Rafaela Scariot

Maxillofacial injuries in a group of Brazilian subjects under 18 years of age

Objective: The purpose of this study was to perform a clinical retrospective analysis of the etiology, incidence and treatment of selected oral and maxillofacial injuries in Brazilian children and adolescents. Materials and Methods: This study was conducted during a 14-year period between 1986 and 2000. All patients were admitted to Hospital XV in the city of Curitiba, State of Paraná. Age, gender, monthly distribution, etiology, soft injuries, associated injuries, site of fractures and methods of treatment were reviewed. Results: Of the total of 350 patients of all ages treated for facial injuries, 29.42% were within the age range of the study (0 to 18 years). Mean age was 10.61. Of the patients, 63.1% were male. The most common cause of injury was accidental falls (37.87%), followed by bicycle and motorcycle accidents (21.36%). Of the 103 patients, 88.34% had single injuries. Mandibular fractures were the most common and the condylar region was particularly affected. Conclusion: Facial trauma is a relatively common occurrence in children. The study indicates that fractures in children and adolescents differ quite considerably from an adult population.

Influence of orthognathic surgery for symptoms of temporomandibular dysfunction

OBJECTIVE To evaluate the influence of orthognathic surgery on the clinical signs and symptoms of temporomandibular disorders (TMDs). STUDY DESIGN In a cohort study, 54 patients undergoing orthognathic surgery were evaluated with regard to the signs and symptoms of TMDs through subjective and objective assessments. These evaluations were performed 1 week preoperatively (T1), 1 month postoperatively (T2), and 6 months postoperatively (T3). The evaluations included patient variables and surgery. Univariate analyzes were performed to verify the association of the variables (P < .05). RESULTS The incidence of TMD 6 months after orthognathic surgery was significantly lower (P < .001). TMD intensity decreases significantly in the postoperative period. Females had a higher prevalence of TMD (P = .003) and muscular disorders preoperatively (P = .001). There was a decrease in clicks between T1 and T3 (P = .013). Mouth opening without pain worsened from T1 to T2 (P < .001) and improved from T1 to T3 (P = .015) and T2 to T3 (P < .001). The results were similar for mouth opening with pain (P < .001). In patients undergoing jaw fixation with bicortical screws, mouth opening without pain was significantly less in T3 patients than in patients undergoing fixation with plate and monocortical screws (P = .048). CONCLUSIONS Orthognathic surgery reduces the clinical signs and symptoms of TMD.

Epidemiological analysis of orthognathic surgery in a hospital in Curitiba, Brazil: Review of 195 cases

Abstract Objective The present retrospective study explored the spectrum and characteristics of patients treated with orthognathic surgery at the Universidade Federal do Parana, Brazil. Materials and method Over a six-year period from July 2002 to July 2008, the records of 195 patients with dentofacial deformities who underwent orthognathic surgical procedures were followed up. Results Mean patient age was 25.87 years (range 14 to 65 years) and the female to male ratio was 1.5:1. The predominant racial group was “white”. Most patients belonged to the economically productive population. Sixty-two patients had complete dentition. Only 3.59% patients had local anesthesia (rapid palatal expansion). Transverse maxillary deficiency was the most common deformity, followed by maxillary anteroposterior deficiency associated with mandibular anteroposterior excess. Mandibular set-back was the intervention most frequently performed. The surgical procedures took an average of 3 hours 51 minutes and orthodontic treatments took an average of 44.48 months. Complications occurred in 22.57% of patients, the most common of which were permanent paresthesia of the lower lip (7.17%) and inadequate fracture reduction (5.12%). Conclusions The findings included concepts that were useful for characterizing the profile of patients who undergo orthognathic surgery in southern Brazil. The results also may help to correctly develop protocols for patient care designed to improve the overall results of the procedures.

Radiographic and histological evaluation of ectopic application of deproteinized bovine bone matrix.

Objective: To evaluate, through radiographic and histological analysis, the tissue reaction induced by a biomaterial based on deproteinized bovine bone matrix (DBBM) in the muscle of sheep. sMaterials and Methods: Sixteen sheep were used. The animals underwent surgery to insert polyethylene tubes containing the biomaterial in the muscle of the lower back (ectopic site) and were euthanized after 3 and 6 months. Each sheep received three tubes: Group 1 - sham group (negative control - tube without biomaterial), Group 2 - particulate autogenous bone (positive control), and Group 3 - DBBM biomaterial (GenOx Inorg). The material removed was evaluated by radiographic, macroscopic, and microscopic analysis, descriptively. Results: Macroscopic analysis showed that Group 3 had a greater tissue volume maintenance. Microscopic analysis indicated that Group 1 had a higher concentration of dense, thin collagen fibers (3 and 6 months); in Group 2, there was a decrease in the inflammatory process and the deposition of dense, thin collagen fibers (3 and 6 months); in Group 3, the presence of a dense connective tissue was noted, in which the DBBM particles (3 months) were found. On the periphery of these particles, a deposition of basophilic material was found, indicating the formation of mineral particles and the formation of tissues with osteoid characteristics (6 months). Conclusion: Based on the results obtained, it can be concluded that the biomaterial based on DBBM led to the formation of tissue with similar characteristics to an osteoid matrix in a postoperative period of 6 months. However, none of the groups evaluated showed ectopic bone neoformation.

