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1.
J Appl Oral Sci ; 29: e20210383, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34787280

RESUMO

OBJECTIVE: The effects of the number of photobiomodulation (PBM) sessions on the postoperative inflammatory process remain controversial. The current literature comparing single and repeated PBM sessions is limited. This study aimed to compare the effects of single and repeated PBM sessions, applied at two different therapeutic wavelengths within the infrared spectrum, on postoperative inflammatory response after impacted third molar tooth extraction. METHODOLOGY: This randomized, double-blind clinical study included 40 patients with bilateral impacted mandibular third molars (80 teeth). The patients were divided into two groups each including 20 subjects (40 teeth) to receive either single-session laser at 810 nm (20 teeth) and 940 nm (20 teeth) immediately after the surgery or repeated laser sessions at 810 nm (20 teeth) and 940 nm (20 teeth) (immediately after the surgery and on postoperative Day 1). Lasers at 940 nm (power density 0.5 Watt/cm2, energy density 4 J/cm2 for a time until the cumulative energy on the device screen reaches 50 J from 0 J, in continuous mode, spot size 2.8 cm2) and at 810 nm (power density 0.14 Watt/cm2, energy density 4 J/cm2, for 30 seconds, in continuous mode, spot size 2.1 cm2) were applied intra- and extra-orally. Pain, swelling, and trismus were evaluated postoperatively. RESULTS: No significant differences were determined between the groups on the evaluated parameters (p>0.05). CONCLUSION: Within the study limitations, in PBM, the effects of 810 nm and 940 nm and those of single and repeated applications were similar regarding pain, swelling and trismus. Immediate postoperative PBM could be preferred to repeated applications performed by point application within a 24-hour period.


Assuntos
Terapia com Luz de Baixa Intensidade , Dente Impactado , Método Duplo-Cego , Edema/etiologia , Edema/prevenção & controle , Humanos , Dente Serotino/cirurgia , Dor Pós-Operatória/prevenção & controle , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/etiologia , Trismo/prevenção & controle
2.
J Craniofac Surg ; 32(8): 2611-2614, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34727465

RESUMO

ABSTRACT: The authors' aim was to evaluate the effect of perioperative systemic dexamethasone (DXM) administration on postoperative pain, edema, and trismus in mandibular fracture patients. The authors conducted a prospective randomized study of 45 patients with one or 2 noncomminuted fractures of the dentate part of the mandible. All patients underwent surgery for intraoral miniplate fixation. Patients in the study group were given a total of 30 mg DXM, while patients in the control group received neither DXM nor placebo. Only paracetamol and opioids were served as analgesics. Pain severity was assessed using the visual analog scale. The effect in facial swelling was measured in centimeters and analyzed as percentage change. Trismus was evaluated as the difference in maximal mouth opening by measuring interincisal distance in millimeters. The Mann-Whitney U test was applied to determine the statistical significance of differences between the groups. Thirty-four patients were included in the statistical analysis. The visual analog scale score was significantly lower in the study group than in the control group at 18 hours postoperatively (P = 0.033). Significant differences in edema or trismus were not found postoperatively between the DXM and control groups. In conclusion, perioperative DXM decreases postoperative pain in mandibular fracture patients when nonsteroidal anti-inflammatory drugs are not used, but it does not seem to be effective in reducing edema or trismus.


Assuntos
Fraturas Mandibulares , Dente Impactado , Anti-Inflamatórios/uso terapêutico , Dexametasona/uso terapêutico , Edema/etiologia , Edema/prevenção & controle , Humanos , Fraturas Mandibulares/cirurgia , Dente Serotino , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Extração Dentária , Trismo/etiologia , Trismo/prevenção & controle
3.
BMJ Case Rep ; 14(9)2021 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-34551913

RESUMO

Osteomas are benign tumours of bone tissue restricted to the craniofacial skeleton. The aim of this article is to present and discuss the demographic and clinical aspects and the management of craniomaxillofacial osteomas. When the patient was submitted from primary care to our hospital, he was 68 years old, and he had ankylosis of the temporomandibular joint for the previos 4 years. A CT scan was performed, finding a giant mandibular osteoma. Conservative treatment and radiological follow-up were carried out with clinical stability. Osteomas more often are seen in the paranasal sinuses and in young adults, with no differences in gender. Most are asymptomatic, but they can cause local problems. For its diagnosis, CT is usually performed. Treatment options are conservative management and follow-up or surgery. Although rarely, they can recur. Mandibular peripheral osteoma is a rare entity. Depending on the symptoms, a conservative or surgical treatment can be chosen. A clinical and radiological follow-up is necessary to detect possible recurrences or enlargement.


