Conhecimento e atitudes de indivíduos leigos sobre avulsão de dentes permanentes / Knowledge and atitudes of lay individuals about avulsion of permanente teeth / Conocimientos y actitudes de los legos sobre la avulsión de los dientes permanentes

Introdução: A avulsão dentária é caracterizada pelo deslocamento total do elemento dentário para fora do alvéolo em decorrência de um trauma externo e as medidas emergenciais prestadas ainda no local do acidente são imprescindíveis para um bom prognóstico. Objetivo: Investigou-se o nível de conhecimento e atitudes de leigos sobre possíveis condutas frente à avulsão de dentes permanentes. Métodos: A coleta de dados foi realizada a partir de um questionário contendo perguntas sobre características gerais da lesão e as atitudes que os pacientes tomariam em um caso de avulsão. Os dados foram analisados pelo teste de Mann Whitney, considerando um nível de significância de 5% (p <0,05). Resultados: Questionários foram respondidos por 120 pacientes enquanto aguardavam atendimento. A média geral de respostas corretas / atitudes esperadas foi de 3,74. Os participantes que possuíam informação prévia acerca do tema, obtiveram médias significativamente maiores, o mesmo não foi verificado com aqueles que possuíam experiência prévia com trauma. Conclusão: Conclui-se que o conhecimento sobre avulsão dentária dos pacientes é baixo e que a educação em saúde, através da informação da população pode ser um fator relevante para a melhora da conduta emergencial no local do trauma pela população leiga... (AU)

Introduction: Tooth avulsion is characterized by the total displacement of the tooth out of the socket as a result of an external trauma and emergency measures provided at the accident site are essential for a good prognosis. Objective: We investigated the level of knowledge and attitudes of lay people about possible behaviors in the face of avulsion of permanent teeth. Methods: Data collection was performed using a questionnaire containing questions about general characteristics of the lesion and the attitudes that patients would take in a case of avulsion. Data were analyzed using the Mann-Whitney test, considering a significance level of 5% (p <0,05). Results: Questionnaires were answered by 120 patients while waiting for care. The overall average of correct answers/expected attitudes was 3.74. Participants who had previous information on the subject had significantly higher averages, the same was not verified with those who had previous experience with trauma. Conclusion: It is concluded that the knowledge about dental avulsion of patients is low and that health education, through population information can be a relevant factor for the improvement of emergency management at the trauma site by the lay population... (AU)

Introducción: La avulsión dentaria se caracteriza por el desplazamiento total del diente fuera del alvéolo como consecuencia de un traumatismo externo y las medidas de urgencia en el lugar del accidente son fundamentales para un buen pronóstico. Objetivo: Indagamos el nivel de conocimientos y actitudes de los legos sobre posibles comportamientos ante la avulsión de dientes permanentes. Métodos: La recolección de datos se realizó mediante un cuestionario que contenía preguntas sobre las características generales de la lesión y las actitudes que tomarían los pacientes en caso de avulsión. Los datos fueron analizados mediante la prueba de Mann-Whitney, considerando un nivel de significación del 5% (p<0,05). Resultados: Los cuestionarios fueron respondidos por 120 pacientes en espera de atención. La media global de aciertos/ actitudes esperadas fue de 3,74. Los participantes que tenían información previa sobre el tema tuvieron promedios significativamente más altos, lo mismo no se verificó con aquellos que tenían experiencia previa con el trauma. Conclusión: Se concluye que el conocimiento sobre la avulsión dentaria de los pacientes es bajo y que la educación en salud, a través de la información poblacional, puede ser un factor relevante para la mejora del manejo de la emergencia en el sitio del trauma por parte de la población no especializada... (AU)

Tratamento cirúrgico em fratura de mandíbula atrófica: uma revisão de literatura / Surgical treatment of atrophic jaw fracture: a literature review

Analisar o manejo de fraturas em mandíbula atrófica voltado para a abordagem cirúrgica com ênfase na melhor técnica indicada. A perda óssea alveolar tem sido uma das consequências do edentulismo, que tem o potencial de levar a atrofia óssea. As fraturas de mandíbulas atróficas, normalmente são consideradas um procedimento desafiador, devido ser encontrada em pacientes idosos ou em virtude da perda dentária precoce resultando em um reparo dessas fraturas mais complexo. Os principais fatores etiológicos têm sido os acidentes automobilísticos, seguidos de queda e agressão. Geralmente, as causas das quedas decorrem de desequilíbrio, fraqueza muscular, tontura, e uso crônico de medicamentos como sedativos. As opções terapêuticas objetivam restaurar forma, função e imobilização apropriada desse possível evento. A individualização do tratamento de escolha é de grande importância, pois geralmente o paciente apresenta alterações fisiológicas decorrentes do envelhecimento e ossos mais fragilizados com potencial osteogênico reduzido, que dificultam a abordagem cirúrgica. Entretanto, deve ser considerado para o manejo dessas fraturas, a idade do paciente, as condições e quantidade de tecido ósseo e tecido mole. Porém, vale ressaltar que o envelhecimento não apresenta contraindicação, apenas exige condições especiais que devem ser consideradas. Nesse sentido, quando há oportunidade de dispositivos tecnológicos, como os biomodelos que contribuem significativamente para procedimentos cirúrgicos bucomaxilofaciais, esses fornecem maior previsibilidade de resultados, bem como redução do tempo cirúrgico.

