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This report describes an unusual case of trilobate Stafne bone cavity in a 72-year-old male asymptomatic patient, presenting as a radiolucency in the left mandibular body with an irregular peripheral border and a central area of reduced density on panoramic radiograph.

Objective: The aim of this retrospective study was to assess the morbidity of the harvest of the anterior iliac bone graft and the overall satisfaction rates in a group of patients who underwent harvesting of iliac crest bone graft., Patients and Methods: Patients who underwent iliac crest bone graft procedures from January 2002 to August 2009 were recalled and invited to answer a questionnaire about postoperative pain, sensory disturbance, functional limitations, and cosmetic appearance., Results: A total of 61 patients were included in this retrospective study. Seventeen patients (28%) reported postoperative pain. A patient reported an intraoperative hip fracture. Sensory disturbances were reported by 3 patients., Conclusions: Anterior iliac crest can still be considered a favorable donor site for preprosthetic and cleft surgery. Given its relatively low morbidity rate, early ambulation, and hospital discharge, anterior iliac crest still remains the donor site of choice according to the authors., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: The prevention of dental injuries during full-contact sports such as rugby is extremely important. Wearing a mouthguard can significantly reduce the frequency and severity of orofacial injuries, but it is not always used as athletes find it difficult to tolerate. The purpose of the present study was to determine the awareness and the extent of mouthguard use in a sample of young rugby athletes in the North West of Italy., Material and Methods: The athletes of four amateurs rugby teams based in the Province of Turin, Italy completed a questionnaire about playing history, current use and type of mouthguards, disturbs associated with mouthguard use, and general attitudes towards mouthguards., Results: Only 53.85% of the subjects reported wearing their mouthguard all the time both during training and games. The most commonly reported problem associated with using a mouthguard was the discomfort on speech, followed by difficulty in closing lips, adversely affected breathing, adversely affected swallowing and slipping sensation. A statistically significant association between patients <22 years and non-use of mouthguards was observed., Conclusion:  Limited knowledge about oral injury prevention and limited use of mouthguards were observed. The present study suggests that educational courses for rugby players and coaches to promote the use of mouthguards would be extremely important to reduce common complaints about these devices and increase their usage., (© 2011 John Wiley & Sons A/S.)

The removal of mandibular third molars is probably the most frequently performed procedure in oral and maxillofacial surgery, and it is the most common surgical procedure associated with lingual nerve deficit. Lingual sensory impairment remains a clinical problem in oral and maxillofacial surgery and has serious medical and legal implications. In fact, damage to the lingual nerve is a common cause of litigation in dentistry. The purpose of this article was to review the literature about lingual nerve deficit following mandibular third molar removal and discuss the associated medicolegal aspects., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to report our experience in treating patients affected by spreading odontogenic infections and to discuss their management and outcome., Study Design: Demographic and clinical information was collected from hospitalized patient records. Decayed, missing, and filled teeth (DMFT) index was calculated for 45 randomly selected patients. Statistical analysis was used to search for associations among multiple variables., Results: Statistical analysis of the variance by univariate test found significant associations between a longer hospital stay and patients >30 years old (P < .05) and patients with the presenting symptoms of dysphagia and/or dyspnea (P < .05). Statistical analysis using Fisher exact test found significant associations between patients with a DMFT index >10 and female patients (P < .05), patients >30 years old (P < .005), and a hospital stay >4 days (P < .0005)., Conclusions: Rapid resolution of the infection was appreciated when removal of the cause, drainage of the infection, and intravenous antibiotics were performed., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: Concussion is a common issue in most contact sports, such as rugby, being one of the most troublesome injuries facing the sports medicine physician. The aim of this article was to survey the knowledge and beliefs concerning concussion in a sample of young rugby athletes in the northwest of Italy., Methods: The athletes of 4 amateur rugby teams completed a questionnaire about their knowledge about the signs and symptoms of concussion and of return-to-play strategies and protocols., Results: Twenty-five athletes reported that they had not been informed by anyone about symptoms of concussion and its consequences. Among these, 7 players thought they could return to play immediately after a concussion during the very same match., Conclusions: The surveyed group in this study presented a general lack of knowledge of concussion. Rugby athletes and coaches must be made aware about signs and symptoms of concussion to suspect this injury. It would be desirable that rugby players are educated regarding the potential risks of playing while symptomatic.

