Marcos Kazuo Yamamoto

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.

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.

Evaluación del Efecto del Plasma Rico en Plaquetas en la Cicatrización de Heridas Alveolares en Ratas

Opinions about the clinical utility of platelet-rich plasma (PRP) vary, as a large number of experimental studies have questioned its efficacy. The purpose of this study was to evaluate the effects of PRP on experimental alveolar wound heali ng in rats. Fifty young adult male Wistar rats were divided in control and PRP groups and submitted to extraction of the right maxillary in cisor. In the PRP group, blood was collected by cardiac puncture, and the socket was filled with a PRP gel. Animals were euthanized after 1, 3, 7, 14 and 30 days. Histological and histomorphometric analyses were performed at each experimental time point. Semiquantitative hi stological analysis showed that the PRP group exhibited significantly more collagen-matrix deposition and less bone-matrix formation in th e socket than did the control group from 7 to 30 days. Histomorphometric analyses showed that the PRP group also exhibited lower bonetissue areas than the control group at 7 (p=0.0250) and 14 days (p<0.0001), but at 30 days, no significant difference between t he groups was observed. In the present study, PRP did not enhance alveolar wound healing, and PRP-treated rats exhibited low rates of bon e deposition during the intermediate phases of alveolar socket repair.