RESUMEN

OBJECTIVE: To summarize published information about the desmoplastic fibroma of the gnathic bones into a descriptive analysis of the main features of this condition. MATERIAL AND METHODS: A systematic review according to the PRISMA guidelines was conducted. Electronic search was performed in four databases and in the gray literature. Case reports and case series were included. Frequencies were obtained for descriptive analysis. RESULTS: We identified 66 articles, for a total of 96 cases. Female patients (55.8%) in the first decade of life (40.6%) with a mean age of 18.2 years were more affected. The mandible was the most affected bone with 81.2% of the cases. The main clinical feature was painless swelling (54.2%). Most of the imaging examinations (radiological, computed tomography, and magnetic resonance) showed well-defined radiolucencies (65.4%) lesions. The treatment was surgical removal in all cases. The recurrence rate was 10.8% and all in the posterior mandible. Spindle cell fibroblasts in a collagenized stroma were often described in the histopathological features. Vimentin, smooth muscle actin, and ß-catenin were common immunohistochemical markers. CONCLUSION: Desmoplastic fibroma is a locally aggressive lesion that commonly affects the jaws in children. Histopathology is essential for diagnosis, and the pathogenesis of this tumor should be further investigated.

RESUMEN

Study Design: Cross-sectional study. Objective: The prevalence and etiology of facial fractures differ in each country. The aim of this study was to determine the patterns, trauma mechanism, and treatment of midface and mandible fractures in a government hospital in Mexico City. Methods: A three-year cross-sectional study was done at Balbuena General Hospital in Mexico City. The variables of interest were age, gender, place of origin, fracture site, trauma mechanism, and treatment. Between 2016 and 2019, physical and electronic data records of patients that exhibited facial fractures were included. Statistical analyses performed included descriptive analysis and a chi-square test. Results: A total of 490 cases of fractures in the maxillofacial region were reviewed, of which 237 (47%) cases presented fractures in the midface. A higher male ratio (M: F 12:1) was observed. The age range varied between 18 and 80 years, with a mean of 35.58 ± 14 years. The most frequent diagnosis was a zygomatic complex fracture, 37.97%. (n = 90). The most frequent trauma mechanism was interpersonal violence at 55.93% (n = 132) in both places of origin (P = .06). Conservative treatment was more frequent at 71.67% in intrapersonal violence (P = .019). Interpersonal violence was more frequent in males at 61.64%, and motor vehicle accident was more frequent in female at 61.11% (P = .028). Conclusions: The analysis provides information that can help to focus preventive measures regarding facial fractures, especially on efforts to reduce interpersonal violence.

RESUMEN

Pierre Fauchard, considered the father of dentistry, contributed to the development of different fields of dentistry that we know today. However, the contribution of this important individual to the fields of oral medicine and oral and maxillofacial pathology is unknown. This study aimed to identify Pierre Fauchard's contribution to these areas of dentistry. We focused on "Le Chirurgien Dentiste, or Traité des Dents" in both French and English, looking for information about the oral diseases diagnosed and treated by Fauchard. Information on patient history, disease description, treatment applied, and clinical follow-up was collected. A contemporary analysis of the diseases was performed, and the collected data were systematized, reported, and analyzed descriptively, according to the current literature on the addressed topics. Information on conditions such as scurvy, parulides, epulides, oral ulcers, dentoalveolar abscesses, dental alterations, and post-exodontia incidents were elucidated. Findings indicated that Pierre Fauchard described, diagnosed, and treated different soft and hard tissue diseases of great interest to the fields of oral medicine and oral and maxillofacial pathology.

Asunto(s)

RESUMEN

El angiolipoma es una neoplasia del tejido adiposo maduro, acompañado de vasos sanguíneos y clasificándose en dos categorías, infiltrantes y no infiltrantes. La localización de esta lesión en la región maxilofacial es poco frecuente en la edad adulta y más aún en los niños. La tomografía computarizada y la resonancia magnética permiten establecer su diagnóstico. El tratamiento de elección es la escisión quirúrgica. Presentamos un caso de angiolipoma de región maxilofacial en una paciente de 4 años de edad, con afectación de la estética facial que, tras su valoración clínica e imagenológica, fue tratada mediante escisión quirúrgica intraoral en el Servicio de Cirugía Máxilofacial del Hospital del Niño Dr. Ovidio Aliaga Uría

Angiolipoma is a neoplasia composed of mature adipose tissue accompanied by blood vessels. It is classified into two categories: infiltrating and non-infiltrating. The occurrence of this lesion in the maxillofacial region is uncommon in adults and even rarer in children. Diagnostic tools such as computed tomography (CT) and magnetic resonance imaging (MRI) aid to stablish the diagnosis. Surgical excision is the treatment to be choice. We present a case of angiolipoma in the maxillofacial region of a 4-yearold patient, with facial aesthetic involvement. After clinical evaluation and imaging assessment, the lesion was successfully treated via intraoral surgical excision at the Pediatric Maxillofacial Surgery Service of the Dr. Ovidio Aliaga Uría Children's Hospital

