Evaluating changes in the condylar head after orthognathic surgery with or without articular disc repositioning: a systematic review

Failures in orthognathic surgery are associated with different factors, including those related to untreated or undiagnosed preoperative temporomandibular joint (TMJ) disorders. This systematic review aimed to assess potential alterations in the condylar head following orthognathic surgery. A systematic search for randomised controlled trials and retrospective studies was performed. For inclusion in the review, studies had to meet the following eligibility criteria according to the PICO framework: Patients: patients with orthognathic deformity and temporomandibular dysfunction (or temporomandibular osteoarthritis); Intervention: patients submitted to orthognathic surgery concomitantly with TMJ disjunction; Control: patients undergoing only orthognathic surgery with or without presurgical data; and Outcome: changes in temporomandibular joint position and volume. Nine studies met all the inclusion criteria and were selected for qualitative analysis. The results of this review show that simultaneous articular disc repositioning and orthognathic surgery provide better results in patients with preoperatively diagnosed condylar osteoarthritic changes. In conclusion, condylar remodelling (resorption/deposition) and its extent are determined by the direction of condylar displacement during surgery. Other factors such as age are also associated with the development of condylar resorption.

Impact of COVID-19 on maxillofacial surgery practice: a systematic review

OBJECTIVES

The aim of this systematic review was to evaluate the possible impacts of COVID-19 on oral and maxillofacial surgery practice, as well as the protocols employed by oral and maxillofacial surgeons to minimize the risks of contamination.

METHODS

Searches were performed in different databases up to 15 March 2021. Articles related to oral surgery dynamics within the context of the COVID-19 pandemic were included. The articles were considered eligible if they met the following inclusion criteria: observational studies that provided recommendations regarding maxillofacial surgery measures during the COVID-19 pandemic and that analyzed the risk of contamination of patients/professionals with SARS-CoV-2.

RESULTS

Seven studies met the inclusion criteria and were selected for the present systematic review. Demands for personal protective equipment increased significantly, with studies reporting the scarcity of fundamental equipment such as FFP2/N95 masks. Significant changes in the infrastructure of outpatient, surgical and inpatient units and in the care protocols themselves were observed.

CONCLUSION

The COVID-19 pandemic particularly affected the routine of oral and maxillofacial surgery residents. Several additional recommendations for surgical practice or for the surgical team were evaluated and discussed, such as performing primarily urgent and emergency surgeries, remote patient care and screening, postponing elective surgeries, and new teaching methods in oral and maxillofacial surgery residency programs. In addition, screening of patients and of the surgery team for COVID-19 is strongly recommended.

The efficacy of mesenchymal stem cells in regenerating structures associated with the temporomandibular joint: A systematic review

OBJECTIVES

The objective of this systematic review is to evaluate the role of mesenchymal stem cells in the regenerative treatment of temporomandibular joint resorption.

DESIGN

Search strategies were performed in the following databases: PubMed/MEDLINE, EMBASE, Cochrane Collaboration Library, and Web of Science. Two independent reviewers selected the included articles using a two-phase process based on the eligibility criteria. The reviewers independently collected the required information from the included articles. The methodological quality of the selected studies was assessed individually.

RESULT

In accordance with the inclusion and exclusion criteria, 703 studies were found and 8 articles were included. Thus, six studies using animal models and two human studies were included in this systematic review.

CONCLUSION

Based on the data of our systematic review, the use of mesenchymal stem cells is a promising method for the repair and regeneration of temporomandibular joint components.

One Abutment at One Time Concept for Platform-Switched Morse Implants: Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to compare the peri-implant vertical bone loss of immediate loading of implant crowns using the one abutment at one time (AOT) protocol and implants with abutment removal (AR). This systematic review with meta-analysis was reported according to the PRISMA statement, with guidance from the Cochrane Collaboration Handbook. A total of 103 publications were identified in the PubMed database and reference lists of examined articles. After the screening of titles and abstracts, the eligibility of eight full-text articles was assessed. Five studies published between 2010 and 2015 were included in the meta-analysis. There was less peri-implant vertical bone loss at implants using an AOT protocol than at implants using AR protocol (WMD -0.19, 95% CI -0.26 to -0.13; p<0.0001; random-effects model). In conclusion, the use of the AOT protocol with platform-switched Morse implants results in less bone loss than do AR procedures, but this effect may not be clinically relevant. The preservation of marginal bone level achieved with the AOT protocol may not enhance the aesthetics. These results should be interpreted with caution.

