Evaluation of enamel pearls by cone-beam computed tomography (CBCT)

OBJECTIVE

The aim of this study was to evaluate the frequency of enamel pearls according to population, sex and tooth groups on Cone-Beam Computed Tomography (CBCT) or Dental Volumetric Tomography (DVT) scans of patients, retrospectively.

STUDY DESIGN

In this study, 15185 teeth belonging to 768 patients, 430 female and 338 male, was performed cross-sectional examination by CBCT. The volumetric Computed Tomography used in the study is Newton FP based on flat-panel. The data were analyzed with Pearson chi-squared test.

RESULTS

Enamel pearls were detected in 36 subjects (4.69%). Of these enamel pearls, 19 were detected in male and 17 were in male. There was no statistically a significant association between prevalence of enamel pearls and sex. All of enamel pearls were detected in molar teeth, for prevalence 0.83%.

CONCLUSION

All of enamel pearls are found upper and lower molar teeth, especially the most commonly in maxillary second and third molars.

Life-threatening cervical spine collapse as a result of postradiation osteonecrosis-case report and review of the literature

BACKGROUND

Mandibular osteoradionecrosis (ORN) is a well-known complication of head and neck radiotherapy; however, ORN of the cervical spine is rarely reported.

METHODS

Herein, we present a patient with a history of tonsillar carcinoma treated with chemoradiation who developed acute, severe progressive neck pain due to cervical spine collapse as a result of ORN. We also discuss diagnosis and treatment of cervical ORN based on a review of the literature.

RESULTS

The patient was successfully treated with antibiotics and surgical debridement and fixation.

CONCLUSION

Delayed diagnosis of cervical ORN can result in marked disability and pain due to spinal cord compression, as well as serious deformity and instability requiring surgical intervention, and even death. It is important for otolaryngologists who treat head and neck malignancies to be aware of this potential complication so that patients may be diagnosed as early as possible and treated with conservative measures.

Zygomatic implants: a critical review of the surgical techniques

PURPOSE

The purpose of the present study is to identify and describe the different surgical techniques for placement of zygomatic implants reported in the literature and discuss the differences between them.

METHODS

An electronic search was undertaken in July 2011. The titles and abstracts from these results (n = 130) were read for identifying studies, which reported different surgical techniques for placement of zygomatic implants, which resulted in 41 articles.

RESULTS

Five different surgical approaches were identified: (1) the classical approach, (2) the sinus slot technique, (3) the exteriorized approach, (4) the minimally invasive approach by the use of custom-made drill guides, and (5) the computer-aided surgical navigation system approach. When the maxilla is severely resorbed, the concavity formed by the ridge crest is small, and the original classical technique should be used. When maxillary resorption generates a large concavity, it would be better to exteriorize the zygomatic implant. The externalized technique has fewer surgical steps than the classical and sinus slot methods, is less invasive, and reduces surgical time. It is recommended that utilization of the sinus slot technique together with the CT-based drilling guide would enhance the final results. Although the technique that uses the computer-aided surgical navigation system approach may produce an improved precision in the clinical procedure, its use is expensive, prolongs the operation time, and is limited to centers that have the necessary equipment for the surgery.

CONCLUSIONS

Preference for one technique over the other should take into consideration the concavity formed by the ridge crest, maxillary sinus, and region of implant insertion in the zygomatic bone.

[Epidemiological profile of emergency care for dental and oral injuries in Brazil, 2006-2007]

Injuries resulting from accidents and violence occupy a key place in the current epidemiological scenario. The head and face are one of the main sites of lesions from external causes, especially dental and oral injuries. This article aims to present the epidemiological profile of emergency care for dental and oral lesions from external causes. The study used data from the Surveillance System for Violence and Accidents (VIVA) for the years 2006 and 2007. There were a total of 106,075 emergency visits involving external causes, of which 939 (~1%) presented dental and oral lesions. There were a majority or large proportions of males (65.5%), children < 10 years (44.3%), black individuals (66%), and individuals with low schooling (45.9%). High proportions of the injuries occurred at home (48.3%) or on public byways (30%). Frequent characteristics were cuts or puncture wounds (63.3%) and lesions resulting from falls (43%), traffic accidents (19.9%), and physical assault (13%).

