Aline Monise Sebastiani

Influence of orthognathic surgery for symptoms of temporomandibular dysfunction

OBJECTIVE To evaluate the influence of orthognathic surgery on the clinical signs and symptoms of temporomandibular disorders (TMDs). STUDY DESIGN In a cohort study, 54 patients undergoing orthognathic surgery were evaluated with regard to the signs and symptoms of TMDs through subjective and objective assessments. These evaluations were performed 1 week preoperatively (T1), 1 month postoperatively (T2), and 6 months postoperatively (T3). The evaluations included patient variables and surgery. Univariate analyzes were performed to verify the association of the variables (P < .05). RESULTS The incidence of TMD 6 months after orthognathic surgery was significantly lower (P < .001). TMD intensity decreases significantly in the postoperative period. Females had a higher prevalence of TMD (P = .003) and muscular disorders preoperatively (P = .001). There was a decrease in clicks between T1 and T3 (P = .013). Mouth opening without pain worsened from T1 to T2 (P < .001) and improved from T1 to T3 (P = .015) and T2 to T3 (P < .001). The results were similar for mouth opening with pain (P < .001). In patients undergoing jaw fixation with bicortical screws, mouth opening without pain was significantly less in T3 patients than in patients undergoing fixation with plate and monocortical screws (P = .048). CONCLUSIONS Orthognathic surgery reduces the clinical signs and symptoms of TMD.

Cleidocranial Dysplasia: Diagnosis, Surgical and Orthodontic Planning and Interventions in a Pediatric Patient

La displasia cleidocraneal (CCD) es un trastorno oseo, autosomico dominante, causado por un defecto en el gen CBFA1 y se caracteriza por anomalias esqueleticas, craneofaciales y bucodentales. En este trabajo se describen los principales aspectos de un caso de CCD, desde el diagnostico y la planificacion para la primera etapa de las intervenciones. Un paciente varon de 11 anos de edad, concurrio a la Clinica de Odontologia Pediatrica de la Universidad Federal de Parana (Brasil) con un problema de retencion prolongada de casi todos sus dientes de leche. Se describen los examenes clinicos y de imagen dirigidos al diagnostico de la CCD y el plan de tratamiento. La primera etapa consistio en la extraccion de cuatro dientes primarios, dos dientes permanentes y dos dientes supernumerarios del maxilar, seguido de separacion del paladar, traccion de los dientes afectados y traccion inversa del maxilar. El paciente permanece en tratamiento. El seguimiento clinico, asi como la concientizacion y motivacion de la familia son factores importantes en este tipo de casos.

Genetic variants in ACTN3 and MYO1H are associated with sagittal and vertical craniofacial skeletal patterns

OBJECTIVE This study aimed to evaluate the association of genetic variants inACTN3 and MYO1H with craniofacial skeletal patterns in Brazilians. DESIGN This cross-sectional study enrolled orthodontic and orthognathic patients selected from 4 regions of Brazil. Lateral cephalograms were used and digital cephalometric tracings and analyzes were performed for craniofacial phenotype determination. Participants were classified according to the skeletal malocclusion in Class I, II or III; and according to the facial type in Mesofacial, Dolichofacial or Brachyfacial. Genomic DNA was extracted from saliva samples containing exfoliated buccal epithelial cells and analyzed for genetic variants inACTN3 (rs678397 and rs1815739) and MYO1H (rs10850110) by real-time PCR. Chi-square or Fishers exact tests were used for statistical analysis (α = 5%). RESULTS A total of 646 patients were included in the present study. There was statistically significant association of the genotypes and/or alleles distributions with the skeletal malocclusion (sagittal skeletal pattern) and facial type (vertical pattern) for the variants assessed inACTN3 (P < 0.05). For the genetic variant evaluated in MYO1H, there was statistically significant difference between the genotypes frequencies for skeletal Class I and Class II (P < 0.05). The reported associations were different depending on the region evaluated. CONCLUSION ACTN3 and MYO1H are associated with sagittal and vertical craniofacial skeletal patterns in Brazilian populations.

Does orthognathic surgery improve myofacial pain in individuals with skeletal class III? One-year follow-up

OBJECTIVE The objective of the study was to evaluate the effect of orthognathic surgery on temporomandibular disorder (TMD) in patients with skeletal class III malocclusion. STUDY DESIGN Forty-seven patients undergoing surgery were evaluated by a trained examiner using Axis I of the Research Diagnostic Criteria/TMD index, consecutively, at 3 different periods: 1 week before operation (T0), 6 months after operation (T1), and 1 year after operation (T2). Bivariate analyses were performed to compare the evaluation periods (P < .05). RESULTS The prevalence of TMD in the sampled patients from T0 to T1 decreased from 30 (63.8%) to 22 (46.8%) (P = .021). Even in T2, the prevalence of TMD remained lower than that in T0, at 21 (44.7%) diagnosed patients (P = .049). The reported frequencies of myofascial pain and headache were lower in T1 and T2 than in T0 (P < .001). Decrease in the frequency of joint pain and joint sounds was observed only from T0 to T1 (P = .039 and P = .021, respectively). The mean maximum of mouth opening decreased from T0 to T1 (P < .001) and increased again at T2 (P < .001). CONCLUSIONS Orthognathic surgery promoted reduction in the frequencies of myofascial pain and headache reported by patients with skeletal class III malocclusion.

