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OBJECTIVE: To compare clinical and imaging results of two needles arthrocentesis (TNA) versus double-needle cannula arthrocentesis (DNCA) in the treatment of temporomandibular joint disc displacement (DD). METHODS: Twenty patients with DD were randomly divided into two groups: TNA and DNCA. Clinical data (pain scores; maximal interincisal distance [MID], and protrusion and laterality movements) were evaluated before and 24 months after the arthrocentesis. Disc and condyle position and joint effusion (JE) were evaluated by magnetic resonance exams. RESULTS: Both groups presented improvement in the MID, including pain reduction, modifications in disc and condyle positions, and reduction of the presence of JE, without difference between groups (p > 0.05). The DNCA was performed significantly faster (p = 0.0001). CONCLUSION: Both TNA and DNCA are efficient in promoting improvement in the MID: reduction in pain, modifications in disc and condyle positions, and, in part, may account for less JE, without difference between techniques.

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PURPOSE: To evaluate the accuracy of three-dimensional (3D) soft tissue prediction in bimaxillary orthognathic surgery. METHODS: Cone-beam computed tomographs of 88 patients with class II (n = 46) and class III (n = 42) malocclusions, who underwent bimaxillary orthognathic surgery, were included in this retrospective study. 3D soft tissue prediction and postoperative outcome were compared by using ten landmarks of facial soft tissues. Patients' sex and age were also assessed. Results were analyzed using a mixed model methodology (p < 0.05). RESULTS: The success criterion adopted was a mean discrepancy of < 2 mm. Most mandibular landmarks indicated a tendency for underprediction with a downward direction in class II patients, with some values > 2 mm. In class III, there was overprediction with a downward direction for the mandibular landmarks, with values < 2 mm. More accurate results were found in female and older patients. CONCLUSIONS: 3D surgical planning showed clinically acceptable results for predicting soft tissues in patients undergoing bimaxillary orthognathic surgery, with more accurate results for class III patients. Although some differences were found when age and sex were interacted, a consistent association between these variables could not be stated. These results support the clinician, as accuracy can provide a strong guide to the surgeon when planning surgical orthodontic treatment.

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Introdução: A sialolitíase é um distúrbio da glândula salivar que afeta 12 em cada 1.000 indivíduos adultos. É caracterizada pela deposição de minerais dentro de seu ducto ou parênquima, sendo a glândula submandibular a mais afetada. Os sialolitos têm tamanhos variados, quando maiores que 15 mm são raros e relatados como sialolitos gigantes. Sialolitos gigantes dentro do parênquima glandular ou porção proximal do ducto são geralmente tratados de forma invasiva por via extraoral com excisão da glândula associada. Relato de caso: Este estudo relata um caso incomum de um paciente diagnosticado com sialolito salivar gigante localizado na porção proximal de um ducto da glândula submandibular, assintomática, tratado por remoção cirúrgica por via intraoral, minimizando riscos potenciais e obtendo sucesso no tratamento. Considerações finais: Mesmo sialolitos localizados em regiões mais profundas do ducto submandibular, o acesso intraoral pode ser uma alternativa viável e de menor risco... (AU)

Introduction: Sialolithiasis is a disorder of the salivary gland that affects 12 out of 1,000 adult individuals. It is characterized by the deposition of minerals within its duct or parenchyma, with the submandibular gland being the most affected. Sialolites have varying sizes, when larger than 15 mm they are rare and reported as giant sialolites. Giant sialoliths within the glandular parenchyma or proximal portion of the duct are usually treated invasively by the extraoral route with excision of the associated gland. Case report: This study reports an unusual case of a patient diagnosed with giant salivary sialolith located in the proximal portion of a submandibular gland duct, asymptomatic, treated by intraoral surgical removal, minimizing potential risks and achieving treatment success. Final considerations: Even sialoliths located in deeper regions of the submandibular duct, intraoral access can be a viable and less risky alternative... (AU)

