Recurrent dislocation of the temporomandibular joint: a literature review and two case reports treated with eminectomy.

AIMS: Dislocation of the temporomandibular joint (TMJ) is a troublesome condition that occurs in a chronic or acute form. It is a distressing and highly embarrassing situation that may occur as a result of daily activities such as yawning, laughing, or during events that require keeping the mouth open for a long time. This review aims to present and discuss different conservative and surgical techniques to treat patients with a dislocated mandible, and to present two cases of surgical treatment. METHODOLOGY: A search of the literature was completed (Medline, PubMed) using the keywords TMJ dislocation, TMJ luxation, mandibular dislocation and surgical and non-surgical methods of treatment for this condition. RESULTS: Eminectomy (Myrhaug's surgery) has been used with satisfactory results. Most of reports present large series of patients with more than one year of follow-up and no recurrence of complications. Is less invasive and take a short operation time; need no bone transplantation or placing any kind of foreign body into the joint. CONCLUSION: Eminectomy results in long-term resolution of recurrent TMJ dislocations, when compared with others surgical techniques.

Horizontal and vertical maxillary osteotomy stability, in cleft lip and palate patients, using allogeneic bone graft.

OBJECTIVE: This study was carried out to evaluate maxillary stability after orthodontic-surgical treatment of patients with cleft lip and palate. Cephalometric analysis was applied to two different groups, with and without allogeneic bone graft. METHODS: The sample comprised 48 patients with cleft lip and palate. The test group comprised 25 patients who, after correction of maxillary position, received allogeneic bone graft at the gap created by Le Fort I osteotomy. The control group comprised 23 patients and its surgical procedures were similar to those applied to the test group, except for the use of bone graft. Manual cephalometric analysis and comparison between lateral teleradiographs, obtained at the preoperative phase, immediate postoperative phase and after a minimum period of six months, were carried out. RESULTS: An higher horizontal relapse was observed in the control group (p>0.05). There were no statistically significant differences in vertical relapses between test and control groups (p<0.05). CONCLUSION: The use of allogeneic bone graft in cleft lip and palate patients submitted to Le Fort I osteotomy contributed to increase postoperative stability when compared to surgeries without bone graft.

Horizontal and vertical maxillary osteotomy stability, in cleft lip and palate patients, using allogeneic bone graft

OBJECTIVE: This study was carried out to evaluate maxillary stability after orthodontic-surgical treatment of patients with cleft lip and palate. Cephalometric analysis was applied to two different groups, with and without allogeneic bone graft. METHODS: The sample comprised 48 patients with cleft lip and palate. The test group comprised 25 patients who, after correction of maxillary position, received allogeneic bone graft at the gap created by Le Fort I osteotomy. The control group comprised 23 patients and its surgical procedures were similar to those applied to the test group, except for the use of bone graft. Manual cephalometric analysis and comparison between lateral teleradiographs, obtained at the preoperative phase, immediate postoperative phase and after a minimum period of six months, were carried out. RESULTS: An higher horizontal relapse was observed in the control group (p<0.05). There were no statistically significant differences in vertical relapses between test and control groups (p>0.05). CONCLUSION: The use of allogeneic bone graft in cleft lip and palate patients submitted to Le Fort I osteotomy contributed to increase postoperative stability when compared to surgeries without bone graft.

OBJETIVO: avaliar a estabilidade maxilar após o tratamento ortodôntico-cirúrgico de pacientes portadores de fissura labiopalatal, por meio de análise cefalométrica, em dois diferentes grupos, com e sem utilização de enxerto ósseo alógeno. MÉTODOS: a amostra foi constituída de 48 pacientes portadores de fissura labiopalatal. O grupo teste foi composto de 25 pacientes que, após a correção da posição da maxila, receberam enxertia óssea alógena para preenchimento dos espaços gerados pelas osteotomias maxilares do tipo Le Fort I. O grupo controle foi composto por 23 pacientes, com os procedimentos cirúrgicos similares aos do grupo teste, com a diferença de que não se utilizou enxertia óssea. Realizaram-se traçados cefalométricos manuais e comparação entre as telerradiografias em perfil, obtidas no pré-operatório, no pós-operatório imediato e após o período mínimo de seis meses. RESULTADOS: ocorreu maior recidiva horizontal no grupo controle (p < 0,05). Não houve diferenças estatisticamente significativas nas recidivas verticais entre os grupos teste e controle (p > 0,05). CONCLUSÃO: a utilização de enxertos alógenos em pacientes portadores de fissura labiopalatal submetidos a osteotomias maxilares Le Fort I contribuiu para o aumento da estabilidade horizontal pós-operatória, quando comparada com cirurgias sem enxertia óssea.

