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1.
Int. j. odontostomatol. (Print) ; 13(3): 258-265, set. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1012419

RESUMO

ABSTRACT: The aim of this research was to perform a systematic review to identify the most frequent uses of PLA/ PGA in alveolar bone regeneration and their results. A study was designed to answer the question: What are the most frequent uses of PLA/PLGA and their copolymers in alveolar bone regeneration?. A systematic search was done on MEDLINE, EMBASE and LILACS from April 1993 to December 2017. The search string used on MEDLINE was: (((polylactic acid) OR PLA) OR PLA-based copolymers) OR PLA blends) OR PLA scaffolds)) AND ((("Bone Regeneration"[Mesh]) OR bone regeneration) OR guided bone regeneration). The search was complemented by a manual review of the references from the articles included. Most of the studies selected were weak and, regarding the most frequent uses of PLA/PGA, 13 studies used it as a resorbable membrane, two as an absorbable mesh, one as an absorbable screw and three as filling material. Based on our results, the authors consider that PLA/PGA requires a delicate relation between the mechanical resistance and the degradation process. PLA/PGA does not interrupt bone regeneration; however, the influence in cellular events related to bone regeneration and later osseointegration have not been identified.


RESUMEN: El objetivo de esta revisión fue realizar una revisión sistemática de la literatura para identificar los usos más frecuentes de PLA/PGA en regeneración ósea en área maxilofacial y sus resultados. Se diseñó un estudio para responder a la pregunta: ¿Cuáles son los usos más frecuentes de PLA/PLGA y sus copolímeros en regeneración ósea en el sector maxilofacial?. Los estudios seleccionados fueron en su mayoría débiles y sobre los usos más frecuentes de PLA/PGA, 13 estudios lo utilizaron como membrana reabsorbible, 2 estudios como malla absorbible, un estudio como tornillo absorbible y 3 estudios como material de relleno. En base a nuestros resultados, los autores estiman que PLA/PGA requiere una delicada relación entre la resistencia mecánica que ofrece y la degradación que se produce; PLA/ PGA no interrumpe la regeneración ósea, sin embargo, no se ha identificado la potencialidad o influencia que presenta en los eventos celulares de la regeneración y posterior oseointegración.

2.
Int. j. odontostomatol. (Print) ; 13(3): 310-315, set. 2019. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1012428

RESUMO

RESUMEN: La odontodisplasia regional (OR) es una alteración en el desarrollo, no hereditario y que afecta tanto la dentición temporal como la dentición definitiva. Involucra a los tejidos mesodérmicos y ectodérmicos de los dientes lo que es condescendiente con hallazgos clínicos, radiográficos e histológicos. Su etiología aun es desconocida y se presenta mayoritariamente en mujeres. Clínicamente puede afectar al maxilar, a la mandíbula o ambas arcadas pero generalmente solo se ve comprometida una ellas, principalmente el más afectado es el hueso maxilar. Radiográficamente se observa una pobre diferencia entre los tejidos del esmalte y la dentina, siendo tejidos menos radiopacos que su contraparte sana generando un aspecto descrito como "diente fantasma". Histológicamente se observan zonas hipocalcificadas del esmalte con un orden de prismas irregulares mientras que la dentina se observa con un número reducido de túbulos dentinarios y de consistencia más fibrosa en su zona coronal. El tratamiento de la OR es controversial ya que su incidencia es baja y la literatura al respecto no es clara. El objetivo de este manuscrito, fue reportar un caso de OR y revisar la literatura relacionada. Presentamos un caso de OR en una paciente de 12 años que presenta ausencia de los dientes 2.4, 2.5 y 2.6; restos radiculares y agenesia de los dientes 3.5 y 4.5. Se describirán sus aspectos clínicos, radiográficos e histológicos. Se realizó una búsqueda sistemática en las siguientes bases de datos: Clínical key, Science Direct, PubMed y SciELO.


ABSTRACT: Regional odontodysplasia (RO) is a variation in the development; it is not hereditary and it affects both deciduous and permanent dentition. It involves the mesodermal and ectodermal tissues of dental pieces, and coincides with clinical, radiographic and histological findings. Its etiology is still unknown and it reportedly occurs mostly in women. Clinically it can affect the maxilla, mandible or both arches but generally only one is compromised, mainly the maxilla which is affected the most. Radiographically there is limited difference between enamel and dentin tissue, which is less radiopaque than their healthy counterpart, generating an aspect described as "phantom tooth". Histologically hypocalcified areas of the enamel are observed with an irregular order of prisms while the dentine is observed with a reduced number of dentinal tubules and more fibrous consistency in the coronal area. RO treatment is controversial since its incidence is low and the literature on these events is not clear. The aim of this manuscript was to report a case of RO and review related literature. We present a case of RO in a 12-year-old patient who presents absence of parts 2.4.2.5 and 2.6; radicular remains and agenesis of parts 3.5 and 4.5. Its clinical, radiographic and histological aspects are described. A systematic search was carried out in the following databases: Clinical key, Science Direct, PubMed and SciELO.

3.
Biomed Res Int ; 2019: 8043510, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31428646

RESUMO

The aim was to analyze histologically the bone repair in a mandibular osteotomy model with different gaps between the segments. Nine male rabbits who underwent osteotomies on the mandibular body were fixed with a 1.5 system plate and no bone graft; group 1 (2 mm gap between segments), group 2 (5 mm gap between segments), and group 3 (8 mm gap between segments) were included. After 8 weeks they were euthanized and the sample was processed for histological analysis. Group 1 showed advanced bone repair with cartilaginous tissue and cancellous bone, showing osteoblasts and type III collagenous fibers. In group 2, a more delayed ossification was observed, with an extensive area of peripheral ossifying cartilage and chondrocytes in greater number at the center of the defect; group 3 showed no evidence of ossification with fibrous tissue, a very low level of chondrocytes, and some bone sequestrate. We can conclude that, in this animal model, 2 or 5 mm gap in the osteotomy could be repaired as bone when fixation is used. The size of the gap is an important factor for the use of bone grafts considering endochondral ossification. This model can be used for graft analysis and related technologies.