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OBJECTIVE: The aim of this study was to evaluate the thickness of the zygomatic-maxillary cortical bone using computed tomography in different skeletal patterns. METHODS: A total of 54 patients of both sexes, divided into three groups according to the vertical skeletal pattern, were evaluated for cortical bone thickness of the anterior slope of the zygomatic process of the maxilla, using cone beam computed tomography. Measurements were made at 2mm, 4mm, 6mm, 8mm and 10mm above from first molar mesial root apex. Vertical skeletal pattern was determined by Frankfurt mandibular angle (FMA). RESULTS: The hyperdivergent pattern had the lowest cortical thickness value, nevertheless, no patient in the hyperdivergent group presented cortical thickness exceeding 2mm, and no patient in the hypodivergent group presented cortical thickness less than 1mm. However, the correlation between cortical thickness and mandibular plane angle was weak and not significant. CONCLUSION: Although higher prevalence of thick cortical was observed in the hypodivergent patients, and thin cortical groups in the hyperdivergent group, the vertical skeletal pattern could not be used as determinant of the zygomatic-maxillary cortical thickness.

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Gorlin-Goltz Syndrome is a genetic disorder characterized by a series of clinical changes, including the presence of multiple odontogenic keratocysts and nevus basal cell carcinomas. As these lesions involve the maxillofacial region and can evolve to severe sequelae, it is essential that the dental surgeon recognize this pathology, in order to promote a correct investigation and early multidisciplinary diagnosis and treatment. The treatment for the cysts varies according to the lesion's characteristics and location, and therefore, the request for complementary exams is essential. According to literature, the approach varies from conservative to more invasive, and several supporting therapies are mentioned. Thus, this article aims to report a case of a young patient diagnosed with Gorlin-Goltz Syndrome by a dental surgeon, who treated conservatively and interdisciplinarly, and obtained a satisfactory result. In addition, it makes a bibliographic review on this genetic condition, elucidating its therapeutic forms.

El síndrome de Gorlin-Goltz es un trastorno genético caracterizado por una serie de cambios clínicos, que incluyen la presencia de múltiples queratoquistes odontogénicos y nevus carcinomas basocelulares. Como estas lesiones involucran la región maxilofacial y pueden evolucionar a secuelas severas, es esencial que el cirujano oral conozca esta patología para realizar una investigación correcta y un diagnóstico y tratamiento multidisciplinario temprano. El plan de tratamiento para los quistes varía de acuerdo con las características y la ubicación de la lesión y, por lo tanto, la solicitud de exámenes complementarios es esencial. Según la literatura, el enfoque varía de conservador a más invasivo, y se mencionan varias terapias de apoyo. Por lo tanto, este artículo tiene como objetivo informar un caso de un paciente joven diagnosticado con el síndrome de Gorlin-Goltz por un cirujano dentista, que trató de forma conservadora e interdisciplinaria, y obtuvo un resultado satis- factorio. Además, realiza una revisión bibliográfica sobre esta condición genética, aclarando sus formas terapéuticas.

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Objective: To evaluate the presence of joint effusion and morphology of the articular disc (AD) viewed in the sagittal plane in patients with disc displacement with reduction (DDWR) and to correlate the results with clinical findings.Methods: The sample consisted of 116 patients with DDWR who were evaluated clinically and with magnetic resonance imaging. The AD's morphology was assessed from the sagittal view with the mouth both open and closed. The statistical analysis demonstrated a significance level of 5%.Results: With a mean age of 35 years, 79 patients (68.10%) showed joint effusion, and the female gender was most prevalent (p < 0.05). The results showed a relationship between joint effusion and DDWR in both sides (p < 0.05).Conclusion: Clinically, the present study can infer that DDWR is associated with joint effusion, and females are the most affected. It can be suggested that the pain may be associated with joint effusion.

