Bilateral alloplastic prostheses for temporomandibular joint reconstruction in a patient with ankylosing spondylitis.

Ankylosing spondylitis (AS) or Bechterew disease is a chronic, usually progressive, systemic inflammatory joint disease, which predominantly affects the spine and sacroiliac joints. In these joints, early inflammatory changes are followed by lumbosacral pain and progressive restriction of spinal movement associated with radiologically visible intervertebral ossification. Peripheral joint involvement occurs in 10 to 30% of patients and shows a predilection for the shoulders, knees, ankles, feet, and wrists. Temporomandibular joint (TMJ) involvement has been described, and its reported frequency varies from 11 to 35%. However, ankylosis is uncommon with a single documented case utilizing an alloplastic prosthesis for total joint replacement. A case report of bilateral ankylosis of the jaw treated with alloplastic prostheses for total TMJ replacement using a Brazilian system in a patient with AS is presented.

Determination of relative in vivo osteoconductivity of modified potassium fluorrichterite glass-ceramics compared with 45S5 bioglass.

Potassium fluorrichterite (KNaCaMg(5)Si(8)O(22)F(2)) glass-ceramics were modified by either increasing the concentration of calcium (GC5) or by the addition of P(2)O(5) (GP2). Rods (2 × 4 mm) of stoichiometric fluorrichterite (GST), modified compositions (GC5 and GP2) and 45S5 bioglass, which was used as the reference material, were prepared using a conventional lost-wax technique. Osteoconductivity was investigated by implantation into healing defects in the midshaft of rabbit femora. Specimens were harvested at 4 and 12 weeks following implantation and tissue response was investigated using computed microtomography (µCT) and histological analyses. The results showed greatest bone to implant contact in the 45S5 bioglass reference material at 4 and 12 weeks following implantation, however, GST, GC5 and GP2 all showed direct bone tissue contact with evidence of new bone formation and cell proliferation along the implant surface into the medullary space. There was no evidence of bone necrosis or fibrous tissue encapsulation around the test specimens. Of the modified potassium fluorrichterite compositions, GP2 showed the greatest promise as a bone substitute material due to its osteoconductive potential and superior mechanical properties.

Tomographic, histological, and immunohistochemical evidences on the use of N-butyl-2-cyanoacrilate for onlay graft fixation in rabbits.

BACKGROUND: The bone tissue responses to Cyanoacrylate have been described in the literature, but none used N-butyl-2-cyanoacrilate (NB-Cn) for bone graft fixation. PURPOSE: The aims of the study were: (a) to analyze the bone grafts volume maintenance fixed either with NB-Cn or titanium screw; (b) to assess the incorporation of onlay grafts on perforated recipient bed; and (c) the differences of expression level of tartrate-resistant acid phosphatase (TRAP) protein involved in bone resorption. MATERIALS AND METHODS: Eighteen New Zealand White rabbits were submitted to calvaria onlay grafting on both sides of the mandible. On one side, the graft was fixed with NB-Cn, while on the other hand the bone graft was secured with an osteosynthesis screw. The computed tomography (CT) was performed just after surgery and at animals sacrifice, after 1 (n = 9) and 6 weeks (n = 9), in order to estimate the bone grafts volume along the experiments. Histological sections of the grafted areas were prepared to evaluate the healing of bone grafts and to assess the expression of TRAP protein. RESULTS: The CT scan showed better volume maintenance of bone grafts fixed with NB-Cn (p ≤ 0.05) compared with those fixed with screws, in both experimental times (analysis of variance). The immunohistochemical evaluation showed that the TRAP expression in a 6-week period was significantly higher compared with the 1-week period, without showing significant difference between the groups (Wilcoxon and Mann-Whitney). Histological analysis revealed that the NB-Cn caused periosteum damage, but provided bone graft stabilization and incorporation similar to the control group. CONCLUSION: The perforation provided by screw insertion into the graft during fixation may have triggered early revascularization and remodeling to render increased volume loss compared with the experimental group. These results indicate that the NB-Cn possesses equivalent properties to titanium screw to be used as bone fixation material in osteosynthesis.

Temporal abscess after third molar extraction in the mandible.

