TRABALHOS CIENTÍFICOS APRESENTAÇÕES ORAIS

Transcrição

TRABALHOS CIENTÍFICOS
APRESENTAÇÕES ORAIS
SESSÃO I: ATM
Condylar reconstruction: A case of total cutom-made joint prosthesis for temporomandibular joint
reconstruction bilaterally
Michelle Alonso Coutinho*, Leonardo Augustus Peral Ferriera Pinto, Bruno Coutinho Vargas, Viviane Ramos
Peral Ferriera Pinto.
Face Treatment Center - CTFace
Resumo
The temporomandibular joint (TMJ) is composed of the condyle extremity of the mandible and the glenoid fossa formed in
the temporal bone wich are separated by the articular disc that may or may not be destroyed in the degeneration causing
pain, inflammation areas, morphostructural change until complete immobility. This process can be uni or bilaterally. Patients
with worsening jaw function, severe chronic pain problems, and other associated systemic, nutritional, and immunological
illnesses that cause extreme disability, inflammatory diseases, autoimmune diseases, ankylosis and tumors may have the
best opportunity of successful treatment with a total joint prosthesis. The patient's prognosis depends of the prosthesis type,
so the prosthesis with metal-ultra-high-molecular-weight polyethylene articulation should be chosen to present average
duration of 10 years, less hypersensitivity, lower risk of metallosis, low release of chromium and cobalt and better
postsurgical results related to incisal opening, pain, jaw function and diet. These advantages associated with custom-made
prosthesis which provides anatomic information, in preoperative and intraoperative contributing significantly to safety of the
procedure, the determination of the osteotomies and the reduction of surgical time becomes invaluable. The patient, under
general anesthesia, underwent bilateral total reconstruction and correction of TMJs with custom-made prosthesis of TMJ
Concepts by presenting condylar bone degeneration bilaterally compatible with morphostructural change sclerosis of the
bone surfaces, marginal osteophytes and subchondral cysts. On the right side showed condylar hyperplasia. The patient
had severe difficulty in mouth opening, bilateral pain and limitation in mouth opening movement, laterality and protrusion.
The patient had their food only by a pasty-liquid diet by not achieve mouth opening caused by the pains that are compatible
with the degeneration in the joints bilaterally, which led her submit your Body Mass Index below normal. She required
surgical intervention in the TMJs to prevent worsening of the present situation.
Using of piezosurgery in temporomandibular joint ankylosis treatment
Gustavo Almeida Souza*, Leandro Souza Pozzer, Alexander Tadeu Sverzut, Márcio de Moraes.
Piracicaba Dental School, State University of Campinas - FOP UNICAMP
Resumo
The development of piezoelectricity and its success in bone cut revolutionized the oral and maxillofacial surgery, as is
currently shown in the literature. The benefits associated with this ultrasonic non-invasive technique are: precise incision,
minimal damage of the adjacent soft tissues, more bone preservation, controlled inflammation, stimulation of the bone
remodeling and decreased bone heating. The piezoelectric systems in a lower frequency (25-29 kHz) create microvibrations
able to cut only mineralized tissues. In higher frequency (0,50 kHz) the soft tissues can be cut. Many piezoelectricity
applications are described, as: periodontal surgery, surgery for orthodontic treatments, preprosthetic surgery, removal of
bone graft, lateralization of the inferior alveolar nerve, orthognatic surgery, joint surgery. The temporomandibular joint
ankylose is a disabling disease, that commit the chewing, digestion, speech, appearance and oral hygiene. Among the
various treatments described to it, the gap arthroplasty is well established in the literature and is the procedure of choice for
many surgeons. The surgical procedure consists in removal of approximately 1,5 cm of ankylotic mass, with or without
interposition of soft tissue or alloplastic material, institution of aggressive postoperative physiotherapy. Traditionally, saws
and drills have been used in the osteotomy. The advantages of piezosurgery utilization in the treatment of TMJ’s ankylosis
are mainly: precise cutting, less risk of injury to blood vessels and nerve bunches, decreasing of transoperative bleeding
and therefore better visualization of the surgical site, formation less bones debris. The aim of this study is to present the
advantages of TMJ ankylosis treatment using piezosurgery, emphasizing the technical aspects.
Associação dos sinais e sintomas de Disfunção Têmporomandibular com características imaginológicas
de TC e RMN da ATM
Samuel de Souza Moraes*, Rodrigo Correia Tavares, Érica Cristina Marchiori, Fábio Ricardo Loureiro Sato,
Roger William Fernandes Moreira.
Hospital of the defects of the face - HDF
Resumo
Desarranjos nas articulações têmporo-mandibulares (ATMs) são condições relativamente comuns, mais ocorrentes em
mulheres acima de 40 anos de idade. As desordens têmporo-mandibulares (DTMs) podem ser musculares ou intraarticulares, e pertencem a um dos mais desafiadores campos de atuação do cirurgião buco-maxilo-facial. Normalmente são
caracterizadas por dor, diminuição da função e mobilidade e ainda pela ocorrência de sons articulares como cliques e
crepitação. Os exames complementares são de extrema importância para o diagnóstico das patologias que acometem a
ATM, bem como para o planejamento do tratamento. Auxiliam na investigação do estágio atual da doença, além de auxiliar
na investigação da etiologia em alguns casos. A tomografia computadorizada (TC) em seus cortes coronais, axiais e
sagitais, bem como a reconstrução em 3 dimensões (3D) tem por objetivo avaliar as partes ósseas da ATM: cavidade
glenóide, eminência articular e côndilo mandibular. É possível detectar a presença de erosões, osteófitos e cistos
subcondrais, reabsorção condilar, hipo ou hiperexcursão condilar, redução do espaço intra-articular e perda de
corticalização condilar e da eminência articular. A ressonância magnética nuclear (RMN) fornece informações sobre a
condição dos tecidos moles da articulação, incluindo disco articular, músculos, ligamentos, cartilagem e cápsula articular.
Além disso, a porção medular do tecido ósseo também é bem visualizada. Com este exame de imagem é possível
identificar formato alterado do disco articular, podendo sugerir uma possível perfuração discal (esta só é possível de ser
visualizada no trans-operatório); derrame articular; deslocamento do disco com ou sem redução. Baseados nessas
informações, o objetivo deste estudo retrospectivo é correlacionar a sintomatologia das DTMs com os achados
imaginológicos (TC e RMN) de pacientes atendidos pela equipe de Cirurgia e Traumatologia Buco-maxilo-faciais do
Hospital dos Defeitos da Face da Cruz Vermelha Brasileira - Filial do Estado de São Paulo, no período de março de 2013 a
julho de 2014.
Diagnostic arthroscopy of the TMJ: A critical review
Francesco Salvatore Mannarino*, Leonard Duarte Moreira, Cáudio Roberto Pacheco Jodas, Rubens Gonçalves
Teixeira, Rafael Tardeli Zeni.
São Leopoldo Mandic dental school - SLMANDIC
Resumo
The Temporomandibular joint disorder is a common cause of chronic facial pain that can be treated conservatively, but
when this method fails, arthroscopy of the temporomandibular joint (TMJ) should be considered as a diagnostic and
therapeutic tool. Due to the high incidence of intra-articular disorders affecting the TMJ, ranging from inflammatory
adhesions, through internal derangements and associated pain with or without functional limitation, or even advanced
stages of degenerative intra-articular diseases, highlights the importance of establishing a reliable method for the differential
diagnosis. Through critical review on applicability and accuracy of the TMJ diagnostic arthroscopy, several authors
correlated these data and compared with the histological findings, others have compared sensitivity and specificity in
relation to magnetic resonance imaging of the TMJ; still others confronted the arthroscopic findings with those of open joint
surgery. Suitable for diverse situations, diagnostic arthroscopy, besides collecting consistent data for clinical trial as the
Wilkes classification of intra-articular disease, also allows procedures in the same surgical procedure such as lysis and
lavage of the joint with substantial improvement in patients with acute inflammatory conditions, internal or degenerative
derangements. Among the evaluated clinical parameters in the pre-and postoperative periods, these include subjective pain
scale analysis, mouth opening assessment, range of mandibular motion and food consistency. As possible complications of
TMJ arthroscopy are auditory, neurologic, infectious, hemorrhagic or broken instruments. Taking into account the low
complication rates and high sensitivity, specificity and accuracy of the TMJ diagnostic arthroscopy, this technique becomes
the state-of-the-art as diagnostic and therapeutic tool for the treatment of temporomandibular disorders based on evidence.
LOW LEVEL LASER THERAPY ON BONE FORMATION OF THE MANDIBULAR CONDYLE
Larissa Emanuelle Sestari*, Marcos Vinicios Borges Galdino, Mara Rubia Marques.
School of Dentistry, Federal University of Goiás - UFG, 4 UFG - Biological Sciences Institute, Federal University
of Goiás (Campus II - Samambaia, Goiânia - GO), 5 UFG - Biological Sciences Institute, Federal University of
Goiás (Campus II - Samambaia, Goiânia - GO)
Resumo
The mandibular condyle is an important growing center of the mandible and its metabolism is directly influenced by several
stimuli acting on temporomandibular joint. Low level laser Therapy (LLLT) has shown promising results in bone formation. In
order to evaluate the effects of LLLT on bone formation in the mandibular condyle, eight male Wistar rats aging 30 days
were divided into Control and Laser groups. The Laser group was bilaterally irradiated on temporomandibular joint with 10
J/cm2 low level laser (780nm, 40mW and 10s) in alternate days. The Control group received no treatment. After 15 days the
condyles were dissected, fixed in Methacarn and demineralized in EDTA. Histological sections of 5µm were stained with HE
and images of the cartilage-bone interface were digitized for stereological analyzes. The relative percentage of bone mass
and the thickness of the trabeculae were determined. The percentage of total bone mass was 35.7%±0.7 in the control
group and increased to 43.2%±0.7 in the Laser group (p<0.01). Considering the anterior, central and posterior regions of the
condyle the relative percentages of bone mass in the control group were 35.2%±1.3; 35.7%±1.1 and 36.4%±1.0,
respectively. In the Laser group this parameter increased to 45.7%±1.1; 41.1%±1.0 and 43.7±1.2%, respectively (p<0,01).
The thickness of the trabeculae in the control group was 29.7±0.5 µm in the anterior region, 27.9±0.4 µm in the central
region and 27.3±0.4 µm in the posterior region. In the Laser group we observed an increase to 43.8±0.7 µm; 37.8±0,6 µm
and 45.6±0.6 µm, respectively (p<0.01). The results suggest that LLLT promotes bone formation in the mandibular condyle
of rats.
Autologous Blood Injection for the Treatment of Chronic Recurrent Temporomandibular Joint
Dislocation
Hugo Leonardo Mendes Barros*, Raphael Castiglioni Coser, Paulo José D'Albuquerque Medeiros, Fábio
Gamboa Ritto, Thaís Pimentel de Sá Bahia.
State University of Rio de Janeiro - UERJ
Resumo
Within the disorders of joint hypermobility, the luxation of the temporomandibular joint (TMJ) represents an anterior
positioned mandibular condyle in relation to articular eminence. There is a complete separation of the articular surfaces and
consequent locking of the jaw at maximum aperture, requiring mechanical reduction by a trained professional. When a
patient presents several dislocations of the TMJ, this condition is called TMJ recurrent dislocation. The treatment for this
pathology usually requires surgery, such as the eminectomy or the use of mini-plates. It may also be treated by
conservative means, including the use of botulinum toxin type A or sclerosing substances such as autologous blood. This
study aimed to evaluate the effectiveness of treatment of recurrent dislocation with infiltration of autologous blood as well as
its possible complications. Eleven patients, diagnosed with recurrent luxation of the TMJ, received bilateral injections of
autologous blood in the superior joint compartment and pericapsular region. The patients selected for the study had at least
3 dislocations in the last six months, had no history of previous surgery to the TMJ or psychiatric conditions, and did not
present any parafunctional habits. After a follow-up period that ranged from 24 to 35 months (average of 31.09 months)
results demonstrated the following: 8 patients (72.7%) were treated successfully, without recurrences, while 3 patients
(27.3%) presented relapse and the procedure was performed again, but without success, and they are referred to
eminectomy. Other findings of the initial screening included 3 patients presenting planing of the condilar surface; no patients
presenting osteophytes; and 6 patients (54%) presenting discomfort and feeling of buzz after the procedure; . The study
demonstrated that the procedure is simple, rapid, minimally invasive, cost effective and with minimum possibility of
complications, being a feasible alternative of treatment before surgical procedures.
ANCHORING OF TEMPOROMANDIBULAR JOINT DISC BY ARTHROSCOPIC VIEW
Wladimir Genovesi*, Iara Comenale, Wladimir Genovesi Filho, Glaucia Fukuda.
Hospital 9 de Julho - H9J
Resumo
ABSTRACT The arthroscopy diagnostic/surgery is a success full in orthopedics practice. Since 1975 this technique has
been developed for TMJ , for the visualization of the relationship of the disc, Glenoide fossa, Condile and articular
Eminence. TMJ arthroscopy has shown a great value for the diagnostic and surgical treatment for TMJ disorders. The
papers work of Helsing, McCain, Murakami, Omnishi and Sanders and the development of the arthroscopy for small joints
has provided perfect conditions for the visualization of the structures that have never seen “ IN VIVO” before. The normal
anatomy and pathological conditions are being studying and micro surgery techniques are being improved based on the
arthroscope finds. After 25 years of experience in TMJ arthroscopy diagnostic/surgery , was realized a better understanding
of the pathologies and lesion inherent a synovial joints. The TMJ open surgery experience show to us that the indications
must be precise, otherwise the results will be disastrous. With the evolution of surgery technique for synovial joints, detach
the anchoring meniscus/disc technique. Grounded in orthapaedic principals, Prof.Dr. L.M Wolford started using a micro
anchor for disc replacement 1992. This techinique was introduced in Brasil in 1992, this is an open surgery techinique, with
small Endaural incision. With the advanced arthroscopy surgery technique by triangulation, was developed the same
surgery technique for the disc anchorage by arthroscopy. After 25 years of experience using the arthroscopy technique for
diagnostic / triangulation surgery, I believe that the Course Dentistry , with regard to the understanding of TMJ, will be
confirmed with this technique, which for some is new, but is already devoted worldwide, which caused much controversy in
the '90s, exposing dental occlusion as the source of joint problems, correlating TMJ with other synovial joints.
Temporomandibular Joint Reconstruction with Customized Prosthesis: A Case Report
André Luis Chiodi Bim*, Mariana Saideles , Carlos Eduardo Chrzanowski Pereira de Souza, Marcos Cesar
Pitta, José Nazareno Gil.
Federal University of Santa Catarina - UFSC, 2 MC Pitta - Institute of Orthognathic Surgery Dr. Marcos C. Pitta
(Av Angélica, 688 Conj 507)
Resumo
Rheumatoid arthritis is the most common autoimmune disease that affects the temporomandibular joint, among other
systemic inflammatory diseases such as psoriatic arthritis, systemic lupus erythematosus, ankylosing spondylitis and gout. It
usually causes progressive resorption of articular structures resulting in retruded mandible, loss of condylar vertical
dimension of the mandibular ramus, high occlusal plane, occlusal class II anterior open bite and articular derangement
followed by constant headache, pain, popping, trismus and loss of masticatory function. Although predominated initially by
the process of resorption, in the final stages ankylosis may be present due to prolonged hypomobility. Resorption and
narrowing of the medial-lateral condyle, resorption of the articular eminence and the articular disc, which usually may be
surround by a reactive tissue, can be observed by magnetic resonance imaging and computed tomography. The most
predictable treatment of temporomandibular joint in patients with rheumatoid arthritis consists of reconstruction with bilateral
prosthesis, bilateral coronoidectomy, orthognathic surgery with counterclockwise rotation of the occlusal plane and
mandibular advancement. There are other treatment options with the use of autogenous tissue as temporal fascia and
muscle flaps, dermal graft, rib graft, sternoclavicular graft, vertical sliding ramus osteotomy. However, because it’s an
autoimmune disease, the success and long-term stability makes these techniques unpredictable. The reconstruction of the
TMJ with alloplastic material is the best option because it eliminates the disease progression, improves function and
aesthetics, can reduce or eliminate the pain. The proposal of this case report is to demonstrate the characteristics of the
disease and surgical planning to obtain predictable results aimed at restoring function, breathing and aesthetics.
SESSÃO II: ATM E CIRURGIA
ORTOGNÁTICA
Autologous blood injection for treatment of recurrent temporomandibular joint luxation: a case report
Thales Morgan Guimarães Sá*, Gabriela dos Santos Lopes, Lucas Souza Cerqueira, Deyvid da Silva
Rebouças, Adriano Silva Perez, Antônio Márcio Teixeira Marchionni.
Escola Bahiana de Medicina e Saúde Pública - EBMSP
Resumo
Luxation of temporomandibular joint occur when the head of mandible moves out of the glenoid fossa crossing the limits of
the articular eminence and remains locked there, preventing the closing of the mouth by the patient. Recurrent episodes in
short periods of time characterizing the recurrent temporomandibular joint luxation. The main causes of luxation are
hypermobility, laxity of the temporomandibular ligaments, muscle spasm, an unusual size of the articular eminence,
excessive mouth opening during dental treatment or trauma. Many different nonsurgical and surgical modalities have been
described in the literature as a treatment option for recurrent temporomandibular join luxation. Among the most conservative
techniques, the autologous blood injection to superior joint space and pericapsular tissues, despite the uncertainty of its
mechanism of action, has shown good results in the literature. Is a simple, safe and cost-effective technique that does not
require general anesthesia and minimizes possible postoperative complications related to surgical access, such as facial
nerve injuries, infection or pain. The aim of this work is to report a clinical case of a female patient, 24-year-old, was referred
to the Department of Oral and Maxillo Facial Surgery (OMFS) at the Hospital Geral Roberto Santos complaining of
mandibular luxation approximately 04 months with a history of more than five episodes per week. The patient was submitted
to autologous blood injection in bilateral temporomandibular joint under local anesthesia. Currently, the patient is on follow
up examination with significant improvement. We conclude that this conservative approach can be considered as an
alternative prior to performing a more invasive surgical intervention.
Avaliação de parâmetros clínicos e da satisfação de pacientes submetidos à reabilitação articular com
prótese total da articulação temporomandibular
THAIZ CARRERA ARRABAL FERNANDES*, Luiz Fernando Lobo, Rogério Heládio Lopes Motta Heládio Lopes
Motta, Juliana Cama Ramacciato, Rubens Rubens Teixeira.
Dental Research Center São Leopoldo Mandic - SLM, 2 HSP - oral and maxillofacial surgery service Santa
Paula (Avenida Santo Amaro, 2468 - Vila Olímpia, São Paulo - SP, 04556-100)
Resumo
O objetivo deste estudo foi avaliar alguns parâmetros clínicos e a satisfação de pacientes submetidos à reabilitação
articular com prótese total da articulação temporomandibular. No total foram avaliados 44 pacientes com no mínimo 12
meses de pós operatório, sendo 17 homens com idade média (±erro padrão) de 37,2±1,9 anos, e 27 mulheres com idade
de 40,9±2,1 anos. Todos os pacientes avaliados foram submetidos a uma avaliação clínico-funcional para avaliação de
diferentes parâmetros clínicos: condição odontológica e as etiologias, frequência de estalos, crepitação, cefaléia, assimetria
facial, desvio de abertura bucal, edema, dificuldade para mastigar, dor local e grau de abertura bucal, lateralidade e
protrusão. Também foi avaliada a satisfação do paciente por meio de questionários padronizados. Para a análise dos
resultados foram utilizados os testes de Mann-Whitney, teste exato de Fischer, teste do Qui-quadrado, Wilcoxon e KruskalWallis, com nível de significância de 5%, e os softwares utilizados foram o BioEstat 5.0 e o GraphPad 6.0. Em relação aos
resultados obtidos, não houve diferenças estatisticamente significantes entre as idades, em função dos gêneros. O tempo
de uso das próteses pelos voluntários foi, na sua maioria, de 5 anos. Foi possível observar que a abertura bucal no pósoperatório foi maior do que aquela do pré-operatório exibindo um aumento médio de 14,6±8,04 mm (p<0,05). Da mesma
forma, a medida da lateralidade e a protrusão também aumentaram significativamente no pós-operatório. Os relatos de
estalo, crepitação, cefaleia, assimetria facial e principalmente dor local diminuíram significativamente (teste Exato de
Fisher, p<0,05) após as cirurgias. Também foi possível observar que 37 (84,1%) sujeitos apresentaram melhora na
mastigação e 40 (90,9%) apresentaram melhora no convívio social. Considerando a amostra estudada, pode-se concluir
que a reabilitação articular com prótese total da articulação temporomandibular pode ser uma opção eficaz quando
necessária.
Obstructive Sleep Apnea Syndrome Following Mandibular Setback: A Systematic Review of the
Literature.
João Vitor dos Santos Canellas*, Fabio Gamboa Ritto, Paulo José de Albuquerque Medeiros , Hugo Leonardo
Mendes Barros .
Rio de Janeiro State University - UERJ
Resumo
Purpose: The effect of mandibular setback surgery on patients without sleep apnea obstructive syndrome is a controversial
topic. Mandibular setback reduces space in the pharyngeal airway, and it has been suggested that it might induce sleepdisorderd breathing. Therefore, an evidence-based literature review was conducted to identify the effect of mandibular
setback on the respiratory function during sleep. Materials and Methods: The authors performed a systematic review of
pertinent literature published up to 2014. The present analysis included only publications in English. A structured search of
literature was performed, with predefined criteria, using computer and manual searches. A survey of PubMed,
ScienceDirect and Cochrane database was performed. A manual search of oral and maxillofacial surgery-related journals
was accomplished, and the references of the selected studies were also scanned for possible additional studies. Potentially
relevant studies then had their full-text publication reviewed. Results: A total of 1.780 publications were evaluated, through
which 9 papers were selected for the final review. No evidence of sleep disorder after 6 months was related in 7 studies,
totaling 184 patients. In the remaining articles, 4 patients developed OSAS after surgery, and 6 patients presented increase
of obstructive apneas/hypopneas events, and oxygen desaturation index. The most important risk factors for development
of OSAS cited is the obesity and a large amount of mandibular setback. Conclusion: There was no evidence of
postoperative OSAS after mandibular setback surgery. However, one should always consider a potential reduction of the
upper airway space during treatment plan. Obese patients and those submitted to large amounts of mandibular setback
present a higher chance to develop OSAS.
Mid-Sagittal surgical mandible osteogenic distraction for treatment of severe mandibular deficiency
Michelle Alonso Coutinho*, Leonardo Augustus Peral Ferriera Pinto, Bruno Coutinho Vargas, Viviane Ramos
Peral Ferriera Pinto.
Resumo
The mandibular hypoplasia is a transverse deficiency, that when severe, needs surgical procedures that assist in bone gain
and should be taken together with orthodontic procedures. Distraction osteogenesis is a biologic process of new bone
formation between the surfaces of bone segments that are gradually separated by incremental traction wich produces
tension on the surfaces of bone segments, stimulating bone formation. The symphysis distraction osteogenesis allows the
increase of mandibular arch, normalizes the format of the dental arch and harmonizing with the mandibular bone base. The
aim of this paper is to present the case of a patient with severe hypoplasia mandibular, Class II dental and skeletal, with
diastema in the upper arch, accentuated overjet and reverse curve of Spee in the lower arch, which was surgically treated
with mandibular expansion with an intraoral bone supported distractors outside the alveolus under general anesthesia. The
incision was made as made for genioplasty, the mucoperiosteal flap was detached and the mandibular symphysis was
exposed for access to the region where the median sagittal split osteotomy was performed itself. The distractor device was
fixed and then activated to verify separation of osteotomized segments. Then the vise was completely deactivated to return
to its initial position. The sutures were made and one week postoperatively, device activation was started with one turn three
times daily to achieve the size of 1,5cm that was set by the orthodontist as ideal. None tooth was extracted because of the
Bolton discrepancy. For eight weeks the containment was maintained and, in this period the orthodontic treatment had
begun in the upper arch. After removal of the mandibular distractor, he also treated the lower jaw to perform the combined
orthognathic surgery.
Bone-borne distractor used in surgically assisted rapid maxillary expansion: Clinical case
Michelle Alonso Coutinho*, Leonardo Augustus Peral Ferriera Pinto, Viviane Ramos Peral Ferriera Pinto, Bruno
Coutinho Vargas.
Resumo
The surgically assisted rapid expansion maxillary is an ortho-surgical procedure performed in patients with maturity bone
and maxillary transverse discrepancies, uni or bilateral, associated or not with other facial deformities. A bone-borne
distractor has shown better than tooth-borne distractor type Hyrax for not: - Depend on tooth presence for your installation
and periodontal health; - Depend on intact teeth or without prostheses which are likely to fracture; - Buccal inclines, extrude,
resorb the roots, fenestrate the bone, retract the gums and loosen the anchor banded teeth. - Further relapse or asymmetric
expansion during and after expansion; - Need to replace it with a trans-palatal bar in period of contention for installation of
fixed orthodontic appliance reducing the total time of treatment of the patient. The use of the bone-borne distractor, has the
disadvantage of trans-surgical installation and the need for subsequent surgical removal. Case Report: Patient LSA, 23
years, presented maxillary atresia, posterior crossbite, anterior open bite and laterognathism, needing to undergo correction
of skeletal transverse deformity in maxillary. Under general anesthesia, the fixation of bone-borne distractor with 14mm was
performed through incisions between the roots of the 2nd premolars and 1st molars bilaterally. After the Le Fort I and sagital
osteotomy been performed, the device has been activated and closed to check for possible interference and suture were
done finalizing the procedure. With one week the patient underwent device activation with a 1/3mm spin in the morning and
at night, corresponding to daily 0.6mm until the correct bite. At this point, the screw thread was locked and maintained for 4
months, when it was found radiographically the healing of the sutures and bone-borne distractor was removed in clinical.
The patient will undergo a second surgical procedure (combined orthognathic and genioplasty).
Bidimensional evaluation of predictability between traditional model surgery and virtual model surgery
for orthognathic surgery
André Luis Fernandes da Silva*, Michael Miloro, Vanessa Kowalski Muller, Rafael Santana Caetano, Alvaro
Henrique Borges, Alexandre Meireles Borba.
Masters Program on Integrated Dental Sciences - UNIC, 2 HGU-UNIC - University General Hospital (Rua Treze
de Junho 2101, Cuiabá-MT, CEP 78016-000), 3 UIC - Department of Oral & Maxillofacial Surgery (801 South
Paulina Street, Room 110, Chicago, Illinois 60612-7211)
Resumo
Orthognathic surgery aims repositioning the supporting bone of upper and lower teeth (maxilla and mandible) in cases of
dentofacial deformities. Methods that provide greater predictability of results are welcome. Conventional surgical planning is
the spatial reproduction of the position of the maxilla and mandible by mounting the respective dental casts in a dental
articulator, reproducing the relationship of dental occlusion with the maxilla and mandible bones and their relationship to the
rest of the skull. Then, model surgery is performed, when the cast model of the segment requiring surgical intervention maxilla, mandible or both - is repositioned in accordance with the surgical planning, obtaining a dental occlusion reference
that serves as end position of the jaws. On the other hand, virtual model surgery is based on the tridimensional
reconstruction of the craniofacial region of the patient through the unification of facial photos with computed tomography of
the face, including scanning of tooth surfaces, and subsequent simulation of osteotomies of the maxilla and/or mandible
with your virtual repositioning, ending with the fabrication of the surgical guide for prototyping. The objective of this research
was to evaluate the predictability of results when using the technique of conventional planning compared to the technique of
virtual planning. For such, two groups of patients (operated by conventional planning method or by the method of virtual
planning) were evaluated for the degree of accuracy of the predicted result by the overlapping of pre and immediate
postoperative lateral radiographs. The movement performed by the upper central incisor in the superior-inferior and anteriorposterior direction was compared to planned preoperatively movement, thus determining the accuracy of the two types of
surgical planning. The results demonstrate the predictability variance between the two methods, especially when one takes
into account the differences between the horizontal and vertical axes.
Orthognathic surgery in the maxilla and mandible for treatment of anterior open bite - A case report
Wanderley da Silva Félix Junior*, Leonardo da Silva Benato, Aline Monise Sebastiani, Rafaela Scariot de
Moraes, Delson João da Costa, Nelson Luis Barbosa Rebellato.
Federal University of Parana - UFPR
Resumo
The orthognathic surgery is the recommended treatment for patients who have dentofacial deformities. One way to correct
anterior open bite requires a combination of orthognathic surgery associated with orthodontic treatment, aiming to eliminate
or reduce this skeletal disharmony. The patient often presents with a vertical excess of maxilla besides the anterior open
bite, which may be of skeletal origin. In adult patients, the conditions of occurrence of anterior open bite impose restrictions
on orthodontic treatment, and when changes in the vertical component are needed surgery is indicated. The aim of this
study is to report the case of a 25 year-old female patient with dentofacial deformity that sought the Department of Oral and
Maxillofacial Surgery, Federal University of Paraná. Facial analysis observed a concave profile. Intraoral examination
revealed an Angle Class II pattern of malocclusion, anterior open bite with 2mm upper incisor exposure with the lip at rest
and 4mm of gingival exposure at smiling. Radiographic examination revealed vertical excess of maxilla and anteroposterior
mandibular deficiency, confirming the diagnosis. The proposed treatment plan included segmentation of the maxilla with a
4mm impaction in the anterior segment and 2 mm in the posterior, and mandible advancement of 5mm with counterclockwise turning of the maxillomandibular complex. A multidisciplinary approach is necessary for the treatment of anterior
open bite, since the malocclusion has a greater functional aesthetic negative impact, beyond the dental and skeletal
changes that modify not only the morphology but also the function of the stomatognathic system. After 18 months, the
patient reported without aesthetic or functional complaints.
