Surgical Treatment of Bilateral Atrophic Mandible Fracture.

Poor proprioception, weakness, and impaired reflexes increase the incidence of facial fracture in the elderly. Mandibular fractures in these people range from 10.1% to 56%. Fragment reduction and fracture consolidation are difficult due to bone atrophy, decreased capacity for bone regeneration, and lack of anatomical landmarks to guide the alignment of the fragments. This study reports 2 patients with different conducts regarding the treatment of bilateral fractures in atrophic mandible. The first patient refers to the removal of plates of the 2.4 mm system with low profile, which failed during the mandibular function, being replaced by the 2.4 mm system with high profile. The 2nd clinical reports the use of the 2.0 mm system only to simplify the mandibular fracture, and then reconstructing that with a 2.4-mm system with high profile, using the load bearing principles. Regarding mandibular fractures, an important goal is to neutralize the muscle action aiming the bone stability. There are several methods to treat that the indication should consider the load bearing and load sharing concepts. The incorrect fixation choice in these patients can result in complications as bad union, material failure, infection, and consequent treatment failure.

Influence of surgical ultrasound used in the detachment of flaps, osteotomy and odontosection in lower third molar surgeries. A prospective, randomized, and "split-mouth" clinical study

BACKGROUND: As third molar surgery is the most commonly procedure performed in Dentistry and has been accompanied by serious postoperative disorders such as pain, edema and trismus, the study aimed to evaluate if ultrasound device would be able to reduce such postoperative features. The aim of this study was to assess the effects of soft tissue flap elevation, osteotomy and odontosection using piezosurgery versus conventional technique in mandibular third molar extractions. MATERIAL AND METHODS: Twenty patients with impacted mandibular third molars underwent tooth extractions using two different methods. Ten patients were included in the Piezo Flap Group (PFG - the flap was elevated using piezosurgery) and ten patients were part of the Piezo Ostectomy Group (POG - osteotomy and odontosection were carried out with ultrasound tips). The contralateral tooth was included in the Control Group (CG - conventional technique). The patients were evaluated at postoperative periods of 1, 3, 7 and 14-days. The measured parameters were duration of surgery, pain, trismus and swelling. RESULTS: The mean duration of surgery for the PFG was 17.21 minutes (CG 10.07 minutes) and POG was 40.09 minutes (CG 15.97 minutes). There was no statistically significant difference in pain and trismus for any of the postoperative periods evaluated in PFG and POG (p > 0.05). There was a statistically significant difference in swelling between the PFG and POG, presenting less swelling at the 3-day postoperative period (p = 0.038; p < 0,05). However, for the remaining analyzed periods there was no difference (p > 0.05). CONCLUSIONS: Piezosurgery for tissue elevation of the surgical flap, osteotomy and dental sectioning in mandibular third molar extraction surgery promoted less edema in the early postoperative stages in mandibular third molar extractions despite the longer surgical duration

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Caracterização inovadora da morfologia da cabeça de bebês nascidos com o vírus zika: uma inovação metodológica para amplas aplicações clínicas / Novel characterization of head morphology of infants born with Zika Virus: a methodological innovation for broad clinical applications

Introdução: A epidemia do vírus Zika em 2016 constituiu uma emergência de saúde pública, com o chamando da OMS para vigilância reforçada na detecção precoce de microcefalia relacionada às condições neurológicas. Métodos: Quarenta e quatro crianças infectadas pelo vírus Zika foram avaliadas e comparadas com crianças saudáveis com o objetivo de identificar as medidas mais confiáveis do formato e tamanho da cabeça, explorando o relacionamento entre fenótipo craniofacial e anormalidades cerebrais. A análise de componentes principais (ACP) foi utilizada para identificar padrões de variação na morfologia craniofacial. As seguintes medições adicionais da abóboda craniana foram realizadas; altura cefálica (AC), comprimento cefálico (ComC), circunferência cefálica (CC) e ângulo naso-frontal (ANF). O nível de anormalidade cerebral presente nas tomografias, a gravidade da perda de volume do parênquima cerebral e ventriculomegalia foram classificadas como leve, moderada ou grave. Resultados: Os 12 primeiros componentes principais das abóbodas analisadas explicaram 91% da variação da abóboda craniana. Correlações significativas foram detectadas entre a pontuação do segundo CP da abóbada craniana e CC (+0,66), AC (+0,87), ComC (+0,80) e ANF (-0,48). Conclusão: Este estudo recomenda mensurar a AC em pacientes com infecção pelo vírus Zika, em vez de CC como recomendado pela OMS, para melhorar a sensibilidade e especificidade da detecção precoce(AU)

