Computed tomography analysis of fascial space involvement demonstrates correlations with laboratory tests, length of hospital stays and admission to the intensive care unit in odontogenic infections

Abstract Objectives: Odontogenic infections are frequent and can spread, leading to complications such as sepsis and the need for admission to an Intensive Care Unit (ICU). The purpose of this study was to perform a computed tomography analysis of the fascial space involvement and correlate with personal data, laboratory tests, length of hospital stays and admission to the ICU in patients with odontogenic infections who required hospitalization. Methods: Patients with odontogenic infections admitted between June 2017 and May 2018 were prospectively evaluated. The fascial spaces involved were studied using computed tomography with contrast. The possible correlations of tomographic findings with comorbidities, nutritional status, the causative tooth, laboratory tests, length of hospital stays and admission to the ICU were analyzed. Results: We identified 66 cases of odontogenic infections which were admitted in the period analyzed. The involvement of primary spaces (86.7%) predominated, followed by secondary ones (8.7%), and cervical (4.6%). The most frequently involved fascial spaces were submandibular (27.1%), buccal (20.8%), sublingual (18.3%), submental (16.7%), and others (17.1%). There were significant differences between laboratory tests (p < 0.001), mean hospital stays (p < 0.001), and admissions to the ICU (p < 0.001) depending on the number of fascial spaces involved. There was no influence of comorbidities, nutritional status, or causative tooth on fascial space involvement. Conclusion: There was a relationship between greater involvement of fascial spaces assessed by computed tomography and higher values of laboratory tests, more extended hospitalization stays and admission to the ICU. Level of evidence: Level 2b.

Cone-beam computed tomography analysis of degenerative changes, condylar excursions and positioning and possible correlations with temporomandibular disorder signs and symptoms

Aim: To describe cone-beam computed tomography (CBCT) features in patients with temporomandibular disorders (TMDs), in terms of degenerative changes, condylar excursions and positioning as well as their possible correlations with signs and symptoms. Methods: Clinical records of patients diagnosed with TMD who were seen between January 2018 and December 2019 were retrospectively evaluated. These patients were divided into the following groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): arthralgia, myalgia, and arthralgia and myalgia groups. The CBCT examination findings of the patients were evaluated in relation to degenerative changes, estimates of condylar excursion, and condylar positioning. The likelihood ratio test was used to verify the possible differences among the three groups, whereas the chi-square test was used to verify the possible differences among the signs and symptoms for the tomographic findings (p ≤ 0.050). Results: In this study, 65 patients with TMD were included. These patients were predominantly female (84.6%) with a mean age of 40.6 years. Tomographic findings of flattening, hyperexcursion and posterior condylar positioning were frequent. A significant correlation was noted between osteophyte and lateral capsule pain (p = 0.027), erosion and posterior capsule pain (p = 0.026), and flattening, pseudocysts (p < 0.050) and condylar excursion (p < 0.001) with mouth opening. Conclusion: Few correlations were noted between degenerative changes and signs of joint pain as well as degenerative changes and condylar hypoexcursion with mouth opening. These correlations were likely associated with division by diagnosis, whereas condylar positioning did not correlate with signs and symptoms

Computed tomography analysis of fascial space involvement demonstrates correlations with laboratory tests, length of hospital stays and admission to the intensive care unit in odontogenic infections.

