Férulas de Gunning. Una alternativa de tratamiento que sigue presente. Reporte de 02 casos / Gunning's splints. An alternative treatment that is still present. A report of 02 cases

Las fracturas condilares continúan siendo un desafío para los cirujanos maxilofaciales, debido a los múltiples tipos de fracturas que pueden ocurrir y los tratamientos disponibles. El tratamiento de este tipo de fractura podría dificultarse si el paciente presenta edentulismo. Así, entre las opciones de tratamiento, el uso de una férula o la prótesis dental preexistente como medio de fijación se muestra como una opción viable. Se presentan 02 casos clínicos de pacientes masculinos de 36 y 83 años de edad que presentan un maxilar edéntulo y fracturande cóndilo mandibular de lado derecho; para su tratamiento se utilizó una férula de Gunning superior con fijación intermaxilar mediante el uso de tornillos de fijación intermaxilar y elásticos intermaxilares durante 4 semanas. Después de 3 meses de evolución, ambos pacientes presentaron una adecuada apertura bucal, sin desviaciones o limitación a la apertura bucal. Las férulas de Gunning, a pesar que actualmente son poco usadas, continúan siendo una opción apropiada para los casos de fractura del cóndilo mandibular en pacientes edéntulos.

Condylar fractures continue to be a challenge for maxillofacial surgeons, due to the multiple types of fractures that can occur and the treatments available. Treatment of this type of fracture could be difficult if the patient has edentulism. Thus, among the treatment options, the use of a splint or the pre-existing dental prosthesis as a means of fixation appears to be a viable option. Two clinical cases are presented of male patients aged 36 and 83 years who present an edentulous maxilla and fracture of the mandibular condyle on the right side; For treatment, an upper Gunning splint with intermaxillary fixation was used through the use of intermaxillary fixation screws and intermaxillary elastics for 4 weeks. After 3 months of evolution, both patients presented adequate mouth opening, without deviations or limitations to mouth opening. Gunning splints, although they are currently rarely used, continue to be an appropriate option for cases of fracture of the mandibular condyle in edentulous patients.

Digital repair for a patient with limited mouth opening: a case report and literature review / 口腔疾病防治

Objective@#To explore an accurate method to obtain an intraoral model of patients with specific limited mouth opening (microstomia) due to systemic scleroderma.@*Methods@#This study followed medical ethics, and informed consent has been obtained from patients. A case of Ken's Type I mandibular dentition defect scleroderma with limited mouth opening was addressed with digital technology as the leading method combined with the traditional impression method of segmental impression. Individual trays were made based on the patient's left and right mandibular dentition, and segmented molds were obtained. Simultaneously, intraoral scanning was performed to obtain the morphological data of both the soft and hard tissues of the upper and lower mandibles. After each part of the model was obtained, the mandibular model was scanned and digitally aligned to form the final denture model, and the final removable partial denture was designed and made by computer aided design/computer aided manufacturing (CAD/CAM) technology. At the same time, combined with the literature, the diagnosis and treatment of removable partial denture in patients with limited mouth opening were retrospectively analyzed.@*Results@#The denture was well retained and achieved a good repair effect. The patients expressed satisfaction with the mastication efficiency and other functions of the denture. The findings of the literature review show that the integration of digital technology with the traditional impression method, along with computer fitting, can accurately obtain the patient's oral model and facilitate successful follow-up repairs. However, when the anterior mandibular dentition of the patient is absent, the margin of error is increased in this procedure, which deserves further exploration.@*Conclusion@#Utilizing digital technology as the leading method, combined with the traditional impression method of segmental impression, for the repair of dental defects in patients with limited mouth opening, has proven to be effective. Thus, patients report a positive medical experience with high satisfaction, indicating that this approach is worthy of clinical promotion.

