Double mandible coronoid process: a very unusual feature.

PURPOSE: The double coronoid process (DCP) is a very unusual feature in patient. The literature, which briefly describes just only one case. Being this a very unusual feature, the aim of the paper is to describe the finding, discuss the anatomic, radiological, and clinical characteristics of a DCP. METHODS: A 61-year-old-woman with no significant medical history, extraoral and intraoral examination was unremarkable. Following panoramic radiography (PR) for assessment of periodontal support and pre-implant planning suspicious radiopaque area in the mandibular notch on the left side was observed. Cone-Beam Computed Tomography (CBCT) and Magnetic resonance imaging (MRI) were subsequently performed. RESULTS: No signs and symptoms of syndromes or medical records with a relevant contribution to the DCP existence and the patient denied any type of facial trauma. CBCT image showed the structure found on the PR was indeed a DCP and it was not superimposed on the mandibular notch area, MRI was performed to investigate soft tissue components and temporomandibular joint (TMJ) or other alterations. CONCLUSION: DPC is extremely rare with the only case reported in the literature within the same comparison parameters. In this case images revealed the muscles, articular surfaces and articular disc were well preserved, and no other alterations were found.

Implications of anatomical variation of the sphenoid sinus for orthognathic surgery: a case report in cone beam computed tomography / Implicações da variação anatômica do seio esfenoidal para cirurgia ortognática: um relato de caso em tomografia computadorizada de feixe cônico

ABSTRACT The Sphenoid Sinus is considered the paranasal sinus with more variation to the degree of pneumatization. Thus, this work aimed report to the first case on the interference of this anatomical variation for orthognathic surgery. A 18- year-old woman, with isolated cleft palate repaired, was submitted to orthognathic surgery to correct the maxillomandibular skeletal discrepancy. The cone beam computed tomography (CBCT) exam performed for preoperative planning showed a great extension for the adjacent structures, with proximity to the posterior wall of the maxillary sinus and pterygomaxillary fissure bilaterally. The postoperative CBCT image evidenced the compromise of the sinus floor due to the factors related to the transoperative period. This case, along with literature review, highlighted the importance of identifying sphenoid sinus variation in CBCT exams prior to orthognathic surgery, in order to avoid serious complications for the patient, such as sinus infections; hemorrhages; mucocele formation or intracranial involvement.

RESUMO O Seio Esfenoidal é considerado o seio paranasal com maior variação quanto ao grau de pneumatização. Assim, este trabalho objetivou relatar o primeiro caso sobre a interferência dessa variação anatômica para a cirurgia ortognática. Mulher,18 anos, com fissura de palato isolada reparada, foi submetida à cirurgia ortognática para correção da discrepância esquelética maxilomandibular. O exame de tomografia computadorizada de feixe cônico (TCFC), realizado para planejamento pré-operatório, mostrou grande extensão para as estruturas adjacentes, e com proximidade da parede posterior do seio maxilar e fissura pterigomaxilar bilateralmente. A imagem de TCFC pós-operatória evidenciou o comprometimento do assoalho do seio devido aos fatores relacionados ao transoperatório. Este caso, juntamente com a revisão da literatura, destacou a importância de identificar a variação do seio esfenoidal nos exames de TCFC prévios à cirurgia ortognática, a fim de evitar complicações graves para o paciente, tais como sinusite, hemorragias, formação de mucoceles ou, até mesmo, envolvimento intracraniano.

Radiographic characteristics of the maxillomandibular complex in neufibromatosis: short communication and literature review.

