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The impaction of foreign bodies in the maxillofacial region is a rare complication of dental procedures. Removal of such foreign bodies is difficult, and frequently fails because of the complex anatomical structures in this region. Navigation surgery has been introduced for the oral and maxillofacial region, but accurate registration is challenging in the mandibular region due to its mobility. The aim of this report is to describe the validity of using an all-in-one splint to facilitate easy and accurate navigation surgery of the mandible. A 55-year-old woman was referred to our hospital for the management of a suspected odontoma in the right side of the mandible. Navigation surgery was planned to remove the lesion that was suspected to be the tooth root. An all-in-one splint that a reference frame and fiducial markers were installed on was generated for the navigation surgery. Simple registration and successful removal were performed using the all-in-one splint, with high accuracy and minimal invasion. The all-in-one splint with the reference frame and fiducial markers was easier to use, and more effective than a conventional splint for navigation surgery in the mandibular region.

A randomized controlled trial was performed to evaluate and compare the changes in implant stability quotient (ISQ) of implants of the same brand, design, length, and diameter but with two different surface treatments, placed in the posterior mandible: sandblasted and acid-etched (SAE) and chemically modified SAE (hydrophilic). Twenty implants of the same design, length, and diameter (cylindrical and compressive, 3.75×11mm) but with different surface treatments (control group: 10 SAE; test group: 10 modified SAE) were randomly assigned to placement in the posterior mandibular region in 20 different patients. ISQ values were assessed in a blinded manner for six consecutive weeks. The maximum and minimum ISQ values observed during follow-up were 76.0 and 48.5, respectively, in the test group, and 76.0 and 49.0, respectively, in the control group. There was no statistically significant difference (P=0.19) in ISQ variation for the test group implants (modified SAE). Comparison between the test and control groups revealed a significant difference in the measurements: the ISQ in the test group was higher than that in the control group during the follow-up period (parametric Mann-Whitney test). This study demonstrated that implants with a modified SAE surface installed in the posterior mandible showed higher and faster ISQ stability during the healing period when compared to implants with a SAE surface.

Swelling of the submandibular region is a pathological condition that is frequently encountered in clinical practice. However, the fact that it can result from "sublingual gland herniation," in which the sublingual gland protrudes from a fissure of the mylohyoid muscle into the submandibular space, is not well known. Here, we report our experience with a case in which swelling of the submandibular region was caused by sublingual gland herniation. The patient visited our hospital with a chief complaint of swelling of the mandibular region. Detailed examination (including ultrasonography, computed tomography (CT), and functional magnetic resonance imaging (MRI) with Valsalva maneuver) confirmed the presence of a fissure in the mylohyoid muscle and protrusion of the sublingual gland into the submandibular space. As a result of no findings indicating inflammation or lymph node swelling including a malignant disease, a follow-up observation was performed. These findings suggested that it was necessary to consider the sublingual gland herniation in a case of submandibular swelling and that echographic and/or MRI examinations combined with the Valsalva maneuever were useful to distinguish.

Ameloblastoma is an epithelial odontogenic tumor that primarily affects the posterior mandible in patients from 20 to 60 years of age. It usually presents as a well-defined, unilocular to multilocular radiolucency with associated expansion of the jaws. Ameloblastoma arising from the anterior mandibular region is rare. We report 2 cases of ameloblastoma affecting the anterior mandible. The first case is a 59-year-old male patient with a swelling of 1 year duration, and the second is from a 74-year-old female with a painless swelling and tooth mobility lasting 2 years. Panoramic radiography showed in both cases a well-defined multilocular radiolucency with thin corticated borders. Microscopic analysis of both cases revealed islands of odontogenic epithelium with central stellate reticulum-like areas and peripheral ameloblastic areas, arranged in a follicular pattern. The treatment was surgical resection, and no evidence of recurrences was observed.

