Corticocancellous fresh-frozen allograft bone blocks for augmenting atrophied posterior mandibles in humans.

BACKGROUND: Allograft fresh-frozen bone (FFB) is an alternative to autogenous bone for oral implantation due to bone quantity availability and lower morbidity for patients. Few specific studies about the use of FFB for reconstructing the posterior mandibular alveolar crest have been conducted. OBJECTIVE: The objective of this study was to evaluate histological, histomorphometrical, and volumetric aspects of FFB allografts used to augment atrophied posterior mandible bone ridges. MATERIALS AND METHODS: Sixteen hemi-mandibles of twelve patients presenting with critical alveolar atrophy were three-dimensionally reconstructed using corticocancellous FFB. Thirty blocks were fixed with titanium screws and covered with particulate bovine bone mineral and collagen membrane. Volumetric data were obtained by cone beam computed tomography analysis after 6 months, implants were inserted, and bone biopsies were harvested and sent for histological and histomorphometric analyses. RESULTS: The blocks were distributed between nine female and three male patients (mean age, 50.9 ± 8.3 years). Thirty implants were installed, and the implant survival rate was 96.66%. Histology demonstrated newly formed vital bone contacting residual acellular allograft bone and connective tissue. The histomorphometric analysis showed 18.9 ± 8.1% newly formed bone and 32.5 ± 14.8% allograft residual bone. Graft absorption was 45% for height and volume, and both measures were significantly different (P < 0.001). CONCLUSION: Fresh-frozen allografts are a viable alternative for reconstructing an atrophied mandible in the posterior region, allowing for new bone formation, installation of implants, and prosthetic loading.

Methylene Blue-Mediated Photodynamic Inactivation Followed by Low-Laser Therapy versus Miconazole Gel in the Treatment of Denture Stomatitis.

PURPOSE: Photodynamic therapy (PDT) appears to be an effective method for the in vitro and in vivo inactivation of Candida spp., but no clinical trials in this context have yet been conducted. The aim of this study was to compare the effect of oral miconazole gel to PDT combined with low-power laser (LPL) therapy in the treatment of denture stomatitis. MATERIALS AND METHODS: Forty participants with clinical and microbiological diagnoses of type II denture stomatitis were randomly allocated to two treatment groups (PDT and miconazole gel), each with 20 individuals. The PDT group was submitted to one session of methylene blue-mediated PDT plus two sessions of low-laser therapy twice a week for 15 days. The miconazole group was submitted to the drug four times a day for 15 days. RESULTS: Forty percent of the patients achieved clinical and microbiological resolution of denture stomatitis after methylene blue-mediated photodynamic inactivation followed by low-laser therapy. The cure rate associated with miconazole was 80% (p < 0.05). Fifteen days after the end of treatment, the recurrence rate was 25% in patients treated with PDT combined with LPL therapy and 12.5% in patients treated with miconazole. CONCLUSION: Miconazole gel provides better results than a protocol combining methylene blue-mediated PDT and LPL therapy in the treatment of type II denture stomatitis.

Health-Related Quality of Life Patients With a Cleft Lip and/or Palate.

BACKGROUND: The authors evaluated health-related quality of life (HRQoL) in patients with cleft lip and/or palate (CLP). METHODS: A descriptive, observational, cross-sectional study was conducted in the largest referral facility for treating individuals with CLP in Sergipe state. The authors created 3 groups with 97 subjects each: CLP, family, and control. An initial cognitive evaluation was performed with the Mini-Mental State Examination, and the Medical Outcomes Study 36 item Short-Form Health Survey (SF-36) was applied to evaluate HRQoL in individuals with sufficient cognitive capacity. RESULTS: Individuals with CLP usually had a primary education, were single, and had incomes between 1 and 2 minimum wages, and slightly more than half presented with a transforamen cleft (59.8%). No significant difference was observed in the overall HRQoL score among the 3 groups (cleft: 72.2; family: 70.6; control: 72.5). Individuals with CLP had a lower average on the Emotional Aspects domain of the SF-36 than that in the control group, whereas the CLP group had higher averages in the Vitality domain when compared with their relatives. Men had higher averages on the Physical Function (PF) and Mental Health (MH) domains. Patients operated on at the optimal time (≤12 months of age) had higher mean PF domain scores. CONCLUSIONS: Patients with CLP and their families often represent people with low purchasing power, strengthening the socioeconomic inequality. Although the global HRQoL was similar among all groups surveyed, the cleft influenced both the patients and their relatives.

