Aneurysmal Bone Cyst in the Anterior Region of the Mandible.

Aneurysmal bone cyst is a rare osteolytic lesion of uncertain etiology, commonly observed in the lower limbs, with only 1-2% of reports in gnathic bones. We present the case of a 27-year-old male patient referred to the oral and maxillofacial surgery and traumatology service due to complaints of paresthesia in the mental region and increased mandibular volume. Physical examination revealed midline shift and hard consistency. Imaging examinations demonstrated a radiolucent/hypodense lesion with disruption of the mandibular cortices. The histopathological examination of incisional biopsy material led to the diagnosis of a central giant cell lesion. The patient underwent surgical resection, and the histopathological analysis of the specimen revealed a predominantly solid lesion, characterized by blood-filled spaces of varying size, not covered by epithelium or endothelium, with the presence of spindle cells, multinucleated giant cells, and basophilic osteoid material, concluding the diagnosis of mixed-type aneurysmal bone cyst. Despite being uncommon, aneurysmal bone cysts should be considered in the differential diagnosis of volumetric increase in the gnathic bones of young patients.

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.

The Effect of Advanced Platelet-Rich Fibrin in Tissue Regeneration in Reconstructive and Graft Surgery: Systematic Review.

This systematic review answered the guiding question using the PICO system: "What are the effects of advanced platelet-rich fibrin (A-PRF) on alveolar ridge preservation and tissue gain in reconstructive and jaw graft surgery?" Searches were performed in the PubMed|MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, and LILACS|bvs databases. In total, 573 articles were found in the initial search, and 564 were evaluated after the removal of duplicates, of which 5 randomized controlled trials met the eligibility criteria and were included 2 studies investigated the effect of A-PRF on the preservation of the bone ridge, 1 study evaluated the tissue repair after tooth extraction with A-PRF, 1 evaluated the peri-implant gap filling with A-PRF-xenograft mixture, and other the A-PRF on the treatment of alveolar osteitis. Advanced-PRF preparation protocol varied between the included studies from 8 to 13 minutes of centrifugation, at 1300 RPM (200 g ). The use of A-PRF provided greater dimensions of height and more favorable maintenance of the ridge profile, probing depth, and gingival margin level after extraction. Advanced-PRF also increased bone density, vital bone, epithelial healing, and control of postoperative pain and swelling after tooth extraction and in the treatment of alveolar osteitis.

Biological and Cellular Properties of Advanced Platelet-Rich Fibrin (A-PRF) Compared to Other Platelet Concentrates: Systematic Review and Meta-Analysis.

Platelet concentrates are used for cell induction and stimulation in tissue repair processes. The aim of the present systematic review and meta-analysis was to compare the biological and cellular properties of advanced platelet-rich fibrin (A-PRF) to those of other platelet concentrates. Searches were conducted on the PubMed/Medline, Scopus, Web of Science, Embase and LILACS databases using a search strategy oriented by the guiding question. A total of 589 records were retrieved. Seven articles of in vitro experimental studies were selected for qualitative data analysis and four were selected for meta-analysis. The release of growth factors, distribution of cells in the fibrin membrane, and cell viability, the fibrin network, and fibroblast migration were investigated. In the final analysis, statistically significant differences were found for the A-PRF group with regard to platelet-derived growth factor, transforming growth factor, epidermal growth factor and vascular endothelial growth factor at all assessment times. A difference was found with regard to bone morphogenetic protein only in the later assessment, and no differences among groups were found with regard to platelet-derived growth factor or insulin-like growth factor. The results of this systematic review and meta-analysis suggest that A-PRF has superior cellular properties and better release of growth factors compared to other platelet concentrates.

