Combinação de técnicas para tratamento cirúrgico de fratura do complexo zigomático-maxilar: relato de caso

The zygomatic-maxillary complex due to its projection framed as one of the areas hardest hit by injuries, as well as the nasal bones. Component important in this context, the zygomatic arch fracture is under the direct action of forces due to its structure fragile, resulting in loss of normal convex curvature. Therefore, it is aimed to report a clinical case of male patient, who had leucoderma zygomatic bone fracture using access transcutaneous and intra-oral fracture reduction body of zygoma and zygomatic arch. In addition to evidence combination of closed and open techniques for solving the case. The technique provided the patient excellent cosmetic and functional results.

Estudo histomorfométrico do processo de cicatrização óssea em defeitos cirúrgicos de tamanho crítico em calvárias de ratos preenchidos com polímero de mamona

Objectives: The aim of this study was to evaluate the behavior of the polymer histomorphometrically castor during the healing process of defects of critical size calvarial preparations in rats. Materials and Methods: Twenty animals underwent a surgical procedure that was to be held in the calvaria of each animal a critical defect of 8 mm in diameter with a drill trephine. The rats were divided into two groups according to the following procedures: group C received no treatment and the bone defect site was filled with blood clot, group M, the bone defect was filled with castor oil polymer particles. The animals were sacrificed 180 days after the surgical procedures. After routine laboratory procedures the specimens were subjected to analysis histomorphometric. Results: In groups C the newly formed bone tissue was well developed, with adjacent areas of osteoid matrix rich in osteoblasts, and restricted to the vicinity of the edges of the defect. In animals of group M was observed newly formed lamellar bone tissue restricted to the vicinity of the defect edges and particles of polymer Castor distributed throughout the defect. There was a higher percentage of newly formed bone area was statistically significant in group C compared to animals in group M. Conclusions: Within the limits of this study can conclude that the castor oil polymer is biocompatible and had kept the area during the healing of critical size defects in surgically prepared rat calvariae

Correção da deficiência transversa da maxila por meio da expansão rápida da maxila cirurgicamente assistida

Fundamentation: The correction of maxillary transverse deficiencies involves orthodontic and surgical procedures that can be performed before or after skeletal maturity. The surgically assisted rapid maxillary expansion (SAR ME) is performed by osteotomies through the lateral walls of the maxilla, zygomatic and canines buttresses, palatal and pterygomaxillary sutures, causing the maxillary disjunction. Followed by activation of the expander to the desired over-expansion in order to correct intercuspal later. Objective: The purpose of this study was to discuss the issues involved in the diagnosis of maxillary atresia, SAR ME indications, as well as surgical technique, through a case study. Methods: The male patient, 19 years old, had severe transverse maxillary deficiency with facial pattern III , Class III , with great lip incompetence. The patient underwent general anesthesia in a hospital environment, the osteotomies was done according to the technique described by Epker and Wolford (1980). Postoperatively, the patient underwent activations daily for 15 days and after 6 months, the orthodontist installed fixed orthodontic appliance to prepare the patient to orthognathic surgery later. Conclusion: The diagnosis by clinical evaluation and models study is essential for the indication of SAR ME and this procedure provides good predictability in the correction of transverse deficiency, with minimal morbidity.

Reconstrução imediata de fenestração peri-implantar com enxerto autógeno em bloco de ramo mandibular

Alveolar wall fenestrations are common during implant placement. The aim of this paper is to report a case where a peri-implant bone fenestration was reconstructed immediately after implant placement by an autogenous mandibular bone block. A male patient was referred to the Department of Surgical and Integrated Clinics to substitute his Kennedy´s Class IV removable partial denture for an implantsupported fixed prosthesis. A peri-implant bone fenestration at the buccal wall was seen at the region of 12, being reconstructed by a mandibular bone block secured by a bicortical screw. Six months later the surgical procedures, an implant-supported complete fixed partial prosthesis was developed. The autogenous bone block harvested from the mandibular ramus was a safe alternative to reconstruct the peri-implant bone defect such as fenestration types.

A standartized research protocol for platelet-rich plasma (PRP) preparation in rats

Introduction: The urgent need for studies using standardized protocols to evaluate the real biological effects of PRP has been emphasized by several authors. Objective: The purpose of this study was to standardize a methodology for autologous Platelet-Rich Plasma (PRP) preparation in rats. Material and methods: Twentyfour, 5 to 6-month-old, male rats, weighing 450 to 500 g were used. After general anesthesia, 3.15 ml of blood was collected from each animal, via cannulation of the jugular vein. A standardized technique of double centrifugation was used to prepare PRP. PRP samples and peripheral blood platelets were then manually counted using a Neubauer chamber. Student’s t-test was used to compare the differences between the number of platelets in peripheral blood and PRP samples (p < 0.05). In addition, PRP and peripheral blood smears were stained to see platelets’ morphology. Results: All surgical procedures were well tolerated by the animals and they were healthy during the entire experimental period. PRP samples showed higher significantly platelet concentrations than peripheral blood samples (2,677,583 and 683,680 respectively). Conclusion: Within the limits of this study, it can be concluded that the method used produced autologous PRP with appropriated platelet quantity and quality, in rats.

