Are There Differences in Fracture Patterns in Mandibular Ramus Sagittal Osteotomies Between Hunsuck/Epker, Wolford, and Posnick Modifications?

PURPOSE: Despite decades of study, the best technique for mandibular ramus sagittal osteotomy has not been definitively determined. The purpose of the present study was to compare fracture patterns, inferior alveolar nerve (IAN) visualization, and torque required for mandibular sagittal splitting using the Hunsuck/Epker, Wolford, and Posnick techniques. METHODS: This was a laboratory (ex vivo), randomized, a single-blind study performed to evaluate sagittal split osteotomies in porcine mandibles using a specifically designed test system. The study's predictor variable was the osteotomy technique, which was divided into 3 groups: Group Hunsuck/Epker (GHE), group Wolford (GW), and group Posnick (GP). The outcome variables were lingual fracture pattern, torque in newtons (N) required to separate the mandible, and IAN visualization. The covariates were mandibular radiodensity and time between dejection and the experiment. The Kolmogorov-Smirnov normality statistics and analysis of variance with Tukey post test statistics were performed. P value <.05 was considered statistically significant. RESULTS: The sample was composed of 120 equally divided porcine hemimandibles in each group. The torque forces were significantly lower (P < .001) when using the Posnick technique (2.07 ± 0.22 N) than when using the Hunsuck/Epker technique (4.45 ± 0.32 N) and Wolford (3.00 ± 0.21 N). GW (93.3%) and GHE (56.7%) showed a higher prevalence of lingual fracture in the posterior region of the mandibular canal (P < .001), while the GP (90%) had a higher frequency of lingual fracture pattern on the mylohyoid sulcus (P < .001). In more than 90% (P < .001) of the mandibles in GW and GHE, the IAN visualization was higher than 50%. In the GP, 90% (P < .001) of patients had IAN visualization of less than 50%. CONCLUSIONS: The Posnick technique required less torque to perform the sagittal osteotomy in a pig mandible and had good predictability (90%) for the less preferred lingual fracture pattern and minimal visualization of the nerve. The Wolford technique provided the best predictability (93%) for the preferred lingual fracture pattern and the best nerve visualization. Caution must be exercised when extrapolating the results from animal models to human applications.

Treatment of the Temporomandibular Joint Ankylosis with a Customized Prosthesis in a Single Stage: The Use of 3D Cutting Guides and Virtual Surgical Planning.

BACKGROUND: Ankylosis of the temporomandibular joint (TMJ) is a debilitating condition and disabling as a result of craniomandibular fusion, which can result in trismus, pain and a poor quality of life. Current management includes interposition arthroplasty, gap arthroplasty, and reconstruction. Traditionally, the joints are reconstructed with pre-made prostheses (in stock), or the procedure is performed in two steps; with a computerized tomography scan, its design is observed between the respective and reconstructive procedures. STUDY DESIGN: A technical note about the customization management of ankylosis of the temporomandibular joint. OBJECTIVE AND METHODS: Describe a modification of technique using 3D surgical cutting and positioning guides digitally created to help determine the position and dimensions of the osteotomies as an auxiliary tool in the management of TMJ ankylosis, enabling the installation of personalized prostheses in a single stage. CONCLUSION: This technique has the advantage of allowing the installation of customized TMJ prostheses in a single stage, allowing greater predictability, less surgical time and less morbidity, in addition to being relatively simple and can be easily picked up by young surgeons.

Pseudoaneurisma como complicação de fratura de côndilo mandibular / Pseudoaneuriysm as complication of mandibular côdilo fracture

INTRODUÇÃO: Pseudoaneurismas são geralmente resultantes de trauma sem corte levando provocando a laceração de parte da parede do vaso promovendo o extravasamento de sangue para os tecidos circundantes, seguidos por tamponamento e formação do coágulo. OBJETIVO: Apresentar um caso de pseudoaneurisma em artéria carótida externa como complicação de fratura de côndilo mandibular. RELATO DE CASO: Paciente de 18 anos de idade, vítima de acidente motociclístico compareceu à emergência do Hospital Regional do Cariri com fratura de côndilo mandibular associada à fratura de coronoide e parassínfise, evoluindo com pseudoaneurisma de artéria carótida externa e submetido à embolização seletiva. CONCLUSÃO: Ressaltamos que pseudoaneurismas da artéria carótida externa apresentam as fraturas de côndilo mandibular como fatores etiológicos raros, no entanto uma cuidadosa análise das suas características anatômicas assim como o diagnóstico precoce concorrem para a prevenção de acidentes e complicações graves nas abordagens dos traumas de face... (AU)