OBJECTIVES: Odontogenic infections are frequent and can spread, leading to complications such as sepsis and the need for admission to an Intensive Care Unit (ICU). The purpose of this study was to perform a computed tomography analysis of the fascial space involvement and correlate with personal data, laboratory tests, length of hospital stays and admission to the ICU in patients with odontogenic infections who required hospitalization. METHODS: Patients with odontogenic infections admitted between June 2017 and May 2018 were prospectively evaluated. The fascial spaces involved were studied using computed tomography with contrast. The possible correlations of tomographic findings with comorbidities, nutritional status, the causative tooth, laboratory tests, length of hospital stays and admission to the ICU were analyzed. RESULTS: We identified 66 cases of odontogenic infections which were admitted in the period analyzed. The involvement of primary spaces (86.7%) predominated, followed by secondary ones (8.7%), and cervical (4.6%). The most frequently involved fascial spaces were submandibular (27.1%), buccal (20.8%), sublingual (18.3%), submental (16.7%), and others (17.1%). There were significant differences between laboratory tests (p < 0.001), mean hospital stays (p < 0.001), and admissions to the ICU (p < 0.001) depending on the number of fascial spaces involved. There was no influence of comorbidities, nutritional status, or causative tooth on fascial space involvement. CONCLUSION: There was a relationship between greater involvement of fascial spaces assessed by computed tomography and higher values of laboratory tests, more extended hospitalization stays and admission to the ICU. LEVEL OF EVIDENCE: Level 2b.

Do the stages of orthodontic-surgical treatment affect patients' quality of life and self-esteem?

The orthodontic-surgical treatment comprises different stages from diagnosis to final soft tissue accommodation, but there are no data regarding the patient's perception during these phases. This study aimed to investigate the impact of these stages on quality of life and self-esteem of patients with dentofacial deformity. Patients were divided into 4 groups according to the treatment stage: initial orthodontic pre-treatment (1), one week before surgery (2), three months after surgery (3), and after the removal of the orthodontic appliance (4) (n = 20 / group). They filled the following questionnaires: Oral Health Impact Profile (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ) and Rosenberg Self-Esteem Scale (RSES). Data were evaluated by Kruskal-Wallis test. Differences among groups were noticed in all evaluated scales (p = 0.001 for all). No statistically significant differences between patients in groups 1 and 2 (OHIP, OQLQ, and RSES, p >0.05 for all), while patients at group 4 presented different scores in all questionnaires compared to 1, 2, and 3 (p < 0.05 for all), irrespective of the type of dentofacial deformity (p > 0.05). The results indicate that dental decompensation stage did not negatively affect patient's confidence and well-being. Despite the improvement noticed few months after the orthognathic surgery, the main impact on patient's quality of life and self-esteem was evidenced after the removal of the orthodontic appliance. We highlight the important role of counselling patients to discuss all the treatment stages to clarify patients' subjective expectations before any intervention is carried out.

Retrospective study of sports-related maxillofacial fractures in a Brazilian trauma care center

Aim: Maxillofacial fractures occur frequently in the general population, and sports-related fractures represent some of these cases. However, few studies have been carried out in Brazilian populations aimed at sports-related maxillofacial fractures. This study assessed the demographic and fracture characteristics of patients with sports-related maxillofacial fractures who were seen at a Brazilian trauma care center. Methods: Medical records of patients with a history of sports-related maxillofacial fractures treated between January 2018 and December 2019 were retrospectively evaluated. Personal data, fracture characteristics, sport type, treatment performed and need for hospitalization were collected. The data were subjected to statistical analyses with likelihood ratio test using the Statistical Package for Social Sciences (SPSS) 25.0 (p ≤ 0.050). Results: Forty cases (4.96% of the total) of facial fractures were included. The mean age was 24.9 (± 9.8) years, with a predominance of males (92.5%). The use of protective equipment was rare. The most frequently involved sport modality was soccer (47.5%), followed by cycling (27.5%). The most frequent fracture location was nose (45%), followed by mandible (25%) and zygomatic complex (17.5%). Soccer was responsible for most nose fractures (61.1%), while cycling caused the majority of mandibular fractures (60%). Conservative treatment predominated (60%). There was only a significant difference between fracture location and the need for hospitalization (p = 0.021). Conclusion: Patients with sportsrelated maxillofacial fractures were typically young adult males, the injury was more often located in the nose and mandible and related to soccer or cycling. The use of protective equipment must be reinforced

