RESUMO
As complicações oftalmológicas decorrentes do uso de anestésicos locais em odontologia apresentam um baixo índice de ocorrência. Entretanto, torna-se fundamental o reconhecimento e conduta do cirurgião-dentista frente a essas possíveis complicações. O trabalho em questão tem como objetivo a identificação das alterações oftalmológicas decorrentes da injeção de anestésicos locais. Foi realizada uma revisão de literatura descrevendo as possíveis fisiopatologias, as estruturas mais acometidas, as técnicas anestésicas mais suscetíveis, bem como, a correta conduta caso ocorra e a importância do diagnóstico diferencial, visto que as alterações oftalmológicas estão presentes em outras alterações, como lesões centrais. Dessa forma pode-se concluir que as complicações, embora temporárias e geralmente benignas, podem ser angustiantes tanto para o paciente quanto para o profissional, sendo de extrema importância o reconhecimento das estruturas alteradas, possibilitando a devida explicação ao paciente e conduta a ser executada.
Ophthalmologic complications resulting from the use of local anesthetics in dentistry have a low rate of occurrence. However, it is essential to recognize and conduct the dentist in the face of these possible complications. This study aims to identify ophthalmologic alterations resulting from the injection of local anesthetics. A literature review was conducted describing the possible pathologies, the most affected structures, the most susceptible anesthetic techniques, as well as the correct conduct if it occurs and the importance of the differential diagnosis, since ophthalmologic alterations are present in other alterations, such as central lesions. Complications, although temporary and generally benign, can be distressing for both the patient and the professional, being extremely important the recognition of altered structures, allowing proper explanation to the patient and conduct to be performed.
Assuntos
Padrões de Prática Odontológica , Odontologia , Manifestações Oculares , Anestésicos Locais , Nervo Mandibular , Nervo MaxilarRESUMO
OBJECTIVE: The aim of this retrospective study is to investigate the prevalence of Infraorbital Canal Protrusion (ICP) degree into the maxillary sinus and its relationship with variations in adjacent structures on Cone Beam Computed Tomography (CBCT) images. METHODS: 350 CBCT images (700 Infraorbital Canal [IC]) were evaluated retrospectively. ICP was divided into 3 subtypes according to the protrusion degree. The correlation between IC types and variations in adjacent anatomical structures (Haller cell, middle nasal concha pneumatization, maxillary sinus mucosal thickening and septa) was evaluated. The distance between Infraorbital Canal and Cnine Root (IC-CR) was also measured. For type 3, measurements were performed on IC as the length of the bony septum from the IC to the Mxillary Sinus Wall (IC-MSW), the distance from the inferior orbital rim, where the IC begins to protrude into the maxillary sinus (IOR-ICP), the vertical distance from the IC to the Maxillary Sinus Roof (IC-MSR) and Floor (IC-MSF). RESULTS: The prevalence of type 1, 2 and 3 was 62.9%, 29.1%, and 8% respectively. IC-CR was 10.2, 10.7 and 11.4â¯mm in type 1, 2 and 3, respectively. IC-MSW, IOR-ICP, IC-MSR and floor IC-MSF was 3.8, 10.9, 7.4 and 27.7â¯mm, respectively. On the right and left side, statistically significant correlation was found between IC types and the presence of the Haller cell and sinus septa. But there was no significant correlation between IC types and middle concha pneumatization. CONCLUSION: Accurate diagnosis of ICP is very important in preventing infraorbital nerve damage in surgical procedures to be performed in the maxillary region. The results of this study could be a guide for surgical planning in this region. LEVEL OF EVIDENCE: Retrospective study.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Seio Maxilar , Humanos , Seio Maxilar/diagnóstico por imagem , Estudos Retrospectivos , Nervo Maxilar , EndoscopiaRESUMO
SUMMARY: To study the morphometric location of the incisive, greater, and lesser palatine foramina for maxillary nerve block. Two hundred Thai dry skulls were randomly organized from the Forensic Osteology Research Center. The distances of the parameters were measured via Vernier caliper.: Thedistances from the incisive foramen to the incisive margin of the premaxilla were 10.93?2.42 mm in males and 10.98?2.06 mm in females. From the left side, the incisive foramen to the greater palatine foramen (GPF) was39.07?2.23mm in males and 38.57?2.41 mm in females, and from the right side were 39.81?2.37 mm in males and 38.62?2.53mm in females. From the left side, the incisive foramen to the lesser palatine foramen (LPF) was 43.16?2.23 mm in males and 41.84?2.42mm in females and from the right side were 42.93?2.14 mm in males and 41.76?2.61 mm in females. The GPF found at medial to the maxillary third molar were 94-95 % in males and 84 % in females. These findings suggest that the medial position to the third molar teeth be used as a landmark for a palatine nerve block in Thais. These findings will help dentists to perform local anesthetic procedures, especially the nasopalatine and greater palatine nerve blocks, more effectively.
