Dentistry Oral and Maxillofacial Surgery

In this clinical study hyperbaric ropivacaine in spinal anaesthesia for lower limb and hip surgery was evaluated and results obtained were compared with those using hyperbaric bupivacaine. Methodology: Two hundred patients scheduled for lower limb and hip surgery were randomly divided into two groups of 100 patients each. These patients received a spinal injection of either 3ml (15mg) of 0.5% hyperbaric ropivacaine or 3ml (15mg) of 0.5% hyperbaric bupivacaine using 25G Quincke type spinal needle. The parameters studied were -onset and total duration of sensory block, onset and total duration of motor block, quality of intraoperative anaesthesia, hemodynamic alterations, and any intraoperative and postoperative complications. Results: The mean onset of sensory block (6±1.3min vs. 3±1.1min; p value<0.05) and motor block (13±1.6min vs. 9±1.3min; p value< 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in ropivacaine group (160±12.9min) than in bupivacaine group (260±16.1min; p value <0.05). The mean duration of motor block was also shorter in ropivacaine group compared to bupivacaine group (126±9.2min vs. 174±12.6min; p value<0.05). Conclusion: The quality of anaesthesia was excellent in both the groups. In conclusion, a solution of ropivacaine (hyperbaric) can be used for spinal anaesthesia and is comparable with hyperbaric bupivacaine in terms of quality of block, but has shorter recovery profile.

benign intraosseous tumors that histologically contain giant cells.
Various entities in the jaws may share this histological feature including
hyperparathyroidism, cherubism, and central giant cell granuloma. It
can be classifi ed as: aggressive and non-aggressive, based on clinical
and radiographic characteristics. Traditional treatment has been
surgical excision, the extension of which can vary from simple curettage
to block resections, the use of curettage combined with cryotherapy or
peripheral ostectomy has also been reported. Recurrence rates after
surgical treatment range from 11 to 49%; however, in aggressive lesions,
rates of up to 72% have been reported. We present a case of a patient
with a central giant cell lesion with aggressive behavior was treated
with surgical resection with a favorable outcome.

Loss of eye has a bad effect on the psychology of the patient. Eye prosthesis is fabricated to
regain the patient’s confidence by meticulous replacement of the missing eye. Immediate
fitting of an anophthalmic socket with an artificial eye may not always be possible, and a
delayed prosthesis delivery may result in settling and sinking of the prosthesis into the
socket, therefore requiring orbital cavity conformation. It becomes a challenging task for a
maxillofacial prosthodontist to fabricate a prosthesis that replicates the healthy side of the
face. This article presents a short review of three functional ocular impression techniques
to achieve a better fit of the prosthesis to the defect area. These techniques aim to combine
cosmetic excellence with comfort for greater benefit to the patients.

Fractures of the mandible (lower jaw) are a common occurrence and usually related to interpersonal violence or road traffic accidents.
Mandibular fractures may be treated using open (surgical) and closed (non-surgical) techniques. Fracture sites are immobilized with
intermaxillary fixation (IMF) or other external or internal devices (i.e. plates and screws) to allow bone healing. Various techniques
have been used, however uncertainty exists with respect to the specific indications for each approach.
Objectives
The objective of this review is to provide reliable evidence of the effects of any interventions either open (surgical) or closed (nonsurgical)
that can be used in the management of mandibular fractures, excluding the condyles, in adult patients.
Search methods
We searched the following electronic databases: the Cochrane Oral Health Group’s Trials Register (to 28 February 2013), the Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE via OVID (1950 to 28 February
2013), EMBASE via OVID (1980 to 28 February 2013), metaRegister of Controlled Trials (to 7 April 2013), ClinicalTrials.gov (to 7
April 2013) and the WHO International Clinical Trials Registry Platform (to 7 April 2013). The reference lists of all trials identified
were checked for further studies. There were no restrictions regarding language or date of publication.
Selection criteria
Randomised controlled trials evaluating the management of mandibular fractures without condylar involvement. Any studies that
compared different treatment approaches were included.
Data collection and analysis
At least two review authors independently assessed trial quality and extracted data. Results were to be expressed as random-effects
models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals.
Heterogeneity was to be investigated to include both clinical and methodological factors. Main results
Twelve studies, assessed as high (six) and unclear (six) risk of bias, comprising 689 participants (830 fractures), were included. Interventions
examined different plate materials and morphology; use of one or two lag screws; microplate versus miniplate; early and delayed
mobilization; eyelet wires versus Rapid IMF™ and the management of angle fractures with intraoral access alone or combined with
a transbuccal approach. Patient-oriented outcomes were largely ignored and post-operative pain scores were inadequately reported.
Unfortunately, only one or two trials with small sample sizes were conducted for each comparison and outcome. Our results and
conclusions should therefore be interpreted with caution. We were able to pool the results for two comparisons assessing one outcome.
Pooled data from two studies comparing two miniplates versus one miniplate revealed no significant difference in the risk of postoperative
infection of surgical site (risk ratio (RR) 1.32, 95% CI 0.41 to 4.22, P = 0.64, I2 = 0%). Similarly, no difference in postoperative
infection between the use of two 3-dimensional (3D) and standard (2D) miniplates was determined (RR 1.26, 95% CI 0.19
to 8.13, P = 0.81, I2 = 27%). The included studies involved a small number of participants with a low number of events.
Authors’ conclusions
This review illustrates that there is currently inadequate evidence to support the effectiveness of a single approach in themanagement of
mandibular fractures without condylar involvement. The lack of high quality evidence may be explained by clinical diversity, variability
in assessment tools used and difficulty in grading outcomes with existing measurement tools. Until high level evidence is available,
treatment decisions should continue to be based on the clinician’s prior experience and the individual circumstances