The adult gingival cyst is an uncommon lesion, considered a representative of the soft tissue counterpart of the lateral periodontal cyst, being derived from the dental blade. The cyst has a striking predilection for the canine region and lower premolars. The aim of this study is to report a case of adult gingival cyst in a 74-year-old patient. A cystic lesion in the mandibular region, in gingival, between 32 and 33, about 1.0 cm was observed. An excisional biopsy was performed. Microscopic findings confirmed the diagnosis of adult gingival cyst. About 1 year later there is no sign of recidivation. This study was important for documenting an unusual lesion in the population.

Ameloblastic fibroma (AF) is an uncommon benign odontogenic tumor in which both the epithelial and ectomesenchymal components are neoplastic. We report a case of a 6-year-old male patient presenting a painless swelling in the left posterior mandibular region with 1-month evolution. Computed tomography scans showed a large osteolytic lesion (6.0 × 4.5 cm). An incisional biopsy was performed, and the histopathologic analysis revealed cords and islands of proliferating odontogenic epithelium laid in a loose cell-rich connective tissue. The diagnosis was AF. A surgical conservative excision followed by curettage was performed, but the lesion recurred after 6 years, which was histologically confirmed. A new surgical excision and curettage was performed, including the removal of the tooth involved. The patient is under follow-up for 3 months with no recurrence sign. Despite the benign nature, a judicious pathologic analysis in cases of recurrent tumors is essential to rule out any malignant changes.

Solid ameloblastoma is an odontogenic epithelial benign neoplasia, but it is aggressive and affects mainly young adults between their third and seventh decade of life, with no predilection for sex. It is clinically characterized as a slow-growing tumor, asymptomatic and with a high recurrence rate. Radiographically, it may present as unilocular or multilocular radiolucent lesions, usually with well-defined borders similar to "soap bubbles" or "honeycombs." This study aims to report a case of solid ameloblastoma that occurred in a 29-year-old patient, submitted to treatment of segmental mandibular resection, presenting a satisfactory result. It is fundamental to know the characteristics of the lesion and to request complementary examinations for a correct diagnosis of this pathology.

Summary Aim This 1-year cohort study investigated stability and peri-implant marginal bone level of immediately loaded mini dental implants used to retain overdentures. Materials and methods Each of 30 edentulous patients received 4 mini dental implants (1.8 mm × 13 mm) in the interforaminal mandibular region. The implants were immediately loaded with pre-made overdentures. Outcome measures included implant stability and bone resorption. Implant stability was measured using the Periotest Classic ® device immediately after placement and on the 3rd and 6th weeks and the 4th, 6th and 12th months postoperatively. The peri-implant marginal bone level (PIBL) was evaluated at the implant’s mesial and distal sides from the polished platform to the marginal crest. Radiographs were taken using a tailored film holder to reproducibly position the X-ray tube at the 6th week, 4th and 12th months postoperatively. Results The primary stability (Periotest value, PTV) measured −0.27 ± 3.41 on a scale of −8 to + 50 (lower PTV reflects higher stability). The secondary stability decreased significantly until week 6 (mean PTV = 7.61 ± 7.05) then increased significantly reaching (PTV = 6.17 ± 6.15) at 12 months. The mean PIBL measured −0.40 mm after 1 year of functional loading, with no statistically significant differences at the various follow-ups ( p = 0.218). Conclusions Mini dental implants placed into the interforaminal region could achieve a favorable primary stability for immediate loading. The follow-up Periotest values fluctuated, apparently reflecting the dynamics of bone remodeling, with the implants remaining clinically stable (98.3%) after 1 year of function. The 1-year bone resorption around immediately loaded MDIs is within the clinically acceptable range for standard implants.

Osseous dysplasia (OD) are idiopathic processes located in the periapical region of the tooth bearing areas jaws areas characterized by a replacement of normal bone by fibrous tissue and metaplastic bone. These are categorized into four types on basis of the clinical and radiographic features: periapical, focal and florid and familial gigantiform cementoma. Periapical OD (PerOD) is the most common, followed by Focal OD (FocOD) and Florid OD (FloOD). Per OD is confined to the anterior aspect of the jaw while Foc OD and Flo OD are related to posterior mandibular region. Most of these have a benign course and are asymtomatic, but can be aggressive with a rapid increase in size and other symptoms. We report a case of OD of posterior maxilla, an uncommon site, in a 46-year-old female who presented with pain and increase in the size of the swelling and was adequately treated.

