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Lower third molar extraction is a common procedure in Oral and Maxillofacial Surgeons routine. However, even though this procedure is frequent, sometimes its course is unexpected. In this scenario, some developed classifications help to predict the difficulty level for such extractions. Objective This study aimed to verify the association of Pell and Gregory classifications I and II and surgical difficulty through lower third molar extractions. Methods Voluntary patients from the Dentistry Course of the State University of Rio Grande do Norte, between 16 and 45 years of age, who met the inclusion criteria, had their third molars classified according to Pell and Gregory. Results A total of 42 elements were extracted. There were no statistically significant differences for the correlation of Pell and Gregory classification with the surgical difficulty considering the variables such as surgery time (p=0.419), osteotomy needs (p=0.428) and number of anesthetic tubes (0.939). As for the need for odontosection, only when comparing the teeth classified as AI and IIA, the difference in favor of AI elements was statistically significant (p=0.008). There were no accidents or complications. Conclusions Pell and Gregory classification was not a good predictor of surgical difficulty, and further studies on this subject are recommended. RESUMO A exodontia dos terceiros molares inferiores é um procedimento comum na rotina dos Cirurgiões Bucomaxilofaciais. Entretanto, mesmo este procedimento sendo frequente, por vezes, o seu curso se mostra de forma inesperada. Neste cenário, algumas classificações desenvolvidas auxiliam na predição do nível de dificuldade para tais extrações. Objetivo Este trabalho objetivou, por meio de extrações de terceiros molares inferiores, verificar a associação das classificações I e II de Pell e Gregory e a dificuldade cirúrgica. Métodos Pacientes voluntários do Curso de Odontologia da Universidade do Estado do Rio Grande do Norte, entre a faixa etária de 16 a 45 anos, que se encaixaram nos critérios de inclusão, tiveram seus terceiros molares classificados de acordo com Pell e Gregory e extraídos. Resultados Um total de 42 elementos foram extraídos. Não existiram diferenças estatisticamente significantes para a correlação da classificação de Pell e Gregory com a dificuldade cirúrgica levando-se em conta as variáveis tempo de cirurgia (p = 0,419), necessidades de osteotomia (p= 0,428) e quantidade de anestubes (0,939), quanto a necessidade de odontossecção, apenas quando comparados os dentes classificados como IA e IIA, a diferença a favor dos elementos IA foi estatisticamente significativa (p = 0,008), inexistindo acidentes e complicações. Conclusão A classificação de Pell e Gregory não se mostrou como um bom preditor da dificuldade cirúrgica, sendo recomendado que novos estudos sejam realizados sobre essa temática.

A intubação submentoniana consiste em uma técnica de manutenção da via aérea que tem seu acesso cirúrgico situado na região submentual medial/paramedial, paralelamente à base da mandíbula. O seu principal objetivo é substituir a intubação nasotraqueal quando esta é contraindicada, surgindo como uma opção à traqueostomia, que seria o próximo passo nesses casos. Esse artigo é uma scoping review com o objetivo de descrever as evidências de forma a elucidar as dificuldades encontradas na intubaçãosubmentoniana no trauma facial. A estratégia de busca se deu nos bancos de dados SciELO, LILACS, PubMed, The Cochrane Library, Web of Science, SCOPUS, CINAHL e Academic Search Premier (via plataforma EBSCO), Biblioteca Digital de Teses e Dissertações USP,Busca Integrada USP e banco de teses CAPES, considerando elegíveis estudos primários, revisões,metanálises e/ou metassínteses,livros e guidelines, teses e dissertações, publicados em fontes indexadas ou na literatura cinzenta e nos idiomas português, inglês e espanhol. Na literatura revisada, foram encontrados 23 diferentes grupos de dificuldades relacionadas ao procedimento. Entre elas, destacam-se como as mais descritas os danos ao tubo endotraqueal e a dificuldade na passagem do tubo pela incisão submentoniana. Portanto, os estudos analisados demonstraram uma grande variedade de dificuldades relacionadas a vários aspectos intrinsecamente relacionados a realização do procedimento da intubação submentoniana Submental intubation consists of an airway maintenance technique that has its surgical access located in the medial / paramedial submental region, parallel to the base of the mandible. Its main objective is to replace nasotracheal intubation when it is impossible, appearing as an option to tracheostomy, which would be the next step in these cases. This article is a scoping review in order to describe the evidence in order to elucidate the difficulties encountered in submental intubation in facial trauma. The search strategy took place in the databases SciELO, LILACS,PubMed, The Cochrane Library, Web of Science, SCOPUS, CINAHL and Academic Search Premier (via EBSCO platform), Digital Library of Theses and Dissertations USP,USP Integrated Search and bank of CAPES theses, considering eligible primary studies, reviews, meta-analyzes and / or meta-syntheses, books and guidelines, theses and dissertations, published in indexed sources or in grayliterature and in Portuguese, English and Spanish. In the reviewed literature, 23 different groups of difficulties related to theprocedure were found. Among them, damage to the endotracheal tube and difficulty in passing the tube through the submental incision stand out as the most described. Therefore, the studies analyzed demonstrated a wide variety of difficulties related to several aspects intrinsically related to the performance of the submentonian intubation procedure

