Ear pruritus: a new otologic finding related to temporomandibular disorder.

This prospective clinical study evaluated the correlation among temporomandibular disorder (TMD), otologic manifestations, and parafunctional habits in a sample of 100 patients with TMD. The subjects were evaluated by clinical examination, use of a simplified anamnestic questionnaire for TMD diagnosis, and the investigation of otologic manifestations and parafunctional habits of the stomatognathic system. The prevalence of TMD and correlations with otologic manifestations and parafunctional habits were calculated. Patients ranged in age from 13 to 70 years, and 79.0% of the patients were between the ages of 30 and 59 years. Women represented 88.0% of the sample. Otologic manifestations were found in 92.0% of patients with TMD. Sex showed a significant correlation with severity of TMD (P = 0.024). A significant correlation was observed between female patients and both otalgia (P = 0.036) and ear pruritus (P < 0.001). Otalgia showed a significant association with the symptoms of TMD (P = 0.003). Significant correlations between severe TMD and otalgia (P < 0.001), tinnitus (P = 0.010), ear pruritus (P < 0.001), and aural fullness (P = 0.014) were also observed. Ear pruritus, otalgia, and aural fullness are the most common otologic manifestations in patients with TMD, showing a significant correlation with the female sex, severity of TMD, and frequency of TMD symptoms.

Decision making in third molar surgery: a survey of Brazilian oral and maxillofacial surgeons.

This study was designed to evaluate the variations in decision making among Brazilian oral and maxillofacial surgeons (OMFS) and trainees in relation to third molar surgery. A survey on 18 diverse clinical situations related to the assessment and treatment of the third molar surgeries was conducted during the 20th Brazilian National OMFS meeting. Participants were divided into three groups according to their level of training. Another variable studied was length of experience. Correlation between the question answers and the variables was analysed using the chi-square test and the f test. The mean age of participants was 32.68 years, and their mean length of experience was 5.24 years. There were no statistical differences between the level of training and number of years of experience and the responses to 15 of the 18 questions on clinical situations. However, differences were found in responses to prophylactic extraction of asymptomatic third molars, use of non-steriodal anti-inflammatory drugs (NSAIDs) during the preoperative surgical period and the use of additional imaging to plan extractions. The group with shorter time of experience (3.8 ± 3.94 years) tended to recommend extractions of asymptomatic third molars more frequently compared with the more experienced surgeons (P = 0.041). More experienced surgeons used NSAIDs in the preoperative surgical period, whereas the majority of the youngest surgeons (4.1 ± 5.96 years of experience) did not (P = 0.0042). The certificated trained and in practice group tended to treat deep lower third molar impactions based on the findings of a panoramic radiograph, without obtaining additional imaging [cone beam computed tomography (CBCT)] before treatment (P = 0.0132). Decision making regarding third molar treatment differs according to the level of training and is influenced by the number of years of experience. Therefore, further continuous education programmes in this area are warranted to make recommendations regarding third molars consistent with the current literature.

Effect of surgical repair of the joint capsule in mandibular condyle fractures in adult rats.

PURPOSE: The aim of the present study was to assess histologic changes in the temporomandibular joint (TMJ) of adult rats subjected to unilateral fracture of the mandibular condyle and soft tissue injury. MATERIALS AND METHODS: The animals were divided into 2 groups: one had surgical treatment for soft tissue repair and the other had no soft tissue treatment. All histologic evaluations were performed according to the presence or absence of synovitis, vascularity, presence or absence of joint inflammation, and presence or absence of the articular disc. The contralateral TMJs also were evaluated. RESULTS: The results showed few histologic changes in the synovial membrane and joint disc for the 2 groups and in the synovial membrane and disc of the contralateral side, where indirect trauma occurred in the unoperated joint. CONCLUSION: This study showed that treating or not treating soft tissues does not change the treatment results of condyle fracture or interfere with TMJ pathosis.

Juvenile psammomatoid ossifying fibroma with massive mandibular involvement.

Juvenile psammomatoid ossifying fibroma (JPOF) is a histologic variant of an ossifying fibroma. While an ossifying fibroma varies in appearance, it consists of fibrocellular tissue and mineralized material. JPOF is a rare benign lesion; however, it can be extended locally and mimic a malignant tumor. It is considered a specific clinicopathologic entity, due to its occurrence in children and adolescents, the presence of psammomas, and its purported tendency for local aggressive growth and recurrence. It commonly affects the maxilla, nasal cavity, paranasal sinuses, and ethmoid region. This article describes a rare, aggressive case of a large JPOF that led to the total destruction of the mandible.

Evaluation of changes in nasal airway in patients having undergone surgically assisted maxillary expansion.