Asunto(s)

RESUMEN

Extensive odontogenic cysts in children may represent surgical challenges, as they may have common clinical characteristics and different approaches. The main objective of this study is to compare two cases of pediatric odontogenic cysts in maxilla with similar surgical treatment and different histopathological diagnosis. The case series collected included two children, both 12 years old, with encapsulated osteolytic lesions in the region of the maxilla and zygoma body, with clinical and imaging characteristics that suggested odontogenic cysts. The histopathological diagnosis was dentigerous cyst and radicular cyst. In this way, we address the clinical-surgical diagnostic and therapeutic process adopted, analyzing clinical data, such as signs and symptoms, as well as pre- and postoperative tomography scans. Outpatient visits at regular intervals were planned. Both patients achieved significant regression of initial signs and symptoms and returned to their daily activities. It is noticeable that a good stratification of surgical need and planned action in diagnosis and surgery offer benefits with a favorable prognosis for pediatric odontogenic cysts of the jaw.

Los quistes odontogénicos extensos en niños pueden representar desafíos quirúrgicos, ya que pueden tener características clínicas comunes y diferentes abordajes. El objetivo principal de este estudio fue comparar dos casos de quistes odontogénicos en mandíbulas de niños con tratamiento quirúrgico similar y diagnóstico histopatológico diferente. La serie de casos recolectada incluyó dos niños, ambos de 12 años, con lesiones osteolíticas encapsuladas en la región mandibular y cuerpo cigomático, con características clínicas e imagenológicas que sugerían quistes odontógenos. El diagnóstico histopatológico fue quiste dentígero y quiste radicular. De esta manera abordamos el proceso diagnóstico y terapéutico clínico-quirúrgico adoptado, analizando datos clínicos, como signos y síntomas, así como tomografías pre y postoperatorias. Se planificaron visitas ambulatorias a intervalos regulares. Ambos pacientes lograron una regresión significativa de los signos y síntomas iniciales y regresaron a sus actividades diarias. Se destaca que una buena estratificación de la necesidad quirúrgica y una acción planificada en diagnóstico y cirugía ofrecen beneficios con un pronóstico favorable para los quistes odontogénicos de la mandíbula en pediatría.

RESUMEN

PURPOSE: To evaluate in situ the influence of sweat, oil, sunscreen, and disinfectant solution on the color stability, hardness, and roughness of elastomer for facial prostheses. MATERIALS AND METHODS: Standardized and intrinsically pigmented specimens remained in contact with human skin from the same person for 30 days, considering exposures (n = 36 per group), absent of exposition (Control, C); sweat and oiliness contact (SO); sweat and oiliness associated with sunscreen (SOS); 0.12% chlorhexidine digluconate immersion (CD0.12%); and all agents exposed (SOSCD). The main variables were color change (CIELab and National Standard Bureau system, NBS), Shore A hardness, and surface roughness, measured at baseline and 30 days. Qualitative analyses were performed by atomic force microscopy (AFM) and scanning electron microscopy (SEM). The data were analyzed by Kruskal-Wallis tests (color) and two-way ANOVA (hardness and roughness) with Sidak post-test (α = 0.05). RESULTS: CD0.12% (1.54 ± 0.49) and SOSCD (2.10 ± 1.03) had similar effects and caused the smallest color changes, considered mild and noticeable (NBS), respectively. SOS promoted the greatest color change (6.99 ± 1.43, NBS: large) and hardness (17.97 ± 0.56); SOS promoted intermediate roughness (3.48 ± 1.05) between SOSCD (2.25 ± 0.53), and two similar groups: C (4.46 ± 0.95), and CD0.12% (4.39 ± 1.26). The qualitative analysis showed an irregular, dense, dry, and whitish layer on the surface of the specimens exposed to sunscreen, which was reduced when in contact with 0.12% chlorhexidine digluconate. CONCLUSIONS: Endogenous and exogenous factors are capable of altering elastomer properties. The 0.12% chlorhexidine digluconate minimized the changes caused by sweat, oil, and sunscreen.

RESUMEN

Traumatic dental injuries (TDI) are a prevalent public health concern, requiring preventive measures as well as timely and appropriate interventions to prevent adverse outcomes and optimize patients' prognosis. Although dental trauma injuries require prompt clinical intervention, some challenges persist in effectively managing these injuries. In dental traumatology, the implementation of public health policies assumes critical importance, these policies play an important role in addressing preventive measures and mitigating the repercussions of TDI. This review aims to emphasize the importance of developing comprehensive public health policies in dental traumatology, recognizing the strategic importance of this approach and its benefits. By proactively addressing issues associated with dental injuries, these policies have extensive implications for individual quality of life and public health in general. Furthermore, this review will present a suggested structured framework for the development of public health policies, encompassing key domains including prevention, intervention, and education in dental traumatology. The creation and implementation of these policies will address dental trauma through prevention programs, research, and development, and will provide a significant step toward enhancing the well-being of the population and dental trauma victims' prognosis promoting a more resilient healthcare system.

