Desde os primórdios da Medicina, a grande preocupação do profissional era ser humanista, com conhecimento cultural, sociológico, familiar, psicológico e espiritual do seu paciente. Durante a primeira metade do século XX, houve uma verdadeira explosão de novas técnicas operatórias e de evoluções no campo tecnológico, principalmente durante e logo após as duas grandes guerras mundiais. Novas especialidades, dentre essas a Cancerologia e suas subdivisões, iniciaram técnicas próprias de tratamento cirúrgico. Desde então, os tratamentos impulsionaram a realização de novos métodos de reconstrução dos defeitos produzidos pelas cirurgias, cada vez mais invasivas e mutiladoras. Portanto, além do diagnóstico e tratamento das enfermidades, começou a existir a preocupação com o resultado destes, como o tipo de contribuição e resultados funcionais para o paciente. Nas últimas décadas, houve a necessidade de avaliar a Qualidade de Vida (QV) destes pacientes frente aos tratamentos realizados. As neoplasias malignas de cabeça e pescoço, pela própria localização anatômica, podem acarretar alterações significativas em funções vitais relacionadas à alimentação, comunicação e interação social dos indivíduos afetados. Objetivo: Avaliar a qualidade de vida dos pacientes com neoplasias malignas avançadas de cavidade oral submetidos a operações radicais com intenção curativa, comparando um grupo de pacientes submetidos à reconstrução funcional de mandíbula com um grupo de pacientes nos quais esta reconstrução não foi efetuada. Material e métodos: 47 pacientes matriculados na Seção de Cirurgia de Cabeça e Pescoço do Hospital do Câncer (HCI-INCa), portadores de carcinoma espinocelular (CEC) de cavidade oral, em estádios III e IV, foram submetidos ao tratamento cirúrgico com mandibulectomia segmentar e radioterapia complementar. Todos foram submetidos ao teste de Qualidade de Vida após o tempo mínimo de seis meses do tratamento cirúrgico. A maioria tinha como sitio anatômico da lesão primária mucosa jugal (49%), seguido do rebordo gengival (33%). As avaliações dos dados colhidos foram analisadas utilizando valores médios, medianas, desvios padrões, frequências simples e percentuais. A avaliação foi feita comparando os tipos de reconstrução: pacientes submetidos a mandibulectomia sem reconstrução funcional da mandíbula (Grupo 1) e com reconstrução funcional da mandíbula (Grupo2). O teste aplicado foi o da Universidade de Washington (UW-QOL). Resultados: Inicialmente, foram selecionados 183 pacientes, contudo em apenas 47 (25,7%) pacientes foi possível a realização da entrevista, sendo estes a amostra para o estudo. A maioria dos pacientes do grupo selecionado era do sexo masculino, total de 39 homens (82,9%). A idade média foi de 64,4 anos (25-94 anos). A maioria dos pacientes apresentava estadiamento clínico IV (83%), foram submetidos à radioterapia adjuvante (95,4%). Treze (27,65%) pacientes receberam reconstrução funcional da mandíbula (grupo 2). A média do escore obtido após a avaliação dos questionários foi de 64,6 (50 a 86,83), a média do escore do Grupo 1 foi de 65 e do Grupo 2 foi de 63,1. Os piores escores foram encontrados nos quesitos deglutição ( Grupo 1 escore de 54,13 e Grupo 2 escore de 53,92) e mastigação (Grupo 1 escore de 25 e Grupo 2 escore de 23,08). Não houve diferenças estatisticamente significativas em nenhum quesito quando comparamos os dois grupos. Pacientes com estadiamento clínico III apresentaram a variável idade na data da entrevista mostrou significância clínica e estatística no domínio dor (p=0,049), evidenciando que pacientes com mais de 60 anos relatavam melhor escore do que os com idade inferior a 60 anos na data da entrevista. A situação conjugal foi estatisticamente associada à qualidade de vida no domínio saliva (p=0,045) e clinicamente, nos domínios aparência e ombro. Pacientes com estadiamento clínico III apresentaram clinicamente melhores escores do que os com estádio IV, evidenciando significância estatística no domínio recreação (p = 0,034). Os pacientes com mais de dois anos de tempo transcorrido entre a cirurgia e a entrevista apresentaram melhores escores de qualidade de vida dos que os com menos de dois anos, com significância estatística para os domínios dor (p=0,032), recreação (p=0,034), fala (p=0,046), paladar (p=0,009), ansiedade (p=0,011) e escore composto. Pacientes com menos de 2 anos de tratamento apresentaram pior escore composto, único quesito com significância estatística entre os grupos (p=0,023). Conclusão: Não houve diferenças estatisticamente significativas nos domínios de Qualidade de Vida entre os dois grupos estudados (com reconstrução óssea versus sem reconstrução óssea), pacientes entrevistados 2 anos ou mais após o tratamento apresentaram escores superiores (p=0,023), único dado com