Search

Abstract: This systematic review was carried out to determine if maxillomandibular fixation, used in the treatment of maxillary fractures, interferes with respiratory function, and appraised studies that evaluated pulmonary function using spirometry on patients with and without maxillomandibular fixation. Searches were conducted on the following databases: Medline/Pubmed, Embase, Cochrane, Web of Science, Scopus, and Scielo, in addition to a search of the grey literature and a manual search. Five studies were included in the qualitative analysis, but it was not possible to conduct a quantitative study due to the lack of data. Forced vital capacity, forced expiratory volume in the first second, the ratio of these values, and peak expiratory flow were the parameters studied. In all the studies included in this review, it was possible to observe the lowest respiratory parameter values during maxillomandibular fixation and, after removal, normal respiratory function was restored. Accordingly, it was possible to conclude that maxillo-mandibular fixation temporarily affects respiratory function, during use, but it is restored on removal, therefore, not precluding its use on healthy patients who have good nasal breathing prior to the procedure. However, in patients suffering from some form of respiratory limitation or pulmonary disease, and also mouth breathers, maxillomandibular fixation should not be used so as to avoid more severe respiratory complications, underlining the importance of preoperative pulmonary evaluation., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)

Background/aims: Oral and maxillofacial trauma (OMFT) is a public health problem due to its high occurrence and demand for resources for its management and the financial and social impact of OMFT victims on the health system. The aim of this study was to conduct an 8-year prospective analysis of OMFT cases from an emergency service., Materials and Methods: A hospital-based 8-year prospective study on OMFT and associated factors was performed on data from December 2011 to December 2019. Data regarding sociodemographic (gender, age, and skin color) and socio-economic profiles (educational level, family income, and occupation), OMFT profile (etiology, OMFT type, and treatment), associated factors [alcohol consumption and personal protective equipment (PPE) use], OMFT occurrence (injury day and hour), length of hospital stay, and cost were collected. Descriptive and inferential analyses of data were performed., Results: Most OMFT cases involved men with low schooling and family income, resulting from traffic accidents. OMFT severity was associated with longer hospital stay, higher hospital costs and nonuse of PPE, midface fractures (mainly orbital-zygomatic fractures), closed reduction, and open reduction/internal fixation. Traffic accidents were the main cause of longer hospital stays for victims aged 41-60 years with better socio-economic status compared with cases that had higher hospital costs. In general, higher hospital costs were associated with victims of violence under 40 years of age, with low schooling and farmers. Alcohol consumption and non-use of PPE also contributed to increasing the length of hospital stay., Conclusion: Oral and maxillofacial trauma severity was associated with longer hospital stay and higher hospital costs. Associated factors such as alcohol consumption and non-use of PPE contributed to increase the length of hospital stay and OMFT severity., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The objective of this systematic review was to assess whether the use of topical anesthetics reduces the perception of pain during puncture and anesthetic infiltration. Twenty-two randomized controlled clinical trials, published in English on or before August 6, 2020, were found in the PubMed/MEDLINE, Scopus, and Cochrane Library databases. Risk of bias was determined for randomization and other issues. A total of 1029 patients were evaluated using parameters such as type of topical anesthetic, application site, and pain (measured on a scale). Some studies assessed more than one topical anesthetic. Seventeen of them showed a reduction in pain from needle puncture and four from infiltration. Meta-analyses for some results showed considerable statistical heterogeneity. Regarding pain during needle puncture of the maxilla, statistically significant differences were observed in the topical anesthetics group, in both the vestibular (P = 0.0002) and palatal (P = 0.005) region. This was different from the mandible, for which there was no statistically significant difference (P = 0.07). With regard to pain caused by anesthetic infiltration in the maxilla, there was no difference in the use of anesthetic in relation to the control group (P = 0.11). Given these findings, using topical anesthetics only relieves pain during needle puncture and in the maxilla. PROSPERO 2020: CRD42020206362., (Copyright © 2021 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: Peripheral nerves transmit nerve signals between periphery and the spinal cord or brain stem. Its function can be compromised by trauma to the nerve, such as those that occur in surgical procedures such as orthognathic surgery. Depending on the type of injury, treatment may be proposed, but this is still a controversial point in literature. Alternative methods that assist in the treatment of paresthesia should be studied, and in this context, selegiline hydrochloride seems to be a promising drug., Aim: Based on the above, the aim of this study was to evaluate the effectiveness of selegiline hydrochloride in the treatment of facial sensory changes resulting from nerve injuries in patients undergoing maxillary orthognathic surgery., Methods: This was a double-blind randomized clinical trial with the voluntary participation of individuals who underwent orthognathic surgery. The facial sensitivity of these patients was evaluated by 2-point discrimination tests and directional perception in the region related to the lower alveolar nerve. Tests were comparatively applied at times T0 (before surgery), T8 (8 days after surgery), T15 (15 days after surgery), T30 (30 days after surgery), T60 (60 days after surgery), and T90 (90 days after surgery)., Results: The mean age of patients was 31.14 years. With the comparative analysis of the 2-point static test on the chin, difference was observed between groups at times T15 (P = 0.007), T30 (P = 0.010), and T90 (P = 0.027) in the intergroup evaluation. Regarding results of the comparative analysis of the 2-point static test on the lip, difference was observed between groups at times T30 (P = 0.023), T60 (P < 0.001), and T90 (P = 0.005) in the intergroup evaluation. In the direction test on the chin, difference was observed between groups at times T30 (P = 0.015), T60 (P = 0.001), and T90 (P < 0.001) in the intergroup evaluation., Conclusions: Selegiline hydrochloride has shown promising results in the treatment of neurosensory disorders resulting from maxillary orthognathic surgery.

