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Background Infection is the most feared complication of a penile prosthesis. Diabetes mellitus (DM) is widely known to increase the risk of several infections, but its role in the penile prosthesis is still controversial. This systematic review aims to show the contemporary scenario of penile prosthesis infection and present a meta-analysis about DM contribution to penile prosthesis infection. Methods The review was performed with no language or time limitation, including ten databases. The included articles were about the male population who received a penile prosthesis with no model restriction, with a minimum follow up of 1 year, and outcomes adequately reported. Results The mean infection incidence of penile prosthesis ranged from 0.33 to 11.4%. In early 2000, the general incidence of infection was 3 to 5%, then, the introduction of coated materials decreased it to 0.3 to 2.7%. The meta-analysis showed that diabetes mellitus is related to an increased risk of penile prosthesis infection with an odds ratio of 1.53 (95% CI 1.15–2.04). Conclusions Penile prosthesis infection decreased in the last decades but remains a significant cause of reoperation, and it is related to lower prosthesis survival. Meta-analysis concludes that diabetes mellitus is related to a higher risk of penile prosthesis infection.

Resorbable and titanium systems have been used in maxillary fixation. The aim of this review was to evaluate stability and morbidity of Le Fort I osteotomy by comparing both systems. It was performed in 11 databases, and reported according to preferred reporting items for systematic reviews and meta-analysis. Randomized and nonrandomized clinical trials, and retrospective comparative studies with patients who underwent nonsegmented Le Fort I osteotomy were included. Eleven articles were selected, with a total of 262 patients treated with resorbable and 252 with titanium fixation. The meta-analysis showed that when measured at point A, horizontal stability was 0.06 mm (95% confidence interval [CI] -0.19, 0.30), vertical stability for impaction was -0.43 mm (95% CI -0.94, 0.07), and for inferior repositioning was -1.29 mm (95% CI -2.62, 0.04). Morbidity was similar in the groups. Regarding infection, resorbable presented an absolute risk (AR) = 0.032, and titanium an AR = 0.025 (P = 1.0). For soft tissue reaction, an AR = 0.120 was shown for resorbable, and an AR = 0.132 for titanium (P = 0.85). Removal of fixation showed an AR = 0.024 for resorbable, and an AR = 0.025 for titanium (P = 1.0). Based on these results, resorbable and metal fixation systems seem to be equivalent with respect to stability and morbidity. This review was limited by the quality of the studies. Future studies should address these quality limitations to improve comparison between these 2 fixation approaches.

This article introduces a method that extends the McNamara cephalometric analysis to produce 3-dimensional (3D) measurement values from cone-beam computed tomography images. In the extended method, the cephalometric landmarks are represented by 3D points; the bilateral cephalometric landmarks are identified on both sides of the skull; the cephalometric lines, with the exception of the facial axis, are represented by 3D lines; the cephalometric planes, with the exception of the facial plane, are represented by planes; the effective mandibular length, the effective midfacial length, and the lower anterior facial height are measured as 3D point-to-point distances; the nasion perpendicular to point A, the pogonion to nasion perpendicular, the upper incisor to point A vertical, and the lower incisor to point A-pogonion line are measured each as components of a vector; the facial axis angle is measured as a line-to-plane angle; and the mandibular plane angle is measured as a plane-to-plane angle. As a result, the method provides real effective lengths of the maxilla and mandible on both sides of the skull; real height of the lower anterior face; directed distances from the point A to the nasion perpendicular, from the pogonion to the nasion perpendicular, from the left and right upper incisor to the point A vertical, and from the left and right lower incisor to the point A-pogonion line for both the lateral and posteroanterior views of the skull; and real angles of the facial axis and the mandibular plane. Additionality, the method enables the identification of craniofacial asymmetries.

Objective : Obstructive Sleep Apnea (OSA) occurs by recurrent collapse of the upper airway during sleep. It results in complete (apnea) or partial (hypopnea) reduction of airflow and has intimate relation with the upper airway anatomy. Cephalometric analysis has been used to quantify airway dimensions. The aim of this study is evaluate the correlation between the anteroposterior dimension of the upper airway and the severity of obstructive sleep apnea. Material and Methods : A retrospective analysis was performed reviewing polysomnographic data (AHI) and anteroposterior cephalometric measurements of pharynx subregions: nasopharynx, oropharynx, hypopharynx. Results : The sample consisted of 30 patients. The mean body mass index was 29.60 kg/m 2 and the average age was 46.8 years. Nine patients presented severe OSA, seven had moderate OSA , seven had mild OSA, and seven were healthy. The Pearson's correlation index between the anteroposterior dimension of the nasopharynx, oropharynx and hypopharynx and AHI was respectively -0.128 (p=0.517), -0.272 (p=0.162) and -0.129 (p=0.513). Conclusion: The correlation between anteroposterior linear dimension of the airway and OSA severity, assessed by AHI, was not positive. As an isolated parameter it did not correlate to the severity of the obstrucive sleep apnea syndrome and should be evaluated in conjunction with other factors. Keywords Upper Airway; Obstructive sleep apnea; Cone beam CT.

