Metastasis of Prostate Adenocarcinoma in the Mandible: Rare Occurrence in Maxillary Bones.

OBJECTIVE: This article describes the case report of a prostate adenocarcinoma in the mandible. BACKGROUND: Prostate adenocarcinoma is a malignant tumor common in men from the fourth decade of life. The occurrence of oral metastatic lesions is rare. CASE REPORT: A 78-year-old male patient was referred to the oral and maxillofacial surgery service of the Pontifical Catholic University of Rio Grande do Sul for complaints of painless volume increase in the mandible. The diagnosis through the association of clinical, radiographic, and histopathological examination with the patient's health history determined that the lesion was prostatic adenocarcinoma metastasis. CONCLUSION: Despite the rare occurrence of metastases in the oral region, the dental surgeon should be aware of the possibility for correct diagnostic conduction and, subsequently, the institution of treatment in the early stages of disease.

Temporal Muscle Flap as a Treatment of an Extensive Cleft Palate in an Adult Patient.

For the management of cleft palate, the surgical approach has been suggested at an early stage even in childhood, varying in the number of interventions. Once the interventions are not performed at appropriate times, such as sequences that may accompany specific psychological, functional, and aesthetic effects. Since it has been indicated, temporal muscle flap is a technique with satisfactory results for a resolution of extensive clef palate in adult patients. The purpose of this paper is reporting a case of temporal muscle flap in the soft and hard palate of an adult with a reconstruction of the donor area with a titanium mesh. A 37 year old male patient with cleft lip/palate, complained of difficulty in speech, chewing, swallowing, and breathing. Clinically, it was observed oroantral communication in the region of the hard and soft palate, with a previous cheiloplasty. A temporal rotation was planned to close the fissure for the treatment. The modified coronal approach was used. Temporal muscle traction and its interposition in the palate region were performed through the tunneling technique, and mass suturing was performed. After 3 years, he presented satisfactory results, with the improvement of the quality of life, as well as the area of exposure. In conclusion, since it has been indicated, temporal muscle flap is a technique with satisfactory results for a resolution of extensive cleft palate in adult patients.

Juvenile Nasopharyngeal Angiofibroma With Sphenoid Sinus Invasion and Protrusion: Treatment Approach With Le Fort I Osteotomy.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor that occurs predominantly in young males. The authors report the case of a 22-year-old male patient who presented with a painless, exophytic tumor mass protruding through the right nostril, with anterior lateral extension associated with severe posterior involvement, erosion of the sphenoid bone to the right of the pterygoid process, and significant epistaxis. The preoperative evaluation, surgical approach, postoperative results, and a review of the literature are presented. The surgical approach with Le Fort I osteotomy was designed to facilitate surgical access to the tumor in the nasal cavity. Before down-fracture of the maxilla, plates were placed for fixation and holes were made to produce reference points for restoration of normal anatomy after tumor removal. Although the literature describes the use of nonsurgical therapies, it is well established that surgical treatment is the best option for patients with JNA. Treatment also requires preoperative embolization to avoid bleeding and ensure safety during tumor resection. Long-term imaging follow-up every 6 to 8 months for at least 3 years after surgery is needed for detection of residual tumor/recurrence. The modified technique used here together with preoperative embolization was essential to successful outcome.

Use of Recombinant Human Bone Morphogenetic Protein-2 Associated With Lyophilized Bovine Bone in Reconstruction of Atrophic Maxilla.

