Aggressive localized juvenile spongiotic gingival hyperplasia (LJSGS) in a 33-year-old patient: a case report

The aim of this study is to report a case of an extensive and aggressive gingival lesion, compatible with localized juvenile spongiotic gingival hyperplasia (LJSGH), demonstrating the difficulties of diagnosis and management. A 33 years-old male patient was referred to Department of Oral and Maxillofacial Surgery at the Erasto Gaertner Hospital with a lesion on anterior maxillary gingiva, with 3-months evolution period. The patient had complete permanent dentition and good oral hygiene. The gingival hyperplasia involved the gums of teeth 11 and 12, and was solitary, asymptomatic, red, flaccid and bleeding on palpation. No palpable lymph nodes were found. An incisional biopsy was performed, with anatomopathological result of "squamous mucosa with pseudoepitheliomatous hyperplasia and lymphoplasmocytic infiltrate with neutrophils". The lesion was fully excised and the anatomopathological report confirmed the biopsy showing no malignancy in the sample and negative for the investigation of fungus. Biofilm control, mouth rinses with hydrogen peroxide, Chlorhexidine Digluconate 0.12% and Amoxicilin 500mg+Potassium Clavulanate 125mg have not demonstrated efficacy, and the patient kept showing recurrence of the lesion in short time even after the complete excision. Against this situation, the patient was referred to an infectologist, by the suspicion of a resistant microorganism. He started antibacterial therapy with Sulfamethoxazole 800mg+Trimethoprim 160mg that showed good results after 3 months. Currently, the patient remains in follow-up without signs of recurrence. LJSGH is a clinicopathological benign entity that appears in young patients as a soft, bleeding and reddish mass, mainly in the buccal gingiva of the upper anterior maxilla and lonely in most cases. The management of this condition is very difficult because of the few cases described in literature, and establishing the correct diagnosis is essential to ensure that the appropriate treatment is followed. (AU)

Risk factors for medication-related osteonecrosis of the jaw and salivary IL-6 IN cancer patients / Fatores de risco para osteonecrose dos maxilares relacionada à medicação e níveis salivares de IL-6 em pacientes com câncer

Abstract Introduction Medication-related osteonecrosis of the jaws is a severe complication of the use of antiresorptive and antiangiogenic therapy, with limited treatment options and great impact on patient's quality pf life. Objective The aim of this study was to assess the risk factors associated with medication-related osteonecrosis of the jaws in oncologic patients undergoing bisphosphonate treatment. In addition, salivary levels of interleukin-6, IL-6, were measured to investigate their association with severity and risk of medication-related osteonecrosis of the jaws. Methods Case-control study with 74 patients with bone metastases from solid tumors and multiple myeloma was included. Patients were divided into three groups: 1) those undergoing bisphosphonate treatment with medication-related osteonecrosis of the jaws; 2) those undergoing bisphosphonate without medication-related osteonecrosis of the jaws; and 3) those with bisphosphonate pretreatment. The demographic and medical data of the patients were collected to assess risk. The clinical evaluation was performed to diagnose medication-related osteonecrosis of the jaws and unstimulated saliva was collected for quantification of IL-6. Results As result, it was observed that patients diagnosed with medication-related osteonecrosis of the jaws were submitted to higher number of bisphosphonate doses (p= 0.001) and monthly infusion protocol (p= 0.044; OR = 7.75). Patients who did not have routine followup with specialized dentists during therapy with bisphosphonate and smoking were associated with medication-related osteonecrosis of the jaws (p= 0.019; OR = 8.25 and p= 0.031; OR = 9.37 respectively). Group 1 had a higher frequency of treatment with chemotherapy and corticosteroids concomitant with bisphosphonate, and surgical dental procedures (p= 0.129). Salivary IL-6 levels showed no statistically significant difference between the groups (p= 0.571) or association with medication-related osteonecrosis of the jaws severity (p= 0.923). Conclusion A higher number of bisphosphonate cycles, monthly infusion protocol, no dental follow-up for oral health maintenance and smoking were associated with medication-related osteonecrosis of the jaws. Specialized dental follow up during bisphosphonate treatment has been shown to be an important factor in preventing this complication.

