Trismus and oral health conditions during diagnosis of malignant oral neoplasms / Trismo e condições de saúde bucal no diagnóstico de neoplasias malignas da cavidadeoral

Abstract Introduction: Trismus has been considered a late complication of cancer treatment. It can occur prior to treatment, mainly caused by tumor invasion or muscle spasms induced by the presence of the tumor. Objective: In this study, we evaluated the incidence of trismus and its effect on oral health in patients with malignant neoplasms of the oral cavity before performing the cancer treatment. Methods: This review was carried out via interviews, visual clinical inspection and objective measurement of maximal mouth opening in 35 consecutive patients. Trismus was defined as a maximal mouth opening <35 mm. Results: Trismus was observed in 15 patients, with a total incidence of 42%. A high rate of tooth loss was recorded, and trismus association with tooth loss was statistically verified using the Chi-square and Fisher's exact tests, the t-student test and Mann-Whitney non-parametric test. All tests were performed at p < 0.05. Conclusion: Edentulous patients are eight times more likely to have trismus compared to patients that are partially and fully dentate. Trismus was demonstrated to be correlated with tooth loss; however other oral health conditions were not shown to be a modifying factor.

Resumo Introdução: O trismo tem sido considerado uma complicação tardia do tratamento do câncer, pode ocorrer antes do tratamento, causado principalmente por invasão tumoral ou espasmos musculares induzidos pela presença do tumor. Objetivo: Avaliar a incidência do trismo e seu efeito sobre a saúde bucal em pacientes com neoplasias malignas da cavidade bucal antes de se submeterem ao tratamento do câncer. Método: Esta revisão foi realizada por meio de entrevistas, inspeção clínica visual e mensuração objetiva da abertura bucal máxima em 35 pacientes consecutivos. O trismo foi definido como abertura bucal máxima < 35 mm. Resultados: O trismo foi observado em 15 pacientes, com uma incidência de 42%. Uma alta taxa de perda dentária foi registrada e a associação do trismo com a perda dentária foi verificada estatisticamente com os testes qui-quadrado, exato de Fisher, t de Student e não paramétrico de Mann-Whitney. Todos os testes foram realizada com p < 0,05. Conclusão: Pacientes edêntulos são oito vezes mais propensos a ter trismo do que os pacientes parcial e totalmente dentados. O trismo demonstrou estar correlacionado com a perda dentária. Entretanto, as outras condições de saúde bucal não se mostraram um fator modificador.

Trismus and oral health conditions during diagnosis of malignant oral neoplasms.

INTRODUCTION: Trismus has been considered a late complication of cancer treatment. It can occur prior to treatment, mainly caused by tumor invasion or muscle spasms induced by the presence of the tumor. OBJECTIVE: In this study, we evaluated the incidence of trismus and its effect on oral health in patients with malignant neoplasms of the oral cavity before performing the cancer treatment. METHODS: This review was carried out via interviews, visual clinical inspection and objective measurement of maximal mouth opening in 35 consecutive patients. Trismus was defined as a maximal mouth opening <35mm. RESULTS: Trismus was observed in 15 patients, with a total incidence of 42%. A high rate of tooth loss was recorded, and trismus association with tooth loss was statistically verified using the Chi-square and Fisher's exact tests, the t-student test and Mann-Whitney non-parametric test. All tests were performed at p<0.05. CONCLUSION: Edentulous patients are eight times more likely to have trismus compared to patients that are partially and fully dentate. Trismus was demonstrated to be correlated with tooth loss; however other oral health conditions were not shown to be a modifying factor.

Re: Brazilian Consensus Recommendation on the Use of Polymethylmethacrylate Filler in Facial and Corporal Aesthetics by Túlio Armanini Blanco Souza, Letícia Marques Colomé, Eduardo André Bender, Gottfriede Lemperle Aesthethic Plastic Surgery 2018; 42(5): 1244-51.