Cases of severely atrophic edentulous maxilla require reconstruction techniques employing bone grafts to promote adequate bone dimension for the successful placement of dental implants for prosthetic rehabilitation that reestablishes the patient's function and aesthetics. This study aims to present a severely atrophic edentulous maxilla reconstruction with the off-label use of recombinant human bone morphogenetic protein type 2 (rhBMP-2) associated with lyophilized particulate bovine bone xenograft for the prosthetic rehabilitation with osseointegrable dental implants. The paper describes a case of severely atrophic edentulous maxilla in a 42-year-old woman referred to the dental school with complaint of failure in adaptating to the dentures. The patient reported 27 years of maxilla edentulism and consecutive treatment failures, so the proposed therapy was the reconstruction of the maxilla with an association of rhBMP-2 and lyophilized bovine bone xenograft for increasing bone volume and further prosthetic rehabilitation with osseointegrated dental implants. The present report illustrates a case of atrophic edentulous maxilla in which the off-label use of rhBMP-2 was successful and the patient's prosthetic rehabilitation could be concluded. The 8 dental implants received prosthetic functional load during 1 year of follow-up with no complications. Based on the case presented, the association between rhBMP-2 and a bovine bone xenograft could be considered a viable option for the reconstruction of atrophic edentulous maxilla. After a year of functional prosthetic load follow-up, the patient is asymptomatic and satisfactorily adaptated to the prosthesis, which restored her functional and aesthetic demands.

Anterior Skull Base Tumors: The Role of Transfacial Approaches in the Endoscopic Era.

The basis of craniofacial tumor surgery is complete surgical extirpation, preferably en bloc or with free borders. Craniofacial techniques are the gold standard and primary strategies in the treatment of anterior skull base tumors. In the last decade, the reports favoring results of endoscopic techniques have increased. One could conclude that the classical transfacial approaches might become useless, but, in fact, there is little research comparing these techniques.In this article, the authors present their experience with combined craniofacial resection of anterior craniofacial skull base tumors in 9 consecutive patients between January 2013 and July 2015. This article aims to review some of the traditional transfacial approaches, illustrating them with this series of surgical patients. Benefits and drawbacks of these approaches are discussed.

Giant Peripheral Temporomandibular Osteoma With Immediate Reconstruction of Mandible.

Osteoma is a benign osteogenic tumor, which is characterized the slow-growing proliferation of compact or cancellous bone. The etiology of the lesion is not well established. Among the hypotheses, the following are related: a traumatic factor, infectious processes, or true neoplasm due to the origin of cartilaginous cells. It can present at any age, usually in young adult individuals, with equal prevalence in both sexes. The clinical characteristics of the peripheral osteoma are represented by slow asymptomatic growth, which leads to swelling and, thus, facial asymmetry. When it is related to the mandibular condyle, this growth can cause functional impairment, such as malocclusion, temporomandibular joint dysfunction, and even limited mouth-opening owing to ankylosis.

Assessment of the Postoperative Stability of Mandibular Orthognathic Surgery for Correction of Class III Skeletal Malocclusion.

To assess the stability of mandible position after orthognathic surgery for correction of class III skeletal malocclusion. Twenty adult males, aged 18 to 40 years, with Angle class III skeletal malocclusion underwent preoperative orthodontic treatment for elimination of dental compensations followed by combined maxillomandibular surgery with rigid internal fixation. Lateral cephalograms from each patient, obtained in the natural head position before surgery, immediately after surgery, and at 6-month follow-up, were retrieved from the files of the Pontifical Catholic University of Rio Grande do Sul outpatient Oral and Maxillofacial Surgery clinic and compared. Comparison of craniometric landmark measurements showed that the precision of mandibular setback was compromised in the horizontal plane, with a mean mandibular relapse of 37.75% at point B and 45.85% at point Pg. Improved intercuspation and adaptation of the musculature to the new position of the jaws after orthognathic surgery lead to counterclockwise rotation of the mandible, ultimately displacing the mandible more anteriorly than desired.

Comparison of Neck Screw and Conventional Fixation Techniques in Mandibular Condyle Fractures Using 3-Dimensional Finite Element Analysis.

