Accurate Approach in the Treatment of Oral Bisphosphonate-Related Jaw Osteonecrosis

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is not completely understood and difficult to treat. Even though the occurrence of BRONJ is mainly related to the therapy with intravenous bisphosphonates (BPs), this article reports a case of long-term oral BP use and BRONJ occurrence. In addition, a literature review provides some additional information about BPs, BRONJ, and also a guideline for the prevention and treatment of BRONJ stages. A 79-year-old patient presented intense and persistent pain, purulent secretion, and exposed bone at the right side of the lower jaw. Thus, she was submitted to anamnesis, radiologic and tomographic examinations, and bacterial culture and sensitivity tests. These procedures were followed by surgical debridement of the bone and surrounding tissues/cyst and antibiotic prescription and histopathologic analysis of the fragments. Together, the examinations performed showed the occurrence of stage 2 BRONJ. Moreover, the antibiotic prescription, discontinuation of oral BP, and surgical procedures ensure that the patient had no more symptoms. Therefore, considering the presented case, we believe that an accurate approach is promising to diagnose and treat stage 2 BRONJ and other associated pathologic findings.

Cephalometric Evaluation of Pharyngeal Airway Space Changes in Class III Patients Undergoing Orthognathic Surgery

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of orthognathic surgery for class III correction on quality of life as measured by SF-36

The purpose of this work was to evaluate the quality of life of patients with Angle's class III malocclusion submitted to orthognathic surgery. Twenty-nine patients of both sexes, ranging in age from 17 to 46 years, with Angle's class III malocclusion and indication for surgical treatment, were evaluated about 30 days before surgery and 6 months postoperatively. Surgery consisted of maxillary advancement or mandibular retrusion, or both. The generic SF-36 questionnaire was used to evaluate the following eight domains: functional capacity, physical aspects, pain, general health status, mental health, emotional aspects, social aspects and vitality. Descriptive and inferential statistical analyses were used to determine possible interactions between timing of evaluation, gender and type of surgery. With respect to physical and social aspects, a significant difference in outcomes was observed, with mean scores being higher after surgery regardless of gender or type of surgery. Regarding emotional aspects, an interaction effect was observed for timing and gender, with higher mean scores only being obtained for females after Surgery. Orthognathic Surgery had a positive impact on the quality of life of both male and female patients, improving physical and social aspects, and on that of female patients, improving emotional aspects.

Densidade mineral óssea em cadelas submetidas à ovarioisterectomia com e sem reposição estrogênica oral

Estudaram-se os efeitos da ovarioisterectomia na densidade mineral óssea de cadelas e da reposição de estrógenos após a cirurgia. Foram utilizadas 12 cadelas, sem raça definida, entre dois e seis anos de idade e pesos entre 5 e 15kg. Os animais, submetidos à ovarioisterectomia, foram separados em dois grupos de seis. Um grupo serviu como controle, e o outro recebeu estrógenos naturais conjugados na dose de 0,01mg/kg via oral a cada 48 horas, durante 12 meses. No dia da cirurgia e após 12 meses, foram feitas radiografias com vistas à densitometria óptica em imagem radiográfica. A ovarioisterectomia diminuiu a densidade óssea, e a reposição estrogênica, na dose utilizada, foi capaz de preservá-la.

Referral letters in oral medicine: an approach for the general dental practitioner

The aim of this study was to analyze the contents of referral letters related to clinical history and reason for consultation. A total of 236 consecutive referral letters were evaluated. Analysis of the referral letters was based on key items concerning patient identification. chief complaint, previous consultation. laboratory investigation and use of drugs for the chief complaint. A database was organized (Epinfo 6.04) and the chi (2) test (a = 0.05) was applied to the results. of the 800 files examined. only 30%, (236) had a referral letter. of the 236 referral letters. 67% were from dentists, 22% from physicians and 11% from unidentified professionals. Patient age did not appear in 70%, of the letters and the chief complaint was mentioned only in 55%. The letters had no details such as description of the oral lesion (80%), anatomical site (34%), size (99%), symptoms (83%), or period of evolution (92%). Clinical diagnosis was not included in 84% of the letters. Less than 5% of the referral letters contained information about previous consultation and laboratory investigation. The chi (2) test showed significant differences for ail items of the referral letter. Referral letters did not satisfy minimal requirements about clinical history or reason for consultation. leading to failed communication among professionals. Based on this study, we suggest that standard letters are important to improve the quality of the letters, reducing the rate of omission of relevant items.