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ABSTRACT Objective: The aim of this study was to evaluate the thickness of the zygomatic-maxillary cortical bone using computed tomography in different skeletal patterns. Methods: A total of 54 patients of both sexes, divided into three groups according to the vertical skeletal pattern, were evaluated for cortical bone thickness of the anterior slope of the zygomatic process of the maxilla, using cone beam computed tomography. Measurements were made at 2mm, 4mm, 6mm, 8mm and 10mm above from first molar mesial root apex. Vertical skeletal pattern was determined by Frankfurt mandibular angle (FMA). Results: The hyperdivergent pattern had the lowest cortical thickness value, nevertheless, no patient in the hyperdivergent group presented cortical thickness exceeding 2mm, and no patient in the hypodivergent group presented cortical thickness less than 1mm. However, the correlation between cortical thickness and mandibular plane angle was weak and not significant. Conclusion: Although higher prevalence of thick cortical was observed in the hypodivergent patients, and thin cortical groups in the hyperdivergent group, the vertical skeletal pattern could not be used as determinant of the zygomatic-maxillary cortical thickness.

RESUMO Objetivo: O objetivo do presente estudo foi avaliar a espessura da cortical óssea zigomático-maxilar por meio de tomografia computadorizada em diferentes padrões esqueléticos. Métodos: Um total de 54 pacientes de ambos os sexos, divididos em três grupos, de acordo com o padrão esquelético vertical, foi avaliado quanto à espessura da cortical óssea na vertente anterior do processo zigomático da maxila, por meio de tomografia computadorizada de feixe cônico. As medidas foram feitas a 2mm, 4mm, 6mm, 8mm e 10mm acima do ápice da raiz mesial do primeiro molar. O padrão esquelético vertical foi determinado pelo Ângulo do Plano Mandibular (FMA). Resultados: O padrão hiperdivergente apresentou o menor valor de espessura de cortical. No entanto, nenhum paciente do grupo hiperdivergente apresentou espessura cortical superior a 2mm e nenhum paciente do grupo hipodivergente apresentou espessura cortical inferior a 1mm. No entanto, a correlação entre a espessura da cortical e o ângulo do plano mandibular foi fraca e não significativa. Conclusão: Embora tenha havido uma maior prevalência de cortical espessa no grupo hipodivergente e cortical fina no grupo hiperdivergente, o padrão esquelético vertical não pode ser utilizado como determinante da espessura cortical zigomático-maxilar.

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OBJECTIVE: This retrospective and observational study evaluated the accuracy of a 3D virtual surgical planning (VSP) for the maxillary positioning and orientation in patients undergoing bimaxillary orthognathic surgery, comparing the planned and postoperative outcomes. SETTING AND SAMPLE POPULATION: Seventy consecutive patients of both sexes, who were submitted to bimaxillary orthognathic surgery between 2015 and 2019 were included in our study. MATERIAL AND METHODS: The patients were evaluated by fusing preoperative planning and postoperative outcome using cone-beam computed tomography scan evaluation. Three-dimensional VSP and postoperative outcomes were compared by using three linear and three angular measurements. The main outcome interest was the difference between the VSP movement, and the surgical movement obtained. The success criterion adopted was a mean linear difference of <2 mm and a mean angular difference of <4°. RESULTS: Results were analysed using a linear mixed model with fixed and random effects, at α = .05. No significant statistical differences were found for linear and angular measurements between the planned and postsurgical outcomes (P > .05). All overlapping points presented values within the range considered clinically irrelevant (<2 mm; <1°). CONCLUSIONS: Three-dimensional VSP was executed with a high degree of accuracy. When comparing the planned and postsurgical outcomes, all overlapping points presented values within the range considered clinically irrelevant.

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OBJECTIVE: The aim of this study was to evaluate the correlation among age, gender and the number of temporomandibular disorder (TMD) findings. METHODS: The records from 228 patients with TMD were analyzed for the presence of these findings: morphological changes, disc displacement with reduction (DDWR) and without reduction (DDWOR), bone edema, effusion, and avascular necrosis. Statistical analyses were conducted using multinomial regression with a 5% significance level. RESULTS: DDWR was the most frequent finding. Group 1 was composed of 94 patients (41.22%), Group 2, of 67 patients (29.38%), and Group 3, of 67 patients (29.38%). Men were significantly less likely to belong to Group 3 than women (p = 0.5517). Older patients were slightly more likely to fall in Groups 2 and 3 than in Group 1. DISCUSSION: Women were shown to be more susceptible to developing a higher number of concomitant conditions than men, and the number of findings tended to increase with age.

