Surgical reconstruction of a frontonasal orbital-etmoidal fracture

Frontal sinus fractures are originated from high intensity accidents, including automobile accidents, altercations, sports accidents and falls. Normally, they are associated with fractures of the middle third of the face, including maxillary, nasal-orbital-etmoidal and zygomatic fractures. Several treatment modalities have been proposed to reconstruct fronto-nasal-orbital-etmoidal fractures, including fixation of bone fragments with plates and screws, reconstruction with bone grafts and titanium mesh implants. In the case here presented, bicoronal access was used to reconstruct the anterior wall of the frontal sinus and to reestablish the fronto-nasal-orbital-etmoidal contour, using a bone graft from the cranial cap for this purpose. The integrity of fronto-nasal duct was verified, and there was no need to canalize it. This procedure is an important guideline in the treatment plan, since it determines obliteration or canalization of the duct. After one year of follow-up, no complication or sequela was observed. Long periods of post-operative follow up are very important to evaluate possible complications

Treatment of Complex Mandibular Body Fractures and Functional Reimplantation of the Maxillary Alveolar Fragment

Introduction. This report aims at demonstrating the treatment of complex mandibular fracture functional reimplantation of the maxillary alveolar fragment (FRAF), denoting the possibility and feasibility of this reduction with an excellent prognosis. Case Report. Patient E.M.S, 25 years old, male, leucoderma, referred to the Emergency Room of our institute. He reported being a victim of physical aggression, occlusal alteration, limitation of mouth opening, sensibility loss in the mentalis region, right infraorbital, and denied visual alteration. On physical examination, during the inspection and palpation, the crackling was observed in the right mandibular region and apical displacement of the maxillary alveolar process, corresponding to elements 13, 14, and 15. Conclusion. The rigid fixation of the complex jaw fracture and alveolar maxilla process, through functional reduction, indicated satisfactory applicability, and favorable prognosis

Smile analysis following orthognathic surgery

Aim : This study compared the different views between orthodontists and oral maxillofacial surgeons, as for smile analysis in patients subjected to orthognathic surgery. Methods: Thirty individuals who had undergone orthognathic surgery and had a minimum postoperative period of 6 months were selected. Posttreatment frontal smile photographs were obtained and examined. Smile features were recorded by 4 professionals (2 orthodontists and 2 surgeons) and the agreement between them was assessed. Results: The subjective analysis of smile as well as the observation of incisal and gingival exposure showed a statistically significant agreement percentage between the two groups. Nevertheless, no agreement was seen between the surgeons, while evaluating the buccal corridor and the parallelism between the incisal edge of antero-superior teeth and the lower lip. Significant agreement percentage (60%) was seen only between the orthodontists regarding the smile arch parallelism. Conclusions : Professionals must be alert as for facial analysis, mainly in terms of smile harmony, so that the orthognathic surgery will satisfactorily reestablish the facial esthetics in all the parameters outlined

Correção da deficiência transversa da maxila por meio da expansão rápida da maxila cirurgicamente assistida

Fundamentation: The correction of maxillary transverse deficiencies involves orthodontic and surgical procedures that can be performed before or after skeletal maturity. The surgically assisted rapid maxillary expansion (SAR ME) is performed by osteotomies through the lateral walls of the maxilla, zygomatic and canines buttresses, palatal and pterygomaxillary sutures, causing the maxillary disjunction. Followed by activation of the expander to the desired over-expansion in order to correct intercuspal later. Objective: The purpose of this study was to discuss the issues involved in the diagnosis of maxillary atresia, SAR ME indications, as well as surgical technique, through a case study. Methods: The male patient, 19 years old, had severe transverse maxillary deficiency with facial pattern III , Class III , with great lip incompetence. The patient underwent general anesthesia in a hospital environment, the osteotomies was done according to the technique described by Epker and Wolford (1980). Postoperatively, the patient underwent activations daily for 15 days and after 6 months, the orthodontist installed fixed orthodontic appliance to prepare the patient to orthognathic surgery later. Conclusion: The diagnosis by clinical evaluation and models study is essential for the indication of SAR ME and this procedure provides good predictability in the correction of transverse deficiency, with minimal morbidity.Fundamentação: A correção das deficiências transversais da maxila envolve procedimentos ortodônticos e cirúrgicos, que podem ser realizados antes ou após a maturidade esquelética. A expansão rápida da maxila cirurgicamente assistida (ER MCA) é realizada por meio de osteotomias nas paredes laterais da maxila, pilares zigomáticos e caninos, sutura palatina mediana e sutura pterigomaxilar, ocasionando a disjunção maxilar. Seguido da ativação do aparelho expansor até a sobre-expansão desejada visando a correta intercuspidação posteriormente. Objetivo: O propósito deste trabalho foi discutir a respeito do diagnóstico da atresia maxilar, bem como as indicações e a técnica cirúrgica da ER MCA, por meio de caso clínico. Métodos: Paciente do sexo masculino, 19 anos de idade, apresentava severa deficiência transversal da maxila, com padrão facial III , Classe III , com grande incompetência labial. O mesmo se submeteu a ER MCA sob anestesia geral, em ambiente hospitalar, pela técnica descrita por Epker e Wolford (1980). No pós-operatório, o paciente realizou as ativações diárias por 15 dias e após 6 meses, o ortodontista instalou aparelho fixo e prosseguiu com a mecânica ortodôntica para posterior Cirurgia Ortognática. Conclusão: O diagnóstico por meio da avaliação clínica e dos modelos de estudo é essencial para a indicação da ER MCA e este procedimento proporciona boa previsibilidade na correção da deficiência transversal, com mínima morbidade

