Introdução: A região da face corresponde a parte do corpo mais atingida em casos de traumas. Isso ocorre por ser uma área sem proteção e de localização favorável. Traumas nessa região tem como principais causas acidente de trânsito, quedas ou agressões. A consequência mais prevalente é a fratura na região mandibular. Em decorrência disso, é possível perceber diversos prejuízos, dentre eles a limitação na abertura bucal. No entanto, para que seja definido um dano é necessário que se conheça o padrão de normalidade. O Código Civil brasileiro aponta que todo o dano causado por ato ilícito deve ser reparado proporcionalmente ao prejuízo criado na vítima. A utilização de tabelas na quantificação do dano corporal tem sido um elemento importante para a unificação da linguagem e dos critérios, permitindo que uma mesma situação seja avaliada e entendida de forma semelhante. Objetivo: a) Obter a média de abertura bucal de uma população brasileira associando com sexo, idade, estatura e perfil facial; b) Correlacionar a média de abertura bucal de pacientes considerados dentro do padrão de normalidade e pacientes com fratura mandibular; c) Correlacionar os valores de abertura bucal obtidos na pesquisa com a Tabela Nacional de Avaliação de Incapacidades Permanentes em Direito Civil da legislação portuguesa, a tabela brasileira SUSEP e a tabela DPVAT; d) Elaborar uma fórmula para a determinação da redução de abertura bucal. Metodologia: Um questionário relacionado a percepção de dor foi aplicado em pacientes do grupo controle e pacientes analisados em um hospital de São Paulo com fratura de mandíbula. Na sequência, foi verificada a abertura bucal máxima com um paquímetro e tomadas as medidas do terço médio e inferior para determinação do tipo de perfil facial. Além disso, através de um estadiômetro, foi medida a estatura. Os dados foram analisados estatisticamente e relacionados com as três tabelas citadas. Resultados: A média de abertura bucal no sexo masculino foi de 51,71 mm enquanto no sexo feminino foi de 47,94 mm onde foi encontrada correlação positiva entre sexo e abertura bucal. Entretanto não foi possível estabelecer significância com as demais variáveis. Quanto aos pacientes com fratura de mandíbula, a média de abertura bucal para homens foi de 38,91 mm e em mulheres de 41 mm, a etiologia mais prevalente foi acidentes automobilísticos e o local mais acometido foi na região condilar. Conclusão: Foi possível encontrar associação positiva com o sexo, onde homens tendem a ter uma abertura bucal maior que mulheres; Não foi encontrada relação significativa com idade, estatura e perfil facial; Pacientes com fratura mandibular possuem uma amplitude de abertura menor que pacientes considerados dentro dos padrões de normalidade; As tabelas brasileiras, DPVAT e SUSEP são insuficientes para valorar danos odontológicos e a tabela da legislação portuguesa necessita de adaptações e com base nas médias de abertura bucal obtidas, foram elaborada as seguintes fórmulas para o cálculo de redução de abertura bucal, onde para pacientes do sexo masculino usa-se RA=[100-(A.1,93) ] .0,3 e para o sexo feminino RA=[100-(A.2,08) ] .0,3 . / Background: The face is the body part most commonly affected in cases of trauma, since it is an unprotected and vulnerable area. Facial traumas are caused mainly by traffic accidents, falls, or physical assault. Mandibular fracture is the most prevalent consequence of these events. This type of fracture causes some damage, including limited mouth opening. However, in order to define this damage, it is necessary to know what the normal pattern is. The Brazilian Civil Code establishes that any harm caused by the practice of an illicit act must be repaired proportionately to the injury inflicted on the victim. The use of rating charts for quantification of bodily harm has played an important role in standardizing both the language and criteria, thus allowing one to assess and understand the same situation in a similar fashion. Objective: a) To estimate the mean jaw range of motion of the