OBJECTIVE: To report radiographic characteristics of a case of a patient with neurofibromatosis involving the maxillomandibular complex and to point out other dental radiographic characteristics that are found in the scientific literature to help the dentist when faced with a case of neurofibromatosis. SHORT COMMUNICATION: Male, 31 years old, referred for radiographic examination. During anamnesis and physical examination, lesions were noted, which were papules and café-au-lait patches larger than 1 cm on the trunk and upper limbs, further to Lisch nodules (brown spots on the iris) and axillary and inguinal ephelides. When investigating the history of the disease, the patient reported the presence of such skin atlterations since birth and mentioned that his mother had been diagnosed with neurofibromatosis. During radiographic evaluation, a significant increase in the caliber of the mandibular canal and mental foramen was observed, bilaterally. CONCLUSION: Completing the combination of skin characteristics present in the patient, anamnesis data and current history of the disease with interpretation of radiographic alterations, it was possible to arrive at the diagnostic hypothesis of Neurofibromatosis type 1 and correct clinical management. Therefore, it is extremely important for the dentist to be aware of the clinical, physical and radiographic characteristics that this condition presents for the correct management and success of dental treatment.

Cephalometric predictors of hypernasality and nasal air emission.

BACKGROUND: During times of increasingly recognized importance of interprofessional practices, professionals in Medicine, Dentistry, and Speech Pathology areas cooperate to optimize treatment of velopharyngeal dysfunction (VPD), after primary palatoplasty for correction of cleft palate. OBJECTIVE: Our study aims to compare velar length, velar thickness, and depth of the nasopharynx of patients with unilateral cleft lip and palate (UCLP) with the presence, or absence, of hypernasality and nasal air emission; and to verify if the depth:length ratio, between nasopharynx and velum, would be predictive of consistent hypernasality and nasal air emission (speech signs of VPD). METHODOLOGY: Cephalometric radiographs and outcome of speech assessment were obtained from 429 individuals, between 6 and 9 years of age, with repaired unilateral cleft lip and palate. Velar length, velar thickness, depth of the nasopharynx, depth:length ratio, scores of hypernasality, and scores of nasal air emission were studied and compared; grouping the radiographs according to presence or absence of hypernasality and nasal air emission. RESULTS: For the group with speech signs of velopharyngeal dysfunction (those with consistent hypernasality and nasal air emission), the velums were shorter and thinner; the nasopharynx was deeper and the depth:length ratio was larger than the group without hypernasality and nasal air emission. Velar length was significantly shorter in individuals with consistent hypernasality and nasal air emission (p<0.001) and with history of palatal fistula (p=0.032). Depth of nasopharynx was significantly greater in individuals with consistent hypernasality and nasal air emission (p<0.001). Depthlength ratio was significantly larger in individuals with consistent hypernasality and nasal air emission (p<0.001). A depth:length ratio larger than 0.93 was always associated with speech signs of VPD. CONCLUSION: Estimated with cephalometric radiographs, a depth:length ratio greater than 0.93, between the nasopharyngeal space and the velum, was 100% accurate in predicting hypernasality and nasal air emission after primary repair of unilateral cleft lip and palate.

Cleft lip and palate cause large variations in size and location of the posterior superior alveolar canal.

OBJECTIVE: The aim of this study was to evaluate the posterior superior alveolar canal (PSAC) in patients with cleft lip and palate (CLP) as compared to patients with no cleft lip and palate (NC) using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This was a retrospective multicenter study based on two steps: (1) evaluating intra- and inter-calibration and (2) detecting the presence or absence of PSAC and its location, diameter, and anastomosis with anterior superior alveolar canal. RESULTS: A total of 300 patients were selected for the study, out of which 150 were categorized as CLP (75 men, 75 women; mean age: 29.8 years) and 150 were categorized as NC (75 men, 75 women; mean age: 40.3 years). PSAC in patients with CLP and NC was visible in 100% of the cases, in men and women, bilaterally. PSAC location in CLP was middle and upper third of the maxillary sinus as compared to NC (lower third) (chi-squared < 0.001). PSAC mean diameter in CLP was 1.12 mm. It was larger compared to 0.6 mm in NC (t-test < 0.0001). CONCLUSION: PSAC location in patients with CLP was predominantly in the middle and upper third of the maxillary sinus, compared with NC. PSAC mean diameter in CLP was 1.12 mm. It was larger compared to that of 0.6 mm in NC. CLINICAL RELEVANCE: These anatomical variations in CLP are important and should be acknowledged by surgeons for the following reasons: (1) to perform pre-surgical planning, (2) to avoid bleeding, and (3) to avoid neurosensory alterations.

