RESUMEN
Abstract Treatment of oral vascular anomalies (OVA) has focused on minimally invasive techniques rather than radical surgery. We investigated the efficacy and safety of diode laser using the photocoagulation technique in the management of OVA. Forty-seven subjects with OVA were treated with forced dehydration with induced photocoagulation (FDIP) using diode laser (808 nm/4.5 W). This series consisted mostly of male (63.8%) and non-white (63.8%) patients with a mean age of 57.4 years. Varices (91.5%), venous malformations (6.4%), and hemangiomas (2.1%) with a mean size of 7.1 (±4.9) mm were the conditions treated. OVA presented as a nodular lesion (63.8%) involving mainly the lower lip (46.8%). Pulsed laser mode was used as standard and the number of applications varied from one to four sessions, with the majority requiring only one (83%) FDIP session. Kaplan-Meier analysis revealed that complete clinical healing can occur on the 15th day (n=9/29.5%), followed by the 20th (n=6/45.5%), and 30th (n=7/70.5%) days. Postoperative edema was observed in 31 (66%) patients, and recurrence of the lesion occurred in two (4.2%). Based on the data on complete clinical healing, minimal patient discomfort, and satisfactory esthetic results, we can confirm that FDIP by diode laser is a promising candidate for the safe and efficacious treatment of OVA.
RESUMEN
Abstract The aim of this study was to investigate the prevalence of oral and maxillofacial lesions among children from representative regions of Brazil. A retrospective descriptive study was conducted. Biopsy records comprising the period from 2000 to 2015 were obtained from the archives of three Brazilian oral pathology referral centers. A total of 32,506 biopsy specimens were analyzed, and specimens from 1,706 children aged 0-12 years were selected. Gender, age, anatomical location and histopathological diagnosis were evaluated. Descriptive statistics was carried out. Likelihood ratio tests were used to evaluate the association between the categorical variables. The level of significance was set at 0.05. The post-hoc test was used to identify the subgroups that significantly differed from one another, and the Bonferroni correction was applied. A total of 1,706 oral and maxillofacial lesions were diagnosed in pediatric patients, including 51.9% girls. Oral mucocele was the most prevalent reactive/inflammatory lesion (64%). The most commonly affected sites were the lips (34.5%) and mandible (19.9%). A significant association was observed between age and the group of lesions of the oral cavity (p < 0.001), and between age and anatomical location (p < 0.001). Pediatric oral and maxillofacial lesions were frequent and showed wide diversity, with the prevalence of mucocele. Knowledge of oral lesions is important for pediatric dentists worldwide, since it provides accurate data for the diagnosis and oral health of children.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Niño , Enfermedades Mandibulares/epidemiología , Enfermedades de la Boca/epidemiología , Distribución por Edad , Biopsia , Brasil/epidemiología , Enfermedades Mandibulares/patología , Enfermedades de la Boca/patología , Mucosa Bucal/patología , Mucocele/epidemiología , Mucocele/patología , Prevalencia , Estudios Retrospectivos , Distribución por SexoRESUMEN
As lesões fibro-ósseas (LFOs) caracterizam-se pela substituição do osso normal por tecido conjuntivo fibroso e material mineralizado. Displasia fibrosa, fibroma ossificante e displasia cemento-óssea (DCO) compõem este grupo, que além da semelhança histopatológica, pode sobrepor características radiográficas. A correlação de dados clínicos, radiográficos e histopatológicos é necessária para o diagnóstico definitivo. Este trabalho teve como objetivo descrever e avaliar exames odontológicos de imagem de indivíduos diagnosticados com LFOs. Foram desenvolvidos três estudos com metodologias independentes. O primeiro estudo avaliou os efeitos da displasia cemento-óssea em estruturas anatômicas adjacentes por meio de tomografia computadorizada de feixe cônico (TCFC). Foram avaliados 60 casos de DCO, com 244 áreas de lesão envolvendo 426 dentes. A maioria das lesões apresentou aproximadamente 10 mm de diâmetro. Afilamento (n=80) expansão (n=62) e perfuração (n=60) foram os efeitos comuns na cortical óssea. A lâmina dura e o espaço do ligamento periodontal foram descontínuos em todos os dentes. No segundo estudo, 50 radiografias panorâmicas de mulheres com diagnóstico de DCO foram pareadas por idade com 50 radiografias panorâmicas de mulheres sem DCO. Os grupos DCO e não-DCO foram comparados através do índice de