Alterações neurossensoriais após cirurgia ortognática

Orientador : Priscila Brenner Heiligenberg SydneyMonografia (especialização) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Curso de Especialização em Disfunção Temporomandibular e dor orofacial.Inclui referênciasResumo : O dano ao feixe nervoso alveolar inferior permanece como uma das maiores desvantagens da cirurgia ortognática, sendo causa de estresse e desapontamento pelos pacientes. Os testes sensoriais quantitativos (TSQs) estabelecem um perfil de pacientes com várias condições de alteração neurossensorial. O objetivo do presente estudo foi determinar os limiares mecânicos e de dor em pacientes submetidos à cirurgia ortognática, utilizando o TSQ. Vinte e sete indivíduos submetidos à cirurgia ortognática, entre 4 e 24 meses de acompanhamento pós-operatório, foram avaliados para o limiar de detecção mecânica (MDT), limiar de dor mecânica (MPT) e alodínia mecânica dinâmica (DMA) em combinação com o questionário Oral Health Impact Profile (OHIP-14). O grupo controle foi pareado por sexo e idade. Todos os grupos foram comparados com o teste de Kruskal-Wallis e Mann Whitney, com nível de significância de 0,05. Alterações estatisticamente significantes foram identificadas nos testes de MDT. Indivíduos com mais de 7 meses de cirurgia resentaram tendência a diminuir os valores da MDT (p < 0,001). A alodínia foi descrita para 5 indivíduos em um período de 4 a 6 meses de pós-operatório, representando 18,51% da amostra (p < 0,05). A cirurgia ortognática altera significativamente o limiar de detecção mecânica do nervo trigêmeo. Há maior incidência de alodinia em indivíduos submetidos a cirurgia ortognática

Avaliação neurossensorial do nervo alveolar inferior após cirurgia ortognática com laserterapia de baixa intensidade

Orientador : Prof. Dr. Delson João da CostaCoorientadora: Profa. Dra. Rafaela Scariot de MoraesMonografia (especialização) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Curso de Especialização em Cirurgia e Traumatologia Buco-Maxilo-FaciaisInclui referênciasResumo : Poucos estudos têm mostrado a eficácia do tratamento da Laserterapia (LLLT) de Baixa Potência nas alterações neurossensoriais em pacientes de cirurgia ortognática. Nem sempre é possível a realização de tantas sessões de laser para que o paciente possa seguir os protocolos já descritos na literatura. O objetivo deste trabalho é avaliar a eficácia de um protocolo de aplicação da LLLT com 4 sessões em pacientes com alteração neurossensorial do nervo alveolar inferior após cirurgia ortognática. Foram avaliados trinta pacientes submetidos a 4 sessões de laser: 2, 7, 15 e 30 dias de pós-operatório. No lado direito da face do paciente foi aplicado LLLT e no lado contra-lateral luz placebo. A avaliação da sensibilidade foi realizada em 6 pontos distintos em cada lado a partir dos testes mecânico superficial, mecânico profundo e térmico nos mesmos tempos de aplicação somados a 90 e 180 dias de pós-operatório. O lado irradiado apresentou resultados melhores do que o lado controle em todas as avaliações ao final dos tempos (p<0,05). Houve melhora de ambos os lados com relação ao tempo para todos os testes (p<0,001). O teste térmico apresentou-se como o melhor teste para detectar as alterações neurossensoriais. Neste protocolo, a LLLT mostrou-se eficaz quando comparados ambos os lados em todos os parâmetros avaliados

Evaluation Of The Impact Of Orthognathic Surgery On Quality Of Life

Dental treatment and surgery is a well-established method of correcting dentofacial deformities, and such treatment has an impact on the quality of life of individuals. The objective of this study was to evaluate the effect of orthognathic surgery on the quality of life of patients receiving treatment at the Universidade Federal do Parana - UFPR. Clinical data were evaluated for the control group, and a quality-of-life evaluation questionnaire was completed [Oral Health Impact Profile (OHIP-14)]. For the case group, the same data were gathered along with information regarding their dentofacial deformity. The OHIP-14 questionnaire was also completed at three distinct stages of the experiment. The median age in the control group was 23.5 years. In the case group, the predominant gender was female, and the mean age of patients was 29.4 years. There was a statistically significant association between gender and OHIP-14 (p < 0.001). No such association was observed between age and OHIP-14 scores (p = 0.616). In the control group the OHIP-14 median score was 11.5. In the case group, the average OHIP-14 score at was 18 at T0, 21 at T1, and 8 at T2. The results demonstrated a statistically significant association between the three time stages at which OHIP-14 was analyzed (p < 0.001). There was a Smaller reduction in the negative impact for transversal deformities of the jaw when compared with other deformities. Orthognathic surgery led to a reduction in the negative effects on the quality of life of patients.30

