O aumento da procura pela reabilitação de rebordos desdentados com cirurgias reconstrutivas e implantes osseointegráveis, faz com que se torne necessário um estudo mais detalhado das características anatômicas dos ossos maxilares e suas possíveis variações. Neste contexto, a fixação zigomática é uma alternativa aos enxertos ósseos para a reabilitação de rebordos maxilares atróficos, onde altura e largura da crista óssea insuficientes impedem a instalação de implantes convencionais. As variações da anatomia do osso zigomático indicam a necessidade de um planejamento tridimensional. O exame por tomografia computadorizada de feixe-cônico (TCFC) se mostra adequado para exame das estruturas ósseas maxilofaciais e ainda apresenta vantagens como baixo custo e menor dose de radiação quando comparada à tomografia computadorizada helicoidal. Este estudo, composto de duas amostras independentes, se propôs a avaliar aspectos relacionados à anatomia do osso zigomático (OZ) e, mais especificamente, o forame zigomático-facial (FZF), em pacientes e em crânios macerados. Em um primeiro momento, foram avaliadas, retrospectivamente, imagens de TCFC de 40 pacientes (80 ossos zigomáticos), obtidas pelo aparelho i-CAT Classic®. Foram observados a presença e número do FZF, quando presente; avaliada a espessura média do OZ e delimitada uma região no osso zigomático a partir de pontos antropométricos Jugale (Ju) e Zigomaxilare (Zm), para dimensionar o local de inserção de implantes zigomáticos, em valores de área e volume. A incidência de um único forame foi observada em 40% dos ossos zigomáticos (n=32), dois forames em 20% (n=16), e três em 3,75% dos OZs (n=3). Em 36,25% dos ossos zigomáticos (n=29), o forame estava ausente. A espessura média do OZ encontrada foi de 10,3mm, variando de 5,45mm a 16,8mm. A área e volume médios para instalação de implantes zigomáticos foi de 147,93mm2 e 1102,9 mm3, respectivamente. Em um segundo momento, foram estudados 151 crânios macerados, totalizando 302 ossos zigomáticos, quanto à presença e número do FZF, quando presente, e a incidência encontrada foi de um forame em 44% dos ossos zigomáticos (n=133), dois forames em 28% (n=86), e três em 8% dos OZ (n=24). Em 19% dos ossos zigomáticos (n=57), o forame estava ausente e em 2 casos apenas haviam quatro forames (1%). Destes 151 crânios, 20 foram selecionados aleatoriamente para mensuração do diâmetro desses FZF, e posteriormente os mesmos foram submetidos à TCFC para que se avaliasse a acurácia deste exame em mostrar esta estrutura anatômica (FZF). A média de diâmetro encontrada foi de 0,57mm (±0,27mm). Todos os forames, mesmo os de menor calibre puderam ser observados nos cortes tomográficos. Os resultados levam a concluir que o exame tridimensional do osso zigomático é de extrema importância quando se pretende intervir nesta região, dada a sua variabilidade anatômica, e que a tomografia computadorizada de feixe cônico se mostrou adequada para esta finalidade. / The increased demand for rehabilitation of edentulous ridges with reconstructive surgery and dental implants, does it become necessary a more detailed study of the anatomical features of the jaws and their possible variations. In this context, the zygomatic implants are an alternative to bone grafting in the rehabilitation of atrophic maxillary ridges, where insufficient height and width of the bony crest prevent the installation of conventional implants. The variation in the anatomy of the zygomatic bone indicates the need for a three-dimensional planning system. Examination by cone-beam computed tomography scan is more appropriate for a thorough examination of the maxilofacial structures and has advantages as low cost and less radiation dose compared with convencional computed tomography. This study, composed of two independent samples, aimed to evaluate aspects related to the anatomy of the zygomatic bone and more specifically, the zygomatic-facial foramen in patients and in macerated skulls. At first, were evaluated, retrospectively, the CBCT images of 40 patients (80 zygomatic bones), obtained by the apparatus i-CAT Classic®. Were observed the presence and number of ZFF, when present, evaluated the average thickness of ZB and mapped an area on the zygomatic bone from anthropometric points Jugale and Zigomaxilare to scale the approximate area of