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Prelomi predstavljaju značajan javnozdravstveni problem koji utiče na sve aspekte života povređenog. Etiologija i mehanizam nastanka važni su faktori za pravilan odabir lečenja preloma. Principi vraćanja koštanih fragmenata u anatomski položaj i omogućavanje optimalnih uslova zarastanja imobilizacijom, kao i vraćanje okluzije u prvobitno stanje predstavljaju vodiče u odabiru adekvatne metode lečenja. Iako invazivnija, hirurška metoda lečenja češće je indikovana i praćena razvojem savremenih osteosintetskih materijala.

Prelomi donje vilice nastaju dejstvom direktne ili indirektne sile. Mogu biti prelomi: bradnog predela, tela, ugla, grane, zglobnog i mišićnog nastavka. Prelomi grane i mišićnog nastavka su dosta retki zbog svog položaja i zaštite od strane okolnih mišića. Prilikom preloma formira se frakturna linija koja može biti povoljna ili nepovoljna. Kod preloma je bitno uzeti u obzir pripoje i funkciju mastikatornih mišića zbog eventualne dislokacije fragmenata. Dalje podele preloma su na: otvorene i zatvorene; sa ili bez dislokacije fragmenata; nepotpuni i potpuni. Kod dijagnostike preloma donje vilice najbitnije je uzeti u obzir sigurne i nesigurne znake preloma. Sigurni znaci su: koštani stepenik, patološka pokretljivost, krepitacije i isticanje likvora. Nesigurni znaci su oni koji mogu pratiti prelome ali se javljaju i kod drugih trauma i oboljenja. To su: poremećaj okluzije zuba u vidu: otvorenog zagrižaja u prednjem delu, bočno otvorenog zagrižaja, poremećaja sredine zagrižaja; krvarenje, otok, krvni podliv, bol, palpatorna bolna osetljivost, ograničeno ili onemogućeno otvaranje usta, pojačano lučenje pljuvačke, zadah iz usta, poremećaj osteljivosti. Terapija podrazumeva repoziciju i imobilizaciju. Repozicija može biti manuelna, repozicija vučom (gumice ili žice) ili hirurška. Imobilizacija može biti privremena (transportna)(zavoji) i definitivna (metalne šine, splintovi). Kod hirurške terapije pristup može biti intra ili ekstraoralni. Lečenje može biti konzervativno i hirurško. Izbor metode je individualan i zavisi od vrste preloma, frakturne linije, uzrasta, zdravstvenog stanja, okolnih struktura.

Maligni tumori kože lica podeljeni su u dve osnovne grupe, ne-melanomske karcinome kože (eng. Non melanoma skin cancer) u koje spadaju karcinomi sa boljom prognozom, bazocelularni i planocelularni i oni sa lošijom prognozom, među koje su Merkell Cell karcinom, angiosarcoma, adneksalni karcinom i na melanome kože. Bazocelularni karcinom je najčešći maligni tumori kod čoveka. Smatra se da je poreklom od ćelija folikula dlake i epidermisa i klinički se deli na: nodulo-ulcerativni (nodularni tip), superficijalni tip, pigmentni, cistični, i nešto agresivnije forme koje se javljaju u 10% slučajeva : bazoskvamozni, infiltrativni, mikronodularni, sklerozirajući. Primarna terapija je hirurška. Metastaze bazocelularnog karcinoma su retke i kreću se između 0,00028% do 0.55%. Planocelularni karcinom je tumor epidermalnog porekla (od keranocita) čija invazivna forma poseduje sve karakteristike malignog tumora: aplazija, brz rast, invazija, destrukcija okolnog tkiva, sposobnost metastaziranja (limfogeno, ređe hematogeno) i može dovesti do smrti. Standardna hirurška tehnika sa ekscizijom predstavlja najčešći vid terapije. Planocelularni karcinom daje metastaze u proseku između 2,3%- 5,2%. Izlečenje kod primarnih planocelularnih tumora u toku 5-to godišnjeg praćenja je 92%, dok kod rekurentnih je 77%. Melanomi kože su najznačajniji tumori melanocitnog sistema. Karakteriše se visokim malignim potencijalnom i mogućnošću da daje metastaze. Klinički razlikuju se četiri tipa melanoma: melanom sa površinskim širenjem, nodularni melanom, akro-lentiginozni melanom, lentigo maligna melanom. Maligni melanomi leče se ekscizionom hirurgijom sa marginalizacijom praćenom Breslowim indeksom debljine, ukoliko su prisutne metastaze, hemoterapija je pokazala najbolje rezultate, dok konsenzus oko lečenja melanoma i dalje ne postoji.