diferença estatisticamente significativa / Since the beginning of Medicine, the major concern of the professional was to be humanist, having cultural, sociological, family-related, psychological and spiritual knowledge of his patient. During the first half of the twentieth century there was an explosion of new surgical techniques and developments in the technological field, especially during and after the two world wars. New specialties, among these the Oncology and their subdivisions initiated proper techniques of surgical treatment. Since then the treatments have boosted the implementation of new methods of reconstruction of defects produced by surgery, increasingly invasive and mutilating, therefore, in addition to the diagnosis and treatment of diseases, came into being the concern about the outcome of these, such as the type of contribution and functional results for the patient. Over the last decades there was a need to assess the Quality of Life (QL) of these patients compared to the treatments performed. Malignant neoplasms of the head and neck, by their own anatomical location, may entail significant changes in vital functions related to feeding, communication and social interaction of the affected individuals. Objective: Assessing the quality of life of patients with advanced malignant neoplasms of the oral cavity undergoing radical operations with curative interaction, comparing a group of patients undergoing functional reconstruction of the jaw with a group of patients in whom this reconstruction was not performed. Material and methods: A total of 47 patients enrolled in the Head and Neck Surgery Section of the Cancer Hospital (HCI-INCA). Carriers of squamous cell carcinoma (SCC/CEC) of the oral cavity, in stages III and IV., were submitted to surgical treatment with segmental mandibulectomy and complementary radiotherapy. All were submitted to the Quality of Life test after a minimum period of six months from the surgery. Most had the anatomical site of primary buccal mucosa (49%), followed by gingival border (33%). The assessment of the data collected was analyzed using averages, medians, standard deviations, simple frequencies and percentages. The evaluation was made by comparing the types of reconstruction: patients undergoing mandibulectomy without functional reconstruction of the jaw (Group 1) and functional reconstruction of the jaw (Group 2). The test used was the University of Washington (UW-QOL). Outcome: Initially, 183 patients were selected, but with only 47 (25.7%) patients the interview was possible, which are the sample for the study. Most of the selected group of patients were male, total 39 men (82.9%). The average age was 64.4 years (25-94 year-old). Most of the patients had clinical stage IV (83%), underwent adjuvant radiotherapy (95.4%). Thirteen (27.65%) patients had functional reconstruction of the mandible (Group 2). The mean score obtained after the evaluation of the questionnaires was 64.6 (50 to 86.83), Group 1\'s average score was 65 and Group 2 was 63.1. The worst scores were found in swallowing (Group 1 score of 54.13 and Group 2 score of 53.92) and chewing questions (Group 1 score of 25 and Group 2 score of 23.08). There were no statistically significant differences in any question when we compare the two groups. Patients with clinical stage III presented a variable age at the interview showed clinical and statistical significance in the pain domain (p = 0.049), showing that patients older than 60 years reported better score than under the age of 60 years at the interview. Marital status was statistically associated with quality of life in the saliva domain (p = 0.045) and clinically in the fields appearance and shoulder. Patients with clinical stage III showed clinically better scores than those with stage IV, showing statistical significance in the recreation area (p = 0.034). Patients with more than two years of time between surgery and the interview have better quality of life scores than those with less than two years, with statistical significance for the pain domain (p = 0.032), recreation (p = 0.034 ), speech (p = 0.046), taste (p = 0.009), anxiety (p = 0.011) and composite score. Patients younger than 2 years of treatment had worse composite score, only question statistically significant between groups (p = 0.023). Conclusion: There were no statistically significant differences in the areas of quality of life between the two groups (with bone reconstruction versus without bone reconstruction), patients interviewed two years or more after treatment had higher scores (p = 0.023), only data showing a statistically significant difference