Assuntos
Anquilose , Osteoma , Seios Paranasais , Idoso , Anquilose/diagnóstico por imagem , Anquilose/etiologia , Humanos , Masculino , Recidiva Local de Neoplasia , Osteoma/diagnóstico , Osteoma/diagnóstico por imagem , Trismo , Adulto Jovem
4.
BMJ Case Rep ; 14(9)2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544711

RESUMO

We present a case of colorectal cancer with temporomandibular joint dysfunction and discuss the management of the case. Type IIIb temporomandibular disorder involves anterior dislocation of the articular disk, trismus and difficult intubation. A 68-year-old woman was scheduled for colectomy. The day before surgery, the patient had temporomandibular pain. On examination, the mouth opening was 13 mm. We diagnosed type IIIb temporomandibular disorder. A simple splint was fabricated with gauze and she bit it. The mouth opening was 55 mm on the day of surgery. The pain disappeared, and intubation was uneventful. Temporomandibular disorders are generally treated by dentists. It is beneficial for general hospitals without a dentistry department to employ a dental anaesthesiologist to assist in potentially difficult intubations in patients with temporomandibular disorders.


Assuntos
Luxações Articulares , Transtornos da Articulação Temporomandibular , Idoso , Feminino , Humanos , Contenções , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/cirurgia , Trismo
5.
Evid Based Dent ; 22(3): 104-105, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-34561661

RESUMO

Data sources The review carried out electronic searches using several online databases through November 2018, namely PubMed, Virtual Health Library, Cochrane Library and Scopus. Terms searched for on these databases included third molar, flap and variations thereof. A grey literature search was also conducted.Study selection In total, 2,455 articles were identified,1,449 being duplicates. Additionally, 1,006 articles remained for assessment which, with clear exclusion criteria listed, was reduced to 20. From the 20 incorporated into the review, 18 articles were utilised for meta-analysis. Three of the researchers were involved in assessing the articles after research management software was used to remove the aforementioned duplicates. A Cohen's kappa index was calculated to confirm inter-rater consistency using 10% of the articles.Data extraction and synthesis Data extraction followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance.Results From their systematic review and meta-analyses, the authors found that flap design had no effect on common post-operative complications including pain, trismus, dehiscence, or osteitis. The triangular flap did, however, have greater post-operative ecchymosis but reduced periodontal probing depth on day seven when compared to the envelope flap in mandibular third molar surgeries.Conclusions Third molar surgery is carried out across all facets of dentistry, including general and specialised. Further studies must be carried out that look specifically at these variables utilising randomised controlled trials so a consensus can be achieved across the profession of which flap is of superior design.


Assuntos
Dente Serotino , Dente Impactado , Humanos , Mandíbula , Dente Serotino/cirurgia , Extração Dentária , Trismo
6.
J Evid Based Dent Pract ; 21(3): 101582, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34479679

RESUMO

PURPOSE: The present study aimed to assess differences in postoperative morbidity between prophylactic and symptomatic third molar removals, and to assess the effect of age on the recovery of the patient. METHODS: Patients admitted for third molar removal were prospectively followed up four times during treatment in context of the M3BE study. Data were collected through pre-, peri and postoperative surveys (days 3 and 10). Uni- and multivariable logistic regression was used to assess the probability of postoperative symptoms of discomfort on day 3 and day 10 according to several patient- and surgery-related predictive factors (age, gender, indication for removal, method of extraction, anesthesia and number of extracted maxillary and/or mandibular third molars). RESULTS: In total, 6010 patients with a mean age of 25.2 (± 11.2) underwent 6347 surgeries to have 15,357 third molars removed. Frequently observed symptoms of postoperative discomfort were pain, trismus and swelling, all of which were transient in nature with steep decreases from postoperative days 3 to 10. Increasing age was associated with an enhanced risk of persistent pain, trismus and swelling and a significantly higher risk of iatrogenic injury to the inferior alveolar nerve. Symptomatic indications for removal were more common in patients over age 25 years, but these pre-existing pathologies did not compromise the postoperative recovery process. Other factors related to postoperative morbidity were female gender, intraoperative osteotomy and the number of extractions. CONCLUSION: The results of this study suggest that there are convincing patient- and surgery-related factors that favor timely third molar removal, preferably before the age of 25, especially in order to avoid persistent morbidity and nerve complications.


