Submental Endotracheal Intubation: A Valuable Resource for the Management of Panfacial Fractures

Modern techniques for surgical treatment of midfacial and panfacial fractures in maxillofacial trauma lead to special problems for airway management. Usually, in perioperative management of panfacial fractures, the surgeon needs to control the dental occlusion and nasal pyramid assessment. For these reasons, oral and nasal endotracheal intubations are contraindicated for the management of panfacial fractures. Tracheotomy is considered by many as the preferred route for airway management in patients with severe maxillofacial fractures, but there are often perioperative and postoperative complications concerning this technique. The submental route for endotracheal intubation has been proposed as an alternative to tracheotomy in the surgical management of patients with panfacial fractures, besides it is accompanied by low morbidity. Thus, this paper aimed to describe the submental endotracheal intubation technique in a patient experiencing panfacial fracture. The subject was well treated using the submental endotracheal intubation to get good reconstruction of the fractures because the authors obtained free access of all facial fractures.

Crown and crown-root fractures: an evaluation of the treatment plans for management proposed by 154 specialists in restorative dentistry

Traumatic tooth injuries involve function and aesthetics and cause damage that range from minimal enamel loss to complex fractures involving the pulp tissue and even loss of the tooth crown. Technical knowledge and clinical experience are essential to establish an accurate diagnosis and provide a rational treatment. The purpose of this study was to evaluate the knowledge of Restorative Dentistry specialists about the management of crown and crown-root fractures based on treatment plans proposed by these professionals for these cases. A descriptive questionnaire was mailed to 245 Restorative Dentistry specialists with questions referring to their professional profile and the treatment plans they would propose for the management of crown and crow-root fractures resulting from dental trauma. One hundred and fifty-four questionnaires were returned properly filled. The data were subjected to descriptive statistics and the chi-square test was used to determine the frequency and the level of the significance among the variables. The analysis of data showed that in spite of having a specialist title, all interviewees had great difficulty in planning the treatments. As much as 42.8% of the participants were unable to treat all types of dental trauma. Complicated and uncomplicated crown-root fractures posed the greatest difficulties for the dentists to establish adequate treatment plans because these fractures require multidisciplinary knowledge and approach for a correct case planning and prognosis.

In vitro evaluation of conventional and locking miniplate/screw systems for the treatment of mandibular angle fractures

This in vitro study evaluated the influence of the type of miniplate and the number of screws installed in the proximal and distal segments on the stability and resistance of Champy's osteosynthesis in mandibular angle fractures. Sixty polyurethane hemimandibles with bone-like consistency were randomly assigned to four groups (n = 15) and sectioned in the mandibular angle region to simulate fracture. The bone segments were fixed by different osteosynthesis methods using 2.0 mm miniplates and 2.0 mm x 6 mm rnonocortical screws. In groups 1 and 2, two conventional (G1) or locking (G2) screws were installed in each bone segment using a conventional (G1) or a locking (02) straight miniplate; in groups 3 and 4, three conventional (03) or locking (04) screws were installed in the proximal segment and four conventional (G3) or locking (04) screws were installed in the distal segment using a conventional (G3) or a locking (G4) seven-hole straight miniplate. The hemimandibles were loaded in compressive strength until a 4 mm displacement occurred between the segments, vertically or horizontally. Locking plate/screw systems provided significantly greater resistance to displacement than conventional ones (p < .01). Locking miniplates offered more resistance than conventional miniplates. Long locking miniplates provided greater stability than short ones.

