José Rodrigues Laureano Filho

Oral and maxillofacial myiasis: a case series and literature review

OBJECTIVE The aim of this study was to describe a series of 10 cases of oral-maxillofacial myiasis, discussing its main features, demographic distribution, and treatment aspects. STUDY DESIGN A retrospective study was carried out involving male and female patients of any age with oral-maxillofacial myiasis. The sample was determined by spontaneous demand at the emergency ward of a hospital between January 2005 and January 2011 (6 years). After treatment of each case, data were gathered on the presence of associated systemic disorders, time elapsed since onset of the disease, and treatment established. A review of the literature on this topic was also carried out. RESULTS The sample was made up of 10 patients, all treated with surgical debridement whether or not associated with the use of oral ivermectin. Mean time elapsed since the onset of the disease ranged from 4 to 36 months. The middle third of the face was the most frequently affected region (7 cases). Oral-maxillofacial myiasis predominantly affected the male gender (70%). CONCLUSIONS Oral-maxillofacial myiasis affects individuals with poor hygiene and neurologic and/or psychologic alterations. It occurs predominantly in countries near the tropics. The treatment of choice is surgical debridement.

Comparative analysis of preemptive analgesic effect of tramadol chlorhydrate and nimesulide following third molar surgery

The aim of this prospective, randomized, controlled, paired trial was to perform a comparative analysis of the preemptive analgesic effect of nimesulide and tramadol chlorhydrate during third molar surgery. The study was carried out between March and November 2009, involving 94 operations in 47 male and female patients with bilateral impacted lower third molars in comparable positions. The sample was divided into two groups. Group A received an oral dose of 100 mg of nimesulide 1 h prior to surgery. Group B received an oral dose of 100 mg of tramadol chlorhydrate 1 h prior to surgery. The following aspects were evaluated in the postoperative period: adverse effects of the drugs; amount of rescue medication used (acetaminophen 750 mg); and pain 5, 6, 24, 36, 48, 60, 72 and 84 h after surgery using a visual analog pain scale. Peak pain occurred 5 h after surgery in both groups, with a mean pain score of 2.3 in Group A and 3.0 in Group B; this difference did not achieve statistical significance (p > 0.141). Based on the sample studied, nimesulide and tramadol chlorhydrate demonstrate similar preemptive analgesic effects when used in lower third molar surgeries.

Comparative Finite Element Analysis of the Biomechanical Stability of 2.0 Fixation Plates in Atrophic Mandibular Fractures

PURPOSE The objective of the present study was to conduct a computational, laboratory-based comparison of the biomechanical stability of 2.0 fixation locking plates with different profiles in Class III atrophic mandibular fractures using 3-dimensional finite element analysis. MATERIALS AND METHODS Three-dimensional finite element models simulating Class III atrophic mandibular fractures were constructed. The models were divided into 4 groups according to plate thickness (1.0, 1.5, 2.0, and 2.5 mm). Fractures were simulated in left mandibular bodies, and 3 locking screws were used on each side of each fracture for fixation. Bite forces of approximately 63 N were simulated in the incisor and molar regions of the mandibles in finite element models. RESULTS The level of compressive strain on the bone around the screw was within the physiological limit. No significant difference was observed in the displacement of bone segments in the fracture region. Von Mises stress was higher during simulated bites in the molar region for plates with thicknesses of 1.0 mm. Plate tension values were below the level required for permanent deformation or fracture in all models. The 2.5-mm-thick plate presented better biomechanical performance than all other plates. The 2.0-mm-thick plate also showed satisfactory results and adequate safety limits. CONCLUSION Large-profile (2.0-mm-thick) locking plates showed better biomechanical performance than did 1.0- and 1.5-mm-thick plates and can be considered an alternative reconstruction plate for the treatment of Class III atrophic mandibular fractures.

Obstructive Sleep Apnea–Hypopnea Syndrome—The Role of Bariatric and Maxillofacial Surgeries

Obstructive sleep apnea–hypopnea syndrome (OSAHS) is a complex disease with multifactorial etiology. It is marked by the occurrence of apnea and hypopnea events caused by repeated obstructions of the upper airways. OSAHS is strongly associated with obesity, and the prevalence of this disease in morbidly obese patients is very high. Nevertheless, not all patients with OSAHS are obese, and for this reason, there may be other anatomical predispositions to airway collapse. In obese patients, fatty deposition in the parapharyngeal region results in airway reduction and predisposes to airway collapse, worsened by neurologic loss of the normal dilator muscle tone of the neck. However, in nonobese patients, specific craniofacial characteristics such as posterior air pharyngeal space, tongue length, hyoid position, and maxillomandibular deficiencies may predispose some people to develop OSAHS. Treatment strategies for OSAHS patients vary from clinical treatment with continuous positive airway pressure, oral appliances, or medications for mild and moderate OSAHS patients, bariatric surgery for severe obese OSAHS patients to maxillomandibular advancement for obese or nonobese OSAHS patients.