4.
Int. j. morphol ; 37(1): 82-86, 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-990009

RESUMO

SUMMARY: The aim of this study was to characterize a commercial beta tricalcium phosphate (β-TCP) block allograft for use in maxillofacial reconstruction, evaluating its homogeneity, porosity and mineralization. Two commercial 5 x 5 x10 mm chronOS Vivify β-TCP blocks were used, which were evaluated by a STEM SU-3500 variable pressure scanning electron microscope (SEM-STEM) (Hitachi, Japan). For the semi-quantitative microanalysis of elements, the QUANTAX 100 energy dispersive x-ray spectrometer detector (EDX) (Bruker, Germany) was used. The homogeneity of the structural morphology, macropore and micropore size and component homogeneity were evaluated. The microscopic analysis showed micropores of 164.92 mm (± 35.032 mm) in diameter in the outer area and micropores in the inner area of 54.44 mm (± 17.676 mm). The formation of porosities and irregularities present in the block was heterogeneous between the outer and inner surfaces. The mineral content of the blocks presented homogeneity with the presence of carbon (2.02 %), oxygen (44.33 %), phosphate (16.62 %) and calcium (37.87 %). The β-TCP block can be used in bone reconstruction but the presence of reduced macropore and micropore sizes could limit efficiency in the substitution and bone regeneration phase.


RESUMEN: El objetivo de este estudio fue caracterizar un aloinjerto de bloqueo de fosfato tricálcico (β-TCP) comercial para su uso en la reconstrucción maxilofacial, evaluando su homogeneidad, porosidad y mineralización. Se utilizaron dos bloques comerciales de 5 x 5 x 10 mm de vivify β-TCP de chronOS, que se evaluaron mediante un microscopio electrónico de barrido de presión variable STEM SU-3500 (SEM-STEM) (Hitachi, Japón). Para el microanálisis de elementos semicuantitativo, se utilizó el detector de espectrómetro de rayos X de dispersión de energía QUANTAX 100 (EDX) (Bruker, Alemania). Se evaluó la homogeneidad de la morfología estructural, el tamaño del macroporo y microporo y la homogeneidad de los componentes. El análisis microscópico mostró microporos de 164,92 mm (± 35,032 mm) de diámetro en el área externa y microporos en el área interna de 54,44 mm (± 17,676 mm). La formación de porosidades e irregularidades presentes en el bloque fue heterogénea entre las superficies externas e internas. El contenido mineral de los bloques presentó homogeneidad con la presencia de carbono (2,02 %), oxígeno (44,33 %), fosfato (16,62 %) y calcio (37,87 %). El bloque β-TCP se puede utilizar en la reconstrucción ósea, pero la presencia de macroporos y tamaños de microporos reducidos podría limitar la eficacia en la fase de sustitución y regeneración ósea.

5.
Int. j. morphol ; 37(1): 232-236, 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-990032

RESUMO

SUMMARY: The nasolabial region is the central esthetic unit of the face and is considered one of the most important determinants of the facial esthetic. The facial morphometry of soft tissues is a very important tool in facial surgery. Advances have been made recently in the capture and analysis of 3D images, which offer great development potential in the diagnosis and treatment of facial deformities. The aim of this study was to characterize the nasolabial region of patient candidates for orthognathic surgery using 3D facial captures. A study was conducted to characterize the width of the nasal base and the nasolabial angle in adult patients through 3D photographs. 30 subjects were included, taking two 3D photos each, one in a resting position and the other smiling. The three-dimensional capture was done with the 3dMDface System. The measurements were taken with the 3dMD Vultus software. The length of the alar base was an average of 34.3 ± 2.6 mm at rest, and 39.1 ± 2.9 mm smiling. The mean of the nasolabial angle was 104.6 ± 9.6° at rest and 105.4 ± 14.3º smiling. Additionally, the distance of the alar base smiling compared to its distance at rest increased an average of 4.83 mm, whereas the nasolabial angle smiling increased an average of 0.8º compared to at rest. In this study, the nasolabial angle did not present any significant changes so that its assessments in the case of facial modifications can be standard; the width of the nasal base is significantly modified with the smile and thus a more intense study of any type of modification in this area is required.


RESUMEN: La región nasolabial es la unidad estética central de la cara y se considera uno de los determinantes más importantes de la estética facial. La morfometría facial en tejidos bandos, es una herramienta de gran importancia en Cirugía Facial. En el último tiempo, se han realizado avances en captura y análisis de imágenes 3D, las cuales ofrecen un gran potencial de desarrollo en el diagnóstico y tratamiento de las deformidades faciales. El objetivo de éste trabajo fue caracterizar mediante capturas faciales 3D la región nasolabial de pacientes candidatos a cirugía ortognática. Se realizó un estudio para caracterizar a través de fotografías tridimensionales de pacientes adultos el ancho de la base nasal y el ángulo nasolabial. Se incluyeron 30 sujetos, tomando 2 fotografías 3D a cada uno, una en posición de reposo y otra en sonrisa. Se realizó la captura tridimensional con la camara facial 3dMDface System. Las mediciones fueron realizadas con el software 3dMD Vultus. La longitud de base alar en reposo, fue en promedio de 34,3 ± 2,6 mm, y de 39,1 ± 2,9 mm, en sonrisa. Por otra parte, la media del ángulo nasolabial en reposo fue de 104,6 ± 9,6° y en sonrisa, de 105,4 ± 14,3º. Por otro lado, la distancia de la base alar en sonrisa respecto a su distancia en reposo, aumentó un promedio de 4,83 mm, mientras que el ángulo nasolabial en sonrisa, aumentó en promedio 0,8º respecto a la posición de reposo. En esta investigación, el ángulo nasolabial no presentó cambios significativos de forma que su valoración frente a modificaciones faciales puede ser estándar; el ancho de base nasal se modifica significativamente con la sonrisa de forma que su estudio debe ser más agudo frente a cualquier tipo de modificación en esta zona.