Background: The 2016 Zika virus epidemic constituted a public health emergency, with the WHO calling for strengthened surveillance for the early detection of related microcephaly and associated neurological conditions. Methods: We analysed 44 Zika infected infants and matched controls to identify the most reliable measurements of head shape and size and explore the relationship between craniofacial phenotype and brain abnormalities. Principal component analysis (PCA) was applied to identify patterns of variation in the craniofacial morphology of Zika cases relative to controls. We carried out the following additional measurements of the cranial vault, the head circumference (HC), head height (HH), head length (HL) and naso-frontal-angle (NFA). The level of brain abnormality present in the CT scans, mainly the severity of parenchymal volume loss and ventriculomegaly, was classified as being mild, moderate or severe. Results: The first 12 PCs of the vaults we analysed explained 91% of the variation of the cranial vault between Zika cases and controls. Significant correlations were detected between the score of the 2nd PC of the cranial vault and HC (+0.66); HH (+0.87); HL (+0.80) and NFA (-0.48). Conclusion: We recommend measuring HH in Zika patients, rather than HC as recommended by WHO, to improve the sensitivity and specificity of early detection(AU)

Influência do número de roscas e da densidade dos blocos de poliuretano na estabilidade primária de implantes do sistema intraoss / The influence of implant thread number and polyurethane block density on primary stability values of the Intraoss implant system

Objetivo: avaliar e comparar a estabilidade primária dos implantes cilíndricos de 3,75 mm x 11 mm Titaoss e Titaoss dupla rosca, do Sistema Intraoss, instalados em blocos de poliuretano com baixa densidade. Material e métodos: foram realizadas 32 cavidades em dois blocos de poliuretano, simulando as densidades de ossos tipo III e IV. As estabilidades dos implantes foram mensuradas por meio do torque de inserção e frequência de ressonância. Resultados: os implantes Titaoss instalados no osso tipo III apresentaram valores de torque de inserção de 43,1 ± 14,87 Ncm, enquanto os valores dos implantes Titaoss dupla rosca foram 46,9 ± 5,3 Ncm. No osso tipo IV, os implantes Titaoss apresentaram valores de 30 ± 0,0 Ncm e os dupla rosca de 29,4 ± 1,77 Ncm. Não houve diferença significante na estabilidade primária entre os grupos dos implantes (p > 0,05) instalados no mesmo tipo de osso. Os implantes Titaoss instalados no osso tipo III apresentaram valores de ISQ de 57,3 ± 4,69, ao passo que os valores para os implantes Titaoss dupla rosca foram 54,9 ± 3,98. No osso tipo IV, os implantes Titaoss apresentaram valores de 48,4 ± 4,07 ISQ e os dupla rosca de 50,8 ± 3,98 ISQ. As estabilidades primárias dos implantes foram maiores no osso tipo III quando comparado ao IV (p < 0,05). Conclusão: os dois desenhos de implantes permitem a obtenção da estabilidade primária para a técnica da carga mediata. No entanto, para submeter esses tipos de implante à carga imediata, indica-se a técnica da subfresagem.

Objectives: this in vitro study aimed to evaluate and compare the primary stability of the cylindrical implants (3.75 mm x 11 mm) Titaoss and Titaoss double thread from Titaoss System placed in cavities made of low-density polyurethane blocks. Material and methods: 32 cavities were made in two types of polyurethane blocks simulating the type III and IV bone densities. The implant stability values were measured using the final insertion torque and resonance frequency analysis. Results: the Titaoss implants placed in type III bone achieved 43.1 ± 14.87 Ncm, while the double-thread values were 46.9 ± 5.3 Ncm. For bone type IV, the Titaoss implants reached 30Ncm and the double thread 29.4± 1.77 Ncm. No statistically significant differences on implant stability were seen for both groups (p > 0.05) for the same bone type. the Titaoss implants in bone type III had 57.3 ± 4.69 and the double thread 54.9 ± 3.98 ISQ values. In type IV bone, Titaoss reached 48.4 ± 4.07 and the double thread 50.8 ± 3.98 ISQ units. The primary stability values were greater at type III than type IV bone (p < 0.05). Conclusion: both implant designs allow for primary stability. However, the use of an underpreparation technique is recommended in cases of immediate loading protocols.

