An alternative approach for the surgical correction of unilateral crossbite.

This case report aims to describe a modified surgically assisted rapid palatal expansion technique to treat an asymmetrical posterior crossbite with no mandibular shift without causing an interincisal diastema. A clinical patient with an asymmetrical crossbite, large tooth-size-arch length, and Bolton discrepancy is used to illustrate the modified technique. Instead of traditional osteotomies, in this technique, the osteotomy is done between the maxillary right canine and lateral incisor (connecting the piriform aperture to the alveolar process) along with a unilateral LeFort I osteotomy. The expansion forces are produced by the activation of a conventional hyrax appliance. The skeletal unilateral crossbite was corrected without major changes to the opposite side and without causing an anesthetic diastema between the maxillary central incisors. A mandibular incisor extraction produced the space needed to treat the tooth size-arch length and corrected the Bolton discrepancy. This allowed a successful treatment of the problems initially presented by the patient.

Quality of Life and Temporomandibular Disorders in Patients With Skeletal Class III Malocclusion With Cleft Lip and Palate.

OBJECTIVE: The aim of the study was to assess the quality of life (QOL), oral health-related QOL (OHRQOL), temporomandibular disorders (TMDs), and psychological factors in patients with skeletal Class III malocclusion with cleft lip and palate (CLP) and without CLP. DESIGN: Case-control. SETTING: Primary care, institutional practice. PATIENTS: One hundred thirty-six patients with skeletal Class III malocclusion with CLP (n = 68) and without CLP (n = 68). MAIN OUTCOME MEASURES: QOL and OHRQOL were assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and the Oral Health Impact Profile-14 questionnaire, respectively. TMDs and psychological factors were assessed using the Research Diagnostic Criteria for TMD (RDC/TMD). RESULTS: No differences in QOL were found between the groups (P > 0.05). Patients with CLP reported a better OHRQOL (P = 0.025) in the physical pain, physical disability, and psychological disability domains (P < 0.05). Patients with CLP presented with less myofascial pain (OR, 0.28; 95% CI, 0.11-0.71] and other articular conditions (OR 0.24; 95% CI 0.06-0.90]. More patients with CLP reported no chronic pain (P = 0.012). The QOL of patients with CLP with no depression or with no nonspecific physical symptoms including pain (NSPSIP) was better than that of patients without CLP. The OHRQOL of patients with CLP without TMDs or no psychological factors was better than that of patients without CLP. CONCLUSIONS: Patients with skeletal Class III malocclusion who require orthognathic surgery with CLP have better OHRQOL and present with fewer TMDs than those patients without CLP.

Labio-facial Necrotizing Fasciitis in a Young Patient.

ABSTRACT: Necrotizing fasciitis (NF) is an infection of the deeper tissues that results in progressive destruction of muscle fascia and overlying subcutaneous fat. It has a fast and destructive course. Moreover, it is related to immunosuppression and could be fatal. The aim of this study is to report a clinical case of a young patient, without immunosuppression, who developed NF evolution due to an erroneous diagnosis of abscess at the beginning of the disease. Patient was submitted to broad-spectrum antibiotic therapy and aggressive surgical treatment. Adequate treatment led to a satisfactory evolution in a short period of time. Early recognition and adequate treatment are essential for a favorable prognosis.

Le Fort I Down-Fracture for Management of Midface Tumors.

OBJECTIVE: To perform an integrative review associating current literature with a clinical series regarding the use of Le Fort I osteotomy for the removal of tumors located in the midface and central region of the skull base. METHODS: A systematic review was performed through the PubMed, SCOPUS, and Cochrane databases. In addition, 4 different patients operated using the above-cited technique are described in this study. RESULTS: Initially, 123 articles were found. After the removal of duplicates, and title and abstract reading, 27 articles were selected for data extraction. The Le Fort I surgical approach of tumors was performed in 183 patients. CONCLUSION: The Le Fort I surgical approach allows lesion exeresis with good visualization, low rates of recurrences and complications, and without aesthetic compromises for the patient.

Bonegraft Wrap Technique: Avoiding Accentuated Labiomental Groove After Genioplasty.