Background/Aims Management of maxillofacial trauma in the geriatric population poses a great challenge due to anatomical variations and medical comorbidities. The aim of this study was to analyze the management variables, timing, and outcomes of facial fractures in elderly patients (aged 70 years or more) at several European departments of oral and maxillofacial surgery. Materials and Methods This study was based on a systematic computer-assisted database that allowed the recording of data from all geriatric patients with facial fractures from the involved maxillofacial surgical units across Europe between 2013 and 2017. Results A total of 1334 patients were included in the study: 665 patients underwent closed or open surgical treatment. A significant association (P lt .005) was found between the presence of concomitant injuries and a prolonged time between hospital admission and treatment. The absence of indications to treatment was associated with comorbidities and an older age (P lt .000005). Conclusions Elderly patients require specific attention and multidisciplinary collaboration in the diagnosis and sequencing of trauma treatment. A prudent attitude may be kept in selected cases, especially when severe comorbidities are associated and function is not impaired.

Introduction: Treatment of condylar fractures in patients with atrophic edentulous mandibles is a peculiar field that has been little considered in the literature. The aim of the study was to assess the demographic and clinical variables as well as management and outcome of mandibular condylar fractures in edentulous patients with atrophic mandibles that were treated at several European departments of oral and maxillofacial surgery. Methods: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017. Only patients that were diagnosed with condylar fractures of the edentulous atrophic mandible were included. Results: A total of 52 patients met the inclusion criteria and were included in the study: 79% of patients reported one or more comorbidities. Thirty-four unilateral neck or subcondylar fractures, 9 bilateral neck or subcondylar condylar fractures, 7 unilateral head condylar fractures, and 2 bilateral head condylar fractures were diagnosed. No treatment was performed in 37 cases, whereas in 4 patients a closed treatment was decided, and 11 patients underwent open reduction and internal fixation. Outcome was considered to be satisfying in 48 patients, with no complications. Conclusions: The golden rule still remains that the diagnosis of a subcondylar or neck fracture in an edentulous patient should constitute an indication for open reduction and internal fixation. However, an appropriate choice of management options has to be individualized on a case by case basis, also depending on the patient consent.

Introduction Management of body fractures in patients with edentulous atrophic mandibles represents a challenging task due to patient's age, medical comorbidities, poor bone quality, and vascularity, as well as reduced contact area between the fracture ends. The aim of the study was to assess the demographic and clinical variables, the surgical technique, and outcomes of unilateral body fractures of the edentulous atrophic mandible managed at several European departments of oral and maxillofacial surgery. Methods This study is based on a systematic computer-assisted database that allowed the recording of data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between 2008 and 2017. The following data were recorded for each patient: gender, age, comorbidities, etiology, synchronous body injuries, degree of atrophy of the mandible according to Luhr classification, type of surgical approach and fixation, length of hospitalization, and presence and type of complications. Results A total of 43 patients were included in the study: 17 patients' mandibles were classified as class I according to Luhr, 15 as class II, and 11 as class III. All patients underwent open reduction and internal fixation by extraoral approach in 25 patients, intraoral in 15 patients, and mixed in 3 patients. A single 2.0 miniplate was used in 16 patients, followed by a single 2.4 reconstruction plate in 13 patients, by two 2.0 miniplates, and three 2.0 miniplates. Outcome was considered to be satisfying in 30 patients, with no complications. Complications were observed in 13 cases. Conclusions Treatment of unilateral body fractures of the edentulous mandible must still be based on the type of fracture, degree of atrophy, experience of the surgeon, and patients' preference. An adequate stability can be obtained by different plating techniques that have to be appropriately tailored to every single specific patient.

