Patient?s perception of improvement after surgical assisted maxillary expansion (SAME) : pilot study

Objective: Clinicians often assume that changes following orthognathic surgery are both physically and psychologically beneficial to the patient. The present study investigates patient perception regarding improvement after surgically assisted rapid maxillary expansion. Study design: A survey with twenty-three patients was carried out to identify satisfaction with the surgical outcome and assess whether the surgery met patient expectations. General information was also collected on schooling, age, gender, chief complaint and reasons for seeking treatment. Results: Most patients (n = 19; 82%) were advised to undergo surgery by a dentist. Twenty-two (95%) patients reported being satisfied with the operation procedure. Twenty-one (91%) patients reported that the procedure met their expectations. Nineteen respondents would undergo the same operation again and would recommend treatment to others with similar problems. Conclusion: The need for surgery associated with orthodontic appliances to correct a transverse maxillary deficiency requires a proper explanation to patients regarding the procedure and postoperative period in order to ensure realistic expectations concerning the surgical goals

Reconstrução nasal após trauma facial: relato de caso / Nasal reconstruction after facial trauma: case report

Introdução: O trauma nasal pode ocasionar sintomas graves devido a sua posição central na face, como quadros severos de epistaxe, deformidades faciais e disfunções olfatórias. Este trabalho tem o objetivo de relatar e discutir a complexidade de uma reconstrução nasal após trauma de alta intensidade. Relato de caso: Paciente do sexo feminino, 26 anos, foi admitida na emergência do Hospital Getúlio Vargas, Recife – PE. Vítima de atropelamento, com severo trauma em face, apresentando destruição severa da região nasal. No exame físico, foi observado lesão corto contusa extensa causando desinserção do tecido mole e cartilaginoso do nariz, mobilidade, crepitação óssea acentuada na região de ossos próprios nasais, epistaxe severa e confirmação do diagnóstico com exame tomográfico. Após o diagnóstico e avaliação dos danos, foi realizado redução e fixação das fraturas ósseas envolvidas, reinserção do septo cartilaginoso e reposicionamento dos tecidos moles adjacentes. Considerações finais: As fraturas nasais podem se apresentar como um grande desafio para os cirurgiões, com a presença de perdas teciduais e destruição da estrutura óssea nasal. Frente a isso, o conhecimento anatômico e de técnicas cirúrgicas reconstrutivas de tecidos moles e da estrutura óssea é de suma importância para a obtenção de um resultado funcional e estético desejado

Hemorragia após exodontia relacionada a uma malformação arteriovenosa intraóssea/Hemorrhage after dental extraction related to an intraossal arteriovenous malformation

Introdução: As malformações arteriovenosas intraósseas são patologias do desenvolvimento caracterizadas por malformação do sistema circulatório e compreendem lesões vasculares infiltrativas e destrutivas com alto fluxo sanguíneo. Objetivo: O objetivo deste artigo foi descrever e relatar um caso de hemorragia pós-extração relacionada a malformações arteriovenosas e apresentar as abordagens terapêuticas e os resultados relatados na literatura. Métodos: Este estudo consiste em uma revisão integrativa e um relato de caso sobre malformações arteriovenosas, relacionadas à extração dentária. A literatura científica foi consultada nas bases de dados PubMed.gov, SciELO.org, bvsalud.org e Cochrane Library, usando os termos MeSH e DeCS. Resultados: 17 artigos científicos foram incluídos na revisão. O número de casos de hemorragia pós-extração associados à malformação arteriovenosa não diferiu entre homens e mulheres. Foi mais frequente em jovens menores de 18 anos e comestíveis, e 88,2% dos eventos hemorrágicos necessitaram de embolização. 70,6% dos pacientes receberam tratamento sintomático, como transfusão de sangue e / ou cristaloides. Conclusão: As lesões clinicamente detectadas ou identificadas por exames de imagem com possível diagnóstico de hemangioma ou malformação vascular devem ser tratadas por uma equipe multidisciplinar e tratadas em ambiente hospitalar

Submental intubation in oral maxillofacial surgery : review of the literature and analysis of 13 cases

Objectives: Various different methods of intubation are suitable for facial trauma cases. A choice often has to be made between orotracheal and nasotracheal when surgical access to the nasal or oral cavity is necessary. This work presents our current experience using submental intubation in the airway management of facial trauma patients. Study design: From July 2003 to February 2005, 13 sufferers from facial trauma benefited from submental intubation. All the patients were males and the ages ranged from 19 to 35 years (mean, 27 years). Results: In all the patients, the submental intubation permitted simultaneous reduction and fixation of all fractures and intraoperative control of the dental occlusion without interference from the tube during the operation. There was only one intra-operative complication, when the tracheal pressure increased as a result of deviation and compression of the tube. No post-operative complications were reported. Conclusion: Submental intubation is a simple, secure and effective procedure for operative airway control in major maxillofacial traumas