Orientador: Renato Mazzonetto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-12T05:52:39Z (GMT). No. of bitstreams: 1 RodriguezChessa_JaimeGiuseppe_M.pdf: 1416977 bytes, checksum: 2b782ab4c409f0bfb1fc8e34d43c205b (MD5) Previous issue date: 2008 / Resumo: O propósito deste trabalho foi avaliar e comparar a resistência mecânica à flexão de placas e parafusos metálicos e reabsorvíveis para fixação interna rígida. Foram utilizadas hemimandíbulas sintéticas de poliuretano, nas quais se realizou uma osteotomia entre o segundo pré-molar e o primeiro molar inferior, simulando uma fratura de corpo mandibular. Foram estabelecidos dois grupos para placas e parafusos metálicos e dois grupos para reabsorvíveis de acordo com a seguinte disposição: duas placas metálicas mantidas com parafusos monocorticais de 6 mm na zona de tensão e outra com parafusos bicorticais de 12 mm de comprimento na zona de compressão. Após a fixação rígida, foi realizado o teste de resistência à flexão em máquina de ensaio universal (Instron®, modelo 4411) programada com velocidade de deslocamento linear de 1 mm/min e com célula de carga de 500N para obtenção do valor da resistência à flexão em quilograma-força com incidência de carga em região de incisivo e pré-molar em cada um dos grupos estudados. Os resultados demonstraram não existir diferença estatisticamente significante entre os sistemas de fixação interna rígida de titânio e reabsorvível, quando avaliadas as variáveis deslocamento (em mm) e a carga de pico (em kgf) para os 4 grupos amostrais. / Abstract: The meaning of this study was to evaluate and compare the resistance to flexion between metallic and absorbable plates and screws for rigid internal fixation. It was used synthetic hemimandible of polyurethane, in which one was performed a straight cut between second premolar and first molar, simulating a breaking of mandibular body. It was established two groups for metallic plates and screws and two groups for absorbable according to following disposal: two metallic plates kept with 6mm monocortical screws in the tension zone and another one with 12mm bicortical screws in the compression zone. After the rigid fixation, it was carried out the flexion resistance test thru a universal assay machine (Instron®, model 4411) performed with 1mm/minute linear displacement speeding with 500N of bearing cell for attainment the flexion resistance value in kilogram-force with the load incidence in the incisor and premolar regions on each group studied. The results had demonstrated to not exist statistical significant difference between the titanium and absorbable systems, when evaluated the variable displacement (in mm) and the peak load (in kgf) for the 4 groups tested. / Mestrado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Mestre em Clínica Odontológica

Orientador: Luciana Asprino / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-20T21:58:02Z (GMT). No. of bitstreams: 1 Freire_SimeiAndredaSilvaRodrigues_D.pdf: 1346412 bytes, checksum: 35f4f1e8f5181ebc1bf60768170c3f2c (MD5) Previous issue date: 2012 / Resumo: O objetivo desse trabalho foi avaliar a epidemiologia e características do tratamento de fraturas de mandíbula atrófica; comparar a resistência mecânica e a distribuição de tensões de três técnicas de fixação interna aplicadas em fraturas de mandíbulas atróficas. CAPÍTULO I: Dados foram coletados de pacientes vítimas de fraturas em mandíbulas atróficas em um período de dez anos (1999-2009). Os dados analisados continham informações demográficas e socioeconômicas, etiologia dos traumas, diagnóstico, tipos de traumas, deslocamento das fraturas, o método de fixação utilizado, região das fraturas, traumas associados, tempo decorrido entre o trauma e tratamento. A principal causa das fraturas em mandíbulas atróficas foi a queda da própria altura, acometendo principalmente pacientes do gênero masculino desempregados. A faixa etária mais acometida foi a de trinta a sessenta anos ocorrendo predominantemente fraturas bilaterais na região de corpo mandibular. CAPÍTULO II: Avaliou-se a resistência, in vitro, por meio de testes de carregamento linear a fixação de fraturas de mandíbulas atróficas com defeito de continuidade por meio de três sistemas de fixação. Foram utilizadas réplicas de mandíbulas humanas atróficas de poliuretano submetidas a simulação de fratura com defeito de continuidade de 15mm em corpo direito, fixadas pelos seguintes sistemas: Grupo 1 - sistema 2,4mm conventional, Grupo 2 - sistema 2,4 mm com travamento e Grupo 3 - sistema 2,0mm com travamento. Pelos resultados obtidos o sistema com travamento aumentou a resistência da fixação pela melhor e mais favorável distribuição de cargas, os sistemas 2,4mm de fixação interna estável testados apresentaram adequada resistência mecânica para tratamento de fraturas de mandíbulas atróficas com defeito de continuidade. CAPÍTULO III: Avaliou-se, in sílico, pelo método de elementos finitos