RESUMEN

Purpose: Pycnodysostosis (PYCD), an autosomal recessive syndrome, is characterized by an imbalance in bone remodeling that produces various clinical and radiographic craniofacial manifestations. This review represents a systematic examination of these manifestations, as well as oral features associated with PYCD. Materials and Methods: A systematic review was conducted across 8 databases from February to March 2023. The search strategy focused on studies reporting cases of PYCD that examined the clinical and radiographic craniofacial and oral characteristics associated with this syndrome. Results: The review included 84 studies, encompassing a total of 179 cases of PYCD. More than half of the patients were female (55.3%), and the mean age was 14.7 years. Parental consanguinity was reported in 51.4% of the cases. The most common craniofacial clinical manifestation was a prominent nose, observed in 57.5% of cases. Radiographically, the most frequently reported craniofacial characteristics included the presence of an obtuse mandibular angle (84.3%) and frontal cranial bosses (82.1%). Clinical and radiographic examinations revealed oral alterations, with micrognathia present in 62.6% of patients and malocclusion in 59.2%. Among dental anomalies, tooth agenesis was the most commonly reported, affecting 15.6% of patients. Conclusion: Understanding the clinical and radiographic craniofacial features of PYCD is crucial for dental professionals. This knowledge enables these clinicians to devise effective treatment plans and improve patient quality of life.

RESUMEN

Purpose: Aiming to evaluate and study the epidemiological profile of frontal sinus fractures treated in the region of Ribeirão Preto-Brazil. Methods: Sixteen years of activity in the Oral and Maxillofacial service of the Faculty of Dentistry of Ribeirão Preto/SP (FORP/USP), totaling 9,736 consultations, 4,524 with facial fractures, those diagnosed with frontal sinus fracture (113) were evaluated and selected for the study. Results: Frontal sinus fractures accounted for 2.5% of facial fractures, the majority occurring in men (89.4%), concentrated in the age group 21-30 years old, with 52.2% of cases being caused by road traffic accidents (RTA). Associations with other facial fractures are common and appeared in 75.2% of cases. Treatment was followed either surgically, by open reduction internal fixation (52.2%) or conservatively (35.4%). Analyzing only the 28 isolated frontal sinus fractures, the most common treatment was conservative (46.4%). surgical treatment dropped to 25%. The most common postoperative complications were temporal branch paralysis and supraorbital nerve paresthesia, both occurring in 30.5% of surgical cases. Conclusion: The frequency of frontal sinus fractures may be decreasing, but the pattern of occurrence in young men due to road traffic accidents does not seem to change, fortunately the appearance of serious complications is not common and it is usually associated with more severe trauma.

RESUMEN

Objective: Cleft lip and palate is the most common craniofacial birth anomaly and requires surgery in the first year of life. However, craniofacial surgery training opportunities are limited. The aim of this study was to present and evaluate an open-source cleft lip and palate hybrid (casting and three-dimensional (3D) printing) simulation model which can be replicated at low cost to facilitate the teaching and training of cleft surgery anatomy and techniques. Design: The soft tissue component of the cleft surgery training model was casted using a 3D printed 5-component mold and silicone. The bony structure was designed to simulate the facial anatomy and to hold the silicone soft tissue. Setting: Two groups, one group of trainees and one group of expert surgeons, at University Hospital Basel in Switzerland and Pontifical Catholic University of Chile in Santiago, Chile, tested the cleft lip and palate simulation model. Participants completed a Likert-based face and content validity questionnaire to assess the realism of the model and its usefulness in surgical training. Results: More than 70 % of the participants agreed that the model accurately simulated human tissues found in patients with unilateral cleft lip and palate. Over 60 % of the participants also agreed that the model realistically replicated surgical procedures. In addition, 80-90 % of the participants found the model to be a useful and appropriate tool for teaching the anatomy and surgical techniques involved in performing unilateral cleft lip and palate repair. Conclusion: This open-source protocol provides a cost-effective solution for surgeons to introduce the cleft morphology and surgical techniques to trainees on a regular basis. It addresses the current financial barrier that limits access to commercially available models during the early stages of surgeon training prior to specialization in the field.

RESUMEN

Introdução: a região orbitária é bastante suscetível a fraturas, devido a sua posição exposta e a ossos frágeis. As fraturas do tipo blow-out caracterizam-se pela fratura do assoalho orbitário com ou sem herniação de conteúdo para o seio maxilar, gerando consequências funcionais e estéticas. Relato do caso: paciente do sexo feminino, 48 anos de idade, vítima de queda da própria altura, compareceu ao Hospital Geral do Estado da Bahia com queixa de diplopia, apresentando fratura de assoalho de órbita direita. Foi programada uma abordagem transconjuntival e instalação de tela de titânio para reconstrução. Na alta hospitalar, a paciente negou diplopia, não apresentando prejuízos funcionais ou estéticos. Conclusão: o acesso transconjuntival possibilita uma adequada exposição do assoalho de órbita, para colocação de telas, deixando uma cicatriz imperceptível na conjuntiva. Apesar das vantagens, este acesso cirúrgico apresenta maior complexidade técnica, sendo pouco realizado pelos cirurgiões