ABSTRAK Latar Belakang: Tatalaksana fraktur pada tulang alveolar bisa dilakukan hanya dengan reduksi tertutup, akan tetapi pada fraktur yang disertai dengan malunion dan maloklusi, perlu tindakan operatif untuk mereduksi fragmen fraktur ke posisi semula. Maloklusi biasanya disebabkan oleh perubahan letak fragmen fraktur. Jika maloklusi tidak dapat dikoreksi dengan reduksi tertutup karena malunion atau melibatkan struktur lain tulang disekitarnya, maka reduksi terbuka dapat menjadi pilihan utama. Tujuan : Memilih tatalaksana yang tepat pada kasus malunion fraktur segmental alveolar maxilla sinistra Laporan Kasus: Wanita 45 tahun datang ke Poli Bedah Mulut RSUP Dr. Sardjito karena kesulitan mengunyah selama 2 bulan setelah mengalami kecelakaan lalu lintas. Pemeriksaan fisik tampak sedikit asimetri wajah pada sisi kiri, malposisi gigi 21, 22, 23, 24, dan 25 sehingga menyebabkan kontak prematur dengan gigi antagonisnya serta open bite gigi geligi sisi kanan. Pemeriksaan penunjang dengan CT Scan Kepala 3D menunjukkan bahwa terdapat fraktur pada tulang alveolar maksila sinistra berbentuk piramida dari mesial gigi 21 sampai distal gigi 25. Penatalaksanaan: Pada kasus ini dilakukan refrakturing dan reduksi terbuka dengan 2 buah miniplat berbentuk L dan Mandibulo-Maxillary Fixation (MMF) untuk mengembalikan dan memfiksasi fragmen fraktur ke tempat semula. Kesimpulan: Malunion fraktur segmental alveolar pada kasus ini memerlukan reduksi terbuka agar reposisi dan fiksasi fragmen fraktur bisa kembali normal secara anatomis, fungsional, dan estetik. PENDAHULUAN Fraktur segmental alveolar didefinisikan sebagai fraktur pada prosesus alveolaris, dimana segmen patahan tulangnya melibatkan lebih dari dua gigi dan terjadi pergeseran gigi geligi ke arah aksial dan lateral yang mengakibatkan gangguan oklusi. Jika fragmen fraktur digerakkan, maka seluruh gigi yang terletak dalam fragmen fraktur tersebut akan ikut bergerak. Fraktur segmental alveolar maksila yang luas dapat menyerupai fraktur Le Fort 1 unilateral. Prevalensi kejadian untuk kasus ini sangat jarang, pada umumnya fraktur hanya melibatkan tulang maksila saja atau tulang Kata Kunci: Fraktur segmental alveolar, fraktur malunion, reduksi terbuka

Bone grafts are widely used for augmentation procedures in oral and maxillofacial surgery, with autogenous bone being the gold standard. Recently, the focus of research has shifted towards synthetic bone substitutes, as no second surgery is needed and large quantities of graft can easily be provided. Within the broad range of bone substitutes, synthetic hydroxyapatite has drawn much attention, as they are considered to be biocompatible, non-immunogenic, osteoconductive and osteoinductive. Scope of this review is to summarize existing knowledge concerning the molecular, cellular and pharmaceutical aspects of synthetic bone substitutes for oral and maxillofacial grafting.

periapical pathoses. The sensitivity for the MPS was 63% (95% CI 59.2-68.0) for tooth-specific disease and the specificity was 92% (95% CI 92.2-94.5). The likelihood ratios (LR) were LRϩ 9 and LRϪ Ϫ.39. The P value (McNemars P Յ .0001) was significant for MPS compared with FMS.

Objective: To investigate diplopia (binocular single vision [BSV] test) and ocular motility (uniocular field of fixation [UFOF] test) characteristics in blow-out fractures of the orbit and their value in fracture management. Material and methods: Patients with isolated blow-out fractures treated from 2000 to 2010 were included. BSV scores were stratified into three categories: low BSV category (0e60); moderate BSV category (61e80), and high BSV category (81e100). UFOF scores were also divided into three categories: low score (60e240), moderate score (241e270), and high score (271e365) categories. Results: A total of 183 patients (106 surgically and 77 conservatively managed) met the inclusion criteria. There was no significant improvement in BSV postoperatively in surgically managed patients with preoperatively high BSV, whereas there was significant improvement (p < 0.05) for the high BSV category in the conservative group. Preoperative BSV was found to be significantly related (p < 0.05) to post-operative BSV, subjective diplopia outcome, follow-up time, and number of follow-up visits. However, improvement of BSV score in the surgical group was not found to be significantly correlated with subjective outcome in relation to diplopia. Preoperative UFOF score has no influence on subjective outcome in relation to diplopia. Surgical timing, approach, and choice of implant material were not found to be statistically related to final diplopia outcome, follow-up time, or number of follow-up visits. Conclusions: BSV is better correlated with diplopia outcome, follow-up time, and number of follow-up visits than is UFOF. On the basis of this study, surgical intervention would not be recommended for blow-out fracture cases with BSV score >80% for correction of diplopia alone.

