado direito o implante tinha a superfície tratada e do lado esquerdo a superfície foi usinado. Na segunda etapa, realizada três meses após a primeira, o swab na mucosa foi refeito e foi realizado um esfregaço na superfície do implante com um microbrush estéril. Os meios de cultura utilizados foram: ágar sangue, ágar chocolate, ágar Mac Conkey, ágar sal manitol e ágar Sabouraud. A análise estatística foi realizada com os testes T student, binomial e Exato de Fisher. Resultados – Na primeira etapa a amostra apresentou 37.5% dos seios com crescimento positivo passando para 50% na segunda etapa e com 80% dos implantes inseridos colonizados por microrganismos. Após três meses da colocação dos implantes houve uma proliferação de Staphylococcus aureus e um crescimento significativo de leveduras (test T student, p = 0.0413) com edema importante da mucosa do seio maxilar apesar de não apresentar nenhum sinal clínico de infecção, dois implantes usinados não osseointegraram. Não houve diferença significativa entre os implantes usinados e com superfície tratada na colonização de microrganismos. Conclusão - A exposição de implantes ao seio maxilar propicia uma proliferação de Staphilococcus aureus e fungos e não houve diferença entre implantes de superfície tratada com implantes usinados na colonização de microrganismos...

The purpose of this study is to evaluate the microbiological changes with exposure expiras of dental implants in the maxillary sinus. Materials and methods - The experiment goes through two stages where eight sheep were used. In the first phase swabs were performed in the maxillary sinuses for pathway extra orally immediately followed by the placement of an implant in each maxillary sinus via the same pathway. On the right side the implant had the treated surface and the left surface has been machined. In the second stage, performed three months after the first, the in the mucosa swab was redone and a smear was performed at the implant surface with a sterile microbrush. The culture media used were blood agar, chocolate agar, MacConkey, mannitol salt agar and Sabouraud agar. Statistical analysis was performed using the Student t test, Fisher and Binomial. Results - In the first stage of the study showed 37.5% of breasts with positive growth rising to 50% in the second stage and 80% of the placed implants colonized by microorganisms. Three months after implant placement has been a proliferation of Staphylococcus aureus and significant growth of yeasts (student t test, p = 0.0413) with significant edema of the mucosa of the maxillary sinus despite not presenting any clinical signs of infection, two machined implants do not osseointegraram. There was no significant difference between the machined surface implants and treated with the colonization of microorganisms. Conclusion - Exposure of implants to the maxillary sinus provides a proliferation of Staphylococcus aureus and fungi and there was no difference between the treated surface machined in the colonization of microorganisms implants...

Incomplete mandibular fracture after lateralization of the inferior alveolar nerve for implant placement.

PURPOSE: The present case describes an inferior alveolar nerve lateralization for implant placement that caused mandible fracture a few days after surgery. CLINICAL REPORT: In this case, a 56-year-old female patient who had a severely atrophied jaw and showing bone height less than 7 mm from the bone crest and the mandibular canal was submitted to surgery lateralization of the inferior alveolar conducted with piezzo. Even with all postoperative care, the patient suffered an incomplete fracture of the mandible a few days after lateralization of the inferior alveolar nerve for implant placement. The patient was treated with soft diet and medications for pain and antibiotics, besides removing the implant associated with the fracture. CONCLUSION: It is suggested that this procedure may be conducted in 2 operative periods: firstly, the lateralization of the inferior alveolar; and secondly, after a period of 3 months, the implant placement in a situation of more bone stability.