Topical application of tranexamic acid in anticoagulated patients undergoing minor oral surgery: A systematic review and meta-analysis of randomized clinical trials

PURPOSE

To perform a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the efficacy and safety of topical tranexamic acid (TXA) to prevent postoperative bleeding in anticoagulated patients undergoing minor oral surgery.

MATERIAL AND METHODS

We analyzed RCTs comparing the use of topical TXA versus other topical hemostatic agents or placebo solutions for minor oral surgeries. We assessed the risk of bias and strength of evidence according to the Cochrane guidelines and GRADE rating system, respectively. The pooled relative risk (RR) was calculated for the effect of topical application of TXA on postsurgical bleeding.

RESULTS

Five RCTs were included in the study. The combined RR for the number of patients receiving TXA in comparison to the control group was 0.13 (95% CI 0.05-0.36; P = 0.01), indicating a protective effect of topical TXA on bleeding after minor oral surgeries. Subgroup analysis revealed that topical TXA was effective in preventing postsurgical bleeding compared to placebo and epsilon-aminocaproic acid. No cases of thromboembolic events were reported.

CONCLUSIONS

Currently available evidence suggests that surgical site irrigation with TXA followed by mouthwash during the first postoperative week is safe and may reduce the risk of bleeding after minor oral surgeries in anticoagulated patients.

Effect of collagen sponge and fibrin glue on bone repair

The ability of hemostatic agents to promote bone repair has been investigated using in vitro and in vivo models but, up to now, the results are inconclusive.

Evaluation of inorganic bovine bone graft in periodontal defects after third molar surgery

Aim:

This study evaluated the e cacy of inorganic bovine bone graft (IBB) in periodontal defect after mandibular third molar (3M) surgery.

Methods:

The authors conducted a split-mouth, prospective, randomized, blinded, placebo-controlled clinical trial involving 20 participants with a mean age of 21.60 ± 6.5 years who had symmetrical bilateral lower 3M randomly assigned to receive IBB or left empty (blooding clot). The clinical variables studied were probing depth and clinical attachment level (CAL) at preoperative and postoperative periods of 10, 30, and 60 days. Radiographic measures included the distance from the alveolar bone crest to the cementoenamel junction and the bone density at 30 and 60 days postsurgical procedure. For statistical analysis, we used the paired t-test at a level of signi cance of 5%.

Results:

It was observed a reduction in pocket depth and CAL in both groups, but IBB did not provide better results than blooding clot (P > 0.05). On the other hand, IBB group showed an increased in the bone density, and a decrease in the periodontal defect on the distal surface of second molar (2M) after 30 and 60 days of surgery compared to the control group (P < 0.05).

Conclusion:

The use of inorganic bone graft (GenOx) did not enhance the probing depth after 3M removal. Although the radiographic ndings have showed an increase in bone density and a decrease in the periodontal defect on the distal surface of the 2M, we cannot recommend the use of IBB as a treatment for periodontal defect prevention after 3M removal.

Methylene Blue-Mediated Photodynamic Inactivation Followed by Low-Laser Therapy versus Miconazole Gel in the Treatment of Denture Stomatitis

PURPOSE

Photodynamic therapy (PDT) appears to be an effective method for the in vitro and in vivo inactivation of Candida spp., but no clinical trials in this context have yet been conducted. The aim of this study was to compare the effect of oral miconazole gel to PDT combined with low-power laser (LPL) therapy in the treatment of denture stomatitis.

MATERIALS AND METHODS

Forty participants with clinical and microbiological diagnoses of type II denture stomatitis were randomly allocated to two treatment groups (PDT and miconazole gel), each with 20 individuals. The PDT group was submitted to one session of methylene blue-mediated PDT plus two sessions of low-laser therapy twice a week for 15 days. The miconazole group was submitted to the drug four times a day for 15 days.

RESULTS

Forty percent of the patients achieved clinical and microbiological resolution of denture stomatitis after methylene blue-mediated photodynamic inactivation followed by low-laser therapy. The cure rate associated with miconazole was 80% (p < 0.05). Fifteen days after the end of treatment, the recurrence rate was 25% in patients treated with PDT combined with LPL therapy and 12.5% in patients treated with miconazole.

CONCLUSION

Miconazole gel provides better results than a protocol combining methylene blue-mediated PDT and LPL therapy in the treatment of type II denture stomatitis.

