Reconstrucción maxilofacial de la región orbitaria / Maxillofacial reconstruction of the orbital region

La región orbitaria representa una unidad estética funcional muy importante en la región facial. Se presenta un trabajo retrospectivo de un período de 20 años (2000-2020) de actividad pública-privada en el tratamiento de patología tumoral y traumática de la región orbitaria. Analizamos en 580 casos operados, 184 oncológicos y 396 traumáticos, diferentes aspectos comunes que intervienen en el tratamiento reconstructivo de la región: abordajes, técnicas quirúrgicas, consideraciones anatomofuncionales, principios básicos en cirugía maxilofacial orbitaria y complicaciones, resaltando la importancia del manejo correcto de los tejidos regionales en su reconstrucción. La mejor posibilidad para el paciente de lograr un buen resultado es con una operación primaria correcta. Sus complicaciones son de difícil tratamiento

The orbital region represents a very important functional aesthetic unit in the facial region. A retrospective study of a 20-year period (2000- 2020) of public-private activity in the treatment of tumor and traumatic pathology of the orbital region is presented. We analyzed in 580 operated cases, 184 oncological and 396 traumatic, different common aspects involved in the reconstructive treatment of the region: approaches, surgical techniques, anatomofunctional considerations, basic principles in orbital maxillofacial surgery and complications, highlighting the importance of the correct management of regional tissues in their reconstruction. The best possibility for the patient to achieve a good result is with a correct primary operation. Its complications are difficult to treat

Actualización de la Epidemiología de Tratamientos Quirúrgicos Maxilofaciales en Hospital Público de Santiago de Chile: Estudio Comparativo - Retrospectivo de 4 Años / Epidemiological Update of Maxillofacial Surgical Treatments in a Public Hospital in Santiago de Chile: A Comparative Retrospective Study of 4 Years

La cirugía maxilofacial es una especialidad médico quirúrgica que se encarga tanto del diagnóstico como del tratamiento de enfermedades que afecta al territorio craneofacial. En Chile existen pocos estudios epidemiológicos en cirugía maxilofacial que describan con detalle el tipo de intervenciones realizadas más allá del trauma maxilofacial, y que además involucren el período por pandemia COVID-19. El objetivo del estudio fue actualizar la epidemiología de resolución quirúrgica bajo anestesia general en el Hospital San José de Santiago de Chile entre los años 2018 y 2021 y compararlo con el estudio realizado en mismo recinto entre los años 2007 y 2013. Se realizó un estudio retrospectivo con 607 pacientes. Se recopiló información de acuerdo a edad, género del paciente y tipo de intervención. Del total de intervenciones realizadas, 176 (29%) correspondieron a trauma maxilofacial y 431 (71%) a cirugías de etiología no traumática. Edad promedio de 38,7 años. Proporción entre el sexo masculino y femenino de 1,28:1. La fractura más frecuente fue la mandibular (59,66%), seguida de la orbito cigomática (23,86%) y la panfacial (4,55%). En las cirugías de etiología no traumática predominaron las intervenciones por dismorfosis dentofaciales (23,2%), seguido tumores de los maxilares (20,41%), lesiones orales (18,56%), defocaciones dentarias (16,24%), infecciones (8,81%), patologías de articulación temporomandibular (8,35%) y finalmente retiro de material de osteosíntesis (4.41%). Las intervenciones de etiología no traumática y la resolución de fracturas mandibulares fueron los procedimientos más realizados por la unidad. El conocimiento de estos datos y la comparación con el estudio anterior permite observar el cambio en la epidemiologia, que puede explicarse por la pandemia por COVID-19. Considerando lo anterior, ambos tipos de intervenciones deben ser abordadas de manera integral y con las condiciones adecuadas. Para ello es importante enfocar los recursos en esas áreas y desarrollar mayor entrenamiento en las mismas.

Maxillofacial surgery is a medical- surgical specialty that deals with both diagnosis and treatment of diseases affecting the craniofacial territory. In Chile there are few epidemiological studies in maxillofacial surgery that describe in detail the type of interventions performed beyond maxillofacial trauma, and that also involve the COVID-19 pandemic period. The aim of the study was to update the epidemiology of surgical resolution under general anesthesia at the Hospital San José in Santiago de Chile between 2018 and 2021 and to compare it with the study performed at the same hospital between 2007 and 2013. A retrospective study was performed with 607 patients. Information was collected according to age, patient gender and type of intervention. Of the total number of interventions performed, 176 (29%) corresponded to maxillofacial trauma and 431 (71%) to surgeries of non-traumatic etiology. Average age of 38.7 years. Male to female sex ratio of 1.28:1. The most frequent fracture was mandibular (59.66%), followed by orbito-zygomatic (23.86%) and panfacial (4.55%). In surgeries of non-traumatic etiology, interventions for dentofacial dysmorphosis predominated (23.2%), followed by tumors of the jaws (20.41%), oral lesions (18.56%), dental defocations (16.24%), infections (8.81%), temporomandibular joint pathologies (8.35%) and finally removal of osteosynthesis material (4.41%). Interventions of non-traumatic etiology and resolution of mandibular fractures were the procedures most performed by the unit. The knowledge of these data and the comparison with the previous study allows us to observe the change in epidemiology, which can be explained by the COVID-19 pandemic. Considering the above, both types of interventions should be approached in a comprehensive manner and with the appropriate conditions. To this end, it is important to focus resources in these areas and to develop more training in them.

Rehabilitación implanto protésica en paciente con injerto mandibular de larga data / Implant-prosthetic rehabilitation in a patient with a longstanding mandibular graft / Reabilitação protética com implantes em pacientes com enxerto mandibular de longa data

En la actualidad es cada vez más frecuente la consulta de pacientes que siendo sometidos en edades tempranas a cirugías de extirpación tumoral y posterior reconstrucción con injertos presentan problemas tanto funcionales como estéticos, el uso de prótesis implantosoportadas mejora la calidad de vida, pero al mismo tiempo representan un desafío por la baja disponibilidad ósea. Se presenta un caso clínico de rehabilitación protésica implantosoportada en una paciente con gran déficit óseo mandibular como consecuencia de le extirpación de una neoplasia y posterior injerto de costilla. Se colocaron 2 implantes osteointegrados en hueso remanente y rehabilitación con prótesis removible sostenida a una barra colada. Por ser un tratamiento poco invasivo y conservador fue aceptado fácilmente por la paciente y la mejora tanto en la estética como en la función fue notoria.