Brazilian population by associating it with sex, age, height, and facial profile; b) to correlate patients with a normal jaw range of motion with those with mandibular fracture; c) to correlate jaw range of motion in the Portuguese National Rating Chart for Permanent Disability Assessment with that in the Brazilian SUSEP and DPVAT charts; d) to develop a formula for limited mouth opening estimation. Method: A pain perception questionnaire was applied to patients from the control group and to those with mandibular fracture assessed at a hospital in the city of São Paulo, Brazil. Maximum mouth opening was measured with a caliper, whereas middle and lower third measurements were made to determine the type of facial profile. Height was measured using a stadiometer. The data were analyzed statistically and compared with those described in the three rating charts. Results: The mean jaw range of motion was 51.71 mm in male patients and 47.94 mm in female patients, and there was a positive correlation between sex and mouth opening. It was not possible to determine the significance of mouth opening relative to the other variables. In patients with mandibular fracture, the mean jaw range of motion was 38.91 mm for men and 41 mm for women; vehicle motor accidents were the major cause of the trauma; and the mandibular condyle was the most frequently affected site. Conclusion: There was a positive correlation with sex, as men tend to have a greater jaw range of motion than women. There was no significant correlation with age, height, and facial profile. Patients with mandibular fracture have a smaller jaw range of motion than those who fall into normal standards. Brazilian charts, DPVAT and SUSEP, are inefficient in rating dental damage, whereas the Portuguese chart requires some adaptations. The following formulas were developed based on the mean jaw range of motion measurements, and they allow estimating limited mouth opening: LMO=[100-(MO x 1.93)] x 0.3 for men and LMO=[100-(MO x 2.08)] x 0.3 for women.

Introdução: A região da face corresponde a parte do corpo mais atingida em casos de traumas. Isso ocorre por ser uma área sem proteção e de localização favorável. Traumas nessa região tem como principais causas acidente de trânsito, quedas ou agressões. A consequência mais prevalente é a fratura na região mandibular. Em decorrência disso, é possível perceber diversos prejuízos, dentre eles a limitação na abertura bucal. No entanto, para que seja definido um dano é necessário que se conheça o padrão de normalidade. O Código Civil brasileiro aponta que todo o dano causado por ato ilícito deve ser reparado proporcionalmente ao prejuízo criado na vítima. A utilização de tabelas na quantificação do dano corporal tem sido um elemento importante para a unificação da linguagem e dos critérios, permitindo que uma mesma situação seja avaliada e entendida de forma semelhante. Objetivo: a) Obter a média de abertura bucal de uma população brasileira associando com sexo, idade, estatura e perfil facial; b) Correlacionar a média de abertura bucal de pacientes considerados dentro do padrão de normalidade e pacientes com fratura mandibular; c) Correlacionar os valores de abertura bucal obtidos na pesquisa com a Tabela Nacional de Avaliação de Incapacidades Permanentes em Direito Civil da legislação portuguesa, a tabela brasileira SUSEP e a tabela DPVAT; d) Elaborar uma fórmula para a determinação da redução de abertura bucal. Metodologia: Um questionário relacionado a percepção de dor foi aplicado em pacientes do grupo controle e pacientes analisados em um hospital de São Paulo com fratura de mandíbula. Na sequência, foi verificada a abertura bucal máxima com um paquímetro e tomadas as medidas do terço médio e inferior para determinação do tipo de perfil facial. Além disso, através de um estadiômetro, foi medida a estatura. Os dados foram analisados estatisticamente e relacionados com as três tabelas citadas. Resultados: A média de abertura bucal no sexo masculino foi de 51,71 mm enquanto no sexo feminino foi de 