Luciana Asprino

Incidence and patterns of mandibular condyle fractures

PURPOSE The aim of the present study was to retrospectively evaluate the epidemiologic characteristics of the prevalence, type, and treatment modalities of condylar fractures of the mandible. PATIENTS AND METHODS Data were collected from patients during an 8-year period (1999 to 2007). The data recorded included demographic data, etiology, diagnosis, type, dislocation, use of protective devices, state of the dentition, associated facial and general trauma, soft tissue lesions, treatment methods, and the interval between trauma and treatment. Data analysis included a descriptive analysis, chi(2) test, Fishers exact test, t test, and Kruskal-Wallis test. RESULTS During the 8-year period, 209 unilateral fractures and 54 bilateral fractures were treated, with a male/female ratio of 3.05:1 and a mean age of 28.4 years, for a total of 317 condylar fractures. Male gender was significantly associated with the presence of a condylar fracture (P < .05). The most common cause of condylar fractures was road traffic accidents (57.8%). Of the 317 fractures, 300 were classified as simple fractures, and 249 fractures were not displaced. Protective devices significantly decreased the number of condylar fractures occurring from road traffic accidents (P < .05). Symphysis fractures were significantly associated with both unilateral and bilateral fractures of the mandibular condyle (P < .05). Subcondylar displaced fractures were significantly associated with surgical treatment (P < .05). CONCLUSIONS Young adults were involved in most of the accidents. Road traffic accidents were the main cause of condylar fractures. The mandatory use of safety helmets and seatbelts and education of those using the road are essential to decrease the number of facial fractures.

Comparative Biomechanical and Photoelastic Evaluation of Different Fixation Techniques of Sagittal Split Ramus Osteotomy in Mandibular Advancement

PURPOSE The aim of the present study was to comparatively evaluate the resistance and tension areas created after load incidence in different varieties of sagittal split ramus osteotomy fixation techniques. MATERIALS AND METHODS Fifty synthetic polyurethane hemimandible replicas were subjected to linear loading tests to evaluate 4 fixation techniques of the sagittal split ramus osteotomy using 2-mm system plates and screws. The hemimandibles were fixed with three 90 degrees linear screws, three 60 degrees linear screws, 3 screws in a reversed L arrangement, and one titanium miniplate. Each group was subjected to linear loading using an Instron 4411 servohydraulic mechanical testing unit. The load peak value and peak displacement were measured. Another 4 hemimandible replicas were made of photoelastic resin and subjected to photoelastic analysis after linear loading with a 3-mm displacement. RESULTS The results of the mechanical tests showed statistically significant differences between the fixation groups. The linear 90 degrees fixation and the reversed L arrangement presented with greater loading resistance, followed by the linear 60 degrees fixation and miniplates. In relation to the stress distribution in the photoelastic analysis, the fringes were concentrated near the osteotomy and to the lower part of the mandible in the linear 90 degrees -screw system and reversed L arrangement. In the case of the linear 60 degrees screws, most fringes were located around and between the screws. In the case of the miniplates, the fringes were concentrated around the screws near the osteotomy and more distally. CONCLUSION Under the conditions tested, the linear 90 degrees and reversed L arrangements provided the most favorable behavior.

Pattern and treatment of facial trauma in pediatric and adolescent patients.

Pediatric maxillofacial trauma is a challenge for surgeons. There are no completely defined protocols, and sometimes, the initial management could be complex. The aim of this research was to perform a retrospective study to analyze the pattern and treatment of maxillofacial fractures in pediatric and adolescent patients. We reviewed the clinical records of 2986 patients treated at the Oral and Maxillofacial Surgery Division of Piracicaba Dental School between 1999 and 2008. Seven hundred fifty-seven patients were younger than 18 years and were divided into 3 groups according to age; the age and sex of the patients, etiology, fractures and associated injury, treatment, and complications were evaluated. Five hundred thirty boys (70.01%) and 227 girls (29.99%) were treated for injuries with major prevalence in adolescents. The most common injury causes were bicycle accidents (29.06%) and falls (28.40%). The mandible was the most fractured bone (44.8%); associated injuries were lacerations of the soft tissue and dental trauma. Surgical treatment was performed in 75 cases (30%) with minor complications (10% of surgical patients). We conclude that maxillofacial trauma in child is associated to fall and bicycle accidents; the mandible is more affected than other maxillofacial structures, and frequently, nonsurgical treatment is performed.

