The analysis of patients treated with maxillary reconstruction using iliac crest autogenous bone grafts for implant rehabilitation in the Oral and Maxillofacial surgery Division, Piracicaba Dental School, Unicam

Orientador: Roger William Fernandes MoreiraDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O presente estudo tem por objetivo a avaliação dos tratamentos visando reconstrução dos maxilares com enxertos autógenos de crista ilíaca desenvolvidos na Faculdade de Odontologia de Piracicaba, Universidade de Campinas do período de primeiro de Janeiro de 2004 a trinta de junho de 2005. Foram avaliados 16 casos, nos quais se analisou dados extraídos da anamnese, exame físico e complementar, bem como indicação, planejamento, tratamento utilizado e proservação tanto da cirurgia para remoção de enxerto da crista ilíaca quanto da cirurgia para instalação de implantes. Um questionário foi usado para coletar dados relativos ao período pós-operatório da cirurgia da crista ilíaca, como dor, padrão de cicatrização, distúrbios sensoriais e motores, resolução do tratamento e seqüelas; e dados relativos à satisfação do paciente frente às dificuldades, sucessos e insucessos possíveis. A dor pós-operatória foi referida em 100% dos pacientes submetidos ao enxerto, 93,5% de distúrbio de marcha, 25% de queixa quanto à cicatriz e 12,5% de perda de enxerto. Os resultados sugerem, também, relação entre maior dor pós-operatória no sítio doador em pacientes com índices de massa corpórea acima do normal. Quanto à cirurgia de implantes foi constada falha precoce em 2,0% dos 98 implantes instalados. Assim, a reconstrução de maxilares é um procedimento seguro com altas taxas de sucesso devendo ser usada sempre que necessárioAbstract: The aim of the present study is to evaluate treatment outcomes for reconstructive surgery of the jaws with iliac crest as donnor site performed at Piracicaba Dental School, UNICAMP, between the begin of january 2004 and the end of june 2005. Sixteen cases were selected and data obtained from the clinical records were analysed. This data included medical history, physical examination, treatment indications and planning as well as follow up observations for the donnor site and dental implants installed in the grafted area. A questionnaire was applied to evaluate data relative to postoperative pain, healing pattern, motor and neurosensorial disturbances, treatment outcomes and overall satisfaction. Data analysis related to the graft procedure revealed postoperative pain in 100% of the patients, gait disturbances in 93.5%, visible scar in 25% and graft loss in 12.5%. Related to implant surgery, it was observed early loss in 2.0% of the 98 implants installed. The results also suggest a relationship between postoperative higher scores of pain in the donor site in elevated body mass indexes patients. Therefore, maxillary reconstruction is safe procedure with elevated success ratesMestradoCirurgia e Traumatologia Buco-Maxilo-FaciaisMestre em Clínica Odontológic

Osteoma em côndilo mandibular associado à síndrome de gardner: relato de caso

Os osteomas geralmente são lesões solitárias, de crescimento lento e assintomáticas. Os locais de ocorrência mais comuns são o corpo da mandíbula e o côndilo, mas quando envolvem esta região podem causar alterações na oclusão do paciente, desvio progressivo e lento de linha média, assim como aumento do volume facial acompanhado de dor e limitação de abertura bucal. Cerca de 90% dos pacientes portadores da Síndrome de Gardner apresentam anormalidades esqueléticas, fazendo os osteomas as lesões mais frequentes e de maior ocorrência em seios paranasais e nos maxilares. O objetivo deste trabalho é relatar o caso clínico de uma paciente do gênero feminino, portadora de Síndrome de Gardner com osteoma localizado em côndilo mandibular esquerdo que, devido aos sintomas relatados pelo paciente, foi submetida à ressecção cirúrgica por meio de acesso intra oral para melhor abordagem da lesão e que evoluiu para a solução da sintomatologia apresentada como queixa principal quando procurou o serviço de Cirurgia e Traumatologia Buco-maxilo-facial

Trophoblast cell surface antigen 2 expression predicts outcome in oral squamous cell carcinomas

