Gabriela Granja Porto

Treatment of Chronic Mandibular Dislocations: A Comparison Between Eminectomy and Miniplates

PURPOSE Temporomandibular joint dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. The purpose of this study was to compare 2 types of treatment for chronic mandibular dislocations, eminectomy and miniplates, evaluate the results of these surgeries, and make a critical review of the literature. PATIENTS AND METHODS The sample was obtained from the records of Oswaldo Cruz Hospital (Recife, Brazil) and comprised cases submitted to chronic mandibular dislocation treatment by eminectomy and by use of miniplates between 2000 and 2006. Preoperative and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of dislocations, recurrence rate, and presence of facial nerve paralysis. RESULTS After eminectomy, the mean maximal mouth opening was 48.4 +/- 8.5 mm preoperatively and 41.3 +/- 5.0 mm postoperatively. After the use of miniplates, it was 42.75 +/- 11.53 and 45.62 +/- 8.52 mm, respectively. There was no facial nerve paralysis after either treatment. Recurrence occurred with miniplates (11.11%) but not with eminectomy. CONCLUSION Eminectomy had less chance of recurrence without creating articular damage, and with miniplates, the chance of recurrence increased because there is always the possibility of the miniplate fracturing.

Comparison between human and rat TMJ: anatomic and histopathologic features

PURPOSE To describe and evaluate normal rat temporomandibular joints from anatomic and histopathologic point of view and make a comparison between this joint in rats and humans. METHODS Twelve male adult Wistar rats (12 same side joints) were used in this procedure. The following anatomical structures were histologically evaluated in a qualitative fashion: condyle, disc, temporal bone, retrodiscal tissue and synovia. The macroscopical and microscopic study of the human TMJ was based on the current literature. RESULTS The TMJ is surrounded by a thin capsule, consisting of fibrous tissue, and a synovial lining. The mandibular angle has a prominent shape. The glenoid fossa is flat, with no eminences. Histologically, the TMJ is composed of different tissues that comprise the mandibular head, mandibular fossa and fibrocartilaginous disc. A layer of hyaline cartilage covers the articulating cortical condyle and temporal bone. CONCLUSION Morphologically and histologically, the articular structure of rats is, on the whole, similar to that of humans. In these animals there is no articular eminence.

Physical therapy and anesthetic blockage for treating temporomandibular disorders: A clinical trial

Purpose: the aim of this study was to evaluate the use of physical therapy and anesthetic blockage of the auriculotemporal nerve as a treatment for temporomandibular joint disorders. Methods: the sample comprised of twenty patients with a diagnosis of disc displacement with/ without reduction and arthralgia according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD Axis I Group IIa, IIb and IIIa). Ten patients (group 1) underwent a cycle of eight anesthetic blockages of the auriculotemporal nerve with injections (1 per week) of 1 ml of bupivacaine 0.5% without vasoconstrictor for 8 weeks. The other 10 patients (group 2) received anesthetic blockage and physical therapy (massage and muscular stretching exercises). After the end of treatment all patients were evaluated at baseline, 1st week, 4th week and 2 months. The t-Student and F (ANOVA) tests were used for statistical analysis, with a significance rate of 5%. Results: there was a significant difference when both groups were compared according to VAS score (p=0.027). There was no significant difference for the other variables: MMO and jaw protrusion. Conclusion: the anesthetic blockage and physical therapy, when used together, are effective in the reduction of pain in patients with TMD. Key words:Temporomandibular joint disorders, physical therapy, physiotherapy and nerve block, local anesthetic, bupivacaine.

Expansão rápida da maxila cirurgicamente assistida: estudo preliminar

A expansao rapida da maxila cirurgicamente assistida e eficiente para o tratamento de deficiencias transversais da maxila em pacientes adultos. OBJETIVO: Estudar duas tecnicas de expansao rapida da maxila cirurgicamente assistida - com separacao ou nao dos processos pterigoides. MATERIAL E METODOS: O estudo de coorte contemporânea longitudinal foi composto de 10 pacientes, com 18-40 anos de idade e com discrepância transversa da maxila de mais de 4mm. Dois grupos foram estabelecidos de forma aleatoria, cinco pacientes em cada grupo, de acordo com a separacao ou nao dos processos pterigoides. Alem disso, em ambos os grupos, foram realizadas as osteotomias dos pilares zigomaticos e da sutura intermaxilar. A discrepância transversal foi medida em modelos de estudo, uma radiografia cefalometrica postero-anterior avaliou os planos zigomaticos superior e inferior e a distância inter-tuberes e uma radiografia oclusal avaliou a disjuncao intermaxilar no periodo pre-operatorio e 30 dias de pos-operatorio. Um periodo de 7 dias foi aguardado apos as osteotomias, antes de iniciar a expansao de um quarto de volta por dia. RESULTADOS: Nao houve diferenca estatistica entre as medidas pre e pos-operatorias. CONCLUSAO: Ha poucos estudos controlados na literatura comparando as duas tecnicas de expansao cirurgica da maxila. Estudos com amostras maiores devem ser realizados.