Evaluating changes in the condylar head after orthognathic surgery with or without articular disc repositioning: a systematic review.

Failures in orthognathic surgery are associated with different factors, including those related to untreated or undiagnosed preoperative temporomandibular joint (TMJ) disorders. This systematic review aimed to assess potential alterations in the condylar head following orthognathic surgery. A systematic search for randomised controlled trials and retrospective studies was performed. For inclusion in the review, studies had to meet the following eligibility criteria according to the PICO framework: Patients: patients with orthognathic deformity and temporomandibular dysfunction (or temporomandibular osteoarthritis); Intervention: patients submitted to orthognathic surgery concomitantly with TMJ disjunction; Control: patients undergoing only orthognathic surgery with or without presurgical data; and Outcome: changes in temporomandibular joint position and volume. Nine studies met all the inclusion criteria and were selected for qualitative analysis. The results of this review show that simultaneous articular disc repositioning and orthognathic surgery provide better results in patients with preoperatively diagnosed condylar osteoarthritic changes. In conclusion, condylar remodelling (resorption/deposition) and its extent are determined by the direction of condylar displacement during surgery. Other factors such as age are also associated with the development of condylar resorption.

Management of subcondylar fracture by intraoral approach.

Condylar fracture osteosynthesis is nowadays commonly practiced, but only a few studies report the intraoral approach with angulated devices. Subcondylar fractures with little or lateral displacement can be treated using an intraoral approach with satisfactory results. The advantages of this approach are the absence of visible scars, the avoidance of facial nerve injury inherent to the extraoral approach, quick access to the fracture, and a reduced risk of infection. The authors report a case of subcondylar fracture treated through an intraoral approach. Despite the considerable lateral dislocation of the condyle, treatment consisted of the reduction of the fracture and osteosynthesis with a trapezoidal condylar plate using an intraoral surgical approach.

Calcifying cystic odontogenic tumor radiographically mimicking a sinus mucocele.

The calcifying cystic odontogenic tumor or Gorlin cyst is an uncommon lesion with a variable clinical behavior and considerable histopathologic diversity. The authors report a case of calcifying cystic odontogenic tumor that was being treated as a maxillary sinus mucocele. The possibility of mimicking numerous odontogenic and nonodontogenic lesions makes the calcifying cystic odontogenic tumor difficult for a clinical diagnosis. The present case demonstrates that a specific knowledge in oral pathology is required to differentiate odontogenic lesions.

Destructive aneurysmal bone cyst of the mandible.

Aneurysmal bone cyst (ABC) is an uncommon osteolytic lesion of the bones, usually affecting the long bones and spine. The lesion is rare in the jaws and is found most commonly in the body and ramus of the mandible. In some cases, ABCs may be present as rdestructive lesions simulating malignancies. In these cases, a careful diagnosis should be done, including in the differential diagnosis malignant tumors such as telangiectasic osteosarcoma and intraosseous fibrosarcoma. Removing the lesion is usually easy if it is confined within the bone, but it may prove difficult if the lesions are multilocular, expansive, divided by multiple bony septa, or destructive or when the cortical is perforated. Therefore, the surgical treatment of the destructive ABCs should be more radical.

Prediction of postoperative facial swelling, pain and trismus following third molar surgery based on preoperative variables.

OBJECTIVE: This paper investigates the relationship between preoperative findings and short-term outcome in third molar surgery. STUDY DESIGN: A prospective study was carried out involving 80 patients who required 160 surgical extractions of impacted mandibular third molars between January 2009 and December 2010. All extractions were performed under local anesthesia by the same dental surgeon. Swelling and maximal inter-incisor distance were measured at 48 h and on the 7th day postoperatively. Mean visual analogue pain scores were determined at four different time periods. RESULTS: One-hundred eight (67.5%) of the 160 extractions were performed on male subjects and 52 (32.5%) were performed on female subjects. Median age was 22.46 years. The amount of facial swelling varied depending on gender and operating time. Trismus varied depending on gender, operating time and tooth sectioning. The influence of age, gender and operating time varied depending on the pain evaluation period (p < 0.05). CONCLUSIONS: Short-term outcomes of third molar operations (swelling, trismus and pain) differ depending on the patients' characteristics (age, gender and body mass index). Moreover, surgery characteristics such as operating time and tooth sectioning were also associated with postoperative variables.

Survey on complications of orthognathic surgery among oral and maxillofacial surgeons.