RESUMEN: El objetivo de este trabajo fue estudiar la localización morfométrica de los forámenes palatinos incisivos, mayores y menores para el bloqueo del nervio maxilar. Se organizaron al azar doscientos cráneos secos tailandeses del Centro de Investigación de Osteología Forense. Las distancias de los parámetros se midieron mediante un calibre Vernier. Las distancias desde el foramen incisivo hasta el margen incisivo de la premaxila fueron 10,93 ? 2,42 mm en hombres y 10,98 ? 2,06 mm en mujeres. Desde el lado izquierdo, el foramen incisivo al foramen palatino mayor (FPM) fue de 39,07 ? 2,23 mm en los hombres y 38,57 ? 2,41 mm en las mujeres, y del lado derecho fue de 39,81 ? 2,37 mm en los hombres y 38,62 ? 2,53 mm en las mujeres. Del lado izquierdo, el foramen incisivo al foramen palatino menor (LPF) fue de 43,16 ? 2,23 mm en hombres y 41,84 ? 2,42 mm en mujeres y del lado derecho 42,93 ? 2,14 mm en hombres y 41,76 ? 2,61 mm en mujeres. El FPM encontrado medial al tercer molar maxilar fue 94-95 % en hombres y 84 % en mujeres. Estos hallazgos sugieren que la posición medial de los terceros molares se utilice como punto de referencia para un bloqueo del nervio palatino en individuos tailandeses. Estos hallazgos ayudarán, de manera más eficaz, a los dentistas a realizar procedimientos anestésicos locales, especialmente los bloqueos nasopalatinos y del nervio palatino mayor.
Assuntos
Humanos , Masculino , Feminino , Palato Duro/anatomia & histologia , Tailândia , Nervo Maxilar , Bloqueio NervosoRESUMO
SUMMARY: The canalis sinuosus (CS) is a double-curved bone canal in the anterior region of the maxilla. The CS contains a vasculo-nervous bundle consisting of the anterior superior alveolar nerve and its corresponding arteries and veins. The CS and its accessory canals (AC) have been little described in the literature and are often omitted in imaging evaluations before procedures in the region. The object of the present study was to evaluate the frequency of the CS and its AC in Chilean individuals, and to carry out a morphometric analysis of these anatomical structures by cone-beam computed tomography (CBCT) by sex, side and age range. CBCT examinations of 28 patients were studied, evaluating the presence, diameter and terminal portion of the CS. We also evaluated the presence and number of AC, and their terminal portion. The diameter of the AC was classified as greater or smaller than 1.0 mm. Non-parametric tests were used for quantitative variables and chi-squared for qualitative variables. The SPSS v.27.0 software was used, with a significance threshold of 5 %. The CS was present in all the samples analysed, generally presenting a diameter greater than 1.0 mm. Alterations were found, and the diameter could be greater depending on the segment evaluated, however it was not affected by sex, side or age range. The terminal portion of the CS is usually located adjacent to the region of the nasal cavity. The frequency of AC was very high, and the most common location was in the region of the upper central incisor; in 61.3 % of cases their diameter ?1.0 mm. The high frequency of CS and AC shows the importance of carrying out a detailed imaging study before invasive procedures in the anterior region of the maxilla.