BACKGROUND: Dental infections resulting before or after third molar removal are complications in which the maxillofacial surgeon may have to initiate an earlier management. The severe dental infections resulting before or after this procedure is one of the few life-threatening complications in which the maxillofacial surgeon may have to initiate an earlier management. Infections involving the temporal space are rare and infrequently reported. Infections in this space have also been observed secondary to maxillary sinusitis, maxillary sinus fracture, temporomandibular arthroscopy, and drug injection, although more commonly associated to third molar infections. CASE REPORT: A 22-year-old man had undergone extraction of tooth 38 secondary to pericoronaritis by a general dentist. Physical examination of his face demonstrated severe trismus, pain, and swelling in temporal region. A CT scan showed an inflammatory area into the temporal space. He was started on IV cephalosporin, but the clinical course of the patient was not satisfactory. Incision and drainage were performed from an extraoral and intraoral approach. After discharged, the antibiotic was switched to clindamycin IO 600 mg. DISCUSSION: The retromaxillary and temporal infections are quite common after maxillary molar extractions but not after mandibular third molar, the spread mechanism of ascension must be involved with the virulence of microorganisms, but more studies are necessary to clarify this occurrence.

Retropharyngeal and cervicofacial subcutaneous emphysema after maxillofacial trauma.

INTRODUCTION: Subcutaneous emphysema in the cervical region is a well-documented event that may occur secondary to tonsillectomy, dental treatment, oropharyngeal barotraumas, scaling and root planning therapy, punch biopsy, endotracheal intubation, orthognathic surgery, extraction of impacted teeth, or after maxillofacial trauma. After trauma episodes, subcutaneous emphysema may be caused by a maxillary antral wall fracture that occurs when air pressure is introduced into the fascial planes of the connective tissue. Retropharyngeal emphysema is a severe condition associated with traumatic aerodigestive tract injury and may be associated with life-threatening situations requiring prompt attention and diagnosis in order to prevent serious consequences. CASE REPORT: We reported a case of cervicofacial and retropharyngeal emphysema in a 54-year-old patient who stated concerns after blowing his nose several times after a traumatic episode involving orbitozygomatic region. During the patient's hospital course, his airway remained stable, and he was discharged from the hospital 7 days later with a prognosis of full recovery, excellent occlusion and facial appearance, and complete resolution of subcutaneous emphysema.

Use of zoledronic acid in the treatment of Gorham's disease.

Gorham's disease (Gorham-Stout syndrome) is a rare condition of unknown etiology involving a localized endothelial proliferation of lymph vessels resulting in destruction with bone resorption. The syndrome is rarely seen in the facial skeleton and has a large variety of prognoses and treatments. A case of this syndrome in a 9-year-old boy is presented. The clinical aspects are described, together with the treatment involving zoledronic acid. Other treatments described in the literature are reviewed. The authors believe that this report is one of the first cases in which a child afflicted in the first decade of life survives.

Fibroma Ameloblástico: Consideraciones Clínicas, Caso Clínico

Los tumores odontogénicos comprenden un grupo complejo de lesiones de comportamiento clínico y tipos histológicos diversos. Algunas de estas lesiones son neoplasias verdaderas y raramente pueden presentar un comportamiento maligno. Otras pueden representar malformaciones semejantes a tumores (hamartomas). El fibroma ameloblástico es considerado un verdadero tumor mixto, en el cual los tejidos epitelial y mesenquimal son neoplásicos. El presente trabajo tiene por objetivo describir el caso de una paciente perteneciente a la segunda década de vida, asintomática donde fue diagnosticado un fibroma ameloblástico siendo realizado tratamiento quirúrgico para remoción de la lesión; así como realizar diversas consideraciones con respecto a las principales características clínicas de esta neoplasia, haciendo referencias al diagnóstico y su tratamiento clínico.

Os tumores odontogênicos compreendem um grupo complexo de lesões de comportamento clínicos e tipos histológicos diversos. Algumas destas lesões são verdadeiras neoplasias e raramente podem apresentar um comportamento maligno. Outras podem representar malformações semelhantes a tumores (hamartomas). O fibroma ameloblástico é considerado um verdadeiro tumor misto, no qual os tecidos epitelial e mesenquimal são neoplásicos. O presente trabalho têm por objetivo descrever o caso de uma paciente pertencente a segunda década de vida, assintomática onde foi diagnósticada a lesão acima citada, sendo posteriormente realizado tratamento cirúrgico para remoçao da lesão; e fazer diversas considerações a respeito das principais características clínicas desta neoplasia, fazendo referências ao diagnóstico e seu tratamento clínico.

Odontogenic tumors are a complex group of injuries that presents several types of clinical behaviors and histological types. Some of these tumors are true neoplasms and rarely present in malignant forms. Others can present tumors-like malformations (hamartomas). The ameloblastic fibroma is considered a true mixed odontogenic tumor, in which epithelial and mesenchymal Tissues are neoplasics. The aim of this study was to describe a case of a second -decade of life patient, asymptomatic, that was diagnosed the lesion above cited, being latter carried surgical treatment for tumor removal. It was also done considerations regarding the main clinical characteristics of this neoplasm, and made references to the diagnosis and its clinical treatment.