This retrospective cohort study aims to describe characteristics of patients with MRONJ, to identify factors associated with MRONJ development, and to examine variables associated with favourable outcome. Totally 32 patients were followed and observed: 21 females and 11 males, in the age range 35-84 in the period from 2009 to 2018. Clinical, radiological examination (Orthopantomograph and CBCT) and biopsy were performed in order to achieve diagnosis. Demographic and clinical variables were taken into consideration: sex, age, primary disease, medication type, mode of delivery, anatomic location, drug treatment duration, timing of tooth extraction, chemotherapy, presence of bone metastasis, aetiology of MRONJ, disease stage, and treatment modality. MRONJ developed under osteoporosis and malignant disease in 11 and 21 patients, respectively. MRONJ development was triggered by tooth extraction or trauma in 30 out of 32 cases, whereas the two patients developed MRONJ spontaneously. Stages I, II, and III were confirmed in 5 (16%), 18 (58%), and 9 (28%) patients, respectively. Mandible was affected in 23 (72%) patients. MRONJ was treated in our department by conservative and surgical modality. In this study we found that 65% of all patients were classified in the cured/improvement group and 35% in the stable/progression group. The female gender, osteoporosis as primary disease, oral regime intake, shorter period on BPs, earlier stage of disease, and specific anatomic localisation (frontal and premolar maxilla) were factors associated with better response to therapy and favourable clinical outcome. Comprehensive treatment protocol and further randomized studies are necessary for further improvements.

Introduction: The progressive aging of European population seems to determine a change in the epidemiology, incidence and etiology of maxillofacial fractures with an increase in the frequency of old patients sustaining craniofacial trauma. The objective of the present study was to assess the demographic variables, causes, and patterns of facial fractures in elderly population (with 70 years or more). Materials and methods: The data from all geriatric patients (70 years or more) with facial fractures between January 1, 2013, and December 31, 2017, were collected. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, etiology, site of facial fractures, synchronous body injuries, Facial Injury Severity Score (FISS). Results: A total of 1334 patients (599 male and 735 female patients) were included in the study. Mean age was 79.3 years, and 66% of patients reported one or more comorbidities. The most frequent cause of injury was fall and zygomatic fractures were the most frequently observed injuries. Falls were associated with a low FISS value (P lt .005). Concomitant injuries were observed in 27.3% of patients. Falls were associated with the absence of concomitant injuries. The ninth decade (P lt .05) and a high FISS score (P lt .005) were associated with concomitant body injuries too. Conclusions: This study confirms the role of falls in the epidemiology of facial trauma in the elderly, but also highlights the frequency of involvement of females, and the high frequency of zygomatic fractures.

BACKGROUND Immediate functional loading is a hot topic in dental implantology. The use of conventional dental implants has proven to be successful for very few techniques and if enough jaw bone is present. In this study we report about the outcomes of treatments using the technology of the Strategic Implant (R) in specialized clinics without any patient selection. The purpose of this study was to evaluate the presently used protocol for immediate functional loading (within max. 3 days) of single piece implants which are placed according to the following principles- Axial implants with 2nd cortical anchorage (BECES (R)/BECES (R) N/BCS (R)), Lateral implants with dual mode of integration and cortical anchorage in horizontal direction (BOI (R)), Single piece compression screw implants (KOS/KOC) with conical endosseous implant body. MATERIALS AND METHODS This retrospective cohort study included totally 394 patients who were treated with 4570 immediately loaded single piece implants (BECES (R) or BECES N (R), BCS (R), BOI (R) BBBS/BAST and KOC (R) Strategic Implant (R), all obtained from Simpladent GmbH, Switzerland, Manufacturer: Dr. Ihde Dental AG) supporting fixed complete-arch maxillary or mandibular metal-acrylic prostheses, or metal-ceramic bridges or segment reconstructions in both jaws. Furthermore, 26 implants for single tooth replacement were inserted during the study period and 90 (2.0%) single tooth on more than one implant reconstruction have been used, as shown in Table 1. The patients were asked to return for follow up examinations at 6, 12, 18 and 24 months postoperatively. Radiographic assessment of: The marginal bone level, The integration of the load transmitting parts of the implants, The healing of sockets containing vertical implant parts, were performed after at least 1 year in function for all patients. Furthermore The reliability of possible target corticals The survival of bent and unbent implants, and the The survival of implants in fresh extra