Evaluation of the Effect of Phototherapy in Patients with Mandibular Fracture on Mandibular Dynamics, Pain, Edema, and Bite Force: A Pilot Study.

OBJECTIVE: The aim of this study was to evaluate the effect of phototherapy on bite force, facial swelling, mandibular movements, and pain in patients having undergone surgical treatment for mandibular fractures. BACKGROUND: These are among the predominant types of facial fractures, and treatment involving surgical fixation with titanium plates is one of the most common procedures in oral-maxillofacial surgery. Phototherapy has been used to accelerate the muscle healing process and significantly improves muscle regeneration by inducing the formation of new muscle fibers. METHODS: The patients were divided into two groups: Group 1-active phototherapy, and Group 2-sham phototherapy. Both groups underwent the surgical procedure by the same surgeon using the same surgical technique. Dosimetric parameters are wavelength, 660 nm; power, 108 mW; radiant energy, 21.6 J; fluency, 21.6 J/cm2; radiance, 38197 mW/cm2; exposure time, 200 sec per point, 10 points bilaterally. Photobiomodulation was performed in 15 sessions. RESULTS: The primary variable was bite force measured with a gnathodynamometer and the secondary variables were facial swelling, mandibular movements (measured with digital calipers), and pain. The Student's t-test was used to determine intergroup differences. CONCLUSIONS: The findings suggest improvements in the laser group in comparison with the sham group with regard to mandibular dynamics, a reduction in postoperative facial swelling, a reduction in pain, and an increase in bite force.

Trends in Le Fort Fractures at a South American Trauma Care Center: Characteristics and Management.

PURPOSE: To assess the trends in Le Fort (maxillary) fractures in patients seen at a South American trauma care center based on the characteristics and management of these. MATERIALS AND METHODS: Of all patients with facial fractures seen at a trauma hospital during a six-year period, 50 (6.6 %) presented with Le Fort fractures. Medical charts were reviewed for characteristics presented and management performed. To improve the analyses, computed tomography and intraoperative findings were used. Statistical analyses involved descriptive statistics and the likelihood ratio test. RESULTS: The fractures were Le Fort II (52 %), Le Fort I (22 %), Le Fort type-associated (20 %) and Le Fort III (6 %). Male patients (90 %) in their third decade of life (38 %) were more frequent (p = 0.022). Traffic accidents (56 %) were the major etiologic factor (p = 0.048). There were 1.4 additional facial fractures per patient, with predominance of zygoma fractures (36.5 %). Most of the cases were managed by open reduction (60 %) (p = 0.015) with the subciliary approach (42.7 %) (p = 0.001). The 1.5-mm system was the most used fixation and the zygomaticomaxillary suture the most frequent location (p = 0.001). CONCLUSION: the most common patient with a Le Fort fracture is an adult male, with a Le Fort II fracture due to a traffic accident requiring surgical fixation on zygomaticomaxillary suture.

Characteristics and management of patients requiring hospitalization for treatment of odontogenic infections.

Odontogenic infections usually respond well to outpatient care; however, these can be very complicated and demand hospitalization. The aim of this study was to assess retrospectively the characteristics and medical management of patients needing hospitalization for the treatment of odontogenic infections. The personal data, symptoms presented, and therapeutic procedures adopted were analyzed. The predominant age group was from 0 to 10 years (30%), and a sex relation of 1:1 was found, but there was no significant difference (P = 0.337). The most frequent diagnosis was of dentoalveolar abscess (86.3%). Pain (47.1%) was the prevailing reason for hospitalization, with pulpal necrosis (67.5%) as the main cause. There was a prevalence of involvement of the lower permanent teeth (41.4%) and lower deciduous teeth (23%). The prevalent clinical aspect was submandibular or facial swelling (61.4%). The most administered antibiotic was penicillin G associated with metronidazole (25.3%). Most cases (58.7%) presented regression with antibiotic therapy, and in some cases, surgical drainage was necessary (18.7%). One case of Ludwig angina resulted in death. The mean length of hospital stay was 4.4 days, being higher in the cases of Ludwig angina. It was concluded that most cases of odontogenic infections requiring hospitalization were of dentoalveolar abscess occurring in young people of both sexes, associated to the lower permanent molar teeth, presenting with swelling, with regression of the symptoms after antibiotic therapy and hospitalization for some days, with some of the cases requiring drainage.

Gunshot injuries in the maxillofacial region: a retrospective analysis and management

Aim: To analyze gunshot wounds to the face, assessing the characteristics, immediate treatment,late treatment, complications and after effects. Methods: A retrospective observational study wascarried out involving 75 cases of victims of gunshot wounds to the face treated at the Oral andMaxillofacial Traumatology Unit of the Dr. Arthur Ribeiro de Saboya Hospital in the city of SãoPaulo (Brazil).Data analysis used the chi-square test with the level of significance set at 5% (p dd0.05). Results: There was a predominance of the 21-to-30-year-old age group (38.7%), malegender (92%) and wounds occurring due to assaults (37.3%). There was a predominance ofentry wounds on the left side of the face (58.5%). The most affected sites were the mandible(50.7%), maxilla (18.3%), zygomatic region (7.0%), eye socket (4.2%) and nose (1.4%).Comminuted fractures (88.2%) and simple fractures (10.3%) were recorded. No fracture occurredin 1.5% of the cases. The predominant treatment was rigid internal fixation (RIF) (57.2%),followed by exploratory surgery (23.2%) and conservative treatment (19.6%). Among thecases in which the RIF system was used, there was predominance in the mandible (64.0%). Thechi-square test revealed a significant correlation between the 2.4-mm RIF system and the mandiblein 48.0 % of cases. Conclusions: In conclusion, gunshot wounds tended to pierce the face,mainly affecting the mandible and caused comminuted fractures treated with rigid internal fixation.Immediate complications occurred in 25% of cases and after effects occurred in 11.7%.