Mandibular distraction osteogenesis in children with Pierre Robin sequence presenting severe airway
obstruction: Impact on health-related quality of life.
ASSIS FILIPE MEDEIROS ALBUQUERQUE*, VICTOR DINIZ BORBOREMA DOS SANTOS, MARCIO
MENEZES NOVAES, FÁBIO WILDSON GURGEL COSTA, JOSÉ SANDRO PEREIRA DA SILVA, ADRIANO
ROCHA GERMANO.
Federal University of Rio Grande do Norte - UFRN, 2 UFC - Federal University of Ceará (Rua Alexandre
Baraúna, 949 - Rodolfo Teófilo - Fortaleza - CE CEP 60430-160)
Resumo
The Pierre Robin syndrome is a congenital sequence which is characterized by the presence of specific malformations as
micrognathia, cleft palate in the form of "U" and glossoptosis that may cause upper airway obstruction requiring surgical
intervention. Although signs such as micrognathia can already be detected in the prenatal period by ultrasonography, the
diagnosis is usually made at birth. As a consequence of the micrognathia, the tongue protrudes backwards causing airway
obstruction which can bring about a variety of problems, for instance hypoxemia, pulmonary edema, feeding difficulties,
malnutrition and occasionally death. There are some techniques to relieve respiratory obstruction and feed these patients
including tracheostomy, prone positioning, nasopharyngeal device, intubation, feeding tube and glossorrafia. Nevertheless,
there are limitations in the use of these techniques. Distraction osteogenesis is a technique used successfully in patients
with this syndrome. This study aims at present a case report of a patient with Pierre Robin syndrome, 4 years old, who was
tracheostomized in the neonatal period due to severe airway obstruction. The patient went through a procedure of bilateral
mandibular distraction osteogenesis; it tensioned the glossopharyngeal region allowing airway clearance. He is currently in
5 month post-operative follow-up and is eupneic, breathing on his own without the tracheostomy tube . It was concluded that
mandibular distraction using internal devices is an useful, suitable and comfortable method for children as it increases
airway and provides better quality of life to the patients. So that, it might be considered an effective and definitive treatment
in patients with severe airway obstruction.
Treatment of obstructive sleep apnea through surgical orthodontic correction.
Ricardo Alexandre Galdioli Senko*, Nataira Regina Momesso, Gabriel Cury Batista Mendes, Omar Ayub, Paulo
Domingos Ribeiro Junior.
University of the Sacred Heart, Bauru – SP. - USC
Resumo
The orthognathic surgery (OS) procedure is performed to treatment of skeletal dento facial deformities. It is the goal of OS
assist in correcting malocclusions, provide facial asymmetries, assist in the treatment of disorders of the treatment
temporomandibular articulation and also is an adjunct in the treatment of obstructive sleep apnea syndrome, that is
characterized by recurrent collapse of the pharyngeal area during sleep, resulting in substantial reduction in airflow. Surgical
movement of the jaws produces changes in the soft tissue of the orofacial complex, directly related to the tension of the
muscles, produced by the advances of the jaws. Where observed changes in the morphology of the airways. The purpose
of this study is to report a case of surgical orthodontic treatment performed on a patient complaining of difficulty sleeping.
Patient 56 years old, male, carrier skeletal dento facial deformity, class I with severe dental crowding and obstructive sleep
apnea. Initially the installation of the palatal expander and a surgically assisted rapid maxillary expansion was performed
(SARME) was performed. After healing of the SARME a orthodontic treatment aiming at a bimaxillary orthognathic the
surgery was performed. The orthognathic surgery was composed of a bimaxillary advancement followed of orthodontics
refinement. The patient showed improvement of sleep quality, clinical and laboratory. After four years of the procedure the
patient shows no signs of obstructive sleep apnea. Thus, it is possible to consider that the bimaxillary advancement
produces increases in airways, and orthognathic surgery should be included as one of the obstructive sleep apnea
syndrome treatments.
Analyze the changes in PAS and AHI related to maxillo-mandibular advancement and genioplasty
surgery
Francisco Clóvis Rombe Filho*, Sérgio Luis de Miranda, Roberto Moreno, Rafael Alves de Miranda, Márcio
Abrahão .
Equipe Cranio Maxilo Facial do HIAE - HIAE
Resumo
The apnea (OSA) and hypopnea obstructive sleep has recently received considerable attention in the medical community
because of the potential of serious systemic consequences. This syndrome is characterized as repetitive breathing
interruptions during sleep caused by partial or complete obstruction of upper airway, physiologically OSA increases the risk
of systemic complications as a result of nocturnal hypoxia and hypercapnia. These include arrhythmias, heart failure,
ischemic heart disease, hypertension and pulmonary, neurological complications and even mortality. The disease is
measured and classified using some parameters commonly adopted, such as the apnea-hypoapnea index (AHI) and lowest
oxygen saturation (Lsat). Today, a quality of life is valued as an important aspect of patient care. Numerous surgical
treatment options have been proposed to treat this syndrome without a real general agreement about their respective
nominations. Counterclockwise rotation of the maxillomandibular complex significantly affects the postsurgical PAS
dimension in patients with HOP facial morphology. It may be the preferred approach for orthognathic treatment of OSA in
patients with HOP angles by increasing the PAS. In addition, it allows for predictable correction of the dentofacial deformity
thus maximizing both functional and esthetic results. The surgical maxillomandibular advancement (MMA) is one of the
most effective surgical procedures for OSAS. However, the current literature is strongly inclined towards studies with use of
CPAP and the positive results are attributed solely to CPAP. The typical patient orthognathic surgery is usually a woman, in
the second or third decade of life with average weight and with specific dentofacial deformity, while the group with OSAS is
primarily middle-aged men, obese and with no dentofacial deformity. This case report aims to analyze the changes in PAS
and AHI related to maxillo-mandibular advancement and genioplasty.
SESSÃO III: CIRURGIA ORTOGNÁTICA
ESTUDO COMPARATIVO DA RESISTÊNCIA MECÂNICA CÍCLICA E LINEAR ENTRE PLACAS PRÉDOBRADAS E DOBRADAS MANUALMENTE PARA AVANÇO MAXILAR EM CIRURGIA ORTOGNÁTICA
Andrezza Lauria*, Raquel Correia de Medeiros, Fábio Ricardo Loureiro Sato, Roger William Fernandes
Moreira.
Faculdade de Odontologia de Piracicaba - FOP UNICAMP, 2 HDF - Hospital Defeitos da Face (Av Moreira
Guimarães, 699, São Paulo)
Resumo
O objetivo no estudo foi avaliar comparativamente, através de teste de carregamento linear e cíclico, placas pré-dobradas e
dobradas manualmente para avanço maxilar em cirurgia ortognática. Os grupos foram divididos em: Grupo I com placas
pré-dobradas para avanço maxilar de 5mm, fixadas em blocos de poliuretano para o teste linear e blocos de alumínio para
o teste cíclico; e grupo II, com placas dobradas manualmente simulando avanço maxilar de 5mm, fixadas em blocos de
poliuretano e alumínio. Os testes de carregamento linear foram realizados com 8 amostras em cada grupo e com auxílio da
máquina para ensaio universal mecânica Instron® 4411 até a falha do material. Já o teste cíclico foi realizado com 5
amostras em cada grupo através de uma máquina para ensaio universal Instron® E3000 e foram submetidas à carga de
12N a 120N, frequência de 3 Hz até a fratura da placa ou parafuso e com o número máximo de 500.000 ciclos. As médias
e desvio padrão foram avaliadas através dos testes t-Student e Mann-Whitney em nível de significância de 5%. Os
resultados do teste mecânico linear mostraram que não houve diferença estatística entre os grupos de placas pré-dobradas
e dobradas manualmente, quando comparados em relação a carga de pico (p=0.09) e deslocamento de pico (p=0.63). Já o
teste cíclico apresentou diferença estatística entre os grupos, onde o grupo de placas pré-dobradas atingiu o limite de
500.000 ciclos sem fratura e o grupo de placas dobradas manualmente fraturaram em uma média de 94.737 ciclos
(p=0.008). A resistência mecânica in vitro entre os grupos de placas pré-dobradas e as dobradas manualmente não alterou
com a confecção de dobras no teste de carregamento linear, porém, a confecção das mesmas pode ter criado
microfraturas e fragilizações que, com o teste de ciclagem, causaram fratura prematura das placas com dobras manuais.
Variation of tent pole technique: use of computer-aided planning and intraoperative surgical guide
Andrezza Lauria*, Gustavo Almeida Souza, Alexander Tadeu Sverzut, Márcio de Moraes.
Faculdade de Odontologia de Piracicaba - FOP UNICAMP
Resumo
Dental implant rehabilitation of edentulous patients with resorbed mandible presents significant challenges for both the
prosthodontist and surgeon. For these patients, augmentation procedures can be used to obtain sufficient bone volume for
dental implants insertion and prosthetic rehabilitation, but may lead to morbid complications, such as bone graft failure,
progressive bone resorption or infection. In 2002, a technique called soft tissue matrix expansion was first described by
Marx et al., in which 4 to 6 dental implants were used as ‘‘tent poles’’ with a concomitant autogenous bone graft from the
iliac crest, through a transcutaneous submental approach. This technique, however, due to its extraoral technique, can
cause improper angulation of dental implants. This report describes a case of a 50 years-old woman that was submitted to a
mandibular reconstruction with the use of a computer-aided planning using DentalSlice® program to evaluate the CT and
plan the position, angulation and length of the dental implants. Dental implants planned to be inserted had morse cone
connection, with 3,75mm of diameter and 11mm of height (Neodent®), which 5mm stayed endosseous and 6mm remained
extra-osseous. Then, Bioparts® made a surgical guide for intraoperative surgical drilling and subsequent insertion of dental
implants and a titanium mesh was used to overlay the particulate bone graft from the iliac crest. The use of the presented
technique provided a more accurate planning for implants placement using the tent pole technique in relation to the position,
distance and angulation of dental implants. The higher accuracy in dental implants angulation and 3-dimensional position
can provide a more appropriate prosthetic rehabilitation.
IMPORTANCE OF THE CHIN: NARROWING GENIOPLASTY TO REDUCING THE WIDTH OF THE LOWER
FACE
Thais Pimentel de Sa Bahia*, Henrique Martins da Silveira, Albertino Gomes de Alcantara Junior, Hugo
Leonardo Mendes Barros, Alan Robert Moreira Schmitt.
Universidade do Estado do Rio de Janeiro - UERJ
Resumo
A prominent mandible and squared contour are typical facial features considered unattractive, because it gives a strong,
masculine image. Patients who have prominent mandibles are likely to have broad lower face, and to reduce the width of
the face and have more delicate and feminine facial shape he can undergo a mandibular contouring surgery. The term
“prominent mandibular angle” was used in 1989, and an operation to reduce the width of the lower face by contouring the
mandible was done. Since then, various methods of mandible contouring have been reported, but the most frequently used
operative method is, resection of the mandibular angle, with or without reduction of the mandible. While reviewing the
surgical cases of mandible reduction, good results were achieved when the chin were also operated with the mandible. This
case report describes a patient who had a complaint about his broad face and large mandible. A narrowing genioplasty by
reduction of the center of the chin was performed, to excise the rectangular segment of the bone and reduce the width of
the chin, in addition to mandible body reduction. The mid symphyseal section procedure produces the desired, shape and
width of the chin and satisfactory results. The most frequent complaint about the mandibular contouring surgery is that the
change is clear from the side but not from the frontal view and with this approach, the patient has the change on both frontal
and side view. Postoperatively, the patient`s chin appeared slender and softer with a more feminine contour. Narrowing
genioplasty can be an alternative to mandible reduce, either as a single procedure or in combination with mandible
reduction, makes the lower face appear slender and produces a more feminine contour.
RESORPTION CONDYLAR PROGRESSIVE AFTER SURGERY IN PATIENTS ORTHOGNATHIC ANGLE OF
CLASS II.
Pamela Santos Lira*, Gabriel Pires Pastore, Luciano Del Santo, Patricia Raidac, Alexandre Javaroni Prati.
Paulista University - UNIP
Resumo
To this increasingly widespread and popular, orthognathic surgery seen the evolution of surgical technique, his
instrumentals and fastening materials that leave the postoperative easier and the patient's return to their daily activities
easier and soon. Along with the increase in the number of surgical procedures the number of recurrences and postoperative
complications is also growing, one of the postoperative complications that worries surgeons is the progressive condylar
resorption, which is defined as a change in the morphology of the condyle. A previous diagnosis of pathologies related to
the temporomandibular joint is of paramount importance for the indication and planning of surgery for correction of DDF
(dento facial deformities). Progressive condylar resorption is a condition that affects patients with a higher incidence of
females suffering from malocclusion Class II malocclusion associated with anterior open bite or not, increased mandibular
plane, progressive mandibular retrusion, with a history of TMD (temporomandibular dysfunction mandibular) prior to
orthognathic surgery. The facial analysis, along with the clinical examination and MRI (magnetic resonance imaging) are the
most appropriate to define the type of treatment to be performed examinations election, beyond that occlusion and patient
complaints are the primary issues determinants indications for surgical planning and patient. It is critical that patients receive
necessary care and guidance of the TMD treatment before surgery so they have a better prognosis of the case. However,
postoperative occlusal instability may also favor the progressive condylar resorption, thus the appropriate and necessary to
minimize the effects of an occlusal instability preparation. This paper aims to show a case of progressive condylar
resorption in Class II malocclusion patient underwent orthognathic surgery for mandibular advancement.
Planejamento Cirúrgico Digital no Planejamento da Correção das Assimetrias Faciais
Suellen Aredes*, Octavio Cintra, Aluisio Galiano, Marcos Pitta, Carlos Saiki, Gustavo Scalon.
Well Clinic Ortognática - WCO
Resumo
O desenvolvimento histórico da cirurgia ortognática não tem sido uniforme e contínuo, todavia tem seguido um curso
intermitente. A tecnologia tem sido envolvida ao longo do tempo e tem otimizado a previsibilidade dos resultados. Precisão
é imprescindível desde a primeira análise clínica do paciente e deve ser incorporada no plano de tratamento. A técnica
exige que cada paciente seja posicionado de acordo com a posição natural da cabeça assistida, utilizando-se disto como
referência para todas as tomadas de dados. Este protocolo permite que o cirurgião estabeleça uma comunicação bem
informada tanto com o ortodontista, que deve ser envolvido no tratamento em praticamente todos os casos, bem como com
o paciente. O diagnóstico preciso leva ao planejamento cirúrgico adequado e portanto a resultados favoráveis. O processo
de diagnóstico diferencial leva a uma lista de opções a serem discutidas com o paciente e o procedimento mais apropriado
a ser selecionado deve se basear no objetivo antecipado do cirurgião com respeito a estética, função e estabilidade,
confrontando-as com os objetivos e expectativas do paciente. A seleção do procedimento cirúrgico deve levar à
estabilidade do resultado e considerar a previsibilidade das alterações dos tecidos duros e moles para se atingir o equilíbrio
facial adequado de acordo com a resposta individual do paciente. O sistema de planejamento digital trata-se de uma
ferramenta que tem sido incorporada ao conceito do plano de tratamento em cirurgia ortognática, bem como em outros
campos das ciências médicas. O planejamento digital permite uma análise criteriosa das estruturas dentofaciais que
podem ter sido negligenciadas durante tomadas clínicas, fotográficas ou baseadas em modelos e montagens articulares
tradicionais. Especialmente em assimetrias faciais, os softwares 3D podem precisamente identificar o melhor
posicionamento das osteotomias, prever áreas de colisão óssea, evitando-as ou corrigindo-as previamente. A
implementação do protocolo digital torna o tratamento mais eficiente e confiável. Os esforços para se realizar o
planejamento digital são recompensados por uma sequência de tratamento mais lógica e objetiva, devido ao benefício da
economia de tempo e da precisão obtida.
Total subapical mandibular osteotomy in class 2 patient.
Bruno Henrique Alonso da Luz*, Mario Francisco Real Gabrielli, Marisa Aparecida Cabrini Gabrielli, Valfrido
Antonio Pereira Filho, Marcelo Silva Monnazzi.
São Paulo State University - Unesp
Resumo
The class II dentofacial deformities in adult are normally managed by a combined orthodontic and orthognathic surgery
afterwards. Involved a careful and individual evaluation of the patient deformities. The surgical procedure could involve a
single or double jaw osteotomy. The sagittal split ramus osteotomy is the most often mandibular osteotomy applied in order
to correct such cases. However, some particularities of the deformity, could add some difficulty in the treatment planning.
Such as, the class II occlusion with a well-positioned chin at the facial profile analysis, or even a huge mentolabial fold
combined to a good chin due to a retroprojection of all the dentoalveolar segment. The total subapical mandibular
osteotomy was described over 20 years ago, this osteotomy does not change the projection of the chin, making the
movement just the dentoalveolar segment, correting the huge mentolabial fold and it can be applied in these selected
cases. Despite the reports in the literature be sparse, this technique is reliable, useful and safe when properly conducted.
We report a clinical case, in wich the patient presented a class II malocclusion with a good chin and a great mentolabial fold,
which was her main complain, the average maxillary line was diverted. The treatment planning involved a total subapical
mandibular osteotomy associated to a Le Fort I osteotomy. This surgical modality, despiste having some technical
pecularities and require special care for some details, it seems to be safe and shall be used in selected cases, by skilled
surgeons in the conduct and treatment of dentofacial deformities in adult.
Functional and aesthetic repercussions after oclusal plane alteration in class III patients
Bárbara Gressy Duarte Souza Carneiro*, Ernest Cavalcante Pouchain, Francisco Samuel Rodrigues Carvalho,
Rafael Linard Avelar, Marcelo Ferraro Bezerra, Eduardo Costa Studart Soares.
Federal University of Ceará - UFC, 2 UFC - Federal University of Ceará (Rua Alexandre Baraúna, 949 - Rodolfo
Teófilo - Fortaleza - CE )
Resumo
Treating skeletal-based poor occlusion involves pre-orthognathic odontologal surgery planning, aimed at the ideal
positioning of teeth in a a spatial relationship with bone bases. This precaution must be considered, given that stable
surgical treatment depends on this factor. When there is an insufficient amount of satisfactory overjet for the desired
esthetic result using conventional treatment methods and the tooth position is favorable, rotation of the maxillomandibular
complex is an option in orthognathic surgery. In the case of class III patients, clockwise rotation results in posterior rotation
of the mentum, making it less prominent for later reduction in facial height. An 18-year-old male patient presented with
accentuated maxillomandibular discrepancy, with obvious mandibular protusion, vertical excess of the mentum, open
anterior bite and absence of lip sealing. Based on these findings, the patient was diagnosed with class III dentofacial
deformity and orthognathic surgery was established as the best treatment option. A number of limitations were observed
during planning such as small dental discrepancy compared to skeletal discrepancy and accentuated incisor angulation
(30º). After facial and cephalometric analysis, the patient was submitted to maxillary advancement surgery as well as
intrusion with clockwise rotation of the occlusal plane. Next, auto-rotation of the mandible was performed and the mentum
was reduced vertically, promoved functional and aesthetic repercussions . Despite being complex, the movements enabled
more stable positioning of the occlusal plane and the upper incisors compared to the pre-surgery position. Furthermore, it
provided the patient a more harmonious facial profile and class I occlusion was established.
Oral rehabilitation of full arch maxillary edentulism and dentofacial deformities using dental implants
and orthognathic surgery: 10-year outcomes of clincial experience
Gabriel Cury Batista Mendes*, Thiago Freire Lima, Hugo Nary Filho, Eduardo Antonio Ayub, Ricardo Alexandre
Galdioli Senko, Paulo Domingos Ribeiro Junior.
Sacred Heart University - USC, 2 IEA - Eduardo Ayub Institute (R. Jeriba, 265 - Chácara Cachoeira, Campo
Grande - MS, 79040-120)
Resumo
The oral rehabilitation using dental implants (DI) is a safe and predictable alternative in the treatment of full arch edentulism.
However, a severe maxillary atrophy can cause or aggravate a maxillo-mandibular discrepancy. A palatal approach of the
DI is usually required in this situation. However, the result is a prosthesis with great compensation and unfavorable
biomechanics. In these situations, the association of orthognathic surgery and DI rehabilitation can be a suitable alternative.
The pourpose of this study is to demonstrate the survival rate of DI and treatment’s stability in cases with severlly atrophic
maxilla treated with DIs and orthognathic surgery, in 10-year experience. It is reported 13 cases treated with implantsupported rehabilitations in patients with unfavorable maxillo-mandibular relationship. Aiming a correct tree-dimentional
position of DI, previous reconstructive procedures were necessary, such as inlay and onlay grafts. The placement of DI was
directed by a surgical guide seeking a dental prosthesis, without compensation. The ideal occlusion was achieved with
orthognathic surgery, allowing the rehabilitation with a prosthesis without compensation. In the results, the success rate of
the DI was 99%, with osseointegration failure in only one dental implant. There were no significant relapses of orthognathic
surgeries. In conclusion, The rehabilitation of full arch maxillary edentulism in patients with maxillofacial derformities
remains a challenge. A treatment with implant fixed prosthesis alone may result in bulky dentures, cleaning difficulty,
unfavorable biomechanic, and poor aesthetics outcome. Our clinical experience demomstrates that the assossiation of
implant rehabilitations and orthognathic surgery is a safe and predictable alternative in cases with large maxillo-mandibular
dicrepancies, even in cases that prior bone reconstruction is required.
SESSÃO IV:
IMPLANTES / RECONSTRUÇÃO
Reabilitação Oral em Pacientes que Apresentam Maxila Atrófica Através da Técnica Interposicional com
Enxerto Livre de Fíbula – Relato de Caso
José Luis de Sousa Castro Junior*, Paulo Afonso de Oliveira Junior, Danilo Dressano, Danilo Siqueria Pino,
Leonardo de Almeida Prado Domingues.
Hospital Santa Casa de Piracicaba - APCD - Piracicaba
Resumo
Com a perda dos elementos dentais, o osso alveolar pode sofrer severa reabsorção. Com a pouca atividade e associados
ou não a doenças endócrinas, tais como processos naturais de envelhecimento ou osteoporose, geralmente a atrofia do
osso alveolar pode resultar em problemas estéticos e funcionais, incluindo a retenção insuficiente da prótese, perda do
suporte de tecidos moles, perda da dimensão vertical, dificuldades de mastigação e de fonação. Entre os procedimentos
reconstrutivos, especialmente a maxila, apresenta grande complexidade pois, além da baixa qualidade óssea, apresenta
particularidades anatômicas que dificultam sua reconstrução. No presente relato os autores apresentam um caso de
reconstrução de maxila severamente atrófica utilizando enxerto ósseo autógeno livre de fíbula, através da técnica Down
Fracture da maxila com fixação de enxerto interposicional, proposta por Obwegeiser, Keller e Sailer. Esta se resume em
uma osteotomia tipo Le Fort I, possibilitando o reposicionamento da maxila nos sentidos anterior e inferior em situação
mais favorável para a reabilitação, além de oferecer um sítio receptor com propícia vascularização para receber enxertos
ósseos interpostos e fixados à maxila com placas e parafusos. O uso da fíbula deve-se às vantagens de baixa morbidade
do sítio doador, por sua fácil obtenção, de menor desconforto pós-operatório e por apresentar excelentes características
mecânicas por ser constituído majoritariamente de osso cortical. Para um planejamento com maior precisão, foi
confeccionado um protótipo da maxila. Um ano após a cirurgia de enxertia foram utilizados implantes osseointegrados na
região posterior da maxila. Esta técnica apresenta um significativo aumento em volume, altura e espessura e com
excelente grau de densidade para estabilização de implantes dentários. Com o sucesso obtido neste e noutros
procedimentos semelhantes, os autores afirmam que esta pode ser uma alternativa adequada para reabilitação oral em
pacientes condenados ao uso de próteses totais sem condições mínimas de estabilidade.
Tomographic analysis of bone formation in segmental defects created in rabbit jaws filled with integral
bovine bone
Juliana Dreyer da Silva de Menezes*, Danilo da Silva Corrêa, Renato Yassutaka Faria Yaedú, Eduardo
Sant'Ana, Paulo Sergio Perri de Carvalho, Victor Henrique Parazzi.
School of Dentistry of Bauru - FOB - USP, 2 HRAC - USP - Hospital for Rehabilitation of Craniofacial Anomalies
(Rua Sílvio Marchione, 3-20 - Bauru - SP - 17012-900)
Resumo
Currently the higher demand for implant-supported prosthetics has caused an increase in indicating and performing bone
grafts and thus new techniques and materials have been developed for this purpose. The integral bovine bone (IBB) was
recently proposed as an alternative to traditional bone grafting materials. Its processing eliminates the cellular and fatty
portions of the bone preserving the porous mineral structure which is essential for cell migration during bone regeneration.
The sample consisted of 18 rabbits divided into 6 groups which underwent surgical procedures for creating segmental
defects (1x1cm) in the mandibular body, following the study model of split mouth. This study evaluates bone formation in
segmental mandibular defect filled with IBB by cone beam CT, Dolphin imaging 11.5 and I cat vision softwares. The animals
were sacrificed at times 0 hour, 3 and 6 months. Bone formation in the defects was evaluated qualitatively and quantitatively
using 20 reformatted panoramic and parasagittal of 0.5 mm. In the qualitative assessment, there was complete regeneration
in the control group, leaving a concave residual defect in the mandible base, confirming that the defect had reached a
critical size. In the experimental group, there was great variation in density, in three months all grafts were integrated with
decrease in density, suggesting partial resorption, while at six months regeneration in a more advanced stage was
observed. In the quantitative analysis there was significant difference in the control group between the times 0 and 3 and 0
and 6 months. In the experimental groups there was no difference between times, however when compared to the control
group, a statistically significant difference was observed. The results suggest that the IBB may be a viable alternative in the
treatment of bone defects in the jaws, providing better conditions for placement of dental implants.
DISTRAÇÃO OSTEOGÊNICA NA RECONSTRUÇÃO DE REBORDO ALVEOLAR DE MAXILA ATRÓFICA:
RELATO DE CASO
Vitor José da Fonseca*, Joanna Farias da Cunha, Luiz Felipe Lehman, Felipe Baires Campos, Wagner
Henriques de Castro.
Federal University of Minas Gerais - HC-UFMG
Resumo
Paciente L.A.S. do gênero masculino, feoderma, 19 anos de idade, foi encaminhado ao serviço de Cirurgia e Traumatologia
Bucomaxilofacial do Hospital das Clínicas (HC) da Universidade Federal de Minas Gerais (UFMG) com história de acidente
automobilístico, ocorrido há 10 anos, e apresentando queixas estética e funcional em relação aos dentes e à face. Durante
o exame físico intrabucal do paciente observou-se a ausência dos elementos dentários 11 e 21, que foram avulsionados e,
em seguida reimplantados sem sucesso. Dessa forma, dois anos após o re-implante esses dentes foram perdidos. Em
decorrência das ausências dentárias ocorreu severa atrofia do rebordo alveolar na região anterior de maxila, que foi
confirmada pelo exame tomográfico (TC). Como uma primeira etapa do seu tratamento foi planejada confecção de
próteses fixas sobre implantes para o paciente, visando à reabilitação da área edêntula. Para tanto, a primeira cirurgia
consistiu da realização de uma distração osteogênica do osso alveolar para proporcionar ganho ósseo em altura. O
aparelho foi ativado por um período de 20 dias, com ganho considerável de altura de rebordo alveolar. Depois de
alcançada uma altura do rebordo satisfatória, visando o ganho ósseo em espessura, procedeu-se à enxertia óssea
autógena proveniente da sínfise mandibular. Seis meses após a enxertia, realizamos a instalação de implantes
osteointegrados e posterior confecção das próteses. O acompanhamento periódico do paciente mostra implantes
osteointegrados, clinicamente saudáveis, com suporte adequado as cargas mastigatórias. O paciente ficou satisfeito com o
seu tratamento e está sendo preparado para procedimento de cirurgia ortognática para complementação do plano
terapêutico.
Assessment of Compatibility of Biomaterials and Implants System: Sheep as Experimental Animal Model
Fúlvio Borges *, Suelen Cristina , jhonathan barros, Mônica Diuana, José Mauro .