A miíase refere-se a um quadro amplamente associado à interação entre moscas e hospedeiros, resultando na infestação por lavas, as quais se alimentam de tecido vivo ou morto, gerando processo infeccioso. Tal quadro em cabeça e pescoço caracteriza casos ainda mais agravantes, exigindo medidas intervencionistas e preventivas imediatas. O presente trabalho descreve acerca de um caso de miíase, resultante de exposição prolongada de afecção gerada por trauma de viscerocrânio em paciente de 32 anos, vítima de acidente motociclístico, agravado por condições de higiene inapropriadas e o não tratamento da lesão. O paciente foi encaminhado ao bloco cirúrgico sob anestesia geral, o manejo escolhido foi remoção mecânica com auxílio de éter, com posterior administração de ivermectina, para remoção de larvas remanescentes, e cirurgia para redução das fraturas com fixação interna de mandíbula., Revista Portuguesa de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, v. 58 n. 1 (2020): Março

Myiasis refers to a condition widely associated with the interaction between flies and hosts, resulting in infestation by lavas, which feed on living or dead tissue, generating an infectious process. Such a head and neck condition characterizes even more aggravating cases, requiring immediate interventionist and preventive measures. The present work describes about a case of myiasis, resulting from prolonged exposure of a condition caused by viscerocranial trauma in a 32-year-old patient, victim of a motorcycle accident, aggravated by inappropriate hygiene conditions and the non-treatment of the injury. The patient was referred to the operating room under general anesthesia, the management chosen was mechanical removal with the aid of ether, with subsequent administration of ivermectin, to remove remaining larvae, and surgery for reduction of fractures with internal mandible fixation. La miasis se refiere a una afección ampliamente asociada con la interacción entre moscas y huéspedes, lo que resulta en la infestación por lavas, que se alimentan de tejido vivo o muerto, generando un proceso infeccioso. Tal condición de cabeza y cuello caracteriza casos aún más agravantes, que requieren medidas intervencionistas y preventivas inmediatas. El presente trabajo describe un caso de miasis, resultante de la exposición prolongada de una afección causada por un traumatismo viscerocraneal en un paciente de 32 años, víctima de un accidente de motocicleta, agravado por condiciones inadecuadas de higiene y el no tratamiento de la lesión. El paciente fue derivado al quirófano bajo anestesia general, el tratamiento elegido fue la extracción mecánica con ayuda de éter, con la administración posterior de ivermectina, para eliminar las larvas restantes y la cirugía para la reducción de fracturas con fijación mandibular interna. A miíase refere-se a um quadro amplamente associado à interação entre moscas e hospedeiros, resultando na infestação por lavas, as quais se alimentam de tecido vivo ou morto, gerando processo infeccioso. Tal quadro em cabeça e pescoço caracteriza casos ainda mais agravantes, exigindo medidas intervencionistas e preventivas imediatas. O presente trabalho descreve acerca de um caso de miíase, resultante de exposição prolongada de afecção gerada por trauma de viscerocrânio em paciente de 32 anos, vítima de acidente motociclístico, agravado por condições de higiene inapropriadas e o não tratamento da lesão. O paciente foi encaminhado ao bloco cirúrgico sob anestesia geral, o manejo escolhido foi remoção mecânica com auxílio de éter, com posterior administração de ivermectina, para remoção de larvas remanescentes, e cirurgia para redução das fraturas com fixação interna de mandíbula.