Background Trophoblast cell surface antigen 2 (TROP2) has unclear clinical role in oral squamous cell carcinomas (OSCC). Here, we investigated the association of TROP2 immunoexpression with clinicopathological parameters and survival of OSCC patients. Subjects and Methods Cancer-specific survival (CSS) and disease-free survival (DFS) were assessed in a cohort composed of 266 OSCC. An independent cohort with 88 OSCC samples matched with the normal oral tissue, as well as 17 metastatic lymph nodes, was used for validation. Results Multivariate analysis showed TROP2 as an independent marker of favorable prognosis for both CSS (HR: 0.60, 95% CI: 0.40-0.90, p = .01) and DFS (HR: 0.57, 95% CI: 0.36-0.89, p = .01). Furthermore, TROP2 protein expression was significantly higher in morphologically normal tissues compared to primary tumors (p <.0001) and lymph node metastases (p = .001), and it was significantly associated with CSS (HR: 0.26, 95% CI: 0.09-0.74, p = .008) in the validation cohort. A pooled mRNA analysis performed on the Oncomine (TM) database confirmed the underexpression in OSCC compared with normal tissues (p = .014). Conclusions In summary, our results point to a favorable prognostic significance of TROP2 overexpression in a large cohort of oral cancer patients, suggesting it as an attractive clinical marker.Peer reviewe

Quebra da resistência em pimentão contra o Pepper yellow mosaic virus

Plants of Capsicum annuum cv. Magali R, resistant to Pepper yellow mosaic virus (PepYMV), which showed severe yellow mosaic, leaf malformation and stunting were observed during the 2003/04 growing season in Lins, São Paulo State, Brazil. Potyvirus-like particles observed in leaf sap from infected plants under the electron microscope reacted with an antiserum against PepYMV in PTA-ELISA. In addition to C. annuum cv. Magali R, this potyvirus also infected systemically the resistant C. annuum cv. Rubia R. The nucleotide sequence of part of the CP gene of this potyvirus shared 96-98% identity with that of other PepYMV isolates. The partial nucleotide sequence of the 3' NTR showed 94-96% identity with that of PepYMV. These data indicate that this potyvirus is a resistance-breaking isolate of PepYMV.Plantas de Capsicum annuum cv. Magali R, resistentes ao Pepper yellow mosaic virus (PepYMV), exibindo sintomas severos de mosaico amarelo, malformação foliar e subdesenvolvimento foram encontradas em plantios na região de Lins, SP, Brasil, em 2003/04. Partículas semelhantes àquelas do gênero Potyvirus foram observadas em extrato foliar de planta infectada examinado em microscópio eletrônico de transmissão. O extrato foliar também reagiu com anti-soro contra o PepYMV em PTA-ELISA. Além de C. annuum cv. Magali R, esse potyvirus também infectou sistemicamente C. annuum cv. Rubia R, que é resistente ao PepYMV. A seqüência de nucleotídeos de parte do gene da proteína capsidial (CP) desse potyvirus apresentou 96-98% de identidade com a de outros isolados do PepYMV. A seqüência parcial de nucleotídeos da região 3' não traduzida (3' NTR) apresentou 94-96% de identidade com a do PepYMV. Esses resultados são indicativos de que o potyvirus que quebrou a resistência em pimentão é um isolado do PepYMV

Stanniocalcin 2 contributes to aggressiveness and is a prognostic marker for oral squamous cell carcinoma

Stanniocalcin 2 (STC2), a glycoprotein that regulates calcium and phosphate homeostasis during mineral metabolism, appears to display multiple roles in tumorigenesis and cancer progression. This study aimed to access the prognostic value of STC2 in oral squamous cell carcinoma (OSCC) and its implications in oral tumorigenesis. STC2 expression was examined in 2 independent cohorts of OSCC tissues by immunohistochemistry. A loss-of-function strategy using shRNA targeting STC2 was employed to investigate STC2 in vitro effects on proliferation, apoptosis, migration, invasion, epithelial-mesenchymal transition (EMT) and possible activation of signaling pathways. Moreover, STC2 effects were assessed in vivo in a xenograft mouse cancer model. High expression of STC2 was significantly associated with poor disease-specific survival (HR: 2.67, 95% CI: 1.37-5.21, p = 0.001) and high rate of recurrence with a hazard ratio of 2.80 (95% CI: 1.07-5.71, p = 0.03). In vitro downregulation of STC2 expression in OSCC cells attenuated proliferation, migration and invasiveness while increased apoptotic rates. In addition, the STC2 downregulation controlled EMT phenotype of OSCC cells, with regulation on E-cadherin, vimentin, Snaill, Twist and Zeb2. The reactivation of STC2 was observed in the STC2 knockdown cells in the in vivo xenograft model, and no influence on tumor growth was observed. Modulation of STC2 expression levels did not alter consistently the phosphorylation status of CREB, ERK, JNK, p38, p70 S6K, STAT3, STAT5A/B and AKT. Our findings suggest that STC2 overexpression is an independent marker of OSCC outcome and may contribute to tumor progression via regulation of proliferation, survival and invasiveness of OSCC cells.Peer reviewe