Universidade Federal Fluminense - UFF, 2 INMETRO - Instituto Nacional de Metrologia, Qualidade e
Tecnologia (Duque de Caxias, Rio de Janeiro)
Resumo
Animal models have been widely used in biomedical research, because they provide basic and essential information about
physiological and pathological mechanisms of living humans and animals tissues; new techniques and validation of existing
methods and new biomaterials for biomedical applications prior to clinical use. The animal model to be chosen for the
experimental design needs to be appropriate, ethical and technically, to provide the desired information, especially with
regard to the possibility of developing experiments that minimize the clinical situation in humans. This study will provide
relevant information about the sheep as an experimental animal model. Using data from systematic review, studies in vitro
and in vivo and surgical experience of our research group, we gather the main steps involved in the different stages of the
experiments with sheep, since the care in creating and maintaining the animals to obtain specimens for laboratory
processing, highlighting the lack of necessity for euthanasia of the animals at the end of the study, in accordance with the
guidelines of the 3Rs program (Reduction, Refinement , Replacement). Furthermore, we present a protocol for
implementation of the implant system used by our research group. The sheep are suitable for biomedical research due to
availability, easy handling and housing, animal cost and acceptance by the animal research company large animals. Sheep,
due to their size, have macroscopic bone structure similar to humans, and thus, favor the adequate evaluation of orthopedic
and dental implants produced with dimensions suitable for use in humans, favoring thus the extrapolation of the results to
human use. According to our experience, this model is extremely interesting from an ethical point of view, since it is possible
to perform up to 12 implants per animal and they can still be kept alive at the end ofthe study.
Can raloxifene and alendronate improve peri-implant bone healing in osteoporotis rats?
Leonardo Faverani*, Gabriel Ramalho-Ferreira, Sabrina Ferreira, Idelmo Garcia-Júnior, Tetuo Okamoto,
Roberta Okamoto.
Aracatuba Dental School - Univ. Estadual Paulista - FOA-UNESP
Resumo
Osteporosis is a systemic disorder commonly found in postmenopausal women, caused by estrogen deficiency. Several
medications are used to treat osteoporosis in order to increase bone density and prevent fractures, or be able to beat the
masticatory loads on treatment with implant-supported prostheses. This study aimed to evaluate the process of bone repair
in bone/implant interface in rats with induced osteoporosis treated with raloxifene or alendronate. Rats female divided in four
groups according to induced osteoporosis and drug treatment (SHAM; OVX NT = osteporotic rats without drug treatment;
OVX RAL = osteoporotic treated with raloxifene and OVX ALE = osteoporotic rats treated with alendronate sodium). Each
animal received two implants, one in each tibial metaphysis. The implants that were installed in the right tibia with machined
surface, and the left tibia received one implant with modified surface by double acid-etching. Euthanasia of the animals shall
be carried out in the period 14 days (immunohistochemical analysis) and 42 days (removal torque and histology analysis)
after implants installation. Data of removal torque were stastistically analysed for the Anova 2 way and Tukey test as posttest. The significance level of 0.05 was adopted. The immunostaining for RUNX2 and OP showed the presence of
osteoblastic lineage cells by the newly formed bone in SHAM, OVX ALE and OVX RAL groups. Removal torque showed
statistical significance in the variable surface treatment (P=0.02) and drug treatment (P<0.01). The Tukey post -test showed
that for the variable treatment of osteoporosis, the SHAM group has statistically significant difference when compared to
OVX NT and OVX ALE (P<0.01), but no statistically significant difference when compared to OVX RAL (p=0.861).
Therefore, the treated surface implants promoted greater reverse torque, and raloxifene was the medication showed better
immunohistochemical and removal torque results to osteoporosis treatment.
Computer-guided surgery with immediate implantation in the aesthetic area: Case report
Marcelo Salles Munerato*, Jéssica Lemos Gulinelli, Paulo Domingos Ribeiro Junior, Edilson José Ferreira,
Marcos Rikio Kuabara.
University of Sacred Heart - USC, 2 UNESP - Dental School of Araçatuba, São Paulo State University
(Endereço. Rua José Bonifácio, 1193 CEP 16015-050 - Araçatuba, SP Brasil)
Resumo
With the advent of osseointegration, modern implantology presents itself as an excellent alternative for oral rehabilitation of
patients with missing teeth. The initial protocol, known as classical technique, indicate the installation of the implants,
followed by a repair period of 3 to 6 months in the absence of load. However, this technique requires a greater number of
operations, which increases the cost and time of treatment. Aiming to avoid these, enabling scientific research evolved a
technique in which the implant and the prosthesis are installed in the same procedure (immediate loading). Immediate
implant loading post exodontics has an excellent prognosis, minimize treatment time, stabilizes adjacent soft tissues and
increases patient satisfaction. The most important factors to consider when contemplating the use of dental implants in the
anterior esthetic area is the vertical and horizontal height of the alveolar process, their occlusal relationship with the
proposed position for the final restoration and the mesiodistal space. The computer-guided surgery and flapless reduces
trauma and postoperative morbidity. For proper rehabilitation there is a need for a precise reverse planning with the
selection of implants and prosthetic components. This paper aims to present the clinical case of a female patient, 34 years
of age with mobility of upper lateral incisors after orthodontic treatment. The extractions were performed with immediate
implant placement in computer-guided surgery and use the very crown of the tooth for the fabrication of provisional. This
case report suggests that the terms included in this complex rehabilitation treatment in aesthetic area were adequate and
essential for the maintenance of the contours and thicknesses of soft and hard tissues ensuring excellence in rehabilitation.
Photoelastic analysis of fixed partial prosthesis crown height and implant length on distribution of
stress in two dental implant systems
Antonio Gabriel Lanata Flores*, Evandro Portela Figueirêdo, Zarina Tátia Barbosa Vieira dos Santos.
The State University of Campinas - FOP/UNICAMP
Resumo
The aim of this study was to use photoelasticity to compare, under axial and non-axial loading, stress distribution on short
and long implants of two different dental implant systems in 2-unit implant-supported fixed partial prostheses of two different
crown heights. Therefore, 16 photoelastic models were divided into 4 groups: I - Long implant (5x11mm) Neodent® Titamax
Cortical CM; II - Long implant (5x11mm) Bicon; III - Short Implant (5x6mm) Neodent® Titamax Cortical WS; IV - Short
Implants (5x6mm) Bicon. In each group were applied axial (0°, 0,5 Kgf) and non-axial loads (15°, 0.5 Kgf), with either 8 and
13 mm prosthetic crown height. The results showed that implant length was a statistically significant factor for both axial and
non-axial loading. Under axial loading, the Neodent implant system with 13 mm-prosthetic crown had higher stress (31.5 ±
16.5 MPa) compared to 8 mm-prosthetic crown on the same system (25.7 ± 11.4 MPa) (p <0.05). Short implants had
greater stress (33.4 ± 16.0 MPa) than long implants (24.6 ± 12.5 MPa) when 8 mm-prosthetic crown were used under axial
loading (p <0.05). Neodent implant system with 8 mm-prosthetic crown had a higher stress values (± 31.43 15:44 MPa) than
Bicon implant system (26.18 ± 13.00 MPa) when non-axial load was applied (p <0.05). 13 mm-prosthetic crown did not
result in statistically significant differences in the stress distribution between the two implant systems and two implant
lengths included in this study, regardless of the type of loading (p> 0.05). According with the present study, it can be
concluded that short implants concentrated larger stress values when compared to long implants, however, when prosthetic
factors that maximize stress around implants are present, as prosthetic crown with increased height, the implant system and
implant length were not relevant factors.
Morphometric Study of Craniofacial Bones for Rehabilitation with Facial Prostheses Retained by
Extrabucal Implants
Eder Alberto Sigua-Rodriguez*, Sergio Olate, Zarina Tatia Barbosa Vieira dos Santos, Jose Ricardo de
Albergaria Barbosa.
Piracicaba Dental School, State University of Campinas - Unicamp
Resumo
Craniofacial fixation have been used for retention and support of facial prosthetic devices, useful in patients with sequelae of
treatment for cancer, tumors, trauma and congenital or genetic malformations. We conducted a descriptive study to
establish the bone thickness in different regions of the cranium complex to define the best locations for craniofacial
implants. In 40 human skulls (31 men and 9 female), between 20 to 60 years old, from the Laboratory of Anatomy of
FOPUNICAMP were performed tomography computed volumetric cone beam with the ICAT VISION in the area of Dental
Radiology of FOP-UNICAMP. Subsequent images were analyzed in InVesalius 3.0 software by two researchers to perform
bone morphometry. The measurement were performed in the periorbital, perinasal and periauricular region and the area of
zygomatic bone, determining the distance between the internal and external cortical senses in sagittal, axial and coronal
views. The values were determined for each individual unit. In the supraorbital area, the minimum values were 7.92 mm ±
1.82 mm and the lateral area were 7.54 mm ± 0.98 mm allowing the installation of 5mm or 6mm length implants, the area of
the zygomatic bone minimum values were 10 , 4 mm ± 2.35 mm allowing the insertion of implants of 8 mm. In the
periauricular areas the values in the upper region were 2.93mm ± 0.55mm and lower were 3.1mm ± 0.7mm; the region of
the mastoid process allowed the installation of 5mm implants. In the perinasal region 4mm or 5mm length implants could be
installed. We conclude that in the craniummaxillofacial area there are regions for acceptable thickness for extrabucal
implant installation being the superior temporal bone area that show has major limitations.
SESSÃO V:
OUTROS E CIRURGIA ORTOGNÁTICA
Soft tissue prediction analisys using tridimensional software in orthognathic surgical planning
Carlos Eduardo Chrzanowski Pereira de Souza*, José Nazareno Gil, André Luis Chiodi Bim, Luiz Fernando Gil.
Universidade Federal de Santa Catarina - UFSC, 2 UFSC - Universidade Federal de Santa Catarina (Cidade
Universitária de Florianópolis), 3 UFSC - Universidade Federal de Santa Catarina (Cidade Universitária de
Florianópolis), 4 UFSC - Universidade Federal de Santa Catarina (Cidade Universitária de Florianópolis)
Resumo
Tridimensional virtual planning in dentofacial deformities has a hi level of acceptance among orthognathic surgeons due to
the possibility of visualization of bone structures , soft tissues and teeth movement simultaneously. Despite the previously
described advantage, the decrease of laboratory time, elimination of face bow and dental casts model surgery errors are
some of the many advantages of this tipe of planning. The logistic factors envolved such as the acquirement of cone beam
CT (CBCT) and surgical splints impression sometimes can delay the surgical act on itself, it has been the main fator of
reluctance of the professionals in using this softwares. Many softwares are available at the market, but few studies
regarding the precision in predicting soft tissue changes in orthognathic surgery were made. Regarding Dolphin Imaging 3D
(Dolphin 3D) there is no study the sugests reliability of soft tissue prediction in orthognathic surgery. The aim of this study is
to investigate if soft tissue prediction is reliable during orthognathic moves simulation, when Dolphin 3D is the planning
software of choice. A total of 15 patients that were submited to orthognathic surgery in the period of 2011 to 2013.
Syndromic patients were excluded of our study. The minimum period of postoperative control was 6 months. The patients
had CBCT acquired in pre and postoperative period. This images were superimposed and the real orthognathic moves were
obtained. This moves were transfered to the preoperative CBCT and a treatment was simulated. Linear and angular
measurements were taken from the soft tissue of this simulation and compared to the same measurements taken from the
post operative CBCT sof tissue. The results were submited to statistical analisys. Understanding the limitations of Dolphin
3D is the better way to improve our tratment planning and achieve our surgical goals.
Challenges of the maxillary bone reconstruction in bilateral cleft lip and palate patients: Cases report
Rubens Caliento*, André Luis Fernandes da Silva, Nilton Pires de Araujo Filho, Alessandra Nogueira Porto,
Orlando Aguirre Guedes, Alexandre Meireles Borba.
University General Hospital - HGU-UNIC
Resumo
The alveolar bone reconstruction in bilateral cleft lip and palate (BCLP) patients presents as a challenge to the maxillofacial
surgeon. There is a certain difficulty in achieving satisfactory results due to the lack of alveolar bone in the cleft region,
insufficient mucosal tissue in the cleft area to cover the defect and even a possible misaligned, unleveled and mobile
premaxilla. Secondary alveolar bone grafting, current gold standard technique, is a well-recognized procedure in literature to
BCLP management, which should be performed prior to the eruption of the cleft-related permanent canine (or a viable
lateral incisor) when two thirds of its root formation is completed, around 8 to 12 years-old. Bone grafts can be obtained
from different donor areas, as the mandible (oblique line or symphysis), maxillary tuberosity, calvarial vault, rib and anterior
iliac crest; the bone material obtained (including cancellous and/or cortical bone) can be used in particulate or in block
forms. In situations where bone grafting is necessary and premaxilla requires to be surgically repositioned, premaxilla and
bone graft stabilization are key factors to allow osteointegration, to reduce dehiscence risks and eventual infection. Different
devices can be used, like miniplates and screws, arch bars associated with surgical cement and occlusal splints. The
resolution of the aesthetical and functional problems caused by BCLP on the correct time offers viability of orthodontic
treatment, conditions for speech therapy treatment, self-esteem improvement and consequent patient’s social integration.
The aim of this study is to call the attention to the difficulties related to the maxillary alveolar bone reconstruction in BCLP
cases treated by the Oral and Maxillofacial Service of the University General Hospital of the University of Cuiabá.
Evaluation of maxillofacial bone plates retrieved from patients with clinical indication: Metallographic,
Gas and Energy dispersive x-ray analyses
Clarice Maia Soares de Alcântara Pinto*, Douglas Rangel Goulart, Raquel Correia de Medeiros, Márcio de
Moraes.
Piracicaba Dental School - University of Campinas - FOP Unicamp
Resumo
Titanium bone plates are an important part in the management of facial bone trauma, orthognathic, craniofacial and
maxillofacial reconstructive surgery. Despite excellent clinical performance presented by titanium plates, doubts have
emerged about their long-term behavior and their potential local and systemic effects. There is agreement that in
symptomatic cases, plates should be removed, but there is no consensus about the need for routine plates removal in
asymptomatic cases. The aim of the present study was to evaluate the microscopic structure and chemical composition of
titanium bone plates and screws retrieved from 30 patients with clinical indication and to relate the results with the clinical
conditions associated with these devices removal. Plates and screws removed were studied by metallographic, gas and
energy dispersive X-ray (EDX) analyses. Medical records were reviewed and the following data were recorded: age,
gender, type of surgical procedure, implants retention period, indication for removal, site of removal and general medical
condition. Twenty-two patients were male and 8 female, with an age range of 13–70 years at plate removal time. The
retention period ranged between 11 days and 10 years. All the plates and screws were within the ASTM (American Society
for Testing and Materials) specifications at metallographic and EDX analyses. Metallographic analysis revealed that all the
plates were manufactured from commercially pure titanium (cp Ti). The screw samples analyzed consisted of Ti-6Al-4V
alloy, except 4 samples, which consisted of cp Ti. Gas analysis of Ti-6Al-4V screw samples revealed that three samples
were out of the standard values. One cp Ti screw sample and one plate sample were also out of the standard values at gas
analysis. From the present study, it was concluded that plates and screws physical properties and chemical composition did
not correspond with the need of these devices removal.
Modified LeFort III osteotomy for midface advancement: a case report
Bruno Viezzer Fernandes*, Aline Monise Sebastiani, Nelson Luis Barbosa Rebellato, Delson João da Costa,
Leandro Eduardo Klüppel, Rafaela Scariot de Moraes.
Federal University of Paraná - UFPR
Resumo
The maxillary retrusion combined with midface deficiency is a well described craniofacial deformity, although not commonly
addressed by many oral and maxillofacial surgeons. A number of techniques have been suggested for its management,
including LeFort I, II and III osteotomies, its variations and combinations, possibly associated with bone grafts. First reported
by Gilles in 1950 and later refined by Tessier, the LeFort III osteotomy is usually applied in the treatment of syndromic
midface hypoplasia. A complete preoperative planning is essential for a predictable outcome and should include
cephalogram tracings, model surgery and surgical splints fabrication. Surgical approach must meet the individual case
needs based on the patient’s functional and esthetic demands. Maintenance or correction of facial symmetry is an important
concern and defines the applied technique. Frequently the midface advancement amount is different than the maxillary
advancement, and the simultaneous LeFort III/LeFort I osteotomies are indicated. Additional mandibular surgery may be
done in order to correct concomitant deformity. Technique refinements are contributing for the outcome’s stability from a
skeletal point of view. Despite the difficulty in predicting the final soft tissue profile, a well planned and correctly indicated
case may provide good esthetic and occlusal results. This report describes the use of simultaneous modified LeFort
III/LeFort I osteotomies in the treatment of a severe craniofacial deformity, along with its preoperative planning and final
outcome. A nonsyndromic 23 year-old male patient presented to the Oral and Maxillofacial Surgery Department of the
Federal University of Paraná (UFPR) with a severe prognathism and major functional and esthetic complaints. Combined
orthognatic surgery was performed under general anesthesia, achieving a final midface advancement of 4mm, additional
5mm maxillary advancement, 7mm mandibular setback and 6mm vertical reduction genioplasty. The patient showed great
improvement on function and satisfactory esthetic result at the end of the treatment.
Use of collagen matrix (mucograft®) in vestibuloplasty: case report.
Ricardo Alexandre Galdioli Senko*, Gabriel Cury Batista Mendes, Luiz Eduardo Marques Padovan, Patricia
Pinto Saraiva, Paulo Domingos Ribeiro Junior.
University of the Sacred Heart, Bauru - SP. - USC, 2 ILAPEO - Latin American Institute for Dental Research and
Education (Rua Jacarezinho, 656, Mercês, Curitiba,Paraná, Brasil. CEP 80.710-150)
Resumo
The tissue reconstruction in implant has been used in various types of materials for grafting. Among these biological in
origin as autogenous bone grafts, epithelial, connective, among others. These still represent the gold standard in the
replacement of damaged tissues. The soft tissue grafts have been used in various procedures in dentistry for tissue
reconstruction improves both for the quality and the amount of tissue in the oral cavity. But morbidity and the possibility of
complications related to the donor area is a constancy by the search for substitutes for grafting. In order to avoid the
necessity of harvesting an autograft and decrease post-operative morbidity is suggested in the literature to the use of a
matrix of porcine collagen to replace the autogenous tissue graft. The objective of this study was to review the literature and
report a case of use of a matrix of collagen origin porcine type I and III origin (Mucograft®) for increasing keratinized tissue
in a procedure vestibuloplasty. a case report: patient victim of an automobile accident resulting in the loss of the maxillary
incisors, where onlay bone graft was performed and subsequently the procedure previously vestibuloplasty rehabilitation
with osseointegrated dental implants. Through the findings from the literature and from the clinical study of this case can be
concluded that the matrix of collagen origin porcine type I and III origin (Mucograft®) can be used as a substitute for the
autogenous epithelial graft in selected cases where there is no need for large increases in keratinized tissue.
CLINICAL EVALUATION OF NASAL BASE IN SURGICAL MAXILLARY DISJUNCTION
MAYSA NOGUEIRA DE BARROS MELO*, SANYRA LOPES DIAS, RAFAEL ALMEIDA NERY, FABIO DE
FREITAS PEREIRA FREIRE, JOAQUIM ALMEIDA DULTRA.
Federal University of Bahia - UFBA
Resumo
Dentofacial deformities treatment is often complicated by discrepancies in the transverse dimension of the maxilla. Surgical
maxillary disjunction is an effective technique in the treatment of these deformities, but is limited by the patient´s stage of
development and anatomical changes.The advantages of this treatment are known: the maintenance of periodontal health,
improvement in nasal airflow, eliminate the subsequent negative space, avoid extractions, minimal morbidity and discomfort
during the expansion and high stability. However, has been clinically observed a widening of the nasal base after this
surgical procedure, and the scientific community diverge about indicating or not a nasal suture as a protocol to achieve a
better nasal aesthetics. A study was proposed with 21 individuals (aged into 16 to 36 years old) with transverse maxillary
deficiency, who would be submitted to surgically-assisted maxillary expansion. Patients who received the nasal suture and
patients who did not received were divided into two groups - surgically-assisted maxillary disjunction was performed at
Santo Antonio Hospital. The measurements of nasal base were determined by the measurement of nasal wings and the
distance between the elements 11 and 21. The nasal base distance was determined preoperatively using a digital steel
caliper (300mm Mitutoyo®), and also in 30 and 90 days postoperatively. The inter-dental distance was measured only in two
months postoperatively. As result, this study could observe a broadening of the nasal base of 85.71% on both groups of
patients. It was not found any statistically significant change on nasal base when the nasal suture was performed during
surgery.
Correlação entre a prevalência de maloclusão de acordo com o tipo de fissura labiopalatal no Hospital
dos Defeitos da Face da Cruz Vermelha Brasileira
Jee Park*, Magno Liberato, Fábio Ricardo Loureiro Sato, Érica Cristina Marchiori, Roger William Fernandes
Moreira.
Hospital of the defects of the face - HDF
Resumo
O presente estudo tem como objetivo correlacionar à prevalência da maloclusão de acordo com o tipo de fissura
labiopalatal. Foram avaliados dados como o perfil epidemiológico da população, tipo de fissura labiopalatal, chaves de
oclusão de acordo com a classificação de Angle, presença de mordida aberta e cruzada. Como critério de inclusão foram
selecionados pacientes portadores de fissura labiopalatal na faixa etária acima de 12 anos e que foram submetidas a
procedimentos cirúrgicos no Hospital Defeitos da Face- Cruz Vermelha Brasileira no período entre o ano 2013 e 2014.
Como critérios de exclusão foram extraídos pacientes que tinham dentição mista ou decídua, ou com ausências dentárias
Dessa forma, foram selecionados 20 pacientes que estavam dentro do critério de inclusão e exclusão da amostra. Desse
total, 12 eram do gênero masculino (60%) e 8 do feminino (40%), sendo a média de idade de 27 anos e 6 meses. Em
relação ao tipo de fissura, 7 foram do tipo pré-forame (sendo 5 unilaterais – 2 à direita e 3 à esquerda; e 2 bilaterais) e 13
transforame (sendo 9 unilaterais – 5 à direita e 4 à esquerda; e 4 bilaterais). Entre os pacientes que apresentavam fissura
pré-forame (7 casos), 4 (57%) apresentavam oclusão Classe I, 2 (29%) oclusão Classe III e 1 (14%) oclusão Classe II no
lado afetado. Já os paciente com fissura transforame (13 casos), 5 (38%) tinham oclusão Classe III, 5 (38%) oclusão
Classe II e 3 (24%) oclusão Classe I no lado afetado. Em relação às alterações oclusais, nos pacientes com fissura préforame, 1 (14%) paciente apresentava mordida aberta e 6 (85%) apresentavam mordida cruzada. Nos pacientes com
fissura transforame, 6 (46%) tinham mordida aberta e 11 (84%) apresentavam mordida cruzada. Baseado nesses
resultados concluiu-se que o tipo de fissura não apresenta influência quanto à prevalência das maloclusão.
Surgical treatment protocol in cleft patients of Centrinho Irmã Dulce
João Nunes Nogueira Neto*, Clarisse Samara de Andrade, Rafael Fernandes de Almeida Neri, Paulo Plessim
de Almeida, Roberto Almeida de Azevedo.
Federal University of Bahia - UFBA, 2 HSA / OSID - Santo Antonio Hospital (Av Dendezeiros do Bonfim,
Bonfim, Salvador, Bahia, CEP 40415000)
Resumo
Numerous attempts have been proposed overtime for the treatment of patients affected by craniofacial clefts. However, the
definition of protocols that would delimit the exact sequence of treatment is relatively recent. The cause of this condition is
still unknown, with genetic and environmental interactions mutually acting for malformation during embryological stage. The
clefts may be complete or incomplete, unilateral, median or bilateral, involving one or more bones of the craniofacial
complex. Due to its high complexity, patients need follow-up with different areas of health and their specialties; hence the
importance of this treatment being performed in multi and interdisciplinary hospitals. The Santo Antonio Hospital - HSA
(Social Work Irmã Dulce - OSID) has the Centre for Rehabilitation of Craniofacial Anomalies (Centrinho Irmã Dulce) since
1998, being now the second largest unit in the country in recovering patients from cleft. With direct action between the
teams of Social Welfare, Psychology, Speech Therapy, Plastic Surgery and Dentistry, the Centrinho Irmã Dulce is
considered by the Ministry of Health as reference treatment of these patients in Bahia state. Surgery is an important part in
the treatment of cleft patients performing procedures such as: palatoplasty, cheiloplasty, alveolar bone grafts, alveoloplasty,
dental implants and orthognathic surgery. However, it is essential that the surgeries are performed at the right time and
following a logical sequence to obtain the best results in the medium and long term. This work aims at presenting the
surgical sequence used in Centrinho Irmã Dulce through case reports, to demonstrate the importance of conducting primary
and secondary surgeries at the right time, thus obtaining the best aesthetic and functional results to the patient with
lip/palate cleft.
SESSÃO VI: OUTROS E
PATOLOGIA / ESTOMATOLOGIA
COMPARISON OF THE USE OF DEXAMETHASONE AND DICLOFENAC THE IMMEDIATE
POSTOPERATIVE ON THIRD MOLAR SURGERY, PRELIMINARY RESULTS
Carlos Alysson Aragão Lima*, Rogério Almeida Silva, Fábio Ricardo Loureiro Sato, Mark Jon Santana Sabey.
Hospital Geral Vila Penteado - HGVP
Resumo
The principle of preemptive analgesia is that therapy must precede sensitization of pain receptors, helping to reduce the
total concentration of inflammatory mediators in the tissues. The use of dexamethasone in order to reduce edema, trismus,
and post-surgical pain is well established in the literature. However, it is believed that the greatest relief of pain, swelling and
trismus are achieved with maintenance of corticosteroids in the immediate postoperative period. Given the variety of
methods of preemptive analgesia and the absence of a well accepted protocol by the oral and maxillofacial surgeons
community the purpose of this clinical trial was to compare pain, analgesic requirements, trismus and swelling(objectively)
after extraction of third molar with the use of pharmacotherapy protocols preemptive analgesia with dexamethasone and
maintenance in the immediate postoperative period (three days) compared with diclofenac. Thus, we selected 10 patients
with symmetrical inclusions of third molars, all patients underwent two surgical procedures left and right, and in both
surgeries were administered dexamethasone 8 mg preoperatively, with maintenance dexamethasone 8mg / day for 3 days
in one side and diclofenac 150 mg / day for 3 days in the other, at random, double-blind cross so that all patients acted as
control of themselves (split mouth). The other drugs used in postoperative rescue analgesics and antibiotics, were identical
for all patients. Among the variables analyzed the swelling was measured by comparing the values of three facial lines at
three different times (preoperative, second and seventh days postoperatively), trismus was assessed based on the distance
between the incisal edges of the incisors central upper and lower at three different times (preoperative, second and seventh
days postoperatively), the pain was analyzed from the visual analog pain scale (VAS) and total number of analgesics
consumed
Maxillary sagittal osteotomy to osteogenesis distraction: modification technique.
Sérgio Schiefferdecker*, Rubens Souza Jr, Kelly Bienk Dias.
MAXIFACE - diagnostic and treatment orofacial service. - MAXIFACE / HED
Resumo
Transverse maxillary deficiency, deformity that affects 3-18% of the population, is characterized by the discrepancy of this
structure in relation to the mandible in the transverse direction, which may cause posterior cross-bite, crowding, malformed
palatal arch, high palate and also problems respiratory and phonetic order. Its accuracy is indicated by or exclusively
orthodontic treatment or ortho-surgical. One of the alternatives when the ortho-surgical treatment is osteogenic distraction to
induce bone formation in the transverse direction. The osteotomy recommended by the protocol is in the Le Fort I line,
associated with a median sagittal osteotomy. When approaching the nasal spine’s, the osteotomy deflected to one side,
causing asymmetry. The authors aim through the presentation of the case, demonstrate a modification in the sagittal split
osteotomy, complementary to the Le Fort I osteotomy, using a "Y" design combined in the anterior maxilla, to preserve the
anterior nasal spine along the septal cartilage, and this way, not interfere or interfere minimally in your position before your
facial portion of the skull, avoiding the undesirable asymmetry of the nasal tip. With the proposed technique is preserved
nasal spine to the nasal septum, allowing osteogenic distraction jaw without changing the position of this anatomical
reference. We present the clinical case of a 17 year-old female patient, with malocclusion and skeletal discrepancy of type
III to be submitted to surgical treatment of osteogenic distraction to correct its transverse maxillary deficiency prior to
orthodontic treatment, aimed at achieving future combined orthognathic surgery to correct the maxillo-mandibular
anteroposterior discrepancy.
The Use of Botulinum Toxin in the Treatment of Myofascial Pain Associated with Facial Deformity
Amanda Heffner*, Clarice Maia Soares de Alcântara Pinto, Andrezza Andrezza Lauria de Moura, Márcio de
Moraes.