insertion of zygomatic implants, in area values and volume. The incidence of a single foramen was found in 40% of zygomatic bone (n = 32), two foramen in 20% (n = 16) and three at 3.75% ZB (n = 3). In 36.25% of the zygomatic bone (n = 29), the foramen was absent. The average thickness of ZB was found to be 10.3 mm, ranging from 5.45 mm to 16.8 mm. The average area and volume for installation of zygomatic implants was 147.93 mm2 mm3 and 1102.9, respectively. In a second step, were studied 151 macerated skulls, totaling 302 zygomatic bones regarding to the presence and number of ZFF were evaluated, when present, and the incidence found was a foramen in 44% of the zygomatic bone (n = 133), two foramina in 28 % (n = 86) and three in 8% of ZB (n = 24). In 19% of zygomatic bone (n = 57) the foramen was absent and in only 2 cases had four foramen (1%). Of these 151 skulls, 20 were randomly selected for measuring the diameter of ZFF, and later they were submitted to CBCT in order to assess the accuracy of this exame to show this anatomical structure (ZFF). The average diameter was found to be 0.57 mm (± 0.27 mm). All foramen, even with smaller diameters were observed in tomography slices. The results support a conclusion that the tridimensional exam of the zygomatic bone is extremely important when it intends to intervene in this region, in view of the anatomical variability, and that the CBCT is more suitable for this purpose.

O aumento da procura pela reabilitação de rebordos desdentados com cirurgias reconstrutivas e implantes osseointegráveis, faz com que se torne necessário um estudo mais detalhado das características anatômicas dos ossos maxilares e suas possíveis variações. Neste contexto, a fixação zigomática é uma alternativa aos enxertos ósseos para a reabilitação de rebordos maxilares atróficos, onde altura e largura da crista óssea insuficientes impedem a instalação de implantes convencionais. As variações da anatomia do osso zigomático indicam a necessidade de um planejamento tridimensional. O exame por tomografia computadorizada de feixe-cônico (TCFC) se mostra adequado para exame das estruturas ósseas maxilofaciais e ainda apresenta vantagens como baixo custo e menor dose de radiação quando comparada à tomografia computadorizada helicoidal. Este estudo, composto de duas amostras independentes, se propôs a avaliar aspectos relacionados à anatomia do osso zigomático (OZ) e, mais especificamente, o forame zigomático-facial (FZF), em pacientes e em crânios macerados. Em um primeiro momento, foram avaliadas, retrospectivamente, imagens de TCFC de 40 pacientes (80 ossos zigomáticos), obtidas pelo aparelho i-CAT Classic®. Foram observados a presença e número do FZF, quando presente; avaliada a espessura média do OZ e delimitada uma região no osso zigomático a partir de pontos antropométricos Jugale (Ju) e Zigomaxilare (Zm), para dimensionar o local de inserção de implantes zigomáticos, em valores de área e volume. A incidência de um único forame foi observada em 40% dos ossos zigomáticos (n=32), dois forames em 20% (n=16), e três em 3,75% dos OZs (n=3). Em 36,25% dos ossos zigomáticos (n=29), o forame estava ausente. A espessura média do OZ encontrada foi de 10,3mm, variando de 5,45mm a 16,8mm. A área e volume médios para instalação de implantes zigomáticos foi de 147,93mm2 e 1102,9 mm3, respectivamente. Em um segundo momento, foram estudados 151 crânios macerados, totalizando 302 ossos zigomáticos, quanto à presença e número do FZF, quando presente, e a incidência encontrada foi de um forame em 44% dos ossos zigomáticos (n=133), dois forames em 28% (n=86), e três em 8% dos OZ (n=24). Em 19% dos ossos zigomáticos (n=57), o forame estava ausente e em 2 casos apenas haviam quatro forames (1%). Destes 151 crânios, 20 foram selecionados aleatoriamente para mensuração do diâmetro desses FZF, e posteriormente os mesmos foram submetidos à TCFC para que se avaliasse a acurácia deste exame em mostrar esta estrutura anatômica (FZF). A média de diâmetro encontrada foi de 0,57mm (±0,27mm). Todos os forames, mesmo os de menor calibre puderam ser observados nos cortes tomográficos. Os resultados levam a concluir que o exame tridimensional do osso zigomático é de extrema importância quando se pretende intervir nesta região, dada a sua variabilidade anatômica, e que a tomografia