Resumo Introdução A osteonecrose dos maxilares relacionada à medicação é uma complicação grave da terapia antirreabsortiva e antiangiogênica, com opção de tratamento limitada e grande impacto na qualidade de vida do paciente. Objetivo Avaliar os fatores de risco associados à osteonecrose dos maxilares relacionada à medicação em pacientes oncológicos em tratamento com bifosfonato Além disso, os níveis salivares de interleucina-6 (IL-6) foram medidos para investigar sua associação com a gravidade e o risco de osteonecrose dos maxilares relacionada à medicação. Método Estudo caso-controle com 74 pacientes com metástases ósseas de tumores sólidos e mieloma múltiplo. Os pacientes foram divididos em três grupos: 1) em tratamento por bifosfonato com osteonecrose dos maxilares relacionada à medicação; 2) submetidos ao bifosfonato sem osteonecrose dos maxilares relacionada à medicação; e 3) pré-tratamento de bifosfonato. Os dados demográficos e médicos dos pacientes foram coletados para avaliar o risco. A avaliação clínica foi feita para diagnosticar osteonecrose dos maxilares relacionada à medicação e a saliva não estimulada foi coletada para quantificação da IL-6. Resultados Observou-se que os pacientes diagnosticados com osteonecrose dos maxilares relacionada à medicação foram submetidos a maior número de doses de bifosfonato (p = 0,001) e protocolo de infusão mensal (p = 0,044; OR = 7,75). Pacientes que não tiveram acompanhamento de rotina com dentistas especializados durante a terapia com bifosfonato e tabagismo foram associados ao osteonecrose dos maxilares relacionada à medicação (p = 0,019; OR = 8,25 e p = 0,031; OR = 9,37, respectivamente). O grupo 1 apresentou maior frequência de tratamento com quimioterapia e corticosteroides concomitantes ao bifosfonato e procedimentos odontológicos cirúrgicos (p = 0,129). Os níveis salivares de IL-6 não apresentaram diferença estatisticamente significante entre os grupos (p = 0,571) ou associação com a gravidade do osteonecrose dos maxilares relacionada à medicação (p = 0,923). Conclusão Maior número de ciclos de bifosfonato, protocolo de infusão mensal, ausência de acompanhamento odontológico para manutenção da saúde bucal e tabagismo foram associados ao osteonecrose dos maxilares relacionada à medicação. O acompanhamento odontológico especializado durante o tratamento demonstrou ser importante na prevenção dessa complicação.

Epithelial-mesenchymal markers and their correlation with clinical aspects in odontogenic keratocysts / Marcadores epitélio-mesênquima e sua correlação com aspectos clínicos em lesões de ceratocisto odontogênico

ABSTRACT Objective: Odontogenic keratocysts have a high recurrence rate and aggressive clinical behavior. The event called epithelial-mesenchymal transition is a process in which the epithelial cell loses its epithelial characteristics and acquires properties typical of mesenchymal cells. Studies have already demonstrated that odontogenic keratocysts has expression of tumor markers, but the lack of clarification about its development mechanism and molecular composition makes the therapeutic options remain limited. The aim of this study is to evaluate the expression of epithelial-mesenchymal transition marker proteins in these lesions, correlating the expression of these proteins with clinical aspects of each case. Methods: Patients with odontogenic keratocysts diagnoses, treated by the Department of Oral and Maxillofacial Surgery of the Erasto Gaertner Hospital, Curitiba, Brazil in the period between 2016 and 2019 were evaluated by immunohistochemical analysis, to assess the expression of epithelial-mesenchymal transition markers (Vimentin, beta-catenin and E-cadherin) by qualitative analysis. Results: Eighteen patients were included, with a mean age of 43 years, and most of them were male. The mandible was more affected than the maxilla. No association between the clinical characteristics of the cysts and the immunohistochemical profile for epithelial-mesenchymal transition proteins was observed. Conclusion: The positivity of E-cadherin and negativity of vimentin demonstrates that its function is preserved. Loss of function of E-cadherin is associated with worse prognosis. The identification of the epithelial-mesenchymal transition process as a prognostic marker for odontogenic cysts and tumors could be an important tool for defining treatment.

RESUMO Objetivo: O ceratocisto odontogênico têm uma alta taxa de recorrência e comportamento clínico agressivo. O evento chamado transição epitelial-mesênquima (TEM) é um processo no qual a célula epitelial perde suas características epiteliais e adquire propriedades típicas das células mesenquimais. Estudos já demonstraram que o ceratocisto odontogênico tem expressão de marcadores tumorais, mas a falta de esclarecimento sobre seu mecanismo de desenvolvimento e composição molecular faz com que as opções terapêuticas permaneçam limitadas. O objetivo deste estudo é avaliar a expressão das proteínas marcadoras de transição epitelial-mesênquima nestas lesões, correlacionando a expressão destas proteínas com os aspectos clínicos de cada caso. Métodos: Os pacientes com diagnóstico de ceratocisto odontogênico, tratados pelo Serviço de Cirurgia Bucomaxilofacial do Hospital Erasto Gaertner, Curitiba, Brasil, no período entre 2016 e 2019, foram avaliados por análise imunohistoquímica, para avaliar a expressão dos marcadores transição epitelial-mesênquima (Vimentina, beta-catenina e E-cadherina). Resultados: Foram incluídos 18 pacientes, com idade média de 43 anos, e a maioria deles eram do sexo masculino. A mandíbula foi mais afetada do que a maxila. Não foi observada associação entre as características clínicas dos cistos e o perfil imuno-histoquímico das proteínas transição epitelial-mesênquima. Conclusão: A positividade da E-caderina e a negatividade da vimentina demonstram que a sua função está preservada. A perda da função da E-caderina está associada a um pior prognóstico. Identificar o processo da transição epitelial-mesênquima como um marcador de prognóstico para cistos e tumores odontogênicos pode ser uma ferramenta importante para definir o tratamento dessas lesões.

How can the dental surgeon promote oral health in patients submitted to chemotherapy? / Como o cirurgião dentista pode promover saúde bucal em pacientes submetidos à quimioterapia?

