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PURPOSE: The aim of this study was to evaluate the effect of two different concentrations (4 and 8 mg) of dexamethasone to decrease the swelling and trismus after the surgical extraction of mandibular impacted third molars. METHODS: This randomized clinical trial comprised thirty (30) adult patients of both genders with no local or systemic problems, with bilateral impacted lower third molars in similar position, where surgical extraction had been indicated. They were given 4 mg and 8 mg of dexamethasone 1 hour before the surgical procedure at the first or second surgery. The choice of which side to operate first and the amount of concentration of medication to use was made randomly and double-blindly. Postoperative pain was evaluated using a visual analog scale (VAS) and the degree of swelling was evaluated through facial reference points' variation. The presence of trismus was analyzed through measurement of the interincisal distance (IID). These assessments were obtained before the operation and 24h and 48 h after the surgery. RESULTS: Based on statistic analysis (pared t-student and Wilcoxon tests), the results showed a significant difference in the measurements of the degree of swelling and trismus of the treated sample. 8 mg of dexamethasone promoted a greater reduction of symptoms than 4 mg of dexamethasone CONCLUSIONS: The administration of 8 mg of the dexamethasone was more effective than 4 mg of the dexamethasone to reduce the degree of swelling and trismus. However, it had no effect on pain control.

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OBJECTIVE: The aim of the study was to evaluate the patient s perception of the events during and after an osteogenic alveolar distraction (OAD) procedure MATERIALS AND METHODS: A total of fifty-five (55) osteogenic alveolar distraction (OAD) procedures were performed in fifty (50) patients, who then were asked to answer ten (10) questions related to the treatment. Six (6) questions made reference to predefined values in a Visual Analogical Scale (VAS), three (3) questions could be answered by a predetermined answer, and only one (1) question had a free answer. RESULTS: In 76% of cases, the patient s description of the sensation felt during the surgery was good and bearable; 84% of the patients didn t feel pain after surgery. 4% of the patients felt pain during the activation period and 58% of the patients described the sensation during the activation period as pressure, felt most commonly, at the end of the period, and for about 20 minutes (66.6 %). In these cases the most frequently used analgesic was Paracetamol. Also, 46% expressed having had some difficulty to activate the device, with 10% of them in need of extra help. The presence of the activation rod caused discomfort in 52%. Finally, 78% of the patients treated with OAD would undergo this procedure again if it was necessary. A bone graft was performed in 27 out of the 50 treated patients, with 70% of them describing the bone graft surgery as more painful than the OAD. CONCLUSION: The OAD technique had a high degree of acceptance among the treated patients, however, some details as the interference of the activation rod continue to disturb them. The acceptance of the OAD technique is much better when compared with bone graft surgery technique as a second treatment.

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Facial nerve paralysis (FNP) is the most common cranial nerve disorders and it results in a characteristic facial distortion that is determined in part by the nerves branches involved. With multiples etiologies, these included trauma, tumor formation, idiopathic conditions, cerebral infarct, pseudobulbar palsy and viruses. FNP during dental treatment is very rare and can be associated with the injection of local anesthetic, prolonged attempt to remove a mandibular third molar and subsequent infection. We report a case of a 21 years-old black woman who developed a Bell's palsy after an impacted third molar surgery under local anaesthesia, present a FNP classified like a grade IV by the House-Brackmann's grading system. The treatment was based of prescription of a cytidine and uridine complex (NUCLEO CMP tm) one tablet twice per day and a close follow up. Three months later that had beginning the treatment, the patient recovery her normal facial muscle activity.

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PURPOSE: The objective of this study was to report our experience with the treatment of 30 odontogenic keratocyst (OKC) patients with a conservative treatment protocol based on decompression with reference to the recurrence rate. PATIENTS AND METHODS: Twenty-eight patients (19 females, 9 males) with 30 OKCs attended the OMS Department of the Piracicaba Dental School of Campinas State University between 1995 and 2003. Age range was 13 to 69 years (mean, 30 years of age). Initial biopsy was carried out in all patients and the OKCs were diagnosed after histological examination by the Oral Pathology Department. The cases were treated according to the treatment employed in this department, consisting mainly of decompression and curettage of the remaining lesion. The average follow-up for the 28 cases was 24.89 months (+/-9.74). RESULTS: The majority of the lesions (16 patients, 53.3%) occurred in the angle of the mandible and mandibular ramus. The most common histological pattern of OKC was parakeratinized (66.6%) and 13 of 28 patients presented impacted teeth associated with the lesion. The mean time for decompression was 9.27 months. Recurrence occurred in 4 patients (14.3%) with 4 OKCs. These patients were treated initially with decompression and curettage (2 cases), or with decompression only (2 cases). All the cases were monitored continuously with panoramic radiographies and clinical evaluations. CONCLUSIONS: The treatment protocol for OKC based on decompression offers a conservative and effective option with low morbidity and similar recurrence rates to those reported in the literature. The systematic and long-term post-surgical follow-up is considered to be a key element for successful results.

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Actualmente la reducción abierta de las fracturas mandibulares y la fijación y estabilización de los segmentos óseos por medio de la fijación interna rígida es considerado el tratamiento de elección versus técnicas mas conservadores como lo son la reducción cerrada y el bloqueo maxilo-mandibular o el uso de osteosíntesis por medio de alambre de acero. La fijación interna rígida es una técnica que brinda la suficiente estabilidad para propiciar un correcto reparo óseo así como brindar al paciente un postoperatorio mas confortable y una reincorporación mas temprana a su vida normal, sin limitar notablemente sus actividades fisiológicas y sociales, en comparación con las técnicas antes mencionadas.

At the moment, the open reduction of the mandibular fractures and the fixation and stabilization of the bone segments by rigid internal fixation is considered the election treatment versus more conservative techniques as are the closed reduction and the intermaxillary fixation or the use of osteosíntesis by steel wire. The rigid internal fixation is a technique that offers enough stability to propitiate a correct bone repair as well as to offer the patient a more comfortable postoperative period and an early reincorporation to a normal life, without limiting his activities, in comparison with the techniques before mentioned.

Atualmente, a redução aberta das fraturas mandibulares e a fixação dos segmentos ósseos por meio da fixação interna rígida é considerado o tratamento de eleição frente a técnicas mais conservadoras como são a redução fechada e o bloqueio maxilo-mandibular, ou o uso de osteosíntesis por meio de fio de aço. A fixação interna rígida é uma técnica que oferece a suficiente estabilidade para propiciar um adequado reparo ósseo, além de oferecer ao paciente um pós-operatório mais confortável e uma reincorporação mais precoce a suas atividades, sem limitar notavelmente suas atividades fisiológicas e sociais, em comparação com as outras técnicas anteriormente mencionadas.