Removal of lower third molar corresponds to one of the most common procedures in oral surgery. The extraction can result in several intraoperative or postoperative complications, especially when fully impacted molars are involved. This case report describes a mandibular angle fracture following removal of a fully impacted lower third molar of a 41 years old male patient. The fracture occurred 3 days after the attempt to extract the tooth 38 by a dentist surgeon. Several factors influencing the possibility of fracture including gender, age, dental position, and angulation were reviewed and associated with the injury. A fracture line in the angular region of the jaw was observed in radiological and tomographic analysis, both essential to perform the diagnosis. Open reduction internal fixation treatment approach was realized to ensure the best patient’s recovery. We conclude that the difficult to maintain a soft diet and the complete dentition factor could have been determinant to cause the fracture.Descriptors: Mandibular Fractures; Fracture Fixation; Molar, Third.ReferencesAl-Belasy FA, Tozoglu S, Ertas U. Mastication and late mandibular fracture after surgery of impacted third molars associated with no gross pathology. J Oral Maxillofac Surg. 2009; 67(4):856-61.daBodner L, Brennan PA, McLeod NM. Characteristics of iatrogenic mandibular fractures associated with tooth removal: review and analysis of 189 cases. Br J Oral Maxillofac Surg. 2011;49(7):567-72.Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 2007; 19(1):117-28.Joshi A, Goel M, Thorat A. Identifying the risk factors causing iatrogenic mandibular fractures associated with exodontia: a systemic meta-analysis of 200 cases from 1953 to 2015. Oral Maxillofac Surg. 2016;20(4):391-96.Libersa P, Roze D, Cachart T, Libersa JC. Immediate and late mandibular fractures after third molar removal. J Oral Maxillofac Surg. 2002;60(2):163-66.Perry PA, Goldberg MH. Late mandibular fracture after third molar surgery: a survey of Connecticut oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2000;58(8):858-61.Pires WR, Bonardi JP, Faverani LP, Momesso GAC, Muñoz XMJP, Silva AFM et al. Late mandibular fracture occurring in the postoperative period after third molar removal: systematic review and analysis of 124 cases. Int J Oral Maxillofac Surg. 2017;46(1):46-53.Krimmel M, Reinert S. Mandibular fracture after third molar removal. J Oral Maxillofac Surg. 2000;58(10):1110-12.Wagner KW, Otten JE, Schoen R, Schmelzeisen R. Pathological mandibular fractures following third molar removal. Int J Oral Maxillofac Surg. 2005;34(7):722-26.Ethunandan M, Shanahan D, Patel M. Iatrogenic mandibular fractures following removal of impacted third molars: an analysis of 130 cases. Br Dent J. 2012;212(4):179-84.Ellis E 3rd. Management of fractures through the angle of the mandible. Oral Maxillofac Surg Clin North Am. 2009;21(2):163-74.Pell GJ, Gregory GT. Report on a ten year study of a tooth division technique for removal of impacted teeth. Am J Orthodont Surg. 1942; 28:660-71.Antoun JS, Lee KH. Sports-related maxillofacial fractures over an 11-year period. J Oral Maxillofac Surg. 2008;66(3):504-8.Chrcanovic BR, Custódio AL. Considerations of mandibular angle fractures during and after surgery for removal of third molars: a review of the literature. Oral Maxillofac Surg. 2010; 14(2):71-80. Iizuka T, Tanner S, Berthold H. Mandibular fractures following third molar extraction. A retrospective clinical and radiological study. Int J Oral Maxillofac Surg. 1997;26(5):338-43.Woldenberg Y, Gatot I, Bodner L. Iatrogenic mandibular fracture associated with third molar removal. Can it be prevented?. Med Oral Patol Oral Cir Bucal. 2007;12(1):E70-2.Miyaura K, Matsuka Y, Morita M, Yamashita A, Watanabe T. Comparison of biting forces in different age and sex groups: a study of biting efficiency with mobile and non-mobile teeth. J Oral Rehabil. 1999;26(3):223-27.Bezerra TP, Studart-Soares EC, Pita-Neto IC, Costa FW, Batista SH. Do third molars weaken the mandibular angle?. Med Oral Patol Oral Cir Bucal. 2011;16(5):e657-63.Grau-Manclús V, Gargallo-Albiol J, Almendros-Marqués N, Gay-Escoda C. Mandibular fractures related to the surgical extraction of impacted lower third molars: a report of 11 cases. J Oral Maxillofac Surg. 2011;69(5):1286-90.
