Condylar positioning in orthognathic surgery

Aim: Orthognathic surgery aims to correct facial skeletal deformities and the correct condylar positioning is very important for stable results. The aim of the present study was to verify the occurrence of changes in the postoperative condylar positioning in artificial skulls with a skeletal Class II maxillomandibular relationship submitted to bilateral sagittal split osteotomy when the method of cephalometric data transfer was used. Methods: Ten skeletal Angle class II polyurethane skulls were used with metallic markers in the articular surfaces of the temporomandibular joint and mandibular condyles. The skulls were submitted to preoperative and postoperative cone beam computed tomography before and after the bilateral sagittal split osteotomy. To verify the condylar positioning, measurements between the distances of the markers at the temporal bones and mandibular condyles were taken in the coronal and sagittal views by the DISTANCE tool of the iCat Vision software. All measurements were obtained by one examiner in the preoperative and postoperative CBCTs, tabulated and submitted to statistical analysis by the Wilcoxon test with a level of significance of 5% (p<0,05). After 15 days of the completion of the first data collection, all measurements were redone to determine the random and systematic error by the Intraclass Correlation Coefficient. Results: With the exception of the average of the lateral-medial distance (from the measurements between the medium left markers only), the averages of the anterior-posterior distances (only in the left posterior and lateral right markers) and the vertical average (only in the central markers) showed no statistically significant differences between the preoperative and postoperative distances of the metallic markers. Conclusion: Even when using the method of cephalometric data transfer, variation of the condylar positioning occurred between the preoperative and postoperative periods. This variation occurred only in a few points of the mandibular condyles.

Clinical, tomographic aspects and relevance of torus palatinus: case report of two sisters

Despite the nomenclature suggested to be a tumor, torus palatinus (TP) is an overgrowth of the bone in the palatal region and represents an anatomic variation. Its prevalence varies among the population studied and its etiology is still unclear; however, it seems to be a multifactorial disorder with genetics and environmental involvement. Surgical removal of the TP is indicated in the following circumstances: (1) deglutition and speech impairment, (2) cancer phobia, (3) traumatized mucosa over the torus, and (4) prosthetic reasons. The aim of this case report is describe cases that occurred in two sisters, emphasizing the genetic etiology of this anatomic variation. In addition, intra-oral exam and computed tomography scan (axial, coronal and sagittal view) provided a detailed assessment of the TP and elimination of other possible diagnoses, furthermore allowed a better analyzes of the anatomic relation with adjacentes structures. No surgical removal was indicated for both cases.

Surgical treatment of extensive complex odontoma in the mandible by corticotomy. A case report

Odontomas represent the most prevalent odontogenic tumors in the jaw. The treatment of choice is surgical removal, usually performed by conventional techniques involving ostectomies to expose the tumor. In this paper, the authors describe, through the report of a case of complex odontoma located in the mandibular angle, a more conservative surgical technique called corticotomy, in which the bone removed for access to the tumor (buccal cortical) is repositioned and fixed by titanium plates of 1.5 mm.

Complicações após expansão de maxila cirurgicamente assistida

INTRODUÇÃO: O tratamento da deficiência transversal de maxila, em adultos, exige a expansão de maxila cirurgicamente assistida. Diversas técnicas cirúrgicas são conhecidas para a realização desse procedimento, porém estas relacionam-se com complicações. OBJETIVO: Avaliar a incidência de complicações associadas ao procedimento de expansão de maxila cirurgicamente assistida. MATERIAL E MÉTODO: Trinta e três indivíduos com deficiência transversal de maxila foram submetidos ao procedimento de expansão pela técnica da osteotomia Le Fort I subtotal com degrau no pilar zigomático-maxilar, disjunção ptérigo-maxilar e osteotomia da sutura intermaxilar. Durante os períodos trans e pós-operatório, as complicações relacionadas ao procedimento e as distâncias interdentais foram registradas. RESULTADO: Doze homens e 21 mulheres, com idade média de 24,64 anos, submeteram-se ao procedimento. As mensurações das distâncias interdentais evidenciaram aumento das mesmas entre os períodos pré-operatório e pós-operatório de 2 meses. As complicações prevalentes foram sinusite (6%) e deslocamento associado à inclinação dental (6%). CONCLUSÃO: A expansão de maxila cirurgicamente assistida é um procedimento eficaz e de baixa morbidade para o tratamento da deficiência transversal de maxila em indivíduos adultos.

The use of Le Fort I Approach in the resection of an extensive ossifying fibroma

INTRODUCTION

Ossifying fibroma (OF) is a well-defined benign neoplasm characterized by slow growth and predilection for the posterior mandible site, usually treated by conservative surgical approaches. In this context, Le Fort I Approach (LFIA) has been increasingly used providing good visualization and an easy access to the lesion. It also allows removal of the lesion quickly. Although there are case reports using LFIA for the management of benign neoplasms, odontogenic cysts and tumors of the middle third of face, to our knowledge, only one article describes the use of surgical LFIA for OF of the maxilla. Thus, the objective of this study was to report the second paper on the use of horizontal osteotomy of the maxilla in the resection of an extensive OF and conduct a brief literature review on this surgical approach.

CASE REPORT

The following case report describes a 33-year-old man who was diagnosed with OF. Oral examination showed a painless swelling of hard consistency, covered by normal mucosa in edentulous alveolar ridge of the maxillary posterior region of the right side. Tomographic slices revealed that the image with mixed density had a centrifugal growth, with expansion of the buccal and lingual cortical with an upper displacement of the maxillary sinus. The patient was admitted to the hospital for surgical resection of the lesion via LFIA. Satisfactory functional results were obtained after 18-month follow-up period. In addition, no recurrence or clinical complaints were noted.

DISCUSSION

LFIA shall be considered as a feasible option when planning surgery for removal of extensive benign lesions located in midfacial region because it is a predictable technique and routinely performed by the oral and maxillo-facial surgeons.

Clinical and surgical treatment of a rare lingual cyst in a 12-year-old girl

Cysts lined with gastrointestinal or respiratory epithelium are rarely found in the oral cavity. These lesions usually involve the ventral surface of the tongue or floor of the mouth. This article describes a new case of a lingual cyst lined by respiratory epithelium, discussing its clinical relevance, surgical management, and ideal time for intervention.

[Complete atrioventricular block in Kearns-Sayre syndrome]

A thirty-three year old woman, known to have Kearns-Sayre syndrome for eight years, had an ECG pattern of right bundle branch block and left anterior fascicular block that evolved to complete atrioventricular block, leading her to a syncopal episode. A temporary pacemaker and a permanent one were installed. The patient has been asymptomatic so far.