Clinicopathological characteristics of odontogenic carcinosarcoma: A systematic review.

BACKGROUND: The aim of the present systematic review was to summarize evidence on odontogenic carcinosarcoma, analyzing clinical, epidemiological, imaging, histopathological, immunohistochemical, therapeutic, and prognostic features of this tumor. MATERIALS AND METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in the Ovid MEDLINE (Wolters Kluwer), PubMed (National Library of Medicine), Web of Science (Thomson Reuters), Scopus (Elsevier), and LILACS (Latin American and Caribbean Center on Health Sciences Information) databases, without publication date or language restrictions. Case reports or case series of OCS reporting clinical, radiological, and histopathological data that confirmed the diagnosis were selected. The Joanna Briggs Institute-University of Adelaide tool was used for critical appraisal of the included articles. RESULTS: Odontogenic carcinosarcoma is a rare, aggressive tumor associated with high mortality; however, the metastasis rate is low. The tumor has a male predilection. The mean patient age is 40 years, but there is no predilection for age. The left posterior mandible is the most affected site, but no specific radiographic features have been reported. CONCLUSION: Given its rarity, dentists, oral-maxillofacial surgeons, and physicians need to be aware of odontogenic carcinosarcoma in order to increase the diagnostic potential, preventing delays in diagnosis and treatment and thus contributing to lower morbidity of the tumor.

Surgical Treatment of Osteoma in the Basilar Region of the Mandible.

Osteoma is an uncommon benign osteogenic tumor characterized by the proliferation of compact and cancellous bone. The objective of this study was to report a case of osteoma in the basilar region of the mandible. The patient reported no pain, but the affected area was tender to touch and there was esthetic concern because of the apparent swelling. The mass measured approximately 5 cm in diameter and extended to the lingual area of the mandible. A vestibular approach was used for surgical treatment. After infiltration of a local anesthetic and vasoconstrictor, to expose the mandibular ramus, an incision was made with an electric scalpel along the external oblique ridge through the mucosa, submucosa and muscle, fascia and periosteum until the lower second molar, 3 to 5 mm inferior to the mucogingival junction. A mucoperiosteal flap was raised until the base of the mandible to access the tumor. Osteotomy was performed and the tumor was removed. The patient shows no recurrence of the tumor after 1 year and 6 months of follow-up. Periodical clinical and radiographic follow-up are satisfactory since recurrence is rare.

Pseudo-ankylosis caused by osteoma of the coronoid process.

Osteoma of the coronoid process is a rare, slow-growing tumor that can lead to restrictive mandibular movements. This paper describes a case of osteoma of the right coronoid process in a 45-year-old woman who reported progressive facial asymmetry and the loss of mandibular movements. Aspects regarding the differential diagnosis, treatment, surgical access, possible complications and postoperative follow up of the case are also discussed. The osteoma of the coronoid process is a benign tumor that can reach a significant size, causing an increase in volume, facial asymmetry, limited mouth opening and fracture of the zygomatic complex in some cases. The combination of extraoral and intraoral accesses is useful in the case of large tumors of difficult access, such as in this case reported.

A viabilidade e efetividade do acesso subciliar no tratamento cirúrgico de fraturas do complexo zigomaticomaxilar: relato de caso clínico / An alternative management in fractures of zigomaticomaxillary complex using a subciliary incision: case report

As fraturas do complexo zigomático-maxilar são as segundas mais comuns de todas as fraturas faciais. Mais especificamente as etiologias com maior incidência são os eventos como agressão física, acidente automobilístico ou queda de própria altura. Sendo assim, é de suma importância que, diante de informações obtidas no exame clínico, juntamente com exames de imagem, obtenha-se o diagnóstico correto, para que seja elaborado um plano de tratamento adequado. Dessa forma, quando o tratamento cirúrgico com fixação interna estável é determinado, a incisão subciliar se faz presente como uma opção para expor a região fraturada. Assim, com conhecimentos sobre anatomia cirúrgica orbitária, vantagens, desvantagens e complicações (tais como o aumento da exposição da esclera e o ectrópio) e domínio da técnica, o cirurgião apresenta condições de realizar seu tratamento cirúrgico em pacientes vítimas de trauma maxilofacial em terço médio de face, mais especificamente em fraturas do complexo zigomaticomaxilar. Este trabalho vem expor um caso clínico, em que serão abordados detalhes e informações que tornam o referido acesso uma opção realmente viável no tratamento do tipo de fratura em questão... (AU)

