RESUMO
Objetivo: Las comunicaciones bucosinusales y buco- nasales son condiciones patológicas que se caracterizan por la presencia de una solución de continuidad entre la cavidad bucal y el seno maxilar o la cavidad nasal respectivamente. Una vez que se ha instalado una comunicación es deseable ce- rrar este defecto, evitando así la infección del seno maxilar y posibles dificultades en la deglución, fonación y masticación. Se han propuesto diferentes tratamientos para su resolución, algunos no quirúrgicos y otros quirúrgicos. Los quirúrgicos pueden realizarse desplazando tejidos locales, regionales o injertando. El presente trabajo tiene como objetivo presentar situaciones clínicas de comunicaciones bucosinusales y buco- nasales con diferentes etiologías y sus distintos tratamientos según tamaño y ubicación del defecto. Casos clínicos: Se identificaron pacientes que asistie- ron al Servicio de Cirugía Maxilofacial del Hospital Piñero presentando cuatro comunicaciones bucosinusales agudas y crónicas y una comunicación buconasal crónica. Los casos analizados fueron tratados de manera quirúrgica utilizando di- versos colgajos según tamaño y ubicación del defecto (AU)
Aim: Oroantral and oronasal communications are patho- logical conditions characterized by the presence of a solu- tion of continuity between the oral cavity and the maxillary sinus or nasal cavity respectively. Once a communication has been installed, it is desirable to close this defect, thus avoid- ing infection of the maxillary sinus and possible difficulties in swallowing, phonation, and mastication. Different treatments have been proposed for its resolution, some non-surgical and others surgical. Surgical procedures can be performed by dis- placing local or regional tissue or by grafting. The aim of this case report is to present clinical situations of oral sinus and oral nasal communication with different etiologies and their different treatments according to the size and location of the defect. Clinical cases: A group of patients who attended the Maxillofacial Surgery Service of Piñero Hospital presenting four acute and chronic oral sinus and one oronasal communi- cations were identified. The analyzed cases were treated sur- gically using different flaps according to the size and location of the defect (AU)
Assuntos
Humanos , Masculino , Feminino , Fístula Bucoantral/cirurgia , Fístula Bucoantral/etiologia , Fístula Bucoantral/terapia , Argentina , Retalhos Cirúrgicos , Unidade Hospitalar de OdontologiaRESUMO
Los quistes odontogénicos se dividen en dos grupos principales de acuerdo a la patogénesis de la entidad. Uno de esos grupos incluye a los quistes radiculares de origen inflamatorio. Nuestra situación es una paciente de sexo femenino que a causa de un molar superior con tratamiento endodóntico la patología quística invadió la cavidad sinusal comprometiendo las estructuras vecinas y al realizar la exodoncia se generó una comunicación bucosinusal con infección de esa entidad patológica. El diagnostico de certeza se confirmó a través de la biopsia previa, y se la intervino bajo anestesia general para la extirpación total de la patología quística (AU)
Assuntos
Humanos , Feminino , Adulto , Cistos Odontogênicos/cirurgia , Cistos Odontogênicos/diagnóstico por imagem , Fístula Bucoantral/etiologia , Argentina , Retalhos Cirúrgicos , Extração Dentária , Biópsia/métodos , Diagnóstico por Imagem , Descompressão Cirúrgica , Procedimentos Cirúrgicos Bucais , Unidade Hospitalar de OdontologiaRESUMO
Presentamos un caso de fístula oroantral y rinosinusitis maxilar, resuelto por abordaje combinado endoscópico, nasal e intraoral en el cual se utilizó colgajo de mucosa palatina y hueso vómer para el cierre de la misma. Describimos el caso de una paciente femenina de 66 años de edad, que consultó por presentar cacosmia, algia facial izquierda y rinorrea posterior purulenta, 3 semanas posterior a extracción de segundo molar superior izquierdo, la tomograffa axial computarizada (TC) de senos paranasales evidenció velamiento total maxilar izquierdo, parcial etmoidal izquierdo y defecto óseo en reborde alveolar superior izquierdo. Se realizó toma de fragmento de hueso vómer. Seguidamente abordaje de cavidad antral izquierda por vía endoscópica; e intraoral, se concluyó disección, cierre óseo y mucoso de la fístula.