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Objective: This study evaluated the clinical efficacy of arthrocentesis when varying the irrigation volume in patients with disc displacement without reduction (DDWOR). Methods: Thirty DDWOR patients were equally divided into two groups: G1 (50 mL) and G2 (200 mL). Information was compared for pain, the maximum interincisal distance (MID), protrusion, and right and left laterality. Results: Arthrocentesis was able to reduce the pain and increase the MID, protrusion, and both laterality values significantly one year after the procedure (p < 0.001) in both groups. However, comparisons between the groups revealed no significant difference (p > 0.05). Furthermore, changes in volume did not affect the arthrocentesis results (p = 0.626, odds ratio = 1.625; 95% confidence interval = 0.230-11.461). Conclusion: Arthrocentesis techniques using 50- and 200-mL irrigation volumes were both effective, with no significant differences between techniques observed after one year of follow-up.

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Resumo Introdução: O tratamento das fraturas condilares causadas por um projétil de arma de fogo possui controvérsias na literatura. Objetivo: Descrever um caso clínico de fratura do côndilo mandibular causado por ferimento de arma de fogo que foi tratado com elasticoterapia e fisioterapia. Discussão: A região maxilofacial tem sido alvo constante desse tipo de trauma, refletindo a alta violência urbana. Frequentemente, esses traumas envolvem fraturas cominutivas na região e a abordagem terapêutica para esses casos depende do deslocamento, grau de cominação da fratura e cooperação do paciente. Apesar das diferentes possibilidades de tratamento das fraturas mandibulares, o tratamento não cirúrgico é uma opção válida como primeira escolha, principalmente nos casos de fraturas favoráveis, sem grandes deslocamentos ósseos e associadas à adesão do paciente ao tratamento. Considerações finais: A combinação de bloqueio maxilo-mandibular e elasticoterapia como tratamento conservador é preconizada para a restauração da funcionalidade estomatognática, seguida de acompanhamento periódico. (AU)

Abstract Introduction: The treatment of condylar fractures caused by firearm projectile has controversies in the literature. Objective: This study aimed to describe a clinical case of mandibular condyle fracture caused by firearm injury and treated with elastic therapy and physiotherapy. Discussion: The maxillofacial region has been a constant target for this type of trauma, reflecting the high urban violence. Frequently these traumas involve comminuted fractures in the region and the therapeutic approach for these cases depends on the displacement, degree of fracture comminution and patient cooperation. Despite the different possibilities for treatment of mandibular fractures, non-surgical treatment is a valid option as first choice, especially in cases of favorable fractures, without large bone displacements and associated with patient adherence to treatment. Final considerations: The combination of maxillo-mandibular block and elastic therapy as a conservative treatment is recommended for the restoration of stomatognathic functionality, followed by periodic follow-up (AU)

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COVID-19 es una enfermedad altamente contagiosa y potencialmente mortal que nos acompañara por largo tiempo. Las profesiones de la salud y la vida en general ha sido afectada de forma significativa en todo lugar del mundo. La odontología ha pasado de una etapa de gran desarrollo clínico a una etapa donde el manejo de barrera de protección, el control de tratamientos y el tiempo asignado a los pacientes cambiará la forma de realizar la profesión. El presente trabajo pretende resumir las indicaciones y recomendaciones basadas en la evidencia disponible y realizar un análisis de la condiciones de salud oral para Latinoamérica en esta época de pandemia.

COVID-19 is a profound, highly contagious and life-threatening viral disease that will be with us for a long time. Health Care-related professions and life in its entirety are significantly, and perhaps irreversibly affected, all around the World. COVID-19 is and will continue to transform Dentistry and its practise. Based on the available evidence accrued to date, this work attempts to address such changes, current and anticipated, as well as present recommendations for clinical practise implementation, tailored for Latin/South America, in light of such lifealtering momentous pandemic.