The self-titled study Brazilian Consensus Recommendation cannot be considered a consensus and more specifically cannot be considered a Brazilian consensus. The study does not represent the point-of-view of members of the Brazilian Society of Plastic Surgery. The content of this paper is plenty of contradictory and questionable affirmations. Method is flaw and does not inform any consistent data. Results and discussion are in the same section, making unclear what is result and what is pure speculation. This report is not a consensus nor reflects the opinion of plastic surgeons represented by the Brazilian Society of Plastic Surgery (SBCP). Moreover, SBCP does not approve the use of PMMA as a filler for esthetical purposes in healthy patients.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Successful Treatment of a Complex Vascular Malformation With Sirolimus and Surgical Resection.

Management of complex vascular malformation represents a challenge as it may include a wide variety of options such as embolization, laser therapy, sclerotherapy, and surgical resection but may lead to significant morbidity and is associated with high recurrence rates. In extreme and/or recurrent cases, successful use of sirolimus has been described. We report a case of large unresectable complex venous malformation treated with oral sirolimus for 24 months. Therapy was well tolerated. Patient had substantial improvement in symptoms and shrinkage of the lesion. The Medical Therapy made excision of the malformation possible and patient had a successful surgical procedure. This report provides further evidence that sirolimus should be considered as part of the armamentarium in the management of these rare conditions.

Surgical Treatment of Facial Infantile Hemangiomas: An Analysis Based on Tumor Characteristics and Outcomes.

BACKGROUND: Surgical treatment of infantile hemangiomas may interfere with patient appearance. The use of an algorithm is essential to select candidates. The objective of this study was to evaluate outcomes of surgical treatment based on tumor characteristics. METHODS: Seventy-four patients were treated surgically between 1997 and 2010. Demographics, tumor characteristics, surgical approach, and outcomes were evaluated. RESULTS: The female-to-male ratio was 5.7:1. Mean age and follow-up were 24 years and 33 months, respectively. Surgery was elective in 83.8 percent and emergent in 16.2 percent of patients. Most frequent locations were lips, nose, eyelids, and cheeks. Surgery was performed during the proliferative phase in 43 patients (58.1 percent), and growth-related deformity was the main indication. No significant association between sex and the presence of complications or treatment indication was observed. Patients who underwent emergency procedures were younger (p = 0.0031) and had a higher incidence of evolutional complications (p = 0.012). Also, they were more frequently operated on during the proliferative phase (p = 0.011). Favorable outcome of surgical treatment was observed in both simple and complex cases for facial contour, volume reduction, and need for reoperation. The best candidates for elective surgery were patients with localized eyelid, nasal, or lip hemangiomas, presenting growth-related deformities during the proliferative phase. For patients undergoing emergency procedures, the best candidates were nonresponders to pharmacologic therapy with segmental periorbital hemangiomas, treated by partial resection. CONCLUSIONS: A profile of patients and their specific surgical approach was established. Satisfactory results could be achieved following the proposed algorithm. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Surgical treatment of extracranial arteriovenous malformations after multiple embolizations: outcomes in a series of 31 patients.

BACKGROUND: Surgical resection after embolization is the most accepted approach to treating arteriovenous malformations. The authors analyzed the outcome of surgically treated patients and how surgical resection was influenced by multiple embolizations. METHODS: Thirty-one patients were included from January of 2000 to December of 2012. The mean patient age was 24.9 years. Anatomical involvement, definition of limits, functional impairment, number of embolizations, type of resection, reconstruction method, blood transfusion, and hospital stay were evaluated. Morbidity, mortality, and regrowth rates and need for additional procedures were evaluated. RESULTS: Lesions were preferentially located at the orbits, cheeks, and lips. The number of embolizations per patient increased with lesion complexity. In 22 cases, total excision was accomplished, and in nine, subtotal resections were performed to favor function. After multiple embolizations, better lesion identification was observed. Primary closure was performed in 20 cases, local flaps were performed in seven cases, axial flaps were performed in two patients, and free flaps were performed in two cases. There were no deaths. Regrowth rates were influenced by limits between arteriovenous malformations and surrounding tissues (15.8 percent of cases with precise limits versus 58.3 percent of lesions with imprecise limits; p = 0.021) and by type of resection (18.2 percent of cases after total resection versus 66.7 percent after subtotal resections; p = 0.015). CONCLUSIONS: Multiple therapeutic embolizations seem to increase safety in the treatment of arteriovenous vascular malformations and suggest an additional positive effect besides bleeding control. Preoperative definition of limits and establishment of conditions for total resection are critical to determine management and risk of regrowth. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Soccer-related Facial Trauma: Multicenter Experience in 2 Brazilian University Hospitals.

