Osteonecrose maxilar associada ao uso de bisfosfonatos

Os bisfosfonatos (BFs) têm sido indicados para o tratamento de doenças do metabolismo ósseo. Atualmente, seu emprego terapêutico aumentou e, com ele, os efeitos adversos, dos quais um dos mais importantes é a indução da osteonecrose dos maxilares, uma complicação de difíceis tratamento e solução. Até o presente, não se sabe ao certo qual é o mecanismo de desenvolvimento da osteonecrose dos maxilares induzida por bisfosfonatos (ONMB), nem qual deve ser o tratamento estabelecido perante essa manifestação. Apesar de a literatura apresentar formas variadas de tratamento, não existe um protocolo definido. Apresentamos uma revisão sobre a ONMB, enfocando sua etiopatogenia e as formas reportadas de tratamento.

A new species of Anchoviella Fowler, 1911 (Clupeiformes: Engraulidae) from the Amazon basin, Brazil

Anchoviella juruasanga is described from the drainages of rios Negro, Madeira, Tapajós, Trombetas, Tocantins, and Jari, in the Amazon basin, Brazil. The new species is distinguished from its congeners by having a short upper jaw, with its posterior tip extending between the verticals through anterior and posterior margins of the pupil (vs. posterior tip of upper jaw extending beyond the vertical through posterior margin of the pupil). Anchoviella juruasanga is also distinct from other strictly freshwater Amazonian species of the genus by the distance from tip of snout to posterior end of upper jaw between 8 and 11% in standard length (vs. 14% or more in A. alleni, A. carrikeri, A. guianensis, and A. jamesi). The anal-fin origin slightly posterior to or at the vertical through the base of the last dorsal-fin ray further distinguishes the new species from A. alleni (anal-fin origin posterior to the vertical through the last anal-fin ray by at least 14% of head length) and A. jamesi (anal-fin origin anterior to the vertical through the last anal-fin ray). An identification key for the Amazonian species of Anchoviella, including marine and estuarine species known to occur in the lower portion of the basin, is presented.

Crenicichla chicha, a new species of pike cichlid (Teleostei: Cichlidae) from the rio Papagaio, upper rio Tapajós basin, Mato Grosso, Brazil

Crenicichla chicha, new species, occurs in clear, fast-running waters with rocky substrates in the rio Papagaio and tributaries. It is distinguished from all other Crenicichla species by the combination of two character states: infraorbitals 3 and 4 co-ossified (vs. separated) and 66-75 scales in the row immediately above to that containing the lower lateral line (E1 row scales). Crenicichla chicha shares a smooth preopercular margin, co-ossification of infraorbitals 3 and 4, and some color features with C. hemera from the adjacent rio Aripuanã drainage, rio Madeira basin. It differs from Crenicichla hemera in more E1 scales (66-75 vs. 58-65) and presence of a conspicuous black narrow stripe running from infraorbital 3 obliquely caudoventrad toward the preopercular margin vs. a rounded and faint suborbital marking present on infraorbitals 3-4. Examination of the type series and additional material from the rio Aripuanã confirms that Crenicichla guentheri Ploeg, 1991 is a junior subjective synonym of C. hemera Kullander, 1990.

Facial lesions caused by renal osteodystrophy in a patient with chronic renal insufficiency: a case report

