Facial nerve paralysis after impacted lower third molar surgery: A literature review and case report

Facial nerve paralisys (FNP) is the most commom cranial nerve disorders and it results in a characteristic facial distortion that is determined in part by the nerves branches involved. With multiples etiologies, these included trauma, tumor formation, idiopathic conditions, cerebral infarct, pseudobulbar palsy and viruses. FNP during dental treatment is very rare and can be associated with the injection of local anesthetic, prolonged attempt to remove a mandibular third molar and subsequent infection. We report a case of a 21 years-old black woman who developed a Bell?s palsy after an impacted third molar surgery under local anaesthesia, present a FNP classificated like a grade IV by the House-Brackmann?s grading system. The treatment was based of prescription of a citidine and uridine complex (NÚCLEO CMP tm) one tablet twice per day and a close follow up. Three months later that had begining the treatment, the patient recovery her normal facial muscle activity

Treatment of condylar fractures: : a retrospective cohort study

Objective: Evaluate routine alterations in patients submitted to treatment of unilateral fractures of the mandibular condyle. Patients and methods: The sample consisted of 30 patients of both sexes submitted to surgical and nonsurgical treatment. All patients answered an evaluation questionnaire on perception of the Oral Impact on Daily Performances (OIDP) and underwent physical and imaging examination. The following aspects were evaluated in temporo mandibular join (TMJ) physical examination: maximum mouth opening, left/right lateral movements and protrusive movements. Vertical height measurements of right and left mandibular branches were evaluated by means of orthopantomography. Lateromedial and anteroposterior displacements were measured using Hirtz?s axial radiography. Evaluation of diameter of the mandibular fossa and height of the glenoid fossa were measured by hypocycloidal tomography. Results: A minority (13.3%) answered the questions on OIDP positively, with a similar rate for both treatments. With regard to the vertical height variable, average vertical height was similar for both treatments. However, comparing fractured and nonfractured sides, the difference observed was statistically significant for both treatments. On the basis of the statistical results of this study, for both treatments there were no significant alterations in the maximum mouth opening variable, with an average of 43.35 mm for open treatment and 44 mm for closed treatment. Conclusion: In the present study there were no significant differences between open and closed treatment of unilateral fractures of the mandibular condyle

Relationship between mandibular fracture and impacted lower third molar

Many studies have shown that the greatest risk of fracture of the mandibular angle is related to the presence of an unerupted lower third molar, based on the hypothesis that there is a decrease in the area of bone and absorption of the impact in this area, leading some surgeons to indicate its prophylactic removal in patients most exposed to the risk factors of facial trauma. On the other hand, other authors have observed a greater frequency of condylar fractures in patients without an impacted lower third molar.Purpose: The aim of this study was to relate the condylar and angle fracture with an unerupted lower third molar, taking into account the position of the tooth.Material and Methods: Panoramic radiographs were used to determine if the presence or absence of the third molar is related to the occurrence of mandibular fractures, such as angle and condylar fractures.Results: In a total of 43 patients with angle fractures, the greatest percentage had erupted teeth, and 41.9% had impacted teeth; however there was no significant difference between the fractured side and the tooth condition (p=0.350). There were 91 condylar fractures and in 42.9% the third molar was absent and in 40.7% the tooth was erupted . There was no significant difference between the fractured side and the tooth condition (p=0.852).Conclusion: The absence of an impacted third molar may increase the risk of condylar fractures and decrease the prevalence of mandibular angle fractures

Occupational stress among Brazilian oral-maxillofacial surgeons

Purpose: The aim of the present study was to assess the stress level of oral-maxillofacial surgeons, based on the Demand-Control Model. Methods: A cross-sectional study was carried out with 128 oral-maxillofacial surgeons who participated in the Brazilian Congress of Oral-Maxillofacial Surgery held in the city of Florianópolis, State of Santa Catarina, Brazil. Data was obtained using a questionnaire that incorporated the Demand-Control Model (Job Content Questionnaire), which evaluates psychosocial experiences at work. Information on age, gender and professional qualification was also collected. The data was displayed in contingency tables. The following statistical tests were used with a 5% level of significance: chi-square test and ?Fisher exact test?. Results: Oralmaxillofacial surgeons were classified according to the Demand-Control Model as follows: High Demand (28%), Low Demand (28%); Passive Work (27%), Active Work (16.4%). Conclusion: The majority of oral-maxillofacial surgeons exercise their profession in unsatisfactory working conditions, as less than 1/3 of the population studied worked under the ideal condition of low demand

Alcohol abusive use increases facial trauma?

Trauma is among the main death causes and morbidity in the world and is often related to the use of alcohol and its abuse has reached massive proportions, no matter if the country is developed or not, being considered as public health problem. Since there are very few randomized and prospective studies in literature about the association of facial trauma and the use of alcohol, this study aims to investigate the impact of alcohol use in facial trauma. This was a prospective and cross sectional study, involving facial trauma patients attended at Oral Maxillofacial Surgery Division of a State Hospital. Variables included patient´s profile, trauma etiology, facial region involved, type of injury and treatment and days of hospitalization. AUDIT test was applied to identify risks and damages of alcohol use and chemical dependence. Absolute distribution, uni and mutilvaried percentages were made for data evaluation. Pearson´s qui-squared and Fisher´s Exact tests were also used. One hundred patients were evaluated. The patient´s mean age was 33.50 years-old, 48% had between 17 and 29 years old, 28% had 30 to 39, and 24% 40 or more. Most of them were male (86%). The most frequent etiology was traffic accident (57%), the extraoral area was most committed (62%), the most frequent type of injury was fractures (78%) and the most affected bone was the mandible (36%). More than half of the patients (53%) had surgical treatment. 38% had their discharge from hospital right after the first attendance. The AUDIT most frequent answer was ?moderate use? (46%) and use at risk (39%). There was significant difference between the use of alcohol (AUDIT) and hematoma (0.003) and number of days of hospitalization (p=0.005). In this study it was not observed association between alcohol consumption using the AUDIT and trauma etiology, but patient victims of traffic accidents were classified as with risk in the scale. Most of the trauma were caused by traffic accidents using motorcycles and occurred in young aged men

