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The number of dental implants placed and restored every year is increasing across the world. However, there has been an increase in the number of reports with implant-related surgical complications in which the inferior alveolar nerve injury is the most serious one. This surgical problem can be avoided by using cone beam computed tomography (CBCT), three-dimensional (3D) implant planning software, and computer-aided design and computer-aided manufacturing (CAD-CAM) technology such as stereolithographic surgical guides. The objective of this report is to present the clinical and radiologic findings of a female patient with the injury of inferior alveolar nerve after implant insertion where CBCT has not been used prior to implant placement.

Background: Endoscopic transoral thyroidectomy is a recently introduced technique of remote access thyroidectomy. We previously reported the feasibility of the robotic approach (TORT). Nevertheless, experience to date is limited, with scant data on outcomes in patients with papillary thyroid carcinoma (PTC)., Methods: This was a retrospective analysis of prospectively collected data. Patients with PTC, who underwent TORT at a single center between March 2016 and February 2017, were analyzed., Results: There were a total of 100 patients (85 women, 15 men) with a mean age of 40.7 ± 9.8 years, and a mean tumor size of 0.8 ± 0.5 cm. Nine patients underwent a total thyroidectomy, and 91 underwent a lobectomy. The operative time for a total thyroidectomy and lobectomy was 270.0 ± 9.3 and 210.8 ± 32.9 min, respectively. Ipsilateral prophylactic central neck compartment dissection was performed routinely with retrieval of 5.0 ± 3.6 lymph nodes. Perioperative morbidity was present in nine patients including transient recurrent laryngeal nerve palsy (n = 1), postoperative bleeding requiring surgical intervention (n = 1), zygomatic bruising (n = 2), chin flap perforation (n = 1), oral commissure tearing (n = 2), and chin dimpling (n = 2). There was no conversion to endoscopic or conventional open thyroid surgery., Conclusion: In this study, TORT could be safely performed in a large series of patients with PTC without serious complications. In selected patients, TORT by experienced surgeons could be considered an alternative approach for remote access thyroidectomy.

Background: Tissue adhesive is widely used in the emergency department to repair minor lacerations but there exists a debate as to whether it should be used for chin lacerations. The main objective of this study was to evaluate the rate of wound dehiscence of chin lacerations repaired with tissue adhesive in comparison to sutures., Methods: This was a retrospective chart review including all children requiring a facial laceration reparation in a single tertiary care paediatric hospital. The primary outcome was wound dehiscence in the 30 days following reparation, comparing the use of tissue adhesive and sutures. The independent variable of interest was the use of tissue adhesive vs suture. A random sample of charts was reviewed in duplicate to insure reliability of the chart review., Results: Among the 2044 children presenting with a facial laceration requiring an intervention, 1804 (88%) were repaired using tissue adhesive. The laceration was located on the chin in 360 (18%) of patients. The use of tissue adhesive was not statistically associated with a higher risk of dehiscence for all facial lacerations (difference: 0.2; 95%CI: -1.9 to 0.8%), nor for chin lacerations (difference 2.2%; 95%CI: -7.5 to 4.4%). However, the probability of dehiscence was higher for chin laceration in comparison to other localizations (difference of 1.6%; 95%CI: 0.5-3.6%)., Conclusion: While the rate of dehiscence was higher for chin lacerations compared to other facial localizations, the risk of dehiscence was not statistically different for chin laceration repaired with tissue adhesive or sutures., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Reverse headgear (a facial mask) is one of the most frequently used interceptive orthodontic devices in patients with Class III malocclusion. It is a simple device but may present some drawbacks related to pressure on the skin generated by the forehead and chin supports linked to the maxillary intraoral appliance by elastics. This can cause injury to the chin and lips., Methods: Patients between 7 and 8 years of age were selected from the Unit of Pediatric Dentistry. Orthopedic therapy with a rapid palatal expander and reverse headgear was prescribed for all subjects. The patients were divided into two groups: those who used a facial mask without a silicone chin cup and those who used a facial mask with a silicone chin cup., Results: Two-hundred subjects including 90 male patients and 110 female patients were enrolled. The groups that used a facial mask with and without a silicone chin cup included 100 patients each. The percentage of subjects without irritation was significantly greater in the group with a silicone chin cup than in the group without a silicone chin cup., Conclusions: The authors propose a simple and effective solution to prevent skin irritation on the chin caused by a facial mask. A chin mask is a custom solution that can prevent injury to the chin during treatment when coupled with facial mask therapy.