RESUMEN: El canal sinuoso (CS) es un canal óseo que presenta doble curvatura, ubicado en la región anterior de maxila. El CS contiene un paquete vásculonervioso formado por nervio alveolar superior anterior, arterias y venas correspondientes. El CS y sus canales accesorios (CA) han sido poco descritos en la literatura y muchas veces son omitidos en evaluaciones imagenológicas previas a procedimientos en la región. El objetivo del presente estudio fue evaluar la frecuencia del CS y de sus CA en individuos Chilenos, bien como realizar un análisis morfométrico de estas estructuras anatómicas mediante tomografía computarizada cone-beam (TCCB) según sexo, lado y rangos etarios. Fueron evaluados exámenes de TCCB de 28 pacientes. Se evaluó la presencia, diámetro y porción terminal del CS. Se evaluó la presencia del CA, cantidad y porción terminal. El diámetro del CA fue clasificado en mayor o menor a 1,0 mm. Se utilizaron pruebas no paramétricas para variables cuantitativas y chi-cuadrado para variables cualitativas. Se utilizó el software SPSS 27.0, considerándose umbral de significación de 5 %. El CS estuvo presente en todas las muestras analizadas, presentando en general un diámetro mayor a 1,0 mm. El diámetro del CS sufre alteraciones pudiendo ser mayor dependiendo de la región evaluada, sin embargo no se ve afectado por sexo, lado o rangos etarios. La porción terminal de CS suele ubicarse adyacente a la región de cavidad nasal. La frecuencia de CA es muy alta, en un 61,3 % presentan diámetro ?1,0 mm, siendo la región de incisivo central superior su ubicación más común. La alta frecuencia de CS y de CA demuestra la importancia de realizarse un detallado estudio imagenológico previo a procedimientos invasivos en región anterior de la maxila.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Tomografia Computadorizada de Feixe Cônico , Maxila/diagnóstico por imagem , Chile , Fatores Sexuais , Estudos Transversais , Estudos Retrospectivos , Fatores Etários , Maxila/anatomia & histologia , Nervo MaxilarRESUMO
PURPOSE: Anatomical knowledge of the zygomatic region is important, because the zygomatic nerve and its branches may suffer lesions during surgical procedures in the periorbital region. The position and frequency of zygomaticofacial foramina (ZFF) may vary between individuals, and between one side and the other in the same individual. In the present study, we analysed the presence and location of ZFF, as well as the distance between them and the orbital cavity, in macerated skulls of adult individuals. METHODS: We examined 287 macerated skulls, of individuals of both sexes, analysing the frequency and location of ZFF and the distance from the ZFF to the margin of the orbital cavity (OC). RESULTS: Zygomaticofacial foramina are very frequent structures which tend to appear singly. They are generally located in the temporal process of the zygomatic bone, but in many cases, they may be located in the mid portion of the bone. They also tend to appear at the same distance from the OC when left and right sides are compared. Sex was an important factor in determining differences in ZFF; the distance from the ZFF to the margin of the OC was greater in males than in females. Sex, age, side and skin colour did not affect the frequency and location of the ZFF. CONCLUSION: We consider that the mid portion of the zygomatic bone is the safest place to anchor zygomatic implants (ZI), since ZFF are less frequently located there than in the temporal process of the zygomatic bone.
