Intubación orotraqueal con vía submandibular en Cirugía yTraumatología Bucomaxilofacial

Introduction: Submandibular tracheal intubation is a technique that can be applied in Oral and Maxillofacial Surgery and Traumatology,as well asother surgical specialties. Its main advantages are helpingin the surgical manipulation of the middle facial skeleton and jaw and allowing the intraoperative control of dental occlusion. The technique is analternative to elective tracheostomy. Objective and case report: The article presents the treatment of an adult patient, with sequelae of multiple fractures in the face due to a car accident, with endotracheal intubation using submandibular approach.Final considerations: In large surgical manipulations of the face, the submandibular approach for tracheal intubation allows a faster, facilitated anatomical access with a lower risk of damage to adjacent structures when compared to other pathways. It also guarantees excellent cervical mobility, the possibility of wide manipulation and the use of occlusion as a guide for surgical intervention.Introdução:A intubação orotraqueal com trajeto submandibular é uma técnica que pode ser aplicada em Cirurgia e Traumatologia Buco-maxilo-faciais e outras especialidades cirúrgicas. Tem sua indicação diante da necessidade de manipulação cirúrgica do esqueleto fixo da face e mandíbula, permitindo o estabelecimentoda oclusão trans-operatória. A técnica é uma alternativa à realização da traqueostomia eletiva. Objetivo e relato do caso: O artigo tem por objetivo apresentar a intubação orotraqueal com trajeto submandibular, que foi aplicada em um paciente adulto, vítima de acidente automobilístico, com sequela de múltiplas fraturas em face. Considerações finais:Nas grandes manipulações cirúrgicas da face, o trajeto cirúrgico submandibular, para a passagem do tubo de anestesia, permite um acesso anatômico mais rápido, facilitado e com menor risco de danos às estruturas adjacentes, quando comparado com outras vias. Garante ainda, excelente mobilidade cervical, possibilidade de ampla manipulação e utilização da oclusão como guia para intervenção cirúrgica.Introdución:La intubación orotraqueal con vía submandibular es una técnica que se puede aplicar en Cirugía y Traumatología Buccomaxilofacial y otras especialidades quirúrgicas. Está indicado por la necesidad de manipulación quirúrgica del esqueleto fijo de rostro y mandíbula, permitiendo el establecimiento de oclusión intraoperatoria. La técnica es una alternativa a la realización de una traqueotomía electiva. Objetivo y relato de caso: El artículotiene como objetivo presentar la intubación orotraqueal con vía submandibular, la cual se aplicó a un paciente adulto, víctima de un accidente automovilístico, con secuelas de múltiples fracturas en la cara. Consideraciones finales: En manipulaciones quirúrgicas mayores del rostro, la vía quirúrgica submandibular, para el paso del tubo de anestesia, permite unacceso anatómico más rápido, más fácil y con menor riesgo de daño a las estructuras adyacentes, en comparación con otras vías. También garantiza unaexcelente movilidad cervical, posibilidad de amplia manipulación y uso de la oclusión como guía para la intervención quirúrgica

Thirty-eight-year follow-up of the first patient of mandibular reconstruction with free vascularized fibula flap

Background: The mandible is responsible for vital functions of the stomatognathic system, and its loss results in functional and aesthetic impairment. Mandibular reconstruction with free fibula flap is considered the gold standard for mandibular reconstruction. Case presentation: We describe here the 38-year follow-up of the patient who was the first case of mandibular reconstruction with free fibula flap reported in the literature. The original report describes a 27-year-old woman who had undergone extensive mandibulectomy due to an osteosarcoma. A microvascularized fibula flap was used for mandibular reconstruction in 1983. Two years later, a vestibulo-lingual sulcoplasty with skin graft was performed to allow the construction of a total dental prosthesis. Fifteen years after the initial treatment, an autologous iliac crest graft was placed in the fibula flap, aimed at increasing bone thickness and height for rehabilitation with implant supported prosthesis. In 2015, a rib graft was positioned in the mental region, enhancing the support to the soft tissues of the face and improving the oral function. A recent review of the patient shows well-balanced facial morphology and optimal functional results of the procedure. Conclusions: The fibula flap method, described in 1975 and first reported for mandibular reconstruction in 1985, continues to be applied as originally described, especially where soft tissue damage is not extensive. Its use in reconstructive surgery was expanded by advancements in surgery and techniques such as virtual surgical planning. However, there is still a lack of evidence related to the long-term evaluation of outcomes. The present work represents the longest-term follow-up of a patient undergoing mandibular reconstruction with free vascularized fibula flap, presenting results showing that, even after 38 years, the procedure continues to provide excellent results