Evaluation of canalis sinuosus in individuals with cleft lip and palate: a cross-sectional study using cone beam computed tomography.

OBJECTIVE: To evaluate the canalis sinuosus (CS) in individuals with cleft lip and palate (CLP) and compare the findings with individual's NON-CLP using cone beam computed tomography (CBCT). MATERIALS AND METHODS: The sample consisted of 100 CBCT exams of NON-CLP individuals (G1 group) and 200 of CLP individuals (G2 group). Recorded parameters included presence of CS, accessory canal to the CS, diameter greater than 1 mm, gender, age, localization in relation to teeth, and adjacent structures. Statistical tests were used to compare the findings between groups. A p value of < 0.05 was considered as significant. RESULTS: A higher prevalence of accessory canal was found in the G2 (p < 0.001). The anteroposterior diameter of the right side CS in G2 was higher than G1 (p < 0.05), with average of 1.4 mm ± 0.4 mm. The accessory canal had a larger diameter in G2 than G1 (p < 0.05) with average of 1.3 mm ± 0.3 mm. Between UCLP, the CS presented the largest diameter for the side NON-CLP (p < 0.001). The accessory canal was more distant from the cortical buccal in G2 (P < 0.05). The dental region incidence of the accessory canal was molars and premolars for G2 and canines and incisors in G1. CONCLUSION: Individuals with CLP show higher prevalence of accessory canal to the CS with larger diameters than NON-CLP. It is necessary that the professional make adequate planning prior to surgeries, using the CBCT, in order to avoid neurovascular lesions, since these individuals undergo several surgeries in the CS region.

Cephalometric predictors of hypernasality and nasal air emission

Abstract During times of increasingly recognized importance of interprofessional practices, professionals in Medicine, Dentistry, and Speech Pathology areas cooperate to optimize treatment of velopharyngeal dysfunction (VPD), after primary palatoplasty for correction of cleft palate. Objective Our study aims to compare velar length, velar thickness, and depth of the nasopharynx of patients with unilateral cleft lip and palate (UCLP) with the presence, or absence, of hypernasality and nasal air emission; and to verify if the depth:length ratio, between nasopharynx and velum, would be predictive of consistent hypernasality and nasal air emission (speech signs of VPD). Methodology Cephalometric radiographs and outcome of speech assessment were obtained from 429 individuals, between 6 and 9 years of age, with repaired unilateral cleft lip and palate. Velar length, velar thickness, depth of the nasopharynx, depth:length ratio, scores of hypernasality, and scores of nasal air emission were studied and compared; grouping the radiographs according to presence or absence of hypernasality and nasal air emission. Results For the group with speech signs of velopharyngeal dysfunction (those with consistent hypernasality and nasal air emission), the velums were shorter and thinner; the nasopharynx was deeper and the depth:length ratio was larger than the group without hypernasality and nasal air emission. Velar length was significantly shorter in individuals with consistent hypernasality and nasal air emission (p<0.001) and with history of palatal fistula (p=0.032). Depth of nasopharynx was significantly greater in individuals with consistent hypernasality and nasal air emission (p<0.001). Depthlength ratio was significantly larger in individuals with consistent hypernasality and nasal air emission (p<0.001). A depth:length ratio larger than 0.93 was always associated with speech signs of VPD. Conclusion Estimated with cephalometric radiographs, a depth:length ratio greater than 0.93, between the nasopharyngeal space and the velum, was 100% accurate in predicting hypernasality and nasal air emission after primary repair of unilateral cleft lip and palate.

