Surgical Treatment of Condylar Hyperplasia Associated with Dentofacial Deformity: Low Condylectomy, Articular Disc Repositioning, and Orthognathic Surgery / Tratamiento Quirúrgico de Hiperplasia Condilar Asociado a la Deformidad Dentofacial: Condilectomía Baja, Reposicionamiento del Disco Articular y Cirugía Ortognática

Due to the complexity of the treatment of condylar hyperplasia associated with dentofacial deformities and its complications, if left untreated, the surgeon should be alert to these factors at the time of surgical planning to tailor the optimal therapy for an individual patient. This case report describes a patient with right condylar hyperplasia associated with dentofacial deformity who was treated surgically with low condylectomy, articular disc repositioning and anchoring, and orthognathic surgery, concomitantly, with stable results, satisfactory occlusion and facial harmony.

Debido a la complejidad del tratamiento de la hiperplasia condilar asociada con deformidades dentofaciales y sus complicaciones, si no se trata, el cirujano debe estar alerta ante estos factores en el momento de la planificación quirúrgica para adaptar la terapia óptima para cada paciente. Este caso describe un paciente con hiperplasia condilar derecha asociada con la deformidad dentofacial que fue tratado quirúrgicamente con condilectomía baja, reposicionamiento y anclaje del disco articular, y la cirugía ortognática, concomitantemente, con resultados estables, oclusión satisfactoria y armonía facial.

Jaw-opening oromandibular dystonia secondary to Wilson's Disease treated with botulinum toxin type A / Distonia oromandibular com abertura da boca secundária à doença de Wilson tratada com toxina botulínica tipo A

We have reported a case series of five patients with jaw-opening oromandibular dystonia secondary to Wilson's disease (WD), in which the patients were treated with botulinum toxin type A (BTX-A). In all cases, dystonia score was partially reduced three weeks after injections. The most common side effect was transient mild dysphagia. This preliminary study showed that jaw-opening oromandibular dystonia in WD may be partially responsive to the use of BTX-A.

Relata-se uma série de cinco casos de distonia oromandibular com abertura da boca, secundária à doença de Wilson, em que os pacientes foram tratados com toxina botulínica tipo A. Em todos os casos, a distonia oromandibular com abertura da boca foi parcialmente reduzida três semanas após as injeções. O efeito adverso mais comum foi a disfagia leve e transitória. Este estudo preliminar mostrou melhora parcial da distonia oromandibular com abertura da boca.

Cisto ósseo traumático da mandíbula: revisão de 26 casos / Traumatic bone cyst of the mandible: a review of 26 cases

O cisto ósseo traumático é uma entidade patológica caracterizada pela presença de uma cavidade óssea assintomática desprovida de revestimento epitelial, sendo raramente encontrado nos maxilares. OBJETIVO: Descrever as características clínico-cirúrgicas e radiográficas dos cistos ósseos traumáticos. MATERIAL E MÉTODO: Estudo de caráter retrospectivo dos pacientes diagnosticados com cisto ósseo traumático em um serviço de patologia oral no período de 1992 a 2007. Informações referentes às características clínicas, radiográficas e cirúrgicas foram coletadas. RESULTADOS: Vinte e seis casos de cisto ósseo traumático foram diagnosticados no período de 15 anos, 17 pertencentes ao sexo masculino e 09 ao sexo feminino. A maioria dos pacientes afetados pertencia às duas primeiras décadas de vida, não relatava sintomatologia dolorosa, bem como história de trauma na região da lesão. O padrão multilocular foi observado em apenas sete casos, dando às lesões uma aparência radiográfica tumoral. A presença de ar no interior da cavidade patológica foi relatada em aproximadamente 70% dos casos, sendo rara a presença de conteúdo serossanguíneo e seroso. CONCLUSÃO: A maior prevalência de casos em pacientes jovens, a infrequente história de trauma e o pequeno número de lesões com conteúdo serossanguíneo refletem a necessidade de se discutir a real patogênese do cisto ósseo traumático.

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.

Submasseteric abscess: A rare head and neck abscess.

The objective of the article is to highlight and make people aware of a rare abscess which is often missed or misdiagnosed. As only a few cases have been reported, the authors feel that reporting such a case would help in proper management of the disease. We are presenting a 6.5-year-old male child with 3 weeks history of right facial swelling in the parotid region, with low-grade fever and trismus. Submasseteric abscess is a rare abscess which is often misdiagnosed as a parotid abscess or parotitis. Only a few cases have been reported. The cause is mostly dental in origin. Intravenous antibiotics often fail to alleviate the symptoms as this is a closed space and needs prompt drainage. Therefore, awareness of this complication of dental infections is vital for proper diagnosis and timely management.