Extenso ameloblastoma em mandíbula: relato de caso / Large ameloblastoma in mandible: case report

O ameloblastoma é um tumor odontogênico benigno, localmente agressivo, com predileção pela região posterior de mandíbula. Acredita-se que se origina de remanescentes do aparelho de formação dentária, semelhante ao desenvolvimento do órgão do esmalte. Não há clara preferência por gênero, sendo mais prevalente entre a terceira e quinta décadas de vida. O ameloblastoma tem sido classificado em quatro tipos: unicístico, sólido/multicístico, desmoplásico e periférico. O tipo sólido pode apresentar algumas variantes histológicas, sendo as mais comuns a folicular e a plexiforme. Dentre as formas de tratamento, a excisão cirúrgica ampla com margens de segurança é o método de tratamento preferido. Recomenda-se um acompanhamento de mais de 10 anos com intervalos regulares após tratamento cirúrgico apropriado O objetivo deste trabalho é relatar o caso de um paciente portador de extenso ameloblastoma em região posterior de mandíbula, tratado a partir da ressecção da lesão com aposição de uma placa reconstrutiva do sistema lock. No momento, o paciente se encontra em acompanhamento pós-operatório de um ano sem sinais de recidiva. A partir deste trabalho pôde-se concluir que o tratamento realizado se mostrou adequado, no entanto um maior período de acompanhamento se faz necessário para indicar a cura do paciente

Ameloblastoma is a benign odontogenic tumor, locally aggressive being more found in posterior region of mandible. It is believed that it is originated from remnants of the dental formation apparatus, such as the developing enamel organ. There is no clear predilection by gender, being most prevalent between the third and fifth decades of life. Ameloblastoma has been classified into four types: unicystic, solid/multicystic, desmoplastic and peripheral. The solid type can present some histological variants, being most common follicular and plexiform types. Among treatment forms, wide surgical excision with safe margins is the preferred method of treatment. It is recommended a follow of more than 10 years, with regular intervals after the proper treatment. The aim of this study is to report a case of a patient showing large ameloblatoma in posterior region of mandible treated with resection of the lesion and the position of a reconstructive plate of the locking system. At the moment, a year follow up patient showed no signs of recurrence. From this study it could be concluded the performed treatment showed itself suitable, however, a longer period of follow is necessary to indicate the patient's cure

Surgical Treatment of Posttraumatic Ophthalmoplegia Through the Reconstruction of the Lateral Orbital Wall.

Orbital fractures are injuries frequently related to traumas of the midface. These fractures can be associated with ocular lesions, ranging from small abrasions on the cornea to serious complications such as hyphema and ocular globe rupture. Diplopia and ophthalmoplegia are common findings in orbital fractures. They can be caused by mechanical factors as bone fragments or muscle imprisonment. The aim of this study was to report a case of a 40-year patient, male showing diplopia and ophthalmoplegia due to the orbital fracture. The patient was treated by general anesthesia. It was performed a supra orbital approach and the fragments were removed. A titanium mesh to restore the orbital anatomy was installed. After 40 days of follow-up, the patient has no aesthetic or functional complaints. In orbital traumas, the ophthalmological evaluation should be performed carefully aiming to avoid ocular sequelaes. In surgical patients, the surgery should be done as early as the clinical conditions permit, to restore the ocular function.

Partial Glossectomy as an Adjunctive Method to Ortho-Surgical Treatment.

The macroglossia is a rare condition, congenital or acquired, characterized by hypertrophy of the lingual muscles that can cause both aesthetic and functional changes such as mandibular prognathism and malocclusion. Diagnosis is through clinical examination. Treatment consists of excision of part of the tongue and different surgical techniques have been described in the literature. The keyhole lingual resection technique has shown satisfactory results in reducing the volume and preservation of the neurovascular bundles of the tongue. This work aims to present a clinical report of true macroglossia associated with dental-skeletal discrepancies, submitted to partial glossectomy previously to orthognathic surgery.

