Abordagem cirúrgica em fratura de sínfise e côndilo mandibular bilateral em paciente pediátrico: um relato de caso / Surgical approach for syphysis and bilateral mandibular condyle fracture in a pediatric patient: a case report

As indicações de tratamento das fraturas mandibulares em paciente pediátrico variam em conservador, fixação não rígida e interna rígida. Alterações no crescimento ósseo, disfunções na articulação temporomandibular e assimetrias faciais podem ser decorrentes ao insucesso do tratamento. O objetivo deste trabalho consiste em relatar abordagem cirúrgica em fratura de sínfise e côndilo mandibular bilateral em paciente pediátrico. Paciente gênero feminino, 09 anos de idade, foi encaminhada ao Hospital Geral do Estado - Bahia vítima de queda de nível, cursando com trauma em face. Apresentou queixa principal, referida pela progenitora, de dificuldades em fechar a boca. Ao exame físico, a paciente apresentou mobilidade atípica à manipulação da mandíbula, mordida aberta anterior, equimose sublingual, ausência das unidades dentárias 74 e 75, com abertura bucal regular e suturas em posição em região de mento. Ao exame de imagem de tomografia computadorizada da face, pôde-se notar sinais sugestivos de fratura em região de sínfise e côndilos mandibulares bilateral. Após diagnóstico das fraturas, a paciente foi submetida à cirurgia sob anestesia geral para redução e fixação das mesmas. Realizou-se acessos em ferimento na região mentual e retromandibular bilateral com posterior síntese das fraturas utilizando fixação interna rígida com placas do sistema 2.0mm, associada a odontossíntese na fratura de sínfise. Ao acompanhamento periódico, a eleição do tratamento cirúrgico para fraturas mandibulares em pacientes pediátricos, pode permitir segurança no crescimento ósseo mandibular e facial(AU)

The indications for treatment of mandibular fractures in pediatric patients vary from conservative, non-rigid fixation and rigid internal fixation. Changes in bone growth, temporomandibular joint disorders and facial asymmetries may be due to treatment failure. The objective of this work is to report a surgical approach to bilateral symphysis and mandibular condyle fractures in a pediatric patient. Female patient, 9 years old, was sent to the State General Hospital - Bahia, victim of a fall in level, suffering from trauma to the face. She presented a main complaint, mentioned by her mother, of difficulties in closing her mouth. On physical examination, the patient presented atypical mobility when manipulating the jaw, anterior open bite, sublingual ecchymosis, absence of dental units 74 and 75, with regular mouth opening and sutures in position in the chin region. When examining the computed tomography image of the face, signs suggestive of fracture in the region of the symphysis and bilateral mandibular condyles were noted. After diagnosis of the fractures, the patient underwent surgery under general anesthesia to reduce and fix them. Access was performed on a wound in the mental and bilateral retromandibular region with subsequent synthesis of the fractures using rigid internal fixation with 2.0mm system plates, associated with odontosynthesis in the symphysis fracture. With periodic monitoring, the choice of surgical treatment for mandibular fractures in pediatric patients can allow for safe mandibular and facial bone growth(AU)

Complications following chin laceration reparation using tissue adhesive compared to suture in children.

BACKGROUND: Tissue adhesive is widely used in the emergency department to repair minor lacerations but there exists a debate as to whether it should be used for chin lacerations. The main objective of this study was to evaluate the rate of wound dehiscence of chin lacerations repaired with tissue adhesive in comparison to sutures. METHODS: This was a retrospective chart review including all children requiring a facial laceration reparation in a single tertiary care paediatric hospital. The primary outcome was wound dehiscence in the 30 days following reparation, comparing the use of tissue adhesive and sutures. The independent variable of interest was the use of tissue adhesive vs suture. A random sample of charts was reviewed in duplicate to insure reliability of the chart review. RESULTS: Among the 2044 children presenting with a facial laceration requiring an intervention, 1804 (88%) were repaired using tissue adhesive. The laceration was located on the chin in 360 (18%) of patients. The use of tissue adhesive was not statistically associated with a higher risk of dehiscence for all facial lacerations (difference: 0.2; 95%CI: -1.9 to 0.8%), nor for chin lacerations (difference 2.2%; 95%CI: -7.5 to 4.4%). However, the probability of dehiscence was higher for chin laceration in comparison to other localizations (difference of 1.6%; 95%CI: 0.5-3.6%). CONCLUSION: While the rate of dehiscence was higher for chin lacerations compared to other facial localizations, the risk of dehiscence was not statistically different for chin laceration repaired with tissue adhesive or sutures.