Introduction: the orbital region is very susceptible to fractures due to its exposed position and fragile bones. Blow-out fractures are characterized by fractures of the orbital floor with or without herniation of contents to the maxillary sinus, generating functional and aesthetic consequences. Case report: a 48-year-old female patient, victim of a fall from her height, presented to the General Hospital of the State of Bahia complaining of diplopia, presenting with a fracture of the floor of the right orbit. A transconjunctival approach and installation of titanium mesh for reconstruction were scheduled. At hospital discharge, the patient denied diplopia, with no functional or aesthetic impairments. Conclusion: the transconjunctival approach allows adequate exposure of the orbital floor for mesh placement, leaving an imperceptible scar on the conjunctiva. Despite the advantages, this surgical approach presents greater technical complexity and is rarely performed by surgeons.

Asunto(s)

RESUMEN

BACKGROUND/AIMS: Domestic violence (DV) encompasses a series of abusive behaviors, perpetrated in a family environment, against individuals of all ages and genders. Injuries to the head, neck, and face are frequent findings among victims of abuse, negatively impacting their quality of life. Although oral and maxillofacial injuries (OMFI) and traumatic dental injuries (TDI) are commonly diagnosed among DV victims, their prevalence is still unknown. This systematic review was aimed to assess the prevalence of OMFI and TDI among victims of DV. METHODS: The protocol of the review was registered in PROSPERO (CRD42023424235). Literature searches were performed in eight electronic databases, up to August 7th, 2023. Observational studies published in the Latin-roman alphabet and reporting the prevalence of OMFI and/or TDI were included. The Joanna Briggs Institute's critical appraisal tool, checklist for prevalence studies, was used for quality assessment. Results were presented as qualitative and quantitative syntheses. RESULTS: Seventeen studies, totaling 12,375 victims of domestic violence, were included. Meta-analyses showed an overall prevalence of 29% (95% CI: 15%-48%, I2 = 99%) and 4% (95% CI: 1%-10%, I2 = 98%) for OMFI and TDI, respectively. Higher pooled prevalence for OMFI (41%, 95% CI: 13%-46%, I2 = 99%) was demonstrated in samples with only women. OMFI was less prevalent (20%) among DV victims under 18, while TDI was lower among adults (1%). Hospital samples presented higher pooled prevalence of OMFI (32%), and forensic data from fatal victims presented higher prevalence of TDI (8%). CONCLUSION: The overall prevalence of OMFI and TDI in DV victims was 29% and 4%, respectively. Women victims of DV presented higher rates of OFMI (41%) and TDI (6%).

Asunto(s)

RESUMEN

AIM: This study evaluated records of patients with maxillofacial trauma due to interpersonal violence (IPV) being treated in the emergency room of a level I trauma center hospital in São Paulo, Brazil. MATERIAL AND METHODS: Data of patients with maxillofacial trauma due to IPV recorded between January 2019 and December 2019 were retrospectively examined. Personal data, days on which they experienced IPV, and the type of maxillofacial trauma sustained were extracted and statistically analyzed (p < .050). RESULTS: During the analysis, 1034 patients with maxillofacial trauma were identified; of these patients, 292 (28.2%) who experienced trauma due to IPV were included in this study. There was a mean age of 32.6 years and the most common type of trauma was soft tissue injuries (38.7%). Mandible and nose fractures were more prevalent in males and females, respectively. Our data, when compared with other studies on maxillofacial trauma due to IPV, showed a lower prevalence and male-to-female ratio, and a higher presence of dentoalveolar trauma. Additionally, our data when compared with studies on maxillofacial trauma due to other causes showed lower mean age and male-to-female ratios, and a higher occurrence of nose fractures differing from the predominance of mandibular fractures. CONCLUSION: Oral and maxillofacial surgeons must be able to suspect and identify cases due to IPV among their patients with trauma. With our results, although each case has its individuality, we can suggest that cases of maxillofacial trauma in young, female, and nasal fracture patients may be suspicious for IPV.

Asunto(s)

RESUMEN

BACKGROUND/AIM: Maxillofacial trauma resulting from intimate partner violence (IPV) represents an important oral health problem. In this sense, the aim of this study was to investigate the spatial-temporal distribution of maxillofacial trauma resulting from IPV against women, using a geostatistical approach. MATERIALS AND METHODS: An ecological study was carried out including the analysis of confirmed IPV cases against women treated at a Center for Forensic Medicine and Dentistry over a four-year observation period, as well as the evaluation of population data from the victims' places of residence extracted from the last demographic census of the Brazilian Institute of Geography and Statistics. Statistical analysis included: (i) finite mixture modeling to establish incidence trajectory patterns; (ii) Getis-Ord indicator (Gi*) for spatial autocorrelation; (iii) spatial regression analysis (p < .05). RESULTS: Two distinct trajectory patterns (TP1 and TP2) related to IPV incidence were identified using finite mixture modeling, suggesting spatial-temporal disparities at the regional level. In TP1, it was observed that IPV incidence was relatively low and remained stable over time, covering almost two-thirds (62.0%) of investigated spatial units. TP2 was characterized by higher IPV incidence with a tendency to increase in the last year, including more than one-third of neighborhoods (38.0%). Autocorrelation analysis showed a predominance of hot areas (hotspots) in the Eastern zone (p < .05) and in the Western zone (p < .05); and cold areas (coldspots) in the Northern zone (p < .05). In addition, statistically significant association was observed among neighborhoods with higher percentage of households with family householder without income and higher incidence of maxillofacial trauma resulting from IPV against women (ß = 5.305; SE = 1.741; p = .002). CONCLUSIONS: The findings indicate an association between higher IPV incidence against women, maxillofacial trauma, and socio-spatial vulnerability.

