A new classification for mandibular defects after oncological resection.

No universally accepted classification system exists for mandibular defects after oncological resection. Here, we discuss the scientific literature on classifications for mandibular defects that are sufficiently presented either pictorially or descriptively, and propose a new classification system based on these findings. Of 167 studies included in the data analysis, 49 of these reports sufficiently described the defect for analysis. These reports were analysed for classification, reconstruction, size of defect, number of osteotomies needed, and complications. On the basis of these findings, a new classification is proposed based on the four corners of the mandible (two angles and two canines): class I (lateral), class II (hemimandibulectomy), class III (anterior), and class IV (extensive). Further classes (Ic, IIc, and IVc) include condylectomy. The increasing defect class relates to the size of the defect, osteotomy rate, and functional and aesthetic outcome, and could guide the method of reconstruction.

Reconstruction of acquired oromandibular defects.

Acquired defects of the mandible resulting from trauma, infection, osteoradionecrosis, and ablative surgery of the oral cavity and lower face are particularly debilitating. Familiarity with mandibular and cervical anatomy is crucial in achieving mandibular reconstruction. The surgeon must evaluate which components of the hard and soft tissue are missing in selecting a method of reconstruction. Complexity of mandibular reconstruction ranges from simple rigid internal fixation to microvascular free tissue transfer, depending on defect- and patient-related factors. Modern techniques for microvascular tissue transfer provide a wide array of reconstructive options that can be tailored to patients' specific needs.

Comparative study of 5 different membranes for guided bone regeneration of rabbit mandibular defects beyond critical size.

BACKGROUND: Although several studies have examined use of collagen membranes in guided bone regeneration (GBR), none has examined the use of human fascia temporalis as a bioabsorbable barrier. The majority of studies related to GBR have examined critical size defects. We sought to assess the human fascia temporalis and other well-documented membranes applied for GBR in mandibular osseous defects beyond critical size. MATERIAL/METHODS: Fifty adult male New Zealand white rabbits were used in this study. Five groups of 10 animals each were used: HFL (human fascia lata membrane), HP (human pericardium), HFT (human fascia temporalis), BP (bovine pericardium), and PTFE (expanded polytetrafluoroethylene). Animals were killed 10 weeks after membrane application. In each animal, 9-mm circular mandibular defects were created bilaterally. On 1 side of the jaw, the defect was covered with 1 of the test membranes; the defect on the other side served as a control. Harvested specimens were examined histologically. RESULTS: Membranes were significantly superior to the controls in all animals (P<0.001). Paired comparisons showed that groups HFL, HP, BP, and PTFE were significantly superior to HFT (P<0.05). Conversely, comparisons of HFL-HP, HFL-BP, HFL-PTFE, HP-BP, HP-PTFE, and BP-PTFE, showed no significant differences (P>0.05). CONCLUSIONS: According to our results, the fascia temporalis is not recommended for GBR techniques. The fascia lata, human pericardium, bovine pericardium, and e-PTFE advance bone regeneration and can be successfully used as GBR membranes for osseous defects beyond the critical size.

Tratamento cirúrgico do cisto ósseo traumático por finalidade ortodôntica / Surgical treatment of traumatic bone cyst for orthodontic purpose

O cisto ósseo traumático ou cisto ósseo solitário é uma lesão óssea de etiologia pouco definida, que apresenta como características clínicas uma cavidade vazia, desprovida de membrana ou epitélio, assintomática e que, radiograficamente, apresenta radiolucidez ocasionada pela falta de estrutura na região. Caso clínico: paciente M.A.S., 21 anos, gênero feminino procurou a clínica odontológica para exodontia dos terceiros molares por encaminhamento ortodôntico. Após exame radiográfico panorâmico constatou-se a presenção de lesão radiolúcida de 2 mm de diâmetro na região mentoniana do lado esquerdo, abaixo dos ápices dos dentes 31, 32, 41 e 42 sem envolvê-los. Ao exame clínico não foi observada nenhuma alteração de volume na região. Durante a anamnese nehuma história traumática foi constatada recetemente. Porém, a mãe da paciente recordou que aos 2 anos de idade a filha caiu de um berço traumatizando a região do mento. Após análise de uma radiografia panorâmica antiga, realizada aos 9 anos de idade, a lesão também pôde ser observada, estando esta com diâmetro inferior a 10 mm. Como a paciente necessitava ser submetida a tratamento ortodôntico, optou-se pela abordagem cirúrgica da lesão, o que confirmou o diagnóstico do cisto ósseo traumático. A curetagem realizada foi eficiente como terapia curativa da lesão

