Clínica, epidemiología e imagenología del fibroma osificante y la displasia fibrosa del territorio cráneo-maxilofacial: revisión narrativa / Clinical, epidemiology and imaging of ossifiying fibroma and fibrous dysplasia of the cranio-maxillofacial territory: narrative review

Introducción: El fibroma osificante (FO) y la displasia fibrosa (DF) tienen características imagenológicas e histopatológicas similares que dificultan el diagnóstico diferencial. El propósito de la presente revisión narrativa es analizar las características clínicas, epidemiológicas e imagenológicas del FO y la DF, y evaluar la relación entre las características imagenológicas y las variantes histopatológicas del FO, en reportes y series de casos publicados.Materiales y métodos:Se realizó una búsqueda de reportes y series de casos de FO y DF entre 2017-2021 en PubMed, Scopus y Web of Science. Los casos debían tener suficiente información clínica, epidemiológica, histopatológica e imagenológica.Resultados:Se incluyeron 23 artículos con 25 lesiones: 17 FO y 8 DF. El tiempo de evolución de DF es más prolongado que FO. FO se ubica con mayor tendencia en complejo osteomeatal en comparación con DF. Sólo FO presentó alteraciones en piel, radiolucidez/hipodensidad periférica, perforación ósea y rizalisis externa, además, tuvo mayor tendencia al avance a espacios anatómicos adyacentes y a generar asimetría facial y/o craneal. FO psammomatoide y FO trabecular comparten patrones imagenológicos y tienen límites definidos corticalizados. FO convencional tuvo mayor tendencia a perforar corticales. DF puede tener límites mal definidos y definidos corticalizados. El FO mostró características imagenológicas de mayor agresividad que la DF.Conclusiones:La histología e imagenología por sí solas no son decisivas en el diagnóstico de FO y DF. Es imprescindible considerar conjuntamente clínica, imagenología e histopatología, enfatizando en las características que orienten el diagnóstico diferencial.(AU)

Introduction: Ossifying fibroma (OF) and fibrous dysplasia (FD) have similar imaging and histopathological characteristics, which make differential diagnosis difficult. The aim of this narrative review was to analyze the clinical, epidemiological and imaging characteristics of OF and FD, as well as to evaluate the relationship between imaging characteristics and histopathologic variants of OF, in reports and case series published.Materials and methods:A search of reports and case series of OF and FD between 2017-2021 in PubMed, Scopus and Web of Science was performed. The cases had to have enough clinical, epidemiological, histopathological and imaging information.Results:23 articles with 25 lesions were included: 17 OF and 8 FD. FD had a longer time of evolution than OF. OF is more likely to be in osteomeatal complex compared to FD. Only OF had skin alterations, peripheral radiolucency/hypodensity, bone perforation and external root resorption, in addition, it had a greater tendency to advance to adjacent anatomical spaces and generate facial and/or cranial asymmetry. Psammomatoid OF and trabecular OF share imaging patterns and have defined and corticated margins. Conventional OF had a greater tendency to cortical perforation. DF can have ill-defined and defined and corticated margins. OF has imaging characteristics of greater aggressiveness than FD.Conclusion:Histology and imaging alone are not decisive in OF and FD diagnosis. It is essential to consider clinical, imaging and histopathological evaluations as a whole, emphasizing in the characteristics that guide the differential diagnosis.(AU)

Manifestación oral de linfoma linfoblástico de células-T: un caso inusual y desafiante / Oral manifestation of T-cell lymphoblastic lymphoma: an unusual and challenging case

Las neoplasias malignas de origen linfoide corresponden a un complejo grupo de enfermedades cuyo diagnóstico es complicado, ya que requiere la aplicación de pruebas inmunohistoquímicas, un exhaustivo análisis por parte del equipo histopatológico, así como también una muestra representativa del tejido a examinar. Se presenta el caso de un paciente previamente diagnosticado con linfoma no-Hodgkin estirpe T, con manifestación clínica en cavidad oral, el cual presentó una mala respuesta al esquema quimioterapéutico inicial. Debido al fracaso terapéutico, se solicitaron nuevas biopsias y análisis inmunohistoquímicos, siendo la muestra de cavidad oral la que confirma el diagnóstico, esta vez acertado, de linfoma linfoblástico de células T. Se modifica el esquema terapéutico a uno de mayor intensidad, logrando una evolución favorable de la enfermedad. El presente artículo corresponde al primer caso de linfoma linfoblástico de células T con localización en maxilar superior reportado en la literatura. Se recalca la dificultad diagnóstica de los variados tipos de linfomas y destaca la importancia de los exámenes complementarios para lograr un correcto diagnóstico y manejo de esta patología. (AU)

