Incidencia de sinusite maxilar apos osteotomia Le Fort I : estudo clinico, radiografico e endoscopico

Orientador: Mario Francisco Real GabrielliTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A correção das deformidades maxilomandibulares muitas vezes envolve a realização de osteotomias maxilares, que são procedimentos bem estabelecidos na área da Cirurgia e Traumatologia Buco-Maxilo-Facial. Entretanto, podem ocorrer complicações pós-operatórias, entre as quais, a sinusite maxilar. No presente estudo foi avaliada a incidência de sinusite maxilar após a realização de osteotomias tipo Le Fort I. Para isso, foram avaliados vinte e dois pacientes adultos que submeteram-se à cirurgia de maxila (osteotomia Le Fort I) ou à cirurgia combinada (osteotomia Le Fort I mais osteotomia de mandíbula) para correção de deformidades esqueléticas dento-faciais. A verificação da incidência de sinusite maxilar foi realizada por meio de um breve questionário, de radiografias (PA Waters) e de vídeo-endoscopia nasal. Estas avaliações foram realizadas nos períodos pré-operatório imediato e pós-operatório, de 6 a 8 meses. Após a análise dos resultados, obtivemos uma incidência de 4,76% de sinusite como complicação pós-operatória deste tipo de osteotomiaAbstract: The correction of maxillomandibular deformities can involve maxillary osteotomy procedures, which are well stablished in maxillofacial surgery. However, there might be postoperative complications, among which is maxillary sinusitis. The present study evaluated the incidence of maxillary sinusitis after le Fort I osteotomy. Twenty-two adult patients submitted to maxillary surgery (le Fort I osteotomy) or bimaxillary surgery (le Fort I osteotomy plus mandibular osteotomy) for correction of dentofacial deformities were evaluated. The verification of the presence of maxillary sinusitis was done through a brief questionnaire, X-rays (Water's view) and nasal endoscopy. These evaluations were made in immediate preoperative and postoperative periods, the latterranging from six to eight months. Analysis of results showed an incidence of 4,76% of maxillary sinusitis as postoperative complication in the studied populationDoutoradoCirurgia Buco-Maxilo-FacialDoutor em Clínica Odontológic

Buccal fat pad removal to improve facial aesthetics : an established technique?

Buccal fat pad (BFP) is a singular structure between the facial muscles. Its removal may enhance the zygomatic prominences resulting in an inverted triangle of beauty. Objective: The aim of this study was to perform a systematic review of literature about BFP removal for facial aesthetic improvement. In order to answer the following research question: What are the indications, complication types and rates, surgical techniques and outcomes of the technique? The initial search in Pubmed, Scopus, and Cochrane databases recognized 220 articles. The final review included eight of them. None of the included studies were clinical trials. BPF removal was performed by intraoral incision or associated with the face lift procedure. In 71 patients submitted to the procedure and evaluated about complications, only 8.45% presented minor complications. Parotid duct and facial nerve injuries were not found. No study evaluated facial aging and long-term effects, therefore the harmless effect of the procedure to those features is not clear. Although it is not a novel procedure, there is a lack of information about long-term outcomes. Thus, controlled clinical studies should be performed to achieve adequate clinical evidence of those aspects

Intraoral Schwannomas: presentation of a series of 12 cases

Introduction: Schwannomas are benign and not very frequent tumors of the peripheral nerves, derived from the nerve supporting Schwann cells. Study Design: Data were collected on the clinical manifestations (sex, age), location, size and symptonts of the lesions as well as the evolution time and the initial (presumption) diagnosis. Results: Twelve patients were documented, with a mean age of 29,5 ± 12,1 years (range 16-50) and a balanced gender distribution. The mean duration of the lesions was 42,17± 45,3 months. The lesion located in the floor of the mouth was the largest tumor, measuring about 4 cm in maximum diameter, while the average size of the 12 schwannomas was 2.04± 1.1 cm. Conclusion: We present 12 oral schwannomas diagnosed and treated over a period of 10 years

Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents:A multicentric and prospective study

BACKGROUND/AIMS: Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1‐year period. METHODS: The following data were collected: age (preschool [0–6 years], school age [7–12 years], and adolescent [13–18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software. RESULTS: Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0–18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001). CONCLUSION: The main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0–6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood

