The effect of facial fractures on mouth opening range: a case series

Introduction: Facial fractures can result in limitation of mouth opening range, which consequently leads to functional impairments. Objective: To identify the influence of facial fractures and their corrective surgery on mouth opening range. Material and methods: Consecutive patients submitted to maxillofacial surgery had their mouth opening range measured at four different moments: preoperative (T0), immediate post-operative (within 24 hours afteroperation) (T1), one-week post-operative (T2) and one-month postoperative (T3). Eighteen subjects composed the sample, majorly represented by male gender, fractures caused by direct trauma as in traffic accidents, age among 21-30 years old and presenting mandible fracture. Results: Mouth opening at T0 demonstrated a mean value of 26.63 mm, T1 decreased to a mean of 22.59 mm, T2 mean value evolved to 26.42 mm and T3 displayed mean value of34.57 mm. Statistical evaluation demonstrated overall significance forthe comparison among all different periods, particularly for isolated mandible fractures, except between T0 and T2. Conclusion: It can be suggested that fracture itself and surgery for its correction have a negative effect on mouth opening range; however, the capacity of mouth opening presents signs of recovery since the first post-operative week, with notable progression until one month after surgery.Introduction: Facial fractures can result in limitation of mouth opening range, which consequently leads to functional impairments. Objective: To identify the influence of facial fractures and their corrective surgery on mouth opening range. Material and methods: Consecutive patients submitted to maxillofacial surgery had their mouth opening range measured at four different moments: preoperative (T0), immediate post-operative (within 24 hours afteroperation) (T1), one-week post-operative (T2) and one-month postoperative (T3). Eighteen subjects composed the sample, majorly represented by male gender, fractures caused by direct trauma as in traffic accidents, age among 21-30 years old and presenting mandible fracture. Results: Mouth opening at T0 demonstrated a mean value of 26.63 mm, T1 decreased to a mean of 22.59 mm, T2 mean value evolved to 26.42 mm and T3 displayed mean value of34.57 mm. Statistical evaluation demonstrated overall significance forthe comparison among all different periods, particularly for isolated mandible fractures, except between T0 and T2. Conclusion: It can be suggested that fracture itself and surgery for its correction have a negative effect on mouth opening range; however, the capacity of mouth opening presents signs of recovery since the first post-operative week, with notable progression until one month after surgery

Physicochemical Properties of MTA and Portland Cement after Addition of Aloe Vera

Introduction: The aim of this in vitro study was to determine the liquid-powder ratio, setting time, solubility, dimensional change, pH, and radiopacity of white structural and non-structural Portland cement, ProRoot MTA and MTA Bio, associated with a 2% glycolic solution containing Aloe Vera, as vehicle. Methods and Materials: Five samples of each material were used for each test, according to the American National Standards Institute/American Dental Association (ANSI/ADA) specification No. 57. Statistical analyses were performed using ANOVA and Tukey’s test at 5% significance. When sample distribution was not normal, non-parametric analysis of variance and the Kruskal-Wallis test were used (α=0.05). Results: No statistical differences were found in liquid-powder ratios among the tested materials. ProRoot MTA showed the longest setting time. Dimensional change values were acceptable in all groups. Also, no significant differences were found in pH values and pH was alkaline in all samples throughout the experiment. Mean radiopacity results obtained for white Portland cements did not meet ANSI/ADA requirements, and were significantly lower than those obtained for MTA-based cements. Finally, Portland cements showed significantly higher mean solubility values compared to the other samples. Conclusion: The physicochemical properties of the tested materials in association with Aloe Vera were compatible with ANSI/ADA requirements, except for the white Portland cements, which failed to meet the radiopacity specification.Keywords: Aloe Vera; MTA; Physicochemical Properties; Portland Cemen

Remoção de lipoma em face sob anestesia local e sedação: Relato de caso / Lipoma removal in face under local anesthesia and sedation: Case report