Asunto(s)

RESUMEN

O aumento da população de idosos ativos é um fenômeno mundial, também visto no Brasil. Essa alteração no perfil demográfico, tende a uma mudança na morbimortalidade para a qual o sistema de saúde e a população em geral devem se adaptar para oferecer o melhor cuidado possível. Pesquisas indicam elevada ocorrência de quedas em idosos, sendo um fator de risco para esta população, principalmente para os mais longevos devido a fatores intrínsecos e extrínsecos, podendo contribuir para o aumento da morbimortalidade neste grupo. Até o momento, foram localizados poucos estudos comparativos de queda em idosos nos períodos pré-pandêmico e pandêmico de Covid-19. A pandemia da Covid-19 alterou a rotina dos idosos devido às restrições de circulação e ao distanciamento social. O distanciamento pode propiciar a ocorrência de quedas e consequentes traumatismos maxilofaciais impactando as vítimas e a sociedade. Esse estudo aborda os traumatismos maxilofaciais em idosos vítimas de queda com avaliação dos períodos pré-pandêmico e pandêmico de Covid-19 em um hospital público de Belo HorizonteBrasil. Tem como objetivos analisar o perfil epidemiológico das vítimas de acordo com o gênero, faixa etária e tipo de traumatismo sofrido; comparar os eventos de queda nos períodos pré-pandêmico e pandêmico de Covid-19; analisar a prevalência dos diferentes mecanismos de queda, do tipo e localização do traumatismo sofrido; analisar o período do dia e da semana em que ocorreram as quedas; analisar a modalidade do tratamento proposto; apresentar um algoritmo e um protocolo para tomada de decisão em atendimentos de idosos vítimas de traumatismo maxilofacial. Trata-se de estudo transversal realizado a partir da coleta de dados secundários do serviço de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Metropolitano Odilon Behrens. Foram incluídos os casos de pacientes idosos vítimas de traumatismo maxilofacial decorrente de queda atendidos neste hospital entre 1º de janeiro de 2017 e 31 de dezembro de 2022. As variáveis independentes de interesse foram: período do dia, dia da semana, tipos de queda, idade das vítimas (60 a 74 anos e 75 anos ou mais), tipos de traumatismo maxilofacial sofrido, tipo de tratamento proposto. Foram excluídos todos os eventos que não tiverem relação com o desfecho queda. As análises envolveram estatística descritiva e análise bivariada utilizando o software SPSS versão 20.1 a partir de bancos de dados coletados e tabulados no Programa Excel. Esta pesquisa foi submetida aos Comitês de Ética em Pesquisa da Universidade Federal de Minas Gerais e do Hospital Metropolitano Odilon Behrens. A amostra foi composta por 835 idosos (idade variou de 60 até 101 anos de idade). Aproximadamente 59% da amostra era composta por idosos não longevos (60-74 anos) e 59,0% eram do sexo feminino. A queda da própria altura foi citada por mais de 85,0% dos idosos; a maioria das quedas (51,1%) ocorreram durante o período diurno e 72,8% das quedas ocorreram durante a semana. No período pré-pandêmico (2017 até 2019), a frequência de quedas foi de 51,3% e no período pandêmico (2020 até 2022), houve uma discreta diminuição (48,7%). Os tipos de traumatismos foram os seguintes: lesões de partes moles (54,9%), seguido de fraturas simples (32,9%); lesões dentoalveolares (6,6%) e por último, fraturas múltiplas (5,6%). O tratamento conservador foi superior a 90% nos casos de quedas. Na análise bivariada, a frequência de queda na pandemia foi maior entre idosos do sexo masculino (p=0,031). Não houve associação com as outras variáveis. As mulheres prevaleceram nas quedas, exceto durante a pandemia quando os homens sofreram mais quedas. Na maioria dos casos, a etiologia foi a queda da própria altura. Houve uma redução nos casos de quedas no período pandêmico. Os traumatismos maxilofaciais de tecido mole e fraturas simples foram os mais prevalentes. O tratamento conservador foi o mais empregado. As quedas em idosos são multifatoriais e de complexa análise, sendo necessários mais estudos para compreensão da epidemiologia dos traumatismos maxilofaciais e intervenção dos fatores associados. Com estes resultados foram construídos três produtos técnico/científicos, um artigo, um protocolo e um algoritmo. A alta prevalência, o aumento considerável desta parcela da população na sociedade e a escassez de pesquisas relacionadas ao tema, exige um tratamento diferenciado e requer um olhar mais atento por parte dos gestores do sistema de saúde e da comunidade científica, não só pelas particularidades desta população, mas também para reforçar os meios de prevenção de traumatismos maxilofaciais que na maioria das vezes poderiam ser evitados.