Student to student administration of dental local anesthesia training has possible risk to cause nerve and muscle trauma. This research aims to create the newest technology for dental local anesthesia training in mandibular region using electrolyte switch and capacitive sensor system. The device facilitates user to inject the fluid at the injection site, knows the accuracy of the dosage according to clinical standard operating procedure and knows the accuracy of the injection site, so the student can feel a real sensation in anesthetic training even without using human being as their subject. In this research, there were 3 methods, first was technique of prototype formation, second was sensor accuracy test and the last was data analysis. The result of this research was the creation of the newest technology of smart wet injection phantom with electrolyte switch and capacitive sensor system. Electrolyte switch could detect the accuracy of the injected fluid, using voltaic cell principle to make the switch-like system at each fluid level with electrode and electrolyte solution as the component of the switch. The capacitive sensor could detect accuracy of the injection site and placed in the injection area for inferior alveolar nerve, buccal nerve and lingual nerve. Accuracy of capacitive sensor and electrolyte switch system were above 80% and 90%, so it could be interpreted that the sensors had good accuracy. From this study, we conclude that the combination of electrolyte switch and capacitive sensor system can produce smart wet injection phantom which has good sensor accuracy so it can help dental student to practice local anesthesia in mandibular region accurately.

Central giant cell granuloma (GCCG) is a benign osteolytic proliferation with diverse clinical and radiologic behavior patterns, characterized by the presence of multinucleated giant cells in a vascular stroma. A 25-year-old man presented with bilateral swelling in the posterior mandibular region of 2-month duration with painful symptomatology. Intraoral exam showed bilateral expansion of the vestibular cortical bones in the mandibular retromolar region. Panoramic radiograph and computed tomography revealed extensive bilateral multilocular mandibular areas causing bilateral expansion of the vestibular cortical bones. The histopathologic examination showed benign fibroblasts matrix with variable number of giant cells and hemorrhagic content. Immunohistochemistry for CD-68 glycoprotein showed positive immunoreactivity. Biochemical examination showed no signs of hyperparathyroidism. Diagnosis of CGCG is a complex task, even more so when the clinical presentation is unusual. Currently, it is known that the occurrence of multiple lesions of CGCG is associated with different systemic diseases.

Objective To describe the profile of individuals diagnosed with osteoradionecrosis of the jaws at a reference center for oral lesions from 2010 to 2016. Study Design This is a cross-sectional study where sociodemographic, clinical, and lifestyle variables were obtained from clinical records and analyzed descriptively. Results There were 9 cases of osteoradionecrosis diagnosed in individuals with a mean age of 61.7 years. From those, the majority occurred in males (88.9%), with low educational level (55.5%), and smokers (44.4%). History of squamous cell carcinoma was observed in 77.8% of the individuals, mainly located in the alveolar mucosa (22.2%), tongue, mouth floor, and lower lip (11.1%). Combined radiotherapy and chemotherapy was the most used for tumor treatment (55.6%). Osteoradionecrosis lesions were predominantly in the mandibular region (77.8%), and posttreatment radiotherapeutic exodontia was performed by 33.3% of the individuals. Conclusions Recognition of the profile of individuals at greater risk for osteoradionecrosis, their awareness of preventive measures, and compliance with protocols before, during, and after head and neck radiotherapy are important measures to prevent osteoradionecrosis.

Rarely, the giant ossifying fibroma is a neoplasm with high growth potential. These lesions have frequently been associated with heterogeneous clinical and radiographic features, leading to difficulty in diagnosis. Generally, peripheral ossifying fibroma presents predilection for the female sex as well as by the jaw region and affects patients of variable age. This paper aims to report the clinical-surgical approach of a case of extensive ossifying fibroma in the right mandibular region, clinically mimicking a malignant lesion, and its histologic characteristics that led to the establishment of the diagnosis.