6.
Int. j. odontostomatol. (Print) ; 12(3): 309-319, Sept. 2018. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-975750

RESUMO

RESUMEN: La reconstrucción de la cabeza y el cuello contempla avances importantes a lo largo de los años. Los colgajos microvasculares se han convertido en la primera opción de tratamiento en grandes defectos del territorio maxilofacial, mientras tanto, la tecnología con el uso de microscopía y luego las imágenes como CT, angiografía por tomografía computarizada, dispositivo ultrasónico, RNM o Doppler contribuyen a lograr una predictibilidad excepcional de estos colgajos microvasculares. Por lo general, la técnica de anastomosis consiste en una sutura de 9-0 en 360°, pero existen autores que han descrito diversos métodos que no son de sutura con un rendimiento aceptable. Existe un buen número de diferentes colgajos microvasculares, cuatro de ellos son los más comunes en la reconstrucción maxilofacial: fíbula, ilíaco, antebrazo radial, escápula. Además el colgajo anterolateral, muy útil en defectos de piel y tejidos blandos. La evolución de los colgajos microvasculares implica los colgajos quiméricos, muy útiles en defectos grandes. El objetivo de este artículo es describir y exponer el desarrollo de la microcirugía y las diversas opciones de colgajos microvasculares en la reconstrucción maxilofacial.


ABSTRACT: Head and neck reconstruction have shown important advances over the years. Microvasculars flaps transfer has become the first treatment option in large defects of the maxillofacial area. Meanwhile technology through the use of microscopy and the subsequent use of images such as CT, CT angiography, RNM or Doppler ultrasonic device, and additional new techniques have contributed to an exceptional predictability of these microvascular flaps. Typically, the anastomosis technique consists in 9-0 suture in 360°, but since the vascular flaps exist, authors have described diverse non-suture methods with acceptable performance. There are a number of different microvasculars flaps, four of them are the most common in maxillofacial reconstruction: fibula, iliac, radial forearm, scapula. In addition the anterolateral tight flap, very useful in skin and soft tissues defects. The microvascular flaps evolution involves the chimeric flaps that are useful in large defects. The aim of this article is to describe and expose microsurgery development and the diverse microvascular flap options in maxillofacial reconstruction.

7.
Int. j. odontostomatol. (Print) ; 12(2): 137-141, jun. 2018. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-954255

RESUMO

RESUMEN: El objetivo de este artículo es presentar un caso clínico con la utilización de un innovador sistema de osteosíntesis basado en la mezcla de hidroxiapatita (HA) y acido poliláctico (PLLA). La paciente fue admitida en el Hospital Abraham González Peña de Lautaro (Chile) debido a una deformidad facial que exigió realizar una cirugía ortognática monomaxilar para avance y aumento transversal del maxilar; se utilizaron placas de tipo L y tornillos de HA/PLLA de 5 mm para la fijación maxilar, realizando la cirugía sin complicaciones; el proceso técnico y alta hospitalaria se ejecutó de forma convencional. Se realizó un análisis de la literatura donde se analiza la versatilidad, la seguridad y la estabilidad de segmentos cuando se utiliza este innovador material y se concluye que este tipo de osteosíntesis es aplicable a cirugía maxilofacial, exigiendo una curva de aprendizaje por parte del cirujano, necesaria para obtener resultados adecuados.


ABSTRACT: The aim of this paper is to show a clinical case, where was used an innovative osteosynthesys system based on the mixture of hidroxiapatite (HA) and polilactic acid (PLLA). The patient was admitted into Abraham González Peña Hospital (Chile), showing a facial deformity to treat with monomaxillary orthognathic surgery for advance and transversal increase of the maxilla.; were used type L plates and 5 mm screws of HA/PLLA for the internal fixation, performing the surgery without complications; the technical process and the ALTA hospital was realized in a conventional strategy. Was realized a literature review showing the versatility, safe and stability of bone segment when used this innovative material and it´s concluded that this osteosynthesis system can be used normally in maxillofacial surgery; a learning curve to learn about this material is needed by surgeons.

8.
J Craniofac Surg ; 29(2): 427-431, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29509170

RESUMO

: Temporomandibular joint ankylosis, according to age of onset, causes severe functional and morphological disorders, as well as stunted craniofacial growth and development.The primary goal of treatment is to resolve the functional and morphological disorders. METHOD: Pre- and posttreatment clinical and cephalometric registries were conducted in 15 patients with temporomandibular joint ankylosis over a 10-year period (2002-2012). All the patients underwent complete removal of the ankylotic block, gap arthroplasty, and ipsilateral coronoidectomy. Distraction osteogenesis was performed on 12 patients. RESULTS: Fifteen patients, 8 female and 7 male, ranging from 3 to 30 years of age, were included in this study. The posttreatment follow-up period ranged from 3 to 13 years.The mean preoperative maximum mouth opening was 3 ± 1.7 mm, and the mean postoperative maximum mouth opening was 36 ± 6.5 mm. The labial inclination with respect to the true horizontal decreased considerably (6.2° ± 2.3° preoperative to 1° ± 1.6° postoperative). A correction of the mandibular deviation was measured at the symphysis with respect to the facial midline (8° ± 2° preoperative to 2° postoperative). Finally, the height ratio of both mandibular rami (the healthy side and the affected side) decreased considerably (1.27 ± 0.05 preoperative to 1.07 ± 0.06 postoperative).Reankylosis only occurred in 2 patients, who were then successfully treated by means of gap arthroplasty. CONCLUSIONS: The therapeutic algorithm proposed in the present work provides favorable functional and morphological results. Early and aggressive functional physiotherapy is essential to minimize the risk of reankylosis.


