The challenges of reconstruction and rehabilitation of atrophic jaw with an autogenous graft from skull cap ­ a case report / Os desafios da reconstrução e reabilitação de mandíbula atrófica com enxerto autógeno de calota craniana ­ relato de caso

Introduction: One of the challenges of maxillofacial surgery is the rehabilitation of patients with severe bone loss, using implant-supported prostheses. This challenge is based on the small remaining bone structure, and on the need to reconstruct the structure for the rehabilitation with autogenous or exogenous grafts. Case report: We report the case of a patient with severe maxillary atrophy, where a skullcap graft was performed associated with implant placement and prosthetic completion 14 months after the start of treatment. Final considerations: We demonstrate clinical safety for the use of extraoral grafts without complications, representing a good alternative treatment for this group of patients.

Introdução: um dos desafios da cirurgia bucomaxilofacial é a reabilitação de pacientes com perda óssea severa, utilizando próteses implantossuportadas. Este desafio baseia-se na pequena estrutura óssea remanescente e na necessidade de reconstrução da estrutura para a reabilitação com enxertos autógenos ou exógenos. Relato de caso: Relatamos o caso de um paciente com atrofia maxilar grave, onde foi realizado enxerto de calota craniana associado à instalação de implante, com finalização protética 14 meses após o início do tratamento. Consideracoes finais: Demonstramos segurança clínica para o uso de enxertos extrabucais sem complicações, representando uma boa alternativa de tratamento para este grupo de pacientes.

Efficacy of photobiomodulation therapy on healing of ionizing irradiated bone: a systematic review of in vivo animal studies.

This systematic review aimed to answer the research focused question: What are the effects of photobiomodulation (PBM) therapy on bone healing after ionizing irradiation in animal models? The EMBASE, LILACS, LIVIVO, PubMed, Scopus, and Web of Science databases, including gray literature, were searched using the following keywords: "Head and Neck Neoplasms"; "Ionizing Radiation"; "Low-Level Light Therapy"; and "Bone regeneration", focusing on the primary studies that assessed the effects of PBM therapy on animal models of irradiated bone. Six studies have met the eligibility criteria and presented an overall regular quality according to the risk of bias assessment tools. All the studies utilized rat animal model and near-infrared laser PBM at low power output setting. Most of the studies showed increased new bone formation, osteocytes, osteoblasts, and vascularization networking, as a result of PBM therapy. However, only one out of the six studies has not shown any differences in bone healing in both lased and non-lased animal groups. Nevertheless, PBM therapy is a potential tool to improve bone healing induced by ionizing radiation. However, due to the scarce number of studies and the great variability of laser parameters and treatment protocols, a clear conclusion cannot be drawn. Hence, extensive preclinical in vivo studies are warranted to ensure these beneficial effects have been addressed prior to translational clinical trials.

Implant-supported Dental Prosthesis and Orthognathic Surgery for Rehabilitation of Patients with Obstructive Sleep Apnea / Prótese Dentária Implanto-suportada e Cirurgia Ortognática para Reabilitação de Pacientes com Apneia Obstrutiva do Sono

Among the treatment options for Obstructive Sleep Apnea (OSA) we have surgery to correct dentofacial deformities. OSA patients are routinely and predictably submitted to surgical treatment for dentofacial deformities. Frequently, orthognathic surgery and osseointegrated implants may be necessary to enable fixed rehabilitation. Patients submitted to orthognathic surgery have a transient decrease in blood supply after maxillary and mandibular osteotomy procedures, which can impair the results in these cases. This case report aimed to present and discuss the conflicting situation of an OSA patient in need of orthognathic surgery and dental implants. The treatment consisted of: (1) extraction of all teeth; (2) complete rehabilitation of the upper and lower jaw with dental implants and prosthesis without compensation; (3) bimaxillary orthognathic surgery to re-establish the maxillomandibular relationship and increase the upper airway volume. This rehabilitation sequence was a safe alternative for a case of Class II OSA, and rapidly achieved a final restoration with enhanced esthetics, functionality, biomechanics, maintenance of oral hygiene, and patient satisfaction (AU)

Entre as opções de tratamento da Apneia Obstrutiva do Sono (AOS) temos a cirurgia para correção das deformidades dentofaciais. Freqüentemente, a combinação de cirurgia ortognática e implantes osseointegráveis pode ser necessária para permitir a reabilitação dental. Pacientes submetidos à cirurgia ortognática apresentam diminuição transitória do suprimento sanguíneo após procedimentos de osteotomia maxilar e mandibular, o que pode prejudicar os resultados nestes casos. Este relato de caso teve como objetivo apresentar e discutir a situação de um paciente com AOS que necessita de cirurgia ortognática e implantes dentários. O tratamento consistiu em: (1) extração de todos os dentes; (2) reabilitação completa da mandíbula superior e inferior com implantes dentários e próteses sem compensação; (3) cirurgia ortognática bimaxilar para restabelecer a relação maxilomandibular e aumentar o volume das vias aéreas superiores. Essa sequência de reabilitação foi uma alternativa segura para um caso de AOS Classe II, e rapidamente alcançou uma reabilitação com estética, funcionalidade, biomecânica aprimorada, manutenção da higiene oral e satisfação do paciente