Ressecção segmentar de granuloma central de células gigantes: relato de caso / Segmentation of central giant cell granuloma: case report

O Granuloma central de células gigantes é próprio dos ossos gnáticos, sendo um tumor benigno não odontogênico. É uma lesão de crescimento normalmente lento, bem circunscrito e assintomático, geralmente diagnosticado através de algum exame de rotina ou, em casos mais avançados, quando se começa a visualizar alguma alteração estético-anatômica. O tratamento de eleição para este tipo de lesão é a simples curetagem ou a ressecção em bloco. No entanto, em pacientes adultos jovens e em crianças, o efeito mutilante que este tipo de tratamento pode acarretar deve ser levado em consideração, utilizando tratamentos não cirúrgicos, como injeção intralesional de corticosteroides, administração de interferon alpha e calcitonina. Assim, o objetivo deste trabalho é relatar um caso de tratamento com ressecção segmentar de granuloma central de células gigantes. Tumores mais agressivos e recorrentes devem ser submetidos à ressecção e mesmo assim deve se levar em consideração o efeito estético que pode causar na face do paciente, principalmente, se forem crianças e adultos jovens... (AU)

The central granuloma of giant cells is specific to gnathic bones, being a benign non-odontogenic tumor. It's a growth injury usually slow, well circumscribed and asymptomatic, usually diagnosed through some routine examination or, in more advanced cases, when it begins to visualize some aesthetic-an atomical alteration. The treatment of choice for this type of injury is a simple curettage or resection in block. However, in young adult patients and children, the mutilating effect that this type of treatment can bring must be taken in to consideration, using non-surgical treatments, such as intralesional injection of corticosteroids, administration of alpha interferon and calcitonin. Therefore, the objective of this work is to report a case of treatment with resection segment of central granuloma of giant cells. More aggressive and recurrent tumors must be submitted to resection and even then taking into account the aesthetic effect it can have on the patient's face, especially if they are children and young adults... (AU)

Surgical Management of Odontogenic Infection in Sturge-Weber Syndrome: Report of a Case.

ABSTRACT: Surgical management of odontogenic infections in Sturge-Weber Syndrome is challenging, due to the risk of massive bleeding and difficulty to achieve hemostasis. The authors describe the use of preoperative vascular embolization for oral surgery in a 29-year-old patient. The authors highlight the importance of hemostatic agents and primary wound closure and the role of vascular embolization as a potential tool for preventing hemorrhage in these cases.

Surgical management of multiple myeloma in the mandible: a case report.

Multiple myeloma (MM), solitary bone plasmacytoma, and extramedullary plasmacytoma are different types of plasma cell neoplasia, which is a lymphoid neoplastic proliferation of ß-cells. While MM is most frequently seen in the vertebrae and long bones, 30% of MM cases are found in the jaws. This case report presents a 58-year-old man with mandibular swelling; his medical history indicated he had a fracture of the humerus 1 month earlier. Panoramic radiography revealed a radiolucent lesion in the mandibular posterior region. Biopsy was performed and the histopathological examination indicated plasmocytoma. However, given the patient's dental and medical history, and the presence of multiple osteolytic lesions, the final diagnosis was MM. The patient underwent chemotherapy for the MM. To treat the pathological fracture of the jaw, a hemimandibulectomy was followed by the installation of a reconstructive plate.

Conservative treatment of comminuted mandibular fracture involving maxillomandibular fixation with miniplates.

Bars and steel wires are the most commonly used methods to achieve maxillomandibular fixation, although there are numerous alternatives described for this same purpose. In cases of edentulous candidates for the conservative treatment of facial fractures, none of the conventional methods can be instituted for maxillomandibular fixation. Fixation in such cases is achieved with the aid of the total dentures of the patient or the confection of splints, but these methods lead to eating and oral hygiene problems. This article reports the case of an edentulous patient with a comminuted mandible fracture treated with a rarely described technique in which intermaxillary fixation was achieved with titanium miniplates.