Assuntos
Algoritmos , Anquilose/cirurgia , Artroplastia , Assimetria Facial/cirurgia , Osteogênese por Distração , Transtornos da Articulação Temporomandibular/cirurgia , Articulação Temporomandibular/cirurgia , Adolescente , Adulto , Anquilose/fisiopatologia , Cefalometria , Criança , Pré-Escolar , Assimetria Facial/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Mandíbula/patologia , Mandíbula/cirurgia , Recidiva , Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia
9.
Int. j. morphol ; 35(3): 1133-1139, Sept. 2017. ilus
Artigo em Inglês | LILACS | ID: biblio-893105

RESUMO

The aim of this study was to quantify the presence of cortical and cancellous bone in the mandibular symphysis. A descriptive study was conducted using cone beam computed tomography where skeletal class I and class III subjects were included, defined according to characteristics detected on dental, clinical and dental occlusion x-rays. From the 3D reconstruction, sections were used in relation to the axial axis of the teeth of the anterior sector; the amount of buccal cortical, cortical, lingual, inferior cortical and cancellous bone as well as symphysis height were determined. The measurements were taken using routine methods and analyzed with ANOVA and Tukey's HSD test with p <0.05 for statistical significance. 20 skeletal class I subjects aged 23 years (± 4.5) and 20 class III subjects aged 22 years (± 5.2) were included. Symphysis height was significantly greater in skeletal class III subjects, exceeding by 0.8 mm the height of class I subjects; the buccal cortical bone presented on average 2 mm less at different dental levels, whereas the lingual cortical and inferior basal bones were significantly larger than the buccal cortical bone. The cancellous and cortical bones did not present any significant differences between the two groups (p=0.093). The buccal and basilar cortical bone is smaller than lingual cortical bone.


El objetivo fue determinar la presencia de hueso cortical y esponjoso en sínfisis mandibular. Se realizó un estudio descriptivo en tomografías computadorizadas cone beam donde se analizaron sujetos clase I y clase III esqueletal definidos según características dentales, clínicas y radiográficas de oclusión dental y características radiográficas. Desde la reconstrucción 3D se utilizaron cortes en relación al eje axial de los dientes del sector anterior; en ellos se determinó la cantidad de hueso cortical bucal, cortical, lingual, cortical inferior, hueso esponjoso y altura de sínfisis. Las mediciones fueron realizadas con métodos de rutina y fueron analizados con la prueba ANOVA y HDS Turkey considerando un valor de p <0.05 para considerar significancia estadística. 20 sujetos clase I esqueletal con 23 años (+ 4.5) y 20 sujetos clase III esqueletal con edad de 23 años (+ 4.5) fueron incluidos. La altura de sínfisis fue significativamente mayor en sujetos de clase III esqueletal, superando por 0.8 mm la altura de sujetos clase I; el hueso cortical bucal presento en promedio menor de 2 mm en diferentes niveles dentarios, mientras que la cortical lingual y basal inferior fueron significativamente mayor que la cortical bucal. El hueso esponjoso y hueso cortical no presentó diferencias significativas entre ambos grupos (p=0.093). La cortical bucal y basilar son menores que el hueso cortical lingual.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Osso Esponjoso , Queixo/patologia , Osso Cortical , Mandíbula/patologia , Má Oclusão de Angle Classe III/patologia , Má Oclusão de Angle Classe I/patologia
10.
Int. j. morphol ; 35(3): 1185-1190, Sept. 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-893112

RESUMO

El propósito de este estudio fue de evaluar la técnica quirúrgica propuesta para estudios de resección y reconstrucción mandibular en modelos experimentales en conejos. Se utilizaron 7 conejos neozelandeses (Orictolagus cuniculus), en los cuales se realizó la resección del cuerpo mandibular izquierdo, una vez asegurada la movilidad de los segmentos, se reconstruyó con placa de osteosíntesis de titanio de 1,5 mm y tornillos monocorticales de 5 mm, en la zona resecada se fijó un bloque de beta fosfato tricálcico y estabilizado con tornbillo de 1,2 mm. Se sacrificaron los animales a los 2 meses. Todos los animales sobrevivieron al procedimiento y se pudo llevar a cabo la resección y reconstrucción en todos ellos. No se presentaron signos ni síntomas de infección en el sitio quirúrgico mientras duró el experimento. El tiempo promedio de cirugía fue de 68 minutos. El peso promedio de los animales fue de 3925 g, la pérdida promedio de peso fue de 2,03 %. No se realizó eutanasia de ningún animal por motivos de sufrimiento. Al examen macroscópico de las muestras extraídas se observó la presencia de todos los elementos de osteosíntesis en posición, así como continuidad de la estructura ósea casi en su totalidad en la superficie . La utilización de conejos en modelos de reconstrucción maxilofacial es un modelo probado debido a la similitud de los procesos reparativos, su facilidad de manipulación y cuidados. El modelo propuesto representa una alternativa más cercana a los procesos reconstructivos en cirugía resectiva maxilofacial, debido a que somete los injertos a las fuerzas propias de la masticación y de la función orofacial.