Terceiro Molar Ectópico em Incisura Mandibular / Ectopic Third Molar in the Mandibular Notch

Dentes ectópicos são frequentemente encontrados, entretanto, terceiros molares inferiores ectópicos são inco-muns, com etiologia obscura e pouco descritos na literatura pertinente. Sua localização já foi relatada nas regiões condilar, subcondilar, incisura mandibular, ângulo e borda inferior da mandíbula. Devido à importância do plane-jamento terapêutico, manejo adequado e variedade das manifestações clínicas desta condição, este trabalho teve como objetivo relatar um caso clínico de terceiro molar inferior ectópico na região de incisura mandibular, com radiolucência aumentada ao redor da coroa, em um paciente do gênero masculino, de 28 anos e sem sintomato-logia. Acompanhamento radiográfico pode ser indicado, no entanto, em pacientes sintomáticos ou com alterações patológicas associadas, a extração deve ser considerada. Diante disso, o tratamento de escolha foi a extração do dente 38 sob anestesia geral, por via intraoral, tendo em vista a posição dentária, radiolucência e morbidade as-sociada à cirurgia. O tecido mole circundante foi enviado para análise anatomopatológica. O paciente evoluiu sem intercorrências durante avaliação pós-operatória (AU)

Ectopic teeth are frequently found, however, ectopic lower third molars are uncommon, with obscure etiology and little described in the pertinent literature. Its location has been reported in the condylar, subcondylar, mandibular notch, angle and lower edge of the mandible. Due to the importance of therapeutic planning, adequate manage-ment and variety of clinical manifestations of this condition, this study aimed to report a clinical case of an ectopic lower third molar in the region of the mandibular notch, with increased radiolucency around the crown, in a male gender pacient, 28 years old and without symptoms. Radiographic follow-up may be indicated, however, in symp-tomatic patients or patients with associated pathological changes, extraction should be considered. Therefore, the treatment of choice was the extraction of tooth 38 under general anesthesia, intraorally approach, considering the dental position, radiolucency and morbidity associated with the surgery. The surrounding soft tissue was sent for anatomopathological analysis. The patient evolved uneventfully during the postoperative evaluation (AU)

Implant-supported Dental Prosthesis and Orthognathic Surgery for Rehabilitation of Patients with Obstructive Sleep Apnea / Prótese Dentária Implanto-suportada e Cirurgia Ortognática para Reabilitação de Pacientes com Apneia Obstrutiva do Sono

ABSTRACT: Among the treatment options for Obstructive Sleep Apnea (OSA) we have surgery to correct dentofacial deformities. OSA patients are routinely and predictably submitted to surgical treatment for dentofacial deformities. Frequently, orthognathic surgery and osseointegrated implants may be necessary to enable fixed rehabilitation. Patients submitted to orthognathic surgery have a transient decrease in blood supply after maxillary and mandibular osteotomy procedures, which can impair the results in these cases. This case report aimed to present and discuss the conflicting situation of an OSA patient in need of orthognathic surgery and dental implants. The treatment consisted of: (1) extraction of all teeth; (2) complete rehabilitation of the upper and lower jaw with dental implants and prosthesis without compensation; (3) bimaxillary orthognathic surgery to re-establish the maxillomandibular relationship and increase the upper airway volume. This rehabilitation sequence was a safe alternative for a case of Class II OSA, and rapidly achieved a final restoration with enhanced esthetics, functionality, biomechanics, maintenance of oral hygiene, and patient satisfaction. (AU)

RESUMO: Entre as opções de tratamento da Apneia Obstrutiva do Sono (AOS) temos a cirurgia para correção das deformidades dentofaciais. Freqüentemente, a combinação de cirurgia ortognática e implantes osseointegráveis pode ser necessária para permitir a reabilitação dental. Pacientes submetidos à cirurgia ortognática apresentam diminuição transitória do suprimento sanguíneo após procedimentos de osteotomia maxilar e mandibular, o que pode prejudicar os resultados nestes casos. Este relato de caso teve como objetivo apresentar e discutir a situação de um paciente com AOS que necessita de cirurgia ortognática e implantes dentários. O tratamento consistiu em: (1) extração de todos os dentes; (2) reabilitação completa da mandíbula superior e inferior com implantes dentários e próteses sem compensação; (3) cirurgia ortognática bimaxilar para restabelecer a relação maxilomandibular e aumentar o volume das vias aéreas superiores. Essa sequência de reabilitação foi uma alternativa segura para um caso de AOS Classe II, e rapidamente alcançou uma reabilitação com estética, funcionalidade, biomecânica aprimorada, manutenção da higiene oral e satisfação do paciente. (AU)

Automatic Segmentation of Bone Canals in Histological Images.

