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Purpose: A randomized controlled trial was performed to evaluate the effects of light-emitting diode (LED) therapy on sensory changes in the inferior alveolar nerve after surgical treatment of mandibular fractures., Methods: Patients admitted with surgically treated mandibular fractures between January 2018 and December 2019 were evaluated. Personal data, fracture location, fracture type, and dislocation degree were obtained. The cases were randomly allocated into two groups: LED therapy (LEDT) (57 points of 660 nm and 74 points of 850 nm, 6.4 mV/cm 2 , and 7.64 J) with the use of a prototype device and control (CTRL). For 6 months, tactile and thermal tests were used in the mental region. Data were analyzed using the Mann─Whitney U test and likelihood ratio test (p ≤ 0.050)., Results: The study included 42 patients, 25 of whom had bilateral fractures and 17 had unilateral fractures, totaling 67 fractures. The mean values of the tactile and thermal sensitivity tests were lower in the LEDT group in all evaluation periods. There was a significant difference between the groups in the parasymphysis location, displacement < 5 mm, and intraoral access. Sensory changes were observed in 68.7% of all fractures upon admission, with 91.2% in the LEDT group and 78.8% in the CTRL group demonstrating complete remission during the final period of the study., Conclusion: LED photobiomodulation accelerated the process of sensory change remission. There was an influence of the fracture location, degree of displacement, and surgical access, with a better response in the LEDT group., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: This study evaluated records of patients with maxillofacial trauma due to interpersonal violence (IPV) being treated in the emergency room of a level I trauma center hospital in São Paulo, Brazil., Material and Methods: Data of patients with maxillofacial trauma due to IPV recorded between January 2019 and December 2019 were retrospectively examined. Personal data, days on which they experienced IPV, and the type of maxillofacial trauma sustained were extracted and statistically analyzed (p < .050)., Results: During the analysis, 1034 patients with maxillofacial trauma were identified; of these patients, 292 (28.2%) who experienced trauma due to IPV were included in this study. There was a mean age of 32.6 years and the most common type of trauma was soft tissue injuries (38.7%). Mandible and nose fractures were more prevalent in males and females, respectively. Our data, when compared with other studies on maxillofacial trauma due to IPV, showed a lower prevalence and male-to-female ratio, and a higher presence of dentoalveolar trauma. Additionally, our data when compared with studies on maxillofacial trauma due to other causes showed lower mean age and male-to-female ratios, and a higher occurrence of nose fractures differing from the predominance of mandibular fractures., Conclusion: Oral and maxillofacial surgeons must be able to suspect and identify cases due to IPV among their patients with trauma. With our results, although each case has its individuality, we can suggest that cases of maxillofacial trauma in young, female, and nasal fracture patients may be suspicious for IPV., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background/aims: The ideal management of teeth in the line of mandibular fractures is unclear and controversial. The aim of this study was to analyze the characteristics and management of teeth in the line of mandibular fractures treated with open reduction and internal fixation., Material and Methods: Medical records of patients with mandibular fractures in the symphysis, body and angle regions seen between July 2019 and January 2021 were evaluated. Personal data, etiology, location of fractures, characteristics of the teeth involved in the fracture lines and management were collected. The relationship between the fracture lines and the periodontium was classified according to Kamboozia & Punnia-Moorthy. Fractures were divided into two groups according to the management of the tooth in the fracture line: removal and retention. The likelihood ratio test was used (p < .050)., Results: During the study period, 52 patients with mandibular fractures were seen, of which 42 patients (83.3% men) with a mean age of 29.6 years and 54 fractures were included. The most frequent location was the angle of the mandible (41.3%) (p < .001). The removal group represented 35.2% of the fractures, and the retention group represented 64.8%. The most frequently removed tooth was the third molar (p < .001), and the most frequent classification of dental involvement in the fracture line was type II (p = .047). There was no correlation between age, gender, or etiology and the management of the teeth involved., Conclusion: The retention of teeth in the fracture line predominated, and the third molar in angle fractures was the most often removed tooth when the fracture line followed the