Influence of wrong determination of occlusal plane in maxillary advancement : a model surgery study

Orientador: Roger William Fernandes MoreiraDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Os resultados em cirurgia ortognática dependem de um diagnóstico acurado e planejamento correto, portanto a cirurgia de modelo deverá ser com a menor quantidade de erros possível. Sabe-se que o uso do arco facial leva a diversos erros de aquisição do posicionamento tridimensional da maxila. Este estudo visou analisar se a alteração da angulação do plano oclusal influencia no resultado final após a cirurgia de modelos em avanços maxilares. Para esta análise dois tipos de avanço foram abordados: de 4 e de 8 milímetros. Foram montados 20 modelos maxilares com angulação de plano oclusal de 13 graus (grupo controle) e 20 modelos maxilares com angulação de 7 graus (grupo estudo) para cada grupo de avanço maxilar. A cirurgia de modelo com o respectivo avanço maxilar foi realizada utilizando-se o plano de 13 graus para a confecção do guia intermediário. Os 40 modelos foram remontados utilizando-se o mesmo guia. Mensurações foram realizadas com paquímetro digital utilizando plataforma de Erickson mais base metálica nos três planos: vertical, anteroposterior e médiolateral. A análise estatística revelou resultados significativos nos três planos. A alteração da angulação do plano oclusal em menos 6 graus alterou o resultado final nas medidas verticais: molar direito do grupo de avanço maxilar de 4 milímetros (p<0.0001) e molar esquerdo dos dois grupos de avanço (p<0.0001); na medida anteroposterior a partir do incisivo central superior do grupo de avanço de 4 milímetros (p<0.005) e do grupo de 8 milímetros (p<0.0001). Embora resultados estatisticamente significativos tenham sido encontrados, nenhuma significância clínica pode ser observadaAbstract: This study investigated whether an occlusal plane error of acquisition can influence in the treatment planning and result of maxillary advancement in double-jaw surgeries. Advancement of 8 and 4 millimeters were studied in different groups. For each group 20 maxillary models were mounted by a 13 degrees platform with superior articulator arm (control group) and another 20 models mounted with minus 6 degrees (study group). Intermediate splint was obtained by cast surgery performed in the control group. All the 40 maxillary models were remounted with this intermediate splint. Measurements in vertical and anteroposterior planes were accomplished pre and post-operatively by digital caliper rule and Erickson's platform. Statistical analysis showed significant results in all planes. The alteration of occlusal plane from 13 degrees to 7 degrees modified the final result in vertical measurements: right molar from group of 4 mm advancement (p<0.0001) and left molar from two groups of advancement (p<0.0001); in anteroposterior measurements: maxillary incisor from 4 mm of advancement (p<0.005) and 8 mm of advancement (p<0.0001). Notwithstanding the importance of statistical findings, this study was limited by a range of 4 mm of advancement and a range of 6 degrees of angle alteration because the sample were chosen by the laboratorial methodology. Clinical studies evolving these questions must be supplied in scientific literatureMestradoCirurgia e Traumatologia Buco-Maxilo-FaciaisMestre em Clínica Odontológic

Immediate impact of orthognathic surgery on respiratory parameters in patients with obstructive sleep apnea disorder