To analyze the management of fractures in atrophic mandible aimed at the surgical approach, emphasizing which technique is best indicated. Alveolar bone loss has been one of the consequences of edentulism, which has the potential to lead to bone atrophy. Atrophic jaw fractures are usually considered a challenging procedure, as they are found in elderly patients or due to early tooth loss, resulting in a more complex repair of these fractures. The main etiological factors have been described as car accidents, followed by falls and aggression. Commonly, the causes of falls stem from imbalance, muscle weakness, dizziness, and chronic use of medications such as sedatives. The therapeutic options aim to restore form, function and appropriate immobilization of this possible event. The individualization of the treatment of choice is of great importance, as the patient usually presents physiological changes resulting from aging and more brittle bones and a reduced osteogenic potential, which makes the surgical approach difficult. However, the patient's age, conditions and amount of bone and soft tissue must be taken into consideration for the management of these fractures. However, it is noteworthy that aging has no contraindication, it only requires special conditions that must be considered. In this sense, when there is an opportunity for technological devices, such as biomodels that significantly contribute to maxillofacial surgical procedures, it provides greater predictability of results, as well as reduced surgical time.

Concordancia clínica e histopatológica de lesiones óseas orales. Estudio retrospectivo / Clinical and Histopathological Concordance of oral Bone Lesions. Retrospective Study

Resumen Las lesiones óseas de los maxilares tienen su origen a partir de estructuras odontogénicas y no odontogénicas. Pueden ser benignas o malignas, asintomáticas, pueden ubicarse alrededor de la raíz del diente, alrededor de la corona y en el área interradicular o pueden no tener relación con los dientes. OBJETIVO: determinar la frecuencia de las diferentes lesiones óseas y la concordancia existente entre el diagnóstico clínico e histopatológico, en el internado clínico de la Facultad de Odontología de la Universidad de Costa Rica (UCR). METODOLOGÍA: estudio retrospectivo de lesiones óseas recuperados del archivo de biopsias de la Facultad de Odontología de la UCR del 2008 a 2015. Se evaluaron y analizaron de forma descriptiva y cualitativa información sobre el sexo, edad, localización de la lesión, diagnóstico clínico y diagnóstico histopatológico. La concordancia entre el diagnóstico clínico e histopatológico fue verificada mediante el test Kappa. RESULTADOS: los 77 casos de lesiones óseas orales afectaron preferentemente a los hombres 53.8 % (n=41), el promedio de edad fue 34.7±19.6 años y con lesiones predominantemente localizadas en mandíbula posterior 36.4 % (n=28) y maxila anterior 35.1% (n=27). Los quistes odontogénicos (QO) 42.9% (n=33), diagnóstico no específico o sin clasificación 28.6% (n=22) y lesiones inflamatorias de origen pulpar y periapical 14.2% (n=11). Los TO representaron el 7.8% (n=6) de las lesiones. Las cuatro lesiones más predominantes fueron el quiste radicular, diagnóstico inespecífico, quiste dentígero y granuloma periapical. La concordancia con la primera hipótesis diagnóstica se presentó en 24 (31.2%) casos, el valor de Kappa fue de 0.274 (concordancia discreta) y un 20,8 % sin diagnóstico clínico solo una descripción de la lesión. CONCLUSIONES: Los QO fueron los predominantes; siendo en forma individual el quiste radicular la lesión más frecuente. La concordancia clínica e histopatológica fue discreta.

Abstract Bone lesions of the jaws have their origin from odontogenic and non- odontogenic structures. They can be benign or malignant, asymptomatic, they can be located around the root of the tooth, around the crown and in the interradicular area or they may not be related to the teeth. OBJECTIVE: to determine the frequency of the different bone lesions and the concordance between the clinical and histopathological diagnosis, in the clinical internship of the Faculty of Dentistry of the University of Costa Rica (UCR). METHODOLOGY: retrospective study of bone lesions recovered from the biopsy archive of the Faculty of Dentistry of the UCR from 2008 to 2015. Information on sex, age, location of the lesion, clinical diagnosis and diagnosis were evaluated and described. The agreement between the clinical and histopathological diagnosis was verified by the Kappa test. RESULTS: The 77 cases of oral bone lesions preferentially affected men 53.8% (n=41), the average age was 34.7 years (s.d.±19.6) and with lesions predominantly located in the posterior jaw 36.4% (n=28) and anterior maxilla 35.1% (n=27). Odontogenic cysts (OC) 42.9% (n=33), non-specific or unclassified diagnosis 28.6% (n=22) and inflammatory lesions of pulp and periapical origin 14.2% (n=11). TOs accounted for 7.8% (n=6) of the lesions. The four most predominant lesions were the radicular cyst, nonspecific diagnosis, dentigerous cyst and periapical granuloma. Concordance with the first diagnostic hypothesis was presented in 24 (31.2%) cases, the value of Kappa was 0.274 (discrete concordance) and 20.8% without clinical diagnosis only a description of the lesion. CONCLUSIONS: The OC were the predominant; being individually the radicular cyst the most frequent lesion. The clinical and histopathological concordance was discrete.