Burnout syndrome in oral and maxillofacial surgeons: a critical analysis

The aim of this study was to determine the prevalence of burnout syndrome among Brazilian oral and maxillofacial surgeons and its relationship with socio-demographic, clinical, and habit variables. The sample of this study comprised 116 surgeons. The syndrome was quantified using the Maslach Burnout Inventory (General Survey), which defines burnout as the triad of high emotional exhaustion, high depersonalization, and low personal accomplishment. The criteria of Grunfeld et al. were used to evaluate the presence of the syndrome (17.2%). No significant differences between the surgeons diagnosed with and without the syndrome were observed according to age (P=0.804), sex (P=0.197), marital status (P=0.238), number of children (P=0.336), years of professional experience (P=0.102), patients attended per day (P=0.735), hours worked per week (P=0.350), use of alcohol (P=0.148), sports practice (P=0.243), hobbies (P=0.161), or vacation period per year (P=0.215). Significant differences occurred in the variables sex in the emotional exhaustion subscale (P=0.002) and use or not of alcohol in the personal accomplishment subscale (P=0.035). Burnout syndrome among Brazilian surgeons is average, showing a low personal accomplishment.

Adenomatoid odontogenic tumor

The adenomatoid odontogenic tumor (AOT) is usually an asymptomatic slow growth lesion. When grown, one can palpate a hard and large lesion. It is common for the tumor to cause shifting of neighboring teeth because tumor expansion is more common than teeth root resorption. Radiographically, there is a unilocular mass involving an unerupted tooth, sometimes opaque in the center and sclerotic in the periphery. Considering it to be an encapsulated tumor, treatment of choice is enucleation. This paper describes three cases of these tumors and their symptoms, their radiographic characteristics and anatomic findings.

Temporo mandibular joint ankylosis

UNLABELLED Ankylosis may be defined as joint surfaces fusion. The treatment of temporomandibular joint ankylosis poses a significant challenge because of the high recurrence rate. AIM The aim of this study is to report six cases treated by joint reconstruction, evaluate the results of these surgeries and review the literature. METHODS The sample in this retrospective study was obtained from the records of the university hospital, patients who had to undergo ankylosis treatment by alloplastic or autogenous graft between March 2001 and October 2005. Pre - and post-operative assessment included a throughout history and physical examination to determine the cause of ankylosis, the Maximum mouth opening (MMO), etiology and type of ankylosis, recurrence rate and presence of facial nerve paralysis. RESULTS The mean MMO in the pre-operative period was 9.6 mm (0 mm to 17 mm) and in the post-operative period it was of 31.33 mm (14 mm to 41 mm), there was no facial nerve paralysis and there was recurrence in just one case. CONCLUSION The joint reconstruction with alloplastic or autogenous grafts for the ankylosis treatment proved to be efficient in relation to the post-operative MMO, recurrence and joint function.

Evaluation of the nasal shape after orthognathic surgery

INTRODUCTION Patients with dentofacial deformities may benefit from orthognathic surgery in the maxilla. Maxillary osteotomy may include procedures in the bone, cartilaginous, and soft tissues of the nose, leading to shape alterations. OBJECTIVE To evaluate the anatomic alterations of the nasal region in patients undergoing a Le Fort I osteotomy for advancement or superior impaction. METHODS This is a clinical prospective study. Twenty-one patients were evaluated during the pre- and postoperative periods. The positioning of the nasal tip and the modification of the nasal base were evaluated. RESULTS The results showed that the nasal tip was superiorly positioned in 85% of the cases, advanced in 80%, rotated in 80%, and there was a wide nasal base in 95%, resulting in esthetic improvement. CONCLUSIONS Surgeries of maxillary advancement and superior reposition tend to cause elevation and advancement of the nasal tip, as well as enlargement of the nasal base.

Treatment of chronic mandibular dislocations using a new miniplate

Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. The aim of this study was to describe a modified miniplate designed for treating chronic mandibular dislocations and evaluate the results of its placement in one patient, who was followed for 18 months. The treatment of chronic mandibular dislocation using this modified miniplate was shown to be efficient in relation to the postoperative maximal mouth opening, recurrence and articular function.

Anquilose da articulação têmporo-mandibular

Ankylosis may be defined as joint surfaces fusion. The treatment of temporomandibular joint ankylosis poses a significant challenge because of the high recurrence rate. AIM: The aim of this study is to report six cases treated by joint reconstruction, evaluate the results of these surgeries and review the literature. METHODS: The sample in this retrospective study was obtained from the records of the university hospital, patients who had to undergo ankylosis treatment by alloplastic or autogenous graft between March 2001 and October 2005. Pre - and post-operative assessment included a throughout history and physical examination to determine the cause of ankylosis, the Maximum mouth opening (MMO), etiology and type of ankylosis, recurrence rate and presence of facial nerve paralysis. RESULTS: The mean MMO in the pre-operative period was 9.6 mm (0 mm to 17 mm) and in the post-operative period it was of 31.33 mm (14 mm to 41 mm), there was no facial nerve paralysis and there was recurrence in just one case. CONCLUSION: The joint reconstruction with alloplastic or autogenous grafts for the ankylosis treatment proved to be efficient in relation to the post-operative MMO, recurrence and joint function.