In the repair of extensive lower lip and chin defects, the reconstruction of vermilion at the same time is a great challenge to plastic surgeons. We describe a novel method for the reconstruction of lower vermilion with musculomucosal flap from the upper lip in the repair of extensive lower lip and chin defects. Two patients underwent extensive lower lip and chin reconstruction together with vermilion reconstruction. This technique used 3 basic components: musculomucosal flap from the upper lip, buccal mucosal advancement flap, and cutaneous rotational flap from the neck. All the flaps survived without significant complications. Labial function in the motions of expression and speaking was maintained. The patients could basically close their mouths completely, and there were no drooping or small-mouth deformities postoperatively. Functional and cosmetically acceptable lower-lip and chin reconstructions in both patients were achieved.

Penetrating pencil-tip injuries are common among children and usually resolve without long-term sequelae. However, failure to detect and remove embedded pencil fragments can result in increased morbidity or misdiagnoses of other, more serious, conditions. We report on the case of a 10-year-old boy stabbed with a pencil on his right chin. Initial treatment in the emergency department included irrigation and closure of the laceration. Following suture removal, the patient returned to the emergency department (with bright-purple drainage from the wound site). Radiographic evaluation led to the discovery of an embedded foreign body requiring surgical removal.

The aim of this study was to evaluate the degeneration and regeneration of a sensory nerve and a motor nerve at the histological level after a crush injury. Twenty-five female Wistar rats had their mental nerve and the buccal branch of their facial nerve compressed unilaterally against a glass rod for 30s. Specimens of the compressed nerves and the corresponding control nerves were dissected at 3, 7, and 19 days after surgery. Nerve cross-sections were stained with osmium tetroxide and toluidine blue and analysed using two-dimensional stereology. We found differences between the two nerves both in the normal anatomy and in the regenerative pattern. The mental nerve had a larger cross-sectional area including all tissue components. The mental nerve had a larger volume fraction of myelinated axons and a correspondingly smaller volume fraction of endoneurium. No differences were observed in the degenerative pattern; however, at day 19 the buccal branch had regenerated to the normal number of axons, whereas the mental nerve had only regained 50% of the normal number of axons. We conclude that the regenerative process is faster and/or more complete in the facial nerve (motor function) than it is in the mental nerve (somatosensory function)., (Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

A 7-year-old boy presented with an annular verrucous plaque on the chin of 5 weeks duration. The lesion occurred after a bicycle accident and was unresponsive to antibiotics. Fungal culture grew Sporothrix schenckii. Sporotrichosis should be considered and fungal culture obtained whenever a nodule or plaque fails to respond to initial treatment., (© 2012 Wiley Periodicals, Inc.)

Traumatic injuries to the chin are not uncommon in children. Nevertheless, crown fractures, which are common sequelae to this type of injury, might be overlooked, especially if dental care is not sought immediately after a visit to a non-dental facility. The present case report reviews the delayed diagnosis and treatment outcome of a bilateral posterior complicated crown fracture affecting mandibular second primary molars in a young child. Pharmacologic and orthodontic considerations are also discussed in the paper., (© 2011 John Wiley & Sons A/S.)

Neurofibroma is a benign neoplasm derived from peripheral nerves whose etiology is still unclear. It may present as a solitary lesion or be associated with other diseases such as neurofibromatosis type I and II syndrome. This paper aims to report an extremely rare case of a solitary giant neurofibroma of the mental nerve whose etiology was related to a local trauma. A 14-year-old female patient presented an extensive left facial mass with a size of 7 × 5 × 4 cm, located between the teeth 33 and 37 in the mandible region. It has begun to grow 3 months after a local trauma. Imaging studies were suggestive of a soft-tissue lesion, with minimal bone changes and maintaining the integrity of the mandibular canal and mental foramen. Histopathological tests showed spindle cells with undulated and hyperchromatic nuclei, and sparse cytoplasm in a stroma composed of dense fibrous connective tissue. Immunohistochemistry revealed positive expression for the proteins S-100 and vimentin, confirming the diagnosis of neurofibroma. The patient underwent surgical removal of the lesion by intraoral approach and evolved with an excellent cosmetic result and no signs of recurrence after 2 years of follow up. We report a rare case of solitary giant neurofibroma whose etiology was related to a local trauma. To our knowledge, this is the first report of a mental nerve neurofibroma. Although the etiology remains unclear, we suggest the investigation of local trauma as a possible etiologic factor for solitary neurofibromas of the jaw.