Occurrence and remission of loss of sensitivity of inferior alveolar nerve in mandibular fractures

ABSTRACT Purpose: to evaluate the occurrence of loss of sensitivity of the inferior alveolar nerve, and to monitor the remission of this change in patients with mandibular fractures subjected to surgical treatment. Methods: patients with mandibular fractures, surgically treated within one year, were prospectively evaluated. Data regarding etiology, fracture location, type and displacement, and surgical access, were obtained. The tactile and thermal tests were applied at eighteen points in the mental region, within a period of six months. Statistical tests were applied to compare the categories of variables and the period of observation (p ≤ 0.050). Results: during the study, 37 patients were included. There were 24 bilateral and 13 unilateral fractures. Sensory changes occurred in 56.8% of the patients in the preoperative period, in 83.8% of the patients, in the postoperative period, and 35.1% of the patients presented complete remission during the final period of the study. Conclusion: sensory changes occurred in about half of the patients, due to the fracture, increasing greatly in the postoperative period, with complete remission in about one third of the cases. The fracture type, degree of displacement and surgical access type influenced the occurrence of sensory alterations.

Impact of Temporomandibular Joint Discectomy on Condyle Morphology: An Animal Study.

PURPOSE: Temporomandibular disorders lead to parafunctional activity that may alter bone remodeling of mandibular components. This animal study aimed to assess the impact of temporomandibular joint discectomy on condylar bone microarchitecture. MATERIALS AND METHODS: A total of 30 one-month-old Wistar rats were assessed and divided into 3 equal groups (2 test groups and 1 control group) of 10. The first test group underwent disc removal, the second test group underwent disc and condylar cartilage removal, and the 10 remaining rats were analyzed as sham-operated controls, following a split-mouth design. The rats were killed humanely 2 months after surgery, and the respective mandibles were scanned with micro-computed tomography for quantitative morphometric analysis. RESULTS: There were significant differences among the 3 groups analyzed (disc removal, disc and condylar cartilage removal, and sham-operated control) for bone volume fraction (ratio of bone volume to total volume, P = .044), structure model index (P < .001), fractal dimension (P = .024), and porosity (P = .023). In addition, operated and contralateral nonoperated sides significantly differed for all variables in at least 1 of the test groups (P < .05) but not in the control group (P > .05). CONCLUSIONS: Within the limitations of this study, our results suggest that discectomy may lead to alterations of the mandibular condylar morphology.

Adverse effects of the amlodipine on bone healing of the mandibular fracture: an experimental study in rats.

BACKGROUND: Calcium channel blockers are effective antihypertensive agents, but they may affect many metabolic processes, including bone metabolism. PURPOSE: The aim of this study was to evaluate by radiographic, histologic, and biochemical analyses the effects of amlodipine on bone healing of a defect simulating a fracture in mandibular ramus of rats. METHODS: Fifty male Wistar rats were submitted to the same unilateral surgical procedure simulating a mandibular fracture. Experimental group received oral doses of amlodipine 0.04 mg/rat/day starting 12 days before procedure, while control group received water. Animals were sacrificed at 1, 7, 14, 30, and 90 days postoperatively. Numerical values were submitted to statistical analyses. RESULTS: Radiographic analysis showed larger radiolucent area into bone defect to the experimental group at the periods of 14 (p = 0.016), 30 (p = 0.009), and 90 (p = 0.028) days. In the histological analysis, the experimental group had a slight delay in the chronology of the repair process. In the histomorphometric analysis, the experimental group presented significant lowering of newly formed bone volume at 7 and 14 days periods (p = 0.049). There was a significant decrease of alkaline phosphatase levels in experimental group in the initial periods (p = 0.049). CONCLUSIONS: It was concluded that chronic use of amlodipine compromised bone neoformation in the repairing process of surgical defect in the mandibular ramus of rats, but no precluded occurrence of fracture consolidation.