Prevalence of Forward Head Posture and its Effect on Active Mouth Opening in Young Female Weightlifters

Background: To objectively assess the prevalence of forward head posture and its effect on active mouth opening. Material & Methods: Correlational study design. Setting – Subjects were selected from various gyms and fitness centers located in South Delhi. Subjects were selected for the study according to the following inclusion and exclusion criteria. Method of Sampling- Sample of convenience. Instrumentation / Tools/ Scales/ Outcome Measure- Markers, UTHSCSA Software version 3.0, Calibrated Ruler, Digi Cam; 16 Mega Pixel with stand, Laptop, Liquid Disinfectant, Calibrated Ruler to measure active mouth opening. Craniovertebral angle was measured using UTHSCSA Image tool program. Statistical analysis was done using SPSS 20.0 version software. Descriptive statistics was used to compute means. The Pearson’s coefficient of correlation was used to examine the relationships between craniovertebral angle and active mouth opening. Results were considered significant at ‘p’ < 0.05. Results: The purpose of conducting this study was to find out the effect on active mouth opening in female weightlifters which was conducted on females performing weight lifting task in the gyms and fitness centers situated in South Delhi. It was observed that there was a statistically significant correlation with CV angle with active mouth opening. Conclusion: By the virtue of this study, we can conclude that our participant group of weightlifters had a below normal craniovertebral angle. The result demonstrated that there is a significant effect on active mouth opening.

Clinical decision making of implant guidance methods guided by new classification of surgical area mouth ope-ning / 华西口腔医学杂志

When selecting implant guidance methods or judging whether the patient can be implanted, many doctors ignore or only use visual inspection to estimate a patient's mouth opening. This phenomenon often leads to failure to complete the implantation due to insufficient mouth opening or the deflection of the implant due to limited angle, resulting in the high incidence of corresponding complications. The main reason is that doctors lack accurate analysis and control of the overall geometric conditions of the intraoral surgical area, and three-dimensional position blocking of surgical instruments occurs during the operation. In the past, mouth opening was defined as the distance between the incisor edges of the upper and lower central incisors when the patient opens his mouth widely, and the implant area could be in any missing tooth position. When it is in the posterior tooth area, the specific measurement scheme of the mouth opening could not be simply equivalent to the previous measurement method in the anterior tooth area. However, how to measure quickly and conveniently the mouth opening of any surgical area to determine whether it could be implanted and meet the needs of the selected guidance method remains unclear. This paper introduces new concepts, establishes new classification and corresponding accurate measurement scheme of implant area, and establishes a decision tree of implant methods guided by the actually measured value. Results provide a quantitative basis for rational formulation and implementation of implant treatment.

Importancia de la apertura bucal para cirugía guiada de implantes dentales. Reporte de caso y recomendaciones / Importance of buccal opening for guided dental implant surgery. Case report and recommendations

La cirugía guiada asistida por computadora consiste en la fabricación de una guía quirúrgica mediante un protocolo digital que nos brinda diversos beneficios a la hora de colocar los implantes dentales; sin embargo, no todos los pacientes son candidatos para operar con este procedimiento, especialmente en el sector posterior debido a las limitaciones de la apertura bucal. En el presente caso, incluimos en el protocolo completo el registro de las dimensiones de apertura bucal del paciente como requisito previo al flujo de trabajo digital, como un elemento importante en la toma de decisión previa a la planificación para la fabricación de la guía quirúrgica. Adicionalmente, según el contexto, brindamos recomendaciones para tener en cuenta con respecto a la apertura bucal mínima suficiente para la colocación de implantes de diferentes longitudes mediante el protocolo guiado Straumann®.

Computer-guided surgery consists of the manufacture of a surgical guide using a digital protocol that provides various benefits when placing dental implants; however, not all patients are candidates to be operated with this procedure, especially in the posterior sector due to the limitations of the mouth opening. In the present case, the recording of the patient's mouth opening dimensions was included in the complete protocol as a prerequisite to the digital workflow, as an important element in the decision-making prior to the planning for the manufacture of the surgical guide. In addition, depending on the context, we provide recommendations to consider regarding the sufficient minimum mouth opening for the placement of implants of different lengths using the Straumann® Guided Protocol.