PURPOSE: Chronic renal insufficiency (CRI) is the last stage of a chronic renal condition in which the kidney loses its filtration and endocrine functions. Chronic endocrine hypofunction causes generalized damage to the body known as Uremic Syndrome, which affects the central nervous system as well as the cardiovascular, hematologic, dermatologic, ophthalmic, endocrine, respiratory, gastrointestinal and skeletal systems. The present study reports the case of a female patient with CRI who presented facial osteodystrophy of the osteitis fibrosa type, and highlights the main features of this condition. CASE DESCRIPTION: A 24-year old, female, Caucasian patient presented chronic glomerulonephritis recurrence and lost the transplanted kidney five years before, undergoing arteriovenous fistula hemodialysis three times a week. She presented swelling of the left masseter area with a hard consistency on palpation, covered by intact skin, swelling at the bottom of the left atrium, with a hard consistency on palpation, a mucosa-like color and absence of inflammation signs, suggesting expansive bone lesions on the face. These features were compatible with hyperparathyroidism brown tumor and/or osteodystrophy. The CT scan showed expansive bone lesions of heterogeneous appearance on the left jaw, maxilla/nasal floor, and right frontotemporal suture areas. The clinical and histopathological characteristics of the lesion, in association with PHT hormone high serum levels led to renal osteodystrophy diagnosis. The patient was referred to the nephrology services. CONCLUSION: Osteodystrophic bone alterations have a high prevalence in renal disease patients, and the dentist must take these alterations into consideration in bone lesion diagnosis for this specific group of patients.

Efecto del contenido de DHA en el enriquecimiento de rotíferos sobre la aparición de deformidades esqueléticas en la dorada Sparus aurata (Linnaeus, 1758)

Since sudden mortalities and increased skeletal deformities in gilthead seabream juveniles are currently found in production hatcheries, this study aimed to evaluate the contribution of essential fatty acids, particularly DHA over early feed quality, larval growth, survival and the apparition of skeleton abnormalities in highly commercial interest specie such as Sparus aurata. Sea bream larvae were reared under intensive conditions and fed rotifers enriched with two different enrichment emulsions differing in DHA content. Thus, essential fatty acid composition of rotifers, showed fatty acid profile of enrichment emulsions. The increase in rotifers DHA (10.0 to 25.4% TFA) were also reflected in a higher DHA content in the FA composition of larval fed this rotifers (13.0 to 20.4% TFA) when these preys were the main source of food (14dah). Survival at 50 days after hatching (13.9±4.3) and growth evolution from 3dah until day 50, were similar in both treatments, whereas bone malformations, particularly opercula reduction, and jaw deformities were higher in higher DHA rotifers fed larvae.

Riabilitazione protesica ed implanto-protesica di pazienti in età evolutiva affetti da Displasia Ectodermica