Introdução: Os bifosfonatos são medicamentos que objetivam reduzir a reabsorção óssea por provocarem a apoptose de osteoclastos. Por essa razão, são frequentemente empregados em pacientes com osteoporose e no tratamento do câncer. Contudo, apesar dos benefícios associados ao tratamento com bifosfonatos, esses medicamentos vêm sendo relacionados a osteonecrose maxilo-mandibular, materializando-se como um preocupante quadro de interesse à saúde pública. Objetivo: Apresentar um caso clínico de osteonecrose mandibular associada ao uso de bifosfanato, após extração de um elemento dentário, bem como contribuir com as discussões sobre as possibilidades terapêuticas desta enfermidade. Descrição do caso: Paciente do sexo masculino, 59 anos, encaminhado ao serviço de Cirurgia e Traumatologia Bucomaxilofacial dois meses após a extração do elemento dentário 45. O diagnóstico foi de Osteonecrose Maxilomandibular Relacionada a Bifosfonatos (OMRB), optando-se, inicialmente, pela remoção dos traumas existentes, como também o cuidado com a área exposta. Posteriormente, optou-se pela remoção do segmento ósseo necrótico. Conclusões: A complexa fisiopatologia da OMRB, exige dos cirurgiões dentistas a tomada de medidas em tempo oportuno e que cause o mínimo transtorno à vida dos pacientes. Assim, deve-se avaliar o estado da lesão, havendo indicação de terapia conservadora para os achados precoces. O desbridamento cirúrgico é aconselhado para o tratamento da doença avançada e não responsiva Introduction:Bisphosphonates are medications that aim to reduce bone resorption by causing osteoclast apoptosis. For this reason, they are often used in patients with osteoporosis and in the treatment of cancer. However, despite the benefits associated with treatment with bisphosphonates, these drugs have been linked to maxillomandibular osteonecrosis, materializing as a worrying picture of public health concern. Objective:To present a clinical case of mandibular osteonecrosis associated with the use of bisphosphateafter extraction of a dental element, as well as to contribute to the discussions about the therapeutic possibilities of this disease. Case description:Male patient, 59 years old, referred to the Buccomaxillofacial Surgery and Traumatology service, two months after extraction of the dental element 45. The diagnosis was Bisphosphonate-Related Maxillomandibular Osteonecrosis, initially performed, the removal of existing traumas, as well as care for the exposed area. Subsequently, it was decided to remove the necrotic bone segment. Conclusions: The complex pathophysiology of the type of osteonecrosis studied requires that dental surgeons take measures in a timely manner and cause the least disturbance to patients' lives. Thus, the condition of the lesion should be assessed, with an indication for conservative therapy for early findings. Surgical debridement is recommended for the treatment of advanced and unresponsive diseases

Peripheral odontoma is a very rare odontogenic hamartoma arising in soft tissues. Here, we report a case of peripheral odontoma in a pediatric patient and review the cases published in the literature. An 11-year-old male patient presented a nodular lesion in the anterior region of the palate for over 1 year. Under the clinical hypothesis of fibroma, an excisional biopsy was performed. Histopathological examination revealed the presence of tooth-like structures, formed by enamel, and dentin matrix, occasionally associated with the dental papilla and surrounding pulp tissue, thus, the histopathological diagnosis of peripheral odontoma was established. The patient has been undergoing follow-up for 6 months without any signs of lesion recurrence. Peripheral odontomas are uncommon lesions that usually affect young patients and display a preference for the maxilla and limited growth potential. The recognition of the clinical and histopathological features of the peripheral odontoma is indispensable for the establishment of its diagnosis.

SUMMARY: Mesenchymal cells (MCs) exhibit great regenerative potential due to their intrinsic properties and ability to restore tissue function, either directly through transdifferentiation or indirectly through paracrine effects. This study aimed to evaluate morphometric and phenotypic changes in MCs grown with facial nerve-conditioned medium in the presence or absence of fibroblast growth factor 2 (FGF-2). For quantitative phenotypic analysis, the expression of GFAP, OX-42, MAP-2, β-tubulin III, NeuN, and NF-200 was analyzed by immunocytochemistry. Cells cultured with facial nerve-conditioned medium in the presence of FGF-2 expressed GFAP, OX-42, MAP-2, β-tubulin III, NeuN, and NF-200. On average, the area and perimeter of GFAP-positive cells were higher in the group cultured with facial nerve-conditioned medium compared to the group cultured with conditioned medium and FGF-2 (p=0.0001). This study demonstrated the plasticity of MCs for neuronal and glial lineages and opens up new research perspectives in cell therapy and trans.differentiation.