Evaluation of quality of life profile of patients submitted to bichectomy

Introduction: The bichectomy has been increasingly sought in dental practice, whether due to functional or aesthetic complaints. It is considered an aesthetic and functional surgery, for improving both facial harmony and chewing. Objective: This study aimed to establish a quality of life profile of patients submitted to bichectomy surgery in a private service in Curitiba, PR, Brazil. Material and methods: The OHIP-14 was applied in a single moment in patients who underwent bichectomy in the last 6 to 18 months. Results: Thirty-six individuals of both sexes were evaluated, being 1 man and 35 women, with the median age of 31 (19-53) years. The median OHIP-14 scores were 0.00 (0-24) points. There was no association between OHIP-14 with age, postoperative complications, postoperative time or tobacco smoking (p > 0.05). Conclusion: The individuals were satisfied after performing the surgical procedure, presenting very low scores when compared to the literature.Introduction: The bichectomy has been increasingly sought in dental practice, whether due to functional or aesthetic complaints. It is considered an aesthetic and functional surgery, for improving both facial harmony and chewing. Objective: This study aimed to establish a quality of life profile of patients submitted to bichectomy surgery in a private service in Curitiba, PR, Brazil. Material and methods: The OHIP-14 was applied in a single moment in patients who underwent bichectomy in the last 6 to 18 months. Results: Thirty-six individuals of both sexes were evaluated, being 1 man and 35 women, with the median age of 31 (19-53) years. The median OHIP-14 scores were 0.00 (0-24) points. There was no association between OHIP-14 with age, postoperative complications, postoperative time or tobacco smoking (p > 0.05). Conclusion: The individuals were satisfied after performing the surgical procedure, presenting very low scores when compared to the literature

Jaw osteonecrosis after dental implants associated with oral bisphosphonates – case report of resection of mandible

Osteonecrosis of the jaw is associated with defects in vascularization and with the use of oral bisphosphonates. Osseous exposition and infection may occur. Recommended treatment is variable, from antibiotic medication, bony decortication to resections of the mandible in severe cases. Reconstruction of mandible, in cases of resections is essential for maintaining esthetic profile and adequate form and function. Objective: To report a case about the dangers oforal bisphosphonates in association with invasive procedures such as dental implants Case report: Female patient, 64 years-old, with osteonecrosis of the jaw caused by use of oral bisphosphonates after rehabilitation with dental implants. She had an edentulous and atrophic mandible and poor healthy. After diagnosis, partial resection of the jaw was performed together with the reconstruction with titanium plate, with no success. Then, iliac bone graft fixed by plates and screws was attempted, again with no success. Conclusion: Despiteof the small number of cases of osteonecrosis associated with oral bisphosphonate reported in the literature, a simple implant surgery could result in adverse consequences if the use of this medication were overlooked in the anamnesis.Osteonecrosis of the jaw is associated with defects in vascularization and with the use of oral bisphosphonates. Osseous exposition and infection may occur. Recommended treatment is variable, from antibiotic medication, bony decortication to resections of the mandible in severe cases. Reconstruction of mandible, in cases of resections is essential for maintaining esthetic profile and adequate form and function. Objective: To report a case about the dangers oforal bisphosphonates in association with invasive procedures such as dental implants Case report: Female patient, 64 years-old, with osteonecrosis of the jaw caused by use of oral bisphosphonates after rehabilitation with dental implants. She had an edentulous and atrophic mandible and poor healthy. After diagnosis, partial resection of the jaw was performed together with the reconstruction with titanium plate, with no success. Then, iliac bone graft fixed by plates and screws was attempted, again with no success. Conclusion: Despiteof the small number of cases of osteonecrosis associated with oral bisphosphonate reported in the literature, a simple implant surgery could result in adverse consequences if the use of this medication were overlooked in the anamnesis

Tratamento cirúrgico de cisto periapical inflamatório de grande extensão em maxila: relato de caso Surgical treatment of large extension inflammatory periapical cyst in maxilla: a case report

