Is there a superiority between arthrocentesis and stabilizing occlusal splint for the treatment of anterior disc displacement with reduction and intermittent block and anterior disc displacement without reduction in TMJ? Randomized clinical trial.

INTRODUCTION: Anterior displacement of the temporomandibular joint (TMJ) disc is a disorder in which the articular disc is dislocated from its correct position relative to the mandibular condyle and mandibular fossa. Traditionally, the initial treatment of disc displacements involves various conservative measures, including the use of a stabilizing interocclusal splint. However, in cases where there is associated limited mouth opening, as in the case of anterior disc displacement with reduction and intermittent block (ADDwRIB), and anterior disc displacement without reduction (ADDw/oR), arthrocentesis has been suggested as another modality of initial treatment due to its faster effect in preventing disease progression to a more advanced stage, as well as reducing the chances of pain chronification and central sensitization. OBJECTIVES: This study aimed to analyze whether there is a preponderance in efficacy between treatments with a stabilizing interocclusal splint or arthrocentesis in these patients. METHODS: A randomized, prospective, longitudinal clinical trial was conducted. The sample was obtained by convenience, between June 2021 and January 2023. Twenty-four patients with diagnoses of ADDwRIB and ADDw/oR were included. The diagnosis and clinical evaluations followed the DC/TMD criteria, and TMJ MRI was performed. Patients were randomly allocated to 2 treatment groups. Group 1 (n = 13): stabilizing interocclusal splint. Group 2 (n = 11): arthrocentesis. Patients were evaluated after 1, 2, 3, and 6 months for clinical parameters of pain, functionality, and psychosocial status. RESULTS: Both treatments were effective in reducing pain levels, with no statistically significant differences. Group 1 showed significantly greater mouth-opening levels compared to Group 2 (P = .041). CONCLUSION: Both groups showed significant improvements in various parameters evaluated throughout the study, indicating they are equally effective in pain control and most functional and quality of life parameters. However, the stabilizing interocclusal splint treatment was superior in restoring mouth opening.

Synovial chondromatosis of the temporomandibular joint-clinical, surgical, and imaging findings of a Milgram stage III case series.

Synovial chondromatosis of the temporomandibular joint (TMJ) is a rare disease characterized by cartilaginous metaplasia of the mesenchymal remnants of the synovial membrane with formation of loose cartilaginous nodules. It is prevalent in middle-aged women and the main clinical characteristics are swelling, pain, and limited jaw movements. Diagnosis is difficult, especially in the early stages, because the signs and symptoms are like other TMJ diseases such as internal derangements and tumors. Imaging exams are fundamental in differential diagnosis for detection of synovitis and free cartilaginous bodies. Magnetic resonance imaging with a gadolinium contrast would be of particular interest for this purpose. Treatment involves the removal of the cartilaginous nodules and synovectomy. It can be performed by arthroscopy or arthrotomy depending on the size of the lesion, the number of corpuscles, and the need for auxiliary surgical procedures. Final diagnosis is anatomopathologic. Postoperative follow-up is necessary due to the risk of recurrence.

Successful Management of a Gigantic Ameloblastic Fibroma: A 12-Year Follow-up.

An ameloblastic fibroma (AF) is a benign mixed odontogenic tumor that mainly affects patients in the first and second decades of life. It is usually associated with an impacted tooth, commonly the first or second permanent molar. We present a case of an 11-year-old male patient diagnosed with AF, showing well-defined borders almost completely affecting the body and inferior alveolar nerve (IAN) branch on the right side of the mandible and displacing teeth 46 and 47 associated with the lesion. The treatment included conservative surgery, with oral rehabilitation, including IAN lateralization, implant placement without sensorial alteration, and posterior rehabilitation, performed after 10 years of follow-up. Rehabilitation with implants is a safe and effective procedure for the prosthetic rehabilitation of the posterior atrophic mandible. However, sensorial alteration of the IAN occurs in 100% of cases and tends to regress with time or may be permanent in few cases.

Maxillary reconstruction with particulate bone graft and titanium mesh: a treatment option for large complex odontoma of the maxilla.