The literature provides many works that focused on cell nuclei segmentation in histological images. However, automatic segmentation of bone canals is still a less explored field. In this sense, this paper presents a method for automatic segmentation approach to assist specialists in the analysis of the bone vascular network. We evaluated the method on an image set through sensitivity, specificity and accuracy metrics and the Dice coefficient. We compared the results with other automatic segmentation methods (neighborhood valley emphasis (NVE), valley emphasis (VE) and Otsu). Results show that our approach is proved to be more efficient than comparable methods and a feasible alternative to analyze the bone vascular network.

Important aspects during advanced lingual laceration management: report of 2 cases / Aspectos importantes para o manejo das lacerações complexas da língua: relato de 2 casos

ABSTRACT Intraoral injuries affect the stomatognathic system, creating difficulties in mastication and speech articulation, especially when they affect the tongue. In this context, the quality of the suture and local care are important to proper recovery and the patient's brief return to their normal functions. Oral lacerations resulting from trauma require specific approaches. Treatments of this type of trauma may primarily be performed by professionals who conduct emergency care; however, they may require the attention of specialists. This article contains recommendations for the primary approach, treatment, and postoperative care of complex lacerations in the tongue.

RESUMO As lesões intraorais afetam o sistema estomatognático, gerando dificuldades na mastigação e na articulação da fala, principalmente quando afetam a língua. Nesse contexto, a qualidade da sutura e o cuidado local são importantes para a recuperação adequada e o breve retorno do paciente às suas funções normais. As lacerações orais resultantes de trauma requerem abordagens específicas. Os tratamentos desse tipo de trauma podem ser realizados principalmente por profissionais que realizam atendimento de emergência; no entanto, eles podem exigir a atenção de especialistas. Este artigo contém recomendações para a abordagem primária, tratamento e cuidados pós-operatórios de lacerações complexas da língua.

Cisto odontogênico glandular tratamento cirúrgico por marsupialização e enucleação: relato de caso / Glandular odontogenic cyst surgical treatment by marsupialization and enucleation: case report

O cisto odontogênico glandular (COG) é o cisto de desenvolvimento mais agressivo e raro dentre todos os odontogênicos, portando características epiteliais glandulares ou salivares. O presente artigo visa retratar uma abordagem mais conservadora para esta importante lesão, no sentido de minimizar a morbidade decorrente da abordagem mais radical. Paciente com 57 anos, leucoderma, assintomático e edêntulo, compareceu ao ambulatório de estomatologia com notável expansão no fundo de saco vestibular e rebordo inferior direito, com tempo indeterminado de evolução. Os exames imaginológicos revelaram uma lesão radiolúcida unilocular extensa e bem delimitada na região anterior da mandíbula. Nas condutas propedêuticas, foi realizada uma punção aspiratória positiva para líquido cístico seguido de biópsia incisional. Diante destes achados, a marsupialização foi realizada no sentido de se conseguir a redução das dimensões lesionais, seguido da enucleação com estectomia periférica após 9 meses. Nos primeiros 2 anos de proservação o paciente mantém- -se sem recidivas e em constante acompanhamento. Conclui-se que o dentista pode preferir o método conservador pela técnica de marsupialização seguida de enucleação na abordagem de extenso cisto odontogênico glandular, desde que haja colaboração do paciente nos cuidados pós-operatórios.

The glandular odontogenic cyst (GOC) is the most aggressive and rare cyst of development among all odontogenics, with glandular or salivary epithelial characteristics. This article aims to portray a more conservative approach to this important lesion, in order to minimize the morbidity resulting from the more radical approach. Patient 57 years-old, leucoderma, asymptomatic and edentulous, attended the stomatology outpatient clinic with a remarkable expansion in the vestibular bag fundus and lower right border, with indeterminate evolution time. Imaging examinations revealed an extensive and well delimited unilocular radiolucent lesion in the anterior region of the mandible. In the propaedeutic procedures, a positive aspiration puncture was performed for cystic fluid followed by incisional biopsy. In view of these findings, marsupialization was performed in order to reduce lesion dimensions, followed by enucleation with peripheral ostectomy after 9 months. In the first 2 years of proservation, the patient remains without relapses and in constant follow-up. It is concluded that the dentist may prefer the conservative method by the marsupialization technique followed by enucleation in the approach of extensive glandular odontogenic cyst, provided there is collaboration of the patient in the postoperative care.