A 25-year-old woman underwent surgical tooth extraction. Several hours after the procedure, the woman complained of severe retrosternal pain and mild dyspnea. Subsequent imaging revealed subcutaneous emphysema from the mandibular region extending to the mediastinum and left side pneumothorax, as well as pneumopericardium. After treatment with antibiotics and analgesics, the patient recovered without any complications. Resumo: Uma mulher de 25 anos foi submetida a uma extração dentária. Várias horas após o procedimento, a mulher queixou-se de dor retroesternal aguda e dispneia ligeira. Imagiologia posterior revelou enfisema subcutâneo da região mandibular estendendo-se ao mediastino e pneumotórax à esquerda, bem como pneumopericárdio. Após o tratamento com antibióticos e analgésicos, a paciente recuperou sem quaisquer complicações. Keywords: Pneumothorax, Mediastinal infection, Palavras-chave: Pneumotórax, Infeção do mediastino

A 78-year-old woman with a history of transient ischemic attacks was found in the doorway of her house in a somnolent and unresponsive condition. In the right mandibular region, a small skin wound was localized, which was surgically treated. Six days after admission to the hospital, an exploratory craniotomy was performed because of abnormal CT findings. Apart from tissue lesions and hemorrhages a small bone fragment was detected in the right cerebral cortex, which was removed. After 11 days in hospital, the patient died from failure of central regulatory functions. At the forensic autopsy, a 15 cm long wound track running upward from the skin wound in the right mandibular region through the bony skull base to the right parietal lobe of the brain was noted. Apparently, the surgically removed bone fragment had been displaced from the right middle cranial fossa. The site of the incident in the deceased's house was inspected again and a bamboo pole used to stabilize a potted plant standing on the floor was found and sent to the trace evidence laboratory. Analysis showed blood and tissue deposits from the victim. On the basis of all the findings and the circumstances of the case, a fatal impalement injury caused by an accidental fall could be assumed.

We report herein a case of extensive osteomyelitis of the mandibular region in a 32-year-old woman on hemodialysis. This patient, who showed extensive malnutrition and formation of an abscess in the pterygo-mandibular and lateral pharyngeal space, was referred to our hospital on suspicion of infection. Use of antibiotics allowed reduction of the abscess. However, over the next 12 months, all the teeth of the mandibular region were lost and severe osteomyelitis developed. This patient is being followed up on a regular basis without further treatment. Osteomyelitis of the mandible is still present.

Background: Mini-implants can facilitate orthodontic tooth movement by serving as anchors. The purpose of this investigation was to determine whether the pull-out strength of screws in bone varies depending on the site of insertion in the maxilla or the mandible. Materials: Fifty-six titanium screws (2 mm diameter, 6 mm length, Synthes USA, Monument, Colo) were placed in 4 beagle dogs (14 screws per dog) within 30 minutes after they were killed. The screws were inserted to obtain monocortical anchorage, at predetermined sites in the anterior, middle, and posterior regions of the jaws bilaterally. Two screws were placed in the posterior palate in each dog. The jaws were harvested, and bone blocks, each containing a screw, were prepared for mechanical testing. The bone/screw block was aligned on a custom-made fixture, and the maximum force (F max ) at pullout was recorded. Cortical bone thickness was measured after extraction of the screw. Statistical analyses to test for differences were conducted with ANOVA and Tukey-Kramer tests. Results: Screws placed in the anterior mandibular region had significantly ( P max (134.5 ± 24N, mean ± SE) than those placed in the posterior mandibular region (388.3 ± 23.1N). Regression analyses suggested a weak (r = 0.39, P = .02) but significant correlation between F max and cortical bone thickness. Conclusions: The bone supporting monocortical screws would most likely withstand immediate loading and support tooth-moving forces.

