Treatment of Mandibular Condyle Fractures Using a Modified Transparotid Approach via the Parotid Mini-Incision: Experience with 31 Cases

PubMed Central

Shi, Jun; Yuan, Hao; Xu, Bing

2013-01-01

Surgery for mandibular condyle fractures must allow direct vision of the fracture, reduce surgical trauma and achieve reduction and fixation while avoiding facial nerve injury. This prospective study was conducted to introduce a new surgical approach for open reduction and internal fixation of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision, and surgical outcomes were evaluated. The modified transparotid approach via the parotid mini-incision was applied and rigid internal fixation using a small titanium plate was carried out for 36 mandibular condyle fractures in 31 cases. Postoperative follow-up of patients ranged from 3 to 26 months; in the first 3 months after surgery, outcomes for all patients were analyzed by evaluating the degree of mouth opening, occlusal relationship, facial nerve function and results of imaging studies. The occlusal relationships were excellent in all patients and none had symptoms of intraoperative ipsilateral facial nerve injury. The mean degree of mouth opening was 4.0 (maximum 4.8 cm, minimum 3.0 cm). No mandibular deviations were noted in any patient during mouth opening. CT showed complete anatomical reduction of the mandibular condyle fracture in all patients. The modified transparotid approach via the smaller, easily concealed parotid mini-incision is minimally invasive and achieves anatomical reduction and rigid internal fixation with a simplified procedure that directly exposes the fracture site. Study results showed that this procedure is safe and feasible for treating mandibular condyle fracture, and offers a short operative path, protection of the facial nerve and satisfactory aesthetic outcomes. PMID:24386221

Comparison of Periodontal Ligament Injection and Inferior Alveolar Nerve Block in Mandibular Primary Molars Pulpotomy: A Randomized Control Trial

PubMed Central

Haghgoo, Roza; Taleghani, Ferial

2015-01-01

Background: Inferior alveolar nerve block is a common technique for anesthesia of the primary mandibular molars. A number of disadvantages have been shown to be associated with this technique. Periodontal ligament (PDL) injection could be considered as an alternative to inferior alveolar nerve block. The aim of this study was to evaluate the effectiveness of PDL injection in the anesthesia of primary molar pulpotomy with mandibular block. Methods: This study was performed using a sequential double-blind randomized trial design. 80 children aged 3-7 years old who required pulpotomy in symmetrical mandibular primary molars were selected. The teeth of these children were anesthetized with periodontal injection on one side of the mandible and block on the other. Pulpotomy was performed on each patient during the same appointment. Signs of discomfort, including hand and body tension and eye movement, the verbal complaint and crying (SEM scale), were evaluated by a dental assistant who was blinded to the treatment allocation of the patients. Finally, the data were analyzed using the exact Fisher test and Pearson Chi-squared exact test. Results: Success rate was 88/75 and 91/25 in the PDL injection and nerve block groups, respectively. There was no statistically significant difference between the two techniques (P = 0.250). Conclusion: Results showed that PDL injection can be used as an alternative to nerve block in pulpotomy of the mandibular primary molars. PMID:26028895

Coronectomy of the mandibular third molar: Respect for the inferior alveolar nerve.

PubMed

Kouwenberg, A J; Stroy, L P P; Rijt, E D Vree-V D; Mensink, G; Gooris, P J J

2016-05-01

The aim of this study was to evaluate the outcomes of coronectomy as an alternative surgical procedure to complete removal of the impacted mandibular third molar in patients with a suspected close relationship between the tooth root(s) and the mandibular canal. A total of 151 patients underwent coronectomy and were followed up with clinical examinations and panoramic radiographs for a minimum of 6 months after surgery. None of the patients exhibited inferior alveolar nerve injury. Eruption of the retained root(s) was more frequent in younger patients (18-35 years). Thirty-six patients (23.8%) exhibited insufficient growth of new bone in the alveolar defect, and 11.3% required a second surgical procedure to remove the root remnant(s). Our results indicate that coronectomy can be a reliable alternative to complete removal of the impacted mandibular third molar in patients exhibiting an increased risk of damage to the inferior alveolar nerve on panoramic radiographs. Copyright © 2016. Published by Elsevier Ltd.

The relationship between the fistula tract and the facial nerve in type II first branchial cleft anomalies.

PubMed

Ertas, Burak; Gunaydin, Rıza Onder; Unal, Omer Faruk

2015-04-01

To share our experience involving seven patients with type II first branchial cleft anomalies (hereafter, type II anomalies), to determine whether the location of the external fistula openings of the anomalies are associated with the location of the facial nerve tract, and elucidate the relationship between the location of the fistula opening and the facial nerve. The medical records of seven patients who underwent surgery from 2005 to 2013 for type II anomalies were retrospectively examined. The relationship between the fistula opening and the facial nerve was evaluated in each patient with respect to whether the fistula opening was superior or inferior to the mandibular angle. All patients underwent partial parotidectomy, facial nerve exposure, and total excision of the mass together with connection of a small cuff of the external auditory canal skin to the fistula tract. The fistula tracts were located medially to the facial nerve in two patients, and both fistulae had openings inferior to the mandibular angle. The fistula tracts were located laterally to the facial nerve in the remaining five patients: one patient had no external opening, one had an opening inferior to the mandibular angle, and the remaining three had openings superior to the mandibular angle. Because type II anomalies are rare, their diagnosis is difficult. Surgery of such lesions is challenging and associated with a high risk due to their proximity to the facial nerve. We believe that the location of the fistula opening may help to identify the relationship between the anomalous lesion and facial nerve. Studies involving larger series of cases are needed to confirm our hypothesis; however, because of the rarity of this specific anomaly, it will not be easy to compile a large number of cases. We believe that our study will encourage further investigation on this subject. Copyright © 2014. Published by Elsevier Ireland Ltd.

MANDIBULAR MORPHOMETRY APPLIED TO ANESTHETIC BLOCKAGE IN THE MANED WOLF (CHRYSOCYON BRACHYURUS).

PubMed

de Souza Junior, Paulo; de Moraes, Flavio Machado; de Carvalho, Natan da Cruz; Canelo, Evandro Alves; Thiesen, Roberto; Santos, André Luiz Quagliatto

2016-03-01

Chrysocyon brachyurus (maned wolf) is the biggest South American canid and has a high frequency of dental injuries, both in the wild and in captivity. Thus, veterinary procedures are necessary to preserve the feeding capacity of hundreds of captive specimens worldwide. The aim of this study was to investigate the mandibular morphometry of the maned wolf with emphasis on the establishment of anatomic references for anesthetic block of the inferior alveolar and mental nerves. Therefore, 16 measurements in 22 mandibles of C. brachyurus adults were taken. For extraoral block of the inferior alveolar nerve at the level of the mandibular foramen, the needle should be advanced close to the medial face of the mandibular ramus for 11.4 mm perpendicular to the palpable concavity. In another extraoral approach, the needle may be introduced for 30.4 mm from the angular process at a 20-25° angle to the ventral margin. For blocking only the mental nerve, the needle should be inserted for 10 mm from ventral border, close to the labial surface of the mandibular body, at the level of the lower first premolar. The mandibular foramen showed similar position, size, and symmetry in the maned wolf specimens examined. Comparison of the data observed here with those available for other carnivores indicates the need to determine these anatomic references specifically for each species.

Prevention of neurological injuries during mandibular third molar surgery: technical notes

PubMed Central

La Monaca, Gerardo; Vozza, Iole; Giardino, Rita; Annibali, Susanna; Pranno, Nicola; Cristalli, Maria Paola

2017-01-01

Summary Surgery to the mandibular third molar is common, and injuries to the inferior alveolar nerve and the lingual nerve are well-recognized complications of this procedure. The aim of these technical notes is to describe operative measures for reducing neurological complications during mandibular third molar surgery. The following procedure should be used to prevent damage to the inferior alveolar nerve: a well-designed mucoperiosteal flap, to obtain appropriate access to the surgical area; a conservative ostectomy on the distal and distal-lingual side; tooth sectioning, to facilitate its removal by decreasing the retention zones; tooth dislocation in the path of withdrawal imposed by the curvature of the root apex; and careful socket debridement, when the roots of the extracted tooth are in intimate contact with the mandibular canal. To prevent injury to the lingual nerve, it is important (I) to assess the integrity of the mandibular inner cortex and exclude the presence of fenestration, which could cause the dislocation of the tooth or its fragment into the sublingual or submandibular space; (II) to avoid inappropriate or excessive dislocation proceedings, in order to prevent lingual cortex fracture; (III) to perform horizontal mesial-distal crown sectioning of the lingually inclined tooth; (IV) to protect the lingual flap with a retractor showing the cortical ridge; and (V) to pass the suture not too apically and from the inner side in a buccal-lingual direction in the retromolar area. PMID:29299188

Useful Method for Intraoperative Monitoring of Facial Nerve in a Scarred Bed.

PubMed

Aysal, Bilge Kagan; Yapici, Abdulkerim; Bayram, Yalcin; Zor, Fatih

2016-10-01

Facial nerve is the main cranial nerve for the innervation of facial expression muscles. Main trunk of facial nerve passes approximately 1 to 2 cm deep to tragal pointer. In some patients, where a patient has multiple operations, fibrosis due to previous operations may change the natural anatomy and direction of the branches of facial nerve. A 22-year-old male patient had 2 operations for mandibular reconstruction after gunshot wound. During the second operation, there was a possible injury to the marginal mandibular nerve and a nerve stimulator was used intraoperatively to monitor the nerve at the tragal pointer because the excitability of the distal segments remains intact for 24 to 48 hours after nerve injuries. Thus, using a nerve stimulator at the operational site may lead to false-positive muscle movements in case of injuries. Using the nerve stimulator to stimulate the main trunk at the tragal point may help to distinguish the presence of possible injuries. A reliable method for intraoperative facial nerve monitoring in a scarred operational site was introduced in this letter.

Microsurgical Decompression of Inferior Alveolar Nerve After Endodontic Treatment Complications.

PubMed

Bianchi, Bernardo; Ferri, Andrea; Varazzani, Andrea; Bergonzani, Michela; Sesenna, Enrico

2017-07-01

Iatrogenic injury in oral surgery is the most frequent cause of sensory disturbance in the distribution of the inferior alveolar nerve (IAN) and mental nerve.Inferior alveolar nerve damage can occur during third molar extraction, implant location, orthognathic surgery, preprosthetic surgery, salivary gland surgery, local anesthetic injections or during the resection of benign or malignant tumors.Injuries to the IAN can be caused also by endodontic treatment of mandibular molars and premolars when filling material is forced into the tooth and mandibular canal.The sensory disturbances that could follow a damage of the IAN could be hypoesthesia, dysesthesia, hyperesthesia, anesthesia, and sometimes a painful anesthesia that strike ipsilateral lower lip, chin, and teeth. These can undermine life quality by affecting speech, chewing, and social interaction.Treatment of these complications is sometimes difficult and could consist in observation or in surgical decompression of the involved nerve to relieve the patient's symptoms and improve sensory recovery. The most debated points are the timing of intervention and the effective role of decompression in clinical outcome-improvement.The purpose of this article is to show authors' experience with 2 patients treated with microsurgical nerve decompression to remove endodontic material from the mandibular canal and providing also a comprehensive review of the literature.

[Relationship between Work Ⅱ type of congenital first branchial cleft anomaly and facial nerve and surgical strategies].

PubMed

Zhang, B; Chen, L S; Huang, S L; Liang, L; Gong, X X; Wu, P N; Zhang, S Y; Luo, X N; Zhan, J D; Sheng, X L; Lu, Z M

2017-10-07

Objective: To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies. Methods: Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases. Results: Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web. Conclusions: CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.

Anesthetic technique for inferior alveolar nerve block: a new approach

PubMed Central

PALTI, Dafna Geller; de ALMEIDA, Cristiane Machado; RODRIGUES, Antonio de Castro; ANDREO, Jesus Carlos; LIMA, José Eduardo Oliveira

2011-01-01

Background Effective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular region. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. Data demonstrate that the indirect technique is considered ineffective in 15% of cases and the direct technique in 1329% of cases. Objective Objective: The aim of this study was to describe an alternative technique for inferior alveolar nerve block using several anatomical points for reference, simplifying the procedure and enabling greater success and a more rapid learning curve. Materials and Methods A total of 193 mandibles (146 with permanent dentition and 47 with primary dentition) from dry skulls were used to establish a relationship between the teeth and the mandibular foramen. By using two wires, the first passing through the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of the primary second molar or permanent first molar (right side), and the second following the oclusal plane (left side), a line can be achieved whose projection coincides with the left mandibular foramen. Results The obtained data showed correlation in 82.88% of cases using the permanent first molar, and in 93.62% of cases using the primary second molar. Conclusion This method is potentially effective for inferior alveolar nerve block, especially in Pediatric Dentistry. PMID:21437463

Comparison of the efficacy of articaine and prilocaine local anaesthesia for pulpotomy of maxillary and mandibular primary molars.

PubMed

Yilmaz, Y; Eyuboglu, O; Keles, S

2011-06-01

The aim of this study was to compare the local anaesthetic efficacy of articaine HCl and prilocaine HCl during an operative procedure after their administration by either mandibular nerve block or maxillary infiltration. The study was a double-blind clinical study which comprised 162 children (81 boys and 81 girls), who required a pulpotomy on their primary molars. Pain-related behaviours were used to assess the severity of pain during the injection of either prilocaine HCl or articaine HCl and the operative procedures following either a maxillary infiltration or mandibular nerve block of the two local anaesthetic agents. The frequencies of post-procedural adverse events in the prilocaine and articaine anaesthetised groups were also determined. Significantly more discomfort (p<0.05) was observed following maxillary infiltration compared to mandibular nerve block. There were no significant differences in the pain-related behaviours scores between the two local anaesthetic agents administered during the dental operative procedures, except for the removal of the coronal pulp. For this latter procedure, the pain-related behaviour score was 1.5- times higher in the prilocain-anaesthetised children than in the articaine-anaesthetised children. The frequencies of post- procedural adverse events in the prilocaine-treated children were similar to those found in the articaine-treated children. We concluded that local anaesthesia following mandibular nerve block is more effective than that following maxillary infiltration in 6-8-year-old children. However, the intensity of pain that was experienced by the children during administration of either prilocaine or articaine and some of the dental procedures after their administration were similar.

Lateralization Technique and Inferior Alveolar Nerve Transposition

PubMed Central

Sanches, Marco Antonio; Ramalho, Gabriel Cardoso; Manzi, Marcello Roberto

2016-01-01

Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics. PMID:27433360

Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report

PubMed Central

2016-01-01

During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar. PMID:26877992

Morphometric study on mandibular foramen and incidence of accessory mandibular foramen in mandibles of south Indian population and its clinical implications in inferior alveolar nerve block.

PubMed

Shalini, R; RaviVarman, C; Manoranjitham, R; Veeramuthu, M

2016-12-01

The mandibular foramen is a landmark for procedures like inferior alveolar nerve block, mandibular implant treatment, and mandibular osteotomies. The present study was aimed to identify the precise location of the mandibular foramen and the incidence of accessory mandibular foramen in dry adult mandibles of South Indian population. The distance of mandibular foramen from the anterior border of the ramus, posterior border of the ramus, mandibular notch, base of the mandible, third molar, and apex of retromolar trigone was measured with a vernier caliper in 204 mandibles. The mean distance of mandibular foramen from the anterior border of ramus of mandible was 17.11±2.74 mm on the right side and 17.41±3.05 mm on the left side, from posterior border was 10.47±2.11 mm on the right side and 9.68±2.03 mm on the left side, from mandibular notch was 21.74±2.74 mm on the right side and 21.92±3.33 mm on the left side, from the base of the ramus was 22.33±3.32 mm on the right side and 25.35±4.5 mm on the left side, from the third molar tooth was 22.84±3.94 mm on the right side and 23.23±4.21 mm on the left side, from the apex of retromolar trigone was 12.27±12.13 mm on the right side and 12.13±2.35 mm on the left side. Accessory mandibular foramen was present in 32.36% of mandibles. Knowledge of location mandibular foramen is useful to the maxillofacial surgeons, oncologists and radiologists.

Morphometric study on mandibular foramen and incidence of accessory mandibular foramen in mandibles of south Indian population and its clinical implications in inferior alveolar nerve block

PubMed Central

RaviVarman, C.; Manoranjitham, R.; Veeramuthu, M.

2016-01-01

The mandibular foramen is a landmark for procedures like inferior alveolar nerve block, mandibular implant treatment, and mandibular osteotomies. The present study was aimed to identify the precise location of the mandibular foramen and the incidence of accessory mandibular foramen in dry adult mandibles of South Indian population. The distance of mandibular foramen from the anterior border of the ramus, posterior border of the ramus, mandibular notch, base of the mandible, third molar, and apex of retromolar trigone was measured with a vernier caliper in 204 mandibles. The mean distance of mandibular foramen from the anterior border of ramus of mandible was 17.11±2.74 mm on the right side and 17.41±3.05 mm on the left side, from posterior border was 10.47±2.11 mm on the right side and 9.68±2.03 mm on the left side, from mandibular notch was 21.74±2.74 mm on the right side and 21.92±3.33 mm on the left side, from the base of the ramus was 22.33±3.32 mm on the right side and 25.35±4.5 mm on the left side, from the third molar tooth was 22.84±3.94 mm on the right side and 23.23±4.21 mm on the left side, from the apex of retromolar trigone was 12.27±12.13 mm on the right side and 12.13±2.35 mm on the left side. Accessory mandibular foramen was present in 32.36% of mandibles. Knowledge of location mandibular foramen is useful to the maxillofacial surgeons, oncologists and radiologists. PMID:28127498

Peripheral axotomy of the rat mandibular trigeminal nerve leads to an increase in VIP and decrease of other primary afferent neuropeptides in the spinal trigeminal nucleus.

PubMed

Atkinson, M E; Shehab, S A

1986-12-01

In the vasoactive intestinal polypeptide (VIP)-rich lumbosacral spinal cord, VIP increases at the expense of other neuropeptides after primary sensory nerve axotomy. This study was undertaken to ascertain whether similar changes occur in peripherally axotomised cranial sensory nerves. VIP immunoreactivity increased in the terminal region of the mandibular nerve in the trigeminal nucleus caudalis following unilateral section of the sensory root of the mandibular trigeminal nerve at the foramen orale. Other primary afferent neuropeptides (substance P, cholecystokinin and somatostatin) were depleted and fluoride-resistant acid phosphatase activity was abolished in the same circumscribed areas of the nucleus caudalis. The rise in VIP and depletion of other markers began 4 days postoperatively and was maximal by 10 days, these levels remaining unchanged up to 1 year postoperatively. VIP-immunoreactive cell bodies were absent from trigeminal ganglia from the unoperated side but small and medium cells stained intensely in the ganglia of the operated side after axotomy. These observations indicate that increase of VIP in sensory nerve terminals is a general phenomenon occurring in both cranial and spinal sensory terminal areas. The intense VIP immunoreactivity in axotomised trigeminal ganglia suggests that the increased levels of VIP in the nucleus caudalis are of peripheral origin, indicating a change in expression of neuropeptides within primary afferent neurons following peripheral axotomy.

Evaluation of Buccal Infiltration with Articaine and Inferior Alveolar Nerve Block with Lignocaine for Pulp Therapy in Mandibular Primary Molars.

PubMed

Chopra, Radhika; Marwaha, Mohita; Bansal, Kalpana; Mittal, Meenu

2016-01-01

Failure of inferior alveolar nerve block in achieving profound anesthesia of the pulp due to various reasons has led to the introduction of more potent local anesthetic agents like articaine. This study was conducted to compare the efficacy of buccal infiltration with articaine in achieving pulpal anesthesia of primary molars as compared to inferior alveolar nerve block with lignocaine. 30 patients (4-8 years) with indication of pulp therapy in at least two mandibular primary molars were selected. Patients were randomly assigned to receive nerve block with lignocaine or infiltration with articaine on first appointment and the other solution on second appointment. All the pulpotomies and pulpectomies were performed by a pediatric dentist. Two researchers standing at a distance of 1.5 m recorded the Pain Scores and Sound, Eye, Motor (SEM) scores. After the completion of procedure, the patient was asked to record the Facial Image score and Heft-Parker Visual Analogue Score (HP-VAS). Pain Score recorded at the time of injection showed significantly more movements with block as compared to infiltration (p<0.001). SEM scores at time of pulp extirpation were also higher for block than infiltration (p<0.001). Articaine infiltration has the potential to replace inferior alveolar nerve block for primary mandibular molars.

Mandibular Third Molar Impaction: Review of Literature and a Proposal of a Classification

PubMed Central

Daugela, Povilas

2013-01-01

ABSTRACT Objectives The purpose of present article was to review impacted mandibular third molar aetiology, clinical anatomy, radiologic examination, surgical treatment and possible complications, as well as to create new mandibular third molar impaction and extraction difficulty degree classification based on anatomical and radiologic findings and literature review results. Material and Methods Literature was selected through a search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular third molar, impacted mandibular third molar, inferior alveolar nerve injury third molar, lingual nerve injury third molar. The search was restricted to English language articles, published from 1976 to April 2013. Additionally, a manual search in the major anatomy and oral surgery journals and books was performed. The publications there selected by including clinical and human anatomy studies. Results In total 75 literature sources were obtained and reviewed. Impacted mandibular third molar aetiology, clinical anatomy, radiographic examination, surgical extraction of and possible complications, classifications and risk factors were discussed. New mandibular third molar impaction and extraction difficulty degree classification based on anatomical and radiologic findings and literature review results was proposed. Conclusions The classification proposed here based on anatomical and radiological impacted mandibular third molar features is promising to be a helpful tool for impacted tooth assessment as well as for planning for surgical operation. Further clinical studies should be conducted for new classification validation and reliability evaluation. PMID:24422029

Anomalous Bilateral Communication between the Inferior Alveolar Nerve and the Auriculotemporal Nerve: A Rare Variation

PubMed Central

BHARDWAJ, Nikha; SAHNI, Priya; SINGHVI, Abhishek; NAYAK, Meghanand; TIWARI, Vineeta

2014-01-01

Branches of the posterior division of the mandibular nerve show various anomalous communications in the infratemporal region. Understanding such communication has relevance in the management of neuropathies and surgical procedures in this region. This study was conducted to explore such communicating branches, anticipating that they might provide information of clinical significance. A total of 15 human cadavers (30 infratemporal regions) were studied to explore such communicating branches in infratemporal region. The branches of the posterior division of the mandibular nerve were carefully dissected, and these branches were studied and analysed for any abnormal course. In one case, a rare type of bilateral communication between the auriculotemporal nerve and the inferior alveolar nerve, forming a loop with no association with any structure, was observed. It is possible that such communicating branches may be associated with delayed regression of the first arch vessels. The clinical implications of these anomalous communications require further detailed study for improved management of neuropathies and surgical procedures. PMID:25977637

Functional anatomy of the temporo-mandibular joint (II).

PubMed

Sava, Anca; Scutariu, Monica

2012-01-01

Jaw movement is analyzed as an action between two rigid components jointed together in a particular way, the movable mandible against the stabilized cranium. Opening and closing movements are symmetrical; that is, both sides of the cranio-mandibular articulation are making the same movements. Protrusive and retrusive movements may also be symmetrical. The mandibular muscles determine all the complicated postures and-movements of the jaw. Their behavior can be greatly clarified by restating certain fundamentals crucial to purposive muscular activity. The joint derives its arterial supply from the superficial temporal artery and the maxillary artery. Branches of the auriculo-temporal and masseteric nerves and postganglionic sympathetic nerves supply the tissues associated with the capsular ligament and the looser posterior bilaminar extension of the disc.

Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer

PubMed Central

Alonso-Ezpeleta, Oscar; Martín, Pablo J.; López-López, José; Castellanos-Cosano, Lizett; Martín-González, Jenifer; Segura-Egea, Juan J.

2014-01-01

A case of orofacial pain and inferior alveolar nerve (IAN) paraesthesia after extrusion of endodontic sealer within the mandibular canal treated with prednisone and pregabalin is described. A 36-year-old woman underwent root canal treatment of the mandibular second right premolar tooth. Post-operative panoramic radiograph revealed the presence of radiopaque canal sealer in the mandibular canal. Damage to IAN consecutive to extrusion of endodontic sealer was diagnosed. Non-surgical management was decided, including: 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. Six weeks after the incident the signs and symptoms were gone. The complete resolution of paraesthesia and the control of pain achieved suggest that a non-surgical approach, combining prednisone and the GABA analogue pregabalin, is a good option in the management of the IAN damage subsequent to endodontic sealer extrusion. Key words:Endodontics, inferior alveolar nerve, neuropathic pain, orofacial pain, paraesthesia, pregabalin. PMID:24790724

Clinical Anatomy of the Lingual Nerve: A Review.

PubMed

Sittitavornwong, Somsak; Babston, Michael; Denson, Douglas; Zehren, Steven; Friend, Jonathan

2017-05-01

Knowledge of lingual nerve anatomy is of paramount importance to dental practitioners and maxillofacial surgeons. The purpose of this article is to review lingual nerve anatomy from the cranial base to its insertion in the tongue and provide a more detailed explanation of its course to prevent procedural nerve injuries. Fifteen human cadavers from the University of Alabama at Birmingham School of Medicine's Anatomical Donor Program were reviewed. The anatomic structures and landmarks were identified and confirmed by anatomists. Lingual nerve dissection was carried out and reviewed on 15 halved human cadaver skulls (total specimens, 28). Cadaveric dissection provides a detailed examination of the lingual nerve from the cranial base to tongue insertion. The lingual nerve receives the chorda tympani nerve approximately 1 cm below the bifurcation of the lingual and inferior alveolar nerves. The pathway of the lingual nerve is in contact with the periosteum of the mandible just behind the internal oblique ridge. The lingual nerve crosses the submandibular duct at the interproximal space between the mandibular first and second molars. The submandibular ganglion is suspended from the lingual nerve at the distal area of the second mandibular molar. A zoning classification is another way to more accurately describe the lingual nerve based on close anatomic landmarks as seen in human cadaveric specimens. This system could identify particular areas of interest that might be at greater procedural risk. Published by Elsevier Inc.

A histomorphometric analysis of the nature of the mandibular canal in the anterior molar region.

PubMed

Bertl, Kristina; Heimel, Patrick; Reich, Karoline Maria; Schwarze, Uwe Yacine; Ulm, Christian

2014-01-01

Knowledge of the position and configuration of the mandibular canal is a basic requirement before implant placement in the mandible. Radiological studies suggest a positive correlation between alveolar trabecular bone quality and mandibular canal corticalization. The aim of this study was to test this assumption histomorphometrically in the anterior molar region, which is one of the most frequent places for implantation. Fifty thin ground sections (from 28 male and 22 female cadavers) of the first molar region were investigated for trabecular bone volume and thickness and the presence of a mandibular canal wall. Trabecular bone volume was significantly higher in males (p = 0.009). Further, it correlated significantly with the presence of a canal wall (rho = 0.585, p < 0.001), indicating that a reduced trabecular bone volume is associated with a reduced amount of bone surrounding the alveolar nerve. The cranial aspects of the canal wall were present at a significantly lower frequency (64.64 %) than the buccal, lingual, or caudal sides (p < 0.006). The present study demonstrated that low trabecular bone volume correlates with only a fragmentarily present mandibular canal wall. This suggests that bone surrounding the alveolar nerve is of trabecular, not cortical, origin and possibly affected by reduction of the trabecular bone. These results imply that oral surgeons should pay particular attention to implant placement in patients with low alveolar bone quality. The cranial aspects of the mandibular canal might be only fragmentarily or even completely missing. Consequently, they hardly present resistance during implant site preparation, and the risk for nerve injury, e.g., due to post-surgery hematoma, could be increased.

Arched needle technique for inferior alveolar mandibular nerve block.

PubMed

Chakranarayan, Ashish; Mukherjee, B

2013-03-01

One of the most commonly used local anesthetic techniques in dentistry is the Fischer's technique for the inferior alveolar nerve block. Incidentally this technique also suffers the maximum failure rate of approximately 35-45%. We studied a method of inferior alveolar nerve block by injecting a local anesthetic solution into the pterygomandibular space by arching and changing the approach angle of the conventional technique and estimated its efficacy. The needle after the initial insertion is arched and inserted in a manner that it approaches the medial surface of the ramus at an angle almost perpendicular to it. The technique was applied to 100 patients for mandibular molar extraction and the anesthetic effects were assessed. A success rate of 98% was obtained.

Evaluation of Efficacy of Intraligamentary Injection Technique for Extraction of Mandibular Teeth-A Prospective Study

PubMed Central

Pradhan, Raunak; Kulkarni, Deepak

2017-01-01

Introduction Fear of dental pain is one of the most common reasons for delaying dental treatment. Local Anaesthesia (LA) is the most commonly employed technique of achieving pain control in dentistry. Pterygomandibular Nerve Block (PNB), for achieving mandibular anaesthesia has been the traditional technique used and is associated with a few set of complications which include pain, nerve injury, trismus, and rarely facial nerve palsy, and sustained soft tissue anaesthesia. These complications have resulted in a rapid need for research on alternative local anaesthetic techniques. Aim This study was undertaken with the objective to determine pain, duration, profoundness and complications associated with administration of Intraligamentary Injection Technique (ILT). Materials and Methods This study was conducted on 194 patients (male=122, female=72) who reported for dental extractions in mandibular posteriors. The ILT was administered with ligajet intraligamentary jet injector using cartridge containing lignocaine hydrochloride 2% with adrenaline 1:80000 and a 30 gauge needle at buccal (mesiobuccal), lingual, mesial and distal aspect of the mandibular molars. The data was analyzed by using statistical computer software SPSS 11.0 (Statistical package for social sciences 11.O version of SPSS Inc.). Median was derived for Pain on Injection (PI) and Pain during Procedure (PP). Mean and standard deviation was derived for Duration of Anaesthesia (DA). Results Various advantages were seen such as, localized soft tissue anaesthesia, decreased PI (SD=0.83), and minimal PP (SD=0.94). The DA (SD=4.62) and mean value of 24.06 minutes. Conclusion This study is one of its kinds where intraligamentary injection has been used for extraction of mandibular molars. It was also successfully used in patients with exaggerated gag reflex and patients suffering from trismus due to oral submucous fibrosis. The intraligamentary injection technique can thus be used effectively to anaesthetize mandibular molars, as a primary technique for extraction of mandibular posterior teeth. PMID:28274058

Preoperative percutaneous cranial nerve mapping in head and neck surgery.

PubMed

Park, Jung I

2003-01-01

To identify and map the course of the peripheral branches of the cranial nerve preoperatively and percutaneously. Prospective study. Preoperative percutaneous nerve mapping performed prior to the operation under deep sedation or general anesthesia without muscle paralysis. Private office surgery suite, freestanding surgery center, and regional medical centers. A total of 142 patients undergoing head and neck surgery and facial plastic surgery between August 1994 and July 1999. Monopolar probe was used for nerve stimulation. Electromyographic reading was done through intramuscular bipolar recording electrodes. The equipment used was a nerve monitor. The mandibular divisions were tested in 142 cases, the frontal division in 60 cases, the accessory nerve in 12 cases, and the hypoglossal nerve in 3 cases. Satisfactory mappings were obtained in 115 cases of the mandibular division, 49 cases of the frontal division, 8 cases of the accessory division, and 1 case of the hypoglossal nerve. Preoperative percutaneous nerve mapping is a new method of identifying the location of the peripheral branches of the cranial nerves. Identifying and mapping the course of peripheral branches of the cranial nerves safely assists the head and neck surgeon in the placement of incisions in a favorable location and in the dissection of the area involving the nerves. Mapping alerts the surgeon to an area containing a nerve and allows the surgeon to avoid just the specific area where a nerve is present, preventing large-scale abandonment of unmapped areas for fear of potential nerve damage.

Anatomical relationship between mental foramen, mandibular teeth and risk of nerve injury with endodontic treatment.

PubMed

Chong, Bun San; Gohil, Kajal; Pawar, Ravikiran; Makdissi, Jimmy

2017-01-01

The objective of the present study was to evaluate the anatomical relationship between mental foramen (MF), including the incidence of the anterior loop of the inferior alveolar nerve (AL), and roots of mandibular teeth in relation to risk of nerve injury with endodontic treatment. Cone-beam computed tomography (CBCT) images, which included teeth either side of the MF, were randomly selected. The anonymised CBCT images were reconstructed and examined in coronal, axial and sagittal planes, using three-dimensional viewing software, to determine the relationship and distance between MF and adjacent mandibular teeth. The actual distance between the root apex and MF was calculated mathematically using Pythagoras' theorem. If present, the incidence of an AL in the axial plane was also recorded. The root apex of the mandibular second premolar (70 %), followed by the first premolar (18 %) and then the first molar (12 %), was the closest to the MF. Ninety-six percent of root apices evaluated were >3 mm from the MF. An AL was present in 88 % of the cases. With regards to endodontic treatment, the risk of nerve injury in the vicinity of the MF would appear to be low. However, the high incidence of the AL highlights the need for clinicians to be aware and careful of this important anatomical feature. The risk of injury to the MN with endodontic treatment would appear to be low, but given the high incidence, it is important to be aware and be careful of the AL.

Mandibular marginal contouring in oriental aesthetic surgery: refined surgical concept and operative procedure.

PubMed

Satoh, Kaneshige; Mitsukawa, Nobuyuki

2014-05-01

In aesthetic mandibular contouring surgery, which is often conducted in Asians, the operative procedure is thought to deliver a more aesthetic mandibular shape by means of contouring conducted as a whole from the ramus to the symphysis. The authors describe the refined concept and operative procedures of mandibular marginal contouring. For the 7-year period from 2004 to 2011, mandibular marginal contouring has been used in 57 consecutive series of Japanese subjects. Patient ages ranged from 18 to 33 years, and the subjects included 15 men and 42 women. The surgery was carried out by cutting off the protruding deformed mandibular margin from the ramus to the symphysis. In 53 of 57 cases, the focus was on angle contouring. Concomitant genioplasty by horizontal osteotomy of the chin was conducted in 42 of 57 cases (recession, advancement, shortening, elongation, and correction of the shift variously). In 22 materials exhibiting bulk around the mandibular, the ramus to the body was excised sagittally and thinned. In all the patients, mandibular marginal contouring from the ramus to the symphysis was completed. Partial masseter muscle resection was conducted in 11 of 57 cases. Mandibular contouring effectively achieved a highly satisfactory result in all cases. The upper portion of the peripheral branch of the trunk of the mental nerve was dissected by an electric scalpel in 1 case but sutured immediately using an 8-0 nylon stitch. Transient palsy of the mental nerve was noticed in a few cases but subsided in 1 to 2 months. No particular complications were encountered. No secondary revision was required in this series. In mandibular angle plasty, mandibular marginal contouring from the ramus to the symphysis should be carried out by cutting off the angle keeping in mind the entire mandibular shape. This concept and the procedure can deliver greater patient satisfaction.

Inferior alveolar nerve block: Alternative technique

PubMed Central

Thangavelu, K.; Kannan, R.; Kumar, N. Senthil

2012-01-01

Background: Inferior alveolar nerve block (IANB) is a technique of dental anesthesia, used to produce anesthesia of the mandibular teeth, gingivae of the mandible and lower lip. The conventional IANB is the most commonly used the nerve block technique for achieving local anesthesia for mandibular surgical procedures. In certain cases, however, this nerve block fails, even when performed by the most experienced clinician. Therefore, it would be advantageous to find an alternative simple technique. Aim and Objective: The objective of this study is to find an alternative inferior alveolar nerve block that has a higher success rate than other routine techniques. To this purpose, a simple painless inferior alveolar nerve block was designed to anesthetize the inferior alveolar nerve. Materials and Methods: This study was conducted in Oral surgery department of Vinayaka Mission's dental college Salem from May 2009 to May 2011. Five hundred patients between the age of 20 years and 65 years who required extraction of teeth in mandible were included in the study. Out of 500 patients 270 were males and 230 were females. The effectiveness of the IANB was evaluated by using a sharp dental explorer in the regions innervated by the inferior alveolar, lingual, and buccal nerves after 3, 5, and 7 min, respectively. Conclusion: This study concludes that inferior alveolar nerve block is an appropriate alternative nerve block to anesthetize inferior alveolar nerve due to its several advantages. PMID:25885503

Inferior alveolar nerve block: Alternative technique.

PubMed

Thangavelu, K; Kannan, R; Kumar, N Senthil

2012-01-01

Inferior alveolar nerve block (IANB) is a technique of dental anesthesia, used to produce anesthesia of the mandibular teeth, gingivae of the mandible and lower lip. The conventional IANB is the most commonly used the nerve block technique for achieving local anesthesia for mandibular surgical procedures. In certain cases, however, this nerve block fails, even when performed by the most experienced clinician. Therefore, it would be advantageous to find an alternative simple technique. The objective of this study is to find an alternative inferior alveolar nerve block that has a higher success rate than other routine techniques. To this purpose, a simple painless inferior alveolar nerve block was designed to anesthetize the inferior alveolar nerve. This study was conducted in Oral surgery department of Vinayaka Mission's dental college Salem from May 2009 to May 2011. Five hundred patients between the age of 20 years and 65 years who required extraction of teeth in mandible were included in the study. Out of 500 patients 270 were males and 230 were females. The effectiveness of the IANB was evaluated by using a sharp dental explorer in the regions innervated by the inferior alveolar, lingual, and buccal nerves after 3, 5, and 7 min, respectively. This study concludes that inferior alveolar nerve block is an appropriate alternative nerve block to anesthetize inferior alveolar nerve due to its several advantages.

Positional relationships between the masticatory muscles and their innervating nerves with special reference to the lateral pterygoid and the midmedial and discotemporal muscle bundles of temporalis

PubMed Central

AKITA, KEIICHI; SHIMOKAWA, TAKASHI; SATO, TATSUO

2000-01-01

For an accurate assessment of jaw movement, it is crucial to understand the comprehensive formation of the masticatory muscles with special reference to the relationship to the disc of the temporomandibular joint. Detailed dissection was performed on 26 head halves of 14 Japanese cadavers in order to obtain precise anatomical information of the positional relationships between the masticatory muscles and the branches of the mandibular nerve. After complete removal of the bony elements, the midmedial muscle bundle in all specimens and the discotemporal muscle bundle in 6 specimens, derivatives of the temporalis, which insert into the disc were observed. On the anterior area of the articular capsule and the disc of the temporomandibular joint, the upper head of the lateral pterygoid, the midmedial muscle bundle of temporalis and the discotemporal bundle of temporalis were attached mediolaterally, and in 3 specimens the posterosuperior margin of the zygomaticomandibularis was attached to the anterolateral area of the disc. It is suggested that these muscles and muscle bundles contribute to various mandibular movements. Although various patterns of the positional relationships between the muscles and muscle bundles and the their innervating nerves are observed in the present study, relative positional relationships of the muscles and muscle bundles and of nerves of the mandibular nerve are consistent. A possible scheme of the developmental formation of the masticatory muscles based on the findings of the positional relationships between the muscles and the nerves is presented. PMID:11005720

Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal: A Retrospective Study.

PubMed

Ge, Jing; Yang, Chi; Zheng, Jiawei; Qian, Wentao

2016-03-01

The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery.Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed.All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment.Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar.

Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal

PubMed Central

Ge, Jing; Yang, Chi; Zheng, Jiawei; Qian, Wentao

2016-01-01

Abstract The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery. Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed. All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment. Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar. PMID:27015214

[Oral Anatomy.

PubMed

Abe, Shinichi

With regard to oral cavity, it is known that jaw bone morphology greatly changes with tooth loss. Therefore, it is necessary to consider the muscles attached to the jaw bone and the surrounding vessels and nerves, in connection with the jaw bone morphology after tooth loss. As an example, the height of the mandibular bone decreases to the position of the mylohyoid line after tooth loss. By this marked morphological change in the alveolar area, the lingual nerve and the lingual artery branches running in the sublingual area on the mandibular inner surface becomes located in the area almost the same as the alveolar crest.

Inferior alveolar nerve cutting; legal liability versus desired patient outcomes.

PubMed

Kim, Soung Min; Lee, Jong Ho

2017-10-01

Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

Blocking the buccal nerve using two methods of inferior alveolar block injection.

PubMed

Aker, F D

2001-01-01

The anatomic relations of the buccal nerve branch of the mandibular division of the trigeminal nerve were studied to explain the rationale for the discrepancy in blocking the buccal nerve using two methods of blocking the inferior alveolar nerve, the conventional method and the Gow-Gates method. The conventional method rarely blocks the buccal nerve, while the Gow-Gates method is reported to consistently block the buccal nerve. Eight head and mandibular specimens were dissected to observe the path of buccal nerve and its relationship to the path of needles in the conventional and Gow-Gates techniques. The buccal nerve descends on the medial and then anterior aspect of the deep head of the temporalis muscle (Tdh). At the latter position the buccal nerve enters the retromolar fossa and is encased in a fascial sleeve created by a dense fascial band that spans between the temporalis muscle tendons and the buccinator muscle. At the level of the conventional block injection the buccal nerve was shielded from the path of the needle by the Tdh and the fascial band. In the Gow-Gates block injection, the buccal nerve was exposed on the medial surface of the Tdh, immediately lateral to the path of the needle and proximal to the fascial sleeve. Consequently, the anatomical relations of the buccal nerve in the conventional block method essentially shield the nerve from being bathed by anesthetic solution while in the Gow-Gates method the relations are such that the buccal nerve can be exposed to anesthetic solution and thus blocked, explaining the findings in clinical dentistry. Copyright Wiley-Liss, Inc.

Anatomy of Mandibular Vital Structures. Part II: Mandibular Incisive Canal, Mental Foramen and Associated Neurovascular Bundles in Relation with Dental Implantology

PubMed Central

Wang, Hom-Lay; Sabalys, Gintautas

2010-01-01

ABSTRACT Objectives The purpose of the present study was to review the literature of how to identify the mental foramen, mandibular incisive canal and associated neurovascular bundles during implant surgery and how to detect and avoid the damage of these vital structures during implant therapy. Material and Methods Literature was selected through a search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular incisive canal, mental foramen, mental nerve, anterior mental loop. The search was restricted to English language articles, published from 1979 to November 2009. Additionally, a manual search in the major anatomy, dental implant, and periodontal journals and books was performed. Results In total, 47 literature sources were obtained and reviewed. The morphology and variations of the mandibular incisive canal, mental foramen and associated neurovascular bundles were presented as two entities. It suggested that clinicians should carefully assess these vital structures to avoid nerve/artery damage. Conclusions The mandibular incisive canal, mental foramen and associated neurovascular bundles exist in different locations and possess many variations. Individual, gender, age, race, assessing technique used and degree of edentulous alveolar bone atrophy largely influence these variations. It suggests that the clinicians should carefully identify these anatomical landmarks, by analyzing all influencing factors, prior to their implant surgical operation. PMID:24421959

Anesthetic Efficacy of Gow-Gates Nerve Block, Inferior Alveolar Nerve Block, and Their Combination in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Clinical Trial.

PubMed

Saatchi, Masoud; Shafiee, Maryam; Khademi, Abbasali; Memarzadeh, Bahareh

2018-03-01

The purpose of this prospective, randomized clinical trial was to evaluate the anesthetic efficacy of the Gow-Gates nerve block (GGNB), the inferior alveolar nerve block (IANB), and their combination for mandibular molars in patients with symptomatic irreversible pulpitis. One hundred fifty patients diagnosed with symptomatic irreversible pulpitis of a mandibular molar were selected. The patients randomly received 2 GGNB injections, 2 IANB injections, or 1 GGNB injection plus 1 IANB injection of 1.8 mL 2% lidocaine with 1:80,000 epinephrine. Access cavity preparation was initiated 15 minutes after injections. Lip numbness was a requisite for all of the patients. Success was specified as no or mild pain on the basis of Heft-Parker visual analog scale recordings during access cavity preparation or initial instrumentation. Data were analyzed with the chi-square, Kruskal-Wallis, and analysis of variance tests. The success rates of anesthesia were 40%, 44%, and 70% for the GGNB, IANB, and GGNB + IANB groups, respectively. There was no statistically significant difference in the success rate of anesthesia between the GGNB and IANB groups (P > .05). The anesthesia success rate for the GGNB + IANB group was significantly different from those of the GGNB and IANB groups (P < .05). A combination of GGNB and IANB could improve the efficacy of anesthesia in mandibular molars with symptomatic irreversible pulpitis, but it would still require supplemental anesthesia. Further research may be needed to confirm the results of this study. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Retroauricular transmeatal approach to manage mandibular condylar head fractures.

PubMed

Benech, Arnaldo; Arcuri, Francesco; Baragiotta, Nicola; Nicolotti, Matteo; Brucoli, Matteo

2011-03-01

There is a multitude of reported surgical approaches and technical variants with some unresolved technical problems to gain direct access to mandibular condylar head fractures; they can be divided into 2 groups: intraoral and extraoral. In 2005, Neff et al (Mund Kiefer Gesichtschir 2005;9:80), supported by a previous experimental work, reported a successful clinical study of condylar head fractures treated by a retroauricular approach; this article is in German, and the later English-language literature does not mention about this approach to open reduction and internal fixation of mandibular condylar fractures. The retroauricular transmeatal access, selected and performed by the senior author to treat 14 patients affected by highly located condylar head fracture, is illustrated in details. We collected data of 14 consecutive adult patients who, after the discussion about all options, had consented to have 16 mandibular condylar head fractures treated with open reduction and internal fixation by miniplates and screws via a retroauricular transmeatal approach. We exposed the temporomandibular joint area easily and better by dissecting via a retroauricular route with identification, ligation, and transection of the retromandibular vein; because of the posterior access, the frontal branch of the facial nerve and the auriculotemporal nerve are located and protected within the substance of the anteriorly retracted flap, superficial to the retromandibular vein. The follow-up clinical examination showed temporary weakness of the frontal branch of the facial nerve in 1 case with a recovery to normal function of 1.6 months; no patients had permanent weakness of the facial nerve or injury of the auriculotemporal nerve. There was absence of any salivary fistula, sialocele, and Frey syndrome; hearing was preserved in all cases, without any auditory stenosis or aesthetic deformity, and there was absence of any infections, hematoma, or scarring. Retroauricular approach provides good exposure of the temporomandibular joint and satisfactory protection from nerve injuries and vascular lesions, allowing an adequate osteosynthesis. The scar is hidden behind the ear, and the morbidity is low in terms of auditory stenosis, aesthetic deformity, and salivary fistulas.

Treatment of chronic mandibular dislocations by eminectomy: follow-up of 10 cases and literature review.

PubMed

Vasconcelos, Belmiro-Cavalcanti do Egito; Porto, Gabriela-Granja; Neto, José-Pacheco-Martins-Ribeiro; Vasconcelos, César-Freire de Melo

2009-11-01

Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence, with complete separation of the articular surfaces and fixation in that position. To report ten cases treated by eminectomy for chronic mandibular dislocations, to evaluate the results of these surgeries and make a critical review of the literature. The sample was obtained from the records of the Department of Oral and Maxillofacial Surgery, University of Pernambuco and comprises cases submitted to chronic mandibular dislocation treatment by eminectomy between 2002 and 2007. Pre- and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxations, recurrence rate and presence of facial nerve paralysis. The mean maximal mouth opening in the preoperative period was 48.4 +/- 8.5 mm and in the postoperative period it was 41.3 +/- 5.0 mm. No facial nerve paralysis or recurrence was observed. The treatment of chronic mandibular dislocations by eminectomy was shown to be efficient in relationship to the postoperative maximal mouth opening, recurrence and articular function.

The Functional Anatomy of Nerves Innervating the Ventral Grooved Blubber of Fin Whales (Balaenoptera Physalus).

PubMed

Vogl, Wayne; Petersen, Hannes; Adams, Arlo; Lillie, Margo A; Shadwick, Robert E

2017-11-01

Nerves that supply the floor of the oral cavity in rorqual whales are extensible to accommodate the dramatic changes in tissue dimensions that occur during "lunge feeding" in this group. We report here that the large nerves innervating the muscle component of the ventral grooved blubber (VGB) in fin whales are branches of cranial nerve VII (facial nerve). Therefore, the muscles of the VGB are homologous to second branchial arch derived muscles, which in humans include the muscles of "facial expression." We speculate, based on the presence of numerous foramina on the dorsolateral surface of the mandibular bones, that general sensation from the VGB likely is carried by branches of the mandibular division (V3) of cranial nerve V (trigeminal nerve), and that these small branches travel in the lipid-rich layer directly underlying the skin. We show that intercostal and phrenic nerves, which are not extensible, have a different wall and nerve core morphology than the large VGB nerves that are branches of VII. Although these VGB nerves are known to have two levels of waviness, the intercostal and phrenic nerves have only one in which the nerve fascicles in the nerve core are moderately wavy. In addition, the VGB nerves have inner and outer parts to their walls with numerous large elastin fibers in the outer part, whereas intercostal and phrenic nerves have single walls formed predominantly of collagen. Our results illustrate that overall nerve morphology depends greatly on location and the forces to which the structures are exposed. Anat Rec, 300:1963-1972, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Efficacy of low level laser therapy on neurosensory recovery after injury to the inferior alveolar nerve

PubMed Central

Ozen, Tuncer; Orhan, Kaan; Gorur, Ilker; Ozturk, Adnan

2006-01-01

Background The most severe complication after the removal of mandibular third molars is injury to the inferior alveolar nerve or the lingual nerve. These complications are rather uncommon (0.4% to 8.4%) and most of them are transient. However, some of them persist for longer than 6 months, which can leave various degrees of long-term permanent disability. While several methods such as pharmacologic therapy, microneurosurgery, autogenous and alloplastic grafting can be used for the treatment of long-standing sensory aberrations in the inferior alveolar nerve, there are few reports regarding low level laser treatment. This paper reports the effects of low level laser therapy in 4 patients with longstanding sensory nerve impairment following mandibular third molar surgery. Methods Four female patients had complaints of paresthesia and dysesthesia of the lip, chin and gingiva, and buccal regions. Each patient had undergone mandibular third molar surgery at least 1 year before. All patients were treated with low level laser therapy. Clinical neurosensory tests (the brush stroke directional discrimination test, 2-point discrimination test, and a subjective assessment of neurosensory function using a visual analog scale) were used before and after treatment, and the responses were plotted over time. Results When the neurosensory assessment scores after treatment with LLL therapy were compared with the baseline values prior to treatment, there was a significant acceleration in the time course, as well as in the magnitude, of neurosensory return. The VAS analysis revealed progressive improvement over time. Conclusion Low level laser therapy seemed to be conducive to the reduction of long-standing sensory nerve impairment following third molar surgery. Further studies are worthwhile regarding the clinical application of this treatment modality. PMID:16480503

[Orthodontic Management of the Impacted Mandibular Second Molar Tooth].

PubMed

Mah, Michael; Takada, Kenji

2016-09-01

When the mandibular permanent second molar becomes impacted, it is identified as a malocclusion that needs treatment as it often leads to unwanted complications such as caries and periodontitis of the adjacent permanent first molar. Other less common complications include root resorption of the adjacent first molar root or continued root development to be in close proximity to the inferior dental alveolar nerve. This paper seeks to differentiate various levels of severity of impaction and review treatment options that are considered clinically available for the proper management of the impacted mandibular permanent second molar. Treatment options that will be discussed in this article include timing of second molar removal for replacement by the third molar, relief of impaction via second premolar removal, surgical repositioning and the combination of third molar removal, surgical exposure and orthodontic uprighting of the impacted tooth. Depending on the severity of the impaction, most impactions can be easily and predictably corrected with nickel titanium archwires or auxillary open coil springs or uprighting springs. Uncommonly, the mandibular permanent second molar can become severely impacted and in close proximity to the inferior dentoalveolar nerve. In these instances, the use of temporary anchorage devices such as microimplants has shown to be successful in uprighting the severely impacted mandibular permanent second molars. © EDP Sciences, SFODF, 2016.

Significance of localization of mandibular foramen in an inferior alveolar nerve block.

PubMed

Thangavelu, K; Kannan, R; Kumar, N Senthil; Rethish, E; Sabitha, S; Sayeeganesh, N

2012-07-01

The mandibular foramen (MF) is an opening on the internal surface of the ramus for divisions of the mandibular vessels and nerve to pass. The aim of this study is to determine the position of the MF from various anatomical landmarks in several dry adult mandibles. A total of 102 human dry mandibles were examined, of which 93 were of dentulous and 9 were of edentulous. The measurements were taken from the anterior border of the ramus (coronoid notch) to the midportion of the MF and then from the midportion of the MF to the other landmarks such as internal oblique ridge, inferior border, sigmoid notch, and condyle were measured and recorded. The data were compared using Student's t-test. The MF is positioned at a mean distance of 19 mm (with SD 2.34) from coronoid notch of the anterior border of the ramus. Superio-inferiorly from the condyle to the inferior border MF is situated 5 mm inferior to the midpoint of condyle to the inferior border distance (ramus height). We conclude that failures in the anesthesia of the inferior alveolar nerve are due to the operator error and not due to the anatomical variation.

The variable position of the inferior alveolar nerve (IAN) in the mandibular ramus: a computed tomography (CT) study.

PubMed

Yeh, Andrew Y E; Finn, Brian P; Jones, Robert H B; Goss, Alastair N

2018-06-01

This study was designed to quantify the important anatomical landmarks and the path of the inferior alveolar nerve (IAN) within the human mandibular body and ramus, in particular with reference to the bilateral sagittal split osteotomy (BSSO). Four hundred and eleven CT scans were studied, 299 of these were involved in determining the position of lingula; and 230 were involved in determining the course of IAN in the mandibular molar region, namely from the mesial of the mandibular first molar to the distal of the mandibular second molar; 118 were involved with both measurements. On average, the lingula was located 17.0 ± 2.2 mm from the external oblique ridge; 11.6 ± 2.0 mm from the internal oblique ridge; 17.2 ± 2.7 mm from the sigmoid notch; and 15.6 ± 1.9 mm from the posterior border of the mandible. The course of the IAN in the mandibular molar region was found to descend vertically from the distal of the mandibular second molar (7) to reach its lowest point between the first and second molars (6 and 7), and then ascend towards the mesial of the first molar (6). Horizontally, the IAN was found to traverse medially between the distal of the 7 and the middle of the 7, and then changes its path laterally towards the mesial of the 6. Precise knowledge of the individual's position of the IAN will help surgical planning.

Virtual Surgical Planning for Inferior Alveolar Nerve Reconstruction.

PubMed

Miloro, Michael; Markiewicz, Michael R

2017-11-01

The purpose of this study was to assess the outcomes after preoperative virtual surgical planning (VSP) for inferior alveolar nerve (IAN) reconstruction in ablative mandibular surgery. We performed a retrospective evaluation of consecutive surgical cases using standard VSP for hard tissue resection and reconstructive surgery in addition to IAN VSP performed simultaneously during surgery. Cases were assessed regarding the planning time, additional costs involved, surgeon's subjective impression of the process, accuracy of the prediction during surgery, and operative time during surgery compared with cases performed without VSP. The study sample was composed of 5 cases of mandibular resection for benign disease, with bony, soft tissue, and neural reconstruction with the use of VSP. The addition of IAN reconstruction to the VSP session added no additional expense to the planning session but resulted in an additional 22.5 minutes (±7.5 minutes) for the webinar session. From a subjective standpoint, IAN VSP provided the surgeon with a discreet plan for surgery. From an objective standpoint, IAN VSP provided the exact length and diameter of nerve graft required for surgery, facilitated the surgeon's ability to visualize the actual nerve graft procedure, and limited the additional time required for simultaneous nerve reconstruction. Despite perceived prejudice against simultaneous IAN reconstruction with complex mandibular resection and reconstruction, the use of IAN VSP may facilitate the actual surgical procedure and result in considerably improved patient outcomes without considerable additional time or cost associated with this protocol. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Neurovascular structures of the mandibular angle and condyle: a comprehensive anatomical review.

PubMed

Yang, Hun-Mu; Won, Sung-Yoon; Kim, Hee-Jin; Hu, Kyung-Seok

2015-11-01

Various surgical interventions including esthetic surgery, salivary gland excision, and open reduction of fracture have been performed in the area around the mandibular angle and condyle. This study aimed to comprehensively review the anatomy of the neurovascular structures on the angle and condyle with recent anatomic and clinical research. We provide detailed information about the branching and distributing patterns of the neurovascular structures at the mandibular angle and condyle, with reported data of measurements and proportions from previous anatomical and clinical research. Our report should serve to help practitioners gain a better understanding of the area in order or reduce potential complications during local procedures. Reckless manipulation during mandibular angle reduction could mutilate arterial branches, not only from the facial artery, but also from the external carotid artery. The transverse facial artery and superficial temporal artery could be damaged during approach and incision in the condylar area. The marginal mandibular branch of the facial nerve can be easily damaged during submandibular gland excision or facial rejuvenation treatment. The main trunk of the facial nerve and its upper and lower distinct divisions have been damaged during parotidectomy, rhytidectomy, and open reductions of condylar fractures. By revisiting the information in the present study, surgeons will be able to more accurately prevent procedure-related complications, such as iatrogenic vascular accidents on the mandibular angle and condyle, complete and partial facial palsy, gustatory sweating (Frey syndrome), and traumatic neuroma after parotidectomy.

Teaching alternatives to the standard inferior alveolar nerve block in dental education: outcomes in clinical practice.

PubMed

Johnson, Thomas M; Badovinac, Rachel; Shaefer, Jeffry

2007-09-01

Surveys were sent to Harvard School of Dental Medicine students and graduates from the classes of 2000 through 2006 to determine their current primary means of achieving mandibular anesthesia. Orthodontists and orthodontic residents were excluded. All subjects received clinical training in the conventional inferior alveolar nerve block and two alternative techniques (the Akinosi mandibular block and the Gow-Gates mandibular block) during their predoctoral dental education. This study tests the hypothesis that students and graduates who received training in the conventional inferior alveolar nerve block, the Akinosi mandibular block, and the Gow-Gates mandibular block will report more frequent current utilization of alternatives to the conventional inferior alveolar nerve block than clinicians trained in the conventional technique only. At the 95 percent confidence level, we estimated that between 3.7 percent and 16.1 percent (mean=8.5 percent) of clinicians trained in using the Gow-Gates technique use this injection technique primarily, and between 35.4 percent and 56.3 percent (mean=47.5 percent) of those trained in the Gow-Gates method never use this technique. At the same confidence level, between 0.0 percent and 3.8 percent (mean=0.0 percent) of clinicians trained in using the Akinosi technique use this injection clinical technique primarily, and between 62.2 percent and 81.1 percent (mean=72.3 percent) of those trained in the Akinosi method never use this technique. No control group that was completely untrained in the Gow-Gates or Akinosi techniques was available for comparison. However, we presume that zero percent of clinicians who have not been trained in a given technique will use the technique in clinical practice. The confidence interval for the Gow-Gates method excludes this value, while the confidence interval for the Akinosi technique includes zero percent. We conclude that, in the study population, formal clinical training in the Gow-Gates and Akinosi injection techniques lead to a small but significant increase in current primary utilization of the Gow-Gates technique. No significant increase in current primary utilization of the Akinosi technique was found.

Inferior alveolar nerve paresthesia after overfilling of endodontic sealer into the mandibular canal.

PubMed

González-Martín, Maribel; Torres-Lagares, Daniel; Gutiérrez-Pérez, José Luis; Segura-Egea, Juan José

2010-08-01

The present study describes a case of endodontic sealer (AH Plus) penetration within and along the mandibular canal from the periapical zone of a lower second molar after endodontic treatment. The clinical manifestations comprised anesthesia of the left side of the lower lip, paresthesia and anesthesia of the gums in the third quadrant, and paresthesia and anesthesia of the left mental nerve, appearing immediately after endodontic treatment. The paresthesia and anesthesia of the lip and gums were seen to decrease, but the mental nerve paresthesia and anesthesia persisted after 3.5 years. This case illustrates the need to expend great care with all endodontic techniques when performing nonsurgical root canal therapy, especially when the root apices are in close proximity to vital anatomic structures such as the inferior alveolar canal. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The influence of mandibular skeletal characteristics on inferior alveolar nerve block anesthesia.

PubMed

You, Tae Min; Kim, Kee-Deog; Huh, Jisun; Woo, Eun-Jung; Park, Wonse

2015-09-01

The inferior alveolar nerve block (IANB) is the most common anesthetic techniques in dentistry; however, its success rate is low. The purpose of this study was to determine the correlation between IANB failure and mandibular skeletal characteristics. In total, 693 cases of lower third molar extraction (n = 575 patients) were examined in this study. The ratio of the condylar and coronoid distances from the mandibular foramen (condyle-coronoid ratio [CC ratio]) was calculated, and the mandibular skeleton was then classified as normal, retrognathic, or prognathic. The correlation between IANB failure and sex, treatment side, and the CC ratio was assessed. The IANB failure rates for normal, retrognathic, and prognathic mandibles were 7.3%, 14.5%, and 9.5%, respectively, and the failure rate was highest among those with a CC ratio < 0.8 (severe retrognathic mandible). The failure rate was significantly higher in the retrognathic group than in normal group (P = 0.019), and there was no statistically significant difference between the other two groups. IANB failure could be attributable, in part, to the skeletal characteristics of the mandible. In addition, the failure rate was found to be significantly higher in the retrognathic group.

The influence of mandibular skeletal characteristics on inferior alveolar nerve block anesthesia

PubMed Central

You, Tae Min; Kim, Kee-Deog; Huh, Jisun; Woo, Eun-Jung

2015-01-01

Background The inferior alveolar nerve block (IANB) is the most common anesthetic techniques in dentistry; however, its success rate is low. The purpose of this study was to determine the correlation between IANB failure and mandibular skeletal characteristics Methods In total, 693 cases of lower third molar extraction (n = 575 patients) were examined in this study. The ratio of the condylar and coronoid distances from the mandibular foramen (condyle-coronoid ratio [CC ratio]) was calculated, and the mandibular skeleton was then classified as normal, retrognathic, or prognathic. The correlation between IANB failure and sex, treatment side, and the CC ratio was assessed. Results The IANB failure rates for normal, retrognathic, and prognathic mandibles were 7.3%, 14.5%, and 9.5%, respectively, and the failure rate was highest among those with a CC ratio < 0.8 (severe retrognathic mandible). The failure rate was significantly higher in the retrognathic group than in normal group (P = 0.019), and there was no statistically significant difference between the other two groups. Conclusions IANB failure could be attributable, in part, to the skeletal characteristics of the mandible. In addition, the failure rate was found to be significantly higher in the retrognathic group. PMID:28879267

Anesthetic Efficacy of 4 % Articaine During Extraction of the Mandibular Posterior Teeth by Using Inferior Alveolar Nerve Block and Buccal Infiltration Techniques.

PubMed

El-Kholey, Khalid E

2017-03-01

The study was designed to evaluate the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine (A100) in infiltration and inferior alveolar nerve block (IANB) anesthetic techniques for the pain control during extraction of the mandibular posterior teeth. This prospective randomized single-blind clinical trial included 100 patients needing extraction of at least two mandibular molars. Patients received either infiltration in the buccal vestibule opposite to the first molar supplemented with lingual infiltration or standard IANB with A100. For assessment of depth of anesthesia obtained by the two anaethetic techniques, presence or absence of pain during the extraction were rated using the visual analog scale. Fifty patients received infiltration anesthesia and fifty patients were anesthetized by IANB. The success rate of pain-free extraction after buccal infiltration was 94 %, whereas by using IANB with the same anesthetic it was 92 %. No statistical differences were detected in the success rates between the two anesthetic techniques ( P  = 0.15). Buccal Infiltration can be considered a good option during extraction of the mandibular molar and premolar teeth of course, with supplemental lingual anesthesia.

Comparison of Anaesthetic Efficacy of 4% Articaine Primary Buccal Infiltration Versus 2% Lidocaine Inferior Alveolar Nerve Block in Symptomatic Mandibular First Molar Teeth.

PubMed

Zain, Muhammad; Rehman Khattak, Shakeel Ur; Sikandar, Huma; Shah, Shafqat Ali; Fayyaz

2016-01-01

To evaluate success of pulpal anaesthesia of mandibular 1st molar by using 4% articaine in buccal infiltration versus 2% lidocaine in inferior alveolar nerve block. Randomized control trial. Department of Operative Dentistry, Sardar Begum Dental College, Gandhara University, Peshawar, from March to August 2014. One hundred and fifty-six emergency patients, who had 1st molar diagnosed with irreversible pulpitis, participated in the study. Subjects were divided into two groups by random allocation. One group received 4% articaine buccal infiltration and the other group received inferior alveolar nerve block of 2% lidocaine. Subjects’self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anaesthetic administration during access cavity preparation and pulp extirpation. Mean age of subjects was 31.46 ±10.994 years. The success rate of 4% buccal infiltration was 76.9%; whereas the success rate of 2% lidocaine inferior alveolar nerve block was 62.8%. There was no statistically significant difference between the two groups. 4% articaine buccal infiltration can be considered a viable alternative to 2% lidocaine inferior alveolar nerve block in securing successful pulpal anaesthesia for endodontic therapy.

Comparative Evaluation of Mental Incisal Nerve Block, Inferior Alveolar Nerve Block, and Their Combination on the Anesthetic Success Rate in Symptomatic Mandibular Premolars: A Randomized Double-blind Clinical Trial.

PubMed

Aggarwal, Vivek; Singla, Mamta; Miglani, Sanjay; Kohli, Sarita

2016-06-01

The purpose of this study was to compare the effectiveness of mental incisive nerve block (MINB) and inferior alveolar nerve block (IANB) that were given alone or in combination to provide anesthesia to symptomatic mandibular premolars. One hundred fifty-three patients participated in this randomized, double-blind clinical trial. The patients were divided into 3 groups; first group received MINB with 2 mL 2% lidocaine with 1:200,000 epinephrine and a mock IANB with 2 mL sterile saline, patients in group 2 received mock MINB and an IANB with 2 mL 2% lidocaine, and patients in group 3 received both MINB and IANB with 2 mL each of 2% lidocaine. Access cavity preparation was initiated after 10 minutes. Success was defined as no pain or faint/weak/mild pain during endodontic access preparation and instrumentation. The anesthetic success rates were analyzed with Pearson χ(2) test at 5% significance levels. The MINB and IANB gave 53% and 47% anesthetic success rates, respectively, with no significant difference between them. Adding an IANB to MINB significantly improved the success rates to 82%. A combination of MINB and IANB can provide improved local anesthesia for symptomatic mandibular premolars. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Unilateral Multiple Facial Nerve Branch Reconstruction Using “End-to-side Loop Graft” Supercharged by Hypoglossal Nerve

PubMed Central

Sasaki, Ryo; Takeuchi, Yuichi; Watanabe, Yorikatsu; Niimi, Yosuke; Sakurai, Hiroyuki; Miyata, Mariko; Yamato, Masayuki

2014-01-01

Background: Extensive facial nerve defects between the facial nerve trunk and its branches can be clinically reconstructed by incorporating double innervation into an end-to-side loop graft technique. This study developed a new animal model to evaluate the technique’s ability to promote nerve regeneration. Methods: Rats were divided into the intact, nonsupercharge, and supercharge groups. Artificially created facial nerve defects were reconstructed with a nerve graft, which was end-to-end sutured from proximal facial nerve stump to the mandibular branch (nonsupercharge group), or with the graft of which other end was end-to-side sutured to the hypoglossal nerve (supercharge group). And they were evaluated after 30 weeks. Results: Axonal diameter was significantly larger in the supercharge group than in the nonsupercharge group for the buccal (3.78 ± 1.68 vs 3.16 ± 1.22; P < 0.0001) and marginal mandibular branches (3.97 ± 2.31 vs 3.46 ± 1.57; P < 0.0001), but the diameter was significantly larger in the intact group for all branches except the temporal branch. In the supercharge group, compound muscle action potential amplitude was significantly higher than in the nonsupercharge group (4.18 ± 1.49 mV vs 1.87 ± 0.37 mV; P < 0.0001) and similar to that in the intact group (4.11 ± 0.68 mV). Retrograde labeling showed that the mimetic muscles were double-innervated by facial and hypoglossal nerve nuclei in the supercharge group. Conclusions: Multiple facial nerve branch reconstruction with an end-to-side loop graft was able to achieve axonal distribution. Additionally, axonal supercharge from the hypoglossal nerve significantly improved outcomes. PMID:25426357

Dietary correlates associated with the mental foramen in primates: implications for interpreting the fossil record.

PubMed

Muchlinski, Magdalena N; Deane, Andrew S

2016-07-01

The mandibular nerve is a sensory and motor nerve that innervates the muscles of mastication, the lower dentition, and the lower lip and surrounding structures. Although this nerve contains both efferent and afferent fibers, the mental nerve, a terminal branch of the mandibular nerve, is a strictly sensory nerve that exits the mental foramen and innervates the lower lip, the skin overlaying the mandible, and the oral mucosa around the mandible. Osteological foramina are often used as proxies for nerve cross section area and they often correlate well with some aspect of a primate's ecology (e.g., optic foramen and visual acuity). The primary objective of this study is to explore the correlation between the mental foramen and dietary preference among primates. The mental foramen of 40 primate species (n = 180) was measured from 3-D surface models of the mandible. Both conventional and phylogenetic tests indicate that although frugivores have larger mental foramina than folivores, the differences were not significant. These results show that while structures like the infraorbital foramen correlate well with diet and touch sensitivity, the mental foramen does not. Based on these findings, the mental foramen is not a suggested morphological character for interpreting of the fossil record. J. Morphol. 277:978-985, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Significance of localization of mandibular foramen in an inferior alveolar nerve block

PubMed Central

Thangavelu, K.; Kannan, R.; Kumar, N. Senthil; Rethish, E.; Sabitha, S.; SayeeGanesh, N.

2012-01-01

Background: The mandibular foramen (MF) is an opening on the internal surface of the ramus for divisions of the mandibular vessels and nerve to pass. The aim of this study is to determine the position of the MF from various anatomical landmarks in several dry adult mandibles. Materials and Methods: A total of 102 human dry mandibles were examined, of which 93 were of dentulous and 9 were of edentulous. The measurements were taken from the anterior border of the ramus (coronoid notch) to the midportion of the MF and then from the midportion of the MF to the other landmarks such as internal oblique ridge, inferior border, sigmoid notch, and condyle were measured and recorded. Results: The data were compared using Student's t-test. The MF is positioned at a mean distance of 19 mm (with SD 2.34) from coronoid notch of the anterior border of the ramus. Superio-inferiorly from the condyle to the inferior border MF is situated 5 mm inferior to the midpoint of condyle to the inferior border distance (ramus height). Conclusion: We conclude that failures in the anesthesia of the inferior alveolar nerve are due to the operator error and not due to the anatomical variation. PMID:23225978

Randomized clinical study comparing piezosurgery and conventional rotatory surgery in mandibular cyst enucleation.

PubMed

Pappalardo, Sabrina; Guarnieri, Renzo

2014-07-01

The aim of the present study is to compare piezoelectric surgery to the conventional rotatory surgery in mandibular cyst enucleation, and to determine the 2 method's suitability and the postoperative outcomes. Eighty patients were included in the study. 35 male and 45 female, which showed cystic mandibular lesions, compared with the inferior alveolar nerve or the mental nerve. The patients were randomly divided into two groups. In the test group, cystectomy was performed using conventional rotatory instrumentation (rotatory-group), and in the other one piezoelectric surgery (piezo-group). The swelling was documented 24/48/72 h and 1 week post-surgery and the patients recorded their subjective postoperative pain daily for 7 days using a Visual Analog Scale (VAS). Patients treated with piezoelectric technique have presented a lower VAS, minor swelling and less recovery time compared to the rotatory-group. No lesions of the mandible nerve were detected with piezosurgery whereas surgery with rotary instruments resulted in 8% hypesthesia at least up to one week. The results of this study suggest that piezosurgery may be considered effective in cyst enucleation compared to traditional procedures with burs, since it grants the patients significantly less post-surgical pain and swelling. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis.

PubMed

Claffey, Elizabeth; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel

2004-08-01

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.

Coronectomy of third molar: a reduced risk technique for inferior alveolar nerve damage.

PubMed

Ahmed, Chkoura; Wafae, El Wady; Bouchra, Taleb

2011-05-01

Causing damage to the inferior alveolar nerve (IAN) when extracting lower third molars is due to the intimate relationship between the nerve and the roots of the teeth. When the proximity radiologic markers between the IAN and the root of the third molars are present, the technique of coronectomy can be proposed as an alternative to extraction to minimize the risk of nerve injury, with minimal complications. Nerve injury after the extraction of the mandibular third molar is a serious complication. The technique of coronectomy can be proposed to minimize the risk.

[Features of maxillary and mandibular nerves imaging during stem regional blockades. From paresthesia to 3D-CT guidance].

PubMed

Zaytsev, A Yu; Nazaryan, D N; Kim, S Yu; Dubrovin, K V; Svetlov, V A; Khovrin, V V

2014-01-01

There are difficulties in procedure of regional block of 2 and 3 brunches of the trigeminal nerve despite availability of many different methods of nerves imaging. The difficulties are connected with complex anatomy structure. Neurostimulation not always effective and as a rule, is accompanied with wrong interpretation of movement response on stimulation. The changing of the tactics on paraesthesia search improves the situation. The use of new methods of nerves imaging (3D-CT) also allows decreasing the frequency of fails during procedure of regional block of the brunches of the trigeminal nerve.

A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth.

PubMed

Kanaa, Mohammad D; Whitworth, John M; Meechan, John Gerard

2012-04-01

The objective of this study was to compare the efficacy of supplementary repeat inferior alveolar nerve block with 2% lidocaine and epinephrine, buccal infiltration with 4% articaine with epinephrine, intraligamentary injection, or intraosseous injection (both with 2% lidocaine with epinephrine) after failed inferior alveolar nerve block (IANB) for securing pain-free treatment in patients experiencing irreversible pulpitis in mandibular permanent teeth. This randomized clinical trial included 182 patients diagnosed with irreversible pulpitis in mandibular teeth. Patients received 2.0 mL of 2% lidocaine with 1:80,000 epinephrine as an IANB injection. Patients who did not experience pain-free treatment received randomly 1 of 4 supplementary techniques, namely repeat lidocaine IANB (rIANB), articaine buccal infiltration (ABI), lidocaine intraligamentary injection (PDL), or lidocaine intraosseous injection (IO). Successful pulp anesthesia was considered to have occurred when no response was obtained to the maximum stimulation (80 reading) of the pulp tester, at which time treatment commenced. Treatment was regarded as being successfully completed when it was associated with no pain. Data were analyzed by χ(2) and Fisher exact tests. Of the 182 patients, 122 achieved successful pulpal anesthesia within 10 minutes after initial IANB injection; 82 experienced pain-free treatment. ABI and IO allowed more successful (pain-free) treatment (84% and 68%, respectively) than rIANB or PDL supplementary techniques (32% and 48%, respectively); this was statistically significant (P = .001). IANB injection alone does not always allow pain-free treatment for mandibular teeth with irreversible pulpitis. Supplementary buccal infiltration with 4% articaine with epinephrine and intraosseous injection with 2% lidocaine with epinephrine are more likely to allow pain-free treatment than intraligamentary and repeat IANB injections with 2% lidocaine with epinephrine for patients experiencing irreversible pulpitis in mandibular permanent teeth. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures.

PubMed

Shi, Dan; Patil, Pavan Manohar; Gupta, Ritika

2015-04-01

To document facial nerve (FN) injuries after surgical treatment of mandibular condylar fractures using the retromandibular transparotid approach and to identify risk factors associated with these injuries. A retrospective study of patients surgically treated for mandibular condylar fractures using the retromandibular transparotid approach over seven years was conducted. The primary study variable was the postoperative change in FN function after fracture fixation. Risk factors were categorized as demographic, anatomic, experience of the operator, fracture displacement/dislocation and number of miniplates placed at the fracture site. Appropriate statistics were computed. Ninety patients with 102 fractures were analysed. Thirty two fractures (31%) were located in the condylar neck and 70 fractures (69%) were subcondylar (located below the sigmoid notch). The condylar segment was undisplaced in twelve cases (12%), displaced medially in thirty five (34%), laterally displaced in thirty (29%) and dislocated in 25 (24.5%). In 18 fractures (18%), postoperative examination revealed various degrees of damage to the FN. All nerve injuries recovered completely in 8-24 weeks. In a multivariate model, condylar neck fractures, fracture dislocation and operator inexperience were associated with a statistically significant risk of postoperative deterioration of FN function (P ≤ 0.05). The majority of facial nerve injuries after surgical treatment of condylar fractures by the retromandibular transparotid approach are transient in nature. Condylar neck fractures, fracture dislocation and operator inexperience were associated with an increased risk for FN injury. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Flare-up with associated paresthesia of a mandibular second premolar with three root canals.

PubMed

Glassman, G D

1987-07-01

A case report is presented that deals with mental nerve paresthesia resulting from the "flare-up" of a mandibular second premolar with three root canals. A review of the literature and discussion follow, which suggest possible mechanisms that may be responsible for paresthesia as well as treatment regimens that may be used to minimize the incidence of this unexpected but occasional post-treatment endodontic sequela.

Endoscopically assisted enucleation of a large mandibular periapical cyst.

