Reconstruction of TMJ with Prosthesis Joint

Temporomandibular joint (TMJ) and the associated muscles turn possible mandibular movements as a complex engineering appliance that may be affected by signs and symptoms such as pain, including in head and neck areas, abnormal jaw movement and clicking or crepitus sounds, classified as temporomandibular disorders (TMD). Some procedures such as discopexy, eminectomy, or arthroplasties, which we consider conservative, can result in ankylosis, even resorption and joint degeneration, limiting surgical options to treat TMJ. The alloplastic prosthesis becomes an option. Total joint reconstruction using prosthesis becomes the treatment choice during the following conditions: previous surgeries including autogenous grafts fail; presence of arthritic diseases; fibrous or bony ankylosis; tumors involving the TMJ; loss of vertical posterior mandible dimension by other TMJ pathologies; and previous prosthetic joint fail. The use of TMJ prosthesis, when compared to other reconstructive procedures, provides immediate function, reducing the duration of surgery and hospitalization time. Disadvantages of the TMJ prosthesis include high cost, prosthesis failure, functional mandibular movements loss, such as protrusion and laterality, and limited fit of stock prosthesis

Recurrent respiratory papillomatosis: clinical characteristics and viral genotyping in a Brazilian population

This study presents 25 cases of recurrent respiratory papillomatosis (RRP) that occurred in Sao Luis, Maranhao State, Northeast region, Brazil, between January 2007 and December 2018. Sociodemographic and clinical profile of patients as well as human papillomavirus (HPV) infection status were evaluated. Clinical and histopathological data were collected from the patients’ medical records. For the HPV infection analysis, DNA was extracted and subjected to amplification by a nested polymerase chain reaction. Viral genotyping was performed by automated sequencing. The median age of patients was 12.40 ± 12.6. years, and the juvenile form of the disease (68%) was the predominant form of disease. Female participants were predominant (60%), and they were from cities located in the interior of the State (60%). The most common clinical manifestation was dysphonia; recurrence was observed in most cases (56%), and tracheostomy was necessary in seven patients (26.9%). When comparing the RRP forms, patients in the juvenile-RRP group had higher recurrence rates and need of tracheostomy than those in the adult-RRP group. The viral genotyping analysis revealed that 47.8% of patients had low-risk HPVs, whereas 13.1% had high-risk HPVs, and in 39.1% of patients the viral genotype was not obtained. HPV-6 was the most prevalent type and Juvenile-RRP was more prevalent in our population. HPV was present at a high rate, and HPV-6 was the predominant genotype. This study serves as the basis for further studies to be conducted in the Brazilian population. Our findings aid the better understanding of RRP, possibly suggesting some prognostic factors associated with the disease aggressiveness

Complicações após expansão de maxila cirurgicamente assistida

INTRODUÇÃO: O tratamento da deficiência transversal de maxila, em adultos, exige a expansão de maxila cirurgicamente assistida. Diversas técnicas cirúrgicas são conhecidas para a realização desse procedimento, porém estas relacionam-se com complicações. OBJETIVO: Avaliar a incidência de complicações associadas ao procedimento de expansão de maxila cirurgicamente assistida. MATERIAL E MÉTODO: Trinta e três indivíduos com deficiência transversal de maxila foram submetidos ao procedimento de expansão pela técnica da osteotomia Le Fort I subtotal com degrau no pilar zigomático-maxilar, disjunção ptérigo-maxilar e osteotomia da sutura intermaxilar. Durante os períodos trans e pós-operatório, as complicações relacionadas ao procedimento e as distâncias interdentais foram registradas. RESULTADO: Doze homens e 21 mulheres, com idade média de 24,64 anos, submeteram-se ao procedimento. As mensurações das distâncias interdentais evidenciaram aumento das mesmas entre os períodos pré-operatório e pós-operatório de 2 meses. As complicações prevalentes foram sinusite (6%) e deslocamento associado à inclinação dental (6%). CONCLUSÃO: A expansão de maxila cirurgicamente assistida é um procedimento eficaz e de baixa morbidade para o tratamento da deficiência transversal de maxila em indivíduos adultos

Complicações após expansão de maxila cirurgicamente assistida

INTRODUÇÃO: O tratamento da deficiência transversal de maxila, em adultos, exige a expansão de maxila cirurgicamente assistida. Diversas técnicas cirúrgicas são conhecidas para a realização desse procedimento, porém estas relacionam-se com complicações. OBJETIVO: Avaliar a incidência de complicações associadas ao procedimento de expansão de maxila cirurgicamente assistida. MATERIAL E MÉTODO: Trinta e três indivíduos com deficiência transversal de maxila foram submetidos ao procedimento de expansão pela técnica da osteotomia Le Fort I subtotal com degrau no pilar zigomático-maxilar, disjunção ptérigo-maxilar e osteotomia da sutura intermaxilar. Durante os períodos trans e pós-operatório, as complicações relacionadas ao procedimento e as distâncias interdentais foram registradas. RESULTADO: Doze homens e 21 mulheres, com idade média de 24,64 anos, submeteram-se ao procedimento. As mensurações das distâncias interdentais evidenciaram aumento das mesmas entre os períodos pré-operatório e pós-operatório de 2 meses. As complicações prevalentes foram sinusite (6%) e deslocamento associado à inclinação dental (6%). CONCLUSÃO: A expansão de maxila cirurgicamente assistida é um procedimento eficaz e de baixa morbidade para o tratamento da deficiência transversal de maxila em indivíduos adultos