INTRODUCTION: Surgically assisted maxillary expansion (SAME) is used to treat transverse maxillary discrepancies. The effect of this technique on the nasal airway has been the subject of a large number of studies. OBJECTIVE: The aim of the present study was to identify changes in the nasal airway in patients having undergone SAME. MATERIALS AND METHODS: A prospective study was carried out on a sample of 10 patients having undergone SAME who agreed to participate in all phases of the study. Data acquisition involved a questionnaire, Glatzel mirror, and computed tomography measurements in both the preoperative and postoperative periods. RESULTS: Nasal width increased in all patients following SAME (mean increase: 1.29 mm). The mean opening of the intermaxillary space was 5.30 mm. The postoperative nasal airway was larger in 8 patients (80%), with a mean increase of 0.30 cm(2) (18.52%). A significant overall increase (P < 0.05) in the nasal valve angle occurred in the postoperative period. The use of the Glatzel mirror revealed a smaller area of condensation in the postoperative period in only 1 patient. CONCLUSIONS: The nasal airway underwent a positive change following surgically assisted maxillary expansion. Moreover, the nasal valve angle is suggested as a new parameter for the analysis of this improvement.

Surgical management of multiple myeloma in the mandible: a case report.

Multiple myeloma (MM), solitary bone plasmacytoma, and extramedullary plasmacytoma are different types of plasma cell neoplasia, which is a lymphoid neoplastic proliferation of ß-cells. While MM is most frequently seen in the vertebrae and long bones, 30% of MM cases are found in the jaws. This case report presents a 58-year-old man with mandibular swelling; his medical history indicated he had a fracture of the humerus 1 month earlier. Panoramic radiography revealed a radiolucent lesion in the mandibular posterior region. Biopsy was performed and the histopathological examination indicated plasmocytoma. However, given the patient's dental and medical history, and the presence of multiple osteolytic lesions, the final diagnosis was MM. The patient underwent chemotherapy for the MM. To treat the pathological fracture of the jaw, a hemimandibulectomy was followed by the installation of a reconstructive plate.

Evaluation of fixation techniques with titanium plates and Kirschner wires for zygoma fractures: preliminary study.

OBJECTIVE: The aim of the present study was to assess the quality of treatment using two reduction and fixation techniques for zygoma fractures. PATIENTS AND METHODS: A randomized clinical trial was carried out involving a sample of 10 patients with Knight and North type III, IV and V zygoma fractures divided into two groups. One group underwent the closed reduction technique and fixation with Kirschner wire and the other group underwent the open reduction technique and fixation with titanium plates. The groups were submitted to subjective evaluation based on the patient's perception of areas of deformity and paresthesia as well as the measurement of range of mouth opening and pain upon mouth opening in the preoperative (T0) and postoperative (T1) periods. The assessment of bone reduction quality was performed using quantifiable points (lateral wall of the orbit, anteroposterior projection of the zygoma and ocular globe projection), measured based on tomographic images. RESULTS: Seventy percent of the patients remained with paresthesia and 20% remained with the complaint of deformity at T1. Mouth opening range increased in both groups at T1. In the overall sample, mean total disjunction of the lateral wall of the orbit and the difference in the anteroposterior projection of the zygoma were reduced between T0 and T1 (4.36 mm to 1.25 mm and 6.94 mm to 2.86 mm, respectively). There was also a reduction in ocular globe projection in both groups between T0 and T1. CONCLUSIONS: Both techniques achieved adequate reduction of zygoma fractures in the postoperative period.

Conservative treatment of comminuted mandibular fracture involving maxillomandibular fixation with miniplates.

Bars and steel wires are the most commonly used methods to achieve maxillomandibular fixation, although there are numerous alternatives described for this same purpose. In cases of edentulous candidates for the conservative treatment of facial fractures, none of the conventional methods can be instituted for maxillomandibular fixation. Fixation in such cases is achieved with the aid of the total dentures of the patient or the confection of splints, but these methods lead to eating and oral hygiene problems. This article reports the case of an edentulous patient with a comminuted mandible fracture treated with a rarely described technique in which intermaxillary fixation was achieved with titanium miniplates.

Current approach in the management of patients with foreign bodies in the maxillofacial region.

The aim of the present study was to describe and discuss the gamut of current diagnostic and therapeutic modalities regarding impacted foreign bodies in the head and neck region, addressing xeroradiography, magnetic resonance imaging, computed tomography, and ultrasonography as diagnostic aids and stressing the importance of a multidisciplinary team in the treatment of such injuries. Considerations are also offered on the different types and forms of presentation of foreign bodies that may be impacted in the maxillofacial region and specific treatment methods.

Fracture of the atrophic mandible: case series and critical review.

