Treatment of temporomandibular joint ankylosis by gap arthroplasty

Purpose: The purpose of this paper is to show that gap arthroplasty improve mouth opening when treating TMJ ankylosis. Patients and methods: Eight patients with TMJ ankylosis were treated by gap arthroplasty. The patients were evaluated by at least twenty-four months (minimum 24 and maximum 48 months). Results: Of the eight patients (eleven joints), five (62.5%) had unilateral involvement and three patients (37.5%) had bilateral involvement. The mean age was 20 years ± 9 (range 3 to 30 years). The mean maximal incisal opening (MIO) in the preoperative period was 9.25 ± 6.41 mm and in the postoperative period it was 29.88± 4.16 mm. The complication of temporary facial nerve paresis was encountered in two patients (25%). No recurrence was observed in our series. Conclusions: Trauma was the major cause of tempomandibular joint ankylosis in our sample. Gap arthroplasty showed good results when treating TMJ ankylosis

Is Overweight a Risk Factor for Adverse Events during Removal of Impacted Lower Third Molars?

Being overweight is recognised as a significant risk factor for several morbidities; however, the experience of the dentistry faculties focusing on this population is still low. The aim of the present study was to determine the occurrence of adverse events during removal of impacted lower third molars in overweight patients. A prospective cohort study was carried out involving overweight patients subjected to surgical removal of impacted lower third molar as part of a line of research on third molar surgery. Predictor variables indicative of the occurrence of adverse events during surgery were classified by their demographic, clinical, radiographic, and surgical aspects. Descriptive and bivariate statistics were computed. In total, 140 patients fulfilled the eligibility criteria, and 280 surgeries were performed. Patients’ mean age was 25.1 ± 2.2  years, and the proportion of women to men was 3 : 1. Eight different adverse events during surgery were recorded. These events occurred in approximately 29.3% of cases and were significantly associated with predictor variables (P < 0.05). Excess weight is recognised as a risk factor for the high rate of adverse events in impacted third molar surgery. The study suggests that overweight patients are highly likely to experience morbidities

Treatment of chronic mandibular dislocations by eminectomy : follow-up of 10 cases and literature review

Introduction: Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence, with complete separation of the articular surfaces and fixation in that position. Objectives: To report ten cases treated by eminectomy for chronic mandibular dislocations, to evaluate the results of these surgeries and make a critical review of the literature. Methods: The sample was obtained from the records of the Department of Oral and Maxillofacial Surgery, University of Pernambuco and comprises cases submitted to chronic mandibular dislocation treatment by eminectomy between 2002 and 2007. Pre- and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxations, recurrence rate and presence of facial nerve paralysis. Results: The mean maximal mouth opening in the preoperative period was 48.4 ± 8.5 mm and in the postoperative period it was 41.3 ± 5.0 mm. No facial nerve paralysis or recurrence was observed. Conclusion: The treatment of chronic mandibular dislocations by eminectomy was shown to be efficient in relationship to the postoperative maximal mouth opening, recurrence and articular function

Effect of preemptive dexamethasone and etoricoxib on postoperative period following impacted third molar surgery - a randomized clinical trial

The aim of this study was to compare the anti-inflammatory effects of dexamethasone and etoricoxib after third molar extraction. A prospective, randomized, controlled, split-mouth study was conducted. 19 volunteers were allocated randomly to receive 90mg etoricoxib 1 hour prior to the procedure or 4mg intramuscular dexamethasone immediately after anesthesia. Baseline measurements were obtained preoperatively, and subsequent assessments were made on immediate postoperative, at 72 hours and 7 days after surgery to measure postoperative facial swelling by use of linear measurements, interincisal mouth opening width and visual analog scale score for pain. The amount of analgesics consumed was recorded. Descriptive statistics and the independent-samples t-test were used to compare the two groups at P < 0.05. Dexamethasone was effective in the control roasted edema for measurements of the mandibular angle - wing of the nose and mandibular angle - labial commissure 72 hours after surgery. And for the measurement mandibular angle - mentum, in the time of 72 hours and 7 days. There was no statistically significant difference in relation to pain and trismus. Considering significant results for some measures of the variable edema for the group that used intramuscular dexamethasone and the difference without statistical significance between groups for the other variables studied, we seem to reflect the intramuscular indication of the corticosteroid in a single dosage in relation to the use of etoricoxib as pre-emptive medication

The use of carrageenan for limiting the mandibular movement in rats : a preliminary experimental study

Purpose: The objective of this study was to evaluate if the carrageenan may be used for limiting the mandibular movement. Material and Methods: Eighteen adult male Wistar rats were used for the research, 20 µl of carrageenan (4%) was infiltrated in the extra articular region, in front of the condyle to induce fibrosis. The rats were divided into groups according to the time of euthanasia (7, 15 and 30 days). Maximal mouth opening (MMO), mandibular deviation, initial and final weights were recorded and evaluated. After the euthanasia, the specimens were submitted to histological study in order to classify the inflammatory process using scores. Results: The mean differences between initial and final MMO were 1.50 mm, being greatest at the 7 days evaluation and lowest at 30 days, and were not statistically significant at any time. No mandibular deviation was observed at any of the times of evaluation. The histological scores tended to increase with time of evaluation from 7 to 30 days, but without progression of the process. Conclusion: The study model permitted the development of fibrosis in the extra-articular region in the majority of the animals

Conduction velocity of the rabbit facial nerve: a noninvasive functional evaluation