Postsurgical stability of oropharyngeal airway changes following counter-clockwise maxillo-mandibular advancement surgery

Purpose: This study evaluated oropharyngeal airway changes and stability following surgical counter-clockwise rotation and advancement of the maxillo-mandibular complex.Methods and Patients: Fifty-six adults (48 females, 8 males), between 15 and 51 years of age, were treated with Le Fort I osteotomies and bilateral mandibular ramus sagittal split osteotomies to advance the maxillo-mandibular complex with a counter-clockwise rotation. The average postsurgical follow-up was 34 months. Each patient's lateral cephalograms were traced, digitized twice, and averaged to estimate Surgical changes (T2-T1) and Postsurgical changes (T3-T2).Results: During surgery, the occlusal plane angle decreased significantly (8.6 +/- 5.8 degrees) and the maxillo-mandibular complex advanced and rotated counter-clock-wise. The maxilla moved forward (2.4 +/- 2.7 mm) at ANS and the mandible was advanced 13.1 +/- 5.1 min at menton, 10 +/- 4.4 mm at point B, and 6.9 +/- 3.7 mm at lower incisor edge. Postsurgical hard tissue changes were not statistically significant. While the upper oropharyngeal airway decreased significantly (4.2 +/- 3.4 min) immediately after surgery, the narrowest retropalatal, lowest retropalatal airway, and the narrowest retroglossal airway measurements increased 2.9 +/- 2.7, 3.7 +/- 3.2, and 4.4 +/- 4.4 mm, respectively. Over the average 34 months Postsurgical period, upper retropalatal airway increased 3.9 +/- 3.7 mm, while narrowest retropalatal, lowest retropalatal airway, and narrowest retroglossal airway remained stable. Head posture showed flexure immediately after Surgery (4.8 +/- 5.9 degrees) and extension postsurgically (1.6 +/- 5.6 degrees).Conclusion: Maxillo-mandibular advancement with counter-clockwise rotation produces immediate increases in middle and lower oropharyngeal airway dimensions, which were constrained by changes in head posture but remain stable over the postsurgical period. The upper oropharyngeal airway space increased only on the longest follow-up. (C) 2006 American Association of Oral and Maxillofacial Surgeons.

Referral letters in oral medicine: standard versus non-standard letters

Usually referral letters are the only means of communication between general practitioners and specialists in the health area. However, they are inadequate if important basic data are omitted. The aim of this study was to compare the content of standard and non-standard letters. A total of 1956 files from the Oral Medicine Service were consecutively evaluated (March 1996 to September 2000). Key items were considered for analysis and the results were stored in a database using the Epinfo 6.04 program. The X-2 test (a=0.05) was applied to the results. of the 1956 files examined, 34% (662) had a referral letter, 31% of them being standard letters and 69% non-standard letters. Most standard letters (87%) were from professionals of public health institutions. Most percent discrepancies between standard and non-standard letters were observed for patient address (14.90 vs 1.32%), patient age (54.81 vs 9.47%), chief complaint (32.21 vs 8.37%), fundamental lesion (29.33 vs 13.66%), and symptoms (27.81 vs 15.42%,,). Statistically significant differences were observed for patient age, professional referring the patient, chief complaint, and site of the lesion. The quality and quantity of the information differed significantly between the two types of letters. The standard letters were more complete and contained information commonly absent in the non-standard letters. We suggest the use of standard letters for improving the quality of communication among professionals.

Is oral nutritional therapy effective for the treatment of chylothorax? A case report

We report a case of a female patient who underwent corrective aortic coarctation surgery that progressed to chylothorax on the fifth postoperative day. Because the patient was clinically stable and had a functioning digestive tract, the nutritional team decided to treat her by oral nutritional support with a low-lipid diet, rich in medium-chain triacylglycerols. After 20 d, the patient returned to her habitual home diet and did not develop pleural spilling, showing full healing of the thoracic duct. (C) 2008 Elsevier B.V. All rights reserved.

Treatment of oral myiasis caused by Cochliomyia hominivorax: two cases treated with ivermectin

The term myiasis is applied to the injurious action that larvae of certain diptera Cause to the organism of Vertebrate animals in the living or dead tissue in which they grow. Because of its great destructive potential. appropriate and preventative treatment are necessary. Among, the sites of infestation. the human mouth is a common site. mainly in tropical countries. We present two cases of oral myiasis Caused by Cochliomyia hominivorax spp. Ivermectin is all extremely effective semi-synthetic macrolides, in the treatment of, this condition. (C) 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Sildenafil for pulmonary hypertension treatment after cardiac surgery

Objective: To report on the use of sildenafil for pulmonary hypertension treatment of a newborn patient after cardiac surgery. Description: A female, full term newborn infant with diagnosis of double outlet right ventricle, pulmonary hypoplasia and subaortic ventricular septal defect, was submitted to Blalock surgery in the first week of life. In postoperative the newborn had pulmonary hypertension and persistent hypoxia, without response to nitric oxide, but with improved oxygenation after continuous intravenous infusion of prostaglandin E1. After several failed attempts to discontinue prostaglandin E1, oral sildenafil was used. There was a decrease in pulmonary vascular resistance with consequent oxygenation improvement and 48 hours later it was possible to discontinue prostaglandin E1 infusion. Comments: Sildenafil can be an alternative therapy for pulmonary hypertension, especially when there is no response to conventional therapy. Copyright © 2005 by Sociedade Brasileira de Pediatria.