Eagle's syndrome in an orthodontic patient

This purpose of this article was to report the clinical case of a patient with Eagle's syndrome. She was referred to the orthodontic clinic by her general clinician, with the complaint of temporomandibular dysfunction. The orthodontic records showed a styloid process elongation accompanied by calcification and fracture on the right side. Eagle's syndrome was diagnosed, and the patient was referred to a buccomaxillofacial surgeon for surgical correction.

[Radiation-related caries: etiology and possible preventive strategies. What should the radiotherapist know?]

BACKGROUND

After radiation treatment of head-and-neck cancer, the impairment of patient's quality of life still remains an issue. After completion of the treatment course, a substantial number of patients develop so-called radiation caries. In addition, almost 50% of all cases of infectious osteoradionecrosis (iORN) of the jaws are directly associated with radiation caries. This review addresses our current knowledge on the etiology and pathogenesis of radiation caries including possible preventive strategies.

MATERIALS AND METHODS

A PubMed search using the terms "radiation caries" ("radiation related caries", "radiation related damage to dentition") and "radiogenic caries" ("postradiation caries", "dental complications and radiotherapy") was performed. The analysis of its content focused on the etiology, the pathogenesis, and the available knowledge on prophylaxis as well as treatment of radiation caries.

RESULTS

For this review, 60 publications were selected. As main causal factors for radiogenic caries, either indirect impairment, resulting from alterations in the oral environment (e.g., radiation-induced xerostomia) or direct radiation-induced damage in teeth hard tissues are discussed. Radiation caries remains a lifelong threat and, therefore, requires permanent prevention programs.

CONCLUSION

To enable optimal medical care of the patients during the time course of radiotherapy as well as afterwards, close interdisciplinary cooperation between radiotherapists, oral surgeons, otorhinolaryngologists, and dentists is absolutely essential.

A review of the mandibular and maxillary nerve supplies and their clinical relevance

Mandibular and maxillary nerve supplies are described in most anatomy textbooks. Nevertheless, several anatomical variations can be found and some of them are clinically relevant. Several studies have described the anatomical variations of the branching pattern of the trigeminal nerve in great detail. The aim of this review is to collect data from the literature and gives a detailed description of the innervation of the mandible and maxilla. We carried out a search of studies published in PubMed up to 2011, including clinical, anatomical and radiological studies. This paper gives an overview of the main anatomical variations of the maxillary and mandibular nerve supplies, describing the anatomical variations that should be considered by the clinicians to understand pathological situations better and to avoid complications associated with anaesthesia and surgical procedures.

Feasibility of treating irradiated bone with intramedullary delivered autologous mesenchymal stem cells

Background. We aimed to explore (i) the short-term retention of intramedullary implanted mesenchymal stem cells BMSCs and (ii) their impact on the bone blood flow and metabolism in a rat model of hindlimb irradiation. Methods. Three months after 30 Gy irradiation, fourteen animals were referred into 2 groups: a sham-operated group (n = 6) and a treated group (n = 8) in which ¹¹¹In-labelled BMSCs (2 × 10⁶ cells) were injected in irradiated tibias. Bone blood flow and metabolism were assessed by serial ^99mTc-HDP scintigraphy and 1-wk cell retention by recordings of ^99mTc/¹¹¹In activities. Results. The amount of intramedullary implanted BMSCs was of 70% at 2 H, 40% at 48 H, and 38% at 168 H. Bone blood flow and bone metabolism were significantly increased during the first week after cell transplantation, but these effects were found to reduce at 2-mo followup. Conclusion. Short-term cell retention produced concomitant enhancement in irradiated bone blood flow and metabolism.

Measurement of the midpalatal suture width

OBJECTIVE

To conduct a pilot study to investigate the potentiality to determine the midpalatal sutural width radiographically with a flat-panel volume computed tomography (fpVCT) in a porcine model.

