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PURPOSE: A randomized controlled trial was performed to evaluate the effects of light-emitting diode (LED) therapy on sensory changes in the inferior alveolar nerve after surgical treatment of mandibular fractures. METHODS: Patients admitted with surgically treated mandibular fractures between January 2018 and December 2019 were evaluated. Personal data, fracture location, fracture type, and dislocation degree were obtained. The cases were randomly allocated into two groups: LED therapy (LEDT) (57 points of 660 nm and 74 points of 850 nm, 6.4 mV/cm2, and 7.64 J) with the use of a prototype device and control (CTRL). For 6 months, tactile and thermal tests were used in the mental region. Data were analyzed using the Mann─Whitney U test and likelihood ratio test (p ≤ 0.050). RESULTS: The study included 42 patients, 25 of whom had bilateral fractures and 17 had unilateral fractures, totaling 67 fractures. The mean values of the tactile and thermal sensitivity tests were lower in the LEDT group in all evaluation periods. There was a significant difference between the groups in the parasymphysis location, displacement < 5 mm, and intraoral access. Sensory changes were observed in 68.7% of all fractures upon admission, with 91.2% in the LEDT group and 78.8% in the CTRL group demonstrating complete remission during the final period of the study. CONCLUSION: LED photobiomodulation accelerated the process of sensory change remission. There was an influence of the fracture location, degree of displacement, and surgical access, with a better response in the LEDT group.

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RESUMEN: En la práctica clínica odontológica, reconocer estructuras anatómicas es determinante en la planificación de distintos tratamientos que involucren algún riesgo. Uno de los exámenes complementarios recomendados para la planificación de diferentes tratamientos en odontología es la Tomografía Computarizada de Haz Cónico (CBCT). Con este examen, se pueden pesquisar variantes anatómicas como el Foramen Mental Accesorio (FMA), el cual es importante identificar para prevenir complicaciones. El objetivo de este trabajo fue determinar la frecuencia y caracterización de FMA en una población chilena adulta, de la ciudad de Valdivia, Chile. Este estudio es de tipo observacional descriptivo. Se revisaron 247 exploraciones de diferentes centros radiológicos de la ciudad de Valdivia, cumpliendo 143 con los criterios de selección. Este estudio fue aprobado por el Comité ético científico del Servicio de Salud de Valdivia. Se encontró presencia de FMA en el 17,48 % que corresponde a 25 pacientes de un total de 143, correspondiendo un 80 % al sexo femenino. El rango etario en que se encontró con mayor frecuencia correspondió a 18-39 años. La distancia promedio entre FMA y FM (Foramen Mental) fue de 5,76 mm, correspondiendo a 2 mm la distancia mínima y 11,5 mm la distancia máxima. La distancia promedio entre FMA y ápice dentario más cercano fue de 5,36 mm. La distancia mínima y máxima fueron de 0,8 mm y 10,2 mm respectivamente. El ápice radicular mayormente asociado al FMA correspondió al segundo premolar con una frecuencia de 60 % (n=15). Este estudio confirma la importancia de la correcta evaluación de la región mental ante procedimientos en la zona, la cual es vital para prevenir lesiones en relación a esta variante anatómica.

SUMMARY: The recognition of key anatomical structures is decisive to avoid complications in the dental clinical practice. Cone Beam Computed Tomography (CBCT) is a complementary exam recommended for the planning of different procedures in dentistry. With this exam, anatomical variants can be identified, such as the Accessory Mental Foramen (AMF). The objective of this work was to determine the frequency and characteristics of AMF in an adult Chilean population from the city of Valdivia, Chile. This is an observational study that included 247 CBCT exams from different radiological centers in Valdivia. According to the selection criteria, 143 CBCT exams were included. This study was approved by the Scientific Ethics Committee of the Valdivia Health Services. AMF was identified in 25 patients representing 17.48 %. From this result, 80 % were found in females. AMF was most frequently identified in patients from 18 to 39 years old. The average distance between AMF and Mental Foramen (MF) was 5.76 mm, which corresponds to 2 mm the minimum distance and 11.5 mm the maximum distance. The average distance between AMF and the nearest dental apex was 5.36 mm, and the minimum and maximum distance were 0.8 mm and 10.2 mm, respectively. The root apex of the second premolar was most frequently associated with the AMF, representing 60 % (n=15). This study confirms the importance of the correct evaluation of the mental region before initiating procedures in the area, which is vital to prevent injuries associated with this anatomical variant.

