Strategy of Mandibular Central Arch Reconstruction After Firearm Injury.

Gunshot wounds can cause extensive destruction of soft tissue and bone, and the maxillofacial region is often affected. The reconstructive treatment is complex due to the difficulty to reestablish the central arch mandibular contour and volume. Moreover, the goal is to avoid postoperative infections and obtain bone graft neovascularization. Therefore, this report shows a clinical case of a patient presenting mandibular deformity with a mandibular central arch discontinuity caused by a firearm injury. The strategy to the reconstructive treatment as performed with a condensed and stabilized particulate autogenous bone graft was essential and effectiveness. After 1 year, it was obtained a satisfactory result to the patient.

Treatment of frontal bone fracture sequelae through inversion of the bone fragment / Inversão do segmento fraturado para tratamento das sequelas de fratura do seio frontal

ABSTRACT Treatment of frontal sinus fractures depends on the structures involved: the anterior wall, the posterior wall and the nasofrontal duct. It may vary from the correction of the defect in the anterior wall to the cranialization with obliteration of the nasofrontal duct. The inversion of the frontal sinus's anterior wall to correct the defect in the fractured region is a good treatment option for sequelae, since this technique eliminates or reduces the use of biomaterial in the area, and allows direct assessment of the permeability of the nasofrontal duct. This work describes the technique of fractured segment inversion for the treatment of frontal sinus fracture sequelae in a motorcycle accident victim.

RESUMO O tratamento das fraturas do seio frontal depende das estruturas envolvidas: a parede anterior, a parede posterior e o ducto nasofrontal. Os tratamentos podem variar entre corrigir um defeito na parede anterior até a realização de uma cranialização com obliteração do ducto nasofrontal. O uso da inversão da parede anterior do seio frontal para corrigir o defeito na região fraturada representa uma boa opção de tratamento para os casos de sequelas, já que esta técnica elimina ou reduz a utilização de biomaterial nesta área, e permite avaliação da permeabilidade do ducto nasofrontal por acesso direto. Este trabalho descreve a técnica de inversão do segmento fraturado para tratamento de sequelas de fratura do seio frontal em paciente vítima de acidente motociclístico.

Tomographic Evaluation of Mandibular Thickness on Premolar and Molar Regions Related to Monocortical Screws.

The aim of this study was to measure the thickness of the mandible from the external cortical plate to the teeth roots on premolar and molar regions using CT scan to determine the safety margin for the application of monocortical screws for internal rigid fixation. Thirty-one patients underwent CT-scan imaging for surgical planning. The images were used to measure bilaterally the distance from the external cortex of the mandible to the roots of teeth on premolar and molar region by means of Dental Slice software (Bioparts Prototipagem Biomedica, Brasília, DF, Brazil). Mean, median, standard deviation, one-way ANOVA and post hoc Tukey's test were used for statistical analysis. No statistical differences for thickness were found between right and left side (p = 0.1652). The mean thickness for the left side was 4.17 ± 1.68 mm and for right side 3.93 ± 1.49 mm. Increase in mandibular thickness from anterior to posterior regions in both sides was observed and statistical difference was found among the different groups according to the measured region (p < 0.05). The present results can predict the safety zone for the use of monocortical screws in the mandible, but the use of CT scan is imperative and individual analysis is desired owing to anatomical variations. Further studies with larger samples are necessary to confirm these data and should include other anatomic structures, different regions of mandible/maxilla, as well as other ethnic groups.

Treatment of frontal bone fracture sequelae through inversion of the bone fragment.

Treatment of frontal sinus fractures depends on the structures involved: the anterior wall, the posterior wall and the nasofrontal duct. It may vary from the correction of the defect in the anterior wall to the cranialization with obliteration of the nasofrontal duct. The inversion of the frontal sinus's anterior wall to correct the defect in the fractured region is a good treatment option for sequelae, since this technique eliminates or reduces the use of biomaterial in the area, and allows direct assessment of the permeability of the nasofrontal duct. This work describes the technique of fractured segment inversion for the treatment of frontal sinus fracture sequelae in a motorcycle accident victim.