Purpose The fixation of combined mandibular fractures, especially symphyseal-condylar fractures, although occurring commonly and having a higher complication rate in the clinic, is rarely investigated regarding predictable therapeutic approaches. Thus this study's aim was to assess different forms of condylar fixation when combined with symphyseal fracture fixation. Materials and Methods Using finite element models, we analyzed the stress distribution that occurs when a condylar fracture is fixed with 1 miniplate, 2 miniplates, or a trapezoidal condylar miniplate and when a symphyseal fracture is fixed with 2 parallel plates, 2 perpendicular plates, or 2 lag screws. The null hypothesis was that there would be no differences among the different fixation techniques. Results The results showed a stress concentration in the anterior region of the condyle, close to the sigmoid notch. Moreover, adequate fixation in the symphysis could result in less tension at the condylar region. Therefore, when the symphysis was fixed with a lag-screw technique, condylar fixation was less required, showing a more adequate stress distribution when the condyle was fixed with 1 or 2 plates. Conversely, when the symphyseal fixation was less effective, by use of perpendicular plates, there was a change in the stress distribution at the condylar region, altering fixation behavior and resulting in more tension and displacement in the condyle, especially when a trapezoidal plate was used. Conclusions A lag screw and parallel double plates appear to be suitable for symphyseal fixation, whereas 2 straightly positioned plates and a trapezoidal plate are suitable for condylar fixation. However, the combination of perpendicular plates in symphyseal fixation and a trapezoidal plate in condylar fixation showed an altered stress distribution.

Made available in DSpace on 2018-12-11T17:11:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-09-01 This retrospective study evaluated the nasolabial changes in patients who underwent surgically assisted rapid maxillary expansion (SARME) using two different approaches. Nineteen patients were included in the study, divided into two groups according to the kind of surgical approach performed: group 1 (n = 9), SARME performed through the standard Le Fort I circumvestibular approach followed by the alar base cinch, and group 2 (n = 10), SARME performed through a subtotal vestibular approach associated to a V-shaped incision at the maxillary midline in the labial frenulum region, without alar base cinch. Measurements of width, length, and nasal projection as well as upper lip length were taken from cone beam tomographic images obtained before surgery (T1) and 6 months postoperatively (T2). Both groups presented an increase in the alar base width postoperatively (P < 0.05). The approach used in group 2 resulted in smaller changes in the alar base width as measured at the superior alar curvature (P < 0.05). Nasal length and projection and upper lip length were not altered by SARME. The type of surgical approach influenced nasolabial changes, but did not eliminate increase in width of the alar base. Surgical Sciences School of Medical Sciences State University of Campinas UNICAMP Department of Orthodontics Araraquara Dental School São Paulo State University UNESP Department of Oral and Maxillofacial Surgery Araraquara Dental School São Paulo State University UNESP Department of Stomatology Bauru Dental School University of São Paulo USP School of Medical Sciences State University of Campinas UNICAMP Department of Orthodontics Araraquara Dental School São Paulo State University UNESP Department of Oral and Maxillofacial Surgery Araraquara Dental School São Paulo State University UNESP

Nasal obstruction (NO) is a common symptom present in 25% of the general population, which significantly interferes with the quality of life. The different facial profiles and malocclusion patterns could be associated with the degree of NO. In order to evaluate the nasal function in patients with different facial morphology patterns, the authors developed a prospective study in which 88 patients from a dentofacial deformities center were included. These patients were submitted to fibrorhinoscopy (Mashida, ENT PIII) with a 3.2-mm cannula under topical anesthesia to evaluate septal deviation, inferior and medium turbinates, and pharyngeal tonsils. The 88 patients included in the study were divided into 3 groups according to the classification of the facial profile, distributed as follows: 32 class I, 28 class II, and 28 class III; the data collected was statistically analyzed by analysis of variance and the results are shown. The patients included in this study presented similar prevalence of NO with the reduction of airway function efficiency. Although it was not a statistically different, the group II presented higher mean Nasal Obstruction Syndrome Evaluation scores.

OBJECTIVE To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis). METHODS A Markov model was developed to capture long-term clinical and economic outcomes. The model’s population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost – in BRL, and effectiveness – measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed. RESUMO OBJETIVO Conduzir uma análise de custo-efetividade das alternativas para tratamento reabilitador do edentulismo mandibular no contexto do Sistema Único de Saúde (prótese total implanto-suportada e prótese total convencional). MÉTODOS Foi desenvolvido um modelo de Markov para captar os resultados clínicos e econômicos de longo prazo. A população do modelo consistiu em uma coorte hipotética de 1.000.000 pacientes, com 55 anos, desdentados totais mandibulares e sem contraindicações médicas para a realização de procedimentos cirúrgicos. A perspectiva de análise adotada foi a do Sistema Único de Saúde. Com base no modelo proposto, calculamos o custo (em reais) e a efetividade, medida pelo ano de prótese ajustado à qualidade (QAPY). O horizonte temporal da análise foi de 20 anos. RESULTADOS Considerando o desconto de 5% nos custos e efeitos, a razão de custo-efetividade incremental da prótese total implanto-suportada em relação à prótese total convencional (R$ 464,22/QAPY) foi menor que o limiar de disposição a pagar adotado no modelo (R$ 3.050,00/QAPY). CONCLUSÕES Os resultados desta análise econômica mostraram que a reabilitação de edêntulos mandibulares por meio da prótese total implanto-suportada é muito custo-efetiva em comparação à prótese total convencional, de acordo com os limites de custo-efetividade empregados.