The volume of masticatory muscle and volume of the mandibular region corresponding to the denture base (V. M. D. B.) of edentulous Japanese cadavers were measured using Spiral X-ray CT to assess the correlation between masticatory muscles and V. M. D. B.. For the results, the average volume was the highest for the masseter (15.06 ± 7.12 cm 3 , n=32, followed by the medial pterygoid (6.72 ±2.94 cm 3 , n=32 and lateral pterygoid (5.74 ±2.76 cm 3 , n=32. The average volume of the mandible of the male cadavers was 52.69 ±10.01 cm 3 (n=18), and that of female cadavers was 36.11 ±6.22 cm 3 (n=14). The average volume of the V. M. D. B. of male cadavers was 6.58 ±2.79 cm 3 (n=18), and that of female cadavers was 3.51 ±1.36 cm 3 (n=14). The relationship of the masticatory muscles with the volume of the mandible and V. M. D. B. was assessed statistically, and the results showed that the volume of the mandible and V. M. D. B. correlated with the volumes of the medial and lateral pterygoids, but not with the volume of the masseter. The results suggest that various factors may be involved in the relationship between muscle and mandible volumes, and poor denture fit or misuse may play a major role. And if prosthetical factors play a major role in anatomical structure, the volumes of the medial and lateral pterygoids are unlikely to be affected by the use of dentures, but the volume of the masseter can be affected by denture use.

SUMMARY. We investigated the efficacy of alveolar distraction for reducing crown height:implant length ratio in the posterior mandible. Ten alveolar distractions were done in seven patients. The pre-distraction ratio of required crown height to bone height available for implantation was in all cases ≥1. Two implants were placed in each distracted area (total 20 implants). Before distraction, the mean (SD) predicted crown height was 12.8 (2.1) mm; mean bone height available for implantation was 7.8 (1.5) mm. After distraction and insertion of implants, mean crown height was 8.1 (1.9) mm, and mean implant length was 11.3 (1.9) mm. Before distraction, the mean required crown height:available bone height ratio was 1.7 (0.3); after distraction and insertion of implants, the mean crown:implant ratio was 0.7 (0.2) (P > 0.0005). Alveolar distraction is effective for increasing the height of the alveolar ridge in the posterior mandibular region, and should be considered when the height of the predicted crown that is required is greater than or equal to the maximum height of bone available for implantation. © 2003 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Mesiodens is the most common supernumerary teeth located mesial to both centrals; appearing peg shaped in a normal or inverted position. Their occurrence in the mandibular region is very rare and in the maxilla, most commonly they occur in the premaxillary region. Here we present a case of mandibular mesiodens and a case of midpalatal mesiodens in a seven year old.

The silicone implant has been widely used in facial aesthetic surgery for chin augmentation. A case of a 71-year-old woman with a lesion in the anterior mandibular region detected by radiographies and suggestive of benign soft tissue tumor is presented. The patient denied previous surgical intervention in the mental area. A biopsy was performed and initially interpreted as low-grade liposarcoma. After an immunohistochemistry study showing CD-68-positive cells and complementary information regarding a silicone implant for chin augmentation, the definitive diagnosis was silicone granuloma. This case reinforces that silicone implant in the mandibular region can be misdiagnosed as malignant tumor and the correct diagnosis is heavily dependent on close collaboration between clinician and pathologist in order to avoid unnecessary surgical intervention.

Chondrosarcomas are malignant tumours of cartilaginous origin. Chondrosarcomas are rarely found in the jaw bones. Their presentation may vary from a well-differentiated lesion to a high-grade malignancy with aggressive local behaviour and potential to metastasise. The clinical and radiographic features are similar to those seen in other jaw tumours, often delaying diagnosis and treatment. We report a patient with chondrosarcoma of the anterior mandibular region, who was treated with segmental resection and reconstruction. No signs of recurrence or distant metastasis have been observed at the 1-year follow-up.

Extranodal malignant lymphoma is relatively rare. When it occurs in the oral region, it is sometimes misdiagnosed as inflammatory disease. This report details a case of malignant lymphoma that involved the fight mandibular region.