A comunicação bucosinusal trata-se da comunicação não natural da cavidade bucal com o seio maxilar, estando muitas vezes relacionada a extração dos dentes superiores posteriores. A literatura apresenta diversas opções de tratamento para esses casos, entre eles o fechamento com o retalho pediculado com o corpo adiposo bucal. O objetivo deste trabalho foi relatar um caso de fístula bucosinusal em paciente diabético, discutindo alternativas cirúrgicas correlacionadas com problema sistêmico do paciente e características locais do defeito. Paciente do sexo masculino, 55 anos de idade, com histórico de dez dias de exodontia do elemento 27, com queixa de passagem de ar ao meio bucal através do sítio cirúrgico. Com base nos exames, o diagnóstico definitivo foi de comunicação bucosinusal, sendo estipulado o tratamento cirúrgico para o fechamento da comunicação através de duas camadas com o corpo adiposo da bochecha seguido do retalho vestibular. No acompanhamento de 8 meses e meio o paciente não apresenta queixas e pode-se observar o fechamento completo da comunicação bucosinusal. O retalho pediculado do corpo adiposo bucal seguido do retalho vestibular mostrou-se efetivo no tratamento da fístula bucosinusal em paciente diabético controlado.Descritores: Fístula Bucoantral; Cirurgia Bucal; Diabetes Mellitus.ReferênciasLozano-Carrascal N, Salomó-Coll O, Gehrke SA, Calvo-Guirado JL, Hernández-Alfaro F, Gargallo-Albiol J. Radiological evaluation of maxillary sinus anatomy: A cross-sectional study of 300 patients. Ann Anat. 2017;214:1-8.Jang JK, Kwak SW, Ha JH, Kim HC. Anatomical relationship of maxillary posterior teeth with the sinus floor and buccal cortex. J Oral Rehabil. 2017;44(8):617-25. Khandelwal P, Hajira N. Management of Oro-antral Communication and Fistula: Various Surgical Options. World J Plast Surg. 2017;6(1):3-8.Parvini P, Obreja K, Begic A, et al. Decision-making in closure of oroantral communication and fistula. Int J Implant Dent. 2019;5(1):13.Lin PT, Bukachevsky R, Blake M. Management of odontogenic sinusitis with persistent oro-antral fistula. Ear Nose Throat J. 1991;70(8):488-90.Al-Juboori MJ, Al-Attas MA, Magno Filho LC. Treatment of chronic oroantral fistula with platelet-rich fibrin clot and collagen membrane: a case report. Clin Cosmet Investig Dent. 2018; 10:245-49.Kiran Kumar Krishanappa S, Eachempati P, Kumbargere Nagraj S, Shetty NY, Moe S, Aggarwal H et al. Interventions for treating oro-antral communications and fistulae due to dental procedures. Cochrane Database Syst Rev. 2018;8(8):CD011784. Darr A, Jolly K, Martin T, Monaghan A, Grime P, Isles M et al. Three-layered technique to repair an oroantral fistula using a posterior-pedicled inferior turbinate, buccal fat pad, and buccal mucosal advancement flap. Br J Oral Maxillofac Surg. 2018;56(7):638-39.Parvini P, Obreja K, Sader R, Becker J, Schwarz F, Salti L. Surgical options in oroantral fistula management: a narrative review. Int J Implant Dent. 2018;4(1):40. Lin PT, Bukachevsky R, Blake M. Management of odontogenic sinusitis with persistent oro-antral fistula. Ear Nose Throat J. 1991;70(8):488-90.Borgonovo AE, Berardinelli FV, Favale M, Maiorana C. Surgical options in oroantral fistula treatment. Open Dent J. 2012;6:94-8.Ribeiro FS, de Toledo CT, Aleixo MR, Durigan MC, Silva WC, Bueno SK et al. Treatment of Oroantral Communication Using the Lateral Palatal Sliding Flap Technique. Case Rep Med. 2015;2015:730623.Erdoğan O, Esen E, Ustün Y. Bony palatal necrosis in a diabetic patient secondary to palatal rotational flap. J Diabetes Complications. 2005;19(6):364-67.Tideman H, Bosanquet A, Scott J. Use of the buccal fat pad as a pedicled graft. J Oral Maxillofac Surg. 1986;44(6):435-40.Yang S, Jee YJ, Ryu DM. Reconstruction of large oroantral defects using a pedicled buccal fat pad. Maxillofac Plast Reconstr Surg. 2018; 40(1):7.Raldi FV, Sardinha SCS, Albergaria-Barbosa JR. Fechamento de comunicação bucossinusal usando enxerto pediculado com corpo adiposo bucal. BCI. 2000;7(25):60-3.Poeschl PW, Baumann A, Russmueller G, Poeschl E, Klug C, Ewers R. Closure of oroantral communications with Bichat's buccal fat pad. J Oral Maxillofac Surg. 2009;67(7):1460-66.Batra H, Jindal G, Kaur S. Evaluation of different treatment modalities for closure of oro-antral communications and formulation of a rational approach. J Maxillofac Oral Surg. 2010;9(1):13-8. Weinstock RJ, Nikoyan L, Dym H. Composite three-layer closure of oral antral communication with 10 months follow-up-a case study. J Oral Maxillofac Surg. 2014;72(2):266.e1-266.e2667.Candamourty R, Jain MK, Sankar K, Babu MR. Double-layered closure of oroantral fistula using buccal fat pad and buccal advancement flap. J Nat Sci Biol Med. 2012;3(2):203-5.
Conclusion and Clinical Implications : Despite the limitations of the study, our findings showed that NDI can be considered as a possible alternative treatment with promising survival rates. However, longer follow-up studies are needed to confirm these results.
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