Early Reconstruction of Gunshot Mandible Fracture: A Modified Approach.

The management of victims of gunshot fractures is a challenge for surgeons, mainly due to the complexity of the injury itself and degree of bone comminution. The titanium functionally dynamic bridging plate has often been used in reconstructive surgery after mandibular fractures. The classic indication for bridge plate use is comminuted fractures with or without associated substance losses. The aim of this article is report the case of gunshot victim and to discuss the bridge plate technique utilized for treatment. A 21 years-old, melanoderma, male patient was victim of a firearm-related assault, with comminutive fracture of the mandibular body. The protocol for the bridging plate technique was performed. The patient is in postoperative follow-up of eight months, not present aesthetic or functional complaints, stable occlusion, satisfactory mouth opening and no clinical signs of infection.

Technique of the Buccal Fat Pad Flap as an Alternative for the Surgical Defect of Pleomorphic Adenoma.

Pleomorphic adenoma (PA) is the most common benign salivary gland neoplasm, and its malignant transformation rarely occurs. Diagnosis is based on clinical features of local or regional malignancy or distant metastasis, and histological identification of invasion and cellular atypia. Buccal fat pad, also called Bichat fat pad, is an excellent option to create tissue coverage over surgically treated areas, providing great blood supply. Thus, this study aims to report a surgical treatment of a patient who reported to the Oral and Maxillofacial Surgery and Traumatology service of a hospital in the city of Fortaleza, presenting a large lesion in the right side of the palate. Clinical examination revealed a nodular volume increase with smooth surface, sessile insertion, firm to palpation and coloration similar to the mucosa, no pain complaints, and 2 years of evolution. Orthopantomographic examination did not reveal alterations in the adjacent anatomical structures. After clinical and radiographic evaluation, an incisional biopsy was performed and histopathological diagnosis was PA. Patient was submitted to surgery for tumor excision with narrow surgical margins, including oral lining mucosa to reduce recurrence chances. In the same surgical act, after the excision of the lesion, the right buccal fat pad pedicle flap was sutured onto the residual mucosa in order to act as a framework for re-epithelialization of the palatal mucosa, phenomenon of metaplasia, and reduction of patient's morbidity. Surgical piece obtained was sent to anatomopathological study, confirming initial diagnosis. After 12-month follow-up, patient is esthetically and functionally rehabilitated, and satisfied with clinical and surgical plans executed.

Rapid Prototyping as an Auxiliary in Mandibular Reconstructions.

The reconstruction of mandible is a challenge with regard to aesthetic and reconstructive demands. The etiology of mandibular fractures is variable, trauma, pathology, bone infections. There are many materials that provide an excellent form of rehabilitation for these defects, where the autogenous graft presents important characteristics that favor a greater success rate. Furthermore, the rapid prototyping method is quite interesting, because it brings a series of advantages to the surgeon, like reducing the operative time, among others. The purpose of the present article is to describe a clinical case of a patient with mandible bone defect caused by gunshot perforation, treated through iliac crest bone graft with planning through rapid prototyping. The mandibular reconstruction can present a real challenge for the surgeon. Biomodels should be required in complex cases because they help to decrease surgical time and to increase the predictability of the procedure.