RESUMO
Le Fort I osteotomy is the technique most applied worldwide in the treatment of dentoskeletal deformity involving the maxilla. Even though it is considered a very safe technique with good intra- and postoperative results, many complications have been described. This paper presents a case of carotid jugular fistula developed in a 22-year-old white male submitted to Le Fort I osteotomy for the treatment of anteroposterior maxillary deficiency, and discusses the possible aetiology and management of this serious complication.
Assuntos
Fístula Arteriovenosa/etiologia , Lesões das Artérias Carótidas/etiologia , Veias Jugulares/lesões , Osteotomia de Le Fort/efeitos adversos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Angiografia Cerebral , Diagnóstico Diferencial , Humanos , Masculino , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
The purpose of this study was to compare the mechanical resistance of three different plates used to treat fractures of the mandibular angle: a regular 4-hole plate, a longer 4-hole plate (both positioned using the Champy technique), and a 3-dimensional plate positioned over the oblique line. Three equal groups of replicas of human dentate mandibles made out of polyurethane resin were used (n=21 in each group). The force was applied perpendicular to the occlusal plane at a rate of 2mm/minute at three different points: the first molar on the sectioned side; the first molar on the contralateral side; and between the central incisors. This was followed by a resistance-to-load test. The two varying factors (type of plate and site-of-load application) were tested by analysis of variance, and probabilities of less than 0.05 were accepted as significant. There were no significant differences between the subgroups, or between the mean values of the different types of plates (p=0.925). The three types of plates showed similar mechanical behaviour, which showed that the 3-dimensional plates positioned over the oblique line can produce mechanical scores similar to those of conventional plates.
Assuntos
Placas Ósseas , Fixação de Fratura/instrumentação , Fraturas Mandibulares/cirurgia , Placas Ósseas/classificação , Humanos , Modelos AnatômicosRESUMO
The aim of this in vitro study was to evaluate the mechanical resistance of a 2.0-mm titanium system applied to the mandibular angle, either with or without continuity of the inferior border of the mandible. Polyurethane mandibles were used as substrates and divided into two groups: unfavourable and favourable to treatment. A single cut was made through the retromolar region, simulating an angle fracture either unfavourable or favourable to treatment. In addition, a small fragment of the inferior border of the mandible was removed in some of the mandibles, creating a discontinuity. The fragments were stabilized in accordance with the technique of Champy et al. The substrates were adapted to a universal mechanical testing machine and submitted to a constant load applied at three different points; load values were obtained at three different moments of displacement: 1mm, 2mm, and fixation failure. The value of the tip dislocation at final displacement was obtained. When the load was applied at the first molars, regardless of the side, no statistically significant difference was observed between the groups. When the load was applied at the central incisors, a statistically significant difference was observed at fixation failure in the unfavourable to treatment group, with better results in the subgroup with continuity of the inferior border of the mandible compared to the subgroup without continuity. Discontinuity of the inferior border of the mandible did not decrease the mechanical resistance of the fixation.
Assuntos
Fixação Interna de Fraturas/instrumentação , Fixadores Internos , Fraturas Mandibulares/cirurgia , Fenômenos Biomecânicos , Humanos , Técnicas In Vitro , Modelos Anatômicos , Poliuretanos , Desenho de Prótese , Estresse Mecânico , TitânioRESUMO
The objective of this study was to compare the bone repair along a mandibular body osteotomy stabilized with 2.0 mm absorbable and metallic systems. 12 male, adult mongrel dogs were divided into two groups (metallic and absorbable) and subjected to unilateral osteotomy between the mandibular third and fourth premolars, which was stabilized by applying two 4-hole plates. At 2 and 18 weeks, three dogs from each group were killed and the osteotomy sites were removed and divided equally into three parts: the upper part was labelled the tension third (TT), the lower part the compression third (CT), and the part between the TT and CT the intermediary third (IT). Regardless of the treatment system, union between the fragments was observed at 18 weeks and the CT showed more advanced stages of bone repair than the TT. Histometric analysis did not reveal any significant differences among the 3 parts or systems in the distance between bone fragments at 2 weeks. Although at 18 weeks the proportions of newly formed bone did not differ among TT, IT and CT, significantly enhanced bone formation was observed in all sections for the metallic group. The patterns of repair were distinct between treatments.
Assuntos
Materiais Biocompatíveis , Fixadores Internos , Mandíbula/cirurgia , Metais , Osteotomia , Animais , CãesRESUMO
This manuscript reports an uncommon case of inferior third molar facial abscess with purulent secretion drainage through the left external acoustic meatus. The patient's left external acoustic meatus was filled with a purulent secretion observed on a CT scan. He underwent surgery to drain the facial abscess. Despite facial abscesses being routine occurrences, the literature does not contain many case reports of odontogenic facial abscesses with drainage via the external acoustic meatus. These situations occur in two possible ways: multiple fissures in the anterior wall of the cartilaginous portion of the external acoustic meatus; and congenital defects that are occasionally present in the anterior-superior aspect of the external acoustic meatus, known as the foramen of Huschke, which allow communication between the external acoustic meatus and mandibular fossa. These defects may also predispose the patient to the spread of the infection or tumour from the external auditory canal to the infratemporal fossa and vice versa. No otological sequelae were observed in this case. The authors conclude that the hypothesis of bone malformation cannot be excluded, and affirm that any facial abscess requires appropriate and immediate treatment for adequate resolution, by removing the causal factor and providing systemic support.