Assuntos
Variação Anatômica , Implantação Dentária/efeitos adversos , Nervo Maxilar/anatomia & histologia , Complicações Pós-Operatórias/prevenção & controle , Zigoma/inervação , Adolescente , Adulto , Fatores Etários , Implantação Dentária/instrumentação , Implantação Dentária/métodos , Implantes Dentários/efeitos adversos , Feminino , Hormônios Esteroides Gonadais , Humanos , Masculino , Nervo Maxilar/lesões , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Adulto Jovem , Zigoma/cirurgiaRESUMO
RESUMEN La elevación de piso de seno maxilar ha sido sumamente documentada en implantología como una técnica segura y predecible en el procedimiento de ganancia vertical ósea, en el maxilar posterior atrófico. Sin embargo, conjuntamente se han reportado complicaciones en este procedimiento, las cuales podrían poner en peligro los resultados de la regeneración, y por consiguiente la colocación del implante. El propósito de esta revisión de literatura es exponer y analizar diferentes complicaciones que pueden presentarse en la elevación de piso de seno maxilar.
ABSTRACT Maxillary sinus floor elevation has been extensively documented as a safe and predictable procedure for gaining vertical bone height in the atrophic posterior maxilla. Even though, complications have been reported, which can potentially jeopardize the outcome of the regeneration and implant therapy. Therefore, the purpose of this literature review is to present, debate and analyze the different complications that can occur during a sinus floor elevation.
Assuntos
Implantes Dentários/efeitos adversos , Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Seio Maxilar/cirurgia , Nervo Maxilar/lesões , Mucosa Nasal/lesõesRESUMO
The aim of this paper was to determine the frequency of Canalis Sinuosus (CS) and its anatomic variations. A total of 236 cone beam computed tomography (CBCT) images were studied. Characteristics of the canal such as its form, pathway and diameter were analyzed. The CS was clearly visualized in 100 % of the images with variations in the canal observed in up to 46 % of the cases. In 79 % of the cases the variation was found to be bilateral. The most common variation was an increase in the diameter (> 1mm) of the CS. Considering that the anterior region of the middle third of the face is a common place for clinical interventions, this study supports the need to perform a thorough evaluation of the maxillary region prior to clinical interventions in order to prevent complications such as direct or indirect injury to the anterior superior alveolar neurovascular bundle contained within the CS.
El objetivo de este trabajo fue determinar la frecuencia de Canalis Sinuosus (CS) y sus variaciones anatómicas. Se estudiaron un total de 236 imágenes de tomografía computarizada de haz cónico (CBCT). Se analizaron las características del canal, como su forma, vía y diámetro. El CS se visualizó claramente en el 100 % de las imágenes, observándose variaciones en el canal en hasta el 46 % de los casos. En el 79 % de los casos la variación fue bilateral. La variación más común fue un aumento en el diámetro (> 1 mm) de la CS. Teniendo en cuenta que la región anterior del tercio medio de la cara es un lugar común para las intervenciones clínicas, este estudio apoya la necesidad de realizar una evaluación exhaustiva de la región maxilar antes de las intervenciones clínicas para prevenir complicaciones como lesiones directas o indirectas a el haz neurovascular alveolar superior anterior contenido dentro de la CS.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Tomografia Computadorizada de Feixe Cônico , Variação Anatômica , Maxila/diagnóstico por imagem , Prevalência , Estudos Transversais , Estudos Retrospectivos , Distribuição por Idade e Sexo , Maxila/inervação , Nervo Maxilar/anatomia & histologia , Nervo Maxilar/diagnóstico por imagemRESUMO
Relato de caso: Relatar um caso de canal acessório do Canalis Sinuosos, localizado por palatino à raiz do dente 21 que, na radiografia panorâmica, foi observada como uma área radiolúcida sobreposta aos terços médio-apical dente 21, indicando reabsorção radicular, sendo indispensável uma investigação acurada por tomografia computadorizada de feixe cônico (TCFC). Conclusão: A TCFC se mostrou eficiente na identificação do Canalis Sinuosos em relação à radiografia panorâmica, possibilitando um correto diagnóstico para o caso.
Case report: This report describes a case of Canalis sinuosus accessory canal, lingually to the root of the tooth 21, that was observed on panoramic radiograph as a radiolucent area superimposed over the middle and apical thirds, indicating root resorption. However, cone-beam computed tomography (CBCT) recommended for an accurated diagnosis of the case disclose the presence of this anatomic variation. Conclusion: CBCT was more accurate in detection of Canalis sinuosus than panoramic radiography.