Evaluation of the Nasopharyngeal Cannula Use After Orthognathic Surgery: Permeability of the Nasal Airways and Discomfort of the Patient With Cleft Lip and Palate.

It is believed that the use of the nasopharyngeal cannula can maintain the patent upper airway in the immediate post-operative period of orthognathic surgery. The present study is a randomized clinical trial with the objective of evaluating the difference in the use of the nasopharyngeal cannula in the post-operative period of orthognathic surgery with respect to permeability and discomfort. The sample was composed of 26 individuals with repaired cleft lip and palate randomly distributed in 2 groups with and without nasopharyngeal cannula. The evaluation was composed by Visual Analogue Scale (VAS), test with Altman mirror in 4 pre-operative periods, 6, 24, 30 hours after the operation. Rhinomanometry was also performed, a flow- pressure technique in 2 distinct moments, 6 and 24 hours after surgery. As a result, greater discomfort, greater obstruction as well as a reduction in the area of bilateral minimum nasal cross-section (ASTM) and increased resistance in the group with nasopharyngeal cannula are observed. In the intra-group comparison with the lowest ASTM values, the test group showed a significant difference between the first and the second moments (P = 0.001). It can be concluded that the nasopharyngeal cannula contributes to increase discomfort, worsens airway permeability by decreasing ASTM and increasing nasal resistance. Regarding the length of stay of the nasopharyngeal cannula, it can be said that from 6 hours onwards it does not contribute to the reduction of discomfort, airway permeability and assist in hemostasis.

Immediate Removal of a Dislocated Dental Fragment from the Submandibular Space during Extraction of the Lower Third Molar: Case Report and Literature Review / Remoção Imediata de fragmento Radicular Deslocado Para o Espaço Submandibular Durante a Exodontia de Terceiro Molar Inferior. Relato de Caso e Revisão de Literatura

This paper aims to report a case of radicular displacement to the submandibular space and to review the literature seeking reports of dental displacements / fragments published in the period from 2007 to 2017 in PubMed evidencing risk factors, prevention and forms of treatment. In this article a case of displacement of dental fragments to the submandibular space with immediate removal is reported. The third molar or its roots displacement into facial spaces is a rare situation. The preoperative surgical planning is fundamental to avoid this type of complication. The association of (1) good surgical planning, (2) surgical technique utilization and adequate instruments, and (3) the surgeon experience are determining factors to avoid the occurrence of this complication. (AU).

A extração de terceiros molares é o procedimento cirúrgico mais frequente nos consultórios odontológicos. Como qualquer cirurgia, existe a possibilidade de complicações trans e pós-operatórias. O deslocamento desses dentes ou fragmento dentário para espaços faciais é raro, com frequência extremamente baixa. Este trabalho tem como objetivo relatar um caso de deslocamento radicular para o espaço submandibular e revisar a literatura buscando relatos de deslocamentos dentários/fragmentos publicados no período de 2007 a 2017 no Pubmed evidenciando fatores de risco, prevenção e formas de tratamento. Nesse artigo nós relatamos um caso de deslocamento de um fragmento radicular para o espaço submandibular, sendo este removido imediatamente. O deslocamento do terceiro molar ou de fragmentos radiculares para os espaços faciais é raro. A avaliação pré-operatória é fundamental para evitar esse tipo de complicação. A associação entre (1) planejamento cirúrgico correto, (2) utilização de técnica e materiais corretos e (3) experiência do profissional, são fatores determinantes para evitar esse tipo de complicação. (AU).

Morphometric evaluation of bone regeneration in segmental mandibular bone defects filled with bovine bone xenografts in a split-mouth rabbit model.