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ABSTRACT Purpose: to evaluate the occurrence of loss of sensitivity of the inferior alveolar nerve, and to monitor the remission of this change in patients with mandibular fractures subjected to surgical treatment. Methods: patients with mandibular fractures, surgically treated within one year, were prospectively evaluated. Data regarding etiology, fracture location, type and displacement, and surgical access, were obtained. The tactile and thermal tests were applied at eighteen points in the mental region, within a period of six months. Statistical tests were applied to compare the categories of variables and the period of observation (p ≤ 0.050). Results: during the study, 37 patients were included. There were 24 bilateral and 13 unilateral fractures. Sensory changes occurred in 56.8% of the patients in the preoperative period, in 83.8% of the patients, in the postoperative period, and 35.1% of the patients presented complete remission during the final period of the study. Conclusion: sensory changes occurred in about half of the patients, due to the fracture, increasing greatly in the postoperative period, with complete remission in about one third of the cases. The fracture type, degree of displacement and surgical access type influenced the occurrence of sensory alterations.

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RESUMEN Las fracturas faciales son poco frecuentes en los niños, motivo por el cual se presenta el caso de una niña de 10 años de edad, de color de piel mestiza, procedencia urbana, con antecedentes de salud, la que, tras una caída de aproximadamente 2,5 m de altura, sufrió un severo traumatismo dentoalveolar anterosuperior y anteroinferior que le ocasionó fractura dentoalveolar en el sector anterosuperior de 12 a 22, luxación de 12, 11 y 22 y avulsión de 21(el cual pudo ser recuperado en el lugar del trauma) y fractura dentoalveolar en el sector anteroinferior de 32 a 42. Fue recibida en el cuerpo de guardia del Hospital Pediátrico Universitario Paquito González Cueto y atendida en el salón de Cirugía Maxilofacial de este hospital. Se aplicó tratamiento quirúrgico para heridas de partes blandas realizando sutura, reducción y estabilización de la fractura en el sector anterosuperior mediante férula de Erich y en el sector anteroinferior mediante osteosíntesis con alambre en ocho. Se reimplantó 21 y se fijó a la férula mediante osteosíntesis con alambre. Se indicó tratamiento con dieta blanda y líquida, analgésicos, antibioticoterapia, termoterapia y buchadas tibias con solución salina. Se mantuvo la férula durante 21 días, logrando consolidar las fracturas y 21 en su alveolo. Se logró reimplantar el diente avulsionado evitando las secuelas estéticas, funcionales y psíquicas del trauma; la niña se reincorporó a la sociedad.

ABSTRACT Facial fractures are rare in children, for that reason the case of a 10-year-old girl is presented. She is a mestizo, urban origin, with a history of health who after a fall of approximately 2.5 m in height, suffered a severe anterior and inferior anterior dentoalveolar trauma causing a dentoalveolar fracture in the anterior superior sector from 12 to 22, dislocation of 12, 11 and 22 and avulsion of 21 (which could be recovered at the site of the trauma) and dentoalveolar fracture in the anteroinferior sector from 32 to 42. The case was received at the emergency department of the Pediatric Hospital Paquito González Cueto University and attended in the Maxillofacial Surgery room. Surgical treatment for soft tissue wounds was performed by suturing, reducing and stabilizing the fracture in the anterior superior sector by means of Erich's splint and in the anteroinferior sector by means of osteosynthesis with wire in figure-eight. Twenty first was reimplanted and fixed to the splint by osteosynthesis with wire. Treatment with soft and liquid diet, analgesics, antibiotic therapy, thermotherapy and warm mouth rinse with saline solution was indicated. The splint was maintained for 21 days, managing to consolidate the fractures and 21 in its socket. It was possible to reimplant the avulsed tooth avoiding the aesthetic, functional and psychic consequences of trauma; the girl rejoined society.