Assuntos
Nervo Maxilar , Tomografia Computadorizada de Feixe Cônico , Variação AnatômicaRESUMO
Abstract Introduction: The course of the infraorbital canal may leave the infraorbital nerve susceptible to injury during reconstructive and endoscopic surgery, particularly when surgically manipulating the roof of the maxillary sinus. Objective: We investigated both the morphometry and variations of the infraorbital canal with the aim to show the relationship between them relative to endoscopic approaches. Methods: This retrospective study was performed on paranasal multidetector computed tomography images of 200 patients. Results: The infraorbital canal corpus types were categorized as Type 1: within the maxillary bony roof (55.3%), Type 2: partially protruding into maxillary sinus (26.7%), Type 3: within the maxillary sinus (9.5%), Type 4: located anatomically at the outer limit of the zygomatic recess of the maxillary bone (8.5%). The internal angulation and the length of the infraorbital canal, the infraorbital foramen entry angles and the distances related to the infraorbital foramen localization were measured and their relationships with the infraorbital canal variations were analyzed. We reported that the internal angulations in both sagittal and axial sections were mostly found in infraorbital canal Type 1 and 4 (69.2%, 64.7%) but, there were commonly no angulation in Type 3 (68.4%) (p < 0.001). The length of the infraorbital canal and the distances from the infraorbital foramen to the infraorbital rim and piriform aperture was measured as the longest in Type 3 and the smallest in Type 1 (p < 0.001). The sagittal infraorbital foramen entry angles were detected significantly smaller in Type 3 and larger in Type 1 than that in other types (p = 0.003). The maxillary sinus septa and the Haller cell were observed in 28% and 16% of the images, respectively. Conclusion: Precise knowledge of the infraorbital canal corpus types and relationship with the morphometry allow surgeons to choose an appropriate surgical approach to avoid iatrogenic infraorbital nerve injury.
Resumo: Introdução: O trajeto do canal infraorbitário pode predispor o nervo infraorbitário a lesões durante cirurgias reconstrutoras e endoscópicas com manipulação do teto do seio maxilar. Objetivo: Investigamos a morfometria e as variações do canal infraorbitário e objetivamos demonstrar a relação entre elas, visando as abordagens endoscópicas. Método: Este estudo retrospectivo foi realizado em imagens de tomografia computadorizada multidetectora de seios paranasais de 200 pacientes. Resultados: Os tipos de corpos do canal infraorbitário foram categorizados como Tipo 1; inseridos no teto ósseo maxilar (55,3%), Tipo 2; projetando-se parcialmente dentro do seio maxilar (26,7%), Tipo 3; dentro do seio maxilar (9,5%), Tipo 4; localizado anatomicamente no limite externo do recesso zigomático do osso maxilar (8,5%). A angulação interna e o comprimento do canal infraorbitário, os ângulos de entrada do forame infraorbitário e as distâncias relacionadas à localização do forame foram medidos e suas relações com as variações do canal infraorbitário foram analisadas. Observamos que as angulações internas em ambos os cortes sagital e axial foram encontradas em sua maioria em canais infraorbitários Tipo 1 e 4 (69,2%, 64,7%) e, no geral, não houve angulação no canal Tipo 3 (68,4%) (p < 0,001). O comprimento do canal infraorbitário e as distâncias desde o forame infraorbitário até o rebordo infraorbitário e a abertura piriforme foram medidos e os mais longos foram identificadas no Tipo 3 e os mais curtos no Tipo 1 (p < 0,001). Os ângulos de entrada do forame infraorbitário em projeção sagital foram significativamente menores no Tipo 3 e maiores no Tipo 1, em relação aos outros tipos (p = 0,003). Septos nos seios maxilares e as células de Haller foram observados em 28% e 16% das imagens, respectivamente. Conclusão: O conhecimento preciso dos tipos de corpo do canal infraorbitário e a relação com a morfometria permitem que o cirurgião escolha uma abordagem cirúrgica apropriada para evitar lesões iatrogênicas do nervo infraorbitário.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Seios Paranasais/anatomia & histologia , Variação Anatômica , Órbita/anatomia & histologia , Órbita/diagnóstico por imagem , Seios Paranasais/diagnóstico por imagem , Estudos Retrospectivos , Endoscopia/efeitos adversos , Tomografia Computadorizada Multidetectores , Doença Iatrogênica/prevenção & controle , Nervo Maxilar/diagnóstico por imagemRESUMO