Epidemiological analysis of 736 patients who suffered facial trauma in Brazil / Análisis epidemiológico de 736 pacientes que sufrieron trauma facial en Brasil

The etiology of facial fractures is directly related to the studied country, varying according to the socioeconomic, cultural condition of the population, besides the period of investigation. The objective of the present study is to evaluate the epidemiological characteristics of the prevalence, treatment modalities and complications rates of maxillofacial fractures in a hospital in the state of Espírito Santo, over a period of 5 years. A total of 428 patients presented a facial fracture, with a prevalence of males (436), with a mean age of 40 years. Regarding the number of fractures, 291 individuals suffered fractures only in the fixed skeleton, 97 only in the mandible, and 48 suffered fractures in both fixed and mandibular skeletons. The predominant anatomical site in fixed skeletal fractures was zygomatic complex (56.6 %), orbit (31.9 %) and nose (29.2 %); while in the mandible the condyle (33.8 %), body (17.9 %) and angle (13.1 %). The frequent etiology was falls, physical aggression, sports accidents. Regarding the type of treatment, in fixed skeleton 192 fractures were treated conservatively and 303 by surgery. Already in the mandible, the numbers were 43 and 143, respectively. In addition, 24 patients progressed with some type of complication in one or more operated sites. It is worth mentioning that epidemiological assessments provide important support in the creation of legislation in the attempt to reduce important for the establishment of clinical and research priorities, since risk factors and patterns of presentation can be identified. Accordingly in an attempt to reduce these rates.

La etiología de las fracturas faciales está directamente relacionada con el país estudiado, variando según la condición socioeconómica y cultural de la población, además del período de investigación. El objetivo del presente estudio fue evaluar las características epidemiológicas de la prevalencia, las modalidades de tratamiento y las tasas de complicaciones de las fracturas maxilofaciales en un hospital en el estado de Espírito Santo, durante un período de 5 años. Un total de 428 pacientes presentaron fractura facial, con una prevalencia de varones (436), con una edad media de 40 años. Con respecto al número de fracturas, 291 individuos sufrieron fracturas solo en el esqueleto fijo, 97 solo en la mandíbula y 48 sufrieron fracturas tanto en el esqueleto fijo como en el mandibular. El sitio anatómico predominante en las fracturas esqueléticas fijas fue el complejo cigomático (56,6 %), la órbita (31,9 %) y la nariz (29,2 %); mientras que en la mandíbula el cóndilo (33,8 %), el cuerpo (17,9 %) y el ángulo (13,1 %). La etiología frecuente fue caídas, agresión física, accidentes deportivos. En cuanto al tipo de tratamiento, en el esqueleto fijo se trataron 192 fracturas de forma conservadora y 303 mediante cirugía. Ya en la mandíbula, los números eran 43 y 143, respectivamente. Además, 24 pacientes progresaron con algún tipo de complicación en uno o más sitios operados. Cabe mencionar que las evaluaciones epidemiológicas brindan un apoyo importante en la creación de legislación en estos casos, para establecer prioridades clínicas y de investigación, debido a que se pueden identificar factores de riesgo y patrones de presentación. En consecuencia, en un intento de reducir estas tasas.

Extensive hyperdense zone in the mandible: a case report

Hyperdense zones are considered a generic term to define an area of increased density regardless of its cause. Idiopathic hyperdense zones are referred in literature as enostosis, focal osteosclerosis, periapical osteopetrosis or bone scar and are found as imaging finding during a rutine radiograph. They have greater predilection for long bones, but can also appear in the maxillary bones in certain occasions, often located in the jaw, especially in the molar region, with an informed incidence rate that varies from 2,3 to 9,7% depending on the population in which the study is being applied. In 40% of the cases, in spite of being of idiopathic origin, they seem to be associated with patients with occlusal trauma or can be a result of a predominant development of isolated bone during bone growth. The case of a 36-year-old female patient is described, who presents hyperdensity that differs in form, location and imaging features from the commonly documented in this type of anatomical variations. It was diagnosed as idiopathic osteosclerosis, periodic imaging controls were established. The purpose of this case report is to emphasize the importance of performing an appropriate differential diagnosis among hyperdense lesions at maxillofacial level.

Quiste dentígero en tercer molar mandibular en posición invertida / Dentigerous cyst in an inverted mandibular third molar

Introducción: la erupción es un proceso complejo y, debido a esto pueden aparecer fallas en él. Objetivo: presentar un caso clínico de un quiste dentígero en un tercer molar mandibular invertido. Caso clínico: paciente masculino de 36 años de edad, quien refiere haber asistido a una clínica estomatológica por molestias en la región mandibular derecha y que al realizársele una ortopantomografía, se detecta la presencia del 48 retenido, por lo que es remitido. Al examen físico bucal se detecta ausencia clínica del 48 con expansión de la tabla vertibular en la zona. Al observarse la ortopantomografía se aprecia en la zona de molares derechos reabsorción radicular en el 47, con 48 en posición invertida y una imagen radiolúcida de límites bien definidos en relación con la corona del 48. Se realiza, bajo anestesia local, la exéresis del 47, 48 y la lesión responsable de la imagen radiolúcida mandibular mediante curetaje. Se indica el estudio histopatológico de la lesión, que indica la presencia de un quiste dentígero. El paciente mostró buena evolución posoperatoria. Conclusiones: lo inusual de la presencia de un quiste dentígero, como complicación de la retención dentaria, en un tercer molar mandibular invertido, permitió valerse de los beneficios de estudios imaginológicos digitales y del método clínico para crear un plan de tratamiento que desencadenó en la exéresis exitosa, sin complicaciones transoperatorias, de los dientes y la lesión asociada(AU)