espessura da cortical mandibular (ECM), a dimensão fractal (DF) da região de osso trabecular e cortical e o índice cortical mandibular (ICM). O índice de ECM do grupo DCO foi de 3,12 mm (2,15-4,55) e do grupo não-DCO foi 3,52 mm (1,90- 4,70) com diferença estatística entre os grupos (p=0,034). A DF do trabeculado ósseo alveolar normal foi semelhante nos dois grupos, enquanto que menores médias de DF no osso cortical foram encontradas no grupo DCO (p=0,046). A classificação C3 do ICM foi mais comum no grupo DCO (p=0,009). O terceiro foi um estudo preliminar que avaliou a DF em imagens bidimensionais e tridimensionais de TCFC de seis casos de displasia fibrosa e seis de fibroma ossificante. Cortes de reconstrução panorâmica, axial, coronal e sagital foram selecionados em quatro espessuras: 0,25; 5; 15 e 25 mm, e avaliados em 3 formatos de regiões de interesse (RI). Duas metodologias compararam quatro formatos de volumes do interior das lesões. A média de DF das imagens bidimensionais de reconstrução panorâmica e axiais, com 0,25 mm de espessura mostrou diferença significativa entre displasia fibrosa e fibroma ossificante (p<0.05), independente do formato da RI (p>0,05). A média da DF de imagens tridimensionais foi diferente entre os grupos de lesões para a maioria das comparações (p<0.05), independente da metodologia usada. Informações detalhadas sobre a lesão e o envolvimento de estruturas adjacentes podem ser visualizadas em TCFC. Métodos não invasivos como os índices radiomorfométricos e análise fractal podem ser úteis na detecção de baixa densidade mineral óssea, ou mesmo como possível ferramenta de estudo da complexidade de imagens de LFOs.
Fibro-osseous lesions (FOLs) are characterized by the replacement of normal bone with fibrous connective tissue and mineralized material. The group includes the fibrous dysplasia, ossifying fibroma and cemento-osseous dysplasia (COD). These three lesions show similar histopathological and radiographic features. Clinical, radiographic and histopathological data correlation is necessary for the definitive diagnosis. This study aimed to describe and to evaluate dental imaging exams of individuals diagnosed with FOLs. Three studies with independent methodologies were developed. The first study evaluated the effects of COD on the adjacent anatomical structures by means of cone beam computed tomography (CBCT). Sixty cases of COD were evaluated. The assessment of the 60 cases involved 244 lesion areas and 426 teeth. Most lesions presented nearly 10 millimeters (mm) of diameter. Thinning (n=80), expansion (n=62) and perforation (n=60) were common effects on the cortical bone. All 426 teeth presented discontinuation of the lamina dura and of the periodontal ligament space. In the second study, 50 panoramic radiographies of women diagnosed with COD were matched with 50 panoramic radiographies of women without COD according to the individuals' age. Comparisons between groups regarding the mandibular cortical width index (MCW), the fractal dimension (FD) of the region of the trabecular and the cortical bone and the mandibular cortical index (MCI) were carried out. The MCW of the COD group was 3.12 mm (2.15-4.55) and the MCW of the non-COD group was 3.52 mm (1.90-4.70). A significant difference between groups was observed (p=0.034). FD of the normal trabecular alveolar bone was similar in both groups. For the cortical bone, a lower mean FD was observed in the COD group (p=0.046). The MCI C3 was more common in the COD group (p=0.009). The third was a preliminary study, in which the FD was evaluated on twodimensional and three-dimensional CBCT images of six cases of fibrous dysplasia and six cases of ossifying fibroma. Panoramic reconstruction, axial, coronal and sagittal slices were selected in four thicknesses (0.25, 5, 15 and 25 mm) and evaluated in three shapes of regions of interest (ROI). Two methodologies compared four volume formats from inside the lesions. A significant difference between fibrous dysplasia and ossifying fibroma was observed for the mean FD of the twodimensional images of panoramic reconstruction and axial slices with a thickness of 0.25 mm (p<0.05), regardless of the ROI shape (p>0.05). The mean DF of threedimensional images was different between lesion groups for most comparisons (p <0.05), regardless of the methodology used. Detailed information on lesions and involvement of adjacent structures can be viewed in CBCT. Non-invasive methods, such as radiomorphometric indices and fractal analysis may be useful in the detection of low bone mineral density or as a helpful tool for the differentiation of distinct types of FOLs.