This work presents the wrap technique developed by the authors aiming to avoid the occurrence of unaesthetic deep labiomental fold in genioplasty. The technique recommends the use of particulate bone graft that is wrapped on collagen or a Surgicel membrane which is placed over the osteotomized segment of the chin fixated with a prebent 4-hole titanium plate.

Large Anterior Oronasal Fistula Repair Using Pedicled Buccal Fat Pad and Fibroepithelial Tissue.

Oronasal fistula (ONF) is the most common complication after palatoplasty in patients with cleft lip and palate (CLP). When left untreated, it may negatively affect the quality of life, leading to development of other comorbidities. This study reports for the first time, the use of a portion of a hyperplasic tissue associated with pedicled buccal fat pad flap to repair a large anterior ONF in a 60-year-old man. The hyperplasic tissue may have developed due to the combination of a loose fitting upper denture and long-term use of dihydropyridine calcium channel blocker (amlodipine besylate). There is controversy in the literature about use of pedicled buccal fat pad flap in the anterior region. However, in this study, we report successful repair of a large anterior ONF using a portion of a fibroepithelial hyperplasic tissue associated with pedicled buccal fat pad flap.

Mandibular Reconstruction by Osteogenic Distraction Due to Two Different Injuries.

Varied factors, whether intrinsic or extrinsic, may lead to a decrease in the bone volume of the jaws. Trauma and pathology can be listed as examples of such factors. The aim of this study is to present the osteogenic distraction technique as alternative to augmentation of low mandibular bone volume caused by different etiologies. The first case reports a mandibular marginal resection of ameloblastoma and the second one reports a male patient presenting mandibular fracture sequelae. Both cases were treated according to the osteogenic distraction technique. Several factors have influence on the decision of treatment management of these conditions. Although autogenous bonegraft is considered criterion standard for alveolar reconstruction, its high rates of resorption and the morbidity associated to donor sites lead surgeons to seek for other surgical alternatives such as osteogenic distraction. Therefore, it also aims to expose the advantages and benefits of this technique as well as the satisfactory results achieved.

Rabdomyosarcoma of the Mandible: An Uncommon Clinical Presentation.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. Most patients present with a mass in the head and neck region, urogenital region, or with distal extremity involvement. The authors describe a challenging case of a 6-year-old male patient presenting with mandibular RMS. The clinical/radiographic/tomographic evaluations classified the tumor as an advanced stage (stage IV), with a mass of 6.0 cm involving the left side of the mandible and parotid region. The biopsy revealed round, spindled, and pleomorphic cells with hyperchromatic nuclei and rare larger rhabdomyoblasts with eosinophilic cytoplasm. The diagnosis was of embryonal RMS. The patient was referred for treatment with cycles of chemotherapy; however, pulmonary and bone marrow metastasis were identified. Radiotherapy and local surgery with microvascular reconstruction were performed later; however, the patient died after a few months. Early diagnosis is critical for a good prognosis and cure of patients with RMS. Correct diagnosis considering also the histological subtype is important for adequate treatment, which according to the literature is not uniform probably because of the rarity of this neoplasm.

Surgical Resolution of Bilateral Hypertrophy of Masseter Muscle Through Intraoral Approach.

Masseter muscle hypertrophy is an untypical anomaly with no definite cause and its diagnosis is easily completed through physical examination and imaging examinations. In some cases, patient may report signs and symptoms of well-localizated pain. However, it is generally asymptomatic and patient's chief complaint is about esthetic because of facial asymmetry. In this case, surgery is carefully indicated. The aim of this article is to report a case of a male patient with no painful and functional complaints but an important unease over his facial asymmetry. Patient underwent surgery involving bilateral resection of mandibular angles and unilateral resection of masseter muscle through intraoral approach. Surgical approaches and techniques rely heavily on surgeon. There are few reports in the literature about this anomaly, but those available present several techniques. The surgeon's dexterity and knowledge become extremely important, whereas this procedure is essentiallyesthetic.

Extra-Oral Excision of a Buccal Fat Pad Lipoma.

