Results of a Novel Technique for Increasing Bone Contact and Stability in Mandibular Reconstruction with Micro-vascularized Fibula Flap.

Background: Reconstruction of large mandibular defects requires reestablishment of mandibular continuity with bone and soft tissue. The microvascularized fibula flap (MFF) has the advantage of providing both, with adequate length, low resorption rate, low infection risk and possibility of dental implant insertion. It can be adapted to mandibular defects in many different ways. Purpose: This retrospective study will present and evaluate the results of the male-female joint technique for flap positioning and fixation. Methods: The technique consists of designing osteotomies on the binding edge of the MFF and recipient jaw, increasing bone contact from one to five faces. Patients submitted to mandibular reconstruction through this technique were included and evaluated regarding systemic compromise, complication occurrence as well as primary and long-term stability. Results: Ten patients underwent mandibular reconstruction with the male-female joint technique. Sixteen joints were applied, and excluding an early loss due to vascular failure, all remaining 14 joints healed uneventfully. None showed signs of early or late mobility. Conclusion: Fitting the MFF through a male-female joint that provides greater bone contact may improve stability and reduce screw loosening and mini-plate removal rates.

Evaluation of photobiomodulation therapy (PBMT) on salivary flow and composition in head and neck cancer patients undergoing radiation therapy.

OBJECTIVE: Assess the impact of photobiomodulation therapy (PBMT) on xerostomia, salivary flow rate (SFR) and composition in patients undergoing radiotherapy (RT) for head and neck cancer (HNC). STUDY DESIGN: Thirty patients undergoing RT (65 Gy) for HNC were enrolled. Saliva and xerostomia evaluations collected pre- and post-PBMT-RT. PBMT involved irradiation of extra and intraoral points, 15-20 sessions, 2-3 times/week. SFR, trace elements, total protein, alkaline phosphatase, xerostomia, and pH were analyzed. RESULTS: The average age was 60.7 years. After treatment, there was not a significant reduction in SFR and there was no difference on xerostomia. Significant reductions in Al, Cd, Fe, Ni, P, and Sb concentrations were observed, along with a significant increase in Mg concentration. Sample data were organized into 3 groups based on a self-organizing map. Low concentrations of Al, As, Co, Cr, Cu, Fe, Mn, Mo, S, Sr, and Zn were the primary discriminatory factors for group A, while group B consisted of post-PBMT-RT samples with high concentrations of Ca, K, Mg, Na, and S. CONCLUSIONS: PBMT prevented a significant reduction in SFR and xerostomia induced by radiation therapy. These findings suggest that PBMT prevents salivary gland damage minimizing the decline in salivary flow.

Use of Leukocyte- and Platelet-Rich Fibrin to Prevent Osteonecrosis of the Jaws Associated with the Use of Bisphosphonate Therapy: A Case Series.

Medication-related osteonecrosis of the jaws (MRONJ) consists of an area of exposed intraoral or extraoral bone that affects patients with a history of use of antiresorptive and antiangiogenic medications, and who have not undergone head and neck radiotherapy. Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous material of great potential, used as an adjuvant in surgical treatments, especially where healing is compromised. The aim of this article is to report three cases of the use of L-PRF in the prevention of MRONJ in three female Caucasian under bisphosphonates therapy. Patient 1, 86 years old, with osteoporosis, complained of intense pain in tooth 33, which presented edema and periapical lesion and association with MRONJ. Patient 2, 61 years old, undergoing treatment for bone metastases due to breast cancer, reported pain symptoms in tooth 47, as well as suppuration in the dental element, grade I mobility, pain on periapical palpation and radiographically an endoperiodontal lesion was evidenced. Patient 3, 56 years old, also undergoing treatment for breast cancer, presented with severe pain in tooth 36. On clinical examination, she presented pain, mobility and suppuration, and radiographs indicated a furcation lesion on tooth 36. The treatment option in the three cases was the extraction of the affected teeth and the use of L-PRF to promote healing. All patients present a favorable outcome in follow-up. The use of L-PRF can be an adjuvant in the prevention of MRONJ; however, further studies are needed to prove its effectiveness.

Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic acid-case-control study.

INTRODUCTION: Medication-related osteonecrosis of the jaws (MRONJ) is a complication that develops in patients who use or have used antiresorptive or antiangiogenic medications for the treatment of bone metabolic disease and bone metastases. Clinically, MRONJ is characterized by the appearance of an inflammation in soft tissues and exposure of necrotic bone tissue in mandible or maxilla, for a period of 8 weeks, in patients with no history of head and neck radiotherapy that were being or are being treated with antiresorptive and/or antiangiogenic agents. The fibrin-rich platelets and leukocytes (L-PRF) membrane has been used as an alternative for MRONJ prevention. The aim of this study was to evaluate the use of L-PRF in prevention and treatment of bone necrosis. MATERIAL AND METHODS: The patients included had MRONJ diagnosis confirmed after clinical and radiographic examination and patients whose only therapeutic option was dental extraction. RESULTS: Twenty patients were included in the study and were divided in three groups. Two patients were removed from the study due to previous history of pentoxifylline and tocopherol use. The result of surgical treatment was successful in 57% in group 1 (control/MRONJ prevention), 100% in group 2 (MRONJ prevention), and 80% in group 3 (MRONJ treatment). CONCLUSION: L-PRF is an autologous biomaterial that allows the release of growth factors for a prolonged time, resulting in a better healing, reducing the risk contamination, edema, and postoperative pain, being a great ally in the prevention and treatment of MRONJ because it returns to these patients, mainly quality of life, reducing pain, and recurrent infections commonly seen in the processes of bone necrosis of the jaws.