Current weaponry possesses unobserved new, biodynamic wounding effects. For many victims, high velocity, large shell fragments have resulted in massive lower jaw "chopped off" hard and soft tissues injuries accompanied by tongue prolapse. The management challenges begin with lifesaving which is possibly complicated by airway compromise, severe hemorrhage, massive lower jaw loss, and a prolapsed tongue. Consequently, the goal shall be "No patient should die from massive facial tissue injuries alone". That is, if feasible, sensible, lifesaving techniques are applied at the appropriate time. Following general condition stabilization, the surgical management steps of massive lower jaw tissue loss should begin with immediate lost tissue reconstruction. Seventeen cases were selected from an unquantified number patients who had massive mandibular tissue losses in which the tongue, surprisingly, remained intact. In these cases, definitive, early scaffolding stabilization was accomplished by joining the remaining two lower jaw intact segments. The successful procedure consists of using a 2 mm horseshoe shaped Kirschner wire bridging the gap of the mandibular arch which effectively is used as a "scaffold" for rebuilding the soft tissue. Proper, initial, surgical management resulted in protecting lacerated tissue, diminishing subsequent morbidity and disfigurement, preventing a prolapsed tongue and preserving the intact tissues physiological functions. As the spectrum of injuries continues to evolve the clinical characterization of the severity of facial wounds need an expanded classification, appropriate to massive facial injuries. It is suggested it has the following descriptors: blast, penetration, perforation, avulsions and "chopping off" (BPPAC)., (Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: This retrospective study was conducted to report the epidemiology of maxillofacial injuries of children <15 years old in China., Study Design: Data collected in this study included age, sex, etiology, date of injury, anatomic site of injury, and treatment modality. Regarding treatment, conservative technique and surgery were both used. The analyses involved were descriptive statistics and χ(2) test., Results: There were 335 men and 135 women, with a gender ratio of 2.48:1. Bicycle accident was the leading cause of injury. The common sites of soft tissue injury included gingiva, chin, lip, cheek, palate/pharynx, and tongue/mouth floor. In addition, the mandible was most involved in facial skeleton injury. Conservative treatment was generally preferred for such pediatric patients., Conclusions: Boys were prone to be victims of maxillofacial trauma. Preventive measures should be applied both indoors and outdoors. Patients in the growing phase should be monitored periodically to detect and prevent early facial asymmetry or malocclusion., (Copyright © 2013 Elsevier Inc. All rights reserved.)

It has been suggested that third molars increase mandibular fragility because they do not contribute to its strength. For ethical reasons, a human study design that would permit the elucidation of this interference is not possible. This study evaluated the impact of the presence of erupted third molars on the mandibular angle of resistance when submitted to trauma. A three-dimensional (3D) mandibular model was obtained through finite element methodology using computed tomography (CT) with the geometry and mechanical properties to reproduce a normal mandibular structure. Human mandibles with no, one or two erupted third molars were evaluated. Whenever the third molar was present there was a greater concentration of tensions around the cervical part of its alveolus. Approximated Von Mises equivalent stress of the third molar region was 107.035 MPa in the mandible with teeth and 64.6948 MPa in the mandible without teeth. In the condylar region it was 151.65 MPa when the third molar was present and 184.496 MPa when it was absent. The digital models created proved that the mandibular angle becomes more fragile in the presence of third molars. When they are absent the energy concentrates on the lateral e posterior aspect of the condylar neck., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Maxime Champy advised the use of two miniplates for parasymphysis fractures because of the high torsional forces in the anterior region of the mandible. According to him there is no need for intraoperative or postoperative intermaxillary fixation, but most surgeons use arch bars for intraoperative or postoperative intermaxillary fixation. This study evaluated the role of the lower arch bar as a tension band eliminating the need for an upper miniplate (tension band plate) in cases of parasymphysis fractures. 3 groups underwent treatment. In the first group, two titanium miniplates were placed across the fracture site along with Erich's arch bar for 6 weeks. In the second group, two titanium miniplates were used for osteosynthesis without Erich's arch bar. In the third group, one titanium miniplate was placed along with Erich's arch bar for 6 weeks. The results of third group were statistically non-significant compared with those of the first and second groups., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Dental traumas are highly prevalent lesions in primary teeth, but crown-root fractures are seldom observed in primary molars. When trauma is sustained to the chin, the posterior primary teeth are at increased risk of trauma. The treatment of fractured teeth can be complicated, sometimes because of difficulties with the final restoration., Case Report: A 4-year-old girl was referred to a Specialty Dental clinic by a general dental practitioner with complaints of pain in her left mandibular posterior teeth region while biting. History revealed that she had fallen ten days before while playing. Chin laceration was sutured in the trauma centre, but no dental treatment was carried out. She was subsequently discharged. Later, she had pain while biting for which she was referred to the clinic by her general dental practitioner. Extra-oral examination demonstrated a healing laceration on the chin. Radiographic examination showed the presence of an unusual complicated crown-root fracture of the left mandibular first primary molar. Pulpectomy was carried out and the fracture was stabilised with glass ionomer cement and a preformed metal crown was placed., Follow-Up: Patient was reviewed after 3, 6 and 12 months both radiographically and clinically. Though radiographically it was found that the obturating material was resorbed completely at the 12 month visit, clinically the patient was asymptomatic until now (after 15 months). The patient is still under review., Conclusion: This case highlights the need for a systematic history and examination in all cases of dental trauma. It also demonstrates that conservative management is possible and not all primary teeth with crown-root fractures need to be extracted.

