Penetrating Orbital Trauma by Large Foreign Body: Case Series Study with Treatment Guidelines and Literature Review.

Purpose: The present study aims to describe a case study of large penetrating orbital trauma and treatment guidelines associated with a review of English-language literature of large foreign bodies impacting the orbit from 1997 to 2020. Patients and Methods: Five patients suffered large penetrating orbital trauma and required emergency surgical procedures. Results: Together with this present study, a total of 33 cases were selected. The present work has data similar to the literature, and emergency surgical treatment was required in the majority of the cases. Conclusion: Penetrating orbital trauma by large objects is a challenge. The initial assessment and treatment are fundamental to determine the case severity. The large foreign body should be surgically removed by a trained and experienced team in an advanced hospital unit as soon as possible to minimize visual, functional and aesthetic sequelae.

Did physical aggression in women increase during the novel coronavirus 2019 (COVID-19) pandemic? A perspective of facial trauma.

PURPOSE: The present study aimed to assess whether there was an increase in physical aggression in women treated in Belo Horizonte, Minas Gerais, through the mandatory quarantine. METHODS: Data from a cross-sectional study were collected and analyzed, from March 1 to December 31, 2020. Additionally, data from the same period the previous year were collected for comparison. RESULTS: Of the etiologies reviewed for 2020, physical aggression had the highest percentage increase (+ 4.9%) and was the only etiology that showed a significant difference (p = 0.045). The mean age of the included patients was 34.05 years in 2019 and 33.97 in 2020, and most of the women had facial fractures, with nasal fractures being the most frequent, followed by jaw fractures. There was a significant increase (p = 0.34) in the conservative treatment of fractures from 2019 (48.6%) to 2020 (71.7%) and a minor (p = 0.088) increase in aggression toward intimate partners (2019, 40.9%; 2020, 63.9%). CONCLUSION: Physical aggression against women increased during the period of mandatory social isolation that resulted from the COVID-19 pandemic. Health professionals, including emergency services professionals, must be trained to identify victims and refer them to specialized care.

New Device for Submental Endotracheal Intubation: A Prospective Cohort Study.

PURPOSE: Silveira et al (2020) described a new device that aims to facilitate submental intubation. This study aimed to verify the clinical complications from using this new device for submental endotracheal compared to the conventional technique. MATERIAL AND METHODS: Patients who underwent submental intubation with the orotracheal tube transposition device were compared to those who underwent the conventional technique in a prospective cohort study. The primary predictor variable was intubation technique: conventional versus device-assisted. The primary outcome was total complications (all complications trans and postoperative, were recorded). Secondary variables were 1) age, 2) sex, 3) etiology, 4) race/ethnicity, 5) fracture types, and 6) intubation procedure time. The data were analyzed using descriptive and inferential statistics. Differences were considered statistically significant at P < .05. RESULTS: Forty-two cases are described, including 24 cases with the device and 18 cases using the conventional technique. The mean age was 30.5 ± 11.228 years. The majority of patients were of male sex (88%), non-white (64%), and victims of motorcycle accidents (33%). The mean time to perform submental intubation was 9.9 minutes (±2.1293). Nine complications were recorded, including 2 intraoperative (2 tube dislocations) and 7 postoperative (5 unesthetic scars, one localized hematoma, and one skin infection). The technique used did not affect the time to submental intubation (P = .610). There was no association between technique and occurrence of intraoperative (P = .679; RR = 0.75; confidence interval [CI], 0.05-11.2), postoperative (P = .656; RR = 1.000; CI, 0.255-3.922), or total complications (P = .602; RR = 0.938; CI, 0.293-3.003). CONCLUSION: The new device proposed seems to be a good option with similar complication rates as compared to conventional submental intubation.

Profile of patients with TMJ dislocation in a level-1 emergency hospital: A cross-sectional study.

OBJECTIVE: To describe a cross-sectional study of TMJ dislocation in a Brazilian level-one trauma center. METHODS: The data were collected and analyzed from electronic medical records in a period from 2013 to 2020. RESULTS: Bilateral TMJ dislocation occurred in the majority of cases, being reduced by the Nélaton maneuver associated with Barton's bandage. The average time between the dislocation and specialist appointment was 30.69 hours. Elderly patients were associated with an increased number of recurrent dislocations (p = 0.03). Furthermore, a longer dislocation time was associated with the reduction under intravenous (IV) sedation (p < 0.05). CONCLUSION: The literature is still scarce concerning demographic data, treatment modalities, and follow-up. More studies are necessary to better understand TMJ dislocation management.