O objetivo deste estudo foi avaliar os dados padronizados de velocidade de condução para o nervo facial não lesado e o nervo facial reparado com enxerto autógeno e com materiais sintéticos. Na avaliação foram medidas as diferenças pré-operatórias de velocidade de condução do nervo facial em cada lado e verificada a existência de uma correlação positiva entre a velocidade de condução do nervo facial e o número de axônios regenerados no pós-operatório. O potencial de ação motora bilateral do nervo facial de 17 coelhos foi registrado no pré e no pós-operatório. Os eletrodos superficiais de estimulação foram colocados no pavilhão auricular (tronco do nervo facial) e os eletrodos superficiais de gravação foram colocados no músculo quadratus labii inferior. Os nervos faciais foram isolados, transeccionados e separados a 10 mm. O espaço entre os dois cotos nervosos terminais foi reparado com enxertos nervosos autólogos e PTFE-e (politetrafluoretileno) ou tubos de colágeno. A média da máxima velocidade de condução do nervo facial foi 41,10 m/s. Nenhuma condução nervosa foi observada no grupo avaliado após 15 dias. A velocidade de condução média nos subgrupos avaliados para o período de 2 e 4 meses foi de aproximadamente 50% do valor normal. A avaliação funcional não invasiva com eletrodos de superfície pode ser útil para a estimulação e registro do potencial de ação muscular e para medir o estado funcional do nervo facial.The aim of this study was to evaluate standardized conduction velocity data for uninjured facial nerve and facial nerve repaired with autologous graft nerves and synthetic materials. An evaluation was made measuring the preoperative differences in the facial nerve conduction velocities on either side, and ascertaining the existence of a positive correlation between facial nerve conduction velocity and the number of axons regenerated postoperatively. In 17 rabbits, bilateral facial nerve motor action potentials were recorded pre- and postoperatively. The stimulation surface electrodes were placed on the auricular pavilion (facial nerve trunk) and the recording surface electrodes were placed on the quadratus labii inferior muscle. The facial nerves were isolated, transected and separated 10 mm apart. The gap between the two nerve ends was repaired with autologous nerve grafts and PTFE-e (polytetrafluoroethylene) or collagen tubes. The mean of maximal conduction velocity of the facial nerve was 41.10 m/s. After 15 days no nerve conduction was evoked in the evaluated group. For the period of 2 and 4 months the mean conduction velocity was approximately 50% of the normal value in the subgroups assessed. A significant correlation was observed between the conduction velocity and the number of regenerated axons. Noninvasive functional evaluation with surface electrodes can be useful for stimulating and recording muscle action potentials and for assessing the functional state of the facial nerve

Occupational stress among Brazilian oral-maxillofacial surgeons

Purpose: The aim of the present study was to assess the stress level of oral-maxillofacial surgeons, based on the Demand-Control Model. Methods: A cross-sectional study was carried out with 128 oral-maxillofacial surgeons who participated in the Brazilian Congress of Oral-Maxillofacial Surgery held in the city of Florianópolis, State of Santa Catarina, Brazil. Data was obtained using a questionnaire that incorporated the Demand-Control Model (Job Content Questionnaire), which evaluates psychosocial experiences at work. Information on age, gender and professional qualification was also collected. The data was displayed in contingency tables. The following statistical tests were used with a 5% level of significance: chi-square test and ?Fisher exact test?. Results: Oralmaxillofacial surgeons were classified according to the Demand-Control Model as follows: High Demand (28%), Low Demand (28%); Passive Work (27%), Active Work (16.4%). Conclusion: The majority of oral-maxillofacial surgeons exercise their profession in unsatisfactory working conditions, as less than 1/3 of the population studied worked under the ideal condition of low demand

Relationship between mandibular fracture and impacted lower third molar

Many studies have shown that the greatest risk of fracture of the mandibular angle is related to the presence of an unerupted lower third molar, based on the hypothesis that there is a decrease in the area of bone and absorption of the impact in this area, leading some surgeons to indicate its prophylactic removal in patients most exposed to the risk factors of facial trauma. On the other hand, other authors have observed a greater frequency of condylar fractures in patients without an impacted lower third molar.Purpose: The aim of this study was to relate the condylar and angle fracture with an unerupted lower third molar, taking into account the position of the tooth.Material and Methods: Panoramic radiographs were used to determine if the presence or absence of the third molar is related to the occurrence of mandibular fractures, such as angle and condylar fractures.Results: In a total of 43 patients with angle fractures, the greatest percentage had erupted teeth, and 41.9% had impacted teeth; however there was no significant difference between the fractured side and the tooth condition (p=0.350). There were 91 condylar fractures and in 42.9% the third molar was absent and in 40.7% the tooth was erupted . There was no significant difference between the fractured side and the tooth condition (p=0.852).Conclusion: The absence of an impacted third molar may increase the risk of condylar fractures and decrease the prevalence of mandibular angle fractures

SAÚDE: Direito Assegurado Constitucionalmente

A  Constituição Federal almeja a igualdade entre os seres humanos, tratamento igualitário independente de sua origem. Logo, surge o ordenamento social que busca o bem-estar e a justiça social, seus aspectos são regidos com o objetivo de trazer igualdade de condições e condições adequadas às necessidades básicas do ser humano. Concentra-se o referido trabalho na ordem social referente à saúde, um acesso devido a todos e que apresenta um trâmite que, muitas vezes, pode ocasionar sérios danos, devido à lenta marcha da máquina jurisdicional. Assim, tentando-se amenizar sofrimentos maiores, responsabiliza-se o Poder Público vindo desta forma a gerar uma grande discussão de quem seria responsabilidade no fornecimento dos referidos medicamentos