Diego José Stringhini

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.

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.

Extra-Oral Excision of a Buccal Fat Pad Lipoma.

Lipomas and its variants are common soft tissue tumors, and however occur infrequently in the oral and maxillofacial region. Their incidence in the oral cavity is low among all oral lesions. Oral lipoma is yellowish and soft to palpation, and histologically can be mistaken by other lipoma variants. The aim of this study is to report a case of a lipoma located at the buccal fat pad which was removed through an extra-oral access. A 43-year-old male is presenting an augmentation in the right buccal region, being a soft consistency mobile lesion with 1.5 cm of diameter, asymptomatic, and 2 years of growing. Computed tomography scan showed hypodensity compatible with adipose tissue. The lesion was removed through an extra-oral access. The lipoma described in this clinical report had an unusual location and once the lesion was very superficial an extra-oral access was the first treatment option despite the fact that was a benign tumor.Lipomas and its variants are common soft tissue tumors, and however occur infrequently in the oral and maxillofacial region. Their incidence in the oral cavity is low among all oral lesions. Oral lipoma is yellowish and soft to palpation, and histologically can be mistaken by other lipoma variants. The aim of this study is to report a case of a lipoma located at the buccal fat pad which was removed through an extra-oral access. A 43-year-old male is presenting an augmentation in the right buccal region, being a soft consistency mobile lesion with 1.5 cm of diameter, asymptomatic, and 2 years of growing. Computed tomography scan showed hypodensity compatible with adipose tissue. The lesion was removed through an extra-oral access. The lipoma described in this clinical report had an unusual location and once the lesion was very superficial an extra-oral access was the first treatment option despite the fact that was a benign tumor.

REMOÇÃO TARDIA DE TERCEIRO MOLAR SUPERIOR DESLOCADO PARA A FOSSA INFRATEMPORAL

A remocao de terceiros molares superiores impactados e um procedimento comumente realizado pelo cirurgiao dentista e geralmente associado com pouca morbidade e complicacoes. Uma complicacao raramente reportada e o deslocamento do dente para a fossa infratemporal. Diferentes formas de manejo cirurgico sao encontradas na literatura. O tratamento recomendado inclui a remocao cirurgica imediata se possivel, o acompanhamento ou a remocao em um segundo momento cirurgico. O objetivo do trabalho e relatar a remocao de um dente da fossa infratemporal. Paciente do genero masculino, 14 anos foi encaminhado ao Servico de Cirurgia e Traumatologia Buco-maxilo-faciais para remocao de terceiros molares. Durante a remocao do terceiro molar superior direito (18) houve o deslocamento do mesmo para a fossa infratemporal. No momento o paciente e o responsavel foram avisados da situacao. Optou-se pela remocao do dente em um segundo momento. Apos quatro meses, o procedimento cirurgico foi realizado sob anestesia local atraves de incisao com eletrocauterio sobre o ponto de palpacao dentario que estava localizado em fundo de vestibulo. O dente encontrava-se envolto por fibras musculares que foram dissecadas permitindo a remocao do dente. O paciente encontra-se sem queixas funcionais. Em nova radiografia panorâmica foi possivel observar a completa remocao do dente.