Injuries to the face represent a significant risk to the health of the individual, mainly because of its significance, both functional, because it houses sensory organs and part of the respiratory and digestive systems, as well as esthetic. In this scenario, gunshot wounds in this location cause great concern on account of the magnitude of the damage, and the Oral and Maxillofacial Surgery and Traumatology team must act so that the treatment enables the rehabilitation of the patient in the shortest possible time, with a minimum of complications and sequelae. The objective of this study is to report a clinical case of a 19-year-old female patient with a comminuted fracture of the mandible body caused by a firearm projectile, treated immediately with stable internal fixation using the 2.00 mm plate-screw system for simplification of the fracture and a 2.4 mm reconstruction locking-plate on the bone gap. Relevant aspects of the surgical technique and tactics are reviewed and long-term follow-up of the patient is presented As lesões em face representam um grande agravo à saúde do indivíduo, principalmente pela sua significância, tanto funcional, por abrigar órgãos sensitivos e parte dos sistemas respiratório e digestório, quanto estético. Neste cenário, ferimentos por arma de fogo neste local, geram grande preocupação pela magnitude de seus danos, devendo a equipe de Cirurgia e Traumatologia Bucomaxilofacial agir para que o tratamento possibilite a reabilitação do paciente no menor tempo possível, com o mínimo de complicações e sequelas. O objetivo desse trabalho é relatar um caso clínico de uma paciente de 19 anos de idade, apresentando uma fratura cominutiva, com perda de substância, em corpo de mandíbula por projétil de arma de fogo, tratada de forma imediata, com fixação interna estável, utilizando o sistema placa-parafuso 2,0 mm para a simplificação da fratura e placa de reconstrução 2,4 mm locking sobre a lacuna óssea. Aspectos relevantes da técnica e tática cirúrgica são revistos e o acompanhamento da paciente em longo prazo é apresentado

Penetrating orbitocranial trauma is an infrequent episode, which may be caused by penetration of the most diverse foreign bodies such as knife, pencil and scissors that tend to take a direction into the orbital apex, with access to the cranial cavity and potential risk of cerebral lesion and mortality. It is essential to evaluate the tomographic images in order to establish the exact location of the foreign body, making it possible to check the entire trajectory of the object; also the possibility of performing an angiography should be considered for the initial analysis. The attempt to remove penetrating objects outside the operating room compromises patient’s safety; it may cause profuse hemorrhage since in most cases the object itself stops the hemorrhage. if there is no intracranial emergency, the orbital injury must be prioritized. This article reports the case of a patient submitted to facial injury by a motorcycle handlebar, in which the foreign body penetrated the orbital region into the cranial middle fossa.

Objetivos: O presente trabalho pretende apresentar um protocolo de uma revisão sistemática que busca comparar as alterações hemodinâmicas ocorridas em pacientes que foram submetidos à técnica de sedação consciente por via oral com o diazepam versus o midazolam, durante a exodontia de terceiros molares inferiores. Métodos: Protocolo para uma revisão sistemática de ensaios clínicos randomizados, sendo utilizado as bases de dados Embase, PubMed/MEDLINE, Cochrane Library, Portal Regional da BVS, literatura cinzenta e buscas de forma manual nos principais periódicos da área de cirurgia bucomaxilofacial. O referido protocolo foi registrado no International Prospective Register of Systematic Reviews (PROSPERO), ressaltando-se que esta revisão será conduzida de acordo com as diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Considerações finais: A necessidade de se manter a maior estabilidade hemodinâmica durante a exodontia de terceiros molares inferiores, frente a sedação consciente por via oral, torna relevante que esta revisão sistemática seja realizada.

Introdução: Corpos estranhos intraoculares são a maior causa de lesões traumáticas em órbita, possuem características diversas, que abrangem do edema palpebral ao trauma órbito craniano, resultando em sequelas graves e algumas vezes fatais. Objetivo: O objetivo do presente estudo é apresentar uma série de casos de trauma por corpo estranho penetrante na órbita ocular associado a uma revisão da literatura sobre o tema. Desenho: Estudo retrospectivo de casos. Metodologia: Revisão de acordo com a declaração PRISMA, por meio das bases de dados PubMed, Science Direct e SciELO, além dos relatos de casos e análise retrospectiva de 12 pacientes submetidos à diferentes manejos. Resultados: A idade média dos pacientes foi de 31,16 anos, sendo 91,6% dos pacientes do sexo masculino, a etiologia em 50% dos casos foi por material de madeira, em 41,7% foi por metal e em 8,3% por vidro. A tomografia computadorizada foi utilizada em todos os casos fornecendo resultados altamente efetivos. Em 58,3% dos casos ocorreram na órbita esquerda. Cinquenta por cento dos casos tratados evoluíram sem sequelas. Conclusão: O diagnóstico precoce e manejo imediato de lesões orbitárias são imprescindíveis para um prognóstico positivo, assim como exames de imagem adequados. A tomografia computadorizada, a ressonância magnética e a angiografia por tomografia computadorizada são modalidades de imagem frequentemente utilizadas e eficazes.

