Nelson Studart Rocha

Temporomandibular joint arthrocententesis: evaluation of results and review of the literature

AIM This study was designed to investigate the effects of arthrocentesis on the improvement of internal derangement symptoms and jaw function in a series of patients with anterior disc displacement and closed lockjaw. PATIENTS AND METHODS The study was based on a review of patients records before and after treatment using clinical examinations and radiographs. Visual analog scales were used to measure pain before and after arthrocentesis. Six patients (12 temporomandibular joints) with closed lock symptoms (2 cases) and internal derangements (4 cases) were treated at the Oswaldo Cruz Hospital. The mean follow-up was 11.5 months. RESULTS The mean maximum vertical opening before treatment was 31.83 mm and after arthrocentesis was 36.50 mm. The visual analog scale for pain before treatment was 7 points (mean) and after arthrocentesis the mean was 4.3. CONCLUSION Arthrocentesis was shown to be effective in reducing pain and increasing jaw motion in this series of cases.

Artrocentese da articulação temporomandibular: avaliação de resultados e revisão da literatura

OBJETIVO: Avaliar o efeito da artrocentese em relacao a sintomatologia e movimentacao mandibular em uma serie de pacientes com deslocamento anterior de disco e travamento mandibular. MATERIAIS E METODOS: O estudo foi baseado nos dados pre e pos-operatorio de pacientes atraves de exame clinico e radiografico. A Escala Analogica Visual (EAV) foi usada para quantificar a dor no pre e pos-operatorio. Foram avaliados 6 pacientes (12 articulacoes) tratados no Hospital Universitario Oswaldo Cruz (HUOC) com travamento mandibular (2 casos) e desarranjo interno (4 casos). O periodo medio de acompanhamento foi de 11,5 meses. RESULTADOS: A media de abertura bucal pre-operatoria foi de 31,83mm e no pos-operatorio foi de 36,50mm. A media de dor articular segundo a escala visual analogica encontrada foi de 7 e no pos-operatorio foi de 4,3. CONCLUSAO: A artrocentese mostrou-se efetiva na melhora da dor articular e na movimentacao mandibular nesta serie de casos.

Clinical study of hemodynamic changes comparing 4% articaine hydrochloride with 1:100,000 and 1:200,000 epinephrine

OBJECTIVE To evaluate hemodynamic changes with the use of 4% articaine and 2 different concentrations of epinephrine (1:100,000 and 1:200,000) in the surgical removal of symmetrically positioned lower third molars. STUDY DESIGN A prospective, randomized, double-blind clinical trial was carried out involving 42 patients each undergoing 2 surgeries on separate occasions under local anesthesia with 4% articaine and either epinephrine 1:100,000 or 1:200,000. The following parameters were assessed at 4 different moments: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product (RPP); and pressure rate quotient (PRQ). RESULTS The concentration of epinephrine did not affect diastolic blood pressure or oxygen saturation during the surgeries. Significant differences between were detected for heart rate, RPP, and PRQ (P < .05). CONCLUSIONS The epinephrine concentration (1:100,000 or 1:200,000) in a 4% articaine solution influences hemodynamic parameters without perceptible clinical changes in healthy patients undergoing lower third molar removal.

A rare case of iatrogenic gingival Kaposi’s sarcoma

Kaposis sarcoma is an angioproliferative tumour rarely found in the oral cavity. We present the 3rd case of iatrogenic gingival Kaposis sarcoma reported in the English-language literature which developed in a young patient 5 years after a renal transplant and discuss their histological features and differential diagnosis.

Transmaxillary approach to the cranial base: an evaluation of 11 cases

UNLABELLED Surgical access to the skull base is always difficult, especially because of the noble anatomic structures present there. Maxillary osteotomy provides direct view to the clivus region and the neck spine, and it also bears less morbidity when compared to the many other accesses described in the literature. AIM to assess 11 patients submitted to transmaxillary osteotomy, describing the surgical technique and postoperative results and complications. MATERIALS AND METHODS A retrospective study involving eleven patients submitted to transmaxillary approach to the brainstem. We studied dental occlusion, trans and postoperative bleeding, bone necrosis and soft tissue alterations. All followed the same surgical protocol and were followed up for two years. RESULTS after treatment, all the patients improved in their clinical status and had no neurological complication, trans and postoperative hemorrhage or major complications were seen. Among the complications, two patients had incomplete maxilla fracture, two had laceration of their nasal mucosa and one had, as late complication, an oral-sinusal fistula. CONCLUSION Transmaxillary osteotomy provided proper access to the clivus for brainstem decompression with low rate of complications in this series.

Acesso transmaxilar à base do crânio: avaliação de 11 casos

Surgical access to the skull base is always difficult, especially because of the noble anatomic structures present there. Maxillary osteotomy provides direct view to the clivus region and the neck spine, and it also bears less morbidity when compared to the many other accesses described in the literature. AIM: to assess 11 patients submitted to transmaxillary osteotomy, describing the surgical technique and postoperative results and complications. MATERIALS AND METHODS: A retrospective study involving eleven patients submitted to transmaxillary approach to the brainstem. We studied dental occlusion, trans and postoperative bleeding, bone necrosis and soft tissue alterations. All followed the same surgical protocol and were followed up for two years. RESULTS: after treatment, all the patients improved in their clinical status and had no neurological complication, trans and postoperative hemorrhage or major complications were seen. Among the complications, two patients had incomplete maxilla fracture, two had laceration of their nasal mucosa and one had, as late complication, an oral-sinusal fistula. CONCLUSION: Transmaxillary osteotomy provided proper access to the clivus for brainstem decompression with low rate of complications in this series.