Malignant neoplasms of lymphoid origin correspond to a complex group of diseases whose diagnosis is difficult since it requires the application of immunohistochemical tests, an exhaustive analysis by the histopathological team as well as a representative sample of the tissue to be examined. We present the case of a patient previously diagnosed with non-Hodgkin’s lymphoma type T, with clinical manifestation in the oral cavity, who presented a poor response to the initial chemotherapeutic scheme. Due to the therapeutic failure, new biopsies and immunohistochemical analysis were requested, being the oral cavity sample the one that confirmed the diagnosis, this time correctly, of T-cell lymphoblastic lymphoma, thus modifying the initial therapeutic scheme to one of greater intensity, achieving a favorable evolution of the disease. The present article corresponds to the first case of T-cell lymphoblastic lymphoma with maxillary location reported in the literature. It emphasizes the diagnostic difficulty of the different types of lymphomas and highlights the importance of complementary examinations to achieve a correct diagnosis and management of this pathology.We believe that this new, relatively simple technique can be an alternative to complex surgeries that involve the use of complicated bone grafts, with the consequent savings in time and morbidity for patients who associate maxillary hypoplasia and edentulism with severe bone atrophy. (AU)

Fratura complexa de teto de órbita associada disjunção traumática do complexo zigomático / Complex Orbit Roof Fracture Associated with Traumatic Disjunction of the Zygomatic Complex / Fractura Compleja del Techo de la Órbita Asociada a Disyunción Traumática del Complejo Cigomático

Objetivo: As fraturas do complexo zigomático-maxilar (CZM) constituem as principais fraturas do terço médio da face. O diagnóstico é complexo, por envolver uma área alternente sensorial e nobre da face. Portanto o tratamento não visa apenas devolver os contornos ósseos, mas também preservar as funções oculares. No presente caso paciente apresentou severo trauma facial associado a TCE com afundamento do frontal e teto de órbita. Relato de caso: Paciente do sexo masculino, 33 anos, vítima de queda da própria altura. No exame físico notou-se FCC extenso em região frontal, se estendendo para a região supra-orbital esquerda, blefaroedema periorbital esquerdo, com oclusão palpebral e distopia ocular. Escoriações em face e afundamento em região fronto parietal esquerda e perda de consciência. O diagnóstico apontou para fratura do complexo zigomático-maxilar associada a afundamento do osso frontal. Paciente submetido à osteossíntese das fraturas com por meio da ferida e complementado com acesso subciliar e caldwel luc. Foi alcançada boa reabilitação estética e funcional. Conclusão: Portanto, a redução aberta com fixação funcional estável com placas e parafusos segue sendo o padrão ouro para o tratamento de fraturas complexas do CZM. Sendo imperativo uma adequada redução e o reestabelecimento do continente orbitário... (AU)

Objective: Fractures of the zygomatic-maxillary complex are the main fractures of the middle third of the face. The diagnosis is complex, as it involves an alternating sensory and noble area of the face. Therefore, the treatment is not only aimed at restoring bone contours but also preserving ocular functions. In the present case, the patient presented severe facial trauma associated with TBI with frontal and orbital sinking. Case Report: Male patient, 33 years old, victim of a fall from standing height. Physical examination revealed extensive CCF in the frontal region, extending to the left supraorbital region, left periorbital blepharoedema, with eyelid occlusion and ocular dystopia. Excoriations on the face and sinking in the left fronto-parietal region and loss of consciousness. The diagnosis pointed to fracture of the zygomatic-maxillary complex associated with frontal bone sinking. Patient undergoing osteosynthesis of fractures through the wound and complemented with subciliary access and caldwell luc. Good aesthetic and functional rehabilitation were achieved. Conclusion: Therefore, open reduction with stable functional fixation with plates and screws remains the gold standard for the treatment of complex ZMC fractures. An adequate reduction and reestablishment of the orbiting continent is imperative... (AU)

Objetivo: Las fracturas del complejo cigomático maxilar son las principales fracturas del tercio medio de la cara. El diagnóstico es complejo, ya que involucra una zona sensorial y noble alternada de la cara. Por lo tanto, el tratamiento no solo está dirigido a restaurar los contornos óseos sino también a preservar las funciones oculares. En el presente caso, el paciente presentó trauma facial severo asociado a TCE con hundimiento frontal y orbitario. Caso Clínico: Paciente masculino, 33 años, víctima de caída desde altura de pie. A la exploración física destacaba FCC extensa en región frontal, con extensión a región supraorbitaria izquierda, blefaroedema periorbitario izquierdo, con oclusión palpebral y distopía ocular. Excoriaciones en la cara y hundimiento en la región fronto-parietal izquierda y pérdida del conocimiento. El diagnóstico apuntó a fractura del complejo cigomático-maxilar asociada a hundimiento del hueso frontal. Paciente con osteosíntesis de fractura a través de herida y complemento acceso subciliar y calwell luc. Se logró una buena rehabilitación estética y funcional. Conclusión: Por lo tanto, la reducción abierta con fijación funcional estable con placas y tornillos sigue siendo el estándar de oro para el tratamiento de fracturas CCM complejas. Es imperativo una adecuada reducción y restablecimiento del continente en órbita... (AU)

Modified Reconstruction of Brown II Defects With Anterolateral Thigh Flaps Following Tumor Resection.