Faculdade de Odontologia de Piracicaba-Unicamp - FOP-UNICAMP
Resumo
The botulinum toxin is a neurotoxin produced by the Clostridium botulinum bacterium. Its main mechanism of action
consists of blocking the release of extracellular acetylcholine (Ach), the main neurotransmitter endplate. The mechanism of
neuromuscular transmission occurs when an action potential depolarizes the nerve ending, promoting the release of
acetylcholine. The botulinum neurotoxin inhibits the release of Ach at the pre-synaptic neuromuscular junction, causing a
flaccid paralysis. There are seven distinct forms of neurotoxin ranging from Type A to G, with Type A being the most
commonly used. Among the clinical applications, its use in Dentistry has gained attention in patients with bruxism,
hypertrophy of the masseter and temporomandibular joint disorders. The objective of this study was to evaluate the use of
botulinum toxin in a case of a female patient, 50-year-old, who presented to evaluation complaining of intense pain
symptomatology in TMJs and in the right side of the face. During anamnesis, the patient reported to present the symptoms
for about ten years and denied prior history of facial trauma. At the clinical and radiographic examination, the patient
presented pain on palpation of the muscles of mastication on the right side, facial asymmetry, laterognatia, with deviation of
the chin to the right side, edentulism, unilateral mandibular hypoplasia, right bifid condyle and morphological changes in
mandibular ramus and body in the right side. The diagnosis was facial deformity associated with temporomandibular joint
dysfunction and myofascia pain. The initial treatment planning was orthognathic surgery, however it was opted for botulinum
toxin type A infiltration in masticatory muscles to earlier symptoms relief. Currently, the patient is in postoperative follow-up
of 5 months, without pain symptoms and presenting an improvement in mouth opening and masticatory function.
TECHNICAL DISCRIPTION OF HYPERTELORISM SURGICAL CORRECTION
Tila Fortuna Costa*, Deyvid Silva Rebouças, Thaise Gomes Ferreira, Fernando Bastos Pereira Júnior, Antônio
Márcio Teixeira Marchionni, Carlos Elias Freitas.
Bahiana School of Medicine and Public Health - EBMSP, 2 HGRS - Roberto Santos General Hospital (Cabula,
Salvador - Bahia)
Resumo
Background: Hypertelorism has been associated with a variety of congenital derformities. It refers to an abnormal increase
in the bony interorbital distance and must be distinguished from other deformities. Surgical procedures for corrections of
hypertelorism have undergone significant evolution during the last century, with foundation for contemporary combined
intracranial and extracranial approaches. A multitude of factors undoubtely contributes to the decision as to when surgical
correction should be attempted. Some authors show that the orbits can be repositioned with stability in patients averaging
3.9 years at the time of surgery and suggest that there may be a psychosocial benefit for operating at a young age. We aim
to present a case report illustrating the technique of orbital box osteotomy, to correct a congenital case of hypertelorism.
Case report: Female, 3 year old patient with craniofacial malformation caused by an amniotic band, underwent surgical
approach to correct hypertelorism. Intra and extracranial approaches were used to make orbital box osteotomies. Coronal
incision were used to gain subperiosteal exposure of the frontal bones, orbits and upper part of midface. A bifrontal
craniotomy was performed. Circumferencial orbital osteotomies were made and the zigomaticomaxillary and nasomaxillary
buttresses were also cut. The central frontoethmoidal segment osteotomy was planned for ressection due to a previous
craniofacial fistula. After removal of the median segment, orbits were translocated medially. Medial canthopexy was
performed using transnasal wiring. Nasofrontal processes of the maxila were fixed with wires, and the vertical buttresses
were rigidly fixed with titanium plates and screws. Conclusion: The surgical correction of orbital hypertelorism is a challenge.
The reestablishment of an aesthetic facial curve is critical to obtain a satisfying aesthetic result.
Ameloblastic fibroma in growing young patient: Case report
Daniel Ricaldoni de Albuquerque*, Sérgio Antonucci Amaral, Carina Cristina Montalvany Alves, Maria Cássia
Ferreira Aguiar, Júlio César Tanos de Lacerda.
Hospital Municipal Odilon Behrens - HMOB, 2 UFMG - Universidade Federal de Minas Gerais (Avenida Antonio
Carlos,6627 - Campus Pampulha - Belo Horizonte)
Resumo
Ameloblastic fibroma in growing young patient: Case report LVOF patient, age 07, female, was referred to the Department
of Oral and Maxillo-Facial Surgery of Hospital Municipal Odilon Behrens for evaluation of swelling in the right mandibular
region with an evolution of 90 days. According to the child´s guardian, she had no systemic symptoms and no pain
complaint. The extra-oral examination revealed a discreet facial asymmetry in the right side. Intra-oral examination revealed
a swelling in the right posterior region of the mandible extending to the mandibular ramus. On palpation, the lesion was rigid
causing expansion of the buccal and lingual corticals. A panoramic radiograph revealed the presence of large unilocular
radiolucent area involving the body, angle, ramus, condyle and coronoid process with displacement of tooth 47 to the
inferior border.The CT scan showed extensive well-defined hypodense area, causing expansion and thinning of the cortical
bone and mandibular base. The child was then subjected to puncture aspiration and biopsy. The collected material was
then sent to the pathology´s laboratory at UFMG and the diagnosis was suggestive of tumor of odontogenic origin. The
histological sections showed odontogenic neoplastic characterized by proliferation of epithelial cells in nests and cords,
sometimes anastomosing among a cellularized mesenchymal tissue with cells showing ovoid or starry nucleus in a loose
matrix. Immunohistochemistry was performed with average p53 positivity (15%) and Ki67 (4%). The disease was then
diagnosed as ameloblastic fibroma. Then, surgery to remove the tumor with a proposal of conservative treatment was
indicated and the specimen was sent for histopathological examination to confirm the diagnosis. The clinical and
radiographic 18 months follow-up showed good postoperative course with preserved masticatory function and facial
aesthetics.
MULTIDISCIPLINARY APPROACH IN THE DIAGNOSIS AND SURGICAL TREATMENT OF AN OSTEOMA
CAUSING FACIAL ASSYMETRY. CASE REPORT.
Marcelo Leite Machado da Silveira*, Ernest Cavalcante Pouchain, Bárbara Gressy Duarte Souza Carneiro,
José Rômulo de Medeiros, Alexandre Simões Nogueira , Eduardo Costa Studart Soares.
Federal University of Ceará - UFC, 3 HUWC - Walter Cantídio University Hospital (Rua Capitão Francisco
Pedro, 1290 - Rodolfo Teófilo, Fortaleza, CE )
Resumo
Osteomas, benign jawbone lesions rarely found in other bones, can affect the periosteum or medullary bone. It is more
commonly seen in the maxilla than the mandible, especially in the condyle or the lingual aspect of the body. Although a
number of authors consider them to be neoplasias, a local inflammatory process has been attributed as the cause for their
development in many cases, causing local deposition of new-formed bone tissue in the affected area. Treatment consists of
conservative surgical excision in the majority of cases, since these lesions rarely recur when completely removed. The
present paper aims to describe the case of a fifty two year-old woman who sought treatment complaining of a painless,
slow-growing swelling in the left mandibular angle causing facial asymmetry. CT scan revealed a hyperdense mass with
well-defined contours and a pedicle base inserted into the basilar portion of the left mandibular angle measuring
approximately 4cm in its larger diameter. Treatment consisted of surgical excision, under general anesthesia, through a
submandibular approach, due to the inferior position of the lesion. Further histopathological examination revealed the
presence of compact bone and osteoblasts, confirming the clinical suspicion of osteoma. The patient was then referred to a
gastroenterology facility, where Gardner’s Syndrome was ruled out. After a thirteen month follow-up period, there was
neither clinical nor radiographic sign of recurrence. The present case highlights the importance of multidisciplinary work in
determining the correct diagnosis and the importance of the surgical planning in order to achieve the best therapeutic choice
for each case.
A utilização do afastador autoestático de Wilkes modificado na técnica da artroplastia em GAP no
tratamento de Anquilose de ATM (relato de técnica)
Leandro Monetti Sanches*, Paulo Afonso de Oliveira Junior, Danilo Dressano, Gilberto Soares da Silva Junior,
Carlos Alexandre Wisch.
Paulista Association of Dental surgeons - APCD - Piracicaba
Resumo
No presente estudo iremos demonstrar a utilização do afastador de Wilkes modificado. Este instrumento foi idealizado para
cirurgias na articulação temporomandibular e tem a finalidadede promover a dilatação do espaço articular, isto permite e
facilita a realização de procedimentos na região das articulações tempomandibulares, como discoplastia, discopexia,
artroplastia entre outros. A anquilose da ATM, é uma patologia limitante, envolvendo a fusão do côndilo mandibular com a
base do crânio, causando distúrbios na mastigação, digestão, fonação, aparência e higiene. Essa patologia está mais
comumente associada ao trauma, infecções locais ou associada a doenças sistêmicas, como a espondilite anquilosante,
artrite reumatoide, psoríase. ou mesmo como sequela de fraturas condilares não tratadas ou tratadas inadequadamente. A
artroplastia em gap é utilizada no tratamento da anquilose, se baseia na ressecção do osso anquilosado sem a
interposição de materiais ou enxertos. Segundo a literatura, recomenda-se a criação de um espaço de pelo menos 15 mm
entre a fossa mandibular recontornando a mandíbula. É uma técnica simples e de curto tempo operatório e permite melhor
visualização das estruturas da articulação temporomandibular pois possibilita o afastamento adequado entre a cavidade
articular e o ramo mandibular. O instrumento sofreu alterações em seu desenho original, facilitando sobretudo sua
utilização em diversas modalidades de cirurgias da articulação temporomandibular. Iremos demonstrar como este tipo de
instrumental pode ser utilizado também em cirurgias de Anquilose da ATM, especialmente na técnica da artroplastia em
GAP. Esta técnica pode fornecer melhor tempo cirúrgico ao procedimento proposto, possibilitando maior agilidade do
profissional e submetendo o paciente a uma menor exposição ao ambiente cirúrgico.
CASO RARO DE OSTEOMIELITE SUPURATIVA CRÔNICA COM ENVOLVIMENTO TOTAL DE MANDIBULA
– RELATO DE CASO
José Leozir Pedroso Júnior*, Rogerio Bonfante Moraes, Joazir Ferreira Castanharo Junior, Diogo Loureiro de
Freitas.
Hospital Regional de Cacoal - Rondonia - HRC
Resumo
A osteomielite é uma doença pouco comum, sendo definida como uma inflamação óssea com envolvimento da cortical e
sua medular, podendo se estender para o periósteo e tecidos moles adjacentes. Ocorre normalmente por uma infecção
bacteriana que desencadeia uma osteólise extensa, com supuração e formação de sequestro ósseo. De acordo com o
estágio de evolução esta pode ser classificada como aguda ou crônica. Seu diagnóstico é feito através de exames clínicos,
radiográficos e laboratoriais. O tratamento pode ser feito por meio de antibioticoterapia, drenagem de abscessos, remoção
de sequestros ósseos e intervenção cirúrgica. O presente trabalho relata o caso de um paciente do sexo masculino,
leucoderma, 27 anos, fumante, sem histórico de doenças sistêmicas, com quadro de infecção odontogênica após extração
de dentes posteriores mandibulares bilaterais, com evolução de dois meses, que resultou em uma osteomielite extensa,
atingindo uma grande porção do osso mandibular, desde o corpo mandibular direito ao ramo mandibular esquerdo. Havia
queixa de dor crônica, com edema difuso bilateral em região mandibular, drenagem espontânea de secreção purulenta
intra e extra-oral e formação de sequestros ósseos no rebordo alveolar. O tratamento foi conduzido em ambiente hospitalar
com antibioticoterapia endovenosa por longo período, intervenção cirúrgica ampla e antisséptico bucal diário. Aos dois
meses de pós-operatório, foi observado resolução do quadro infeccioso, com satisfatório resultado estético e clínico. Aos
oito meses de pós-operatório o paciente não apresentava qualquer recidiva do quadro infeccioso. Concluiu-se que a
osteomielite mandibular, quando extensa, é uma complicação infecciosa grave que necessita um acompanhamento
hospitalar rigoroso, com uso de antibióticos por longos períodos e intervenção cirúrgica agressiva para remoção de todo
tecido infectado.
High condylectomy associated with orthognathic surgery for the treatment of condylar hyperplasia
Felipe Alexander Caldas Afonso*, Flávio Wellington da Silva Ferraz, José Benedito Dias Lemos, Yuri
Slusarenko da Silva, Bruno Henrique de Oliveira.
University Hospital of the Sao Paulo University - HU-USP
Resumo
Condylar hyperplasia (CH) is an uncommon mandibular benign pathology1 that is characterized by a progressive
development of a facial asymmetry, consequence of an excessive unilateral growth of the condylar cartilage. It results in
aesthetic, occlusal, and functional abnormalities1. Various methods have been used to diagnosis CH, including radiographic
studies, bone scintigraphy, and histopathologic assessment2,3. Treatment is primarily surgical, with or without orthodontics,
and depends on the degree of severity and the status of condylar growth, ranging from high condylectomy to orthognathic
surgery or even a combination of both5. The objective of this work is to present a case of CH treated in the service of
residence in Oral and Maxillofacial Surgery of the University Hospital of Sao Paulo University. Patient, 20 years-old, female,
caucasians, attended in May 2010 with history of progressive deviation of the mandible midline after orthodontic treatment
finalization. During facial examination it was observed facial asymmetry due to deviation of the chin to the right. During oral
examination it was observed a deviation of 5 mm of the mandible middle line to the right, negative overjet, type III
dentofacial deformity, and laterognathism to the right. In the CT it was observed an increase of the head and neck of the left
condyle. It was taken a bone scintigraphy, which confirmed a moderate region of active growth in the left mandibular
condyle. After 6 months of orthodontic prepare, the patient was submitted to high condylectomy surgery, with discopexy,
bilateral saggital osteotomy of the mandibular ramus and mentoplasty. After 2 years of post operative it was observed a
better symmetry, facial harmony and occlusion. It was concluded that the treatment of CH with high condilectomy and
orthognathic surgery in the same surgery time was a satisfactory treatment alternative to this patient.
Bisphosphonate x implants: Literature review
Jhonathan Barros*, Marlon Amaral, Monica Calasans, Marcelo José Uzeda, Rodrigo Resende.
Universidade Federal Fluminense - UFF
Resumo
It is increasingly common the presence of cancer patients in routine in various specialties such as periodontics,
implantology and maxillofacial surgery.Some cancers of the head and neck is particularly important regarding the influence
of the treatment on the need for further oral rehabilitation. The treatment of these disorders is often performed through radio
and / or chemotherapy drugs, or combined with surgical resection, with subsequent and imperative need of replacement
bone and tooth by using dental implants, with the goal of esthetic and functional recovery. Bisphosphonates are synthetic
drugs similar to pyrophosphates, with action on bone remodeling and osteoclast-mediated vascularization, commonly used
in the treatment and prevention of bone tumors. In recent years this class of drugs has been the subject of enormous
interest to dentistry especially in the areas of Oral and Maxillofacial Surgery, Periodontics and Implantology. Recent studies
show its relationship with the development of osteonecrosis in both maxilla as in the mandible. The main risks of using
dental implants in irradiated patients is the occurrence of osteoradionecrosis and non osseointegration of the implant.
Treatment with the use of radiotherapy, as well as of bisphosphonates in cancer patients, has main role in osteoblast,
osteoclast and vascular activity, interfering directly in the physiological quality of the bone support. The objective of this
paper is to review the current literature discussing and analyzing the consequences of radiotherapy used in many cancer
treatments, in relation to dental implants, their survival rate and the influence of the use of bisphosphonates as
chemotherapy medication.
SESSÃO VII:
Tratamento cirúrgico de exoftalmia pela síndrome de Graves: Relato de caso
Fernando Zahorcsak*, Fabio Ricardo Loureiro Sato, Rogério Almeida Silva.
HOSPITAL GERAL DE VILA PENTEADO DR JOSE PANGELLA - HGVP
Resumo
A síndrome de Graves é uma doença auto-imune. O médico Robert Graves a descreveu em 1835 e o médico alemão Karl
Adolph von Basedow independentemente a descreveu em 1840. A fisiopatologia da doença se dá pelo papel dos linfócitos
T CD4+ no reconhecimento de antígenos compartilhados por ambos: tireóide e tecidos orbitais. Em estudos
epidemiológicos se apresenta como a principal causa de hipertireoidismo, atinge 2% das mulheres na menopausa, sendo 7
mulheres para cada homem afetado, mais freqüente durante a gestação e bilateral em 75% dos casos. O tratamento de
primeira escolha para esta doença são medicamentos que inibem a liberação de hormônios tireoidianos associados à
betabloqueadores, iodoterapia e tireoidectomia total ou parcial. O tratamento cirúrgico da exoftalmia é adiado até o controle
da doença. Vários tratamentos cirúrgicos de descompressão da órbita podem ser utilizados como a remoção de duas, três
ou quatro paredes, a lipectomia da gordura periorbital e uso de enxertos livres. O caso clínico consta de uma paciente de
24 anos, encaminhada pelo Serviço de Cirurgia Plástica para correção de exoftalmia devido a Doença de Graves. Refere
hipertireoidismo, atualmente controlado, porém permanece parte do exoftalmo endócrino. Foi utilizada e a técnica de
aumento do volume orbital através da remoção da parede e arco lateral da órbita, além da lipectomia parcial da gordura
periorbital. Conclui-se que o tratamento cirúrgico tem um papel fundamental no tratamento das exoftalmias refratárias ao
tratamento clínico, a técnica utilizada permite um aumento do volume orbital e estabilidade às estruturas reconstruídas,
proporciona a redução previsível da proptose e desde que a técnica seja corretamente empregada as comorbidades são
mínimas.
Treatment of keratocystic odontogenic tumor associated with cryotherapy with liquid nitrogen
Luis Gustavo Mafioletti Rosso*, Carlos Eduardo Chrzanowski Pereira de Souza, André Luis Chiodi Bim,
Mariana Saideles Martins, José Nazareno Gil.
Federal University of Santa Catarina - UFSC
Resumo
The keratocystic odontogenic tumor, former odontogenic keratocyst, is one of the most aggressive and recurrent
odontogenic benign tumors. It originated from cellular remains of dental lamina, sorted by their specific clinical behavior and
histopathological features. Its prevalence is higher in males, in the range 10-40 years old and has a recurrence rate of about
30%. The case presented in this paper is about a 27 year old female patient, the diagnosis was made by histopathology.
Radiographic examination showed a radiolucent unilocular image with defined limits, and without bone expansion
associated with the 48 teeth included in the posterior mandible. When multifocal, it may be associated with Gorlin-Goltz
syndrome. In histopathological presented a stratified epithelial lining parakeratinized with hyperchromatic basal cells,
externally it has fibrous connective tissue that may contain cysts satellites. The treatment began with a cystic
decompression with a acrylic drain, to eliminate the intracystic pressure, resulting in thickening of the cystic lining, which
subsequently allowed an easy removal. The cavity had grown a gradual peripheral bone neoformation. At the time it was
found a bony blade above the inferior alveolar nerve (NAI), which would allow enucleation of the lesion, so the surgery was
performed. Cryotherapy with liquid nitrogen was used to obtain the safety margin, preserving the NAI and having an
excellent prognosis in this type of injury. The basic principle is to increase the concentration of electrolyte in the cell to make
a hyperosmotic environment, causing the water outlet of the cell. In this case cryotherapy resulted in injury to soft tissue,
which generated a necrosis and suture dehiscence, which is the most common complication of this therapy. The objective of
this paper is to show the treatment of injury associated with cryotherapy and therapeutic decision of the complication
causes.
Closure of oronasal communication in bone grafting in patients with unilateral cleft transforamen –
cases report
Nilton Pires de Araújo Filho*, Rubens Caliento, Bruno Reinoso Noronha, Andreza Maria Fabio Aranha,
Alessandra Nogueira Porto, Alexandre Meireles Borba.
University General Hospital - HGU-UNIC, 2 UNIC - Masters Program on Integrated Dental Sciences (Av Manoel
José de Arruda 3100, Cuiaba - MT, CEP 78065-900)
Resumo
Patients with cleft lip and palate (CLP) presents as a spectrum of maxillofacial clefts that can affect lip, maxillary alveolar
bone and/or palate. The occurrence of this deformity causes functional and aesthetic changes with important psychological
and social consequences. Therefore, they require multidisciplinary care and a varied number of surgical interventions to
provide better conditions for development. Alveolar bone grafting, current gold standard technique, performed preferably
before ipsilateral permanent canine’s eruption (or a viable lateral incisor), when two-thirds of its roots formation is
completed, around 6 to 12 years-old, aims at reconstruction of the alveolar process and reestablishment of a single
maxillary dental arch, allowing the eruption of the cleft-related tooth, or if necessary, conditions for complete rehabilitation of
patients with dental implants. On the CLP, the maxillary alveolar ridge is involved by the clef toward the palate creating a
nasal cavity communication; to ensure success of this alveolar bone grafting, this communication closure is a key point to
be performed. To a complete oronasal communication closure, palatal and buccal mucosal flaps should have enough
mobility to perform a free tension suture, which is a difficult task especially in the palatal mucosa, which will serve as a
posterior wall to accommodate the graft. This area represents the union of the new nasal floor with previously operated
palatal mucosa, therefore, being essential to create a water-proof barrier between the oral and nasal cavities, providing a
favorable recipient for bone grafting. The aim of this study is to illustrate in detail the challenge of soft tissues closuring of
the oronasal communication in alveolar bone grafting of cleft lip and palate surgeries in unilateral cases treated by the Oral
and Maxillofacial Service of the University Gereral Hospital of Cuiabá.
Surgical managements of large myxoma in the mandible: eight years follow-up
Raí Heidenreich*, José Nazareno GIl, Carlos Eduardo Chrvanowski Pereira de Souza, André Luis Chiodi Bim,
Mariana Saideles Martins.
Resumo
Odontogenic myxoma is defined as a benign tumor that originates from odontogenic ectomesenchyme, with histological
resemblance to the pulp ectomesenchyme. It is commonly found in young adults, with an average age of 25 to 30 years,
there is not predilection for gender and the mandible is more affected than the maxilla. Injuries reduced sizes may be
asymptomatic, as often occurs in larger lions painless expanção the bone involved. Radiographically presents as a
radiolucent lesion with irregular margins, uni or multilocular, which often contains residual trabecular bone that are arranged
at right angles to each other or in the form of "soap bubbles". Microscopically is composed of cells arranged in star-shaped,
spindle-shaped or rounded in an abundant, slack and myxoid where one notes the presence of some stromal collagen
fibrils. In immunohistochemical analysis, we note that the myxoma cells show diffuse immunoreactivity to antibodies
directed against vimentin and focal reactivity for muscle-specific actin. The treatment is based on curettage in small lesions
monitoring at least 5 years, and larger lesions is indicated resective surgery with due safety margin. Studies show that
carrying out the resection, placement of the plate and graft during the same first surgery, have an increased hazard ratio for
wound infection, jeopardizing the success of the procedure. The objective of this work is to present a clinical case of
odontogenic myxoma in body and branch of the left mandible, where resective treatment with a safety margin of 1 cm, with
submandibular access, placement of plate and iliac crest bone graft was performed at the same time surgical. Postoperative
graft infection occurred, which was approached debridement and partial removal of the same, placing new graft from the
iliac crest and eight years follow-up.
PINDBORG TUMOR FOUND BILATERALLY
Lourival Raimundo dos Santos Junior*, Davani Latarullo Costa, Paulo Eduardo Przysiezny, Eduardo Thome
Azevedo, Max Ernest Furlong.
Latin American Institute for Dental Research and Education - ILAPEO
Resumo
The calcifying epithelial odontogenic tumor, also named as Pindborg tumor, is a benign and rare tumor. Mainly occurs
between the third and fourth decades of life, being more common in women. The region with the highest prevalence is the
posterior portion of the jaw. This paper aims to report a case of bilateral TOEC. Contributing to the collection of literature
maxillofacial surgery, where there are few published reports of cases of this type of tumor found bilaterally. Patient of 36
years males sought specialized care complaining of hard volumetric increase, no bleeding, bilaterally in the vestibular region
of the lower premolars with growth for more than six months and in pain while chewing. In the radiograph report it was found
bone lesion with localized blowing aspect bilaterally in the transition between body and mandibular branch, in pericoronal
region along the teeth 35 and 45, showing mixed density, with small sclerotic areas and component highly calcified. Was
chosen for the conduct of clinical case performing the surgical removal of the lesion and teeth associated, with a small
safety margin and sent the materials collected for histopathologic examination. This tumor type represents only about 0.6%
to 1.7% of all odontogenic tumors, is composed of polyhedral epithelial cells, in some cases, prominent intercellular bridges.
Among the masses of tumor cells, the homogeneous commonly calcify, causing the appearance of calcified tumor. The
patient return to the office with histopathological report and to verify the result was confirmed the diagnosis the supposed
tumor Pindborg. However, concluded that this type of tumor can be found bilaterally but at a lower frequency, since there
are few reports of this tumor found in this way.
Erupted Compound Odontoma mimicking the mandibular second molar: a case report
Marcela Oliveira Andrade*, Marco Antonio Oliveira Filho, Laurindo Moacir Sassi, Andrea Duarte Doetzer.
Hospital Universitário Evangélico of Curitiba - HUEC, 2 HEG - Hospital Erasto Gaertner (R. Dr. Ovande do
Amaral, 201 - Jardim das Américas CEP 81.520-060 - Curitiba/PR )
Resumo
The odontoma is the most common odontogenic tumor, considered not a true neoplasm, but an alteration of development.
The lesions can be classify into two types: compound and complex odontoma. The compound type is formed by multiple
organized structures similar to mini teeth. The complex type is a mass of dental tissues, but not organized as the teeth. In
general, these lesions are asymptomatic, found in routine radiographic examinations or when seeking the cause of a
missing tooth. This paper is a case report of a 17-year-old boy reported to the Department of Bucomaxillofacial Trauma and
Surgery, at the Hospital Universitário Evangélico of Curitiba, with a chief complaint of pain in the right posterior mandibular
gingiva. The clinical examination revealed an erupted calcified mass distal to the first molar, with accumulation of calculus
and peripheral inflammation in the gingiva plus absence of the second molar tooth. The orthopantomographic exam
revealed radiopaque lesion surrounded by a radiolucent area superior to the lower second molar crown, with was located
impacted under the lesion. The patient underwent surgical resection of the lesion and extraction of the second molar,
because the impacted tooth could not be orthodontically retracted. The surgical site was thoroughly curetted and the
surgical wound was sutured with 4-0 Vicryl. After surgery, the patient presented paresthesia in right side of the jaw, which
resolved in four months. The follow up of six months shows satisfactory evolution. Odontomas erupting into the oral cavity
are considered rare. The diagnosis of compound odontoma was established.
Odontogenic Myxoma: Diagnosis, Treatment, Follow-up and Prosthetic Rehabilitation - Case Report
Aécio Abner Campos Pinto Junior*, Joanna Farias da Cunha, Luiz Felipe Cardoso Lehman, Felipe Eduardo
Baires Campos, Wagner Henriques de Castro.
Hospital das Clínicas da UFMG - HC-UFMG
Resumo
A 21-year-old, male patient, sought for the Service of Oral and Maxillofacial Surgery of Clinics Hospital, of Universidade
Federal de Minas Gerais (HC-UFMG), when he was 13 years-old. He was referred for evaluation of an asymptomatic
swelling in the maxilla, with evolution time of 04 months. At the occasion on physical examination, showed the presence of
an asymptomatic swelling, on the anterior region of the maxilla, firm to the touch and covered by normal mucosa. A
computerized tomography exam was requested and revealed the presence of a hypodense unilocular well-defined lesion on
maxilla, extending from the deciduous first right upper molar to the upper left deciduous canine. The hypothesis of
Ameloblastoma, Keratocystic Odontogenic Tumour and Odontogenic Myxoma were considered. Incisional biopsy was
performed under local anesthesia, and the removed fragment was sent for histopathological examination which confirmed
the diagnosis of Odontogenic Myxoma. The patient underwent a first surgical procedure under general anesthesia, at the
HC-UFMG, for resection of the lesion. After 08 years of follow up, the patient had no clinical or imaging signs of recurrence.
Thus, a new surgical procedure was proposed. The objective of the second procedure was the reconstruction of atrophic
maxillary ridge with a free autogenous bone graft, from the anterior iliac crest. Four months after the partial reconstruction of
the maxillary ridge, the patient underwent insertion of dental implants seeking for prosthetic rehabilitation. Six months after
implants placement, the prosthetic treatment was completed. The patient currently is rehabilitated morphological, functional
and aesthetically, with no signs of recurrence of the lesion.
Combined treatment of central giant cell lesion in the upper jaw
Clarice Maia Soares de Alcântara Pinto*, Raquel Correia de Medeiros, Andres Humberto Cáceres Barreno,
Márcio de Moraes.
Piracicaba Dental School - University of Campinas - FOP - Unicamp
Resumo
The central giant cell lesion (CGCL) is an uncommon benign lesion which presents an uncertain aetiology and different
therapeutic approaches. Predominantly, the treatment advocated for CGCL has been surgery, ranging from simple
curettage to resection. Alternative non-surgical treatments have been extensively reported, including systemic calcitonin,
interferon and intralesional corticosteroids. The aim of the present work was to present the case of an 8-year-old boy who
attended for initial evaluation presenting a paranasal expanding swelling over a 15-month period. The diagnosis of CGCL
had been previously established after an incisional biopsy performed by another professional. The clinical and radiographic
examination revealed facial asymmetry, mixed dentition with tooth displacement in the left anterior maxilla, intraoral left
buccal vestibule swelling and a radiolucent lesion extending from the left central incisor to the germ of the left first premolar.