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ABSTRACT Introduction: The cemento-ossifying fibroma is a benign bone neoplasm that affects mainly the female sex during the third or fourth decades of life. This lesion has a slow growth and the treatment is the surgical removal of the tumor, because radiotherapy is not indicated. Objective: to describe and discuss a case of central cemento-ossifying fibroma. Case report: A 41-year-old female patient sought dental treatment due to tooth mobility in the anterior region of the mandible. In this region of the mandible, an increase in volume was noted with a firm consistency on palpation, covered by normal mucosa, and displacement of teeth. Radiographically, the presence of an extensive lesion in this region was observed. An incisional biopsy was performed which led to the final diagnosis of central cemento-ossifying fibroma. Subsequently the tumor was completely removed. An autogenous bone graft was performed and four osseointegrated implants were installed to rehabilitate the patient. Implant-supported prostheses (lower arch) and a complete denture (upper arch) were installed to restore esthetics and function of the patient's oral cavity. Conclusion: Despite being a benign tumor, the central cemento-ossifying fibroma caused functional and aesthetic damage to the patient and required a complex rehabilitation treatment. After approximately 5 years of tumor removal, there was no recurrence of the lesion or signs of peri-implant or periodontal diseases, evidencing the success of the treatments(AU)

RESUMEN Introducción: El fibroma cemento-osificante es una neoplasia ósea benigna que afecta principalmente al sexo femenino durante la tercera o cuarta décadas de la vida. Esta lesión tiene un crecimiento lento y el tratamiento es la extirpación quirúrgica del tumor, porque la radioterapia no está indicada. Objetivo: Describir y analizar un caso de un fibroma cemento-osificante central. Presentación caso: Paciente de 41 años de edad buscó tratamiento dental debido a la movilidad dental en la región anterior de la mandíbula. En esta región de la mandíbula se observó un aumento de volumen con una consistencia firme a la palpación, cubierta por la mucosa normal y desplazamiento de los dientes. Radiográficamente, se observó la presencia de una lesión extensa en esta región. Se realizó una biopsia incisional, que indicó el diagnóstico final del fibroma cemento-osificante central. Después el tumor fue completamente extirpado. Se realizó un injerto óseo autógeno y, posteriormente, se instalaron cuatro implantes osteointegrados para rehabilitar al paciente. Se instalaron prótesis soportadas por implantes (arco inferior) y una dentadura (arco superior) para restablecer la estética y la función de la cavidad bucal de la paciente. Conclusiones: A pesar de ser un tumor benigno, el fibroma cemento-osificante central causó daños funcionales y estéticos al paciente y requirió un complejo tratamiento de rehabilitación. Después de 5 años de la extirpación del tumor, no hubo recurrencia de la lesión. Además, no hubo signos de enfermedades periimplantarias y/o periodontales, lo que demuestra el éxito del tratamiento(AU)

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RESUMEN: Los exámenes imagenológicos tridimensionales en odontología son cada día mas frecuentes, contando también con algunas tecnologías gratuitas; el objetivo de este estudio fue analizar tres software gratuitos de conversión desde el formato DICOM al STL. Se evaluaron los programas computacionales 3DSlicer, InVesalius e ImageVis3D. La metodología empleada para evaluar fue basada en el modelo del proceso de evaluación de calidad, según la norma NBR ISO / IEC 9126-, incluyendo 6 observadores en la investigación. Se determinó que el programa más fácil de manipular en la etapa de segmentación, en la representación de volumen y en la conversión de archivos STL fue InVesalius, pero el programa más completo y preciso, para estas fases fue el software 3DSlider. Se puede concluir es necesario un entrenamiento adecuado para que la manipulación de estos programas sea lo más preciso posible.