47,94 mm onde foi encontrada correlação positiva entre sexo e abertura bucal. Entretanto não foi possível estabelecer significância com as demais variáveis. Quanto aos pacientes com fratura de mandíbula, a média de abertura bucal para homens foi de 38,91 mm e em mulheres de 41 mm, a etiologia mais prevalente foi acidentes automobilísticos e o local mais acometido foi na região condilar. Conclusão: Foi possível encontrar associação positiva com o sexo, onde homens tendem a ter uma abertura bucal maior que mulheres; Não foi encontrada relação significativa com idade, estatura e perfil facial; Pacientes com fratura mandibular possuem uma amplitude de abertura menor que pacientes considerados dentro dos padrões de normalidade; As tabelas brasileiras, DPVAT e SUSEP são insuficientes para valorar danos odontológicos e a tabela da legislação portuguesa necessita de adaptações e com base nas médias de abertura bucal obtidas, foram elaborada as seguintes fórmulas para o cálculo de redução de abertura bucal, onde para pacientes do sexo masculino usa-se RA=[100-(A.1,93) ] .0,3 e para o sexo feminino RA=[100-(A.2,08) ] .0,3 . / Background: The face is the body part most commonly affected in cases of trauma, since it is an unprotected and vulnerable area. Facial traumas are caused mainly by traffic accidents, falls, or physical assault. Mandibular fracture is the most prevalent consequence of these events. This type of fracture causes some damage, including limited mouth opening. However, in order to define this damage, it is necessary to know what the normal pattern is. The Brazilian Civil Code establishes that any harm caused by the practice of an illicit act must be repaired proportionately to the injury inflicted on the victim. The use of rating charts for quantification of bodily harm has played an important role in standardizing both the language and criteria, thus allowing one to assess and understand the same situation in a similar fashion. Objective: a) To estimate the mean jaw range of motion of the Brazilian population by associating it with sex, age, height, and facial profile; b) to correlate patients with a normal jaw range of motion with those with mandibular fracture; c) to correlate jaw range of motion in the Portuguese National Rating Chart for Permanent Disability Assessment with that in the Brazilian SUSEP and DPVAT charts; d) to develop a formula for limited mouth opening estimation. Method: A pain perception questionnaire was applied to patients from the control group and to those with mandibular fracture assessed at a hospital in the city of São Paulo, Brazil. Maximum mouth opening was measured with a caliper, whereas middle and lower third measurements were made to determine the type of facial profile. Height was measured using a stadiometer. The data were analyzed statistically and compared with those described in the three rating charts. Results: The mean jaw range of motion was 51.71 mm in male patients and 47.94 mm in female patients, and there was a positive correlation between sex and mouth opening. It was not possible to determine the significance of mouth opening relative to the other variables. In patients with mandibular fracture, the mean jaw range of motion was 38.91 mm for men and 41 mm for women; vehicle motor accidents were the major cause of the trauma; and the mandibular condyle was the most frequently affected site. Conclusion: There was a positive correlation with sex, as men tend to have a greater jaw range of motion than women. There was no significant correlation with age, height, and facial profile. Patients with mandibular fracture have a smaller jaw range of motion than those who fall into normal standards. Brazilian charts, DPVAT and SUSEP, are inefficient in rating dental damage, whereas the Portuguese chart requires some adaptations. The following formulas were developed based on the mean jaw range of motion measurements, and they allow estimating limited mouth opening: LMO=[100-(MO x 1.93)] x 0.3 for men and LMO=[100-(MO x 2.08)] x 0.3 for women.

