Treatment of condylar fractures: : a retrospective cohort study

Objective: Evaluate routine alterations in patients submitted to treatment of unilateral fractures of the mandibular condyle. Patients and methods: The sample consisted of 30 patients of both sexes submitted to surgical and nonsurgical treatment. All patients answered an evaluation questionnaire on perception of the Oral Impact on Daily Performances (OIDP) and underwent physical and imaging examination. The following aspects were evaluated in temporo mandibular join (TMJ) physical examination: maximum mouth opening, left/right lateral movements and protrusive movements. Vertical height measurements of right and left mandibular branches were evaluated by means of orthopantomography. Lateromedial and anteroposterior displacements were measured using Hirtz?s axial radiography. Evaluation of diameter of the mandibular fossa and height of the glenoid fossa were measured by hypocycloidal tomography. Results: A minority (13.3%) answered the questions on OIDP positively, with a similar rate for both treatments. With regard to the vertical height variable, average vertical height was similar for both treatments. However, comparing fractured and nonfractured sides, the difference observed was statistically significant for both treatments. On the basis of the statistical results of this study, for both treatments there were no significant alterations in the maximum mouth opening variable, with an average of 43.35 mm for open treatment and 44 mm for closed treatment. Conclusion: In the present study there were no significant differences between open and closed treatment of unilateral fractures of the mandibular condyle

Risk factors for temporomandibular disorder: binary logistic regression analysis

Objectives: To analyze the influence of socioeconomic and demographic factors (gender, economic class, age and marital status) on the occurrence of temporomandibular disorder. Study Design: One hundred individuals from urban areas in the city of Recife (Brazil) registered at Family Health Units was examined using Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/ TMD) which addresses myofascial pain and joint problems (disc displacement, arthralgia, osteoarthritis and oeste - oarthrosis). The Brazilian Economic Classification Criteria (CCEB) was used for the collection of socioeconomic and demographic data. Then, it was categorized as Class A (high social class), Classes B/C (middle class) and Classes D/E (very poor social class). The results were analyzed using Pearson's chi-square test for proportions, Fisher's exact test, nonparametric Mann-Whitney test and Binary logistic regression analysis. Results: None of the participants belonged to Class A, 72% belonged to Classes B/C and 28% belonged to Classes D/E. The multivariate analysis revealed that participants from Classes D/E had a 4.35-fold greater chance of ex - hibiting myofascial pain and 11.3-fold greater chance of exhibiting joint problems. Conclusions: Poverty is a important condition to exhibit myofascial pain and joint problems

Oral Health Care of Children and Adolescents with Different Impairments of Cerebral Palsy: Barriers and Challenges

Objective: To evaluate the barriers to access and oral health care faced by children and adolescents with Cerebral Palsy (CP) according to their motor impairment through the perception of caregivers. Material and Methods: A case series study was carried out at three health institutions in Pernambuco, Brazil. The study sample consisted of 94 caregivers of 5-to-18-year-old patients with CP, according to GMFCS (The Gross Motor Function Classification System). Data were collected using a semi-structured form to evaluate the barriers to access and analyzed statistically by the chi-square and Fisher exact tests, adopting a 5% level of significance. In addition, binary logistic regression was performed to determine the weight of the variables in explaining the outcome variable. Results: There were major difficulties involving transportation (p=0.04) and structural accessibility to dental services (p<0.01) among children and adolescents with severe CP. In addition, the more severe the CP, the greater the difficulty of accessibility (OR=4.09,) and the lower the income (OR=8.80), the greater the motor impairment. Conclusion: Despite the availability of access to dental services, low-income families have more severe CP patients, contributing to the daily difficulties already faced by them in oral health care

Survival and prognostic factors in patients with oral squamous cell carcinoma

This study aimed to evaluate sociodemographic and clinical factors influencing overall survival (OS) in patients with oral squamous cell carcinoma (OSCC). Medical charts of 547 patients with OSCC from a public hospital in northeastern Brazil seen between 1999 and 2013 were evaluated. Survival analysis was performed using the Kaplan-Meier method. The influence of age, sex, ethnicity, clinical stage, anatomical location, type of treatment, and comorbidities on the patients? prognosis was evaluated. Cox proportional hazards regression model was used to identify independent prognostic factors. The 5-year OS was 39%. Multivariate analysis showed that age < 40 years (HR = 2.20; 95%CI: 1.02-4.72) and a single treatment modality (HR = 1.91; 95%CI: 1.37-2.67) were associated with a poor prognosis, while early clinical stage resulted in better outcomes (HR = 0.38; 95%CI: 0.25-0.58). OSCC patients in advanced clinical stages, diagnosed at a younger age, and submitted to a single therapeutic modality have a poorer prognosis

Ressecção de carcinoma basocelular do tipo metatípico com reconstrução a base de autoenxertia / Resection of metatypical type basocellular carcinoma with self-grafting reconstruction

O carcinoma basocelular constitui a maior parte do chamado câncer de pele não melanoma e pode ser classificado em várias formas que demonstram comportamentos clínicos diferentes. Têm patogênese multifatorial, com a influência da radiação ultravioleta. Os pacientes geralmente são de meia-idade ou idosos e é mais comum em caucasianos. A incidência é aproximadamente 30% maior em homens que em mulheres e cerca de 80% estão localizados na cabeça ou no pescoço. O carcinoma metatípico é um tipo incomum de carcinoma basocelular que exibe um comportamento clínico agressivo. Ele mostra uma frente invasiva exibindo uma mistura de carcinoma basocelular e carcinoma espinocelular com um carcinoma basocelular superficial ou nodular claro sobrejacente. O tratamento pode ser cirúrgico ou não-cirúrgico. O presente artigo tem o objetivo de relatar um caso clínico de uma paciente do sexo feminino, 77 anos de idade, que apresentava um carcinoma metatípico na região parassinfisária. A paciente foi submetida à ressecção do tecido lesionado seguida de reconstrução através de um autoenxerto com tecido retirado da região peitoral. Observa-se que devido ao alto grau de malignidade e recidiva da patologia  foi realizada uma minuciosa anamnese e conduta clínica minimizando os riscos que envolvem a patologia e devolvendo estética e função a paciente. 