Lesions that affect the oral cavity resulting from chemotherapy can lead to systemic impairment, increasing the length of hospital stay, impairing the patient's quality of life. Through a integrative review, this work aims to show the conduct and importance of dentists in promoting oral health and preventing an oral infectious focus. The search was performed in the Pubmed, Cochrone, SciElo and Virtual Health Library (VHL) databases, using the descriptors in English, oral care and Chemotherapy and Cancer treatment and dentistry, filtering only articles in English and published between 2006 and 2021. The search located six hundred and twenty articles, but only seven met the search criteria. One author used a mouthwash containing propolis where 65% of patients were cured on the seventh day after the onset of oral mucositis (OM) lesions. One author used cryotherapy with chamomile infusion, patients who underwent this approach did not pass grade I, being effective in reducing the occurrence of OM, and the other two authors proposed a protocol for oral cavity care. All authors obtained satisfactory results.(AU)

As lesões que acometem a cavidade oral decorrente ao tratamento quimioterápico podem levar a um comprometimento sistêmico aumentando o tempo de internação hospitalar, prejudicando a qualidade de vida do paciente. O foco principal do cirurgião-dentista é identificar e remover fontes de infecção na cavidade oral antes do início da quimioterapia, controlar as possíveis lesões durante o tratamento. Após o tratamento quimioterápico, o paciente retornará para os cuidados dentários gerais, proporcionando manutenção da saúde bucal e prevenção de complicações ao longo prazo do tratamento do câncer. Através de uma revisão integrativa o objetivo desse trabalho é mostrar a conduta e a importância do cirurgião-dentista para promover saúde bucal e prevenir um foco infeccioso oral. A busca foi realizada nas bases de dados Pubmed, Cochrone, SciElo e Biblioteca virtual em saúde (BVS), foram utilizados os descritores em inglês, oral care and Chemotherapy and Cancer treatment and dentistry, filtrando somente os artigos na língua inglesa, estudos com seres humanos e os artigos publicados no intervalo de 2006-2021. A busca com os descritores citados encontrou seiscentos e vinte artigos, entretanto somente sete estavam dentro dos critérios da pesquisa. Um autor utilizou bochecho de própolis, outro crioterapia com infusão de camomila e os outros dois propuseram protocolo de cuidados com a cavidade oral. Todos os autores obtiveram resultados satisfatórios. (AU)

Ocupações relacionadas ao câncer de cabeça e pescoço em uma cidade do Sul do Brasil, 1998 a 2012 / Occupations associated with head and neck cancer in a city in Southern Brazil, 1998 to 2012

INTRODUÇÃO: O câncer é uma doença multifatorial e depende de múltiplas etapas. A redução da incidência ou a modificação da evolução da doença se dão pela eliminação dos fatores de risco associados ao câncer. A identificação de fatores de risco para o desenvolvimento de câncer de cabeça e pescoço associados à ocupação profissional pode complementar ações de vigilância desse tipo de câncer e também favorecer a implantação de medidas preventivas nos ambientes de trabalho. OBJETIVO: Identificar as ocupações de pacientes com câncer de cavidade oral (CCO) e de orofaringe (COF) na cidade de Curitiba, Paraná. MÉTODO: Foi realizado um estudo transversal que avaliou 896 casos de CCO e COF a partir do Registro de Câncer de Base Populacional, entre 1998 e 2012. As ocupações coletadas foram classificadas em quatro grupos baseados no grau de risco definido pelo Ministério do Trabalho e foi analisado o consumo de álcool e tabaco pelos pacientes. RESULTADOS: Os grupos ocupacionais associados aos serviços de limpeza e construção, setor administrativo, agricultura e transportes mantiveram as maiores frequências. O grau de risco 3 concentrou o maior número de casos, com 55,2% do total, atingindo 65,5% quando foram avaliados indivíduos com história de consumo de tabaco e álcool. Comércio, construção, limpeza e serviços mecânicos tiveram o maior número de CCO e COF no município estudado. CONCLUSÃO: Foram encontradas 131 ocupações na amostra estuda, sendo a maior concentração observada no grupo de risco 3. Dessa forma, entende-se que o risco ocupacional deve ser levado em consideração no planejamento de ações preventivas da doença

BACKGROUND: Cancer is a multifactorial disease and depends on multiple stages. Eliminating risk factors contributes to reduce the incidence of disease or modifies its progression. Identifying risk factors for head and neck cancer associated with definite occupations might complement surveillance actions and help in the implementation of preventive measures in the workplace. OBJECTIVE: To identify the occupations of patients with oral cavity (OCC) or oropharyngeal (OPC) cancer in Curitiba, Parana, Brazil. METHODS: Cross-sectional study in which we analyzed 896 cases of OCC and OPC based on the Population-based Cancer Registry, 1998­2012. The located occupations were categorized in four risk groups following the classification formulated by the Ministry of Labor. We also analyzed variables smoking and alcohol consumption. RESULTS: The highest rates of oral cancer corresponded to occupations associated with cleaning, construction, administration, agriculture and transport. Most occupations, 52.2%, were categorized as risk grade 3. This rate increased to 65.5% when smoking and alcohol consumption were included in analysis. Workers in trade, construction, cleaning services and mechanics accounted for the largest number of OCC and OPC cases in the analyzed municipality. CONCLUSION: We found 131 occupations associated with cases of oral cancer, most of which were categorized as risk grade 3. In consequence, occupational risk should be considered in the planning of preventive actions.

