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.

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)

Primary Myiasis in Surgical Wound of Mandible Symphisis Fracture.

A 42 year old patient was referred to the Department of Oral and Maxillofacial Surgery of the Federal University of Uberlândia, for treatment of mandibular fractures (condyles and symphysis), a victim of a run over. The symphysis was surgically approached, using as surgical access the pre-existing laceration in the submental region. Five days after discharge, the patient returned with dehiscence of the wound and physical examination showed infestation by larvae in the symphysis. Mechanical removal and debridement were performed under local anesthesia, where plate exposure was noted. The patient underwent oral ivermectin therapy, intravenous antibiotic therapy and a thorough debridement was performed under general anesthesia due to the invasion of deep spaces in the supra-hyoid region. After 2 weeks, it presented with purulent drainage at the site. The miniplates were replaced by a 2.4 mm reconstruction plate and antibiotic therapy was maintained. Due to the social risk, the patient remained hospitalized for 45 days, when he was discharged with outpatient return, but did not attend the returns.