The increase in the active elderly population is a worldwide phenomenon, which has also been seen in Brazil. This change in demographic profile tends to lead to a change in morbidity and mortality to which the health system and the population in general must adapt in order to offer the best possible care. Research indicates a high occurrence of falls in the elderly and they are a risk factor for this population, especially for the oldest old due to intrinsic and extrinsic factors, which can lead to morbidity and mortality. To our knowledge, no comparative studies of falls in the elderly in the prepandemic and pandemic periods of Covid-19 have been found. The Covid-19 pandemic has changed the routine of the elderly due to movement restrictions and social distancing. The social distancing can lead to falls and consequent maxillofacial injuries, impacting victims and society. This study addresses maxillofacial injuries in elderly fall victims and evaluates the pre-pandemic and pandemic periods of Covid-19 in a public hospital in Belo Horizonte, Brazil. Its objectives are to analyze the epidemiological profile of the victims according to gender, age group and type of injury suffered; to comparatively analyze fall events in the pre-pandemic and pandemic periods of Covid-19; to analyze the prevalence of the different fall mechanisms, the type and location of the injury suffered; to analyze the period of the day and week in which the falls occurred; to analyze the proposed treatment modality; to present an algorithm and a protocol for decision-making in the care of elderly victims of maxillofacial injury. This cross-sectional study carried out from the collection of secondary data from the Oral and Maxillofacial Surgery and Traumatology service of the Hospital Metropolitano Odilon Behrens. Cases of elderly patients suffering from maxillofacial injury resulting from a fall treated at this hospital between January 1, 2017 and December 31, 2022 were included. The independent variables of interest were: time of day, day of week, types of fall, age of victims (60 to 74 years old and 75 years or older), types of maxillofacial injury suffered and type of proposed treatment. All events unrelated to the fall outcome were excluded. The analyzes involved descriptive statistics and bivariate analysis using SPSS version 20.1 software from databases collected and tabulated in the Excel program. This research was submitted to the Research Ethics Committees of the Federal University of Minas Gerais and the Hospital Metropolitano Odilon Behrens. The sample consisted of 835 elderly people (ages ranged from 60 to 101 years old). Approximately 59% of the sample was made up of non-long-lived elderly people aged (60-74 years) and 59.0% were female. The fall from one's own height was reported by more than 85.0% of the elderly; the majority of falls (51.1%) occurred during the day and 72.8% of falls occurred during the week. In the pre-pandemic period (2017 to 2019), the frequency of falls was 51.3% and in the pandemic period (2020 to 2022), there was a slight decrease (48.7%). The types of injuries were as follows: soft tissue injuries (54.9%), followed by simple fractures (32.9%); dentoalveolar injuries (6.6%) and lastly, multiple fractures (5.6%). Conservative treatment was more than 90% in cases of falls. In the bivariate analysis, the frequency of falls during the pandemic was higher among elderly men (p=0.031). There was no association with the other variables. Women prevailed in falls, except during the pandemic when men suffered more falls. In most cases, the etiology was a fall from a height. There was a reduction in cases of falls during the pandemic period. Maxillofacial soft tissue injuries and simple fractures were the most prevalent. Conservative treatment was the most used. Falls in the elderly are multifactorial and complex to analyze, requiring more studies to understand the epidemiology of maxillofacial trauma and intervention on associated factors. With these results, three technical/scientific products were created: an article, a protocol, and an algorithm. The high prevalence, the considerable increase in this portion of the population in society and the scarcity of research related to the topic, requires a differentiated treatment and requires a more attentive look on the part of health system managers and the scientific community, not only due to the particularities of this population, but also to reinforce the means of preventing maxillofacial trauma, which in most cases could be avoided.

Asunto(s)

RESUMEN

Aim: To investigate the bacteriological profile of oral and maxillofacial infections and the pattern of sensitivity to a specific group of antibiotics in a reference emergency hospital in Brazil. Methods: This is a prospective cohort institutional study that studied patients affected by oral and/ or maxillofacial infections in a Brazilian emergency hospital, over a 12-month period, of different etiologies, through data collection, culture and antibiogram tests, and monitoring of the process of resolution of the infectious condition. The variables were analyzed using the chi-square and Mann-Whitney tests, using a significance level of 5%. Results: The sample consisted of 61 patients, 62.3% male. The mean age of participants was 34.3 years. Odontogenic infection was the most frequent etiology and the submandibular space was the most affected. The bacterial species Streptococcus viridans was isolated in 21.6% of cases. Levofloxacin, vancomycin and penicillin were the antibiotics with the highest frequency of bacterial sensitivity, while clindamycin and erythromycin showed the highest percentages of resistance. Conclusions: The results suggest that, among the most used antibiotics for the treatment of these infections, penicillin remains an excellent option of choice for empirical therapy

