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Globally, pre-eclampsia and eclampsia are major contributors to maternal and perinatal mortality; of which the vast majority of deaths occur in less developed countries. In addition, a disproportionate number of morbidities and mortalities occur due to delayed access to health services. The Community Level Interventions for Pre-eclampsia (CLIP) Trial aims to task-shift to community health workers the identification and emergency management of pre-eclampsia and eclampsia to improve access and timely care. Literature revealed paucity of published feasibility assessments prior to initiating large-scale community-based interventions. Arguably, well-conducted feasibility studies can provide valuable information about the potential success of clinical trials prior to implementation.

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This study reports on the quality of mental healthcare delivered to rural and urban Department of Veterans Affairs (VA) patients across COVID-19 pandemic. This is a retrospective study using VA medical records between 3/10/2019 and 9/22/2022. This study divided the COVID-19 pandemic into Eras based on significant historical events. Quality metrics represented core mental health services. Delivery modalities included on-site, telephone, and video. The study calculated the percentage of patients, by rural and urban strata, who met each quality metric throughout defined COVID Eras. This research used logistic regression to identify predictors of receiving quality mental healthcare. During the pre-COVID Era, primary care (PC) and mental health (MH) encounters using remote video were rare making up a fraction of all care (Rural PC = 0.1%, Urban PC = 0.1%; Rural MH = 0.2%, Urban MH = 0.3%). There was a dramatic increase in remote video encounters during the Early COVID Era, but urban patients experienced a much larger increase versus rural counterparts (Rural PC = 0.9%, Urban PC = 2.0%; Rural MH = 1.3%, Urban MH = 2.8%). The effect of COVID Eras on quality was mixed depending on the metric examined. Across all Eras, rural patients and patients receiving remote care only received substantially lower quality mental health care compared to urban patients and patients who received a combination of remote and on-site care. Overall, there were dramatic changes to service delivery modalities across the COVID-19 pandemic. Quality of mental health care remained persistently lower among rural patients.

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"Cat scratch colon" (CSC), characterized by spontaneous bright-red linear markings or mucosal laceration with bleeding due to air insufflation barotrauma, is a rare complication during colonoscopy. These mucosal lacerations can present as superficial tears that do not generally have clinical repercussions or as deeper tears that damage the muscularis and cause perforation. CSC occurs in the colon with submucosal stiffening disease, such as collagenous colitis; however, in cases unrelated to these diseases, CSC appears in the cecum or ascending colon for anatomical reasons. Herein, we report a case of CSC that caused cecal perforation. A 79-year-old woman underwent a colonoscopy for anal bleeding. Although insertion of the colonoscope was easy, as soon as the cecum expanded with air insufflation, the cecal mucosa was torn, and bleeding occurred. The endoscopist determined these findings as shallow mucosal tears and inactive bleeding, and a colonoscopy was completed. She visited our hospital 2 days after colonoscopy with a complaint of abdominal pain that appeared in the morning after colonoscopy. Computed tomography revealed inflammation around the cecum, with free air. Emergency surgery was performed to diagnose an iatrogenic colonic perforation caused by colonoscopy. During surgery, a necrotic area was found in the cecal wall, requiring ileocecal resection. The resected specimen showed cecal mucosal tears with necrosis, which were pathologically consistent with cecal rupture resulting from mucosal laceration. The postoperative course was uneventful. When CSC is encountered along with endoscopic findings of deep mucosal tears in the colon, the possibility of perforation after colonoscopy should be considered.

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A 73-year-old man visited our hospital due to hyperintestinal peristalsis and diarrhea. He had been undergoing regular annual checkups for dust lung disease. Contrast-enhanced computed tomography scan showed edematous thickening of the rectal wall with contrast effect. A colonoscopy revealed a submucosal tumor-like protrusion in the Rb lesion of the rectum without neoplastic epithelial changes. Forceps biopsies of the overlying mucosa were non-diagnostic; however, endoscopic ultrasound-guided fine needle biopsy revealed that the specimen was poorly differentiated non-small cell invasive carcinoma. Then, we performed a chest computed tomography and a newly detected mass lesion in the upper lobe of the right lung. Based on immunohistochemical analysis and image findings, the patient was diagnosed with rectal metastasis from lung cancer. Subsequently, sputum cytology confirmed the diagnosis of lung adenocarcinoma. Rectal submucosal tumor-like protrusions are occasionally encountered. When a non-exposed rectal tumor is identified, it is important to differentiate metastatic diseases, consider endoscopic ultrasound-guided fine needle biopsy, and make a definitive diagnosis through detailed immunohistochemical evaluation and systemic imaging surveillance.

