RESUMO
The median lingual foramen (MLF), which contains neurovascular bundles, is located in an area commonly considered safe for surgical procedures. However, published reports of severe complications after interventions in the mandibular symphysis area indicate the need for caution when approaching this region surgically. The aim of this study was to evaluate the vertical location of the MLF and the median lingual canal (MLC) by measuring the distances of these landmarks to the root apex of the lower central incisors (LCI) and to the menton cephalometric point (Me) on pre-orthognathic surgery cone beam computed tomography scans (N = 100). The results were analyzed in relation to the patients' type of deformity, age, sex, and number of foramina (single vs multiple). The median MLF-LCI and MLF-Me distances were 5.9 mm and 15.0 mm, respectively, while the mean MLC-LCI and MLC-Me distances were 9.7 mm and 11.6 mm, respectively. The mean LCI-Me distance was 21.3 mm, while the mean MLC length was 3.4 mm. Apart from the length of the MLC, the distances were all significantly greater in the male patients than in the female patients. The MLC-Me distance and MLC length differed significantly according to the number of foramina. In preoperative planning, the vertical locations of the MLF and respective MLC appear to be relevant for avoiding neurovascular complications.
Assuntos
Pontos de Referência Anatômicos , Cefalometria , Tomografia Computadorizada de Feixe Cônico , Procedimentos Cirúrgicos Ortognáticos , Planejamento de Assistência ao Paciente , Humanos , Masculino , Feminino , Adulto , Procedimentos Cirúrgicos Ortognáticos/métodos , Adolescente , Mandíbula/cirurgia , Mandíbula/diagnóstico por imagem , Mandíbula/anatomia & histologia , Incisivo/diagnóstico por imagem , Incisivo/anatomia & histologia , Pessoa de Meia-Idade , Cirurgia Assistida por Computador/métodosRESUMO
The purpose of this study was to investigate the influence of time, and experience, on the accuracy of maxillary repositioning in bimaxillary orthognathic surgery performed using virtual surgical planning (VSP). Patients who had undergone bimaxillary orthognathic surgery were reviewed. Maxillary position on pre- and postoperative computed tomography scans was compared. The patients were divided into groups according to the year in which VSP was performed and surgery completed. Linear distances between upper jaw reference landmarks were measured in all three planes of space to determine accuracy between the preoperative VSP and the surgical outcome at various time points. One hundred subjects met the eligibility criteria for assessment and were allocated to groups: 2013 (n=10), 2014 (n=17), 2015 (n=39), 2016 (n=20), and 2017 (n=14). Overall, the results demonstrated improved precision in maxillary position over the years, with more accurate results in patients who underwent surgery in 2015, 2016, and 2017. Mean linear differences between planned and obtained results demonstrated more accurate results in the horizontal direction, followed by transverse and vertical directions. An overall average difference within 1mm was observed for 51.3% of the measurements included in the sample group. Time, and surgeon experience, can influence the accuracy of maxillary positioning in bimaxillary orthognathic surgery.
Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Cirurgia Assistida por Computador , Humanos , Imageamento Tridimensional , Curva de Aprendizado , Maxila , Planejamento de Assistência ao PacienteRESUMO
OBJECTIVE: Keratocystic odontogenic tumors (KOTs) can be treated with Carnoy's solution, although this treatment modality is not free from complications. It is important to verify the incidence of complications after the use of Carnoy's solution and compare these with the literature. MATERIALS AND METHODS: This study verified the effects of a complementary treatment for KOTs and assessed the incidence of such complications as recurrence, infection, sequestrum formation, mandibular fracture, dehiscence, and neuropathy. RESULTS: Twenty-two KOTs treated with Carnoy's solution combined with peripheral ostectomy were included, and the follow-up period varied from 12 to 78months with a mean of 42.9months. Complications included recurrence (4.5%), dehiscence (22.7%), infection (4.5%), and paresthesia (18.2%). No difference was found among lesions associated (9.1%) or not (0%) with nevoid basal cell carcinoma syndrome (P>0.05). Dehiscence was influenced by marsupialization (P<0.05), and paresthesia was observed exclusively in cases of mandibular canal fenestration (P<0.01). CONCLUSIONS: Complementary treatment with Carnoy's solution and peripheral ostectomy appear to provide efficient treatment for KOTs. Complications originating from the use of the solution are less frequent and less serious than complications associated with cryotherapy. Neuropathy seems to be related to direct contact between the solution and the epineurium.