The purpose of this study was to evaluate the surgical technique proposed for studies of resection and mandibular reconstruction in experimental models in rabbits. Seven rabbits (Orictolagus cuniculus) were used, in which the left mandibular body was resected, once the mobility of the segments was assured, reconstructed with 1.5 mm titanium osteosynthesis plate and monocortical screws of 5 mm, in the resected area a block of beta-tricalcium phosphate was stabilized and stabilized with tornbillo of 1.2 mm. The animals were sacrificed at 2 months. All animals survived the procedure, and resection and reconstruction were performed in all of them. There were no signs or symptoms of infection at the surgical site during the experiment. The average length of surgery was 68 minutes. The average weight of the animals was 3.925 g, the average weight loss was 2.03 %. No animal was euthanized for reasons of suffering. Macroscopic examination of the extracted samples showed the presence of all elements of osteosynthesis in position, as well as continuity of the bone structure almost entirely on the surface. The use of rabbits in models of maxillofacial reconstruction is a proven model due to the similarity of the reparative processes, their ease of manipulation and care. Our proposed model represents a closer alternative to the reconstructive processes in maxillofacial resective surgery, because it subjects the grafts to the forces of chewing and orofacial function.


Assuntos
Animais , Masculino , Coelhos , Transplante Ósseo/métodos , Reconstrução Mandibular/métodos , Peso Corporal , Modelos Animais , Tamanho do Órgão
11.
Int. j. morphol ; 35(2): 745-750, June 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-893049

RESUMO

Los osteomas fronto-etmoidales son los tumores benignos más frecuentes de los senos paranasales, pudiendo evolucionar con complicaciones por compresión de estructuras adyacentes. Se presenta el caso de una paciente de 63 años de edad, que consultó por aumento de volumen nasofrontal, cefalea y diplopía. Tras el examen clínico, se evidenció una asimetría facial con lateralización del bulbo ocular derecho y exoftalmo. La tomografía de los senos paranasales mostró una lesión que ocupa parcialmente el seno frontal, etmoidal y parte de la cavidad nasal. Los cuidados anatómicos y planificación quirúrgica se desarrollaron en un modelo estereolitográfico mientras que la cirugía de exéresis total se realizó con ayuda del sistema piezoeléctrico. El examen histológico confirmó el diagnostico de osteoma. Se obtuvo una reconstrucción exitosa, recuperando totalmente simetría y función ocular.


Fronto-ethmoidal osteomas are the most frequent benign tumors of the paranasal sinuses, and may evolve with complications by compression of adjacent structures. The case is a 63-year-old female patient, who consulted about increased nasofrontal volume, headache and diplopia. After the clinical exam, she presented a facial asymmetry with lateralization of the right eyeball and exophthalmus. Computed tomography of the sinuses showed a lesion that partially occupies the frontal sinus, ethmoidal sinus and part of the nasal cavity. The anatomical care and surgical planning was developed in a stereolithographic model while the total excision surgery was performed with the help of the piezoelectric system. Histological examination confirmed the diagnosis of osteoma. A successful reconstruction is obtained, fully recovering symmetry and ocular function.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Osso Etmoide/cirurgia , Seio Frontal/cirurgia , Osteoma/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Piezocirurgia/métodos , Cirurgia Assistida por Computador , Osso Etmoide/patologia , Seio Frontal/patologia , Modelos Anatômicos , Osteoma/patologia , Neoplasias dos Seios Paranasais/patologia , Planejamento de Assistência ao Paciente
12.
Int. j. morphol ; 35(1): 310-318, Mar. 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-840971

RESUMO

La proteína morfogenética ósea (BMP), es una proteína endógena que ha mostrado efectos significativos en la promoción de la formación ósea. El uso de BMP ha sido descrito en la reconstrucción de defectos óseos de origen traumáticos y patológicos, incluyendo la fisura alveolar, el aumento de reborde alveolar, la elevación de seno maxilar, el injerto de alveolo post-extracción, y la cirugía perimplantaria entre otros. A pesar de las ventajas asociadas al uso de BMP y que en la actualidad se aplica en combinación con matrices de colágeno, ciertas propiedades tales como su baja resistencia mecánica y su elevada tasa de liberación inicial disminuyen su eficacia en la formación ósea. En este contexto, el desarrollo de nuevos sistemas de liberación prolongada de BMP que permitan la quimiotaxis de células mesenquimáticas y su posterior diferenciación a osteoblastos representa un desafío con alto potencial clínico para la estimulación de la formación ósea. En este trabajo, se describe el uso de BMP en la reconstrucción de fisuras alveolares y en particular se discuten las ventajas de su administración en micropartículas poliméricas comosistemas de liberación de BMP (rhBMP-2) con promisorias aplicaciones en la estimulación de la formación ósea.


Bone morphogenetic protein (BMP) is an endogenous protein that has shown significant effects in the promotion of bone formation. BMP also has been described in the reconstruction of traumatic and pathological bone defects, including alveolar cleft, alveolar ridge augmentation, maxillary sinus elevation, and applications in post-extraction alveolus graft, and peri-implant surgery among others. Despite the advantages associated with the use of BMP, currently is applied in combination with collagen matrices, which has certain properties such as low mechanical resistance and a high burst initial release that diminish its effectiveness in bone formation. In this context, the development of novel systems with greater mechanical resistance and prolonged release of BMP, that lead to chemotaxis of mesenchymal cells, following by its differentiation to osteoblasts represents a major challenge that holds outstanding clinical potential for the stimulation of bone formation. In this paper, we describe the use of BMP for the reconstruction of alveolar clefts, and its advantages being administrated in polymeric microparticles as sustain release system with promising applications in the stimulation of bone formation.