Diagnóstico precoce da neuropatia diabética e profilaxia do pé diabético

Introduction: the diabetic foot is one of the most serious complications of diabetes mellitus. About 50% of non-traumatic amputations occur in these patients. In addition, it is an important public health problem and constitutes a chronic and complex metabolic disorder that is characterized by impaired metabolism of glucose and other complications in essential organs for the maintenance of life. Objective: to evaluate the sensitivity and specificity of diabetic neuropathy using the Michigan self-assessment and physical examination in type 1 and type 2 diabetics. Methods: this is a cross-sectional study. The “Michigan Neuropathy Screening Instruments” classification was used to assess the degree of peripheral neuropathy, in which participants answered the questionnaire and were evaluated for the presence of foot lesions. All participants were stratified by the risk of developing foot ulcers according to the IWGDF protocol. Results: the sample had 200 participants. Regarding the IWGDF classification, 23 patients were classified as moderate risk (11.50%) and 61 as high risk for developing foot ulcers (30.50%). Using a cutoff of 2.5 on the physical examination score to diagnose neuropathy, a sensitivity of 97.62% and a specificity of 47.41% were obtained. Using a score greater than or equal to 6 in the self-assessment for the diagnosis of neuropathy, a sensitivity of 50.00% and a specificity of 94.83% were found. Conclusion: the association of the Michigan physical examination (high sensitivity) with self-assessment (high specificity) increases the accuracy for the diagnosis of diabetic neuropathy.Introdução: o pé diabético é uma das complicações mais sérias do diabetes mellitus. Cerca de 50% das amputações não traumáticas ocorrem nesses pacientes. Além disso, é um importante problema de saúde pública por ser um distúrbio metabólico crônico e complexo que se caracteriza pelo comprometimento do metabolismo da glicose associada a outras complicações em órgãos essenciais para manutenção vital. Objetivo: avaliar a sensibilidade e especificidade para neuropatia diabética da autoavaliação e do exame físico de Michigan nos diabéticos tipo 1 e tipo 2. Método: trata-se de um estudo transversal. Foi utilizada a classificação “Michigan Neuropathy Screening Instruments” para avaliação do grau de neuropatia periférica, em que os participantes responderam ao questionário e foram avaliados quanto a presença de lesões nos pés. Todos os participantes foram estratificados quanto ao risco de desenvolver úlcera nos pés de acordo com o protocolo do IWGDF. Resultados: a amostra contou com 200 participantes. Quanto à classificação do IWGDF, 23 pacientes foram classificados como risco moderado (11,50%) e 61 como alto risco para o desenvolvimento de úlceras nos pés (30,50%). Utilizando-se um corte de 2,5 na pontuação do exame físico para diagnosticar a neuropatia, foi obtida uma sensibilidade de 97,62% e uma especificidade de 47,41%. Utilizando-se uma pontuação maior ou igual a 6 na autoavaliação para o diagnóstico de neuropatia, foi obtida uma sensibilidade de 50,00% e uma especificidade de 94,83%. Conclusão: a associação do exame físico de Michigan (alta sensibilidade) com a autoavaliação (alta especificidade) tem melhor acurácia para o diagnóstico de neuropatia diabética

Variables Related To Surgical And Nonsurgical Treatment Of Zygomatic Complex Fracture.

The aim of this retrospective research was to establish the association between variables for the surgical treatment of zygomatic complex (ZC) fractures. In a 10-year period, 532 patients were examined for ZC fractures. The medical records of patients were analyzed to obtain information related to sociodemographic characteristics, trauma etiology, sign and symptoms of patients, and surgical or nonsurgical treatment. Statistical analysis was performed using χ test with statistical significance of P < 0.05. Most fractures were sustained by subjects between 21 and 40 years of age (55.8%), being principally men (80.1%), and 153 patients underwent surgery (28.8%). Surgical treatment of ZC fractures was statistically associated to the presence of other facial fractures (P = 0.004), alteration of occlusion (P = 0.0001; probably due to jaw fractures), presence of the comminuted fractures (P = 0.0002), and infraorbital nerve sensory disturbances (P = 0.003). A mixture of complex variables can be associated to surgical treatment; however, variables as comminuted fracture and alteration of occlusion were associated to surgical treatment indications.221200-

Maxillofacial Trauma And Seat Belt: A 10-year Retrospective Study.