Introduction: Pseudoaneurysms are usually the result of blunt trauma leading to laceration of part of the vessel wall promoting extravasation of blood into surrounding tissues followed by tamponade and clot formation. Purpose: To present a case of external carotid artery pseudoaneurysm as a complication of mandibular condyle fracture. Case report: An 18-year-old patient, a motorcycle accident victim, attended the emergency of the Cariri Regional Hospital with a mandibular condyle fracture associated with a coronoid fracture and a parasymphysis, evolving with external carotid artery pseudoaneurysm and submitted to selective embolization. Conclusion: We emphasize that pseudoaneurysms of the external carotid artery present mandibular condyle fractures as rare etiological factors, however a careful analysis of their anatomical characteristics as well as early diagnosis contributes to the prevention of accidents and serious complications in the face trauma approaches... (AU)

Perfil clínico e epidemiológico das alterações bucais em portadores do HIV / Clinical and epidemiological profile of oral changes in HIV patients / Perfil clínico y epidemiológico de las alteraciones bucales en portadores del VIH/SIDA

Introdução: Pacientes portadores do vírus da imunodeficiência humana apresentam susceptibilidade a desenvolver alterações bucais, em que estas estão intimamente relacionadas ao grau de carga viral e consequentemente a contagem de células linfocitárias. Objetivo: Traçar um perfil clínico-epidemiológico de alterações bucais em pacientes portadores do HIV. Material e Método: Realizou-se uma revisão onde foram analisados artigos científicos obtidos da base de dados PubMed. Foram incluídos os estudos do período de 2000 a 2017, de acordo com os descritores: HIV; Linfócitos T CD4-positivos; Doenças da boca, bem como a associação dos termos. Totalizando-se 19 estudos para realização da pesquisa. As pesquisas que não se enquadraram a esses critérios foram excluídas. Os dados foram analisados a partir de estatística descritiva. Conclusão: Conclui-se que a cavidade oral é a área de maior frequência para manifestações do HIV/AIDS sendo a candidose, leucoplasia pilosa e as doenças periodontais as lesões mais ocorrentes em todo o mundo. Em relação ao sexo, conclui-se que a maior prevalência varia de acordo com a população estudada, sendo o sexo masculino o mais prevalente no Brasil, porém o sexo feminino quando afetado possuíam idade mais precoce(AU)

Introduction: Patients with human immunodeficiency virus are susceptible to develop oral alterations, in which they are closely related to the viral load and consequently the lymphocyte count. Objective: To establish a clinical-epidemiological profile of oral alterations in patients with HIV. Material and Method: A review was carried out, where scientific articles were retrieved from the PubMed database. We included studies from the period 2000 to 2017, according to the descriptors: HIV; CD4-positive T lymphocytes; Diseases of the mouth, as well as the association of terms. A total of 19 studies were carried out to carry out the research. Searches that did not meet these criteria were excluded. Data were analyzed from descriptive statistics. Conclusion: It is concluded that the oral cavity is the area of greatest frequency for manifestations of HIV / AIDS being candidosis, hairy leukoplakia and periodontal diseases the most frequent lesions worldwide. Regarding sex, it was concluded that the highest prevalence varies according to the population studied, being the male sex the most prevalent in Brazil, but the female sex when affected had an earlier age(AU)