BACKGROUND: Soccer is the most popular sport in Brazil and a high incidence of related trauma is reported. Maxillofacial trauma can be quite common, sometimes requiring prolonged hospitalization and invasive procedures. To characterize soccer-related facial fractures needing surgery in 2 major Brazilian Centers. METHODS: A retrospective review of trauma medical records from the Plastic Surgery Divisions at the Universidade Federal de São Paulo-Escola Paulista de Medicina and the Hospital das Clinicas-Universidade de São Paulo was carried out to identify patients who underwent invasive surgical procedures due to acute soccer-related facial fractures. Data points reviewed included gender, date of injury, type of fracture, date of surgery, and procedure performed. RESULTS: A total of 45 patients (31 from Escola Paulista de Medicina and 14 from Universidade de São Paulo) underwent surgical procedures to address facial fractures between March 2000 and September 2013. Forty-four patients were men, and mean age was 28 years. The fracture patterns seen were nasal bones (16 patients, 35%), orbitozygomatic (16 patients, 35%), mandibular (7 patients, 16%), orbital (6 patients, 13%), frontal (1 patient, 2%), and naso-orbito-ethmoid (1 patient, 2%). Mechanisms of injury included collisions with another player (n = 39) and being struck by the ball (n = 6). CONCLUSIONS: Although it is less common than orthopedic injuries, soccer players do sustain maxillofacial trauma. Knowledge of its frequency is important to first responders, nurses, and physicians who have initial contact with patients. Missed diagnosis or delayed treatment can lead to facial deformities and functional problems in the physiological actions of breathing, vision, and chewing.

Alterações dentoesqueléticas decorrentes da Expansão Rápida da Maxila Assistida Cirurgicamente (Ermac) / Dental and skeletal changes following Surgically Assisted Rapid Maxillary Expansion (Sarme)

Este estudo avaliou as alterações produzidas nos arcos dentais superiores de pacientes submetidos à Expansão Rápida da Maxila Assistida Cirurgicamente (Ermac). A amostra utilizada foi composta por 54 modelos de gesso superiores de 18 pacientes, sendo seis do sexo masculino e 12 do sexo feminino, com média de idade de 23,3 anos. Para cada paciente foram preparados três modelos de gesso: inicial, antes do procedimentooperatório (T1), pós-expansão e contenção, três meses pós-cirurgia, (T2) e seis meses pós expansão (T3). O dispositivo expansor utilizado foi o disjuntor tipo Hyrax. O procedimentocirúrgico adotado foi a osteotomia lateral da maxila sem o envolvimento da lâmina pterigoide, osteotomia da espinha nasal à linha média dental, separação da sutura palatina mediana e separação do septo nasal. As medidas foram realizadas por meio da máquina de mediçãotridimensional, baseando-se nas alterações nos três planos. Concluiu-se que: 1. Houve um aumento estatisticamente significante nas distâncias transversais em todos os grupos de dentes (de incisivos centrais até segundos molares) de 1l para T2, demonstrando a efetividadedo tratamento. De T2 para T3 não houve diferença estatisticamente significante para nenhuma variável, indicando, assim, estabilidade após seis meses do término da Ermac; 2. Houve um aumento estatisticamente significante nas inclinações dos primeiros molaresdos lados direito e esquerdo, porém sem diferença para os primeiros pré-molares; 3. Houve um aumento estatisticamente significante na largura palatina entre T1 x T2 e T1 x T3; 4. Não foram observadas diferenças estatisticamente significantes na profundidade palatina nos intervalos analisados.