Ultrasonography on the Early Postoperative Control of Severe Odontogenic Infections.

The management of odontogenic infections remains an important segment of the oral-maxillofacial surgical practice. The implementation of ultrasonography (US) imaging for the diagnosis of head and neck infections increases the possibility of visualizing the abscess collections in the deep neck spaces of lateral pharyngeal, masticator, and submandibular areas. The US imaging can detect the presence of fluid collections and edema, which may indicate local inflammation. Signs of deeper infections, such as subcutaneous emphysema and perifascial fluid, may also be apparent via US imaging. We present a new technique that uses US imaging to evaluate the deep neck infections after drainage from the early postoperative time to determine the locations of the drains inside the collection area and the edema of adjacent tissues. This technique is less costly than computed tomography or magnetic resonance imaging and allows for early assessment of adjacent tissues, leading to an earlier extubation and reduced hospitalization time and costs.

Does the Lockdown Influence the Oral and Maxillofacial Surgery Service in a Level 1 Trauma Hospital During the COVID-19 Pandemic?

ABSTRACT: The pandemic status of the Novel Coronavirus 2019 has affected many countries around the world, due to the high virulence of the SARS-CoV-2, the recommended protocol to prevent infection is social isolation. The purpose of this study was to compare the number of patients admitted and their epidemiological data on a Level 1 Trauma Hospital after the declaration of the pandemic status and the first week of mandatory lockdown, with the same period of time in the last year. This was a retrospective study of medical records from the patients admitted in the Oral and Maxillofacial Surgery of the João XXIII Hospital, between the March 24 and March 31 of 2020 and the same period of the last year. There was a 52.27% decrease in the total number of patients and 76.34% decrease in the total consultations of the service of oral and maxillofacial surgery during the lockdown. All the groups presented a decrease in significance with motor vehicle accidents events, the group 11 to 20 years old presented an increase on the correlation with violence (P = 0.019) and falls (P = 0.002). When comparing both sex with the etiologies, the male one presented an increase in the correlation with violence and falls. The female sex presented correlations only with the minor causes. No valid significance was observed when comparing females with violence events. The lockdown is an effective way to reduce the transmission of the COVID-19, the hospital usage and occupation.

What Do We Know About COVID-19?: Maxillofacial Surgeons Survey.

Coronavírus disease 2019 (COVID-19) is a virus of mass dissemination, with an impact on international public health, leading to hospitalizations and death. The main symptoms of COVID-19 are fever, fatigue, dry cough; however, myalgia and dyspnea and the transmission routes include direct transmission by cough, sneeze, droplet inhalation, or contact transmission with the oral, nasal, or eye mucous membranes. The dental professionals are the main risk group to COVID-19 due to the transmission routes that are directly related to the dental practice. In addition, the oral and maxillofacial surgeons (OMFS) are even more exposed, due to increased contact with the population in hospitals and emergency services. OMFS should be able to identify a suspected case of COVID-19, its symptoms, risk groups, disease severity, laboratorial and computed tomography alterations, and treatment guidelines. In the present study, the authors performed a nationwide survey with Brazilian OMFS to evaluate the knowledge of these professionals about the pandemic status of the COVID-19. A total of 142 OMFS replied the survey and the results brings light to an incomparable health public problem that the OMFS in Brazil are no able to protect itself, diagnose the suspicious and probable cases, request and interpret the correct laboratorial examinations for the treatment of the COVID-19 patients.

Epithelioid rhabdomyosarcoma: Report of the first case in the jaw.