Introduction: tooth eruption is a complex process and due to this complexity flaws may appear in it. Objective: present a clinical case of a dentigerous cyst in an inverted mandibular third molar. Clinical case: a male 36-year-old patient reports having visited a dental clinic for discomfort in the right mandibular region. Orthopantomography was indicated which revealed that tooth 48 was retained; the patient was therefore referred. Clinical oral examination detected the absence of tooth 48 and an expanded vestibular table in the area. The orthopantomograph showed root resorption of tooth 47 in the area of the right molars, with 48 in an inverted position and a radiolucent image of clear-cut boundaries in relation to the crown of 48. Exeresis of 47 and 48 was performed under local anesthesia, and the lesion responsible for the mandibular radiolucent image was removed by curettage. Histopathological examination of the lesion was indicated, revealing the presence of a dentigerous cyst. Postoperative evolution was satisfactory. Conclusions: the infrequent presence of a dentigerous cyst as a complication of dental retention in an inverted mandibular third molar prompted the use of the benefits offered by digital imaging studies and the clinical method to develop a treatment plan leading to successful exeresis of the teeth involved and the associated lesion, without any perioperative complications(AU)

Tumor odontogénico adenomatoide extrafolicular de localización mandibular / Mandibular extrafollicular adenomatoid odontogenic tumor

Introducción: el tumor odontogénico adenomatoide es un tumor odontogénico benigno compuesto por epitelio odontogénico con estroma fibroso maduro sin participación del ectomesénquima. Representa entre el 2 por ciento y el 7 por ciento de estos tumores. Más del 90 por ciento aparecen antes de los 30 años con tres variantes clínicas: folicular, extrafolicular y periférica. Su aspecto clínico-radiográfico varía y puede ser confundido con otras lesiones quísticas o neoplásicas de la cavidad bucal, por lo que es necesario el diagnóstico anatomopatológico. Objetivo: presentar un caso de un tumor odontogénico adenomatoide extrafolicular mandibular. Presentación del caso: paciente femenina de 12 años de edad, con aumento de volumen asintomático en la encía mandibular del lado izquierdo, sin antecedentes patológicos de interés, de tiempo de evolución no precisado. Al examen físico se observó aumento de volumen de forma redondeada de 1,5 cm que desplazaba la encía mandibular izquierda entre incisivo lateral y canino. La radiografía reveló una lesión radiolúcida unilocular entre 42 y 43 que expandía la cortical ósea. Se detectó ausencia de vitalidad pulpar de estos dientes. Con el diagnóstico clínico de quiste periapical se realizó excisión quirúrgica, se envió la muestra al laboratorio de Anatomía Patológica, y se concluyó el diagnóstico de tumor odontogénico adenomatoide extrafolicular. Conclusiones: el tumor odontogénico adenomatoide, más común en la maxila, puede presentarse en la mandíbula. Los hallazgos clínico-radiográficos semejan otras lesiones odontogénicas como quistes dentígeros, otras neoplasias y lesiones periapicales inflamatorias, siendo el diagnóstico anatomopatológico el concluyente(AU)

Introduction: adenomatoid odontogenic tumor is a benign odontogenic tumor composed of odontogenic epithelium with mature fibrous stroma without ectomesenchymal involvement. It represents between 2 percent and 7 percent of these tumors. More than 90 percent appear before age 30, with three clinical variants: follicular, extrafollicular and peripheral. Its clinical-radiographic aspect may vary, and it may be confused with other cystic or neoplastic lesions of the oral cavity, hence the need for an anatomo-pathological diagnosis. Objective: present a case of mandibular extrafollicular adenomatoid odontogenic tumor. Case presentation: afemale 12-year-old patient presents with asymptomatic left mandibular gum swelling, with no pathological antecedents of interest and an imprecise time of evolution. Physical examination found a round 1.5 cm swelling displacing the left mandibular gum between the lateral incisor and the canine. Radiography revealed a unilocular radiolucent lesion between teeth 42 and 43 expanding the cortical bone. The teeth involved showed no pulpal vitality. Upon reaching a clinical diagnosis of periapical cyst, surgical excision was performed and a sample was submitted to the Anatomical Pathology laboratory. The anatomo-pathological diagnosis was extrafollicular adenomatoid odontogenic tumor. Conclusions: though more common in the maxilla, adenomatoid odontogenic tumors may also occur in the mandible. Clinical and radiological features may be similar to those of other odontogenic lesions, such as dentigerous cysts, other neoplasms and periapical inflammatory lesions; therefore, the final diagnosis should be provided by anatomo-pathological evaluation(AU)

Formas de presentación de los terceros molares mandibulares incluidos e impactados. Hospital General Provincial Docente Riobamba / Forms of presentation of mandibular third molars included and impacted. General Hospital of Riobamba

La diversidad de posibles posiciones que pueden adoptar los terceros molares durante el proceso de erupción, hacen que estos se muestren como piezas incluidas, retenidas o impacta-das, problemática asociada a trastornos mecánicos como la obstrucción de tejidos blandos o duros o por motivos embriológicos. Se realizó un estudio descriptivo, transversal, con enfo-que mixto; con el objetivo de caracterizar las formas de presentación de este tipo de dientes en los individuos que conformaron la población de estudio, la que quedó determinada por la totalidad de pacientes atendidos por sintomatología relacionada a la presencia de terceros molares mandibulares incluidos e impactados (164) en el Servicio de Odontología del Hospi-tal General Provincial Docente Riobamba entre enero y diciembre del 2015; de los cuales, mediante un muestreo no probabilístico del tipo intencional, se seleccionaron 103 enfermos con edades comprendidas entre los 15 a 60 años de edad, con óptimo estado de salud mental y diagnóstico radiológico en historia clínica de tercer molar retenido. Las características mor-fológicas de los terceros molares observados se acercan a las descripciones anatómicas referi-das por la ciencia, predominando la inclinación vertical del eje longitudinal respecto al segun-do molar. La presencia de esta anomalía se observó de forma mayoritaria en el sexo masculi-no y en el grupo etario conformado por individuos adolescentes y adultos jóvenes, los que no refirieron poseer antecedentes patológicos familiares relacionados a este padecimiento.