Eagle's syndrome: treatment by intraoral bilateral resection of the ossified stylohyoid ligament. A review and report of two cases.

The complexities of Eagle's syndrome are examined according to anatomical, historical, clinical, and treatment aspects. There appears to be little correlation between the extent, form, and size of the anomalies of the styloid process and the stylohyoid ligament and the predictability of patients with related symptoms. Surgical treatment and the advantages and disadvantages of each surgical approach (intra- and extraoral) are discussed. The probable causes of enlargement of the styloid process and ossification of the stylohyoid ligament are addressed. Two cases of Eagle's syndrome are presented: one unilateral and the other bilateral. An intraoral modified surgical technique is presented.

Idiopathic thrombocytopenic purpura and oral surgery: case report / Púrpura trombocitopênica idiopática e cirurgia bucal: relato de caso

OBJECTIVES: To review the function of platelets in the blood clotting mechanism. To address,conceptualize and classify thrombocytopenic purpura, especially idiopathic thrombocytopenic purpura (ITP),emphasizing the immunological aspects involved in the etiology of the disease. To address the clinicalmanifestations of the disease and the appropriate therapy. To present the case study of a patient with ITPwho requires oral surgical intervention. DISCUSSION: Leukopenia in ITP can be subclinical. The firstmanifestation of the disease can be severe hemorrhaging due to small lacerations or minor medical anddental surgical procedures. The cause of the platelet reduction is idiopathic; an autoimmune reaction in whichthe antibodies destroy the platelets appears to participate in the process. A variety of situations can occur,leading to mild to severe thrombocytopenia. One frequent aspect is the instability of the platelet count,which oscillates inconsistently and may be related to infections and other factors that have not been clearlydetermined, including stress. In the case presented here, the leukopenia in the patient was mild in presentation.However, it was decided that the patient should be referred to a hematologist for preparation and clearance.Oral surgery that compromises the bone, such as exodontia, can present significant difficulties in localizingand clamping intraosseous vessels, which does not only occur in small soft tissue surgeries. CONCLUSIONS:Platelet destruction in ITP occurs from a complex process that is comprised of multiple components of theimmune system. The platelets are prematurely destroyed by antibodies that are aimed at the platelet glycoprotein,which can results in serious, even fatal consequences. It is important to emphasize the significance of themedical history and the appropriate physical examination during the diagnostic process, as well as collaborationwith the patient’s medical...

OBJETIVOS: Revisar a função das plaquetas no mecanismo de coagulação sanguínea. Conceituare classificar a púrpura trombocitopênica, especialmente a púrpura idiopática, enfatizando osaspectos imunológicos envolvidos na etiologia da doença. Enfocar as manifestações clínicas dadoença e a terapia apropriada. Apresentar um caso de manifestação clínica da doença e a terapiaapropriada. Apresentar o caso de uma paciente com púrpura que necessitava de intervençãocirúrgica bucal. DISCUSSÃO: A leucopenia na púrpura trombocitopênica idiopática pode sersubclínica. A primeira manifestação da doença pode ser uma hemorragia severa por causa depequenas lacerações ou pequenos procedimentos médicos e odontológicos. A causa da reduçãodas plaquetas é idiopática; uma reação autoimune na qual os anticorpos destroem as plaquetasparece participar do processo. Uma variedade de situações pode ocorrer, levando àtrombocitopenia discreta a severa. Um aspecto frequente é a instabilidade da contagem plaquetária,que oscila inconsistentemente e pode relacionar-se com infecções e outros fatores ainda nãoclaramente determinados, incluindo estresse. No presente caso, o paciente apresentava discretaleucopenia. Entretanto, decidiu-se que o paciente deveria ser avaliado por um hematologista,para preparação e liberação para cirurgia, pois a cirurgia bucal que compromete osso, como aexodontia, pode apresentar dificuldades significativas na localização e pinçamento de vasosintraósseos, o que não acontece em pequenas cirurgias de tecidos moles. CONCLUSÕES: Adestruição plaquetária na púrpura trombocitopênica ocorre por meio de um complexo processo,com múltipos componentes do sistema imune. As plaquetas são destruídas prematuramente poranticorpos dirigidos contra as glicoproteínas plaquetárias, o que pode resultar em sérias – emesmo fatais – consequências. É importante enfatizar o significado da história médica e o examefísico adequado no processo diagnóstico...