Transoral Robotic Thyroidectomy for Papillary Thyroid Carcinoma: Perioperative Outcomes of 100 Consecutive Patients.

BACKGROUND: Endoscopic transoral thyroidectomy is a recently introduced technique of remote access thyroidectomy. We previously reported the feasibility of the robotic approach (TORT). Nevertheless, experience to date is limited, with scant data on outcomes in patients with papillary thyroid carcinoma (PTC). METHODS: This was a retrospective analysis of prospectively collected data. Patients with PTC, who underwent TORT at a single center between March 2016 and February 2017, were analyzed. RESULTS: There were a total of 100 patients (85 women, 15 men) with a mean age of 40.7 ± 9.8 years, and a mean tumor size of 0.8 ± 0.5 cm. Nine patients underwent a total thyroidectomy, and 91 underwent a lobectomy. The operative time for a total thyroidectomy and lobectomy was 270.0 ± 9.3 and 210.8 ± 32.9 min, respectively. Ipsilateral prophylactic central neck compartment dissection was performed routinely with retrieval of 5.0 ± 3.6 lymph nodes. Perioperative morbidity was present in nine patients including transient recurrent laryngeal nerve palsy (n = 1), postoperative bleeding requiring surgical intervention (n = 1), zygomatic bruising (n = 2), chin flap perforation (n = 1), oral commissure tearing (n = 2), and chin dimpling (n = 2). There was no conversion to endoscopic or conventional open thyroid surgery. CONCLUSION: In this study, TORT could be safely performed in a large series of patients with PTC without serious complications. In selected patients, TORT by experienced surgeons could be considered an alternative approach for remote access thyroidectomy.

Skin irritation from a facial mask in Class III malocclusion: evaluation of individual silicone chin cups in a group of 100 children.

BACKGROUND: Reverse headgear (a facial mask) is one of the most frequently used interceptive orthodontic devices in patients with Class III malocclusion. It is a simple device but may present some drawbacks related to pressure on the skin generated by the forehead and chin supports linked to the maxillary intraoral appliance by elastics. This can cause injury to the chin and lips. METHODS: Patients between 7 and 8 years of age were selected from the Unit of Pediatric Dentistry. Orthopedic therapy with a rapid palatal expander and reverse headgear was prescribed for all subjects. The patients were divided into two groups: those who used a facial mask without a silicone chin cup and those who used a facial mask with a silicone chin cup. RESULTS: Two-hundred subjects including 90 male patients and 110 female patients were enrolled. The groups that used a facial mask with and without a silicone chin cup included 100 patients each. The percentage of subjects without irritation was significantly greater in the group with a silicone chin cup than in the group without a silicone chin cup. CONCLUSIONS: The authors propose a simple and effective solution to prevent skin irritation on the chin caused by a facial mask. A chin mask is a custom solution that can prevent injury to the chin during treatment when coupled with facial mask therapy.

Lesión inflamatoria en el mentón / Inflammatory injury on the chin

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Síndrome del mentón entumecido. A propósito de un caso / Numb chin syndrome. A case report

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Comentario al artículo 'Anatomía quirúrgica de la platismoplastia medial submentoniana. Variabilidad anatómica en cadáveres' / No disponible

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Unusual sequela from a pencil stab wound reveals a retained graphite foreign body.

Penetrating pencil-tip injuries are common among children and usually resolve without long-term sequelae. However, failure to detect and remove embedded pencil fragments can result in increased morbidity or misdiagnoses of other, more serious, conditions. We report on the case of a 10-year-old boy stabbed with a pencil on his right chin. Initial treatment in the emergency department included irrigation and closure of the laceration. Following suture removal, the patient returned to the emergency department (with bright-purple drainage from the wound site). Radiographic evaluation led to the discovery of an embedded foreign body requiring surgical removal.