Sedação consciente em odontologia / Conscious sedation in dentistry

O óxido nitroso, primeiro gás inalatório utilizado na sedação consciente, foi indentificado por Joseph Priestley. Esse composto ficou conhecido como gás hilariante, porém só em 1844 teve sua primeira aplicação em pacientes. Tem como características farmacológicas metabolização lenta no organismo, início e término de ação rápidos, mas alcançando concentrações cerebrais eficientes. Sua técnica baseia-se na administração de O2 seguida de N2O, até alcançar o nível de sedação ideal. Essas técnicas são indicadas para pacientes ansiosos, tensos e situações em que não existam contra-indicações, porém essas são técnicas apenas relativas e não absolutas, e estão relacionadas principalmente ao risco de hipóxia, aumento de volume ou pressão em espaços fechados, alterações hematológicas e neurológicas. Os benzodiazepínicos servem também como método de sedação consciente devido a sua ação ansiolítica: vale destacar o midazolam, diazepam, alprazolam, triazolam e lorazepam. Os efeitos colaterais são variados abrangendo degeneração da medula óssea, náuseas, teratogênese, entre outros. O objetivo deste trabalho é realizar uma revisão da literatura para mostrar a importância da sedação consciente nos procedimentos odontológicos.

Nitrous oxide, the first inhaled gas used in conscious sedation, was identified by Joseph Priestley. This compound was known as laughing gas, but only in 1844 had its first application in patients. Its pharmacological characteristics are don?t be metabolized in the body, beginning and ending of fast action, but reaching effi cient concentrations in the brain. Its technique is based on the administration of O2 followed by N2O, to achieve the optimal level of sedation. Such techniques are indicated for anxious and tense patients, and situations that have no contraindications, but these are only relative and not absolute, and are due mainly to the risk of hypoxia, volume or pressure increase in enclosed spaces, hematological and neurological changes. The benzodiazepines also serve as a conscious sedation method because of their anxiolytic action, highlight the valley midazolam, diazepam, alprazolam, triazolam and lorazepam. Side effects are varied covering bone marrow degeneration, nausea, teratogenesis, among others. The aim of this article is to realize a review in order to show the value of conscious sedation to dental procedures.

Reações alérgicas medicamentosas no consultório odontológico / Allergic reactions medicinal in dentist?s office

Todas as drogas são capazes de desencadear reações tanto benéficas como nocivas. As reações adversas aos medicamentos dependem do fármaco, da dose administrada, da farmacocinética, da farmacodinâmica e da predisposição individual. As alterações são bastante variáveis, incluindo desde eritema na pele até reação de anafilaxia. O tratamento dessas reações compreende a retirada imediata do medicamento e a terapêutica habitual para as diferentes manifestações clínicas. O cirurgião-dentista deve conhecer o mecanismo de ação das drogas mais utilizadas no consultório odontológico, como anestésicos locais, antibióticos, analgésicos e anti-inflamatórios não esteroidais (AINES), assim poderá entender as possíveis reações alérgicas medicamentosas.

All drugs are capable to unchain benefic and noxious reactions. The adverse reactions to medicines depend on the drug, dose administration, pharmacokinetic, pharmacodynamic and individual predisposition. Changes are quite variable, ranging from skin eritema to anaphylaxis reaction. The treatment of these reactions includes the immediate medication withdrawal and habitual therapy for the different clinical manifestations. The dental surgeon must know the action of the most used drugs in dentist?s office, as local anesthesics, anthibiotics, analgesics and non-steroidal anti-inflammatory (NSAID), then he will be able to understand the possible alergical reactions.

Estudo epidemiológico de 829 casos de fratura de mandíbula / epidemiological study of 829 cases of jaw fracture

A meta deste estudo epidemiológico foi analisar os dados dos registros de 829 casos de fratura de mandíbula tratadas cirurgicamente no Serviço de Cirurgia Traumatologia Buco-Maxilo-Facila do Hospital das Clínicas-FMUSP entre os anos de 1990 a 2002. Métodos: foram revisados os prontuários de 915 pacientes, classificados como tendo o diagnóstico de fratura de mandíbula, que sofreram tratamento cirurgico, ocorridos a partir de janeiro de 1990 a dezembro de 2002. Dentre 915 prontuários, 829 prontuários foram incluídos no estudo...

The goal of this study was to analyze records of 829 cases of mandible fractures surgically treated at the Oral and Maxiillo-Facial Service of the Hospital das Clínicas-FMUSP between 1990 and 2002. Records of 915 patients classified as having diagnosis of mandible fracture underdoing surgical treatment from january/1990 to december/2002 were reviewed. Among 9115 records, 829 were incluid inthe study...