Risk factors for medication-related osteonecrosis of the jaw and salivary IL-6 IN cancer patients / Fatores de risco para osteonecrose dos maxilares relacionada à medicação e níveis salivares de IL-6 em pacientes com câncer

Abstract Introduction Medication-related osteonecrosis of the jaws is a severe complication of the use of antiresorptive and antiangiogenic therapy, with limited treatment options and great impact on patient's quality pf life. Objective The aim of this study was to assess the risk factors associated with medication-related osteonecrosis of the jaws in oncologic patients undergoing bisphosphonate treatment. In addition, salivary levels of interleukin-6, IL-6, were measured to investigate their association with severity and risk of medication-related osteonecrosis of the jaws. Methods Case-control study with 74 patients with bone metastases from solid tumors and multiple myeloma was included. Patients were divided into three groups: 1) those undergoing bisphosphonate treatment with medication-related osteonecrosis of the jaws; 2) those undergoing bisphosphonate without medication-related osteonecrosis of the jaws; and 3) those with bisphosphonate pretreatment. The demographic and medical data of the patients were collected to assess risk. The clinical evaluation was performed to diagnose medication-related osteonecrosis of the jaws and unstimulated saliva was collected for quantification of IL-6. Results As result, it was observed that patients diagnosed with medication-related osteonecrosis of the jaws were submitted to higher number of bisphosphonate doses (p= 0.001) and monthly infusion protocol (p= 0.044; OR = 7.75). Patients who did not have routine followup with specialized dentists during therapy with bisphosphonate and smoking were associated with medication-related osteonecrosis of the jaws (p= 0.019; OR = 8.25 and p= 0.031; OR = 9.37 respectively). Group 1 had a higher frequency of treatment with chemotherapy and corticosteroids concomitant with bisphosphonate, and surgical dental procedures (p= 0.129). Salivary IL-6 levels showed no statistically significant difference between the groups (p= 0.571) or association with medication-related osteonecrosis of the jaws severity (p= 0.923). Conclusion A higher number of bisphosphonate cycles, monthly infusion protocol, no dental follow-up for oral health maintenance and smoking were associated with medication-related osteonecrosis of the jaws. Specialized dental follow up during bisphosphonate treatment has been shown to be an important factor in preventing this complication.

Resumo Introdução A osteonecrose dos maxilares relacionada à medicação é uma complicação grave da terapia antirreabsortiva e antiangiogênica, com opção de tratamento limitada e grande impacto na qualidade de vida do paciente. Objetivo Avaliar os fatores de risco associados à osteonecrose dos maxilares relacionada à medicação em pacientes oncológicos em tratamento com bifosfonato Além disso, os níveis salivares de interleucina-6 (IL-6) foram medidos para investigar sua associação com a gravidade e o risco de osteonecrose dos maxilares relacionada à medicação. Método Estudo caso-controle com 74 pacientes com metástases ósseas de tumores sólidos e mieloma múltiplo. Os pacientes foram divididos em três grupos: 1) em tratamento por bifosfonato com osteonecrose dos maxilares relacionada à medicação; 2) submetidos ao bifosfonato sem osteonecrose dos maxilares relacionada à medicação; e 3) pré-tratamento de bifosfonato. Os dados demográficos e médicos dos pacientes foram coletados para avaliar o risco. A avaliação clínica foi feita para diagnosticar osteonecrose dos maxilares relacionada à medicação e a saliva não estimulada foi coletada para quantificação da IL-6. Resultados Observou-se que os pacientes diagnosticados com osteonecrose dos maxilares relacionada à medicação foram submetidos a maior número de doses de bifosfonato (p = 0,001) e protocolo de infusão mensal (p = 0,044; OR = 7,75). Pacientes que não tiveram acompanhamento de rotina com dentistas especializados durante a terapia com bifosfonato e tabagismo foram associados ao osteonecrose dos maxilares relacionada à medicação (p = 0,019; OR = 8,25 e p = 0,031; OR = 9,37, respectivamente). O grupo 1 apresentou maior frequência de tratamento com quimioterapia e corticosteroides concomitantes ao bifosfonato e procedimentos odontológicos cirúrgicos (p = 0,129). Os níveis salivares de IL-6 não apresentaram diferença estatisticamente significante entre os grupos (p = 0,571) ou associação com a gravidade do osteonecrose dos maxilares relacionada à medicação (p = 0,923). Conclusão Maior número de ciclos de bifosfonato, protocolo de infusão mensal, ausência de acompanhamento odontológico para manutenção da saúde bucal e tabagismo foram associados ao osteonecrose dos maxilares relacionada à medicação. O acompanhamento odontológico especializado durante o tratamento demonstrou ser importante na prevenção dessa complicação.

Maxillary and Orbital Floor Reconstruction with Parallel Segments of the Fibula Free Flap: A Technical Note.

