Lingual accessory mental foramen: a report of an extremely rare anatomical variation.

The presence of accessory foramina and canals in the mandible is frequently overlooked in clinical procedures. It is important to note that these anatomical variations may only be pre-surgically detected on imaging exams, and such detection may directly influence therapeutic success. We describe a previously unreported case of accessory mental foramen located in the lingual cortical bone of the mandible.

Acessory mental foramen: case report

Forame mentual acessório: relato de caso. Variações anatômicas associadas ao forame mentual são relativamente incomuns. Dentre tais variações, a presença de um ou mais forames mentuais acessórios tem sido relatada em raros casos. O conhecimento da sua localização em relação ao forame mentual principal é de fundamental importância na avaliação prévia de procedimentos cirúrgicos e endodônticos. Neste artigo, um caso de forame mentual acessório foi apresentado através de imagens por tomografia computadorizada, e as principais complicações relacionadas a essa variação anatômica são discutidas

Assessment of computerized tomography density patterns of ameloblastomas and keratocystic odontogenic tumors.

The aim of this study was to evaluate computerized tomography (CT) density patterns of solid ameloblastomas (SA), unicystic ameloblastomas (UA), and sporadic and multiple keratocystic odontogenic tumors (SK and MK, respectively). A region of interest (ROI) was delimited corresponding to almost the entire lesional area on each axial slice of 25 CT exams. For each ROI, CT values (HU(ROI)) and heterogeneity (HTG(ROI)) were recorded and compared among lesion groups as well as among central and peripheral slices of the same lesion. The average HU(ROI) were: SA 35.9 +/- 12.6; UA 31.0 +/- 6.0; SK 28.4 +/- 10.5; and MK 30.5 +/- 20.6. SK and MK had the lowest CT values and highest heterogeneity. SA and UA did not show statistical difference for HU(ROI). However, SA had greater HTG(ROI) values. SA presented a different pattern when the central slices were compared with the peripheral slices. HU(ROI) was higher, whereas HTG(ROI) was lower, among the central slices of SA.

Single-injection femoral nerve block with 0.25% ropivacaine or 0.25% bupivacaine for postoperative analgesia after total knee replacement or anterior cruciate ligament reconstruction.

STUDY OBJECTIVE: To investigate the effects of single-injection femoral nerve block (FNB) in postoperative pain after total knee replacement (TKR) and anterior cruciate ligament (ACL) reconstruction. DESIGN: Prospective, randomized, double-blind study. PATIENTS: 96 ASA physical status I, II, and III patients, scheduled for TKR or ACL reconstruction. INTERVENTIONS: All patients received a standard spinal anesthetic, then were randomly divided into three treatment groups as follows: Group B (n = 30) received an FNB with 40 mL of 0.25% bupivacaine containing epinephrine, 1:200,000; Group R (n = 32) received an FNB with 40 mL of 0.25% ropivacaine; and Group C (n = 28) received no FNB. MEASUREMENTS: The following clinical outcomes were assessed at up to 6 hours (T1), 6 to 10 hours (T2), and 10 to 24 hours (T3) after spinal anesthesia was given: visual analog scale (VAS) for pain, both at rest and on movement (no or mild pain, moderate pain, or severe pain); morphine use; sensory block in the femoral, obturator, and lateral femoral cutaneous nerve dermatomes; and motor block of the femoral and obturator nerves. MAIN RESULTS: Except for VAS during rest and on movement at time T3, there were more Group C patients who experienced moderate or severe pain than those who had no pain or mild pain, when compared with Groups R and B. Sensory block in the femoral and lateral femoral cutaneous nerve dermatomes did not differ between Groups R and B at any times. However, sensory block in the obturator nerve dermatome was lower in Group R than Group B only at T3. We observed a lower, significant use of morphine at T2 when comparing Groups R and B with Group C. No Group R patient and about 30% of Group B patients remained with motor block of femoral and obturator nerves at T3. Except for frequency of nausea, which was highest in Group C, the frequency of other side effects was similar among the three groups. CONCLUSIONS: Femoral nerve block using 0.25% ropivacaine or 0.25% bupivacaine is an effective method of postoperative analgesia after TKR and ACL reconstruction, particularly for the first 10 hours after spinal anesthesia.

Assessment of x-ray units for intraoral radiographic techniques in Salvador, Bahia (Brasil) / Avaliação do nível de adequação de aparelhos de raio X para técnicas intrabucais da cidade de salvador, Bahia (Brasil)

The aim of this study was to assess the adequacy of x-rays units for intraoral radiographic techniques in Salvador, Bahia (Brazil). The sample was composed of 150 units randomly selected from a total of 652 units evaluated by a dosimetry kit (IRD/CNEN Institute of Radiation Protection and Dosimetry of the National Commission of Nuclear Energy - Ministry of Health). Three parametrs were considered: (a)maximum skin exposure, 500 mRem; (b)radiation field size, 5.0-6.0 cm; and (c)minimum aluminum filtration, 1.5 mm. If any of the parameters did not comply with IRD/CNEN standards, the x-ray unit was considered to be out of order. Pearson's correlation test, degree of dependence (Pearson's Qui-square test), and the degree of association between the variables (V Cramér coefficient)were used for the statistical analysis. The results showed that 59.33 porcento of the units failed to comply with at least one of the three parameters evaluated. Radiation field size was the criterion that showed the highest level of failure (40.67 porcento). Filtration and skin exposure were responsible for the failure of 30 por cento and 20.7 por cento of the x-ray units, respectively. Perarson's correlation test showed a statistically significant positive correlation between skin exposure and radiation field size, and negative correlation between skin exposure and filtration, indicating that akin exposure tends to increase with the size of the radiation field and/or decreases with filtration. The highest association was detected between skin exposure and filtration. The results show the importance of promoting an educational program about source-skin distance, exposure time, film sensitivity, film processing, film-holding devices; adopting filtration and collimation standards; and the use of rectangular collimator as mandatory. Such a program and update of the rules would stimulate increased use of the ALARA principle (as low as reasonably achievable) for patients undergoing intraoral radiography

Síndrome de Goldenhar: relato de caso / Goldenhar’s syndrome: a case report

A Síndrome de Goldenhar é uma condição rara, geralmente de ocorrência esporádica, caracterizada por microssomiahemifacial, dermóide epibulbar, más formações do pavilhão auditivo e anomalias vertebrais. Existem também relatos deassociações da síndrome com outras condições sistêmicas. Os autores relatam um caso de Síndrome de Goldenhar empaciente do sexo feminino, 28 anos, sem antecedentes familiares, que apresentava microssomia hemifacial, o quecomprometia os músculos da mastigação, a expressão facial e os ossos da face (mandíbula, maxila e zigomático) do lado esquerdo, presença de broto auricular, história médica de dermóide epibulbar e fissura lateral de face, ipsilateralmente. Na avaliação sistêmica, foram encontrados ectopia do rim esquerdo e discreto espessamento dos folhetos mitrais, com refluxo mitral de grau leve.