Masseter muscle flap for reconstruction of intra-oral defects in patients with early cancer of posterior-inferior parts of the oral cavity / Retalho do músculo masseter para reconstrução de defeitos intraorais em pacientes com câncer inicial de partes póstero‐inferiores da cavidade oral

Abstract Introduction Early carcinomas of the oral cavity in the posterior-inferior regions poses a challenge for reconstruction due to the lack of muscle support underneath and the limited space available to use some of the frequently-used flaps. Objective This study was done to evaluate the efficacy of the superiorly based masseter muscle flap in reconstruction of intra-oral post- ablation defects in patients with early oral carcinoma of the posterior-inferior part of the oral cavity. Methods A superiorly based masseter muscle flap were used to reconstruct the post-surgical intra- oral defect in 60 patients with early squamous cell carcinoma (T < 4 cm) of the posterior-inferior part of the oral cavity. The patients were followed up at 1-week and 1-month postoperatively to check for flap viability, complications, change in mouth opening and deviation of the mandible on mouth opening. To rule out any recurrence in the oral cavity masseter flaps, the patients were followed up for 1 year. Results The flap was viable in all patients and underwent mucosalization. 7/60 patients had postoperative infections, while 2/60 patients developed an oro-cutaneous fistula which required a secondary corrective procedure. The mean ± standard deviation of change in mouth opening at 1 week postoperatively was +1.917 ± 3.36 mm, which increased to +2.633 ± 2.95 mm at 1 month after surgery. The Friedman test revealed that there was a statistically significant change in mouth opening from preoperative period to the1 week and 1 month postoperative periods (p = 0.000). Female patients showed better improvement in mouth opening postoperatively. The ipsilateral deviation of the mandible on mouth opening was between 0-5 mm in 39 patients, 5-10 mm in 17 patients and more than 10 mm in 4 patients. There were no recurrences noted in the masseter flaps used. Conclusion The study infers that the superiorly based masseter muscle flap is a reliable method for reconstruction in early oral cancer patients yielding good functional results and acceptable cosmesis with nominal postoperative complications.

Resumo Introdução Os carcinomas iniciais da cavidade oral nas regiões póstero‐inferiores representam um desafio para a reconstrução devido à falta de suporte muscular abaixo da região e ao espaço limitado disponível para o uso de alguns dos retalhos mais empregados. Objetivo Avaliar a eficácia do retalho do músculo masseter de base superior na reconstrução de defeitos intraorais pós‐ablação em pacientes com carcinoma oral inicial da parte póstero‐inferior da cavidade oral. Método Um retalho do músculo masseter de base superior foi usado para reconstruir o defeito intraoral pós‐cirúrgico em 60 pacientes com carcinoma espinocelular inicial (T < 4 cm) localizado na parte póstero‐inferior da cavidade oral. Os pacientes foram acompanhados após uma semana e um mês de pós‐operatório para verificação da viabilidade do retalho, complicações, alteração na abertura bucal e desvio da mandíbula na abertura bucal. Para descartar recidiva nos retalhos do masseter, os pacientes foram acompanhados por um ano. Resultados O retalho foi viável em todos os pacientes e foi submetido à mucolização; 7/60 pacientes tiveram infecções pós‐operatórias, enquanto 2/60 pacientes desenvolveram uma fístula orocutânea que exigiu um procedimento corretivo secundário. A média ± desvio‐padrão da alteração na abertura da boca em uma semana de pós‐operatório foi + 1,917 ± 3,36 mm, que aumentou para + 2,633 ± 2,95 mm em um mês de pós‐operatório. O teste de Friedman revelou que houve uma alteração estatisticamente significante na abertura da boca do período pré‐operatório para os períodos de uma semana e um mês de pós‐operatório (p = 0,000). Pacientes do sexo feminino apresentaram maior melhoria na abertura da boca no pós‐operatório. O desvio ipsilateral da mandíbula na abertura da boca ficou entre 0 a 5 mm em 39 pacientes, 5 a 10 mm em 17 pacientes e mais de 10 mm em 4 pacientes. Não foram observadas recidivas nos retalhos de masseter usados. Conclusão O retalho do músculo masseter com base superior é um método confiável para reconstrução em casos de câncer oral inicial, produz bons resultados funcionais e resultados cosméticos aceitáveis com complicações pós‐operatórias insignificantes.