PURPOSE: Atrophic mandible fracture is common among elderly patients. Such fractures present management difficulties related to anatomic and physiologic alterations in this population. The purpose of this study was to evaluate the results of this type of fracture treatment and to realize a critical review of literature on the subject. PATIENTS AND METHODS: The sample was obtained from records of patients of Restauração Hospital (Recife, Brazil) who underwent surgical treatment of atrophic mandible fracture between 2006 and 2009. Data, such as etiology, location, and degree of displacement of the fractures, as well as access, type of fixation used, and the presence of postoperative complications, were analyzed. RESULTS: Successful bone union was achieved in 100% of cases. Complications were related to those patients treated with reconstruction plates (2.4 mm). CONCLUSIONS: Open reduction and internal fixation with miniplates seem a feasible option for primary treatment of atrophic mandible fractures without comminution or loss of substance. The level of scientific evidence for the treatment of atrophic mandible fractures is low.

Central osteoma of the maxilla with involvement of paranasal sinus.

Osteoma is an osteoblastic benign tumor characterized by the proliferation of either compact or cancellous bone. In the jaws, the most of cases reported in the literature presented as peripheral solitary lesions, involving preferably the posterior region of the mandible. However, central osteomas are quite rare, especially in the maxillary bone. The purpose of this article was to present the clinical, radiographic, surgical, and histologic features of a solitary central osteoma of the maxilla with involvement of the paranasal sinus and to review the literature for central osteomas located in the jaws. Our clinical report participates to literature as the 12th case of central osteoma in the jaws and the fourth case in the maxillary bone.

Impacted foreign bodies in the maxillofacial region-diagnosis and treatment.

Foreign bodies are often encountered by oral and maxillofacial surgeons and may present a diagnostic challenge to the trauma surgeon due to many factors such as the size of the object, the difficult access, and a close anatomic relationship of the foreign body to vital structures. They are usually a result of injuries or operations. Fragments of broken instruments can be left behind and entire teeth or their fragments can be displaced during extraction. The approach to this kind of injury should be sequential and multidisciplinary, beginning with the trauma unit that will provide maintenance of the airways, hemodynamic stabilization, and, but only if necessary, neurologic, ophthalmologic, and vascular evaluation. With a view to illustrating and discussing the diagnosis and treatment of this kind of injury, this study reports impacted foreign bodies in oral and maxillofacial region. The following data were collected: age, sex, race, etiology, occurrence of fracture, anatomic location of the fracture, daytime of the traumatic event, type of the object, signal and symptoms, type of imaging examination used, type of anesthesia, approach, transoperative complication, period between surgery and hospital liberation, and the occurrence of death. Foreign body injuries in the maxillofacial region can place the patient's life at risk, so a correct initial treatment performed by a multidisciplinary team increases the survival of this kind of patient.

Tooth embedded in tongue following firearm trauma: report of two cases.

Injuries caused by projectiles from firearms involve diverse patterns of dentoalveolar trauma due to the different types of wound and extent of tissue damage. This article reports two cases in which tooth fragments were embedded in the tongue following aggression from a firearm projectile in the facial region. Radiographs confirmed the presence of foreign bodies, which were surgically removed under local anesthesia. When dentoalveolar trauma occurs in facial injuries, both hard and soft tissues must be carefully examined to avoid overlooking embedded tooth fragments not located immediately in the soft tissue.

Recurrence of central odontogenic fibroma: a rare case.

Central odontogenic fibroma (COF) is a rare, benign, painless, slow-growing tumor associated with expansion of the bone cortex. Histologically, it consists of fibrous connective tissue that contains multiple islands of odontogenic epithelium. Some lesions have diffuse spherical calcifications that usually are related to islands or cords of epithelium. The majority of cases respond well to conservative treatment such as enucleation and the prognosis is favorable; recurrences are rare. This article presents a rare case of COF that was located in the anterior region of the maxilla and treated with enucleation; the case recurred five years following the initial treatment.

Inflammatory fibrous hyperplasia: a rare case in a child / Hiperplasia fibrosa inflamatória: um caso raro em Odontopediatria

ABSTRACT This paper aims to describe an inflammatory fibrous hyperplasia case caused by chronic irritation due to poor dental positioning after trauma. An 11-year-old female patient was sent to a dental specialty center with the complaint of a soft tissue growth in the place of an unerupted maxillary central incisor, causing her behavioral changes becoming more timid. After anamnesis and clinical examination it was noted that tooth 11 was in a vestibular position, covered with a hyperplastic lesion. Surgical treatment was performed and the histopathological exam revealed inflammatory fibrous hyperplasia. Over the course of the follow-up appointments, it was possible to observe improvement on the mentioned tooth and the patient's satisfaction. In face of the low prevalence of inflammatory fibrous hyperplasia, it is worth mentioning that the tooth positioning, outside its correct alignment in the arch, can cause repeated trauma to the mucosa, and then turning into etiological factor to inflammatory fibrous hyperplasia, affecting even children and adolescents. Thus, the dentistry must be alert to establish a diagnosis and clinical treatment, in addition to monitoring these cases.

