The mandibular fracture takes the second position among facial bones fractures, with significant increase of cases in the last years. The aim of this paper is to report a clinical case of a patient with facial trauma due to an automotive accident, resulting in an atypical fracture in a unilateral mandibular angle. In the image examinations an atypical favorable fracture in the right mandibular angle region involving the apex of the erupted 48 tooth was found. The fracture line started in the posterior region of mandibular ramus, below mandibular condyle, and spread out until inferior border of the mandible in premolar region. Despite the atypical design of the mandibular angle fracture described in this paper, the treatment showed satisfactory results, without any aesthetic or functional changes for the patient.
Introdução: Casos acidentais de deslocamento de terceiros molares para espaços fasciais profundos podem apresentar diferentes etiologias, desde limitações anatômicas até situações iatrogênicas. Espaços anatômicos adjacentes, como espaço faríngeo lateral, fossa infratemporal, espaço pterigomandibular e bucal, têm sido relatados na literatura. Objetivo: O objetivo principal do presente artigo é relatar dois diferentes casos de deslocamento de terceiros molares, e destacar suas implicações anatômicas. Relato dos casos: O primeiro caso trata-se de um deslocamento do terceiro molar superior direito para o espaço bucal. O dente foi removido através de uma incisão submucosa sob a papila parotídea, usando um elevador periosteal. No segundo caso, o terceiro molar inferior direito foi deslocado para o espaço submandibular. Sua remo- ção foi conduzida por meio de uma abordagem extrabucal, devido à sua proximidade com a base da mandíbula. Discussão e Considerações: Conhecer as características anatômicas da região maxilofacial é importante para que o cirurgião bucomaxilofacial conduza diagnóstico e tratamento corretos dos deslocamentos de terceiros molares para espaços fasciais. Quando os elementos dentários se encontrarem em posições desfavoráveis, sugere-se a realização de procedimentos cirúrgicos abertos, em vez do uso de elevadores ou força excessiva.
Introduction Class II division I malocclusions are the most common dentofacial deformities seen in clinical practice. Severe cases or cases in which growth has ceased may require full correction combining orthodontic and surgical treatment. We report a case of a total mandibular subapical alveolar osteotomy, performed to correct a class II division I dentofacial deformity. Case Report A 19-year-old female patient was referred to the oral and maxillofacial surgery department at the Federal University of Paraná with chin aesthetic complaints as well as class II malocclusion. The proposed treatment was total mandibular subapical alveolar osteotomy, retaining the chin position and eliminating the need for genioplasty, since, although the patient presented with a class II dentofacial deformity, the chin was well positioned. Under general anesthesia, a “V-shaped” incision was conducted from the right retromolar region to the left retromolar region. A ring of cortical bone was removed around the mental foramen, with the aim to create a space around the mental nerve. Fixation was conducted with plates and screws of the 2.0 system. The patient on six-year follow-up showed osteotomy stability, a better overall occlusion, and outcome satisfaction.
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