a fixação de fraturas de mandíbulas atróficas por meio de três sistemas de fixação submetidas a testes de carregamento linear. Os modelos criados em elementos finitos de fratura de mandíbula atrófica foram fixados pelos seguintes sistemas, sistema 2,4mm convencional, sistema 2,4mm com travamento e sistema 2,0mm com travamento. Pelos resultados obtidos o sistema 2,4mm convencional demonstrou suportar toda carga aplicada nesta simulação, os sistemas com travamento apresentaram dissipação das tensões para região anterior e posterior da mandíbula e no sistema de fixação convencional as tensões se localizaram na porção entre os furos do sistema de fixação assim como no sistema com travamento, porém este ainda apresentou dissipação para os parafusos, com concentração crescente para região apical dos parafusos próximos a simulação do traço de fratura / Abstract: The aim of this study was to evaluate the epidemiology and treatment characteristics of atrophic mandibular fractures; to compare the mechanical strength and stress distribution of three internal fixation techniques applied in atrophic mandibles fractures treatment. CHAPTER I: Data were collected from patients suffering from atrophic mandibles fractures in a period of ten years (1999-2009). The data analyzed contained demographic and socioeconomic characteristics, etiology of trauma, diagnosis, types of trauma, displacement of the fractures, the region of fracture, associated trauma, time elapsed between trauma and treatment. The main cause of fractures in atrophic mandibles was fall accidents, affecting mainly male unemployed patients. The age group most affected was between thirty to sixty years occurring bilateral fractures predominantly in the mandibular body region. CHAPTER II: Resistance was evaluated in vitro by linear loading test in the atrophic mandible fracture simulation with continuity defect by three stable internal fixation systems. It was used replicas of human atrophic polyurethane mandible subjected to simulated fracture defect continuity of 15mm in right body region, fixed by the following systems: Group 1 - 2.4mm conventional system, Group 2 - 2.4 mm locking system and Group 3 - 2.0mm locking system. The results obtained with the locking system increased the resistance setting for the better and more favorable load distribution, the 2.4mm stable internal fixation systems tested had adequate mechanical strength for the treatment of fractures of atrophic mandibles with continuity defects. CHAPTER III: It was evaluated ,in silico, by the method of finite elements with linear force three stable internal fixation systems for the treatment of atrophic mandible fractures. The finite element models created in the atrophic mandible fracture were fixed by the following systems, the conventional system 2.4mm, 2.4mm locking system and 2.0mm locking system. The results obtained demonstrated that the locking system increased the resistance by a favorable and better distribution of the stresses during the loading test when applied in atrophic mandible fractures with continuity defects. The three internal fixation systems tested in this study showed adequate mechanical efficiency to be applied in atrophic mandible fractures with continuity defects treatment / Doutorado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Doutor em Clínica Odontológica

>Magister Scientiae - MSc / Sex determination of human remains is often a dilemma for forensic experts due to the decomposing factor, or, if only part of a body is found. The analysis of DNA is thought to be the most accurate method for sex determination, but the cost and time involvement usually causes a delay in the identification process and in some cases, DNA is not obtainable due to the state of decomposition or contamination. Sexual dimorphism refers to the difference in shape, form or appearance between male and females in the same species. It can also be described as the systematic difference between individuals of different sex in the same species. Dimorphism in the human skeletal system and dentition is well establish. It is generally assumed that the male dentition is larger than the female dentition. In this study, the mesio-distal width of the maxillary incisors and canines, as well as the mandibular canines were measured. Orthodontic study models were used in this study, 50 males and 50 females, in which the sizes of the maxillary central incisors, maxillary lateral incisors, and maxillary and mandibular canines were measured. The results showed that the sizes of the maxillary and the mandibular canines were significantly more accurate in determining sexual dimorphism than the incisors. The logistic regression model, using tooth 13 and 33, provides prediction accuracy of 52% for males and 74% for females.