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Introduction: Colonoscopy is the gold standard investigation in the lower gastrointestinal tract. However, 75% of patients can experience pain with moderate sedation. The application of robotic technology aims to overcome difficulties faced including better utilization of rooms for advanced procedures and to achieve a complete colonoscopy in patients restricted by pain and technical challenges. Methods: This pilot study, the first at a UK-National Health Service Hospital between January 2023 to August 2024 with one expert endoscopist performing the robotic colonoscopy (RC). Patients with failed previous standard colonoscopy (SC) along with index diagnostic procedures deemed potentially difficult were recruited. Procedures were performed outside the endoscopy unit similar to an outpatient clinical room. Results: Ninety-three patients were recruited (41 men:52 women), mean age of 53.8 years over 20 months. The commonest indications for RC were rectal bleeding (26.9%), failed SC (22.6%), and change in bowel habits (17.2%). Twenty-one patients had failed the previous SC with 14 patients achieving completion with subsequent RC (66% improvement). The average cecal intubation time of 41.07 min with an average total procedure time of 76.48 min. A significant improvement in patient discomfort score was reported (4.71 SC vs. 1.71 RC; p < 0.001). Conclusions: RC provides a significantly more comfortable colonoscopy and has great potential to improve safety in colonoscopy from this early cohort of patients. Direct visualization, biopsy, and polypectomy are still possible with RC. This study has demonstrated a viable alternative to SC. With no sedation it allows procedures to be conducted outside the traditional endoscopy unit such as outpatients. The study highlights a learning curve to reduce cecal intubation time.

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Hemobilia, or hemorrhage within the biliary system, is an uncommon cause of stent obstruction associated with bile duct strictures that are rarely observed with plastic stents. Reports of a pseudoaneurysm as a cause of hemobilia after plastic stent placement are also rare. We present a rare case of hemobilia caused by a pseudoaneurysm that resulted in obstructive cholangitis in a patient who underwent plastic stent placement for bile duct invasion caused by pancreatic cancer. A 78-year-old man with a history of stroke who was using antiplatelet therapy presented with obstructive jaundice caused by locally advanced pancreatic cancer and underwent endoscopic plastic stent placement in the bile duct followed by concurrent chemoradiotherapy. Second-line chemotherapy was administered as the disease progressed; however, he experienced obstructive cholangitis and was admitted to our hospital. Hemobilia was identified as the underlying cause; notably, it was not evident during the initial evaluation and was diagnosed during endoscopic stent replacement. Emergency angiography revealed a pseudoaneurysm of the posterior superior pancreaticoduodenal artery, which was successfully treated using coil embolization. Cholangitis and hemobilia resolved, and the patient was discharged without bleeding recurrence.

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A 74-year-old man with decreased appetite, weight, and heartburn was referred to our hospital. His medications included olmesartan. Esophagogastroduodenoscopy (EGD) revealed antral-dominant erosive gastritis and nodular mucosa. A gastric biopsy revealed inflammatory cell infiltration. The serum anti-Helicobacter pylori immunoglobulin G antibody test result was negative. Famotidine was ineffective in relieving his symptoms, and esomeprazole failed to prevent overt gastric bleeding, which required endoscopic hemostasis. The working diagnosis was drug-induced gastritis, particularly olmesartan-induced gastritis. His appetite loss started to improve within a week of olmesartan withdrawal. The erosions healed on EGD 2 months later. Over the next 10 months, he remained in his usual state until olmesartan was inadvertently administered. Subsequent EGD revealed a mild gastritis relapse. We diagnosed olmesartan-induced gastritis and discontinued olmesartan treatment. Mucosal healing was confirmed by EGD 1 year later. Olmesartan is known to cause angiotensin II receptor blocker-induced enteropathy. Although angiotensin II receptor blocker-induced enteropathy affects the stomach, angiotensin II receptor blocker-induced gastritis without lower gastrointestinal symptoms is rare. The characteristic endoscopic appearance may provide a clue to the correct diagnosis.