Efficacy of topical tulsi (Ocimum sanctum) paste for the management of oral submucous fibrosis – A clinical study

Context: Oral submucous fibrosis (OSMF) is a chronic insidious oral potentially malignant disorder characterized by increased collagen deposition and reduced collagen degradation causing burning sensation and difficulty in mouth opening. Aim: To assess the efficacy of topical Tulsi (Ocimum sanctum) paste for the management of OSMF. Settings and Design: Institution?based clinical trial. Materials and Methods: The study included a total of 60 OSMF patients categorized into three Groups A, B and C (20 in each) depending on the severity according to Lai DR et al. classification. The patients were advised for topical Tulsi paste application and were evaluated for the reduction in the burning sensation and improvement in mouth opening every month for 3 subsequent months using the numeric pain rating scale (NRS) and a Vernier calliper, respectively. Statistical Analysis: The baseline and 3?month recordings were subjected to inter? and intra?group statistical analysis using Kruskal–Wallis analysis of variance (ANOVA), Mann–Whitney U, one?way ANOVA, Tukey’s multiple post?hoc and Wilcoxon matched?pairs tests. Results: There was a reduction in the burning sensation and improvement in the mouth opening in all three groups. The reduction in the burning sensation was statistically significant among all the groups (P < 0.05) and the NRS scores after 3 months among the three groups were not statistically significant (P > 0.05). There was a statistically significant difference (P < 0.05) in the improvement of mouth opening between Group A and B; A and C; but not between B and C. Conclusion: Tulsi paste showed a significant reduction in the burning sensation and improvement of the mouth opening thereby proving to be a safe and promising medicament for OSMF

Research progress in the treatment of oral submucous fibrosis with traditional Chinese medicine and Western medicine / 口腔疾病防治

@#Oral submucous fibrosis is a chronic, occult and progressive potentially malignant disease that seriously affects the oral function and quality of life of patients. The oral burning sensation and limitation of mouth opening are the main reasons for patients to see a doctor. At present, the main treatment for oral submucosal fibrosis is still drug therapy. To provide ideas and references for the clinical treatment of oral submucosal fibrosis, this article reviews the mechanism, therapeutic effect and characteristics of common Chinese and Western medicine in the treatment of oral submucosal fibrosis. The results of the literature review show that salvia miltiorrhiza, aloe, lycopene, curcumin and other traditional Chinese medicine and Western medicine are effective in the treatment of oral submucosal fibrosis; in addition, Taohong Siwu Decoction combined with Western medicine and other combinations of traditional Chinese and Western medicine are effective and reduce side effects, and clinicians can choose appropriate drugs according to the patient’s main symptoms and general condition. In the future, researchers can study more combinations of traditional Chinese and Western medicine to treat oral submucosal fibrosis.

Etiology, pathogenesis, diagnosis and treatment of oral submucous fibrosis / 口腔疾病防治

@#Oral submucous fibrosis (OSF) is a chronic disease that produces scars, tissue fibrosis, and precancerous lesions. Epidemiological studies have shown that chewing betel nut is the most significant risk factor for OSF. Many studies have also indicated that habits such as chewing and smoking tobacco and drinking alcohol increase the risk of OSF, which is widely recognized as an oral precancerous lesion or a potentially malignant oral disorder. Pathological characteristics include chronic inflammation, excessive collagen deposition in the connective tissues below the oral mucous epithelium and local inflammation in the lamina propria or deep connective tissues. OSF patients have a 7%~30% chance of developing oral cancer. Submucosal local injection of triamcinolone and tanshinone was mainly used for the treatment of oral submucosal fibrosis. This treatment improves mouth opening and alleviates the burning sensation in OSF, and the treatment efficacy was as high as 93%. The article will discuss the occurrence, development, diagnosis and treatment of oral submucous fibrosis for clinical management by the medical community.

