Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture.

The aim of the present study was to evaluate the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening (NRS) 2002 and the American Society of Anesthesiologists Physical Status Score (ASA) as predictors of gait status and mortality 6 months after hip fracture. A total of eighty-eight consecutive patients over the age of 65 years with hip fracture admitted to an orthopaedic unit were prospectively evaluated. Within the first 72 h of admission, each patient's characteristics were recorded, and the MNA, the NRS 2002 and the ASA were performed. Gait status and mortality were evaluated 6 months after hip fracture. Of the total patients, two were excluded because of pathological fractures. The remaining eighty-six patients (aged 80·2 (sd 7·3) years) were studied. Among these patients 76·7 % were female, 69·8 % walked with or without support and 12·8 % died 6 months after the fracture. In a multivariate analysis, only the MNA was associated with gait status 6 months after hip fracture (OR 0·773, 95 % CI 0·663, 0·901; P= 0·001). In the Cox regression model, only the MNA was associated with mortality 6 months after hip fracture (hazard ratio 0·869, 95 % CI 0·757, 0·998; P= 0·04). In conclusion, the MNA best predicts gait status and mortality 6 months after hip fracture. These results suggest that the MNA should be included in the clinical stratification of patients with hip fracture to identify and treat malnutrition in order to improve the outcomes.

Management of pure medial orbital wall fracture with autogenous bone graft

The orbit is an irregular conical cavity formed from 7 bones including the frontal, sphenoid, zygomatic, maxillary, ethmoid, lacrimal, and palatine bones. Fractures of the internal orbit can cause a number of problems, including diplopia, ocular muscle entrapment, and enophthalmos. Although muscle entrapment is relatively rare, diplopia and enophthalmos are relatively common sequelae of internal orbital fractures. Medial orbital wall fracture is relatively uncommon and represents a challenge for its anatomical reconstruction. In this context, autogenous bone graft has been the criterion standard to provide framework for facial skeleton and orbital walls. Therefore, it is possible to harvest grafts of varying size and contour, and the operation is performed through the bicoronal incision, which is the usual approach to major orbital reconstruction. Thus, this article aimed to describe a patient with a pure medial orbital wall fracture, and it was causing diplopia and enophthalmos. The orbital fracture was treated using autogenous bone graft from calvarial bone. The authors show a follow-up of 12 months, with facial symmetry and without diplopia and enophthalmos. In addition, a computed tomography scan shows excellent bone healing at the anterior and posterior parts of the medial orbital wall reconstruction. Copyright © 2013 by Mutaz B. Habal, MD.

Using the bottom-up and outside-in sequence for panfacial fracture management: Does it provide a clinical significance?

Panfacial fractures usually refer to simultaneous facial fractures, which affect the upper, middle, and lower thirds of the face. The management of panfacial fracture is complex because of the lack of reliable landmarks. Literature has shown many approaches for management of panfacial fractures. Every segment of bone has a precise function in the repair. Therefore, the bottom-up and outside-in sequence is the most widely used approach in the management of panfacial fractures. These facial fractures present remarkable challenges for both experienced and inexperienced surgeons. This article aimed to report a case of a panfacial fracture (mandibular condylar and symphysis fractures associated with an atypical Le Fort III fracture) in a 48-year-old man. The patient was successfully treated using bottom-up and outside-in sequence by accessing all facial injuries. Postoperatively, radiograph examination revealed good reduction and fixation of titanium plates, and physical examination revealed good functional and esthetic outcomes. Copyright © 2013 by Mutaz B. Habal, MD.

Tratamento cirúrgico intrabucal das fraturas de ângulo mandibular com uma miniplaca de titânio: estudo clínico e radiográfico

Pós-graduação em Odontologia - FOA

Determinação das lesões orais e das estruturas anatônicas ósseas odontológias mandibulares e maxilares utilizando a tomografia computadorizada em gato-do-mato-pequeno (Leopardus tigrinus) e gato-mourisco (Puma yagouaroundi)

Pós-graduação em Medicina Veterinária - FMVZ

Estudo radiográfico retrospectivo de lesões ósseas mandibulares em cães

Pós-graduação em Cirurgia Veterinária - FCAV

Conservative Approach: Using Decompression Procedure for Management of a Large Unicystic Ameloblastoma of the Mandible

Ameloblastoma is a relatively uncommon benign odontogenic tumor, which is locally aggressive and has a high tendency to recur, despite its benign histopathologic features. This pathology can be classified into 4 groups: unicystic, solid or multicystic, peripheral, and malignant. There are 3 variants of unicystic ameloblastoma, as luminal, intraluminal, and mural. Therefore, in mural ameloblastoma, the fibrous wall of the cyst is infiltrated with tumor nodules, and for this reason it is considered the most aggressive variant of unicystic ameloblastomas. Various treatment techniques for ameloblastomas have been proposed, which include decompression, enucleation/curettage, sclerotizing solution, cryosurgery, marginal resection, and aggressive resection. Literature shows treatment of this lesion continues to be a subject of intense interest and some controversy. Thus, the authors aimed to describe a case of a mural unicystic ameloblastoma of follicular subtype in a 19-year-old subject who was successfully treated using conservative approaches, as decompression. The patient has been followed up for 3 years, and has remained clinically and radiographically disease-free.

Unerupted Lower Third Molar Extractions and Their Risks for Mandibular Fracture

As every surgical procedure extraction of third molars can result in several complications, among them the mandibular angle fracture. Predisposing factors for fracture should be analyzed during and after the surgery. This paper aims to discuss the predisposing factors to the occurrence of mandibular angle fractures during and after the procedure for third molars extraction, as well as surgical principles to avoid this complication.