PURPOSE:

Although dry socket (DS) is commonly investigated, many of its risk factors remain highly controversial. In addition, few studies are available to show the preventive effect of chlorhexidine gel on DS. Moreover, multivariable analyses of DS risk factors are scarce, and their interactions have not been assessed previously. Therefore, the simultaneous effect of chlorhexidine gel and 4 DS risk factors and their interactions were analyzed within a multivariable framework.
MATERIALS AND METHODS:

Using a split-mouth randomized clinical trial design, the investigators enrolled a cohort of patients requiring extraction of 2 mandibular third molars. The primary predictor variable was extraction socket treatment status, classified as experimental or standard. Experimental treatment was the insertion of chlorhexidine gel (0.2%) into the extraction socket. Each patient had 1 third molar randomly selected as the treatment site. The contralateral third molar served as the control socket and was treated in the usual manner. The primary outcome variable was DS status, present or absent, assessed on postoperative day 3. Other study variables were categorized as demographic, smoking, and surgical difficulty according to the Pederson scale. Appropriate bivariate and multiple logistic regression statistics were used to measure the association between risk for DS and chlorhexidine gel use, age, gender, smoking, and surgical difficulty and their interactions (α = 0.05).
RESULTS:

The sample consisted of 90 bilateral extraction sockets in 45 patients (24 men; 21 smokers; mean age, 21.1 ± 2.7 yr). Regression analysis showed that when other factors and their interactions were controlled for, chlorhexidine gel application lowered the risk of DS (odds ratio [OR] = 0.05; P = .004). Increasing age (OR = 2.9; P = .030) was associated with an increased risk for DS. A similar association existed between increased difficulty level of extraction and DS risk (OR = 3.8; P = .051). The effect of gender was marginally significant (P = .091), whereas smoking did not have a significant influence (P = .4).
CONCLUSIONS:

Intra-alveolar application of chlorhexidine gel and practicing less traumatic surgeries are advocated, particularly in older patients. Smoking seems unlikely to affect DS frequency. The role of gender is inconclusive.

The aim of this study was to compare the micro-shear bond strength of composite resin cured with halogen visible light
and blue light emitting diode curing units. Flat enamel surfaces of 50 segments of teeth were prepared. 50 cylindrical composite
resin specimens were bonded to the prepared teeth segments. Specimens were divided into 5 groups, three groups
were cured for 10, 20 and 40 seconds using blue light emitting diode and 2 groups were cured for 20 and 40 seconds using
halogen light. Specimens were submitted to micro-shear bond test at 1mm / min cross-head speed. Mean micro-shear bond
strengths were analyzed by analysis of variance (One-way ANOVA) and Tukey's test at P<0.05. At 40 seconds curing, the
halogen light produced significantly higher bond strength than that of blue light emitting diode. No significant difference
was found between both lights at 20 seconds. There were no significant differences in bond strength ratios between 10 and
20 seconds blue light emitting diode, and 20 seconds halogen light. At 40 seconds, the blue light emitting diode produced
significantly higher bond strength than that of blue light emitting diode at10 and 20 seconds, and halogen light at 20 seconds.
It was concluded that despite the higher micro-shear bond strength of halogen light at 40 seconds, blue light emitting
diode curing unit provided sufficient output to exceed minimum requirements in terms of composites’ micro-shear bond
strength according to ISO 11405, 1994. During incremental application of composite resin, 10 seconds blue light emitting
diode curing time is sufficient to produce acceptable micro-shear bond strength values.
Keywords: Micro-Shear Bond Strength; Enamel; Halogen Light-Curing; LED Light-Curing.

Hemangiomas are mesenchymal lesions, represent 7% of benign childhood tumors, can occur anywhere in the body, are more frequent in the head and neck, representing 60% of cases, followed by their presence in the trunk in 25% and 15% in the extremities; appear after birth and go hand in hand with the growth of the patient, are of idiopathic etiology, have a predilection for the female gender, and are usually diagnosed as a clinical finding, reporting in mostly as a red-violet spot or tumor. They usually disappear spontaneously due to their self-regulation, however their persistence, cosmetic or functional affection, as well as the involvement of orificial structures or with systemic compromise could require simple or compound specialized management. A literature review was conducted in order to highlight the generalities and characteristics of intraoral hemangiomas, as well as to estimate the most appropriate treatment.

Purpose: The aim of this study was to assess the effects of tooth/bone-borne (hybrid) and tooth-borne (TB) surgically assisted rapid maxillary expansion (SARME) on the width of the nasal soft and hard tissue. Patients and methods: Twenty skeletally mature patients (nine males and 11 females; mean age 19.4 years) with transverse maxillary hypoplasia were randomly assigned to hybrid or TB devices. The patients had undergone SARME operations, performed by the same surgical team using the same procedure (Le Fort I osteotomy with pterygomaxillary dysjunction, midline osteotomy, and no down- fracture). Nasal soft- and hard-tissue changes were analyzed using CBCT preoperatively (T0), at the end of the active expansion phase (T1), and after 6 months of retention (T2). The study was approved by the relevant ethics committee.
Results: The skeletal and soft-tissue nasal parameters increased significantly in the T0eT1 and T0eT2 periods in both groups (P < 0.05). No statistically significant differences between the groups were observed. The mean piriform aperture width increased from 1.26 mm in T0eT1 to 0.97 mm in T1eT2 and 2.17 mm in T0eT2 (P < 0.008). In the soft tissue, the alar base width increased to 2.78 mm and the alar width to 2.95 mm in T0eT2 (P 1⁄4 0.001). There was a positive correlation (63.6%) between the changes in skeletal and soft-tissue values.
Conclusion: The hybrid and TB devices led to similarly significant widening effects in nasal soft and hard tissues in both the short term and 6 months after SARME.