Nowadays, it is becoming more and more frequent to see patients who underwent surgery for tumor removal and subsequent reconstruction with grafts at an early age, presenting both functional and esthetic problems. The use of implant-supported prostheses improves the quality of life, but at the same time represents a challenge due to the low availability of bone. A clinical case of implant-supported prosthetic rehabilitation is presented in a patient with a great mandibular bone deficit as a consequence of the removal of a neoplasm and subsequent rib graft. Two osseointegrated implants were placed in the remaining bone and rehabilitation with a removable prosthesis supported by a cast bar. Being a minimally invasive and conservative treatment, it was easily accepted by the patient and the improvement in both esthetics and function was notorious.

Atualmente, são cada vez mais frequentes os pacientes submetidos à cirurgia de remoção de tumores e posterior reconstrução com enxertos em idade precoce que apresentam problemas funcionais e estéticos. O uso de próteses implanto-suportadas melhora a qualidade de vida, mas, ao mesmo tempo, representa um desafio devido à baixa disponibilidade de osso. Apresentamos um caso clínico de reabilitação protética implanto-suportada em um paciente com grande déficit ósseo mandibular em consequência da remoção de uma neoplasia e posterior enxerto de costela. Dois implantes osseointegrados foram colocados no osso remanescente e a reabilitação foi feita com uma prótese removível suportada por uma barra de gesso. Por se tratar de um tratamento minimamente invasivo e conservador, foi facilmente aceito pelo paciente e a melhora na estética e na função foi perceptível.

Tercer molar heterotópico, etiología y manejo quirúrgico / Heterotopic third molar, etiology and surgical management

Los terceros molares heterotópicos son dientes que se encuentran incluidos en los maxilares y la mandíbula distantes a su sitio de erupción habitual. Su etiología no está bien definida y existen diversas teorías. Estos dientes pueden aparecer en diferentes zonas de las estructuras óseas, teniendo predilección por la mandíbula. Suelen aparecer entre la segunda y la séptima década de la vida, la mayoría de los casos son hallazgos imagenológicos en la consulta odontológica. El tercer molar mandibular es el diente que presenta heterotopía con mayor frecuencia, siendo su localización habitual en rama mandibular y en la región subcondílea. El quiste dentígero es la patología asociada más común. Presentamos un caso de tercer molar heterotópico en rama mandibular derecha de larga evolución, relacionado a un quiste dentígero, el cual se manejó bajo anestesia regional. Se describe la etiología, técnica quirúrgica y consideraciones especiales relacionados con los dientes heterotópicos (AU)

Heterotopic third molars are teeth that are embedded in the maxilla and mandible, remote from their usual eruption site. Its etiology is not well defined and there are various theories at the moment. These teeth can appear in different areas of the bone's structures, having a predilection for the jaw. They usually appear between the second and seventh decade of life, and in most cases are imaging findings. The mandibular third molar is the tooth with the most frequent heterotopia, being its usual location in the mandibular branch and in the subcondylar region. The dentigerous cyst is the most common associated pathology. We present a case of a long evolution heterotopic third molar in the right mandibular branch, related to a dentigerous cyst which was managed under local anesthesia. The etiology, surgical technique and special considerations related to heterotopic teeth are described (AU)

Surgical Treatment of Oral Fibrous Hyperplasia with Diode Laser: An Integrative Review / Tratamiento Quirúrgico de la Hiperplasia Fibrosa Oral con Láser de Diodo: Una Revisión Integradora

This study aimed to carry out an integrative review of the use of diode lasers in the treatment of oral fibrous hyperplasia in order to observe surgical efficacy, healing process, and main microscopic findings. The following databases-PubMed/MEDLINE, Embase, Virtual Health Library, Scopus, Web of Science, and gray literature-were searched without regard to the time of year or language. Diode laser treatment cases described in case reports and case series were included, but those who did not undergo microscopic analysis to confirm the diagnosis or who did not provide postoperative information were excluded. Twelve studies (64 patients) were included. Prevalence was observed for females (68.75 %, n=44). In view of the diagnosis, there was a prevalence of focal fibrous hyperplasia (79.68 %, n=51), followed by inflammatory fibrous hyperplasia (20.31 %, n=13). For surgical removal, a diode laser was used with a wavelength ranging from 808 to 960 nm, in continuous mode, and an average power of 2830 mW. In general, there were no intercurrences in the trans and postoperative periods and wound healing occurred by second intention, with excellent evolution. High-powered diode lasers can be an excellent therapeutic option for oral hyperplastic lesions. Long-term clinical trials should be conducted to determine laser setting parameters in various oral lesions.

El objetivo de este estudio fue realizar una revisión integradora sobre el uso del láser de diodo en el tratamiento de la hiperplasia fibrosa oral, con el fin de visualizar la eficacia quirúrgica, el patrón de cicatrización y el análisis de los principales resultados microscópicos. Se realizó una búsqueda sin restricciones de año e idioma en PubMed/MEDLINE, Embase, Virtual Health Library, Scopus, Web of Science y literatura gris. Se incluyeron reportes de casos y series de casos que brindaron información sobre pacientes diagnosticados con lesiones hiperplásicas orales tratados con láser de diodo, excluyendo aquellos a los que no se les había realizado análisis microscópico para confirmar el diagnóstico, así como aquellos que no brindaron información postoperatoria. Se incluyeron doce estudios (64 pacientes). Se observó prevalencia en el sexo femenino (68,75 %, n=44). Ante el diagnóstico, predominó la hyperplasia fibrosa focal (79,68 %, n=51), seguida de la hiperplasia fibrosa inflamatoria (20,31 %, n=13). Para la remoción quirúrgica se utilizó un láser de diodo con una longitud de onda de 808 a 960 nm, en modo continuo, y una potencia promedio de 2830 mW. En general, no hubo intercurrencias en el trans y postoperatorio y la cicatrización de la herida ocurrió por segunda intención, con excelente evolución. El uso de láseres de diodo de alta potencia puede ser una excelente alternativa terapéutica para las lesiones hiperplásicas orales. Se deben realizar más estudios clínicos a largo plazo para determinar los parámetros de ajuste del láser en diferentes lesiones orales.