Treatment of Large Thyroglossal Duct Cyst.

The thyroglossal duct cyst is the neck congenital abnormality most common in the childhood. Clinically, it shows itself as a solitary neck mass in the region of hyoid bone, it is painless and can be dislocated during de physical examination and tongue protrusion. The most common treatment is its removal through the Sistrunk technique. Patient with diagnosis of thyroglossal duct cyst in neck region with extension to the mouth floor was treated by total surgical removal through intraoral access. The intraoral approach to the treatment of the thyroglossal duct cyst showed itself practicable and permitted the total removal of the lesion with no recurrence signs.

Reconstruction of Frontal Bone With Custom-Made Prosthesis Using Rapid Prototyping.

Frontal bone fracture treatment is still an issue of research in craniofacial surgery and neurosurgery. The aims of the treatment are to reduce the complication risks and to keep the aesthetic of the face. Before the management of this fracture type, it is necessary to consider the permanence or not of the frontal sinus function. Rapid prototyping has been an aid tool on planning and simulation of the surgical procedure, improving the diagnostic quality and the implant manufacture, beyond reducing the operative time. Among the used materials on treatment of these fractures, titanium mesh shows large versatility and ease of handling. Poly(methyl methacrylate) has been used in defects of partial thickness or irregularities on cranial surface. The aim of this study is to report a case of a patient presenting sequelae of large fracture of anterior wall of frontal bone, treated by a titanium mesh associated with the customized poly(methyl methacrylate) implant from the rapid prototyping. It could be concluded that the use of this technique showed itself effective on patient treatment, and rapid prototyping demonstrated being a valuable tool showing predictable and satisfactory results.

Avaliação da estabilidade primária de implantes instalados em cavidades confeccionadas por meio do ultrassom cirúrgico e instrumentos rotatórios convencionais: estudo in vitro / Assessment of the primary stability of dental implants prepared cavities with piezosurgery and conventional rotatory instruments: in vitro study

A estabilidade primária de implantes dentários corresponde a um fenômeno mecânico relativo à qualidade ou quantidade óssea, ao tipo de implante e a técnica de instalação. O objetivo deste trabalho foi avaliar o tempo de fresagem, aquecimento dos sítios fresados e a estabilidade dos implantes instalados em cavidades realizadas com ultrassom cirúrgico e instrumentos rotatórios. Foram realizadas 64 cavidades em 04 blocos de poliuretano simulando as densidades de ossos tipo I, II, III e IV. A temperatura da superfície do bloco nos leitos foi medida durante a fresagem. A estabilidade dos implantes foi mensurada por meio do torque de inserção, de remoção e frequência de ressonância. O implante cilíndrico TitaOss 3,75 x 11 mm foi instalado em todas as cavidades. Os resultados mostraram maior tempo e temperatura para o grupo em que foi usado o ultrassom. Quanto à estabilidade primária não houve diferença significante entre os grupos estudados. Pôde-se concluir que a estabilidade primária dos implantes não foi influenciada pelos métodos de fresagem utilizados e que o ultrassom cirúrgico necessitou de mais tempo e gerou mais calor do que o instrumento rotatório para o preparo das cavidades(AU)

The primary stability of dental implants corresponds to a mechanical phenomenon related to bone quality or quantity, type of implant and installation technique. The objective of this study was to evaluate the time of drilling, heating drilled sites and stability of implants placed in cavities made with piezosurgery and rotary instruments. Polyurethane blocks were used simulating the densities of bone type I, II, III and IV. The surface temperature of the block was measured in the cavity during drilling, and recorded the highest temperature variation. The stability of the implants was measured with a torque insertion, torque of removal and resonance frequency. The cylindrical implant TitaOss 3.75 x 11 mm was used in all cavities. The results showed greater time and temperature for the group that was used piezosurgery. The primary stability was no significant difference between groups. It could be concluded that implant primary stability was not influenced by the used methods and piezosurgery took more time and generated more heat than the conventional rotatory instruments to prepare the cavities(AU)

Association of Titanium Mesh and Bovine Pericardium Membrane in the Treatment of Severe Enophthalmos.