Periodontal plastic surgery associated with treatment for the removal of gingival overgrowth

Background: Excisional biopsies of gingival overgrowths, performed with safety margins, frequently result in mucogingival defects. These defects may produce esthetic problems and increase the chances of dentin hyperesthesia and its possibility of hindering oral hygiene. Methods: Two clinical cases are reported in which gingival overgrowths were removed by excisional biopsy, resulting in unsightly defects. The first clinical case presents an invasive approach for the treatment of a recurrent pyogenic granuloma in the anterior maxilla, and the second depicts a complete removal of a peripheral odontogenic fibroma in the posterior maxilla. In both situations, the soft-tissue defects were repaired by periodontal plastic surgery, including a laterally positioned flap and a coronally positioned flap, respectively. Results: Periodontal plastic surgery successfully restored the defects that resulted from biopsies, and no recurrence has been noticed in the 5-year postoperative follow-up period. Conclusions: The combination of biopsy and periodontal plastic surgery in a one-step procedure seems to be suitable to remove gingival overgrowths in most areas of the mouth, regardless of esthetic significance. Such procedures seem to restore gingival health, encourage healing, and create both esthetics and function in the excised area.

Orthognathic Surgery in the Young Cleft Patient: Preliminary Study on Subsequent Facial Growth

Purpose: This study evaluated the long-term effects of orthognathic surgery on subsequent growth of the maxillomandibular complex in the young cleft patient. Patients and Methods: We evaluated 12 young cleft patients (9 male and 3 female patients), with a mean age of 12 years 6 months (range, 9 years 8 months to 15 years 4 months), who underwent Le Fort I osteotomies, with maxillary advancement, expansion, and/or downgrafting, by use of autogenous bone or hydroxyapatite grafts, when indicated, for maxillary stabilization. Five patients had concomitant osteotomies of the mandibular ramus. All patients had presurgical and postsurgical orthodontic treatment to control the occlusion. Radiographs taken at initial evaluation (T1) and presurgery (T2) were compared to establish the facial growth vector before surgery, whereas radiographs taken immediately postsurgery (T3) and at longest follow-up (T4) were used to determine postsurgical growth. Each patient's lateral cephalograms were traced, and 16 landmarks were identified and used to compute 11 measurements describing presurgical and postsurgical growth. Results: Before surgery, all patients had relatively normal growth. After surgery, cephalograms showed statistically significant growth changes from T3 to T4, with the maxillary depth decreasing by -3.3° ± 1.8°, Sella-nasion-point A by -3.3° ± 1.8°, and point A-nasion-point B by -3.6° ± 2.8°. The angulation of the maxillary incisors increased by 9.2° ± 11.7°. Of 12 patients, 11 showed disproportionate postsurgical jaw growth. Maxillary growth occurred predominantly in a vertical vector with no anteroposterior growth, even though most patients had shown anteroposterior growth before surgery. The distance increased in the linear measurement from nasion to gnathion by 10.3 ± 7.9 mm. Four of 5 patients operated on during the mixed dentition phase had teeth that erupted through the cleft area. A variable impairment of postoperative growth was seen with the 2 types of grafting material used. No significant difference was noted in the effect on growth in patients with unilateral clefts versus those with bilateral clefts. The presence of a pharyngeal flap was noted to adversely affect growth, whereas simultaneous mandibular surgery did not. After surgery, 11 of 12 patients tended toward a Class III end-on occlusal relation. Conclusions: Orthognathic surgery may be performed on growing cleft patients when mandated by psychological and/or functional concerns. The surgeon must be cognizant of the adverse postsurgical growth outcomes when performing orthognathic surgery on growing cleft patients with the possibility for further surgery requirements. Performing maxillary osteotomies on cleft patients would be more predictable after completion of facial growth. © 2008 American Association of Oral and Maxillofacial Surgeons.

Influence of dental exposure to oral environment on smear layer removal and collagen exhibition after using different conditioning agents

Although in vitro studies have shown encouraging results for root surface conditioning with demineralizing agents, in vivo studies have failed to show its benefits in periodontal healing. This can be attributed to several factors, among which, the hypermineralization of dental surface. Therefore, this in vitro study compared, using scanning electron microscopy (SEM), the effect of root surface conditioning with different conditioners (1% and 25% citric acid, 24% EDTA and 50 mg/mL tetracycline hydrochloride) in impacted teeth and in teeth that had their roots exposed to the oral environment. One trained examiner assessed the SEM micrographs using a root surface modification index. There was a tendency of more root surface modification in the group of impacted teeth, suggesting that the degree of root mineralization influences its chemical demineralization.