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La presente publicación ofrece un marco de orientación y se introducen requisitos de verificación adicionales para los equipos médicos que estén en fase de preparación o que ya estén participando en la respuesta a emergencias de salud, en conflictos armados y otros entornos inseguros. El Libro rojo se sustenta en el imperativo humanitario de actuar y no retrasar la atención médica. En este sentido, ofrece un marco importante para guiar y mejorar la seguridad y el acceso de los equipos mientras las Naciones Unidas, los países y las partes beligerantes realizan esfuerzos diplomáticos para encontrar una solución pacífica y duradera al conflicto o situación de inseguridad

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O presente artigo busca realizar uma análise dos vínculos e construções afetivas como potências transformadoras no âmbito do Acolhimento Institucional infanto-juvenil, compreendendo o cuidado enquanto uma dimensão ético-política. Em um viés de retificação do papel formativo dos afetos nos processos de subjetivação dos(as) acolhidos(as) e dos trabalhadores, salienta-se a importância do desenvolvimento de Políticas de Assistência Social de superação ao tecnicismo como estratégia de rompimento às narrativas de "culpabilização" que reiteram e reafirmam as condições de vulnerabilidade, violências e pobreza vivenciadas. Alinhado com o pensamento Espinosano, este artigo transcreve o caminho de um relato de experiência no campo da psicologia, construída a partir das vivências de um estágio curricular em um Acolhimento Institucional no município de Vitória - ES. Assim, aponta-se para a importância da construção de vínculos e afetos alegres nas práticas profissionais nos serviços de acolhimento, bem como o fortalecimento de Políticas de Assistência Social em uma postura crítica e implicada atravessada pela defesa dos direitos sociais.

This article aims to analyze the bonds and the affections as a power to transform the practices in children shelters, understanding care as na ethical-political dimension. In a view of endorse the formative role of affections in the subjective processes of sheltered and workers, the importance of developing Social Assistance Policies to overcome technicality as a strategy to break the narratives of "blaming" that reiterate and reaffirm the conditions of vulnerability, violence and poverty experienced. Aligned with the Spinozian thought, this article comprehends a methodological path of a qualitative research in psychology, build through internship experiences in a children shelter in Vitoria-ES, BR. Thus, this article appeal to the value of establish and improve the positive bonds and affections in the professional practices in sheltering services, as well as the strengthening of Social Assistance Policies in a critical and involved attitude permeated by the defense of social rights.

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Boletim epidemiológico que apresenta informações sobre os casos de HIV no estado de Goiás e tem como objetivo descrever o perfil epidemiológico, tendências da infecção na população adulta entre os anos 2020 a 2024 e fornecer subsídios para a tomada de decisão, medidas de vigilância, prevenção e controle da infecção pelo HIV em sua quinta década de epidemia. Trata-se de um estudo descritivo, a partir dos dados obtidos do Sistema de Informação de Agravos de Notificação (SINAN) e Sistema de Informação de Mortalidade (SIM). Foram tabulados os dados: diagnosticados e notificados por HIV/Aids por município de residência

Epidemiological bulletin that presents information on HIV cases in the state of Goiás and aims to describe the epidemiological profile, infection trends in the adult population between the years 2020 and 2024 and provide support for decision-making, surveillance, prevention and control of HIV infection in its fifth decade of epidemic. This is a descriptive study, based on data obtained from the Notifiable Diseases Information System (SINAN) and the Mortality Information System (SIM). The data were tabulated: diagnosed and reported by HIV/AIDS by municipality of residence

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Ticks and tick-borne diseases are a growing burden worldwide and vaccines are effective control interventions. Vaccine formulations with tick antigens such as BM86/BM95 (BM) and Subolesin (SUB) have shown reduction in tick fitness and infestation in immunized hosts. However, antigen combination is a challenging approach to improve vaccine efficacy (E) against multiple tick species. Herein, in silico and in music algorithms were integrated to model BM-SUB protein-protein interactions to apply a quantum vaccinology approach for combining protective epitopes or immunological quantum in the chimeric antigen Q38-95. Cattle immunized with Q38-95 and infested with African blue tick Rhipicephalus decoloratus showed an 82% E similar to BM86 and higher than SUB. The immune mechanisms activated in cattle in response to vaccination with Q38-95 were mediated by anti-BM/SUB antibodies that interfered with BM-SUB interactions and through activation of other innate and adaptive immune pathways. The results support modelling protein-protein interactions affecting E to identify and combine candidate protective epitopes in chimeric antigens. (AU)