Made available in DSpace on 2020-12-12T02:18:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Introduction: Obstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance. Objective: This study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea. Methods: The study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy. Results: Analysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m2. Obese and non-obese groups were determined by using cut-off 30 kg/m2. In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p = 0.02), NOSE instrument (p = 0.033) and inferior turbinate hypertrophy (p = 0.036), with odds ratio 1.983 (95% IC 1.048 − 3.753). nasal septum deviation (p = 0.126) and nasal airway volume evaluation (p = 0.177) showed no significant results. Conclusion: Obesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation. Level of Evidence: 3b - Individual case-control study. Universidade de Araraquara (Uniara) Faculdade de Medicina Divisão de Otorrinolaringologia Universidade Estadual de São Paulo (UNESP) Faculdade de Odontologia de Araraquara Departamento de Diagnóstico e Cirurgia Universidade Estadual de São Paulo (UNESP) Faculdade de Odontologia de Araraquara Departamento de Diagnóstico e Cirurgia Divisão de Cirurgia Oral e Maxilofacial Universidade de Araraquara (Uniara) Faculdade de Medicina Universidade Estadual de Campinas (UNICAMP) Faculdade de Ciências Médicas Departamento de Cirurgia Universidade Estadual de São Paulo (UNESP) Faculdade de Odontologia de Araraquara Departamento de Diagnóstico e Cirurgia Universidade Estadual de São Paulo (UNESP) Faculdade de Odontologia de Araraquara Departamento de Diagnóstico e Cirurgia Divisão de Cirurgia Oral e Maxilofacial

The aim of this study was to assess through biomechanical testing if different synthetic materials used to fabricate test specimens have a different biomechanical behavior in comparison with other materials when simulating in vitro load resistance of a fixation method established for sagittal split ramus osteotomy (SSRO). Thirty synthetic and standardized human hemimandible replicas with SSRO were divided into three groups of 10 samples each. Group A—ABS plastic; Group B—polyamide; and Group C—polyurethane. These were fixated with three bicortical position screws (16 mm in length, 2.0-mm system) in an inverted L pattern using perforation guide and 5-mm advancement. Each sample was submitted to linear vertical load, and load strength values were recorded at 1, 3, 5, 7, and 10 mm of displacement. The means and standard deviation were compared using the analysis of variance ( p < 0.05) and the Tukey test. A tendency for lower values was observed in Group B in comparison with Groups A and C. At 3 and 5 mm of displacement, a difference between Groups A and C was found in comparison with Group B ( p < 0.05). At 7 and 10 mm of displacement, a difference was found among the three groups, in which Group C showed the highest values and Group B the lowest ( p < 0.05). Taking into consideration the results obtained and the behavior of each material used as a substrate, significant differences occurred among the materials when compared among them.

The aim of this study was to make a comparison of the biomechanical behavior of four different internal fixation systems for mandibular angle fractures. A total of 40 polyurethane mandible replicas were employed with different fixation methods: group 1SP, one 2.0-mm four-hole miniplate; group 2PPL, two 2.0-mm four-hole parallel miniplates; group 3DP, one 3D 2.0-mm four-hole miniplate; and group 3DPP, one 3D 2.0-mm eight-hole miniplate. Each group was subjected to incisal or homolateral molar region loading. The load resistance values were measured at load application causing tip displacement of 1, 3, and 5 mm, and at the time at which the system achieves its maximum strength (MS). Means and standard deviations were compared among groups using analysis of variance and the Tukey test. Group 2PPL showed higher strength for all the displacements. For incisal loading, no statistically significant differences were found between groups 1SP, 3DP, and 3DPP. For molar loading, group 1SP and 3DPP showed statistically significant differences. For MS testing, group 1SP and 2PPL showed statistically significant differences in incisal loading; group 1SP and 3DP showed no statistically significant differences; and group 3DPP showed lower values of strength. Two parallel miniplates provide the most favorable mechanical behavior under the conditions tested.

The objective of this retrospective study was to evaluate some epidemiological characteristics, surgical treatment methods, and complications of cases involving mandibular fractures. Records from 119 patients treated for mandibular fractures between January 2006 and December 2011 were analyzed. We find mandibular fractures mostly affect Caucasian (72.2%) men (80.7%). The mean age of the patients was 28.1 years. Road traffic accidents (RTA) caused the most fractures (49.5%), followed by physical violence, including gunshot wounds (21%). Motorcycle accidents were the most common cause of RTA (76.2%). The most affected mandibular regions were the parasymphysis (26.9%) and the mandible angle (25.1%). Both surgical and nonsurgical treatments were applied (90.4% and 9.6%, respectively). The most common surgical approach was the intraoral (64.9%), using the 2.0-mm fixation system (88.0%). Complications such as postoperative infections, malocclusion, and paresthesia occurred in 36 patients (30.2%). This research revealed interesting features about the etiology of mandibular fractures that were mostly associated with RTA. Severity of the trauma and noncompliance of the patients were factors that contributed to the development of postoperative complications.

