Giant sialolith of submandibular gland: case report

The sialolith, also known as saliva stone or sialolithiasis is a calcified structure which develops inside the salivary ductal system or on the salivary gland parenchyma; it grows gradual, asymptomatic, and slowly. Most of the stones are sized less than 10 mm and only 7% of them are larger than 15 millimeters; those are considered giant salivary gland stones. Objective: This study aimed to report a case of two sialoliths that have merged, forming a giant sialolith, located in the Wharton duct in the left submandibular gland. Methods and Results: Clinical diagnosis was confirmed by occlusal and panoramic radiographs. A surgical removal was performed with intraoral incision under local anesthesia, through sialolith anchorage by suture thread and removal of two sialoliths, sized about 13 mm and 16 mm. Marsupialization suture was performed at the local where the incision was made, forming a new gland duct. Conclusion: The sialolithiasis treatment methods are very different and should be taken into account the affected gland, size and location of sialolith, always opting for the more conservative methods

DIAGNOSTICO E TRATAMENTO DE ODONTOMA COMPLEXO: relato de caso

The complex odontoma is characterized as a hamartoma, a developmental tumor with mineralized dental tissue in its composition. This pathology is the most common among odontogenic tumors and is frequently diagnosed in the second decade of life. These lesions are asymptomatic and may be related to tooth eruption disorders and it can be diagnosed during routine radiographic examinations, evaluations of a missing tooth or orthodontic planning. Case report: The objective of this report is to demonstrate a clinical case of complex odontoma in the mandible in which the final diagnosis was based on radiographic finds and histopathological results, as well as conservative surgical treatment. Highlighting the importance of the surgeon's knowledge for correct diagnosis and management in surgery, therefore, recommending a more conservative treatment as it presents a rare recurrence.  O odontoma complexo é caracterizado como um hamartoma, tumor de desenvolvimento que possui em sua composição tecido dentário mineralizado, sendo esta patologia a mais comum entre os tumores odontogênicos e é frequentemente diagnosticado na segunda década de vida. As lesões provocadas por ele são assintomáticas, podendo estar relacionadas a distúrbios de erupção dentária, e são diagnosticadas nos exames radiográficos de rotina, nas avaliações de um dente ausente ou planejamentos ortodônticos. O objetivo deste estudo de caso é demonstrar um caso clínico de odontoma complexo em mandíbula que teve seu diagnostico final encontrado pelos achados radiográficos e resultado do histopatológico, assim como o tratamento cirúrgico conservador.  É necessário ressaltar a importância do conhecimento do cirurgião para o correto diagnóstico e manejo na cirurgia, propondo o tratamento mais conservador, assim apresentando uma rara recidiva

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

PROTOCOLOS DE FOTOBIOMODULAÇÃO NO TRATAMENTO DE ALTERAÇÕES NEUROSSENSORIAIS DECORRENTES DE CIRURGIA ORTOGNÁTICA: revisão da literatura

Anomalies in the craniomaxillofacial complex, resulting from changes in the development of the neurocranium or viscerocranium, may arise from the intrauterine period or due to etiological factors throughout life. Orthognathic surgery, aiming to correct such irregularities, often involves techniques such as mandibular ramus sagittal osteotomy (BSSO) to adjust malocclusions. However, neurosensory deficits after BSSO are common, with 1-2% of cases persisting for long periods, affecting quality of life. The inferior alveolar nerve (IAN) is often damaged during BSSO, causing atypical sensations or numbness. Although sensorineural recovery often occurs spontaneously, there is a search for methods that accelerate this process. Photobiomodulation (FBM) emerges as a promising non-invasive approach. This work aims to carry out a narrative review of the literature on protocols for using photobiomodulation (FBM) as an auxiliary tool in the treatment of sensorineural disorders resulting from orthognathic surgery. FBM is effective in neurosensory recovery after orthognathic surgery involving the IAN. The technique, minimally invasive, is recommended for use in the postoperative period, with intraoral and extraoral application. However, the lack of a standard protocol for FBM highlights the need for more research to clarify its effects and effectiveness in treating postoperative neurosensory disorders.Anomalias no complexo craniomaxilofacial, resultantes de alterações no desenvolvimento do neurocrânio ou viscerocrânio, podem surgir desde o período intrauterino ou devido a fatores etiológicos ao longo da vida. A cirurgia ortognática, visando corrigir tais irregularidades, frequentemente envolve técnicas como a osteotomia sagital do ramo mandibular (BSSO) para ajustar maloclusões. No entanto, déficits neurossensoriais após BSSO são comuns, com 1-2% dos casos persistindo por longos períodos, afetando a qualidade de vida. O nervo alveolar inferior (NAI) é muitas vezes danificado durante a BSSO, causando sensações atípicas ou dormência. Apesar da recuperação neurossensorial muitas vezes ocorrer espontaneamente, há uma busca por métodos que acelerem esse processo. A fotobiomodulação (FBM) surge como uma abordagem não invasiva promissora. Este trabalho tem como objetivo realizar uma revisão narrativa da literatura sobre os protocolos de uso da fotobiomodulação (FBM) como ferramenta auxiliar no tratamento das neurossensoriais decorrentes de cirurgia ortognática. A FBM é eficaz na recuperação neurossensorial pós-cirurgia ortognática envolvendo o NAI. A técnica, minimamente invasiva, tem seu uso recomendado no pós-operatório, com aplicação intraoral e extraoral. Contudo, a falta de um protocolo padrão para FBM evidencia a necessidade de mais pesquisas para esclarecer seus efeitos e eficácia no tratamento de distúrbios neurossensoriais pós-operatórios

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events