root surface but did not cross the apical region, probably due to the greater frequency of this type of relationship between the fractures and the periodontium., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Odontogenic infections are frequent and can spread, leading to complications such as sepsis and the need for admission to an Intensive Care Unit (ICU). The purpose of this study was to perform a computed tomography analysis of the fascial space involvement and correlate with personal data, laboratory tests, length of hospital stays and admission to the ICU in patients with odontogenic infections who required hospitalization., Methods: Patients with odontogenic infections admitted between June 2017 and May 2018 were prospectively evaluated. The fascial spaces involved were studied using computed tomography with contrast. The possible correlations of tomographic findings with comorbidities, nutritional status, the causative tooth, laboratory tests, length of hospital stays and admission to the ICU were analyzed., Results: We identified 66 cases of odontogenic infections which were admitted in the period analyzed. The involvement of primary spaces (86.7%) predominated, followed by secondary ones (8.7%), and cervical (4.6%). The most frequently involved fascial spaces were submandibular (27.1%), buccal (20.8%), sublingual (18.3%), submental (16.7%), and others (17.1%). There were significant differences between laboratory tests (p < 0.001), mean hospital stays (p < 0.001), and admissions to the ICU (p < 0.001) depending on the number of fascial spaces involved. There was no influence of comorbidities, nutritional status, or causative tooth on fascial space involvement., Conclusion: There was a relationship between greater involvement of fascial spaces assessed by computed tomography and higher values of laboratory tests, more extended hospitalization stays and admission to the ICU., Level of Evidence: Level 2b., (Copyright © 2022 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

The orthodontic-surgical treatment comprises different stages from diagnosis to final soft tissue accommodation, but there are no data regarding the patient's perception during these phases. This study aimed to investigate the impact of these stages on quality of life and self-esteem of patients with dentofacial deformity. Patients were divided into 4 groups according to the treatment stage: initial orthodontic pre-treatment (1), one week before surgery (2), three months after surgery (3), and after the removal of the orthodontic appliance (4) (n = 20 / group). They filled the following questionnaires: Oral Health Impact Profile (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ) and Rosenberg Self-Esteem Scale (RSES). Data were evaluated by Kruskal-Wallis test. Differences among groups were noticed in all evaluated scales (p = 0.001 for all). No statistically significant differences between patients in groups 1 and 2 (OHIP, OQLQ, and RSES, p >0.05 for all), while patients at group 4 presented different scores in all questionnaires compared to 1, 2, and 3 (p < 0.05 for all), irrespective of the type of dentofacial deformity (p > 0.05). The results indicate that dental decompensation stage did not negatively affect patient's confidence and well-being. Despite the improvement noticed few months after the orthognathic surgery, the main impact on patient's quality of life and self-esteem was evidenced after the removal of the orthodontic appliance. We highlight the important role of counselling patients to discuss all the treatment stages to clarify patients' subjective expectations before any intervention is carried out., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

The aim of this study was to analyze the effect of chronic ethanol ingestion on dendritic cell repopulation during the repair process of rat oral mucosa and in the rat spleen by analyzing the immunohistochemical expression of dendritic cell markers. Wistar rats ingested 20% ethanol solution for 28 days; a surgical wound was performed on the rat tongue after this period. The repair process and the number of CD1a+, CD11c+, and CD207+ cells in the regions adjacent to the wound were determined at day 1, 3, and 7 following the wound as well as in the rat spleen. The wound-only group (no ethanol exposure) had complete reepithelization after 7 days, but this did not occur in the ethanol + wound group at this time point. The inflammatory infiltrate was significantly reduced in animals exposed to ethanol, which also showed significantly lower counts of CD1a+, CD11c+, and CD207+ cells than the wound-only group at all experimental time points. In addition, ethanol exposure also resulted in lower densities of CD11c+ and CD207+ cells in the rat spleen. In conclusion, chronic ethanol intake had a negative impact on dendritic cell numbers, a fact that may contribute to delay in oral mucosa repair., (© 2022 Scandinavian Division of the International Association for Dental Research. Published by John Wiley & Sons Ltd.)