A conservative treatment was initiated with weekly intralesional infiltration of triamcinolone hexacetonide and a daily use of
systemic calcitonin via nasal spray. The patient remained under regular clinical and radiographic follow-up and presented
stabilization of the lesion with signs of intralesional bone formation at radiologic exam. A new incisional biopsy was
performed and the results were compatible with a fibro-osseous lesion. Twelve months after the initial therapy, the patient
presented an increase of the lesion, extending to the left infra-orbital region. Surgical treatment was planned and performed
under general anesthesia through a Weber Ferguson approach. During surgery was noticed that the lesion had a hard
consistency in the anterior area and a more soft consistency in the posterior and superior areas. Currently, the patient has 7
years of follow-up without any recurrence signs.
SESSÃO VIII:
Mental neuropathy in a patient with metastases from colorectal cancer
FÁBIO WILDSON GURGEL COSTA*, DIEGO FELIPE SILVEIRA ESSES, ERNEST CAVALCANTE
POUCHAIN, ANA PAULA NEGREIROS NUNES ALVES, RÉGIA MARIA VIDAL DO SOCORRO PATROCÍNIO,
EDUARDO COSTA STUDART SOARES.
Federal University of Ceará - UFC
Resumo
Mental neuropathy, also know as numb chin syndrome, is a rare peripheral neuropathy characterized by sensory disorders
(hypoesthesia, paresthesia, anesthesia) along the distribution of the inferior alveolar nerve or mental nerve. The main
causes of mental neuropathy are dental in origin (iatrogenic from injections or other dental procedures), followed by
malignancies. In this context, metastatic tumours comprise approximately 1% of malignant oral neoplasms. Although colon
adenocarcinoma is a common cancer, reports of oral metastases are rare. Additionally, mental neuropathy is most often
related to breast cancer in women and prostate cancer in men. The aim of this work is to describe an 81-year-old male that
presented with a history of a mandibular swelling of approximately 3 months duration after extraction of tooth 45, which was
associated with mental neuropathy. Previous medical history revealed a diagnosis of colon adenocarcinoma with liver
metastasis. Clinically, a right mandibular swelling associated with an ulcerated nodule was observed. Radiographically, a
mixed lesion with a sunburst pattern was observed. After incisional biopsy, histological diagnosis was adenocarcinoma.
Immunohistochemical profile showed positivity for CDX2, CK20, and CEA, but not CK7, confirming the diagnosis of
metastatic colon adenocarcinoma. Chemotherapy was the adopted treatment. However, the patient died within 2 months of
diagnosis of oral metastasis. This case highlighted the clinical and imaging features as possible signs of a metastatic
disease in the oral cavity. In addition, mental neuropathy can be the early symptom of oral metastasis from a colorectal
cancer. However, more often, it is a harbinger of progression or relapse.
Intraosseous pleomorphic adenoma treated by enucleation through Le Fort I osteotomy: a case report
RAQUEL MEDEIROS*, Douglas Rangel Goulart, Gustavo Almeida Souza, Marcio de Moraes.
Faculdade de Odontologia de Piracicaba - FOP-UNICAMP
Resumo
Objective: This study reports a clinical case of intra-osseous pleomorphic adenoma located in the anterior maxilla treated
with enucleation by Le Fort I osteotomy. Case Report: Patient J.A.R.S., 31 years of old, female, leucoderma, was served in
the Oral and Maxillo Facial Surgery of Piracicaba Dental School- UNICAMP due to swelling in face started 04 months ago.
On physical examination, there was swelling in the maxillary vestibular sulcus, in the region between 11 and 14 rounded
hardened and painless palpation. During anamnesis, the patient reported surgical treatment of lesions in the palate in
childhood with diagnosis of pleomorphic adenoma, but denied postoperative follow-up. In images of cone beam computed
tomography, there was intra-osseous lesion in the maxilla, involving the apex of the elements 11-16, with displacement of
the nasal floor, however no expansion of the cortical bone of the palate and no communication with the maxillary sinus. The
patient also reported desire to perform orthognathic surgery for correction of vertical maxillary excess and anteroposterior
deficiency ment, despite occlusion of Class I. The patient underwent orthognathic surgery for maxillary impaction and
advancement genioplasty to, and after osteotomy Le Fort I, enucleation of the lesion was performed. The diagnosis of the
surgical specimen was pleomorphic adenoma. The patient, at the time, lies in the postoperative period of two months, in
good evolution with Class I occlusion, and no signs of recurrence. Conclusion: The surgical treatment of intraosseous
spleomorphic adenoma by enucleation through wide access after the Le Fort I osteotomy was successful and the Le Fort I
osteotomy is indicated for the treatment of this type of lesion in this location.
Tratamento cirúrgico de osteocondroma: relato de caso com 5 anos de preservação
Leonardo de Almeida Prado Domingues*, Paulo Afonso de Oliveira Júnior, Danilo Dressano, Lisiane Aguiar,
José Luis de Sousa Castro Júnior, Alexandre Wisch.
Hospital Santa Casa de Piracicaba - APCD - Piracicaba
Resumo
O osteocondroma é caracterizado como uma lesão exofítica que surge do córtex do osso, ou seja, uma protuberância
óssea recoberta de cartilagem que se forma na superfície cortical por isso também é conhecida como exostose
osteocartilaginosa . Estes tipos de tumores podem ocorrer na forma solitária ou em múltiplos tumores. Apesar de ser
bastante frequente nos ossos longos, sua presença na região oral e maxilofacial é relativamente rara, sendo estes de
maior frequência em côndilo e processo coronóide . No presente relato apresentamos um caso clínico de osteocondroma
condilar, onde foi realizado tratamento cirúrgico conservador . O paciente apresentava como queixa principal uma
crescente assimetria facial e dor na região pré-auricular esquerda, além de apresentar redução da abertura bucal, desvio
de mandíbula e mordida cruzada posterior. A radiografia panorâmica revelou um aumento do côndilo esquerdo, enquanto a
tomografia computadorizada e reconstrução 3D revelaram um crescimento ósseo bem definido na porção medial do
côndilo esquerdo. O paciente foi submetido a cirurgia de condilectomia alta para exérese do osteocondroma, discopexia
para reposicionamento do disco articular e osteotomia sagital de ramo mandibular contra lateral para correção da oclusão.
Com o acompanhamento pós opertatório clinico e tomográfico de 5 anos, não apresentou sinais de recidiva da lesão. Com
base na bibliografia pesquisada e nos resultados obtidos é possível concluir que o tratamento proposto pode ser muito
eficaz e apresenta excelentes resultados pós operatórios em casos como este onde o paciente apresentava uma lesão
significativa na porção medial do côndilo, e foi removida sem sinais de reicidiva da lesão até o presente momento.
THE USE OF BUCCAL FAT PAD AFTER EXCISION OF A PLEOMORPHIC ADENOMA IN THE PALATE
Diogo Loureiro*, Rogério Moraes, Maurílio Matos, José Leozir, Carlos Alberto.
Hospital Regional de Cacoal - HRC
Resumo
The pleomorphic adenoma is a benign mixed tumor of salivary glands that primarily affects the parotid and submandibular
glands, it may also affect, in lower frequency, minor salivary glands, especially on the palate. In the treatment of this lesion it
is indicated the complete removal with a safety margin due to the lack of a complete capsule, and therefore to the injury’s
many small projections to the inside of healthy adjacent tissue. Thus, when in the palate, its removal must include the
overlying mucosa as well as the underlying periosteum The removal of this tissue results in a large bone exposure which
becomes difficult to cover it back. Thus, taking into account the scarcity of reports in the literature, this work aims to show
the surgical technique and postoperative results of the use of buccal fat pad to cover the surgical wound after excision of a
pleomorphic adenoma in the palate. A pedicellate flap from the buccal fat pad was obtained by an incision at the base of the
buccal flap in the region posterior to the zygomatic-alveolar crest, followed by divulsion. This pedicle was carefully rotated
and sutured to the remaining palatal mucosa. In the postoperative period, the patient did not report any pain and discomfort
and it was noticed an astonishing rapidity in epithelialization over the exposed fat tissue in the oral cavity, being noticed an
excellent healing process. It was concluded that the coverage of the wound with the buccal fat pad results in less
postoperative morbidity, being a useful technique after excision of a pleomorphic adenoma in the palate.
HPV e câncer bucal: Mito ou verdade ?
Carlos Eduardo Xavier dos Santos Ribeiro da Silva*, André Carvalho Rodriguez, Daniela Marti Costa, Valdir de
Oliveira, Marcio Martins.
Faculdade de Odontologia - UNISA, 2 APCD - Escola de Aperfeiçoamento Profissional (Praça Campo de
Bagatelle, S/N), 3 HASP - Hospital Adventista de São Paulo (Rua Rocha Pombo, 34)
Resumo
Os papilomavírus humanos (HPVs) ontogênicos são importantes agentes na gênese do câncer ginecológico e nos dias de
hoje tem se discutido de forma exaustiva sua atuação também como fator predisponente dos cânceres da boca. Com
objetivo de avaliar a relação entre o HPV e o carcinoma espino-celular (CEC) da língua, foram selecionados 50 pacientes
do sexo masculino, da raça branca, fumantes e com diagnóstico histológico de CEC, e um grupo controle composto por 10
pacientes sem evidências clínicas de lesão na língua. A reação em cadeia pela polimerase (PCR) foi utilizada para detectar
a presença do gnoma HPV em amostras de tecido fresco, provenientes CEC da margem da língua. Utilizou-se o PCR pela
sua especificidade e confiabilidade dos resultados, já que muitos trabalhos da literatura tentaram detectar sinais do vírus
apenas através de anátomo-patológico. Optamos ainda por tecido fresco quando outros autores utilizaram tecidos já
parafinados e que portanto havia destruição do material genético dos vírus. Trinta e sete pacientes, o que representava um
percentual de 74% das amostras apresentaram resultado positivo de PCR para papilomavírus oncogênicos, sendo que no
grupo controle apenas uma amostra (10%) foi positiva para os papilomavírus não-oncogênicos. Pôde-se concluir através
de análise estatística deste trabalho que o paciente portador de papilomavírus oncogênico na cavidade bucal possui 25,6
vezes mais chance de desenvolver o CEC da língua, devendo portanto ser acompanhado de forma sistemática pelo
cirurgião dentista. A presença do HPV pode ser um importante marcador de risco de desenvolvimento do câncer bucal e
que deve portanto ser avaliada juntamente com outros fatores oncogênicos como o fumo e o álcool.
Surgical treatment of Teratoma (Epignathus) of the cranial base.
Sylvio Luiz Cota de Moraes*, Alexandre Maurity de Paula Afonso, Roberto Gomes dos Santos, Ricardo Pereira
Mattos, Bruno Gomes Duarte.
Cranio-Maxilo-Facial Surgery Clinic, São Francisco Hospital - RECONFACE, 2 HUAP-UFF - Emergency Unity,
Antônio Pedro University Hospital ( Rua Marques de Paraná, 303 - Niterói - Rio de Janeiro - Brasil - CEP:
24033-900)
Resumo
The Teratona (Epignathus) or oropharyngeal teratoma is a rare congenital complex tumor composed of all three embryonic
germ layers: ectoderm, mesoderm, and endoderm that are not indigenous to their site of origin. These lesions originate from
aberrant germ cells at the 4th or 5th week of gestation, with proliferation and differentiate in mature (mature) or fetal
(immature) tissue. In the head and neck region, these tumors are considered to be mature teratomas in 60 to 80% of cases.
Neonatal teratomas are usually benign; they’re being a higher incidence of malignancy in teratomas diagnosed in adult life.
The differential diagnosis is limited and must include: hamartoma, dermoid cyst and gastrointestinal heterotropic. Teratomas
of the head and neck represent 5 to 15% of all sites, with a female predominance. This tumor may be originate from
thyrocervical area, palate, or nasopharynx, attached to the sphenoid bone and protrude from the fetus’ mouth, which
represents a risk to airway. Clinical examination identifies the lesion and possible complications (deformity of the facial
bones, cleft palate, etc.). Imaging (head and neck CT and MRI) is essential to define extension of the lesion, anatomical
relations and determine the possibilities of resection, which represents the gold standard in the treatment of the teratomas.
An injury remain relate to malignant transformation. This study reports a clinical case of a patient 40 days born, female who
had agenesis of the hard palate and finish muco-periosteum and skull base tumor with the presence of the teratoma that
was operated by the Maxillofacial Surgery Team integrated by the authors. The patient was underwent soft tissue
reconstruction of the palate by using the tongue flap and she is kept under outpatient control.
Distraction osteogenesis in a patient with bilateral TMJ ankylosis and severe apnea: case report
Hugo Leonardo Mendes Barros*, Gustavo Ramos Suassuna, Alan Robert Moreira Schmitt, Alana Benevides
Kohn, Luciene Guardin, Henrique Martins da Silveira.
State University of Rio de Janeiro - UERJ
Resumo
Condylar damage during early childhood can produce ankylosis and alteration of the mandibular growth. The most
frequente causes of condylar damage are trauma to the joint and infecctions, but some other causes are possible.
Mandibular retrognathism due to temporomandibular joint ankylosis is one of the important contributing factors to the
obstructive sleep apnea. Such patients suffer from number of apneic or hyponeic events during sleep, snoring, day time
sleepiness, fatigue,inability to concentrate, irritability. Distraction osteogenesisis is a surgical technique in the management
of OSA, secondary to TMJ ankylosis. This study presents a case-report of a patient, 6 years old,female presented limited
mouth opening and chewing difficulty seen by her mother at 1 year of age. Without complications in childbirth, reported
hospitalization with four days of life due to perinatal lung infection. Reported restless sleep, wheezing, frequent awakenings.
On admission to hospital treatment showed thinness and very lowheight for age, characterizing chronic malnutrition. Patient
in poor general condition, body and head projecting forward, pale, hydrated, cyanosis and jaundice. Saturation were 52%
and severe day time sleepiness. Due to respiratory complications, tracheostomy was performed to secure the airway
maintenance. Bilateral distraction osteogenesis has been conducted to accomplish stretching of the jaw to increase the size
of the airway with success. After six months was performing the ankylosis removal performed bilaterally and the opening of
the mouth in trans-surgical was 52mm. Postoperative physical therapy to maintain mouth opening was held, with an
amplitude of 35mm. After regression of edema surgery for removal of ankylosis, the tracheostomy was removed. In the
pediatric assessment after surgery, was showed the significant improvement of the patient by addressing respiratory
complaints, as is normal with height and weight for age, which shows success in treatment.
USE OF LE FORT I OSTEOTOMY IN TREATMENT OF MAXILLARY LESIONS REPORT OF 3 CASES
Francisco Samuel Rodrigues Carvalho*, Marcelo Leite Machado da Silveira, Maykel Sullyvan Marinho de
Souza, Marcelo Ferraro Bezerra, Tácio Pinheiro Bezerra, Eduardo Costa Studart Soares.
Walter Cantídio Universitary Hospital - UFC
Resumo
Horizontal maxillary osteotomy, also known as Le Fort I osteotomy (LFIO) is a widely used and disseminated surgical
procedure for treatment of dentofacial deformities involving discrepancies in the middle third of the face. It is a surgical
modality with a low degree of morbidity and high predictability when correctly performed. In spite of its wide use in
orthognathic surgery, the technique was originally described by Langenbeck in 1861, for treatment of a tumor located in the
pterygopalatine fossa. In the literature, there are various cases related to the use of OLFI as surgical access for
management of benign neoplasms, odontogenic cysts and tumors of the middle third of the face. The fact that access by
means of LFIO allows direct visualization of the middle third of the face, helps with better definition of the margins of the
lesion. Furthermore, its use helps to diminish the risk of surgical wound dehiscence, with possible appearance of buccosinus communication. The aim of this report is to relate 3 cases of patients who presented to the Oral and Maxillofacial
Surgery and Traumatology Service of the University Hospital Walter Cantido, in whom OLFI was used for the treatment of
benign lesions of the maxillae as a conservative surgical approach. At present all the patients are being clinically followedup, without any esthetic and/or functional complaints. The high success rate and low degree of morbidity in resolution of the
cases presented, emphasizes the importance of taking this technique into consideration in the treatment of lesions located
deeply in the maxilla.
SESSÃO IX:
Cementoblastoma, a rare odontogenic tumor: Report of a case
Rafael Luís Ferreira Netto Cardoso*, Pedro Henrique Mattos de Carvalho, Valdir Meirelles Júnior, Márcia Grillo
Cabral , Maria Elisa Rangel Janini.
FEDERAL UNIVERSITY OF RIO DE JANEIRO - UFRJ
Resumo
Cementoblastoma is a relatively rare benign neoplasm of the cementum, derived from ectomesenchyme of odontogenic
origin, and represents less than 1% of all odontogenic tumors. It usually occurs in people among the age of 20 and 30,
without gender prevalence. Generally, involves the permanent mandibular molars or premolars. The involved tooth usually
has a vital pulp. It is attached to the tooth root and may cause its resorption. Also, it grows slowly, tends to expand the
overlying cortical plates, and, except for the enlargement produced, is usually asymptomatic. However, may be associated
with diffuse pain and tooth mobility, but the tooth is still vital. This benign tumor affects the buccal and lingual aspects of the
alveolar ridges. Since a cementoblastoma is a benign neoplasm, it grossly forms a mass of cementum-like tissue as an
irregular or round mass attached to the roots of a tooth, usually the permanent mandibular first molar. Radiographically, it
appears as a well-defined, markedly radiopaque mass, with a radiolucent peripheral line, which overlies and obliterates the
tooth root. Surgical excision of the lesion is done, and depending upon the clinical circumstances, this may or may not
involve removal of the involved tooth. With incomplete removal, recurrence is common. We report a case of a 28 years-old,
female patient, who presented a slight swelling within the buccal aspect of the mandible, near the left first molar. The
panoramic and periapical radiographs revealed a sclerotic mass, with a radiolucent peripheral line, surrounding the root of
the affected tooth, clearly attached to it. A surgical procedure was made, where the entire tooth was removed with both
cortical. The histopathological examination confirmed the hypothesis of cementoblastoma. The patient is under annual
control, showing neither clinical nor radiological signs of recurrence.
Association between neurofibromatosis type I and Central Giant Cell Lesion: Case report.
MONYQUE TRINDADE*, Nathalia Cayuela Nogueira, Yuri Slusarenko da Silva, Fernando Melhem Elias, Flavio
Welington da Silva Ferraz.
University Hospital (HU) - USP
Resumo
Neurofibromatosis type I (NF1), or Von Recklinghausen disease, is characterized by café-au-lait macules and
neurofibromas in skin, bone defects, hamartomas in the iris (Lisch nodules) and tumors in the central nervous system. The
central giant cell granuloma (CGCG) non-neoplasic, radiolucent central entity of bone with well defined borders, which can
change the position of the teeth, but rarely causes root resorption. The association between neurofibromatosis type I and
CGCG has been reported in the literature. Patient CRP, 39, female, attended the service presented swelling in the anterior
maxilla and discreet intra oral bulging in the anterior region of the mandible with approximate evolution of two years,
painless. The patient already had a diagnosis of neurofibromatosis type I. Incisional biopsy which found CGCG was
performed. Treatment consisted of curettage and bone lesions regularization was conducted three years ago and no signs
of recurrence. The occurrence of CGCG in multiple locations is uncommon and is usually associated with cherubism,
hyperparathyroidism, Ramon syndrome, Jaffe Campanacci syndrome, Noonan-like syndrome and neurofibromatosis type 1.
Our patient had two features of NF1 (multiple neurofibromas in skin and freckles in the armpits) and CGCG in different
places, which agrees with the association being found in the literature. The apparent association between NF1 and an
increased incidence of CGCGs of the jaws could represent a coincidental association, a genetic linkage, or an underlying
susceptibility to developing CGCG in qualitatively abnormal bone. In cases of multiple CGCG, the presence of
hyperparathyroidism, cherubism and syndromes, such as neurofibromatosis type I, must be considered. The research of
systemic factors and clinical signs are important for performing differential diagnosis. The differentiation of these lesions in
aggressive and non-aggressive should be performed to improve individual treatment planning. Surgical curettage is suitable
for the treatment of jaw CGCG without aggressive signs.
DISPLASIA MODERADA EM LESÕES LEUCOPLASICA DA CAVIDADE ORAL. FOLLOW-UP OU
REMOÇAÕ CIRURGICA
Sergio Kignel*, Cristian Correa, Selmar Alves Lobo Jr, Raphael Castro, Douglas Oliveira.
Fundação Herminio Ometto- Faculdade de odontologia - FHO
Resumo
A leucoplasia é a lesão cancerizável mais prevalente da cavidade bucal. São mais freqüentes no vermelhão do lábio
inferior, mucosa jugal e gengiva, mas podem ocorrer em qualquer região da boca. Clinicamente podemos dividi-las em
homogêneas e não homogêneas, as primeiras geralmente apresentam alterações celulares discretas (com pequena
possibilidade de transformação maligna - 1 a 7%) , enquanto as outras evidenciam maior ocorrência de displasia epitelial
severa e carcinoma invasivo (possibilidade de transformação maligna de 4 a 15%). Dentro de certo consenso, as
leucoplasias orais devem ser tratadas, mas nenhum tratamento disponível tem a capacidade de prevenir a transformação
maligna com exceção da remoção total da lesão com alguma margem de segurança . Para as leucoplasias de pequenas
dimensões, a opção cirúrgica parece ser bastante fácil, o problema encontra-se em lesões de grandes dimensões.
Diversos formas de tratamentos não cirúrgicos tem sido propostos como o uso tópico do Licopeno, do ácido retinóide e
crioterapia. O tratamento por lasers de alta potência (CO2 e diodo) mostraram-se eficientes na remoção das lesões,
embora não tenha evitado desfechos clínicos de recorrência, desenvolvimento de novas lesões e transformação maligna.
Fatores reconhecidamente de risco como hábitos nocivos (álcool e tabagismo), características clínicas das lesões, grau de
displasia, localização da lesão além de outros dados como sexo, idade e raça do paciente devem orientar o planejamento
cirúrgico e principalmente sua proservação. Este trabalho tem como objetivo mostrar a importância do seu
diagnóstico,discutir seu tratamento e exemplificar as leucoplasias homogêneas e as não homogêneas apresentando–as
nas diferentes regiões anatômicas da cavidade bucal.
Bilateral temporomandibular joint ankylosis in children: case report
Rodrigo Chenu Migliolo*, Shajadi Carlos Pardo Kaba, Henrique Camargo Bauer, José Benedito Dias Lemos,
Yuri Slusarenko da Silva.
hospital universitário da universidade de são paulo - HU-USP, 2 HU-USP - hospital universitário da
universidade de são paulo (Av. Prof. Lineu Prestes 2565)
Resumo
Ankylosis can be defined as a fusion of the articular surfaces of the jaw to the skull, resulting in severe functional problems
(chewing, speech), aesthetic (facial asymmetry, mandibular micrognathia) and psychological for its sufferers. Trauma,
infection and systemic diseases (ankylosing spondylitis, rheumatoid arthritis and psoriatic arthritis) have been implicated in
its etiology. Ankylosis can be classified by location (intra-or extra-articular), tissue involved (bony, fibrous, fibro-osseous)
and extension (complete or incomplete), or by Sawhney system (four different types). Its treatment is complex and involves
various techniques such as gap arthroplasty, interpositional arthroplasty and joint reconstruction. When this disease affects
individuals in growth, early detection and prompt intervention with wide resection and reconstruction of the condyle is
mandatory. The growth potential of costochondral graft makes it the material of choice in pediatric patients .Intensive
physiotherapy and long-term monitoring are key to successful treatment. Kaban et al developed a protocol for treatment of
ankylosis in pediatric patients consisting of wide resection of the bone mass, coronoidectomy ipsilateral, contralateral
coronoidectomy if maximum interincisal opening is less than 35 mm, interposition with temporalis fascia or native disk(if
repairable), reconstruction with costochondral graft or distraction osteogenesis, early mobilization and aggressive
physiotherapy. This study reports a case of a child with bilateral TMJ ankylosis treated in our hospital, following Kaban’s
protocol. The patient keeps on postoperative follow-up of one year and six months, with 40 mm interincisal opening, which
ensures the success of our treatment to restore jaw function, despite the possibility of future orthognathic procedures for
finalizing the case.
UTILIZAÇÃO DA OSTEOTOMIA SAGITAL DA MANDÍBULA PARA EXÉRESE DE EXTENSO TUMOR
ODONTOGÊNICO: RELATO DE CASO.
Gilberto Junior*, Rodrigo Gonçalves, Paulo Afonso de Oliveira Junior, Carlos Alexandre Wisch, Leandro
Monetti Sanches, Francisco José de Nadai Dias.
Associação Paulista de Cirurgiões Dentistas - APCD, 2 HISCMP - Irmandade Santa Casa de Misericórdia de
Piracicaba (Av. Independência, 953 - Bairro Alto - Cep. 13419-155)
Resumo
Os odontomas são os tumores odontogênicos mais comumente encontrados na população mundial, sendo normalmente
descobertos em exame s radiográficos de rotina , pois na maior parte dos casos são assintomáticos, estando por vezes
associados a retenção de dentes decíduos, não erupção de dentes permanentes, dor, expansão de cortical óssea e a
deslocamento dental, acometem preferencialmente indivíduos na segunda e terceira décadas de vida, contudo, sem
encontrar prevalência quanto aos sexos. A localização mais frequente do odontoma composto é observada na região
anterior da maxila, ao passo que o odontoma complexo ocorre na região posterior em ambos maxilares.
Radiograficamente, os odontomas compostos apresentam-se como um conjunto de estruturas semelhantes aos dentes, de
forma e tamanho variáveis, envoltos por uma zona radiolúcida, sendo sua imagem patognomônica constituída de 2 ou mais
dentículos de pequeno tamanho. Já os odontomas complexos aparecem como massas radiopacas amorfas, envolvidas
também por uma estreita zona radiolúcida. Histologicamente, as lesões apresentam todas as estruturas dentárias: matriz
de esmalte; dentina ou material dentinóide; polpa e cemento em um estroma de tecido conjuntivo fibroso, sendo toda a
massa envolta por uma cápsula fibrosa. O tratamento preconizado é a enucleação quando o tumor não atinge grandes
proporções, porém, quando as dimensões do tumor são grandes, e sua exérese envolve sacrifícios de grandes
quantidades de osso, risco potencial de fratura de mandíbula e risco de danos ao nervo alveolar inferior, podemos lançar
mão da técnica da osteotomia sagital da mandíbula (OSM) para acesso ao tumor. A utilização da OSM como acesso
cirúrgico para retirada de terceiros molares em posições complexas já tem sido indicada na literatura. No presente relato os
autores descrevem a utilização da OSM para tratamento de um odontoma de grandes proporções na região de ângulo
mandibular.
Miosite ossificante traumática em músculo pterigóideo medial após exodontia de terceiro molar: Relato
de caso.
Saulo dos Reis Mariano Souza*, Amanda da Costa Nardis, Alexandre Machado Torres, Rogério Almeida da
Silva, Larissa Martini Vicente, Beatrice Mitye Ogusco.
Vila Penteado General Hospital - HGVP
Resumo
Miosite ossificante traumatica (MOT) é um distúrbio em que ocorre a formação de osso heterotópico em tecido múscular ou
fáscia. A incidência de miosite ossificante traumática na região maxilofacial é rara. O principal sintoma do acometimento
dos músculos da mastigação é o trismo severo, que repercute em grande comprometimento da função e saúde bucal.
Embora a patogênese não esteja clara, o trauma é comumente reconhecido como evento desencadeador desta patologia.
Os autores relatam o caso de uma paciente com 36 anos de idade, saudável, leucoderma, sexo feminino, que foi
submetida a extração do terceiro molar superior direito, evoluindo com dor e trismo na primeira semana, após quatro
meses ela apresentava abertura máxima interincisal (MIO) de 4 milímetros e um diagnóstico de MOT foi considerado. A
paciente foi submetida a uma biópsia excisional na região de músculo pterigoideo lateral direito com melhora imediata dos
movimentos mandibulares e recidiva do trismo durante o acompanhamento. Ela foi encaminhada ao Hospital Geral de Vila
Penteado, São Paulo, Brasil. TC de face revelou uma massa ossificada no músculo pterigóideo medial direito. A remoção
da ossificação foi realizada sob anestesia geral e um enxerto de gordura abdominal interposto entre o aspecto medial do
ramo e as placas pterigóides para prevenir a recorrência. No segundo mês pós-operatório, a paciente evoluiu com trismo e
nova TC foi realizada evidenciando uma massa ossificada no espaço pterigóideo medial. A excisão cirúrgica de ossificação
é a modalidade de tratamento mais relatada na literatura. Este relato de caso visa discutir esta patologia e resultados
alcançados.
Osteomielite crônica em mandíbula – relato de caso clínico.
Michel Figueiró Garcia*, Thais Benedetti Haddad Cappellanes, Basílio de Almeida Milani, Thiago Mesquita,
Talita Lopes.
Hospital Municipal Dr. Fernando Mauro Pires da Rocha - HMCL
Resumo
A osteomielite é um processo inflamatório da medula e superfície cortical óssea, induzido por infecção bacteriana. A causa
principal é odontogênica , sendo, o trauma, outro fator menos frequente. Pode ser classificada em aguda ou crônica.