OBJECTIVES: Epithelioid rhabdomyosarcoma (EpiRMS) is a novel morphologically distinct variant of rhabdomyosarcoma, with an unusually challenging microscopic diagnosis. The occurrence of rhabdomyosarcomas in the jaws is extremely rare. This study presents the first case of EpiRMS in the jaw (mandible) and a literature review of the previous 35 cases of EpiRMS. STUDY DESIGN: Here, we report a case of EpiRMS affecting an 18-year-old male patient. Clinical, imaging, microscopic, and immunohistochemical features are discussed and previously reported cases of EpiRMS are reviewed. RESULTS: An 18-year-old male patient presented with an exophytic sessile growth on the buccal gingiva, and orthopantomography revealed irregular bone loss. Microscopic analysis showed a large number of cells with epithelioid appearance. Immunohistochemistry staining was positive for desmin, myogenin, MyoD1, smooth muscle actin, h-caldesmon, INI-1, and AE1-AE3. The patient's disease was staged as T4aN1M0 and was treated with surgical excision combined with chemotherapy. CONCLUSIONS: The occurrence of RMS in the mandible is rare, and this is the first case of EpiRMS in the jaw. EpiRMS is an unusual histologic subtype that mimics other sarcomas and epithelial malignancies, making diagnosis a challenge. A specific immunohistochemistry panel aids in the diagnosis. EpiRMS has an aggressive course and an unfavorable prognosis.

New Device For Submental Endotracheal Intubation.

The submental intubation is a well-described technique as an alternative for the tracheostomy in the airway management in patients with contraindications for the nasotracheal and cannot remain in the orotracheal position due to the need to maintain the intermaxillary fixation. Residents and young oral and maxillofacial surgeons could have experienced some difficulty performing the technique first described by Altemir (1986). This report aims to describe a new device designed to facilitate and simplify the technique helping surgeons on the submental endotracheal intubation.

Síndrome da fissura orbital superior associada a traumatismos craniomaxilofaciais / Superior orbital fissure syndrome associated with craniomaxillofacial traumatism

Introdução: A Síndrome da Fissura Orbital Superior (SFOS) é uma condição de ocorrência rara, inicialmente descrita por Hirchfield em 1858. Caracterizada pela presença de oftalmoplegia, ptose da pálpebra superior e midríase, podendo ocorrer parestesia da pálpebra superior e da região frontal, associada à lesão dos pares de nervos cranianos: oculomotor, troclear, abducente (III, IV e VI) e, por vezes, o nervo trigêmeo (V). A identificação da SFOS é importante, visto que sua incidência é rara no trauma, e sua identificação pode ajudar a direcionar o tratamento de forma mais adequada. Relato de caso: O presente trabalho descreve dois casos da SFOS associados a traumas craniofaciais, cita as possíveis etiologias relacionadas a essa síndrome e descreve a situação de trauma agudo. Considerações Finais: A avaliação das condições sistêmicas do paciente e de exames complementares, como tomografias computadorizadas, auxilia o diagnóstico diferencial entre patologias que acometem a região orbital e a base de crânio, fraturas e traumas craniofaciais. A identificação da SFOS no trauma agudo orienta a abordagem imediata ou precoce quando indicada, como nos casos de hematomas retrobulbares ou em grandes deslocamentos ósseos maxilofaciais com necessidade de redução cirúrgica. Nos casos com indicação de abordagem tardia, as fraturas craniofaciais são tratadas de forma conservadora, e o paciente é encaminhado para atendimento especializado... (AU)

Introduction: The superior orbital fissure syndrome (SOFS) is a rare condition and initially described by Hirchfield in 1858. Characterized by the presence of ophthalmoplegia, upper eyelid ptosis and mydriasis, and there may be paresthesia of the upper eyelid and forehead associated by the injury of the cranial nerves like: oculomotor, trochlear, abducens (III, IV and VI) and sometimes the trigeminal nerve (V). The identification of SOFS is important, since its incidence is rare in trauma, and its identification may help to target the treatment more adequately. Case report: The present study describes two cases of SFOS associated with craniofacial trauma, cites the possible etiologies related to this syndrome and describes the situation of acute trauma. Final considerations: The evaluation of the patient's systemic conditions and complementary exams, such as computed tomography, help the differential diagnosis between pathologies that affect the orbital region and the skull base, and fractures and traumatic head injuries. The identification of SFOS in acute trauma guides the immediate or early approach when indicated, as in cases of retrobulbar hematomas or large maxillofacial bone dislocations requiring surgical reduction. In cases with indication for late approach, craniofacial fractures are treated conservatively and the patient is referred for specialized care... (AU)

Supernumerary nasal tooth removed with a modified maxillary vestibular approach: case report and literature review.

