Abstract: The aim of this study was to evaluate patient perception of surgical discomfort in third molar surgery and the association with clinical variables and polymorphisms associated with the FKBP5, SLC6A4, and COMT genes. This cross-sectional observational study was carried out on 196 participants aged between 18 and 64 years at the Federal University of Paraná in 11 months. The intensity of surgical discomfort was assessed using the QCirDental questionnaire. Data on surgical and individual procedures were also cataloged. The oral health related quality of life was assessed by the Oral Health Impact Profile questionnaire (OHIP-14). The DNA sample was obtained from cells of the oral mucosa. Five markers of the FKBP5, SLC6A4, and COMT genes were genotyped. The data were submitted to statistical analysis with a significance level of 5%. Women reported greater intensity of discomfort associated with third molar surgery compared to men (p = 0.001). In the recessive model, the AA genotype of the rs3800373 marker was associated with greater surgical discomfort (p = 0.026). Therefore, women and individuals of the AA genotype for the rs3800373 marker in the FKBP5 gene reported greater surgical discomfort associated with third molar surgery.
Abstract The aim of this study was to evaluate the stress and dislodgement resistance by finite element analysis of different types of fixation in mandibular orthognathic surgery. A 3D solid finite element model of a hemi-mandible was obtained. A bilateral sagittal split osteotomy was simulated and the distal segment was advanced 5 mm forward. After the adjustment and superimposing of segments, 9 different types of osteosynthesis with 2.0 miniplates and screws were simulated: A, one 4-hole conventional straight miniplate; B, one 4-hole locking straight miniplate; C, one 4-hole conventional miniplate and one bicortical screw; D, one 4-hole locking miniplate and 1 bicortical screws; E, one 6-hole conventional straight miniplate; F, one 6-hole locking miniplate; G, two 4-hole conventional straight miniplates; H, two 4-hole locking straight miniplates; and I, 3 bicortical screws in an inverted-L pattern. In each model, forces simulating the masticatory muscles were applied. The values of stress in the plates and screws were checked. The dislodgement resistance was checked at the proximal segment since the distal segment was stable because of the screen at the occlusal tooth. The regions with the lowest and highest displacement were measured. The offset between the osteotomized segments was verified by millimeter intervals. Inverted-L with bicortical screws was the model that had the lowest dislodgment and the model with the lowest tension was the one with two conventional plates. The results suggest that the tension was better distributed in the locking miniplates, but the locking screws presented higher concentration of tension.
Resumo O objetivo deste estudo foi verificar o estresse e a resistência ao deslocamento, pela análise de elementos finitos, de diferentes tipos de fixação em cirurgia ortognática mandibular. Um modelo 3D de elementos finitos sólidos de uma hemi-mandíbula foi obtido. Uma osteotomia sagital bilateral foi simulada e o segmento distal foi avançado 5 mm. Após o ajuste e sobreposição dos segmentos, foram simulados 9 diferentes tipos de osteossíntese com miniplacas e parafusos 2.0: A, uma miniplaca reta convencional de 4 furos; B, uma miniplaca reta lock de 4 furos; C, uma miniplaca convencional de 4 furos e um parafuso bicortical; D, uma placa lock de 4 furos e 1 parafuso bicortical; E, uma miniplaca reta convencional de 6 furos; F, uma miniplaca lock de 6 furos; G, duas miniplacas retas convencionais de 4 furos; H, duas miniplacas lock de 4 furos; e I, três parafusos bicorticais em um padrão L invertido. Em cada modelo foram aplicadas forças simulando os músculos mastigatórios. Foram verificados os valores da tensão nas placas e parafusos. A resistência ao deslocamento foi verificada no segmento proximal, uma vez que o segmento distal era estável. Foi medida a região com o maior deslocamento inferior e superior. O deslocamento entre os segmentos osteotomizados foi verificado por intervalos milimétricos. Parafusos bicorticais em L invertido foram o modelo que teve o menor descolamento inferior, e o modelo com a tensão mais baixa foi o de duas placas convencionais. Os resultados sugerem que a tensão foi melhor distribuída nas miniplacas do tipo lock, mas os parafusos de fixação apresentaram maior concentração de tensão.
