Belini Freire-Maia

Facial fractures in children and adolescents: a retrospective study of 3 years in a hospital in Belo Horizonte, Brazil

AIM The purpose of this study was to review the etiology, incidence and treatment of selected oral and maxillofacial fractures in children in Belo Horizonte, Brazil, during a period of 3 years. MATERIALS AND METHODS The data collected for this study included age, gender, etiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture and treatment. The analysis involved descriptive statistics and chi-squared test, Bonferroni test, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests and analysis of variance. RESULTS AND CONCLUSIONS This study examined 566 facial fractures in 464 children of 18 years of age or less. The majority of fractures were observed in children within the age group of 13-18 years of age. Bicycle accidents were the major cause of trauma, followed by falls. The mandible was found to be the most common fractured bone in the facial skeleton, followed by the nose. A conservative approach was applied in most cases.

Facial fractures in the elderly: a retrospective study in a hospital in Belo Horizonte, Brazil.

BACKGROUND An increasing incidence of maxillofacial trauma in the elderly has been noted, as a consequence of increased longevity, resulting in a higher percentage of elderly people in the population. METHODS A retrospective study was undertaken to assess facial fractures in elderly presenting during the period 2000 to 2002 in Belo Horizonte, Brazil. The data collected included age, gender, etiology, date of trauma, maxillofacial trauma, anatomic site of fracture, and treatment. The statistical analysis involved evaluation of measures of central tendency and variability and calculation of proportions. RESULTS It encountered 165 facial fractures in 122 elderly aged 60 years or older. The majority of fractures were sustained by elderly in the age group 60 years to 69 years. Falls was the major cause of trauma followed by car accidents. The mandible was found to be the most common fractured bone in the facial skeleton, followed by the zygomatic complex. A conservative approach was accomplished in the most of cases. CONCLUSION Gender was associated with the presence or absence of fractures and with the etiology. There was no association between age and fractures. No association was found between etiology and age for women and men. The proportion of fractures of the zygomatic arch, mandible body, and parasymphysis treated surgically were statistically higher than the same proportion among the cases of other fractures. The fractures of the nose were more often treated conservatively than other fractures.

Dermoid Cyst of the Floor of the Mouth

Dermoid cysts of the floor of the mouth are rare lesions thought to be caused by entrapment of germinal epithelium during the closure of the mandibular and hyoid branchial arches. They usually present as a nonpainful swelling. This type of lesion occurs more frequently in patients between 15 and 35 years, but can be seen in all age ranges. Histologically, all dermoids are lined by epidermis. The contents of the cyst lining determine the histological categories of the cyst: epidermoid, if epidermis is lining the cyst; dermoid, if skin annexes exist; or teratoid, if there are tissues derivated from the three germinal layers. Anatomical classification is useful for surgical approach choice, intra- or extraorally. This report presents a case of a dermoid cyst of the floor of the mouth in a 12-year-old patient, and a review of all steps necessary for its diagnosis and treatment was made.

Risk factors and prevention of bad splits during sagittal split osteotomy

PurposeOne of the operative complications of the sagittal split osteotomy of the mandible is a bad split, which describes an unfavorable or irregular fracture of the mandible in the course of the osteotomy. The purpose of this study is to identify previous studies which reported incidences of bad split occurrence during sagittal split osteotomy and to discuss its mechanisms and risk factors, based on a literature review, in order to minimize their occurrence. A few illustrative cases are also presented.MethodsAn electronic search was undertaken in January 2011. The titles and abstracts from these results (n = 363) were read for identifying studies which reported incidences of bad split occurrence during sagittal split osteotomy procedures.ResultsTwenty-one studies were identified and assessed. The incidence of bad splits from these studies varied between 0.21% and 22.72%. The buccal plate of the proximal segment and the posterior aspect of the distal segment were the most affected areas.DiscussionThe surgical patient should be evaluated according to age and the presence of unerupted/impacted third molars. Prevention is focused on adequate osteotomy design, eliminating sharp angle where abnormal stress occurs on bony segments, completion of adequate cuts into the retrolingular depression and through the inferior border, and careful separation of the segments. The SSO is an extremely technical and sensitive procedure, and careful attention will probably prevent most unfavorable splits. If a fracture occurs, the fractured segments should be incorporated into the fixation scheme if possible. The occurrence of bad splits cannot always be avoided. When adequately treated the chances of functional success are good.

Management of Fractures of the Zygomaticomaxillary Complex

The zygomaticomaxillary complex (ZMC) has important aesthetic, structural, and functional roles that need to be preserved and/or restored during treatment of facial fractures. Surgical treatment of ZMC fractures is indicated when there is displacement of the bony fragments, and open reduction and internal fixation is the treatment of choice in cases of comminution or fracture instability. The surgical approaches used for fracture reduction as well as the type, number, and location of the fixation will be determined by the pattern of the fracture and the surgeons preference. This article discusses the main points of the management of ZMC fractures.

