Reabilitação com prótese bucomaxilofacial: revisão de literatura / Rehabilitation with maxillofacial prosthetics

A odontologia reabilitadora tem como um dos seus ramos a especialidade de Prótese Bucomaxilofacial (PBMF), que visa restaurar ou substituir estruturas perdidas na região facial e no sistema estomatognático artificialmente, podendo ser ou não removidos pelo paciente. O presente trabalho objetiva revisar a leitura a respeito da reabilitação com PBMF e a sua aplicabilidade na clínica odontológica. Os indivíduos com alguma perda de estrutura na região de cabeça e pescoço, devido a traumas físicos e/ou químicos, defeitos congênitos, doenças autoimunes, neoplasias, infecções e parasitas, são pacientes para os quais há a indicação da reposição da parte ausente. As reconstruções podem ser perdas intraorais (área da maxila, mandíbula), extraorais (oculopalpebral, ocular, nasal, facial extensa e auricular) ou conjugadas. Esse é um trabalho multidisciplinar, com especialistas de áreas abrangentes e todos os especialistas trabalham de forma conjunta. Pode-se concluir que, embora seja uma das especialidades mais nobres da odontologia, ainda é muito desconhecida por parte dos estudantes e profissionais das áreas da saúde e são próteses absolutamente fundamentais para a reabilitação e qualidade de vida dos indivíduos que tem a necessidade do uso da prótese PBMF(AU)

Rehabilitating dentistry has as one of its branches the specialty of Oral and Maxillofacial Prosthesis (PBMF), which aims to restore or replace structures lost in the facial region and in the stomatognathic system artificially, which may or may not be removed by the patient. The present study aims to review the reading about rehabilitation with PBMF and its applicability in dental clinic. Individuals with some loss of structure in the head and neck region, due to physical and/or chemical trauma, birth defects, autoimmune diseases, neoplasms, infections and parasites, are patients in whom there is an indication for replacement of the absent part. Reconstructions can be intraoral (maximal area, mandible), extraoral (oculopalpebral, ocular, nasal, extensive facial and auricular) or conjugated losses. It is a multidisciplinary work, with specialists from the comprehensive areas and that all specialists work together. It can be concluded that although it is one of the noblest specialties of dentistry, it is still very unknown to students and health professionals, and they are absolutely fundamental prostheses for the rehabilitation and quality of life of individuals who need the use the PBMFprosthesis(AU)

Guía diagnóstica de hábitos lesivos orales para pediatras / Diagnostic guide of oral injurious habits for pediatricians / Guia de diagnóstico para pediatras sobre hábitos lesivos orais

Introducción: la etiología de las maloclusiones se encuentra relacionada a factores genéticos y ambientales, siendo relevantes los hábitos lesivos orales en ella; por lo que en un concepto de Salud Integral de los niños, debemos contar no solo con el rol activo preventivo del odontólogo sino también de pediatra. Método: crear guía clínico práctica para médicos pediatras, que permitan identificar sistemáticamente hábitos no fisiológicos vinculados a maloclusiones. Resultado: el pediatra con los conocimientos básicos podrá elaborar revisiones preventivas durante los controles periódicos de rutina. Discusión: considerar la atención en equipo multidisciplinario, con énfasis en la prevención, punto donde todo el equipo de salud debe contribuir. Conclusiones: consideramos que los efectos sobre el crecimiento y desarrollo provocados por hábitos lesivos orales/funciones no fisiológicas tendrán mayor o menor repercusión según la edad en que se inicia el hábito. Si actuamos de manera temprana tendremos más posibilidades de modificar el patrón de crecimiento de los maxilares y el desarrollo de los arcos dentarios. Se impone entonces un interrogatorio y examen funcional precoz y sistemático para la detección de desviaciones y trastornos funcionales en niños, así como enfocar los tratamientos desde equipos multidisciplinarios (odontólogo, pediatra, fonoaudiólogo, otorrinolaringólogo, psicólogo) y alcanzar resultados de excelencia.

