IntroductionPseudoaneurysm is a vascular injury typically caused by rupture of arteries with extravasation of blood. The involvement of this entity in facial arteries after firearm aggression is extremely rare, and they need treatment as early as possible, thus avoiding irreversible damage to patients.Study designA 40-year-old male victim of gunshot attack with an entrance orifice in the right posterior cervical region with ascending trajectory, lodging in the ipsilateral zygomatic-orbitary complex, which was submitted to removal of the bone fragments and the bullet. In the intraoperative period, the patient developed profuse hemorrhage and, after complementary examinations, he was diagnosed with pseudoaneurysm of the internal maxillary artery, which was treated by selective endovascular embolization.ResultsThe patient was hemodynamically stable, with no complaints and was discharged after 48 hours, without postoperative bleeding recurrences. He had no more complications after 8 months of follow-up.ConclusionsThe main forms of treatment and diagnosis of vascular lesions are reviewed, and embolization is demonstrated as a technically safe procedure with few complications. Key words:Gunshot wound, pseudoaneurysm, maxillary artery, therapeutic embolization.
Mediastinitis is a rare, progressive, and destructive infectious process due to cervical or odontogenic infections, which, if not diagnosed early, may lead to several complications, including airway involvement and even an imminent risk of death. Herein, we report an unusual case of a 37-year-old male with a bilateral submandibular hard swelling after the left third molar extraction. After surgical intervention with submandibular drainage and antibiotic therapy, the infection persisted without explanation, since the patient was not hypertensive, did not have diabetes mellitus or sexually transmitted infections such as HIV or syphilis, and did not smoke or drink alcoholic beverages. A thoracic surgeon then intervened, treating the mediastinitis surgically by drainage, thus obtaining a significant improvement of the patient's health. Mediastinitis is a serious condition. Clinicians and maxillofacial surgeons should be alert to make an immediate diagnosis and select the appropriate treatment in order to prevent worsening of the patient's clinical condition.
Displacement of orthodontic appliances to the fascial spaces and segments of the airways during orthognathic surgery is rare; however, it may cause potential complications to the patients. Additionally, the removal of foreign bodies in the maxillofacial region can be a great challenge. Herein, we describe a case of a 43-year-old female patient with an orthodontic band displaced to the coronoid process during orthognathic surgery. In addition, the indications, treatments and outcomes of the image intensifier used in maxillofacial surgery were discussed. The object was successfully removed using an image intensifier, which allowed real-time visualization of the displaced appliance while using a haemostat to remove it through a conservative surgical wound. This article reports on a viable and safe method of a navigation system for the removal of foreign bodies in the region of the coronoid process. Maxillofacial surgeons should introduce this technique in selected cases in order to ensure safe and minimally invasive surgery.
Background: Arnold Chiari malformation (ACM) is characterized by an anatomical defect at the base of the skull where the cerebellum and the spinal cord herniate through the foramen magnum into the cervical spinal canal. Among the subtypes of the condition, ACM type I (ACM-I) is particularly outstanding because of the severity of symptoms. This study aimed to analyze the orofacial clinical manifestations of patients with ACM-I, and discuss their demographic distribution and clinical features in light of the literature. Material and Methods: A case series with patients with ACM-I treated between 2012 and 2015 was described. The sample consisted of patients who were referred by the Department of Neurosurgery to the Oral and Maxillofacial Surgery Service of Hospital da Restauração in Brazil for the assessment of facial symptomatology. A questionnaire was applied to evaluate the presence of painful orofacial findings. Data are reported using descriptive statistical methods. Results: Mean patient age was 39.3 years and the sample consisted mostly of male patients. A high prevalence of headache (50%) and pain in the neck (66.7%) and masticatory muscles (50%) was found. Only one patient reported difficulty in performing mandibular movements and two reported jaw clicking sounds. Mean mouth opening was 40.83 mm. Conclusions: ACM-I patients may exhibit orofacial symptoms which may mimic temporomandibular joint disorders. This study brings interesting information that could help clinicians and oral and maxillofacial surgeons to understand this uncommon condition and also help with the diagnosis of patients with similar physical characteristics by referring them to a neurosurgeon.
Introduction Late mandibular angle fracture after surgical removal of a lower third molar is a major complication. The aetiology of this complication is believed to be multifactorial and might be associated with age, gender, angulation and the level of third molar impaction. The aims of this study were to report the case of a mandibular angle fracture that occurred 21 days after third molar removal and to perform a critical review of the subject. Case report A 44‐year‐old male patient reported a distinct cracking noise in his right mandibular angle during masticatory movements, 21 days after surgery to remove his right lower third molar. Based on the clinical and imaging findings, surgical reduction was performed under general anaesthesia and the fracture was properly fixed with two 2.0‐mm plate and screw systems installed at fractured site using transbuccal instrumentation. Discussion Multiple factors are related to mandibular angle fractures resulting from the removal of third molars, such as age, gender, state of dentition, parafunctional habits, angulation and level of impaction of the third molar, relative depth and volume of the tooth in bone and local or systemic disease, which may compromise bone strength and the surgical technique. Conclusions The decision to remove lower third molars must be made taking into account all risks associated with the procedure, especially mandibular angle fractures. An accurate diagnosis and optimal timing of this procedure are necessary to minimize the occurrence of these complications.
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