PubMed

Nestal Zibo, Heleia; Miller, Ene

2011-01-01

Enucleation of large cysts in the jaws is an invasive method that might be associated with complications. Marsupialization is a less invasive alternative method but it involves a prolonged and uncomfortable healing period. This study addresses a contemporaneous and less invasive surgical technique for treating larger mandibular cysts. MATERIALS AND METHODS. A 48-year-old woman presented with a large mandibular apical cyst involving the left parasymphysis, body, ramus and condylar neck, with involvement of the alveolar inferior nerve. The cystic lesion was enucleated using a 30° 4.0 mm endoscopic scope and endoscopic instruments through two small accesses: the ostectomy site of previously performed marsupialization and the alveolus of the involved third molar extracted of the time of the enucleation of the cyst. RESULTS. The endoscopic scope provided good visualization of the whole cystic cavity allowing the removal of any residual pathologic tissue and preservation of the integrity of the involved inferior alveolar nerve. The morbidity of the surgical procedure was extremely reduced. At a 6-month follow-up the patient did not present any symptom of inflammation and a panoramic X-ray showed good bone repair and remodelation. CONCLUSIONS. Endoscopically assisted enucleation proved to be effective method of treating a large mandibular cyst, providing total enucleation with a minimal invasive technique.

A fine-structural survey of the pulpal innervation in the rat mandibular incisor.

PubMed

Bishop, M A

1981-02-01

The innervation of the rat incisor pulp has been studied using transmission electron microscopy and light microscopy. Transverse sections of mandibular incisor pulp (380-460 gm rats) from numerous positions in the long axis of the tooth were examined systematically in the electron microscopy. Quantitative data on total axon populations were obtained. The nerve fibers were found to pass through the lingual half of the pulp from the apical end to within 2 mm of the incisal tip. Although the nerve fibers were seen to lie amongst the connective tissue cells between the blood vessels, the electron microscopic observations showed that the blood vessels are not innervated. Throughout their pulpal course the nerve fibers showed no trace of perineurial investment. Virtually all the axons were unmyelinated. Total numbers of axons were small (233-328) and peak diameters of 0.3-0.4 microM confirmed the observed immature appearance of the nerve supply. Obvious nerve endings were seldom observed and the axons showed no structural association with odontoblasts. The evidence indicates that, although most axons terminate near the incisal end of the tooth, no specific structure is supplied. The qualitative features of the axons do not suggest autonomic function; however, they are consistent with a sensory role.

Ramus marginalis mandibulae nervus facialis palsy in hemifacial microsomia.

PubMed

Silvestri, A; Mariani, G; Vernucci, R A

2008-12-01

The paralysis of the ramus marginalis mandibulae nervus facialis may occur in Hemifacial Microsomia (HM); the combination of both HM and palsy contributes to an elongation of the mandibular body. This study explores a possible correlation between neurological deficit, muscular atony, and structural deficiency. Of 58 patients with HM who had come to the University of Rome (Sapienza) Pre-surgical Orthodontics Unit, 4 patients were afflicted with Hemifacial Microsomia and ramus marginalis mandibulae nervus palsy; these patients underwent physical, neurological, opthamologic and systemic examinations. The results were then analysed in order to determine a possible correlation between neuro-muscular and structural deficit. Electroneurographic and electromyographic examinations were performed to estimate facial nerve and muscles involvement. Neuroelectrographic exam showed a damage of the nervous motor fibres of the facial nerve ipsilateral to HM, with an associated damage of the muscular function, while neuro-muscular functions on the healthy side were normal. The peripheral nervous and muscular deficits affect the function of facial soft tissues and the growth of mandibular body with an asymmetry characterised by a hypodevelopment of the ramus (due to the HM) and by an elongation of the mandibular body (due to ramus marginalis mandibulae nerve palsy), so that the chin deviation is contralateral to HM. In these forms, a neurological examination is necessary to assess the neurological damage on the HM side. Neuromuscular deficiency can also contribute to a relapse tendency after a surgical-orthodontic treatment.

Anesthetic efficacy of the supplemental X-tip intraosseous injection in patients with irreversible pulpitis.

PubMed

Nusstein, John; Kennedy, Shawn; Reader, Al; Beck, Mike; Weaver, Joel

2003-11-01

The purpose of this study was to determine the anesthetic efficacy of the supplemental intraosseous injection, using the X-tip system in an apical location, in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve block failed. Thirty-three emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe pain on endodontic access. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The X-tip injection site was 3- to 7-mm apical to the mucogingival junction of the affected tooth. Success of the X-tip intraosseous injection was defined as none or mild pain on endodontic access or initial instrumentation. The results of this study demonstrated that 6 of 33 (18%) X-tip injections resulted in backflow of anesthetic solution into the oral cavity; none were successful in obtaining anesthesia. Twenty-seven of the remaining 33 X-tip injections (82%) were successful. We conclude that when the inferior alveolar nerve block fails to provide profound pulpal anesthesia, the X-tip system, when used in an apical location and when there was no backflow of the anesthetic solution into the oral cavity, was successful in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.

The occurrence of paraesthesia of the maxillary division of the trigeminal nerve after dental local anaesthetic use: a case report.

PubMed

Moorthy, Advan; Stassen, Leo F A

2015-01-01

Paraesthesia can be a complication of surgical intervention. Its occurrence after dental local anaesthetic use is a rare event in general dental practice. Reported cases have mainly described its presentation for the mandibular division of the trigeminal nerve with very few reports for the maxillary division of this nerve. This report describes a case of paraesthesia in the maxillary region following local anaesthetic use prior to removal of an upper molar tooth.

Tic douloureux.

PubMed

Sweeney, P J

1981-02-01

Tic douloureux (trigerminal neuralgia) usually has its onset in the sixth or seventh decade and is characterized by severe, excruciating facial pain which is almost always unilateral. The mandibular division and the maxillary division of the fifth cranial nerve are most commonly affected. Carbamazepine is the drug of choice. Currently popular surgical procedures include decompression of the fifth cranial nerve and percutaneous thermal lesioning of the gasserian ganglion.

Endodontic-related inferior alveolar nerve injuries: A review and a therapeutic flow chart.

PubMed

Castro, R; Guivarc'h, M; Foletti, J M; Catherine, J H; Chossegros, C; Guyot, L

2018-05-03

Inferior alveolar nerve (IAN) lesions related to endodontic treatments can be explained by the anatomical proximity between the apices of the mandibular posterior teeth and the mandibular canal. The aim of this article is to review the management of inferior alveolar nerve lesions due to endodontic treatments and to establish a therapeutic flow chart. A review of publications reporting IAN damage related to endodontic treatment over the past 20 years has been conducted, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; it combines an electronic search of the Pubmed ® and Google Scholar ® databasis. Forty-two full-text articles corresponding to 115 clinical cases have been selected. Two personal clinical cases were additionally reported. IAN lesions due to endodontic treatments require urgent management. Early surgical removal of the excess of endodontic material, in contact with the nerve allows the best recovery prognosis (72h). Beyond this delay, irreversible nervous lesions prevail and a medical symptomatic treatment, most of the time with pregabalin, must be/can be carried out. A delayed surgical procedure shows some good benefits for patients. However, the healing prognosis remains poorly predictable. Copyright © 2018. Published by Elsevier Masson SAS.

Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis.

PubMed

Bigby, Jason; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel

2006-11-01

The purpose of this study was to determine the anesthetic efficacy and heart rate effect of 4% articaine with 1:100,000 epinephrine for supplemental intraosseous injection in mandibular posterior teeth diagnosed with irreversible pulpitis. Thirty-seven emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe pain upon endodontic access. The Stabident system was used to administer 1.8 ml of 4% articaine with 1:100,000 epinephrine. Success of the intraosseous injection was defined as none or mild pain upon endodontic access or initial instrumentation. The results demonstrated that anesthetic success was obtained in 86% (32 of 37) of the patients. Maximum mean heart rate was increased 32 beats/minute during the intraosseous injection. We can conclude that when the inferior alveolar nerve block fails to provide profound pulpal anesthesia, the intraosseous injection of 4% articaine with 1:100,000 epinephrine would be successful 86% of the time in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.

Bi-modal radiofrequency treatment for coexisting neuralgia and neuropathy in adjacent divisions of the trigeminal nerve.

PubMed

Bhatjiwale, M; Bhatjiwale, M; Naik, L D; Chopade, P

2018-05-29

Trigeminal neuralgia and deafferentation neuropathic pain, or trigeminal neuropathy, are different symptomatologies, rarely reported to present together. The case of a 65-year-old gentleman suffering from trigeminal neuralgia of the maxillary and mandibular division is reported. He first underwent an infraorbital neurectomy that was complicated by deafferentation neuropathic pain, whilst his mandibular neuralgia continued. He was treated successfully for both the neuropathic and neuralgic symptoms in the same session using ultra-extended euthermic pulsed radiofrequency treatment for the maxillary division (V2) and radiofrequency thermocoagulation for the mandibular division (V3). This report is novel in describing the use of dual modalities in the same session for two distinct coexisting clinical entities in two different divisions of the same cranial nerve. The use of ultra-extended pulsed radiofrequency treatment for neuropathic pain in this case is also unique. Nearly 2years after the procedure, the patient continues to have complete pain relief. Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Cleaning and decompression of inferior alveolar canal to treat dysesthesia and paresthesia following endodontic treatment of a third molar.

PubMed

Scala, Rudy; Cucchi, Alessandro; Cappellina, Luca; Ghensi, Paolo

2014-01-01

Endodontic overfilling involving the mandibular canal may cause an injury of the inferior alveolar nerve (IAN). We report a case of disabling dysesthesia and paresthesia of a 70-year-old man after endodontic treatment of his mandibular left third molar that caused leakage of root canal filling material into the mandibular canal. After radiographic evaluation, extraction of the third molar and distal osteotomy, a surgical exploration was performed and followed by removal of the material and decompression of the IAN. The patient reported an improvement in sensation and immediate disappearance of dysesthesia already from the first postoperative day.

Anatomic study on mental canal and incisive nerve canal in interforaminal region in Chinese population.

PubMed

Xu, Yun; Suo, Ning; Tian, Xiufen; Li, Fei; Zhong, Guangxin; Liu, Xiaoran; Bao, Yongxing; Song, Tao; Tian, Hua

2015-08-01

This study was aimed to detect the positions of mental canal and incisive nerve canal as well as the prolongation of mandibular canal in interforaminal region in Chinese population to supply the reference data of the surgical safe zone in chin for clinicians. A total of 80 formalin-fixed semi-mandibles of Chinese adult cadavers were dissected, the positions and courses of mental canal and incisive nerve canal as well as the prolongation of mandibular canal in interforaminal region were measured. The mental foramina were present in all cases (100 %), and most of them were located below 2nd premolar (58.75 %). Accessory mental foramina were observed in 5 %. The anterior end of mandibular canal, extending along the course of 7.37 ± 1.10 mm above the lower border of mandible to interforaminal region about 3.54 ± 0.70 mm medial to the mental foramen, most often ended below between the two premolars (73.75 %), where it continued as the incisive nerve canal (100 %) and the mental canal (96.25 %). Mental canal, with the wall formed by compact bone, being 2.60 ± 0.60 mm in diameter and 4.01 ± 1.20 mm in length, opened into mental foramen. Incisive nerve canal, with the wall formed by thin compact bone and/or partly or completely by spongy bone, being 1.76 ± 0.27 mm in diameter and 24.87 ± 2.23 mm in length, extended to the incisor region along the course of 9.53 ± 1.43 mm above the lower border of mandible, and most often ended below the lateral incisor (70.00 %). This research recommended for chin operations in Chinese population: the surgical safe zone could be set in the region about over 4 mm anterior to the mental foramen, and over 12 mm above inferior border of mandible for anterior alveolar surgery, or within 9 mm above inferior border of mandible for genioplasty.

Locally Produced BDNF Promotes Sclerotic Change in Alveolar Bone after Nerve Injury

PubMed Central

Ida-Yonemochi, Hiroko; Yamada, Yurie; Yoshikawa, Hiroyuki

2017-01-01

Brain-derived neurotrophic factor (BDNF), which is released due to nerve injury, is known to promote the natural healing of injured nerves. It is often observed that damage of mandibular canal induces local sclerotic changes in alveolar bone. We reported that peripheral nerve injury promotes the local production of BDNF; therefore, it was possible to hypothesize that peripheral nerve injury affects sclerotic changes in the alveolar bone. This study aimed to evaluate the effect of BDNF on osteogenesis using in vitro osteoblast-lineage cell culture and an in vivo rat osteotomy model. MC3T3-E1 cells were cultured with BDNF and were examined for cell proliferative activity, chemotaxis and mRNA expression levels of osteoblast differentiation markers. For in vivo study, inferior alveolar nerve (IAN) injury experiments and mandibular cortical osteotomy were performed using a rat model. In the osteotomy model, exogenous BDNF was applied to bone surfaces after corticotomy of the mandible, and we morphologically analyzed the new bone formation. As a result, mRNA expression of osteoblast differentiation marker, osteocalcin, was significantly increased by BDNF, although cell proliferation and migration were not affected. In the in vivo study, osteopontin-positive new bone formation was significantly accelerated in the BDNF-grafted groups, and active bone remodeling, involving trkB-positive osteoblasts and osteocytes, continued after 28 days. In conclusion, BDNF stimulated the differentiation of MC3T3-E1 cells and it promoted new bone formation and maturation. These results suggested that local BDNF produced by peripheral nerve injury contributes to accelerating sclerotic changes in the alveolar bone. PMID:28072837

CASE SERIES: Malignant Peripheral Nerve Sheath Tumor in the Course of the Mandibular Nerve.

PubMed

Monika, Probst; Steffen, Koerdt; Maximilian, Ritschl Lucas; Oliver, Bissinger; Friederike, Liesche; Jens, Gempt; Bernhard, Meyer; Egon, Burian; Nina, Lummel; Andreas, Kolk

2018-06-05

Malignant peripheral nerve sheath tumors (MPNST) are infiltrating, aggressive tumors belonging to the group of soft tissue sarcomas. This report refers to three patients with a tumorous swelling in the entire inferior alveolar nerve (IAN) with similar disease courses suspect for a MPNST, which is particularly rare in the trigeminal nerve. Diagnostic tools, surgical proceedings and reconstructive procedures were highlighted. Three male patients (58-68 years), who suffered from numbness, pain and mild swelling in the sensation area served by the mental nerve presented at the department of oral and maxillofacial surgery and underwent diagnostic workup including CT, MRI, F18-PET-CT, as well as a biopsy of the clinical visible tumor mass with histopathological and molecular pathological analysis. MR imaging revealed the full extent of the tumor comprising the course of the entire mandibular nerve (one case bilateral) starting in the trigeminal ganglion through the IAN and ending in the mental foramen. Hence, both a neurosurgical and maxillofacial intervention with jaw replacement were necessary. Adjuvant radiation of the intracranial closed resection margins, and in one case of parts of the mandible was required. In order to reveal the full extent of tumor spread of MPNSTs sufficient preoperative imaging is crucial as it is an important step in therapy planning. MRI and PET-CT are the imaging modalities with the best prospect of success in depicting the whole extent of the disease. Radical surgical management is the treatment of choice whereas radiochemotherapy shows an ancillary part. Copyright © 2018 Elsevier Inc. All rights reserved.

Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part II: a Systematic Review of Neurosensory Complications.

PubMed

Abayev, Boris; Juodzbalys, Gintaras

2015-01-01

This article, the second in a two-part series, continues the discussion of inferior alveolar nerve lateralization/transposition for dental implant placement. The aim of this article is to review the scientific literature and clinical reports in order to analyse the neurosensory complications, risks and disadvantages of lateralization/transposition of the inferior alveolar nerve followed by implant placement in an edentulous atrophic posterior mandible. A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC databases, as well as academic sites and books. The articles were searched from January 1997 to July 2014. Articles in English language, which included adult patients between 18 - 80 years of age who had minimal residual bone above the mandibular canal and had undergone inferior alveolar nerve (IAN) repositioning, with minimum 6 months of follow-up, were included. A total of 21 studies were included in this review. Ten were related to IAN transposition, 7 to IAN lateralization and 4 to both transposition and lateralization. The IAN neurosensory disturbance function was present in most patients (99.47% [376/378]) for 1 to 6 months. In total, 0.53% (2/378) of procedures the disturbances were permanent. Inferior alveolar nerve repositioning is related to initial transient change in sensation in the majority of cases. The most popular causes of nerve damage are spatula-caused traction in the mucoperiosteal flap, pressure due to severe inflammation or retention of fluid around the nerve and subsequent development of transient ischemia, and mandibular body fracture.

A case of mental nerve paresthesia due to dynamic compression of alveolar inferior nerve along an elongated styloid process.

PubMed

Gooris, Peter J J; Zijlmans, Jan C M; Bergsma, J Eelco; Mensink, Gertjan

2014-07-01

Spontaneous paresthesia of the mental nerve is considered an ominous clinical sign. Mental nerve paresthesia has also been referred to as numb chin syndrome. Several potentially different factors have been investigated for their role in interfering with the inferior alveolar nerve (IAN) and causing mental nerve neuropathy. In the present case, the patient had an elongated calcified styloid process that we hypothesized had caused IAN irritation during mandibular movement. This eventually resulted in progressive loss of sensation in the mental nerve region. To our knowledge, this dynamic irritation, with complete recovery after resection of the styloid process, has not been previously reported. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Submandibular approach to the C2-3 disc level: microsurgical anatomy with clinical application.

PubMed

Russo, Antonino; Albanese, Erminia; Quiroga, Monica; Ulm, Arthur J

2009-04-01

Approaching the C2-3 disc level is challenging because of its location behind the mandible and the vital neurovascular structures overlying the area. The purpose of this study was to illustrate in a stepwise fashion the microsurgical anatomy of the submandibular approach to the C2-3 disc. Ten adult formalin-fixed cadaveric specimens (20 sides) were studied. Particular attention was paid to the structures limiting the exposure. The authors measured the distance between the inferior border of the mandible and the marginal mandibular branch of the facial nerve running inferior to the mandible, the distance between the horizontal segment of the hypoglossal nerve and the hyoid bone, and the distance between the horizontal segment of the hypoglossal nerve and the mandible. They compared the location of the superior laryngeal nerve with regard to the submandibular and the standard Smith-Robinson approaches. A clinical case illustrating the usefulness of the surgical technique in this region is presented. The mean distance between the inferior border of the mandible and the lowest point of the marginal mandibular branch of the facial nerve was 6.7 +/- 1.69 mm. The hypoglossal nerve's mean distance above the hyoid bone was 8.4 +/- 1.78 mm and below the mandible was 19.6 +/- 6.39 mm. The internal branch of the superior laryngeal nerve, with respect to the cervical spine, always entered the thyrohyoid membrane just inferior to the C-3 vertebral body. The superior laryngeal nerve was found to be an impediment to approaching the C2-3 disc through the standard Smith-Robinson approach. The submandibular approach provides excellent exposure, with a perpendicular view of the C2-3 disc level. This approach is one of the options to be considered when dealing with high cervical pathologies.

FAMI Screws for Mandibulo-Maxillary fixation in mandibular fracture treatment - Clinico-radiological evaluation.

PubMed

Kauke, Martin; Safi, Ali-Farid; Timmer, Marco; Nickenig, Hans-Joachim; Zöller, Joachim; Kreppel, Matthias

2018-04-01

Mandibulo-maxillary fixation (MMF) is indispensable for mandibular fracture treatment. Various means for MMF have been proposed, of which arch bars are widely considered to be the mainstay. However, disadvantages to this method have initiated a quest for an alternative, leading to the introduction of MMF screws. MMF screws have frequently been criticized for poor stability of fracture sites, root damage, hardware failure, and nerve damage. We retrospectively evaluate the FAMI (Fixation and Adaptation in Mandibular Injuries) screw in mandibular fracture treatment by scanning for clinically and radiologically visible complications. In total, 534 FAMI screws were used in the successful treatment of 96 males and 34 females. Condylar fractures were most commonly encountered, representing 120 of 241 fracture sites. 15 general fracture-related complications occurred, with the most common being nerve function impairment (3.8%) and postoperative malocclusion (4.6%). In nine cases (7%), clinically visible FAMI-screw-related complications occurred, with the most prevalent being screw loosening (2.3%) and mucosal signs of inflammation (3.1%). Duration of FAMI screws was associated with the occurrence of clinically visible complications (p = 0.042). Radiologically, clinically invisible dental hard tissue damage was noted in 21 individuals (16%). Therefore, FAMI screws seem to be a reliable and safe method for mandibulo-maxillary fixation. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Comparative Analysis of the Anesthetic Efficacy of 0.5 and 0.75 % Ropivacaine for Inferior Alveolar Nerve Block in Surgical Removal of Impacted Mandibular Third Molars.

PubMed

Bhargava, Darpan; Chakravorty, Nupur; Rethish, Elangovan; Deshpande, Ashwini

2014-12-01

Ropivacaine belongs to pipecoloxylidide group of local anesthetics. There are reports supporting the use of ropivacaine as a long acting local anesthetic in oral and maxillofacial surgical procedures, with variable data on the concentration that is clinically suitable. A prospective randomized double-blind study protocol was undertaken to assess the efficacy of 0.5 and 0.75 % ropivacaine for inferior alveolar nerve block in surgical extraction of impacted mandibular third molars. A total of 60 procedures were performed, of which thirty patients received 0.5 % and thirty received 0.75 % concentration of the study drug. All the patients in both the study groups reported subjective numbness of lip and tongue. The time of onset was longer for 0.5 % ropivacaine when compared to 0.75 % solution. 90 % of the study patients in 0.5 % ropivacaine group reported pain corresponding to VAS ≥3 during bone guttering and 93.3 % patients reported pain corresponding to VAS >4 during tooth elevation. None of the patients in 0.75 % ropivacaine group reported VAS >3 at any stage of the surgical procedure. The duration of soft tissue anesthesia recorded with 0.75 % ropivacaine was average 287.57 ± 42.0 min. 0.75 % ropivacaine was found suitable for inferior alveolar nerve blocks in surgical extraction of impacted mandibular third molars.

Facial Paralysis in Patients With Hemifacial Microsomia: Frequency, Distribution, and Association With Other OMENS Abnormalities.

PubMed

Li, Qiang; Zhou, Xu; Wang, Yue; Qian, Jin; Zhang, Qingguo

2018-05-15

Although facial paralysis is a fundamental feature of hemifacial microsomia, the frequency and distribution of nerve abnormalities in patients with hemifacial microsomia remain unclear. In this study, the authors classified 1125 cases with microtia (including 339 patients with hemifacial microsomia and 786 with isolated microtia) according to Orbital Distortion Mandibular Hypoplasia Ear Anomaly Nerve Involvement Soft Tissue Dependency (OMENS) scheme. Then, the authors performed an independent analysis to describe the distribution feature of nerve abnormalities and reveal the possible relationships between facial paralysis and the other 4 fundamental features in the OMENS system. Results revealed that facial paralysis is present 23.9% of patients with hemifacial microsomia. The frontal-temporal branch is the most vulnerable branch in the total 1125 cases with microtia. The occurrence of facial paralysis is positively correlated with mandibular hypoplasia and soft tissue deficiency both in the total 1125 cases and the hemifacial microsomia patients. Orbital asymmetry is related to facial paralysis only in the total microtia cases, and ear deformity is related to facial paralysis only in hemifacial microsomia patients. No significant association was found between the severity of facial paralysis and any of the other 4 OMENS anomalies. These data suggest that the occurrence of facial paralysis may be associated with other OMENS abnormalities. The presence of serious mandibular hypoplasia or soft tissue deficiency should alert the clinician to a high possibility but not a high severity of facial paralysis.

Diplopia after inferior alveolar nerve block: case report and related physiology.

PubMed

You, Tae Min

2015-06-01

Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management.

Diplopia after inferior alveolar nerve block: case report and related physiology

PubMed Central

2015-01-01

Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management. PMID:28879264

[Trigeminal motor paralysis and dislocation of the temporo-mandibular joints].

PubMed

Ohkawa, S; Yoshida, T; Ohsumi, Y; Tabuchi, M

1996-07-01

A 64-year-old woman with diabetes mellitus was admitted to our hospital with left hemiparesis of sudden onset. A brain MRI demonstrated a cerebral infarction in the ventral part of the right lower pons. When left hemiparesis worsened, she had dislocation of the temporo-mandibular joints repeatedly. Then, her lower jaw deviated to the right when she opened her mouth. Also, there was decreased contraction of the right masseter when she clenched her teeth. These findings suggest that there was trigeminal motor paralysis on the right side resulting from involvement of the intrapontine trigeminal motor nerve. She has no history of dislocation of the temporo-mandibular joints. An X-ray film showed that the temporo-mandibular joints were intact. Thus, it is possible that deviation of the lower jaw was the cause of this dislocation. We suspect that dislocation of the temporo-mandibular joints may occur as a complication of unilateral trigeminal motor paralysis. This has not been reported to our knowledge.

Ocular complications associated with local anesthesia administration in dentistry.

PubMed

Boynes, Sean G; Echeverria, Zydnia; Abdulwahab, Mohammad

2010-10-01

The most widely used method for controlling pain during dental procedures is the intraoral administration of local anesthetics in close proximity to a specific nerve or fiber to obtund nerve conduction. The most commonly anesthetized nerves in dentistry are branches or nerve trunks associated with the maxillary and mandibular divisions of the trigeminal nerve (cranial nerve V). However, other nerves may be inadvertently affected by intraoral local anesthesia injections, resulting in anesthetic complications of structures far from the oral cavity. Practitioners should be aware of potential ocular complications following intraoral injections in dentistry. These complications include oculomotor paralysis and vision loss. The knowledge of these conditions and their potential cause should alert the dentist to the importance of appropriate injection techniques and an understanding of management protocol. Copyright © 2010 Elsevier Inc. All rights reserved.

Anesthetic efficacy of the supplemental X-tip intraosseous injection using 4% articaine with 1:100,000 adrenaline in patients with irreversible pulpitis: An in vivo study.

PubMed

Bhuyan, Atool Chandra; Latha, Satheesh Sasidharan; Jain, Shefali; Kataki, Rubi

2014-11-01

Pain management remains the utmost important qualifying criteria in minimizing patient agony and establishing a strong dentist-patient rapport. Symptomatic irreversible pulpitis is a painful condition necessitating immediate attention and supplemental anesthetic techniques are often resorted to in addition to conventional inferior alveolar nerve block. The purpose of the study was to evaluate the anesthetic efficacy of X-tip intraosseous injection in patients with symptomatic irreversible pulpitis, in mandibular posterior teeth, using 4% Articaine with 1:100,000 adrenaline as local anesthetic, when the conventional inferior alveolar nerve block proved ineffective. X-tip system was used to administer 1.7 ml of 4% articaine with 1:100,000 adrenaline in 30 patients diagnosed with irreversible pulpitis of mandibular posterior teeth with moderate to severe pain on endodontic access after administration of an inferior alveolar nerve block. The results of the study showed that 25 X-tip injections (83.33%) were successful and 5 X-tip injections (16.66%) were unsuccessful. When the inferior alveolar nerve block fails to provide adequate pulpal anesthesia, X-tip system using 4% articaine with 1:100,000 adrenaline was successful in achieving pulpal anesthesia in patients with irreversible pulpitis.

Clinical significance of computed tomography assessment for third molar surgery

PubMed Central

Nakamori, Kenji; Tomihara, Kei; Noguchi, Makoto

2014-01-01

Surgical extraction of the third molar is the most commonly performed surgical procedure in the clinical practice of oral surgery. Third molar surgery is warranted when there is inadequate space for eruption, malpositioning, or risk for cyst or odontogenic tumor formation. Preoperative assessment should include a detailed morphologic analysis of the third molar and its relationship to adjacent structures and surrounding tissues. Due to developments in medical engineering technology, computed tomography (CT) now plays a critical role in providing the clear images required for adequate assessment prior to third molar surgery. Removal of the maxillary third molar is associated with a risk for maxillary sinus perforation, whereas removal of the mandibular third molar can put patients at risk for a neurosensory deficit from damage to the lingual nerve or inferior alveolar nerve. Multiple factors, including demographic, anatomic, and treatment-related factors, influence the incidence of nerve injury during or following removal of the third molar. CT assessment of the third molar prior to surgery can identify some of these risk factors, such as the absence of cortication between the mandibular third molar and the inferior alveolar canal, prior to surgery to reduce the risk for nerve damage. This topic highlight presents an overview of the clinical significance of CT assessment in third molar surgery. PMID:25071882

Anesthetic efficacy of the supplemental X-tip intraosseous injection using 4% articaine with 1:100,000 adrenaline in patients with irreversible pulpitis: An in vivo study

PubMed Central

Bhuyan, Atool Chandra; Latha, Satheesh Sasidharan; Jain, Shefali; Kataki, Rubi

2014-01-01

Introduction: Pain management remains the utmost important qualifying criteria in minimizing patient agony and establishing a strong dentist–patient rapport. Symptomatic irreversible pulpitis is a painful condition necessitating immediate attention and supplemental anesthetic techniques are often resorted to in addition to conventional inferior alveolar nerve block. Aim: The purpose of the study was to evaluate the anesthetic efficacy of X-tip intraosseous injection in patients with symptomatic irreversible pulpitis, in mandibular posterior teeth, using 4% Articaine with 1:100,000 adrenaline as local anesthetic, when the conventional inferior alveolar nerve block proved ineffective. Materials and Methods: X-tip system was used to administer 1.7 ml of 4% articaine with 1:100,000 adrenaline in 30 patients diagnosed with irreversible pulpitis of mandibular posterior teeth with moderate to severe pain on endodontic access after administration of an inferior alveolar nerve block. Results: The results of the study showed that 25 X-tip injections (83.33%) were successful and 5 X-tip injections (16.66%) were unsuccessful. Conclusion: When the inferior alveolar nerve block fails to provide adequate pulpal anesthesia, X-tip system using 4% articaine with 1:100,000 adrenaline was successful in achieving pulpal anesthesia in patients with irreversible pulpitis. PMID:25506137

Application of Digital Diagnosis and Treatment Technique in Benign Mandibular Diseases.

PubMed

Ju, Rui; Zeng, Wei; Lian, Xiaotian; Chen, Gang; Yin, Huaqiang; Tang, Wei

2018-05-01

To explore the feasibility of preoperative planning for treatment of benign mandibular lesions (BML) using digital technologies such as three-dimensional (3D) reconstruction, measurement, visualization as well as image contrast and design of neural positioning protection template (NPPT) in combination with 3D printing technology in the BML diagnosis and treatment. The 3D models of BML and inferior alveolar nerves (IAN) of 10 BML patients were reconstructed based on their digital imaging and communications in medicine (DICOM) data using MIMICS16.0 software. The models were used to visualize lesions and nerve contrast measurement and guide design of personalized NPPT and osteotomy after operation modality was determined in order to achieve accurate, minimally invasive operation with shortened intraoperative time. Intraoperative NPPT application could accurately locate lesions and their scope and assist osteotomy. The measurement results were consistent with those of preoperative reconstruction and measurement. The BML were curetted completely without damage IAN. The 10 BML patients had no numbness and other discomforts in the lower lip and mandibular teeth after operation. The digital diagnosis and treatment technology is an effective method for functional treatment of BML patients and its application could achieve personalized, minimally invasive and precise treatment and save intraoperation time.

Correlations between the clinical, histological and neurophysiological examinations in patients before and after parotid gland tumor surgery: verification of facial nerve transmission.

PubMed

Wiertel-Krawczuk, Agnieszka; Huber, Juliusz; Wojtysiak, Magdalena; Golusiński, Wojciech; Pieńkowski, Piotr; Golusiński, Paweł

2015-05-01

Parotid gland tumor surgery sometimes leads to facial nerve paralysis. Malignant more than benign tumors determine nerve function preoperatively, while postoperative observations based on clinical, histological and neurophysiological studies have not been reported in detail. The aims of this pilot study were evaluation and correlations of histological properties of tumor (its size and location) and clinical and neurophysiological assessment of facial nerve function pre- and post-operatively (1 and 6 months). Comparative studies included 17 patients with benign (n = 13) and malignant (n = 4) tumors. Clinical assessment was based on House-Brackmann scale (H-B), neurophysiological diagnostics included facial electroneurography [ENG, compound muscle action potential (CMAP)], mimetic muscle electromyography (EMG) and blink-reflex examinations (BR). Mainly grade I of H-B was recorded both pre- (n = 13) and post-operatively (n = 12) in patients with small (1.5-2.4 cm) benign tumors located in superficial lobes. Patients with medium size (2.5-3.4 cm) malignant tumors in both lobes were scored at grade I (n = 2) and III (n = 2) pre- and mainly VI (n = 4) post-operatively. CMAP amplitudes after stimulation of mandibular marginal branch were reduced at about 25 % in patients with benign tumors after surgery. In the cases of malignant tumors CMAPs were not recorded following stimulation of any branch. A similar trend was found for BR results. H-B and ENG results revealed positive correlations between the type of tumor and surgery with facial nerve function. Neurophysiological studies detected clinically silent facial nerve neuropathy of mandibular marginal branch in postoperative period. Needle EMG, ENG and BR examinations allow for the evaluation of face muscles reinnervation and facial nerve regeneration.

Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars.

PubMed

Venkat Narayanan, J; Gurram, Prashanthi; Krishnan, Radhika; Muthusubramanian, Veerabahu; Sadesh Kannan, V

2017-09-01

The aim of this study is to assess the efficacy of 4% articaine with 1:100,000 adrenaline given as buccal and lingual infiltration in adult patients undergoing erupted mandibular first and second molar teeth extraction versus inferior alveolar nerve block technique using 2% lignocaine with 1:80,000 adrenaline. A total of 100 patients undergoing extraction of mandibular posterior teeth were divided into two equally matched groups for the study, out of which 50 patients were given 4% articaine with 1:100,000 adrenaline as buccal and lingual infiltration and 50 patients were given 2% lignocaine with 1:80,000 adrenaline using classic direct inferior alveolar nerve block with lingual and buccal nerve block. Efficacy of anesthesia was determined using a numeric analog scale (NAS) ranging from 0 indicating no pain to 10 indicating the worst pain imaginable. The NAS was taken by a different operator to avoid bias. The pain scores in both groups were analyzed using the Mann-Whitney U test, and a p value of 0.338 was obtained which is not statistically significant. Hence, no significant difference in the pain score was established between both groups. The adverse effects of both the local anesthetics if any were noted. From this study, we concluded that the use of 4% articaine with 1:100,000 adrenaline is as effective as inferior alveolar nerve block with lignocaine but without the risk of attendant adverse effects of inferior alveolar nerve block technique.

Advantages of anterior inferior alveolar nerve block with felypressin-propitocaine over conventional epinephrine-lidocaine: an efficacy and safety study

PubMed Central

Sunada, Katsuhisa

2015-01-01

Background Conventional anesthetic nerve block injections into the mandibular foramen risk causing nerve damage. This study aimed to compare the efficacy and safety of the anterior technique (AT) of inferior alveolar nerve block using felypressin-propitocaine with a conventional nerve block technique (CT) using epinephrine and lidocaine for anesthesia via the mandibular foramen. Methods Forty healthy university students with no recent dental work were recruited as subjects and assigned to two groups: right side CT or right side AT. Anesthesia was evaluated in terms of success rate, duration of action, and injection pain. These parameters were assessed at the first incisor, premolar, and molar, 60 min after injection. Chi-square and unpaired t-tests were used for statistical comparisons, with a P value of < 0.05 designating significance. Results The two nerve block techniques generated comparable success rates for the right mandible, with rates of 65% (CT) and 60% (AT) at both the first molar and premolar, and rates of 60% (CT) and 50% (AT) at the lateral incisor. The duration of anesthesia using the CT was 233 ± 37 min, which was approximately 40 min shorter than using the AT. This difference was statistically significant (P < 0.05). Injection pain using the AT was rated as milder compared with the CT. This difference was also statistically significant (P < 0.05). Conclusions The AT is no less successful than the CT for inducing anesthesia, and has the added benefits of a significantly longer duration of action and significantly less pain. PMID:28879260

Advantages of anterior inferior alveolar nerve block with felypressin-propitocaine over conventional epinephrine-lidocaine: an efficacy and safety study.

PubMed

Shinzaki, Hazuki; Sunada, Katsuhisa

2015-06-01

Conventional anesthetic nerve block injections into the mandibular foramen risk causing nerve damage. This study aimed to compare the efficacy and safety of the anterior technique (AT) of inferior alveolar nerve block using felypressin-propitocaine with a conventional nerve block technique (CT) using epinephrine and lidocaine for anesthesia via the mandibular foramen. Forty healthy university students with no recent dental work were recruited as subjects and assigned to two groups: right side CT or right side AT. Anesthesia was evaluated in terms of success rate, duration of action, and injection pain. These parameters were assessed at the first incisor, premolar, and molar, 60 min after injection. Chi-square and unpaired t-tests were used for statistical comparisons, with a P value of < 0.05 designating significance. The two nerve block techniques generated comparable success rates for the right mandible, with rates of 65% (CT) and 60% (AT) at both the first molar and premolar, and rates of 60% (CT) and 50% (AT) at the lateral incisor. The duration of anesthesia using the CT was 233 ± 37 min, which was approximately 40 min shorter than using the AT. This difference was statistically significant (P < 0.05). Injection pain using the AT was rated as milder compared with the CT. This difference was also statistically significant (P < 0.05). The AT is no less successful than the CT for inducing anesthesia, and has the added benefits of a significantly longer duration of action and significantly less pain.

The efficacy of supplemental intraosseous anesthesia after insufficient mandibular block.

PubMed

Prohić, Samir; Sulejmanagić, Halid; Secić, Sadeta

2005-02-01

It is a well-known scientific fact that only a small percentage of infiltration of inferior alveolar nerve is clinically proven to be efficient. The objective of this study was to determine the anesthetic efficacy of supplemental intraosseous injection, used after the insufficient classical mandibular block that didn't provide deep pulp anesthesia of mandibular molar planed for extraction. The experimental teeth consisted of 98 mandibular molars with clinical indication for extraction. Based on the history of disease, we indicated the extraction of the tooth. After that each tooth was tested with a electric pulp tester P1. We tested the pulp vitality and precisely determined the level of vitality. After that, each patient received classical mandibular block, and the pulp vitality was tested again. If the pulp tester indicated negative vitality for the certain mandibular molar, and the patient didn't complain about pain or discomfort during the extraction, the molar was extracted and the result was added to anesthetic success rate for the classical mandibular block. If, five minutes after receiving the mandibular block, the pulp tester indicated positive vitality (parameters of vitality) or the patient complained about pain or discomfort (parameters of pain and discomfort), we used the Stabident intraosseous anesthesia system. Three minutes after the application of supplemental intraosseous injection the molar was tested with the pulp tester again. The anesthetic solution used in both anesthetic techniques is lidocaine with 1:100.000 epinephrine. The results of this study indicate that the anesthetic efficacy of the mandibular block is 74.5%, and that supplemental intraosseous anesthesia, applied after the insufficient mandibular block, provides pulpal anesthesia in 94.9% of mandibular molars. The difference between anesthetic efficacy of the classical mandibular block and anesthetic efficacy of the supplemental intraosseous anesthesia, applied after the insufficient mandibular block, is obvious.

Patient's pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block.

PubMed

Bataineh, Anwar B; Alwarafi, Majid A

2016-11-01

The aim of this study was to investigate the effectiveness of a local anesthetic agent comprising of 4 % articaine with 1:100,000 adrenaline, administered through an infiltration technique prior to the extraction of mandibular permanent first molar teeth. The study adopted a split mouth approach and involved patients who needed simple extractions of permanent mandibular first molar teeth on both sides. A combination of buccal and lingual infiltrations was used on one side, while the conventional inferior alveolar nerve block (IANB) technique, with a 1.8-ml cartridge of 4 % articaine with 1:100,000 epinephrine, was administered to the other. The patients' pain perception was assessed using visual analogue scale (VAS) and verbal rating scale (VRS) after the injection, followed by extraction. As a part of the study, 104 teeth were extracted from mouths of 52 patients. The difference in pain perception was statistically insignificant (p > .05) regarding the local anesthetic injection between the two techniques. The difference in pain perception regarding the extraction between the two techniques was also statistically insignificant (p < .05). No difference in pain perception between the two techniques among the study population was noted. This indicates that the extraction of permanent mandibular first molar teeth is possible without the administration of an IANB with the use of 4 % articaine with 1:100,000 epinephrine. The buccal and lingual infiltrations are slightly less painful than the conventional IANB technique.

Alveolar nerve repositioning with rescue implants for management of previous treatment. A clinical report.

PubMed

Amet, Edward M; Uehlein, Chris

2013-12-01

The goal of modern implant dentistry is to return patients to oral health in a rapid and predictable fashion, following a diagnostically driven treatment plan. If only a limited number of implants can be placed, or some fail and the prosthetic phase of implant dentistry is chosen to complete the patient's treatment, the final outcome may result in partial patient satisfaction and is commonly referred to as a "compromise." Previous All-on-4 implant treatment for the patient presented here resulted in a compromise, with an inadequate support system for the mandibular prosthesis and a maxillary complete denture with poor esthetics. The patient was unable to function adequately and also was disappointed with the resulting appearance. Correction of the compromised treatment consisted of bilateral inferior alveolar nerve elevation and repositioning without bone removal for lateral transposition, to gain room for rescue implants for a totally implant-supported and stabilized prosthesis. Treatment time to return the patient to satisfactory comfort, function, facial esthetics, and speech was approximately 2 weeks. The definitive mandibular prosthesis was designed for total implant support and stability with patient retrievability. Adequate space between the mandibular bar system and the soft tissue created a high water bridge effect for self-cleansing. Following a short interim mandibular healing period, the maxillary sinuses were bilaterally grafted to compensate for bone inadequacies and deficiencies for future maxillary implant reconstruction. © 2013 by the American College of Prosthodontists.

Effect of intraosseous injection versus inferior alveolar nerve block as primary pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis: a prospective randomized clinical trial.

PubMed

Farhad, Alireza; Razavian, Hamid; Shafiee, Maryam

2018-01-27

This study sought to assess the success rate, effect on blood pressure, and pain of intraosseous injection (IO) and inferior alveolar nerve block (IANB) for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis as the primary anaesthetic technique. This randomized clinical trial (IRCT2013022712634N1) was conducted on 60 patients between 18 and 65 years suffering from symptomatic irreversible pulpitis of a mandibular posterior tooth. Patients were randomly divided into two groups. Group one received IO while group two received IANB with 3% mepivacaine. After anaesthetic injection, success rate of pulpal anaesthesia was assessed by pulp testing in the two groups. Systolic and diastolic blood pressures of patients were compared before and after the anaesthetic injections. Level of pain during injection was scored using a visual analogue scale. The data were analyzed using SPSS version 20, t-test and chi square test at p = .05 level of significance. Success rate of IO (56.7%) was significantly higher than that of IANB (23.3%) (p = .008). There was no significant difference in pain during anaesthetic injection (p = .304) or change in systolic (p = .80) and diastolic (p = .28) blood pressures following injection between the two techniques. IO had a higher success rate than IANB for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis. Neither technique provided profound pulpal anaesthesia.

Buccal infiltration versus inferior alveolar nerve block in mandibular 2nd premolars with irreversible pulpitis.

PubMed

Yilmaz, K; Tunga, U; Ozyurek, T

2018-04-01

The purpose of this study is to compare the success rates of inferior alveolar nerve block (IANB) and buccal infiltration anesthesia of mandibular second premolar with irreversible pulpitis and to evaluate the level of patient discomfort with these methods. Forty patients, who had irreversible pulpitis in the mandibular 2 nd premolar teeth, were included in the study. Patients were randomly distributed in two groups. In one group IANB, in the other group buccal infiltration anesthesia were performed. The efficacy of these two different anesthesia techniques on the related teeth was investigated with the Heft-Parker visual analog scale. In addition, with a pulse oximetry device, the changes in the patients' heart rates were compared between the groups. The obtained data were evaluated statistically. Both anesthesia techniques reduced the pain significantly in patients before the administration (P < 0.05), but there was no significant difference among the groups regarding the pain control and success rates of anesthesia (P > 0.05). Both of the anesthesia techniques increased the heart rate (P < 0.05). The increase in the heart rate of the patients was significantly higher in the buccal infiltration anesthesia group than the other anesthesia group (P < 0.05). Within the limitation of this in vivo study, there was no difference between the efficacies of the buccal infiltration anesthesia and IANB anesthesia in the mandibular 2 nd premolar teeth with irreversible pulpitis. Buccal infiltration anesthesia caused more discomfort in the patients compared with the IANB during the administration.

Diagnostic value of panoramic radiography in predicting inferior alveolar nerve injury after mandibular third molar extraction: a meta-analysis.

PubMed

Liu, W; Yin, W; Zhang, R; Li, J; Zheng, Y

2015-06-01

The aim of this study was to evaluate the predictive value of panoramic radiography on inferior alveolar nerve (IAN) injury after extraction of the mandibular third molar. Relevant studies up to 1 June 2014 that discussed the association of panoramic radiography signs and post-mandibular third molar extraction IAN injury were systematically retrieved from the databases of PubMed, Embase, Springerlink, Web of Science and Cochrane library. The effect size of pooled sensitivity, specificity, positive likelihood ratios (PLR), negative likelihood ratios (NLR) and diagnostic odds ratio (DOR) with their 95% confidence intervals (CI) were statistically analysed with Meta-disc 1.4 software. Nine articles were included in this meta-analysis. The pooled estimates of sensitivity and specificity were 0.56 (95% CI: 0.50-0.61) and 0.86 (95% CI: 0.84-0.87), respectively. The overall PLR was 3.46 (95% CI: 2.02-5.92) and overall NLR was 0.58 (95% CI: 0.45-0.73). The pooled estimate of DOR was 6.49 (95% CI: 2.92-14.44). The area under the summary receiver operating characteristic curve was 0.7143 ± 0.0604. The meta-analysis indicated that interpretation of panoramic radiography based on darkening of the root had a high specificity in predicting IAN injury after mandibular third molar extraction. However, the ability of this panoramic radiography marker to detect true positive IAN injury was not satisfactory. © 2015 Australian Dental Association.

Cranial nerve injury after Le Fort I osteotomy.

PubMed

Kim, J-W; Chin, B-R; Park, H-S; Lee, S-H; Kwon, T-G

2011-03-01

A Le Fort I osteotomy is widely used to correct dentofacial deformity because it is a safe and reliable surgical method. Although rare, various complications have been reported in relation to pterygomaxillary separation. Cranial nerve damage is one of the serious complications that can occur after Le Fort I osteotomy. In this report, a 19-year-old man with unilateral cleft lip and palate underwent surgery to correct maxillary hypoplasia, asymmetry and mandibular prognathism. After the Le Fort I maxillary osteotomy, the patient showed multiple cranial nerve damage; an impairment of outward movement of the eye (abducens nerve), decreased vision (optic nerve), and paraesthesia of the frontal and upper cheek area (ophthalmic and maxillary nerve). The damage to the cranial nerve was related to an unexpected sphenoid bone fracture and subsequent trauma in the cavernous sinus during the pterygomaxillary osteotomy. Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Anatomy of Mandibular Vital Structures. Part I: Mandibular Canal and Inferior Alveolar Neurovascular Bundle in Relation with Dental Implantology

PubMed Central

Wang, Hom-Lay; Sabalys, Gintautas

2010-01-01

ABSTRACT Objectives It is critical to determine the location and configuration of the mandibular canal and related vital structures during the implant treatment. The purpose of the present study was to review the literature concerning the mandibular canal and inferior alveolar neurovascular bundle anatomical variations related to the implant surgery. Material and Methods Literature was selected through the search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular canal, inferior alveolar nerve, and inferior alveolar neurovascular bundle. The search was restricted to English language articles, published from 1973 to November 2009. Additionally, a manual search in the major anatomy, dental implant, prosthetic and periodontal journals and books were performed. Results In total, 46 literature sources were obtained and morphological aspects and variations of the anatomy related to implant treatment in posterior mandible were presented as two entities: intraosseous mandibular canal and associated inferior alveolar neurovascular bundle. Conclusions A review of morphological aspects and variations of the anatomy related to mandibular canal and mandibular vital structures are very important especially in implant therapy since inferior alveolar neurovascular bundle exists in different locations and possesses many variations. Individual, gender, age, race, assessing technique used and degree of edentulous alveolar bone atrophy largely influence these variations. It suggests that osteotomies in implant dentistry should not be developed in the posterior mandible until the position of the mandibular canal is established. PMID:24421958

Evaluation of Relative Position of Mandibular Foramen in Children as a Reference for Inferior Alveolar Nerve Block using Orthopantamograph.

PubMed

Krishnamurthy, Navin Hadadi; Unnikrishnan, Surej; Ramachandra, Jaya Agali; Arali, Veena

2017-03-01

The Mandibular Foramen (MF) is a landmark for administering local anaesthetic solution for Inferior Alveolar Nerve Block (IANB). The position of MF shows considerable variation among different ethnicity, ages and on either sides even within the same individual. Failure to achieve IANB leading to repeated injection of the local anaesthetic solution will not only pose a behaviour problem in children but can also lead to systemic toxic level of anaesthetic solution being administered. To determine the relative position of the mandibular foramen in 7 to 12-year-old children in relation to the mandibular occlusal plane and the deepest point on coronoid notch. Ninety orthopantamograph of 7 to 12-year-old children were selected from the database and were divided into three groups: Group 1 (G1): seven to eight-year-old, Group 2 (G2): 9 to 10-year-old and Group 3 (G3): 11 to 12-year-old. The radiographs were traced on acetate paper, anatomical landmarks were marked and linear measurements were noted from the Mandibular Lingula (ML) to the occlusal plane, and to the deepest point on coronoid notch. The data obtained was tabulated and subjected to statistical analysis. One way ANOVA test followed by Bonferroni post hoc analysis and Student's paired t-test were used. Mandibular foramen is approximately, 2-3 mm above the occlusal plane and 11.6-13.0 mm from deepest point of coronoid notch for seven to eight-year-old children, 3-4 mm above the occlusal plane and 13.0-13.9 mm from deepest point of coronoid notch for 9-10 year age group and 5.5-6.5 mm above the occlusal plane and 11.9-12.2 mm from deepest point of coronoid notch for children of the ages 11-12 years. The linear distance from the deepest point of coronoid notch to the mandibular lingula showed statistical significance in G2 vs G3 on right side G1 vs G2 and G2 vs G3 on the left side. The variance of this distance for either side showed statistical significance for G1 and G2. The distance from the mandibular lingula to the occlusal plane showed gradual increase in all the three groups, which was statistically significant. The position of the mandibular foramen is not bilaterally symmetrically for any of the considered age groups.

[Clinical study of modified Gow-Gates technique of inferior alveolar nerve block in impacted mandibular third molar extraction].

PubMed

Hu, Yi-ping; Jin, Gui-fang

2015-06-01

To introduce a minimally invasive and more effective technique of inferior alveolar nerve block. Two hundred and six patients who needed extraction of the impacted mandibular third molar were divided randomly into 2 groups: the experimental group (105 cases) with modified Gow-Gates technique (modified Gow-Gates group) and the control group (101 cases) with Halstead technique (Halstead group). The anesthetic success rates, effects and complications were recorded and analyzed with SPSS17.0 software package. The anesthetic success rate was 97.15% in modified Gow-Gates group and 89.10% in Halstead group with significant difference between the 2 groups (P=0.038<0.05); In comparing the anesthesia grade, the ration of grade A and B accounted for 90.48% in modified Gow-Gates group and 87.13% in Halstead group (P=0.446>0.05). Modified Gow-Gates group had much fewer of complications than Halstead group (P=0.014<0.05). Modified Gow-Gates technique is a minimally invasive and more effective technique for inferior alveolar nerve block anesthesia. Supported by Science and Technology Planning Project of Yueqing City (2014y027).

Conservative surgical and microsurgical techniques for the management of dental implants that impinge on the inferior alveolar nerve.

PubMed

Gennaro, Paolo; Chisci, Glauco; Gabriele, Guido; Iannetti, Giorgio

2014-07-01

Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Extraoral approach to mandibular condylar fractures: our experience with 100 cases.

PubMed

Colletti, Giacomo; Battista, Valeria Marinella Augusta; Allevi, Fabiana; Giovanditto, Federica; Rabbiosi, Dimitri; Biglioli, Federico

2014-07-01

Mandibular condylar fractures are very common. The current literature contains many indications and methods of treatment. Extraoral approaches are complicated by the need to avoid injury to the facial nerve. On the other hand intraoral approaches can make fracture reduction and/or fixation difficult. The mini-retromandibular approach provides an excellent view of the surgical field, minimises the risk of injury to the facial nerve, and allows rapid and easy management of condylar fractures. We have collected and reviewed our first 100 condylar fractures treated by means of a mini-retromandibular approach. Between June 2006 and June 2012, Eighty-seven patients with extracapsular condylar fractures underwent open reduction and rigid fixation for 100 extracapsular condylar fractures via a mini-retromandibular approach. Dental occlusion and anatomic reduction were restored in all 100 condylar fractures. Postoperative infection developed in three patients. There was one sialocele and one case of plate fracture. Four patients experienced transient palsy of the buccal branch of the facial nerve. No permanent deficit of any facial nerve branch was observed. No patient showed condylar head resorption. Our experience with the treatment of the first 100 condylar fractures using the mini-retromandibular approach has demonstrated that this technique has allowed the Authors to safely manage extracapsular condylar fractures at all levels. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: a Systematic Review of Surgical Techniques

PubMed Central

Juodzbalys, Gintaras

2015-01-01

ABSTRACT Objectives The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. Material and Methods A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN) repositioning with a minimum 6 months of follow-up. Results A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Conclusions Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments. PMID:25937873

Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children?

PubMed

Pourkazemi, Maryam; Erfanparast, Leila; Sheykhgermchi, Sanaz; Ghanizadeh, Milad

2017-01-01

Pain control is one of the most important aspects of behavior management in children. The most common way to achieve pain control is by using local anesthetics (LA). Many studies describe that the buccal nerve innervates the buccal gingiva and mucosa of the mandible for a variable extent from the vicinity of the lower third molar to the lower canine. Regarding the importance of appropriate and complete LA in child-behavior control, in this study, we examined the frequency of buccal gingiva anesthesia of primary mandibular molars and canine after inferior alveolar nerve block injection in 4- to 6-year-old children. In this descriptive cross-sectional study, 220 4- to 6-year-old children were randomly selected and entered into the study. Inferior alveolar nerve block was injected with the same method and standards for all children, and after ensuring the success of block injection, anesthesia of buccal mucosa of primary molars and canine was examined by stick test and reaction of child using sound, eye, motor (SEM) scale. The data from the study were analyzed using descriptive statistics and statistical software Statistical Package for the Social Sciences (SPSS) version 21. The area that was the highest nonanesthetized was recorded as in the distobuccal of the second primary molars. The area of the lowest nonanesthesia was also reported in the gingiva of primary canine tooth. According to this study, in 15 to 30% of cases, after inferior alveolar nerve block injection, the primary mandibular molars' buccal mucosa is not anesthetized. How to cite this article: Pourkazemi M, Erfanparast L, Sheykhgermchi S, Ghanizadeh M. Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children? Int J Clin Pediatr Dent 2017;10(4):369-372.

Variation in Lingual Nerve Course: A Human Cadaveric Study

PubMed Central

Al-Amery, Samah M.; Nambiar, Phrabhakaran; Naidu, Murali

2016-01-01

The lingual nerve is a terminal branch of the mandibular nerve. It is varied in its course and in its relationship to the mandibular alveolar crest, submandibular duct and also the related muscles in the floor of the mouth. This study aims to understand the course of the lingual nerve from the molar area until its insertion into the tongue muscle. This cadaveric research involved the study of 14 hemi-mandibles and consisted of two parts: (i) obtaining morphometrical measurements of the lingual nerve to three landmarks on the alveolar ridge, and (b) understanding non-metrical or morphological appearance of its terminal branches inserting in the ventral surface of the tongue. The mean distance between the fourteen lingual nerves and the alveolar ridge was 12.36 mm, and they were located 12.03 mm from the lower border of the mandible. These distances were varied when near the first molar (M1), second molar (M2) and third molar (M3). The lingual nerve coursed on the floor of the mouth for approximately 25.43 mm before it deviated toward the tongue anywhere between the mesial of M1 and distal of M2. Thirteen lingual nerves were found to loop around the submandibular duct for an average distance of 6.92 mm (95% CI: 5.24 to 8.60 mm). Their looping occurred anywhere between the M2 and M3. In 76.9% of the cases the loop started around the M3 region and the majority (69.2%) of these looping ended at between the first and second molars and at the lingual developmental groove of the second molar. It gave out as many as 4 branches at its terminal end at the ventral surface of the tongue, with the presence of 2 branches being the most common pattern. An awareness of the variations of the lingual nerve is important to prevent any untoward complications or nerve injury and it is hoped that these findings will be useful for planning of surgical procedures related to the alveolar crest, submandibular gland/ duct and surrounding areas. PMID:27662622

Differential diagnosis of endodontic-related inferior alveolar nerve paraesthesia with cone beam computed tomography: a case report.

PubMed

Gambarini, G; Plotino, G; Grande, N M; Testarelli, L; Prencipe, M; Messineo, D; Fratini, L; D'Ambrosio, F

2011-02-01

To discuss the use of cone-beam computed tomography (CBCT) in the differential diagnosis of a case of labiomandibular paraesthesia caused by extrusion of endodontic sealer into the mandibular canal. A 59-year-old woman suffering from a paraesthesia on the left posterior mandible and numbness on the left side of the lower lip was referred to an endodontic specialist 1 month after multiple root canal treatments. A panoramic radiograph revealed the presence of extruded root filling material beyond the apex of the mesial root of the mandibular left second molar and also beyond the apex of the first premolar. A cone beam computed tomography examination was undertaken, which confirmed the presence of radiopaque root canal filling material in the periapical area of the second molar, and revealed that the material was inside the mandibular canal. No extruded filling material was found inside the mental foramen beyond the apex of the first premolar tooth. Small field of view CBCT (where possible) can be considered an effective radiographic diagnostic device when endodontic-related inferior alveolar nerve or mental foramen paraesthesia are suspected. CBCT is able to provide detailed three-dimensional images of the tooth, the root canal system and the surrounding tissue. © 2010 International Endodontic Journal.

Piezosurgery for the lingual split technique in mandibular third molar removal: a suggestion.

PubMed

Pippi, Roberto; Alvaro, Roberto

2013-03-01

The lingual split technique is a surgical procedure for extraction of impacted mandibular third molar throughout a lingual approach. The main disadvantage of this technique is the high rate of temporary lingual nerve injury mainly because of the trauma induced by the lingual flap retraction. The purpose of this paper is to suggest the use of piezosurgery in performing the lingual cortical plate osteotomy of the third molar alveolar process. Surgical procedure was performed under general anesthesia, and it lasted approximately 60 minutes. After the buccal and lingual full-thickness flaps were incised and elevated, a piezosurgical device was used for osteotomy. A well-defined bony window was then removed, and it allowed the entire tooth was extracted in a lingual direction. The patient did not show any neurological postoperative complication. Lingual and inferior alveolar nerve functionality was normal before as well as after surgery. The use of piezoelectric surgery seems to be a good option in removing lower third molars when a lingual access is clearly indicated. The only disadvantage of this technique can be represented by an operating time lengthening possibly because of a lower power cut of the piezoelectric device, to the high mineralization of the mandibular cortical bone and to the use of inserts with a low degree of sharpening.

Origin of the styloglossus muscle in the human fetus

PubMed Central

Mérida-Velasco, J R; Rodríguez-Vazquez, J F; de la Cuadra Blanco, C; Sánchez-Montesinos, I; Mérida-Velasco, J A

2006-01-01

The origin of the styloglossus muscle was histologically studied bilaterally in nine human fetuses (18 sides). In all cases, the muscle originated in Reichert's cartilage, which gives rise to the temporal styloid process. We identified three types of variation: type A, an accessory muscle fascicle originating from the mandibular angle, found in 7 cases (12 sides); type B, where the styloglossus muscle was attached to the mandibular angle by fibrous tracts, found in three cases (4 sides); and type C, where an accessory muscle fascicle arose from the fibrous tract connecting Reichert's cartilage to the mandibular angle; found in one case. In all cases (2 sides), the styloglossus muscle was innervated by the hypoglossal nerve. Relationships between the styloglossus muscle and vasculonervous elements of the prestyloid and retrostyloid spaces were analysed. PMID:16637887

Total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and computer-aided designed and manufactured surgical splints: a favorable combination of three techniques in the management of severe mouth asymmetry in Parry-Romberg syndrome.

PubMed

Scolozzi, Paolo; Herzog, Georges

2014-05-01

Although its pathogenesis remains obscure, Parry-Romberg syndrome (PRS) has been associated with the linear scleroderma en coup de sabre. PRS is characterized by unilateral facial atrophy of the skin, subcutaneous tissue, muscles, and bones with at least 1 dermatome supplied by the trigeminal nerve. Facial asymmetry represents the most common sequela and can involve the soft tissues, craniomaxillofacial skeleton, dentoalveolar area, and temporomandibular joint. Although orthognathic procedures have been reported for skeletal reconstruction, treatment of facial asymmetry has been directed to augmentation of the soft tissue volume on the atrophic side using different recontouring or volumetric augmentation techniques. Total mandibular subapical osteotomy has been used in the management of dentofacial deformities, such as open bite and mandibular dentoalveolar retrusion or protrusion associated with an imbalance between the lower lip and the chin. Management of orthognathic procedures has been improved by the recent introduction of stereolithographic surgical splints using computer-aided design (CAD) and computer-aided manufacturing (CAM) technology and piezosurgery. Piezosurgery has increased security during surgery, especially for delicate procedures associated with a high risk of nerve injury. The present report describes a combined total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and surgical splints fabricated using CAD and CAM for the correction of severe mouth asymmetry related to vertical dentoalveolar disharmony in a patient with PRS. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Effects of agmatine sulphate on facial nerve injuries.

PubMed

Surmelioglu, O; Sencar, L; Ozdemir, S; Tarkan, O; Dagkiran, M; Surmelioglu, N; Tuncer, U; Polat, S

2017-03-01

To evaluate the effect of agmatine sulphate on facial nerve regeneration after facial nerve injury using electron and light microscopy. The study was performed on 30 male Wistar albino rats split into: a control group, a sham-treated group, a study control group, an anastomosis group, and an anastomosis plus agmatine sulphate treatment group. The mandibular branch of the facial nerve was dissected, and a piece was removed for histological and electron microscopic examination. Regeneration was better in the anastomosis group than in the study control group. However, the best regeneration findings were seen in the agmatine sulphate treatment group. There was a significant difference between the agmatine group and the others in terms of median axon numbers (p < 0.004) and diameters (p < 0.004). Agmatine sulphate treatment with anastomosis in traumatic facial paralysis may enhance nerve regeneration.

Temporary Mental Nerve Paresthesia Originating from Periapical Infection

PubMed Central

Genc Sen, Ozgur; Kaplan, Volkan

2015-01-01

Many systemic and local factors can cause paresthesia, and it is rarely caused by infections of dental origin. This report presents a case of mental nerve paresthesia caused by endodontic infection of a mandibular left second premolar. Resolution of the paresthesia began two weeks after conventional root canal treatment associated with antibiotic therapy and was completed in eight weeks. One year follow-up radiograph indicated complete healing of the radiolucent periapical lesion. The tooth was asymptomatic and functional. PMID:26345692

A safe and accurate method to perform esthetic mandibular contouring surgery for Far Eastern Asians.

PubMed

Hsieh, A M-C; Huon, L-K; Jiang, H-R; Liu, S Y-C

2017-05-01

A tapered mandibular contour is popular with Far Eastern Asians. This study describes a safe and accurate method of using preoperative virtual surgical planning (VSP) and an intraoperative ostectomy guide to maximize the esthetic outcomes of mandibular symmetry and tapering while mitigating injury to the inferior alveolar nerve (IAN). Twelve subjects with chief complaints of a wide and square lower face underwent this protocol from January to June 2015. VSP was used to confirm symmetry and preserve the IAN while maximizing the surgeon's ability to taper the lower face via mandibular inferior border ostectomy. The accuracy of this method was confirmed by superimposition of the perioperative computed tomography scans in all subjects. No subjects complained of prolonged paresthesia after 3 months. A safe and accurate protocol for achieving an esthetic lower face in indicated Far Eastern individuals is described. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery.

PubMed

da Silva-Junior, Geraldo Prisco; de Almeida Souza, Liane Maciel; Groppo, Francisco Carlos

In order to compare the efficacy of lidocaine and articaine for pain control during third molar surgery, 160 patients presenting bilateral asymptomatic impacted mandibular third molars were selected. They received 1.8 mL of 2% lidocaine with epinephrine 1:100,000 during inferior alveolar nerve block. In group 1 (n = 80), an infiltrative injection of 0.9 mL of 2% lidocaine with epinephrine 1:100,000 was performed in buccal-distal mucosa of the third molar. Group 2 (n = 80) received 0.9 mL of 4% articaine with epinephrine 1:100,000 in the contralateral side. All procedures were performed at the same visit, by a single operator, in a double-blind and parallel design. The duration of each surgery and the moment when the patient expressed pain were noted. Data were analyzed by nonpaired t test and chi-square test (alpha = 5%). Duration of surgery did not differ (p = .83) between Groups 1 (19.8 ± 2.3 minutes) and 2 (19.7 ± 3.0 minutes). Pain was expressed more in group 1 (26.3%) than in group 2 (10%) (odds ratio = 3.2, p = .0138). In both groups, tooth sectioning was the most painful event (p < .0001). No influence of gender (p = .85) or age (p = .96) was observed in pain response. Buccal infiltration of 4% articaine with epinephrine 1:100,000 showed more efficacy than 2% lidocaine with epinephrine 1:100,000 when used in combination with inferior alveolar nerve block in controlling intraoperative pain related to impacted mandibular third molar surgery.

3.0 Tesla MRI in the early evaluation of inferior alveolar nerve neurological complications after mandibular third molar extraction: a prospective study

PubMed Central

Pranno, N; Barchetti, F; Sorrentino, V; Lo Mele, L

2014-01-01

Objectives: To evaluate the use of 3.0 T MRI in the prognosis of inferior alveolar nerve (IAN) sensory disorders after mandibular third molar extraction, in the early post-operative period. Methods: 343 IANs were examined before and 3 days after surgery. Two radiologists evaluated the course of the nerve and the relative signal intensity (RSI). Cohen's kappa coefficient (κ) and intraclass correlation coefficient (ICC) were used to evaluate the interobserver (k = 0.891) and intra-observer variability (ICC = 0.927; 0.914, respectively). The IANs were divided into four groups on the basis of neurosensory disorders recovery time. ANOVA was used to evaluate the differences among the RSIs of the four groups, and multiple comparisons were performed with Tukey's range test. Results: No differences in the course of IANs were found before and after surgery. In 280 IANs, no iatrogenic paraesthesia was found (Group A). 63 IANs showed a neurosensory impairment. 38 IANs showed recovery of post-operative paraesthesia at 3-month follow-up (Group B). 16 IANs showed a full recovery of iatrogenic paraesthesia at 6-month follow-up (Group C). Seven IANs displayed a full recovery at 12-month follow-up and two IANs showed persistence of neurosensory disorders at 18-month follow-up (Group D). The one-way ANOVA results indicated statistically significant difference among all groups (p < 0.05), except between Groups C and D (p = 0.504). Conclusions: The early evaluation of RSI values represents a valid tool to determine the prognosis of IAN sensory disorders after mandibular third molar extraction. PMID:24947977

Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery

PubMed Central

da Silva-Junior, Geraldo Prisco; de Almeida Souza, Liane Maciel; Groppo, Francisco Carlos

2017-01-01

In order to compare the efficacy of lidocaine and articaine for pain control during third molar surgery, 160 patients presenting bilateral asymptomatic impacted mandibular third molars were selected. They received 1.8 mL of 2% lidocaine with epinephrine 1:100,000 during inferior alveolar nerve block. In group 1 (n = 80), an infiltrative injection of 0.9 mL of 2% lidocaine with epinephrine 1:100,000 was performed in buccal-distal mucosa of the third molar. Group 2 (n = 80) received 0.9 mL of 4% articaine with epinephrine 1:100,000 in the contralateral side. All procedures were performed at the same visit, by a single operator, in a double-blind and parallel design. The duration of each surgery and the moment when the patient expressed pain were noted. Data were analyzed by nonpaired t test and chi-square test (alpha = 5%). Duration of surgery did not differ (p = .83) between Groups 1 (19.8 ± 2.3 minutes) and 2 (19.7 ± 3.0 minutes). Pain was expressed more in group 1 (26.3%) than in group 2 (10%) (odds ratio = 3.2, p = .0138). In both groups, tooth sectioning was the most painful event (p < .0001). No influence of gender (p = .85) or age (p = .96) was observed in pain response. Buccal infiltration of 4% articaine with epinephrine 1:100,000 showed more efficacy than 2% lidocaine with epinephrine 1:100,000 when used in combination with inferior alveolar nerve block in controlling intraoperative pain related to impacted mandibular third molar surgery. PMID:28604089

Significance of radiological variables studied on orthopantamogram to pridict post-operative inferior alveoler nerve paresthesia after third molar extraction.

PubMed

Pathak, Sachin; Mishra, Nitin; Rastogi, Madhur Kant; Sharma, Shalini

2014-05-01

Removal of impacted third molar is a procedure that is often associated with post-operative complications. The rate of complications is somewhat high because of its proximity to the vital structures. Inferior alveolar nerve paresthesia is one of the common complications of impacted their molar surgery. This is due to intimate relationship between roots of mandibular third molar and inferior alveolar canal. To access the proximity of inferior alveolar canal to third molar many diagnostic methods are suggested but in conventional radiography orthopantamogram is considered as the best. There are many findings onorthopantamogram that are suggestive of close proximity of nerve to the canal. In this study authors reviewed seven radiographic findings related to proximity of roots to the inferior alveolar nerve as seen on orthopantamogram and try to find a relationship between these radiographic variables and presence of post-operative paresthesia. The study containd 100 impacted third molars need to be removed. Presence of radiographic findings on orthopantamogram were noted and analyzed, to find a relationship with occurrence of post-operative inferior alveolar nerve paresthesia. This study comprises of 100 impacted third molar teeth indicated for extraction. Cases were randomly selected from the patients, needs to undergo extraction of impacted mandibular third molar. After extraction cases were evaluated for occurrence of inferior alveolar nerve paresthesia. Stastical Analyisis: Data was transferred to SPss 21 software for frequency calculation, and two tailed p-values were obtained betweens these variables and post-operative paresthesia, by applying Fischer's exact test (GRAPH PAD SOFTWARE). Out of seven, four radiological findings that are grooving of roots, hooked roots, bifid roots and obliteration of white line are significantly related to post-operative paresthesia while bending of canal, narrow canal and darkening of tooth roots over the canal are not significantly associated with post-operative morbidity of facial nerve.

Prospective clinical study comparing intraligamentary anesthesia and inferior alveolar nerve block for extraction of posterior mandibular teeth.

PubMed

Kämmerer, P W; Adubae, A; Buttchereit, I; Thiem, D G E; Daubländer, M; Frerich, B

2018-04-01

The aim of the study was to compare the efficacy of intraligamentary anesthesia (ILA) with conventional inferior alveolar nerve block (IANB) for extraction of mandibular posterior teeth. In a prospective clinical trial, a total of 301 mandibular posterior teeth were extracted in 266 patients. Randomization was conducted into those who received ILA (patients n = 98; teeth n = 105) and those who received IANB (patient n = 140; teeth n = 140). Twenty-eight patients were subjected to bilateral mandibular dental extractions and received both ILA und IANB (teeth n = 56 (ILA n = 28; IANB n = 28)). The primary objective was to evaluate the differences in pain during injection, in pain during tooth extraction (numeric rating scale (NRS)), and in anesthetic quality (complete/sufficient vs. insufficient/no effect). Differences in latency time, amount of anesthetic solution, need for second injection, and duration of local numbness as well as in the incidence of dry socket were assessed. ILA had significant lower pain of injection (p < 0.001), shorter latency time (p < 0.001), and shorter duration of local numbness (p < 0.001) and required lesser amount of local anesthetic solution (p < 0.001) together with a similar anesthetic quality (p = 0.082) compared to IANB. Concerning pain during extraction (p = 0.211), frequency of second injection (p = 0.197), and incidence of dry socket (p = 0.178), no significant differences were detected. ILA fulfills the requirements of a minimal invasive and patient-friendly local anesthetic technique. In accordance, it represents a safe and reliable alternative to IANB for extraction of mandibular posterior teeth. ILA can be recommended for routine dental extractions.

Parotid Abscess with Involvement of Facial Nerve Branches.

PubMed

Ozkan, Adile; Ors, Ceyda Hayretdag; Kosar, Sule; Ozisik Karaman, Handan Isin

2015-08-01

Facial nerve paresis is only rarely seen with benign diseases of the parotid gland. A 22-year male had muscle loss in the preauricular region of the right side of his face that extended towards the mandibular angle for the last 6 months. The neurological examination did not reveal any pathology other than right preauricular region muscle atrophy that was limited by the mandibular angle. The Electroneuronography (EnoG) provided a ratio of 55.38%, compared the affected side to left side. Ultrasonography of the defined region showed two mass lesions 13.5 x 7 mm and 10 x 5 mm in size in the anteromedial section of the right parotid gland that were close to each other, without internal calcific foci, and heterogenous hyperechogenic structure without internal vascularization. Fine needle aspiration obtained many polymorphonuclear leukocytes, cell debris, a few mononuclear inflammatory cells and many crystalloid structures. The lesion was diagnosed as a parotid abscess. Antibiotic treatment was started for the parotid gland abscess.

Does 3-dimensional imaging of the third molar reduce the risk of experiencing inferior alveolar nerve injury owing to extraction?: A meta-analysis.

PubMed

Clé-Ovejero, Adrià; Sánchez-Torres, Alba; Camps-Font, Octavi; Gay-Escoda, Cosme; Figueiredo, Rui; Valmaseda-Castellón, Eduard

2017-08-01

Clinicians generally use panoramic radiographic (PR) images to assess the proximity of the mandibular third molar to the inferior alveolar nerve (IAN). However, in cases in which a patient needs to undergo a third-molar extraction, many clinicians also assess computed tomographic (CT) images to prevent nerve damage. Two of the authors independently searched MEDLINE (through PubMed), Cochrane Library, Scopus, and Ovid. The authors included randomized or nonrandomized longitudinal studies whose investigators had compared the number of IAN injuries after third-molar extraction in patients who had undergone preoperative CT with patients who had undergone only PR. The authors analyzed the full text of 26 of the 745 articles they initially selected. They included 6 studies in the meta-analysis. Four of the studies had a high risk of bias, and the investigators of only 1 study had used blinding with the patients. The authors observed no statistically significant differences between groups related to the total number of nerve injuries (risk ratio, 0.96; 95% confidence interval, 0.50 to 1.85; P = .91). The prognosis of the injuries was similar for both groups. Although having preoperative CT images might be useful for clinicians in terms of diagnosing and extracting mandibular third molars, having these CT images does not reduce patients' risk of experiencing IAN injuries nor does it affect their prognosis. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

The application of the Risdon approach for mandibular condyle fractures.

PubMed

Nam, Seung Min; Lee, Jang Hyun; Kim, Jun Hyuk

2013-07-06

Many novel approaches to mandibular condyle fracture have been reported, but there is a relative lack of reports on the Risdon approach. In this study, the feasibility of the Risdon approach for condylar neck and subcondylar fractures of the mandible is demonstrated. A review of patients with mandibular condylar neck and subcondylar fractures was performed from March 2008 to June 2012. A total of 25 patients, 19 males and 6 females, had 14 condylar neck fractures and 11 subcondylar fractures. All of the cases were reduced using the Risdon approach. For subcondylar fractures, reduction and fixation with plates was done under direct vision. For condylar neck fractures, reduction and fixation was done with the aid of a trochar in adults and a percutaneous threaded Kirschner wire in children. There were no malunions or nonunions revealed in follow-up care. Mild transient neuropraxia of the marginal mandibular nerve was seen in 4 patients, which was resolved within 1-2 months. The Risdon approach is a technique for reducing the condylar neck and subcondylar fractures that is easy to perform and easy to learn. Its value in the reduction of mandibular condyle fractures should be emphasized.

The application of the Risdon approach for mandibular condyle fractures

PubMed Central

2013-01-01

Background Many novel approaches to mandibular condyle fracture have been reported, but there is a relative lack of reports on the Risdon approach. In this study, the feasibility of the Risdon approach for condylar neck and subcondylar fractures of the mandible is demonstrated. Methods A review of patients with mandibular condylar neck and subcondylar fractures was performed from March 2008 to June 2012. A total of 25 patients, 19 males and 6 females, had 14 condylar neck fractures and 11 subcondylar fractures. Results All of the cases were reduced using the Risdon approach. For subcondylar fractures, reduction and fixation with plates was done under direct vision. For condylar neck fractures, reduction and fixation was done with the aid of a trochar in adults and a percutaneous threaded Kirschner wire in children. There were no malunions or nonunions revealed in follow-up care. Mild transient neuropraxia of the marginal mandibular nerve was seen in 4 patients, which was resolved within 1–2 months. Conclusions The Risdon approach is a technique for reducing the condylar neck and subcondylar fractures that is easy to perform and easy to learn. Its value in the reduction of mandibular condyle fractures should be emphasized. PMID:23829537

Effect of Sodium Bicarbonate Buccal Infiltration on the Success of Inferior Alveolar Nerve Block in Mandibular First Molars with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Double-blind Study.