Análise microscópica na articulação temporomandibular a partir da mudança de direção do vetor de força da mandíbula em relação à base do crânio : estudo experimental em coelhos (Oryctolagus cuniculus l.)

The correlation between TMJ's growing, structure and function is consensual in the specialized literature. Until the moment, the little knowledge about post-birth changes are studied by observation of condylar growth and disc reestructuration. In an experimental model in rabbits (Oryctolagus cuniculus 1.), it was observed tecidual alterations of the TMJ's components — mandibular condyle, articular disc and temporal bone, face to a direction change of mandibular power axis, which has the incidence upon these structures. Twentyfour rabbit were divided in four groups. Two of each group formed a control group. Four experimental periods were established 15, 30, 60 and 90 days. The animals from the experimental group were submitted to surgical procedure involving the mandible right side, changing the direction of mandibular power axis, which has incidence in the TMJ. Histological observations of TMJ in the control group, at different times, the growth and development of this structure were showed, compatible to the normality. At experimental group, the change of mandibular power axis caused alteration of the mandibular condyle and the discal structure. Significative responses at temporal bone were observed too, as a process of osseous modelation, suggestive of growth of this cranial structure.A correlação entre crescimento, estrutura e função da articulação temporomandibular (ATM) é consenso na literatura especializada. Até o presente momento, as mudanças pós-natais pouco conhecidas são exploradas na observação do crescimento condilar e reestruturação do disco articular. Em estudo experimental em coelhos (Oryctolagus cuniculus l.), observaram-se alterações teciduais dos componentes articulares - côndilo mandibular, disco articular e osso temporal, frente à mudança de direção do vetor de força da mandíbula que incide sobre estas estruturas. Foram utilizados 24 coelhos divididos em quatro grupos. De cada grupo, dois coelhos formaram o grupo controle. Foram estabelecidos quatro períodos experimentais: 15, 30, 60 e 90 dias. Os animais do grupo experimental foram submetidos ao procedimento cirúrgico envolvendo a mandíbula do lado direito, com a mudança de direção do vetor de força mandibular que incide na ATM. As observações histológicas na ATM do grupo controle nos diferentes tempos mostraram o crescimento e o desenvolvimento desta estrutura compatíveis com a normalidade. No grupo experimental, a mudança de direção do vetor de força da mandíbula causou alterações no côndilo mandibular e na estrutura discal. Observaram-se, ainda, respostas significativas no osso temporal, com um processo de modelação óssea sugerindo crescimento dessa estrutura craniana

Estudo in vitro das alterações morfológicas da superfície de raízes submetidas à apicectomia e írradiadas com laser de Nd:YAG