Enfisema subcutâneo durante a remoção de terceiros molares: aspectos de interesse ao cirurgião-dentista / Subcutaneous emphysema during removal of third molars: aspects of interest to the surgeon

O enfisema subcutâneo é um acidente relativamente raro em odontologia, sendo provocado pela penetraçãoforçada de ar ou outros gases para dentro dos tecidos moles, resultando na distensão da pele ou mucosa sobrejacentes. As causas mais comuns se relacionam ao ar liberado pela caneta de alta rotação ou pela seringatríplice. Geralmente seu tratamento é apenas sintomático e apresenta boa resolução, mas, dependendo da localização anatômica e do volume de ar injetado, espaços fasciais profundos podem ser atingidos e evoluir para complicações infecciosas ou cardiorrespiratórias que ameaçam a vida. Objetivos: O objetivo deste estudoé descrever um caso de enfisema subcutâneo periorbital. Relato de caso: Tal episódio se desenvolveu numamulher com trinta anos de idade durante uma cirurgia de remoção dos terceiros molares, realizada com turbina de alta rotação, e alertar os cirurgiões dentistas sobre os principais aspectos relacionados a este acidente.O diagnóstico imediato foi obtido com base no rápido aumento de volume da área afetada, associado à crepitaçãoà palpação. O tratamento envolveu o controle medicamentoso do desconforto local e antibioticoterapia, assim como o acompanhamento de possíveis alterações cardiorrespiratórias. Houve remissão espontânea do enfisema subcutâneo após duas semanas. Considerações finais: embora o enfisema subcutâneo necessite de acompanhamento clínico diá rio, sua regressão geralmente ocorre sem complicações. O conhecimentoadequado de todos os aspectos associados ao enfisema subcutâneo é fundamental para o cirurgião-dentistaprevenir sua ocorrência e tratá-lo corretamente

Maloclusões morfológicas e sinais verificados em pacientes com disfunções temporomandibulares / Morphologic malocclusion and signs verified in patients with temporomandibular dysfunctions

Os autores avaliaram a freqüência e as características das maloclusões morfológicas e os sinais presentes em 30 pacientes portadores de disfunções da articulação temporomandibular (ATM). Foi utilizada a classificação de Angle e avaliadas outras maloclusões morfológicas, sendo os pacientes examinados com palpação dos músculos da mastigação e da região cervical e da ATM. Foi encontrada maior freqüência da classe II, mordida profunda e pacientes sem ausência dentária. Os músculos mais envolvidos foram masseter seguido do pterigóideo medial. Os sinais articulares de maior freqüência foram os estalos e dor na ATM lateral à cápsula. Foi concluído que houve associação entre a ocorrência de sinais articulares ou musculares com maloclusão classe II e mordida profunda, enquanto que sinais articulares foram associadas a pacientes sem ausências dentárias e sinais musculares foram associados a pacientes com ausências dentárias.

Avaliação clínica dos procedimentos de expansão cirurgicamente assistida da maxila (ECAM) / Clinical evaluation of surgically assisted maxillary expansion (SAME)

OBJETIVO: avaliação clínica dos procedimentos de expansão cirurgicamente assistida da maxila. METODOLOGIA: foram avaliados 10 pacientes tratados através da expansão ortopédica com auxílio cirúrgico, conhecida como expansão cirurgicamente assistida da maxila (ECAM). Avaliou-se a efetividade deste procedimento cirúrgico no auxílio à expansão transversal da maxila proporcionada através de aparelho do tipo Hyrax, a estabilidade desta expansão, as ocorrências pós-operatórias, a quantidade e qualidade da expansão conseguida e alterações estéticas deste procedimento. RESULTADOS E CONCLUSÕES: concluiu-se, com um acompanhamento a longo prazo, que a ECAM trata-se de um procedimento eficiente, estável, que proporciona mudanças funcionais e pouca alteração estética facial.