The aim of the study was to compare open reduction with internal fixation (ORIF) and endoscopic open reduction with internal fixation (EORIF) of condylar fractures (CF) in adults in terms of reducing both needing of reoperation and/or facial nerve injury. An electronic search was undertaken (PubMed/MEDLINE, Web of Science, SCOPUS, and The Cochrane Library). The inclusion criteria were full text, published from their inception to June 2020, clinical trials, randomized or not, and retrospective studies, that compared ORIF and EORIF. The estimates of an intervention were expressed as the risk ratio (RR). From the 1338 articles found, 5 publications were included. There was no statistically significant difference between ORIF and EORIF regarding needing of reoperation (RR = 2.46, p = 0.42) or facial nerve injury (RR = 0.45, p = 0.14). Meta-analysis suggests that there is no difference between open reduction with internal fixation (ORIF) and endoscopic open reduction with internal fixation (EORIF) of condylar fractures (CF) regarding facial nerve injury risk or need for reoperation., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background/aim: There are few studies in the literature evaluating possible alterations in laboratory tests in patients with maxillofacial fractures. The aim of this study was to analyze the changes in admission laboratory tests of patients with maxillofacial fractures with indications for surgical treatment, including the influence of dento-alveolar trauma., Material and Methods: Data from complete blood counts, blood coagulation tests, blood chemistries, and urinalysis results were obtained. The occurrence of concomitant dento-alveolar trauma was noted. The medical records were also re-evaluated later to verify the treatment outcome and the occurrence of complications. Statistical analyses were performed using the likelihood-ratio test to verify significant changes in the evaluated parameters (P ≤ .050)., Results: There was a prevalence of males (78%) with a mean age of 35.9 years. Lower erythrocyte counts, hemoglobin levels, and/or hematocrit were observed in males with associated fractures and with simultaneous dento-alveolar fractures. Higher mean neutrophil, segmented neutrophil, and lymphocyte counts were observed in patients with simultaneous dento-alveolar trauma. A higher mean activated partial thromboplastin time (aPTT) ratio was also observed. Lower potassium levels were observed for patients in the fourth decade of life. Higher leukocyte counts not associated with trauma were observed in the urinalysis results of females and in the group of patients aged 20 or younger. Verification of treatment outcome showed two cases of infections and two cases that needed re-operation after mandible fractures. These four cases showed no significant changes in laboratory tests regarding the predisposition for complications., Conclusion: Patients with maxillofacial fractures had neutrophilia, increased aPTT, and non-traumatic leukocyturia. There was an influence of associated fractures and dento-alveolar trauma on the decrease in red blood cell parameters, neutrophilia, and lymphocytosis and of age on hypokalemia., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study analyzed the effects of photobiomodulation (PBM) with low-level laser therapy on nociceptive behavior and neuronal activity in the trigeminal nucleus after experimental unilateral temporomandibular joint (TMJ) disc injury. The animals were divided into 4 groups (n = 10 each): group 1, surgical injury of the articular disc and PBM; group 2, sham-operated subjected to PBM; group 3, surgical injury of the articular disc; and group 4, control (Naïve). Ten sessions of PBM were performed using GaAs laser with a wavelength of 904 nm, power of 75 W pico, average power of 0.043 W, area of the beam of 0.13 cm 2 , duration of the pulses of 60 nseg (in the frequency of 9500 Hz), energy density of 5.95 J/cm 2 , energy per point of 0.7 J, and power density of 333.8 mW/cm 2 , and the irradiation was done for 18 s per point. Neuropathic symptoms were evaluated using the von Frey test. Trigeminal ganglion samples underwent immunoblotting to examine the expression of substance P, vanilloid transient potential receptor of subtype-1 (TRPV-1), and peptide related to the calcitonin gene (CGRP). There was a total decrease in pain sensitivity after the second session of PBM in operated animals, and this decrease remains until the last session. There was a significant decrease in the expression of SP, TRPV-1, and CGRP after PBM. Photobiomodulation therapy was effective in reducing nociceptive behavior and trigeminal nucleus neuronal activity after TMJ disc injury.