Introduction. Ectodermal Dysplasias are a heterogeneous group of inherited disorders characterized by dysplasia of tissues of ectodermal origin (hair, nails, teeth, skins and glands). Clinically, it may be divided into two broad categories: the X-linked hypoidrotic form and the hidrotic form. Hypohidrotic Ectodermal Dysplasia (H.E.D) is characterized by the triad oligo-anodontia, hypotricosis, hypo-anhydrosis (Christ-Siemens-Tourane syndrome). The incidence of HED is about 1/100,000. Mutation in the actodysplasin-A (EDA) and ectodysplasin-A receptor (EDAR) genes are responsible for X-linked and autosomal HED. The clinical features include sparse, fine hair, missing or conical-shaped teeth, decreased sweat and mucous glands, hypoplastic skin, and heat intolerance with exercise or increased ambient temperature. Complete or partial anodontia and malformation of teeth are the most frequent dental findings. Incisors and canines are often conical-shaped while primarily second molars, if present, are mostly affected by taurodontism. Treatment is supportive and includes protection from heat exposure, early prosthetic rehabilitation, skin, hair ear, nose and nail care, and genetic counseling for family planning. The diagnosis of HED in the neonatal and early infancy period may be difficult since sparse hair and absent teeth are normal finding at this age. In childhood the diagnosis is more easily made on the basis of history and clinical examination. Dental abnormalities are the most common complaint. Prosthetic rehabilitation has been recommended as an essential part of the management of HED because is important from functional, esthetic, and psychological standpoint. A team approach that includes input from a pediatric dentist, an orthodontist, a prosthodontist, and an oral and maxillofacial surgeon is necessary for a successful outcome. Conventional prosthodontic rehabilitation in young patient is often difficult because of the anatomical abnormalities of existing teeth and alveolar ridges. The conical shaped teeth and “knife-edge” alveolar ridges result in poor retention and instability of dentures. Moreover, denture must permit jaws expansion and a correct pattern of growth. Materials and Methods. Complete removable dentures were provided to allow for normal physiological development and a corrected masticatory function. Initial maxillary and mandibular impressions were made with smallest stock trays and irreversible hydrocolloid and then final impressions ware made with light-bodied polysulfide rubber base impression material. A base of autopolymerizing resin was constructed and a wax rim was added to the base. The patient’s vertical dimension of occlusion was established by assessing phonetic and esthetic criteria. Preliminary occlusal relations were recorded, and the mandibular cast was mounted on the articulator. Acrylic resin teeth specific for children dentures were selected and mounted. The dentures were tried in and, after proper adjustments, were inserted. The patients were monitored clinically every month to fit prostheses. Cephalometric radiographs were taken every 6 month with the prostheses in place in order to evaluate correct pattern of growth. Cephalometric measurements were realized and used to evaluate the effect of rehabilitation on craniofacial growth. Cephalometric measurements of sound patients were compared with ED patients. After two month expander screws (three-way screw in the upper denture and two-way the lower one)were inserted in each denture in order to permit the expansion of the denture and the jaws growth. Where conical teeth were present, composite crown were realized and luted to improve the esthetic and phonesis. In order to improve retention the placement of endosseous implants was carried out. TC 3D Accuitomo was performed and a resin model of mandibular bone of the patient was realized. At the age of 11 years two implants were inserted into anterior mandible in a child with anodontia. Despite a remarkable multi-dimensional atrophy of the mandibular alveolar process, the insertion of two tapered screw implants (SAMO Smiler, diameter 3.8, length 10 mm). After a submerged healing period of two-three month, the implants were exposed. Implants were connected with an expansion guide that permits mandibular growth and prosthetic retention. The amount of mandibular growth was also evaluate dusing the expansion guide. Results. Early oral rehabilitation improve oral function, phonesis and esthetic, reducing social impairment. Treated patients showed normal cephalometric measurement. Early rehabilitation is able to prevent the prognatissm of the mandibula . The number of teeth was significantly related to several changes in craniofacial morphology. Discussion. In the present study the 5,3% of ED patients showed hypodontia, the l’89,4% di oligodontia, and the 5,3% di anodontia. The cephalometric analysis supports that ED patients showed midface hypoplasia. ED groups showed an increased pogonion to nasion measurement than sound patients, indicative of class III tendency. The present study demonstrated that number of teeth was significantly correlated with deviation of cephalometric measurements from normality. Oligoanodontia is responsible for changing of cephalometric measuraments also on sagittal plane with a class III tendency. Maxillary jaw showed a retrused position related to the presence of hypodontia.

Anatomy, phylogeny, and palaeoecology of the basal thalattosuchians (Mesoeucrocodylia) from the Liassic of Central Europe