PubMed

Saatchi, Masoud; Farhad, Ali Reza; Shenasa, Naghmeh; Haghighi, Saeideh Karimi

2016-10-01

The purpose of this prospective, randomized, double-blind study was to evaluate the effect of a buccal infiltration of sodium bicarbonate on the anesthetic success of the inferior alveolar nerve block (IANB) for mandibular first molars in patients with symptomatic irreversible pulpitis. One hundred patients diagnosed with symptomatic irreversible pulpitis of a mandibular first molar were selected. The patients randomly received a buccal infiltration injection of either 0.7 mL 8.4% sodium bicarbonate with 0.3 mL 2% lidocaine containing 1:80,000 epinephrine or 0.7 mL sterile distilled water with 0.3 mL 2% lidocaine containing 1:80,000 epinephrine in a double-blind manner. After 15 minutes, all the patients received conventional IANB injection using 3.6 mL 2% lidocaine with 1:80,000 epinephrine. Access cavity preparation was initiated 15 minutes after the IANB injection. Lip numbness was a requisite for all the patients. Success was determined as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed using the t, chi-square and Mann-Whitney U tests. The success rate after the buccal infiltration of sodium bicarbonate was 78%, whereas without the buccal infiltration of sodium bicarbonate it was 44% (P < .001). A buccal infiltration of 0.7 mL 8.4% sodium bicarbonate increased the success rate of IANBs in mandibular first molars with symptomatic irreversible pulpitis. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

A novel surgical approach to impacted mandibular third molars to reduce the risk of paresthesia: a case series.

PubMed

Landi, Luca; Manicone, Paolo Francesco; Piccinelli, Stefano; Raia, Alessandro; Raia, Roberto

2010-05-01

Extraction of impacted mandibular third molars (M3s) may cause temporary or permanent neurosensorial disturbances of the inferior alveolar nerve (IAN). Although the incidence of this complication is low, a great range of variability has been reported in the literature. Several methods to reduce or eliminate this complication have been proposed, such as orthodontic-assisted extraction, extraction of the second molar, or intentional odontoectomy. The purpose of this series of cases is to present a novel approach for a riskless extraction of impacted mandibular M3s in contact with the IAN. Nine consecutive patients (4 male and 5 female; mean age 24.9 years, range 18-43 years) required the extraction of 10 horizontally or mesioangular impacted mandibular M3s. In all cases the M3 was in contact with the IAN with a high risk of nerve injury. A staged approached was proposed and accepted by the patients. This approach consisted in the surgical removal of the mesial portion of the anatomic crown to create adequate space for mesial M3 migration. After the migration of the M3 had taken place, the extraction could then be accomplished in a second surgical session minimizing neurological risks. All M3s moved mesially within 6 months (mean 174.1 days, range 92-354 days) and could be successfully removed without any neurological consequences. This technique may be considered as an alternative approach to the extraction of horizontally or mesioangular impacted M3s in proximity to the IAN. Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Open Reduction With K-Wire Stabilization of Fracture Dislocations of the Mandibular Condyle: A Retrospective Review.

PubMed

Haghighi, Kayvon; Manolakakis, Manolis G; Balog, Connor

2017-06-01

The aim of this study was to determine the feasibility of direct transcortical stabilization of fracture dislocations of the mandibular condyle (FDMCs) using narrow-diameter non-threaded Kirschner wire (K-wire). This retrospective review reports on the treatment outcomes for 12 patients (15 fractures) with FDMCs treated with open reduction using transcortical 0.027-inch K-wire stabilization. Postoperative parameters of relevance included infection, facial nerve function, hardware removal, mandibular range of motion, and radiographic determination of fracture union. Three patients had bilateral FDMCs and 9 had unilateral FDMCs (age range at time of injury, 14 to 72 yr; mean age, 32 yr). Postoperative follow-up ranged from 6 weeks to 2 years. Four patients required removal of K-wire hardware for different reasons. K-wires were removed because of infection in 1 patient. Another patient required removal because of migration of the pin into the joint space. One pin was removed electively and another was removed for nonspecific postoperative symptoms that resolved after pin removal. Persistent facial nerve deficit was observed in 1 patient. Open reduction with transcortical K-wire stabilization can achieve satisfactory outcomes for the treatment of FDMC. Further investigation is needed in determining the efficacy of this fixation technique in the management of FDMC. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Removal of a fractured needle during inferior alveolar nerve block: two case reports.

PubMed

You, Jae-Seek; Kim, Su-Gwan; Oh, Ji-Su; Choi, Hae-In; Jih, Myeong-Kwan

2017-09-01

The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.

[Anatomical and radiological studies on additional mandible teeth anesthesia considering innervation variability].

PubMed

Tarasenko, S V; Dydykin, S S; Kuzin, A V

2013-01-01

The paper presents studies on nutritional foramina of the mandible. Some nutritional foramina located in the frontal mandibular region on the lingual surface and containing significant blood vessels and nerves are found to be more typical for teeth-bearing mandible. In retromolar area in case of third molars presence intraosseous canals were revealed leading to inferior alveolar nerve canal. One should consider intraligamental and lingual anesthesia by lower incisors extraction. Intraosseous anesthesia and retromolar area infiltration significantly increase anesthesia efficiency by third molar extraction.

[Damage to cranial and peripheral nerves following patency restoration of the internal carotid artery].

PubMed

Myrcha, P; Ciostek, P; Szopiński, P; Noszczyk, W

2001-01-01

The aim of the study was an assessment of the incidence of injury to cranial and peripheral nerves as complication of patency restoration of the internal carotid artery, and analysis of the effect of peripheral nerve injury on the results of carotid patency restoration. From Oct 1987 to Sept 1999 543 procedures were carried out for restoration of patency of the internal carotid artery. After the operation hypoglossus nerve injury was found in 7 cases (1.4%), vagus injury in 9 (1.8%). Signs of exclusively recurrent laryngeal nerve damage were found in 6 cases (1.2%). Glossopharyngeus nerve was damaged in 2 cases (0.4%), transient phrenic nerve palsy as a result of conduction anaesthesia was noted in 2 cases (0.4%). Damage to the transverse cervical nerve was found in 96 cases (60%). In 2 patients (1.2%) lower position of mouth angle was due to section of the mandibular ramus of the facial nerve. In another 2 cases skin sensation disturbances were a consequence of lesion of the auricularis magnus nerve and always they coexisted with signs of transverse cervical nerve damage. damage to the cranial nerves during operation for carotid patency restoration are frequent but mostly they are not connected with any health risks and often they regress spontaneously.

Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children?

PubMed Central

Erfanparast, Leila; Sheykhgermchi, Sanaz; Ghanizadeh, Milad

2017-01-01

Introduction Pain control is one of the most important aspects of behavior management in children. The most common way to achieve pain control is by using local anesthetics (LA). Many studies describe that the buccal nerve innervates the buccal gingiva and mucosa of the mandible for a variable extent from the vicinity of the lower third molar to the lower canine. Regarding the importance of appropriate and complete LA in child-behavior control, in this study, we examined the frequency of buccal gingiva anesthesia of primary mandibular molars and canine after inferior alveolar nerve block injection in 4- to 6-year-old children. Study design In this descriptive cross-sectional study, 220 4- to 6-year-old children were randomly selected and entered into the study. Inferior alveolar nerve block was injected with the same method and standards for all children, and after ensuring the success of block injection, anesthesia of buccal mucosa of primary molars and canine was examined by stick test and reaction of child using sound, eye, motor (SEM) scale. The data from the study were analyzed using descriptive statistics and statistical software Statistical Package for the Social Sciences (SPSS) version 21. Results The area that was the highest nonanesthetized was recorded as in the distobuccal of the second primary molars. The area of the lowest nonanesthesia was also reported in the gingiva of primary canine tooth. Conclusion According to this study, in 15 to 30% of cases, after inferior alveolar nerve block injection, the primary mandibular molars’ buccal mucosa is not anesthetized. How to cite this article: Pourkazemi M, Erfanparast L, Sheykhgermchi S, Ghanizadeh M. Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children? Int J Clin Pediatr Dent 2017;10(4):369-372. PMID:29403231

Ultrasound-Guided Intervention for Treatment of Trigeminal Neuralgia: An Updated Review of Anatomy and Techniques

PubMed Central

Allam, Abdallah El-Sayed; Khalil, Adham Aboul Fotouh; Eltawab, Basma Aly; Wu, Wei-Ting

2018-01-01

Orofacial myofascial pain is prevalent and most often results from entrapment of branches of the trigeminal nerves. It is challenging to inject branches of the trigeminal nerve, a large portion of which are shielded by the facial bones. Bony landmarks of the cranium serve as important guides for palpation-guided injections and can be delineated using ultrasound. Ultrasound also provides real-time images of the adjacent muscles and accompanying arteries and can be used to guide the needle to the target region. Most importantly, ultrasound guidance significantly reduces the risk of collateral injury to vital neurovascular structures. In this review, we aimed to summarize the regional anatomy and ultrasound-guided injection techniques for the trigeminal nerve and its branches, including the supraorbital, infraorbital, mental, auriculotemporal, maxillary, and mandibular nerves. PMID:29808105

The pediatric mandible: I. A primer on growth and development.

PubMed

Smartt, James M; Low, David W; Bartlett, Scott P

2005-07-01

After studying this article, the participant should be able to: 1. Describe embryonic and fetal mandibular development. 2. Summarize the aggregate changes in mandibular form from birth to puberty. 3. Describe the eruption and maturation of the deciduous and permanent mandibular dentition. In this, the first of two articles addressing the surgical management of pediatric mandibular fractures, the authors provide a detailed discussion of mandibular development and anatomy during the fetal period, infancy, and childhood. A review of the pertinent literature was performed. The changing structure of the developing mandible is discussed, with particular attention to surgically relevant anatomical structures. Throughout development, key anatomical structures with relevance to surgical therapy change markedly in position. The mandible undergoes significant change in its bony structure and the composition of its surrounding soft tissues. The mandible's bony structure becomes more robust, with an increasingly acute gonial angle and enlargement of the ramus and body. Furthermore, the mandible provides the bony structure from which tooth buds erupt as the deciduous and permanent dentition--a process that generates significant growth of the alveolar process. As a consequence, the distance between the developing dentition and the inferior mandibular border increases. While the canal of the inferior alveolar nerve undergoes significant superior displacement, the mental foramen becomes positioned more posteriorly over time. In addition, the ligamentous and muscular attachments that surround the temporomandibular joint become increasingly robust. Throughout childhood and adolescence, the blood supply of the mandibular body changes little, with the buccal periosteal plexus and inferior dental artery making significant contributions. Mandibular growth provides the basis for normal occlusal relations and the generation of increasingly large masticatory force. Although the exact mechanisms of bone remodeling during mandibular development remain unclear, the process likely receives contributions from primary growth centers and the response to local alterations in biomechanical force produced by surrounding soft-tissue structures. A working knowledge of the changing mandibular anatomy is a prerequisite for effective clinical management of traumatic injury.

A low dose of subperiosteal anaesthesia injection versus a high dose of infiltration anaesthesia to minimise the risk of nerve damage at implant placement: A randomised controlled trial.

PubMed

Sánchez-Siles, Mariano; Camacho-Alonso, Fabio; Salazar-Sánchez, Noemi; Aguinaga-Ontoso, Enrique; Muñoz, Javier Guardia; Calvo-Guirado, Jose Luis

2016-01-01

To evaluate whether a low-dose subperiosteal anaesthesia is effective in minimising risks of inferior alveolar nerve damage at implant placement when compared to high-dose infiltration anaesthesia. One hundred and twenty patients requiring the placement of a single implant in order to replace a missing first mandibular were randomly allocated to two groups: group A (awake hemilip) subperiosteal crestal injection equal to 0.9 ml of articaine with 0.5% epinephrine and group B (numb hemilip) infiltration equal to 7.2 ml of articaine with 0.5% epinephrine in the vestibular fundus. Intraoperative sensory control using sensory tests was carried out in all patients. Outcome measures were neurological complications, intraoperative and postoperative visual analogue scale (VAS) scores for pain and swelling, and a questionnaire evaluating patient satisfaction. Patients were followed for 1 week postoperatively. There were no cases of nerve injury. Seven days after surgery the postoperative VAS score for pain and swelling was lower in group A in a statistically significant manner (difference = -3.41%; 95% CI: -5.57, -1.26; P = 0.002 and difference = -3.33%; 95% CI: -5.41, -1.25; P = 0.002, respectively). No nerve damage occurred using either anaesthesia types, therefore the choice of type of anaesthesia is a subjective clinical decision, however it may be preferable to use a low dose (0.9 ml) of subperiosteal anaesthesia, since it is unnecessary to deliver 7.2 ml of articaine to anaesthetise a single mandibular molar implant site.

Herpes zoster: A clinicocytopathological insight.

PubMed

Shah, Snehal; Singaraju, Sasidhar; Einstein, A; Sharma, Ashish

2016-01-01

Herpes zoster or shingles is reactivation of the varicella zoster virus that had entered the cutaneous nerve endings during an earlier episode of chicken pox traveled to the dorsal root ganglia and remained in a latent form. This condition is characterized by occurrence of multiple, painful, unilateral vesicles and ulceration which shows a typical single dermatome involvement. In this case report, we present a patient with herpes zoster involving the mandibular division of the trigeminal nerve, with unilateral vesicles over the right side of lower third of face along the trigeminal nerve tract, with intraoral involvement of buccal mucosa, labial mucosa and the tongue of the same side. Cytopathology revealed classic features of herpes infection including inclusion bodies, perinuclear halo and multinucleated cells.

Perineural tumour spread from colon cancer, an unusual cause of trigeminal neuropathy - a case report

PubMed Central

Nair, Kavitha; George, Thomas; El Beltagi, Ahmed

2015-01-01

Malignant trigeminal neuralgia due to perineural spread along the branches of the trigeminal nerve, is known to commonly occur secondary to squamous cell carcinomas, lymphomas and adenoid cystic carcinomas in the head and neck region. Rarely metastases to the trigeminal nerve have been reported in breast cancer, prostate cancer and colon cancer. To the best of our knowledge trigeminal neuropathy due to skull base metastases and perineural spread along the maxillary (V2) and mandibular (V3) branches of the trigeminal nerve, secondary to colon cancer, has not been previously reported. The diagnosis in our index case was made on magnetic resonance imaging, and patient was treated accordingly by fractionated stereotactic radiotherapy, with subsequent relief of her pain. PMID:26629299

Use of rectangular grid miniplates for fracture fixation at the mandibular angle.

PubMed

Hochuli-Vieira, Eduardo; Ha, Thi Khanh Linh; Pereira-Filho, Valfrido Antonio; Landes, Constantin Alexander

2011-05-01

The aim of this study was to evaluate the clinical outcome of patients with mandibular angle fractures treated by intraoral access and a rectangular grid miniplate with 4 holes and stabilized with monocortical screws. This study included 45 patients with mandibular angle fractures from the Department of Oral and Maxillofacial Surgery São Paulo State University, Araraquara, Brazil, and from the Clinic of Oral and Maxillofacial Surgery at the University of Frankfurt, Germany. The 45 fractures of the mandibular angle were treated with a rectangular grid miniplate of a 2.0-mm system by an intraoral approach with monocortical screws. Clinical evaluations were postoperatively performed at 15 and 30 days and 3 and 6 months, and the complications encountered were recorded and treated. The infection rate was 4.44% (2 patients), and in 1 patient it was necessary to replace hardware. This patient also had a fracture of the left mandibular body; 3 patients (6.66%) had minor occlusal changes that have been resolved with small occlusal adjustments. Before surgery, 15 patients (33.33%) presented with hypoesthesia of the inferior alveolar nerve; 4 (8.88%) had this change until the last clinical control, at 6 months. The rectangular grid miniplate used in this study was stable for the treatment of simple mandibular angle fractures through intraoral access, with low complication rates, easy handling, and easy adjustment, with a low cost. Concomitant mandibular fracture may increase the rate of complications. This plate should be indicated in fractures with sufficient interfragmentary contact. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Neuropathic pain resulting from implant placement: case report and diagnostic conclusions.

PubMed

Leckel, M; Kress, B; Schmitter, M

2009-07-01

Temporary or persisting dysesthesia of the nervus alveolaris inferior has often been described as a complication of implant surgery of the lower mandible. In most cases, lesion of the nerve results in anaesthesia of the innervated region, a symptom clearly indicative of correct diagnosis. In our case report, however, a minor perforation of the roof of the mandibular canal during implant placement apparently provoked discrete irritation of the nerve, resulting in persistent neuropathic pain without concomitant hypesthesia or dysesthesia. Because the canal could not be detected in conventional dental radiographs, this uncharacteristic situation made correct diagnosis difficult and led to unnecessary surgical procedures including extraction of adjacent teeth. Medical imaging [computed tomography (CT)] finally revealed the close proximity of the apex of the implant and the bony structure of the mandibular canal. The effect on the nervus alveolaris inferior was also demonstrated using an innovative high-resolution dental magnetic-resonance-imaging technique reflecting vascular reactions of the neurovascular bundle after potentially damaging surgical intervention. After removal of the causative implant, the pain gradually faded over a period of a year.

A Comparison of Different Volumes of Articaine for Inferior Alveolar Nerve Block for Molar Teeth with Symptomatic Irreversible Pulpitis.

PubMed

Abazarpoor, Ramin; Parirokh, Masoud; Nakhaee, Nouzar; Abbott, Paul V

2015-09-01

Achieving anesthesia in mandibular molar teeth with irreversible pulpitis is very difficult. The aim of this study was to compare the efficacy of 1.8 mL and 3.6 mL articaine for an inferior alveolar nerve block (IANB) when treating molars with symptomatic irreversible pulpitis. In a randomized, double-blind clinical trial, 82 first mandibular molar teeth with symptomatic irreversible pulpitis randomly received conventional IANB injection either with 1 (1.8 mL) or 2 cartridges (3.6 mL) of 4% articaine with 1:100,000 epinephrine. The patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation using a Heft-Parker visual analog scale. No or mild pain was considered as successful anesthesia. Data were analyzed by t and chi-square tests. Eighty patients were eligible to participate in this study, which showed that 3.6 mL articaine provided a significantly higher success rate (77.5%) of IANBs compared with 1.8 mL of the same anesthetic solution (27.5%) although neither group had 100% successful anesthesia (P < .001). Increasing the volume of articaine provided a significantly higher success rate of IANBs in mandibular first molar teeth with symptomatic irreversible pulpitis, but it did not result in 100% anesthetic success. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effect of sodium bicarbonate-buffered lidocaine on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a prospective, randomized double-blind study.

PubMed

Saatchi, Masoud; Khademi, Abbasali; Baghaei, Badri; Noormohammadi, Hamid

2015-01-01

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of buffered with nonbuffered 2% lidocaine with 1:80,000 epinephrine solution for inferior alveolar nerve (IAN) block in patients with mandibular posterior teeth experiencing symptomatic irreversible pulpitis. Eighty adult patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received 2 cartridges of either 2% lidocaine with 1:80,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate or 2% lidocaine with 1:80,000 epinephrine with 0.18 mL sterile distilled water using conventional IAN block injections. Endodontic access preparation was initiated 15 minutes after injection. Lip numbness was required for all the patients. Success was determined as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed by the t, Mann-Whitney, and chi-square tests. The success rates were 62.5% and 47.5% for buffered and nonbuffered groups, respectively, with no significant differences between the two groups (P = .381). Buffering the 2% lidocaine with 1:80,000 epinephrine with 8.4% sodium bicarbonate did not improve the success of the IAN block in mandibular molars in patients with symptomatic irreversible pulpitis. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effect of preoperative acetaminophen/hydrocodone on the efficacy of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, randomized, double-blind, placebo-controlled study.

PubMed

Fullmer, Spencer; Drum, Melissa; Reader, Al; Nusstein, John; Beck, Mike

2014-01-01

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of the administration of the combination acetaminophen/hydrocodone on the anesthetic success of mandibular posterior teeth in patients experiencing symptomatic irreversible pulpitis. One hundred emergency patients in moderate to severe pain diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, identical capsules of either a combination dose of 1000 mg acetaminophen/10 mg hydrocodone or placebo 60 minutes before the administration of a conventional inferior alveolar nerve (IAN) block. Endodontic access was begun 15 minutes after completion of the block, and all patients used for data analysis had profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) on pulpal access or instrumentation. The success rate for the IAN block was 32% for the combination dose of 1000 mg acetaminophen/10 hydrocodone and 28% for the placebo dose, with no statistically significant difference between the 2 groups (P = .662). A combination dose of 1000 mg acetaminophen/10 mg hydrocodone given 60 minutes before the administration of the IAN block did not result in a statistically significant increase in anesthetic success for mandibular posterior teeth in patients experiencing symptomatic irreversible pulpitis. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The effect of preoperative submucosal administration of tramadol on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: a randomized, double-blind placebo-controlled clinical trial.

PubMed

De Pedro-Muñoz, A; Mena-Álvarez, J

2017-12-01

This randomized, double-blind, placebo-controlled, clinical trial was designed to improve the success of inferior alveolar nerve blocks (IANB) in mandibular molars with symptomatic irreversible pulpitis (SIP) by means of preoperative submucosal administration of 50 mg tramadol. Forty-two patients with a mandibular molar diagnosed with SIP took part in the trial. Patients were assigned randomly to one of two groups: tramadol group (n = 21), who received 50 mg tramadol in 1 mL by mandibular infiltration, and a placebo group (n = 21), who received 1 mL of normal saline administered to the affected tooth by the same means. Ten minutes later, all patients received an IANB with 4% articaine with epinephrine 1 : 100 000. A 10-min waiting time was established after local anaesthetic (LA) administration before carrying out three consecutive tests to assess anaesthesia of the pulp, that is two consecutive negative responses to an electric pulp test, positive or negative response to a cold test and no pain during access cavity preparation. IANB was considered successful only if the patient did not experience pain arising from these tests. Data were analysed by the Chi-squared frequency test and the Fisher's exact test, for qualitative variables, Mann-Whitney U-test for independent samples and two-way anova for more than two independent samples. In the tramadol group IANB was achieved successfully in 57% of the sample, whilst the placebo group obtained 29%. The difference between groups was not significant (P = 0.06). When performing endodontic access, the anaesthetic success rate was significantly in favour of tramadol (P = 0.03). Preoperative submucosal administration of 50 mg tramadol in mandibular molars with SIP significantly improved the success of IANB using 4% articaine with 1 : 100 000 epinephrine during access cavity preparation in comparison with a placebo. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Occipital neuralgia evoked by facial herpes zoster infection.

PubMed

Kihara, Takeshi; Shimohama, Shun

2006-01-01

Occipital neuralgia is a pain syndrome which may usually be induced by spasms of the cervical muscles or trauma to the greater or lesser occipital nerves. We report a patient with occipital neuralgia followed by facial herpes lesion. A 74-year-old male experienced sudden-onset severe headache in the occipital area. The pain was localized to the distribution of the right side of the greater occipital nerve, and palpation of the right greater occipital nerve reproduces the pain. He was diagnosed with occipital neuralgia according to ICHD-II criteria. A few days later, the occipital pain was followed by reddening of the skin and the appearance, of varying size, of vesicles on the right side of his face (the maxillary nerve and the mandibular nerve region). This was diagnosed as herpes zoster. This case represents a combination of facial herpes lesions and pain in the C2 and C3 regions. The pain syndromes can be confusing, and the classic herpes zoster infection should be considered even when no skin lesions are established.

[Orthodontic partial disimpaction of mandibular third molars prior to surgical extraction].

PubMed

Derton, Nicolà; Perini, Alessandro; Giordanetto, José; Biondi, Giovanni; Siciliani, Giuseppe

2009-06-01

Odontodysplasia of the third molars is a relatively common anomaly. The frequent complications associated with this disorder very often constitute an indication for extraction of the third molar. This surgical treatment can damage the lower alveolar nerve and/or trigger distal bone loss of the second molar, thus jeopardizing the future status of the periodontium. The author presents two case studies treated exclusively with miniscrews with no dental anchorage in order to achieve partial eruption of the third molar moving it away from the lower alveolar nerve and to avoid unwanted impact on other teeth. Following this procedure, the third molar was extracted without complications. In conclusion, this approach can offer an alternative to surgical treatment alone in cases where the proximity of tooth and nerve poses a significant risk.

How to improve retromandibular transmasseteric anteroparotid approach for mandibular condylar fractures: our clinical experience.

PubMed

Salgarelli, A C; Anesi, A; Bellini, P; Pollastri, G; Tanza, D; Barberini, S; Chiarini, L

2013-04-01

Fractures of the mandibular condyle are common and account for 25-35% of all mandibular fractures reported in the literature. Even with the development of a consensus on the preference for open reduction and internal fixation of these fractures, the clinician is still faced with a dilemma concerning the optimal approach to the ramus-condyle unit. Limited access and injury to the facial nerve are the most common problems. The most commonly used extraoral approaches are the submandibular, retromandibular and preauricular methods. In this study, we propose a modified cosmetic preauricular incision with a short end in the neck, to improve the transmasseteric anteroparotid (TMAP) approach previously described by Wilson et al. in 2005. We retrospectively analysed 13 patients treated in our department for mandibular condylar fractures. Post-operative complications, occlusal status, interincisal opening and joint tenderness were evaluated at 3 months after surgery. The wider skin incision described here provides a convenient approach for open reduction and rigid internal fixation, and good results were obtained. The follow-up ranged from 6 to 40 months. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Functional and Anatomical Outcomes of Facial Nerve Injury With Application of Polyethylene Glycol in a Rat Model.

PubMed

Brown, Brandon L; Asante, Tony; Welch, Haley R; Sandelski, Morgan M; Drejet, Sarah M; Shah, Kishan; Runge, Elizabeth M; Shipchandler, Taha Z; Jones, Kathryn J; Walker, Chandler L

2018-05-17

Functional and anatomical outcomes after surgical repair of facial nerve injury may be improved with the addition of polyethylene glycol (PEG) to direct suture neurorrhaphy. The application of PEG has shown promise in treating spinal nerve injuries, but its efficacy has not been evaluated in treatment of cranial nerve injuries. To determine whether PEG in addition to neurorrhaphy can improve functional outcomes and synkinesis after facial nerve injury. In this animal experiment, 36 rats underwent right facial nerve transection and neurorrhaphy with addition of PEG. Weekly behavioral scoring was done for 10 rats for 6 weeks and 14 rats for 16 weeks after the operations. In the 16-week study, the buccal branches were labeled and tissue analysis was performed. In the 6-week study, the mandibular and buccal branches were labeled and tissue analysis was performed. Histologic analysis was performed for 10 rats in a 1-week study to assess the association of PEG with axonal continuity and Wallerian degeneration. Six rats served as the uninjured control group. Data were collected from February 8, 2016, through July 10, 2017. Polyethylene glycol applied to the facial nerve after neurorrhaphy. Functional recovery was assessed weekly for the 16- and 6-week studies, as well as motoneuron survival, amount of regrowth, specificity of regrowth, and aberrant branching. Short-term effects of PEG were assessed in the 1-week study. Among the 40 male rats included in the study, PEG addition to neurorrhaphy showed no functional benefit in eye blink reflex (mean [SEM], 3.57 [0.88] weeks; 95% CI, -2.8 to 1.9 weeks; P = .70) or whisking function (mean [SEM], 4.00 [0.72] weeks; 95% CI, -3.6 to 2.4 weeks; P = .69) compared with suturing alone at 16 weeks. Motoneuron survival was not changed by PEG in the 16-week (mean, 132.1 motoneurons per tissue section; 95% CI, -21.0 to 8.4; P = .13) or 6-week (mean, 131.1 motoneurons per tissue section; 95% CI, -11.0 to 10.0; P = .06) studies. Compared with controls, neither surgical group showed differences in buccal branch regrowth at 16 (36.9 motoneurons per tissue section; 95% CI, -14.5 to 22.0; P = .28) or 6 (36.7 motoneurons per tissue section; 95% CI, -7.8 to 18.5; P = .48) weeks or in the mandibular branch at 6 weeks (25.2 motoneurons per tissue section; 95% CI, -14.5 to 15.5; P = .99). Addition of PEG had no advantage in regrowth specificity compared with suturing alone at 16 weeks (15.3% buccal branch motoneurons with misguided projections; 95% CI, -7.2% to 11.0%; P = .84). After 6 weeks, the number of motoneurons with misguided projections to the mandibular branch showed no advantage of PEG treatment compared with suturing alone (12.1% buccal branch motoneurons with misguided projections; 95% CI, -8.2% to 9.2%; P = .98). In the 1-week study, improved axonal continuity and muscular innervation were not observed in PEG-treated rats. Although PEG has shown efficacy in treating other nervous system injuries, PEG in addition to neurorraphy was not beneficial in a rat model of facial nerve injury. The addition of PEG to suturing may not be warranted in the surgical repair of facial nerve injury. NA.

Application of a real-time three-dimensional navigation system to various oral and maxillofacial surgical procedures.

PubMed

Ohba, Seigo; Yoshimura, Hitoshi; Ishimaru, Kyoko; Awara, Kousuke; Sano, Kazuo

2015-09-01

The aim of this study was to confirm the effectiveness of a real-time three-dimensional navigation system for use during various oral and maxillofacial surgeries. Five surgeries were performed with this real-time three-dimensional navigation system. For mandibular surgery, patients wore acrylic surgical splints when they underwent computed tomography examinations and the operation to maintain the mandibular position. The incidence of complications during and after surgery was assessed. No connection with the nasal cavity or maxillary sinus was observed at the maxilla during the operation. The inferior alveolar nerve was not injured directly, and any paresthesia around the lower lip and mental region had disappeared within several days after the surgery. In both maxillary and mandibular cases, there was no abnormal hemorrhage during or after the operation. Real-time three-dimensional computer-navigated surgery allows minimally invasive, safe procedures to be performed with precision. It results in minimal complications and early recovery.

Four osteotomy methods with piezosurgery to remove complicated mandibular third molars: a retrospective study.

PubMed

Ge, Jing; Yang, Chi; Zheng, Jia-Wei; He, Dong-Mei; Zheng, Ling-Yan; Hu, Ying-Kai

2014-11-01

Piezosurgery has been used widely in oral and maxillofacial surgery, but there has been no report systematically describing an osteotomy method with piezosurgery for complicated mandibular third molar removal. The aim of this study was to introduce 4 osteotomy methods using piezosurgery and evaluate their effects. A retrospective study was conducted of patients with a complicated impacted mandibular third molar requiring extraction. The predictor variable was the extraction technique. Four osteotomy methods using piezosurgery were tested according to different impaction types: method 1 involved complete bone removal; method 2 involved segmental bone removal; method 3 involved bone removal combined with tooth splitting; and method 4 involved block bone removal. Outcome variables were success rate, operative time, major complications (including nerve injury, mandible fracture, severe hematoma, or severe edema), and serious pyogenic infection. Data were analyzed using descriptive statistics. The study was composed of 55 patients with 74 complicated impacted mandibular third molars. All impacted mandibular third molars were removed successfully. The average surgical time was 15 minutes (range, 8 to 26 minutes). Thirty-eight molars (51.4%) were extracted by method 1, 18 molars (24.3%) by method 2, 12 molars (16.2%) by method 3, and 6 molars (8.1%) by method 4. Two cases (2.7%) developed postoperative infections and recovered within 1 week using drainage and antibiotic administration. The 4 osteotomy methods with piezosurgery provide effective ways of removing complicated impacted mandibular third molars. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Anesthetic efficacy of X-tip intraosseous injection using 2% lidocaine with 1:80,000 epinephrine in patients with irreversible pulpitis after inferior alveolar nerve block: A clinical study.

PubMed

Verma, Pushpendra Kumar; Srivastava, Ruchi; Ramesh, Kumar M

2013-03-01

The inferior alveolar nerve block (IAN) is the most frequently used mandibular injection technique for achieving local anesthesia in endodontics. Supplemental injections are essential to overcome failure of IAN block in patients with irreversible pulpitis. To evaluate the anesthetic efficacy of X-tip intraosseous injection (2% lidocaine with 1:80,000 epinephrine) in patients with irreversible pulpitis in mandibular posterior teeth when conventional IAN block failed. Thirty emergency patients diagnosed with irreversible pulpitis in a mandibular posterior tooth received an IAN block and experienced moderate to severe pain on endodontic access or initial instrumentation. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:80,000 epinephrine. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analogue scale ratings < 54 mm) on endodontic access or initial instrumentation. Ninety-three percent of X-tip injections were successful and 7% were unsuccessful. Discomfort rating for X-tip perforation: 96.66% patients reported none or mild pain, whereas 3.34% reported moderate to severe pain. For discomfort rating during solution deposition, 74.99% patients reported none or mild pain and 24.92% reported moderate to severe pain. Ninety-six percent of the patients had subjective/objective increase in heart rate. Supplemental X-tip intraosseous injection using 2% lignocaine with 1:80,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis.

Anesthetic efficacy of X-tip intraosseous injection using 2% lidocaine with 1:80,000 epinephrine in patients with irreversible pulpitis after inferior alveolar nerve block: A clinical study

PubMed Central

Verma, Pushpendra Kumar; Srivastava, Ruchi; Ramesh, Kumar M

2013-01-01

Introduction: The inferior alveolar nerve block (IAN) is the most frequently used mandibular injection technique for achieving local anesthesia in endodontics. Supplemental injections are essential to overcome failure of IAN block in patients with irreversible pulpitis. Aim: To evaluate the anesthetic efficacy of X-tip intraosseous injection (2% lidocaine with 1:80,000 epinephrine) in patients with irreversible pulpitis in mandibular posterior teeth when conventional IAN block failed. Materials and Methods: Thirty emergency patients diagnosed with irreversible pulpitis in a mandibular posterior tooth received an IAN block and experienced moderate to severe pain on endodontic access or initial instrumentation. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:80,000 epinephrine. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analogue scale ratings < 54 mm) on endodontic access or initial instrumentation. Results: Ninety-three percent of X-tip injections were successful and 7% were unsuccessful. Discomfort rating for X-tip perforation: 96.66% patients reported none or mild pain, whereas 3.34% reported moderate to severe pain. For discomfort rating during solution deposition, 74.99% patients reported none or mild pain and 24.92% reported moderate to severe pain. Ninety-six percent of the patients had subjective/objective increase in heart rate. Conclusions: Supplemental X-tip intraosseous injection using 2% lignocaine with 1:80,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis. PMID:23716971

Orthodontic Extraction of High-Risk Impacted Mandibular Third Molars in Close Proximity to the Mandibular Canal: A Systematic Review.

PubMed

Kalantar Motamedi, Mahmood Reza; Heidarpour, Majid; Siadat, Sara; Kalantar Motamedi, Alimohammad; Bahreman, Ali Akbar

2015-09-01

Extraction of mandibular third molars (M3s) in close proximity to the mandibular canal has some inherent risks to adjacent structures, such as neurologic damage to teeth, bone defects distal to the mandibular second molar (M2), or pathologic fractures in association with enlarged dentigerous cysts. The procedure for extrusion and subsequent extraction of high-risk M3s is called orthodontic extraction. This is a systematic review of the available approaches for orthodontic extraction of impacted mandibular M3s in close proximity to the mandibular canal and their outcomes. The PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), DOAJ, Google Scholar, OpenGrey, Iranian Science Information Database (SID), Iranmedex, and Irandoc databases were searched using specific keywords up to June 2, 2014. Studies were evaluated based on predetermined eligibility criteria, treatment approaches, and their outcomes. Thirteen articles met the inclusion criteria. A total of 123 impacted teeth were extracted by orthodontic extraction and 2 cases were complicated by transient paresthesia. Three types of biomechanical approaches were used: 1) using the posterior maxillary region as the anchor for orthodontic extrusion of lower M3s, 2) simple cantilever springs attached to the M3 buttonhole, and 3) cantilever springs tied to a bonded orthodontic bracket on the M3 plus multiple-loop spring wire for distal movement of the M3. Osteo-periodontal status of M2s also improved uneventfully. Despite the drawbacks of orthodontic extraction, removal of deeply impacted M3s using the described techniques is safe with regard to mandibular nerve injury and neurologic damage. Orthodontic extraction is recommended for extraction of impacted M3s that present a high risk of postoperative osteo-periodontal defects on the distal surface of the adjacent M2 and those associated with dentigerous cysts. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Higher concentration local anaesthetics causing prolonged anaesthesia. Do they? A literature review and case reports.

PubMed

Kingon, A; Sambrook, P; Goss, A

2011-12-01

Higher concentration dental local anaesthetics (3% and 4%) have become more available in Australia in recent years. Benefits claimed include a faster onset of anaesthesia and improved success with injections compared to 2% solutions. Recent reports suggest that the higher concentration carries a greater risk of prolonged anaesthesia to the mandibular and particularly the lingual nerves. The literature was reviewed and those studies which demonstrated adverse effects of different concentrations of local anaesthetics were analysed. Recent cases are presented. There is an extensive international literature which confirms increased concentration of local anaesthetic does show an increased risk, by about ×6, of prolonged anaesthesia. Five case reports illustrate the impact of this complication on patients' quality of life. Careful consideration needs to be given before using higher concentration local anaesthetic agents for mandibular and lingual blocks as lower concentration local anaesthetics are safer. If acceptable to individual patients, avoidance of block injections or any local anaesthetic for minor restorative tasks could be encouraged given the severity of the complication. It is safe to use the higher concentration agents for infiltrations away from major nerves. © 2011 Australian Dental Association.

Intraosseous repair of the inferior alveolar nerve in rats: an experimental model.

PubMed

Curtis, N J; Trickett, R I; Owen, E; Lanzetta, M

1998-08-01

A reliable method of exposure of the inferior alveolar nerve in Wistar rats has been developed, to allow intraosseous repair with two microsurgical techniques under halothane inhalational anaesthesia. The microsuturing technique involves anastomosis with 10-0 nylon sutures; a laser-weld technique uses an albumin-based solder containing indocyanine green, plus an infrared (810 nm wavelength) diode laser Seven animals had left inferior alveolar nerve repairs performed with the microsuture and laser-weld techniques. Controls were provided by unoperated nerves in the repaired cases. Histochemical analysis was performed utilizing neuron counts and horseradish peroxidase tracer (HRP) uptake in the mandibular division of the trigeminal ganglion, following sacrifice and staining of frozen sections with cresyl violet and diaminobenzidene. The results of this analysis showed similar mean neuron counts and mean HRP uptake by neurons for the unoperated controls and both microsuture and laser-weld groups. This new technique of intraosseous exposure of the inferior alveolar nerve in rats is described. It allows reliable and reproducible microsurgical repairs using both microsuture and laser-weld techniques.

Motor fiber organization in the extratemporal trunk of the facial nerve in rats: A retrograde Fluoro-Gold study

PubMed Central

CHEN, LIJIE; HU, MIN; ZHANG, LIHAI; LIU, SANXIA; LUO, JINCHAO; DENG, TIANZHENG; TAO, YE

2012-01-01

Understanding the microanatomy of the facial nerve is vital to functional restoration of facial nerve injury. This study aimed to locate the spatial orientation of five branches in the extratemporal trunk of the rat facial nerve (ETFN). Fifteen adult Sprague-Dawley albino rats were divided randomly into five groups corresponding to the five facial nerves. Fluoro-Gold™ (FG) was applied to one branch in all three rats in each group. The trunk of the facial nerve was cut at three points for fluorescence detection. Staining results showed that each branch of the facial motor nerve had a topographical orientation in the distal part of the ETFN. The temporal branch was located in the medial and acroscopic quadrant of the nerve trunk. The zygomatic branch was located in the lateral and acroscopic quadrant. The buccal branch occupied the upper half of the nerve trunk, whereas the mandibular branch occupied the lower half. The cervical branch presented a square-shaped distribution in the lateral nerve trunk. In the middle part of the ETFN, the topographical orientation remained clear, but the FG-labeled zone was extended to some extent. In the stylomastoid foramen region, all branches diffused, thereby blurring the orientation. In conclusion, each branch of the facial motor nerve had a topographical orientation and distribution in the crotch and middle part of the ETFN, but the branches diffused near the stylomastoid foramen. PMID:23226737

Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches.

PubMed

Al-Moraissi, Essam Ahmed; Louvrier, Aurélien; Colletti, Giacomo; Wolford, Larry M; Biglioli, Federico; Ragaey, Marwa; Meyer, Christophe; Ellis, Edward

2018-03-01

The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing (ORIF) of mandibular condylar fractures by different surgical approaches. A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when (ORIF) of mandibular condylar fractures was performed using different surgical approaches. The main outcome variable was transient facial nerve injury (TFNI) and permanent facial nerve injury (PFNI) according to the fracture levels, namely: condylar head fractures (CHFs), condylar neck fractures (CNFs), and condylar base fractures (CBFs). For studies where there was no delineation between CNFs and CBFs, the fractures were defined as CNFs/CBFs. The dependent variables were the surgical approaches. A total of 3873 patients enrolled in 96 studies were included in this analysis. TFNI rates reported in the literature were as follows: A) For the transoral approach: a) for strictly intraoral 0.72% (1.3 in CNFs and 0% for CBFs); b) for the transbuccal trocar instrumentation 2.7% (4.2% in CNFs and 0% for CBFs); and c) for endoscopically assisted ORIF 4.2% (5% in CNFs, and 4% in CBFs). B) For low submandibular approach 15.3% (26.1% for CNFs, 11.8% for CBFs, and 13.7% for CNFs/CBFs). C) For the high submandibular/angular subparotid approach with masseter transection 0% in CBFs. D) For the high submandibular/angular transmassetric anteroparotid approach 0% (CNFs and CBFs). E) For the transparotid retromandibular approach a) with nerve facial preparation 14.4% (23.9% in CNFs, 11.8% in CBFs and 13.7% for CNFs/CBFs); b) without facial nerve preparation 19% (24.3% for CNFs and 10.5% for CBFs). F) For retromandibular transmassetric anteroparotid approach 3.4% in CNFs/CBFs. G) For retromandibular transmassetric anteroparotid approach with preauricular extension 2.3% for CNFs/CBFs. H) For preauricular approach a) deep subfascial dissection plane 0% in CHFs b) for subfascial approach using traditional preauricular incision 10% (8.5% in CHFs and 11.5% in CNFs). I) For retroauricular approach 3% for CHFs. PFNI rates reported in the literature were as follows: A) for low submandibular approach 2.2%, B) for retromandibular transparotid approach 1.4%; C) for preauricular approach 0.33%; D) for high submandibular approach 0.3%; E) for deep retroparotid approach 1.5%. According to published data for CHFs, a retroauricular approach or deep subfascial preauricular approach was the safest to protect the facial nerve. For CNFs, a transmassetric anteroparotid approach with retromandibular and preauricular extension was the safest approach to decrease risk of FNI. For CBFs, high submandibular incisions with either transmassetric anteroparotid approach with retromandibular or transmassetric subparotid approach, followed by intraoral (with or without endoscopic/transbuccal trocar) were the safest approaches with respect to decreased risk of FNI. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Clinical comparison between the retromandibular approach for reduction and fixation and endoscope-assisted open reduction and internal fixation for mandibular condyle fractures.

PubMed

Nogami, Shinnosuke; Takahashi, Tetsu; Yamauchi, Kensuke; Miyamoto, Ikuya; Kaneuji, Takeshi; Yamamoto, Noriaki; Yoshiga, Daigo; Yamashita, Yoshihiro

2012-11-01

Endoscope-assisted transoral open reduction and internal fixation (EAORIF) for mandibular condyle fractures has recently become popular because it is minimally invasive, provides excellent visibility without a large incision, and reduces surgical scarring and the risk of facial nerve injury. This report describes a retrospective clinical study that compared certain clinical parameters, including postoperative function, between the retromandibular (RM) approach and EAORIF. Fifteen patients were treated by the RM approach, whereas 15 underwent EAORIF between July 2006 and September 2011 at Kyushu Dental College, Japan. Clinical indices comprised fracture line, fracture type, number of plates used, surgical duration, bleeding amount, and functional items, including maximum interincisal opening, mandibular deviation on the opening pathway, malocclusion, facial paresthesia, and temporomandibular joint pain and clicking. The areas subjected to either approach included lower neck and subcondyle. The RM approach was used for mandibular condyle fractures with dislocation of a small bone segment. Both groups used 2 plates in all cases. Surgical duration, maximum interincisal opening, mandibular deviation, occlusion, and temporomandibular joint function at 6 months after surgery were comparable between groups. The average bleeding amount in the EAORIF group was greater than in the RM group. One patient from the RM group developed facial paresthesia that persisted for 6 months after surgery. It was concluded that surgical treatment was suitable for fractures of the lower neck and subcondylar. Both procedures showed good results in the functional items of this study.

Essentials of Endodontic Microsurgery

DTIC Science & Technology

2010-04-01

protocol is divided into regional and local injections and are as follows: 1. The administration of a long-acting anesthetic agent such as bupivicaine (Mar...mandibular anterior teeth receive bilateral mental nerve blocks. All of these can be supplemented, as need be, with corresponding palatal or lingual...infiltrations of the same anesthetic . In studies examining the effectiveness of lidocaine versus bupivicaine, it was shown that lidocaine was faster in

Soldier-Specific Modification of the Mandibular Motor Neurons in Termites

PubMed Central

Ishikawa, Yuki; Aonuma, Hitoshi; Miura, Toru

2008-01-01

Social insects exhibit a variety of caste-specific behavioral tendencies that constitute the basis of division of labor within the colony. In termites, the soldier caste display distinctive defense behaviors, such as aggressively attacking enemies with well-developed mandibles, while the other castes retreat into the colony without exhibiting any aggressive response. It is thus likely that some form of soldier-specific neuronal modification exists in termites. In this study, the authors compared the brain (cerebral ganglion) and the suboesophageal ganglion (SOG) of soldiers and pseudergates (workers) in the damp-wood termite, Hodotermopsis sjostedti. The size of the SOG was significantly larger in soldiers than in pseudergates, but no difference in brain size was apparent between castes. Furthermore, mandibular nerves were thicker in soldiers than in pseudergates. Retrograde staining revealed that the somata sizes of the mandibular motor neurons (MdMNs) in soldiers were more than twice as large as those of pseudergates. The enlargement of MdMNs was also observed in individuals treated with a juvenile hormone analogue (JHA), indicating that MdMNs become enlarged in response to juvenile hormone (JH) action during soldier differentiation. This enlargement is likely to have two functions: a behavioral function in which soldier termites will be able to defend more effectively through relatively faster and stronger mandibular movements, and a developmental function that associates with the development of soldier-specific mandibular muscle morphogenesis in termite head. The soldier-specific enlargement of mandibular motor neurons was observed in all examined species in five termite families that have different mechanisms of defense, suggesting that such neuronal modification was already present in the common ancestor of termites and is significant for soldier function. PMID:18612458

Large Parotid Gland Lipoblastoma in a Teenager.

PubMed

Jandali, Danny; Heilingoetter, Ashley; Ghai, Ritu; Jeffe, Jill; Al-Khudari, Samer

2018-01-01

Lipoblastomas are rare benign neoplasms that arise from fetal white fat cells. They are typically found in children under the age of 3 and have been reported in the mediastinum, extremities, and infrequently in the head and neck. We present a rare case of a lipoblastoma arising from the parotid gland and the first known report of a parotid lipoblastoma in a teenager. A 15-year-old male presented with a painless, slowly enlarging parotid mass and left facial swelling. A fine needle aspiration was non-diagnostic and initial MRI showed a 3.8 cm × 5.0 cm × 4.0 cm fatty lesion involving the superficial and deep lobes of the left parotid gland and masticator space with widening of the stylo-mandibular tunnel and thinning of the adjacent mandibular condyle. The patient was taken to the operating room, and the mass was excised under general anesthesia via a transcervical parotid approach with facial nerve monitoring. The most superficial aspect of the parotid bed was spared and with upper and lower divisions of the facial nerve preserved. The tumor, which primarily involved the deep lobe of the parotid, was entirely excised. Final pathology revealed a 5.2 cm lipoblastoma. The patient did well post-operatively with full function of the facial nerve and 20 months of follow up without evidence of recurrence. This is the first reported case of a lipoblastoma of the parotid gland in a teenager. Although a rare tumor, it should be considered in the differential diagnosis of a parotid mass in this population.

Clinical and radiological outcomes of transoral endoscope-assisted treatment of mandibular condylar fractures.

PubMed

You, H-J; Moon, K-C; Yoon, E-S; Lee, B-I; Park, S-H

2016-03-01

Fractures of the mandibular condyle are one of the most common craniofacial fractures. However, the diagnosis and treatment of these fractures is controversial because of the multiple surgical approaches available. The purposes of this study were to identify surgery-related technical tips for better outcomes and to evaluate the results as well as complications encountered during 7 years of endoscope use to supplement the limited intraoral approach in the treatment of mandibular condylar fractures. Between 2005 and 2012, 50 patients with condylar fractures underwent endoscope-assisted reduction surgery. Postoperative facial bone computed tomography and panoramic radiography demonstrated adequate reduction of the condylar fractures in all patients. No condylar resorption was detected, and most patients displayed a satisfactory functional and structural recovery. There was no facial nerve damage or transitory hypoesthesia, and there were no visible scars after the surgery. Transoral endoscope-assisted treatment is a challenging but reliable method with lower morbidity and a rapid recovery. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The intracranial facial nerve as seen through different surgical windows: an extensive anatomosurgical study.

PubMed

Bernardo, Antonio; Evins, Alexander I; Visca, Anna; Stieg, Phillip E

2013-06-01

The facial nerve has a short intracranial course but crosses critical and frequently accessed surgical structures during cranial base surgery. When performing approaches to complex intracranial regions, it is essential to understand the nerve's conventional and topographic anatomy from different surgical perspectives as well as its relationship with surrounding structures. To describe the entire intracranial course of the facial nerve as observed via different neurosurgical approaches and to provide an analytical evaluation of the degree of nerve exposure achieved with each approach. Anterior petrosectomies (middle fossa, extended middle fossa), posterior petrosectomies (translabyrinthine, retrolabyrinthine, transcochlear), a retrosigmoid, a far lateral, and anterior transfacial (extended maxillectomy, mandibular swing) approaches were performed on 10 adult cadaveric heads (20 sides). The degree of facial nerve exposure achieved per segment for each approach was assessed and graded independently by 3 surgeons. The anterior petrosal approaches offered good visualization of the nerve in the cerebellopontine angle and intracanalicular portion superiorly, whereas the posterior petrosectomies provided more direct visualization without the need for cerebellar retraction. The far lateral approach exposed part of the posterior and the entire inferior quadrants, whereas the retrosigmoid approach exposed parts of the superior and inferior quadrants and the entire posterior quadrant. Anterior and anteroinferior exposure of the facial nerve was achieved via the transfacial approaches. The surgical route used must rely on the size, nature, and general location of the lesion, as well as on the capability of the particular approach to better expose the appropriate segment of the facial nerve.

Comparison of anesthetic efficacy between lidocaine with and without magnesium sulfate USP 50% for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis.

PubMed

Shetty, Krishna Prasad; Satish, Sarvepalli Venkata; Kilaru, Krishna Rao; Sardar, Poonam; Luke, Alexander M

2015-04-01

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to compare the anesthetic efficacy between lidocaine with and without magnesium sulfate USP 50% for inferior alveolar nerve (IAN) blocks in patients with symptomatic irreversible pulpitis. One hundred patients with symptomatic irreversible pulpitis of mandibular posterior teeth were selected for the study. The patients received 1 mL magnesium sulfate USP 50% or distilled water (placebo) 1 hour before administration of conventional IAN block. Endodontic access cavity preparation was initiated 15 minutes after the IAN block injection. Lip numbness was recorded for all the patients. Success of IAN block was defined as no or mild pain on the visual analogue scale during access cavity preparation and initial instrumentation. The success rate for the IAN block was 58% for magnesium sulfate group and 32% for the placebo group, with statistically significant difference between the 2 groups (P = .016). In mandibular posterior teeth diagnosed with symptomatic irreversible pulpitis, preoperative administration of 1 mL magnesium sulfate USP 50% resulted in statistically significant increase in success of IAN block compared with placebo. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal: retrospective study of 400 cases.

PubMed

Szalma, József; Lempel, Edina; Jeges, Sára; Szabó, Gyula; Olasz, Lajos

2010-02-01

The aim of the study was to estimate the accuracy of panoramic radiographic signs predicting inferior alveolar nerve (IAN) paresthesia after lower third molar removal. In a case-control study the sample was composed of 41 cases with postoperative IAN paresthesia and 359 control cases without it. The collected data included "classic" specific signs indicating a close spatial relationship between third molar root and inferior alveolar canal (IAC), root curvatures, and the extent of IAC-root tip overlap. Bivariate and multivariate logistic regression analyses were completed to estimate the association between radiographic findings and IAN paresthesia. The multivariate logistic analysis identified 3 signs significantly associated with IAN paresthesia (P < .001): interruption of the superior cortex of the canal wall, diversion of the canal, and darkening of the root. The sensitivities and specificities ranged from 14.6% to 68.3% and from 85.5% to 96.9%, respectively. The positive predictive values, calculated to factor a 1.1% prevalence of paresthesia, ranged from 3.6% to 10.9%, whereas the negative predictive values >99%. Panoramic radiography is an inadequate screening method for predicting IAN paresthesia after mandibular third molar removal. Copyright (c) 2010 Mosby, Inc. All rights reserved.

[Peripheral facial nerve lesion induced long-term dendritic retraction in pyramidal cortico-facial neurons].

PubMed

Urrego, Diana; Múnera, Alejandro; Troncoso, Julieta

2011-01-01

Little evidence is available concerning the morphological modifications of motor cortex neurons associated with peripheral nerve injuries, and the consequences of those injuries on post lesion functional recovery. Dendritic branching of cortico-facial neurons was characterized with respect to the effects of irreversible facial nerve injury. Twenty-four adult male rats were distributed into four groups: sham (no lesion surgery), and dendritic assessment at 1, 3 and 5 weeks post surgery. Eighteen lesion animals underwent surgical transection of the mandibular and buccal branches of the facial nerve. Dendritic branching was examined by contralateral primary motor cortex slices stained with the Golgi-Cox technique. Layer V pyramidal (cortico-facial) neurons from sham and injured animals were reconstructed and their dendritic branching was compared using Sholl analysis. Animals with facial nerve lesions displayed persistent vibrissal paralysis throughout the five week observation period. Compared with control animal neurons, cortico-facial pyramidal neurons of surgically injured animals displayed shrinkage of their dendritic branches at statistically significant levels. This shrinkage persisted for at least five weeks after facial nerve injury. Irreversible facial motoneuron axonal damage induced persistent dendritic arborization shrinkage in contralateral cortico-facial neurons. This morphological reorganization may be the physiological basis of functional sequelae observed in peripheral facial palsy patients.

Inferior alveolar nerve injury after mandibular third molar extraction: a literature review.

PubMed

Sarikov, Rafael; Juodzbalys, Gintaras

2014-01-01

The purpose of this study was to systematically review the comprehensive overview of literature data about injury to the inferior alveolar nerve after lower third molar extraction to discover the prevalence of injury, the risk factors, recovery rates, and alternative methods of treatment. Literature was selected through a search of PubMed electronic databases. Articles from January 2009 to June 2014 were searched. English language articles with a minimum of 6 months patient follow-up and injury analysis by patient's reporting, radiographic, and neurosensory testing were selected. In total, 84 literature sources were reviewed, and 14 of the most relevant articles that are suitable to the criteria were selected. Articles were analyzed on men and women. The influence of lower third molar extraction (especially impacted) on the inferior alveolar nerve was clearly seen. The incidence of injury to the inferior alveolar nerve after lower third molar extraction was about 0.35 - 8.4%. The injury of the inferior alveolar nerve can be predicted by various radiological signs. There are few risk factors that may increase the risk of injury to the nerve such as patients over the age of 24 years old, with horizontal impactions, and extraction by trainee surgeons. Recovery is preferable and permanent injury is very rare.

Factors predictive of the onset and duration of action of local anesthesia in mandibular third-molar surgery: a prospective study.

PubMed

Al-Shayyab, Mohammad H; Baqain, Zaid H

2018-04-01

The aim of this study was to assess the influence of patients' and surgical variables on the onset and duration of action of local anesthesia (LA) in mandibular third-molar (M3) surgery. Patients scheduled for mandibular M3 surgery were considered for inclusion in this prospective cohort study. Patients' and surgical variables were recorded. Two per cent (2%) lidocaine with 1:100,000 epinephrine was used to block the nerves for extraction of mandibular M3. Then, the onset of action and duration of LA were monitored. Univariate analysis and multivariate regression analysis were used to analyze the data. The final cohort included 88 subjects (32 men and 56 women; mean age ± SD = 29.3 ± 12.3 yr). With univariate analysis, age, gender, body mass index (BMI), smoking quantity and duration, operation time, and 'volume of local anesthetic needed' significantly influenced the onset of action and duration of LA. Multivariate regression revealed that age and smoking quantity were the only statistically significant predictors of the onset of action of LA, whereas age, smoking quantity, and 'volume of local anesthetic needed' were the only statistically significant predictors of duration of LA. Further studies are recommended to uncover other predictors of the onset of action and duration of LA. © 2018 Eur J Oral Sci.

A computer-guided bone block harvesting procedure: a proof-of-principle case report and technical notes.

PubMed

De Stavola, Luca; Fincato, Andrea; Albiero, Alberto Maria

2015-01-01

During autogenous mandibular bone harvesting, there is a risk of damage to anatomical structures, as the surgeon has no three-dimensional control of the osteotomy planes. The aim of this proof-of-principle case report is to describe a procedure for harvesting a mandibular bone block that applies a computer-guided surgery concept. A partially dentate patient who presented with two vertical defects (one in the maxilla and one in the mandible) was selected for an autogenous mandibular bone block graft. The bone block was planned using a computer-aided design process, with ideal bone osteotomy planes defined beforehand to prevent damage to anatomical structures (nerves, dental roots, etc) and to generate a surgical guide, which defined the working directions in three dimensions for the bone-cutting instrument. Bone block dimensions were planned so that both defects could be repaired. The projected bone block was 37.5 mm in length, 10 mm in height, and 5.7 mm in thickness, and it was grafted in two vertical bone augmentations: an 8 × 21-mm mandibular defect and a 6.5 × 18-mm defect in the maxilla. Supraimposition of the preoperative and postoperative computed tomographic images revealed a procedure accuracy of 0.25 mm. This computer-guided bone harvesting technique enables clinicians to obtain sufficient autogenous bone to manage multiple defects safely.

[Osteosynthesis in the Surgical Treatment of Prognathism: State of The Art].

PubMed

Durão, Nuno; Amarante, José

2017-03-31

Prognathism is a common skeletal facial abnormality, associated with class III malocclusion, often with repercussions in quality of life. In addition to orthodontic treatment, sagittal split ramus osteotomy is the most common technique for its correction, and segment osteosynthesis is an important element of the post-surgical outcome. A search for relevant literature was conducted in the PubMed/MEDLINE database and in other relevant sources. The stability of different fixation methods, their repercussions on inferior alveolar nerve lesions, and the type of material are among the most researched subjects. Recent research about the type of osteosynthesis applied in the sagittal split ramus osteotomy for mandibular setback is discussed. Miniplates appear to be the better option for fixation of sagittal split osteotomy for mandibular setback. Bioabsorbable osteosynthesis may be an acceptable alternative to titanium.

Fetal developmental change in topographical relationship between the human lateral pterygoid muscle and buccal nerve

PubMed Central

Katori, Y; Yamamoto, M; Asakawa, S; Maki, H; Rodríguez-Vázquez, J F; Murakami, G; Abe, S

2012-01-01

In adults, the lateral pterygoid muscle (LPM) is usually divided into the upper and lower heads, between which the buccal nerve passes. Using sagittal or horizontal sections of 14 fetuses and seven embryos (five specimens at approximately 20–25 weeks; five at 14–16 weeks; four at 8 weeks; seven at 6–7 weeks), we examined the topographical relationship between the LPM and the buccal nerve. In large fetuses later than 15 weeks, the upper head of the LPM was clearly discriminated from the lower head. However, the upper head was much smaller than the lower head in the smaller fetuses. Thus, in the latter, the upper head was better described as an ‘anterior slip’ extending from the lower head or the major muscle mass to the anterior side of the buccal nerve. The postero-anterior nerve course seemed to be determined by a branch to the temporalis muscle (i.e. the anterior deep temporal nerve). At 8 weeks, the buccal nerve passed through the roof of the small, fan-like LPM. At 6–7 weeks, the LPM anlage was embedded between the temporobuccal nerve trunk and the inferior alveolar nerve. Therefore, parts of the LPM were likely to ‘leak’ out of slits between the origins of the mandibular nerve branches at 7–8 weeks, and seemed to grow in size during weeks 14–20 and extend anterosuperiorly along the infratemporal surface of the prominently developing greater wing of the sphenoid bone. Consequently, the topographical relationship between the LPM and the buccal nerve appeared to ‘change’ during fetal development due to delayed development of the upper head. PMID:22352373

Electrophysiologic and functional evaluations of regenerated facial nerve defects with a tube containing dental pulp cells in rats.

PubMed

Sasaki, Ryo; Matsumine, Hajime; Watanabe, Yorikatsu; Takeuchi, Yuichi; Yamato, Masayuki; Okano, Teruo; Miyata, Mariko; Ando, Tomohiro

2014-11-01

Dental pulp tissue contains Schwann and neural progenitor cells. Tissue-engineered nerve conduits with dental pulp cells promote facial nerve regeneration in rats. However, no nerve functional or electrophysiologic evaluations were performed. This study investigated the compound muscle action potential recordings and facial functional analysis of dental pulp cell regenerated nerve in rats. A silicone tube containing rat dental pulp cells in type I collagen gel was transplanted into a 7-mm gap of the buccal branch of the facial nerve in Lewis rats; the same defect was created in the marginal mandibular branch, which was ligatured. Compound muscle action potential recordings of vibrissal muscles and facial functional analysis with facial palsy score of the nerve were performed. Tubulation with dental pulp cells showed significantly lower facial palsy scores than the autograft group between 3 and 10 weeks postoperatively. However, the dental pulp cell facial palsy scores showed no significant difference from those of autograft after 11 weeks. Amplitude and duration of compound muscle action potentials in the dental pulp cell group showed no significant difference from those of the intact and autograft groups, and there was no significant difference in the latency of compound muscle action potentials between the groups at 13 weeks postoperatively. However, the latency in the dental pulp cell group was prolonged more than that of the intact group. Tubulation with dental pulp cells could recover facial nerve defects functionally and electrophysiologically, and the recovery became comparable to that of nerve autografting in rats.

Trigemino-gustatory interactions: a randomized controlled clinical trial assessing the effects of selective anesthesia of dental afferents on taste thresholds.

PubMed

Lecor, Papa Abdou; Touré, Babacar; Boucher, Yves

2018-03-01

This study aimed at analyzing the effect of the temporary removal of trigeminal dental afferents on electrogustometric thresholds (EGMt). EGMt were measured in 300 healthy subjects randomized in three groups, in nine loci on the right and left side (RS, LS) of the tongue surface before and after anesthesia. Group IAN (n = 56 RS, n = 44 LS) received intraosseous local anesthesia of the inferior alveolar nerve (IAN). Group MdN received mandibular nerve (MdN) block targeting IAN before its entrance into the mandibular foramen (n = 60, RS, and n = 40, LS); group MxN receiving maxillary nerve (MxN) anesthesia (n = 56 RS and n = 44 LS) was the control group. Differences between mean EGMt were analyzed with the Wilcoxon test; correlation between type of anesthesia and EGMt was performed with Spearman's rho, all with a level of significance set at p ≤ 0.05. Significant EGMt (μA) differences before and after anesthesia were found in all loci with MdN and IAN on the ipsilateral side (p < 0.05), but not with MxN. Anesthesia of the MdN was positively correlated with the increase in EGMt (p < 0.001). Selective anesthesia of IAN was positively correlated only with the increase in EGMt measured at posterior and dorsal loci of the tongue surface (p < 0.01). The increase in EGMt following IAN anesthesia suggests a participation of dental afferents in taste perception. Extraction of teeth may impair food intake not only due to impaired masticatory ability but also to alteration of neurological trigemino-gustatory interactions. PACTR201602001452260.

Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures.

PubMed

Gali, Rajasekhar; Devireddy, Sathya Kumar; Venkata, Kishore Kumar Rayadurgam; Kanubaddy, Sridhar Reddy; Nemaly, Chaithanyaa; Dasari, Mallikarjuna

2016-01-01

Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP) approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a) the ease of access for retrieval, reimplantation and fixation of the proximal segment; b) the postoperative approach related complications; c) the adequacy of anatomical reduction and stability of fixation; d) the occlusal changes; and the e) TMJ function and radiological changes. Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch) palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby permitting perpendicular placement of screws with minimal risk of damage to the facial nerve.

Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures

PubMed Central

Gali, Rajasekhar; Devireddy, Sathya Kumar; Venkata, Kishore Kumar Rayadurgam; Kanubaddy, Sridhar Reddy; Nemaly, Chaithanyaa; Dasari, Mallikarjuna

2016-01-01

Introduction: Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. Purpose: This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP) approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. Patients and Methods: This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a) the ease of access for retrieval, reimplantation and fixation of the proximal segment; b) the postoperative approach related complications; c) the adequacy of anatomical reduction and stability of fixation; d) the occlusal changes; and the e) TMJ function and radiological changes. Results: Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch) palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. Conclusion: The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby permitting perpendicular placement of screws with minimal risk of damage to the facial nerve. PMID:27274123

Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study.

PubMed

Zrounba, Hugues; Lutz, Jean-Christophe; Zink, Simone; Wilk, Astrid

2014-09-01

Surgical management of mandibular condyle fractures is still controversial. Although it provides better outcome than closed treatment questions still remain about the surgical approach and the osteosynthesis devices to be used. Between 2005 and 2010, we managed 168 mandibular condyle fractures with open treatment. Two surgical approaches were used in this study, a pre-auricular and a high submandibular approach (one or the other or as a combined approach). Internal fixation was performed using TCP(®) plates (Medartis, Basel, Switzerland) or with two lag screws (15 and 17 mm). Delta plates were used in 15 cases (8.9%). We report the epidemiology of these fractures and the outcomes of the surgical treatment. We assessed the complications related to the surgical procedure and those related to the osteosynthesis material. The facial nerve related complication rate was very low and the osteosynthesis materials used proved to be strong enough to realize a stable fixation. The two approaches used in this study appeared to be safe with good aesthetic results. Most of the surgical procedure failures occurred in high subcondylar fractures especially when bilateral. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Anatomy of the Cervicomental Region: Insights From an Anatomy Laboratory and Roundtable Discussion.

PubMed

Kenkel, Jeffrey M; Jones, Derek H; Fagien, Steven; Glaser, Dee Anna; Monheit, Gary D; Stauffer, Karen; Sykes, Jonathan M

2016-11-01

In 2015, ATX-101 (deoxycholic acid injection; Kybella in the United States and Belkyra in Canada; Kythera Biopharmaceuticals, Inc., Westlake Village, CA [an affiliate of Allergan plc, Dublin, Ireland]) was approved as a first-in-class injectable drug for reduction of submental fat. Use of a pharmacologic/injectable therapy within the submental region requires a thorough understanding of cervicomental anatomy to ensure proper injection technique and safe administration. To this end, an anatomy laboratory was conducted to review key external landmarks and important internal anatomic structures that characterize the lower face and anterior neck. External landmarks that define the boundaries of the cervicomental and submental regions were identified including the inferior mandibular border, the anterior border of the sternocleidomastoid muscle, the antegonial notch, the submental crease, the thyroid notch, and the hyoid bone. Relevant internal anatomic structures, including preplatysmal submental fat (the target tissue for ATX-101) and the platysma muscle as well as critical neurovascular and glandular tissues were revealed by dissection. Of particular interest was the marginal mandibular branch of the facial nerve because it typically courses along the inferior mandibular border near the proposed treatment area for ATX-101.

Anesthetic efficacy of the supplemental intraosseous injection for teeth with irreversible pulpitis.

PubMed

Parente, S A; Anderson, R W; Herman, W W; Kimbrough, W F; Weller, R N

1998-12-01

The purpose of this study was to determine the efficacy of a supplemental intraosseous injection (IOI) of 2% lidocaine with 1:100,000 epinephrine using the Stabident device, after conventional anesthetic methods had failed. Patients who experienced pain during endodontic access and required a supplemental IOI using 0.45 to 0.90 ml of the local anesthetic were identified. All 37 of the patients treated had teeth diagnosed with irreversible pulpitis. Thirty-four of the teeth were mandibular posterior teeth, 2 were maxillary posterior teeth, and 1 was a maxillary anterior tooth. Patients with maxillary teeth had received infiltration anesthesia, and those with mandibular teeth had received an inferior alveolar nerve block in conjunction with long buccal infiltration. A minimum of 3.6 ml of local anesthetic was used with the conventional techniques. Modified visual analogue scales, coupled with operator evaluations, were used to measure success. The Stabident IOI was an effective supplemental anesthetic technique in 89% (+/- 5.1) or 33/37 patients evaluated. The 95% confidence interval was 74 to 97%. The IOI was successful in 91% (+/- 4.9) of the mandibular posterior teeth (31/34), and 67% of the maxillary teeth (2/3).

Early extraction: a silver bullet to avoid nerve injury in lower third molar removal?

PubMed

Zhang, Q-B; Zhang, Z-Q

2012-10-01

This retrospective study evaluated the effects of early extraction of immature lower third molar on preventing complications, particularly nerve injury following lower third molar removal. Patients were grouped according to age and radiographic results: group A (518 patients, ≤23 years, immature teeth with apical foramen not closed); group B (532 patients, >23 years, mature teeth with closed apical foramen). Group A included 230 males and 288 females (average age 17 years). In group A, 808 lower mandibular third molars were extracted bilaterally in 290 and unilaterally in 228 patients; the incidence of complications was 2.48% (20/808) (all were temporary), the incidence of nerve injury was 0%. Group B included 250 males and 282 females (average age 39 years). In group B, 810 lower third molars were extracted bilaterally in 278 and unilaterally in 254 patients; the incidence of complications was 10% (81/810), the incidence of nerve injury was 1.6% (13/810). All complications were temporary, except two removals of permanent inferior alveolar nerve numbness (>6 months). In this study, early removal of the lower third molar was effective in avoiding some postoperative complications, especially nerve injury. Early extraction of lower third molar in youngsters is recommended following a team consultation. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparison of the Efficacy of Local Infiltration and Mandibular Block Anesthesia With Articaine for Harvesting Ramus Grafts.

PubMed

Göçmen, Gökhan; Özkan, Yaşar

2016-11-01

We compared the efficacy of local infiltrative anesthesia and regional mandibular block anesthesia using articaine to harvest ramus grafts and the postoperative sequelae. A total of 20 patients with alveolar bone deficiency participated in the present comparative, prospective, randomized study. The first group received regional anesthesia with the mandibular block technique (group A; n = 10), and those in the second group received local infiltration anesthesia (group B; n = 10). Intraoperative pain and bleeding were evaluated as the primary outcome variables. The visual analog scale (VAS) scores were compared at 0.5, 1, 2, and 4 hours postoperatively. The maximal interincisal mouth opening (MIO) (on days 3 and 7) and VAS scores (at 6, 12, 24, and 48 hours and on days 3 and 7) were compared as secondary outcome variables. The correlation between pain (VAS scores) and trismus (MIO) were also compared. A painless procedure was performed in both groups. The VAS score, MIO, and intraoperative bleeding were not significantly different between the 2 groups. Paresthesia was not observed in either group postoperatively. No statistically significant correlations were found between the VAS scores and MIO. Local infiltrative anesthesia preserves almost the same depth of anesthesia as mandibular block anesthesia. No differences were found between these techniques in terms of efficacy and postoperative sequelae during and after ramus graft harvest. Thus, using articaine with a local infiltration technique is an alternative to mandibular block anesthesia during ramus graft harvesting and results in a reduced risk of inferior alveolar nerve damage. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Neurosensoric disturbances after surgical removal of the mandibular third molar based on either panoramic imaging or cone beam CT scanning: A randomized controlled trial (RCT)

PubMed Central

Vaeth, Michael; Wenzel, Ann

2016-01-01

Objective: Pre-surgical CBCT has been suggested before removal of the mandibular third molar. Currently, the standard-of-care is two-dimensional (2D) panoramic imaging. The aim of this randomized controlled trial was to analyse possible differences in neurosensoric disturbances of the inferior alveolar nerve between patients undergoing either panoramic imaging or CBCT before surgical removal of the mandibular third molar. Furthermore, the aim was to perform a sensitivity analysis to assess the statistical significance of different assumptions related to sample size calculations. Methods: 230 patients were randomized to a scan group and a non-scan group. All patients were referred from practicing dentists in the Copenhagen area. Inclusion criteria were overlap of the root complex and the mandibular canal on a 2D radiographic image. Central allocation of the randomization code and double blind settings were established. The surgical removal was performed in a specialized surgical practice geographically and personally separated from the study practice. Registration of neurosensoric anomalies was performed with a Semmes–Weinstein test and a visual analogue scale questionnaire pre- and post-surgically. Results: In the scan group (n = 114), 21 episodes of neurosensoric disturbances were registered and in the non-scan group (n = 116), 13 episodes of neurosensoric disturbances were registered. There was no statistically significant difference between the two groups (p = 0.14). Performing a sensitivity analysis confirmed that CBCT was not superior to panoramic imaging in avoiding neurosensoric disturbances. Conclusions: The use of CBCT before removal of the mandibular third molar does not seem to reduce the number of neurosensoric disturbances. PMID:26648386

Neurosensoric disturbances after surgical removal of the mandibular third molar based on either panoramic imaging or cone beam CT scanning: A randomized controlled trial (RCT).

PubMed

Petersen, Lars B; Vaeth, Michael; Wenzel, Ann

2016-01-01

Pre-surgical CBCT has been suggested before removal of the mandibular third molar. Currently, the standard-of-care is two-dimensional (2D) panoramic imaging. The aim of this randomized controlled trial was to analyse possible differences in neurosensoric disturbances of the inferior alveolar nerve between patients undergoing either panoramic imaging or CBCT before surgical removal of the mandibular third molar. Furthermore, the aim was to perform a sensitivity analysis to assess the statistical significance of different assumptions related to sample size calculations. 230 patients were randomized to a scan group and a non-scan group. All patients were referred from practicing dentists in the Copenhagen area. Inclusion criteria were overlap of the root complex and the mandibular canal on a 2D radiographic image. Central allocation of the randomization code and double blind settings were established. The surgical removal was performed in a specialized surgical practice geographically and personally separated from the study practice. Registration of neurosensoric anomalies was performed with a Semmes-Weinstein test and a visual analogue scale questionnaire pre- and post-surgically. In the scan group (n = 114), 21 episodes of neurosensoric disturbances were registered and in the non-scan group (n = 116), 13 episodes of neurosensoric disturbances were registered. There was no statistically significant difference between the two groups (p = 0.14). Performing a sensitivity analysis confirmed that CBCT was not superior to panoramic imaging in avoiding neurosensoric disturbances. The use of CBCT before removal of the mandibular third molar does not seem to reduce the number of neurosensoric disturbances.

Microstructural and ultrastructural assessment of inferior alveolar nerve damage following nerve lateralization and implant placement: an experimental study in rabbits.

PubMed

Yoshimoto, Marcelo; Watanabe, Il-sei; Martins, Marília T; Salles, Marcos B; Ten Eyck, Gary R; Coelho, Paulo G

2009-01-01

The present study assessed damage to the inferior alveolar nerve (IAN) following nerve lateralization and implant placement surgery through optical and transmission electron microscopy (TEM). IAN lateralization was performed in 16 adult female rabbits (Oryctolagus cuniculus). During the nerve lateralization procedure, one implant was placed through the mandibular canal, and the IAN was replaced in direct contact with the implant. The implant was placed in the right mandible, and the left side was used as a control (no surgical procedure). After 8 weeks, the animals were sacrificed and samples were prepared for optical and TEM analysis of IAN structural damage. Histomorphometric analysis was performed to determine the number and cross-sectional dimensions of nerve fascicles and myelin sheath thickness between experimental and control groups. The different parameters were compared by one-way analysis of variance at the 95% significance level. Alterations in the perineural and endoneural regions of the IAN, with higher degrees of vascularization, were observed in the experimental group. TEM showed that the majority of the myelinated nerve fibers were not affected in the experimental samples. No significant variation in the number of fascicles was observed, significantly larger fascicle height and width were observed in the control group, and significantly thicker myelin sheaths were observed in the experimental samples. IAN lateralization resulted in substantial degrees of tissue disorganization at the microstructural level because of the presence of edema. However, at the ultrastructural level, small amounts of fiber degeneration were observed.

Rare Occurrence of the Left Maxillary Horizontal Third Molar Impaction, the Right Maxillary Third Molar Vertical Impaction and the Left Mandibular Third Molar Vertical Impaction with Inferior Alveolar Nerve Proximity in a 30 Year Old Female: A Case Report.

PubMed

Shunmugavelu, Karthik

2017-01-01

A combination of horizontal and vertical third molar impaction is a rare occurrence.When the tooth is unable to erupt to its proper position and fail to achieve a normal occlusion, it is known as impacted tooth. In this scientific article, case report of a female patient aged 30 years reported with acombination of horizontally and vertically impacted third molars in the maxilla and mandible has been presented. The treatment included surgical removal of the impacted teeth without any damage to underlying structures. Horizontal impaction of left maxillary third molar, vertical impaction of right maxillary third molar and left mandibular third molar is a rare occurrence. If symptomatic, surgical removal has to be planned as earlier as possible rather than late complications.