computadorizada de feixe cônico se mostrou adequada para esta finalidade. / The increased demand for rehabilitation of edentulous ridges with reconstructive surgery and dental implants, does it become necessary a more detailed study of the anatomical features of the jaws and their possible variations. In this context, the zygomatic implants are an alternative to bone grafting in the rehabilitation of atrophic maxillary ridges, where insufficient height and width of the bony crest prevent the installation of conventional implants. The variation in the anatomy of the zygomatic bone indicates the need for a three-dimensional planning system. Examination by cone-beam computed tomography scan is more appropriate for a thorough examination of the maxilofacial structures and has advantages as low cost and less radiation dose compared with convencional computed tomography. This study, composed of two independent samples, aimed to evaluate aspects related to the anatomy of the zygomatic bone and more specifically, the zygomatic-facial foramen in patients and in macerated skulls. At first, were evaluated, retrospectively, the CBCT images of 40 patients (80 zygomatic bones), obtained by the apparatus i-CAT Classic®. Were observed the presence and number of ZFF, when present, evaluated the average thickness of ZB and mapped an area on the zygomatic bone from anthropometric points Jugale and Zigomaxilare to scale the approximate area of insertion of zygomatic implants, in area values and volume. The incidence of a single foramen was found in 40% of zygomatic bone (n = 32), two foramen in 20% (n = 16) and three at 3.75% ZB (n = 3). In 36.25% of the zygomatic bone (n = 29), the foramen was absent. The average thickness of ZB was found to be 10.3 mm, ranging from 5.45 mm to 16.8 mm. The average area and volume for installation of zygomatic implants was 147.93 mm2 mm3 and 1102.9, respectively. In a second step, were studied 151 macerated skulls, totaling 302 zygomatic bones regarding to the presence and number of ZFF were evaluated, when present, and the incidence found was a foramen in 44% of the zygomatic bone (n = 133), two foramina in 28 % (n = 86) and three in 8% of ZB (n = 24). In 19% of zygomatic bone (n = 57) the foramen was absent and in only 2 cases had four foramen (1%). Of these 151 skulls, 20 were randomly selected for measuring the diameter of ZFF, and later they were submitted to CBCT in order to assess the accuracy of this exame to show this anatomical structure (ZFF). The average diameter was found to be 0.57 mm (± 0.27 mm). All foramen, even with smaller diameters were observed in tomography slices. The results support a conclusion that the tridimensional exam of the zygomatic bone is extremely important when it intends to intervene in this region, in view of the anatomical variability, and that the CBCT is more suitable for this purpose.

abstract: Craniofacial morphology in primates can vary on the basis of their diet because foods are often disparate in the amount and duration of force required to break them down. Therefore diet has the potential to exercise considerable selective pressure on the morphology of the masticatory system. The zygomatic arch is a known site of relatively high masticatory strain and yet the relationship between arch form and load type is relatively unknown in primates. While the relative position and robusticity of the arch is considered a key indicator of craniofacial adaptations to a mechanically challenging diet, and central to efforts to infer diet in past species, the relationships between morphology and diet type in this feature are not well established. This study tested hypotheses using two diet categorizations: total consumption percent and food material properties (FMPs). The first hypothesis that cortical bone area (CA) and section moduli (bone strength) are positively correlated with masticatory loading tests whether CA and moduli measures were greatest anteriorly and decreased posteriorly along the arch. The results found these measures adhered to this predicted pattern in the majority of taxa. The second hypothesis examines sutural complexity in the zygomaticotemporal suture as a function of dietary loading differences by calculating fractal dimensions as indices of complexity. No predictable pattern was found linking sutural