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.

Mandibular Angle Fracture Treated With New Three-Dimensional Grid Miniplate

Fractures of the mandibular angle deserve particular attention because they represent the highest percentage of mandibular fractures and have the highest postsurgical complication rate, making them the most challenging and unpredictable mandibular fractures to treat. Despite the evolution in the treatment of maxillofacial trauma and fixation methods, no single treatment modality has been revealed to be ideal for mandibular angle fractures. Several methods of internal fixation have been studied with great variation in complications rates, especially postoperative infections. Recently, new studies have shown reduction of postsurgical complications rates using three-dimensional plates to treat mandibular angle fractures. Nevertheless, only few surgeons have used this type of plate for the treatment of mandibular angle fractures. The aim of this clinical report was to describe a case of a patient with a mandibular angle fracture treated by an intraoral approach and a three-dimensional rectangular grid miniplate with 4 holes, which was stabilized with monocortical screws. The authors show a follow-up of 8 months, without infection and with occlusal stability.

Frontal sinus obliteration with iliac crest bone grafts: review of 8 cases

This study evaluated postoperative results of 8 cases of frontal sinus fractures treated by frontal sinus obliteration with autogenous bone from the anterior iliac crest. Patients and methods: The medical charts of patients sequentially treated for frontal sinus fractures by obliteration with autogenous cancellous iliac crest bone in the Oral and Maxillofacial Surgery Division of this institution were reviewed. From those, eight had complete records and adequately described long-term follow-up. All were operated by the same surgical team. Those patients were recalled and independently evaluated by 2 examiners. Radiographs and/or CT scans were available for this evaluation. Associated fractures and complications were noted. The average postoperative follow-up was 7 years, ranging from 3 to 16 years. The main complication was infection. Four patients (50%) had uneventful long-term follow-ups and four (50%) experienced complications requiring reoperation. Based on the studied sample studied the authors conclude that the obliteration with autogenous bone presented a high percentage of complications in this series.

Lesões bucomaxilofaciais: estudo dos casos periciados de 2007 a 2013 no Instituto Médico Legal Nina Rodrigues - Salvador / BA

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Oral and maxillofacial reconstruction in a cat using wire and acrylic

A 15-month-old DSH cat was presented with facial deformity secondary to multiple oral and maxillofacial fractures after being struck by an automobile. Multiple wires and dental acrylics were used for fracture repair.

Metabolismo da glicose cerebral no trauma crânio-encefálico: uma avaliação

Os autores apresentam revisão geral da distribuição e metabolização da glicose, com ênfase para os distúrbios que ocorrem no trauma crânio-encefálico, como a hiperglicemia que ocorre na fase aguda. Finalizando, são feitos comentários sobre as possíveis conseqüências desses conhecimentos sobre os procedimentos atuais, que aconselham a restrição na oferta de glicose a pacientes com catabolismo acentuado e que necessitam poupar o contingente de proteína corporal.

Trauma and envenoming caused by stingrays and other fish in a fishing community in Pontal do Paranapanema, state of São Paulo, Brazil: epidemiology, clinical aspects, and therapeutic and preventive measures

INTRODUÇÃO: Os acidentes causados por peixes são comuns em comunidades de pescadores fluviais no Brasil, sendo acidentes ocupacionais na maioria das vezes. Estas populações não têm informações dos mecanismos de trauma e envenenamento. MÉTODOS: Através de um questionário aplicado aos pescadores, foram obtidos dados clínicos e epidemiológicos sobre acidentes em Rosana, Pontal do Paranapanema, Estado de São Paulo, Brasil. Estes dados foram analisados e convertidos em um programa de prevenção e tratamento de acidentes através de um folheto de fácil assimilação RESULTADOS: Trinta e nove pescadores responderam o questionário. Todos os pacientes apresentaram ferimentos causados por algum peixe. Dos peixes mencionados, mandijubas (Pimelodus maculatus) foram os mais associados aos ferimentos, mas outros também causaram traumas. em relação às arraias, seis pescadores tinham sido envenenados. Dor intensa e úlceras foram os principais sintomas. Aproximadamente metade dos acidentados usou apenas medidas de tratamentos populares. CONCLUSÕES: Os pescadores apresentaram acidentes múltiplos por mandis, que são peçonhentos e causam dor intensa, assim como traumas por outros peixes, como surubins, traíras, corvinas de água doce e piranhas. Cerca de 16% dos entrevistados apresentaram envenenamento por arraias. Nossos dados e experiência prévia permitiram a criação de um folheto de fácil assimilação pelas populações locais que pode ajudar os pescadores de forma efetiva, em uma área extremamente carente de serviços de saúde e prevenção de doenças. Esta iniciativa é aplicável a toda a bacia do Rio da Prata, área extensa e de fauna similar.