Fracture of the coronoid and pterygoid processes by firearms: case report

A rare case of fracture of the coronoid and the pterygoid process caused by firearms is described. A 28-year-old male was hit by a bullet in the face, resulting in restricted mouth opening, difficulty in chewing and pain when opening the mouth. Clinical examination revealed a perforating wound in the right parotid region and a similar wound on the left side of the same region. A CT scan showed comminuted fracture of the left coronoid process and bilateral comminuted fracture of the pterygoid processes. Treatment was conservative, speech therapy was conducted and it was successful. Details of the clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.

Histological comparison of demineralized bone matrix and the Ricinus communis polymer on bone regeneration

AIM The aim of the present study is to make a histologic analysis the effects of a human demineralized bone matrix and a polyurethane resin derived from the Ricinus communis, on bone regeneration process. MATERIALS AND METHODS For this, 24 rabbits were submitted to two surgical calvaria bone defects, one on the right and another on the left side of the parietal suture. The animals were divided in two groups. In group I the experimental defect (right side) was treated with a human demineralized bone matrix, while in group II the experimental cavity was treated with the polyurethane resin derived from Ricinus communis. The control defects were filled with the animals own blood. The animals were slaughtered after subsequent periods of 04, 07 and 15 weeks. RESULTS The histological analysis revealed that all groups (control and experiment), presented increased bone regeneration with time, but this repair was faster in the control group, even showing important decrease in defect thickness. CONCLUSION Both materials proved to be biologically compatible, however polyurethane was more slowly resorbed presented considerable better results when compared with demineralized bone matrix.

Improvement in respiration and craniofacial changes associated with weight loss after bariatric surgery.

PURPOSE To study weight loss, craniofacial changes, and respiratory quality among obese patients before and after bariatric surgery. MATERIAL AND METHODS The obese group comprised 17 male and female patients aged between 18 and 60 years with body mass index (BMI) ≥ 40 kg/m(2) who were scheduled to undergo bariatric surgery. All patients were evaluated in the preoperative period and at least 4 months following surgery by means of clinical, physical, anthropometric, facial, nasal, oral, and oropharyngeal examinations as well as radiographic examinations of the facial profile with individual cephalometric analysis. Patients also completed the Nasal Obstruction Symptom Evaluation scale. The control group underwent the same examinations and included 10 male and female volunteers with BMI between 18 and 30 kg/m(2), good dental occlusion, harmonious facial features, and no history of respiratory or sleep disorders. RESULTS There were significant reductions in weight, BMI, and neck circumference as well as an improvement in Nasal Obstruction Symptom Evaluation scores in the obese group after bariatric surgery (P < .05). There was a reduction in craniocervical length, increase in velopharyngeal air space, and reduction in the distance between the hyoid bone and mentum following weight loss. The Mallampati Scale revealed a significant inversion of palate position categories between evaluations. CONCLUSIONS There was improvement in respiratory quality and craniofacial changes caused by weight loss, especially in soft tissues around the upper air space, as well as craniocervical length and position of the hyoid bone.

Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: Results of a multicentre study

BACKGROUND This multicentre study aimed to investigate long-term radiographic and functional results following the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach. METHODS Twenty-nine patients with a total of 32 condylar fractures were evaluated. The patients were investigated prospectively based on the following variables: age, sex, aetiology, side, location and classification of the fracture, degree of displacement, associated fractures, surgical approach, oral health status, type of osteosynthesis plate, duration of surgery, mouth-opening, complications, and duration of follow-up. RESULTS The fractures were classified as subcondylar (n = 25) or condylar neck (n = 7). Mean patient age was 36.38 ± 16.60 years. The median duration of postoperative follow-up was 24.39 ± 13.94 months. No joint noise, weakness of the facial nerve, joint pain, or muscle pain was observed. An additional retromandibular approach was necessary to enable the treatment of one subcondylar fracture with medial displacement. CONCLUSION Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results with the advantages of the absence of visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture.

Horizontal maxillary osteotomy approach for resection of juvenile nasopharyngeal angiofibroma.

Juvenile angiofibroma is a benign fibroangiomatous tumor of relatively rare occurrence, developing most frequently in male adolescents. It has local characteristics of aggressiveness and expansion. The treatment of choice is surgical excision. In this article, the advantages and disadvantages of the surgical technique using the Le Fort I osteotomy are described, and the literature correlated with 2 case reports.

Foreign body ingestion during dental implant procedures.

Two cases of swallowing of foreign material related to dental implants during dental practice are described. A conservative approach by clinical-radiographic follow-up was performed in both cases; however, one of the patients required colonoscopy under general anesthesia for the removal of the impacted foreign body from the intestinal region. These complications not only have associated economic cost but also carry the risk of malpractice litigation against the professional; thus, the surgeon was responsible for all the costs of hospital and surgery management of this case. Details of the clinical signs, radiographic examinations, type of treatment, and follow-up are presented.