Assuntos
Dente Serotino , Dente Impactado , Adulto , Feminino , Humanos , Mandíbula/cirurgia , Dente Serotino/cirurgia , Morbidade , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/prevenção & controle
7.
Br J Oral Maxillofac Surg ; 59(8): 888-893, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34417074

RESUMO

The aim of this paper was to clinically evaluate the efficacy of the greater palatine pedicled flap (GPPF) for the correction of trismus in oral submucous fibrosis (OSMF). This retrospective study was designed from the patients diagnosed with OSMF who underwent transection of fibrous bands and coverage of the defect in the retromolar trigone (RMT) region using GPPF from 2008-2019. Cases were analysed for preoperative (MOpre-op), and postoperative mouth opening (MOpost-op), secondary healing of the palate, and complications of the procedure. A total of 29 diagnosed cases of OSMF were divided into two groups: group I/stage III (n=13) and group II/stage IV (n=16). The mean (SD) follow up was 29.6 (2.92) months for Group I and 32.4 (3.54) months for Group II. Increase in MOpost-op in group I from 20.0 to 32.92 mm (p=0.0001) and in group II from 6.81 to 26.31 (p=0.0001) was statistically significant. The mean difference of 6.57 mm in MOpre-op and MOpost-op among the groups was also statistically significant (p=0.0001). The mean (SD) duration for secondary healing of the palate was 5 (1) week(s) and flap necrosis was encountered in two cases of group II/stage IV OSMF. We conclude that GPPF is reliable for the treatment of trismus in advanced stages of OSMF.


Assuntos
Fibrose Oral Submucosa , Humanos , Fibrose Oral Submucosa/cirurgia , Palato , Estudos Retrospectivos , Retalhos Cirúrgicos , Trismo/etiologia , Trismo/cirurgia
8.
BMC Oral Health ; 21(1): 393, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380473

RESUMO

BACKGROUND: Surgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain. METHODS: A randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7. RESULTS: The surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001). CONCLUSION: The association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery. TRIAL REGISTRATION: NCT04889781 ( https://clinicaltrials.gov/ ), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1.


Assuntos
Dente Serotino , Dente Impactado , Dexametasona/uso terapêutico , Edema/etiologia , Edema/prevenção & controle , Humanos , Injeções Intramusculares , Mandíbula/cirurgia , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/prevenção & controle
9.
Clin Oral Investig ; 25(9): 5139-5148, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34297233

RESUMO

OBJECTIVE: The purpose of this study was to evaluate whether Kinesio taping (KT) can improve patient discomfort after mandibular third molar surgery. MATERIALS AND METHODS: This systematic review and meta-analysis was conducted according to the PICO strategy. We searched 4 databases for related articles. All controlled trials or randomized controlled trials that evaluated the application of KT after mandibular third molar surgery were included. Screening and article selection were carried out by two independent reviewers. The main evaluation indicators were facial swelling, pain, and trismus. All statistical analyses were conducted using Review Manager 5.3 software. RESULT: This analysis included 8 articles. The combined results showed that compared with the control group, the postoperative application of KT significantly reduced pain in the early (early stage mean difference (MD), - 2.00; 95% confidence interval (CI), - 2.40 to - 1.60; P < 0.00001) and late (late stage MD, - 1.18; 95% CI, - 2.26 to - 0.11; P = 0.03) postoperative periods and, thus, reduced the intake of painkillers. KT also reduced facial swelling in the early and late postoperative periods (early stage standardized mean difference (SMD), - 1.34; 95% CI, - 1.99 to - 0.68; P < 0.0001; late stage SMD, - 0.31; 95% CI, - 0.51 to - 0.11; P = 0.002). In addition, the postoperative application of KT improved restricted mouth opening in the early and late postoperative periods (early stage MD, - 5.03 mm; 95% CI, - 6.32 to - 3.74 mm; P < 0.00001; late stage MD, - 3.42 mm; 95% CI, - 5.31 to - 1.52 mm; P = 0.0004). CONCLUSION: KT can significantly reduce postoperative pain, swelling, and trismus after impacted mandibular tooth extraction. Additional high-quality and rigorously designed randomized controlled trials should be conducted to verify these conclusions. CLINICAL RELEVANCE: KT is a low-cost, simple, effective nondrug therapy for the postoperative management of mandibular third molar extraction and has broad prospects for clinical application.


