RESUMO
Oral and maxillofacial surgeons are often faced with the clinical challenge of foreign body displacement into the perioral tissues and soft tissues of the head and neck. This mainly occurs either because of trauma or inadvertently during dental treatment. In addition to the maxillary sinus, iatrogenic foreign body displacement during dental treatment could happen into one of the 16 distinct fascial spaces of the head and neck region. Commonly displaced foreign bodies related to dental treatment include tooth roots or fragments, local anesthetic needles, implants and restorations. The clinical sequelae of a displaced foreign body depend on its size, shape, anatomic location and proximity to vital structures. Although patients may remain asymptomatic for a considerable amount of time, retained foreign bodies result in persistent pain, recurrent infection and scarring of soft tissue due to inflammation, all of which may complicate delayed retrieval. In addition to the history, imaging modalities such as plain radiographs and computed tomography (CT) help in locating the displaced foreign body and its subsequent retrieval. Surgical retrieval may be attempted through intraoral, transcervical and endoscopic approaches. Additionally, surgery may be aided by real-time imaging such as fluoroscopy. The present report aims to detail a case of inadvertent displacement of an orthodontic mini-screw, commonly used as a temporary anchorage device (TAD), into the lateral pharyngeal space, while attempting placement in the mandibular retromolar area. The case report also describes the surgical retrieval procedure of the TAD screw using an intraoral approach and with fluoroscopy guidance using C-Arm radiographic imaging. This case is reported along with the pertinent review of literature, as it not only explains a rare complication of orthodontic mini-screw placement but also details a modality to remove displaced foreign bodies from fascial spaces of the head and neck, which are otherwise directly inaccessible.
RESUMO
The aim of the current study was to evaluate the accuracy of computer-guided mandibular fracture reduction. A total of 24 patients with fractured mandible were included in the current study. A preoperative cone beam computed tomography (CBCT) scan was performed on all of the patients. Based on CBCT, three-dimensional reconstruction and virtual reduction of the mandibular fracture segments were done and a virtual bone borne surgical guide was designed and exported as Standard Tessellation Language file. A physical guide was then fabricated using a three-dimensional printing machine. Open reduction and internal fixation was done for all of the patients and the fracture segments were anatomically reduced with the aid of the custom-fabricated surgical guide. Postoperative CBCT was performed after 7 days and results of which were compared with the virtually reduced preoperative mandibular models. Comparison of values of lingula-sagittal plane, inferior border-sagittal plane, and anteroposterior measurements revealed no statistically significant differences between the virtual and the clinically reduced CBCT models. Based on the results of the current study, computer-based surgical guide aid in obtaining accurate anatomical reduction of the displaced mandibular fractured segments. Moreover, the computer-based surgical guides were found to be beneficial in reducing fractures of completely and partially edentulous mandibles.