Autosomal-dominant osteopetrosis: An incidental finding.

Osteopetrosis is a descriptive term that refers to a group of rare, heritable disorders of the skeleton. Osteopetrotic conditions vary greatly in their presentation and severity, from just as an incidental finding on radiographs to causing life-threatening complications such as bone marrow suppression. It is caused by failure of osteoclast development and function. Osteopetrosis can be inherited as autosomal-recessive, autosomal-dominant or as X-linked traits, with the most severe forms being the autosomal-recessive ones. The severity of the disease is mild to moderate in the autosomal-dominant forms, with normal life expectancy. Diagnosis is largely based on clinical and radiographic evaluation. The present paper reports a case of autosomal-dominant osteopetrosis complicated by osteomyelitis with a short review of the condition.

Torus mandibular / Torus mandibular

Introdução: o torus mandibular é um crescimento ósseo protuberante, conhecido como hiperostose ou exostose, que ocorre na região mandibular da cavidade oral. Não é uma patologia ou uma formação tumoral, mas uma peculiaridade anatômica rara, assintomática que, em geral, não causa danos ao paciente. Ocasionalmente precisa ser removido. Objetivos: apresentar um caso clínico de torus mandibular e revisar as várias hipóteses relativas à etiologia, as indicações para remoção do torus e o diagnóstico diferencial. Descrição do caso: torus mandibular bilateral, diagnosticado por meio de anamnese, exame clínico e radiográfico. Conclusão: após completo exame foi assegurada a ausência de qualquer característica clínica particular (dor espontânea ou dor à palpação, mobilidade dental), pode-se eliminar a possibilidade de neoplasia. O torus mandibular não causa desconforto ou perturbação funcional, a não ser em casos especiais como quando impede a mobilidade da língua.

Introduction: the torus mandibular is a protuberant bony growth, known as hyperostosis or exostosis, that it happens in the area mandibular of the oral cavity. It is not a pathology or tumoral formation, but a rare anatomical peculiarity, asymptomatic that, in general, it doesn’t cause damages to the patient. Occasionally they need to be removed. Aim: present a case of mandibular torus and the several relative hypotheses are revised to the etiology, the indications for removal of the torus and the differential diagnosis. Case description: bilateral mandibular torus, diagnosed by history, clinical and radiographic examination. Conclusion: after thorough examination was assured the absence of any particular clinical feature (spontaneous pain or pain on palpation, tooth mobility), can eliminate the possibility of neoplasia. The mandibular torus does not cause discomfort or or functional disorder, except in special cases such as when it impedes the mobility of the tongue.functional disorder, except in special cases such as when it impedes the mobility of the tongue.

Osteomyelitis in infantile osteopetrosis: a case report with review of literature.

Osteopetrosis is a rare genetic disorder that causes generalized sclerosis of bone due to a defect in bone resorption and remodeling. Dental abnormality may be attributed to pathological changes in bone remodeling. Osteomyelitis is well documented as a complication of osteopetrosis. This disease can be severe and difficult to treat in the osteopetrotic patient. This is a case of 10-year-old girl previously diagnosed as suffering from osteopetrosis and presenting with the complaint of swelling of jaw with extra-oral draining sinus.

Osteonecrosis avascular maxilar: guías de prevención para pacientes tratados con bifosfonatos / Avascular necrosis of the jaw: prevention guidelines for patients with biphosphonates treatment

Los bifosfonatos conforman un grupo de medicamentos que se utilizan desde hace unos 30 años para resolver diferentes condiciones que afectan la calidad del hueso de soporte. El uso actual es masivo, por tiempos prolongados y los esquemas de dosis grandes e intermitentes, de productos de alta potencia anti-resortiva ósea se asocian con la aparición de nuevos eventos adversos como la osteonecrosis de mandíbula (ONM). La ONM es sin embargo poco frecuente, se ha visto en el 0,8 por ciento de los pacientes con cáncer y factores de riesgo, tratados con productos intravenosos, dosis altas por tiempos de 3 o más años. Este evento es casi anecdótico con los esquemas orales intermitentes, en pacientes con osteoporosis, e inexistente cuando se utilizan diariamente productos de potencia anti-resortiva ósea moderada, por la vía oral y períodos de hasta un año. Aquí se resumen algunas recomendaciones elementales para que el odontólogo identifique los casos con riesgo y prevenga la aparición eventual de ONM.