The third molars can adopt a diversity of possible positions during the process of eruption. These positions make them appear as pieces included, retained or impacted, problematic associated with mechanical disorders such as obstruction of soft or hard tissues, or embryolo-gical reasons. A descriptive, cross-sectional study with a mixed approach was carried out in order to characterize the ways of presenting this type of teeth in the subjects of the study. The population was determined by the totality of patients treated for symptoms related to the presence of included and impacted third mandibular molars (164) in the Dental Service of the General Hospital of Riobamba between January and December 2015. 103 patients aged between 15 and 60 years were selected through a non-probabilistic sampling of the intentio-nal type, considering some aspects like optimal mental health status and radiological diagno-sis in retained third molar clinical history. The morphological characteristics of the observed third molars are close to the anatomical descriptions given by science, predominantly the vertical inclination of the longitudinal axis with respect to the second molar. The presence of this anomaly was observed mainly in the male sex and in the age group formed by adoles-cents and young adults who did not report having a family history of pathologies related to this condition.

Fratura complexa de mandíbula: relato de caso / Mandible complex fracture: case report

Das injurias que acometem a face, a fratura da mandíbula encontra-se no segundo lugar na maioria dos estudos, apesar de possuir estrutura óssea densa e resistente. Quando há fratura de mandíbula, devido a ações musculares e descontinuidade do arco mandibular, pode existir o deslocamento dos cotos ósseos, classificando-a em uma fratura desfavorável. Dentre as classificações, uma fratura mandibular complexa se dá quando há o acometimento de regiões anatômicas distintas, tendo como principal acometimento as regiões de ângulo e parassínfise. Esse trabalho tem como objetivo relatar um caso clínico de fratura complexa de mandíbula. Paciente A.R.S. 50 anos, leucoderma, sexo masculino, vítima de atropelamento procurou o serviço de CTBMF da UFBA para reabilitação de fratura complexa de mandíbula, com queixa principal de dor na mastigação. Ao exame físico notou-se edentulismo parcial em ambas arcadas, limitação de abertura bucal, mobilidade atípica a manipulação da mandíbula, aumento de volume em região bucal esquerda e hipoestesia em região de lábio inferior. Ao exame de imagem observouse sinais sugestivos de fratura de parassínfise e corpo mandibular esquerdo e fratura de côndilo mandibular bilateral. Determinou-se o tratamento cirúrgico para as fraturas em parassínfise e corpo de mandíbula, e conservador para de côndilo. Após reunir as características das fraturas, bem como os sinais clínicos e a queixa principal do paciente, foi de grande valia a associação do tratamento cirúrgico e conservador(AU)

Of the injuries that affect the face, the fracture of the mandible is in second place in most studies, despite having a dense and resistant bone structure. When there is a mandible fracture, due to muscular actions and discontinuity of the mandibular arch, there may be displacement of the bone stumps, classifying it as an unfavorable fracture. Among the classifications, a complex mandibular fracture occurs when there is involvement of distinct anatomical regions, with the main involvement of the regions of angle and parsiphysis. This paper aims to report a clinical case of complex jaw fracture. A.R.S patient 50 years old, leucoderma, male, victim of trampling searched the UFBA CTBMF service for complex jaw fracture rehabilitation, with a major complaint of chewing pain. Physical examination revealed partial edentulism in both arches, limitation of buccal opening, atypical mobility of jaw manipulation, volume increase in the left buccal region and hypoesthesia in the lower lip region. At the imaging examination, signs suggestive of a fracture of the mandibular parsley and left mandibular condyle were observed. Surgical treatment was determined for the fractures in the mandibular and mandibular parasite, and conservative for the mandibular condyle. After gathering the characteristics of the fractures, as well as the clinical signs and the main complaint of the patient, the association of surgical and conservative treatment was of great value(AU)

Reconstrucción mandibular postraumática / Posttraumatic mandibular reconstruction

Introducción: dentro de los factores que conducen a deformidades persistentes después de traumatismos craneofaciales, se incluye el tratamiento inicial excesivamente retardado. La reconstrucción mandibular ideal proporcionará un arco dentario sólido para articularse con el maxilar y restaurar el habla, deglución, masticación y estética. Objetivo: caracterizar un caso de reconstrucción mandibular en una deformidad postraumática mandibular. Presentación del caso: paciente femenina de 49 años que solo puede alimentarse con comida licuada a partir de un trauma craneofacial recibido seis meses atrás. Se encontró al examen físico facial asimetría con aumento de la dimensión vertical del tercio inferior de la cara con incompetencia bilabial, y al bucal que se trataba de una paciente desdentada total superior y parcial inferior rehabilitada protésicamente en la arcada maxilar, con imposibilidad para el cierre bucal y con la presencia de un escalón visible en el reborde residual a altura del 45 y por distal del 37. Se llegó al diagnóstico de una deformidad postraumática por fractura mandibular bilateral. Se valoró de conjunto con la especialidad de Prótesis, y se decidió tratamiento quirúrgico encaminado a la reconstrucción mandibular mediante abordaje cervical, refractura, reubicación mandibular con fijación de la guía oclusal y colocación de placas mandibulares de carga soportada con tornillos bicorticales. Se realizó el seguimiento por consulta externa después del alta hospitalaria. La paciente refiere estar muy conforme con su aspecto estético y con la mejoría funcional alcanzada. Conclusiones: las secuelas postraumáticas se acompañan frecuentemente de daños en tejidos blandos y duros de la región facial con diferente grado de alteración estética y funcional para el paciente. Lograr restituir estos mediante la reconstrucción facial suele ser un reto profesional que puede ser mejor enfrentado mediante el tratamiento en equipo y transdisciplinario(AU)