We report a case of an oroantral fistula and maxillary rhinosinusitis, that was resolved by combined approach, in which palatal mucosa flap and vomer bone was used for its closure. We describe the case of a female patient of 66 years old, who consulted for having cacosmia, left facial pain and purulent rhinorrhea, after left second molar extraction. CT-scan sinus showed the total left maxillary sinus, partial left ethmoid opacity and bone defect in left alveolar ridge. A vomer bone graft was taken from the nasal septum; left maxillary sinus surgerywas done by endoscopic approach and intraoral closure of bony and mucosa fístula was concluded.
Assuntos
Humanos , Feminino , Idoso , Sinusite Maxilar/cirurgia , Rinite/cirurgia , Fístula Bucoantral/cirurgia , Vômer/transplante , Extração Dentária/efeitos adversos , Sinusite Maxilar/etiologia , Rinite/etiologia , Transplante Ósseo , Fístula Bucoantral/etiologia , Endoscopia/métodosRESUMO
El levantamiento de piso de seno maxilar es una de las técnicas quirúrgicas más utilizadas para rehabilitar sectores posterosuperiores edéntulos, con el objetivo de ganar altura ósea para la posterior colocación de implantes y rehabilitación protética. El propósito de este trabajo fue realizar una revisión de las posibles complicaciones en el levantamiento del piso del seno maxilar y ponerlas al alcance del profesional...
Assuntos
Humanos , Implantação Dentária Endóssea , Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Complicações Pós-Operatórias , Falha de Restauração Dentária , Fístula Bucoantral/etiologia , Prognóstico , Procedimentos Cirúrgicos Bucais/métodos , Seio Maxilar/anatomia & histologia , Sinusite Maxilar/etiologia , CicatrizaçãoRESUMO
This report presents a new use for rehabilitation protocol for oral sinus communications in patients with antiresorptive agent-induced osteonecrosis of the jaw. The treatment plan consisted of constructing an atraumatic complete denture with rounded edges, made with nontoxic resin, to prevent any injury to the mucosa and recurrence of the disease. The patient was followed up for 4 years, without any complications, and was socially reintegrated by resuming the normal life he experienced before tooth loss.
Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/complicações , Prótese Total Superior , Fístula Bucoantral/reabilitação , Obturadores Palatinos , Planejamento de Assistência ao Paciente , Adenocarcinoma/terapia , Idoso , Conservadores da Densidade Óssea/administração & dosagem , Protocolos Clínicos , Planejamento de Prótese Dentária , Planejamento de Dentadura , Difosfonatos/administração & dosagem , Seguimentos , Humanos , Imidazóis/administração & dosagem , Arcada Edêntula/terapia , Masculino , Maxila/patologia , Terapia Neoadjuvante/métodos , Fístula Bucoantral/etiologia , Neoplasias da Próstata/terapia , Ácido ZoledrônicoRESUMO
OBJECTIVE: The aim of this work is to demonstrate the accidents and complications rates on third molars surgeries performed by senior dentistry students. METHODS: A retrospective study of 122 patient charts submitted to third molars surgeries was done. Patient age, gender, dental in arch position, and accidents/complications were considered with the charts presenting incomplete dates being excluded from the study. After all, 88 patients (210 surgeries) were included. RESULTS: The majority of the patients were female (70.4 %), with the average age of 24 years. Mandibular molars represented more than half of the surgical procedures (56.2 %), with teeth at vertical position the most found (60.3 %). The cases of accidents and complications totalized 10.4 % of all performed procedures, being hemorrhage (1.9 %), root fractures (1.9 %), and maxillary tuberosity fracture (1.9 %) the most found. Suture dehiscence (1.4 %), dry socket (1.4 %), oroantral communications (0.9 %), paresthesia (0.9 %), and infection (0.4 %) were also observed. CONCLUSIONS: Surgeons' inexperience was not considered a determinant factor to modify the rates of accidents and complications at third molars surgeries when compared to previous works developed by experienced surgeons. It is important to highlight the necessity of the students' knowledge of the most adequate treatments of each of the accidents and complications.