Avaliação tomográfica de fraturas do complexo zigomático-orbitário tratadas com o auxílio de planejamento em Biomodelos / Tomographic evaluation of zygomatic-orbital fractures treated with planning on Biomodels

A correção das fraturas do complexo zigomático-orbitário são desafiadoras ao cirurgião, pela complexidade da sua anatomia e sua intima relação com múltiplos ossos da face. A prototipagem rápida pode ser um instrumento auxiliar no planejamento cirúrgico dessas fraturas com o objetivo de devolver a anatomia anterior ao trauma. Este é um estudo tomográfico de fraturas zigomático-orbitarias que foram tratadas com o auxílio de planejamento em biomodelos. Métodos: Foram incluídos seis pacientes com fratura unilateral da região zigomática-orbitaria classificados como Knight e North tipo III, IV, V e VI. A cirurgia para redução e fixação da fratura foi planejada com o auxílio de biomodelos 3D, onde a hemiface não afetada foi espelhada sobre o lado fraturado, e as placas de fixação foram pré-moldadas se baseando no lado espelhado, com o objetivo de garantir a correta projeção. A qualidade da redução cirúrgica foi avaliada usando pontos quantificáveis (parede lateral da órbita, projeção ântero-posterior do zigoma e projeção do globo ocular), que foram mensurados nas imagens tomográficas pré e pós-operatórias. Resultados: Houve ganho estatisticamente positivo na variável de projeção antero-posterior do zigoma, porém a abordagem foi mais factível com poucos pontos de fratura. Conclusão: O planejamento com biomodelos se mostrou útil na recuperação da projeção zigomática, sendo necessário levar em consideração o alto custo e o tipo de fratura na hora de optar pelo planejamento com biomodelos

Complications associated with submental liposuction:a scoping review

Liposuction is one of the most commonly performed cosmetic procedures worldwide. Complications associated with submental liposuction are rare. However, when they occur they are significant and can cause disFiguring consequences. The objective of this study was evaluated complications from submentual liposuction in literature and description of clinical experience of complication after submentual liposuction. At first, a scoping review was carried out online search with no time restrictions for complications after submental liposuction was performed in the databases Medline / PubMed, Embase, and Web of Science. The variables analyzed were: age, sex, type of esthetic procedure, anesthesia, complications, time after Procedure, treatment, follow-up care, and sequelae. Then, a case of a patient with submental hematoma after an aesthetic procedure for submental liposuction was described. Firstly, 539 articles were selected, after application of the inclusion criteria, 4 studies were included. Most cases were female (8:1), with a mean age of 55.77 years. Postoperative complications were found, such as submental depression, submental edema, hypertrophic scar formation, scar contracture, cervical necrotizing fasciitis, Cervico-facial dystonia and transient facial nerve paralysis. The follow-up period for cases ranged from 3 to 12 months. The clinical case presented there was no sequelae. Submental liposuction requires the surgeon's attention. Anatomical knowledge, correct clinical and surgical management, diagnosis, and immediate approach to adverse situations are points that must be respected in this type of esthetic procedure to avoid more serious complications

Tratamento de lesão extensa em face decorrente de trauma. Relato de caso / Treatment of extensive injury to the face from trauma. Case report

Os danos faciais, em particular, dos tecidos moles acontecem normalmente oriundos de acidentes automobilísticos, quedas, violência, e acidentes durante atividades recreativas. A região maxilofacial está relacionada a várias funções importantes, como: visão, olfato, alimentação, respiração e fala. Essas funções são gravemente afetadas, resultando em comprometimento da qualidade de vida. A face também realiza um papel significante na criação das relações sociais, e o trauma facial é a principal causa de sua desfiguração, dessa forma as manipulações das lesões faciais por trauma merecem ser discutidas. O objetivo deste trabalho é relatar um caso de lesão extensa em tecidos moles da face, decorrente de um acidente de trânsito. Paciente do gênero masculino, 35 anos, vítima de acidente motociclístico resultando em traumatismo craniano grave e ferimento extenso em face e couro cabeludo, sem fratura em ossos da face. O tratamento realizado foi a síntese tecidual por planos, e antibioticoterapia venosa. Em acompanhamento pós-operatório do paciente observou-se ausência de deiscência e débito purulento no ferimento. As lesões faciais podem ser tratadas de forma satisfatória com a aproximação dos tecidos, que é mais comumente alcançada via sutura, facilitando ótimos resultados estéticos ao permitir que as bordas da ferida sejam evertidas e alinhadas com precisão, permitindo um reparo tecidual adequado, livre de infecção. O tratamento da lesão em tecidos moles da face por trauma é desafiador para o cirurgião bucomaxilofacial, mas se os princípios de síntese tecidual forem devidamente realizados, o reparo tecidual bem como a reprodução da forma e da função anterior ao trauma serão alcançados com sucesso.