ABSTRACT: The three-dimensional imaging in medical sciences nowadays is increasing and some of these technologies are free; the aim of this study was to analyze three free conversion software: 3DSlicer, InVesalius and ImageVis3D. The methodology used to evaluate the software was based on the model of the quality evaluation process, according to the standard NBR ISO/IEC 9126-1. It was observed that the easiest software to manipulate in the segmentation stage, in the representation of volume and in the conversion of STL (Standard Tessellation Language) files was InVesalius, but the most complete and precise software for these phases was the 3DSlider software. Thus, it was concluded that adequate training is necessary so that the handling of these three software is as accurate as possible.

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The aim of this study was to evaluate the efficacy of the use of the arthrocentesis in patients with disc displacement without reduction (DDWOR). Two hundred and thirty-four (234) patients with DDWOR were evaluated and the following data collected: gender; affected side; age (years); duration of the pain (months); patient's perception of pain (measured by Visual Analogue Scale [VAS 0-10]); maximal interincisal distance (MID) (mm); and joint disc position, determined by magnetic resonance imaging. Data were obtained in two different moments: before the arthrocentesis (M1) and three or four months later (M2). Paired t-Student Test, Scores Test and Wilcoxon Test showed a statistical significant difference (p<0.0001) between the M1 and M2 for the variables VAS and MID. There was an alteration in the joint disc position in 93.88% of the cases after arthrocentesis. There was no association between the general characteristics of the patients on the M1 and the results of the arthrocentesis (p>0.05). It can be concluded that the arthrocentesis is efficient in reducing the pain, in increasing interincisal distance, and altering the joint disc position in patients with DDWOR regardless gender, age side and pain duration.

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Objective: To correlate the clinical aspects of symptomatic patients with chronic articular disc displacement with reduction with alterations in the articular disc (AD) morphology and sagittal position. Methods: Records from 109 patients were selected that included data on AD morphology and sagittal position as determined by MRI. According to the MRI results, the sagittal position and AD morphology with opened and closed mouth were correlated with many clinical variables. Results: More than half of the patients studied were female, and the biconcave and hemiconvex morphologies were most common. Thirty-four patients (31.3%) presented with restricted maximum interincisal distance (MID). The biplanar morphology was associated with eccentric bruxism and MID (p < 0.05). Visual analog scale (VAS) scores between 2 and 7 were shown to be risk factors (p < 0.05). Conclusion: The mouth position can influence AD morphology and eccentric bruxism. VAS scores and unknown etiology were risk factors.

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OBJECTIVE: The objective of this retrospective study was to evaluate the impact of myofascial trigger points (MTrPs) in patients with articular disc displacement with reduction (DDWR) and to identify which clinical variables are associated with the concomitant presence of DDWR and MTrPs. MATERIAL AND METHODS: 130 patients were selected that sought treatment due to joint pain, with ages ≥18 years, of both genders, with DDWR confirmed by magnetic resonance imaging. The sample was divided into two groups: Group 1, patients with DDWR and MTrPs (N=101); and Group 2, patients with DDWR and no MTrPs (N=29). Information on gender, age, pain duration, pain scores, and maximal interincisal distance (MID) were collected. The logistic regression model was used and the odds ratios (OR) was calculated (p<0.05). RESULTS: Group 1 presented statistically significant higher mean pain scores (p=0.007), and smaller MID (p=0.0268) than Group 2. OR were significant for the pain scores (1.429), MID (0.937) and gender (women) (2.810). CONCLUSIONS: Patients with DDWR and MTrPs had increased pain scores and a MID decrease compared to patients with DDWR and no MTrPs. The variables pain scores, MID, and gender (women) showed a significant association with the concomitant presence of DDWR and MTrPs.