Influência dos níveis de densitometria mineral óssea na perda óssea alveolar e parâmetros clínicos periodontais em mulheres na pós-menopausa / Influence of the bone mineral densitometry's levels in the alveolar bone loss and periodontal clinical parameters in the post menopausal women

Objetivo: Verificar a relação da influência do nível de densitometria mineral óssea (DOM) na perda óssea alveolar e parâmetros clínicos periodontais em mulheres na pósmenopausa. Métodos: Em um estudo seccional, foram avaliadas 23 mulheres na menopausa, com idade variando de 44-61 anos de idade. Densitometria óssea mineral da coluna lombar e do fêmur foram obtidas pela técnica DEXA. Foram incluídos exame clínico (profundidade a sondagem, perda de inserção, profundidade a sondagem e o número de ausência dental) e radiográfico para determinar a gravidade da doença periodontal. Os dados foram comparados pelo teste t Student e correlacionados pelo teste de Pearson (r). Resultados: Das 23 mulheres, duas eram osteoporóticas, 14 osteopênicas e 7 em condi- ção de normalidade. Para as comparações dos parâmetros clínicos periodontais com o perfil da DOM não foram encontradas diferenças significativas em nenhuma das análises. O coeficiente de correlação de Pearson foi fraco e negativo quando comparada a DOM com os parâmetros periodontais. Conclusão: No presente estudo não foi encontrada uma associação entre as modificações estruturais ósseas com os parâmetros periodontais (AU)

Objective: To correlate levels of bone mineral densitometry (BMD) and periodontal clinical parameters, including radiographic alveolar bone loss in postmenopausal women. Methods: This cross-sectional study included 23 postmenopausal women. Their ages ranged from 44 to 61 years-old. BMD of the lumbar vertebra and femur were obtained through the DEXA technique. Periodontal clinical examination (probing depth, clinical attachment level and number of missing teeth) and periapical radiographs were obtained to determine the severity of periodontal disease. The data obtained was analyzed using both student t test and Pearson correlation. Results: BMD revealed that 2 participants were osteoporotic, 14 were osteopenic, and 7 were healthy. Comparisons between periodontal clinical and radiographic parameters and BMD profile, among the distinct groups, showed no statistically significant differences. The coefficient for Pearson correlation was weak and negative when comparing BMD with all periodontal parameters. Conclusion: This study showed no association between bone structural modifications and clinical and radiographic periodontal parameters (AU)

Garre's sclerosing osteomyelitis.

Garre's sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults. This disease entity is well-described in dental literature and is commonly associated with an odontogenic infection resulting from dental caries. This paper describes a case of Garre's osteomyelitis in a 10-year-old boy, in whom the condition arose following pulpoperiapical infection in relation to permanent mandibular right first molar. Clinically the patient presented with bony hard, non-tender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance. The elimination of periapical infection was achieved by endodontic therapy and the complete bone remodeling was seen radiographically after three months follow-up.

Pyogenic granuloma associated with bone loss in an eight year old child: A case report.

Soft tissue enlargements of the oral cavity often present a diagnostic challenge because a diverse group of pathologic processes can produce such lesions. An enlargement may represent a variation of normal anatomic structures, inflammation, cysts, developmental anomalies and neoplasm. Within these lesions is a group of reactive hyperplasias, which develop in response to a chronic, recurring tissue injury that stimulates an exuberant or excessive tissue repair response. The pyogenic granuloma is a reactive enlargement that is an inflammatory response to local irritation such as calculus, a fractured tooth, rough dental restoration and foreign materials. This article aims to present a case of pyogenic granuloma in 8 year old child patient associated with resorption of bone in relation to the tooth.

Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis

Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including profilatic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1 percent) patients developed radiation caries and 5 out of 23 cases (21.3 percent - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental condictions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.

Pacientes portadores de carcinomas espinocelulares em cabeça e pescoço necessitam receber tratamento odontológico antes da radioterapia. Mesmo pacientes que visitam regularmente consultórios odontológicos requerem especial atenção incluindo profilaxias e tratamentos curativos. Os objetivos desse estudo foram avaliar a condição odontológica de 40 pacientes de baixo nível sócio-econômico antes da radioterapia em cabeça e pescoço e discutir o tratamento odontológico realizado. Os pacientes foram acompanhados durante o tratamento oncológico. Antes da radioterapia, 28 pacientes eram dentados e doze edêntulos, sendo que todos esses apresentavam péssimas condições sistêmicas e higiene oral deficiente. O tratamento mais comumente empregado foi a extração dentária e 23 pacientes tiveram a média de 8,6 dentes extraídos (Grupo I). Um em 9 (11,1 por cento) pacientes desenvolveram cárie por radiação e 5 em 23 (21,73 por cento) osteorradionecrose, sendo um caso associado a extrações dentárias prévias à radioterapia e outros de origem multifatorial. Pacientes de baixo nível socioeconômico com carcinoma espinocelular em cabeça e pescoço receberam múltiplas extrações dentárias devido à condição dentária precária e má higienização. O tratamento odontológico não preveniu a osteorradionecrose, que apresenta origem multifatorial na maioria dos casos.