In the marine Jurassic deposits of Europe, a group of marine crocodilians, the Thalattosuchia, belongs to the frequently found reptiles. Thalattosuchia are widely spread in Central Europe from the Jurassic to Lower Cretaceous, and some taxa are also distributed worldwide. The task of the work was to examine all taxa known from the Liassic of Europe. The most frequently known taxa Steneosaurus bollensis and Pelagosaurus typus are anatomically revised. New discoveries at the skull of Pelagosaurus typus e.g., the fact of a partly paired frontal are described by means of computed tomography investigations. In addition, juvenile specimens of this taxon are studied in detail for the first time. The rarely occurring taxon Platysuchus multiscrobiculatus is anatomically described in detail for the first time. It shows both in the skull and in the postcranial material morphological differences to Steneosaurus bollensis and Pelagosaurus typus. Thus Pl. multiscrobiculatus possesses, e.g., an ilium with a deeper acetabulum and a femur with a distinctly flexed femoral head. A juvenile specimen of Pl. multiscrobiculatus is now discovered and is described in parts for the first time, too. Furthermore, Steneosaurus gracilirostris and Steneosaurus brevior known from Lower Jurassic deposits of England are examined and in parts revised. In this work, Steneosaurs brevior is discovered with one specimen from the Upper Liassic of Holzmaden, Germany for the first time, and provides new evidence for the palaeobiogeographical distribution of the taxon. Because of the high number of investigated specimens, it is possible to study ontogenetic development from juvenile to adult stage in Steneosaurus bollensis, Pelagosaurus typus, and Platysuchus multiscrobiculatus. Biometric data are collected from thalattosuchians and extant crocodilians (e.g. Gavialis gangeticus) to investigate intraspecific variation, ontogenetic development, and taxa differentiation. The skulls of Platysuchus multiscrobiculatus and Steneosaurus bollensis are reconstructed three-dimensionally as wax models. The skull reconstructions form the basis of the jaw muscle restoration of Steneosaurus bollensis in connection with comparative studies at extant crocodilians. By means of functional morphologic analysis of the jaw musculature, the dentition, and the locomotor system of S. bollensis, possible conclusions are drawn for the prey options and the hunting behaviour. To clarify the relationships within the Thalattosuchia, a computer-based cladistic phylogenetic in-group analyse of 25 Thalattosuchia taxa is performed. For the analysis, following Thalattosuchia taxa are studied likewise at original material for comparisons: Metriorhynchus superciliosus, Metriorhynchus hastifer, Metriorhynchus leedsi, Geosaurus gracilis, Geosaurus giganteus, Teleidosaurus calvadosi, Teleidosaurus gaudryi, Teleosaurus cadomensis, Teleosaurus geoffroyi, Steneosaurus priscus, Steneosaurus edwardsi, Steneosaurus heberti, Steneosaurus leedsi, Steneosaurus boutilieri, Steneosaurus megarhinus, Steneosaurus obtusidens, and Machimosaurus hugii. The phylogenetic in-group analyse based on 115 characters, reveals a sister-group relationship of the monophyletic Teleosauridae and monophyletic Metriorhynchidae. Within the groups, some taxa are probably paraphyletic. The taxon Pelagosaurus typus is nested inside the Teleosauridae and not outside or within the Metriorhynchidae, as many authors suggested it so far. Based on these results, a tentative palaeobiogeographical-evolutionary scenario is developed.

Ergebnisse der Behandlung mit Kortikalisschrauben

Im Rahmen der vorliegenden Dissertation wurden 106 Minipins bei 62 Patienten (29 Männer und 33 Frauen)untersucht.rnÜberlebensrate betrug 76,4%. Misserfolge, die zum Verlust der Minipins führten wie Mukositis, Lockerung oder Wurzelperforation, stellten sich in 23,7 % (n=25) der Fälle ein. Dabei gingen beim Auftreten von Mukositis 9 von 14 (8,5 %), bei der Lockerung der Minischrauben 8 von 10 (7,5 %) der Minischrauben verloren. Eine Wurzelperforation trat in einem Fall auf. rnDie einzige lingual im Unterkiefer implantierte Schraube ging verloren. Implantation palatinal im Oberkiefer führte in zwei von vier Fällen zum Verlust. rnDie Sofortbelastung der kieferorthopädischen Kortikalisschrauben erscheint ein praktikables Belastungskonzept zu sein.rnDie Verlustraten bei der vestibulären Implantation betrugen 3,8 % (n=4) für den Oberkiefer und 15,1 % (n=16) für den Unterkiefer.rnBei der Implantation in befestigte bzw. unbefestigte Mukosa betrug die Überlebensrate entsprechend 83,3 % (n=72) und 62,3 % (n=22). rn

The prehistoric inhabitants of the Wadi Howar : an anthropological study of human skeletal remains from the Sudanese part of the Eastern Sahara