Medication-related osteonecrosis of the jaw, osteoradionecrosis, and osteomyelitis: A comparative histopathological study

Abstract It is largely known that some oral diseases can be diagnosed based upon their clinical manifestation combined with the patient's medical history and generally not depending on examination. This is the case of some bone diseases such as osteoradionecrosis of the jaw (ORNJ), osteomyelitis of the jaw (OMJ), and medication-related osteonecrosis of the jaw (MRONJ). The present study aimed to analyze the histopathological features of these specific bone diseases in order to evaluate similarities and differences. Forty-four bone specimens resected from each bone disease (22 cases of ORNJ, 6 cases of OMJ, and 16 cases of MRONJ) were analyzed by two experienced oral pathologists without prior knowledge of the diagnosis, considering bone tissue condition, inflammation, vascularization, and the presence of microorganisms. In addition, the examiners formulated a diagnostic hypothesis for each specimen. Many histopathological similarities were found among the diseases, especially considering the presence of necrotic bone, inflammation, and microorganisms. Statistically significant differences were detected in empty bone lacunae, which was decreased in ORN (p = 0.042), and considering neutrophil count, which was low in the MRONJ group (p ≤ 0.001). The Kappa coefficient was calculated and agreement was detected based on the histopathological parameters, but not for diagnostic suggestion (p=0.23). In conclusion, histopathological aspects of ORNJ, OMJ, and MRONJ do not permit a conclusive diagnosis, emphasizing the necessity of a detailed clinical report.

Impaction of primary tooth molar in mandibule ­ case report / Primeiro molar decíduo impactado em mandíbula - relato de caso

Tooth impaction results from a mechanical blocking that prevents the tooth from erupt. This situation is frequently associated to permanent tooth as wisdom teeth and canines. Impaction of a primary tooth can be associated to systemic or local etiologic factors. Treatment options could include dental extraction, removal of lesion associated without removing the primary tooth and others. The aim of this article is to present a rare case report of an impacted primary tooth in a 42 yearold man, with no complain of swelling. Extra oral examination revealed no alteration of normality. The panoramic radiograph showed a primary tooth impacted in the left body of the mandible. Most of the time the cause for non-eruption of primary tooth is the presence of a mechanical obstacle, not anatomical, in its trajectory. The surgical intervention is a possibility, but it can stay unaltered with no problems related to the impacted tooth. Many times the professional experience and the activity together in various areas of knowledge are the most important and wise conduct to be taken in health care.(AU)

A impactação dental resulta de um bloqueio mecânico que impede o dente de erupcionar. Esta situação está frequentemente associada à dentes permanentes como os terceiros molares e os caninos. Impactação de um dente decíduo pode estar associada a fatores sistêmicos ou locais. Opções de tratamento podem incluir extração dental, remoção da lesão associada sem remoção do dente decíduo, entre outros. O objetivo deste artigo é apresentar um raro relato de caso de um dente decíduo impactado em um paciente do gênero masculino, 42 anos de idade, sem queixas de inchaço. A avaliação extra-bucal não mostrou alterações de normalidade. A radiografia panorâmica evidenciou um dente decíduo impactado em corpo de mandíbula, lado esquerdo. Na maioria dos casos a causa para não erupção de um dente decíduo é a presença de um obstáculo mecânico, não anatômico, em sua trajetória de erupção. A intervenção cirúrgica é uma possibilidade, mas pode permanecer inalterada sem problemas relacionados ao dente impactado. Em muitos casos a experiência profissional e a atividade em conjunto com várias áreas do conhecimento são as condutas mais importantes e sábias a serem tomadas no cuidado em saúde.(AU)

Bilateral maxillary osteoplasty with esthetic purpose in patient with secondary hyperparathyroidism-related brown tumor: case report

Introduction and Objective: To report a case of a patient with secondary hyperparathyroidism that developed brown tumour in bilateral maxilla surgically managed with bilateral osteoplasty for aesthetic reasons. Case report: A 46 years-old woman patient with chronic kidney disease with complain of a painless bilateral growth on the maxilla, beginning 10 years before that ceased after surgical removal of the parathyroid eight years before. A CT scan showed a diffuse and heterogeneous bone lesion, with lytic areas and increased multilobulated volume on the maxilla, bilaterally. The surgery was an osteoplasty of the maxilla bone and performed under general anaesthesia. At 16-month follow-up, no recurrence was observed and the patient is satisfied with aesthetic and functional results. Conclusion: Secondary hyperparathyroidism related with oral brown tumour is a rare condition that affects function and aesthetic. The case reported in this paper was appropriately managed, achieving patient expectation and improving her life quality.