Neurotrophic factors and peripheral nerves are known to be good substrates for bridging CNS trauma. The involvement of fibroblast growth factor-2 (FGF-2) activation in the dorsal root ganglion (DRG) was examined following spinal cord injury in the rat. We evaluated whether FGF-2 increases the ability of a sciatic nerve graft to enhance neuronal plasticity, in a gap promoted by complete transection of the spinal cord. The rats were subjected to a 4 mm-long gap at low thoracic level and were repaired with saline (Saline or control group, n = 10), or fragment of the sciatic nerve (Nerve group, n = 10), or fragment of the sciatic nerve to which FGF-2 (Nerve + FGF-2 group, n = 10) had been added immediately after lesion. The effects of the FGF-2 and fragment of the sciatic nerve grafts on neuronal plasticity were investigated using choline acetyl transferase (ChAT)-immunoreactivity of neurons in the dorsal root ganglion after 8 weeks. Preservation of the area and diameter of neuronal cell bodies in dorsal root ganglion (DRG) was seen in animals treated with the sciatic nerve, an effect enhanced by the addition of FGF-2. Thus, the addition of exogenous FGF-2 to a sciatic nerve fragment grafted in a gap of the rat spinal cord submitted to complete transection was able to improve neuroprotection in the DRG. The results emphasized that the manipulation of the microenvironment in the wound might amplify the regenerative capacity of peripheral neurons

OBJECTIVE The aim of this randomized, double-blind, controlled trial was to compare the computed and conventional inferior alveolar nerve block techniques in symmetrically positioned inferior third molars. PATIENTS AND METHODS Both computed and conventional anesthetic techniques were performed in 29 healthy patients (58 surgeries) aged between 18 and 40 years. The anesthetic of choice was 2% lidocaine with 1: 200,000 epinephrine. The Visual Analogue Scale assessed the pain variable after anesthetic infiltration. Patient satisfaction was evaluated using the Likert Scale. Heart and respiratory rates, mean time to perform technique, and the need for additional anesthesia were also evaluated. RESULTS Pain variable means were higher for the conventional technique as compared with computed, 3.45 ± 2.73 and 2.86 ± 1.96, respectively, but no statistically significant differences were found (P > 0.05). Patient satisfaction showed no statistically significant differences. The average computed technique runtime and the conventional were 3.85 and 1.61 minutes, respectively, showing statistically significant differences (P

The aim of the present study was to compare hemodynamic changes using midazolam 7.5 mg and diazepam 10.0 mg during the surgical removal of symmetrically positioned third molars. A prospective, randomized, double-blind, clinical trial was carried out involving 120 patients divided into three groups: Group 1 (diazepam and placebo), Group 2 (midazolam and placebo), and Group 3 (diazepam and midazolam). Each subject underwent two surgeries on separate occasions under local anesthesia. The following parameters were assessed at five different times (T0, T1, T2, T3, and T4): systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP, respectively); heart rate (HR); oxygen saturation (SpO(2)); rate pressure product (RPP); and pressure rate quotient (PRQ). Statistically significant differences were found regarding heart rate at T2 and T3 (p 0.005) in Group 2, with a higher rate occurring during midazolam administration. Moreover, significant differences in rate pressure product were found at T2, T3, and T4 in this group, with higher values also occurring during midazolam administration. In Group 3, significant differences in diastolic blood pressure were found at T3 and T4, with higher values occurring during diazepam administration, whereas a higher heart rate occurred at T3 with midazolam. Midazolam 7.5 mg and diazepam 10.0 mg exert an influence on some hemodynamic parameters without perceptible clinical changes in healthy patients undergoing lower third molar surgery.

Highlights • Prototyping is efficient for surgical zygomatic-orbital correction. • The use of preshaped titanium plates reduces operative time and improves esthetics. • Prototyping provides a better outcome for the patient than conventional surgery., Introduction Zygomatic-orbital complex fractures are the most common facial traumas that can result in severe esthetic and functional sequelae. Surgical correction of these fractures is a delicate approach and prototyping is an excellent tool to facilitate this procedure. Presentation of case A 27-year-old man, a motorcycle accident victim, was hospitalized in the intensive care unit for 30 days. After this period, facial fractures were treated surgically, leaving sequelae such as enophthalmos, dystopia and loss of projection of the zygomatic arch. A second intervention was planned after one year for reconstruction of the orbit with the help of prototyping. Better outcomes were achieved than in the first intervention. Discussion This report permits to compare the result of conventional surgery and the use of a prototype in the same patient. Noticeably better outcomes were achieved with the second approach. Prototyping made the surgical procedure more predictable and reduced operative time because of the possibility of using preshaped titanium plates. Conclusions Prototyping was found to be an excellent option to overcome the deficiencies of the conventional technique, recovering the functional and esthetic characteristics of the patient’s face and ensuring a markedly satisfactory outcome.