Assuntos
Dente Serotino , Dente Impactado , Edema/etiologia , Edema/prevenção & controle , Humanos , Mandíbula/cirurgia , Dente Serotino/cirurgia , Dor Pós-Operatória/prevenção & controle , Extração Dentária , Trismo/prevenção & controle
10.
Cancer Radiother ; 25(6-7): 584-592, 2021 Oct.
Artigo em Francês | MEDLINE | ID: mdl-34272181

RESUMO

PURPOSE: To evaluate the current and potential indications of photobiomodulation (PBM) and their level of evidence in the prevention or management of radiation therapy-related side effects. MATERIALS AND METHODS: The Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, and LILACS databases were systematically reviewed to include and analyze publications of clinical studies that have assessed PBM in the prevention or management of radiotherapy-related side effects. The keywords used were "photobiomodulation"; "low level laser therapy"; "acute oral mucositis"; "acute dysphagia"; "acute radiation dermatitis"; "lymphedema"; "xerostomia"; "hyposalivation"; "trismus"; "bone necrosis"; "osteoradionecrosis"; and "radiation induced fibrosis". Prospective studies were included, whereas retrospective cohorts and non-original articles were excluded from the analysis. RESULTS: PBM in the red or infrared spectrum has demonstrated efficacy in randomized controlled trials in the prevention and management of radiotherapy-related side effects, especially acute oral mucositis, acute radiation dermatitis, and upper extremity lymphedema. The level of evidence associated with PBM was heterogeneous, but overall was still moderate. The main shortcomings were the diversity and lack of detail in treatment protocols, which could have compromised efficiency and reproducibility of PBM results. CONCLUSION: The published data suggest that PBM may be considered as a full-fledged supportive care for patients treated with radiotherapy, or at least in the setting of a therapeutic clinical trial. However, until strong evidence has been published on its long-term safety, the use of PBM should be considered with caution, specifically when applied near areas with proven or potential tumors. The patient should be informed of the theoretical benefits and risks of PBM in order to obtain his informed consent before treatment.


Assuntos
Terapia com Luz de Baixa Intensidade/métodos , Lesões por Radiação/radioterapia , Doença Aguda , Protocolos Clínicos , Transtornos de Deglutição/radioterapia , Fibrose/radioterapia , Humanos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Linfedema/radioterapia , Osteorradionecrose/radioterapia , Estudos Prospectivos , Radiodermatite/radioterapia , Radioterapia/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Estomatite/radioterapia , Trismo/radioterapia , Xerostomia/radioterapia
11.
J Craniofac Surg ; 32(8): 2798-2801, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34261973

RESUMO

ABSTRACT: Hyperplasia of the coronoid process is a rare condition, potentially leading to a mechanical mouth opening restriction. Diagnostic workup and treatment will be discussed based on 5 cases. This article presents 5 cases of true coronoid process hyperplasia. In addition, we reviewed accessible literature on the topic with special attention to pathophysiologic theories, surgical approach, and postoperative physiotherapy. The improvement in the maximal intercuspidal opening ranged from 4 and 31 mm. Greater maximal intercuspidal opening improvement was connected to compliant patients, while poor outcome occurred in the case of a patient that neither followed the recommendations for physical therapy nor showed up for his follow up appointments. The success of the therapy is defined by a long-lasting and stable improvement of the mouth opening compared to the preoperative situation. In the presented cases, the outcome was strongly dependent on the patients' postoperative compliance. Based on the cases described, we conclude that a good outcome is accomplishable for patients using the methods presented, as long as patients cooperate well after surgery.Diagnostic workup in patients with trismus should be thorough to correctly diagnose rare entities such as coronoid hyperplasia. If treated correctly this condition has a good outcome, as long as the compliance of the patient is adequate.