Predominantemente. ocorre na mandíbula por apresentar suprimento sanguíneo menor. Nosso objetivo é de relatar o caso
de osteomielite crônica de um paciente do sexo masculino, de 40 anos de idade. Procurou o serviço Cirurgia
BucoMaxiloFacial do Hospital Municipal do Campo Limpo, com histórico de 10 dias pós-exodontia do dente 46, que evoluiu
com um quadro de trismo severo, dor e edema da região submandibular direita. A principio, a hipótese diagnóstica foi de
alveolite. Com a melhora da abertura de boca , o quadro clinico e radiográfico sugeria uma osteomielite crônica. Mesmo
com a antibioticoterapia instaurada, desde a avaliação inicial, não houve remissão do quadro clinico. Sob anestesia geral,
foi realizado a corticotomia vestibular da mandíbula, com curetagem e ostectomia periférica. Optamos pelo acesso
intrasulcular , com incisão relaxante. Durante o procedimento, optou-se pela fixação com uma placa de osteossíntese reta,
com 6 furos (Synthes®), em virtude do grande comprometimento ósseo observado e consequente fragilização do corpo
mandibular direito. O material coletado foi enviado para estudo anatomopatológico e para realização de cultura e
antibiograma. Fistulectomia intraoral também foi realizada. O paciente permaneceu em controle radiográfico ,não
apresentando sinais de recidiva e evoluindo com neoformação óssea. Osteomielite é uma doença grave que pode trazer
grande morbidade ao paciente. É de suma importância a intervenção precoce e o acompanhamento profissional rigoroso.
Unusual localization of Unicystic Mural Ameloblastoma in the maxilla: A case report
Gabriela dos Santos Lopes*, Thales Morgan Guimarães Sá, Eduardo de Lima Andrade, Wilton Costa Neto,
Lívia Prates Soares-Zerbinati, Antônio Márcio Marchionni.
Resumo
Ameloblastoma is a benign odontotogenic tumor with slow growth and continuous, of epithelial origin and homologous with
the dental lamina at the beginning of the odontogenese, according to the World Health Organization. This lesions
represents 1% of oral cavity tumors. Reported cases occur over a wide range of ages, with the peak incidence in the third
and fourth decades, without preference by race or sex. In 80% of the cases affecting the mandible, the have a wide
histological type and a high rate of recurrence. Their clinical presents is a variant, usually the symptoms are unnoticeable,
expands bone without symptoms, mobility, displacement of dental and asymmetry facial. Their classified according with
clinical examination and radiographic, multicystic or solid, unicystic and peripheral or extra-osseous. The treatment propose
for this odontogenic tumor is a very discussed in the literature including enucleation, curettage, bloc resection with safety
margin, cryotherapy and radiotherapy. The case reported here is that of a 45-year-old, male, who attended the ambulatory
Oral and Maxillo Facial Surgery of the Escola Bahiana de Medicina e Saúde Pública/Hospital Geral Roberto Santos
(EBMSP/HGRS) showing an increase in volume in face left, after extraction of units 2.5 and 2.6, painless, that associated
with imaging diagnoses aroused Ameloblastoma suspicion despite being an unusual localization. After the histopathological
examination was confirmed Unicystic Mural Ameloblastoma by an incisional biopsy, the patient underwent anesthesia for
surgical procedures ressectives with safety margin. In the moment the patient has been followed in the ambulatory with no
signs of recurrence of the tumor.
SESSÃO X:
Implantação de prótese articular customizada após resecção de ameloblastoma multicístico.
José Renato Brandão*, Ramiro Beato Souza, Alan Robert Moreira Schmitt.
State University of Rio de Janeiro - UERJ, 2 UERJ - State University of Rio de Janeiro (Avenida 28 de
Setembro, 158. Vila Isabel.), 3 UERJ - State University of Rio de Janeiro (Avenida 28 de Setembro, 158. Vila
Isabel.)
Resumo
O ameloblastoma é um tumor odontogênico comum, apresenta um comportamento localmente agressivo e é capaz de
causar extenso acometimento dos maxilares. A lesão acomete frequentemente a mandíbula, especialmente a região dos
molares e ângulo mandibular. No exame radiográfico, geralmente tem aspecto radiolúcido e multilocular, apresentando na
maioria dos casos, expansões das corticais e reabsorção das raízes dos dentes adjacentes. O objetivo do trabalho é fazer
relato de um caso clínico de um paciente de 72 anos, do gênero masculino, leucoderma, atendido no Serviço de Cirurgia
Buco-maxilo-facial da Universidade do Estado do Rio de Janeiro (UERJ). Na primeira consulta, o paciente apresentava
aumento de volume assintomático no lado direito da face e intra-oral. Ao exame tomográfico, observou-se imagem
hipodensa, multiloculada, com perfuração das corticais, estendendo-se desde a porção posterior do corpo mandibular até o
colo do côndilo e o processo coronóide do lado direito. Foi realizada a biópsia incisional que demonstrou o resultado de
ameloblastoma multicístico. A equipe decidiu realizar a ressecção em bloco da lesão, com desarticulação e reconstrução
com prótese customizada da ATM. Em virtude da burocracia e do tempo necessário para aquisição desta prótese, foi
necessário realizar o tratamento em dois tempos cirúrgicos. Portanto, optou-se por ressecar a lesão e realizar a
reconstrução temporária do defeito com placa de reconstrução .4mm, parafusos bicorticais e polimetilmetacrilato na porção
do ramo mandibular e do côndilo. Aproximadamente 6 meses após a cirurgia de remoção da lesão, foi realizada a
renconstrução definitiva com prótese customizada da ATM. Atualmente, o paciente encontra-se em pós operatório de 4
meses do segundo ato operatório sem evidências de infecção ou recidiva da lesão. Apresenta-se com contorno facial
devolvido e com função mastigatória satisfatória.
Type III left TMJ bone ankylosis in an 8-year-old child due a nondiagnosed mandibular condyle fracture:
a case report
Carla Salvi*, Greison Rabelo de Oliveira, Eleonor Álvaro Garbin Junior, Geraldo Luiz Griza, Bruno Marques
Sbardelotto.
Department of Oral and Maxillofacial Surgery - UNIOESTE
Resumo
The ankylosis of the temporomandibular joint, said as the fusion of the condyle to the base of the skull, is a condition that
can cause functional, esthetic and psychosocial limitations. It is classified according to the combination of location, type of
tissue involved and the extent of fusion, or even as type I, where the condyle is present and contains only fibrous
adhesions; type II, where there is bone fusion, remodeled condyle, but the medial pole is intact; type III, where there is an
ankylotic block, mandibular ramus fusioned to the zygomatic arch, but medial pole still intact; and type IV, where there is a
true ankylotic block with totally altered anatomy. Among many etiological factors, trauma is the most common. This paper
reports the case of a 8 years old male patient, victim of car accident 4 years ago, which had fracture of the lateral pole of the
left mandibular condyle, which was not initially diagnosed, with maintenance of the medial pole in the mandibular fossa. The
patient has evolved with constant pain symptoms and severe trismus due to the formation of an ankylotic mass in the lateral
condylar face. When first attended to our clinic, the patient presented mouth opening of 6 mm. The adopted surgical
protocol was the intervention in condylar region through pre-auricular access, making the removal of the lateral bone block
and keeping the medial pole, which kept proper function. An ipsilateral coronoidectomy was also performed, but after a 25
mm mouth opening, the removal of the contralateral coronoid process was also required, which was performed through
intraoral access, resulting in an intraoperative mouth opening of 40 mm and 38 mm in the postoperative period. Therefore,
the established surgical treatment protocol and the immediate postoperative physiotherapy were decisive for the
achievement of this favorable outcome.
Brown tumor of hyperparathyroidism in mandible: Case report
Danilo de Paula Ribeiro Borges*, Antonio Márcio Teixeira Marchionni, Adriano Freitas de Assis, Thales Morgan
Guimarães Sá, Deyvid da Silva Rebouças, Thaise Gomes Ferreira.
Bahiana School of Medicine and Public Health - EBMSP
Resumo
Brown tumors are uncommon focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on
bone tissue in some patients who have hyperparathyroidism. It may occur in any bone, such as the jaw, albeit rarely in this
case. The name of this metabolic bone lesion is derived from the color of the tissue specimen, which generally ranges from
dark red to brown, due to the presence of abundant hemorrhage and deposition of hemosiderin inside the tumor.
Radiographically, they appear as well demarcated monolocular or multilocular osteolytic lesions. It founded most frequently
in females in the 3rd, 4th and 6th decades of life, being the mandible the most commonly affected site in the maxillofacial
area. Brown tumor of hyperparathyroidism is histologically identical to the central giant cell lesion, which makes it mandatory
to conduct an examination of serum calcium, phosphorus, alkaline phosphatase and parathyroid hormone, in patients with
suspected of central giant cell lesion. The aim of this study was to report a case of brown tumor of hyperparathyroidism in
mandible. The patient was a male, 45 years old. He complained of pain and swelling in the jaw which had appeared about
11 months earlier. The patient had systemic arterial hypertension and had been undergoing hemodialysis for 15 years. An
incisional biopsy was performed and histopathological analysis of the specimen revealed a central giant cell lesion. Based
on careful and detailed anamnesis in conjunction with clinical, radiographic, and histopathological features as well as
complementary laboratory tests, the diagnosis of brown tumor associated with secondary hyperparathyroidism was
established. The treatment stipulated was enucleation and curettage of the lesion, and rehabilitation with dental implants, as
well as referral to an endocrinologist for control of metabolic disorders.
TRANSLOCAÇÃO FACIAL: ABORDAGEM AOS TUMORES CRANIOFACIAIS DE DIFÍCIL ACESSO
Beatrice Mitye Ogusco*, Larissa Martini Vicente, Rogério Almeida Silva, Claudio Roberto Cernea, Sérgio
Gonçalves.
Hospital Geral de Vila Penteado Doutor José Pangella - HGVP, 2 HCFMUSP - Hospital das Clínicas da
Faculdade de Medicina da USP (Avenida Doutor Enéas de Carvalho Aguiar, 255 - Cerqueira César, São Paulo
- SP), 3 ICESP - Instituto do Câncer do Estado de São Paulo (Av. Dr. Arnaldo, 251 - Sumaré, São Paulo - SP,
01255-000)
Resumo
A base do crânio representa uma das regiões mais complexas do corpo humano, definida como a região anatômica que
separa o neurocrânio da face, sendo a única conexão do sistema nervoso central com a região cervical, onde importantes
estruturas vasculares e nervosas entram e saem através da base do crânio. A visualização adequada de pontos de
referência anatômico e principais estruturas neurovasculares é pré-requisito para cirurgias de base de crânio. A realização
de um amplo acesso à base do crânio é muito importante para facilitar a visualização de lesões localizadas profundamente,
para permitir a ressecção em bloco, tridimensional e com margens histológicas livres, evitando o mínimo ou nenhum
afastamento do cérebro e consequentemente, diminuindo a morbidade. O acesso denominado translocação facial permite
o deslocamento do esqueleto craniofacial e uma exposição direta e ampla das regiões da nasofaringe, clivus, esfenóide,
seio cavernoso, junção crânio-vertebral, fossa infra temporal e regiões de fossa craniana anterior e fossa craniana média.
Seguido de um reposicionamento dos tecidos deslocados, com bons resultados funcionais e estéticos. O Cirurgião
Bucomaxilofacial está habituado com as osteotomias faciais eletivas e reconstruções das injúrias traumáticas, podendo
atuar de maneira importante na equipe multidisciplinar em 3 aspectos: 1) obtendo o acesso à base do crânio, 2) facilitando
a ressecção da lesão, 3) fornecendo reconstrução imediata ao defeito cirúrgico. O objetivo deste trabalho é a apresentação
da técnica do acesso de translocação facial, o qual pode ser facilmente realizado pelo Cirurgião Bucomaxilofacial,
auxiliando profissionais que atuam nessa região do corpo, bem como a descrição de dois casos clínicos.
Cryotherapy as treatment for central giant cell granuloma: a case report.
Daniel Marques Novaes*, Alberto Ferreira da Silva Junior, Marcio Tadashi Tino, Bruno Sousa Pinto Ferreira,
Camila Fialho da Silva Neves Araújo.
URGENCY HOSPITAL OF GOIÂNIA - STATE DEPARTMENT OF HEALTH - HUGO - SES
Resumo
The central giant cell granuloma is considered as a non neoplastic proliferative lesion. Locally aggressive with a potencial
recidivation, often occurs in gnathic bones, specially in mandible. Many treatments have been described. Cryotherapy arise
as an alternative to conservative treatments which results in high rates of recurrence. Furthermore, radical treatments may
cause functional and aesthetic damage to the patient. The objective of this study is to describe a 25-year-old male patient,
admitted at maxillofacial surgery department of a terciary hospital of Goiânia city, with a swelling on the right side of the
mandible, resulting in facial asymmetry. The lesion was painless, with slow growth, no fremitus, oral mucosa with normal
texture and color, bone expansion of the lingual and buccal mandibular cortical. CT scan demonstrated extensive area with
multilocular aspect at body, angle and ramus on the right mandibular side, with cortical fenestration. In biochemical exams
there where no changes in serum calcium, phosphorus and parathormone levels. In face of central giant cells granuloma
hypotesis diagnoses, initially, incisional biopsy was performed. After histopathological confirmation, cryosurgical treatment
was chosen. With submandibular access, first the lesion curettage, then a mixture of propane, butane, and isobutane gas
(Endo - Frost Spray ®) application for one minute. Thereon an internal fixation with 01 reconstruction plate was used for
future reconstruction with bone graft. In postoperative control of 11 months, was observed a considerable area of bone
repair, without signs of recurrence yet. Clinical follow-up care and periodic imaging will be continued to preserve the case.
Tratamento de Tumor Odontogênico Ceratocístico Mandibular – relato de caso
Thiago Marques de Mesquita*, Leandro Curvello Teixeira, Lisana Fernandes Massaine, Talita Lopes, Fabio
Lopes Duarte, Basilio Almeida Milani.
Field Municipal Hospital Clean - HMCL
Resumo
Inicialmente chamado de Ceratocisto Odontogênico, sendo considerado uma forma diferente de cisto odontogênico do
desenvolvimento, este tipo de lesão passou a ser considerada uma neoplasia benigna e baseada em seu comportamento
biológico, a OMS (Organização Mundial da Saúde), em 2005, recomendou a alteração na classificação e sua nova
nomenclatura passou a ser Tumor Odontogênico Ceratocístico (TOC). O tumor odontogênico ceratocístico surge a partir
dos restos celulares da lâmina dental, acometendo tanto a maxila, quanto a mandíbula, sendo a mandíbula acometida em
60% a 80% dos casos, tendo a região do corpo posterior e ramo como as mais envolvidas. Um dente não erupcionado está
envolvido na lesão em 25% a 40% dos casos. A faixa de idade dos pacientes que apresentam o tumor odontogênico
ceratocístico é, em média, entre 10 e 40 anos, sendo os homens os indivíduos mais afetados, tendo uma leve prevalência
sobre as mulheres. Histologicamente, o TOC apresenta um revestimento epitelial é composto por um epitélio escamoso
estratificado paraceratinizado, geralmente com seis a oito células de espessura, que apresenta-se bastante delgado e
friável. Possui uma taxa de recidiva considerada elevada, atingindo uma média de 30% em alguns estudos. As formas de
tratamento descritas na literatura incluem, enucleação, curetagem, ressecção, marsupialização, podendo-se associar ainda
o uso da solução de Carnoy. Este trabalho tem como objetivo apresentar um caso clínico de tumor odontogênico
ceratocístico, localizado na região de ângulo/ramo mandibular, associado com terceiro e quarto molares inclusos e que foi
tratado através de descompressão, seguido de enucleação e ostectomia periférica, sendo discutido o tipo de tratamento
realizado.
THE USE OF AUTOGENOUS BLOOD IN TEMPOROMANDIBULAR JOINT FOR TREATMENT OF THE
MANDIBULAR RECURRENT DISLOCATIONS: REPORT OF FOUR CASES
PIETRY DY TARSO INA ALVES MALAQUIAS*, RAPHAEL CASTIGLIONI COSER, LETÍCIA ALMEIDA
CHEFFER, CHRISTIANO SAMPAIO QUEIROZ, RODRIGO TAVARES BOMFIM.
FEDERAL UNIVERSITY OF BAHIA - UFBA
Resumo
Temporomandibular joint dislocation is a common occurrence in urgent and emergency departments. This can become a
chronic condition that can significantly decrease the patient's quality of life and require some form of intervention for
correction. Some method of treatment had been described, either the injection of autologous blood in the
temporomandibular joint. The purpose of this study is to present a minimally invasive alternative treatment for
temporomandibular joint dislocation. Materials and Methods: Four patients diagnosed with recurrent mandibular dislocation
in the authors' instituition in Bahia Brazil received injections of autologous blood in the upper joint compartment and
pericapsular region. Follow-up ranging from 12 to 17 months (mean 14 months). Results: 02 patients (50%) had one
recurrence episode, they were followed up postoperatively and there were no other dislocations, and no other interventions
were made. The reduction in buccal opening was 3.5 cm on average (range of 1 to 8 cm) after an average period of followup of 14 months. Conclusion: Injection of autologous blood in the TMJ is a simple, quick and minimally invasive method,
with low cost and minimal possibility of complications for the treatment of recurrent temporomandibular joint dislocation,
making a viable alternative treatment before recommending surgical procedures. A A A A A A A A A A A A A A A A A A A A
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
Reconstrução de defeito em osso frontal com prótese em polimetilmetacrilato: Relato de caso.
Lucas Souza Cerqueira*, Adriano Assis de Freitas, Fernando Bastos Pereira Júnior, Deyvid Silva Rebouças,
Murillo Leite Mascarenhas, Danilo de Paula Ribeiro Borges.
Resumo
Os defeitos maxilo-faciais decorrentes de traumas e cirurgias mutiladoras provocam deformidades estéticos funcionais e
resultam em sequelas que interferem diretamente na qualidade de vida dos indivíduos. A abordagem tardia das fraturas
(devido a períodos prolongados em unidades de terapia intensiva), a perda de substância e remode¬lação dos ossos
fraturados torna muito difícil uma redução satisfatória dos segmentos. A reconstrução e o reparo dos defeitos geralmente
são desafiadores ao cirurgião, necessitam de um tratamento multidisciplinar e dificilmente alcança-se o resultado desejado
na primeira intervenção cirúrgica. Os principais recursos utilizados para reconstrução de deformidades são enxertos
ósseos (autógenos, alógenos e xenógenos) e os materiais aloplásticos como titânio, polietileno de alta densidade,
hidroxiapatita e polimetilmetacrilato. Sendo o polimetilmetacrilato o material de escolha para defeitos extensos por ter boa
adaptação ao contorno do defeito craniano, baixo custo, fácil manipulação, impermeável e não biodegradável. O objetivo
deste trabalho é relatar o caso clínico de um paciente portador de extenso defeito em osso frontal decorrente de um
acidente motociclístico que foi reconstruído com prótese customizada fabricada em polimetilmetacrilato e houve como
intercorrência fratura da prótese após 02 meses de pós-operatório devido à queda do paciente da própria altura. O
planejamento cirúrgico foi realizado através do exame físico, exame de imagem (tomografia) e do biomodelo. A
reconstrução foi realizada através de acesso coronal, isolamento da duramáter, instalação de prótese e adaptação dos
tecidos moles, além de correção da posição do osso zigomático. A utilização da prototipagem foi fundamental para
obtenção de uma prótese anatomicamente individualizada que contribuiu para um resultado estético favorável. O paciente
encontra-se em acompanhamento pela equipe Cirurgia Buco-Maxilo-Facial e em planejamento para segunda intervenção
cirúrgica.
Carcinoma espinocelular em lábio inferior: relato de caso.
Marília Maria Lacerda Pedrosa*, Basílio de Almeida Milani, Fábio Lopes Duarte, Michel Figueiró Garcia, Talita
Lopes, Thiago Marques de Mesquita.
Resumo
O carcinoma espinocelular é o segundo tipo histológico mais comum de câncer de pele, e sua incidência vem aumentando
nas últimas décadas. Sua prevalência tem relação com tabagismo e etilismo, bem como exposição à radiação solar. Pode
assumir diversas características clínicas distintas, sendo, portanto, de importância vital a boa condução do caso para
diagnóstico e tratamento adequado. Dentre as maiores dificuldades na evolução do caso encontram-se a demora do
paciente em perceber a lesão – e a comum ausência de sintomatologia nos primeiros dias a semanas do surgimento da
lesão, o que leva o paciente a procurar tratamentos alternativos e automedicação, levando a um atraso no diagnóstico de
lesões deste tipo. Ao mesmo tempo, devido às diversas características clínicas distintas e a dificuldade do paciente em
relatar com fidelidade os sinais e sintomas que apresenta, bem como seu surgimento e duração, podem dificultar o
diagnóstico clínico por parte do cirurgião-dentista. O presente caso se refere a paciente do gênero feminino, leucoderma,
não tabagista e não etilista, trabalhadora do campo, apresentando lesão em lábio inferior há cerca de um mês antes do
primeiro atendimento. Paciente referiu prurido intenso, aparecimento de crosta e ausência de dor, além de discreto
aumento de volume até que procurasse atendimento. Referiu, ainda, ter feito uso de antifúngicos tópicos sob orientação de
cirurgião dentista e de pomadas à base de corticoesteróides em automedicação. Foi realizada biópsia incisional com
resultado anátomo patológico de carcinoma espinocelular. O objetivo desde trabalho é relatar a importância de uma
profunda investigação clínica e da realização de exames complementares para o devido tratamento do paciente que, em
muitos casos, necessita de abordagem multiprofissional no pré, trans e pós operatório.
Diagnóstico da Síndrome de Gardner a partir de Manifestação Buco-Maxilo-Facial
Thaise Gomes Ferreira*, Tila Fortuna Costa, Victor Araújo, Danilo de Paula Ribeiro Borges, Antonio Márcio
Teixeira Marchionni, Fernando Bastos Pereira Júnior.
Resumo
A síndrome de Gardner é uma desordem rara, determinada por um gene autossômico dominante, na qual
aproximadamente um terço dos casos acontece espontaneamente e parece representar mutações genéticas. Esta
síndrome é considerada como parte de um espectro de doenças caracterizada por polipose colorretal familial, além de
outras anormalidades gastrointestinais que são observadas juntas com uma variedade de achados que podem envolver a
pele, tecidos moles, retina, sistema esquelético e dentes. Anomalias orais e faciais são comumente observadas em
pacientes afetados por esta desordem, entre elas, pode-se destacar a presença de odontomas, impactação de dentes e
dentes supranumerários, embora este último achado não seja tão frequente nesta síndrome. Geralmente, ela está
associada a tumores de tecidos moles e duros, incluindo os cistos epidermóides, fibromas e osteomas, sendo estes o tipo
mais comum. Cerca da metade dos pacientes diagnosticados com a síndrome podem desenvolver carcinoma colorretal a
partir da transformação maligna dos pólipos intestinais, sendo essa a complicação mais importante da enfermidade. O
presente trabalho tem como objetivo relatar um caso clínico de uma paciente do gênero feminino, 21 anos, que
compareceu ao Serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial (CTBMF), do Hospital Geral Roberto
Santos/Escola Bahiana de Medicina e Saúde Pública, queixando-se de ausências dentárias e cuja anamnese minuciosa
revelou a presença de dentes inclusos, odontomas e cistos epidermóides em membros superiores e inferiores. A partir
destes sinais, foi realizada uma avaliação gastrenterológica e a presença de pólipos intestinais foi confirmada, chegandose ao diagnóstico final de síndrome de Gardner. A paciente foi submetida a cirurgia sob anestesia geral para exodontia das
unidades impactadas e exérese dos tumores. Atualmente, encontra-se em acompanhamento pela equipe de CTBMF e pela
equipe de cirurgia do aparelho digestivo.
SESSÃO XI:
E TRAUMATOLOGIA
Inferences on the pathogenesis of bisphosphonate-related osteonecrosis of the jaws: histological
observations in rat and human samples
Paulo Henrique Luiz de Freitas*, Tomomaya Yamamoto, Tomoka Hasegawa, Edvaldo Fernandes do Santos,
Djalma Carmo da Silva Júnior, Norio Amizuka.
Federal University of Sergipe at Lagarto - UFS-Lagarto, 2 Hokudai - Hokkaido University Graduate School of
Dental Medicine (Sapporo Shi, Kita Ku, Kita 13, Nishi 7)
Resumo
Long-term use of bisphosphonates has been pinned down as the cause of a condition known as “bisphosphonate-related
osteonecrosis of the jaws” (BRONJ). While over a decade has passed since the first report on BRONJ by Robert Marx in
2002, the underlying cellular and histopathological features of the disease are still vague. In this work, we used a murine
model to assess the behavior of bone cells following alendronate (ALN) administration by means of histology,
immunohistochemistry, confocal scanning microscopy and transmission electron microscopy. Additionally, samples from a
human subject suffering from BRONJ were assessed by histology and immunohistochemistry. As expected, ALN increases
bone volume in the rat tibia; it does so mostly by inhibiting bone resorption, as it induces osteoclast apoptosis. ALN seems
to have a negative effect on bone formation, which is a common indirect effect of inhibited bone resorption. However, our
assessments suggests that osteocytes may suffer directly after ALN administration, since empty osteocytic lacunae and
unviable osteocytes were identified as soon as 24 hrs after ALN administration. Interestingly, several macrophages were
seen surrounding dying osteoclasts in the human samples, suggesting that those cells may be phagocyting osteoclastic
debris and be secondarily affected by ALN. Altogether, our examinations suggest two additional possible cellular
mechanisms involved in the pathogenesis of BRONJ: 1) direct osteocyte damage following bisphosphonate administration,
which mortifies the bone and leaves it susceptible to bacterial colonization, and 2) a possible reduction in macrophage
numbers and/or function, which could create a locally compromised immune response against oral bacteria.
Treatment of bilateral fracture in atrophic Class III Luhr mandible
Lais Papini Fernandes*, Eduardo Zancopé, Leandro Valentini Junqueira Zoccoli, Alan Fernando Panarello.
Escola de Aperfeiçoamento Profissional dos Cirurgioes Dentis - EAPGOIAS
Resumo
The frequency of fractures in atrophic edentulous mandible is low compared to other facial fractures. Little experience of
most surgeons on treating this kind of fracture contrast with the increasing of life expectancy of the population, increasing
the number of patients with atrophic mandible. Complications such as infection, nonunion, pseudoartrosis and the variety of
systemic disorders may complicate the treatment of this type of patient. The aim of this study is to report a case of bilateral
fracture in atrophic edentulous mandible (Class III of Luhr), in the region of the body of the mandible at a 60 year old female
that suffered a fall. At clinical examination she showed limited mouth opening, large mandibular displacement and
paresthesia of the inferior alveolar nerve. She reported having hypertension, diabetes, advanced osteoporosis and final
renal chronic failure, in dialysis three times a week. As treatment, a large submandibular access was performed, followed by
reduction and simplification of the fracture with a 2.0 mm miniplate. The definitive fixation was made with a single 2.4 mm
reconstruction plate with bicortical screws fixed on the symphysis and mandibular angle. The patient progressed
satisfactorially with no report of complication. Patients with atrophic mandibles usually have systemic complications
associated with advanced age. This may induce the surgeon to search for a more conservative treatment. However, the
atrophic edentulous mandible is subjected to the same muscle forces as a toothed jaw. The suprahyoid muscles and the
mandible elevator muscles acting in opposite ways may contribute for a plate fracture. Therefore, is better to begin with an
initial invasive approach to reduce the risk of a second surgical procedure. It is preferred the fixation of the load-bearing type
on these cases, along with an extra-oral approach to prevent contamination by intra-oral exposure and subsequent infection
of the surgical site.
Epidemiological study of mandibular angle fractures treated at the Oral and Maxillofacial Surgery
Division of Piracicaba Dental School – State University of Campinas
Darklilson Pereira Santos*, Douglas Rangel Goulart, Márcio de Moraes, Luciana Asprino.
Piracicaba Dental School - FOP/Unicamp
Resumo
Mandibular angle fractures are common, with a high incidence among facial fractures. Epidemiological studies provide
information on the profile of patients victims of facial trauma, assisting in methods of prevention and perfecting treatment
procedures. This is a retrospective, longitudinal, and observational study, aiming at evaluating the epidemiology, etiology,
frequency and type of treatment used, as well as complications, regarding mandibular angle fractures in patients treated at
the Department of Oral and Maxillofacial Surgery, Piracicaba Dental School - FOP/Unicamp, from April 1999 to December
2012. 201 patients with 204 mandibular angle fractures were enrolled, showing higher incidence on the left side (55.9%),
and a descriptive statistical analysis revealed the following prevalence: male subjects (88.6%), white subjects (52.2%), and
mean age of 27.95 years old ± 9.9 years. The majority had some kind of addiction (56.7%), the most common etiology was
physical aggression (33%) and malocclusion was the sign with the highest incidence (72.6%), while the most frequent
symptom was pain (75.6%) and 111 fractures (54.4%) had third molars in the line of fracture. Surgical treatment was
employed in most fractures (78%), and intraoral access was the most frequent access used (60.0%). The fixation technique
most often employed was the use of one 2.0 mm miniplate system (42.0%), with a low complication rate (9.5%) in the
treatment of patients in this study. It was concluded that the most affected group consists of young male adults, victims of
physical aggression and that most subjects underwent surgical treatment with few complications. Periodic assessments of
the epidemiology and treatment characteristics of mandibular angle fractures generate data that assist in the establishment
of prevention campaigns, clinical protocols for the treatment of these lesions, and also in directing future research.