Reconstrução de fratura panfacial cominuta ­ relato de caso / Reconstruction of panfacial fracture - case report

RESUMO: Modelo de estudo: Relato de Caso. Importância do problema: As fraturas panfaciais recebem essa denominação quando os terços faciais apresentam fraturas concomitantes. Com frequência, essas lesões estão relacionadas a danos importantes aos tecidos moles, cominuição e perda de segmentos ósseos e/ou dentários, que podem gerar má oclusão e graves deformidades faciais, visto que etiologia de tal condição se deve à acidentes de alta dissipação de energia. O tratamento das fraturas panfaciais com o uso de fixação interna rígida permite restaurar as funções mastigatórias, bem como os contornos faciais. Comentários: O objetivo desse trabalho é relatar a reconstrução de uma fratura panfacial, envolvendo a mandíbula e com elevado grau de cominuição do complexo zigomático orbitário e do arco zigomático, em uma paciente do sexo feminino, em que acesso hemicoronal e retromandibular foram escolhidos para reconstrução e reestruturação do complexo facial. Conclusão: O correto manejo das fraturas panfaciais, é um dos grandes desafios do cirurgião buco maxilo facial, visto o nível de dificuldade para reestabelecer de maneira satisfatória as condições estéticas e funcionais existentes previamente ao trauma. Diferentes sequências de tratamento vêm sendo propostas, podendo ser utilizadas com sucesso após análise adequada do caso clínico e correta indicação. (AU)

ABSTRACT: Study model: Case Report. Importance of the problem: Panfacial fractures receive this designation when the facial thirds have concomitant fractures. Frequently, these lesions are related to important soft tissue damage, comminution, and loss of bone and/or dental segments, which may lead to malocclusion and severe facial deformities, since the etiology of such condition is due to accidents of high energy dissipation. The treatment of the panfacial fractures with the use of rigid internal fixation allows restoring the masticatory functions, as well as the facial contours. Comments: This study aimed to report the reconstruction of a panfacial fracture, involving the mandible and with a high degree of comminution of the zygomatic or zygomatic arch, in a female patient, whose hemicoronal and retromandibular access were chosen for reconstruction and restructuring of the facial complex. Conclusion: The correct management of panfacial fractures is one of the greatest challenges of the maxillofacial surgeon, given the level of difficulty to satisfactorily reestablish the aesthetic and functional conditions existing before the trauma. Different treatment sequences have been proposed to be used successfully after adequate analysis of the clinical case and correct indication. (AU)

The effect of hyperbaric oxygen therapy on bone macroscopy, composition and biomechanical properties after ionizing radiation injury.

BACKGROUND: Radiotherapy used in tumor treatment compromises vascularization of bone tissue. Hyperbaric oxygenation (HBO) increases oxygen availability and improves vascularization, minimizing the deleterious effects of ionizing radiation (IR). Therefore, the aim of this study was to evaluate HBO therapy effect on bone macroscopy, composition and biomechanical properties after IR damage. METHODS: Twenty male Wistar rats weighing 300 ± 20 g (10 weeks of age) were submitted to IR (30 Gy) to the left leg, where the right leg was not irradiated. After 30 days, ten animals were submitted to HBO therapy, which was performed daily for 1 week at 250 kPa for 90-min sessions. All animals were euthanized 37 days after irradiation and the tibia were separated into four groups (n = 10): from animals without HBO - right tibia Non-irradiated (noIRnoHBO) and left tibia Irradiated (IRnoHBO); and from animals with HBO - right tibiae Non-irradiated (noIRHBO) and left tibia Irradiated (IRHBO). The length (proximal-distal) and thickness (anteroposterior and mediolateral) of the tibiae were measured. Biomechanical analysis evaluated flexural strength and stiffness. Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy (ATR-FTIR) was used to calculate the amide I ratio, crystallinity index, and matrix to mineral ratios. RESULTS: In the macroscopic and ATR-FTIR analysis, the IRnoHBO showed lower values of length, thickness and amide I ratio, crystallinity index and matrix to mineral ratios compared to noIRnoHBO (p < 0.03). IRnoHBO showed no statistical difference compared to IRHBO for these analyses (p > 0.05). Biomechanics analysis showed that the IRnoHBO group had lower values of flexural strength and stiffness compared to noIRnoHBO and IRHBO groups (p < 0.04). In addition, the noIRHBO group showed higher value of flexural strength when compared to noIRnoHBO and IRHBO groups (p < 0.02). CONCLUSIONS: The present study concluded that IR arrests bone development, decreases the collagen maturation and mineral deposition process, thus reducing the flexural strength and stiffness bone mechanical parameters. Moreover, HBO therapy minimizes deleterious effects of irradiation on flexural strength and the bone stiffness analysis.