Assuntos
Acidentes , Dente Serotino/cirurgia , Complicações Pós-Operatórias , Estudantes de Odontologia , Extração Dentária/efeitos adversos , Brasil , Alvéolo Seco/etiologia , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Fraturas Maxilares/etiologia , Hemorragia Bucal/etiologia , Fístula Bucoantral/etiologia , Parestesia/etiologia , Estudos Retrospectivos , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/etiologia , Fraturas dos Dentes/etiologia , Raiz Dentária/lesões , Adulto JovemRESUMO
INTRODUCTION: Orbital infections may result in permanent morbidity because of the severity of infection. Furthermore, delayed diagnosis or treatment of orbital infections can lead to intracranial complications and even death. The majority of orbital infections develop from paranasal sinus infections, cutaneous infections, and periorbital trauma. Dacryocystitis and odontogenic infection are also accounted as potential etiologies but are scarcely reported in scientific literature. METHODS: The patient revealed a history of having endodontic treatment on left maxillary second molar performed 2 weeks previously. Moreover, she exhibited signs of facial pain accompanied by sinusitis symptoms, fever, and nasal obstruction the week after this endodontic procedure. The patient presented proptosis, impairment of ocular motility to the right side, facial tenderness, palpebral erythema, and referred decreased visual acuity. Intraoral exam revealed root fragments of left maxillary first molar and an extensive carious lesion on left maxillary second molar. Computed tomography enabled the observation of frontal sinus, left-sided maxillary, opacity of sphenoidal and ethmoidal sinuses, and apical lesion of left maxillary first and second molars, all suggesting the presence of their apex in the maxillary sinus. In addition, images revealed ocular proptosis and presence of high-density areas suggestive of pus in the medial orbital wall region. RESULTS: The patient was submitted to surgical drainage under general anesthesia approximately 8 hours after the clinical evaluation. CONCLUSIONS: Early detection of orbital infection, proper diagnostic tests, and treatment may provide successful outcomes of this rarely occurring disease.
Assuntos
Celulite Orbitária/etiologia , Fístula Bucoantral , Abscesso Periapical/complicações , Tratamento do Canal Radicular/efeitos adversos , Feminino , Humanos , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/cirurgia , Celulite Orbitária/diagnóstico por imagem , Celulite Orbitária/cirurgia , Fístula Bucoantral/complicações , Fístula Bucoantral/etiologia , Fístula Bucoantral/cirurgia , Abscesso Periapical/cirurgia , Radiografia , Extração DentáriaRESUMO
PURPOSE: To evaluate the use of the buccal fat pad flap (BFPF) technique as an option to prevent complications in the treatment of patients with atrophic maxillae rehabilitated after complex zygomatic implant surgery. MATERIALS AND METHODS: A retrospective study was made of completely edentulous patients submitted to zygomatic implant surgery between May 2005 and November 2007. Patients with severely atrophic maxillae received conventional and zygomatic implants and were followed after the implants were loaded. Preoperative evaluation included panoramic radiography and computed tomographic scans of the maxilla to identify the anatomic conditions and presence of pathology. RESULTS: Eight male patients with a mean age of 57 years and atrophic maxillae were rehabilitated with zygomatic implants placed using the BFPF technique. The BFPF technique was used in complex situations, including oroantral communication-associated sites, areas that had lost the sinus wall, and extrasinus implant placement. A total of 16 conventional implants, 4 long (21-mm) tilted implants, and 22 zygomatic implants was placed. The patients were rehabilitated with fixed prostheses and were followed for a minimum of 15 months. None of the conventional implants failed and none of the zygomatic implants failed or presented with soft tissue complications. CONCLUSION: The BFPF presented a high success rate, demonstrating that it is a viable and predictable treatment option to prevent and treat soft tissue complications in complex zygomatic implant surgery.