Introduction: overly delayed initial treatment is one the factors leading to persistent deformities after craniofacial trauma. Ideal mandibular reconstruction will create a solid dental arch which will articulate with the maxilla and restore speech, swallowing, mastication and esthetics. Objective: present a case of mandibular reconstruction of a posttraumatic mandibular deformity. Case presentation: a 49-year-old female patient can only feed herself liquid food after a craniofacial trauma undergone six months before. Physical examination revealed facial asymmetry with an increase in the vertical dimension of the lower third of the face and bilabial incompetence. Oral examination, on the other hand, revealed that the patient had a totally edentulous upper dental arch and partial prosthetic rehabilitation of the maxillary arch, impossibility of oral closure, and the presence of a visible step on the residual ridge at the 45 and distal 37. Diagnosis was a posttraumatic deformity due to bilateral mandibular fracture. Evaluation was carried out in joint coordination with the prosthesis service, and it was decided to perform surgical mandibular reconstruction by cervical approach, refracture, mandibular relocation with fixation of the occlusal guide, and placement of load bearing mandibular plates with bicortical screws. Outpatient follow-up was conducted after hospital discharge. The patient states that she is very pleased with her esthetic appearance and the functional improvement achieved. Conclusions: posttraumatic sequelae are frequently accompanied by damage to soft and hard tissues of the facial region with varying degrees of esthetic and functional alteration. Restoration by means of facial reconstruction is often a professional challenge which may be best tackled with a team, transdisciplinary therapeutic approach(AU)

Gigantic reactive lesion of mandibular gingival tissue / Lesión gigante reactiva del tejido gengival mandibula

Irritation fibroma are the most common form of reactive lesions found within the oralcavity. These lesions normally attain a small size and show a slow growth rate. This paper reports a case ofgigantic intraoral irritational fibroma with a history of rapid growth. Complete excision was performed andthe specimen was sent for immunohistochemistry (IHC) staining. It was found positive for vimentin, hencereported as irritation fibroma.

Los fibromas irritativos son las forma más común de lesiones reactivas encontradas en la cavidad oral. Estas lesiones normalmente son de pequeño tamaño y muestran una tasa de crecimiento lenta. Este artículo reporta el caso de un fibroma irritativo gigante intraoral con historia de crecimiento rápido. Se realizó la extirpación completa y fue enviado para análisis inmunohistoquímico. Arrojó positivo para Vimentina, por lo tanto, se reportó como fibroma irritativo.

Defeito ósseo de Stafne: relato de dois casos e considerações sobre o diagnóstico / Stafne bone defect: a report of two cases and diagnostic considerations

Defeitos ósseos de Stafne são cavidades ósseas assintomáticas localizadas em mandíbula, frequentemente causadas pela inclusão de tecidos moles. A variante comum desta entidade acomete a região de terceiros molares, abaixo do canal mandibular, sendo geralmente diagnosticada de forma incidental durante exames radiográficos de rotina. A variante em região anterior é incomum e localiza-se nas proximidades dos pré-molares mandibulares. Acredita-se que as glândulas salivares sublinguais estejam implicadas no desenvolvimento desta variante. O objetivo deste relato foi descrever um caso de defeito ósseo de Stafne na região anterior de mandíbula e um caso em mandíbula posterior, com ênfase nos achados clínicos e radiográficos. Cirurgiões dentistas deveriam ter conhecimento desta entidade para evitar biópsias desnecessárias. Na maioria dos casos, acompanhamento clínico-radiográfico constitui a conduta recomendada (AU)

Stafne bone defects are asymptomatic lingual bone depressions of the lower jaw, frequently caused by soft tissue inclusion. The common variant of this entity affects the third molar region, below mandibular canal, and is mostly diagnosed incidentally during routine radiographic examination. The uncommon anterior variant is relatively rare and located in the premolar region of the mandible. Sublingual salivary glands are thought to be responsible for the development of this variant. The aim of this report was to describe a case of Stafne bone defect in the anterior region of mandible and a case in posterior mandible, with emphasis on clinical and radiographic findings. Dental clinicians should be aware of this entity, aiming to avoid unnecessary biopsies. In most cases, clinical and radiographic follow-up is the recommended conduct (AU)

Quiste óseo aneurismático mandibular / Aneurysmal mandibular bone cyst

El quiste óseo aneurismático es definido como una lesión osteolítica expansiva que consiste en espacios llenos de sangre y canales divididos por tabiques de tejido conectivo, los cuales contienen tejido osteoide y células gigantes multinucleadas. El objetivo es presentar un caso clínico poco común de un quiste óseo aneurismático de la región del cuerpo mandibular. Se trata de una paciente femenina de 39 años de edad que acudió a consulta externa del Servicio de Cirugía Maxilofacial del Hospital Universitario General Calixto García por aumento de volumen en región mandibular derecha y dolor intenso de 1 mes de evolución. Radiográficamente se detectó un área radiolúcida unilocular de bordes bien definidos; se realizó curetaje de la cavidad, y estudio histopatológico de la lesión que informó la presencia de un quiste óseo aneurismático. Se concluye que el quiste óseo aneurismático es más común en los huesos largos y en la región del ángulo mandibular en el esqueleto facial, por lo que la presentación de este en el cuerpo mandibular resulta de interés(AU)