Introduction: success rates of apical surgery are variable, and there are several causes of failure related in the literature. Among them, permeability of exposed dentin at the apical surface after apicoectomies has been receiving much attention, Nd: YAG laser irradiation can decrease this permeability, but its effects on root surface are not completely known. Objectives: evaluate morphological alterations of apical surface, specially surface smoothness, after Nd: YAG non contact laser irradiation, in different powers, in vitro. Material and Methods: thirty extracted human cuspids, maintained in distilled water had its crowns removed, and were endodontically treated in standard technique. Apicoectomy performed, removing 4 mm most apical of roots, using handpiece. Teeth were divided in three groups of 10 each. Half of the area of each apical surface was irradiated with Nd:YAG laser in non contact mode, for 30 seconds. Three different powers were used- three groups of 10 each. Half of the area of each apical surface was irradiated.Introdução: os índices de sucesso da cirurgia apical são variáveis, sendo diversas as causas de fracasso relatadas na literatura. Dentre elas, a permeabilidade da dentina exposta na superfície apical após apicectomias tem recebido grande atenção. A irradiação com laser de Nd:YAG é capaz de diminui-la, mas não se conhece completamente seu efeito sobre a superfície de corte apical. Proposição: avaliar as alterações morfológicas da superfície de corte apical promovidas pela irradiação com laser de Nd:YAG sem contato, em diferentes potências, in vitro. Metodologia: trinta dentes caninos humanos, após a remoção de suas coroas, receberam tratamento endodôntico e tiveram seus quatro milímetros mais apicais ressecados com fresa cirúrgica em baixa rotação, sob irrigação. Foram divididos em três grupos de dez dentes cada. A metade da área de suas superfícies apicais foi irradiada com laser de Nd:YAG, à distância de dois milímetros entre a extremidade da fibra óptica e o tecido alvo, durante 30 segundos. As potências médias empregadas foram 1,6 W, 2,0 W e 2,4 W, variando de acordo com os respectivos grupos. As raízes foram estudadas com MEV. Resultados: áreas de fusão e derretimento da superfície de smear layer foram observadas nas superfícies irradiadas, que se mostraram mais compactas pela diminuição da porosidade. Crateras e áreas de danos térmicos foram de observação eventual. Os efeitos da irradiação não foram homogêneos ao longo das superfícies. Conclusões: o laser de Nd:YAG, aplicado sem contato nas condições descritas, foi capaz de promover fusão e recristalização da smear layer nas superfícies de corte de apicectomias

Occurrence of dermoid cyst in the floor of the mouth: the importance of differential diagnosis in pediatric patients

Lesions in the floor of the mouth can be a challenging diagnosis due to the variety of pathological conditions that might be found in this area. Within a broad range of lesions, attention has to be addressed to those that require specific management, such as a dermoid cyst (DC) and a ranula. Especially in pediatric patients, in whom the failure of diagnosis can postpone the correct treatment and cause sequelae later in life. DC, a developmental anomaly, is managed primarily by surgical resection. On the other hand, ranula is a pseudocyst that may be treated by marsupialization. This article reports a large and painful lesion in the floor of the mouth in a pediatric patient. With a diagnostic hypothesis of ranula, two surgical interventions were performed, but there were recurrences of the lesion. Subsequently, the patient was referred to the Oral and Maxillofacial Surgery Unit for re-evaluation. Computed tomography showed a semi-transparent image suggesting a cystic formation. Another surgical procedure was performed where the lesion was completely removed. Anatomopathological analysis confirmed the diagnosis of DC. The five-year follow-up showed no signs of recurrence. This article indicates that although DC in the floor of the mouth is rare, it should be considered in the differential diagnosis of other diseases in this area. This precaution may be particularly important in the following circumstances: 1) Similar lesions that have different therapeutic approaches and, 2) To prevent future sequelae in pediatric patients

Estudo histológico do polímero poliuretano da mamona implantado no ângulo mandibular de ratos