OBJECTIVE: Maxillary defects reconstructed with flaps usually cause nasalomaxillary fistula, discomfort oral lining, and poor function of denture. To resolve these problems, this study introduces a modified method of anterolateral thigh flap (ALTF) with skin and myofascial paddles to reconstruct nasal and oral lining of maxillary defects. METHODS: This study retrospectively reviewed 66 consecutive patients of Brown II maxillary defects following tumor resection reconstructed with ALTFs of modified or conventional methods. In modified group, oral lining was reconstructed with myofascial paddle and nasal lining was reconstructed with skin paddle. The functional and aesthetic outcomes, and the scores based on the University of Washington quality of life questionnaire were assessed. RESULTS: All flaps were successful in reconstruction of Brown II maxillary defects. No nasalomaxillary fistula and obstruction of the nasal cavity were found in modified ALTFs group. The functions of removable denture were better in modified ALTFs group. There was no significant difference about tumor recurrence, range of mouth opening, and aesthetic outcomes between the 2 groups. CONCLUSIONS: The modified method of ALTF with skin and myofascial piddle to reconstruct Brown IIa and IIb defects following tumor resection is simple and reliable, which improves the oral comfortability and function of denture, and avoids obstruction of the nasal cavity.

Sequelae of Major Trauma Patients with Maxillofacial Fractures.

OBJECTIVES: Sequelae after maxillofacial fractures are frequent and may affect the patient's quality of life. This study examined sequelae associated with maxillofacial fractures of severely traumatized patients focusing mainly on nerve injuries. METHODS: A retrospective study including trauma patients with relevant facial fractures admitted to our Trauma Center in the period 2011-2016. Presence of posttraumatic maxillofacial sequelae was identified by examining the medical records of the included patients. Focusing on facial sensory deficits and facial nerve paralysis, but also comprising data on diplopia, blindness, malocclusion, trismus, eye globe malposition, flattening of the malar, facial contour changes, and wound infections. RESULTS: Two-hundred-seventy-five severely traumatized patients were included, comprising 201 men (73%), with a median age of 40 years and ISS of 20. 163 (59%) patients only had assessments within 3 months from trauma of which 79 patients (48.5%) had facial complications at initial examination, mostly malocclusion and trismus. Most patients in this group had no or only minor sequelae at their last clinical assessment, mainly being sensory deficits. 112 (41%) patients had assessments both within and beyond 3 months of which 73 patients (65.2%) had facial complications at initial examination, while 91 patients (81%) had reported sequelae within 3 months decreasing to 47 patients (42%) at their last clinical assessment beyond 3 months from trauma, mostly sensory deficits. An improvement of most sequelae was observed. CONCLUSION: Objective sequelae were found to be quite common after maxillofacial fractures in severely traumatized patients, especially sensory deficits. However, most of the addressed sequelae seemed to improve over time.

Influence of Monobloc/Le Fort III Surgery on the Developing Posterior Maxillary Dentition and Its Resultant Effect on Orthognathic Surgery.

BACKGROUND: Timing of frontofacial surgery for the syndromic craniosynostosis as it relates to various surgical risks has not been adequately studied. The purpose of this study was to investigate posterior dental complications of midface advancement in patients with syndromic craniosynostosis undergoing surgery at different ages and the effects on subsequent orthognathic surgery. METHODS: A retrospective chart review of patients with syndromic craniosynostosis treated with midface advancement (monobloc or Le Fort III) from 1999 to 2018 was carried out. Patient demographics, records, and imaging studies were reviewed. A subanalysis of those patients who were also treated with orthognathic surgery from 2014 to 2018 with imaging studies available for analysis was also performed. RESULTS: Thirty-seven patients met the inclusion criteria. Sixty-four percent of the patients had radiographic evidence of maxillary molar dental abnormality. Older age at the time of surgery was significantly associated with a lower odds of sustaining dental injury (OR, 0.55; p = 0.034). The odds of damaging second or third maxillary molars was significantly higher with a younger age at the time of surgery (p = 0.021 and p = 0.034). The odds of sustaining dental injury increased moving posteriorly, showing the risk of abnormal pattern of M3 greater than M2 greater than M1. Advanced age at the time of surgery was significantly associated with decreased odds of dental injury (OR, 0.55; p = 0.034). CONCLUSIONS: Damage to the developing permanent maxillary molars may affect orthodontic management, mastication, and potentially maxillary development. Delaying frontofacial surgery until development of the permanent maxillary dentition should be considered if other indications do not mandate earlier intervention.

Propuesta de manejo en reconstrucción microquirúrgica maxilar: serie de casos / Treatment proposal in microsurgical reconstruction of the maxilla: case series