Reconstruction of the lower vermilion with a musculomucosal flap from the upper lip in the repair of extensive lower lip and chin defects.

In the repair of extensive lower lip and chin defects, the reconstruction of vermilion at the same time is a great challenge to plastic surgeons. We describe a novel method for the reconstruction of lower vermilion with musculomucosal flap from the upper lip in the repair of extensive lower lip and chin defects. Two patients underwent extensive lower lip and chin reconstruction together with vermilion reconstruction. This technique used 3 basic components: musculomucosal flap from the upper lip, buccal mucosal advancement flap, and cutaneous rotational flap from the neck. All the flaps survived without significant complications. Labial function in the motions of expression and speaking was maintained. The patients could basically close their mouths completely, and there were no drooping or small-mouth deformities postoperatively. Functional and cosmetically acceptable lower-lip and chin reconstructions in both patients were achieved.

Degeneration and regeneration of motor and sensory nerves: a stereological study of crush lesions in rat facial and mental nerves.

The aim of this study was to evaluate the degeneration and regeneration of a sensory nerve and a motor nerve at the histological level after a crush injury. Twenty-five female Wistar rats had their mental nerve and the buccal branch of their facial nerve compressed unilaterally against a glass rod for 30s. Specimens of the compressed nerves and the corresponding control nerves were dissected at 3, 7, and 19 days after surgery. Nerve cross-sections were stained with osmium tetroxide and toluidine blue and analysed using two-dimensional stereology. We found differences between the two nerves both in the normal anatomy and in the regenerative pattern. The mental nerve had a larger cross-sectional area including all tissue components. The mental nerve had a larger volume fraction of myelinated axons and a correspondingly smaller volume fraction of endoneurium. No differences were observed in the degenerative pattern; however, at day 19 the buccal branch had regenerated to the normal number of axons, whereas the mental nerve had only regained 50% of the normal number of axons. We conclude that the regenerative process is faster and/or more complete in the facial nerve (motor function) than it is in the mental nerve (somatosensory function).

Solitary giant neurofibroma of the mental nerve: a trauma-related lesion?

Neurofibroma is a benign neoplasm derived from peripheral nerves whose etiology is still unclear. It may present as a solitary lesion or be associated with other diseases such as neurofibromatosis type I and II syndrome. This paper aims to report an extremely rare case of a solitary giant neurofibroma of the mental nerve whose etiology was related to a local trauma. A 14-year-old female patient presented an extensive left facial mass with a size of 7 × 5 × 4 cm, located between the teeth 33 and 37 in the mandible region. It has begun to grow 3 months after a local trauma. Imaging studies were suggestive of a soft-tissue lesion, with minimal bone changes and maintaining the integrity of the mandibular canal and mental foramen. Histopathological tests showed spindle cells with undulated and hyperchromatic nuclei, and sparse cytoplasm in a stroma composed of dense fibrous connective tissue. Immunohistochemistry revealed positive expression for the proteins S-100 and vimentin, confirming the diagnosis of neurofibroma. The patient underwent surgical removal of the lesion by intraoral approach and evolved with an excellent cosmetic result and no signs of recurrence after 2 years of follow up. We report a rare case of solitary giant neurofibroma whose etiology was related to a local trauma. To our knowledge, this is the first report of a mental nerve neurofibroma. Although the etiology remains unclear, we suggest the investigation of local trauma as a possible etiologic factor for solitary neurofibromas of the jaw.

Epidemiology of maxillofacial injury in children under 15 years of age in southern China.