Nevoid Basal Cell Carcinoma Syndrome: A Long-Term Study in a Family

We present a family case series with 10 individuals having nevoid basal cell carcinoma syndrome (NBCCS) with a 10-year follow-up. All articles published in the literature between 1967 and 2011 on familial Gorlin-Goltz syndrome in any language were surveyed to determine the mapping of cases per country of occurrence of this disease. All patients in the present series were presented with calcification of the falx cerebri, mild hypertelorism, and frontal bossing. Odontogenic keratocystic tumors, palmar and plantar pits, and multiple basal cell carcinomas occurred in 90, 40, and 20%, respectively, of the patients. One of the patients died of skin cancer. Diagnosis of odontogenic keratocyst tumors was confirmed by histopathological examination. NBCCS is a rare autosomal dominant cancer predisposition syndrome; it is important to recognize it when a patient has multiple odontogenic keratocyst tumors because life-long monitoring is essential for patient management.

A Multicenter Retrospective Cohort Study on Pediatric Oral Lesions

PURPOSE

The purpose of this study was to evaluate the profile of pediatric oral lesions in northeastern Brazil.

METHODS

Biopsy records of oral lesions were retrieved from patients aged zero to 18 years who were treated over 18 years in two university hospitals in northeastern Brazil. Routine pathological sections were re-examined and classified into six groups: (1) odontogenic and nonodontogenic cysts; (2) odontogenic tumors; (3) salivary gland pathology; (4) nonodontogenic tumors and tumor-like lesions; (5) bone pathology; and (6) miscellaneous.

RESULTS

From a total of 4,690 oral biopsies, 564 (12 percent) were from children and adolescents. The largest number of cases was salivary gland pathology, followed by nonodontogenic tumors and tumor-like lesions. The most common oral biopsies were mucocele, pericoronal dental follicle, pyogenic granuloma, dentigerous cyst, and odontoma. Only three cases of malignant tumors were observed. Our results were similar to most studies.

CONCLUSIONS

Although malignant tumors comprised a small portion of the pediatric oral biopsies, the possibility of their occurrence in children and adolescents should not be overlooked.

Association of mesenchymal stem cells and osteoblasts for bone repair

Aim: We tested the hypothesis that the association of bone marrow mesenchymal stem cells (MSCs) and osteoblasts (OBs) optimize bone repair. Materials & Methods: MSCs were cultured in growth or osteogenic medium and seeded into gelatin sponge prior to implantation. Defects were created into rat calvariae and implanted with gelatin sponge without cells, with MSCs, with OBs and with association of MSCs and OBs. Histological analysis and micro-CT-based histomorphometry were carried out after 4 weeks. Results: Increased bone formation was observed in defects treated with cells and bone volume was greater in defects treated with either OBs or MSCs/OBs. Conclusion: Association of MSCs and OBs did not increase the process of bone repair compared with cell-based therapy using either MSCs or OBs alone.

Focal fibrous hyperplasia: A review of 193 cases

CONTEXT

Focal fibrous hyperplasia, also known as irritation or traumatic fibroma, is a reactive, inflammatory hyperplastic lesion of the connective tissue.

AIM

The aim of this study is to perform a retrospective study of a focal fibrous hyperplasia of 18 years.

MATERIALS AND METHODS

We retrospectively reviewed 193 cases of focal fibrous hyperplasia of the oral cavity from the medical and histological reports of the Department of Oral Pathology, Pernambuco University, Brazil, during the period between January 1992 and December 2009.

SETTINGS AND DESIGN

Data with regard to age, gender, location, size of the lesion (equal to or less than 1 cm, between 1 and 2 cm and greater than 2 cm), pain, history of trauma, treatment, length of follow-up (from diagnosis to release or last review) and recurrence, were collected.

RESULTS

The most commonly affected site was the buccal mucosa (n = 119, 61.7%). Almost two-thirds of the cases were concentrated from the second to the fifth decade of life. Females were more affected than men and a history of trauma was related by 90.7% of the patients. Two recurrences were notified (1.0%).

CONCLUSION

Further studies are needed on the distribution of the lesion in different ethnic and geographical populations. The influence of sex hormones on the development of focal fibrous hyperplasia must be clarified.

Ameloblastoma in the Northeast region of Brazil: A review of 112 cases

Context:

Ameloblastomas are benign tumors of the jaws with locally invasive capacity.

Aim:

The aim of this study was to review 112 cases of ameloblastoma seen over an 18-year period (1992-2009) at the Pernambuco Dental School, University of Pernambuco and at Federal University of Sergipe, in the northeast region of Brazil.