INTRODUCCIÓN Y OBJETIVO: Para la reconstrucción del maxilar se han descrito múltiples clasificaciones y algoritmos de manejo. Actualmente, el más aceptado es el planteado por Cordeiro y Santamaría. Presentamos nuestra experiencia en reconstrucción microquirúrgica del maxilar con colgajos libres de peroné y ánterolateral de muslo, con el objetivo de que se consideren herramientas de primera elección en la reconstrucción de defectos clasificados como tipo II y III. MATERIAL Y MÉTODO: Estudio retrospectivo descriptivo, serie de casos, en el que presentamos 7 casos clínicos de reconstrucción de maxilar con colgajo libre de peroné y ánterolateral de muslo realizados en el Hospital Universitario de La Samaritana (HUS) en Bogotá, Colombia, entre enero de 2018 y febrero de 2019. RESULTADOS: Para la reconstrucción de los defectos IIa, IIb y IIIa utilizamos el colgajo libre de peroné. En maxilectomías clasificadas como IIIb implementamos el colgajo ánterolateral de muslo quimérico con vasto lateral. La supervivencia de los colgajos fue del 100%. CONCLUSIONES: El colgajo libre de peroné es nuestra principal opción reconstructiva en los defectos por maxilectomías IIa, IIb y IIIa, mientras que el colgajo ánterolateral de muslo quimérico con vasto lateral es nuestro colgajo de elección en defectos tipo IIIb

BACKGROUND AND OBJECTIVE: Multiple classifications and management algorithms have been described for maxillary reconstruction, at the present time, the most widely accepted is described by Cordeiro and Santamaría. We present our experience in microsurgical reconstruction of the maxillary with free flaps retrieved from fibula and anterolateral thigh with the intent to consider it as a first-choice option in the reconstruction of defects classified as type II and III. METHODS: A retrospective, descriptive, case series study of 7 maxillary reconstruction cases with free flap from fibula and anterolateral thigh is described. Database was recollected between January 2018 and February 2019 from Hospital Universitario de La Samaritana (HUS) in Bogotá, Colombia. RESULTS: For the reconstruction of IIa, IIb and IIIa defects, a fibular free flap was used. For maxillectomies classified as IIIb, an anterolateral thigh and vast lateral chimeric free flap was implemented. Survival rate of the free flaps was observed at 100%. CONCLUSIONS: The fibular free flap is our primary reconstructive option in defects by maxillectomy classified as IIa, IIb and IIIa. In defects constituted as IIIb, our choice is an anterolateral thigh and vast lateral chimeric flap

A case study of monofilament line entanglement in a common bottlenose dolphin (Tursiops truncatus): entanglement, disentanglement, and subsequent death.

BACKGROUND: Free-ranging common bottlenose dolphins (Tursiops truncatus) can become entangled in fishing line and other marine debris. Infrequently, dolphins can be successfully disentangled, released back into the wild, and later examined postmortem to better understand the pathology and long-term effects of these entanglements. CASE PRESENTATION: An entangled common bottlenose dolphin (Tursiops truncatus) calf was observed in the Indian River Lagoon, Florida, USA, with monofilament fishing line wrapped tightly around its maxilla. A multi-agency team successfully disentangled the dolphin for immediate release back into its natural habitat. A year after disentanglement, photos and observations indicated that the now independent calf showed a decline in body condition, characterized by grossly visible ribs and a prominent post-nuchal depression. More than 2 years post-disentanglement, the freshly dead carcass of this juvenile dolphin was recovered with extensive predation wounds. Despite the forestomach being ~ 50% full of ingesta (fish), the dolphin was emaciated. During postmortem examination, we collected and evaluated photographs and measurements of the maxillary damage resulting from the entanglement. CONCLUSION: The monofilament entanglement caused permanent, bilateral deformation of the maxillary dental arcade, including a 4.0-4.2 cm long, 0.5 cm deep linear groove where the entanglement eroded the lateral edges of the maxilla. There was no evidence of maxillary fracture and the dolphin survived for more than 2 years after disentanglement. External evidence of propeller scars and a fishing hook discovered embedded in the laryngeal mucosa at necropsy indicated repeated human interactions.

Feline skull injuries: Treatment goals and recommended approaches.

PRACTICAL RELEVANCE: Skull trauma in cats, which includes fractures of the mandible and maxilla, as well as temporomandibular joint (TMJ) conditions, is frequently encountered in general practice. CLINICAL APPROACH: Head trauma requires immediate attention and the initial approach should be focused on stabilisation of the patient and evaluation of the major body systems, including respiratory and cardiovascular assessment, and neurological and ophthalmic examination. The head, oral occlusion and the patient's ability to open and close the mouth should be carefully evaluated. Once the cat is stable enough for anaesthesia, diagnostic imaging is essential to assess for skull injuries. Radiography may be helpful, although some conditions may be difficult to visualise due to soft tissue and bony structure superimposition. CT is a more sensitive technique for detecting skull injuries. TREATMENT GOALS AND TECHNIQUES: A variety of stabilisation techniques have been described in the feline patient, and repair goals focus on restoration of the animal's oral function, while ensuring adequate dental occlusion, minimal invasiveness and morbidity, and pain relief. Surgical repair of mandibular and maxillary fractures may variously involve interdental wiring, interarcade wiring or suture, use of interfragmentary wires, plate and screw fixation, external skeletal fixation and use of dental acrylic. Decision-making with regard to treatment options depends on dental occlusion, type and location of the fracture, fracture stability and pain. AIM: This review, directed at general practitioners working with cats, describes the relevant anatomy of the feline skull, the most common mandibular, maxillary and TMJ conditions, and their recommended management.