Periodontite ulcerativa necrosante: tratamento fisico da superficie radicular com Er YAG laser

Necrotizing ulcerative periodontitis is associated with bacteria and predisposing risk factors. The treatment is centered in elimination and/or control of the bacteria and predisposing risk factors. However the disease acute phase could induce sequelae as periodontal tissue destruction which may be treated by periodontal surgical procedures.

O uso de drogas anticoagulantes e antiplaquetárias orais em pacientes cirúrgicos ambulatoriais: revisão de literatura

The oral anticoagulants (AOC) and platelet antiagregants are drugs used for the prevention of thromboembolic phenomena, such as pulmonary embolism in patients with atrial fribrilation heart valves, thrombosis and pulmonary embolism. For patients who are undergoing surgical procedures-dentistry were asked to discontinue the use of anticoagulants until the value of the INR remained = 2.0, that in order to avoid trans and hemorrhages in the postoperative period. However, the AOC can cause the formation of a clot, leading to obstruction of blood pathways. Thus, it became doubtful the medicine for surgery, in which local hemostatic measures would be sufficient to promote hemostasis. Thus, the objective of the review was to evaluate the risk of bleeding in patients AOC users that are subjected to surgical procedures, through a bibliographical survey carried out in relevant clinical studies published between 1990 and 2012, by the MedlinePubMed data. In this review of literature was concluded that the benefit of thromboembolism prevention overcomes the risk hemorrhage, therefore, it is recommended to keep the dose of anticoagulant therapy unchanged for patients undergoing oral surgery and implant dentistry, using appropriate INR levels with the assistance of local hemostatic. In addition, a refined surgical technique should be performed in these patients. With respect to the most invasive oral surgery, with a risk of bleeding, treatment may be necessary in conjunction with the medical staff.

Fratura do seio frontal: relato de caso

The frontal sinus fractures are derived from accidents of great intensity. Are usually associated with fractures of the midface, including the naso-orbital fractures and zygomatic ethmoid. Several treatment modalities have been proposed. In this case it was used to access bicoronal reconstruction of the anterior frontal sinus, and restore contour fronto-naso-orbital-ethmoid with satisfactory results.

Protocolo radiográfico para a instalação de mini-implantes: descrição da técnica

In the last decade mini-screws have gained popularity in orthodontics field and a correct placement of mini-screws is a critical point to the success of the skeletal anchorage. A careful clinical and radiographic diagnostic before insertion mini-screw is an essential requirement to achieve the central point of the radicular septum. The correct application of these pre-surgical procedures should avoid possible iatrogenic damages in periodontal ligament, dental roots, nasomaxillary cavities, or even important vascular tissues. As of today, periapical radiographs is a regular pre surgical procedure during mini-screw insertion technique. Nevertheless, accurate execution of the radiographic parallax technique can offer to us useful and precise radiographic images, to decide the right local insertion of mini-screws in to the septum bone. The purpose of this paper is to describe the ¬application of new positioning circular guides in conjunction with a ¬parallax radiographic protocol before placement of orthodontic mini-screws.

Opportunistic microorganisms in patients with head and neck trauma

The use of antimicrobial agents has facilitated the dissemination of multi-resistant microorganisms, compromising dental and medical treatment. The aim of this study was to evaluate the distribution of different opportunistic microbial species in patients who suffered head and neck trauma, under temporary maintenance in nosocomial environment, particularly intensive care units, on the occurrence of such microorganisms in the oral cavity of the patients. It was selected 38 patients subjected to head and neck traumas. After emergency surgical procedures, clinical samples of saliva, sub and supragingival biofilms and mucosal surfaces were collected at two different moments: just after stabilization of the patient and soon after patients’ release from medical units. The presence of opportunistic and superinfecting microorganisms was evaluated by culture on selective and non-selective media, and the presence of the family Enterobacteriaceae, as well as genera Enterococcus, Pseudomonas, and Staphylococcus was assessed by PCR. It was found that the use of antimicrobials, even for short periods of time was sufficient to facilitate colonization by microorganisms of the families Enterobacteriaceae and Pseudomonadaceae, as well as yeasts and enterococci. These results support the concept that medical and dental teams should make a periodically change of antimicrobials used in treatment protocols in hospital for head and neck trauma patients, in order to minimize dissemination of opportunistic or superinfecting microorganisms.