Non-familial Cherubism – Report of a case / Querubim não familiar - Relatório de caso

The Cherubism is a rare disease that affects the middle and lower third of the facein individuals at the time of childhood. It is a rarehereditary benign bone disease with an autosomal dominant inheritance. The familial distribution may affect different generations and isolated nonfamilial cases have also been reported in literature. Lesions appear as cystic multilocular radiolucencies, histologically, they resemble central giant cell granluloma and hyperpara thyroidism brown tumorwith numerous randomly distributed multinuclea tedgiant cells and vascular spaces within a fibrous connective tissue stroma. Objective: The aim of this study is to report the importance of the diagnosis of this pathology and the variety of treatments availablein the literature, thus guiding to an individualized treatment. Case Report: Caucasian 8 years-oldfemale, in good general condition, was referred to Service of Oral and Maxillofacial Surgery of Erasto Gaertner Hospital (EGH), Curitiba – PR, Brazil, complaining of bilateral swelling of the maxilla and mandible since 4 years-old. Apparently, the girl isthe first one who developed the genetic pathologyin at least 4 generations of her family. After biopsy, cherubism diagnosis was confirmed and the treatment of choice was periodic monitoring. Discussion: Cherubism studies with long-term follow-up with clinical and radiographic documentation indicate that the spontaneous resolution of bone lesions israre. Treatment of cherubism is controversial and various modalities have been reported as the use of calcitonin, osseous plasty surgery, curettage, orthognathic surgery, liposuction and palliative treatments. Conclusion: cherubism is a rarecondition that affects individuals in childhood that lead to some facial alterations, those patients need an special care and an well trained team to treat these disease more carefully and wisely noting that exist a series of option of new treatments in this cases...

Introdução: O Querubismo é uma doença rara que afeta o terço médio e inferior da face em indivíduos no momento da infância. É uma doença óssea hereditária benigna com herança autossômica dominante sendo que a distribuição familial pode afetar diferentes gerações, todavia casos não-familiares isolados também foram relatados na literatura. As lesões apresentam se radiograficamente como cistos multiloculados radiolúcidos e histologicamente se assemelham ao granuloma central de células gigantes e ao tumor marrom do hiper paratireoidismo com numerosas células gigantes multinucleadas distribuídos aleatoriamente e espaços vasculares dentro de um estroma de tecido conjuntivo fibroso. Objetivos: O objetivo deste estudo é relatar a importância do diagnóstico desta patologia e da variedade de tratamentos disponíveis na literatura, orientando dessa maneira a um tratamento individualizado. Relato de Caso: Mulher, caucasiana, 8 anos de idade, em bom estado geral. Foi encaminhada ao Serviço de Cirurgia Bucomaxilofacial do Hospital Erasto Gaertner (EGH), Curitiba - PR, Brasil, com queixa de inchaço bilateral da maxila e da mandíbula desde os 4 anos de idade. Em avaliação notou-se que menina é a primeira pessoa que desenvolveu a patologia empelo menos quatro gerações de sua família. Após biópsia o diagnóstico de cherubism foi confirmado e o tratamento de escolha foi a monitorização periódica. Discussão: estudos de cherubism a longo prazo de follow-up com documentação clínica e radiográficas indicam que a resolução espontânea das lesões ósseas são raras. O tratamento do cherubism é controverso e diversas modalidades têm sido relatados como o uso de calcitonina, a cirurgia de plastia óssea, curetagem cirurgia ortognática, lipoaspiração e tratamentos paliativos...

Myiasis in maxillofacial region: series of three cases

Introduction: Myiasis is a disease caused by larvae of flies in organs and tissues of man or other vertebrate animals, where they install and evolve as parasites. The human myiasis is common in tropical countries, most frequently affecting rural people, immunocompromised patients and those with psychiatric disorders. It has great destructive potential and needs adequate prevention and treatment for resolution or non-occurrence of this manifestation. Objective: This paper aims to report a series of three cases of patients with presence of myiasis in face: 1) firearm injury postoperative complication in the mandible in a drug user patient; 2) wound after trauma in the region of the upper lip in a patient using illicit drugs; and 3) complication due to poor oral hygiene of a patient with neurological and motor deficits. Case report: The care required by these patients is different because this complication is easily prevented by basic and personal health care, although it represents a complicating factor for surgical procedures and/or dental care. Conclusion: The role of health professionals in patients with special needs and/or drug addiction become sometimes a challenge for dental practice, requiring individualized attention to each patient.

Brazilian minipig as a large-animal model for basic research and stem cell-based tissue engineering. Characterization and in vitro differentiation of bone marrow-derived mesenchymal stem cells

Stem cell-based regenerative medicine is one of the most intensively researched medical issues. Pre-clinical studies in a large-animal model, especially in swine or miniature pigs, are highly relevant to human applications. Mesenchymal stem cells (MSCs) have been isolated and expanded from different sources. Objective: This study aimed at isolating and characterizing, for the first time, bone marrow-derived MSCs (BM-MSCs) from a Brazilian minipig (BR1). Also, this aimed to validate a new large-animal model for stem cell-based tissue engineering. Material and Methods: Bone marrow (BM) was aspirated from the posterior iliac crest of twelve adult male BR1 under general anesthesia. MSCs were selected by plastic-adherence as originally described by Friedenstein. Cell morphology, surface marker expression, and cellular differentiation were examined. The immunophenotypic profile was determined by flow cytometry. The differentiation potential was assessed by cytological staining and by RT-PCR. Results: MSCs were present in all minipig BM samples. These cells showed fibroblastic morphology and were positive for the surface markers CD90 (88.6%), CD29 (89.8%), CD44 (86.9%) and negative for CD34 (1.61%), CD45 (1.83%), CD14 (1.77%) and MHC-II (2.69%). MSCs were differentiated into adipocytes, osteoblasts, and chondroblasts as demonstrated by the presence of lipidic-rich vacuoles, the mineralized extracellular matrix, and the great presence of glycosaminoglycans, respectively. The higher gene expression of adipocyte fatty-acid binding protein (AP2), alkaline phosphatase (ALP) and collagen type 2 (COLII) also confirmed the trilineage differentiation (p<0.001, p<0.001, p=0.031; respectively). Conclusions: The isolation, cultivation, and differentiation of BM-MSCs from BR1 makes this animal eligible as a useful large-animal model for stem cell-based studies in Brazil. .