O esportista e a prevalência de trauma bucomaxilofacial: conhecimento e uso de protetor bucal, hábitos e respiração na prática esportiva / The athlete and the prevalence of maxillofacial trauma: knowledge and use of mouth guard, habits and breathing in sports practice

O trauma buco maxilo facial (TBMF) relacionado à prática esportiva tem aumentado nos últimos anos, portanto é fundamental investigar os esportes de maior ocorrência, a saúde bucal dos atletas e a adoção de medidas preventivas. O objetivo neste estudo foi verificar a prevalência de trauma buco-maxilo-facial (BMF) em atletas; a relação com a modalidade esportiva praticada, bem como conhecimento e uso de protetores bucais, hábitos de higiene bucal, hábitos sociais e de hidratação. Trata-se de um estudo transversal, descritivo, envolvendo 647 atletas praticantes de diferentes esportes em um município do Brasil. Os participantes responderam a um questionário que abordava como desfecho primário a ocorrência de trauma na região da cabeça e pescoço durante atividades esportivas e o conhecimento e uso de protetores bucais. As seguintes variáveis também foram investigadas: esporte praticado, região afetada, escovação, uso do fio dental, consumo de refrigerantes, bebidas alcoólicas, tabagismo, hidratação e a respiração durante a prática esportiva. Do total, 148 atletas (22,87%) sofreram TBMF e os esportes de maior ocorrência foram o basquetebol e o futebol. Houve associação significativa entre ocorrência de TBMF e desconhecimento sobre protetores bucais (p=0,0042) e modalidade esportiva (p<0,0001). A boca foi o local mais acometido (30,40%), a cotovelada foi a principal causa (32,54%). O protetor bucal era conhecido por 538 atletas (83,15%), no entanto, apenas 169 (26,12%) utilizavam, sendo 13 (7,69%) deles personalizados. Verificou-se que 313 atletas (48,53%) respiravam pela boca durante a prática esportiva, 381 (58,89%) não ingeriam refrigerantes, 618 (95,52%) não fumavam e 98 (15,15%) consumiam bebidas alcoólicas ao menos duas vezes por semana. A maioria dos atletas (n=554; 85,63%) ingeria apenas água, enquanto 138 (21,33%) consumiam energéticos durante o exercício. O fio dental não era usado por 212 (32,77%) atletas e 606 (93,67%) escovavam os dentes 2 a 3 vezes ao dia. A maioria dos atletas conhecia os protetores bucais, no entanto, poucos faziam uso. Grande parte dos atletas apresentava respiração bucal durante a prática esportiva e embora todos realizassem a escovação dentária, uma parcela considerável não fazia uso de fio dental. O consumo de refrigerante, bebidas alcoólicas e cigarros foi baixo(AU)

Buccomaxillofacial trauma (TBMF) related to sports practice has increased in recent years, so it is essential to investigate the sports with the highest occurrence of TBMF, the oral health of athletes and the adoption of preventive measures. The aim of this study was to verify the prevalence of buccomaxillofacial trauma (BMF) in athletes; the relationship with the sport practiced, as well as knowledge and use of mouthguards, oral hygiene habits, social habits and hydration. This is a cross-sectional, descriptive study, involving 647 athletes practicing different sports in a municipality in Brazil. Participants answered a questionnaire that addressed the occurrence of trauma in the head and neck during sports activities and the knowledge and use of mouthguards as the primary outcome. The following variables were also investigated: sport practiced, affected region, brushing, flossing, consumption of soft drinks, alcoholic beverages, smoking, hydration and breathing during sports practice. Of the total, 148 athletes (22.87%) suffered TBMF and the most frequent sports were basketball and football. There was a significant association between the occurrence of TBMF and lack of knowledge about mouthguards (p=0.0042) and sports (p <0.0001). The mouth was the most affected site (30.40%), the elbow was the main cause (32.54%). The mouthguard was known by 538 athletes (83.15%), however, only 169 (26.12%) used it, 13 (7.69%) of whom were personalized. It was found that 313 athletes (48.53%) breathed through the mouth during sports, 381 (58.89%) did not drink soft drinks, 618 (95.52%) did not smoke and 98 (15.15%) consumed drinks alcoholic at least twice a week. Most athletes (n = 554; 85.63%) drank only water, while 138 (21.33%) consumed energy drinks during exercise. The dental floss was not used by 212 (32.77%) athletes and 606 (93.67%) brushed their teeth 2 to 3 times a day. Most athletes knew about mouthguards, however, few used them. Most of the athletes had mouth breathing during sports practice and although all of them performed tooth brushing, a considerable portion did not use dental floss. The consumption of soft drinks, alcoholic beverages and cigarettes was low(AU)

Estudo clínico comparando duas técnicas de expansão ortocirúrgica da maxila: avaliação clínica e tomográfica / Clinical study comparing two techniques of surgically assisted rapid maxillary expansion: clinical and tomographic evaluation