PURPOSE: To study the repair of pericranium-cutaneous flaps fixed with suture anchored in a skull bone tunnel or N-butyl-2cyanoacrylate adhesive in Wistar rats with emphasis on the cellular inflammatory response and the production of types I and III collagen. METHODS: The operated region in the cephalic region of Wistar rats was removed minutes before euthanasia, fixed in formalin, and subjected to histological preparation. Slides were stained with hematoxylin–eosin and Picrosirius. Standardized counts of polymorphonuclear and mononuclear cells, fibroblasts, and macrophages were performed, and the percentages of types I and III collagen were determined. Data collection occurred on days 3, 7, 14, 21, and 45 postoperatively. A value of p

PURPOSE: To develop an experimental model to study and radiologically monitor displacement of skin flaps in the pericranium of rats subjected to traction and surgical fixation using suture anchored in a skull bone tunnel or with N-butyl-2-cyanoacrylate (Histoacryl TM) surgical adhesive. METHODS: Radiological markers were placed in the subcutis of Wistar rats undergoing subperiosteal detachment of the pericranium with pulling and fixation of the flap. We performed radiography on postoperative days 3, 7, 14, 21, and 45. A p-value of

Recent studies have evaluated many methods of internal fixation for sagittal split ramus osteotomy (SSRO), aiming to increase stability of the bone segments while minimizing condylar displacement. The purpose of this study was to evaluate, through biomechanical testing, the stability of the fixation comparing a specially designed bone plate to other two commonly used methods. Thirty hemimandibles were separated into three equal groups. All specimens received SSRO. In Group I the osteotomies were fixed with three 15 mm bicortical positional screws in an inverted-L pattern with an insertion angle of 908. In Group II, fixation was carried out with a four-hole straight plate and four 6 mm monocortical screws. In Group III, fixation was performed with an adjustable sagittal plate and eight 6 mm monocortical screws. Hemimandibles were submitted to vertical compressive loads, by a mechanical testing unit. Averages and standard deviations were submitted to analysis of variance using the Tukey test with a 5% level of significance. Bicortical screws presented the greatest values of loading resistance. The adjustable miniplate demonstrated 60% lower resistance compared to bicortical screws. Group II presented on average 40% less resistant to the axial loading.

Purpose To develop a computer-based method for automating the repositioning of jaw segments in the skull during three-dimensional virtual treatment planning of orthognathic surgery. The method speeds up the planning phase of the orthognathic procedure, releasing surgeons from laborious and time-consuming tasks. Materials and methods The method finds the optimal positions for the maxilla, mandibular body, and bony chin in the skull. Minimization of cephalometric differences between measured and standard values is considered. Cone-beam computed tomographic images acquired from four preoperative patients with skeletal malocclusion were used for evaluating the method. Results Dentofacial problems of the four patients were rectified, including skeletal malocclusion, facial asymmetry, and jaw discrepancies. Conclusions The results show that the method is potentially able to be used in routine clinical practice as support for treatment-planning decisions in orthognathic surgery.

This study established cone beam computed tomography (CBCT)-based cephalometric norms for Brazilian adults, including the assessment of sexual dimorphism. An observer performed McNamara's cephalometric analysis twice on 60 CBCT datasets acquired from patients with a normal dental occlusion, divided equally into two groups by sex. Welch's t-test was applied to assess differences between the sexes in hard tissue cephalometric measurements, and Dahlberg's formula was used to calculate measurement error introduced by the observer. The cephalometric measurements of effective mandibular length, effective midfacial length, maxillomandibular differential, and lower anterior facial height presented sexual dimorphism. Linear measurements had error ≤0.78mm, and angular measurements had error ≤1.24°. The results show that (1) the CBCT-based cephalometric norms established in this study are reliable for use by researchers and clinicians, and (2) Brazilian adult males and females have similar craniofacial morphology, with males possessing larger jaws than females.

Made available in DSpace on 2018-12-11T17:12:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-10-01 Obstructive sleep apnoea (OSA) results from the recurrent collapse of the upper airway during sleep. Nasal abnormalities influence the stability of the pharynx. The aim of this study was to evaluate the volumetric and anatomical changes of the nasal cavity in patients with OSA. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to grade nasal obstruction. Sleep-related breathing disorders were evaluated by polysomnography. The nasal airway volume was obtained from computed tomography scans through volumetric reconstruction of the nasal airway. Alterations to the nasal anatomy were identified by nasal fibre-optic endoscopy. Ninety-four patient charts were analyzed. The final sample comprised 32 patients with severe OSA, 16 with moderate OSA, 23 with mild OSA, and 20 without OSA. Three groups were established based on nasal obstruction and OSA. The groups were compared for nasal airway volume (P = 0.464) and body mass index (P = 0.001). The presence of nasal septum deviation and inferior turbinate hypertrophy were related to the NOSE score (P = 0.05 for both), apnoea–hypopnoea index (P = 0.03 and P = 0.05, respectively), and nasal airway volume (P = 0.71 and P = 0.78, respectively). In this nasal airway evaluation of OSA patients, the presence of sites of obstruction was correlated with the severity of OSA; this was not the case for the evaluation of the nasal airway volume dimensions. Otolaryngology Division Medical School University of Araraquara – UNIARA Department of Diagnosis and Surgery Division of Oral and Maxillofacial Surgery Dental School at Araraquara – UNESP Graduate Programme Medical School University of Araraquara – UNIARA Oral and Maxillofacial Surgery Department of Surgery School of Medical Sciences – UNICAMP Department of Diagnosis and Surgery Division of Oral and Maxillofacial Surgery Dental School at Araraquara – UNESP

