mastoid air cells extends into the subperiosteal space. Chronic otitis media with or without cholesteatoma can cause facial paralysis through involvement of a dehiscent nerve or through bony erosion. Facial paralysis secondary to COM or cholesteatoma generally has a slow progression and a worse prognosis. 13 C ¸ ilcan et al 10 reported mastoid abscess in 14 patients, labyrinthitis in 28 patients, facial paralysis in 12 patients, and labyrinthine fistula in 4 patients, totally 25 extracranial complications among 324 COM cases. They did not have any intracranial complication in patients who had extracranial complications. However, in our case, we had 2 intracranial and 2 extracranial complications together, and the only complaint of the patient was about the facial paralysis. It is important to know that a patient could have multiple complications and one of the complications may mask the others. Even a sigmoid sinus thrombosis could mask the cere- bellar abscess as mentioned in a clinical report. 14 Early diagnosis of intracranial complications may have been life saving. 11 CONCLUSIONS In this study, we aimed to emphasize that a patient may have multiple complications due to COM even if it has been talked that the complications of COM have been rarely seen recent years. In ad- dition, our patient did not have any complicated complaints except facial paralysis and fever. This situation shows that the clinicians should be careful and keep in mind that a patient with minimal symptoms may have multiple COM complications together. REFERENCES 1. Deri( D, Arsovi( N, Dordevi( V. Pathogenesis and methods of treatment of otogenic brain abscess. Med Pregl 1998;51:51Y55 2. Goldstein NA, Casselbrant ML, Bluestone CD, et al. Intratemporal complications of acute otitis media in infants and children. Otolaryngol Head Neck Surg 1998;119:444Y454 3. Murthy PS, Sukumar R, Hazarika P, et al. 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Indian J Otol 2011;17:132Y134 Anterior Mandibular Zone Safe for Implants Nu ¨khet Ku ¨tu ¨k, DDS, PhD, Ahmet Emin Demirbaz, DDS, Zeynep Bur0in Go ¨nen, DDS, Cihan Topan, DDS, Erdem Kili0, DDS, PhD, Osman A. Eto ¨z, DDS, PhD, Alper Alkan, DDS, PhD Abstract: During implantology procedures, one of the most serious complications is damage of the inferior alveolar nerve (IAN). The mandibular incisive nerve is described as a terminal branch of the IAN and provides innervation to the lower anterior teeth and canines. The incisive nerve and canal are located in the interforaminal area. Although numerous studies report IAN damage during implant placement, few reports in the literature describes sensory distur- bances, such as neuropathic pain, related to mandibular incisive nerve damage. The purpose of this retrospective clinical study was to evaluate the risk of neuropathic pain caused by implant placement in the interforaminal region of the mandible. Panaromic radiographs of patients who were treated with dental implants in the Department of Maxillofacial Surgery, Faculty of Dentistry at Erciyes University, between 2007 and 2012, were examined. Fifty-five patients with suspected relationship between mandibular incisive canal and dental implant were included into this study. Computed tomography scans were obtained from 10 patients who have postoperative neuropathic pain. Relationship between dental implant and mandibular incisive nerve was evaluated using a three-dimensional software program. Mandibular incisive nerve perforation by at least 1 implant was observed in all 10 patients. Descriptive analyses were also provided. Neuropathic pain may occur after implant placement in the interforaminal region due to the perforation of the incisive canal and nerve. According to the results of this retrospective study, the inci- sive canal and nerve perforation should be considered as a compli- cation of implant surgery in the mandibular anterior area. Key Words: Mandibular incisive nerve, dental implant, neuropathic pain, dental volumetric tomography From the Department of Oral & Maxillofacial Surgery, Facultyof Dentistry, Erciyes University, Kayseri, Turkey. Received January 22, 2013. Accepted for publication March 10, 2013. Address correspondence and reprint requests to Ahmet Emin Demirbaz, DDS, Erciyes U ¨ niversitesi, Diz Hekimlig ˘i Faku ¨ltesi, Ag ˘ Nz Diz C ¸ ene Cerrahisi AD, 38039 Kayseri, Turkey; E-mail: aemindemirbas@ hotmail.com A part of this study was presented as an oral presentation at the sixth International Congress of Oral and Maxillofacial Surgery Society (ACBID), Antalya, Turkey, 2012. The authors report no conflicts of interest. Copyright * 2013 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e318292c7d5 The Journal of Craniofacial Surgery & Volume 24, Number 4, July 2013 Brief Clinical Studies * 2013 Mutaz B. Habal, MD e405 Copyright © 2013 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.