Introdução: pacientes com Apneia Obstrutiva do Sono (AOS) — que são submetidos a procedimentos cirúrgicos — têm maior risco de apresentarem complicações imediatas, como alterações cardiovasculares e respiratórias. Apesar disso, não há estudo suficiente sobre os parâmetros respiratórios pós-operatórios do paciente com Distúrbio Respiratório Obstrutivo do Sono (DROS), submetido à cirurgia ortognática. Objetivo: avaliar o impacto imediato da cirurgia ortognática de avanço bimaxilar em relação aos parâmetros respiratórios de pacientes adultos com DROS, por meio de Tonometria Arterial (TA) pré e pós-operatória, além de correlacionar os parâmetros respiratórios entre TA e polissonografia tipo 1(PSG1). Método: para esse ensaio clínico prospectivo, foram incluídos 20 pacientes com DROS e indicação de cirurgia ortognática. Os parâmetros respiratórios no sono foram monitorados no pré-operatório (PSG1 e TA) e no pós-operatório imediato (TA). Resultados: as médias do Índice de Apneia e Hipopneia por Hora de Sono (IAH) e índice de distúrbio respiratório por hora de sono (IDR) apresentaram aumento de 9.77 e 11.22 no pré-operatório, para 13.74 e 14.81 (P = 0.021, 0.102) no pós-operatório, respectivamente. Enquanto as medianas da porcentagem de sono REM e NREM foram de 27.30 e 72.70, no pré-operatório, para 12.75 e 86.29 (P = 0.002) respectivamente no pós-operatório. Também foi observada uma forte correlação positiva entre o IAH no pré-operatório pela PSG1 e pela TA (rs = 0.743). Conclusões: verificou-se piora dos parâmetros respiratórios no pós-operatório imediato dos pacientes com DROS submetidos a cirurgia ortognática de avanço bimaxilar. Os dados sugerem que a TA pode ser considerada como dispositivo de triagem em pacientes com suspeita de AOS candidatos à cirurgia ortognática.ntroduction: p atients with obstructive sleep apnea (OSA) that undergone surgical procedures can present immediate complications such as cardiovascular and respiratory alterations. Despite that, there is no consensus in the literature on post op OSA patien t management submitted to orthognathic surgery. Objective: e valuate the immediate impact of orthognathic surgery for bimaxillary advancement in respiratory parameters of adult patients with obstructive sleep apnea measured by arterial tonometry (WatchPat) pre and post operatory and correlate the respiratory parameters between arterial tonometry and type 1 polysomnography . Methods: i n this prospective clinical trial, were included 20 patients with obstructive sleep apnea and orthognathic surgery indication. The sleep respiratory parameters were monitored at pre op (Type 1 polysomnography and arterial tonometry) and at immediate post op (arterial tonometry). Results: t he mean apnea disturbance index (IDR) presented increashypopnea index (IAH) and respiratory e of 9.77 and 11.22 at pre op, to 13.74 and 14.81 (P = 0.021, 0.102) on post op period, respectively. While the median of percentage of REM and NREM sleep was 27.30 and 72.70 at pre op and changed to 12.75 and 86.29 (P = 0.002) respectively on post op peri od. There was observed a strong positive correlation between the IAH at the pre op by polysomnography and by arterial tonometry (r s = 0.743). Conclusions: t he data suggest that the arterial tonometry is a valid method to register respiratory parameters and can be considered as a sorting device in patients with suspected OSA and orthognathic surgery indication. Was observed worsening of respiratory parameters in the immediate post op of OSA patients submitted to orthognathic surgery for bimaxillary advanceme nt. This was related to supine position to sleep and edema in facial inferior third at post operatory. More studies in most characteristic populations to OSA are necessary.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)88887.513020/2020-0

Influence of wrong determination of occlusal plane in maxillary advancement: a model surgery study

Aim: This study investigated whether an occlusal plane error of acquisition can influence on the treatment planning of maxillary advancement in double-jaw surgeries. Methods: Advancement of 8 and 4 mm were studied in different groups. For each group, 20 maxillary models were mounted by a 13-degree platform with superior articulator arm (control group) and other 20 models mounted with 7 degrees (study group). Intermediate splint was obtained by cast surgery performed in the control group. All the 40 maxillary models were remounted with this intermediate splint. Measurements in vertical and anteroposterior planes were accomplished pre- and postoperatively by digital caliper rule and Erickson’s platform. Results: Statistical analysis showed significant results in two planes. The alteration of occlusal plane from 13 degrees to 7 degrees modified the final result in vertical measurements: right molar from group of 4 mm advancement (p<0.0001) and left molar from two groups of advancement (p<0.0001); in anteroposterior measurements: maxillary incisor from 4 mm of advancement (p<0.005) and 8 mm of advancement (p<0.0001). Conclusions: Notwithstanding the importance of statistical findings, the result probably did not show clinical relevance in orthognathic surgery. Clinical studies addressing these concerns must be supplied in scientific literature

Analysis of 185 maxillofacial fractures in the state of Santa Catarina, Brazil

A retrospective study was performed to assess maxillofacial fractures in patients treated at a public hospital from 2002 to 2006. The data collected included age, gender, etiology, type of injury, treatment modalities and period of treatment. Causes were grouped into seven categories: road traffic collisions, sports accidents, occupational accidents, gunshot fractures, falls, violence and other causes. The analyses involved descriptive statistics, the Chi-squared Test and the Fisher Exact Test. Records from 132 patients sustaining 185 maxillofacial fractures were evaluated. The mandible (54.6%) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6%). The mean age of the patients was 37.7 years, and the male:female ratio was 4.3:1. Most fractures occurred in adults with ages ranging from 18 to 39 years. A significant statistical relation was found between the age and the etiology of the trauma (p < 0.05), and between the number of fractured sites and the age of the patient (p < 0.05). Considering the age groups, accidents were the most frequent cause of maxillofacial fractures in the age group between 18 to 39 years, and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 to 59 years. Treatment was performed on the same day as the diagnosis in 44.7% of the patients. Open surgery with internal stable fixation was indicated for most of the patients. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Traffic road collisions were the main etiologic factor associated with maxillofacial trauma