Research progress on posttreatment trismus in malignant head and neck tumors / 口腔疾病防治

@#Malignant tumors in the head and neck seriously threaten the physical and mental health of patients. After treatment, they may cause many complications, such as facial deformity, difficulties with chewing, dysphagia and asaphia. Among them, trismus (restricted mouth opening) is one of the most common complications after treatment of malignant oral-maxillofacial tumors. In severe cases, patients may even suffer from trismus and eating difficulties, finally leading to malnutrition and even cachexia. Therefore, it not only affects the quality of life of patients and even endangers their lives but also brings heavy social and economic burdens. How to effectively prevent and treat posttreatment trismus is a clinical problem that is easily ignored by head and neck surgeons and urgently needs to be solved. The results of a literature review showed that trismus may be related to the tumor clinical stage, tumor site, treatment used, radiotherapy site, radiotherapy dose, radiotherapy type, and other factors. The incidence of trismus tends to be significant 6 months after treatment. Without early intervention, the resulting dysfunction may become more severe. Current studies have shown that the prevention and treatment of restricted mouth opening is based on controlling the progress of restricted mouth opening and restoring function. Exercise intervention for trismus can significantly improve the restricted mouth opening of patients with malignant head and neck tumors after treatment.

Trismus and oral health conditions during diagnosis of malignant oral neoplasms / Trismo e condições de saúde bucal no diagnóstico de neoplasias malignas da cavidadeoral

Abstract Introduction: Trismus has been considered a late complication of cancer treatment. It can occur prior to treatment, mainly caused by tumor invasion or muscle spasms induced by the presence of the tumor. Objective: In this study, we evaluated the incidence of trismus and its effect on oral health in patients with malignant neoplasms of the oral cavity before performing the cancer treatment. Methods: This review was carried out via interviews, visual clinical inspection and objective measurement of maximal mouth opening in 35 consecutive patients. Trismus was defined as a maximal mouth opening <35 mm. Results: Trismus was observed in 15 patients, with a total incidence of 42%. A high rate of tooth loss was recorded, and trismus association with tooth loss was statistically verified using the Chi-square and Fisher's exact tests, the t-student test and Mann-Whitney non-parametric test. All tests were performed at p < 0.05. Conclusion: Edentulous patients are eight times more likely to have trismus compared to patients that are partially and fully dentate. Trismus was demonstrated to be correlated with tooth loss; however other oral health conditions were not shown to be a modifying factor.

Resumo Introdução: O trismo tem sido considerado uma complicação tardia do tratamento do câncer, pode ocorrer antes do tratamento, causado principalmente por invasão tumoral ou espasmos musculares induzidos pela presença do tumor. Objetivo: Avaliar a incidência do trismo e seu efeito sobre a saúde bucal em pacientes com neoplasias malignas da cavidade bucal antes de se submeterem ao tratamento do câncer. Método: Esta revisão foi realizada por meio de entrevistas, inspeção clínica visual e mensuração objetiva da abertura bucal máxima em 35 pacientes consecutivos. O trismo foi definido como abertura bucal máxima < 35 mm. Resultados: O trismo foi observado em 15 pacientes, com uma incidência de 42%. Uma alta taxa de perda dentária foi registrada e a associação do trismo com a perda dentária foi verificada estatisticamente com os testes qui-quadrado, exato de Fisher, t de Student e não paramétrico de Mann-Whitney. Todos os testes foram realizada com p < 0,05. Conclusão: Pacientes edêntulos são oito vezes mais propensos a ter trismo do que os pacientes parcial e totalmente dentados. O trismo demonstrou estar correlacionado com a perda dentária. Entretanto, as outras condições de saúde bucal não se mostraram um fator modificador.

Application research of teach-back in mouth-opening training of patients with nasopharyngeal carcinoma / 中国实用护理杂志