Hiperplasia adenomatoide de glândulas salivares menores: relato de dois casos / Adenomatoid hyperplasia of minor salivary glands: a report of two cases

A hiperplasia adenomatoide de glândulas salivares menores é uma lesão benigna rara que pode ser confundida com outras neoplasias de glândulas salivares. Apresenta-se como um pequeno nódulo firme ou como massa exofítica, geralmente indolor, com mucosa de aparência normal, levemente avermelhada ou azul. Histologicamente, observa-se a presença de agregados acinares relativamente normais e lóbulos da mucosa em maiores quantidades, causando aumento do volume e, por vezes, dor. Relato do caso: São relatatos dois casos de hiperplasia adenomatoide de glândula salivar menor, sendo um em menino de 12 anos de idade, em mucosa bucal esquerda, e o outro em mulher de 44 anos de idade em mucosa labial; uma revisão dos relatos anteriores já descritos na literatura também é apresentada. O aparecimento clínico do tumor é indistinguível em comparação com neoplasia da glândula salivar; assim, o exame patológico é essencial para o diagnóstico definitivo desta patologia. Nos dois casos descritos, o tratamento escolhido foi o acompanhamento clínico após diagnóstico; não foram observadas alterações no período de 2 anos desde a primeira consulta...

Adenomatoid hyperplasia of minor salivary glands is a rare benign lesion that can be mistakenly diagnosed as other types of salivary gland neoplasms. It presents as a small firm nodule or as an exophytic mass, usually painless with normal mucosa, and slightly red or blue. Histologically, aggregates of relatively normal acinar lobule mucosa can be seen in larger amounts than expected, causing increased volume and sometimes pain. Case report: This article describes two cases of adenomatoid hyperplasia of minor salivary glands, the first in the left buccal mucosa of a 12 year-old boy and the second in the labial mucosa of a 44 year-old woman, and a review of previous reports of this pathology in English literature. The clinical appearance of the tumor is indistinguishable from salivary gland neoplasms and pathological examination is therefore essential for definitive diagnosis of this pathology. In both cases the treatment chosen after diagnosis was follow up and no changes were observed over 2 years from the first appointment...

Prevalence of oral lesions in 25 years of Oral Cancer Prevention campaigns in Paraná State, Brazil, 1988 to 2013

Introduction: Epidemiological studies add up as a large area of scientific research and play an important role revealing the prevalence of the several diseases in the place where they applied. Public and health professionals have become more aware of the importance of oral mucosal lesions. Objective: To determine the frequency of the oral lesions and determinate the epidemiological profile of patients attending the prevention of oral cancer campaigns in the state of Paraná, Brazil, between 1988 and 2013. Material and methods: A prospective study was conducted evaluating 25 years of oral cancer prevention campaigns in the state of Paraná, Brazil, between 1988 and 2013. All patients were evaluated in a systematic way and were older than 30 years, answering one questionnaire with data relating to harmful health habits, family history of cancer, family income, frequency of visits to dentists and knowledge on the subject. Results: A total of 22,300 patients were evaluated during the 25 years of projects and 3,731 had oral lesions, while 18,569 patients had no oral alterations during the evaluation. Among those patients, 13779 (61.78%) were female and 8521 (38.78%) were male, 843 (22.59%) were smokers, 578 (15.49%) used alcohol and in 1386 (37.14%) had the habit of using yerba mate. The prevalence of lesions occurred as follows: 533 (14.28%) cases of lesions with aspect of leukoplakia, 1095 (29.34%) inflammatory lesions, 1934 (51.83%) of traumatic origin and 169 (4 5%) classified as other. Conclusion: The campaigns have brought benefits to the health of the elderly population but it is still not enough to make up for low levels of oral lesions appearance. Education of the population should in this way be approached more seriously and effectively.

Unilateral Gingival Fibromatosis: a case report / Fibromatose Gengival Unilateral: um relato de caso

The gingival fibromatosis is a slow and progressive benign proliferation, which affects the gingival tissues. It may present a genetic inheritance and association with some syndromes. There are conservative and radical treatments, ranging from hygiene care to bloc resection of the affected bone. This case scenario is a 07 year-old child, who presented a nodular unilateral hyperplastic lesion in the right mandible, with sessile base and approximately 5 cm in its largest diameter. The patient presented difficulty of lip closure and slight swelling in the right area of the face. The tomographic image showed infiltration in buccal and lingual cortical of right mandible and tooth displacement. After lesion removal, the histopathologic diagnosis of fibromatosis was confirmed, with no relapse after 20 months of follow-up.

A Fibromatose Gengival é uma proliferação benigna, lenta e progressiva, que afeta os tecidos gengivais. Pode apresentar herança genética e associação à uma série de síndromes. Existem tratamentos conservadores e radicais, desde cuidados com higiene à ressecção em bloco do tecido ósseo afetado. Este é o caso clínico de uma criança, que apresentou lesão hiperplásica unilateral em mandíbula, com deslocamento dentário. Após remoção, o diagnóstico de hiperplasia gengival foi confirmado e não há recidiva da lesão até o momento.