Oral and maxillofacial manifestations of familial adenomatous polyposis (Gardner's syndrome): a report of two cases.

AIM: The aim of this case report is to emphasize the importance of an early diagnosis of Gardner's syndrome through the detection of lesions appearing in the oral and maxillofacial area as well as to present two cases of the disease. BACKGROUND: Gardner's syndrome is an autosomal dominant disease characterized by gastrointestinal polyps that develop in the colon as well as in the stomach and upper intestine, along with multiple osteomas, skin, and soft tissue tumors. Cutaneous findings may include desmoid tumors, epidermoid cysts, and other benign tumors. Early diagnosis and therapy of the disease are critical because polyps have a 100% risk of undergoing malignant transformation. Craniomaxillofacial manifestations (osteoma formation, tooth impaction, diffuse opacities in the skull, mandible and maxilla, scalp tumors) usually precede polyposis. REPORT: Case 1: Gardner's syndrome was diagnosed in a 25-year-old Caucasian man who was referred by his endodontist for evaluation of an uncommon radiographic image in the mandibular molar area. Further investigation revealed a familial adenomatous polyposis (FAP) complicated by adenocarcinoma of the colon. A colectomy and an ileorectal anastomosis were performed. Case 2: A 12-year-old Caucasian girl, who is a niece of the patient described in Case 1, presented with progressive difficulty with mouth opening but no complaints of digestive problems. Radiographic examination revealed multiple radiopacities in the maxilla, mandible left temporomandibular joint, and in the left mandibular angle. Multiple impacted teeth were present. A colonoscopy was suggested, but the patient's parents decided to continue the investigation and treatment with their own physician in their home town. SUMMARY: Since an early diagnosis is essential and general dental practitioners may be the first healthcare professionals to suspect the diagnosis, it is important for them to be familiar with the features of Gardner's syndrome.

Cirurgia ortognática: estética e/ou função / Ortognatic surgery: aesthetic and/or function

Esta revisão tem como objetivo trazer informações a respeito das indicações e planejamento, bem como das técnicas cirúrgicas usadas para tratamento das deformidades dentofaciais. A relação multidisciplinar não apenas do planejamento ortocirúrgico, mais do preparo psicológico e da oportunidade do procedimento, pois as mudanças faciais relativas à busca deste equilíbrio e estabilidades oclusal pela movimentação dos ossos da face repercutiram intensamente na vida pessoal e social do indivíduo.

Oral focal mucinosis.

Oral focal mucinosis is an uncommon clinicopathologic condition that is considered the oral counterpart of cutaneous focal mucinosis. It is a disease of unknown etiology where the connective tissue undergoes a focal myxoid degeneration. A literature review disclosed 47 published cases of oral focal mucinosis. An additional case is presented; the clinical and histologic differential diagnosis, sex, age, location, treatment, and recurrence are discussed.

Osteogenic sarcoma of the maxilla: case report

Osteosarcoma (OS) is one of the most common primary malignant bone neoplasms, which predominantly occurs in the long bones and rarely in the maxillofacial area. We present a rare case of maxillary OS early diagnosed in a 17-year-old girl through clinical, radiological and histological examination. The treatment involved surgical resection of the tumor followed by radiation therapy and chemotherapy. The patient was much younger than the average age of presentation of a jaw tumor, which typically presents in the third to fourth decades of life. Although there is a consensus in the literature that OS of the jaws is less aggressive and less prone to metastasis than OS of the long bones, that was not true in this case, where in spite of early diagnosis and treatment the patient died due to brain metastasis.