complexity and diet in this primate sample, though hard object consumers possessed the most complex sutures. Lastly, cross-sectional geometric properties were measured to investigate whether bending and torsional resistance and cross-sectional shape are related to differences in masticatory loading. The highest measures of mechanical resistance tracked with areas of greatest strain in the majority of taxa. Cross-sectional shape differences do appear to reflect dietary differences. FMPs were not correlated with cross-sectional variables, however pairwise comparisons suggest taxa that ingest foods of greater stiffness experience relatively larger measures of bending and torsional resistance. The current study reveals that internal and external morphological factors vary across the arch and in conjunction with diet in primates. These findings underscore the importance of incorporating these mechanical differences in models of zygomatic arch mechanical behavior and primate craniofacial biomechanics. / Dissertation/Thesis / Appendix A / Appendix B / Appendix D / Doctoral Dissertation Anthropology 2017

Abstract This study focuses on the development of a bone collecting device for intra-oral bone harvesting and on the introduction of a new bone graft donor site, zygomatic bone. A bone collector was constructed and tested in vitro. This bone collector is suitable and efficient in dental implant related bone grafting surgery. It was also found to be more efficient and with a larger capacity in bone harvesting when compared to the two commercially available bone collectors. A zygomatic bone harvesting technique is introduced in this study. The safety and morbidity of the method was assessed in a cadaver and a prospective clinical study. In the cadaver study, 40 procedures were performed. The complications during the cadaver harvesting included 15 perforations into the maxillary sinus and 7 perforations into the infratemporal fossa. The only intra-operative complication in 32 clinical operations was perforation of the maxillary sinus in 33% of the zygomatic sites. None of these patients experienced any post-operative problems related to the perforation. Patients needed pain medication for a mean time of four days and they did not demonstrate any paresthesias or altered sensations in the donor area. The yield of the bone graft from zygomatic bone was quantified in cadaver and clinical studies. In the cadaver study, the average yield of the graft was 0.59 ml. In the clinical study the average graft volume was 0.90 ml. The required reconstructions were accomplished in all clinical cases. In the prospective clinical study, the bone grafts from the zygomatic bone were used simultaneously with one-stage dental implants placement. Bone grafting was employed at 72 of the 82 implant sites. Two of the bone grafted implants failed, yielding a survival rate of 97.2% for bone grafted implants and 97.6% for the whole study group. Grafted sites healed remarkably well, and no obvious signs of graft resorption were noted during the 26.9 months follow-up period. The bone collector developed in this study is an effective instrument in intra-oral bone harvesting. The zygomatic bone can be regarded as a safe bone harvesting donor site and the yield of bone graft from this area is sufficient for moderate defects in resorbed alveolar ridges.

We present surgical clipping of a giant middle cerebral artery aneurysm. The patient is a 64-year-old woman who suffered subarachnoid hemorrhage in 2005. She was treated with coiling of the aneurysm at an outside institution. She presented to our clinic with headaches and was found on angiography to have giant recurrence of the aneurysm. To allow adequate exposure for clipping, we performed the surgery through a cranio-orbito-zygomatic (COZ) skull base approach, which is demonstrated. The surgery was performed in an operating room/angiography hybrid suite allowing for high quality intraoperative angiography. The technique and room flow are also demonstrated.

Introduction: Zygomatic fractures form a major entity in craniomaxillofacial traumatology. Few studies have dealt with biomechanical basics and none with the role of the facial soft tissues. Therefore this study should investigate, whether facial soft tissue plays a protecting role in lateral midfacial trauma.