Clinical evaluation of the bicoronal flap in the treatment of facial fractures. Retrospective study of 132 patients

The aim of the present study was to evaluate the postoperative complications of bicoronal flaps used to treat facial fractures. One hundred and thirty two patients that received bicoronal flaps for the treatment of upper and middle third facial fractures were called for clinical and radiographic examination. Minimum follow-up was 1 year and all patients had charts with adequate information about their perioperative care pertinent to the study. Results showed as complications hypoesthesia (17%), partial unilateral frontal motor deficit (11%), infection (3%), hypertrophic scars (3%), varying degrees of alopecia (18%), seroma or hematoma in the immediate postoperative period (5%). The flap provided wide surgical access to the upper and middle facial thirds with very few serious complications, most frequently allowing good aesthetic results. (C) 2011 European Association for Cranio-Maxillo-Facial Surgery.

Immediate reconstruction of frontal sinus fractures: review of 26 cases

Purpose: the purpose of this study was to evaluate complications occurring after immediate reconstruction of severe frontal sinus fractures, including cases where the fracture was not limited to the anterior wall and also involved the posterior wall and/or sinus floor.Patients and Methods: the records of twenty-six patients presently undergoing follow-up for frontal sinus fracture reconstruction were reviewed. Information regarding demographics, fracture characteristics and causes, associated facial fractures, use of grafts or implants, type of fixation used, nasofrontal duct management, use of antibiotics, and complications were noted. Patients were asked to return for clinical and radiographic follow-up to access late complications.Results: the average age of patients with frontal fractures was 29.1 years and 92.3% were male. Mean follow-up was 3.6 years. The most common causes of fracture were motor vehicle accidents and physical aggression. All patients presented with comminuted and dislocated anterior wall fractures, 34.6% presented with posterior wall fractures, and 46% had sinus floor fractures. Complications occurred in 7 patients (26.92%) and included pneumoencephalus, frontal cutaneous fistula, frontal bone irregularity, and sinusitis.Conclusions: Frontal sinus reconstruction is a good procedure for immediate fracture treatment if there is not excessive comminution, dislocation, or instability of the posterior wall and if the frontonasal duct area is intact or can be repaired. Most complications result from incorrect indication for reconstruction. (C) 2004 American Association of Oral and Maxillofacial Surgeons.

Low-level laser on femoral growth plate in rats

OBJETIVO: Determinar a influência do Laser Terapêutico de Baixa Potência sobre a placa de crescimento de ratos. MÉTODOS: Trinta ratos Wistar machos com 40 dias de idade foram divididos em dois grupos, G1 e G2. O grupo G1 foi submetido à irradiação com laser GaAlAs 830 nm, potência de saída de 40 mW, e densidade de energia de 10 J/cm2. A irradiação foi aplicada diariamente por um período máximo de 21 dias. O mesmo procedimento foi realizado no grupo G2, com a probe desativada. Cinco animais em cada grupo foram sacrificados nos dias 7, 14 e 21 e submetidas à análise histomorfométrica. RESULTADOS: em ambos os grupos, o disco fisário esteve radiograficamente visível em todos os momentos nas incidências craniocaudal e médio-lateral. No 21º dia a porcentagem de comprimento longitudinal do fêmur foi maior em G1 que em G2 em relação ao valor basal, e o número de condrócitos da zona hipertrófica foi maior em G1 que em G2. A zona de cartilagem calcificada estava maior em G1 em relação a G2 em todos os momentos de avaliação. A angiogênese foi maior em G1 que em G2 nos 14º e 21º dias. CONCLUSÃO: A terapia com laser terapêutico de baixa potência influenciou negativamente o disco fisário distal do fêmur de ratos.

Interaction between Advanced Glycation End Products Formation and Vascular Responses in Femoral and Coronary Arteries from Exercised Diabetic Rats

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

A Short Note on Transverse Vibrations of a Shaft Carrying Two (or One) Disk Excited by a Nonideal Motor

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Osteotomia femoral em cúpula para correção do ângulo de inclinação do colo do fémur

Utilizou-se a osteotomia femoral em cúpula em um cão que apresentava aumento do ângulo de inclinação do colo do fêmur e subluxação da articulação coxofemoral. A linha de osteotomia situou-se cerca de 1 cm distal ao trocanter menor, no sentido látero-medial. Para a imobilização utilizou-se um fio de Steinmann passando pelo trocanter maior e por toda a extensão do fêmur. Um fio de aço foi colocado em orifícios ósseos produzidos nos segmentos proximal e distal do fêmur para a realização de sutura óssea. A técnica empregada culminou em: diminuição de 35° no ângulo de inclinação, rebaixamento da cabeça do fêmur, elevação do trocanter maior, congruência da articulação e encurtamento de 3cm do membro. A consolidação ocorreu cerca de 90 dias após a cirurgia.