Anesthetic Efficacy of Articaine and Ketamine for Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Prospective Randomized Double-Blind Study.

PubMed

Sakhaeimanesh, Vahid; Khazaei, Saber; Kaviani, Naser; Saatchi, Masoud; Shafiei, Maryam; Khademi, Abbasali

2017-01-01

The aim of this prospective, randomized, double-blind study was to investigate the effect of articaine combined with ketamine on the success rate of inferior alveolar nerve block (IANB) in posterior mandible teeth with symptomatic irreversible pulpitis. Forty two adult patients with diagnosis of symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received two cartridges of either containing 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL 50 mg/mL ketamine hydrochloride (A-ketamine group) or 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL normal saline (A-saline group) using conventional IANB injections. Access cavity preparation started 15 min after injection. Lip numbness was required for all the patients. Success was considered as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed by independent student t , Mann-Whitney and Chi -square tests. The success rates were 55% and 42.9% for A-ketamine and A-saline group, respectively, with no significant differences between the two groups ( P =0.437) . Adding 0.4 mL 50 mg/mL ketamine hydrochloride to the articaine local anesthetic did not increase the efficacy of IANB for posterior mandibular teeth with symptomatic irreversible pulpitis.

Effect of preoperative alprazolam on the success of inferior alveolar nerve block for teeth with irreversible pulpitis.

PubMed

Khademi, Abbas Ali; Saatchi, Masoud; Minaiyan, Mohsen; Rostamizadeh, Nasim; Sharafi, Fatemeh

2012-10-01

Success of inferior alveolar nerve (IAN) block decreases in patients with irreversible pulpitis. The purpose of this study was to evaluate the effect of preoperative administration of alprazolam on the success of the IAN block for teeth with irreversible pulpitis. Sixty patients with irreversible pulpitis of a mandibular molar were selected for this prospective, randomized, double-blind, placebo-controlled study. The patients received identical capsules of either 0.5 mg of alprazolam or placebo 45 minutes before the administration of a conventional IAN block. Access cavity preparation was initiated 15 minutes after the IAN block injection. Lip numbness was recorded for all the patients. Success was defined as no or mild pain on the basis of visual analogue scale recordings during access cavity preparation and initial instrumentation. Data were analyzed by t test, Mann-Whitney, and χ(2) tests. The success rate was 53% for alprazolam group and 40% for placebo group, with no significant difference between the 2 groups (P = .301). Within the scope of the current study, preoperative oral administration of 0.5 mg of alprazolam did not improve the success of the IAN block in mandibular molars in patients with irreversible pulpitis, and the success rate was not adequate to ensure profound pulpal anesthesia. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Occurrence of paresthesia after dental local anesthetic administration in the United States.

PubMed

Garisto, Gabriella A; Gaffen, Andrew S; Lawrence, Herenia P; Tenenbaum, Howard C; Haas, Daniel A

2010-07-01

Several studies have suggested that the likelihood of paresthesia may depend on the local anesthetic used. The purpose of this study was to determine if the type of local anesthetic administered had any effect on reports of paresthesia in dentistry in the United States. The authors obtained reports of paresthesia involving dental local anesthetics during the period from November 1997 through August 2008 from the U.S. Food and Drug Administration Adverse Event Reporting System. They used chi(2) analysis to compare expected frequencies, on the basis of U.S. local anesthetic sales data, with observed reports of oral paresthesia. During the study period, 248 cases of paresthesia occurring after dental procedures were reported. Most cases (94.5 percent) involved mandibular nerve block. The lingual nerve was affected in 89.0 percent of cases. Reports involving 4 percent prilocaine and 4 percent articaine were 7.3 and 3.6 times, respectively, greater than expected (chi(2), P < .0001) on the basis of local anesthetic use by U.S. dentists. These data suggest that paresthesia occurs more commonly after use of 4 percent local anesthetic formulations. These findings are consistent with those reported in a number of studies from other countries. Until further research indicates otherwise, dentists should consider these results when assessing the risks and benefits of using 4 percent local anesthetics for mandibular block anesthesia.

Piezoelectric-assisted removal of a benign fibrous histiocytoma of the mandible: An innovative technique for prevention of dentoalveolar nerve injury

PubMed Central

2011-01-01

In this article, we present our experience with a piezoelectric-assisted surgical device by resection of a benign fibrous histiocytoma of the mandible. A 41 year-old male was admitted to our hospital because of slowly progressive right buccal swelling. After further radiographic diagnosis surgical removal of the yellowish-white mass was performed. Histologic analysis showed proliferating histiocytic cells with foamy, granular cytoplasm and no signs of malignancy. The tumor was positive for CD68 and vimentin in immunohistochemical staining. Therefore the tumor was diagnosed as primary benign fibrous histiocytoma. This work provides a new treatment device for benign mandibular tumour disease. By using a novel piezoelectric-assisted cutting device, protection of the dentoalveolar nerve could be achieved. PMID:22040611

A Review of In-Office Dynamic Image Navigation for Extraction of Complex Mandibular Third Molars.

PubMed

Emery, Robert W; Korj, Oxana; Agarwal, Ravi

2017-08-01

We performed a retrospective review of in-office removal of complex mandibular third molars with a dynamic image navigation system (DINS). A retrospective review was conducted of cases completed from 2010 to 2014 by a single oral and maxillofacial surgeon. The average age of the patients was 47 years (range, 27 to 72 years). Extraction complexity was classified with Juodzbalys and Daugela's classification system. The included study cases had complexity scores of 9 or greater. Each patient received custom intraoral splints to secure the tracking array and underwent cone beam computed tomography image acquisition. All surgical procedures were performed with a precalibrated tracking straight handpiece under dynamic navigation. All 25 cases were treated successfully with the use of the DINS. Twelve of these cases were associated with pathologic lesions. Three patients were noted to have inferior alveolar nerve paresthesia. One patient sustained a pathologic fracture at week 2. Postoperative infections were noted in 7 cases, 2 of which had a pre-existing infection. One patient reported temporary limitation of mouth opening. A coronectomy was performed in 1 case. We present results using a new technology, the DINS, for removal of complex mandibular third molars. Potential advantages are 1) improved visualization and localization of anatomic structures such as the inferior alveolar nerve, lingual cortical plate, and adjacent roots; 2) improved control during osteotomy; 3) decreased surgical access requirements and reduction in overall bone removal; 4) ability to perform complex procedures successfully in an in-office setting; 5) decreased surgical time resulting from improved visualization; and 6) potential use as a teaching tool. Possible limitations of the use of an in-office DINS include increased cost, increased time attributed to presurgical planning, initial learning curve, and optical array interference by the surgeon or assistants during surgery. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Evidence for a neural influence on tooth germ generation in a polyphyodont species.

PubMed

Tuisku, F; Hildebrand, C

1994-09-01

It has been suggested that nerve endings emanating from the dental nerve plexus of the jaw might be involved in the formation of tooth germs. In the present study we examine the effect of unilateral denervation on the formation of tooth germs in the lower jaw of a polyphyodont teleost--the cichild Tilapia mariae. Repeated inspection of the lower jaw dentition in normal animals over a period of about 300 days showed that the functional time of an average individual tooth is 101 days. In operated animals, the functional time was normal on the unoperated side, but on the denervated side tooth turnover ceased about 100 days after surgery. Radiographic plates from lower jaw specimens revealed that mineralized replacement teeth were present on the unoperated side, but not on the denervated side, 300 days after denervation. Light microscopic examination of semi-thin transverse sections from decalcified plastic-embedded lower jaws showed that soft-tissue tooth primordia and nerves were lacking on the denervated side, while present within the undisturbed half-jaw. It is concluded that the local presence of mandibular nerve branches is necessary for the formation of tooth germs in the lower jaw of the cichlid T. mariae.

The Anatomical Nature of Dental Paresthesia: A Quick Review

PubMed Central

Ahmad, Maha

2018-01-01

Dental paresthesia is loss of sensation caused by maxillary or mandibular anesthetic administration before dental treatment. This review examines inferior alveolar block paresthesia symptoms, side effect and complications. Understanding the anatomy of the pterygomandibular fossa will help in understanding the nature and causes of the dental paresthesia. In this review, we review the anatomy of the region surrounding inferior alveolar injections, anesthetic agents and also will look also into the histology and injury process of the inferior alveolar nerve. PMID:29541262

Achieving profound anesthesia using the intraosseous technique.

PubMed

Coury, K A

1997-10-01

The intraosseous technique has been described as a useful adjunct to primary anesthetic administration. It has several advantages (Table 3) over other supplemental techniques in that it is relatively simple to implement into routine practice, it affords fast, predictable results, and it is relatively painless. The technique has been shown to be very successful in achieving profound pulpal anesthesia when administered as a supplement to the inferior alveolar nerve block and is effective in achieving profound anesthesia in irreversibly inflamed teeth, especially mandibular molars.

Parotid Branches of the Auriculotemporal Nerve: An Anatomical Study With Implications for Frey Syndrome.

PubMed

Iwanaga, Joe; Fisahn, Christian; Watanabe, Koichi; Bobek, Samuel L; Ogata, Kinuko; Tanoue, Ryuichiro; Kusukawa, Jingo; Oskouian, Rod J; Tubbs, R Shane

2017-01-01

The auriculotemporal nerve is one of the many branches of the mandibular division of the trigeminal nerve. Of these, its superficial temporal branch has been most described. Although the parotid branches, secretomotor fibers to the parotid gland, are well known as the cause of Frey syndrome, there have been almost no descriptions of their anatomy. In this study, the authors dissected the parotid branches of the auriculotemporal nerve to elucidate their anatomy. A total of 10 sides from 7 adult and embalmed cadaver heads were used in this study. The specimens were derived from 3 males and 4 females, the age of cadavers at death ranged from 65 to 92 years old. Measurements included their diameter and the distance of their branching point from the main trunk of the auriculotemporal nerve from the middle of the tragus. Three of 10 sides had 2 parotid branches and 7 sides were found to have 1 parotid branch. The vertical distance between middle of the tragus to branching point of the parotid branch ranged from 1.79 to 16.17 mm. The horizontal distance between middle of the tragus to branching point of the parotid branch ranged from 3.03 to 12.62 mm. The diameter of the parotid branch ranged from 0.31 to 0.49 mm. An improved knowledge of the parotid branch of the auriculotemporal nerve might decrease injury to these structures with the potential for postoperative.

Peripheral facial nerve lesions induce changes in the firing properties of primary motor cortex layer 5 pyramidal cells.

PubMed

Múnera, A; Cuestas, D M; Troncoso, J

2012-10-25

Facial nerve lesions elicit long-lasting changes in vibrissal primary motor cortex (M1) muscular representation in rodents. Reorganization of cortical representation has been attributed to potentiation of preexisting horizontal connections coming from neighboring muscle representation. However, changes in layer 5 pyramidal neuron activity induced by facial nerve lesion have not yet been explored. To do so, the effect of irreversible facial nerve injury on electrophysiological properties of layer 5 pyramidal neurons was characterized. Twenty-four adult male Wistar rats were randomly subjected to two experimental treatments: either surgical transection of mandibular and buccal branches of the facial nerve (n=18) or sham surgery (n=6). Unitary and population activity of vibrissal M1 layer 5 pyramidal neurons recorded in vivo under general anesthesia was compared between sham-operated and facial nerve-injured animals. Injured animals were allowed either one (n=6), three (n=6), or five (n=6) weeks recovery before recording in order to characterize the evolution of changes in electrophysiological activity. As compared to control, facial nerve-injured animals displayed the following sustained and significant changes in spontaneous activity: increased basal firing frequency, decreased spike-associated local field oscillation amplitude, and decreased spontaneous theta burst firing frequency. Significant changes in evoked-activity with whisker pad stimulation included: increased short latency population spike amplitude, decreased long latency population oscillations amplitude and frequency, and decreased peak frequency during evoked single-unit burst firing. Taken together, such changes demonstrate that peripheral facial nerve lesions induce robust and sustained changes of layer 5 pyramidal neurons in vibrissal motor cortex. Copyright © 2012 IBRO. Published by Elsevier Ltd. All rights reserved.

Open reduction and internal fixation of intra-articular fractures of the mandibular condyle: our first experiences.

PubMed

Vesnaver, Ales

2008-10-01

Treatment of intra-articular fractures of the mandibular condyle head is conservative at most institutions dealing with facial fractures. Recently, reports had been published about benefits of surgical treatment in these fractures. From July 2004 until the end of June 2006, 13 patients with 16 displaced intra-articular fractures of the mandibular condyle were treated with open reduction and internal fixation at the Department of Oral and Maxillofacial Surgery in Ljubljana, Slovenia, using the preauricular approach and the lag screw technique. Twelve of the 13 patients could open their mouths for 40 mm or more, and 10 had a deflection of the chin of less than 2 mm upon maximal opening. None of the patients experienced pain upon rest, palpation, or chewing. Occlusion was not noted as altered in any of the cases, neither subjectively, nor on examination. There were no cases of postoperative weakness of the temporal branch of the facial nerve. Surgical treatment of intra-articular condyle fractures using the preauricular approach achieves a good exposure and enables proper reduction. Stable fixation of fractured bony fragments can be achieved using the lag screw technique. Another benefit of open exposure is revision and repair of TMJ soft tissues. With the appropriate surgical technique, the surgical procedure is safe and leads to good results.

Occurrence of the Retromolar Foramen in Dry Mandibles of South-Eastern Part of India: A Morphological Study with Review of the Literature

PubMed Central

Potu, Bhagath Kumar; Kumar, Vinod; Salem, Abdel-Halim; Abu-Hijleh, Marwan

2014-01-01

The retromolar foramen (RMF) is a rare anatomical structure situated in the retromolar fossa behind the third molar tooth. When it is present, the foramen is connected with the mandibular canal and is believed to transmit neurovascular structures that provide accessory source to the mandibular molars and the buccal area. Reports from the literature show that the presence of RMF could pose a challenge in complete blockage of the inferior alveolar nerve during mandibular surgeries. We report the incidence of retromolar foramen from ninety-four dry mandibles of south-eastern part of Karnataka State, India. The foramen was observed in 11 mandibles out of 94 included in the study (11.7%). In three mandibles, the foramen was present bilaterally (3.2%) and in three it was on the left side (3.2%) and in five it was on the right side (5.3%). For the first time, we also measured the dimensions of the retromolar area and distance of the foramen from third molar tooth to understand its risks during the surgical extraction of the lower third molar tooth. A thorough review of the literature has also been done to compare the present findings with the studies reported from the various populations. PMID:25489487

Anesthetic Efficacy of Bupivacaine Solutions in Inferior Alveolar Nerve Block

PubMed Central

Volpato, Maria Cristina; Ranali, José; Ramacciato, Juliana Cama; de Oliveira, Patrícia Cristine; Ambrosano, Glaúcia Maria Bovi; Groppo, Francisco Carlos

2005-01-01

The purpose of this study was to compare the anesthetic efficacy of 2 bupivacaine solutions. Twenty-two volunteers randomly received in a crossover, double-blinded manner 2 inferior alveolar nerve blocks with 1.8 mL of racemic bupivacaine and a mixture of 75% levobupivacaine and 25% dextrobupivacaine, both 0.5% and with 1 : 200,000 epinephrine. Before and after the injection, the first mandibular pre-molar was evaluated every 2 minutes until no response to the maximal output (80 reading) of the pulp tester and then again every 20 minutes. Data were analyzed using the Wilcoxon paired test and the paired t test. No differences were found between the solutions for onset and duration of pulpal anesthesia and duration of soft tissue anesthesia (P > .05). It was concluded that the solutions have similar anesthetic efficacy. PMID:16596912

An alternative approach to extruding a vertically impacted lower third molar using an orthodontic miniscrew: A case report with cone-beam CT follow-up

PubMed Central

No-Cortes, Juliana; Cavalcanti, Marcelo Gusmão Paraíso; Arita, Emiko Saito

2014-01-01

One of the most common oral surgical procedures is the extraction of the lower third molar (LTM). Postoperative complications such as paresthesia due to inferior alveolar nerve (IAN) injury are commonly observed in cases of horizontal and vertical impaction. The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst. An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts. An orthodontic miniscrew was then used to extrude the LTM prior to its surgical removal in order to avoid the risk of inferior alveolar nerve injury. CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion. PMID:24944969

An alternative approach to extruding a vertically impacted lower third molar using an orthodontic miniscrew: A case report with cone-beam CT follow-up.

PubMed

Cortes, Arthur Rodriguez Gonzalez; No-Cortes, Juliana; Cavalcanti, Marcelo Gusmão Paraíso; Arita, Emiko Saito

2014-06-01

One of the most common oral surgical procedures is the extraction of the lower third molar (LTM). Postoperative complications such as paresthesia due to inferior alveolar nerve (IAN) injury are commonly observed in cases of horizontal and vertical impaction. The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst. An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts. An orthodontic miniscrew was then used to extrude the LTM prior to its surgical removal in order to avoid the risk of inferior alveolar nerve injury. CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion.

[Pure trigeminal motor neuropathy presenting with temporo-mandibular joint dysfunction in a patient with HIV and HCV infections].

PubMed

Anheim, M; Echaniz-Laguna, A; Rey, D; Tranchant, C

2006-01-01

Pure trigeminal motor neuropathy (PTMN) is a rarely described condition. We report the case of a 41-year-old woman infected with the human immunodeficiency virus (HIV1) and hepatitis C virus who presented with weakness of left temporalis and masseter muscles and painful left temporomandibular joint dysfunction (TMD) a few months after cerebral toxoplasmosis revealing acquired immunodeficiency syndrome (AIDS). Magnetic resonance imaging revealed severe wasting and fat replacement of the left temporalis, pterygoid and masseter muscles and showed neither abnormalities in the left motor nucleus of the trigeminal nerve nor compression of the left trigeminal nerve. Electromyographic examination gave evidence of denervation in the left temporalis, masseter and pterygoid muscles and blink reflex studies were normal, confirming the diagnosis of PTMN which was probably secondary to HIV and HCV co-infection.

Analysis of two different surgical approaches for fractures of the mandibular condyle.

PubMed

Kumaran, S; Thambiah, L J

2012-01-01

Fractures of the condyle account for one third of all the mandibular fractures. Different surgical approaches to the condyle described hitherto testify to the advantages and disadvantages of the different surgical techniques used for approaching the condyle in such cases of fractures. We have described and compared two of such surgical techniques in this study. The aim of this study is to compare the outcome of dealing with condylar fractures by two different surgical techniques: the mini retromandibular approach, and the preauricular approach. A prospective study of 31 patients who had suffered with mandibular condylar fractures was carried out. Of these, 26 patients had unilateral condylar fractures, and 5 patients had a bilateral fracture. Further, 19 of these patients were treated by the mini retromandibular approach and 12 by the preauricular approach. The treated patients were followed up and evaluated for a minimum period of 1 year and assessed for parameters such as the maximum mouth opening, lateral movement on the fractured side, mandibular movements such as protrusion, dental occlusion, scar formation, facial nerve weakness, salivary fistula formation and time taken for the completion of the surgical procedure. t- test was used for statistical analysis of the data obtained in the study. Dental occlusion was restored in all the cases, and good anatomical reduction was achieved. The mean operating time was higher 63.53 (mean) ± 18.12 minutes standard deviation (SD) in the preauricular approach compared to 45.22 (mean) ± 18.86 minutes SD in the mini retromandibular approach. Scar formation was satisfactory in almost all the cases.

Radiographic study of the mandibular retromolar canal: an anatomic structure with clinical importance.

PubMed

von Arx, Thomas; Hänni, Andrea; Sendi, Pedram; Buser, Daniel; Bornstein, Michael M

2011-12-01

The retromolar canal is an anatomic structure of the mandible with clinical importance. This canal branches off from the mandibular canal behind the third molar and travels to the retromolar foramen in the retromolar fossa. The retromolar canal might conduct accessory innervation to the mandibular molars or contain an aberrant buccal nerve. Patients referred for panoramic radiography were consecutively enrolled, provided a limited cone-beam computed tomography (CBCT) scan had also been taken in the area of interest. Radiographs were retrospectively screened for the presence of a retromolar canal, and linear measurements (distance to second molar, height, width) were taken. One hundred twenty-one sides in 100 patients were evaluated (100 unilateral and 21 bilateral cases). A total of 31 retromolar canals were identified with CBCT (25.6%). Only 7 of these canals were also seen on the corresponding panoramic radiographs. The existence of a retromolar canal was not statistically related to gender or side. With regard to the linear measurements, the mean distance from the retromolar canal to the second molar was 15.16 mm (±2.39 mm), the mean height of the canal was 11.34 mm (±2.36 mm), and the mean width was 0.99 mm (±0.31 mm). This radiographic study documents a frequency of 25% for the presence of a retromolar canal. The clinician is advised to preserve this anatomic variation when performing surgery in the retromolar area and to consider additional locoregional anesthesia in the case of failed mandibular block anesthesia. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Surgical Management of Laterognathia in Orthofacial Surgery.

PubMed

García Y Sánchez, J M; Gómez Rodríguez, C L; Romero Flores, J

2017-09-01

Each year around the world, various surgical procedures are carried out with the goal of correcting laterognathia; both the intraoral vertical ramus osteotomy (IVRO) and bilateral sagittal split ramus osteotomy (OSB) have been the most used techniques in mandibular surgery. These techniques have advantages and disadvantages; for example the advantages of the OSB include: increased coefficient of friction between bony segments, for both the forward and the retroposition, as well as decrease in the time of intermaxillary fixation (IMF). Disadvantages include injury to the inferior alveolar nerve (IAN), hemorrhage, bad split, among others. The advantages of IVRO include decrease of possibility of injury to the IAN, ease of implementation of the technique, a lower incidence of hemorrhage and the short duration of the surgical procedure. Their disadvantages include: lower coefficient of friction between bony segments, requires a relatively long period of IMF. The combination between the techniques of mandibular osteotomy for the correction of minor 10 mm laterognathia is the ideal treatment, since it avoids potential recurrence. We describe two cases of patients with laterognathia greater than 6 mm associated with maxilla deformity, which were treated with combined osteotomies. At Maxillofacial Surgery Service, Specialty Hospital, National Medical Center XXI Century, we describe the advantages and disadvantages, pre and postoperative nosocomial, by comparing them with the reports of the literature. The combination of techniques in the correction of laterognathias greater than 4 mm (smaller than 10 mm) is the ideal treatment, eliminating problems of articular compression, recurrence and damage to the alveolar nerve.

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain.

PubMed

Parirokh, Masoud; Yosefi, Mohammad Hosein; Nakhaee, Nouzar; Abbott, Paul V; Manochehrifar, Hamed

2015-05-01

Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

Effects of Two Different Anesthetic Solutions on Injection Pain, Efficacy, and Duration of Soft-Tissue Anesthesia with Inferior Alveolar Nerve Block for Primary Molars.

PubMed

Elbay, Ülkü Şermet; Elbay, Mesut; Kaya, Emine; Yıldırım, Sinem

The purpose of the study was to compare the efficacy, injection pain, duration of soft tissue anesthesia, and postoperative complications of two different anesthetics (2% lidocaine with 1:80,000 epinephrine and 3% plain mepivacaine) in pediatric patients in inferior alveolar nerve block (IANB) administered by a computer-controlled delivery system (CCDS). The study was conducted as a randomized, controlled-crossover, double-blind clinical trial with 60 children requiring bilateral pulpotomy or extraction of primary mandibular molars. A CCDS was used to deliver 3% mepivacaine to 1 primary tooth and 2% lidocaine to the contralateral tooth with an IANB technique. Severity of pain and efficacy of anesthesia were evaluated using the Face, Legs, Activity, Cry, Consolability Scale, and comfort and side effects were assessed using a questionnaire. Data were analyzed using the Mann-Whitney U, Wilcoxon t, and Fisher exact tests. Patients receiving 2% lidocaine experienced significantly less pain during injection than those receiving 3% mepivacaine, and no significant differences were found in the pain scores during treatments or in postoperative complications between the two anesthetics. The mean durations of anesthesia for 3% mepivacaine and 2% lidocaine were 139.68 minutes and 149.10 minutes, respectively. Plain mepivacaine and 2% lidocaine were similarly effective in pulpotomy and the extraction of primary mandibular molars. Although the use of 3% mepivacaine provided a shorter duration of anesthesia than 2% lidocaine, both solutions showed similar results in terms of postoperative complications.

Anesthetic Efficacy of Articaine and Ketamine for Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Prospective Randomized Double-Blind Study

PubMed Central

Sakhaeimanesh, Vahid; Khazaei, Saber; Kaviani, Naser; Saatchi, Masoud; Shafiei, Maryam; Khademi, Abbasali

2017-01-01

Introduction: The aim of this prospective, randomized, double-blind study was to investigate the effect of articaine combined with ketamine on the success rate of inferior alveolar nerve block (IANB) in posterior mandible teeth with symptomatic irreversible pulpitis. Methods and Materials: Forty two adult patients with diagnosis of symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received two cartridges of either containing 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL 50 mg/mL ketamine hydrochloride (A-ketamine group) or 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL normal saline (A-saline group) using conventional IANB injections. Access cavity preparation started 15 min after injection. Lip numbness was required for all the patients. Success was considered as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed by independent student t, Mann-Whitney and Chi-square tests. Results: The success rates were 55% and 42.9% for A-ketamine and A-saline group, respectively, with no significant differences between the two groups (P=0.437). Conclusion: Adding 0.4 mL 50 mg/mL ketamine hydrochloride to the articaine local anesthetic did not increase the efficacy of IANB for posterior mandibular teeth with symptomatic irreversible pulpitis. PMID:29225640

An anatomical study of the pterygospinous bar and foramen of Civinini.

PubMed

Goyal, Neeru; Jain, Anjali

2016-10-01

The pterygospinous ligament extends from the posterior free margin of the lateral pterygoid plate till the spine of the sphenoid. The ligament may ossify partly or completely leading to the formation of the pterygospinous bar. A complete ossification of the ligament results in the formation of the foramen of Civinini. Presence of the complete or incomplete pterygospinous bar may lead to a difficulty in passing the needle during anaesthesia for the trigeminal neuralgia or the bar may also compress the mandibular nerve and its branches to cause lingual numbness, pain and speech impairment. Presence of the complete or incomplete pterygospinous bar and the foramen of Civinini were studied in 55 dried adult skulls and 20 sphenoid bones. Partial or complete ossification of the pterygospinous ligament was seen in 17.33 % skulls. One skull showed the presence of bilateral complete pterygospinous bar while another skull had the unilateral complete pterygospinous bar on right side. Two skulls and one sphenoid had bilateral incomplete pterygospinous bar while seven skulls and one sphenoid bone had unilateral incomplete pterygospinous bar. In three cases, the bar was passing just below the foramen ovale. The pterygospinous bar when present medial to the foramen ovale may not have much clinical significance but when the bar is present just below the foramen ovale, it may cause a compression of the mandibular nerve and its branches and may also obstruct the passage for the transoval approach to the neighbouring regions.

Autogenous Partial Bone Chip Grafting on the Exposed Inferior Alveolar Nerve After Cystic Enucleation.

PubMed

Seo, Mi Hyun; Eo, Mi Young; Cho, Yun Ju; Kim, Soung Min; Lee, Suk Keun

2018-03-01

This prospective study evaluated the clinical effectiveness of the new approach of partial autogenous bone chip grafts for the treatment of mandibular cystic lesions related to the inferior alveolar nerve (IAN). A total of 38 patients treated for mandibular cysts or benign tumors were included in this prospective study and subsequently divided into 3 groups depending on the bone grafting method used: cystic enucleation without a bone graft (group 1), partial bone chip graft covering the exposed IAN (group 2), and autogenous bone graft covering the entire defect (group 3). We evaluated the symptoms, clinical signs, and radiographic changes using dental panorama preoperatively, immediate postoperatively, and at 1, 3, 6, and 12 months postoperatively. Radiographic densities were compared using Adobe Photoshop CS5 (Adobe Systems Inc., San Jose, CA). Repeated measures analysis of variance was used for statistical evaluation with SPSS 22.0 (SPSS Inc, Chicago, IL), and P < 0.05 was considered statistically significant.Radiopacities were the most increased at 1 year postoperative in group 3; groups 2 and 3 did not show statistically significant differences, whereas groups 1 and 3 were statistically significant. In terms of radiographic bone healing with clinical regeneration of the exposed IAN, healing occurred in all patients, although the best healing was achieved in group 2.This autogenous partial bone chip grafting procedure to cover the exposed IAN is suggested as a new surgical protocol for the treatment of cystic lesions associated with the IAN.

Effect of nitrous oxide on the efficacy of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis.

PubMed

Stanley, William; Drum, Melissa; Nusstein, John; Reader, Al; Beck, Mike

2012-05-01

The inferior alveolar nerve (IAN) block does not always result in successful pulpal anesthesia. Anesthetic success rates might be affected by increased anxiety. Nitrous oxide has been shown to have both anxiolytic and analgesic properties. Therefore, the purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of nitrous oxide on the anesthetic success of the IAN block in patients experiencing symptomatic irreversible pulpitis. One hundred emergency patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth were enrolled in this study. Each patient was randomly assigned to receive an inhalation regimen of nitrous oxide/oxygen mix or room air/oxygen mix (placebo) 5 minutes before the administration of the IAN block. Endodontic access was begun 15 minutes after completion of the IAN block, and all patients had profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) on access or instrumentation. The success rate for the IAN block was 50% for the nitrous oxide group and 28% for the placebo group. There was a statistically significant difference between the 2 groups (P = .024). For mandibular teeth diagnosed with symptomatic irreversible pulpitis, administration of 30%-50% nitrous oxide resulted in a statistically significant increase in the success of the IAN block compared with room air/oxygen. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Evaluation of surgical treatment in mandibular condyle fractures.

PubMed

Vesnaver, Aleš; Ahčan, Uroš; Rozman, Janez

2012-12-01

In the past, fractures of the mandibular condylar process were, as a rule, treated conservatively. At the Department of Maxillofacial and Oral Surgery of the University Medical Centre Ljubljana, Slovenia, our doctrine was changed in 2002 on the basis of preliminary results and reports in the literature, and these fractures were started to be treated surgically by open reduction and internal fixation with miniplates and screws, which led to good results and a shorter rehabilitation period. The goal of this study was to determine the safety and efficiency of surgical treatment, as well as to compare long-term results of surgical and conservative treatment, as objectively as possible. Two groups of patients, which had all sustained a unilateral, extra-articular mandibular condyle fracture, were compared. In the test group, there were 42 surgically treated patients, and in the control group, 20 conservatively treated patients. Clinical parameters and X-ray images were assessed in both groups and compared by the two tailed Student t test, and in case of attributive variables by the χ(2) test. Within the surgically treated group, postoperative and intraoperative complications were noted: temporary facial nerve palsy, development of a parotid salivary fistula, disturbance of auricle sensibility due to injury of the greater auricular nerve, miniplate fracture, as well as intraoperative bleeding, postoperative haematoma formation, infection, reoperation due to fragment malposition and other complications. Postoperative scars were also assessed. Statistically significant differences between the surgically and conservatively treated patients were found when comparing clinical parameters as well as X-ray images, the results being better in the surgically treated group. Complications of surgical treatment were also noted, the most important among them temporary paresis of facial nerve branches, which occurred in 10 patients (24%). Plate fractures occurred in five patients (12%), in four of them miniplates of sizes less than 2.0mm were used. There were no cases of significant intraoperative bleeding, two cases (5%) required drainage of postoperative haematomas, and one patient (2%) experienced a mild postoperative infection, which was easily controlled with amoxicillin with clavulanic acid. The scar was hidden best if a facelift incision was used, and a hypertrophic scar developed in only one patient (2%). Results of surgical treatment of condylar process fractures are superior to the results of conservative treatment, and the procedure is safe with the transparotid surgical approach and adequate surgical technique. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Comparison of anesthetic efficacy of 2 and 4 % articaine in inferior alveolar nerve block for tooth extraction-a double-blinded randomized clinical trial.

PubMed

Kämmerer, P W; Schneider, D; Palarie, V; Schiegnitz, E; Daubländer, M

2017-01-01

The purpose of this clinical prospective, randomized, double-blind trial was to compare the anesthetic efficacy of 2 % articaine and 4 % articaine in inferior alveolar nerve block anesthesia for extraction of mandibular teeth. In 95 patients, 105 lower molar and premolar teeth were extracted after intraoral inferior alveolar nerve block. In 53 cases, 2 % articaine (group I) and, in 52 cases, 4 % articaine (group II) was administered. The primary objective was to analyze the differences of anesthetic effects between the two groups (complete/sufficient vs. insufficient/none). Furthermore, differences in pulpal anesthesia (onset and depth, examined with pulp vitality tester (min)), as well as in length of soft tissue anesthesia (min), were evaluated. Additionally, the need of a second injection, pain while injecting (numeric rating scale (NRS)), pain during treatment (NRS), pain after treatment (NRS), and other possible complications (excessive pain, bleeding events, prolonged deafness) were analyzed. Anesthesia was sufficient for dental extractions in both groups without significant differences (p = 0.201). The onset of anesthesia did not differ significantly (p = 0.297). A significantly shorter duration of soft tissue anesthesia was seen in group I (2.9 vs. 4 h; p < 0.001). There was no significant difference in the need for a second injection (p = 0.359), in injection pain (p = 0.386), as well as in pain during (p = 0.287) or after treatment (p = 0.121). In both groups, no complications were seen. The local anesthetic effect of the 4 % articaine solution is not significantly better when compared to 2 % articaine. For mandibular tooth extraction, articaine 2 % may be used as alternative as well.

A comparative evaluation of pain and anxiety levels in 2 different anesthesia techniques: locoregional anesthesia using conventional syringe versus intraosseous anesthesia using a computer-controlled system (Quicksleeper).

PubMed

Özer, Senem; Yaltirik, Mehmet; Kirli, Irem; Yargic, Ilhan

2012-11-01

The aim of this study was to compare anxiety and pain levels during anesthesia and efficacy of Quicksleeper intraosseous (IO) injection system, which delivers computer-controlled IO anesthesia and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molars. Forty subjects with bilateral impacted mandibular third molars randomly received IO injection or conventional IANB at 2 successive appointments. The subjects received 1.8 mL 2% articaine. IO injection has many advantages, such as enabling painless anesthesia with less soft tissue numbness and quick onset of anesthesia as well as lingual and palatal anesthesia with single needle penetration. Although IO injection is a useful technique commonly used during various treatments in dentistry, the duration of injection takes longer than conventional techniques, there is a possibility of obstruction at the needle tip, and, the duration of the anesthetic effect is inadequate for prolonged surgical procedures. Copyright © 2012 Elsevier Inc. All rights reserved.

Management of pediatric mandibular fractures using bioresorbable plating system - Efficacy, stability, and clinical outcomes: Our experiences and literature review.

PubMed

Singh, Mahinder; Singh, R K; Passi, Deepak; Aggarwal, Mohit; Kaur, Guneet

2016-01-01

The purpose of this study was to determine the efficacy and stability of the biodegradable fixation system for treatment of mandible fractures in pediatric patients by measuring the bite force. Sixty pediatric patients with mandibular fractures (36 males, 24 females) were included in this study. The 2.5-mm resorbable plates were adapted along Champy's line of ideal osteosynthesis and secured with four 2.5 mm diameter monocortical resorbable screws, 8 mm in length. All patients were followed for 10 months. Clinical parameters, such as soft tissue infection, nonunion, malunion, implant exposure, malocclusion, nerve injury, and bite force for stability, were prospectively assessed. Adequate fixation and primary bone healing was achieved in 100% of the cases. Six minor complications (10%) were observed: 2 soft tissue infections (3%), 1 plate dehiscence (2%), 1 malocclusion (2%), and 2 paresthesia (3%). 2.5-mm resorbable plating system along Champy's line of ideal osteosynthesis is a good treatment modality for mandible fractures in pediatric patients.

Cervicothoracic Subcutaneous Emphysema and Pneumomediastinum After Third Molar Extraction.

PubMed

Picard, Maxime; Pham Dang, Nathalie; Mondie, Jean Michel; Barthelemy, Isabelle

2015-12-01

Third molar extraction is one of the most common interventions in dental and maxillofacial surgery. Complications are frequent and well documented, with swelling, pain, bleeding, infection, and lingual or alveolar nerve injury being the most common. This report describes a case of subcutaneous extensive emphysema and pneumomediastinum that occurred 4 days after extraction of an impacted right mandibular third molar. The management and etiology of this case and those reported in the literature are discussed. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Comparative study of the prognosis of an extracorporeal reduction and a closed treatment in mandibular condyle head and/or neck fractures.

PubMed

Park, Jung-Min; Jang, Yong-Wook; Kim, Seong-Gon; Park, Young-Wook; Rotaru, Horatiu; Baciut, Grigore; Hurubeanu, Lucia

2010-12-01

The objective of this study was a comparison of the prognosis between an extracorporeal reduction technique and closed treatment of a mandibular condyle fracture. The relationship between condylar resorption and several clinical variables was also studied. Seventy-one patients who had a mandibular condyle fracture took part in this study. Thirty-five patients (female: 7, male: 28, age: 30.46 ± 14.27 years) were treated by extracorporeal reduction, and 36 patients (male: 24, female: 12, age: 24.28 ± 9.99 years) were treated using a closed treatment. The presence of complications such as condylar resorption, malocclusion, nerve disorder, and disc displacement was evaluated with panoramic radiographs and clinical examinations 12 months after treatment. The relationships between the complications and other clinical variables were evaluated statistically. The anatomic site and fracture type were closely related to condyle resorption in the bivariate analysis. Condylar head fractures showed significantly higher condyle resorption than condylar neck fractures (P = .023). A complex or compound fracture showed significantly higher condyle resorption compared with a simple fracture (P = .006). Patients who had a complex/compound fracture were 34.366 times more likely to have condyle resorption compared with those who had a simple fracture (P = .002). The patient's age and treatment method were also significant predictors for condyle resorption. Fracture type was the strongest predictor of condylar resorption. Because treatment method and patient age were also related to the prognosis, the optimal treatment for mandibular condylar head and/or neck fractures should be individualized according to the patient's condition. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Efficacy of articaine versus lidocaine as a supplemental buccal infiltration in mandibular molars with irreversible pulpitis: a prospective, randomized, double-blind study.

PubMed

Rogers, Brandon S; Botero, Tatiana M; McDonald, Neville J; Gardner, Richard J; Peters, Mathilde C

2014-06-01

Profound pulpal anesthesia in mandibular molars with irreversible pulpitis (IP) is often difficult to obtain and often requires supplemental injections after an ineffective inferior alveolar nerve block (IANB). The purpose of this prospective, randomized, double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for supplemental buccal infiltrations (BIs) after an ineffective IANB in mandibular molars with IP. In addition, the use of articaine for IANB and intraosseous injections was investigated. One hundred emergency patients diagnosed with IP of a mandibular molar were selected and received an IANB with 4% articaine. All injections were 1.7 mL with 1:100,000 epinephrine. All patients reported profound lip numbness after IANB. Patients with ineffective IANB (positive pulpal response to cold or pain on access) randomly received 4% articaine or 2% lidocaine as a supplemental BI. Endodontic access was initiated 5 minutes after deposition of the infiltration solution. Success was defined as no pain or no more than mild pain during endodontic access and instrumentation as measured on a visual analogue scale. Seventy-four patients failed to achieve pulpal anesthesia after IANB with 4% articaine, resulting in IANB success rate of 26%. Success rates for supplemental BIs were 62% for articaine and 37% for lidocaine (P < .05). This effect was most pronounced in second molars (P < .05). Supplemental BI with articaine was significantly more effective than lidocaine. The IANB success rate of 4% articaine confirmed published data. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Closed reduction of displaced or dislocated mandibular condyle fractures in children using threaded Kirschner wire and external rubber traction.

PubMed

Kim, J H; Nam, D H

2015-10-01

Most surgeons agree that closed treatment provides the best results for condylar fractures in children. Nevertheless, treatment of the paediatric mandibular condyle fracture that is severely displaced or dislocated is controversial. The purpose of this study was to investigate the long-term clinical and radiological outcomes following the treatment of displaced or dislocated condylar fractures in children using threaded Kirschner wire and external rubber traction. This procedure can strengthen the advantage of closed reduction and make up for the shortcomings of open reduction. From March 1, 2005 to December 25, 2011, 11 children aged between 4 and 12 years with displaced or dislocated mandibular condyle fractures were treated using threaded Kirschner wire and external rubber traction under portable C-arm fluoroscopy. All patients had unilateral displaced or dislocated condylar fractures. The follow-up period ranged from 24 to 42 months (mean 29.3 months). Normal occlusion and pain-free function of the temporomandibular joint, without deviation or limitation of jaw opening, was achieved in all patients. This closed reduction technique in displaced or dislocated condylar fractures in children offers a reliable solution in preventing the unfavourable sequelae of closed treatment and the open technique, such as altered morphology, functional disturbances, and facial nerve damage. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparison of various approaches for the treatment of fractures of the mandibular condylar process.

PubMed

Handschel, Jörg; Rüggeberg, Tim; Depprich, Rita; Schwarz, Frank; Meyer, Ulrich; Kübler, Norbert R; Naujoks, Christian

2012-12-01

Fractures of the mandibular condyle process are the most common fractures of the lower jaw. Unfortunately, the type of treatment is still a matter of debate. The aim of this investigation was to compare the outcome of different treatment approaches regarding function and surgical side-effects. 111 fractures of the mandibular condyle representing all types according to the classification of Spiessl and Schroll were included. Both closed reduction (CR) and open reduction with internal fixation (ORIF) including the retromandibular/transparotid, submandibular, preauricular and intraoral approach were performed. The clinical examination included functional and aesthetic aspects at least 1 year after the fracture. The majority of fractures (45%) were classified into Type II and IV according to Spiessl and Schroll followed by fractures without any displacement or dislocation (29.7%). The submandibular approach showed the worst outcome regarding permanent palsy of the facial nerve and hypertrophic scarring. No significant differences between the various approaches were detected in the functional status in any diagnosis group. Inferior condylar neck fractures benefit from ORIF by an intraoral approach whereas in high condylar neck fractures the retromandibular/transparotid approach shows the best results. Fractures of the condylar head were almost all treated by CR and our results cannot contribute to the debate of CR vs. ORIF in this type of fracture. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The role of intraoperative positioning of the inferior alveolar nerve on postoperative paresthesia after bilateral sagittal split osteotomy of the mandible: prospective clinical study.

PubMed

Hanzelka, T; Foltán, R; Pavlíková, G; Horká, E; Sedý, J

2011-09-01

Bilateral sagittal split osteotomy (BSSO) aims to correct congenital or acquired mandibular abnormities. Temporary or permanent neurosensory disturbance is the most frequent complication of BSSO. To evaluate the influence of IAN handling during osteotomy, the authors undertook a prospective study in 290 patients who underwent BSSO. The occurrence and duration of paresthesia was evaluated 4 weeks, 3 months, 6 months, and 1 year after surgery. Paresthesia developed immediately after surgery in almost half of the patients. Most cases of paresthesia resolved within 1 year after surgery. A significantly higher prevalence of paresthesia was observed on the left side. The authors found a correlation between the type of IAN position between the left and right side. The type of split (and IAN exposure) did not have a significant effect on the occurrence or duration of neurosensory disturbance of the IAN. The authors did not find a correlation between the occurrence and duration of paresthesia and the direction of BSSO. Mandibular hypoplasia or mandibular progenia did not represent a predisposition for the development of paresthesia. In the development of IAN paresthesia, the type of IAN exposure and the split is less important than the side on which the split is carried out. Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparison of cardiovascular responses after injection of lidocaine with either clonidine or adrenaline: a two-year comparative analysis.

PubMed

Dandriyal, R; Pachauri, S; Giri, K Y; Rastogi, S; Prasad, N I B; Agarwal, S; Singh, H P

2017-01-01

Our aim was to evaluate the efficacy of clonidine with lidocaine as a local anaesthetic agent for inferior alveolar mandibular nerve blocks for dental extraction. We studied 200 patients who required extraction of mandibular teeth and divided them into two groups of 100 each, the first of which was given lidocaine and adrenaline (12.5μg/ml) and the second lidocaine and clonidine (15μg/ml). Cardiovascular vascular variables (blood pressure, heart rate, and mean arterial pressure) were assessed before, during, and after extraction, and postoperative pain was measured on a visual analogue scale. There was a significant reduction in systolic blood pressure (p=0.0001) and heart rate (p=0.000) after injection of clonidine. However, they both increased after injections of lidocaine plus adrenaline, and there was a significant reduction in pain at four hours postoperatively with clonidine (p=0.000). Our results showed that anaesthesia with lidocaine and clonidine decreases systolic blood pressure and heart rate 10minutes after injection for extraction of lower mandibular teeth. We suggest that patients who have local anaesthetic with lidocaine and clonidine are at minimal cardiovascular risk and there is no difference in the onset of anaesthesia. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Which risk factors are associated with neurosensory deficits of inferior alveolar nerve after mandibular third molar extraction?

PubMed

Kim, Jin-Woo; Cha, In-Ho; Kim, Sun-Jong; Kim, Myung-Rae

2012-11-01

Mandibular third molar extraction is a commonly performed procedure and is recognized as a relatively frequent cause of inferior alveolar nerve (IAN) injury. The aim of the present study was to investigate the specific risk factors for neurosensory deficits, including age, gender, impaction depth, angulation of the third molar, and various radiographic superimposition signs. In a case-control study of patients who had undergone mandibular third molar extraction, a case group was developed of patients showing neurosensory deficits of the IAN, and a control group was formed of randomly selected patients without any neurosensory symptoms. Bivariate analyses were performed to assess the relationship between each variable and IAN injury. A multivariate logistic regression model was used to compute the odds ratios, P values, and predictive values of the radiographic superimposition signs. Of 12,842 total patients, the study group included 104 cases and 135 controls. The results indicated that older age and deeper impaction status were significant risk factors (P < .05). Darkening of the roots, deflection of the roots, narrowing of the roots, dark and bifid apexes of the roots, and narrowing of the canal were also significant risk factors. The positive predictive values ranged from 0.7% to 6.9% and the negative predictive values from 99% to 100%, with adjustment for the definitive prevalence of IAN injury (0.81%, 104/12,842 patients). However, the relatively low positive predictive value renders questionable the predictability of superimposition signs on orthopantomography. In the absence of specific radiographic signs, the risk of neurosensory deficit of the IAN could be negligible. The sensory symptoms disappeared after 6 months in 92.3% of the patients and 98.1% showed recovery after 1 year. The results of the present study have demonstrated a significant association between several risk factors and neurosensory deficits of the IAN after third molar extraction. With a case group of 104 patients, the number of subjects was significantly greater than that in previous studies, increasing the reliability of these results. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

PubMed Central

Yosefi, Mohammad Hosein; Nakhaee, Nouzar

2015-01-01

Objectives Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. Materials and Methods Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. Results At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. Conclusions There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment. PMID:25984478

Comparison of anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine for inferior alveolar nerve block in patients with irreversible pulpitis.

PubMed

Sood, Ravi; Hans, Manoj-Kumar; Shetty, Shashit

2014-12-01

This study was done to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine with that of 2% lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in mandibular posterior teeth. Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics, K.D. Dental College, randomly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine. After the patient's subjective assessment of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation was recorded and the absence/presence of pain was recorded through visual analogue scale. The pulpal anesthesia success for articaine (76%) was slightly more than with lidocaine (58%) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine (88%) was slightly more than that of lidocaine (82%) although the difference between the two solutions was not statistically significant. Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block. Key words:Anesthesia, articaine, lignocaine, pulpitis.

Comparison of anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine for inferior alveolar nerve block in patients with irreversible pulpitis

PubMed Central

Sood, Ravi; Shetty, Shashit

2014-01-01

Objectives: This study was done to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine with that of 2% lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in mandibular posterior teeth. Material and Methods: Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics, K.D. Dental College, randomly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine. After the patient’s subjective assessment of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation was recorded and the absence/presence of pain was recorded through visual analogue scale. Results: The pulpal anesthesia success for articaine (76%) was slightly more than with lidocaine (58%) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine (88%) was slightly more than that of lidocaine (82%) although the difference between the two solutions was not statistically significant. Conclusions: Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block. Key words:Anesthesia, articaine, lignocaine, pulpitis. PMID:25674319

Management of pain secondary to temporomandibular joint syndrome with peripheral nerve stimulation.

PubMed

Rodriguez-Lopez, Manuel J; Fernandez-Baena, Mariano; Aldaya-Valverde, Carlos

2015-01-01

Temporomandibular joint syndrome, or Costen syndrome, is a clinically diagnosed disorder whose most common symptoms include joint pain and clicking, difficulty opening the mouth, and temporomandibular joint discomfort. The temporomandibular joint (TMJ) is supplied by the auriculotemporal nerve, a collateral branch of the mandibular nerve (the V3 branch of the trigeminal nerve). The aim of this study is to assess the effectiveness and safety of permanent peripheral nerve stimulation to relieve TMJ pain. This case series is a prospective study. Pain Unit of a regional universitary hospital. The study included 6 female patients with temporomandibular pain lasting from 2 to 8 years that did not respond to intraarticular local anesthetic and corticoid injections. After a positive diagnostic block test, the patients were implanted with quadripolar or octapolar leads in the affected preauricular region for a 2-week stimulation test phase, after which the leads were connected to a permanent implanted pulse generator. Results of the visual analog scale, SF-12 Health Survey, Brief Pain Inventory, and drug intake were recorded at baseline and at 4, 12, and 24 weeks after the permanent implant. Five out of 6 patients experienced pain relief exceeding 80% (average 72%) and received a permanent implant. The SF-12 Health Survey results were very positive for all specific questions, especially items concerning the physical component. Patients reported returning to normal physical activity and rest at night. Four patients discontinued their analgesic medication and 1 patient reduced their gabapentin dose by 50%. Sample size; impossibility of placebo control. Patients affected with TMJ syndrome who do not respond to conservative treatments may find a solution in peripheral nerve stimulation, a simple technique with a relatively low level of complications.

[Iatrogenic risks during the obturation of the root canal system].

PubMed

Aesaert, G

2000-01-01

A hermetic seal is the main goal of obturation of the root canal system. For that purpose guttapercha still remains the filling material of choice. Most filling techniques use plasticized guttapercha and a condensation technique to fulfil the requirements of hermetic seal. The heat to plasticize and the forces applied to condense that material may have an influence on the periodontal ligament and/or the remaining tooth structure. Furthermore can overfilling of guttapercha and more likely the sealer, affect the periodontal tissue. Although rare, mandibular nerve damage and adverse effects on the sinus maxillaris can be the result of inadequate treatment.

Short Lingual Osteotomy Using a Piezosurgery Ultrasonic Bone-Cutting Device During Sagittal Split Ramus Osteotomy.

PubMed

Kawase-Koga, Yoko; Mori, Yoshiyuki; Kanno, Yuki; Hoshi, Kazuto; Takato, Tsuyoshi

2015-10-01

Short lingual osteotomy is a useful method for the performance of sagittal split ramus osteotomy involving interference between the proximal and distal bone fragments when lateral differences exist in the setback distance. However, this procedure occasionally results in abnormal fracture and nerve injury; expert surgical skill is thus required. We herein describe a novel technique involving the use of an ultrasonic bone-cutting device (Piezosurgery; Mectron Medical Technology, Carasco, Italy) for vertical osteotomy posterior to the mandibular foramen. Successful short lingual osteotomy was performed using this technique with avoidance of abnormal fracture and neurovascular bundle damage.

Perception of discomfort during injection and the need for supplemental anesthesia in the intraosseous technique using 4% articaine.

PubMed

Martínez Martínez, Adel; Lujan Pardo, María Del Pilar; Harris Ricardo, Jonathan

2016-12-01

The authors conducted an experimental study to determine patient perception of discomfort during injection and the need for supplemental anesthesia using the intraosseous technique with 4% articaine with 1:100,000 epinephrine in patients with symptomatic pulpitis in mandibular molars. At different clinical sessions, researchers used 4% articaine with 1:100,000 epinephrine to apply intraosseous injection (Group 1) or inferior alveolar nerve block (Group 2). Each technique was applied in 35 patients. In each group, the need for additional anesthesia was determined and patient discomfort during injection was assessed with a Visual Analogue Scale (VAS) test. In the intraosseous group, no supplemental technique was needed in 22 patients (62.85 %), and results were similar for the inferior alveolar technique (n: 23 65.71%). The intraosseous technique proved to be more comfortable than the mandibular technique (18 patients - 25.7%). This study found that the use of intraosseous technique with 4% articaine shows promising results regarding patient comfort and reducing the need for additional anesthesia. Sociedad Argentina de Investigación Odontológica.

Management of pediatric mandibular fractures using bioresorbable plating system – Efficacy, stability, and clinical outcomes: Our experiences and literature review

PubMed Central

Singh, Mahinder; Singh, R.K.; Passi, Deepak; Aggarwal, Mohit; Kaur, Guneet

2015-01-01

Aims The purpose of this study was to determine the efficacy and stability of the biodegradable fixation system for treatment of mandible fractures in pediatric patients by measuring the bite force. Methods Sixty pediatric patients with mandibular fractures (36 males, 24 females) were included in this study. The 2.5-mm resorbable plates were adapted along Champy's line of ideal osteosynthesis and secured with four 2.5 mm diameter monocortical resorbable screws, 8 mm in length. All patients were followed for 10 months. Clinical parameters, such as soft tissue infection, nonunion, malunion, implant exposure, malocclusion, nerve injury, and bite force for stability, were prospectively assessed. Results Adequate fixation and primary bone healing was achieved in 100% of the cases. Six minor complications (10%) were observed: 2 soft tissue infections (3%), 1 plate dehiscence (2%), 1 malocclusion (2%), and 2 paresthesia (3%). Conclusion 2.5-mm resorbable plating system along Champy's line of ideal osteosynthesis is a good treatment modality for mandible fractures in pediatric patients. PMID:27195206

Intraoral extraction of an ectopic mandibular third molar detected in the subcondylar region without a pathological cause: A case report and literature review.

PubMed

Okuyama, Kohei; Sakamoto, Yuki; Naruse, Tomofumi; Kawakita, Akiko; Yanamoto, Souichi; Furukawa, Kohei; Umeda, Masahiro

2017-09-01

To present a case report on the presence of an ectopic mandibular third molar (EMTM), the surgical treatment, and outcome. A 63-year-old woman presented with right preauricular facial swelling, limited jaw function, and pain. Radiographic assessment demonstrated an EMTM positioned in the superoposterior aspect of the ramus. Radiographically, there was a bony tunnel extending from the third molar to distal of the second molar. The patient was treated by an intraoral approach on the medial aspect of the ramus for removal of the ectopic third molar, as well as the tissue in the bony tunnel. The patient healed uneventfully. The soft tissue in the bony canal was granulation tissue, and nerve function was preserved. A literature search of EMTMs was conducted identifying 17 reported cases. Three-dimensional imaging in the management of EMTM can be beneficial in identifying position of the tooth, associated pathology, and identifying the position of neurovascular structures to aid in removal of the ectopic tooth.

In vivo potency of different ligands on voltage-gated sodium channels.

PubMed

Safrany-Fark, Arpad; Petrovszki, Zita; Kekesi, Gabriella; Liszli, Peter; Benedek, Gyorgy; Keresztes, Csilla; Horvath, Gyongyi

2015-09-05

The Ranvier nodes of thick myelinated nerve fibers contain almost exclusively voltage-gated sodium channels (Navs), while the unmyelinated fibers have several receptors (e.g., cannabinoid, transient receptor potential vanilloid receptor 1), too. Therefore, a nerve which contains only motor fibers can be an appropriate in vivo model for selective influence of Navs. The goals were to evaluate the potency of local anesthetic drugs on such a nerve in vivo; furthermore, to investigate the effects of ligands with different structures (arachidonic acid, anandamide, capsaicin and nisoxetine) that were proved to inhibit Navs in vitro with antinociceptive properties. The marginal mandibular branch of the facial nerve was explored in anesthetized Wistar rats; after its stimulation, the electrical activity of the vibrissae muscles was registered following the perineural injection of different drugs. Lidocaine, bupivacaine and ropivacaine evoked dose-dependent decrease in electromyographic activity, i.e., lidocaine had lower potency than bupivacaine or ropivacaine. QX-314 did not cause any effect by itself, but its co-application with lidocaine produced a prolonged inhibition. Nisoxetine had a very low potency. While anandamide and capsaicin in high doses caused about 50% decrease in the amplitude of action potential, arachidonic acid did not influence the responses. We proved that the classical local anesthetics have high potency on motor nerves, suggesting that this method might be a reliable model for selective targeting of Navs in vivo circumstances. It is proposed that the effects of these endogenous lipids and capsaicin on sensory fibers are not primarily mediated by Navs. Copyright © 2015 Elsevier B.V. All rights reserved.

[Outcome of endoscopically assisted surgical treatment of mandibular condyle fractures: a retrospective study of 22 patients].

PubMed

Prade, V; Seguin, P; Boutet, C; Alix, T

2014-12-01

The condylar region is a frequent localization of mandibular fractures; there are various types of management. Mini-invasive endoscopic surgery is an alternative to open reduction. We had as goal to evaluate the outcome of this technique. We performed a monocentric retrospective study of patients consecutively operated for a condylar fracture (type II to V in the Spiessl and Schroll classification) with intraoral route and endoscopic assistance, during 30 months. We assessed the functional and radiological outcomes, and the complications. Twenty-two patients (25 fractures) were included. Seventeen patients (19 fractures) could be followed (mean follow-up: 16.7 months). The mean values were: interincisal opening, 45mm (±8.4); protrusion, 8.3mm (±1.9); ipsilateral excursion of the jaw: 8.6mm (±2); contralateral excursion: 8.7mm (±4). Three routes were used combined with a preauricular approach. The fracture reduction was good for 10 of the 19 fractures and poor for 3. The complications were: 3 cases of infection, 1 case of fixation failure with good consolidation; for combined approaches: 2 cases of temporary facial palsy and 2 cases of Frey syndrome. Endoscopic assistance for the surgical management of the fracture of mandibular condyle is a reliable technique, with a good functional outcome, and a low rate of specific complications, especially for facial nerve lesion or esthetic outcome. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

X-tip intraosseous injection system as a primary anesthesia for irreversible pulpitis of posterior mandibular teeth: A randomized clinical trail

PubMed Central

Razavian, Hamid; Kazemi, Shantia; Khazaei, Saber; Jahromi, Maryam Zare

2013-01-01

Background: Successful anesthesia during root canal therapy may be difficult to obtain. Intraosseous injection significantly improves anesthesia's success as a supplemental pulpal anesthesia, particularly in cases of irreversible pulpitis. The aim of this study was to compare the efficacy of X-tip intraosseous injection and inferior alveolar nerve (IAN) block in primary anesthesia for mandibular posterior teeth with irreversible pulpitis. Materials and Methods: Forty emergency patients with an irreversible pulpitis of mandibular posterior teeth were randomly assigned to receive either intraosseous injection using the X-tip intraosseous injection system or IAN block as the primary injection method for pulpal anesthesia. Pulpal anesthesia was evaluated using an electric pulp tester and endo ice at 5-min intervals for 15 min. Anesthesia's success or failure rates were recorded and analyzed using SPSS version 12 statistical software. Success or failure rates were compared using a Fisher's exact test, and the time duration for the onset of anesthesia was compared using Mann–Whitney U test. P < 0.05 was considered significant. Results: Intraosseous injection system resulted in successful anesthesia in 17 out of 20 patients (85%). Successful anesthesia was achieved with the IAN block in 14 out of 20 patients (70%). However, the difference (15%) was not statistically significant (P = 0.2). Conclusion: Considering the relatively expensive armamentarium, probability of penetrator separation, temporary tachycardia, and possibility of damage to root during drilling, the authors do not suggest intraosseous injection as a suitable primary technique. PMID:23946738

X-tip intraosseous injection system as a primary anesthesia for irreversible pulpitis of posterior mandibular teeth: A randomized clinical trail.

PubMed

Razavian, Hamid; Kazemi, Shantia; Khazaei, Saber; Jahromi, Maryam Zare

2013-03-01

Successful anesthesia during root canal therapy may be difficult to obtain. Intraosseous injection significantly improves anesthesia's success as a supplemental pulpal anesthesia, particularly in cases of irreversible pulpitis. The aim of this study was to compare the efficacy of X-tip intraosseous injection and inferior alveolar nerve (IAN) block in primary anesthesia for mandibular posterior teeth with irreversible pulpitis. Forty emergency patients with an irreversible pulpitis of mandibular posterior teeth were randomly assigned to receive either intraosseous injection using the X-tip intraosseous injection system or IAN block as the primary injection method for pulpal anesthesia. Pulpal anesthesia was evaluated using an electric pulp tester and endo ice at 5-min intervals for 15 min. Anesthesia's success or failure rates were recorded and analyzed using SPSS version 12 statistical software. Success or failure rates were compared using a Fisher's exact test, and the time duration for the onset of anesthesia was compared using Mann-Whitney U test. P < 0.05 was considered significant. Intraosseous injection system resulted in successful anesthesia in 17 out of 20 patients (85%). Successful anesthesia was achieved with the IAN block in 14 out of 20 patients (70%). However, the difference (15%) was not statistically significant (P = 0.2). Considering the relatively expensive armamentarium, probability of penetrator separation, temporary tachycardia, and possibility of damage to root during drilling, the authors do not suggest intraosseous injection as a suitable primary technique.

The lateral line system in anuran tadpoles: neuromast morphology, arrangement, and innervation.

PubMed

Quinzio, Silvia; Fabrezi, Marissa

2014-08-01

Anuran larvae have been classified into four morphological types which reflect intraordinal macroevolution. At present, complete characterizations of the lateral line system are only available for Xenopus laevis (Type I) and Discoglossus pictus (Type III). We analyzed the morphology, arrangement, and innervation of neuromasts related to the anterodorsal and anteroventral lateral line nerves in 10 anuran species representing Types I, II, and IV with the aim of interpreting the existing variation and discussing the evolution of the lateral line in anuran larvae. We found: (1) the presence of two orbital and three mandibular neuromast lines in all anuran larvae studied, (2) the ventral arrangement of mandibular neuromast lines appears to have evolved convergently in Larval Types I and II, and the lateroventral arrangement of mandibular lines of neuromasts appears to have evolved in Larval Types III and IV; (3) interspecific variation in the organization, size, and number of sensory cells per neuromast within the lines; and (4) the supralabial extension of the Angular line in Lepidobatrachus spp. and the tentacular location of the Oral neuromasts in X. laevis are concomitant with their particular morphologies. Based on the variation described we find that the lateral line system in anuran larvae seems to have been maintained without significant changes, with the exception of Lepidobatrachus spp. and Xenopus. These unique features added to other of Lepidobatrachus tadpoles are sufficient to propose a new Larval Type (V). Copyright © 2014 Wiley Periodicals, Inc.

Alveoli, teeth, and tooth loss: Understanding the homology of internal mandibular structures in mysticete cetaceans

PubMed Central

Pyenson, Nicholas D.; Uhen, Mark D.; Marshall, Christopher D.

2017-01-01

The evolution of filter feeding in baleen whales (Mysticeti) facilitated a wide range of ecological diversity and extreme gigantism. The innovation of filter feeding evolved in a shift from a mineralized upper and lower dentition in stem mysticetes to keratinous baleen plates that hang only from the roof of the mouth in extant species, which are all edentulous as adults. While all extant mysticetes are born with a mandible lacking a specialized feeding structure (i.e., baleen), the bony surface retains small foramina with elongated sulci that often merge together in what has been termed the alveolar gutter. Because mysticete embryos develop tooth buds that resorb in utero, these foramina have been interpreted as homologous to tooth alveoli in other mammals. Here, we test this homology by creating 3D models of the internal mandibular morphology from terrestrial artiodactyls and fossil and extant cetaceans, including stem cetaceans, odontocetes and mysticetes. We demonstrate that dorsal foramina on the mandible communicate with the mandibular canal via smaller canals, which we explain within the context of known mechanical models of bone resorption. We suggest that these dorsal foramina represent distinct branches of the inferior alveolar nerve (or artery), rather than alveoli homologous with those of other mammals. As a functional explanation, we propose that these branches provide sensation to the dorsal margin of the mandible to facilitate placement and occlusion of the baleen plates during filer feeding. PMID:28542468

MicroSaw and Piezosurgery in Harvesting Mandibular Bone Blocks from the Retromolar Region: A Randomized Split-Mouth Prospective Clinical Trial.

PubMed

Hanser, Thomas; Doliveux, Romain

The aim of this randomized prospective split-mouth clinical trial was to evaluate the outcome of bone block harvesting from the retromolar region using the MicroSaw and Piezosurgery. Fifty-three patients for extensive bilateral bone grafting procedures with or without concomitant implant placement in the maxilla and/or mandible were scheduled. In each patient, bone blocks were harvested in the retromolar area within the external oblique ridge of the mandible. Using a randomized protocol, bone blocks were harvested with the MicroSaw and Piezosurgery either from the right or the left side. Clinical outcome parameters were the comparison of osteotomy time; volume of block graft; and clinical determination of intraoperative complications such as hemorrhage, nerve injury, pain, swelling, and healing of the donor site. The mean osteotomy time for harvesting including luxating a bone block was 5.63 (± 1.37) minutes using the MicroSaw and 16.47 (± 2.74) minutes using Piezosurgery (P < .05). A mean graft volume of 1.62 (± 0.27) cm 3 was measured with the MicroSaw and 1.26 (± 0.27) cm 3 with the piezoelectric surgical device (P < .05). No heavy bleeding at the donor site occurred in any of the cases. Complications due to injury of adjacent teeth or nerve lesion of the mandibular nerve were not observed in any cases. According to a scale, there was little postoperative pain with both instruments, and it decreased within 14 days postoperatively (P > .05). Swelling did not appear significantly different either (P > .05), and none of the donor sites showed primary healing complications. The data described in this randomized prospective split-mouth clinical trial indicate that the MicroSaw and Piezosurgery allowed efficient and safe bone block harvesting from the external oblique ridge. Clinically, concerning harvesting time and volume of the grafts, the MicroSaw performed significantly better, whereas pain, swelling, and healing did not appear to be considerably different. Given the improved visibility, precise cut geometries, and the margin of safety afforded by the MicroSaw and Piezosurgery, they are both instruments of choice when harvesting bone from the retromolar area.

Effect of Buffered 4% Lidocaine on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Study.

PubMed

Schellenberg, Jared; Drum, Melissa; Reader, Al; Nusstein, John; Fowler, Sara; Beck, Mike

2015-06-01

Medical studies have suggested that buffering local anesthetic may increase the ability to achieve anesthesia. The purpose of this study was to determine the effect of 4% buffered lidocaine on the anesthetic success of the inferior alveolar nerve (IAN) block in patients experiencing symptomatic irreversible pulpitis. One hundred emergency patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received a conventional IAN block using either 2.8 mL 4% lidocaine with 1:100,000 epinephrine or 2.8 mL 4% lidocaine with 1:100,000 epinephrine buffered with sodium bicarbonate in a double-blind manner. For the buffered solution, each cartridge was buffered with 8.4% sodium bicarbonate using the OnPharma (Los Gatos, CA) system to produce a final concentration of 0.18 mEq/mL sodium bicarbonate. Fifteen minutes after administration of the IAN block, profound lip numbness was confirmed, and endodontic access was initiated. Success was defined as no or mild pain (≤54 mm on a 170-mm visual analog scale) on access or instrumentation of the root canal. The success rate for the IAN block was 32% for the buffered group and 40% for the nonbuffered group, with no significant difference (P = .4047) between the groups. Injection pain ratings for the IAN block were not significantly (P = .9080) different between the 2 formulations. For mandibular posterior teeth, a 4% buffered lidocaine formulation did not result in a statistically significant increase in the success rate or a decrease in injection pain of the IAN block in patients with symptomatic irreversible pulpitis. Copyright © 2015. Published by Elsevier Inc.

Anaesthetic efficacy of lidocaine/clonidine for inferior alveolar nerve block in patients with irreversible pulpitis.

PubMed

Shadmehr, E; Aminozarbian, M G; Akhavan, A; Mahdavian, P; Davoudi, A

2017-06-01

This prospective, randomized, double-blind study aimed to compare the efficacy of lidocaine with epinephrine versus lidocaine with clonidine for inferior alveolar nerve block (IANB) and hemodynamic stability (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) in patients with irreversible pulpitis. One hundred patients with irreversible pulpitis in mandibular molar teeth randomly received 1.8 mL of 2% lidocaine with clonidine (15 μg mL -1 ) or 1.8 mL of 2% lidocaine with epinephrine (12.5 μg mL -1 ), using a conventional IANB technique. Endodontic access cavities were prepared 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as no or mild pain (visual analog scale recording) upon endodontic access cavity preparation or initial canal instrumentation. The hemodynamic parameters were measured before, during and 5, 10 and 30 min after administration. Finally, the collected data were subjected to independent t-test, chi-square and Fisher's exact test using spss software ver.20 at a significant level of 0.05. The success rates for IANB using lidocaine with epinephrine and lidocaine with clonidine solutions were 29% and 59%, respectively. The clonidine group exhibited a significantly higher success rate (P < 0.05). Five minutes after drug administration, systolic blood pressure and heart rate significantly increased in the lidocaine with epinephrine group and insignificantly decreased in lidocaine with clonidine group. For mandibular molars with irreversible pulpitis, addition of clonidine to lidocaine improved the success rate of IANB compared to a standard lidocaine/epinephrine solution. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Evaluation of proximity of mandibular molars and second premolar to inferior alveolar nerve canal among central Indians: A cone-beam computed tomographic retrospective study.

PubMed

Hiremath, Hemalatha; Agarwal, Rolly; Hiremath, Vishwanath; Phulambrikar, Tushar

2016-01-01

A study was done to assess the average distances of root apices of mandibular first molar, second molar, and second premolar to inferior alveolar nerve canal (IANC), among males and females in central India. High-resolution full-volume cone-beam computed tomography (CBCT) scans were obtained from the radiology database at the Sri Aurobindo College of Dentistry, Indore. After scrutinizing the database, CBCT of 40 males and 40 females that conformed to the inclusion and exclusion criteria were selected for the study. All the data were analyzed using SPSS, Version 16. Descriptive statistics of the variables and measurements are presented using Students t-test (paired and unpaired), and correlation between age was tabled by Karl Pearson's correlation coefficient method. For the second premolar, the average distance to the IANC was 0.88-13.03 mm for males and 0.00-5.49 mm for females. The average distance of IANC to the mesial root apex of first molar was 1.46-13.23 mm for males and 0.93-8.03 mm for females. For the second molar, the average distance was 1.31-14.71 mm for males and 0.00-6.91 mm for females (values on left side were shorter as compared to right side). In the overall population, only second molar exhibited significant difference in the distance from root apex to IANC when compared bilaterally. In addition to gender differences, age-related differences were found to be significant for the first molar on left side and second molar on the right side of the population (P< 0.05).

Bilateral sagittal split mandibular osteotomies for enhanced exposure of the anterior cervical spine in children: technical note.

PubMed

Karsy, Michael; Moores, Neal; Siddiqi, Faizi; Brockmeyer, Douglas L; Bollo, Robert J

2017-04-01

The bilateral sagittal split mandibular osteotomy (BSSMO), a common maxillofacial technique for expanding the oropharynx during treatment of micrognathia, is a rarely employed but useful adjunct to improve surgical access to the ventral cervical spine in children. Specifically, it provides enhanced exposure of the craniocervical junction in the context of midface hypoplasia, and of the subaxial cervical spine in children with severe kyphosis. The authors describe their technique for BSSMO and evaluate long-term outcomes in patients. The pediatric neurosurgical database at a single center was queried to identify children who underwent BSSMO as an adjunct to cervical spine surgery over a 22-year study period (1993-2015). The authors retrospectively reviewed clinical and radiographic data in all patients. The authors identified 5 children (mean age 5.3 ± 3.1 years, range 2.1-10.0 years) who underwent BSSMO during cervical spine surgery. The mean clinical follow-up was 3.0 ± 1.9 years. In 4 children, BSSMO was used to increase the size of the oropharynx and facilitate transoral resection of the odontoid and anterior decompression of the craniocervical junction. In 1 patient with subaxial kyphosis and chin-on-chest deformity, BSSMO was used to elevate the chin, improve anterior exposure of the subaxial cervical spine, and facilitate cervical corpectomy. Careful attention to neurovascular structures, including the inferior alveolar nerve, lingual nerve, and mental branch of the inferior alveolar artery, as well as minimizing tongue manipulation and compression, are critical to complication avoidance. The BSSMO is a rarely used but extremely versatile technique that significantly enhances anterior exposure of the craniocervical junction and subaxial cervical spine in children in whom adequate visualization of critical structures is not otherwise possible.

Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis

PubMed Central

Rodríguez-Wong, Laura; Noguera-González, Danny; Esparza-Villalpando, Vicente; Montero-Aguilar, Mauricio

2017-01-01

Introduction The inferior alveolar nerve block (IANB) is the most common anesthetic technique used on mandibular teeth during root canal treatment. Its success in the presence of preoperative inflammation is still controversial. The aim of this study was to evaluate the sensitivity, specificity, predictive values, and accuracy of three diagnostic tests used to predict IANB failure in symptomatic irreversible pulpitis (SIP). Methodology A cross-sectional study was carried out on the mandibular molars of 53 patients with SIP. All patients received a single cartridge of mepivacaine 2% with 1 : 100000 epinephrine using the IANB technique. Three diagnostic clinical tests were performed to detect anesthetic failure. Anesthetic failure was defined as a positive painful response to any of the three tests. Sensitivity, specificity, predictive values, accuracy, and ROC curves were calculated and compared and significant differences were analyzed. Results IANB failure was determined in 71.7% of the patients. The sensitivity scores for the three tests (lip numbness, the cold stimuli test, and responsiveness during endodontic access) were 0.03, 0.35, and 0.55, respectively, and the specificity score was determined as 1 for all of the tests. Clinically, none of the evaluated tests demonstrated a high enough accuracy (0.30, 0.53, and 0.68 for lip numbness, the cold stimuli test, and responsiveness during endodontic access, resp.). A comparison of the areas under the curve in the ROC analyses showed statistically significant differences between the three tests (p < 0.05). Conclusion None of the analyzed tests demonstrated a high enough accuracy to be considered a reliable diagnostic tool for the prediction of anesthetic failure. PMID:28694714

Anesthetic efficacy of a repeated intraosseous injection given 30 min following an inferior alveolar nerve block/intraosseous injection.

PubMed

Reitz, J; Reader, A; Nist, R; Beck, M; Meyers, W J

1998-01-01

To determine whether a repeated intraosseous (IO) injection would increase or prolong pulpal anesthesia, we measured the degree of anesthesia obtained by a repeated IO injection given 30 min following a combination inferior alveolar nerve block/intraosseous injection (IAN/IO) in mandibular second premolars and in first and second molars. Using a repeated-measures design, we randomly assigned 38 subjects to receive two combinations of injections at two separate appointments. The combinations were an IAN/IO injection followed approximately 30 min later by another IO injection of 0.9 ml of 2% lidocaine with 1:100,000 epinephrine and a combination IAN/IO injection followed approximately 30 min later by a mock IO injection. The second premolar, first molar, and second molar were blindly tested with an Analytic Technology pulp tester at 2-min cycles for 120 min postinjection. Anesthesia was considered successful when two consecutive readings of 80 were obtained. One hundred percent of the subjects had lip numbness with IAN/IO and with IAN/IO plus repeated IO techniques. Rates of anesthetic success for the IAN/IO and for the IAN/IO plus repeated IO injection, respectively, were 100% and 97% for the second premolar, 95% and 95% for the first molar, and 87% and 87% for the second molar. The repeated IO injection increased pulpal anesthesia for approximately 14 min in the second premolar and for 6 min in the first molar, but no statistically significant differences (P > 0.05) were shown. In conclusion, the repeated IO injection of 0.9 ml of 2% lidocaine with 1:100,000 epinephrine given 30 min following a combination IAN/IO injection did not significantly increase pulpal anesthesia in mandibular second premolars or in first and second molars.

Comparison of Preoperative Oral Ketorolac on Anesthetic Efficacy of Inferior Alveolar Nerve Block and Buccal and Lingual Infiltration with Articaine and Lidocaine in Patients with Irreversible Pulpitis: A Prospective, Randomized, Controlled, Double-blind Study.

PubMed

Yadav, Meetu; Grewal, Mandeep S; Grewal, Stutee; Deshwal, Parul

2015-11-01

Irreversible pulpitis (IP) commonly results in decreased anesthetic efficacy of the inferior alveolar nerve block (IANB) for mandibular molar. It has been shown that supplementary buccal and/or lingual infiltration as well as premedication with ketorolac result in improved efficacy of the IANB. One hundred fifty emergency patients who had their lower first or/and second molar diagnosed with IP participated in the study. All patients were randomly divided into 2 major IANB groups: 1 group received 4% articaine with 1:100,000 epinephrine, and the other group received 2% lidocaine with 1:80,000 epinephrine. Each group was further divided into 3 subgroups of 25 each: (1) buccal and lingual infiltration with articaine and lidocaine, respectively; (2) preoperative oral medication of ketorolac; and (3) preoperative oral medication of ketorolac followed by buccal and lingual infiltration with articaine and lidocaine, respectively. Endodontic access was initiated 15 minutes after solution deposition, and all patients were required to have profound lip numbness. Success of the anesthetic was defined as none or mild pain on endodontic access and initial instrumentation. Statistical analysis was performed using multiple-comparison analysis of variance (Kruskal-Wallis) and t tests. Articaine IANB with infiltrations plus oral ketorolac premedication significantly increased the success rate to 76%. The success rate after the administration of an articaine IANB with infiltration injections was 64%, whereas with lidocaine it was 32% (P < .05). Premedication with ketorolac significantly increases the anesthetic efficacy of articaine IANB plus infiltration in mandibular molars with IP. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Animating functional anatomy for the web.