Assuntos
Abscesso/diagnóstico , Meato Acústico Externo/anormalidades , Doenças Mandibulares/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Adulto , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Drenagem , Dor de Orelha/diagnóstico , Seguimentos , Humanos , Masculino , Dente Serotino/cirurgia , Supuração , Osso Temporal/anormalidades , Irrigação Terapêutica , Extração DentáriaRESUMO
The purpose of this study was to compare, by mechanical in vitro testing, a 2.0-mm system made with poly-L-DL-lactide acid with an analogue titanium-based system. Mandible replicas were used as a substrate and uniformly sectioned on the left mandibular angle. The 4-hole plates were adapted and stabilized passively in the same site in both groups using four screws, 6.0mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side; first molar at the contralateral side; and between the central incisors. At 1mm of displacement, no statistically significant difference was found. At 2mm displacement, a statistically significant difference was observed when an unfavourable fracture was simulated and the load was applied in the contralateral first molar and when a favourable fracture was simulated and the load was applied between the central incisors. At the failure displacement, a statistically significant difference was observed only when the favourable fracture was simulated and the load was applied on the first molar at the plated side. In conclusion, despite more failure, the poly-L-DL-lactic acid-based system was effective.
Assuntos
Implantes Absorvíveis , Materiais Biocompatíveis/química , Placas Ósseas , Parafusos Ósseos , Fixação de Fratura/instrumentação , Ácido Láctico/química , Fraturas Mandibulares/cirurgia , Polímeros/química , Titânio/química , Fenômenos Biomecânicos , Arco Dental/patologia , Falha de Equipamento , Humanos , Incisivo/patologia , Fixadores Internos , Mandíbula/patologia , Teste de Materiais , Modelos Anatômicos , Dente Molar/patologia , Poliésteres , Poliuretanos/química , Estresse MecânicoRESUMO
This retrospective study evaluated the epidemiology, treatment and complications of mandibular fracture associated, or not associated, with other facial fractures, when the influence of the surgeon's skill and preference for any rigid internal fixation (RIF) system devices was minimized. The files of 700 patients with facial trauma were available, and 126 files were chosen for review. Data were collected regarding gender, age, race, date of trauma, date of surgery, addictions, etiology, signs and symptoms, fracture area, complications, treatment performed, date of hospital discharge, and medication. 126 patients suffered mandibular fractures associated, or not, with other maxillofacial fractures, and a total of 201 mandibular fractures were found. The incidence of mandibular fractures was more prevalent in males, in Caucasians and during the third decade of life. The most common site was the condyle, followed by the mandibular body. The therapy applied was effective in handling this type of fracture and the success rates were comparable with other published data.
Assuntos
Fraturas Mandibulares/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Criança , Pré-Escolar , Queixo/lesões , Queixo/inervação , Ossos Faciais/lesões , Feminino , Seguimentos , Fixação de Fratura/estatística & dados numéricos , Humanos , Incidência , Estudos Longitudinais , Masculino , Côndilo Mandibular/lesões , Fraturas Mandibulares/classificação , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Transtornos de Sensação/epidemiologia , Fatores Sexuais , Fraturas Cranianas/epidemiologia , Fumar/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto JovemRESUMO
The aim of this study was to determine the biocompatibility and osteoconductive potential of a high-strength canasite glass ceramic. Glass-ceramic rods were produced using the lost-wax casting technique and implanted in the mid-shafts rabbit femurs. Implants were harvested at 4, 13 and 22 weeks and prepared for light and electron microscopy. Hydroxyapatite was used as a control material. Hydroxyapatite implants were surrounded by new mineralised bone tissue after 4 weeks of implantation. The amount of bone surrounding the implant increased slightly at 13 weeks. In contrast, canasite glass and glass ceramic implants were almost entirely surrounded by soft tissue during all the time periods. Close contact between bone and canasite glass-ceramic implant without the intervening fibrous tissue was observed in only a few regions. The canasite formulation evaluated was not osteoconductive and appeared to degrade in the biological environment. It was therefore concluded that the canasite formulation used was unsuitable for use as implant. Further work is required to improve the biocompatibility of these materials with bone tissue. It is possible that this could be achieved by reducing the solubility of the glass and glass ceramic.
Assuntos
Materiais Biocompatíveis , Cerâmica , Fêmur/metabolismo , Vidro , Implantes Experimentais , Animais , Durapatita/química , Durapatita/metabolismo , Fêmur/citologia , Teste de Materiais , Microscopia Eletrônica de Varredura , Osseointegração/fisiologia , Osteogênese/fisiologia , CoelhosRESUMO
The aim of this study was to determine, through cephalometric analysis, the anterior height of the mandible after vestibuloplasty through the lipswitch technique. Thirteen patients (8 women and 5 men) with ages between 32 and 77 years (mean age of 54.3 years) were evaluated. The postoperative periods were 30, 90 and 180 days. During this time there was a reduction of 0.6 mm in the anterior height of the mandible, which was not significant.
Assuntos
Mandíbula/diagnóstico por imagem , Vestibuloplastia/métodos , Adulto , Idoso , Cefalometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , RadiografiaRESUMO
The effectiveness of lidocaine and benzocaine in reducing pain produced by needle insertion into the palate was evaluated in a double-blind and placebo-controlled study using a more suitable method. Twenty subjects, 10 men and 10 women, submitted to 4 sessions in which they were randomly treated with 5% lidocaine, a placebo that tasted like lidocaine, 20% benzocaine, and a placebo that tasted like benzocaine. At each session, a 27-gauge needle was inserted into the palate twice, once before (baseline) and once after drug application for 1 minute. Immediately after each insertion, subjects indicated on a visual analog scale the pain intensity perceived. Lidocaine and benzocaine were equally efficient, and both were better than placebo in reducing pain caused by insertion of needles into the palate.