Nonsyndromic oral clefts and associated risk factors in the state of Bahia, Brazil.

AIM: Nonsyndromic cleft lip and/or palate (NSCL ± P) is the most common craniofacial birth defect. This study aims to determine demographic characteristics and the epidemiologic profile of NSCL ± P in Bahia, Brazil. SUBJECT AND METHODS: 692 patients of three Cleft Lip and Palate Treatment Centers were interviewed. RESULTS: Cleft lip and palate (CLP) was the most frequent type of oral cleft (52.8%), particularly unilateral (34.8%) and affecting the left side (p < 0.001). Family history of cleft was found in 27.6%, especially between cousins (49.7%; p < 0.001). The Salvador metropolitan area represented 45.2% of the samples, followed by Mid-South (17.7%) and Mid-North Bahia (13.9%). In the South of the state, the risk of developing CL and CLP was statistically significant (p = 0.03; p = 0.006, respectively), and in the region of Vale do São Francisco there was a significant risk of developing CLP (p = 0.01), both in relation to CP. Young age and alcohol use in pregnancy were associated to giving birth to children with CLP (p = 0.02, p = 0.03, respectively). The use of folate and other vitamins diminished the risk of developing CL and CLP if compared to CP (p = 0.009). CONCLUSION: It is hoped that the results of this research may be useful in planning actions of public service that should take care of affected individuals.

Extenso ameloblastoma unicístico em mandíbula: relato de caso / Extensive unicystic ameloblastoma in the mandible: case report

Objetivo: relatar um caso de ameloblastoma unicístico em região anterior de mandíbula, descrevendo os métodos diagnósticos utilizados e o tratamento empregado. Relato de caso: paciente do gênero feminino, com 40 anos de idade, compareceu ao serviço de Cirurgia e Traumatologia Bucomaxilofacial da Faculdade de Odontologia da Universidade Federal da Bahia, com queixas de aumento de volume em região anterior de mandíbula, com evolução de 10 meses. O exame de imagem revelou lesão unilocular extensa que expandia cortical óssea em região de mento. Optou-se pela biópsia excisional da lesão, sob anestesia geral. O exame do espécime obtido confirmou o diagnóstico de ameloblastoma unicístico, para o qual se decidiu pela manutenção da terapêutica inicial. A paciente segue em acompanhamento pela equipe, sem sinais de recidivas. Considerações finais: o manejo do ameloblastoma unicístico, por vezes, demanda a biópsia excisional da lesão, a fim de diferenciá-la dos cistos odontogênicos e de individualizar seu padrão histológico. A abordagem conservadora pode ser adotada, desde que um acompanhamento rigoroso seja procedido. (AU)

Objective: to report a case of unicystic ameloblastoma in the anterior region of the mandible, describing the diagnostic methods used and the treatment applied. Case report: a 40-year-old female patient attended the Oral and Maxillofacial Surgery and Traumatology Service of the School of Dentistry at the Federal University of Bahia, Brazil, complaining of increased volume in the anterior region of the mandible, with a 10-month evolution. Imaging tests revealed extensive unilocular lesion that expanded the cortical bone in the mental region. Excisional biopsy of the lesion was performed under general anesthesia. The examination of the specimen obtained confirmed the diagnosis of unicystic ameloblastoma, for which it was decided to maintain the initial therapy. The patient is still being followed-up by the team, with no signs of relapses. Final considerations: the management of unicystic ameloblastoma sometimes requires excisional biopsy of the lesion to differentiate it from odontogenic cysts and isolate its histological pattern. The conservative approach may be adopted if along with strict monitoring. (AU)

Acesso retromandibular não transparotídeo para tratamento de fratura condilar ­ relato de caso / Non-transparotetic retromandibular access for condilar fracture treatment ­ case report

Os métodos de tratamento para fraturas do côndilo mandibular são bastante controversos e ainda geram discussões entre cirurgiões sobre as indicações e contraindicações para o tratamento conservador ou cirúrgico. Ao optar-se pelo tratamento aberto destas fraturas, os acessos cirúrgicos trazem dúvidas, principalmente com relação às injurias ao nervo facial. Os inúmeros acessos descritos na literatura apresentam peculiaridades anatômicas, sendo os extrabucais pré-auricular, submandibular (Risdon) e retromandibular os mais utilizados. A abordagem retromandibular foi descrita pela primeira vez por Hinds;Girotti (1967)5, e é realizada através da divulsão do sistema músculo-aponeurótico superficial (SMAS) e na intimidade da glândula parótida, entretanto, novas formas de abordagem retromandibular têm sido descritas. Sendo assim, o objetivo desse trabalho é demonstrar o passo a passo do acesso retromandibular não transparotídeo realizado através de uma incisão localizada posteriormente ao ramo mandibular, abaixo do lóbulo da orelha, sendo que os cotos fraturados são acessados através de uma clivagem entre a glândula parótida e o músculo masseter, utilizada rotineiramente pela equipe de Cirurgia Bucomaxilofacial do Hospital Geral do Estado da Bahia, como alternativa terapêutica para fraturas do côndilo mandibular. O acesso retromandibular constitui-se como excelente alternativa para cirurgias de tratamento das fraturas condilares, apresentando bons resultados funcionais, estéticos e baixa morbidade ao nervo facial (AU).

