RESUMO
Surgical approaches to the head and maxillofacial area have been described and modified by multiple authors throughout history. It was during nineteenth and twentieth century when most of the techniques evolved due to advances in anesthesia and antibiotic therapy. Currently, a myriad of surgical approaches are employed to gain access to the maxillofacial complex, with each of them having advantages and disadvantages. Although the approaches are presented in numerous textbooks and articles, few texts describe the circumstances or historical context under which they were developed. In a series of three articles, we will provide a historical perspective of the evolution of the most common surgical approaches to the head and face employed today. Descriptions contain advantages and disadvantages of the approaches and modifications are also provided. The purpose of the present article (2/3) is to review the approaches to the midface.
Assuntos
Face , Procedimentos Cirúrgicos Ortognáticos , Face/cirurgia , HumanosRESUMO
Surgical approaches to the head and maxillofacial area have been described and modified by many authors throughout history. It was, however, during the nineteenth and twentieth centuries due in large part to improvements in the delivery of anesthesia and antibiotic therapy when most of the techniques were described. Currently, a myriad of surgical techniques are employed to access the maxillofacial complex with advantages and disadvantages for each one. Although each approach is described in many text and articles, few describe the circumstances or the historical context under which they were designed. In a series of three articles, a historical perspective will be provided on the evolution of some of the most commonly employed today. Descriptions will enumerate the advantages and disadvantages of as well as later modifications. The purpose of the present article (1/3) is to review the approaches to the head and upper face.
Assuntos
Face , HumanosRESUMO
Surgical approaches to the head and maxillofacial area have been described and modified by many authors throughout history. It was, however, during the nineteenth and twentieth centuries when most of the techniques were described, mainly thanks to the advent of anesthesia and antibiotic therapy. Currently, a myriad of surgical techniques are employed to access the maxillofacial complex, with each of them having advantages and disadvantages. Although the approaches are the subject of textbooks and articles, most do not describe the circumstances or the historical context under which they were designed. In a series of three articles, we will provide a historical perspective of the most common surgical approaches to the head and face employed today. Descriptions contain advantages and disadvantages and modifications are provided. The purpose of the present article (3/3) is to review the approaches to the lower face.
Assuntos
Face , HumanosRESUMO
BACKGROUND: Lower third molar (M3) eruption is unpredictable. The purpose of this study was to correlate radiographic position of M3 on a preexistent film with the current clinical, histopathological, and radiographic findings. METHODS: A retrospective cohort study was performed. The sample was collected from a database of patients covered by Medical Fund of Brazilian Army. Radiographs were obtained a minimum of 5 years prior to the presurgical visit and after their clinical exam. The primary outcome variables were the teeth positions using Pell and Gregory/Winter classifications on panoramic X-rays. Those variables were analyzed at both the beginning (T0) and end of the study (T1). Clinical assessments and histopathological study of the thirds that were extracted were performed only at T1. Correlation between the teeth positions were related to the clinical, histopathological, and radiographic parameters using statistical analysis tests with significance set at p < 0.05. RESULTS: Twenty-six patients with 49 M3 were assessed over 10 months. Mean age was 14.92 years at T0 and 21.87 years at T1. The average time between T0 and T1 was 6.77 years. A significant relationship (p = 0.024) was found between the presences of root resorption on the second molar if M3 presented in an IB horizontal position at T1. There was also a significant correlation (p = 0.039) between dental crowding of the anterior lower teeth with IIIB position at T0 and if the patient finished orthodontic treatment without lingual retainers. CONCLUSIONS: Lower M3 in position IIIB seen in a teenager and IB seen in an adult is more likely to have negative consequences and should be followed closely.