Introduction: One of the complications of odontogenic abscess is cervicofacial necrotizing fasciitis; which is infrequent in the cervicofacial
region. This disease usually occurs in immunosuppressed patients. Treatment is broad spectrum antibiotics and surgery. Material and Method: A research study was conducted with the following characteristics: retrospective, descriptive, cross-sectional and observational, for a year, in the maxillofacial surgery service, of specialty hospital: “Dr. Antonio Fraga Mouret”, national medical center“ La Raza ” (IMSS), Mexico city; all patients (six) diagnosed with necrotizing cervicofacial fasciitis secondary to Odontogenic abscess, older than 18 years were included. The protocol consisted of taking a biopsy, antibiotic, culture with an antibiogram and surgical management. Data were collected to estimate the frequency of this pathology in the maxillofacial surgery service. Results: In one year, 6 patients with a diagnosis of necrotizing cervicofacial fasciitis secondary to odontogenic abscess were treated. No significant differences were found with respect to gender, the mean age was 69.16 years, (86; minimum 40). The mean number of affected aponeurotic spaces was 6.5 (maximum: 14; minimum: 2); the most affected side was the right. The most frequent aponeurotic spaces were: the facial (in turn, more were reported in the submandibular followed by submental and genian aponeurotic space) and one third the cervical. Surgical management was: cannulation and drainage of persistent abscess or purulent collection in four patients, surgical lavage was performed in all, 3 patients required more than 4 surgical washes. Debridement was performed in all patients. Discussion: The importance of this study is to show and report the frequency with which necrotizing cervicofacial fasciitis appears secondary to
odontogenic abscess, to continue with the control and report in maxillofacial surgery, as well as improvements and proposals for a better management of patients who are diagnosed with this disease.