Lipomas and its variants are common soft tissue tumors, and however occur infrequently in the oral and maxillofacial region. Their incidence in the oral cavity is low among all oral lesions. Oral lipoma is yellowish and soft to palpation, and histologically can be mistaken by other lipoma variants. The aim of this study is to report a case of a lipoma located at the buccal fat pad which was removed through an extra-oral access. A 43-year-old male is presenting an augmentation in the right buccal region, being a soft consistency mobile lesion with 1.5 cm of diameter, asymptomatic, and 2 years of growing. Computed tomography scan showed hypodensity compatible with adipose tissue. The lesion was removed through an extra-oral access. The lipoma described in this clinical report had an unusual location and once the lesion was very superficial an extra-oral access was the first treatment option despite the fact that was a benign tumor.

Endoscopic Removal of Displaced Sagittal Intracapsular Condylar Fracture.

Fractures involving the mandibular condyle are among the most common fractures of facial bones and still generate great discussion concerning therapeutic issues. Several factors have influence on the decision of treatment management of these fractures. In some patients, even when there is displacement of fractured fragments, the choice for conservative treatment is made. However, the removal of the condyle fragment may be required. In the oral surgery scope, endoscopy is a procedure used in many areas, and can be helpful to improve the visualization of surgical sites with difficult access. The endoscopic surgery brings benefits to patient such as no scar or minimal scar, lower risk to nerve damage, and decreased of surgical trauma and bleeding. In addition, according to surgeon experience, the surgery may become more dynamic. The aim of this study is to present an endoscopic technique associated with a transoral approach to remove a displaced sagittal intracapsular condyle fragment. Furthermore, to expose the advantages and benefits of this technique as well as the satisfactory results achieved.

The Importance of Early Diagnosis of Retrobulbar Hemorrhage.

Midface fractures usually affect the orbital cavity. This trauma may result in severe and rare consequences such as retrobulbar hemorrhage. This condition requires immediate diagnosis and early intervention to avoid blindness. The treatment usually requires evaluation of an oral and maxillofacial surgeon. This patient report aims to describe a facial trauma resulting in blindness after 4 days. An 83-year-old woman fell and hit her face on the floor. The initial evaluation only found a contusion on her left orbit, and an ophthalmologic examination was not made. After 72 hours, the patient searched for the oral and maxillofacial surgeon, showing blindness of her left eye. Despite the treatment, the vision was not recovered. Blindness can become irreversible 90 minutes after trauma, and this condition must be treated as an emergency.

Factors Affecting the Duration of Surgery in the Management of Condylar Head Fractures.

Prolonged operation times should be avoided due to the associated complications and negative effects on the efficiency of the use of operating room resources. Surgical treatment of mandibular condylar head fractures is a well-established routine procedure at our department, nevertheless, we recognized fluctuating operating times. This study aims to pinpoint the influencing factors, in particular the hypothesis whether the efficiency of intraoperative muscle relaxation may decisively affect the duration of surgery. It analyses 168 mandibular condylar head fractures that were surgically treated in the period from 2007 to 2022 regarding the duration of the surgery and potential factors affecting it. The potential predictors' influence on the dependent variable operation time was mainly calculated as a bivariate analysis or linear regression. Efficiency of relaxation (p ≤ 0.001), fragmentation type (p = 0.031), and fracture age (p = 0.003) could be identified as decisive factors affecting the duration of surgery, as the first surgeon was a constant. In conclusion, surgical intervention should start as soon as possible after a traumatic incident. In addition, a dosage regimen to optimize the efficiency of relaxation should be established in future studies. Fragmentation type and concomitant fractures should also be considered for a more accurate estimation of the operating time.

Tissue response to different incision tools in animal model.

PURPOSE: The aim of this study is to compare the repair of incisions performed with microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser, and conventional scalpel blade in a in vivo model. METHODS: Different incisions were performed in adults Holtzman rats using the four types of instruments: microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser, and conventional scalpel blade, in different periods of healing process. Thirty rats were divided into 5 groups, according to the period of euthanasia-24 h, 48 h, 72 h, 7 days, and 14 days. All animals received four incisions, each by a different method. Quantitative histological and histomorphometric analyses were performed using hematoxylin and eosin (HE) and Picrosirius Red staining. RESULTS: Inflammatory profile and tissue repair presented small statistically significance differences comparing conventional scalpel blade and microdissection tip; moreover, both presented quantitatively superior to the others. CONCLUSION: It is believed that the microdissection tip can perform a dynamic incision just as a common scalpel blade, but more effective. Furthermore, it can promote a better hemostatic control of the surgical field that is comparable to conventional electrocautery tip without affecting tissue repair.