Brazil is among the countries with the highest prevalence of people injured by traffic accidents, showing that in 2008, levels reached 18.3 victims for 100,000 habitants were victims of traffic accidents. This retrospective study involved data collected from treated patients' charts at seven different hospitals located in three different cities all in the state of São Paulo, Brazil. Information was obtained through a standardized form, which was designed to investigate the epidemiologic features of maxillofacial traumas, restricted to victims of car accidents. Three hundred ninety-six patients were victims of car crashes with mean age 29.75 years. The age group 18-30 years showed an association with facial trauma in 96 patients, 41.56 % of whom reported using seat belt. Le Fort I, II and III (70 %) and mandible (63.11 %) were more associated with body traumas and seat belt use. The most common soft tissue lesion was laceration with 189 cases (42.3 %). The treatment way was assessed, 93 (23 %) were treated surgically and 303 (77 %) underwent conservative treatment. Classically, it is known front seat belt use was positively correlated with back seat belt use, healthy diet, dental and general health, regular walking, adequate sleep and no smoking. Accidents involving cars occurred more frequently in age group 18-30 years, suffering more general traumas and representing the nonusers group that wore fewer seat belts, caused, perhaps, by bigger access of the youth to cars, driving in high speed and to an inefficient fiscalization of the traffic laws.1721-

Aspergillosis Of The Maxillary Sinus Associated With A Zygomatic Implant.

The use of a specially designed implant to be anchored in the zygomatic bone has been proposed in the literature as an alternative to bone grafting in the prosthetic rehabilitation of the severely resorbed maxilla, an option that has few postoperative complications. However, some complications can arise, such as the fungal infection the authors describe in this article. The authors report a case of aspergillosis of the maxillary sinus after zygomatic implant placement. Twelve months after placement of the implant, the patient returned with symptoms of sinusitis, and a computed tomographic scan showed failure in zygomatic implant osseointegration and a radiopaque mass in the left maxillary sinus. The implant was removed, as was a friable brownish-yellow mass from the sinus. Histopathological analysis revealed a noninvasive hyphal mass compatible with Aspergillus. At a 12-month follow up, the patient experienced no recurrence of fungal sinusitis. Zygomatic implant placement is a safe surgical procedure. Nevertheless, postoperative maxillary sinus infections by bacteria, virus and fungus can occur and therefore need to be considered in the diagnosis of infection in the vicinity of dental and maxillofacial implants.1411231-

Fractographic Analysis Of 2.0-mm Plates With A Screw Locking System In Simulated Fractures Of The Mandibular Body.

The purpose of the present study was to analyze the fractured plates from 2 brands of 2.0-mm locking fixation systems submitted to axial linear load testing. Four aluminum hemimandibles with linear sectioning to simulate a mandibular body fracture were used as a substrate and fixed with 2 fixation techniques from 2 national brands: Tóride and Traumec. The techniques were as follows: one 4-hole plate, with four 6-mm screws in the tension zone, and one 4-hole plate, with four 10-mm screws in the compression zone; and one 4-hole plate, with four 6-mm holes in the neutral zone. The hemimandibles were submitted to vertical linear load tests using an Instron 4411 mechanical test machine. The system was submitted to the test until complete failure had occurred. Next, a topographic analysis of the surface of the plates was performed using a stereomicroscope and an electronic scanning microscope. The samples were evaluated using different magnifications, and images were obtained. The surface of the fracture analyzed in scanning electron microscopy demonstrated a ductile-type fracture, usually found in the traction test bodies of ductile materials, such as titanium. No evidence of failure was observed in any fracture surface from a change in the structure or composition of the material. The plates were fractured by a ductile rupture mechanism, as expected, suggesting that the manufacturing of the national brand name plates used in the present study has been under adequate quality control, with no structural changes produced by the manufacturing process that could compromise their function.721130-