Estudo dos traumas de face atendidos e tratados cirurgicamente no Hospital Regional de São José Drº
Homero de Miranda Gomes, nos anos de 2012 e 2013.
Juliana Terezinha Garcia*, Frederico Gonzaga, Priscila Sell, Maria Inês Meurer, Aira Maria Bonfim Santos,
Eduardo Meurer.
Federal University of Santa Catarina - UFSC, 5 HRSJ-HMG - Regional Hospital of Saint Joseph DrºHomero de
Miranda Gomes (São José - Santa Catarina)
Resumo
Trauma is considered by the World Health Organization as a major cause of death worldwide. The face is a region very
exposed of the body with low protection and many of trauma affecting the face generates fractures due to its position. The
causes of facial trauma are several, the main ones being: violence, automobile accidents and falls. This work is
characterized as a retrospective cross-sectional descriptive study and it aims to determine the prevalence of the types of
facial fractures of patients surgically treated in the Oral and Maxillofacial Surgery Service at Regional Hospital of St. Joseph
Dr. Homero de Miranda Gomes, São Jose, Santa Catarina, Brazil, in the years 2012 and 2013. Data were collected and
recorded in an electronic file by the staff of the service, maintaining complete secrecy about the identity of the patients. This
sought to identify gender, age, fracture type, main causes, in order to generate information for the organization and planning
of this service in this hospital. It was observed that the genre has suffered most fractures in this period was male (82%), and
the most affected age group was above 30 years (48%), followed by the age group of 20-30 years (36%) . Regarding the
etiology of fractures was observed that aggression was the most affected the population, accounted for 30% of the operated
cases, followed by motorcycle accidents (20%). Finally, it was found that during this period, the mandible was the most
affected by fractures (48%) anatomic site, followed by fractures of the zygomatic-maxillary complex (22%) and fractures of
the maxilla bone (13%).
"Traumatismos bucomaxilofaciais em um hospital público do Brasil Central: estudo retrospectivo."
Guilherme Scartezini*, Carlos Estrela, Daniel Decurcio, Orlando Guedes.
Faculdade de Medicina - FM/UFG
Resumo
Objetivo: avaliar os aspectos epidemiológicos dos traumatismos bucomaxilofaciais em prontuários de pacientes atendidos
em um hospital público do Brasil Central. Material e método: a amostra do estudo foi proveniente da revisão de prontuários
de 405 pacientes atendidos no serviço de cirurgia e traumatologia bucomaxilofacial (CTBMF) do Hospital de Urgências de
Aparecida de Goiânia (HUAPA) - GO, Brasil, entre os anos de 2011 e 2013. Os seguintes dados foram coletados dos
registros hospitalares de cada paciente: gênero, idade, fator etiológico, data do atendimento, procedência e região
anatômica atingida. O tratamento estatístico analisou os dados frente à distribuição de frequência e qui-quadrado. O nível
de significância foi de p<0,05. Resultados: observou-se elevada frequência de traumatismos bucomaxilofaciais em
indivíduos do gênero masculino (n=294; 72,59%). A faixa etária mais acometida foi entre 21-30 anos (n=106; 26,17%),
provenientes da cidade de Aparecida de Goiânia. Os principais fatores etiológicos foram os acidentes de trânsito
motorizados (n=124; 30,62%), quedas (n=92; 22,72%) e violência (n=87; 21,48%). A distribuição sazonal evidenciou
elevado número de traumatismos no outono (n=154; 38,02%) e no verão (n=138; 34,07%). O traumatismo mais comum foi
a fratura facial (n=324; 80,0%), sendo o nariz, a região anatômica mais atingida (n=161; 39,75%). Foram observadas
associações significantes entre fator etiológico, gênero e faixa etária (p<0,005). Conclusão: os dados obtidos se
assemelham aos encontrados na literatura, no que diz respeito à prevalência do gênero masculino, da faixa etária e dos
acidentes de trânsito como principal agente etiológico. Palavras-chave: Traumatismo bucomaxilofacial, trauma, acidente
automobilístico, fratura de face, fratura de nariz, epidemiologia, prevenção.
IMPLANT SUPPORTED REHABILITATION AFTER TREATMENT OF ATROPHIC MANDIBULAR
FRACTURES: REPORT OF TWO CASES.
Leandro Oliveira*, Mario Gabrielli, Marisa Gabrielli, Valfrido Pereira-Filho.
Universidade Estadual Paulista - Unesp - FoAr
Resumo
Edentulism is a condition which is spread worldwide affecting mainly the elderly and resulting in maxillary and mandibular
atrophy. In the United Kingdom, Netherlands and Iceland the prevalence is respectively 46%, 65% and 64%. More than half
of the Canadians over 65 years old and one third of the elderly americans are edentulous. Atrophic mandible fractures
represent 1 to 5% of all mandible fractures and their treatment can be challenging. Severe bone atrophy leads to difficulty in
reduction and healing of the fracture, reduction in bone regenerative capacity and anatomical alterations which make
treatment more complex. Also atrophy difficults the use of a lower denture due to insufficient retention and pain, leading to
limitations in mastication and speech, as well as esthetic alterations and social problems. The objective this presentation is
to present options of rehabilitation with dental implants in two cases of severely atrophic mandibles (<10mm) after rigid
internal fixation of fractures. Two patients who sustained fractures in severely atrophic mandibles with less than 10mm of
bone height were treated by open reduction and internal fixation through a transcervical access. Internal fixation was
obtained with 2.4 locking reconstruction plates. The first patient presented satisfactory bone height at the area between the
mental foramens. After 2 years she received flapless guided implants in the anterior mandible and an immediate protocol
prosthesis. The second patient received a tent pole iliac crest autogenous graft after two years of fracture treatment and
immediate implants. After 5 months a protocol prosthesis was installed. The mean follow-up are 4.5 years. In both cases the
internal fixation followed AO principles for load-bearing osteosynthesis. Both prosthetic devices were Branemark protocol
prosthesis. The mandibular reconstruction plates were not removed. Both patients are rehabilitated without complications
and satisfied with esthetic and functional results.
ENDOSCOPIC ASSISTANCE FOR REDUCTION AND OSTEOSYNTHESIS OF ISOLATED FRACTURE OF
THE ZYGOMATIC ARCH - A PROPOSAL OF A NEW TECHNIQUE
PAULO ALEXANDRE SILVA*.
Vivalle hospital of São José dos Campos - VIVALLE
Resumo
INTRODUCTION The correct reduction of zygomatic arch fracture is very important for anteroposterior projection of the
midface and for function of mouth opening. In most cases these fractures are reduced with use of percutaneous lifts or
hooks. However, in cases of comminution or unstable fractures, an open surgery is necessary for an appropriate reduction
and osteosynthesis. Several surgical approaches were describe. In recent years, some autores have used the endoscopic
assistance for reduction and osteosynthesis of the zygomatic arch, by small incisions extraoral, with good results. AIM: In
this paper we suggest a technique of reduction and osteosynthesis of the zygomatic arch with endoscopic assistance by
intraoral approach as an alternative to endoscopic assistance by extraoral approach. MATERIAL AND METHODS: Three
patients, two male and one female, with isolated and unstable fractures of the zygomatic arch, 2 left and 1 right, mean age
38.2, etiologies: 1 falling from height, 1 traffic accident, 1 assault, treated between October and December 2013. The
reduction and osteosynthesis were performed by intraoral approach with endoscopic assistance, and the patientes were
followed to six months . RESULTS: The mean surgical time was about 52 minutes. All patients showed local edema and
discomfort compatible with the postoperative. No complications were observed or reported. Reduction and osteosynthesis
remained stable, providing good bone healing and excellent aesthetic and functional results CONCLUSION: The reduction
and osteosynthesis of the isolated and unstable fracture of the zygomatic arch using endoscopic assistance by intraoral
approach, proved to be a viable alternative to extra oral techniques, especially regarding the absence of visible scars. The
technique requires specific training and a long learning curve. New clinical papers with more cases, performed by other
hands, applying the proposed technique are required to consolidate the results.
Disgeusia em decorrência de fratura Le Fort III: Relato de Caso clínico.
João Paulo Bonardi*, Thiago Henrique Martins, Fernanda Herrera Costa, Marcos Massahiro Suzuki, Cecilia
Luiz Pereira Stabile , Glaykon Alex Vitti Stabile.
State University of Londrina - UEL
Resumo
Vários fatores podem estar relacionados à disgeusia como a xerostomia, infecções bucais, irradiações, uso de
medicamentos, desordens cerebrais e trauma na região de cabeça e pescoço1. Os primeiros relatos sobre a perda do
olfato e paladar após trauma craniano foram descritos na literatura médica em meados de 18002. A disgeusia associada a
trauma cefálico é rara, com incidência de 0,4-0,5% segundo alguns autores3. Seu mecanismo pós-traumático incluem
lesões na língua, nos nervos cranianos VII, IX, X ou no tronco cerebral2. Nosso objetivo é relatar o caso clínico de um
paciente do gênero masculino, 32 anos de idade, vítima de acidente desportivo com traumatismo craniano leve e fraturas
de face com alteração de oclusão. Na anamnese não apresentou história médica relevante, negando hábitos, alergias e
comorbidades. Por meio dos exames clínico e imaginológicos, foram diagnosticadas fraturas tipo Le Fort I e Le Fort III,
tratadas por meio de redução e fixação interna estável. Durante o controle pós-operatório, o paciente referiu melhora
parcial da anosmia que já estava presente no pré-operatório e desenvolvimento tardio de disgeusia por alteração dos
sabores doce e salgado, a qual foi investigada por meio de exames clínicos como avaliação das papilas gustativas e fluxo
salivar, testes gustativos com soluções de sacarose 1M e NaCl 1M4, aplicação tópica de chocolate com porcentagens de
cacau variadas bem como exames laboratoriais (concentração sérica de zinco e cobre), para tentar diferenciar a disgeusia
por desordem periférica da causada por desordem central4. Por meio dos testes e exames realizados e por critério de
exclusão definimos o diagnóstico de Disgeusia pós-traumática periférica, na qual o prognóstico segundo a literatura é
favorável e o tratamento é expectante.
SESSÃO XII: TRAUMATOLOGIA
Prospective study of the results of surgical treatment of fractures of the zygomatic complex based on
symptomatology.
Rubens Camino Junior Camino*, Ricardo Pimenta D'avila Pimenta D'avila, Maria Cristina Zindel Deboni Zindel
Deboni, Maria da Graça Naclério-Homem Naclério-Homem, João Gualberto de Cerqueira Luz Cerqueira Luz.
Faculty of Dentistry University of São Paulo - FOUSP
Resumo
Introduction: The zygomatic complex due to its projected position is frequent site of facial trauamtismos. The zygomatic
bone is a pyramid and has a sturdy body and four processes as the temporal, orbital, maxillary and frontal. Besides offering
protection to the eyeball, and serves as a sink transmitter masticatory shocks, especially the zygomatic pillar. Researchers
do not care about functional impairment and yes, aesthetic patients. However, lies not in the world literature on these
aspects. Materials: We evaluated and followed up during the period of ninety days, twenty patients and clinic patients
imaginológicamente zygomatic complex fractures, treated in a hospital ward in the city of São Paulo - Brazil. Was included
regardless of gender, age less than 18 years and excluded other facial fractures. Method: All evaluated pre-and
postoperatively in one and two weeks; one, two and three months. Annotated symptoms will inspection and palpation, and
the amplitude of the maximum mouth opening with a caliper between interincisais distances.Results: The observed signs
were facial asymmetry (95%), edema (55%), bruising (55%), subconjunctival bruising (55%) and periorbital bruise (50%).
Symptoms prevailed sensory deficits in the territory infrfa-orbital nerve (90%), frontozigomático (75%) and the zygomatic
arch (55%). Conclusions: It was found qie within one week there was a regression of signs will palpation in a month
remission of facial asymmetry in most cases. The mouth opening tev and progresive gain reaching the value of 35,6mm.
Referências: Newaskar Septa VP, Agrawal D, Tibra S. Etiology, incidence and patterns of mid-face fractures and
associated ocular injuries. J Maxillofac Oral Surg. 2014 Jun;13(2):115-9. Salentijn EG, Boffano P, Boverhoff J, van den
Bergh B, Forouzanfar T. The epidemiological characteristics of zygomatic complex fractures: A comparison between the
surgically and non-surgically treated patients. Natl J Maxillofac Surg. 2013 Jul;4(2):214-8.
Surgical treatment of complex zygomatic fracture and high impact of the zygomatic-orbital complex
Luis Gustavo Mafioletti Rosso*, Carlos Eduardo Chrzanowski Pereira de Souza, André Luis Chiodi Bim, Murillo
Chiarelli, José Nazareno Gil.
Resumo
The zygomatic-orbital complex (ZOC), is a region that is susceptible to fractures by traumatic injuries because of its location
and projection. It comprises the zygomatic bone and arch and it has four processes that are the most fragile regions. These
fractures are classified by the energy of impact according to the Manson’s classification, and by the sprain according to
Knight&North. The case presented in this paper is classified as type II of Manson and as type VI of Knight&North and the
patient was a 20 year old male. After a physical examination and CT scan a diagnosis was made that showed pain, edema,
eyelid ptosis, eye lid hematoma, anteroposterior loss of projection, asymmetry, bone diastasis, diplopia and enophthalmos.
Access to the fractures was realized with the Caldwell-Luc incision technique, and subciliary bicoronal aimed at reducing the
zygomatic maxillary pillars, infraorbital margin and frontozygomatic suture, respectively. The fracture of the orbital floor was
reconstructed with titanium mesh, which provides good support to the orbital contents and anteroposterior projection of the
eyeball, and avoids enophthalmos and dystopia. The ZOC fractures disturb the maxillary sinus, so it is necessary to
prescribe an antibiotic for infection control and a nasal decongestant to unclog the airways. The prognosis was favorable, in
two weeks the patient had a great aesthetic appearance compared to the asymmetry and sinking that he presented, and a
good functional recovery. For being a high-impact fracture, the ZOC caused a large displacement and fragmentation of the
zygomatic body, requiring broad exposure to acquire better references in the 3D repositioning of the zygomatic bone, thus
justifying the bicoronal incision. This case had a good resolution due to wide fracture exposure and correct internal fixation
of ZC pillars.
A 3D finite element study to determine if an erupted third-molar weaken the mandibular angle after a chin
trauma.
Carlos Bruno Pinheiro Nogueira*, Assis Filipe Medeiros Albuquerque, Carlos Diego Lopes Sá, Tacio Pinheiro
Bezerra, Henrique Classen Scaparo, Eduardo Costa Studart Soares.
Federal University of Ceara - UFC
Resumo
The mandible is one of the bones most susceptible to trauma in the facial region due to its more projected position in the
facial skeleton. It has been suggested that third molars increase mandibular fragility because they do not contribute to its
strength. For ethical reasons, a human study design that would permit the elucidation of this interference is not possible.
This study evaluated the impact of the presence of erupted third molars on the mandibular angle of resistance when
submitted to trauma. A three-dimensional (3D) mandibular model was obtained through finite element methodology using
computed tomography (CT) with the geometry and mechanical properties to reproduce a normal mandibular structure.
Human mandibles with no, one or two erupted third molars were evaluated. Whenever the third molar was present there
was a greater concentration of tensions around the cervical part of its alveolus. Approximated Von Mises equivalent stress
of the third molar region was 107.035 MPa in the mandible with teeth and 64.6948 MPa in the mandible without teeth. In the
condylar region it was 151.65 MPa when the third molar was present and 184.496 MPa when it was absent. The digital
models created proved that the mandibular angle becomes more fragile in the presence of third molars. When they are
absent the energy concentrates on the lateral e posterior aspect of the condylar neck. These findings must be considered in
the decision making about prophylactic removal of third molars in subjects prone to receiving facial trauma. Future
simplifications of this method and its evolution into a more user-friendly modality for dentistry may facilitate the use of FEA
in the preoperative analysis of specific surgical sites.
Frontal sinus outer table and floor fractures: a case report
Yuri Slusarenko da Silva*, Monyque Cunha Trindade, Felipe Alexander Caldas Afonso, Shajadi Carlos Pardo
Kaba, José Benedito Dias Lemos.
Hospital Universitário da Universidade de São Paulo - HU-USP
Resumo
The frontal bone is the largest bone of the upper third of the face and consists of an outer table, inner table and between
them there is the frontal sinus that may be divided by a septum. Its floor also participates to the orbital roof. Trauma in this
structure may generate fractures in those tables and compromise the patient aesthetically or functionally, demanding
visualization of the frontal sinuses with a computed tomography to verify the fracture relationship with the drainage of the
naso-frontal duct, mainly if the medial orbital wall is compromised. In cases of aesthetically compromise, like flattening of
the forehead, the treatment indicated is open reduction and internal fixation of the fragments, or the reconstruction of outer
table with alloplastic material for the comminuted fractures. In those cases of functional compromise, with naso-frontal duct
obstruction, the frontal sinus will become non-functional and must be isolated from the nasal cavity by total removal of the
sinus epithelial lining, plugging the ducts with autogenous material and obliteration of the sinus to close dead space. If the
inner table is grossly fractured, the dura-mater must be repaired and the brain afforded to expand inside the frontal sinus.
This study reports a case of a male patient, 23 years old, who suffered a blunt trauma in the upper third of the face during a
football game. He arrived at our service three weeks after the trauma, with a main complain of flattening at forehead area
and diplopia while looking upwards. The computed tomography showed a left side outer table and orbital roof fracture. The
planned surgery was open reduction and internal fixation through an upper eyelid approach. It was achieved an adequate
forehead contour and there was no functional complains at the postoperatory period.
Total Reconstruction of the Orbital rim and lateral Wall in Traumatology
Marcela Oliveira Andrade*, Marco Antonio Oliveira Filho, Laurindo Moacir Sassi, Andrea Duarte Doetzer.
Hospital Universitário Evangélico of Curitiba - HUEC, 2 HEG - Hospital Erasto Gaertner (R. Dr. Ovande do
Amaral, 201 - Jardim das Américas CEP 81.520-060 - Curitiba/PR )
Resumo
In many situations facial trauma represents a challenge, especially when taking into account the difficulties and surgical
limitations. Among these difficult situations to solve, there are the total lateral orbital wall loses. The lateral orbital wall is
formed by zygomatic bone and greater wing of sphenoid. The lateral orbital rim is composed by the frontal process of the
zygomatic bone, and zygomatic process of the frontal bone (smaller part). The region of greater narrowing and fragility of
the lateral rim is the frontozygomatic suture, which continues along the lateral orbital wall were the sphenoid bone unites
with the zygomatic bone. It is common in orbital trauma linear bone disjunction in these areas of less resistance. In rare
occasions, there is significant bone loss on the lateral orbital wall or rim. The aim of this study is to present two clinical
cases of extensive bone loss in the orbit, which has been reconstructed with titanium mesh. In the first case, the bone of
lateral orbital wall was completely destructed, as well as the floor, rim and part or the zygomatic bone. This patient also
presented traumatic telecanthus. In the second case, the bone loss was located on the orbital lateral superior wall, and
lateral and superior rim. Titanium meshes were adapted in the ideal position to reconstruct and stabilize the orbita in both
cases. The use of titanium mesh allowed the ideal reconstruction and stabilization of the remaining bone. The presented
cases have one year follow-up, with satisfactory aesthetics and functional results
White-eyed orbital floor fracture trapdoor-type: case report
Renan Roberto da Costa*, Mário Francisco Real Gabrielli, Marcelo Silva Monnazzi, Rafael Ferreira e Costa,
Marisa Aparecida Cabrini Gabrielli .
School of Dentistry at Araraquara - UNESP
Resumo
The orbital floor fractures are usually caused by direct trauma that leads to bony walls rupture, which can increase the
orbital continent, trap tissues, cause limitation of ocular movement, diplopia, dystopia, enophthalmos, among other sings.
The orbital fractures where lesion to the external soft tissues is minimal, without clear sings, are named white-eyed, and
when it occurs herniation and entrapment of orbital tissues they are called trapdoor, which are common in children. In those
fractures where it occurs entrapment of orbital content the precocious intervention is determinant to case’s resolution. The
postponement of approach or delay in diagnosis leads to the condition of muscle tissue ischemia and resorption of the
orbital fat. Secondarily to these processes it happens functional and aesthetic repercussions that may be irreversible as
decrease in the visual field and permanent diplopias. This paper reports a case of white-eyed orbital fracture in a pediatric
patient, treated belatedly after the trampling. At the image exams it is evident the orbital floor defect and clinically is
observed eyes’ movement restriction and binocular diplopia. Surgical treatment consisted of orbital cavity reconstruction on
the first moment. At the fortieth day post-operatory, after discarding intrinsic causes, the patient was submitted to reviewing
of the former procedure due to signs of residual diplopia for some ocular moviments. Currently the patient is kept under
ambulatory follow up and with optometrist, showing regression of symptoms. The aim of this paper is to emphasize that the
delay in treatment of this type of fracture led to significant postoperative sequels.
Importance of multidisciplinary care in aesthetic and functional rehabilitation of patient victim of
complex fractures of the middle and lower third of the face: case report
Soraia Gois*, Samuel carvalho, romulo medeiros, Henrique clasen, Eduardo studart.
Faculdade de Odontologia - UFC
Resumo
Most etiologies of complex facial fractures are high-impact traumas, such as automobile accidents. In these cases, the
speed of the vehicle and the force of the impact cause severe polytrauma, resulting in functional and esthetic sequelae.
Thus, our aim is to relate the clinical case of a 20-year-old car accident victim, who, after primary care at an emergency
hospital, was referred to the Surgery and Oral and Maxillofacial Traumatology Facility of Walter Cantídio University Hospital.
Inspection revealed an extensive edema in the middle and lower thirds of the region, in addition to a previously sutured cut
in the right labial region. Palpation showed maxillary mobility on the right side, infraorbital rim on the left side, and
mandibular mobility in the bilateral parasympheal region. Intraoral examination showed avulsion of teeth 22 and 23, in
addition to reduced mouth opening, glossoptosis and myoptosis. Imagiological examination, using computerized
tomography, suggested a fracture in the right maxillary region, left zygomatic complex, bilateral condylar fracture, in addition
to bilateral parasympheal fracture. In a hospital setting under general anesthesia, the patient was submitted to surgery to
reduce and fix the fractured teeth with system 2.0 titanium plates and screws. After surgery the patient underwent extensive
oral rehabilitation treatment involving dental, orthodontic, endodontic and prosthetic specialties. At 36 months postoperatory, the patient is extremely satisfied, although a number of treatment adjustment procedures remain to be
performed. It is important that oral and maxillofacial surgeons be aware of the need for follow-up, with the help of other
specialists, in order to provide comprehensive treatment to victims of high-impact trauma.
The use of bone graft in hinge format for orbital reconstruction.
Sylvio Luiz Cota de Moraes*, Alexandre Maurity de Paula Afonso, Roberto Gomes dos Santos, Ricardo Pereira
Mattos, Bruno Gomes Duarte.
Cranio-Maxilo-Facial Surgery Clinic, São Francisco Hospital - RECONFACE, 2 HUAP-UFF - Emergency Unity,
Antônio Pedro University Hospital ( Rua Marques de Paraná, 303 - Niterói - Rio de Janeiro - Brasil - CEP:
24033-900)
Resumo
Orbital fractures is a very common injuries in craniomaxilofacial trauma affecting only orbital walls (roof, floor, medial wall,
and lateral wall) or associated with other fractures, such as part of zygomatic-maxillary complex (forming part of the lateral
wall and inferior wallthe lateral wall and inferior wall), or cranio-orbital-facial injuries. When orbital fracture is associated with
a palpebral injury, the context gains greater complexity because a scar retraction may arise. These fractures may be related
to severe displacement, resulting in aesthetic, functional and sensory defects alterations (enopthalmos, hipophtalmus,
diplopia and amaurosis). The orbital reconstruction represents a challenge for oral and maxillofacial surgeon; the local
anatomy should be analised very carefully, and the choice of the material to be used should considerer : 1- the size of the
defect to be reconstructed; 2- involvement of multiple walls; 3- internal contour of the orbit; 4- restoration of orbital volume;
5- prevent displacement, risks of other orbital trauma; 6- Restriction of eye movements; 7- the time of treatment: immediate
or delayed; and 8- reduced surgical time in patients with comorbidities. Autologous bone graft represents the gold standard,
with intra and extra-oral donor sites. This work aims to report a case of orbital reconstruction with a calvaria bone graft like a
hinge in a complex with extensive cominutted orbito-zygomatic-maxillary fracture on the left side, affecting lateral wall and
the external frontal-orbital apophisis, associated to zygomatic arch fracture, and a complex miocutaneous injurie in upper
and inferior eyelids. The treatment consisted in the orbital and palpebral reconstruction, that reached a very satisfactory
result.
SESSÃO XIII: TRAUMATOLOGIA
Development of titanium plate for mandibular fracture with triangular defect
Douglas Goulart*, Clarice PInto, Eder Sigua, Márcio de Moraes.
Faculdade de Odontologia de Piracicaba - FOP-UNICAMP
Resumo
Fractures of the mandibular angle are the most problematic in the facial region because of the high frequency of
complications. Infection and nonunion are commonly reported after treatment of these fractures (1). The mandibular angle
fractures could be attributable to the presence of the mandibular third molar, authors have suggested that the angle of the
mandible forms an area of lowered resistance to fracture (2). The aim of this study was develop a plate for the treatment of
mandibular angle fractures by the finite element method and mechanical testing. A three dimensional model of the fractured
mandible was generated in Rhinoceros 4.0 software. The models have been exported to ANSYS ®, in which it was
performed a static application of displacement of 3 mm in the first molar region. Three groups were evaluated according to
the method of internal fixation of 2.0 mm system: two plates non-locking and locking, and a new design locking plate. The
computational model was transferred to an in vitro experiment with polyurethane mandibles. Each group with five samples
was subjected to linear loading test in a universal testing machine. A balanced distribution of stress in the new plate design
was observed. This plate modified the mechanical behavior of the fractured region with less displacement between fractured
segments. In the mechanical test the group with two locking plates showed greater resistance to the 3 mm displacement
with statistically significant difference than the new plate group (ANOVA, p = 013). The new plate showed a more balanced
distribution of the stress; however the group with two locking plates showed higher mechanical resistance.
Delayed treatment of zygomatic orbital complex and naso-orbito-ethmoidal fractures
Eduardo Isomura*, Gláucia Gonçalves Faro Fukuda, Rodrigo Bracco Silva, Gabriel Baldasserini Guimarães,
Daniel Falbo Martins Souza, Eduardo Vasques Fonseca.
Conjunto Hospitalar do Mandaqui - CHM
Resumo
Zygomatic-orbital complex fractures are the second most affected facial region due to its facial proeminence. Despite of the
low incidence naso-orbito-ethmoid complex fractures, represents 2-15% of all facial fractures. These fractures are from
multiple ethiology such as physical agression, traffic accidents, falls, sports accidents and gunshots. The main signs and
symptoms related to these fractures are: facial asymmetry, loss of projection of the zygomatic region, dystopia,
enophthalmos, ophthalmoplegia, paresthesia of the ION, saddle nose, traumatic telecanthus, decreased nasal airflow and
nasolacrimal duct patency. Facial trauma from traffic accidents often accompany high-intensity lesions in other regions such
as head, abdomen and chest injuries. Because of these ones represents prior urgency, facial fractures may receive delayed
treatment, leading to possible malunion. Midface´s malunion fractures, may also be results from diagnoses fail, complex
lesions or even inadequated treatment fractures. A 25 years old male patient, motorcycle´s accident victim (motorcycle X
auto) without helmet, came to our service, six months after trauma, presenting a malunion zygomatic-orbital complex
associated with a naso-orbital-ethmoid. During his physical exam were noticed: Facial asymmetry due to lack of anteroposterior zygomatic´s projection , enophthalmos, dystopia (5mm), traumatic telecanthus, decreased nasal patency in right
nostril, hyposmia, temporal hypoesthesia, referring ION paresthesia, palpable bony step in zygomatic pillar and a right eye
amaurosis, although the preserved ocular movements, satisfactory mouth opening of 35mm, free and palpable condyles..
The patient was submited to surgical treatment, with consequent improvement in dystopia, significant decreasement in the
intercantal distance, improving the aesthetic and psychosocial patient´s condition.
Surgical treatment of atrophic mandible fracture: a case report
Bruna de Rezende Marins*, Aline Alves Luciano, Eleonor Álvaro Garbin Jr, Geraldo Luiz Griza, Greison Rabelo
de Oliveira.
