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OBJECTIVES: This study aimed to compare the reconstruction with type 2.4 and three-dimensional (3D) grid plates relating the areas of weakness to anatomical regions of force incidence in atrophic mandibles with and without segmentation using finite element analysis (FEA). MATERIALS AND METHODS: Strength and force quality in the mandible were also determined. The atrophic mandible models with and without segmentation were divided into four groups, and the behavior of each plate was analyzed using finite element analysis. In the atrophic mandible without segmentation using the type 2.4 reconstruction plate, the highest stress concentration in the plate was observed in the posterior region of the mandibular body and in the grid type 3D reconstruction plate was observed in the mandibular angle. RESULTS: In the segmented atrophic mandible with the 2.4 reconstruction plate, higher stress concentration was observed in the mandibular segment defect. Analysis of the 3D grid-like reconstruction plate revealed that the geometry of the plate conferred greater stiffness to the assembly, as the most significant stress concentration was observed at the mandibular angle. CONCLUSION: The width of the plate design may influence the strength, not the thickness.
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ABSTRACT: Craniofacial harpoon injuries are extremely rare, especially when caused by attempted suicide. The approach to surgical removal becomes dependent on the characteristics of the device, with or without barbs on the spear, and its path, which presents with significant changes between accidents and suicide attempts. This report presents the successful treatment carried out in a dramatic case of harpoon suicide attempt. The approaches to complete and cautious removal of the spear from the occipital region, reconstruction of the orbital cavity, evisceration of the left eyeball due to amaurosis and psychiatric follow-up were successful, which allowed the restoration of the patient's physical and mental health.
Assuntos
Tentativa de Suicídio , Humanos , Fatores de RiscoRESUMO
Introdução: O termo trismo incialmente foi definido como espasmo tetânico e prolongado dos músculos mastigatórios, associado ao tétano. Tem sido utilizado de forma abrangente para descrever qualquer tipo de restrição ou limitação à abertura de boca, causados por trauma, radioterapia, cirurgia e conseqüente à complicações tardias em câncer de cabeça e pescoço. Frequentemente, é o resultado da ação de diversos fatores sobre a articulação têmporo-mandibular e a musculatura adjacente. A limitação de abertura de boca pode ser resultado de dano à musculatura mastigatória, dano na articulação têmporo-mandibular, rápida cicatrização tecidual que gera fibrose determinada pela localização do tumor como complicação tardia de radioterapia. Objetivo. Avaliar retrospectivamente a incidência de trismo em pacientes submetidos a mandibulectomias por câncer de cabeça e pescoço, atendidos no Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia do Hospital A. C. Camargo, sua metodologia utilizada para diagnóstico ,relação entre o desenvolvimento do trismo e as modalidades de tratamento instituídas, bem como os possíveis fatores etiológicos para o seu desenvolvimento. Método. Avaliados de maneira retrospectiva 214 pacientes portadores de neoplasias malignas da região topográfica da cabeça e pescoço, submetidos a mandibulectomias, no período de 2000 a 2009, avaliando-se os pacientes que apresentaram diagnóstico objetivo de trismo ou descrições em sua evolução, sugestivas de limitação de abertura bucal que configure critérios diagnóstico de trismo. O trabalho foi realizado por meio do levantamento de prontuários, baseados nos diagnósticos (CID-10), contanto com o apoio do Laboratório de Bioinformática do Hospital A.C. Camargo. Resultados. Na presente casuística, 12 pacientes eram do sexo feminino correspondendo a 24% e 38 do sexo masculino correspondendo a 76% dos 50 pacientes submetidos à mandibulectomias. A localização anatômica das lesões neoplásicas, a regiões mais acometidas foram retromolar em 16 casos (32%) e assoalho de boca em 15 casos (30%), seguidas por gengiva em 7 casos (14%), rebordo alveolar em 4 (8%) casos, língua em 3 (6%) casos, mucosa julgal em 3(6%) casos, orofaringe, palato e ramo mandibular em 1 caso (2%). Dos 24 pacientes submetidos a mandibulectomias e desenvolveram trismo, 17 casos (70.8%) eram do gênero masculino e 7 casos (30.2%) do gênero feminino, tendo uma proporção aproximada de 2:1. Apens 6 casos obtiveram medidas objetivas do trismo sendo classificadas em trismo severo. Conclusão: A falta de dados objetivos como menção de medidas de abertura de boca quando este dado era citado e a falta de dados subjetivos é um fator relevante para este presente trabalho. Um critério de avaliação de medidas de amplitude de abertura de boca pos operatórias nas cirurgias de cabeça e pescoço bem como a fisioterapia imediata e de seguimento ao tratamento deve ser relevado. O trismo não está somente associado ao tratamento radioterápico mais sim ao tratamento cirúrgico associado ou potencializado pelo tratamento radioterápico.
Introduction: The term was initially defined as lockjaw tetanus and prolonged spasm of masticatory muscles, associated with tetanus. It has been used broadly to describe any type of restriction or limitation on mouth opening, caused by trauma, radiotherapy, surgery and the consequent late complications in head and neck cancer. It is often the result of action of various factors on temporomandibular joint and adjacent muscles. The limitation of mouth opening may be a result from damage to the chewing muscles, damage to the temporomandibular joint, which causes rapid tissue healing fibrosis determined by the location of the tumor as a late complication of radiotherapy. Objective. To evaluate retrospectively the incidence of trismus in patients undergoing mandibulectomy for cancer of head and neck treated at the Department of Head and Neck Surgery and Otorhinolaryngology, Hospital A.C. Camargo, the methodology used for diagnosis, relationship between the development of trismus and established treatment modalities as well as the possible etiologic factors for its development. Method. Retrospectively analyzed 214 patients with malignancies of the topographic region of the head and neck who underwent mandibulectomy in the period 2000 to 2009, assessing the patients who had trismus purpose of diagnosis or descriptions in their evolution, suggesting limited mouth opening that set criteria for diagnosis trismus. The study was conducted through the records survey, based on diagnoses (ICD-10), provided with support from the Bioinformatics Laboratory of Hospital A.C. Camargo. Results. In this series, 12 patients were female, accounting for 24% and 38 males representing 76% of 50 patients who underwent mandibulectomy. The anatomical location of some lesions, the regions most affected were retromolar in 16 cases (32%) and floor of mouth in 15 cases (30%), followed by gengival area in 7 cases (14%), alveolar process in 4 (8% ) cases, togue in 3 (6%) cases, julgal mucosa in 3 (6%) patients, oropharynx, palate and mandibular ramus in 1 case (2%). Of the 24 patients who underwent mandibulectomy and developed lockjaw, 17 cases (70.8%) were male and 7 cases (30.2%) were female, with an approximate ratio of 2:1. Attachment 6 cases achieved objective measures of trismus were classified in severe trismus. Conclusion: The lack of objective data such as mention of measures to open your mouth when this figure was mentioned and the lack of subjective data is a relevant factor in this study. This evaluation criterion measures of range of mouth opening post operative surgeries head and neck as well as physical therapy and immediate follow-up treatment should be concidered. The trismus is not only associated with radiotherapy rather more associated with surgical treatment or radiotherapy enhanced by.