Made available in DSpace on 2015-05-14T12:56:07Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 801421 bytes, checksum: 4440d1e021758c701533d36507d5edd3 (MD5) Previous issue date: 2009-12-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Ocular trauma is a relatively frequent condition in Urgency and Emergency Services, being many times associated to facial skeleton fractures. This study aims to evaluate the prevalence of ocular lesions in patient victims of facial trauma involving maxilla or zygomaticomaxillary complex. This is a prospective, cross-sectional study, composed of facial trauma victims subjects admitted to an Oral and Maxillofacial Surgery Service of Emergency and Trauma Hospital - Senador Humberto Lucena (João Pessoa - PB), from may to october 2009. The sample consisted of 100 patients. The mean age was 32,54 years. The most common etiology of trauma was motorcycle accident (41%), followed by physical aggression (14%). The most commom type of fracture was zygomaticomaxillary complex fracture, 26 patients in group 1 and 20 in group 2 and the prevalence of maxillary fractures was Le fort I in 8, Le Fort II in 4 and Le Fort III in 10 patients. Presence of fracture and concomintant ocular lesion represented 83% of all patients with ocular lesion. Subconjunctival hemorrhage was the most common lesion (43%), followed by Lack of the pupillary reflex (5%), reduction visual acuity (5%) and diplopia (2%). Facial trauma involving maxilla and zygomaticomaxillary complex associated to fractures of these structures increases the prevalence of ocular lesion. / O trauma ocular é uma condição relativamente frequente em Serviços de atendimento a Urgência e Emergência, estando muitas vezes associado à fraturas do esqueleto facial. Este estudo tem o objetivo de avaliar a prevalência de lesões oculares em vítimas de trauma facial envolvendo a maxila e/ou complexo zigomático-maxilar. É um estudo do tipo prospectivo, transversal, em pacientes que deram entrada no Serviço de Cirurgia e Traumatologia Buco- Maxilo-Facial do Hospital de Emergência e Trauma - Senador Humberto Lucena (João Pessoa - PB), durante o período de maio a outubro de 2009. A amostra consistiu em 100 pacientes com idade média de 32,54 anos. A etiologia mais frequente do trauma foi acidente motociclístico (41%), seguido por agressão física (14%). O tipo de fratura mais frequente foi do complexo zigomatico-maxilar, tendo o grupo 1: 26 pacientes e o grupo 2: 20. Quanto às fraturas de maxila, as Le Fort I corresponderam à 8, Le Fort II à 4 e Le Fort III à 10. Os pacientes com fratura e lesão ocular concomitante representaram 83% de todos os pacientes com lesão ocular. Hemorragia subconjuntival foi a lesão ocular mais freqüente (43%), seguida por diminuição do reflexo pupilar (5%), diminuição da acuidade visual (5%) e diplopia (2%). Concluiu-se que o trauma facial envolvendo maxila e complexo zigomático-maxilar associado à fratura dessas estruturas aumentam a prevalência de lesões oculares.

Este estudo avaliou a força de mordida, eletromiografia e mobilidade mandibular em pacientes submetidos à cirurgia para tratamento de fraturas que acometeram, isoladamente, a mandíbula e o complexo zigomático-orbitário. A força de mordida foi registrada por meio de gnatodinamômetro na região dos molares do lado da fratura e contra-lateral e entre os incisivos centrais. Os sinais eletromiográficos foram captados dos músculos masseteres e temporais. A mobilidade mandibular foi avaliada por mensuração, com paquímetro digital, da abertura bucal, lateralidade direita e esquerda, e na protrusão mandibular, todos em amplitude máxima. A amostra foi constituída por três grupos: Grupo 1 - Controle (sem fratura avaliação única) com 12 indivíduos; Grupo 2 - Fratura mandibular, com 8 indivíduos; Grupo 3 - Fratura do complexo zigomático-orbitário (CZO), com 5 indivíduos. As fraturas foram tratadas cirurgicamente por meio de FIR (fixação interna rígida) em todos os casos, utilizando-se acessos intra e ou extrabucais. O tempo de acompanhamento foi de 2 meses para o grupo 2 e para o grupo 3 foram 6 meses. Nas avaliações realizadas, os grupos 2 e 3, apresentaram redução da força de mordida, e elevação da atividade eletromiográfica nos períodos pós operatórios iniciais. No entanto atingiram padrão de normalidade a partir do 2º mês de pós operatório. Quanto à mobilidade mandibular, a mesma se apresentou diferentemente nos dois grupos, sendo que para o grupo 2, ela mostrou redução da amplitude de todos os movimentos mandibulares avaliados, retomando padrão de normalidade no 2º mês pós operatório. Já para o grupo 3, apenas a abertura bucal máxima mostrou-se reduzida e retomou padrão de normalidade no 1º mês pós operatório. / This study evaluated the bite force, electromyography and jaw mobility in patients undergoing surgery for treatment of fractures that attacked alone, the mandible and the zygomatic-orbital complex. The bite force was recorded by gnathodynamometer in the region of the molars on the side of the fracture and contralateral side and between the central incisors. The electromyographic signals were captured of masseter and temporal muscles. The mandibular mobility was assessed by measuring with a digital caliper, mouth opening, right and left laterality, and protruding jaw, all in the maximum amplitude. The sample consisted of three groups: Group 1 - Control (without fracture - ranking only) with 12 subjects, Group 2 - mandibular fracture, with 8 subjects and Group 3 - Fracture of the zygomatic-orbital complex (CZO), with 5 individuals. The fractures were treated surgically by means of FIR (internal fixation) in all cases, using access and intra or extraoral. The follow up was 2 months for group 2 and group 3 was 6 months. In the assessments, groups 2 and 3 had a reduction of bite force, and increased EMG activity in the early postoperative period. However reached normal range from 2 months postoperatively. The jaw mobility, it is presented differently in two groups, in Group 2, it showed a reduction in the amplitude of all mandibular movements measured, resuming normal pattern in the 2 months after surgery. As for group 3, only maximum mouth opening was reduced and resumed normal range at 1 month postoperatively.