PubMed

Guttmann, G D

2000-04-15

The instructor sometimes has a complex task in explaining the concepts of functional anatomy and embryology to health professional students. However, animations can easily illustrate functional anatomy, clinical procedures, or the developing embryo. Web animation increases the accessibility of this information and makes it much more useful for independent student learning. A modified version of the animation can also be used for patient education. This article defines animation, provides a brief history of animation, discusses the principles of animation, illustrates and evaluates some of the video-editing or movie-making computer software programs, and shows examples of two of the author's animations. These two animations are the inferior alveolar nerve block from the mandibular nerve anesthetics unit and normal temporomandibular joint (TMJ) function from the muscles of the mastication and the TMJ function unit. The software discussed are the industry leaders and have made the job of producing computer-based animations much easier. The programs are Adobe Premiere, Adobe After Effects, Apple QuickTime and Macromedia Flash .

Globe penetration in a cat following maxillary nerve block for dental surgery.

PubMed

Perry, Rachel; Moore, Denise; Scurrell, Emma

2015-01-01

Dental treatment was carried out in an 8.5-year-old castrated male domestic shorthair cat found to have tooth resorption. Right mandibular, and right and left maxillary nerve blocks were administered using a 1 ml syringe attached to a 25 G x 5/8 inch needle and an intraoral technique. The following day the cat displayed blepharospasm of the right eye. The ocular signs progressed and 5 days later an ophthalmologist confirmed a blind, glaucomatous right eye. It was suspected that the eye had suffered a penetrating injury during dental surgery. Enucleation of the right eye was performed and gross and histopathological examination revealed a penetrating wound consistent with a needle tract injury. Complications arising from veterinary dental regional anaesthesia appear to be rare; however, it may be that they are under-reported. This case report highlights the risks involved and reviews the safest and most efficacious regional anaesthesia technique for the feline maxilla. © ISFM and AAFP 2015.

Evidence Suggesting that the Buccal and Zygomatic Branches of the Facial Nerve May Contain Parasympathetic Secretomotor Fibers to the Parotid Gland by Means of Communications from the Auriculotemporal Nerve.

PubMed

Tansatit, Tanvaa; Apinuntrum, Prawit; Phetudom, Thavorn

2015-12-01

The auriculotemporal nerve is one of the peripheral nerves that communicates with the facial nerve. However, the function of these communications is poorly understood. Details of how these communications form and connect with each other are still unclear. In addition, a reliable anatomical landmark for locating these communications during surgery has not been sufficiently described. Microdissection was performed on 20 lateral hemifaces of 10 soft-embalmed cadavers to investigate facial-auriculotemporal nerve communications with emphasis on determining their function. The auriculotemporal nerve was identified in the retromandibular space and traced towards its terminations. The communicating branches were followed and the anatomical relationships to surrounding structures observed. The auriculotemporal nerve is suspended above the maxillary artery in the dense retromandibular fascia behind the mandibular ramus. It forms a knot and fans out, providing multiple branches in all directions in the sagittal plane. Inferiorly, it connects the maxillary periarterial plexus, while minute branches supply the temporomandibular joint anteriorly. The larger branches mainly communicate with the branches of the temporofacial division of the facial nerve, and the auricular branches enter the fascia of the auricular cartilage posteriorly. The temporal branches and occasionally the zygomatic branches arise superiorly to distribute within the temporoparietal fascia. The auriculotemporal nerve forms the parotid retromandibular plexus through two types of communication. It sends one to three branches to join the zygomatic and buccal branches of the facial nerve at the branching area of the temporofacial division. It also communicates with the periarterial plexus of the superficial temporal and maxillary arteries. This plexus continues anteriorly along the branches of the facial nerve and the periarterial plexus of the transverse facial artery as the parotid periductal autonomic plexus, supplying the branches of the parotid duct within the loop of the two main divisions of the parotid gland. A single cutaneous zygomatic branch arising from the auriculotemporal nerve in some specimens, the intraparotid communications with the zygomatic and the buccal trunks of the facial nerve, the retromandibular communications with the superficial temporal-maxillary periarterial plexuses, and the periductal autonomic plexus between the loop of the two main facial divisions lead to the suggestion that these communications of the auriculotemporal nerve convey the secretomotor to the zygomatic and buccal branches of the facial nerve. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Solitary giant neurofibroma of the mental nerve: a trauma-related lesion?

PubMed

da Rosa, Marina R P; Ribeiro, André Luis Ribeiro; de Menezes, Sílvio A F; Pinheiro, João J V; Alves-Junior, Sérgio M

2013-05-01

Neurofibroma is a benign neoplasm derived from peripheral nerves whose etiology is still unclear. It may present as a solitary lesion or be associated with other diseases such as neurofibromatosis type I and II syndrome. This paper aims to report an extremely rare case of a solitary giant neurofibroma of the mental nerve whose etiology was related to a local trauma. A 14-year-old female patient presented an extensive left facial mass with a size of 7 × 5 × 4 cm, located between the teeth 33 and 37 in the mandible region. It has begun to grow 3 months after a local trauma. Imaging studies were suggestive of a soft-tissue lesion, with minimal bone changes and maintaining the integrity of the mandibular canal and mental foramen. Histopathological tests showed spindle cells with undulated and hyperchromatic nuclei, and sparse cytoplasm in a stroma composed of dense fibrous connective tissue. Immunohistochemistry revealed positive expression for the proteins S-100 and vimentin, confirming the diagnosis of neurofibroma. The patient underwent surgical removal of the lesion by intraoral approach and evolved with an excellent cosmetic result and no signs of recurrence after 2 years of follow up. We report a rare case of solitary giant neurofibroma whose etiology was related to a local trauma. To our knowledge, this is the first report of a mental nerve neurofibroma. Although the etiology remains unclear, we suggest the investigation of local trauma as a possible etiologic factor for solitary neurofibromas of the jaw.

Carotid endarterectomy: comparison of complications between transverse and longitudinal incision.

PubMed

Mendes, George A C; Zabramski, Joseph M; Elhadi, Ali M; Kalani, M Yashar S; Preul, Mark C; Nakaji, Peter; Spetzler, Robert F

2014-08-01

Cranial nerve injury (CNI) is the most common neurological complication associated with carotid endarterectomy (CEA). Some authors postulate that the transverse skin incision leads to increased risk of CNI. We compared the incidence of CNI associated with the transverse and longitudinal skin incisions in a high-volume cerebrovascular center. We reviewed the charts of 226 consecutive patients who underwent CEAs between January 2007 and August 2009. Pre- and postoperative standardized neurological evaluations were performed by faculty neurologists and neurosurgeons. One hundred sixty nine of 226 (75%) CEAs were performed with the use of a transverse incision. The longitudinal incision was generally reserved for patients with a high-riding carotid bifurcation. Mean patient age was 69 years (range, 45-91 years); 62% were men; 59% of patients were symptomatic and had high-grade stenosis (70%-99%). CNI occurred in 8 cases (3.5%): 5 (3%) in transverse and 3 (5.3%) with longitudinal incisions (P = .42). There were 2 marginal mandibular nerve injuries, 1 (0.6%) transverse and 1 longitudinal; 5 recurrent laryngeal nerve injuries, 4 transverse and 1 longitudinal; and 1 case of hypoglossal nerve injury associated with longitudinal incision. One hematoma was associated with CNI. All injuries were transient. Fourteen wound hematomas required surgical evacuation. The transverse skin incision for CEAs is not associated with an increased risk of CNI (P =.42). In this study, the incidence of CNI associated with the transverse incision was 3% (n = 5) vs 5% (n = 3) for longitudinal incisions. All CNIs were temporary.

Study of the anesthetic efficacy of inferior alveolar nerve block using articaine in irreversible pulpitis.

PubMed

Ahmad, Zeeshan H; Ravikumar, H; Karale, Rupali; Preethanath, R S; Sukumaran, Anil

2014-01-01

The purpose of this study was to determine the anesthetic efficacy of inferior alveolar nerve block (IANB) using 4% articaine and 2% lidocaine supplemented with buccal infiltration. Forty five patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth were included in the study. The first group of 15 patients received 2% lidocaine with 1:200000 epinephrine, the second group 2% lidocaine with 1: 80,000 epinephrine and the third group of 15 subjects received 4% articaine with 1:100000 epinephrine. During the access cavity preparation those patients who complained of pain received an additional buccal infiltration. The percentage of subjects who got profound anesthesia and failure to achieve anesthesia were calculated and tabulated using a visual analog scale. The results revealed that 87% of subjects who received 4% Articaine with 1:100,000 epinephrine got satisfactory anesthesia with inferior alveolar nerve block alone. Only 2 (13%) subjects received an additional buccal infiltration and none of the patients failed to obtain complete anesthesia with articaine. In comparison only 40% of subjects got complete anesthesia with 2% lidocaine with 1:200000 and 60% with 2% lidocaine with 1:80,000. It can be concluded that 4% articaine can be used effectively for obtaining profound anesthesia for endodontic procedures in patients with irreversible pulpitis.

Macroscopic Innervation of the Dura Mater Covering the Middle Cranial Fossa in Humans Correlated to Neurovascular Headache

PubMed Central

Lee, Shin-Hyo; Hwang, Seung-Jun; Koh, Ki-Seok; Song, Wu-Chul; Han, Sang-Don

2017-01-01

The trigeminovascular system within the cranial dura mater is a possible cause of headaches. The aim of this study is to investigate macroscopically dural innervation around the middle meningeal artery (MMA) in the middle cranial fossa. Forty-four sides of the cranial dura overlying the skull base obtained from 24 human cadavers were stained using Sihler’s method. Overall, the nervus spinosus (NS) from either the maxillary or mandibular trigeminal divisions ran along the lateral wall of the middle meningeal vein rather than that of the MMA. Distinct bundles of the NS running along the course of the frontal branches of the MMA were present in 81.8% of cases (N = 36). Others did not form dominant nerve bundles, instead giving off free nerve endings along the course of the MMA or dural connective tissue. The distribution of these nerve endings was similar to that of the course of the frontal, parietal and petrosal branches of the MMA (11.4%). The others were not restricted to a perivascular plexus, crossing the dural connective tissues far from the MMA (6.8%). These findings indicate that the NS generally travels alongside the course of the frontal branches of the MMA and terminates in the vicinity of the pterion. PMID:29311855

Macroscopic Innervation of the Dura Mater Covering the Middle Cranial Fossa in Humans Correlated to Neurovascular Headache.

PubMed

Lee, Shin-Hyo; Hwang, Seung-Jun; Koh, Ki-Seok; Song, Wu-Chul; Han, Sang-Don

2017-01-01

The trigeminovascular system within the cranial dura mater is a possible cause of headaches. The aim of this study is to investigate macroscopically dural innervation around the middle meningeal artery (MMA) in the middle cranial fossa. Forty-four sides of the cranial dura overlying the skull base obtained from 24 human cadavers were stained using Sihler's method. Overall, the nervus spinosus (NS) from either the maxillary or mandibular trigeminal divisions ran along the lateral wall of the middle meningeal vein rather than that of the MMA. Distinct bundles of the NS running along the course of the frontal branches of the MMA were present in 81.8% of cases ( N = 36). Others did not form dominant nerve bundles, instead giving off free nerve endings along the course of the MMA or dural connective tissue. The distribution of these nerve endings was similar to that of the course of the frontal, parietal and petrosal branches of the MMA (11.4%). The others were not restricted to a perivascular plexus, crossing the dural connective tissues far from the MMA (6.8%). These findings indicate that the NS generally travels alongside the course of the frontal branches of the MMA and terminates in the vicinity of the pterion.

Displacement of a Broken Dental Injection Needle Into the Perivertebral Space.

PubMed

Sahin, Bayram; Yildirimturk, Senem; Sirin, Yigit; Basaran, Bora

2017-07-01

Dental injection needle breakage is an uncommon problem in dental practice. Displacement of the broken fragment into anatomical spaces is, on the other hand, a serious complication that occurs most commonly during inferior alveolar nerve blocks as a result of material wear, incorrect application of the anesthesia technique, or sudden movement of the patient during injection. Further complications such as infection, trismus, and nerve paralysis may exacerbate the condition and, if not treated adequately, life-threatening conditions may develop over time as the fragment dislodges deeper in soft tissues. Clinical symptoms of the patient, as well as the findings gathered from detailed physical examination and radiographic evaluation, are important factors to consider before performing an exploratory surgery. Removal of a broken needle may be troublesome due to its proximity to vital anatomic structures. Multislice computed tomography is a reliable imaging modality that provides accurate information to pinpoint the exact location of the needle fragment.This report describes a case of needle breakage occurred during inferior alveolar nerve block which was performed to extract a third molar tooth and the migration of the broken fragment from the right mandibular ramus area into the perivertebral space, with special emphasis on the surgical retrieval technique with multiplanar computed tomography imaging guidance.

Paresthesia during orthodontic treatment: case report and review.

PubMed

Monini, André da Costa; Martins, Renato Parsekian; Martins, Isabela Parsekian; Martins, Lídia Parsekian

2011-10-01

Paresthesia of the lower lip is uncommon during orthodontic treatment. In the present case, paresthesia occurred during orthodontic leveling of an extruded mandibular left second molar. It was decided to remove this tooth from the appliance and allow it to relapse. A reanatomization was then performed by grinding. The causes and treatment options of this rare disorder are reviewed and discussed. The main cause of paresthesia during orthodontic treatment may be associated with contact between the dental roots and inferior alveolar nerve, which may be well observed on tomography scans. Treatment usually involves tooth movement in the opposite direction of the cause of the disorder.

Anesthetic efficacy of the intraosseous injection of 0.9 mL of 2% lidocaine (1:100,000 epinephrine) to augment an inferior alveolar nerve block.

PubMed

Reitz, J; Reader, A; Nist, R; Beck, M; Meyers, W J

1998-11-01

The purpose of this study was to determine the anesthetic efficacy of an intraosseous injection of 0.9 mL of 2% lidocaine with 1:100,000 epinephrine to augment an inferior alveolar nerve block in mandibular posterior teeth. With the use of a repeated-measures design, each of 38 subjects randomly received one or the other of 2 combinations of injections at 2 separate appointments. The combinations were inferior alveolar nerve block + intraosseous injection (on the distal of the second premolar) through use of 0.9 mL of 2% lidocaine with 1:100,000 epinephrine and inferior alveolar nerve block + mock intraosseous injection. The first molar, second premolar, and second molar were blindly tested with an Analytic Technology pulp tester at 2-minute cycles for 120 minutes postinjection. Anesthesia was considered successful when 2 consecutive 80 readings were obtained. One hundred percent of the subjects had lip numbness with the inferior alveolar nerve block + intraosseous injection combination technique. The respective anesthetic success rates for the inferior alveolar nerve block + mock intraosseous injection combination and the inferior alveolar nerve block + intraosseous injection combination were 60% and 100% for the second premolar, 71% and 95% for the first molar, and 74% and 87% for the second molar. The differences were significant (P < .05) for the second premolar through 50 minutes and for the first molar through 20 minutes. There were no significant (P > .05) differences for the second molar. Sixty-eight percent of the subjects had a subjective increase in heart rate with the intraosseous injection. The results of this study indicate that the supplemental intraosseous injection of 0.9 mL of 2% lidocaine with 1:100,000 epinephrine, given distal to the second premolar, significantly increased the success of pulpal anesthesia in the second premolar (for 50 minutes) and first molar (for 20 minutes) in comparison with the inferior alveolar nerve block alone. The intraosseous injection did not statistically increase success in the second molar.

Geometric morphometric analysis of allometric variation in the mandibular morphology of the hominids of Atapuerca, Sima de los Huesos site.

PubMed

Rosas, Antonio; Bastir, Markus

2004-06-01

Allometry is an important factor of morphological integration that contributes to the organization of the phenotype and its variation. Variation in the allometric shape of the mandible is particularly important in hominid evolution because the mandible carries important taxonomic traits. Some of these traits are known to covary with size, particularly the retromolar space, symphyseal curvature, and position of the mental foramen. The mandible is a well studied system in the context of the evolutionary development of complex morphological structures because it is composed of different developmental units that are integrated within a single bone. In the present study, we investigated the allometric variation of two important developmental units that are separated by the inferior nerve (a branch of CN V3). We tested the null hypothesis that there would be no difference in allometric variation between the two components. Procrustes-based geometric morphometrics of 20 two-dimensional (2D) landmarks were analyzed by multivariate regressions of shape on size in samples from 121 humans, 48 chimpanzees, and 50 gorillas (all recent specimens), eight fossil hominids from Atapuerca, Sima de los Huesos (AT-SH), and 17 Neandertals. The findings show that in all of the examined species, there was significantly greater allometric variation in the supra-nerve unit than in the infra-nerve unit. The formation of the retromolar space exhibited an allometric relationship with the supra-nerve unit in all of the species studied. The formation of the chin-like morphology is an "apodynamic" feature of the infra-nerve unit in the AT-SH hominids. The results of this study support the hypothesis that allometry contributes to the organization of variation in complex morphological structures. Copyright 2004 Wiley-Liss, Inc.

A morphometric analysis of the superior cervical ganglion and its surrounding structures.

PubMed

Fazliogullari, Zeliha; Kilic, Cenk; Karabulut, Ahmet Kagan; Yazar, Fatih

2016-04-01

The aim of this cadaveric study was to detect the superior cervical ganglion (SCG) in a topographic manner according to vertebrae and to determine the relationship between the vertebrae, mandibular angle and longus colli muscle through morphometric analysis. The present study was performed on 40 SCG of 20 human cadavers (16 males, 4 females). The level of the SCG was determined based on the vertebrae. Ganglion length, width and thickness were detected. Distance to the adjacent vertebra, the mandibular angle and medial side of the longus colli muscle were measured. The results were evaluated statistically. The SCG existing in all cadavers was detected at the C2 vertebra level in 34 cadavers and at the C3 vertebra level in 6 cadavers. The average length, width and thickness of the SCG were 15.18 ± 1.12, 4.62 ± 0.25, and 1.83 ± 0.10 mm, respectively. No statistically significant difference was detected in terms of the distances between the ganglion and anterior tubercle of transverse processes of the vertebrae as well as the mandibular angle on either side. The distance between the SCG and the medial edge of the longus colli muscle was significantly greater on the left side in both men (p < 0.001) and women (p < 0.01). Recognition of morphometric characteristics of the SCG and detection of its location according to adjacent formations may serve as a guide for nerve blockage studies and help surgeons to preserve the ganglion in both anterior and anterolateral cervical approaches.

Temporal Evaluation of Neurosensory Complications After Mandibular Third Molar Extraction: Current Problems for Diagnosis and Treatment.

PubMed

Akashi, Masaya; Hiraoka, Yujiro; Hasegawa, Takumi; Komori, Takahide

2016-01-01

This retrospective study aimed to report the incidence of neurosensory complications after third molar extraction and also to identify current problems and discuss appropriate management of these complications. Patients who underwent extraction of deeply impacted mandibular third molars under general anesthesia were included. The following epidemiological data were retrospectively gathered from medical charts: type of neurosensory complication, treatment for complication, and outcome. A total 369 mandibular third molars were extracted in 210 patients under general anesthesia during this study period. Thirty-one of the 369 teeth (8.4%) in 31 patients had neurosensory complications during the first postoperative week resulting from inferior alveolar nerve damage. Neurosensory complications lasting from 1 to 3 months postoperatively included 17 cases of hypoesthesia and 8 of dysesthesia in 19 patients. Five cases of hypoesthesia and 4 of dysesthesia in 5 patients persisted over 1 year postoperatively. Sixteen of 369 teeth (4.3%) in 16 patients had persistent neurosensory complications after third molar extraction under general anesthesia. Stellate ganglion block was performed in 4 patients. Early initiation of stellate ganglion block (within 2 weeks postoperatively) produced better outcomes than late stellate ganglion block (over 6 months postoperatively). Refractory neurosensory complications after third molar extraction often combine both hypoesthesia and dysesthesia. Current problems in diagnosis and treatment included delayed detection of dysesthesia and the lack of uniform timing of stellate ganglion block. In the future, routinely inquiring about dysesthesia and promptly providing affected patients with information about stellate ganglion block might produce better outcomes.

Temporal Evaluation of Neurosensory Complications After Mandibular Third Molar Extraction: Current Problems for Diagnosis and Treatment

PubMed Central

Akashi, Masaya; Hiraoka, Yujiro; Hasegawa, Takumi; Komori, Takahide

2016-01-01

Objective: This retrospective study aimed to report the incidence of neurosensory complications after third molar extraction and also to identify current problems and discuss appropriate management of these complications. Method: Patients who underwent extraction of deeply impacted mandibular third molars under general anesthesia were included. The following epidemiological data were retrospectively gathered from medical charts: type of neurosensory complication, treatment for complication, and outcome. Results: A total 369 mandibular third molars were extracted in 210 patients under general anesthesia during this study period. Thirty-one of the 369 teeth (8.4%) in 31 patients had neurosensory complications during the first postoperative week resulting from inferior alveolar nerve damage. Neurosensory complications lasting from 1 to 3 months postoperatively included 17 cases of hypoesthesia and 8 of dysesthesia in 19 patients. Five cases of hypoesthesia and 4 of dysesthesia in 5 patients persisted over 1 year postoperatively. Sixteen of 369 teeth (4.3%) in 16 patients had persistent neurosensory complications after third molar extraction under general anesthesia. Stellate ganglion block was performed in 4 patients. Early initiation of stellate ganglion block (within 2 weeks postoperatively) produced better outcomes than late stellate ganglion block (over 6 months postoperatively). Conclusion: Refractory neurosensory complications after third molar extraction often combine both hypoesthesia and dysesthesia. Current problems in diagnosis and treatment included delayed detection of dysesthesia and the lack of uniform timing of stellate ganglion block. In the future, routinely inquiring about dysesthesia and promptly providing affected patients with information about stellate ganglion block might produce better outcomes. PMID:28217188

Displacement of mandibular fractures: is there a correlation with sensory loss and recovery?

PubMed

Scott, R A; Teo, N; Perry, M

2014-05-01

Fractures of the mandible are common. However, the correlation between the severity of the fracture and the recovery of any associated inferior dental (ID) nerve injury is still poorly understood. We aimed to examine the relationship between the amount of fracture displacement and how it relates to the recovery of sensation to the lower lip. One hundred and fifty patients requiring treatment of a mandibular fracture (where the fracture passed across the ID canal) were assessed. One hundred were initially assessed in a retrospective double-blinded study. A further 50 patients were then followed up prospectively. Both the maximal displacement of the fracture and the displacement specifically at the ID canal were measured. Sensory recovery, or persistence of numbness, was also recorded for each patient. Although there appeared to be a correlation between increasing displacement at the ID canal and a poorer recovery, there was not a clear relationship between the two, and there were many exceptions. Persistent numbness (>1 year) still occurred in fractures with relatively minimal displacement (≤3mm). Possible reasons for persistent numbness are discussed. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Update on mandibular condylar fracture management.

PubMed

Weiss, Joshua P; Sawhney, Raja

2016-08-01

Fractures of the mandibular condyle have provided a lasting source of controversy in the field of facial trauma. Concerns regarding facial nerve injury as well as reasonable functional outcomes with closed management led to a reluctance to treat with an open operative intervention. This article reviews how incorporating new technologies and surgical methods have changed the treatment paradigm. Multiple large studies and meta-analyses continue to demonstrate superior outcomes for condylar fractures when managed surgically. Innovations, including endoscopic techniques, three-dimensional miniplates, and angled drills provide increased options in the treatment of condylar fractures. The literature on pediatric condylar fractures is limited and continues to favor a more conservative approach. There continues to be mounting evidence in radiographic, quality of life, and functional outcome studies to support open reduction with internal fixation for the treatment of condylar fractures in patients with malocclusion, significant displacement, or dislocation of the temporomandibular joint. The utilization of three-dimensional trapezoidal miniplates has shown improved outcomes and theoretically enhanced biomechanical properties when compared with traditional fixation with single or double miniplates. Endoscopic-assisted techniques can decrease surgical morbidity, but are technically challenging, require skilled assistants, and utilize specialized equipment.

Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis.

PubMed

Nusstein, J; Reader, A; Nist, R; Beck, M; Meyers, W J

1998-07-01

The purpose of this study was to determine the anesthetic efficacy of a supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in teeth diagnosed with irreversible pulpitis. Fifty-one patients with symptomatic, vital maxillary, and mandibular posterior teeth diagnosed with irreversible pulpitis received conventional infiltrations or inferior alveolar nerve blocks. Pulp testing was used to determine pulpal anesthesia after "clinically successful" injections. Patients who were positive to the pulp tests, or were negative to the pulp tests but felt pain during endodontic access, received an intraosseous injection using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The results demonstrated that 42% of the patients who tested negative to the pulp tests reported pain during treatment and required supplemental anesthesia. Eighty-one percent of the mandibular teeth and 12% of maxillary teeth required an intraosseous injection due to failure to gain pulpal anesthesia. Overall, the Stabident intraosseous injection was found to be 88% successful in gaining total pulpal anesthesia for endodontic therapy. We concluded that, for posterior teeth diagnosed with irreversible pulpitis, the supplemental intraosseous injection of 2% lidocaine (1:100,000 epinephrine) was successful when conventional techniques failed.

Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis.

PubMed

Reisman, D; Reader, A; Nist, R; Beck, M; Weaver, J

1997-12-01

To determine the efficacy of a supplemental intraosseous injection of 3% mepivacaine in mandibular posterior teeth with irreversible pulpitis. Intraosseous injection pain, subjective heart rate increase, and pain ratings during endodontic treatment were also assessed. Forty-eight patients with irreversible pulpitis received conventional inferior alveolar nerve blocks. Electric pulp testing was used to determine pulpal anesthesia. Patients who were positive to the pulp testing, or negative to pulp testing but felt pain during endodontic treatment, received an intraosseous injection of 1.8 ml of 3% mepivacaine. A second intraosseous injection of 3% mepivacaine (1.8 ml) was given if the first injection was unsuccessful. Seventy-five percent of patients required an initial intraosseous injection because of failure to gain pulpal anesthesia. The inferior alveolar block was 25% successful; the first intraosseous injection increased success to 80%. A second intraosseous injection further increased success to 98%. These differences were significant (p < 0.05). Eight percent (4/48) of the initial intraosseous injections resulted in solution being expressed into the oral cavity: these were considered technique failures. For mandibular posterior teeth with irreversible pulpitis, a supplemental intraosseous injection of 3% mepivacaine increased anesthetic success. A second intraosseous injection, when necessary, further improved success.

[Bone graft reconstruction for posterior mandibular segment using the formwork technique].

PubMed

Pascual, D; Roig, R; Chossegros, C

2014-04-01

Pre-implant bone graft in posterior mandibular segments is difficult because of masticatory and lingual mechanical constraints, because of the limited bone vascularization, and because of the difficulty to cover it with the mucosa. The formwork technique is especially well adapted to this topography. The recipient site is abraded with a drill. Grooves are created to receive and stabilize the grafts. The bone grafts were harvested from the ramus. The thinned cortices are assembled in a formwork and synthesized by mini-plates. The gaps are filled by bone powder collected during bone harvesting. The bone volume reconstructed with the formwork technique allows anchoring implants more than 8mm long. The proximity of the inferior alveolar nerve does not contra indicate this technique. The formwork size and its positioning on the alveolar crest can be adapted to prosthetic requirements by using osteosynthesis plates. The lateral implant walls are supported by the formwork cortices; the implant apex is anchored on the native alveolar crest. The primary stability of implants is high, and the torque is important. The ramus harvesting decreases operative risks. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Therapeutic objectives and surgical treatment of mandibular condyle fractures. Personal experience.

PubMed

Burlini, D

2004-10-01

A review of condylar fractures treated ''non-surgically'' and ''surgically'' over the last 5 years (1996-2001) at the Maxillofacial Surgery Division of the Brescia Civil Hospital (Italy) is presented. The non surgical and surgical treatments carried out, as well as their effectiveness and therapeutic aims, are illustrated. From June 1996 to June 2001, at the Maxillofacial Surgery Division of the Brescia Civil Hospital, 179 fractures of the mandibular condyle were treated. Of the 179 cases treated, a distinction was immediately made between ''non-surgical'' (103 cases) and ''surgical'' cases (76 cases). The 76 ''surgical'' cases were all treated with the same surgical technique. Out-patient follow-up was at days 20, 60, 90, and 1 year, together with a radiographic check-up at 60 days. Of the 76 condylar fractures treated surgically, 15 patients selected at random were re-examined; the medical history was investigated and clinical and radiological examinations performed. For each patient, the type of condylar fracture and whether this was associated with other mandibular fractures were recorded. The following data were also recorded: age of the patient; pain at the surgical site or at the mandible at the time of check-up; presence of normal occlusion and laterodeviation; any surgical sequelae at the facial nerve on the operated side; maximum mouth opening; any radiological defect; time since surgery. Then, the patient was asked to give his/her own evaluation of the surgical outcome, by expressing adequate, good or excellent result. In patients treated surgically the indication is almost absolute in the following cases: condylar fractures types II and IV of the Spiessl/Schroll classification, low or high condylar fractures with medial dislocation of the condyle; non-surgical treatment cannot be applied for reasons of patient's health; condylar fracture associated with other open fractures of the face. The use of rigid fixation also may help in the success of the technique adopted. In all the cases (surgical and non-surgical) it is important to achieve early mobilization of the mandible and carry out a rehabilitation program for masticatory function. The goals of condylar treatment may therefore be summarized as follows: to achieve a good occlusion; to eliminate pain; to achieve a proper mandibular symmetry; to achieve good mandibular movement in the 3 planes of space.

Burkitt non-Hodgkin lymphoma presenting with mental neuropathy ('numb chin' syndrome) in an HIV-positive patient.

PubMed

Vora, N; Haryee, H; Dickson, J C; Miller, R F

2018-05-01

Mental nerve neuropathy is usually due to local trauma or dental causes, but may be a manifestation of malignancy. A patient with virologically controlled human immunodeficiency virus (HIV) infection presented with a 'numb chin' on the background of long-standing night sweats, malaise and weight loss, worsening respiratory symptoms, and lymphadenopathy. Burkitt non-Hodgkin lymphoma was diagnosed from histology of a lymph node. Imaging (magnetic resonance imaging and 18 fluorodeoxyglucose [FDG]-positron emission tomography-computed tomography [PET-CT]) showed abnormal intracranial enhancement of the right mandibular nerve and extensive 18 FDG-avid lymphadenopathy above and below the diaphragm, focal lesions in the spleen and within the right mandible. The patient received chemotherapy and remains in clinical and radiological remission seven years later. This case highlights the need for clinicians to maintain a high index of suspicion for underlying malignancy when an HIV-infected patient presents with new onset of a 'numb chin'. Additionally, it demonstrates the importance of functional 18 FDG-PET-CT and neuroimaging in order to identify site(s) of pathology.

Temporo mandibular joint ankylosis.

PubMed

Vasconcelos, Belmiro Cavalcanti do Egito; Porto, Gabriela Granja; Bessa-Nogueira, Ricardo Viana

2008-01-01

Ankylosis may be defined as joint surfaces fusion. The treatment of temporomandibular joint ankylosis poses a significant challenge because of the high recurrence rate. The aim of this study is to report six cases treated by joint reconstruction, evaluate the results of these surgeries and review the literature. The sample in this retrospective study was obtained from the records of the university hospital, patients who had to undergo ankylosis treatment by alloplastic or autogenous graft between March 2001 and October 2005. Pre - and post-operative assessment included a throughout history and physical examination to determine the cause of ankylosis, the Maximum mouth opening (MMO), etiology and type of ankylosis, recurrence rate and presence of facial nerve paralysis. The mean MMO in the pre-operative period was 9.6 mm (0 mm to 17 mm) and in the post-operative period it was of 31.33 mm (14 mm to 41 mm), there was no facial nerve paralysis and there was recurrence in just one case. The joint reconstruction with alloplastic or autogenous grafts for the ankylosis treatment proved to be efficient in relation to the post-operative MMO, recurrence and joint function.

Double osteotomy of mandibula in the treatment of carotid body tumors with skull base extension.

PubMed

Prouse, Giorgio; Mazzaccaro, Daniela; Settembrini, Fernanda; Carmo, Michele; Biglioli, Federico; Settembrini, Piergiorgio G

2013-08-01

We report two patients with a carotid body paraganglioma that extended to the skull base, a position that is surgically inaccessible by means of a traditional lateral cervical approach. In both patients we were able to remove the lesion by performing a double mandibular osteotomy. Both patients underwent preoperative embolization to reduce the mass. In our experience, this approach has allowed a safe radical excision of exceptionally high lesions with only minor permanent nerve damage. In our opinion this advantage definitely outweighs the consequences of the increased invasiveness of this technique. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Piezosurgery for Excision of Large Osteoid Osteoma.

PubMed

Gadre, Pushkar; Singh, Divya; Gadre, Kiran; Khan, Imran

2016-10-01

Osteoid osteoma, a rare benign osteoblastic tumor first described by Jaffe in 1935, is characterized as a small but painful lesion that mostly affects younger people. Usually benign and harmless, osteomas are removed for pain or esthetic reasons.Piezoelectric surgery is also increasingly being used effectively in major and minor osseous oral and maxillofacial surgeries, in delicate areas. It is used regularly for various procedures, including sinus lift procedures, bone graft harvesting, osteogenic distraction, ridge expansion, inferior alveolar nerve decompression and lateralization, cyst removal, dental extraction, and impacted tooth removal.The following report presents a patient of intraoral excision of a large osteoid osteoma from lingual aspect of mandibular lower border in the body region using piezoelectric surgery.

Role of intraseptal anesthesia for pain-free dental treatment

PubMed Central

Gazal, G; Fareed, WM; Zafar, MS

2016-01-01

Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia. PMID:26955316

Role of intraseptal anesthesia for pain-free dental treatment.

PubMed

Gazal, G; Fareed, W M; Zafar, M S

2016-01-01

Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia.

Surgical treatment of mandibular condyle fractures using the retromandibular anterior transparotid approach and a triangular-positioned double miniplate osteosynthesis technique: A clinical and radiological evaluation of 124 fractures.

PubMed

Dalla Torre, Daniel; Burtscher, Doris; Widmann, Gerlig; Pichler, Albina; Rasse, Michael; Puelacher, Wolfgang

2015-07-01

Different modalities have been described regarding the treatment of mandibular condyle fractures. The most advantageous and safest one is still a topic of discussion. The present analysis describes the combination of a retromandibular, transparotideal approach combined to a triangular-positioned double-miniplate osteosynthesis, with a special regard for the patients' long term outcomes. Clinical data of 102 patients with 124 condyle fractures treated with the mentioned surgical procedure were evaluated. Functional parameters such as the maximal interincisal distance, deviations/deflections, facial nerve function, occlusion as well as complications regarding the parotid gland, osteosynthesis, and esthetics were evaluated 1 week, 2 weeks, 3 months, and 6 months postoperatively. The mean maximal interincisal distance ranged from 38 mm after 1 week to 45 mm after 6 months. Deviations/deflections were seen in 22.5% of the cases 1 week postoperatively and decreased to 2% at 6 months postoperatively. A temporary facial palsy was diagnosed in 3.9% during the first follow-up, whereas no impairment was recorded after 3 or 6 months. At the same time, no patient had occlusional disturbances or complications regarding the parotid gland or the osteosynthesis 6 months postoperatively. Direct fracture visualization and a stable three-dimensional fracture stabilization are the main advantages of the presented combination of a surgical approach and osteosynthesis technique. Additionally, the absence of long-term complications confirms the safety of the procedure. Therefore, it may be considered as a successful treatment option for mandibular condyle fractures. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Dental occlusion ties: A rapid, safe, and non‐invasive maxillo‐mandibular fixation technology

PubMed Central

2017-01-01

Objectives For decades, Erich arch bars have been a standard in establishing maxillo‐mandibular fixation (MMF). While reliable, the approach risks sharps injury, consumes operating room time, and inflicts gingival trauma. Newer technologies including screw‐based techniques and “hybrid” techniques have improved MMF by reducing sharps injuries and operating room time, but risk injury to tooth roots, nerves, and gingiva. This study aims to establish the application, strengths, and limitations of dental occlusion ties as a novel alternative in maxillo‐mandibular fixation. Study Design Prospective, non‐blinded, human feasibility clinical trial. Materials and Methods An iterative prototyping process was used to invent dental occlusion ties (brand name: Minne Ties). Development included 3D printing, cadaver prototype testing, human apical embrasure measurement, and ultimately non‐significant risk human clinical trial testing. In the IRB‐approved feasibility clinical trial, the devices were applied to mandible and maxilla fracture candidates with fractures amenable to intra‐operative MMF with open reduction with internal fixation. The ties were removed prior to extubation. Pre‐teens, comminuted fracture patients, and patients requiring post‐operative MMF were excluded. Results Manufactured, sterile prototypes secured MMF successfully in management of unilateral and bilateral mandible and maxilla fractures. All patients reported correction of pre‐operative malocclusion. Application times were typically 12–15 minutes for a single surgeon to achieve MMF. Patients incurred negligible gingival trauma from the technology as the ties require no tissue penetration for application. Conclusions Dental occlusion ties offer a non‐invasive solution featuring operating room efficiency, minimized sharps risk, and less bony and soft tissue trauma than current commercialized solutions. Level of Evidence Therapeutic, IV PMID:28894837

A Comparative Study of 3-Dimensional Titanium Versus 2-Dimensional Titanium Miniplates for Open Reduction and Fixation of Mandibular Parasymphysis Fracture.

PubMed

Mittal, Yogesh; Varghese, K George; Mohan, S; Jayakumar, N; Chhag, Somil

2016-03-01

Three dimensional titanium plating system was developed by Farmand in 1995 to meet the requirements of semi rigid fixation with lesser complication. The purpose of this in vivo prospective study was to evaluate and compare the clinical effectiveness of three dimensional and two dimensional Titanium miniplates for open reduction and fixation of mandibular parasymphysis fracture. Thirty patients with non-comminuted mandibular parasymphysis fractures were divided randomly into two equal groups and were treated with 2 mm 3D and 2D miniplate system respectively. All patients were systematically monitored at 1st, 2nd, 3rd, 6th week, 3rd and 6th month postoperatively. The outcome parameters recorded were severity of pain, infection, mobility, occlusion derangement, paresthesia and implant failure. The data so collected was analyzed using independent t test and Chi square test (α = .05). The results showed that one patient in each group had post-operative infection, occlusion derangement and mobility (p > .05). In Group A, one patient had paresthesia while in Group B, two patients had paresthesia (p > .05). None of the patients in both the groups had implant failure. There was no statistically significant difference between 3D and 2D miniplate system in all the recorded parameters at all the follow-ups (p > .05). 3D miniplates were found to be better than 2D miniplates in terms of cost, ease of surgery and operative time. However, 3D miniplates were unfavorable for cases where fracture line was oblique and in close proximity to mental foramen, where they were difficult to adapt and more chances for tooth-root damage and inadvertent injury to the mental nerve due to traction.

Articaine and mepivacaine buccal infiltration in securing mandibular first molar pulp anesthesia following mepivacaine inferior alveolar nerve block: A randomized, double-blind crossover study

PubMed Central

Gazal, Giath; Alharbi, Abdullah Muteb; Al-Samadani, Khalid HidayatAllah; Kanaa, Mohammad Dib

2015-01-01

Aims: A crossover double-blind, randomized study was designed to explore the efficacy of 2% mepivacaine with 1:100,000 adrenaline buccal infiltration and 4% articaine with 1:100,000 adrenaline buccal infiltration following 2% mepivacaine with 1:100,000 adrenaline inferior alveolar nerve block (IANB) for testing pulp anesthesia of mandibular first molar teeth in adult volunteers. Materials and Methods: A total of 23 healthy adult volunteers received two regimens with at least 1-week apart; one with 4% articaine buccal infiltration and 2% mepivacaine IANB (articaine regimen) and another with 2% mepivacaine buccal infiltration supplemented to 2% mepivacaine IANB (mepivacaine regimen). Pulp testing of first molar tooth was electronically measured twice at baseline, then at intervals of 2 min for the first 10 min, then every 5 min until 45 min postinjection. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation were obtained within 10 min and continuously sustained for 45 min postinjection. Results: In total, the number of no sensations to maximum pulp testing for first molar teeth were significantly higher after articaine regimen than mepivacaine during 45 min postinjection (267 vs. 250 episodes, respectively, P < 0.001), however, both articaine and mepivacaine buccal infiltrations are equally effective in securing anesthetic success for first molar pulp anesthesia when supplemented to mepivacaine IANB injections (P > 0.05). Interestingly, volunteers in the articaine regimen provided faster onset and longer duration (means 2.78 min, 42.22 min, respectively) than mepivacaine regimen (means 4.26 min, 40.74 min, respectively) for first molar pulp anesthesia (P < 0.001). Conclusions: Supplementary mepivacaine and articaine buccal infiltrations produced similar successful first molar pulp anesthesia following mepivacaine IANB injections in volunteers. Articaine buccal infiltration produced faster onset and longer duration than mepivacaine buccal infiltration following mepivacaine IANB injections. PMID:26543456

Articaine and mepivacaine buccal infiltration in securing mandibular first molar pulp anesthesia following mepivacaine inferior alveolar nerve block: A randomized, double-blind crossover study.

PubMed

Gazal, Giath; Alharbi, Abdullah Muteb; Al-Samadani, Khalid HidayatAllah; Kanaa, Mohammad Dib

2015-01-01

A crossover double-blind, randomized study was designed to explore the efficacy of 2% mepivacaine with 1:100,000 adrenaline buccal infiltration and 4% articaine with 1:100,000 adrenaline buccal infiltration following 2% mepivacaine with 1:100,000 adrenaline inferior alveolar nerve block (IANB) for testing pulp anesthesia of mandibular first molar teeth in adult volunteers. A total of 23 healthy adult volunteers received two regimens with at least 1-week apart; one with 4% articaine buccal infiltration and 2% mepivacaine IANB (articaine regimen) and another with 2% mepivacaine buccal infiltration supplemented to 2% mepivacaine IANB (mepivacaine regimen). Pulp testing of first molar tooth was electronically measured twice at baseline, then at intervals of 2 min for the first 10 min, then every 5 min until 45 min postinjection. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation were obtained within 10 min and continuously sustained for 45 min postinjection. In total, the number of no sensations to maximum pulp testing for first molar teeth were significantly higher after articaine regimen than mepivacaine during 45 min postinjection (267 vs. 250 episodes, respectively, P < 0.001), however, both articaine and mepivacaine buccal infiltrations are equally effective in securing anesthetic success for first molar pulp anesthesia when supplemented to mepivacaine IANB injections (P > 0.05). Interestingly, volunteers in the articaine regimen provided faster onset and longer duration (means 2.78 min, 42.22 min, respectively) than mepivacaine regimen (means 4.26 min, 40.74 min, respectively) for first molar pulp anesthesia (P < 0.001). Supplementary mepivacaine and articaine buccal infiltrations produced similar successful first molar pulp anesthesia following mepivacaine IANB injections in volunteers. Articaine buccal infiltration produced faster onset and longer duration than mepivacaine buccal infiltration following mepivacaine IANB injections.

Oral Squamous Cell Carcinoma Found Inline with the Fields of Repeat Stereotactic Radiosurgery for Recurrent Trigeminal Neuralgia.

PubMed

Berti, Aldo; Granville, Michelle; Jacobson, Robert E

2018-01-12

A case of an extremely healthy, active, 96-year-old patient, nonsmoker, is reviewed. He was initially treated for left V1, V2, and V3 trigeminal neuralgia in 2001, at age 80, with stereotactic radiosurgery (SRS) with a dose of 80 Gy to the left retrogasserian trigeminal nerve. He remained asymptomatic for nine years until his trigeminal pain recurred in 2010. He was first treated medically but was intolerant to increasing doses of carbamazepine and gabapentin. He underwent a second SRS in 2012 with a dose of 65.5 Gy to the same retrogasserian area of the trigeminal nerve, making the total cumulative dose 125.5 Gy. In late 2016, four years after the 2 nd SRS, he was found to have invasive keratinizing squamous cell carcinoma in the left posterior mandibular oral mucosa. Keratinizing squamous cell carcinoma is seen primarily in smokers or associated with the human papillomavirus, neither of which was found in this patient. A review of his two SRS plans shows that the left lower posterior mandibular area was clearly within the radiation fields for both SRS treatments. It is postulated that his cancer developed secondary to the long-term radiation effect with a very localized area being exposed twice to a focused, cumulative, high-dose radiation. There are individual reports in the literature of oral mucositis immediately after radiation for trigeminal neuralgia and the delayed development of malignant tumors, including glioblastoma found after SRS for acoustic neuromas, but there are no reports of delayed malignant tumors developing within the general radiation field. Using repeat SRS is an accepted treatment for recurrent trigeminal neuralgia, but physicians and patients should be aware of the potential effects of higher cumulative radiation effects within the treatment field when patients undergo repeat procedures.

Comparison of success rate and onset time of two different anesthesia techniques

PubMed Central

Haghighat, Abbas; Hasheminia, Dariush; Samandari, Mohammad-Hasan; Safarian, Vajihe; Davoudi, Amin

2015-01-01

Background Using local anesthetic is common to control the pain through blocking the nerve reversibly in dental procedures. Gow-Gates (GG) technique has a high success rate but less common. This study aimed to compare the onset time and success rate in GG and standard technique of inferior alveolar nerve block (IANB). Material and Methods This descriptive, single blind study was consisted of 136 patients (59 males and 77 females) who were randomly received GG or IANB for extraction of mandibular molar teeth. Comparisons between the successes of two anesthetic injection techniques were analyzed with Chi-square test. Incidence of pulpal anesthesia and soft tissue anesthesia were analyzed with Kaplan-Meier method. Mean onset times of pulpal anesthesia, soft tissue and lip numbness were analyzed with Log-Rank test. Comparisons were considered significant at P≤0.05 by using SPSS software ver.15. Results The incidence of pulpal anesthesia in the IANB group (canine 49.3%, premolar 60.3%) were not significantly different from the GG group (canine 41.3%, premolar 74.6%) (P=0.200 and P=0.723). The success rate in the IANB group (80.82%) was not significantly different from the GG group (92.02%) (P=0.123). Furthermore, onset time of lip and buccal soft tissue numbness in GG group (3.25, 4.96 minutes) was quite similar to IANB group (3.22, 4.89 minutes) (all Pvalues >0.05). Conclusions Although this study demonstrated higher clinical success rate for GG than IANB technique, no significant differences in success rates and onset time were observed between two techniques. Key words: Anesthesia, Inferior alveolar nerve, nerve block, success rate. PMID:25858085

Local vs general anaesthesia in the development of neurosensory disturbances after mandibular third molars extraction: A retrospective study of 534 cases

PubMed Central

Biasotto, Matteo; Maglione, Michele; Di Lenarda, Roberto

2016-01-01

Background The choice of the anaesthetic modality is one of the primary steps during planning of third molar surgery. The aim of the present study was to compare the risk of developing neurological injures of the inferior alveolar nerve (IAN) and lingual nerve (LN) in patients treated for wisdom teeth removal under general anaesthesia (GA) with a group treated under local anaesthesia (LA). Material and Methods This is an observational retrospective, unicentric study; between September 2013 and September 2014, 534 patients underwent third molar surgery, 194 (36,3%) under GA and 340 (63,7%) under LA by the same oral surgeon. Differences in the incidence of IAN and LN injures between groups have been statistically analyzed with Fisher exact test and estimated odd ratio for development of such complications has been calculated. Results In GA patients the incidence of IAN and LN injures was 4.6% and 2.1%, respectively while in the LA group it was and 0.3% and 0%, respectively. A significant difference in IAN and LN involvement between groups was observed (IAN lesion: Fisher exact test, p<0.001; LN lesions: Fisher exact test, p<0.05). The estimated odd ratio for development of IAN injures after GA was 16.49 (95% CI: 2.07-131.19) and was not calculable for LN injures because no cases were observed in the LA group. Conclusions Since GA is a perioperative variable that seems to significantly increase the risk of developing IAN and LN lesions, when treating patients that request GA, they must be adequately informed that an higher incidence of post-surgical sensory disturbances is expected. Key words:Third molars, general anaesthesia, local anaesthesia, inferior alveolar nerve, lingual nerve. PMID:27694783

Kindler syndrome.

PubMed

Sharma, Ramesh Chander; Mahajan, Vikram; Sharma, Nand Lal; Sharma, Ashok K

2003-09-01

Kindler syndrome is a rare genodermatosis characterized by acral bullae and photosensitivity. The photosensitivity improves with advancing age and results in progressive poikiloderma and cutaneous atrophy, and many additional features have also been described. This report describes two male Kindler syndrome patients with classical features of acral blistering and photosensitivity in childhood, and subsequent development of poikiloderma, leukokeratosis of oro-ano-genital mucosae, phimosis and meatal stenosis. The first patient had additional ophthalmic features of chronic simple conjunctivitis caused by persistent irritation, multiple stromal nebular corneal opacities and thickened corneal nerves. The second patient showed skeletal changes, namely a dome-shaped skull (turri-cephaly), bifid fourth rib, missing fifth rib, short fourth and fifth metacarpals and mandibular abnormalities. This is the first report of such ophthalmic and skeletal features of Kindler syndrome.

Unilateral severe chronic periodontitis associated with ipsilateral surgical resection of cranial nerves V, VI, and VII.

PubMed

Zavarella, Matthew M; Leblebicioglu, Binnaz; Claman, Lewis J; Tatakis, Dimitris N

2006-01-01

The central and peripheral nervous systems participate in several local physiological and pathological processes. There is experimental evidence that the inflammatory, local immune, and wound healing responses of a tissue can be modulated by its innervation. The aim of this clinical report is to present a case of unilateral severe periodontitis associated with ipsilateral surgical resection of the fifth, sixth, and seventh cranial nerves and to discuss the possible contribution of the nervous system to periodontal pathogenesis. A 39-year-old female patient with a history of a cerebrovascular accident caused by a right pontine arteriovenous malformation and destruction of the right fifth, sixth, and seventh cranial nerves was diagnosed with severe chronic periodontitis affecting only the right maxillary and mandibular quadrants. The patient's oral hygiene was similar for right and left sides of the mouth. Percentages of tooth surfaces carrying dental plaque were 41% and 36% for right and left sides, respectively. Non-surgical and surgical periodontal therapy was performed, and the patient was placed on a regular periodontal maintenance schedule. Healing following initial periodontal therapy and osseous periodontal surgery occurred without complications. Follow-up clinical findings at 1 year revealed stable periodontal health. This case report suggests that periodontal innervation may contribute to the regulation of local processes involved in periodontitis pathogenesis. It also suggests that periodontal therapy can be performed successfully at sites and in patients affected by paralysis.

Retrospective review of voluntary reports of nonsurgical paresthesia in dentistry.

PubMed

Gaffen, Andrew S; Haas, Daniel A

2009-10-01

Paresthesia is an adverse event that may be associated with the administration of local anesthetics in dentistry. The purpose of this retrospective study was to analyze cases of paresthesia associated with local anesthetic injection that were voluntarily reported to Ontario"s Professional Liability Program (PLP) from 1999 to 2008 inclusive, to see if the findings were consistent with those from 1973 to 1998 from this same source. All cases of nonsurgical paresthesia reported from 1999 to 2008 were reviewed; cases involving surgical procedures were excluded. Variables examined included patient age and gender, type and volume of local anesthetic, anatomic site of nerve injury, affected side and pain on injection or any other symptoms. During the study period, 182 PLP reports of paresthesia following nonsurgical procedures were made; all but 2 were associated with mandibular block injection. There was no significant gender predilection, but the lingual nerve was affected more than twice as frequently as the inferior alveolar nerve. During 2006-2008 alone, 64 cases of nonsurgical paresthesia were reported to PLP, a reported incidence of 1 in 609,000 injections. For the 2 local anesthetic drugs available in dental cartridges as 4% solutions, i.e., articaine and prilocaine, the frequencies of reporting of paresthesia were significantly greater than expected (chi2, exact binomial distribution; p < 0.01) based on their level of use by Ontario dentists. These data suggest that local anesthetic neurotoxicity may be at least partly involved in the development of postinjection paresthesia.

An update on the causes, assessment and management of third division sensory trigeminal neuropathies.

PubMed

Carter, E; Yilmaz, Z; Devine, M; Renton, T

2016-06-24

Introduction Sensory neuropathies of the mandibular division of the trigeminal (V3) nerve can be debilitating, causing difficulty with daily function. It has a variety of causes, including iatrogenic injury, usually caused by third molar removal, local anaesthetic administration, implant placement or endodontic treatment. Non-iatrogenic causes include infection, primary or secondary neoplasia and various medical conditions.Objective To review the aetiology, evaluation and management of V3 neuropathy in a retrospective case-series of patients referred to a specialist nerve injury clinic over an eight-year period, particularly focusing on the non-iatrogenic causes of this presentation.Methods A retrospective analysis of the case notes of 372 patients referred to the specialist nerve injury clinic between 2006 and 2014 was carried out to establish the cause of the neuropathy and subsequent management or referral. The assessment protocol of trigeminal neuropathy used in the clinic is also outlined.Results Most patients (89.5%) presented with neuropathy due to iatrogenic injury. Of the non-iatrogenic causes (10.5%), malignancy accounted for a fifth of presentations, and infection almost two-fifths, demonstrating the importance of prompt identification of a cause and management by the clinician, or referral to the appropriate specialty. Other, more rare causes are also presented, including multiple sclerosis, sickle-cell anaemia and Paget's disease, highlighting the importance to the clinician of considering differential diagnoses.Conclusions This case series demonstrates the less frequent, but nevertheless important, non-iatrogenic causes which clinicians should consider when assessing patients with trigeminal neuropathy.

Effect of Preoperative Pain on Inferior Alveolar Nerve Block.

PubMed

Aggarwal, Vivek; Singla, Mamta; Subbiya, Arunajatesan; Vivekanandhan, Paramasivam; Sharma, Vikram; Sharma, Ritu; Prakash, Venkatachalam; Geethapriya, Nagarajan

2015-01-01

The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.

Surgical Approaches to First Branchial Cleft Anomaly Excision: A Case Series.

PubMed

Quintanilla-Dieck, Lourdes; Virgin, Frank; Wootten, Chistopher; Goudy, Steven; Penn, Edward

2016-01-01

Objectives. First branchial cleft anomalies (BCAs) constitute a rare entity with variable clinical presentations and anatomic findings. Given the high rate of recurrence with incomplete excision, identification of the entire tract during surgical treatment is of paramount importance. The objectives of this paper were to present five anatomic variations of first BCAs and describe the presentation, evaluation, and surgical approach to each one. Methods. A retrospective case review and literature review were performed. We describe patient characteristics, presentation, evaluation, and surgical approach of five patients with first BCAs. Results. Age at definitive surgical treatment ranged from 8 months to 7 years. Various clinical presentations were encountered, some of which were atypical for first BCAs. All had preoperative imaging demonstrating the tract. Four surgical approaches required a superficial parotidectomy with identification of the facial nerve, one of which revealed an aberrant facial nerve. In one case the tract was found to travel into the angle of the mandible, terminating as a mandibular cyst. This required en bloc excision that included the lateral cortex of the mandible. Conclusions. First BCAs have variable presentations. Complete surgical excision can be challenging. Therefore, careful preoperative planning and the recognition of atypical variants during surgery are essential.

Surgical Approaches to First Branchial Cleft Anomaly Excision: A Case Series

PubMed Central

Quintanilla-Dieck, Lourdes; Virgin, Frank; Wootten, Chistopher; Goudy, Steven; Penn, Edward

2016-01-01

Objectives. First branchial cleft anomalies (BCAs) constitute a rare entity with variable clinical presentations and anatomic findings. Given the high rate of recurrence with incomplete excision, identification of the entire tract during surgical treatment is of paramount importance. The objectives of this paper were to present five anatomic variations of first BCAs and describe the presentation, evaluation, and surgical approach to each one. Methods. A retrospective case review and literature review were performed. We describe patient characteristics, presentation, evaluation, and surgical approach of five patients with first BCAs. Results. Age at definitive surgical treatment ranged from 8 months to 7 years. Various clinical presentations were encountered, some of which were atypical for first BCAs. All had preoperative imaging demonstrating the tract. Four surgical approaches required a superficial parotidectomy with identification of the facial nerve, one of which revealed an aberrant facial nerve. In one case the tract was found to travel into the angle of the mandible, terminating as a mandibular cyst. This required en bloc excision that included the lateral cortex of the mandible. Conclusions. First BCAs have variable presentations. Complete surgical excision can be challenging. Therefore, careful preoperative planning and the recognition of atypical variants during surgery are essential. PMID:27034873

Complications of the retromandibular transparotid approach for low condylar neck and subcondylar fractures: a retrospective study

PubMed Central

2018-01-01

Objectives The goal of this study was to evaluate the rates of complications, morbidity, and safety with the transparotid approach. Materials and Methods A retrospective study was conducted and consisted of 53 surgically treated patients in the past five years for low condylar neck and subcondylar fractures. Only patients with malocclusion and who underwent open reduction with internal fixation with the retromandibular transparotid approach were included. The examined parameters were postoperative suboptimal occlusion, deflection, saliva fistula, and facial nerve weakness. Results Fifty-three patients had an open reduction with internal fixation on 55 sides (41 males, 77.4%; mean age, 42 years [range, 18–72 years]). Four patients (7.5%) experienced transient facial nerve weakness of the marginal mandibular branch, but none was permanent. Four patients had a salivary fistula, and 5 patients showed postoperative malocclusion, where one needed repeat surgery after one year. One patient showed long-term deflection. No other complications were observed. Conclusion The retromandibular transparotid approach is a safe procedure for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications. PMID:29732312

Open treatment of unilateral mandibular condyle fractures in adults: a systematic review.

PubMed

Rozeboom, A; Dubois, L; Bos, R; Spijker, R; de Lange, J

2017-10-01

Since the introduction of rigid internal fixation devices, more and more surgeons favour an open approach to treating condylar fractures of the mandible in adult patients. Different indications for open treatment have been published. Open treatment is associated with surgical complications because of the technique employed. The aim of this systematic review was to provide an overview of the studies published exclusively on open treatment, and to summarize the existing open treatment modalities and their clinical outcomes. A total of seventy studies were selected for detailed analysis. Most studies reported good results with regard to the outcome measures of open treatment. Surgical complications including hematoma, wound infection, weakness of the facial nerve, sialocele, salivary fistula, sensory disturbance of the great auricular nerve, unsatisfactory scarring, and fixation failure were reported in the studies. This review suggests that because of the high level of methodological variance in the relevant studies published to date, among other factors, there are currently no evidence-based conclusions or guidelines that can be formulated with regard to the most appropriate open treatment. Establishment of such standards could potentially improve treatment outcomes. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Maxillary Expansion and Mandibular Setback Surgery With and Without Mandibular Anterior Segment Osteotomy to Correct Mandibular Prognathism With Obstructive Sleep Apnea.

PubMed

Han, Jeong Joon; Hong, Dong Hwan; Hwang, Soon Jung

2017-05-01

Mandibular prognathism is usually treated with mandibular setback surgery. However, this approach reduces the pharyngeal airway space, and can aggravate obstructive phenomena in patients with obstructive sleep apnea (OSA). While maxillary expansion is known to lead to an increase in the pharyngeal airway volume (PAS), its effect on the PAS in mandibular setback surgery has not yet been reported. The authors report a surgical approach with maxillary expansion in 2 patients with mandibular prognathism that was accompanied by OSA: maxillary midsagittal expansion with minimum maxillary advancement and minor mandibular setback without mandibular anterior segmental osteotomy (ASO) or major mandibular setback with mandibular ASO. Preoperative and postoperative computed tomography and polysomnography indicated that OSA was improved and pharyngeal airway space was increased or sustained, and the prognathic profile could be corrected to an acceptable facial esthetic profile. In summary, maxillary transversal expansion and mandibular setback with or without mandibular ASO can be successfully applied to treat mandibular prognathism with OSA.

Epidermoid Cyst of Mandible Ramus: Case Report.

PubMed

Loxha, Mergime Prekazi; Salihu, Sami; Kryeziu, Kaltrina; Loxha, Sadushe; Agani, Zana; Hamiti, Vjosa; Rexhepi, Aida

2016-06-01

An epidermoid cyst is a benign cyst usually found on the skin. Bone cysts are very rare and if they appear in bone they usually appear in the distal phalanges of the fingers. Epidermoid cysts of the jaws are uncommon. We present a case, of a 41 year-old female patient admitted to our department because of pain and swelling in the parotid and masseteric region-left side. There was no trismus, pathological findings in skin, high body temperature level, infra-alveolar nerves anesthesia or lymphadenopathy present. The orthopantomography revealed a cystic lesion and a unilocular lesion that included mandibular ramus on the left side with 3 cm in diameter. Under total anesthesia, a cyst had been reached and was enucleated. Histopathologic findings showed that the pathologic lesion was an epidermoid cyst. Epidermoid and dermoid cysts are rare, benign lesions found throughout the body. Only a few cases in literature describe an intraossesus epidermoid cyst. Our case is an epidermoid cyst with a rare location in the region of the mandibular ramus. It is not associated with any trauma in this region except medical history reveals there was an operative removal of a wisdom tooth 12 years ago in the same side. These cysts are interesting from the etiological point of view. They should be considered in the differential diagnosis of other radiolucent lesions of the jaws. Surgically they have a very good prognosis, and are non-aggressive lesions.

Anaesthetic efficacy of 4% articaine mandibular buccal infiltration compared to 2% lignocaine inferior alveolar nerve block in children with irreversible pulpitis.

PubMed

Arali, Veena; P, Mytri

2015-04-01

Lidocaine is the gold standard anaesthetic solution that has been used since its inception into dentistry till date. Around 80% of failures have been reported when lignocaine has been used for inferior alveolar nerve block in children and adults with irreversible pulpitis. There is a need to use newer drugs which are available which have been reported to be effective like lignocaine, such as articaine. Although articaine has been used in adults, literature supporting its use in children is sparse. The purpose of this study is to compare the anaesthetic efficacy of 4% articaine buccal infiltration and 2% lignocaine inferior alveolar nerve block in children with irreversible pulpitis. It also aims to assess the need for supplemental intrapulpal injections. This study was designed as a randomized double-blind cross over trial comparing the anaesthetic effectiveness of 4% articaine with 1:100,000 epinephrine in buccal infiltration and 2% lignocaine IAN block anaesthesia. The study subject and the pediatric dentist performing the pulpectomy procedures were blinded to the study. A sample size of 40 subjects in the age group of 5-8 y was included in the study. The onset of anaesthesia with 4% articaine was faster as compared to 2% lignocaine. The duration of anaesthesia with articaine infiltration was shorter. The need for supplemental injection in the articaine group was less. Four percent articaine infiltration can be used in children with irreversible pulpitis. It can be used to replace the IAN block in children thereby reducing the post anaesthetic complications like lip biting.

Anatomy of the Platysma Muscle.

PubMed

Hwang, Kun; Kim, Ji Yeon; Lim, Jae Hyun

2017-03-01

The aim of this paper was to review the anatomy the platysma systematically.The term "platysma AND anatomy" was used to search PubMed and Scopus, producing 394 and 214 papers, respectively. After excluding 95 duplicate titles, 513 abstracts and 98 full papers were reviewed. Among these 98 papers, 83 were excluded and 5 were added. Ultimately, 20 papers were analyzed.The most common aging-related change of the platysma was shortening (70.7%), followed by thinning (25.2%). The platysma most commonly originated from the upper portion of thorax anterior to clavicle (67.7%), followed by the subcutaneous tissue of the subclavicular and acromial regions (22.6%) and pectoralis (9.7%). The platysma ascended upward and medially (68.5%) or ascended from the clavicle to the face (31.5%). The platysma most commonly inserted on the cheek skin (57.5%), followed by the cutaneous muscles around the mouth (18.6%), the mandibulocutaneous ligament or zygoma (18.6%), and the parotid fascia or periosteum of the mandible (5.3%). The platysma was most commonly innervated by the cervical branch of the facial nerve (38.2%) or the cervical branch and mandibular branch of the facial nerve (60.5%), followed by the cervical plexus (0.6%), the cervical motor nucleus (0.6%), and the glossopharyngeal nerve (0.1%). The most common action of the platysma was drawing the lips inferiorly (83.3%) or posteriorly (12.9%). Four papers classified the platysma into subtypes; however, these classification strategies used arbitrary standards.Further studies will be necessary to establish the thickness of the platysma and to characterize age-related changes of the platysma.

Prevalence and Length of the Anterior Loop of the Inferior Alveolar Nerve in Iranians.

PubMed

Moghddam, Maryam Rastegar; Davoudmanesh, Zeinab; Azizi, Nasim; Rakhshan, Vahid; Shariati, Mahsa

2017-10-01

The anterior loop of the inferior alveolar nerve is a sensitive anatomical feature that should be taken into account during installation of dental implants anterior to the mental foramen. This study was conducted to explore the controversy regarding prevalence and length. A total of 452 mandible quadrants of 234 patients (age: 50.1 ± 13.3 years, 113 males, 121 females) were studied using cone-beam computerized tomography. After reconstructing axial, frontal, and sagittal slices, the region between the most anterior point on the mental foramen and the most anterior part of the mandibular nerve was inspected for signs of anterior loop presence. If positive, the length of the anterior loop was measured in mm as the distance between the anterior border of mental foramen and the anterior border of the loop. Prevalence and length of the anterior loop were compared statistically between sexes and age groups. The anterior loop was observed in 106 quadrants (23.5% of 451 quadrants) of 95 patients (40.6% of 234 patients), of whom 11 had bilateral anterior loops. Prevalences were similar in males (41%) and females (39%, chi-square P =.791). The mean anterior loop length was 2.77 ± 1.56 mm (95% CI: 2.5-3.1 mm), without significant sex (regression beta = -0.159, P = .134) or age (beta = -0.059, P = .578) differences. The anterior loop might exist in about 40% of patients, regardless of their gender. The mean safe anterior distance from the anterior loop is about 3 mm + (2.5-3.1 mm) = 5.5-6.1 mm, regardless of age.

Management of refractory trigeminal neuralgia using extended duration pulsed radiofrequency application.

PubMed

Thapa, Deepak; Ahuja, Vanita; Dass, Christopher; Verma, Parul

2015-01-01

Trigeminal neuralgia (TN) produces incapacitating facial pain that reduces quality of life in patients. Thermal radiofrequency (RF) ablation of gasserian ganglion (GG) is associated with masseter weakness and unpleasant sensations along the distribution of the ablated nerve. Pulsed radiofrequency (PRF) of GG has minimal side effects but literature is inconclusive regarding its benefit in refractory TN. Increasing the duration of PRF application to 6 minutes in TN produced encouraging results. PRF application to the saphenous nerve for 8 minutes reported improved pain relief and patient satisfaction. We report successful management of two patients of classic TN, which were refractory to medical management and interventional nerve blocks. The lesion site were confirmed with motor and sensory stimulation through a 22 G, 10 cm RF needle with 5 mm active tip. Both the patients received four cycles of PRF at 42 °C with each cycle of 120 seconds (8 minutes). The visual analogue scale (VAS) in case 1 reduced from pre-block score of 80 to score 10 post-block, while in case 2 the VAS reduced from pre-block score of 85 to score 15 post-block. During follow up both the patients are now pain free with minimal dose of carbamazepine at 12 and 6 months respectively. We used PRF for longer duration (8 minutes) in these patients, which resulted in improved VAS and WHOQOL-BREF score in these patients. PRF of mandibular division of GG for extended duration provided long-term effective pain relief and quality of life in patients of refractory classic TN.

Anatomical study of the superficial temporal branches of the auriculotemporal nerve: Application to surgery and other invasive treatments to the temporal region.

PubMed

Iwanaga, Joe; Watanabe, Koichi; Saga, Tsuyoshi; Fisahn, Christian; Oskouian, Rod J; Tubbs, R Shane

2017-03-01

The auriculotemporal nerve (ATN) is one of the branches of the mandibular division of the trigeminal nerve, which gives rise to many branches to the retromandibular and temporal regions. Of these, the superficial temporal branch can occasionally be the cause of migraine headaches and auriculotemporal neuralgia. The purpose of this study was to elucidate the anatomy of the superficial temporal branch, which has never been described in detail. A total of 14 sides of cadaveric heads were used for this study. The number of superficial temporal branch was counted, and the horizontal and vertical distances from the middle of the tragus to the branching point were measured. Three of 14 sides had two main trunks, and 11 sides had one main trunk. Each of the duplicated ATN had already branches into two main trunks as they left the retromandibular space. The number of superficial temporal branches ranged from two to seven. The vertical and horizontal distances from the middle of the tragus to the branching point of the superficial temporal branch ranged from 6.19 to 25.65 mm and from 3.45 to 11.88 mm, respectively. The communicating branches occasionally formed a loop or so-called "ansa," and a double ansa was identified in one case. These data can provide surgeons a better view of the course of these distant branches, so that skin incisions can be better planned. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

A personalized 3D-printed prosthetic joint replacement for the human temporomandibular joint: From implant design to implantation.

PubMed

Ackland, David C; Robinson, Dale; Redhead, Michael; Lee, Peter Vee Sin; Moskaljuk, Adrian; Dimitroulis, George

2017-05-01

Personalized prosthetic joint replacements have important applications in cases of complex bone and joint conditions where the shape and size of off-the-shelf components may not be adequate. The objective of this study was to design, test and fabricate a personalized 3D-printed prosthesis for a patient requiring total joint replacement surgery of the temporomandibular joint (TMJ). The new 'Melbourne' prosthetic TMJ design featured a condylar component sized specifically to the patient and fixation screw positions that avoid potential intra-operative damage to the mandibular nerve. The Melbourne prosthetic TMJ was developed for a 58-year-old female recipient with end-stage osteoarthritis of the TMJ. The load response of the prosthesis during chewing and a maximum-force bite was quantified using a personalized musculoskeletal model of the patient's masticatory system developed using medical images. The simulations were then repeated after implantation of the Biomet Microfixation prosthetic TMJ, an established stock device. The maximum condylar stresses, screw stress and mandibular stress at the screw-bone interface were lower in the Melbourne prosthetic TMJ (259.6MPa, 312.9MPa and 198.4MPa, respectively) than those in the Biomet Microfixation device (284.0MPa, 416.0MPa and 262.2MPa, respectively) during the maximum-force bite, with similar trends also observed during the chewing bite. After trialing surgical placement and evaluating prosthetic TMJ stability using cadaveric specimens, the prosthesis was fabricated using 3D printing, sterilized, and implanted into the female recipient. Six months post-operatively, the prosthesis recipient had a normal jaw opening distance (40.0 mm), with no complications identified. The new design features and immediate load response of the Melbourne prosthetic TMJ suggests that it may provide improved clinical and biomechanical joint function compared to a commonly used stock device, and reduce risk of intra-operative nerve damage during placement. The framework presented may be useful for designing and testing customized devices for the treatment of debilitating bone and joint conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Predictive Value of Panoramic Radiography for Injury of Inferior Alveolar Nerve After Mandibular Third Molar Surgery.

PubMed

Su, Naichuan; van Wijk, Arjen; Berkhout, Erwin; Sanderink, Gerard; De Lange, Jan; Wang, Hang; van der Heijden, Geert J M G

2017-04-01

The purpose of the present systematic review was to assess the added value of panoramic radiography in predicting postoperative injury of the inferior alveolar nerve (IAN) in the decision-making before mandibular third molar (MM3) surgery. MEDLINE and EMBASE were searched electronically to identify the diagnostic accuracy of studies that had assessed the predictive value of 7 panoramic radiographic signs, including root-related signs (darkening of the root, deflection of the root, narrowing of the root, and dark and bifid apex of the root) and canal-related signs (interruption of the white line of the canal, diversion of the canal, and narrowing of the canal) for IAN injury after MM3 surgery. A total of 8 studies qualified for the meta-analysis. The pooled sensitivity and specificity of the 7 signs ranged from 0.06 to 0.49 and 0.81 to 0.97, respectively. The area under the summary area under the receiver operating characteristic curve ranged from 0.42 to 0.89. The pooled positive predictive value (PPV) and negative predictive value (NPV) ranged from 7.5 to 26.6% and 95.9 to 97.7%, respectively. The added value of a positive sign for ruling in an IAN injury (PPV minus the prior probability) ranged from 3.4 to 22.2%. The added value of a negative sign for ruling out an IAN injury (NPV minus [1 minus the prior probability]) ranged from 0.1 to 2.2%. For all 7 signs, the added value of panoramic radiography is too low to consider it appropriate for ruling out postoperative IAN in the decision-making before MM3 surgery. The added value of panoramic radiography for determining the presence of diversion of the canal, interruption of the white line of the canal, and darkening of the root can be considered sufficient for ruling in the risk of postoperative IAN injury in the decision-making before MM3 surgery. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Efficacy of mepivacaine-tramadol combination on the success of inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis: a randomized clinical trial.

PubMed

Rodríguez-Wong, L; Pozos-Guillen, A; Silva-Herzog, D; Chavarría-Bolaños, D

2016-04-01

To compare the success of an inferior alveolar nerve block (IANB) after injecting a combination of mepivacaine and tramadol or mepivacaine alone in patients with symptomatic irreversible pulpitis (SIP) in mandibular permanent molars. This study was a double-blind, randomized, controlled clinical trial. Two study groups were selected, each consisting of 28 patients who exhibited SIP on the first or second mandibular molars. All included patients presented with moderate-to-severe preoperative pain according to the modified Heft-Parker visual analogue scale (VAS). Patients were anaesthetized using the IANB technique employing identical cartridges that contained either 1.3 mL of 2% mepivacaine with epinephrine 1 : 100 000 plus 0.5 mL of tramadol 50 mg mL(-1) (experimental group) or 1.8 mL of 2% mepivacaine with epinephrine 1 : 100 000 (control group). After 15 min, anaesthesia was evaluated by a progressive four-test examination, that is numbness of the lip, positive or negative cold test, asymptomatic management of dental hard tissues and access to dental pulp. Success of the IANB was defined as the absence of pain during any of these evaluations. The data were analysed with a chi-square, Fisher's or Mann-Whitney U test. A total of 74 patients were initially assessed, with 56 patients eventually included and 18 excluded. No significant differences in age (P = 0.384) or gender (P = 1) were found between the two groups. The success rates of anaesthesia with the IANB for the experimental and control groups were 57.1 and 46.4%, respectively. The success rate of anaesthesia in the experimental group was not significantly different (P ˃ 0.05) from that of the control group. The duration of the anaesthetic effect was significantly longer for the experimental group (P = 0.026). The combination of mepivacaine-tramadol achieved similar success rates for IANB when compared to mepivacaine 2% epinephrine 1 : 100 000. There was no significant difference in the anaesthetic efficacy between the control and experimental solutions, and none of the solutions tested were completely successful. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

The Rare Painful Phenomena - Chronic Paroxysmal Hemicrania-tic Syndrome as a Clinically Isolated Syndrome of the Central Nervous System.

PubMed

Ljubisavljevic, Srdjan; Prazic, Ana; Lazarevic, Miodrag; Stojanov, Dragan; Savic, Dejan; Vojinovic, Slobadan

2017-02-01

The association of paroxysmal hemicrania with trigeminal neuralgia (TN) has been described and called paroxysmal hemicrania-tic syndrome (PH-tic). We report the case of a patient diagnosed as having chronic PH-tic (CPH-tic) syndrome as a clinically isolated syndrome of the central nervous system (CNS) (CIS).A forty year old woman was admitted to our hospital suffering from right facial pain for the last 2 years. The attacks were paroxysmal, neuralgiform, consisting of throb-like sensations, which developed spontaneously or were triggered by different stimuli in right facial (maxilar and mandibular) areas. Parallel with those, she felt a throbbing orbital and frontal pain with homolateral autonomic symptoms such as conjunctival injection, lacrimation, and the feeling that the ear on the same side was full. This pain lasted most often between 15 and 20 minutes. Beyond hemifacial hypoesthesia in the region of right maxilar and mandibular nerve, the other neurological finding was normal. Magnetic resonance imaging (MRI) study showed a T2-weighted multiple hyperintense paraventricular lesion and hyperintense lesion in the right trigeminal main sensory nucleus and root inlet, all of them being hypointense on T1-weighted image. All of these lesions were hypointense in gadolinium-enhanced T1-weighted images. Neurophysiological studies of trigeminal nerve (somatosensory evoked potentials and blink reflex) correlated with MRI described lesions. The patient's pain bouts were improved immediately after treatment with indomethacin, and were completely relieved with lamotrigine for a longer period. According to the actual McDonald's criteria, clinical state was defined as CIS which was clinically presented by CPH-tic syndrome.Even though it is a clinical rarity and its etiology is usually idiopathic, CPH-tic syndrome can also be symptomatic. When dealing with symptomatic cases, like the one described here, when causal therapy is not possible due to the nature of the primary pathological process, a therapeutic approach, although symptomatic, can be fully effective in controlling this painful syndrome. The case report could be a contribution to the pathophysiological and clinical understanding of the association of CPH and TN.Key words: Paroxysmal hemicrania, trigeminal neuralgia, clinically isolated syndrome.