Assuntos
Humanos , Processo Alveolar/cirurgia , Proteína Morfogenética Óssea 2/uso terapêutico , Proteínas Morfogenéticas Ósseas/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Regeneração Óssea/efeitos dos fármacos , Fissura Palatina/cirurgia , Nanopartículas
13.
J. oral res. (Impresa) ; 5(8): 302-306, Dec. 2016. tab
Artigo em Inglês | LILACS | ID: biblio-907693

RESUMO

Abstract: to compare the presurgical and immediate postsurgical quality of life in Chilean patients with orthognathic surgery. Material and Methods: Cohort study. The study included 30 patients (mean age 20.73, 53.33 percent male) who underwent orthognathic surgery primarily for severe skeletal abnormalities, (17 surgeries, 56.7 percent) and moderate skeletal abnormalities (12 surgeries, 40 percent), from three Chilean hospitals between February and June 2016. Patients were asked to answer the World Health Organization quality of life Bref version questionnaire (WHOQOL-BREF) validated in Spanish to measure quality of life (QoL) two weeks before and three months after the surgery. Scores for general QoL and for every domain of QoL were described. Variations in the scores of general QoL were analyzed according to sex and severity of orofacial malformation (mild, moderate or severe) (t-test p<0.05; STATA 10.0). Results: The average score for QoL according to the WHOQOL-BREF scale was 76.43 +/- 13.83 before surgery and 90.5 +/-7.18 three months after surgery (p<0.001). Statistically significant differences according to sex and type of orofacial malformation were found (p<0.01). An increase in the score in all the domains of the WHOQOOL-BREF scale was observed. Conclusion: Orthognathic surgery significantly improved QoL scores in Chilean patients according to the WHOQOL-BREF scale.


Resumen: comparar la calidad de vida pre y postquirúrgica inmediata en pacientes chilenos sometidos a cirugía ortognática. Materiales y método: Estudio de cohorte. Participaron 30 pacientes (edad promedio 20.73, 53.33 por ciento hombres) sometidos a cirugía ortognática, principalmente por anomalía esqueletal severa (17 cirugías, 56.7 por ciento) y moderada (12 cirugías, 40 por ciento) de tres hospitales chilenos entre los meses de febrero y junio del 2016. Cada paciente respondió el cuestionario autocumplido World Health Organization Quality of Life Bref version (WHOQOL-BREF) validado en español para el registro de la calidad de vida (CV) en cirugía ortognática, previo a la cirugía y luego de tres meses postoperatorio. Se describieron los puntajes de CV general y por dominios, se analizaron los cambios en la CV general según sexo y severidad de la malformación orofacial (leve, moderada o severa) (t-test p<0.05; STATA 10.0). Resultados: El promedio del puntaje de CV fue 76.43 +/- 13.83 antes de cirugía y 90.5 +/- 7.18 después de tres meses de cirugía (p<0.001). Las diferencias fueron estadísticamente significativas según sexo y tipo de malformación orofacial (p<0.01). Se observó un aumento de los valores en todos los dominios de la encuesta WHOQOOL- BREF. Conclusión: La cirugía ortognática mejoró significativamente los puntajes de CV en pacientes chilenos según la escala WHOQOL-BREF.


Assuntos
Masculino , Feminino , Humanos , Adolescente , Adulto , Adulto Jovem , Deformidades Dentofaciais/psicologia , Deformidades Dentofaciais/cirurgia , Procedimentos Cirúrgicos Ortognáticos/psicologia , Qualidade de Vida , Chile , Estudos de Coortes , Inquéritos e Questionários
14.
Int. j. morphol ; 34(4): 1502-1505, Dec. 2016. ilus
Artigo em Espanhol | LILACS | ID: biblio-840915

RESUMO

El objetivo de esta investigación es determinar la inclinación de incisivos maxilares en sujetos con maloclusión de clase III. Se incluyeron 35 sujetos que presentaran deformidad facial de clase III (DF-III) para analizar la tomografía computarizada de haz cónico; las mediciones se realizaron para los cuatro incisivos maxilares identificando el plano palatino considerado entre espina nasal anterior y posterior y el eje axial dentario obtenido por la unión entre punto coronal y punto apical; los resultados mostraron angulaciones de 111,6 a 113,7 para los incisivos, lo cual permite obtener valores cercanos a la normalidad de angulación dentaria. Se concluye que los sujetos seleccionados presentan una angulación dentaria adecuada para la realización de procedimientos de cirugía primero.


The objective of this research was to determine the inclination of maxillary incisors in subjects with class III malocclusion. Were included 35 subjects with Class III facial deformity (DF-III) to analyze cone beam computed tomography; measurements were realized in the four maxillary incisors identifying the palatal plane considered between anterior and posterior nasal spine and dental axial axis from the union between coronal point and apical point; The results showed angulations from 111.6 to 113.7 for the incisors, which allows estimation of values close to normal dental angulation. It is concluded that the selected subjects present adequate dental angulation to perform surgery first.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Incisivo/diagnóstico por imagem , Incisivo/patologia , Má Oclusão de Angle Classe III/diagnóstico por imagem , Má Oclusão de Angle Classe III/patologia , Tomografia Computadorizada de Feixe Cônico
15.
Int. j. morphol ; 34(4): 1531-1538, Dec. 2016. ilus
Artigo em Espanhol | LILACS | ID: biblio-840919

