Assessment of postoperative pain in patients undergoing temporomandibular joint arthroscopy with infiltration of dexamethasone disodium phosphate in different concentrations. A randomized controlled trial.

The main aim of this work was to evaluate the effect of intra-articular, sub-synovial steroid injections (IASSSI) with different doses during temporomandibular joint (TMJ) arthroscopy. Using a single-blind, randomized clinical trial, the investigators enrolled a sample of subjects who underwent TMJ arthroscopy with vs. without IASSSI for treating TMJ disorder (TMD). The predictor variable was the treatment group classified as no treatment (A - without IASSSI) or active treatments (IASSSI (B) with 2 mg or (C) 4-mg dexamethasone). Study medications were randomly assigned. Only subjects were blinded to treatment assignment. The main outcome variables included the following: 1) pain assessed up to postoperative day 30 with the McGill Pain Questionnaire and visual analog scale (VAS); 2) maximum mouth opening (MMO); and 3) analgesic and anti-inflammatory drug consumption. Other variables were demographic (age, sex) or pathologic (disease manifestations and classifications). Descriptive and bivariate statistics were computed. Statistical significance was set at p ≤ 0.5, one-tailed test of hypothesis. The sample comprised 36 patients (n = 12 per study group). In the active group with 4 mg corticosteroids, pain reduction measured by VAS (odds ratio [OR] = 0.18; p = 0.013) and McGill scale scores (OR = 0.15; p = 0.048) was significantly higher than in the control group. The McGill scale scores significantly decreased in both IASSSI groups, compared to the control group, at the final follow-up (all p < 0.012), and IASSSI was significantly associated with reduced analgesic consumption at postoperative days 7 and 14 (p = 0.003). However, there was no significant difference regarding MMO among the three groups. Within the limitations of the study, it seems that intra-articular, sub-synovial steroid injections (IASSSI) with 4 mg dexamethasone should be preferred whenever appropriate when pain relief is the priority of the procedure. Brazilian Registry of Clinical Trials (ReBec)- 28yb2g.

An Atypical Bilateral Presentation of Fibrous Dysplasia (FD) in the Mandible: Clinical, imaging and therapeutic characterization.

INTRODUCTION AND IMPORTANCE: Fibrous Dysplasia (FD) is a benign fibro-osseous lesion, characterized by replacement with fibrous connective tissue instead of normal bone. The best treatment option for the condition has not yet been established, although several therapeutic approaches have been reported. The present case report describes the clinical, imaging and therapeutic aspects of an atypical bilateral presentation of FD in the mandible. CASE PRESENTATION: A 26-year-old afro-descendent woman, who had previously undergone surgery to remove FD in the right hemimandible, complained of asymptomatic swelling in the left hemimandible. Imaging analysis showed an ipsilateral extensive multilocular mandibular lesion, with thinning of the cortical bone. After diagnosis of FD, complete surgical removal was performed, associated with immediate local reconstruction with xenograft and covering membrane, with primary wound closure. CLINICAL DISCUSSION: Bilateral presentation of FD is uncommon, and its diagnosis by means of clinical data, imaging and histopathological analysis, is relevant in order to establish the correct therapy. CONCLUSION: Complete surgical removal associated with immediate local bone reconstruction, has shown satisfactory clinical results, when adequate follow-up is performed.

An Extraoral Surgical Approach to Treat Chronic Submandibular Sialolithiasis - A Case Series.

Sialolithiasis is the most common cause of sialadenitis in the submandibular gland, in which the highest incidence of this condition occurs, among the major salivary glands. This could be explained by the anatomy of Wharton's duct, and the chemical composition of the saliva produced by this gland. There are several alternatives and techniques for the treatment of sialolithiasis, including lithotripsy, sialoendoscopy, and conservative removal of the sialoliths or complete removal of the submandibular gland, through the transoral and extraoral routes for access to the gland. To determine the form of treatment, characteristics such as topography, diameter, and location of the sialolith in the duct are observed. The aim of this case series was to show our experience gained in two clinical cases of submandibular gland excision through an extraoral approach, using the submandibular access technique. In addition, we discussed the cause of sialolithiasis in these patients and after follow-up, compared the clinical results we obtained with this technique with those reported in the current literature. The submandibular approach or Risdon access continues to be a safe approach to removing the submandibular gland, as it is a commonly used technique and obtained satisfactory results, as shown in these cases. However, the major disadvantages were the less favorable esthetic results and paralysis of the marginal mandibular branch of the facial nerve.

Surgical Management of Palatal Pleomorphic Adenoma (PPA) Recurrence After 10 years, Treated at a Brazilian Center - A Case Report.