The blowout fractures may be classified as pure or impure depending on the associated structures. There are 2 main theories attempting to describe the mechanism of injury, the hydraulic, and blocking mechanism. The complications of this type of fracture may involve diplopia, enophthalmos, and ocular movement restriction. Several materials are available for the reconstruction of orbital floor, including the titanium mesh, which present great properties, such as easy modeling and stabilization, small thickness, and shape maintenance. There, however, are disadvantages such as the possibility of adherence formation. The aim of this report is to describe the case of a patient with an 8-month blowout fracture sequel, presenting extensive enophthalmos and treated by affixing a titanium mesh associated with bovine pericardium membrane in the orbital floor. Therefore, based on a 2-year follow-up, it was possible to observe how effective the association between these 2 materials in solving the case was.

Bisphosphonate-Related Osteonecrosis of the Jaw After Tooth Extraction.

Bisphosphonates are widely used for treatment or prevention of bone diseases characterized by high osteoclastic activity. Among the oral medicines used to treat osteoporosis, alendronate has been often used. Despite of the low rate of complications on its use, cases of osteonecrosis of the jaw have been reported on literature after tooth extractions. The main symptoms include pain, tooth mobility, swelling, erythema, and ulceration. The risk factors related to osteonecrosis of the jaw associated with bisphosphonate are exposition time to the medicine, routes of administration, and oral surgical procedures performed. The aim of this work is to report a case of a patient showing osteonecrosis of the jaw associated with the use of oral bisphosphonates after tooth extractions. The patient was treated through the suspension of the alendronate with the removal of the necrotic tissue and the foci of infection. After a year's follow-up, the patient showed no recurrence signs. From the foregoing, the interruption of the alendronate use and the surgical treatment associated to antibiotic therapy showed effective on the patient's treatment.

Adenoma pleomórfico em lábio inferior: relato de caso / Pleomorphic adenoma in lower lip: case report

O adenoma pleomórfico é o tumor benigno mais comum de glândulas salivares, acometendo, com mais frequência, as glândulas salivares maiores, especialmente a glândula parótida. Geralmente se apresenta como nódulo firme, indolor e de crescimento lento. Suas localizações mais comuns, em glândulas salivares menores, são o palato mole, duro e lábio superior, podendo ser encontrado em outras regiões com menos frequência. Essa lesão tem ligeira preferência pelo gênero feminino e seu tratamento consiste na excisão cirúrgica. O prognóstico é bom para as lesões benignas enucleadas. O objetivo deste trabalho é relatar o caso de um paciente portador de adenoma pleomórfico em lábio inferior. O paciente foi tratado sem intercorrências por meio da excisão cirúrgica da lesão e encontra-se em acompanhamento pós-operatório de um ano sem sinais de recidiva e sem queixas funcionais ou estéticas. No entanto, um acompanhamento mais prolongado se faz necessário para indicar cura do paciente... (AU)

Pleomorphic adenoma is a benign tumor most common of salivary glands, it usually occurs in major salivary glands, especially the parotid gland. Normally, it is seen as a firm nodule, painless with slow growth. Its locations most common, in minor salivary glands, are the soft and hard palate and upper lip, it can be found in other regions less frequently. This lesion has slight preference for females and its treatment consists on surgical excision. The prognosis is good to the removed benign lesions. The aim of this work is to report the case of a patient with the diagnosis of pleomorphic adenoma in lower lip. The case was treated without complications, and a year follow-up patient showed no recurrence, but longer follow is necessary to indicate patient's cure... (AU)

Epidemiologia dos traumatismos de face em pacientes jovens no Estado do Ceará / Epidemiology of facial trauma in young patients in the State of Ceará

Objetivo: O objetivo deste trabalho foi analisar a prevalência de fraturas de ossos da face de crianças e adolescentes atendidas no Hospital Instituto Dr. José Frota, em Fortaleza- CE. Metodologia: Foi realizada a análise de prontuários dos pacientes internados no Instituto Dr. José Frota no período de janeiro de 2010 a dezembro de 2012, sendo avaliada a prevalência de fraturas de ossos da face quanto ao gênero, faixa etária, procedência, etiologia, tipo de tratamento e tempo médio de internação hospitalar. Resultados: Foram avaliados 119 prontuários. O gênero masculino foi acometido em 93 casos. Sessenta e seis pacientes foram provenientes de Fortaleza. A média de internação foi de 4,5 dias. O acidente motociclístico foi observado em 34 casos. Os ossos mais fraturados foram os ossos próprios do nariz seguidos das fraturas mandibulares. A redução incruenta foi realizada em65 casos e a redução cruenta em 44 casos. Conclusão: De acordo com a análise dos resultados foi possível concluir que os jovens com fraturas maxilofaciais têm sido tratados com técnicas menos invasivas, diminuindo desta forma o tempo de internação, com alto índice de sucesso e menores gastos hospitalares... (AU)