MATERIALS AND METHODS

Bone samples from the midpalatal suture of five young (16 weeks) and five old (200 weeks) sus scrofa domestica were gathered. The midpalatal suture width was measured via fpVCT and compared to respective histological preparations. Results with P < .05 were considered significant.

RESULTS

The data obtained by fpVCT and by histomorphometric analysis reveal a highly significant age dependency of the measured suture width (both P < .0001), with lower suture width values in older subjects compared to the younger group. The averaged suture widths measured in the fpVCT images shows a distinctively higher mean compared to the histomorphometric data with high statistical significance (P < .0001). The evaluated difference between both methods was almost constant.

CONCLUSION

fpVCT is a powerful tool for determining midpalatal sutural width.

Metaanalysis of maxillofacial trauma in the northern districts of kerala: one year prospective study

PURPOSE

There is an increased incidence of maxillofacial trauma all over the world. A study was conducted to find out the epidemiological characteristics of maxillofacial trauma in Northern districts of Kerala.

METHODS

All the trauma patients who attended the Department of Oral and Maxillofacial Surgery, Government Dental College, Calicut, Kerala during the period of 2006-2007 was included in the study. The incidence, prevalence, age and sex distribution, seasonal and daily variations and aetiology of maxillofacial trauma were studied. The pattern and demographic distribution of fractures of maxillofacial skeleton also were studied.

RESULTS

This study indicates a significant increase in the incidence of maxillofacial trauma in the region. There was a male predominance and the highest incidence was in the age group of 20-40 years. Road traffic accident was the most common aetiological factor causing maxillofacial trauma. More than 30% of trauma cases suffered fracture of maxillofacial skeleton. There was an increased incidence of midface fracture when compared to mandibular fractures in the study. Most common site of mandibular fracture was in the parasymphysis region and in the midface was the zygomatic complex region.

CONCLUSION

The increased incidence of maxillofacial trauma following road traffic accidents noted in this study reveals the need for formulating preventive measures in the state of Kerala. Increasing facilities for the management of maxillofacial trauma at local hospitals and medical colleges is mandatory. Training of the paramedical personnel, health workers and also the public regarding first aid and primary trauma care is also necessary.

Factors influencing the incidence of maxillofacial fractures

PURPOSE

Maxillofacial injuries occur in a significant proportion of trauma patients. Trauma causes considerable economic expense due to procedural costs, the time a patient is off work, and the associated loss of income. For these reasons, it is an important health and economic issue. The aim of this study is to discuss the factors that may influence the incidence of maxillofacial fractures. As it is necessary to determine trends to help guide the development of new methods of injury prevention, preventative measures are also discussed.

METHODS

An electronic search was undertaken in March 2011, including articles published between 1980 and 2011 with the terms "facial fractures" and "maxillofacial fractures" in the title. The texts of epidemiological studies were reviewed in order to identify factors that may influence the incidence of maxillofacial fractures.

RESULTS

From the selected articles, ten factors were identified: age, gender, geographic region and cultural aspects, socioeconomic status, temporal and climatic influence, use of alcohol and drugs, compliance with road traffic legislation, domestic violence, osteoporosis, and etiology of the maxillofacial trauma.

CONCLUSIONS

Care of injured patients should include not only management of the acute phase, but also combine preventive programs and interventional programs aimed at reducing the incidence of maxillofacial fractures. Therefore, there is a need to ensure strict compliance of traffic rules and regulations, implement improvement in automotive safety devices, organize prevention programs to minimize assaults, implement school education in alcohol abuse and handling potentially hostile situations (especially for men), improve protection during sporting activities, and legislate wearing of protective headgear in workers. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of trauma. Societal attitudes and behaviors must be modified before a significant reduction in the incidence of maxillofacial fractures will be seen.

Minimally invasive endoscopic osteosynthesis for frontozygomatic fracture: a new approach

Miniplate fixation on the lateral face of the orbital rim using existing endoscopic methods for frontozygomatic fracture still has some disadvantages, such as cosmetic disturbance from the lateral brow incision for the trocar, and abnormal palpability of the miniplate. We applied a new method of endoscopic osteosynthesis by access through temporal incisions alone and miniplate fixation on the lateral temporal face of the frontozygoma. Postoperative courses were uneventful in all four cases treated, and we achieved cosmetic improvement (minimizing incision and scars) as well as decreased palpability of the miniplate.