Objective@#To investigate the effect of teach-back on the compliance of mouth-opening training in patients with nasopharyngeal carcinoma after radiotherapy.@*Methods@#Eighty patients with nasopharyngeal carcinoma in the First Affiliated Hospital of Gannan Medical University were selected. They were divided into intervention group and control group according to the random number table method. The intervention group used the teach-back method for health education, and the control group used conventional methods for health education. The knowledge mastery of mouth-opening training, the degree of compliance with mouth-opening training and the difficulty of mouth opening were compared between the two groups.@*Results@#Within 1 week of the intervention group, the complete mastery rate, partial mastery rate, and unmastered rate was 77.5% (31/40), 17.5% (7/40), and 5.0% (2/40), respectively, within 2 weeks, that was 97.5% (39/40), 2.5% (1/40), 0. Within 1 week of the control group was 65.0% (26/40), 10.0% (4/40), 25.0% (10/40), respectively, within 2 weeks, that was 75.0% (30/40), 20.0% (8/40), and 5.0% (2/40). The knowledge mastery of mouth-opening training in the intervention group was higher than that in the control group within 1 week and 2 weeks, and the difference between the two groups was statistically significant (χ2=6.590, 8.618, P<0.05). At the end of radiotherapy, the complete compliance rate, partial compliance rate, and non-compliance rate of the intervention group was 90.0% (36/40), 10.0% (4/40), 0, respectively. After 3 months of radiotherapy, the rate was 75.0% (30/40), 22.5% (9/40), 2.5% (1/40). At the end of 6 months of radiotherapy, the rate was 60.0% (24/40),30.0% (12/40) and 10.0% (4/40). At the end of the radiotherapy, the control group was 70.0% (28/40), 20.0% (8/40), and 10.0% (4/40), respectively. After 3 months of radiotherapy, the rate was 40.0% (16/40), 45.0% (18/40) and 15.0% (6/40). After 6 months of radiotherapy, the rate was 20.0% (4/40), 40.0% (16/40), and 40.0% (16/40). The compliance of the intervention group at the end of radiotherapy, 3 months after radiotherapy, and 6 months after radiotherapy was higher than that of the control group, and the difference between the two groups was statistically significant (χ2=5.986, 10.615, 15.771, P<0.05 or 0.01). In the intervention group, the incidence of Ⅰ degree, Ⅱ degree, Ⅲ degree and Ⅳ degree difficulty of mouth opening after 6 months of radiotherapy was 10.0% (4/40), 5.0% (2/40), 0, 0, respectively, and the control group was 15.0% (6/40), 15.0% (6/40), 2.5% (1/40), 2.5% (1/40), the incidence of difficulty of mouth opening of the intervention group was lower than that of the control group, and the difference between the two groups was statistically significant (Z=15.737, P<0.01).@*Conclusions@#Teach-back can effectively improve the mastery of patients′ mouth-opening training knowledge and the compliance of mouth-opening training, which is beneficial to reduce the incidence of mouth-opening difficulties in patients with nasopharyngeal carcinoma. It is worthy of clinical promotion.

Microstomia: Difficult Proposition to Rehabilitate

Introduction: The rehabilitation of microstomia patientspresents difficulties during fabrication of denture as themaximal mouth opening is inadequate. This condition mayresult from the surgical treatment of orofacial cancer, cleft lip,trauma, burns, Plummer–Vinson syndrome or scleroderma.The reduced mouth opening also leads to difficulty in speech,mastication and psychological problems secondary to facialdisfigurement.Case report: It is often difficult to apply conventional clinicalprocedures to fabricate prosthesis for patients who demonstratelimited mouth opening, since it is difficult to follow theprotocol of fabrication of prosthesis and also insertion andremoval of one-piece prosthesis into the oral cavity. Thepresent case report focuses on rehabilitation of microstomiausing sectional prosthesis and intraoral magnets with whichenabled easier and competent removal and insertion by thepatient.Conclusion: The sectional denture attached by the magnetcan be more comfortably removed and inserted by the patientwith reduced mouth opening. It is simple and cost-effectivemethod for rehabilitation of microstomia patient.

Recurrent oral submucous fibrosis with nil mouth opening surgical management and reconstruction with bilateral nasolabial flap: A case report and review of literature

Oral submucous fibrosis [OSF] is a premalignant condition characterized by inflammation and progressive fibrosis of submucosal tissue, resulting in trismus. It is associated with chewing of areca nut in betel quid. Mortality rate is significant because it transforms into oral squamous cell carcinoma at a rate of 2.3%–7.6%. The aim of this article is to share our experience in managing a case of recurrent oral submucous fibrosis with nil mouth opening by surgical excision, coronoidotomy, and reconstruction of buccal defect using bilateral inferiorly based nasolabial flap, followed by active oral physiotherapy. The patient had reached an acceptable mouth opening with no further recurrence. The patient was observed closely for any malignant transformation. Surgical excision of bands and coronoidotomy followed by reconstruction with nasolabial flaps and active physiotherapy in the postoperative period remains a good option for recurrent and advanced cases of OSF with acceptable functional and cosmetic results.