Asunto(s)

RESUMEN

Aim: This study aimed to review the scientific literature to describe the main care and hygiene protocols for different types of maxillofacial prostheses (MFP). Methods: A bibliographic search on the PubMed / Medline database using the following keywords: ["maxillofacial prosthesis" OR "ocular prostheses" OR "palatal obturators"] AND ["Cleaning" OR "disinfection"] AND ["care"] AND ["color stability"] OR ["denture cleansers" OR "cleansing agents"]. Articles addressing materials, cleaning and disinfection protocols, and care related to MFP were included. The following exclusion criteria were applied: no adequate methodology, incompatibility with the area of interest, and unavailability for reading in full. Results: The papers were grouped into the following topics: facial prostheses, ocular prostheses, maxillofacial intraoral prostheses, and retention systems. Conclusion: Despite the MFP changes over time, its degradation decreases upon following the recommendations and post-adaptation care. The guidelines for cleaning and disinfection must be individualized to guarantee the longevity of the prosthesis and the patient health

Asunto(s)

RESUMEN

To evaluate retrospectively the epidemiological characteristics of the prevalence, type and treatment modalities of the condylar mandibular fractures. Data of all patients who underwent surgical or nonsurgical management for condyle mandibular fracture were collected. The study was conducted to assess the trauma etiology, age group, gender, treatment method, anatomic distribution of injury and complications by reviewing patients' records. There were 139 patients with 171 mandibular condylar fractures. Among these patients, 85% were men, with an overall male-to-female ratio of 5.6:1. The highest occurrence of trauma was in the 21-30 years age group. The most frequently observed etiology was motorcycle traffic accidents and the subcondylar region was the most common location with 109 fractures. There was statistically significant difference between treatments (p < 0,001). In the nonsurgical treatment group, the prevalence of complications was observed compared to the surgical group (p < 0.001). The predominant complications were: mouth opening limitation, mandibular deviation, malocclusion, temporomandibular disorder, paresthesia and facial paralysis. Considering the limitations of this study, subcondylar fractures were the most frequent, especially in men aged 21-30 years, and the surgical treatment showed the fewest complications.

RESUMEN

Aging may increase the risk of maxillofacial and dentoalveolar trauma (MDT). This review assessed global trends in scientific publications on MDT in the elderly. Six databases were searched. Studies about MDT in the elderly (≥60 years old) were included in two text mining stages (S1 and S2). In S1, all studies with elderly subjects were included, while in S2 only studies in which the elderly were assessed in a separate set of data or in a subanalysis by age groups were included. In S1, relevant data were mined using VantagePoint™ software. In S2, data were descriptively analyzed. There were 2265 studies at S1 and 110 at S2. The publication dates spanned from 1963 to 2023. In S1, the most cited keywords and terms were aged (n = 1872), male (n = 1839), female (n = 1777), "mandible fracture" (n = 460), "orbit fracture" (n = 362), and "maxilla fracture" (n = 118). Thirty authors published 10 or more articles with visible collaboration networks. There was a progressive increase in publications, especially in Europe (n = 150). In S2, most studies were case reports/case series (n = 62). The primary etiology was accidental falls (n = 84), the most affected region was the middle third of the face (n = 65), and dental trauma was rarely reported (n = 15). Cone Beam computed tomography was the most used diagnostic tool (n = 67). Of the 81 articles that addressed therapy, 52 opted for surgical treatment. Although there has been an increase in the number of articles on MDT over the years, studies with the elderly population as a specific study group are still needed. Accidental falls were the most reported etiology, while the middle third of the face and the mandible were the anatomic region and bone most affected, respectively. The high number of case reports indicates the need for improvement in the available scientific evidence about MDT in the elderly.

Asunto(s)