Materials and Methods:

The following data were selected for analysis: age, gender, race, site distribution, radiographic appearance, association with an impacted tooth, size, presence of symptoms, clinicopathologic subtypes and recurrence.

Settings and Design:

In this retrospective study, Pearson's χ² test and t-test were employed. The critical level of significance was set at P < 0.05.

Results:

The mean age of the patients at presentation was 35.1 ± 16.8 years with a slight female preference. The peak prevalence was in the 11- to 20-year age group and declined with increasing age. Total 75 patients were black and 37 were white, for a 2:1 black: white ratio. The location of the ameloblastomas showed a marked predominance in the mandible (84.8%) and 69% of the cases presented with a multilocular radiographic appearance. The tumor was associated with an embedded tooth in 14 cases (12.7%): nine unilocular and five multilocular ameloblastomas. The maximum radiological extension of the lesions on panoramic radiographs was 0.5-20 cm (mean ± SD: 5.2 ± 3.3 cm) and most cases were symptom-free (75.9%). Solid/multicystic ameloblastoma was the most common clinicopathologic subtype. There was an association between the clinicopathologic subtypes and radiographic appearance (P < 0.001). Recurrence was observed in 13.3% of cases.

Conclusion:

We propose that racial factors may have strong influence on the incidence of ameloblastomas in the northeast region of Brazil, since most people have African descent. Data related to gender, location, radiographic appearance, size, symptoms, clinicopathologic subtypes and recurrence were similar to previous studies conducted in various parts of the world.

Two-stage treatment of facial asymmetry caused by unilateral condylar hyperplasia

Condylar hyperplasia (CH) is a rare, self-limiting process manifesting between the first and third decades of life. CH causes facial asymmetry and derangement of the occlusion. Management involves resection of the condylar head and orthognathic surgery. This paper describes the case of a 37-year-old woman with spontaneous onset of CH over a span of approximately 25 years. The condition was managed with resection of the condyle alone, which dramatically improved facial asymmetry and altered the occlusion within a few months of follow up. Orthodontic treatment was then carried out and the patient underwent orthognathic surgery after 3 years. The patient is currently satisfied with her appearance and function and there are no signs of recurrence.

Fresh-frozen allografts combined with bovine bone mineral enhance bone formation in sinus augmentation

We evaluated histologically, histomorphometrically, and tomographically the effects of the association of fresh-frozen bone allograft (FFB) with bovine bone mineral (BBM) in maxillary sinus floor augmentation. In total, 34 maxillary sinuses from 29 patients, with a mean age of 51.32 (±6.44) years, underwent sinus augmentation. Patients were divided into control and test groups (17 sinuses each). The controls were grafted with allograft bone, and the test group received a combination of FFB and BBM at a 2:1 ratio. After 6 months, bone samples were collected for histological and histomorphometric examinations. The implant survival rates were 93.02% (control group) and 100% (test group) at 6 months after functional loading. Median volumetric reductions of 28.32% (17.05-44.05) and 12.62% (5.65-16.87) were observed for the control and test groups, respectively. Statistically significant histomorphometric differences were found between the control and test groups regarding newly formed bone 12.54% (10.50-13.33) vs. 24.42% (17.62-35.92), p < 0.001, total bone 48.34% (39.03-54.42) vs. 61.32% (50.61-64.96), p = 0.007, and connective tissue 51.66% (45.57-60.97) vs. 39.30% (35.03-49.37), p = 0.007. The addition of BBM to allograft bone in maxillary sinus augmentation resulted in higher percentages of new bone formation and total bone, and permitted implant placement with a low rate of osseointegration failure at the 6-month follow-up.

Multiple supernumerary teeth in a nonsyndromic 12-year-old female patient - a case report

Supernumerary teeth (ST) are uncommon alterations of development that may appear in either of the dental arches and that are frequently associated with syndromes such as cleidocranial dysplasia and Gardner syndrome. Multiple ST in individuals with no other disease or syndrome are very rare. In view of this situation, correct diagnosis, treatment and evaluation of ST with the use of appropriate imaging techniques are highly important. This case report presents radiographic images of a nonsyndromic 12-year-old female patient who presented with 14 supernumerary teeth and was treated under general anesthesia, with the extraction of all ST in a single surgical intervention. During the postoperative period, the patient did not complain of pain nor did she present any signs or symptoms of infection. During late follow-up period, due to difficulty in traction of the maxillary right canine and mandibular left first premolar towards the dental arch, it was necessary to extract these teeth under local anesthesia. Radiographic examination 3 years after surgery revealed the absence of ST and of diseases related to the existence of these teeth.