PURPOSE: To compare the mechanical stress on the mandibular condyle after the reduction and fixation of mandibular condylar fractures using the neck screw and 2 other conventional techniques according to 3-dimensional finite element analysis. MATERIALS AND METHODS: A 3-dimensional finite element model of a mandible was created and graphically simulated on a computer screen. The model was fixed with 3 different techniques: a 2.0-mm plate with 4 screws, 2 plates (1 1.5-mm plate and 1 2.0-mm plate) with 4 screws, and a neck screw. Loads were applied that simulated muscular action, with restrictions of the upper movements of the mandible, differentiation of the cortical and medullary bone, and the virtual "folds" of the plates and screws so that they could adjust to the condylar surface. Afterward, the data were exported for graphic visualization of the results and quantitative analysis was performed. RESULTS: The 2-plate technique exhibited better stability in regard to displacement of fractures, deformity of the synthesis materials, and minimum and maximum tension values. The results with the neck screw were satisfactory and were similar to those found when a miniplate was used. CONCLUSION: Although the study shows that 2 isolated plates yielded better results compared with the other groups using other fixation systems and methods, the neck screw could be an option for condylar fracture reduction.

Modified submandibular access for open reduction and internal rigid fixation in condylar fractures.

PURPOSE: The purpose of the present study was to describe a surgical technique for treatment of condylar fractures through the modified submandibular access, by means of a small incision in the mandibular angle that promotes a dissection between the parotideomasseteric and the transmasseteric fascia in a quick way and with low morbidity. Fixation may be made with plates and screws according to the technique prescribed by the surgeon. METHODS: Owing to the high incidence and importance of condylar fractures, various therapeutic methods have been described and may be divided into conservative and surgical methods. Various open surgical techniques are recommended in the treatment of mandibular condylar fractures, and the methods of internal rigid fixation and surgical accesses vary. The techniques that offer an adequate treatment of these fractures with shorter surgical time very often remain matters of controversy among surgeons. The procedure must guarantee maximum safety for the facial nerve and must provide a good cosmetic outcome, besides providing a suitable surgical field. RESULTS: A modified submandibular access is a safe and reproducible procedure providing excellent functional results. This procedure has been routinely performed in our department.

Reduction and fixation of mandibular condylar fractures with neck screw.

PURPOSE: The purpose of the present study is to describe a surgical technique for the treatment of condylar fractures using an intramedullary screw. MATERIALS AND METHODS: The treatment of these fractures remains very controversial. At the time of the choice of the surgical treatment, a wide range of accesses and of techniques of reduction and fixation is used, depending on the type of the fracture, the experience of the surgeon, and aesthetical issues. Among the difficulties posed by this type of fracture is the correct repositioning of the fractured condylar portion for which we have developed a technique that uses a neck screw, with intramedullary insertion. Because this is a round-headed screw, it is necessary to install a plate, which may be straight or "L" shape, and is placed perpendicular and superjacent to the screw so that it does not allow the rotation of the condylar portion. RESULTS: Neck screw can be used, resulting in satisfactory stability, for the reduction and fixation of these fractures.

Histologic and biomechanical evaluation of 2 resorbable-blasting media implant surfaces at early implantation times.

This study evaluated 3 implant surfaces in a dog model: (1) resorbable-blasting media + acid-etched (RBMa), alumina-blasting + acid-etching (AB/AE), and AB/AE + RBMa (hybrid). All of the surfaces were minimally rough, and Ca and P were present for the RBMa and hybrid surfaces. Following 2 weeks in vivo, no significant differences were observed for torque, bone-to-implant contact, and bone-area fraction occupied measurements. Newly formed woven bone was observed in proximity with all surfaces.

The Hyrax appliance with tooth anchorage variations in surgically assisted rapid maxillary expansion: a finite element analysis.