Complicaciones Asociadas a la Remoción Estética del Cuerpo Adiposo de la Boca (de Bichat) - Revisión Narrativa / Complications Associated with Aesthetic Removal of the Buccal Adipose Body (Bichat's fat-pad) - Narrative Review

El cuerpo adiposo de la boca (CAB) es un componente adiposo multilobulado bien delimitado, localizado de manera bilateral en la región facial íntimamente relacionado a estructuras nerviosas y vasculares. La remoción de CAB es un procedimiento ampliamente estudiado en el campo de la cirugía maxilofacial, utilizado principalmente para cubrir defectos. Su influencia en la estética facial ha iniciado una popularización de la remoción de la extensión bucal de CAB para obtener un rostro más estilizado, intervención difundida como poco invasiva y sin complicaciones. El objetivo de este estudio fue recopilar y evaluar estudios que reporten y evalúen complicaciones asociadas a la remoción por razones estéticas de CAB. Se revisó la evidencia en las bases de datos Medline vía PubMed, Epistemonikos, Scopus y Google Scholar, utilizando términos predefinidos, seleccionando estudios primarios de reportes de casos. Se incluyeron 7 artículos con un total de 10 pacientes; de estos, ocho pacientes se realizaron este procedimiento en Brasil, uno en Estados Unidos y uno en Chile. La distribución de la población fue de 3:7 entre hombres y mujeres con edad promedio de 35 años y un rango entre los 23 a los 49 años. En relación a las complicaciones reportadas, 100 % de los pacientes presentaron asimetría facial, un 80 % presentó edema facial, 30 % manifestaron sialocele, Trismus 20 %, 40 % presentó hematoma, 20 % compromiso del estado general, 20 % presentaron disfagia, en los casos de hipoestesia, parestesia, absceso, seroma, parálisis facial, odinofagia, fiebre se expresaron en 10 % de la población estudiada. En todos los estudios se describió una reintervención quirúrgica posterior a la remoción estética del cuerpo adiposo de bichat. La escasa literatura y la baja calidad de esta, no permite estimar el porcentaje real de posibles complicaciones, tampoco es posible determinar sus resultados a largo plazo ya que no existe en la evidencia un seguimiento apropiado para estos pacientes.

The buccal adipose body (BAB) is a well- defined multilobulated adipose component, located bilaterally in the facial region, closely related to nervous and vascular structures. BAB removal is a widely studied procedure in the field of maxillofacial surgery, used mainly to cover defects. Its influence on facial aesthetics has started to popularize the removal of the BAB buccal extension to obtain a more stylized face, an intervention widely known as minimally invasive and without complications. The objective of this study was to collect and evaluate studies that report and evaluate complications associated with the removal of BAB for cosmetic reasons. The evidence was reviewed in the Medline databases via PubMed, Epistemonikos, Scopus, and Google Scholar, using predefined terms, selecting primary studies from case reports. 7 articles with a total of 10 patients were included; Of these, eight patients underwent this procedure in Brazil, one in the United States, and one in Chile. The distribution of the population was 3:7 between men and women with an average age of 35 years and a range between 23 to 49 years. In relation to the reported complications, 100 % of the patients presented facial asymmetry, 80 % presented facial edema, 30 % manifested sialocele, trismus 20 %, 40 % presented hematoma, 20 % compromised general state, 20 % presented dysphagia, in the cases of hypoesthesia, paresthesia, abscess, seroma, facial paralysis, odynophagia, fever were expressed in 10 % of the studied population. All the studies described a surgical reintervention after cosmetic removal of the bichat adipose body. The scarce literature and its low quality do not allow estimating the real percentage of possible complications, nor is it possible to determine their long-term results since there is no evidence of appropriate follow-up for these patients.

Parestesia do nervo alveolar inferior decorrente de procedimentos cirúrgicos e suas formas de tratamentos / Paresthesi of the lower alveolar nerve resulting from surgical procedures and its forms of treatment

Nas cirurgias odontológicas é possível que ocorra alguns acidentes ou complicações que podem interferir no dia a dia do paciente. A lesão do nervo alveolar inferior é uma complicação decorrente de cirurgias orais que podem causar um distúrbio de sensibilidade transitória ou persistente, na região do lábio inferior e na região delimitada do forame mentoniano e hemi-arco da mucosa. O diagnóstico da parestesia pode ser feito através de testes mecanoceptivos e nocioceptivos em que o profissional escolherá para qual melhor se adapte no paciente. O objetivo do presente trabalho foi abordar por meio de uma revisão de literatura as formas de diagnóstico e tratamento da parestesia do nervo alveolar inferior decorrentes de cirurgias orais. As bases de dados utilizadas para confecção desta revisão são encontradas nas bibliotecas virtuais eletrônicas: BVS (Biblioteca Virtual em Saúde), LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Pubmed. Como critério de inclusão foram selecionados artigos publicados de 2012 a 2022 em língua inglesa, portuguesa e espanhola. Após a leitura do título e resumo dos resultados da pesquisa e aplicação dos critérios de inclusão e exclusão dentre eles foram excluídos 883, pois não se enquadravam no nosso critério de inclusão. No final, foram selecionados 13 estudos por meio de base de dados, que serviram de base para esta revisão. Concluímos que as formas de tratamento para a parestesia na literatura, são um pouco escassas e conflitantes, mas relata que o uso da laserterapia e acupuntura tem sido uma forma de tratamento com um bom índice de sucesso, e para os casos que não sejam suficientes tais tratamentos, pode-se optar por uma cirurgia(AU)

In dental surgeries it is possible to have some accidents or complications that can interfere with the patient's day. Injury to the inferior alveolar nerve is a complication resulting from oral surgeries that can cause a disturbance of sensitivity that can be transient or persistent in the region of the lower lip and in the delimited region of the mental foramen and hemiarch of the mucosa. The diagnosis of paresthesia can be made through mechanoceptive and nocioceptive tests that the professional will choose, which best suits the patient. The objective of the present work is to approach, through a literature review, the forms of diagnosis and treatment aimed at inferior alveolar nerve paresthesia resulting from oral surgeries. The databases used for this review are found in the virtual electronic libraries: VHL (Virtual Health Library), LILACS (Latin American and Caribbean Literature on Health Sciences) and Pubmed. As inclusion criteria, articles published from 2012 to 2022 in English, Portuguese and Spanish were selected. After reading the title and summary of the research results and applying the inclusion and exclusion criteria, 883 were excluded, as they did not meet our inclusion criteria. In the end, 13 studies were selected from the database, which served as the basis for this review. We conclude that the forms of treatment for paresthesia in the literature are a little scarce and conflicting, but it reports that the use of laser therapy and acupuncture has been a form of treatment with a good success rate, and for cases that are not enough, such treatments, one can opt for surgery(AU)