A rare case of iatrogenic gingival Kaposi's sarcoma

Kaposi's sarcoma is an angioproliferative tumour rarely found in the oral cavity. We present the 3rd case of iatrogenic gingival Kaposi's sarcoma reported in the English-language literature which developed in a young patient 5 years after a renal transplant and discuss their histological features and differential diagnosis. (c) 2011 European Association for Cranio-Maxillo-Facial Surgery

Transmaxillary approach to the cranial base: an evaluation of 11 cases

Summary: Surgical access to the skull base is always difficult, especially because of the noble anatomic structures present there. Maxillary osteotomy provides direct view to the clivus region and the neck spine, and it also bears less morbidity when compared to the many other accesses described in the literature. Aim: to assess 11 patients submitted to transmaxillary osteotomy, describing the surgical technique and postoperative results and complications. Materials and Methods: A retrospective study involving eleven patients submitted to transmaxillary approach to the brainstem. We studied dental occlusion, trans and postoperative bleeding, bone necrosis and soft tissue alterations. All followed the same surgical protocol and were followed up for two years. Results: after treatment, all the patients improved in their clinical status and had no neurological complication, trans and postoperative hemorrhage or major complications were seen. Among the complications, two patients had incomplete maxilla fracture, two had laceration of their nasal mucosa and one had, as late complication, an oral-sinusal fistula. Conclusion: Transmaxillary osteotomy provided proper access to the clivus for brainstem decompression with low rate of complications in this series. Keywords: maxilla, osteotom

Evaluation of life quality of patients submitted to orthognathic surgery

OBJECTIVE: To compare changes related to self-esteem and appearance satisfaction between pre and postsurgical phases in patients undergoing orthognathic surgery and to assess the quality of life and psychosocial changes of these patients six months after surgery. METHODS: A longitudinal observational qualitative study was performed. The sample comprised 15 patients with dentofacial deformities who underwent orthognathic surgery. One questionnaire and two forms were answered during pre and postoperative phases. RESULTS: The results showed that 13.3% of patients demonstrated self-esteem improvement, especially in relation to appearance satisfaction. Improvements were also noted in social, occupational and family relationships. With regard to the assessment of quality of life, according to the World Health Organization questionnaire, the lowest improvement averages corresponded to environmental control. CONCLUSION: Orthognathic surgery brings along many emotional changes that should be considered before and after surgery, since the patients' psychological state may be favorable and/or unfavorable during recovery, influencing their quality of life, self-esteem and appearance satisfaction

Artrocentese da articulação temporomandibular: avaliação de resultados e revisão da literatura Temporomandibular joint arthrocententesis: evaluation of results and review of the literature

OBJETIVO: Avaliar o efeito da artrocentese em relação à sintomatologia e movimentação mandibular em uma serie de pacientes com deslocamento anterior de disco e travamento mandibular. MATERIAIS E MÉTODOS: O estudo foi baseado nos dados pré e pós-operatório de pacientes através de exame clínico e radiográfico. A Escala Analógica Visual (EAV) foi usada para quantificar a dor no pré e pós-operatório. Foram avaliados 6 pacientes (12 articulações) tratados no Hospital Universitário Oswaldo Cruz (HUOC) com travamento mandibular (2 casos) e desarranjo interno (4 casos). O período médio de acompanhamento foi de 11,5 meses. RESULTADOS: A média de abertura bucal pré-operatória foi de 31,83mm e no pós-operatório foi de 36,50mm. A média de dor articular segundo a escala visual analógica encontrada foi de 7 e no pós-operatório foi de 4,3. CONCLUSÃO: A artrocentese mostrou-se efetiva na melhora da dor articular e na movimentação mandibular nesta série de casos.<br>AIM: This study was designed to investigate the effects of arthrocentesis on the improvement of internal derangement symptoms and jaw function in a series of patients with anterior disc displacement and closed lockjaw. PATIENTS AND METHODS: The study was based on a review of patients’ records before and after treatment using clinical examinations and radiographs. Visual analog scales were used to measure pain before and after arthrocentesis. Six patients (12 temporomandibular joints) with closed lock symptoms (2 cases) and internal derangements (4 cases) were treated at the Oswaldo Cruz Hospital. The mean follow-up was 11.5 months. RESULTS: The mean maximum vertical opening before treatment was 31.83 mm and after arthrocentesis was 36.50 mm. The visual analog scale for pain before treatment was 7 points (mean) and after arthrocentesis the mean was 4.3. CONCLUSION: Arthrocentesis was shown to be effective in reducing pain and increasing jaw motion in this series of cases