Introduction: The fibula free flap (FFF) is considered a gold standard for maxillary reconstructions, and in the last few decades, this flap has been widely used for mandibular defects, with a range of modifications, which have allowed the improvement and greater success. The reconstructions of the maxilla and midface are less reported than mandibular reconstructions, despite the remarkable evolution over the years. In the reconstruction of type IIIa maxillary defects using FFF, some authors report that it may not provide enough height to support the orbit in class 3 and 4 defects. Others also encountered several difficulties, mainly in modeling fibular bone (FB) for the zygomatic-maxilla complex reconstruction and orbital floor, due to the difficulty in rotating the soft tissues, pedicle, orientation of the (FB) segments. Objective: To show this new technique presents another option for maxillary reconstruction with a FFF in type IIIa defects. Methods: After harvesting FFF in the standard fashion, differentiated osteotomies, modeling, and arrangement of the fibular bone segments are performed. Results and Conclusion: This new technique presented has the advantage of requiring only one flap, promoting the resolution of the technical difficulties previously reported.

Risk factors for medication-related osteonecrosis of the jaw and salivary IL-6 IN cancer patients.

INTRODUCTION: Medication-related osteonecrosis of the jaws is a severe complication of the use of antiresorptive and antiangiogenic therapy, with limited treatment options and great impact on patient's quality pf life. OBJECTIVE: The aim of this study was to assess the risk factors associated with medication-related osteonecrosis of the jaws in oncologic patients undergoing bisphosphonate treatment. In addition, salivary levels of interleukin-6, IL-6, were measured to investigate their association with severity and risk of medication-related osteonecrosis of the jaws. METHODS: Case-control study with 74 patients with bone metastases from solid tumors and multiple myeloma was included. Patients were divided into three groups: 1) those undergoing bisphosphonate treatment with medication-related osteonecrosis of the jaws; 2) those undergoing bisphosphonate without medication-related osteonecrosis of the jaws; and 3) those with bisphosphonate pretreatment. The demographic and medical data of the patients were collected to assess risk. The clinical evaluation was performed to diagnose medication-related osteonecrosis of the jaws and unstimulated saliva was collected for quantification of IL-6. RESULTS: As result, it was observed that patients diagnosed with medication-related osteonecrosis of the jaws were submitted to higher number of bisphosphonate doses (p = 0.001) and monthly infusion protocol (p = 0.044; OR = 7.75). Patients who did not have routine followup with specialized dentists during therapy with bisphosphonate and smoking were associated with medication-related osteonecrosis of the jaws (p = 0.019; OR = 8.25 and p = 0.031; OR = 9.37 respectively). Group 1 had a higher frequency of treatment with chemotherapy and corticosteroids concomitant with bisphosphonate, and surgical dental procedures (p = 0.129). Salivary IL-6 levels showed no statistically significant difference between the groups (p = 0.571) or association with medication-related osteonecrosis of the jaws severity (p = 0.923). CONCLUSION: A higher number of bisphosphonate cycles, monthly infusion protocol, no dental follow-up for oral health maintenance and smoking were associated with medication-related osteonecrosis of the jaws. Specialized dental follow up during bisphosphonate treatment has been shown to be an important factor in preventing this complication.

How can the dental surgeon promote oral health in patients submitted to chemotherapy? / Como o cirurgião dentista pode promover saúde bucal em pacientes submetidos à quimioterapia?

Lesions that affect the oral cavity resulting from chemotherapy can lead to systemic impairment, increasing the length of hospital stay, impairing the patient's quality of life. Through a integrative review, this work aims to show the conduct and importance of dentists in promoting oral health and preventing an oral infectious focus. The search was performed in the Pubmed, Cochrone, SciElo and Virtual Health Library (VHL) databases, using the descriptors in English, oral care and Chemotherapy and Cancer treatment and dentistry, filtering only articles in English and published between 2006 and 2021. The search located six hundred and twenty articles, but only seven met the search criteria. One author used a mouthwash containing propolis where 65% of patients were cured on the seventh day after the onset of oral mucositis (OM) lesions. One author used cryotherapy with chamomile infusion, patients who underwent this approach did not pass grade I, being effective in reducing the occurrence of OM, and the other two authors proposed a protocol for oral cavity care. All authors obtained satisfactory results.(AU)

As lesões que acometem a cavidade oral decorrente ao tratamento quimioterápico podem levar a um comprometimento sistêmico aumentando o tempo de internação hospitalar, prejudicando a qualidade de vida do paciente. O foco principal do cirurgião-dentista é identificar e remover fontes de infecção na cavidade oral antes do início da quimioterapia, controlar as possíveis lesões durante o tratamento. Após o tratamento quimioterápico, o paciente retornará para os cuidados dentários gerais, proporcionando manutenção da saúde bucal e prevenção de complicações ao longo prazo do tratamento do câncer. Através de uma revisão integrativa o objetivo desse trabalho é mostrar a conduta e a importância do cirurgião-dentista para promover saúde bucal e prevenir um foco infeccioso oral. A busca foi realizada nas bases de dados Pubmed, Cochrone, SciElo e Biblioteca virtual em saúde (BVS), foram utilizados os descritores em inglês, oral care and Chemotherapy and Cancer treatment and dentistry, filtrando somente os artigos na língua inglesa, estudos com seres humanos e os artigos publicados no intervalo de 2006-2021. A busca com os descritores citados encontrou seiscentos e vinte artigos, entretanto somente sete estavam dentro dos critérios da pesquisa. Um autor utilizou bochecho de própolis, outro crioterapia com infusão de camomila e os outros dois propuseram protocolo de cuidados com a cavidade oral. Todos os autores obtiveram resultados satisfatórios. (AU)

