Douglas Rangel Goulart

What is expected from a facial trauma caused by violence

ABSTRACT Objectives The aim of this retrospective study was to compare the peculiarities of maxillofacial injuries caused by interpersonal violence with other etiologic factors. Material and Methods Medical records of 3,724 patients with maxillofacial injuries in São Paulo state (Brazil) were retrospectively analyzed. The data were submitted to statistical analysis (simple descriptive statistics and Chi-squared test) using SPSS 18.0 software. Results Data of 612 patients with facial injuries caused by violence were analyzed. The majority of the patients were male (81%; n = 496), with a mean age of 31.28 years (standard deviation of 13.33 years). These patients were more affected by mandibular and nose fractures, when compared with all other patients (P < 0.01), although fewer injuries were recorded in other body parts (χ2 = 17.54; P < 0.01); Victims of interpersonal violence exhibited more injuries when the neurocranium was analyzed in isolation (χ2 = 6.85; P < 0.01). Conclusions Facial trauma due to interpersonal violence seem to be related to a higher rate of facial fractures and lacerations when compared to all patients with facial injuries. Prominent areas of the face and neurocranium were more affected by injuries.

Development of a Titanium Plate for Mandibular Angle Fractures with a Bone Defect in the Lower Border: Finite Element Analysis and Mechanical Test

ABSTRACT Objectives The aim of the present study was to develop a plate to treat mandibular angle fractures using the finite element method and mechanical testing. Material and Methods A three-dimensional model of a fractured mandible was generated using Rhinoceros 4.0 software. The models were exported to ANSYS®, in which a static application of displacement (3 mm) was performed in the first molar region. Three groups were assessed according to the method of internal fixation (2 mm system): two non-locking plates; two locking plates and a new design locking plate. The computational model was transferred to an in vitro experiment with polyurethane mandibles. Each group contained five samples and was subjected to a linear loading test in a universal testing machine. Results A balanced distribution of stress was associated with the new plate design. This plate modified the mechanical behavior of the fractured region, with less displacement between the fractured segments. In the mechanical test, the group with two locking plates exhibited greater resistance to the 3 mm displacement, with a statistically significant difference when compared with the new plate group (ANOVA, P = 0.016). Conclusions The new plate exhibited a more balanced distribution of stress. However, the group with two locking plates exhibited greater mechanical resistance.

No differences in morphological characteristics between hyperplastic condyle and class III condyle

The aim of this research was to compare the condylar morphology of patients with unilateral condylar hyperplasia (UCH) and patients with a class III skeletal relationship using cone beam computed tomography (CBCT). A prospective study was conducted on patients with facial asymmetry attending the division of oral and maxillofacial surgery of the study university in Chile. Fifteen patients with UCH and 15 with a class III skeletal relationship were selected. Linear measurements of the condylar processes were obtained at a scale of 1:1 using the software Ez3D Viewer Plus. Analysis of variance (ANOVA) and the paired t-test were used, considering P<0.05. Patients with UCH presented statistical differences between the hyperplastic condyle and non-hyperplastic condyle for anteroposterior and mediolateral diameters, condylar neck length, and ramus height. Patients with a class III skeletal relationship showed no differences between the right and left sides; the morphology of their condyles was similar to the condyles with hyperplasia and presented statistical differences when compared with the non-hyperplastic condyles (one-way ANOVA, P<0.05). The condylar morphology of UCH patients could be related to the development of a class III skeletal relationship. These findings provide an insight into the possibility of some class III patients presenting bilateral condylar hyperplasia.

Conservative Management for Lingual Thyroid Ectopic

Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with Tc99m and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years.

Removal of a Solitary Synovial Chondromatosis of the Temporomandibular Joint Using Arthroscopy.

AbstractThe diagnosis of synovial chrondromatosis of temporomandibular joint (TMJ) requires a combined assessment consisting of clinical, radiologic, and histopathologic examinations. The purpose of this study is to report in 1 patient the removal of a single large cartilaginous nodule floating in the upper joint compartment using arthroscopy. A 30-year-old woman was referred to our department complaining about pain in preauricular area and restricted mouth opening. Imaging of magnetic resonance reveals anterior disc displacement and right joint effusion. Arthroscopy of TMJ was performed for diagnosis and treatment. During the arthroscopy a large loose body was identified and removed with a biopsy forceps; lavage was conducted with ringer solution. Hyaluronic acid was injected in TMJ at surgery, 1 and 3 months after surgery. Postoperative magnetic resonance imaging showed articular disc on position and no effusion. The patient was followed up of 1 year without sign and symptoms. Arthroscopic procedure of TMJ was effective in diagnosis and removal of a solitary loose body of synovial chrondromatosis. Viscosupplementation appers to offer benefits in controlling pain and functional improvements.

Characteristics of Maxillofacial Trauma Among Alcohol and Drug Users.

AbstractThe aim of the current study was to identify and compare the characteristics of maxillofacial trauma in alcohol and drug users with those of nonusers. A retrospective study was conducted using the medical records of patients treated for facial trauma between April 1999 and March 2012 at the Maxillofacial Surgery Division of the Piracicaba Dental School. The data were analyzed by descriptive analysis, binary logistic regression, and correlational analysis using SPSS 18.0 software. The results were considered relevant at P < 0.05. Medical records of 3724 patients with facial trauma were analyzed, of which 173 were illicit drug users and 19.36% reported alcohol intake. The use of illicit drugs was reported by 4.64%. The prevalent etiological factor among drug and alcohol users was interpersonal violence. The mandible was the face part most affected by fractures. Male patients exhibited increased odds of experiencing fractures (OR = 1.43), as did users of illicit drugs (OR = 1.62), when compared with nonusers. When faced with maxillofacial trauma, male drug users exhibited an increased chance of experiencing fractures. This knowledge should be used as a baseline to implement more efficient prevention strategies for this population.