Morphological and histomorphometric evaluation of autogenous bone graft resorption in rabbits treated with alendronate sodium

Abstract Introduction Different rates of resorption are mediated by osteoclasts that may be affected by bisphosphonates during bone graft repair. Bisphosphonates are drugs that act as inhibitors of bone resorption. Objective The aim of the present study was to evaluate the rate of resorption of skullcap grafts in rabbits with and without the use of alendronate sodium. Material and method Thirty two New Zealand rabbits were divided into two groups (control group and alendronate group) and divided again into four periods (7, 14, 30 and 60 days). The control group did not receive alendronate, while animals of the experimental group received 4 mg of alendronate sodium weekly after the surgery. An 8 mm diameter bone block was removed from the parietal bone and fixed by screws to the contralateral parietal bone. During the periods of 7, 14, 30 and 60 days, the animals had undergone euthanasia and samples were removed for further analysis. Morphological and histomorphometric tests were used to compare graft thicknesses and to evaluate the newly formed bone at the interface between the graft and receptor site. The Wilcoxon and Mann-Whitney tests were used for statistical analyses. Result All grafts healed and integrated uneventfully and no statistically significant differences in resorption rates or bone deposition were detected after the final incorporation of the graft in both groups. Conclusion Alendronate Sodium did not decrease the bone graft resorption rates, but there was a tendency for better results in the control group regarding the resorption and neoformation in autogenous calvarial bone grafts in rabbits

Estudo radiográfico digital indireto do efeito da expansão de maxila cirurgicamente assistida (EMCA) sobre o septo nasal Indirect digital radiographic study about the effect of surgically assisted maxillary expansion (SAME) on the nasal septum

INTRODUÇÃO: a deficiência transversal da maxila é caracterizada pela atresia maxilar, palato ogival, apinhamento e rotação dos dentes, além da mordida cruzada posterior (uni ou bilateral). O tratamento dos pacientes com esta deficiência consiste no alargamento das bases ósseas maxilares. Nos pacientes com maturidade esquelética, a expansão da maxila é obtida através de procedimentos ortocirúrgicos (conhecidos como expansão de maxila cirurgicamente assistida - EMCA) que podem gerar efeitos sobre a cavidade e sobre o septo nasal. OBJETIVO: avaliar o comportamento do septo nasal frente aos procedimentos de EMCA. METODOLOGIA: foram avaliadas radiografias cefalométricas em norma póstero-anterior e radiografias oclusais totais de maxila, obtidas pela técnica convencional e posteriormente digitalizadas, de 16 pacientes submetidos à EMCA pela técnica de osteotomia Le Fort I subtotal. As radiografias foram obtidas no período pré-operatório (inicial) e pós-operatório mediato ou ao final da expansão e foram digitalizadas e mensuradas utilizando o programa DIGORA. Foram medidas, ainda, as distâncias entre os dentes (caninos, primeiro pré-molares, segundo pré-molares, primeiros molares e segundos molares). RESULTADOS: após a análise estatística pode-se constatar o aumento das distâncias interdentárias e intermaxilares, além do aumento da largura da porção basal da abertura piriforme e das distâncias entre a parede lateral da porção basal da abertura piriforme e o septo nasal. CONCLUSÃO: a EMCA é um procedimento eficaz, capaz de alargar a porção basal da abertura piriforme, que parece não influenciar no posicionamento do septo nasal.<br>INTRODUCTION: Maxillary transversal deficiency is characterized by constricted maxillary arch, dental crowding and rotation, along with posterior uni or bilateral crossbite. The treatment of this deficiency is based on the widening of maxillary bone. In skeletal mature patients the maxillary expansion is achieved by means of surgical-orthodontic procedures (known as surgically assisted maxillary expansion - SAME) that can cause some effects on the nasal cavity and septum. AIM: To evaluate the behavior of the nasal septum after the procedures of SAME. METHODS: Post-anterior cephalometric and maxillary occlusal radiographs, taken by conventional technique and therefore digitalized, were analyzed from 16 patients undergone SAME. For all patients, the SAME technique consisted of subtotal Le Fort I osteotomy. The radiographs were taken before the surgical procedure, right after (mediate post-operatory time) or after the expansion, and thereafter digitalized and measured using DIGORA program. Also, the distances between teeth (canines, first premolars, second premolars, first molars and second molars) were registered. RESULTS: The statistical treatment showed an increase in interdental and intermaxillary distances, along with an increase in the width of the base of piriform aperture and in the distances between the base of lateral wall of the piriform aperture and nasal septum. CONCLUSION: SAME is an efficient procedure that seems not to influence the septum position