Aim: The aim of this study was to evaluate the available evidence to identify the influence of pterygomaxillary disjunction on the result of surgically assisted maxillary expansion., Background: LeFort I type osteotomy with disjunction of the pterygomaxillary suture is a procedure widely used in maxillofacial surgery. However, the need for its performance during surgically assisted maxillary expansions has been discussed in literature, since serious complications can be caused during this stage., Review Results: Systematic review of articles was performed using three databases (PubMed, Web of Science, and Cochrane) published until May 2019. After applying the selection criteria, five articles were included in the systematic review, with a total of 141 patients. Meta-analysis showed the absence of significant difference between intervention and control groups in the preoperative period (standardized mean difference = -0.28; confidence interval, CI 95% = -0.81, 0.26; p = 0.31) and postoperative period (standardized mean difference = -0.12; 95% CI = -0.65, 0.42; p = 0.66). In general, the heterogeneity of statistical estimates was low ( I 2 = 0%)., Conclusion: No statistically significant difference was observed between control group (without pterygomaxillary disjunction) and intervention group (with pterygomaxillary disjunction)., Clinical Significance: Based on the data analyzed in this systematic review, it could be concluded that pterygomaxillary disjunction is not a mandatory step to achieve satisfactory maxillary expansion. Thus, not performing pterygomaxillary disjunction can prevent complications and reduce surgical time.

Odontogenic tumors (OTs) are important lesions of the gnathic bones due to their clinicopathological heterogeneity and variable biological behavior; therefore, epidemiological studies are needed to outline the incidence and behavior of these tumors. To evaluate the incidence and epidemiological profile of ameloblastoma (AMB) and keratocystic odontogenic tumor (KCOT) from an oral pathology service, and correlate morphological findings of these tumors with the immunoexpression of a cellular proliferation marker (Ki-67), a retrospective study (2002-2012) was conducted to characterize demographic, clinical, radiological, and morphological data of AMBs and KCOTs. Then, a representative sample composed of 49 cases of each tumor was selected to perform immunohistochemical (IHC) analysis of Ki-67 through the streptavidin biotin peroxidase technique. For statistical analysis, we used Fisher's exact test (p < 0.05). A total of 279 OTs were found in the service, in which 91 (32.6%) were AMB and 98 (35 %) were KCOT. Most cases occurred in white women, and the average age of patients with AMB and KCOT was 32 and 33 years, respectively. The maxilla-mandible ratio was 1:6 and 1:3.6 for AMB and KCOT, respectively. Regarding IHC analysis, AMB and KCOT had similar levels of cellular proliferation. However, KCOTs with intense inflammation showed higher Ki-67 expression (p < 0.001). Recurrent cases had similar Ki-67 immunoexpression. The demographic profile of the studied tumors corroborates with data reported in the literature, and the levels of cellular proliferation were similar in both tumors, although the inflammation seems to induce a differential proliferative behavior in KCOT.