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PURPOSE: Double and multiple mandibular fractures are associated to high morbidity and functional damage. This study aimed to evaluate the characteristics and outcomes of double unilateral, bilateral, and multiple mandibular fractures. METHODS: A 7-year observational retrospective analysis was performed, and the injury-related data were collected from the medical records. Statistical analysis was performed using Fisher's exact test (p < 0.05). RESULTS: In this period, 283 patients showed mandibular fractures. Of them, 83 (29.7%) had double or multiple mandibular fractures and were included in the study. Double bilateral fractures were more prevalent than multiple or double unilateral. Multiple fractures presented significant association with the combination of load-bearing and load-sharing fixation protocols. Most cases (94.0%) applied at least one type of internal fixation system. However, there was a positive association between condylar fractures and non-surgical treatment (p < 0.01). Moreover, mandibular body fractures were associated with load-bearing fixation (p < 0.01). In 56 cases, no complications were observed (67.5%). Complications were divided into treatment failure (10.8%) and transitory or minor complications (21.7%). There was no statistical association between complications and fracture pattern, fracture-tooth relation, and treatment modality. CONCLUSION: Double and multiple mandibular fractures represented almost one third of all mandibular fractures, and regardless to treatment protocol, there was no difference about complications. Moreover, although a considerable complication rate was found, most of them were minor or transitory.

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BACKGROUND: Suspicion of mandibular invasion directly influences perioperative strategy, requiring marginal or segmental mandibulectomy, or reconstruction in some cases. This has a considerable impact on outcome and quality of life. The aim of this study was to evaluate the accuracy of magnetic resonance and computed tomography in the prediction of mandibular invasion in patients with oral cavity cancer. METHOD: A systematic review was conducted, including diagnostic studies comparing magnetic resonance imaging with computed tomography in the prediction of bone invasion. Sensitivity, specificity, positive and negative likelihood values and summary receiver operating characteristic (sROC) curves were calculated. RESULTS: The electronic and manual search identified 346 articles. Of these, 11 studies were included in the systematic review for a total of 477 patients. The sensitivity, specificity, and positive and negative likelihood values for MRI were 78%, 86%, 5.29 and 0.23, respectively. For CT, they were 76%, 89%, 6.00 and 0.28, respectively. The sROC curves for MRI and CT were 82.3% and 82.5%, respectively. CONCLUSION: No superiority was observed between the diagnostic methods regarding mandibular invasion detection.

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O côndilo mandibular apresenta-se como um dos locais mais comumente acometidos nas fraturas mandibulares, sendo, na maioria das vezes, decorrente de um trauma na região de sínfise ou de para-sínfise mandibular. A ptar pelo tratamento cirúrgico ou conservador é motivo de controvérsias, principalmente devido às diversas complicações pós-tratamento relatadas na literatura. Uma das principais indicações para a redução cirúrgica consiste na impossibilidade de estabelecer uma satisfatória oclusão dentária pelo tratamento conservador, geralmente associado às fraturas bilaterais. O sucesso do tratamento está relacionado a uma aderência cuidadosa nos princípios cirúrgicos e fisiológicos e em um acompanhamento pós-operatório rigoroso, aumentando a capacidade funcional a longo prazo e possibilitando uma menor incidência de complicações. Este trabalho objetiva relatar um caso clínico de redução cirúrgica de fratura bilateral de côndilo associada à fratura de corpo mandibular, enfocando, principalmente, os aspectos relacionados às indicações e complicações desse tipo de tratamento.

The mandibular condyle is presented as one of the most commonly sites involved in jaw fractures, most often due to trauma in the region of the mandibular symphysis. The choice of surgical or conservative treatment is a highly controversial issue, mainly due to the various post-treatment complications reported in the literature. One of the main indications for surgical reduction is the inability to establish a satisfactory dental occlusion by conservative treatment, usually associated with bilateral fractures. Successful treatment is related to a careful adherence to surgical and physiological principles with a rigid follow up, increasing the long-term functional capacity and allowing a lower incidence of complications. This study reports a case of surgical reduction of bilateral condyle fracture associated with fracture of the mandibular body, focusing on aspects related with indications and complications of this treatment.