Evaluation of life quality of patients submitted to orthognathic surgery

OBJECTIVE

To compare changes related to self-esteem and appearance satisfaction between pre and postsurgical phases in patients undergoing orthognathic surgery and to assess the quality of life and psychosocial changes of these patients six months after surgery.

METHODS

A longitudinal observational qualitative study was performed. The sample comprised 15 patients with dentofacial deformities who underwent orthognathic surgery. One questionnaire and two forms were answered during pre and postoperative phases.

RESULTS

The results showed that 13.3% of patients demonstrated self-esteem improvement, especially in relation to appearance satisfaction. Improvements were also noted in social, occupational and family relationships. With regard to the assessment of quality of life, according to the World Health Organization questionnaire, the lowest improvement averages corresponded to environmental control.

CONCLUSION

Orthognathic surgery brings along many emotional changes that should be considered before and after surgery, since the patients' psychological state may be favorable and/or unfavorable during recovery, influencing their quality of life, self-esteem and appearance satisfaction.

Destructive aneurysmal bone cyst of the mandible

Aneurysmal bone cyst (ABC) is an uncommon osteolytic lesion of the bones, usually affecting the long bones and spine. The lesion is rare in the jaws and is found most commonly in the body and ramus of the mandible. In some cases, ABCs may be present as rdestructive lesions simulating malignancies. In these cases, a careful diagnosis should be done, including in the differential diagnosis malignant tumors such as telangiectasic osteosarcoma and intraosseous fibrosarcoma. Removing the lesion is usually easy if it is confined within the bone, but it may prove difficult if the lesions are multilocular, expansive, divided by multiple bony septa, or destructive or when the cortical is perforated. Therefore, the surgical treatment of the destructive ABCs should be more radical.

Evaluation of reliability and reproducibility of linear measurements of cone-beam-computed tomography

OBJECTIVE

it was to evaluate intra- and interexaminer reliability and reproducibility of linear measurements in cone-beam tomography (CBCT) images.

MATERIALS AND METHODS

CBCT scans were obtained from 50 patients of a private clinic. Two examiners located the landmarks twice in two-dimensional and three-dimensional images on different days, with images performed 1 week apart. Intra- and interexaminer reproducibility and reliability were analyzed.

RESULTS

the measurement error (ME) did not show significant differences between intra- and interexaminers. The intraclass correlations (ICC) between the intra- and interexaminer readings obtained with the different methods showed almost perfect matches. The results demonstrated high examiner reproducibility for linear and volumetric parameters with high intraclass correlation coefficient (ICC) and coefficient of variation (CV). The ICC showed that the methodology was highly reliable and reproducible (ICC- >0.99 and CV <1.5%).

CONCLUSION

the measurements demonstrated strong agreement between examiners and significant reliability and reproducibility. Therefore, this methodology can serve as a standard for linear measurement analysis of the topography of mandibular canal and osseous adjacent structures.

Clinical study of hemodynamic changes comparing 4% articaine hydrochloride with 1:100,000 and 1:200,000 epinephrine

OBJECTIVE

To evaluate hemodynamic changes with the use of 4% articaine and 2 different concentrations of epinephrine (1:100,000 and 1:200,000) in the surgical removal of symmetrically positioned lower third molars.

STUDY DESIGN

A prospective, randomized, double-blind clinical trial was carried out involving 42 patients each undergoing 2 surgeries on separate occasions under local anesthesia with 4% articaine and either epinephrine 1:100,000 or 1:200,000. The following parameters were assessed at 4 different moments: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product (RPP); and pressure rate quotient (PRQ).

RESULTS

The concentration of epinephrine did not affect diastolic blood pressure or oxygen saturation during the surgeries. Significant differences between were detected for heart rate, RPP, and PRQ (P < .05).

CONCLUSIONS

The epinephrine concentration (1:100,000 or 1:200,000) in a 4% articaine solution influences hemodynamic parameters without perceptible clinical changes in healthy patients undergoing lower third molar removal.

Cisto ósseo traumático da mandíbula: revisão de 26 casos

The traumatic bone cyst is characterized by the presence of an asymptomatic sinus devoid of epithelial lining, which is rarely found in the jaws.

Objective

To describe the clinical, surgical and radiographic findings of traumatic bone cysts.

Material and Method

A retrospective study was made of patients diagnosed with traumatic bone cysts at an oral pathology department from 1992 to 2007. Data on the clinical, radiographic and surgical complications were gathered.