Universidade Estadual do Oeste do Paraná - UNIOESTE
Resumo
The atrophic mandible fractures are rare among the facial fractures and are difficult-to-treat cases for the maxillofacial
surgeon, especially for afflict, in considerable numbers, patients with more advanced age and with some type of systemic
involvement. The edentulism, pre-existing periodontal disease and use of total prosthesis for a long period, confer an
important morphological change, which usually leads to a large bone atrophy. The bone becomes dense, with a decreased
osteogenesis and repair, small contact between the fractured extremities and with commitment of the vascularization,
becoming less resistant to traumatic forces and more prone to fractures and its complications. Nowadays, there is a wide
range of therapeutic possibilities involving from the more conservative treatment, like the closed approach with the use of
Gunning-type splints, for the more invasive procedures, such as the open reduction and fixation, followed or not by bone
grafting. Discussions about the method of treatment, benefits or difficulties encountered during the procedure are reported
with divergent opinions in the literature. The objective of this study is to report a clinical case of a bilateral atrophic mandible
fracture sequel, in a 91 years old female patient, with a history of low-level fall 3 months ago. The unilateral surgical
treatment was chosen, in the region with non-union of the fracture, through extraoral submandibular approach and fixation
with a 2.4mm reconstruction plate for its stabilization. The patient progressed with satisfactory mandible contour and
fracture repair, with no complaints of pain, demonstrating that the surgical treatment was a good choice for the case
treatment.
Fracture of the mandibular condyle caused by firearms: presentation of clinical case.
Antonio José Carneiro Freire *, walter Paulesini Junior, João Gabriel Santos , Douglas Baitelo Marinho.
Padre Bento Hospital Complex - CHPBG
Resumo
The objective of this work is show a cynical case of a patient JDN 49 years old, leucoderma, males who were victims of
assault by firearm. 12 hours after the assault began in the patient evaluation with the team and Trauma Surgery MaxilloFacial Hospital Padre Bento de Guarulhos (CHPBG) complex. Patient physical examination, she was alert, oriented, in good
general condition, hemodynamically stable, without compromising airway. Presented with facial asymmetry due to edema
++ / 4 + at pre-auricular and retro-mandibular left, with penetrating injury 5 mm forward of the left earlobe (entrance hole);
The intraoral examination showed the absence occlusal changes, but the movement had limited mouth opening (+ - 20 mm
aperture), referring to articulate (in the region of the left TMJ) during mandibular movements and cervical pain. ; denied
numbness in the face, muscle movements of the face preserved suggesting preservation of the left facial nerve. The milk
duct of the left parotid gland, presence of saliva without color or viscosity. The CT examination revealed a fracture of
intracapsular incomplete left mandibular condyle without displacement or presence of condylar dislocation and the presence
of a foreign body in the region of the second cervical vertebra (which was accompanied by conservatively neurosurgical
team). The characteristic fracture decided by conservative treatment, guide the patient to keep the joint in function, the
patient was referred to the physiotherapy service CHPBG to assessment and treatment, the patient remained in outpatient
treatment and 30 days mandibular movements returned to normal no pain.
Tratamento de Sequelas de Fraturas do Complexo Zigomático por Acidente de Trânsito
Débora Laís Feijó Pinheiro*.
Universidade Paulista - UNIP
Resumo
Entre os traumas que podem causar fraturas de face, encontramos o acidente automobilístico como sendo um dos agentes
etiológicos de importância. Embora a lei que regulamenta o uso do cinto de segurança implementada em setembro de
1997, fez com que houvesse a diminuição dos casos de acidentes automobilístico com vítimas fatais, o uso de drogas e
álcool mostram que ainda hoje, são comuns os acidentes de trânsito que envolvem diversos tipos de fratura seja em corpo
ou face. No caso da especialidade de Bucomaxilofacial, a incidência desses traumas diminuiu, no entanto, não é raro
encontrar esse tipo de paciente. Uma vez que acidentes automobilísticos, por muitas vezes, envolvem traumatismos crânio
encefálicos, entre outras complicações, o tratamento cirúrgico do trauma em face fica para um segundo momento, pois, o
paciente deve ser estabilizado e acompanhado do ponto de vista sistêmico. Por este motivo as fraturas quando são
abordadas já são consideradas sequelas Graças aos avanços tecnológicos na área da imagenologia alguns dispositivos
auxiliam o cirurgião bucomaxilofacial no planejamento cirúrgico otimizando o tempo da cirurgia, como por exemplo os
modelos estereolitograficos que podem ser utilizados para o planejamento prévio da cirurgia, permitindo a confecção de
guias cirúrgicos, e até mesmo pré-moldar as placas que serão utilizadas para promover a fixação interna estável. Este
trabalho tem como objetivo mostrar dois casos clínicos que apresentavam fraturas de face, terço médio e superior, que
foram tratadas entre novembro de 2013 e agosto de 2014, ambos 4 meses após o acidente, com o auxílio de modelos
impressos (estereolitograficos).
Management of Pediatric Mandibular Fractures: A Case Report
Rodrigo Bracco da Silva*, Jorge Gdikian Filho, Eduardo Yoiti Isomura , Daniel Falbo Martins de Souza,
Eduardo Vasquez da Fonseca , Nickollas Fernandes Mendes.
Conjunto Hospitalar do Mandaqui - CHM
Resumo
1
The mandible is commonly affected in maxillofacial trauma due to its position and prominence . In pediatric trauma, this type
of fracture is less common than in adults, since the child has skeleton relative elasticity as well as less exposure to
2,3
etiological factors . The treatment of pediatric mandibular fractures has important peculiarities. It occurs because of the
4
fast repair tissue, richly vascularized, labile cells and adaptive capacity of developing orofacial structures . Treatment is
complicated by the presence of deciduous teeth which may provide mobility and whose anatomy exhibits poor retention
5
6
required for installation of wires . The presence of teeth germ preclude the use of mini plates in the tension zone . It has
much been discussed about the fixing materials available, they are absorbable or non-absorbable. In this study, we report a
case of a mandibular fracture in an infant with 6 years old, male, victim of an automobile accident by running over with
fracture in the region of the right mandibular angle, mandibular symphysis and left intracapsular condyle. The patient came
up with pain, limited mouth opening, occlusal changes, submandibular ecchymosis, palpable bony step in the symphysis
region, referred alveolar nerve paresthesia of the lower right, deviation in opening to the left. He remained in monitoring and
after release the surgical procedure was programmed. The patient was in a period of mixed dentition, because of the
presence of teeth germs we chose to plate 2.4 mm in the compression zone at the right angle, plate 2.4 mm in the
compression zone in symphysis and maintaining loop in tension zone. To the condyle, we opted for conservative treatment
and follow-up of mouth opening. The patient is followed up by the Oral and Maxillofacial Surgery section of the Hospital
Complex of Mandaqui.
Tratamento de Fratura Complexa de Mandíbula Ocasionada por Acidente Automobilístico – Relato de
Caso
Thiago Marques de Mesquita*, Leandro Curvello Teixeira, Lisana Fernandes Massaine, Talita Lopes, Fabio
Lopes Duarte, Guilherme Borges Manta.
Field Municipal Hospital Clean - HMCL
Resumo
As fraturas mandibulares estão entre os tipos de fratura mais comuns que envolvem a face, sendo decorrentes, em sua
maioria, de acidentes automobilísticos, seguidas de agressões, quedas, acidentes desportivos, entre outras causas.
Dependendo da intensidade, da natureza e da direção do trauma as fraturas mandibulares podem ser classificadas em:
simples, compostas ou cominutivas. Podem localizar-se em diferentes regiões da mandíbula, entre elas: corpo, côndilo,
ângulo, sínfise, ramo e processo coronóide. No passado as fraturas mandibulares foram tratadas através de redução
fechada, utilizando-se bloqueio maxilomandibular. A redução aberta foi possível quando a fixação com fios de aço passou
a ser empregada nas fraturas mandibulares, diminuindo o desconforto do bloqueio maxilomandibular. Com o advento do
sistema de fixação com miniplacas foi possível uma qualidade ainda maior no tratamento destas fraturas, desempenhando
um papel importante na osteossíntese mandibular. Tradicionalmente, extensas fraturas mandibulares cominutivas foram
consideradas indicações para a redução fechada, a fim de evitar a remoção do periósteo e desvascularização dos
segmentos ósseos cominutos. Nos últimos 30 anos, porém, houve uma mudança na perspectiva do tratamento de tais
lesões, impulsionado por avanços em técnicas de fixação rígida. Ainda é controverso se a redução fechada é o melhor
tratamento para fraturas cominutivas, em comparação com a redução aberta e fixação interna. O objetivo deste trabalho é
apresentar um caso clínico de tratamento de fratura complexa de mandíbula, localizada em região de parrassínfise direita e
sínfise, associada com fratura dentoalveolar na região de dentes incisivos, ocasionada por acidente automobilístico e que
foi tratada com redução aberta e fixação com miniplacas, sendo discutidos o tipo de fixação e o tipo de acesso.
Mandibular osteomyelitis associated with pathological fracture in a patient with osteopetrosis.
Guilherme Cândido do Espírito Santo Rocha*, Marcelo Teixeira da Silva Junior, Glauber Bareia Liberato da
Rocha, Andre Caroli Rocha, Maria Paula Siqueira Melo Peres.
Clinics Hospital of Medical School of São Paulo University - HCFMUSP
Resumo
Osteopetrosis is an hereditary condition that increases bone density, changing the activity of osteoclasts. Thus, there is a
decrease in bone resorption with cortical thickening and sclerosis of medullary bone. As major complications it can be
observed a delayed tooth eruption, cranial foramina nip and osteomyelitis. The aim of this study is to report a case of a 41
year old male, feoderma, sent by the orthopedic team for evaluation of infection in the jaw by the need of the fixing material
in the right lower limb fracture approach. Extra oral physical examination showed bulging in the lower third of the left face
and two fistulae in the left submandibular region with active drainage. Intra oral examination the presence of infectious
dental focus and pus drainage on left mandibular body and foul odor. In imaging it could be observed the bone change
pattern with diffuse increased density, regions of bone sequestration, retained teeth and pathological fracture in left
mandibular body region. The patient underwent two surgical procedures under general anesthesia. In the first, mandibular
segmental resection was performed and installation of a reconstructive plate fixation 2.4mm to preserve the mandibular
perimeter. After 04 months it progressed with pus drainage and intra oral evidence on imaging of bone lysis around some
screws and bone kidnappings. In the second surgical procedure, the synthesis material was removed and surgical cleaning.
The patient is 09 months of postoperative follow-up, showing no signs of recurrence of the infectious and capable of
performing the procedure with orthopedic team.
Fratura de mandíbula por tração de veículo automotor: relato de caso.
Marília Maria Lacerda Pedrosa*, Guilherme Borges Manta, Talita Lopes, Michel Figueiró Garcia, Thiago
Marques de Mesquita, Fábio Lopes Duarte.
Resumo
Dentre as fraturas de face, as fraturas de mandíbula apresentam-se em segundo lugar com relação ao número de casos.
Podem apresentar etiologias diversas, sendo as mais comuns os acidentes automobilísticos e a violência interpessoal.
Ocorrem numa proporção aproximada de 4h:1m, principalmente entre adultos jovens. Embora incomuns, outras etiologias
podem ser relacionadas, o que envolve diferentes padrões de fratura e, consequentemente, diferentes abordagens
cirúrgicas e, em alguns casos, até mesmo abordagem psicossocial específica. O presente caso tem como objetivo relatar o
atendimento inicial e o tratamento de um paciente do gênero masculino, 29 anos, trazendo consigo bloco dentoalveolar
avulsionado intencionalmente por tração de veículo automotor. O paciente referiu avulsão dos elementos dentários por
sofrer de odontalgia sem tratamento. Apresentava desoclusão, perda de bloco dentoalveolar em região de parassínfise
mandibular direita e de tecidos periodontais adjacentes, além de limitada abertura de boca e dor em região pré auricular
bilateral. Ao exame de imagem (tomografia computadorizada), observou-se fratura alta de côndilos mandibulares,
posteriormente elucidada como decorrência da queda da própria altura após a súbita tração do bloco dentoalveolar pelo
automóvel e fratura desalinhada em região de parassínfise direita e ausência dos elementos 43, 44 e 45. Foi realizado
bloqueio maxilo mandibular rígido com barras de Erich e amarrias com fios de aço para contenção de fratura até que
houvesse oportunidade cirúrgica, tendo sido o paciente submetido a procedimento cirúrgico para redução e fixação de
fratura de parassínfise. As fraturas dos côndilos foram submetidas a tratamento conservador e acompanhamento clínico.
Paciente encontra-se em acompanhamento pós operatório tardio, apresentando oclusão satisfarória e boa recuperação
dos tecidos periodontais adjacentes ao tecido avulsionado.
FRATURAS DO COMPLEXO ZIGOMÁTICO-ORBITÁRIO: ANÁLISE DE 40 CASOS DE UMA POPULAÇÃO
DO NORDESTE BRASILEIRO.
HEITOR FONTES DA SILVA*, DANIEL FACO DA SILVEIRA SANTOS, MANOEL DE JESUS RODRIGUES
MELLO, ANDREA SILVIA WALTER DE AGUIAR.
Hospital Instituto Dr José Frota - Fortaleza CE - IJF, 2 HBM - Hospital Batista Memorial - Fortaleza CE (Rua
Padre Antônio Tomás, 2013)
Resumo
Introdução: As fraturas do complexo zigomático-orbirtário(CZO) são o segundo tipo mais comum de fraturas faciais em
traumas contusos, depois das fraturas nasais. O deslocamento e a perda óssea podem variar de acordo com a quantidade
de força aplicada no local de fratura. Desta forma, um amplo espectro de padrões de fratura variam de fraturas não
deslocadas à grandes deslocamentos com componentes de cominução óssea.Existem diversas formas de tratamento
destas fraturas, variando-se de simples redução incruenta, até 1,2,3 e 4 pontos de fixação com placas e parafusos.O
objetivo deste trabalho é relatar a experiência de 40 casos de tratamento de fraturas do CZO comparando 3 tipos de
Fixação Interna Estável (FIE) instituídas em tratamento aberto e suas variáveis pós-operatórias. Materias e Métodos: No
período de Janeiro 2012 a Agosto de 2013, 40 pacientes consecutivos, portando exclusivamente fraturas do CZO foram
envolvidos no estudo.Dentre as variáveis operatórias analisadas, destacam-se: 1) etiologia do traumatismo maxilofacial; 2)
sinais e sintomas das fraturas do CZO; 3) palpabilidade dos materiais de osteossintese; 4) sensibilidade dos materiais de
osteossíntese; 5) satisfação com o procedimento cirúrgico; 6) sistema de FIE utilizado e 7) cicatrizes desfavoráveis na
região Fronto-Zigomática e Rebordo Infra Orbitário. Resultados:A injúria etiológica mais frequente foram os acidentes
motociclísticos (55%), seguidos por atropelamento (10%) e violência interpessoal (10%). Dentre as principais
complicações, destacaram-se dor associado a edema (40%),palpabilidade(27,5%) e sensibilidade térmica aos materiais de
fixação (22,5%).Conclusão:1 ponto de fixação através de incisão intra-oral mucogengival foi o padrão esteticamente mais
bem aceito pelos pacientes, além de proporcionar o retorno da altura e projeção facial.
SESSÃO XIV: TRAUMATOLOGIA E
CIRURGIA ORAL
IRF of mandibular condyle fractures compared by Finit Element Analysis (FEA)
Ricardo Augusto Conci*, Flavio Henrique Silveira Tomazi, Ricardo Giacomini de Marco, Guilherme Genehr
Fritscher, Claiton Heitz.
Pontifícia Universidade Católica do Rio Grande do Sul - PUC RS
Resumo
Mandibular condylar fractures are a theme of great importance within Oral and Maxillofacial Surgery due to their high
incidence among facial fractures, and to numerous discussions regarding forms of treatment, surgical approaches, and the
type of material used for fracture fixation. Treatment can be either surgical or nonsurgical, and depends upon certain
situations and directions. When the choice is for surgical treatment proper fracture reduction and efficient internal fixation
must be pursued to achieve good final results. Numerous plate configurations, whether or not isolated, with various shapes
and sizes, are used for the surgical resolution of condylar fractures. In order to enhance the advantages and minimize the
disadvantages of fixation techniques, the Neck Screw was developed, aiming at the necessary stability for proper fixation
through a dynamic compression system that could increase the contact between the fractured stumps, and, at the same
time, assist at the time of fracture reduction. The purpose of this study was to assess the fixation and stability of mandibular
condylar fractures, and to compare three fixation techniques, in that the first configuration had a 2.0 mm plate with 4 holes,
and with 6-mm-long screws, the second configuration had two plates ─ one of 1.5 mm and the other of 2mm ─-both with 4
holes, and with 6-mm-long screws, and the last had a Neck Screw. The results showed improved stability when using two
plates, in regard to displacement of the fractures, deformation of the synthesis materials, and minimum and maximum
tension values. The results with the Neck Screw were satisfactory, similar to those found when using a Mini-Plate, and it is
thus an alternative for the reduction and fixation of condylar fractures, provided it is correctly prescribed, and follows an
appropriate surgical sequence and technique.
Patients with epilepsy and the predisposition to fractures of facial bones: report of two cases.
Talita Lopes*, Thais Benedetti Cappellanes, Basílio Almeida Milani, Waldyr Antonio Jorge, Ricardo Luiz
Piscciolaro.
Municipal Hospital Fernando Mauro Pires da Rocha - HMCL
Resumo
Epilepsy is a common and diverse set of chronic neurological disorder characterized by seizures, which affects men and
women in all age groups. About 50 million people worldwide have epilepsy, with an annual incidence of 43 cases per 100
000 inhabitants in industrialized countries and twice in developing countries. In Brazil, the prevalence has ranged from 0.4%
to 0.8% of the population. Antiepileptic drugs are used to treat epilepsy since 1857 and since then, numerous drugs were
introduced into clinical practice for the treatment of several types of epilepsy, however, be extended by using these can
interfere with bone metabolism by different mechanisms, including direct effects on bone cells, changes in the
metabolism,osteoporosys, and action of vitamin D, hypocalcemia, among others. This work aims to report two cases of
patients with epilepsy, who suffered facial trauma after seizure. The first patient is male 27 years, underwent frontal sinus
fracture after fall due seizure, underwent surgery under general anesthesia for reduction and fixation of the fracture, using
coronal access. In the second case, the patient is a 17 years old female, epilepsy seizure, victim of bashing face on gate
after seizure. It submitted extensive wound in the face and mandibular body fracture. The patient underwent surgery under
general anesthesia for reduction and fixation of the fracture via existing access by trauma, as well as plans for repositioning
by suture of the anatomic structures. In both cases were satisfactorily restored anatomical and functional aspects of patients
and the seizures are controlled so far no signs of other trauma yet.
The prophylactic extraction of third molars, a clinical management based on scientific evidences?
Rodolfo Francisco Haltenhoff Melani*, Emerson Nakao, Leandro Stocco Baccarin.
Faculty of Dentisty, University of São Paulo - FOUSP, 2 SLMandic - Faculty of Dentistry São Leopoldo Mandic
(Rua Dr. José Rocha Junqueira, 13 - Ponte Preta - Campinas - SP)
Resumo
Third molars are often observed in the population and in most cases do not cause significant symptoms, however, its
prophylactic removal is still held and defended as a way to prevent potential complications, even in the absence of
symptoms or pathological changes (NICE, 2000 , Suska et al, 2010;. Mettes et al, 2014). The third molar may be associated
with pathological changes, such asinflammation of the gums around the tooth, root resorption, gum and alveolar bone
disease, damage to the adjacente teeth and the development of cysts and tumours (Mettes et al, 2014). The surgical
procedure was adopted almost universally, attracting attention, particularly those who study and propose health policies.
From questions about the effectiveness of removal of third molars as a preventive measure compared to the expected
development of pathologies (White, 2007), it is observed that prophylactic extraction occurs in a disorderly manner, without
clearly defined criteria (Costa et al, 2013). Hence the need to look up clinical studies that endorse updated criteria
recommended for the procedure to be effectively supported by clinical data (Mettes et al, 2014). This systematic review was
performed through PubMed, BIREME, LILACS, BBO and Cochrane databases. The search for evidence considered clinical
scenarios and systematic reviews published, using the keywords (MeSH terms): tooth extraction; third molar; wisdom tooth;
tooth crowding; periodontal disease; tooth loss; tooth, unerupted; tooth, impacted; pathology; clinical trial. In conclusion,
there is no clinical evidence to support the prophylactic removal of the third molars (NICE, 2000; White, 2007; Bagheri,
Khan, 2008; Kandasamy et al, 2009; Suska et al, 2010; Costa et al, 2013; Mettes et al, 2014).
ATYPICAL DENS IN DENTE - SURGICAL AND PROSTHETIC REHABILITATION TREATMENT
Suyany Gabriely Weiss*, Alex Landucci, Melissa Rodrigues de Araujo, Delson João Costa, Rafaela Scariot.
Universidade Positivo - UP, 2 UFPR - Universidade Federal do Paraná (Jardim Botanico, Matriz, Curitiba - PR)
Resumo
Dens invaginatus, also known as "dens in dent", or "dilated odontome" in its most extreme form, is an anomaly of
morphological differentiation that occurs primarily in the upper teeth and it is characterized by invagination of the crown or
root bounded by enamel. It commonly occurs in maxillary permanent lateral incisors, which are the most affected, followed
by the maxillary central incisors, premolars, canines and less often in the molars. This anomaly may cause early pulp
necrosis, abscess formation, retention or displacement of adjacent teeth, cysts, among others. J.F., 18 yo, female, was
reffered to the surgery department for evaluation of dental anomaly associated with upper canine tooth. At clinical
examination, swelling on the buccal plate of maxillae associated with this tooth was observed. Panoramic and tomography
exams were required and, at the imaging studies, a significant increase in volume associated with the root of the tooth and
circumscribed radiolucent image in periapex were noticed. Due to the fact that endodontic treatment was impossible, the
chosen treatment was enucleation of the lesion and removal of the tooth at the same time. The lesion was large and
required a extensive surgical acess, hence a bone graft would be necessary for gain in bone thickness of the affected
region. After four months, bone autograft was perfomed, with the mandibular branch as a donor area, as well as the surgical
removal of the mandibular third molar. Past five months, the adaptation of an osseointegrated implant in the region was
done. Whitin 6 months the prosthesis was adjusted. Currently, the patient finds herself without aesthetic or functional
complaints.
Displacement of third molars: Surgical or conservative treatment?
Andrés Cáceres Barreno*, Pauline Magalhaes, Raquel Correia de Medeiros, Luciana Asprino.
Faculdade de odontologia - UNICAMP
Resumo
Third molars extractions are currently performed by oral and maxillofacial surgeons around the world and the complications
rate associated with this procedure ranges from 2.6% to 30.9%. Establishing a pre-surgical planning is one of the key points
for avoiding complications and have a good clinical result. However, in some cases, due to complexity of the extraction or
lack of surgeon's experience, the probability of having this complication increases. So, the most appropriate decision for
each case must be taken: Conservative or surgical treatment. Iatrogenic tooth displacement is a rare complication during
extraction of impacted molars; therefore it represents a challenging situation for the clinician. However, there is the
possibility of accidental displacement, especially when the third molar is deeply impacted. Others factors to be considered
includes: Unfavorable anatomic conditions such as poor bone density or bone defects, distolingual angulation or less root
development; the presence of a pathology associated; inadequate surgical technique; improper surgical instruments
handling; insufficient surgical access and inadequate radiograph or tomograph examination. In relation to the affected
areas, there are: maxillary sinus, which is the most common affected area, the infratemporal, pterygomandibular, buccal,
submandibular and lateral pharyngeal spaces. The facial spaces require a careful analysis in order to avoid any functional
restriction or vascular/neurologic injury. According to the literature, choosing a surgical or conservative treatment represent
a controversial situation especially if exists the risk of injuring an important anatomical structures and considering the
probability of a surgical procedure under general anesthesia. Surgical treatment seems to decrease the incidence of any
future complication. On the other hand, conservative treatment approaches includes a constant follow-up for a long period it
is not an underestimated choice. Making a balance scale with the risks and benefit is a prudent decision. The purpose of
this report is to describe our clinical experience.
Queiloplastia primária em paciente portador de fissura labial unilateral: Relato de caso
Mark Jon Santana Sabey*, Fábio Ricardo Loureiro Sato, Rogério Almeida Silva, Carlos Alysson Aragão Lima.
Vila Penteado General Hospital - HGVP
Resumo
As fissuras labiais são deformidades congênitas que rompem a integridade do lábio, sendo a anomalia congênita mais
comum da face. Há séculos vêm desafiando os cirurgiões pela necessidade de compreensão tridimensional da anatomia
do fissurado e restauração da mesma para que o paciente readquira funções normais de mastigação e fonação. Quando
não tratada na época correta, diversas sequelas funcionais e psicológicas podem ser geradas, tanto na criança como nos
pais. Diversas foram às técnicas de queiloplastia descritas na literatura, porém a técnica de Millard, descrita inicialmente
em 1955 ainda é a mais amplamente utilizada em todo mundo, apesar de já ter recebido diversas modificações ao longo do
tempo. O objetivo deste trabalho é descrever o relato de um caso de uma paciente de 04 meses, gênero feminino,
portadora de fissura labial pré-forame unilateral incompleta, que compareceu ao serviço de cirurgia bucomaxilofacial do
Hospital Geral de Vila Penteado, com os pais relatando queixa estética e dificuldade de amamentação. A mesma foi
submetida à queiloplastia primária pela técnica de Millard modificada sob anestesia geral. A paciente atualmente está com
seis meses de pós-operatório e com excelente evolução desde o procedimento, tanto do ponto de vista estético como
funcional. A queiloplastia primária segundo a técnica de Millard modificada é um procedimento relativamente simples,
acessível a todos os profissionais da área, porém que muitos profissionais ainda têm receio pela falta de treinamento e
cujos benefícios são inúmeros e duradouros, tanto para os pacientes como para os pais que também são afetados
psicologicamente pela deformidade dos filhos.
Protocol in managing oral surgical patients in treatment with new oral anticoagulants (NOACs): A series
of cases.
Gustavo Luiz Alkmin Paiva*, Marcela Alves dos Santos Paul, Tânia Cristina Pedroso Montano, Cíntia Maria
Alencar de Carvalho, Itamara Lucia Itagiba Neves, Ricardo Simões Neves.
Heart Institute of Hospital das Clínicas - InCor HCFMUSP
Resumo
INTRODUCTION:The feasibility to perform surgical dental procedures in patients on anticoagulation with vitamin K
antagonist has been widely discussed and intervention protocols with therapeutic INR ranging between 2.0 and 3.0 are well
established in the literature, showing no increased risk of bleeding compared to the general population [1]. The use of new
oral anticoagulation (NOACs) in clinical practice used to prevent stroke and systemic embolism in patients with non-valvular
atrial fibrillation, present efficacy superior or noninferior to vitamin K antagonist [2], nevertheless the risk of perioperative
bleeding is unknown due da absence of laboratory monitoring and reversal agents [3,4]. OBJECTIVE: Perform multiple
tooth extractions in patients with atrial fibrillation in use of NOACs,dabigatran and rivaroxaban, without interruption of the
medication in the preoperative period, avoiding stroke and systemic embolism. METHODS: All tooth extractions were
performed six hours after the last dose of NOACs, without the interruption of subsequent dose. The intraoperative care
followed the protocol used for vitamin K antagonist in relation to maneuvers local homeostatic that corresponds: the local
application of tranexamic acid powder combined with saline in the tooth socket, massive sutures, biological glue on the
surgical site and icepack on the face until one hour, followed by reassessment of the area to observe if bleeding ceased. All
cases were revalued after seven days of the surgery. RESULTS: We performed 17 tooth extractions in five patients
between January and October of 2014, being 15 in presence of dabigaran and two of them in presence of rivaroxaban. It
wasn’t observed any significant bleeding during or after the surgery. CONCLUSION: There are evidences that the protocol
proposed is safe on the treatment of the patients that were submitted on a surgical treatment in use of NOACs. We affirm
that new studies may be performed to consolidate this protocol.
SIALOENDOSCOPY: REPORT OF 7 CASES
Vinicius Tatsumoto Favarini*, Amanda da Costa Nardis, Rogério Almeida Silva, George Boraks.
General Hospital of Vila Penteado "Dr. José Pangella " - GHVP
Resumo
Obstructive sialadenitis is the most common cause of disorders in the salivary glands. The obstruction can be caused by
stones (66%), duct strictures, anatomical abnormalities and foreign bodies. Conventional diagnostic techniques (Rx,
Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and sialography) are limited and not always diagnose the
cause and location of obstruction. Sialoendoscopia is a minimally invasive technique, low risk and has proven to be a good
option for diagnosis and treatment of these diseases. The technique is indicated in cases of recurrent increase volume
without apparent cause, evidence of stenosis or dilatation by sialography or ultrasonic and sialolithiasis (estimated 1.2% of
the world population). This paper claims to present sialoendoscopy as a diagnostic and therapeutic method of obstructive
disorders in major salivary glands based on a report of seven clinical cases with their failures, successes and complications.
As a result, there were two failures in the duct catheterization, two obstructions caused by mucoid debris, two obstructions
caused by stones and one caused by duct stenosis. All five completed sialoendoscopies had a good prognosis and clinical
improvement, and in one of these cases there was a need for concurrent sialodenectomy. The two failures in the duct
catheterization occurred in parotid glands. As a disadvantage the technique has a long learning curve and some limitations
by the size and positioning of the stone in the duct. The experience of various services has confirmed increasing the
effectiveness of the technique. Continuous technological advances and closer contact with the endoscopic surgeons, best
results will be reported.

TRABALHOS CIENTÍFICOS APRESENTAÇÕES ORAIS

Transcrição

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