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Ameloblastoma is a benign odontogenic tumor accounting for 1% of all tumors of the maxilla and mandibula. The mandibula is committed in 85% of the cases. The tumor is locally invasive, able to infiltrate bone marrow spaces, without radiographic or macroscopic evidence. High recurrence rates are associated with different surgical techniques, which range from simple tumoral enucleation to extensive resections. The authors report a case of a 26-year old female patient with an 8-year history of progressive, non-tender, swelling of the left mandibular region. The intraoral examination showed that the floor of mouth was raised on the left side by a bulging along the bottom of the left mandibular vestibule as well as the lingual region. Over this area, there were ulcerated areas in the alveolar region of the molars and mucosal fenestration in the alveolar and lingual regions were present. A panoramic radiography revealed a multicystic lesion, resembling the soap-bubble shape endosseous lesion. The computed tomography revealed an expandable multicystic lesion compromising both mandibular cortices. The patient underwent a biopsy, which revealed the diagnosis of a multicystic variant of Ameloblastoma, with plexiform pattern, treated with left mandibular resection and immediate installation of a customized prosthesis. After a year of follow-up, no evidence of the tumor relapse was evidenced.

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INTRODUÇÃO: As fraturas de mandíbula são frequentemente causadas por traumatismo direto, mas, eventualmente, podem surgir fraturas patológicas, em função de lesões tumorais. A abordagem cirúrgica é determinada pelo tipo e pela localização da fratura na mandíbula. O objetivo deste estudo foi avaliar o perfil epidemiológico de 70 pacientes que sofreram fratura de mandíbula e foram operados no Instituto Dr. José Frota (Fortaleza, CE) no período de janeiro de 2005 a dezembro de 2009. MÉTODO: Foram analisados prontuários de 70 pacientes submetidos a cirurgia para correção de fratura de mandíbula, avaliando-se sexo, idade, cor, procedência, sítio anatômico da fratura, etiologia, fraturas associadas, tratamento, tempo de internação e complicações. RESULTADOS:Houve predomínio do sexo masculino (90 por cento), com média de idade de 28,25 + 11,04 anos. A maioria dos pacientes (80 por cento) era de cor branca e procedente do interior (68 por cento). Os locais da mandíbula mais acometidos foram a região da parassínfise, o corpo e o ângulo, tendo como principal causa os acidentes de trânsito (70 por cento), sendo os acidentes motociclísticos (55,7 por cento) mais prevalentes. As principais fraturas de face associadas foram de maxila do tipo Le Fort e zigomático-orbitário. O tratamento cirúrgico foi feito com fixação interna rígida na maioria dos pacientes (75 por cento). A única complicação foi infecção, observada em um paciente. CONCLUSÕES: A redução e a fixação das fraturas mandibulares devem ocorrer tão precisa e rapidamente quanto possível, visto que a maloclusão é uma complicação grave a longo prazo. Neste estudo, essa complicação não foi observada, havendo apenas um caso de infecção. Coincidindo com os achados de outros estudos, houve prevalência de adultos jovens do sexo masculino e de acidentes de trânsito como etiologia. As fraturas foram localizadas preferencialmente na região da parassínfise e corrigidas por meio de fixação interna rígida em 75 por cento dos casos.

BACKGROUND: Mandible fractures are most often caused by direct trauma, but occasionally, pathologic fractures may occur due to tumor lesions. The surgical approach is determined by the type and the location of the mandible fracture. This study aimed to evaluate the epidemiological profile of 70 patients who suffered mandible fracture and underwent surgery at Instituto Dr. José Frota (Fortaleza, CE) between January 2005 and December 2009. METHODS: We analyzed medical records of 70 patients who underwent surgical treatment for mandibular fractures and assessed gender, age, skin color, anatomic site of fracture, etiology, associated fractures, treatment, hospitalization and complications. RESULTS: There was male predominance (90 percent) among patients, with a mean patient age of 28.25 + 11.04 years. Most patients (80 percent) were Caucasian and from small towns (68 percent). The most affected jaw sites, in descending order, were the parasymphysis region, body, and angle. The major cause was traffic accidents (70 percent), with motorcycle accidents being the most prevalent (55.7 percent). The main associated facial fractures were maxilla fracture type Le Fort and zygomatic-orbital. Surgical treatment was carried out with rigid internal fixation in most patients (75 percent). The only complication was infection in one patient. CONCLUSIONS: Reduction and fixation of mandibular fractures should occur as accurately and quickly as possible, since malocclusion is an important long-term complication. In our study, we did not observe such a complication; there was only one case of infection. Concurrent with the findings of other studies, there was a prevalence of young adult males among patients, and traffic accidents were the main cause. The fractures were frequently located in the parasymphysis region and were corrected through rigid internal fixation in 75 percent of cases.

