João Gualberto de Cerqueira Luz

Healing of the displaced condylar process fracture: an experimental study

Healing of the displaced condylar process fracture was analysed by means of an experimental model using adults rats. Displaced fractures of the right condylar process were achieved under general anaesthesia. Histological data initially demonstrated neutrophilic exudation along the articular capsule and adjacent muscle fibres. One week later, devitalized bone areas at the fracture site, as well as proliferation of cartilaginous and osseous tissue were observed. Subsequently, exuberant callus formation and a decrease in the inflammatory process occurred. After 3 months, the condylar process presented characteristics of normality and was centralized into the temporal fossa, with interposition of the articular disc. These results indicate that experimentally induced, displaced condylar process fractures heal by callus formation with simultaneous repositioning of the condyle.

Prevalência das maloclusões e dos índices anamnésicos e clínicos, em pacientes com disfunção da articulação temporomandibular

The authors analyzed the frequency of malocclusion, Helkimo (1974) anamnestic and clinical dysfunction indexes in patients with temporomandibular joint dysfunction and their possible correlation. One hundred and ten patients with these conditions were evaluated independent of age and gender. Signs and symptoms were evaluated, indicating levels of Helkimo indexes, Angle classification, over-jet, over-bite, cross-bite and missing teeth. The authors concluded that there was a high incidence of Angle class II and overjet larger than two milimeters. Among the Helkimo indexes there was a slight predominance of Anamnesthic Index AiII (symptoms of severe dysfunction) and Clinical Index level DiI (mild dysfunction). A statistically significant relationship was found between the Clinical Index and the Angle classification as between Anamnestic Index and overbite.

Evaluation of surgical retreatment of mandibular fractures.

INTRODUCTION Mandibular fractures are frequent, and treatment for these fractures involves rigid fixation. Complications can occur after treatment and may require a new surgical procedure; however, there are limited studies evaluating surgical retreatment. AIM The purpose of this retrospective study was to evaluate the characteristics and the types of treatment carried out in patients requiring surgical retreatment of mandibular fractures. MATERIALS AND METHODS From all patients with mandibular fractures treated by rigid internal fixation at a trauma hospital during a 7-year-period, 20 patients (4.7% of the cases) required a second surgery. RESULTS The most common complaints were pain, infection with the presence of fistula, and abnormal mobility. There was a predominance of Staphylococcus aureus in the bacterial culture. The most frequent radiographic images were diffuse bone resorption, loosening of screws, and a visible fracture line. The diagnoses were nonunion in 10 (50%) cases, soft tissue infection associated with screw loosening or plate exposure in 7 (35%) cases, osteomyelitis in 2 (10%) cases, and malunion in 1 (5%) case. Seven cases of nonunion presented with fistula, and four of these patients had bone sequestration. The required procedures included new fixation in 6 (30%) patients, removal of bone sequestration and new fixation in 4 (20%) patients, surgical exploration and removal of fixation material in 7 (35%) patients, removal of bone sequestration in 2 (10%) patients, and refracture in 1 (5%) patient. CONCLUSION It was concluded that most cases requiring surgical retreatment of mandibular fractures comprised nonunion or soft tissue infection associated with screw loosening or plate exposure. Consequently, the main procedures needed were new fixation or surgical exploration with the removal of fixation material.

Study of the inflammatory process induced by injection of carrageenan or formalin in the rat temporomandibular joint

The aim of this study was to evaluate the effects of the injection of two phlogistic agents, carrageenan and formalin, in the rat TMJ, and the inflammatory process induced by these substances. In this study, a total of 45 adult rats were distributed in two experimental groups and a control group. The animals were sacrificed after three hours, 24 hours, three days, seven days, and 15 days after a single injection of each substance. Histological data initially demonstrated an inflammatory process represented by acute infiltration, which later became mixed, and finally chronic in both experimental groups. Hyperplasia of the synovial membrane was observed after three days, being intense at seven days, and present after 15 days only in the formalin group. Local saline injection in the control group caused no inflammatory reaction. It was concluded that a single local injection of carrageenan or formalin was enough to induce inflammatory reaction in the TMJ and periarticular soft tissues, and that the resulting processes were similar, but more persistent in the formalin group.

Avaliação clínica dos procedimentos de expansão cirurgicamente assistida da maxila (ECAM)

AIM: clinical evaluation of surgically assisted maxillary expansion. METHODS: the present study evaluated 10 patients who underwent surgically assisted maxillary expansion. The efficacy of the surgical procedure helping transverse maxillary expansion given by the Hyrax, expansion stability, post-operatory discomfort during the activation of the device, the quantity and quality of the expansion achieved, the age of the patients, nasal base alteration, and nasal breathing were analyzed. RESULTS AND CONCLUSIONS: from the results, it was possible to observe that surgically assisted maxillary expansion is an efficient and stable treatment, which offers functional changes and minimal aesthetic alterations.