Neurofibromatosis type 1 associated with bilateral central giant cell granuloma of the mandible

Neurofibromatosis type 1, or von Recklinghausen disease, is one of the most common hereditary neurocutaneous disorders in humans. Clinically, Neurofibromatosis type 1 is characterized by café-au-lait spots, freckling, skin neurofibroma, plexiform neurofibroma, bony defects, Lisch nodules and tumors of the central nervous system. Central giant cell granuloma is a benign central lesion of bone, primarily involving the jaws, of variably aggressive nature characterized by aggregates of multinucleated giant cells in a background of cellular vascular fibrous connective tissue and spindle-shaped mononuclear stromal cells. The association between neurofibromatosis and central giant cell granuloma has been reported in the literature. A case of mandibular bilateral central giant cell granuloma in a patient with Neurofibromatosis type 1 was conservatively but successfully treated by adequate surgical curettage of mandibular bone lesions.

Considerations of maxillary tuberosity fractures during extraction of upper molars: a literature review

BACKGROUND Maxillary tuberosity fractures during molar teeth extraction commonly occur in dental practice; however, very few cases have been reported and discussed in the literature. A correct preoperative radiographic interpretation, coupled with the anatomical knowledge of the structures involved, is essential to prevent such complications. AIM The purpose of this paper is to enumerate the predisposing and etiological factors of maxillary tuberosity fractures during the extraction of upper molars, discuss the procedures that need to be taken when small or large fractured fragments of the tuberosity are evident during surgery, and suggest appropriate recommendations. This study is based on a thorough literature review. CONCLUSIONS Upon discovering that a maxillary tuberosity has fractured, the dentist must first halt the procedure before inadvertent laceration of the adjoining soft tissue occurs and then determine the extent of the fracture by palpating the mobile fragment. After performing the dissection of the soft tissues, immediate removal of the small fractures, including the tooth with small bony fragments, may be the best option, because of the difficulty incurred when attempting to retain the bone. When a large bony fragment is present, it is recommended (i) that the extraction be abandoned and surgical removal of the tooth be performed using root sectioning, (ii) that the dentist tries to detach the fractured tuberosity from the roots, or (iii) that the dentist stabilizes the mobile part(s) of the bone by means of a rigid fixation technique for 4-6 weeks and, at a future moment, attempts a surgical removal without the use of a forceps.

Small Central Odontogenic Fibroma Mimicking Hyperplastic Dental Follicle and Dentigerous Cyst

Central odontogenic fibroma has been defined as a benign odontogenic tumor, representing the intraosseous counterpart of a peripheral odontogenic fibroma. The odontogenic fibroma is a rare tumor. Differential diagnosis of radiolucent lesions in the molar-premolar region of mandible which involve impacted tooth may include central odontogenic fibroma, hyperplastic dental follicle, dentigerous cyst, unicystic ameloblastoma, and keratocystic odontogenic tumor. We describe an example of a small central odontogenic fibroma mimicking hyperplastic dental follicle and dentigerous cyst, resulting in uneruption of a primary tooth.

Paradental (Mandibular Inflammatory Buccal) Cyst

The paradental cyst is commonly misinterpreted when associated with atypical clinical and radiographic characteristics, in turn causing diagnostic problems. For this reason, the study of the differential diagnosis of this lesion has become extremely important. In addition, the correlation of clinical, histologic, and radiographic findings are also of great value in obtaining accurate diagnoses. The minor variations in the clinical appearance of paradental cysts make it feasible to consider the two main groups of cysts separately: those associated with 1st and 2nd permanent molars of the mandible and those associated with the 3rd mandibular molar. Moreover, this distinction in localization may well dictate the necessary treatment. Bearing in mind the minor clinical variations, the present article aims to discuss the differential diagnosis of this lesion and its different possible treatments by presenting a case report to illustrate the findings.

Maxillary sinus aplasia

PurposeA case of unilateral aplasia is reported. Associated anatomical anomalies and review of the literature is described, and a comparison with maxillary sinus hypoplasia is made.PatientA 40-year-old male was complaining of an esthetic “defect” in his face. There was an antero-posterior depression in the left infraorbital region. Computed tomography showed absence of the left maxillary antrum, uncinate process, and maxillary infundibulum. The ipsilateral orbit was increased in volume inferiorly, and the inferior margin was immediately adjacent to the root of the inferior turbinate. The left inferior and middle turbinate was hyperplastic. The nasal septum was a little dislocated to the ipsilateral side. There was no history of antecedent sinusitis or surgery, and no evidence of systemic disease. An appositional en bloc autogenous bone graft was placed on the left infraorbital depression.ConclusionsWith precise computed tomography assessments, a maxillary sinus hypoplasia or aplasia can be diagnosed and distinguished from other maxillary sinus anomalies, and may help the surgeon to plan his surgical procedure and identify the limits of dissection accordingly. The condition can also “cause” an esthetical deficit in the infraorbital/zygomatic region, which can be resolved with an appositional graft.