PURPOSE: The aim of this present study is to describe a case of supernumerary nasal tooth removed with a modified maxillary vestibular approach with subperiosteal dissection. METHODS: Also, a review of English-language literature of supernumerary nasal teeth from 1959 to 2018 was performed. RESULTS: This study demonstrated that the modified maxillary approach with subperiosteal intranasal dissection is a useful approach for the exposure and removal of teeth impacted in the floor of the nasal cavity. The advantage of its use versus the other techniques is the lower risk of complications and postoperative morbidity. The use of computed tomography is essential to determinate the position of the tooth and to help in the surgical planning. CONCLUSIONS: The transoral approaches are more natural to the oral and maxillofacial surgeons than the transnasal or endoscopic ones.

Traumatic Anterosuperior Dislocation of the Intact Mandibular Condyle into the Temporal Fossa.

Temporomandibular joint (TMJ) dislocation, or luxation, occurs when the condyle crosses the articular eminence in such a way that it does not return to its correct anatomical position, unless aided by a reduction in external forces for TMJ. The diagnosis of condylar luxation is clinical; however, image exams are important in classifying the types of condylar luxation and associated fractures. Displacement of the TMJ can occur due to either an exaggerated mouth opening or a forced opening and occasionally is associated with a high-impact trauma to the jaw, the latter being an extremely rare condition. Few cases of anterosuperior dislocation of the intact mandibular condyles into the temporal fossa (ADIMC) have been documented in medical literature, many of which are associated with craniofacial trauma. This study describes the case of an ADIMC of the left side combined with facial fractures, as well as the treatment performed. A review of cases found in the literature from 1969 to 2017 was conducted through a detailed bibliographical study.

Facial fractures caused by less-lethal rubber bullet weapons: case series report and literature review.

PURPOSE: The present study aims to describe three cases of patients inflicted by rubber bullets with severe facial fractures. METHODS: In addition, a review of English-language literature involving facial fractures by rubber bullets from 1975 to 2016 was performed. RESULTS: This current study demonstrated that the use of the LLRBW is unsafety even when applied by police enforcements exclusively. CONCLUSIONS: Management of facial fractures caused by LLRBW is done in a usual manner with closed or open reduction associated with bone mini-plates or reconstruction plates when indicated. Special initial wound care should be done to avoid secondary infection and additional procedures.

Correção de fratura fronto-naso-órbito-etmoidal: passos cirúrgicos para resultado estético / Correction of fronto-naso-orbital-ethmoid fractures: surgical steps for aesthetic outcome

As fraturas fronto-naso-órbito-etmoidal (FNOE) envolvem o centro superior e médio da face e são injúrias de difíceis diagnóstico e terapêutica. O diagnóstico é baseado em exames clínicos e de imagem por meio da tomografia computadorizada (TC). O tratamento das fraturas FNOE visa restaurar adequadamente a arquitetura do osso frontal, a correta distância intercantal entre as comissuras palpebrais mediais, a projeção do dorso nasal, o nivelamento do globo ocular, além da relação de drenagem do seio frontal pelo ducto frontonasal, que por muitas vezes, pode não estar patente, gerando possíveis processos patológicos. Sabe-se que a complexidade do trauma e, consequentemente, das fraturas, além do tempo de intervenção cirúrgica, repercute diretamente no resultado do tratamento funcional e estético. O avanço nas técnicas cirúrgicas, a TC, os materiais de osteossíntese atuais e a experiência coletiva dos cirurgiões, têm contribuído para a redução das sequelas resultantes das fraturas FNOE, oferecendo um resultado mais previsível. O objetivo deste estudo é reportar um tratamento de fratura FNOE, descrevendo os passos cirúrgicos realizados, discutindo suas vantagens e desvantagens e servindo de guia para cirurgiões e residentes, além de mostrar o resultado funcional e estético satisfatório... (AU)

