Introduction: Digastric is a suprahyoid muscle and usually consists of two bellies. Its action consists in drawing the mental region downwards and backwards when opening the mouth, resulting in the depression of the mandible. Methods and Results: During a routine dissection of the cervical region, a muscle bundle arising from the intermediary tendon going towards the middle line was found. The supranumerary belly arised from the intermediary tendon so that some bundles inserted on the middle rafe and others continued towards the mento and inserted on the belly of mylohyoid muscle at the same side. These anatomic variations on the anterior belly of the digastric muscle could be significant during surgical procedures involving the submental region. Conclusion: Besides this surgical importance, we suggest that these supranumerary bellies have no direct action on the mandible, but on the floor of the mouth, due to its insertions on the mylohyoid muscle.

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Introduction: In Brazil, about 18.500 people have some kind of hereditary coagulopathy. In combination, the increase in life expectancy has led to an increasingly frequent presence of older people in medical offices. These patients make use of many drugs, including those that produce anticoagulant effects. The dentist should be aware about the impact of bleeding disorders during the approach of their patients, especially if invasive procedures are considered. Objective: To identify the most prevalent blood dyscrasias presented by patients covered by the Program of dental surgical care to patients with blood dyscrasias; to establish the presence of associated diseases and investigate the correlation between pre- and postoperative drug protocols and the occurrence of postoperative complications. Methods: This was an epidemiological retrospective cross-sectional study of medical reports used by the program. After the survey of defined variables, data were tabulated in Microsoft Excel ® software and evaluated using the chi-square and Fisher’s exact tests. Results: One patient was identified as having Human Immunodeficiency Virus and 18 with Hepatitis C virus. There was a statistically significant difference between patients with haemophilia B and Hepatitis C. The administration of tranexamic acid as pre- and post-surgical protocol was the therapy of choice. Of the 11 patients with vWD, 7 of them received tranexamic acid as preoperative medication. Conclusion: The appropriate retention system for the patient depends on several factors, including indication, advantages and disadvantages, retention provided, aesthetics and clinical performance.