Purpose This in vitro investigation was developed with the purpose of comparing the biomechanical features of 3 different methods of rigid internal fixation for sagittal split ramus osteotomies for mandibular advancement. Materials and Methods Rigid internal fixation techniques included a 4-hole plate and 4 monocortical screws (miniplate group), a 4-hole plate and 4 monocortical screws with 1 additional bicortical positional screw (hybrid group), and 3 bicortical positional screws in a traditional inverted-L pattern (inverted-L group). Screws and miniplates were made of titanium and from a 2.0-mm system (MDT, Rio Claro, SP, Brazil). Sixty polyurethane replicas of human hemimandibles (Nacional, Jau, SP, Brazil) were used as substrates, simulating a 5-mm advancement surgery by a sagittal split ramus osteotomy. They were adapted to a test support, and were submitted to lateral torsional forces on the buccal molar surface and vertical cantilever loading on the incisal edge by an Instron 4411 mechanical testing unit (Instron, Norwood, MA) for recording peak loading at 1 mm, 3 mm, 5 mm, and 10 mm of displacement. Each group was formed by 10 replicas, subjected to a linear noncyclical testing only once. Means and standard deviation were analyzed using analysis of variance and Tukey tests, with a 5% level of significance. Testing failures were also recorded. Results The miniplate group showed lowest load peak scores (P < .01) when compared with the other fixation techniques, irrespective of the direction of force. The inverted-L group showed higher resistance (P < .01) than the hybrid group when vertical forces were applied. For molar load, the hybrid and inverted-L groups showed no significant difference. Conclusions For mandibular advancement surgery of 5 mm, it was concluded that the rigid internal fixation technique for sagittal split ramus osteotomies based on 3 bicortical screws in the inverted-L pattern was the most stable in a laboratory environment. Furthermore, the results suggested that installation of a bicortical positional screw in the retromolar region may significantly optimize the resistance of the miniplate and monocortical screw fixation.

The authors verified the anatomical location of the mandibular foramen, lingula and antilingula in dry mandibles, aiming to obtain information that could be used when performing mandibular osteotomies. Forty-four mandibles (88 sides) were evaluated. The distances were measured using a sliding calliper, with the mandibles fixed in a reproducible position. Results showed that the mandibular foramen is on average 5.82 mm below the lingula. Regarding the statistical comparison between the mandibular foramen entrance and the antilingula position, there is no correlation between the position of those two structures in the studied sample. The mandibular foramen is slightly posterior in relation to the centre of the ramus. The lingula is an important anatomic landmark for ramus surgery, and for determining the distance to the mandibular foramen entrance. The use of the antilingula as a landmark for the position of the vertical ramus osteotomy is not recommended.

The aim of this study was to evaluate the efficacy and safety of traumatic orbital defect reconstruction with titanium mesh. A retrospective study was made. Evaluations were made after a minimum postoperative follow-up of 12 months, looking for the main complications. Twenty-four patients were included in this evaluation; 19 were male (79.1%) and 5 (20.8%) were female. The main injury etiology was vehicle accidents (50%) followed by other causes. Fourteen patients (58.3%) presented orbital floor fractures, and 10 had more than one wall fractured (41.6%). Permanent infraorbital nerve hypoesthesia was observed in two patients (8.3%), enophthalmos occurred in five patients (20.8%), and exophthalmos was found in two patients (8.3%). Four patients (16.6%) still presented evidence of residual prolapsed intraorbital content, and one of those needed further surgical correction; sinusitis occurred in one patient (4.1%). Titanium mesh is a reliable option for orbital reconstruction, despite some complications found in this sample.

Bisphosphonates are potent inhibitors of bone resorption, and are used in the treatment of osteoporosis and other diseases that cause bone mass loss, such as Paget's disease, bone metastases, and multiple myeloma, to prevent pathological fractures. Since 2003, avascular osteonecrosis of the jaw has been associated with the use of bisphosphonates, mainly intravenous. According to the literature, the occurrence of osteonecrosis of the jaw has ranged from 0.8% to 12% of the patients on bisphosphonates, most of them on prolonged use. Physicians and odontologists should be aware of that potential complication in dental treatment.

Purpose The correction of maxillomandibular deformities may require maxillary osteotomy procedures that usually present low rates of postoperative complications, such as maxillary sinusitis. The present study evaluated the incidence of maxillary sinusitis after Le Fort I osteotomy in 21 adult patients who underwent maxillary surgery (Le Fort I osteotomy) or bimaxillary surgery (Le Fort I osteotomy plus sagittal mandibular osteotomies) for correction of dentofacial deformities. Patients and Methods Verification of the presence of maxillary sinusitis was assessed through a brief questionnaire, x-rays (Waters views), and nasal endoscopy before surgery and 6 to 8 months after surgery. Results Analysis of results showed an incidence of 4.76% of maxillary sinusitis as a postoperative complication in the studied population. Conclusion Symptomatic patients with a positive radiographic finding or an increased risk for postoperative sinusitis will benefit from endoscopic evaluation to aid in treatment planning and follow-up.