A Retrospective Analysis of Submental Intubation in Maxillofacial Trauma Patients

PURPOSE The aim of this study was to retrospectively evaluate the frequency, indications, and outcomes of airway management by submental intubation in maxillofacial trauma patients. PATIENTS AND METHODS Data were collected from patients during a 10-year period (1999-2009) from clinical notes and surgical records from each patient using a standardized data collection form that was specifically developed to investigate the epidemiological features of maxillofacial trauma. Data about anesthetic management were assessed. RESULTS During the study period, 3,149 patients, victims of facial trauma, were evaluated: 2,090 patients presented facial fractures; 674 were submitted to surgery under general anesthesia. There were 449 nasal intubations, 204 oral intubations, 6 tracheotomies, and 15 submental intubations. Submental intubation permitted reduction and fixation of all the fractures without the interference of the tube during surgical procedure in all of the patients. There were no intra- or postoperative complications. CONCLUSIONS Submental intubation is a simple, safe, with low morbidity technique for operative airway management in maxillofacial trauma patients when there are fractures involving the nasal region and concomitant dental occlusion disturbances.

Short-Term Outcome of Postoperative Patient Recovery Perception After Surgical Removal of Third Molars

PURPOSE The aim of this study was to depict surgical difficulties related to third molar removal with symptoms and signs presented by postoperative patients, identifying the most frequent occurrences and postoperative complications to prevent them or lessen their intensity. PATIENTS AND METHODS Data were acquired from questionnaires answered by patients and surgeons after surgery. A total of 128 patients participated in this study, answering questionnaires regarding postoperative signs/symptoms on a daily basis for a period of 7 days. Surgeons answered a questionnaire about the surgical procedure. RESULTS Main patient complaints were related to swelling and bad taste/breath, considering that the former was more intense during the first days after operation, and the latter lingered during the 7-day postoperative period of research. Pain was reportedly more intense during the first day after operation and presented continuous reduction throughout the recovery period. Mouth opening (trismus) and eating were the main activities affected by third molar extraction. A positive and significant relevance was only detected regarding surgical duration and difficulties encountered by the surgeon. There was no significant relation between the above-mentioned variables and average and peak pain during the postoperative period. CONCLUSION Results show that during the first postoperative week some patients nay experience quality reduction in their daily activities. Considering that objective (ie, surgery duration) and subjective (ie, difficulties during surgery) indicators were not related to postoperative pain, it was concluded that all patients are entitled to knowing that their lifestyles may be negatively affected by the after-effects, contributing to a better professional-patient relationship.

A Comparison of Motorcycle and Bicycle Accidents in Oral and Maxillofacial Trauma

PURPOSE The aim of this study was to present a large series of motorcycle- and bicycle-related traumas to the face in an attempt to identify the injury pattern in motorcyclists and bicyclists. PATIENTS AND METHODS Data were collected from patients during a 10-year period (1999 through 2009), which included demographic data, diagnosis of facial fractures, use of protective devices, dentoalveolar trauma, and facial soft tissue injuries. RESULTS There were 556 patients with bicycle accidents and 367 with motorcycle accidents. Men were involved in 79% (436) of bicycles accidents and 82% (299) of motorcycle accidents. Young male patients were more frequent in bicycle and motorcycle accidents. Two hundred fifty bicyclists showed 311 maxillofacial fractures. Two hundred twenty-one motorcyclists showed 338 maxillofacial fractures. Motorcycle accidents caused multiple fractures in more patients. Seventy-six percent of motorcyclists were using helmets at the time of the accidents, whereas 6% of cyclists were using helmets. Motorcyclists showed a larger number of lacerations, whereas bicyclists showed a larger number of abrasions. Avulsion was the most common dentoalveolar injury for these accident types. Hospital stays were 3.8 days for motorcyclists and 1.3 days for bicyclists. CONCLUSIONS The high-impact collisions typically observed in motorcycle accidents is directly related to larger percentages of soft tissue lacerations and facial fractures. The low-impact trauma that is observed in bicycle accidents is more commonly associated with soft tissue abrasion, hematoma, and dentoalveolar fractures. This stresses the need for compulsory legislation for helmet use with face-guards for cyclists and motorcyclists. It is important to take measures to alert the public regarding the severity of injuries likely to occur in bicycle- and motorcycle-related accidents and ways to prevent them.

A comparative evaluation of the hybrid technique for fixation of the sagittal split ramus osteotomy in mandibular advancement by mechanical, photoelastic, and finite element analysis

OBJECTIVE This study evaluated the mechanical characteristics and stress distribution of the hybrid technique fixation of the sagittal split ramus osteotomy. STUDY DESIGN In the mechanical test, 10 polyurethane replicas of human hemimandibles of each group were submitted to linear loading test. For the photoelastic evaluation, 3 hemimandible replicas of photoelastic resin were subjected to photoelastic analysis. In the finite element analysis, 3 computer models simulated the displacement and the results of maximum principal stress were analyzed. RESULTS The results of this study demonstrated that the fixation technique with 3 bicortical screws presented better mechanical resistance and stress distribution pattern when compared with the hybrid technique that, on the other hand, presents better results in comparison with a miniplate and monocortical screws. CONCLUSIONS The results suggest that the hybrid technique increased the resistance and improved stress distribution of miniplate/monocortical screw fixation, maintaining most of the advantages of this technique.