Introduction: the etiology of malocclusions is related to genetic and environmental factors, and oral injurious habits are relevant in it; therefore, in a concept of integral health of children, we should count not only on the active preventive role of the dentist but also of the pediatrician. Method: to create a practical clinical guide for pediatricians that will allow the systematic identification of non-physiological habits linked to malocclusions. Result: the pediatrician with basic knowledge will be able to elaborate preventive check-ups during routine periodic check-ups. Discussion: consider multidisciplinary team care, with emphasis on prevention, a point to which the entire health team should contribute. Conclusions: we consider that the effects on growth and development caused by harmful oral habits/non-physiological functions will have greater or lesser repercussions depending on the age at which the habit begins. If we act early we will have more possibilities of modifying the growth pattern of the jaws and the development of the dental arches. Therefore, an early and systematic interrogation and functional examination is necessary to detect deviations and functional disorders in children, as well as to focus the treatments from multidisciplinary teams (dentist, pediatrician, speech therapist, otorhinolaryngologist, psychologist) and achieve excellent results.

Introdução: a etiologia das más oclusões está relacionada a fatores genéticos e ambientais, e hábitos orais nocivos são relevantes para ela; portanto, em um conceito de saúde integral das crianças, devemos confiar não apenas no papel ativo preventivo do dentista, mas também no do pediatra. Método: criar um guia clínico prático para que os pediatras identifiquem sistematicamente os hábitos não fisiológicos ligados às más oclusões. Resultado: o pediatra com conhecimentos básicos será capaz de desenvolver check-ups preventivos durante check-ups periódicos de rotina. Discussão: considerar os cuidados de equipe multidisciplinar, com ênfase na prevenção, um ponto para o qual toda a equipe de saúde deve contribuir. Conclusões: consideramos que os efeitos no crescimento e desenvolvimento causados por hábitos orais nocivos/ funções não-fisiológicas terão maiores ou menores repercussões dependendo da idade em que o hábito começa. Se agirmos cedo, teremos mais chances de modificar o padrão de crescimento das mandíbulas e o desenvolvimento dos arcos dentários. O questionamento precoce e sistemático e o exame funcional são, portanto, necessários para a detecção de desvios e distúrbios funcionais em crianças, assim como a aproximação de tratamento de equipes multidisciplinares (dentista, pediatra, fonoaudiólogo, otorrinolaringologista, psicólogo) e a obtenção de excelentes resultados.

Alterações estomatognáticas em paciente com trauma de face em um hospital de urgência e emergência / Stomatognatic changes in a patient with face trauma in an emergency and emergency hospital

Introdução: O trauma decorrente de causas externas é um problema de saúde em várias regiões do mundo. Além de altos índices de mortalidade e morbidade, os traumas de face resultam em impactos estéticos, estruturais e psicológicos na vida do indivíduo e na sociedade, gerando, também, um alto custo com gastos hospitalares. Objetivo: Relatar o caso de um paciente com trauma de face por acidente ciclístico, com alterações na funcionalidade do sistema estomatognático. Metodologia: Foi realizada avaliação fonoaudiológica por meio do Protocolo de Avaliação Preliminar (PAP), para observação do aspecto das estruturas orais, funções do sistema estomatognático, voz e reflexos protetivos de vias aéreas superiores. Na sequência, foi aplicado o Protocolo de Avaliação do Risco para Disfagia (PARD), para avaliação direta da deglutição. Resultados: Na avaliação dos órgãos fonoarticulatórios foi observado alterações de sensibilidade, mobilidade e redução significativa de força. Na avaliação direta da deglutição foi observada dificuldade na captação do alimento, escape anterior de alimento, elevação laríngea reduzida e múltiplas deglutições. Conclusão: O paciente foi classificado com Disfagia Orofaríngea leve a moderada, mantendo dieta via oral com consistência adaptada e orientação para continuidade de terapia fonoaudiológica. Devido ao alto número de casos semelhantes ao relatado nos hospitais de urgência e emergência, constata-se a necessidade de avaliação do sistema estomatognático para promover a melhor abordagem aos pacientes com trauma de face