Imaging of the Head and Neck following Radiation Treatment

Squamous cell carcinoma of the head and neck occurs in approximately 40,000 patients annually in the United States and is often treated with radiation therapy. Radiological studies are obtained following treatment for head and neck malignancies to assess for recurrent tumor, posttreatment changes, and associated complications. Radiation treatment creates a difficult clinical picture for oncologists, head and neck surgeons, neuroradiologists, and neuropathologists. As post-treatment imaging studies are often discussed at radiology/pathology working conferences, knowledge of the imaging appearance of radiation-associated changes in the head and neck and the terminology used by neuroradiologists may not only aid in interpretation of the pathologic specimen, but also assist in communications with neuroradiologists and referring clinicians.

Osteodistraction of the maxilla in transverse deficiency in adults: analysis of the literature and clinical case

Osteogenic distraction is a bone regeneration and reconstruction technique. Razdolsky et al. (2001) [1] have defined it as "the process of creating new bone by stretching". Disjunction entails separating two anatomical structures at their junction system and, therefore, at a suture. Usually, it involves separating two semi-maxillae in the transverse dimension by means of an osteotomy. Transverse maxillary distraction appears to offer an alternative of choice to orthognathic surgery alone, which is frequently prone to relapse (Betts et al., 2004) [2]. The greatest benefit of osteogenic distraction lies in its greater potential for expansion and concurrent growth of the soft tissues. Among other things, this technique increases arch length, thus precluding tooth extractions in cases of maxillary crowding, and appears to provide more stable results than conventional surgical intermaxillary disjunction.

A mandibular body fracture related to mouth-opening training in a dialysis patient

A mandibular body fracture related to mouth-opening training in a dialysis patient is reported. A 61-year-old male patient had noticed pain in the right mandibular body and difficulty in mouth opening a week previously. The patient had been performing mouth-opening training for a couple of weeks. The right lower face was slightly swollen with tenderness at the right lower border of the mandible. Hypoesthesia of the right lower lip was also observed. A bone step was palpable on the alveolar ridge of the right mandible, but mobility was not marked. The mandible was atrophic in the body region with only four anterior teeth left. Panoramic X-ray examination revealed a moderately displaced fracture in the right molar region of the mandible. The patient had no severe pain or difficulty in eating using a partial denture. The patient had received dialysis for 17 years and had also been treated by warfarin and aspirin. The patient was followed up under restricted mouth opening. Osteosynthesis with bone remodeling was confirmed after 6 months by X-ray examination. No complication requiring further treatment occurred during the follow-up period. In this patient, a medically compromised condition under long-term dialysis is considered a predisposing factor, which made the atrophic mandible more susceptible to the stress related to mouth-opening training.

1,454 mandibular fractures: a 3-year study in a hospital in Belo Horizonte, Brazil

OBJECTIVE

To analyze the mandibular fractures which presented over a 3-year period at an emergency hospital in Belo Horizonte, Brazil.

METHODS

The data collected included age, sex, aetiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture, and treatment. The analysis involved descriptive statistics and the Pearson's chi-square, Bonferroni, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests, and analysis of variance.

RESULTS

There were 1,454 mandibular fractures in 1,023 patients. Males of 20-29 years of age sustained the majority of fractures. Traffic accidents were the major causes of trauma, followed by violence and falls. A high incidence of fractures in women due to violence was observed. The condyle region was found to be the most common fracture site in the mandible. A surgical approach was performed in most cases. There were more accidents causing mandibular fractures on the weekends.

CONCLUSION

The individuals with mandibular fractures due to "traffic accidents" were younger than those due to "violence" and "falls". There was a significant statistical association between age and aetiology as well as between sex and aetiology of mandibular fractures.