‫ـﺎﺋﻲ.‬ ‫ـ‬ ‫اﻹﺣﺼ‬ ‫ـﺎﺋﺞ‬ ‫ـ‬ ‫اﻟﻨﺘ‬ ‫ـﺔ‬ ‫ـ‬ ‫اﻟﻌﻴﻨ‬ ‫ـﻤﻨﺖ‬ ‫ـ‬ ‫ﺗﻀ‬ : ٦٢.٥ ‫ا‬ ‫ـﻦ‬ ‫ـ‬ ‫ﻣ‬ % ‫و‬ ‫ـﺎث‬ ‫ـ‬ ‫ﻹﻧ‬ ٣٧.٥ ‫ـﺮ‬ ‫ـ‬ ‫اﻟﻌﻤ‬ ‫ـﻂ‬ ‫ـ‬ ‫ﻣﺘﻮﺳ‬ ‫ـﺎن‬ ‫ـ‬ ‫ﻛ‬ ‫ـﺬﻛﻮر،‬ ‫ـ‬ ‫اﻟ‬ ‫ـﻦ‬ ‫ـ‬ ‫ﻣ‬ % ٢٤.٥ ‫ـﻢ‬ ‫ـ‬ ‫اﻟﻔ‬ ‫ـﺔ‬ ‫ـ‬ ‫ﻓﺘﺤ‬ ‫ـﺪل‬ ‫ـ‬ ‫ﻣﻌ‬ ‫و‬ ‫ـﻨﺔ،‬ ‫ـ‬ ‫ﺳ‬ ٣٩ ‫ـﻴﺔ‬ ‫ـ‬ ‫ﺋﻴﺴ‬ ‫اﻟﺮ‬ ‫ـﻜﻮى‬ ‫ـ‬ ‫اﻟﺸ‬ ‫ـﻢ،‬ ‫ـ‬ ‫ﻣﻠ‬ ‫اﱂ‬ ‫ـﺎﱄ)‬ ‫ـ‬ ‫اﻟﺘ‬ ‫ـﻜﻞ‬ ‫ـ‬ ‫ﺑﺎﻟﺸ‬ ‫ـﺖ‬ ‫ـ‬ ‫ﺗﻮزﻋ‬ ٦٥ ‫ـﺔ‬ ‫ـ‬ ‫ﻳ‬ ‫دور‬ ‫ـﺔ‬ ‫ـ‬ ‫اﺟﻌ‬ ‫ﻣﺮ‬ ،% ٢٥.٨ ‫ـﻨﺎن‬ ‫ـ‬ ‫أﺳ‬ ‫ـﻮﱘ‬ ‫ـ‬ ‫ﺗﻘ‬ ،% ٦.٧ ‫ـﺮى‬ ‫ـ‬ ‫أﺧ‬ ‫ـﺒﺎب‬ ‫ـ‬ ‫أﺳ‬ ،% ٢.٥ ‫ـﻜﻞ‬ ‫ـ‬ ‫ﺑﺎﻟﺸ‬ ‫ـﺐ‬ ‫ـ‬ ‫اﻟﻨﺴ‬ ‫ـﺖ‬ ‫ـ‬ ‫ﺗﻮزﻋ‬ ‫ـﻮري‬ ‫ـ‬ ‫ﺟﺮﳚ‬ ‫و‬ ‫ـﻞ‬ ‫ـ‬ ‫ﺑﻴ‬ ‫ـﻨﻴﻒ‬ ‫ـ‬ ‫ﺗﺼ‬ ‫ـﺐ‬ ‫ـ‬ ‫ﲝﺴ‬ (% ‫ـﻨﻒ‬ ‫ﺻ‬ ‫ـﺎﱄ)‬ ‫اﻟﺘ‬ І ٤٤.٢ ‫ـﻨﻒ‬ ‫،ﺻ‬ % ІІ ٤٤.١ ،% ‫ـﻨﻒ‬ ‫ﺻ‬ ІІІ ١١.٧ ‫ـﻲ‬ ‫اﻷﻓﻘ‬ ‫ـﺖ‬ ‫ﻛﺎﻧ‬ ‫ـﻮر‬ ‫اﳌﻄﻤ‬ ‫ـﺮس‬ ‫اﻟﻀ‬ ‫ـﺔ‬ ‫اوﻳ‬ ‫ز‬ ‫إﱃ‬ ‫ـﺒﺔ‬ ‫ﺑﺎﻟﻨﺴ‬ (% ١٥.٨ ‫ـﺔ‬ ‫اوﻳ‬ ‫اﻟﺰ‬ ‫ـﻲ‬ ‫اﻧﺴ‬ % ٤٤.٢ ‫ـﻮدي‬ ‫ـ‬ ‫ﻋﻤ‬ ، % ٢٤.٢ ‫اوﻳﺔ‬ ‫اﻟﺰ‬ ‫وﺣﺸﻲ‬ ، % ١٥.٨ ‫ا‬ ‫ـﺘﻮى‬ ‫اﳌﺴ‬) ‫ـﺖ‬ ‫ﻛﺎﻧ‬ ‫ﻟﻠﻤﺴﺘﻮﻳﺎت‬ ‫ﺑﺎﻟﻨﺴﺒﺔ‬ ‫و‬ ،% ٤٠ ‫ب‬ ‫ـﺘﻮى‬ ‫اﳌﺴ‬ ‫و‬ % ٣٦ ‫ج‬ ‫ـﺘﻮى‬ ‫ﻣﺴ‬ ‫و‬ % ١٧ ‫ـﺒﺔ‬ ‫ﺑﺎﻟﻨﺴ‬ ‫ـﺘﻐﺮق‬ ‫اﳌﺴ‬ ‫ـﺰﻣﻦ‬ ‫اﻟ‬ ‫ـﺪل‬ ‫ﻣﻌ‬ ‫ـﺎن‬ ‫ﻛ‬ ‫%(و‬ ‫اﳋﱪة‬ ‫ذوي‬ ‫اﺣﲔ‬ ‫ﻟﻠﺠﺮ‬ ٢٣.٣٣ ‫دﻗﻴﻘ‬ ‫ﻟﻐﲑﻫﻢ‬ ‫اﻟﻮﻗﺖ‬ ‫ﻛﺎن‬ ‫ﺑﻴﻨﻤﺎ‬ ‫ﺔ‬ ABSTRACT Aims: The aim of the study is to evaluate the relationship of the general and local factors which have an impact on the difficulty during the removal of impacted lower wisdom teeth. Several factors such as age , gender, mouth opening , chief complain, bone surrounding and radiographic appearance and surgeon experience, will be included as factors which affect the difficulty during the removal of impacted lower wisdom teeth. Materials and methods: One hundred twenty medically fit patients were selected with an age range between 17-47 years of both sexes had impacted lower third molars and indicated for surgical extraction. Surgical removal performed by senior surgeon and junior, operation was performed under local anesthesia, all cases done between November 2008-June 2010, in oral and maxillo-facial surgery department\dentistry college university of Mosul the collected data were analyzed statistically by using SPSS program. Results: the sample comprised of 62.5% female and 37.5% male with mean age 24.5 years, the mean of the mouth opening was 39mm, the chief complain distributed as fol-low(pain 65%, dental check up 25.8%, orthodontic reasons 6.7% and others 2.5%), according to Pell and Gregory classification the percentage were class І 44.2%, class ІІ 44.1%, class ІІІ 11.7%, while the angulations were horizontally 15.8%, mesioangular 44.2%, vertical 24.2%,distoangular 15.8%, levels position A 40%, position B 36%, position C 17%. The mean time for the experienced surgeon was 23.33 minutes while for the non experienced 53.11 minutes. There was statistically significant difference between the time of the operation and the experience of the surgeon at P value =0.003. The relation between the time of the operation and class, level and angulations of impaction was statistically not significant. To successfully evaluate the difficulty of lower third molar extraction prior to surgery, clinical, radiologic findings, local and general factors must be taken into account and there are special indexes used in the assessment of difficulty in lower wisdom tooth surgery with no one of them considered the most reliable one because of the difference in the studies samples and in the local and general factors that had been used in the assessment of difficulty like age, gender, mouth opening , chief complain in addition to the clinical and radio graphical features. Conclusions: in regardless of type of difficulty index used in addition to local and general factors as a criteria for the assessment of lower molar 115 tooth extraction , we concluded that the factor of experience of the surgeon is the most important factor that have a significant effect on the duration of the surgery.