The aneurysmal bone cyst is defined as an expansive osteolytic lesion consisting of blood-filled spaces and divided by partitions of connective tissue, which contain bone tissue and giant cells channels. The objective is to present a rare case of an aneurysmal bone cyst in the region of the mandibular body. This is a case of a 39-year-old female who attended the outpatient Maxillofacial Surgery Service of General Calixto Garcia University Hospital due to an increased volume in right mandibular region and intense pain of a month, both in evolution. Radiographically, a unilocular radiolucent area with well-defined edges was detected; curettage of the cavity and histopathological examination of the lesion were performed, which reported the presence of an aneurysmal bone cyst. It is concluded that the aneurysmal bone cyst is most commonly presented in the long bones and in the region of the mandibular angle in the facial skeleton, so the presentation of this in the mandibular body is of interest(AU)

Distracción osteogénica en defecto mandibular complejo / Osteogenic distraction in complex mandibular defect

La distracción osteogénica (DO) es una técnica quirúrgica utilizada en el tratamiento de deformidades y malformaciones faciales, así como también en el tratamiento de deficiencias óseas de hueso alveolar. El objetivo de este artículo, es presentar el caso clínico de un paciente con edentulismo parcial del sector antero inferior, con una deficiencia ósea vertical y horizontal severa producto de un trauma mandibular.En el análisis inicial, el paciente relataba una historia reciente de fractura mandibular en sínfisis y ángulo derecho; el tratamiento con osteosíntesis no había sido totalmente exitoso, por lo cual, luego de estudiar lasopciones, se definió por un tratamiento en diferentes etapas: Etapa 1, cirugía para el retiro de osteosíntesis,preparación de tejidos blandos y reposición de margen posterior de sínfisis mandibular; etapa 2, distracción osteogénica, realizada luego de 3 meses de la primera intervención; y etapa 3, retiro del distractor e instalación de implantes, realizada 6 meses después de la segunda intervención. Se discuten algunos factores involucrados en el éxito del tratamiento.

Distraction osteogenesis (DO) is a surgical technique used in the treatment of facial deformities and malformations and also in the treatment of alveolar bone deficiencies. The aim of this paper is to show the case of a patient with partial edentulism in the symphysis area with a severe vertical and horizontal bone deficiency caused by mandibular trauma. At the initial analysis, the patient related a recent history of fracture in symphysis and right angle of the mandible. Treatment had not been entirely succesfull,therefore, after studying the options, we opted for a treatment at different stages: Stage 1, surgery for osteoshynthesis removal, soft tissue preparation and replacement of the posterior margin of mandibular symphysis;stage 2, distraction osteogenesis, performed 3 months after the first intervention and stage 3, distractor device removal and dental implant installation, performed 6 months after the second intervention. We discuss some factors involved in the treatment success.

Fibrosarcoma ameloblástico en la mandíbula / Ameloblastic fibrosarcoma arising in the mandible

Ameloblastic fibrosarcoma is a rare odontogenic neoplasm and is considered the malignant counterpart of ameloblastic fibroma. The diagnosis is made by histopathological and immunohistochemical evaluation, since the epithelial component remains benign and the mesenchymal component becomes malignant. Until 2012, only 72 cases were published in English-literature. This article presents a case of intraoral mass at the posterior mandible of a 23 year-old female patient. Panoramic radiography showed a multilocular radiolucent lesion with ill-defined borders and tooth involvement. The mandibular canal presented loss of architecture also. The computed tomography images (bone window) showed hypodense lesion leading to expansion, tapering and irregular destruction of cortical, and tooth involvement. Incisional biopsy was performed for histopathological evaluation. The results revealed a mixed lesion with epithelial and mesenchymal cellular proliferation. At immunohistochemical analysis, the mesenchymal portion was vimentin positive and the epithelial component was positive for cytokeratin AE1-AE3. It also showed p53 intense labeling in all tumorous cells. The final diagnosis was ameloblastic fibrosarcoma. The lesion was surgically excised with clear margins. The radiographic appearance, even imperative for treatment planning, poorly contributed to final diagnosis, which was reached by histopathological and immunohistochemical evaluations. The treatment is still controversial, without a definition regarding chemotherapy and radiotherapy as coadjutant treatment(AU)

El fibrosarcoma ameloblástico es una neoplasia odontogénica poco frecuente y es considerada la contraparte maligna del fibroma ameloblástico. El diagnóstico se realiza mediante la evaluación histopatológica e inmunohistoquímica, ya que el componente epitelial sigue siendo benigno y el componente mesenquimal se convierte en maligno. Hasta 2012, solo 72 casos fueron publicados en la literatura inglesa. En este artículo se presenta un caso de masa intraoral en la mandíbula parte posterior, de una paciente de 23 años de edad. La radiografía panorámica mostró una lesión radiolúcida multilocular con bordes mal definidos y con un diente incluso en la lesión. El canal mandibular también presentaba pérdida de la arquitectura. La tomografía computarizada (TC) (ventana de hueso) presentó lesión hipodensa que provocaba una expansión que se estrechaba y destruía irregularmente la cortical, además envolvía la pieza dentaria. Se realizó biopsia incisional para evaluación histopatológica. Los resultados revelaron una lesión mixta con proliferación celular epitelial y mesenquimal. En el análisis inmunohistoquímico, la porción mesenquimal fue positivo para vimentina y el componente epitelial fue positivo para citoqueratina AE1-AE3. También mostró marcación intensa para p53 en todas las células tumorales. El diagnóstico final fue de fibrosarcoma ameloblástico. La lesión fue extirpada quirúrgicamente con márgenes de seguridad. El aspecto radiológico, aunque imprescindible para la planificación del tratamiento, poco contribuyó al diagnóstico final, que fue alcanzado por las evaluaciones histopatológicas e inmunohistoquímicas. El tratamiento sigue siendo controvertido, sin una definición respecto de la quimioterapia y la radioterapia como tratamiento coadyuvante(AU)