Fractura conminuta de la mandíbula en niños: informe de un caso / Jaw conminuted fractures in children: a case report

Debido a la complejidad de la fractura conminuta de la mandíbula en menores, se presenta el caso de un niño de 9 años de edad, atendido quirúrgicamente, con satisfactorios resultados(AU)

Facial gunshot wounds: a 4-year experience.

PURPOSE: Facial gunshot wounds can result in devastating functional and aesthetic consequences for patients. In an attempt to evaluate the management and outcome in these patients, a 4-year retrospective review was undertaken of all patients presenting with facial gunshot wounds at a level I trauma center. PATIENTS AND METHODS: A total of 121 patients were identified. Medical documentation could be obtained on 84 of those patients. The patients' maxillofacial injuries were treated by the 3 participating services: plastic surgery, oral and maxillofacial surgery, and otorhinolaryngology. The patients ranged in age from 6 to 64 years, with a mean age of 27 years. RESULTS: The gunshot wounds were single in 64% of the cases and multiple in 36% of the cases. Overall mortality in the series was 11%. Sixty-seven percent (56/84) of the patients suffered an injury to the underlying craniofacial skeleton. Seventy-five percent of these patients required surgical intervention. Twenty-one percent of the patients (16/75) required tracheostomy emergently for management of the airway. Eighteen percent (15/84) of these patients had an intracranial injury, with 50% of these patients requiring surgery. Fourteen percent of the patients in the series (12/84) had great vessel injuries diagnosed at the time of angiography, with 50% of these patients requiring surgery for treatment. CONCLUSION: Contrary to much of the published literature, most patients in this series required surgical intervention for treatment of their facial gunshot wounds. Reconstructive procedures were performed early in the patient's course and, when possible, addressed both the soft tissue and underlying bony injury in a minimum number of stages.

Traumatismos craneofaciales / Diagnostic Imaging of craneofacial fractures

La valoración precisa de las fracturas craneofaciales es indispensable para instituir un tratamiento correcto y de esa manera evitar defectos anatómicos,funcionales y estéticos. En la actualidad el algoritmo de estudio de los traumatismos craneofaciales incluye las radiografías convencionales y la tomografía computada. Se presenta una experiencia conjunta de radiólogos y cirujanos en el estudio de 63 pacientes, 51 hombres y 12 mujeres, con traumatismos craneofaciales asistidos en nuestra institución en los últimos 4 años, con un rango etario que va de 15 a 38 años y una edad media de 30,8 años. Se analizan los hallazgos radiológicos en correlación con la clínica y el mecanismo lesional, así como las técnicas de examen más adecuadas para cada tipo de fractura. Concluímos que la tomografía computada (TC) es el método ideal en la valoración del paciente con traumatismo craneofacial en la planificación del tratamiento quirúrgico(AU)

Traumatismos craneofaciales / Diagnostic Imaging of craneofacial fractures

La valoración precisa de las fracturas craneofaciales es indispensable para instituir un tratamiento correcto y de esa manera evitar defectos anatómicos,funcionales y estéticos. En la actualidad el algoritmo de estudio de los traumatismos craneofaciales incluye las radiografías convencionales y la tomografía computada. Se presenta una experiencia conjunta de radiólogos y cirujanos en el estudio de 63 pacientes, 51 hombres y 12 mujeres, con traumatismos craneofaciales asistidos en nuestra institución en los últimos 4 años, con un rango etario que va de 15 a 38 años y una edad media de 30,8 años. Se analizan los hallazgos radiológicos en correlación con la clínica y el mecanismo lesional, así como las técnicas de examen más adecuadas para cada tipo de fractura. Concluímos que la tomografía computada (TC) es el método ideal en la valoración del paciente con traumatismo craneofacial en la planificación del tratamiento quirúrgico