All currently available human skeletal remains from the Wadi Howar (Eastern Sahara, Sudan) were employed in an anthropological study. The study’s first aim was to describe this unique 5th to 2nd millennium BCE material, which comprised representatives of all three prehistoric occupation phases of the region. Detecting diachronic differences in robusticity, occupational stress levels and health within the spatially, temporally and culturally heterogeneous sample was its second objective. The study’s third goal was to reveal metric and non-metric affinities between the different parts of the series and between the Wadi Howar material and other relevant prehistoric as well as modern African populations. rnThe reconstruction and comprehensive osteological analysis of 23 as yet unpublished individuals, the bulk of the Wadi Howar series, constituted the first stage of the study. The analyses focused on each individual’s in situ position, state of preservation, sex, age at death, living height, living weight, physique, biological ancestry, epigenetic traits, robusticity, occupational stress markers, health and metric as well as morphological characteristics. Building on the results of these efforts and the re-examination of the rest of the material, the Wadi Howar series as a whole, altogether 32 individuals, could be described. rnA wide variety of robusticity, occupational stress and health variables was evaluated. The pre-Leiterband (hunter-gatherer-fisher/hunter-gatherer-fisher-herder) and the Leiterband (herder-gatherer) data of over a third of these variables differed statistically significantly or in tendency from each other. The Leiterband sub-sample was characterised by higher enamel hypoplasia frequencies, lower mean ages at death and less pronounced expressions of occupational stress traits. This pattern was interpreted as evidence that the adoption and intensification of animal husbandry did probably not constitute reactions to worsening conditions. Apart from that, the relevant observations, noteworthy tendencies and significant differences were explained as results of a broader spectrum of pre-Leiterband subsistence activities and the negative side effects of the increasingly specialised herder-gatherer economy of the Leiterband phase. rnUsing only the data which could actually be collected from it, multiple, separate, individualised discriminant function analyses were carried out for each Wadi Howar skeleton to determine which prehistoric and which modern comparative sample it was most similar to. The results of all individual analyses were then summarised and examined as a whole. Thus it became possible to draw conclusions about the affinities the Wadi Howar material shared with prehistoric as well as modern populations and to answer questions concerning the diachronic links between the Wadi Howar’s prehistoric populations. When the Wadi Howar remains were positioned in the context of the selected prehistoric (Jebel Sahaba/Tushka, A-Group, Malian Sahara) and modern comparative samples (Southern Sudan, Chad, Mandinka, Somalis, Haya) in this fashion three main findings emerged. Firstly, the series as a whole displayed very strong affinities with the prehistoric sample from the Malian Sahara (Hassi el Abiod, Kobadi, Erg Ine Sakane, etc.) and the modern material from Southern Sudan and, to a lesser extent, Chad. Secondly, the pre-Leiterband and the Leiterband sub-sample were closer to the prehistoric Malian as well as the modern Southern Sudanese material than they were to each other. Thirdly, the group of pre-Leiterband individuals approached the Late Pleistocene sample from Jebel Sahaba/Tushka under certain circumstances. A theory offering explanations for these findings was developed. According to this theory, the entire prehistoric population of the Wadi Howar belonged to a Saharo-Nilotic population complex. The Jebel Sahaba/Tushka population constituted an old Nilotic and the early population of the Malian Sahara a younger Saharan part of this complex. The pre-Leiterband groups probably colonised the Wadi Howar from the east, either during or soon after the original Saharo-Nilotic expansion. Unlike the pre-Leiterband groups, the Leiterband people originated somewhere west of the Wadi Howar. They entered the region in the context of a later, secondary Saharo-Nilotic expansion. In the process, the incoming Leiterband groups absorbed many members of the Wadi Howar’s older pre-Leiterband population. The increasing aridification of the Wadi Howar region ultimately forced its prehistoric inhabitants to abandon the wadi. Most of them migrated south and west. They, or groups closely related to them, probably were the ancestors of the majority of the Nilo-Saharan-speaking pastoralists of modern-day Southern Sudan and Eastern Chad.