Avaliação clínica da expansão maxilar cirurgicamente assistida / Avaliação clínica da expansão maxilar cirurgicamente assistida Clinical evaluation of surgically assisted maxillary expansion

Na maxila, a dimensão transversal é a que menos cresce, podendo ocasionar uma deficiência transversal maxilar. A correta correção dessas deformidades em pacientes adultos, para alcançar uma oclusão funcional estável, muitas vezes, se faz necessária uma expansão maxilar cirurgicamente assistida, na qual consiste basicamente em um procedimento auxiliar, com o objetivo de liberar as áreas de maior resistência maxilares, por meio de osteotomias, permitindo, assim, a obtenção de uma expansão maxilar satisfatória. Diante do exposto, o presente estudo tem como objetivo avaliar clinicamente os resultados obtidos em uma série de casos de pacientes submetidos à expansão maxilar cirurgicamente assistida e discutir sobre a literatura vigente.

The maxillary transverse dimension is the least that grows, can cause a maxillary transverse deficiency. The surgically assisted maxillary expansion (SAME) it is often necessary in adult patients, to achieve a stable and functional occlusion. SAME consists of a procedure to assist for release the greatest resistance maxillary region through osteotomies, thus obtaining the maxillary expansion satisfactorily. The aim of this study is evaluate the results of patients who have undergone maxillary expansion assisted surgery and discuss the current literature.

Odontoma Complexo Atípico: Relato de Caso / Atypical Complex Odontoma: Case Report

Os odontomas são classificados como tumores benignos, originados do epitélio e do ectomesênquima odontogênico e são considerados mais anomalias de desenvolvimento - hamartomas - do que verdadeiras neoplasias. Representam, sem dúvida, os tumores mais comumente observados entre todos aqueles de origem odontogênica. Sua etiopatogenia constitui um aspecto muito investigado, embora se apresente indeterminada, ficando restringida ao campo das hipóteses, indo desde traumatismos e infecções locais a fatores genéticos. São mais frequentemente diagnosticados na segunda década de vida. Frequentemente, encontram-se inclusos e assintomáticos e geralmente são descobertos em radiografias de rotina, sendo vistos como uma massa intensamente radiopaca, circundada por linha radiolúcida. Raramente ocorre sua irrupção em cavidade oral, e existem algumas teorias que tentam explicá-la. O presente trabalho tem por objetivo apresentar um caso clínico de extenso odontoma irrompido em cavidade oral, discutindo aspectos relevantes do ponto de vista clínico-cirúrgico.

Odontomas are classified as benign tumors arising from epithelium and mesenchyme odontogenic and are considered more developmental abnormalities - Hamartoma - than true neoplasms. Undoubtedly, they are the most commonly tumors seen among those of odontogenic origin. Its pathogenesis is a very investigated, despite presenting indeterminate, being restricted to the realm of hypotheses, ranging from local infections and trauma to genetic factors. They are most frequently diagnosed in the second decade of life, often are included and asymptomatic, and usually are discovered in routine radiographs, being seen as an intensely radiopaque mass surrounded by a radiolucent line. Rarely it occurs eruption in the oral cavity and there are some theories that might explain it. This paper aims to present a case of extensive odontoma erupted into the oral cavity, discussing relevant aspects of the clinical surgery.

Reconstrução nasal parcial com retalho frontal oblíquo: relato de caso / Partial nasal reconstruction partial with an oblique frontal flap: a case report

Os ferimentos avulsivos na região nasal podem ser de origem traumática ou patológica. A reconstrução desses defeitos apresenta grande complexidade devido à região nasal ser importante do ponto de vista funcional e estético. A escolha do método reconstrutivo é baseada no tamanho, na localização e na profundidade do defeito a ser corrigido. O objetivo deste trabalho é relatar o caso de uma paciente que apresentou avulsão parcial de nariz cujo tratamento cirúrgico proposto foi a reconstrução nasal por meio de retalho frontal oblíquo.

The avulsive wound of the nose may be of traumatic or pathological origin. The reconstruction of these wounds is difficult because the nasal region is functionally and aesthetically important. The method of treatment is based on size, localization and depth of the defect to be corrected. The aim of this study is to present a case report of a partial avulsive wound of the nose treated surgically by nasal reconstruction using an oblique frontal flap.