Introduction: Animal bites can result in extensive avulsion injuries of the face justifying microsurgical replantation attempts. Reconstruction using local tissue harvesting increases the local morbidity while distant tissues can result in colour and skin texture mismatching. Skin grafting of the skin paddle by a split-thickness skin graft is a conventional approach to help overcome this problem., Patient and Methods: An 18-year-old patient was treated for a chin avulsion after a dog bite injury. The avulsed segment included the whole chin aesthetic unit and one-fifth of the lower lip. The segment was replanted on the inferior labial artery. The replantation failed and a reconstruction with a parascapular free flap was performed. Despite a debulking at 1 month, the aesthetic result had a poor colour match. The technique used to improve this was to de-epithelialise the skin and apply non-cultured autologous epidermal cells (NCAECs) 100 days after the reconstruction., Results: The reconstruction was uneventful. At 3 months follow-up, the patient was able to purse her lips and had regained sensation. After 5 months, the free flap paddle was consistent in colour, pigmentation and texture with the surrounding skin. At 10 months, the patient's only complaint was residual firmness in her scar and flap. The long-term follow-up, over 23 months, confirmed the stability of the results., Conclusion: The use of an NCAEC spray to treat the dyschromia on a parascapular flap used for facial reconstruction is less invasive than split-thickness overgrafting and could extend the use of distant flaps that have been avoided due to poor colour match., (Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Reconstruction of lower face defects or deformity often presents as a challenge for plastic surgeons. Many methods, including skin graft, tissue expander, or free flap are introduced. Submental artery perforator flaps have been used in the reconstruction of defects or deformities of the lower face., Methods: Between August 2006 and December 2008, 22 patients with lower face defects or deformity underwent reconstruction with pedicled submental artery perforator flaps. Their age ranged between 14 and 36 years. The perforator arteries were detected and labeled with a hand-held Doppler flowmeter. The size of flaps ranged from 4 × 6 to 6 × 7 cm, and the designed flaps included the perforator artery., Results: All the flaps survived well, except 1 flap which resulted in partial necrosis in distal region and healed after conservative therapy. No other complication occurred with satisfactory aesthetic appearance of the donor site., Conclusions: The submental artery perforator flap is a thin and reliable flap with robust blood supply. This flap can reduce donor-site morbidity significantly and is a good choice for reconstructive surgery of lower face.

Chin-to-chest impact commonly occurs in frontal crash simulations with restrained anthropomorphic test devices (ATDs) in non-airbag situations. This study investigated the biofidelity of this contact by evaluating the impact response of both the chin and manubrium of adult post-mortem human subjects (PMHSs). The adult PMHS data were scaled to a 10-year-old (YO) human size and then compared with the Hybrid III 10YO child (HIII-10C) ATD response with the same test configurations. For both the chin and manubrium, the responses of the scaled PMHS had different characteristics than the HIII-10C ATD responses. Elevated energy impact tests to the PMHS mandible provided a mean injury tolerance value for chin impact force. Chin contact forces in the HIII-10C ATD were calculated in previously conducted HYGE sled crash simulation tests, and these contact forces were strongly correlated with the Head Injury Criterion (HIC(36 ms)). The mean injurious force from the PMHS tests corresponded to a HIC(36 ms) value that would predict an elevated injury risk if it is assumed that fractures of the chin and skull are similarly correlated with HIC(36 ms). Given the rarity of same occupant-induced chin injury in booster-seated occupants in real crash data and the disparity in chin and manubrium stiffnesses between scaled PMHS and HIII-10C ATD, the data from this study can be made use of to improve biofidelity of chin-to-manubrium contact in ATDs.