Assuntos
Anormalidades da Boca , Trismo , Humanos , Hiperplasia/patologia , Mandíbula/patologia , Modalidades de Fisioterapia , Trismo/etiologia
12.
J Appl Oral Sci ; 29: e20200932, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34105693

RESUMO

Third molar removal surgery usually comes accompanied by postoperative discomfort, which could be influenced by the surgical approach chosen. This scoping systematic review aimed at compiling the available evidence focused on the influence of flap design, including envelope flap (EF), triangular flap (TF), and modified triangular flap (MTF), on postoperative pain, swelling, and trismus, as primary outcome measures, and any result mentioning healing promotion or delay, as secondary outcome measure, after mandibular third molar extraction surgery. An electronic search, complemented by a manual search, of articles published from 1999 to 2020 was conducted in the Medline (PubMed), EMBASE and Web of Science databases including human randomized controlled trials, prospective, and retrospective studies with at least 15 patients. The risk of bias of the included studies was assessed either with the Cochrane's Risk of Bias tool or with the Newcastle-Ottawa scale. Every step of the review was performed independently and in duplicate. The initial electronic search recovered 2102 articles. After applying the inclusion criteria, 12 articles were included. For patient's perceived postoperative pain, TF and MTF frequently reported better results than EF. For swelling, the literature is divided, despite a trend favoring EF. For trismus, data showed that its occurrence is mostly associated with the duration of the surgery rather than with the chosen flap. For healing, the limited data is inconclusive. Finally, randomized studies showed a high risk of bias, whereas nonrandomized studies were mostly of good quality and low risk of bias. Although there was no clear consensus regarding the influence of different flap designs for third mandibular molar extraction on postoperative clinical morbidities; the surgeon's experience, estimated surgical difficulty, molar position and orientation, and surg ery duration should be considered when choosing among the different flap designs.


Assuntos
Dente Impactado , Trismo , Edema/etiologia , Humanos , Mandíbula , Dente Molar , Dente Serotino/cirurgia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias , Estudos Prospectivos , Estudos Retrospectivos , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/etiologia
13.
Age Ageing ; 50(5): 1861-1862, 2021 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115833

RESUMO

While tetanus is now a rare disease in the UK, it remains an important differential diagnosis for trismus and muscle spasms. Even more so in older adults, as this population is less likely to have received full vaccination. Hence, the highest incidence of tetanus in England is seen in older adults. Written informed consent for publication of their clinical details was obtained from the patient proxy.


Assuntos
Transtornos de Deglutição , Delírio , Tétano , Idoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Humanos , Espasmo/diagnóstico , Tétano/diagnóstico , Trismo/diagnóstico , Trismo/etiologia
14.
BMJ Case Rep ; 14(5)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059547

RESUMO

Intracranial extension of acquired cholesteatoma is a rare occurrence that can develop secondary to trauma, chronic otitis media or acquired aural cholesteatoma. The most commonly observed symptoms are headache and hearing loss. The authors report on a rare case of intracranial cholesteatoma presenting with atypic symptoms: swelling and temporomandibular joint disorders.


Assuntos
Colesteatoma da Orelha Média , Perda Auditiva , Otite Média , Transtornos da Articulação Temporomandibular , Colesteatoma da Orelha Média/complicações , Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/cirurgia , Humanos , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/etiologia , Trismo/etiologia
15.
Anesth Prog ; 68(2): 117-118, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34185859

RESUMO

Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive disease characterized by the presence of tissue nodules, joint contractures, and gingival hyperplasia. With a 1-year-9-month-old female patient scheduled for a gingivectomy and excision of a lower lip mass under general anesthesia, it was anticipated that airway management would be difficult because of trismus and limited cervical movement. Intubation with video-laryngoscopic assistance could not be achieved because gingival hyperplasia and trismus prevented blade insertion and manipulation. Therefore, 2 endotracheal tubes were used: 1 used as a nasopharyngeal airway for assisted ventilation, and 1 used for intubation along with a flexible fiberoptic scope. This case demonstrated a useful method for managing ventilation and intubation in patients with JHF, particularly when the use of oral airway devices is difficult.