Epithelial-mesenchymal markers and their correlation with clinical aspects in odontogenic keratocysts / Marcadores epitélio-mesênquima e sua correlação com aspectos clínicos em lesões de ceratocisto odontogênico

ABSTRACT Objective: Odontogenic keratocysts have a high recurrence rate and aggressive clinical behavior. The event called epithelial-mesenchymal transition is a process in which the epithelial cell loses its epithelial characteristics and acquires properties typical of mesenchymal cells. Studies have already demonstrated that odontogenic keratocysts has expression of tumor markers, but the lack of clarification about its development mechanism and molecular composition makes the therapeutic options remain limited. The aim of this study is to evaluate the expression of epithelial-mesenchymal transition marker proteins in these lesions, correlating the expression of these proteins with clinical aspects of each case. Methods: Patients with odontogenic keratocysts diagnoses, treated by the Department of Oral and Maxillofacial Surgery of the Erasto Gaertner Hospital, Curitiba, Brazil in the period between 2016 and 2019 were evaluated by immunohistochemical analysis, to assess the expression of epithelial-mesenchymal transition markers (Vimentin, beta-catenin and E-cadherin) by qualitative analysis. Results: Eighteen patients were included, with a mean age of 43 years, and most of them were male. The mandible was more affected than the maxilla. No association between the clinical characteristics of the cysts and the immunohistochemical profile for epithelial-mesenchymal transition proteins was observed. Conclusion: The positivity of E-cadherin and negativity of vimentin demonstrates that its function is preserved. Loss of function of E-cadherin is associated with worse prognosis. The identification of the epithelial-mesenchymal transition process as a prognostic marker for odontogenic cysts and tumors could be an important tool for defining treatment.

RESUMO Objetivo: O ceratocisto odontogênico têm uma alta taxa de recorrência e comportamento clínico agressivo. O evento chamado transição epitelial-mesênquima (TEM) é um processo no qual a célula epitelial perde suas características epiteliais e adquire propriedades típicas das células mesenquimais. Estudos já demonstraram que o ceratocisto odontogênico tem expressão de marcadores tumorais, mas a falta de esclarecimento sobre seu mecanismo de desenvolvimento e composição molecular faz com que as opções terapêuticas permaneçam limitadas. O objetivo deste estudo é avaliar a expressão das proteínas marcadoras de transição epitelial-mesênquima nestas lesões, correlacionando a expressão destas proteínas com os aspectos clínicos de cada caso. Métodos: Os pacientes com diagnóstico de ceratocisto odontogênico, tratados pelo Serviço de Cirurgia Bucomaxilofacial do Hospital Erasto Gaertner, Curitiba, Brasil, no período entre 2016 e 2019, foram avaliados por análise imunohistoquímica, para avaliar a expressão dos marcadores transição epitelial-mesênquima (Vimentina, beta-catenina e E-cadherina). Resultados: Foram incluídos 18 pacientes, com idade média de 43 anos, e a maioria deles eram do sexo masculino. A mandíbula foi mais afetada do que a maxila. Não foi observada associação entre as características clínicas dos cistos e o perfil imuno-histoquímico das proteínas transição epitelial-mesênquima. Conclusão: A positividade da E-caderina e a negatividade da vimentina demonstram que a sua função está preservada. A perda da função da E-caderina está associada a um pior prognóstico. Identificar o processo da transição epitelial-mesênquima como um marcador de prognóstico para cistos e tumores odontogênicos pode ser uma ferramenta importante para definir o tratamento dessas lesões.

Quality of life in cancer patients with or without medication-related osteonecrosis of the jaw.

PURPOSE: Cancer and its therapies can have a significant impact on general and oral health and, therefore, cause a reduction in patients' quality of life (QoL). The study aimed to evaluate the QoL of cancer patients who use antiresorptive and anti-angiogenic medications with or without the development of medication-related osteonecrosis of the jaws (MRONJ). METHODS: Sixty-two patients diagnosed with cancer under antiresorptive therapy answered three instruments from the European Organization for Cancer Research and Treatment (EORTC). The first questionnaire (QLQ-C30) aimed to measure the overall QoL, the second (QLQ-ELD14) is a complementary module for elderly patients, and the third (QLQ-OH15) aimed to assess oral health related to QoL. RESULTS: The mean age of the patients was 62.19 years, and 12.9% developed MRONJ. There was no significant difference between sex and MRONJ. Among the QLQ-C30 scales, the item "role functioning (RF2)" presented a significant result (p = 0.019). Those patients without MRONJ had a better function performance both in their daily chores and in their free time. Age was not associated to MRONJ, although some concerns are common to the elderly and cancer patients. QoL related to oral health presented a significant result (p = 0.048) showing that MRONJ has a negative impact on patients' QoL. CONCLUSION: Our results showed that MRONJ has a significant impact on the general and oral QoL of cancer patients, and therefore prevention and awareness must be a priority.

Antiresorptive medication in oncology: the clinical and dental profile of patients in a reference center.