BACKGROUND: Orthognathic surgery is performed to correct dentofacial and craniofacial deformities and improve facial aesthetics, occlusal relations, and the functionality of the stomatognathic apparatus. However, complications in orthognathic surgery may occur at any time during the course of treatment: in the preoperative judgment and planning, during perioperative orthodontic care, or intraoperatively. The aim of the current study was to survey oral and maxillofacial surgeons regarding the main complications of orthognathic surgery. METHODS: One hundred oral and maxillofacial surgeons with at least 5 years of experience in dentofacial management were interviewed during a Brazilian national oral and maxillofacial surgery meeting by 2 calibrated postgraduate students, using a questionnaire addressing complications of orthognathic surgery. RESULTS: No significant differences were found regarding educational background or postgraduate degrees among the oral and maxillofacial surgeons (P > 0.05). A total of 28.0% had no experience with vertical osteotomy of the mandibular ramus, 35.0% had no experience with subapical osteotomy of the mandible, and 4.0% had no experience with genioplasty. All participants had experience with sagittal osteotomy of the mandibular ramus. Among mandible procedures, the most common complication was nerve damage, followed by unfavorable osteotomy. The most common Le Fort I complication was also nerve damage (40%), followed by hemorrhage (29%). Regarding osteosynthesis fixation, fractures of the material were more frequent in the mandible (23%) and maxilla (10%). CONCLUSIONS: Most oral and maxillofacial surgeons experienced similar orthognathic surgery complications to those reported in retrospective studies.

Intraoral approach for removal of large sialolith in submandibular gland.

Sialolithiasis is a benign pathology that occurs most frequently in the submandibular salivary gland due to its anatomic features. Depending on the size and degree of calcification, a sialolith can be visible in radiographic examinations. Patients commonly experience pain and/or edema when the ducts are obstructed. The authors report two cases of sialolithiasis of the submandibular gland after searching for the source of swelling in the submandibular region. The diagnosis was confirmed by clinical and tomographic examinations. Despite the considerable size of the sialoliths, treatment consisted of the removal of the calcified mass using an intraoral surgical approach. The prognosis is often good and there is generally no recurrence of the condition.

Hemodynamic changes comparing lidocaine HCl with epinephrine and articaine HCl with epinephrine.

BACKGROUND: The aim of the present study was to analyze hemodynamic changes after the administration of either 2% lidocaine with epinephrine 1:100,000 (L100) or 4% articaine with epinephrine 1:200,000 (A200) in the surgical removal of symmetrically positioned lower third molars. METHODS: A prospective, randomized, double-blind, clinical trial was carried out involving 43 patients. Each patient underwent 2 surgeries on different occasions-one under local anesthesia with L100 and the other with A200. The following parameters were assessed at 4 different times: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product (RPP); and pressure rate quotient (PRQ). RESULTS: No hypertensive peak was observed in systolic, diastolic, and mean blood pressure at any evaluation time. Moreover, the type of anesthetic solution did not affect diastolic blood pressure, oxygen saturation or PRQ during the surgeries. Statistically significant differences between groups were detected with regard to heart rate and RPP (P < 0.05). CONCLUSIONS: The epinephrine concentration (1:100,000 or 1:200,000) and local anesthetic solutions used (2% lidocaine or 4% articaine) influenced hemodynamic parameters without perceptible clinical changes in healthy patients undergoing lower third molar removal.

One-stage treatment of hemimandibular hyperplasia.

Hemimandibular hyperplasia (HH) is a rare, self-limiting process manifesting between the first and third decades of life. HH causes facial asymmetry and derangement of the occlusion. Management involves resection of the condylar head and orthognathic surgery. This paper describes the case of a 38-year-old woman with spontaneous onset HH over a span of approximately 30 years. The condition was managed with resection of the condyle with simultaneous orthognathic surgery. The patient is currently satisfied with her appearance and function, and there are no signs of recurrence after 2 years.

Influence of helmet use in facial trauma and moderate traumatic brain injury victims of motorcycle accidents.

OBJECTIVE: The objective of this research was to study the influence of the use of helmet in facial trauma victims of motorcycle accidents with moderate traumatic brain injury. METHODS: We retrospectively reviewed the incidence of facial injuries in helmeted and nonhelmeted victims with moderate traumatic brain injury at a referral trauma hospital. RESULTS: The sample consisted of 272 patients predominantly men (94.5%) and between 21 and 40 years old (62.9%). The majority of patients were using helmet (80.1%). The occurrence of facial fractures was most frequent for zygomatic bone (51.8%), followed by mandible (18.8%) and nasal bones (9.2%). CONCLUSIONS: Individuals in the most productive age group are most affected, which causes a great loss to financial and labor systems. It is important to take measures to alert the public regarding the severity of injuries likely to occur in motorcycle-related accidents and ways to prevent them.