Purpose: The purpose of this study was to evaluate the profile of pediatric oral lesions in northeastern Brazil., Methods: Biopsy records of oral lesions were retrieved from patients aged zero to 18 years who were treated over 18 years in two university hospitals in northeastern Brazil. Routine pathological sections were re-examined and classified into six groups: (1) odontogenic and nonodontogenic cysts; (2) odontogenic tumors; (3) salivary gland pathology; (4) nonodontogenic tumors and tumor-like lesions; (5) bone pathology; and (6) miscellaneous., Results: From a total of 4,690 oral biopsies, 564 (12 percent) were from children and adolescents. The largest number of cases was salivary gland pathology, followed by nonodontogenic tumors and tumor-like lesions. The most common oral biopsies were mucocele, pericoronal dental follicle, pyogenic granuloma, dentigerous cyst, and odontoma. Only three cases of malignant tumors were observed. Our results were similar to most studies., Conclusions: Although malignant tumors comprised a small portion of the pediatric oral biopsies, the possibility of their occurrence in children and adolescents should not be overlooked.

Context: Focal fibrous hyperplasia, also known as irritation or traumatic fibroma, is a reactive, inflammatory hyperplastic lesion of the connective tissue., Aim: The aim of this study is to perform a retrospective study of a focal fibrous hyperplasia of 18 years., Materials and Methods: We retrospectively reviewed 193 cases of focal fibrous hyperplasia of the oral cavity from the medical and histological reports of the Department of Oral Pathology, Pernambuco University, Brazil, during the period between January 1992 and December 2009., Settings and Design: Data with regard to age, gender, location, size of the lesion (equal to or less than 1 cm, between 1 and 2 cm and greater than 2 cm), pain, history of trauma, treatment, length of follow-up (from diagnosis to release or last review) and recurrence, were collected., Results: The most commonly affected site was the buccal mucosa (n = 119, 61.7%). Almost two-thirds of the cases were concentrated from the second to the fifth decade of life. Females were more affected than men and a history of trauma was related by 90.7% of the patients. Two recurrences were notified (1.0%)., Conclusion: Further studies are needed on the distribution of the lesion in different ethnic and geographical populations. The influence of sex hormones on the development of focal fibrous hyperplasia must be clarified.

Due to the frequent presence of inflammation in cases of carcinoma and its use as a parameter for the assessment of tumor aggressiveness, the role of inflammation in oral carcinogenesis was investigated. This was performed by evaluating the expression of cellular markers, cytokines and nuclear transcription factors that identify the cells that participate in the antitumor defense in cases of oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). A semi-quantitative immunohistochemical analysis was performed for the transcription factors cluster of differentiation 8 (CD8), forkhead box P3 (FOXP3), transforming growth factor (TGF)-β, tumor necrosis factor (TNF)-α and nuclear factor κ-light chain enhancer of activated B-cells (NF-κB), in cases of OED and OSCC. CD8, TGF-β, TNF-α and NF-κB participated in the processes of tumor transformation and progression. The presence of inflammatory infiltrate in cases of OED favors the transformation and invasion process when stromal TNF-α and NF-kB are overexpressed, as NF-kB activated by TNF-α during inflammation predisposes the lesion to transformation, functioning as a link between inflammation and cancer. The control of these inflammatory mediators may prevent malignant transformation in the oral cavity.

The aim of the present study was to compare the expression of α2β1, α3β1, and α5β1 integrins between 28 pleomorphic adenomas (PAs) and 10 adenoid cystic carcinomas (ACCs), and investigate differences in the expression of these integrins according to histologic subtypes of ACCs. It was taken into consideration the presence or absence, distribution, and localization of integrin immunoexpression. There was immunoreactivity in the intercellular contacts of the strands, nests, and solid sheets of PAs, as well as in the luminal and nonluminal cells of the duct-like structures, with a predominant immunoexpression in the luminal cells. The immunoexpression in ACCs varied with histologic subtype of the tumor. It was verified for a tendency of absence and/or reduced expression of all integrins in the solid subtype of ACCs. In general, PAs revealed a more diffuse and remarkable immunoexpression of all studied integrins than ACCs. The reduced integrins expression in ACC may be related to a lesser degree of cell differentiation in this neoplasm. Moreover, the absence and/or reduced expression of the studied integrins in solid ACC suggest a possible role in pathogenesis and more aggressive biological behavior of this histologic subtype.