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El trauma maxilofacial es muy frecuente y se encuentra asociado a una alta incidencia de fracturas faciales en diferentes combinaciones. Este puede ser causado por hechos viales, violencia personal, prácticas deportivas y heridas por proyectil percutido por arma de fuego, siendo estas últimas, lesiones devastadoras que pueden comprometer la vida del paciente. Teniendo en cuenta que el Hospital Universitario de los Andes es uno de los centros asistenciales más importantes de Venezuela, en el manejo del trauma de alta energía, incluyendo el trauma facial, reportamos el caso de un paciente masculino de 33 años, remitido a esta institución por presentar trauma mandibular secundario a herida por arma de fuego, el cual generó una fractura compleja del ángulo, rama y cóndilo izquierdo de la mandíbula. Esta lesión fue resuelta a través de reducción directa, osteosíntesis y hemiartroplastia con un solo implante. Mediante este procedimiento se logró obtener un adecuado resultado funcional y estético. El principal objetivo, a favor preservar la biomecánica de la Articulación Temporomandibular (ATM) afectada, a través del uso de implantes y técnicas especiales, desarrolladas para tal fin

Maxillofacial trauma is very common and is associated with a high incidence of facial fractures in different combinations. This can be caused by traffic accidents, personal violence, sports, and gunshot wound, being devastating injuries that can compromise the patient’s life. The Hospital Universitario de Los Andes is one of the most important health centers in Venezuela in the management of high energy trauma, including facial trauma. We report the case of a 33 year old male pacient, received in this institution for a mandible trauma secondary to a gunshot wound, generating an angle, branch and the left condyle complex fracture of the mandible. This lesion was treated by direct reduction, osteosynthesis and hemiarthroplasty with a single implant. This procedure is able to obtain adequate functional and cosmetic results. The main objective was to preserve the biomechanics of the affected temporomandibular joint, through the use of implants and techniques developed for this purpose

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Mandibulectomia é a remoção total ou parcial de uma ou de ambas as mandíbulas. Dentre suas indicaçõesem cães, a mais frequente é o tratamento de neoplasias da cavidade oral. Outras indicações sãoo tratamento de fraturas cominutivas e de alterações funcionais adquiridas. O tratamento é efetivo edeve ser executado por profi ssional com treinamento na área e materiais adequados. Os cães via deregra se adaptam bem à perda de tecido ósseo e tem boa qualidade de vida. com percepção de melhoraestética e funcional pelos proprietários

Mandibulectomy is the partial or total removal of one or both jaws. Among its indications in dogs,the most common is the treatment of cancers of the oral cavity. Other indications are the treatment ofcomminuted fractures and functional alterations acquired. The treatment is effective and should berun by a trained professional in the area and suitable materials. Dogs usually adapt well to the loss ofbone tissue and have good quality of life, with perception of aesthetic and functional improvementby owners

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Mandibulectomia é a remoção total ou parcial de uma ou de ambas as mandíbulas. Dentre suas indicaçõesem cães, a mais frequente é o tratamento de neoplasias da cavidade oral. Outras indicações sãoo tratamento de fraturas cominutivas e de alterações funcionais adquiridas. O tratamento é efetivo edeve ser executado por profi ssional com treinamento na área e materiais adequados. Os cães via deregra se adaptam bem à perda de tecido ósseo e tem boa qualidade de vida. com percepção de melhoraestética e funcional pelos proprietários(AU)