Osteonecrosis of the jaw related to sunitinib

CASE REPORT

A 59-year-old male patient was referred to the hospital with exposed bone measuring 10 mm in diameter in the posterior, left-side region of the lower jaw. Two months previous, the first molar had been extracted. The patient had contracted renal cell carcinoma and had been treated by nephrectomy in 2003. Soft tissue metastases occurred. After initial therapy with interferon and vinblastine, a relapse occurred and the therapy was changed to sorafenib, followed by sunitinib. Osteonecrosis of the lower jaw appeared 1 year after initial and exclusive therapy with sunitinib.

CONCLUSIONS

Bisphosphonates had never been applied. With increasing application of multi-kinase inhibitors, complications due to osteonecrosis could occur more frequently.

Infection, vascularization, remodelling--are stem cells the answers for bone diseases of the jaws?

Osteonecrosis after craniofacial radiation (ORN), osteomyelitis and bisphosphonates related necrosis of the jaw (BRONJ) are the predominant bone diseases in Cranio- and Maxillofacial surgery. Although various hypothesis for the pathophysiological mechanisms including infection, altered vascularisation or remodelling exist, the treatment is still a challenge for clinicians. As the classical pharmacological or surgical treatment protocols have only limited success, stem cells might be a promising treatment option, indicated by recently published data.

Facial fractures in the elderly: a retrospective study in a hospital in Belo Horizonte, Brazil

BACKGROUND

An increasing incidence of maxillofacial trauma in the elderly has been noted, as a consequence of increased longevity, resulting in a higher percentage of elderly people in the population.

METHODS

A retrospective study was undertaken to assess facial fractures in elderly presenting during the period 2000 to 2002 in Belo Horizonte, Brazil. The data collected included age, gender, etiology, date of trauma, maxillofacial trauma, anatomic site of fracture, and treatment. The statistical analysis involved evaluation of measures of central tendency and variability and calculation of proportions.

RESULTS

It encountered 165 facial fractures in 122 elderly aged 60 years or older. The majority of fractures were sustained by elderly in the age group 60 years to 69 years. Falls was the major cause of trauma followed by car accidents. The mandible was found to be the most common fractured bone in the facial skeleton, followed by the zygomatic complex. A conservative approach was accomplished in the most of cases.

CONCLUSION

Gender was associated with the presence or absence of fractures and with the etiology. There was no association between age and fractures. No association was found between etiology and age for women and men. The proportion of fractures of the zygomatic arch, mandible body, and parasymphysis treated surgically were statistically higher than the same proportion among the cases of other fractures. The fractures of the nose were more often treated conservatively than other fractures.

Iatrogenic mandibular fracture associated with third molar removal

Third molar extraction is one of the most common procedures performed in oral and maxillofacial surgery units. It is sometimes accompanied by complications such as alveolar osteitis, secondary infection, hemorrhage, dysesthesia and, most severely, iatrogenic fracture. This article describes two mandibular angle fractures that occurred in two patients during the surgical extraction of one erupted and one unerupted third molar, including a brief review of the literature.

Paradental (mandibular inflammatory buccal) cyst

The paradental cyst is commonly misinterpreted when associated with atypical clinical and radiographic characteristics, in turn causing diagnostic problems. For this reason, the study of the differential diagnosis of this lesion has become extremely important. In addition, the correlation of clinical, histologic, and radiographic findings are also of great value in obtaining accurate diagnoses. The minor variations in the clinical appearance of paradental cysts make it feasible to consider the two main groups of cysts separately: those associated with 1st and 2nd permanent molars of the mandible and those associated with the 3rd mandibular molar. Moreover, this distinction in localization may well dictate the necessary treatment. Bearing in mind the minor clinical variations, the present article aims to discuss the differential diagnosis of this lesion and its different possible treatments by presenting a case report to illustrate the findings.