Fractures of the zygomatic-maxillary complex are the second most prevalent among facial fractures. More specifically, etiologies of higher incidence are physical aggression, car accidents or fall from one's own height. It is of great importance to obtain an accurate diagnosis, regarding clinical exam information, in addition to imaging exam, in order to elaborate a proper treatment plan. Thereby, once surgical treatment with stable internal fixation is determined, subciliary incision is an option to expose the fractured area. Thus, knowledge concerning surgical anatomy of orbital area, advantages and disadvantages, complications (such as increased scleral exposition and ectropion), and surgical experience, enables surgical treatment of victims of maxillofacial trauma involving midface region, more specifically, fractures of the zygomatic-maxillary complex. This study reports a clinical case, its details and information, which makes subciliary approach a viable option for this type of fractures... (AU)

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.

Avaliação clínico-radiográfica dos caninos após tratamento orto-cirúrgico / Clinical-radiographic analysis of canines after orthodonthic-surgical treatment

A ocorrência de caninos inclusos é uma condição comum na população que procura tratamento ortodôntico e a excelência da terapia ortodôntico-cirúrgica traduz-se na correção da oclusão, harmonia do sorriso, saúde periodontal, manutenção da saúde pulpar e estabilidade pós-tratamento. Para obtenção de tais condições, ressalta-se a importância de um trabalho multidisciplinar. O presente trabalho objetiva abordar os aspectos clínicos e radiográficos dos caninos inclusos submetidos à tratamento orto-cirúrgico. O estudo foi realizado na Faculdade de Odontologia de Pernambuco (FOP-UPE) no período de 2000 a 2007. Realizou-se uma avaliação clínica (cor, forma da gengiva, posição no arco) e radiográfica, (dilaceração, lâmina dura, presença de processo periapical). Como resultado, observamos que 4 pacientes (23,5%) apresentaram retração gengival com hipersensibilidade associada, apenas um paciente (6,25%) apresentou mobilidade dentária, nenhum dos dentes examinados apresentou alteração de forma e do total 14 dentes (82,35%) responderam positivamente ao teste de vitalidade pulpar. A avaliação Radiográfica foi realizada em 14 dentes, destes 07 (50%) apresentaram dilaceração radicular, 04 dentes (28,60%) estavam relacionados à odontomas, 02 dentes (14,28%) apresentaram reabsorção da crista óssea alveolar, 02 dentes (14,28%) mostraram calcificação intracanal. Tracionamento ortodôntico na amostra estudada aparece como um procedimento eficaz, seguro e reprodutível.

The occurrence of impacted canine is a common condition in the population who seeks orthodontic therapy and the excellence in orthodontic- surgical treatment leads to the correction of the occlusion, smile harmony, periodontal health, maintenance and stability of pulp tissue. To obtain these conditions, the study highlights the importance of a multidisciplinary work. This paper aim to address the clinical and radiographic findings of impacted canines who underwent ortho-surgical treatment. The study was conducted at the Faculty of Dentistry of Pernambuco (FOP-UPE) in the period of 2000 to 2007. Clinical parameters (color, gingiva aspect, arch position) and radiographic features (dilacerations, periapical inflammation) were observed. As a result, four patients (23.5%) had gingival recession associated with hypersensitivity, only one patient (6.25%) had tooth mobility, none of the teeth examined showed a change of form and 14 teeth (82.35 %) responded positively to vitality test. Radiographic evaluation was performed in 14 teeth, 07 of these (50%) had root dilaceration , 04 teeth (28.60%) were related to odontomas, 02 teeth (14.28%) had resorption of alveolar bone crest, 02 teeth ( 14.28%) showed intracanal calcification. Ortho-surgical treatment appears to be a safe, efficient and reproducible.