Odontomas are the most common type of odontogenic tumor and are generally asymptomatic. The purpose of this paper was to describe the case of a complex odontoma in a patient who had asymptomatic swelling in the central maxillary region, along with unerupted central and lateral incisors. In this case, surgical excision of the lesion was performed and an iliac bone graft was introduced into the defect area with a titanium mesh covering up the grafted harvesting bone. After 2 years of followup, no recurrence was identified. Patient followup is still in progress to evaluate bone graft resorption, and the patient awaits complete bone development. Oral rehabilitation with an osseointegrated titanium implant is expected in the future. An option of the large complex odontoma treatment is discussed.

Osteochondroma of the temporomandibular joint: a case report.

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.

Complex odontoma: report of a five-year follow-up case.

Odontomas are odontogenic tumors that usually present as benign lesions. They are easily diagnosed and affect individuals in their first and second decades of life. In most cases, odontomas are asymptomatic and the presence could be suspected due to the delay in tooth eruption or via routine radiographic examinations. Treatment of choice has been surgical removal of the lesion, and prognosis is usually favorable because of its benign characteristics and rare recurrence. The purpose of this study is to report the case of a complex odontoma in a child impacting a permanent molar and preventing its eruption. The lesion was surgically removed, and the eruption of the permanent mandibular left second molar tooth occurred after 5 months. Clinical, radiographic, and histopathological characteristics were studied in this case.

Use of retinoids in the treatment of oral leukoplakia: a review / Uso de retinoides no tratamento de leucoplasias bucais: revisão

OBJECTIVE: The purpose of this paper is to review the literature regarding the topical use of the retinoids in the treatment of oral leukoplakia, discussing their mechanisms of action, indications, effectiveness, and adverse effects. DISCUSSION: Leukoplakia is defined as white lesion in oral mucous membrane that cannot be characterized as any other entity and it has potential for malignancy. It does not present specific histological pattern. Due to its potential for malignancy and high prevalence, dentists should know how to diagnose and treat it correctly. The retinoids are chemopreventive agents derived from the vitamin A. They could be either natural or synthetic and their main role is to suppress cellular mitosis. Retinoid derivatives have been used as agents for chemoprevention of malignant transformation of leukoplakias due to its potential effect on the control of the differentiation and proliferation of the epithelial cells, as well as their induction of apoptosis. CONCLUSION: The topical use of retinoids to treat oral leukoplakia is safe, convenient and effective, with minor side effects than the systemic administration.

OBJETIVO: A proposta deste artigo é revisar a literatura referente ao uso de retinoides no tratamento de lecoplasiasbucais e discutir o mecanismo de ação, indicações, efetividade e efeitos adversos. DISCUSSÃO: Leucoplasia é definida como lesão branca na mucosa bucal que não pode ser caracterizada como qualquer outra entidade e tem potencial de malignização. Não apresenta padrão histológico específico e, por causa de seu potencial de malignização e alta prevalência, os cirurgiões-dentistas devem conhecer como diagnosticá-la e tratá-la corretamente. Os retinoidestêm sido usados como agentes quimio-profiláticos para a transformação maligna das leucoplasias por seu efeito potencial no controle da diferenciação e proliferação da células epiteliais, bem como capazes de indução de apoptose. CONCLUSÃO: O uso tópico de retinoides para tratar leucoplasias é seguro, conveniente e efetivo, com efeitos colaterais menores do que na administração sistêmica.

Recidiva de cisto dermoide congênito de localização paramediana / Recurrence of congenital dermoid cyst of paramedian location

Introdução: O cisto dermoide é um cisto de desenvolvimento incomum na face e envolve mais frequentemente o assoalho bucal. A maioria das lesões ocorre em adultos jovens, com ligeira predileção pelo gênero masculino. As lesões neonatais e em crianças são extremamente raras. Manifesta-se como tumefação flutuante, assintomática e de crescimento lento e progressivo, atingindo dimensões variadas. Sua cápsula pode conter um ou mais anexos cutâneos, como glândulas sebáceas, pêlos ou unhas. O tratamento é cirúrgico, através de enucleação, sendo sua recidiva incomum. O aspecto clínico, histopatológico, diagnóstico diferencial e tratamento de um caso de cisto dermoide congênito, e de sua recidiva, são discutidos pelos autores.