Este artículo puede ser consultado en versión completa en http://www.medigraphic.com/facultadodontologiaunam RESUMEN Se denominan lipomas aquellas lesiones benignas, perte-necientes al grupo de neoplasias mesenquimatosas com-puestas por tejido adiposo con o sin cápsula fibrosa u otros elementos histológicos que determinarán sus características físicas. Dentro de las neoplasias benignas se presentan del 13-20% en cabeza y cuello, reportándose 0.5-5% en cavidad bucal, por lo que se considera poco común en la región maxi-lofacial, siendo más frecuente después de la quinta década de vida, es raro que se presente en pacientes jóvenes o ni-ños. Es por ello que presentamos el reporte de un caso de lipoma en paciente pediátrico, el cual tratamos en el Servicio de Cirugía Maxilofacial Pediátrica del Hospital de Pediatría «Dr. Silvestre Frenk Freud», Centro Médico Siglo XXI. Palabras clave: Lipoma facial, niños, neoplasia o tumor adiposo. IntroduccIón Los lipomas son lesiones del grupo de las neoplasias be-nignas de tejido adiposo de origen mesenquimatoso. 1-4 Fueron descritos por primera vez en 1848 por Roux como: «épulis amarillo»; 2 MacGregor y Dyson describen los primeros lipomas orales en 1966, posteriormente se reportan series de casos en múltiples estudios que da-tan de 145 a 200 casos de lipomas en cavidad bucal. En 2001, Fregnani y cols. realizaron una revisión en el periodo de 1970-2001, reportando 46 lipomas bucales, el 0.5% de todos los tumores bucales, de ellos fueron más frecuentes en la mucosa yugal (45.7%), lengua y labios (13%) y en piso de boca (10.9%). 2,3 En la región cervicofacial, los lipomas representan del 13-20% en cabeza y cuello (siendo más frecuentes los cervicales posteriores), en la literatura se reporta que del 0.5-5% de los casos aparecen en cavidad bucal. 3,5-8 Tienen predilección por adultos de la quinta década de vida en adelante. Se reporta mínima o nula diferencia significa-tiva por predilección en género (1.5:1 o entre 57.8% en sexo masculino y 54.4% femenino). 2,3,9,10 Cuando los lipomas aparecen en región maxilofacial, se presentan más frecuente intraoral que extraoralmente. Se hace énfasis en que su presencia en niños es muy rara, habiendo pocos casos clínicos reportados. 1-3 En adolescentes, se reporta un estudio que inclu-ye tres pacientes de 16 años con lipoma. 10 La principal etiología es idiopática, sin embargo, hay factores asociados como traumatismo, comorbilidades 25.7% (diabetes mellitus [DM 11.4%], hipercolesterolemia [14.3%] y el 1.7% otras patologías), artritis reumatoi-de, tabaquismo, alcoholismo, factores hereditarios, hormonales, congénitos, obesidad, factores irritativos crónicos, nidos de células embrionarias lipoblásticas, infecciones y asociados con síndromes. 1-3,9-11 Dentro de los diagnósticos diferenciales se inclu-yen: quiste dermoide, adenoma pleomorfo, carcinoma mucoepidermoide, y las variantes histológicas depen-diendo de su predominio histológico (angiolipoma, fibrolipoma, linfoma maligno, mixolipoma, lipoblasto-matosis o lipoma fetal, lipomatosis múltiple y los aso-ciados con síndromes). 3,10,12 Es necesario apoyarse de auxiliares de diagnóstico como ultrasonido (USG), biopsia que puede ser por aspiración (FNA), tomo-grafía computarizada (CT) en donde se aprecia como una masa hipodensa (de 50-150 UH) si es mayor la densidad se sospecha de otra lesión (por ejemplo el fibrolipoma), resonancia magnética (RM) donde se ve una imagen hiperdensa con alta T1 y bajo T2 bordes mal definidos (características de tejido adiposo).

Keratocysts are considered benign lesions, however, as has been reported in many works by different authors, it has been considered aggressive due to its expansion and high recurrence rate. Currently, numerous articles have been published worldwide on different studies for this type of pathology, which propose different treatment alternatives, ranging from conservative management, for example the use of adjuvants, chelators, cryotherapy, decompression, use of decompressive valves, etc. And surgical treatments among these are those carried out with local anesthesia and / or considered minor surgeries such as enucleations, surgical washes and curettage, of which block or extensive resection with or without reconstruction that can be done at the same time are mentioned Surgical or subsequent, so it was decided to carry out a combination of different treatments with which there is literature reporting their efficacy in order to provide a better prognosis to the patient and to avoid, if possible, achieving wide resections. Therefore, a representative case of a patient diagnosed with Keratocyst, treated in Maxillofacial Service of Specialty Hospital, National Medical Center, XXI Century, IMSS. With multimodal treatment, using different decompressive and reconstruction means is presented, resulting in the eradication of two large-sized lesions and without recurrence two years after their management.

Ghost Cell Odontogenic Carcinoma is an extremely rare odontogenic tumor with unclear etiology. Although known by many names, the basic histologic identifying feature includes the identification of the ghost cells and the malignant changes associated with the cells. These tumors show a spectrum of growth from a slow-growing locally invasive tumor to a highly aggressive, rapidly growing, infiltrative tumor. Therefore, it is prudent to perform a wide local excision with histologically clear margins. Is seen associated with squamous cell carcinoma, radiotherapy also should be included in the treatment plan. Long term follow-up is highly recommended. The  calcifying  odontogenic  cyst  (COC),  classified  as  an odontogenic tumor by the World Health Organization (WHO), was first identified as a distinct entity by Gorlin et al. in 1962 [1]. In 1972, Fejerskov and Krogh [2] used the label calcifying ghost cell odontogenic tumor. The Odontogenic Ghost Cell Carcinoma (OGCC) belongs to the fourth of the four categories of WHO classification of odontogenic carcinoma. In 1981, Praetorius et al. [3] recognized four different histological patterns of COC and classified them as type 1A (simple unicystic), type 1B (odontome-producing), type 1C (ameloblastomatous proliferating) and type 2 (dentinogenic ghost celltumor).  They  opined  that  although  type  2  shows  histological  characteristics of cystic variants, its solid growth pattern suggests that its classification as a neoplasm is more appropriate.