Prevalência das lesões periféricas dos nervos trigêmeo e facial, decorrentes de fratura na face por trauma / Prevalence of peripheral nerve injury, trigeminal and facial fracture caused by trauma in the face

Objetivo: Objetivo deste trabalho foi realizar um estudo transversal e prospectivo para identificar lesões de ramos dos nervos trigêmeo e facial, decorrentes de fraturas dos ossos da face...

Objective: The aim of this research was to carry out a transversal prospective study to identify lesions of the facial and trigeminal nerve divisions resulting from fractures of the facial bones...

Estudio de la correlación de signos y síntomas entre nurinoma del acústico y desórdenes temoromandibulares: presentación de 5 casos clínicos / Study of correlacio no sign and sintomas between nurinoma of acustico and temporomandibular disorders: introduction of 5 cases

La correlación de síntomas que afectan pacientes portadores de neurinoma del acústico y dolor y disfunción de la articulación temporomandibular es frecuente. El neurinoma del acústico puede presentarse clinicamente con cefalea, dolor periaricular, hipoacusia, zumbidos o falta de equilibrio. Los transtornos que afectan a articulación temporo-mandibular son variados. Hay muchas causas que pueden originar la presencia de dolor y disfunción de esta articulación. Por ser una articulación única, con característica anatómica y fisiológica, permite padecer de vários procesos patológicos. Los principales síntomas que se presentan, frecuentemente incluyen dolor y trastornos funcionales, afectando al cráneo, región cervical y cara, extendiéndose principalmente hacia la región preauricular, siguiendo hasta la región submandibular. La suma de conocimientos sobre estas patologías permite hacer el diagnóstico diferencial entre neurinoma del acústico y dolor y disfunción de la articulación temporo-mandibular. Así, en la evaluación clínica y (relato de casos) en la anamnesis de cinco pacientes, diagnosticados tardíamente de neurinoma de acústico, fue observado que 60% fueron evaluados primariamente por Cirujanos Dentistas, que tenían como hipotes de diagnóstico, desorden temporo-mandibular, instituyendo de este modo, conductas terapéuticas diversas para esta enfermedad, pero, sin remisión del cuadro. Por lo tanto, a través de este trabajo, los autores pretenden resaltar la importancia del diagnóstico diferencial para los trastornos de la articulación temporo-mandibular.

The correlacion whether sintomas affecting patients with neurinomas acustico and pain and articulacion temporomandibular dysfunción is frequent. The neurinomas acustico climay be filed only with headache, pain periaricular, hearring loss, ringing or lack of balance. Disorders that affect articulacion temporomandibular are varied. There are many causes that could lead to the presence of pain and disfuncion this articulacion. As a articulacion unica, characterística anatomica and fisiologyca allows processes suffer from several diseases patológics. The more impotant sintomas that they are submitted often include pain and functional disorders, affecting craneo, regional cervical and face, extendiendose mainly towards preauricular region, according to regional submandibular. The amount of knowledge about these pathology a allows for diagnosticd differential between reurinomas acustico and pain and temporomandibular dysfunción. So, in the clinic evaluations and (relate of cases) in the history of five patients diagnosed lately of neurinoma of acustico, it was observed that 60% were assessed primarily by Surgeons Dentists, that had hipoteses of diagnostic the temporomandibular dysfunction, instituting thus conducts various terapeuticas for this disease, but without remision the clinic. Therefore in this work, the authors emphasize the importance of diagnostic differential for the articulacion temporomandibular disfunción.

Transmaxillary approach to the cranial base: an evaluation of 11 cases.