RESUMO O objetivo deste trabalho é apresentar um caso de hiperplasia fibrosa inflamatória provocada por irritação crônica decorrente do mau posicionamento dental após trauma. Uma adolescente, 11 anos, foi encaminhada ao Centro de Especialidades Odontológicas, com queixa de que o incisivo central superior não havia erupcionado e em seu lugar havia surgido uma lesão de tecido mole, acarretando mudanças no comportamento da mesma que se tornou mais tímida. Após anamnese e exame clínico, constatou-se a presença do dente 11 em posição bastante vestibularizada, coberto por lesão hiperplásica. Foi realizado o tratamento cirúrgico e o resultado do exame histopatológico revelou que se tratava de hiperplasia fibrosa inflamatória. Durante as consultas para acompanhamento, foi possível observar a melhora no posicionamento do dente em questão e a satisfação da adolescente. Diante da baixa prevalência de hiperplasia fibrosa inflamatória na população infantil, vale ressaltar que o posicionamento do dente, fora do seu alinhamento correto no arco, pode provocar traumas repetidos em mucosa e, com isso, tornar-se fator etiológico para hiperplasia fibrosa inflamatória, acometendo, inclusive, crianças e adolescentes. Assim, o cirurgião dentista deve estar atento para estabelecer um diagnóstico e tratamento clínico oportunos, além do acompanhamento destes casos.

An impressive case of complete traumatic maxillofacial degloving.

By definition, degloving is skin and subcutaneous tissue detachment, most often affecting the limbs and extremities and occasionally the scalp. Degloving generally stems from high-energy trauma, but can also be intentional, such as in the case of planned surgical access in the anterior region of the mandible in oral-maxillofacial surgery. This paper describes an extreme case of complete traumatic maxillofacial degloving that caused partial avulsion of the soft tissues and maxilla. This is an extremely rare condition that has not previously been described in the literature, as the patient survived despite the risk of imminent death. This case report addresses the decisions made regarding the prevention of necrosis and infection that guided the emergency care and subsequent elective steps.

Evaluation of reliability and reproducibility of linear measurements of cone-beam-computed tomography.

OBJECTIVE: it was to evaluate intra- and interexaminer reliability and reproducibility of linear measurements in cone-beam tomography (CBCT) images. MATERIALS AND METHODS: CBCT scans were obtained from 50 patients of a private clinic. Two examiners located the landmarks twice in two-dimensional and three-dimensional images on different days, with images performed 1 week apart. Intra- and interexaminer reproducibility and reliability were analyzed. RESULTS: the measurement error (ME) did not show significant differences between intra- and interexaminers. The intraclass correlations (ICC) between the intra- and interexaminer readings obtained with the different methods showed almost perfect matches. The results demonstrated high examiner reproducibility for linear and volumetric parameters with high intraclass correlation coefficient (ICC) and coefficient of variation (CV). The ICC showed that the methodology was highly reliable and reproducible (ICC- >0.99 and CV <1.5%). CONCLUSION: the measurements demonstrated strong agreement between examiners and significant reliability and reproducibility. Therefore, this methodology can serve as a standard for linear measurement analysis of the topography of mandibular canal and osseous adjacent structures.

Impacted foreign bodies in orbital region: review of nine cases.

Orbital injuries with a foreign body may result in severe structural and functional damage to the eye or orbital contents. Management and prognosis depend on the composition and location of the foreign body and whether there is secondary infection. Metallic objects and glass are the most frequently encountered and well-tolerated, whereas organic foreign bodies can elicit an inflammatory reaction and lead to serious complications. Despite the modern imaging methods, it is often difficult to identify and locate organic intraorbital foreign bodies. This paper presents a review of nine cases of impacted foreign bodies in the orbital region and discusses the diagnosis and treatment of this kind of injury. The following data were collected: age, gender, etiology of injury, occurrence of fracture, anatomical location of fracture, type of object, signs and symptoms, type of imaging exam used, approach, transoperative complication and occurrence of death. Foreign body injuries in the orbital region can be treated with a combination of clinical suspicion, basic knowledge and diagnostic tests and depend on the skill and experience of the surgeon, thereby decreasing the surgical risk of iatrogenic injury in relation to the inherent risk of retaining an organic intraorbital foreign body.