Bisphosphonat-assoziierte Osteonekrose der Kiefer : In-vitro-Untersuchungen zur Pathologie und zu möglichen Therapieansätzen

Die Bisphosphonat-assoziierte Osteonekrose der Kiefer (BP-ONJ) stellt eine ernstzunehmende Nebenwirkung der Therapie mit stickstoffhaltigen Bisphosphonaten (N-BP) dar, deren Ätiologie bisher noch nicht vollständig geklärt ist. Da entzündliche Prozesse eine wichtige Rolle zu spielen scheinen, wurde der Einfluss verschiedener Bisphosphonate auf die Mechanismen der granulozytären Erregerabwehr untersucht. Die N-BP Ibandronat, Pamidronat und Zoledronat steigerten die Phagozytose und den oxidativen Burst signifikant. Die fMLP-stimulierte Chemotaxis wurde durch Ibandronat und Zoledronat signifikant reduziert. Das stickstofffreie Clodronat zeigte keinen Effekt auf die getesteten Abwehrmechanismen. Auf der Suche nach therapeutischen Optionen gegen die BP-ONJ wurden die Isoprenoide Farnesol, Geranylgeraniol, Eugenol, Menthol, Limonene und Squalene auf deren Fähigkeit untersucht, die schädigenden Effekte Zoledronats auf verschiedene Zelllinien zu antagonisieren. Geranylgeraniol zeigte als einzige Verbindung eine protektive Wirkung auf gingivale Fibroblasten, Endothelzellen und Osteoblasten. Desweiteren kam es unter Zoledronat zum Anstieg der kleinen GTPasen RhoA und RhoB in gingivalen Fibroblasten. Auch der Gehalt an GTP-gebundenem RhoA stieg nach Zoledronat-Inkubation. Der Einfluss des N-BPs ließ sich auch auf Proteinebene durch Geranylgeraniol antagonisieren und nicht durch Farnesol. Die Tatsache, dass N-BP die granulozytäre Abwehr beeinflussen, unterstützt die Bedeutung keimreduzierender Maßnahmen im Rahmen der Nekroseprophylaxe und -therapie. Außerdem untermauern die Ergebnisse der Arbeit das Potential Geranylgeraniols als neue therapeutische Option.

Palatal swelling as the first and only manifestation of extranodal follicular non-Hodgkin lymphoma: a case presentation

Non-Hodgkin lymphomas (NHLs) in the head and neck region are malignant lymphoid neoplasms that usually originate from B-lymphocytic cell lines. Primary extranodal manifestations of this hematolymphoid tumor in the oral cavity are rare and involve the maxillary jaw including the palatal soft tissues, the mandible, and gingival tissues in patients between 60 and 70 years of age without sex predilection. This case report of an extra-nodal NHL in the palate of a 75-year-old patient emphasizes the importance of accurate clinical, radiographic, and histologic diagnostic procedures to avoid delayed diagnosis or inappropriate treatment strategies. Chemotherapy, radiotherapy, or a combination of the two with a regular clinical and hemic follow-up is recommended.

Bone marrow-derived cells in palatal wound healing

OBJECTIVE: Myofibroblasts are responsible for contraction and scarring after cleft palate repair. This leads to growth disturbances in the upper jaw. We hypothesized that cells from the bone marrow are recruited to palatal wounds and differentiate into myofibroblasts. METHODS: We transplanted bone marrow from green fluorescent protein (GFP)-transgenic rats into lethally irradiated wild-type rats. After recovery, experimental wounds were made in the palatal mucoperiosteum, and harvested 2 weeks later. GFP-expressing cells were identified using immunostaining. Myofibroblasts, activated fibroblasts, endothelial cells, and myeloid cells were quantified with specific markers. RESULTS: After transplantation, 89 ± 8.9% of mononuclear cells in the blood expressed the GFP and about 50% of adherent cells in the bone marrow. Tissue obtained during initial wounding contained only minor numbers of GFP-positive cells, like adjacent control tissue. Following wound healing, 8.1 ± 5.1% of all cells in the wound area were positive, and 5.0 ± 4.0% of the myofibroblasts, which was significantly higher than in adjacent tissue. Similar percentages were found for activated fibroblasts and endothelial cells, but for myeloid cells it was considerably higher (22 ± 9%). CONCLUSIONS: Bone marrow-derived cells contribute to palatal wound healing, but are not the main source of myofibroblasts. In small wounds, the local precursor cells are probably sufficient to replenish the defect.