Analysis of 185 maxillofacial fractures in the state of Santa Catarina, Brazil

A retrospective study was performed to assess maxillofacial fractures in patients treated at a public hospital from 2002 to 2006. The data collected included age, gender, etiology, type of injury, treatment modalities and period of treatment. Causes were grouped into seven categories: road traffic collisions, sports accidents, occupational accidents, gunshot fractures, falls, violence and other causes. The analyses involved descriptive statistics, the Chi-squared Test and the Fisher Exact Test. Records from 132 patients sustaining 185 maxillofacial fractures were evaluated. The mandible (54.6%) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6%). The mean age of the patients was 37.7 years, and the male:female ratio was 4.3:1. Most fractures occurred in adults with ages ranging from 18 to 39 years. A significant statistical relation was found between the age and the etiology of the trauma (p < 0.05), and between the number of fractured sites and the age of the patient (p < 0.05). Considering the age groups, accidents were the most frequent cause of maxillofacial fractures in the age group between 18 to 39 years, and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 to 59 years. Treatment was performed on the same day as the diagnosis in 44.7% of the patients. Open surgery with internal stable fixation was indicated for most of the patients. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Traffic road collisions were the main etiologic factor associated with maxillofacial trauma.

Eagle's syndrome - A case report and review of the literature

Eagle's syndrome (ES) occurs when an elongated styloid process or calcified stylohyoid ligament causes recurrent throat pain or foreign body sensation, dysphagia, or facial pain. Additional symptoms may include neck or throat pain with radiation to the ipsilateral ear. The symptoms related to this condition can be confused with those attributed to a wide variety of facial neuralgias. ES can be diagnosed radiologically and by physical examination. The treatment of ES is primarily surgical. The styloid process can be shortened through an intraoral or external approach. In this paper a case of ES exhibiting unilateral symptoms with bilateral elongation of styloid process is reported and the literature is reviewed.

Review of floor of mouth dysontogenic cysts

OBJECTIVES

We report the common surgical approaches, incidence of sinus tracts, and recurrence rates of floor of mouth dysontogenic (epidermoid, dermoid, and teratoid) cysts in the pediatric population.

METHODS

Data were derived from PubMed, Medline, Embase, Google Scholar, and manual searches. Three cases from the senior author's (J.P.M.) practice were included. All English-language studies consisting of floor of mouth dysontogenic cysts were included. Case reports of tongue dysontogenic cysts, mandibular dysontogenic cysts, maxillary dysontogenic cysts, and dysontogenic cysts in the neck below the hyoid bone were excluded.

RESULTS

There are 198 case reports, including those presented here, of floor of mouth dysontogenic cysts. They are more common in male patients (55.1%), and the most common location is in the sublingual space (104 or 52.5%). Most floor of mouth dysontogenic cysts can be excised by an intraoral approach. There are 5 reported cases in the literature of recurrent dysontogenic cysts and 11 cases of multiple floor of mouth dysontogenic cysts.

CONCLUSIONS

Floor of mouth dysontogenic cysts most commonly present in the sublingual space, and most can be excised by an intraoral approach. Multiple dysontogenic cysts often require a combination of intraoral and extraoral approaches. Recurrence of a dysontogenic cyst may be secondary to a tract not identified at the time of surgery.

Surgical excision of intra-oral dermoid cyst under local anaesthesia: a review of nine cases

OBJECTIVE

The purpose of this article is to highlight the effectiveness of local anaesthesia in the surgical excision of intral-oral dermoid cyst in the absence of available modern and efficient general anaesthetic options as experienced in our environment.

PATIENTS AND METHODS

A retrospective review of nine patients with intra-oral dermoid cysts seen at the oral and maxillofacial surgery units of three specialist hospitals in eastern Nigeria was carried out between 1996 and 2007. We used simple clinical findings and the aspiration technique for our provisional diagnosis and treated our patients by using local anaesthesia, which contains 2% lignocaine hydrochloride in 1: 80,000 adrenaline.

RESULTS

Out of the nine cases seen, the male-to-female ratio was 2:1, representing six male and three female. The age range was 13-22 years, with a mean age of 19 years. The use of local anaesthesia was uneventful and despite the limited options of treatment and the absence of advanced imaging techniques we achieved total success and good results in all nine patients.