Introduction: Penetrating foreign bodies occurring after maxillofacial injuries are a diagnostic challenge for the trauma surgeon. Different materials and various sites of penetration in the maxillofacial region are described in the literature. We present the peculiar course of a patient with an endoral retained foreign body after a penetrating facial injury. The diagnostic pitfall in this type of trauma is highlighted owing to the hyperdensity of the foreign body that, at the computed tomographic (CT) axial scan, simulated a vestibular cortical fracture of the mandibular body and deceived both the radiologist and the surgeon., Clinical Report: We introduce the case of a boy who fell from his bicycle. Computed tomography was performed to detect any bone injuries. The radiologic report stated that a left condylar fracture was presented, associated to a vestibular cortical fracture of the mandibular body. Anamnestic questions revealed that the boy fell from his bicycle in a dug-up street. Clinical examination revealed 2 extraoral open wounds in the subnasal and periorbital areas and an endoral linear wound in the inferior fornix at the mandibular symphyseal region. Consequently, the left condylar fracture was surgically treated, and the mandibular body was explored by the endoral wound revealing an intact cortex: the road metal was removed from the soft tissue of the chin. The initial diagnostic pitfall was clarified: the radiodense foreign bodies penetrated the endoral wound in the soft tissue of the chin during the fall. They simulated a vestibular cortical fracture of the mandibular body at the CT scan deceiving both the radiologist and the surgeon., Discussion: According to the literature, soft tissue foreign bodies can be detected by ultrasonography, plain radiography, CT, and magnetic resonance imaging. Superficially retained foreign bodies are easily detected with ultrasonography if they are not covered by overlying bone or gas. If this easily available technique had been applied initially in this case, the correct diagnosis might have been established at the initial admittance. Deeply located foreign bodies are best visualized by CT. The foreign body in the case introduced was made by radiopaque substance it presented the same radiodensity as the bone.

This study investigated the characteristic of bifid condyle secondary to temporomandibular joint (TMJ) trauma, aiming to analyse the pathogenesis of post-traumatic bifid condyle. Four cases identified as having bifid condyle secondary to TMJ trauma were involved in this study. The relative information extracted from the case records included patients' complaint, history of injury and radiographic appearance, which were used to analyse the characteristic and pathogenesis of post-traumatic bifid condyle. The results indicated that there was a correlation between condylar trauma degree and bifid condylar head appearance after trauma. For severe condylar fracture, it might result in Y-shaped condyle associated with TMJ ankylosis; and condylar groove could be associated with the slight trauma in condyle articulating surface. In conclusion, as a specific entity, post-traumatic bifid condyle may develop in cases with insufficient remodelling capacity after condyle trauma, and it seems that the severity degree of trauma, the site of trauma and its relation to the insertion of the lateral pterygoid muscles are factors associated with the appearance and orientation of bifid condyle., (© 2011 John Wiley & Sons A/S.)

Some patients who have heterotrophic ossification (HO) in a postburn scar are occasionally seen in the clinic. The occurrence of HO following hip and abdominal surgery is common in males, whereas females are frequently affected following burns. The HO of skin grafts in burn scars of the superior body parts is uncommon, especially on the face. We report a recent case of a male patient in whom HO arose on skin grafts on his chin. The patient presented with a history of a painless chin mass for 48 years. Computed tomography scan suggested that the mass was located within subcutaneous tissue away from the lower jaw. The density of the mass was almost the same as the cortical bone of the lower jaw. The mass was completely resected under general anesthesia. It was a rectangular mass of 3× 0.5× 0.3 cm. Histological examination gave the diagnosis of HO, which was also confirmed by immunohistochemical stainings for vimentin. Recurrence was not found in this case by clinical and radiologic follow-up at 1 year after surgery.

Burns of the neck are common and expose them to functional and aesthetic complications which are sometimes very serious. Care in the acute stage and treatment of sequelae contribute to a common goal of restoration: Maintain or recreate a chin-neck angle and get a quality skin as close as possible to the original skin, in terms of flexibility, texture, thickness and color. The wide variety of cases encountered requires knowing the armamentarium available to us today, and the anatomical basis and clinical underlying indications., (Copyright © 2011. Published by Elsevier SAS.)