The fronto-naso-orbital-ethmoid (FNOE) fractures involves the upper and middle portion of the face and it is injuries of difficult to diagnostic and therapeutic. The diagnosis is based on clinical exams and imaging tests by computed tomography. The treatment of FNOE fractures aims to restore properly the architecture of the frontal bone, the correct intercantal distance between the medial palpebral commissure, the projection of the nasal dorsum, the leveling of the eyeball, and the ratio of frontal sinus drainage by naso-frontal duct that by often cannot be patent, resulting in possible pathological processes. It is known that the complexity of the trauma and hence of fractures, and the time of surgery, directly affect in the outcome of the functional and aesthetic treatment. The advances in the surgical techniques, CT, current osteosynthesis materials and the collective experience of the surgeons, have helped to reduce the sequelae resulting of the FNOE fractures and providing an outcome more predictable. The aim of this study is to report a treatment of FNOE fracture describing the surgical steps performed, discussing their advantages and disadvantages, and serving as a guide for surgeons and residents, besides showing satisfactory aesthetic and functional results... (AU)

Self-drilling and self-tapping screws: an ultrastructural study.

OBJECTIVE: The aim of the current study was to compare self-drilling and self-tapping screws with regard to bone contact and the production of bone debris using scanning electron microscopy. MATERIALS AND METHODS: Three New Zealand rabbit calvariae were used. Self-tapping and self-drilling screws were inserted into the outer surface of the skull with and without saline solution irrigation. All screws were 5 mm in length and were inserted until their tips projected through the endosteal side. Sixteen screws were used--8 with a head diameter of 1.5 mm and 8 with 2.0 mm. All self-tapping screws were inserted through a drill bit hole (1.6 mm for 2.0-mm screws and 1.3 mm for 1.5-mm screws). RESULTS: There was no damage to the screws after insertion. Bone damage occurred when irrigation was not used during the installment of the self-tapping screws. Bone debris formed during the installment of the self-drilling screws, which is considered beneficial. CONCLUSIONS: Because the insertion of self-drilling screws is performed with manual pressure, irrigation is not essential. Unlike the drilling that occurs with self-tapping screw, the bone debris formed with self-drilling screws is not the result of the heat generated, but rather the result of biologically active bone tissue capable of reacting with the screw and improving its performance. The animal model used proved highly appropriate for comparisons with human beings because the bone structures of the head have the same density and thickness.

Bone repair process in calvarial defects using bioactive glass and calcium sulfate barrier / Processo de reparo ósseo em defeitos experimentais de calotas cranianas frente a utilização do vidro bioativo e da barreira de sulfato de cálcio

PURPOSE: To analyze bone repair process in Wistar rats' calvaria, with the use of two different biomaterials. METHODS: Forty two male Wistar rats were used, and four bicortical cranial cavities were created in each animal. The cavities were filled with: bioactive glass (BG); calcium sulfate barrier (CSB); bioactive glass covered with calcium sulfate barrier (BG/CSB); and autogenous blood clot (control). The animals were euthanized 7, 14, 21, 30, 60, 90, e 120 days after surgery. The scalps were removed and submitted to a routine process for histological preparation: staining with Haematoxylin and Eosin (HE). RESULTS: The BG was not completely resorbed; however, after 60 days, a decrease in size as well as a change in the morphological granule were observed. CSB was not observed in the last group (after 120 days). CONCLUSIONS: In Wistar rat calvaria bioactive glass, in an isolated form, negatively interfered in the bone repair process; the calcium sulfate barrier, in an isolated form, presented the capacity to maintain space, allowing the flow of osteogenic cells; the bioactive glass covered with calcium sulfate barrier association presented a better osteoconductive capacity when compared to isolated materials; calcium sulfate barrier was completely resorbed after 90 days; control cavities did not completely heal until 120 days after surgery.

OBJETIVO: Analisar o processo de reparo ósseo em calotas cranianas de ratos Wistar, frente ao uso de diferentes biomateriais. MÉTODOS: Foram quatro cavidades, bicorticais, nas calotas cranianas de quarenta e dois ratos Wistar machos. As cavidades foram preenchidas com: vidro bioativo (VB); barreira de sulfato de cálcio (BSC); vidro bioativo coberto com barreira de sulfato de cálcio (VB/BSC); coágulo sangüíneo (controle). Os animais foram mortos aos 7, 14, 21, 30, 60, 90 e 120 dias após a cirurgia. As calotas foram removidas e submetidas ao processo de rotina para confecções de lâminas coradas com Hematoxilina e Eosina (HE). RESULTADOS: O VB não foi totalmente reabsorvido, contudo, a partir dos 60 dias, observaram-se alterações no tamanho e forma dos grânulos. A BSC não foi observada no último grupo (120 dias). CONCLUSÕES: Em calotas cranianas de ratos Wistar, o vidro bioativo na forma isolada interferiu negativamente no processo de reparo ósseo. A barreira de sulfato de cálcio na forma isolada apresentou a capacidade de manutenção do espaço preenchido, permitindo a migração de células osteogênicas. A associação vidro bioativo coberto com barreira de sulfato de cálcio apresentou uma maior capacidade osteocondutora quando comparada aos materiais nas formas isoladas. A barreira de sulfato de cálcio foi totalmente reabsorvida após 90 dias; As cavidades utilizadas como controle não cicatrizaram completamente até o período de 120 dias.