Osteochondroma of the mandibular condyle: literature review and report of a case.

AIM: The intent of this report is to present a brief review of the literature on osteochondroma and to present a case involving the surgical removal and replacement of a major portion of the condyle and angle of the mandible using free autogenous mandibular bone. BACKGROUND: While osteochondroma is the most common tumor of skeletal bones, it is relatively uncommon in the jaws occurring at the condyle or the tip of the coronoid process. This benign cartilage-capped growth is usually discovered incidentally on radiographic examination or on palpation of a protruding mass in the affected area. Malocclusion and progressive facial asymmetry are common findings in most cases of condylar osteochondroma. REPORT: A case of a 29-year-old woman with an osteochondroma of the mandibular condyle is presented. Surgical treatment was tumor resection, grafting, and reshaping of the mandibular angle and ramus. As this lesion is usually asymptomatic and discovered incidentally on radiographic examination, the general practitioner usually is the first professional to make the diagnosis. SUMMARY: Condylectomy cannot be recommended as routine in all cases.37 Common surgical treatments include condylectomy and reconstruction.24 If the tumor involves only a limited area of the condylar surface, then preservation of the remaining portion of the condyle and reshaping should be done. Reasons for not taking such a conservative approach are the possibilities of malignancy and the risk of recurrence. In this case report the extraoral vertical ramus osteotomy, associated with free autogenous mandibular bone, presented several advantages.

Treatment of extrusive luxation by intentional replantation.

BACKGROUND: The accepted treatment for extrusive luxation is repositioning of the extruded tooth at the earliest possible opportunity. CASE REPORT: Repositioning was not possible in a patient who presented for treatment 4 days after the accident, and therefore, an intentional replantation was performed instead. The tooth was carefully extracted, the blood clot removed from the alveolus and the tooth was then replanted. CONCLUSION: Intentional replantation involves the deliberate removal of a tooth and its reinsertion into the alveolus almost immediately afterwards. It is now an accepted endodontic procedure. The favourable outcome of this case suggests that intentional replantation of severely extruded teeth may be a treatment option in cases where the tooth cannot be repositioned and if treatment conditions are adequately followed.

Knowledge of general practitioners dentists about the emergency management of dental avulsion in Curitiba, Brazil.

The prognosis of traumatized teeth in general and of avulsed teeth in particular depends on prompt and appropriate treatment. Management of traumatic injuries may be a challenge to the non-specialized dentist, as they may occur when dentists are least prepared for it. The objective of this research was to investigate the knowledge of general practitioner dentists about the emergency management of dental avulsion in Curitiba, PR, Brazil. A group of 250 professionals were interviewed. The questions were related to knowledge of how to treat traumatic avulsion of teeth. The results suggest that the level of knowledge on the management of dental avulsion of the general practitioners dentists in Curitiba is adequate.

Traumatic pseudolipoma of the oral cavity: report of a case.

An uncommon traumatic pseudolipoma of the oral cavity is presented. In this particular case there was evidence of previous trauma to the buccal fat pad during a difficult extraction of a maxillary premolar. Evidence is presented that iatrogenic trauma resulting in foreign body introduction might produce traumatic pseudolipoma in the oral cavity. The morphology of the buccal fat pad, the possible pathogenisis of the condition, as well as the diagnostic and the management of the case are presented.

Dentoalveolar and mandibular body fractures caused by a horse kick: report of a case.

A rare case of multiple mandibular fractures and severe facial laceration is presented. The cause was a horse hoof kick to an unmounted equestrian. The pertinent literature is reviewed and the maxillofacial injuries associated with animal interaction are discussed.

