Persistent Necrotizing Mediastinitis after Dental Extraction.

Mediastinitis is a rare, progressive, and destructive infectious process due to cervical or odontogenic infections, which, if not diagnosed early, may lead to several complications, including airway involvement and even an imminent risk of death. Herein, we report an unusual case of a 37-year-old male with a bilateral submandibular hard swelling after the left third molar extraction. After surgical intervention with submandibular drainage and antibiotic therapy, the infection persisted without explanation, since the patient was not hypertensive, did not have diabetes mellitus or sexually transmitted infections such as HIV or syphilis, and did not smoke or drink alcoholic beverages. A thoracic surgeon then intervened, treating the mediastinitis surgically by drainage, thus obtaining a significant improvement of the patient's health. Mediastinitis is a serious condition. Clinicians and maxillofacial surgeons should be alert to make an immediate diagnosis and select the appropriate treatment in order to prevent worsening of the patient's clinical condition.

Pseudoaneurysm in internal maxillary artery after gunshot wound: Critical review and case report.

INTRODUCTION: Pseudoaneurysm is a vascular injury typically caused by rupture of arteries with extravasation of blood. The involvement of this entity in facial arteries after firearm aggression is extremely rare, and they need treatment as early as possible, thus avoiding irreversible damage to patients. STUDY DESIGN: A 40-year-old male victim of gunshot attack with an entrance orifice in the right posterior cervical region with ascending trajectory, lodging in the ipsilateral zygomatic-orbitary complex, which was submitted to removal of the bone fragments and the bullet. In the intraoperative period, the patient developed profuse hemorrhage and, after complementary examinations, he was diagnosed with pseudoaneurysm of the internal maxillary artery, which was treated by selective endovascular embolization. RESULTS: The patient was hemodynamically stable, with no complaints and was discharged after 48 hours, without postoperative bleeding recurrences. He had no more complications after 8 months of follow-up. CONCLUSIONS: The main forms of treatment and diagnosis of vascular lesions are reviewed, and embolization is demonstrated as a technically safe procedure with few complications. Key words:Gunshot wound, pseudoaneurysm, maxillary artery, therapeutic embolization.

Conservative treatment of an aggressive odontogenic tumor: a case report.

An ameloblastoma is a polymorphic, benign, locally invasive tumor made up of odontogenic epithelium, clinically characterized by slow, progressive, painless growth. There are reports in the literature on the treatment of ameloblastomas with aggressive mural invasion through resections, in order to minimize recurrence. However, different approaches may be used at the bone level, such as curettage combined with a chemical fixative (Carnoy's solution), cryotherapy, or thermal cauterization. The findings of this case report demonstrate that the use of Carnoy's solution following the enucleation of a unicysticameloblastoma with mural invasion may be a treatment alternative with a low rate of recurrence, as well as a reduced rate of postoperative complications, a reduction in costs, and preservation of both esthetics and function.

Sialocele como Complicação de Acesso Retromandibular: Relato de Caso / Sialocele as a complication of the retromandibular approach: a case report

A sialocele é o acúmulo de extravasamento salivar numa cavidade subcutânea, ocorrendo, principalmente, após, um episódio traumático ou infeccioso no parênquima da glândula parótida, lesão do ducto parotídeo ou estenose ductal com subsequente dilatação. A realização do correto diagnóstico e o tratamento imediato das lesões traumáticas da glândula parótida tornam-se importantes para evitar complicações. Várias modalidades de tratamento são mencionadas na literatura, e a escolha dependerá do tempo de evolução desde a lesão à região acometida. O presente caso envolve um paciente do gênero masculino vítima de acidente motociclístico que evoluiu com uma sialocele pós-operatória devido à abordagem retromandibular para redução cruenta de fratura condilar. O tratamento realizado foi a instalação de um cateter provisório, criando um novo trajeto para secreção da glândula parótida.

The condition known as sialocele is an accumulation of salivary extravasation in a subcutaneous cavity occurring mainly after a traumatic or infectious episode in the parenchyma of the parotid gland, a parotid duct injury or stenosis with subsequent ductal dilatation. The correct diagnosis and treatment of traumatic lesions of the parotid gland are important in order to avoid complications. Several treatment options are mentioned in the literature and the choice will depend on the time elapsed since injury and the affected region. The patient in the case reported is a male victim of a motorcycle accident who developed a postoperative sialocele due to the use of the retromandibular approach for open reduction of a condylar fracture. The treatment performed was the insertion of a temporary catheter creating a new pathway for secretion of the parotid gland.

Oral and maxillofacial myiasis: a case series and literature review.

OBJECTIVE: The aim of this study was to describe a series of 10 cases of oral-maxillofacial myiasis, discussing its main features, demographic distribution, and treatment aspects. STUDY DESIGN: A retrospective study was carried out involving male and female patients of any age with oral-maxillofacial myiasis. The sample was determined by spontaneous demand at the emergency ward of a hospital between January 2005 and January 2011 (6 years). After treatment of each case, data were gathered on the presence of associated systemic disorders, time elapsed since onset of the disease, and treatment established. A review of the literature on this topic was also carried out. RESULTS: The sample was made up of 10 patients, all treated with surgical debridement whether or not associated with the use of oral ivermectin. Mean time elapsed since the onset of the disease ranged from 4 to 36 months. The middle third of the face was the most frequently affected region (7 cases). Oral-maxillofacial myiasis predominantly affected the male gender (70%). CONCLUSIONS: Oral-maxillofacial myiasis affects individuals with poor hygiene and neurologic and/or psychologic alterations. It occurs predominantly in countries near the tropics. The treatment of choice is surgical debridement.