Introduction: The dermoid cyst is a cyst of unusual development in the face and more often involves the mouth floor. Most injuries occur in young adults with a slight predilection for males. Lesions in neonatal and children are extremely rare. It manifests as swelling floating asymptomatic and slow-growing and progressive, reaching dimensions. His capsule may contain one or more skin appendages such as sebaceous glands, hair or nails. The treatment is surgical, by enucleation, and its recurrence uncommon. The clinical appearance, histopathology, differential diagnosis and treatment of a case of congenital dermoid cyst, and its recurrence, are discussed by the authors.

Osteochondroma of the temporomandibular joint: a case report

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.

Osteocondroma de côndilo mandibular é raro na região craniofacial. Este artigo descreve um caso de osteocondroma de côndilo mandibular em uma mulher de 20 anos que foi encaminhada ao nosso serviço apresentando assimetria facial, desvio de mento, mordida cruzada para o lado contralateral, alterações na morfologia condilar, limitação de abertura bucal e maloclusão. Tomografia computadorizada foi realizada para melhor avaliação da condição patológica da ATM. Devido à base no exame clínico, histórico do paciente e exames complementares, foi estabelecida uma hipótese de osteocondroma. Um procedimento de condilectomia utilizando abordagem preauricular com uma total remoção da lesão foi executado. Após três anos de acompanhamento pós-operatório e ortodôntico, o paciente está livre dos sintomas e tem uma abertura normal sem desvio de padrão durante a abertura.

Escleroterapia de hemangioma labial / Sclerotherapy of labial hemangioma

O hemangioma é um tumor benigno que se caracteriza por proliferação anormal de vasos sanguíneos. Acomete, na cavidade bucal, mais comumente a região de lábios, língua e mucosa jugal. Dentre as opções terapêuticas, a escleroterapia vem sendo utilizada com resultados satisfatórios clínicos e estéticos. O propósito deste trabalho é apresentar o caso de hemangioma labial em paciente do gênero feminino, tratado através de injeções de solução esclerosante de oleato de monoetanolamina com remissão total da lesão. Neste caso, foi possível promover a involução da lesão com segurança, através de procedimento não cirúrgico, favorecendo no pós-operatório, a estética da paciente.

Hemangioma is a benign tumor that characterized for abnormal proliferation of sanguineous vessels. It afectted the oral cavity, more commonly in the region of lips, tongue and bucal mucosa. Among the therapeutical options, the sclerotherapy was being used with clinical and aesthetic satisfactory results. The aim of this work is to present one case of lip hemangioma in female patient, treated through injections to sclerosing solution of monoethanolamine oleate with total remission of the lesion. In this case it was possible to promote the regression of the lesion with security, without surgical procedures, been less invasive and more favorable to aesthetic of the patient.

Adenoma pleomórfico em palato mole / Pleomorphic adenoma of the soft palate

Adenoma pleomórfico (AP) é a neoplasia de glândula salivar mais comum. A lesão apresenta-se como uma massa firme de crescimento lento e indolor. Pode ocorrer em qualquer idade, sendo mais comum em adultos jovens entre 30 e 50 anos. A diversidade do padrão morfológico histopatológico é um dos seus aspectos mais característicos. Este artigo relata um caso de adenoma pleomórfico de palato mole, enfatizando aspectos diagnósticos e terapêuticos.

Pleomorphic adenoma (PA) is the most common salivary gland neoplasm. The lesion present as firm mass with slow rate of growth and asymptomatic. It can occur at any age, but young adults between 30 and 50 years are common. The diversity morphologic pattern is one of the most characteristic aspects of this lesion. This article report a case of pleomorphic adenoma of the soft palate emphasizing diagnostic aspects and therapeutics.

Correção cirúrgica da deficiência transversal da maxila: relato de caso / Surgery correction of the maxillary transverse deficiency: case report

A deficiência transversal da maxila ou atresia maxilar é deformidade dento-facial, caracterizada pela presença de mordida cruzada posterior uni ou bilateral, palato ogival, apinhamentos dentários, dificuldade de respiração nasal, hipoplasia zigomática, base nasal estreita e sulco nasolabial profundo. O tratamento baseia-se na expansão rápida maxilar por meio de tratamento ortopédico-ortodôntico em pacientes jovens com uso de disjuntores (expansores) e a associação cirúrgica-ortodôntica em pacientes adultos, realizando osteotomias para a fragilização das zonas de resistência óssea a disjunção. O objetivo deste trabalho é relatar uma breve revisão de literatura e um caso submetido à disjunção maxilar cirurgicamente assistida complementar ao tratamento ortodôntico.