Introduction: Trauma due to external causes is a health problem in several regions of the world. In addition to high rates of mortality and morbidity, facial traumas result in aesthetic, structural and psychological impacts on the individual's life and on society, also generating a high cost of hospital expenses. Objective: Report the case of a patient with facial trauma due to a cycling accident, with changes in the functionality of the stomatognathic system. Methodology: Speech therapy evaluation was carried out through the Preliminary Evaluation Protocol, to observe the appearance of oral structures, functions of the stomatognathic system, voice and protective reflexes of the upper airways. Then, the Risk Assessment Protocol for Dysphagia was applied, for direct swallowing assessment. Results: In the evaluation of Organs phonoarticulatory organs, changes in sensitivity, mobility and significant reduction in strength were observed. In the direct evaluation of swallowing, difficulty in capturing food, previous escape of food, reduced laryngeal elevation and multiple swallowing were observed. Conclusion: The patient was classified with Mild to Moderate Oropharyngeal Dysphagia, maintaining an oral diet with consistency adapted and guidance for continuing speech therapy. Due to the high number of cases similar to that reported in urgent and emergency hospitals, there is a need to evaluate the stomatognathic system to promote the best approach to patients with facial trauma.

Injuries to the Stomatognathic System in Brazilian Jiu-Jitsu Athletes.

As a contact sport, Brazilian jiu-jitsu requires the fighter to expose his/her stomatognathic system to the adversary, making him/her more susceptible to oral and maxillofacial injuries and disorders. The aim of the present study was to determine the prevalence of injuries and disorders of the stomatognathic system and associated factors among practitioners of Brazilian jiu-jitsu. A total of 179 athletes were interviewed and submitted to a physical examination. The majority was male, in the beginner category and had participated in competitions. Athletes with more experience had a higher frequency of orofacial injuries (PR = 1.77; 95% CI: 1.01-1.38), such as oral mucous lacerations and skin abrasions in the facial region, which mainly occurred during training sessions. A mouthguard is not mandatory for the sport and many athletes (both beginners and more experienced athletes) do not use one due to difficulty breathing with the device. A prefabricated (type II) mouthguard was the most common among the athletes who used this equipment, although it does not offer adequate protection. Athletes on more advanced levels wore mouthguards significantly more often (PR = 1.96; 95% CI: 1.11-2.45). In conclusion, more experienced jiu-jitsu athletes had a higher frequency of orofacial injuries, such as lacerations and abrasions, and are more likely to wear a mouthguard. However, longitudinal studies are needed in order to assess the possible causes and risks.

Further considerations in terms of the permanent impairment of the of chewing organ.

Nowadays, the drawbacks to utilizing criminal law with regards to a traumatic event, whether accidental or iatrogenic, involving the dental apparatus are still prevailing. A lesion affecting the stomatognathic apparatus can in fact integrate the offense of grievous bodily harm under Art.583 of the Italian Criminal Code (cc) as "permanent weakening of the organ" or the functions to which is appointed, i.e. the masticatory function, but also to the indwelling voice, appearance and taste. Repeatedly, jurisprudence, in the past and more recently, has set an opinion on the issue and, currently, it is possible to indicate some recognized cornerstones as deep-seated on the matter. It is a well-known fact that the organ of mastication does not represent a defined anatomical organ but, instead, it is an anatomical and functional entity consisting of a complex of different structures and not just from the dental apparatus. Moreover, any functional anatomic alteration of any single entity can have a certain weight on the other components and, therefore, on the whole organ in its entirety. Medical-legal doctrine, already in the past, supported the need for a tangible assessment of the impairment, determining whether and how much the loss of even one anatomical element could have a negative impact on the operational equilibrium of the entire stomatognathic system, whilst verifying the actual subsistence of a weakening. The loss of a dental element can take on a different meaning when such event occurs on a system already functionally deficient. In such instances, one should consider whether any pre-existing condition compromise the system, and to what extent, so that the trauma has considerable bearing on the remaining masticatory function. If the apparatus is in a position to perform even in part its function, the blunt force trauma is likely to set the aggravating circumstance.