Condylar fractures in pediatric patients occur frequently, often with minimal pain and discomfort. Thus, these fractures in children are overlooked during emergency care. Condylar fractures can be treated conservatively or by open reduction. As a rule, very good healing results are achieved by conservative treatment. In these cases, jaw function restoration using physiotherapy at an early stage can prevent complications such as asymmetry, interference in the facial growth, and ankylosis. The purpose of this case report was to discuss the peculiarities of treatment of mandibular condyle fractures in pediatric patients and report a case in which the condyles were successfully treated conservatively in a 10-year-old patient. The case was followed up for seven years.

The local anesthetics used in dentistry are considered very safe and have a low incidence of adverse reactions associated with their administration. A frequent finding by clinicians engaged in treatment of children is, following a dental appointment requiring local anesthesia to treat dental disease, a child may bite his or her lip out of curiosity associated with the unfamiliar sensation of being numb or inadvertently because no pain is felt. We describe two unusual case reports of postanesthetic self-inflicted injuries in this article. The first being the ulceration due to lip biting and the scratch injury on the chin after inferior alveolar nerve block. The second report presents an unusual scratch injury on the ala of nose following maxillary infiltration anesthesia. The common treatment modalities and the possible methods of prevention are discussed.

One hundred and three patients with maxillofacial fractures due to work-related accidents were analysed. Ninety-nine patients (96.1%) were male and 4 (3.9%) were female. The average age was 46.8 years (range 18-75 years). The injuries were most commonly sustained during construction (42 patients, 40.8%) followed by agriculture and forestry (31 patients, 30.1%) and manufacturing (15 patients, 14.6%). Being struck by an object was the main cause of injury (43 patients, 41.7%) followed by fall from one level to another (31 patients, 30.1%). Fifty-four patients (52.4%) had fractures in the mandible, 41 (39.8%) in the midface, and 8 (7.8%) in both the mandible and the midface. The most common sites for fractures were the condyle and symphysis in the mandible and zygoma in the midface. The facial injury severity scale ranged from 1 to 6 with an average of 1.99±1.18. There was no difference in the nature of the work being undertaken or the cause of the injury. Fractures in other sites were observed in 22 patients (21.4%). Open reduction and fixation was the most frequent treatment for mandibular fractures (25 patients, 40.3%) followed by maxillomandibular fixation (19 patients, 30.6%). Observation was most commonly used for midface fractures (18 patients, 36.7%) followed by open reduction and fixation (15 patients, 30.6%) and transcutaneous reduction (8 patients, 16.3%)., (Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Preoperative massive subcutaneous emphysema before intubation is extremely rare. However, this complication may be potentially lethal, depend on the condition of air spreading. Subcutaneous emphysema which occurs intra- or postoperative period is sometimes iatrogenic because the air is introduced into the tissue space through the hole injured by the operation. But the emphysema in this case occurred preoperatively by the pressure of the bag valve mask, because the patient had an intra-oral wound, which reaches the submental space. In this report, we describe an extremely rare case of preoperative massive emphysema of the patient with the mandibular fracture.

Purpose: To design and optimize a bone plate for fractures of the mandibular symphysis that will provide maximum fracture stability with minimal implanted volume and patient intrusion. The design will be driven by the unique biomechanics specific to this fracture location., Materials and Methods: A finite element model of a fractured human mandible was created using computed tomography scans. The boundary conditions included simulating molar, canine, and incisal loading. The bone plate design process included a shape optimization routine and design parameter analysis using the model. The optimized bone plate design was finally compared with standard bone plate configurations according to stress and strain measures., Results: Compared with the miniplate combination, the InterFlex III plate, with the same thickness and just 14% more implanted volume, had only 55% of the plate stress and 25% less fracture strain under the strongest loads considered by the model. Compared with the band/fracture plate combination, the InterFlex plate had 88% of the fracture strain and 74% of the plate stress, despite having only 60% of the plate volume., Conclusions: The results have demonstrated that the new optimized plate is a hybrid of fixation hardware with the small profile of the smallest miniplate configuration and the superior fixation strength and safety that exceeds that of the larger fracture plate configuration., (Copyright 2010 American Association of Oral and Maxillofacial Surgeons. All rights reserved.)