OBJECTIVES: : The aim of this study was to evaluate the profile of patients on antiresorptive therapies for cancer treatment and assess presence of oral lesions, oral hygiene status, and knowledge regarding medication-related osteonecrosis of the jaw (MRONJ). MATERIALS AND METHODS: This was an observational cross-sectional study that evaluated patients treated with antiresorptive medication at a single cancer hospital. Clinical data were collected and oral examination was performed to assess patient oral health. RESULTS: From July 2017 to December 2018, 90 patients were assessed; 64 were female and 26 were male, and the mean age was 61 years. The most common drug was an intravenous bisphosphonate, zoledronic acid. Among the 90 patients, 47 presented with some type of oral disease, isolated or associated. Among these 47 patients, 9 patients (10%) developed osteonecrosis. Oral hygiene was evaluated, and most patients, with or without MRONJ, presented with regular to poor condition. Regarding patient knowledge of the risks of MRONJ and the risks associated with dental surgery, 60% stated that they were not aware of the risks. CONCLUSION: Identifying the profile of patients and their needs facilitates not only the preventive process, but also the emergence of new therapeutic options. Our study shows that most patients are weakened both by metastatic disease and antineoplastic treatment as well as by issues associated with aging because most were over 60 years of age. Collectively, this information should be considered for management of preventive and therapeutic measures.

The effect of bone marrow-derived stem cells associated with platelet-rich plasma on the osseointegration of immediately placed implants.

BACKGROUND: Stem cells associated with growth factors have been shown to improve bone healing and the osseointegration of dental implants. A Brazilian miniature pig model was used to evaluate the effect of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) associated with platelet-rich plasma (PRP) on the osseointegration of immediately placed dental implants. MATERIAL AND METHODS: A total of four male adult miniature pigs were used in this study. BM-MSCs from each pig were isolated from the iliac crest and expanded in vitro. The undifferentiated BM-MSCs were mixed with autologous PRP and implanted in the post-extraction sockets at the experimental sites before implant placement (10 x 106 cells/ socket). The control sites did not receive either BM-MSC or PRP. Each animal received four implants in the control side and 04 on the experimental side, totalizing 32 implants. The specimens were analyzed radiographically and histomorphometrically to determine the implant loss rate (ILR), the bone-implant contact (BIC), and bone density within the threads (BDWT). RESULTS: The ILR, the BIC, and the BDWT for the control and experimental sites were respectively 25.0% and 18.7% (p=0.686); 39.0% and 27.7% (p=0.110); 46.8% and 36.5% (p=0.247). CONCLUSIONS: The use of BM-MSCs + PRP in conjunction with immediately placed implants showed a lower ILR but there was no significant effect on the osseointegration of the dental implants. More preclinical studies, in large animal models, are needed to establish whether BM-MSCs associated with PRP could be used for the enhancement of the osseointegration of dental implants. Key words:Osseointegration, bone marrow-derived mesenchymal stem cells, platelet-rich plasma, dental implants, minipigs.

The interval since first symptoms until diagnosis of squamous cell carcinoma in the head and neck region is still a problem in southern Brazil

BACKGROUND: The aim was to examine the interval since first symptoms until final diagnosis of squamous cell carcinoma (SCC) in the head and neck region in southern Brazil. MATERIAL AND METHODS: The individuals were prospectively selected and underwent anamnesis, physical examination and interview in the first medical consultation at a Cancer Hospital from south of Brazil. RESULTS: From 488 patients who underwent clinical examination, 105 were included in the study with diagnosis of SCC. Patients average interval from first symptoms to final diagnosis was 152 days (median 86; max: 1105; min: 1), the average professional interval was 108 days (median: 97; max: 525; min: 1), and the average total period interval was 258 days (median: 186; max: 1177; min: 45). Factors statistically associated with patient and diagnosis itinerary intervals were smoking and poorly adapted dentures and distance from home to hospital, respectively. CONCLUSIONS: The identification of the itinerary characteristics of this specific population may reflect in more effective public policies, such as primary and secondary prevention programs, aiming to increase the survival of oncological patient. Furthermore, the knowledge of the variables that influence the late diagnosis minimizes patient's journey in search of care to cancer centers through health programs

No disponible

Evaluation of different stable internal fixation in unfavorable mandible fractures under finite element analysis.

INTRODUCTION: The mandibular angle fracture is the most common fracture between this type of injury in jaw bone and also is the type of fracture treatment that presents a larger number of complications, and a series different osteosynthesis types have been studied over the years by the world literature. The finite element method is a form of mathematical analysis, which is based on dividing a structure into a finite number of small areas. It has the ability tomathematically model structures, making it possible to apply forces anywhere. MATERIAL AND METHODS: For this study, a three-dimensional mandible with an unfavorable angle fracture was simulated. Five different types of fixations were evaluated: group 1, Champy technique with one 4-holes miniplate, 2.0 system; group 2, technique with two parallel 4-holes conventional miniplates, 2.0 system; group 3, technique with two parallel 4-holes locking miniplates, 2.0 system; group 4, technique with one reconstruction 6-holes plate, 2.8 system in base jaw; and group 5, technique with one reconstruction 6-holes plates, 2.8 system in jaw body + one parallel 4-holes conventional miniplate, 2.0 system. RESULTS: The results showed that strains are better distributed through the locking miniplate and screws system and presented less stress concentration when compared with the conventional ones. The Champy technique had the worst results about of all groups. The use of the locking system shows less stress compared to the non-locking system, and the presence of a reconstruction plate associated with a mini plate does not lead to increased stability compared with an isolated reconstruction plate.