PURPOSE: It is known that a correct transverse maxillary dimension is a key factor for a stable occlusion, which brings functional and esthetic benefits for the patient. In patients presenting maxillary atresia and the completion of bone growth, a highly recommended option for correction is the surgically assisted rapid maxillary expansion (SARME) associated with the Hyrax appliance. The objective of this study was to evaluate the influence of tooth anchorage variations of the Hyrax appliance in SARME through finite element analysis, evaluating which anchorage option might be associated with more effective orthopedic results with less undesired side effects. METHODS: Five different dental anchoring conditions for the Hyrax appliance were simulated through FE analysis applying premolars and molars as anchorage, having the same force applied by the activation of the Hyrax screw (0.5 mm) in all groups. The maxillary displacement results (axes X, Y, and Z) and generated stresses for both teeth and maxillary bone were calculated and represented using a color scale. RESULTS: All groups presented significant bone displacement and stress concentration on anchoring teeth, with the group presenting anchorage in the 1st and 2nd molars showing the greatest maxillary horizontal displacement (axis X) and suggesting the lowest tendency of dental vestibular inclination. CONCLUSIONS: Variations in dental anchorage might substantially affect the maxillary bone and teeth displacement outcome. The protocol for the Hyrax apparatus in SARME applying the 1st and 2nd molars as anchorage might generate less tilting and inclination of the anchoring teeth.

Assessment for treatment of tripod fractures of the zygoma with microcompressive screws.

PURPOSE: The present prospective study sought to evaluate a new rigid internal fixation device called a "neck screw," which was applied to patients presenting with a tripod fracture of the zygomaticomaxillary complex. PATIENTS AND METHODS: Seventeen patients with tripod fractures received surgical treatment from 2007 to 2010, and had their zygomaticomaxillary complex monofragments fixed using the neck screw protocol. The adequacy of fracture reduction, stability of the zygomatic monofragment after fixation, cosmetic outcomes, and postoperative complications were used to determine the efficacy of this protocol. The stability provided by the neck screw was evaluated by computed tomography (CT) scans by comparing the immediate postoperative distances between the fractured bone segments (control group) with those distances measured on CT scans obtained 5 weeks later (late group). RESULTS: The average distance observed between the fractured ends on the immediate postoperative CT scan was less than 0.58 mm, demonstrating adequate fracture reduction. No significant changes were seen in these postoperative values after 5 weeks (Wilcoxon test, P = 1.0000), demonstrating no displacement of the zygomaticomaxillary complex monofragment after fixation using the neck screw. CONCLUSIONS: The proposed surgical treatment proved efficient in 17 patients. The fixation stability provided by the neck screw was confirmed by subsequent CT scan measurements, statistical analysis, and clinical follow-up during the postoperative period, in which patients showed no significant associated complications, facial asymmetry, enophthalmos, or diplopia.

Oral myiasis.

Human myiasis results from parasitic tissue infestation by maggots. It often develops in open or necrotic wounds and has its highest prevalence among poor populations in tropical regions. This study reports 2 cases of human myiasis in the oral cavity and describes its clinical aspect and treatment.

A preliminary study of hardness and modulus of elasticity in sheep mandibles submitted to distraction osteogenesis and low-level laser therapy.

OBJECTIVES: To investigate the quality of newly formed bone in sheep mandibles submitted to distraction osteogenesis and low-level laser therapy (LLLT), based on hardness and modulus of elasticity values. The ideal moment for laser application (during the latency/activation period vs. during the bone consolidation period) was also evaluated. Computed tomography imaging was used to assess relapse as a result of early device removal. STUDY DESIGN: Extraoral distraction devices were placed in five sheep so as to achieve 1.5 cm of lengthened bone in 60 days. Distraction devices were removed 50, 40, and 33 days after surgery. Four animals were treated with LLLT, at different times, and one was used as control (no LLLT). RESULTS: When applied during the bone consolidation period, LLLT caused an increase in hardness and modulus of elasticity values. On the other hand, animals irradiated with LLLT during the latency/activation period presented a delay in bone healing. A period of consolidation of 13 days (early device removal) was associated with relapse. CONCLUSIONS: Nanoindentation tests were able to detect slight abnormalities in bone metabolism and proved to be important tools for the assessment of bone quality following distraction osteogenesis. LLLT provided increased benefits when applied during the bone consolidation period, once it promoted an increase in hardness and modulus of elasticity values. According to our results, the bone consolidation period should be of at least 3 weeks, so as to prevent relapse.