Avulsion of globe following maxillofacial trauma.

Avulsion of the eye globe is a rare condition that is unexpected in maxillofacial trauma and results from severe trauma to the orbit and face. A search of the literature reveals very few reported cases. The present article reports a case of this singular, challenging condition and comments on several other related causes, pathophysiology mechanisms, risks, complications, and management.

Oral lesions in renal transplant.

To prevent rejection of kidney transplants, patients must be kept in immunosuppressive therapy for a long time, which includes the use of drugs such as cyclosporine, azathioprine, cyclophosphamide, and prednisone. The action of these drugs reduces the general immune response of transplant patients and thus increases their susceptibility to infections. Moreover, these drugs increase the potential of developing lesions. Therefore, oral hygiene in kidney transplant recipients contributes to maintenance of the transplanted organ and its function. Thus, an investigation of oral lesions could be counted as a notable work. The aim of this study was to investigate oral lesions in a group of 21 kidney transplant patients under immunosuppressive therapy attended during a 1-year period in the Nephrology Department of the Federal University of Sergipe, Brazil. Data related to sex, age, etiology of renal disease, types of renal transplant, time elapsed after transplantation, immunosuppressive treatment, use of concomitant agents, and presence of oral lesions were obtained. All patients received a kidney transplant from a living donor, and the mean posttransplantation follow-up time was 31.6 months; 71.5% used triple immunosuppressive therapy with cyclosporine A, azathioprine, and prednisone. Ten patients were also treated with calcium-channel blockers. Of the 21 transplant patients, 17 (81%) presented oral lesions. Gingival overgrowth was the most common alteration, followed by candidiasis and superficial ulcers. One case of spindle cell carcinoma of the lower lip was observed. Oral cavity can harbor a variety of manifestations related to renal transplantation under immunosuppressive therapy.

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.

Hemodynamic changes comparing 2% lidocaine and 4% articaine with epinephrine 1: 100,000 in lower third molar surgery.

BACKGROUND: An increase in blood pressure during dental treatment has been investigated with regard to potential medical risks since previous studies suggest that dental procedures may cause stress to the patient and, consequently, the cardiovascular system. The aim of the present study was to analyze hemodynamic changes following the administration of either 2% lidocaine (L100) or 4% articaine (A100) (both with epinephrine 1:100,000) in the surgical removal of symmetrically positioned lower third molars. METHODS: A prospective, randomized, double-blind, clinical trial was carried out involving 47 patients. Each patient underwent 1 surgery at each of 2 appointments--one under local anesthesia with L100 and the other with A100. The following parameters were assessed at 4 different times: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product; and pressure rate quotient. RESULTS: No hypertensive peak was observed in systolic, diastolic, and mean blood pressure at any evaluation time. Moreover, the type of anesthetic solution did not affect diastolic blood pressure, heart rate, or oxygen saturation during the surgeries. The pressure rate quotient was the only parameter to exhibit statistically significant differences between groups at different evaluation times (P < 0.05). CONCLUSIONS: The hemodynamic parameters evaluated in third molar surgery with 2% lidocaine and 4% articaine (both with epinephrine 1:100,000) did not show significant differences.

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.

Horizontal maxillary osteotomy approach for resection of juvenile nasopharyngeal angiofibroma.

Juvenile angiofibroma is a benign fibroangiomatous tumor of relatively rare occurrence, developing most frequently in male adolescents. It has local characteristics of aggressiveness and expansion. The treatment of choice is surgical excision. In this article, the advantages and disadvantages of the surgical technique using the Le Fort I osteotomy are described, and the literature correlated with 2 case reports.

Treatment of zygomatic arch fracture with lag screws.

Zygomatic arch fractures often occur as part of a zygoma fracture or Le Fort type III fractures of the maxillary. Isolated fractures of the zygomatic arch comprise around 10% of all zygoma fractures. The main etiologic factors are traffic accidents, falls, assaults, and sport accidents. Treatment may involve minimally invasive surgical procedures for slightly dislocated fractures or surgery with more extensive access for large dislocations of bone segments. This article reports the case of a 41-year-old male victim of physical aggression to the face with a steel sickle with an exposed, unstable fracture of the zygomatic arch. The patient underwent general anesthesia, and after the reduction of the fractures, the bone segments were fixed with 2.0-mm screws.