Cicatricial Ectropion Correction in the Inferior Eyelid with Cartilaginous Tissue Graft: Case Report

Transcutaneous approaches of the lower eyelid are commonly used to provide adequate exposure of the orbital floor and zygomaticomaxillary suture during treatment of facial fractures. Cicatricial ectropion is a rare complication that results in a shortened eyelid. This condition can be temporary in some cases but when it is permanent it must be surgically corrected, aiming to restore function, improve the aesthetical outcomes and to prevent ophthalmological disorders such as epiphora and corneal ulceration. The present study describes a novel surgical approach, associated with a concomitant cartilaginous graft, to treat severe lower eyelid ectropion resultant from a previously performed subtarsal incision.

Total Mandibular Subapical Alveolar Osteotomy to Correct Class II Division I Dentofacial Deformity

Introduction Class II division I malocclusions are the most common dentofacial deformities seen in clinical practice. Severe cases or cases in which growth has ceased may require full correction combining orthodontic and surgical treatment. We report a case of a total mandibular subapical alveolar osteotomy, performed to correct a class II division I dentofacial deformity. Case Report A 19-year-old female patient was referred to the oral and maxillofacial surgery department at the Federal University of Paraná with chin aesthetic complaints as well as class II malocclusion. The proposed treatment was total mandibular subapical alveolar osteotomy, retaining the chin position and eliminating the need for genioplasty, since, although the patient presented with a class II dentofacial deformity, the chin was well positioned. Under general anesthesia, a “V-shaped” incision was conducted from the right retromolar region to the left retromolar region. A ring of cortical bone was removed around the mental foramen, with the aim to create a space around the mental nerve. Fixation was conducted with plates and screws of the 2.0 system. The patient on six-year follow-up showed osteotomy stability, a better overall occlusion, and outcome satisfaction.

Le Fort III osteotomy for severe dentofacial deformity correction associated with hypoplasia of the midface

A combinacao da terapia ortodontica com a cirurgia ortognatica e uma modalidade de tratamento bem estabelecida para a correcao de deformidades dentofaciais. Quando estas deformidades apresentam maior severidade, envolvendo a hipoplasia do terco medio da face, exigem tecnicas cirurgicas nao utilizadas como rotina no tratamento das alteracoes faciais, como a osteotomias Le Fort III ou as variacoes destas tecnicas. Poucos estudos relatam o uso desta tecnica ou de suas modificacoes em pacientes nao sindromicos. Este trabalho tem como objetivo demonstrar uma resolucao ortodontica-cirurgica de um paciente apresentando deformidade de face com ma-oclusao Classe III severa, envolvendo hipoplasia do terco medio facial, com a realizacao de uma tecnica modificada da osteotomia Le Fort III, associada as osteotomias Le Fort I e osteotomia sagital dos ramos mandibulares. O paciente encontra-se com tres anos de acompanhamento pos-operatorio, com melhora significativa na sua habilidade mastigatoria, sem queixas funcionais, relatando alta satisfacao com a estetica e melhora na qualidade de vida.

ENXERTO ÓSSEO AUTÓGENO DE RAMO MANDIBULAR: RELATO DE CASO

Os enxertos osseos autogenos em bloco de origem bucal sao indicados para os pacientes com interesse de reabilitacao com implantes osseointegrados, que se apresentam com insuficiencia ossea do processo alveolar em uma area desdentada unitaria ou parcial (TRYPLETT E SHOW, 1998). Paciente de 45 anos de idade com protese fixa mal adaptada na regiao de incisivo central do lado direito e com enxerto de material aloplastico naoosseointegrador na regiao. A conduta foi remocao daquele material, realizacao de cirurgia de enxerto osseo autogeno, para conseguir condicoes adequadas para reabilitacao com protese sobre implante. O enxerto osseo foi removido do ramo mandibular, o sitio receptor foi preparado na tabua ossea vestibular realizando-se uma pequena caixa para receber o enxerto, e com perfuracoes feitas com broca esferica para aumentar a perfusao sanguinea, facilitando a integracao e substituicao ossea. O enxerto foi fixado com um parafuso de titânio. Foi utilizado osso liofilizado de origem bovina (Bio-Oss) para preenchimento de pequenos espacos entre o enxerto e a area receptora. Toda area do enxerto osseo foi coberta com uma membrana (Bio-Gide) para evitar a migracao das celulas do tecido conjuntivo para o espaco. Cinco meses depois, o osso encontrava-se em excelentes condicoes para instalacao do implante.