RESUMO

O osso é um tecido conjuntivo especializado, vascularizado e dinâmico que se modifica ao longo da vida. Quando é lesado, possui a capacidade de regeneração e reparação sem a presença de cicatrizes, mas em algumas situações devido a extensão do defeito ósseo, o tecido não se regenera completamente. Assim, faz-se necessária a realização de procedimentos de regeneração óssea. Existem diversos tipos de enxertos e técnicas com a utilização de diferentes barreiras e membranas para essa finalidade. Tendo em vista a importância das reconstruções ósseas, torna-se necessário conhecer a viabilidade e a influência dos biomateriais, associados ou não a enxertos autógenos e xenógenos na reparação óssea. Como metodologia do trabalho obteve-se 1567 artigos nos resultados totais da busca. Foram aplicados os critérios de análise de título e leitura do resumo. Os artigos que se distanciaram do objeto de observação foram excluídos e os duplicados foram removidos, para leitura na íntegra restaram 32 artigos. Foram selecionados, 14 artigos sobre Membranas Absorvíveis, 14 artigos sobre Membranas Absorvíveis e Membranas Não absorvíveis e 4 publicações sobre Membranas Não Absorvíveis. O objetivo do presente estudo foi realizar uma revisão sistemática visando listar os tipos de barreiras e membranas mais empregadas nas cirurgias ósseas realizadas na odontologia, e suas composições e indicações.

Bone is a specialized, vascularized and dynamic connective tissue that changes throughout life. When it is damaged, it has the capacity to regenerate and repair itself without the presence of scars, but in some situations, due to the extent of the bone defect, the tissue does not regenerate completely. Bone regeneration procedures are therefore necessary. There are various types of grafts and techniques using different barriers and membranes for this purpose. Given the importance of bone reconstruction, it is necessary to know the viability and influence of biomaterials, associated or not with autogenous and xenogenous grafts, on bone repair. The aim of this study was to carry out a systematic review to list the types of barriers and membranes most commonly used in dental bone surgery, their composition and indications.

RESUMO

O objetivo desta revisão integrativa é compilar e analisar, por meio da literatura científica dos últimos anos, evidências de desafios referentes aos cuidados em saúde bucal de crianças com autismo vivenciados por pais/cuidadores. Trata-se de uma revisão integrativa da literatura desenvolvida pelo método da Prática Baseada em Evidências. A pesquisa dos artigos foi realizada nas bases de dados da área da saúde ­ Literatura Latino-Americana e do Caribe em Ciências da Saúde e U.S. National Institutes of Health's National Library of Medicine. Considerando-se os critérios de inclusão e exclusão, selecionaram-se nove artigos. A partir da análise interpretativa, emergiram quatro categorias temáticas: Desafios na escovação dentária de crianças com autismo, Desafios frente à assistência odontológica, Medo com relação aos cuidados em saúde bucal e Estratégias de cuidado em saúde bucal. Espera-se que este trabalho estimule a produção de outras pesquisas em torno do binômio pais/criança com Transtorno do Espectro Autista, tendo em vista as implicações que a saúde bucal apresenta em sua qualidade de vida.

The objective of this integrative review is to compile and analyze, through the scientific literature of recent years, evidence of challenges related to oral health care for children with autism experienced by parents/caregivers. This is an integrative literature review developed using the Evidence-Based Practice method. The search for articles was conducted in health databases - Latin American and Caribbean Health Sciences Literature and U.S. National Institutes of Health's National Library of Medicine. Considering the inclusion and exclusion criteria, nine articles were selected. From the interpretative analysis, four thematic categories emerged: Challenges in dental brushing for children with ASD, Challenges in dental care assistance, Fear regarding oral health care, and Oral health care strategies. It is expected that this work will stimulate the production of further research around the parent/child dyad with Autism Spectrum Disorder, considering the implications that oral health presents in their quality of life.

