A Technical Note on a Modified Subcrestal Buccal Flap Approach to All-on-Four: A Case Report.

This case report describes a dual full-arch rehabilitation focusing on a modified buccal incision for installation of four implants for full-arch rehabilitation of an edentulous maxilla. A modified buccal incision was performed in the subcrestal buccal region to promote direct access to the periosteum without incising the muscles in the region. For the installation of anterior implants, an 8.5 mm implant was locked in the cortical bone of the alveolar ridge and in the cortical bone of the floor of the pyriform cavity. The drilling point of the posterior implants was defined using the anterior implants as a visual reference, and the entry point could be visually estimated from the topography of the palatal surface of the maxilla. After bone leveling, the drilling enlargement sequence was carried out using drills that allowed the installation of long implants (18 mm). Straight mini-abutments were installed in the anterior implants and angled at 30º in the posterior implants. The flap was then perforated in the exact region where the mini-abutments were located. The buccal incision line was sutured with continuous 5-0 nylon suture. On the following day, aesthetic tests were carried out with teeth mounting. The patient presented minimal edema, and the lip motricity and smile width were completely preserved. The prosthesis was delivered five days after surgery. The suture was removed, and the prosthesis was installed while maintaining compression on the gingival tissue. The patient reported no pain during the prosthesis installation. The modified buccal flap enables implant placement for full-arch rehabilitation of an edentulous maxilla.

Atypical Typical Avulsion Zygomatic Bone Fracture / Fratura avulsiva atípica de zigona

Avulsion injuries of facial bones are rare, as well as accounts regarding the management of these lesions. This study describes a facial trauma that resulted from a bull gore, which caused the avulsion of the zygomatic bone, which was left hanging by only a small pedicle. The case study involved a 36 year old male leukoderma patient who sought the Maxillo-Facial Surgery and Trauma Department at the Emergency Unit in Pelotas-RS (Brazil). Clinical examination showed extensive laceration of the face in the middle third area on the left side, with the avulsion of the zygomatic body, causing the displacement of the eyeball towards the maxillary sinus. Treatment included bone and eyeball repositioning, zygoma fixation and suture, yielding good aesthetic and functional results. The peculiarity of the etiology and the particular features of the trauma are highlighted... (AU)

Lesões avulsivas dos ossos faciais são raras, assim como descrições quanto ao manejo dessas injúrias. Este estudo descreve um traumatismo facial decorrente de uma chifrada de um boi, que ocasionou a avulsão do osso zigomático, restando preso apenas por um pequeno pedículo. Trata-se de um paciente gênero masculino, 36 anos, leucoderma, que procurou o serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial do Hospital de Pronto-Socorro da cidade de Pelotas-RS (Brasil). Ao exame clínico observava-se extensa laceração na face, em área de terço médio, lado esquerdo, com avulsão do corpo do zigoma, determinando o deslocamento do globo ocular em direção ao seio maxilar. O tratamento constou de reposicionamento ósseo e do globo ocular, fixação do zigoma e sutura, obtendo-se um bom resultado estético e funcional. Destaca-se a peculiaridade da etiologia e características únicas deste trauma... (AU)

Oroantral communication closure using a pedicled buccal fat pad graft / Fechamento de comunicação buco-sinusal utilizando enxerto pediculado de corpo adiposo da bochecha

Purpose: This paper reports the procedure used to close a late oroantral fistula using rotating flaps of the pedicled buccal fat pad. Case description: A 66-year-old, male patient with leukoderma, in good general health, was referred for closure of an extensive late oroantral communication. Upon clinical examination, an approximately 10-mm fistula was observed connecting the oral cavity to the maxillary sinus. An outpatient surgical procedure was performed with the use of local anesthetics to close the oroantral fistula with a rotating pedicled buccal fat pad flap. The healing of the wound and closure of the defect could be seen after a 30-day postoperative period, with complete epithelialization. Conclusion: Grafting of the pedicled buccal fat pad is thought to be an efficient, safe and easy alternative to a larger oroantral fistula closure. Pedicled buccal fat pad grafting corrected the defect without generating any sequelae and/or great postoperative discomfort to the patient.

Objetivo: O objetivo deste artigo foi relatar um caso clínico de fechamento de fístula buco-sinusal tardia utilizando rotação de enxerto de tecido adiposo pediculado do corpo adiposo da bochecha. Descrição do Caso: Paciente do sexo masculino, 66 anos, leucoderma, em boas condições de saúde geral, foi encaminhado para fechamento de extensa comunicação buco-sinusal. Ao exame clínico, observou-se uma fístula de aproximadamente 10 mm de diâmetro comunicando a cavidade oral com o seio maxilar. A cirurgia foi realizada em nível ambulatorial, sob anestesia local, para fechar a fístula buco-sinusal com um enxerto de tecido adiposo pediculado do corpo adiposo da bochecha. A reparação da ferida e o fechamento do defeito foram observados no pós-operatório de 30 dias, com completa epitelização. Conclusão: O enxerto pediculado de tecido do corpo adiposo da bochecha mostrou-se uma alternativa simples, eficaz e segura no fechamento mediato da fístula buco-sinusal apresentada neste caso clínico.