Comparative analysis of 2 techniques of double-gloving protection during arch bar placement for intermaxillary fixation.

PURPOSE: This study was conducted to comparatively evaluate, in a prospective and randomized manner, 2 techniques for providing double-gloving protection during arch bar placement for intermaxillary fixation. MATERIALS AND METHODS: A total of 42 consecutive patients in whom application of an Erich bar was indicated for intermaxillary fixation were equally divided into 2 groups. In group 1, 2 sterile surgical gloves were used; in group 2, a nonsterile disposable inner glove was used under a sterile surgical glove. Wilcoxon, Mann-Whitney, Kruskal-Wallis, and binomial statistical tests were used to analyze the findings. RESULTS: A total of 103 perforations were found in the outer gloves (47 in group 1 and 56 in group 2), along with 5 perforations in inner gloves in both groups (alpha = .01). No significant statistical difference was found between groups in terms of inner glove perforations (alpha = .05). The nondominant hand presented with 70.9% of the perforations, statistically significant to 1%. CONCLUSIONS: Both double-gloving techniques were found to provide effective clinician protection. The use of a nonsterile disposable glove under the surgical glove is possible for less-invasive procedures, offering the same safety as using 2 sterile surgical gloves while decreasing operational costs. This method does not eliminate the need to change gloves when a perforation is suspected or noted during the surgery, however.

A prospective study of dentoalveolar trauma at the Hospital das Clínicas, São Paulo University Medical School.

PURPOSE: This prospective study evaluated the profile of patients with dentoalveolar trauma assisted at the emergency room of the Oral and Maxillofacial Trauma and Surgery Service at the Hospital das Clínicas, São Paulo University Medical School (Brazil). METHODS: A prospective study by a questionnaire applied during the first attendance of those patients, in a period of eight months. RESULTS: The collected data were statistically analyzed. It was observed that 4.7% of the patients that sought treatment at the Service had sustained dentoalveolar trauma and among these 74% were male. The most affected individuals were children aged 0 to 5 years and fall was the most prevalent etiologic factor. Avulsion and coronal/crown-root fractures were the most common types of dentoalveolar traumatic injures. As the age increases, the most common etiologic factors are traffic accidents and physical assault. CONCLUSION: The incidence of dentoalveolar trauma decreased with age and the main etiologic factors in adult patients were traffic accidents and physical assault.

A prospective study of dentoalveolar trauma at the Hospital das Clínicas, São Paulo University Medical School

PURPOSE: This prospective study evaluated the profile of patients with dentoalveolar trauma assisted at the emergency room of the Oral and Maxillofacial Trauma and Surgery Service at the Hospital das Clínicas, São Paulo University Medical School (Brazil). METHODS: A prospective study by a questionnaire applied during the first attendance of those patients, in a period of eight months. RESULTS: The collected data were statistically analyzed. It was observed that 4.7 percent of the patients that sought treatment at the Service had sustained dentoalveolar trauma and among these 74 percent were male. The most affected individuals were children aged 0 to 5 years and fall was the most prevalent etiologic factor. Avulsion and coronal/crown-root fractures were the most common types of dentoalveolar traumatic injures. As the age increases, the most common etiologic factors are traffic accidents and physical assault. CONCLUSION: The incidence of dentoalveolar trauma decreased with age and the main etiologic factors in adult patients were traffic accidents and physical assault.

PROPOSIÇÃO: Avaliar o perfil dos pacientes, com traumatismo dento-alveolar, atendidos no Pronto-Socorro do Serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Brasil). MÉTODOS: Foi realizado um estudo prospectivo, através de um questionário aplicado, durante o primeiro atendimento desses pacientes, em um período de oito meses. RESULTADOS: Os dados obtidos foram analisados estatisticamente e verificou-se que dos pacientes atendidos 4,7 por cento apresentavam traumatismo dento-alveolar, e destes, 74 por cento eram do gênero masculino; as crianças de 0 a 5 anos eram as mais acometidas, a etiologia mais comum foi a queda; e o tipos de traumas mais freqüentes foram a avulsão e fratura dental. A medida que a idade avança os fatores etiológicos mais comuns são os acidentes de trânsito e as agressões físicas. CONCLUSÃO: A incidência de trauma de dentoalveolar diminuiu com a idade e o principal fator etiologico nos pacientes adulto foi acidentes de tráfico e agressão física.