Bone repair process in calvarial defects using bioactive glass and calcium sulfate barrier / Processo de reparo ósseo em defeitos experimentais de calotas cranianas frente a utilização do vidro bioativo e da barreira de sulfato de cálcio

PURPOSE: To analyze bone repair process in Wistar rats' calvaria, with the use of two different biomaterials. METHODS: Forty two male Wistar rats were used, and four bicortical cranial cavities were created in each animal. The cavities were filled with: bioactive glass (BG); calcium sulfate barrier (CSB); bioactive glass covered with calcium sulfate barrier (BG/CSB); and autogenous blood clot (control). The animals were euthanized 7, 14, 21, 30, 60, 90, e 120 days after surgery. The scalps were removed and submitted to a routine process for histological preparation: staining with Haematoxylin and Eosin (HE). RESULTS: The BG was not completely resorbed; however, after 60 days, a decrease in size as well as a change in the morphological granule were observed. CSB was not observed in the last group (after 120 days). CONCLUSIONS: In Wistar rat calvaria bioactive glass, in an isolated form, negatively interfered in the bone repair process; the calcium sulfate barrier, in an isolated form, presented the capacity to maintain space, allowing the flow of osteogenic cells; the bioactive glass covered with calcium sulfate barrier association presented a better osteoconductive capacity when compared to isolated materials; calcium sulfate barrier was completely resorbed after 90 days; control cavities did not completely heal until 120 days after surgery.

OBJETIVO: Analisar o processo de reparo ósseo em calotas cranianas de ratos Wistar, frente ao uso de diferentes biomateriais. MÉTODOS: Foram quatro cavidades, bicorticais, nas calotas cranianas de quarenta e dois ratos Wistar machos. As cavidades foram preenchidas com: vidro bioativo (VB); barreira de sulfato de cálcio (BSC); vidro bioativo coberto com barreira de sulfato de cálcio (VB/BSC); coágulo sangüíneo (controle). Os animais foram mortos aos 7, 14, 21, 30, 60, 90 e 120 dias após a cirurgia. As calotas foram removidas e submetidas ao processo de rotina para confecções de lâminas coradas com Hematoxilina e Eosina (HE). RESULTADOS: O VB não foi totalmente reabsorvido, contudo, a partir dos 60 dias, observaram-se alterações no tamanho e forma dos grânulos. A BSC não foi observada no último grupo (120 dias). CONCLUSÕES: Em calotas cranianas de ratos Wistar, o vidro bioativo na forma isolada interferiu negativamente no processo de reparo ósseo. A barreira de sulfato de cálcio na forma isolada apresentou a capacidade de manutenção do espaço preenchido, permitindo a migração de células osteogênicas. A associação vidro bioativo coberto com barreira de sulfato de cálcio apresentou uma maior capacidade osteocondutora quando comparada aos materiais nas formas isoladas. A barreira de sulfato de cálcio foi totalmente reabsorvida após 90 dias; As cavidades utilizadas como controle não cicatrizaram completamente até o período de 120 dias.

Bone repair process in calvarial defects using bioactive glass and calcium sulfate barrier.