Peripheral odontoma is an odontogenic hamartoma considered extremely uncommon whose development results from the rests of odontogenic epithelium that resides in the soft tissues of the maxillomandibular complex. We report here a case of an 11-year-old female patient showing an asymptomatic nodular exophytic lesion on the anterior region of the palate with normochromic coloration, hardened consistency, and 1 year of duration. From the observed clinical features and under the hypothesis of fibroma, an excisional biopsy was performed. Anatomopathologic analysis revealed the presence of teeth-like structures formed by enamel and dentin matrix sometimes associated with the dental papilla or surrounding pulp tissue; thus, the diagnosis of compound odontoma was established. The patient has been under follow-up for 6 months without signs of recurrence.

Dentigerous cysts are frequently found in the maxilla. After radicular cysts, dentigerous cysts are those most commonly diagnosed, accounting for 20% of all jaw cysts. They are often asymptomatic and diagnosed incidentally during routine examinations. Clinical complications such as dental displacement, ectopic eruption, dental impaction, adjacent tooth root resorption, cortical expansion with facial asymmetry, paresthesia, pathological fracture, and even malignant transformation may occur. Despite these classical features, definitive diagnosis must always be based on histological examination. Most dentigerous cysts are solitary. The aim of this article is to report a case of bilateral mandibular dentigerous cysts in a non-syndromic patient and, through a literature review, present the available treatment modalities used successfully in this case.

Objective To evaluate hemodynamic changes with the use of 4% articaine and 2 different concentrations of epinephrine (1:100,000 and 1:200,000) in the surgical removal of symmetrically positioned lower third molars. Study Design A prospective, randomized, double-blind clinical trial was carried out involving 42 patients each undergoing 2 surgeries on separate occasions under local anesthesia with 4% articaine and either epinephrine 1:100,000 or 1:200,000. The following parameters were assessed at 4 different moments: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product (RPP); and pressure rate quotient (PRQ). Results The concentration of epinephrine did not affect diastolic blood pressure or oxygen saturation during the surgeries. Significant differences between were detected for heart rate, RPP, and PRQ ( P Conclusions The epinephrine concentration (1:100,000 or 1:200,000) in a 4% articaine solution influences hemodynamic parameters without perceptible clinical changes in healthy patients undergoing lower third molar removal.

Septic arthritis of the temporomandibular joint (TMJ) is an uncommon condition; thus, reports in the specialized literature are still scarce. The TMJ may be affected by extension of a local infectious process, by post-traumatic hematoma, or secondarily, by hematogenous spread. Septic arthritis is more common in the large joints, with the knee and hip most frequently affected. It is characterized by insidious onset and a marked inflammatory process, and is monoarticular in 80% of cases. The present report describes the case of a 6-year-old boy with a history of rheumatoid arthritis who presented with pain, swelling, and redness in the right TMJ region, as well as limited jaw opening, closure, and lateral excursion bilaterally. The differential diagnosis and treatment of this rare clinical entity are described. Aspects concerning antibiotic therapy and imaging studies are also addressed. RESUMO A artrite séptica da articulação têmporo-mandibular (ATM) é uma entidade pouco freqüente, e por isso ainda pouco descrita na literatura internacional especializada. A articulação têmporo-mandibular pode ser afetada por uma extensão de um processo séptico local, hematoma pós-trauma ou secundariamente por disseminação pela via hematogência. É mais comum a sua apresentação nas grandes articulações, com o joelho e articulação coxo-femural liderando essa estatística. Apresenta-se de forma insidiosa, com intenso processo inflamatório, que em 80% dos casos é mono articular. O presente trabalho relata um caso clínico em uma criança, do sexo masculino, leucoderma, de seis anos de idade, que evoluía com dor, edema e eritema em região da ATM direita, bem como limitação dos movimentos mandibulares de abertura, fechamento e lateralidade bilateral. Possuía histórico de artrite reumatóide. Aborda-se também neste trabalho diagnósticos diferenciais e medidas terapêuticas para esta rara entidade nosológica. Aspectos referentes à antibioticoterapia e exames de imagens também são abordados.