Lipomas são neoplasias benignas, originárias do tecido adiposo. Possuem prevalência de 15-20% na cabeça e pescoço, além de até 4% em cavidade bucal.  Apresentam leve predileção por homens, sendo mais comuns na sexta e sétima década de vida. A etiologia não foi esclarecida, sendo provavelmente decorrente de traumas locais, síndromes, hereditariedade ou até mesmo infecções. O tratamento é a excisão cirúrgica com pouco índice de recidiva. O objetivo desse trabalho é descrever um caso de lesão em face, região submandibular esquerda em um paciente do sexo masculino, de 34 anos, leucoderma, atendido no serviço de Cirurgia de Traumatologia Bucomaxilofaciais do Hospital Geral de Cuiabá. A lesão apresentava-se com aproximadamente 7 cm em face e evolução de 3 anos, ocasionando desconforto estético. O paciente foi submetido a excisão cirúrgica através de anestesia local e sedação, obtendo-se o laudo histopatológico de lipoma

Pre and transoperative evaluation of different occlusal registrations in subjects with dentofacial deformity

A cirurgia ortognática é uma modalidade terapêutica que vem se tornando cada vez mais comum ao cotidiano de cirurgiões bucomaxilofaciais e ortodontistas. Os dados presentes na literatura quanto a variabilidade do posicionamento mandibular em indivíduos com discrepâncias maxilomandibulares são escassos, fruto de poucas pesquisas ou somente refletem opinião de autores. O presente estudo objetivou a avaliação da variabilidade no posicionamento mandibular entre diferentes registros oclusais e o entendimento da influência das variáveis faixa etária, gênero, tipo de deformidade ou tipo de cirurgia aos resultados. Utilizando amostra composta por 30 indivíduos com deformidade dentofacial a serem submetidos a cirurgia ortognática, estudamos o registro da oclusão dental obtido em três diferentes situações: relação cêntrica, máxima intercuspidação e sob anestesia geral. Tais referências oclusais foram utilizadas para montagem de modelos mandibulares de gesso em articulador semi-ajustável e três pontos dentais (um anterior, um posterior direito e um posterior esquerdo) foram utilizados para determinar possível variação da posição mandibular. Os resultados indicaram tendência geral, com significância estatística, para recuo da mandíbula quando comparamos sua mudança de posição de máxima intercuspidação para relação cêntrica, não havendo significância estatística para a posição mandibular sob anestesia geral quando comparada à posição em relação cêntrica. Faixa etária e tipo de deformidade demonstraram-se como variáveis de influência significante aos resultados.Orthognathic surgery is a surgical therapeutical modality that has become more common among oral and maxillofacial surgeons and orthodontists. Current data regarding variability of mandibular positioning are scarce, mainly the result of few researches or author`s opinions. The present study aimed the evaluation of the variability of mandibular positioning among different occlusal registrations and the knowledge of whether age, gender, type of deformity or type of proposed surgery would influence results. Through a sample of 30 subjects with dentofacial deformities to be submitted to orthognathic surgery, dental occlusion registrations in three different situations were evaluated: centric relation, maximum intercuspation and under general anesthesia. Such registrations were used to mount cast models on semi-adjustable articulators and three dental points (one anterior, one posterior to the right and one posterior to the left) were used to determine possible variation of the mandibular position. Results indicated overall tendency with statistical significance for mandibular retrusion of the mandible when its position in maximum intercuspation is compared with centric relation, not presenting statistical significance for the mandible position under general anesthesia when compared to centric relation. Age and type of deformity did represent themselves as variables of influence to the results

Biological stability evaluation of the keratocystic odontogenic tumor in different moments