Large desmoplastic fibroma: case report using microvascularized fibula graft for reconstruction / Fibroma desmoplásico de grandes proporções: relato de caso usando enxerto microvascularizado de fibula para reconstrução

The Desmoplastic Fibroma is a benign rare tumor of fibroblastic origin, representing only 0.03% of benign bone tumors. Displays aggressive behavior and high rates of recurrence, which makes the treatment more aggressive. The authors present a case of an 11 years-old female, complaining of increased volume in the jaw. The patient had an extensive swelling of the left mandibular body with invasion of the border of the tongue and floor of the mouth at the same side. She had a history of 4 recurrences at the same site. Image exams revealed expansive lesion in body and ramus of the mandible with involvement of soft tissue on the lingual side of the lesion. The treatment was excision of the lesion with extra oral access and reconstruction with microvascularized fibula graft. The patient has been followed for 2 years with no clinical or radiographic signs and without recurrence

O Fibroma Desmoplásico é um tumor benigno raro de origem fibroblástica que representa apenas 0,03% dos tumores ósseos benignos. Apresenta comportamento agressivo e elevadas taxas de recorrência, o que torna o seu tratamento mais agressivo. Os autores apresentam um relato de caso de uma paciente do sexo feminino de 11 anos de idade com queixa de aumento de volume em mandíbula. A mesma apresentou extensa expansão do corpo mandibular esquerdo, com invasão da borda da língua e assoalho da boca do mesmo lado, com histórico de quatro recorrências na mesma localização. Os exames de imagem revelaram lesão expansiva no corpo e ramo da mandíbula com envolvimento dos tecidos moles do lado lingual da lesão. O tratamento foi a excisão da lesão com acesso extra-oral e reconstrução com enxerto microvascularizado de fíbula. A paciente apresenta seguimento de 2 anos sem sinais clínicos ou radiográficos de recidiva.

Prevalence of oral lesions in elderly patients on oral cancer prevention campaigns in Paraná state Brazil 1989-2013 / Prevalência de lesões orais em pacientes idosos atendidos em campanhas de prevenção de câncer bucal no estado do Paraná, Brasil entre 1989 - 2013

Objective: recently, there has been a rapid aging process of the world population. Despite of a longer permanence of natural teeth and a reduction of oral diseases caused by the improvement of life conditions and the provision of health care, the prevalence of oral diseases in the elderly is still considered significant. Therefore, the aim of this study is to evaluate the epidemiological profile of elderly patients (above 60 years old) attended in 25 years of campaigns oral cancer prevention in the Paraná state, Brazil, between 1989 and 2013. Material and Methods: Patients, volunteers, were evaluated during 25 years of oral cancer prevention by the campaign team and all patients were evaluated in a methodical way with inspection of all intra-oral areas. Results: a total of 22,909 patients were attended during the 25 years of projects. Of these, 6,134 were older than 60 years old, with appearance of 1,523 oral lesions during the examination and 4,611 patients had no oral alterations during the dentist evaluation, among those were found injuries by traumatic origin, inflammatory lesions and others types of injury. Conclusion: it is clear the necessity for specialized care and active surveillance of these patients, since it is a consensus in the literature that the best treatment is early diagnosis. It is also necessary the development of epidemiological studies of the elderly population, which are scarce and difficult to elaboration of plans for effective action to meet the specific demands of this age group.

Objetivo: a população mundial atualmente sofre com um rápido processo de envelhecimento. Apesar de uma maior permanência dos dentes naturais e da redução de doenças bucais causadas pela melhoria das condições de vida e da prestação de cuidados de saúde, a prevalência de doenças bucais em idosos ainda é considerado significativa. Portanto, o objetivo deste estudo é avaliar o perfil epidemiológico dos pacientes idosos (acima de 60 anos) que foram atendidos em 25 anos de campanhas de prevenção do câncer de boca no estado do Paraná, Brasil, entre 1989 e 2013. Material e Métodos: Os pacientes foram selecionados voluntariamente e avaliados durante 25 anos de prevenção de câncer bucal pela equipe participante, os quais foram avaliados de forma metódica com a inspeção de todas as áreas intra-orais. Resultados: um total de 22.909 pacientes foram atendidos durante os 25 anos de projetos. Destes, 6.134 tinham mais de 60 anos, com presença de 1.523 pacientes com lesões orais durante o exame e 4.611 pacientes sem alterações orais durante a avaliação do dentista. As lesões encontradas tinham origem traumática, inflamatórias e outras. Conclusão: é evidente a necessidade de atendimento especializado e da busca ativa desses pacientes, uma vez que é um consenso na literatura de que o melhor tratamento de lesões orais é o diagnóstico precoce. Também é necessário o desenvolvimento de estudos epidemiológicos da população idosa, que são escassos e difíceis de elaboração assim como a realização de planos de ação eficazes para atender às demandas específicas desta faixa etária.