Gene expression, immunohistochemical and microarchitectural evaluation of bone formation around two implant surfaces placed in bone defects filled or not with bone substitute material.

OBJECTIVE: The aim of this study is to evaluate through gene expression, immunohistochemical and microtomographic (micro-CT) analysis the response of peri-implant bone tissue around titanium implants with different surface treatments, placed in bone defects filled or not with bone substitute materials. In addition, to investigate the hypothesis that porous-hydrophilic surface induces a faster bone formation. MATERIALS AND METHODS: Twenty-six animals were divided into two groups according to implant surface treatment. In each tibia, a bone defect was created followed by the placement of one implant. On the left tibia, the defect was filled with blood clot (BC), and on the right tibia, the defect was filled with biphasic hydroxyapatite/ß-tricalcium-phosphate (HA/TCP) generating four subgroups: BC-N: bone defect filled with blood clot and porous surface titanium implant installed; BC-A: bone defect filled with blood clot and porous-hydrophilic surface titanium implant installed; HA/TCP-N: bone defect filled with bone substitute material and porous surface titanium implant installed; and HA/TCP-A: bone defect filled with bone substitute material and porous-hydrophilic surface titanium implant installed. The animals were submitted to euthanasia at 15, 30, and 60 days after implant installation. The expression of two genes was evaluated: RUNX2 and BSP. Immunohistochemical analyses were performed for detection of RUNX2, OPN, OCN, OPG, and RANKL antibodies and bone matrix proteins. Finally, four parameters were chosen for micro-CT analysis: trabecular number, separation and thickness, and connectivity density. RESULTS: Descriptive analysis showed similar findings among the experimental groups. Moreover, porous-hydrophilic surfaces presented a higher expression of RUNX2, which is probably an indicative of better osteogenesis; although the data from this study may be considered an insufficient support for a concrete statement. CONCLUSION: Porous hydrophilic surface can improve and accelerate protein expression and bone formation.

Bone formation around two titanium implant surfaces placed in bone defects with and without a bone substitute material: A histological, histomorphometric, and micro-computed tomography evaluation.

OBJECTIVE: To evaluate the histological and microtomographic response of peri-implant bone tissue around titanium implants with different surface treatments, placed in bone defects filled or not filled with bone substitute materials. MATERIALS AND METHODS: Thirty rabbits were divided into two groups according to the implant surface treatment. A bone defect was created in both tibias of all the rabbits, followed by the placement of one implant in each of these defects. On the left tibia, the defect was filled with a blood clot (BC), and on the right tibia, the defect was filled with biphasic hydroxyapatite/ß-tricalcium-phosphate (HA/TCP); thus, there were four groups in total: BC-N: bone defect filled with a BC and porous surface titanium implant (control group); BC-A: bone defect filled with a BC and porous-hydrophilic surface titanium implant; HA/TCP-N: bone defect filled with a bone substitute material and porous surface titanium implant; HA/TCP-A: bone defect filled with a bone substitute material and porous-hydrophilic surface titanium implant. The animals were submitted for euthanasia at three distinct periods: 15, 30, and 60 days after implant installation. The samples were evaluated histologically and histometrically, to assess the quantity and quality of cells and the remaining bone substitute material in the grafted areas. The bone quantity was assessed by micro-computed tomography (CT). RESULTS: For both surface types, the presence of a bone substitute material led to higher values in all evaluated micro-CT parameters, except in the bone surface/volume ratio parameter. No significant statistical difference was found for new bone formation between the four groups (P < .05; CI 95%). At all periods, the HA/TCP-A group had a higher percentage of new bone formation. CONCLUSION: These results suggest that a porous hydrophilic surface in the presence of bone substitute material can accelerate peri-implant bone tissue formation.

Intranasal Ectopic Tooth in Adult and Pediatric Patients: A Report of Two Cases.