Surgical techniques for maxillary bone grafting: literature review

For oral rehabilitation with implant-supported prostheses, there are required procedures to create the bone volume needed for installation of the implants. Thus, bone grafts from intraoral or extraoral donor sites represent a very favorable opportunity. This study aimed to review the literature on the subject, seeking to discuss parameters for the indications, advantages and complications of techniques for autogenous bone grafts.Para a reabilitação bucal com as próteses implantossuportadas é necessário a realização de procedimentos para criar o volume ósseo necessário para a instalação dos implantes. Com isso, os enxertos ósseos provenientes de áreas doadoras intrabucais ou extrabucais, representam uma possibilidade bastante favorável. O presente trabalho objetivou realizar uma revisão da literatura em que procurou discutir parâmetros para as indicações, as vantagens e complicações para as técnicas dos enxertos ósseos autógenos

Smile analysis following orthognathic surgery

is study compared the different views between orthodontists and oral maxillofacial surgeons, as for smile analysis in patients subjected to orthognathic surgery. Methods: Thirty individuals who had undergone orthognathic surgery and had a minimum postoperative period of 6 months were selected. Posttreatment frontal smile photographs were obtained and examined. Smile features were recorded by 4 professionals (2 orthodontists and 2 surgeons) and the agreement between them was assessed. Results: The subjective analysis of smile as well as the observation of incisal and gingival exposure showed a statistically significant agreement percentage between the two groups. Nevertheless, no agreement was seen between the surgeons, while evaluating the buccal corridor and the parallelism between the incisal edge of antero-superior teeth and the lower lip. Significant agreement percentage (60%) was seen only between the orthodontists regarding the smile arch parallelism. Conclusions: Professionals must be alert as for facial analysis, mainly in terms of smile harmony, so that the orthognathic surgery will satisfactorily reestablish the facial esthetics in all the parameters outlined

Intraoperative blood loss and blood transfusion requirements in patients undergoing orthognathic surgery

Procedures for the surgical correction of dentofacial deformities may produce important complications, whether due to the potential for vascular injury or to prolonged surgery, both of which may lead to severe blood loss. Fluid replacement with crystalloid, colloid, or even blood products may be required. The aim of this study was to assess blood loss and transfusion requirements in 45 patients (18 males and 27 females; mean age 29.29 years, range 16-52 years) undergoing orthognathic surgery, assigned to one of two groups according to procedure type-rapid maxillary expansion or double-jaw orthognathic surgery. Preoperative hemoglobin and hematocrit levels and intraoperative blood loss were measured. There was a substantial individual variation in pre- and postoperative hemoglobin values (10.3-17 and 8.8-15.4 g/dL, respectively; p < 0.05). Mean hematocrit values were 41.53 % preoperatively (range 31.3-50.0 %) and 36.56 % postoperatively (range 25-43.8 %) (p < 0.05). Mean blood loss was 274.60 mL (range 45-855 mL). Only two patients required blood transfusion. Although blood loss and transfusion requirements were minimal in the present study, surgical teams should monitor the duration of surgery and follow meticulous protocols to minimize the risks