Synchronous Ossifying Fibromas of Maxilla and Mandible

Ossifying fibroma is a benign neoplasm composed of fibrocellular tissue and mineralized material of varying appearance, which is most commonly seen in the posterior region of the mandible as a solitary lesion. We report an unusual case of synchronous ossifying fibroma of maxilla and mandible. To the best of our knowledge, only 13 similar cases have been previously reported.

Effect of root canal preparation, type of endodontic post and mechanical cycling on root fracture strength

Objective: To evaluate the impact of the type of root canal preparation, intraradicular post and mechanical cycling on the fracture strength of roots. Material and Methods: Eighty human single rooted teeth were divided into 8 groups according to the instruments used for root canal preparation (manual or rotary instruments), the type of intraradicular post (fiber posts-FRC and cast post and core-CPC) and the use of mechanical cycling (MC) as follows: Manual and FRC; Manual, FRC and MC; Manual and CPC; Manual, CPC and MC; Rotary and FRC; Rotary, FRC and MC; Rotary and CPC; Rotary, CPC and MC. The filling was performed by lateral compactation. All root canals were prepared for a post with a 10 mm length, using the custom # 2 bur of the glass fiber post system. For mechanical cycling, the protocol was applied as follows: an angle of incidence of 45 degrees, 37 degrees C, 88 N, 4 Hz, 2 million pulses. All groups were submitted to fracture strength test in a 45 degrees device with 1 mm/min cross-head speed until failure occurred. Results: The 3-way ANOVA showed that the root canal preparation strategy (p<0.03) and post type (p<0.0001) affected the fracture strength results, while mechanical cycling (p=0.29) did not. Conclusion: The root canal preparation strategy only influenced the root fracture strength when restoring with a fiber post and mechanical cycling, so it does not seem to be an important factor in this scenario.

The fracture resistance of a CAD/CAM Resin Nano Ceramic (RNC) and a CAD ceramic at different thicknesses

Objective. This study aimed to investigate the influence of restoration thickness to the fracture resistance of adhesively bonded Lava (TM) Ultimate CAD/CAM, a Resin Nano Ceramic(RNC), and IPS e. max CAD ceramic.Methods. Polished Lava (TM) Ultimate CAD/CAM (Group L), sandblasted Lava (TM) Ultimate CAD/CAM (Group LS), and sandblasted IPS e.max CAD (Group ES) discs (n=8, phi=10 mm) with a thickness of respectively 0.5 mm, 1.0 mm, 1.5 mm, 2.0 mm, and 3.0 mm were cemented to corresponding epoxy supporting discs, achieving a final thickness of 3.5 mm. All the 120 specimens were loaded with a universal testing machine at a crosshead speed of 1 mm/min. The load (N) at failure was recorded as fracture resistance. The stress distribution for 0.5 mm restorative discs of each group was analyzed by Finite Element Analysis (FEA). The results of facture resistances were analyzed by one-way ANOVA and regression.Results. For the same thickness of testing discs, the fracture resistance of Group L was always significantly lower than the other two groups. The 0.5 mm discs in Group L resulted in the lowest value of 1028 (112) N. There was no significant difference between Group LS and Group ES when the restoration thickness ranged between 1.0 mm and 2.0 mm. There was a linear relation between fracture resistance and restoration thickness in Group L (R = 0.621, P < 0.001) and in Group ES (R = 0.854, P < 0.001). FEA showed a compressive permanent damage in all groups.Significance. The materials tested in this in vitro study with the thickness above 0.5 mm could afford the normal bite force. When Lava Ultimate CAD/CAM is used, sandblasting is suggested to get a better bonding. (C) 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Position paper from the IBRA Symposium on Surgery of the Head - The 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012

Background: This is a position paper from the 2nd International Bone Research Association (IBRA) Symposium for Condylar Fracture Osteosynthesis 2012 was held at Marseille, succeeding the first congress in Strasbourg, France, in 2007. The goal of this IBRA symposium and this paper was to evaluate current trends and potential changes of treatment strategies for mandibular condylar fractures, which remain controversial over the past decades.Methods: Using a cross-sectional study design, we enrolled the consensus based on the panel of experts and participants in the IBRA Symposium 2012. The outcomes of interest were the panel and electronic votes on management of condylar base, neck and head fractures, and panel votes on endoscopic and paediatric condylar fractures. Appropriate descriptive and univariate statistics were used.Results: The consensus derived from 14 experts and 41 participant surgeons, using 12 case scenarios and 27 statements. The experts and participants had similar decision on the treatment of condylar base, neck and head fractures, as well as similar opinion on complications of condylar fracture osteosynthesis. They had a parallel agreement on using open reduction with internal fixation (ORIF) as treatment of choice for condylar base and neck fractures in adults. Endoscopic approaches should be considered for selected cases, such as condylar base fractures with lateral displacement. There was also a growing tendency to perform ORIF in condylar head fractures. The experts also agreed to treat children (> 12 years old) in the same way as adults and to consider open reduction in severely displaced and dislocated fractures even in younger children. Nevertheless, non-surgical treatment should be the first choice for children <6 years of age. The decision to perform surgery in children was based on factors influencing facial growth, appropriate age for ORIF, and disagreement to use resorbable materials in children.Conclusions: The experts and participating surgeons had comparable opinion on management of condylar fractures and complications of ORIF. Compared to the first Condylar Fracture Symposium 2007 in Strasbourg, ORIF may now be considered as the gold standard for both condylar base and neck fractures with displacement and dislocation. Although ORIF in condylar head fractures in adults and condylar fractures in children with mixed dentition is highly recommended, but this recommendation requires further investigations. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Mechanical properties and fracture dynamics of silicene membranes

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)