Distribution of traumatic injuries after the installation of complete dentures in adult patients

Aim Describe the location of traumatic lesions of the oral mucosa that develop after the installation of complete dentures, as well as to quantify the number of post-operative controls that are required. A descriptive study was conducted by examining 84 patients who attended the dental center of Universidad de Los Andes, San Bernardo, during the period from July 2012 to July 2013. A sample of 120 edentulous patients was obtained. After the fabrication and installation of the complete dentures, at least 3 post-operative controls were performed and the location of oral lesions was recorded. Documentation of the association between the patient's clinical variables and the appearance of oral lesions during the first 3 controls was performed using a logistic regression. Results For maxillary dentures, 5 post-operative visits were made and 6 controls for mandible dentures. In the upper jaw the anatomical areas of higher incidence of traumatic injuries were: canine fossa (23.9%), average bridle (23.1%), and distobuccal sulcus (20.1%). In the lower jaw, the highest number of lesions were recorded on the anterior lingual flank (16.5%), anterior and posterior lingual flank (13.4%), and distobuccal sulcus (12.8%). A significant association was observed between subjects who reported consumption of cholesterol-lowering medications and the development of traumatic lesions of the oral mucosa (OR: 0.25 and 95% CI: 0.055-0.939). The installation of complete dentures does not determine that the treatment has ended. Post-operative controls are needed to assess areas of erythema and ulceration.

Objetivo Describir la ubicación y frecuencia de las lesiones traumáticas de la mucosa oral que se generan después de la instalación de las prótesis dentales completas, y cuantificar el número de controles postoperatorios necesarios. Se realizó un estudio descriptivo, examinando a 84 pacientes que asistieron al centro dental de la Universidad de Los Andes, durante el período comprendido entre de julio de 2012 y julio del de 2013. Se obtuvo una muestra de 120 pacientes edéntulos. Después de la fabricación e instalación de las dentaduras completas se realizaron por lo menos 3 controles postoperatorios y la localización de las lesiones orales fue registrada. La documentación de la asociación entre las variables clínicas de los pacientes y la aparición de lesiones orales durante los 3 primeros controles fue realizado por medio de una regresión logística. Resultados Para prótesis maxilar 5 visitas de controles postoperatorios fueron realizados y 6 para mandibulares. En el maxilar superior las zonas de mayor incidencia de lesiones traumáticas fueron: fosa canina (23,9%), flanco medio (23,1%) y distovestibular del surco (20,1%). En la mandíbula se registraron mayor frecuencia de las lesiones en el flanco lingual anterior (16,5%), anterior y posterior (13,4%) y distovestibular del surco (12,8%). Una asociación significativa se observó entre los sujetos que reportaron consumo de medicamentos reductores del colesterol y el desarrollo de las lesiones traumáticas de la mucosa oral (o: 0,25 e IC: 0,055-0,939). La instalación de las prótesis dentales completas no determina que el tratamiento haya terminado. Los controles postoperatorios son necesarios para evaluar las áreas de eritema y ulceración.

Effects of surgery duration on post-extraction sequelae following impacted third molar surgery by using two different bone cutting methods; a double blind randomized trial

The objective of this research was to analyze the impact of duration of surgery on post-operative pain and swelling after surgical removal ofmandibular third molars

This study was planned as double blind randomized clinical trial that comprised of 60 patients experiencing unilateral mandibular third molar extraction who were recruited into two groups before surgery on the basis of bone cutting method. The study duration was three months, executed at Department of Oral and Maxillofacial Surgery, Dow International Dental College, Dow University of Health Sciences, Karachi. Post-operative complications [pain and swelling] were assessed pre operatively and then on 3rd and 7th day post operatively using visual analogue scale and objective scale for swelling measurement using five anatomical points on face. Surgery duration was divided into two groups, 10-20 minutes group and 20 minutes onwards

Mann Whitney test was used to assess the impact of duration on pain and swelling in both groups. In 10-20 minutes group, mean difference for pain on day one, day 3 and day 7 was calculated with p-value of 0.15, 0.641 and 0.081 respectively while in group having surgery duration of 20 minutes and more, the computed p-value were 0.002, 0.0168 and 0.02 respectively. Mean difference for swelling was calculated in both bone cutting groups with p-value of 0.0916 in 10- 20 minute group and 0.004 in 20 minute onward group

Increasing time duration was associated with more pain and swelling irrespective of the method used for bone cutting. Conventional slow speed hand piece used for bone cutting was associated with less post-operative complications

Screening for variations in anterior digastric musculature prior to correction of post-traumatic anterior open bite by injection of botulinum toxin type A: a technical note

It has recently been reported that long-standing post-traumatic open bite can be successfully corrected with botulinum toxin type A (BTX-A) injection into the anterior belly of the digastric muscle (ABDM). The report documented an individual with bilaterally symmetrical and otherwise unremarkable anterior digastric musculature. However, the existence of variant anterior digastric musculature is common and may complicate the management of anterior open bite with BTX-A injection. Screening for variant ABDM can be accomplished via ultrasound, computed tomography, and magnetic resonance imaging. Screening for variant ABDM should be performed prior to BTX-A injection in order to account for musculature that may exert undesired forces, such as inferolateral deviation, on the anterior mandible in patients with anterior open bite.