A long-term evaluation of periodontal phenotypes before and after the periodontal-orthodontic-orthognathic combined treatment of lower anterior teeth in patients with skeletal Angle class Ⅲ malocclusion / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the changes of periodontal phenotype (width of keratinized gingiva, thickness and height of alveolar bone) of lower anterior teeth in patients with skeletal class Ⅲ malocclusion before and after the periodontal-orthodontic-orthognathic combined treatment.@*METHODS@#In the study, 20 patients with skeletal class Ⅲ malocclusion (6 males and 14 females) completed the periodontal-orthodontic-orthognathic combined treatment were included from March 2017 to June 2022, with 39 central incisors, 40 lateral incisors and 40 canines. The mean age was (25.40±4.27) years (20-34 years). The mean follow-up time was (3.70±1.05) years from the beginning of periodontal corticotomy regenerative surgery (PCRS) to the end of the combined treatment. Cone-beam computed tomography (CBCT) was used to measure the thickness, area and height of alveolar bone by the same researcher, taken before the PCRS (T0), 6 months after the PCRS (T1), 12 months after the PCRS (T2), before the orthognathic surgery (T3), and after the periodontal-orthodontic-orthognathic combined treatment (T4). The periodontal clinical parameters were used to evaluate changes in the soft tissue by another researcher, measured before the PCRS (T0) and after the combined treatment (T4). Changes of soft and hard tissue were evaluated by the periodontal phenotype.@*RESULTS@#The width of keratinized gingiva increased significantly (all P < 0.001) in lower anterior teeth, the central incisors, lateral incisors and canines increased by (1.82±1.57) mm, (2.03±1.48) mm and (2.05±1.27) mm, respectively. The proportion of thick periodontal biotype in the central and lateral incisors increased significantly (all P < 0.001), while the changes of periodontal biotypes in the lower canines were not obvious. The thickness of labial alveolar bone of lower anterior teeth all increased significantly after periodontal corticotomy regenerative surgery and the combined treatment (all P < 0.001). The area of labial alveolar bone of lower anterior teeth also increased significantly after the combined treatment (all P < 0.001). The whole area of labial and lingual alveolar bone of central and lateral incisors increased (P < 0.001), while the whole area of canines remained the same. All The height of the alveolar bone increased (all P < 0.001) on the labial side after the treatment.@*CONCLUSION@#The periodontal phenotypes of lower anterior teeth were significantly improved after the periodontal-orthodontic-orthognathic combined treatment in patients with skeletal Angle class Ⅲ malocclusion. The improvement was long-termly stable, and the periodontal risk was reduced.

Waste management practices among dental surgery staff of major hospitals in Accra: a descriptive cross-sectional study

Introduction: the practice of dentistry in contemporary times produces considerable waste that could be harmful to individuals and the environment at large. In Ghana and many other jurisdictions, there are guidelines that outline how these wastes should be managed. This study was conducted to explore practices concerning dental waste management among dental surgery staff in some public facilities in Accra, Ghana. Methods: a descriptive cross-sectional study involving dental surgery staff of four major facilities in Accra was done. Overall, 124 staff from the selected facilities participated in the study, and 51 different dental surgeries were assessed. Data were collected using a structured questionnaire and an observation checklist. The questionnaire included questions on socio-demographics, as well as knowledge and practices regarding dental waste management. Results: there was unsatisfactory knowledge of waste disposal, while practices did not generally meet international recommendations and the Ministry of Health´s (MOH) guidelines. Though all respondents stored their sharp waste in puncture-proof containers, 98.4% did not label their clinical waste, while 62.9% would dispose of used X-ray fixers by pouring them down the drain. None of the 51 surgeries observed had more than one colour code available. Conclusion: there is a palpable need for education, monitoring, and empowerment concerning waste management in Ghana´s oral healthcare system.

Anterior Teeth Measurement among Subjects in the University of Port Harcourt as a Sex Indicator and Aid to Maxillofacial Reconstruction

Background: The aim of this study is to determine sexual dimorphism using anterior teeth measurements and its use as an ancillary tool for sexual determination. Methods:In this study, the measurements of the anterior teeth were carried out on one hundred and forty students (80M: 60F) of the University of Port-Harcourt ranging from 15-30 years. The mesiodistal diameter of the central and lateral incisors, right and left canines and their inter-canine distance were measured. These measurements were done with the aid ofa digital Vernier caliper. Also, the percentages of sexual dimorphism were calculated. The values were subjected to statistical analysis.Results:The mean mesiodistal central incisor (MDCI) value for males was 9.78 ± 0.47mm while that of the females was 9.29±0.46mm. The mean mesiodistal lateral incisor (MDLI) value for males was 7.80 ±0.54mm while that of the females was 7.40±0.54mm. The mean mesiodistal right canine (MDRC) value for males was 7.43±0.49mm while that of the females was 7.04±0.40mm. The mean mesiodistal left canine (MDLI) value for males was 7.39±0.51mm while that of the females was 7.03±0.55mm. The mean mandibular inter-canine distance (MICD) value for males was 33.73±1.15mm while that of the females was 32.23±0.98mm. They were all statistically significantat p<0.05.Conclusion:It can be concluded that the incisors and the canines are useful tools in sex determination. The data obtained can be useful in maxillofacial reconstructive surgery

Anesthesia management for patient with bipolar disorder complicated with hypothyroidism during oral surgery: a case report / 华西口腔医学杂志

Bipolar disorder is a major mental illness that is difficult to treat and has a high degree of recurrence. This article reports general anesthesia for oral surgery in a patient with bipolar disorder complicated with hypothyroidism. It also discusses the rational application of antipsychotic drugs and anesthetics with reference to the literature to improve the understanding of the disease and help patients with mental disorders complete the surgical treatment quietly and smoothly.

Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction / 华西口腔医学杂志

OBJECTIVES@#This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction.@*METHODS@#Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction.@*RESULTS@#At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations.@*CONCLUSIONS@#The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.