Avaliação da subtração radiográfica digital na detecção de cáries proximais simuladas / Evaluation of digital radiograph subtraction for detection of simulated approximal caries

Avaliou-se o recurso de subtração radiográfica em imagens digitalizadas para detectar desmineralizações no esmalte de faces proximais dentßrias simulando cáries precoces. O estudo foi realizado em 4 pares de dentes pré-molares, posicionados em blocos confeccionados em gesso e silicona pesada. Confeccionou-se ainda, uma base em gesso onde foram fixados o posicionador e o simulador de tecidos moles para a padronização das tomadas radiogrßficas com o filme E-Speed (Kodakâ). Os dentes foram isolados com esmalte para unhas, deixando-se uma ßrea de 2mm de diâmetro para ser condicionada por ßcido clorídrico a 18%. Inicialmente realizaram-se radiografias controle (I); após os dentes foram imersos em ßcido por 3 (II), 6 (III) e 9 minutos (IV). Entre cada imersão foram realizadas novas tomadas radiogrßficas, sendo estas digitalizadas com resolução de 300 dpi e arquivadas em extensão TIFF. Após, realizou-se a subtração radiogrßfica utilizando o programa Image Tool entre as situações: inicial e 3 (S1), inicial e 6 (S2), inicial e 9 minutos (S3). Aplicou-se ainda, a ferramenta threshold, que identifica pixels de contrastes semelhantes, para quantificar a perda de estrutura mineral tanto nas imagens originais quanto entre as situações comparativas. Os resultados encontrados mostraram haver um aumento significativo na quantidade de pixels semelhantes nas regiões desmineralizadas, tanto nas imagens originais quanto entre as situações S1/S3 e S2/S3 (p < 0,05). Concluiu-se que, embora haja um aumento significativo da quantidade de pixels semelhantes nas ßreas desmineralizadas quando utilizado o recurso da subtração radiogrßfica, a anßlise das imagens originais evidenciou valores superiores quando comparados às subtraídas.

Report of ankylosis of the temporomandibular joint: treatment with a temporalis muscle flap and augmentation genioplasty.

A case of true bilateral ankylosis of the temporomandibular joint (TMJ) is presented. A 19-year-old male patient had a life-threatening ear infection at the age of ten resulting in a progressive restriction of his mouth opening. He presented with almost complete lack of mobility of the mandible. Surgical treatment was a resection of the ankylotic mass, interpositional temporalis composite muscle flaps, and early mobilization and aggressive physiotherapy. The functional results of the interpositional arthroplasty were excellent. After a two-year follow up, an augmentation genioplasty was performed in order to improve facial aesthetics.

Estudo radiográfico da densidade óssea mandibular em pixels e milímetros equivalentes de alumínio / Radiographic study of mandibular bone density in pixels and aluminum equivalents milimeters

O objetivo deste trabalho foi comparar, em pixels e milímetros equivalentes de alumínio, a densidade óssea relativa mandibular, da região retromolar e região intermediária entre molares e pré-molares. Para a mensuração dos níveis de cinza em mmEq/Al nas referidas regiões, utilizou-se uma escala de alumínio constituída por 16 degraus, com 0,3 mm de espessura entre cada um deles. Utillizou-se 5 mandíbulas humanas secas, as quais foram tecnicamente radiografadas, nas regiões anteriormente citadas, com filmes Ultra-speed, tempo de exposição de 0,5 segundos e distância focal de 25 cm. Estas radiografias foram processadas pelo método de tempo e temperatura, e posteriormente, escaneadas com 300 dpi e 8 bytes. As imagens digitalizadas foram medidas por meio da ferramenta histograma, do programa Image Tool, versão 3.0 (UTHSCSA, USA). Inicialmente, foram manipuladas através da função automática de alteração de brilho e contraste e em seguida, foram selecionadas para as medições nas regiões ósseas, áreas de 32x32 pixels. Nos degraus da escala, mediram-se áreas de 20x50 pixels. A análise dos resultados, pelo teste estatístico t de Student, mostrou valores semelhantes entre a densidade óssea da região retromolar e o degrau de número 16 da escala de alumínio, e entre a densidade óssea da região intermediária entre molares e pré-molares e o degrau de número 15 da escala (p>0,05). Concluiu-se que a densidade da escala de alumínio, utilizada neste estudo é semelhante a densidade óssea relativa das regiões avaliadas, podendo ser utilizada como unidade de medida referencial na análise dos níveis de cinza mandibulares