The role of simultaneous gap arthroplasty and distraction osteogenesis in the management of temporo-mandibular joint ankylosis with mandibular deformity in children.

PubMed

Rao, Krishna; Kumar, Sudhir; Kumar, Vijay; Singh, Arun Kumar; Bhatnagar, Sudhir Kumar

2004-02-01

Temporo-mandibular joint ankylosis is a common cause of acquired deformity in children. Surgical correction of the ankylosis only leaves the patient with an uncorrected mandibular deformity. This study was to evaluate the use of distraction osteogenesis for simultaneous correction of the mandibular deformity. This study was done on six children with temporo-mandibular joint ankylosis and mandibular deformity. Uniaxial double pin distractors with Schanz pins were used in this study. The patients underwent simultaneous gap arthroplasty and mandibular osteotomy (retromolar) with distractor insertion. Distraction was started on the fifth post-operative day. The patients were put on dynamic temporo-mandibular joint exercises on the first post-operative day. All patients had a satisfactory mouth opening on follow-up. Satisfactory cosmetic correction of the mandibular deformity was also achieved in all these patients. Some degree of malocclusion resulted from treatment due to which the patients were placed on orthodontic treatment. Distraction osteogenesis can be used simultaneously with gap arthroplasty in patients with temporo-mandibular ankylosis, for the correction of the mandibular deformity.

Ophthalmic branch radiofrequency thermocoagulation for atypical trigeminal neuralgia:a case report.

PubMed

Du, Shibin; Ma, Xiaoliang; Li, Xiaoqin; Yuan, Hongjie

2015-01-01

Trigeminal neuralgia is an intense neuralgia involving facial areas supplied by trigeminal nerve. The pain is characterized by sudden onset, short persistence, sharp or lancinating. Trigeminal neuralgia commonly affects frontal areas, infraorbital or paranasal areas, mandibular areas and teeth. While Trigeminal neuralgia affecting merely the upper eyelid is rare. Here we report a case of atypical Trigeminal neuralgia confined to the upper eyelid. The patient was pain free during the follow-up period of 6 months after unusual ophthalmic branch radiofrequency thermocoagulation. A 55-year-old female patient was diagnosed as primary trigeminal neuralgia involving the right upper eyelid. As the pain could not be controlled by drug therapy, peripheral nerve branch radiofrequency thermocoagulation was recommended. A combination of infratrochlear, supratrochlear and lacrimal radiofrequency thermocoagulation was implemented in this case. The point where the bridge of the nose abuts the supraorbital ridge and the point slightly above the lateral canthus along outer border of the orbit were selected respectively as the puncture sites. After positive diagnostic test, radiofrequency thermocoagulation of the above-mentioned nerve branches was performed respectively. The patient was pain free immediately after the treatment and during the follow-up period of 6 months. Trigeminal neuralgia is a common severe and chronic facial neuralgia which requires accurate diagnosis and effective therapy. With typical clinical symptoms, normal neurological signs, normal CT and MRI findings, the patient was diagnosed as classic trigeminal neuralgia. As the patient was drug resistant, some invasive treatments were considered. Peripheral branch neurolysis was chosen for its minimal invasiveness, convenience, low risk and not affecting further invasive treatments. According to the anatomic data and the diagnostic test results, infratrochlear, supratrochlear and lacrimal nerve were responsible, therefore, an unusual combination of infratrochlear, supratrochlear, and lacrimal radiofrequency thermocoagulation was implemented for this patient. Radiofrequency thermocoagulation is an effective treatment option for trigeminal neuralgia. Peripheral branch radiofrequency thermocoagulation for trigeminal neuralgia should be considered preferentially due to its minimal invasiveness and convenience. Furthermore, as the sensory innervation of the upper eyelid is complex, the knowledge of peripheral distribution of trigeminal nerve is essential.

How does tooth eruption relate to vertical mandibular growth displacement?

PubMed

Liu, Sean Shih-Yao; Buschang, Peter H

2011-06-01

Our objectives were to investigate the eruptive patterns of the mandibular teeth and assess their associations with mandibular growth displacements. Cephalograms for a mixed-longitudinal sample of 124 French-Canadian girls were evaluated between 10 and 15 years of age. Vertical mandibular displacement and mandibular eruption were evaluated by using cranial and mandibular superimpositions, respectively. Multilevel modeling procedures were used to estimate each subject's growth change over time. Stepwise multiple regressions were used to determine the amount and relative magnitudes of variations in mandibular eruption explained by mandibular growth displacement, controlling for vertical maxillary tooth movements. Cubic polynomial models explained between 91% and 98% of the variations in eruption and vertical growth displacement. All curves showed acceleration of eruption until approximately 12 years of age, after which eruption decelerated. The eruption of the mandibular teeth demonstrated greater relative variability than did vertical mandibular growth displacements. Independent of the overall movements of the maxillary molars, inferior mandibular growth displacement explained approximately 54% of the variation in mandibular molar eruption between 10.5 and 14.5 years of age. Inferior mandibular growth displacement and dental eruption followed similar patterns of change during adolescence. Based on their associations and the differences in variability identified, mandibular eruption appears to compensate for or adapt to growth displacements. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

[Orthodontic treatment of Class III patients with mandibular asymmetry].

PubMed

Duan, Yin-Zhong; Huo, Na; Chen, Lei; Chen, Xue-Peng; Lin, Yang

2008-12-01

To investigate the treatment outcome of Class III patients with dental, functional and mild skeletal mandibular asymmetry. Thirty-five patients (14 males and 21 females) with dental, functional and mild skeletal mandibular asymmetry were selected. The age range of the patients was 7 - 22 years with a mean age of 16.5 years. Dental mandibular asymmetry was treated with expansion of maxillary arch to help the mandible returning to normal position. Functional mandibular asymmetry was treated with activator or asymmetrical protraction and Class III elastics. Mild skeletal mandibular asymmetry was treated with camouflage treatment. Good occlusal relationships were achieved and facial esthetics was greatly improved after orthodontic treatment in patients with dental and functional mandibular asymmetry. However, patients with skeletal mandibular asymmetry should be treated with both extraction and genioplasty. Orthodontic treatment was suitable for patients with dental and functional mandibular asymmetry, while combined orthodontics and surgery could get good results in patients with skeletal mandibular asymmetry.

Comparison of injection pain caused by the DentalVibe Injection System versus a traditional syringe for inferior alveolar nerve block anaesthesia in paediatric patients.

PubMed

Elbay, M; Şermet Elbay, Ü; Yıldırım, S; Uğurluel, C; Kaya, C; Baydemir, C

2015-06-01

To compare paediatric patients' pain during needle insertion and injection in inferior alveoler nerve block (IANB) anaesthesia injected by either a traditional syringe (TS) or the DentalVibe Injection Comfort System (DV). the study was a randomised controlled crossover clinical trial, comprised of 60 children aged 6-12 requiring an operative procedure with IANB anaesthesia on their mandibular molars bilaterally. One of the molar teeth was treated with TS and the contralateral tooth was treated with DV. On each visit, subjective and objective pain was evaluated using the Wond-Baker Faces Pain Rating Scale (PRS) and the Face, Legg, Cry, Consolability Scale (FLACC Scale). Patients were asked which anaesthesia technique they preferred. Data were analysed using Wilcoxon signed rank, Spearman correlation, and Mann-Whitney U tests. There were no statistically significant differences for pain evalution during needle insertion and injection of each injection system. However, a negative correlation was found on the FLACC between age and pain scores during injection after using DV. Paediatric patients experienced similar pain during IANB anaesthesia administered with TS and DV. With increased age, pain values reduced during anaesthetic agent injection with DV according to FLACC. The traditional procedure was preferred to DV in paediatric patients.

Effect of preoperative medications on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A placebo-controlled clinical study

PubMed Central

Jena, Amit; Shashirekha, Govind

2013-01-01

Background: The purpose of this prospective, randomized, double-blind, placebo-controlled study was to compare the effect of the administration of preoperative ibuprofen, ketorolac, combination of etodolac with paracetamol and combination of aceclofenac with paracetamol versus placebo for the potential increased effectiveness of the inferior alveolar nerve block [IANB] anesthesia. Materials and Methods: A total of 100 endodontic emergency patients in moderate to severe pain diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, either a drug or placebo 30 minutes before the administration of a conventional IANB. Cold testing was done before administration of anesthesia to determine level of pain using Heft-Parker Visual Analogue Scale (VAS) score. Success was defined as no pain or pain (VAS) on access or initial instrumentation. Results: Overall success was 54% for all the groups. Success was highest (70%) for the ketorolac group, 55% for both ibuprofen group and combination of aceclofenac with paracetamol group, 50% for combination of etodolac with paracetamol group, and 40% for the placebo group. Conclusions: Under the conditions of this study, the use of preoperative medication did improve the anesthetic efficacy of IANB for the treatment of teeth diagnosed with irreversible pulpitis but not significantly. PMID:23716973

Effect of preoperative medications on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A placebo-controlled clinical study.

PubMed

Jena, Amit; Shashirekha, Govind

2013-03-01

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to compare the effect of the administration of preoperative ibuprofen, ketorolac, combination of etodolac with paracetamol and combination of aceclofenac with paracetamol versus placebo for the potential increased effectiveness of the inferior alveolar nerve block [IANB] anesthesia. A total of 100 endodontic emergency patients in moderate to severe pain diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, either a drug or placebo 30 minutes before the administration of a conventional IANB. Cold testing was done before administration of anesthesia to determine level of pain using Heft-Parker Visual Analogue Scale (VAS) score. Success was defined as no pain or pain (VAS) on access or initial instrumentation. Overall success was 54% for all the groups. Success was highest (70%) for the ketorolac group, 55% for both ibuprofen group and combination of aceclofenac with paracetamol group, 50% for combination of etodolac with paracetamol group, and 40% for the placebo group. Under the conditions of this study, the use of preoperative medication did improve the anesthetic efficacy of IANB for the treatment of teeth diagnosed with irreversible pulpitis but not significantly.

Dental Occlusion and Ophthalmology: A Literature Review

PubMed Central

Marchili, Nicola; Ortu, Eleonora; Pietropaoli, Davide; Cattaneo, Ruggero; Monaco, Annalisa

2016-01-01

Stomatognathic system is strictly correlated to other anatomical regions; many studies investigated relationship between temporomandibular joint and posture, several articles describe cranio-facial pain from dental causes, such as trigger points. Until now less interest has been given to connections between dental occlusion and ophthalmology, even if they are important and involving. Clinical experience in dental practice claims that mandibular latero-deviation is connected both to eye dominance and to defects of ocular convergence. The trigeminal nerve is the largest and most complex of the twelve cranial nerves. The trigeminal system represents the connection between somitic structures and those derived from the branchial arches, collecting the proprioception from both somitic structures and oculomotor muscles. The intermedius nucleus of the medulla is a small perihypoglossal brainstem nucleus, which acts to integrate information from the head and neck and relays it on to the nucleus of the solitary tract where autonomic responses are generated. This intriguing neurophysiological web led our research group to investigate anatomical and functional associations between dental occlusion and vision. In conclusion, nervous system and functional pathways strictly connect vision and dental occlusion, and in the future both dentists and oculists should be more and more aware of this correlation for a better diagnosis and therapy. PMID:27733873

Complications of local anaesthesia. An observational study.

PubMed

Brand, H S; Bekker, W; Baart, J A

2009-11-01

Local anaesthesia is increasingly used by dental hygienists. As little is known about the incidence of adverse effects during and after the administration of local anaesthetics, we evaluated side-effects associated with local anaesthesia. A prospective observational study was conducted using standard criteria among a group of 103 patients receiving mandibular block anaesthesia. Physical reactions like clenching fists (14.5%), moaning (12.6%) and turning pale (7.8%) were frequently observed. Patients (3.8%) showed a painful reaction because of needle contact with a nerve or the periosteum. Systemic complications were not observed. After the injection, 41.7% said they felt tense during the administration; 4.9% of the patients reported swallowing problems and 3.9% a tachycardia. These results suggest that administration of local anaesthesia has a small risk of adverse events. Complications, if they occur, seem minor and transient in nature.

Treatment of paraesthesia following root canal treatment by intentional tooth replantation: a review of the literature and a case report.

PubMed

Tsesis, Igor; Taschieri, Silvio; Rosen, Eyal; Corbella, Stefano; Del Fabbro, Massimo

2014-01-01

Some endodontic procedures may cause damage to the inferior alveolar nerve, leading to paraesthesia. When such complication is due to extrusion of obturation material beyond the apex, it can be managed by intentional replantation (IR). IR consists of the removal of a tooth and its re-insertion into the socket after performing a proper root end manipulation. It is a relatively conservative procedure aimed at preserving the tooth and, with correct case selection, can provide a predictable outcome. The aim of the present paper is to report a case of paraesthesia following endodontic treatment of second mandibular molar successfully treated by intentional replantation. In our opinion this treatment modality may be considered when the extrusion of root canal filling material causes irritation to the periapical tissues and endodontic retreatment is unfeasible.

Mandibular canine: A tool for sex identification in forensic odontology.

PubMed

Kumawat, Ramniwas M; Dindgire, Sarika L; Gadhari, Mangesh; Khobragade, Pratima G; Kadoo, Priyanka S; Yadav, Pradeep

2017-01-01

The aim of this study was to investigate the accuracy of mandibular canine index (MCI) and mandibular mesiodistal odontometrics in sex identification in the age group of 17-25 years in central Indian population. The study sample comprised total 300 individuals (150 males and 150 females) of an age group ranging from 17 to 25 years of central Indian population. The maximum mesiodistal diameter of mandibular canines, the linear distance between the tips of mandibular canines, was measured using digital vernier caliper on the study models. Overall sex could be predicted accurately in 79.66% (81.33% males and 78% females) of the population by MCI. Whereas, considering the mandibular canine width for sex identification, the overall accuracy was 75% for the right mandibular canine and 73% for the left mandibular canine observed. Sexual dimorphism of canine is population specific, and among the Indian population, MCI and mesiodistal dimension of mandibular canine can aid in sex determination.

Rotational Distraction for the Treatment of Severe Mandibular Retrognathia

PubMed Central

Mitsugi, Masaharu; Alcalde, Rafael E.; Yano, Tomoyuki; Uemura, Noriko; Okazaki, Mutsumi

2015-01-01

Backgrounds: The main problem with intraoral distraction of the mandible is the inability to achieve the three-dimensional mandibular correction as planned preoperatively. We developed a technique that allows spontaneous changes in the direction of mandibular elongation using an intraoral distractor. Methods: After mandibular osteotomy, the distractor is fixed to the distal segment of the mandible using a single bicortical screw, allowing anterior-posterior, vertical and limited lateromedial changes in the vector of distraction. Mandibular lengthening is performed while keeping the maxilla and mandible in class I occlusion with intermaxillary fixation. Results: As the distraction device is activated allowing mandibular elongation, the proximal segment, guided by the surrounding soft tissues, moves and rotates posterosuperiorly. Mandibular lengthening is continued until the condylar head reaches an adequate position in the mandibular fossa as confirmed clinically and radiographically. Conclusion Thirty-three patients with mandibular retrognathia received this treatment and good results were obtained. PMID:26301156

Rotational Distraction for the Treatment of Severe Mandibular Retrognathia.

PubMed

Ito, Osamu; Mitsugi, Masaharu; Alcalde, Rafael E; Yano, Tomoyuki; Uemura, Noriko; Okazaki, Mutsumi

2015-07-01

The main problem with intraoral distraction of the mandible is the inability to achieve the three-dimensional mandibular correction as planned preoperatively. We developed a technique that allows spontaneous changes in the direction of mandibular elongation using an intraoral distractor. After mandibular osteotomy, the distractor is fixed to the distal segment of the mandible using a single bicortical screw, allowing anterior-posterior, vertical and limited lateromedial changes in the vector of distraction. Mandibular lengthening is performed while keeping the maxilla and mandible in class I occlusion with intermaxillary fixation. As the distraction device is activated allowing mandibular elongation, the proximal segment, guided by the surrounding soft tissues, moves and rotates posterosuperiorly. Mandibular lengthening is continued until the condylar head reaches an adequate position in the mandibular fossa as confirmed clinically and radiographically. Thirty-three patients with mandibular retrognathia received this treatment and good results were obtained.

[Influence of the mandibular second premolar extraction on the angulation of the mandibular third molar].

PubMed

Feng, Guang-yao; Zou, Bing-shuang; Gao, Xue-mei; Zeng, Xiang-long; Wang, Xiu-jing; Yan, Yan

2013-02-18

To compare the angular changes in the developing mandibular third molars in the mandibular second premolar extraction and non-extraction cases and to determine whether the mandibular second premolar extraction causes favorable rotational changes in the angulations of the developing mandibular third molars and benefits its later eruption. Pretreatment and posttreatment panoramic radiographs were taken from 45 subjects who had been treated by the extraction of the mandibular second premolars and 48 subjects who had been treated without extraction. The horizontal reference plane was used to measure and compare the changes in the angulations of the developing mandibular third molars. The mean uprighting of the mandibular third molars seen in the extraction group was (5.9±2.5) degrees on the right side and (8.0±3.4) degrees on the left side following treatment. For the nonextraction group the mean uprighting was (1.8±2.4) degrees on the right side and (1.5±2.1) degrees on the left side. There was a statistically significant difference between the groups (P<0.05). Mandibular second premolar extraction might be a helpful procedure on the angulations of the developing mandibular third molars.

Correlation of panoramic radiography and cone beam CT findings in the assessment of the relationship between impacted mandibular third molars and the mandibular canal

PubMed Central

Neves, F S; Souza, T C; Almeida, S M; Haiter-Neto, F; Freitas, D Q; Bóscolo, F N

2012-01-01

Objectives The aim of this study was to assess the reliability of four panoramic radiographic findings, both individually and in association, in predicting the absence of corticalization between the mandibular canal and the third molar on cone beam CT (CBCT) images. Methods The sample consisted of 72 individuals (142 mandibular third molars) who underwent pre-operative radiographic evaluation before extraction of impacted mandibular third molars. On panoramic radiographs, the most common signs of corticalization (darkening of roots, diversion of mandibular canal, narrowing of mandibular canal and interruption of white line) and the presence or absence of corticalization between the mandibular third molar and the mandibular canal on CBCT images were evaluated. Results Darkening of roots and interruption of white line associated with the absence of corticalization between the mandibular third molar and the mandibular canal on CBCT images were statistically significant, both as isolated findings (p = 0.0001 and p = 0.0006, respectively) and in association (p = 0.002). No statistically significant association was observed for the other panoramic radiographic findings, either individually or in association (p > 0.05). Conclusion Darkening of roots and interruption of white line observed on panoramic radiographs, both as isolated findings and in association, were effective in determining the risk relationship between the tooth roots and the mandibular canal, requiring three-dimensional evaluation of the case. PMID:22282507

Prevalence of Temporal Bone Fractures in Patients with Mandibular Fractures Using Multidetector-Row CT.

PubMed

Ogura, I; Kaneda, T; Sasaki, Y; Buch, K; Sakai, O

2015-06-01

Temporal bone fracture after mandibular trauma is thought to be rare, and its prevalence has not been reported in the literature. The purpose of this study was to investigate the prevalence of temporal bone fractures in patients with mandibular fractures and the relationship between temporal bone fractures and the mandibular fracture location using multidetector-row computed tomography (MDCT). A prospective study was performed in 201 patients with mandibular fractures who underwent 64-MDCT scans. The mandibular fracture locations were classified as median, paramedian, angle, and condylar types. Statistical analysis for the relationship between prevalence of temporal bone fractures and mandibular fracture locations was performed using χ(2) test with Fisher's exact test. A P-value < 0.05 was considered statistically significant. The percentage of cases with temporal bone fracture was 3.0 % of all patients with mandibular fractures and 19.0 % of those with multiple mandibular fractures of paramedian and condylar type. There was a significant relationship between the incidence of temporal bone fracture and the paramedian- and condylar-type mandibular fracture (P = 0.001). Multiple mandibular fractures of paramedian and condylar type may be a stronger indicator for temporal bone fractures. This study suggests that patients with mandibular fracture, especially the paramedian and condylar type, should be examined for coexisting temporal bone fracture using MDCT.

Clinical outcomes of three different types of hardware for the treatment of mandibular angle fractures: a comparative retrospective study.

PubMed

Elsayed, S A; Mohamed, F I; Khalifa, G A

2015-10-01

A retrospective study was conducted to compare the clinical outcomes of three different types of hardware that are used in mandibular angle fracture fixation. Thirty patients were selected from the hospital database. The patients were categorized into the following groups: group A, in which a single 2.0-mm locking miniplate was used; group B, in which a single rigid 2.3-mm plate was used; and group C, in which a single lag screw was inserted. All patients were followed for 6 months. With regard to intraoperative variables, significant differences were found among the groups in the duration of surgery and cost. Group C had the shortest surgical time, followed by group A and then group B. Two patients, one in group A and one in group B, suffered an occlusal discrepancy after surgery. Of the group A patients, two exhibited wound dehiscence and one had an infection. One patient in group B had an exposed plate. Sensory nerve involvement was noted in three group C patients and one group B patient. The lag screw was associated with the fewest complications and exhibited all of the advantages of plating systems in the treatment of angle fracture. The lag screw involved the least hardware and a short operating time, however the differences were not significant. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Ectopic application of recombinant BMP-2 and BMP-4 can change patterning of developing chick facial primordia.

PubMed

Barlow, A J; Francis-West, P H

1997-01-01

The facial primordia initially consist of buds of undifferentiated mesenchyme, which give rise to a variety of tissues including cartilage, muscle and nerve. These must be arranged in a precise spatial order for correct function. The signals that control facial outgrowth and patterning are largely unknown. The bone morphogenetic proteins Bmp-2 and Bmp-4 are expressed in discrete regions at the distal tips of the early facial primordia suggesting possible roles for BMP-2 and BMP-4 during chick facial development. We show that expression of Bmp-4 and Bmp-2 is correlated with the expression of Msx-1 and Msx-2 and that ectopic application of BMP-2 and BMP-4 can activate Msx-1 and Msx-2 gene expression in the developing facial primordia. We correlate this activation of gene expression with changes in skeletal development. For example, activation of Msx-1 gene expression across the distal tip of the mandibular primordium is associated with an extension of Fgf-4 expression in the epithelium and bifurcation of Meckel's cartilage. In the maxillary primordium, extension of the normal domain of Msx-1 gene expression is correlated with extended epithelial expression of shh and bifurcation of the palatine bone. We also show that application of BMP-2 can increase cell proliferation of the mandibular primordia. Our data suggest that BMP-2 and BMP-4 are part of a signalling cascade that controls outgrowth and patterning of the facial primordia.

Epidermoid Cyst of Mandible Ramus: Case Report

PubMed Central

Loxha, Mergime Prekazi; Salihu, Sami; Kryeziu, Kaltrina; Loxha, Sadushe; Agani, Zana; Hamiti, Vjosa; Rexhepi, Aida

2016-01-01

Introduction: An epidermoid cyst is a benign cyst usually found on the skin. Bone cysts are very rare and if they appear in bone they usually appear in the distal phalanges of the fingers. Epidermoid cysts of the jaws are uncommon. Case presentation: We present a case, of a 41 year-old female patient admitted to our department because of pain and swelling in the parotid and masseteric region–left side. There was no trismus, pathological findings in skin, high body temperature level, infra-alveolar nerves anesthesia or lymphadenopathy present. The orthopantomography revealed a cystic lesion and a unilocular lesion that included mandibular ramus on the left side with 3 cm in diameter. Under total anesthesia, a cyst had been reached and was enucleated. Histopathologic findings showed that the pathologic lesion was an epidermoid cyst. Discussion: Epidermoid and dermoid cysts are rare, benign lesions found throughout the body. Only a few cases in literature describe an intraossesus epidermoid cyst. Conclusion: Our case is an epidermoid cyst with a rare location in the region of the mandibular ramus. It is not associated with any trauma in this region except medical history reveals there was an operative removal of a wisdom tooth 12 years ago in the same side. These cysts are interesting from the etiological point of view. They should be considered in the differential diagnosis of other radiolucent lesions of the jaws. Surgically they have a very good prognosis, and are non-aggressive lesions. PMID:27594757

Do flexible acrylic resin lingual flanges improve retention of mandibular complete dentures?

PubMed Central

Ahmed Elmorsy, Ayman Elmorsy; Ahmed Ibraheem, Eman Mostafa; Ela, Alaa Aboul; Fahmy, Ahmed; Nassani, Mohammad Zakaria

2015-01-01

Objectives: The aim of this study was to compare the retention of conventional mandibular complete dentures with that of mandibular complete dentures having lingual flanges constructed with flexible acrylic resin “Versacryl.” Materials and Methods: The study sample comprised 10 completely edentulous patients. Each patient received one maxillary complete denture and two mandibular complete dentures. One mandibular denture was made of conventional heat-cured acrylic resin and the other had its lingual flanges made of flexible acrylic resin Versacryl. Digital force-meter was used to measure retention of mandibular dentures at delivery and at 2 weeks and 45 days following denture insertion. Results: The statistical analysis showed that at baseline and follow-up appointments, retention of mandibular complete dentures with flexible lingual flanges was significantly greater than retention of conventional mandibular dentures (P < 0.05). In both types of mandibular dentures, retention of dentures increased significantly over the follow-up period (P < 0.05). Conclusions: The use of flexible acrylic resin lingual flanges in the construction of mandibular complete dentures improved denture retention. PMID:26539387

Extraction of mandibular premolars and molars: comparison between local infiltration via pressure syringe and inferior alveolar nerve block anesthesia.

PubMed

Thiem, Daniel G E; Schnaith, Florian; Van Aken, Caroline M E; Köntges, Anne; Kumar, Vinay V; Al-Nawas, Bilal; Kämmerer, Peer W

2018-04-01

The purpose of this study was to evaluate the anesthetic efficiency of local infiltration anesthesia administered with a pressure syringe (P-INF) via a special technique versus direct block anesthesia of the inferior alveolar nerve (IANB) for tooth extraction in the posterior mandible. In a prospective randomized study, 101 teeth in 101 patients were extracted in the posterior mandible under local anesthesia whereby two different administration techniques were used (P-INF n = 48; IANB n = 53). Primary objectives were comparisons of anesthetic success rate (yes/no) and efficacy (full/sufficient vs. insufficient). Secondary objectives were patients' pain perception during treatment, pain of injection (numerical rating scale), need for second injections (always IANB), time until onset of anesthetic action (min), and duration of local numbness (min). IANB was successful in all cases, whereas initial P-INF achieved 35% of success only. Furthermore, IANB reached significant higher values of anesthetic efficacy compared to P-INF (P < 0.001). Concerning pain of injection, patients rated IANB to be more painful (P = 0.039). Second injections were significantly more often necessary for P-INF (P = 0.006) whereas duration until onset of action as well as the duration of local numbness were found to be equal. For anesthetic efficacy as well as anesthetic success, block anesthesia of the inferior alveolar nerve (IANB) turned out to be more proficient to local infiltration via special delivering system with a special technique. Infiltration, even when performed with 4% articaine and a pressure syringe system, is not a suitable method of anesthesia in the posterior mandible.

Piezosurgery versus conventional osteotomy in orthognathic surgery: a paradigm shift in treatment.

PubMed

Bertossi, Dario; Lucchese, Alessandra; Albanese, Massimo; Turra, Matteo; Faccioni, Fiorenzo; Nocini, Pierfrancesco; Rodriguez Y Baena, Ruggero

2013-01-01

The aim of the study was to compare in a randomized controlled clinical trial the use of the piezoelectric osteotomy as an alternative to the conventional approach in terms of surgery time, intraoperative blood loss, cut quality, nerve injury, and costs.One hundred ten patients who had orthognathic surgery procedures with bimaxillary osteotomy were divided into 2 groups: group A was treated with a piezosurgery device, and group B, with a reciprocating saw and bur.The piezosurgical bone osteotomy permitted individualized cut designs. The surgical time in group A was reduced, with a mean for the mandibular osteotomy (1 side) between 3 minutes 31 seconds and 5 minutes 2 seconds, whereas in group B, the surgical time was between 7 minutes 23 seconds and 10 minutes 22 seconds. The surgical time in group A for the Le Fort I osteotomy was between 5 minutes 17 seconds and 7 minutes 55 seconds in group A and between 8 minutes 38 seconds and 15 minutes 11 seconds in group B. All patients in group A had a low blood loss (<300 mL) versus patients of group B who had a medium to high blood loss (medium loss: 400 mL, high loss: >500 mL). Inferior alveolar nerve sensation was retained in 98.2% of group A versus 92.7% in group B at 6 months postoperative testing.Piezoelectric osteotomy reduced surgical time, blood loss, and inferior alveolar nerve injury in bimaxillary osteotomy. Absence of macrovibrations makes the instrument more manageable and easy to use and allows greater intraoperative control with higher safety in cutting in difficult anatomical regions.

21 CFR 872.4770 - Temporary mandibular condyle reconstruction plate.

Code of Federal Regulations, 2014 CFR

2014-04-01

... device that is intended to stabilize mandibular bone and provide for temporary reconstruction of the... surgical procedures requiring removal of the mandibular condyle and mandibular bone. This device is not...

Signaling pathways regulating the expression of Prx1 and Prx2 in the Chick Mandibular Mesenchyme

PubMed Central

Doufexi, Aikaterini-El; Mina, Mina

2009-01-01

Prx1 and Prx2 are members of the aristaless-related homeobox genes shown to play redundant but essential roles in morphogenesis of the mandibular processes. To gain insight into the signaling pathways that regulate expression of Prx genes in the mandibular mesenchyme, we used the chick as a model system. We examined the patterns of gene expression in the face and the roles of signals derived from the epithelium on the expression of Prx genes in the mandibular mesenchyme. Our results demonstrated stage-dependent roles of mandibular epithelium on the expression of Prx in the mandibular mesenchyme and provide evidence for positive roles of members of the fibroblast and hedgehog families derived from mandibular epithelium on the expression of Prx genes in the mandibular mesenchyme. Our studies suggest that endothelin-1 signaling derived from the mesenchyme is involved in restricting the expression of Prx2 to the medial mandibular mesenchyme. PMID:18942149

The use of the mandibular infiltration anesthetic technique in adults.

PubMed

Meechan, John G

2011-09-01

The author describes the use of the infiltration anesthetic technique to anesthetize mandibular teeth in adults and explores its mechanism of action. The author reviewed articles describing randomized controlled trials of the mandibular infiltration anesthetic technique in healthy participants. The author found that using the mandibular infiltration anesthetic technique can produce anesthesia in adult mandibular teeth. The success was dose dependent and the choice of anesthetic solution was significant; 4 percent articaine with 1:100,000 epinephrine was more effective than 2 percent lidocaine with 1:100,000 epinephrine. Combining buccal and lingual infiltrations increased success in the mandibular incisor region. The success of the mechanism of infiltration of anesthetic at the mandibular first molar appeared to depend on the mental foramen. The mandibular infiltration anesthetic technique is an effective method of anesthetizing mandibular incisors. Four percent articaine with epinephrine appears to be the preferred solution. The choice of anesthetic solution is important when using the infiltration anesthetic technique in the adult mandible.

Mandibular Fracture Patterns at a Medical Center in Central Taiwan: A 3-Year Epidemiological Review.

PubMed

Lin, Fu-Yu; Wu, Chao-I; Cheng, Hsu-Tang

2017-12-01

Mandibular fractures constitute a major portion of maxillofacial trauma and may lead to considerable functional and aesthetic sequelae if treatment is inadequate or delayed. An epidemiology study on mandibular fractures may guide the preventive efforts of the Taiwan public health care system. Therefore, a retrospective review was conducted at a medical center in central Taiwan to evaluate the current mandibular fracture epidemiology.The medical records and digitized radiographs of 198 patients who received treatment for mandibular fractures during a 3-year period (from October 2010 to September 2013) at a medical center in central Taiwan were reviewed to obtain demographic and injury data.The average age was 29.4 years (3-82 years). Patients aged 21 to 30 years sustained the most mandibular fractures (62 patients, 31.3%). The overall sex distribution (male to female) ratio was 1.8. Motor-vehicle accidents (MVAs) were the most common mechanism of injury (162 patients, 82%), and scooter and motorcycle riders wearing partial-coverage helmets constituted the majority of patients. A chart review identified 198 patients with 335 mandibular fractures; 113 patients (57.1%) had multiple mandibular fractures. The most common fracture sites were the symphysis and parasymphysis regions (38.9%), followed by the condyle (26.0%), angle (14.3%), body (14.3%), and ramus (6.6%).MVAs are the major cause of mandibular fractures in central Taiwan, and patients aged <30 years sustained the most mandibular fractures. Compared with previous studies, the present study has a higher percentage of women with mandibular fractures. In addition, inadequate mandibular protection by partial-coverage helmets may be a major reason for mandibular fractures most commonly localized in the symphysis and parasymphysis regions. The incidence and causes of mandibular fractures may reflect the trauma patterns within the community, thus facilitating the development of a preventive strategy for the socioeconomic and environmental background of central Taiwan. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Unusual complication after genioplasty.

PubMed

Avelar, Rafael Linard; Sá, Carlos Diego Lopes; Esses, Diego Felipe Silveira; Becker, Otávio Emmel; Soares, Eduardo Costa Studart; de Oliveira, Rogerio Belle

2014-01-01

Facial beauty depends on shape, proportion, and harmony between the facial thirds. The chin is one of the most important components of the inferior third and has an important role on the definition of facial aesthetic and harmony in both frontal and lateral views. There are 2 principal therapeutic approaches that one can choose to treat mental deformities, alloplastic implants, and mental basilar ostectomy, also known as genioplasty. The latest is more commonly used because of great versatility in the correction of three-dimensional deformities of the chin and smaller taxes of postoperative complications. Possible transoperative and postoperative complications of genioplasty include mental nerve lesion, bleeding, damage to tooth roots, bone resorption of the mobilized segment, mandibular fracture, ptosis of the lower lip, and failure to stabilize the ostectomized segment. The study presents 2 cases of displacement of the osteotomized segment after genioplasty associated with facial trauma during postoperative orthognathic surgery followed by rare complications with no reports in the literature.

Safety of liposuction of the neck using tumescent local anesthesia: experience in 320 cases.

PubMed

Roland, Boeni

2012-11-01

Liposuction of the neck has become a popular, minimally invasive technique for fat reduction and skin tightening. To evaluate the safety of neck liposuction in a large series of patients. Between 2003 and 2011, 320 patients underwent liposuction of the neck. Complications were recorded, and all patients were followed up after 8 weeks. There were no serious complications. Four patients required closer follow-up because of hematoma (n = 1), transient mandibular nerve inflammation (n = 2), and globus pharyngeus (n = 1). Liposuction of the neck with tumescent local anesthesia requires a higher amount of patient monitoring than liposuction of the body. In the hands of an experienced surgeon, it is a safe method rendering excellent aesthetic results. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

The efficacy of IntraFlow intraosseous injection as a primary anesthesia technique.

PubMed

Remmers, Todd; Glickman, Gerald; Spears, Robert; He, Jianing

2008-03-01

The purpose of this study was to compare the efficacy of intraosseous injection and inferior alveolar (IA) nerve block in anesthetizing mandibular posterior teeth with irreversible pulpitis. Thirty human subjects were randomly assigned to receive either intraosseous injection using the IntraFlow system (Pro-Dex Inc, Santa Ana, CA) or IA block as the primary anesthesia method. Pulpal anesthesia was evaluated via electric pulp testing at 4-minute intervals for 20 minutes. Two consecutive 80/80 readings were considered successful pulpal anesthesia. Anesthesia success or failure was recorded and groups compared. Intraosseous injection provided successful anesthesia in 13 of 15 subjects (87%). The IA block provided successful anesthesia in 9 of 15 subjects (60%). Although this difference was not statistically significant (p = 0.2148), the results of this preliminary study indicate that the IntraFlow system can be used as the primary anesthesia method in teeth with irreversible pulpitis to achieve predictable pulpal anesthesia.

Sexual dimorphism of the internal mandibular chamber in Fayum Pliohyracidae (Mammalia)

USGS Publications Warehouse

de Blieux, D.D.; Baumrind, M.R.; Simons, E.L.; Chatrath, P.S.; Meyer, G.E.; Attia, Y.S.

2006-01-01

An internal mandibular fenestra and chamber are found in many fossil hyracoids. The internal mandibular fenestra is located on the lingual surface of the mandibular corpus and opens into a chamber within the mandible. The mandibular chamber is maximally developed in late Eocene Thyrohyrax meyeri and early Oligocene Thyrohyrax domorictus from the Fayum Province of Egypt. The function of this chamber is unknown as it is not found in extant hyraxes, nor is it known to occur in any other mammal. In Thyrohyrax, this feature appears to be sexually dimorphic because it is confined to roughly one half of the specimens that otherwise cannot be separated by dental characteristics or measurements. It has been suggested that the chamber is found in females based on the presumed distribution of this character in other fossil hyracoids. Fossils from Fayum Quarry L-41, preserving the sexually dimorphic anterior dentition, show that, in Thyrohyrax meyeri and Thyrohyrax domorictus, the internal mandibular chamber is found in males. In Thyrohyrax litholagus, an internal mandibular fenestra and inflated mandibular chamber occurs in males whereas females show the variable presence of an internal mandibular fossa or fenestra but lack an expanded chamber. Other genera show differing patterns of sexual variation in which some Fayum hyracoids have an internal mandibular fenestra in both sexes but with the greatest development of the mandibular chamber occurring in males. We review functions proposed for the internal mandibular chamber and suggest that it housed a laryngeal air sac that may have had a vocal function by acting as a resonating chamber. ?? 2006 by the Society of Vertebrate Paleontology.

[Temporo-mandibular joint. Morpho-functional considerations].

PubMed

Scutariu, M D; Indrei, Anca

2004-01-01

The temporo-mandibular joint is distinguished from most other synovial joints of the body by two features: 1. the two jointed components carry teeth whose position and occlusion introduce a very strong influence on the movements of the temporo-mandibular joint and 2. its articular surfaces are not covered by hyaline cartilage, but by a dense, fibrous tissue. This paper describes the parts of the temporo-mandibular joint: the articular surfaces (the condylar process of the mandible and the glenoid part of the temporal bone), the fibrocartilaginous disc which is interposed between the mandibular and the temporal surface, the fibrous capsule of the temporo-mandibular joint and the ligaments of this joint. All these parts present a very strong adaptation at the important functions of the temporo-mandibular joint.

[Clinical analysis of caries status of the mandibular second molar].

PubMed

You, Chun-an; Zheng, Ping; Hu, Ning; Su, Qin

2014-04-01

To collect the cases which have caries on the mandibular second molar and analyze the caries status and correlative factors. Patients treated in the Department of Endodontics in West China Hospital of Stomatology were randomly collected. The baseline information, primary sites and severity of dental caries on the mandibular second molar, and eruption pattern of the mandibular third molar were recorded. The data was analyzed with SPSS13.0 software package. Four hundred eighty-one patients including 227 males and 254 females were collected. Caries on the mandibular second molar starting from the occlusal, distal proximal and buccal surfaces accounted for 33.8%, 33.2% and 24.4%, respectively. Caries involving dental pulp (49.7%) were significantly more than deep and shallow to moderate caries (31.7% and 18.6%). Gender was not correlated with the site and severity of caries. However, impacted mandibular third molars and age were significantly related to both caries site and severity. Occlusal and distal proximal surfaces are the most predisposed sites to have caries on mandibular second molar. Impacted mandibular third molar and age are significantly related to caries of mandibular second molar.

Long Term Stability and Relapse Following Mandibular Advancement and Mandibular Setback Surgeries: A Cephalometric Study

PubMed Central

Darshan, S Vinay; Ronad, Yusuf Ahammed; Kishore, M S V; Shetty, K Sadashiva; Rajesh, M; Suman, S D

2014-01-01

Background: The aim was to evaluate the long-term hard and soft tissue changes following mandibular advancement and setback surgeries. Materials and Methods: A total of 16 subjects each were selected who underwent bilateral sagittal split osteotomy mandibular advancement and mandibular setback groups. Pre-surgical (T1), immediate post-surgical (T2) and long-term post-surgical (T3) cephalograms were compared for hard and soft tissue changes. After cephalometric measurements, the quantity of changes between T1-T2 and T1-T3 were determined for each patient. The mean difference between T1-T2 and T1-T3 was compared with assess the long-term changes and stability. Results: In mandibular advancement the mean difference between immediate post-surgical and long term post-surgical is 7%, which accounts for a relapse of 7%. In mandibular setback, the mean difference between immediate post-surgical and long-term post-surgical is 29%, which accounts for a relapse of 29%. Conclusion: Mandibular advancement remained stable over the long period when compared to mandibular setback. PMID:25395792

Long term stability and relapse following mandibular advancement and mandibular setback surgeries: a cephalometric study.

PubMed

Darshan, S Vinay; Ronad, Yusuf Ahammed; Kishore, M S V; Shetty, K Sadashiva; Rajesh, M; Suman, S D

2014-09-01

The aim was to evaluate the long-term hard and soft tissue changes following mandibular advancement and setback surgeries. A total of 16 subjects each were selected who underwent bilateral sagittal split osteotomy mandibular advancement and mandibular setback groups. Pre-surgical (T1), immediate post-surgical (T2) and long-term post-surgical (T3) cephalograms were compared for hard and soft tissue changes. After cephalometric measurements, the quantity of changes between T1-T2 and T1-T3 were determined for each patient. The mean difference between T1-T2 and T1-T3 was compared with assess the long-term changes and stability. In mandibular advancement the mean difference between immediate post-surgical and long term post-surgical is 7%, which accounts for a relapse of 7%. In mandibular setback, the mean difference between immediate post-surgical and long-term post-surgical is 29%, which accounts for a relapse of 29%. Mandibular advancement remained stable over the long period when compared to mandibular setback.

[EMG activities of the head, neck and upper trunk muscles with mandibular movements in healthy adults and mandibular asymmetry patients].

PubMed

Jiang, Ting; Zhang, Zhenkang; Yang, Zhaohui; Yi, Biao; Feng, Hailan; Wang, Xing

2002-03-25

To study the activities of head, neck and upper trunk muscles during mandibular movements in healthy adults and mandibular asymmetry patients. Electromyographic integrogram was used to record and analyze the electromyographic activities of the anterior temporal (Ta), posterior temporal (Tp), sternocleidomastoid (SCM), and trapezius (TRAP) muscles in rest position and during mandibular movement among 10 normal adults and 10 mandibular asymmetry patients. All the four muscles showed constant electromyographic activities when the mandible was in the rest position. The activities of Ta, Tp, and SCM muscles increased with protrusion of mandible, mouth opening, tapping, maximum clenching, and chewing. The activities of Ta and Tp muscles of the patients were 1.7 times greater than that of the normal adults during mandibular movement without occlusion, and were weaker by 50% during mandibular movement with occlusion. The difference between electromyographic activities during mandibular movement and in rest position was less among patients than among normal adults. The TRAP muscle of the patients showed constant electromyographic activities with the activity volume nearly 1.8 times that of the normal adults. The difference between the muscle and its namesake at the opposite side was greater among the patients (21%) than among the normal adults (8%). All the four muscles participate in the maintenance of rest position of mandible and the realization of mandibular movements. The coordination of muscular activities among mandibular asymmetry patients is poorer than that among normal adults.

Comparison of Effect of Oral Premedication with Ibuprofen or Dexamethasone on Anesthetic Efficacy of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Prospective, Randomized, Controlled, Double-blind Study.

PubMed

Bidar, Maryam; Mortazavi, Soheil; Forghani, Maryam; Akhlaghi, Saeed

2017-01-01

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of preoperative oral administration of ibuprofen or dexamethasone on the success rate of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. Seventy-eight patients with irreversible pulpitis were randomly divided into 3 groups (26 per group) and given one of the following at 1 hr prior to performing local anesthesia: a placebo; 400 mg ibuprofen; or 4 mg dexamethasone. Each patient recorded their pain level on a visual analog scale before taking the medication or placebo, at 15 min after completion of IANB, and during treatment if pain occurred. The success of the anesthesia was defined as no or mild pain at any stage during the endodontic procedure. The success rate of the IANB was 38.5, 73.1, and 80.8% with the placebo, ibuprofen, and dexamethasone, respectively. Both ibuprofen and dexamethasone were significantly more effective than the placebo. No significant difference was observed, however, between the two experimental medications in terms of effectiveness. The results of the present study suggest that premedication with ibuprofen or dexamethasone increases the success rate of an IANB in patients with symptomatic irreversible pulpitis in the mandibular molars.

Intraosseous injection as an adjunct to conventional local anesthetic techniques: A clinical study.

PubMed

Idris, Mohamed; Sakkir, Nasil; Naik, Kishore Gopalakrishna; Jayaram, Nandakishore Kunijal

2014-09-01

The achievement of successful local anesthesia is a continual challenge in dentistry. Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection (the Stabident system and the X-tip system) have been proposed to be advantageous in cases where the conventional local anesthetic techniques have failed. A clinical study was undertaken using intraosseous injection system by name X-tip to evaluate its effectiveness in cases where inferior alveolar nerve block has failed to provide pulpal anesthesia. Sixty adult patients selected were to undergo endodontic treatment for a mandibular molar tooth. Inferior alveolar nerve block was given using 4% articaine with 1:100,000 epinephrine. Twenty-four patients (40%) had pain even after administration of IAN block; intraosseous injection was administered using 4% articaine containing 1:100,000 epinephrine, using the X-tip system. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analog scale ratings ≤ 54 mm) on endodontic access or initial instrumentation. Intraosseous injection technique was successful in 21 out of 24 patients (87.5%), except three patients who had pain even after supplemental X-tip injection. Within the limits of this study, we can conclude that supplemental intraosseous injection using 4% articaine with 1:100,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis.

An easy way to apply orthodontic extraction for impacted lower third molar compressing to the inferior alveolar nerve.

PubMed

Wang, Yong; He, Dongmei; Yang, Chi; Wang, Baoli; Qian, Wentao

2012-04-01

To study the results of an easy orthodontic extraction method for impacted lower third molar removal which had roots compressing to the inferior alveolar nerve (IAN). Forty patients were divided into two groups according to their desire. Orthodontic traction group (n=20) had brackets or mini bone screws on the antagonist maxillary molars as anchorage for orthodontic traction from 3 to 10 weeks until the roots' tip was away from the IAN, the tooth was then removed. Traditional extraction group (n=20) had the tooth removed immediately by the same surgeon. Post-operative results were compared between the two groups. All 20 patients in the orthodontic extraction group had their lower impacted third molar removed easily without lower lip numbness after surgery, while 5 patients in the traditional extraction group had transient IAN injury and went away 1 week later. There were no anchorage teeth and adjacent mandibular second molar loose or displacement. Application of orthodontic brackets or mini bone screws on the antagonist maxillary molars is an easy way for orthodontic extraction of impacted lower third molar with roots' tip compressed to the IAN. It is an effective way to avoid IAN injury during tooth extraction. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Intraosseous injection as an adjunct to conventional local anesthetic techniques: A clinical study

PubMed Central

Idris, Mohamed; Sakkir, Nasil; Naik, Kishore Gopalakrishna; Jayaram, Nandakishore Kunijal

2014-01-01

Background: The achievement of successful local anesthesia is a continual challenge in dentistry. Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection (the Stabident system and the X-tip system) have been proposed to be advantageous in cases where the conventional local anesthetic techniques have failed. Aim: A clinical study was undertaken using intraosseous injection system by name X-tip to evaluate its effectiveness in cases where inferior alveolar nerve block has failed to provide pulpal anesthesia. Materials and Methods: Sixty adult patients selected were to undergo endodontic treatment for a mandibular molar tooth. Inferior alveolar nerve block was given using 4% articaine with 1:100,000 epinephrine. Twenty-four patients (40%) had pain even after administration of IAN block; intraosseous injection was administered using 4% articaine containing 1:100,000 epinephrine, using the X-tip system. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analog scale ratings ≤ 54 mm) on endodontic access or initial instrumentation. Results: Intraosseous injection technique was successful in 21 out of 24 patients (87.5%), except three patients who had pain even after supplemental X-tip injection. Conclusion: Within the limits of this study, we can conclude that supplemental intraosseous injection using 4% articaine with 1:100,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis. PMID:25298642

Factors associated with mandibular third molar eruption and impaction.

PubMed

Tsai, Hung-Huey

2005-01-01

A retrospective study, using panoramic radiographs, was conducted on 152 Taiwanese (72 males and 80 females) to investigate mandibular third molar eruption and impaction. The following measurements were made: inclinations and mesiodistal crown widths of the mandibular molars, vertical and horizontal spaces between the distal surface of the second molar and the anterior surface of the ramus, lengths and widths of the mandibular ramus and body, the ramus inclination, the mandibular plane angle, and the mandibular gonial angle. Differences between non-impaction and impaction groups were studied, and the variables were analyzed with multivariate discriminatory analysis. Significant differences between the two groups were found; variables describing spaces between the anterior of the ramus and the distal of the mandibular second molar and tooth size appeared to be the primary contributors to the differences observed.

Endodontic management of contralateral mandibular first molars with six root canals

PubMed Central

Bhargav, Kambhampati; Sirisha, Kantheti; Jyothi, Mandava; Boddeda, Mohan Rao

2017-01-01

The knowledge of variations in root canal morphology is essential for a successful endodontic outcome. Contralateral mandibular molar with six root canals is a rare entity. Root canal treatment of mandibular molars with aberrant canal configuration can be diagnostically and technically challenging. While dealing with variant mandibular molars, mishaps may happen. This case report describes variations in contralateral mandibular molars and also an endodontic mishap while managing them. PMID:29259369

A Correlational Study of Scoliosis and Trunk Balance in Adult Patients with Mandibular Deviation

PubMed Central

Yang, Yang; Wang, Na; Wang, Wenyong; Ding, Yin; Sun, Shiyao

2013-01-01

Previous studies have confirmed that patients with mandibular deviation often have abnormal morphology of their cervical vertebrae. However, the relationship between mandibular deviation, scoliosis, and trunk balance has not been studied. Currently, mandibular deviation is usually treated as a single pathology, which leads to poor clinical efficiency. We investigated the relationship of spine coronal morphology and trunk balance in adult patients with mandibular deviation, and compared the finding to those in healthy volunteers. 35 adult patients with skeletal mandibular deviation and 10 healthy volunteers underwent anterior X-ray films of the head and posteroanterior X-ray films of the spine. Landmarks and lines were drawn and measured on these films. The axis distance method was used to measure the degree of scoliosis and the balance angle method was used to measure trunk balance. The relationship of mandibular deviation, spine coronal morphology and trunk balance was evaluated with the Pearson correlation method. The spine coronal morphology of patients with mandibular deviation demonstrated an “S” type curve, while a straight line parallel with the gravity line was found in the control group (significant difference, p<0.01). The trunk balance of patients with mandibular deviation was disturbed (imbalance angle >1°), while the control group had a normal trunk balance (imbalance angle <1°). There was a significant difference between the two groups (p<0.01). The degree of scoliosis and shoulder imbalance correlated with the degree of mandibular deviation, and presented a linear trend. The direction of mandibular deviation was the same as that of the lateral bending of thoracolumbar vertebrae, which was opposite to the direction of lateral bending of cervical vertebrae. Our study shows the degree of mandibular deviation has a high correlation with the degree of scoliosis and trunk imbalance, all the three deformities should be clinically evaluated in the management of mandibular deviation. PMID:23555836

Treatment of Osteomyelitis: A Case for Disruption of the Affected Adjacent Periosteum.

PubMed

Hudson, John W; Daly, Austin P; Foster, Michael

2017-10-01

To evaluate the response of mandibular osteomyelitis treated by surgical decortication with disruption of the affected adjacent periosteum in concert with long-term targeted antibiotic therapy. The hypothesis is that, by removing the buccal cortical plate and disrupting the hypertrophically inflamed adjacent periosteum, the medullary bone will be brought in contact with bleeding tissue and circulating immunologic factors and antibiotics, which will promote definitive resolution. A retrospective review was conducted of 7 patient charts with associated radiographs from November 2010 to August 2016 treated by the first author at the University of Tennessee Medical Center (Knoxville, TN). Patients with chronic suppurative or nonsuppurative osteomyelitis of the mandible without condylar involvement or pathologic fracture were selected and treated with decortication with periosteal disruption in combination with long-term targeted antibiotic therapy. Seven patients (3 women and 4 men; mean age, 60 yr) underwent decortication with periosteal disruption of the affected area and received at least 6 weeks of targeted intravenous antibiotics. Computed tomography was performed preoperatively and a repeat study was performed after completion of antibiotics. In each case, post-treatment imaging showed definitive resolution after treatment with decortication in concert with disruption of the inflamed hypertrophic periosteum and intravenous antibiotics. Debridement of the infected cortical bone with restoration of the blood supply through disruption of the adjacent periosteum provided definitive resolution of mandibular osteomyelitis in the 7 patients treated. The hypothesis is that disruption of the affected adjacent periosteum reintroduces an immune-mediated response in concert with improved antibiotic delivery to and penetrance of the diseased mandible, aiding in definitive resolution. Decortication with periosteal disruption allows for preservation of the inferior alveolar nerve, maintains mandibular integrity, and obviates reconstructive surgery. Decortication with disruption of the adjacent periosteum, when combined with targeted antimicrobial therapy, produced definitive resolution of osteomyelitis as shown by postoperative imaging. It is the authors' assertion that not only decortication, but also disruption of the adjacent periosteum in combination with targeted antibiotic therapy should be considered a valid and principal therapeutic option for the surgical treatment of osteomyelitis of the mandible. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Superolateral dislocation of an intact mandibular condyle into the temporal fossa: case report and literature review.

PubMed

Sharma, Divashree; Khasgiwala, Ankit; Maheshwari, Bharat; Singh, Charanpreet; Shakya, Neelam

2017-02-01

Temporomandibular joint dislocation refers to the dislodgement of mandibular condyle from the glenoid fossa. Anterior and anteromedial dislocations of the mandibular condyle are frequently reported in the literature, but superolateral dislocation is a rare presentation. This report outlines a case of superolateral dislocation of an intact mandibular condyle that occurred in conjunction with an ipsilateral mandibular parasymphysis fracture. A review of the clinical features of superolateral dislocation of the mandibular condyle and the possible techniques of its reduction ranging from the most conservative means to extensive surgical interventions is presented. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Management of mandibular body fractures in pediatric patients: a case report with review of literature.

PubMed

John, Baby; John, Reena R; Stalin, A; Elango, Indumathi

2010-10-01

Mandibular fractures are relatively less frequent in children when compared to adults, which may be due to the child's protected anatomic features and infrequent exposure of children to alcohol related traffic accidents. Treatment principles of mandibular fractures differ from that of adults due to concerns regarding mandibular growth and development of dentition. A case of a 4.5-year-old boy with fractured body of mandible managed by closed reduction using open occlusal acrylic splint and circum mandibular wiring is presented. This article also provides a review of literature regarding the management of mandibular body fracture in young children.

Management of mandibular body fractures in pediatric patients: A case report with review of literature

PubMed Central

John, Baby; John, Reena R.; Stalin, A.; Elango, Indumathi

2010-01-01

Mandibular fractures are relatively less frequent in children when compared to adults, which may be due to the child's protected anatomic features and infrequent exposure of children to alcohol related traffic accidents. Treatment principles of mandibular fractures differ from that of adults due to concerns regarding mandibular growth and development of dentition. A case of a 4.5-year-old boy with fractured body of mandible managed by closed reduction using open occlusal acrylic splint and circum mandibular wiring is presented. This article also provides a review of literature regarding the management of mandibular body fracture in young children. PMID:22114443

Heritability of mandibular cephalometric variables in twins with completed craniofacial growth.

PubMed

Šidlauskas, Mantas; Šalomskienė, Loreta; Andriuškevičiūtė, Irena; Šidlauskienė, Monika; Labanauskas, Žygimantas; Vasiliauskas, Arūnas; Kupčinskas, Limas; Juzėnas, Simonas; Šidlauskas, Antanas

2016-10-01

To determine genetic and environmental impact on mandibular morphology using lateral cephalometric analysis of twins with completed mandibular growth and deoxyribonucleic acid (DNA) based zygosity determination. The 39 cephalometric variables of 141 same gender adult pair of twins were analysed. Zygosity was determined using 15 specific DNA markers and cervical vertebral maturation method was used to assess completion of the mandibular growth. A genetic analysis was performed using maximum likelihood genetic structural equation modelling (GSEM). The genetic heritability estimates of angular variables describing horizontal mandibular position in relationship to cranial base and maxilla were considerably higher than in those describing vertical position. The mandibular skeletal cephalometric variables also showed high heritability estimates with angular measurements being considerably higher than linear ones. Results of this study indicate that the angular measurements representing mandibular skeletal morphology (mandibular form) have greater genetic determination than the linear measurements (mandibular size). The shape and sagittal position of the mandible is under stronger genetic control, than is its size and vertical relationship to cranial base. © The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Reliability of mandibular canines as indicators for sexual dichotomy.

PubMed

Hosmani, Jagadish V; Nayak, Ramakant S; Kotrashetti, Vijayalakshmi S; S, Pradeep; Babji, Deepa

2013-02-01

Amongst the various calcified structures in the human body, teeth have gained lot of popularity in estimating the sex of an individual as they are highly resistant to destruction and decomposition. Using permanent mandibular canines many researchers have predicted a high level of accuracy in identifying the sex correctly. The purpose of our study was to gauge the effectiveness of mandibular canines in discerning sex. Fifty dental casts each of males and females were utilized for the study. Mesio-distal dimension and inter-canine distance of mandibular right and left canine was recorded using digital vernier caliper and mandibular canine index was calculated. The mean value of mesio-distal dimensions of right and left mandibular canine was slightly greater in males compared to females. The mandibular canine index was equal in both sexes. Inter-canine distance was marginally higher in males compared to females. Despite of higher values in males none of the parameters were statistically significant. The results herein bolster contemporary studies that mesio-distal dimensions of mandibular canines and mandibular canine index do not reflect sexual dimorphism and that its application should be discontinued in sex prediction among Indian populations. How to cite this article: Hosmani J V, Nayak R S, Kotrashetti V S, Pradeep S, Babji D. Reliability of Mandibular Canines as Indicators for Sexual Dichotomy. J Int Oral Health 2013; 5(1):1-7.

Long-Term Results of Mandibular Distraction Osteogenesis with a Resorbable Device in Infants with Robin Sequence: Effects on Developing Molars and Mandibular Growth.

PubMed

Paes, Emma C; Bittermann, Gerhard K P; Bittermann, Dirk; Muradin, Marvick M; van Hogezand, Rose; Etty, Erika; Mink van der Molen, Aebele B; Kon, Moshe; Breugem, Corstiaan C

2016-02-01

Mandibular distraction osteogenesis with a unidirectional resorbable device is an effective treatment option for severe upper airway obstruction in infants with Robin sequence. Long-term effects, especially with regard to tooth development and mandibular outgrowth, are not known. Robin sequence infants with a follow-up of greater than or equal to 5 years were included. Baseline characteristics were extracted from medical records. Panoramic and lateral cephalometric radiographs were analyzed and patients were recalled for physical examination. Ten infants underwent mandibular distraction osteogenesis at a mean age of 3.7 months (median, 19 months; range, 11 days to 27 months). Mean length of follow-up was 6.8 years (range, 5.0 to 7.9 years). Ten Robin sequence infants without mandibular distraction osteogenesis (mean length of follow-up, 7.4 years; range, 6.7 to 8.9 years) were the controls. Shape anomalies, positional changes, and root malformations of molars were seen significantly more often than in the control group (p = 0.007, p = 0.009, and p = 0.043, respectively). Mandibular length was shorter (p = 0.030), but mandibular ramus height was comparable (p = 0.838) with that of the non-mandibular distraction osteogenesis group. Compared with healthy controls, all Robin sequence infants had a significantly shorter mandible. Mandibular distraction osteogenesis with a resorbable system reveals overall good short- and long-term results, but the effects on developing molars and mandibular outgrowth likely necessitate secondary procedures. This factor should be considered when deciding on treatment options and counseling of parents. Therapeutic, III.

21 CFR 872.3960 - Mandibular condyle prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device that is intended to be implanted in the human jaw to... requirement for premarket approval for any mandibular condyle prosthesis intended to be implanted in the human...

Comparison of the anaesthetic efficacy of and heart rate changes after periodontal ligament or intraosseous X-Tip injection in mandibular molars: a randomized controlled clinical trial.

PubMed

Zarei, M; Ghoddusi, J; Sharifi, E; Forghani, M; Afkhami, F; Marouzi, Parviz

2012-10-01

To compare the efficacy of supplemental anaesthesia using periodontal ligament injections (PDL) and intraosseous injections with the X-Tip system in terms of the measured heart rate and patient reported pain level. In this single-blind randomized clinical trial, 40 patients (22 women, 18 men) with irreversible pulpitis who had experienced unsuccessful pain management by inferior alveolar nerve block with 2% lidocaine and 1 : 100 000 epinephrine were selected. Patients were divided equally and randomly into two groups. Supplementary anaesthesia was provided through intraosseous injection with the X-Tip system (X-Tip group) or by PDL injection (PDL group). After each step of injection, pain severity was assessed using a visual analogue scale. Patient heart rate was recorded with a pulse oximeter. Data were coded and analysed using Mann-Whitney U-test with SPSS (version 16) software. Anaesthetic success was obtained in 100% of X-Tip and 70% of PDL group patients after the first supplemental injection. Compared with the first PDL injection, the first intraosseous injection resulted in a significant increase in heart rate (P = 0.001); however, this increase was short-lived (mean increase: 9-10 beats per min). No significant difference in heart rate or anaesthesia success was observed between men and women. Intraosseous injection using the X-Tip system was more effective than PDL injection as a supplementary anaesthetic for pulpectomy in mandibular molars or second premolars. However, the former resulted in a transient increase in heart rate. © 2012 International Endodontic Journal.

Effect of mini-implant-supported mandibular overdentures on electromyographic activity of the masseter muscle during chewing of hard and soft food.

PubMed

Ashmawy, Tarek Mohy; El Talawy, Dina Bahgat; Shaheen, Nasser Hussein

2014-09-01

To objectively evaluate the effect of mini-implant- supported mandibular overdentures on electromyographic activity (EMG) of the masseter muscle during chewing of hard and soft foods. Twelve completely edentulous patients (4 females and 8 males) with maladaptive experience of wearing mandibular dentures received new maxillary and mandibular dentures. After 3 months of adaptation, four mini dental implants (MDIs) were inserted in the interforaminal region of the mandible, and the new mandibular dentures were connected to the implants immediately with O/ring attachments. The activity of masseter muscle (EMG) and the duration of chewing cycle were measured during chewing hard (carrot) and soft (gum) foods. The measurements were made 3 months after wearing each of the following prostheses: the new conventional dentures; and the MDI-retained mandibular overdentures. The EMG of masseter muscle increased and the DC decreased with MDI-retained mandibular overdentures when compared to conventional dentures. Hard food (carrot) was associated with increased EMG and decreased DC when compared to soft food (gum) for both conventional dentures and MDI-retained mandibular overdentures. Mini-implant-supported mandibular overdentures are associated with increased activity of masseter muscle and decreased duration of chewing cycle for both hard and soft foods when compared to conventional dentures.

A rare case of canine anomaly - a possible algorithm for treating it.

PubMed

Vaida, Ligia; Todor, Bianca Ioana; Corega, Claudia; Băciuţ, Mihaela; Băciuţ, Grigore

2014-01-01

Canine transmigration is a very rare dental anomaly in which an unerupted mandibular canine migrates, crossing the mandibular midline. This unusual condition is most often diagnosed by chance during a routine X-ray examination. The most common clinical signs announcing the presence of this anomaly are over-retention of the deciduous canine and the absence of permanent canine from the dental arch after its physiological period of eruption. In this paper, we present a clinical case, 10-year-old boy, who was diagnosed with mandibular right canine transmigration at three years after the start of orthodontic treatment, during which we were expecting the eruption of mandibular canines. The orthopantomograph revealed the mandibular right canine to be in a horizontal position under the apices of the incisors - type 2 transmigration pattern classified by Mupparapu (2002). Based on cone-beam computer tomography examination, we recommended a surgical exposure of the canine and orthodontic alignment. Due to the risk of root resorption of the mandibular right lateral incisor during orthodontic movement phase of canine transmigrated to the dental arch, we decided to align the mandibular right canine in a transposition, between the two mandibular right incisors. Then we resorted to adapting the mandibular right lateral incisor coronary morphology to simulate a canine and also to reshaping the canine coronary morphology to resemble a lateral incisor. This therapeutic approach allowed us to restore morphologically and functionally the mandibular dento-alveolar arch, preserving the entire dental system.

Thin-plate spline analysis of mandibular growth.

PubMed

Franchi, L; Baccetti, T; McNamara, J A

2001-04-01

The analysis of mandibular growth changes around the pubertal spurt in humans has several important implications for the diagnosis and orthopedic correction of skeletal disharmonies. The purpose of this study was to evaluate mandibular shape and size growth changes around the pubertal spurt in a longitudinal sample of subjects with normal occlusion by means of an appropriate morphometric technique (thin-plate spline analysis). Ten mandibular landmarks were identified on lateral cephalograms of 29 subjects at 6 different developmental phases. The 6 phases corresponded to 6 different maturational stages in cervical vertebrae during accelerative and decelerative phases of the pubertal growth curve of the mandible. Differences in shape between average mandibular configurations at the 6 developmental stages were visualized by means of thin-plate spline analysis and subjected to permutation test. Centroid size was used as the measure of the geometric size of each mandibular specimen. Differences in size at the 6 developmental phases were tested statistically. The results of graphical analysis indicated a statistically significant change in mandibular shape only for the growth interval from stage 3 to stage 4 in cervical vertebral maturation. Significant increases in centroid size were found at all developmental phases, with evidence of a prepubertal minimum and of a pubertal maximum. The existence of a pubertal peak in human mandibular growth, therefore, is confirmed by thin-plate spline analysis. Significant morphological changes in the mandible during the growth interval from stage 3 to stage 4 in cervical vertebral maturation may be described as an upward-forward direction of condylar growth determining an overall "shrinkage" of the mandibular configuration along the measurement of total mandibular length. This biological mechanism is particularly efficient in compensating for major increments in mandibular size at the adolescent spurt.

Three-Dimensional Analysis of Mandibular Angle Classification and Aesthetic Evaluation of the Lower Face in Chinese Female Adults.

PubMed

Mao, Xiaoyan; Fu, Xi; Niu, Feng; Chen, Ying; Jin, Qi; Qiao, Jia; Gui, Lai

2018-05-14

Reduction gonioplasty is very popular in East Asia. However, there has been little quantitative criteria for mandibular angle classification or aesthetics. The aim of this study was to investigate the quantitative differences of mandibular angle types and determine the morphologic features of mandibular angle in attractive women. We created a database of skull computed tomography and standardized frontal and lateral photographs of 96 Chinese female adults. Mandibular angle was classified into 3 groups, namely, extraversion, introversion, and healthy group, based on the position of gonion. We used a 5-point Likert scale to quantify attractiveness based on photographs. Those who scored 4 or higher were defined as attractive women. Three types of computed tomography measurements of the mandible were taken, including 4 distances, 4 angles, and 3 proportions. Discriminant analysis was applied to establish a mathematic model for mandibular angle aesthetics evaluation. Significant differences were observed between the different types of mandibular angle in lower facial width (Gol-Gor), mandibular angle (Co-Go-Me), and gonion divergence angle (Gol-Me-Gor) (P < 0.01). Chinese attractive women had a mandibular angle of 123.913 ± 2.989 degrees, a FH-MP of 27.033 ± 2.695 degrees, and a Go-Me/Co-Go index of 2.0. The "healthy" women had a mandibular angle of 116.402 ± 5.373 degrees, a FH-MP of 19.556 ± 5.999 degrees, and a Go-Me/Co-Go index of 1.6. The estimated Fisher linear discriminant function for the identification of attractive women was as follows: Y = -0.1516X1(Co-Go) + 0.128X2(Go-Me) + 0.04936X3(Co-Go-Me) +0.0218X4(FH-MP). Our study quantified the differences of mandibular angle types and identified the morphological features of mandibular angle in attractive Chinese female adults. Our results could assist plastic surgeons in presurgical designing of new aesthetic gonion and help to evaluate lower face aesthetics.

To Evaluate the Correlation Between Skeletal and Dental Parameters to the Amount of Crowding in Class II Div. 1 Malocclusions.

PubMed

Singh, Shivani; Shivaprakash, G

2017-09-01

Crowding of teeth is one of the most common problem that motivates the patient to seek orthodontic treatment. Determination of etiology of crowding could have a significant effect on treatment planning and prognosis of Class II malocclusion. Aim of this study was to evaluate the relationship of skeletal and dental parameters to amount of dental crowding in patients with Class II Divison 1 (div.1) malocclusion. Pretreatment lateral cephalograms and dental casts of 60 patients with skeletal Class II malocclusion were collected for the study. The sample was divided into two groups according to severity of pretreatment mandibular crowding. Group I consisted of cases with crowding ≥3 mm and Group II with crowding <3 mm. Lateral cephalograms for each patient was manually traced and skeletal parameters (effective maxillary and mandibular length, mandibular plane angle, Y Axis, lower anterior face height) and dental parameters (axial inclination of lower incisor, inclination of lower incisor to mandibular plane, interincisal angle) were measured. Unpaired t-test was used for intergroup comparison and relationship between different measurements was investigated using Pearson correlation coefficient. Among the skeletal parameters measured, only effective mandibular length exhibited statistically significant difference between the two groups. No statistically significant difference was found between the two groups for any of the dental parameters. Significant inverse correlation was found between mandibular crowding and effective mandibular length. Subjects with Class II div.1 malocclusion and moderate to severe mandibular crowding have significantly smaller effective mandibular base length than subjects with the same malocclusion and slight mandibular crowding.

A randomized clinical trial comparing mandibular incisor proclination produced by fixed labial appliances and clear aligners.

PubMed

Hennessy, Joe; Garvey, Thérèse; Al-Awadhi, Ebrahim A

2016-09-01

To compare the mandibular incisor proclination produced by fixed labial appliances and third generation clear aligners. Patients underwent a course of orthodontic treatment using either fixed labial appliances or clear aligners (Invisalign). Mandibular incisor proclination was measured by comparing pretreatment and near-end treatment lateral cephalograms. Eligibility criteria included adult patients with mild mandibular incisor crowding (<4 mm) and Class I skeletal bases (ANB, 1-4°). The main outcome was the cephalometric change in mandibular incisor inclination to the mandibular plane at the end of treatment. Eligible patients picking a sealed opaque envelope, which indicated their group allocation, was used to achieve randomization. Data was analyzed using a Welch two-sample t-test. Forty-four patients (mean age, 26.4 ± 7.7 years) were randomized in a 1:1 ratio to either the fixed labial appliance or the clear aligner group. Baseline characteristics were similar for both groups: Fixed appliance mean crowding was 2.1 ± 1.3 mm vs clear aligner mean crowding, 2.5 ± 1.3 mm; pretreatment mean mandibular incisor inclination for the fixed appliance group was 90.8 ± 5.4° vs 91.6 ± 6.4° for the clear aligner group. Fixed appliances produced 5.3 ± 4.3° of mandibular incisor proclination. Clear aligners proclined the mandibular incisors by 3.4 ± 3.2°. The difference between the two groups was not statistically significant (P > .05). There was no difference in the amount of mandibular incisor proclination produced by clear aligners and fixed labial appliances in mild crowding cases.

Association between third molar and mandibular angle fracture: A systematic review and meta-analysis.

PubMed

Giovacchini, Francesco; Paradiso, Daniele; Bensi, Caterina; Belli, Stefano; Lomurno, Giuseppe; Tullio, Antonio

2018-04-01

The aim of this study was to investigate the risk of mandibular angle fracture associated with the presence of a mandibular third molar and its position when the mandibular fracture occurs. A systematic literary search was performed in Pubmed, Scopus, and the Cochrane Library for observational studies with at least 250 patients that included frequency of mandibular angle fracture, presence of third molar, and its position. A total of seven studies were included in the review, from an initial search of 622 titles. The relative risk of mandibular angle fracture with third molar was 1.90 (95% CI = 1.47-2.46). The relative risk of mandibular angle fracture related to third molar position (according to the Pell and Gregory classification) was 1.18 (95% CI = 0.62-2.25), 1.98 (95% CI = 0.95-4.10), 2.72 (95% CI = 1.78-4.16), 1.31 (95% CI = 0.80-2.14), 2.21 (95% CI = 1.69-2.87) and 2.99 (95% CI = 2.12-4.22) for Class A, Class B, Class C, Class I, Class II, and Class III, respectively. Our meta-analysis reported a two-fold increased risk of mandibular angle fracture with the presence of a third molar in patients who presented with mandibular fractures. Even the third molar position seemed to influence mandibular angle fracture, especially Class C, Class II, and Class III. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Mandibular reconstruction using plates prebent to fit rapid prototyping 3-dimensional printing models ameliorates contour deformity.

PubMed

Azuma, Masaki; Yanagawa, Toru; Ishibashi-Kanno, Naomi; Uchida, Fumihiko; Ito, Takaaki; Yamagata, Kenji; Hasegawa, Shogo; Sasaki, Kaoru; Adachi, Koji; Tabuchi, Katsuhiko; Sekido, Mitsuru; Bukawa, Hiroki

2014-10-23

Recently, medical rapid prototyping (MRP) models, fabricated with computer-aided design and computer-aided manufacture (CAD/CAM) techniques, have been applied to reconstructive surgery in the treatment of head and neck cancers. Here, we tested the use of preoperatively manufactured reconstruction plates, which were produced using MRP models. The clinical efficacy and esthetic outcome of using these products in mandibular reconstruction was evaluated. A series of 28 patients with malignant oral tumors underwent unilateral segmental resection of the mandible and simultaneous mandibular reconstruction. Twelve patients were treated with prebent reconstruction plates that were molded to MRP mandibular models designed with CAD/CAM techniques and fabricated on a combined powder bed and inkjet head three-dimensional printer. The remaining 16 patients were treated using conventional reconstruction methods. The surgical and esthetic outcomes of the two groups were compared by imaging analysis using post-operative panoramic tomography. The mandibular symmetry in patients receiving the MRP-model-based prebent plates was significantly better than that in patients receiving conventional reconstructive surgery. Patients with head and neck cancer undergoing reconstructive surgery using a prebent reconstruction plate fabricated according to an MRP mandibular model showed improved mandibular contour compared to patients undergoing conventional mandibular reconstruction. Thus, use of this new technology for mandibular reconstruction results in an improved esthetic outcome with the potential for improved quality of life for patients.

Effect of removable functional appliances on mandibular length in patients with class II with retrognathism: systematic review and meta-analysis.

PubMed

Santamaría-Villegas, Adriana; Manrique-Hernandez, Rubén; Alvarez-Varela, Emery; Restrepo-Serna, Claudia

2017-02-01

Orthopedic functional devices, are used to improve mandibular length in skeletal class II patients. However, the orthopedic functional device with the best effect to increasing the mandibular length, has not been identified before. Thus, the aim of the present investigation was to evaluate Randomized Controlled Trials (RCT), to determine the best functional appliance improving mandibular length in subjects with retrognathism. A systematic review and meta-analysis was performed, including studies published and indexed in databases between 1966 and 2016. RCTs evaluating functional appliances' effects on mandibular length (Condilion-Gnation (Co-Gn) and Condilion-Pogonion (Co-Po)), were included. Reports' structure was evaluated according to 2010 CONSORT guide. The outcome measure was distance between Co-Gn and/or Co-Po after treatment. Data were analyzed with Cochran Q Test and random effects model. Five studies were included in the meta-analysis. The overall difference in mandibular length was 1.53 mm (Confidence Interval (CI) 95% 1.15-1.92) in comparison to non-treated group. The Sander Bite Jumping reported the greatest increase in mandibular length (3.40 mm; CI 95% 1.69-5.11), followed by Twin Block, Bionator, Harvold Activator and Frankel devices. All removable functional appliances, aiming to increase mandibular length, are useful. Sander Bite Jumping was observed to be the most effective device to improve the mandibular length.

Human mandibular shape is associated with masticatory muscle force.

PubMed

Sella-Tunis, Tanya; Pokhojaev, Ariel; Sarig, Rachel; O'Higgins, Paul; May, Hila

2018-04-16

Understanding how and to what extent forces applied to the mandible by the masticatory muscles influence its form, is of considerable importance from clinical, anthropological and evolutionary perspectives. This study investigates these questions. Head CT scans of 382 adults were utilized to measure masseter and temporalis muscle cross-sectional areas (CSA) as a surrogate for muscle force, and 17 mandibular anthropometric measurements. Sixty-two mandibles of young individuals (20-40 years) whose scans were without artefacts (e.g., due to tooth filling) were segmented and landmarked for geometric morphometric analysis. The association between shape and muscle CSA (controlled for size) was assessed using two-block partial least squares analysis. Correlations were computed between mandibular variables and muscle CSAs (all controlled for size). A significant association was found between mandibular shape and muscle CSAs, i.e. larger CSAs are associated with a wider more trapezoidal ramus, more massive coronoid, more rectangular body and a more curved basal arch. Linear measurements yielded low correlations with muscle CSAs. In conclusion, this study demonstrates an association between mandibular muscle force and mandibular shape, which is not as readily identified from linear measurements. Retrodiction of masticatory muscle force and so of mandibular loading is therefore best based on overall mandibular shape.