RESUMO

El propósito de este estudio fue evaluar la evidencia en relación al empleo de técnicas reconstructivas en el área cráneo-facial asociado el uso de células troncales en humanos. Se realizó una revisión sistemática de la literatura en las bases Medline, ScienceDirect, EMBASE, TripDatabase, LILACS entre marzo del 2004 a marzo del 2016 con criterios de elegibilidad y estrategia de búsqueda definida. La selección de artículos fue realizada por dos investigadores de forma independiente y cuando ellos presentaron discordancia, un tercer investigador realizó le selección. Se encontraron un total de 382 artículos, se realizó una selección de artículos, eliminado duplicados, estudios experimentales en animales y selección según análisis de resúmenes, se seleccionaros 14 artículos con procedimientos reconstructivos en el área cráneo-facial asociado a células troncales. Existe limitada evidencia de calidad en relación a la utilización de células troncales en reconstrucción cráneo facial en humanos. A excepción de un estudio (ensayo clínico de bajo nivel de evidencia), todos corresponden a series o reporte de casos, con lo cual no es posible recomendar su utilización en procedimientos reconstructivos. Es necesario realizar estudios de evidencia sustentable con el empleo de células troncales que permitan identificar su real rendimiento al compararlo con otras técnicas quirúrgicas.


The purpose of this study was to evaluate the evidence regarding the use of reconstructive techniques in the craniofacial area associated with the use of stem cells in humans. A systematic review of the literature was conducted in the databases Medline, ScienceDirect, EMBASE, TripDatabase, LILACS between March 2004 and March 2016 with eligibility criteria and defined search strategy. The selection of articles was done by two researchers independently and when they presented discordance, a third researcher made the selection. We found a total of 382 articles, made a selection of articles, removed duplicates, experimental studies in animals and selection according to analysis of abstracts, we selected 14 articles with reconstructive procedures in the craniofacial area associated with stem cells. There is limited quality evidence regarding the use of stem cells in the craniofacial reconstruction in humans. With the exception of one study (clinical trial of low level of evidence), all correspond to series or report of cases, with which it is not possible to recommend its use in reconstructive procedures. It is necessary to carry out studies of sustainable evidence with the use of stem cells that allow to identify its real performance when compared with other surgical techniques.


Assuntos
Humanos , Procedimentos Cirúrgicos Bucais/métodos , Transplante de Células-Tronco/métodos , Engenharia Tecidual , Células-Tronco Adultas , Procedimentos Cirúrgicos Reconstrutivos/métodos
16.
Plast Reconstr Surg Glob Open ; 4(8): e845, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27622113

RESUMO

BACKGROUND: Mandibular reconstruction has been the subject of much debate and research in the fields of maxillofacial surgery and head and neck surgery. MATERIALS AND METHODS: A retrospective observational study was undertaken with 14 patients diagnosed with benign tumorous pathologies and who underwent immediate mandibular resection and reconstruction at the Hospital del Salvador Maxillofacial Surgery Unit and Dr. Rodrigo Fariña's private clinic between the years 2002 and 2012. We propose a treatment algorithm, which is previous teeth extractions in area that will be removed. RESULTS: Fourteen patients underwent surgery, and a total of 40 dental implants were installed in 6 men and 8 women, the mean age of 33.5 (age range, 14-58 y). Reconstruction with iliac crest bone graft, and rehabilitation following this protocol (average of reconstruction was 8.7 cm), was successful with no complications at all in 12 patients. One patient had a minor complication, and the graft was partially reabsorbed because of communication of the graft with the oral cavity. This complication did not impede rehabilitation with dental implants. Another patient suffered the total loss of the graft due to infection because of dehiscence of oral mucosa and great communication with the mouth. Another iliac crest free graft reconstruction was undertaken 6 months later. CONCLUSIONS: The scientific evidence suggests that mandibular reconstruction using free grafts following the removal of benign tumors is a biologically sustainable alternative. The critical factor to improve the prognosis of free grafts reconstruction in benign tumors is to have good quality soft tissue and avoid communication with the oral cavity. For this, it is vital to do dental extractions before removing the tumor.

17.
Int. j. morphol ; 33(2): 759-763, jun. 2015. ilus
Artigo em Inglês | LILACS | ID: lil-755540

RESUMO

The different aspects of unilateral condylar hyperplasia have been studied and continue to be controversial; nevertheless, treatment based on condylectomy has been established as part of the working protocol. The aim of this investigation was to identify the bone repair observed in surgically treated condyles after 1 year using cone beam computed tomography (CBCT). Nine subjects were included in this study (6 female and 3 male) with an average age of 18.5 years. They had been diagnosed with active unilateral condylar hyperplasia using SPECT, clinical follow-up of progressive facial asymmetry and CBCT. Patients underwent exclusive condylectomy surgery with a piezoelectric system without disc replacement, orthognatic surgery or any other type of adjunct surgical procedure. Later, they were treated orthodontically for dental compensation or as preparation for orthognatic surgery. A CBCT was performed in the first postoperative month and after 1 year from the surgery to analyze variables. The CBCT at 1 month showed a clear and distinct slice of the condyle without defects or irregularities; the distance from the condylar remnant to the articular fossa reached 8.5 mm in the most extreme case. After 1 year, condylar bone remodeling was observed, with areas of lateral and superior curvature and characteristics of normal condyles, with cortical bone present and a maximum distance of 4.5 mm from the condylar fossa. In conclusion, condylar repair and remodeling can be obtained in these types of surgeries and the morphology of resected condyles after 1 year is quite close to normal macroscopic anatomy.