BACKGROUND: Bovine bone grafts have been widely used in dentistry for guided tissue regeneration and can support new bone formation in direct contact with the graft. The aim of this study was to compare the morphometric and bone density changes after using two different bovine bone graft blocks in segmental osseous defects in the mandible of rabbits following different postoperative periods. MATERIAL AND METHODS: Critical size segmental defects were surgically created bilaterally in the jaw of 18 rabbits. The defects were filled with either deproteinized bovine bone mineral with 10% collagen (DBBM-C; BioOss Collagen®), lyophilized bovine medullary bone (LBMB; Orthogen®), or left untreated according to a split-mouth design. Animals were sacrificed after 3 or 6 months of healing. The hemimandibles were scanned ex vivo using a high-resolution (19 µm) microcomputed tomography. Morphometric and bone density parameters were calculated in the region of the defect using CT-Analyser (Bruker). Initial graft blocks were used as baseline. RESULTS: DBBM-C presented a denser microarchitecture, in comparison to LBMB at baseline. DBBM-C and LBMB grafted regions showed a similar progressive remodeling, with a significant decrease in structure complexity and maintenance of bone volume fraction during the postoperative follow-up periods. Both graft materials showed an enhanced bone replacement and more complex structure compared to untreated defects. The apparent fusion between the graft and host bone was observed only in the defects filled with LBMB. CONCLUSION: LBMB grafts showed a similar behavior as DBBM-C regarding structural remodeling. In LBMB samples, apparent integration between the host bone and the graft was present.

Predictors of Velopharyngeal Dysfunction in Individuals With Cleft Palate Following Surgical Maxillary Advancement: Clinical and Tomographic Assessments.

OBJECTIVE: To investigate whether morphofunctional velopharyngeal aspects may be considered predictors of appearance or worsening of hypernasality in patients with cleft palate after surgical maxillary advancement (MA). DESIGN: Prospective. SETTING: National referral center for cleft lip and palate rehabilitation. PARTICIPANTS: Fifty-two patients with repaired cleft palate, skeletal class III malocclusion, and normal speech resonance completed speech audio recordings and cone-beam computed tomography examination before (T1) and, on average, 14 months after (T2) MA. INTERVENTIONS: Hypernasality was rated by 3 experienced speech-language pathologists using a 4-point scale and morphofunctional aspects on a 3-point scale. Cone-beam computed tomography image measurements were performed using Amira and Dolphin 3D software. For each velopharyngeal morphofunctional aspect analyzed, patients were compared according to the absence (G1) and presence (G2) of postoperative hypernasality. MAIN OUTCOME MEASURES: Comparison of hypernasality scores between T1 and T2 and association between hypernasality and each velopharyngeal morphofunctional aspect. RESULTS: Significant difference was observed between T1 and T2 for hypernasality ( P = .031) and between G1 and G2 ( P = .015) for velar mobility, with significant association between this variable and hypernasality on T2 (P = .041). CONCLUSIONS: Levator veli palatini mobility influenced the appearance of hypernasality after MA.

Conservative Treatment of Chronic Osteomyelitis Associated with Florid Osseous Dysplasia / Tratamiento Conservador de la Osteomielitis Crónica Asociada con Displasia Ósea Florida

ABSTRACT: Florid osseous dysplasia (FOD) is an extensive form of osseous dysplasia where normal trabecular bone is substituted by fibrous connective tissue and amorphous mineralized tissue. Usually, the lesions are mainly asymptomatic and the patients should be followed with clinical and imaging examination, requiring no intervention. Nevertheless, due to the poor vascularization of the lesion and to local trauma, secondary infections and osteomyelitis may occur. Patients may present with pain, mucosal ulceration, lesion exposure in the oral cavity, fistula and swelling. In such cases, the correct diagnosis and management of the lesion is decisive to reestablish patient's health and quality of life. The aim of this article is to present a case of complicating secondary chronic osteomyelitis treated successfully with conservative intervention. A 68-year-old black female patient reported a "swelling of the gums" that was present for eleven years, with episodes of periodic pain and swelling. On physical examination, a papule with suppuration in the alveolar mucosa in the right side of the mandible was observed. Panoramic radiography and CBCT showed a mixed lesion surrounded by sclerotic bone. The patient was diagnosed with chronic osteomyelitis in association with FOD and treated with antibiotic therapy together with surgical curettage. The incidence, etiophatology, differential diagnosis, treatment and prevention of secondary osteomyelitis associated with FOD are discussed in the light of literature. This information might assist the dentists while choosing the best treatment options for similar cases.