RESUMEN

A prótese obturadora (PO) permite o restabelecimento estético e funcional de indivíduos maxilectomizados. Os objetivos deste estudo foram: 1. avaliar pelo método de elementos finitos (MEF), o comportamento biomecânico de infraestruturas metálicas de próteses parciais removíveis obturadoras (PPRO) para uma maxila com ressecção do tipo Classe II de Aramany, variando o tipo de conector maior; 2. realizar uma revisão sistemática com meta-análise em rede sobre a eficácia da PO, e outros tratamentos na qualidade de vida de seus usuários. No primeiro estudo, um modelo virtual simulando uma maxila Classe II de Aramany com ressecção óssea do lado esquerdo, e ausência dos dentes 24, 25, 26 e 27 foi construído no programa Rhinoceros® 7.0, a partir de duas tomografias. Em seguida, três infraestruturas de PPRO digitais foram confeccionadas variando o tipo de conector maior: grupo controle com conector maior tipo placa palatina com extensão reduzida (GC), conector maior tipo placa palatina com extensão total (ME), e conector maior tipo barra anteroposterior com extensão reduzida (AP). A análise de elementos finitos foi realizada no software Optistruct 2022, e os resultados analisados no HyperView 2022. Os resultados foram avaliados de forma qualitativa por meio da observação visual das imagens gráficas com variação dos gradientes de cores, de acordo com a distribuição de tensão, e quantitativa por meio da tensão de von Mises (σVM), tensão máxima principal (σmax), tensão mínima principal (σmin) e deslocamento (mm). No segundo estudo foi realizada uma revisão sistemática com meta-análise em rede (PROSPERO #CRD42023430827). Foram incluídos ensaios clínicos randomizados (ECRs) e estudos de intervenção não randomizados (EINRs) com pacientes reabilitados com prótese obturadora como um dos tratamentos de reabilitação. Sete desfechos reportados pelos pacientes foram analisados separadamente para cada desenho de estudo, de acordo com os questionários de QV: aparência, mastigação, dor, contato social, fala, deglutição e QV geral. Os dados foram convertidos para o questionário UW-QOL v4, exceto o contato social que foi convertido para o EORTC QLQ-H&N35. Foi usada meta-análise em rede Bayesiana modelo randômico para calcular as diferenças médias, e intervalos de credibilidade de 95% (Crl) para cada comparação entre tratamentos. A interpretação seguiu a certeza da evidência por meio da abordagem GRADE para meta-análise e a diferença mínima importante (DMI). A revisão incluiu 4 ECRs e 9 EINRs. Sete tratamentos foram avaliados: pré-cirúrgico (considerado sem tratamento), obturador pós-cirúrgico, obturador provisório, obturador convencional, obturador suportado por implante, obturador magnético e retalho, totalizando 120 comparações de tratamentos em todos os sete desfechos. Verificou-se pelos resultados do primeiro estudo que CG e AP apresentaram comportamentos semelhantes, já ME apresentou maiores valores de tensão para praticamente todos os componentes do sistema. Nenhum dos grupos apresentou valores de deslocamento significativos. Para a revisão sistemática, observou-se que a estimativa de efeito de alguns tratamentos alcançou a DMI, entretanto, o intervalo de credibilidade cruzou a linha de efeito nulo, com certeza da evidência muito baixa, portanto, nenhum tratamento foi mais eficaz que o outro. Para ambos os estudos, mais estudos laboratoriais e ensaios clínicos randomizados são incentivados para confirmar as evidências encontradas.

The obturator prosthesis (OP) allows the restoration of speech, aesthetics, and oral function in patients with maxilectomized individuals. The objectives of the study were: 1. to evaluate, using the finite element analysis (FEA) methodology, the biomechanical behavior of metallic infrastructures of removable partial denture obturator (RPDO) for a maxilla with Aramany Class II resection, varying the type of major connector; 2. carry out a systematic review with network meta-analysis on the effectiveness of the OP and other treatments on the quality of life of its users. In the first study, a virtual model simulating an Aramany Class II maxilla with bone resection on the maxillary left side and absence of teeth 24, 25, 26 and 27 was developed using the Rhinoceros® 7.0 program based on two tomography scans. After obtaining the virtual model, three infrastructures digital RPDOs were created varying the type of major connector: major connector with reduced coverage (RPDO1), major connector with extensive coverage (RPDO2) and major connector with anteroposterior bar (RPDO3). The FEA analysis was carried out using the Optistruct 2022 software, and the results were analyzed using the HyperView 2022 software. The results were evaluated qualitatively through visual observation of graphic images with variation of color gradients according to the stress distribution and quantitative von Mises stress (σVM), maximum principal stress (σmax), minimum principal stress (σmin) and displacement (mm). For the second study, the systematic review with network meta-analysis (PROSPERO #CRD42023430827). Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSIs) with obturator prosthesis as one of the treatments were included. Seven patient-reported outcomes were analyzed separately for each study design, according to the QOL questionnaires: appearance, chewing, pain, social contact, speech, swallowing and general QOL. Data were converted to the UW-QOL v4 questionnaire, except social contact, which was converted to the EORTC QLQ-H&N35. Network meta-analysis (NMA) Bayesian random model was used to calculate mean differences (MD) and 95% credibility intervals (Crl) for each treatment comparison. Interpretation followed the certainty of evidence through the GRADE approach for NMA and the least important difference (DMI). The review included 4 RCTs and 9 NRSIs. Seven treatments were evaluated: presurgical (considered no treatment), surgical obturator, interim obturator, obturator, implant-supported obturator, magnet obturator, and flap, totaling 120 treatment comparisons in all seven outcomes. The results of the first study indicate that RPDO1 and RPDO3 showed similar behaviors, while RPDO2 presented the highest stress values for all system components. None of the groups presented significant displacement values. In the systematic review, it was observed that the effect estimates of some treatments reached the DMI, however, for all treatment comparisons, the credibility interval crossed the null effect line with very low certainty of evidence. No treatment showed superiority compared to another for any outcome. For both studies, further laboratory studies and RCTs are encouraged to confirm the evidence.

Asunto(s)