Central-facial mutilations, located within the nose lips and chin triangle, require great quality repairs regarding morphology and function. Plastic surgery history affords the ideas evolution in this field crossing over nose and lips reconstructions, which were the subject of successive reports within our society, in 1994 (nose reconstruction) and 2002 (lips reconstruction). Now a day, following this progress, the plastic surgeon has a large choice of reliable techniques. His choice is dictated by a precise evaluation of the limits of the substance loss to repair, according to a (mapping) classification of the nose-lip and chin triangle. This classification defines three units (nose-labial, bilabial and chin-labial) as reflexion bases to the therapeutic indications. This anatomical and surgical approach was built starting from a retrospective study of 195 central-facial mutilations caused by ballistic damage and dog bites. The results evaluation makes possible to carry out a reflexion on the potential indications regarding allograft as a therapeutic alternative to the traditional reconstructions of this territory., (2009 Elsevier Masson SAS. All rights reserved.)

Dislocation of the temporomandibular joint (TMJ) represents 3% of all reported dislocated joints. Traditionally, dislocation of the TMJ occurs when the mandibular condyle is displaced anteriorly beyond the articular eminence. Traumatic dislocation of the condyle into the middle cranial fossa is well defined in the literature, but posterior dislocation without fracture is rarely described. This report documents a case of young male with posterior dislocation of the intact mandibular condyle after facial trauma. The clinical symptoms, diagnosis and treatment are discussed, and a critical review of the literature is provided., (Copyright 2009. Published by Elsevier Ltd.)

This retrospective study evaluated the epidemiology, treatment and complications of mandibular fracture associated, or not associated, with other facial fractures, when the influence of the surgeon's skill and preference for any rigid internal fixation (RIF) system devices was minimized. The files of 700 patients with facial trauma were available, and 126 files were chosen for review. Data were collected regarding gender, age, race, date of trauma, date of surgery, addictions, etiology, signs and symptoms, fracture area, complications, treatment performed, date of hospital discharge, and medication. 126 patients suffered mandibular fractures associated, or not, with other maxillofacial fractures, and a total of 201 mandibular fractures were found. The incidence of mandibular fractures was more prevalent in males, in Caucasians and during the third decade of life. The most common site was the condyle, followed by the mandibular body. The therapy applied was effective in handling this type of fracture and the success rates were comparable with other published data., (Copyright 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

A review of the consequences and treatment of traumatic injury to the chin of a 5-year-old child resulting in a complete fracture and dislocation of the mandibular left condyle. The success of elastic therapy is demonstrated.

Bone and posterior tooth fractures can be serious injuries that are difficult to diagnose, particularly in emergencies. The aim of this study was to report a case of a parasymphyseal fracture associated with the fracture of a maxillary primary molar in a child.

We report an autopsy case of a pedestrian victim of car traffic accident with the chin-sternum-heart syndrome type of injury. A drunken man who lay on the road was run over by a car. He died immediately at the scene. The autopsy findings were as follows: large scalp lacerations, abrasions in the chin and the sternal region, a transverse fracture of the sternum, ruptures of the heart, ruptures of the ascending and descending aortae, rupture and hemorrhage of the nuchal muscle, ring fracture of the base of the skull, subarachnoid hemorrhage at the base of the brain, multiple rib fractures, anterior compression fracture of the 11th thoracic vertebra, and small lacerations of the liver. Blood ethanol level was 2.92 mg/g. These findings indicate that there was hyperflexion of the neck and then the victim's heart was strongly compressed and ruptured by the collision of the chin with the sternal region of the chest.

Fixation of mandibular fractures using rigid hardware has gained wide acceptance over the past 3 decades. The goal of rigid internal fixation is to allow for fracture healing with limited, or no, time in maxillo-mandibular fixation. There has been significant evolution in plate and screw materials and design over the past 30 years. The term miniplate is used to describe a fracture plate with a screw diameter of 2.0 mm or less. With correct diagnosis and understanding of the forces affecting mandible fractures, miniplates can be applied transorally in various situations, allowing for less invasive treatment with open reduction of mandible fractures. This article describes the use of monocortical miniplates for the intraoral treatment of mandibular fractures.

The conservative approach in the treatment of maxillofacial trauma in children has been widely adopted. The type of fracture and its presence within the growing facial skeleton along with the presence of tooth buds may result in different management strategies to that employed in adults. An understanding of conservative treatment options is essential to make informed choices which will best manage these injuries, and an example is presented in this paper. This case report describes a 14-year-old boy who sustained trauma to the chin as a result of a fall, causing a mandibular symphyseal fracture. He was successfully treated by the means of applying direct interdental wiring combined with an acrylic splint.