This study evaluated the alterations produced in the superior dental arcs of patients submitted to the Surgically Assisted Rapid Maxillary Expansion. The sample was composed of 54 orthodontic models of 18 patients (six males and 12 females). The average age was 23,3 years. For each patient three orthodontic models had been prepared: pre-operative stage (T1), three months after the operative procedure (T2), and six months of post-expansion period (T3). The appliance used in this study was the Hyrax type. The adopted surgical procedure was the lateral osteotomy of the maxilla, without involving the pterygoid pia te, osteotomy from the nasal spine to the maxillary dental midline, the midpalatal suture separation and the separation of nasal septum also. The measures had been carried, based on the alterations in the three plans. Conclusions: 1. There were statistically significant increase in the transversal distances in all the teeth groups (from central incisors to second molars) of T1 for T2, demonstrating the effectiveness of the treatment. The variables did not show statistically significant difference of T2 for T3, indicating stability after six months following the Sarme; 2. There were a statistically significant increase in the inclinations of the tirst molar of right and left sides, but there is no difference for first bicuspid; 3. There were an increase statistically significant in the palatine width between T1 x T2 and T1 x T3; and 4. Statistically significant differences were not observed in the palatine depth in the analyzed intervals.

Hyrax appliance opening and pattern of skeletal maxillary expansion after surgically assisted rapid palatal expansion: a computed tomography evaluation.

OBJECTIVE: The objective of this study was to evaluate, using computed tomography, correlations between Hyrax appliance opening and post-SARPE skeletal changes. STUDY DESIGN: Fifteen patients underwent SARPE according to a specific protocol and were followed. Linear and angular measurements of the anterior, intermediate, and posterior portions of the maxilla were evaluated. The correlation between maxillary expansion and appliance opening was investigated. RESULTS: Significant overall expansion was observed. In the anterior and intermediate portions of the maxilla, the increase in maxillary width was greater than that observed in the posterior portion. The degree of appliance opening was significantly greater than that of the skeletal expansion. Also, no linear correlation between appliance opening and regional maxillary expansion was established. CONCLUSION: The transverse expansion of the maxilla was less than uniform. The lack of linear correlation between appliance opening and skeletal expansion is attributable to multiple factors, including those related to the device, the surgical technique, and the craniofacial deformity itself.

The role of micro-anchor devices in medial canthopexy.

Telecanthus, the lateral displacement of the medial canthus, can be a congenital deformity or can occur after facial trauma or tumor resection. Treatment of telecanthus remains a challenge for plastic surgeons. For proper correction, it is necessary to shift the medial canthus medially, fixing its tendon to the bone. The ideal technique would allow easy, safe, and stable fixation of the tendon, permit a unilateral approach with minimal incisions, and be cost-effective. The purpose of this study was to evaluate the feasibility and results (immediate and long-term) of medial telecanthus repair using ipsilateral titanium microanchor fixation. Nine patients, 7 with unilateral telecanthus and 2 with bilateral telecanthus, underwent ipsilateral canthopexy involving a microanchor device. Anthropometric measurements of the orbital regions were taken before, immediately after, and at 1 year after surgery. Data for the affected sides were compared with those for the unaffected sides, and the evolution of those values was assessed throughout the 1-year follow-up period. For all patients, the final values were lower than those initially obtained. At 1 year after surgery, the intercanthal distance was reduced to age-adjusted normal values in all cases. On the operated side, stable improvement was observed in terms of the distance from the medial canthus to the midline, although some degree of recurrence was noted in most of the patients. The use of a microanchor system for medial canthopexy can be considered an easily performed and effective option for treating canthal dystopia, especially when an ipsilateral approach is preferred.

Ressecção volumétrica nas anomalias vasculares dos lábios: tática cirúrgica e avaliação dos resultados / Volumetric resection in the lips vascular anomalies: surgical technique and results evualtion