Background: Bisphosphonate-related osteonecrosis is an infrequent but potentially serious complication. Its treatment remains complex, and in some cases can be mutilating. Prevention, a correct diagnosis and opportune management are crucial. Material and Methods: A cross-sectional study was made, interviewing 410 dentists with the aim of assessing their knowledge of the subject. Results: Practically all of the dental professionals (99.7%) were found to lack sufficient knowledge of the prevention , diagnosis and management of bisphosphonate-related osteonecrosis. Conclusions: Actions including increased diffusion in the professional media and inclusion of the subject in training programs are needed in order to enhance the knowledge of bisphosphonate-related osteonecrosis among dentists and thus prevent complications in this group of patients.

The factors affecting the attractiveness of the soft tissue profile are assessed in only very few nonmatched and controversial studies. We aimed to evaluate these factors in a matched comprehensive study. Profile photographs of 100 students with good occlusion were sorted according to facial beauty by 20 judges. After excluding 40 unmatched subjects or those with marginal scores, 12 soft tissue variables were compared among profiles of 30 attractive and 30 unattractive matched participants (t test, α = 0.05). As the most important factor, excessive mandibular retrusion made both men and women unattractive. Both attractive men and women tended to have less prominent noses with higher nose tips, protruded upper lips compared with the position of lower lips, and deeper lower faces. Closeness of lips to the middle of vertical chin-nose distance enhanced female beauty only. Straight profiles and more protruded maxillae merely made men more attractive.

Keratocysts are the second most frequent odontogenic cyst to appear, when a relationship is made of the location of these lesions, it is reported in the literature with a lower incidence and frequency of their location in the Maxilla. That is why a descriptive study of Maxillary Keratocysts was carried out in the  Maxillofacial Surgery service of the XXI Century, National Medical Center. During the one-year period (January to December 2019), having a universe of 8 patients, of which only 2 patients presented with Maxillary Keratocyst, the rest were located in the mandible. The management given to the two maxillary Keratocysts was with enucleation and curettage of the lesions with total closure of the surgical bed, afterwards postoperative control was performed without presenting recurrence of the lesion.

Objectives: To analyze the frequency and type of benign orofacial lesions submitted for diagnosis at Tripoli Medical Centre over 17 years period (1997-2013). Materials and Methods: Entries for specimens from patients were retrieved and compiled into 9 diagnostic categories and 82 diagnoses. Results: During the 17 years period, a total of 975 specimens were evaluated, it comprised a male-female ratio of 0.76:1. The mean age of biopsied patients was 36.3±18.32 years. The diagnostic category with the highest number of specimens was skin and mucosal pathology (22.87%); and the most frequent diagnosis was pyogenic granuloma (14.05%). Conclusion: Pyogenic granuloma, lichen planus, radicular cyst and fibroepithelial polyp were found to be the most predominant diagnoses. Frequencies of most benign orofacial diseases were comparable to similar studies in the literature and to those reported from the eastern region of Libya. Further surveys are needed to define the epidemiology of orofacial diseases in Libyan population.

BACKGROUND AND AIM: The factors affecting the attractiveness of the soft tissue profile are assessed in only very few nonmatched and controversial studies. We aimed to evaluate these factors in a matched comprehensive study.

METHODS: Profile photographs of 100 students with good occlusion were sorted according to facial beauty by 20 judges. After excluding 40 unmatched subjects or those with marginal scores, 12 soft tissue variables were compared among profiles of 30 attractive and 30 unattractive matched participants (t test, α = 0.05).

RESULTS AND CONCLUSION: As the most important factor, excessive mandibular retrusion made both men and women unattractive. Both attractive men and women tended to have less prominent noses with higher nose tips, protruded upper lips compared with the position of lower lips, and deeper lower faces. Closeness of lips to the middle of vertical chin-nose distance enhanced female beauty only. Straight profiles and more protruded maxillae merely made men more attractive.

Behcet's syndrome is an autoimmune disease of the seronegative vasculitic type, with a disease of vessels of variable caliber. It is mainly characterized by oral ulcers, genital ulcers and uveitis. The purpose of this case is to describe the oral manifestations and therapeutic behavior to be followed before a patient with Behcet syndrome. For our purpose, the case of a 20-year-old patient, female, black race, urban origin, who goes to the emergency departments of Maxillofacial Surgery of the body of guard of the Provincial Hospital Dr. Gustavo Aldereguía Lima in the province of Cienfuegos, referred by the specialist in Comprehensive General Stomatology who provided services in the area of health corresponding to the patient for presenting multiple ulcerated lesions throughout the oral cavity and lips. It was concluded that oral ulcers in Behcet's disease are the first clinical manifestation, which in most cases, lead the patient to seek medical help and are considered by countless authors as the cornerstone to reach the diagnosis of this disease. A total of 14 bibliographies were consulted.