Rapid prototyping and inclined plane technique in the treatment of maxillofacial malformations in a fox

An approximately 9-month-old fox (Pseudalopex ventulus) was presented With malocclusion and deviation of the lower jaw to the right side. Orthodontic treatment was performed using the inclined plane technique. Virtual 3D models and prototypes of the head were based on computed tomography (CT) image data to assist in diagnosis and treatment.

A resposta metabólica ao trauma cranioencefálico é autolimitada? Análise das proteínas de fase aguda e glicemia

Nos últimos anos tem havido referências à limitação da resposta metabólica nas duas primeiras semanas após trauma cranioencefálico (TCE). Foi feita proposta de estudo a partir de experimento clínico em pacientes com trauma encefálico grave, que foram avaliados por volta de 7 dias após a lesão (M1). A segunda avaliação ocorreu 4 dias após (M2), e a terceira 3 a 4 dias após (M3). em um período de 2 anos, foram selecionados 28 pacientes do sexo masculino, com trauma encefálico grave, escala de gravidade de Glasgow entre 4 e 6. Dentre os 28 pacientes, 6 completaram o estudo proposto. Os pacientes foram acompanhados clinicamente durante toda a fase do experimento. em cada um dos momentos de análise, foram feitas análises da excreção nitrogenada e proteínas de fase aguda. da mesma forma foram feitas determinações da glicemia plasmática, N-amínico e triglicerídeos. Os resultados do estudo demonstraram não haver modificações no balanço nitrogenado, normalização da proteína-C-reativa e redução relativa da glicemia ao final do experimento. Os autores tecem considerações sobre os possíveis mecanismos envolvidos na modulação da resposta metabólica e concluem que o hipermetabolismo, a basear-se na análise da glicemia e das proteínas de fase aguda, não persiste além do 13° dia do período de recuperação pós-trauma. São feitas sugestões de estudos futuros que possam elucidar os mecanismos envolvidos na normalização do hipercatabolismo e hipermetabolismo observados nas duas primeiras semanas após TCE.

Testicular fine needle aspiration cytology from a stallion with testicular degeneration after external genitalia trauma.

A seven-year-old Quarter Horse had a serious external genitalia trauma with severe swelling of ventrum, penis, prepuce and scrotum after falling over a fence. Appropriated treatment was rapidly started after clinical examination. During recovery period, the spermatogenesis assess by semen evaluation was not possible due to stallion's inability to ejaculate. Therefore, for testicular evaluation fine needle aspiration cytology (FNAC) was performed. The first FNAC showed a deviation of germ cell line towards immature cells, mainly by primary spermatocytes (59.5%) with very few late spermatids and spermatozoa (2.5% each), and an increased Sertoli cells/germ cells ratio (478/100), which characterized testicular degeneration. One month after the first FNAC, the second exam presented a drastic decrease of Sertoli cells/germ cells ratio (7/100) and marked increase of mature cell number, specially by early and late spermatids (50% and 24.5%, respectively). In this case, the results of both FNAC could demonstrate a partial recovery of spermatogenesis activity. Two months later, the stallion had mated two mares successfully and they became pregnant. In conclusion, the adequate treatment allowed a complete recovery of the stallion's reproductive function, and since semen collection was impossible during treatment, testicular FNAC showed to be an efficient diagnostic method for evaluating acute damage in the spermatogenesis.