Ocupações relacionadas ao câncer de cabeça e pescoço em uma cidade do Sul do Brasil, 1998 a 2012 / Occupations associated with head and neck cancer in a city in Southern Brazil, 1998 to 2012

INTRODUÇÃO: O câncer é uma doença multifatorial e depende de múltiplas etapas. A redução da incidência ou a modificação da evolução da doença se dão pela eliminação dos fatores de risco associados ao câncer. A identificação de fatores de risco para o desenvolvimento de câncer de cabeça e pescoço associados à ocupação profissional pode complementar ações de vigilância desse tipo de câncer e também favorecer a implantação de medidas preventivas nos ambientes de trabalho. OBJETIVO: Identificar as ocupações de pacientes com câncer de cavidade oral (CCO) e de orofaringe (COF) na cidade de Curitiba, Paraná. MÉTODO: Foi realizado um estudo transversal que avaliou 896 casos de CCO e COF a partir do Registro de Câncer de Base Populacional, entre 1998 e 2012. As ocupações coletadas foram classificadas em quatro grupos baseados no grau de risco definido pelo Ministério do Trabalho e foi analisado o consumo de álcool e tabaco pelos pacientes. RESULTADOS: Os grupos ocupacionais associados aos serviços de limpeza e construção, setor administrativo, agricultura e transportes mantiveram as maiores frequências. O grau de risco 3 concentrou o maior número de casos, com 55,2% do total, atingindo 65,5% quando foram avaliados indivíduos com história de consumo de tabaco e álcool. Comércio, construção, limpeza e serviços mecânicos tiveram o maior número de CCO e COF no município estudado. CONCLUSÃO: Foram encontradas 131 ocupações na amostra estuda, sendo a maior concentração observada no grupo de risco 3. Dessa forma, entende-se que o risco ocupacional deve ser levado em consideração no planejamento de ações preventivas da doença

BACKGROUND: Cancer is a multifactorial disease and depends on multiple stages. Eliminating risk factors contributes to reduce the incidence of disease or modifies its progression. Identifying risk factors for head and neck cancer associated with definite occupations might complement surveillance actions and help in the implementation of preventive measures in the workplace. OBJECTIVE: To identify the occupations of patients with oral cavity (OCC) or oropharyngeal (OPC) cancer in Curitiba, Parana, Brazil. METHODS: Cross-sectional study in which we analyzed 896 cases of OCC and OPC based on the Population-based Cancer Registry, 1998­2012. The located occupations were categorized in four risk groups following the classification formulated by the Ministry of Labor. We also analyzed variables smoking and alcohol consumption. RESULTS: The highest rates of oral cancer corresponded to occupations associated with cleaning, construction, administration, agriculture and transport. Most occupations, 52.2%, were categorized as risk grade 3. This rate increased to 65.5% when smoking and alcohol consumption were included in analysis. Workers in trade, construction, cleaning services and mechanics accounted for the largest number of OCC and OPC cases in the analyzed municipality. CONCLUSION: We found 131 occupations associated with cases of oral cancer, most of which were categorized as risk grade 3. In consequence, occupational risk should be considered in the planning of preventive actions.

Occupations associated with head and neck cancer in a city in Southern Brazil, 1998 to 2012.

BACKGROUND: Cancer is a multifactorial disease and depends on multiple stages. Eliminating risk factors contributes to reduce the incidence of disease or modifies its progression. Identifying risk factors for head and neck cancer associated with definite occupations might complement surveillance actions and help in the implementation of preventive measures in the workplace. OBJECTIVE: To identify the occupations of patients with oral cavity (OCC) or oropharyngeal (OPC) cancer in Curitiba, Parana, Brazil. METHODS: Cross-sectional study in which we analyzed 896 cases of OCC and OPC based on the Population-based Cancer Registry, 1998-2012. The located occupations were categorized in four risk groups following the classification formulated by the Ministry of Labor. We also analyzed variables smoking and alcohol consumption. RESULTS: The highest rates of oral cancer corresponded to occupations associated with cleaning, construction, administration, agriculture and transport. Most occupations, 52.2%, were categorized as risk grade 3. This rate increased to 65.5% when smoking and alcohol consumption were included in analysis. Workers in trade, construction, cleaning services and mechanics accounted for the largest number of OCC and OPC cases in the analyzed municipality. CONCLUSION: We found 131 occupations associated with cases of oral cancer, most of which were categorized as risk grade 3. In consequence, occupational risk should be considered in the planning of preventive actions.

INTRODUÇÃO: O câncer é uma doença multifatorial e depende de múltiplas etapas. A redução da incidência ou a modificação da evolução da doença se dão pela eliminação dos fatores de risco associados ao câncer. A identificação de fatores de risco para o desenvolvimento de câncer de cabeça e pescoço associados à ocupação profissional pode complementar ações de vigilância desse tipo de câncer e também favorecer a implantação de medidas preventivas nos ambientes de trabalho. OBJETIVO: Identificar as ocupações de pacientes com câncer de cavidade oral (CCO) e de orofaringe (COF) na cidade de Curitiba, Paraná. MÉTODO: Foi realizado um estudo transversal que avaliou 896 casos de CCO e COF a partir do Registro de Câncer de Base Populacional, entre 1998 e 2012. As ocupações coletadas foram classificadas em quatro grupos baseados no grau de risco definido pelo Ministério do Trabalho e foi analisado o consumo de álcool e tabaco pelos pacientes. RESULTADOS: Os grupos ocupacionais associados aos serviços de limpeza e construção, setor administrativo, agricultura e transportes mantiveram as maiores frequências. O grau de risco 3 concentrou o maior número de casos, com 55,2% do total, atingindo 65,5% quando foram avaliados indivíduos com história de consumo de tabaco e álcool. Comércio, construção, limpeza e serviços mecânicos tiveram o maior número de CCO e COF no município estudado. CONCLUSÃO: Foram encontradas 131 ocupações na amostra estuda, sendo a maior concentração observada no grupo de risco 3. Dessa forma, entende-se que o risco ocupacional deve ser levado em consideração no planejamento de ações preventivas da doença.