Treatment methods for mandibular condyle fractures are quite controversial and still generate discussions among surgeons about indications and contraindications of conservative or surgical treatment. When choosing the open treatment of these fractures, the surgical accesses bring doubts, mainly regarding to injuries to the facial nerve. The numerous accesses described in the literature present anatomical peculiarities, the pre-auricular extrabuccal, submandibular (Risdon), and the retromandibular are the most used. The retromandibular approach was first described by Hinds;Girotti (1967), and is performed through the divulsion of the superficial musculo-aponeurotic system (SMAS) and in the intimacy of the parotid gland, however, new forms of retromandibular approach have been described. Thus, the objective of this work is to demonstrate the step-by-step non-transparotetic retromandibular access by means of an incision located posteriorly to the mandibular branch, below the earlobe, where the fractured stumps are accessed through a cleavage between the parotid gland and the masseter muscle, routinely used by the Buccomaxillofacial Surgery team of the General Hospital of the State of Bahia, as a therapeutic alternative for mandibular condyle fractures. Retromandibular access is an excellent alternative for condylar fracture surgery, presenting good functional and aesthetic results, and facial nerve low morbidity (AU).

Dental anomalies inside the cleft region in individuals with nonsyndromic cleft lip with or without cleft palate

BACKGROUND: Individuals with nonsyndromic cleft lip with or without cleft palate (NSCL±P) present high frequency of dental anomalies, which may represent complicating factors for dental treatment. The aim of this study was to investigate the prevalence of dental anomalies inside cleft area in a group of Brazilians with NSCL±P. MATERIAL AND METHODS: Retrospective analysis of 178 panoramic radiographs of patients aged from 12 to 45 years old and without history of tooth extraction or orthodontic treatment was performed. Association between cleft type and the prevalence of dental anomalies was assessed by chi-square test with a significance level set at pless than or equal to 0.05. RESULTS: Dental anomalies were found in 88.2% (n = 157) of the patients. Tooth agenesis (47.1%), giroversion (20%) and microdontia (15.5%) were the most common anomalies. Individuals with unilateral complete cleft lip and palate (CLP, p< 0.0001) were more affected by tooth agenesis than individuals with other cleft types. The maxillary lateral incisors were the most affected teeth (p < 0.0001). CONCLUSIONS: The present study revealed a high frequency of dental anomalies inside cleft region in NSCL±P patients, and further demonstrated that patients with unilateral complete CLP and bilateral incomplete CLP were frequently more affected by dental anomalies. Moreover, our results demonstrate that dental anomalies should be considered during dental treatment planning of individuals affected by NSCL±P

Dental anomalies inside the cleft region in individuals with nonsyndromic cleft lip with or without cleft palate.

BACKGROUND: Individuals with nonsyndromic cleft lip with or without cleft palate (NSCL±P) present high frequency of dental anomalies, which may represent complicating factors for dental treatment. The aim of this study was to investigate the prevalence of dental anomalies inside cleft area in a group of Brazilians with NSCL±P. MATERIAL AND METHODS: Retrospective analysis of 178 panoramic radiographs of patients aged from 12 to 45 years old and without history of tooth extraction or orthodontic treatment was performed. Association between cleft type and the prevalence of dental anomalies was assessed by chi-square test with a significance level set at p≤ 0.05. RESULTS: Dental anomalies were found in 88.2% (n=157) of the patients. Tooth agenesis (47.1%), giroversion (20%) and microdontia (15.5%) were the most common anomalies. Individuals with unilateral complete cleft lip and palate (CLP, p<0.0001), bilateral complete CLP (p=0.0002) and bilateral incomplete CLP (p< 0.0001) were more affected by tooth agenesis than individuals with other cleft types. The maxillary lateral incisors were the most affected teeth (p<0.0001). CONCLUSIONS: The present study revealed a high frequency of dental anomalies inside cleft region in NSCL±P patients, and further demonstrated that patients with unilateral complete CLP and bilateral incomplete CLP were frequently more affected by dental anomalies. Moreover, our results demonstrate that dental anomalies should be considered during dental treatment planning of individuals affected by NSCL±P.