Introducción: Los pacientes portadores del virus de la inmunodeficiencia humana son susceptibles a desarrollar alteraciones bucales, que están íntimamente relacionadas al grado de carga viral y al recuento de células linfocitarias. Objetivo: Trazar un perfil clínicoepidemiológico de alteraciones bucales en pacientes portadores del VIH. Material y Método: Se realizó una revisión bibliográfica, fueron analizados artículos científicos obtenidos de la base de datos PubMed. Se incluyeron los estudios del período 2000 a 2017, de acuerdo con los descriptores: VIH; Linfocitos T CD4-positivos; Enfermedades de la boca, así como la asociación de los términos. En un total de 19 estudios para la realización de la investigación. Las encuestas que no se relacionaron a estos criterios, se excluyeron. Los datos analizados a partir de estadística descriptiva. Conclusión: Se concluye que la cavidad oral es el área de mayor frecuencia para manifestaciones del VIH/SIDA siendo la candidiasis, leucoplasia pilosa y las enfermedades periodontal las lesiones más frecuentes en todo el mundo. En cuanto al sexo, se concluye que la mayor prevalencia varía de acuerdo con la población estudiada, siendo el sexo masculino el más prevalente en Brasil, pero el sexo femenino cuando afectado poseía edad más precoz(AU)

Factors Associated With the Complexity of Facial Trauma.

INTRODUCTION: Facial fractures have their incidence, etiology, clinical presentation, and features influenced by variables such as economic, cultural, and demographic factors. A large number of these fractures require simple or more complex approaches, and it becomes important to understand their clinical and epidemiological profile and factors associated with the fracture event and surgical indication. OBJECTIVE: The objective of this research is to analyze the clinical and epidemiological profile of surgical fractures and their associations with causal factors such as alcohol consumption, day of the incident, and nonuse of helmet for motorcycle accidents. METHOD: A retrospective study was conducted with collection of data from medical records of patients operated for facial fractures at the Hospital Regional of Cariri, state of Ceara, the Northeast of Brazil. Records from 2012 to 2014 were acquired highlighting sex, age, occupation, etiology, anatomical sites of fractures, and surgeries of varying complexities for single or multiple fractures. The day of the event, report or signs of alcohol consumption, and the use of helmets in motorcycle accidents were named associated factors. RESULTS: As a result the authors had a total of 624 cases of surgical facial fractures. Out of these, 546 (87.5%) were male and the majority of them presented between 20 and 30 years of age (40.5%). It was also observed that as an etiological factor motorcycle accidents led to more cases of surgical facial fractures, with 357 cases (62.1%), followed by physical aggression with 72 cases (12.5%). CONCLUSIONS: It can be concluded that there is a high prevalence of surgical facial fractures in male patients between 20 and 30 years of age, caused by motorcycle accidents, and that there was a strong association between the consumption of alcohol, failure to wear a helmet, and the presence of surgical facial multiple fractures.

Comparative Analysis of the Effectiveness of the Topical Administration of Benzocaine and EMLA® on Oral Pain and Tactile Sensitivity.

OBJECTIVES: To compare the effectiveness of the topical administration of benzocaine and EMLA on oral pain and tactile sensitivity. MATERIALS AND METHODS: A randomized, double-blind, split-mouth clinical trial was carried out with 20 volunteers. The sensorial and quantitative tests were applied before the contact with topical anesthetic and after the application. RESULTS: In the superficial tactile perception test, when we compared each group singly, there were statistically significant values in the decrease of superficial tactile perception when compared to the moment prior to the application of anesthetic agents. For the sensitivity to mechanical pain, no statistical significant difference was observed at evaluated times. In the needle penetration test, in an intergroup analysis, we found a decrease in the pain sensitivity to needle penetration at 5 min (p=0.053) and at 10 min (p=0.019) after the contact of the anesthetic drug with the oral mucosa. CONCLUSION: The application of topical anesthetic drugs reduces the discomfort associated with this procedure, mainly until the first 10 minutes. Only the needle penetration sensitivity test showed sufficient sensitivity to reveal a difference in the anesthetic effect between EMLA and benzocaine. This trial is registered with RBR-2N2GSW.

Non-linear indices of heart rate variability during endodontic treatment.