O objetivo deste estudo foi comparar duas técnicas de expansão ortocirúrgica da maxila, a osteotomia convencional em 2 segmentos, entre os incisivos centrais superiores, versus a osteotomia em 3 segmentos entre os incisivos laterais e os caninos superiores bilateralmente. Um estudo prospectivo foi realizado com 19 pacientes. Foram divididos em dois grupos: osteotomia convencional em 2 segmentos (dez pacientes) e osteotomia em 3 segmentos (nove pacientes). Na metodologia do presente trabalho foram analizadas medidas dentárias e esqueléticas das imagens de tomografia computadorizada de feixe cônico, pré e pós-operatória. Foi realizada a sondagem periodontal pré e pós-operatória. A percepção estética dos pacientes foi avaliada em uma escala analógica visual colorida. Além disso o tempo decorrido durante a cirurgia foi medido com um cronômetro regular. A homocedasticidade foi confirmada pelo teste de Levene e o teste t das amostras independentes foi utilizado para comparar as médias. No presente estudo a expansão ortocirúrgica da maxila em três segmentos resultou em uma maior expansão transversa, menor inclinação dos dentes molares e menor comprometimento estético. A cirurgia levou mais tempo do que a expansão convencional em 2 segmentos, provavelmente devido à etapas extras e à curva de aprendizado do cirurgião (AU)

The purpose of this study was to compare the two surgically assisted rapid maxillary expansion techniques, the conventional 2-segment osteotomy between maxillary central incisors versus the 3-segment osteotomy between maxillary lateral incisors and canines bilaterally. A prospective study was conducted with 19 patients. they were divided into two groups: conventional 2-segment osteotomy (ten patients) and 3-segment osteotomy (nine patients). Dental and skeletal measurements of the preoperative and postoperative cone beam computed tomography images were analyzed in the present study. Pre and post-operative periodontal probing was performed, patients` cosmetic perception was evaluated in a colored visual analogue scale, and time elapsed during surgery was measured with a regular chronometer. Homoscedaticity was confirmed by the Levene`s test, and independent samples t-test was utilized to compare means. Three segment surgically assisted rapid maxillary expansion in the current study resulted in greater transverse expansion, less molar inclination and less aesthetic compromise. Surgery took longer than conventional 2 segment SARME probably due to extra steps and surgeon's learning curve (AU)

Prevenção e manejo terapêutico da osteoradionecrose dos maxilares: revisão de literatura / Prevention and therapeutic management of osteoradionecrose of maxilars: literature review

O objetivo desse estudo foi revisar a literatura e enfatizar os aspectos relacionados ao manejo preventivo e terapêutico da osteorradionecrose dos maxilares. Realizou-se revisão bibliográfica não sistemática, descritiva e qualitativa nas plataformas de pesquisa Scielo, Pubmed e Medline, utilizando os descritores, osteoradionecrosis/osteoradionecrose e/ou radiotherapy/radioterapia e/ou jaw/arcada maxilares. Os critérios de inclusão foram: artigos publicados em inglês, espanhol ou português, pesquisas clínicas ou relatos de casos abordando tratamento com radioterapia de cabeça e pescoço e artigos publicados entre 1980-2018, excluindo da pesquisa trabalhos experimentais em animais, artigos publicados na forma de nota técnica ou carta ao editor e artigos baseados em opinião de especialistas. Baseando-se nos critérios de pesquisa, foram selecionados 56 artigos. A radioterapia é eficaz e amplamente utilizada como terapia nas neoplasias malignas de cabeça e pescoço, entretanto produz efeitos colaterais, sendo a osteorradionecrose uma das mais graves. Na maioria dos casos, progride lentamente, tornando-se extensa e dolorosa, suas manifestações tardias compreendem infecção e fratura óssea patológica. Nas últimas décadas, várias opções profiláticas ou terapêuticas foram consideradas no manejo da osteorradionecrose, sendo as mais relatadas: medidas de suporte, antibioticoterapia/antibioticoprofilaxia, pentoxifilina e tocoferol, oxigênio hiperbárico e ressecção cirúrgica com enxerto ósseo. A adequação do meio bucal e cirurgias orais antes de iniciar a radioterapiaainda é o tratamento ideal para prevenir a osteorradionecrose. A antibioticoterapia e/ou antibioticoprofilaxia sistêmica, anti-sépticos locais, pentoxifilina e tocoferol e oxigênio hiperbárico são os tratamentos mais relatados na literatura e que buscam minimizar a incidência da osteorradionecrose após procedimentos cirúrgicos odontológicos em pacientes submetidos a tratamentos de radioterapia(AU)

The purpose of this paper was to review the literature and to emphasize the aspects related to the preventive and therapeutic management of osteorradionecrosis of the jaws. Methods: A nonsystematic, descriptive and qualitative bibliographic review was performed on the Scielo, Pubmed and Medline research platforms, using the descriptors, osteoradionecrosis/osteoradionecrose and/or radiotherapy/radioterapia and/or jaw/maxilares. The inclusion criteria were: articles published in English, Spanish or Portuguese, clinical research or reports of cases approaching of treatment with head and neck radiotherapy and articles published between 1980- 2018, excluding from the research experimental study on animals, articles published in the form of technical note or letter to the editor and articles based on expert opinion. Results: Based on the search criteria, 56 articles were selected. Radiotherapy is effective and widely used as a therapy for malignant head and neck neoplasias, however it produces side effects, being osteoradionecrosis the most severe one. In most cases, it progresses slowly, becoming extensive and painful; its late manifestations comprise infection and pathological bone fracture. In the last decades, several prophylactic or therapeutic options have been considered in the management of osteoradionecrosis, being reported: supportive measures, antibiotic therapy/prophylaxis, pentoxifylline, tocopherol, hyperbaric oxygen and surgical resection with bone graft. Conclusion: The suitability of the oral cavity and oral surgery before starting the radiation therapy is still an ideal treatment to prevent osteoradionecrosis. Antibiotic therapy/prophylaxis, local antiseptics, pentoxifylline, tocopherol and hyperbaric oxygen are the most commonly reported treatments in the literature and seek to minimize the incidence of osteoradionecrosis after dental surgical procedures in patients undergoing radiation therapy(AU)