Aims  and  Objectives:  To study the prevalence of jaw swellings among maxillofacial surgery patients, the demographics of the patients with jaw swellings and the radiological characteristics of these jaw swellings seen over a period of fifteen years.Methods: Descriptive retrospective-prospective study. (A retrospective review of cases seen in a ten year period  between 1996 and 2005 and a prospective study of cases seen in a five year period between 2006 and 2010). Data of interest were age, gender, anatomic location of the lesions; radiographic characteristics of the lesions- radiolucent, radio-opaque or mixed radiolucent/radio-opaque lesions and the nature of the borders on plain radiographic films.Results: There were 38,220 attendances to the clinic within the period studied and 1,513 of these presented with maxillofacial swellings, made up of 660 males and 853 females. This is an incidence of 4.0% of maxillofacial swellings among attendants of the maxillofacial clinic.Age range (median) of patients with maxillofacial swelling is 1-87 (30) years. Radiolucency was the most presented radiographic form 1067, radiopaque lesions were 228 and mixed forms were 218 of all the cases of swellings included in the study. Most, 1182 of the lesions are located in the mandible. There were 505 of these lesions in the posterior mandible.Conclusion: This study concludes that a sizeable number of patients attending to see a maxillofacial surgeon present with a facial swelling, with a slight female predilection and most of the lesions occur in the posterior mandible. Advocacy for purposeful preventive measures and a more equitable distribution of available human and material resources is recommended. Different  pathologies  in  the  maxillofacial  region  present  with swelling. Swellings of the jaw are signs of inflammatory, cystic  and  neoplastic  disorders  of  the  jaw  caused  by  hypertrophy,  hyperplasia, neoplasia and pooling of fluids [1]. These may or may not be associated with pain or ulcerations. These swellings have  similar  clinical  features  and  require  further  evaluation  to  differentiate  them.  Many  diagnostic  tools  exist  for  diagnostic  and  therapeutic  guidance  for  surgeons  to  precisely  diagnose  types  as  well as delineate the extent, and location of maxillofacial swellings [2,3]. Among the myriads of cross-sectional imaging modalities developed  to  evaluation  and  diagnosis,  radiological  modality  is  a  first-line and the most important evaluation [4,5] of maxillofacial swellings.

Clear  cell  odontogenic  carcinoma  is  a  rare  jaw  lesion  with  predominantly  clear  cell  characteristics.  Although  touted  as  a  benign  lesion  in the initial stages, once the aggressive nature of the lesion became evident, it was reclassified as a malignant tumor by the World Health Organization. Etiology of this lesion remains elusive, and association with any precursory lesion is yet to be proved. It may have their origins from  odontogenic  epithelium,  salivary  gland  pathologies  or  even  as  metastasis  from  distant  locations  like  kidneys.  That  the  ideal  treatment  plan  should  be  composite  resection  along  with  elective  neck  dissection,  followed  by  reconstruction  of  the  defect.  If  clinical  and  radiological  examination of the patient reveals, extensive soft tissue invasion, perineural spread, lymph node metastasis with an extra - nodal involvement or in those where tumor-free margins are not possible, then, the use of adjuvant radiation therapy should be considered and employed at the surgeon’s discretion. Even though initial tumor free margins are attained, it is emphasized that the patient should be kept under the long-term follow-up to identify recurrences. Hansen et al. [1] coined the term “clear cell odontogenic tumor” in 1985 when they described an odontogenic epithelialtumor with predominantly clear cell characteristics. Since all their cases were located centrally in the jaws, they contended upon the odontogenic origin  of  the  lesion.  Although  previously  excluded  from  the  World  Health Organization (WHO) classifications of odontogenic tumors, its tendency to recur and metastasis is, since then, well documented [2,3].  Therefore,  it  was  agreed  upon  that  “clear  cell  odontogenic  carcinoma”  (CCOC)  is  a  more  appropriate  nomenclature,  and  Reichart  and  Philipsen,  later,  adopted  the  same  in  their  latest  classification of odontogenic tumors approved by the WHO [4]. In 1992 WHO defined CCOC as “A benign but locally invasive neoplasm originating  from  odontogenic  epithelium  and  characterized  by  sheets and islands of uniform, vacuolated and clear cells.”

M. El Deeb, M. T. Roszkowski, L El Hakim." Subcutaneous implantation of hydroxylapatite/collagen in induced diabetic and non-diabetic rats. Int. J. Oral Maxil-lofac. Surg. 1990; 19: 113-119. Abstract. To evaluate tissue reaction to hydroxylapatite (HA) and HA/collagen mixtures in rats with uncontrolled induced diabetes, 48 males were divided: 24 with induced diabetes (ID) from Streptozotocin (70 mg/kg) and 24 non-diabetic (ND) controls. Three subcutaneous sites in each chest were randomly implanted with non-porous HA, or non-porous HA and bovine collagen, or non-porous HA and purified fibrillar collagen. Subgroups of 6 ID and 6 ND rats were killed at 4, 6, 12, and 24 weeks post-implantation. Histologic specimens showed that all materials elicited greater inflammatory response in ID than in ND at all intervals. Each specimen had HA particles encapsulated by host fibrous tissue. Compared to ND, ID specimens had markedly reduced ingrowth and maturity of collagen at each time interval. There was no osteogenesis, but there was dystrophic mineralization within the implant sites in both ID and ND. Mixed HA/collagen exceeded HA alone in maintaining implant contour. In soft tissue, no materials were osteoinductive. Adding collagen did not increase or decrease inflammatory reaction nor improve density and maturity of tissue synthesized around implants.