Oral and maxillofacial surgery - Helmet and maxillofacial trauma: a 10-year retrospective study

Aim: The aim of the present study was to retrospectively evaluate the epidemiologic characteristics of the prevalence, type and treatment modalities of maxillofacial trauma according to use of helmets by motorcyclists in traffic accidents. Methods: Data was collected from patients during a 10-year period (1999-2009). Data recorded included demographic, etiology, diagnosis, type of fracture, use of helmet, associated facial and general trauma, soft tissue lesions and treatment methods. Data analysis included a descriptive analysis, Chi-square test and Kruskal-Wallis test. Results: From 376 motorcycle crash victims, 260 had maxillofacial fractures with a male/female ratio of 4:1 and a mean age of 26.1. Considering the helmet as a security device, 89 patients were not wearing a helmet during the crash against 287 patients that were wearing it. One hundred and sixteen patients had soft tissue lesions, 80 of them wore a helmet at the moment of the crash and 36 did not (p<0.05). The most frequently fractured facial bone was the zygoma (24%) followed by the mandible. Conclusions: Motorcycle accidents represented almost one third of all maxillofacial injuries seen at this Oral and Maxillofacial Surgery Division, causing high morbidity. Educational campaigns, defensive driving and use of adequate helmets are necessary to decrease the number of facial injuries in such accidents

Oral and maxillofacial surgery - Helmet and maxillofacial trauma: a 10-year retrospective study

e aim of the present study was to retrospectively evaluate the epidemiologic characteristics of the prevalence, type and treatment modalities of maxillofacial trauma according to use of helmets by motorcyclists in traffic accidents. Methods: Data was collected from patients during a 10-year period (1999-2009). Data recorded included demographic, etiology, diagnosis, type of fracture, use of helmet, associated facial and general trauma, soft tissue lesions and treatment methods. Data analysis included a descriptive analysis, Chi-square test and Kruskal-Wallis test. Results: From 376 motorcycle crash victims, 260 had maxillofacial fractures with a male/female ratio of 4:1 and a mean age of 26.1. Considering the helmet as a security device, 89 patients were not wearing a helmet during the crash against 287 patients that were wearing it. One hundred and sixteen patients had soft tissue lesions, 80 of them wore a helmet at the moment of the crash and 36 did not (p<0.05). The most frequently fractured facial bone was the zygoma (24%) followed by the mandible. Conclusions: Motorcycle accidents represented almost one third of all maxillofacial injuries seen at this Oral and Maxillofacial Surgery Division, causing high morbidity. Educational campaigns, defensive driving and use of adequate helmets are necessary to decrease the number of facial injuries in such accidents

Temporal Abscess After Third Molar Extraction In The Mandible.

Dental infections resulting before or after third molar removal are complications in which the maxillofacial surgeon may have to initiate an earlier management. The severe dental infections resulting before or after this procedure is one of the few life-threatening complications in which the maxillofacial surgeon may have to initiate an earlier management. Infections involving the temporal space are rare and infrequently reported. Infections in this space have also been observed secondary to maxillary sinusitis, maxillary sinus fracture, temporomandibular arthroscopy, and drug injection, although more commonly associated to third molar infections. A 22-year-old man had undergone extraction of tooth 38 secondary to pericoronaritis by a general dentist. Physical examination of his face demonstrated severe trismus, pain, and swelling in temporal region. A CT scan showed an inflammatory area into the temporal space. He was started on IV cephalosporin, but the clinical course of the patient was not satisfactory. Incision and drainage were performed from an extraoral and intraoral approach. After discharged, the antibiotic was switched to clindamycin IO 600 mg. The retromaxillary and temporal infections are quite common after maxillary molar extractions but not after mandibular third molar, the spread mechanism of ascension must be involved with the virulence of microorganisms, but more studies are necessary to clarify this occurrence.16107-1