Results

Twenty-six cases of traumatic bone cyst were diagnosed in 15 years; 17 were male and 09 were female. Most patients were within first two decades of life and had no pain or history of trauma in the affected area. The multilocular pattern was observed in only seven cases, its radiographic appearance suggests a tumor. Air was found inside the lesion in about 70% of cases; serous fluid with blood and blood only were uncommon within the lesions.

Conclusion

A higher prevalence in young patients, absence of a history of trauma, and a small number of lesions containing serous fluid with blood reflects the need to discuss the true pathogenesis of traumatic bone cysts.

Comparative analysis of preemptive analgesic effect of tramadol chlorhydrate and nimesulide following third molar surgery

The aim of this prospective, randomized, controlled, paired trial was to perform a comparative analysis of the preemptive analgesic effect of nimesulide and tramadol chlorhydrate during third molar surgery. The study was carried out between March and November 2009, involving 94 operations in 47 male and female patients with bilateral impacted lower third molars in comparable positions. The sample was divided into two groups. Group A received an oral dose of 100 mg of nimesulide 1 h prior to surgery. Group B received an oral dose of 100 mg of tramadol chlorhydrate 1 h prior to surgery. The following aspects were evaluated in the postoperative period: adverse effects of the drugs; amount of rescue medication used (acetaminophen 750 mg); and pain 5, 6, 24, 36, 48, 60, 72 and 84 h after surgery using a visual analog pain scale. Peak pain occurred 5 h after surgery in both groups, with a mean pain score of 2.3 in Group A and 3.0 in Group B; this difference did not achieve statistical significance (p > 0.141). Based on the sample studied, nimesulide and tramadol chlorhydrate demonstrate similar preemptive analgesic effects when used in lower third molar surgeries.

Inverted papilloma (Schneiderian papilloma) with involvement of the oral cavity: report of an unusual case

Inverted Schneiderian papilloma (ISP) is a neoplasm of epithelial lining origin which arises in the respiratory mucosa that lines the nasal cavity and paranasal sinuses. The inverted Schneiderian papilloma frequently appears as a unilateral lesion in the nasal septum and extends secondarily to the nasal and paranasal sinuses. This paper reports an unusual case of this pathology with involvement of the oral cavity in a 61-year-old white man. Clinical evaluation revealed a vegetating mass in the alveolar ridge of the right maxilla that had been present for approximately 4 months. After radiographic evaluation, involvement of the maxillary sinus was detected. Microscopic evaluation, in situ hybridization and immunohistochemical analysis of the specimen led to a diagnosis of ISP moderate dysplasia associated with HPV infection.

Familial case of oral white sponge nevus--a rare hereditary condition

White sponge nevus (WSN) is an autosomal dominant skin disorder characterized by white, corrugated and diffuse plaques mainly affecting the oral mucosa. The condition has a high penetrance and variable expressivity, but familial reports are uncommon. This report presents a familial case of WSN in which two sisters are affected by the disorder.

Extensive intraoral blue nevus--case report

Nevus is a congenital pigmented malformation rarely found in the oral mucosa. Around one third of cases located in this anatomical region are of the blue type, a histological variant with considerable tendency to malignancy. This study reports the case of a male patient, chronic smoker, with a blue nevus measuring 5 cm in diameter on the hard palate. Since controversy exists in the literature regarding the incisional biopsy of pigmented lesions with malignant or malignant potential, excision without previous biopsy of the lesion was the therapy of choice for this case. The patient was followed-up for two years with no sign of recurrence or malignant transformation.

A clinicopathologic review of 138 cases of mucoceles in a pediatric population

OBJECTIVE

To evaluate the clinicopathologic features of pediatric mucoceles diagnosed in two public institutions in Brazil during an 18-year period.

METHOD AND MATERIALS

Clinical data (age, sex, history of trauma, location, and size) of 138 cases of mucoceles in children 0 to 16 years of age were obtained from medical records. The lesions were classified as mucus extravasation phenomenon and mucus retention phenomenon, depending on the presence of epithelial lining in the microscopic analysis.

RESULTS

Mucoceles made up 24.5% of the oral pediatric lesions diagnosed in the period of study. Age at diagnosis ranged from 0.4 to 16.0 years, with a mean age of 10.8 years. Of the total of mucoceles, 87 were observed in females and 51 in males. The lower lip was the most commonly affected site, and a history of trauma was related by 87% of the patients. Histologically, 96.4% of mucoceles were diagnosed as mucus extravasation phenomenon. Cases of mucus retention phenomenon were relatively more common in the floor of the mouth, since one in three lesions in this location belonged to this histologic type. Regarding lesions in the lower lip, only 2.65% were diagnosed as mucus retention phenomenon.