Sialolitiasis, sialoadenitis y sialoadenosis. Revisión de literatura y reporte de un caso clínico / Sialolithiasis, sialadenitis and sialadenosis. Review of literature and report of a clinical case

Introducción: la formación de sialolitos se considera la alteración más común en las glándulas salivales. Su origen aún no es claro en cuanto a qué provoca la obstrucción parcial o total del sistema de conductos salivales, con una predilección significativa en las glán - dulas submandibulares, lo que permite un desplazamiento retrógrado de bacterias a través del conducto salival hacia la glándula afectada, el cual se traducirá clínicamente como inflamación unilateral o bila - teral. El tratamiento para la sialolitiasis y sialoadenitis puede variar desde un manejo conservador hasta tratamientos que implican la remoción de la glándula salival afectada. La sialoadenosis difiere de las anteriores en su origen, ya que ésta no se considera inflamatoria ni neoplásica y no afecta la función glandular de excretar saliva. Presentación de caso clínico: se trata de paciente masculino con diagnósticos presuntivos de sialoadenitis y sialolitiasis, al cual se le realizó biopsia escisional de la glándula afectada, su estudio histo- patológico corroboró los diagnósticos mencionados anteriormente que además confirmó un diagnóstico de sialoadenosis. Conclusio- nes: la escisión de la glándula salival involucrada se realizará en casos diagnosticados de sialoadenitis y sialolitiasis con sialolitos de gran tamaño y procesos supurativos crónicos que no resuelven con antibioticoterapia (AU)

Manejo del paciente anticoagulado en una cirugía dental / Management of the anticoagulated patient in dental surgery / Gerenciamento do paciente anticoagulado em cirurgia odontológica

Introducción: una adecuada hemostasia es crucial para el éxito del tratamiento odontológico invasivo, ya que los problemas de sangrado pueden dar lugar a complicaciones asociadas a una importante morbimortalidad. El tratamiento odontológico de pacientes que tienden a un mayor riesgo de sangrado debido al uso de fármacos anticoagulantes plantea un desafío en la práctica diaria de los profesionales de la odontología. El conocimiento adecuado de los mecanismos subyacentes a la hemostasia y el manejo optimizado de estos pacientes son, por lo tanto, cuestiones muy importantes. Se realiza un estudio de los fármacos anticoagulantes actualmente disponibles en el mercado, evaluando los riesgos y beneficios de suspender dicho fármaco previo a un tratamiento odontológico invasivo. Además, se hace una revisión de los protocolos de manejo actuales que se utilizan en estos pacientes. Material y métodos: se realizó una búsqueda bibliográfica en las bases de datos Epistemonikos y Medline/PubMed; en el portal Timbó y en la biblioteca virtual Scielo. Abarcando todos los estudios publicados en los últimos 15 años en inglés y español. Se encontraron 30 artículos, se seleccionaron 15 en primera instancia para finalizar con 11 artículos. En dicha selección el filtro fue que los demás artículos se referían a otros anticoagulantes que no eran parte de este trabajo. Resultados: se han desarrollado múltiples protocolos de manejo, aunque en todos los casos se requiere una historia clínica completa, junto con pruebas hemostáticas complementarias para minimizar los riesgos derivados del tratamiento odontológico. Discusión: muchos autores consideran que la medicación de los pacientes indicada para el tratamiento de una enfermedad de base no debe ser alterada o suspendida a menos que así lo indique el médico prescriptor. Se ha demostrado que las medidas hemostáticas locales son suficientes para controlar los posibles problemas de sangrado derivados del tratamiento dental.

Introduction: Adequate hemostasis is crucial for the success of invasive dental treatment, since bleeding problems can lead to complications associated with significant morbidity and mortality. The dental treatment of patients who are prone to an increased risk of bleeding due to the use of anticoagulant drugs poses a challenge in the daily practice of dental professionals. Adequate knowledge of the mechanisms underlying hemostasis and optimized management of these patients are therefore very important issues. A review is made of the anticoagulant drugs currently available on the market, evaluating the risks and benefits of suspending such a drug prior to invasive dental treatment. In addition, a review is made of the current management protocols used in these patients. Material and methods: A bibliographic search was carried out in the Epistemonikos and Medline/PubMed databases; in the Timbo portal and in the Scielo virtual library. All the studies published in the last 15 years in English and Spanish were included. Thirty articles were found, 15 were selected in the first instance to end up with 11 articles. In this selection, the filter was that the other articles referred to other anticoagulants that were not part of this work. Results: multiple management protocols have been developed, although in all cases a complete clinical history is required, together with complementary hemostatic tests to minimize the risks derived from dental treatment. Discussion: many authors consider that the patient's medication indicated for the treatment of an underlying disease should not be altered or suspended unless so indicated by the prescribing physician. It has been shown that local hemostatic measures are sufficient to control possible bleeding problems derived from dental treatment.

Introdução: A hemostasia adequada é crucial para o sucesso do tratamento dentário invasivo, pois problemas de sangramento podem levar a complicações associadas a uma morbidade e mortalidade significativas. O tratamento odontológico de pacientes que são propensos a um risco maior de sangramento devido ao uso de drogas anticoagulantes representa um desafio na prática diária dos profissionais da odontologia. O conhecimento adequado dos mecanismos subjacentes à hemostasia e o gerenciamento otimizado desses pacientes são, portanto, questões muito importantes. É realizada uma revisão dos anticoagulantes atualmente disponíveis no mercado, avaliando os riscos e benefícios de descontinuar tal medicamento antes do tratamento dentário invasivo. Além disso, é feita uma revisão dos protocolos de gerenciamento atuais usados nesses pacientes. Material e métodos: Foi realizada uma pesquisa bibliográfica nas bases de dados Epistemonikos e Medline/PubMed; no portal Timbo e na biblioteca virtual Scielo. Todos os estudos publicados nos últimos 15 anos, em inglês e espanhol, foram incluídos. Trinta artigos foram encontrados, 15 foram selecionados em primeira instância para acabar com 11 artigos. Nesta seleção, o filtro foi que os outros artigos se referiam a outros anticoagulantes que não faziam parte deste trabalho. Resultados: foram desenvolvidos múltiplos protocolos de gerenciamento, embora em todos os casos seja necessário um histórico clínico completo, juntamente com testes hemostáticos complementares para minimizar os riscos derivados do tratamento odontológico. Discussão: muitos autores consideram que a medicação os pacientes indicada para o tratamento de uma doença subjacente não deve ser alterada ou descontinuada, a menos que o médico que a prescreve dê instruções nesse sentido. Medidas hemostáticas locais demonstraram ser suficientes para controlar potenciais problemas de sangramento resultantes do tratamento odontológico.