We describe a patient with panniculitis ossificans traumatica that arose adjacent to the mandible. Panniculitis ossificans traumatica is an unusual form of heterotopic calcification that develops within subcutaneous fat as a result of injury. There have been few reported cases, and we know of none in the maxillofacial region despite the frequency of trauma to this region. As a result few treatment protocols exist. We describe an experience with its diagnosis and management.

Purpose: The purpose of this investigation was to evaluate and compare the biomechanical behavior of 5 different methods used to repair mandibular symphysis/parasymphysis fractures., Materials and Methods: Sixty synthetic polyurethane mandible replicas (Synbone, Laudquart, Switzerland) were used in this investigation. Ten controls and 10 each of the experimental groups were tested by subjecting 5 constructs in each group to vertical loading at the incisal edge and 5 constructs to torsional loading at the molar region by an Instron 1331 (Instron, Canton, MA) servohydraulic mechanical testing unit. The 5 methods of reconstruction include: arch bars using 18-gauge stainless steel wire with an acrylic lingual splint, 2 2.4-mm lag screw technique, 2 2.0-mm 4-hole locking miniplates, 2 2.0-mm 6-hole nonlocking miniplates, and 2 2.4-mm 6-hole limited-contact dynamic-compression plates. Mechanical deformation data within a 0 to 900 N range were recorded. Yield load, displacement at yield load, and stiffness were determined. Means and standard deviations were derived and compared for statistical significance using a Fisher's protected least significant differences test with a confidence level of 95% (P < .05). Third-order polynomial best-fit curves also were created for each group to further evaluate and compare the mechanical behavior., Results: For incisal edge loading, statistically significant differences were noted between the lag screw technique and the arch bar, limited-contact dynamic-compression plate and locking miniplate; and between the nonlocking miniplate and the arch bar, limited-contact dynamic-compression plate and locking miniplate for stiffness. Additionally, statistically significant differences were noted between the lag screw technique and arch bar; and between the nonlocking miniplate and the arch bar, dynamic-compression plate and locking miniplate for yield load. For molar loading, statistically significant differences were noted between the lag screw technique and all other groups for both yield load and stiffness; as well as the arch bar and locking miniplate for stiffness. No statistically significant differences were noted between any groups for displacement at yield, for either incisal edge or molar loading., Conclusions: Although statistically significant differences were noted between each of the fixation systems in their abilities to resist loads under the conditions tested, when placed in the context of functional parameters, all systems met the requirements for incisal edge loading. When molar loading was considered, the lag screw technique performed more favorably than the other systems.

This case report is an insight in to pediatric traumatology whereby bilateral greenstick fracture of condyle is used as a means to discuss the incidence and anatomic considerations for the management of the same, highlighting the fact that dental surgeons require a unique understanding of the anatomy, growth considerations, healing pattern and operative management involving minimal manipulation while managing pediatric facial fractures.

Nodular primary localized cutaneous amyloidosis (NPLCA) has been associated with progression to systemic amyloidosis. The reported estimate of 50% progression to systemic amyloidosis has come under scrutiny as recent studies have suggested a significantly lower rate. Still, it is essential to consider systemic amyloidosis after making the diagnosis of NPLCA and to follow up patients longitudinally for possible progression to systemic disease. We present a case of a 24-year-old woman with NPLCA with onset after traumatic injury, review the literature, and discuss the proposed rate of progression of NPLCA to systemic amyloidosis.

Purpose: To review, retrospectively, the outcomes of 102 patients who underwent lag screw technique fixation of fractures of the anterior mandible., Patients and Methods: A total of 102 consecutive, skeletally mature patients who have undergone open reduction internal fixation for fractures of the anterior mandible utilizing the lag screw technique were reviewed. All patients had a clinically mobile fracture between the mental foramina of the mandible. The patients were followed at usual postoperative intervals with shortest long-term follow-up of 2 months. Intraoperative and long-term postoperative outcomes including status of union, infection, and intraoperative surgical misadventure were recorded., Results: Data from the 102 patients showed that there was 1 fixation failure due to inappropriate patient selection, 1 nonunion requiring bone grafting, 1 with infected screws but with union, 1 with an infected screw and delayed union treated conservatively, and 6 with broken drills from intraoperative surgical misadventures., Conclusions: Lag screw osteosynthesis of anterior mandibular fractures is a sensitive, facile, predictable, and relatively inexpensive method for internal fixation of indicated fractures. As with all methods of rigid internal fixation, most failures or complications are the result of operator judgment or technique.