The sphenoidal tubercle is a bone elevation located in the anterior edge of the infratemporal crest of the sphenoid greater wing, where the temporal and lateral pterygoid muscles have their origin. This bone accident presents varied morphology so its description and denomination are a topic of discussion. 60 dry skulls obtained from the morphology laboratory of the Biomedical Basic Sciences Department of the University of Talca were used for a morphological and morphometric analysis of the sphenoidal tubercle including its morphology, diameters (anteroposterior, transverse and vertical) and the distance to the grooves for the maxillary artery and maxillary nerve. Sphenoidal tubercle had a prevalence of 98.4 % of all dry skulls analyzed with a bilateral presentation in the 76.6 % of the cases. According to its different forms of presentation established by Cáceres et al., (2016) the pyramidal form was the most frequent with a 25.7 %. The average diameters were of 4.12 mm anteroposterior, 5.50 mm transverse and 3.89 mm vertical. The average distance to the grooves of the maxillary artery and maxillary nerve were 9.04 mm and 7.6 mm, respectively. Sphenoidal tubercle is a constant bone accident with a variated morphology and measures. Due to its anatomical relations with important neurovascular elements such as the maxillary artery and the maxillary nerve, it may be used as a reference point for surgical access to the infratemporal fossa. From this analysis we establish that the denomination of "infratemporal process" is more accurate, because the development of this bone accident is from muscular traction performed by the lateral pterygoid muscle and the deep portion of the temporal muscle causing great variations in its morphology, probably due to external and functional parameters or even influenced by the biotype.
El tubérculo esfenoidal es una elevación ósea ubicada en el extremo anterior de la cresta infratemporal del ala mayor del hueso esfenoides, donde presta inserción al músculo temporal y pterigoideo lateral. Presenta morfología variada, por lo que su descripción y denominación resultan motivo de discusión. 60 cráneos secos obtenidos del Laboratorio de Morfología del Departamento de Ciencias Básicas Biomédicas de la Universidad de Talca, fueron utilizados para realizar un análisis morfológico y morfométrico del tubérculo esfenoidal evaluando forma, diámetros (anteroposterior, laterolateral y vertical) y distancia con el surco de la arteria y nervio maxilar. El tubérculo esfenoidal tuvo una prevalencia del 98,4 % del total de cráneos analizados, presentándose bilateralmente en el 76,6 % de los casos. De acuerdo a las diferentes formas de presentación establecidas por Cáceres et al (2016) la forma piramidal fue la más frecuente con un 25,7 %. Los diámetros promedio fueron de 4,12 mm anteroposterior, 5,50 mm laterolateral y 3,89 mm vertical. Las distancias promedio con el surco de la arteria y nervio maxilar fueron de 9,04 mm y 7,6mm, respectivamente. El tubérculo esfenoidal es un accidente óseo constante de morfología y dimensiones variadas. Debido a sus relaciones con elementos vasculares de importancia, tales como la arteria y nervio maxilar, podría ser utilizado como elemento de referencia para el acceso quirúrgico a la fosa infratemporal. A partir de su análisis planteamos que su denominación como "proceso infratemporal" sería más apropiado, debido a que se desarrollaría a partir de la tracción muscular ejercida por el musculo pterigoideo lateral y la porción profunda del músculo temporal, ocasionando variaciones notables en su morfología, probablemente debido a factores externos y funcionales o incluso influenciada por el biotipo.