Violência contra a mulher, coesão familiar e drogas

OBJETIVO: Avaliar a associação entre coesão, adaptabilidade e risco mental familiar com violência física contra a mulher e uso de drogas. MÉTODOS: Estudo tipo caso-controle pareado realizado entre 2004 e 2005 na cidade de João Pessoa, Paraíba. A amostra foi constituída por 260 mulheres, divididas em 130 agredidas e 130 não agredidas. O grupo caso foi constituído de mulheres que prestaram queixa por agressão física doméstica na Delegacia Especializada da Mulher. O grupo controle foi pareado com mulheres vizinhas de bairro das vítimas queixosas na Delegacia. A coesão, a adaptabilidade e o risco mental foram avaliados pela escala Family Adaptability and Cohesion Evaluation Scales. Na análise estatística, foram utilizados os testes qui-quadrado e Exato de Fisher, com nível de significância de 5%. RESULTADOS: Os dois grupos se comportaram de forma diferente em relação ao risco mental e coesão, mas semelhantes quanto à adaptabilidade familiar (p=0,0917). As mulheres agredidas apresentaram risco mental alto (43,1%) e médio (39,2%), diferentemente das não agredidas (p=0,0016), que apresentaram médio risco (55,4%). Houve diferença significativa entre os dois grupos para o uso de drogas, com consumo maior nas famílias das mulheres agredidas (90,8%) do que das não agredidas (56,9%). A droga mais utilizada foi o álcool, sendo o mais alto fator de risco para a agressão, quando consumido diariamente (OR=37,33) ou associado a outra droga (OR=29,56). CONCLUSÕES: O desequilíbrio pela falta de união entre a família e o uso de drogas altera decisivamente no funcionamento familiar, podendo gerar conflitos e agressões domésticas

Dimensões da violência sexual contra crianças e adolescentes do sexo masculino: Um estudo exploratório sob a ótica do gênero

Objective: To characterize victims, aggressors and sexual violence against adolescents of both genders, occurred in Brazil. Method: The population was composed for 14.361 victims of complaints of violence in the Management of Child and Adolescent Policy. The variables analyzed were related to adolescent, to sexual violence and to offender. To identify victims and offenders characteristics according to the types of sexual violence, t-Student test with analysis of variance and Qui-square test were used at a significance equal to 5,0%. Results: Sexual violence corresponded to 2.136 (14.9%) of total denouncements. Amongst sexual violence, sexual abuse was more frequent (98%) than commercial sexual exploration (2%). Considered the age groups, boys were more victimized in early adolescence and girls in late adolescence (p=0,031). Most offenders were male (92.8%), aged between 20 and 39 years old (66.7%), and were acquaintance of the adolescent (83.5%). Concerning to victims’ age, it showed significant association with offender’s gender and age, who belonged to the victims family circle and had ignored labor situation. The violent attempted against one’s modesty was associated with male victims, aging from 10 to 14 years old (p<0.001). Conclusions: The high occurrence of sexual crimes against male adolescents confirms the need for public policies and (re) analysis of legal aspects to face the problem.Objetivos: Caracterizar as vítimas, os agressores, as violências e os crimes sexuais contra adolescentes do sexo masculino ocorridos no Brasil. Métodos: O universo de estudo foi composto por 14.361 menores que tiveram registro de ter sido vítima de delito registrado na Gerência de Polícia da Criança e do Adolescente (GPCA). As variáveis de estudo foram agrupadas segundo três critérios: relativas ao adolescente, ao agressor e à violência sexual. Para análise dos dados empregouse o teste de Qui-quadrado ou teste exato de Fisher. Todos os testes foram analisados em nível de significância de 0,05. Resultados: No período foram registrados 14.361 violências das quais 2.136 (14,9%) foram classificadas como violência sexual. Dentre as violências sexuais, 2.094 (98%) constituíram abusos sexuais e 2% pertencia à categoria exploração sexual comercial. Consideradas as faixas etárias, os meninos foram mais vitimados na adolescência inicial e as meninas, na adolescência tardia, diferença esta significativa (p=0,031). Os agressores mais freqüentemente eram do sexo masculino (92,8%), com idade entre 20 e 39 anos (66,7%) e do circulo de relações do adolescente (83,5%). O atentado violento ao pudor foi mais freqüente entre vítimas adolescentes do sexo masculino, na faixa etária de 10 a 14 anos e essas diferenças foram significativas (p<0,001). Conclusões: A alta ocorrência de crimes sexuais contra adolescentes masculinos confirma a necessidade de políticas públicas e (re)análise dos dispositivos legais para o correto enfrentamento do problema