Imobilização de fraturas femorais em gatos usando pino intramedular conectado ou não ao fixador esquelético externo

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

Afecções ortopédicas dos membros pélvicos em cães: estudo retrospectivo

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Study of stress distribution with finite element method in a root with prefabricated threaded split shaft post - Part I

A finite element analysis was carried out to study the role of prefabricated threaded split shaft post (Flexi-Post) on dentinal stress in pulpless tooth. Three dimensional plane strain model of mesio-distal section of a human maxillary central incisor without restoration was analysed with the MSC/NASTRAN (MacNeal/ Schwendler) general purpose finite analysis program was executed on a microcomputer. The model as discretized into 48.954 axisymmetric finite elements defined by 10.355 nodes. Each element was assigned unique elastic properties to represent the materials modeled. Homogeneity, isotropy and linear elasticity were assume for all material. A simulation of static load of 100N was applied to the incisal edge of the post; vertical. Maximal principal stresses and von Mises equivalent stress were calculated. Using the element analysis model employed in this study, the following can be concluded concerning threaded split shaft post (Flexi-Post): Maximum principal stresses in dentin were located at cervical place and at the post apex. The apical threads of the post not redirecting stresses away from the root.

Analysis of the crown fractures and crown-root fractures due to dental trauma assisted by the Integrated Clinic from 1992 to 2002

The purpose of this study was to analyze crown fractures and crown-root fractures due to dentoalveolar trauma, treated in the Integrated Clinic comprehensive dental care at Aracatuba School of Dentistry (UNESP), from January 1992 to July 2002. The data were obtained from files of trauma cases. on the analysis period, 293 patients had crown fractures or crown-root fractures, in 605 teeth. Sixty-nine percent were males and 31% were females. Adolescents between 11 and 18 years old were the most prevalent group (41.6%) and the maxillary arch was the most commonly traumatized (83%). The most commonly affected tooth was the maxillary central incisor (58.3%). The most frequent causes were falls from bicycles (30.8%). It was concluded that the reality of the local service is similar to the published data.

Consequences of crown fractures with pulpal exposure: histopathological evaluation in dogs

When a crown fracture involving pulpal exposure is produced, the therapeutic treatment to be applied depends to a great extent on the general histopathological condition of the exposed pulp. Hence, the objective of this study was to evaluate histopathological and bacteriological changes occurring in dental tissue and periradicular tissue of crown-fractured teeth with pulpal exposure. Twenty-four anterior teeth (central and lateral incisors) from the maxillary teeth of four young, adult Mongrel dogs were used. At 48 and 72 h after performing the crown fractures, the animals were sacrificed and the results evaluated. Both observation periods revealed the existence of an area of superficial inflammation with the formation of hyperplastic tissue towards the external surface. Intense neutrophilic infiltrate was observed below it. Mean depth of inflammation was greater at 48 h (4633.33 mum) than at 72 h (3933.33 mum), perhaps coinciding with the bigger pulp chamber opening (x1332.14 mum at 48 h vs. x479.52 mum at 72 h). Upon approaching the cervical portion, the inflammation became less. Bacterial contamination was constant in all the cases evaluated, worsening the histopathological findings with exposure time. This study demonstrates that when a crown fracture with pulpal exposure is produced, the success in treating it depends partly on how quickly therapeutic treatment is administered.