Prevalência das complicações em cirurgia de terceiros molares inferiores: um estudo transversal / Prevalencia de complicaciones en cirugía de terceros molares inferiores: un estudio transversal / Prevalence of Complications in Inferior Third Molar Surgery: A Cross-Sectional Study

Introdução: A extração de terceiros molares é um dos procedimentos mais comuns realizados pelos cirurgiões bucomaxilofaciais e as potenciais complicações dessa intervenção estão bem documentadas. Objetivo: O objetivo deste estudo é encontrar as associações entre essas complicações e variáveis relacionadas aos dentes ou aos pacientes e, assim, ajudar os cirurgiões a predizê-las e preveni-las. Métodos: Nosso estudo avalia a prevalência de omplicações em exodontias de terceiros molares inferiores utilizando uma amostra populacional brasileira em um período de 10 anos para estabelecer a probabilidade dessas complicações e sua associação com variáveis como idade, sexo e posição do dente na arcada . As mesmas variáveis foram usadas em relação a pericoronarite prévia. Trata-se de um estudo observacional retrospectivo transversal, seguindo as diretrizes STROBE. Resultados e Conclusões: Mil e nove pacientes tiveram 1.822 terceiros molares extraídos, sem associação detectada entre condições sistêmicas e complicações, embora esses pacientes com complicações sistêmicas tenham 1,9 vezes mais chances de ter pericoronarite. A pericoronarite foi mais prevalente em pacientes saudáveis, com classificação A e III de Pell & Gregory e posição distoangular. Esses achados corroboram a literatura atual ao comparar a classificação de Pell e Gregory e a maior prevalência de complicações... (AU)

Introducción: La extracción de terceros molares es uno de los procedimientos más comunes realizados por los cirujanos orales y maxilofaciales y las posibles complicaciones de esta intervención están bien documentadas. Objetivo: El objetivo de este estudio es encontrar las asociaciones entre estas complicaciones y variables relacionadas con dientes o pacientes y así ayudar a los cirujanos a predecirlas y prevenirlas. Métodos: Nuestro estudio evalúa la prevalencia de complicaciones en extracciones de terceros molares inferiores utilizando una muestra de población brasileña durante un período de 10 años para establecer la probabilidad de estas complicaciones y su asociación con variables como la edad, el sexo y la posición de los dientes en el arco. Las mismas variables se utilizaron para determinar pericoronitis previa. Se trata de un estudio observacional, transversal, retrospectivo, siguiendo las directrices STROBE. Resultados y Conclusiones: A mil nueve pacientes se les extrajeron 1.822 terceros molares, no detectándose asociación entre condiciones sistémicas y complicaciones, aunque estos pacientes tenían 1,9 veces más probabilidad de tener pericoronitis. La pericoronitis fue más prevalente en pacientes sanos, con clasificación A y III de Pell & Gregory y posición distoangular. Estos hallazgos corroboran la literatura actual al comparar la clasificación de Pell y Gregory y la mayor prevalencia de complicaciones... (AU)

Introduction: Extraction of third molars is one the most common procedures carried out by Oral and Maxillofacial Surgeons and the potential complications of such intervention are well documented. Purpose: The objective of this study is to find the associations between these complications and variables related either to the teeth or the patients and thus help surgeons to predict and prevent them. Methods: Our study evaluate the prevalence of complications in extractions of the lower third molars using a Brazilian population sample over a period of 10 years to establish the probability of these complications and their association with variables such as age, sex and tooth position in the arch. The same variables were used to determine previous pericoronitis. This is a retrospective cross-sectional observational study, following the STROBE guidelines. Results and Conclusions: One thousand and nine patients had 1,822 third molars extracted, with no associations detected between systemic conditions and complications, although these patients are 1.9 times more likely to have pericoronitis. Pericoronitis was more prevalent in healthy patients, with Pell & Gregory classification A and III and distoangular position. These findings corroborate the current literature when comparing Pell and Gregory classification and the higher prevalence of complications... (AU)

Abordagem cirúrgica de cisto periapical abscedado na maxila: relato de caso / Surgical approach of absceded periapical cyst in the maxilla: case report / Abordaje quirúrgico de quiste periapical abscedido en la maxila: reporte de caso

O cisto radicular é uma lesão inflamatória associada à necrose pulpar que ocorre frequentemente em maxila. Objetivo: Descrever um caso cirúrgico detalhado de Cisto Periapical Abscedado. Relato de Caso: paciente gênero feminino, 40 anos, hipertensa, diabética Tipo II, compareceu à clínica queixando-se de dor ao ingerir alimentos frios e quentes na região da maxila, lado esquerdo. Ao exame físico, observou-se destruição coronária e presença de fístula na região do elemento dentário 23. Ao exame radiográfico, observou-se uma área radiolúcida ovalada bem circunscrita com halo radiopaco envolvendo a região apical do elemento dentário 23. Frente ao aspecto clínico e radiográfico, foram sugeridas as hipóteses diagnósticas de abscesso periapical crônico, granuloma periapical ou cisto apical abscedado. Foi realizada a exodontia do elemento 23 seguida de enucleação cística. O diagnóstico histopatológico final foi de cisto abscedado. Após 5 meses de evolução observa-se mucosa íntegra e reparo ósseo alveolar. Conclusão: É imprescindível um exame clínico cuidadoso associado ao exame radiográfico e histopatológico para analisar minuciosamente o caso a fim de oferecer ao paciente melhores condutas de tratamento. O diagnóstico de lesões intraósseas associado ao correto tratamento interrompe a evolução do processo patológico, evita danos maiores e restabelece a condição de saúde dos pacientes... (AU)

The radicular cyst is an inflammatory lesion associated with pulp necrosis that often occurs in the maxilla. Objective: To describe a detailed surgical case of Abscessed Periapical Cyst. Case Report: female patient, 40 years old, hypertensive, type II diabetic, came to the clinic complaining of pain when ingesting cold and hot foods in the left side of the maxilla. On physical examination, coronary destruction and the presence of a fistula in the region of the tooth 23 were observed. The radiographic examination showed a well-circumscribed oval radiolucent area with a radiopaque halo involving the apical region of the tooth 23. In view of the clinical and radiography, the diagnostic hypotheses of chronic periapical abscess, periapical granuloma or abscessed apical cyst were suggested. Element 23 extraction was performed followed by cystic enucleation. The final histopathological diagnosis was an abscessed cyst. After 5 months of evolution, intact mucosa and alveolar bone repair are observed. Conclusion: A careful clinical examination associated with radiographic and histopathological data is essential to systematically analyze the case in order to offer the patient better treatment. The diagnosis of intraosseous lesions associated with the correct treatment interrupts the evolution of the pathological process, avoids further damage and restores the patients' health condition... (AU)