Orofacial injuries reported by junior and senior basketball players.

The increased popularity of sports, apart from being beneficial to health, also results in a larger number of injuries, a part of which are also injuries to the stomatognatic system. According to the data from literature orofacial injuries in basketball are frequent, but relatively minor. The World Dental Federation places basketball into the category of medium-risk sports for the occurrence of injuries to the stomatognatic system. The purpose of this investigation was to determine incidence, type and severity of orofacial injuries during basketball and the frequent of the mouthguard use in a selected sample of basketball players from the City of Zagreb and the Zagreb County. The sample consists of 195 athletes who actively participate in basketball, 61 junior and 134 senior players. A total of 2 615 injuries to the stomatognatic system were documented in this research, 529 (20.2%) of those refer to juniors and 2 086 (79.8%) to seniors. The most common injuries are lacerations and contusions of soft tissue 84.4% (21.5% juniors and 78.5% seniors), followed by temporomandibular joint injuries and oral muscles stiffness 13.4% (14.9% juniors and 85.1% seniors) and 2.2% dental injuries (3.5% juniors and 96.5% seniors). Only 6.7% of players (13 players--2 juniors and 11 seniors) have tried to wear a mouthguard, while only one 1% of them (2 players--one junior and one senior) frequently used it. Total number of injuries shows that sports injuries are common during basketball. Average number of almost 4 injuries per player is relatively high. Dental injuries and temporomandibular joint injuries and oral muscles stiffness are relatively rare, only 16%. Lacerations and contusions of soft tissues represent 84% of all injuries and that minor injuries do not require professional care.

A summary of trauma and trauma-related papers published in BJOMS during 2008-2009.

This paper provides a summary of the 49 trauma and related papers published in British Journal of Oral and Maxillofacial Surgery during the period January 2008 to December 2009. 16/49 (32%) of these publications were full length articles, which covered areas such as epidemiology, service provision, materials and operative surgery. In addition there were other articles including short communications, technical notes, letters to the editor and interesting cases. Whilst fewer full length articles were published compared to the other sub-specialties, it was reassuring to see that the studies represent all aspects of trauma. More basic science and randomized control studies relating to trauma need to be encouraged.

Algunas consideraciones sobre los trastornos temporomandibulares / Some considerations on the temporomandibular disorders

Se realizó una revisión documental mediante revistas, libros, tesis y otros documentos en formato electrónico acerca de la epidemiología de los trastornos de la articulación temporomandibular, con el objetivo de actualizar el material existente y ampliar nuestros conocimientos sobre esta alteración. En nuestro país se han llevado a cabo en las 2 últimas décadas, varios estudios epidemiológicos sobre los trastornos temporomandibulares (TTM) y se ha hecho un esfuerzo notable por esclarecer su causa. De forma general, se acepta la idea de que el origen de los disturbios funcionales del sistema estomatognático es multifactorial, pero a pesar de que tanto en niños como en adultos la prevalencia de los trastornos temporomandibulares (TTM) ha sido alta, no se ha evidenciado un factor causal predominante. La literatura alude que estas disfunciones afectan a un porcentaje muy elevado de la población mundial 80 (por ciento), con una edad media de 34 años y una proporción de 3 mujeres por cada hombre. Este dato es muy interesante, porque los estudios precisan que las mujeres de edades comprendidas entre los 25 y los 35 años presentan trastornos temporomandibulares (TTM) con más asiduidad(AU)

A documental review of different sources was carried out to study the disfunctions of temporal mandibular joint (TMJ) with the objective of updating and enlarge our knowledge of this disorder. In or country in the last two decades several epidemiological studies about the temporal mandibular joint dysfunction were carried out. In a general wade the idea about of the origin of the functional problems of the stomatognatic system is multifactioral. But although, in children as well as in adults the prevalence of temporal mandibular dysfunction (DTM) has been high, a casual predominant factor has not been evidenced. Literature states that this dysfunction affect a very high percentage of the world populations, 80 percent , the mean age 34 years old and the proportion 3 woman for each man. This fact is very interesting because the studies specify the woman between 25 and 35 years present disfunción craneomandibular with more assiduity(AU)

Functional outcomes after free flap reconstruction of the upper aerodigestive tract.

