Manual lymphatic drainage was effective in reducing facial measurements in orthognathic surgery postoperatory. When considering patient's pain and swelling perception, no difference was found between groups.
This chapter will discuss the expected edema and intercurrences in maxillofacial surgery, which involves important anatomical structures, such as the upper airways. It will also discuss important issues such as intrinsic and extrinsic enhancers of edema and the main consequences of a severe edema setting according to physiological, functional, and psychosocial points of view. Edema assessment and measurement is still performed subjectively in the clinical routine. However, for the accomplishment of studies, more objective forms are being tested, but still not very successful for clinical applicability. It is known that the best way to deal with edema is prevention; so in elective surgeries, much is discussed about the best management forms. This way, besides edema prevention, it is important not to cause unwanted reactions for the patient or in the performed procedure. Therefore, it will also be debated about preoperative medications and their consequences. Another point discussed involves main treatments for the underdeveloping edema and the one already installed, such as manual lymphatic drainage therapy, a treatment that is well known and used in other specialties, but is still very little widespread among maxillofacial surgeons.
The Sphenoid Sinus is considered the paranasal sinus with more variation to the degree of pneumatization. Thus, this work aimed report to the first case on the interference of this anatomical variation for orthognathic surgery. A 18- year-old woman, with isolated cleft palate repaired, was submitted to orthognathic surgery to correct the maxillomandibular skeletal discrepancy. The cone beam computed tomography (CBCT) exam performed for preoperative planning showed a great extension for the adjacent structures, with proximity to the posterior wall of the maxillary sinus and pterygomaxillary fissure bilaterally. The postoperative CBCT image evidenced the compromise of the sinus floor due to the factors related to the transoperative period. This case, along with literature review, highlighted the importance of identifying sphenoid sinus variation in CBCT exams prior to orthognathic surgery, in order to avoid serious complications for the patient, such as sinus infections; hemorrhages; mucocele formation or intracranial involvement.
A reabilitação de maxilas atróficas sempre foi um desafio para o cirurgião dentista, e a utilização de implantes zigomáticos tem se popularizado como uma alternativa de tratamento à reconstrução alveolar. O presente trabalho realizou uma revista da literatura buscando complicações trans e pós-cirúrgicas mais comuns relacionadas à cirurgia de implantes zigomáticos. Foi realizada busca na base de dados PubMed por artigos publicados entre 2010 e 2015, sendo encontrados 92 artigos. Destes, foram selecionados estudos que atendessem aos critérios de inclusão e exclusão. Doze dos 92 artigos foram selecionados para revisão, somando um total de 5.425 implantes zigomáticos instalados. Artigos que consideraram apenas as complicações protéticas não foram selecionados. As complicações pós-operatórias relatadas foram: 162 casos de sinusites (2.98%), 129 de infecção dos tecidos moles (2.37%), 16 parestesias (0.29%), 21 fístulas orosinusais (0.38%), 2 enfisemas subcutâneos (0.036%), 1 penetração da cavidade orbital (0.018%), 9 de dor persistente (0.16%), 5 exposições do implante (0.092%) e 16 falhas de osseointegração (0.29%). Artigos de casos clínicos, com um grupo amostral pequeno, relataram ausência de complicações clínicas. O follow-up variou de 1 a 7 anos. A complicação mais frequente é a sinusite maxilar, e a técnica de fixação zigomática pode incorrer em inúmeras complicações se o cirurgião for inexperiente e/ou não tiver bom conhecimento anatômico da região. Faltam estudos com casos controle que discussão as complicações trans e pós-operatórias.
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