Immunohistochemical analysis of BRAF V600E mutation in ameloblastomas.

OBJECTIVE: This study aimed to investigate the presence of BRAF V600E mutation in mandible ameloblastomas by correlating clinical and imaging data on the cases studied. METHODS: Eighty-four cases diagnosed as mandibular ameloblastoma were selected for analysis. The specimens were submitted to immunohistochemistry for detection of BRAF V600E mutated protein. Clinical-pathological data such as age, gender, tumour size, mandibular location, radiographic aspects, histological type and sub-type, and tumour status were collected. The clinical-pathological parameters were categorised and analysed according to BRAF V600E detection. RESULTS: Of the 84 patients, 78.6% (66 cases) demonstrated positivity for anti-BRAF V600E antibody, whereas 18 were negative (21.4%). The correlation between BRAF expression and variables showed statistical significances for mandibular location (P = 0.0353) and tumour size (P = 0.008), whereas no statistical significance was observed for gender, age, radiographic aspect, histological pattern, histological sub-type and tumour status. Multivariate logistic regression revealed a significant risk for BRAF positivity in tumours with posterior mandibular location (OR = 7.23, P = 0.0451) and size > 4 cm (OR = 7.29, P = 0.0150). CONCLUSION: BRAF V600E mutation is common in mandibular ameloblastomas, especially in cases of tumours larger than 4 cm and in the posterior region of the mandible. In addition, this mutation can occur regardless of histological type of the tumour, age, gender, radiographic aspect and tumour status. CLINICAL SIGNIFICANCE: The association between clinical-pathologic features and BRAF V600E mutation in ameloblastomas may provide directions for the treatment of this neoplasia. The use of BRAF inhibitors for targeted therapy could lead to an establishment of an alternative compared to the resective surgery.

Alterações no perfil da microbiota bucal durante permanência na UTI: colonização por patógenos respiratórios potenciais / Changes in the oral microbiota profile during ICU stay: colonization by potential respiratory pathogens / Alteraciones en el perfil de la microbiota bucal durante permanencia en la UTI: colonización por patógenos respiratorios potenciales

Introdução: Pacientes hospitalizados em Unidade de Terapia Intensiva (UTI) geralmente mostram má higiene bucal, o que contribui significativamente para o agravamento da contaminação local, com a presença de patógenos respiratórios potenciais. Objetivo: Caracterizar qualitativamente o perfil da microbiota bucal durante permanência na UTI, além da identificação de alterações bucais e salivares. Materiais e métodos: Foi realizado um estudo prospectivo em pacientes internados na UTI de um hospital oncológico, os quais foram avaliados clínica e microbiologicamente após 24 (T1), 72 (T2) e 120 (T3) horas consecutivas à admissão na UTI. Foram identificados os principais patógenos em cada momento e o perfil da microbiota oral foi comparado. Resultados: A amostra final foi de 30 pacientes, 23 homens e 7 mulheres, com idade média de 61 anos. Em T1, 96,67% dos pacientes apresentaram crescimento de microorganismos patogênicos, sendo identificados 14 tipos diferentes. Em T2 18 tipos de patógenos diferentes e em T3, 21 tipos, dos quais os mais prevalentes nas três coletas foram Staphylococcus não produtor de coagulase e Candida albicans. Clinicamente foram observados presença e progressão do biofilme visível (61%), cálculo (36,89%), condição periodontal deficiente (33,11%). Em relação à condição salivar verificou-se saburra lingual (92,11%), ressecamento labial (86,67%), hipossalivação (36,67%), assialia (52%) e escoamento salivar (8,89%). Conclusão: O biofilme do dorso de língua de pacientes em UTI pode representar um nicho considerável de patógenos respiratórios potenciais, uma vez que microorganismos etiológicos relacionados à pneumonia nosocomial foram isolados já no primeiro dia de internação, com a colonização subsequente por uma variedade de microorganismos predominantemente gram-negativos(AU)