Assuntos
Anestésicos , Hialinose Sistêmica , Feminino , Humanos , Lactente , Trismo/etiologia , Trismo/terapia
16.
Ann Ital Chir ; 92: 116-118, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34031281

RESUMO

Trismus is defined as a tonic contraction of the muscles of mastication. It can also refer to limited mouth opening of any cause. Trismus is a classical symptom of masticatory space infections and it can be a sign of an infection in the anterior compartment of lateral pharyngeal space. Common causes in clinical practice followed by trismus are odontogenic infection which can be periodontal or pericoronal. This article will present a clinical report on intraoral management of mandibular odontogenic infection accompanied by severe trismus under local anesthesia using modified Akinosi technique in an outpatient environment. Treatment and postoperative period were routine. This kind of approach provides access to the infection at an early stage without general anesthesia, it shortens the hospital treatment and it enables faster recovery. KEY WORDS: Local Anesthesia, Odontogenic infection, Trismus.


Assuntos
Anestesia Local , Antibacterianos/uso terapêutico , Doenças Estomatognáticas/tratamento farmacológico , Doenças Estomatognáticas/cirurgia , Trismo , Adulto , Anestesia Local/métodos , Humanos , Masculino , Boca , Doenças Estomatognáticas/complicações , Doenças Dentárias/tratamento farmacológico , Doenças Dentárias/cirurgia , Raiz Dentária/cirurgia , Trismo/etiologia , Trismo/terapia
17.
Integr Cancer Ther ; 20: 15347354211006474, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34014116

RESUMO

BACKGROUND: Current treatment for head and neck cancers (HNCs) have led to an improved survival. However, the sequelae of cancer treatment often result in trismus, or reduced mouth opening. The purpose of this report is to identify interventional studies for trismus management in HNC patients. METHODS: A search of PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature, and the Cochrane Library was conducted in March 2020 for randomized controlled trials (RCTs) involving interventions for trismus for head and neck cancer within 10 years. Intervention could involve the use of an exercise regime, jaw rehabilitation device, technological device, medication or massage therapy. The primary outcome was the measurement of mouth opening. RESULTS: Eleven RCTs involving a total of 685 patients with HNC were included. Six RCTs evaluated the effectiveness of a jaw mobilization device with exercises; there was no significant benefit of an exercise regime with a jaw mobilization device either initiated before, during or after treatment compared to no exercise. Two RCTs compared 2 intervention groups that involved exercises only, with 1 study assessing the benefit of weekly supervised physical therapy with gum chewing and another evaluating the benefit of immediate (1-2 days) versus delayed (7-10 days) initiation of exercise post-surgery; there was no significant difference between groups in either study. One RCT that recruited only patients with trismus demonstrated that an exercise regime in combination with low-level laser therapy or low-intensity ultrasound had superior results in mouth opening measurements compared to exercise alone. Two RCTs compared intervention groups with and without follow-up reminders; both studies showed a significant improvement in mouth opening measurements in groups with follow-up reminders. CONCLUSION: This systematic review did not convey a clear consensus as to optimal intervention for trismus in HNC patients. A variety of exercise regimens and jaw rehabilitation devices appear to have comparable effectiveness. However, efforts focused on increasing adherence to a particular intervention protocol may positively impact mouth opening measures in head and neck cancer patients. Also, low-level laser therapy and low-intensity ultrasound coupled with exercise may be beneficial for patients with trismus.


