Undiagnosed mandibular degloving following dental trauma.

A 12-year-old girl presented to the Department of Paediatric Dentistry of the Toulouse University Hospital 10 days after a facial injury, complaining of persistent pain and halitosis. Previous examinations only reported trauma of the upper incisors. Further clinical exploration showed an 8 cm laceration of the oral mucosa in the lower labial sulcus, 1.5 cm inferior to the gingival margin and exposing the symphyseal bone. The diagnosis of mental protuberance degloving was established. The treatment consisted of debridement of the wound, removal of the necrotic tissue, multiple plane sutures and antibiotics. Complete healing of the wound with no sensory deficit was achieved. Mental degloving injuries occur when a shearing force is applied to the soft tissues overlying the chin, stripping them from the labial bone. This type of wound is rare and can go undetected if a meticulous oral examination is not performed. Early management is essential so healing is not compromised.

Sex estimation in the cranium and mandible: a multislice computed tomography (MSCT) study using anthropometric and geometric morphometry methods.

INTRODUCTION: The purpose of this study was to analyze the respective contribution of the skull and mandible to sex estimation in an entire cranium using metric and geometric morphometric methods and multislice computed tomography (MSCT) analysis. MATERIALS: The study sample comprised 120 individuals aged 23 to 84 years and divided into three groups (whole sample and over or under 40 years of age). METHODS: Forty-eight osteometric landmarks were positioned using Osirix®, 34 for the cranium and 14 for the mandible. The data were analyzed using univariate analyses and logistic regression using backward stepwise selection with cross-validation of the classification results. Generalized procrustes analysis (GPA) was used, and Goodall's F test and Mahalanobis D2 matrices allowed an assessment of statistical significance. RESULTS: The classification accuracy of cranium models ranged from 87% to 88.3%, and from 68% to 81.4% for the mandibular models. With geometric morphometry, accuracy was of 94-100% for the cranium and 84.2% for the mandible. DISCUSSION: We conclude that the mandible had a higher accuracy rate for individuals over 40 years than individuals under 40 years of age, although the accuracy of geometric morphometry did not differ significantly between the age groups. The cranium, however, presented greater predictability for all the parameters assessed.

Sexual dimorphism of the mandibular conformational changes in aging human adults: A multislice computed tomographic study by geometric morphometrics.

The aging process has an impact on mandibular bone morphology and can therefore affect shape sexual dimorphism. Understanding the effect of senescence on mandibular shape changes is particularly important to correctly estimate the sex of an individual and predict age-related conformational modifications. The purpose of this study was to assess age-related changes in mandibular shape and sexual dimorphism. The study sample comprised 160 Multi Slice Computed Tomography examinations of individuals aged 40 to 79 years. Geometric morphometric analysis of fourteen osteometric landmarks was used to examine sexual dimorphism and patterns of mandibular shape variation with age. Results showed that mandibular sexual dimorphism of shape remained significant with aging. Conformational changes occurred between 50 and 70 years and were different for male and female individuals. Females presented earlier and more marked age-related shape changes than males. These observations suggest that mandibular senescence is a sexually dimorphic process since its onset, rate, and the areas subjected to conformational changes differ from male to female individuals. Senescence-related changes present substantial variability, and further investigation is required to determine precisely the age that marks their onset.

Brain Abscess Secondary to a Dental Infection.

The risk of a brain abscess is a complication of odontogenic infection that is rarely considered by physicians and little spoken of, yet treating dental infections may avoid a potentially life-threatening condition. We report a case of 7-year-old boy with a brain abscess secondary to a dental infection. He was immediately taken to the operating theatre for drainage and cleaning of the abscess. A dental examination revealed root abscesses on temporary molars, which were extracted under general anaesthetic. Two months after his admission, the child was switched to oral antibiotherapy and could return home. A brain abscess represents a life-threatening disease. Childhood brain abscess is uncommon but may be encountered by all physicians and students as a clinical emergency. It is indispensable that physicians finding symptoms similar to those in this case study refer the patient for emergency care and that possible dental foci of infection be assessed, whether or not the patient is being followed for dental care.

The mandibular plane: a stable reference to localize the mandibular foramen, even during growth.

OBJECTIVES: The location of the mandibular foramen is essential for the quality of the inferior alveolar nerve block anaesthesia and has often been studied with contradictory results over the years. The aim of this study was to locate the mandibular foramen, according to the dental age of the subject, through 3D analysis. METHODS: Three-dimensional images were reconstructed from mandibular computed tomography of 260 children, adolescents and adults. The occlusal plane was determined as the average plane passing through the buccal cusps of mandibular molars, premolars, and canines, and through the incisor edge. The mandibular foramen was located three dimensionally in relation to the anterior edge of the ramus (or coronoid notch), the sagittal plane and the occlusal plane. RESULTS: All along mandibular growth, the three distances defining the relative position of the mandibular foramen showed negligible changes. The mandibular foramen is located from - 0.4 to 2.9 mm above the occlusal plane. The distance between the mandibular foramen and the leading edge of the mandibular ramus ranged from 17 to 19.5 mm. The angle between the ramus and the sagittal plane ranged from 3° to 5.4°. CONCLUSION: In our sample, and using the occlusal plane and the anterior edge of the ramus as anatomical references, the location of the mandibular foramen was considered to be similar in all patients regardless of age.

Orofacial manifestations of SAPHO syndrome: a systematic review of case reports.

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a poorly known disease with cutaneous and osteo-articular manifestations requiring a multidisciplinary care. The aim of this study was to review the case reports that have described oral manifestations in patients suffering for this syndrome. A systematic review of case reports was performed on PubMed and Science Direct on January 2020 among all the articles dealing with the disease. In vitro, preclinical, and clinical studies have not been included to select only the case reports. Eighteen articles, published between 1999 and 2019, were included. All the patients presented mandibular osteomyelitis or sclerosis, associated with various other symptoms such as trismus, temporomandibular joint arthritis, or dysphagia. The data highlight the high variability in the disease's manifestations between people and also in the treatments applied. Knowing the orofacial signs of the SAPHO syndrome, the dental surgeon has a crucial role in the diagnosis procedure and must take place in the multidisciplinary medical team involved in the patient following. Some care adaptations are needed for oral interventions in these patients, depending on their treatments and their handicap. Key Points • Orofacial manifestations of SAPHO syndrome mainly occur on the mandible. • In cases of mandible sclerosis, decorticalization surgeries may be performed. • Oral care are encouraged, especially the preventive treatments to limit the necessity of surgeries. • The complexity in the management of patients suffering for a SAPHO syndrome concerns the oral manifestations, the patient general health and the treatments he has to take every day.