Tratamento tardio de fratura do complexo zigomático-orbitário com uso de fixação interna rígida / Late treatment of the zygomatic-orbital complex fracture with rigid internal fixation

RESUMO: As fraturas do complexo zigomático-orbitário são bastante frequentes devido a sua localização e projeção na face, podendo gerar grandes transtornos funcionais e estéticos ao paciente. O osso zigomático é essencial na configuração da face, sendo a principal estrutura formadora do terço médio dela. Os traumas que mais frequentemente provocam fraturas do complexo zigomático-orbitário são agressões físicas, acidentes de trânsito e esportivos. O tipo de fratura, tempo decorrido, a severidade e o envolvimento de outras estruturas faciais influenciam a modalidade de tratamento a ser empregado. O presente trabalho apresenta um caso clínico de fratura do complexo zigomático-orbitário esquerdo, diagnosticada tardiamente, e tratada por meio de osteotomia, redução e fixação em três pontos com placas e parafusos do sistema 1.5, e reconstrução do assoalho orbitário com tela de titânio. (AU)

ABSTRACT: Fractures of the zygomatic-orbital complex are quite frequent due to their location and projection on the face, which can cause major functional and aesthetic disorders to the patient. The zygomatic bone is essential in the configuration of the face, being the main forming structure of the middle third of it. The traumas that most often cause fractures of the zygomatic-orbital complex are physical aggression, traffic accidents, and sports. The type of fracture, elapsed time, severity, and the involvement of other facial structures influence the type of treatment to be employed. The present work presents a clinical case of fracture of the left zygomatic-orbital complex, diagnosed late, and treated by osteotomy, reduction, and fixation in three points with 1.5 system plates and screws, and reconstruction of the orbital floor with titanium mesh. (AU)

Removal of firearm projectile from the maxillary sinus: a case report / Remoção de projétil de arma de fogo do seio maxilar: relato de caso

ABSTRACT Foreign bodies in the paranasal sinuses after critical accidents are rare occurrences that have sporadically been reported worldwide. Firearm projectiles, daggers, knives, glass fragments, stones, teeth, and wood can get lodged in the soft and hard tissues of the face. The management and prognosis in these cases depend on the composition and location of the foreign body as well as on the presence or absence of infection. Although there are reports involving the soft tissues of the face, the ethmoid, sphenoid, frontal, and maxillary sinuses are the most frequently involved sites. The main manifestation of this condition is sinusitis arising from infection and/or inflammation caused by the foreign body, which is a contaminated object. We report a case of removal of a firearm projectile located in the maxillary sinus of a 34-year-old patient under local anesthesia.

RESUMO Corpos estranhos nos seios paranasais são ocorrências raras que têm sido esporadicamente relatadas na literatura em todo o mundo. Projéteis de arma de fogo, punhais, facas, fragmentos de vidro, pedras, dentes e madeira podem ficar alojados nos tecidos moles e duros do rosto. O manejo e o prognóstico nesses casos dependem da composição e localização do corpo estranho, bem como da presença ou ausência de infecção. Embora haja relatos envolvendo os tecidos moles da face, os seios etmoidal, esfenoidal, frontal e maxilar são os locais mais frequentemente envolvidos. A principal manifestação dessa condição é sinusite decorrente de infecção e / ou inflamação causada pelo corpo estranho, que é um objeto contaminado. Relatamos um caso de remoção de um projétil de arma de fogo localizado no seio maxilar de um paciente de 34 anos de idade, sob anestesia local.

Análise eletromiográfica do efeito da fisioterapia no músculo masseter em pós-operatório de politrauma de face / Electromyographic analysis of the effect of physical therapy on the masseter muscle in post-operative facial polytrauma

Em situações de acidente, os traumas faciais têm ocupado lugar de destaque, e as fraturas mandibulares compreendem o maior percentual de injúrias tratadas pelos cirurgiões bucomaxilofaciais. Intervenções fisioterapêuticas vêm sendo somadas à reabilitação pós-operatória, otimizando a atividade muscular pós-trauma, colaborando na recuperação das funções mastigatórias, de fonação, deglutição e posturais. Objetivo: o presente estudo objetivou comparar a evolução longitudinal da atividade elétrica do músculo masseter por meio de exame eletromiográfico em um indivíduo politraumatizado submetido à fisioterapia e outro com fratura de mandíbula sem tratamento fisioterapêutico. Sujeitos e método: para tal pesquisa, analisou-se um voluntário politraumatizado submetido a tratamento fisioterapêutico, um voluntário com fratura de mandíbula sem tratamento fisioterapêutico e três voluntários sem fraturas como grupo controle. Foi realizada uma primeira coleta de dados eletromiográficos nos primeiros dias após alta do serviço de cirurgia responsável pelo tratamento das fraturas e uma segunda coleta 60 dias após. No indivíduo submetido ao tratamento fisioterápico, realizou-se ainda uma terceira coleta após 90 dias. Resultados: o voluntário politraumatizado submetido ao tratamento fisioterapêutico, em 90 dias, obteve atividade elétrica do músculo masseter, semelhante ao grupo controle. Já o voluntário com fretura mandibular não submetido ao tratamento fisioterapêutico apresentou resultados semelhantes ao grupo controle após 60 dias de alta hospitalar. Considerações finais: conclui-se que a intervenção fisioterapêutica em pacientes politraumatizados é de grande relevância, devolvendo a condição muscular fisiológica de mastigação, no que tange à atividade elétrica, num prazo de até 90 dias, apresentando, além disso, vantagens na redução da sintomatologia desarmonizadora da função.(AU)