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 occasionsVone 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 G 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.

Ameloblastic fibroma (AF) is an extremely rare true mixed benign tumor that can occur in either the mandible or the maxilla, but is most frequently found in the posterior region of the mandible. It usually occurs in the first two decades of life and is associated with tooth enclosure, causing a delay in eruption or altering the dental eruption sequence. AF is diagnosed on routine radiographic evaluation and is clinically and radiographically similar to ameloblastic fibrodontoma and odontoma, which makes an accurate diagnosis mandatory. There is controversy in the literature as to whether treatment should be conservative or agressive. A conservative treatment strategy, such as enucleation and curettage, is usually sufficient. However, extensive lesions require radical treatment. We describe a case of ameloblastic fibroma with a very unusual clinical manifestation: it demonstrated considerable extension but no associated impacted tooth, was located in the anterior region of the mandible, and became symptomatic in the fifth decade of life. A radical surgical approach was taken, with immediate reconstruction. (J Oral Sci 51, 293-296, 2009)

O acesso cirúrgico à região de base do crânio é sempre difícil principalmente pelas estruturas anatômicas nobres associadas. A osteotomia maxilar proporciona visão direta à região de clivus e coluna cervical, além de apresentar uma menor morbidade em relação aos diversos acessos descritos na literatura. OBJETIVO: Avaliar 11 casos submetidos à osteotomia transmaxilar, descrevendo técnica cirúrgica, resultados e complicações pós-operatórias. PACIENTES E MÉTODOS: O estudo retrospectivo de onze pacientes foi submetido à cirurgia transmaxilar para acesso à região do tronco encefálico. Registros quanto à oclusão dentária, hemorragia trans e pós-operatória, necrose óssea e alterações de tecido mole foram estudados. Todos seguiram o mesmo protocolo cirúrgico e acompanhamento médio de dois anos. RESULTADOS: Após o tratamento todos os pacientes apresentaram melhora do quadro clínico e nenhum dano neurológico, hemorragia trans e pós-operatória ou intercorrências maiores foram identificadas. Dentre as complicações, em dois pacientes ocorreu fratura incompleta da maxila, dois apresentaram laceração da mucosa nasal e um apresentou como complicação tardia uma fístula bucossinusal. CONCLUSÃO: A osteotomia transmaxilar possibilitou adequado acesso a região de clivus para descompressão do tronco encefálico com baixo índice de complicações nesta série de casos.Surgical access to the skull base is always difficult, especially because of the noble anatomic structures present there. Maxillary osteotomy provides direct view to the clivus region and the neck spine, and it also bears less morbidity when compared to the many other accesses described in the literature. AIM: to assess 11 patients submitted to transmaxillary osteotomy, describing the surgical technique and postoperative results and complications. MATERIALS AND METHODS: A retrospective study involving eleven patients submitted to transmaxillary approach to the brainstem. We studied dental occlusion, trans and postoperative bleeding, bone necrosis and soft tissue alterations. All followed the same surgical protocol and were followed up for two years. RESULTS: after treatment, all the patients improved in their clinical status and had no neurological complication, trans and postoperative hemorrhage or major complications were seen. Among the complications, two patients had incomplete maxilla fracture, two had laceration of their nasal mucosa and one had, as late complication, an oral-sinusal fistula. CONCLUSION: Transmaxillary osteotomy provided proper access to the clivus for brainstem decompression with low rate of complications in this series.

Accidents with firearms can result in extensive orbital trauma. Moreover, gun parts can come loose and impale the maxillofacial region. These injuries can cause the loss of visual acuity and impair eye movements. Multidisciplinary treatment is required for injuries associated with this type of trauma. Computed tomography with three-dimensional reconstruction is useful for determining the precise location and size of the object lodged in the facial skeleton, thereby facilitating the planning of the correct surgical approach. The temporal approach is a fast, simple technique with few complications that is indicated for access to the infratemporal fossa. This article describes the use of the temporal approach on a firearm victim in whom the breech of a rifle had impaled orbital region, with the extremity lodged in the infratemporal fossa.

We describe a rare case of large congenital lipoma in the upper lip of a six-month-old infant. Surgical excision of the tumor was successful, with satisfactory esthetic and functional results. (J Oral Sci 51, 489-491, 2009)

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.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.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 (P0.05).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.