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. MATERIAL 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. CONCLUSIONS: 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.

This in vitro investigation was developed with the purpose of comparing the biomechanical features of 3 different methods of rigid internal fixation for sagittal split ramus osteotomies for mandibular advancement.Rigid internal fixation techniques included a 4-hole plate and 4 monocortical screws (miniplate group), a 4-hole plate and 4 monocortical screws with 1 additional bicortical positional screw (hybrid group), and 3 bicortical positional screws in a traditional inverted-L pattern (inverted-L group). Screws and miniplates were made of titanium and from a 2.0-mm system (MDT, Rio Claro, SP, Brazil). Sixty polyurethane replicas of human hemimandibles (Nacional, Jaú, SP, Brazil) were used as substrates, simulating a 5-mm advancement surgery by a sagittal split ramus osteotomy. They were adapted to a test support, and were submitted to lateral torsional forces on the buccal molar surface and vertical cantilever loading on the incisal edge by an Instron 4411 mechanical testing unit (Instron, Norwood, MA) for recording peak loading at 1 mm, 3 mm, 5 mm, and 10 mm of displacement. Each group was formed by 10 replicas, subjected to a linear noncyclical testing only once. Means and standard deviation were analyzed using analysis of variance and Tukey tests, with a 5% level of significance. Testing failures were also recorded.The miniplate group showed lowest load peak scores (P.01) when compared with the other fixation techniques, irrespective of the direction of force. The inverted-L group showed higher resistance (P.01) than the hybrid group when vertical forces were applied. For molar load, the hybrid and inverted-L groups showed no significant difference.For mandibular advancement surgery of 5 mm, it was concluded that the rigid internal fixation technique for sagittal split ramus osteotomies based on 3 bicortical screws in the inverted-L pattern was the most stable in a laboratory environment. Furthermore, the results suggested that installation of a bicortical positional screw in the retromolar region may significantly optimize the resistance of the miniplate and monocortical screw fixation.

Purpose This retrospective study reviewed cases of fractures of the mandibular angle to identify personal data, social traits, fracture characteristics, treatment modalities, and postoperative complications. Patients and Methods From April 1999 until July 2004, 114 patients were treated for 115 fractures of the mandibular angle by the Division of Oral and Maxillofacial Surgery at Piracicaba Dental School-Unicamp, in Brazil. Results More angle fractures were observed in Caucasian (55%) men (89%) with some kind of drug addiction (62%). Patient mean age was 27 years. The majority of fractures in this study were sustained in altercations, including gunshot wounds (43%), followed by vehicle accidents, including bicycles and being struck by a car (39%). Open fractures were the most frequent (90%), with prevalence of the left side (57%). Only 1 patient sustained bilateral angle fractures. Ninety-seven patients (85%) underwent open reduction. Complications occurred in 19 patients (17%); 10 (9%) were infections. Of the total number of complications, 3 underwent another surgical intervention for refixation. The factors that contributed to the development of postoperative complications were social risks that included alcohol abuse, smoking, and intravenous and nonintravenous drug abuse. Conclusions Angle fracture management outcomes are affected by many factors beyond method of fixation.

Introduction The Frankfort horizontal (FH) is a plane that intersects both porions and the left orbitale. However, other combinations of points have also been used to define this plane in 3-dimensional cephalometry. These variations are based on the hypothesis that they do not affect the cephalometric analysis. We investigated the validity of this hypothesis. Methods The material included cone-beam computed tomography data sets of 82 adult subjects with Class I molar relationship. A third-party method of cone-beam computed tomography-based 3-dimensional cephalometry was performed using 7 setups of the FH plane. Six lateral cephalometric hard tissue measurements relative to the FH plane were carried out for each setup. Measurement differences were calculated for each pair of setups of the FH plane. The number of occurrences of differences greater than the limits of agreement was counted for each of the 6 measurements. Results Only 3 of 21 pairs of setups had no occurrences for the 6 measurements. No measurement had no occurrences for the 21 pairs of setups. Setups based on left or right porion and both orbitales had the greatest number of occurrences for the 6 measurements. Conclusions This investigation showed that significant and undesirable measurement differences can be produced by varying the definition of the FH plane.