Dentigerous cyst - a case report

The purpose of this article is to report a rare case of a dentigerous/follicular cyst developing from a mesiodens. Although dentigerious cysts in association to supernumerary teeth are frequently reported in the mandible maxilla, their association with a mesiodens is rare

Otolaryngological complications of osteopetrosis.

Osteopetrosis is a rare inherited bone disease that affects both humans and various mammals. The authors report on two cases of osteopetrosis with otolaryngological complications. One patient had the childhood form and presented with chronic otitis media and brain abscess. The second patient had the adult form and presented with sinusitis from tooth extraction which developed into chronic osteomyelitis of the maxillary bone.

Garre's osteomyelitis: a case report.

Garre's Osteomyelitis is a distinctive type of chronic osteomyelitis associated with gross thickening of the periosteum of the bones and peripheral reactive bone formation resulting from mild irritation or infections. The condition is seen exclusively in children or young adults. Mandible is more often affected than the maxilla. Clinically it manifests as bony hard, non-tender swelling which is slowly progressive and associated with painful carious tooth. In this article, a case report of a eight year old female is presented along with complete investigations and treatment.

Odontogenic keratocyst: a Prospective study of twenty one cases diagnosed in Benghazi, Libya

The aim of the present study was to examine the relative frequency, the age, sex and site distribution and the malignant transformation of the odontogenic keratocysts diagnosed in Benghazi, Libya and compare the results with similar data from other parts of the world. A total of 21 odontogenic keratocysts have been retrieved from 442 cysts of the jaws and the oral soft tissue diagnosed in the Oral Medicine andPathology Department, Dental School, Benghazi, in the period of 1989. The results showed that the relative frequency was 4.8% the age range was 10-65 years, the mean age of the index cyst was 29.3 years [S.D. 16.3], the M:F ration was 2.5:1 The mandible was more affected than maxilla and the molar-ramus area is the most common site. None of the 21 keratocysts included in this study showed any malignant transformation. The results were found to concur with many of the studies in other parts of the world

Traumatic bone cyst--a case report.

Traumatic bone cyst is an asymptomatic, slow growing, non expansile lesion commonly diagnosed during routine radiographic examination of the jaw bones. It is more frequently seen in young age, with predilection for anterior region of the mandible leading to a dramatic healing of the lesion. A typical case of traumatic bone cyst in a 12 year old girl is reported. A routine radiologic assessment of the patient with panoramic radiograph revealed a fairly large lesion in the anterior region of the mandible. On surgical exploration, clinical diagnosis was confirmed. Post operative successive radiograph shows progressive osseous healing.

Síndrome de Eagle / Eagleïs syndrome

Se presenta un caso clínico de síndrome de Eagle. Se trata de un hombre adulto aquejado por un dolor submandibular de un año de evolución y de origen incierto. Posteriormente se sospechó la presencia de una elongación patológica de la apófisis estiloides, que fue confirmado radiológicamente. El paciente fue intervenido quirúrgicamente, por vía externa. Se realiza una revisión del síndrome de Eagle, considerando sus aspectos clínicos, etiopatogenia, los elementos de diagnóstico y las alternativas terapéuticas

Progressive systemic sclerosis. Case report.

A case of progressive systemic sclerosis in a 36 year old woman is reported. The systemic, clinical, radiological and oral manifestations have been discussed.

Paratiroidectomía médica: su eficacia en el tratamiento de un tumor pardo en el maxilar inferior / Medical parathyroidectomy: its efficacy in treatment of lower maxillary brown tumor

Se presenta el caso de un paciente en hemodiálisis crônica que desarrolla hiperparatiroidismo secundaria severo, incluyendo la presencia de un tumor pardo en el maxilar inferior. La terapeútica habituál implica cirugía local, radiaciones, esteroides y/o paratiroidectomía. Como alternativa y para obviar las posibles complicaciones de la cirugía, se suprimió la actividad paratiroidea mediante la administración de calcitriol oral en dosis crecientes -3,5 a 9 ug/semana- y carbonato de calcio. Luego de 19 meses de tratamiento se constato la desaparición del tumor y de todos los signos clínicos y radiológicos del hiperparatiroidismo.