Dental treatment and surgery is a well-established method of correcting dentofacial deformities, and such treatment has an impact on the quality of life of individuals. The objective of this study was to evaluate the effect of orthognathic surgery on the quality of life of patients receiving treatment at the Universidade Federal do Paraná – UFPR. Clinical data were evaluated for the control group, and a quality-of-life evaluation questionnaire was completed [Oral Health Impact Profile (OHIP-14)]. For the case group, the same data were gathered along with information regarding their dentofacial deformity. The OHIP-14 questionnaire was also completed at three distinct stages of the experiment. The median age in the control group was 23.5 years. In the case group, the predominant gender was female, and the mean age of patients was 29.4 years. There was a statistically significant association between gender and OHIP-14 (p< 0.001). No such association was observed between age and OHIP-14 scores (p= 0.616). In the control group the OHIP-14 median score was 11.5. In the case group, the average OHIP-14 score at was 18 at T0, 21 at T1, and 8 at T2. The results demonstrated a statistically significant association between the three time stages at which OHIP-14 was analyzed (p< 0.001). There was a smaller reduction in the negative impact for transversal deformities of the jaw when compared with other deformities. Orthognathic surgery led to a reduction in the negative effects on the quality of life of patients.
Abstract Introduction: Patients with dentofacial deformities may undergo orthodontic or orthodontic-surgical treatment. Both modalities can affect esthetics. Objective: This study aims to evaluate clinical and radiographic changes in exposure of maxillary central incisors occurring after orthognathic surgery for maxillary advancement. Methods: A total of 17 patients who underwent orthognathic surgery for maxillary advancement between September, 2010 and July, 2011 were selected. Exposure of maxillary central incisors was evaluated clinically and by lateral cephalograms. Measurements were taken one week before and three months after surgery. Data were paired in terms of sex, age, nasolabial angle, height and thickness of the upper lip, the amount of maxillary advancement, clinical exposure and inclination of maxillary central incisor by statistical tests (CI 95%). Results: After maxillary advancement, incisor clinical exposure had increased even with relaxed lips and under forced smile. Moreover, there was a mean increase of 23.33% revealed by lateral cephalograms. There was an inverse correlation between upper lip thickness and incisors postsurgical exposure revealed by radiographic images (p = 0.002). Conclusions: Significant changes in the exposure of maxillary central incisors occur after maxillary advancement, under the influence of some factors, especially lip thickness.
Resumo Introdução: pacientes portadores de deformidades dentofaciais podem submeter-se a tratamento ortodôntico ou ortodôntico-cirúrgico. Ambos podem modificar a estética do paciente. Objetivo: esse estudo tem por objetivo avaliar, clinicamente e radiograficamente, as mudanças na exposição dos incisivos centrais superiores em pacientes submetidos à cirurgia ortognática de avanço de maxila. Métodos: foram selecionados 17 pacientes submetidos à cirurgia ortognática de avanço maxilar no período de setembro de 2010 a julho de 2011. A exposição dos incisivos centrais superiores foi avaliada clinicamente e por meio de radiografias cefalométricas em norma lateral. Essas medidas foram tomadas uma semana antes e três meses depois da cirurgia. Os dados foram, por meio de testes estatísticos (CI 95%), correlacionados por sexo, idade, ângulo nasolabial, altura e espessura do lábio superior, quantidade de avanço maxilar, exposição clínica e inclinação dos incisivos centrais superiores. Resultados: após o avanço maxilar, houve um aumento da exposição clínica dos incisivos tanto com o lábio superior relaxado quanto sob sorriso forçado. Além disso, obteve-se um aumento médio de 23,33% na exposição dos incisivos nas radiografias cefalométricas em norma lateral. Houve correlação inversa entre a espessura do lábio superior e a exposição pós-cirúrgica dos incisivos nas imagens radiográficas (p = 0,002). Conclusão: mudanças significativas na exposição dos incisivos centrais superiores ocorrem após o avanço maxilar, sob influências de certos fatores, especialmente a espessura do lábio superior.