Dental evaluation specificity in orofacial damage assessment: A serial case study.

INTRODUCTION: The evaluation of medico-legal post-traumatic events has been increasing over the last decades. This study analysed the input of dental evaluation in orofacial damage assessment, highlighting the individual's biopsychosocial model, by a serial case study. It is aimed to analyse the physical as well as the psychological repercussions of traumatic events. It also aimed to relate the type of trauma impact with the individual's sequelae. MATERIAL AND METHOD: An observational and retrospective study was carried out of Portuguese medico-legal database. A serial case study was distinguished by the direction of the impact: frontal striking, lateral striking and clashing with a bidirectional (frontal-lateral). RESULTS AND DISCUSSION: 7 cases fulfilled the inclusion criteria, as a pilot study. They have in common the involvement of the 2 lower thirds of the face, including the temporomandibular joint. The consolidation of the maxillary bone fractures does not always correspond to restituto ad integrum. CONCLUSION: The impact direction may guide clinical examination in detecting permanent impairment, emphasizing temporomandibular joint disorders, as well as their association with psychosocial repercussions. The medical-dental examination is differentiating and relevant to the accomplishment of the general objective of damage assessment.

Use of Porous Implants for the Prosthetic Rehabilitation of Fibula Free Flap Reconstructed Patients.

Vascularized free flaps represent today the gold standard in Maxillo-Facial reconstructive treatment of the upper and lower compromised maxillas.The aim of this study is to perform the advantages and disadvantages of the vascularized fibula free flap and the available rehabilitation options with porous implants.In this study the authors analyzed 45 patients with 211 inserted implants treated and reconstructed with vascularized fibula flaps. The authors compared the use of 103 titanium tapered implants (with micro rough surface) versus 108 tantalum-titanium porous implants to evaluate the bone reabsorption and implant survival. Immediate implant stability, the peri-implant reabsorption, and the survival were evaluated. The follow-up was after 3, 6, 12, and 24 months.The authors found that for the 108 Zimmer TM they had an average bone loss of 1 mm ± 0.2 mm after 1 year of follow-up, compared with the other implants where the average bone loss was 2.27 mm ± 0.4.This study demonstrated that the problems caused by different fibula flaps level, compared with the mandibula or, with adjacent teeth in the maxilla, can be solved using TM porous implants that almost duplicate the fixture surface and guarantees long life prognosis to the authors' prosthetic devices.

Removal of Foreign Bodies in Orbit-Zygomatic-Maxillary Complex.

Trauma is one of the leading causes of death worldwide. Due to its anatomy and position in the facial skeleton, the orbit becomes a region susceptible to trauma which may also involve the penetration of foreign bodies (FBs). These events can have serious repercussions depending on their extent due to the proximity of the orbit with other noble structures of the face and skull. Because of this, a system of prehospital management of traumas must be established, in order to promote a better prognosis for patients. The present study aims to report the case of a patient suffering from a motorcycle accident with multiple fragments of FBs in the region of orbit-zygomatic-maxillary complex. The emergency surgical removal of the fragments was performed by a multidisciplinary team, involving Ophthalmology and Oral and Maxillofacial Surgery and Traumatology (OMST). Wound cleansing and debridement were performed with subsequent removal of the foreign bodies by the OMST team, in addition to the reduction and fixation of related fractures. As for Ophthalmology, the evisceration of the affected eye was performed due to its anatomical and functional impairment. The patient is 12 months postoperatively, with no aesthetic or functional complaints regarding OMST. The anatomical knowledge of the traumatized region, besides the establishment of the conduct regarding the removal of possible associated foreign bodies are required so that the success of the treatment can be obtained, aiming to minimize the damages to the patient.

Potential neurovascular damage as a result of dental implant placement in the anterior maxilla.

Introduction A patient requested dental implant therapy to replace his missing upper left central incisor. Pre-operative cone beam computed tomography (CBCT) imaging revealed a complex neurovascular supply to the anterior maxilla.Discussion Imaging demonstrated accessory neurovascular canals around the nasopalatine foramen which directly communicate with canalis sinuosus. They are, therefore, most likely to carry branches of the anterior superior alveolar nerve and vessels. One of these canals was directly in the path of proposed dental implant placement. A review of the dental literature suggests that such anatomical variation is relatively common. Some authors have proposed that injury to these structures is a cause of intractable pain following dental implant placement. Following discussion with the patient, it was agreed that the provision of an adhesive bridge was a realistic alternative in this case.Conclusion The availability of CBCT imaging in recent years has shown that complex neurovascular anatomy in the anterior maxilla is not uncommon. Evidence is lacking regarding the relevance of this to dental implant placement but it is possible that injury to these structures explains some cases of postoperative intractable pain.