Este estudo avaliou a força de mordida, eletromiografia e mobilidade mandibular em pacientes submetidos à cirurgia para tratamento de fraturas que acometeram, isoladamente, a mandíbula e o complexo zigomático-orbitário. A força de mordida foi registrada por meio de gnatodinamômetro na região dos molares do lado da fratura e contra-lateral e entre os incisivos centrais. Os sinais eletromiográficos foram captados dos músculos masseteres e temporais. A mobilidade mandibular foi avaliada por mensuração, com paquímetro digital, da abertura bucal, lateralidade direita e esquerda, e na protrusão mandibular, todos em amplitude máxima. A amostra foi constituída por três grupos: Grupo 1 - Controle (sem fratura avaliação única) com 12 indivíduos; Grupo 2 - Fratura mandibular, com 8 indivíduos; Grupo 3 - Fratura do complexo zigomático-orbitário (CZO), com 5 indivíduos. As fraturas foram tratadas cirurgicamente por meio de FIR (fixação interna rígida) em todos os casos, utilizando-se acessos intra e ou extrabucais. O tempo de acompanhamento foi de 2 meses para o grupo 2 e para o grupo 3 foram 6 meses. Nas avaliações realizadas, os grupos 2 e 3, apresentaram redução da força de mordida, e elevação da atividade eletromiográfica nos períodos pós operatórios iniciais. No entanto atingiram padrão de normalidade a partir do 2º mês de pós operatório. Quanto à mobilidade mandibular, a mesma se apresentou diferentemente nos dois grupos, sendo que para o grupo 2, ela mostrou redução da amplitude de todos os movimentos mandibulares avaliados, retomando padrão de normalidade no 2º mês pós operatório. Já para o grupo 3, apenas a abertura bucal máxima mostrou-se reduzida e retomou padrão de normalidade no 1º mês pós operatório. / This study evaluated the bite force, electromyography and jaw mobility in patients undergoing surgery for treatment of fractures that attacked alone, the mandible and the zygomatic-orbital complex. The bite force was recorded by gnathodynamometer in the region of the molars on the side of the fracture and contralateral side and between the central incisors. The electromyographic signals were captured of masseter and temporal muscles. The mandibular mobility was assessed by measuring with a digital caliper, mouth opening, right and left laterality, and protruding jaw, all in the maximum amplitude. The sample consisted of three groups: Group 1 - Control (without fracture - ranking only) with 12 subjects, Group 2 - mandibular fracture, with 8 subjects and Group 3 - Fracture of the zygomatic-orbital complex (CZO), with 5 individuals. The fractures were treated surgically by means of FIR (internal fixation) in all cases, using access and intra or extraoral. The follow up was 2 months for group 2 and group 3 was 6 months. In the assessments, groups 2 and 3 had a reduction of bite force, and increased EMG activity in the early postoperative period. However reached normal range from 2 months postoperatively. The jaw mobility, it is presented differently in two groups, in Group 2, it showed a reduction in the amplitude of all mandibular movements measured, resuming normal pattern in the 2 months after surgery. As for group 3, only maximum mouth opening was reduced and resumed normal range at 1 month postoperatively.

Introduction: Zygomatic fractures form a major entity in craniomaxillofacial traumatology. Few studies have dealt with biomechanical basics and none with the role of the facial soft tissues. Therefore this study should investigate, whether facial soft tissue plays a protecting role in lateral midfacial trauma.