[Only a denture sore? Causes of a possible denture sore from a maxillary complete denture]

This case presentation documents the treatment sequence of a 74 years old patient who complained about a sore spot of the palatal mucosa underneath the complete denture. The intraoral examination revealed a dark spot, redness and swelling of the mucosa around this spot and halitosis. The mucosa exhibited a perforation of 3 x 10 mm in diameter. A radiographic 3-D picture showed an impacted canine tooth, which was partly covered by the palatal bone. Firstly the denture base was relieved and the swelling gradually disappeared. Then a biopsy was taken for histological analysis to exclude any malignant process. In local anesthesia the tooth was extracted, which exhibited a deep carious lesion of the entire crown. After surgery a visible collapse of the jaw crest was observed. During a period of two months the denture was relined with a soft material to improve its fit and to enhance the healing process. With a final rebasement, the existing denture could be adapted again and the patient continued to wear it.

Comparison of actual surgical outcomes and 3-dimensional surgical simulations

PURPOSE: The advent of imaging software programs has proved to be useful for diagnosis, treatment planning, and outcome measurement, but precision of 3-dimensional (3D) surgical simulation still needs to be tested. This study was conducted to determine whether the virtual surgery performed on 3D models constructed from cone-beam computed tomography (CBCT) can correctly simulate the actual surgical outcome and to validate the ability of this emerging technology to recreate the orthognathic surgery hard tissue movements in 3 translational and 3 rotational planes of space. MATERIALS AND METHODS: Construction of pre- and postsurgery 3D models from CBCTs of 14 patients who had combined maxillary advancement and mandibular setback surgery and 6 patients who had 1-piece maxillary advancement surgery was performed. The postsurgery and virtually simulated surgery 3D models were registered at the cranial base to quantify differences between simulated and actual surgery models. Hotelling t tests were used to assess the differences between simulated and actual surgical outcomes. RESULTS: For all anatomic regions of interest, there was no statistically significant difference between the simulated and the actual surgical models. The right lateral ramus was the only region that showed a statistically significant, but small difference when comparing 2- and 1-jaw surgeries. CONCLUSIONS: Virtual surgical methods were reliably reproduced. Oral surgery residents could benefit from virtual surgical training. Computer simulation has the potential to increase predictability in the operating room.

Reduced endurance of the cervical flexor muscles in patients with concurrent temporomandibular disorders and neck disability

Subjects with temporomandibular disorders (TMDs) have been found to have clinical signs and symptoms of cervical dysfunction. Although many studies have investigated the relationship between the cervical spine and TMD, no study has evaluated the endurance capacity of the cervical muscles in patients with TMD. Thus the objective of this study was to determine whether patients with TMD had a reduced endurance of the cervical flexor muscles at any level of muscular contraction when compared with healthy subjects. One hundred and forty-nine participants provided data for this study (49 subjects were healthy, 54 had myogenous TMD, and 46 had mixed TMD). There was a significant difference in holding time at 25% MVC between subjects with mixed TMD when compared to subjects with myogenous TMD and healthy subjects. This implies that subjects with mixed TMD had less endurance capacity at a lower level of contraction (25% MVC) than healthy subjects and subjects with myogenous TMD. No significant associations between neck disability, jaw disability, clinical variables and neck flexor endurance test were found.