Ricinoleic acid polyurethane polymer behaviour, implanted subperiostic in rat's mandibular angles was studied. liventy Rattus novergicus (Alhinus rodentia mammalia, cepa Wistar) were divided in for groups of five animals each. The polymer polyurethane, added of calcium carbonate, was implanted at mandibular angle of them. One animal from and 90 days after surgery. Histological examination showed the stability of the implant, the almost total absence of inflammatory response, the fibrous capsule formed surrounding the implant, and bone neoformation. According the experimental model, we concluded that the subperiostic implanted ricinoleic acid polyurethane polymer did not unleash a significant later inflammatory reaction, it has took to the development of a districted fibrous capsule, with evolution for bone neoformation. Signals of rejection, exposition or expel of the implant were not registered.Este estudo analisou o comportamento do polímero poliuretano da mamona implantado em leito subperióstico em ângulos mandibulares de ratos. Vinte Rattus novergicus (var. Albinus rodentia mammalia, cepa Wistar) foram divididos em quatro grupos de cinco animais. O polímero poliuretano da mamona, com adição de carbonato de cálcio, foi implantado no bordo inferior da mandíbula dos mesmos. Em cada grupo, um animal correspondeu ao controle, tendo sido submetido à cirurgia sem a colocação do implante. Os animais foram sacrificados após 15, 30, 60 e 90 dias pós-operatórios. Ao exame histológico, em cortes corados com hematoxilina e eosina (HE), observou-se a estabilidade do implante, a ausência significativa de reação inflamatória, a formação de cápsula fibrosa circunjacente ao implante, e neoformação óssea. Segundo as condições experimentais, concluímos que o polímero poliuretano da mâmona, implantado em leito subperióstico, não desencadeou reação inflamatória tardia significativa, tendo levado ao desenvolvimento de cápsula fibrosa circunscrita, com evolução para neoformação óssea. Sinais de rejeição, exposição ou expulsâo do implante não foram observados

Incisivo central superior com desvio do eixo de erupção e dilacerado: recuperação ortodôntica-cirúrgica

A intrusão de um dente decíduo numa faixa etária precoce, pode causar sérios danos ao seu sucessor permanente. Um caso clínico é relatado no qual, devido a este tipo de traumatismo na dentadura decídua, houve desvio do eixo de erupção, com a conseqüente dilaceração do dente permanente. Num acompanhamento de dois (2) anos é descrito o tratamento ortodôntico-cirúrgico, em cuja técnica é aplicada a laçada dupla

Effects of a buried magnetic field on cranial bone reconstruction in rats

The understanding of bone repair phenomena is a fundamental part of dentistry and maxillofacial surgery. Objective The present study aimed to evaluate the influence of buried magnetic field stimulation on bone repair in rat calvaria after reconstruction with autogenous bone grafts, synthetic powdered hydroxyapatite, or allogeneic cartilage grafts, with or without exposure to magnetic stimulation. Material and Methods Ninety male Wistar rats were divided into 18 groups of five animals each. Critical bone defects were created in the rats’ calvaria and immediately reconstructed with autogenous bone, powdered synthetic hydroxyapatite or allogeneic cartilage. Magnetic implants were also placed in half the animals. Rats were euthanized for analysis at 15, 30, and 60 postoperative days. Histomorphometric analyses of the quantity of bone repair were performed at all times. Results These analyses showed significant group by postoperative time interactions (p=0.008). Among the rats subjected to autogenous bone reconstruction, those exposed to magnetic stimulation had higher bone fill percentages than those without magnetic implants. Results also showed that the quality of bone repair remained higher in the former group as compared to the latter at 60 postoperative days. Conclusions After 60 postoperative days, bone repair was greater in the group treated with autogenous bone grafts and exposed to a magnetic field, and bone repair was most pronounced in animals treated with autogenous bone grafts, followed by those treated with powdered synthetic hydroxyapatite and allogeneic cartilage grafts

Histomorphometric analysis of the temporal bone after change of direction of force vector of mandible: an experimental study in rabbits

OBJECTIVES: The present study aimed at performing a histological evaluation of the response of temporal bone tissue to a change of direction of the force vector of the mandible in relation to the base of the skull. MATERIAL AND METHODS: Adult rabbits were assigned into four groups with two control and four experimental animals in each group. experimental animals underwent surgery, which resulted in a change of direction of the force vector on the right temporomandibular joint. Samples were collected after 15, 30, 60 and 90 days for histological analysis. RESULTS: In the two-way analysis of variance, the effect of group and time was statistically significant (