PURPOSE OF REVIEW: When the complex structures of the upper aerodigestive tract are disrupted after resection of head and neck tumors, an appropriate reconstructive option should be chosen in an attempt to regain maximum function. Reconstructions using microvascular free tissue transfer offer unparalleled flexibility, both in tissue composition and in placement. This article will examine functional outcomes after free flap reconstruction of the upper aerodigestive tract. RECENT FINDINGS: With the maturation of free tissue transfer techniques, functional outcomes are being analyzed with increasing frequency. Recent reports show promising results for free flap reconstruction of oral cavity, oropharyngeal, and hypopharyngeal soft tissue defects, as well as for bony mandibular and maxillary defects. SUMMARY: For both soft tissue and bony defects of the upper aerodigestive tract, microvascular free flaps provide good functional outcomes. In the future, randomized studies are needed to compare the functional outcomes of microvascular free flaps with those of other reconstructive options.

Relationship between dental factors and risk of upper aerodigestive tract cancer / Relação entre os fatores dentais e risco de cancer no trato aero-digestivo alto

We examined the relationship between dental health variables and risk of upper aerodigestive tract (UADT) cancers in a case-control study in Southern Brazil. The study population included 717 cases of cancers of the mouth, pharynx, and larynx and 1434 controls matched on age, gender, period of admission and study site. The association with dental factors was investigated by conditional logistic regression using extensive adjustment for a priori and empirical confounders, including tobacco and alcohol consumption, diet and sociodemographic variables. Lifetime use of dentures was not associated with risk of any UADT cancer, but history of oral sores secondary to ill-fitting dentures was associated with cancers of the mouth (odds ratio [OR] = 2.3, 95 per cent confidence interval [CI] 1.2-4.6) and of the pharynx (OR = 2.7, 95 per cent CI 1.1-6.2) among those using dentures...

[The role of the basic skeletal system in the stomatognathic apparatus. A critical review of the literature]. / Ruolo del sistema scheletrico basale nell'apparato stomatognatico. Rassegna critica della letteratura.

The authors make a literature review on the different interpretations of the stomatognathic apparatus and try to identify any component of it and to underline the importance of the basal skeletal structures (maxilla and mandible). In this study the authors examined three female patients affected by different pathologies (dysfunctional, malformative, and traumatic) treated at the Maxillo-Facial Surgery Department of "La Sapienza" University of Rome; in all cases the basal skeletal structures were involved with a total functional alteration of the stomatognathic apparatus. The primary aim of any maxillo-facial surgical treatment is the restoring of skeletal structural harmony with a re-equilibrium of all the components of the apparatus. In conclusion the authors confirm the importance of the basal skeletal system which is strictly connected to all other elements, for the physiologic structural development and functional harmony of the stomatognathic apparatus.

Dental injuries at the 1989 Canada games: an epidemiological study.

The management and prevention of dental trauma is an integral part of the medical services provided at major athletic events. This paper reviews the organization and delivery of the dental services provided at the 1989 Canada Games. The nature, incidence and management of the dental problems reported in the participant population of 3,411 athletes are also described. During the two-week competition, 15 participants were assessed and treated for various dental conditions, including hard- and soft-tissue injury of the oral cavity, and temporomandibular joint sprain. The sports with the highest incidence of dental injury for the male population were wrestling (one per cent) and basketball (0.8 per cent). For the female population, these sports were basketball (2.5 per cent) and field hockey (1.3 per cent). The dental services provided during the games included emergency assessment and treatment, fabrication of mouthguards, and in-service education to medical team members.