Cicatrización de una lesión adenopática submaxilar por micobacteria no tuberculosa / Healing of submaxillary adenopathic wound due to nontuberculous mycobacterium

Introducción: Las infecciones micobacterianas fueron ya descritas en la antigüedad. En nuestro país se está produciendo un aumento en la identificación de determinadas especies de micobacterias no tuberculosas, como Mycobacterium lentiflavum. En la población pediátrica es frecuente encontrar linfadenopatías originadas por estos microorganismos, que ocasionan generalmente lesiones en la cabeza y el cuello. Caso clínico: Se presenta el caso de un lactante con lesión submaxilar derecha. Tras la realización de pruebas analíticas, radiológicas y anatomopatológicas se llegó al diagnóstico de sialoadenitis submaxilar derecha sobreinfectada. Se instauraron tratamiento sistémico antibiótico y tratamiento local de la lesión en la cara lateral del cuello, que presentaba fibrina y un exudado abundante y purulento, con diferentes productos de cura en ambiente húmedo según las necesidades requeridas. Conclusión: La lesión epitelizó a los 80 días desde su seguimiento en la unidad de asesoría en heridas. La utilización de productos que favorecen un medio ambiente húmedo se ha mostrado como una estrategia adecuada para conseguir la cicatrización de las lesiones

Introduction: Mycobacterial infections were already described in antiquity. In our country there is an increase in the identification of certain species of nontuberculous mycobacteria, such as Mycobacterium lentiflavum. In the pediatric population it is common to find lymphadenopathies caused by these microorganisms, which usually cause injuries to the head and neck. Case report: We present the case of an infant with a right submaxillary lesion. After performing analytical, radiological and anatomopathological tests, it was reached the diagnosis of overinfected right submaxillary sialoadenitis. It was established systemic antibiotic treatment and local treatment of the lesion on the lateral side of the neck, which showed fibrin and abundant and purulent exudate, with different products of moist healing environment according to the required needs. Conclusion: The lesion epithelialized after 80 days of follow-up in the wound advisory unit. The use of products that promote a moist environment has been shown as an adequate strategy to achieve the healing of the lesions

A novel image-based retrieval system for characterization of maxillofacial lesions in cone beam CT images.

PURPOSE: The objective of medical content-based image retrieval (CBIR) is to assist clinicians in decision making by retrieving the most similar cases to a given query image from a large database. Herein, a new method for content-based image retrieval of cone beam CT (CBCT) scans is presented. METHODS: The introduced framework consists of two main phases: training database construction and querying. The goal of the training phase is database construction, which consists of three main steps. First, automatic segmentation of lesions using 3D symmetry analysis is performed. Embedding the prior shape knowledge of the 3D symmetry characteristics of the healthy human head structure increases the accuracy of automatic segmentation. Then, spatial pyramid matching is used for feature extraction, and the relative importance of each feature is learned using classifiers. RESULTS: The method was applied to a dataset of 1145 volumetric CBCT images with four classes of maxillofacial lesions. A symmetry-based analysis model for automatic lesion segmentation was evaluated using similarity measures. Mean Dice coefficients of 0.89, 0.85, 0.92, and 0.87 were achieved for maxillary sinus perforation, radiolucent lesion, unerupted tooth, and root fracture classes, respectively. Moreover, the execution time of automatic segmentation was reduced to 3 min per case. The performance of the proposed search engine was evaluated using mean average precision and normalized discounted cumulative gain. A mean average retrieval accuracy and normalized discounted cumulative gain of 0.90 and 0.92, respectively, were achieved. CONCLUSION: Quantitative results show that the proposed approach is more effective than previous methods in the literature, and it can facilitate the introduction of CBIR in clinical CBCT applications.

Evaluation of stress distribution in critical anatomic regions following the Le Fort I osteotomy by three-dimensional finite element analysis.

In this study, we aimed to measure the stresses both on the pterygoid plates and the cranial base during the down-fracture and at the time of pterygomaxillary osteotomy by using the finite element analysis method to have an idea about the possible causes of complications. Three different surgical approaches were applied to the obtained models. In the Model 1, Le Fort I cuts without pterygomaxillary separation was applied. In the Model 2, same standard Le Fort I cuts were applied with pterygomaxillary separation. Then both models were subjected to a force of 150 N over the anterior spina nasalis to simulate down-fracture. In the third model, same standard Le Fort I cuts were applied. Following this procedure, a force of 50 N was applied with a sharp osteotome to the pterygomaxillary junction to simulate osteotomy. According to the results of this experimental study, the cranial base stress values decreased during the down-fracture in the Model 2. Moreover, it was found that the force transmitted to the base of the skull is less when the height of the pterygomaxillary osteotome is limited to 1 cm as we applied in Model 3.