A 9-Year Retrospective Study of Dental Trauma in Piracicaba and Neighboring Regions in the State of São Paulo, Brazil

PURPOSE The purpose of this study was to evaluate the occurrence of dentoalveolar trauma during a 9-year period in the Oral and Maxillofacial Surgery Division at Piracicaba Dental School, State University of Campinas in patients from the Piracicaba municipality and neighborhood regions in São Paulo, Brazil. PATIENTS AND METHODS This retrospective epidemiologic study from January 1999 to December 2007 evaluated all patients who presented at the Oral and Maxillofacial Surgery Division at Piracicaba Dental School with sustained oral and maxillofacial traumatic injuries associated with dentoalveolar trauma. Information regarding age, gender, etiology, use of protective devices such seatbelts, crash helmets, and presence of facial fractures and general trauma, oral condition, stage of dentition, date of trauma, drug abuse, type, teeth affected, and classification of the trauma were gathered from the medical files. Descriptive analysis was conducted. RESULTS In total, 2,785 patients were analyzed and 542 (19.46%) were included in this study. The male to female ratio was 2.81:1. Most patients presented with oral hygiene as regular (51.85%). Friday, Saturday, and Sunday were the most prevalent days. Smoking was the most common harmful habit analyzed (16.05%) followed by alcohol use (15.87%). Bicycle accidents (26.94%) were the most common cause, followed by falls (22.69%). With regard to protective devices, 31.51% of drivers were wearing seatbelts during the accidents and helmets were used by 84.38% of motorcycle drivers at the moment of injury. One hundred thirty-five facial fractures were associated with dental and dentoalveolar traumas, and the mandible was the facial bone most associated with dentoalveolar trauma. Upper and lower limbs were most frequently associated with general trauma, accounting for 140 (38.78%) and 111 (30.75%), respectively. CONCLUSION This study shows that dentoalveolar trauma rates and patterns in the Piracicaba municipality and neighborhood regions in São Paulo are similar to other populations. The weekend is the period with the major incidence of dentoalveolar trauma. Alcohol consumption was linked with this type of trauma. Dentoalveolar trauma is involved in and closely related to severe maxillofacial trauma. The use of a helmet is as important as that of a seatbelt. More studies are necessary for a better knowledge and understanding when considering protocols and organization charts in emergency rooms.

Photoelastic Analysis of Stress Distribution of Surgically Assisted Rapid Maxillary Expansion With and Without Separation of the Pterygomaxillary Suture

PURPOSE The aim of this study was to evaluate in vitro the mechanical effect over teeth and bone structures of surgically assisted rapid maxillary expansion (SARME) in photoelastic analogs by observing stress produced during Hyrax-type and Haas-type appliances activation. MATERIALS AND METHODS Two photoelastic analogs were fabricated by use of birefringent materials to simulate an adult skull that contained teeth, bone, and maxillary sinus. Hyrax-type and Haas-type appliances were applied to the anchor teeth and incrementally activated. SARME was simulated by subsequent cuts of the lateral maxillary wall and midpalatine suture and separation of the pterygomaxillary junction. After each osteotomy, the appliances were activated. Resulting stress patterns were recorded photographically in the field of a plane polariscope. RESULTS Before any osteotomy, the activation of the appliances distributed stress through the anchoring teeth to the zygomaticomaxillary walls, concentrating at the zygomaticomaxillary and zygomaticofrontal sutures and at the midline of the maxilla. After midpalatal and maxillary wall osteotomies, a marked reduction of the stress at the zygomaticomaxillary walls was observed. With successive activations, the stresses increased in intensity at the molars, maxillary tuberosity, and pterygoid plates. After pterygomaxillary separation, the stress intensity at the molar area, maxillary tuberosity, and pterygoid plates decreased considerably. With successive activations, stress increased in intensity around the molars and maxillary tuberosity. There were no differences between stresses produced by the 2 appliances. CONCLUSIONS In this biomechanical model, sectioning of all maxillary articulations, including separation of the pterygomaxillary junction, caused a decrease in stress over anchorage teeth. These data cannot be completely extrapolated to the clinical situation but indicate that electing to perform the SARME technique should be based on periodontal health and amount of expansion necessary for each case.

Oral myiasis caused by Cochliomyia hominivorax treated nonsurgically with nitrofurazone: report of 2 cases

Accidental oral myiasis are caused by ingestion of flys eggs or direct oviposition over a compromised area of the host. Here the authors report 2 cases of accidental oral myiasis caused by direct oviposition over an edentulous area in the first patient and in the periodontium in the second patient. Both cases were treated successfully with topical applications of nitrofurazone during a 3-day period. No surgical procedures were required. Flushing the wound with nitrofurazone caused the maggots to endure a liquid-filled anaerobic environment. Healing was uneventful in the 2 cases presented and no adverse reactions were observed during the treatment after 2 months of follow-up. The maggots of both patients were identified as Cochliomyia hominivorax.