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A Doença periodontal (DP) envolve doença bucal infecciosa de cunho polimicrobiano e multifatorial, que pode ocasionar inflamação crônica no periodonto. O câncer engloba a contextualização empregada para uma somatória de cerca de cem patologias que concomitantemente possuem características que envolvem crescimento desordenado ou anormal de células e que podem afligir qualquer localidade do organismo. Sabe-se que determinados órgãos podem ser mais afligidos do que outros e que se pode conviver com tumores com maior e menor agressividade. Estudos epidemiológicos consideram a presença da DP como fator a ser relevado ao considerar nos pacientes o risco para surgimento do câncer. Sabe-se que a DP leva a instalação de processo inflamatório, fundamento de Medicina Periodontal e que o mesmo pode acarretar repercussões sistemicamente, entre as quais o câncer. O objetivo do presente artigo foi o de analisar como pode haver possibilidade de associação entre DP e o aparecimento de câncer. Realizou-se revisão narrativa da literatura com levantamento de estudos acerca da possibilidade de associação entre câncer e doenças periodontais. O processo inflamatório persistente de baixo grau presente na DP pode ser associado ao aparecimento do câncer. DP são capazes de promover processo inflamatório e de ocasionar patologias sistêmicas, entre as quais o acometimento pelo câncer. Mecanismos responsáveis pela correlação DP e câncer envovem a desregulação da imunidade. Concluiu-se que pode haver inter-relação entre o acometimento pela DP e o surgimento de câncer e que se deve primar por uma abordagem com cunho preventivo, que seja capaz de deter o avanço da neoplasia ou que possa identificar a presença do câncer precocemente, promovendo tratamentos antineoplásicos menos dispendiosos.

Periodontal disease (PD) involves a polymicrobial and multifactorial infectious disease in the mouth, which can cause chronic inflammation in the periodontium. Cancer encompasses the contextualization used for a sum of around one hundred pathologies that concomitantly have characteristics that involve disordered or abnormal growth of cells and that can afflict any location in the body. It is known that certain organs can be more affected than others and that one can live with more and less aggressive tumors. Epidemiological studies consider the presence of PD as a factor to be taken into account when considering the risk of cancer in patients. It is known that PD leads to the onset of an inflammatory process, the basis of Periodontal Medicine, and that it can have systemic repercussions, including cancer. The objective of this article was to analyze how there may be a possibility of an association between PD and the onset of cancer. A narrative review of the literature was carried out with a survey of studies on the possibility of an association between cancer and periodontal diseases. The persistent low-grade inflammatory process present in PD may be associated with the onset of cancer. PD are capable of promoting an inflammatory process and causing systemic pathologies, including cancer. Mechanisms responsible for the correlation between PD and cancer involve dysregulation of immunity. It was concluded that there may be an interrelationship between PD and the appearance of cancer and that a preventive approach should be adopted that is capable of stopping the progression of the neoplasia or that can identify the presence of cancer early, promoting less expensive antineoplastic treatments.

RESUMO

As manifestações bucais provenientes de síndromes podem ser os primeiros sinais relevantes para um diagnóstico precoce. Quanto mais rápido forem notadas e diagnosticadas, melhor será o curso do tratamento. O presente estudo objetiva discorrer sobre as principais manifestações orais, métodos de diagnóstico e tratamento de quatro principais síndromes com acometimento bucal primário. Trata-se de uma revisão integrativa da literatura através de artigos científicos publicados entre 2012 a 2023 e divulgados na língua portuguesa, inglesa e espanhola. Foram encontrados nas bases de dados: PubMed, SciELO, LILACS, BVS e Google Acadêmico e o operador booleano foi "AND". Os Descritores em Ciência da Saúde (DeCS) foram: "Síndromes", "Manifestações Bucais", "Cavidade Oral" e "Odontologia". A Síndrome de Sjogren é caracterizada como um distúrbio crônico sistêmico e autoimune, que prejudica as glândulas salivares e lacrimais, causando xerostomia, xeroftalmia, hipossalivação e o desenvolvimento de secura em outras regiões de mucosa, enquanto a Síndrome de Gardner é uma doença autossômica dominante genética que podem ocorrer na cavidade oral por meio de odontomas, osteomas, tumores de tecido conjuntivo, carcinomas e dentes supranumerários. A Síndrome de Peutz-Jeghers's, por sua vez, também se caracteriza como uma doença autossômica dominante hereditária, apresentando-se como manchas melanícas na língua, mucosa bucal e lábios, com características planas e indolores. Conclui-se que é de extrema relevância conhecer os sinais clínicos dessas síndromes para que seja realizado o tratamento prévio e ocorra evolução clínica e prognóstico favorável do paciente.