La hiperplasia condilar unilateral ha sido estudiada en diferentes aspectos y continua siendo controversial; aun así, el tratamiento en base a condilectomía se establece como parte del protocolo de trabajo. El objetivo de esta investigación es reconocer la reparación ósea observada en cóndilos operados después de 1 año mediante tomografía computadorizada cone beam (TCCB). Nueve sujetos fueron incluidos en este estudio (6 sexo femenino y 3 sexo masculino) con una edad promedio de 18,5 años; en ellos se realizó el diagnóstico de hiperplasia condilar unilateral activa mediante estudio de SPECT, seguimiento clínico de la asimetría facial progresiva y TCCB. Se realizó la cirugía de condilectomía exclusiva con sistema piezoeléctrico sin reposición de disco, cirugía ortognática u otro tipo de procedimiento quirúrgico adjunto; posteriormente, los pacientes fueron tratados ortodoncicamente para compensación dentaria o para preparación previa a cirugía ortognática. Se realizó TCCB dentro del primer mes postquirúrgico y después de 1 año de realizada la cirugía para análisis de variables. Se observó en la TCCB de 1 mes un corte nítido y neto del cóndilo, sin defectos o irregularidades; la distancia desde el remanente condilar hasta la fosa articular llegó hasta 8,5 mm en el caso máximo. Después de 1 año, se observo remodelación ósea condilar, con áreas de curvatura lateral y superior características de cóndilos normales, con presencia de hueso cortical y con una distancia máxima de 4,5 mm desde la fosa condilar. Se puede concluir que la reparación y remodelación condilar es viable de obtenerse en este tipo de cirugías y que la morfología de cóndilos resecados después de 1 año es bastante próxima de la anatomía macroscópica normal.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Côndilo Mandibular/patologia , Côndilo Mandibular/cirurgia , Regeneração Óssea , Tomografia Computadorizada de Feixe Cônico , Hiperplasia/patologia , Hiperplasia/cirurgia , Resultado do Tratamento
18.
Int. j. morphol ; 32(2): 646-651, jun. 2014. ilus
Artigo em Espanhol | LILACS | ID: lil-714322

RESUMO

El objetivo de este trabajo es presentar los riesgos anatómicos en el abordaje de la anquilosis de la articulación temporo mandibular (ATM) y el uso del sistema piezoeléctrico para realizar la resección de la misma. La paciente sexo femenino, 12 años, presento una anquilosis de la ATM derecha, previamente operada en base a reconstrucción con un injerto costocondral. Luego de 4 años de realizada la primera reconstrucción se presentó con una nueva anquilosis del área presentando una masa de tejido óseo de 31 mm en sentido latero-medial, que abarcaba hasta el foramen oval en la base de cráneo y de 28 mm en sentido anteroposterior. La lesión fue abordada con un acceso preauricular y posterior resección con sistema piezoeléctrico, utilizando una técnica de resección en bloque. Se presenta la técnica y se discute la potencialidad de realizar este procedimientos con los nuevos sistemas piezoeléctrico.


The aim of this report is to present the anatomical risk for to treat the temporo mandibular joint (TMJ) ankylosis and the use of the piezoelectric system for to make the bone resection. Female patient, 12 years old, presented a right TMJ ankylosis, that was previously operated with a costocondral graft reconstruction. After 4 year from these reconstructive surgery the patient was involved in a new TMJ anklylosis of the same side showing a bone mass with 31mm in an meddle-lateral direction, with compromise until to oval foramen in the skull base and 28mm in the anterior-posterior direction. The lesion was operated by a preauricular approach and then a bone resection with the piezoelectric system, using a block resection technique. In this report it´s present the technique and is discusses the potentiality of the new piezoelectric system for these procedures.


Assuntos
Humanos , Feminino , Criança , Articulação Temporomandibular/cirurgia , Articulação Temporomandibular/patologia , Piezocirurgia/métodos , Anquilose/cirurgia , Anquilose/patologia , Osteotomia/métodos , Recidiva , Articulação Temporomandibular/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Anquilose/diagnóstico por imagem
19.
Int J Clin Exp Med ; 6(9): 727-37, 2013 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-24179565

RESUMO

Condylar hyperplasia (CH) is a bone disease characterized by the increased development of one mandibular condyle. It regularly presents as an active growth with facial asymmetry generally without pain. Statistically it affects more women in adolescence, although it does not discriminate by age or gender. Its best-known consequence is asymmetric facial deformity (AFD), which combined with alteration of the dental occlusion with unilateral crossbite or open bite. It is not known when CH begins and how long it lasts; diagnostic examinations are described and are efficient in some research about diagnosis. Protocol treatment is not well studie and depends on the criteria described in this paper. The aim of this research is to provide up-to-date information about the diagnosis of this disease and to analyze the treatment protocol, visualizing the CH and AFD presented.

20.
Int J Clin Exp Med ; 6(10): 937-41, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24260600

RESUMO

Facial asymmetry associated with condylar hyperplasia (CH) has been become the object of study in recent years. The aim of this study is to demonstrate the importance of analyzing the presence of CH in cases of facial asymmetry. Twenty-seven consecutive patients were studied without distinction of age or gender; all the patients consulted for treatment of facial and/or mandibular asymmetry and voluntarily agreed to participate in the study. All the patients underwent facial cone beam tomography and bilateral TMJ as well as a detailed history where they indicated the progression of the disease; in cases of active evolution determined by clinical analysis and imaging, a SPECT analysis was performed to define the isotope uptake. 29.6% of the subjects with scintigram exhibited active CH with a more than 10% difference in uptake between the two condyles; 18.5% presented differences in uptake between 5% and 10%. Active CH was related to the age and gender of the subjects, being more prevalent in women than in men. The aggression level of the uptake was also related to the subject's age. 55% of the subjects presented with some type of orthodontic treatment with no diagnosis of TMJ pathology in the initial consultation. It can be concluded that CH is associated with facial asymmetries and must be studied integrally before assessing treatment options.

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