The calcifying cystic odontogenic tumor or Gorlin cyst is an uncommon lesion with a variable clinical behavior and considerable histopathologic diversity. The authors report a case of calcifying cystic odontogenic tumor that was being treated as a maxillary sinus mucocele. The possibility of mimicking numerous odontogenic and nonodontogenic lesions makes the calcifying cystic odontogenic tumor difficult for a clinical diagnosis. The present case demonstrates that a specific knowledge in oral pathology is required to differentiate odontogenic lesions.

Purpose: The purpose of this study was to determine the prevalence and predicitve factors of dental anxiety among Brazilian adolescents., Methods: This was a cross-sectional study of a random sample of 340 Brazilian adolescents, done between 2005 and 2010. Corah's Dental Anxiety Scale and an objective questionnaire were used to determine the degree of dental anxiety., Results: The prevalence of moderate to severe dental anxiety was approximately 18%. Dental anxiety was correlated with the following factors: gender (P<.05), age group (P<.001), degree of schooling (P<.001), access to newspapers and/or the Internet (P<02), oral hygiene frequency (P=.005), visits to the dentist (P<.02), reason for last visit to the dentist (P<.001), and experience with dental pain (P=.002)., Conclusions: Dental fear and anxiety in Brazilian adolescents are associated with lack of economic resources, negligence of oral health, low educational level, female gender, and younger age.

The aim of the present study was to assess the suppressant role of the inflammatory infiltrate in oral carcinogenesis through the immunohistochemical expression of CD8 and FOXP3 and to discuss how representative this expression proved, as well as other parameters considered to be of prognostic value. A total of 20 cases of oral epithelial dysplasia and 40 cases of oral squamous cell carcinoma were selected. The criteria suggested by the World Health Organization were used for the histological grading of dysplasia. For carcinoma, a binary method was developed for the present study using parameters such as type of invasion, maturity, presence of epithelial masses and dysmorphism of the masses. Immunohistochemical analysis was performed for assessment of the expression of anti-CD8 and anti-FOXP3 in cases of dysplasia and carcinoma. Although the inflammatory infiltrate was more intense in the majority of carcinomas, it exercised a protective role in the dysplasia cases, as CD8 expression was significantly greater. Although a correlation was found between CD8 and the intensity of the inflammatory infiltrate in the carcinoma cases, CD8 demonstrated >5% expression in only 32.5% of the cases, compared to 80% of the dysplasia cases. Thus, we suggest that the inflammatory infiltrate should not be used as a parameter in routine examinations, as it plays different roles in the various stages of carcinogenesis. The histological grading system for malignancy employed in the present study is indicated for the assessment of oral squamous cell carcinoma.

Unlabelled: Because of its biocompatibility and osteoconductive properties, calcium-phosphate cement has been used as bone surrogate., Objective: The purpose of this study was to do a histomorphometric comparison of bone regeneration using hydroxyapatite biphasic ceramic, calcium-phosphate cement and autogenous bone graft., Study Design: Prospective and laboratorial experiment., Materials and Methods: Two 5mm in diameter cavities (left and right--test and control) were made in the parietal bone of 72 rats. The GI, GII, GIII and GIV test cavities were filled with calcium-phosphate cement, biphasic ceramic hydroxyapatite, autogenous bone graft and blood. The animals were killed at 30, 60 and 90 days and the specimens underwent histomorphometric analysis., Results: The results showed that autogenous bone graft treated defects had significantly more new bone at 30 days compared to other test groups. Within 60 and 90 days, bone formation was more significant in the test groups GI, GII and GIII; GI and GII encompassed larger areas. Throughout the evaluation periods, GII tests showed more bone formation when compared to GI., Conclusions: Biomaterials depicted a significantly increase in bone content, when compared to autogenous bone graft, concerning bone regeneration.

