Juliana Gonçalves Göelzer

Use of autologous fat graft for correction of facial asymmetry stemming from Parry-Romberg syndrome.

Facial hemiatrophy is a typical manifestation of Parry-Romberg syndrome, characterized by a slow progressive atrophy that appears in early stages of life, primarily affecting the subcutaneous tissue and subjacent fat on 1 side of the face. We describe the case of a 42-year-old female patient with stabilized moderate facial hemiatrophy on the left side of the face, successfully treated with a 2-stage autologous fat transplant and the use of subcutaneous tunnels among the musculature for the placement of the graft. We also describe the principal forms of correcting facial asymmetry in patients with Parry-Romberg syndrome and demonstrate that an autologous fat graft provides good results in the correction of this deformity, with improved esthetics and patient satisfaction.

Embolization of pseudoaneurysm of the internal maxillary artery after orthognathic surgery.

In orthognathic surgery, Le Fort I osteotomy is one of the most often used methods for the correction of dental-facial deformities and is considered technically safe. However, this procedure may lead to diverse complications, including uncommon vascular complications. A clinical case is described of late development of pseudoaneurysm in one of the branches of the maxillary artery in a 20-year-old patient who had undergone Le Fort I osteotomy, bilateral sagittal osteotomy of mandibular branch, and mentoplasty and subsequently treated with embolization. The main forms of treating vascular injuries are reviewed, and embolization is demonstrated to be a technically safe procedure with few complications.

Assessing change in quality of life using the Oral Health Impact Profile (OHIP) in patients with different dentofacial deformities undergoing orthognathic surgery: a before and after comparison

Dentofacial deformities and their treatment have physical and psychological repercussions on quality of life (QOL). Seventy-four patients were evaluated preoperatively (T0) and at 4-6 months postoperatively (T1). Oral health-related QOL was assessed using the short form of the Oral Health Impact Profile (OHIP-14). There was a statistically significant reduction in the average overall OHIP-14 score between T0 (13.23±6.45) and T1 (3.26±4.19). In addition, there were significant decreases in all seven OHIP-14 domains. Class III patients benefited in all domains evaluated, while a significant improvement was seen only in the psychological disability domain for class I patients. Class II patients showed a significant benefit in all domains except the domain of functional limitation. With regard to the total sample (n=74) and class III patients (n=58), correlations between domains were identified for all domains. The same correlation was not identified for class I (n=5) and II (n=11) patients. The entire sample and class III patients showed significant improvements in OHIP-14 scores for all degrees of postoperative sensory disturbance in the upper and lower lips, except for patients with degree 5 (extreme) disturbance of the upper lip. Orthognathic surgical treatment had a positive impact on oral health-related QOL in the patients evaluated.

Evaluation of tissue response and genotoxicity of poly(L/D-lactic acid) disks implanted in rat calvarium

The aim of the present study was to evaluate local and cytotoxicity systemic tissue reaction in the skull of rats using the implantation of disks of poly (lactic L/D-acid) and evaluate its genotoxicity. 25 males Wistar rats were used, 20 animals underwent surgical procedures and had the discs implanted in the parietal bone, and 5 animals received postoperative medication in the same way, serving as a control group for genotoxicity. The results were subjected to statistical evaluation by analysis of variance (ANOVA). In histological evaluation, between periods of 90 and 120 days in the control group, a new formation at the edges of the defect was noticed. In the experimental group, there was new bone formation at the edges of the defect, migrating below the site occupied by the disk, an absence of inflammatory infiltrate. Regarding the evaluation of genotoxicity, a significant reduction in the frequency of polychromatic erythrocytes in relation to negative control or significant increase in the polychromatic erythrocytes with micronuclei was not detected. So, the material used in this study is biocompatible and well tolerated by the tissues studied, and found to be negative for chromosomal mutagenicity.

Implant handpiece with adapted drills in orthognathic surgery: preventing facial scars.

The attachment of bilateral sagittal-split osteotomy of the mandibular ramus with bicortical screws or the combination of miniplates and a bicortical screw is complicated through the intraoral approach because of the angle required for insertion of screws, so it is necessary to use a trocater. This article aimed to report a technique developed and used in 60 patients, wherein an implant handpiece with adapted drills was used in the intraoral attachment. The setting was performed intraorally to prevent scarring and extraoral facial nerve damage, which may be caused by extraoral and transbuccal approaches routinely performed when using the trocater. The versatility of the handpiece implant allows for the insertion of monocortical and bicortical screws and rigid internal fixation of mandibular sagittal-split osteotomy, as well as surgical time reduction, decreasing postoperative morbidity.

Self-drilling and Self-tapping Screws: An Ultrastructural Study

Objective:The aim of the current study was to compare self-drilling and self-tapping screws with regard to bone contact and the production of bone debris using scanning electron microscopy. Materials and Methods:Three New Zealand rabbit calvariae were used. Self-tapping and self-drilling screws were inserted into the outer surface of the skull with and without saline solution irrigation. All screws were 5 mm in length and were inserted until their tips projected through the endosteal side. Sixteen screws were used-8 with a head diameter of 1.5 mm and 8 with 2.0 mm. All self-tapping screws were inserted through a drill bit hole (1.6 mm for 2.0-mm screws and 1.3 mm for 1.5-mm screws). Results:There was no damage to the screws after insertion. Bone damage occurred when irrigation was not used during the installment of the self-tapping screws. Bone debris formed during the installment of the self-drilling screws, which is considered beneficial. Conclusions:Because the insertion of self-drilling screws is performed with manual pressure, irrigation is not essential. Unlike the drilling that occurs with self-tapping screw, the bone debris formed with self-drilling screws is not the result of the heat generated, but rather the result of biologically active bone tissue capable of reacting with the screw and improving its performance. The animal model used proved highly appropriate for comparisons with human beings because the bone structures of the head have the same density and thickness.