<p>In a prospective randomised double-blind study eighty patients with MRI verified lumbar disc herniation and corresponding clinical findings underwent microscopic disc removal. The patients were peroperatively given systemic and local corticosteroids or placebo, and followed for 2 years. The hospital stay and time to return to full-time work was significantly shorter in the treatment group. Pain measured as worst pain during the last week was also lower in the corticosteroid group. The results indicate that peroperative treatment with corticosteroids reduces pain and improves the functional outcome in patients operated for lumbar disc herniations.</p><p>To evaluate whether thermal quantitative sensory testing (QST) is applicable in the study of sensory dysfunction in lumbar disc herniations 66 patients with disc herniations underwent thermal QST. We found that thermal QST reflects sensory dysfunction in patients with lumbar disc herniations. However, thermal QST seems to have a poor predictive value for identifying the anatomic location of a herniated lumbar disc.</p><p>Quantitative sensory testing (QST) was used to detect damage to the myelinated A-delta fibres (cold sense) and the unmyelinated C-fibres (warmth sense). Corticosteroids combined with surgery in lumbar disc surgery improved the normalisation for the warmth disturbance compared to the control group. </p><p>A prospective analysis was performed on the predictive value of preoperatively determined lumbar lordosis and flexion for pain and disability in patients treated by microscopic lumbar disc surgery. Preoperative hyperlordosis correlated to more pain postoperatively (p=0.004). In patients with hypoflexion there was an association between hyperlordosis and moderate or severe pain postoperatively (p<0.001). The same outcomes were found for DRI. The stiff and straight back indicates a good outcome of lumbar disc surgery concerning pain and disability. </p>

In a prospective randomised double-blind study eighty patients with MRI verified lumbar disc herniation and corresponding clinical findings underwent microscopic disc removal. The patients were peroperatively given systemic and local corticosteroids or placebo, and followed for 2 years. The hospital stay and time to return to full-time work was significantly shorter in the treatment group. Pain measured as worst pain during the last week was also lower in the corticosteroid group. The results indicate that peroperative treatment with corticosteroids reduces pain and improves the functional outcome in patients operated for lumbar disc herniations. To evaluate whether thermal quantitative sensory testing (QST) is applicable in the study of sensory dysfunction in lumbar disc herniations 66 patients with disc herniations underwent thermal QST. We found that thermal QST reflects sensory dysfunction in patients with lumbar disc herniations. However, thermal QST seems to have a poor predictive value for identifying the anatomic location of a herniated lumbar disc. Quantitative sensory testing (QST) was used to detect damage to the myelinated A-delta fibres (cold sense) and the unmyelinated C-fibres (warmth sense). Corticosteroids combined with surgery in lumbar disc surgery improved the normalisation for the warmth disturbance compared to the control group. A prospective analysis was performed on the predictive value of preoperatively determined lumbar lordosis and flexion for pain and disability in patients treated by microscopic lumbar disc surgery. Preoperative hyperlordosis correlated to more pain postoperatively (p=0.004). In patients with hypoflexion there was an association between hyperlordosis and moderate or severe pain postoperatively (p&lt;0.001). The same outcomes were found for DRI. The stiff and straight back indicates a good outcome of lumbar disc surgery concerning pain and disability.

Objectives. To assess outcome of manual therapy in addition to stay-active care in sub-acute low back pain patients and to investigate the predictive power of pain drawing sketch variables for return to work. Materials and methods. The study was designed as a randomised controlled trial with a factorial design, and included 160 patients with acute or sub-acute low back pain allocated to one of the four treatment groups during 10 weeks. Group 1 received stay-active care only, Group 2 the same treatment as in Group 1 + muscle stretching, Group 3 the same treatment as in Group 2 plus manual therapy, and Group 4 the same treatment as Group 3 plus steroid injections. Outcome included pain intensity, pain extension, functional and health related quality of life variables and return to work. Results. Pain intensity and disability rating improved faster in Groups 3 and 4 than in Groups 1 and 2 (p&lt;0.05 and p&lt;0.05). Also health related quality of life was affected by the treatments given; the more treatment options the better the effect (trend across the groups p&lt;0.05). Pain extension as described on a pain drawing sketch decreased in all groups across the study period. The pain modality ‘numbness’ was the most painful one among patients with no pain radiation. Pain radiation according to the pain drawing sketch was the strongest predictor for return to work (p=0.03, Wald χ2=4.56). Conclusions. The manual therapy concept used in this study reduced pain intensity and disability rating better than the stay active concept. The effects on health related quality of life were greater the larger the number of treatment modalities available. Pain drawing information was significantly correlated with pain and functional variables. Pain radiation according to the pain drawing adds significant information to the prediction of return to work.