O tratamento das anomalias vasculares consiste em grande desafio. As dificuldades de classificação e terminologia retardaram, significativamente, o desenvolvimento de uma filosofia adequada na abordagem terapêutica dessas lesões. Método: Estudo prospectivo realizado envolvendo nove pacientes portadores de anomalias vasculares de baixo fluxo nos lábios, incluindo malformações venosas, linfáticas e hemangiomas, com o objetivo de padronizar um método confiável de abordagem cirúrgica em casos indicados, procurando evitar seqüelas e deformidades decorrentes de ressecções excessivas. Em sete dos nove pacientes, as lesões eram basicamente restritas ao vermelhidão e a técnica foi padronizada. Nos outros dois, as lesões acometiam principlamente a pele dos lábios, necessitando modificações individuais. Os resultados foram avaliados de forma objetiva, com medidas labiais determinadas, comparadas pré e pós- operatoriamente, e subjetiva, por meio de questionários preenchidos pelos pacientes ou responsáveis, contendo aspectos psicossociais e estéticos. Houve, ainda, avaliação comparativa realizada por dois cirurgiões plásticos independentes, por meio de uma escala de pontuação. Conclusão: Concluiu-se que a técnica sugerida é segura, simples e eficaz, com benefícios estéticos e funcionais elevados, alto grau de satisfação de pacientes/familiares e baixos índices de complicações.

Fissura número 9 de Tessier: aspectos clínicos radiológicos e abordagem cirúrgica / Tessier number 9 cleft: clinical and radiological aspects and surgical approach

Devido a sua raridade, poucos relatos na literatura detalham os aspectos clínicos e radiológicos da fissura 9 de Tessier. A proposta do presente estudo é descrever cinco pacientes portadores desta fissura facial. No período entre 1999 e 2006, conco pacientes foram acompanhados em nosso serviço, com o diagnóstico de fissura 9 de Tessier. Destes, qutro eram do sexo feminino e apresentavam fissuras unilaterais. Em um único caso, a fissura 9 foi único achado clínico. Em dois pacientes, outras fissuras faciais foram observadas e, em outros dois pacientes, outras deformidades craniofaciais estavam associadas, incluindo microftalmia, ptose palpebral grave, além de deformidades em extremidades. As deformidades em partes moles e esqueléticas não eram porporcionais, observando-se deformidades leves em partes moles associadas a fissuras completas e deformidades graves de partes moles associadas a fissuras parciais. As deformidades orbitárias foram tratadas por meio de reconstrução palpebral, reposicionamento do canto lateral e cranioplastias. A presença de banda fibrosa ao longo da fissura foi essencial para reposicionamento tecidual adequado. As deformidades de partes moles e as deformidades esqueléticas não são proporcionais, tornando complexa uma única teoria etiológica para seu aparecimento e dificultando muitas vezes o diagnóstico. Investigação dos sinais clínicos de métodos de imagem é fundamental para o diagnóstico adequado e, conseqüentemente, para o tratamento cirúrgico apropriado.

Comprometimento pulmonar em trauma eletrico: relato de caso / Pulmonary lesion in eletric injury: case report

Trauma eletricos severos constituem cerca de 5 por cento das admissoes em Unidades de Queimados. O acometimento visceral pela corrente eletrica apresenta grande morbidade e mortalidade. A presenca de lesoes viscerais sem continuidade com lesao de partes moles e pouco referida, porem de extrema gravidade, principalmente pela dificuldade diagnostica que apresenta. Lesoes cardiacas tem sido mais frequentemente relatadas, ocorrendo em 10 a 25 por cento dos pacientes, consistinto basicamente em arritmias e disturbios de conducao, consequentes a espasmos coronarios ou lesao muscular difusa pela corrente...

Queimaduras eletricas dos membros superiores / Electrical burns of the upper limbs

No periodo de 27 meses, entre 1991 e 1993, 15 pacientes apresentando lesoes dos membros superiores ocasionados por descargas eletricas foram atendidos no Pronto Socorro de Queimaduras do Hospital das Clinicas da FMUSP. Representam uma condicao frequentemente dramatica, onde o conhecimento da fisiopatologia deste tipo de trauma e condicao fundamental para estabelecer um diagnostico preciso e intervencao mais precoce. Mesmo apos longos periodos de internacao (media:2 meses), a reintegracao desses pacientes determina elevados encargos socio-economicos, devido ao alto indice de sequelas definitivamente incapacitantes. Baseados na experiencia adquirida, preconizamos uma abordagem menos agressiva, porem seguida de frequentes reavaliacoes, que possibilitarao abreviar o periodo necessario para recuperacao desses individuos.