In cases of accident, facial trauma has stood out and mandibular fractures comprise the highest rate of injuries treated by oral and maxillofacial surgeons. Physiotherapeutic interventions have been added to postoperative rehabilitation, optimizing post-trauma muscle activity, aiding the recovery of masticatory, phonation, swallowing, and postural functions. Objective: the present study aimed to compare the longitudinal evolution of the electrical activity of the masseter muscle through electromyographic examination in a polytraumatized individual subjected to physical therapy and another individual with mandibular fracture without physical therapy. Subjects and method: the study analyzed a polytraumatized volunteer subjected to physical therapy treatment, a volunteer with mandibular fracture without physical therapy treatment, and three volunteers without fractures as control group. A first electromyographic data collection was performed in the first days after the discharge from the surgery department responsible for the treatment of fractures, and a second collection occurred 60 days later. In the individual subjected to physiotherapeutic treatment, a third collection was performed 90 days later. Results: the polytraumatized volunteer subjected to the physiotherapeutic treatment obtained, in 90 days, electrical activity of the masseter muscle similar to the control group. The volunteer with mandibular fracture not subjected to physical therapy presented results similar to the control group 60 days after hospital discharge. Final considerations: it is concluded that the physiotherapeutic intervention in polytraumatized patients is of great relevance, returning the physiological muscular condition of chewing, regarding the electrical activity, within a period of up to 90 days, also presenting advantages in the reduction of the function disharmonizing symptomatology.(AU)

Tratamento cirúrgico de terceiro molar inferior invertido: relato de caso / Treatment of third invested lower molar: case report

A presença de terceiros molares invertidos se apresenta como uma condição pouco relatada na literatura. Diversas hipóteses têm sido propostas para explicar o deslocamento destes elementos, entretanto suas causas e tratamentos permanecem incertos. O objetivo deste trabalho é relatar um caso clínico de impacção invertida de terceiro molar inferior direito, onde optou-se pela exodontia sob anestesia local com osteotomia conservadora e exérese total do elemento em paciente do sexo feminino de 52 anos. Terceiros molares com esta variação de erupção são raros na clínica, sendo geralmente visualizados em exames radiográficos de rotina e observados clinicamente após início de sintomatologia. Diversos tratamentos têm sido propostos, variando de abordagem cirúrgica, ao acompanhamento de longo prazo. A abordagem intraoral associada a uma conduta conservadora tem se mostrado o tratamento de escolha na maioria dos casos. Entretanto, a escolha do planejamento dependerá, dentre outros fatores, da sintomatologia do paciente e a presença de patologias associadas, sempre optando-se pela técnica que promoverá menor morbidade operatória e melhor resolubilidade do caso(AU)

The presence of inverted third molars presents as a condition poorly reported in the literature. Several hypotheses have been proposed to explain the displacement of these elements, however their causes and treatments remain uncertain. The objective of this study is to report a clinical case of inverted impaction of the right lower third molar, where it was chosen exodontia under local anesthesia with conservative osteotomy and total exeresis of the element in a 52-year-old female patient. Third molars with this variation of eruption are rare in the clinic and are usually visualized in routine radiographic examinations and observed clinically after start symptomatology. Several treatments have been proposed, ranging from a surgical approach to long-term follow-up. The intraoral approach associated with conservative management has been shown to be the treatment of choice in most cases. However, the choice of planning will depend, among other factors, on the patient's symptoms and the presence of associated pathologies, always opting for the technique that will promote less operative morbidity and better solubility of the case(AU)

Ionizing radiation and bone quality: time-dependent effects.