Avaliação quantitativa dos movimentos mandibulares horizontais e verticais em relação aos tipos faciais propostos por Ricketts. Parte I: movimentos mandibulares / Quantitative evaluation of the horizontal and vertical mandibular positions in connection with the facial types proposed by Rickets. Part I: mandibular border positions

Introdução - A avaliação dos movimentos bordejantes da mandfbula é um importante exame para verificar as condições de saúde da articulação temporomandibular e/ou da musculatura da mastigação. Embora existam valores médios considerados normais, descritos na literatura, estes são, geralmente, o resultado de estudos realizados em uma população geral, isto é, sem a consideração das diferentes características faciais dos indivíduos. Métodos - Na primeira parte deste estudo, avaliaram-se os movimentos bordejantes da mandíbula de um grupo de 95 adultos jovens do sexo feminino, sem sinais nem sintomas de desordens temporomandibulares. Num segundo estudo, os resultados foram correlacionados aos tipos faciais propostos por Ricketts et aL28 (1982), no intuito de contribuir para o aperfeiçoamento do diagnóstico das desordens temporomandibulares (DTM). Os valores médios e limites "normais" mínimos foram comparados a outros relatados na literatura odontológica. Resultados - Os resultados obtidos neste estudo mostraram valores médios da extensão dos movimentos bordejantes da mandíbula semelhantes a outros registrados na literatura para movimento de abertura bucal máxima, passiva e ativa. No entanto, os movimentos de lateralidade e protrusão foram, em média, menores do que aqueles registrados na literatura. Conclusão - Os valores-limites mínimos para movimentos mandibulares verticais e horizontais, encontrados neste estudo, estão próximos dos de outros trabalhos registrados na literatura.

Manifestações clínicas e tratamento cirúrgico da displasia cementiforme / Clinical manifestations and surgical treatment of cemental dysplasia

Foi realizado um estudo sobre as manifestações clínicas e o tratamento cirúrgico da displasia cementiforme. São apresentados oito casos clínicos em que essa lesão foi tratada e os achados são discutidos com os encontrados na literatura. As lesões ocorreram no gênero feminino com idade média de 53,1 anos. A maioria dos casos apresentou queixa de dificuldade de utilização de prótese total. Clinicamente, metade dos casos foi classificada como displasia cemento-óssea focal e metade, como displasia cemento-óssea florida. A excisão das lesões constou basicamente de osteotomia com broca cirúrgica e liberação com cinzéis, sendo que cuidados foram tomados na preservação do processo alveolar, com osteotomia vestibular. O exame anatomopatológico das lesões removidas confirmou o diagnóstico de displasia cementiforme

Sintomatologia das disfunções da articulação temporomandibular conforme o gênero e a faixa etária por meio dos índices de Helkimo / Symptomatology of temporomandibular joint dysfunctions according to gender and age through Helkimo`s indexes

Introdução - Estudos tem afirmado haver influência de faixa etária e independência do gênero na sintomatologia das disfunções de articulação temporomandibular (DTM). A utilização de índices permite a quantificação confiável dos sinais e sintomas. Métodos - Foi analisada a sintomatologia das DTM conforme o gênero e a faixa etária por meio dos índices de Helkimo. Os valores destes índices foram obtidos do prontuário de setenta pacientes com diagnóstico de DTM. Resultados - Com a aplicação do teste de qui-quadrado não houve diferença significante de acordo com o Índice Anamnésico e gênero (p = 0,100) e o Índice Anamnésico e a faixa etária (p = 0,267). Com a aplicação do teste t de Student de acordo com o Índice Clínico de Disfunção e gênero houve diferença significante (p = 0,034). Com a aplicação do teste ANOVA de acordo com o Índice Clínico de Disfunção e faixa etária não houve diferença significante (p = 0,124). Conclusão - Foi concluído que apenas foi significante a diferença entre os gêneros com a utilização do Índice Clínico de Disfunção