CONCLUSION

The anaesthetic difficulties and uncertainties associated with the management of intral-oral dermoid cysts especially in an environment that lack modern general anaesthetic options can be avoided by the use of local anaesthesia. This may, therefore, be an effective alternative to difficult and sometime expensive general anaesthetic methods used in developed countries and could be emulated by oral and maxillofacial surgeons in poorer countries.

Osteoradionecrosis: an update

Osteoradionecrosis (ORN) of the mandible is the most serious and severe side effect of combined treatment of head and neck tumors. A new theory for the pathogenesis of ORN has been proposed relating it to a fibro-atrophic mechanism including free radical formation, endothelial dysfunction, inflammation, microvascular thrombosis leading to bone and tissue necrosis. Risk factors mainly include radiation related risk factors, surgery and, tobacco and alcohol abuse. Removing of diseased teeth after and even probably after radiotherapy is generally considered the main risk factor in ORN. Conversely, steroid use before or after radiation may have a protective effect related to the inhibition of the initial inflammatory phase of ORN. Prevention of ORN is still based on the preventive extractions of decayed or periodontally compromised teeth before radiotherapy. Based on the current understanding of ORN pathophysiology, new preventive and therapeutic protocols have been suggested for mild to moderate stages. Free tissue surgical transfers is the treatment of choice of severe, extensive and long established ORN.

Facial fractures in children and adolescents: a retrospective study of 3 years in a hospital in Belo Horizonte, Brazil

AIM

The purpose of this study was to review the etiology, incidence and treatment of selected oral and maxillofacial fractures in children in Belo Horizonte, Brazil, during a period of 3 years.

MATERIALS AND METHODS

The data collected for this study included age, gender, etiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture and treatment. The analysis involved descriptive statistics and chi-squared test, Bonferroni test, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests and analysis of variance.

RESULTS AND CONCLUSIONS

This study examined 566 facial fractures in 464 children of 18 years of age or less. The majority of fractures were observed in children within the age group of 13-18 years of age. Bicycle accidents were the major cause of trauma, followed by falls. The mandible was found to be the most common fractured bone in the facial skeleton, followed by the nose. A conservative approach was applied in most cases.

Facial trauma in the largest city in Latin America, São Paulo, 15 years after the enactment of the compulsory seat belt law

Traffic accidents are a reality throughout Brazil. The face is one of the anatomic parts most affected by these accidents, especially when a seat belt is not used. These accidents are costly for the public health system and have a significant impact on society and the lives of families involved. The compulsory use of seat belts in Brazil, especially in São Paulo, has decreased the rate of facial trauma. This suggests that the public health policies and measures adopted by the Brazilian authorities have benefited the population 15 years after the enactment of the law of compulsory seat belts in the city of São Paulo.

Epidermoid cyst of the floor of the mouth: two case reports

Introduction

Epidermoid cysts that appear in the midline floor of the mouth are, usually, a result of entrapped ectodermal tissue of the first and second branchial arches, which fuse during the third and fourth weeks in utero. The incidence in the floor of the mouth of the oral cavity is rare and development sites are the sublingual, submaxillary and submandibular spaces.

It was present two cases of epidermoid cyst of the floor of the mouth and discussed the different surgical approaches for this lesion.

Cases presentation

Two cases of midline epidermoid cysts of the floor of the mouth are presented, evaluating the different surgical approaches. The preoperative assessment was made using ultrasonography and computed tomography in both cases. Regarding surgical techniques used, a transcutaneous approach was adopted when the cysts were under the geniohyoid muscle and a midline incision of the oral mucosa along the lingual frenulum was used for sublingual cysts. During the postoperative course, there were no complications, except for mild edema in one case. Follow-up ranged between 5 months and 4 years; no recurrence or malignant changes were observed.

Conclusions

Surgery of epidermoid cyst of the floor of the mouth is the treatment of choice. Access depends on the lesion's location in relation to the mylohyoid or geniohyoid muscles. If the cyst is located over the mylohyoid, surgery is carried out only through the oral cavity, whereas the extraoral incision was necessary only when the cysts were under the geniohyoid muscle.