El quiste radicular es una lesión inflamatoria asociada a necrosis pulpar que frecuentemente se presenta en el maxilar. Objetivo: Describir un caso quirúrgico detallado de Quiste Periapical Absceso. Caso Clínico: paciente femenina, de 40 años, hipertensa, diabética tipo II, acudió a la consulta quejándose de dolor al ingerir alimentos fríos y calientes en el lado izquierdo del maxilar. Al examen físico se observó destrucción coronaria y la presencia de una fístula en la región del diente 23. El examen radiográfico mostró un área radiolúcida oval bien delimitada con un halo radiopaco que involucraba la región apical del diente 23. En vista de la clínico y radiográfico, se sugirieron las hipótesis diagnósticas de absceso periapical crónico, granuloma periapical o quiste apical abscesificado. Se realizó la extracción del elemento 23 seguida de enucleación quística. El diagnóstico histopatológico final fue de quiste abscesificado. A los 5 meses de evolución se observa mucosa intacta y reparación del hueso alveolar. Conclusión: Un examen clínico cuidadoso asociado con el examen radiográfico e histopatológico es fundamental para analizar a fondo el caso con el fin de ofrecer al paciente mejores enfoques de tratamiento. El diagnóstico de lesiones intraóseas asociado al correcto tratamiento interrumpe la evolución del proceso patológico, previene mayores daños y restablece el estado de salud de los pacientes... (AU)

Avaliação do perfil dos pacientes e procedimentos realizados por liga cirúrgica acadêmica / Evaluación del perfil de pacientes y procedimientos realizados por una liga quirúrgica académica / Profile assessment of patients and procedures performed by academic surgical league

Esta pesquisa tem como objetivo analisar e relacionar as informações sobre o perfil sociodemográfico, condição de saúde geral dos pacientes e os procedimentos cirúrgicos realizados pela Liga Acadêmica de Cirurgia na Clínica Odontológica da Universidade Federal de Campina Grande. Trata-se de uma pesquisa transversal, descritiva e quantitativa, realizada por meio de uma análise dos prontuários odontológicos no período entre 2016 e 2018. Os dados coletados foram tabulados e a análise estatística foi realizada no software Statistical Package for the Social Sciences. Foram analisados 336 prontuários e o sexo feminino representou 66,4% da amostra. 31,1% dos pacientes não residiam na cidade da Clínica Escola e a utilização de medicamentos foi relatada por 34,8% dos pacientes. Foram contabilizadas 387 exodontias de terceiros molares, representado o procedimento mais realizado. Destas, 75,7% tiveram como causa a remoção profilática. Quanto a classificação dos terceiros molares de acordo com Winter, todos casos encontrados nas posições distoangulado e linguoversão necessitaram de osteotomia e/ ou odontosecção para sua remoção. Em relação a classificação de Pell e Gregory, a posição IA foi a mais encontrada nos elementos 38 e 48, com respectivamente 56,5% e 52,0%. A análise das informações desta pesquisa poderá contribuir no planejamento e qualificação dos serviços oferecidos a comunidade... (AU)

Esta investigación tiene como objetivo analizar y relacionar información sobre el perfil sociodemográfico, el estado general de salud de los pacientes y los procedimientos quirúrgicos realizados por la Liga Académica de Cirugía en la Clínica Odontológica de la Universidad Federal de Campina Grande. Se trata de una investigación transversal, descriptiva y cuantitativa, realizada a través de un análisis de registros odontológicos en el período comprendido entre 2016 y 2018. Los datos recolectados fueron tabulados y el análisis estadístico se realizó mediante el software Statistical Package for the Social Sciences. Se analizaron 336 historias clínicas y el género femenino representó el 66,4% de la muestra. El 31,1% de los pacientes no residía en el municipio de Clínica Escola y el uso de medicamentos fue relatado por el 34,8% de los pacientes. Se contabilizaron un total de 387 extracciones de terceros molares, lo que representa el procedimiento más realizado. De estos, el 75,7% fueron causados por retiro profiláctico. En cuanto a la clasificación de los terceros molares según Winter, todos los casos que se encontraron en las posiciones de distoangulación y linguoversión requirieron osteotomía y/o odontotomía para su remoción. En cuanto a la clasificación de Pell y Gregory, la posición IA fue la más encontrada en los elementos 38 y 48, con 56,5% y 52,0% respectivamente. El análisis de la información de esta investigación puede contribuir a la planificación y calificación de los servicios ofrecidos a la comunidade... (AU)

This study aimed to analyze and relate information about the sociodemographic profile, the patient's general health condition, and the surgical procedures performed by the Academic Surgical League at the dental school of the Federal University of Campina Grande. This is a cross-sectional, descriptive, and quantitative study where dental records in the period between 2016 and 2018 were analyzed. The data were tabulated and the statistical analysis was done using the Statistical Package for the Social Sciences software. A total of 336 medical records were analyzed and the female gender represented 66.4% of the sample. 31.1% of the patients did not live in the dental school's city and 34.8% of the patients reported using medication. 387 third molar extractions were realized, representing the most performed procedure. Of these, 75.7% were caused by prophylactic removal. According to Winter classification of third molars, all cases found in the distoangular and lingualversion positions required osteotomy and/or tooth sectioning for their removal. Regarding the classification by Pell and Gregory, position IA was the most found in elements 38 and 48, with 56.5% and 52.0%, respectively. The information analysis from this research can contribute to the planning and qualification of the services offered to the community... (AU)

Drogas antiagregantes plaquetárias e anticoagulantes em pacientes que se submeterão à cirurgia oral: conduta / Antiagregant platelet and anticoagulant drugs in patients who will submit oral surgery: conduct