Masticatory muscle tendon-aponeurosis hyperplasia accompanied by limited mouth opening

Patients with masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) experience limited mouth opening due to restricted muscle extension. Hyperplastic aponeurosis and tendons lead to the restriction of muscle extension. The criteria for the diagnosis of MMTAH are limited mouth opening that progresses very slowly from adolescence, intraoral palpation reveals a hard cord-like structure along the overhang of the anterior border of the masseter muscle on maximum mouth opening, and a square mandible. Conservative treatment, including pharmacotherapy, occlusal splint and physical therapy are ineffective. The standard therapy is surgical treatment, such as anterior partial aponeurectomy of the masseter muscle and coronoidectomy. The long-term results are very satisfying.

Application of the nasolabial fold "smile" incision approach in posterior buccal cancer ablation / 华西口腔医学杂志

OBJECTIVE@#This study investigated the feasibility and clinical result of radical resection of posterior buccal carcinoma by using the facial nasolabial fold "smile" incision approach.@*METHODS@#From August 2016 to March 2017, 23 patients with posterior buccal carcinoma were included in this study and underwent radical surgery. Upon finishing the cervical lymph node dissection, an arc-shaped incision was made at 1 cm lateral to the ipsilateral angulus oris, extending along the nasolabial fold upward to the inferolateral margin of the nasal alar while downward in direct continuity with the neck dissection incision.@*RESULTS@#Satisfactory exposure and easy resection of the primary tumor with negative surgical margin were achieved in all 23 patients. After 12-22 months of follow-up (16.5 months on average), all patients recovered favorably, and no local recurrence or distant metastasis was observed. Mouth opening was restored to normal in all cases. The scars were hidden in the nasolabial fold, thus named "smile" incision.@*CONCLUSIONS@#For posterior buccal cancer patients, the facial "smile" incision approach can satisfy the need of surgical exposure, facilitate operative performance, and preserve the annular integrity of the lips without affecting the radical tumor ablation, thereby maintaining a favorable mouth opening. With these advantages, the "smile" incision approach is considered worthy of being popularized in clinical application.

Tratamento cirúrgico da limitação de abertura bucal causada por hiperplasia do processo coronoide: relato de caso / Surgical treatment for mouth opening limitation caused by coronoid process hyperplasia: case report

A hiperplasia do processo coronoide é uma condiçãoincomum de etiologia desconhecida que se apresentaclinicamente por meio da limitação de abertura bucal enão possui sintomatologia dolorosa durante a aberturae o fechamento bucal. Objetivo: relatar e discutir, pormeio de um caso cirúrgico, o tratamento da limitaçãode abertura bucal causada por hiperplasia bilateral doprocesso coronoide. Relato de caso: paciente do sexofeminino, com 11 anos de idade, foi encaminhada paraatendimento devido à dificuldade de mastigação emfunção da limitação de abertura bucal, sem históricode trauma em face ou na região articular. O exame tomográficoevidenciou o alongamento bilateral do processocoronoide, fazendo com que ele colidisse com oarco zigomático durante a abertura bucal e causasse otravamento. O tratamento proposto foi a coronoidectomiabilateral com acesso cirúrgico intraoral, obtendono pós-cirúrgico imediato um ganho na abertura bucal.Considerações finais: a coronoidectomia é uma abordagemcirúrgica de fácil acesso por via intraoral, poucotraumática e eficaz no tratamento de pacientes com hiperplasiado processo coronoide. (AU)