Dental treatment promotes psychosomatic change that can influence the procedure and compromise the general well-being of the patient. In this context, it highlights the importance of evaluating the function of the autonomic nervous system in individuals undergoing endodontic treatment. Thus, this manuscript aimed to analyse cardiac autonomic modulation, through non-linear indices of heart rate variability (HRV) during endodontic treatment. Analysis of 50 subjects of either sex aged between 18 and 40 years diagnosed with irreversible pulp necrosis of lower molars undergoing endodontic treatment was undertaken. We carried out fractal and symbolic analysis of HRV, which was recorded in the first session of the endodontic treatment at four intervals: T1: 0-10 min before the onset of the treatment session; T2: 0-10 min after the application of anaesthesia; T3: throughout the period of treatment; and T4: 0-30 min after the end of the treatment session. There was reduction of α1 in T2 compared to T1 and T4 (p < 0.0001). The α2 index also reduced in T2 compared to T3 (p = 0.0035). There was an increase in the α1/α2 ratio in T4 compared to T2 and T3 (p = 0.0003). It was found that 0V% was significantly lower in T2 (p = 0.002), while 2UV% was significantly higher (p < 0.0001) when compared to other points in time. In conclusion, HRV is reduced during endodontic treatment, and after applying local anaesthetic the parasympathetic component of HRV increases. These data indicate that endodontic treatment acutely overcharges the heart, supporting the stress involved in this situation.

Non-linear indices of heart rate variability during endodontic treatment

Abstract Dental treatment promotes psychosomatic change that can influence the procedure and compromise the general well-being of the patient. In this context, it highlights the importance of evaluating the function of the autonomic nervous system in individuals undergoing endodontic treatment. Thus, this manuscript aimed to analyse cardiac autonomic modulation, through non-linear indices of heart rate variability (HRV) during endodontic treatment. Analysis of 50 subjects of either sex aged between 18 and 40 years diagnosed with irreversible pulp necrosis of lower molars undergoing endodontic treatment was undertaken. We carried out fractal and symbolic analysis of HRV, which was recorded in the first session of the endodontic treatment at four intervals: T1: 0-10 min before the onset of the treatment session; T2: 0-10 min after the application of anaesthesia; T3: throughout the period of treatment; and T4: 0-30 min after the end of the treatment session. There was reduction of α1 in T2 compared to T1 and T4 (p < 0.0001). The α2 index also reduced in T2 compared to T3 (p = 0.0035). There was an increase in the α1/α2 ratio in T4 compared to T2 and T3 (p = 0.0003). It was found that 0V% was significantly lower in T2 (p = 0.002), while 2UV% was significantly higher (p < 0.0001) when compared to other points in time. In conclusion, HRV is reduced during endodontic treatment, and after applying local anaesthetic the parasympathetic component of HRV increases. These data indicate that endodontic treatment acutely overcharges the heart, supporting the stress involved in this situation.

Do third molars weaken the mandibular angle?

Objective: The purpose of this study is to estimate how is the magnitude of the impact of a mandibular third molaron the mandibular angle stiffness.Study Design: It was performed a literature search on whole MEDLINE and LILACS data base to find articlesthat match the following inclusion criteria: cohort studies presenting data on patients with mandibular fracturesand third molars; that had a similar angle fracture definition; and that present data available to be cross-classifiedin a statistic analysis.Results: The sample was composed by 4 studies, involving 2533 patients from USA, Nigeria, Germany and Jordan,evaluated between 1976 and 2001. The analysis of the sample shows a relative risk for a mandibula to fracture,comparing patients with and without third molars, ranging from 1,18 to 2,25. The data of the sample wasgrouped because of the homogeneity of the articles methods. The estimated relative risk across the 4 studies was1,94 (95% CI 1,6 – 2,35).Conclusions: The presence of a third molar may double the risk of an angle fracture of the mandible to occur. Evenwith this data, the present study cannot support conditions related to the third molar that may affect this impact.Further studies are necessary to discuss the true indication of removal of these teeth as a prophylactic measure inpopulation groups more predisposed to fracture (AU)

Avaliação do Conhecimento do Público Leigo e de Profissionais de Saúde Sobre a Cirurgia e Traumatologia Buco-Maxilo-Facial em Fortaleza-CE / The knowledge of the Lay Public and Health Professionals about the Oral and Maxillofacial Surgery in Fortaleza City