Primary mandibular xanthoma: case report

Xanthoma is a very rare bone tumor, especially in the mandible, that can be associated with metabolic diseases such as hyperlipidemia. A 14-year-old girl presented with a non-corticated unilocular radiolucent lesion observed on panoramic radiography. The lesion was located between the roots of the left first and second premolar teeth, extending from the cervical to the apical region, measuring approximately 1 cm in greatest dimension. An excisional biopsy revealed foam cells and occasional nonfoamy mononuclear macrophage-like cells spread among a discrete fibrous stroma. Immunohistochemically, the xanthomatous cells were CD68 and vimentin positive, focally positive for S100, CD1a, and CD3 and negative for AE1/AE3, CD20, CD117, and HMB45. Hematologic and biochemical investigations ruled out systemic disease.

Leukocyte-platelet-rich plasma diminishes bone matrix deposition in rat calvaria treated with autograft due to simultaneous increase in immunohistochemical expression of Indian Hedgehog, transforming growth factor-β, and parathyroid-1 receptor

PURPOSE This study evaluated the immunohistochemical presence of Indian Hedgehog (IHH), transforming growth factor-β (TGF-β), and parathyroid-1 receptor (PTH1R) in calvaria bone repair, and compared these results with the histological bone matrix features in defects treated with autograft in the presence or absence of L-PRP. MATERIAL AND METHODS An artificial bone defect measuring 5 × 1 mm was produced in the calvaria of 28 Wistar rats. Randomly the defects were treated with autograft and autograft mixed with L-PRP. The animals were euthanized at 15 and 40 days post-surgery. Data were analyzed by Student-Newman-Keuls test (p ≤ .05) for immunohistochemical interpretation. RESULTS The results revealed that the histological characteristic of bone matrix deposited in the defect was different in the defects treated with L-PRP. The group that received only the autograft demonstrated larger haversian bone matrix deposited, whereas the group that received autograft mixed with L-PRP revealed trabecular bone deposition. These results coincided with significantly higher immunopositivity for IHH, TGF-β1, and PTH1R in the L-PRP group. CONCLUSION These results suggest that L-PRP altered the biological characteristic of the autograft, increasing the bone cells IHH+ but inducing a trabecular bone associated with intense quantities of TGF-β and PTH1R.

Intermittent administration of PTH induces the expression of osteocalcin and BMP-2 on choroid plexus cells associated with suppression of sclerostin, TGF-β1, and Na+K+ATPase

The parathyroid hormone (PTH) is a key hormone that acts on the regulation of calcium homeostasis and bone turnover. Despite evidence that this hormone has a dual action, for example, anabolic or catabolic effects, researchers have described that when the PTH is administrated in an intermittent form, it acts in favor of bone formation, which is why the Food and Drug Administration supports it for the treatment of osteoporosis [1]. According to this premise, some experiments with model animals have reinforced the hypothesis that this therapeutic approach may be a likely alternative to induce osteoneogenesis in areas that have been lost due to trauma, intra bonny cysts, or neoplasia [2]. The positive action of PTH signaling on bone is mediated by a G protein–coupled receptor referred to as PTH receptor-1 (PTH1R). In this way, the PTH/PTH1R interaction stimulates the Gαs-mediated activation of adenylate cyclase, which, in turn, enhances bone morphogenetic protein-2 (BMP-2) activity, either through the synthesis of morphogenetic protein [3] or by stimulating the BMP-2 through the supression of its antagonist, known as sclerostin [4]. As a result, the induction of the immunoexpression of osteocalcin, which is an osteogenic biomarker, occurs [3]. In addition, it has been reported that PTH may regulate the synthesis and amplification of transforming growth factor beta-1 (TGF-β1), which is an important growth factor for osteoprogenitor cells’ chemotaxis and its likely osteoblast differentiation [5]. Despite this attractive clinical approach, the action of PTH seems to be systemic. However, no concrete evidence exists as to whether its effects may provoke histomorphological modifications or changes related to the immunolocalization of proteins in nonclassical organs and tissues where PTH1R may also be expressed, which include brain sites, especially the choroid plexus and ependymal cells. Corroborating this point of the view, evidence reveals that during their development, both osteogenic and neurogenic niches share the same BMP signaling pathways [6]. Despite the fact that no genuine evidence for the action of PTH exists in these brain cells, the literature has revealed the presence of PTH or its analogous-hormone, called Parathyroid hormone-related protein (PTHrP), in brain areas, inferring that these proteins could act as a neurotransmissor or even as an inductor of the release of arginine vasopressin from the supraoptic nucleus [7]. Particularly on the choroid plexus and ependymal cells, the presence of PTH1R suggests its importance in ionic calcium metabolism during the production and reabsorbtion of cerebrospinal fluid [7]. The cerebrospinal fluid is regulated at distinctly different concentrations than in the blood, whose correction for the usual osmotic gradient is regulated by an ionic pump dependent on ATP, especially NaKATPAse [8], as well as TGF-β1, which seems to play a role in glucose uptake [9] at the same time that it works as a neuroprotective factor [10]. Because it is previously known that PTH possesses chemoattraction for its receptor PTH1R, and this hormone * Allan Fernando Giovanini afgiovanini@gmail.com

Extra-Oral Excision of a Buccal Fat Pad Lipoma.