RESUMEN: La displasia ósea florida (DOF) es una forma de displasia ósea donde el hueso trabecular normal es sustituido por tejido conectivo fibroso y tejido mineralizado amorfo. En general, las lesiones son de origen asintomático y los pacientes deben ser seguidos con el examen clínico. Sin embargo, debido a la pobre vascularización de la lesión y al trauma local, pueden producirse lesiones secundarias y osteomielitis. Los pacientes pueden presentarse con dolor, ulceración mucosa, lesión de exposición en la cavidad oral, fístula y edema. En estos casos, el correcto diagnóstico y tratamiento de la lesión es decisivo para reestabilizar la salud y la calidad de la vida. El objetivo de este artículo consistió en presentar un caso de complicación secundaria crónica de osteomielitis tratados con tratamiento conservador. El paciente, negro, de 68 años de edad, consulta por "hinchazón de las encías" que se presentó durante once años, con episodios de dolor. En el examen intraoral, se observó una pápula con supuración en la mucosa alveolar en el lado derecho de la mandíbula. La radiografía panorámica y CBCT mostraron una lesión mixta rodeada de hueso esclerótico. El paciente fue diagnosticado con osteomielitis crónica en asociación con DOF y fue tratado con tratamiento antibiótico junto con curetaje quirúrgico. La incidencia, la etiopatología, el diagnóstico diferencial, el tratamiento y la prevención de la osteomielitis secundaria asociada con DOF se discuten a la luz de la literatura. Esta información puede ayudar a los dentistas a elegir las mejores opciones de tratamiento para casos similares.

Canalis sinuosus: a systematic review of the literature.

OBJECTIVE: The aim of this study was to conduct a systematic review of the frequency, location, diameter, variations in course, relationship to the course of the anterior superior alveolar nerve (ASAN), patient age and gender, and surgical implications of canalis sinuosus (CS), identified through imaging examinations, macerated skulls, or cadaver heads. STUDY DESIGN: Medline, Scopus, and Web of Science databases were searched, and the retrieved articles were analyzed by 2 reviewers. The articles were selected by using well-established inclusion criteria. The Hawker scale was used for quality analysis. A kappa test was used to measure interobserver agreement. RESULT: The search identified 70 articles, of which 11 were selected for extraction and data analysis. Most studies consisted of cone beam computed tomography examinations of the location, diameter, and variable presence of accessory channels (ACs) in the CS. In total, 90.9% of the studies were of high or moderate quality. CONCLUSIONS: The CS may present variations in its course, location, and diameter. It involves ASAN and a extension to the anterior palate region, the ACs. No statistically significant differences with regard to age or gender were discovered in the studies. Most articles report the relevance of the CS identification in surgical procedures close to the canal and emphasize the importance of awareness of the variable appearance of the CS.

Relapse after Le Fort I surgery in oral cleft patients: a 2-year follow-up using digitized and 3D models.