Mandibulectomy is the partial or total removal of one or both jaws. Among its indications in dogs,the most common is the treatment of cancers of the oral cavity. Other indications are the treatment ofcomminuted fractures and functional alterations acquired. The treatment is effective and should berun by a trained professional in the area and suitable materials. Dogs usually adapt well to the loss ofbone tissue and have good quality of life, with perception of aesthetic and functional improvementby owners(AU)

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Relata-se o caso de paciente atendido no Pronto-Socorro com fratura exposta cominutiva grave de mandíbula, com perda óssea importante causada por projétil de arma de fogo. Foi submetido àa operação de urgência, sendo necessário o uso de placas de fixação e reconstrução. Apresentou evolução demorada, com período de internação hospitalar de 28 dias. À alta, apresentava deformidade facial e dificuldade na movimentação da mandíbula e articulação de palavras. Devido ao tratamento com cirurgia precoce e ao uso de recursos adequados, o paciente obteve bons resultados estéticos e funcionais no controle ambulatorial.

Mandible fractures are among the most common lesions encountered in the trauma centers. They are usually caused by assault or gunshot and the risk factors include low socioeconomic level, drug abuse and unemployment, being male young adults the most frequent victims. This report is about a patient who was brought to the emergency room with a severe gunshot comminuted mandible fracture. He was submitted to an early surgical repair, in which fixation and reconstruction plates were needed. There was a 28 day in-hospital stay and the patient showed facial deformation and difficulty in word pronunciation at discharge. Due to the aggressive management with early surgical repair and adequate resources the patient presented with good functional and aesthetical results in the follow up.

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Cleidocranial dysplasia is a developmental anomaly of the skeleton and teeth. It can be inherited as an autosomal dominant characteristic with high penetrance and variable expressivity. It occurs with equal frequency in both genders and races. The clinical appearance of cleidocranial dysplasia is pathognomonic. The stature is mildly to moderately shortened, with neck appearing long and narrow and the shoulders markedly drooped. Maxillary hypoplasia gives the mandible a relatively prognathic appearance, although some patients may show variable mandibular prognathism due to increased length of the mandible in conjunction with short cranial base. The head and neck features are very variable. Herein, we are described one cleidocranial dysplasia case, in an 84 year female patient, with the dentigerous cyst, which she were not kwon the diagnosis of the her congenital syndrome.

A displasia cleidocraniana é uma alteração de desenvolvimento do esqueleto e dos dentes. É uma desordem autossômica dominante com alta penetrância e expressibilidade variada. Ocorre em igual frequência em ambos os gêneros e raças. Suas características clínicas são patognomônicas. Apresenta estatura baixa a moderada, com aparência do pescoço longo e os ombros caídos. Hipoplasia da maxila gera um aparente prognatismo. As características clinicas em cabeça e pescoço são muito variadas. Este relato descreve um caso de uma paciente de 84 anos com displasia cleidocraniana associada a cisto dentígero a qual não sabia ser portadora de tal síndrome congênita.

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Conventional radiography has shown limitation in acquiring image of the ATM region, thus, computed tomography (CT) scanning has been the best option to the present date for diagnosis, surgical planning and treatment of bone lesions, owing to its specific properties. OBJECTIVE: The aim of the study was to evaluate images of simulated bone lesions at the head of the mandible by multislice CT. MATERIAL AND METHODS: Spherical lesions were made with dental spherical drills (sizes 1, 3, and 6) and were evaluated by using multislice CT (64 rows), by two observers in two different occasions, deploying two protocols: axial, coronal, and sagittal images, and parasagittal images for pole visualization (anterior, lateral, posterior, medial and superior). Acquired images were then compared with those lesions in the dry mandible (gold standard) to evaluate the specificity and sensibility of both protocols. Statistical methods included: Kappa statistics, validity test and chi-square test. Results demonstrated the advantage of associating axial, coronal, and sagittal slices with parasagittal slices for lesion detection at the head of the mandible. RESULTS: There was no statistically significant difference between the types of protocols regarding a particular localization of lesions at the poles. CONCLUSIONS: Protocols for the assessment of the head of the mandible were established to improve the visualization of alterations of each of the poles of the mandible's head. The anterior and posterior poles were better visualized in lateral-medial planes while lateral, medial and superior poles were better visualized in the anterior-posterior plane.

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