Objetivo: Este trabalho descreve um estudo da avaliação do conhecimento do público leigo e de profissionais de saúde sobre a cirurgia e traumatologia buco-maxilo-facial na cidade de Fortaleza, CE. Metodologia: Por meio de questionários, foram entrevistados acadêmicos e profissionais cirurgiões-dentistas, médicos, enfermeiros e o público leigo. Foram descritos casos clínicos e solicitada aos entrevistados a escolha de um especialista para tratar cada caso, dentre eles o cirurgião-plástico, o otorrinolaringologista, o cirurgião buco-maxilo-facial, o cirurgião de cabeça e pescoço e "outros". A análise dos resultados consistiu na construção de tabelas de contingência, com teste do Qui-Quadrado (X²) e associação V de Cramer. Nas comparações, o nível de significância adotado no presente estudo foi de α= 0,05. Resultados: Verificou-se que, para a fratura de nariz, câncer de língua, aumento de volume no pescoço, cirurgia estética do nariz e insatisfação com a estética facial, todos os grupos foram classificados com conhecimento RUIM. Para a remoção de glândula salivar, biópsia de lesões na boca, tumor benigno de mandíbula, aumento de volume na mandíbula, criança com fissura labial, palatal e lábio-palatal, os grupos da medicina foram classificados com conhecimento RUIM. Conclusão: Concluiu-se que o estudo da avaliação do conhecimento sobre a CTBMF revela dados de conhecimento insatisfatório em relação aos grupos estudados.

Purpose: This paper describes a study assessing the knowledge of the lay public and health professionals about the oral and maxillofacial surgery in the city of Fortaleza, CE. Methodology: Through questionnaires, were addressed to academics and professionals of the dentistry, medical, nursing and the lay public. It described several cases of clinical and asked the respondents to choose a specialist to treat each case, including the plastic surgeon, ENT, oral and maxillofacial surgeon, head and neck surgeon and the "other". The analysis consisted in the construction of contingency tables, applying the chi-square (X ²) and association of Cramer V. In comparison, bilateral tests were used where the value of the level of significance adopted in this study was α = 0.05. Results: It was found that for fracture of nose, tongue cancer, increase in volume in the neck, cosmetic surgery of the nose and dissatisfaction with facial aesthetics, that all groups were classified as knowledge BAD. To removal of salivary gland, biopsy of lesions in the mouth, benign tumor of mandible, increase in volume in the mandible, children with cleft lip, palate and lip-palate, groups 3 and 4 were classified with knowledge BAD. Conclusion: It was concluded that the sample of the results of the study assessing the knowledge of the data reveals OMFS of poor knowledge in relation to groups.

Síndrome de Sjõgren secundária: revista de literatura e relato de caso clínico / Secondary Sjõgren syndrome: literature review and clinical case report

A Síndrome de Sjõgren é uma desordem auto-imune, multi-sistêmica, inflamatória crônica que afeta glândulas exócrinas, principalmente as salivares e lacrimais, levando a um prejuízo funcional característico. Acomete prevalentemente indivíduos de meia idade, do sexo feminino e apresenta um amplo espectro de manifestações clínicas. Dentro da sintomatologia a xeroftalmia e xerostomia são as manifestações mais frequentes. Pode ser sub-dividida em primária na forma clássica ou secundária, quando associada a outras doenças auto-imunes de tecidos conjuntivos como a esclerodermia, artrite reumatóide ou lúpus eritematoso sistêmico. O presente trabalho objetiva revisar a literatura e relatar o caso de uma paciente portadora da Síndrome de Sjõgren secundária, com história clínica de oito anos, que procurou o serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial para a avaliação e acompanhamento odontológico de sua condição.

Sensitivity and specificity of pantomography to predict inferior alveolar nerve damage during extraction of impacted lower third molars.

PURPOSE: The purpose of the study was to assess the sensitivity and specificity of maxillary radiographic image findings in predicting nerve lesions in third molar surgery. PATIENTS AND METHODS: A total of 260 third molars were assessed prior to surgical removal by means of panoramic radiography in the sample of 153 patients (73.8% female). The tooth root was classified according to the presence or absence of a radiological sign of a close relationship with the mandibular canal. Of the 260 cases assessed, the presence of a radiological sign of a close relationship with the mandibular canal was recorded in 159 cases. RESULTS: Of the 260 cases, 9 (3.5%) presented postsurgical sensory complications. Though this percentage was higher among those in which there was judged to be a radiological sign of a close relationship with the mandibular canal than in those without such a sign, no significant association was shown to exist between the presence of the radiological sign and postsurgical changes in the inferior alveolar nerve (P = .94). The positive and negative predictive values were 0.03 and 0.97, respectively. Calculations on the results of the radiological examination in relation to the frequency of nerve lesions yielded values of 66% for sensitivity and 39% for specificity. CONCLUSIONS: Panoramic radiography does not provide the reliable images required for predicting nerve lesions in third molar surgery.

