Orthognathic surgery in a patient with von Willebrand disease: case report

Aim: This study aims to report the perioperative management of a patient with von Willebrand disease (vWd) who underwent orthognathic surgery. The report follows the guidelines of the Case Report Guidelines (CARE) and focuses on the steps taken to prevent bleeding during the surgical procedure. Methods: A 39-year-old female patient with skeletal Class III was treated with maxillary advancement and mandibular setback. Despite normal test results for ristocetin cofactor activity, measures were taken to prevent bleeding, including atraumatic surgical techniques, use of antifibrinolytic medication, induced hypotension during anesthesia, and preparation of blood products for transfusion during trans and postoperative periods if needed. In the end, these measures were not required. Results: The patient did not experience any bleeding during the surgical procedure or postoperative period, demonstrating the effectiveness of the measures taken to manage their blood dyscrasia. Two years after the surgery, the patient had satisfactory aesthetic and functional results and no evidence of relapse. Conclusion: Thus, this case report demonstrates that vWd does not prevent largescale oral and maxillofacial surgeries such as orthognathic surgery as long as proper precautions are taken pre-, intraand postoperatively

Oral and maxillofacial rehabilitation of a patient suffering from intraosseous adenoid cystic carcinoma / Reabilitação bucomaxilofacial de paciente portador de carcinoma adenóide cístico intraósseo

ABSTRACT Treatment of cancers of the head and neck may provoke sequelae that affect the quality of life of patients during and after treatment. Mouth-sinus communication resulting from partial or total surgical resection of the palate leads to the patient experiencing dysphagia, dysphonia and trismus, which can lead to social isolation of the individual. As a result, the work of the dental surgeon, together with the multidisciplinary team caring for cancer patients, is fundamental and can help with the diagnosis, assist in the management of chemotherapy and radiotherapy complications and enable postsurgical rehabilitation. The present study reports the case of a patient with adenoid cystic carcinoma in the right maxilla, who underwent a partial maxillectomy, the resulting sequela being mouth-sinus communication. The dental treatment was performed at the Hospital of the Federal University of Pelotas preoperatively, during and after treatment. At this time the patient is rehabilitated with an obturator prosthesis and is being monitored by the dental team and the head and neck surgeon.

RESUMO O tratamento das neoplasias em região de cabeça e pescoço pode deixar sequelas que afetam a qualidade de vida do paciente durante e após o tratamento. A comunicação buconasosinusal decorrente da ressecção cirúrgica parcial ou total do palato traz ao paciente alterações na função mastigatória, estética, fonética e de deglutição o que pode levar a um isolamento social do indivíduo. Em vista disso, a atuação do cirurgião dentista junto à equipe multiprofissional de atendimento ao paciente oncológico se faz fundamental, podendo contribuir no diagnóstico, auxiliar no manejo de complicações do tratamento quimioterápico/radioterápico, e na reabilitação bucomaxilofacial, sendo esta uma alternativa para melhorar a qualidade de vida do paciente, pois visa restabelecer as funções alteradas em decorrência do procedimento cirúrgico. O presente estudo relata o caso de uma paciente portadora de carcinoma adenóide cístico na maxila submetida à maxilectomia parcial, deixando como seqüela a comunicação buconasosinusal. O acompanhamento odontológico foi realizado no Hospital Escola da Universidade Federal de Pelotas no pré-operatório, durante e após o tratamento. No momento a paciente está reabilitada com uma prótese obturadora em acompanhamento pela equipe de odontologia e pelo cirurgião de cabeça e pescoço.