A patient with mandibular deviation and 3 mandibular incisors treated with asymmetrically bent improved superelastic nickel-titanium alloy wires.

PubMed

Ikeda, Yuhei; Kokai, Satoshi; Ono, Takashi

2018-01-01

Skeletal and dental discrepancies cause asymmetric malocclusions in orthodontic patients. It is difficult to achieve adequate functional occlusion and guidance in patients with congenital absence of a mandibular incisor due to the tooth-size discrepancy. Here, we describe the orthodontic treatment of a 22-year-old woman with an asymmetric Angle Class II malocclusion, mandibular deviation to the left, and 3 mandibular incisors. The anterior teeth and maxillary canines were crowded. We used an improved superelastic nickel-titanium alloy wire (Tomy International, Tokyo, Japan) to compensate for the asymmetric mandibular arch and an asymmetrically bent archwire to move the maxillary molars distally. A skeletal anchorage system provided traction for intermaxillary elastics, and extractions were not needed. We alleviated the crowding and created an ideal occlusion with proper overjet, overbite, and anterior guidance with Class I canine and molar relationships. This method of treatment with an asymmetrically bent nickel-titanium alloy wire provided proper Class I occlusion and anterior guidance despite the mandibular deviation to the left and 3 mandibular incisors, without the need for extractions. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Backward distraction osteogenesis in a patient with severe mandibular micrognathia.

PubMed

Mitsukawa, Nobuyuki; Morishita, Tadashi; Saiga, Atsuomi; Akita, Shinsuke; Kubota, Yoshitaka; Satoh, Kaneshige

2013-09-01

Maxillary skeletal prognathism can involve severe mandibular micrognathia with marked mandibular retrognathism or hypoplasia. For patients with such a condition, a conventional treatment is mandibular advancement by sagittal split ramus osteotomy (SSRO). This procedure has problems such as insufficient advancement, instability of jaw position, and postoperative relapse. Thus, in recent years, mandibular distraction osteogenesis has been used in some patients. Mandibular distraction has many advantages, but an ideal occlusion is difficult to achieve using this procedure. That is, 3-dimensional control cannot be attained using an internal device that is unidirectional. This report describes a case of severe mandibular micrognathia in a 14-year-old girl treated using backward distraction osteogenesis. This procedure was first reported by Ishii et al (Jpn J Jaw Deform 2004; 14:49) and involves a combination of SSRO and ramus distraction osteogenesis. In the present study, intermaxillary fixation in centric occlusion was performed after osteotomy, and proximal bone segments were distracted in a posterosuperior direction. This procedure is a superior surgical technique that avoids the drawbacks of SSRO and conventional mandibular distraction. However, it applies a large load to the temporomandibular joints and requires thorough management. Thus, careful evaluation needs to be made of the indication for backward distraction osteogenesis.

Retrospective Study of Root Canal Configurations of Mandibular Third Molars Using CBCT- Part-II.

PubMed

Somasundaram, Pavithra; Rawtiya, Manjusha; Wadhwani, Shefali; Uthappa, Roshan; Shivagange, Vinay; Khan, Sheeba

2017-06-01

Abnormal root canal morphologies of third molars can be diagnostically and technically challenging during root canal treatment. The aim of this retrospective study was to investigate the root and canal morphology of mandibular third molars in Central India population by using Cone Beam Computed Tomography (CBCT) analysis. CBCT images of 171 mandibular third molars were observed and data regarding number of roots, number of canals, Vertucci's classification in each root, prevalence of C shaped canal, gender and topographical relation of morphology in mandibular third molar was statistically evaluated. Majority of mandibular third molars had two roots (84.2%) and three canals (64.3%). Most mesial root had Vertucci Type II (55.6%) and Vertucci Type IV (22.2%), distal root had Type I canals (87.5%). Over all prevalence of C shaped canals in mandibular third molars was 9.4%. There was a high prevalence of two rooted mandibular third molars with three canals.

[Mandibular-driven simultaneous maxillo-mandibular distraction for hemifacial microsomia with rapid prototyping technology].

PubMed

Gao, Quan-Wen; Song, Hui-Feng; Xu, Ming-Huo; Liu, Chun-Ming; Chai, Jia-Ke

2013-11-01

To explore the clinical application of mandibular-driven simultaneous maxillo-mandihular distraction to correct hemifacial microsomia with rapid prototyping technology. The patient' s skull resin model was manufactured with rapid prototyping technology. The osteotomy was designed on skull resin model. According to the preoperative design, the patients underwent Le Fort I osteotomy and mandibular ramus osteotomy. The internal mandible distractor was embedded onto the osteotomy position. The occlusal titanium pin was implanted. Distraction were carried out by mandibular-driven simultaneous maxillo-mandihular distraction 5 days after operation. The distraction in five patients was complete as designed. No infection and dysosteogenesis happened. The longest distance of distraction was 28 mm, and the shortest distance was 16 mm. The facial asymmetry deformity was significantly improved at the end of distraction. The ocelusal plane of patients obviously improved. Rapid prototyping technology is helpful to design precisely osteotomy before operation. Mandibular-driven simultaneous maxillo-mandibular distraction can correct hemifacial microsomia. It is worth to clinical application.

Elders with implant overdentures: a 22-year clinical report.

PubMed

Alsabeeha, Nabeel H M

2012-09-01

To report on the long-term survival and prosthodontic maintenance of two edentulous adults with mandibular overdentures supported by hydroxyapatite (HA)-coated implants. Mandibular implant overdentures are a successful treatment option with positive impact on the quality of life of elderly edentulous adults. Long-term survival of the implants requires continued rigorous prosthodontic maintenance. Two elderly edentulous adults with mandibular overdentures supported by 2 HA-coated implants were presented for prosthodontic rehabilitation after 22 years of placement. The implants were osseo-integrated and surviving at presentation based on accepted criteria. The mandibular implant overdentures suffered recurrent loss of retention and stability. Prosthodontic treatment involving the replacement of defective attachment systems and construction of new sets of mandibular implant overdentures opposing complete maxillary dentures is presented. The long-term survival of mandibular 2-implant overdentures requires continued prosthodontic maintenance. A conservative approach in the rehabilitation of two older edentulous adults with mandibular 2-implant overdentures was described including proper selection of attachment systems. © 2012 The Gerodontology Society and John Wiley & Sons A/S.

Retrospective Study of Root Canal Configurations of Mandibular Third Molars Using CBCT- Part-II

PubMed Central

Somasundaram, Pavithra; Wadhwani, Shefali; Uthappa, Roshan; Shivagange, Vinay; Khan, Sheeba

2017-01-01

Introduction Abnormal root canal morphologies of third molars can be diagnostically and technically challenging during root canal treatment. Aim The aim of this retrospective study was to investigate the root and canal morphology of mandibular third molars in Central India population by using Cone Beam Computed Tomography (CBCT) analysis. Materials and Methods CBCT images of 171 mandibular third molars were observed and data regarding number of roots, number of canals, Vertucci’s classification in each root, prevalence of C shaped canal, gender and topographical relation of morphology in mandibular third molar was statistically evaluated. Results Majority of mandibular third molars had two roots (84.2%) and three canals (64.3%). Most mesial root had Vertucci Type II (55.6%) and Vertucci Type IV (22.2%), distal root had Type I canals (87.5%). Over all prevalence of C shaped canals in mandibular third molars was 9.4%. Conclusion There was a high prevalence of two rooted mandibular third molars with three canals. PMID:28764294

X-cephalometric study of different parts of the upper airway space and changes in hyoid position following mandibular fractures.

PubMed

Chen, L-J; Zhao, M-C; Pan, X-F; Wei, Y-Q; Wang, D-Y

2013-09-01

This study analyses the different parts of the upper airway space and the changes in hyoid position. The results provide a clinical reference for developing timely and effective treatment programmes for patients with mandibular fractures caused by maxillofacial trauma. Standard X-cephalometric measurements of the lateral skull of 210 subjects were taken. The subjects were divided into four fracture groups: condylar, mandibular angle, mandibular body, and parasymphyseal. The radiographs of the mandibular fracture groups were compared with the normal occlusion group to analyse the upper airway space and the changes in hyoid position. Different types of fractures have different effects on the upper airway space. Bilateral mandibular body fracture and the parasymphyseal fracture have a significant influence on the lower oropharyngeal and laryngopharyngeal airway spaces, with serious obstructions severely restricting the ventilatory function of patients. Fractures at different parts of the mandibular structure are closely related to the upper airway and hyoid position.

[Inferior hemiarthroplasty of the temporo-mandibular joint with articulated condylar prosthesis type Stryker].

PubMed

Bucur, A; Dincă, O; Totan, C; Ghită, V

2007-01-01

The optimal reconstruction of the mandible and of the temporo-mandibular joint after mandibular hemi-resection with disarticulation is still controversial in literature. This paperwork presents our experience on four cases in the reconstruction of the mandible together with the inferior arthroplasty of the temporo-mandibular joint, after the resection of extended benign tumors of the mandible, based on fibular free vascularized grafts having attached a Stryker titanium condylar prosthesis reconstructing the inferior segment of the temporo-mandibular joint. Our results for the this technique were excellent, with a functional rehabilitation very close to normal. After reviewing the various techniques and their arguments in literature, with accent on the TMJ reconstruction, we consider this method to be optimal for the reconstruction of mandibular defects in patients with neoplastic conditions.

Aplasia of the mandibular condyle associated with some orthopaedic abnormalities

PubMed Central

Canger, E M; Çelenk, P

2012-01-01

A rare case of aplasia of mandibular condyle associated with some other orthopaedic problems is presented. A 5-year-old boy attended our clinic with a chief complaint of facial asymmetry and chewing difficulty. The mandible was deviated to the left. The occlusion also showed a deflection to the left of the mandibular midline. He also had walking difficulty owing to a hip abnormality. Panoramic radiographic examination of the patient revealed that the left mandibular condyl was totally absent. The right condyle was unremarkable. His history revealed neither trauma nor any significant disease. Aplasia is a rare anomaly and means the insufficient development of the mandibular condyle. True agnesis of the mandibular condyle is extremely rare. Association of the manifestations of the patient with some orthopaedic problems makes this case interesting. PMID:22116127

An Assessment of Curve of Spee in Healthy Human Permanent Dentitions: A Cross Sectional Analytical Study in a Group of Young Indian Population.

PubMed

Krishnamurthy, Sushma; Hallikerimath, Rajendra B; Mandroli, Praveenkumar S

2017-01-01

An awareness of the standard value of the maxillary and the mandibular curves of Spee may aid the clinician in developing occlusion in the sagittal plane and would be useful when providing prosthetic rehabilitation for patients with occlusal derangement. To assess and compare the radius and depth of curve of Spee in maxillary and mandibular arches in men and women, in a group of young Indian population. The study cohort consisted of 25 men and 25 women between 19 to 24 years. Impression of maxillary and mandibular arches were made with alginate. Casts were poured in die stone. Standardized digital pictures of the right side of maxillary and mandibular dental casts were made with a digital camera and transferred to a computer. Tips of the distal cusps of molars, premolars and canines of the maxilla and mandible were located. The radius and the depth of the curve of Spee were measured from the digital photographs of dental casts, with the help of 'dimension tool' in the computer software (Corel DRAW X5). Mann-Whitney test was used to analyze the difference in the curve of Spee between men and women and the difference between maxillary and mandibular arches. The mean values were as follows: a) Men: Radii of curve of Spee in the maxillary and mandibular arch were 140.22±65.98 and 109.67±46.80 respectively; depths of curve of Spee in maxillary and mandibular arch were 1.65±0.67 and 1.49±0.74 respectively; b) Women: Radii of curve of Spee in the maxillary and mandibular arch were 120.58±63.91 and 98.31±63.59 respectively; depths of curve of Spee in maxillary and mandibular arch were 1.45±0.54 and 1.40±0.61 respectively. In the mandibular arch, the difference in the radii (p=0.0467) was statistically significant between men and women. In women, the difference in radii (p=0.0467) between maxillary and mandibular arches was statistically significant. The radii and depths of curve of Spee were larger in maxillary than mandibular arches in both men and women. Also, the difference in the radii of mandibular arch was statistically significant between men and women.

An overlay partial denture to restore worn mandibular anterior teeth.

PubMed

Samant, Asha; DeSciscio, Peter

2014-01-01

Restoring worn anterior mandibular teeth is a challenge, especially when teeth are small, esthetics are a concern, the long-term prognosis is questionable, and/or patient finances are an issue. This article describes an alternate treatment for a patient with a collapsed bite, missing posterior mandibular teeth, an ill-fitting complete maxillary denture with poor esthetics, and irregular, worn mandibular anterior teeth.

Relationship between fracture of mandibular condyle and absence of unerupted mandibular third molar-a retrospective study.

PubMed

Rajan, Ritesh; Verma, Dinesh Kumar; Borle, R M; Yadav, Abhilasha

2016-06-01

The purpose of the present study was to find, if there exists, a co-relation between presence of unerupted mandibular third molar and fracture of mandibular condyle. A retrospective, multicenter study was done collecting the data of all mandibular condyle fractures treated from November 2006 till August 2015. Data was collected from the patient's records and radiographs for the following information: age, sex, etiology of fracture, presence and state of lower third molars, and associated fracture. The results were subjected to statistical analysis. Out of 180 patients of condylar fracture, unerupted third molars were present in 35 (19.44 %) cases compared to 145 (80.55 %) cases of condylar fracture where the unerupted third molars were not present. The difference was statistically significant (p < 0.05). In the unerupted third molar present group, isolated bilateral condylar fracture was seen in 4 (11.4 %) cases, bilateral condylar fracture associated with other mandibular fractures in 9 (25.7 %) cases, isolated unilateral condylar fracture in 0 (0.0 %) cases, and unilateral condylar fracture associated with other mandibular fractures in 17 (48.5 %) cases and condylar fracture associated with mid face fractures in 5 (14.2 %) cases. In the unerupted third molar absent group, isolated bilateral condylar fracture was seen in 5 (3.4 %) cases, bilateral condylar fracture associated with other mandibular fractures in 30 (20.6 %) cases, isolated unilateral condylar fracture in 24 (16.5 %) cases, unilateral condylar fracture associated with other mandibular fractures in 73 (50.34 %) cases, and condylar fracture associated with mid face fractures in 13(8.96 %) cases. The difference between the groups was statistically significant (p = 0.032). This study suggests that the fractures of mandibular condylar region have a significantly higher incidence in patients without an unerupted mandibular third molar.

Epidemiology of Surgically Managed Mandibular Condylar Fractures at a Tertiary Referral Hospital in Urban Southwest China.

PubMed

Thapa, Swosti; Wang, Jun; Hu, Hong-Tao; Zhang, Fu-Gui; Ji, Ping

2017-01-01

Mandibular condylar fracture is one of the commonest maxillofacial fractures treated by maxillofacial surgeons. Demography of the patients, causation, and characteristics of the fracture depends on various socio-economic factors. Hence, maxillofacial surgeons should be familiar with epidemiology of mandibular condylar fracture. This study retrospectively describes the demography, etiology, fracture characteristics, and hospital utilization of surgically treated mandibular condylar fractures in a tertiary referral hospital in urban China in past five years. Data of all patients who underwent surgical management between 2011 and 2015 were collected. This included aetiology, characteristics of fracture, time, age, sex, associated injuries, and hospital utilization of 166 patients with 208 mandibular condylar fractures. These patients had undergone open reduction and internal fixation with either miniplates or lag screws. Among the fracture of head of mandibular condyle, 21.28% of the patients had the fracture segments removed. These data were statistically analyzed to describe the epidemiology of mandibular condylar fracture. Most of the patients had unilateral mandibular condylar fractures (74.7%). Male patients (76.51%) outnumbered female patients (23.49%) in this cohort. The average age of the patients was 37 years. The fractures were mostly caused by fall from height (60.84%) and were located at the condylar neck (53.61%). Most of the patients had other associated maxillofacial injuries (71.08%) which were mostly located at symphysis and parasymphysis (44.59%). It took 12.58 +/- 0.35 days of hospitalization for the treatment. Fall from height was the most prevalent cause of mandibular condylar injury in mountainous urban China. The people at highest risk were middle-aged men. Mandibular condylar fracture was mostly located at the condylar neck and was usually associated with fracture at the symphysis and parasymphysis.

TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia: a cross-sectional study

PubMed Central

Sofyanti, Ervina; Boel, Trelia; Soegiharto, Benny; Auerkari, Elza I.

2018-01-01

Background: Temporomandibular joint disorder (TMD) includes symptoms of pain and dysfunction in the muscles of mastication and the temporomandibular joint. Differences in vertical condylar height, observed in the assessment of mandibular asymmetry, is a structural alteration that represents a risk factor for TMD. The study aimed to evaluate the association between TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia.  Methods: The cross-sectional study included 18-25-year-old (mean ± SD, 21.9 ± 2.0 years) old orthodontic patients admitted to the Dental Hospital of Universitas Sumatera Utara, Medan, between June 2016 and March 2017. Vertical mandibular asymmetry was assessed from all 106 subjects using Kjellberg’s technique from pre-treatment panoramic radiographs. The TMD symptoms were assessed by structural interviews using modified questionnaires based on Temporomandibular Disorder Diagnostic Index and Fonseca’s Anamnestic Index. Results: Of the 106 subjects, 26 (24.5% of the total) with vertical mandibular symmetry and 39 (36.8%) with vertical mandibular asymmetry were positive for TMD symptoms. By contrast, 17 patients (16.0% of the total) with vertical condylar symmetry and 24 patients (22.6%) with vertical mandibular asymmetry were regarded negative for TMD symptoms. There was no significant difference (p=0.520) in TMD symptoms based on vertical mandibular symmetry. Conclusion: The results from this studied Sumatran population indicate that there are common TMD symptoms in young adult orthodontic patients, but there is no significant association between vertical mandibular asymmetry and TMD symptoms. Further study on the development of TMD, mandibular asymmetry and treatment planning for growing patients is suggested, using longitudinal and transitional approaches.

Patient satisfaction and dissatisfaction with mandibular two-implant overdentures using different attachment systems: 5-year outcomes.

PubMed

Al-Zubeidi, Mohammed I; Alsabeeha, Nabeel H M; Thomson, W Murray; Payne, Alan G T

2012-10-01

Different attachment systems for mandibular two-implant overdentures could influence levels of patient satisfaction. Positive consensus of the majority of patients being satisfied does not preclude the possibility of dissatisfaction for some. To evaluate patient satisfaction and dissatisfaction before and after 5 years of wearing mandibular two implant overdentures using different attachment systems ; to determine the prognostic relevance of pretreatment complete denture complaints to treatment outcomes. A total of 106 edentulous participants enrolled in a clinical trial completed a preliminary self-report inventory of their original complete denture complaints.New complete maxillary dentures and mandibular two-implant overdentures were provided to each participant using one of six different attachment systems. Patient satisfaction was determined at pretreatment; at baseline with mandibular two-implant overdenture insertion; and then annually for 5 years, using visual analogue and Likert-type scales. Patient satisfaction with mandibular two-implant overdentures showed significant changes pre- to posttreatment(baseline) in all domains, but these were significant immediately and maintained without further significance for 5 years, other than pain with the overdenture. After 5 years, no significant differences were observed with all the attachment systems. Highly significant differences were found with some social and psychological aspects by the fifth year compared to baseline. Diagnostic and prognostic indicators from a pretreatment inventory identified 12 participants (13.5%) who were dissatisfied. These indicators revealed a maladaptive predisposition to mandibular two-implant overdentures. The provision of mandibular two-implant overdentures will, in the majority of patients, significantly enhance levels of patient satisfaction for 5 years, as compared to complete mandibular dentures, regardless of the attachment system. Careful evaluation of pretreatment complaints with conventional dentures can possibly identify patient dissatisfaction with mandibular two-implant overdentures [corrected]. © 2010 Wiley Periodicals, Inc.

Posterior Mandibular Ridge Resorption Associated with Different Retentive Systems for Overdentures: A 7-Year Retrospective Preliminary Study.

PubMed

Elsyad, Moustafa Abdou; Mohamed, Shahinaz Sayed; Shawky, Ahmad Fathalla

This retrospective study compared posterior mandibular residual ridge resorption with two different retentive mechanisms for overdentures after 7 years. A convenience sample of 18 edentulous men was assigned to one of two equal groups. Two implants were placed in the mandibular canine areas for each patient using the conventional two-stage surgical protocol, and the implants were splinted with a round bar 3 months later. New mandibular overdentures were then connected to the bars with clips (clip-retained overdentures, CR group) or resilient liners (resilient liner-retained overdentures, RR group). Posterior mandibular ridge resorption (PMRR) was recorded using proportional measurements and posterior area index (PAI) on panoramic radiographs taken immediately after overdenture insertion (T 0 ) and 7 years later (T 7 ). A linear regression model was used to verify the relationship between PAI and the following considerations: attachment type, age, initial mandibular ridge height, period of mandibular edentulism, number of previously worn dentures, and relining events. After 7 years, the RR group demonstrated a significantly (P = .014) higher change in PAI (0.11 ± 0.02) than the CR group (0.06 ± 0.04). The average PMRR for each mm of posterior mandibular ridge was 0.79 mm (0.11 mm/year) in the CR group and 1.4 mm (0.2 mm/year) in the RR group. Attachment type, initial mandibular ridge height, and relining times were significantly correlated with change in the PAI (P = .004, P = .035, and P = .045, respectively). Within the limitations of this preliminary study's design, it was observed that following a 7-year period of use, resilient liner attachments for bar/implant-retained overdentures appear to be associated with greater posterior mandibular ridge resorption when compared to clip attachments.

Surgical treatment of comminuted mandibular fractures using a low-profile locking mandibular reconstruction plate system

PubMed Central

Kanno, Takahiro; Sukegawa, Shintaro; Nariai, Yoshiki; Tatsumi, Hiroto; Ishibashi, Hiroaki; Furuki, Yoshihiko; Sekine, Joji

2014-01-01

Objective: The treatment of comminuted mandibular fractures is challenging due to the severity of associated injuries and the need for a careful diagnosis with adequate treatment planning. Recently, open reduction and stable internal fixation (OR-IF) with a load-bearing reconstruction plate have been advocated for reliable clinical outcomes with minimal complications. This clinical prospective study evaluated OR-IF in the surgical management of comminuted mandibular fractures with a new low-profile, thin, mandibular locking reconstruction plate. Materials and Methods: We prospectively assessed OR-IF of comminuted mandibular fractures with a low-profile locking mandibular reconstruction plate in 12 patients (nine men, three women; mean age 32.2 [range 16-71] years) between April 2010 and December 2011. The clinical characteristics and associated clinical parameters of patients were evaluated over a minimum follow-up period of 12 months. Results: Traffic accidents caused 50% of the fractures, followed by falls (25%). Four patients (33.3%) had associated midfacial maxillofacial fractures, while five patients had other mandibular fractures. Seven patients (58.3%) needed emergency surgery, mostly for airway management. Anatomical reduction of the comminuted segments re-established the mandibular skeleton in stable occlusion with rigid IF via extraoral (33.3%), intraoral (50%), or combined (16.7%) approaches. Immediate functional recovery was achieved. Sound bone healing was confirmed in all patients, with no complications such as malocclusion, surgical site infection, or malunion with a mean follow-up of 16.3 (range 12-24) months. Conclusions: OR-IF using a low-profile reconstruction plate system is a reliable treatment for comminuted mandibular fractures, enabling immediate functional recovery with good clinical results. PMID:25593862

Multifactorial etiology of Torus mandibularis: study of twins.

PubMed

Auškalnis, Adomas; Rutkūnas, Vygandas; Bernhardt, Olaf; Šidlauskas, Mantas; Šalomskienė, Loreta; Basevičienė, Nomeda

2015-01-01

The aim of this study is to investigate the multifactorial etiology of mandibular tori analyzing the influence of genetics, occlusal overload, various clinical variables and their interactions. Overall, plaster casts of 162 twins (81 twin pairs) were analyzed for the presence or absence of mandibular tori. Atypical wear facets on canine tips or incisors were recorded to diagnose bruxism. Angle Class, any kind of anterior open bite and positive, negative or flat curve of Wilson were recorded. Zygosity determination was carried out using a DNA test. Mandibular tori were found in 56.8% of the cases. In 93.6% of all monozygotic twin pairs both individuals had or did not have mandibular tori (κ=0.96±0.04; p<0.001), compared to 79.4% concordance of mandibular tori in dizygotic co-twins (κ=0.7±0.12; p<0.001). Prevalence of mandibular tori was significantly higher in the group of bruxers (67.5%) compared to non-bruxers (31.3%) (p<0.001). Significant association between mandibular tori and negative or flat curve of Wilson in the maxillary second premolars and first molars was found (OR=2.55, 95% CI (1.19-5.46), p=0.016). In all monozygotic bruxers, 97.1% showed concordance of mandibular tori presence in both co-twins compared to 78.9% dizygotic bruxers, and this difference is statistically significant (p=0.007). Our results suggest that the mandibular tori are of a multifactorial origin. Mandibular tori seem to have genetic predisposition, and may be associated with teeth grinding as well as with negative or flat CW in region of maxillary second premolar and first molar.

Early extraction of the mandibular third molar in case of eruption disturbances of the second molar.

PubMed

Kavadia, S; Antoniades, K; Kaklamanos, E; Antoniades, V; Markovitsi, E; Zafiriadis, L

2003-01-01

General consensus has been reached on extracting mandibular third molars when they are involved in pathologic processes. However, early extraction is advisable in cases of eruption disturbances of the mandibular second molar, before or during orthodontic treatment. Thirty-two patients with early extraction of the mandibular third molar before or during orthodontic treatment were examined. In these cases either the presence of the third molar presented an obstacle in the eruption path of the second, or third molar germ removal was considered beneficial to the course of orthodontic treatment. Early extraction of the mandibular third molar facilitates the eruption of the second molar, especially in cases where evidence of crowding and lack of space in the posterior mandibular region exist. Orthodontic treatment may, in some cases, aggravate eruption disturbances of the second molar.

Success rates of the first inferior alveolar nerve block administered by dental practitioners.

PubMed

Kriangcherdsak, Yutthasak; Raucharernporn, Somchart; Chaiyasamut, Teeranut; Wongsirichat, Natthamet

2016-06-01

Inferior alveolar nerve block (IANB) of the mandible is commonly used in the oral cavity as an anesthetic technique for dental procedures. This study evaluated the success rate of the first IANB administered by dental practitioners. Volunteer dental practitioners at Mahidol University who had never performed an INAB carried out 106 INAB procedures. The practitioners were divided into 12 groups with their advisors by randomized control trials. We recorded the success rate via pain visual analog scale (VAS) scores. A large percentage of the dental practitioners (85.26%) used the standard method to locate the anatomical landmarks, injecting the local anesthetic at the correct position, with the barrel of the syringe parallel to the occlusal plane of the mandibular teeth. Further, 68.42% of the dental practitioners injected the local anesthetic on the right side by using the left index finger for retraction. The onset time was approximately 0-5 mins for nearly half of the dental practitioners (47.37% for subjective onset and 43.16% for objective onset), while the duration of the IANB was approximately 240-300 minutes (36.84%) after the initiation of numbness. Moreover, the VAS pain scores were 2.5 ± 1.85 and 2.1 ± 1.8 while injecting and delivering local anesthesia, respectively. The only recorded factor that affected the success of the local anesthetic was the administering practitioner. This reinforces the notion that local anesthesia administration is a technique-sensitive procedure.

TMJ function after partial condylectomy in active mandibular condylar hyperplasia

PubMed Central

Olate, Sergio; Martinez, Felipe; Uribe, Francisca; Pozzer, Leandro; Cavalieri-Pereira, Lucas; de Moraes, Marcio

2014-01-01

Condylar hyperplasia is a frequent pathology that causes severe facial asymmetries. The partial condylectomy generally halts the disease. The aim of this research was to examine post-condylectomy TMJ function; 14 patients were included in this study, 6 male and 8 female. The average age was 21 years old. In all, the partial condylectomy was performed with preauricular or endaural access and the osteotomy were performed with drills, saw or an ultrasonic system. The patients were assessed with 3 or more time after surgery and were considering maximum mouth opening, right and left lateralities, presence of pain, noises, alterations in the facial nerve (VII) and esthetic alteration from the scar. The analysis was performed with the visual analog scale (VAS) and with a 7 cm metallic rule. Data analysis was descriptive plus chi-square test considering p value < 0.05 for statistical differences. With an average of 11 month after surgery, the results showed that the open mouth (over 35 mm) and lateralities (average 9 mm for the both right and left side) were normal and without statistical differences between the right or left side. Noise was observed in 3 patients and pain was observed in two patients with level 2 and 1 (VAS score). Scar was not related to problem with patient and the temporal branch of facial nerve was observed with limitations but without problem for patients. It can be concluded that the condylectomy is a safe and effective procedure with low morbidity for patients. PMID:24753777

Aspects of vertebrate gustatory phylogeny: morphology and turnover of chick taste bud cells.

PubMed

Ganchrow, J R; Ganchrow, D; Royer, S M; Kinnamon, J C

1993-10-01

The taste bud is a receptor form observed across vertebrates. The present report compares chick taste buds to those of other vertebrates using light and electron microscopy. Unlike mammals, but common to many modern avians, the dorsal surface of chick anterior tongue lacks taste papillae and taste buds. Ultrastructurally, chick buds located in the anterior floor of the mouth (as in some reptiles and amphibians) and palate contain dark, intermediate, light, and basal cell types. Dark, intermediate, and light cells extend microvilli into intragemmal lumina and pores communicating with the oral cavity. As specialized features, dark cell apices lack dense granules and exhibit short microvilli relative to light and intermediate cells. Dark cell cytoplasmic fingers envelop intragemmal nerve fibers and cells as in other species, and sometimes contain abundant clear vesicles. Nerve profile expansions often are located adjacent to dark, intermediate, and light cell nuclei. Classical afferent synaptic contacts are rarely observed. Taste cell turnover is suggested by mitotic and degenerating figures in chick buds. In addition, tritiated thymidine injected into hatchlings, whose anterior mandibular oral taste bud population approximates that in adults, reveals a turnover rate of about 4.5 days. This is about half that observed in altricial mammals, reflecting a species difference or developmental factor in precocial avians. It is concluded that chick taste buds exhibit morphologic features common to other vertebrate buds with specializations reflecting the influences of niche, glandular relations, and/or age.

Eagle syndrome surgical treatment with piezosurgery.

PubMed

Bertossi, Dario; Albanese, Massimo; Chiarini, Luigi; Corega, Claudia; Mortellaro, Carmen; Nocini, Pierfrancesco

2014-05-01

Eagle syndrome (ES) is an uncommon complication of styloid process elongation with stylohyoideal complex symptomatic calcification. It is an uncommon condition (4% of the population) that is symptomatic in only 4% of the cases. Eagle syndrome is usually an acquired condition that can be related to tonsillectomy or to a neck trauma. A type of ES is the styloid-carotid syndrome, a consequence of the irritation of pericarotid sympathetic fibers and compression on the carotid artery. Clinical manifestations are found most frequently after head turning and neck compression. Although conservative treatment (analgesics, anticonvulsants, antidepressants, local infiltration with steroids, or anesthetic agents) have been used, surgical treatment is often the only effective treatment in symptomatic cases. We present the case of a 55-year-old patient, successfully treated under endotracheal anesthesia. The cranial portion of the calcified styloid process was shortened through an external approach, using a piezoelectric cutting device (Piezosurgery Medical II; Mectron Medical Technology, Carasco, Italy) with MT1-10 insert, pump level 4, vibration level 7. No major postoperative complications such as nerve damage, hematoma, or wound dehiscence occurred. After 6 months, the patient was completely recovered. Two years after the surgery, the patient did not refer any symptoms related to ES. The transcervical surgical approach in patients with ES seems to be safe and effective, despite the remarkable risk for transient marginal mandibular nerve palsy. This risk can be decreased by the use of the piezoelectric device for its distinctive characteristics--such as precision, selective cut action, and bloodless cut.

Management of pediatric mandibular fracture using orthodontic vacuum-formed thermoplastic splint: A case report and review of literature.

PubMed

Sanu, O O; Ayodele, Aos; Akeredolu, M O

2017-05-01

Fractures of the mandible are relatively less frequent in children when compared to adults. The anatomic features of children are protected. Children have a higher adaptation to maxillofacial fractures compared to adults. Treatment principles of mandibular fractures in children differ from that of adults due to concerns regarding mandibular growth and the developing dentition. A case of a 6-year-old boy with fractured mandibular symphysis managed by closed reduction using a vacuum formed thermoplastic splint and circummandibular wiring is presented. This article also provides a review of the literature regarding the management of mandibular fracture in young children.

[Topographological-anatomic changes in the structure of temporo-mandibular joint in case of fracture of the mandible condylar process at cervical level].

PubMed

Volkov, S I; Bazhenov, D V; Semkin, V A

2011-01-01

Pathological changes in soft tissues surrounding the fracture site as well as in the structural elements of temporo-mandibular joint always occured in condylar process fracture with shift at cervical mandibular jaw level. Other changes were also seen in the joint on the opposite normal side. Modelling of condylar process fracture at mandibular cervical level by means of three-dimensional computer model of temporo-mandibular joint contributed to proper understanding of this pathology emergence as well as to prediction and elimination of disorders arising in adjacent to the fracture site tissues.

Mandibular Symmetrical Bilateral Canine-Lateral Incisors Transposition: Its Early Diagnosis and Treatment Considerations.

PubMed

Shapira, Yehoshua; Finkelstein, Tamar; Kadry, Rana; Schonberger, Shirley; Shpack, Nir

2016-01-01

Bilateral mandibular tooth transposition is a relatively rare dental anomaly caused by distal migration of the mandibular lateral incisors and can be detected in the early mixed dentition by radiographic examination. Early diagnosis and interceptive intervention may reduce the risk of possible transposition between the mandibular canine and lateral incisor. This report illustrates the orthodontic management of bilateral mandibular canine-lateral incisor transposition. Correct positioning of the affected teeth was achieved on the left side while teeth on the right side were aligned in their transposed position. It demonstrates the outcome of good alignment of the teeth in the dental arch.

Bilateral mandibular angle fractures: clinical considerations.

PubMed

Boffano, Paolo; Roccia, Fabio

2010-03-01

The mandibular angle is a frequent site of fracture. It is a weak zone that is more exposed to fractures than other areas of the mandibular bone. The presence of incompletely erupted third molars is associated with a further increased risk of angle fractures. Our objective was to evaluate and discuss the surgical outcomes of a group of patients with bilateral mandibular angle fractures.In our study, patients with bilateral mandibular angle fractures surgically treated from January 1, 2001, to June 30, 2009, at the Division of Maxillofacial Surgery of the University of Turin were retrospectively analyzed. A combined transbuccal and intraoral approach or an intraoral approach only was adopted.Eight patients (7 men and 1 woman) underwent surgery for bilateral mandibular angle fractures. Good to satisfactory reduction of the fractures was obtained with both surgical techniques. Good to fair restored occlusion was observed postoperatively in all patients.Successful treatment of bilateral mandibular angle fractures may be achieved via different techniques. Superficially impacted third molars seem to be associated with an increased risk of angle fractures. Bilateral angle fractures are an ideal model to study the biomechanical pathogenesis of angle fractures.

Chincup treatment modifies the mandibular shape in children with prognathism.

PubMed

Alarcón, José Antonio; Bastir, Markus; Rosas, Antonio; Molero, Julia

2011-07-01

Although chincups are the preferred treatment for growing children with mandibular prognathism, the mechanism by which chincups improve this condition remains unclear. The aim of this study was to use geometric morphometrics to evaluate changes in the shape of the mandible of prognathic children treated with a chincup. Geometric morphometrics were used to evaluate the short-term mandibular shape changes in 50 prognathic children treated with chincups compared with 40 untreated matched controls. Twenty-one 2-dimensional mandibular landmarks from cephalograms taken before and after 36 months of treatment or observation were analyzed by Procrustes superimposition and thin plate spline. Permutation tests of the treated patients showed highly significant differences in the mandibular shapes before and after treatment, and compared with the control group after the observation period. The thin plate spline grid deformations indicated more rectangular mandibular configuration, forward condyle orientation, condyle neck compression, gonial area compression, and symphysis narrowing. Early chincup treatment widely modifies the mandibular shape of prognathic children to improve Class III malocclusion. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Effects on G Tolerance While Biting Down on a Mandibular Orthopedic Repositioning Appliance (MORA) Levels.

DTIC Science & Technology

1990-10-01

Repositioning Appliance (MORA) that properly aligns the temporo mandibular joint (TMJ) requires voluntary contraction of the masseter and temporal’s...growth, malocclusion, or bad oral posture may cause the Temporo Mandibular Joint (TMJ) to grad- ually become misaligned. The masseter and other muscles...books have been published on the use of a Mandibular Orthopedic Repositioning Appliance (MORA) to realign the joint (Figure 1). Realignment is claimed

Temporo-mandibular joint chondrosarcoma: Case report and review of the literature.

PubMed

Giorgione, C; Passali, F M; Varakliotis, T; Sibilia, M; Ottaviani, F

2015-06-01

Chondrosarcoma is a malignant mesenchymal tumour of cartilaginous origin. It represents 11% of all malignant primary bone tumours, and the pelvis, ribs, femur and humerus are most frequently involved. Chondrosarcoma of the head and neck region is a rare disease, and represents approximately 0.1% of all head and neck neoplasms. This report describes a rare localisation of chondrosarcoma in a 56-year-old man who presented with swelling in the right preauricular area and mild limitation and pain in the mouth opening. Since 1959, just a few cases of temporomandibular joint (TMJ) chondrosarcoma have been described. Computed tomography revealed a large mass (39 x 46 x 40 mm) in the right preauricular and parotid region with morpho-structural alterations of the condyle and an intense periostotic reaction. The tumour was treated by total parotidectomy and condylotomy. The VII cranial nerve was preserved. Histopathologic examination revealed a low grade chondrosarcoma with a 50% proliferation index. At present, the patient is still receiving routine follow-up after radiotherapy and physiotherapy.

Ultra-low frequency transcutaneous electric nerve stimulation does not affect the centric relation registration.

PubMed

de Bragança, Rafaella Mariana Fontes; Rodrigues, Carolina Almeida; Melchior, Melissa Oliveira; Magri, Laís Valencise; Mazzetto, Marcelo Oliveira

2018-01-01

To evaluate the influence of ULF-TENS on the displacement of the mandibular condyle and on the repeatability of centric relation (CR) registration of three different techniques: bimanual manipulation (BM), long strip technique, and harmonic centric occlusal relationship (R.O.C.A. wires). Twenty-five participants without temporomandibular disorder (TMD) underwent two study stages conducted via electronic position analysis: (1) three CR records were made, one for each manipulation technique; (2) the ULF-TENS was applied for 30 min, and after that the same CR records were repeated. Mann-Whitney, ICC, and one-tailed F test. The ULF-TENS did not influence the condyle total displacement, regardless of CR recording technique used (p > 0.05). BM showed an improvement in repeatability after ULF-TENS. Concerning the variance, BM showed less variation at the X-axis. Long strip technique and R.O.C.A. wires varied less at the Y-axis. Long strip technique was again less variable at the Z-axis.

Removal of a foreign body from the skull base using a customized computer-designed guide bar.

PubMed

Wei, Ran; Xiang-Zhen, Liu; Bing, Guo; Da-Long, Shu; Ze-Ming, Tan

2010-06-01

Foreign bodies located at the base of the skull pose a surgical challenge. Here, a customized computer-designed surgical guide bar was designed to facilitate removal of a skull base foreign body. Within 24h of the patient's presentation, a guide bar and mounting platform were designed to remove a foreign body located adjacent to the transverse process of the atlas and pressing against the internal carotid artery. The foreign body was successfully located and removed using the custom designed guide bar and computer operative planning. Ten months postoperatively the patient was free of complaints and lacked any complications such as restricted opening of the mouth or false aneurysm. The inferior alveolar nerve damage noted immediately postoperatively (a consequence of mandibular osteotomy) was slightly reduced at follow-up, but labial numbness persisted. The navigation tools described herein were successfully employed to aid foreign body removal from the skull base. Copyright (c) 2009 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Partial facial duplication (diprosopus) in a goat kid.

PubMed

Mukaratirwa, S; Sayi, S T

2006-03-01

The anatomical and clinical features of a live-born diprosopic goat kid are described. The kid had two faces with two eyes each, two complete oral cavities and nostrils and two ears. Caudal to the neck, the kid grossly appeared normal. Both mouths of the kid showed synchronous suckling motions. Elevated respiratory and heart rates were recorded and the temperature was subnormal. Radiological examination showed a single trunk and vertebral column, normal limbs, two sets of jaws, three orbits, and contrast radiography revealed a single patent oesophagus. There was maxillary and mandibular duplication resulting in two faces. There was a cleft palate. The oropharyngeal regions of each face merged to form a single laryngopharynx and oesophagus. There was a single brain with hypoplasia of the cerebellum. The left and right cerebral hemispheres were fused rostrally, and there was duplication of the optic chiasma and the pituitary gland. The olfactory tract was absent and the superficial origins of most of the cranial nerves were not discernible.

A Rodent Model of Dynamic Facial Reanimation Using Functional Electrical Stimulation

PubMed Central

Attiah, Mark A.; de Vries, Julius; Richardson, Andrew G.; Lucas, Timothy H.

2017-01-01

Facial paralysis can be a devastating condition, causing disfiguring facial droop, slurred speech, eye dryness, scarring and blindness. This study investigated the utility of closed-loop functional electric stimulation (FES) for reanimating paralyzed facial muscles in a quantitative rodent model. The right buccal and marginal mandibular branches of the rat facial nerve were transected for selective, unilateral paralysis of whisker muscles. Microwire electrodes were implanted bilaterally into the facial musculature for FES and electromyographic (EMG) recording. With the rats awake and head-fixed, whisker trajectories were tracked bilaterally with optical micrometers. First, the relationship between EMG and volitional whisker movement was quantified on the intact side of the face. Second, the effect of FES on whisker trajectories was quantified on the paralyzed side. Third, closed-loop experiments were performed in which the EMG signal on the intact side triggered FES on the paralyzed side to restore symmetric whisking. The results demonstrate a novel in vivo platform for developing control strategies for neuromuscular facial prostheses. PMID:28424583

Mandibular gland secretions of meliponine worker bees: further evidence for their role in interspecific and intraspecific defence and aggression and against their role in food source signalling.

PubMed

Schorkopf, Dirk Louis P; Hrncir, Michael; Mateus, Sidnei; Zucchi, Ronaldo; Schmidt, Veronika M; Barth, Friedrich G

2009-04-01

Like ants and termites some species of stingless bees (Meliponini), which are very important pollinators in the tropics, use pheromone trails to communicate the location of a food source. We present data on the communicative role of mandibular gland secretions of Meliponini that resolve a recent controversy about their importance in the laying of such trails. Volatile constituents of the mandibular glands have been erroneously thought both to elicit aggressive/defensive behaviour and to signal food source location. We studied Trigona spinipes and Scaptotrigona aff. depilis ('postica'), two sympatric species to which this hypothesis was applied. Using extracts of carefully dissected glands instead of crude cephalic extracts we analysed the substances contained in the mandibular glands of worker bees. Major components of the extracts were 2-heptanol (both species), nonanal (T. spinipes), benzaldehyde and 2-tridecanone (S. aff. depilis). The effect of mandibular gland extracts and of individual components thereof on the behaviour of worker bees near their nest and at highly profitable food sources was consistent. Independent of the amount of mandibular gland extract applied, the bees overwhelmingly reacted with defensive behaviour and were never attracted to feeders scented with mandibular gland extract or any of the synthetic chemicals tested. Both bee species are capable of using mandibular gland secretions for intra- and interspecific communication of defence and aggression and share 2-heptanol as a major pheromone compound. While confirming the role of the mandibular glands in nest defence, our experiments provide strong evidence against their role in food source signalling.

Mechanical force-mediated pathological cartilage thinning is regulated by necroptosis and apoptosis.

PubMed

Zhang, C; Lin, S; Li, T; Jiang, Y; Huang, Z; Wen, J; Cheng, W; Li, H

2017-08-01

This study aimed to identify the mechanisms underlying mandibular chondrocyte cell death and cartilage thinning in response to mechanical force. An in vivo model (compressive mechanical force) and an in vitro model (TNF-α+cycloheximide) were used to induce mandibular chondrocyte necroptosis. Hematoxylin and eosin staining and transmission electron microscopy were used to assess histological and subcellular changes in mandibular chondrocyte. Immunohistochemistry, western blotting, and real-time PCR were performed to evaluate changes in necroptotic protein markers. Cell activity, mitochondrial membrane potential (MMP) and reactive oxygen species (ROS) were examined in vitro. The expression of RIP1, RIP3 and Caspase-8 in mandibular chondrocytes significantly increased after 4 days of compressive mechanical force. Furthermore, the inhibition of necroptosis by Necrostatin-1 (Nec-1) or the inhibition of apoptosis by N-benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketone (Z-VAD) partially restored mechanical force-mediated mandibular cartilage thinning and chondrocyte death. Moreover, a synergistic effect on cell death inhibition and mandibular cartilage thickness restoration were found when treated with Nec-1+Z-VAD. The results of the in vitro model were in line with the in vivo ones, indicating that the changes in MMP and ROS generation contributed to mandibular chondrocyte apoptosis and necroptosis. In addition to apoptosis, necroptosis also plays critical roles in pathological changes in mandibular cartilage after compressive mechanical force stimulation, implying RIP1, a master protein that mediates both necroptosis and apoptosis, as a potential therapeutic target in temporal mandibular osteoarthritis. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia

PubMed Central

Ata-Ali, Javier; Oltra-Moscardó, María J.; Peñarrocha-Diago, María; Peñarrocha, Miguel

2012-01-01

Objective: To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. Materials and methods: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for res-pective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Results: A total of 200 oral anesthetic procedures were carried out in 100 patients. The mean patient age was 28.6±9.92 years. Fifty-five vestibular infiltrations and 45 mandibular blocks were performed. All patients were also subjected to IA. The type of intervention (conservative or endodontic) exerted no significant influence (p=0.58 and p=0.62, respectively). The latency period was 8.52±2.44 minutes for the conventional techniques and 0.89±0.73 minutes for IA – the difference being statistically significant (p<0.05). Regarding patient anesthesia sensation, the infiltrative techniques lasted a maximum of one hour, the inferior alveolar nerve blocks lasted between 1-3 hours, and IA lasted only 2.5 minutes – the differences being statistically significant (p≤0.0000, Φ=0.29). Anesthetic success was recorded in 89% of the conventional procedures and in 78% of the IA. Most patients preferred IA (61%) (p=0.0032). Conclusions: The two anesthetic procedures have been compared for latency, duration of anesthetic effect, anesthetic success rate and patient preference. Intraosseous anesthesia has been shown to be a technique to be taken into account when planning conservative and endodontic treatments. Key words: Anesthesia, intraosseous, oral anesthesia, Stabident®, infiltrative, mandibular block. PMID:22143700

Comparison of the expression of neurotransmitter and muscular genesis markers in the postnatal male mouse masseter and trigeminal ganglion during development.

PubMed

Kamata, Hiroaki; Karibe, Hiroyuki; Sato, Iwao

2018-06-01

Calcitonin gene-related peptide (CGRP) is released by motor neurons and affects skeletal muscle fiber and transient receptor potential cation channel subfamily V member 1 (TRPV1), an important marker of pain modulation. However, the expression of CGRP and TRPV1 in the trigeminal ganglion (TG) during changes and in feeding patterns has not been described. We used real-time reverse transcription polymerase chain reaction and in situ hybridization to investigate the mRNA expression levels of CGRP and TRPV1 in the TG. The expression of myosin heavy-chain (MyHC) isoforms was also investigated in the masseter muscle (MM) during the transition from sucking to mastication, an important functional trigger for muscle. The mRNA and protein levels of CGRP increased in the MM and TG from postnatal day 10 (P10) to P20 in male mice. The protein levels of TRPV1 were almost constant in the TG from P10 to P20, in contrast to increases in the MM. The mRNA abundance of TRPV1 in the TG and MM was increased from P10 to P20. The localization of an antisense probe was used to count CGRP cell numbers and found to differentiate the ophthalmic, maxillary, and mandibular nerve divisions of the TG. In particular, the number of CGRP + cells per 10,000 μm 2 in the maxillary and mandibular divisions of the TG gradually changed from P10 to P20. The expression of CGRP and TRPV1 in the TG and MM and the patterns of expression of different MyHC isoforms were affected by changes in feeding during male mouse development. © 2017 Wiley Periodicals, Inc.

Characterizing facial features in individuals with craniofacial microsomia: A systematic approach for clinical research.

PubMed

Heike, Carrie L; Wallace, Erin; Speltz, Matthew L; Siebold, Babette; Werler, Martha M; Hing, Anne V; Birgfeld, Craig B; Collett, Brent R; Leroux, Brian G; Luquetti, Daniela V

2016-11-01

Craniofacial microsomia (CFM) is a congenital condition with wide phenotypic variability, including hypoplasia of the mandible and external ear. We assembled a cohort of children with facial features within the CFM spectrum and children without known craniofacial anomalies. We sought to develop a standardized approach to assess and describe the facial characteristics of the study cohort, using multiple sources of information gathered over the course of this longitudinal study and to create case subgroups with shared phenotypic features. Participants were enrolled between 1996 and 2002. We classified the facial phenotype from photographs, ratings using a modified version of the Orbital, Ear, Mandible, Nerve, Soft tissue (OMENS) pictorial system, data from medical record abstraction, and health history questionnaires. The participant sample included 142 cases and 290 controls. The average age was 13.5 years (standard deviation, 1.3 years; range, 11.1-17.1 years). Sixty-one percent of cases were male, 74% were white non-Hispanic. Among cases, the most common features were microtia (66%) and mandibular hypoplasia (50%). Case subgroups with meaningful group definitions included: (1) microtia without other CFM-related features (n = 24), (2) microtia with mandibular hypoplasia (n = 46), (3) other combinations of CFM- related facial features (n = 51), and (4) atypical features (n = 21). We developed a standardized approach for integrating multiple data sources to phenotype individuals with CFM, and created subgroups based on clinically-meaningful, shared characteristics. We hope that this system can be used to explore associations between phenotype and clinical outcomes of children with CFM and to identify the etiology of CFM. Birth Defects Research (Part A) 106:915-926, 2016.© 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

An orthodontic technique for minimally invasive extraction of impacted lower third molar.

PubMed

Ma, Zhi-Gui; Xie, Qian-Yang; Yang, Chi; Xu, Guang-Zhou; Cai, Xie-Yi; Li, Jie-Yan

2013-08-01

To present a novel orthodontic approach for minimally invasive extraction of impacted mandibular third molars (M3s) close to the inferior alveolar nerve (IAN). Eight patients (8 M3s) requiring extraction of M3s were included in this study; there were 2 cases of horizontal impaction, 4 of mesioangular impaction, and 2 of vertical impaction. Cone-beam computed tomogram showed that the roots of impacted M3s in 2 cases interrupted the cortices of the mandibular canal, and those in the other 6 cases were very close to the IAN. Orthodontic treatment was performed in this study. The crowns of 5 impacted teeth were surgically exposed before the application of the orthodontic device, whereas bonding was performed directly to the occlusal surface of the other 3 M3s, which had partially erupted. The opposing maxillary M3s were removed in 3 cases. One-step orthodontic extraction was applied to vertically impacted M3s and 2-step treatment was applied to horizontally or mesioangularly impacted M3s. Success was defined as the separation of the impacted tooth from the IAN as visualized on cone-beam computed tomogram. After orthodontic treatment, all impacted M3s were extruded and separated from the IAN (mean, 6.6 months; range, 4 to 10 months), without any neurologic consequences. The average time of extraction was 5 minutes. In all 8 cases, new bone formation occurred distal to the adjacent second molar. This orthodontic technique may be a minimally invasive approach for the extraction of impacted M3s adjacent to the IAN, with a decreased risk of paresthesias and with osteoperiodontal advantages. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Comprehensive Analysis of Mandibular Residual Asymmetry after Bilateral Sagittal Split Ramus Osteotomy Correction of Menton Point Deviation

PubMed Central

Lin, Qiuping; Huang, Xiaoqiong; Xu, Yue; Yang, Xiaoping

2016-01-01

Purpose Facial asymmetry often persists even after mandibular deviation corrected by the bilateral sagittal split ramus osteotomy (BSSRO) operation, since the reference facial sagittal plane for the asymmetry analysis is usually set up before the mandibular menton (Me) point correction. Our aim is to develop a predictive and quantitative method to assess the true asymmetry of the mandible after a midline correction performed by a virtual BSSRO, and to verify its availability by evaluation of the post-surgical improvement. Patients and Methods A retrospective cohort study was conducted at the Hospital of Stomatology, Sun Yat-sen University (China) of patients with pure hemi-mandibular elongation (HE) from September 2010 through May 2014. Mandibular models were reconstructed from CBCT images of patients with pre-surgical orthodontic treatment. After mandibular de-rotation and midline alignment with virtual BSSRO, the elongation hemi-mandible was virtually mirrored along the facial sagittal plane. The residual asymmetry, defined as the superimposition and boolean operation of the mirrored elongation side on the normal side, was calculated, including the volumetric differences and the length of transversal and vertical asymmetry discrepancy. For more specific evaluation, both sides of the hemi-mandible were divided into the symphysis and parasymphysis (SP), mandibular body (MB), and mandibular angle (MA) regions. Other clinical variables include deviation of Me point, dental midline and molar relationship. The measurement of volumetric discrepancy between the two sides of post-surgical hemi-mandible were also calculated to verify the availability of virtual surgery. Paired t-tests were computed and the P value was set at .05. Results This study included 45 patients. The volume differences were 407.8±64.8 mm3, 2139.1±72.5 mm3, and 422.5±36.9 mm3; residual average transversal discrepancy, 1.9 mm, 1.0 mm, and 2.2 mm; average vertical discrepancy, 1.1 mm, 2.2 mm, and 2.2 mm (before virtual surgery). The post-surgical volumetric measurement showed no statistical differences between bilateral mandibular regions. Conclusions Mandibular asymmetry persists after Me point correction. A 3D quantification of mandibular residual asymmetry after Me point correction and mandible de-rotation with virtual BSSRO sets up a true reference mirror plane for comprehensive asymmetry assessment of bilateral mandibular structure, thereby providing an accurate guidance for orthognathic surgical planning. PMID:27571364

Comprehensive Analysis of Mandibular Residual Asymmetry after Bilateral Sagittal Split Ramus Osteotomy Correction of Menton Point Deviation.

PubMed

Lin, Han; Zhu, Ping; Lin, Qiuping; Huang, Xiaoqiong; Xu, Yue; Yang, Xiaoping

2016-01-01

Facial asymmetry often persists even after mandibular deviation corrected by the bilateral sagittal split ramus osteotomy (BSSRO) operation, since the reference facial sagittal plane for the asymmetry analysis is usually set up before the mandibular menton (Me) point correction. Our aim is to develop a predictive and quantitative method to assess the true asymmetry of the mandible after a midline correction performed by a virtual BSSRO, and to verify its availability by evaluation of the post-surgical improvement. A retrospective cohort study was conducted at the Hospital of Stomatology, Sun Yat-sen University (China) of patients with pure hemi-mandibular elongation (HE) from September 2010 through May 2014. Mandibular models were reconstructed from CBCT images of patients with pre-surgical orthodontic treatment. After mandibular de-rotation and midline alignment with virtual BSSRO, the elongation hemi-mandible was virtually mirrored along the facial sagittal plane. The residual asymmetry, defined as the superimposition and boolean operation of the mirrored elongation side on the normal side, was calculated, including the volumetric differences and the length of transversal and vertical asymmetry discrepancy. For more specific evaluation, both sides of the hemi-mandible were divided into the symphysis and parasymphysis (SP), mandibular body (MB), and mandibular angle (MA) regions. Other clinical variables include deviation of Me point, dental midline and molar relationship. The measurement of volumetric discrepancy between the two sides of post-surgical hemi-mandible were also calculated to verify the availability of virtual surgery. Paired t-tests were computed and the P value was set at .05. This study included 45 patients. The volume differences were 407.8±64.8 mm3, 2139.1±72.5 mm3, and 422.5±36.9 mm3; residual average transversal discrepancy, 1.9 mm, 1.0 mm, and 2.2 mm; average vertical discrepancy, 1.1 mm, 2.2 mm, and 2.2 mm (before virtual surgery). The post-surgical volumetric measurement showed no statistical differences between bilateral mandibular regions. Mandibular asymmetry persists after Me point correction. A 3D quantification of mandibular residual asymmetry after Me point correction and mandible de-rotation with virtual BSSRO sets up a true reference mirror plane for comprehensive asymmetry assessment of bilateral mandibular structure, thereby providing an accurate guidance for orthognathic surgical planning.

[Exploring a new method for superimposition of pre-treatment and post-treatment mandibular digital dental casts in adults].

PubMed

Dai, F F; Liu, Y; Xu, T M; Chen, G

2018-04-18

To explore a cone beam computed tomography (CBCT)-independent method for mandibular digital dental cast superimposition to evaluate three-dimensional (3D) mandibular tooth movement after orthodontic treatment in adults, and to evaluate the accuracy of this method. Fifteen post-extraction orthodontic treatment adults from the Department of Orthodontics, Peking University School and Hospital of Stomatology were included. All the patients had four first premolars extracted, and were treated with straight wire appliance. The pre- and post-treatment plaster dental casts and craniofacial CBCT scans were obtained. The plaster dental casts were transferred to digital dental casts by 3D laser scanning, and lateral cephalograms were created from the craniofacial CBCT scans by orthogonal projection. The lateral cephalogram-based mandibular digital dental cast superimposition was achieved by sequential maxillary dental cast superimposition registered on the palatal stable region, occlusal transfer, and adjustment of mandibular rotation and translation obtained from lateral cephalogram superimposition. The accuracy of the lateral cephalogram-based mandibular digital dental cast superimposition method was evaluated with the CBCT-based mandibular digital dental cast superimposition method as the standard reference. After mandibular digital dental cast superimposition using both methods, 3D coordinate system was established, and 3D displacements of the lower bilateral first molars, canines and central incisors were measured. Differences between the two superimposition methods in tooth displacement measurements were assessed using the paired t-test with the level of statistical significance set at P<0.05. No significant differences were found between the lateral cephalogram-based and CBCT-based mandibular digital dental cast superimposition methods in 3D displacements of the lower first molars, and sagittal and vertical displacements of the canines and central incisors; transverse displacements of the canines and central incisors differed by (0.3±0.5) mm with statistical significance. The lateral cephalogram-based mandibular digital dental cast superimposition method has the similar accuracy as the CBCT-based mandibular digital dental cast superimposition method in 3D evaluation of mandibular orthodontic tooth displacement, except for minor differences for the transverse displacements of anterior teeth. This method is applicable to adult patients with conventional orthodontic treatment records, especially the previous precious orthodontic data in the absence of CBCT scans.

The Application of 3D Printing Technology for Simultaneous Orthognathic Surgery and Mandibular Contour Osteoplasty in the Treatment of Craniofacial Deformities.

PubMed

Xiao, Yanju; Sun, Xiumei; Wang, Lin; Zhang, Yaoyao; Chen, Kai; Wu, Guomin

2017-12-01

Because of the limitation of specific preoperative design and surgical templates, orthognathic surgery and mandibular contour osteoplasty are generally performed in two stages. Three-dimensional printing technology has improved the accuracy of the surgery and results in good surgical predictability easily. This study aims to confirm the effectiveness, feasibility and precision of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. Ten patients, who were diagnosed with mandibular hypertrophy and bimaxillary deformities, were included in the study. In addition to conventional orthognathic surgery, mandibular angle ostectomy, mandibular outer cortex grinding or mandibular border ostectomy was designed for mandibular hypertrophy. Optimal osteotomy lines and simulated surgeries were designed according the 3D printing model of the mandible. Then, surgical templates were made on the 3D printing model. No muscle excision was performed in any patient. Preoperative, predicted and postoperative measurements were taken, including the gonial angle (Ar-Go-Me) and the mandibular width (Go-Go). All the patients had a reposeful postoperative recovery, with no indication of obvious infection, facial paralysis, osteonecrosis or bone displacement. The gonial angle was improved from 110.3° ± 11.1 to 121.3° ± 2.9, and the mandibular width was improved from 117.5 mm ± 6.8 to 111.9 mm ± 4.2. The discrepancies between simulation and postoperation of the left gonial angle, the right gonial angle and the mandibular width were 0.56° ± 0.22, 0.65° ± 0.3 and 0.49 mm ± 0.43, respectively. The results of our study illustrated the predictability, feasibility and reliability of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. Our technique could achieve functional improvement and an aesthetic profile at the same time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[The transverse movement of the temporo-mandibular joint (translation movement) of the dog, also with reference to dysplasia of this joint in the dachshund].

PubMed

Vollmerhaus, B; Roos, H

1996-09-01

Contrary to the accepted opinion, transverse movement is possible in the temporo-mandibular joint of the dog. This movement is arched and is important for mastication. Analysis of transverse movement of the temporo-mandibular joint was done in 20 dog breeds. Accidentally dysplasia of the temporo-mandibular joint was found in the dachshund, a phenomenon which has not been described before.

3-Dimensional Reproducibility of Natural Head Position

DTIC Science & Technology

2012-04-12

the “Six Elements to Orofacial Harmony”. He advocated using his Element II Analysis with natural head orientation for treatment planning, since “it...temporomandibular disorders, neck pain , headache, dentofacial structures, mandibular length, mandibular position, mandibular divergency and overjet (Cuccia, 2009

Prosthetic plate mandibular reconstruction.

PubMed

Davidson, M J; Gullane, P J

1991-12-01

The head and neck surgeon may choose one of several available methods to reconstruct the mandible following tumor ablation. This article discusses the use of metallic mandibular prostheses, the indications for alloplastic mandibular reconstruction, techniques of plate application (AO and THRP), and associated complications.

Mechanics in the Production of Mandibular Fractures: A Clinical, Retrospective Case-Control Study

PubMed Central

Yang, Rongtao; Li, Zhi; Li, Zubing

2016-01-01

As the mandible is susceptible to fracture, the aim of this study was to use multivariate logistic regression analysis to identify and distinguish various internal factors that may influence the location of mandibular fractures. The study included 1131 patients with maxillofacial fractures during the period from January 2000 to December 2009 to evaluate the association of mandibular fracture location (unilateral symphysis, body, angle, condylar, or bilateral condylar fractures) with various internal factors. Among the 1131 patients, 869 had mandibular fractures. Data on age, sex, soft tissue injuries, dental trauma, and maxillofacial fracture type were collected and analyzed using multivariate logistic regression. In total, 387, 210, 139, 319, and 172 patients were diagnosed with unilateral symphysis, body, angle, unilateral, or bilateral condylar fractures, respectively. The dental trauma in patients with bilateral condylar fractures differed from that in patients with unilateral condylar fractures. Patients with mandibular fracture (unilateral symphysis, body, unilateral or bilateral condylar) possessed an approximately equal risk of soft tissue injuries in the mandible. Patients with either unilateral or bilateral condylar fractures were associated with a low risk of mandibular angle fracture (OR < 1). Similarly, patients with mandibular angle fracture were associated with a low risk of unilateral or bilateral condylar fractures (OR < 1). Moreover, patients with symphysis fracture were associated with a low risk of bilateral condylar fractures (90 of 387 [23.3%], OR 0.899). By contrast, patients with bilateral condylar fractures were associated with a high risk of symphysis fracture (90 of 172 [52.3%], OR 17.38). Patients with condylar fractures, particularly those with bilateral condylar fractures, were infrequently associated with secondary mandibular fractures. Mandibular fractures tended to have less of an association with midfacial fractures. The occurrence of mandibular fractures is strongly correlated with age, sex, soft tissue injuries, dental trauma, and the pattern and position of the maxillofacial fractures in patients. PMID:26900699

Lidocaine Concentration in Mandibular Bone After Subperiosteal Infiltration Anesthesia Decreases With Elevation of Periosteal Flap and Irrigation With Saline

PubMed Central

Ogawa, Sachie; Watanabe, Masahiro; Kawaai, Hiroyoshi; Tada, Hitoshi; Yamazaki, Shinya

2014-01-01

It has been reported that the action of infiltration anesthesia on the jawbone is attenuated significantly by elevation of the periosteal flap with saline irrigation in clinical studies; however, the reason is unclear. Therefore, the lidocaine concentration in mandibular bone after subperiosteal infiltration anesthesia was measured under several surgical conditions. The subjects were 48 rabbits. Infiltration anesthesia by 0.5 mL of 2% lidocaine with 1 : 80,000 epinephrine (adrenaline) was injected into the right mandibular angle and left mandibular body, respectively. Under several surgical conditions (presence or absence of periosteal flap, and presence or absence of saline irrigation), both mandibular bone samples were removed at a fixed time after subperiosteal infiltration anesthesia. The lidocaine concentration in each mandibular bone sample was measured by high-performance liquid chromatography. As a result, elevation of the periosteal flap with saline irrigation significantly decreased the lidocaine concentration in the mandibular bone. It is suggested that the anesthetic in the bone was washed out by saline irrigation. Therefore, supplemental conduction and/or general anesthesia should be utilized for long operations that include elevation of the periosteal flap with saline irrigation. PMID:24932978

Thin-plate spline graphical analysis of the mandible in mandibular prognathism.

PubMed

Chang, Hsin-Fu; Chang, Hong-Po; Liu, Pao-Hsin; Chang, Chih-Han

2002-11-01

The chin cup has been used to treat skeletal mandibular prognathism in growing patients for 200 years. The pull on the orthopedic-force chin cup is oriented along a line from the mandibular symphysis to the mandibular condyle. Various levels of success have been reported with this restraining device. The vertical chin cup produces strong vertical compression stress on the maxillary molar regions when the direction of traction is 20 degrees more vertical than the chin-condyle line. This treatment strategy may prevent relapse due to counter-clockwise rotation of the mandible. In this report, we describe a new strategy for using chin-cup therapy involving thin-plate spline (TPS) analysis of lateral cephalometric roentgenograms to visualize transformation of the mandible. The actual sites of mandibular skeletal change are not detectable with conventional cephalometric analysis. A case of mandibular prognathism treated with a chin cup and a case of dental Class III malocclusion without orthodontic treatment are described. The case analysis illustrates that specific patterns of mandibular transformation are associated with Class III malocclusion with or without orthopedic therapy, and that visualization of these deformations is feasible using TPS graphical analysis.

Effects of bite-jumping appliances on mandibular advancement in growing rats: A radiographic study

PubMed Central

Oksayan, Ridvan; Sokucu, Oral; Ucuncu, Neslihan

2014-01-01

Objective: The aim was to evaluate the effects of the use of mandibular advancement appliances on mandibular growth in growing rats. Materials and Methods: Twenty-four 8-week-old male Wistar albino rats were randomly divided into two experimental groups (12 rats each): Group I was a control group, and Group II was the mandibular advancement appliance group. A functional bite-jumping appliance was used in Group II to promote mandibular advancement. Anatomical changes in the condyle and mandible were evaluated by comparing radiographic results from before and after the study, with angular and linear measurements. Friedman and Mann-Whitney U-tests were used in statistical analysis. Results: According to the radiographic results, the growth of mandibles and condyles in Group II was significantly greater than with the length of the condylar process (A-B) and distance from condyle to menton (A-D) variables (P < 0.05). In addition, Group I showed greater mandibular base growth than did Group II (P < 0.05). Conclusions: We conclude that the use of an intraoral bite-jumping appliance can stimulate condylar growth and increase sagittal mandibular advancement in growing rats. PMID:25202205

Anterior mandibular apical base augmentation in the surgical orthodontic treatment of mandibular retrusion.

PubMed

Brusati, R; Giannì, A B

2005-12-01

The authors describe a surgical technique alternative to traditional pre-surgical orthodontics in order to increase the apical base in mandibular retrusion (class II, division I). This subapical osteotomy, optimizing inferior incisal axis without dental extractions and a long orthodontic treatment, associated to genioplasty permits to obtain an ideal labio-dento-mental morphology. This procedure avoids in some cases the need of a mandibular advancement and, if necessary, it reduces his entity with obvious advantages.

Mandibular canine index: A study for gender determination in Gandhinagar population

PubMed Central

Patel, Roseline Ankit; Chaudhary, Anjani Ramchandra; Dudhia, Bhavin Bipinchandra; Macwan, Zonty Sylvestor; Patel, Purv Shashank; Jani, Yesha Vijaykumar

2017-01-01

Introduction: One of the important pieces of information gathered from tooth analysis is the sex of an individual. In most human living populations, mandibular canines show the greatest dimorphism and greatest dimensional differences between males and females. In view of these facts, the aim of this study was to establish the standard mandibular canine index (MCI) and estimate the sexual dimorphism in the population of Gandhinagar district of Gujarat state. Materials and Methods: The study consisted of 400 subjects, 200 males and 200 females in the age group of 20–40 years. The mesiodistal (MD) width of the right and left canine and the intercanine distance were measured. These values were used to derive the MCI and establish the amount of sexual dimorphism exhibited by the mandibular canine. Results: The MD crown width of the permanent mandibular right and left canines as well as mandibular intercanine distance of the males was found to be larger in size than in the females. The right mandibular canine exhibited 8.42% of sexual dimorphism while the left mandibular canine exhibited 8.40% of sexual dimorphism. The intercanine distance showed 2.75% of sexual dimorphism. The value of standard MCI derived using the formula devised by Rao et al. was 0.254 mm for the population residing in the Gandhinagar district. Conclusion: The present study supports the usefulness of the MCI in gender determination. The method of using mandibular canine indices is advantageous as it is easy, rapid, and cost-effective, requires no elaborate apparatus, and is suited for situations where large a number of samples have to be analyzed. PMID:29657490

Impaction of permanent mandibular second molar: A retrospective study

PubMed Central

Altieri, Federica; Di Mambro, Alfonso; Galluccio, Gabriella; Barbato, Ersilia

2013-01-01

Objective: To determine the prevalence of impacted mandibular second molar (MM2) and the association between MM2 impaction and crowding. The clinical significance of the angle between first and second mandibular molar and of the space between the first mandibular molar (MM1) and the anterior margin of mandibular ramus in MM2 impaction were also evaluated. Material and Methods: In this retrospective study , from the dental records of 2,945 caucasian young orthodontics patients, 40 subjects with MM2 impaction were included in a study group (SG) and compared with a control group (CG) of 200 subjects without MM2 impactions. The crowding, the angle of inclination of MM2, the distance between MM1 and mandibular ramus, the canine and molar relationships, and the lower centre line discrepancy were measured. For the statistical analysis , descriptive statistics and t-Student for independent sample groups were used. Results: The prevalence of impacted MM2 was 1.36%. The independent-Samples t-Test between SG and CG showed: the presence of crowding (P≤0.001), an higher angle values of MM2 inclination (P≤0.001) and a smaller distance between MM1 and the anterior margin of mandibular ramus (P≤0.001) in the SG. Conclusion: The impaction of MM2 is a relatively rare occurrence in orthodontic caucasian populations. The crowding, a higher angle values of MM2 inclination and a reduced distance between MM1 and the anterior margin of mandibular ramus, at the time of one third of MM2 root formation (T1), characterize MM2 impaction. Key words:Impacted mandibular second molar, impaction, orthodontics. PMID:23524438

Biology of biomechanics: Finite element analysis of a statically determinate system to rotate the occlusal plane for correction of a skeletal Class III open-bite malocclusion.

PubMed

Roberts, W Eugene; Viecilli, Rodrigo F; Chang, Chris; Katona, Thomas R; Paydar, Nasser H

2015-12-01

In the absence of adequate animal or in-vitro models, the biomechanics of human malocclusion must be studied indirectly. Finite element analysis (FEA) is emerging as a clinical technology to assist in diagnosis, treatment planning, and retrospective analysis. The hypothesis tested is that instantaneous FEA can retrospectively simulate long-term mandibular arch retraction and occlusal plane rotation for the correction of a skeletal Class III malocclusion. Seventeen published case reports were selected of patients treated with statically determinate mechanics using posterior mandible or infrazygomatic crest bone screw anchorage to retract the mandibular arch. Two-dimensional measurements were made for incisor and molar movements, mandibular arch rotation, and retraction relative to the maxillary arch. A patient with cone-beam computed tomography imaging was selected for a retrospective FEA. The mean age for the sample was 23.3 ± 3.3 years; there were 7 men and 10 women. Mean incisor movements were 3.35 ± 1.55 mm of retraction and 2.18 ± 2.51 mm of extrusion. Corresponding molar movements were retractions of 4.85 ± 1.78 mm and intrusions of 0.85 ± 2.22 mm. Retraction of the mandibular arch relative to the maxillary arch was 4.88 ± 1.41 mm. Mean posterior rotation of the mandibular arch was -5.76° ± 4.77° (counterclockwise). The mean treatment time (n = 16) was 36.2 ± 15.3 months. Bone screws in the posterior mandibular region were more efficient for intruding molars and decreasing the vertical dimension of the occlusion to close an open bite. The full-cusp, skeletal Class III patient selected for FEA was treated to an American Board of Orthodontics Cast-Radiograph Evaluation score of 24 points in about 36 months by en-masse retraction and posterior rotation of the mandibular arch: the bilateral load on the mandibular segment was about 200 cN. The mandibular arch was retracted by about 5 mm, posterior rotation was about 16.5°, and molar intrusion was about 3 mm. There was a 4° decrease in the mandibular plane angle to close the skeletal open bite. Retrospective sequential iterations (FEA animation) simulated the clinical response, as documented with longitudinal cephalometrics. The level of periodontal ligament stress was relatively uniform (<5 kPa) for all teeth in the mandibular arch segment. En-masse retraction of the mandibular arch is efficient for conservatively treating a skeletal Class III malocclusion. Posterior mandibular anchorage causes intrusion of the molars to close the vertical dimension of the occlusion and the mandibular plane angle. Instantaneous FEA as modeled here could be used to reasonably predict the clinical results of an applied load. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

A Simplified Way for the Stabilization of Pediatric Mandibular Fracture With an Occlusal Splint.

PubMed

Demirkol, Mehmet; Demirkol, Nermin; Abdo, Omar Hasan; Aras, Mutan Hamdi

2016-06-01

The management of pediatric mandibular fractures is challenging for maxillofacial surgeons due to ongoing mandibular growth involving tooth buds. The treatment of such fractures has been a topic of much research. Generally accepted methods for the treatment of mandibular parasymphyseal or symphyseal fractures in children are conservative approaches involving the use of acrylic splints, lateral compression with an open-cap splint stabilized by circummandibular wiring, and maxillomandibular fixation with an arch bar and eyelet wiring. The aim of this technical note was to describe a straightforward approach to the treatment of pediatric mandibular fractures, in which an occlusal splint is secured to prevent trauma to the soft tissue, without the need for general anesthesia.

Pediatric mandibular fractures treated by rigid internal fixation.

PubMed

Wong, G B

1993-09-01

Mandibular fractures in the pediatric patient population are relatively uncommon. These patients present with their own unique treatment requirements. Most fractures have been treated conservatively by dental splints. Closed reduction techniques with maxillomandibular fixation (MMF) in very young children can pose several concerns, including cooperation, compliance and adequate nutritional intake. Rigid internal fixation of unstable mandibular fractures using miniplates and screws circumvents the need for MMF and allows immediate jaw mobilization. At major pediatric trauma institutions, there has been an increasing trend toward the use of this treatment when open reduction is necessary. This article presents a report of a five-year-old child who presented with bilateral mandibular fractures and was treated by rigid internal fixation and immediate mandibular mobilization.

Influence of mandibular morphology on the hyoid bone in atypical deglutition: a correlational study.

PubMed

Machado, Almiro J; Crespo, Agrício N

2011-11-01

evaluate the possible correlation with the radiographic position of the hyoid bone and mandibular angle in lateral radiographs of children with atypical deglutition. This was an observational study using cephalometric analysis of lateral teleradiographs for the distances of H-MP (hyoid to mandibular plane). Spearman's correlation analysis was performed with MA (mandibular angle) in two groups: the experimental group with atypical deglutition and the control group normal deglutition. Both groups included subjects in mixed dentition stage. there was a significant moderate negative correlation between MA (mandibular angle) and hyoid bone (H-MP) in the normal group (R = -0.406, p = 0.021). However, there was no significant correlation between the MA and H-MP (R = 0.029, p = 0.83) in the group with atypical deglutition. there is a moderate negative correlation between the position of the hyoid bone and mandibular angle in the group of normal swallowing and there is no correlation between variables H-MP and MA in the group of atypical swallowing.

Mandibular growth changes and cervical vertebral maturation. a cephalometric implant study.

PubMed

Gu, Yan; McNamara, James A

2007-11-01

To evaluate mandibular dimensional changes and regional remodeling occurring during five intervals of circumpubertal growth. This investigation evaluated a unique sample of subjects in whom tantalum implants were placed into the craniofacial complex during childhood. The sample was obtained from the Mathews and Ware implant study originally conducted at the University of California San Francisco in the 1970s, with longitudinal cephalometric records of 20 subjects (13 female, 7 male) available for evaluation. Cephalograms at six consecutive stages of cervical vertebral maturation (CS1 through CS6) were analyzed. Peak mandibular growth was noted during the interval from CS3 to CS4. Forward rotation of the mandible was due to greater mandibular growth posteriorly than anteriorly. Progressive closure of the condylar-ramus-occlusal (CRO) angle resulted in a forward and upward orientation of the ramus relative to the corpus of the mandible due to increased vertical growth of the condyle. A peak in mandibular growth at puberty was substantiated. Mandibular remodeling and condylar rotation continue to occur after the growth spurt.