Oral manifestations stemming from syndromes can be the first relevant signs for early diagnosis. The faster they are noticed and diagnosed, the better the course of treatment will be. This study aims to discuss the main oral manifestations, diagnostic methods, and treatment of four primary syndromes with primary oral involvement. It is an integrative literature review through scientific articles published between 2012 and 2023 and disseminated in Portuguese, English, and Spanish. They were found in the following databases: PubMed, SciELO, LILACS, BVS, and Google Scholar, and the Boolean operator was "AND." The Health Science Descriptors (DeCS) were: "Syndromes," "Oral Manifestations," "Oral Cavity," and "Dentistry." Sjogren's Syndrome is characterized as a chronic systemic and autoimmune disorder that affects the salivary and lacrimal glands, causing xerostomia, xerophthalmia, hyposalivation, and the development of dryness in other mucosal regions, while Gardner's Syndrome is a genetic dominant autosomal disease that can occur in the oral cavity through odontomas, osteomas, connective tissue tumors, carcinomas, and supernumerary teeth. Peutz-Jeghers Syndrome, on the other hand, is also characterized as an autosomal dominant hereditary disease, presenting as melanotic spots on the tongue, oral mucosa, and lips, with flat and painless characteristics. It is concluded that it is extremely important to know the clinical signs of these syndromes so that prior treatment can be performed and there is a favorable clinical evolution and prognosis for the patient.

RESUMO

Pacientes de todas as idades em tratamento oncológico podem apresentar lesões bucais dolorosas em decorrência dos efeitos da quimioterapia e radioterapia. Tratamentos não invasivos como os lasers podem ser benéficos na melhoria destas condições e, neste contexto, o uso da fotobiomodulação (PBM), isoladamente ou em combinação com a terapia fotodinâmica antimicrobiana (aPDT), pode ter efeitos positivos na cicatrização tecidual, reduzindo dor, edema e inflamação. O objetivo deste relato de caso foi descrever o tratamento de lesões agudas em gengiva inserida, utilizando PBM isoladamente ou em associação com aPDT, em paciente de 23 anos em tratamento quimioterápico para câncer de ovário. O uso de PBM e aPDT mostrou benefícios tanto na melhora de lesões gengivais agudas quanto na prevenção do aparecimento de novas lesões durante a quimioterapia, confirmando seu potencial como terapia auxiliar benéfica no manejo de pacientes com câncer. A intervenção precoce, aos primeiros sintomas das lesões, e também o uso preventivo do laser nos ciclos subsequentes de quimioterapia podem ter sido decisivos para prevenir sequelas periodontais, como recessão gengival, perda de inserção clínica e perda óssea e, também, trouxe conforto e alívio, reduzindo a dor e contribuindo para a cicatrização dos tecidos. Por se tratar de uma terapia de baixo custo e eficaz, seu uso, seguindo os protocolos descritos, deve ser incentivado para melhorar a qualidade de vida dos pacientes durante o tratamento oncológico envolvendo quimioterapia e/ou radioterapia.

Patients of all ages undergoing cancer treatment can present painful oral lesions as a result of the effects of chemotherapy and radiotherapy. Non-invasive treatments like lasers can be beneficial in improving these conditions and, in this context, the use of photobiomodulation (PBM), alone or in combination with antimicrobial photodynamic therapy (aPDT), can have positive effects on tissue healing, reducing pain, edema and inflammation. The objective of this case report was to describe the treatment of acute lesions in attached gingiva, using PBM alone or in association with aPDT, in a 23-year-old patient undergoing chemotherapy treatment for ovarian cancer. The use of PBM and aPDT showed benefits both in improving acute gingival lesions and in preventing the appearance of new lesions during chemotherapy, confirming its potential as a beneficial auxiliary therapy for the management of cancer patients. Early intervention, at the first symptoms of the lesions, and also the preventive use of laser in subsequent chemotherapy cycles may have been decisive to prevent periodontal sequelae, such as gingival recession, clinical attachment loss and bone loss and it also brought comfort and relief, by reducing pain and contributing to tissue healing. As it is a low-cost and effective therapy, its use, following described protocols, should be encouraged to improve quality of life of patients during cancer treatment involving chemotherapy and/or radiotherapy.