Implications of the use of bisphosphonates in dental treatment - experience of the service of oral and maxillofacial surgery, Erasto Gaertner Hospital, Curitiba, Brazil

Introduction: Bisphosphonates (BP) are effective drugs in the prevention and treatment of various bone pathologies, acting in the regulation of osteoclast function through different mechanisms. Despite the success in the treatment of various diseases, these drugs have the ability to induce an avascular necrosis of bone tissue, especially in the maxilla and mandible. Objective: Due the significant increase number of cases of patients with oral complications associated with BP therapy in the Department of Oral and Maxillofacial Surgery of the Erasto Gaertner Hospital, the study aimed to report our experience in the care of these patients. Material and methods: Patients submitted to BP therapy were enrolled prospectively between the years of 2011 and 2012. Clinical examination was performed in all patients to evaluate dental health as well oral mucosa. All patients are under follow-up in our service. Results: 26 patients who used BP were attended in the ambulatory. Twenty-three patients used BP for oncological indication and three for osteoporosis. Most of patients were women (6666%) with average age of 56 years old. The most frequent medication used was Pamidronate (54%), followed by Zoledronic acid (30%) and Alendronate (15%). Ten patients showed bone exposition, most of then in the mandible (80%), with an average time of one year of exposure. Conclusion: Dentists should advise their patients about the use of BP and the implications for oral health and treatments. These patients must have periodic consultations for evaluation and early detection of osteonecrosis associated to BP for adequate treatment.

Effect of fractionated radiotherapy on the parotid gland: an experimental study in brazilian minipigs

INTRODUCTION: Radiotherapy (RT) of head and neck neoplasms often damages the salivary glands. AIM: To examine the pattern of morphologic changes resulting from RT of the head and neck region in minipig parotid glands in a clinical and experimental research setting. METHODS: Twelve 18-month-old male Brazilian minipigs weighing 30-40 kg were selected. Eight minipigs were assigned to the experimental group (group 1) and 4 to the control group (group 2). The RT was performed under general anesthesia at Erasto Gaertner Hospital, Curitiba, Brazil, using an á/â ratio of 2.5. The minipigs from group 1 underwent 3 sessions of irradiation with Cobalt 60 of the head and neck, bilaterally, with 3 exposures of 8 Gy each at 7-day intervals for a total dose of 24 Gy. The animals were sacrificed 12 weeks post-RT. RESULTS: The irradiated parotid glands displayed reductions in the size and number of acini as well as loss of secretory granules. The presence of fibrosis and loss of parenchyma relative to non-irradiated glands were observed, with an average reduction in volume of 54%. CONCLUSIONS: Our results demonstrate that this model for parotid gland damage resulting from an RT regimen appears to be useful for preclinical large animal studies of RT-induced damage and testing novel potential treatment options. Although recent advances in radiation therapy, such as intensity-modulated radiation therapy, have reduced the dose and limited the field of radiation, considerable salivary gland injury still occurs and can greatly impact the patient's quality of life after cancer treatment.

Osteoma de mandíbula: relato de caso / Osteoma of the mandible: a case report

Osteomas são tumores de crescimento ósseo benigno, que se apresentam sob a forma periosteal ou endosteal e acometem comumente os ossos do esqueleto craniofacial, sendo raramente encontrados em outras partes do corpo. Quando presentes, frequentemente são encontrados na mandíbula, maxila, nos seios paranasais e no osso frontal. São neoplasias de crescimento lento, geralmente assintomáticas, que podem se desenvolver em osso esponjoso ou compacto. O osteoma periférico apresenta-se, geralmente, como um tumor solitário, unilateral, encontrado mais frequentemente no corpo da mandíbula. Neste artigo, é descrito um relato de caso de um osteoma periférico em uma paciente do sexo feminino, na oitava década de vida, sintomático, localizado em corpo mandibular, com 10 anos de evolução.

Osteomas are benign tumors of growing bone that present in a periosteal or endosteal form and commonly affect the craniofacial skeleton bones, being rarely found in other parts of the body. When present, they are often found in the mandible, maxilla, frontal bone and paranasal sinuses. They are slow-growing neoplasms, usually asymptomatic, which can develop in compact or cancellous bone. The peripheral osteoma usually presents as a solitary unilateral tumor, most often found in the body of the mandible. This paper presents a case report of a peripheral osteoma located in the mandibular body in a symptomatic female patient in her eighth decade of life with ten years of progression.

Survey on jaw fractures occurring due to domestic violence against women

Introduction: Violence against women has become a public health problem, and the dentist is the main responsible for the treatment of their victims, since numerous cases with a high incidence of impaired maxillomandibular complex occurred. Objective: The aim of this study was to analyze the prevalence and evolution of jaw fractures in woman due to domestic violence. Material and methods: The medical files from the Hospital and Maternity of São José dos Pinhais/PR (HMSJP) was searched for female patients diagnosed with jaw fractures caused by trauma, considering the aggressor and the prevalence in the period from January 2001 to May 2003. Results: There were 23 women with jaw fractures, aged from 15 to 43 years. Nasal fractures were the most prevalent, followed by the zygomatic complex and mandible fractures. The husbands were the main responsible for the attacks. The fractures treated by reduction had satisfactory bone consolidation. Conclusion: Patients with jaw fractures had favorable bone consolidation after being submitted to surgical treatment. Nasal fractures were the most prevalent type and the husband was most responsible for the attacks.