Surgical specimens from 16 nonirradiated patients with carcinoma of the mandibular region who had undergone resection of the mandible were investigated histologically to evaluate the presence, pattern and extent of bone involvement. Thirteen of the 16 carcinomas had invaded the mandibular bone. Two main patterns of growth were identified: seven carcinomas had infiltrated nonuniformly into the bone and six tumours had advanced as a compact front. Direct invasion from the oral mucosal tumour could be verified in 12 cases. Extension of four of these 12 tumours in bone clearly exceeded their dimension in the overlying mucosa. Carcinoma tissue in the mandibular canal, at a distance from the major tumour extension, was seen in two cases, whereas the periodontal ligament spaces were invaded only when there was a direct contiguous invasion by the tumour. The grade of histologic differentiation of the carcinoma did not definitely correlate with the frequency, pattern or extension of bone involvement. The results indicate that large tumour size, location on the mandibular alveolar ridge and clinical fixation to the mandibular bone predispose to, but are not prerequisites for bone invasion. Taken together, this study has shown that prediction of the presence and extent of bone involvement of the carcinoma located in the mandibular region is difficult on clinical grounds.

Cancers of the mandibular region show the lowest survival rates of all oral cancers. In order to compare the effect of five different modes of treatment (including surgery and/or radiotherapy), a series of 159 patients was analysed. When adjustments were made for age, sex and tumour stage in a log-linear multivariate analysis, no differences between treatments in the 5-year relative survival rates (RSR) could be demonstrated for stage I and II tumours. In stage III and IV tumours, radiation treatment alone resulted in poor survival. Between the other four treatments, all including surgery, no statistically significant differences in the 5-year relative survival rates were found. Radiation therapy as an element in combination therapy may have postponed a recurrence but did not affect the 5-year survival rate. For advanced tumours, mostly responsible for the low overall 5-year RSR, higher survival rates can possibly be achieved by improving surgical treatment of the primary lesion and the neck. At present, however, only earlier diagnosis might significantly increase the survival rates.

Of the various oral carcinoma subsites, those related to the mandibular region are associated with the highest rate of recurrence. To try to find out reasons for this, 162 patients with squamous cell carcinoma in the mandibular region treated between 1973 and 1985 in the three major university hospitals in Finland, were analysed retrospectively, with particular emphasis on clinical features and pretreatment evaluation. The analysis showed that 72% of the patients had stage III–IV disease. Primary tumour size seemed to be a major factor governing prognosis. The presence of palpable lymph nodes was merely a further sign. The poor survival statistics were at least partly attributable to inadequate pretreatment examination and tumour evaluation. Few attempts had been made to evaluate mandibullar bone infiltration and tumour extension before treatment.

A 30 year old brown woman came to our ENT outpatient ward because of a recurrence of a left mandible tumor, with a progressive, painless growth, associated with facial deformity after a surgical remo-val of a giant cell reparative granuloma in the previous year.She reported a prior dental removal, 11 years before in the left mandible region. She denied past diseases.The physical exam showed a hard and painless tumor, a bone notch in the left mandibular region associated with facial deformity.Routine workup, serum calcium, phosphorus and alkaline phosphatase were normal.The panoramic radiograph showed a radiolucent area in the left mandible body, a recent post-surgical area, with mild radiologic signs of bone regeneration.The mandible CT scan showed a morphostructural alteration with bone re-modeling and a large irregular lithic area in the mandible body and left mandible alveolar processes which could correspond to post-surgical alteration or tumor recur-rence (Figure 1).The tumor was surgically excised without complications.The pathology exam confirmed central giant cell granuloma.

The authors report on a rare example of trigerminal nasopharyngeal teratoma in a neonate, a part of which was attached to the mandibular region.

Summary A case of mycetoma of the mandibular region caused by Actinomadura madurae is presented. Diagnostic procedures and rationale for treatment are discussed. In tropical and subtropical areas where mycetoma is endemic it should be included in the differential diagnosis of tumours of the facio-maxillary region.