Treatment of comminuted mandibular fractures: a critical review.

The treatment of comminuted fractures of the mandible is challenging due both to the severity of the injuries generally associated with this type of fracture, and the lack of consensus as to the most appropriate treatment method.There are two distinct approaches for treating comminuted fractures of the mandible: closed reduction with maxillomandibular fixation (MMF) - the oldest and classical treatment - and open operation and internal fixation. The morbidity rate of closed reduction is lower but, with the advent of modern anaesthesia and antibiotics, open surgery has become more frequent. Stable internal fixation (SIF) is acheived using plates, miniplates and/or screws. The advantage of this approach is that there is a more precise reduction of the fragments, with the possibility of early function by eliminating or reducing the time of MMF. This paper reviews the main advantages, disadvantages and differences between the two techniques.

Oral health-related quality of life in women with temporomandibular joint disk anterior displacement before and after disk repositioning and anchoring surgery assessed with the Oral Health Impact Profile (OHIP-14).

OBJECTIVES: The aim of this study was to assess and compare oral health-related quality of life (OHRQOL) in women with temporomandibular joint (TMJ) disk displacement without reduction, before disk repositioning and anchoring surgery, in short-term follow-up, in different age groups, and with use of the Oral Health Impact Profile (OHIP-14). STUDY DESIGN: Fifty women ages between 17 and 60 years were divided into 4 age groups: 17-27, 28-38, 39-49, and 50-60 years. All the patients were asked to answer the OHIP-14 form before surgery and during their short-term follow-up. Seven domains of OHRQOL were rated on a 5-point Likert scale from 0 (never) to 4 (very often). Domains' scores and total OHIP-14 were compared between times by using Student's t test in the whole sample and in the 4 age groups. RESULTS: Both the whole sample and the age groups (17-27, 28-38, 39-49 years) showed a statistically significant decrease in all scores (P < .01). The age group 50-60 years showed a decrease in scores significant only in functional limitation (P = .05) CONCLUSIONS: TMJ disk anterior displacement had a negative impact on women's OHRQOL because of physical pain, physical disability, and psychological discomfort. TMJ disk repositioning and anchoring surgery improved overall OHRQOL in patients between 17 and 49 years of age; however, in patients between 50 and 60 years of age, there was improvement only in physical pain.

The treatment of condylar fractures: to open or not to open? A critical review of this controversy.

The treatment of condylar process fractures has generated a great deal of discussion and controversy in oral and maxillofacial trauma and there are many different methods to treat this injury. For each type of condylar fracture, the techniques must be chosen taking into consideration the presence of teeth, fracture height, patient's adaptation, patient's masticatory system, disturbance of occlusal function, deviation of the mandible, internal derangements of the temporomandibular Joint (TMJ) and ankylosis of the joint with resultant inability to move the jaw, all of which are sequelae of this injury. Many surgeons seem to favor closed treatment with maxillomandibular fixation (MMF), but in recent years, open treatment of condylar fractures with rigid internal fixation (RIF) has become more common. The objective of this review was to evaluate the main variables that determine the choice of method for treatment of condylar fractures: open or closed, pointing out their indications, contra-indications, advantages and disadvantages.

Calcitonin: a non-invasive giant cells therapy.

This paper reports four cases of central giant cell granuloma (CGCG) treated with calcitonin, attesting the efficacy and safety of its use as the chosen therapy for large CGCG. Four patients presenting CGCG treated with calcitonin were included in this study. Salmon calcitonin was administered for 6-28 months. It was observed determination of clear lesion limits for surgery, reduction and limitation of lesions. In aggressive cases, the calcitonin therapy was an excellent option, since it does not harm the patient, and a far less aggressive, complementary surgery may be performed in certain cases, avoiding life-long sequelae.