[Stress analysis of the mandible by 3D FEA in normal human being under three loading conditions].

PubMed

Sun, Jian; Zhang, Fu-qiang; Wang, Dong-wei; Yu, Jia; Wang, Cheng-tao

2004-02-01

The condition and character of stress distribution in the mandibular in normal human being during centric, protrusive, laterotrusive occlusion were analysed. The three-dimensional finite element model of the mandibular was developed by helica CT scanning and CAD/CAM software, and three-dimensional finite element stress analysis was done by ANSYS software. Three-dimensional finite element model of the mandibular was generated. Under these three occlusal conditions, the stress of various regions in the mandible were distributed unequally, and the stress feature was different;while the stress of corresponding region in bilateral mandibular was in symmetric distribution. The stress value of condyle neck, the posterior surface of coronoid process and mandibular angle were high. The material properties of mandible were closely correlated to the value of stress. Stress distribution were similar according to the three different loading patterns, but had different effects on TMJ joint. The concentrated areas of stress were in the condyle neck, the posterior surface of coronoid process and mandibular angle.

Craniofacial morphometric analysis of mandibular prognathism.

PubMed

Chang, H P; Liu, P H; Yang, Y H; Lin, H C; Chang, C H

2006-03-01

The purpose of this study was to provide more information about the morphological characteristics of the craniofacial complex in mandibular prognathism. Forty young adult males having mandibular prognathism were compared with 40 having normal occlusion. This was conducted to carry out geometric morphometric assessments to localize alterations, using Procrustes analysis and thin-plate spline analysis, in addition to conventional cephalometric techniques. Procrustes analysis indicated that the mean craniofacial, midfacial and mandibular morphology was significantly different in prognathic subjects compared with normal controls. This finding was corroborated by the multivariate Hotelling T(2)-test of cephalometric variables. Mandibular prognathism demonstrated a shorter and slightly retropositioned maxilla, a greater total length and anterior positioning of the mandible. Thin-plate spline analysis revealed a developmental diminution of the palatomaxillary region anteroposteriorly and a developmental elongation of the mandible anteroposteriorly, leading to the appearance of a prognathic mandibular profile. In conclusion, thin-plate spline analysis seems to provide a valuable supplement for conventional cephalometric analysis because the complex patterns of craniofacial shape change are visualized suggestive by means of grid deformations.

[Maxillo-facial surgery in skeletal Class II: repercussions on the temporo-mandibular joints].

PubMed

Manière-Ezvan, Armelle; Savoldelli, Charles; Busson, Floriant; Oueiss, Arlette; Orthlieb, Jean-Daniel

2016-03-01

These interventions usually aimed at the correction of the skeletal discrepancy by mandibular retrognatism with an advancement of the distal portion of the mandible after mandibular osteotomy. The position of the condyle is determined during the osteosynthesis with miniplates. Condyles are set back in relation with the supine position of the patient and the weakness of his (her) curarized muscle. All studies show that surgery of mandibular advancement causes a lateral, torque and backward movement of the condyles, all harmful to the condyles. Factors that predispose to condylar resorption are "the patient": a woman, young (between 15 and 40), high mandibular angle, with a history of temporo-mandibular disorders and surgical overload applied to the condyles. What are the possible solutions to avoid failures? Patient preparation before surgery and surgery simulation with an articulator, condylar position control during surgery, working with surgeons to achieve a condylar portion stabilization system (with the CAD), quickly set up a mobilization of the mandible by physiotherapy. © EDP Sciences, SFODF, 2016.

Skeletal maturity assessment using mandibular canine calcification stages.

PubMed

Džemidžić, Vildana; Tiro, Alisa; Zukanović, Amila; Redžić, Ismeta; Nakaš, Enita

2016-11-01

The aims of this study were: to investigate the relationship between mandibular canine calcification stages and skeletal maturity; and to evaluate whether the mandibular canine calcification stages may be used as a reliable diagnostic tool for skeletal maturity assessment. This study included 151 subjects: 81 females and 70 males, with ages ranging from 9 to 16 years (mean age: 12.29±1.86 years). The inclusion criteria for subjects were as follows: age between 9 and 16 years; good general health without any hormonal, nutritional, growth or dental development problems. Subjects who were undergoing or had previously received orthodontic treatment were not included in this study. The calcification stages of the left permanent mandibular canine were assessed according to the method of Demirjian, on panoramic radiographs. Assessment of skeletal maturity was carried out using the cervical vertebral maturation index (CVMI), as proposed by the Hassel-Farman method, on lateral cephalograms. The correlation between the calcification stages of mandibular canine and skeletal maturity was estimated separately for male and female subjects. Correlation coefficients between calcification stages of mandibular canine and skeletal maturity were 0.895 for male and 0.701 for female subjects. A significant correlation was found between the calcification stages of the mandibular canine and skeletal maturity. The calcification stages of the mandibular canine show a satisfactory diagnostic performance only for assessment of pre-pubertal growth phase. Copyright © 2016 by Academy of Sciences and Arts of Bosnia and Herzegovina.

Stress analysis at bone-implant interface of single- and two-implant-retained mandibular overdenture using three-dimensional finite element analysis.

PubMed

Lahoti, Krishnakumar; Pathrabe, Anup; Gade, Jaykumar

2016-01-01

The purpose of this research was to compare stress distribution on the bone between single implant-retained and two-implant-retained mandibular overdentures using three-dimensional (3D) finite element analysis. Two 3D finite element models were designed. The first model included single implant-supported mandibular overdenture placed in the midline of the mandible while the second model included two-implant-supported mandibular overdenture placed in the intra-foramen region, retained by ball attachment of the same diameter. The bone was modeled on the D2 bone depending on the classification given by Misch. A computed tomography scan of the mandible was used to model the bone by plotting the key points on the graph and generating the identical key points on the ANSYS Software (ANSYS, Inc., USA). The implant was modeled using appropriate dimensions as provided by the manufacturer. Stresses were calculated based on the von Mises criteria. Stresses produced in the hard bone (HB) and soft bone (SB) were higher in single implant-retained mandibular overdenture while stresses produced around the denture as well as implant were higher in two-implant-retained mandibular overdenture. Within the limitations of the study, it had been seen that stresses produced were the highest on HB and SB in single implant-retained mandibular overdenture while stresses produced across the denture as well as implant were the highest in two-implant-retained mandibular overdenture.

Assessment of Growth Using Mandibular Canine Calcification Stages and Its Correlation with Modified MP3 Stages.

PubMed

Nayak, Reshma; Nayak, Us Krishna; Hegde, Gautam

2010-01-01

Orthodontic diagnosis and treatment planning for growing children must involve growth prediction, especially in the treatment of skeletal problems. Studies have shown that a strong association exists between skeletal maturity and dental calcification stages. The present study was therefore taken up to provide a simple and practical method for assessing skeletal maturity using a dental periapical film and standard dental X-ray machine, to compare the developmental stages of the mandibular canine with that of developmental stages of modified MP3 and to find out if any correlation exists, to determine if the developmental stages of the mandibular canine alone can be used as a reliable indicator for assessment of skeletal maturity. A total of 160 periapical radiographs (80 males and 80 females), of the mandibular right canine and the MP3 region was taken and assessed according to the Dermirjian's stages of dental calcification and the modified MP3 stages. The correlation between the developmental stages of MP3 and the mandibular right canine in male and female groups, is of high statistical significance (p = 0.001). The correlation coefficient between MP3 stages and developmental stages of mandibular canine and chronological age in male and females was found to be not significant. The correlation between the mandibular canine calcification stages and MP3 stages was found to be significant. The developmental stages of the mandibular canine could be used very reliably as a sole indicator for assessment of skeletal maturity.

Association between eruption state of the third molar and the occurrence of mandibular angle fractures.

PubMed

Rahimi-Nedjat, Roman K; Sagheb, Keyvan; Jacobs, Collin; Walter, Christian

2016-10-01

Fractures of the mandible, especially the mandibular angle, are one of the most frequent types of injuries of the facial skeleton. In many cases, a retained third molar can be found in the line of the fracture. However, it remains unclear whether a relationship between third molars and mandibular angle fractures exists. Patients with isolated or combined fractures of the lower jaw between January 2001 and December 2007 were analyzed retrospectively. Electronic health records were investigated regarding the types of mandibular fractures, and panoramic radiographs were reviewed concerning the existence of third molars. In addition, a systematic review was performed to compare the findings of this study with existing data. Six hundred and thirty-two patients were treated for mandibular fractures within the time frame. Two hundred and sixty-seven had a mandibular angle fracture. In 461 patients, panoramic radiographs were available, of which 45.6% did not have a third molar. About 3.8% were edentulous. There is a significant relationship between the existence of unerupted third molars and the occurrence of mandibular angle fractures (P < 0.001). No correlation exists for erupted third molars. Fractures of the mandibular angle are more likely to appear in patients with retained third molars which might be due to the reduced bone mass. Once the wisdom teeth have erupted, the bone structure is more solid and more resistant to external forces and the development of fractures. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Protraction of mandibular second and third molars assisted by partial corticision and miniscrew anchorage.

PubMed

Mimura, Hiroshi

2013-08-01

A woman, aged 47 years 6 months, with an anterior open bite and a left-shifted mandible was treated with a mandibular right first molar extraction and without orthognathic surgery. However, her mandibular second molar did not move mesially during treatment because of the dense lamina dura; therefore, corticision was applied only on the mesial aspect of the mandibular second molar, and a miniscrew was inserted simultaneously. Corticision was introduced as a supplemental dentoalveolar surgery in orthodontic therapy to achieve accelerated tooth movement with minimal surgical intervention. In this technique, a reinforced scalpel was used as a thin chisel to separate the interproximal cortices transmucosally without a flap. This technique was applied not to accelerate tooth movement, but to protract the mandibular molars. One miniscrew was inserted on the mesiobuccal side of the mandibular right molar for protraction and intrusion. In addition, 2 miniscrews were inserted in the buccal sides of the maxillary first and second molars and the palatal side of the maxillary first molar to intrude them for correction of the mandibular shift and the cant of the occlusal plane. Excellent occlusion and correction of the anterior open bite were achieved without surgery. At the 2-year follow-up examination, the patient had a good occlusion and showed good stability with no opening of the extraction space. A partial corticision is an effective option for facilitating movement of mandibular molars. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Maxillary-driven simultaneous maxillo-mandibular distraction for hemifacial microsomia.

PubMed

Nakajima, Hideo; Sakamoto, Yoshiaki; Tamada, Ikkei; Ogata, Hisao; Kishi, Kazuo; Sakamoto, Teruo

2011-12-01

We treat hemifacial microsomia with a combination of surgery and orthodontic treatment during the growth period, resulting in early improvement in facial asymmetry and the induction of normal growth. We previously used gradual distraction of the mandibular ramus for Pruzansky's type II classification (Pruzansky, 1969). In type II cases, the maxilla should also be treated actively as, using this technique, improvement of the occlusal plane is difficult to achieve, resulting in a cross bite and difficulties in post-operative orthodontic treatment-especially in older patients. Morphologically, the mandibular angle region of the operative side is flat, and the angle of the mouth remains elevated. We performed mandibular-driven simultaneous maxillo-mandibular distraction while the occlusion was maintained using intermaxillary anchorage. However, mandibular-driven distraction tended to elongate the face because the mandible only elongated downwards and the mandibular ramus did not reach the glenoid. Furthermore, external distraction devices produce significant distress for patients until removal of the device and cause scars on the face. We developed a new internal distraction device with a variable angle and performed maxillary-driven simultaneous maxillo-mandibular distraction using this device. The result was morphologically satisfactory and solved the above problems. Because the patient was in the growth period, careful follow-up and induction to normal growth were important while the inferior growth of the affected side was monitored. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

21 CFR 872.3960 - Mandibular condyle prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Mandibular condyle prosthesis. 872.3960 Section 872.3960 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3960 Mandibular condyle prosthesis. (a...

Development of a Mandibular Motion Simulator for Total Joint Replacement

PubMed Central

Celebi, Nukhet; Rohner, E. Carlos; Gateno, Jaime; Noble, Philip C.; Ismaily, Sabir K.; Teichgraeber, John F.; Xia, James J.

2015-01-01

Purpose The purpose of this study was to develop a motion simulator capable of recreating and recording the full range of mandibular motions in a cadaveric preparation for an intact temporomandibular joint (TMJ) and after total joint replacement. Material and Methods A human cadaver head was used. Two sets of tracking balls were attached to the forehead and mandible, respectively. Computed tomographic (CT) scan was performed and 3-dimensional CT models of the skull were generated. The cadaver head was then dissected to attach the muscle activation cables and mounted onto the TMJ simulator. Realistic jaw motions were generated through the application of the following muscle forces: lateral pterygoid muscle, suprahyoid depressors (geniohyoid, mylohyoid, and digastric muscles), and elevator muscles. To simulate muscle contraction, cables were inserted into the mandible at the center area of each muscle's attachment. To provide a minimum mouth closing force at the initial position, the elevator muscles were combined at the anterior mandible. During mandibular movement, each motion was recorded using a high-resolution laser scanner. The right TMJ of the same head was reconstructed with a total TMJ prosthesis. The same forces were applied and the jaw motions were recorded again. CT scan was performed and 3-dimensional CT models of the skull with TMJ prosthesis were generated. Results Mandibular motions, before and after TMJ replacement, with and without lateral pterygoid muscle reattachment, were re-created in a cadaveric preparation. The laser-scanned data during the mandibular motion were used to drive 3-dimensional CT models. A movie for each mandibular motion was subsequently created for motion path analysis. Compared with mandibular motion before TMJ replacement, mandibular lateral and protrusive motions after TMJ replacement, with and without lateral pterygoid muscle reattachment, were greatly limited. The jaw motion recorded before total joint replacement was applied to the mandibular and prostheses models after total TMJ replacement. The condylar component was observed sinking into the fossa during jaw motion. Conclusion A motion simulator capable of re-creating and recording full range of mandibular motions in a cadaveric preparation has been developed. It can be used to simulate mandibular motions for the intact TMJ and total joint prosthesis, and to re-create and record their full range of mandibular motions. In addition, the full range of the recorded motion can be re-created as motion images in a computer. These images can be used for motion path analysis and to study the causation of limited range of motion after total joint replacement and strategies for improvement. PMID:21050636

Bilateral bifid mandibular canal

PubMed Central

Sheikhi, Mahnaz; Badrian, Hamid; Ghorbanizadeh, Sajad

2012-01-01

One of the normal interesting variations that we may encounter in the mandible is bifid mandibular canal. This condition can lead to difficulties when performing mandibular anesthesia or during extraction of lower third molar, placement of implants, and surgery in the mandible. Therefore diagnosis of this variation is sometimes very important and necessary. PMID:23814555

21 CFR 874.3695 - Mandibular implant facial prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Mandibular implant facial prosthesis. 874.3695 Section 874.3695 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... intended to be implanted for use in the functional reconstruction of mandibular deficits. The device is...

21 CFR 874.3695 - Mandibular implant facial prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Mandibular implant facial prosthesis. 874.3695 Section 874.3695 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... intended to be implanted for use in the functional reconstruction of mandibular deficits. The device is...

Prevalence of Extra Roots in Permanent Mandibular First Molars in Iranian Population: A CBCT Analysis.

PubMed

Rahimi, Saeed; Mokhtari, Hadi; Ranjkesh, Bahram; Johari, Masoomeh; Frough Reyhani, Mohammad; Shahi, Shahriar; Seif Reyhani, Sina

2017-01-01

Having knowledge about the anatomy of root canal system is essential for success of endodontic treatment. The present study used cone-beam computed tomography (CBCT), to evaluate the prevalence of third root in mandibular first molars in a selected Iranian population. A total of 386 CBCT images from subjects referred to oral and maxillofacial radiology department of dental faculty of Tabriz University of Medical Sciences from 2011 to 2013 were selected and evaluated for this study and the cases with well-developed permanent mandibular first molars were included. The 3D images were reconstructed in axial cross sections and evaluated by two endodontists for the presence of the third extra lingual (radix entomolaris) or buccal (radix paramolaris) root. The chi-squared test was used to evaluate the relationship between gender and bilateral incidence of extra roots in mandibular first molars. The distribution of three-rooted mandibular first molars with an additional root was 3%, (3.53% in female and 2.50% in male patients). There was no significant relationship between gender and bilateral occurrence of three-rooted mandibular first molars. The occurrence of three-rooted mandibular first molars in Iranian population is not uncommon which should be taken into consideration by the dental practitioners during root canal treatment of these teeth.

Combined use of rapid-prototyping model and surgical guide in correction of mandibular asymmetry malformation patients with normal occlusal relationship.

PubMed

Xu, Haisong; Zhang, Ce; Shim, Yoong Hoon; Li, Hongliang; Cao, Dejun

2015-03-01

The aim of this study is to discuss the application of rapid-prototyping model and surgical guide in the treatment of mandibular asymmetry malformation with normal occlusal relationship. Twenty-four mandibular asymmetry malformation patients with relatively normal occlusal relationship were included in this study. Surgical 3-dimensional rapid-prototyping mandibular models were made for all patients from the computed tomography (CT) DICOM data. The presurgical plan was designed on the model, and the surgical guiders for the osteotomy lines were manufactured. Genioplasty and/or mandibular osteotomy based on the presurgical plan were performed on these patients with the combined use of the rapid-prototyping model and surgical guides. All patients underwent postoperative CT scan and had at least 3-month follow-up. All patients were satisfied with the final results. According to the postoperative CT images and 3-month follow-up, all patients' mandibular asymmetry malformation was significantly improved, and the operation time was distinctly shortened relative to the conventional method. Rapid-prototyping model and surgical guide are viable auxiliary devices for the treatment of mandibular asymmetry malformation with relatively normal occlusal relationship. Combined use of them can make precise preoperative design, improve effects of operation, and shorten operating time.

Prevalence of radix entomolaris in mandibular permanent first molars: a study in a South Indian population.

PubMed

Chandra, Saurabh S; Chandra, Supriya; Shankar, Padmanabhan; Indira, Rajamani

2011-09-01

Anatomical racial variations are an acknowledged characteristic in permanent molars. Generally, mandibular first molars have 2 roots; however, the presence of a third root, radix entomolaris (RE), is a major anatomic variant among many population groups. This study evaluated the prevalence of permanent mandibular first molars featuring a distolingual root in a South Indian population. Five hundred patients of South Indian origin possessing bilateral mandibular first molars were selected. The radiographs of these patients were evaluated under optimal conditions. A total of 1000 mandibular first molars were screened and the incidence of 3-rooted mandibular first molars and the correlation between left and right side occurrence and between either gender was recorded. The prevalence of 3-rooted mandibular first molars was 18.6% of the patients examined and 13.3% of the teeth examined. There was no statistically significant difference between genders or side of occurrence (P > .05). The bilateral incidence of a symmetric distribution was 43.01%. RE is considered an Asiatic trait. The occurrence of this macrostructure in the South Indian population was 13.3%, which was lower than that of other patients of Mongoloid origin. The clinician must thoroughly examine the radiograph before initiation of endodontic therapy. Copyright © 2011 Mosby, Inc. All rights reserved.

Association between mandibular retrognathia and TMJ disorders in adult females.

PubMed

Miller, James R; Burgess, Jeffrey A; Critchlow, Cathy W

2004-01-01

This study assesses the association between temporomandibular joint (TMJ) disorders and mandibular retrognathia. We conducted a case-control study among women, aged 18-70 years, recruited from Kaiser Permanente Northwest Division (KPNW, Portland, OR) and Group Health Cooperative of Puget Sound (GHC, Seattle, WA). Cases (N= 160) were women seeking treatment for TMJ disorders at KPNW and GHC clinics. Controls (N=151) were women without TMJ disorders, selected from among adult female dental hygiene patients at KPNW or GHC enrollees. Case status was determined by questionnaire; mandibular sagittal position (orthognathic, mildly retrognathic, severely retrognathic, or prognathic) was measured using digitized facial photographs. Odds ratios (OR) and associated 95 percent confidence intervals (CI) estimated the magnitude of the association between TMJ disorders and mandibular sagittal position. Women with TMJ disorders were 4.0 times (95% CI=1.5, 10.8) more likely than controls to have severe retrognathia; no association with mild retrognathia or prognathia was seen. Results were similar when cases were restricted to those with recent onset of TMJ pain (OR=6.3; 95% CI=1.8, 21.8). We found a strong association between TMJ disorders and severe mandibular retrognathia in adult females. In some women this likely resulted from TMJ disorders influencing mandibular development over time. However, among a subset of women, our data support the reverse hypothesis--that severe mandibular retrognathia may influence the development of TMJ disorders. Despite this strong association, abnormal mandibular position contributed only a small portion to the overall rate at which women sought treatment for TMJ disorders.

Reduced mandibular range of motion in Duchenne Muscular Dystrophy: predictive factors.

PubMed

van Bruggen, H W; Van Den Engel-Hoek, L; Steenks, M H; Bronkhorst, E M; Creugers, N H J; de Groot, I J M; Kalaykova, S I

2015-06-01

Patients with Duchenne muscular dystrophy (DMD) experience negative effects upon feeding and oral health. We aimed to determine whether the mandibular range of motion in DMD is impaired and to explore predictive factors for the active maximum mouth opening (aMMO). 23 patients with DMD (mean age 16.7 ± 7.7 years) and 23 controls were assessed using a questionnaire about mandibular function and impairments. All participants underwent a clinical examination of the masticatory system, including measurement of mandibular range of motion and variables related to mandibular movements. In all patients, quantitative ultrasound of the digastric muscle and the geniohyoid muscle and the motor function measure (MFM) scale were performed. The patients were divided into early and late ambulatory stage (AS), early non-ambulatory stage (ENAS) and late non-ambulatory stage (LNAS). All mandibular movements were reduced in the patient group (P < 0.001) compared to the controls. Reduction in the aMMO (<40 mm) was found in 26% of the total patient group. LNAS patients had significantly smaller mandibular movements compared to AS and ENAS (P < 0.05). Multiple linear regression analysis for aMMO revealed a positive correlation with the body height and disease progression, with MFM total score as the strongest independent risk factor (R(2) = 0.71). Mandibular movements in DMD are significantly reduced and become more hampered with loss of motor function, including the sitting position, arm function, and neck and head control. We suggest that measurement of the aMMO becomes a part of routine care of patients with DMD. © 2015 John Wiley & Sons Ltd.

Incidence of three-rooted mandibular first molars among contemporary Japanese individuals determined using multidetector computed tomography.

PubMed

Ishii, Namiko; Sakuma, Ayaka; Makino, Yohsuke; Torimitsu, Suguru; Yajima, Daisuke; Inokuchi, Go; Motomura, Ayumi; Chiba, Fumiko; Hoshioka, Yumi; Iwase, Hirotaro; Saitoh, Hisako

2016-09-01

The purpose of this study was to determine the incidence of three-rooted mandibular first molars in a contemporary Japanese population using multidetector computed tomography (MDCT) and examine whether this characteristic root form may be useful for identification purposes. Prior to their forensic autopsies, we obtained MDCT scans of 365 cadavers (255 males, 110 females) with mandibular first molars on both sides. Altogether, 730 mandibular first molars were examined morphologically on reconstructed CT images, and the incidence of three-rooted molars was recorded. The results were analyzed statistically to determine sex and left-right differences using the chi-square test. In all, 189 (25.9%) of the 730 mandibular first molars had three roots: 79 (31.0%) in the 255 males and 35 (31.8%) in the 110 females. No statistically significant difference was found between the sexes. In the 39 individuals who had unilateral three-rooted mandibular first molars, 7 (17.9%) were on the left side and 32 (82.1%) were on the right side, indicating a statistically significant predominance on the right side. The incidence of three-rooted mandibular first molars in contemporary Japanese individuals was 25.9%, with no statistically significant sex difference, but in the case of unilateral three-rooted teeth, with a statistically significant predominance on the right side. Our study found that Japanese and northeastern Asians have a high incidence of the three-rooted mandibular first molars among individuals of Mongolian origin; this finding may be a useful screening tool for identification of unknown individuals. Copyright © 2016. Published by Elsevier Ireland Ltd.

Assessment of Growth Using Mandibular Canine Calcification Stages and Its Correlation with Modified MP3 Stages

PubMed Central

Nayak, US Krishna; Hegde, Gautam

2010-01-01

Background and objectives Orthodontic diagnosis and treatment planning for growing children must involve growth prediction, especially in the treatment of skeletal problems. Studies have shown that a strong association exists between skeletal maturity and dental calcification stages. The present study was therefore taken up to provide a simple and practical method for assessing skeletal maturity using a dental periapical film and standard dental X-ray machine, to compare the developmental stages of the mandibular canine with that of developmental stages of modified MP3 and to find out if any correlation exists, to determine if the developmental stages of the mandibular canine alone can be used as a reliable indicator for assessment of skeletal maturity. Methods A total of 160 periapical radiographs (80 males and 80 females), of the mandibular right canine and the MP3 region was taken and assessed according to the Dermirjian’s stages of dental calcification and the modified MP3 stages. Results The correlation between the developmental stages of MP3 and the mandibular right canine in male and female groups, is of high statistical significance (p = 0.001). The correlation coefficient between MP3 stages and developmental stages of mandibular canine and chronological age in male and females was found to be not significant. Conclusions The correlation between the mandibular canine calcification stages and MP3 stages was found to be significant. The developmental stages of the mandibular canine could be used very reliably as a sole indicator for assessment of skeletal maturity. PMID:27625553

Gender determination: Role of lip prints, finger prints and mandibular canine index

PubMed Central

KRISHNAN, RESHMA POOTHAKULATH; THANGAVELU, RADHIKA; RATHNAVELU, VIDHYA; NARASIMHAN, MALATHI

2016-01-01

Personal identification has a pivotal role in forensic investigations. Gender determination is an essential step in personal identification. Despite the advent of advanced techniques such as DNA fingerprinting, methods such as lip print and fingerprint analysis and mandibular canine index calculations are routinely used in gender determination, as they are simple and cost-effective. The present study investigated the hypothesis that lip print analysis is an effective tool in gender determination compared with fingerprint analysis and the mandibular canine index. The predominant patterns of lip prints and fingerprints were analyzed in males and females, and the efficacy of the mandibular canine index in gender determination was evaluated. The study group comprised 50 students, 25 males and 25 females who were 18–25 years of age. Lip prints and fingerprints were obtained and classified according to Tsuchihashi's classification and Kücken and Newell's classification, respectively. Mandibular impressions were made and the mandibular canine index was calculated. Type I and Type I' lip prints were predominant in females, and Type IV lip prints were predominant in males. The analysis of fingerprints revealed that the loop fingerprint pattern was predominant in both males and females. The mandibular canine index was not found to be significant in gender identification. The predominant patterns of lip prints were distinct for males and females; conversely, fingerprints were demonstrated to be similar in both genders. Therefore, lip prints hold an increased potential for gender determination, as compared with fingerprints, and the mandibular canine index is not a reliable indicator of gender. PMID:27284316

Efficacy of preoperative ibuprofen on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized clinical trial.

PubMed

Noguera-Gonzalez, D; Cerda-Cristerna, B I; Chavarria-Bolaños, D; Flores-Reyes, H; Pozos-Guillen, A

2013-11-01

To evaluate the effect of preoperative oral ibuprofen (IBU) on the success of inferior alveolar nerve blocks (IANBs) with mepivacaine containing 1 : 100 000 epinephrine for patients with symptomatic irreversible pulpitis (SIP). The present study was a double-blind, randomized, placebo-controlled clinical trial. The study included two study groups each consisting of 25 patients who exhibited symptomatic irreversible pulpitis of a mandibular posterior tooth. The patients presented prolonged moderate or severe pain (>10 s) after cold testing and indicated their pain scores on a Heft-Parker visual analogue scale. The patients received identically appearing capsules containing either 600 mg IBU (IBUg) or gelatin (placebo, PLAg) 1 h before administration of IANB with 2% mepivacaine containing 1 : 100 000 epinephrine. After 15 min, the anaesthetic blockade was assessed by a three-step examination (lip numbness, positive/negative response to cold testing and clinical discomfort during endodontic access). IANB success was defined as the absence of pain during any of these evaluations. The data were analysed using the chi-squared test. All of the patients reported moderate or severe pain before the preoperative procedure. Statistically significant differences were observed between the IBUg and PLAg (P < 0.05); the success rates for the IANB were 72% (IBUg) and 36% (PLAg). Preoperative oral administration of IBU significantly improved the efficacy of IANB in patients with symptomatic irreversible pulpitis. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Sphenoid sinus types, dimensions and relationship with surrounding structures.

PubMed

Štoković, Nikola; Trkulja, Vladimir; Dumić-Čule, Ivo; Čuković-Bagić, Ivana; Lauc, Tomislav; Vukičević, Slobodan; Grgurević, Lovorka

2016-01-01

The human sphenoid sinus is an extremely variable cavity and an important landmark in hypophyseal surgery. The aim of this study was to investigate the relationship between the sphenoid sinus type, size, extent of pneumatization and occurrence of protrusions of the adjacent neurovascular structures. A total of 51 randomly selected skulls (≥20 years of age, 33 male; 102 sinuses) were analyzed using cone beam computed tomography to estimate pneumatization extension beyond the body of the sphenoid (planum sphenoidale, pterygoid process, greater wings, clivus, dorsum sellae) and protrusions of the maxillary, mandibular, optic or pterygoid nerve or the internal carotid artery. Difference in pneumatization type between the left and the right-sided sinus was observed in 45% of the skulls. Conchal pneumatization was registered in 2%, presellar in 24%, sellar in 41% and postsellar in 33% of total sinuses. Presellar sinuses frequently pneumatized planum sphenoidale and sporadically other structures, and were characterized by sporadic optic nerve protrusions. Sellar and particularly postsellar sinuses were characterized by simultaneous pneumatization extensions and neurovascular protrusions. In the case of postsellar-type sinuses, the probability of these multiple interactions was not affected by their actual size, while it increased with the increasing sinus dimensions in the case of sellar-type sinuses. A more detailed analysis indicated that increasing sinus height, length or width increased the probability of interactions and pneumatization of particular surrounding structures. Data suggest that the sphenoid sinus pneumatization type and dimensions might be used to estimate the risks of iatrogenic injury during transsphenoidal surgical procedures. Copyright © 2015 Elsevier GmbH. All rights reserved.

Numb chin syndrome: A reflection of malignancy or a harbinger of MRONJ? A multicenter experience.

PubMed

Fortunato, Leonzio; Amato, Massimo; Simeone, Michele; Bennardo, Francesco; Barone, Selene; Giudice, Amerigo

2018-04-20

Numb chin syndrome (NCS) or mental neuropathy (MN) is a disorder characterized by sensory neuropathy on the distribution of the inferior alveolar nerve or mental nerve. The most frequent causes are of odontogenic origin (infections, wrong therapies). Other etiologies are related to primary tumor, metastasis, osteoradionecrosis and medication-related osteonecrosis of the jaw (MRONJ). The aim of this study is to highlight the clinical importance of NCS as one of the first symptoms of cancer or as consequence of drug therapy. The present study was conducted from 2010 to 2016 by recruiting patients who present NCS as one of the symptoms, having excluded those in which it depends on a clear odontogenic cause, on systemic degenerative diseases or metabolic disorders. Data collection included suspected diagnosis at the time of presentation of the symptom, final diagnosis, mandibular localization, treatment performed and diagnostic delay between the first medical examination and the definitive diagnosis. This study included 29 patients in which NCS had not a clear odontogenic cause. NCS was the first symptom of malignancy in 11 cases and the clinical sign of metastasis in 4 cases. In a single patient, it was the first symptom of an immune-mediated disease. In the remaining 13 patients, NCS represented the symptom of MRONJ. NCS can be the first symptom of malignancy, especially in patients with a previous history of cancer, but also a prodromal sign of MRONJ. It should be recognized in order to require deeper examinations for early diagnosis of the disease. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

The Effect of Photobiomodulation on the Depth of Anesthesia During Endodontic Treatment of Teeth With Symptomatic Irreversible Pulpitis (Double Blind Randomized Clinical Trial)

PubMed Central

Ghabraei, Sholeh; Chiniforush, Nasim; Bolhari, Behnam; Aminsobhani, Mohsen; Khosarvi, Abbas

2018-01-01

Introduction: Achieving appropriate anesthesia in patients with symptomatic irreversible pulpitis in mandibular molars during endodontic treatment is always one of the most challenging aspects. Photobiomodulation (PBM) has been used in dentistry due to its anti-inflammatory properties and regenerative effects. This study evaluates the effects of PBM in the depth of anesthesia in inferior alveolar nerve block. Methods: In this randomized clinical trial, 44 patients requiring endodontic treatment in lower molar, left or right were selected, half of them were randomly treated with PBM therapy. Laser irradiation by 980 nm diode laser with a single dose (15 J/cm2, for 20 seconds) before anesthesia was performed at the buccal aspect. Inferior alveolar nerve block was performed once. Success was defined as no or mild pain (no need for any supplemental injection), based on the visual analogue scale during access cavity preparation. Results were evaluated using SPSS software. Results: The results of this study showed that the necessity for supplemental injection was lower in the group receiving laser than in the group without laser (P = 0.033). The mean pain intensity during dentin cutting was lower in the group receiving laser than in the group without laser (P = 0.031). Also, the mean pain intensity during pulp dropping was lower in the group receiving laser, than the group without laser (P = 0.021). Conclusion: Based on the results of this study, it seems that the application of PBM before anesthesia is effective on increasing depth of anesthesia. PMID:29399304

Intracranial extension of adenoid cystic carcinoma: potential involvement of EphA2 expression and epithelial-mesenchymal transition in tumor metastasis: a case report.

PubMed

Fukai, Junya; Fujita, Koji; Yamoto, Toshikazu; Sasaki, Takahiro; Uematsu, Yuji; Nakao, Naoyuki

2014-03-07

Adenoid cystic carcinoma is a malignant epithelial tumor derived from salivary glands and tends to invade the surrounding structures including nervous system. We present a case of adenoid cystic carcinoma with intracranial extension and propose a novel molecular mechanism of adenoid cystic carcinoma metastasis. A 29-year-old Japanese male presented with left trigeminal nerve disturbance. Neuroimaging revealed a tumor located at the right middle cranial and infratemporal fossa. The tumor was removed via a subtemporal extradural and infratemporal fossa approach and histologically diagnosed as adenoid cystic carcinoma. Radiological and operative findings confirmed a perineural spread of the tumor along the mandibular nerve. Immunohistochemical analyses of molecular consequences in this case were performed for better understanding of the biological processes associated with adenoid cystic carcinoma metastasis. First, the neoplastic cells were not immunoreactive for E-cadherin, an epithelial marker, but for vimentin, a mesenchymal marker, suggesting changes in cell phenotype from epithelial to mesenchymal states. Correspondingly, immunoreactivity of transcriptional factors, such as Slug, Twist, matrix metalloproteinase-2 and -9, which are involved in epithelial-mesenchymal transition, were observed. Second, elevated expression of EphA2 receptor, not ephrin-A1, was notable in the neoplastic cells, suggesting morphological changes reminiscent of epithelial-mesenchymal transition and ligand-independent promotion of tumor cell migration and invasion. We report a case of adenoid cystic carcinoma with perineural spread and provide the first published evidence that EphA2 expression without ephrin-A1 and epithelial-mesenchymal transition might play important roles in adenoid cystic carcinoma progression.

Management of Limited Vertical Bone Height in the Posterior Mandible: Short Dental Implants Versus Nerve Lateralization With Standard Length Implants.

PubMed

Dursun, Erhan; Keceli, Huseyin Gencay; Uysal, Serdar; Güngör, Hamiyet; Muhtarogullari, Mehmet; Tözüm, Tolga Fikret

2016-05-01

Inferior alveolar nerve lateralization (IANL) and short dental implants (SDI) are 2 viable implant-based treatment approaches in the presence of atrophied posterior mandible. Despite the risks of dysfunction, infection, and pathologic fractures in IANL, it becomes possible to place standard implants. The purpose of this study was to compare SDI and IANL approaches from clinical and radiographic aspects. Fifteen subjects having unilateral atrophic mandibles were allocated to SDI and IANL treatment groups. Following surgical procedures, early postoperative complications, implant survival, and periimplant clinical and radiographic parameters including probing pocket depth, attachment level, keratinized tissue amount, vertical tissue recession, and marginal bone loss were recorded at baseline and 1-year after prosthetic rehabilitation. In both groups, no implant was lost. Except usual postoperative complications, 2 patients had transient paraesthesia after IANL. According to time-dependent evaluation, both groups showed significant increase in probing pocket depth and attachment level at 1-year follow-up compared with baseline (P < 0.05). Except a slight but significant increase in mesial surface of SDI group (P < 0.05), no remarkable time-dependent change was identified in vertical tissue recession. Keratinized tissue amount did not exhibit any inter- or intragroup difference during whole study period. Marginal bone loss did not show any difference between IANL and SDI groups at follow-up. SDI placement or standard length implant placement with IANL can be considered promising alternatives in the treatment of atrophic mandibular posterior regions. However, SDI may be preferred in terms of lower complication risk.

Endodontic treatment of mandibular canine with two roots and two canals.

PubMed

Moogi, Prashant P; Hegde, Reshma S; Prashanth, B R; Kumar, G Vinay; Biradar, Nandini

2012-11-01

In majority of cases, mandibular canines have one root and one root canal, although 15% may have two canals. Literature report shows incidence of two-rooted canine as low as 1.7%. This article reports a clinical case of endodontic treatment of mandibular canine with two roots and two canals.

Electron microscopic study of the mandibular glands of Kalotermes flavicollis fabr. (isoptera; calotermitidae).

PubMed

Cassier, P; Fain-Maurel, M A; Lebrun, D

1977-08-26

The mandibular glands of Kalotermes were examined in different castes. They show sexual dimorphism in the soldiers and primary reproductives, Moreover, in female soldiers and queens, mandibular gland cells contained numerous crystalline structures of mitochondrial origin. The role of these glands (secretion of saliva or pheromone) is discussed.

Endodontic treatment of an unusual connation of permanent mandibular molars: a case report.

PubMed

Liu, Shengbo; Fan, Bing; Peng, Bin; Fan, Mingwen; Bian, Zhuan

2006-10-01

A 27-year-old patient with an anomalous mandibular molar was referred for endodontic therapy. Clinical and radiographic examination revealed the connation of a second mandibular molar with a third molar. Challenging endodontic therapy was performed in the unusual connated molars. A 2-year recall showed good treatment result.

Consensus or controversy? The classification and treatment decision-making by 491 maxillofacial surgeons from around the world in three cases of a unilateral mandibular condyle fracture.

PubMed

Kommers, Sofie C; Boffano, Paolo; Forouzanfar, Tymour

2015-12-01

Many studies are available in the literature on both classification and treatment of unilateral mandibular condyle fractures. To date however, controversy regarding the best treatment for unilateral mandibular condyle fractures remains. In this study, an attempt was made to quantify the level of agreement between a sample of maxillofacial surgeons worldwide, on the classification and treatment decisions in three different unilateral mandibular condyle fracture cases. In total, 491 of 3044 participants responded. In all three mandibular condyle fracture cases, a fairly high level of disagreement was found. Only in the case of a subcondylar fracture, assuming dysocclusion was present, more than 81% of surgeons agreed that the best treatment would be open reduction and internal fixation. Based on the study results, there is considerable variation among surgeons worldwide with regard to treatment of unilateral mandibular condyle fracture. 3D imaging in higher fractures tends to lead to more invasive treatment decisions. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Evaluation of skeletal and dental age using third molar calcification, condylar height and length of the mandibular body.

PubMed

Kedarisetty, Sunil Gupta; Rao, Guttikonda Venkateswara; Rayapudi, Naveen; Korlepara, Rajani

2015-01-01

To identify the most reliable method for age estimation among three variables, that is, condylar height, length of mandibular body and third molar calcification by Demirjian's method. Orthopantomograms and lateral cephalograms of 60 patients with equal gender ratio were included in the study, among each gender 15 subjects were below 18 years and 15 subjects were above 18 years. Lateral cephalograms were traced, height of condyle and mandibular body are measured manually on the tracing paper, OPG's were observed on radiographic illuminator and maturity score of third molar calcification was noted according to Demirjian's method. All the measurements were subjected to statistical analysis. The results obtained are of no significant difference between estimated age and actual age with all three parameters (P > 0.9780 condylar height, P > 0.9515 length of mandibular body, P > 0.8611 third molar calcification). Among these three, length of mandibular body shows least standard error test (i.e. 0.188). Although all three parameters can be used for age estimation, length of mandibular body is more reliable followed by height of condyle and third molar calcification.

Influence of occlusal plane inclination and mandibular deviation on esthetics

PubMed Central

Corte, Cristiane Cherobini Dalla; da Silveira, Bruno Lopes; Marquezan, Mariana

2015-01-01

Objective: The aim of this study was to assess the degree of perception of occlusal plane inclination and mandibular deviation in facial esthetics, assessed by laypeople, dentists and orthodontists. Methods: A woman with 5.88° of inclination and 5.54 mm of mandibular deviation was selected and, based on her original photograph, four new images were created correcting the deviations and creating more symmetric faces and smiles. Examiners assessed the images by means of a questionnaire. Their opinions were compared by qualitative and quantitative analyses. Results: A total of 45 laypeople, 27 dentists and 31 orthodontists filled out the questionnaires. All groups were able to perceive the asymmetry; however, orthodontists were more sensitive, identifying asymmetries as from 4.32° of occlusal plane inclination and 4.155 mm of mandibular deviation (p< 0.05). The other categories of evaluators identified asymmetries and assigned significantly lower grades, starting from 5.88° of occlusal plane inclination and 5.54 mm of mandibular deviation (p< 0.05). Conclusion: Occlusal plane inclination and mandibular deviation were perceived by all groups, but orthodontists presented higher perception of deviations. PMID:26560821

[Cervical vertebrae: Mandibular growth dynamism indicators?].

PubMed

Raberin, Monique; Cozor, Ilinca; Gobert-Jacquart, Stéphanie

2012-03-01

A study of mandibular growth maturation was performed on a population of 103 patients during orthodontic treatment (69 girls and 34 boys) from 11 to 16 years, having initially a Class II skeletal discrepancy. The relationship between wrist maturation indices and the cervical vertebrae maturation was studied by Lamparski classification. Significant correlations were found between Björk stages, MP3=, MP3 cap and MP3 U and respectively Lamparski stages as CVS 2, CVS 3-4 and CVS 5-6. This retrospective longitudinal study identified three mandibular variables at three different maturation stages according to Björk classification and to the six stages of Lamparski classification. The relationships between these different maturation stages and a quantitative mandibular response permit to estimate optimal time for our orthodontic therapy. The results indicate a significant increase in mandibular length between CVS 4 and CVS 5, suggesting the persistence of a condylar response to a stimulation therapy after CVS3 or CVS 4 stages (MP3 cap). Mandibular growth seems to continue after MP3 U stage or CVS 5 stage. © EDP Sciences, SFODF, 2012.

[Distal movement of the mandibular dentition in the treatment of patients with Class III skeletal pattern].

PubMed

Mou, Lan; Xu, Gengchi; Han, Yaohui; Ge, Zhenlin

2015-06-01

To evaluate the outcome of patients with skeletal Class III malocclusion treated with extraction of mandibular third molars and distalization of molars using implant anchorage combined with MBT appliance. Fifteen patients (mean age 24.0 ± 5.8) with skeletal Class III malocclusion were selected. The mandibular third molars were extracted and the mandibular molars were moved distally using implant combined with MBT appliance. Cephalometric analysis was carried out before and after treatment. After active treatment, ANB, Wits distance, AB-NP and the distance between upper and lower lip position to SnPg' increased by 1.65° ± 1.04°, (4.39 ± 1.93) mm, 3.20° ± 1.61° and (1.13 ± 0.99) mm, respectively. The differences were statistically significant (P < 0.05). The skeletal Class III patients in the permanent dentition could be treated successfully with extraction of mandibular third molars and distalization of mandibular molars using implant anchorage combined with MBT appliance. The soft-tissue profile was improved.

Endodontic treatment of mandibular molars with atypical root canal anatomy: reports of 4 cases.

PubMed

Chauhan, Raju; Singh, Shweta

2015-01-01

The variations in root canal anatomy of multirooted teeth represent a continuous challenge to endodontic diagnosis and treatment. Although the most common configuration of mandibular molars is one containing 2 roots and 3 root canals, there are many different combinations. Very rarely, an additional third (supernumerary) root is seen. When it is located distolingually to the main distal root, this third root is called radix entomolaris (RE), and when it is located mesiobuccally to the mesial root, it is called radix paramolaris (RP). Variations of root canal systems need not always be in the form of extra roots or extra canals. Single roots with single canals can also occur. A general dentist should be aware of these unusual root canal morphologies in mandibular molars for the success of endodontic treatment. These case reports describe the root canal treatment of a case of RE in the mandibular first molar, 2 rare cases of RP (1 each in the mandibular first and second molars), and a mandibular second molar with a single root and root canal.

Morphologic and functional implications of the surgical-orthodontic management of mandibular prognathism: a comprehensive review.

PubMed

Athanasiou, A E

1993-05-01

The aim of this review is to present the various morphologic and functional implications of the surgical-orthodontic management of mandibular prognathism, thus providing a more complete determination of the efficacy of this modality of treatment. Major conclusions that can be drawn from the bibliography indicate that: (1) After treatment considerable improvement takes place on the soft tissue and dentoskeletal profile, occlusal tooth contacts, and temporomandibular joint function and and pain; (2) Surgical management of mandibular prognathism can be associated with decreased maximum interincisal opening; (3) Although immediately after surgery there is a tendency for the condyles to be distracted downward and anteriorly from their preoperative position, in long-term postsurgery the condyles, on the average, regain their initial position; (4) Compensatory alterations in the pharyngeal, suprahyoid, and infrahyoid muscular regions take place postoperatively; (5) Skeletal changes after mandibular setback to correct mandibular prognathism occur frequently, but their magnitude and patterns exhibit variation and are not necessarily detrimental; and (6) Fulfillment of expectations toward surgical-orthodontic management of mandibular prognathism was reported to be frequent.

Pathological mandibular fracture: A severe complication of periimplantitis

PubMed Central

Rodriguez-Campo, Francisco; Naval-Parra, Beatriz; Sastre-Pérez, Jesús

2015-01-01

Nowadays, dental implant treatment is a very common option for patients even in medical compromised conditons. Some complications related to them have been described. Periimplantitis (PI) is one of the biggest concerns complications of these kind of treatments, probably has a multifactorial aethiology. Usually the consequences of PI are the loss of the implants and prostheses, expenses of money and time for dentists and patients. Very often PI implies the necesity of repeating the treatment . Pathological mandibular fracture due to PI is a severe but infrequent complication after dental implant treatment, especially after PI. In this study we present three cases of mandibular pathologic fractures among patients with different medical and dental records but similar management: two of them had been treated years ago of oral squamous cell carcinoma with surgery and radiotherapy, the other patient received oral bisphosphonates for osteoporosis some years after implantation. We analized the causes, consequences and posible prevention of these fractures as well as the special features of this kind of mandibular fractures and the different existing treatments. Key words:Periimplantitis, pathological mandibular fracture, mandibular atrophy, bicortical implants. PMID:26155355

Pathological mandibular fracture: A severe complication of periimplantitis.

PubMed

Naval-Gías, Luis; Rodriguez-Campo, Francisco; Naval-Parra, Beatriz; Sastre-Pérez, Jesús

2015-04-01

Nowadays, dental implant treatment is a very common option for patients even in medical compromised conditons. Some complications related to them have been described. Periimplantitis (PI) is one of the biggest concerns complications of these kind of treatments, probably has a multifactorial aethiology. Usually the consequences of PI are the loss of the implants and prostheses, expenses of money and time for dentists and patients. Very often PI implies the necesity of repeating the treatment . Pathological mandibular fracture due to PI is a severe but infrequent complication after dental implant treatment, especially after PI. In this study we present three cases of mandibular pathologic fractures among patients with different medical and dental records but similar management: two of them had been treated years ago of oral squamous cell carcinoma with surgery and radiotherapy, the other patient received oral bisphosphonates for osteoporosis some years after implantation. We analized the causes, consequences and posible prevention of these fractures as well as the special features of this kind of mandibular fractures and the different existing treatments. Key words:Periimplantitis, pathological mandibular fracture, mandibular atrophy, bicortical implants.

Clinical importance of median mandibular flexure in oral rehabilitation: a review.

PubMed

Sivaraman, K; Chopra, A; Venkatesh, S B

2016-03-01

The mandible has a property to flex inwards around the mandibular symphysis with change in shape and decrease in mandibular arch width during opening and protrusion of the mandible. The mandibular deformation may range from a few micrometres to more than 1 mm. The movement occurs because of the contraction of lateral pterygoid muscles that pulls mandibular condyles medially and causes a sagittal movement of the posterior segments. This movement of mandible can have a profound influence on prognosis and treatment outcome for various restorative, endodontics, fixed, removable and implant-related prosthesis. The review unfolds the causes, importance and clinical implications of median mandibular flexure in oral rehabilitation. This review also highlights the appropriate preventive measures and techniques that should be adopted by clinicians to minimise the effect of flexural movement of the jaw during oral rehabilitation. This would not only help clinicians to achieve a good prosthesis with accurate fit and longevity but also maintain the health of the surrounding periodontal or periimplant gingival tissues and bone. © 2015 John Wiley & Sons Ltd.

Autotransplantation of mandibular third molar: a case report.

PubMed

Ravi Kumar, Pabbati; Jyothi, Mandava; Sirisha, Kantheti; Racca, Khushboo; Uma, Chalasani

2012-01-01

Autogenous transplantation is a feasible, fast, and economical option for the treatment of nonsalvageable teeth when a suitable donor tooth is available. This paper presents successful autotransplantation of a mature mandibular left third molar (38) without anatomical variances is used to replace a mandibular left second molar (37). The mandibular second molar was nonrestorable due to extensive root caries and resorption of distal root. After extraction of mandibular second and third molars, root canal therapy was done for the third molar extraorally, and the tooth was reimplanted into the extracted socket of second molar site. After one year, clinical and radiographic examination revealed satisfactory outcome with no signs or symptoms suggestive of pathology. In selected cases, autogenous tooth transplantation, even after complete root formation of the donor tooth, may be considered as a practical treatment alternative to conventional prosthetic rehabilitation or implant treatment.

Are Biodegradable Plates Applicable in Endoscope-Assisted Open Reduction and Internal Fixation of Mandibular Subcondyle Fractures?

PubMed

Son, Jang-Ho; Ha, Jinhee; Cho, Yeong-Cheol; Sung, Iel-Yong

2017-08-01

To investigate whether biodegradable plates are applicable in endoscope-assisted open reduction and internal fixation (EAORIF) of mandibular subcondyle fractures. This retrospective case-series study included patients with mandibular subcondyle fractures treated with EAORIF using an unsintered hydroxyapatite particles/poly-l-lactide biodegradable plate system, with at least 6 months of clinical follow-up data available. The outcome variables were fracture healing with postoperative stability and postoperative complications. Other variables included age, gender, fracture site, cause of injury, accompanying mandibular fracture, total follow-up period, fracture classification, extent of displacement, preoperative status of occlusion, preoperative mandibular movements, fixation materials in accompanying mandibular fracture, location and number of fixation plates, periods of intermaxillary fixation/elastic bands, and postoperative mandibular movements. Fracture healing in these patients was assessed by comparing the immediate postoperative cone-beam computed tomography (CBCT) images with those obtained at least 3 months after surgery. A total of 11 patients, 9 male and 2 female, with a mean ± standard deviation age of 35.3 ± 15.9 years, were included. The mean follow-up period was 18.8 ± 7.8 months. Four patients had an accompanying mandibular fracture. Two 4-hole, 2.0-mm biodegradable plates were fixed with 6-mm screws along the posterior border of the mandibular ramus and near the sigmoid notch. Complete bone formation around the fracture lines or fading of the fracture lines, with no change in the position of the fractured segments, was observed on the postoperative CBCT images at 3 months. With the exception of 2 patients, no patient complained of plate palpability, deviation in occlusion, or discomfort during the postoperative follow-up period. EAORIF using biodegradable plates for mandible subcondylar fractures is a stable and reliable method, with considerable advantages compared with titanium plates. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Occlusal plane rotation: aesthetic enhancement in mandibular micrognathia.

PubMed

Rosen, H M

1993-06-01

Patients afflicted with extreme degrees of mandibular micrognathia typically have vertically deficient rami as well as sagittally deficient mandibular bodies. This results in deficient posterior facial height, an obtuse gonial angle, excessively steep occlusal and mandibular planes, and a compensatory increase in anterior facial height. The entire maxillomandibular complex is overrotated in a clockwise direction. Standard orthognathic surgical correction fails to address this rotational deformity. As a consequence, the achieved projection of the lower face is inadequate, posterior facial height is further reduced, and occlusal and mandibular planes remain steep. Eleven patients with severe mandibular micrognathia underwent a surgical correction involving occlusal plane rotation to its normal orientation relative to Frankfort horizontal. This was accomplished by Le Fort I osteotomy to shorten the anterior maxilla (creating open bites in seven patients and making preexisting open bites worse in four patients) and sagittal split ramus osteotomies to advance and rotate the mandibular body counterclockwise, thus closing the surgically produced open bite. Counterclockwise rotation of the mandible afforded significantly greater sagittal displacement at the B point (mean 17 mm) than at the first molar (mean 10 mm) and produced adequate degrees of projection of the lower face when accompanied by a modest sliding genioplasty (mean 6.9 mm). Total advancement at the pogonion was a mean of 25.2 mm. In addition, posterior facial height was preserved, and mandibular and occlusal planes were normalized to mean angles of 27 and 10 degrees, respectively. At follow-up, which ranged from 9 to 24 months with a mean of 14.1 months, the mean sagittal relapse at the B point was 1.9 mm. Although heretofore considered unstable and therefore not clinically accepted, maxillomandibular counterclockwise rotation to normalize the occlusal plane rotational deformity provides stable, aesthetically superior results in patients with extreme degrees of mandibular micrognathia. Extended follow-up will be necessary to document long-term stability.

Two-Implant-Supported Mandibular Overdentures: Do Clinical Denture Quality and Inter-Implant Distance Affect Patient Satisfaction?

PubMed

Alfadda, Sara A; Al Amri, Mohammad D; Al-Ohali, Amal; Al-Hakami, Arwa; Al-Madhi, Noura

To investigate the following three null hypotheses in patients rehabilitated with a mandibular overdenture supported by two unsplinted implants: (1) patient satisfaction is not related to the clinical quality of the dentures; (2) inter-implant distance (IID) has no effect on the clinical quality of the dentures; and (3) IID does not influence patient satisfaction. Forty edentulous patients who were rehabilitated with a two-implant-supported mandibular overdenture participated in the study. Independent investigators evaluated the dentures on the basis of five clinical criteria using the validated Denture Quality Evaluation Form, and the patients completed the validated Denture Satisfaction Scale. Irreversible hydrocolloid impressions of the mandible were made and poured immediately in die stone. The IID was measured by adapting an orthodontic wire to the mandibular alveolar ridge crest, extending from the center of one implant to the center of the other. Spearman correlation analyses were used to identify possible correlations, with a significance level set at P < .05. The clinicians' overall mean rating of the clinical quality of the dentures was 91.5% (standard deviation 6.27%). The stability of the mandibular overdenture and of the maxillary conventional complete denture was significantly related to satisfaction (r = 0.389 and r = 0.44, respectively). Significant associations were found between the mandibular stability items and satisfaction with both maxillary and mandibular dentures. The stability of the maxillary denture was significantly associated with patient satisfaction with mandibular denture retention, stability, and comfort. None of the 12 denture satisfaction items were significantly associated with IID. Similarly, IID did not have an effect on the quality of either denture in terms of retention, stability, or occlusion. Denture stability was the feature that had the most influence on patient satisfaction with the mandibular overdenture and with the maxillary conventional denture. IID had no effect on the clinical quality of either denture and did not influence patient satisfaction.

Restricted Mandibular Movement Attributed to Ossification of Mandibular Depressors and Medial Pterygoid Muscles in Patients With Fibrodysplasia Ossificans Progressiva: A Report of 3 Cases.

PubMed

Okuno, Tetsuko; Suzuki, Hitoshi; Inoue, Akio; Kusukawa, Jingo

2017-09-01

Fibrodysplasia ossificans progressiva (FOP) is an extremely rare genetic condition characterized by congenital malformation and progressive heterotopic ossification (HO) caused by a recurrent single nucleotide substitution at position 617 in the ACVR1 gene. As the condition progresses, HO leads to joint ankylosis, breathing difficulties, and mouth-opening restriction, and it can shorten the patient's lifespan. This report describes 3 cases of FOP confirmed by genetic testing in patients with restricted mouth opening. Each patient presented a different onset and degree of jaw movement restriction. The anatomic ossification site of the mandibular joint was examined in each patient using reconstructed computed tomographic (CT) images and 3-dimensional reconstructed CT (3D-CT) images. A 29-year-old woman complained of jaw movement restriction since 13 years of age. 3D-CT image of the mandibular joint showed an osseous bridge, formed by the mandibular depressors that open the mouth, between the hyoid bone and the mentum of the mandible. A 39-year-old man presented with jaw movement restriction that developed at 3 years of age after a mouth injury. 3D-CT image of the jaw showed ankylosis of the jaw from ossification of the mandibular depressors that was worse than in patient 1. CT images showed no HO findings of the masticatory muscles. To the authors' knowledge, these are the first 2 case descriptions of the anatomic site of ankylosis involving HO of the mandibular depressors in the jaw resulting from FOP. In contrast, a 62-year-old bedridden woman with an interincisal distance longer than 10 mm (onset, 39 years of age) had no HO of the mandibular depressors and slight HO of the medial pterygoid muscle on the right and left sides. These findings suggest that restricted mouth opening varies according to the presence or absence of HO of the mandibular depressors. Copyright © 2017. Published by Elsevier Inc.

A Feedback-Controlled Mandibular Positioner Identifies Individuals With Sleep Apnea Who Will Respond to Oral Appliance Therapy.

PubMed

Remmers, John E; Topor, Zbigniew; Grosse, Joshua; Vranjes, Nikola; Mosca, Erin V; Brant, Rollin; Bruehlmann, Sabina; Charkhandeh, Shouresh; Zareian Jahromi, Seyed Abdolali

2017-07-15

Mandibular protruding oral appliances represent a potentially important therapy for obstructive sleep apnea (OSA). However, their clinical utility is limited by a less-than-ideal efficacy rate and uncertainty regarding an efficacious mandibular position, pointing to the need for a tool to assist in delivery of the therapy. The current study assesses the ability to prospectively identify therapeutic responders and determine an efficacious mandibular position. Individuals (n = 202) with OSA participated in a blinded, 2-part investigation. A system for identifying therapeutic responders was developed in part 1 (n = 149); the predictive accuracy of this system was prospectively evaluated on a new population in part 2 (n = 53). Each participant underwent a 2-night, in-home feedback-controlled mandibular positioner (FCMP) test, followed by treatment with a custom oral appliance and an outcome study with the oral appliance in place. A machine learning classification system was trained to predict therapeutic outcome on data obtained from FCMP studies on part 1 participants. The accuracy of this trained system was then evaluated on part 2 participants by examining the agreement between prospectively predicted outcome and observed outcome. A predicted efficacious mandibular position was derived from each FCMP study. Predictive accuracy was as follows: sensitivity 85%; specificity 93%; positive predictive value 97%; and negative predictive value 72%. Of participants correctly predicted to respond to therapy, the predicted mandibular protrusive position proved efficacious in 86% of cases. An unattended, in-home FCMP test prospectively identifies individuals with OSA who will respond to oral appliance therapy and provides an efficacious mandibular position. The trial that this study reports on is registered on www.clinicaltrials.gov, ID NCT03011762, study name: Feasibility and Predictive Accuracy of an In-Home Computer Controlled Mandibular Positioner in Identifying Favourable Candidates for Oral Appliance Therapy. © 2017 American Academy of Sleep Medicine

Sliding mechanics with microscrew implant anchorage.

PubMed

Park, Hyo-Sang; Kwon, Tae-Geon

2004-10-01

Three cases are illustrated. One was treated with maxillary microscrew implants, another with mandibular microscrew implants, and the third with both maxillary and mandibular microscrew implants. With the maxillary microscrew implants, the maxillary anterior teeth were retracted bodily with a slight intrusion and all the premolar extraction space was closed without loss of anchorage. Furthermore, the maxillary posterior teeth showed distal movement. The mandibular microscrew implants controlled the vertical position of the mandibular posterior teeth and played an important role in improving the facial profile. The efficacy of sliding mechanics with microscrew implant anchorage on the treatment of skeletal Class II malocclusion is also discussed.

A novel technique for preventing skin pressure sores using a rubber tube during surgical treatment of mandibular condyle fractures.

PubMed

Kawase-Koga, Yoko; Mori, Yoshiyuki; Hoshi, Kazuhito; Takato, Tsuyoshi

2013-11-01

Craniofacial surgery occasionally results in sores and necrosis of the facial skin because of pressure from surgical instruments. During surgical treatment of mandibular condylar process fractures, the main mandibular fragment is routinely retracted downward using a wire to achieve a satisfactory anatomic reduction. This procedure may injure the facial skin. This potential complication is easily overlooked by medical staff, but it is easily preventable. We herein describe a method of using a rubber tube to avoid causing pressure sores of the facial skin during surgical treatment of mandibular condylar process fractures.

Spline analysis of the mandible in human subjects with class III malocclusion.

PubMed

Singh, G D; McNamara, J A; Lozanoff, S

1997-05-01

This study determines deformations that contribute to a Class III mandibular morphology, employing thin-plate spline (TPS) analysis. A total of 133 lateral cephalographs of prepubertal children of European-American descent with either a Class I molar occlusion or a Class III malocclusion were compared. The cephalographs were traced and checked, and eight homologous landmarks on the mandible were identified and digitized. The datasets were scaled to an equivalent size and subjected to statistical analyses. These tests indicated significant differences between average Class I and Class III mandibular morphologies. When the sample was subdivided into seven age and sex-matched groups statistical differences were maintained for each group. TPS analysis indicated that both affine (uniform) and non-affine transformations contribute towards the total spline, and towards the average mandibular morphology at each age group. For non-affine transformations, partial warp 5 had the highest magnitude, indicating large-scale deformations of the mandibular configuration between articulare and pogonion. In contrast, partial warp 1 indicated localized shape changes in the mandibular symphyseal region. It is concluded that large spatial-scale deformations affect the body of the mandible, in combination with localized distortions further anteriorly. These deformations may represent a developmental elongation of the mandibular corpus antero-posteriorly that, allied with symphyseal changes, leads to the appearance of a Class III prognathic mandibular profile.

Preliminary optical coherence tomography investigation of the temporo-mandibular joint disc

NASA Astrophysics Data System (ADS)

Mărcăuteanu, Corina; Demjan, Enikö; Sinescu, Cosmin; Negrutiu, Meda; Motoc, Adrian; Lighezan, Rodica; Vasile, Liliana; Hughes, Mike; Bradu, Adrian; Dobre, George; Podoleanu, Adrian G.

2010-02-01

Aim and objectives. The morphology and position of the temporo-mandibular disc are key issues in the diagnosis and treatment of arthrogenous temporo-mandibular disorders. Magnetic resonance imaging and arthroscopy are used today to identify: flattening of the pars posterior of the disc, perforation and/or adhesions in the pars intermedia of the disc and disc displacements. The present study proposes the investigation of the temporo-mandibular joint disc by optical coherence tomography (OCT). Material and methods. 8 human temporo-mandibular joint discs were harvested from dead subjects, under 40 year of age, and conserved in formalin. They had a normal morphology, with a thicker pars posterior (2,6 mm on the average) and a thinner pars intermedia (1mm on the average). We investigated the disc samples using two different OCT systems: an en-face OCT (time domain (TD)-OCT) system, working at 1300 nm (C-scan and B-scan mode) and a spectral OCT system (a Fourier domain (FD)-OCT) system , working at 840 nm (B-scan mode). Results. The OCT investigation of the temporo-mandibular joint discs revealed a homogeneous microstructure. The longer wavelength of the TD-OCT offers a higher penetration depth (2,5 mm in air), which is important for the analysis of the pars posterior, while the FD-OCT is much faster. Conclusions: OCT is a promising imaging method for the microstructural characterization of the temporo-mandibular disc.

The Ball Welding Bar: A New Solution for the Immediate Loading of Screw-Retained, Mandibular Fixed Full Arch Prostheses

PubMed Central

Bacchiocchi, Danilo

2017-01-01

Purpose To present a new intraoral welding technique, which can be used to manufacture screw-retained, mandibular fixed full-arch prostheses. Methods Over a 4-year period, all patients with complete mandibular edentulism or irreparably compromised mandibular dentition, who will restore the masticatory function with a fixed mandibular prosthesis, were considered for inclusion in this study. The “Ball Welding Bar” (BWB) technique is characterised by smooth prosthetic cylinders, interconnected by means of titanium bars which are adjustable in terms of distance from ball terminals and are inserted in the rotating rings of the cylinders. All the components are welded and self-posing. Results Forty-two patients (18 males; 24 females; mean age 64.2 ± 6.7 years) were enrolled and 210 fixtures were inserted to support 42 mandibular screw-retained, fixed full-arch prostheses. After two years of loading, 2 fixtures were lost, for an implant survival rate of 97.7%. Five implants suffered from peri-implant mucositis and 3 implants for peri-implantitis. Three of the prostheses (3/42) required repair for fracture (7.1%): the prosthetic success was 92.9%. Conclusions The BWB technique seems to represent a reliable technique for the fabrication of screw-retained mandibular fixed full-arch prostheses. This study was registered in the ISRCTN register with number ISRCTN71229338. PMID:28835752

Prevalence of Extra Roots in Permanent Mandibular First Molars in Iranian Population: A CBCT Analysis

PubMed Central

Rahimi, Saeed; Mokhtari, Hadi; Ranjkesh, Bahram; Johari, Masoomeh; Frough Reyhani, Mohammad; Shahi, Shahriar; Seif Reyhani, Sina

2017-01-01

Introduction: Having knowledge about the anatomy of root canal system is essential for success of endodontic treatment. The present study used cone-beam computed tomography (CBCT), to evaluate the prevalence of third root in mandibular first molars in a selected Iranian population. Methods and Materials: A total of 386 CBCT images from subjects referred to oral and maxillofacial radiology department of dental faculty of Tabriz University of Medical Sciences from 2011 to 2013 were selected and evaluated for this study and the cases with well-developed permanent mandibular first molars were included. The 3D images were reconstructed in axial cross sections and evaluated by two endodontists for the presence of the third extra lingual (radix entomolaris) or buccal (radix paramolaris) root. The chi-squared test was used to evaluate the relationship between gender and bilateral incidence of extra roots in mandibular first molars. Results: The distribution of three-rooted mandibular first molars with an additional root was 3%, (3.53% in female and 2.50% in male patients). There was no significant relationship between gender and bilateral occurrence of three-rooted mandibular first molars. Conclusion: The occurrence of three-rooted mandibular first molars in Iranian population is not uncommon which should be taken into consideration by the dental practitioners during root canal treatment of these teeth. PMID:28179928

Mandibular osteoradionecrosis in squamous cell carcinoma of the oral cavity and oropharynx: incidence and risk factors.

PubMed

Monnier, Yan; Broome, Martin; Betz, Michael; Bouferrache, Kahina; Ozsahin, Mahmut; Jaques, Bertrand

2011-05-01

Mandibular osteoradionecrosis (ORN) is a serious complication of radiotherapy (RT) in head and neck cancer patients. The aim of this study was to analyze the incidence of and risk factors for mandibular ORN in squamous cell carcinoma (SCC) of the oral cavity and oropharynx. Case series with chart review. University tertiary care center for head and neck oncology. Seventy-three patients treated for stage I to IV SCC of the oral cavity and oropharynx between 2000 and 2007, with a minimum follow-up of 2 years, were included in the study. Treatment modalities included both RT with curative intent and adjuvant RT following tumor surgery. The log-rank test and Cox model were used for univariate and multivariate analyses. The incidence of mandibular ORN was 40% at 5 years. Using univariate analysis, the following risk factors were identified: oral cavity tumors (P < .01), bone invasion (P < .02), any surgery prior to RT (P < .04), and bone surgery (P < .0001). By multivariate analysis, mandibular surgery proved to be the most important risk factor and the only one reaching statistical significance (P < .0002). Mandibular ORN is a frequent long-term complication of RT for oral cavity and oropharynx cancers. Mandibular surgery before irradiation is the only independent risk factor. These aspects must be considered when planning treatment for these tumors.

Mandibular single-implant overdentures: a review with surgical and prosthodontic perspectives of a novel approach.

PubMed

Alsabeeha, Nabeel; Payne, Alan G T; De Silva, Rohana K; Swain, Michael V

2009-04-01

To review the literature on mandibular single-implant overdentures (opposing complete maxillary dentures), and present surgical and prosthodontic perspectives of a novel approach for this treatment option. An electronic search through the databases of Pubmed, Embase and Medline using the linked key words 'mandibular single implant overdentures' was performed. The search was limited to English language articles published up to August 2008. Hand searches through articles retrieved from the electronic search, peer-reviewed journals and recent conference proceedings were also conducted. A limited number of reports were identified on mandibular single-implant overdentures (opposing maxillary complete dentures). They comprised of case-series reports, short-term prospective trials and current randomized-controlled clinical trials. Different loading protocols with different implant systems have been used, but always with regular diameter implants. Specific anatomical and vascular dangers of the mandibular midline symphysis are identified including a novel surgical approach using a currently available short, wide diameter tapered implant. In addition, the prosthodontic rationale for using a larger attachment system (incorporating a platform switch) for mandibular single-implant overdentures is described. The review reveals that there is a lack of published randomized clinical trials using mandibular single-implant overdentures, opposing maxillary complete dentures. Without the evidence from randomized clinical trials, routine use of this novel approach cannot be recommended, compared with using regular diameter implants and matching attachment systems.

Mandibular movement range in children.

PubMed

Machado, Barbara Cristina Zanandréa; Medeiros, Ana Paula Magalhães; Felício, Cláudia Maria de

2009-01-01

identification of the mandibular movement range is an important procedure in the evaluation of the stomatognathic system. However, there are few studies in children that focus on normal parameters or abnormalities. to determine the average range of mandibular movements in Brazilian children aged 6 to 12 years; to verify the difference between genders, in each age group, and between the different age groups: 6-8 years; 8.1-10 years; and 10.1-12 years. participants of the study were 240 healthy children selected among regular students from local schools of São Paulo State. The maximum mandibular opening, lateral excursion and protrusive movements, and deviation of the medium line, if present, were measured using a digital caliper. Student T test, Analysis of variance and Tukey test were considered significant for p < 0.05. the mean values observed in the studied sample were: 44.51mm for maximum mandibular opening; 7.71mm for lateral excursion to the right; 7.92mm for lateral excursion to the left; 7.45mm for protrusive movements. No statistical difference was observed between genders. There was a gradual increase in the range of mandibular movements, with significant differences mainly between the ages of 6-8 years and 10.1-12 years. during childhood the range of mandibular movements increases. Age should be considered in this analysis for a greater precision in the diagnosis.

A radiographic template for a two-implant mandibular overdenture using the patient’s existing denture

PubMed Central

Huynh-Ba, G; Alexander, P; Vargas, A; Vierra, M; Oates, TW

2012-01-01

This article introduces a technique for modifying an existing mandibular complete denture for use as a radiographic template with a radiopaque light-activated calcium hydroxide (Ca(OH)2) preparation. This allows prosthetically-driven treatment planning and surgical placement of 2 implants to support the existing mandibular denture. PMID:23328197

Cerebro-costo-mandibular syndrome: Report of two cases.

PubMed

Abdalla, Wael; Panigrahy, Ashok; Bartoletti, Stefano C

2011-01-01

Cerebro-costo-mandibular syndrome (CCMS) is a rare syndrome that includes a constellation of mandibular hypoplasia and posterior rib defects as its basic features. Additional features can include hearing loss, tracheal cartilage abnormalities, scoliosis, elbow hypoplasia, and spina bifida. Here we report two cases of CCMS and discuss the reported long-term outcome of the disease.

Anatomic symmetry of root and root canal morphology of posterior teeth in Indian subpopulation using cone beam computed tomography: A retrospective study

PubMed Central

Felsypremila, Gnanasekaran; Vinothkumar, Thilla Sekar; Kandaswamy, Deivanayagam

2015-01-01

Objective: To investigate the anatomic symmetry of maxillary and mandibular posteriors in Indian subpopulation using cone beam computed tomography (CBCT). Materials and Methods: CBCT images of 246 patients that had at least one noncarious, posterior tooth free of restorations in each quadrant were enrolled for retrospective analysis. A total of 3015 teeth (811 maxillary premolars, 845 mandibular premolars, 738 maxillary molars, and 621 mandibular molars) were analyzed for number of roots and root canals, canal morphology and anatomic symmetry, and concurrent types between the maxilla and mandible. Results: There was no difference in the percentage of symmetry for maxillary first (81.5%) and second (81.5%) premolars. Mandibular second premolars (98.3%) exhibited greater symmetry than mandibular first premolars (96.1%). First molars (77.5% and 82.1%) showed greater symmetry than second molars (70.8% and 78.6%), in both maxillary and mandibular arches, respectively. The most common anatomy observed were: maxillary first premolars – 2 roots with 2 canals, maxillary second premolars – 1 root with 2 canals, mandibular first and second premolars – 1 root with 1 canal, maxillary first and second molars – 3 roots with 4 canals, and mandibular first and second molars – 2 roots with 3 canals. When compared with any other teeth, maximum asymmetry was observed in maxillary second molar (29.2%). Conclusion: The percentage of symmetry observed in the present study varied from 70% to 98% with least percentage of symmetry in maxillary second molars. These data should alert the clinicians while treating homonymous teeth of the same patient. PMID:26929687

Kinematic Modeling of Normal Voluntary Mandibular Opening and Closing Velocity-Initial Study.

PubMed

Gawriołek, Krzysztof; Gawriołek, Maria; Komosa, Marek; Piotrowski, Paweł R; Azer, Shereen S

2015-06-01

Determination and quantification of voluntary mandibular velocity movement has not been a thoroughly studied parameter of masticatory movement. This study attempted to objectively define kinematics of mandibular movement based on numerical (digital) analysis of the relations and interactions of velocity diagram records in healthy female individuals. Using a computerized mandibular scanner (K7 Evaluation Software), 72 diagrams of voluntary mandibular velocity movements (36 for opening, 36 for closing) for women with clinically normal motor and functional activities of the masticatory system were recorded. Multiple measurements were analyzed focusing on the curve for maximum velocity records. For each movement, the loop of temporary velocities was determined. The diagram was then entered into AutoCad calculation software where movement analysis was performed. The real maximum velocity values on opening (Vmax ), closing (V0 ), and average velocity values (Vav ) as well as movement accelerations (a) were recorded. Additionally, functional (A1-A2) and geometric (P1-P4) analysis of loop constituent phases were performed, and the relations between the obtained areas were defined. Velocity means and correlation coefficient values for various velocity phases were calculated. The Wilcoxon test produced the following maximum and average velocity results: Vmax = 394 ± 102, Vav = 222 ± 61 for opening, and Vmax = 409 ± 94, Vav = 225 ± 55 mm/s for closing. Both mandibular movement range and velocity change showed significant variability achieving the highest velocity in P2 phase. Voluntary mandibular velocity presents significant variations between healthy individuals. Maximum velocity is obtained when incisal separation is between 12.8 and 13.5 mm. An improved understanding of the patterns of normal mandibular movements may provide an invaluable diagnostic aid to pathological changes within the masticatory system. © 2014 by the American College of Prosthodontists.

Relationship between cervical vertebral maturation and mandibular growth.

PubMed

Ball, Gina; Woodside, Donald; Tompson, Bryan; Hunter, W Stuart; Posluns, James

2011-05-01

The cervical vertebrae have been proposed as a method of determining biologic maturity. The purposes of this study were to establish a pattern of mandibular growth and to relate this pattern to the stages of cervical vertebral maturation. Cephalometric radiographs, taken annually from ages 9 to 18 years, were evaluated for 90 boys from the Burlington Growth Center, Toronto, Ontario, Canada. Mandibular lengths were measured from articulare to gnathion, and incremental growth was determined. Cervical vertebral maturation stages were assessed by using a 6-stage method. Advanced, average, and delayed maturation groups were established. The prepubertal mandibular growth minimum velocity occurred during cervical stages 1 through 4 (P = 0.7327). Peak mandibular growth velocity occurred most frequently during stage 4 in all 3 maturation groups, with a statistical difference in the average and delayed groups (P <0.0001) and the advanced group (P = 0.0143). The average number of years spent in stage 4 was 3.79 (P <0.0001). The average amount of mandibular growth occurring during stage 4 was 9.40 mm (P <0.0001). The average amount of growth in stages 5 and 6 combined was 7.09 mm. Progression from cervical stages 1 through 6 does not occur annually; time spent in each stage varies depending on the stage and the maturation group. Cervical vertebral maturation stages cannot accurately identify the mandibular prepubertal growth minimum and therefore cannot predict the onset of the peak in mandibular growth. The cervical vertebral maturation stages should be used with other methods of biologic maturity assessment when considering both dentofacial orthopedic treatment and orthognathic surgery. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.