Objetivo: Como a frequência de pacientes em uso de anticoagulantes e antiagragantes plaquetários nos consultórios odontológicos é crescente, este trabalho objetivou avaliar através de Revisão de Literatura, qual o melhor manejo desses medicamentos na prática odontológica perioperatória. Metodologia: Trata-se de uma revisão integrativa da literatura, utilizadas as bases de dados Scielo e PubMed. Foram escolhidos os seguintes descritores disponíveis na BVs e PubMed em inglês "Platelet Aggregation Inhibitors", "Oral Surgical Procedures" e "Antigoagulants" no período de 2016 a 2021. Também foram consultados livros e sites de diretrizes do Governo. Foram escolhidos 20 artigos para elaboração da pesquisa. Resultados: doenças cardiovasculares e outras condições clínicas pró-coagulantes tem prevalência crescente e são conhecidos fatores de risco para a ocorrência de fenômenos tromboembólicos graves. A terapia antitrombótica tem papel definido nesses casos. No perioperatorio de cirurgias orais, a decisão por suspender ou manter a terapia deve ser individualizada e pode ser orientada por guidelines. Conclusão: procedimentos orais de baixo risco de sangramento podem ser conduzidos sem a descontinuação da terapia antitrombótica. Cirurgias de moderado a alto risco frequentemente requerem suspensão temporária das medicações para fins de minimizar os riscos de complicações hemorrágicas... (AU)

Objective: As the frequency of patients using anticoagulants and antiplatelet agents in dental offices is increasing, this study aimed to evaluate, through a Literature Review, which is the best management of these medications in dental perioperative practice. Methodology: This is an integrative literature review, being used Scielo and PubMed databases. The following descriptors available in BVs and PubMed "Platelet aggregation inhibitors", "Oral Surgical Procedures" and "Antigoagulants" were used, from 2016 to 2021. In addition, the search was also performed in guideline books and Government websites. Twenty articles were chosen for research elaboration. Results: established cardiovascular disease and other procoagulant clinical conditions have an increasing prevalence, especially among the elderly, and are known risk factors for the occurrence of severe thromboembolic phenomena. Antithrombotic therapy has defined role in these cases. In the perioperative period of oral surgery, the decision to suspend or maintain therapy must be individualized and may be guided by guidelines. Age appears as a clinical criterion in the main ones used. Conclusion: oral procedures with low risk of bleeding can be carried out without discontinuing antithrombotic therapy. Moderate to high-risk surgeries usually require its temporary suspension in order to minimize the risk of bleeding complications... (AU)

Evaluation of the effectiveness of arnica montana 6ch in the control of postoperative myalgia by isometric effort in dentistry

Arnica montana 6CH is a medicine indicated for inflammatory and painful conditions, especially in muscle structures. The RDC / TMD Axis II questionnaire is a validated tool for the diagnosis of Temporomandibular Muscle Dysfunction. Objective: This multicenter, randomized and controlled study, approved by Human or Animal Research Ethics Committee UniFOA -CAAE: 48680015.3.0000.5237 aimed to verify the clinical performance of Arnica montana 6CH in contractures and muscle pain triggered by isometric stress. Materials and Methods: 70 patients underwent prolongeddental treatment sessions, and they were selected after clinical examination and positive responses to the RDC / TMD questionnaire to confirm signs and symptoms of Temporomandibular Muscle Dysfunction at the first consultation. Randomly, Arnica montana 6CH was prescribed for 35 patients called group I, and placebo for 35 patients called group II, at a dose of 5 globules, 03 times a day, for 1 week. In the second endodontic consultation, after 15 days, a new clinical examination was performed at the beginning and end of the prolonged dental consultation with crossing of data from the RDC questionnaire, to monitor the prevalence of TMD muscle signs and symptoms. The data were tabulated and analyzed. Statistical analysis: The test t de Student was used for paired samples, significant at the level ≤ 0.05%. Results:Anamnetic data from the RDC questionnaire, 86% of the individuals in the GI had lower pain and muscle contracture rates in the second consultation, compared with 22% in the GII. Conclusion:The drug Arnica montana 6CH proved to be effective in preventing muscle changes and clinical symptoms resulting from isometric efforts with a statistically significant difference (p ≤ 0.05).

Tratamento cirúrgico em fratura de mandíbula atrófica: uma revisão de literatura / Surgical treatment of atrophic jaw fracture: a literature review

Analisar o manejo de fraturas em mandíbula atrófica voltado para a abordagem cirúrgica com ênfase na melhor técnica indicada. A perda óssea alveolar tem sido uma das consequências do edentulismo, que tem o potencial de levar a atrofia óssea. As fraturas de mandíbulas atróficas, normalmente são consideradas um procedimento desafiador, devido ser encontrada em pacientes idosos ou em virtude da perda dentária precoce resultando em um reparo dessas fraturas mais complexo. Os principais fatores etiológicos têm sido os acidentes automobilísticos, seguidos de queda e agressão. Geralmente, as causas das quedas decorrem de desequilíbrio, fraqueza muscular, tontura, e uso crônico de medicamentos como sedativos. As opções terapêuticas objetivam restaurar forma, função e imobilização apropriada desse possível evento. A individualização do tratamento de escolha é de grande importância, pois geralmente o paciente apresenta alterações fisiológicas decorrentes do envelhecimento e ossos mais fragilizados com potencial osteogênico reduzido, que dificultam a abordagem cirúrgica. Entretanto, deve ser considerado para o manejo dessas fraturas, a idade do paciente, as condições e quantidade de tecido ósseo e tecido mole. Porém, vale ressaltar que o envelhecimento não apresenta contraindicação, apenas exige condições especiais que devem ser consideradas. Nesse sentido, quando há oportunidade de dispositivos tecnológicos, como os biomodelos que contribuem significativamente para procedimentos cirúrgicos bucomaxilofaciais, esses fornecem maior previsibilidade de resultados, bem como redução do tempo cirúrgico.

To analyze the management of fractures in atrophic mandible aimed at the surgical approach, emphasizing which technique is best indicated. Alveolar bone loss has been one of the consequences of edentulism, which has the potential to lead to bone atrophy. Atrophic jaw fractures are usually considered a challenging procedure, as they are found in elderly patients or due to early tooth loss, resulting in a more complex repair of these fractures. The main etiological factors have been described as car accidents, followed by falls and aggression. Commonly, the causes of falls stem from imbalance, muscle weakness, dizziness, and chronic use of medications such as sedatives. The therapeutic options aim to restore form, function and appropriate immobilization of this possible event. The individualization of the treatment of choice is of great importance, as the patient usually presents physiological changes resulting from aging and more brittle bones and a reduced osteogenic potential, which makes the surgical approach difficult. However, the patient's age, conditions and amount of bone and soft tissue must be taken into consideration for the management of these fractures. However, it is noteworthy that aging has no contraindication, it only requires special conditions that must be considered. In this sense, when there is an opportunity for technological devices, such as biomodels that significantly contribute to maxillofacial surgical procedures, it provides greater predictability of results, as well as reduced surgical time.