<sec><title>Aim:</title><p> To evaluate the increase of pharyngeal airway space (PAS) in patients undergoing mandibular advancement.</p></sec><sec><title>Methods:</title><p> A retrospective cross-sectional study was performed in thirteen patients who underwent mandibular advancement and were evaluated by cephalometric tracing in pre and postoperative lateral radiographs. In cephalometric tracing, the PAS was assessed by measuring the distance from the lower portion of the soft palate to the posterior pharyngeal wall (UP-PHW) and from the tongue base to the posterior pharyngeal wall (TB-PHW).</p></sec><sec><title>Results:</title><p> Patients' age ranged from 22 to 42 years with an average of 28.54 ± 2.23 years. A preoperative mean of 9.20 ± 4.56 mm in the UP-PHW measure and 10.53 ± 5.84 mm in the TB-PHW measure were obtained. The mean values found for those measurements in the postoperative period were 11.61 mm and 13.95 mm, respectively. There was an average increase of 2.4 mm in the UP-PHW and of 2.95 mm in the TB-PHW. The mean mandibular advancement in evaluated patients was 5 mm. There was no statistical correlation between PAS increase and the amount of mandibular advancement for UP-PHW (p=0.058) and TB-PHW (p=0.53), as there was no such correlation either between PAS increase and the age of patients for UP-PHW (p=0.16) and TB-PHW (p=0.26). A greater effect of the retrolingual dimension in mandibular advancement was observed, with an average increase of 24.52% while in the retropalatal dimension an average increase of 20.75% was obtained.</p></sec><sec><title>Conclusions:</title><p> Surgical advancement of the mandible increases the size of the pharyngeal airway space.</p></sec>
Unilocular bone cysts are the most common entities affecting the maxillofacial region. The mechanism of proliferation and expansion remains unclear. Metalloproteinases (MMPs) are associated to diverse pathological conditions. The aim of the present study was to correlate the radiographic aspect (area) and the presence of MMP-2 and MMP-9 in dentigerous cysts, radicular cysts and keratocystic odontogenic tumors. The radiographic area of each lesion was calculated using the mathematical formula of the ellipse area. All specimens were subjected to immunohistochemical analysis for these enzymes. The average radiographic area was 284.17 mm2, 235.81 mm2 and 381.81 mm2, respectively. Statistical analyses revealed no association between the immunoreactivity of MMPs and radiographic area of the lesions in all pathologies studied, except for MMP-2 and radicular cysts, for which smaller lesions had increased immunostaining for this enzyme. The results demonstrate that quantities of MMP-2 and MMP-9 are especially involved with dentigerous and radicular cysts in expansion, whereas these enzymes seem to be related to the biological behavior of keratocystic odontogenic tumors, indicating invasion and cell proliferation. Moreover, there is an inverse association between MMP-2 and MMP-9 in keratocystic odontogenic tumors (p=0.03; rs=-0.660), indicating activity in different regions.
Cistos ósseos uniloculares são as entidades mais comuns que afetam a região maxilofacial. O mecanismo de proliferação e expansão permanece obscuro. As metaloproteinases (MMPs) estão associadas a diversas condições patológicas. O objetivo do presente estudo foi correlacionar o aspecto radiográfico (área) e a presença de MMP-2 e MMP-9 em cistos dentígeros, cistos radiculares e tumores odontogênicos queratocísticos. A área radiográfica de cada lesão foi calculada usando a fórmula matemática da área de elipse. Todas as amostras foram submetidas à análise imunoistoquímica para estas enzimas. A área radiográfica média foi de 284,17 mm2, 235,81 mm2 e 381,81 mm2, respectivamente. As análises estatísticas não mostraram associação entre a imunorreatividade de MMPs e área radiográfica das lesões em todas as patologias estudadas, exceto para MMP-2 e cistos radiculares, nas quais as lesões menores tinham maior imunomarcação para esta enzima. Os resultados demonstraram que a quantidade de imunomarcação da MMP-2 e MMP-9 estão envolvidos com cistos dentígeros e radiculares na expansão óssea, ao passo que estas enzimas parecem estar relacionados com o comportamento biológico dos tumores odontogénicos queratocísticos, indicando invasão e proliferação celular. Além disso, há uma relação inversa entre a MMP-2 e MMP-9 em tumores odontogénicos queratocísticos (p=0,03; rs= -0,660), indicando atividade em diferentes regiões.
