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O presente artigo aborda o trabalho de aproximação facial forense de uma vítima da Batalha de Gotland, ocorrida em 1361 na ilha de mesmo nome, localizada na Suécia. Além de reconstruir o aspecto do indivíduo em vida, o trabalho buscou apresentar o ferimento recebido por um objeto cortante, ao ser golpeado na região frontal da face.

The primary correction of congenital complete unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) is challenging due to inherent lack of palatal tissue and small extent of the palatal shelves at birth. The tissue deficiency affects the nasal mucosa, maxillary bone and palatal mucosa. This condition has driven the evolution of several surgical and non-surgical techniques for mitigating the inherent problem of anatomical deficits. These techniques share the common principle of altering the neighboring tissues around the defect area in order to form a functional seal between the oral and nasal cavity. However, there is currently no option for rectifying the tissue deficiency itself. Investigations have repeatedly shown that despite the structural tissue deficiency of the cleft, craniofacial growth proceeds normal if the clefts remain untreated, but the cleft remains wide. Conversely, craniofacial growth is reduced after surgical repair and the related alteration of the tissues. Therefore, numerous attempts have been made to change the surgical technique and timing so as to reduce the effects of surgical repairs on craniofacial growth, but they have been only minimally effective so far. We have determined whether the intrinsic structural soft and hard tissue deficiency can be ameliorated before surgical repair using the principles of periosteal distraction by means of magnetic traction. Two three-dimensional maxillary finite element models, with cleft patterns of UCLP and BCLP, respectively, were created from computed tomography slice data using dedicated image analysis software. A virtual dental magnet was positioned on either side of the cleft at the mucoperiosteal borders, and an incremental magnetic attraction force of up to 5 N was applied to simulate periosteal distraction. The stresses and strains in the periosteal tissue induced by the magnet were calculated using finite element analysis. For a 1 N attraction force the maximum strains did not exceed 1500 &micro, strain suggesting that adaptive remodeling will not take place for attraction forces lower than 1 N. At 5 N the regions subject to remodeling differed between the UCLP and BCLP models. Stresses and strains at the periosteum of the palatal shelf ridges in the absence of compressive forces at the alveolar borders were greater in the UCLP model than the BCLP model. The findings suggest that in newborns with UCLP and BCLP, periosteal distraction by means of a magnetic 5 N attraction force can promote the generation of soft and hard tissues along the cleft edges and rectify the tissue deficiency associated with the malformation.

Background: Adult patients presenting with skeletal discrepancies may refuse surgical intervention. Materials and methods: Thirty-two patients who declined orthognathic correction of their maxillo-mandibular dysplasia and who were without signs of temporomandibular dysfunction (TMD) were offered mandibular repositioning as a non-invasive alternative. Simulating a skeletal correction, it was explained that the approach was based on results described in case reports. Before commencing treatment, initial records, lateral and frontal head films, study casts and photos were obtained (T0) and the mandible was repositioned to camouflage a retrognathic skeletal discrepancy or a mandibular transverse asymmetry by means of an occlusal build-up using Triad™ gel. Results: Three months later (T1), 23 patients had adapted to the new occlusion reflected by an absence of functional disturbance and without fracture of the composite occlusal build-up. Mandibular position in these patients was maintained by additional orthodontic treatment and an adjustment of the occlusion to the built-up postured position (T1). The skeletal changes occurring during repositioning were assessed on sagittal and frontal head films while intra-articular changes occurring during a two-year follow-up period (T2) were evaluated on images constructed from CBCT scans. No significant change, either in the direction of relapse or in the direction of further normalisation of condylar position, were observed during the two-year observation period. Conclusion: Mandibular repositioning is a non-invasive intervention that may be considered a valid alternative to surgery in selected patients. Morphological variables from the radiographs taken at T0 and the results of the initial clinical evaluation of dysfunction yielded only vague and insignificant indicators regarding the predictability of the adaptation. A CBCT scan at T0 might have contributed to the identification of the patients who would likely accept the repositioning.