OBJECTIVE: This retrospective study was conducted to report the epidemiology of maxillofacial injuries of children <15 years old in China. STUDY DESIGN: Data collected in this study included age, sex, etiology, date of injury, anatomic site of injury, and treatment modality. Regarding treatment, conservative technique and surgery were both used. The analyses involved were descriptive statistics and χ(2) test. RESULTS: There were 335 men and 135 women, with a gender ratio of 2.48:1. Bicycle accident was the leading cause of injury. The common sites of soft tissue injury included gingiva, chin, lip, cheek, palate/pharynx, and tongue/mouth floor. In addition, the mandible was most involved in facial skeleton injury. Conservative treatment was generally preferred for such pediatric patients. CONCLUSIONS: Boys were prone to be victims of maxillofacial trauma. Preventive measures should be applied both indoors and outdoors. Patients in the growing phase should be monitored periodically to detect and prevent early facial asymmetry or malocclusion.

Sporotrichosis on the face of a 7-year-old boy following a bicycle accident.

A 7-year-old boy presented with an annular verrucous plaque on the chin of 5 weeks duration. The lesion occurred after a bicycle accident and was unresponsive to antibiotics. Fungal culture grew Sporothrix schenckii. Sporotrichosis should be considered and fungal culture obtained whenever a nodule or plaque fails to respond to initial treatment.

Bilateral complicated crown fractures secondary to chin injury: a case report.

Traumatic injuries to the chin are not uncommon in children. Nevertheless, crown fractures, which are common sequelae to this type of injury, might be overlooked, especially if dental care is not sought immediately after a visit to a non-dental facility. The present case report reviews the delayed diagnosis and treatment outcome of a bilateral posterior complicated crown fracture affecting mandibular second primary molars in a young child. Pharmacologic and orthodontic considerations are also discussed in the paper.

Emergency treatment strategy and the biodynamic effects of massive, "chopped off", mandibular tissue and a prolapsed tongue.

Current weaponry possesses unobserved new, biodynamic wounding effects. For many victims, high velocity, large shell fragments have resulted in massive lower jaw "chopped off" hard and soft tissues injuries accompanied by tongue prolapse. The management challenges begin with lifesaving which is possibly complicated by airway compromise, severe hemorrhage, massive lower jaw loss, and a prolapsed tongue. Consequently, the goal shall be "No patient should die from massive facial tissue injuries alone". That is, if feasible, sensible, lifesaving techniques are applied at the appropriate time. Following general condition stabilization, the surgical management steps of massive lower jaw tissue loss should begin with immediate lost tissue reconstruction. Seventeen cases were selected from an unquantified number patients who had massive mandibular tissue losses in which the tongue, surprisingly, remained intact. In these cases, definitive, early scaffolding stabilization was accomplished by joining the remaining two lower jaw intact segments. The successful procedure consists of using a 2 mm horseshoe shaped Kirschner wire bridging the gap of the mandibular arch which effectively is used as a "scaffold" for rebuilding the soft tissue. Proper, initial, surgical management resulted in protecting lacerated tissue, diminishing subsequent morbidity and disfigurement, preventing a prolapsed tongue and preserving the intact tissues physiological functions. As the spectrum of injuries continues to evolve the clinical characterization of the severity of facial wounds need an expanded classification, appropriate to massive facial injuries. It is suggested it has the following descriptors: blast, penetration, perforation, avulsions and "chopping off" (BPPAC).

Do erupted third molars weaken the mandibular angle after trauma to the chin region? A 3D finite element study.

It has been suggested that third molars increase mandibular fragility because they do not contribute to its strength. For ethical reasons, a human study design that would permit the elucidation of this interference is not possible. This study evaluated the impact of the presence of erupted third molars on the mandibular angle of resistance when submitted to trauma. A three-dimensional (3D) mandibular model was obtained through finite element methodology using computed tomography (CT) with the geometry and mechanical properties to reproduce a normal mandibular structure. Human mandibles with no, one or two erupted third molars were evaluated. Whenever the third molar was present there was a greater concentration of tensions around the cervical part of its alveolus. Approximated Von Mises equivalent stress of the third molar region was 107.035 MPa in the mandible with teeth and 64.6948 MPa in the mandible without teeth. In the condylar region it was 151.65 MPa when the third molar was present and 184.496 MPa when it was absent. The digital models created proved that the mandibular angle becomes more fragile in the presence of third molars. When they are absent the energy concentrates on the lateral e posterior aspect of the condylar neck.