Dentists' level of knowledge of the treatment plans for periodontal ligament injuries after dentoalveolar trauma

This study investigated the level of knowledge held by dentists about the possible treatment plan procedures for periodontal ligament injuries after dentoalveolar trauma. A 5-item self-applied questionnaire was prepared with questions referring to the professional profile of the interviewees and to the treatment plan they would propose for periodontal ligament injuries secondary to dentoalveolar trauma. The questionnaires were filled out by 693 dentists attending the 23rd Annual Meeting of the Brazilian Society for Dental Research, and the data obtained were subjected to descriptive analysis. Either the chi-square test or Fisher's exact test was applied to assess associations among variables, at a 5% level of significance. The results revealed that dentists experienced difficulty in establishing a treatment plan for subluxation, and for extrusive, lateral and intrusive luxations. In general, holding a dental specialty degree had no influence on the knowledge about treatment plan procedures for the most severe injuries. It could be concluded that the dentists participating in this study, whether specialists or not, did not have sufficient knowledge to treat most of the periodontal ligament injuries resulting from dentoalveolar trauma adequately.

Resolution of a titanium implant fracture after a recurrent trauma

Post-traumatic complications occasionally lead to tooth loss as well as the need for future implants. However, rehabilitation with endosseous osseointegrated implants does not protect the patient from the risk of suffering a new trauma. Implant fracture and the damage of the hexagon are post-traumatic complications that guide the clinician to preparing a more intricate treatment plan. The authors present a clinical case of a recurrent trauma of maxillary implant fracture. The treatment plan was to remove the implants followed by autogenous bone grafting to correct the defect. Two titanium implants were replaced, followed by connective tissue graft after allowing complete the healing process of the bone graft to occur. In the postoperative period of 6 months, satisfactory results have been shown as regards soft and hard tissues wound healing.

Importance of Clinical Examination in Dentoalveolar Trauma

Dental injuries are often the result of direct trauma. The most affected teeth are the upper incisors, and the most frequent lesions are coronal fractures, contusions, and lip and alveolar mucosa lacerations. The objective of this study was to draw attention to the importance of the correct management of cases of crow fractures associated with soft tissue lacerations when the fragment is not located. This is a clinical case of crown fracture, the fragment of which remained lodged inside the lip. After fragment removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical examination to achieve a correct diagnosis and an appropriate treatment plan, which is essential for a favorable prognosis.

Influence of a Parafunctional Oral Habit on Root Fracture Development After Trauma to an Immature Tooth

Root fractures in immature teeth are rare because the resilience of the alveolar bone is more favorable to the occurrence of luxation. This article reports a case of traumatic injury in an immature permanent tooth that progressed to root fracture, having a parafunctional oral habit as the possible modifying factor of case evolution. A 12-year-old boy presented for treatment complaining of a defective restoration and mild pain on the maxillary right central incisor. The patient had a history of crown fracture in this tooth due to trauma 2 years before. The clinical examination showed healthy gingival tissues and no abnormal tooth mobility, whereas radiographic projections revealed healthy periradicular tissues, incomplete root formation, and no visible root fracture. As pulp necrosis was diagnosed, calcium hydroxide therapy was started for canal disinfection and subsequent obturation. However, after 4 weeks of treatment, a horizontal fracture line was observed radiographically in the root's middle third. The patient denied a new traumatic injury, but revealed the habit of chewing on a pencil. Refraining from the deleterious oral habit was strongly advised, and root canal filling with mineral trioxide aggregate was performed to treat the root fracture. After 4 years of follow-up, the tooth has normal function and no abnormal mobility. Images suggestive of remodeling at the apical end of the coronal segment and replacement resorption of the apical segment are seen radiographically. This case demonstrates the need of following cases of dental trauma and the possible influence of parafunctional oral habits as modifying factors of case progression.