Objective: The aim of this study was to analyze the prevalence of fractures of the facial bones in children and adolescents treated at the Institute Dr. José Frota, Fortaleza - CE. Methodology: The analysis of medical records of patients admitted to the Institute Dr. José Frota from January 2010 to December 2012 was performed. Being assessed the prevalence of fractures of the facial bones as gender, age, origin, etiology, type of treatment, mean length of hospital stay.Results: 119 charts were evaluated. The male was involved in 93 cases. Sixty-six patients were from Fortaleza. The mean hospital stay was 4.5 days. The motorcycle accident was observed in 34 cases. Most broken bones were the very bones of the nose followed by mandibular fractures. A closed reduction was performed in 65 cases and open reduction in 44 cases. Conclusion: According tothe analysisof the resultsit was concludedthat young people withmaxillofacialfractureshavebeentreated withless invasive techniques, thereby decreasingthe length of stay, witha high success rateand lowerhospital costs... (AU)

Tratamento combinado de granuloma central de células gigantes através de corticoterapia e enucleação: relato de caso / Combined Treatment of central giant cell granuloma through corticotherapy and enucleation: case report

O granuloma central de células gigantes (GCCG) é uma lesão com predileção pelo sexo feminino, geralmente antes dos 30 anos, que se apresenta radiograficamente uni ou multilocular, mais frequentemente, em região anterior de mandíbula, podendo causar deslocamento dentário e reabsorção radicular, expansão ou destruição das corticais ósseas. As formas de tratamento incluem ressecção, curetagem, aplicações intralesionais de corticoides, calcitonina, interferon ou uma combinação de técnicas. O objetivo deste trabalho é relatar o caso de um paciente portador de GCCG tratado através de injeções intralesionais de triancinolona seguidas de curetagem e ostectomia periférica... (AU)

Central giant cell granuloma (GCCG) is a lesion with a predilection for females, usually before the age of 30, which radiographically presents uni or multilocular, more frequently in the anterior region of the mandible, and may cause tooth displacement and root resorption, expansion or destruction of cortical bone. Forms of treatment include resection, curettage, intralesional applications of corticosteroids, calcitonin, interferon or a combination of techniques. The objective of this study is to report the case of a patient with GCCG treated with intralesional injections of triamcinolone followed by curettage and peripheral ostectomy... (AU)

Simple bone cyst: a case report and review of the literature / Cisto ósseo simples: relato de caso e revisão da literatura

Simple bone cysts are pseudocysts affecting long bones and, less frequently, the jaws, especially the mandible. These cysts are generally detected during routine radiography, with the frequent observation of a well-delimited radiolucent area sending projections between the roots of the teeth involved. Simple bone cysts are mainly diagnosed during the second decade of life and have an excellent prognosis, but their etiology is uncertain. The aim of this paper is to report the case of a simple bone cyst in a 15-year-old adolescent seen at the Stomatology Outpatient Clinic, School of Dentistry, Federal University of Bahia. The etiology, clinical course and prognosis of this lesion are discussed based on a systematic review of the literature.

Cistos ósseos simples são pseudocistos que afetam ossos longos e, menos frequentemente, os ossos maxilares, especialmente da mandíbula. Esses cistos geralmente são detectados durante os exames imaginológicos de rotina, com a observação frequente de uma área radiolúcida bem delimitada com projeções entre as raízes dos dentes envolvidos. Cistos ósseos simples são diagnosticados principalmente durante a segunda década de vida e possuem um excelente prognóstico, mas a sua etiologia é incerta. O objetivo deste artigo é relatar o caso de um cisto ósseo simples em um adolescente de 15 anos de idade, visto no Ambulatório de Estomatologia da Faculdade de Odontologia da Universidade Federal da Bahia. A etiologia, curso clínico e prognóstico desta lesão são discutidos com base em uma revisão de literatura sistemática.