Lipomas and its variants are common soft tissue tumors, and however occur infrequently in the oral and maxillofacial region. Their incidence in the oral cavity is low among all oral lesions. Oral lipoma is yellowish and soft to palpation, and histologically can be mistaken by other lipoma variants. The aim of this study is to report a case of a lipoma located at the buccal fat pad which was removed through an extra-oral access. A 43-year-old male is presenting an augmentation in the right buccal region, being a soft consistency mobile lesion with 1.5 cm of diameter, asymptomatic, and 2 years of growing. Computed tomography scan showed hypodensity compatible with adipose tissue. The lesion was removed through an extra-oral access. The lipoma described in this clinical report had an unusual location and once the lesion was very superficial an extra-oral access was the first treatment option despite the fact that was a benign tumor.Lipomas and its variants are common soft tissue tumors, and however occur infrequently in the oral and maxillofacial region. Their incidence in the oral cavity is low among all oral lesions. Oral lipoma is yellowish and soft to palpation, and histologically can be mistaken by other lipoma variants. The aim of this study is to report a case of a lipoma located at the buccal fat pad which was removed through an extra-oral access. A 43-year-old male is presenting an augmentation in the right buccal region, being a soft consistency mobile lesion with 1.5 cm of diameter, asymptomatic, and 2 years of growing. Computed tomography scan showed hypodensity compatible with adipose tissue. The lesion was removed through an extra-oral access. The lipoma described in this clinical report had an unusual location and once the lesion was very superficial an extra-oral access was the first treatment option despite the fact that was a benign tumor.

Would Be Prophylactic Administrations of Low Concentration of Alendronate an Alternative for Improving the Craniofacial Bone Repair? A Preliminary Study Focused in the Period of Cellular Differentiation and Tissue Organization

Background: Alendronate (ALN) is a nitrogen-bisphosphonate that may induce an anabolic effect on craniofacial bone repair when administrated in low doses. Based on this premise, this study analyzed the influence of prophylactic low doses of ALN on bone healing in defects created in rabbit mandible. Methods: A 5 × 2-mm diameter deep defect was created in the calvaria of 28 rabbits. Fourteen of these rabbits received previously 50 &mgr;g/kg of 1% sodium ALN for 4 weeks, while the other rabbits received only 0.9% physiological saline solution (control). Animals were euthanized at 15 and 60 days postsurgery (n = 7), and the data were analyzed using histomorphometry and immunohistochemistry using the anti-CD34, bone morphogenetic protein -2 (BMP-2), and transforming growth factor (TGF)-&bgr;1 antibodies. Results: On the 15th day postsurgery, the specimens that received previous treatment with ALN demonstrated large vascular lumen and intense positivity to CD34 either concentrated in endothelium or cells spread among the reparative tissue. These results coincided with intense positivity for BMP-2+ cells and TGF-&bgr;1 that was concentrated in both cells and perivascular area. In contrast, the control group revealed scarce cells that exhibited CD34, BMP-2+, and the TGF-&bgr;1 was restricted for perivascular area on well-formed granulation tissue. These patterns of immunohistochemical result, especially found on the 15th day of analysis, seem to be responsible for the development of larger quantities of bone matrix in the specimens that receive ALN on the 60th day postsurgery. Conclusion: These preliminary results showed that the prophylactic administration of low doses of ALN might be an alternative to craniofacial bone craniofacial bone repair because it increases the immunopositivity for TGF-&bgr;1 and consequently improves the CD34+ and BMP-2+ cells on reparative sites.

Cleidocranial Dysplasia: Diagnosis, Surgical and Orthodontic Planning and Interventions in a Pediatric Patient

La displasia cleidocraneal (CCD) es un trastorno oseo, autosomico dominante, causado por un defecto en el gen CBFA1 y se caracteriza por anomalias esqueleticas, craneofaciales y bucodentales. En este trabajo se describen los principales aspectos de un caso de CCD, desde el diagnostico y la planificacion para la primera etapa de las intervenciones. Un paciente varon de 11 anos de edad, concurrio a la Clinica de Odontologia Pediatrica de la Universidad Federal de Parana (Brasil) con un problema de retencion prolongada de casi todos sus dientes de leche. Se describen los examenes clinicos y de imagen dirigidos al diagnostico de la CCD y el plan de tratamiento. La primera etapa consistio en la extraccion de cuatro dientes primarios, dos dientes permanentes y dos dientes supernumerarios del maxilar, seguido de separacion del paladar, traccion de los dientes afectados y traccion inversa del maxilar. El paciente permanece en tratamiento. El seguimiento clinico, asi como la concientizacion y motivacion de la familia son factores importantes en este tipo de casos.