Delson João da Costa

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.

Septic arthritis of the temporomandibular joint.

Abstract Septic arthritis of the temporomandibular joint is a rare acute infectious disease that requires attention from physicians and, once misdiagnosed, can have several implications for a patient. The most common microorganisms related to this disease are Staphylococcus aureus, Neisseria, Haemophilus influenzae, and Streptococcus. The infection of the joint may be caused by a direct spread of a local infection or by hematogenous inoculation from a distant focus. General predisposing factors, such as immunodepression, can eventually be found. The aim of the current study was to report a case in which a patient with an articular infection resulting from hematogenous dissemination from a distant site was successfully treated using joint drainage and systemic antibiotics. Secretion culture from the temporomandibular joint space was positive for S. aureus. After 1 month of antimicrobial therapy, the patient was asymptomatic and mandibular function was normal. Literature related to this topic was reviewed and discussed.

Epidemiological analysis of orthognathic surgery in a hospital in Curitiba, Brazil: Review of 195 cases

Abstract Objective The present retrospective study explored the spectrum and characteristics of patients treated with orthognathic surgery at the Universidade Federal do Parana, Brazil. Materials and method Over a six-year period from July 2002 to July 2008, the records of 195 patients with dentofacial deformities who underwent orthognathic surgical procedures were followed up. Results Mean patient age was 25.87 years (range 14 to 65 years) and the female to male ratio was 1.5:1. The predominant racial group was “white”. Most patients belonged to the economically productive population. Sixty-two patients had complete dentition. Only 3.59% patients had local anesthesia (rapid palatal expansion). Transverse maxillary deficiency was the most common deformity, followed by maxillary anteroposterior deficiency associated with mandibular anteroposterior excess. Mandibular set-back was the intervention most frequently performed. The surgical procedures took an average of 3 hours 51 minutes and orthodontic treatments took an average of 44.48 months. Complications occurred in 22.57% of patients, the most common of which were permanent paresthesia of the lower lip (7.17%) and inadequate fracture reduction (5.12%). Conclusions The findings included concepts that were useful for characterizing the profile of patients who undergo orthognathic surgery in southern Brazil. The results also may help to correctly develop protocols for patient care designed to improve the overall results of the procedures.

Resistance and Stress Finite Element Analysis of Different Types of Fixation for Mandibular Orthognathic Surgery

The aim of this study was to evaluate the stress and dislodgement resistance by finite element analysis of different types of fixation in mandibular orthognathic surgery. A 3D solid finite element model of a hemi-mandible was obtained. A bilateral sagittal split osteotomy was simulated and the distal segment was advanced 5 mm forward. After the adjustment and superimposing of segments, 9 different types of osteosynthesis with 2.0 miniplates and screws were simulated: A, one 4-hole conventional straight miniplate; B, one 4-hole locking straight miniplate; C, one 4-hole conventional miniplate and one bicortical screw; D, one 4-hole locking miniplate and 1 bicortical screws; E, one 6-hole conventional straight miniplate; F, one 6-hole locking miniplate; G, two 4-hole conventional straight miniplates; H, two 4-hole locking straight miniplates; and I, 3 bicortical screws in an inverted-L pattern. In each model, forces simulating the masticatory muscles were applied. The values of stress in the plates and screws were checked. The dislodgement resistance was checked at the proximal segment since the distal segment was stable because of the screen at the occlusal tooth. The regions with the lowest and highest displacement were measured. The offset between the osteotomized segments was verified by millimeter intervals. Inverted-L with bicortical screws was the model that had the lowest dislodgment and the model with the lowest tension was the one with two conventional plates. The results suggest that the tension was better distributed in the locking miniplates, but the locking screws presented higher concentration of tension.

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.

Analysis of Incision Effects on Upper Lip Height and Thickness After Maxillary Surgically Assisted Expansion: A Randomized Clinical Trial

PURPOSE To evaluate changes from maxillary circumvestibular incision performed with a #15 scalpel blade versus electrocautery on the height and thickness of the upper lip (UL) after surgically assisted maxillary expansion. MATERIALS AND METHODS Twenty-three patients who underwent surgically assisted maxillary expansion for transverse maxillary deficiency from April 2011 through April 2012 were included in the study. In group 1 (n = 11), the incision was performed with a Bard-Parker #15 scalpel blade. In group 2 (n = 12), the incision was performed with monopolar electrocautery (blend function, 1; power, 20 Watts; frequency, 480 kHz). Clinical measurements for UL height and radiographic measurements for UL height and thickness were performed preoperatively and postoperatively (mean, 6 months). The collected data were subjected to statistical analysis to test the hypotheses of the study. RESULTS After excluding 2 patients, 21 patients were included in the sample. For UL height, clinical and radiographic measurements showed shortening of the UL, and the differences between pre- and postoperative values were statistically significant (P < .05) in the 2 groups. However, there was no statistically significant difference between groups 1 and 2 for UL height (P > .05) by clinical or radiographic measurements. For UL thickness, the 2 groups showed slight UL thickening in the lower portion, with no statistical difference between pre- and postoperative values (P > .05). Moreover, these results were not statistically different between the 2 groups (P = .754). In the uppermost portion of the UL, there was significant thinning in group 2 (P = .001), but not in group 1 (P = .076), and no statistical difference between groups (P = .535). CONCLUSIONS Maxillary circumvestibular incision causes significant shortening of the UL and thinning of the uppermost portion when using a #15 scalpel blade or electrocautery. However, there is no difference in UL dimensional changes when using either technique for maxillary circumvestibular incision.

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.

Treatment of Zygomatic-Orbital Complex Fracture Through Transconjunctival Approach

Fractures of the zygomatic-orbital complex have been described as common in the midface traumas. The surgical approach election is an important decision when there is a risk of interference to function, aesthetics or an association of both. The pursuit of techniques that offer adequate visualization of the interested area associated with low morbidity has been responsible for the development of new techniques and materials. The better approach still remains with a lot of controversy among different authors. However, the transconjunctival incision can be considered in access fractures of the zygomatic-orbital complex. The purpose of this study is report a case of performing transconjunctival approach associated with lateral canthotomy to treatment of zygomatic-orbital complex fractures caused by sports trauma of a 34 years-old male patient.