O tumor odontogênico queratocístico é um tumor odontogênico benigno recentemente classificado como tal pela Organização Mundial de Saúde. O alto índice de recidiva, a similaridade com outras lesões odontogênicas císticas e mutações genéticas associadas, estimulam continuamente estudos com finalidade de aprimorar o diagnóstico e o entendimento do comportamento desta lesão. As citoqueratinas, principal componente do citoesqueleto epitelial, têm sido utilizadas como possíveis marcadores no diagnóstico do tumor odontogênico queratocístico, apesar da discrepância dos resultados publicados. O gene PTCH1, com mutação já relatada associada ao tumor odontogênico queratocístico, expressa proteína de mesmo nome que parece estar associada com a etiologia ou com o prognóstico do tumor odontogênico queratocístico. Vinte casos de tumor odontogênico queratocístico foram submetidos à técnica de imunoistoquímica para detecção da expressão das citoqueratinas 10, 13, 17 e 19 e da proteína PTCH1. Cada caso foi representado por dois momentos distintos da mesma lesão, sendo metade dos casos representados por lesões sem história de recidiva e a outra metade constituída de casos com história de recidiva. A marcação obtida em cada um dos momentos foi comparada, verificando assim a estabilidade de expressão. A influência da inflamação na expressão imunoistoquímica também foi avaliada. As citoqueratinas 10 e 17 se mostraram com maior porcentagem de positividade (82, 5% e 97,5%, respectivamente) e com maior estabilidade entre os momentos (65% e 95%, respectivamente). A proteína PTCH1 foi positiva em todos os momentos, apresentando assim estabilidade total para os casos estudados. Não houve diferença estatisticamente significante, para nenhum dos anticorpos utilizados, entre os grupos sem ou com história de recidiva ou de expressão nas áreas de inflamação. A estabilidade das citoqueratinas 10 e 17 sugere que estas possam ser utilizadas associadamente como auxiliar de diagnóstico do tumor odontogênico queratocístico. A proteína PTCH1 demonstrou alta positividade e estabilidade; porém não pôde ser relacionado ao comportamento do tumor odontogênico queratocístico.The keratocystic odontogenic tumor is a benign odontogenic tumor recently classified as such by the World Health Organization. The high recurrence rate, the similarity with other odontogenic cystic lesions and the genetic associated mutations continuous stimulate studies intending diagnostic enhancement and behavior understanding of such lesion. The citokeratins, main component of the epithelial cytoskeleton, have been used as possible diagnostic markers of the keratocystic odontogenic tumor, in spite the discrepancy of the published results. The PTCH1 gene, with already reported mutation associated with the keratocystic odontogenic tumor, expresses a protein with the same name that seems to be associated with the etiology or the prognosis of the keratocystic odontogenic tumor. Twenty cases of keratocystic odontogenic tumor were submitted to the immunohistochemical technique for detection of the expression of citokeratins 10, 13, 17 and 19 and the protein PTCH1. Each case was represented by two distinct moments of the same lesion, being half of the cases represented by lesion without recurrence history and the other half constituted of lesion with recurrence history. The obtained staining in each moment was compared, thus verifying the expression stability. The influence of inflammation in the immunohistochemical expression was also evaluated. The cytokeratins 10 and 17 demonstrated higher positivity percentage (82.5% and 97.5%, respectively) and greater stability among the moments (65% and 97.5%, respectively). The PTCH1 protein was positive in all moments, thus presenting total stability for the studied cases. There was no statistical difference, for none of the antibodies, either among the groups without or with history of recurrence or in the expression in areas with inflammation. The stability of the cytokeratins 10 and 17 suggests that they can be used together as auxiliary for the diagnosis of the keratocystic odontogenic tumor. The protein PTCH1 demonstrated high positivity and stability; however it could not be related to the behavior of the keratocystic odontogenic tumor

Cavernous sinus thrombosis in a patient with facial myiasis

Cavernous sinus thrombosis is a severe encephalic complication of the cervicofacial infections that can lead to death if not treated in adequate time. Among the several etiologies related to the development of this infection, myiasis has not been reported, enforcing the importance of the report of a case of thrombosis of the cavernous sinus developed from a facial myiasis. (Quintessence Int 2010;41:e72-e74

PCC 14 / PCC 17

Dois Trabalho

Customized Polymethyl Methacrylate Implants for the Reconstruction of Craniofacial Osseous Defects

Craniofacial defects represent alterations in the anatomy and morphology of the cranial vault and the facial bones that potentially affect an individual’s psychological and social well-being. Although a variety of techniques and restorative procedures have been described for the reconstruction of the affected area, polymethyl methacrylate (PMMA), a biocompatible and nondegradable acrylic resin-based implant, is the most widely used alloplastic material for such craniomaxillofacial reconstruction. The aim of this study was to describe a technique for aesthetic and functional preoperative customized reconstruction of craniofacial bone defects from a small series of patients offered by the Brazilian public health system. Three adult male patients attended consultation with chief complaints directly related to their individual craniofacial bone defects. With the aid of multislice computed tomography scans and subsequent fabrication of the three-dimensional craniofacial prototype, custom-made PMMA implants were fabricated preoperatively. Under general anesthesia, with access to the craniofacial defects with a coronal approach, the PMMA implants were adapted and fixated to the facial skeleton with titanium plates and screws. Postoperative evaluation demonstrated uneventful recovery and an excellent aesthetic result. Customized prefabricated PMMA implants manufactured over the rapid prototyping models proved to be effective and feasible