Introduction: Periapical cysts are the most frequent odontogenic cystic lesions, commonly asymptomatic and discovered in routine dental examinations. The treatment may vary according to the size of the cyst. Objective: The objective of this study is to report the diagnosis and treatment of a large periapical inflammatory cyst in the maxilla. Case report: Patient A.B., 38 years old, male with major complaint of pain in the left maxilla region, facial asymmetrywith increased volume in the zygomatic bone region. After the intrabuccal and radiographic examinations, a lesion with a dimension of approximately 6.5 cm was observed, extending throughout the of the upper left side, with well-defined extension. It was performed the extraction of the affected teeth, collection of the biological material for histopathological analysis and installation of a drain for decompression maintained in the buccal cavity for 6 months with periodic irrigations with saline solution. After regression of the lesion, enucleation and curettage were performed. After 36 months following-up it is possible to observe absence of signs and symptoms of lesion recurrence, with good healing and bone neoformation. Conclusion: Decompression followed by enucleation forthe treatment of periapical inflammatory cyst should be considered as a treatment option because it minimizes damage to adjacent anatomical structures.Introduction: Periapical cysts are the most frequent odontogenic cystic lesions, commonly asymptomatic and discovered in routine dental examinations. The treatment may vary according to the size of the cyst. Objective: The objective of this study is to report the diagnosis and treatment of a large periapical inflammatory cyst in the maxilla. Case report: Patient A.B., 38 years old, male with major complaint of pain in the left maxilla region, facial asymmetrywith increased volume in the zygomatic bone region. After the intrabuccal and radiographic examinations, a lesion with a dimension of approximately 6.5 cm was observed, extending throughout the of the upper left side, with well-defined extension. It was performed the extraction of the affected teeth, collection of the biological material for histopathological analysis and installation of a drain for decompression maintained in the buccal cavity for 6 months with periodic irrigations with saline solution. After regression of the lesion, enucleation and curettage were performed. After 36 months following-up it is possible to observe absence of signs and symptoms of lesion recurrence, with good healing and bone neoformation. Conclusion: Decompression followed by enucleation forthe treatment of periapical inflammatory cyst should be considered as a treatment option because it minimizes damage to adjacent anatomical structures

Central giant cell granuloma (CGCG) in childhood: surgical treatment by maintaining the tooth germs

Introduction: Central Giant Cell Granuloma (CGCG) is a nonneoplasticbenign process, of unknown etiology, more common in children and young adults. When aggressive, the lesion may result in considerable bone destruction and deformation. Oral and Maxillofacial surgery strongly depends on the nature of injury and it may vary from more conservative to more aggressive approach. Case report: The aim of the present study is to report and analyze, a giant cellcentral lesion in a 7-year-old patient on the right side of mandible body treated by surgical enucleation, curettage, and maintenance of the tooth germs. Discussion: In less aggressive lesions, curettage followed by radiographic monitoring is the most widely suggested treatment choice. However, the “gold standard” for aggressive and deforming lesions would be en-bloc resection with a safety margin. Most revisions show recurrence rates of 15 to 20%, thus clinicalmonitoring is necessary at least one year after the intervention. Conclusion: After 12 months, panoramic radiograph and computed tomography indicated new bone formation and no recurrence. In addition, good healing of soft tissues and correct eruption of the teeth #42, #43 and #44 were observed.Introduction: Central Giant Cell Granuloma (CGCG) is a nonneoplasticbenign process, of unknown etiology, more common in children and young adults. When aggressive, the lesion may result in considerable bone destruction and deformation. Oral and Maxillofacial surgery strongly depends on the nature of injury and it may vary from more conservative to more aggressive approach. Case report: The aim of the present study is to report and analyze, a giant cellcentral lesion in a 7-year-old patient on the right side of mandible body treated by surgical enucleation, curettage, and maintenance of the tooth germs. Discussion: In less aggressive lesions, curettage followed by radiographic monitoring is the most widely suggested treatment choice. However, the “gold standard” for aggressive and deforming lesions would be en-bloc resection with a safety margin. Most revisions show recurrence rates of 15 to 20%, thus clinicalmonitoring is necessary at least one year after the intervention. Conclusion: After 12 months, panoramic radiograph and computed tomography indicated new bone formation and no recurrence. In addition, good healing of soft tissues and correct eruption of the teeth #42, #43 and #44 were observed