This retrospective observational study aimed to evaluate and identify the relapse rate after orthognathic surgery for maxillary advancement (Le Fort I maxillary osteotomy) in oral cleft patients through digitized cephalograms and 3D dental models, following 2 years. Lateral cephalograms and dental casts of 17 individuals, enrolled in Orthodontics Department in Hospital of Rehabilitation of Craniofacial Anomalies, were carried out. The digital cephalometric tracings were evaluated in: T1-before surgery, T2-immediate after surgery, T3-6-month to 1-year after surgery. The dental study casts were digitized and evaluated in: F1-before surgery; F2-3-month to 1-year after surgery; F3-1 to 2 years after surgery. The analyses of the dental arches were performed directly on the scanned images. A single examiner previously trained and calibrated performed all the assessments. Repeated measures ANOVA was applied to study the variables and compare the periods, followed by Tukey test to evaluate the statistically significant differences, with level of significance of 5%. The digital cephalogram results showed that the vertical movement statistically differed from T2 to T3 (p = 0.002). The right and left premolar relationship in digitized models revealed that at F2 the individuals exhibited » Class II and Class I, in 29.4 and 23.5% of the cases, respectively; and at F3, Class I, 58.8 and 70.6% of the cases, respectively. The cephalometry showed the relapse in the vertical movement after orthognathic surgery for maxillary advancement, but no relapse in the other evaluated parameters.

Postoperative Orthognathic Surgery Edema Assessment With and Without Manual Lymphatic Drainage.

OBJECTIVE: To evaluate the effects of manual lymphatic drainage (MLD) on facial edema and pain in patients who underwent orthognathic surgery from patient and professional perspectives and clinical measures. METHODS: It is a randomized double-blind clinical trial, where 30 patients who underwent bimaxillary orthognathic surgery were divided into 2 groups (treatment and placebo). One group (treatment) received MLD from 2nd postoperative day, besides cryotherapy and postoperative medications. The other group (placebo) received cryotherapy, medications, and manual superficial sliding movements as placebo. For edema evaluation, facial measurements with tape and photographs were used. To evaluate patients' perception, visual analog scale for pain and edema was used. In statistical analysis, quantitative data were analyzed using Student t test for normally distributed variables and Mann-Whitney test for non-normal to find differences between groups; 5% significance level was adopted. RESULTS: No difference was found between groups in the amount of maximum developed edema (P = 0.290) nor on what day the edema peak occurred (P = 0.091). However, it was found that treatment group showed faster and greater regression of swelling compared with placebo (P < 0.001). Manual lymphatic drainage was not effective in relieving pain in these patients and nor in edema perception (P = 0.784 and P = 0.946, respectively). CONCLUSION: Manual lymphatic drainage was effective in reducing facial measurements in orthognathic surgery postoperatory. When considering patient's pain and swelling perception, no difference was found between groups.

CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: Importance to sagittal split osteotomy

Background: Mandibular Sagittal Split Osteotomy (MSSO) is a popular technique in orthognathic surgery used both to advance and to retreat the mandible. However, MSSO may incur in important complications, such as bad splits and sensorineural injuries. Knowing the location of the fusion between the buccal and lingual cortical (FBLC) in the mandibular ramus and the bone thickness in the region where osteotomies will be performed is determinant in MSSO planning to avoid complications. The aim of this study was to document and evaluate possible differences between sexes regarding the location of the FBLC in relation to the superior cortical of mandibular foramen (MF) and bone thickness in the region of interest for MSSO in a Brazilian population. Material and Methods: Eighty five cone-beam Computed Tomography (CBCT) scans were used to perform linear measurements to determine the location of the FBLC. Bone thickness from the mandibular canal (MC) to the cortical external surfaces and the diameter of the MC were measured at three different points: mandibular ramus (A), mandibular angle (B) and mesial of the second molar (C). Results: The FBLC was located at a mean distance of 8.3 mm from the superior cortical of the MF in males and 8.1 mm in females. There was no difference between males and females regarding the mean bone thickness from the MC to the buccal external surface at all the points investigated (p>0.05). Bone thickness from the lingual external surface to the MC was bigger among females than males in regions B and C (p < 0.05). The diameter of the MC was bigger among males in regions B and C. Conclusions: Sexual dimorphism regarding mandibular bone thickness but not regarding the location of FBLC was present. This fundamental knowledge may assist to the panning of MSSO (AU)

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Ewing's Sarcoma Family Tumors in the Jaws: Case Report, Immunohistochemical Analysis and Literature Review.