La extracción del tercer molar es un procedimiento habitual que pocas veces se asocia a complicaciones. Una posible complicación asociada es el desplazamiento de la pieza dental a la fosa infratemporal, una estructura anatómica que contiene el músculo temporal, el músculo pterigoideo interno y externo, el plexo pterigoideo, la arteria maxilar y sus ramas, el nervio mandibular y sus ramas y la cuerda del tímpano (una rama del nervio facial). El caso descrito en este manuscrito ilustra la extracción quirúrgica diferida de un tercer molar maxilar que se había desplazado a la fosa infratemporal, a través de un acceso intraoral y con anestesia local. A pesar de que es una complicación excepcional, el cirujano experto en cirugía oral y maxilofacial debe conocer su tratamiento y seleccionar la técnica óptima, teniendo en cuenta los signos y síntomas manifestados por el paciente, y en función de sus conocimientos y experiencia.
Third molar extraction is a common procedure and it is rarely associated with complications. One complication that may be associated with this procedure is displacement of the tooth into the infratemporal fossa, an anatomical structure that contains the temporalis muscle, medial and lateral pterygoid muscles, the pterygoid plexus, the maxillary artery and its branches, the mandibular nerve and its branches, and the chorda tympani. The present case report illustrates delayed surgical removal of a maxillary third molar that was displaced into the infratemporal fossa, via the intraoral access and under local anesthesia. Despite the rarity of this complication, oral and maxillofacial surgeons should be aware of its management and able to choose the optimal technique, taking into account the patient's signs and symptoms as well as the knowledge and experience of the surgeon.
Objetivo: Este estudio retrospectivo explora el espectro y las características de los pacientes tratados con cirugía ortognática en la Universidade Federal do Paraná. Material y método: A lo largo de 6 años, a partir de julio de 2002 hasta julio de 2008, se efectuó el seguimiento de 195 pacientes con deformidades dentofaciales que se sometieron a procedimientos de cirugía ortognática. Resultados: La edad media de los pacientes fue de 25,87 años (de 14 a 65) y la proporción de mujeres y hombres fue de 1,5:1. El grupo racial predominante fue el "blanco". La mayoría de los pacientes eran parte de la población económicamente productiva. Sesenta y dos pacientes tenían la dentadura completa. Sólo el 3,59% de los pacientes fueron sometidos a anestesia local (expansión rápida de paladar). La deficiencia transversal maxilar fue la deformidad más común, seguida por la deficiencia anteroposterior del maxilar asociado con el exceso anteroposterior del maxilar inferior. La cirugía más realizada fue el retroceso mandibular. El procedimiento de cirugía duró una media de 3 h y 51 min, y el tratamiento de ortodoncia se prolongó 44,48 meses. Hubo complicaciones en el 22,57% de los pacientes, y las más habituales fueron parestesias (7,17%) y reducción inadecuada de la fractura (5,12%). Conclusiones: Los resultados de esta investigación muestran algunos conceptos que pueden caracterizar el perfil ortognático de los pacientes en el sur de Brasil. También tiene como objetivo colaborar en la correcta instauración de protocolos de cuidado de los pacientes a fin de mejorar los resultados de los procedimientos.
Objective: The present retrospective study explored the spectrum and characteristics of patients treated with orthognathic surgery at the Universidade Federal do Paraná, 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.
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.