Introduction: Hospitalized patients receiving treatment at Intensive Care Units (ICU) usually show poor oral hygiene, and may have the mouth and oropharingeal region colonized by pathogens involved in nosocomial pneumonia. The presence of these pathogens may increase the risk for respiratory diseases. OBJECTIVES: The aim of this study was to qualitatively characterize the oral microbiota profile of critical patients during ICU stay, besides the identification of oral and salivary alterations. Materials and Methods: A prospective study was carried out on patients admitted to the ICU from a cancer hospital, who were evaluated clinically and microbiologically (tongue-to-mouth swabs) after 24h (T1), 72h (T2) and within 120 consecutive hours (T3) after ICU admission to the ICU. The main pathogens were identified at each moment and the oral microbiota profile was compared. In addition, the major oral and salivary changes were identified. Results: The final sample consisted of 30 patients, 23 men and 7 women, with a mean age of 61 years. The reasons for hospitalization were 30% postoperative of oncological surgeries and 70% of medical emergencies. In T1, 96.67% of the patients presented growth of pathogenic microorganisms, being identified 14 different types. In T2, 18 different pathogen types were identified, and in T3, 21 pathogens, of which the most prevalent Coagulase negative staphylococcus and Candida albicans were the most prevalent in the three collections. It was observed the presence and progression of visible biofilm (61%), calculus (36.89%), poor periodontal condition (33.11%), partial teeth presence (26.67%), total edentulism (23.33%), cavities (10%), presence of residual root (20%). In relation to the salivary condition, there was accumulation of lingual (92.11%), labial dryness (86.67%), hyposalivation (36.67%), asialia (52%) and salivary flow (8.89%). Conclusion: The tongue dorsum biofilm of ICU patients may represent a considerable niche of potential respiratory pathogens, since etiological microorganisms related to nosocomial pneumonia were isolated on the first day of hospitalization, with subsequent colonization by a variety of microorganisms predominantly gram-negatives. The introduction of professional care directed to oral health and biofilm control in this group of patients could represent a significant contribution to the reduction of diseases to the health of the patient in the ICU(AU)

Introducción: Pacientes hospitalizados en UTI generalmente muestran mala higiene bucal, lo que contribuye significativamente al agravamiento de la contaminación local, con la presencia de patógenos respiratorios potenciales. Objetivo: Caracterizar cualitativamente el perfil de la microbiota bucal durante permanencia en la UTI, además de la identificación de alteraciones bucales y salivares. Materiales y métodos: Se realizó un estudio prospectivo en pacientes internados en la UTI de un hospital oncológico, los cuales fueron evaluados clínica y microbiológicamente después de 24 (T1), 72 (T2) y 120 (T3) horas consecutivas a la admisión en la UTI. Se identificaron los principales patógenos en cada momento y el perfil de la microbiota oral fue comparado. Resultados: La muestra final fue de 30 pacientes, 23 hombres y 7 mujeres, con edad media de 61 años. En T1, el 96,67% de los pacientes presentaron crecimiento de microorganismos patógenos, siendo identificados 14 tipos diferentes. En T2 18 tipos de patógenos diferentes y en T3, 21 tipos, de los cuales los más prevalentes en las tres colectas fueron Staphylococcus no productor de coagulasa y Candida albicans. Se observó la presencia y progresión del biofilme visible (61%), cálculo (36,89%), condición periodontal deficiente (33,11%). En cuanto a la condición salivar se verificó saburra lingual (92,11%), resecamiento labial (86,67%), hiposalivación (36,67%), asialia (52%) y flujo salivar (8,89%). Conclusión: El biofilm del dorso de lengua de pacientes en UTI puede representar un nicho considerable de patógenos respiratorios potenciales, ya que microorganismos etiológicos relacionados a la neumonía nosocomial se aislaron ya en el primer día de internación, con la colonización subsecuente por una variedad de microorganismos predominantemente gram-negativa(AU)

Medication-related osteonecrosis of the jaw, osteoradionecrosis, and osteomyelitis: A comparative histopathological study.

It is largely known that some oral diseases can be diagnosed based upon their clinical manifestation combined with the patient's medical history and generally not depending on examination. This is the case of some bone diseases such as osteoradionecrosis of the jaw (ORNJ), osteomyelitis of the jaw (OMJ), and medication-related osteonecrosis of the jaw (MRONJ). The present study aimed to analyze the histopathological features of these specific bone diseases in order to evaluate similarities and differences. Forty-four bone specimens resected from each bone disease (22 cases of ORNJ, 6 cases of OMJ, and 16 cases of MRONJ) were analyzed by two experienced oral pathologists without prior knowledge of the diagnosis, considering bone tissue condition, inflammation, vascularization, and the presence of microorganisms. In addition, the examiners formulated a diagnostic hypothesis for each specimen. Many histopathological similarities were found among the diseases, especially considering the presence of necrotic bone, inflammation, and microorganisms. Statistically significant differences were detected in empty bone lacunae, which was decreased in ORN (p = 0.042), and considering neutrophil count, which was low in the MRONJ group (p ≤ 0.001). The Kappa coefficient was calculated and agreement was detected based on the histopathological parameters, but not for diagnostic suggestion (p=0.23). In conclusion, histopathological aspects of ORNJ, OMJ, and MRONJ do not permit a conclusive diagnosis, emphasizing the necessity of a detailed clinical report.

Evaluation of complications and flap losses in mandibular reconstruction with microvascularized fibula flap.

The mandibular defects caused by mandibulectomies can involve esthetic and functional sequelae in patients. The fibula presents positive aspects and can be used as an option for mandibular reconstruction after tumor resections or extensive traumas. Furthermore, this retrospective study of the patients who have passed through a mandibular reconstruction with a microvascular fibular flap over the last 17 years describes the experience of the Oral and Maxillofacial SurgeryService at the ErastoGaertner Hospital, Curitiba/PR. The use of this flap type has a complication rate of 32.3%, which includes the fixation material exposure, flap resorptions, fistulas, pathological fractures, tumor recurrence, infections, seromas, and thrombocytopenia. Most of them are associated with patients who have received radiotherapy and/or chemotherapy. These data suggest a high frequency of complications when a reconstruction plate fixation is used. Minor complications are usual and they should not be overlooked because they can lead to devastating consequences.