Due to the low incidence of the Ewing's Sarcoma (ES) family tumors, the available epidemiology is likely to be unreliable, and at present, there are no standard diagnostic or clinical guidelines outlining their management. This report describes a case of peripheral primitive neuroectodermal tumor (ES/pPNET) which initially mimicked cystic lesions, and describes a comparison between ES and ES/pPNET in the jaws by the World Health Organization classification. This review addressed 63 cases published in the English literature between 1950 and 2016. The majority of cases were ES. Both ES and ES/pPNET mimicked other benign entities such as traumatic, cystic and inflammatory lesions. The patients who died of their disease had a history of metastatic tumors, and primary tumor located in the mandible and maxilla for ES and ES/pPNET, respectively. The differentiation of the ES family tumors from other small blue-cell tumors may be difficult and requires familiarity with histological and immunohistochemical features.

Tomographic Pharyngeal Dimensions in Individuals With Unilateral Cleft Lip/Palate and Class III Malocclusion Are Reduced When Compared With Controls.

OBJECTIVE: The objective of this study was to three-dimensionally evaluate the pharyngeal dimensions of individuals with complete nonsyndromic unilateral cleft lip and palate (UCLP) using cone beam computed tomography. DESIGN: This was a cross-sectional prospective study. SETTING: The study took place at the Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil. PATIENTS AND PARTICIPANTS: The control group (CON) consisted of 23 noncleft adults with class III malocclusion, and the cleft group (UCLP) consisted of 22 individuals with UCLP and class III malocclusion. Two subgroups of individuals with class III malocclusion as a result of maxillary retrusion with (UCLP'; n = 19) and without (CON'; n = 8) clefts were also assessed. INTERVENTIONS: Pharyngeal volume, pharyngeal minimal cross-sectional area (CSA), location of CSA, pharyngeal length, sella-nasion-A point angle (SNA), sella-nasion-B point angle (SNB), and A point-nasion-B point angle (ANB), and body mass index were assessed using Dolphin software. MAIN OUTCOME MEASURE: The pharyngeal dimensions of UCLP individuals are smaller when compared with controls. RESULTS: Mean pharyngeal volume (standard deviation) for the UCLP patients (20.8 [3.9] cm3) and the UCLP' patients (20.3 [3.9] cm3) were significantly decreased when compared with the CON (28.2 [10.0] cm3) and CON' patients (29.1 [10.2] cm3), respectively. No differences were found in the pharyngeal minimal CSA, ANB, or pharyngeal length values between groups (CON versus UCLP and CON' versus UCLP'). CSAs were located mostly at the oropharynx, except in the UCLP' patients, which were mainly at the hypopharynx. Mean SNA in the UCLP (76.4° [4.6°]) and UCLP' groups (75.1° [3.1°]) were significantly smaller than those in the CON (82.8° [4.1°]) and CON' groups (78.6° [1.2°]). SNB values were statistically smaller only for the comparison of CON versus UCLP patients. CONCLUSION: The pharynx of individuals with UCLP and class III malocclusion is volumetrically smaller than that of individuals with class III malocclusion and no clefts.

General anesthesia for dental care management of a patient with epidermolysis bullosa: 24-month follow-up.

Epidermolysis bullosa comprises a group of uncommon skin-related diseases, characterized by the formation of blisters on mucocutaneous regions occurring spontaneously, following a trauma, exposure to heat, or as a result of minimal mechanical trauma. The dental treatment of the patient with epidermolysis bullosa raises many questions and discussions, due to the difficulty of carrying out the procedures. This report aimed to detail the clinical considerations of the treatment under general anesthesia of a patient with epidermolysis bullosa. The extraction of all deciduous teeth under general anesthesia was recommended based on the clinical and radiographic examinations. At 24-month follow-up, the patient had great improvement in oral hygiene without new caries lesions. The patient has been followed-up at every month for caries lesion prevention and permanent tooth development. The treatment under general anesthesia provided the ideal safe conditions and was beneficial for the patient.