The coronoid process hyperplasia is an unusual condition of unknown etiology that is presented clinically through mouth opening limitation, without painful symptoms during mouth opening and closure. Objective: to report and discuss, through a surgical case, the treatment of mouth opening limitation caused by bilateral coronoid process hyperplasia. Case report: female patient, 11 years old, referred due to chewing difficulty by mouth opening limitation. No history of trauma in the face or joint area. The tomographic examination showed the bilateral elongation of the coronoid process, causing it to collide with the zygomatic arch during mouth opening, which caused locking. The treatment proposed was bilateral coronoidectomy with intraoral surgical access, which enhanced mouth opening at the immediate postoperative period. Final considerations: coronoidectomy is a surgical approach with easy intraoral access, non-traumatic, and effective in the treatment of patients with coronoid process hyperplasia. (AU)

Restricted mouth opening and its definitive management: A literature review

This review was intended to discuss the various possible modifications suggested in the literature for prosthetic steps and surgical corrective procedures in nonresponding or complicated cases during rehabilitation of patients with restricted mouth opening. Material and Methods: Medline, PubMed, and Google were searched electronically for articles using keywords: microstomia and treatment options for restricted mouth opening. The various articles on prosthodontic rehabilitation in microstomia were segregated. From these, various modifications in the prosthetic steps were reviewed. Results: Oral hygiene maintenance is difficult for patient either due to limited access or due to associated lack of manual dexterity, so dental decay and periodontal problems are more extensive in such patients; hence, tooth loss is a common finding. All prosthetic procedures require wide mouth opening to carry out various steps, starting from tray placement during impression making to the final prosthesis insertion, especially removable prosthesis. Various prosthetic modifications given by authors are included in this review for each step in prosthodontic management. A total of eight stock tray designs, 12 custom tray designs, and 17 removable prosthesis designs are discussed along with fixed (either tooth-supported or implant-supported) and maxillofacial prosthesis. However, some patients require surgical intervention also for the correction of microstomia either for function or for esthetic purpose before prosthetic rehabilitation and are also enumerated here. Conclusion: Among all prosthetic restorative options, removable prosthesis is most difficult for dentist to fabricate as conventional methods are either very difficult or impossible to apply. To get a more accurate final prosthesis, we need to modify these steps according to the existing case. Several modifications available are discussed here which can help while managing these patients.

Airway management in a displaced comminuted fracture of the mandible and atlas with a vertebral artery injury: A case report

Complex cervical spine fractures are a serious complications of maxillofacial trauma and associated with high mortality and neurological morbidity. Strict vigilance in preventing further insult to the cervical spine is a crucial step in managing patients who are at risk for neurologic compromise. We report a rare case of a right transverse process of atlas fracture with right-sided vertebral artery injury that was associated with a comminuted fracture of the body and angle of the mandible, which restricted mouth opening. Airway management was performed by an awake fiber-optic nasotracheal intubation, where neck movement was avoided with a cervical collar. Vertebral artery injuries may have disastrous consequences, such as basilar territory infarction and death, and should be suspected in patients with head and neck trauma. After mandibular plating, the patient was on cervical collar immobilization for 12 weeks and anti-coagulant therapy.

A retrospective study on mandibular coracoid fractures / 华西口腔医学杂志

OBJECTIVE@#This study aimed to analyze the treatment for mandibular coracoid fractures retrospectively.@*METHODS@#A retrospective study on 37 patients with mandibular coracoid fractures treated at Department of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University from January 2010 to December 2015 was conducted. Eleven patients were treated conservatively, and 26 patients underwent surgical restoration and internal fixation. Mouth opening and pain degree were used as indicators to analyze treatment results.@*RESULTS@#The 37 cases of coracoid fractures accounted for 3.18% of the total mandibular fractures. The average age of patients was 38.05 years. Satisfactory results were obtained in both treatments. A considerable change in the degree of mouth opening before and after 6 months was found in the two groups. The pain degree before treatment and 1 day after operation, 1 day and 4 weeks after operation, and 4 weeks and 6 months after operation indicated that the two groups did not significantly differ. However, substantial changes between the two groups were found before treatment and 6 months after operation.@*CONCLUSIONS@#Conservative treatment is recommended for patients with linear, temporalis muscle-located, and non-displaced coracoid fractures. Surgical treatment is recommended for patients with large fractures and those with accompanying zygomatic arch and mandible fractures.