Purpose A prospective radiographic study analyzed condylar position in patients who had undergone orthodontic treatment and isolated maxillary advancement after Le Fort I osteotomy. Patients and Methods Eleven patients were selected and radiographic images were taken in the immediate preoperative, immediate postoperative (1-2 weeks), and late postoperative periods (minimum of 6 months). Tracings were done on acetate paper for the submento-vertex radiograph, to measure the axial angulation of the condyles, and for the tomographic images of both sides, in the maximal intercuspation, rest position, and maximal opening, for the 3 periods. Linear measurements were taken for the tomograms over the posterior, superior, and anterior articular spaces. These images with the tracings were digitized and measured by means of computer software (UTHSCSA Image Tool 3.0; University of Texas Health Science Center at San Antonio, San Antonio, TX), after it had been adequately calibrated. Results The analysis of variance (ANOVA; 5% of significance) demonstrated 1 ) that there was no statistically significant difference for the linear measurements of the articular spaces in any of the periods, and 2 ) also not for the angular measure of the condyles ( P > .05). In the maximal opening, there was a significant difference for the immediate postoperative period for both sides ( P = .003). Conclusion Le Fort I osteotomy for maxillary advancement did not cause any significant changes in this specific group of patients evaluated.

We used a two-dimensional model that simulated a fractured human mandible to study the extent of load resistance of different plates. We studied 49 bovine ribs in seven groups using varying number (1 or 2), lengths of plates (4 or 6-holes), and location (near the lower or upper border). The number and location of plates had a greater effect on resistance to load than length of plates. The best mean resistance values were achieved by a combination of two parallel plates secured near the lower and upper borders, followed by single plates secured near the upper border. The lowest values were with single plates secured close to the lower border.

Objectives: The aim of this in vivo study was to compare peri-implant bone density assessed by the mean gray value of the histogram in digitized conventional radiographs and two digital subtraction images (DSI) methods: linear and logarithmic. Material and methods: Thirty-four patients were monitored by standardized periapical radiographs 1 week after surgery and 4 months later. The radiographs were digitized and manipulated by means of EMAGO® software. Linear and logarithmic DSI were obtained, and a filter was added to the logarithmic image. Control and test regions were selected and the mean value of the gray level of the histogram of these selected areas was obtained. This process was carried out in the digitized conventional radiographs (DCR) and the two methods of DSI. After that, the images were divided into two groups, with and without bone loss, and statistical analysis was performed. Results: The results indicate that differences between the jaws did not reach significance, in all the images and in the two groups with and without bone loss. Furthermore, there was no statistically significant difference between the radiographic density assessed in the DCR and the two methods of subtraction images. Conclusions: Monitoring of peri-implant bone density by the mean gray value of the histogram in a selected area can be assessed either by linear and logarithmic DSI or by DCR.

Objective The aim of this study was to assess the characteristics of maxillofacial fractures in the Piracicaba region of Brazil during a 5-year period and to delineate comparisons with worldwide facial fracture patterns. Study design A descriptive statistical analysis was developed based on data collected using a specifically designed clinical survey of all patients who attended the Division of Oral and Maxillofacial Surgery at the Piracicaba Dental School from 1999 to 2004. Information regarding age, gender, etiology, and type of maxillofacial injury and its associated lesions were evaluated. In addition, treatment modalities and complication rates during patient follow-up were assessed. Results A total of 1024 patients presenting 1399 maxillofacial fractures were analyzed. Patients’ ages ranged from 0 to 88 years (mean age, 28 ± 16.4 years). The ratio of men to women was 4:1. Most fractures were caused by traffic accidents (45%), followed by assaults (22.6%), falls (17.9%), sports accidents (7.8%), and work accidents (4.5%). The prevalent anatomic regions of facial fractures (in percentages) were the mandible (44.2%), the zygomatic complex (32.5%), and the nasal bones (16.2%). Associated systemic lesions were found in 41.9% of patients, with prevalence for injuries to the upper (24.1%) and lower limbs (15.4%). Patient management was considered to be conservative in 490 patients (47.9%), and surgical therapy was performed in 493 patients (48.1%), of whom 399 (80.9%) were treated with open reduction and rigid internal fixation. Complications occurred in 76 patients (7.4%), mainly due to infection and malocclusion. Conclusion The findings of this study indicated that epidemiological research of maxillofacial fractures allows the presentation patterns of the most affected individuals and the nature of their lesions to be outlined according to the region evaluated. Furthermore, treatment evaluation and complication rate analysis permits a more realistic interpretation of how patients should be managed.

This retrospective study analyzed the etiologic factors, location and treatments for patients with oroantral or oronasal communications (OAC or ONC). Data analysis extended to gender, age, etiology, location, type of treatment and short-term complications from January 1988 to May 2004. A total of 112 patients with 101 (90%) OAC and 11 (10%) ONC were included. The main etiology for OAC was tooth extraction (95%) with similar prevalence between right (49%) and left (51%) side. For ONC, pathological conditions (27%) and exodontia (27%) were the most prevalent. For the treatment of OAC, suture was the technique most frequently used (60%), followed by buccal fat pad (28%), buccal flap (9%), palatal flap (2%) and one dental transplant (1%). For ONC, the following treatments were used: suture (46%), buccal flap (36%) and palatal flap (18%). Failure to eliminate the communication occurred in six (6%) patients of the OAC group and three (27%) of the ONC group. The results confirm that tooth extraction was the most common etiologic factor for ONC and OAC. Suture, when the communication was small (3-5 mm), and the use of a buccal fat pad (100% successful), when a larger communication existed (>5 mm), seemed to be the two best choices for treatment.