Introdução: o zigoma articula-se com quatro ossos e é de extrema importância na força e estabilidade do terço médio da face. Por sua projeção anterior na face, torna-se um osso bastante susceptível aos traumas. Fraturas podem resultar em sequelas funcionais significantes e estéticas. Objetivo: relatar um caso clínico de fratura de zigoma, bem como debater sobre possíveis formas de fixação, suas indicações e sequencia cirúrgica. Materiais e métodos: paciente gênero masculino, 26 anos de idade e com histórico de agressão física. Ao exame clínico e de imagem, constatou-se fratura de complexo zigomático-orbitário direito, que foi tratado com osteossíntese em dois pontos de fixação. Resultados: a abordagem de fixação da fratura nas suturas zigomático-frontal e zigomático-maxilar foi satisfatória e concedeu estabilidade e projeção anteroposterior na face. Paciente segue em acompanhamento de seis meses sem apresentar sequelas ou complicações. Conclusões: o manejo das fraturas do complexo zigomático-maxilar ainda é discutido e controverso na literatura. Porém a abordagem com fixação de dois pontos se mostrou precisa, menos invasiva e com menor custo.Descritores: Zigoma; Fixação de Fratura; Traumatologia.ReferênciasNagaprasad N, Praveen Harish G, Reddy GSG. Clinical Study of Isolated Zygomatic Fractures. Int J Contemp Med Res. 2016;3(7):1983-86.Jardim ECG, Santiago Junior JF, Melo RL, Mendonça JCG, Faverani LP, Garcia Júnior IR et al. Combinação de técnicas para tratamento cirúrgico de fratura do complexo zigomático-maxilar: relato de caso. Arch Health Invest. 2013; 2(3):33-6.Sassi LM, Dissenha JL, Bezeruska C, Guebur MI, Hepp V, Radaelli RL et al. Fraturas de zigomático: revisão de 50 casos. Rev Bras Cir Cabeça Pescoço. 2009; 38:246-7.Mendonça JCG, Crivelli DMB. Tratamento de fratura cominutiva do complexo zigomático orbitário com utilização de fio de aço: relato de caso. Rev Bras Cir Cabeça Pescoço. 2012;41(2):93-5.Oliveira JAGP. Fratura do arco zigomático: relato de caso utilizando o acesso pré-auricular. Rev Cir Traumatol Bucomaxilofac. 2009; 9(1):47-52.Oliva MA. Acesso subciliar para fraturas do complexo zigomático-orbitári. Rev Bras Cir Cabeça Pescoço. 2013;42(2):106-8.Meslemani D, Kellman RM. Zygomaticomaxillary complex fractures. Arch Facial Plast Surg. 2012; 14(1):62-6Rana M, Warraich R, Tahir S, Igbal A, von See C, EcKardt AM et al. Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation– a randomised prospective clinical trial. Trials 2012; 13:36Ellis E 3rd, Kittidumkerng W. Analysis of treatment for isolated zygomatic maxillary complex fractures. J Oral Maxillofac Surg. 1996; 54(4):386-400.Ellis E 3rd, Daniel Perez. An algorithm for the treatment of isolated zygomatico-orbital fractures. J Oral Maxillofac Surg. 2014;72(10):1975-83.Tripathi N, Goyal M, Mishra B, Dhasmana S. Zygomatic complex fracture: A comparative evaluation of stability using titanium and bio‑resorbable plates as one point fixation. Nat J Maxillofac Surg. 2013;4(2):181-87.Yonehara Y, Hirabayashi S, Tachi M, Ishii H. Treatment of zygomatic fractures without inferior orbital rim fixation. J Craniofac Surg. 2005;16(3):481-85.Eski M, Sahin I, Deveci M, Turegun M, Isik S Sengezer M. A retrospective analysis of 101 zygomatico-orbital fractures. J Craniofac Surg. 2006;17(6):1059-64.Chrcanovic BR, Cavalcanti YS, Reher P. Temporal miniplates in the frontozygomatic area-an anatomical study. J Oral Maxillofac Surg. 2009;13(4):201-6.Davidson J, Nickerson D, Nickerson B. Zygomatic fractures: comparison of methods of internal fixation. Plast Reconstr Surg. 1990;86(1):25-32.Kim ST, Godh, Jung JH. Comparison of one point fixation with two point fixation in treating tripod fractures of zygoma, J Oral Maxillofac Surg. 2011; 69(11):2848-52Kovács AF, Ghahremani M. Minimization of zygomatic complexfracture treatment. Int J Oral Maxillofac Surg. 2001; 30(5):380-83.Nasr WF, ElSheikh E, El-Anwar MW, Sweed AH, Bessar A, Ezzeldin N. Two-versus three-point internal fixation of displaced zygomaticomaxillary complex fractures. Craniomaxillofac Trauma Reconstr. 2018;11(4):256-64.

Orbital lymphoma is a rare condition with non-specific and variable clinical course. This features are the main obstacle for diagnosis and treatment. A 43-year-old female patient complaining of vision loss and hemiface paresthesia, Proptosis was noted associated with an expansive lesion involving the right temporal lobe and orbital region. Craniotomy was performed to allow orbital decompression and anatomopathogical analysis. Final diagnosis was Burkitt Lymphoma. Patient evolved to death after seven days. A 40-year-old male patient complaining excessive tearing and sight disturbance. Proptosis on the right eye was noticed. Extra-conal expansive lesion was observed. Final diagnosis was mucosa-associated lymphoid tissue lymphoma. Radio and chemotherapy protocol was initiated. In a 3 year follow-up, there are no signs of recurrence or ocular/orbital impairment. Maxillofacial surgeons should be aware of the initial clinical presentation and always include lymphoid neoplasms as a differential diagnosis in cases which acute functional alterations are present.