The aim of this study was to longitudinally evaluate mandibular movements, pain, and edema in patients who underwent low-power laser (LPL) phototherapy after bimaxillary orthognathic surgery. A double-blind, randomized, controlled clinical trial was conducted using 30 patients, who were divided into a study group (n = 15) and control group (n = 15). The former group received postoperative LPL (3 J/cm 2 , 808 nm, and 100 mW) and the latter group received placebo LPL phototherapy. Over a period of 60 days, these groups were evaluated for: mandibular movements - opening, laterality, and protrusion; pain - visual analogue scale; and edema - measured between cephalometric points. The study group showed significantly better jaw opening (p = 0.009), laterality (p = 0.036), and protrusion (p = 0.029) after 2 weeks in most comparisons. The study group showed significantly less postoperative pain (p < 0.001) in most comparisons, and they recovered from pain earlier than the control group. There was a reduction in edema, with no statistically significant difference for most measurements. As observed in most analyses, there were increases in values for all mandibular movements, no significant differences in the occurrence of edema, and decreases in the occurrence of pain., (Copyright © 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Temporomandibular disorders (TMD) may present with diverse signs and symptoms, and one very significant is the limitation of mandibular movements. Additionally, the Helkimo indices allow for the reliable quantification of the signs and symptoms of TMD. The purpose of this study was to ascertain whether there are any correlations between the Helkimo indices and the maximal mandibular excursion capacity in a group of patients with TMD. Eighty patients (72 women and 8 men, mean age 33.6 years) with diagnosis of TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were evaluated to obtain the Helkimo indices and their maximal mandibular excursion capacities. Normal or decreased maximum mandibular movements, i.e., opening, lateral and protrusion were compared with the anamnestic index, muscular pain symptoms, joint pain symptoms and the dysfunction index. Chi-squared analysis was used to compare normal and decreased movement capacities in terms of the Helkimo indices, and the muscle and temporomandibular joint (TMJ) pain. The statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 19.0. There were statistically significant differences in the clinical dysfunction index with the maximum opening (p = .011) and lateral movements (p = .024) but not with the maximum protrusion. There were no significant differences in the anamnestic index or the muscle pain and TMJ pain items of the clinical dysfunction index according to the mandibular excursions. The occurrences of limitations in the maximum opening and lateral movements are indications of greater TMD intensity., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: Temporomandibular disorders lead to parafunctional activity that may alter bone remodeling of mandibular components. This animal study aimed to assess the impact of temporomandibular joint discectomy on condylar bone microarchitecture., Materials and Methods: A total of 30 one-month-old Wistar rats were assessed and divided into 3 equal groups (2 test groups and 1 control group) of 10. The first test group underwent disc removal, the second test group underwent disc and condylar cartilage removal, and the 10 remaining rats were analyzed as sham-operated controls, following a split-mouth design. The rats were killed humanely 2 months after surgery, and the respective mandibles were scanned with micro-computed tomography for quantitative morphometric analysis., Results: There were significant differences among the 3 groups analyzed (disc removal, disc and condylar cartilage removal, and sham-operated control) for bone volume fraction (ratio of bone volume to total volume, P = .044), structure model index (P < .001), fractal dimension (P = .024), and porosity (P = .023). In addition, operated and contralateral nonoperated sides significantly differed for all variables in at least 1 of the test groups (P < .05) but not in the control group (P > .05)., Conclusions: Within the limitations of this study, our results suggest that discectomy may lead to alterations of the mandibular condylar morphology., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: A comparative study of the use of the 2.0-mm locking fixation system with conventional systems in the treatment of mandibular fractures was performed., Methods: For this study, 87 consecutive patients with 112 mandibular fractures were randomized to receive either 2.0-mm locking plates (n = 45) or conventional 2.0- or 2.4-mm plates (n = 42) and had a minimum follow-up of 6 months. Fractures were classified based on the degree of displacement and complexity. Statistical analyses were used to verify possible differences between the groups when separately compared unfavourable and favourable cases (p ≤ 0.050)., Results: Despite randomization, systemic diseases were more frequent in the 2.0-mm locking group in favourable cases. Substance abuse occurred predominantly in the 2.0-mm locking group, in unfavourable and favourable fractures. There were more cases of complex fractures in the conventional group in unfavourable cases. One case involving a major postoperative complication occurred in the locking group (2.2%) and three cases occurred in the conventional group (7.1%) but with no significant difference between groups. In this study, there were no major differences between conventional and locking 2.0-mm locking systems with regard to the outcome of treated mandibular fractures, showing that both are adequate as long as the criteria of their indication and requirements for installation are met., Conclusions: It was concluded that the 2.0-mm locking fixation system can replace conventional systems in the treatment of mandibular fractures; in addition, this approach was effective in the treatment of unfavourable fractures that typically require the 2.4-mm conventional system.