The maxillary transverse deficiency or atresic maxilla is dentofacial deformity characterized by presence of posterior bilateral or unilateral crossbite, deep ogival palate, nasal breathing difficulty, zigomatic hipoplasic, narrow nasal base and deep nasolabial sulcus. The treatment is based on rapid maxillary expansion through orthodontic-orthopedic treatment in young patients and the orthodontic-surgery association in adults patients, performing osteotomies for fragilization of the bone resistance zones in maxillary disjunction. The purpose of this work is to report a brief review of the literature and a case submitted to surgically assisted rapid maxillary disjunction for complement of orthodontic treatment.

Fibroma ossificante periférico atípico em mandíbula / Atypical peripheral ossifying fibroma in mandible

Este é um relato de caso de Fibroma Ossificante Periférico (FOP) atípico na mandíbula do lado direito, em paciente do sexo masculino de 17 anos. A importância desse caso inclui o tamanho da lesão, comprometimento de tecido mole, dentes e osso. Exames complementares foram realizados, como radiografia panorâmica convencional, punção, tomografia computadorizada e a biópsia incisional. Após o diagnóstico definitivo, foi feita a excisão completa da lesão, juntamente com os dentes envolvidos. O objetivo deste relato éevidenciar esse caso atípico de FOP e as ferramentas utilizadas para o auxílio de seu diagnóstico e planejamento cirúrgico.

This is a case report of Peripheral Ossifying Fibroma (POF) on the right side of the mandible in a seventeen-year-old male. The importance of the case includes the size of the lesion, soft tissue, teeth and bone involved. Complementary exams were performed, like panoramic radiography, punction, computed tomography and incisional biopsy. After the definitive diagnosis, total excision of the lesion was made, together with the teeth involved. The objective of this case report is to show this atypical case of POF and the tools used to help the diagnosis and surgical planning.

Osteonecrose bilateral na maxila induzida por zolendronato / Zoledronate-induced maxillary bilateral osteonecrosis

Os bifosfonatos são drogas utilizadas com diversas finalidades, dentre elas, o tratamento da hipercalcemia secundária a neoplasias malignas. Embora sua eficácia médica seja comprovada, o número de pacientes que apresentam osteonecrose nos maxilares vem aumentando devido ao uso desse medicamento. Este relato mostra o tratamento de um paciente que desenvolveu osteonecrose de maxila após fazer uso crônico de bifosfonato, enfatizando o surgimento de lesões maxilares agressivas concomitantes à piora do estado geral do paciente.

Bisphosphonates are drugs used to treat malignat hypercalcemia in certain types of cancer. Although this drug has clear evidence of medical efficacy, there are an increasing number of patients that develop bisphosphonate associated osteonecrosis of the jaws. This report show the treatment of a patient that present osteonecrosis subsequent the cronic use of bisphosphonate showing a strong correlation between the aggressive aspect of the lesion and general health patient.

Prevalência das lesões diagnosticadas no Serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial (CTBMF) da USP / Prevalence of the lesions diagnosed at the Service of the CTBMF from USP

A meta deste estudo foi analisar os dados dos registros de pacientes atendidos com lesões da cavidade bucal no serviço de Cirurgia e Traumatologia Buco-maxilofacial do HCFMUSP no período de maio a dezembro de 2004. Foram levantadas as seguintes variáveis em 98 prontuários: gênero, raça, idade, tipo de lesão, quantidade e localização anatômica da lesão. Um total de 98 pacientes foi analisado e foram encontrados 40 tipos de lesões. Houve predomínio de pacientes do sexo feminino, brancos, entre 30 a 40 anos. A região anatômica mais frequente foi a mandíbula. As lesões mais prevalentes foram querocisto, hiperplasia fibrosa inflamatória e carcinoma epidermóide.