PURPOSE: To analyze bone repair process in Wistar rats' calvaria, with the use of two different biomaterials. METHODS: Forty two male Wistar rats were used, and four bicortical cranial cavities were created in each animal. The cavities were filled with: bioactive glass (BG); calcium sulfate barrier (CSB); bioactive glass covered with calcium sulfate barrier (BG/CSB); and autogenous blood clot (control). The animals were euthanized 7, 14, 21, 30, 60, 90, e 120 days after surgery. The scalps were removed and submitted to a routine process for histological preparation: staining with Haematoxylin and Eosin (HE). RESULTS: The BG was not completely resorbed; however, after 60 days, a decrease in size as well as a change in the morphological granule were observed. CSB was not observed in the last group (after 120 days). CONCLUSIONS: In Wistar rat calvaria bioactive glass, in an isolated form, negatively interfered in the bone repair process; the calcium sulfate barrier, in an isolated form, presented the capacity to maintain space, allowing the flow of osteogenic cells; the bioactive glass covered with calcium sulfate barrier association presented a better osteoconductive capacity when compared to isolated materials; calcium sulfate barrier was completely resorbed after 90 days; control cavities did not completely heal until 120 days after surgery.

Tratamento de fístula bucosinusal através de retalho palatino / Treatment of Orcantral Fistula by Palantal Rotation Flap

A extração dentária é o fator mais comumente associado à comunicação entre a cavidade bucal e o seio maxilar - comunicação bucosinusal ou oroantral. Este tipo de complicação normalmente ocorre devido à falha no diagnóstico e execução técnica durante exodontias de dentes com raízes intimamente relacionadas ao assoalho do seio maxilar. O tratamento imediato, sempre que possível, deve ser instituído. Entretanto, o tratamento tardio de comunicações antigas e suas seqüelas requer habilidade e experiência na escolha da técnica a ser empregada. Objetiva-se demonstrar a técnica de fechamento de fístulas bucosinusais por meio de rotação de retalho palatino que foi utilizada em dois casos de diferentes origens e tempos de evolução. Em vista do exposto, pode-se considerar que esta técnica apresenta as vantagens de boa irrigação do retalho sem tensão tecidual, preservação do fundo de sulco vestibular sendo eficaz e com resultados satisfatórios em comunicações tardias de tamanhos variados

Bone tissue microscopic findings related to the use of diode laser (830etam) in ovine mandible submitted to distraction osteogenesis

PURPOSE: To analyze the microscopic characteristics of the effect of Gallium-Aluminum Arsenid diode laser (GaAlAs - 830etam) applied during the activation and consolidation period to ovine mandibles submitted to distraction osteogenesis. METHODS: Eighteen sheep underwent surgery in order to have bone distractors implanted in the left side of the jaw area. They were divided into three groups: 1 - Control; 2 - Laser irradiation during the activation period; 3 - Laser irradiation during the fixation period. The irradiation was carried out in five sessions, on every other day, with 4,0J/cm² doses applied to four pre-established areas, totaling 16J per session. After four days of latency under post-operative care, ten days of distractor activation (at 1mm/day) and twenty-one days of fixation the animals were sacrificed and the devices removed for microscopic analysis. RESULTS: The groups that received laser irradiation (GaAlAs) presented a greater amount of mineralized bone trabeculae when compared to the Control Group. Despite that, cartilaginous tissues were also found in Group 2. CONCLUSION: The laser has been more favorable when used in the consolidation period, after bone elongation.

OBJETIVO: Avaliar as características microscópicas do efeito do laser diodo de Arsenieto de Gálio-Alumínio (AsGaAl - 830etam), aplicado no período de ativação e consolidação de mandíbulas de ovelhas submetidas a distração osteogênica. MÉTODOS: Dezoito ovinos foram submetidos a procedimento cirúrgico para colocação de distrator ósseo em região de mandíbula do lado esquerdo, sendo divididos em três grupos: 1 - Controle; 2 - Irradiação de laser no período de ativação; 3 - Irradiação de laser no período de contenção. As irradiações foram feitas em cinco seções em dias alternados, com doses de 4,0J/cm² em quatro pontos pré-determinados, somando 16J por seção. Após quatro dias de latência no pós-operatório, 10 dias de ativação do distrator (1 mm/dia) e 21 dias de contenção os animais foram mortos e as peças removidas para análise microscópica. RESULTADOS: Os resultados foram que os grupos irradiados com laser (AsGaAl) apresentaram maior disposição de trabéculas ósseas mineralizadas em relação ao grupo controle, contudo, no Grupo 2 foi observada a presença de tecido cartilaginoso. CONCLUSÃO: O laser atuou de forma mais favorável quando utilizado no período de consolidação, após o alongamento ósseo.