Análise da sintomatologia em pacientes com disfunções intra-articulares da articulação temporomandibular

The study analyzed the symptomatology in patients with intra-articular disorders of the temporomandibular joint. The most frequent complaint was pain in the preauricular region (40.7%). Articular pain (63.2%) and articular sounds (83.3%) were the most common findings during clinical examination. Muscular pain occurred particularly in the medial and lateral pterygoid muscles and at the insertion of the temporalis muscle. The most frequent articular sound was clicking (66.6%). There was a decrease in extent of protrusion among the mandibular border positions.

Achados radiográficos, sinais e sintomas nas disfunções da articulação temporomandibular

A study of radiographic findings and of signs and symptoms in temporomandibular joint (TMJ) dysfunction was made. Through TMJ transcranial radiographs, the presence of degenerative alterations as well as the estimate of condylar excursion were examined. Data such as chief complaint, pattern of occurrence of pain, signs of muscular pain, and articular signs of dysfunction were evaluated through clinical examination. The most frequent radiographic findings were the degenerative alterations. The most frequent ones were, in decreasing order, flattening, eburnation and osteophyte. Degenerative alterations were more frequent in the condyle than in the articular eminence. The estimates of condylar excursion were, in decreasing order, normo, hyper and hypoexcursion. No relationship between radiographic findings and specific signs or symptoms was observed

Comparative study of two autogenous graft techniques using piezosurgery for sinus lifting

PURPOSE Maxillary sinus lifting is a technique, in which, a possible complication is sinus membrane perforation. The aim of this study was to compare two techniques using ultrasound surgery to perform autogenous graft for maxillary sinus lifting. METHODS Ten rabbits were used in the study, one of them did not undergo surgery. The other nine rabbits had their maxillary sinuses filled with autogenous bone grafts collected from the external skull diploe in particulate form on the right side, and shaved on the left side, both with ultrasonic device. Data on bone density in left and right maxillary sinus, obtained by computed tomography in transverse and longitudinal sections, recorded 90 days after the grafts, were statistically compared. RESULTS There were no statistically significant differences between the two techniques that used shaved and particulate bone collected by means of ultrasonic device from rabbit skulls. CONCLUSION Assessment of operative procedures led to the conclusion that piezoelectric ultrasound was shown to be a safe tool in the surgical approach to the maxillary sinus of rabbits, allowing sinus membrane integrity to be maintained during surgical procedures.

Conseqüências da remoção do côndilo mandibular no crescimento da maxila e da mandíbula. Estudo experimental em ratos

Mandibular growth disturbances due to trauma to the temporomandibular joint are frequent. However, their mechanism are not completely understood. Thus, through an experimental model, it was analyzed the consequences of removal of the mandibular condyle in the growth of the maxilla and mandible. In this study 40 one-month-old Rattus norvegicus, inbred Wistar, were utilized, distributed into three groups: experimental, sham-operated and control. Under general anesthesia, in the first group the right mandibular condyle was removed, in the second a surgical access was made, and in the third no procedure was made. The animals were sacrificed with three months of age, and submitted to axial and rostro-caudal radiographs of the fixed skulls. Thus, dissection was made, and axial projection of the dried skull and a lateral projection of the hemimandibles, were obtained. With these, cephalometric mensurations were made through a computer system. The statistical analyses showed a highly significant difference for the mandibular midline deviation and to the mandibular length in the experimental group, as well as significant difference for the mandibular ramus heigh and maxillary length. It was concluded that condylectomy in the growing period promoted a significant asymmetry in the mandible, also with significant alterations in the maxillary length.

Characteristics and management of patients requiring hospitalization for treatment of odontogenic infections.

Abstract Odontogenic infections usually respond well to outpatient care; however, these can be very complicated and demand hospitalization. The aim of this study was to assess retrospectively the characteristics and medical management of patients needing hospitalization for the treatment of odontogenic infections. The personal data, symptoms presented, and therapeutic procedures adopted were analyzed. The predominant age group was from 0 to 10 years (30%), and a sex relation of 1:1 was found, but there was no significant difference (P = 0.337). The most frequent diagnosis was of dentoalveolar abscess (86.3%). Pain (47.1%) was the prevailing reason for hospitalization, with pulpal necrosis (67.5%) as the main cause. There was a prevalence of involvement of the lower permanent teeth (41.4%) and lower deciduous teeth (23%). The prevalent clinical aspect was submandibular or facial swelling (61.4%). The most administered antibiotic was penicillin G associated with metronidazole (25.3%). Most cases (58.7%) presented regression with antibiotic therapy, and in some cases, surgical drainage was necessary (18.7%). One case of Ludwig angina resulted in death. The mean length of hospital stay was 4.4 days, being higher in the cases of Ludwig angina. It was concluded that most cases of odontogenic infections requiring hospitalization were of dentoalveolar abscess occurring in young people of both sexes, associated to the lower permanent molar teeth, presenting with swelling, with regression of the symptoms after antibiotic therapy and hospitalization for some days, with some of the cases requiring drainage.