Uso dos inibidores seletivos da COX-2 na odontologia / Use of the COX-2 sécific inhibitor in dentistry

O objetivo do presente estudo foi determinar a reprodutibilidade geométrica de um método de exames radiográficos padronizados (PerioSmart ). Foram selecionados 12 indivíduos com periodontite agressiva, participantes de um ensaio clínico que comparava terapias periodontais. Os exames foram repetidos devido à ocorrência de problemas de processamento químico, resultando em uma amostra de 17 pares. Foram utilizados ilmes radiográicos Insight – Kodak, com 0,6 segundos de exposição e processamento automático, sendo feita digitalização com 400 dpi – 8 bits e análise no programa Adobe PhotoShop 7.0. Distâncias horizontais foram medidas dos pontos mais distais e mesiais das superfícies proximais da coroa do dente e verticais da junção amelo-cementária até o ponto mais coronal de uma das cúspides, ambas por um examinador calibrado. Foram analisados 44 pares de dentes, comparando as distâncias por meio do teste t pareado (alfa = 5%). Não foram observadas diferenças signiicativas nas distorções totais horizontal e vertical (0,11 mm, IC 95% -0,48 – 0,69; e 0,50 mm, IC 95% -0,03 – 1,03 mm, respectivamente). Quando analisados molares e pré-molares separadamente, não houve distorções signiicativas. Não houve diferenças signiicativas também entre as distorções horizontal e vertical. No arco superior, foi observada uma distorção horizontal signiicativa (0,25 mm, IC 95% 0,01 – 0,50), porém a distorção vertical não foi signiicativa (0,30 mm, IC 95% -0,20 – 0,80). No arco inferior, não foram detectadas distorções signiicativas. Concluiu-se, portanto, que o método avaliado é reproduzível e gera uma distorção geométrica limitada, o que sugere possibilidade de uso em pesquisas clínicas.

The non steroids anti inlammatory and analgesic medicines are among the most used medicines by population. The use of these medicines in a chronic and acute way promotes some undesirable effects such as gastro intestinal disturbs, skin lesions, adverse kidney effects and other side effects. So the pharmaceutical industries started developing analgesic and anti inlammatory agents presenting selectivity for the COX-2 inhibition, the so called coxibs, in order to achieve the clinical effectiveness with reduced risks of gastro intestinal effects and other side effects. But these drugs have presented some other adverse effects such as cardiac alterations which may limit their use demonstrating that the coxib use on the regular basis in dentistry is not justiied with the exception of patients with medical history of conirmed gastrointestinal disturbs.

Tratamento de pseudoartrose causada por cirurgia ortognática / Pseudoarthrosis treatment caused by orthognathic surgery

As deformidades dontofaciais o tipo Classe III possuem variáveis dentoesqueléticas difícies de se diagnosticar. O correto diagnóstico e plano de tratamento são de vital importância para o sucesso da correção destas alterações, sendo que as formas de tratamento dependem da discrepâncias maxilo-mandibular existente e da idade do paciente. Este artigo relata o tratamento de uma sequela mandibular importante (pseudoartrose), resultado de um planejamento incorreto e técnica cirúrgica inadequada, sendo necessária a realização de tratamento agressivo (acesso extra bucal e enxerto de crista ilíaca) para devolver a função a este paciente

Fratura patológica de mandíbula associada à picnodisostose: relato de caso / Mandibular pathological fracture in a pycnodysostosis syndrome case

A picnodisostose é uma síndrome que se caracteriza por uma alteraçäo do metabolismo ósseo, resultando em uma predisposiçäo a infecçäo e a fraturas patológicas. Este artigo relata um caso de fratura patológica de mandíbula, após uma exodontia, em um paciente com picnodisostose, ressaltando a opçäo pelo tratamento conservador associado à oxigenoterapia hiperbárica