RESUMO
This case report presents a mandible reconstruction with temporomandibular joint (TMJ) prothesis for treatment of osteomyelitis infection following a bimaxillary orthognathic and genioplasty surgeries. The patient, a 41-year-old female, presented with facial pain, difficulty in opening her mouth, and mandibular deviation four months after the initial orthognathic surgery. During the four months, the patient had experienced two more surgerys post-operative for treatment of the complications. Examination revealed mobility between osteotomy segments of the right mandibular osteotomomie between body and ramus, and Computer Tomographic scan analysis revealed osteomyelitis and non-union within the osteotomy side of the right mandible from the previous surgery. Due to the advanced state of the disease and significant bone resorption, treatment was planned in two stages, involving bone debridement and then reconstruction with a custom made extended temporomandibular joint prosthesis. The patient had no postoperative complications and achieved satisfactory functional and aesthetic outcomes. This case emphasizes the importance of careful monitoring and prompt management of postoperative complications following orthognathic surgery to prevent rare but serious complications such as osteomyelitis.
RESUMO
Objetivo: avaliar a atividade antimicrobiana da fibrina rica em plaquetas (PRF) frente a bactérias da cavidade oral. Material e métodos: foram coletadas amostras sanguíneas de seis pacientes que fizeram uso de PRF para fins de tratamento odontológico. Após a coleta, o sangue foi centrifugado seguindo duas metodologias distintas, uma a 1.800 rpm durante dez minutos e outra a 3.000 rpm durante dez minutos. A PRF obtida pelo processo foi separada e imediatamente utilizada para análise de sua atividade antimicrobiana. As cepas Streptococccus mutans, Streptococcus oralis, Streptococcus salivarius, Streptococcus parasanguinis, Streptococcus mitis, Lactobacillus acidophilus e Lactobacillus rhamnosus foram cultivadas em meio Brain Heart Infusion (BHI) suplementado com 1% de sacarose, sob atmosfera de microaerofilia a 37oC durante 48 horas. O potencial bactericida da PRF foi verificado através do teste de resistência ou sensibilidade bacteriana por difusão em ágar. Resultados: após a obtenção dos resultados, pôde-se observar que algumas bactérias, como a S. mutans, S. oralis, S. sanguise e S. parasanguinis, foram suscetíveis à PRF, segundo medição do halo de inibição. Ainda, houve diferenças quanto à atividade da PRF dentre as duas metodologias empregadas. Conclusão: a PRF possui atividade antimicrobiana considerável frente a determinadas espécies bacterianas orais, fato este que a torna um excelente produto para uso em Odontologia. Contudo, outros estudos devem ser realizados visando o mecanismo de ação antimicrobiana deste recurso. (AU)
Objective: to evaluate the antimicrobial activity of platelet-rich fibrin (PRF) against oral bacteria. Material and methods: blood samples were collected from 6 patients who used PRF for dental treatment. After collection, the blood was centrifuged following two different methodologies, one at 1,800 rpm for 10 minutes and the other at 3,000 rpm for 10 minutes. The PRF obtained by the process was separated and immediately used to analyze its antimicrobial activity. Streptococcus mutans, Streptococcus oralis, Streptococcus salivarius, Streptococcus parasanguinis, Streptococcus sanguis, Lactobacillus acidophilus and Lactobacillus rhamnosus were cultured in Brain Heart Infusion (BHI) supplemented with 1% sucrose under a microaerophilic atmosphere at 37oC for 48 hours. The bactericidal potential of the PRF was verified through the bacterial resistance test by diffusion in agar. Results: after obtaining the results, it was observed that some bacteria such as S. mutans, S. oralis, S. sanguis and S. parasanguinis were susceptible to PRF according to the measurement of the inhibition halo. It was also observed that there were differences in PRF activity among the two methodologies used. Conclusion: it was possible to perceive that PRF has considerable antimicrobial activity against certain oral bacterial species, a fact that makes it an excellent product for use in dentistry. However, other studies still needed to be performed aiming at the mechanisms of antimicrobial action of this resource. (AU)