Assuntos
Dente Serotino/anatomia & histologia , Dente Serotino/diagnóstico por imagem , Dente Serotino/patologia , Dente Impactado/diagnóstico por imagem , Dente Impactado/patologia , Adolescente , Adulto , Brasil , Criança , Feminino , Hospitais Militares , Humanos , Masculino , Má Oclusão/epidemiologia , Má Oclusão/etiologia , Mandíbula/patologia , Dente Molar/patologia , Prevalência , Radiografia Panorâmica/métodos , Estudos Retrospectivos , Reabsorção da Raiz , Estatística como Assunto , Doenças Estomatognáticas/epidemiologia , Doenças Estomatognáticas/etiologia , Erupção Dentária , Extração Dentária , Técnicas de Movimentação Dentária , Raiz Dentária/anatomia & histologia , Raiz Dentária/diagnóstico por imagem , Adulto JovemRESUMO
This study was designed to evaluate the variations in decision making among Brazilian oral and maxillofacial surgeons (OMFS) and trainees in relation to third molar surgery. A survey on 18 diverse clinical situations related to the assessment and treatment of the third molar surgeries was conducted during the 20th Brazilian National OMFS meeting. Participants were divided into three groups according to their level of training. Another variable studied was length of experience. Correlation between the question answers and the variables was analysed using the chi-square test and the f test. The mean age of participants was 32.68 years, and their mean length of experience was 5.24 years. There were no statistical differences between the level of training and number of years of experience and the responses to 15 of the 18 questions on clinical situations. However, differences were found in responses to prophylactic extraction of asymptomatic third molars, use of non-steriodal anti-inflammatory drugs (NSAIDs) during the preoperative surgical period and the use of additional imaging to plan extractions. The group with shorter time of experience (3.8 ± 3.94 years) tended to recommend extractions of asymptomatic third molars more frequently compared with the more experienced surgeons (P = 0.041). More experienced surgeons used NSAIDs in the preoperative surgical period, whereas the majority of the youngest surgeons (4.1 ± 5.96 years of experience) did not (P = 0.0042). The certificated trained and in practice group tended to treat deep lower third molar impactions based on the findings of a panoramic radiograph, without obtaining additional imaging [cone beam computed tomography (CBCT)] before treatment (P = 0.0132). Decision making regarding third molar treatment differs according to the level of training and is influenced by the number of years of experience. Therefore, further continuous education programmes in this area are warranted to make recommendations regarding third molars consistent with the current literature.
Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Dente Serotino/cirurgia , Cirurgia Bucal , Extração Dentária/métodos , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Brasil , Competência Clínica , Tomografia Computadorizada de Feixe Cônico/métodos , Humanos , Planejamento de Assistência ao Paciente , Pré-Medicação , Radiografia Panorâmica/métodos , Cirurgia Bucal/educação , Coroa do Dente/cirurgia , Extração Dentária/instrumentação , Dente Impactado/cirurgiaRESUMO
PURPOSE: An increasing number of patients who are 30 years old or older have been presenting for orthognathic surgery, some of whom have impacted third molars. The purpose of our report was to review the incidence of bad splits in this age group, both with and without third molars (3Ms). MATERIALS AND METHODS: A retrospective cohort analysis of all patients who had undergone sagittal split osteotomy (SSO) who were 30 years old or older was performed. The inclusion criteria were age 30 years or older and performance of an SSO. Those with incomplete data or who were younger than 30 years old were excluded. A history and radiographic review was performed to find cases with a bad split that had occurred during the surgical procedures. The fractures were correlated with the presence or absence of the lower 3Ms, the degree of impaction of the 3Ms, and patient age and gender. For this aged sample, the variables of 3M presence and gender were analyzed using the Fisher exact test. For patient age, analysis of variance was applied, and for the degree of impaction, the Pearson test was used. All the tests used the level significance of 0.05%. RESULTS: Of the 220 patients who underwent SSO during the study period, 52 were older than 30 years (24%). Of these, 8 patients (15%) had had at least 1 3M present at surgery. Most of the patients had undergone sagittal splits without complications. A total of 3 patients had had bad splits in this sample, 1 of whom had a 3M present at surgery and 2 of whom did not. No association was found between the occurrence of a bad split and the variables studied, including the presence of a 3M (P = .089), degree of impaction (P = .074), age (P = .963), and gender (P = .266). CONCLUSIONS: From the results in this small subset of patients, 3Ms can be removed in patients older than 30 years concomitant with bilateral SSO.