Abstract Neurosensory disturbance is a common complication of bilateral sagittal split osteotomy (BSSO). This study focuses on the evaluation of factors affecting neurosensory disturbance after BSSO. Furthermore, the study focuses on the measurement of neurosensory disturbance with easily available bedside tests, not only on evaluating the state of sensory disturbance at each follow-up, but also on predicting the potential for recovery. Moreover, panoramic radiography, computerized tomography (CT) and conventional spiral tomography are assessed on locating the mandibular canal. The study was carried out involving a total of 50 patients undergoing BSSO for the correction of mandibular deficiency. In addition, 20 voluntary healthy students participated in this study. Questionnaires, a battery of neurosensory tests and preoperative imaging of the mandibular canal were used. A high incidence of neurosensory disturbance of the lower lip and chin was found after BSSO. However, recovery of sensation occurred with increasing frequency during the follow-up, and after one year sensation of the lower lip and chin returned to the presurgical situation in most patients. A prolonged neurosensory disturbance was more frequent in older patients, in large surgical movements of the mandible and in cases where the inferior alveolar nerve was manipulated during surgery. The bedside tests used in this study correlated well with the patients' subjective evaluation of neurosensory disturbance, and the repeatability of these tests was good. Furthermore, the sensibility testing of the mandibular teeth correlated well with the other tests and patient's subjective evaluation. Four days after surgery, sensibility testing of the mandibular teeth was an efficient test alone to predict the recovery from neurosensory disturbance. On radiographic imaging, the risk for neurosensory disturbance after BSSO could not be predicted from the panoramic radiograph. Before BSSO, CT was the best method to visualize the buccolingual location of the mandibular canal. After BSSO, a clinical follow-up using a battery of mechano- and nociceptive tests in the examination of sensation of the lower lip and chin, sensibility testing of the teeth, and subjective evaluation is needed. CT should be a part of treatment planning of the patients with thin rami or severe asymmetries of the mandible.

Magister Scientiae Dentium - MSc(Dent) / Sexual identification of immature skeletal remains is still a complicated issue to solve in Forensic Anthropology. Sexual dimorphism is the condition where the two sexes of the same species exhibit different characteristics beyond the differences in their sexual organs. (1) The aim of this study is to evaluate the existence of sexual dimorphism in mandibular first molars. The base sample of the study includes 300 Sudanese (150 males and 150 females). Their ages ranged from 17 to 55. The mesio-buccal (MB) disto-lingual (DL) and the mesio-lingual (ML) disto-buccal (DB) surfaces of the mandibular first molars were measured using a digital Vernier caliper on plaster of Paris study casts. The data was analyzed using the t-test. The results showed statistically significant sexual dimorphisms in male and female odontometric features. The mean values of the parameters were greater in males than in females in both (MBDL and MLDB) with greater sexual dimorphism in the MBDL (MBDL dimorphism =28.672 %) than the MLDB (MLDB dimorphism =21.596 %). Conclusion: Sexual dimorphism of 1st molar teeth can aid in the identification of skeletal remains of Sudanese origin.

Evalúa los efectos del aumento de la dimensión vertical oclusal (DVO) en la sonrisa y la posición del cóndilo mandibular. Elabora topes de silicona rígida que aumentaban 2 y 4 mm la DVO para 30 sujetos entre 20 y 30 años de edad. Utiliza la prueba de ANOVA de medidas repetidas y posteriormente el análisis post hoc de Scheffé. Halla diferencias estadísticamente significativas en la altura interlabial y la distancia borde incisal-labio inferior, las cuales se incrementaban con los aumentos de la DV, mientras que el índice de sonrisa disminuía. Encuentra diferencias estadísticamente significativas en los espacios articulares superior, anterior y posterior en los cortes central, medial y lateral al aumentar la DVO. Evidencia variaciones en las dimensiones de la sonrisa al aumentar la DVO. La variación de espacios articulares demuestra movimientos de rotación y traslación condilar al aumentar la DVO 2 y 4 mm. / Tesis

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Previous research indicates that overall, bone turnover decreases with age. The effects of aging on the remodeling of the mandibular condyle have not been studied. As part of the temporomandibular joint, the mandibular condyle (MC) is exposed to a unique pattern of loading. As such, data obtained from studies of other bones may not be applicable to accurately explain the behavior of trabecular bone of the mandibular condyle and its relationship to aging. Recent research has led to the finding that cortical bone turnover in the mandible is much higher than that seen in tibia, and that both sites decline with age. The purpose of this study was to histomorphometrically quantify the effects of aging on the bone remodeling of the canine MC, and to determine whether site-specific differences due to age occur in the dynamic and static parameters between MC and tibial condyle (TC). Fluorochrome labels were used to mark sites of bone formation in ten old and five young dogs. Specimens were obtained from one MC and one TC for each dog and were prepared for analysis of static and dynamic histomorphometric indices. Mineral apposition and bone formation were totally absent in the old group, as shown by the lack of fluorochrome labels. In the young group, they were significantly higher in the MC than in the TC (p < 0.01). Aging resulted in a significant increase of volume density of the subchondral bone (p < 0.05). Trabecular bone volume was not significantly affected by age in the samples studied. The results indicate that bone remodeling is markedly higher in MC than in the TC in young dogs. With aging, it declines to zero in both sites. Whether the loss of remodeling activity in these elderly animals indicates that they are fully adapted to their mechanical environment or that they have lost the intrinsic ability to remodel, remains to be determined.

No description available.