Purpose The purpose of this report was to review and analyze the epidemiologic features of traumatic subcutaneous emphysema (TSE) originating from frontal, nasoethmoidal, and maxillary facial injuries with sinusal involvement in the emergency room setting. Patients and Methods All patients with a fracture involving the paranasal sinuses were evaluated with regard to TSE occurrence. Data analysis extended to gender, age, etiology, fracture sites, TSE location, sinus involvement, treatment, and complications from April 1999 to December 2003. Evaluation methods included computed tomography scan and clinical evaluation. Results A total of 390 patients sustaining 458 paranasal sinus fractures were included. TSE was observed in 29 patients (7.43%) patients (male-female ratio of 3.83:1, with a mean age of 36.71 ± 15.71 years). The main etiologies were vehicle accidents and assaults. Isolated maxillary sinuses fractures were found in 17 cases (58.62%). Ethmoidal and maxillary fractures were associated with 9 cases (31.03%), and 1 (3.45%) case had maxillary and frontal fractures together. Ethmoidal, maxillary, and frontal fractures were found concomitantly in 2 (6.90%) cases. Periorbital emphysema was the most prevalent site of presentation, and edema (86.21%) and bone deformities (79.31%) were the most frequent findings associated with TSE. Conservative treatment was the prevalent treatment choice (55.17%), and 1 complication because of persistent pain was noted. Conclusion The results suggest that TSE of the face associated with paranasal sinus fractures maintained the clinical features of its fractures of origin. The ethmoidal sinuses were considered as the most prevalent etiologic site, and the periorbital region was responsible for addressing the higher incidence of SE following paranasal sinus fractures.

Este estudo cefalométrico retrospectivo foi proposto objetivando analisar a estabilidade do reposicionamento anterior da maxila, utilizando-se a osteotomia Le Fort I. A amostra consistiu de 30 telerradiografias de dez pacientes submetidos a um avanço cirúrgico da maxila, sem segmentação desta ou associação com qualquer cirurgia na mandíbula, realizado pela Área de Cirurgia Buco-Maxilo-Facial da Faculdade de Odontologia de Piracicaba - Unicamp. A mesma técnica de fixação interna rígida foi utilizada para todos os pacientes, e nenhum enxerto ou substituto ósseo foi usado. Três radiografias cefalométricas laterais foram realizadas para cada paciente, nos períodos pré e pós-operatórios imediatos, e com, no mínimo, seis meses após a cirurgia. Sobre estas radiografias foram feitas linhas de referência horizontal e vertical. Os pontos cefalométricos utilizados para calcular as mudanças de posição da maxila foram tanto esqueléticos, quanto dentários. A análise estatística (teste t de student pareado) não demonstrou diferença estatística significante entre os intervalos pós-operatórios imediato e com no mínimo seis meses. Concluímos que o reposicionamento anterior da maxila, utilizando-se a osteotomia Le Fort I, com fixação interna rígida e sem o uso de enxertos autógenos ou qualquer substituto ósseo, é um procedimento estável.

Este estudo cefalométrico retrospectivo foi proposto objetivando analisar a estabilidade do reposicionamento anterior da maxila, utilizando-se a osteotomia Le Fort I. A amostra consistiu de 30 telerradiografias de dez pacientes submetidos a um avanço cirúrgico da maxila, sem segmentação desta ou associação com qualquer cirurgia na mandíbula, realizado pela Área de Cirurgia Buco-Maxilo-Facial da Faculdade de Odontologia de Piracicaba - Unicamp. A mesma técnica de fixação interna rígida foi utilizada para todos os pacientes, e nenhum enxerto ou substituto ósseo foi usado. Três radiografias cefalométricas laterais foram realizadas para cada paciente, nos períodos pré e pós-operatórios imediatos, e com, no mínimo, seis meses após a cirurgia. Sobre estas radiografias foram feitas linhas de referência horizontal e vertical. Os pontos cefalométricos utilizados para calcular as mudanças de posição da maxila foram tanto esqueléticos, quanto dentários. A análise estatística (teste t de student pareado) não demonstrou diferença estatística significante entre os intervalos pós-operatórios imediato e com no mínimo seis meses. Concluímos que o reposicionamento anterior da maxila, utilizando-se a osteotomia Le Fort I, com fixação interna rígida e sem o uso de enxertos autógenos ou qualquer substituto ósseo, é um procedimento estável.This is a retrospective cephalometric study designed to investigate the stability after anterior maxilla repositioning, by Le Fort I osteotomy. Thirty cephalometric radiographs were selected, from ten patients submitted to one-piece surgical maxillary advancement, with no concomitant mandibular surgery, performed by the Division of Oral and Maxillofacial Surgery of Piracicaba Dental School - Unicamp. These cases were submitted to the same internal rigid fixation technique, with no use of bone grafts or any bone substitute. Three lateral cephalometric radiographs were obtained for each patient, immediately presurgery and postsurgery, and at least six months after surgery. Lines were draw upon the X-rays to serve as horizontal and vertical reference lines.The landmarks used to measure maxillary positional changes consisted of skeletal and dental features. Statistical analysis (paired t student test) showed no significant differences between the immediately postsurgery and at least six months postsurgery periods. We concluded that the anterior maxillary repositioning by Le Fort I osteotomy, using rigid internal fixation, with no bone grafts or any bone substitute, is a stable procedure.