BACKGROUND: The aim of this study was to evaluate the ionizing radiation (IR) effects on rat bone 30 and 60 days after irradiation. METHODS: Wistar rats were submitted to IR (30 Gy) on the left leg and were euthanized after 30 and 60 days. The legs were divided into four groups according to the treatment and euthanization time: C30 and C60 (right leg-without IR), IR30 and IR60 (left leg-with IR). RESULTS: CT analysis showed more radiodensity in C60 compared with other groups, and IR60 showed more radiodensity than IR30. In histomorphometric analysis, C30 showed lower bone matrix values compared with IR30 and C60. Lacunarity analyses showed more homogeneous bone channel distribution in C30 than IR30. ATR-FTIR showed decrease in ratio of mature and immature crosslinks in IR30 compared with C30. Crystallinity Index was decrease in IR60 compared with C60. The Amide III + Collagen/HA ratio was increased in C60 compared with C30; however this ratio decreased in IR60 compared with IR30. Biomechanical analysis showed lower values in IR groups in both time. CONCLUSIONS: IR damaged bone quality and decreased stiffness. Moreover, the results suggested that the deleterious effects of IR increased in the late time points.

Influence of Platelet-Poor Plasma on Angiogenesis and Maintenance of Volume in Autogenous Bone Grafts.

PURPOSE: The aim of this study was to evaluate the effect of different storage media on angiogenesis and maintaining autogenous bone graft volume in rabbits. MATERIAL AND METHODS: Two grafts were removed bilaterally from the calvaria of 18 rabbits. One graft was removed and immediately fixed in the right mandibular angle (control group). The other graft was stored for 30 minutes in 1 of the following storage media (n = 6): saline solution (saline group), air exposure (dry group), or platelet-poor plasma (PPP group) and then retained by a screw in the right mandibular angle in the same animal. Four weeks later the animals were euthanized, and the grafted areas were harvested, fixed in 10% phosphate buffered formaldehyde solution, and embedded in paraffin. The 5-µm semi-serial sections were stained in hematoxylin and eosin and Mallory trichrome. RESULTS: Histologic analysis of all groups showed the bone graft was vascularized and well incorporated into the recipient site. The number of blood vessels decreased in the saline and dry groups compared with the control group (P < .03); in contrast, the number of blood vessels increased in the PPP group (P < .05). There were fewer osteoclasts in the saline group compared with the control group (P < .05). Furthermore, the saline group showed larger numbers of blood vessels than the dry group (P < .01). The PPP group showed larger bone graft volumes compared with the dry and saline groups (P < .01). In addition, the saline group showed larger bone graft volumes than the dry group (P < .01). CONCLUSIONS: PPP improved angiogenesis, maintained the volume of the autogenous bone graft, and was a better storage medium during the trans-surgical period than the dry and saline media.

Abordagem clínico-cirúrgica de infecção complexa Em região maxilo-facial: relato de caso / Clinical-surgical approach to complex infection in Maxillofacial region: a case report

Infecções de origem odontogênica possuem o potencial de disseminar-se pelos espaços faciais e comprometer a vida do paciente, devendo, portanto ser tratadas como uma urgência e requerem intervenção imediata. Algumas comorbidades como deficiência imunológica, diabetes e cirrose hepática, podem predispor ao agravamento da infecção e dificultar seu tratamento. Neste relato de caso apresentamos um paciente de 66 anos de idade, com odontalgia em região de molares superiores. Ao exame clínico foi observado sinais flogísticos em fundo de vestíbulo na região de molares e pré-molares superiores direito. Foi iniciada antibioticoterapia por via oral seguida pela extração dos dentes comprometidos. Após 12 horas do primeiro atendimento, o paciente evoluiu com edema extenso de consistência lenhosa em hemiface direita, trismo severo, disfagia, dislalia e dispneia leve. O paciente foi submetido à drenagem cirúrgica do abscesso sob anestesia geral e 72 horas pós-procedimento evoluiu com insuficiência renal aguda, síndrome de abstinência alcoólica, hipertensão arterial sistêmica de difícil controle e piora do quadro infeccioso. Foram solicitados novos exames imaginológicos onde foi observada uma lesão apical inicialmente não diagnosticada associada ao dente 47. O paciente foi submetido à nova drenagem e remoção do dente 47. Após 10 dias do início da nova terapia antibiótica o paciente recebeu alta hospitalar. O mesmo permaneceu em acompanhamento ambulatorial recebendo alta definitiva após 30 dias de acompanhamento em bom estado geral. Para evitar recorrências e instituir um tratamento definitivo para infecções de origem odontogênica, é importante, além da intervenção imediata, um exame minucioso eliminando possíveis focos de infecção