A multicentric, prospective study on oral and maxillofacial trauma in the female population around the world

BACKGROUND/AIMS: Approximately 20% of patients with maxillofacial trauma are women, but few articles have analysed this. The aim of this multicentric, prospective, epidemiological study was to analyse the characteristics of maxillofacial fractures in the female population managed in 14 maxillofacial surgery departments on five continents over a 1‐year period. METHODS: The following data were collected: age (0–18, 19–64, or ≥65 years), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment, and length of hospitalization. RESULTS: Between 30 September 2019 and 4 October 2020, 562 of 2387 patients hospitalized with maxillofacial trauma were females (24%; M: F ratio, 3.2:1) aged between 1 and 96 years (median age, 37 years). Most fractures occurred in patients aged 20–39 years. The main causes were falls (43% [median age, 60.5 years]), which were more common in Australian, European and American units (p < .001). They were followed by road traffic accidents (35% [median age, 29.5 years]). Assaults (15% [median age, 31.5 years]) were statistically associated with alcohol and/or drug abuse (p < .001). Of all patients, 39% underwent open reduction and internal fixation, 36% did not receive surgical treatment, and 25% underwent closed reduction. CONCLUSION: Falls were the main cause of maxillofacial injury in the female population in countries with ageing populations, while road traffic accidents were the main cause in African and some Asian centres, especially in patients ≤65 years. Assaults remain a significant cause of trauma, primarily in patients aged 19–64 years, and they are related to alcohol use

Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine

The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treat- ment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001). The most common adverse events were drowsiness/fatigue (57%), memory/concentration difficulties (24%), and sexual dysfunction (11%) in the clonazepam group and drowsiness/fatigue (81%), sexual dysfunction (70%), and nausea/vomiting (61%) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder

Efeito da esterilização em autoclave sobre propriedades mecanicas das miniplacas de titanio, utilizadas em fixação internas

Orientador: Luiz Augusto PasseriDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: As placas e parafusos de titânio têm grande utilização na fixação de fraturas faciais e em cirurgias ortognáticasi. Esse material permanece acondicionado em caixas e recebe múltiplas esterilizações através de calor úmido, em autoclave. Nesse trabalho, foram avaliados os efeitos dessa forma de esterilização sobre as propriedades mecânicas das miniplacas de titânio (sistema 2.0 mm, Engimplan@). Para isso, foram utilizados quatro grupos de quinze placas, testadas em máquina de ensaio universal (M.E.U.), quan~o à resistência à tração, à flexão e à compressão. O grupo I, ou grupo controle, não foi exposto à ação da autoclave, o grupo 11 recebeu um ciclo de esterilização, o grupo 111, dez ciclos e o grupo IV, vinte ciclos. Após sessenta ensaios mecânicos do tipo destrutivo, calculou-se o limite de escoamento (cre) , em cada unidade experimental testada, com o objetivo de se obter uma variável numérica, que possibilitasse a comparação entre os grupos. Foram feitos testes estatísticos, a fim de se compararem as variáveis estudadas. Analisando-se os résultados , conclui-se que não houve diferença entre os grupos, nos ensaios de tração e de compressão. Entretanto, foi possível observar uma diferença estatisticamente significante no grupo 111 quando comparado com os demais grupos no teste de flexãoAbstract: Titanium plates and screws are used for fixation of facial fractures and orthognatic surgery. That material is kept on proper boxes and receives multiple autoclave sterilization cycles. The present study evaluates the effects of those cycles upon mechanical properties of titanium miniplates (system 2.0, (Engimplan). For that task four groups of fifteen plates were tested on a universal essay machine to verify the resistance to tension, flexion and compression. Group I received no sterilization, whereas Groups li, 111, IV underwent one, ten and twenty cycles, respectively. After sixty destructive mechanical essays data were obtained concerning two variables: strenght and deformation. The data were transformed into graphics plotting strength versus deformation, from 'which the calculus of the yield strength (Sy) was obtained for each tested unit, so that a numeric result was gained in order to compare groups. Results were statistically treated to compare variables. Results did not show differences between groups for the tension and compressive tests. However, there were differences between groups for the flexion testsMestradoCirurgia Buco-Maxilo-FacialMestre em Clínica Odontológic