UNLABELLED: Surgical access to the skull base is always difficult, especially because of the noble anatomic structures present there. Maxillary osteotomy provides direct view to the clivus region and the neck spine, and it also bears less morbidity when compared to the many other accesses described in the literature. AIM: to assess 11 patients submitted to transmaxillary osteotomy, describing the surgical technique and postoperative results and complications. MATERIALS AND METHODS: A retrospective study involving eleven patients submitted to transmaxillary approach to the brainstem. We studied dental occlusion, trans and postoperative bleeding, bone necrosis and soft tissue alterations. All followed the same surgical protocol and were followed up for two years. RESULTS: after treatment, all the patients improved in their clinical status and had no neurological complication, trans and postoperative hemorrhage or major complications were seen. Among the complications, two patients had incomplete maxilla fracture, two had laceration of their nasal mucosa and one had, as late complication, an oral-sinusal fistula. CONCLUSION: Transmaxillary osteotomy provided proper access to the clivus for brainstem decompression with low rate of complications in this series.

Acesso transmaxilar à base do crânio: avaliação de 11 casos / Transmaxillary approach to the cranial base: an evaluation of 11 cases

O acesso cirúrgico à região de base do crânio é sempre difícil principalmente pelas estruturas anatômicas nobres associadas. A osteotomia maxilar proporciona visão direta à região de clivus e coluna cervical, além de apresentar uma menor morbidade em relação aos diversos acessos descritos na literatura. OBJETIVO: Avaliar 11 casos submetidos à osteotomia transmaxilar, descrevendo técnica cirúrgica, resultados e complicações pós-operatórias. PACIENTES E MÉTODOS: O estudo retrospectivo de onze pacientes foi submetido à cirurgia transmaxilar para acesso à região do tronco encefálico. Registros quanto à oclusão dentária, hemorragia trans e pós-operatória, necrose óssea e alterações de tecido mole foram estudados. Todos seguiram o mesmo protocolo cirúrgico e acompanhamento médio de dois anos. RESULTADOS: Após o tratamento todos os pacientes apresentaram melhora do quadro clínico e nenhum dano neurológico, hemorragia trans e pós-operatória ou intercorrências maiores foram identificadas. Dentre as complicações, em dois pacientes ocorreu fratura incompleta da maxila, dois apresentaram laceração da mucosa nasal e um apresentou como complicação tardia uma fístula bucossinusal. CONCLUSÃO: A osteotomia transmaxilar possibilitou adequado acesso a região de clivus para descompressão do tronco encefálico com baixo índice de complicações nesta série de casos.

Surgical access to the skull base is always difficult, especially because of the noble anatomic structures present there. Maxillary osteotomy provides direct view to the clivus region and the neck spine, and it also bears less morbidity when compared to the many other accesses described in the literature. AIM: to assess 11 patients submitted to transmaxillary osteotomy, describing the surgical technique and postoperative results and complications. MATERIALS AND METHODS: A retrospective study involving eleven patients submitted to transmaxillary approach to the brainstem. We studied dental occlusion, trans and postoperative bleeding, bone necrosis and soft tissue alterations. All followed the same surgical protocol and were followed up for two years. RESULTS: after treatment, all the patients improved in their clinical status and had no neurological complication, trans and postoperative hemorrhage or major complications were seen. Among the complications, two patients had incomplete maxilla fracture, two had laceration of their nasal mucosa and one had, as late complication, an oral-sinusal fistula. CONCLUSION: Transmaxillary osteotomy provided proper access to the clivus for brainstem decompression with low rate of complications in this series.

Angina de Ludwig decorrente de exodontias de molares inferiores: relato de caso clínico / Ludwig’s angina caused by exodontia of inferior molars: a case report

A Angina de Ludwig representa uma infecção grave de progressão rápida, envolvendo os espaços fasciais sublingual, submandibular e submentoniano. Os autores relatam um caso de Angina de Ludwig, apresentando,também, uma revisão bibliográfica do assunto, discutindo sua etiologia, aspectos clínicos, seleção de antibióticos, cultura e antibiograma, manutenção de vias aéreas, drenagem e possíveis complicações.