The aim of the present study was to assess the clinical and radiographic repercussions of surgically assisted maxillary expansion on the septum, nasal cavity and nasal conchae. The sample was made up of 15 patients with skeletal maturity (9 females and 6 males between 16 and 45 years of age) and maxillary transverse deficiency. Assessments were performed through anterior rhinoscopy and frontal cephalometric radiographs on three occasions: (T0) preoperative period, (T1) locking of the expander and (T2) six months following the locking procedure. An increase was observed in the basal portion of the pyriform aperture and distances between the lateral wall of the basal portion of the pyriform aperture and the septum. The radiographic exam revealed that the nasal septum did not undergo any statistically significant change in its position. Moreover, no significant changes in the position of the nasal septum or nasal conchae were detected throughout the three evaluation times. The results suggest that surgically assisted maxillary expansion is capable of widening the basal portion of the pyriform aperture, with little repercussion on the anterior position of the nasal septum and inferior nasal conchae.

Hereditary gingival fibromatosis is characterized by a slow, progressive increase in the gingival tissue that develops as either an isolated disorder or as part of the clinical characteristics of diverse syndromes. The present case report describes a Brazilian family with individuals from three generations affected. The proposed treatment was maxillary and mandibular gingivectomy with 12 months of monitoring.

Unlabelled: Odontogenic tumors are neoplasms that develops exclusively in the gnathic bones; they originate from odontogenic tissues, by epithelial or mesenchymal proliferation, or both., Aim: To evaluate the incidence of odontogenic tumors in a specific institution, and to compare these findings with other studies in the literature. STUDY FORMAT: A cross-sectional cohort retrospective study., Material and Method: The sample was obtained from the files of patients with odontogenic tumors diagnosed between January 1992 and March 2007 (15 years). Cases in which the diagnosis could be adapted to the new World Health Organization (WHO) of 2005 were included. Data such as gender, age, anatomical site, histological type and symptomatology were analyzed., Results: Odontogenic tumors were 4.76% of all biopsied lesions within the studied period. The mean age was 30.7 years; 57% of the patients were male. The keratocystic odontogenic tumor was the most prevalent histological type (30%), followed by the ameloblastoma (23,7%). The rate of asymptomatic cases was 75.7%., Conclusion: Odontogenic tumors occurred more frequently in females, in the second and third decades of life, and more commonly in the mandible; most cases were asymptomatic.

The expression of integrins alpha2beta1, alpha3beta1, and alpha5beta1 in 30 ameloblastomas (20 solid and 10 unicystic tumors), 12 adenomatoid odontogenic tumors (AOTs), and 5 human tooth germs in different stages of odontogenesis was analyzed. The distribution, location, pattern, and intensity of immunohistochemical expression were evaluated. Intensity was analyzed using scores (0 = absence, 1 = weak staining, and 2 = strong staining). No difference in the immunoexpression of the integrins was observed between solid and unicystic ameloblastomas. When these two ameloblastoma types were pooled into a single group, the following significant differences were found: immunoexpression of integrin alpha2beta1 was stronger in ameloblastomas than in AOTs and tooth germs, and the expression of integrin alpha5beta1 was stronger in ameloblastomas than in AOTs. The lack of detection of integrin alpha3beta1 in tooth germs and its detection in the odontogenic tumors studied suggest that this integrin might be used as a marker of neoplastic transformation in odontogenic tissues.

The objective of this study was to determine the correlation of the radiographic and morphological features of the dental follicle of unerupted third molars with incomplete root formation. A cross-sectional study was carried out with 56 patients (105 teeth) aged 13 to 24 years. Panoramic radiography was used to determine the stage of root formation to locate and measure pericoronal radiolucency. The width of the dental follicle ranged from 0.0 to 4.0 mm, the distal face being the one most frequently involved, and stage 7 of root formation showing the highest incidence. An inactive enamel reduced epithelium and inactive epithelium remnant also showed a high incidence. Dense connective tissue showed a high incidence, chronic inflammation was infrequent and calcification was a common finding. There was a significant association between the progression of the rhizogenesis and the transformation of the enamel reduced epithelium into a stratified squamous epithelium. No significant association was found between rhizogenesis and the other morphological findings or between the latter and the width of the pericoronal space. It was concluded that there was no clinically significant correlation between the radiographic and morphological features. Every asymptomatic unerupted third molar should be followed up and the follicular tissue analyzed.