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RESUMEN: Los Trastornos Temporomandibulares (TTM) consisten en un conjunto de condiciones patológicas que afectan la articulación temporomandibular (ATM), los músculos de la masticación y las estructuras asociadas. Estudios epidemiológicos estiman que 40 % a 75 % de la población adulta presenta por lo menos un signo de TTM, como ruido articular y 33 % por lo menos un síntoma, como dolor facial o en la ATM. La toxina botulínica (BoNT) es una neurotoxina producida por la bacteria anaerobia Clostridium botulinum, solo la toxina A y B son utilizadas en la práctica clínica después de la aprobación de la Food and Drug Administration en 1989 y 2000; actualmente continúan siendo utilizadas para tratar varias condiciones de dolor, incluyendo la espasticidad muscular, distonia, dolor de cabeza y dolor miofascial. Las propuestas del mecanismo de acción fueron sugeridas a mediados de 1950 manifestando que esta neurotoxina posee alta afinidad con la sinapsis colinérgicas, ocasionando un bloqueo en la liberación de acetilcolina de esos terminales nerviosos, sin alterar la conducción neural de las señales eléctricas o en la síntesis de almacenamiento de acetilcolina. La inyección intramuscular en dosis y localización apropiada, provoca denervación química parcial y disminución de la contractura, sin ocasionar parálisis completa a lo que se le atribuye ser un innovador y eficaz método de tratamiento para el dolor crónico asociada con hiperactividad de los músculos masticatorios. La toxina botulínica tipo A es ser una alternativa para el control de la sintomatología dolorosa presente en los TTMs de etiología miogénica. Los autores recomiendan realizar un correcto diagnóstico, ya que la indicación de este tipo de tratamiento con diagnósticos incorrectos lleva a resultados inciertos.

ABSTRACT: Temporomandibular Disorders (TMD) is a term that was used to describe a set of pathological conditions that affect temporomandibular joint (TMJ), muscles of mastication and associated structures. Epidemiological studies estimates that 40 % to 75 % of the adult population has at least one sign of TMD, such as joint noise and 33 % presented some symptom such as facial or joint pain. Botulinum toxin is a neurotoxin produced by the anaerobic bacterium Clostridium botulinum. There are two types of toxin (A and B) used in clinical practice that were approved by Food and Drug Administration in 1989 and 2000. These medications are in use to treat various diseases including muscle spasticity, dystonia, headache and myofascial pain. The mechanisms of action were suggested in the mid-1950s, this neurotoxin seems to have an action at cholinergic synapses, causing a block in the release of acetylcholine from the nerve terminals without altering the neural conduction of the electrical signals. The synthesis and storage of acetylcholine were preserved. Intramuscular injection in appropriate doses and location causes partial chemical denervation and decreased contracture, without causing complete paralysis of muscles. Due to this features, it has been considered an innovative and effective method to treat chronic pain associated with hyperactivity of masticatory muscles. The botulinum toxin type A appears to be an alternative method for pain control present in TMDs that have myogenic etiology. The authors recommend a correct diagnosis, since the indication of this type of treatment associated with an incorrect diagnosis leads to uncertain outcomes, creating false conclusions.

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PURPOSE: The aim of this retrospective study was to evaluate the accuracy of two-dimensional (2D) virtual surgical planning (VSP) of pharyngeal airway space (PAS) in patients submitted to bimaxillary orthognathic surgery. METHODS: This study was conducted with lateral cephalograms acquired through cone-beam computed tomography records of 33 patients, divided into group 1-patients submitted to maxillary advancement and mandibular setback (n = 17) and group 2-patients submitted to maxillomandibular advancement (n = 16). Records were taken 1 to 2 months prior to surgery, which was used to perform the 2D VSP (Tp), and 6 to 8 months after surgery (T1). In Dolphin Imaging software, the anteroposterior size of the PAS was calculated at the level of four craniometric points: A, occlusal plane (Mx), B, and pogonion (Pog). Two previously calibrated examiners performed these measurements. Statistical analyses were conducted using Kendall and t tests at a 5% level of significance. RESULTS: There was a concordance between the two examiners at all points and times. In group 1, points A and B have statistically significant differences between the PAS measurements performed in Tp and T1, while in group 2, none of the PAS points showed statistically significant differences when comparing Tp to T1. CONCLUSIONS: 2D computer-based cephalometric prediction in Dolphin Imaging software offers a good orientation to professionals during the surgical procedure of bimaxillary surgeries since its use is considered clinically relevant in daily practice.

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