Alterações neurossensoriais após cirurgia ortognática

Orientador : Priscila Brenner Heiligenberg SydneyMonografia (especialização) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Curso de Especialização em Disfunção Temporomandibular e dor orofacial.Inclui referênciasResumo : O dano ao feixe nervoso alveolar inferior permanece como uma das maiores desvantagens da cirurgia ortognática, sendo causa de estresse e desapontamento pelos pacientes. Os testes sensoriais quantitativos (TSQs) estabelecem um perfil de pacientes com várias condições de alteração neurossensorial. O objetivo do presente estudo foi determinar os limiares mecânicos e de dor em pacientes submetidos à cirurgia ortognática, utilizando o TSQ. Vinte e sete indivíduos submetidos à cirurgia ortognática, entre 4 e 24 meses de acompanhamento pós-operatório, foram avaliados para o limiar de detecção mecânica (MDT), limiar de dor mecânica (MPT) e alodínia mecânica dinâmica (DMA) em combinação com o questionário Oral Health Impact Profile (OHIP-14). O grupo controle foi pareado por sexo e idade. Todos os grupos foram comparados com o teste de Kruskal-Wallis e Mann Whitney, com nível de significância de 0,05. Alterações estatisticamente significantes foram identificadas nos testes de MDT. Indivíduos com mais de 7 meses de cirurgia resentaram tendência a diminuir os valores da MDT (p < 0,001). A alodínia foi descrita para 5 indivíduos em um período de 4 a 6 meses de pós-operatório, representando 18,51% da amostra (p < 0,05). A cirurgia ortognática altera significativamente o limiar de detecção mecânica do nervo trigêmeo. Há maior incidência de alodinia em indivíduos submetidos a cirurgia ortognática

Avaliação neurossensorial do nervo alveolar inferior após cirurgia ortognática com laserterapia de baixa intensidade

Orientador : Prof. Dr. Delson João da CostaCoorientadora: Profa. Dra. Rafaela Scariot de MoraesMonografia (especialização) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Curso de Especialização em Cirurgia e Traumatologia Buco-Maxilo-FaciaisInclui referênciasResumo : Poucos estudos têm mostrado a eficácia do tratamento da Laserterapia (LLLT) de Baixa Potência nas alterações neurossensoriais em pacientes de cirurgia ortognática. Nem sempre é possível a realização de tantas sessões de laser para que o paciente possa seguir os protocolos já descritos na literatura. O objetivo deste trabalho é avaliar a eficácia de um protocolo de aplicação da LLLT com 4 sessões em pacientes com alteração neurossensorial do nervo alveolar inferior após cirurgia ortognática. Foram avaliados trinta pacientes submetidos a 4 sessões de laser: 2, 7, 15 e 30 dias de pós-operatório. No lado direito da face do paciente foi aplicado LLLT e no lado contra-lateral luz placebo. A avaliação da sensibilidade foi realizada em 6 pontos distintos em cada lado a partir dos testes mecânico superficial, mecânico profundo e térmico nos mesmos tempos de aplicação somados a 90 e 180 dias de pós-operatório. O lado irradiado apresentou resultados melhores do que o lado controle em todas as avaliações ao final dos tempos (p<0,05). Houve melhora de ambos os lados com relação ao tempo para todos os testes (p<0,001). O teste térmico apresentou-se como o melhor teste para detectar as alterações neurossensoriais. Neste protocolo, a LLLT mostrou-se eficaz quando comparados ambos os lados em todos os parâmetros avaliados

Evaluation Of The Impact Of Orthognathic Surgery On Quality Of Life.

Dental treatment and surgery is a well-established method of correcting dentofacial deformities, and such treatment has an impact on the quality of life of individuals. The objective of this study was to evaluate the effect of orthognathic surgery on the quality of life of patients receiving treatment at the Universidade Federal do Paraná - UFPR. Clinical data were evaluated for the control group, and a quality-of-life evaluation questionnaire was completed [Oral Health Impact Profile (OHIP-14)]. For the case group, the same data were gathered along with information regarding their dentofacial deformity. The OHIP-14 questionnaire was also completed at three distinct stages of the experiment. The median age in the control group was 23.5 years. In the case group, the predominant gender was female, and the mean age of patients was 29.4 years. There was a statistically significant association between gender and OHIP-14 (p< 0.001). No such association was observed between age and OHIP-14 scores (p= 0.616). In the control group the OHIP-14 median score was 11.5. In the case group, the average OHIP-14 score at was 18 at T0, 21 at T1, and 8 at T2. The results demonstrated a statistically significant association between the three time stages at which OHIP-14 was analyzed (p< 0.001). There was a smaller reduction in the negative impact for transversal deformities of the jaw when compared with other deformities. Orthognathic surgery led to a reduction in the negative effects on the quality of life of patients.3