Background: This study was designed to analyze the etiology and patterns of soft-tissue facial lacerations associated with maxillofacial fractures and to identify associations between facial lacerations and underlying fractures., Methods: Of 1960 patients who had been admitted for maxillofacial fractures between 2001 and 2010, only patients with complete clinical records presenting with facial lacerations were considered for this study. Facial lacerations were classified according to the MCFONTZL system., Results: Of the 1960 patients admitted with maxillofacial fractures, 637 had 836 associated facial lacerations. Motor vehicle accidents and falls were responsible for most injuries to patients with facial lacerations. According to etiology, fractures resulting from work-related accidents more frequently produced associated lacerations.For all causes of injury, more facial lacerations were observed over the "T" area formed by the upper orbit and forehead, nose, upper and lower lips, and chin. Lacerations and maxillofacial fractures were more frequently localized to the middle third of the face, followed by the inferior third.There was a strong association between lacerations and fractures in the chin region, considering both symphyseal and parasymphyseal fractures (direct trauma) and condylar fractures (indirect trauma)., Conclusions: An association between facial lacerations and underlying maxillofacial fractures was observed, particularly in the inferior orbital area and over the zygoma, mandible, and chin.

Purpose: The surgical removal of impacted mesioangular mandibular third molars (3Ms) may produce trauma to the soft tissues and bony structures. In particular, healing of postextractive socket may cause periodontal defects at the distal root of the second molar. The aim of the present prospective study was to assess the outcomes of a surgical protocol to remove 3Ms including the use of ultrasound bone surgery devices and platelet-rich fibrin (PRF) as a grafting material., Patients and Methods: Twenty-eight impacted mandibular 3Ms were removed. Fourteen 3Ms were removed by piezoelectric osteotomy and PRF application. Instead, the 14 3Ms of the control group were removed by piezoelectric osteotomy but without PRF application. Probing depth in the distal position for all the mandibular second molars was registered before and 6 months after surgery., Results: No complications were encountered. In the study group, alveolar socket fulfillment was rated as sufficient in 4 cases and adequate in the remaining 10 cases, whereas in the control group, it was rated as insufficient in 3 cases, sufficient in 4 cases, and adequate in 7 cases. Mean preoperative periodontal probing in the control group was 3.78 mm, whereas in the study group, it was 3.93 mm.Six months after surgery, mean periodontal probing was 3.28 mm in the control group and 3.07 mm in the study group., Conclusions: Combined action of PRF and piezoelectric surgery can be considered a safe and fine technique for third molar surgery and alveolar socket healing.

Nasolabial cysts are uncommonly diagnosed nonodontogenic soft tissue lesions located close to the nasal alar region of the face, presenting as extraosseous swelling in the region of the nasolabial fold. Nasolabial cysts are likely to remain undetected unless and until they become infected or are associated with facial deformity. Histologically, it is lined with nonkeratinized squamous epithelium or, more frequently, with respiratory-type cylindrical epithelium with goblet cells. The aim of this article was to present and discuss the surgical management of a case of nasolabial cyst and to briefly review the literature.

Aim: This study was designed to evaluate the incidence of severe ocular injuries associated to maxillofacial fractures and report their management in the Emergency Department., Patients and Methods: Among the 1779 patients admitted for maxillofacial fractures, those with partial or total loss of vision at the time of emergency consultation were included in the study. Data collected from the patients' medical records included age, gender, mechanism of injury, location and type of facial fractures, type of ocular injuries and cause of blindness, methods of treatment, and days of hospitalization., Results: Forty patients (2.2%), 32 men and 8 women, ranging from 17 to 85 years of age, presented with severely reduced vision or blindness associated to fractures of the facial middle third with involvement of one or more orbital walls, mainly caused by motor vehicle and work accidents. In 18 patients, severe ocular injuries were determined by direct lesion of the globe, in 14 by direct or indirect traumatic optic neuropathy and in 8 by a retrobulbar hematoma. Direct lesion of the eyeball was treated by prompt repair or enucleation of the globe, though no or little recovery of vision was obtained. Ophthalmologic and/or maxillofacial treatment of the anterior compartment lesions of the eye allowed a partial or total recovery of the vision. A partial or total recovery of the vision was observed in almost all the patients with indirect traumatic optic neuropathy after administration of steroids according to NASCIS II protocol. Likewise, an evident improvement of the vision was obtained by immediate drainage of retrobulbar hematoma., Conclusions: Early diagnosis of the nature of the ophthalmic injury and treatment are important, and involvement of the ophthalmologist is mandatory.