Osteorradionecrose resultando em fratura patológica de mandíbula: relato de caso clínico / Osteoradionecrosis resulting in pathological fracture of jaw: relate of clinical case

Introdução: A osteorradionecrose (ORN) é uma severa complicação da radioterapia em pacientes portadores de câncer de cabeça e pescoço. Dependendo da localização e extensão da lesão osteorradionecrótica, pode trazer sinais e sintomas como dor, odor fétido, disgeusia, disestesia ou anestesia, trismo, dificuldade de mastigação, deglutição e fonação, formação de fístula, fratura patológica e infecção local ou sistêmica. Objetivo: O presente trabalho teve como objetivo relatar um caso clínico de um paciente portador de osteorradionecrose em corpo mandibular, com presença de infecção, e que resultou em fratura patológica mandibular. Desenvolvimento do caso: Foram realizados esquemas rigorosos de antibioticoterapia,associados a oxigenoterapia hiperbßrica para permitir o tratamento da fratura mandibular com fixação interna rígida, após o tratamento da infecção secundßria, na intenção de eliminar aosteorradionecrose, a qual no caso em questão houve reparação e ausência de qualquer sinal clínico radiogrßfico de recidiva, num acompanhamento de um ano de pós-operatório. Conclusão:Diante da severidade da doença, esgotadas as possibilidades conservadoras e diante de uma necessidade cirúrgica pela fratura patológica, pôde-se observar que o uso da oxigenoterapia hiperbßrica resultou em uma satisfatória cicatrização da ferida cirúrgica, bem como a manutenção da saúde dos tecidos no caso em questão.

Cisto de Gorlin: relato de caso e revisão de literatura / Gorlin’s Cyst: a case report and literature review

O Cisto de Gorlin, também denominado Cisto Odontogênico Calcificante, é uma lesão incomum, que soma, apenas, 0,3 por cento das biópsias da cavidade oral e 2 por cento de todos os cistos e tumores odontogênicos. A sua patogênese permanece desconhecida, embora comumente seja aceito que se desenvolva a partir de remanescentes do epitélio odontogênico, presentes no interior da mandíbula, maxila e gengiva. Desde a sua descrição original, diversos termos têm sido utilizados para denominá-lo. A existência dessa variedade de denominações é um reflexo da sua diversidade histopatológica e da confusão ainda presente a respeito de sua natureza cística, neoplásica ou hamartomatosa. O objetivo deste trabalho é realizar uma revisão da literatura sobre a sua origem e classificação e, relatar o caso de um paciente, de 19 anos de idade, leucoderma, apresentando aumento de volume na face lingual da mandíbula, próximo à linha média, sem sintomatologia dolorosa e radiograficamente apresentando-se como uma lesão radiolúcida de bordas bem definidas.

Leishmaniose muco-cutânea: relato de caso clínico / Mucocutaneous leishmaniasis: a case report

Leishmaniose muco-cutânea é, dentre as variantes da doença tegumentar, uma infecção causada pelo protozoárioLeishmania (Viannia) braziliensis, acometendo pele e mucosas com o desenvolvimento de úlceras. Este trabalhotem por objetivo relatar o caso clínico de um paciente, apresentando lesão ulcerada em região de asa donariz e soalho nasal do lado direito. Em associação havia uma lesão avançada em glande peniana cominfecção secundária. Diante dos achados clínicos, teve-se como diagnóstico provável leishmaniose mucocutânea,o qual foi sugerido pelo exame histopatológico, após biópsia incisional da lesão. Terapêutica medicamentosa específica foi administrada, e o paciente encontra-se com remissão da sintomatologia e em observação.