Severe odontogenic infections have the potential to spread through facial spaces and compromise the patient´s life, thus should be treated as an emergency requiring immediate intervention. Some comorbidities such as immunological deficiency, diabetes and liver cirrhousis, can predispose worsening of infection making it difficult to treat. In this case report we present a 66 year old patient with toothache in the region of upper molars. Clinical examination revealed phlogistic signs in the vestibule fundus region of the upper right molars and premolars. Oral antibiotic therapy was initiated followed by extraction of the involved teeth. After 12 hours of the initial treatment, the patient developed extensive edema with woody consistency in right hemiface, severe trismus, dysphagia, dyslalia and slight dyspnoea. The patient underwent surgical drainage of the abscess under general anesthesia. After 72 hours of this procedure he evolved with acute renal failure, alcohol withdrawal syndrome, systemic arterial hypertension of difficult control and worsening of the infectious condition. New imaging exams were requested where an initial undetected apical lesion associated with tooth 47 was observed. The patient was submitted to new drainage and removal of the tooth 47. After 10 days of the start of the new antibiotic therapy the patient was discharged from hospital. The patient remained in outpatient follow-up receiving definitive discharge after 30 days of followup in good general condition. In order to avoid recurrences and to institute a definitive treatment for odontogenic infections, it is important, besides the immediate intervention, a thorough examination eliminating possible foci of infection

Hyperbaric Oxygen therapy effects on bone regeneration in Type 1 diabetes mellitus in rats.

PURPOSE: The aim of this study was evaluate the effect of HBO on diabetic rats. MATERIALS AND METHODS: Twenty rats were distributed into four groups (n = 5): Control (C); Control + HBO (CH); Diabetes (D) and Diabetes + HBO (DH). Diabetes was induced by streptozotocin, and bone defects were created in both femurs in all animals. HBO therapy began immediately after surgery and was performed daily in the CH and DH groups. After 7 days, the animals were euthanized. The femurs were removed, demineralized, embedded in paraffin, and histologic images were analyzed. RESULTS: Qualitative histologic analyses showed more advanced stage bone regeneration in control groups (C and CH) compared with diabetic groups (D and DH). Histomorphometric analysis showed significantly increased bone neoformation in CH compared with the other groups (p < 0.001). Diabetic Group (D) showed decreased bone neoformation compared with non-diabetic groups (C and CH) (p < 0.001); however DH did not differ from C Group (p > 0.05). The mast cell population increased in CH compared with the other groups (C, D, and DH) (p < 0.05). The mast cell population did not differ between D and DH Groups. CONCLUSIONS: This study showed that HBO therapy improved early bone regeneration in diabetic rats and increased the mast cell population only in non-diabetic animals. HBO was shown to be important treatment for minimizing deleterious effects of diabetes on bone regeneration.

High doses of ionizing radiation on bone repair: is there effect outside the irradiated site?

Local ionizing radiation causes damage to bone metabolism, it reduces blood supply and cellularity over time. Recent studies indicate that radiation promotes biological response outside the treatment field. The aim of this study was to investigate the effects of ionizing radiation on bone repair outside the irradiated field. Ten healthy male Wistar rats were used; and five animals were submitted to radiotherapy on the left femur. After 4 weeks, in all animals were created bone defects in the right and left femurs. Seven days after surgery, animals were euthanized. The femurs were removed and randomly divided into 3 groups (n=5): Control (C) (right femur of the non-irradiated animals); Local ionizing radiation (IR) (left femur of the irradiated animals); Contralateral ionizing radiation (CIR) (right femur of the irradiated animals). The femurs were processed and embedded in paraffin; and bone histologic sections were evaluated to quantify the bone neoformation. Histomorphometric analysis showed that there was no significant difference between groups C (24.6±7.04) and CIR (25.3±4.31); and IR group not showed bone neoformation. The results suggest that ionizing radiation affects bone repair, but does not interfere in bone repair distant from the primary irradiated site.

The effects of ionizing radiation on the growth plate in rat tibiae.

The deleterious effects of ionizing radiation on the growth plate continue to be cause for concern. This study evaluated the ionizing radiation effects on bone development and growth plate in the tibia of rats. All animals were submitted to ionizing radiation on the left leg. The animals were divided into two groups and euthanized 30 and 60 days after radiation. The tibiae were removed and separated into groups: control 30 days, irradiated 30 days, control 60 days and irradiated 60 days. Animals in each group (n = 7) were used for macroscopic and histological analysis. The irradiated tibiae showed arrested growth, angular deformity and limb length discrepancy when compared with nonirradiated tibiae. There was statistical difference between control and radiation groups in all the parameters analyzed, except in the lateral-medial thickness of the distal epiphysis. Histological analysis showed evident changes in the growth plate, which was thicker in the Groups irradiated for 30 days, and irradiated for 60 days, compared with their respective controls. The growth plate showed wide areas with disorganized zones of chondrocytes and severely reduced calcification zone. It was concluded that ionizing radiation damaged the growth plate, compromised the endochondral ossification process, and resulted in complete arrest of bone development.