Objectives: The aim of this prospective study was to assess the clinical and histologic outcomes obtained with calcium sulfate (CS) used as a filler material in fresh premolar and molar postextraction sockets., Materials and Methods: Sixty premolar or molar postextraction sockets were filled with CS. Among the 60 grafted sockets, after 3 months, 50 underwent implant placement and clinical assessment. The removal of a sample core of newly generated intrasocket tissue was performed in 19 sockets. Collected samples were sent for histologic examination. The percentage of vital bone, nonvital bone, residual CS, amorphous material, and connective areas in every sample was calculated and recorded., Results: Fifty postextraction regenerated sockets that underwent implant placement 3 months after tooth removal were included in this study.A partial postoperative exposition of the graft was observed in 12 of 50 sockets. At the surgical reentry, the augmented extraction sockets were completely filled by a hard material with an adequate alveolar crest in 41 cases. Histologic examination of the cores revealed that 63.16% of the intrasocket tissue was new vital bone, 2.1% was nonvital bone, 4.74% was fibrous tissue, and 30% was amorphous material. No residual CS was identified in bone cores., Conclusions: This study confirmed that CS is an ideal grafting material. The clinical adequacy aspect of filled sockets at surgical reentry seemed to be indicative of a qualitatively better bone regeneration. Postoperative exposition of graft material after a first intervention seemed to constitute an important risk factor for a worse bone regeneration.

The objective of the study was to prospectively assess the intraoperative findings and the radiographic signs of a study population of patients with impacted third molars at risk of inferior alveolar nerve injury. One hundred thirty-four patients with impacted mandibular third molars at risk for nerve injury were included in the study. Radiographic signs of possible close relationship between the 2 structures and intraoperative exposition or damage of the inferior alveolar nerve were recorded. The follow-up controls comprised clinical examinations and assessment for the sensation of the lower lip and chin. In 24 patients, a real contiguity was encountered between the third molars and nerve. Among these, intraoperative neural exposition was observed in 19 patients. Four patients complained of postoperative temporary hypoesthesia. No deficit of sensibility was found in cases with no exposition of the nerve. The accidental exposition of the inferior alveolar nerve is associated with an increased risk for neural injuries. At panoramic radiograph, the presence of signs of bifid and radiolucent apex, superimposition, and radiolucent root band should be considered at high risk for neural damage.

Maxillary sinus floor elevation carries the potential risk of compromising the sinus physiology. The aim of this study was to prospectively assess mucociliary function during maxillary sinus augmentation in patients without preoperative signs of maxillary sinusitis. Ten patients underwent unilateral sinus floor elevation under local anesthesia and endoscopic control. Methylene blue was dropped on the floor of the maxillary sinus to evaluate mucociliary function until the ostium region during sinus augmentation. The drainage of methylene blue was noticed in the lateral, medial, posterior, and anterior walls and in the roof of the sinus. As for the sinus floor, only the detached part of mucosa in correspondence of the eroded bony window presented not drained methylene blue, showing an absence of mucociliary function. Mucociliary function is preserved even during the surgical procedure except for the detached area of the schneiderian membrane.

Objectives: Displacement of dental implants in the orbit is extremely rare. The aim of this article is to present and discuss the endoscopic management of a dental implant dislocated in the orbit., Material and Methods: A 40-year-old woman underwent the placement of three dental implants at the upper right molar region, but during the intervention, the implant was displaced in the orbit., Results: The implant was removed endoscopically through the existing oroantral communication: the postoperative course was uneventful., Conclusion: To the authors' knowledge, this is the first report on a displaced non-zygomatic dental implant into the orbit. Furthermore, we demonstrated that the endoscopic approach is highly reliable and minimally invasive to remove foreign bodies from paranasal sinuses.

Inferior alveolar neurovascular bundle (IANB) injury is one of the most common complications of third molar removal and involves important medicolegal issues. An accurate preoperative radiographic assessment of surgical difficulty is necessary to correctly plan the removal of impacted third molars and to estimate the risk of IANB injury. Therefore, the preoperative knowledge of the exact location of the third molar roots in relation to the mandibular canal is mandatory. A direct contact between the tooth and neurovascular bundle is suggested by a radiotransparent band across the roots of the impacted third molar on panoramic radiograph. We present the management of a patient with IANB damage associated with third molar surgery.