RESUMO

A biotecnologia associada ao planejamento digital tem se tornado de grande valor científico em métodos avançados de tecnologias reconstrutivas faciais. O presente trabalho objetivou relatar uma reconstrução mandibular onde houve o planejamento digital prévio concomitante ao uso de materiais osteogênicos buscando melhores resultados funcionais, estéticos e debilitantes pós cirúrgicos. Paciente, 41 anos, sexo masculino, fumante, etilista, usuário de drogas compareceu à clínica particular para tratamento de fratura mandibular causada por projétil de arma de fogo. Em consulta inicial foi solicitado a tomografia de face com reconstrução 3d visando facilitar o reposicionamento condilar via software dolphin imaging que possibilitou a confecção de um protótipo mandibular. Com o protótipo, foi realizado uma moldura prévia da placa de reconstrução para facilitar sua instalação no transcirúrgico. Para isso utilizou-se o acesso submandibular para redução, reconstrução e fixação. Foi empregue tela de reconstrução 3D, Infuse rhBMP-2 e Bio-Oss. Os exames clínicos e complementares pós cirúrgicos revelaram a oclusão restabelecida e o côndilo reposicionado centrado dentro da fossa articular voltando para sua posição real anatômica, resultando no sucesso do tratamento. Portanto, é importante destacar a influência e a constante necessidade de atualização dos cirurgiões dentistas acerca do uso de novas técnicas reconstrutivas visando o melhor prognóstico ao paciente.

Biotechnology associated with digital planning has become of great scientific value in advanced methods of facial reconstructive technologies. The present study aimed to report a mandibular reconstruction where there was prior digital planning concomitant with the use of osteogenic materials seeking better functional, aesthetic and debilitating post-surgical results. Patient 41 years old, male, smoker, alcoholic, drug user attended the private clinic for treatment of mandibular fracture caused by a firearm projectile. In initial consultation, face tomography with 3D reconstruction was requested in order to facilitate condylar repositioning via dolphin imaging software, which made it possible to make a mandibular prototype. With the prototype, a previous frame of the reconstruction plate was made to facilitate its installation in the trans-surgical area. For this, submandibular access was used for reduction, reconstruction and fixation. 3D reconstruction mesh, Infuse rhBMP-2 and Bio-Oss were used. Post-surgical clinical and complementary exams revealed the reestablished occlusion and the repositioned condyle centered inside the articular fossa returning to its real anatomical position, resulting in the success of the treatment. Therefore, it is important to highlight the influence and the constant need to update dental surgeons regarding the use of new reconstructive techniques in order to achieve the best prognosis for the patient.

RESUMO

O presente trabalho apresenta uma breve revisão da literatura e tem como objetivo primário apresentar, a partir um relato de caso clínico, algumas complicações pós-operatórias diagnosticadas em uma paciente submetida à cirurgia para tratar deformidade dentofacial do tipo classe II de Angle e excesso vertical de maxila. Assim como, o tratamento proposto para algumas dessas sequelas e o acompanhamento da evolução do caso. O caso clínico em questão demonstrou a necessidade imperativa do acompanhamento dos pacientes submetidos a cirurgias ortognáticas. Pela proximidade de acidentes anatômicos importantes, o aparecimento de complicações pós operatórias tem que ser sempre consideradas, de forma que medidas terapêuticas consigam mitigar ou muitas das vezes curar lesões decorrentes do ato cirúrgico.

The present work presents a brief review of the literature and its primary objective is to present, based on a clinical case report, some postoperative complications diagnosed in a patient undergoing surgery to treat Angle class II dentofacial deformity and vertical excess of jaw. As well as the proposed treatment for some of these sequelae and monitoring the evolution of the case. The clinical case in question demonstrated the imperative need to monitor patients undergoing orthognathic surgeries. Due to the proximity of important anatomical accidents, the appearance of post-operative complications must always be considered, so that therapeutic measures can mitigate or often cure injuries resulting from the surgical procedure.