Pleomorphic adenoma, considered the most frequent benign mixed neoplasm of the minor salivary glands, occurs mainly in the region of the hard palate, with slight predilection in females and peak of incidence between the third and fifth decades of life. An increase in recurrence rates has been associated with the histopathological variants of the tumor, cellular characteristics, stroma, and capsule rupture during surgical removal of the lesion. The present case report aims to describe the surgical approach performed on the patient, a 45-year-old woman with a recurrent Pleomorphic Adenoma (PA) in the region of the hard palate on the right side, 10 years after initial enucleation of the lesion; her main complaint was an increase in volume in the palatal region. After extensive local surgical excision of the tumor and 2 years of follow-up, there were no signs of recurrence. Computed tomography and a correct histopathological diagnosis are essential to enable the establishment of an appropriate surgical treatment, with the purpose of achieving complete removal of the lesion, with wide surgical margins, including the lining mucosa and the underlying periosteum, as described in the present case.

An atypical presentation of gigantiform torus palatinus: A case report: Atypical tori palatine and surgical management.

INTRODUCTION: Torus palatinus (TP) is a slow growing maxillary exostosis, commonly found in the in the hard palate on either side of the median raphe of the palatine bone. Its aetiology is still unclear, but it has been attributed to genetic events and environmental agents, with a slight predilection for the female gender. PRESENTATION OF CASE: The aim of this case report was to describe an unusual presentation of nodular TP in younger female patient, with medical history of hysterectomy when she was 25 years old. The TP manifested insidious progression that affected functional activities such as eating, swallowing and normal pronunciation. Furthermore, we describe our experience during pre-planning the surgery by using 3D-scan-printing, and the conservative surgical approach performed. DISCUSSION/CONCLUSION: TP may be associated with epidemiological, environmental and systemic disorders of patients suffering from this condition. Conservative surgical removal continues to be the first choice treatment when the TP must be removed. Further studies are considered necessary to elucidate the etiological factors.

Surgical management of mandibular ameloblastoma and immediate reconstruction with nonvascularized bone graft and hyperbaric oxygen therapy / Tratamiento quirúrgico de ameloblastoma mandibular y la reconstrucción inmediata con injerto oseo libre y terapia con oxígeno hiperbárico

Extensive resection of tumor often results in bone and soft tissue defects that cause functional and esthetic consequences. The reconstructive surgery is extremely important for the rehabilitation of these patients. The purpose of this study is to report on the use of Hyperbaric Oxygen therapy (HBO) in the case of a large ameloblastoma treated with segmental resection and reconstructed immediately with nonvascularized bone graft (NVBGs) from iliac crest. A 41-year-old woman was referred to our department because of paresthesia of the inferior alveolar nerve and history of swelling in the molar and ramus region of the left mandible. Panoramic radiograph depicting well-defined multilocular radiolucency extending from second pre-molar region to the left ramus region. An incisional biopsy confirms the diagnosis of solid ameloblastoma. The treatment of choice was segmental mandibular resection and immediate mandibular reconstruction using NVBGs from iliac crest, followed by removal of internal fixation and placement of dental implants with immediate loading. The patient received preoperative HBO (a 90-min session at 2.2-2.4 atmospheres, five times per week for two weeks, for a total of up to 10 sessions). Postoperative HBO (10 further 90-min sessions) was administered within 2weeks. The patient received rehabilitation with a mandibular implant-supported fixed complete dental prosthesis. The present study showed successful management of mandibular ameloblastoma that associated extensive surgery, immediate reconstruction with NVBGs from iliac crest, hyperbaric oxygen therapy and dental implants. These combined procedures allowed removal of lesion and reestablishment of mandibular contour and function.

La resección extensa de un tumor a menudo da lugar a defectos del hueso y de los tejidos blandos, que causan consecuencias funcionales y estéticas. La cirugía reconstructiva es extremadamente importante para la rehabilitación de estos pacientes. El propósito de este estudio fue informar sobre el uso de la terapia de oxígeno hiperbárico (HBO) en un caso de un ameloblastoma de gran tamaño, tratado con resección segmentaria y reconstruido inmediatamente con injerto óseo no vascularizado (IONV) de la cresta ilíaca. Una mujer de 41 años fue derivada a nuestro servicio por parestesia del nervio alveolar inferior e historia de hinchazón en la región molar y ramina de la mandíbula izquierda. Radiografía panorámica que muestra una radiolucencia multilocular bien definida que se extiende desde la segunda región pre-molar hasta la región de la rama izquierda. Una biopsia incisional confirma el diagnóstico de ameloblastoma sólido. El tratamiento de elección fue la resección mandibular segmentaria y la reconstrucción mandibular inmediata mediante IONV de cresta ilíaca, seguido de la eliminación de la fijación interna y la colocación de implantes dentales con carga inmediata. La paciente recibió OHB preoperatoria (una sesión de 90 minutos a 2.2-2.4 atmósferas, cinco veces por semana durante dos semanas, para un total de hasta 10 sesiones). La OHB postoperatoria (10 sesiones adicionales de 90 minutos) se administró en 2 semanas. La paciente recibió rehabilitación con una prótesis dental fija con implante mandibular. El presente estudio mostró un manejo exitoso del ameloblastoma mandibular asociado a una cirugía extensa, reconstrucción inmediata con IONV de cresta ilíaca, oxigenoterapia hiperbárica e implantes dentales. Estos procedimientos combinados permitieron la extirpación de la lesión y el restablecimiento del contorno y la función mandibular.