CONCLUSION

Trauma is the main etiologic factor involved in the development of mucoceles in children. The mucus extravasation phenomenon is the most common histologic type in this age group. Although rare, the retention type seems to be more common in lesions on the floor of the mouth.

Ameloblastic fibro-odontoma in children: report of 2 cases

Ameloblastic fibro-odontoma is a rare, mixed, benign, odontogenic tumor of significant prevalence in the mandible, with epithelial and mesenchymal components. It usually affects pediatric patients and is associated with teeth, causing a delay in eruption chronology or an alteration in the dental eruption pathway. It is occasionally diagnosed during radiographic evaluations of these patients. The literature is unclear whether it is a distinct pathological entity or a stage of odontoma. As it is benign and has a low recurrence rate, conservative treatment is recommended. The purpose of this paper was to present 2 cases of ameloblastic fibro-odontoma in the mandibles of children.

A rare case of iatrogenic gingival Kaposi's sarcoma

Kaposi's sarcoma is an angioproliferative tumour rarely found in the oral cavity. We present the 3rd case of iatrogenic gingival Kaposi's sarcoma reported in the English-language literature which developed in a young patient 5 years after a renal transplant and discuss their histological features and differential diagnosis.

Treatment of zygomatic arch fracture with lag screws

Zygomatic arch fractures often occur as part of a zygoma fracture or Le Fort type III fractures of the maxillary. Isolated fractures of the zygomatic arch comprise around 10% of all zygoma fractures. The main etiologic factors are traffic accidents, falls, assaults, and sport accidents. Treatment may involve minimally invasive surgical procedures for slightly dislocated fractures or surgery with more extensive access for large dislocations of bone segments. This article reports the case of a 41-year-old male victim of physical aggression to the face with a steel sickle with an exposed, unstable fracture of the zygomatic arch. The patient underwent general anesthesia, and after the reduction of the fractures, the bone segments were fixed with 2.0-mm screws.

Tooth embedded in tongue following firearm trauma: report of two cases

Injuries caused by projectiles from firearms involve diverse patterns of dentoalveolar trauma due to the different types of wound and extent of tissue damage. This article reports two cases in which tooth fragments were embedded in the tongue following aggression from a firearm projectile in the facial region. Radiographs confirmed the presence of foreign bodies, which were surgically removed under local anesthesia. When dentoalveolar trauma occurs in facial injuries, both hard and soft tissues must be carefully examined to avoid overlooking embedded tooth fragments not located immediately in the soft tissue.

Glandular odontogenic cyst: case report and review of diagnostic criteria

The glandular odontogenic cyst (GOC) is an uncommon jaw bone cyst of odontogenic origin with unpredictable and potentially aggressive behaviour. It also has the propensity to grow to a large size and tendency towards recurrence. GOC can be easily misdiagnosed microscopically as a central mucoepidermoid carcinoma. This paper reports a case of GOC in a 56-year-old male and reviews the main criteria for accurate diagnosis. The diagnosis of GOC can be extremely difficult due to the rarity of the cyst and lack of clear diagnostic criteria.

Recurrence of central odontogenic fibroma: a rare case

Central odontogenic fibroma (COF) is a rare, benign, painless, slow-growing tumor associated with expansion of the bone cortex. Histologically, it consists of fibrous connective tissue that contains multiple islands of odontogenic epithelium. Some lesions have diffuse spherical calcifications that usually are related to islands or cords of epithelium. The majority of cases respond well to conservative treatment such as enucleation and the prognosis is favorable; recurrences are rare. This article presents a rare case of COF that was located in the anterior region of the maxilla and treated with enucleation; the case recurred five years following the initial treatment.

Revisão Atual da Expressão da Beta-Catenina e suas Implicações no Estudo da Displasia Epitelial Bucal

O surgimento do câncer bucal é frequentemente precedido pelo aparecimento de alguma desordem potencialmente maligna, que pode ser definida como alteração morfológica tecidual, na qual há maior probabilidade de surgimento de neoplasia maligna do que num tecido clinicamente normal. Sendo assim, um conjunto de alterações histopatológicas associadas com uma maior probabilidade de desenvolvimento de carcinomas definem a presença de displasia epitelial que não está relacionada com qualquer apresentação clínica específica. Diversas pesquisas têm sido realizadas com o intuito de estudar a carcinogênese na tentativa de estabelecer uma técnica laboratorial capaz de indicar quais desordens potencialmente malignas possuiriam real capacidade de transformação maligna. A b-catenina é uma proteína de adesão presente no epitélio. A detecção de alterações de sua expressão em células cancerosas permitiu a construção de hipóteses sobre o seu papel em desordens potencialmente malignas. Nesta revisão da literatura, os autores objetivaram reunir informações sobre a expressão imuno-histoquímica da b-catenina em displasias epiteliais bucais, com vistas ao melhor entendimento da carcinogênese bucal.