Immunohistochemical, tomographic, and histological study on onlay bone graft remodeling. Part III: allografts

Objective In the last decades aroused the interest for bone tissue bank as an alternative to autogenous grafting, avoiding donor sites morbidity, surgical time, and costs reduction. The purpose of the study was to compare allografts (ALg) with autografts (AUg) using histology, immunochemistry, and tomographic analysis. Material and methods Fifty-six New Zealand White rabbits were submitted to surgical procedures. Twenty animals were donors and 36 were actually submitted to onlay grafting with ALg (experimental group) and AUg (control group) randomly placed bilaterally in the mandible. Six animals of each group were sacrificed at 3, 5, 7, 10, 20, and 60 postoperative days. Immunolabeling was accomplished with osteoprotegerin (OPG); receptor activator of nuclear factor-k ligand (RANKL); alkaline phosphatase (ALP); osteopontin (OPN); vascular endothelial growth factor (VEGF); tartrate-resistant acid phosphatase (TRAP); collagen type I (COL I); and osteocalcin (OC). Density and volume of the grafts was evaluated on tomography obtained at the surgery and sacrifice. Results The ALg and AUg exhibited similar patterns of density and volume throughout the experiments. The intra-group data showed statistical differences at days 7 and 60 in comparison with other time points (P = 0.001), in both groups. A slight graft expansion from fixation until day 20 (P = 0.532) was observed in the AUg group and then resorbed significantly at the day 60 (P = 0.015). ALg volume remained stable until day 7 and decreased at day 10 (P = 0.045). The light microscopy analysis showed more efficient incorporation of AUg onto the recipient bed if compared with the ALg group. The immunohistochemical labeling picked: at days 10 and 20 with OPG in the AUg group and at day 7 with TRAP in the ALg group (P = 0.001 and P = 0.002, respectively). Conclusions ALg and AUg were not differing in patterns of volume and density during entire experiment. Histological data exhibit more efficient AUg incorporation into recipient bed compared with the ALg group. Immunohistochemistry outcomes demonstrated similar pattern for both ALg and AUg groups, except for an increasing resorption activity in the ALg group mediated by TRAP and in the AUg group by higher OPG labeling. However, this latter observation does not seem to influence clinical outcomes.

Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique

Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

Tenotomia do músculo flexor digital superficial e desmotomia acessória em equinos: goniometria radiometacarpiana, metacarpofalângica e interfalângica

The purpose of this study was to investigate the effects of the superficial digital tenotomy and the superior check ligament desmotomy on the radio-metacarpal, metacarpophalangeal, proximal and distal interphalangeal angles in horses. Under general anesthesia the superficial digital flexor tenotomy and superior check ligament desmotomy were performed, respectively, on the right and left forelimbs in nine horses. Before surgery and on 15th, 30th, and 60th postoperative days the radio-metacarpal, metacarpophalangeal, and proximal and distal interphalangeal angles were measured by radiographic examination. Tenotomy decreased significantly the metacarpophalangeal angle (mean ± standard deviation: preoperative – 140.7º ± 6.85; 60th day – 128.2º ± 5.93) and increased the distal interphalangeal angle (mean ± standard deviation: preoperative – 172.6 ± 1.87; 60th day – 167.6 ± 1.36). Desmotomy decreased the proximal interphalangeal angle (mean ± standard deviation: preoperative – 180.2º ± 5.43; 60th day- 197.3º ± 8.29). These surgical procedures did not change the radio-metacarpal angle. The superficial digital flexor tenotomy and the superior check ligament desmotomy cause different and significant changes in joint angles distal to the carpus.

Acute phase response following ovariohysterectomy in female dogs

The concentrations of acute phase proteins are correlated with the severity of the surgical trauma, being elevated when severe tissue injury is produced. The aim of this study was to evaluate the leukogram and the acute phase proteins concentrations in healthy female dogs submitted to minimally invasive ovariohysterectomy, with the use of nylon cable ties (G1), and conventional (laparotomy) ovariohysterectomy, with the use of nylon suture (G2), as methods to ligate the ovarian pedicles and uterine body, respectively. Blood samples from 30 adult healthy female dogs (15 for each group) were obtained before surgery, and at 24 and 48 h and 7 days after surgery. Serum protein fractions were determined by means of sodium dodecyl sulfate polyacrylamide gel electrophoresis. Neutrophilia was observed 24 h after both surgical procedures but did not differ (P ≥ 0.05) between the groups. In G1, the estimated concentration of ceruloplasmin increased (P ≤ 0.05) 48 h after the surgical procedure. The estimated ceruloplasmin concentration was significantly higher in G1 (P ≤ 0.05) when compared to G2 48 h postoperatively, and the estimated haptoglobin concentration was also significantly greater in G1 (P ≤ 0.05) than in G2 from 24 h to 7 days after surgery. Through the ceruloplasmin and haptoglobin estimated concentrations, we conclude that the minimally invasive ovariohysterectomy caused a more intense inflammatory response, which was not reflected in the white blood cell count.

Avaliação da teneurina-2 (Ten-2) nos astrócitos do córtex cerebral de ratos adultos após lesão mecânica. Estudo imuno-histoquímico e de expressão gênica

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