Analysis of the Condyle, Articular Fossa and Mandibular Ramus in Subjects with Active Condylar Hyperplasia

La asimetria facial es relativamente comun, transformandose en enfermedad cuando se asocia hiperplasia condilar. El objetivo de esta investigacion fue describir y comparar las caracteristicas morfologicas de los condilos hiperplasico con su contralateral no hiperplasico. Quince sujetos de entre 14 y 29 anos de edad, con asimetria facial e hiperplasia condilar unliateral diagnosticada, fueron estudiados mediante tomografia computarizada Cone-Beam. Se determinaron mediciones lineales de la morfologia condilar en vista coronal y sagital, estableciendo tamanos de la fosa articular, rama mandibular, entre otras. Las mediciones condilares sagitales mostraron diferencias significativas (p=0,028) entre los grupos (lado hiperplasico vs. lado no hiperplasico); las mediciones de longitud de rama mostraron diferencias significativas (p=0,034) entre ambos lados. No se observo diferencias significativas (p=0,155) en la relacion de distancia medio lateral (imagen coronal) de condilos hiperplasico y no hiperplasicos. Concluimos que existe un aumento del tamano hemimandibular y de la ATM del lado hiperplasico, aunque investigaciones con mayor numero de pacientes son necesarios para establecer una tendencia mas exacta.

Self-medication Among Myofascial Pain Patients: A Preliminary Study

Background: Self-medication has been reported as an option which people choose to relieve the suffering of conditions that cause pain, however, this could delay the correct diagnosis and therapy. Objective: The aim of the present study was to determine the prevalence of self-medication among patients with Temporomandibular Disorder (TMD), and to analyze correlations with the severity of the disease. Methods: A prospective study was conducted with patients who had been diagnosed with TMD. The patients were submitted to anamnesis and a physical examination. This research also used the Fonseca`s Anamnestic Index (FAI) and a questionnaire that was developed specifically for this study, containing questions related to the first health professional contacted and self-medication. The data were analyzed using comparative and correlative analysis (Version 18.0 of SPSS software), with the level of significance set at p<0.05. Results: Thirty-four patients were included, with a prevalence of females (91.2%) and a mean age of 39.76 years. Half of the patients claimed to have chosen their own medications at time, especially analgesics. Sodium dipyrone was used by 12 of the participants. Dentists were the most commonly contacted health professionals (55.5%). No correlation was found between self-medication and the severity of TMD according to the FAI. Furthermore, the time period between the onset of symptoms and the first consultation was not affected by self-medication. Conclusion: Self-medication seems to be highly prevalent among patients with TMD, although this practice does not seem to alter the severity of the disease.

Retention and Mechanical Behavior of Attachment Systems for Implant-Retained Auricular Prostheses

Objective: Auricular prostheses are artificial substitutes for facial defects. The retention of these has often been a problem. This study aimed to evaluate the mechanical behavior of 3 retained auricular prosthetic connections when submitted to a mechanical cycling test. Materials and Methods: Twelve samples with installed implants were obtained and divided into 3 groups according to their retention system with 4 samples in each group. I: bar-clip system; II: magnet system; and III: ball/o-ring system. Each of samples was submitted to the pull-out test during 3240 cycles (f = 0.5 Hz) to determine its tensile strength. The mechanical cycling test was performed using the servo-hydraulic machine MTS 810-Flex Test 40 (Eden Prairie, MN) that had a 2.5 mm shift at a 10 mm/s velocity. The retaining strength for each of the samples was obtained at 7 intervals. Results: The tensile strength for the group retained by the bar-clip system (29.60 N) was higher with statistically significant difference (P < 0.05) when compared with the group retained by the ball/o-ring system (9.41 N) and magnets system (8.61 N) for all periods assessed. The ball/o-ring system showed loss of retention during the fatigue test (Kruskal–Wallis, chi-squared = 17.28; P < 0.01). Conclusions: The evaluated systems showed a tensile strength compatible with the clinical use and no fractures of the components were observed.

A Rare Case of Malignant Fibrous Histiocytoma (Undifferentiated High-Grade Pleomorphic Sarcoma) of Malar Region

Malignant fibrous histiocytoma is a sarcoma with rare occurrence in the oral and maxillofacial region; surgery is the most reliable treatment. Inadequate resection of the sarcoma on the oral and maxillofacial region is associated with a high incidence of local recurrence and a poor prognosis. Only few patients of malignant fibrous histiocytoma of the malar region have been previously reported in the literature. The authors report a new patient of malignant fibrous histiocytoma on the right malar region that treated a complete tumor surgical excision without lymph node dissection. Examination of the resected specimen revealed that the tumor was completely removed.Malignant fibrous histiocytoma is a sarcoma with rare occurrence in the oral and maxillofacial region; surgery is the most reliable treatment. Inadequate resection of the sarcoma on the oral and maxillofacial region is associated with a high incidence of local recurrence and a poor prognosis. Only few patients of malignant fibrous histiocytoma of the malar region have been previously reported in the literature. The authors report a new patient of malignant fibrous histiocytoma on the right malar region that treated a complete tumor surgical excision without lymph node dissection. Examination of the resected specimen revealed that the tumor was completely removed.