Assuntos
Neoplasias de Cabeça e Pescoço , Trismo , Terapia por Exercício , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Trismo/etiologia , Trismo/terapia
18.
Eur J Med Genet ; 64(7): 104229, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33910095

RESUMO

Crisponi syndrome/Cold Induced Sweating Syndrome 1 (CS/CISS1) is a rare, autosomal recessive, multisystemic disease. Hyperthermia attacks, abnormal contractions in the muscles of the face and oropharynx, respiratory distress, camptodactyly, and swallowing difficulty are the main features of the condition in the neonatal period. Patients experience cold-induced sweating attacks and progressive kyphoscoliosis in childhood and adolescence. Mutations in the cytokine receptor like factor 1 (CRLF1) gene causes the CISS1 (Cold- induced sweating syndrome type 1) disease (over 95% of patients). CRLF1 is located in the ciliary neurotrophic factor receptor (CNTFR) pathway, which plays an important role in development and maintenance of neurons in the nervous system. In this study three patients from Turkey, clinically and molecularly diagnosed with CS/CISS1, are presented. Hyperthermia, swallowing difficulty, camptodactyly and pursing of the lips were present in all patients, and foot deformity in one patient. In the first patient a homozygous nonsense mutation NM_004750.5: c.531G > A; p.(Trp177Ter) in the 4th exon was detected. In the second patient a homozygous nonsense mutation NM_004750.5: c.776C > A; p.(Ser259Ter) in the 5th exon was detected. The third patient was homozygous for a missense mutation NM_004750.5: c.935G > T; p.(Arg312Leu) in the 6th exon. Early diagnosis is very important in this syndrome since most patients die in the neonatal period. Therefore, physicians should be suspicious for this disease in patients with dysmorphic features, hyperthermia attacks, camptodactyly, pursing of lips while crying, and swallowing difficulty.


Assuntos
Deformidades Congênitas da Mão/genética , Hiperidrose/genética , Receptores de Citocinas/genética , Trismo/congênito , Pré-Escolar , Códon sem Sentido , Morte Súbita , Diagnóstico Precoce , Facies , Feminino , Deformidades Congênitas da Mão/diagnóstico , Homozigoto , Humanos , Hiperidrose/diagnóstico , Lactente , Masculino , Mutação de Sentido Incorreto , Fenótipo , Trismo/diagnóstico , Trismo/genética
19.
J Oral Maxillofac Surg ; 79(9): 1829-1836, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33872601

RESUMO

PURPOSE: Methylprednisolone is widely administered after impacted third molar surgery. This study compared the effect of methylprednisolone injection into the masseter and gluteal muscle on pain, edema, and trismus after impacted lower third molar surgery. METHODS: This was a single-blind placebo-controlled randomized clinical trial. Sixty patients with an impacted lower third molar were included and randomly assigned into 3 groups. Each group received 1 of the following medications half an hour before surgery: Group I: 40 mg methylprednisolone injected into masseter muscle; Group II: 40 mg methylprednisolone injected into gluteal muscle; Group III: considered as control group with no intervention. The level of pain was recorded 1, 5, and 7 days after surgery using visual analog scale, and the amount of edema was measured 5 and 7 days after surgery using ultrasound imaging. The amount of trismus was measured 5 and 7 days after surgery based on the distance between incisor edge of upper and lower centrals. Friedman test was used to compare the level of pain, trismus and edema in each group at different times. Kruskal-Wallis test was used to compare the level of pain, trismus and edema among different groups at each time. Significance level was set at P < .05. RESULTS: There was no significant difference among the 3 groups (a total of 60 patients (31 females and 29 males), aged 19 to 35 years) considering edema (P = .250, CI = 0.22 ± 0.42), trismus (P = .337, CI = -5.93 ± 2.22) and pain (P = .285, CI = -2.91 ± 0.40) relief. CONCLUSIONS: Postsurgical pain, edema, and trismus were not reduced by intramuscular injection of methylprednisolone before third molar surgery.


Assuntos
Dente Serotino , Dente Impactado , Método Duplo-Cego , Edema/etiologia , Edema/prevenção & controle , Feminino , Humanos , Masculino , Músculo Masseter/diagnóstico por imagem , Metilprednisolona/uso terapêutico , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Método Simples-Cego , Extração Dentária , Dente Impactado/cirurgia , Trismo/etiologia , Trismo/prevenção & controle
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