Eficácia da laserterapia nas disfunções têmporo-mandibulares: estudo controle

Temporomandibular dysfunction is characterized by the presence of painful joint/muscular symptoms muscle in the face. The main justification for the use of lasers in laser therapy dysfunction is its analgesic effect, which was observed in most studies in the literature.

Aim: We evaluated the effectiveness of laser therapy in the treatment of temporomandibular disorders.

Methods: 50 volunteers with temporomandibular disorders were divided into two groups (control and experimental) had amplitudes of movements of mouth opening, right and left laterality recorded before and after laser application. Was also recorded, the score the individual gave to pain by visual analog scale and, through physical examination, the pain points. We used the AsGaAl laser with a 40mW power, with 80J/cm2 for 16 seconds at four selected points for just one session with reassessment after a week. Study design: Clinical.

Results: It was noted that laser therapy increased the mean amplitude of mandibular movements (p = 0.0317) and decreased significantly (43.6%) the pain intensity measured by the visual analog scale.

Conclusions: The laser decreases the painful symptoms of the patient after application through its analgesic and/or a placebo effect.

Odontogenic tumors: clinical and pathology study of 238 cases

Odontogenic tumors are neoplasms that develops exclusively in the gnathic bones; they originate from odontogenic tissues, by epithelial or mesenchymal proliferation, or both.

AIM

To evaluate the incidence of odontogenic tumors in a specific institution, and to compare these findings with other studies in the literature. STUDY FORMAT: A cross-sectional cohort retrospective study.

MATERIAL AND METHOD

The sample was obtained from the files of patients with odontogenic tumors diagnosed between January 1992 and March 2007 (15 years). Cases in which the diagnosis could be adapted to the new World Health Organization (WHO) of 2005 were included. Data such as gender, age, anatomical site, histological type and symptomatology were analyzed.

RESULTS

Odontogenic tumors were 4.76% of all biopsied lesions within the studied period. The mean age was 30.7 years; 57% of the patients were male. The keratocystic odontogenic tumor was the most prevalent histological type (30%), followed by the ameloblastoma (23,7%). The rate of asymptomatic cases was 75.7%.

CONCLUSION

Odontogenic tumors occurred more frequently in females, in the second and third decades of life, and more commonly in the mandible; most cases were asymptomatic.

Tumores odontogênicos: estudo clínico-patológico de 238 casos

Os tumores odontogênicos são neoplasias que se desenvolvem exclusivamente nos ossos gnáticos, originando-se dos tecidos odontogênicos por proliferação de tecido epitelial, mesenquimal ou ambos. OBJETIVO: Avaliar a incidência de tumores odontogênicos em determinada instituição e comparar com outros estudos da literatura mundial. FORMA DE ESTUDO: Estudo de coorte transversal. MATERIAL E MÉTODO: O material do estudo foi levantado a partir dos registros de pacientes com tumores odontogênicos, no período de janeiro de 1992 a março de 2007 (15 anos). Foram incluídos os casos de pacientes que se enquadravam na Classificação Histológica da Organização Mundial de Saúde (OMS) de 2005. Foram analisados os indicadores gênero, faixa etária, localização anatômica, tipo histológico e presença de sintomatologia. RESULTADOS: Os tumores odontogênicos constituíram 4,76% dentre todas as lesões biopsiadas dentro do período estudado. A idade média dos pacientes foi de 30,7 anos, 57% dos pacientes eram do gênero masculino. O tumor odontogênico ceratocístico foi o tipo histológico mais prevalente (30%), seguido do ameloblastoma (23,7%). Quanto à presença de sintomatologia, 75,7% dos casos apresentaram-se assintomáticos. CONCLUSÃO: Os tumores odontogênicos parecem ter discreta predileção pelo gênero feminino, segunda e terceira décadas de vida, sendo mais freqüentes na mandíbula e, na maioria dos casos apresentam-se assintomáticos.