Which devices can be used to decompress odontogenic cystic lesions in the oral cavity? A systematic review.

Odontogenic cysts are bony lesions in the jaws that can reach large sizes. Decompression, a technique that helps in their surgical treatment, aims to reduce their size. We aimed to conduct a systematic review of the main types of device used for the decompression of odontogenic cysts and to analyse the indications, types, advantages, and disadvantages of the devices used. We searched PubMed, Science Direct, LILACS, EMBASE, and Web of Science until February 2023, with no time restriction. We considered studies with a minimum of 10 patients published only in English, those that reported cases and case series, randomised clinical trials of the decompression of odontogenic cysts, and the types of devices used during the decompression period. All reported odontogenic cysts had to have been confirmed by biopsy in their respective publications. We found 713 articles in the selected databases. After removing duplicates, 499 remained. After reading the titles and abstracts, we excluded 461 articles so 38 remained. Nine studies were selected for the review, totalling 244 patients. A total of 206 lesions were identified and confirmed by anatomopathological examination: 123 keratocysts, 40 dentigerous cysts, 34 radicular cysts, one cyst of epithelial origin but without specification, and eight unicystic ameloblastomas. Although we did not find out which device is best for the decompression of odontogenic cysts, our findings show that those that are most effective should be as comfortable as possible and should remain in place. They should have stability in the oral cavity and be easy for the patient to clean.

Dispositivos utilizados na descompressão de lesões císticas odontogênicas na cavidade oral: uma revisão sistemática / Odontogenic Devices used for decompression of odontogenic cysts in oral cavity: a systematic review

Os cistos odontogênicos são processos patológicos de origem do epitélio odontogênico que ocorrem nos ossos gnáticos. A maioria dos cistos que acometem os ossos gnáticos são originários do epitélio odontogênico. O tratamento pode ser feito através da enucleação cirúrgica, ressecção óssea, ou com o auxílio de técnicas cirúrgicas de marsupialização ou descompressão para obter a redução do tamanho do cisto como também de preservar estruturas nobres na região. O estudo seguiu as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) foi registrado na plataforma PROSPERO sob o número de protocolo: CRD:42021239597. Uma estratégia Population, Intervention, Comparison, Outcome, Study Design (PICOS) foi utilizada. Foram selecionados 08 artigos específicos sobre a utilização de dispositivos de descompressão para cistos odontogênicos. De um total de 181 lesões identificadas e comprovadas por exame anátomo-patológico, foram encontrados 123 queratocistos, 40 cistos dentígeros, 09 cistos radiculares, 01 cisto de origem epitelial, porém sem especificação e 08 ameloblastomas unicísticos. As principais vantagens da descompressão foram minimizar as possiblidades de danos a estruturas nobres anatômicas e objetivando uma cirurgia definitiva com menor morbidade. As principais desvantagens foram: maior tempo de tratamento e dependência da colaboração do paciente. Embora não haja uma resposta sobre qual o melhor dispositivo utilizado para descompressão, este procedimento é benéfico ao tratamento, principalmente em casos de lesões extensas. O objetivo deste trabalho foi fazer uma revisão sistemática sobre os principais tipos de dispositivos utilizados para descompressão de cistos odontogênicos e integrando os dados publicados disponíveis sobre as indicações, tipos, vantagens e desvantagens dos dispositivos utilizados na descompressão de lesões císticas odontogênicas na cavidade oral.

Surgical techniques for pleomorphic adenoma in the hard palate: A case report and literature review

Objective: To report a case of pleomorphic adenoma that was surgically removed and to describe the surgical technique available to remove this lesion. Case Report: A male patient, caucasian, 46 years old, with a 4-year history of pleomorphic adenoma. He mentioned that he went to other services for treatment, but without success. He came at our service for treatment with tumoral excision. Local anesthesia was performed with mepivacaine with a vasoconstrictor and tumoral excision was performed with the overlying mucosa and the periosteal region to avoid recurrence. The patient has been under postoperative follow-up for two years without recurrence. Conclusion: Pleomorphic adenoma is a benign tumor and presents as a submucosal mass of slow growth. The ideal treatment for the Pleomorphic Adenoma tumor is the total excision of the lesion with the removal of the mucosa covering the region to avoid recurrence. (AU)

Maxillofacial infections in a tertiary hospital in São Paulo, Brazil - A two-year retrospective study

Background: Odontogenic infections can cause fatal complications and should be diagnosed and treated as early as possible, in addition to public health measures for preventing these diseases. Objective: This study aimed to conduct an epidemiological survey of patients hospitalized for odontogenic infections at the Mandaqui Hospital (São Paulo, Brazil) be-tween 02/01/2011 and 02/01/2013. Results: The leading cause of maxillofacial infections was odontogenic, corresponding to 89%. The prevalence of odontogenic infections was higher in males (56%), with a predominance in the age group of 21 to 30 years (36%), with teeth affected by cavities with pulp necrosis being the main responsible for triggering this disease, corresponding to 79%. of cases. The average hospitalization period was 5.31 days. The primary surgical treatment was drainage under general anesthesia associated with immediate extraction in 35% of patients. Conclusions: The primary surgical treat-ment was drainage associated with immediate teeth extraction under general anesthesia, which improved most patients effectively, with few complications reported. This finding reinforces the idea that surgical drainage is the main procedure that leads to the patient's clinical improvement regardless of the type of antibiotic used. (AU)

Maintenance of the buccal fat pad (Bichat) as a resource for regional grafting: A case report and literature review

Objective: Report a case of pyogenic granuloma with two years of evolution, three previous removals with external oral and maxillofacial surgeons, and new recurrences. Case Report: A 25-year-old male patient with a history of a pyogenic granuloma with two years of evolution had three previous removals with external maxillofacial and had relapses. The treatment indicated after these relapses were the extraction of the involved teeth and the lesion, performing the closure with a buccal fat pad flap. The lesion underwent metaplasia, transforming into mucosa.Conclusion: This case emphasizes keeping the buccal fat pad as a possible future resource for regional grafting. (AU)

Retrospective study of gunshot wounds in the face in a large hospital in Latin America: a two-year analysis

Objective: This study aims to compare data relating to gender, age, etiology, fractured areas, procedures performed, follow-up and purpose from September 2013 to July 2015. This retrospective study included patients whose medical records were complete and who presented face fractures due to gunshot wounds. Results: A total of 1289 patients diagnosed with fractures in the head and neck region were evaluated, of which only 13 patients had facial fractures caused by firearms. Stabilization of facial fractures with rigid internal fixation should be performed as soon as possible to avoid sequelae to the patient, which was conduc-ted in 8 patients. Conclusions: The study found that male and young patients are the most affected by fire injuries to the face due to the high rate of violence, cultural and socioeconomic differences in the city of São Paulo. Fracture stabilization must be performed as soon as possible to avoid future sequelae. Therefore, the study found that the care of facial trauma by firearm does not have a strict protocol; it depends on the extent and severity of each case. (AU)