Assuntos
Tecido Adiposo/transplante , Implantação Dentária Endóssea/efeitos adversos , Arcada Edêntula/reabilitação , Maxila/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Retalhos Cirúrgicos , Zigoma/cirurgia , Atrofia/diagnóstico por imagem , Atrofia/cirurgia , Implantação Dentária Endóssea/métodos , Prótese Dentária Fixada por Implante/efeitos adversos , Prótese Dentária Fixada por Implante/métodos , Falha de Restauração Dentária , Humanos , Arcada Edêntula/diagnóstico por imagem , Arcada Edêntula/cirurgia , Masculino , Maxila/diagnóstico por imagem , Maxila/patologia , Pessoa de Meia-Idade , Fístula Bucoantral/etiologia , Fístula Bucoantral/patologia , Fístula Bucoantral/cirurgia , Radiografia , Estudos Retrospectivos , Zigoma/diagnóstico por imagem , Zigoma/patologiaRESUMO
La fístula oroantral se presenta entre otras causas como resultado de la extracción de un molar en relación al maxilar Como consecuencia el paciente presenta episodios de sinusitis de evolución tórpida y refractaria a tratamiento médico, siendo la reparación quirúrgica su mejor solución, existiendo distintas técnicas. El objetivo de este caso es mostrar la experiencia de un paciente operado mediante la utilización de un colgajo de rotación y avance palatino e injerto de hueso autólogo. Se trata de una mujer de 32 años que dos semanas después de extracción de molar superior izquierdo presenta reiterados episodios de sinusitis unilateral izquierda. Al examen físico y estudio con tomografía computarizada se diagnostica sinusitis maxilar izquierda, secundaria a fístula oroantral por extracción de pieza dentaria del maxilar. Se realiza reparación quirúrgica con utilización de un colgajo de rotación y avance palatino e injerto de hueso autólogo. Se realizó seguimiento por 6 meses con resultados óptimos, sin complicaciones ni recidivas. Las fístulas oroantrales son un problema que tiene múltiples opciones de tratamiento quirúrgico. La utilización de injertos óseos autólogos y la utilización de un colgajo de rotación y avance palatino, pretende ser una buena opción quirúrgica, permitiendo un cierre definitivo del defecto.
Oroantral fistula occurs between other causes as a result of the extraction of a molar in relation to the maxillary bone. As a result the patient experiences episodes of sinusitis refractory to medical treatment. Surgical repair remains the best solution, there are different techniques. The aim is to show our experience of one case operated using a rotation and advancement palatal flap and autologous bone graft. The clinical case is a 32 year old woman that two weeks after removal of upper left molar suffers repeated episodes of unilateral sinusitis. Physical examination and computed tomography shown left maxillary chronic sinusitis secondary to an oroantral fistula, due to tooth extraction from maxillary bone. Surgical repair is performed using a rotation and advancement palatal flap and autologous bone graft. Six months following there was no complication neither recurrent sinusitis, with optimal results. Oroantral fistula is a problem that has multiple options for surgery. The use of autologous bone graft and rotation and advancement palatal flap intended to be a good surgical option, allowing closure of the defect.
Assuntos
Humanos , Adulto , Feminino , Extração Dentária/efeitos adversos , Fístula Bucoantral/cirurgia , Transplante Autólogo , Transplante Ósseo , Retalhos Cirúrgicos , Complicações Pós-Operatórias , Fístula Bucoantral/etiologia , Resultado do Tratamento , Sinusite Maxilar/etiologiaRESUMO
Se presenta el caso de una comunicación bucosinusal crónica, post extracción de un primer molar superior en un paciente de 65 años de edad. la presencia de un seno maxilar infectado, determinó la necesidad de efectuar su saneamiento previo a la faz quirúrgica, en la cual se llevó adelante el cierre de la comunicación establecida en formasatisfactoria, mediante la confección de un colgajo pediculado vestibular desplazado hacia palatino y adosadosobre un decorticado fibromucoso.