The aim of this study was to report two rare cases of ectopic tooth into the nasal cavity. The first case reports a 32-year-old female patient with the main complaint of having a tooth inside her nose. According to her, this condition causes pain and sporadic nosebleed. The patient had a facial trauma when she was 6 years old. The second case refers to an 8-year-old girl with left incomplete unilateral cleft lip and palate. The main complaint was left-sided nasal obstruction by a white hard mass. The treatment for both cases was surgical removal of the ectopic erupted tooth under general anesthesia. In conclusion, we can state that the surgical removal of intranasal tooth is a safe procedure and improves patient's quality of life.

Horizontal ridge augmentation using xenogenous bone graft-systematic review.

PURPOSE: This study aimed to perform a systematic review about the use of xenogenous bonegraft in horizontal ridge augmentation to answer the following question: In implant patients, treated with xenografts for horizontal ridge augmentation, what would be the outcomes in terms of bone gain, bone resorption, implant survival, and complication rates? METHODS: The main search was performed at PubMed, Cochrane, and Scopus databases, and found 2610 articles. After selection and duplicate removal, 29 studies were included in the final review. The collected data were sample size, number and type of graft, site, horizontal gain, resorption rate, and complications. RESULTS: A total of 610 patients were submitted to 853 bone grafts, both in the maxilla and mandible. Most studies (n = 26) used particulate grafts, isolated or associated with autogenous bone, and covered by collagen membrane or titanium mesh. The mean of horizontal bone gain was 4.44 mm. In addition, the augmented ridges allowed placement of 1325 successful dental implants. The complication rate was 7.85%, and membrane exposure was the most reported complication. CONCLUSIONS: Although the autogenous bone graft remains as the gold standard for alveolar reconstruction, this review suggests that xenogenous bone graft is a feasible alternative for horizontal bone augmentation.

Bone tissue formation around two titanium implant surfaces placed in bone defects filled with bone substitute material or blood clot: A pilot study.

OBJECTIVES: The objective of this study was to evaluate the peri-implant bone tissue formation around titanium implants with different surface treatments, placed in bone defects filled or not with bone substitute material (BSM). MATERIALS AND METHODS: Ten animals were divided into two groups according to implant surface treatment. In each tibia, a bone defect was created followed by the placement of one implant. On the left tibia, the defect was filled with blood clot (BC), and on the right tibia, the defect was filled with biphasic hydroxyapatite/ß-tricalcium-phosphate (HA/TCP) generating four subgroups: BC-N: blood clot and porous surface; BC-A: blood clot and porous-hydrophilic surface; HA/TCP-N: BSM and porous surface; HA/TCP-A: BSM and porous-hydrophilic surface. The animals were submitted to euthanasia 60 days after implant installation. After light-curing resin inclusion, the blocks containing the implant and the bone tissue were stained and evaluated by means of histomorphometry to assess the percentages of bone implant contact (% BIC). Data was normally distributed and the group differences were examined using the parametric tests of Two-Way ANOVA. RESULTS: The BC-A group presented the higher mean value of BIC (46.43%). The HA/TCP-A group presented the higher mean value of BIC. The porous-hydrophilic surfaces presented better results of BIC when compared to the porous surface in both conditions of defect filling. No statistically significant differences were found among all groups (95% confidence interval and P < .05). CONCLUSION: According to histomorphometric analysis, after 60-days in a rabbit model, hydrophilic and hydrophobic surfaces have the same behavior in the presence or absence of HA/TCP.

Comparison of Imaging Softwares for Upper Airway Evaluation: Preliminary Study.

The interest about upper airway evaluation has increased lately. Therefore, many softwares have been developed aiming to improve and facilitate the analysis of airway volume. The objective of this study was to compare two different softwares packages, Mimics and Dolphin, in their accuracy and precision in upper airway space measurements. Preoperative cone beam computed tomography scans of nine nonsyndromic patients submitted to surgically assisted rapid maxillary expansion were included in this study. The imaging exams were converted to DICOM (digital imaging and communications in medicine) files and imported to the softwares. The mean volume for the Dolphin group (G1) was 10.791 cm 3 (SD = 4.269 cm 3 ) and for the Mimics group (G2) was 10.553 cm 3 (SD = 4.564 cm 3 ). There was no statistically significant difference between the two groups ( p = 0.105).