The glandular odontogenic cyst (GOC) is an uncommon jaw bone cyst of odontogenic origin with unpredictable and potentially aggressive behaviour. It also has the propensity to grow to a large size and tendency towards recurrence. GOC can be easily misdiagnosed microscopically as a central mucoepidermoid carcinoma. This paper reports a case of GOC in a 56-year-old male and reviews the main criteria for accurate diagnosis. The diagnosis of GOC can be extremely difficult due to the rarity of the cyst and lack of clear diagnostic criteria.

O acesso cirúrgico à região de base do crânio é sempre difícil principalmente pelas estruturas anatômicas nobres associadas. A osteotomia maxilar proporciona visão direta à região de clivus e coluna cervical, além de apresentar uma menor morbidade em relação aos diversos acessos descritos na literatura. OBJETIVO: Avaliar 11 casos submetidos à osteotomia transmaxilar, descrevendo técnica cirúrgica, resultados e complicações pós-operatórias. PACIENTES E MÉTODOS: O estudo retrospectivo de onze pacientes foi submetido à cirurgia transmaxilar para acesso à região do tronco encefálico. Registros quanto à oclusão dentária, hemorragia trans e pós-operatória, necrose óssea e alterações de tecido mole foram estudados. Todos seguiram o mesmo protocolo cirúrgico e acompanhamento médio de dois anos. RESULTADOS: Após o tratamento todos os pacientes apresentaram melhora do quadro clínico e nenhum dano neurológico, hemorragia trans e pós-operatória ou intercorrências maiores foram identificadas. Dentre as complicações, em dois pacientes ocorreu fratura incompleta da maxila, dois apresentaram laceração da mucosa nasal e um apresentou como complicação tardia uma fístula bucossinusal. CONCLUSÃO: A osteotomia transmaxilar possibilitou adequado acesso a região de clivus para descompressão do tronco encefálico com baixo índice de complicações nesta série de casos. Surgical access to the skull base is always difficult, especially because of the noble anatomic structures present there. Maxillary osteotomy provides direct view to the clivus region and the neck spine, and it also bears less morbidity when compared to the many other accesses described in the literature. AIM: to assess 11 patients submitted to transmaxillary osteotomy, describing the surgical technique and postoperative results and complications. MATERIALS AND METHODS: A retrospective study involving eleven patients submitted to transmaxillary approach to the brainstem. We studied dental occlusion, trans and postoperative bleeding, bone necrosis and soft tissue alterations. All followed the same surgical protocol and were followed up for two years. RESULTS: after treatment, all the patients improved in their clinical status and had no neurological complication, trans and postoperative hemorrhage or major complications were seen. Among the complications, two patients had incomplete maxilla fracture, two had laceration of their nasal mucosa and one had, as late complication, an oral-sinusal fistula. CONCLUSION: Transmaxillary osteotomy provided proper access to the clivus for brainstem decompression with low rate of complications in this series.

ResumoA automutilação em pacientes psiquiátricos não é incomum, podendo estar relacionada a crenças religiosas, impulsividade, abuso de substâncias e sintomas psicóticos. Relatos de lesões em membros superiores e inferiores, órgãos genitais, globo ocular e outras estruturas faciais são geralmente descritos na literatura médica. Grande importância deve ser dada ao primeiro atendimento deste tipo de indivíduo, principalmente em serviços que não dispõem de suporte psiquiátrico. Farmacoterapia e, algumas vezes, até intervenções cirúrgicas, podem ser empregadas para a estabilização do quadro inicial; com o intuito de preservar ao máximo a integridade física e mental dos mesmos. Desta maneira, um correcto manejo destes doentes deve envolver desde cuidados básicos de higiene até o envolvimento de uma equipe multiprofissional especializada. De acordo com o exposto, o presente artigo fomenta apresentar o caso clínico de uma paciente com distúrbio psiquiátrico associado ao fenómeno da automutilação que, em adição a factores de ordem infecciosos, culminou com o desenvolvimento de uma osteomielite mandibular.AbstractSelf-mutilation in psychiatric patients is not uncommon, and may result from religious beliefs, impulsivity, substance abuse and psychotic symptoms. Reports of arms, legs, genitals, ocular and face injuries are usually noticed in medical literature. The first care is very important, mainly in centers doesn’t offers psychiatric support. Pharmacotherapy and surgery may be employ for establish initially the patient, to maintain their physical and mental integrity. Thus, a correct management of this people must involve since primary hygiene attentions until the necessity of a complex staff specialties. According this, the article presents a case report of self-mutilation in a psychiatric patient that, in association with infectious factors, leaded for jaw's osteomyelitis.